hospital_name,last_updated_on,version,location_name,hospital_address,type_2_npi,license_number|TN,attester_name,"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.",,,,,,,,,,,,,,,,,,,
Hawkins County Memorial Hospital,2026-03-23,3.0.0,HAWKINS COUNTY MEMORIAL HOSPITAL (ACU),"851 LOCUST ST, ROGERSVILLE, TN 37857",1174553598,0000000060,Shana Tate,TRUE,,,,,,,,,,,,,,,,,,,
description,code|1,code|1|type,code|2,code|2|type,code|3,code|3|type,code|4,code|4|type,modifiers,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,payer_name,plan_name,standard_charge|negotiated_dollar,standard_charge|negotiated_percentage,standard_charge|negotiated_algorithm,median_amount,10th_percentile,90th_percentile,count,standard_charge|min,standard_charge|max,standard_charge|methodology,additional_generic_notes
AIRSEAL ROBOTIC XI LONG,272,RC,27200002,CDM,,,,,,both,,,1160.8300,174.1200,AETNA,AETNA,495.67,,,,,,,299.6100,1160.8300,percent of total billed charges,"42.7% of $1,160.83 in Billed Charges for Rev 272 = $495.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRSEAL ROBOTIC XI LONG,272,RC,27200002,CDM,,,,,,both,,,1160.8300,174.1200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,812.58,,,,,,,299.6100,1160.8300,percent of total billed charges,"Rev 272 $1,160.83 in Billed Charges at 70% = $812.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRSEAL ROBOTIC XI LONG,272,RC,27200002,CDM,,,,,,both,,,1160.8300,174.1200,CIGNA HEALTHCARE,CIGNA HMO,484.07,,,,,,,299.6100,1160.8300,percent of total billed charges,"41.7% of $1,160.83 in Billed Charges for Rev 272 = $484.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRSEAL ROBOTIC XI LONG,272,RC,27200002,CDM,,,,,,both,,,1160.8300,174.1200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,538.63,,,,,,,299.6100,1160.8300,percent of total billed charges,"46.4% of $1,160.83 in Billed Charges for Rev 272 = $538.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRSEAL ROBOTIC XI LONG,272,RC,27200002,CDM,,,,,,both,,,1160.8300,174.1200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,484.07,,,,,,,299.6100,1160.8300,percent of total billed charges,"41.7% of $1,160.83 in Billed Charges for Rev 272 = $484.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRSEAL ROBOTIC XI LONG,272,RC,27200002,CDM,,,,,,both,,,1160.8300,174.1200,CIGNA HEALTHCARE,CIGNA PPO,484.07,,,,,,,299.6100,1160.8300,percent of total billed charges,"41.7% of $1,160.83 in Billed Charges for Rev 272 = $484.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRSEAL ROBOTIC XI LONG,272,RC,27200002,CDM,,,,,,both,,,1160.8300,174.1200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1044.75,,,,,,,299.6100,1160.8300,percent of total billed charges,"90% of $1,160.83 in Billed Charges for Rev 272 = $1,044.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRSEAL ROBOTIC XI LONG,272,RC,27200002,CDM,,,,,,both,,,1160.8300,174.1200,MEDCOST,MEDCOST VHN,552.44,,,,,,,299.6100,1160.8300,percent of total billed charges,"47.59% of $1,160.83 in Billed Charges for Rev 272 = $552.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRSEAL ROBOTIC XI LONG,272,RC,27200002,CDM,,,,,,both,,,1160.8300,174.1200,SENTARA HEALTH,SENTARA HEALTH,299.61,,,,,,,299.6100,1160.8300,percent of total billed charges,"25.81% of $1,160.83 in Billed Charges for Rev 272 = $299.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRSEAL ROBOTIC XI LONG,272,RC,27200002,CDM,,,,,,both,,,1160.8300,174.1200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1160.83,,,,,,,299.6100,1160.8300,percent of total billed charges,"100% of $1,160.83 in Billed Charges for Rev 272 = $1,160.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRSEAL ROBOTIC XI LONG,272,RC,27200002,CDM,,,,,,both,,,1160.8300,174.1200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,580.42,,,,,,,299.6100,1160.8300,percent of total billed charges,"Rev 272 $1,160.83 in Billed Charges at 50% = $580.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRSEAL ROBOTIC XI LONG,272,RC,27200002,CDM,,,,,,both,,,1160.8300,174.1200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,374.95,,,,,,,299.6100,1160.8300,other,"32.3% of $1,160.83 in Billed Charges for Rev 272 = $374.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
AIRSEAL ROBOTIC XI LONG,272,RC,27200002,CDM,,,,,,both,,,1160.8300,174.1200,UNITED HEALTHCARE,UHC HERITAGE SELECT,356.37,,,,,,,299.6100,1160.8300,other,"30.7% of $1,160.83 in Billed Charges for Rev 272 = $356.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
AIRSEAL ROBOTIC XI LONG,272,RC,27200002,CDM,,,,,,both,,,1160.8300,174.1200,UNITED HEALTHCARE,UNITED HEALTHCARE,374.95,,,,,,,299.6100,1160.8300,percent of total billed charges,"32.3% of $1,160.83 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRSEAL ROBOTIC XI LONG,272,RC,27200002,CDM,,,,,,both,,,1160.8300,174.1200,WELLCARE,WELLCARE MEDICAID,1160.83,,,,,,,299.6100,1160.8300,percent of total billed charges,"100% of $1,160.83 in Billed Charges for Rev 272 = $1,160.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADHESIVE WOUND CLOSURE 3.4X24CM BX 50,272,RC,,,,,,,,both,,,725.9700,108.9000,AETNA,AETNA,309.99,,,,,,,187.3700,725.9700,percent of total billed charges,42.7% of $725.97 in Billed Charges for Rev 272 = $309.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADHESIVE WOUND CLOSURE 3.4X24CM BX 50,272,RC,,,,,,,,both,,,725.9700,108.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,508.18,,,,,,,187.3700,725.9700,percent of total billed charges,Rev 272 $725.97 in Billed Charges at 70% = $508.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADHESIVE WOUND CLOSURE 3.4X24CM BX 50,272,RC,,,,,,,,both,,,725.9700,108.9000,CIGNA HEALTHCARE,CIGNA HMO,302.73,,,,,,,187.3700,725.9700,percent of total billed charges,41.7% of $725.97 in Billed Charges for Rev 272 = $302.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADHESIVE WOUND CLOSURE 3.4X24CM BX 50,272,RC,,,,,,,,both,,,725.9700,108.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,336.85,,,,,,,187.3700,725.9700,percent of total billed charges,46.4% of $725.97 in Billed Charges for Rev 272 = $336.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADHESIVE WOUND CLOSURE 3.4X24CM BX 50,272,RC,,,,,,,,both,,,725.9700,108.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,302.73,,,,,,,187.3700,725.9700,percent of total billed charges,41.7% of $725.97 in Billed Charges for Rev 272 = $302.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADHESIVE WOUND CLOSURE 3.4X24CM BX 50,272,RC,,,,,,,,both,,,725.9700,108.9000,CIGNA HEALTHCARE,CIGNA PPO,302.73,,,,,,,187.3700,725.9700,percent of total billed charges,41.7% of $725.97 in Billed Charges for Rev 272 = $302.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADHESIVE WOUND CLOSURE 3.4X24CM BX 50,272,RC,,,,,,,,both,,,725.9700,108.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,653.37,,,,,,,187.3700,725.9700,percent of total billed charges,90% of $725.97 in Billed Charges for Rev 272 = $653.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADHESIVE WOUND CLOSURE 3.4X24CM BX 50,272,RC,,,,,,,,both,,,725.9700,108.9000,MEDCOST,MEDCOST VHN,345.49,,,,,,,187.3700,725.9700,percent of total billed charges,47.59% of $725.97 in Billed Charges for Rev 272 = $345.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADHESIVE WOUND CLOSURE 3.4X24CM BX 50,272,RC,,,,,,,,both,,,725.9700,108.9000,SENTARA HEALTH,SENTARA HEALTH,187.37,,,,,,,187.3700,725.9700,percent of total billed charges,25.81% of $725.97 in Billed Charges for Rev 272 = $187.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADHESIVE WOUND CLOSURE 3.4X24CM BX 50,272,RC,,,,,,,,both,,,725.9700,108.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",725.97,,,,,,,187.3700,725.9700,percent of total billed charges,100% of $725.97 in Billed Charges for Rev 272 = $725.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADHESIVE WOUND CLOSURE 3.4X24CM BX 50,272,RC,,,,,,,,both,,,725.9700,108.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,362.99,,,,,,,187.3700,725.9700,percent of total billed charges,Rev 272 $725.97 in Billed Charges at 50% = $362.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADHESIVE WOUND CLOSURE 3.4X24CM BX 50,272,RC,,,,,,,,both,,,725.9700,108.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,234.49,,,,,,,187.3700,725.9700,other,32.3% of $725.97 in Billed Charges for Rev 272 = $234.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ADHESIVE WOUND CLOSURE 3.4X24CM BX 50,272,RC,,,,,,,,both,,,725.9700,108.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,222.87,,,,,,,187.3700,725.9700,other,30.7% of $725.97 in Billed Charges for Rev 272 = $222.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ADHESIVE WOUND CLOSURE 3.4X24CM BX 50,272,RC,,,,,,,,both,,,725.9700,108.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,234.49,,,,,,,187.3700,725.9700,percent of total billed charges,32.3% of $725.97 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADHESIVE WOUND CLOSURE 3.4X24CM BX 50,272,RC,,,,,,,,both,,,725.9700,108.9000,WELLCARE,WELLCARE MEDICAID,725.97,,,,,,,187.3700,725.9700,percent of total billed charges,100% of $725.97 in Billed Charges for Rev 272 = $725.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
AIRSEAL PORT 12/100MM LPI,272,RC,27200002,CDM,,,,,,both,,,5815.7500,872.3600,AETNA,AETNA,2483.33,,,,,,,1501.0500,5815.7500,percent of total billed charges,"42.7% of $5,815.75 in Billed Charges for Rev 272 = $2,483.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRSEAL PORT 12/100MM LPI,272,RC,27200002,CDM,,,,,,both,,,5815.7500,872.3600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4071.03,,,,,,,1501.0500,5815.7500,percent of total billed charges,"Rev 272 $5,815.75 in Billed Charges at 70% = $4,071.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRSEAL PORT 12/100MM LPI,272,RC,27200002,CDM,,,,,,both,,,5815.7500,872.3600,CIGNA HEALTHCARE,CIGNA HMO,2425.17,,,,,,,1501.0500,5815.7500,percent of total billed charges,"41.7% of $5,815.75 in Billed Charges for Rev 272 = $2,425.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRSEAL PORT 12/100MM LPI,272,RC,27200002,CDM,,,,,,both,,,5815.7500,872.3600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2698.51,,,,,,,1501.0500,5815.7500,percent of total billed charges,"46.4% of $5,815.75 in Billed Charges for Rev 272 = $2,698.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRSEAL PORT 12/100MM LPI,272,RC,27200002,CDM,,,,,,both,,,5815.7500,872.3600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2425.17,,,,,,,1501.0500,5815.7500,percent of total billed charges,"41.7% of $5,815.75 in Billed Charges for Rev 272 = $2,425.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRSEAL PORT 12/100MM LPI,272,RC,27200002,CDM,,,,,,both,,,5815.7500,872.3600,CIGNA HEALTHCARE,CIGNA PPO,2425.17,,,,,,,1501.0500,5815.7500,percent of total billed charges,"41.7% of $5,815.75 in Billed Charges for Rev 272 = $2,425.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRSEAL PORT 12/100MM LPI,272,RC,27200002,CDM,,,,,,both,,,5815.7500,872.3600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5234.18,,,,,,,1501.0500,5815.7500,percent of total billed charges,"90% of $5,815.75 in Billed Charges for Rev 272 = $5,234.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRSEAL PORT 12/100MM LPI,272,RC,27200002,CDM,,,,,,both,,,5815.7500,872.3600,MEDCOST,MEDCOST VHN,2767.72,,,,,,,1501.0500,5815.7500,percent of total billed charges,"47.59% of $5,815.75 in Billed Charges for Rev 272 = $2,767.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRSEAL PORT 12/100MM LPI,272,RC,27200002,CDM,,,,,,both,,,5815.7500,872.3600,SENTARA HEALTH,SENTARA HEALTH,1501.05,,,,,,,1501.0500,5815.7500,percent of total billed charges,"25.81% of $5,815.75 in Billed Charges for Rev 272 = $1,501.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRSEAL PORT 12/100MM LPI,272,RC,27200002,CDM,,,,,,both,,,5815.7500,872.3600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5815.75,,,,,,,1501.0500,5815.7500,percent of total billed charges,"100% of $5,815.75 in Billed Charges for Rev 272 = $5,815.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRSEAL PORT 12/100MM LPI,272,RC,27200002,CDM,,,,,,both,,,5815.7500,872.3600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2907.88,,,,,,,1501.0500,5815.7500,percent of total billed charges,"Rev 272 $5,815.75 in Billed Charges at 50% = $2,907.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRSEAL PORT 12/100MM LPI,272,RC,27200002,CDM,,,,,,both,,,5815.7500,872.3600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1878.49,,,,,,,1501.0500,5815.7500,other,"32.3% of $5,815.75 in Billed Charges for Rev 272 = $1,878.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
AIRSEAL PORT 12/100MM LPI,272,RC,27200002,CDM,,,,,,both,,,5815.7500,872.3600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1785.44,,,,,,,1501.0500,5815.7500,other,"30.7% of $5,815.75 in Billed Charges for Rev 272 = $1,785.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
AIRSEAL PORT 12/100MM LPI,272,RC,27200002,CDM,,,,,,both,,,5815.7500,872.3600,UNITED HEALTHCARE,UNITED HEALTHCARE,1878.49,,,,,,,1501.0500,5815.7500,percent of total billed charges,"32.3% of $5,815.75 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRSEAL PORT 12/100MM LPI,272,RC,27200002,CDM,,,,,,both,,,5815.7500,872.3600,WELLCARE,WELLCARE MEDICAID,5815.75,,,,,,,1501.0500,5815.7500,percent of total billed charges,"100% of $5,815.75 in Billed Charges for Rev 272 = $5,815.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRWAY COOK 11FR,272,RC,,,,,,,,both,,,985.2500,147.7900,AETNA,AETNA,420.70,,,,,,,254.2900,985.2500,percent of total billed charges,42.7% of $985.25 in Billed Charges for Rev 272 = $420.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
AIRWAY COOK 11FR,272,RC,,,,,,,,both,,,985.2500,147.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,689.68,,,,,,,254.2900,985.2500,percent of total billed charges,Rev 272 $985.25 in Billed Charges at 70% = $689.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
AIRWAY COOK 11FR,272,RC,,,,,,,,both,,,985.2500,147.7900,CIGNA HEALTHCARE,CIGNA HMO,410.85,,,,,,,254.2900,985.2500,percent of total billed charges,41.7% of $985.25 in Billed Charges for Rev 272 = $410.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
AIRWAY COOK 11FR,272,RC,,,,,,,,both,,,985.2500,147.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,457.16,,,,,,,254.2900,985.2500,percent of total billed charges,46.4% of $985.25 in Billed Charges for Rev 272 = $457.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
AIRWAY COOK 11FR,272,RC,,,,,,,,both,,,985.2500,147.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,410.85,,,,,,,254.2900,985.2500,percent of total billed charges,41.7% of $985.25 in Billed Charges for Rev 272 = $410.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
AIRWAY COOK 11FR,272,RC,,,,,,,,both,,,985.2500,147.7900,CIGNA HEALTHCARE,CIGNA PPO,410.85,,,,,,,254.2900,985.2500,percent of total billed charges,41.7% of $985.25 in Billed Charges for Rev 272 = $410.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
AIRWAY COOK 11FR,272,RC,,,,,,,,both,,,985.2500,147.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,886.73,,,,,,,254.2900,985.2500,percent of total billed charges,90% of $985.25 in Billed Charges for Rev 272 = $886.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
AIRWAY COOK 11FR,272,RC,,,,,,,,both,,,985.2500,147.7900,MEDCOST,MEDCOST VHN,468.88,,,,,,,254.2900,985.2500,percent of total billed charges,47.59% of $985.25 in Billed Charges for Rev 272 = $468.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
AIRWAY COOK 11FR,272,RC,,,,,,,,both,,,985.2500,147.7900,SENTARA HEALTH,SENTARA HEALTH,254.29,,,,,,,254.2900,985.2500,percent of total billed charges,25.81% of $985.25 in Billed Charges for Rev 272 = $254.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
AIRWAY COOK 11FR,272,RC,,,,,,,,both,,,985.2500,147.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",985.25,,,,,,,254.2900,985.2500,percent of total billed charges,100% of $985.25 in Billed Charges for Rev 272 = $985.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
AIRWAY COOK 11FR,272,RC,,,,,,,,both,,,985.2500,147.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,492.63,,,,,,,254.2900,985.2500,percent of total billed charges,Rev 272 $985.25 in Billed Charges at 50% = $492.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
AIRWAY COOK 11FR,272,RC,,,,,,,,both,,,985.2500,147.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,318.24,,,,,,,254.2900,985.2500,other,32.3% of $985.25 in Billed Charges for Rev 272 = $318.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
AIRWAY COOK 11FR,272,RC,,,,,,,,both,,,985.2500,147.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,302.47,,,,,,,254.2900,985.2500,other,30.7% of $985.25 in Billed Charges for Rev 272 = $302.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
AIRWAY COOK 11FR,272,RC,,,,,,,,both,,,985.2500,147.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,318.24,,,,,,,254.2900,985.2500,percent of total billed charges,32.3% of $985.25 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
AIRWAY COOK 11FR,272,RC,,,,,,,,both,,,985.2500,147.7900,WELLCARE,WELLCARE MEDICAID,985.25,,,,,,,254.2900,985.2500,percent of total billed charges,100% of $985.25 in Billed Charges for Rev 272 = $985.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
AIRWAY ZERO TIP RETRIEVAL BASKET 12MM M00513200,272,RC,27200002,CDM,,,,,,both,,,4609.2900,691.3900,AETNA,AETNA,1968.17,,,,,,,1189.6600,4609.2900,percent of total billed charges,"42.7% of $4,609.29 in Billed Charges for Rev 272 = $1,968.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRWAY ZERO TIP RETRIEVAL BASKET 12MM M00513200,272,RC,27200002,CDM,,,,,,both,,,4609.2900,691.3900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3226.50,,,,,,,1189.6600,4609.2900,percent of total billed charges,"Rev 272 $4,609.29 in Billed Charges at 70% = $3,226.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRWAY ZERO TIP RETRIEVAL BASKET 12MM M00513200,272,RC,27200002,CDM,,,,,,both,,,4609.2900,691.3900,CIGNA HEALTHCARE,CIGNA HMO,1922.07,,,,,,,1189.6600,4609.2900,percent of total billed charges,"41.7% of $4,609.29 in Billed Charges for Rev 272 = $1,922.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRWAY ZERO TIP RETRIEVAL BASKET 12MM M00513200,272,RC,27200002,CDM,,,,,,both,,,4609.2900,691.3900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2138.71,,,,,,,1189.6600,4609.2900,percent of total billed charges,"46.4% of $4,609.29 in Billed Charges for Rev 272 = $2,138.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRWAY ZERO TIP RETRIEVAL BASKET 12MM M00513200,272,RC,27200002,CDM,,,,,,both,,,4609.2900,691.3900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1922.07,,,,,,,1189.6600,4609.2900,percent of total billed charges,"41.7% of $4,609.29 in Billed Charges for Rev 272 = $1,922.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRWAY ZERO TIP RETRIEVAL BASKET 12MM M00513200,272,RC,27200002,CDM,,,,,,both,,,4609.2900,691.3900,CIGNA HEALTHCARE,CIGNA PPO,1922.07,,,,,,,1189.6600,4609.2900,percent of total billed charges,"41.7% of $4,609.29 in Billed Charges for Rev 272 = $1,922.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRWAY ZERO TIP RETRIEVAL BASKET 12MM M00513200,272,RC,27200002,CDM,,,,,,both,,,4609.2900,691.3900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4148.36,,,,,,,1189.6600,4609.2900,percent of total billed charges,"90% of $4,609.29 in Billed Charges for Rev 272 = $4,148.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRWAY ZERO TIP RETRIEVAL BASKET 12MM M00513200,272,RC,27200002,CDM,,,,,,both,,,4609.2900,691.3900,MEDCOST,MEDCOST VHN,2193.56,,,,,,,1189.6600,4609.2900,percent of total billed charges,"47.59% of $4,609.29 in Billed Charges for Rev 272 = $2,193.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRWAY ZERO TIP RETRIEVAL BASKET 12MM M00513200,272,RC,27200002,CDM,,,,,,both,,,4609.2900,691.3900,SENTARA HEALTH,SENTARA HEALTH,1189.66,,,,,,,1189.6600,4609.2900,percent of total billed charges,"25.81% of $4,609.29 in Billed Charges for Rev 272 = $1,189.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRWAY ZERO TIP RETRIEVAL BASKET 12MM M00513200,272,RC,27200002,CDM,,,,,,both,,,4609.2900,691.3900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4609.29,,,,,,,1189.6600,4609.2900,percent of total billed charges,"100% of $4,609.29 in Billed Charges for Rev 272 = $4,609.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRWAY ZERO TIP RETRIEVAL BASKET 12MM M00513200,272,RC,27200002,CDM,,,,,,both,,,4609.2900,691.3900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2304.65,,,,,,,1189.6600,4609.2900,percent of total billed charges,"Rev 272 $4,609.29 in Billed Charges at 50% = $2,304.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRWAY ZERO TIP RETRIEVAL BASKET 12MM M00513200,272,RC,27200002,CDM,,,,,,both,,,4609.2900,691.3900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1488.80,,,,,,,1189.6600,4609.2900,other,"32.3% of $4,609.29 in Billed Charges for Rev 272 = $1,488.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
AIRWAY ZERO TIP RETRIEVAL BASKET 12MM M00513200,272,RC,27200002,CDM,,,,,,both,,,4609.2900,691.3900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1415.05,,,,,,,1189.6600,4609.2900,other,"30.7% of $4,609.29 in Billed Charges for Rev 272 = $1,415.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
AIRWAY ZERO TIP RETRIEVAL BASKET 12MM M00513200,272,RC,27200002,CDM,,,,,,both,,,4609.2900,691.3900,UNITED HEALTHCARE,UNITED HEALTHCARE,1488.80,,,,,,,1189.6600,4609.2900,percent of total billed charges,"32.3% of $4,609.29 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AIRWAY ZERO TIP RETRIEVAL BASKET 12MM M00513200,272,RC,27200002,CDM,,,,,,both,,,4609.2900,691.3900,WELLCARE,WELLCARE MEDICAID,4609.29,,,,,,,1189.6600,4609.2900,percent of total billed charges,"100% of $4,609.29 in Billed Charges for Rev 272 = $4,609.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AMBIENT SUPRE TURBOVAC 90 WAND,272,RC,27200002,CDM,,,,,,both,,,1887.5200,283.1300,AETNA,AETNA,805.97,,,,,,,487.1700,1887.5200,percent of total billed charges,"42.7% of $1,887.52 in Billed Charges for Rev 272 = $805.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AMBIENT SUPRE TURBOVAC 90 WAND,272,RC,27200002,CDM,,,,,,both,,,1887.5200,283.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1321.26,,,,,,,487.1700,1887.5200,percent of total billed charges,"Rev 272 $1,887.52 in Billed Charges at 70% = $1,321.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AMBIENT SUPRE TURBOVAC 90 WAND,272,RC,27200002,CDM,,,,,,both,,,1887.5200,283.1300,CIGNA HEALTHCARE,CIGNA HMO,787.10,,,,,,,487.1700,1887.5200,percent of total billed charges,"41.7% of $1,887.52 in Billed Charges for Rev 272 = $787.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AMBIENT SUPRE TURBOVAC 90 WAND,272,RC,27200002,CDM,,,,,,both,,,1887.5200,283.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,875.81,,,,,,,487.1700,1887.5200,percent of total billed charges,"46.4% of $1,887.52 in Billed Charges for Rev 272 = $875.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AMBIENT SUPRE TURBOVAC 90 WAND,272,RC,27200002,CDM,,,,,,both,,,1887.5200,283.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,787.10,,,,,,,487.1700,1887.5200,percent of total billed charges,"41.7% of $1,887.52 in Billed Charges for Rev 272 = $787.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AMBIENT SUPRE TURBOVAC 90 WAND,272,RC,27200002,CDM,,,,,,both,,,1887.5200,283.1300,CIGNA HEALTHCARE,CIGNA PPO,787.10,,,,,,,487.1700,1887.5200,percent of total billed charges,"41.7% of $1,887.52 in Billed Charges for Rev 272 = $787.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AMBIENT SUPRE TURBOVAC 90 WAND,272,RC,27200002,CDM,,,,,,both,,,1887.5200,283.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1698.77,,,,,,,487.1700,1887.5200,percent of total billed charges,"90% of $1,887.52 in Billed Charges for Rev 272 = $1,698.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AMBIENT SUPRE TURBOVAC 90 WAND,272,RC,27200002,CDM,,,,,,both,,,1887.5200,283.1300,MEDCOST,MEDCOST VHN,898.27,,,,,,,487.1700,1887.5200,percent of total billed charges,"47.59% of $1,887.52 in Billed Charges for Rev 272 = $898.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AMBIENT SUPRE TURBOVAC 90 WAND,272,RC,27200002,CDM,,,,,,both,,,1887.5200,283.1300,SENTARA HEALTH,SENTARA HEALTH,487.17,,,,,,,487.1700,1887.5200,percent of total billed charges,"25.81% of $1,887.52 in Billed Charges for Rev 272 = $487.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AMBIENT SUPRE TURBOVAC 90 WAND,272,RC,27200002,CDM,,,,,,both,,,1887.5200,283.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1887.52,,,,,,,487.1700,1887.5200,percent of total billed charges,"100% of $1,887.52 in Billed Charges for Rev 272 = $1,887.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AMBIENT SUPRE TURBOVAC 90 WAND,272,RC,27200002,CDM,,,,,,both,,,1887.5200,283.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,943.76,,,,,,,487.1700,1887.5200,percent of total billed charges,"Rev 272 $1,887.52 in Billed Charges at 50% = $943.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AMBIENT SUPRE TURBOVAC 90 WAND,272,RC,27200002,CDM,,,,,,both,,,1887.5200,283.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,609.67,,,,,,,487.1700,1887.5200,other,"32.3% of $1,887.52 in Billed Charges for Rev 272 = $609.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
AMBIENT SUPRE TURBOVAC 90 WAND,272,RC,27200002,CDM,,,,,,both,,,1887.5200,283.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,579.47,,,,,,,487.1700,1887.5200,other,"30.7% of $1,887.52 in Billed Charges for Rev 272 = $579.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
AMBIENT SUPRE TURBOVAC 90 WAND,272,RC,27200002,CDM,,,,,,both,,,1887.5200,283.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,609.67,,,,,,,487.1700,1887.5200,percent of total billed charges,"32.3% of $1,887.52 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AMBIENT SUPRE TURBOVAC 90 WAND,272,RC,27200002,CDM,,,,,,both,,,1887.5200,283.1300,WELLCARE,WELLCARE MEDICAID,1887.52,,,,,,,487.1700,1887.5200,percent of total billed charges,"100% of $1,887.52 in Billed Charges for Rev 272 = $1,887.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR BUMPY 97791,272,RC,27200002,CDM,,,,,,both,,,2074.2000,311.1300,AETNA,AETNA,885.68,,,,,,,535.3500,2074.2000,percent of total billed charges,"42.7% of $2,074.20 in Billed Charges for Rev 272 = $885.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR BUMPY 97791,272,RC,27200002,CDM,,,,,,both,,,2074.2000,311.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1451.94,,,,,,,535.3500,2074.2000,percent of total billed charges,"Rev 272 $2,074.20 in Billed Charges at 70% = $1,451.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR BUMPY 97791,272,RC,27200002,CDM,,,,,,both,,,2074.2000,311.1300,CIGNA HEALTHCARE,CIGNA HMO,864.94,,,,,,,535.3500,2074.2000,percent of total billed charges,"41.7% of $2,074.20 in Billed Charges for Rev 272 = $864.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR BUMPY 97791,272,RC,27200002,CDM,,,,,,both,,,2074.2000,311.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,962.43,,,,,,,535.3500,2074.2000,percent of total billed charges,"46.4% of $2,074.20 in Billed Charges for Rev 272 = $962.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR BUMPY 97791,272,RC,27200002,CDM,,,,,,both,,,2074.2000,311.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,864.94,,,,,,,535.3500,2074.2000,percent of total billed charges,"41.7% of $2,074.20 in Billed Charges for Rev 272 = $864.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR BUMPY 97791,272,RC,27200002,CDM,,,,,,both,,,2074.2000,311.1300,CIGNA HEALTHCARE,CIGNA PPO,864.94,,,,,,,535.3500,2074.2000,percent of total billed charges,"41.7% of $2,074.20 in Billed Charges for Rev 272 = $864.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR BUMPY 97791,272,RC,27200002,CDM,,,,,,both,,,2074.2000,311.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1866.78,,,,,,,535.3500,2074.2000,percent of total billed charges,"90% of $2,074.20 in Billed Charges for Rev 272 = $1,866.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR BUMPY 97791,272,RC,27200002,CDM,,,,,,both,,,2074.2000,311.1300,MEDCOST,MEDCOST VHN,987.11,,,,,,,535.3500,2074.2000,percent of total billed charges,"47.59% of $2,074.20 in Billed Charges for Rev 272 = $987.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR BUMPY 97791,272,RC,27200002,CDM,,,,,,both,,,2074.2000,311.1300,SENTARA HEALTH,SENTARA HEALTH,535.35,,,,,,,535.3500,2074.2000,percent of total billed charges,"25.81% of $2,074.20 in Billed Charges for Rev 272 = $535.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR BUMPY 97791,272,RC,27200002,CDM,,,,,,both,,,2074.2000,311.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2074.20,,,,,,,535.3500,2074.2000,percent of total billed charges,"100% of $2,074.20 in Billed Charges for Rev 272 = $2,074.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR BUMPY 97791,272,RC,27200002,CDM,,,,,,both,,,2074.2000,311.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1037.10,,,,,,,535.3500,2074.2000,percent of total billed charges,"Rev 272 $2,074.20 in Billed Charges at 50% = $1,037.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR BUMPY 97791,272,RC,27200002,CDM,,,,,,both,,,2074.2000,311.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,669.97,,,,,,,535.3500,2074.2000,other,"32.3% of $2,074.20 in Billed Charges for Rev 272 = $669.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ANCHOR BUMPY 97791,272,RC,27200002,CDM,,,,,,both,,,2074.2000,311.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,636.78,,,,,,,535.3500,2074.2000,other,"30.7% of $2,074.20 in Billed Charges for Rev 272 = $636.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ANCHOR BUMPY 97791,272,RC,27200002,CDM,,,,,,both,,,2074.2000,311.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,669.97,,,,,,,535.3500,2074.2000,percent of total billed charges,"32.3% of $2,074.20 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR BUMPY 97791,272,RC,27200002,CDM,,,,,,both,,,2074.2000,311.1300,WELLCARE,WELLCARE MEDICAID,2074.20,,,,,,,535.3500,2074.2000,percent of total billed charges,"100% of $2,074.20 in Billed Charges for Rev 272 = $2,074.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,500.6900,75.1000,AETNA,AETNA,213.79,,,,,,,129.2300,500.6900,percent of total billed charges,42.7% of $500.69 in Billed Charges for Rev 272 = $213.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,500.6900,75.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,350.48,,,,,,,129.2300,500.6900,percent of total billed charges,Rev 272 $500.69 in Billed Charges at 70% = $350.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,500.6900,75.1000,CIGNA HEALTHCARE,CIGNA HMO,208.79,,,,,,,129.2300,500.6900,percent of total billed charges,41.7% of $500.69 in Billed Charges for Rev 272 = $208.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,500.6900,75.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,232.32,,,,,,,129.2300,500.6900,percent of total billed charges,46.4% of $500.69 in Billed Charges for Rev 272 = $232.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,500.6900,75.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,208.79,,,,,,,129.2300,500.6900,percent of total billed charges,41.7% of $500.69 in Billed Charges for Rev 272 = $208.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,500.6900,75.1000,CIGNA HEALTHCARE,CIGNA PPO,208.79,,,,,,,129.2300,500.6900,percent of total billed charges,41.7% of $500.69 in Billed Charges for Rev 272 = $208.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,500.6900,75.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,450.62,,,,,,,129.2300,500.6900,percent of total billed charges,90% of $500.69 in Billed Charges for Rev 272 = $450.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,500.6900,75.1000,MEDCOST,MEDCOST VHN,238.28,,,,,,,129.2300,500.6900,percent of total billed charges,47.59% of $500.69 in Billed Charges for Rev 272 = $238.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,500.6900,75.1000,SENTARA HEALTH,SENTARA HEALTH,129.23,,,,,,,129.2300,500.6900,percent of total billed charges,25.81% of $500.69 in Billed Charges for Rev 272 = $129.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,500.6900,75.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",500.69,,,,,,,129.2300,500.6900,percent of total billed charges,100% of $500.69 in Billed Charges for Rev 272 = $500.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,500.6900,75.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,250.35,,,,,,,129.2300,500.6900,percent of total billed charges,Rev 272 $500.69 in Billed Charges at 50% = $250.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,500.6900,75.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,161.72,,,,,,,129.2300,500.6900,other,32.3% of $500.69 in Billed Charges for Rev 272 = $161.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,500.6900,75.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,153.71,,,,,,,129.2300,500.6900,other,30.7% of $500.69 in Billed Charges for Rev 272 = $153.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,500.6900,75.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,161.72,,,,,,,129.2300,500.6900,percent of total billed charges,32.3% of $500.69 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,500.6900,75.1000,WELLCARE,WELLCARE MEDICAID,500.69,,,,,,,129.2300,500.6900,percent of total billed charges,100% of $500.69 in Billed Charges for Rev 272 = $500.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,2872.6600,430.9000,AETNA,AETNA,1226.63,,,,,,,741.4300,2872.6600,percent of total billed charges,"42.7% of $2,872.66 in Billed Charges for Rev 272 = $1,226.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,2872.6600,430.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2010.86,,,,,,,741.4300,2872.6600,percent of total billed charges,"Rev 272 $2,872.66 in Billed Charges at 70% = $2,010.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,2872.6600,430.9000,CIGNA HEALTHCARE,CIGNA HMO,1197.90,,,,,,,741.4300,2872.6600,percent of total billed charges,"41.7% of $2,872.66 in Billed Charges for Rev 272 = $1,197.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,2872.6600,430.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1332.91,,,,,,,741.4300,2872.6600,percent of total billed charges,"46.4% of $2,872.66 in Billed Charges for Rev 272 = $1,332.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,2872.6600,430.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1197.90,,,,,,,741.4300,2872.6600,percent of total billed charges,"41.7% of $2,872.66 in Billed Charges for Rev 272 = $1,197.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,2872.6600,430.9000,CIGNA HEALTHCARE,CIGNA PPO,1197.90,,,,,,,741.4300,2872.6600,percent of total billed charges,"41.7% of $2,872.66 in Billed Charges for Rev 272 = $1,197.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,2872.6600,430.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2585.39,,,,,,,741.4300,2872.6600,percent of total billed charges,"90% of $2,872.66 in Billed Charges for Rev 272 = $2,585.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,2872.6600,430.9000,MEDCOST,MEDCOST VHN,1367.10,,,,,,,741.4300,2872.6600,percent of total billed charges,"47.59% of $2,872.66 in Billed Charges for Rev 272 = $1,367.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,2872.6600,430.9000,SENTARA HEALTH,SENTARA HEALTH,741.43,,,,,,,741.4300,2872.6600,percent of total billed charges,"25.81% of $2,872.66 in Billed Charges for Rev 272 = $741.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,2872.6600,430.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2872.66,,,,,,,741.4300,2872.6600,percent of total billed charges,"100% of $2,872.66 in Billed Charges for Rev 272 = $2,872.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,2872.6600,430.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1436.33,,,,,,,741.4300,2872.6600,percent of total billed charges,"Rev 272 $2,872.66 in Billed Charges at 50% = $1,436.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,2872.6600,430.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,927.87,,,,,,,741.4300,2872.6600,other,"32.3% of $2,872.66 in Billed Charges for Rev 272 = $927.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,2872.6600,430.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,881.91,,,,,,,741.4300,2872.6600,other,"30.7% of $2,872.66 in Billed Charges for Rev 272 = $881.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,2872.6600,430.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,927.87,,,,,,,741.4300,2872.6600,percent of total billed charges,"32.3% of $2,872.66 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR ENDOSCOPIC SURGIFLO,272,RC,27200002,CDM,,,,,,both,,,2872.6600,430.9000,WELLCARE,WELLCARE MEDICAID,2872.66,,,,,,,741.4300,2872.6600,percent of total billed charges,"100% of $2,872.66 in Billed Charges for Rev 272 = $2,872.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1437.4200,215.6100,AETNA,AETNA,613.78,,,,,,,371.0000,1437.4200,percent of total billed charges,"42.7% of $1,437.42 in Billed Charges for Rev 272 = $613.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1437.4200,215.6100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1006.19,,,,,,,371.0000,1437.4200,percent of total billed charges,"Rev 272 $1,437.42 in Billed Charges at 70% = $1,006.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1437.4200,215.6100,CIGNA HEALTHCARE,CIGNA HMO,599.40,,,,,,,371.0000,1437.4200,percent of total billed charges,"41.7% of $1,437.42 in Billed Charges for Rev 272 = $599.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1437.4200,215.6100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,666.96,,,,,,,371.0000,1437.4200,percent of total billed charges,"46.4% of $1,437.42 in Billed Charges for Rev 272 = $666.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1437.4200,215.6100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,599.40,,,,,,,371.0000,1437.4200,percent of total billed charges,"41.7% of $1,437.42 in Billed Charges for Rev 272 = $599.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1437.4200,215.6100,CIGNA HEALTHCARE,CIGNA PPO,599.40,,,,,,,371.0000,1437.4200,percent of total billed charges,"41.7% of $1,437.42 in Billed Charges for Rev 272 = $599.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1437.4200,215.6100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1293.68,,,,,,,371.0000,1437.4200,percent of total billed charges,"90% of $1,437.42 in Billed Charges for Rev 272 = $1,293.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1437.4200,215.6100,MEDCOST,MEDCOST VHN,684.07,,,,,,,371.0000,1437.4200,percent of total billed charges,"47.59% of $1,437.42 in Billed Charges for Rev 272 = $684.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1437.4200,215.6100,SENTARA HEALTH,SENTARA HEALTH,371.00,,,,,,,371.0000,1437.4200,percent of total billed charges,"25.81% of $1,437.42 in Billed Charges for Rev 272 = $371.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1437.4200,215.6100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1437.42,,,,,,,371.0000,1437.4200,percent of total billed charges,"100% of $1,437.42 in Billed Charges for Rev 272 = $1,437.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1437.4200,215.6100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,718.71,,,,,,,371.0000,1437.4200,percent of total billed charges,"Rev 272 $1,437.42 in Billed Charges at 50% = $718.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1437.4200,215.6100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,464.29,,,,,,,371.0000,1437.4200,other,"32.3% of $1,437.42 in Billed Charges for Rev 272 = $464.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1437.4200,215.6100,UNITED HEALTHCARE,UHC HERITAGE SELECT,441.29,,,,,,,371.0000,1437.4200,other,"30.7% of $1,437.42 in Billed Charges for Rev 272 = $441.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1437.4200,215.6100,UNITED HEALTHCARE,UNITED HEALTHCARE,464.29,,,,,,,371.0000,1437.4200,percent of total billed charges,"32.3% of $1,437.42 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1437.4200,215.6100,WELLCARE,WELLCARE MEDICAID,1437.42,,,,,,,371.0000,1437.4200,percent of total billed charges,"100% of $1,437.42 in Billed Charges for Rev 272 = $1,437.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1969.1900,295.3800,AETNA,AETNA,840.84,,,,,,,508.2500,1969.1900,percent of total billed charges,"42.7% of $1,969.19 in Billed Charges for Rev 272 = $840.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1969.1900,295.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1378.43,,,,,,,508.2500,1969.1900,percent of total billed charges,"Rev 272 $1,969.19 in Billed Charges at 70% = $1,378.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1969.1900,295.3800,CIGNA HEALTHCARE,CIGNA HMO,821.15,,,,,,,508.2500,1969.1900,percent of total billed charges,"41.7% of $1,969.19 in Billed Charges for Rev 272 = $821.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1969.1900,295.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,913.70,,,,,,,508.2500,1969.1900,percent of total billed charges,"46.4% of $1,969.19 in Billed Charges for Rev 272 = $913.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1969.1900,295.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,821.15,,,,,,,508.2500,1969.1900,percent of total billed charges,"41.7% of $1,969.19 in Billed Charges for Rev 272 = $821.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1969.1900,295.3800,CIGNA HEALTHCARE,CIGNA PPO,821.15,,,,,,,508.2500,1969.1900,percent of total billed charges,"41.7% of $1,969.19 in Billed Charges for Rev 272 = $821.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1969.1900,295.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1772.27,,,,,,,508.2500,1969.1900,percent of total billed charges,"90% of $1,969.19 in Billed Charges for Rev 272 = $1,772.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1969.1900,295.3800,MEDCOST,MEDCOST VHN,937.14,,,,,,,508.2500,1969.1900,percent of total billed charges,"47.59% of $1,969.19 in Billed Charges for Rev 272 = $937.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1969.1900,295.3800,SENTARA HEALTH,SENTARA HEALTH,508.25,,,,,,,508.2500,1969.1900,percent of total billed charges,"25.81% of $1,969.19 in Billed Charges for Rev 272 = $508.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1969.1900,295.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1969.19,,,,,,,508.2500,1969.1900,percent of total billed charges,"100% of $1,969.19 in Billed Charges for Rev 272 = $1,969.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1969.1900,295.3800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,984.60,,,,,,,508.2500,1969.1900,percent of total billed charges,"Rev 272 $1,969.19 in Billed Charges at 50% = $984.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1969.1900,295.3800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,636.05,,,,,,,508.2500,1969.1900,other,"32.3% of $1,969.19 in Billed Charges for Rev 272 = $636.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1969.1900,295.3800,UNITED HEALTHCARE,UHC HERITAGE SELECT,604.54,,,,,,,508.2500,1969.1900,other,"30.7% of $1,969.19 in Billed Charges for Rev 272 = $604.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1969.1900,295.3800,UNITED HEALTHCARE,UNITED HEALTHCARE,636.05,,,,,,,508.2500,1969.1900,percent of total billed charges,"32.3% of $1,969.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1969.1900,295.3800,WELLCARE,WELLCARE MEDICAID,1969.19,,,,,,,508.2500,1969.1900,percent of total billed charges,"100% of $1,969.19 in Billed Charges for Rev 272 = $1,969.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR VISTASEAL 35CM,272,RC,27200002,CDM,,,,,,both,,,644.7700,96.7200,AETNA,AETNA,275.32,,,,,,,166.4200,644.7700,percent of total billed charges,42.7% of $644.77 in Billed Charges for Rev 272 = $275.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR VISTASEAL 35CM,272,RC,27200002,CDM,,,,,,both,,,644.7700,96.7200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,451.34,,,,,,,166.4200,644.7700,percent of total billed charges,Rev 272 $644.77 in Billed Charges at 70% = $451.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR VISTASEAL 35CM,272,RC,27200002,CDM,,,,,,both,,,644.7700,96.7200,CIGNA HEALTHCARE,CIGNA HMO,268.87,,,,,,,166.4200,644.7700,percent of total billed charges,41.7% of $644.77 in Billed Charges for Rev 272 = $268.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR VISTASEAL 35CM,272,RC,27200002,CDM,,,,,,both,,,644.7700,96.7200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,299.17,,,,,,,166.4200,644.7700,percent of total billed charges,46.4% of $644.77 in Billed Charges for Rev 272 = $299.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR VISTASEAL 35CM,272,RC,27200002,CDM,,,,,,both,,,644.7700,96.7200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,268.87,,,,,,,166.4200,644.7700,percent of total billed charges,41.7% of $644.77 in Billed Charges for Rev 272 = $268.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR VISTASEAL 35CM,272,RC,27200002,CDM,,,,,,both,,,644.7700,96.7200,CIGNA HEALTHCARE,CIGNA PPO,268.87,,,,,,,166.4200,644.7700,percent of total billed charges,41.7% of $644.77 in Billed Charges for Rev 272 = $268.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR VISTASEAL 35CM,272,RC,27200002,CDM,,,,,,both,,,644.7700,96.7200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,580.29,,,,,,,166.4200,644.7700,percent of total billed charges,90% of $644.77 in Billed Charges for Rev 272 = $580.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR VISTASEAL 35CM,272,RC,27200002,CDM,,,,,,both,,,644.7700,96.7200,MEDCOST,MEDCOST VHN,306.85,,,,,,,166.4200,644.7700,percent of total billed charges,47.59% of $644.77 in Billed Charges for Rev 272 = $306.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR VISTASEAL 35CM,272,RC,27200002,CDM,,,,,,both,,,644.7700,96.7200,SENTARA HEALTH,SENTARA HEALTH,166.42,,,,,,,166.4200,644.7700,percent of total billed charges,25.81% of $644.77 in Billed Charges for Rev 272 = $166.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR VISTASEAL 35CM,272,RC,27200002,CDM,,,,,,both,,,644.7700,96.7200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",644.77,,,,,,,166.4200,644.7700,percent of total billed charges,100% of $644.77 in Billed Charges for Rev 272 = $644.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR VISTASEAL 35CM,272,RC,27200002,CDM,,,,,,both,,,644.7700,96.7200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,322.39,,,,,,,166.4200,644.7700,percent of total billed charges,Rev 272 $644.77 in Billed Charges at 50% = $322.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR VISTASEAL 35CM,272,RC,27200002,CDM,,,,,,both,,,644.7700,96.7200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,208.26,,,,,,,166.4200,644.7700,other,32.3% of $644.77 in Billed Charges for Rev 272 = $208.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
APPLICATOR VISTASEAL 35CM,272,RC,27200002,CDM,,,,,,both,,,644.7700,96.7200,UNITED HEALTHCARE,UHC HERITAGE SELECT,197.94,,,,,,,166.4200,644.7700,other,30.7% of $644.77 in Billed Charges for Rev 272 = $197.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
APPLICATOR VISTASEAL 35CM,272,RC,27200002,CDM,,,,,,both,,,644.7700,96.7200,UNITED HEALTHCARE,UNITED HEALTHCARE,208.26,,,,,,,166.4200,644.7700,percent of total billed charges,32.3% of $644.77 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLICATOR VISTASEAL 35CM,272,RC,27200002,CDM,,,,,,both,,,644.7700,96.7200,WELLCARE,WELLCARE MEDICAID,644.77,,,,,,,166.4200,644.7700,percent of total billed charges,100% of $644.77 in Billed Charges for Rev 272 = $644.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,840.2600,126.0400,AETNA,AETNA,358.79,,,,,,,216.8700,840.2600,percent of total billed charges,42.7% of $840.26 in Billed Charges for Rev 272 = $358.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,840.2600,126.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,588.18,,,,,,,216.8700,840.2600,percent of total billed charges,Rev 272 $840.26 in Billed Charges at 70% = $588.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,840.2600,126.0400,CIGNA HEALTHCARE,CIGNA HMO,350.39,,,,,,,216.8700,840.2600,percent of total billed charges,41.7% of $840.26 in Billed Charges for Rev 272 = $350.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,840.2600,126.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,389.88,,,,,,,216.8700,840.2600,percent of total billed charges,46.4% of $840.26 in Billed Charges for Rev 272 = $389.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,840.2600,126.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,350.39,,,,,,,216.8700,840.2600,percent of total billed charges,41.7% of $840.26 in Billed Charges for Rev 272 = $350.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,840.2600,126.0400,CIGNA HEALTHCARE,CIGNA PPO,350.39,,,,,,,216.8700,840.2600,percent of total billed charges,41.7% of $840.26 in Billed Charges for Rev 272 = $350.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,840.2600,126.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,756.23,,,,,,,216.8700,840.2600,percent of total billed charges,90% of $840.26 in Billed Charges for Rev 272 = $756.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,840.2600,126.0400,MEDCOST,MEDCOST VHN,399.88,,,,,,,216.8700,840.2600,percent of total billed charges,47.59% of $840.26 in Billed Charges for Rev 272 = $399.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,840.2600,126.0400,SENTARA HEALTH,SENTARA HEALTH,216.87,,,,,,,216.8700,840.2600,percent of total billed charges,25.81% of $840.26 in Billed Charges for Rev 272 = $216.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,840.2600,126.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",840.26,,,,,,,216.8700,840.2600,percent of total billed charges,100% of $840.26 in Billed Charges for Rev 272 = $840.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,840.2600,126.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,420.13,,,,,,,216.8700,840.2600,percent of total billed charges,Rev 272 $840.26 in Billed Charges at 50% = $420.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,840.2600,126.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,271.40,,,,,,,216.8700,840.2600,other,32.3% of $840.26 in Billed Charges for Rev 272 = $271.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,840.2600,126.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,257.96,,,,,,,216.8700,840.2600,other,30.7% of $840.26 in Billed Charges for Rev 272 = $257.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,840.2600,126.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,271.40,,,,,,,216.8700,840.2600,percent of total billed charges,32.3% of $840.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,840.2600,126.0400,WELLCARE,WELLCARE MEDICAID,840.26,,,,,,,216.8700,840.2600,percent of total billed charges,100% of $840.26 in Billed Charges for Rev 272 = $840.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ANCHOR OPEN HARD BONE KIT HEALIX ADVANCE,272,RC,27200002,CDM,,,,,,both,,,7242.5900,1086.3900,AETNA,AETNA,3092.59,,,,,,,1869.3100,7242.5900,percent of total billed charges,"42.7% of $7,242.59 in Billed Charges for Rev 272 = $3,092.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR OPEN HARD BONE KIT HEALIX ADVANCE,272,RC,27200002,CDM,,,,,,both,,,7242.5900,1086.3900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5069.81,,,,,,,1869.3100,7242.5900,percent of total billed charges,"Rev 272 $7,242.59 in Billed Charges at 70% = $5,069.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR OPEN HARD BONE KIT HEALIX ADVANCE,272,RC,27200002,CDM,,,,,,both,,,7242.5900,1086.3900,CIGNA HEALTHCARE,CIGNA HMO,3020.16,,,,,,,1869.3100,7242.5900,percent of total billed charges,"41.7% of $7,242.59 in Billed Charges for Rev 272 = $3,020.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR OPEN HARD BONE KIT HEALIX ADVANCE,272,RC,27200002,CDM,,,,,,both,,,7242.5900,1086.3900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3360.56,,,,,,,1869.3100,7242.5900,percent of total billed charges,"46.4% of $7,242.59 in Billed Charges for Rev 272 = $3,360.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR OPEN HARD BONE KIT HEALIX ADVANCE,272,RC,27200002,CDM,,,,,,both,,,7242.5900,1086.3900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3020.16,,,,,,,1869.3100,7242.5900,percent of total billed charges,"41.7% of $7,242.59 in Billed Charges for Rev 272 = $3,020.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR OPEN HARD BONE KIT HEALIX ADVANCE,272,RC,27200002,CDM,,,,,,both,,,7242.5900,1086.3900,CIGNA HEALTHCARE,CIGNA PPO,3020.16,,,,,,,1869.3100,7242.5900,percent of total billed charges,"41.7% of $7,242.59 in Billed Charges for Rev 272 = $3,020.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR OPEN HARD BONE KIT HEALIX ADVANCE,272,RC,27200002,CDM,,,,,,both,,,7242.5900,1086.3900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6518.33,,,,,,,1869.3100,7242.5900,percent of total billed charges,"90% of $7,242.59 in Billed Charges for Rev 272 = $6,518.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR OPEN HARD BONE KIT HEALIX ADVANCE,272,RC,27200002,CDM,,,,,,both,,,7242.5900,1086.3900,MEDCOST,MEDCOST VHN,3446.75,,,,,,,1869.3100,7242.5900,percent of total billed charges,"47.59% of $7,242.59 in Billed Charges for Rev 272 = $3,446.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR OPEN HARD BONE KIT HEALIX ADVANCE,272,RC,27200002,CDM,,,,,,both,,,7242.5900,1086.3900,SENTARA HEALTH,SENTARA HEALTH,1869.31,,,,,,,1869.3100,7242.5900,percent of total billed charges,"25.81% of $7,242.59 in Billed Charges for Rev 272 = $1,869.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR OPEN HARD BONE KIT HEALIX ADVANCE,272,RC,27200002,CDM,,,,,,both,,,7242.5900,1086.3900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7242.59,,,,,,,1869.3100,7242.5900,percent of total billed charges,"100% of $7,242.59 in Billed Charges for Rev 272 = $7,242.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR OPEN HARD BONE KIT HEALIX ADVANCE,272,RC,27200002,CDM,,,,,,both,,,7242.5900,1086.3900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3621.30,,,,,,,1869.3100,7242.5900,percent of total billed charges,"Rev 272 $7,242.59 in Billed Charges at 50% = $3,621.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR OPEN HARD BONE KIT HEALIX ADVANCE,272,RC,27200002,CDM,,,,,,both,,,7242.5900,1086.3900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2339.36,,,,,,,1869.3100,7242.5900,other,"32.3% of $7,242.59 in Billed Charges for Rev 272 = $2,339.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ANCHOR OPEN HARD BONE KIT HEALIX ADVANCE,272,RC,27200002,CDM,,,,,,both,,,7242.5900,1086.3900,UNITED HEALTHCARE,UHC HERITAGE SELECT,2223.48,,,,,,,1869.3100,7242.5900,other,"30.7% of $7,242.59 in Billed Charges for Rev 272 = $2,223.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ANCHOR OPEN HARD BONE KIT HEALIX ADVANCE,272,RC,27200002,CDM,,,,,,both,,,7242.5900,1086.3900,UNITED HEALTHCARE,UNITED HEALTHCARE,2339.36,,,,,,,1869.3100,7242.5900,percent of total billed charges,"32.3% of $7,242.59 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR OPEN HARD BONE KIT HEALIX ADVANCE,272,RC,27200002,CDM,,,,,,both,,,7242.5900,1086.3900,WELLCARE,WELLCARE MEDICAID,7242.59,,,,,,,1869.3100,7242.5900,percent of total billed charges,"100% of $7,242.59 in Billed Charges for Rev 272 = $7,242.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1814.9300,272.2400,AETNA,AETNA,774.98,,,,,,,468.4300,1814.9300,percent of total billed charges,"42.7% of $1,814.93 in Billed Charges for Rev 272 = $774.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1814.9300,272.2400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1270.45,,,,,,,468.4300,1814.9300,percent of total billed charges,"Rev 272 $1,814.93 in Billed Charges at 70% = $1,270.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1814.9300,272.2400,CIGNA HEALTHCARE,CIGNA HMO,756.83,,,,,,,468.4300,1814.9300,percent of total billed charges,"41.7% of $1,814.93 in Billed Charges for Rev 272 = $756.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1814.9300,272.2400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,842.13,,,,,,,468.4300,1814.9300,percent of total billed charges,"46.4% of $1,814.93 in Billed Charges for Rev 272 = $842.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1814.9300,272.2400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,756.83,,,,,,,468.4300,1814.9300,percent of total billed charges,"41.7% of $1,814.93 in Billed Charges for Rev 272 = $756.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1814.9300,272.2400,CIGNA HEALTHCARE,CIGNA PPO,756.83,,,,,,,468.4300,1814.9300,percent of total billed charges,"41.7% of $1,814.93 in Billed Charges for Rev 272 = $756.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1814.9300,272.2400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1633.44,,,,,,,468.4300,1814.9300,percent of total billed charges,"90% of $1,814.93 in Billed Charges for Rev 272 = $1,633.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1814.9300,272.2400,MEDCOST,MEDCOST VHN,863.73,,,,,,,468.4300,1814.9300,percent of total billed charges,"47.59% of $1,814.93 in Billed Charges for Rev 272 = $863.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1814.9300,272.2400,SENTARA HEALTH,SENTARA HEALTH,468.43,,,,,,,468.4300,1814.9300,percent of total billed charges,"25.81% of $1,814.93 in Billed Charges for Rev 272 = $468.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1814.9300,272.2400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1814.93,,,,,,,468.4300,1814.9300,percent of total billed charges,"100% of $1,814.93 in Billed Charges for Rev 272 = $1,814.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1814.9300,272.2400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,907.47,,,,,,,468.4300,1814.9300,percent of total billed charges,"Rev 272 $1,814.93 in Billed Charges at 50% = $907.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1814.9300,272.2400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,586.22,,,,,,,468.4300,1814.9300,other,"32.3% of $1,814.93 in Billed Charges for Rev 272 = $586.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1814.9300,272.2400,UNITED HEALTHCARE,UHC HERITAGE SELECT,557.18,,,,,,,468.4300,1814.9300,other,"30.7% of $1,814.93 in Billed Charges for Rev 272 = $557.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1814.9300,272.2400,UNITED HEALTHCARE,UNITED HEALTHCARE,586.22,,,,,,,468.4300,1814.9300,percent of total billed charges,"32.3% of $1,814.93 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLICATOR PRELOADED AVITENE 10MM X4 2CM W/SHEET,272,RC,27200002,CDM,,,,,,both,,,1814.9300,272.2400,WELLCARE,WELLCARE MEDICAID,1814.93,,,,,,,468.4300,1814.9300,percent of total billed charges,"100% of $1,814.93 in Billed Charges for Rev 272 = $1,814.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,1454.4300,218.1600,AETNA,AETNA,621.04,,,,,,,375.3900,1454.4300,percent of total billed charges,"42.7% of $1,454.43 in Billed Charges for Rev 272 = $621.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,1454.4300,218.1600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1018.10,,,,,,,375.3900,1454.4300,percent of total billed charges,"Rev 272 $1,454.43 in Billed Charges at 70% = $1,018.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,1454.4300,218.1600,CIGNA HEALTHCARE,CIGNA HMO,606.50,,,,,,,375.3900,1454.4300,percent of total billed charges,"41.7% of $1,454.43 in Billed Charges for Rev 272 = $606.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,1454.4300,218.1600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,674.86,,,,,,,375.3900,1454.4300,percent of total billed charges,"46.4% of $1,454.43 in Billed Charges for Rev 272 = $674.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,1454.4300,218.1600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,606.50,,,,,,,375.3900,1454.4300,percent of total billed charges,"41.7% of $1,454.43 in Billed Charges for Rev 272 = $606.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,1454.4300,218.1600,CIGNA HEALTHCARE,CIGNA PPO,606.50,,,,,,,375.3900,1454.4300,percent of total billed charges,"41.7% of $1,454.43 in Billed Charges for Rev 272 = $606.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,1454.4300,218.1600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1308.99,,,,,,,375.3900,1454.4300,percent of total billed charges,"90% of $1,454.43 in Billed Charges for Rev 272 = $1,308.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,1454.4300,218.1600,MEDCOST,MEDCOST VHN,692.16,,,,,,,375.3900,1454.4300,percent of total billed charges,"47.59% of $1,454.43 in Billed Charges for Rev 272 = $692.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,1454.4300,218.1600,SENTARA HEALTH,SENTARA HEALTH,375.39,,,,,,,375.3900,1454.4300,percent of total billed charges,"25.81% of $1,454.43 in Billed Charges for Rev 272 = $375.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,1454.4300,218.1600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1454.43,,,,,,,375.3900,1454.4300,percent of total billed charges,"100% of $1,454.43 in Billed Charges for Rev 272 = $1,454.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,1454.4300,218.1600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,727.22,,,,,,,375.3900,1454.4300,percent of total billed charges,"Rev 272 $1,454.43 in Billed Charges at 50% = $727.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,1454.4300,218.1600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,469.78,,,,,,,375.3900,1454.4300,other,"32.3% of $1,454.43 in Billed Charges for Rev 272 = $469.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,1454.4300,218.1600,UNITED HEALTHCARE,UHC HERITAGE SELECT,446.51,,,,,,,375.3900,1454.4300,other,"30.7% of $1,454.43 in Billed Charges for Rev 272 = $446.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,1454.4300,218.1600,UNITED HEALTHCARE,UNITED HEALTHCARE,469.78,,,,,,,375.3900,1454.4300,percent of total billed charges,"32.3% of $1,454.43 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER CLIP LIGAMAX 5MM EL5ML,272,RC,27200002,CDM,,,,,,both,,,1454.4300,218.1600,WELLCARE,WELLCARE MEDICAID,1454.43,,,,,,,375.3900,1454.4300,percent of total billed charges,"100% of $1,454.43 in Billed Charges for Rev 272 = $1,454.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,622.8500,93.4300,AETNA,AETNA,265.96,,,,,,,160.7600,622.8500,percent of total billed charges,42.7% of $622.85 in Billed Charges for Rev 272 = $265.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,622.8500,93.4300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,436.00,,,,,,,160.7600,622.8500,percent of total billed charges,Rev 272 $622.85 in Billed Charges at 70% = $436.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,622.8500,93.4300,CIGNA HEALTHCARE,CIGNA HMO,259.73,,,,,,,160.7600,622.8500,percent of total billed charges,41.7% of $622.85 in Billed Charges for Rev 272 = $259.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,622.8500,93.4300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,289.00,,,,,,,160.7600,622.8500,percent of total billed charges,46.4% of $622.85 in Billed Charges for Rev 272 = $289.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,622.8500,93.4300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,259.73,,,,,,,160.7600,622.8500,percent of total billed charges,41.7% of $622.85 in Billed Charges for Rev 272 = $259.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,622.8500,93.4300,CIGNA HEALTHCARE,CIGNA PPO,259.73,,,,,,,160.7600,622.8500,percent of total billed charges,41.7% of $622.85 in Billed Charges for Rev 272 = $259.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,622.8500,93.4300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,560.57,,,,,,,160.7600,622.8500,percent of total billed charges,90% of $622.85 in Billed Charges for Rev 272 = $560.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,622.8500,93.4300,MEDCOST,MEDCOST VHN,296.41,,,,,,,160.7600,622.8500,percent of total billed charges,47.59% of $622.85 in Billed Charges for Rev 272 = $296.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,622.8500,93.4300,SENTARA HEALTH,SENTARA HEALTH,160.76,,,,,,,160.7600,622.8500,percent of total billed charges,25.81% of $622.85 in Billed Charges for Rev 272 = $160.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,622.8500,93.4300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",622.85,,,,,,,160.7600,622.8500,percent of total billed charges,100% of $622.85 in Billed Charges for Rev 272 = $622.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,622.8500,93.4300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,311.43,,,,,,,160.7600,622.8500,percent of total billed charges,Rev 272 $622.85 in Billed Charges at 50% = $311.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,622.8500,93.4300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,201.18,,,,,,,160.7600,622.8500,other,32.3% of $622.85 in Billed Charges for Rev 272 = $201.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,622.8500,93.4300,UNITED HEALTHCARE,UHC HERITAGE SELECT,191.22,,,,,,,160.7600,622.8500,other,30.7% of $622.85 in Billed Charges for Rev 272 = $191.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,622.8500,93.4300,UNITED HEALTHCARE,UNITED HEALTHCARE,201.18,,,,,,,160.7600,622.8500,percent of total billed charges,32.3% of $622.85 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,622.8500,93.4300,WELLCARE,WELLCARE MEDICAID,622.85,,,,,,,160.7600,622.8500,percent of total billed charges,100% of $622.85 in Billed Charges for Rev 272 = $622.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1852.1600,277.8200,AETNA,AETNA,790.87,,,,,,,478.0400,1852.1600,percent of total billed charges,"42.7% of $1,852.16 in Billed Charges for Rev 272 = $790.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1852.1600,277.8200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1296.51,,,,,,,478.0400,1852.1600,percent of total billed charges,"Rev 272 $1,852.16 in Billed Charges at 70% = $1,296.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1852.1600,277.8200,CIGNA HEALTHCARE,CIGNA HMO,772.35,,,,,,,478.0400,1852.1600,percent of total billed charges,"41.7% of $1,852.16 in Billed Charges for Rev 272 = $772.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1852.1600,277.8200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,859.40,,,,,,,478.0400,1852.1600,percent of total billed charges,"46.4% of $1,852.16 in Billed Charges for Rev 272 = $859.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1852.1600,277.8200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,772.35,,,,,,,478.0400,1852.1600,percent of total billed charges,"41.7% of $1,852.16 in Billed Charges for Rev 272 = $772.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1852.1600,277.8200,CIGNA HEALTHCARE,CIGNA PPO,772.35,,,,,,,478.0400,1852.1600,percent of total billed charges,"41.7% of $1,852.16 in Billed Charges for Rev 272 = $772.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1852.1600,277.8200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1666.94,,,,,,,478.0400,1852.1600,percent of total billed charges,"90% of $1,852.16 in Billed Charges for Rev 272 = $1,666.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1852.1600,277.8200,MEDCOST,MEDCOST VHN,881.44,,,,,,,478.0400,1852.1600,percent of total billed charges,"47.59% of $1,852.16 in Billed Charges for Rev 272 = $881.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1852.1600,277.8200,SENTARA HEALTH,SENTARA HEALTH,478.04,,,,,,,478.0400,1852.1600,percent of total billed charges,"25.81% of $1,852.16 in Billed Charges for Rev 272 = $478.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1852.1600,277.8200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1852.16,,,,,,,478.0400,1852.1600,percent of total billed charges,"100% of $1,852.16 in Billed Charges for Rev 272 = $1,852.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1852.1600,277.8200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,926.08,,,,,,,478.0400,1852.1600,percent of total billed charges,"Rev 272 $1,852.16 in Billed Charges at 50% = $926.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1852.1600,277.8200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,598.25,,,,,,,478.0400,1852.1600,other,"32.3% of $1,852.16 in Billed Charges for Rev 272 = $598.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1852.1600,277.8200,UNITED HEALTHCARE,UHC HERITAGE SELECT,568.61,,,,,,,478.0400,1852.1600,other,"30.7% of $1,852.16 in Billed Charges for Rev 272 = $568.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1852.1600,277.8200,UNITED HEALTHCARE,UNITED HEALTHCARE,598.25,,,,,,,478.0400,1852.1600,percent of total billed charges,"32.3% of $1,852.16 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1852.1600,277.8200,WELLCARE,WELLCARE MEDICAID,1852.16,,,,,,,478.0400,1852.1600,percent of total billed charges,"100% of $1,852.16 in Billed Charges for Rev 272 = $1,852.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,747.5400,112.1300,AETNA,AETNA,319.20,,,,,,,192.9400,747.5400,percent of total billed charges,42.7% of $747.54 in Billed Charges for Rev 272 = $319.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,747.5400,112.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,523.28,,,,,,,192.9400,747.5400,percent of total billed charges,Rev 272 $747.54 in Billed Charges at 70% = $523.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,747.5400,112.1300,CIGNA HEALTHCARE,CIGNA HMO,311.72,,,,,,,192.9400,747.5400,percent of total billed charges,41.7% of $747.54 in Billed Charges for Rev 272 = $311.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,747.5400,112.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,346.86,,,,,,,192.9400,747.5400,percent of total billed charges,46.4% of $747.54 in Billed Charges for Rev 272 = $346.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,747.5400,112.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,311.72,,,,,,,192.9400,747.5400,percent of total billed charges,41.7% of $747.54 in Billed Charges for Rev 272 = $311.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,747.5400,112.1300,CIGNA HEALTHCARE,CIGNA PPO,311.72,,,,,,,192.9400,747.5400,percent of total billed charges,41.7% of $747.54 in Billed Charges for Rev 272 = $311.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,747.5400,112.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,672.79,,,,,,,192.9400,747.5400,percent of total billed charges,90% of $747.54 in Billed Charges for Rev 272 = $672.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,747.5400,112.1300,MEDCOST,MEDCOST VHN,355.75,,,,,,,192.9400,747.5400,percent of total billed charges,47.59% of $747.54 in Billed Charges for Rev 272 = $355.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,747.5400,112.1300,SENTARA HEALTH,SENTARA HEALTH,192.94,,,,,,,192.9400,747.5400,percent of total billed charges,25.81% of $747.54 in Billed Charges for Rev 272 = $192.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,747.5400,112.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",747.54,,,,,,,192.9400,747.5400,percent of total billed charges,100% of $747.54 in Billed Charges for Rev 272 = $747.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,747.5400,112.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,373.77,,,,,,,192.9400,747.5400,percent of total billed charges,Rev 272 $747.54 in Billed Charges at 50% = $373.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,747.5400,112.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,241.46,,,,,,,192.9400,747.5400,other,32.3% of $747.54 in Billed Charges for Rev 272 = $241.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,747.5400,112.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,229.49,,,,,,,192.9400,747.5400,other,30.7% of $747.54 in Billed Charges for Rev 272 = $229.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,747.5400,112.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,241.46,,,,,,,192.9400,747.5400,percent of total billed charges,32.3% of $747.54 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
APPLIER ENDOCLIP ROTAT SHF,272,RC,27200002,CDM,,,,,,both,,,747.5400,112.1300,WELLCARE,WELLCARE MEDICAID,747.54,,,,,,,192.9400,747.5400,percent of total billed charges,100% of $747.54 in Billed Charges for Rev 272 = $747.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.5 W/STP 60MMX85MM,272,RC,,,,,,,,both,,,1184.9900,177.7500,AETNA,AETNA,505.99,,,,,,,305.8500,1184.9900,percent of total billed charges,"42.7% of $1,184.99 in Billed Charges for Rev 272 = $505.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 W/STP 60MMX85MM,272,RC,,,,,,,,both,,,1184.9900,177.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,829.49,,,,,,,305.8500,1184.9900,percent of total billed charges,"Rev 272 $1,184.99 in Billed Charges at 70% = $829.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 W/STP 60MMX85MM,272,RC,,,,,,,,both,,,1184.9900,177.7500,CIGNA HEALTHCARE,CIGNA HMO,494.14,,,,,,,305.8500,1184.9900,percent of total billed charges,"41.7% of $1,184.99 in Billed Charges for Rev 272 = $494.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 W/STP 60MMX85MM,272,RC,,,,,,,,both,,,1184.9900,177.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,549.84,,,,,,,305.8500,1184.9900,percent of total billed charges,"46.4% of $1,184.99 in Billed Charges for Rev 272 = $549.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 W/STP 60MMX85MM,272,RC,,,,,,,,both,,,1184.9900,177.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,494.14,,,,,,,305.8500,1184.9900,percent of total billed charges,"41.7% of $1,184.99 in Billed Charges for Rev 272 = $494.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 W/STP 60MMX85MM,272,RC,,,,,,,,both,,,1184.9900,177.7500,CIGNA HEALTHCARE,CIGNA PPO,494.14,,,,,,,305.8500,1184.9900,percent of total billed charges,"41.7% of $1,184.99 in Billed Charges for Rev 272 = $494.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 W/STP 60MMX85MM,272,RC,,,,,,,,both,,,1184.9900,177.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1066.49,,,,,,,305.8500,1184.9900,percent of total billed charges,"90% of $1,184.99 in Billed Charges for Rev 272 = $1,066.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 W/STP 60MMX85MM,272,RC,,,,,,,,both,,,1184.9900,177.7500,MEDCOST,MEDCOST VHN,563.94,,,,,,,305.8500,1184.9900,percent of total billed charges,"47.59% of $1,184.99 in Billed Charges for Rev 272 = $563.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 W/STP 60MMX85MM,272,RC,,,,,,,,both,,,1184.9900,177.7500,SENTARA HEALTH,SENTARA HEALTH,305.85,,,,,,,305.8500,1184.9900,percent of total billed charges,"25.81% of $1,184.99 in Billed Charges for Rev 272 = $305.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 W/STP 60MMX85MM,272,RC,,,,,,,,both,,,1184.9900,177.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1184.99,,,,,,,305.8500,1184.9900,percent of total billed charges,"100% of $1,184.99 in Billed Charges for Rev 272 = $1,184.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 W/STP 60MMX85MM,272,RC,,,,,,,,both,,,1184.9900,177.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,592.50,,,,,,,305.8500,1184.9900,percent of total billed charges,"Rev 272 $1,184.99 in Billed Charges at 50% = $592.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 W/STP 60MMX85MM,272,RC,,,,,,,,both,,,1184.9900,177.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,382.75,,,,,,,305.8500,1184.9900,other,"32.3% of $1,184.99 in Billed Charges for Rev 272 = $382.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.5 W/STP 60MMX85MM,272,RC,,,,,,,,both,,,1184.9900,177.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,363.79,,,,,,,305.8500,1184.9900,other,"30.7% of $1,184.99 in Billed Charges for Rev 272 = $363.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.5 W/STP 60MMX85MM,272,RC,,,,,,,,both,,,1184.9900,177.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,382.75,,,,,,,305.8500,1184.9900,percent of total billed charges,"32.3% of $1,184.99 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 W/STP 60MMX85MM,272,RC,,,,,,,,both,,,1184.9900,177.7500,WELLCARE,WELLCARE MEDICAID,1184.99,,,,,,,305.8500,1184.9900,percent of total billed charges,"100% of $1,184.99 in Billed Charges for Rev 272 = $1,184.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 100MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2032.7200,304.9100,AETNA,AETNA,867.97,,,,,,,524.6500,2032.7200,percent of total billed charges,"42.7% of $2,032.72 in Billed Charges for Rev 272 = $867.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 100MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2032.7200,304.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1422.90,,,,,,,524.6500,2032.7200,percent of total billed charges,"Rev 272 $2,032.72 in Billed Charges at 70% = $1,422.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 100MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2032.7200,304.9100,CIGNA HEALTHCARE,CIGNA HMO,847.64,,,,,,,524.6500,2032.7200,percent of total billed charges,"41.7% of $2,032.72 in Billed Charges for Rev 272 = $847.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 100MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2032.7200,304.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,943.18,,,,,,,524.6500,2032.7200,percent of total billed charges,"46.4% of $2,032.72 in Billed Charges for Rev 272 = $943.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 100MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2032.7200,304.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,847.64,,,,,,,524.6500,2032.7200,percent of total billed charges,"41.7% of $2,032.72 in Billed Charges for Rev 272 = $847.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 100MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2032.7200,304.9100,CIGNA HEALTHCARE,CIGNA PPO,847.64,,,,,,,524.6500,2032.7200,percent of total billed charges,"41.7% of $2,032.72 in Billed Charges for Rev 272 = $847.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 100MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2032.7200,304.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1829.45,,,,,,,524.6500,2032.7200,percent of total billed charges,"90% of $2,032.72 in Billed Charges for Rev 272 = $1,829.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 100MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2032.7200,304.9100,MEDCOST,MEDCOST VHN,967.37,,,,,,,524.6500,2032.7200,percent of total billed charges,"47.59% of $2,032.72 in Billed Charges for Rev 272 = $967.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 100MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2032.7200,304.9100,SENTARA HEALTH,SENTARA HEALTH,524.65,,,,,,,524.6500,2032.7200,percent of total billed charges,"25.81% of $2,032.72 in Billed Charges for Rev 272 = $524.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 100MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2032.7200,304.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2032.72,,,,,,,524.6500,2032.7200,percent of total billed charges,"100% of $2,032.72 in Billed Charges for Rev 272 = $2,032.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 100MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2032.7200,304.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1016.36,,,,,,,524.6500,2032.7200,percent of total billed charges,"Rev 272 $2,032.72 in Billed Charges at 50% = $1,016.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 100MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2032.7200,304.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,656.57,,,,,,,524.6500,2032.7200,other,"32.3% of $2,032.72 in Billed Charges for Rev 272 = $656.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.5 X 100MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2032.7200,304.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,624.05,,,,,,,524.6500,2032.7200,other,"30.7% of $2,032.72 in Billed Charges for Rev 272 = $624.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.5 X 100MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2032.7200,304.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,656.57,,,,,,,524.6500,2032.7200,percent of total billed charges,"32.3% of $2,032.72 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 100MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2032.7200,304.9100,WELLCARE,WELLCARE MEDICAID,2032.72,,,,,,,524.6500,2032.7200,percent of total billed charges,"100% of $2,032.72 in Billed Charges for Rev 272 = $2,032.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 50MM 120MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2047.9600,307.1900,AETNA,AETNA,874.48,,,,,,,528.5800,2047.9600,percent of total billed charges,"42.7% of $2,047.96 in Billed Charges for Rev 272 = $874.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 50MM 120MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2047.9600,307.1900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1433.57,,,,,,,528.5800,2047.9600,percent of total billed charges,"Rev 272 $2,047.96 in Billed Charges at 70% = $1,433.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 50MM 120MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2047.9600,307.1900,CIGNA HEALTHCARE,CIGNA HMO,854.00,,,,,,,528.5800,2047.9600,percent of total billed charges,"41.7% of $2,047.96 in Billed Charges for Rev 272 = $854.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 50MM 120MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2047.9600,307.1900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,950.25,,,,,,,528.5800,2047.9600,percent of total billed charges,"46.4% of $2,047.96 in Billed Charges for Rev 272 = $950.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 50MM 120MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2047.9600,307.1900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,854.00,,,,,,,528.5800,2047.9600,percent of total billed charges,"41.7% of $2,047.96 in Billed Charges for Rev 272 = $854.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 50MM 120MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2047.9600,307.1900,CIGNA HEALTHCARE,CIGNA PPO,854.00,,,,,,,528.5800,2047.9600,percent of total billed charges,"41.7% of $2,047.96 in Billed Charges for Rev 272 = $854.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 50MM 120MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2047.9600,307.1900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1843.16,,,,,,,528.5800,2047.9600,percent of total billed charges,"90% of $2,047.96 in Billed Charges for Rev 272 = $1,843.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 50MM 120MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2047.9600,307.1900,MEDCOST,MEDCOST VHN,974.62,,,,,,,528.5800,2047.9600,percent of total billed charges,"47.59% of $2,047.96 in Billed Charges for Rev 272 = $974.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 50MM 120MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2047.9600,307.1900,SENTARA HEALTH,SENTARA HEALTH,528.58,,,,,,,528.5800,2047.9600,percent of total billed charges,"25.81% of $2,047.96 in Billed Charges for Rev 272 = $528.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 50MM 120MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2047.9600,307.1900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2047.96,,,,,,,528.5800,2047.9600,percent of total billed charges,"100% of $2,047.96 in Billed Charges for Rev 272 = $2,047.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 50MM 120MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2047.9600,307.1900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1023.98,,,,,,,528.5800,2047.9600,percent of total billed charges,"Rev 272 $2,047.96 in Billed Charges at 50% = $1,023.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 50MM 120MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2047.9600,307.1900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,661.49,,,,,,,528.5800,2047.9600,other,"32.3% of $2,047.96 in Billed Charges for Rev 272 = $661.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.5 X 50MM 120MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2047.9600,307.1900,UNITED HEALTHCARE,UHC HERITAGE SELECT,628.72,,,,,,,528.5800,2047.9600,other,"30.7% of $2,047.96 in Billed Charges for Rev 272 = $628.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.5 X 50MM 120MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2047.9600,307.1900,UNITED HEALTHCARE,UNITED HEALTHCARE,661.49,,,,,,,528.5800,2047.9600,percent of total billed charges,"32.3% of $2,047.96 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 50MM 120MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2047.9600,307.1900,WELLCARE,WELLCARE MEDICAID,2047.96,,,,,,,528.5800,2047.9600,percent of total billed charges,"100% of $2,047.96 in Billed Charges for Rev 272 = $2,047.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5 X 91 W/ 6MM STOP,272,RC,,,,,,,,both,,,907.4600,136.1200,AETNA,AETNA,387.49,,,,,,,234.2200,907.4600,percent of total billed charges,42.7% of $907.46 in Billed Charges for Rev 272 = $387.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.5 X 91 W/ 6MM STOP,272,RC,,,,,,,,both,,,907.4600,136.1200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,635.22,,,,,,,234.2200,907.4600,percent of total billed charges,Rev 272 $907.46 in Billed Charges at 70% = $635.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.5 X 91 W/ 6MM STOP,272,RC,,,,,,,,both,,,907.4600,136.1200,CIGNA HEALTHCARE,CIGNA HMO,378.41,,,,,,,234.2200,907.4600,percent of total billed charges,41.7% of $907.46 in Billed Charges for Rev 272 = $378.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.5 X 91 W/ 6MM STOP,272,RC,,,,,,,,both,,,907.4600,136.1200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,421.06,,,,,,,234.2200,907.4600,percent of total billed charges,46.4% of $907.46 in Billed Charges for Rev 272 = $421.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.5 X 91 W/ 6MM STOP,272,RC,,,,,,,,both,,,907.4600,136.1200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,378.41,,,,,,,234.2200,907.4600,percent of total billed charges,41.7% of $907.46 in Billed Charges for Rev 272 = $378.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.5 X 91 W/ 6MM STOP,272,RC,,,,,,,,both,,,907.4600,136.1200,CIGNA HEALTHCARE,CIGNA PPO,378.41,,,,,,,234.2200,907.4600,percent of total billed charges,41.7% of $907.46 in Billed Charges for Rev 272 = $378.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.5 X 91 W/ 6MM STOP,272,RC,,,,,,,,both,,,907.4600,136.1200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,816.71,,,,,,,234.2200,907.4600,percent of total billed charges,90% of $907.46 in Billed Charges for Rev 272 = $816.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.5 X 91 W/ 6MM STOP,272,RC,,,,,,,,both,,,907.4600,136.1200,MEDCOST,MEDCOST VHN,431.86,,,,,,,234.2200,907.4600,percent of total billed charges,47.59% of $907.46 in Billed Charges for Rev 272 = $431.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.5 X 91 W/ 6MM STOP,272,RC,,,,,,,,both,,,907.4600,136.1200,SENTARA HEALTH,SENTARA HEALTH,234.22,,,,,,,234.2200,907.4600,percent of total billed charges,25.81% of $907.46 in Billed Charges for Rev 272 = $234.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.5 X 91 W/ 6MM STOP,272,RC,,,,,,,,both,,,907.4600,136.1200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",907.46,,,,,,,234.2200,907.4600,percent of total billed charges,100% of $907.46 in Billed Charges for Rev 272 = $907.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.5 X 91 W/ 6MM STOP,272,RC,,,,,,,,both,,,907.4600,136.1200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,453.73,,,,,,,234.2200,907.4600,percent of total billed charges,Rev 272 $907.46 in Billed Charges at 50% = $453.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.5 X 91 W/ 6MM STOP,272,RC,,,,,,,,both,,,907.4600,136.1200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,293.11,,,,,,,234.2200,907.4600,other,32.3% of $907.46 in Billed Charges for Rev 272 = $293.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 1.5 X 91 W/ 6MM STOP,272,RC,,,,,,,,both,,,907.4600,136.1200,UNITED HEALTHCARE,UHC HERITAGE SELECT,278.59,,,,,,,234.2200,907.4600,other,30.7% of $907.46 in Billed Charges for Rev 272 = $278.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 1.5 X 91 W/ 6MM STOP,272,RC,,,,,,,,both,,,907.4600,136.1200,UNITED HEALTHCARE,UNITED HEALTHCARE,293.11,,,,,,,234.2200,907.4600,percent of total billed charges,32.3% of $907.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.5 X 91 W/ 6MM STOP,272,RC,,,,,,,,both,,,907.4600,136.1200,WELLCARE,WELLCARE MEDICAID,907.46,,,,,,,234.2200,907.4600,percent of total billed charges,100% of $907.46 in Billed Charges for Rev 272 = $907.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1322.7200,198.4100,AETNA,AETNA,564.80,,,,,,,341.3900,1322.7200,percent of total billed charges,"42.7% of $1,322.72 in Billed Charges for Rev 272 = $564.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1322.7200,198.4100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,925.90,,,,,,,341.3900,1322.7200,percent of total billed charges,"Rev 272 $1,322.72 in Billed Charges at 70% = $925.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1322.7200,198.4100,CIGNA HEALTHCARE,CIGNA HMO,551.57,,,,,,,341.3900,1322.7200,percent of total billed charges,"41.7% of $1,322.72 in Billed Charges for Rev 272 = $551.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1322.7200,198.4100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,613.74,,,,,,,341.3900,1322.7200,percent of total billed charges,"46.4% of $1,322.72 in Billed Charges for Rev 272 = $613.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1322.7200,198.4100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,551.57,,,,,,,341.3900,1322.7200,percent of total billed charges,"41.7% of $1,322.72 in Billed Charges for Rev 272 = $551.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1322.7200,198.4100,CIGNA HEALTHCARE,CIGNA PPO,551.57,,,,,,,341.3900,1322.7200,percent of total billed charges,"41.7% of $1,322.72 in Billed Charges for Rev 272 = $551.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1322.7200,198.4100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1190.45,,,,,,,341.3900,1322.7200,percent of total billed charges,"90% of $1,322.72 in Billed Charges for Rev 272 = $1,190.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1322.7200,198.4100,MEDCOST,MEDCOST VHN,629.48,,,,,,,341.3900,1322.7200,percent of total billed charges,"47.59% of $1,322.72 in Billed Charges for Rev 272 = $629.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1322.7200,198.4100,SENTARA HEALTH,SENTARA HEALTH,341.39,,,,,,,341.3900,1322.7200,percent of total billed charges,"25.81% of $1,322.72 in Billed Charges for Rev 272 = $341.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1322.7200,198.4100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1322.72,,,,,,,341.3900,1322.7200,percent of total billed charges,"100% of $1,322.72 in Billed Charges for Rev 272 = $1,322.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1322.7200,198.4100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,661.36,,,,,,,341.3900,1322.7200,percent of total billed charges,"Rev 272 $1,322.72 in Billed Charges at 50% = $661.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1322.7200,198.4100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,427.24,,,,,,,341.3900,1322.7200,other,"32.3% of $1,322.72 in Billed Charges for Rev 272 = $427.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1322.7200,198.4100,UNITED HEALTHCARE,UHC HERITAGE SELECT,406.08,,,,,,,341.3900,1322.7200,other,"30.7% of $1,322.72 in Billed Charges for Rev 272 = $406.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1322.7200,198.4100,UNITED HEALTHCARE,UNITED HEALTHCARE,427.24,,,,,,,341.3900,1322.7200,percent of total billed charges,"32.3% of $1,322.72 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,,,,,,,,both,,,1322.7200,198.4100,WELLCARE,WELLCARE MEDICAID,1322.72,,,,,,,341.3900,1322.7200,percent of total billed charges,"100% of $1,322.72 in Billed Charges for Rev 272 = $1,322.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM 71174901,272,RC,,,,,,,,both,,,1221.3900,183.2100,AETNA,AETNA,521.53,,,,,,,315.2400,1221.3900,percent of total billed charges,"42.7% of $1,221.39 in Billed Charges for Rev 272 = $521.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM 71174901,272,RC,,,,,,,,both,,,1221.3900,183.2100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,854.97,,,,,,,315.2400,1221.3900,percent of total billed charges,"Rev 272 $1,221.39 in Billed Charges at 70% = $854.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM 71174901,272,RC,,,,,,,,both,,,1221.3900,183.2100,CIGNA HEALTHCARE,CIGNA HMO,509.32,,,,,,,315.2400,1221.3900,percent of total billed charges,"41.7% of $1,221.39 in Billed Charges for Rev 272 = $509.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM 71174901,272,RC,,,,,,,,both,,,1221.3900,183.2100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,566.73,,,,,,,315.2400,1221.3900,percent of total billed charges,"46.4% of $1,221.39 in Billed Charges for Rev 272 = $566.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM 71174901,272,RC,,,,,,,,both,,,1221.3900,183.2100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,509.32,,,,,,,315.2400,1221.3900,percent of total billed charges,"41.7% of $1,221.39 in Billed Charges for Rev 272 = $509.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM 71174901,272,RC,,,,,,,,both,,,1221.3900,183.2100,CIGNA HEALTHCARE,CIGNA PPO,509.32,,,,,,,315.2400,1221.3900,percent of total billed charges,"41.7% of $1,221.39 in Billed Charges for Rev 272 = $509.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM 71174901,272,RC,,,,,,,,both,,,1221.3900,183.2100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1099.25,,,,,,,315.2400,1221.3900,percent of total billed charges,"90% of $1,221.39 in Billed Charges for Rev 272 = $1,099.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM 71174901,272,RC,,,,,,,,both,,,1221.3900,183.2100,MEDCOST,MEDCOST VHN,581.26,,,,,,,315.2400,1221.3900,percent of total billed charges,"47.59% of $1,221.39 in Billed Charges for Rev 272 = $581.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM 71174901,272,RC,,,,,,,,both,,,1221.3900,183.2100,SENTARA HEALTH,SENTARA HEALTH,315.24,,,,,,,315.2400,1221.3900,percent of total billed charges,"25.81% of $1,221.39 in Billed Charges for Rev 272 = $315.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM 71174901,272,RC,,,,,,,,both,,,1221.3900,183.2100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1221.39,,,,,,,315.2400,1221.3900,percent of total billed charges,"100% of $1,221.39 in Billed Charges for Rev 272 = $1,221.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM 71174901,272,RC,,,,,,,,both,,,1221.3900,183.2100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,610.70,,,,,,,315.2400,1221.3900,percent of total billed charges,"Rev 272 $1,221.39 in Billed Charges at 50% = $610.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM 71174901,272,RC,,,,,,,,both,,,1221.3900,183.2100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,394.51,,,,,,,315.2400,1221.3900,other,"32.3% of $1,221.39 in Billed Charges for Rev 272 = $394.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.5MM 71174901,272,RC,,,,,,,,both,,,1221.3900,183.2100,UNITED HEALTHCARE,UHC HERITAGE SELECT,374.97,,,,,,,315.2400,1221.3900,other,"30.7% of $1,221.39 in Billed Charges for Rev 272 = $374.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.5MM 71174901,272,RC,,,,,,,,both,,,1221.3900,183.2100,UNITED HEALTHCARE,UNITED HEALTHCARE,394.51,,,,,,,315.2400,1221.3900,percent of total billed charges,"32.3% of $1,221.39 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM 71174901,272,RC,,,,,,,,both,,,1221.3900,183.2100,WELLCARE,WELLCARE MEDICAID,1221.39,,,,,,,315.2400,1221.3900,percent of total billed charges,"100% of $1,221.39 in Billed Charges for Rev 272 = $1,221.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1084.2900,162.6400,AETNA,AETNA,462.99,,,,,,,279.8600,1084.2900,percent of total billed charges,"42.7% of $1,084.29 in Billed Charges for Rev 272 = $462.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1084.2900,162.6400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,759.00,,,,,,,279.8600,1084.2900,percent of total billed charges,"Rev 272 $1,084.29 in Billed Charges at 70% = $759.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1084.2900,162.6400,CIGNA HEALTHCARE,CIGNA HMO,452.15,,,,,,,279.8600,1084.2900,percent of total billed charges,"41.7% of $1,084.29 in Billed Charges for Rev 272 = $452.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1084.2900,162.6400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,503.11,,,,,,,279.8600,1084.2900,percent of total billed charges,"46.4% of $1,084.29 in Billed Charges for Rev 272 = $503.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1084.2900,162.6400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,452.15,,,,,,,279.8600,1084.2900,percent of total billed charges,"41.7% of $1,084.29 in Billed Charges for Rev 272 = $452.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1084.2900,162.6400,CIGNA HEALTHCARE,CIGNA PPO,452.15,,,,,,,279.8600,1084.2900,percent of total billed charges,"41.7% of $1,084.29 in Billed Charges for Rev 272 = $452.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1084.2900,162.6400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,975.86,,,,,,,279.8600,1084.2900,percent of total billed charges,"90% of $1,084.29 in Billed Charges for Rev 272 = $975.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1084.2900,162.6400,MEDCOST,MEDCOST VHN,516.01,,,,,,,279.8600,1084.2900,percent of total billed charges,"47.59% of $1,084.29 in Billed Charges for Rev 272 = $516.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1084.2900,162.6400,SENTARA HEALTH,SENTARA HEALTH,279.86,,,,,,,279.8600,1084.2900,percent of total billed charges,"25.81% of $1,084.29 in Billed Charges for Rev 272 = $279.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1084.2900,162.6400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1084.29,,,,,,,279.8600,1084.2900,percent of total billed charges,"100% of $1,084.29 in Billed Charges for Rev 272 = $1,084.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1084.2900,162.6400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,542.15,,,,,,,279.8600,1084.2900,percent of total billed charges,"Rev 272 $1,084.29 in Billed Charges at 50% = $542.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1084.2900,162.6400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,350.23,,,,,,,279.8600,1084.2900,other,"32.3% of $1,084.29 in Billed Charges for Rev 272 = $350.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1084.2900,162.6400,UNITED HEALTHCARE,UHC HERITAGE SELECT,332.88,,,,,,,279.8600,1084.2900,other,"30.7% of $1,084.29 in Billed Charges for Rev 272 = $332.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1084.2900,162.6400,UNITED HEALTHCARE,UNITED HEALTHCARE,350.23,,,,,,,279.8600,1084.2900,percent of total billed charges,"32.3% of $1,084.29 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1084.2900,162.6400,WELLCARE,WELLCARE MEDICAID,1084.29,,,,,,,279.8600,1084.2900,percent of total billed charges,"100% of $1,084.29 in Billed Charges for Rev 272 = $1,084.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1317.1200,197.5700,AETNA,AETNA,562.41,,,,,,,339.9500,1317.1200,percent of total billed charges,"42.7% of $1,317.12 in Billed Charges for Rev 272 = $562.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1317.1200,197.5700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,921.98,,,,,,,339.9500,1317.1200,percent of total billed charges,"Rev 272 $1,317.12 in Billed Charges at 70% = $921.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1317.1200,197.5700,CIGNA HEALTHCARE,CIGNA HMO,549.24,,,,,,,339.9500,1317.1200,percent of total billed charges,"41.7% of $1,317.12 in Billed Charges for Rev 272 = $549.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1317.1200,197.5700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,611.14,,,,,,,339.9500,1317.1200,percent of total billed charges,"46.4% of $1,317.12 in Billed Charges for Rev 272 = $611.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1317.1200,197.5700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,549.24,,,,,,,339.9500,1317.1200,percent of total billed charges,"41.7% of $1,317.12 in Billed Charges for Rev 272 = $549.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1317.1200,197.5700,CIGNA HEALTHCARE,CIGNA PPO,549.24,,,,,,,339.9500,1317.1200,percent of total billed charges,"41.7% of $1,317.12 in Billed Charges for Rev 272 = $549.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1317.1200,197.5700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1185.41,,,,,,,339.9500,1317.1200,percent of total billed charges,"90% of $1,317.12 in Billed Charges for Rev 272 = $1,185.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1317.1200,197.5700,MEDCOST,MEDCOST VHN,626.82,,,,,,,339.9500,1317.1200,percent of total billed charges,"47.59% of $1,317.12 in Billed Charges for Rev 272 = $626.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1317.1200,197.5700,SENTARA HEALTH,SENTARA HEALTH,339.95,,,,,,,339.9500,1317.1200,percent of total billed charges,"25.81% of $1,317.12 in Billed Charges for Rev 272 = $339.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1317.1200,197.5700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1317.12,,,,,,,339.9500,1317.1200,percent of total billed charges,"100% of $1,317.12 in Billed Charges for Rev 272 = $1,317.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1317.1200,197.5700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,658.56,,,,,,,339.9500,1317.1200,percent of total billed charges,"Rev 272 $1,317.12 in Billed Charges at 50% = $658.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1317.1200,197.5700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,425.43,,,,,,,339.9500,1317.1200,other,"32.3% of $1,317.12 in Billed Charges for Rev 272 = $425.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1317.1200,197.5700,UNITED HEALTHCARE,UHC HERITAGE SELECT,404.36,,,,,,,339.9500,1317.1200,other,"30.7% of $1,317.12 in Billed Charges for Rev 272 = $404.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1317.1200,197.5700,UNITED HEALTHCARE,UNITED HEALTHCARE,425.43,,,,,,,339.9500,1317.1200,percent of total billed charges,"32.3% of $1,317.12 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1317.1200,197.5700,WELLCARE,WELLCARE MEDICAID,1317.12,,,,,,,339.9500,1317.1200,percent of total billed charges,"100% of $1,317.12 in Billed Charges for Rev 272 = $1,317.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1522.6700,228.4000,AETNA,AETNA,650.18,,,,,,,393.0000,1522.6700,percent of total billed charges,"42.7% of $1,522.67 in Billed Charges for Rev 272 = $650.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1522.6700,228.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1065.87,,,,,,,393.0000,1522.6700,percent of total billed charges,"Rev 272 $1,522.67 in Billed Charges at 70% = $1,065.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1522.6700,228.4000,CIGNA HEALTHCARE,CIGNA HMO,634.95,,,,,,,393.0000,1522.6700,percent of total billed charges,"41.7% of $1,522.67 in Billed Charges for Rev 272 = $634.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1522.6700,228.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,706.52,,,,,,,393.0000,1522.6700,percent of total billed charges,"46.4% of $1,522.67 in Billed Charges for Rev 272 = $706.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1522.6700,228.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,634.95,,,,,,,393.0000,1522.6700,percent of total billed charges,"41.7% of $1,522.67 in Billed Charges for Rev 272 = $634.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1522.6700,228.4000,CIGNA HEALTHCARE,CIGNA PPO,634.95,,,,,,,393.0000,1522.6700,percent of total billed charges,"41.7% of $1,522.67 in Billed Charges for Rev 272 = $634.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1522.6700,228.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1370.40,,,,,,,393.0000,1522.6700,percent of total billed charges,"90% of $1,522.67 in Billed Charges for Rev 272 = $1,370.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1522.6700,228.4000,MEDCOST,MEDCOST VHN,724.64,,,,,,,393.0000,1522.6700,percent of total billed charges,"47.59% of $1,522.67 in Billed Charges for Rev 272 = $724.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1522.6700,228.4000,SENTARA HEALTH,SENTARA HEALTH,393.00,,,,,,,393.0000,1522.6700,percent of total billed charges,"25.81% of $1,522.67 in Billed Charges for Rev 272 = $393.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1522.6700,228.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1522.67,,,,,,,393.0000,1522.6700,percent of total billed charges,"100% of $1,522.67 in Billed Charges for Rev 272 = $1,522.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1522.6700,228.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,761.34,,,,,,,393.0000,1522.6700,percent of total billed charges,"Rev 272 $1,522.67 in Billed Charges at 50% = $761.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1522.6700,228.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.82,,,,,,,393.0000,1522.6700,other,"32.3% of $1,522.67 in Billed Charges for Rev 272 = $491.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1522.6700,228.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,467.46,,,,,,,393.0000,1522.6700,other,"30.7% of $1,522.67 in Billed Charges for Rev 272 = $467.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1522.6700,228.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,491.82,,,,,,,393.0000,1522.6700,percent of total billed charges,"32.3% of $1,522.67 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM LONG,272,RC,,,,,,,,both,,,1522.6700,228.4000,WELLCARE,WELLCARE MEDICAID,1522.67,,,,,,,393.0000,1522.6700,percent of total billed charges,"100% of $1,522.67 in Billed Charges for Rev 272 = $1,522.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,27200002,CDM,,,,,,both,,,1970.4900,295.5700,AETNA,AETNA,841.40,,,,,,,508.5800,1970.4900,percent of total billed charges,"42.7% of $1,970.49 in Billed Charges for Rev 272 = $841.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,27200002,CDM,,,,,,both,,,1970.4900,295.5700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1379.34,,,,,,,508.5800,1970.4900,percent of total billed charges,"Rev 272 $1,970.49 in Billed Charges at 70% = $1,379.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,27200002,CDM,,,,,,both,,,1970.4900,295.5700,CIGNA HEALTHCARE,CIGNA HMO,821.69,,,,,,,508.5800,1970.4900,percent of total billed charges,"41.7% of $1,970.49 in Billed Charges for Rev 272 = $821.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,27200002,CDM,,,,,,both,,,1970.4900,295.5700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,914.31,,,,,,,508.5800,1970.4900,percent of total billed charges,"46.4% of $1,970.49 in Billed Charges for Rev 272 = $914.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,27200002,CDM,,,,,,both,,,1970.4900,295.5700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,821.69,,,,,,,508.5800,1970.4900,percent of total billed charges,"41.7% of $1,970.49 in Billed Charges for Rev 272 = $821.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,27200002,CDM,,,,,,both,,,1970.4900,295.5700,CIGNA HEALTHCARE,CIGNA PPO,821.69,,,,,,,508.5800,1970.4900,percent of total billed charges,"41.7% of $1,970.49 in Billed Charges for Rev 272 = $821.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,27200002,CDM,,,,,,both,,,1970.4900,295.5700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1773.44,,,,,,,508.5800,1970.4900,percent of total billed charges,"90% of $1,970.49 in Billed Charges for Rev 272 = $1,773.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,27200002,CDM,,,,,,both,,,1970.4900,295.5700,MEDCOST,MEDCOST VHN,937.76,,,,,,,508.5800,1970.4900,percent of total billed charges,"47.59% of $1,970.49 in Billed Charges for Rev 272 = $937.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,27200002,CDM,,,,,,both,,,1970.4900,295.5700,SENTARA HEALTH,SENTARA HEALTH,508.58,,,,,,,508.5800,1970.4900,percent of total billed charges,"25.81% of $1,970.49 in Billed Charges for Rev 272 = $508.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,27200002,CDM,,,,,,both,,,1970.4900,295.5700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1970.49,,,,,,,508.5800,1970.4900,percent of total billed charges,"100% of $1,970.49 in Billed Charges for Rev 272 = $1,970.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,27200002,CDM,,,,,,both,,,1970.4900,295.5700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,985.25,,,,,,,508.5800,1970.4900,percent of total billed charges,"Rev 272 $1,970.49 in Billed Charges at 50% = $985.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,27200002,CDM,,,,,,both,,,1970.4900,295.5700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,636.47,,,,,,,508.5800,1970.4900,other,"32.3% of $1,970.49 in Billed Charges for Rev 272 = $636.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.5MM,272,RC,27200002,CDM,,,,,,both,,,1970.4900,295.5700,UNITED HEALTHCARE,UHC HERITAGE SELECT,604.94,,,,,,,508.5800,1970.4900,other,"30.7% of $1,970.49 in Billed Charges for Rev 272 = $604.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.5MM,272,RC,27200002,CDM,,,,,,both,,,1970.4900,295.5700,UNITED HEALTHCARE,UNITED HEALTHCARE,636.47,,,,,,,508.5800,1970.4900,percent of total billed charges,"32.3% of $1,970.49 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM,272,RC,27200002,CDM,,,,,,both,,,1970.4900,295.5700,WELLCARE,WELLCARE MEDICAID,1970.49,,,,,,,508.5800,1970.4900,percent of total billed charges,"100% of $1,970.49 in Billed Charges for Rev 272 = $1,970.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM W/ 8MM STOP,272,RC,27200002,CDM,,,,,,both,,,1923.7200,288.5600,AETNA,AETNA,821.43,,,,,,,496.5100,1923.7200,percent of total billed charges,"42.7% of $1,923.72 in Billed Charges for Rev 272 = $821.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM W/ 8MM STOP,272,RC,27200002,CDM,,,,,,both,,,1923.7200,288.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1346.60,,,,,,,496.5100,1923.7200,percent of total billed charges,"Rev 272 $1,923.72 in Billed Charges at 70% = $1,346.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM W/ 8MM STOP,272,RC,27200002,CDM,,,,,,both,,,1923.7200,288.5600,CIGNA HEALTHCARE,CIGNA HMO,802.19,,,,,,,496.5100,1923.7200,percent of total billed charges,"41.7% of $1,923.72 in Billed Charges for Rev 272 = $802.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM W/ 8MM STOP,272,RC,27200002,CDM,,,,,,both,,,1923.7200,288.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,892.61,,,,,,,496.5100,1923.7200,percent of total billed charges,"46.4% of $1,923.72 in Billed Charges for Rev 272 = $892.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM W/ 8MM STOP,272,RC,27200002,CDM,,,,,,both,,,1923.7200,288.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,802.19,,,,,,,496.5100,1923.7200,percent of total billed charges,"41.7% of $1,923.72 in Billed Charges for Rev 272 = $802.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM W/ 8MM STOP,272,RC,27200002,CDM,,,,,,both,,,1923.7200,288.5600,CIGNA HEALTHCARE,CIGNA PPO,802.19,,,,,,,496.5100,1923.7200,percent of total billed charges,"41.7% of $1,923.72 in Billed Charges for Rev 272 = $802.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM W/ 8MM STOP,272,RC,27200002,CDM,,,,,,both,,,1923.7200,288.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1731.35,,,,,,,496.5100,1923.7200,percent of total billed charges,"90% of $1,923.72 in Billed Charges for Rev 272 = $1,731.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM W/ 8MM STOP,272,RC,27200002,CDM,,,,,,both,,,1923.7200,288.5600,MEDCOST,MEDCOST VHN,915.50,,,,,,,496.5100,1923.7200,percent of total billed charges,"47.59% of $1,923.72 in Billed Charges for Rev 272 = $915.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM W/ 8MM STOP,272,RC,27200002,CDM,,,,,,both,,,1923.7200,288.5600,SENTARA HEALTH,SENTARA HEALTH,496.51,,,,,,,496.5100,1923.7200,percent of total billed charges,"25.81% of $1,923.72 in Billed Charges for Rev 272 = $496.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM W/ 8MM STOP,272,RC,27200002,CDM,,,,,,both,,,1923.7200,288.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1923.72,,,,,,,496.5100,1923.7200,percent of total billed charges,"100% of $1,923.72 in Billed Charges for Rev 272 = $1,923.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM W/ 8MM STOP,272,RC,27200002,CDM,,,,,,both,,,1923.7200,288.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,961.86,,,,,,,496.5100,1923.7200,percent of total billed charges,"Rev 272 $1,923.72 in Billed Charges at 50% = $961.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM W/ 8MM STOP,272,RC,27200002,CDM,,,,,,both,,,1923.7200,288.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,621.36,,,,,,,496.5100,1923.7200,other,"32.3% of $1,923.72 in Billed Charges for Rev 272 = $621.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.5MM W/ 8MM STOP,272,RC,27200002,CDM,,,,,,both,,,1923.7200,288.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,590.58,,,,,,,496.5100,1923.7200,other,"30.7% of $1,923.72 in Billed Charges for Rev 272 = $590.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.5MM W/ 8MM STOP,272,RC,27200002,CDM,,,,,,both,,,1923.7200,288.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,621.36,,,,,,,496.5100,1923.7200,percent of total billed charges,"32.3% of $1,923.72 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.5MM W/ 8MM STOP,272,RC,27200002,CDM,,,,,,both,,,1923.7200,288.5600,WELLCARE,WELLCARE MEDICAID,1923.72,,,,,,,496.5100,1923.7200,percent of total billed charges,"100% of $1,923.72 in Billed Charges for Rev 272 = $1,923.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.7MM,272,RC,27200002,CDM,,,,,,both,,,954.1300,143.1200,AETNA,AETNA,407.41,,,,,,,246.2600,954.1300,percent of total billed charges,42.7% of $954.13 in Billed Charges for Rev 272 = $407.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.7MM,272,RC,27200002,CDM,,,,,,both,,,954.1300,143.1200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,667.89,,,,,,,246.2600,954.1300,percent of total billed charges,Rev 272 $954.13 in Billed Charges at 70% = $667.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.7MM,272,RC,27200002,CDM,,,,,,both,,,954.1300,143.1200,CIGNA HEALTHCARE,CIGNA HMO,397.87,,,,,,,246.2600,954.1300,percent of total billed charges,41.7% of $954.13 in Billed Charges for Rev 272 = $397.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.7MM,272,RC,27200002,CDM,,,,,,both,,,954.1300,143.1200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,442.72,,,,,,,246.2600,954.1300,percent of total billed charges,46.4% of $954.13 in Billed Charges for Rev 272 = $442.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.7MM,272,RC,27200002,CDM,,,,,,both,,,954.1300,143.1200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,397.87,,,,,,,246.2600,954.1300,percent of total billed charges,41.7% of $954.13 in Billed Charges for Rev 272 = $397.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.7MM,272,RC,27200002,CDM,,,,,,both,,,954.1300,143.1200,CIGNA HEALTHCARE,CIGNA PPO,397.87,,,,,,,246.2600,954.1300,percent of total billed charges,41.7% of $954.13 in Billed Charges for Rev 272 = $397.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.7MM,272,RC,27200002,CDM,,,,,,both,,,954.1300,143.1200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,858.72,,,,,,,246.2600,954.1300,percent of total billed charges,90% of $954.13 in Billed Charges for Rev 272 = $858.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.7MM,272,RC,27200002,CDM,,,,,,both,,,954.1300,143.1200,MEDCOST,MEDCOST VHN,454.07,,,,,,,246.2600,954.1300,percent of total billed charges,47.59% of $954.13 in Billed Charges for Rev 272 = $454.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.7MM,272,RC,27200002,CDM,,,,,,both,,,954.1300,143.1200,SENTARA HEALTH,SENTARA HEALTH,246.26,,,,,,,246.2600,954.1300,percent of total billed charges,25.81% of $954.13 in Billed Charges for Rev 272 = $246.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.7MM,272,RC,27200002,CDM,,,,,,both,,,954.1300,143.1200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",954.13,,,,,,,246.2600,954.1300,percent of total billed charges,100% of $954.13 in Billed Charges for Rev 272 = $954.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.7MM,272,RC,27200002,CDM,,,,,,both,,,954.1300,143.1200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,477.07,,,,,,,246.2600,954.1300,percent of total billed charges,Rev 272 $954.13 in Billed Charges at 50% = $477.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.7MM,272,RC,27200002,CDM,,,,,,both,,,954.1300,143.1200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,308.18,,,,,,,246.2600,954.1300,other,32.3% of $954.13 in Billed Charges for Rev 272 = $308.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 1.7MM,272,RC,27200002,CDM,,,,,,both,,,954.1300,143.1200,UNITED HEALTHCARE,UHC HERITAGE SELECT,292.92,,,,,,,246.2600,954.1300,other,30.7% of $954.13 in Billed Charges for Rev 272 = $292.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 1.7MM,272,RC,27200002,CDM,,,,,,both,,,954.1300,143.1200,UNITED HEALTHCARE,UNITED HEALTHCARE,308.18,,,,,,,246.2600,954.1300,percent of total billed charges,32.3% of $954.13 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.7MM,272,RC,27200002,CDM,,,,,,both,,,954.1300,143.1200,WELLCARE,WELLCARE MEDICAID,954.13,,,,,,,246.2600,954.1300,percent of total billed charges,100% of $954.13 in Billed Charges for Rev 272 = $954.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.8MM 03.503.561,272,RC,,,,,,,,both,,,2058.8500,308.8300,AETNA,AETNA,879.13,,,,,,,531.3900,2058.8500,percent of total billed charges,"42.7% of $2,058.85 in Billed Charges for Rev 272 = $879.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.8MM 03.503.561,272,RC,,,,,,,,both,,,2058.8500,308.8300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1441.20,,,,,,,531.3900,2058.8500,percent of total billed charges,"Rev 272 $2,058.85 in Billed Charges at 70% = $1,441.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.8MM 03.503.561,272,RC,,,,,,,,both,,,2058.8500,308.8300,CIGNA HEALTHCARE,CIGNA HMO,858.54,,,,,,,531.3900,2058.8500,percent of total billed charges,"41.7% of $2,058.85 in Billed Charges for Rev 272 = $858.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.8MM 03.503.561,272,RC,,,,,,,,both,,,2058.8500,308.8300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,955.31,,,,,,,531.3900,2058.8500,percent of total billed charges,"46.4% of $2,058.85 in Billed Charges for Rev 272 = $955.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.8MM 03.503.561,272,RC,,,,,,,,both,,,2058.8500,308.8300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,858.54,,,,,,,531.3900,2058.8500,percent of total billed charges,"41.7% of $2,058.85 in Billed Charges for Rev 272 = $858.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.8MM 03.503.561,272,RC,,,,,,,,both,,,2058.8500,308.8300,CIGNA HEALTHCARE,CIGNA PPO,858.54,,,,,,,531.3900,2058.8500,percent of total billed charges,"41.7% of $2,058.85 in Billed Charges for Rev 272 = $858.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.8MM 03.503.561,272,RC,,,,,,,,both,,,2058.8500,308.8300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1852.97,,,,,,,531.3900,2058.8500,percent of total billed charges,"90% of $2,058.85 in Billed Charges for Rev 272 = $1,852.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.8MM 03.503.561,272,RC,,,,,,,,both,,,2058.8500,308.8300,MEDCOST,MEDCOST VHN,979.81,,,,,,,531.3900,2058.8500,percent of total billed charges,"47.59% of $2,058.85 in Billed Charges for Rev 272 = $979.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.8MM 03.503.561,272,RC,,,,,,,,both,,,2058.8500,308.8300,SENTARA HEALTH,SENTARA HEALTH,531.39,,,,,,,531.3900,2058.8500,percent of total billed charges,"25.81% of $2,058.85 in Billed Charges for Rev 272 = $531.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.8MM 03.503.561,272,RC,,,,,,,,both,,,2058.8500,308.8300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2058.85,,,,,,,531.3900,2058.8500,percent of total billed charges,"100% of $2,058.85 in Billed Charges for Rev 272 = $2,058.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.8MM 03.503.561,272,RC,,,,,,,,both,,,2058.8500,308.8300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1029.43,,,,,,,531.3900,2058.8500,percent of total billed charges,"Rev 272 $2,058.85 in Billed Charges at 50% = $1,029.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.8MM 03.503.561,272,RC,,,,,,,,both,,,2058.8500,308.8300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,665.01,,,,,,,531.3900,2058.8500,other,"32.3% of $2,058.85 in Billed Charges for Rev 272 = $665.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.8MM 03.503.561,272,RC,,,,,,,,both,,,2058.8500,308.8300,UNITED HEALTHCARE,UHC HERITAGE SELECT,632.07,,,,,,,531.3900,2058.8500,other,"30.7% of $2,058.85 in Billed Charges for Rev 272 = $632.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.8MM 03.503.561,272,RC,,,,,,,,both,,,2058.8500,308.8300,UNITED HEALTHCARE,UNITED HEALTHCARE,665.01,,,,,,,531.3900,2058.8500,percent of total billed charges,"32.3% of $2,058.85 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.8MM 03.503.561,272,RC,,,,,,,,both,,,2058.8500,308.8300,WELLCARE,WELLCARE MEDICAID,2058.85,,,,,,,531.3900,2058.8500,percent of total billed charges,"100% of $2,058.85 in Billed Charges for Rev 272 = $2,058.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1/8,272,RC,27200002,CDM,,,,,,both,,,550.8000,82.6200,AETNA,AETNA,235.19,,,,,,,142.1600,550.8000,percent of total billed charges,42.7% of $550.80 in Billed Charges for Rev 272 = $235.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1/8,272,RC,27200002,CDM,,,,,,both,,,550.8000,82.6200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,385.56,,,,,,,142.1600,550.8000,percent of total billed charges,Rev 272 $550.80 in Billed Charges at 70% = $385.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1/8,272,RC,27200002,CDM,,,,,,both,,,550.8000,82.6200,CIGNA HEALTHCARE,CIGNA HMO,229.68,,,,,,,142.1600,550.8000,percent of total billed charges,41.7% of $550.80 in Billed Charges for Rev 272 = $229.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1/8,272,RC,27200002,CDM,,,,,,both,,,550.8000,82.6200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,255.57,,,,,,,142.1600,550.8000,percent of total billed charges,46.4% of $550.80 in Billed Charges for Rev 272 = $255.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1/8,272,RC,27200002,CDM,,,,,,both,,,550.8000,82.6200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,229.68,,,,,,,142.1600,550.8000,percent of total billed charges,41.7% of $550.80 in Billed Charges for Rev 272 = $229.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1/8,272,RC,27200002,CDM,,,,,,both,,,550.8000,82.6200,CIGNA HEALTHCARE,CIGNA PPO,229.68,,,,,,,142.1600,550.8000,percent of total billed charges,41.7% of $550.80 in Billed Charges for Rev 272 = $229.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1/8,272,RC,27200002,CDM,,,,,,both,,,550.8000,82.6200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,495.72,,,,,,,142.1600,550.8000,percent of total billed charges,90% of $550.80 in Billed Charges for Rev 272 = $495.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1/8,272,RC,27200002,CDM,,,,,,both,,,550.8000,82.6200,MEDCOST,MEDCOST VHN,262.13,,,,,,,142.1600,550.8000,percent of total billed charges,47.59% of $550.80 in Billed Charges for Rev 272 = $262.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1/8,272,RC,27200002,CDM,,,,,,both,,,550.8000,82.6200,SENTARA HEALTH,SENTARA HEALTH,142.16,,,,,,,142.1600,550.8000,percent of total billed charges,25.81% of $550.80 in Billed Charges for Rev 272 = $142.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1/8,272,RC,27200002,CDM,,,,,,both,,,550.8000,82.6200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",550.80,,,,,,,142.1600,550.8000,percent of total billed charges,100% of $550.80 in Billed Charges for Rev 272 = $550.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1/8,272,RC,27200002,CDM,,,,,,both,,,550.8000,82.6200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,275.40,,,,,,,142.1600,550.8000,percent of total billed charges,Rev 272 $550.80 in Billed Charges at 50% = $275.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1/8,272,RC,27200002,CDM,,,,,,both,,,550.8000,82.6200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,177.91,,,,,,,142.1600,550.8000,other,32.3% of $550.80 in Billed Charges for Rev 272 = $177.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 1/8,272,RC,27200002,CDM,,,,,,both,,,550.8000,82.6200,UNITED HEALTHCARE,UHC HERITAGE SELECT,169.10,,,,,,,142.1600,550.8000,other,30.7% of $550.80 in Billed Charges for Rev 272 = $169.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 1/8,272,RC,27200002,CDM,,,,,,both,,,550.8000,82.6200,UNITED HEALTHCARE,UNITED HEALTHCARE,177.91,,,,,,,142.1600,550.8000,percent of total billed charges,32.3% of $550.80 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1/8,272,RC,27200002,CDM,,,,,,both,,,550.8000,82.6200,WELLCARE,WELLCARE MEDICAID,550.80,,,,,,,142.1600,550.8000,percent of total billed charges,100% of $550.80 in Billed Charges for Rev 272 = $550.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 10X190MM 360.05,272,RC,,,,,,,,both,,,4930.3700,739.5600,AETNA,AETNA,2105.27,,,,,,,1272.5300,4930.3700,percent of total billed charges,"42.7% of $4,930.37 in Billed Charges for Rev 272 = $2,105.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10X190MM 360.05,272,RC,,,,,,,,both,,,4930.3700,739.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3451.26,,,,,,,1272.5300,4930.3700,percent of total billed charges,"Rev 272 $4,930.37 in Billed Charges at 70% = $3,451.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10X190MM 360.05,272,RC,,,,,,,,both,,,4930.3700,739.5600,CIGNA HEALTHCARE,CIGNA HMO,2055.96,,,,,,,1272.5300,4930.3700,percent of total billed charges,"41.7% of $4,930.37 in Billed Charges for Rev 272 = $2,055.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10X190MM 360.05,272,RC,,,,,,,,both,,,4930.3700,739.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2287.69,,,,,,,1272.5300,4930.3700,percent of total billed charges,"46.4% of $4,930.37 in Billed Charges for Rev 272 = $2,287.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10X190MM 360.05,272,RC,,,,,,,,both,,,4930.3700,739.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2055.96,,,,,,,1272.5300,4930.3700,percent of total billed charges,"41.7% of $4,930.37 in Billed Charges for Rev 272 = $2,055.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10X190MM 360.05,272,RC,,,,,,,,both,,,4930.3700,739.5600,CIGNA HEALTHCARE,CIGNA PPO,2055.96,,,,,,,1272.5300,4930.3700,percent of total billed charges,"41.7% of $4,930.37 in Billed Charges for Rev 272 = $2,055.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10X190MM 360.05,272,RC,,,,,,,,both,,,4930.3700,739.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4437.33,,,,,,,1272.5300,4930.3700,percent of total billed charges,"90% of $4,930.37 in Billed Charges for Rev 272 = $4,437.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10X190MM 360.05,272,RC,,,,,,,,both,,,4930.3700,739.5600,MEDCOST,MEDCOST VHN,2346.36,,,,,,,1272.5300,4930.3700,percent of total billed charges,"47.59% of $4,930.37 in Billed Charges for Rev 272 = $2,346.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10X190MM 360.05,272,RC,,,,,,,,both,,,4930.3700,739.5600,SENTARA HEALTH,SENTARA HEALTH,1272.53,,,,,,,1272.5300,4930.3700,percent of total billed charges,"25.81% of $4,930.37 in Billed Charges for Rev 272 = $1,272.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10X190MM 360.05,272,RC,,,,,,,,both,,,4930.3700,739.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4930.37,,,,,,,1272.5300,4930.3700,percent of total billed charges,"100% of $4,930.37 in Billed Charges for Rev 272 = $4,930.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10X190MM 360.05,272,RC,,,,,,,,both,,,4930.3700,739.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2465.19,,,,,,,1272.5300,4930.3700,percent of total billed charges,"Rev 272 $4,930.37 in Billed Charges at 50% = $2,465.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10X190MM 360.05,272,RC,,,,,,,,both,,,4930.3700,739.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1592.51,,,,,,,1272.5300,4930.3700,other,"32.3% of $4,930.37 in Billed Charges for Rev 272 = $1,592.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 10X190MM 360.05,272,RC,,,,,,,,both,,,4930.3700,739.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1513.62,,,,,,,1272.5300,4930.3700,other,"30.7% of $4,930.37 in Billed Charges for Rev 272 = $1,513.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 10X190MM 360.05,272,RC,,,,,,,,both,,,4930.3700,739.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,1592.51,,,,,,,1272.5300,4930.3700,percent of total billed charges,"32.3% of $4,930.37 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10X190MM 360.05,272,RC,,,,,,,,both,,,4930.3700,739.5600,WELLCARE,WELLCARE MEDICAID,4930.37,,,,,,,1272.5300,4930.3700,percent of total billed charges,"100% of $4,930.37 in Billed Charges for Rev 272 = $4,930.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.5 TARGETER,272,RC,,,,,,,,both,,,1492.0800,223.8100,AETNA,AETNA,637.12,,,,,,,385.1100,1492.0800,percent of total billed charges,"42.7% of $1,492.08 in Billed Charges for Rev 272 = $637.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.5 TARGETER,272,RC,,,,,,,,both,,,1492.0800,223.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1044.46,,,,,,,385.1100,1492.0800,percent of total billed charges,"Rev 272 $1,492.08 in Billed Charges at 70% = $1,044.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.5 TARGETER,272,RC,,,,,,,,both,,,1492.0800,223.8100,CIGNA HEALTHCARE,CIGNA HMO,622.20,,,,,,,385.1100,1492.0800,percent of total billed charges,"41.7% of $1,492.08 in Billed Charges for Rev 272 = $622.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.5 TARGETER,272,RC,,,,,,,,both,,,1492.0800,223.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,692.33,,,,,,,385.1100,1492.0800,percent of total billed charges,"46.4% of $1,492.08 in Billed Charges for Rev 272 = $692.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.5 TARGETER,272,RC,,,,,,,,both,,,1492.0800,223.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,622.20,,,,,,,385.1100,1492.0800,percent of total billed charges,"41.7% of $1,492.08 in Billed Charges for Rev 272 = $622.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.5 TARGETER,272,RC,,,,,,,,both,,,1492.0800,223.8100,CIGNA HEALTHCARE,CIGNA PPO,622.20,,,,,,,385.1100,1492.0800,percent of total billed charges,"41.7% of $1,492.08 in Billed Charges for Rev 272 = $622.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.5 TARGETER,272,RC,,,,,,,,both,,,1492.0800,223.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1342.87,,,,,,,385.1100,1492.0800,percent of total billed charges,"90% of $1,492.08 in Billed Charges for Rev 272 = $1,342.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.5 TARGETER,272,RC,,,,,,,,both,,,1492.0800,223.8100,MEDCOST,MEDCOST VHN,710.08,,,,,,,385.1100,1492.0800,percent of total billed charges,"47.59% of $1,492.08 in Billed Charges for Rev 272 = $710.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.5 TARGETER,272,RC,,,,,,,,both,,,1492.0800,223.8100,SENTARA HEALTH,SENTARA HEALTH,385.11,,,,,,,385.1100,1492.0800,percent of total billed charges,"25.81% of $1,492.08 in Billed Charges for Rev 272 = $385.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.5 TARGETER,272,RC,,,,,,,,both,,,1492.0800,223.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1492.08,,,,,,,385.1100,1492.0800,percent of total billed charges,"100% of $1,492.08 in Billed Charges for Rev 272 = $1,492.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.5 TARGETER,272,RC,,,,,,,,both,,,1492.0800,223.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,746.04,,,,,,,385.1100,1492.0800,percent of total billed charges,"Rev 272 $1,492.08 in Billed Charges at 50% = $746.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.5 TARGETER,272,RC,,,,,,,,both,,,1492.0800,223.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,481.94,,,,,,,385.1100,1492.0800,other,"32.3% of $1,492.08 in Billed Charges for Rev 272 = $481.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 4.5 TARGETER,272,RC,,,,,,,,both,,,1492.0800,223.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,458.07,,,,,,,385.1100,1492.0800,other,"30.7% of $1,492.08 in Billed Charges for Rev 272 = $458.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 4.5 TARGETER,272,RC,,,,,,,,both,,,1492.0800,223.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,481.94,,,,,,,385.1100,1492.0800,percent of total billed charges,"32.3% of $1,492.08 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.5 TARGETER,272,RC,,,,,,,,both,,,1492.0800,223.8100,WELLCARE,WELLCARE MEDICAID,1492.08,,,,,,,385.1100,1492.0800,percent of total billed charges,"100% of $1,492.08 in Billed Charges for Rev 272 = $1,492.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.9 X 20MM,272,RC,,,,,,,,both,,,3899.5000,584.9300,AETNA,AETNA,1665.09,,,,,,,1006.4600,3899.5000,percent of total billed charges,"42.7% of $3,899.50 in Billed Charges for Rev 272 = $1,665.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.9 X 20MM,272,RC,,,,,,,,both,,,3899.5000,584.9300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2729.65,,,,,,,1006.4600,3899.5000,percent of total billed charges,"Rev 272 $3,899.50 in Billed Charges at 70% = $2,729.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.9 X 20MM,272,RC,,,,,,,,both,,,3899.5000,584.9300,CIGNA HEALTHCARE,CIGNA HMO,1626.09,,,,,,,1006.4600,3899.5000,percent of total billed charges,"41.7% of $3,899.50 in Billed Charges for Rev 272 = $1,626.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.9 X 20MM,272,RC,,,,,,,,both,,,3899.5000,584.9300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1809.37,,,,,,,1006.4600,3899.5000,percent of total billed charges,"46.4% of $3,899.50 in Billed Charges for Rev 272 = $1,809.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.9 X 20MM,272,RC,,,,,,,,both,,,3899.5000,584.9300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1626.09,,,,,,,1006.4600,3899.5000,percent of total billed charges,"41.7% of $3,899.50 in Billed Charges for Rev 272 = $1,626.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.9 X 20MM,272,RC,,,,,,,,both,,,3899.5000,584.9300,CIGNA HEALTHCARE,CIGNA PPO,1626.09,,,,,,,1006.4600,3899.5000,percent of total billed charges,"41.7% of $3,899.50 in Billed Charges for Rev 272 = $1,626.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.9 X 20MM,272,RC,,,,,,,,both,,,3899.5000,584.9300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3509.55,,,,,,,1006.4600,3899.5000,percent of total billed charges,"90% of $3,899.50 in Billed Charges for Rev 272 = $3,509.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.9 X 20MM,272,RC,,,,,,,,both,,,3899.5000,584.9300,MEDCOST,MEDCOST VHN,1855.77,,,,,,,1006.4600,3899.5000,percent of total billed charges,"47.59% of $3,899.50 in Billed Charges for Rev 272 = $1,855.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.9 X 20MM,272,RC,,,,,,,,both,,,3899.5000,584.9300,SENTARA HEALTH,SENTARA HEALTH,1006.46,,,,,,,1006.4600,3899.5000,percent of total billed charges,"25.81% of $3,899.50 in Billed Charges for Rev 272 = $1,006.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.9 X 20MM,272,RC,,,,,,,,both,,,3899.5000,584.9300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3899.50,,,,,,,1006.4600,3899.5000,percent of total billed charges,"100% of $3,899.50 in Billed Charges for Rev 272 = $3,899.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.9 X 20MM,272,RC,,,,,,,,both,,,3899.5000,584.9300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1949.75,,,,,,,1006.4600,3899.5000,percent of total billed charges,"Rev 272 $3,899.50 in Billed Charges at 50% = $1,949.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.9 X 20MM,272,RC,,,,,,,,both,,,3899.5000,584.9300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1259.54,,,,,,,1006.4600,3899.5000,other,"32.3% of $3,899.50 in Billed Charges for Rev 272 = $1,259.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.9 X 20MM,272,RC,,,,,,,,both,,,3899.5000,584.9300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1197.15,,,,,,,1006.4600,3899.5000,other,"30.7% of $3,899.50 in Billed Charges for Rev 272 = $1,197.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.9 X 20MM,272,RC,,,,,,,,both,,,3899.5000,584.9300,UNITED HEALTHCARE,UNITED HEALTHCARE,1259.54,,,,,,,1006.4600,3899.5000,percent of total billed charges,"32.3% of $3,899.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.9 X 20MM,272,RC,,,,,,,,both,,,3899.5000,584.9300,WELLCARE,WELLCARE MEDICAID,3899.50,,,,,,,1006.4600,3899.5000,percent of total billed charges,"100% of $3,899.50 in Billed Charges for Rev 272 = $3,899.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10MM 650.110,272,RC,,,,,,,,both,,,1628.2500,244.2400,AETNA,AETNA,695.26,,,,,,,420.2500,1628.2500,percent of total billed charges,"42.7% of $1,628.25 in Billed Charges for Rev 272 = $695.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10MM 650.110,272,RC,,,,,,,,both,,,1628.2500,244.2400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1139.78,,,,,,,420.2500,1628.2500,percent of total billed charges,"Rev 272 $1,628.25 in Billed Charges at 70% = $1,139.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10MM 650.110,272,RC,,,,,,,,both,,,1628.2500,244.2400,CIGNA HEALTHCARE,CIGNA HMO,678.98,,,,,,,420.2500,1628.2500,percent of total billed charges,"41.7% of $1,628.25 in Billed Charges for Rev 272 = $678.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10MM 650.110,272,RC,,,,,,,,both,,,1628.2500,244.2400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,755.51,,,,,,,420.2500,1628.2500,percent of total billed charges,"46.4% of $1,628.25 in Billed Charges for Rev 272 = $755.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10MM 650.110,272,RC,,,,,,,,both,,,1628.2500,244.2400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,678.98,,,,,,,420.2500,1628.2500,percent of total billed charges,"41.7% of $1,628.25 in Billed Charges for Rev 272 = $678.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10MM 650.110,272,RC,,,,,,,,both,,,1628.2500,244.2400,CIGNA HEALTHCARE,CIGNA PPO,678.98,,,,,,,420.2500,1628.2500,percent of total billed charges,"41.7% of $1,628.25 in Billed Charges for Rev 272 = $678.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10MM 650.110,272,RC,,,,,,,,both,,,1628.2500,244.2400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1465.43,,,,,,,420.2500,1628.2500,percent of total billed charges,"90% of $1,628.25 in Billed Charges for Rev 272 = $1,465.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10MM 650.110,272,RC,,,,,,,,both,,,1628.2500,244.2400,MEDCOST,MEDCOST VHN,774.88,,,,,,,420.2500,1628.2500,percent of total billed charges,"47.59% of $1,628.25 in Billed Charges for Rev 272 = $774.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10MM 650.110,272,RC,,,,,,,,both,,,1628.2500,244.2400,SENTARA HEALTH,SENTARA HEALTH,420.25,,,,,,,420.2500,1628.2500,percent of total billed charges,"25.81% of $1,628.25 in Billed Charges for Rev 272 = $420.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10MM 650.110,272,RC,,,,,,,,both,,,1628.2500,244.2400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1628.25,,,,,,,420.2500,1628.2500,percent of total billed charges,"100% of $1,628.25 in Billed Charges for Rev 272 = $1,628.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10MM 650.110,272,RC,,,,,,,,both,,,1628.2500,244.2400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,814.13,,,,,,,420.2500,1628.2500,percent of total billed charges,"Rev 272 $1,628.25 in Billed Charges at 50% = $814.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10MM 650.110,272,RC,,,,,,,,both,,,1628.2500,244.2400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,525.92,,,,,,,420.2500,1628.2500,other,"32.3% of $1,628.25 in Billed Charges for Rev 272 = $525.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 10MM 650.110,272,RC,,,,,,,,both,,,1628.2500,244.2400,UNITED HEALTHCARE,UHC HERITAGE SELECT,499.87,,,,,,,420.2500,1628.2500,other,"30.7% of $1,628.25 in Billed Charges for Rev 272 = $499.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 10MM 650.110,272,RC,,,,,,,,both,,,1628.2500,244.2400,UNITED HEALTHCARE,UNITED HEALTHCARE,525.92,,,,,,,420.2500,1628.2500,percent of total billed charges,"32.3% of $1,628.25 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 10MM 650.110,272,RC,,,,,,,,both,,,1628.2500,244.2400,WELLCARE,WELLCARE MEDICAID,1628.25,,,,,,,420.2500,1628.2500,percent of total billed charges,"100% of $1,628.25 in Billed Charges for Rev 272 = $1,628.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.9MM,272,RC,,,,,,,,both,,,4033.5900,605.0400,AETNA,AETNA,1722.34,,,,,,,1041.0700,4033.5900,percent of total billed charges,"42.7% of $4,033.59 in Billed Charges for Rev 272 = $1,722.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.9MM,272,RC,,,,,,,,both,,,4033.5900,605.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2823.51,,,,,,,1041.0700,4033.5900,percent of total billed charges,"Rev 272 $4,033.59 in Billed Charges at 70% = $2,823.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.9MM,272,RC,,,,,,,,both,,,4033.5900,605.0400,CIGNA HEALTHCARE,CIGNA HMO,1682.01,,,,,,,1041.0700,4033.5900,percent of total billed charges,"41.7% of $4,033.59 in Billed Charges for Rev 272 = $1,682.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.9MM,272,RC,,,,,,,,both,,,4033.5900,605.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1871.59,,,,,,,1041.0700,4033.5900,percent of total billed charges,"46.4% of $4,033.59 in Billed Charges for Rev 272 = $1,871.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.9MM,272,RC,,,,,,,,both,,,4033.5900,605.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1682.01,,,,,,,1041.0700,4033.5900,percent of total billed charges,"41.7% of $4,033.59 in Billed Charges for Rev 272 = $1,682.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.9MM,272,RC,,,,,,,,both,,,4033.5900,605.0400,CIGNA HEALTHCARE,CIGNA PPO,1682.01,,,,,,,1041.0700,4033.5900,percent of total billed charges,"41.7% of $4,033.59 in Billed Charges for Rev 272 = $1,682.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.9MM,272,RC,,,,,,,,both,,,4033.5900,605.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3630.23,,,,,,,1041.0700,4033.5900,percent of total billed charges,"90% of $4,033.59 in Billed Charges for Rev 272 = $3,630.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.9MM,272,RC,,,,,,,,both,,,4033.5900,605.0400,MEDCOST,MEDCOST VHN,1919.59,,,,,,,1041.0700,4033.5900,percent of total billed charges,"47.59% of $4,033.59 in Billed Charges for Rev 272 = $1,919.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.9MM,272,RC,,,,,,,,both,,,4033.5900,605.0400,SENTARA HEALTH,SENTARA HEALTH,1041.07,,,,,,,1041.0700,4033.5900,percent of total billed charges,"25.81% of $4,033.59 in Billed Charges for Rev 272 = $1,041.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.9MM,272,RC,,,,,,,,both,,,4033.5900,605.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4033.59,,,,,,,1041.0700,4033.5900,percent of total billed charges,"100% of $4,033.59 in Billed Charges for Rev 272 = $4,033.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.9MM,272,RC,,,,,,,,both,,,4033.5900,605.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2016.80,,,,,,,1041.0700,4033.5900,percent of total billed charges,"Rev 272 $4,033.59 in Billed Charges at 50% = $2,016.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.9MM,272,RC,,,,,,,,both,,,4033.5900,605.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1302.85,,,,,,,1041.0700,4033.5900,other,"32.3% of $4,033.59 in Billed Charges for Rev 272 = $1,302.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 4.9MM,272,RC,,,,,,,,both,,,4033.5900,605.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1238.31,,,,,,,1041.0700,4033.5900,other,"30.7% of $4,033.59 in Billed Charges for Rev 272 = $1,238.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 4.9MM,272,RC,,,,,,,,both,,,4033.5900,605.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,1302.85,,,,,,,1041.0700,4033.5900,percent of total billed charges,"32.3% of $4,033.59 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.9MM,272,RC,,,,,,,,both,,,4033.5900,605.0400,WELLCARE,WELLCARE MEDICAID,4033.59,,,,,,,1041.0700,4033.5900,percent of total billed charges,"100% of $4,033.59 in Billed Charges for Rev 272 = $4,033.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.9MM FREEHAND,272,RC,,,,,,,,both,,,923.0200,138.4500,AETNA,AETNA,394.13,,,,,,,238.2300,923.0200,percent of total billed charges,42.7% of $923.02 in Billed Charges for Rev 272 = $394.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 4.9MM FREEHAND,272,RC,,,,,,,,both,,,923.0200,138.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,646.11,,,,,,,238.2300,923.0200,percent of total billed charges,Rev 272 $923.02 in Billed Charges at 70% = $646.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 4.9MM FREEHAND,272,RC,,,,,,,,both,,,923.0200,138.4500,CIGNA HEALTHCARE,CIGNA HMO,384.90,,,,,,,238.2300,923.0200,percent of total billed charges,41.7% of $923.02 in Billed Charges for Rev 272 = $384.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 4.9MM FREEHAND,272,RC,,,,,,,,both,,,923.0200,138.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,428.28,,,,,,,238.2300,923.0200,percent of total billed charges,46.4% of $923.02 in Billed Charges for Rev 272 = $428.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 4.9MM FREEHAND,272,RC,,,,,,,,both,,,923.0200,138.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,384.90,,,,,,,238.2300,923.0200,percent of total billed charges,41.7% of $923.02 in Billed Charges for Rev 272 = $384.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 4.9MM FREEHAND,272,RC,,,,,,,,both,,,923.0200,138.4500,CIGNA HEALTHCARE,CIGNA PPO,384.90,,,,,,,238.2300,923.0200,percent of total billed charges,41.7% of $923.02 in Billed Charges for Rev 272 = $384.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 4.9MM FREEHAND,272,RC,,,,,,,,both,,,923.0200,138.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,830.72,,,,,,,238.2300,923.0200,percent of total billed charges,90% of $923.02 in Billed Charges for Rev 272 = $830.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 4.9MM FREEHAND,272,RC,,,,,,,,both,,,923.0200,138.4500,MEDCOST,MEDCOST VHN,439.27,,,,,,,238.2300,923.0200,percent of total billed charges,47.59% of $923.02 in Billed Charges for Rev 272 = $439.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 4.9MM FREEHAND,272,RC,,,,,,,,both,,,923.0200,138.4500,SENTARA HEALTH,SENTARA HEALTH,238.23,,,,,,,238.2300,923.0200,percent of total billed charges,25.81% of $923.02 in Billed Charges for Rev 272 = $238.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 4.9MM FREEHAND,272,RC,,,,,,,,both,,,923.0200,138.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",923.02,,,,,,,238.2300,923.0200,percent of total billed charges,100% of $923.02 in Billed Charges for Rev 272 = $923.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 4.9MM FREEHAND,272,RC,,,,,,,,both,,,923.0200,138.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,461.51,,,,,,,238.2300,923.0200,percent of total billed charges,Rev 272 $923.02 in Billed Charges at 50% = $461.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 4.9MM FREEHAND,272,RC,,,,,,,,both,,,923.0200,138.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,298.14,,,,,,,238.2300,923.0200,other,32.3% of $923.02 in Billed Charges for Rev 272 = $298.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 4.9MM FREEHAND,272,RC,,,,,,,,both,,,923.0200,138.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,283.37,,,,,,,238.2300,923.0200,other,30.7% of $923.02 in Billed Charges for Rev 272 = $283.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 4.9MM FREEHAND,272,RC,,,,,,,,both,,,923.0200,138.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,298.14,,,,,,,238.2300,923.0200,percent of total billed charges,32.3% of $923.02 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 4.9MM FREEHAND,272,RC,,,,,,,,both,,,923.0200,138.4500,WELLCARE,WELLCARE MEDICAID,923.02,,,,,,,238.2300,923.0200,percent of total billed charges,100% of $923.02 in Billed Charges for Rev 272 = $923.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 40MM / TOTAL KNEE 2107-3340,272,RC,,,,,,,,both,,,518.5500,77.7800,AETNA,AETNA,221.42,,,,,,,133.8400,518.5500,percent of total billed charges,42.7% of $518.55 in Billed Charges for Rev 272 = $221.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 40MM / TOTAL KNEE 2107-3340,272,RC,,,,,,,,both,,,518.5500,77.7800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,362.99,,,,,,,133.8400,518.5500,percent of total billed charges,Rev 272 $518.55 in Billed Charges at 70% = $362.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 40MM / TOTAL KNEE 2107-3340,272,RC,,,,,,,,both,,,518.5500,77.7800,CIGNA HEALTHCARE,CIGNA HMO,216.24,,,,,,,133.8400,518.5500,percent of total billed charges,41.7% of $518.55 in Billed Charges for Rev 272 = $216.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 40MM / TOTAL KNEE 2107-3340,272,RC,,,,,,,,both,,,518.5500,77.7800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,240.61,,,,,,,133.8400,518.5500,percent of total billed charges,46.4% of $518.55 in Billed Charges for Rev 272 = $240.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 40MM / TOTAL KNEE 2107-3340,272,RC,,,,,,,,both,,,518.5500,77.7800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,216.24,,,,,,,133.8400,518.5500,percent of total billed charges,41.7% of $518.55 in Billed Charges for Rev 272 = $216.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 40MM / TOTAL KNEE 2107-3340,272,RC,,,,,,,,both,,,518.5500,77.7800,CIGNA HEALTHCARE,CIGNA PPO,216.24,,,,,,,133.8400,518.5500,percent of total billed charges,41.7% of $518.55 in Billed Charges for Rev 272 = $216.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 40MM / TOTAL KNEE 2107-3340,272,RC,,,,,,,,both,,,518.5500,77.7800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,466.70,,,,,,,133.8400,518.5500,percent of total billed charges,90% of $518.55 in Billed Charges for Rev 272 = $466.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 40MM / TOTAL KNEE 2107-3340,272,RC,,,,,,,,both,,,518.5500,77.7800,MEDCOST,MEDCOST VHN,246.78,,,,,,,133.8400,518.5500,percent of total billed charges,47.59% of $518.55 in Billed Charges for Rev 272 = $246.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 40MM / TOTAL KNEE 2107-3340,272,RC,,,,,,,,both,,,518.5500,77.7800,SENTARA HEALTH,SENTARA HEALTH,133.84,,,,,,,133.8400,518.5500,percent of total billed charges,25.81% of $518.55 in Billed Charges for Rev 272 = $133.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 40MM / TOTAL KNEE 2107-3340,272,RC,,,,,,,,both,,,518.5500,77.7800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",518.55,,,,,,,133.8400,518.5500,percent of total billed charges,100% of $518.55 in Billed Charges for Rev 272 = $518.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 40MM / TOTAL KNEE 2107-3340,272,RC,,,,,,,,both,,,518.5500,77.7800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,259.28,,,,,,,133.8400,518.5500,percent of total billed charges,Rev 272 $518.55 in Billed Charges at 50% = $259.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 40MM / TOTAL KNEE 2107-3340,272,RC,,,,,,,,both,,,518.5500,77.7800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,167.49,,,,,,,133.8400,518.5500,other,32.3% of $518.55 in Billed Charges for Rev 272 = $167.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 40MM / TOTAL KNEE 2107-3340,272,RC,,,,,,,,both,,,518.5500,77.7800,UNITED HEALTHCARE,UHC HERITAGE SELECT,159.19,,,,,,,133.8400,518.5500,other,30.7% of $518.55 in Billed Charges for Rev 272 = $159.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 40MM / TOTAL KNEE 2107-3340,272,RC,,,,,,,,both,,,518.5500,77.7800,UNITED HEALTHCARE,UNITED HEALTHCARE,167.49,,,,,,,133.8400,518.5500,percent of total billed charges,32.3% of $518.55 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 40MM / TOTAL KNEE 2107-3340,272,RC,,,,,,,,both,,,518.5500,77.7800,WELLCARE,WELLCARE MEDICAID,518.55,,,,,,,133.8400,518.5500,percent of total billed charges,100% of $518.55 in Billed Charges for Rev 272 = $518.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 5.0 X 356MM,272,RC,27200002,CDM,,,,,,both,,,2201.8700,330.2800,AETNA,AETNA,940.20,,,,,,,568.3000,2201.8700,percent of total billed charges,"42.7% of $2,201.87 in Billed Charges for Rev 272 = $940.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0 X 356MM,272,RC,27200002,CDM,,,,,,both,,,2201.8700,330.2800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1541.31,,,,,,,568.3000,2201.8700,percent of total billed charges,"Rev 272 $2,201.87 in Billed Charges at 70% = $1,541.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0 X 356MM,272,RC,27200002,CDM,,,,,,both,,,2201.8700,330.2800,CIGNA HEALTHCARE,CIGNA HMO,918.18,,,,,,,568.3000,2201.8700,percent of total billed charges,"41.7% of $2,201.87 in Billed Charges for Rev 272 = $918.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0 X 356MM,272,RC,27200002,CDM,,,,,,both,,,2201.8700,330.2800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1021.67,,,,,,,568.3000,2201.8700,percent of total billed charges,"46.4% of $2,201.87 in Billed Charges for Rev 272 = $1,021.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0 X 356MM,272,RC,27200002,CDM,,,,,,both,,,2201.8700,330.2800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,918.18,,,,,,,568.3000,2201.8700,percent of total billed charges,"41.7% of $2,201.87 in Billed Charges for Rev 272 = $918.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0 X 356MM,272,RC,27200002,CDM,,,,,,both,,,2201.8700,330.2800,CIGNA HEALTHCARE,CIGNA PPO,918.18,,,,,,,568.3000,2201.8700,percent of total billed charges,"41.7% of $2,201.87 in Billed Charges for Rev 272 = $918.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0 X 356MM,272,RC,27200002,CDM,,,,,,both,,,2201.8700,330.2800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1981.68,,,,,,,568.3000,2201.8700,percent of total billed charges,"90% of $2,201.87 in Billed Charges for Rev 272 = $1,981.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0 X 356MM,272,RC,27200002,CDM,,,,,,both,,,2201.8700,330.2800,MEDCOST,MEDCOST VHN,1047.87,,,,,,,568.3000,2201.8700,percent of total billed charges,"47.59% of $2,201.87 in Billed Charges for Rev 272 = $1,047.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0 X 356MM,272,RC,27200002,CDM,,,,,,both,,,2201.8700,330.2800,SENTARA HEALTH,SENTARA HEALTH,568.30,,,,,,,568.3000,2201.8700,percent of total billed charges,"25.81% of $2,201.87 in Billed Charges for Rev 272 = $568.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0 X 356MM,272,RC,27200002,CDM,,,,,,both,,,2201.8700,330.2800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2201.87,,,,,,,568.3000,2201.8700,percent of total billed charges,"100% of $2,201.87 in Billed Charges for Rev 272 = $2,201.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0 X 356MM,272,RC,27200002,CDM,,,,,,both,,,2201.8700,330.2800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1100.94,,,,,,,568.3000,2201.8700,percent of total billed charges,"Rev 272 $2,201.87 in Billed Charges at 50% = $1,100.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0 X 356MM,272,RC,27200002,CDM,,,,,,both,,,2201.8700,330.2800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,711.20,,,,,,,568.3000,2201.8700,other,"32.3% of $2,201.87 in Billed Charges for Rev 272 = $711.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 5.0 X 356MM,272,RC,27200002,CDM,,,,,,both,,,2201.8700,330.2800,UNITED HEALTHCARE,UHC HERITAGE SELECT,675.97,,,,,,,568.3000,2201.8700,other,"30.7% of $2,201.87 in Billed Charges for Rev 272 = $675.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 5.0 X 356MM,272,RC,27200002,CDM,,,,,,both,,,2201.8700,330.2800,UNITED HEALTHCARE,UNITED HEALTHCARE,711.20,,,,,,,568.3000,2201.8700,percent of total billed charges,"32.3% of $2,201.87 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0 X 356MM,272,RC,27200002,CDM,,,,,,both,,,2201.8700,330.2800,WELLCARE,WELLCARE MEDICAID,2201.87,,,,,,,568.3000,2201.8700,percent of total billed charges,"100% of $2,201.87 in Billed Charges for Rev 272 = $2,201.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 45MM FLEXIBLE,272,RC,,,,,,,,both,,,1204.0700,180.6100,AETNA,AETNA,514.14,,,,,,,310.7700,1204.0700,percent of total billed charges,"42.7% of $1,204.07 in Billed Charges for Rev 272 = $514.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 45MM FLEXIBLE,272,RC,,,,,,,,both,,,1204.0700,180.6100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,842.85,,,,,,,310.7700,1204.0700,percent of total billed charges,"Rev 272 $1,204.07 in Billed Charges at 70% = $842.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 45MM FLEXIBLE,272,RC,,,,,,,,both,,,1204.0700,180.6100,CIGNA HEALTHCARE,CIGNA HMO,502.10,,,,,,,310.7700,1204.0700,percent of total billed charges,"41.7% of $1,204.07 in Billed Charges for Rev 272 = $502.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 45MM FLEXIBLE,272,RC,,,,,,,,both,,,1204.0700,180.6100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,558.69,,,,,,,310.7700,1204.0700,percent of total billed charges,"46.4% of $1,204.07 in Billed Charges for Rev 272 = $558.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 45MM FLEXIBLE,272,RC,,,,,,,,both,,,1204.0700,180.6100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,502.10,,,,,,,310.7700,1204.0700,percent of total billed charges,"41.7% of $1,204.07 in Billed Charges for Rev 272 = $502.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 45MM FLEXIBLE,272,RC,,,,,,,,both,,,1204.0700,180.6100,CIGNA HEALTHCARE,CIGNA PPO,502.10,,,,,,,310.7700,1204.0700,percent of total billed charges,"41.7% of $1,204.07 in Billed Charges for Rev 272 = $502.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 45MM FLEXIBLE,272,RC,,,,,,,,both,,,1204.0700,180.6100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1083.66,,,,,,,310.7700,1204.0700,percent of total billed charges,"90% of $1,204.07 in Billed Charges for Rev 272 = $1,083.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 45MM FLEXIBLE,272,RC,,,,,,,,both,,,1204.0700,180.6100,MEDCOST,MEDCOST VHN,573.02,,,,,,,310.7700,1204.0700,percent of total billed charges,"47.59% of $1,204.07 in Billed Charges for Rev 272 = $573.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 45MM FLEXIBLE,272,RC,,,,,,,,both,,,1204.0700,180.6100,SENTARA HEALTH,SENTARA HEALTH,310.77,,,,,,,310.7700,1204.0700,percent of total billed charges,"25.81% of $1,204.07 in Billed Charges for Rev 272 = $310.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 45MM FLEXIBLE,272,RC,,,,,,,,both,,,1204.0700,180.6100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1204.07,,,,,,,310.7700,1204.0700,percent of total billed charges,"100% of $1,204.07 in Billed Charges for Rev 272 = $1,204.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 45MM FLEXIBLE,272,RC,,,,,,,,both,,,1204.0700,180.6100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,602.04,,,,,,,310.7700,1204.0700,percent of total billed charges,"Rev 272 $1,204.07 in Billed Charges at 50% = $602.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 45MM FLEXIBLE,272,RC,,,,,,,,both,,,1204.0700,180.6100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,388.91,,,,,,,310.7700,1204.0700,other,"32.3% of $1,204.07 in Billed Charges for Rev 272 = $388.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 45MM FLEXIBLE,272,RC,,,,,,,,both,,,1204.0700,180.6100,UNITED HEALTHCARE,UHC HERITAGE SELECT,369.65,,,,,,,310.7700,1204.0700,other,"30.7% of $1,204.07 in Billed Charges for Rev 272 = $369.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 45MM FLEXIBLE,272,RC,,,,,,,,both,,,1204.0700,180.6100,UNITED HEALTHCARE,UNITED HEALTHCARE,388.91,,,,,,,310.7700,1204.0700,percent of total billed charges,"32.3% of $1,204.07 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 45MM FLEXIBLE,272,RC,,,,,,,,both,,,1204.0700,180.6100,WELLCARE,WELLCARE MEDICAID,1204.07,,,,,,,310.7700,1204.0700,percent of total billed charges,"100% of $1,204.07 in Billed Charges for Rev 272 = $1,204.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5 X 180MM 1806-5010S,272,RC,,,,,,,,both,,,1166.5300,174.9800,AETNA,AETNA,498.11,,,,,,,301.0800,1166.5300,percent of total billed charges,"42.7% of $1,166.53 in Billed Charges for Rev 272 = $498.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5 X 180MM 1806-5010S,272,RC,,,,,,,,both,,,1166.5300,174.9800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,816.57,,,,,,,301.0800,1166.5300,percent of total billed charges,"Rev 272 $1,166.53 in Billed Charges at 70% = $816.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5 X 180MM 1806-5010S,272,RC,,,,,,,,both,,,1166.5300,174.9800,CIGNA HEALTHCARE,CIGNA HMO,486.44,,,,,,,301.0800,1166.5300,percent of total billed charges,"41.7% of $1,166.53 in Billed Charges for Rev 272 = $486.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5 X 180MM 1806-5010S,272,RC,,,,,,,,both,,,1166.5300,174.9800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,541.27,,,,,,,301.0800,1166.5300,percent of total billed charges,"46.4% of $1,166.53 in Billed Charges for Rev 272 = $541.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5 X 180MM 1806-5010S,272,RC,,,,,,,,both,,,1166.5300,174.9800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,486.44,,,,,,,301.0800,1166.5300,percent of total billed charges,"41.7% of $1,166.53 in Billed Charges for Rev 272 = $486.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5 X 180MM 1806-5010S,272,RC,,,,,,,,both,,,1166.5300,174.9800,CIGNA HEALTHCARE,CIGNA PPO,486.44,,,,,,,301.0800,1166.5300,percent of total billed charges,"41.7% of $1,166.53 in Billed Charges for Rev 272 = $486.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5 X 180MM 1806-5010S,272,RC,,,,,,,,both,,,1166.5300,174.9800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1049.88,,,,,,,301.0800,1166.5300,percent of total billed charges,"90% of $1,166.53 in Billed Charges for Rev 272 = $1,049.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5 X 180MM 1806-5010S,272,RC,,,,,,,,both,,,1166.5300,174.9800,MEDCOST,MEDCOST VHN,555.15,,,,,,,301.0800,1166.5300,percent of total billed charges,"47.59% of $1,166.53 in Billed Charges for Rev 272 = $555.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5 X 180MM 1806-5010S,272,RC,,,,,,,,both,,,1166.5300,174.9800,SENTARA HEALTH,SENTARA HEALTH,301.08,,,,,,,301.0800,1166.5300,percent of total billed charges,"25.81% of $1,166.53 in Billed Charges for Rev 272 = $301.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5 X 180MM 1806-5010S,272,RC,,,,,,,,both,,,1166.5300,174.9800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1166.53,,,,,,,301.0800,1166.5300,percent of total billed charges,"100% of $1,166.53 in Billed Charges for Rev 272 = $1,166.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5 X 180MM 1806-5010S,272,RC,,,,,,,,both,,,1166.5300,174.9800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,583.27,,,,,,,301.0800,1166.5300,percent of total billed charges,"Rev 272 $1,166.53 in Billed Charges at 50% = $583.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5 X 180MM 1806-5010S,272,RC,,,,,,,,both,,,1166.5300,174.9800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,376.79,,,,,,,301.0800,1166.5300,other,"32.3% of $1,166.53 in Billed Charges for Rev 272 = $376.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 5 X 180MM 1806-5010S,272,RC,,,,,,,,both,,,1166.5300,174.9800,UNITED HEALTHCARE,UHC HERITAGE SELECT,358.12,,,,,,,301.0800,1166.5300,other,"30.7% of $1,166.53 in Billed Charges for Rev 272 = $358.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 5 X 180MM 1806-5010S,272,RC,,,,,,,,both,,,1166.5300,174.9800,UNITED HEALTHCARE,UNITED HEALTHCARE,376.79,,,,,,,301.0800,1166.5300,percent of total billed charges,"32.3% of $1,166.53 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5 X 180MM 1806-5010S,272,RC,,,,,,,,both,,,1166.5300,174.9800,WELLCARE,WELLCARE MEDICAID,1166.53,,,,,,,301.0800,1166.5300,percent of total billed charges,"100% of $1,166.53 in Billed Charges for Rev 272 = $1,166.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0MM XL GUIDED,272,RC,27200002,CDM,,,,,,both,,,2929.0800,439.3600,AETNA,AETNA,1250.72,,,,,,,756.0000,2929.0800,percent of total billed charges,"42.7% of $2,929.08 in Billed Charges for Rev 272 = $1,250.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0MM XL GUIDED,272,RC,27200002,CDM,,,,,,both,,,2929.0800,439.3600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2050.36,,,,,,,756.0000,2929.0800,percent of total billed charges,"Rev 272 $2,929.08 in Billed Charges at 70% = $2,050.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0MM XL GUIDED,272,RC,27200002,CDM,,,,,,both,,,2929.0800,439.3600,CIGNA HEALTHCARE,CIGNA HMO,1221.43,,,,,,,756.0000,2929.0800,percent of total billed charges,"41.7% of $2,929.08 in Billed Charges for Rev 272 = $1,221.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0MM XL GUIDED,272,RC,27200002,CDM,,,,,,both,,,2929.0800,439.3600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1359.09,,,,,,,756.0000,2929.0800,percent of total billed charges,"46.4% of $2,929.08 in Billed Charges for Rev 272 = $1,359.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0MM XL GUIDED,272,RC,27200002,CDM,,,,,,both,,,2929.0800,439.3600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1221.43,,,,,,,756.0000,2929.0800,percent of total billed charges,"41.7% of $2,929.08 in Billed Charges for Rev 272 = $1,221.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0MM XL GUIDED,272,RC,27200002,CDM,,,,,,both,,,2929.0800,439.3600,CIGNA HEALTHCARE,CIGNA PPO,1221.43,,,,,,,756.0000,2929.0800,percent of total billed charges,"41.7% of $2,929.08 in Billed Charges for Rev 272 = $1,221.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0MM XL GUIDED,272,RC,27200002,CDM,,,,,,both,,,2929.0800,439.3600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2636.17,,,,,,,756.0000,2929.0800,percent of total billed charges,"90% of $2,929.08 in Billed Charges for Rev 272 = $2,636.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0MM XL GUIDED,272,RC,27200002,CDM,,,,,,both,,,2929.0800,439.3600,MEDCOST,MEDCOST VHN,1393.95,,,,,,,756.0000,2929.0800,percent of total billed charges,"47.59% of $2,929.08 in Billed Charges for Rev 272 = $1,393.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0MM XL GUIDED,272,RC,27200002,CDM,,,,,,both,,,2929.0800,439.3600,SENTARA HEALTH,SENTARA HEALTH,756.00,,,,,,,756.0000,2929.0800,percent of total billed charges,"25.81% of $2,929.08 in Billed Charges for Rev 272 = $756.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0MM XL GUIDED,272,RC,27200002,CDM,,,,,,both,,,2929.0800,439.3600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2929.08,,,,,,,756.0000,2929.0800,percent of total billed charges,"100% of $2,929.08 in Billed Charges for Rev 272 = $2,929.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0MM XL GUIDED,272,RC,27200002,CDM,,,,,,both,,,2929.0800,439.3600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1464.54,,,,,,,756.0000,2929.0800,percent of total billed charges,"Rev 272 $2,929.08 in Billed Charges at 50% = $1,464.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0MM XL GUIDED,272,RC,27200002,CDM,,,,,,both,,,2929.0800,439.3600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,946.09,,,,,,,756.0000,2929.0800,other,"32.3% of $2,929.08 in Billed Charges for Rev 272 = $946.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 5.0MM XL GUIDED,272,RC,27200002,CDM,,,,,,both,,,2929.0800,439.3600,UNITED HEALTHCARE,UHC HERITAGE SELECT,899.23,,,,,,,756.0000,2929.0800,other,"30.7% of $2,929.08 in Billed Charges for Rev 272 = $899.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 5.0MM XL GUIDED,272,RC,27200002,CDM,,,,,,both,,,2929.0800,439.3600,UNITED HEALTHCARE,UNITED HEALTHCARE,946.09,,,,,,,756.0000,2929.0800,percent of total billed charges,"32.3% of $2,929.08 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.0MM XL GUIDED,272,RC,27200002,CDM,,,,,,both,,,2929.0800,439.3600,WELLCARE,WELLCARE MEDICAID,2929.08,,,,,,,756.0000,2929.0800,percent of total billed charges,"100% of $2,929.08 in Billed Charges for Rev 272 = $2,929.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.5,272,RC,,,,,,,,both,,,2982.1800,447.3300,AETNA,AETNA,1273.39,,,,,,,769.7000,2982.1800,percent of total billed charges,"42.7% of $2,982.18 in Billed Charges for Rev 272 = $1,273.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.5,272,RC,,,,,,,,both,,,2982.1800,447.3300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2087.53,,,,,,,769.7000,2982.1800,percent of total billed charges,"Rev 272 $2,982.18 in Billed Charges at 70% = $2,087.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.5,272,RC,,,,,,,,both,,,2982.1800,447.3300,CIGNA HEALTHCARE,CIGNA HMO,1243.57,,,,,,,769.7000,2982.1800,percent of total billed charges,"41.7% of $2,982.18 in Billed Charges for Rev 272 = $1,243.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.5,272,RC,,,,,,,,both,,,2982.1800,447.3300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1383.73,,,,,,,769.7000,2982.1800,percent of total billed charges,"46.4% of $2,982.18 in Billed Charges for Rev 272 = $1,383.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.5,272,RC,,,,,,,,both,,,2982.1800,447.3300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1243.57,,,,,,,769.7000,2982.1800,percent of total billed charges,"41.7% of $2,982.18 in Billed Charges for Rev 272 = $1,243.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.5,272,RC,,,,,,,,both,,,2982.1800,447.3300,CIGNA HEALTHCARE,CIGNA PPO,1243.57,,,,,,,769.7000,2982.1800,percent of total billed charges,"41.7% of $2,982.18 in Billed Charges for Rev 272 = $1,243.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.5,272,RC,,,,,,,,both,,,2982.1800,447.3300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2683.96,,,,,,,769.7000,2982.1800,percent of total billed charges,"90% of $2,982.18 in Billed Charges for Rev 272 = $2,683.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.5,272,RC,,,,,,,,both,,,2982.1800,447.3300,MEDCOST,MEDCOST VHN,1419.22,,,,,,,769.7000,2982.1800,percent of total billed charges,"47.59% of $2,982.18 in Billed Charges for Rev 272 = $1,419.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.5,272,RC,,,,,,,,both,,,2982.1800,447.3300,SENTARA HEALTH,SENTARA HEALTH,769.70,,,,,,,769.7000,2982.1800,percent of total billed charges,"25.81% of $2,982.18 in Billed Charges for Rev 272 = $769.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.5,272,RC,,,,,,,,both,,,2982.1800,447.3300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2982.18,,,,,,,769.7000,2982.1800,percent of total billed charges,"100% of $2,982.18 in Billed Charges for Rev 272 = $2,982.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.5,272,RC,,,,,,,,both,,,2982.1800,447.3300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1491.09,,,,,,,769.7000,2982.1800,percent of total billed charges,"Rev 272 $2,982.18 in Billed Charges at 50% = $1,491.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.5,272,RC,,,,,,,,both,,,2982.1800,447.3300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,963.24,,,,,,,769.7000,2982.1800,other,"32.3% of $2,982.18 in Billed Charges for Rev 272 = $963.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 5.5,272,RC,,,,,,,,both,,,2982.1800,447.3300,UNITED HEALTHCARE,UHC HERITAGE SELECT,915.53,,,,,,,769.7000,2982.1800,other,"30.7% of $2,982.18 in Billed Charges for Rev 272 = $915.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 5.5,272,RC,,,,,,,,both,,,2982.1800,447.3300,UNITED HEALTHCARE,UNITED HEALTHCARE,963.24,,,,,,,769.7000,2982.1800,percent of total billed charges,"32.3% of $2,982.18 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5.5,272,RC,,,,,,,,both,,,2982.1800,447.3300,WELLCARE,WELLCARE MEDICAID,2982.18,,,,,,,769.7000,2982.1800,percent of total billed charges,"100% of $2,982.18 in Billed Charges for Rev 272 = $2,982.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5/64,272,RC,27200002,CDM,,,,,,both,,,1120.0700,168.0100,AETNA,AETNA,478.27,,,,,,,289.0900,1120.0700,percent of total billed charges,"42.7% of $1,120.07 in Billed Charges for Rev 272 = $478.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5/64,272,RC,27200002,CDM,,,,,,both,,,1120.0700,168.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,784.05,,,,,,,289.0900,1120.0700,percent of total billed charges,"Rev 272 $1,120.07 in Billed Charges at 70% = $784.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5/64,272,RC,27200002,CDM,,,,,,both,,,1120.0700,168.0100,CIGNA HEALTHCARE,CIGNA HMO,467.07,,,,,,,289.0900,1120.0700,percent of total billed charges,"41.7% of $1,120.07 in Billed Charges for Rev 272 = $467.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5/64,272,RC,27200002,CDM,,,,,,both,,,1120.0700,168.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,519.71,,,,,,,289.0900,1120.0700,percent of total billed charges,"46.4% of $1,120.07 in Billed Charges for Rev 272 = $519.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5/64,272,RC,27200002,CDM,,,,,,both,,,1120.0700,168.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,467.07,,,,,,,289.0900,1120.0700,percent of total billed charges,"41.7% of $1,120.07 in Billed Charges for Rev 272 = $467.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5/64,272,RC,27200002,CDM,,,,,,both,,,1120.0700,168.0100,CIGNA HEALTHCARE,CIGNA PPO,467.07,,,,,,,289.0900,1120.0700,percent of total billed charges,"41.7% of $1,120.07 in Billed Charges for Rev 272 = $467.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5/64,272,RC,27200002,CDM,,,,,,both,,,1120.0700,168.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1008.06,,,,,,,289.0900,1120.0700,percent of total billed charges,"90% of $1,120.07 in Billed Charges for Rev 272 = $1,008.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5/64,272,RC,27200002,CDM,,,,,,both,,,1120.0700,168.0100,MEDCOST,MEDCOST VHN,533.04,,,,,,,289.0900,1120.0700,percent of total billed charges,"47.59% of $1,120.07 in Billed Charges for Rev 272 = $533.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5/64,272,RC,27200002,CDM,,,,,,both,,,1120.0700,168.0100,SENTARA HEALTH,SENTARA HEALTH,289.09,,,,,,,289.0900,1120.0700,percent of total billed charges,"25.81% of $1,120.07 in Billed Charges for Rev 272 = $289.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5/64,272,RC,27200002,CDM,,,,,,both,,,1120.0700,168.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1120.07,,,,,,,289.0900,1120.0700,percent of total billed charges,"100% of $1,120.07 in Billed Charges for Rev 272 = $1,120.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5/64,272,RC,27200002,CDM,,,,,,both,,,1120.0700,168.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,560.04,,,,,,,289.0900,1120.0700,percent of total billed charges,"Rev 272 $1,120.07 in Billed Charges at 50% = $560.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5/64,272,RC,27200002,CDM,,,,,,both,,,1120.0700,168.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,361.78,,,,,,,289.0900,1120.0700,other,"32.3% of $1,120.07 in Billed Charges for Rev 272 = $361.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 5/64,272,RC,27200002,CDM,,,,,,both,,,1120.0700,168.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,343.86,,,,,,,289.0900,1120.0700,other,"30.7% of $1,120.07 in Billed Charges for Rev 272 = $343.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 5/64,272,RC,27200002,CDM,,,,,,both,,,1120.0700,168.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,361.78,,,,,,,289.0900,1120.0700,percent of total billed charges,"32.3% of $1,120.07 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 5/64,272,RC,27200002,CDM,,,,,,both,,,1120.0700,168.0100,WELLCARE,WELLCARE MEDICAID,1120.07,,,,,,,289.0900,1120.0700,percent of total billed charges,"100% of $1,120.07 in Billed Charges for Rev 272 = $1,120.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6149.1035,272,RC,27200002,CDM,,,,,,both,,,2302.3600,345.3500,AETNA,AETNA,983.11,,,,,,,594.2400,2302.3600,percent of total billed charges,"42.7% of $2,302.36 in Billed Charges for Rev 272 = $983.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6149.1035,272,RC,27200002,CDM,,,,,,both,,,2302.3600,345.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1611.65,,,,,,,594.2400,2302.3600,percent of total billed charges,"Rev 272 $2,302.36 in Billed Charges at 70% = $1,611.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6149.1035,272,RC,27200002,CDM,,,,,,both,,,2302.3600,345.3500,CIGNA HEALTHCARE,CIGNA HMO,960.08,,,,,,,594.2400,2302.3600,percent of total billed charges,"41.7% of $2,302.36 in Billed Charges for Rev 272 = $960.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6149.1035,272,RC,27200002,CDM,,,,,,both,,,2302.3600,345.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1068.30,,,,,,,594.2400,2302.3600,percent of total billed charges,"46.4% of $2,302.36 in Billed Charges for Rev 272 = $1,068.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6149.1035,272,RC,27200002,CDM,,,,,,both,,,2302.3600,345.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,960.08,,,,,,,594.2400,2302.3600,percent of total billed charges,"41.7% of $2,302.36 in Billed Charges for Rev 272 = $960.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6149.1035,272,RC,27200002,CDM,,,,,,both,,,2302.3600,345.3500,CIGNA HEALTHCARE,CIGNA PPO,960.08,,,,,,,594.2400,2302.3600,percent of total billed charges,"41.7% of $2,302.36 in Billed Charges for Rev 272 = $960.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6149.1035,272,RC,27200002,CDM,,,,,,both,,,2302.3600,345.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2072.12,,,,,,,594.2400,2302.3600,percent of total billed charges,"90% of $2,302.36 in Billed Charges for Rev 272 = $2,072.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6149.1035,272,RC,27200002,CDM,,,,,,both,,,2302.3600,345.3500,MEDCOST,MEDCOST VHN,1095.69,,,,,,,594.2400,2302.3600,percent of total billed charges,"47.59% of $2,302.36 in Billed Charges for Rev 272 = $1,095.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6149.1035,272,RC,27200002,CDM,,,,,,both,,,2302.3600,345.3500,SENTARA HEALTH,SENTARA HEALTH,594.24,,,,,,,594.2400,2302.3600,percent of total billed charges,"25.81% of $2,302.36 in Billed Charges for Rev 272 = $594.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6149.1035,272,RC,27200002,CDM,,,,,,both,,,2302.3600,345.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2302.36,,,,,,,594.2400,2302.3600,percent of total billed charges,"100% of $2,302.36 in Billed Charges for Rev 272 = $2,302.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6149.1035,272,RC,27200002,CDM,,,,,,both,,,2302.3600,345.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1151.18,,,,,,,594.2400,2302.3600,percent of total billed charges,"Rev 272 $2,302.36 in Billed Charges at 50% = $1,151.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6149.1035,272,RC,27200002,CDM,,,,,,both,,,2302.3600,345.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,743.66,,,,,,,594.2400,2302.3600,other,"32.3% of $2,302.36 in Billed Charges for Rev 272 = $743.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 6149.1035,272,RC,27200002,CDM,,,,,,both,,,2302.3600,345.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,706.82,,,,,,,594.2400,2302.3600,other,"30.7% of $2,302.36 in Billed Charges for Rev 272 = $706.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 6149.1035,272,RC,27200002,CDM,,,,,,both,,,2302.3600,345.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,743.66,,,,,,,594.2400,2302.3600,percent of total billed charges,"32.3% of $2,302.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6149.1035,272,RC,27200002,CDM,,,,,,both,,,2302.3600,345.3500,WELLCARE,WELLCARE MEDICAID,2302.36,,,,,,,594.2400,2302.3600,percent of total billed charges,"100% of $2,302.36 in Billed Charges for Rev 272 = $2,302.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6975150,272,RC,,,,,,,,both,,,3629.8500,544.4800,AETNA,AETNA,1549.95,,,,,,,936.8600,3629.8500,percent of total billed charges,"42.7% of $3,629.85 in Billed Charges for Rev 272 = $1,549.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6975150,272,RC,,,,,,,,both,,,3629.8500,544.4800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2540.90,,,,,,,936.8600,3629.8500,percent of total billed charges,"Rev 272 $3,629.85 in Billed Charges at 70% = $2,540.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6975150,272,RC,,,,,,,,both,,,3629.8500,544.4800,CIGNA HEALTHCARE,CIGNA HMO,1513.65,,,,,,,936.8600,3629.8500,percent of total billed charges,"41.7% of $3,629.85 in Billed Charges for Rev 272 = $1,513.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6975150,272,RC,,,,,,,,both,,,3629.8500,544.4800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1684.25,,,,,,,936.8600,3629.8500,percent of total billed charges,"46.4% of $3,629.85 in Billed Charges for Rev 272 = $1,684.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6975150,272,RC,,,,,,,,both,,,3629.8500,544.4800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1513.65,,,,,,,936.8600,3629.8500,percent of total billed charges,"41.7% of $3,629.85 in Billed Charges for Rev 272 = $1,513.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6975150,272,RC,,,,,,,,both,,,3629.8500,544.4800,CIGNA HEALTHCARE,CIGNA PPO,1513.65,,,,,,,936.8600,3629.8500,percent of total billed charges,"41.7% of $3,629.85 in Billed Charges for Rev 272 = $1,513.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6975150,272,RC,,,,,,,,both,,,3629.8500,544.4800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3266.87,,,,,,,936.8600,3629.8500,percent of total billed charges,"90% of $3,629.85 in Billed Charges for Rev 272 = $3,266.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6975150,272,RC,,,,,,,,both,,,3629.8500,544.4800,MEDCOST,MEDCOST VHN,1727.45,,,,,,,936.8600,3629.8500,percent of total billed charges,"47.59% of $3,629.85 in Billed Charges for Rev 272 = $1,727.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6975150,272,RC,,,,,,,,both,,,3629.8500,544.4800,SENTARA HEALTH,SENTARA HEALTH,936.86,,,,,,,936.8600,3629.8500,percent of total billed charges,"25.81% of $3,629.85 in Billed Charges for Rev 272 = $936.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6975150,272,RC,,,,,,,,both,,,3629.8500,544.4800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3629.85,,,,,,,936.8600,3629.8500,percent of total billed charges,"100% of $3,629.85 in Billed Charges for Rev 272 = $3,629.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6975150,272,RC,,,,,,,,both,,,3629.8500,544.4800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1814.93,,,,,,,936.8600,3629.8500,percent of total billed charges,"Rev 272 $3,629.85 in Billed Charges at 50% = $1,814.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6975150,272,RC,,,,,,,,both,,,3629.8500,544.4800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1172.44,,,,,,,936.8600,3629.8500,other,"32.3% of $3,629.85 in Billed Charges for Rev 272 = $1,172.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 6975150,272,RC,,,,,,,,both,,,3629.8500,544.4800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1114.36,,,,,,,936.8600,3629.8500,other,"30.7% of $3,629.85 in Billed Charges for Rev 272 = $1,114.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 6975150,272,RC,,,,,,,,both,,,3629.8500,544.4800,UNITED HEALTHCARE,UNITED HEALTHCARE,1172.44,,,,,,,936.8600,3629.8500,percent of total billed charges,"32.3% of $3,629.85 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6975150,272,RC,,,,,,,,both,,,3629.8500,544.4800,WELLCARE,WELLCARE MEDICAID,3629.85,,,,,,,936.8600,3629.8500,percent of total billed charges,"100% of $3,629.85 in Billed Charges for Rev 272 = $3,629.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6MM,272,RC,27200002,CDM,,,,,,both,,,2883.1400,432.4700,AETNA,AETNA,1231.10,,,,,,,744.1400,2883.1400,percent of total billed charges,"42.7% of $2,883.14 in Billed Charges for Rev 272 = $1,231.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6MM,272,RC,27200002,CDM,,,,,,both,,,2883.1400,432.4700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2018.20,,,,,,,744.1400,2883.1400,percent of total billed charges,"Rev 272 $2,883.14 in Billed Charges at 70% = $2,018.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6MM,272,RC,27200002,CDM,,,,,,both,,,2883.1400,432.4700,CIGNA HEALTHCARE,CIGNA HMO,1202.27,,,,,,,744.1400,2883.1400,percent of total billed charges,"41.7% of $2,883.14 in Billed Charges for Rev 272 = $1,202.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6MM,272,RC,27200002,CDM,,,,,,both,,,2883.1400,432.4700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1337.78,,,,,,,744.1400,2883.1400,percent of total billed charges,"46.4% of $2,883.14 in Billed Charges for Rev 272 = $1,337.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6MM,272,RC,27200002,CDM,,,,,,both,,,2883.1400,432.4700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1202.27,,,,,,,744.1400,2883.1400,percent of total billed charges,"41.7% of $2,883.14 in Billed Charges for Rev 272 = $1,202.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6MM,272,RC,27200002,CDM,,,,,,both,,,2883.1400,432.4700,CIGNA HEALTHCARE,CIGNA PPO,1202.27,,,,,,,744.1400,2883.1400,percent of total billed charges,"41.7% of $2,883.14 in Billed Charges for Rev 272 = $1,202.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6MM,272,RC,27200002,CDM,,,,,,both,,,2883.1400,432.4700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2594.83,,,,,,,744.1400,2883.1400,percent of total billed charges,"90% of $2,883.14 in Billed Charges for Rev 272 = $2,594.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6MM,272,RC,27200002,CDM,,,,,,both,,,2883.1400,432.4700,MEDCOST,MEDCOST VHN,1372.09,,,,,,,744.1400,2883.1400,percent of total billed charges,"47.59% of $2,883.14 in Billed Charges for Rev 272 = $1,372.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6MM,272,RC,27200002,CDM,,,,,,both,,,2883.1400,432.4700,SENTARA HEALTH,SENTARA HEALTH,744.14,,,,,,,744.1400,2883.1400,percent of total billed charges,"25.81% of $2,883.14 in Billed Charges for Rev 272 = $744.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6MM,272,RC,27200002,CDM,,,,,,both,,,2883.1400,432.4700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2883.14,,,,,,,744.1400,2883.1400,percent of total billed charges,"100% of $2,883.14 in Billed Charges for Rev 272 = $2,883.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6MM,272,RC,27200002,CDM,,,,,,both,,,2883.1400,432.4700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1441.57,,,,,,,744.1400,2883.1400,percent of total billed charges,"Rev 272 $2,883.14 in Billed Charges at 50% = $1,441.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6MM,272,RC,27200002,CDM,,,,,,both,,,2883.1400,432.4700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,931.25,,,,,,,744.1400,2883.1400,other,"32.3% of $2,883.14 in Billed Charges for Rev 272 = $931.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 6MM,272,RC,27200002,CDM,,,,,,both,,,2883.1400,432.4700,UNITED HEALTHCARE,UHC HERITAGE SELECT,885.12,,,,,,,744.1400,2883.1400,other,"30.7% of $2,883.14 in Billed Charges for Rev 272 = $885.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 6MM,272,RC,27200002,CDM,,,,,,both,,,2883.1400,432.4700,UNITED HEALTHCARE,UNITED HEALTHCARE,931.25,,,,,,,744.1400,2883.1400,percent of total billed charges,"32.3% of $2,883.14 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 6MM,272,RC,27200002,CDM,,,,,,both,,,2883.1400,432.4700,WELLCARE,WELLCARE MEDICAID,2883.14,,,,,,,744.1400,2883.1400,percent of total billed charges,"100% of $2,883.14 in Billed Charges for Rev 272 = $2,883.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 7MM,272,RC,27200002,CDM,,,,,,both,,,2406.0700,360.9100,AETNA,AETNA,1027.39,,,,,,,621.0100,2406.0700,percent of total billed charges,"42.7% of $2,406.07 in Billed Charges for Rev 272 = $1,027.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 7MM,272,RC,27200002,CDM,,,,,,both,,,2406.0700,360.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1684.25,,,,,,,621.0100,2406.0700,percent of total billed charges,"Rev 272 $2,406.07 in Billed Charges at 70% = $1,684.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 7MM,272,RC,27200002,CDM,,,,,,both,,,2406.0700,360.9100,CIGNA HEALTHCARE,CIGNA HMO,1003.33,,,,,,,621.0100,2406.0700,percent of total billed charges,"41.7% of $2,406.07 in Billed Charges for Rev 272 = $1,003.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 7MM,272,RC,27200002,CDM,,,,,,both,,,2406.0700,360.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1116.42,,,,,,,621.0100,2406.0700,percent of total billed charges,"46.4% of $2,406.07 in Billed Charges for Rev 272 = $1,116.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 7MM,272,RC,27200002,CDM,,,,,,both,,,2406.0700,360.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1003.33,,,,,,,621.0100,2406.0700,percent of total billed charges,"41.7% of $2,406.07 in Billed Charges for Rev 272 = $1,003.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 7MM,272,RC,27200002,CDM,,,,,,both,,,2406.0700,360.9100,CIGNA HEALTHCARE,CIGNA PPO,1003.33,,,,,,,621.0100,2406.0700,percent of total billed charges,"41.7% of $2,406.07 in Billed Charges for Rev 272 = $1,003.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 7MM,272,RC,27200002,CDM,,,,,,both,,,2406.0700,360.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2165.46,,,,,,,621.0100,2406.0700,percent of total billed charges,"90% of $2,406.07 in Billed Charges for Rev 272 = $2,165.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 7MM,272,RC,27200002,CDM,,,,,,both,,,2406.0700,360.9100,MEDCOST,MEDCOST VHN,1145.05,,,,,,,621.0100,2406.0700,percent of total billed charges,"47.59% of $2,406.07 in Billed Charges for Rev 272 = $1,145.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 7MM,272,RC,27200002,CDM,,,,,,both,,,2406.0700,360.9100,SENTARA HEALTH,SENTARA HEALTH,621.01,,,,,,,621.0100,2406.0700,percent of total billed charges,"25.81% of $2,406.07 in Billed Charges for Rev 272 = $621.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 7MM,272,RC,27200002,CDM,,,,,,both,,,2406.0700,360.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2406.07,,,,,,,621.0100,2406.0700,percent of total billed charges,"100% of $2,406.07 in Billed Charges for Rev 272 = $2,406.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 7MM,272,RC,27200002,CDM,,,,,,both,,,2406.0700,360.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1203.04,,,,,,,621.0100,2406.0700,percent of total billed charges,"Rev 272 $2,406.07 in Billed Charges at 50% = $1,203.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 7MM,272,RC,27200002,CDM,,,,,,both,,,2406.0700,360.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,777.16,,,,,,,621.0100,2406.0700,other,"32.3% of $2,406.07 in Billed Charges for Rev 272 = $777.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 7MM,272,RC,27200002,CDM,,,,,,both,,,2406.0700,360.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,738.66,,,,,,,621.0100,2406.0700,other,"30.7% of $2,406.07 in Billed Charges for Rev 272 = $738.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 7MM,272,RC,27200002,CDM,,,,,,both,,,2406.0700,360.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,777.16,,,,,,,621.0100,2406.0700,percent of total billed charges,"32.3% of $2,406.07 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 7MM,272,RC,27200002,CDM,,,,,,both,,,2406.0700,360.9100,WELLCARE,WELLCARE MEDICAID,2406.07,,,,,,,621.0100,2406.0700,percent of total billed charges,"100% of $2,406.07 in Billed Charges for Rev 272 = $2,406.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 8530605,272,RC,,,,,,,,both,,,724.9300,108.7400,AETNA,AETNA,309.55,,,,,,,187.1000,724.9300,percent of total billed charges,42.7% of $724.93 in Billed Charges for Rev 272 = $309.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 8530605,272,RC,,,,,,,,both,,,724.9300,108.7400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,507.45,,,,,,,187.1000,724.9300,percent of total billed charges,Rev 272 $724.93 in Billed Charges at 70% = $507.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 8530605,272,RC,,,,,,,,both,,,724.9300,108.7400,CIGNA HEALTHCARE,CIGNA HMO,302.30,,,,,,,187.1000,724.9300,percent of total billed charges,41.7% of $724.93 in Billed Charges for Rev 272 = $302.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 8530605,272,RC,,,,,,,,both,,,724.9300,108.7400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,336.37,,,,,,,187.1000,724.9300,percent of total billed charges,46.4% of $724.93 in Billed Charges for Rev 272 = $336.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 8530605,272,RC,,,,,,,,both,,,724.9300,108.7400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,302.30,,,,,,,187.1000,724.9300,percent of total billed charges,41.7% of $724.93 in Billed Charges for Rev 272 = $302.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 8530605,272,RC,,,,,,,,both,,,724.9300,108.7400,CIGNA HEALTHCARE,CIGNA PPO,302.30,,,,,,,187.1000,724.9300,percent of total billed charges,41.7% of $724.93 in Billed Charges for Rev 272 = $302.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 8530605,272,RC,,,,,,,,both,,,724.9300,108.7400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,652.44,,,,,,,187.1000,724.9300,percent of total billed charges,90% of $724.93 in Billed Charges for Rev 272 = $652.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 8530605,272,RC,,,,,,,,both,,,724.9300,108.7400,MEDCOST,MEDCOST VHN,344.99,,,,,,,187.1000,724.9300,percent of total billed charges,47.59% of $724.93 in Billed Charges for Rev 272 = $344.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 8530605,272,RC,,,,,,,,both,,,724.9300,108.7400,SENTARA HEALTH,SENTARA HEALTH,187.10,,,,,,,187.1000,724.9300,percent of total billed charges,25.81% of $724.93 in Billed Charges for Rev 272 = $187.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 8530605,272,RC,,,,,,,,both,,,724.9300,108.7400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",724.93,,,,,,,187.1000,724.9300,percent of total billed charges,100% of $724.93 in Billed Charges for Rev 272 = $724.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 8530605,272,RC,,,,,,,,both,,,724.9300,108.7400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,362.47,,,,,,,187.1000,724.9300,percent of total billed charges,Rev 272 $724.93 in Billed Charges at 50% = $362.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 8530605,272,RC,,,,,,,,both,,,724.9300,108.7400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,234.15,,,,,,,187.1000,724.9300,other,32.3% of $724.93 in Billed Charges for Rev 272 = $234.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 8530605,272,RC,,,,,,,,both,,,724.9300,108.7400,UNITED HEALTHCARE,UHC HERITAGE SELECT,222.55,,,,,,,187.1000,724.9300,other,30.7% of $724.93 in Billed Charges for Rev 272 = $222.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 8530605,272,RC,,,,,,,,both,,,724.9300,108.7400,UNITED HEALTHCARE,UNITED HEALTHCARE,234.15,,,,,,,187.1000,724.9300,percent of total billed charges,32.3% of $724.93 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 8530605,272,RC,,,,,,,,both,,,724.9300,108.7400,WELLCARE,WELLCARE MEDICAID,724.93,,,,,,,187.1000,724.9300,percent of total billed charges,100% of $724.93 in Billed Charges for Rev 272 = $724.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 8MM W/STOP,272,RC,,,,,,,,both,,,2066.8400,310.0300,AETNA,AETNA,882.54,,,,,,,533.4500,2066.8400,percent of total billed charges,"42.7% of $2,066.84 in Billed Charges for Rev 272 = $882.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 8MM W/STOP,272,RC,,,,,,,,both,,,2066.8400,310.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1446.79,,,,,,,533.4500,2066.8400,percent of total billed charges,"Rev 272 $2,066.84 in Billed Charges at 70% = $1,446.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 8MM W/STOP,272,RC,,,,,,,,both,,,2066.8400,310.0300,CIGNA HEALTHCARE,CIGNA HMO,861.87,,,,,,,533.4500,2066.8400,percent of total billed charges,"41.7% of $2,066.84 in Billed Charges for Rev 272 = $861.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 8MM W/STOP,272,RC,,,,,,,,both,,,2066.8400,310.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,959.01,,,,,,,533.4500,2066.8400,percent of total billed charges,"46.4% of $2,066.84 in Billed Charges for Rev 272 = $959.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 8MM W/STOP,272,RC,,,,,,,,both,,,2066.8400,310.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,861.87,,,,,,,533.4500,2066.8400,percent of total billed charges,"41.7% of $2,066.84 in Billed Charges for Rev 272 = $861.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 8MM W/STOP,272,RC,,,,,,,,both,,,2066.8400,310.0300,CIGNA HEALTHCARE,CIGNA PPO,861.87,,,,,,,533.4500,2066.8400,percent of total billed charges,"41.7% of $2,066.84 in Billed Charges for Rev 272 = $861.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 8MM W/STOP,272,RC,,,,,,,,both,,,2066.8400,310.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1860.16,,,,,,,533.4500,2066.8400,percent of total billed charges,"90% of $2,066.84 in Billed Charges for Rev 272 = $1,860.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 8MM W/STOP,272,RC,,,,,,,,both,,,2066.8400,310.0300,MEDCOST,MEDCOST VHN,983.61,,,,,,,533.4500,2066.8400,percent of total billed charges,"47.59% of $2,066.84 in Billed Charges for Rev 272 = $983.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 8MM W/STOP,272,RC,,,,,,,,both,,,2066.8400,310.0300,SENTARA HEALTH,SENTARA HEALTH,533.45,,,,,,,533.4500,2066.8400,percent of total billed charges,"25.81% of $2,066.84 in Billed Charges for Rev 272 = $533.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 8MM W/STOP,272,RC,,,,,,,,both,,,2066.8400,310.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2066.84,,,,,,,533.4500,2066.8400,percent of total billed charges,"100% of $2,066.84 in Billed Charges for Rev 272 = $2,066.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 8MM W/STOP,272,RC,,,,,,,,both,,,2066.8400,310.0300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1033.42,,,,,,,533.4500,2066.8400,percent of total billed charges,"Rev 272 $2,066.84 in Billed Charges at 50% = $1,033.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 8MM W/STOP,272,RC,,,,,,,,both,,,2066.8400,310.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,667.59,,,,,,,533.4500,2066.8400,other,"32.3% of $2,066.84 in Billed Charges for Rev 272 = $667.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 8MM W/STOP,272,RC,,,,,,,,both,,,2066.8400,310.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,634.52,,,,,,,533.4500,2066.8400,other,"30.7% of $2,066.84 in Billed Charges for Rev 272 = $634.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 8MM W/STOP,272,RC,,,,,,,,both,,,2066.8400,310.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,667.59,,,,,,,533.4500,2066.8400,percent of total billed charges,"32.3% of $2,066.84 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 8MM W/STOP,272,RC,,,,,,,,both,,,2066.8400,310.0300,WELLCARE,WELLCARE MEDICAID,2066.84,,,,,,,533.4500,2066.8400,percent of total billed charges,"100% of $2,066.84 in Billed Charges for Rev 272 = $2,066.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL GRADUATED 1.7MM,272,RC,27200002,CDM,,,,,,both,,,974.8700,146.2300,AETNA,AETNA,416.27,,,,,,,251.6100,974.8700,percent of total billed charges,42.7% of $974.87 in Billed Charges for Rev 272 = $416.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 1.7MM,272,RC,27200002,CDM,,,,,,both,,,974.8700,146.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,682.41,,,,,,,251.6100,974.8700,percent of total billed charges,Rev 272 $974.87 in Billed Charges at 70% = $682.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 1.7MM,272,RC,27200002,CDM,,,,,,both,,,974.8700,146.2300,CIGNA HEALTHCARE,CIGNA HMO,406.52,,,,,,,251.6100,974.8700,percent of total billed charges,41.7% of $974.87 in Billed Charges for Rev 272 = $406.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 1.7MM,272,RC,27200002,CDM,,,,,,both,,,974.8700,146.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,452.34,,,,,,,251.6100,974.8700,percent of total billed charges,46.4% of $974.87 in Billed Charges for Rev 272 = $452.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 1.7MM,272,RC,27200002,CDM,,,,,,both,,,974.8700,146.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,406.52,,,,,,,251.6100,974.8700,percent of total billed charges,41.7% of $974.87 in Billed Charges for Rev 272 = $406.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 1.7MM,272,RC,27200002,CDM,,,,,,both,,,974.8700,146.2300,CIGNA HEALTHCARE,CIGNA PPO,406.52,,,,,,,251.6100,974.8700,percent of total billed charges,41.7% of $974.87 in Billed Charges for Rev 272 = $406.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 1.7MM,272,RC,27200002,CDM,,,,,,both,,,974.8700,146.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,877.38,,,,,,,251.6100,974.8700,percent of total billed charges,90% of $974.87 in Billed Charges for Rev 272 = $877.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 1.7MM,272,RC,27200002,CDM,,,,,,both,,,974.8700,146.2300,MEDCOST,MEDCOST VHN,463.94,,,,,,,251.6100,974.8700,percent of total billed charges,47.59% of $974.87 in Billed Charges for Rev 272 = $463.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 1.7MM,272,RC,27200002,CDM,,,,,,both,,,974.8700,146.2300,SENTARA HEALTH,SENTARA HEALTH,251.61,,,,,,,251.6100,974.8700,percent of total billed charges,25.81% of $974.87 in Billed Charges for Rev 272 = $251.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 1.7MM,272,RC,27200002,CDM,,,,,,both,,,974.8700,146.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",974.87,,,,,,,251.6100,974.8700,percent of total billed charges,100% of $974.87 in Billed Charges for Rev 272 = $974.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 1.7MM,272,RC,27200002,CDM,,,,,,both,,,974.8700,146.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,487.44,,,,,,,251.6100,974.8700,percent of total billed charges,Rev 272 $974.87 in Billed Charges at 50% = $487.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 1.7MM,272,RC,27200002,CDM,,,,,,both,,,974.8700,146.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,314.88,,,,,,,251.6100,974.8700,other,32.3% of $974.87 in Billed Charges for Rev 272 = $314.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL GRADUATED 1.7MM,272,RC,27200002,CDM,,,,,,both,,,974.8700,146.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,299.29,,,,,,,251.6100,974.8700,other,30.7% of $974.87 in Billed Charges for Rev 272 = $299.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL GRADUATED 1.7MM,272,RC,27200002,CDM,,,,,,both,,,974.8700,146.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,314.88,,,,,,,251.6100,974.8700,percent of total billed charges,32.3% of $974.87 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 1.7MM,272,RC,27200002,CDM,,,,,,both,,,974.8700,146.2300,WELLCARE,WELLCARE MEDICAID,974.87,,,,,,,251.6100,974.8700,percent of total billed charges,100% of $974.87 in Billed Charges for Rev 272 = $974.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,840.0500,126.0100,AETNA,AETNA,358.70,,,,,,,216.8200,840.0500,percent of total billed charges,42.7% of $840.05 in Billed Charges for Rev 272 = $358.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,840.0500,126.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,588.04,,,,,,,216.8200,840.0500,percent of total billed charges,Rev 272 $840.05 in Billed Charges at 70% = $588.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,840.0500,126.0100,CIGNA HEALTHCARE,CIGNA HMO,350.30,,,,,,,216.8200,840.0500,percent of total billed charges,41.7% of $840.05 in Billed Charges for Rev 272 = $350.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,840.0500,126.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,389.78,,,,,,,216.8200,840.0500,percent of total billed charges,46.4% of $840.05 in Billed Charges for Rev 272 = $389.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,840.0500,126.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,350.30,,,,,,,216.8200,840.0500,percent of total billed charges,41.7% of $840.05 in Billed Charges for Rev 272 = $350.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,840.0500,126.0100,CIGNA HEALTHCARE,CIGNA PPO,350.30,,,,,,,216.8200,840.0500,percent of total billed charges,41.7% of $840.05 in Billed Charges for Rev 272 = $350.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,840.0500,126.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,756.05,,,,,,,216.8200,840.0500,percent of total billed charges,90% of $840.05 in Billed Charges for Rev 272 = $756.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,840.0500,126.0100,MEDCOST,MEDCOST VHN,399.78,,,,,,,216.8200,840.0500,percent of total billed charges,47.59% of $840.05 in Billed Charges for Rev 272 = $399.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,840.0500,126.0100,SENTARA HEALTH,SENTARA HEALTH,216.82,,,,,,,216.8200,840.0500,percent of total billed charges,25.81% of $840.05 in Billed Charges for Rev 272 = $216.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,840.0500,126.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",840.05,,,,,,,216.8200,840.0500,percent of total billed charges,100% of $840.05 in Billed Charges for Rev 272 = $840.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,840.0500,126.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,420.03,,,,,,,216.8200,840.0500,percent of total billed charges,Rev 272 $840.05 in Billed Charges at 50% = $420.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,840.0500,126.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,271.34,,,,,,,216.8200,840.0500,other,32.3% of $840.05 in Billed Charges for Rev 272 = $271.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL GRADUATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,840.0500,126.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,257.90,,,,,,,216.8200,840.0500,other,30.7% of $840.05 in Billed Charges for Rev 272 = $257.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL GRADUATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,840.0500,126.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,271.34,,,,,,,216.8200,840.0500,percent of total billed charges,32.3% of $840.05 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL GRADUATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,840.0500,126.0100,WELLCARE,WELLCARE MEDICAID,840.05,,,,,,,216.8200,840.0500,percent of total billed charges,100% of $840.05 in Billed Charges for Rev 272 = $840.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL HALL 1.1X12MM 317.12,272,RC,,,,,,,,both,,,1868.1300,280.2200,AETNA,AETNA,797.69,,,,,,,482.1600,1868.1300,percent of total billed charges,"42.7% of $1,868.13 in Billed Charges for Rev 272 = $797.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HALL 1.1X12MM 317.12,272,RC,,,,,,,,both,,,1868.1300,280.2200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1307.69,,,,,,,482.1600,1868.1300,percent of total billed charges,"Rev 272 $1,868.13 in Billed Charges at 70% = $1,307.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HALL 1.1X12MM 317.12,272,RC,,,,,,,,both,,,1868.1300,280.2200,CIGNA HEALTHCARE,CIGNA HMO,779.01,,,,,,,482.1600,1868.1300,percent of total billed charges,"41.7% of $1,868.13 in Billed Charges for Rev 272 = $779.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HALL 1.1X12MM 317.12,272,RC,,,,,,,,both,,,1868.1300,280.2200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,866.81,,,,,,,482.1600,1868.1300,percent of total billed charges,"46.4% of $1,868.13 in Billed Charges for Rev 272 = $866.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HALL 1.1X12MM 317.12,272,RC,,,,,,,,both,,,1868.1300,280.2200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,779.01,,,,,,,482.1600,1868.1300,percent of total billed charges,"41.7% of $1,868.13 in Billed Charges for Rev 272 = $779.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HALL 1.1X12MM 317.12,272,RC,,,,,,,,both,,,1868.1300,280.2200,CIGNA HEALTHCARE,CIGNA PPO,779.01,,,,,,,482.1600,1868.1300,percent of total billed charges,"41.7% of $1,868.13 in Billed Charges for Rev 272 = $779.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HALL 1.1X12MM 317.12,272,RC,,,,,,,,both,,,1868.1300,280.2200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1681.32,,,,,,,482.1600,1868.1300,percent of total billed charges,"90% of $1,868.13 in Billed Charges for Rev 272 = $1,681.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HALL 1.1X12MM 317.12,272,RC,,,,,,,,both,,,1868.1300,280.2200,MEDCOST,MEDCOST VHN,889.04,,,,,,,482.1600,1868.1300,percent of total billed charges,"47.59% of $1,868.13 in Billed Charges for Rev 272 = $889.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HALL 1.1X12MM 317.12,272,RC,,,,,,,,both,,,1868.1300,280.2200,SENTARA HEALTH,SENTARA HEALTH,482.16,,,,,,,482.1600,1868.1300,percent of total billed charges,"25.81% of $1,868.13 in Billed Charges for Rev 272 = $482.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HALL 1.1X12MM 317.12,272,RC,,,,,,,,both,,,1868.1300,280.2200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1868.13,,,,,,,482.1600,1868.1300,percent of total billed charges,"100% of $1,868.13 in Billed Charges for Rev 272 = $1,868.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HALL 1.1X12MM 317.12,272,RC,,,,,,,,both,,,1868.1300,280.2200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,934.07,,,,,,,482.1600,1868.1300,percent of total billed charges,"Rev 272 $1,868.13 in Billed Charges at 50% = $934.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HALL 1.1X12MM 317.12,272,RC,,,,,,,,both,,,1868.1300,280.2200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,603.41,,,,,,,482.1600,1868.1300,other,"32.3% of $1,868.13 in Billed Charges for Rev 272 = $603.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL HALL 1.1X12MM 317.12,272,RC,,,,,,,,both,,,1868.1300,280.2200,UNITED HEALTHCARE,UHC HERITAGE SELECT,573.52,,,,,,,482.1600,1868.1300,other,"30.7% of $1,868.13 in Billed Charges for Rev 272 = $573.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL HALL 1.1X12MM 317.12,272,RC,,,,,,,,both,,,1868.1300,280.2200,UNITED HEALTHCARE,UNITED HEALTHCARE,603.41,,,,,,,482.1600,1868.1300,percent of total billed charges,"32.3% of $1,868.13 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HALL 1.1X12MM 317.12,272,RC,,,,,,,,both,,,1868.1300,280.2200,WELLCARE,WELLCARE MEDICAID,1868.13,,,,,,,482.1600,1868.1300,percent of total billed charges,"100% of $1,868.13 in Billed Charges for Rev 272 = $1,868.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HAND FREE 4.2MM,272,RC,27200002,CDM,,,,,,both,,,4407.6800,661.1500,AETNA,AETNA,1882.08,,,,,,,1137.6200,4407.6800,percent of total billed charges,"42.7% of $4,407.68 in Billed Charges for Rev 272 = $1,882.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HAND FREE 4.2MM,272,RC,27200002,CDM,,,,,,both,,,4407.6800,661.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3085.38,,,,,,,1137.6200,4407.6800,percent of total billed charges,"Rev 272 $4,407.68 in Billed Charges at 70% = $3,085.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HAND FREE 4.2MM,272,RC,27200002,CDM,,,,,,both,,,4407.6800,661.1500,CIGNA HEALTHCARE,CIGNA HMO,1838.00,,,,,,,1137.6200,4407.6800,percent of total billed charges,"41.7% of $4,407.68 in Billed Charges for Rev 272 = $1,838.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HAND FREE 4.2MM,272,RC,27200002,CDM,,,,,,both,,,4407.6800,661.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2045.16,,,,,,,1137.6200,4407.6800,percent of total billed charges,"46.4% of $4,407.68 in Billed Charges for Rev 272 = $2,045.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HAND FREE 4.2MM,272,RC,27200002,CDM,,,,,,both,,,4407.6800,661.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1838.00,,,,,,,1137.6200,4407.6800,percent of total billed charges,"41.7% of $4,407.68 in Billed Charges for Rev 272 = $1,838.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HAND FREE 4.2MM,272,RC,27200002,CDM,,,,,,both,,,4407.6800,661.1500,CIGNA HEALTHCARE,CIGNA PPO,1838.00,,,,,,,1137.6200,4407.6800,percent of total billed charges,"41.7% of $4,407.68 in Billed Charges for Rev 272 = $1,838.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HAND FREE 4.2MM,272,RC,27200002,CDM,,,,,,both,,,4407.6800,661.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3966.91,,,,,,,1137.6200,4407.6800,percent of total billed charges,"90% of $4,407.68 in Billed Charges for Rev 272 = $3,966.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HAND FREE 4.2MM,272,RC,27200002,CDM,,,,,,both,,,4407.6800,661.1500,MEDCOST,MEDCOST VHN,2097.61,,,,,,,1137.6200,4407.6800,percent of total billed charges,"47.59% of $4,407.68 in Billed Charges for Rev 272 = $2,097.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HAND FREE 4.2MM,272,RC,27200002,CDM,,,,,,both,,,4407.6800,661.1500,SENTARA HEALTH,SENTARA HEALTH,1137.62,,,,,,,1137.6200,4407.6800,percent of total billed charges,"25.81% of $4,407.68 in Billed Charges for Rev 272 = $1,137.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HAND FREE 4.2MM,272,RC,27200002,CDM,,,,,,both,,,4407.6800,661.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4407.68,,,,,,,1137.6200,4407.6800,percent of total billed charges,"100% of $4,407.68 in Billed Charges for Rev 272 = $4,407.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HAND FREE 4.2MM,272,RC,27200002,CDM,,,,,,both,,,4407.6800,661.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2203.84,,,,,,,1137.6200,4407.6800,percent of total billed charges,"Rev 272 $4,407.68 in Billed Charges at 50% = $2,203.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HAND FREE 4.2MM,272,RC,27200002,CDM,,,,,,both,,,4407.6800,661.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1423.68,,,,,,,1137.6200,4407.6800,other,"32.3% of $4,407.68 in Billed Charges for Rev 272 = $1,423.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL HAND FREE 4.2MM,272,RC,27200002,CDM,,,,,,both,,,4407.6800,661.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1353.16,,,,,,,1137.6200,4407.6800,other,"30.7% of $4,407.68 in Billed Charges for Rev 272 = $1,353.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL HAND FREE 4.2MM,272,RC,27200002,CDM,,,,,,both,,,4407.6800,661.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,1423.68,,,,,,,1137.6200,4407.6800,percent of total billed charges,"32.3% of $4,407.68 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HAND FREE 4.2MM,272,RC,27200002,CDM,,,,,,both,,,4407.6800,661.1500,WELLCARE,WELLCARE MEDICAID,4407.68,,,,,,,1137.6200,4407.6800,percent of total billed charges,"100% of $4,407.68 in Billed Charges for Rev 272 = $4,407.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HEX 24MM STOP,272,RC,27200002,CDM,,,,,,both,,,1345.0100,201.7500,AETNA,AETNA,574.32,,,,,,,347.1500,1345.0100,percent of total billed charges,"42.7% of $1,345.01 in Billed Charges for Rev 272 = $574.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HEX 24MM STOP,272,RC,27200002,CDM,,,,,,both,,,1345.0100,201.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,941.51,,,,,,,347.1500,1345.0100,percent of total billed charges,"Rev 272 $1,345.01 in Billed Charges at 70% = $941.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HEX 24MM STOP,272,RC,27200002,CDM,,,,,,both,,,1345.0100,201.7500,CIGNA HEALTHCARE,CIGNA HMO,560.87,,,,,,,347.1500,1345.0100,percent of total billed charges,"41.7% of $1,345.01 in Billed Charges for Rev 272 = $560.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HEX 24MM STOP,272,RC,27200002,CDM,,,,,,both,,,1345.0100,201.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,624.08,,,,,,,347.1500,1345.0100,percent of total billed charges,"46.4% of $1,345.01 in Billed Charges for Rev 272 = $624.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HEX 24MM STOP,272,RC,27200002,CDM,,,,,,both,,,1345.0100,201.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,560.87,,,,,,,347.1500,1345.0100,percent of total billed charges,"41.7% of $1,345.01 in Billed Charges for Rev 272 = $560.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HEX 24MM STOP,272,RC,27200002,CDM,,,,,,both,,,1345.0100,201.7500,CIGNA HEALTHCARE,CIGNA PPO,560.87,,,,,,,347.1500,1345.0100,percent of total billed charges,"41.7% of $1,345.01 in Billed Charges for Rev 272 = $560.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HEX 24MM STOP,272,RC,27200002,CDM,,,,,,both,,,1345.0100,201.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1210.51,,,,,,,347.1500,1345.0100,percent of total billed charges,"90% of $1,345.01 in Billed Charges for Rev 272 = $1,210.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HEX 24MM STOP,272,RC,27200002,CDM,,,,,,both,,,1345.0100,201.7500,MEDCOST,MEDCOST VHN,640.09,,,,,,,347.1500,1345.0100,percent of total billed charges,"47.59% of $1,345.01 in Billed Charges for Rev 272 = $640.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HEX 24MM STOP,272,RC,27200002,CDM,,,,,,both,,,1345.0100,201.7500,SENTARA HEALTH,SENTARA HEALTH,347.15,,,,,,,347.1500,1345.0100,percent of total billed charges,"25.81% of $1,345.01 in Billed Charges for Rev 272 = $347.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HEX 24MM STOP,272,RC,27200002,CDM,,,,,,both,,,1345.0100,201.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1345.01,,,,,,,347.1500,1345.0100,percent of total billed charges,"100% of $1,345.01 in Billed Charges for Rev 272 = $1,345.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HEX 24MM STOP,272,RC,27200002,CDM,,,,,,both,,,1345.0100,201.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,672.51,,,,,,,347.1500,1345.0100,percent of total billed charges,"Rev 272 $1,345.01 in Billed Charges at 50% = $672.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HEX 24MM STOP,272,RC,27200002,CDM,,,,,,both,,,1345.0100,201.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,434.44,,,,,,,347.1500,1345.0100,other,"32.3% of $1,345.01 in Billed Charges for Rev 272 = $434.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL HEX 24MM STOP,272,RC,27200002,CDM,,,,,,both,,,1345.0100,201.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,412.92,,,,,,,347.1500,1345.0100,other,"30.7% of $1,345.01 in Billed Charges for Rev 272 = $412.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL HEX 24MM STOP,272,RC,27200002,CDM,,,,,,both,,,1345.0100,201.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,434.44,,,,,,,347.1500,1345.0100,percent of total billed charges,"32.3% of $1,345.01 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HEX 24MM STOP,272,RC,27200002,CDM,,,,,,both,,,1345.0100,201.7500,WELLCARE,WELLCARE MEDICAID,1345.01,,,,,,,347.1500,1345.0100,percent of total billed charges,"100% of $1,345.01 in Billed Charges for Rev 272 = $1,345.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10.0MM,272,RC,,,,,,,,both,,,2388.0300,358.2000,AETNA,AETNA,1019.69,,,,,,,616.3500,2388.0300,percent of total billed charges,"42.7% of $2,388.03 in Billed Charges for Rev 272 = $1,019.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10.0MM,272,RC,,,,,,,,both,,,2388.0300,358.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1671.62,,,,,,,616.3500,2388.0300,percent of total billed charges,"Rev 272 $2,388.03 in Billed Charges at 70% = $1,671.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10.0MM,272,RC,,,,,,,,both,,,2388.0300,358.2000,CIGNA HEALTHCARE,CIGNA HMO,995.81,,,,,,,616.3500,2388.0300,percent of total billed charges,"41.7% of $2,388.03 in Billed Charges for Rev 272 = $995.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10.0MM,272,RC,,,,,,,,both,,,2388.0300,358.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1108.05,,,,,,,616.3500,2388.0300,percent of total billed charges,"46.4% of $2,388.03 in Billed Charges for Rev 272 = $1,108.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10.0MM,272,RC,,,,,,,,both,,,2388.0300,358.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,995.81,,,,,,,616.3500,2388.0300,percent of total billed charges,"41.7% of $2,388.03 in Billed Charges for Rev 272 = $995.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10.0MM,272,RC,,,,,,,,both,,,2388.0300,358.2000,CIGNA HEALTHCARE,CIGNA PPO,995.81,,,,,,,616.3500,2388.0300,percent of total billed charges,"41.7% of $2,388.03 in Billed Charges for Rev 272 = $995.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10.0MM,272,RC,,,,,,,,both,,,2388.0300,358.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2149.23,,,,,,,616.3500,2388.0300,percent of total billed charges,"90% of $2,388.03 in Billed Charges for Rev 272 = $2,149.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10.0MM,272,RC,,,,,,,,both,,,2388.0300,358.2000,MEDCOST,MEDCOST VHN,1136.46,,,,,,,616.3500,2388.0300,percent of total billed charges,"47.59% of $2,388.03 in Billed Charges for Rev 272 = $1,136.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10.0MM,272,RC,,,,,,,,both,,,2388.0300,358.2000,SENTARA HEALTH,SENTARA HEALTH,616.35,,,,,,,616.3500,2388.0300,percent of total billed charges,"25.81% of $2,388.03 in Billed Charges for Rev 272 = $616.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10.0MM,272,RC,,,,,,,,both,,,2388.0300,358.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2388.03,,,,,,,616.3500,2388.0300,percent of total billed charges,"100% of $2,388.03 in Billed Charges for Rev 272 = $2,388.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10.0MM,272,RC,,,,,,,,both,,,2388.0300,358.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1194.02,,,,,,,616.3500,2388.0300,percent of total billed charges,"Rev 272 $2,388.03 in Billed Charges at 50% = $1,194.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10.0MM,272,RC,,,,,,,,both,,,2388.0300,358.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,771.33,,,,,,,616.3500,2388.0300,other,"32.3% of $2,388.03 in Billed Charges for Rev 272 = $771.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL HOLLOW 10.0MM,272,RC,,,,,,,,both,,,2388.0300,358.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,733.13,,,,,,,616.3500,2388.0300,other,"30.7% of $2,388.03 in Billed Charges for Rev 272 = $733.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL HOLLOW 10.0MM,272,RC,,,,,,,,both,,,2388.0300,358.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,771.33,,,,,,,616.3500,2388.0300,percent of total billed charges,"32.3% of $2,388.03 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10.0MM,272,RC,,,,,,,,both,,,2388.0300,358.2000,WELLCARE,WELLCARE MEDICAID,2388.03,,,,,,,616.3500,2388.0300,percent of total billed charges,"100% of $2,388.03 in Billed Charges for Rev 272 = $2,388.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10MM,272,RC,27200002,CDM,,,,,,both,,,2805.6700,420.8500,AETNA,AETNA,1198.02,,,,,,,724.1400,2805.6700,percent of total billed charges,"42.7% of $2,805.67 in Billed Charges for Rev 272 = $1,198.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10MM,272,RC,27200002,CDM,,,,,,both,,,2805.6700,420.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1963.97,,,,,,,724.1400,2805.6700,percent of total billed charges,"Rev 272 $2,805.67 in Billed Charges at 70% = $1,963.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10MM,272,RC,27200002,CDM,,,,,,both,,,2805.6700,420.8500,CIGNA HEALTHCARE,CIGNA HMO,1169.96,,,,,,,724.1400,2805.6700,percent of total billed charges,"41.7% of $2,805.67 in Billed Charges for Rev 272 = $1,169.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10MM,272,RC,27200002,CDM,,,,,,both,,,2805.6700,420.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1301.83,,,,,,,724.1400,2805.6700,percent of total billed charges,"46.4% of $2,805.67 in Billed Charges for Rev 272 = $1,301.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10MM,272,RC,27200002,CDM,,,,,,both,,,2805.6700,420.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1169.96,,,,,,,724.1400,2805.6700,percent of total billed charges,"41.7% of $2,805.67 in Billed Charges for Rev 272 = $1,169.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10MM,272,RC,27200002,CDM,,,,,,both,,,2805.6700,420.8500,CIGNA HEALTHCARE,CIGNA PPO,1169.96,,,,,,,724.1400,2805.6700,percent of total billed charges,"41.7% of $2,805.67 in Billed Charges for Rev 272 = $1,169.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10MM,272,RC,27200002,CDM,,,,,,both,,,2805.6700,420.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2525.10,,,,,,,724.1400,2805.6700,percent of total billed charges,"90% of $2,805.67 in Billed Charges for Rev 272 = $2,525.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10MM,272,RC,27200002,CDM,,,,,,both,,,2805.6700,420.8500,MEDCOST,MEDCOST VHN,1335.22,,,,,,,724.1400,2805.6700,percent of total billed charges,"47.59% of $2,805.67 in Billed Charges for Rev 272 = $1,335.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10MM,272,RC,27200002,CDM,,,,,,both,,,2805.6700,420.8500,SENTARA HEALTH,SENTARA HEALTH,724.14,,,,,,,724.1400,2805.6700,percent of total billed charges,"25.81% of $2,805.67 in Billed Charges for Rev 272 = $724.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10MM,272,RC,27200002,CDM,,,,,,both,,,2805.6700,420.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2805.67,,,,,,,724.1400,2805.6700,percent of total billed charges,"100% of $2,805.67 in Billed Charges for Rev 272 = $2,805.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10MM,272,RC,27200002,CDM,,,,,,both,,,2805.6700,420.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1402.84,,,,,,,724.1400,2805.6700,percent of total billed charges,"Rev 272 $2,805.67 in Billed Charges at 50% = $1,402.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10MM,272,RC,27200002,CDM,,,,,,both,,,2805.6700,420.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,906.23,,,,,,,724.1400,2805.6700,other,"32.3% of $2,805.67 in Billed Charges for Rev 272 = $906.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL HOLLOW 10MM,272,RC,27200002,CDM,,,,,,both,,,2805.6700,420.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,861.34,,,,,,,724.1400,2805.6700,other,"30.7% of $2,805.67 in Billed Charges for Rev 272 = $861.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL HOLLOW 10MM,272,RC,27200002,CDM,,,,,,both,,,2805.6700,420.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,906.23,,,,,,,724.1400,2805.6700,percent of total billed charges,"32.3% of $2,805.67 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL HOLLOW 10MM,272,RC,27200002,CDM,,,,,,both,,,2805.6700,420.8500,WELLCARE,WELLCARE MEDICAID,2805.67,,,,,,,724.1400,2805.6700,percent of total billed charges,"100% of $2,805.67 in Billed Charges for Rev 272 = $2,805.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL INTERLOCK COROENT 2X12MM,272,RC,,,,,,,,both,,,2120.8700,318.1300,AETNA,AETNA,905.61,,,,,,,547.4000,2120.8700,percent of total billed charges,"42.7% of $2,120.87 in Billed Charges for Rev 272 = $905.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL INTERLOCK COROENT 2X12MM,272,RC,,,,,,,,both,,,2120.8700,318.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1484.61,,,,,,,547.4000,2120.8700,percent of total billed charges,"Rev 272 $2,120.87 in Billed Charges at 70% = $1,484.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL INTERLOCK COROENT 2X12MM,272,RC,,,,,,,,both,,,2120.8700,318.1300,CIGNA HEALTHCARE,CIGNA HMO,884.40,,,,,,,547.4000,2120.8700,percent of total billed charges,"41.7% of $2,120.87 in Billed Charges for Rev 272 = $884.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL INTERLOCK COROENT 2X12MM,272,RC,,,,,,,,both,,,2120.8700,318.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,984.08,,,,,,,547.4000,2120.8700,percent of total billed charges,"46.4% of $2,120.87 in Billed Charges for Rev 272 = $984.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL INTERLOCK COROENT 2X12MM,272,RC,,,,,,,,both,,,2120.8700,318.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,884.40,,,,,,,547.4000,2120.8700,percent of total billed charges,"41.7% of $2,120.87 in Billed Charges for Rev 272 = $884.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL INTERLOCK COROENT 2X12MM,272,RC,,,,,,,,both,,,2120.8700,318.1300,CIGNA HEALTHCARE,CIGNA PPO,884.40,,,,,,,547.4000,2120.8700,percent of total billed charges,"41.7% of $2,120.87 in Billed Charges for Rev 272 = $884.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL INTERLOCK COROENT 2X12MM,272,RC,,,,,,,,both,,,2120.8700,318.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1908.78,,,,,,,547.4000,2120.8700,percent of total billed charges,"90% of $2,120.87 in Billed Charges for Rev 272 = $1,908.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL INTERLOCK COROENT 2X12MM,272,RC,,,,,,,,both,,,2120.8700,318.1300,MEDCOST,MEDCOST VHN,1009.32,,,,,,,547.4000,2120.8700,percent of total billed charges,"47.59% of $2,120.87 in Billed Charges for Rev 272 = $1,009.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL INTERLOCK COROENT 2X12MM,272,RC,,,,,,,,both,,,2120.8700,318.1300,SENTARA HEALTH,SENTARA HEALTH,547.40,,,,,,,547.4000,2120.8700,percent of total billed charges,"25.81% of $2,120.87 in Billed Charges for Rev 272 = $547.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL INTERLOCK COROENT 2X12MM,272,RC,,,,,,,,both,,,2120.8700,318.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2120.87,,,,,,,547.4000,2120.8700,percent of total billed charges,"100% of $2,120.87 in Billed Charges for Rev 272 = $2,120.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL INTERLOCK COROENT 2X12MM,272,RC,,,,,,,,both,,,2120.8700,318.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1060.44,,,,,,,547.4000,2120.8700,percent of total billed charges,"Rev 272 $2,120.87 in Billed Charges at 50% = $1,060.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL INTERLOCK COROENT 2X12MM,272,RC,,,,,,,,both,,,2120.8700,318.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,685.04,,,,,,,547.4000,2120.8700,other,"32.3% of $2,120.87 in Billed Charges for Rev 272 = $685.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL INTERLOCK COROENT 2X12MM,272,RC,,,,,,,,both,,,2120.8700,318.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,651.11,,,,,,,547.4000,2120.8700,other,"30.7% of $2,120.87 in Billed Charges for Rev 272 = $651.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL INTERLOCK COROENT 2X12MM,272,RC,,,,,,,,both,,,2120.8700,318.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,685.04,,,,,,,547.4000,2120.8700,percent of total billed charges,"32.3% of $2,120.87 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL INTERLOCK COROENT 2X12MM,272,RC,,,,,,,,both,,,2120.8700,318.1300,WELLCARE,WELLCARE MEDICAID,2120.87,,,,,,,547.4000,2120.8700,percent of total billed charges,"100% of $2,120.87 in Billed Charges for Rev 272 = $2,120.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL J LATCH 1.1MM,272,RC,,,,,,,,both,,,671.9400,100.7900,AETNA,AETNA,286.92,,,,,,,173.4300,671.9400,percent of total billed charges,42.7% of $671.94 in Billed Charges for Rev 272 = $286.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J LATCH 1.1MM,272,RC,,,,,,,,both,,,671.9400,100.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,470.36,,,,,,,173.4300,671.9400,percent of total billed charges,Rev 272 $671.94 in Billed Charges at 70% = $470.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J LATCH 1.1MM,272,RC,,,,,,,,both,,,671.9400,100.7900,CIGNA HEALTHCARE,CIGNA HMO,280.20,,,,,,,173.4300,671.9400,percent of total billed charges,41.7% of $671.94 in Billed Charges for Rev 272 = $280.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J LATCH 1.1MM,272,RC,,,,,,,,both,,,671.9400,100.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,311.78,,,,,,,173.4300,671.9400,percent of total billed charges,46.4% of $671.94 in Billed Charges for Rev 272 = $311.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J LATCH 1.1MM,272,RC,,,,,,,,both,,,671.9400,100.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,280.20,,,,,,,173.4300,671.9400,percent of total billed charges,41.7% of $671.94 in Billed Charges for Rev 272 = $280.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J LATCH 1.1MM,272,RC,,,,,,,,both,,,671.9400,100.7900,CIGNA HEALTHCARE,CIGNA PPO,280.20,,,,,,,173.4300,671.9400,percent of total billed charges,41.7% of $671.94 in Billed Charges for Rev 272 = $280.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J LATCH 1.1MM,272,RC,,,,,,,,both,,,671.9400,100.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,604.75,,,,,,,173.4300,671.9400,percent of total billed charges,90% of $671.94 in Billed Charges for Rev 272 = $604.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J LATCH 1.1MM,272,RC,,,,,,,,both,,,671.9400,100.7900,MEDCOST,MEDCOST VHN,319.78,,,,,,,173.4300,671.9400,percent of total billed charges,47.59% of $671.94 in Billed Charges for Rev 272 = $319.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J LATCH 1.1MM,272,RC,,,,,,,,both,,,671.9400,100.7900,SENTARA HEALTH,SENTARA HEALTH,173.43,,,,,,,173.4300,671.9400,percent of total billed charges,25.81% of $671.94 in Billed Charges for Rev 272 = $173.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J LATCH 1.1MM,272,RC,,,,,,,,both,,,671.9400,100.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",671.94,,,,,,,173.4300,671.9400,percent of total billed charges,100% of $671.94 in Billed Charges for Rev 272 = $671.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J LATCH 1.1MM,272,RC,,,,,,,,both,,,671.9400,100.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,335.97,,,,,,,173.4300,671.9400,percent of total billed charges,Rev 272 $671.94 in Billed Charges at 50% = $335.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J LATCH 1.1MM,272,RC,,,,,,,,both,,,671.9400,100.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,217.04,,,,,,,173.4300,671.9400,other,32.3% of $671.94 in Billed Charges for Rev 272 = $217.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL J LATCH 1.1MM,272,RC,,,,,,,,both,,,671.9400,100.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,206.29,,,,,,,173.4300,671.9400,other,30.7% of $671.94 in Billed Charges for Rev 272 = $206.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL J LATCH 1.1MM,272,RC,,,,,,,,both,,,671.9400,100.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,217.04,,,,,,,173.4300,671.9400,percent of total billed charges,32.3% of $671.94 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J LATCH 1.1MM,272,RC,,,,,,,,both,,,671.9400,100.7900,WELLCARE,WELLCARE MEDICAID,671.94,,,,,,,173.4300,671.9400,percent of total billed charges,100% of $671.94 in Billed Charges for Rev 272 = $671.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J-LATCH FOR CLIDING HOLE 1.5MM,272,RC,27200002,CDM,,,,,,both,,,915.2400,137.2900,AETNA,AETNA,390.81,,,,,,,236.2200,915.2400,percent of total billed charges,42.7% of $915.24 in Billed Charges for Rev 272 = $390.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J-LATCH FOR CLIDING HOLE 1.5MM,272,RC,27200002,CDM,,,,,,both,,,915.2400,137.2900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,640.67,,,,,,,236.2200,915.2400,percent of total billed charges,Rev 272 $915.24 in Billed Charges at 70% = $640.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J-LATCH FOR CLIDING HOLE 1.5MM,272,RC,27200002,CDM,,,,,,both,,,915.2400,137.2900,CIGNA HEALTHCARE,CIGNA HMO,381.66,,,,,,,236.2200,915.2400,percent of total billed charges,41.7% of $915.24 in Billed Charges for Rev 272 = $381.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J-LATCH FOR CLIDING HOLE 1.5MM,272,RC,27200002,CDM,,,,,,both,,,915.2400,137.2900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,424.67,,,,,,,236.2200,915.2400,percent of total billed charges,46.4% of $915.24 in Billed Charges for Rev 272 = $424.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J-LATCH FOR CLIDING HOLE 1.5MM,272,RC,27200002,CDM,,,,,,both,,,915.2400,137.2900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,381.66,,,,,,,236.2200,915.2400,percent of total billed charges,41.7% of $915.24 in Billed Charges for Rev 272 = $381.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J-LATCH FOR CLIDING HOLE 1.5MM,272,RC,27200002,CDM,,,,,,both,,,915.2400,137.2900,CIGNA HEALTHCARE,CIGNA PPO,381.66,,,,,,,236.2200,915.2400,percent of total billed charges,41.7% of $915.24 in Billed Charges for Rev 272 = $381.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J-LATCH FOR CLIDING HOLE 1.5MM,272,RC,27200002,CDM,,,,,,both,,,915.2400,137.2900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,823.72,,,,,,,236.2200,915.2400,percent of total billed charges,90% of $915.24 in Billed Charges for Rev 272 = $823.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J-LATCH FOR CLIDING HOLE 1.5MM,272,RC,27200002,CDM,,,,,,both,,,915.2400,137.2900,MEDCOST,MEDCOST VHN,435.56,,,,,,,236.2200,915.2400,percent of total billed charges,47.59% of $915.24 in Billed Charges for Rev 272 = $435.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J-LATCH FOR CLIDING HOLE 1.5MM,272,RC,27200002,CDM,,,,,,both,,,915.2400,137.2900,SENTARA HEALTH,SENTARA HEALTH,236.22,,,,,,,236.2200,915.2400,percent of total billed charges,25.81% of $915.24 in Billed Charges for Rev 272 = $236.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J-LATCH FOR CLIDING HOLE 1.5MM,272,RC,27200002,CDM,,,,,,both,,,915.2400,137.2900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",915.24,,,,,,,236.2200,915.2400,percent of total billed charges,100% of $915.24 in Billed Charges for Rev 272 = $915.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J-LATCH FOR CLIDING HOLE 1.5MM,272,RC,27200002,CDM,,,,,,both,,,915.2400,137.2900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,457.62,,,,,,,236.2200,915.2400,percent of total billed charges,Rev 272 $915.24 in Billed Charges at 50% = $457.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J-LATCH FOR CLIDING HOLE 1.5MM,272,RC,27200002,CDM,,,,,,both,,,915.2400,137.2900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,295.62,,,,,,,236.2200,915.2400,other,32.3% of $915.24 in Billed Charges for Rev 272 = $295.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL J-LATCH FOR CLIDING HOLE 1.5MM,272,RC,27200002,CDM,,,,,,both,,,915.2400,137.2900,UNITED HEALTHCARE,UHC HERITAGE SELECT,280.98,,,,,,,236.2200,915.2400,other,30.7% of $915.24 in Billed Charges for Rev 272 = $280.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL J-LATCH FOR CLIDING HOLE 1.5MM,272,RC,27200002,CDM,,,,,,both,,,915.2400,137.2900,UNITED HEALTHCARE,UNITED HEALTHCARE,295.62,,,,,,,236.2200,915.2400,percent of total billed charges,32.3% of $915.24 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL J-LATCH FOR CLIDING HOLE 1.5MM,272,RC,27200002,CDM,,,,,,both,,,915.2400,137.2900,WELLCARE,WELLCARE MEDICAID,915.24,,,,,,,236.2200,915.2400,percent of total billed charges,100% of $915.24 in Billed Charges for Rev 272 = $915.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 380MM,272,RC,27200002,CDM,,,,,,both,,,4131.2900,619.6900,AETNA,AETNA,1764.06,,,,,,,1066.2900,4131.2900,percent of total billed charges,"42.7% of $4,131.29 in Billed Charges for Rev 272 = $1,764.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 3.5 X 380MM,272,RC,27200002,CDM,,,,,,both,,,4131.2900,619.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2891.90,,,,,,,1066.2900,4131.2900,percent of total billed charges,"Rev 272 $4,131.29 in Billed Charges at 70% = $2,891.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 3.5 X 380MM,272,RC,27200002,CDM,,,,,,both,,,4131.2900,619.6900,CIGNA HEALTHCARE,CIGNA HMO,1722.75,,,,,,,1066.2900,4131.2900,percent of total billed charges,"41.7% of $4,131.29 in Billed Charges for Rev 272 = $1,722.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 3.5 X 380MM,272,RC,27200002,CDM,,,,,,both,,,4131.2900,619.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1916.92,,,,,,,1066.2900,4131.2900,percent of total billed charges,"46.4% of $4,131.29 in Billed Charges for Rev 272 = $1,916.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 3.5 X 380MM,272,RC,27200002,CDM,,,,,,both,,,4131.2900,619.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1722.75,,,,,,,1066.2900,4131.2900,percent of total billed charges,"41.7% of $4,131.29 in Billed Charges for Rev 272 = $1,722.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 3.5 X 380MM,272,RC,27200002,CDM,,,,,,both,,,4131.2900,619.6900,CIGNA HEALTHCARE,CIGNA PPO,1722.75,,,,,,,1066.2900,4131.2900,percent of total billed charges,"41.7% of $4,131.29 in Billed Charges for Rev 272 = $1,722.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 3.5 X 380MM,272,RC,27200002,CDM,,,,,,both,,,4131.2900,619.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3718.16,,,,,,,1066.2900,4131.2900,percent of total billed charges,"90% of $4,131.29 in Billed Charges for Rev 272 = $3,718.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 3.5 X 380MM,272,RC,27200002,CDM,,,,,,both,,,4131.2900,619.6900,MEDCOST,MEDCOST VHN,1966.08,,,,,,,1066.2900,4131.2900,percent of total billed charges,"47.59% of $4,131.29 in Billed Charges for Rev 272 = $1,966.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 3.5 X 380MM,272,RC,27200002,CDM,,,,,,both,,,4131.2900,619.6900,SENTARA HEALTH,SENTARA HEALTH,1066.29,,,,,,,1066.2900,4131.2900,percent of total billed charges,"25.81% of $4,131.29 in Billed Charges for Rev 272 = $1,066.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 3.5 X 380MM,272,RC,27200002,CDM,,,,,,both,,,4131.2900,619.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4131.29,,,,,,,1066.2900,4131.2900,percent of total billed charges,"100% of $4,131.29 in Billed Charges for Rev 272 = $4,131.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 3.5 X 380MM,272,RC,27200002,CDM,,,,,,both,,,4131.2900,619.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2065.65,,,,,,,1066.2900,4131.2900,percent of total billed charges,"Rev 272 $4,131.29 in Billed Charges at 50% = $2,065.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 3.5 X 380MM,272,RC,27200002,CDM,,,,,,both,,,4131.2900,619.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1334.41,,,,,,,1066.2900,4131.2900,other,"32.3% of $4,131.29 in Billed Charges for Rev 272 = $1,334.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK COUPLING 3.5 X 380MM,272,RC,27200002,CDM,,,,,,both,,,4131.2900,619.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1268.31,,,,,,,1066.2900,4131.2900,other,"30.7% of $4,131.29 in Billed Charges for Rev 272 = $1,268.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK COUPLING 3.5 X 380MM,272,RC,27200002,CDM,,,,,,both,,,4131.2900,619.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,1334.41,,,,,,,1066.2900,4131.2900,percent of total billed charges,"32.3% of $4,131.29 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 3.5 X 380MM,272,RC,27200002,CDM,,,,,,both,,,4131.2900,619.6900,WELLCARE,WELLCARE MEDICAID,4131.29,,,,,,,1066.2900,4131.2900,percent of total billed charges,"100% of $4,131.29 in Billed Charges for Rev 272 = $4,131.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.3 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1039.6900,155.9500,AETNA,AETNA,443.95,,,,,,,268.3400,1039.6900,percent of total billed charges,"42.7% of $1,039.69 in Billed Charges for Rev 272 = $443.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.3 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1039.6900,155.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,727.78,,,,,,,268.3400,1039.6900,percent of total billed charges,"Rev 272 $1,039.69 in Billed Charges at 70% = $727.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.3 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1039.6900,155.9500,CIGNA HEALTHCARE,CIGNA HMO,433.55,,,,,,,268.3400,1039.6900,percent of total billed charges,"41.7% of $1,039.69 in Billed Charges for Rev 272 = $433.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.3 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1039.6900,155.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,482.42,,,,,,,268.3400,1039.6900,percent of total billed charges,"46.4% of $1,039.69 in Billed Charges for Rev 272 = $482.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.3 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1039.6900,155.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,433.55,,,,,,,268.3400,1039.6900,percent of total billed charges,"41.7% of $1,039.69 in Billed Charges for Rev 272 = $433.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.3 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1039.6900,155.9500,CIGNA HEALTHCARE,CIGNA PPO,433.55,,,,,,,268.3400,1039.6900,percent of total billed charges,"41.7% of $1,039.69 in Billed Charges for Rev 272 = $433.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.3 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1039.6900,155.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,935.72,,,,,,,268.3400,1039.6900,percent of total billed charges,"90% of $1,039.69 in Billed Charges for Rev 272 = $935.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.3 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1039.6900,155.9500,MEDCOST,MEDCOST VHN,494.79,,,,,,,268.3400,1039.6900,percent of total billed charges,"47.59% of $1,039.69 in Billed Charges for Rev 272 = $494.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.3 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1039.6900,155.9500,SENTARA HEALTH,SENTARA HEALTH,268.34,,,,,,,268.3400,1039.6900,percent of total billed charges,"25.81% of $1,039.69 in Billed Charges for Rev 272 = $268.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.3 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1039.6900,155.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1039.69,,,,,,,268.3400,1039.6900,percent of total billed charges,"100% of $1,039.69 in Billed Charges for Rev 272 = $1,039.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.3 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1039.6900,155.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,519.85,,,,,,,268.3400,1039.6900,percent of total billed charges,"Rev 272 $1,039.69 in Billed Charges at 50% = $519.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.3 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1039.6900,155.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,335.82,,,,,,,268.3400,1039.6900,other,"32.3% of $1,039.69 in Billed Charges for Rev 272 = $335.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK COUPLING 4.3 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1039.6900,155.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,319.18,,,,,,,268.3400,1039.6900,other,"30.7% of $1,039.69 in Billed Charges for Rev 272 = $319.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK COUPLING 4.3 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1039.6900,155.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,335.82,,,,,,,268.3400,1039.6900,percent of total billed charges,"32.3% of $1,039.69 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.3 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1039.6900,155.9500,WELLCARE,WELLCARE MEDICAID,1039.69,,,,,,,268.3400,1039.6900,percent of total billed charges,"100% of $1,039.69 in Billed Charges for Rev 272 = $1,039.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.5 X 195MM,272,RC,,,,,,,,both,,,1080.4500,162.0700,AETNA,AETNA,461.35,,,,,,,278.8600,1080.4500,percent of total billed charges,"42.7% of $1,080.45 in Billed Charges for Rev 272 = $461.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.5 X 195MM,272,RC,,,,,,,,both,,,1080.4500,162.0700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,756.32,,,,,,,278.8600,1080.4500,percent of total billed charges,"Rev 272 $1,080.45 in Billed Charges at 70% = $756.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.5 X 195MM,272,RC,,,,,,,,both,,,1080.4500,162.0700,CIGNA HEALTHCARE,CIGNA HMO,450.55,,,,,,,278.8600,1080.4500,percent of total billed charges,"41.7% of $1,080.45 in Billed Charges for Rev 272 = $450.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.5 X 195MM,272,RC,,,,,,,,both,,,1080.4500,162.0700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,501.33,,,,,,,278.8600,1080.4500,percent of total billed charges,"46.4% of $1,080.45 in Billed Charges for Rev 272 = $501.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.5 X 195MM,272,RC,,,,,,,,both,,,1080.4500,162.0700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,450.55,,,,,,,278.8600,1080.4500,percent of total billed charges,"41.7% of $1,080.45 in Billed Charges for Rev 272 = $450.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.5 X 195MM,272,RC,,,,,,,,both,,,1080.4500,162.0700,CIGNA HEALTHCARE,CIGNA PPO,450.55,,,,,,,278.8600,1080.4500,percent of total billed charges,"41.7% of $1,080.45 in Billed Charges for Rev 272 = $450.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.5 X 195MM,272,RC,,,,,,,,both,,,1080.4500,162.0700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,972.41,,,,,,,278.8600,1080.4500,percent of total billed charges,"90% of $1,080.45 in Billed Charges for Rev 272 = $972.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.5 X 195MM,272,RC,,,,,,,,both,,,1080.4500,162.0700,MEDCOST,MEDCOST VHN,514.19,,,,,,,278.8600,1080.4500,percent of total billed charges,"47.59% of $1,080.45 in Billed Charges for Rev 272 = $514.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.5 X 195MM,272,RC,,,,,,,,both,,,1080.4500,162.0700,SENTARA HEALTH,SENTARA HEALTH,278.86,,,,,,,278.8600,1080.4500,percent of total billed charges,"25.81% of $1,080.45 in Billed Charges for Rev 272 = $278.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.5 X 195MM,272,RC,,,,,,,,both,,,1080.4500,162.0700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1080.45,,,,,,,278.8600,1080.4500,percent of total billed charges,"100% of $1,080.45 in Billed Charges for Rev 272 = $1,080.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.5 X 195MM,272,RC,,,,,,,,both,,,1080.4500,162.0700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,540.23,,,,,,,278.8600,1080.4500,percent of total billed charges,"Rev 272 $1,080.45 in Billed Charges at 50% = $540.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.5 X 195MM,272,RC,,,,,,,,both,,,1080.4500,162.0700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,348.99,,,,,,,278.8600,1080.4500,other,"32.3% of $1,080.45 in Billed Charges for Rev 272 = $348.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK COUPLING 4.5 X 195MM,272,RC,,,,,,,,both,,,1080.4500,162.0700,UNITED HEALTHCARE,UHC HERITAGE SELECT,331.70,,,,,,,278.8600,1080.4500,other,"30.7% of $1,080.45 in Billed Charges for Rev 272 = $331.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK COUPLING 4.5 X 195MM,272,RC,,,,,,,,both,,,1080.4500,162.0700,UNITED HEALTHCARE,UNITED HEALTHCARE,348.99,,,,,,,278.8600,1080.4500,percent of total billed charges,"32.3% of $1,080.45 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 4.5 X 195MM,272,RC,,,,,,,,both,,,1080.4500,162.0700,WELLCARE,WELLCARE MEDICAID,1080.45,,,,,,,278.8600,1080.4500,percent of total billed charges,"100% of $1,080.45 in Billed Charges for Rev 272 = $1,080.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 3.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,653.7900,98.0700,AETNA,AETNA,279.17,,,,,,,168.7400,653.7900,percent of total billed charges,42.7% of $653.79 in Billed Charges for Rev 272 = $279.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,653.7900,98.0700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,457.65,,,,,,,168.7400,653.7900,percent of total billed charges,Rev 272 $653.79 in Billed Charges at 70% = $457.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,653.7900,98.0700,CIGNA HEALTHCARE,CIGNA HMO,272.63,,,,,,,168.7400,653.7900,percent of total billed charges,41.7% of $653.79 in Billed Charges for Rev 272 = $272.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,653.7900,98.0700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,303.36,,,,,,,168.7400,653.7900,percent of total billed charges,46.4% of $653.79 in Billed Charges for Rev 272 = $303.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,653.7900,98.0700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,272.63,,,,,,,168.7400,653.7900,percent of total billed charges,41.7% of $653.79 in Billed Charges for Rev 272 = $272.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,653.7900,98.0700,CIGNA HEALTHCARE,CIGNA PPO,272.63,,,,,,,168.7400,653.7900,percent of total billed charges,41.7% of $653.79 in Billed Charges for Rev 272 = $272.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,653.7900,98.0700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,588.41,,,,,,,168.7400,653.7900,percent of total billed charges,90% of $653.79 in Billed Charges for Rev 272 = $588.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,653.7900,98.0700,MEDCOST,MEDCOST VHN,311.14,,,,,,,168.7400,653.7900,percent of total billed charges,47.59% of $653.79 in Billed Charges for Rev 272 = $311.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,653.7900,98.0700,SENTARA HEALTH,SENTARA HEALTH,168.74,,,,,,,168.7400,653.7900,percent of total billed charges,25.81% of $653.79 in Billed Charges for Rev 272 = $168.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,653.7900,98.0700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",653.79,,,,,,,168.7400,653.7900,percent of total billed charges,100% of $653.79 in Billed Charges for Rev 272 = $653.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,653.7900,98.0700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,326.90,,,,,,,168.7400,653.7900,percent of total billed charges,Rev 272 $653.79 in Billed Charges at 50% = $326.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,653.7900,98.0700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,211.17,,,,,,,168.7400,653.7900,other,32.3% of $653.79 in Billed Charges for Rev 272 = $211.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL QUICK COUPLING 3.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,653.7900,98.0700,UNITED HEALTHCARE,UHC HERITAGE SELECT,200.71,,,,,,,168.7400,653.7900,other,30.7% of $653.79 in Billed Charges for Rev 272 = $200.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL QUICK COUPLING 3.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,653.7900,98.0700,UNITED HEALTHCARE,UNITED HEALTHCARE,211.17,,,,,,,168.7400,653.7900,percent of total billed charges,32.3% of $653.79 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,653.7900,98.0700,WELLCARE,WELLCARE MEDICAID,653.79,,,,,,,168.7400,653.7900,percent of total billed charges,100% of $653.79 in Billed Charges for Rev 272 = $653.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 195MM,272,RC,27200002,CDM,,,,,,both,,,690.0900,103.5100,AETNA,AETNA,294.67,,,,,,,178.1100,690.0900,percent of total billed charges,42.7% of $690.09 in Billed Charges for Rev 272 = $294.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 195MM,272,RC,27200002,CDM,,,,,,both,,,690.0900,103.5100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,483.06,,,,,,,178.1100,690.0900,percent of total billed charges,Rev 272 $690.09 in Billed Charges at 70% = $483.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 195MM,272,RC,27200002,CDM,,,,,,both,,,690.0900,103.5100,CIGNA HEALTHCARE,CIGNA HMO,287.77,,,,,,,178.1100,690.0900,percent of total billed charges,41.7% of $690.09 in Billed Charges for Rev 272 = $287.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 195MM,272,RC,27200002,CDM,,,,,,both,,,690.0900,103.5100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,320.20,,,,,,,178.1100,690.0900,percent of total billed charges,46.4% of $690.09 in Billed Charges for Rev 272 = $320.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 195MM,272,RC,27200002,CDM,,,,,,both,,,690.0900,103.5100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,287.77,,,,,,,178.1100,690.0900,percent of total billed charges,41.7% of $690.09 in Billed Charges for Rev 272 = $287.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 195MM,272,RC,27200002,CDM,,,,,,both,,,690.0900,103.5100,CIGNA HEALTHCARE,CIGNA PPO,287.77,,,,,,,178.1100,690.0900,percent of total billed charges,41.7% of $690.09 in Billed Charges for Rev 272 = $287.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 195MM,272,RC,27200002,CDM,,,,,,both,,,690.0900,103.5100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,621.08,,,,,,,178.1100,690.0900,percent of total billed charges,90% of $690.09 in Billed Charges for Rev 272 = $621.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 195MM,272,RC,27200002,CDM,,,,,,both,,,690.0900,103.5100,MEDCOST,MEDCOST VHN,328.41,,,,,,,178.1100,690.0900,percent of total billed charges,47.59% of $690.09 in Billed Charges for Rev 272 = $328.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 195MM,272,RC,27200002,CDM,,,,,,both,,,690.0900,103.5100,SENTARA HEALTH,SENTARA HEALTH,178.11,,,,,,,178.1100,690.0900,percent of total billed charges,25.81% of $690.09 in Billed Charges for Rev 272 = $178.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 195MM,272,RC,27200002,CDM,,,,,,both,,,690.0900,103.5100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",690.09,,,,,,,178.1100,690.0900,percent of total billed charges,100% of $690.09 in Billed Charges for Rev 272 = $690.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 195MM,272,RC,27200002,CDM,,,,,,both,,,690.0900,103.5100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,345.05,,,,,,,178.1100,690.0900,percent of total billed charges,Rev 272 $690.09 in Billed Charges at 50% = $345.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 195MM,272,RC,27200002,CDM,,,,,,both,,,690.0900,103.5100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,222.90,,,,,,,178.1100,690.0900,other,32.3% of $690.09 in Billed Charges for Rev 272 = $222.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL QUICK COUPLING 3.5 X 195MM,272,RC,27200002,CDM,,,,,,both,,,690.0900,103.5100,UNITED HEALTHCARE,UHC HERITAGE SELECT,211.86,,,,,,,178.1100,690.0900,other,30.7% of $690.09 in Billed Charges for Rev 272 = $211.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL QUICK COUPLING 3.5 X 195MM,272,RC,27200002,CDM,,,,,,both,,,690.0900,103.5100,UNITED HEALTHCARE,UNITED HEALTHCARE,222.90,,,,,,,178.1100,690.0900,percent of total billed charges,32.3% of $690.09 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.5 X 195MM,272,RC,27200002,CDM,,,,,,both,,,690.0900,103.5100,WELLCARE,WELLCARE MEDICAID,690.09,,,,,,,178.1100,690.0900,percent of total billed charges,100% of $690.09 in Billed Charges for Rev 272 = $690.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 4.5 X 145MM,272,RC,27200002,CDM,,,,,,both,,,649.2200,97.3800,AETNA,AETNA,277.22,,,,,,,167.5600,649.2200,percent of total billed charges,42.7% of $649.22 in Billed Charges for Rev 272 = $277.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 4.5 X 145MM,272,RC,27200002,CDM,,,,,,both,,,649.2200,97.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,454.45,,,,,,,167.5600,649.2200,percent of total billed charges,Rev 272 $649.22 in Billed Charges at 70% = $454.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 4.5 X 145MM,272,RC,27200002,CDM,,,,,,both,,,649.2200,97.3800,CIGNA HEALTHCARE,CIGNA HMO,270.72,,,,,,,167.5600,649.2200,percent of total billed charges,41.7% of $649.22 in Billed Charges for Rev 272 = $270.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 4.5 X 145MM,272,RC,27200002,CDM,,,,,,both,,,649.2200,97.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,301.24,,,,,,,167.5600,649.2200,percent of total billed charges,46.4% of $649.22 in Billed Charges for Rev 272 = $301.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 4.5 X 145MM,272,RC,27200002,CDM,,,,,,both,,,649.2200,97.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,270.72,,,,,,,167.5600,649.2200,percent of total billed charges,41.7% of $649.22 in Billed Charges for Rev 272 = $270.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 4.5 X 145MM,272,RC,27200002,CDM,,,,,,both,,,649.2200,97.3800,CIGNA HEALTHCARE,CIGNA PPO,270.72,,,,,,,167.5600,649.2200,percent of total billed charges,41.7% of $649.22 in Billed Charges for Rev 272 = $270.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 4.5 X 145MM,272,RC,27200002,CDM,,,,,,both,,,649.2200,97.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,584.30,,,,,,,167.5600,649.2200,percent of total billed charges,90% of $649.22 in Billed Charges for Rev 272 = $584.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 4.5 X 145MM,272,RC,27200002,CDM,,,,,,both,,,649.2200,97.3800,MEDCOST,MEDCOST VHN,308.96,,,,,,,167.5600,649.2200,percent of total billed charges,47.59% of $649.22 in Billed Charges for Rev 272 = $308.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 4.5 X 145MM,272,RC,27200002,CDM,,,,,,both,,,649.2200,97.3800,SENTARA HEALTH,SENTARA HEALTH,167.56,,,,,,,167.5600,649.2200,percent of total billed charges,25.81% of $649.22 in Billed Charges for Rev 272 = $167.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 4.5 X 145MM,272,RC,27200002,CDM,,,,,,both,,,649.2200,97.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",649.22,,,,,,,167.5600,649.2200,percent of total billed charges,100% of $649.22 in Billed Charges for Rev 272 = $649.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 4.5 X 145MM,272,RC,27200002,CDM,,,,,,both,,,649.2200,97.3800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,324.61,,,,,,,167.5600,649.2200,percent of total billed charges,Rev 272 $649.22 in Billed Charges at 50% = $324.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 4.5 X 145MM,272,RC,27200002,CDM,,,,,,both,,,649.2200,97.3800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,209.70,,,,,,,167.5600,649.2200,other,32.3% of $649.22 in Billed Charges for Rev 272 = $209.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL QUICK COUPLING 4.5 X 145MM,272,RC,27200002,CDM,,,,,,both,,,649.2200,97.3800,UNITED HEALTHCARE,UHC HERITAGE SELECT,199.31,,,,,,,167.5600,649.2200,other,30.7% of $649.22 in Billed Charges for Rev 272 = $199.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL QUICK COUPLING 4.5 X 145MM,272,RC,27200002,CDM,,,,,,both,,,649.2200,97.3800,UNITED HEALTHCARE,UNITED HEALTHCARE,209.70,,,,,,,167.5600,649.2200,percent of total billed charges,32.3% of $649.22 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 4.5 X 145MM,272,RC,27200002,CDM,,,,,,both,,,649.2200,97.3800,WELLCARE,WELLCARE MEDICAID,649.22,,,,,,,167.5600,649.2200,percent of total billed charges,100% of $649.22 in Billed Charges for Rev 272 = $649.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,595.0900,89.2600,AETNA,AETNA,254.10,,,,,,,153.5900,595.0900,percent of total billed charges,42.7% of $595.09 in Billed Charges for Rev 272 = $254.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,595.0900,89.2600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,416.56,,,,,,,153.5900,595.0900,percent of total billed charges,Rev 272 $595.09 in Billed Charges at 70% = $416.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,595.0900,89.2600,CIGNA HEALTHCARE,CIGNA HMO,248.15,,,,,,,153.5900,595.0900,percent of total billed charges,41.7% of $595.09 in Billed Charges for Rev 272 = $248.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,595.0900,89.2600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,276.12,,,,,,,153.5900,595.0900,percent of total billed charges,46.4% of $595.09 in Billed Charges for Rev 272 = $276.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,595.0900,89.2600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,248.15,,,,,,,153.5900,595.0900,percent of total billed charges,41.7% of $595.09 in Billed Charges for Rev 272 = $248.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,595.0900,89.2600,CIGNA HEALTHCARE,CIGNA PPO,248.15,,,,,,,153.5900,595.0900,percent of total billed charges,41.7% of $595.09 in Billed Charges for Rev 272 = $248.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,595.0900,89.2600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,535.58,,,,,,,153.5900,595.0900,percent of total billed charges,90% of $595.09 in Billed Charges for Rev 272 = $535.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,595.0900,89.2600,MEDCOST,MEDCOST VHN,283.20,,,,,,,153.5900,595.0900,percent of total billed charges,47.59% of $595.09 in Billed Charges for Rev 272 = $283.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,595.0900,89.2600,SENTARA HEALTH,SENTARA HEALTH,153.59,,,,,,,153.5900,595.0900,percent of total billed charges,25.81% of $595.09 in Billed Charges for Rev 272 = $153.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,595.0900,89.2600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",595.09,,,,,,,153.5900,595.0900,percent of total billed charges,100% of $595.09 in Billed Charges for Rev 272 = $595.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,595.0900,89.2600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,297.55,,,,,,,153.5900,595.0900,percent of total billed charges,Rev 272 $595.09 in Billed Charges at 50% = $297.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,595.0900,89.2600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,192.21,,,,,,,153.5900,595.0900,other,32.3% of $595.09 in Billed Charges for Rev 272 = $192.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,595.0900,89.2600,UNITED HEALTHCARE,UHC HERITAGE SELECT,182.69,,,,,,,153.5900,595.0900,other,30.7% of $595.09 in Billed Charges for Rev 272 = $182.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,595.0900,89.2600,UNITED HEALTHCARE,UNITED HEALTHCARE,192.21,,,,,,,153.5900,595.0900,percent of total billed charges,32.3% of $595.09 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,595.0900,89.2600,WELLCARE,WELLCARE MEDICAID,595.09,,,,,,,153.5900,595.0900,percent of total billed charges,100% of $595.09 in Billed Charges for Rev 272 = $595.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING WITH STOP 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,821.8000,123.2700,AETNA,AETNA,350.91,,,,,,,212.1100,821.8000,percent of total billed charges,42.7% of $821.80 in Billed Charges for Rev 272 = $350.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING WITH STOP 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,821.8000,123.2700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,575.26,,,,,,,212.1100,821.8000,percent of total billed charges,Rev 272 $821.80 in Billed Charges at 70% = $575.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING WITH STOP 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,821.8000,123.2700,CIGNA HEALTHCARE,CIGNA HMO,342.69,,,,,,,212.1100,821.8000,percent of total billed charges,41.7% of $821.80 in Billed Charges for Rev 272 = $342.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING WITH STOP 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,821.8000,123.2700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,381.32,,,,,,,212.1100,821.8000,percent of total billed charges,46.4% of $821.80 in Billed Charges for Rev 272 = $381.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING WITH STOP 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,821.8000,123.2700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,342.69,,,,,,,212.1100,821.8000,percent of total billed charges,41.7% of $821.80 in Billed Charges for Rev 272 = $342.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING WITH STOP 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,821.8000,123.2700,CIGNA HEALTHCARE,CIGNA PPO,342.69,,,,,,,212.1100,821.8000,percent of total billed charges,41.7% of $821.80 in Billed Charges for Rev 272 = $342.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING WITH STOP 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,821.8000,123.2700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,739.62,,,,,,,212.1100,821.8000,percent of total billed charges,90% of $821.80 in Billed Charges for Rev 272 = $739.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING WITH STOP 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,821.8000,123.2700,MEDCOST,MEDCOST VHN,391.09,,,,,,,212.1100,821.8000,percent of total billed charges,47.59% of $821.80 in Billed Charges for Rev 272 = $391.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING WITH STOP 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,821.8000,123.2700,SENTARA HEALTH,SENTARA HEALTH,212.11,,,,,,,212.1100,821.8000,percent of total billed charges,25.81% of $821.80 in Billed Charges for Rev 272 = $212.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING WITH STOP 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,821.8000,123.2700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",821.80,,,,,,,212.1100,821.8000,percent of total billed charges,100% of $821.80 in Billed Charges for Rev 272 = $821.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING WITH STOP 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,821.8000,123.2700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,410.90,,,,,,,212.1100,821.8000,percent of total billed charges,Rev 272 $821.80 in Billed Charges at 50% = $410.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING WITH STOP 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,821.8000,123.2700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,265.44,,,,,,,212.1100,821.8000,other,32.3% of $821.80 in Billed Charges for Rev 272 = $265.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL QUICK COUPLING WITH STOP 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,821.8000,123.2700,UNITED HEALTHCARE,UHC HERITAGE SELECT,252.29,,,,,,,212.1100,821.8000,other,30.7% of $821.80 in Billed Charges for Rev 272 = $252.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL QUICK COUPLING WITH STOP 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,821.8000,123.2700,UNITED HEALTHCARE,UNITED HEALTHCARE,265.44,,,,,,,212.1100,821.8000,percent of total billed charges,32.3% of $821.80 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING WITH STOP 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,821.8000,123.2700,WELLCARE,WELLCARE MEDICAID,821.80,,,,,,,212.1100,821.8000,percent of total billed charges,100% of $821.80 in Billed Charges for Rev 272 = $821.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK RELEASE 1.5MM,272,RC,,,,,,,,both,,,1088.9600,163.3400,AETNA,AETNA,464.99,,,,,,,281.0600,1088.9600,percent of total billed charges,"42.7% of $1,088.96 in Billed Charges for Rev 272 = $464.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 1.5MM,272,RC,,,,,,,,both,,,1088.9600,163.3400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,762.27,,,,,,,281.0600,1088.9600,percent of total billed charges,"Rev 272 $1,088.96 in Billed Charges at 70% = $762.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 1.5MM,272,RC,,,,,,,,both,,,1088.9600,163.3400,CIGNA HEALTHCARE,CIGNA HMO,454.10,,,,,,,281.0600,1088.9600,percent of total billed charges,"41.7% of $1,088.96 in Billed Charges for Rev 272 = $454.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 1.5MM,272,RC,,,,,,,,both,,,1088.9600,163.3400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,505.28,,,,,,,281.0600,1088.9600,percent of total billed charges,"46.4% of $1,088.96 in Billed Charges for Rev 272 = $505.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 1.5MM,272,RC,,,,,,,,both,,,1088.9600,163.3400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,454.10,,,,,,,281.0600,1088.9600,percent of total billed charges,"41.7% of $1,088.96 in Billed Charges for Rev 272 = $454.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 1.5MM,272,RC,,,,,,,,both,,,1088.9600,163.3400,CIGNA HEALTHCARE,CIGNA PPO,454.10,,,,,,,281.0600,1088.9600,percent of total billed charges,"41.7% of $1,088.96 in Billed Charges for Rev 272 = $454.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 1.5MM,272,RC,,,,,,,,both,,,1088.9600,163.3400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,980.06,,,,,,,281.0600,1088.9600,percent of total billed charges,"90% of $1,088.96 in Billed Charges for Rev 272 = $980.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 1.5MM,272,RC,,,,,,,,both,,,1088.9600,163.3400,MEDCOST,MEDCOST VHN,518.24,,,,,,,281.0600,1088.9600,percent of total billed charges,"47.59% of $1,088.96 in Billed Charges for Rev 272 = $518.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 1.5MM,272,RC,,,,,,,,both,,,1088.9600,163.3400,SENTARA HEALTH,SENTARA HEALTH,281.06,,,,,,,281.0600,1088.9600,percent of total billed charges,"25.81% of $1,088.96 in Billed Charges for Rev 272 = $281.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 1.5MM,272,RC,,,,,,,,both,,,1088.9600,163.3400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1088.96,,,,,,,281.0600,1088.9600,percent of total billed charges,"100% of $1,088.96 in Billed Charges for Rev 272 = $1,088.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 1.5MM,272,RC,,,,,,,,both,,,1088.9600,163.3400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,544.48,,,,,,,281.0600,1088.9600,percent of total billed charges,"Rev 272 $1,088.96 in Billed Charges at 50% = $544.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 1.5MM,272,RC,,,,,,,,both,,,1088.9600,163.3400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,351.73,,,,,,,281.0600,1088.9600,other,"32.3% of $1,088.96 in Billed Charges for Rev 272 = $351.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK RELEASE 1.5MM,272,RC,,,,,,,,both,,,1088.9600,163.3400,UNITED HEALTHCARE,UHC HERITAGE SELECT,334.31,,,,,,,281.0600,1088.9600,other,"30.7% of $1,088.96 in Billed Charges for Rev 272 = $334.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK RELEASE 1.5MM,272,RC,,,,,,,,both,,,1088.9600,163.3400,UNITED HEALTHCARE,UNITED HEALTHCARE,351.73,,,,,,,281.0600,1088.9600,percent of total billed charges,"32.3% of $1,088.96 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 1.5MM,272,RC,,,,,,,,both,,,1088.9600,163.3400,WELLCARE,WELLCARE MEDICAID,1088.96,,,,,,,281.0600,1088.9600,percent of total billed charges,"100% of $1,088.96 in Billed Charges for Rev 272 = $1,088.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.3MM,272,RC,,,,,,,,both,,,1617.8800,242.6800,AETNA,AETNA,690.83,,,,,,,417.5700,1617.8800,percent of total billed charges,"42.7% of $1,617.88 in Billed Charges for Rev 272 = $690.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.3MM,272,RC,,,,,,,,both,,,1617.8800,242.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1132.52,,,,,,,417.5700,1617.8800,percent of total billed charges,"Rev 272 $1,617.88 in Billed Charges at 70% = $1,132.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.3MM,272,RC,,,,,,,,both,,,1617.8800,242.6800,CIGNA HEALTHCARE,CIGNA HMO,674.66,,,,,,,417.5700,1617.8800,percent of total billed charges,"41.7% of $1,617.88 in Billed Charges for Rev 272 = $674.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.3MM,272,RC,,,,,,,,both,,,1617.8800,242.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,750.70,,,,,,,417.5700,1617.8800,percent of total billed charges,"46.4% of $1,617.88 in Billed Charges for Rev 272 = $750.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.3MM,272,RC,,,,,,,,both,,,1617.8800,242.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,674.66,,,,,,,417.5700,1617.8800,percent of total billed charges,"41.7% of $1,617.88 in Billed Charges for Rev 272 = $674.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.3MM,272,RC,,,,,,,,both,,,1617.8800,242.6800,CIGNA HEALTHCARE,CIGNA PPO,674.66,,,,,,,417.5700,1617.8800,percent of total billed charges,"41.7% of $1,617.88 in Billed Charges for Rev 272 = $674.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.3MM,272,RC,,,,,,,,both,,,1617.8800,242.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1456.09,,,,,,,417.5700,1617.8800,percent of total billed charges,"90% of $1,617.88 in Billed Charges for Rev 272 = $1,456.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.3MM,272,RC,,,,,,,,both,,,1617.8800,242.6800,MEDCOST,MEDCOST VHN,769.95,,,,,,,417.5700,1617.8800,percent of total billed charges,"47.59% of $1,617.88 in Billed Charges for Rev 272 = $769.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.3MM,272,RC,,,,,,,,both,,,1617.8800,242.6800,SENTARA HEALTH,SENTARA HEALTH,417.57,,,,,,,417.5700,1617.8800,percent of total billed charges,"25.81% of $1,617.88 in Billed Charges for Rev 272 = $417.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.3MM,272,RC,,,,,,,,both,,,1617.8800,242.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1617.88,,,,,,,417.5700,1617.8800,percent of total billed charges,"100% of $1,617.88 in Billed Charges for Rev 272 = $1,617.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.3MM,272,RC,,,,,,,,both,,,1617.8800,242.6800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,808.94,,,,,,,417.5700,1617.8800,percent of total billed charges,"Rev 272 $1,617.88 in Billed Charges at 50% = $808.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.3MM,272,RC,,,,,,,,both,,,1617.8800,242.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,522.58,,,,,,,417.5700,1617.8800,other,"32.3% of $1,617.88 in Billed Charges for Rev 272 = $522.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK RELEASE 2.3MM,272,RC,,,,,,,,both,,,1617.8800,242.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,496.69,,,,,,,417.5700,1617.8800,other,"30.7% of $1,617.88 in Billed Charges for Rev 272 = $496.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK RELEASE 2.3MM,272,RC,,,,,,,,both,,,1617.8800,242.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,522.58,,,,,,,417.5700,1617.8800,percent of total billed charges,"32.3% of $1,617.88 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.3MM,272,RC,,,,,,,,both,,,1617.8800,242.6800,WELLCARE,WELLCARE MEDICAID,1617.88,,,,,,,417.5700,1617.8800,percent of total billed charges,"100% of $1,617.88 in Billed Charges for Rev 272 = $1,617.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,612.9300,91.9400,AETNA,AETNA,261.72,,,,,,,158.2000,612.9300,percent of total billed charges,42.7% of $612.93 in Billed Charges for Rev 272 = $261.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,612.9300,91.9400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,429.05,,,,,,,158.2000,612.9300,percent of total billed charges,Rev 272 $612.93 in Billed Charges at 70% = $429.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,612.9300,91.9400,CIGNA HEALTHCARE,CIGNA HMO,255.59,,,,,,,158.2000,612.9300,percent of total billed charges,41.7% of $612.93 in Billed Charges for Rev 272 = $255.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,612.9300,91.9400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,284.40,,,,,,,158.2000,612.9300,percent of total billed charges,46.4% of $612.93 in Billed Charges for Rev 272 = $284.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,612.9300,91.9400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,255.59,,,,,,,158.2000,612.9300,percent of total billed charges,41.7% of $612.93 in Billed Charges for Rev 272 = $255.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,612.9300,91.9400,CIGNA HEALTHCARE,CIGNA PPO,255.59,,,,,,,158.2000,612.9300,percent of total billed charges,41.7% of $612.93 in Billed Charges for Rev 272 = $255.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,612.9300,91.9400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,551.64,,,,,,,158.2000,612.9300,percent of total billed charges,90% of $612.93 in Billed Charges for Rev 272 = $551.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,612.9300,91.9400,MEDCOST,MEDCOST VHN,291.69,,,,,,,158.2000,612.9300,percent of total billed charges,47.59% of $612.93 in Billed Charges for Rev 272 = $291.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,612.9300,91.9400,SENTARA HEALTH,SENTARA HEALTH,158.20,,,,,,,158.2000,612.9300,percent of total billed charges,25.81% of $612.93 in Billed Charges for Rev 272 = $158.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,612.9300,91.9400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",612.93,,,,,,,158.2000,612.9300,percent of total billed charges,100% of $612.93 in Billed Charges for Rev 272 = $612.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,612.9300,91.9400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,306.47,,,,,,,158.2000,612.9300,percent of total billed charges,Rev 272 $612.93 in Billed Charges at 50% = $306.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,612.9300,91.9400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,197.98,,,,,,,158.2000,612.9300,other,32.3% of $612.93 in Billed Charges for Rev 272 = $197.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,612.9300,91.9400,UNITED HEALTHCARE,UHC HERITAGE SELECT,188.17,,,,,,,158.2000,612.9300,other,30.7% of $612.93 in Billed Charges for Rev 272 = $188.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,612.9300,91.9400,UNITED HEALTHCARE,UNITED HEALTHCARE,197.98,,,,,,,158.2000,612.9300,percent of total billed charges,32.3% of $612.93 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING GOLD 2.5 X 110MM,272,RC,27200002,CDM,,,,,,both,,,612.9300,91.9400,WELLCARE,WELLCARE MEDICAID,612.93,,,,,,,158.2000,612.9300,percent of total billed charges,100% of $612.93 in Billed Charges for Rev 272 = $612.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK RELEASE 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1586.7600,238.0100,AETNA,AETNA,677.55,,,,,,,409.5400,1586.7600,percent of total billed charges,"42.7% of $1,586.76 in Billed Charges for Rev 272 = $677.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1586.7600,238.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1110.73,,,,,,,409.5400,1586.7600,percent of total billed charges,"Rev 272 $1,586.76 in Billed Charges at 70% = $1,110.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1586.7600,238.0100,CIGNA HEALTHCARE,CIGNA HMO,661.68,,,,,,,409.5400,1586.7600,percent of total billed charges,"41.7% of $1,586.76 in Billed Charges for Rev 272 = $661.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1586.7600,238.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,736.26,,,,,,,409.5400,1586.7600,percent of total billed charges,"46.4% of $1,586.76 in Billed Charges for Rev 272 = $736.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1586.7600,238.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,661.68,,,,,,,409.5400,1586.7600,percent of total billed charges,"41.7% of $1,586.76 in Billed Charges for Rev 272 = $661.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1586.7600,238.0100,CIGNA HEALTHCARE,CIGNA PPO,661.68,,,,,,,409.5400,1586.7600,percent of total billed charges,"41.7% of $1,586.76 in Billed Charges for Rev 272 = $661.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1586.7600,238.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1428.08,,,,,,,409.5400,1586.7600,percent of total billed charges,"90% of $1,586.76 in Billed Charges for Rev 272 = $1,428.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1586.7600,238.0100,MEDCOST,MEDCOST VHN,755.14,,,,,,,409.5400,1586.7600,percent of total billed charges,"47.59% of $1,586.76 in Billed Charges for Rev 272 = $755.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1586.7600,238.0100,SENTARA HEALTH,SENTARA HEALTH,409.54,,,,,,,409.5400,1586.7600,percent of total billed charges,"25.81% of $1,586.76 in Billed Charges for Rev 272 = $409.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1586.7600,238.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1586.76,,,,,,,409.5400,1586.7600,percent of total billed charges,"100% of $1,586.76 in Billed Charges for Rev 272 = $1,586.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1586.7600,238.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,793.38,,,,,,,409.5400,1586.7600,percent of total billed charges,"Rev 272 $1,586.76 in Billed Charges at 50% = $793.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1586.7600,238.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,512.52,,,,,,,409.5400,1586.7600,other,"32.3% of $1,586.76 in Billed Charges for Rev 272 = $512.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1586.7600,238.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,487.14,,,,,,,409.5400,1586.7600,other,"30.7% of $1,586.76 in Billed Charges for Rev 272 = $487.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1586.7600,238.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,512.52,,,,,,,409.5400,1586.7600,percent of total billed charges,"32.3% of $1,586.76 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1586.7600,238.0100,WELLCARE,WELLCARE MEDICAID,1586.76,,,,,,,409.5400,1586.7600,percent of total billed charges,"100% of $1,586.76 in Billed Charges for Rev 272 = $1,586.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,,,,,,,,both,,,1669.7300,250.4600,AETNA,AETNA,712.97,,,,,,,430.9600,1669.7300,percent of total billed charges,"42.7% of $1,669.73 in Billed Charges for Rev 272 = $712.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,,,,,,,,both,,,1669.7300,250.4600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1168.81,,,,,,,430.9600,1669.7300,percent of total billed charges,"Rev 272 $1,669.73 in Billed Charges at 70% = $1,168.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,,,,,,,,both,,,1669.7300,250.4600,CIGNA HEALTHCARE,CIGNA HMO,696.28,,,,,,,430.9600,1669.7300,percent of total billed charges,"41.7% of $1,669.73 in Billed Charges for Rev 272 = $696.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,,,,,,,,both,,,1669.7300,250.4600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,774.75,,,,,,,430.9600,1669.7300,percent of total billed charges,"46.4% of $1,669.73 in Billed Charges for Rev 272 = $774.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,,,,,,,,both,,,1669.7300,250.4600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,696.28,,,,,,,430.9600,1669.7300,percent of total billed charges,"41.7% of $1,669.73 in Billed Charges for Rev 272 = $696.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,,,,,,,,both,,,1669.7300,250.4600,CIGNA HEALTHCARE,CIGNA PPO,696.28,,,,,,,430.9600,1669.7300,percent of total billed charges,"41.7% of $1,669.73 in Billed Charges for Rev 272 = $696.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,,,,,,,,both,,,1669.7300,250.4600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1502.76,,,,,,,430.9600,1669.7300,percent of total billed charges,"90% of $1,669.73 in Billed Charges for Rev 272 = $1,502.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,,,,,,,,both,,,1669.7300,250.4600,MEDCOST,MEDCOST VHN,794.62,,,,,,,430.9600,1669.7300,percent of total billed charges,"47.59% of $1,669.73 in Billed Charges for Rev 272 = $794.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,,,,,,,,both,,,1669.7300,250.4600,SENTARA HEALTH,SENTARA HEALTH,430.96,,,,,,,430.9600,1669.7300,percent of total billed charges,"25.81% of $1,669.73 in Billed Charges for Rev 272 = $430.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,,,,,,,,both,,,1669.7300,250.4600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1669.73,,,,,,,430.9600,1669.7300,percent of total billed charges,"100% of $1,669.73 in Billed Charges for Rev 272 = $1,669.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,,,,,,,,both,,,1669.7300,250.4600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,834.87,,,,,,,430.9600,1669.7300,percent of total billed charges,"Rev 272 $1,669.73 in Billed Charges at 50% = $834.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,,,,,,,,both,,,1669.7300,250.4600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,539.32,,,,,,,430.9600,1669.7300,other,"32.3% of $1,669.73 in Billed Charges for Rev 272 = $539.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,,,,,,,,both,,,1669.7300,250.4600,UNITED HEALTHCARE,UHC HERITAGE SELECT,512.61,,,,,,,430.9600,1669.7300,other,"30.7% of $1,669.73 in Billed Charges for Rev 272 = $512.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,,,,,,,,both,,,1669.7300,250.4600,UNITED HEALTHCARE,UNITED HEALTHCARE,539.32,,,,,,,430.9600,1669.7300,percent of total billed charges,"32.3% of $1,669.73 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.0MM,272,RC,,,,,,,,both,,,1669.7300,250.4600,WELLCARE,WELLCARE MEDICAID,1669.73,,,,,,,430.9600,1669.7300,percent of total billed charges,"100% of $1,669.73 in Billed Charges for Rev 272 = $1,669.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1721.5900,258.2400,AETNA,AETNA,735.12,,,,,,,444.3400,1721.5900,percent of total billed charges,"42.7% of $1,721.59 in Billed Charges for Rev 272 = $735.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1721.5900,258.2400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1205.11,,,,,,,444.3400,1721.5900,percent of total billed charges,"Rev 272 $1,721.59 in Billed Charges at 70% = $1,205.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1721.5900,258.2400,CIGNA HEALTHCARE,CIGNA HMO,717.90,,,,,,,444.3400,1721.5900,percent of total billed charges,"41.7% of $1,721.59 in Billed Charges for Rev 272 = $717.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1721.5900,258.2400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,798.82,,,,,,,444.3400,1721.5900,percent of total billed charges,"46.4% of $1,721.59 in Billed Charges for Rev 272 = $798.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1721.5900,258.2400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,717.90,,,,,,,444.3400,1721.5900,percent of total billed charges,"41.7% of $1,721.59 in Billed Charges for Rev 272 = $717.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1721.5900,258.2400,CIGNA HEALTHCARE,CIGNA PPO,717.90,,,,,,,444.3400,1721.5900,percent of total billed charges,"41.7% of $1,721.59 in Billed Charges for Rev 272 = $717.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1721.5900,258.2400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1549.43,,,,,,,444.3400,1721.5900,percent of total billed charges,"90% of $1,721.59 in Billed Charges for Rev 272 = $1,549.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1721.5900,258.2400,MEDCOST,MEDCOST VHN,819.30,,,,,,,444.3400,1721.5900,percent of total billed charges,"47.59% of $1,721.59 in Billed Charges for Rev 272 = $819.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1721.5900,258.2400,SENTARA HEALTH,SENTARA HEALTH,444.34,,,,,,,444.3400,1721.5900,percent of total billed charges,"25.81% of $1,721.59 in Billed Charges for Rev 272 = $444.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1721.5900,258.2400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1721.59,,,,,,,444.3400,1721.5900,percent of total billed charges,"100% of $1,721.59 in Billed Charges for Rev 272 = $1,721.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1721.5900,258.2400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,860.80,,,,,,,444.3400,1721.5900,percent of total billed charges,"Rev 272 $1,721.59 in Billed Charges at 50% = $860.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1721.5900,258.2400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,556.07,,,,,,,444.3400,1721.5900,other,"32.3% of $1,721.59 in Billed Charges for Rev 272 = $556.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK RELEASE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1721.5900,258.2400,UNITED HEALTHCARE,UHC HERITAGE SELECT,528.53,,,,,,,444.3400,1721.5900,other,"30.7% of $1,721.59 in Billed Charges for Rev 272 = $528.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK RELEASE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1721.5900,258.2400,UNITED HEALTHCARE,UNITED HEALTHCARE,556.07,,,,,,,444.3400,1721.5900,percent of total billed charges,"32.3% of $1,721.59 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK RELEASE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1721.5900,258.2400,WELLCARE,WELLCARE MEDICAID,1721.59,,,,,,,444.3400,1721.5900,percent of total billed charges,"100% of $1,721.59 in Billed Charges for Rev 272 = $1,721.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL FINE 3.2MM,272,RC,27200002,CDM,,,,,,both,,,3506.7900,526.0200,AETNA,AETNA,1497.40,,,,,,,905.1000,3506.7900,percent of total billed charges,"42.7% of $3,506.79 in Billed Charges for Rev 272 = $1,497.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL FINE 3.2MM,272,RC,27200002,CDM,,,,,,both,,,3506.7900,526.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2454.75,,,,,,,905.1000,3506.7900,percent of total billed charges,"Rev 272 $3,506.79 in Billed Charges at 70% = $2,454.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL FINE 3.2MM,272,RC,27200002,CDM,,,,,,both,,,3506.7900,526.0200,CIGNA HEALTHCARE,CIGNA HMO,1462.33,,,,,,,905.1000,3506.7900,percent of total billed charges,"41.7% of $3,506.79 in Billed Charges for Rev 272 = $1,462.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL FINE 3.2MM,272,RC,27200002,CDM,,,,,,both,,,3506.7900,526.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1627.15,,,,,,,905.1000,3506.7900,percent of total billed charges,"46.4% of $3,506.79 in Billed Charges for Rev 272 = $1,627.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL FINE 3.2MM,272,RC,27200002,CDM,,,,,,both,,,3506.7900,526.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1462.33,,,,,,,905.1000,3506.7900,percent of total billed charges,"41.7% of $3,506.79 in Billed Charges for Rev 272 = $1,462.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL FINE 3.2MM,272,RC,27200002,CDM,,,,,,both,,,3506.7900,526.0200,CIGNA HEALTHCARE,CIGNA PPO,1462.33,,,,,,,905.1000,3506.7900,percent of total billed charges,"41.7% of $3,506.79 in Billed Charges for Rev 272 = $1,462.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL FINE 3.2MM,272,RC,27200002,CDM,,,,,,both,,,3506.7900,526.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3156.11,,,,,,,905.1000,3506.7900,percent of total billed charges,"90% of $3,506.79 in Billed Charges for Rev 272 = $3,156.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL FINE 3.2MM,272,RC,27200002,CDM,,,,,,both,,,3506.7900,526.0200,MEDCOST,MEDCOST VHN,1668.88,,,,,,,905.1000,3506.7900,percent of total billed charges,"47.59% of $3,506.79 in Billed Charges for Rev 272 = $1,668.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL FINE 3.2MM,272,RC,27200002,CDM,,,,,,both,,,3506.7900,526.0200,SENTARA HEALTH,SENTARA HEALTH,905.10,,,,,,,905.1000,3506.7900,percent of total billed charges,"25.81% of $3,506.79 in Billed Charges for Rev 272 = $905.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL FINE 3.2MM,272,RC,27200002,CDM,,,,,,both,,,3506.7900,526.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3506.79,,,,,,,905.1000,3506.7900,percent of total billed charges,"100% of $3,506.79 in Billed Charges for Rev 272 = $3,506.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL FINE 3.2MM,272,RC,27200002,CDM,,,,,,both,,,3506.7900,526.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1753.40,,,,,,,905.1000,3506.7900,percent of total billed charges,"Rev 272 $3,506.79 in Billed Charges at 50% = $1,753.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL FINE 3.2MM,272,RC,27200002,CDM,,,,,,both,,,3506.7900,526.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1132.69,,,,,,,905.1000,3506.7900,other,"32.3% of $3,506.79 in Billed Charges for Rev 272 = $1,132.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE BONE MILL FINE 3.2MM,272,RC,27200002,CDM,,,,,,both,,,3506.7900,526.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1076.58,,,,,,,905.1000,3506.7900,other,"30.7% of $3,506.79 in Billed Charges for Rev 272 = $1,076.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE BONE MILL FINE 3.2MM,272,RC,27200002,CDM,,,,,,both,,,3506.7900,526.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,1132.69,,,,,,,905.1000,3506.7900,percent of total billed charges,"32.3% of $3,506.79 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL FINE 3.2MM,272,RC,27200002,CDM,,,,,,both,,,3506.7900,526.0200,WELLCARE,WELLCARE MEDICAID,3506.79,,,,,,,905.1000,3506.7900,percent of total billed charges,"100% of $3,506.79 in Billed Charges for Rev 272 = $3,506.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CABLE CUTTER,272,RC,,,,,,,,both,,,9724.4700,1458.6700,AETNA,AETNA,4152.35,,,,,,,2509.8900,9724.4700,percent of total billed charges,"42.7% of $9,724.47 in Billed Charges for Rev 272 = $4,152.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CABLE CUTTER,272,RC,,,,,,,,both,,,9724.4700,1458.6700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6807.13,,,,,,,2509.8900,9724.4700,percent of total billed charges,"Rev 272 $9,724.47 in Billed Charges at 70% = $6,807.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CABLE CUTTER,272,RC,,,,,,,,both,,,9724.4700,1458.6700,CIGNA HEALTHCARE,CIGNA HMO,4055.10,,,,,,,2509.8900,9724.4700,percent of total billed charges,"41.7% of $9,724.47 in Billed Charges for Rev 272 = $4,055.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CABLE CUTTER,272,RC,,,,,,,,both,,,9724.4700,1458.6700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4512.15,,,,,,,2509.8900,9724.4700,percent of total billed charges,"46.4% of $9,724.47 in Billed Charges for Rev 272 = $4,512.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CABLE CUTTER,272,RC,,,,,,,,both,,,9724.4700,1458.6700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4055.10,,,,,,,2509.8900,9724.4700,percent of total billed charges,"41.7% of $9,724.47 in Billed Charges for Rev 272 = $4,055.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CABLE CUTTER,272,RC,,,,,,,,both,,,9724.4700,1458.6700,CIGNA HEALTHCARE,CIGNA PPO,4055.10,,,,,,,2509.8900,9724.4700,percent of total billed charges,"41.7% of $9,724.47 in Billed Charges for Rev 272 = $4,055.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CABLE CUTTER,272,RC,,,,,,,,both,,,9724.4700,1458.6700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8752.02,,,,,,,2509.8900,9724.4700,percent of total billed charges,"90% of $9,724.47 in Billed Charges for Rev 272 = $8,752.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CABLE CUTTER,272,RC,,,,,,,,both,,,9724.4700,1458.6700,MEDCOST,MEDCOST VHN,4627.88,,,,,,,2509.8900,9724.4700,percent of total billed charges,"47.59% of $9,724.47 in Billed Charges for Rev 272 = $4,627.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CABLE CUTTER,272,RC,,,,,,,,both,,,9724.4700,1458.6700,SENTARA HEALTH,SENTARA HEALTH,2509.89,,,,,,,2509.8900,9724.4700,percent of total billed charges,"25.81% of $9,724.47 in Billed Charges for Rev 272 = $2,509.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CABLE CUTTER,272,RC,,,,,,,,both,,,9724.4700,1458.6700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9724.47,,,,,,,2509.8900,9724.4700,percent of total billed charges,"100% of $9,724.47 in Billed Charges for Rev 272 = $9,724.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CABLE CUTTER,272,RC,,,,,,,,both,,,9724.4700,1458.6700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4862.24,,,,,,,2509.8900,9724.4700,percent of total billed charges,"Rev 272 $9,724.47 in Billed Charges at 50% = $4,862.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CABLE CUTTER,272,RC,,,,,,,,both,,,9724.4700,1458.6700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3141.00,,,,,,,2509.8900,9724.4700,other,"32.3% of $9,724.47 in Billed Charges for Rev 272 = $3,141.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE CABLE CUTTER,272,RC,,,,,,,,both,,,9724.4700,1458.6700,UNITED HEALTHCARE,UHC HERITAGE SELECT,2985.41,,,,,,,2509.8900,9724.4700,other,"30.7% of $9,724.47 in Billed Charges for Rev 272 = $2,985.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE CABLE CUTTER,272,RC,,,,,,,,both,,,9724.4700,1458.6700,UNITED HEALTHCARE,UNITED HEALTHCARE,3141.00,,,,,,,2509.8900,9724.4700,percent of total billed charges,"32.3% of $9,724.47 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CABLE CUTTER,272,RC,,,,,,,,both,,,9724.4700,1458.6700,WELLCARE,WELLCARE MEDICAID,9724.47,,,,,,,2509.8900,9724.4700,percent of total billed charges,"100% of $9,724.47 in Billed Charges for Rev 272 = $9,724.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICKSET FLEX 30MM,272,RC,,,,,,,,both,,,10557.6800,1583.6500,AETNA,AETNA,4508.13,,,,,,,2724.9400,10557.6800,percent of total billed charges,"42.7% of $10,557.68 in Billed Charges for Rev 272 = $4,508.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICKSET FLEX 30MM,272,RC,,,,,,,,both,,,10557.6800,1583.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7390.38,,,,,,,2724.9400,10557.6800,percent of total billed charges,"Rev 272 $10,557.68 in Billed Charges at 70% = $7,390.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICKSET FLEX 30MM,272,RC,,,,,,,,both,,,10557.6800,1583.6500,CIGNA HEALTHCARE,CIGNA HMO,4402.55,,,,,,,2724.9400,10557.6800,percent of total billed charges,"41.7% of $10,557.68 in Billed Charges for Rev 272 = $4,402.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICKSET FLEX 30MM,272,RC,,,,,,,,both,,,10557.6800,1583.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4898.76,,,,,,,2724.9400,10557.6800,percent of total billed charges,"46.4% of $10,557.68 in Billed Charges for Rev 272 = $4,898.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICKSET FLEX 30MM,272,RC,,,,,,,,both,,,10557.6800,1583.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4402.55,,,,,,,2724.9400,10557.6800,percent of total billed charges,"41.7% of $10,557.68 in Billed Charges for Rev 272 = $4,402.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICKSET FLEX 30MM,272,RC,,,,,,,,both,,,10557.6800,1583.6500,CIGNA HEALTHCARE,CIGNA PPO,4402.55,,,,,,,2724.9400,10557.6800,percent of total billed charges,"41.7% of $10,557.68 in Billed Charges for Rev 272 = $4,402.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICKSET FLEX 30MM,272,RC,,,,,,,,both,,,10557.6800,1583.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9501.91,,,,,,,2724.9400,10557.6800,percent of total billed charges,"90% of $10,557.68 in Billed Charges for Rev 272 = $9,501.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICKSET FLEX 30MM,272,RC,,,,,,,,both,,,10557.6800,1583.6500,MEDCOST,MEDCOST VHN,5024.40,,,,,,,2724.9400,10557.6800,percent of total billed charges,"47.59% of $10,557.68 in Billed Charges for Rev 272 = $5,024.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICKSET FLEX 30MM,272,RC,,,,,,,,both,,,10557.6800,1583.6500,SENTARA HEALTH,SENTARA HEALTH,2724.94,,,,,,,2724.9400,10557.6800,percent of total billed charges,"25.81% of $10,557.68 in Billed Charges for Rev 272 = $2,724.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICKSET FLEX 30MM,272,RC,,,,,,,,both,,,10557.6800,1583.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10557.68,,,,,,,2724.9400,10557.6800,percent of total billed charges,"100% of $10,557.68 in Billed Charges for Rev 272 = $10,557.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICKSET FLEX 30MM,272,RC,,,,,,,,both,,,10557.6800,1583.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5278.84,,,,,,,2724.9400,10557.6800,percent of total billed charges,"Rev 272 $10,557.68 in Billed Charges at 50% = $5,278.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICKSET FLEX 30MM,272,RC,,,,,,,,both,,,10557.6800,1583.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3410.13,,,,,,,2724.9400,10557.6800,other,"32.3% of $10,557.68 in Billed Charges for Rev 272 = $3,410.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICKSET FLEX 30MM,272,RC,,,,,,,,both,,,10557.6800,1583.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3241.21,,,,,,,2724.9400,10557.6800,other,"30.7% of $10,557.68 in Billed Charges for Rev 272 = $3,241.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICKSET FLEX 30MM,272,RC,,,,,,,,both,,,10557.6800,1583.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,3410.13,,,,,,,2724.9400,10557.6800,percent of total billed charges,"32.3% of $10,557.68 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICKSET FLEX 30MM,272,RC,,,,,,,,both,,,10557.6800,1583.6500,WELLCARE,WELLCARE MEDICAID,10557.68,,,,,,,2724.9400,10557.6800,percent of total billed charges,"100% of $10,557.68 in Billed Charges for Rev 272 = $10,557.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BEAVER 6600,270,RC,,,,,,,,both,,,5659.4500,848.9200,AETNA,AETNA,2416.59,,,,,,,1460.7000,5659.4500,percent of total billed charges,"42.7% of $5,659.45 in Billed Charges for Rev 270 = $2,416.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BEAVER 6600,270,RC,,,,,,,,both,,,5659.4500,848.9200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3961.62,,,,,,,1460.7000,5659.4500,percent of total billed charges,"Rev 270 $5,659.45 in Billed Charges at 70% = $3,961.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BEAVER 6600,270,RC,,,,,,,,both,,,5659.4500,848.9200,CIGNA HEALTHCARE,CIGNA HMO,2359.99,,,,,,,1460.7000,5659.4500,percent of total billed charges,"41.7% of $5,659.45 in Billed Charges for Rev 270 = $2,359.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BEAVER 6600,270,RC,,,,,,,,both,,,5659.4500,848.9200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2625.98,,,,,,,1460.7000,5659.4500,percent of total billed charges,"46.4% of $5,659.45 in Billed Charges for Rev 270 = $2,625.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BEAVER 6600,270,RC,,,,,,,,both,,,5659.4500,848.9200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2359.99,,,,,,,1460.7000,5659.4500,percent of total billed charges,"41.7% of $5,659.45 in Billed Charges for Rev 270 = $2,359.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BEAVER 6600,270,RC,,,,,,,,both,,,5659.4500,848.9200,CIGNA HEALTHCARE,CIGNA PPO,2359.99,,,,,,,1460.7000,5659.4500,percent of total billed charges,"41.7% of $5,659.45 in Billed Charges for Rev 270 = $2,359.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BEAVER 6600,270,RC,,,,,,,,both,,,5659.4500,848.9200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5093.51,,,,,,,1460.7000,5659.4500,percent of total billed charges,"90% of $5,659.45 in Billed Charges for Rev 270 = $5,093.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BEAVER 6600,270,RC,,,,,,,,both,,,5659.4500,848.9200,MEDCOST,MEDCOST VHN,2693.33,,,,,,,1460.7000,5659.4500,percent of total billed charges,"47.59% of $5,659.45 in Billed Charges for Rev 270 = $2,693.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BEAVER 6600,270,RC,,,,,,,,both,,,5659.4500,848.9200,SENTARA HEALTH,SENTARA HEALTH,1460.70,,,,,,,1460.7000,5659.4500,percent of total billed charges,"25.81% of $5,659.45 in Billed Charges for Rev 270 = $1,460.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BEAVER 6600,270,RC,,,,,,,,both,,,5659.4500,848.9200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5659.45,,,,,,,1460.7000,5659.4500,percent of total billed charges,"100% of $5,659.45 in Billed Charges for Rev 270 = $5,659.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BEAVER 6600,270,RC,,,,,,,,both,,,5659.4500,848.9200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2829.73,,,,,,,1460.7000,5659.4500,percent of total billed charges,"Rev 270 $5,659.45 in Billed Charges at 50% = $2,829.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BEAVER 6600,270,RC,,,,,,,,both,,,5659.4500,848.9200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1828.00,,,,,,,1460.7000,5659.4500,other,"32.3% of $5,659.45 in Billed Charges for Rev 270 = $1,828.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE BEAVER 6600,270,RC,,,,,,,,both,,,5659.4500,848.9200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1737.45,,,,,,,1460.7000,5659.4500,other,"30.7% of $5,659.45 in Billed Charges for Rev 270 = $1,737.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE BEAVER 6600,270,RC,,,,,,,,both,,,5659.4500,848.9200,UNITED HEALTHCARE,UNITED HEALTHCARE,1828.00,,,,,,,1460.7000,5659.4500,percent of total billed charges,"32.3% of $5,659.45 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BEAVER 6600,270,RC,,,,,,,,both,,,5659.4500,848.9200,WELLCARE,WELLCARE MEDICAID,5659.45,,,,,,,1460.7000,5659.4500,percent of total billed charges,"100% of $5,659.45 in Billed Charges for Rev 270 = $5,659.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BLURR STERILE DISPOSABLE 5.0MM X 13CM,272,RC,,,,,,,,both,,,1213.4100,182.0100,AETNA,AETNA,518.13,,,,,,,313.1800,1213.4100,percent of total billed charges,"42.7% of $1,213.41 in Billed Charges for Rev 272 = $518.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BLURR STERILE DISPOSABLE 5.0MM X 13CM,272,RC,,,,,,,,both,,,1213.4100,182.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,849.39,,,,,,,313.1800,1213.4100,percent of total billed charges,"Rev 272 $1,213.41 in Billed Charges at 70% = $849.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BLURR STERILE DISPOSABLE 5.0MM X 13CM,272,RC,,,,,,,,both,,,1213.4100,182.0100,CIGNA HEALTHCARE,CIGNA HMO,505.99,,,,,,,313.1800,1213.4100,percent of total billed charges,"41.7% of $1,213.41 in Billed Charges for Rev 272 = $505.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BLURR STERILE DISPOSABLE 5.0MM X 13CM,272,RC,,,,,,,,both,,,1213.4100,182.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,563.02,,,,,,,313.1800,1213.4100,percent of total billed charges,"46.4% of $1,213.41 in Billed Charges for Rev 272 = $563.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BLURR STERILE DISPOSABLE 5.0MM X 13CM,272,RC,,,,,,,,both,,,1213.4100,182.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,505.99,,,,,,,313.1800,1213.4100,percent of total billed charges,"41.7% of $1,213.41 in Billed Charges for Rev 272 = $505.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BLURR STERILE DISPOSABLE 5.0MM X 13CM,272,RC,,,,,,,,both,,,1213.4100,182.0100,CIGNA HEALTHCARE,CIGNA PPO,505.99,,,,,,,313.1800,1213.4100,percent of total billed charges,"41.7% of $1,213.41 in Billed Charges for Rev 272 = $505.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BLURR STERILE DISPOSABLE 5.0MM X 13CM,272,RC,,,,,,,,both,,,1213.4100,182.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1092.07,,,,,,,313.1800,1213.4100,percent of total billed charges,"90% of $1,213.41 in Billed Charges for Rev 272 = $1,092.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BLURR STERILE DISPOSABLE 5.0MM X 13CM,272,RC,,,,,,,,both,,,1213.4100,182.0100,MEDCOST,MEDCOST VHN,577.46,,,,,,,313.1800,1213.4100,percent of total billed charges,"47.59% of $1,213.41 in Billed Charges for Rev 272 = $577.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BLURR STERILE DISPOSABLE 5.0MM X 13CM,272,RC,,,,,,,,both,,,1213.4100,182.0100,SENTARA HEALTH,SENTARA HEALTH,313.18,,,,,,,313.1800,1213.4100,percent of total billed charges,"25.81% of $1,213.41 in Billed Charges for Rev 272 = $313.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BLURR STERILE DISPOSABLE 5.0MM X 13CM,272,RC,,,,,,,,both,,,1213.4100,182.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1213.41,,,,,,,313.1800,1213.4100,percent of total billed charges,"100% of $1,213.41 in Billed Charges for Rev 272 = $1,213.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BLURR STERILE DISPOSABLE 5.0MM X 13CM,272,RC,,,,,,,,both,,,1213.4100,182.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,606.71,,,,,,,313.1800,1213.4100,percent of total billed charges,"Rev 272 $1,213.41 in Billed Charges at 50% = $606.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BLURR STERILE DISPOSABLE 5.0MM X 13CM,272,RC,,,,,,,,both,,,1213.4100,182.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,391.93,,,,,,,313.1800,1213.4100,other,"32.3% of $1,213.41 in Billed Charges for Rev 272 = $391.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE BLURR STERILE DISPOSABLE 5.0MM X 13CM,272,RC,,,,,,,,both,,,1213.4100,182.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,372.52,,,,,,,313.1800,1213.4100,other,"30.7% of $1,213.41 in Billed Charges for Rev 272 = $372.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE BLURR STERILE DISPOSABLE 5.0MM X 13CM,272,RC,,,,,,,,both,,,1213.4100,182.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,391.93,,,,,,,313.1800,1213.4100,percent of total billed charges,"32.3% of $1,213.41 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BLURR STERILE DISPOSABLE 5.0MM X 13CM,272,RC,,,,,,,,both,,,1213.4100,182.0100,WELLCARE,WELLCARE MEDICAID,1213.41,,,,,,,313.1800,1213.4100,percent of total billed charges,"100% of $1,213.41 in Billed Charges for Rev 272 = $1,213.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL MEDIUM,272,RC,27200002,CDM,,,,,,both,,,6091.1000,913.6700,AETNA,AETNA,2600.90,,,,,,,1572.1100,6091.1000,percent of total billed charges,"42.7% of $6,091.10 in Billed Charges for Rev 272 = $2,600.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL MEDIUM,272,RC,27200002,CDM,,,,,,both,,,6091.1000,913.6700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4263.77,,,,,,,1572.1100,6091.1000,percent of total billed charges,"Rev 272 $6,091.10 in Billed Charges at 70% = $4,263.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL MEDIUM,272,RC,27200002,CDM,,,,,,both,,,6091.1000,913.6700,CIGNA HEALTHCARE,CIGNA HMO,2539.99,,,,,,,1572.1100,6091.1000,percent of total billed charges,"41.7% of $6,091.10 in Billed Charges for Rev 272 = $2,539.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL MEDIUM,272,RC,27200002,CDM,,,,,,both,,,6091.1000,913.6700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2826.27,,,,,,,1572.1100,6091.1000,percent of total billed charges,"46.4% of $6,091.10 in Billed Charges for Rev 272 = $2,826.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL MEDIUM,272,RC,27200002,CDM,,,,,,both,,,6091.1000,913.6700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2539.99,,,,,,,1572.1100,6091.1000,percent of total billed charges,"41.7% of $6,091.10 in Billed Charges for Rev 272 = $2,539.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL MEDIUM,272,RC,27200002,CDM,,,,,,both,,,6091.1000,913.6700,CIGNA HEALTHCARE,CIGNA PPO,2539.99,,,,,,,1572.1100,6091.1000,percent of total billed charges,"41.7% of $6,091.10 in Billed Charges for Rev 272 = $2,539.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL MEDIUM,272,RC,27200002,CDM,,,,,,both,,,6091.1000,913.6700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5481.99,,,,,,,1572.1100,6091.1000,percent of total billed charges,"90% of $6,091.10 in Billed Charges for Rev 272 = $5,481.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL MEDIUM,272,RC,27200002,CDM,,,,,,both,,,6091.1000,913.6700,MEDCOST,MEDCOST VHN,2898.75,,,,,,,1572.1100,6091.1000,percent of total billed charges,"47.59% of $6,091.10 in Billed Charges for Rev 272 = $2,898.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL MEDIUM,272,RC,27200002,CDM,,,,,,both,,,6091.1000,913.6700,SENTARA HEALTH,SENTARA HEALTH,1572.11,,,,,,,1572.1100,6091.1000,percent of total billed charges,"25.81% of $6,091.10 in Billed Charges for Rev 272 = $1,572.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL MEDIUM,272,RC,27200002,CDM,,,,,,both,,,6091.1000,913.6700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6091.10,,,,,,,1572.1100,6091.1000,percent of total billed charges,"100% of $6,091.10 in Billed Charges for Rev 272 = $6,091.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL MEDIUM,272,RC,27200002,CDM,,,,,,both,,,6091.1000,913.6700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3045.55,,,,,,,1572.1100,6091.1000,percent of total billed charges,"Rev 272 $6,091.10 in Billed Charges at 50% = $3,045.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL MEDIUM,272,RC,27200002,CDM,,,,,,both,,,6091.1000,913.6700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1967.43,,,,,,,1572.1100,6091.1000,other,"32.3% of $6,091.10 in Billed Charges for Rev 272 = $1,967.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE BONE MILL MEDIUM,272,RC,27200002,CDM,,,,,,both,,,6091.1000,913.6700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1869.97,,,,,,,1572.1100,6091.1000,other,"30.7% of $6,091.10 in Billed Charges for Rev 272 = $1,869.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE BONE MILL MEDIUM,272,RC,27200002,CDM,,,,,,both,,,6091.1000,913.6700,UNITED HEALTHCARE,UNITED HEALTHCARE,1967.43,,,,,,,1572.1100,6091.1000,percent of total billed charges,"32.3% of $6,091.10 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE BONE MILL MEDIUM,272,RC,27200002,CDM,,,,,,both,,,6091.1000,913.6700,WELLCARE,WELLCARE MEDICAID,6091.10,,,,,,,1572.1100,6091.1000,percent of total billed charges,"100% of $6,091.10 in Billed Charges for Rev 272 = $6,091.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULE CUT 4MM,272,RC,27200002,CDM,,,,,,both,,,3370.5800,505.5900,AETNA,AETNA,1439.24,,,,,,,869.9500,3370.5800,percent of total billed charges,"42.7% of $3,370.58 in Billed Charges for Rev 272 = $1,439.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULE CUT 4MM,272,RC,27200002,CDM,,,,,,both,,,3370.5800,505.5900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2359.41,,,,,,,869.9500,3370.5800,percent of total billed charges,"Rev 272 $3,370.58 in Billed Charges at 70% = $2,359.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULE CUT 4MM,272,RC,27200002,CDM,,,,,,both,,,3370.5800,505.5900,CIGNA HEALTHCARE,CIGNA HMO,1405.53,,,,,,,869.9500,3370.5800,percent of total billed charges,"41.7% of $3,370.58 in Billed Charges for Rev 272 = $1,405.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULE CUT 4MM,272,RC,27200002,CDM,,,,,,both,,,3370.5800,505.5900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1563.95,,,,,,,869.9500,3370.5800,percent of total billed charges,"46.4% of $3,370.58 in Billed Charges for Rev 272 = $1,563.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULE CUT 4MM,272,RC,27200002,CDM,,,,,,both,,,3370.5800,505.5900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1405.53,,,,,,,869.9500,3370.5800,percent of total billed charges,"41.7% of $3,370.58 in Billed Charges for Rev 272 = $1,405.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULE CUT 4MM,272,RC,27200002,CDM,,,,,,both,,,3370.5800,505.5900,CIGNA HEALTHCARE,CIGNA PPO,1405.53,,,,,,,869.9500,3370.5800,percent of total billed charges,"41.7% of $3,370.58 in Billed Charges for Rev 272 = $1,405.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULE CUT 4MM,272,RC,27200002,CDM,,,,,,both,,,3370.5800,505.5900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3033.52,,,,,,,869.9500,3370.5800,percent of total billed charges,"90% of $3,370.58 in Billed Charges for Rev 272 = $3,033.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULE CUT 4MM,272,RC,27200002,CDM,,,,,,both,,,3370.5800,505.5900,MEDCOST,MEDCOST VHN,1604.06,,,,,,,869.9500,3370.5800,percent of total billed charges,"47.59% of $3,370.58 in Billed Charges for Rev 272 = $1,604.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULE CUT 4MM,272,RC,27200002,CDM,,,,,,both,,,3370.5800,505.5900,SENTARA HEALTH,SENTARA HEALTH,869.95,,,,,,,869.9500,3370.5800,percent of total billed charges,"25.81% of $3,370.58 in Billed Charges for Rev 272 = $869.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULE CUT 4MM,272,RC,27200002,CDM,,,,,,both,,,3370.5800,505.5900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3370.58,,,,,,,869.9500,3370.5800,percent of total billed charges,"100% of $3,370.58 in Billed Charges for Rev 272 = $3,370.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULE CUT 4MM,272,RC,27200002,CDM,,,,,,both,,,3370.5800,505.5900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1685.29,,,,,,,869.9500,3370.5800,percent of total billed charges,"Rev 272 $3,370.58 in Billed Charges at 50% = $1,685.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULE CUT 4MM,272,RC,27200002,CDM,,,,,,both,,,3370.5800,505.5900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1088.70,,,,,,,869.9500,3370.5800,other,"32.3% of $3,370.58 in Billed Charges for Rev 272 = $1,088.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE CAPSULE CUT 4MM,272,RC,27200002,CDM,,,,,,both,,,3370.5800,505.5900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1034.77,,,,,,,869.9500,3370.5800,other,"30.7% of $3,370.58 in Billed Charges for Rev 272 = $1,034.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE CAPSULE CUT 4MM,272,RC,27200002,CDM,,,,,,both,,,3370.5800,505.5900,UNITED HEALTHCARE,UNITED HEALTHCARE,1088.70,,,,,,,869.9500,3370.5800,percent of total billed charges,"32.3% of $3,370.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULE CUT 4MM,272,RC,27200002,CDM,,,,,,both,,,3370.5800,505.5900,WELLCARE,WELLCARE MEDICAID,3370.58,,,,,,,869.9500,3370.5800,percent of total billed charges,"100% of $3,370.58 in Billed Charges for Rev 272 = $3,370.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULOTOMY 4MM CURVED W/HANDLE DISP,272,RC,27200002,CDM,,,,,,both,,,2654.9800,398.2500,AETNA,AETNA,1133.68,,,,,,,685.2500,2654.9800,percent of total billed charges,"42.7% of $2,654.98 in Billed Charges for Rev 272 = $1,133.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULOTOMY 4MM CURVED W/HANDLE DISP,272,RC,27200002,CDM,,,,,,both,,,2654.9800,398.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1858.49,,,,,,,685.2500,2654.9800,percent of total billed charges,"Rev 272 $2,654.98 in Billed Charges at 70% = $1,858.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULOTOMY 4MM CURVED W/HANDLE DISP,272,RC,27200002,CDM,,,,,,both,,,2654.9800,398.2500,CIGNA HEALTHCARE,CIGNA HMO,1107.13,,,,,,,685.2500,2654.9800,percent of total billed charges,"41.7% of $2,654.98 in Billed Charges for Rev 272 = $1,107.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULOTOMY 4MM CURVED W/HANDLE DISP,272,RC,27200002,CDM,,,,,,both,,,2654.9800,398.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1231.91,,,,,,,685.2500,2654.9800,percent of total billed charges,"46.4% of $2,654.98 in Billed Charges for Rev 272 = $1,231.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULOTOMY 4MM CURVED W/HANDLE DISP,272,RC,27200002,CDM,,,,,,both,,,2654.9800,398.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1107.13,,,,,,,685.2500,2654.9800,percent of total billed charges,"41.7% of $2,654.98 in Billed Charges for Rev 272 = $1,107.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULOTOMY 4MM CURVED W/HANDLE DISP,272,RC,27200002,CDM,,,,,,both,,,2654.9800,398.2500,CIGNA HEALTHCARE,CIGNA PPO,1107.13,,,,,,,685.2500,2654.9800,percent of total billed charges,"41.7% of $2,654.98 in Billed Charges for Rev 272 = $1,107.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULOTOMY 4MM CURVED W/HANDLE DISP,272,RC,27200002,CDM,,,,,,both,,,2654.9800,398.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2389.48,,,,,,,685.2500,2654.9800,percent of total billed charges,"90% of $2,654.98 in Billed Charges for Rev 272 = $2,389.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULOTOMY 4MM CURVED W/HANDLE DISP,272,RC,27200002,CDM,,,,,,both,,,2654.9800,398.2500,MEDCOST,MEDCOST VHN,1263.51,,,,,,,685.2500,2654.9800,percent of total billed charges,"47.59% of $2,654.98 in Billed Charges for Rev 272 = $1,263.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULOTOMY 4MM CURVED W/HANDLE DISP,272,RC,27200002,CDM,,,,,,both,,,2654.9800,398.2500,SENTARA HEALTH,SENTARA HEALTH,685.25,,,,,,,685.2500,2654.9800,percent of total billed charges,"25.81% of $2,654.98 in Billed Charges for Rev 272 = $685.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULOTOMY 4MM CURVED W/HANDLE DISP,272,RC,27200002,CDM,,,,,,both,,,2654.9800,398.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2654.98,,,,,,,685.2500,2654.9800,percent of total billed charges,"100% of $2,654.98 in Billed Charges for Rev 272 = $2,654.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULOTOMY 4MM CURVED W/HANDLE DISP,272,RC,27200002,CDM,,,,,,both,,,2654.9800,398.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1327.49,,,,,,,685.2500,2654.9800,percent of total billed charges,"Rev 272 $2,654.98 in Billed Charges at 50% = $1,327.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULOTOMY 4MM CURVED W/HANDLE DISP,272,RC,27200002,CDM,,,,,,both,,,2654.9800,398.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,857.56,,,,,,,685.2500,2654.9800,other,"32.3% of $2,654.98 in Billed Charges for Rev 272 = $857.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE CAPSULOTOMY 4MM CURVED W/HANDLE DISP,272,RC,27200002,CDM,,,,,,both,,,2654.9800,398.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,815.08,,,,,,,685.2500,2654.9800,other,"30.7% of $2,654.98 in Billed Charges for Rev 272 = $815.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE CAPSULOTOMY 4MM CURVED W/HANDLE DISP,272,RC,27200002,CDM,,,,,,both,,,2654.9800,398.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,857.56,,,,,,,685.2500,2654.9800,percent of total billed charges,"32.3% of $2,654.98 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CAPSULOTOMY 4MM CURVED W/HANDLE DISP,272,RC,27200002,CDM,,,,,,both,,,2654.9800,398.2500,WELLCARE,WELLCARE MEDICAID,2654.98,,,,,,,685.2500,2654.9800,percent of total billed charges,"100% of $2,654.98 in Billed Charges for Rev 272 = $2,654.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 13.5 X 0.51 X 25.5MM,272,RC,,,,,,,,both,,,1166.4300,174.9600,AETNA,AETNA,498.07,,,,,,,301.0600,1166.4300,percent of total billed charges,"42.7% of $1,166.43 in Billed Charges for Rev 272 = $498.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 13.5 X 0.51 X 25.5MM,272,RC,,,,,,,,both,,,1166.4300,174.9600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,816.50,,,,,,,301.0600,1166.4300,percent of total billed charges,"Rev 272 $1,166.43 in Billed Charges at 70% = $816.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 13.5 X 0.51 X 25.5MM,272,RC,,,,,,,,both,,,1166.4300,174.9600,CIGNA HEALTHCARE,CIGNA HMO,486.40,,,,,,,301.0600,1166.4300,percent of total billed charges,"41.7% of $1,166.43 in Billed Charges for Rev 272 = $486.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 13.5 X 0.51 X 25.5MM,272,RC,,,,,,,,both,,,1166.4300,174.9600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,541.22,,,,,,,301.0600,1166.4300,percent of total billed charges,"46.4% of $1,166.43 in Billed Charges for Rev 272 = $541.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 13.5 X 0.51 X 25.5MM,272,RC,,,,,,,,both,,,1166.4300,174.9600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,486.40,,,,,,,301.0600,1166.4300,percent of total billed charges,"41.7% of $1,166.43 in Billed Charges for Rev 272 = $486.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 13.5 X 0.51 X 25.5MM,272,RC,,,,,,,,both,,,1166.4300,174.9600,CIGNA HEALTHCARE,CIGNA PPO,486.40,,,,,,,301.0600,1166.4300,percent of total billed charges,"41.7% of $1,166.43 in Billed Charges for Rev 272 = $486.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 13.5 X 0.51 X 25.5MM,272,RC,,,,,,,,both,,,1166.4300,174.9600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1049.79,,,,,,,301.0600,1166.4300,percent of total billed charges,"90% of $1,166.43 in Billed Charges for Rev 272 = $1,049.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 13.5 X 0.51 X 25.5MM,272,RC,,,,,,,,both,,,1166.4300,174.9600,MEDCOST,MEDCOST VHN,555.10,,,,,,,301.0600,1166.4300,percent of total billed charges,"47.59% of $1,166.43 in Billed Charges for Rev 272 = $555.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 13.5 X 0.51 X 25.5MM,272,RC,,,,,,,,both,,,1166.4300,174.9600,SENTARA HEALTH,SENTARA HEALTH,301.06,,,,,,,301.0600,1166.4300,percent of total billed charges,"25.81% of $1,166.43 in Billed Charges for Rev 272 = $301.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 13.5 X 0.51 X 25.5MM,272,RC,,,,,,,,both,,,1166.4300,174.9600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1166.43,,,,,,,301.0600,1166.4300,percent of total billed charges,"100% of $1,166.43 in Billed Charges for Rev 272 = $1,166.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 13.5 X 0.51 X 25.5MM,272,RC,,,,,,,,both,,,1166.4300,174.9600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,583.22,,,,,,,301.0600,1166.4300,percent of total billed charges,"Rev 272 $1,166.43 in Billed Charges at 50% = $583.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 13.5 X 0.51 X 25.5MM,272,RC,,,,,,,,both,,,1166.4300,174.9600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,376.76,,,,,,,301.0600,1166.4300,other,"32.3% of $1,166.43 in Billed Charges for Rev 272 = $376.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE CRESCENTIC 13.5 X 0.51 X 25.5MM,272,RC,,,,,,,,both,,,1166.4300,174.9600,UNITED HEALTHCARE,UHC HERITAGE SELECT,358.09,,,,,,,301.0600,1166.4300,other,"30.7% of $1,166.43 in Billed Charges for Rev 272 = $358.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE CRESCENTIC 13.5 X 0.51 X 25.5MM,272,RC,,,,,,,,both,,,1166.4300,174.9600,UNITED HEALTHCARE,UNITED HEALTHCARE,376.76,,,,,,,301.0600,1166.4300,percent of total billed charges,"32.3% of $1,166.43 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 13.5 X 0.51 X 25.5MM,272,RC,,,,,,,,both,,,1166.4300,174.9600,WELLCARE,WELLCARE MEDICAID,1166.43,,,,,,,301.0600,1166.4300,percent of total billed charges,"100% of $1,166.43 in Billed Charges for Rev 272 = $1,166.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 18.5 X 0.51 X 32MM,272,RC,,,,,,,,both,,,1076.3000,161.4500,AETNA,AETNA,459.58,,,,,,,277.7900,1076.3000,percent of total billed charges,"42.7% of $1,076.30 in Billed Charges for Rev 272 = $459.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 18.5 X 0.51 X 32MM,272,RC,,,,,,,,both,,,1076.3000,161.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,753.41,,,,,,,277.7900,1076.3000,percent of total billed charges,"Rev 272 $1,076.30 in Billed Charges at 70% = $753.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 18.5 X 0.51 X 32MM,272,RC,,,,,,,,both,,,1076.3000,161.4500,CIGNA HEALTHCARE,CIGNA HMO,448.82,,,,,,,277.7900,1076.3000,percent of total billed charges,"41.7% of $1,076.30 in Billed Charges for Rev 272 = $448.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 18.5 X 0.51 X 32MM,272,RC,,,,,,,,both,,,1076.3000,161.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,499.40,,,,,,,277.7900,1076.3000,percent of total billed charges,"46.4% of $1,076.30 in Billed Charges for Rev 272 = $499.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 18.5 X 0.51 X 32MM,272,RC,,,,,,,,both,,,1076.3000,161.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,448.82,,,,,,,277.7900,1076.3000,percent of total billed charges,"41.7% of $1,076.30 in Billed Charges for Rev 272 = $448.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 18.5 X 0.51 X 32MM,272,RC,,,,,,,,both,,,1076.3000,161.4500,CIGNA HEALTHCARE,CIGNA PPO,448.82,,,,,,,277.7900,1076.3000,percent of total billed charges,"41.7% of $1,076.30 in Billed Charges for Rev 272 = $448.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 18.5 X 0.51 X 32MM,272,RC,,,,,,,,both,,,1076.3000,161.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,968.67,,,,,,,277.7900,1076.3000,percent of total billed charges,"90% of $1,076.30 in Billed Charges for Rev 272 = $968.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 18.5 X 0.51 X 32MM,272,RC,,,,,,,,both,,,1076.3000,161.4500,MEDCOST,MEDCOST VHN,512.21,,,,,,,277.7900,1076.3000,percent of total billed charges,"47.59% of $1,076.30 in Billed Charges for Rev 272 = $512.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 18.5 X 0.51 X 32MM,272,RC,,,,,,,,both,,,1076.3000,161.4500,SENTARA HEALTH,SENTARA HEALTH,277.79,,,,,,,277.7900,1076.3000,percent of total billed charges,"25.81% of $1,076.30 in Billed Charges for Rev 272 = $277.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 18.5 X 0.51 X 32MM,272,RC,,,,,,,,both,,,1076.3000,161.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1076.30,,,,,,,277.7900,1076.3000,percent of total billed charges,"100% of $1,076.30 in Billed Charges for Rev 272 = $1,076.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 18.5 X 0.51 X 32MM,272,RC,,,,,,,,both,,,1076.3000,161.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,538.15,,,,,,,277.7900,1076.3000,percent of total billed charges,"Rev 272 $1,076.30 in Billed Charges at 50% = $538.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 18.5 X 0.51 X 32MM,272,RC,,,,,,,,both,,,1076.3000,161.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,347.64,,,,,,,277.7900,1076.3000,other,"32.3% of $1,076.30 in Billed Charges for Rev 272 = $347.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE CRESCENTIC 18.5 X 0.51 X 32MM,272,RC,,,,,,,,both,,,1076.3000,161.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,330.42,,,,,,,277.7900,1076.3000,other,"30.7% of $1,076.30 in Billed Charges for Rev 272 = $330.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE CRESCENTIC 18.5 X 0.51 X 32MM,272,RC,,,,,,,,both,,,1076.3000,161.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,347.64,,,,,,,277.7900,1076.3000,percent of total billed charges,"32.3% of $1,076.30 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTIC 18.5 X 0.51 X 32MM,272,RC,,,,,,,,both,,,1076.3000,161.4500,WELLCARE,WELLCARE MEDICAID,1076.30,,,,,,,277.7900,1076.3000,percent of total billed charges,"100% of $1,076.30 in Billed Charges for Rev 272 = $1,076.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CARPAL TUNNEL RELEASE 81010-6,272,RC,27200002,CDM,,,,,,both,,,2627.3200,394.1000,AETNA,AETNA,1121.87,,,,,,,678.1100,2627.3200,percent of total billed charges,"42.7% of $2,627.32 in Billed Charges for Rev 272 = $1,121.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CARPAL TUNNEL RELEASE 81010-6,272,RC,27200002,CDM,,,,,,both,,,2627.3200,394.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1839.12,,,,,,,678.1100,2627.3200,percent of total billed charges,"Rev 272 $2,627.32 in Billed Charges at 70% = $1,839.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CARPAL TUNNEL RELEASE 81010-6,272,RC,27200002,CDM,,,,,,both,,,2627.3200,394.1000,CIGNA HEALTHCARE,CIGNA HMO,1095.59,,,,,,,678.1100,2627.3200,percent of total billed charges,"41.7% of $2,627.32 in Billed Charges for Rev 272 = $1,095.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CARPAL TUNNEL RELEASE 81010-6,272,RC,27200002,CDM,,,,,,both,,,2627.3200,394.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1219.08,,,,,,,678.1100,2627.3200,percent of total billed charges,"46.4% of $2,627.32 in Billed Charges for Rev 272 = $1,219.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CARPAL TUNNEL RELEASE 81010-6,272,RC,27200002,CDM,,,,,,both,,,2627.3200,394.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1095.59,,,,,,,678.1100,2627.3200,percent of total billed charges,"41.7% of $2,627.32 in Billed Charges for Rev 272 = $1,095.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CARPAL TUNNEL RELEASE 81010-6,272,RC,27200002,CDM,,,,,,both,,,2627.3200,394.1000,CIGNA HEALTHCARE,CIGNA PPO,1095.59,,,,,,,678.1100,2627.3200,percent of total billed charges,"41.7% of $2,627.32 in Billed Charges for Rev 272 = $1,095.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CARPAL TUNNEL RELEASE 81010-6,272,RC,27200002,CDM,,,,,,both,,,2627.3200,394.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2364.59,,,,,,,678.1100,2627.3200,percent of total billed charges,"90% of $2,627.32 in Billed Charges for Rev 272 = $2,364.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CARPAL TUNNEL RELEASE 81010-6,272,RC,27200002,CDM,,,,,,both,,,2627.3200,394.1000,MEDCOST,MEDCOST VHN,1250.34,,,,,,,678.1100,2627.3200,percent of total billed charges,"47.59% of $2,627.32 in Billed Charges for Rev 272 = $1,250.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CARPAL TUNNEL RELEASE 81010-6,272,RC,27200002,CDM,,,,,,both,,,2627.3200,394.1000,SENTARA HEALTH,SENTARA HEALTH,678.11,,,,,,,678.1100,2627.3200,percent of total billed charges,"25.81% of $2,627.32 in Billed Charges for Rev 272 = $678.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CARPAL TUNNEL RELEASE 81010-6,272,RC,27200002,CDM,,,,,,both,,,2627.3200,394.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2627.32,,,,,,,678.1100,2627.3200,percent of total billed charges,"100% of $2,627.32 in Billed Charges for Rev 272 = $2,627.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CARPAL TUNNEL RELEASE 81010-6,272,RC,27200002,CDM,,,,,,both,,,2627.3200,394.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1313.66,,,,,,,678.1100,2627.3200,percent of total billed charges,"Rev 272 $2,627.32 in Billed Charges at 50% = $1,313.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CARPAL TUNNEL RELEASE 81010-6,272,RC,27200002,CDM,,,,,,both,,,2627.3200,394.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,848.62,,,,,,,678.1100,2627.3200,other,"32.3% of $2,627.32 in Billed Charges for Rev 272 = $848.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE CARPAL TUNNEL RELEASE 81010-6,272,RC,27200002,CDM,,,,,,both,,,2627.3200,394.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,806.59,,,,,,,678.1100,2627.3200,other,"30.7% of $2,627.32 in Billed Charges for Rev 272 = $806.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE CARPAL TUNNEL RELEASE 81010-6,272,RC,27200002,CDM,,,,,,both,,,2627.3200,394.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,848.62,,,,,,,678.1100,2627.3200,percent of total billed charges,"32.3% of $2,627.32 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CARPAL TUNNEL RELEASE 81010-6,272,RC,27200002,CDM,,,,,,both,,,2627.3200,394.1000,WELLCARE,WELLCARE MEDICAID,2627.32,,,,,,,678.1100,2627.3200,percent of total billed charges,"100% of $2,627.32 in Billed Charges for Rev 272 = $2,627.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CHISEL WIDTH-LONG 10MM,272,RC,,,,,,,,both,,,1003.3900,150.5100,AETNA,AETNA,428.45,,,,,,,258.9800,1003.3900,percent of total billed charges,"42.7% of $1,003.39 in Billed Charges for Rev 272 = $428.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CHISEL WIDTH-LONG 10MM,272,RC,,,,,,,,both,,,1003.3900,150.5100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,702.37,,,,,,,258.9800,1003.3900,percent of total billed charges,"Rev 272 $1,003.39 in Billed Charges at 70% = $702.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CHISEL WIDTH-LONG 10MM,272,RC,,,,,,,,both,,,1003.3900,150.5100,CIGNA HEALTHCARE,CIGNA HMO,418.41,,,,,,,258.9800,1003.3900,percent of total billed charges,"41.7% of $1,003.39 in Billed Charges for Rev 272 = $418.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CHISEL WIDTH-LONG 10MM,272,RC,,,,,,,,both,,,1003.3900,150.5100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,465.57,,,,,,,258.9800,1003.3900,percent of total billed charges,"46.4% of $1,003.39 in Billed Charges for Rev 272 = $465.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CHISEL WIDTH-LONG 10MM,272,RC,,,,,,,,both,,,1003.3900,150.5100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,418.41,,,,,,,258.9800,1003.3900,percent of total billed charges,"41.7% of $1,003.39 in Billed Charges for Rev 272 = $418.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CHISEL WIDTH-LONG 10MM,272,RC,,,,,,,,both,,,1003.3900,150.5100,CIGNA HEALTHCARE,CIGNA PPO,418.41,,,,,,,258.9800,1003.3900,percent of total billed charges,"41.7% of $1,003.39 in Billed Charges for Rev 272 = $418.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CHISEL WIDTH-LONG 10MM,272,RC,,,,,,,,both,,,1003.3900,150.5100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,903.05,,,,,,,258.9800,1003.3900,percent of total billed charges,"90% of $1,003.39 in Billed Charges for Rev 272 = $903.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CHISEL WIDTH-LONG 10MM,272,RC,,,,,,,,both,,,1003.3900,150.5100,MEDCOST,MEDCOST VHN,477.51,,,,,,,258.9800,1003.3900,percent of total billed charges,"47.59% of $1,003.39 in Billed Charges for Rev 272 = $477.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CHISEL WIDTH-LONG 10MM,272,RC,,,,,,,,both,,,1003.3900,150.5100,SENTARA HEALTH,SENTARA HEALTH,258.98,,,,,,,258.9800,1003.3900,percent of total billed charges,"25.81% of $1,003.39 in Billed Charges for Rev 272 = $258.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CHISEL WIDTH-LONG 10MM,272,RC,,,,,,,,both,,,1003.3900,150.5100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1003.39,,,,,,,258.9800,1003.3900,percent of total billed charges,"100% of $1,003.39 in Billed Charges for Rev 272 = $1,003.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CHISEL WIDTH-LONG 10MM,272,RC,,,,,,,,both,,,1003.3900,150.5100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,501.70,,,,,,,258.9800,1003.3900,percent of total billed charges,"Rev 272 $1,003.39 in Billed Charges at 50% = $501.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CHISEL WIDTH-LONG 10MM,272,RC,,,,,,,,both,,,1003.3900,150.5100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,324.10,,,,,,,258.9800,1003.3900,other,"32.3% of $1,003.39 in Billed Charges for Rev 272 = $324.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE CHISEL WIDTH-LONG 10MM,272,RC,,,,,,,,both,,,1003.3900,150.5100,UNITED HEALTHCARE,UHC HERITAGE SELECT,308.04,,,,,,,258.9800,1003.3900,other,"30.7% of $1,003.39 in Billed Charges for Rev 272 = $308.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE CHISEL WIDTH-LONG 10MM,272,RC,,,,,,,,both,,,1003.3900,150.5100,UNITED HEALTHCARE,UNITED HEALTHCARE,324.10,,,,,,,258.9800,1003.3900,percent of total billed charges,"32.3% of $1,003.39 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CHISEL WIDTH-LONG 10MM,272,RC,,,,,,,,both,,,1003.3900,150.5100,WELLCARE,WELLCARE MEDICAID,1003.39,,,,,,,258.9800,1003.3900,percent of total billed charges,"100% of $1,003.39 in Billed Charges for Rev 272 = $1,003.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTRIC 15MM X 30MM 5400-031-415,272,RC,,,,,,,,both,,,1104.9300,165.7400,AETNA,AETNA,471.81,,,,,,,285.1800,1104.9300,percent of total billed charges,"42.7% of $1,104.93 in Billed Charges for Rev 272 = $471.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTRIC 15MM X 30MM 5400-031-415,272,RC,,,,,,,,both,,,1104.9300,165.7400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,773.45,,,,,,,285.1800,1104.9300,percent of total billed charges,"Rev 272 $1,104.93 in Billed Charges at 70% = $773.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTRIC 15MM X 30MM 5400-031-415,272,RC,,,,,,,,both,,,1104.9300,165.7400,CIGNA HEALTHCARE,CIGNA HMO,460.76,,,,,,,285.1800,1104.9300,percent of total billed charges,"41.7% of $1,104.93 in Billed Charges for Rev 272 = $460.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTRIC 15MM X 30MM 5400-031-415,272,RC,,,,,,,,both,,,1104.9300,165.7400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,512.69,,,,,,,285.1800,1104.9300,percent of total billed charges,"46.4% of $1,104.93 in Billed Charges for Rev 272 = $512.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTRIC 15MM X 30MM 5400-031-415,272,RC,,,,,,,,both,,,1104.9300,165.7400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,460.76,,,,,,,285.1800,1104.9300,percent of total billed charges,"41.7% of $1,104.93 in Billed Charges for Rev 272 = $460.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTRIC 15MM X 30MM 5400-031-415,272,RC,,,,,,,,both,,,1104.9300,165.7400,CIGNA HEALTHCARE,CIGNA PPO,460.76,,,,,,,285.1800,1104.9300,percent of total billed charges,"41.7% of $1,104.93 in Billed Charges for Rev 272 = $460.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTRIC 15MM X 30MM 5400-031-415,272,RC,,,,,,,,both,,,1104.9300,165.7400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,994.44,,,,,,,285.1800,1104.9300,percent of total billed charges,"90% of $1,104.93 in Billed Charges for Rev 272 = $994.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTRIC 15MM X 30MM 5400-031-415,272,RC,,,,,,,,both,,,1104.9300,165.7400,MEDCOST,MEDCOST VHN,525.84,,,,,,,285.1800,1104.9300,percent of total billed charges,"47.59% of $1,104.93 in Billed Charges for Rev 272 = $525.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTRIC 15MM X 30MM 5400-031-415,272,RC,,,,,,,,both,,,1104.9300,165.7400,SENTARA HEALTH,SENTARA HEALTH,285.18,,,,,,,285.1800,1104.9300,percent of total billed charges,"25.81% of $1,104.93 in Billed Charges for Rev 272 = $285.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTRIC 15MM X 30MM 5400-031-415,272,RC,,,,,,,,both,,,1104.9300,165.7400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1104.93,,,,,,,285.1800,1104.9300,percent of total billed charges,"100% of $1,104.93 in Billed Charges for Rev 272 = $1,104.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTRIC 15MM X 30MM 5400-031-415,272,RC,,,,,,,,both,,,1104.9300,165.7400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,552.47,,,,,,,285.1800,1104.9300,percent of total billed charges,"Rev 272 $1,104.93 in Billed Charges at 50% = $552.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTRIC 15MM X 30MM 5400-031-415,272,RC,,,,,,,,both,,,1104.9300,165.7400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,356.89,,,,,,,285.1800,1104.9300,other,"32.3% of $1,104.93 in Billed Charges for Rev 272 = $356.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE CRESCENTRIC 15MM X 30MM 5400-031-415,272,RC,,,,,,,,both,,,1104.9300,165.7400,UNITED HEALTHCARE,UHC HERITAGE SELECT,339.21,,,,,,,285.1800,1104.9300,other,"30.7% of $1,104.93 in Billed Charges for Rev 272 = $339.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE CRESCENTRIC 15MM X 30MM 5400-031-415,272,RC,,,,,,,,both,,,1104.9300,165.7400,UNITED HEALTHCARE,UNITED HEALTHCARE,356.89,,,,,,,285.1800,1104.9300,percent of total billed charges,"32.3% of $1,104.93 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CRESCENTRIC 15MM X 30MM 5400-031-415,272,RC,,,,,,,,both,,,1104.9300,165.7400,WELLCARE,WELLCARE MEDICAID,1104.93,,,,,,,285.1800,1104.9300,percent of total billed charges,"100% of $1,104.93 in Billed Charges for Rev 272 = $1,104.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED HIP #260003,272,RC,,,,,,,,both,,,4812.0400,721.8100,AETNA,AETNA,2054.74,,,,,,,1241.9900,4812.0400,percent of total billed charges,"42.7% of $4,812.04 in Billed Charges for Rev 272 = $2,054.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED HIP #260003,272,RC,,,,,,,,both,,,4812.0400,721.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3368.43,,,,,,,1241.9900,4812.0400,percent of total billed charges,"Rev 272 $4,812.04 in Billed Charges at 70% = $3,368.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED HIP #260003,272,RC,,,,,,,,both,,,4812.0400,721.8100,CIGNA HEALTHCARE,CIGNA HMO,2006.62,,,,,,,1241.9900,4812.0400,percent of total billed charges,"41.7% of $4,812.04 in Billed Charges for Rev 272 = $2,006.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED HIP #260003,272,RC,,,,,,,,both,,,4812.0400,721.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2232.79,,,,,,,1241.9900,4812.0400,percent of total billed charges,"46.4% of $4,812.04 in Billed Charges for Rev 272 = $2,232.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED HIP #260003,272,RC,,,,,,,,both,,,4812.0400,721.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2006.62,,,,,,,1241.9900,4812.0400,percent of total billed charges,"41.7% of $4,812.04 in Billed Charges for Rev 272 = $2,006.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED HIP #260003,272,RC,,,,,,,,both,,,4812.0400,721.8100,CIGNA HEALTHCARE,CIGNA PPO,2006.62,,,,,,,1241.9900,4812.0400,percent of total billed charges,"41.7% of $4,812.04 in Billed Charges for Rev 272 = $2,006.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED HIP #260003,272,RC,,,,,,,,both,,,4812.0400,721.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4330.84,,,,,,,1241.9900,4812.0400,percent of total billed charges,"90% of $4,812.04 in Billed Charges for Rev 272 = $4,330.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED HIP #260003,272,RC,,,,,,,,both,,,4812.0400,721.8100,MEDCOST,MEDCOST VHN,2290.05,,,,,,,1241.9900,4812.0400,percent of total billed charges,"47.59% of $4,812.04 in Billed Charges for Rev 272 = $2,290.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED HIP #260003,272,RC,,,,,,,,both,,,4812.0400,721.8100,SENTARA HEALTH,SENTARA HEALTH,1241.99,,,,,,,1241.9900,4812.0400,percent of total billed charges,"25.81% of $4,812.04 in Billed Charges for Rev 272 = $1,241.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED HIP #260003,272,RC,,,,,,,,both,,,4812.0400,721.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4812.04,,,,,,,1241.9900,4812.0400,percent of total billed charges,"100% of $4,812.04 in Billed Charges for Rev 272 = $4,812.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED HIP #260003,272,RC,,,,,,,,both,,,4812.0400,721.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2406.02,,,,,,,1241.9900,4812.0400,percent of total billed charges,"Rev 272 $4,812.04 in Billed Charges at 50% = $2,406.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED HIP #260003,272,RC,,,,,,,,both,,,4812.0400,721.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1554.29,,,,,,,1241.9900,4812.0400,other,"32.3% of $4,812.04 in Billed Charges for Rev 272 = $1,554.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE CURVED HIP #260003,272,RC,,,,,,,,both,,,4812.0400,721.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1477.30,,,,,,,1241.9900,4812.0400,other,"30.7% of $4,812.04 in Billed Charges for Rev 272 = $1,477.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE CURVED HIP #260003,272,RC,,,,,,,,both,,,4812.0400,721.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,1554.29,,,,,,,1241.9900,4812.0400,percent of total billed charges,"32.3% of $4,812.04 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED HIP #260003,272,RC,,,,,,,,both,,,4812.0400,721.8100,WELLCARE,WELLCARE MEDICAID,4812.04,,,,,,,1241.9900,4812.0400,percent of total billed charges,"100% of $4,812.04 in Billed Charges for Rev 272 = $4,812.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,5123.2700,768.4900,AETNA,AETNA,2187.64,,,,,,,1322.3200,5123.2700,percent of total billed charges,"42.7% of $5,123.27 in Billed Charges for Rev 272 = $2,187.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,5123.2700,768.4900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3586.29,,,,,,,1322.3200,5123.2700,percent of total billed charges,"Rev 272 $5,123.27 in Billed Charges at 70% = $3,586.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,5123.2700,768.4900,CIGNA HEALTHCARE,CIGNA HMO,2136.40,,,,,,,1322.3200,5123.2700,percent of total billed charges,"41.7% of $5,123.27 in Billed Charges for Rev 272 = $2,136.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,5123.2700,768.4900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2377.20,,,,,,,1322.3200,5123.2700,percent of total billed charges,"46.4% of $5,123.27 in Billed Charges for Rev 272 = $2,377.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,5123.2700,768.4900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2136.40,,,,,,,1322.3200,5123.2700,percent of total billed charges,"41.7% of $5,123.27 in Billed Charges for Rev 272 = $2,136.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,5123.2700,768.4900,CIGNA HEALTHCARE,CIGNA PPO,2136.40,,,,,,,1322.3200,5123.2700,percent of total billed charges,"41.7% of $5,123.27 in Billed Charges for Rev 272 = $2,136.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,5123.2700,768.4900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4610.94,,,,,,,1322.3200,5123.2700,percent of total billed charges,"90% of $5,123.27 in Billed Charges for Rev 272 = $4,610.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,5123.2700,768.4900,MEDCOST,MEDCOST VHN,2438.16,,,,,,,1322.3200,5123.2700,percent of total billed charges,"47.59% of $5,123.27 in Billed Charges for Rev 272 = $2,438.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,5123.2700,768.4900,SENTARA HEALTH,SENTARA HEALTH,1322.32,,,,,,,1322.3200,5123.2700,percent of total billed charges,"25.81% of $5,123.27 in Billed Charges for Rev 272 = $1,322.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,5123.2700,768.4900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5123.27,,,,,,,1322.3200,5123.2700,percent of total billed charges,"100% of $5,123.27 in Billed Charges for Rev 272 = $5,123.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,5123.2700,768.4900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2561.64,,,,,,,1322.3200,5123.2700,percent of total billed charges,"Rev 272 $5,123.27 in Billed Charges at 50% = $2,561.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,5123.2700,768.4900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1654.82,,,,,,,1322.3200,5123.2700,other,"32.3% of $5,123.27 in Billed Charges for Rev 272 = $1,654.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE CURVED ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,5123.2700,768.4900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1572.84,,,,,,,1322.3200,5123.2700,other,"30.7% of $5,123.27 in Billed Charges for Rev 272 = $1,572.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE CURVED ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,5123.2700,768.4900,UNITED HEALTHCARE,UNITED HEALTHCARE,1654.82,,,,,,,1322.3200,5123.2700,percent of total billed charges,"32.3% of $5,123.27 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,5123.2700,768.4900,WELLCARE,WELLCARE MEDICAID,5123.27,,,,,,,1322.3200,5123.2700,percent of total billed charges,"100% of $5,123.27 in Billed Charges for Rev 272 = $5,123.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DEEP,272,RC,,,,,,,,both,,,792.3400,118.8500,AETNA,AETNA,338.33,,,,,,,204.5000,792.3400,percent of total billed charges,42.7% of $792.34 in Billed Charges for Rev 272 = $338.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DEEP,272,RC,,,,,,,,both,,,792.3400,118.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,554.64,,,,,,,204.5000,792.3400,percent of total billed charges,Rev 272 $792.34 in Billed Charges at 70% = $554.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DEEP,272,RC,,,,,,,,both,,,792.3400,118.8500,CIGNA HEALTHCARE,CIGNA HMO,330.41,,,,,,,204.5000,792.3400,percent of total billed charges,41.7% of $792.34 in Billed Charges for Rev 272 = $330.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DEEP,272,RC,,,,,,,,both,,,792.3400,118.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,367.65,,,,,,,204.5000,792.3400,percent of total billed charges,46.4% of $792.34 in Billed Charges for Rev 272 = $367.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DEEP,272,RC,,,,,,,,both,,,792.3400,118.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,330.41,,,,,,,204.5000,792.3400,percent of total billed charges,41.7% of $792.34 in Billed Charges for Rev 272 = $330.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DEEP,272,RC,,,,,,,,both,,,792.3400,118.8500,CIGNA HEALTHCARE,CIGNA PPO,330.41,,,,,,,204.5000,792.3400,percent of total billed charges,41.7% of $792.34 in Billed Charges for Rev 272 = $330.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DEEP,272,RC,,,,,,,,both,,,792.3400,118.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,713.11,,,,,,,204.5000,792.3400,percent of total billed charges,90% of $792.34 in Billed Charges for Rev 272 = $713.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DEEP,272,RC,,,,,,,,both,,,792.3400,118.8500,MEDCOST,MEDCOST VHN,377.07,,,,,,,204.5000,792.3400,percent of total billed charges,47.59% of $792.34 in Billed Charges for Rev 272 = $377.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DEEP,272,RC,,,,,,,,both,,,792.3400,118.8500,SENTARA HEALTH,SENTARA HEALTH,204.50,,,,,,,204.5000,792.3400,percent of total billed charges,25.81% of $792.34 in Billed Charges for Rev 272 = $204.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DEEP,272,RC,,,,,,,,both,,,792.3400,118.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",792.34,,,,,,,204.5000,792.3400,percent of total billed charges,100% of $792.34 in Billed Charges for Rev 272 = $792.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DEEP,272,RC,,,,,,,,both,,,792.3400,118.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,396.17,,,,,,,204.5000,792.3400,percent of total billed charges,Rev 272 $792.34 in Billed Charges at 50% = $396.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DEEP,272,RC,,,,,,,,both,,,792.3400,118.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,255.93,,,,,,,204.5000,792.3400,other,32.3% of $792.34 in Billed Charges for Rev 272 = $255.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE DEEP,272,RC,,,,,,,,both,,,792.3400,118.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,243.25,,,,,,,204.5000,792.3400,other,30.7% of $792.34 in Billed Charges for Rev 272 = $243.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE DEEP,272,RC,,,,,,,,both,,,792.3400,118.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,255.93,,,,,,,204.5000,792.3400,percent of total billed charges,32.3% of $792.34 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DEEP,272,RC,,,,,,,,both,,,792.3400,118.8500,WELLCARE,WELLCARE MEDICAID,792.34,,,,,,,204.5000,792.3400,percent of total billed charges,100% of $792.34 in Billed Charges for Rev 272 = $792.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DIEGO SHAVER 4MM,272,RC,,,,,,,,both,,,1704.2200,255.6300,AETNA,AETNA,727.70,,,,,,,439.8600,1704.2200,percent of total billed charges,"42.7% of $1,704.22 in Billed Charges for Rev 272 = $727.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM,272,RC,,,,,,,,both,,,1704.2200,255.6300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1192.95,,,,,,,439.8600,1704.2200,percent of total billed charges,"Rev 272 $1,704.22 in Billed Charges at 70% = $1,192.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM,272,RC,,,,,,,,both,,,1704.2200,255.6300,CIGNA HEALTHCARE,CIGNA HMO,710.66,,,,,,,439.8600,1704.2200,percent of total billed charges,"41.7% of $1,704.22 in Billed Charges for Rev 272 = $710.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM,272,RC,,,,,,,,both,,,1704.2200,255.6300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,790.76,,,,,,,439.8600,1704.2200,percent of total billed charges,"46.4% of $1,704.22 in Billed Charges for Rev 272 = $790.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM,272,RC,,,,,,,,both,,,1704.2200,255.6300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,710.66,,,,,,,439.8600,1704.2200,percent of total billed charges,"41.7% of $1,704.22 in Billed Charges for Rev 272 = $710.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM,272,RC,,,,,,,,both,,,1704.2200,255.6300,CIGNA HEALTHCARE,CIGNA PPO,710.66,,,,,,,439.8600,1704.2200,percent of total billed charges,"41.7% of $1,704.22 in Billed Charges for Rev 272 = $710.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM,272,RC,,,,,,,,both,,,1704.2200,255.6300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1533.80,,,,,,,439.8600,1704.2200,percent of total billed charges,"90% of $1,704.22 in Billed Charges for Rev 272 = $1,533.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM,272,RC,,,,,,,,both,,,1704.2200,255.6300,MEDCOST,MEDCOST VHN,811.04,,,,,,,439.8600,1704.2200,percent of total billed charges,"47.59% of $1,704.22 in Billed Charges for Rev 272 = $811.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM,272,RC,,,,,,,,both,,,1704.2200,255.6300,SENTARA HEALTH,SENTARA HEALTH,439.86,,,,,,,439.8600,1704.2200,percent of total billed charges,"25.81% of $1,704.22 in Billed Charges for Rev 272 = $439.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM,272,RC,,,,,,,,both,,,1704.2200,255.6300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1704.22,,,,,,,439.8600,1704.2200,percent of total billed charges,"100% of $1,704.22 in Billed Charges for Rev 272 = $1,704.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM,272,RC,,,,,,,,both,,,1704.2200,255.6300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,852.11,,,,,,,439.8600,1704.2200,percent of total billed charges,"Rev 272 $1,704.22 in Billed Charges at 50% = $852.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM,272,RC,,,,,,,,both,,,1704.2200,255.6300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,550.46,,,,,,,439.8600,1704.2200,other,"32.3% of $1,704.22 in Billed Charges for Rev 272 = $550.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE DIEGO SHAVER 4MM,272,RC,,,,,,,,both,,,1704.2200,255.6300,UNITED HEALTHCARE,UHC HERITAGE SELECT,523.20,,,,,,,439.8600,1704.2200,other,"30.7% of $1,704.22 in Billed Charges for Rev 272 = $523.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE DIEGO SHAVER 4MM,272,RC,,,,,,,,both,,,1704.2200,255.6300,UNITED HEALTHCARE,UNITED HEALTHCARE,550.46,,,,,,,439.8600,1704.2200,percent of total billed charges,"32.3% of $1,704.22 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM,272,RC,,,,,,,,both,,,1704.2200,255.6300,WELLCARE,WELLCARE MEDICAID,1704.22,,,,,,,439.8600,1704.2200,percent of total billed charges,"100% of $1,704.22 in Billed Charges for Rev 272 = $1,704.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CUPPED 16MMX11CM  5-PACK,272,RC,,,,,,,,both,,,1783.8100,267.5700,AETNA,AETNA,761.69,,,,,,,460.4000,1783.8100,percent of total billed charges,"42.7% of $1,783.81 in Billed Charges for Rev 272 = $761.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CUPPED 16MMX11CM  5-PACK,272,RC,,,,,,,,both,,,1783.8100,267.5700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1248.67,,,,,,,460.4000,1783.8100,percent of total billed charges,"Rev 272 $1,783.81 in Billed Charges at 70% = $1,248.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CUPPED 16MMX11CM  5-PACK,272,RC,,,,,,,,both,,,1783.8100,267.5700,CIGNA HEALTHCARE,CIGNA HMO,743.85,,,,,,,460.4000,1783.8100,percent of total billed charges,"41.7% of $1,783.81 in Billed Charges for Rev 272 = $743.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CUPPED 16MMX11CM  5-PACK,272,RC,,,,,,,,both,,,1783.8100,267.5700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,827.69,,,,,,,460.4000,1783.8100,percent of total billed charges,"46.4% of $1,783.81 in Billed Charges for Rev 272 = $827.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CUPPED 16MMX11CM  5-PACK,272,RC,,,,,,,,both,,,1783.8100,267.5700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,743.85,,,,,,,460.4000,1783.8100,percent of total billed charges,"41.7% of $1,783.81 in Billed Charges for Rev 272 = $743.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CUPPED 16MMX11CM  5-PACK,272,RC,,,,,,,,both,,,1783.8100,267.5700,CIGNA HEALTHCARE,CIGNA PPO,743.85,,,,,,,460.4000,1783.8100,percent of total billed charges,"41.7% of $1,783.81 in Billed Charges for Rev 272 = $743.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CUPPED 16MMX11CM  5-PACK,272,RC,,,,,,,,both,,,1783.8100,267.5700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1605.43,,,,,,,460.4000,1783.8100,percent of total billed charges,"90% of $1,783.81 in Billed Charges for Rev 272 = $1,605.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CUPPED 16MMX11CM  5-PACK,272,RC,,,,,,,,both,,,1783.8100,267.5700,MEDCOST,MEDCOST VHN,848.92,,,,,,,460.4000,1783.8100,percent of total billed charges,"47.59% of $1,783.81 in Billed Charges for Rev 272 = $848.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CUPPED 16MMX11CM  5-PACK,272,RC,,,,,,,,both,,,1783.8100,267.5700,SENTARA HEALTH,SENTARA HEALTH,460.40,,,,,,,460.4000,1783.8100,percent of total billed charges,"25.81% of $1,783.81 in Billed Charges for Rev 272 = $460.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CUPPED 16MMX11CM  5-PACK,272,RC,,,,,,,,both,,,1783.8100,267.5700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1783.81,,,,,,,460.4000,1783.8100,percent of total billed charges,"100% of $1,783.81 in Billed Charges for Rev 272 = $1,783.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CUPPED 16MMX11CM  5-PACK,272,RC,,,,,,,,both,,,1783.8100,267.5700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,891.91,,,,,,,460.4000,1783.8100,percent of total billed charges,"Rev 272 $1,783.81 in Billed Charges at 50% = $891.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CUPPED 16MMX11CM  5-PACK,272,RC,,,,,,,,both,,,1783.8100,267.5700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,576.17,,,,,,,460.4000,1783.8100,other,"32.3% of $1,783.81 in Billed Charges for Rev 272 = $576.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE CUPPED 16MMX11CM  5-PACK,272,RC,,,,,,,,both,,,1783.8100,267.5700,UNITED HEALTHCARE,UHC HERITAGE SELECT,547.63,,,,,,,460.4000,1783.8100,other,"30.7% of $1,783.81 in Billed Charges for Rev 272 = $547.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE CUPPED 16MMX11CM  5-PACK,272,RC,,,,,,,,both,,,1783.8100,267.5700,UNITED HEALTHCARE,UNITED HEALTHCARE,576.17,,,,,,,460.4000,1783.8100,percent of total billed charges,"32.3% of $1,783.81 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CUPPED 16MMX11CM  5-PACK,272,RC,,,,,,,,both,,,1783.8100,267.5700,WELLCARE,WELLCARE MEDICAID,1783.81,,,,,,,460.4000,1783.8100,percent of total billed charges,"100% of $1,783.81 in Billed Charges for Rev 272 = $1,783.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED CAPULOTOMY SAFECUT,272,RC,27200002,CDM,,,,,,both,,,3982.4600,597.3700,AETNA,AETNA,1700.51,,,,,,,1027.8700,3982.4600,percent of total billed charges,"42.7% of $3,982.46 in Billed Charges for Rev 272 = $1,700.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED CAPULOTOMY SAFECUT,272,RC,27200002,CDM,,,,,,both,,,3982.4600,597.3700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2787.72,,,,,,,1027.8700,3982.4600,percent of total billed charges,"Rev 272 $3,982.46 in Billed Charges at 70% = $2,787.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED CAPULOTOMY SAFECUT,272,RC,27200002,CDM,,,,,,both,,,3982.4600,597.3700,CIGNA HEALTHCARE,CIGNA HMO,1660.69,,,,,,,1027.8700,3982.4600,percent of total billed charges,"41.7% of $3,982.46 in Billed Charges for Rev 272 = $1,660.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED CAPULOTOMY SAFECUT,272,RC,27200002,CDM,,,,,,both,,,3982.4600,597.3700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1847.86,,,,,,,1027.8700,3982.4600,percent of total billed charges,"46.4% of $3,982.46 in Billed Charges for Rev 272 = $1,847.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED CAPULOTOMY SAFECUT,272,RC,27200002,CDM,,,,,,both,,,3982.4600,597.3700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1660.69,,,,,,,1027.8700,3982.4600,percent of total billed charges,"41.7% of $3,982.46 in Billed Charges for Rev 272 = $1,660.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED CAPULOTOMY SAFECUT,272,RC,27200002,CDM,,,,,,both,,,3982.4600,597.3700,CIGNA HEALTHCARE,CIGNA PPO,1660.69,,,,,,,1027.8700,3982.4600,percent of total billed charges,"41.7% of $3,982.46 in Billed Charges for Rev 272 = $1,660.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED CAPULOTOMY SAFECUT,272,RC,27200002,CDM,,,,,,both,,,3982.4600,597.3700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3584.21,,,,,,,1027.8700,3982.4600,percent of total billed charges,"90% of $3,982.46 in Billed Charges for Rev 272 = $3,584.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED CAPULOTOMY SAFECUT,272,RC,27200002,CDM,,,,,,both,,,3982.4600,597.3700,MEDCOST,MEDCOST VHN,1895.25,,,,,,,1027.8700,3982.4600,percent of total billed charges,"47.59% of $3,982.46 in Billed Charges for Rev 272 = $1,895.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED CAPULOTOMY SAFECUT,272,RC,27200002,CDM,,,,,,both,,,3982.4600,597.3700,SENTARA HEALTH,SENTARA HEALTH,1027.87,,,,,,,1027.8700,3982.4600,percent of total billed charges,"25.81% of $3,982.46 in Billed Charges for Rev 272 = $1,027.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED CAPULOTOMY SAFECUT,272,RC,27200002,CDM,,,,,,both,,,3982.4600,597.3700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3982.46,,,,,,,1027.8700,3982.4600,percent of total billed charges,"100% of $3,982.46 in Billed Charges for Rev 272 = $3,982.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED CAPULOTOMY SAFECUT,272,RC,27200002,CDM,,,,,,both,,,3982.4600,597.3700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1991.23,,,,,,,1027.8700,3982.4600,percent of total billed charges,"Rev 272 $3,982.46 in Billed Charges at 50% = $1,991.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED CAPULOTOMY SAFECUT,272,RC,27200002,CDM,,,,,,both,,,3982.4600,597.3700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1286.33,,,,,,,1027.8700,3982.4600,other,"32.3% of $3,982.46 in Billed Charges for Rev 272 = $1,286.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE CURVED CAPULOTOMY SAFECUT,272,RC,27200002,CDM,,,,,,both,,,3982.4600,597.3700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1222.62,,,,,,,1027.8700,3982.4600,other,"30.7% of $3,982.46 in Billed Charges for Rev 272 = $1,222.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE CURVED CAPULOTOMY SAFECUT,272,RC,27200002,CDM,,,,,,both,,,3982.4600,597.3700,UNITED HEALTHCARE,UNITED HEALTHCARE,1286.33,,,,,,,1027.8700,3982.4600,percent of total billed charges,"32.3% of $3,982.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE CURVED CAPULOTOMY SAFECUT,272,RC,27200002,CDM,,,,,,both,,,3982.4600,597.3700,WELLCARE,WELLCARE MEDICAID,3982.46,,,,,,,1027.8700,3982.4600,percent of total billed charges,"100% of $3,982.46 in Billed Charges for Rev 272 = $3,982.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL LONG OSTEOTOME BLADE,272,RC,,,,,,,,both,,,1614.7600,242.2100,AETNA,AETNA,689.50,,,,,,,416.7700,1614.7600,percent of total billed charges,"42.7% of $1,614.76 in Billed Charges for Rev 272 = $689.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL LONG OSTEOTOME BLADE,272,RC,,,,,,,,both,,,1614.7600,242.2100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1130.33,,,,,,,416.7700,1614.7600,percent of total billed charges,"Rev 272 $1,614.76 in Billed Charges at 70% = $1,130.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL LONG OSTEOTOME BLADE,272,RC,,,,,,,,both,,,1614.7600,242.2100,CIGNA HEALTHCARE,CIGNA HMO,673.35,,,,,,,416.7700,1614.7600,percent of total billed charges,"41.7% of $1,614.76 in Billed Charges for Rev 272 = $673.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL LONG OSTEOTOME BLADE,272,RC,,,,,,,,both,,,1614.7600,242.2100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,749.25,,,,,,,416.7700,1614.7600,percent of total billed charges,"46.4% of $1,614.76 in Billed Charges for Rev 272 = $749.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL LONG OSTEOTOME BLADE,272,RC,,,,,,,,both,,,1614.7600,242.2100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,673.35,,,,,,,416.7700,1614.7600,percent of total billed charges,"41.7% of $1,614.76 in Billed Charges for Rev 272 = $673.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL LONG OSTEOTOME BLADE,272,RC,,,,,,,,both,,,1614.7600,242.2100,CIGNA HEALTHCARE,CIGNA PPO,673.35,,,,,,,416.7700,1614.7600,percent of total billed charges,"41.7% of $1,614.76 in Billed Charges for Rev 272 = $673.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL LONG OSTEOTOME BLADE,272,RC,,,,,,,,both,,,1614.7600,242.2100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1453.28,,,,,,,416.7700,1614.7600,percent of total billed charges,"90% of $1,614.76 in Billed Charges for Rev 272 = $1,453.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL LONG OSTEOTOME BLADE,272,RC,,,,,,,,both,,,1614.7600,242.2100,MEDCOST,MEDCOST VHN,768.46,,,,,,,416.7700,1614.7600,percent of total billed charges,"47.59% of $1,614.76 in Billed Charges for Rev 272 = $768.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL LONG OSTEOTOME BLADE,272,RC,,,,,,,,both,,,1614.7600,242.2100,SENTARA HEALTH,SENTARA HEALTH,416.77,,,,,,,416.7700,1614.7600,percent of total billed charges,"25.81% of $1,614.76 in Billed Charges for Rev 272 = $416.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL LONG OSTEOTOME BLADE,272,RC,,,,,,,,both,,,1614.7600,242.2100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1614.76,,,,,,,416.7700,1614.7600,percent of total billed charges,"100% of $1,614.76 in Billed Charges for Rev 272 = $1,614.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL LONG OSTEOTOME BLADE,272,RC,,,,,,,,both,,,1614.7600,242.2100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,807.38,,,,,,,416.7700,1614.7600,percent of total billed charges,"Rev 272 $1,614.76 in Billed Charges at 50% = $807.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL LONG OSTEOTOME BLADE,272,RC,,,,,,,,both,,,1614.7600,242.2100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,521.57,,,,,,,416.7700,1614.7600,other,"32.3% of $1,614.76 in Billed Charges for Rev 272 = $521.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE RADIAL LONG OSTEOTOME BLADE,272,RC,,,,,,,,both,,,1614.7600,242.2100,UNITED HEALTHCARE,UHC HERITAGE SELECT,495.73,,,,,,,416.7700,1614.7600,other,"30.7% of $1,614.76 in Billed Charges for Rev 272 = $495.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE RADIAL LONG OSTEOTOME BLADE,272,RC,,,,,,,,both,,,1614.7600,242.2100,UNITED HEALTHCARE,UNITED HEALTHCARE,521.57,,,,,,,416.7700,1614.7600,percent of total billed charges,"32.3% of $1,614.76 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL LONG OSTEOTOME BLADE,272,RC,,,,,,,,both,,,1614.7600,242.2100,WELLCARE,WELLCARE MEDICAID,1614.76,,,,,,,416.7700,1614.7600,percent of total billed charges,"100% of $1,614.76 in Billed Charges for Rev 272 = $1,614.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL OSTEOTOME 10MMX127MM,272,RC,,,,,,,,both,,,5652.2000,847.8300,AETNA,AETNA,2413.49,,,,,,,1458.8300,5652.2000,percent of total billed charges,"42.7% of $5,652.20 in Billed Charges for Rev 272 = $2,413.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL OSTEOTOME 10MMX127MM,272,RC,,,,,,,,both,,,5652.2000,847.8300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3956.54,,,,,,,1458.8300,5652.2000,percent of total billed charges,"Rev 272 $5,652.20 in Billed Charges at 70% = $3,956.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL OSTEOTOME 10MMX127MM,272,RC,,,,,,,,both,,,5652.2000,847.8300,CIGNA HEALTHCARE,CIGNA HMO,2356.97,,,,,,,1458.8300,5652.2000,percent of total billed charges,"41.7% of $5,652.20 in Billed Charges for Rev 272 = $2,356.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL OSTEOTOME 10MMX127MM,272,RC,,,,,,,,both,,,5652.2000,847.8300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2622.62,,,,,,,1458.8300,5652.2000,percent of total billed charges,"46.4% of $5,652.20 in Billed Charges for Rev 272 = $2,622.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL OSTEOTOME 10MMX127MM,272,RC,,,,,,,,both,,,5652.2000,847.8300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2356.97,,,,,,,1458.8300,5652.2000,percent of total billed charges,"41.7% of $5,652.20 in Billed Charges for Rev 272 = $2,356.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL OSTEOTOME 10MMX127MM,272,RC,,,,,,,,both,,,5652.2000,847.8300,CIGNA HEALTHCARE,CIGNA PPO,2356.97,,,,,,,1458.8300,5652.2000,percent of total billed charges,"41.7% of $5,652.20 in Billed Charges for Rev 272 = $2,356.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL OSTEOTOME 10MMX127MM,272,RC,,,,,,,,both,,,5652.2000,847.8300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5086.98,,,,,,,1458.8300,5652.2000,percent of total billed charges,"90% of $5,652.20 in Billed Charges for Rev 272 = $5,086.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL OSTEOTOME 10MMX127MM,272,RC,,,,,,,,both,,,5652.2000,847.8300,MEDCOST,MEDCOST VHN,2689.88,,,,,,,1458.8300,5652.2000,percent of total billed charges,"47.59% of $5,652.20 in Billed Charges for Rev 272 = $2,689.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL OSTEOTOME 10MMX127MM,272,RC,,,,,,,,both,,,5652.2000,847.8300,SENTARA HEALTH,SENTARA HEALTH,1458.83,,,,,,,1458.8300,5652.2000,percent of total billed charges,"25.81% of $5,652.20 in Billed Charges for Rev 272 = $1,458.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL OSTEOTOME 10MMX127MM,272,RC,,,,,,,,both,,,5652.2000,847.8300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5652.20,,,,,,,1458.8300,5652.2000,percent of total billed charges,"100% of $5,652.20 in Billed Charges for Rev 272 = $5,652.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL OSTEOTOME 10MMX127MM,272,RC,,,,,,,,both,,,5652.2000,847.8300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2826.10,,,,,,,1458.8300,5652.2000,percent of total billed charges,"Rev 272 $5,652.20 in Billed Charges at 50% = $2,826.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL OSTEOTOME 10MMX127MM,272,RC,,,,,,,,both,,,5652.2000,847.8300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1825.66,,,,,,,1458.8300,5652.2000,other,"32.3% of $5,652.20 in Billed Charges for Rev 272 = $1,825.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE RADIAL OSTEOTOME 10MMX127MM,272,RC,,,,,,,,both,,,5652.2000,847.8300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1735.23,,,,,,,1458.8300,5652.2000,other,"30.7% of $5,652.20 in Billed Charges for Rev 272 = $1,735.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE RADIAL OSTEOTOME 10MMX127MM,272,RC,,,,,,,,both,,,5652.2000,847.8300,UNITED HEALTHCARE,UNITED HEALTHCARE,1825.66,,,,,,,1458.8300,5652.2000,percent of total billed charges,"32.3% of $5,652.20 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADIAL OSTEOTOME 10MMX127MM,272,RC,,,,,,,,both,,,5652.2000,847.8300,WELLCARE,WELLCARE MEDICAID,5652.20,,,,,,,1458.8300,5652.2000,percent of total billed charges,"100% of $5,652.20 in Billed Charges for Rev 272 = $5,652.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,690.7700,103.6200,AETNA,AETNA,294.96,,,,,,,178.2900,690.7700,percent of total billed charges,42.7% of $690.77 in Billed Charges for Rev 272 = $294.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,690.7700,103.6200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,483.54,,,,,,,178.2900,690.7700,percent of total billed charges,Rev 272 $690.77 in Billed Charges at 70% = $483.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,690.7700,103.6200,CIGNA HEALTHCARE,CIGNA HMO,288.05,,,,,,,178.2900,690.7700,percent of total billed charges,41.7% of $690.77 in Billed Charges for Rev 272 = $288.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,690.7700,103.6200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,320.52,,,,,,,178.2900,690.7700,percent of total billed charges,46.4% of $690.77 in Billed Charges for Rev 272 = $320.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,690.7700,103.6200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,288.05,,,,,,,178.2900,690.7700,percent of total billed charges,41.7% of $690.77 in Billed Charges for Rev 272 = $288.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,690.7700,103.6200,CIGNA HEALTHCARE,CIGNA PPO,288.05,,,,,,,178.2900,690.7700,percent of total billed charges,41.7% of $690.77 in Billed Charges for Rev 272 = $288.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,690.7700,103.6200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,621.69,,,,,,,178.2900,690.7700,percent of total billed charges,90% of $690.77 in Billed Charges for Rev 272 = $621.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,690.7700,103.6200,MEDCOST,MEDCOST VHN,328.74,,,,,,,178.2900,690.7700,percent of total billed charges,47.59% of $690.77 in Billed Charges for Rev 272 = $328.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,690.7700,103.6200,SENTARA HEALTH,SENTARA HEALTH,178.29,,,,,,,178.2900,690.7700,percent of total billed charges,25.81% of $690.77 in Billed Charges for Rev 272 = $178.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,690.7700,103.6200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",690.77,,,,,,,178.2900,690.7700,percent of total billed charges,100% of $690.77 in Billed Charges for Rev 272 = $690.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,690.7700,103.6200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,345.39,,,,,,,178.2900,690.7700,percent of total billed charges,Rev 272 $690.77 in Billed Charges at 50% = $345.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,690.7700,103.6200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,223.12,,,,,,,178.2900,690.7700,other,32.3% of $690.77 in Billed Charges for Rev 272 = $223.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,690.7700,103.6200,UNITED HEALTHCARE,UHC HERITAGE SELECT,212.07,,,,,,,178.2900,690.7700,other,30.7% of $690.77 in Billed Charges for Rev 272 = $212.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,690.7700,103.6200,UNITED HEALTHCARE,UNITED HEALTHCARE,223.12,,,,,,,178.2900,690.7700,percent of total billed charges,32.3% of $690.77 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,690.7700,103.6200,WELLCARE,WELLCARE MEDICAID,690.77,,,,,,,178.2900,690.7700,percent of total billed charges,100% of $690.77 in Billed Charges for Rev 272 = $690.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,718.4000,107.7600,AETNA,AETNA,306.76,,,,,,,185.4200,718.4000,percent of total billed charges,42.7% of $718.40 in Billed Charges for Rev 272 = $306.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,718.4000,107.7600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,502.88,,,,,,,185.4200,718.4000,percent of total billed charges,Rev 272 $718.40 in Billed Charges at 70% = $502.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,718.4000,107.7600,CIGNA HEALTHCARE,CIGNA HMO,299.57,,,,,,,185.4200,718.4000,percent of total billed charges,41.7% of $718.40 in Billed Charges for Rev 272 = $299.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,718.4000,107.7600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,333.34,,,,,,,185.4200,718.4000,percent of total billed charges,46.4% of $718.40 in Billed Charges for Rev 272 = $333.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,718.4000,107.7600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,299.57,,,,,,,185.4200,718.4000,percent of total billed charges,41.7% of $718.40 in Billed Charges for Rev 272 = $299.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,718.4000,107.7600,CIGNA HEALTHCARE,CIGNA PPO,299.57,,,,,,,185.4200,718.4000,percent of total billed charges,41.7% of $718.40 in Billed Charges for Rev 272 = $299.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,718.4000,107.7600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,646.56,,,,,,,185.4200,718.4000,percent of total billed charges,90% of $718.40 in Billed Charges for Rev 272 = $646.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,718.4000,107.7600,MEDCOST,MEDCOST VHN,341.89,,,,,,,185.4200,718.4000,percent of total billed charges,47.59% of $718.40 in Billed Charges for Rev 272 = $341.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,718.4000,107.7600,SENTARA HEALTH,SENTARA HEALTH,185.42,,,,,,,185.4200,718.4000,percent of total billed charges,25.81% of $718.40 in Billed Charges for Rev 272 = $185.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,718.4000,107.7600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",718.40,,,,,,,185.4200,718.4000,percent of total billed charges,100% of $718.40 in Billed Charges for Rev 272 = $718.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,718.4000,107.7600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,359.20,,,,,,,185.4200,718.4000,percent of total billed charges,Rev 272 $718.40 in Billed Charges at 50% = $359.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,718.4000,107.7600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,232.04,,,,,,,185.4200,718.4000,other,32.3% of $718.40 in Billed Charges for Rev 272 = $232.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,718.4000,107.7600,UNITED HEALTHCARE,UHC HERITAGE SELECT,220.55,,,,,,,185.4200,718.4000,other,30.7% of $718.40 in Billed Charges for Rev 272 = $220.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,718.4000,107.7600,UNITED HEALTHCARE,UNITED HEALTHCARE,232.04,,,,,,,185.4200,718.4000,percent of total billed charges,32.3% of $718.40 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 0375-542-000 DUPLICATE USE LN 26494,272,RC,,,,,,,,both,,,718.4000,107.7600,WELLCARE,WELLCARE MEDICAID,718.40,,,,,,,185.4200,718.4000,percent of total billed charges,100% of $718.40 in Billed Charges for Rev 272 = $718.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,3158.2800,473.7400,AETNA,AETNA,1348.59,,,,,,,815.1500,3158.2800,percent of total billed charges,"42.7% of $3,158.28 in Billed Charges for Rev 272 = $1,348.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,3158.2800,473.7400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2210.80,,,,,,,815.1500,3158.2800,percent of total billed charges,"Rev 272 $3,158.28 in Billed Charges at 70% = $2,210.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,3158.2800,473.7400,CIGNA HEALTHCARE,CIGNA HMO,1317.00,,,,,,,815.1500,3158.2800,percent of total billed charges,"41.7% of $3,158.28 in Billed Charges for Rev 272 = $1,317.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,3158.2800,473.7400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1465.44,,,,,,,815.1500,3158.2800,percent of total billed charges,"46.4% of $3,158.28 in Billed Charges for Rev 272 = $1,465.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,3158.2800,473.7400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1317.00,,,,,,,815.1500,3158.2800,percent of total billed charges,"41.7% of $3,158.28 in Billed Charges for Rev 272 = $1,317.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,3158.2800,473.7400,CIGNA HEALTHCARE,CIGNA PPO,1317.00,,,,,,,815.1500,3158.2800,percent of total billed charges,"41.7% of $3,158.28 in Billed Charges for Rev 272 = $1,317.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,3158.2800,473.7400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2842.45,,,,,,,815.1500,3158.2800,percent of total billed charges,"90% of $3,158.28 in Billed Charges for Rev 272 = $2,842.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,3158.2800,473.7400,MEDCOST,MEDCOST VHN,1503.03,,,,,,,815.1500,3158.2800,percent of total billed charges,"47.59% of $3,158.28 in Billed Charges for Rev 272 = $1,503.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,3158.2800,473.7400,SENTARA HEALTH,SENTARA HEALTH,815.15,,,,,,,815.1500,3158.2800,percent of total billed charges,"25.81% of $3,158.28 in Billed Charges for Rev 272 = $815.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,3158.2800,473.7400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3158.28,,,,,,,815.1500,3158.2800,percent of total billed charges,"100% of $3,158.28 in Billed Charges for Rev 272 = $3,158.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,3158.2800,473.7400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1579.14,,,,,,,815.1500,3158.2800,percent of total billed charges,"Rev 272 $3,158.28 in Billed Charges at 50% = $1,579.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,3158.2800,473.7400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1020.12,,,,,,,815.1500,3158.2800,other,"32.3% of $3,158.28 in Billed Charges for Rev 272 = $1,020.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,3158.2800,473.7400,UNITED HEALTHCARE,UHC HERITAGE SELECT,969.59,,,,,,,815.1500,3158.2800,other,"30.7% of $3,158.28 in Billed Charges for Rev 272 = $969.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,3158.2800,473.7400,UNITED HEALTHCARE,UNITED HEALTHCARE,1020.12,,,,,,,815.1500,3158.2800,percent of total billed charges,"32.3% of $3,158.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,3158.2800,473.7400,WELLCARE,WELLCARE MEDICAID,3158.28,,,,,,,815.1500,3158.2800,percent of total billed charges,"100% of $3,158.28 in Billed Charges for Rev 272 = $3,158.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,631.6600,94.7500,AETNA,AETNA,269.72,,,,,,,163.0300,631.6600,percent of total billed charges,42.7% of $631.66 in Billed Charges for Rev 272 = $269.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,631.6600,94.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,442.16,,,,,,,163.0300,631.6600,percent of total billed charges,Rev 272 $631.66 in Billed Charges at 70% = $442.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,631.6600,94.7500,CIGNA HEALTHCARE,CIGNA HMO,263.40,,,,,,,163.0300,631.6600,percent of total billed charges,41.7% of $631.66 in Billed Charges for Rev 272 = $263.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,631.6600,94.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,293.09,,,,,,,163.0300,631.6600,percent of total billed charges,46.4% of $631.66 in Billed Charges for Rev 272 = $293.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,631.6600,94.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,263.40,,,,,,,163.0300,631.6600,percent of total billed charges,41.7% of $631.66 in Billed Charges for Rev 272 = $263.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,631.6600,94.7500,CIGNA HEALTHCARE,CIGNA PPO,263.40,,,,,,,163.0300,631.6600,percent of total billed charges,41.7% of $631.66 in Billed Charges for Rev 272 = $263.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,631.6600,94.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,568.49,,,,,,,163.0300,631.6600,percent of total billed charges,90% of $631.66 in Billed Charges for Rev 272 = $568.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,631.6600,94.7500,MEDCOST,MEDCOST VHN,300.61,,,,,,,163.0300,631.6600,percent of total billed charges,47.59% of $631.66 in Billed Charges for Rev 272 = $300.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,631.6600,94.7500,SENTARA HEALTH,SENTARA HEALTH,163.03,,,,,,,163.0300,631.6600,percent of total billed charges,25.81% of $631.66 in Billed Charges for Rev 272 = $163.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,631.6600,94.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",631.66,,,,,,,163.0300,631.6600,percent of total billed charges,100% of $631.66 in Billed Charges for Rev 272 = $631.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,631.6600,94.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,315.83,,,,,,,163.0300,631.6600,percent of total billed charges,Rev 272 $631.66 in Billed Charges at 50% = $315.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,631.6600,94.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,204.03,,,,,,,163.0300,631.6600,other,32.3% of $631.66 in Billed Charges for Rev 272 = $204.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,631.6600,94.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,193.92,,,,,,,163.0300,631.6600,other,30.7% of $631.66 in Billed Charges for Rev 272 = $193.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,631.6600,94.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,204.03,,,,,,,163.0300,631.6600,percent of total billed charges,32.3% of $631.66 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,631.6600,94.7500,WELLCARE,WELLCARE MEDICAID,631.66,,,,,,,163.0300,631.6600,percent of total billed charges,100% of $631.66 in Billed Charges for Rev 272 = $631.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,656.9200,98.5400,AETNA,AETNA,280.50,,,,,,,169.5500,656.9200,percent of total billed charges,42.7% of $656.92 in Billed Charges for Rev 272 = $280.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,656.9200,98.5400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,459.84,,,,,,,169.5500,656.9200,percent of total billed charges,Rev 272 $656.92 in Billed Charges at 70% = $459.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,656.9200,98.5400,CIGNA HEALTHCARE,CIGNA HMO,273.94,,,,,,,169.5500,656.9200,percent of total billed charges,41.7% of $656.92 in Billed Charges for Rev 272 = $273.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,656.9200,98.5400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,304.81,,,,,,,169.5500,656.9200,percent of total billed charges,46.4% of $656.92 in Billed Charges for Rev 272 = $304.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,656.9200,98.5400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,273.94,,,,,,,169.5500,656.9200,percent of total billed charges,41.7% of $656.92 in Billed Charges for Rev 272 = $273.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,656.9200,98.5400,CIGNA HEALTHCARE,CIGNA PPO,273.94,,,,,,,169.5500,656.9200,percent of total billed charges,41.7% of $656.92 in Billed Charges for Rev 272 = $273.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,656.9200,98.5400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,591.23,,,,,,,169.5500,656.9200,percent of total billed charges,90% of $656.92 in Billed Charges for Rev 272 = $591.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,656.9200,98.5400,MEDCOST,MEDCOST VHN,312.63,,,,,,,169.5500,656.9200,percent of total billed charges,47.59% of $656.92 in Billed Charges for Rev 272 = $312.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,656.9200,98.5400,SENTARA HEALTH,SENTARA HEALTH,169.55,,,,,,,169.5500,656.9200,percent of total billed charges,25.81% of $656.92 in Billed Charges for Rev 272 = $169.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,656.9200,98.5400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",656.92,,,,,,,169.5500,656.9200,percent of total billed charges,100% of $656.92 in Billed Charges for Rev 272 = $656.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,656.9200,98.5400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,328.46,,,,,,,169.5500,656.9200,percent of total billed charges,Rev 272 $656.92 in Billed Charges at 50% = $328.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,656.9200,98.5400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,212.19,,,,,,,169.5500,656.9200,other,32.3% of $656.92 in Billed Charges for Rev 272 = $212.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,656.9200,98.5400,UNITED HEALTHCARE,UHC HERITAGE SELECT,201.67,,,,,,,169.5500,656.9200,other,30.7% of $656.92 in Billed Charges for Rev 272 = $201.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,656.9200,98.5400,UNITED HEALTHCARE,UNITED HEALTHCARE,212.19,,,,,,,169.5500,656.9200,percent of total billed charges,32.3% of $656.92 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RESECTOR 3.5,272,RC,27200002,CDM,,,,,,both,,,656.9200,98.5400,WELLCARE,WELLCARE MEDICAID,656.92,,,,,,,169.5500,656.9200,percent of total billed charges,100% of $656.92 in Billed Charges for Rev 272 = $656.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RIGHT ANGLE SCREWDRIVER 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1491.4500,223.7200,AETNA,AETNA,636.85,,,,,,,384.9400,1491.4500,percent of total billed charges,"42.7% of $1,491.45 in Billed Charges for Rev 272 = $636.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RIGHT ANGLE SCREWDRIVER 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1491.4500,223.7200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1044.02,,,,,,,384.9400,1491.4500,percent of total billed charges,"Rev 272 $1,491.45 in Billed Charges at 70% = $1,044.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RIGHT ANGLE SCREWDRIVER 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1491.4500,223.7200,CIGNA HEALTHCARE,CIGNA HMO,621.93,,,,,,,384.9400,1491.4500,percent of total billed charges,"41.7% of $1,491.45 in Billed Charges for Rev 272 = $621.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RIGHT ANGLE SCREWDRIVER 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1491.4500,223.7200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,692.03,,,,,,,384.9400,1491.4500,percent of total billed charges,"46.4% of $1,491.45 in Billed Charges for Rev 272 = $692.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RIGHT ANGLE SCREWDRIVER 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1491.4500,223.7200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,621.93,,,,,,,384.9400,1491.4500,percent of total billed charges,"41.7% of $1,491.45 in Billed Charges for Rev 272 = $621.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RIGHT ANGLE SCREWDRIVER 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1491.4500,223.7200,CIGNA HEALTHCARE,CIGNA PPO,621.93,,,,,,,384.9400,1491.4500,percent of total billed charges,"41.7% of $1,491.45 in Billed Charges for Rev 272 = $621.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RIGHT ANGLE SCREWDRIVER 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1491.4500,223.7200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1342.31,,,,,,,384.9400,1491.4500,percent of total billed charges,"90% of $1,491.45 in Billed Charges for Rev 272 = $1,342.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RIGHT ANGLE SCREWDRIVER 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1491.4500,223.7200,MEDCOST,MEDCOST VHN,709.78,,,,,,,384.9400,1491.4500,percent of total billed charges,"47.59% of $1,491.45 in Billed Charges for Rev 272 = $709.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RIGHT ANGLE SCREWDRIVER 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1491.4500,223.7200,SENTARA HEALTH,SENTARA HEALTH,384.94,,,,,,,384.9400,1491.4500,percent of total billed charges,"25.81% of $1,491.45 in Billed Charges for Rev 272 = $384.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RIGHT ANGLE SCREWDRIVER 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1491.4500,223.7200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1491.45,,,,,,,384.9400,1491.4500,percent of total billed charges,"100% of $1,491.45 in Billed Charges for Rev 272 = $1,491.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RIGHT ANGLE SCREWDRIVER 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1491.4500,223.7200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,745.73,,,,,,,384.9400,1491.4500,percent of total billed charges,"Rev 272 $1,491.45 in Billed Charges at 50% = $745.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RIGHT ANGLE SCREWDRIVER 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1491.4500,223.7200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,481.74,,,,,,,384.9400,1491.4500,other,"32.3% of $1,491.45 in Billed Charges for Rev 272 = $481.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE RIGHT ANGLE SCREWDRIVER 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1491.4500,223.7200,UNITED HEALTHCARE,UHC HERITAGE SELECT,457.88,,,,,,,384.9400,1491.4500,other,"30.7% of $1,491.45 in Billed Charges for Rev 272 = $457.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE RIGHT ANGLE SCREWDRIVER 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1491.4500,223.7200,UNITED HEALTHCARE,UNITED HEALTHCARE,481.74,,,,,,,384.9400,1491.4500,percent of total billed charges,"32.3% of $1,491.45 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RIGHT ANGLE SCREWDRIVER 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1491.4500,223.7200,WELLCARE,WELLCARE MEDICAID,1491.45,,,,,,,384.9400,1491.4500,percent of total billed charges,"100% of $1,491.45 in Billed Charges for Rev 272 = $1,491.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROTATABLE FUSION 13CM,272,RC,27200002,CDM,,,,,,both,,,3998.6400,599.8000,AETNA,AETNA,1707.42,,,,,,,1032.0500,3998.6400,percent of total billed charges,"42.7% of $3,998.64 in Billed Charges for Rev 272 = $1,707.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROTATABLE FUSION 13CM,272,RC,27200002,CDM,,,,,,both,,,3998.6400,599.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2799.05,,,,,,,1032.0500,3998.6400,percent of total billed charges,"Rev 272 $3,998.64 in Billed Charges at 70% = $2,799.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROTATABLE FUSION 13CM,272,RC,27200002,CDM,,,,,,both,,,3998.6400,599.8000,CIGNA HEALTHCARE,CIGNA HMO,1667.43,,,,,,,1032.0500,3998.6400,percent of total billed charges,"41.7% of $3,998.64 in Billed Charges for Rev 272 = $1,667.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROTATABLE FUSION 13CM,272,RC,27200002,CDM,,,,,,both,,,3998.6400,599.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1855.37,,,,,,,1032.0500,3998.6400,percent of total billed charges,"46.4% of $3,998.64 in Billed Charges for Rev 272 = $1,855.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROTATABLE FUSION 13CM,272,RC,27200002,CDM,,,,,,both,,,3998.6400,599.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1667.43,,,,,,,1032.0500,3998.6400,percent of total billed charges,"41.7% of $3,998.64 in Billed Charges for Rev 272 = $1,667.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROTATABLE FUSION 13CM,272,RC,27200002,CDM,,,,,,both,,,3998.6400,599.8000,CIGNA HEALTHCARE,CIGNA PPO,1667.43,,,,,,,1032.0500,3998.6400,percent of total billed charges,"41.7% of $3,998.64 in Billed Charges for Rev 272 = $1,667.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROTATABLE FUSION 13CM,272,RC,27200002,CDM,,,,,,both,,,3998.6400,599.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3598.78,,,,,,,1032.0500,3998.6400,percent of total billed charges,"90% of $3,998.64 in Billed Charges for Rev 272 = $3,598.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROTATABLE FUSION 13CM,272,RC,27200002,CDM,,,,,,both,,,3998.6400,599.8000,MEDCOST,MEDCOST VHN,1902.95,,,,,,,1032.0500,3998.6400,percent of total billed charges,"47.59% of $3,998.64 in Billed Charges for Rev 272 = $1,902.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROTATABLE FUSION 13CM,272,RC,27200002,CDM,,,,,,both,,,3998.6400,599.8000,SENTARA HEALTH,SENTARA HEALTH,1032.05,,,,,,,1032.0500,3998.6400,percent of total billed charges,"25.81% of $3,998.64 in Billed Charges for Rev 272 = $1,032.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROTATABLE FUSION 13CM,272,RC,27200002,CDM,,,,,,both,,,3998.6400,599.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3998.64,,,,,,,1032.0500,3998.6400,percent of total billed charges,"100% of $3,998.64 in Billed Charges for Rev 272 = $3,998.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROTATABLE FUSION 13CM,272,RC,27200002,CDM,,,,,,both,,,3998.6400,599.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1999.32,,,,,,,1032.0500,3998.6400,percent of total billed charges,"Rev 272 $3,998.64 in Billed Charges at 50% = $1,999.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROTATABLE FUSION 13CM,272,RC,27200002,CDM,,,,,,both,,,3998.6400,599.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1291.56,,,,,,,1032.0500,3998.6400,other,"32.3% of $3,998.64 in Billed Charges for Rev 272 = $1,291.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE ROTATABLE FUSION 13CM,272,RC,27200002,CDM,,,,,,both,,,3998.6400,599.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1227.58,,,,,,,1032.0500,3998.6400,other,"30.7% of $3,998.64 in Billed Charges for Rev 272 = $1,227.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE ROTATABLE FUSION 13CM,272,RC,27200002,CDM,,,,,,both,,,3998.6400,599.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,1291.56,,,,,,,1032.0500,3998.6400,percent of total billed charges,"32.3% of $3,998.64 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROTATABLE FUSION 13CM,272,RC,27200002,CDM,,,,,,both,,,3998.6400,599.8000,WELLCARE,WELLCARE MEDICAID,3998.64,,,,,,,1032.0500,3998.6400,percent of total billed charges,"100% of $3,998.64 in Billed Charges for Rev 272 = $3,998.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROUTER TAPERED 1.7 X 25MM,272,RC,,,,,,,,both,,,1145.8900,171.8800,AETNA,AETNA,489.30,,,,,,,295.7500,1145.8900,percent of total billed charges,"42.7% of $1,145.89 in Billed Charges for Rev 272 = $489.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROUTER TAPERED 1.7 X 25MM,272,RC,,,,,,,,both,,,1145.8900,171.8800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,802.12,,,,,,,295.7500,1145.8900,percent of total billed charges,"Rev 272 $1,145.89 in Billed Charges at 70% = $802.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROUTER TAPERED 1.7 X 25MM,272,RC,,,,,,,,both,,,1145.8900,171.8800,CIGNA HEALTHCARE,CIGNA HMO,477.84,,,,,,,295.7500,1145.8900,percent of total billed charges,"41.7% of $1,145.89 in Billed Charges for Rev 272 = $477.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROUTER TAPERED 1.7 X 25MM,272,RC,,,,,,,,both,,,1145.8900,171.8800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,531.69,,,,,,,295.7500,1145.8900,percent of total billed charges,"46.4% of $1,145.89 in Billed Charges for Rev 272 = $531.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROUTER TAPERED 1.7 X 25MM,272,RC,,,,,,,,both,,,1145.8900,171.8800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,477.84,,,,,,,295.7500,1145.8900,percent of total billed charges,"41.7% of $1,145.89 in Billed Charges for Rev 272 = $477.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROUTER TAPERED 1.7 X 25MM,272,RC,,,,,,,,both,,,1145.8900,171.8800,CIGNA HEALTHCARE,CIGNA PPO,477.84,,,,,,,295.7500,1145.8900,percent of total billed charges,"41.7% of $1,145.89 in Billed Charges for Rev 272 = $477.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROUTER TAPERED 1.7 X 25MM,272,RC,,,,,,,,both,,,1145.8900,171.8800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1031.30,,,,,,,295.7500,1145.8900,percent of total billed charges,"90% of $1,145.89 in Billed Charges for Rev 272 = $1,031.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROUTER TAPERED 1.7 X 25MM,272,RC,,,,,,,,both,,,1145.8900,171.8800,MEDCOST,MEDCOST VHN,545.33,,,,,,,295.7500,1145.8900,percent of total billed charges,"47.59% of $1,145.89 in Billed Charges for Rev 272 = $545.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROUTER TAPERED 1.7 X 25MM,272,RC,,,,,,,,both,,,1145.8900,171.8800,SENTARA HEALTH,SENTARA HEALTH,295.75,,,,,,,295.7500,1145.8900,percent of total billed charges,"25.81% of $1,145.89 in Billed Charges for Rev 272 = $295.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROUTER TAPERED 1.7 X 25MM,272,RC,,,,,,,,both,,,1145.8900,171.8800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1145.89,,,,,,,295.7500,1145.8900,percent of total billed charges,"100% of $1,145.89 in Billed Charges for Rev 272 = $1,145.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROUTER TAPERED 1.7 X 25MM,272,RC,,,,,,,,both,,,1145.8900,171.8800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,572.95,,,,,,,295.7500,1145.8900,percent of total billed charges,"Rev 272 $1,145.89 in Billed Charges at 50% = $572.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROUTER TAPERED 1.7 X 25MM,272,RC,,,,,,,,both,,,1145.8900,171.8800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,370.12,,,,,,,295.7500,1145.8900,other,"32.3% of $1,145.89 in Billed Charges for Rev 272 = $370.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE ROUTER TAPERED 1.7 X 25MM,272,RC,,,,,,,,both,,,1145.8900,171.8800,UNITED HEALTHCARE,UHC HERITAGE SELECT,351.79,,,,,,,295.7500,1145.8900,other,"30.7% of $1,145.89 in Billed Charges for Rev 272 = $351.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE ROUTER TAPERED 1.7 X 25MM,272,RC,,,,,,,,both,,,1145.8900,171.8800,UNITED HEALTHCARE,UNITED HEALTHCARE,370.12,,,,,,,295.7500,1145.8900,percent of total billed charges,"32.3% of $1,145.89 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ROUTER TAPERED 1.7 X 25MM,272,RC,,,,,,,,both,,,1145.8900,171.8800,WELLCARE,WELLCARE MEDICAID,1145.89,,,,,,,295.7500,1145.8900,percent of total billed charges,"100% of $1,145.89 in Billed Charges for Rev 272 = $1,145.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SABRE SMALL JOINT 2MM,272,RC,27200002,CDM,,,,,,both,,,798.5700,119.7900,AETNA,AETNA,340.99,,,,,,,206.1100,798.5700,percent of total billed charges,42.7% of $798.57 in Billed Charges for Rev 272 = $340.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SABRE SMALL JOINT 2MM,272,RC,27200002,CDM,,,,,,both,,,798.5700,119.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,559.00,,,,,,,206.1100,798.5700,percent of total billed charges,Rev 272 $798.57 in Billed Charges at 70% = $559.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SABRE SMALL JOINT 2MM,272,RC,27200002,CDM,,,,,,both,,,798.5700,119.7900,CIGNA HEALTHCARE,CIGNA HMO,333.00,,,,,,,206.1100,798.5700,percent of total billed charges,41.7% of $798.57 in Billed Charges for Rev 272 = $333.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SABRE SMALL JOINT 2MM,272,RC,27200002,CDM,,,,,,both,,,798.5700,119.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,370.54,,,,,,,206.1100,798.5700,percent of total billed charges,46.4% of $798.57 in Billed Charges for Rev 272 = $370.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SABRE SMALL JOINT 2MM,272,RC,27200002,CDM,,,,,,both,,,798.5700,119.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,333.00,,,,,,,206.1100,798.5700,percent of total billed charges,41.7% of $798.57 in Billed Charges for Rev 272 = $333.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SABRE SMALL JOINT 2MM,272,RC,27200002,CDM,,,,,,both,,,798.5700,119.7900,CIGNA HEALTHCARE,CIGNA PPO,333.00,,,,,,,206.1100,798.5700,percent of total billed charges,41.7% of $798.57 in Billed Charges for Rev 272 = $333.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SABRE SMALL JOINT 2MM,272,RC,27200002,CDM,,,,,,both,,,798.5700,119.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,718.71,,,,,,,206.1100,798.5700,percent of total billed charges,90% of $798.57 in Billed Charges for Rev 272 = $718.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SABRE SMALL JOINT 2MM,272,RC,27200002,CDM,,,,,,both,,,798.5700,119.7900,MEDCOST,MEDCOST VHN,380.04,,,,,,,206.1100,798.5700,percent of total billed charges,47.59% of $798.57 in Billed Charges for Rev 272 = $380.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SABRE SMALL JOINT 2MM,272,RC,27200002,CDM,,,,,,both,,,798.5700,119.7900,SENTARA HEALTH,SENTARA HEALTH,206.11,,,,,,,206.1100,798.5700,percent of total billed charges,25.81% of $798.57 in Billed Charges for Rev 272 = $206.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SABRE SMALL JOINT 2MM,272,RC,27200002,CDM,,,,,,both,,,798.5700,119.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",798.57,,,,,,,206.1100,798.5700,percent of total billed charges,100% of $798.57 in Billed Charges for Rev 272 = $798.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SABRE SMALL JOINT 2MM,272,RC,27200002,CDM,,,,,,both,,,798.5700,119.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,399.29,,,,,,,206.1100,798.5700,percent of total billed charges,Rev 272 $798.57 in Billed Charges at 50% = $399.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SABRE SMALL JOINT 2MM,272,RC,27200002,CDM,,,,,,both,,,798.5700,119.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,257.94,,,,,,,206.1100,798.5700,other,32.3% of $798.57 in Billed Charges for Rev 272 = $257.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE SABRE SMALL JOINT 2MM,272,RC,27200002,CDM,,,,,,both,,,798.5700,119.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,245.16,,,,,,,206.1100,798.5700,other,30.7% of $798.57 in Billed Charges for Rev 272 = $245.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE SABRE SMALL JOINT 2MM,272,RC,27200002,CDM,,,,,,both,,,798.5700,119.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,257.94,,,,,,,206.1100,798.5700,percent of total billed charges,32.3% of $798.57 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SABRE SMALL JOINT 2MM,272,RC,27200002,CDM,,,,,,both,,,798.5700,119.7900,WELLCARE,WELLCARE MEDICAID,798.57,,,,,,,206.1100,798.5700,percent of total billed charges,100% of $798.57 in Billed Charges for Rev 272 = $798.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 13MMW X 90MML BEVELED,272,RC,27200002,CDM,,,,,,both,,,572.2700,85.8400,AETNA,AETNA,244.36,,,,,,,147.7000,572.2700,percent of total billed charges,42.7% of $572.27 in Billed Charges for Rev 272 = $244.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 13MMW X 90MML BEVELED,272,RC,27200002,CDM,,,,,,both,,,572.2700,85.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,400.59,,,,,,,147.7000,572.2700,percent of total billed charges,Rev 272 $572.27 in Billed Charges at 70% = $400.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 13MMW X 90MML BEVELED,272,RC,27200002,CDM,,,,,,both,,,572.2700,85.8400,CIGNA HEALTHCARE,CIGNA HMO,238.64,,,,,,,147.7000,572.2700,percent of total billed charges,41.7% of $572.27 in Billed Charges for Rev 272 = $238.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 13MMW X 90MML BEVELED,272,RC,27200002,CDM,,,,,,both,,,572.2700,85.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,265.53,,,,,,,147.7000,572.2700,percent of total billed charges,46.4% of $572.27 in Billed Charges for Rev 272 = $265.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 13MMW X 90MML BEVELED,272,RC,27200002,CDM,,,,,,both,,,572.2700,85.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,238.64,,,,,,,147.7000,572.2700,percent of total billed charges,41.7% of $572.27 in Billed Charges for Rev 272 = $238.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 13MMW X 90MML BEVELED,272,RC,27200002,CDM,,,,,,both,,,572.2700,85.8400,CIGNA HEALTHCARE,CIGNA PPO,238.64,,,,,,,147.7000,572.2700,percent of total billed charges,41.7% of $572.27 in Billed Charges for Rev 272 = $238.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 13MMW X 90MML BEVELED,272,RC,27200002,CDM,,,,,,both,,,572.2700,85.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,515.04,,,,,,,147.7000,572.2700,percent of total billed charges,90% of $572.27 in Billed Charges for Rev 272 = $515.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 13MMW X 90MML BEVELED,272,RC,27200002,CDM,,,,,,both,,,572.2700,85.8400,MEDCOST,MEDCOST VHN,272.34,,,,,,,147.7000,572.2700,percent of total billed charges,47.59% of $572.27 in Billed Charges for Rev 272 = $272.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 13MMW X 90MML BEVELED,272,RC,27200002,CDM,,,,,,both,,,572.2700,85.8400,SENTARA HEALTH,SENTARA HEALTH,147.70,,,,,,,147.7000,572.2700,percent of total billed charges,25.81% of $572.27 in Billed Charges for Rev 272 = $147.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 13MMW X 90MML BEVELED,272,RC,27200002,CDM,,,,,,both,,,572.2700,85.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",572.27,,,,,,,147.7000,572.2700,percent of total billed charges,100% of $572.27 in Billed Charges for Rev 272 = $572.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 13MMW X 90MML BEVELED,272,RC,27200002,CDM,,,,,,both,,,572.2700,85.8400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,286.14,,,,,,,147.7000,572.2700,percent of total billed charges,Rev 272 $572.27 in Billed Charges at 50% = $286.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 13MMW X 90MML BEVELED,272,RC,27200002,CDM,,,,,,both,,,572.2700,85.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,184.84,,,,,,,147.7000,572.2700,other,32.3% of $572.27 in Billed Charges for Rev 272 = $184.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE SAGITTAL 13MMW X 90MML BEVELED,272,RC,27200002,CDM,,,,,,both,,,572.2700,85.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,175.69,,,,,,,147.7000,572.2700,other,30.7% of $572.27 in Billed Charges for Rev 272 = $175.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE SAGITTAL 13MMW X 90MML BEVELED,272,RC,27200002,CDM,,,,,,both,,,572.2700,85.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,184.84,,,,,,,147.7000,572.2700,percent of total billed charges,32.3% of $572.27 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 13MMW X 90MML BEVELED,272,RC,27200002,CDM,,,,,,both,,,572.2700,85.8400,WELLCARE,WELLCARE MEDICAID,572.27,,,,,,,147.7000,572.2700,percent of total billed charges,100% of $572.27 in Billed Charges for Rev 272 = $572.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 25MM,272,RC,27200002,CDM,,,,,,both,,,520.4200,78.0600,AETNA,AETNA,222.22,,,,,,,134.3200,520.4200,percent of total billed charges,42.7% of $520.42 in Billed Charges for Rev 272 = $222.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 25MM,272,RC,27200002,CDM,,,,,,both,,,520.4200,78.0600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,364.29,,,,,,,134.3200,520.4200,percent of total billed charges,Rev 272 $520.42 in Billed Charges at 70% = $364.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 25MM,272,RC,27200002,CDM,,,,,,both,,,520.4200,78.0600,CIGNA HEALTHCARE,CIGNA HMO,217.02,,,,,,,134.3200,520.4200,percent of total billed charges,41.7% of $520.42 in Billed Charges for Rev 272 = $217.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 25MM,272,RC,27200002,CDM,,,,,,both,,,520.4200,78.0600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,241.47,,,,,,,134.3200,520.4200,percent of total billed charges,46.4% of $520.42 in Billed Charges for Rev 272 = $241.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 25MM,272,RC,27200002,CDM,,,,,,both,,,520.4200,78.0600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,217.02,,,,,,,134.3200,520.4200,percent of total billed charges,41.7% of $520.42 in Billed Charges for Rev 272 = $217.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 25MM,272,RC,27200002,CDM,,,,,,both,,,520.4200,78.0600,CIGNA HEALTHCARE,CIGNA PPO,217.02,,,,,,,134.3200,520.4200,percent of total billed charges,41.7% of $520.42 in Billed Charges for Rev 272 = $217.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 25MM,272,RC,27200002,CDM,,,,,,both,,,520.4200,78.0600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,468.38,,,,,,,134.3200,520.4200,percent of total billed charges,90% of $520.42 in Billed Charges for Rev 272 = $468.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 25MM,272,RC,27200002,CDM,,,,,,both,,,520.4200,78.0600,MEDCOST,MEDCOST VHN,247.67,,,,,,,134.3200,520.4200,percent of total billed charges,47.59% of $520.42 in Billed Charges for Rev 272 = $247.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 25MM,272,RC,27200002,CDM,,,,,,both,,,520.4200,78.0600,SENTARA HEALTH,SENTARA HEALTH,134.32,,,,,,,134.3200,520.4200,percent of total billed charges,25.81% of $520.42 in Billed Charges for Rev 272 = $134.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 25MM,272,RC,27200002,CDM,,,,,,both,,,520.4200,78.0600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",520.42,,,,,,,134.3200,520.4200,percent of total billed charges,100% of $520.42 in Billed Charges for Rev 272 = $520.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 25MM,272,RC,27200002,CDM,,,,,,both,,,520.4200,78.0600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,260.21,,,,,,,134.3200,520.4200,percent of total billed charges,Rev 272 $520.42 in Billed Charges at 50% = $260.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 25MM,272,RC,27200002,CDM,,,,,,both,,,520.4200,78.0600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,168.10,,,,,,,134.3200,520.4200,other,32.3% of $520.42 in Billed Charges for Rev 272 = $168.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE SAGITTAL 25MM,272,RC,27200002,CDM,,,,,,both,,,520.4200,78.0600,UNITED HEALTHCARE,UHC HERITAGE SELECT,159.77,,,,,,,134.3200,520.4200,other,30.7% of $520.42 in Billed Charges for Rev 272 = $159.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE SAGITTAL 25MM,272,RC,27200002,CDM,,,,,,both,,,520.4200,78.0600,UNITED HEALTHCARE,UNITED HEALTHCARE,168.10,,,,,,,134.3200,520.4200,percent of total billed charges,32.3% of $520.42 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAGITTAL 25MM,272,RC,27200002,CDM,,,,,,both,,,520.4200,78.0600,WELLCARE,WELLCARE MEDICAID,520.42,,,,,,,134.3200,520.4200,percent of total billed charges,100% of $520.42 in Billed Charges for Rev 272 = $520.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAMURAI PIVOT CURVED FULL RADIUS CAT02421,272,RC,,,,,,,,both,,,2696.3600,404.4500,AETNA,AETNA,1151.35,,,,,,,695.9300,2696.3600,percent of total billed charges,"42.7% of $2,696.36 in Billed Charges for Rev 272 = $1,151.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAMURAI PIVOT CURVED FULL RADIUS CAT02421,272,RC,,,,,,,,both,,,2696.3600,404.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1887.45,,,,,,,695.9300,2696.3600,percent of total billed charges,"Rev 272 $2,696.36 in Billed Charges at 70% = $1,887.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAMURAI PIVOT CURVED FULL RADIUS CAT02421,272,RC,,,,,,,,both,,,2696.3600,404.4500,CIGNA HEALTHCARE,CIGNA HMO,1124.38,,,,,,,695.9300,2696.3600,percent of total billed charges,"41.7% of $2,696.36 in Billed Charges for Rev 272 = $1,124.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAMURAI PIVOT CURVED FULL RADIUS CAT02421,272,RC,,,,,,,,both,,,2696.3600,404.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1251.11,,,,,,,695.9300,2696.3600,percent of total billed charges,"46.4% of $2,696.36 in Billed Charges for Rev 272 = $1,251.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAMURAI PIVOT CURVED FULL RADIUS CAT02421,272,RC,,,,,,,,both,,,2696.3600,404.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1124.38,,,,,,,695.9300,2696.3600,percent of total billed charges,"41.7% of $2,696.36 in Billed Charges for Rev 272 = $1,124.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAMURAI PIVOT CURVED FULL RADIUS CAT02421,272,RC,,,,,,,,both,,,2696.3600,404.4500,CIGNA HEALTHCARE,CIGNA PPO,1124.38,,,,,,,695.9300,2696.3600,percent of total billed charges,"41.7% of $2,696.36 in Billed Charges for Rev 272 = $1,124.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAMURAI PIVOT CURVED FULL RADIUS CAT02421,272,RC,,,,,,,,both,,,2696.3600,404.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2426.72,,,,,,,695.9300,2696.3600,percent of total billed charges,"90% of $2,696.36 in Billed Charges for Rev 272 = $2,426.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAMURAI PIVOT CURVED FULL RADIUS CAT02421,272,RC,,,,,,,,both,,,2696.3600,404.4500,MEDCOST,MEDCOST VHN,1283.20,,,,,,,695.9300,2696.3600,percent of total billed charges,"47.59% of $2,696.36 in Billed Charges for Rev 272 = $1,283.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAMURAI PIVOT CURVED FULL RADIUS CAT02421,272,RC,,,,,,,,both,,,2696.3600,404.4500,SENTARA HEALTH,SENTARA HEALTH,695.93,,,,,,,695.9300,2696.3600,percent of total billed charges,"25.81% of $2,696.36 in Billed Charges for Rev 272 = $695.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAMURAI PIVOT CURVED FULL RADIUS CAT02421,272,RC,,,,,,,,both,,,2696.3600,404.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2696.36,,,,,,,695.9300,2696.3600,percent of total billed charges,"100% of $2,696.36 in Billed Charges for Rev 272 = $2,696.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAMURAI PIVOT CURVED FULL RADIUS CAT02421,272,RC,,,,,,,,both,,,2696.3600,404.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1348.18,,,,,,,695.9300,2696.3600,percent of total billed charges,"Rev 272 $2,696.36 in Billed Charges at 50% = $1,348.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAMURAI PIVOT CURVED FULL RADIUS CAT02421,272,RC,,,,,,,,both,,,2696.3600,404.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,870.92,,,,,,,695.9300,2696.3600,other,"32.3% of $2,696.36 in Billed Charges for Rev 272 = $870.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SAMURAI PIVOT CURVED FULL RADIUS CAT02421,272,RC,,,,,,,,both,,,2696.3600,404.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,827.78,,,,,,,695.9300,2696.3600,other,"30.7% of $2,696.36 in Billed Charges for Rev 272 = $827.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SAMURAI PIVOT CURVED FULL RADIUS CAT02421,272,RC,,,,,,,,both,,,2696.3600,404.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,870.92,,,,,,,695.9300,2696.3600,percent of total billed charges,"32.3% of $2,696.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAMURAI PIVOT CURVED FULL RADIUS CAT02421,272,RC,,,,,,,,both,,,2696.3600,404.4500,WELLCARE,WELLCARE MEDICAID,2696.36,,,,,,,695.9300,2696.3600,percent of total billed charges,"100% of $2,696.36 in Billed Charges for Rev 272 = $2,696.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW 11.5MM,272,RC,,,,,,,,both,,,3275.9900,491.4000,AETNA,AETNA,1398.85,,,,,,,845.5300,3275.9900,percent of total billed charges,"42.7% of $3,275.99 in Billed Charges for Rev 272 = $1,398.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW 11.5MM,272,RC,,,,,,,,both,,,3275.9900,491.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2293.19,,,,,,,845.5300,3275.9900,percent of total billed charges,"Rev 272 $3,275.99 in Billed Charges at 70% = $2,293.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW 11.5MM,272,RC,,,,,,,,both,,,3275.9900,491.4000,CIGNA HEALTHCARE,CIGNA HMO,1366.09,,,,,,,845.5300,3275.9900,percent of total billed charges,"41.7% of $3,275.99 in Billed Charges for Rev 272 = $1,366.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW 11.5MM,272,RC,,,,,,,,both,,,3275.9900,491.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1520.06,,,,,,,845.5300,3275.9900,percent of total billed charges,"46.4% of $3,275.99 in Billed Charges for Rev 272 = $1,520.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW 11.5MM,272,RC,,,,,,,,both,,,3275.9900,491.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1366.09,,,,,,,845.5300,3275.9900,percent of total billed charges,"41.7% of $3,275.99 in Billed Charges for Rev 272 = $1,366.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW 11.5MM,272,RC,,,,,,,,both,,,3275.9900,491.4000,CIGNA HEALTHCARE,CIGNA PPO,1366.09,,,,,,,845.5300,3275.9900,percent of total billed charges,"41.7% of $3,275.99 in Billed Charges for Rev 272 = $1,366.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW 11.5MM,272,RC,,,,,,,,both,,,3275.9900,491.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2948.39,,,,,,,845.5300,3275.9900,percent of total billed charges,"90% of $3,275.99 in Billed Charges for Rev 272 = $2,948.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW 11.5MM,272,RC,,,,,,,,both,,,3275.9900,491.4000,MEDCOST,MEDCOST VHN,1559.04,,,,,,,845.5300,3275.9900,percent of total billed charges,"47.59% of $3,275.99 in Billed Charges for Rev 272 = $1,559.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW 11.5MM,272,RC,,,,,,,,both,,,3275.9900,491.4000,SENTARA HEALTH,SENTARA HEALTH,845.53,,,,,,,845.5300,3275.9900,percent of total billed charges,"25.81% of $3,275.99 in Billed Charges for Rev 272 = $845.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW 11.5MM,272,RC,,,,,,,,both,,,3275.9900,491.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3275.99,,,,,,,845.5300,3275.9900,percent of total billed charges,"100% of $3,275.99 in Billed Charges for Rev 272 = $3,275.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW 11.5MM,272,RC,,,,,,,,both,,,3275.9900,491.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1638.00,,,,,,,845.5300,3275.9900,percent of total billed charges,"Rev 272 $3,275.99 in Billed Charges at 50% = $1,638.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW 11.5MM,272,RC,,,,,,,,both,,,3275.9900,491.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1058.14,,,,,,,845.5300,3275.9900,other,"32.3% of $3,275.99 in Billed Charges for Rev 272 = $1,058.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SAW 11.5MM,272,RC,,,,,,,,both,,,3275.9900,491.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1005.73,,,,,,,845.5300,3275.9900,other,"30.7% of $3,275.99 in Billed Charges for Rev 272 = $1,005.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SAW 11.5MM,272,RC,,,,,,,,both,,,3275.9900,491.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,1058.14,,,,,,,845.5300,3275.9900,percent of total billed charges,"32.3% of $3,275.99 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW 11.5MM,272,RC,,,,,,,,both,,,3275.9900,491.4000,WELLCARE,WELLCARE MEDICAID,3275.99,,,,,,,845.5300,3275.9900,percent of total billed charges,"100% of $3,275.99 in Billed Charges for Rev 272 = $3,275.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EGG 5.0MM 5820-015-050,272,RC,27200002,CDM,,,,,,both,,,1268.1700,190.2300,AETNA,AETNA,541.51,,,,,,,327.3100,1268.1700,percent of total billed charges,"42.7% of $1,268.17 in Billed Charges for Rev 272 = $541.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EGG 5.0MM 5820-015-050,272,RC,27200002,CDM,,,,,,both,,,1268.1700,190.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,887.72,,,,,,,327.3100,1268.1700,percent of total billed charges,"Rev 272 $1,268.17 in Billed Charges at 70% = $887.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EGG 5.0MM 5820-015-050,272,RC,27200002,CDM,,,,,,both,,,1268.1700,190.2300,CIGNA HEALTHCARE,CIGNA HMO,528.83,,,,,,,327.3100,1268.1700,percent of total billed charges,"41.7% of $1,268.17 in Billed Charges for Rev 272 = $528.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EGG 5.0MM 5820-015-050,272,RC,27200002,CDM,,,,,,both,,,1268.1700,190.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,588.43,,,,,,,327.3100,1268.1700,percent of total billed charges,"46.4% of $1,268.17 in Billed Charges for Rev 272 = $588.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EGG 5.0MM 5820-015-050,272,RC,27200002,CDM,,,,,,both,,,1268.1700,190.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,528.83,,,,,,,327.3100,1268.1700,percent of total billed charges,"41.7% of $1,268.17 in Billed Charges for Rev 272 = $528.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EGG 5.0MM 5820-015-050,272,RC,27200002,CDM,,,,,,both,,,1268.1700,190.2300,CIGNA HEALTHCARE,CIGNA PPO,528.83,,,,,,,327.3100,1268.1700,percent of total billed charges,"41.7% of $1,268.17 in Billed Charges for Rev 272 = $528.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EGG 5.0MM 5820-015-050,272,RC,27200002,CDM,,,,,,both,,,1268.1700,190.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1141.35,,,,,,,327.3100,1268.1700,percent of total billed charges,"90% of $1,268.17 in Billed Charges for Rev 272 = $1,141.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EGG 5.0MM 5820-015-050,272,RC,27200002,CDM,,,,,,both,,,1268.1700,190.2300,MEDCOST,MEDCOST VHN,603.52,,,,,,,327.3100,1268.1700,percent of total billed charges,"47.59% of $1,268.17 in Billed Charges for Rev 272 = $603.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EGG 5.0MM 5820-015-050,272,RC,27200002,CDM,,,,,,both,,,1268.1700,190.2300,SENTARA HEALTH,SENTARA HEALTH,327.31,,,,,,,327.3100,1268.1700,percent of total billed charges,"25.81% of $1,268.17 in Billed Charges for Rev 272 = $327.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EGG 5.0MM 5820-015-050,272,RC,27200002,CDM,,,,,,both,,,1268.1700,190.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1268.17,,,,,,,327.3100,1268.1700,percent of total billed charges,"100% of $1,268.17 in Billed Charges for Rev 272 = $1,268.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EGG 5.0MM 5820-015-050,272,RC,27200002,CDM,,,,,,both,,,1268.1700,190.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,634.09,,,,,,,327.3100,1268.1700,percent of total billed charges,"Rev 272 $1,268.17 in Billed Charges at 50% = $634.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EGG 5.0MM 5820-015-050,272,RC,27200002,CDM,,,,,,both,,,1268.1700,190.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,409.62,,,,,,,327.3100,1268.1700,other,"32.3% of $1,268.17 in Billed Charges for Rev 272 = $409.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BUR EGG 5.0MM 5820-015-050,272,RC,27200002,CDM,,,,,,both,,,1268.1700,190.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,389.33,,,,,,,327.3100,1268.1700,other,"30.7% of $1,268.17 in Billed Charges for Rev 272 = $389.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BUR EGG 5.0MM 5820-015-050,272,RC,27200002,CDM,,,,,,both,,,1268.1700,190.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,409.62,,,,,,,327.3100,1268.1700,percent of total billed charges,"32.3% of $1,268.17 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EGG 5.0MM 5820-015-050,272,RC,27200002,CDM,,,,,,both,,,1268.1700,190.2300,WELLCARE,WELLCARE MEDICAID,1268.17,,,,,,,327.3100,1268.1700,percent of total billed charges,"100% of $1,268.17 in Billed Charges for Rev 272 = $1,268.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EGG SHORT 5.0MM,272,RC,,,,,,,,both,,,893.6700,134.0500,AETNA,AETNA,381.60,,,,,,,230.6600,893.6700,percent of total billed charges,42.7% of $893.67 in Billed Charges for Rev 272 = $381.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR EGG SHORT 5.0MM,272,RC,,,,,,,,both,,,893.6700,134.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,625.57,,,,,,,230.6600,893.6700,percent of total billed charges,Rev 272 $893.67 in Billed Charges at 70% = $625.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR EGG SHORT 5.0MM,272,RC,,,,,,,,both,,,893.6700,134.0500,CIGNA HEALTHCARE,CIGNA HMO,372.66,,,,,,,230.6600,893.6700,percent of total billed charges,41.7% of $893.67 in Billed Charges for Rev 272 = $372.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR EGG SHORT 5.0MM,272,RC,,,,,,,,both,,,893.6700,134.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,414.66,,,,,,,230.6600,893.6700,percent of total billed charges,46.4% of $893.67 in Billed Charges for Rev 272 = $414.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR EGG SHORT 5.0MM,272,RC,,,,,,,,both,,,893.6700,134.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,372.66,,,,,,,230.6600,893.6700,percent of total billed charges,41.7% of $893.67 in Billed Charges for Rev 272 = $372.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR EGG SHORT 5.0MM,272,RC,,,,,,,,both,,,893.6700,134.0500,CIGNA HEALTHCARE,CIGNA PPO,372.66,,,,,,,230.6600,893.6700,percent of total billed charges,41.7% of $893.67 in Billed Charges for Rev 272 = $372.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR EGG SHORT 5.0MM,272,RC,,,,,,,,both,,,893.6700,134.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,804.30,,,,,,,230.6600,893.6700,percent of total billed charges,90% of $893.67 in Billed Charges for Rev 272 = $804.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR EGG SHORT 5.0MM,272,RC,,,,,,,,both,,,893.6700,134.0500,MEDCOST,MEDCOST VHN,425.30,,,,,,,230.6600,893.6700,percent of total billed charges,47.59% of $893.67 in Billed Charges for Rev 272 = $425.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR EGG SHORT 5.0MM,272,RC,,,,,,,,both,,,893.6700,134.0500,SENTARA HEALTH,SENTARA HEALTH,230.66,,,,,,,230.6600,893.6700,percent of total billed charges,25.81% of $893.67 in Billed Charges for Rev 272 = $230.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR EGG SHORT 5.0MM,272,RC,,,,,,,,both,,,893.6700,134.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",893.67,,,,,,,230.6600,893.6700,percent of total billed charges,100% of $893.67 in Billed Charges for Rev 272 = $893.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR EGG SHORT 5.0MM,272,RC,,,,,,,,both,,,893.6700,134.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,446.84,,,,,,,230.6600,893.6700,percent of total billed charges,Rev 272 $893.67 in Billed Charges at 50% = $446.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR EGG SHORT 5.0MM,272,RC,,,,,,,,both,,,893.6700,134.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,288.66,,,,,,,230.6600,893.6700,other,32.3% of $893.67 in Billed Charges for Rev 272 = $288.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BUR EGG SHORT 5.0MM,272,RC,,,,,,,,both,,,893.6700,134.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,274.36,,,,,,,230.6600,893.6700,other,30.7% of $893.67 in Billed Charges for Rev 272 = $274.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BUR EGG SHORT 5.0MM,272,RC,,,,,,,,both,,,893.6700,134.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,288.66,,,,,,,230.6600,893.6700,percent of total billed charges,32.3% of $893.67 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR EGG SHORT 5.0MM,272,RC,,,,,,,,both,,,893.6700,134.0500,WELLCARE,WELLCARE MEDICAID,893.67,,,,,,,230.6600,893.6700,percent of total billed charges,100% of $893.67 in Billed Charges for Rev 272 = $893.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR EXTRA COARSE 5.0MM ROUND DIAMOND,272,RC,27200002,CDM,,,,,,both,,,1355.8000,203.3700,AETNA,AETNA,578.93,,,,,,,349.9300,1355.8000,percent of total billed charges,"42.7% of $1,355.80 in Billed Charges for Rev 272 = $578.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EXTRA COARSE 5.0MM ROUND DIAMOND,272,RC,27200002,CDM,,,,,,both,,,1355.8000,203.3700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,949.06,,,,,,,349.9300,1355.8000,percent of total billed charges,"Rev 272 $1,355.80 in Billed Charges at 70% = $949.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EXTRA COARSE 5.0MM ROUND DIAMOND,272,RC,27200002,CDM,,,,,,both,,,1355.8000,203.3700,CIGNA HEALTHCARE,CIGNA HMO,565.37,,,,,,,349.9300,1355.8000,percent of total billed charges,"41.7% of $1,355.80 in Billed Charges for Rev 272 = $565.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EXTRA COARSE 5.0MM ROUND DIAMOND,272,RC,27200002,CDM,,,,,,both,,,1355.8000,203.3700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,629.09,,,,,,,349.9300,1355.8000,percent of total billed charges,"46.4% of $1,355.80 in Billed Charges for Rev 272 = $629.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EXTRA COARSE 5.0MM ROUND DIAMOND,272,RC,27200002,CDM,,,,,,both,,,1355.8000,203.3700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,565.37,,,,,,,349.9300,1355.8000,percent of total billed charges,"41.7% of $1,355.80 in Billed Charges for Rev 272 = $565.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EXTRA COARSE 5.0MM ROUND DIAMOND,272,RC,27200002,CDM,,,,,,both,,,1355.8000,203.3700,CIGNA HEALTHCARE,CIGNA PPO,565.37,,,,,,,349.9300,1355.8000,percent of total billed charges,"41.7% of $1,355.80 in Billed Charges for Rev 272 = $565.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EXTRA COARSE 5.0MM ROUND DIAMOND,272,RC,27200002,CDM,,,,,,both,,,1355.8000,203.3700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1220.22,,,,,,,349.9300,1355.8000,percent of total billed charges,"90% of $1,355.80 in Billed Charges for Rev 272 = $1,220.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EXTRA COARSE 5.0MM ROUND DIAMOND,272,RC,27200002,CDM,,,,,,both,,,1355.8000,203.3700,MEDCOST,MEDCOST VHN,645.23,,,,,,,349.9300,1355.8000,percent of total billed charges,"47.59% of $1,355.80 in Billed Charges for Rev 272 = $645.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EXTRA COARSE 5.0MM ROUND DIAMOND,272,RC,27200002,CDM,,,,,,both,,,1355.8000,203.3700,SENTARA HEALTH,SENTARA HEALTH,349.93,,,,,,,349.9300,1355.8000,percent of total billed charges,"25.81% of $1,355.80 in Billed Charges for Rev 272 = $349.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EXTRA COARSE 5.0MM ROUND DIAMOND,272,RC,27200002,CDM,,,,,,both,,,1355.8000,203.3700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1355.80,,,,,,,349.9300,1355.8000,percent of total billed charges,"100% of $1,355.80 in Billed Charges for Rev 272 = $1,355.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EXTRA COARSE 5.0MM ROUND DIAMOND,272,RC,27200002,CDM,,,,,,both,,,1355.8000,203.3700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,677.90,,,,,,,349.9300,1355.8000,percent of total billed charges,"Rev 272 $1,355.80 in Billed Charges at 50% = $677.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EXTRA COARSE 5.0MM ROUND DIAMOND,272,RC,27200002,CDM,,,,,,both,,,1355.8000,203.3700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,437.92,,,,,,,349.9300,1355.8000,other,"32.3% of $1,355.80 in Billed Charges for Rev 272 = $437.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BUR EXTRA COARSE 5.0MM ROUND DIAMOND,272,RC,27200002,CDM,,,,,,both,,,1355.8000,203.3700,UNITED HEALTHCARE,UHC HERITAGE SELECT,416.23,,,,,,,349.9300,1355.8000,other,"30.7% of $1,355.80 in Billed Charges for Rev 272 = $416.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BUR EXTRA COARSE 5.0MM ROUND DIAMOND,272,RC,27200002,CDM,,,,,,both,,,1355.8000,203.3700,UNITED HEALTHCARE,UNITED HEALTHCARE,437.92,,,,,,,349.9300,1355.8000,percent of total billed charges,"32.3% of $1,355.80 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR EXTRA COARSE 5.0MM ROUND DIAMOND,272,RC,27200002,CDM,,,,,,both,,,1355.8000,203.3700,WELLCARE,WELLCARE MEDICAID,1355.80,,,,,,,349.9300,1355.8000,percent of total billed charges,"100% of $1,355.80 in Billed Charges for Rev 272 = $1,355.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW 5627-15-501,272,RC,,,,,,,,both,,,812.0500,121.8100,AETNA,AETNA,346.75,,,,,,,209.5900,812.0500,percent of total billed charges,42.7% of $812.05 in Billed Charges for Rev 272 = $346.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW 5627-15-501,272,RC,,,,,,,,both,,,812.0500,121.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,568.44,,,,,,,209.5900,812.0500,percent of total billed charges,Rev 272 $812.05 in Billed Charges at 70% = $568.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW 5627-15-501,272,RC,,,,,,,,both,,,812.0500,121.8100,CIGNA HEALTHCARE,CIGNA HMO,338.62,,,,,,,209.5900,812.0500,percent of total billed charges,41.7% of $812.05 in Billed Charges for Rev 272 = $338.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW 5627-15-501,272,RC,,,,,,,,both,,,812.0500,121.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,376.79,,,,,,,209.5900,812.0500,percent of total billed charges,46.4% of $812.05 in Billed Charges for Rev 272 = $376.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW 5627-15-501,272,RC,,,,,,,,both,,,812.0500,121.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,338.62,,,,,,,209.5900,812.0500,percent of total billed charges,41.7% of $812.05 in Billed Charges for Rev 272 = $338.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW 5627-15-501,272,RC,,,,,,,,both,,,812.0500,121.8100,CIGNA HEALTHCARE,CIGNA PPO,338.62,,,,,,,209.5900,812.0500,percent of total billed charges,41.7% of $812.05 in Billed Charges for Rev 272 = $338.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW 5627-15-501,272,RC,,,,,,,,both,,,812.0500,121.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,730.85,,,,,,,209.5900,812.0500,percent of total billed charges,90% of $812.05 in Billed Charges for Rev 272 = $730.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW 5627-15-501,272,RC,,,,,,,,both,,,812.0500,121.8100,MEDCOST,MEDCOST VHN,386.45,,,,,,,209.5900,812.0500,percent of total billed charges,47.59% of $812.05 in Billed Charges for Rev 272 = $386.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW 5627-15-501,272,RC,,,,,,,,both,,,812.0500,121.8100,SENTARA HEALTH,SENTARA HEALTH,209.59,,,,,,,209.5900,812.0500,percent of total billed charges,25.81% of $812.05 in Billed Charges for Rev 272 = $209.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW 5627-15-501,272,RC,,,,,,,,both,,,812.0500,121.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",812.05,,,,,,,209.5900,812.0500,percent of total billed charges,100% of $812.05 in Billed Charges for Rev 272 = $812.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW 5627-15-501,272,RC,,,,,,,,both,,,812.0500,121.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,406.03,,,,,,,209.5900,812.0500,percent of total billed charges,Rev 272 $812.05 in Billed Charges at 50% = $406.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW 5627-15-501,272,RC,,,,,,,,both,,,812.0500,121.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,262.29,,,,,,,209.5900,812.0500,other,32.3% of $812.05 in Billed Charges for Rev 272 = $262.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE SAW 5627-15-501,272,RC,,,,,,,,both,,,812.0500,121.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,249.30,,,,,,,209.5900,812.0500,other,30.7% of $812.05 in Billed Charges for Rev 272 = $249.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE SAW 5627-15-501,272,RC,,,,,,,,both,,,812.0500,121.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,262.29,,,,,,,209.5900,812.0500,percent of total billed charges,32.3% of $812.05 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW 5627-15-501,272,RC,,,,,,,,both,,,812.0500,121.8100,WELLCARE,WELLCARE MEDICAID,812.05,,,,,,,209.5900,812.0500,percent of total billed charges,100% of $812.05 in Billed Charges for Rev 272 = $812.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW CTA,272,RC,,,,,,,,both,,,770.0500,115.5100,AETNA,AETNA,328.81,,,,,,,198.7500,770.0500,percent of total billed charges,42.7% of $770.05 in Billed Charges for Rev 272 = $328.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW CTA,272,RC,,,,,,,,both,,,770.0500,115.5100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,539.04,,,,,,,198.7500,770.0500,percent of total billed charges,Rev 272 $770.05 in Billed Charges at 70% = $539.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW CTA,272,RC,,,,,,,,both,,,770.0500,115.5100,CIGNA HEALTHCARE,CIGNA HMO,321.11,,,,,,,198.7500,770.0500,percent of total billed charges,41.7% of $770.05 in Billed Charges for Rev 272 = $321.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW CTA,272,RC,,,,,,,,both,,,770.0500,115.5100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,357.30,,,,,,,198.7500,770.0500,percent of total billed charges,46.4% of $770.05 in Billed Charges for Rev 272 = $357.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW CTA,272,RC,,,,,,,,both,,,770.0500,115.5100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,321.11,,,,,,,198.7500,770.0500,percent of total billed charges,41.7% of $770.05 in Billed Charges for Rev 272 = $321.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW CTA,272,RC,,,,,,,,both,,,770.0500,115.5100,CIGNA HEALTHCARE,CIGNA PPO,321.11,,,,,,,198.7500,770.0500,percent of total billed charges,41.7% of $770.05 in Billed Charges for Rev 272 = $321.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW CTA,272,RC,,,,,,,,both,,,770.0500,115.5100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,693.05,,,,,,,198.7500,770.0500,percent of total billed charges,90% of $770.05 in Billed Charges for Rev 272 = $693.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW CTA,272,RC,,,,,,,,both,,,770.0500,115.5100,MEDCOST,MEDCOST VHN,366.47,,,,,,,198.7500,770.0500,percent of total billed charges,47.59% of $770.05 in Billed Charges for Rev 272 = $366.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW CTA,272,RC,,,,,,,,both,,,770.0500,115.5100,SENTARA HEALTH,SENTARA HEALTH,198.75,,,,,,,198.7500,770.0500,percent of total billed charges,25.81% of $770.05 in Billed Charges for Rev 272 = $198.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW CTA,272,RC,,,,,,,,both,,,770.0500,115.5100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",770.05,,,,,,,198.7500,770.0500,percent of total billed charges,100% of $770.05 in Billed Charges for Rev 272 = $770.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW CTA,272,RC,,,,,,,,both,,,770.0500,115.5100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,385.03,,,,,,,198.7500,770.0500,percent of total billed charges,Rev 272 $770.05 in Billed Charges at 50% = $385.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW CTA,272,RC,,,,,,,,both,,,770.0500,115.5100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,248.73,,,,,,,198.7500,770.0500,other,32.3% of $770.05 in Billed Charges for Rev 272 = $248.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE SAW CTA,272,RC,,,,,,,,both,,,770.0500,115.5100,UNITED HEALTHCARE,UHC HERITAGE SELECT,236.41,,,,,,,198.7500,770.0500,other,30.7% of $770.05 in Billed Charges for Rev 272 = $236.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE SAW CTA,272,RC,,,,,,,,both,,,770.0500,115.5100,UNITED HEALTHCARE,UNITED HEALTHCARE,248.73,,,,,,,198.7500,770.0500,percent of total billed charges,32.3% of $770.05 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW CTA,272,RC,,,,,,,,both,,,770.0500,115.5100,WELLCARE,WELLCARE MEDICAID,770.05,,,,,,,198.7500,770.0500,percent of total billed charges,100% of $770.05 in Billed Charges for Rev 272 = $770.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8225 E8225,272,RC,,,,,,,,both,,,653.3700,98.0100,AETNA,AETNA,278.99,,,,,,,168.6300,653.3700,percent of total billed charges,42.7% of $653.37 in Billed Charges for Rev 272 = $278.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8225 E8225,272,RC,,,,,,,,both,,,653.3700,98.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,457.36,,,,,,,168.6300,653.3700,percent of total billed charges,Rev 272 $653.37 in Billed Charges at 70% = $457.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8225 E8225,272,RC,,,,,,,,both,,,653.3700,98.0100,CIGNA HEALTHCARE,CIGNA HMO,272.46,,,,,,,168.6300,653.3700,percent of total billed charges,41.7% of $653.37 in Billed Charges for Rev 272 = $272.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8225 E8225,272,RC,,,,,,,,both,,,653.3700,98.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,303.16,,,,,,,168.6300,653.3700,percent of total billed charges,46.4% of $653.37 in Billed Charges for Rev 272 = $303.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8225 E8225,272,RC,,,,,,,,both,,,653.3700,98.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,272.46,,,,,,,168.6300,653.3700,percent of total billed charges,41.7% of $653.37 in Billed Charges for Rev 272 = $272.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8225 E8225,272,RC,,,,,,,,both,,,653.3700,98.0100,CIGNA HEALTHCARE,CIGNA PPO,272.46,,,,,,,168.6300,653.3700,percent of total billed charges,41.7% of $653.37 in Billed Charges for Rev 272 = $272.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8225 E8225,272,RC,,,,,,,,both,,,653.3700,98.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,588.03,,,,,,,168.6300,653.3700,percent of total billed charges,90% of $653.37 in Billed Charges for Rev 272 = $588.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8225 E8225,272,RC,,,,,,,,both,,,653.3700,98.0100,MEDCOST,MEDCOST VHN,310.94,,,,,,,168.6300,653.3700,percent of total billed charges,47.59% of $653.37 in Billed Charges for Rev 272 = $310.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8225 E8225,272,RC,,,,,,,,both,,,653.3700,98.0100,SENTARA HEALTH,SENTARA HEALTH,168.63,,,,,,,168.6300,653.3700,percent of total billed charges,25.81% of $653.37 in Billed Charges for Rev 272 = $168.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8225 E8225,272,RC,,,,,,,,both,,,653.3700,98.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",653.37,,,,,,,168.6300,653.3700,percent of total billed charges,100% of $653.37 in Billed Charges for Rev 272 = $653.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8225 E8225,272,RC,,,,,,,,both,,,653.3700,98.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,326.69,,,,,,,168.6300,653.3700,percent of total billed charges,Rev 272 $653.37 in Billed Charges at 50% = $326.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8225 E8225,272,RC,,,,,,,,both,,,653.3700,98.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,211.04,,,,,,,168.6300,653.3700,other,32.3% of $653.37 in Billed Charges for Rev 272 = $211.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BUR E8225 E8225,272,RC,,,,,,,,both,,,653.3700,98.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,200.58,,,,,,,168.6300,653.3700,other,30.7% of $653.37 in Billed Charges for Rev 272 = $200.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BUR E8225 E8225,272,RC,,,,,,,,both,,,653.3700,98.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,211.04,,,,,,,168.6300,653.3700,percent of total billed charges,32.3% of $653.37 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8225 E8225,272,RC,,,,,,,,both,,,653.3700,98.0100,WELLCARE,WELLCARE MEDICAID,653.37,,,,,,,168.6300,653.3700,percent of total billed charges,100% of $653.37 in Billed Charges for Rev 272 = $653.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTED DRUM 4.7MM,272,RC,,,,,,,,both,,,1000.7000,150.1100,AETNA,AETNA,427.30,,,,,,,258.2800,1000.7000,percent of total billed charges,"42.7% of $1,000.70 in Billed Charges for Rev 272 = $427.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR FLUTED DRUM 4.7MM,272,RC,,,,,,,,both,,,1000.7000,150.1100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,700.49,,,,,,,258.2800,1000.7000,percent of total billed charges,"Rev 272 $1,000.70 in Billed Charges at 70% = $700.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR FLUTED DRUM 4.7MM,272,RC,,,,,,,,both,,,1000.7000,150.1100,CIGNA HEALTHCARE,CIGNA HMO,417.29,,,,,,,258.2800,1000.7000,percent of total billed charges,"41.7% of $1,000.70 in Billed Charges for Rev 272 = $417.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR FLUTED DRUM 4.7MM,272,RC,,,,,,,,both,,,1000.7000,150.1100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,464.32,,,,,,,258.2800,1000.7000,percent of total billed charges,"46.4% of $1,000.70 in Billed Charges for Rev 272 = $464.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR FLUTED DRUM 4.7MM,272,RC,,,,,,,,both,,,1000.7000,150.1100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,417.29,,,,,,,258.2800,1000.7000,percent of total billed charges,"41.7% of $1,000.70 in Billed Charges for Rev 272 = $417.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR FLUTED DRUM 4.7MM,272,RC,,,,,,,,both,,,1000.7000,150.1100,CIGNA HEALTHCARE,CIGNA PPO,417.29,,,,,,,258.2800,1000.7000,percent of total billed charges,"41.7% of $1,000.70 in Billed Charges for Rev 272 = $417.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR FLUTED DRUM 4.7MM,272,RC,,,,,,,,both,,,1000.7000,150.1100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,900.63,,,,,,,258.2800,1000.7000,percent of total billed charges,"90% of $1,000.70 in Billed Charges for Rev 272 = $900.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR FLUTED DRUM 4.7MM,272,RC,,,,,,,,both,,,1000.7000,150.1100,MEDCOST,MEDCOST VHN,476.23,,,,,,,258.2800,1000.7000,percent of total billed charges,"47.59% of $1,000.70 in Billed Charges for Rev 272 = $476.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR FLUTED DRUM 4.7MM,272,RC,,,,,,,,both,,,1000.7000,150.1100,SENTARA HEALTH,SENTARA HEALTH,258.28,,,,,,,258.2800,1000.7000,percent of total billed charges,"25.81% of $1,000.70 in Billed Charges for Rev 272 = $258.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR FLUTED DRUM 4.7MM,272,RC,,,,,,,,both,,,1000.7000,150.1100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1000.70,,,,,,,258.2800,1000.7000,percent of total billed charges,"100% of $1,000.70 in Billed Charges for Rev 272 = $1,000.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR FLUTED DRUM 4.7MM,272,RC,,,,,,,,both,,,1000.7000,150.1100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,500.35,,,,,,,258.2800,1000.7000,percent of total billed charges,"Rev 272 $1,000.70 in Billed Charges at 50% = $500.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR FLUTED DRUM 4.7MM,272,RC,,,,,,,,both,,,1000.7000,150.1100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,323.23,,,,,,,258.2800,1000.7000,other,"32.3% of $1,000.70 in Billed Charges for Rev 272 = $323.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BUR FLUTED DRUM 4.7MM,272,RC,,,,,,,,both,,,1000.7000,150.1100,UNITED HEALTHCARE,UHC HERITAGE SELECT,307.21,,,,,,,258.2800,1000.7000,other,"30.7% of $1,000.70 in Billed Charges for Rev 272 = $307.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BUR FLUTED DRUM 4.7MM,272,RC,,,,,,,,both,,,1000.7000,150.1100,UNITED HEALTHCARE,UNITED HEALTHCARE,323.23,,,,,,,258.2800,1000.7000,percent of total billed charges,"32.3% of $1,000.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR FLUTED DRUM 4.7MM,272,RC,,,,,,,,both,,,1000.7000,150.1100,WELLCARE,WELLCARE MEDICAID,1000.70,,,,,,,258.2800,1000.7000,percent of total billed charges,"100% of $1,000.70 in Billed Charges for Rev 272 = $1,000.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,214.5800,32.1900,AETNA,AETNA,91.63,,,,,,,55.3800,214.5800,percent of total billed charges,42.7% of $214.58 in Billed Charges for Rev 272 = $91.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,214.5800,32.1900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,150.21,,,,,,,55.3800,214.5800,percent of total billed charges,Rev 272 $214.58 in Billed Charges at 70% = $150.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,214.5800,32.1900,CIGNA HEALTHCARE,CIGNA HMO,89.48,,,,,,,55.3800,214.5800,percent of total billed charges,41.7% of $214.58 in Billed Charges for Rev 272 = $89.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,214.5800,32.1900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,99.57,,,,,,,55.3800,214.5800,percent of total billed charges,46.4% of $214.58 in Billed Charges for Rev 272 = $99.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,214.5800,32.1900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,89.48,,,,,,,55.3800,214.5800,percent of total billed charges,41.7% of $214.58 in Billed Charges for Rev 272 = $89.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,214.5800,32.1900,CIGNA HEALTHCARE,CIGNA PPO,89.48,,,,,,,55.3800,214.5800,percent of total billed charges,41.7% of $214.58 in Billed Charges for Rev 272 = $89.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,214.5800,32.1900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,193.12,,,,,,,55.3800,214.5800,percent of total billed charges,90% of $214.58 in Billed Charges for Rev 272 = $193.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,214.5800,32.1900,MEDCOST,MEDCOST VHN,102.12,,,,,,,55.3800,214.5800,percent of total billed charges,47.59% of $214.58 in Billed Charges for Rev 272 = $102.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,214.5800,32.1900,SENTARA HEALTH,SENTARA HEALTH,55.38,,,,,,,55.3800,214.5800,percent of total billed charges,25.81% of $214.58 in Billed Charges for Rev 272 = $55.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,214.5800,32.1900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",214.58,,,,,,,55.3800,214.5800,percent of total billed charges,100% of $214.58 in Billed Charges for Rev 272 = $214.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,214.5800,32.1900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,107.29,,,,,,,55.3800,214.5800,percent of total billed charges,Rev 272 $214.58 in Billed Charges at 50% = $107.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,214.5800,32.1900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,69.31,,,,,,,55.3800,214.5800,other,32.3% of $214.58 in Billed Charges for Rev 272 = $69.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,214.5800,32.1900,UNITED HEALTHCARE,UHC HERITAGE SELECT,65.88,,,,,,,55.3800,214.5800,other,30.7% of $214.58 in Billed Charges for Rev 272 = $65.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,214.5800,32.1900,UNITED HEALTHCARE,UNITED HEALTHCARE,69.31,,,,,,,55.3800,214.5800,percent of total billed charges,32.3% of $214.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,214.5800,32.1900,WELLCARE,WELLCARE MEDICAID,214.58,,,,,,,55.3800,214.5800,percent of total billed charges,100% of $214.58 in Billed Charges for Rev 272 = $214.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,693.4100,104.0100,AETNA,AETNA,296.09,,,,,,,178.9700,693.4100,percent of total billed charges,42.7% of $693.41 in Billed Charges for Rev 272 = $296.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,693.4100,104.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,485.39,,,,,,,178.9700,693.4100,percent of total billed charges,Rev 272 $693.41 in Billed Charges at 70% = $485.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,693.4100,104.0100,CIGNA HEALTHCARE,CIGNA HMO,289.15,,,,,,,178.9700,693.4100,percent of total billed charges,41.7% of $693.41 in Billed Charges for Rev 272 = $289.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,693.4100,104.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,321.74,,,,,,,178.9700,693.4100,percent of total billed charges,46.4% of $693.41 in Billed Charges for Rev 272 = $321.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,693.4100,104.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,289.15,,,,,,,178.9700,693.4100,percent of total billed charges,41.7% of $693.41 in Billed Charges for Rev 272 = $289.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,693.4100,104.0100,CIGNA HEALTHCARE,CIGNA PPO,289.15,,,,,,,178.9700,693.4100,percent of total billed charges,41.7% of $693.41 in Billed Charges for Rev 272 = $289.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,693.4100,104.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,624.07,,,,,,,178.9700,693.4100,percent of total billed charges,90% of $693.41 in Billed Charges for Rev 272 = $624.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,693.4100,104.0100,MEDCOST,MEDCOST VHN,329.99,,,,,,,178.9700,693.4100,percent of total billed charges,47.59% of $693.41 in Billed Charges for Rev 272 = $329.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,693.4100,104.0100,SENTARA HEALTH,SENTARA HEALTH,178.97,,,,,,,178.9700,693.4100,percent of total billed charges,25.81% of $693.41 in Billed Charges for Rev 272 = $178.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,693.4100,104.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",693.41,,,,,,,178.9700,693.4100,percent of total billed charges,100% of $693.41 in Billed Charges for Rev 272 = $693.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,693.4100,104.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,346.71,,,,,,,178.9700,693.4100,percent of total billed charges,Rev 272 $693.41 in Billed Charges at 50% = $346.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,693.4100,104.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,223.97,,,,,,,178.9700,693.4100,other,32.3% of $693.41 in Billed Charges for Rev 272 = $223.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,693.4100,104.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,212.88,,,,,,,178.9700,693.4100,other,30.7% of $693.41 in Billed Charges for Rev 272 = $212.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,693.4100,104.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,223.97,,,,,,,178.9700,693.4100,percent of total billed charges,32.3% of $693.41 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE BARREL HOL FOLD 4.0M BX/5,272,RC,27200002,CDM,,,,,,both,,,693.4100,104.0100,WELLCARE,WELLCARE MEDICAID,693.41,,,,,,,178.9700,693.4100,percent of total billed charges,100% of $693.41 in Billed Charges for Rev 272 = $693.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE RND HOLW 40MM FORML,272,RC,27200002,CDM,,,,,,both,,,758.8500,113.8300,AETNA,AETNA,324.03,,,,,,,195.8600,758.8500,percent of total billed charges,42.7% of $758.85 in Billed Charges for Rev 272 = $324.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE RND HOLW 40MM FORML,272,RC,27200002,CDM,,,,,,both,,,758.8500,113.8300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,531.20,,,,,,,195.8600,758.8500,percent of total billed charges,Rev 272 $758.85 in Billed Charges at 70% = $531.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE RND HOLW 40MM FORML,272,RC,27200002,CDM,,,,,,both,,,758.8500,113.8300,CIGNA HEALTHCARE,CIGNA HMO,316.44,,,,,,,195.8600,758.8500,percent of total billed charges,41.7% of $758.85 in Billed Charges for Rev 272 = $316.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE RND HOLW 40MM FORML,272,RC,27200002,CDM,,,,,,both,,,758.8500,113.8300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,352.11,,,,,,,195.8600,758.8500,percent of total billed charges,46.4% of $758.85 in Billed Charges for Rev 272 = $352.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE RND HOLW 40MM FORML,272,RC,27200002,CDM,,,,,,both,,,758.8500,113.8300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,316.44,,,,,,,195.8600,758.8500,percent of total billed charges,41.7% of $758.85 in Billed Charges for Rev 272 = $316.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE RND HOLW 40MM FORML,272,RC,27200002,CDM,,,,,,both,,,758.8500,113.8300,CIGNA HEALTHCARE,CIGNA PPO,316.44,,,,,,,195.8600,758.8500,percent of total billed charges,41.7% of $758.85 in Billed Charges for Rev 272 = $316.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE RND HOLW 40MM FORML,272,RC,27200002,CDM,,,,,,both,,,758.8500,113.8300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,682.97,,,,,,,195.8600,758.8500,percent of total billed charges,90% of $758.85 in Billed Charges for Rev 272 = $682.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE RND HOLW 40MM FORML,272,RC,27200002,CDM,,,,,,both,,,758.8500,113.8300,MEDCOST,MEDCOST VHN,361.14,,,,,,,195.8600,758.8500,percent of total billed charges,47.59% of $758.85 in Billed Charges for Rev 272 = $361.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE RND HOLW 40MM FORML,272,RC,27200002,CDM,,,,,,both,,,758.8500,113.8300,SENTARA HEALTH,SENTARA HEALTH,195.86,,,,,,,195.8600,758.8500,percent of total billed charges,25.81% of $758.85 in Billed Charges for Rev 272 = $195.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE RND HOLW 40MM FORML,272,RC,27200002,CDM,,,,,,both,,,758.8500,113.8300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",758.85,,,,,,,195.8600,758.8500,percent of total billed charges,100% of $758.85 in Billed Charges for Rev 272 = $758.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE RND HOLW 40MM FORML,272,RC,27200002,CDM,,,,,,both,,,758.8500,113.8300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,379.43,,,,,,,195.8600,758.8500,percent of total billed charges,Rev 272 $758.85 in Billed Charges at 50% = $379.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE RND HOLW 40MM FORML,272,RC,27200002,CDM,,,,,,both,,,758.8500,113.8300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,245.11,,,,,,,195.8600,758.8500,other,32.3% of $758.85 in Billed Charges for Rev 272 = $245.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BUR FLUTE RND HOLW 40MM FORML,272,RC,27200002,CDM,,,,,,both,,,758.8500,113.8300,UNITED HEALTHCARE,UHC HERITAGE SELECT,232.97,,,,,,,195.8600,758.8500,other,30.7% of $758.85 in Billed Charges for Rev 272 = $232.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BUR FLUTE RND HOLW 40MM FORML,272,RC,27200002,CDM,,,,,,both,,,758.8500,113.8300,UNITED HEALTHCARE,UNITED HEALTHCARE,245.11,,,,,,,195.8600,758.8500,percent of total billed charges,32.3% of $758.85 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR FLUTE RND HOLW 40MM FORML,272,RC,27200002,CDM,,,,,,both,,,758.8500,113.8300,WELLCARE,WELLCARE MEDICAID,758.85,,,,,,,195.8600,758.8500,percent of total billed charges,100% of $758.85 in Billed Charges for Rev 272 = $758.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR MIS CURVED 3.0MM 8420-107-30,272,RC,,,,,,,,both,,,2732.6500,409.9000,AETNA,AETNA,1166.84,,,,,,,705.3000,2732.6500,percent of total billed charges,"42.7% of $2,732.65 in Billed Charges for Rev 272 = $1,166.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR MIS CURVED 3.0MM 8420-107-30,272,RC,,,,,,,,both,,,2732.6500,409.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1912.86,,,,,,,705.3000,2732.6500,percent of total billed charges,"Rev 272 $2,732.65 in Billed Charges at 70% = $1,912.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR MIS CURVED 3.0MM 8420-107-30,272,RC,,,,,,,,both,,,2732.6500,409.9000,CIGNA HEALTHCARE,CIGNA HMO,1139.52,,,,,,,705.3000,2732.6500,percent of total billed charges,"41.7% of $2,732.65 in Billed Charges for Rev 272 = $1,139.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR MIS CURVED 3.0MM 8420-107-30,272,RC,,,,,,,,both,,,2732.6500,409.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1267.95,,,,,,,705.3000,2732.6500,percent of total billed charges,"46.4% of $2,732.65 in Billed Charges for Rev 272 = $1,267.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR MIS CURVED 3.0MM 8420-107-30,272,RC,,,,,,,,both,,,2732.6500,409.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1139.52,,,,,,,705.3000,2732.6500,percent of total billed charges,"41.7% of $2,732.65 in Billed Charges for Rev 272 = $1,139.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR MIS CURVED 3.0MM 8420-107-30,272,RC,,,,,,,,both,,,2732.6500,409.9000,CIGNA HEALTHCARE,CIGNA PPO,1139.52,,,,,,,705.3000,2732.6500,percent of total billed charges,"41.7% of $2,732.65 in Billed Charges for Rev 272 = $1,139.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR MIS CURVED 3.0MM 8420-107-30,272,RC,,,,,,,,both,,,2732.6500,409.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2459.39,,,,,,,705.3000,2732.6500,percent of total billed charges,"90% of $2,732.65 in Billed Charges for Rev 272 = $2,459.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR MIS CURVED 3.0MM 8420-107-30,272,RC,,,,,,,,both,,,2732.6500,409.9000,MEDCOST,MEDCOST VHN,1300.47,,,,,,,705.3000,2732.6500,percent of total billed charges,"47.59% of $2,732.65 in Billed Charges for Rev 272 = $1,300.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR MIS CURVED 3.0MM 8420-107-30,272,RC,,,,,,,,both,,,2732.6500,409.9000,SENTARA HEALTH,SENTARA HEALTH,705.30,,,,,,,705.3000,2732.6500,percent of total billed charges,"25.81% of $2,732.65 in Billed Charges for Rev 272 = $705.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR MIS CURVED 3.0MM 8420-107-30,272,RC,,,,,,,,both,,,2732.6500,409.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2732.65,,,,,,,705.3000,2732.6500,percent of total billed charges,"100% of $2,732.65 in Billed Charges for Rev 272 = $2,732.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR MIS CURVED 3.0MM 8420-107-30,272,RC,,,,,,,,both,,,2732.6500,409.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1366.33,,,,,,,705.3000,2732.6500,percent of total billed charges,"Rev 272 $2,732.65 in Billed Charges at 50% = $1,366.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR MIS CURVED 3.0MM 8420-107-30,272,RC,,,,,,,,both,,,2732.6500,409.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,882.65,,,,,,,705.3000,2732.6500,other,"32.3% of $2,732.65 in Billed Charges for Rev 272 = $882.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BUR MIS CURVED 3.0MM 8420-107-30,272,RC,,,,,,,,both,,,2732.6500,409.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,838.92,,,,,,,705.3000,2732.6500,other,"30.7% of $2,732.65 in Billed Charges for Rev 272 = $838.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BUR MIS CURVED 3.0MM 8420-107-30,272,RC,,,,,,,,both,,,2732.6500,409.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,882.65,,,,,,,705.3000,2732.6500,percent of total billed charges,"32.3% of $2,732.65 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR MIS CURVED 3.0MM 8420-107-30,272,RC,,,,,,,,both,,,2732.6500,409.9000,WELLCARE,WELLCARE MEDICAID,2732.65,,,,,,,705.3000,2732.6500,percent of total billed charges,"100% of $2,732.65 in Billed Charges for Rev 272 = $2,732.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND 4.0 MM MULTI FLUTE,272,RC,27200002,CDM,,,,,,both,,,1445.5100,216.8300,AETNA,AETNA,617.23,,,,,,,373.0900,1445.5100,percent of total billed charges,"42.7% of $1,445.51 in Billed Charges for Rev 272 = $617.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND 4.0 MM MULTI FLUTE,272,RC,27200002,CDM,,,,,,both,,,1445.5100,216.8300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1011.86,,,,,,,373.0900,1445.5100,percent of total billed charges,"Rev 272 $1,445.51 in Billed Charges at 70% = $1,011.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND 4.0 MM MULTI FLUTE,272,RC,27200002,CDM,,,,,,both,,,1445.5100,216.8300,CIGNA HEALTHCARE,CIGNA HMO,602.78,,,,,,,373.0900,1445.5100,percent of total billed charges,"41.7% of $1,445.51 in Billed Charges for Rev 272 = $602.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND 4.0 MM MULTI FLUTE,272,RC,27200002,CDM,,,,,,both,,,1445.5100,216.8300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,670.72,,,,,,,373.0900,1445.5100,percent of total billed charges,"46.4% of $1,445.51 in Billed Charges for Rev 272 = $670.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND 4.0 MM MULTI FLUTE,272,RC,27200002,CDM,,,,,,both,,,1445.5100,216.8300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,602.78,,,,,,,373.0900,1445.5100,percent of total billed charges,"41.7% of $1,445.51 in Billed Charges for Rev 272 = $602.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND 4.0 MM MULTI FLUTE,272,RC,27200002,CDM,,,,,,both,,,1445.5100,216.8300,CIGNA HEALTHCARE,CIGNA PPO,602.78,,,,,,,373.0900,1445.5100,percent of total billed charges,"41.7% of $1,445.51 in Billed Charges for Rev 272 = $602.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND 4.0 MM MULTI FLUTE,272,RC,27200002,CDM,,,,,,both,,,1445.5100,216.8300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1300.96,,,,,,,373.0900,1445.5100,percent of total billed charges,"90% of $1,445.51 in Billed Charges for Rev 272 = $1,300.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND 4.0 MM MULTI FLUTE,272,RC,27200002,CDM,,,,,,both,,,1445.5100,216.8300,MEDCOST,MEDCOST VHN,687.92,,,,,,,373.0900,1445.5100,percent of total billed charges,"47.59% of $1,445.51 in Billed Charges for Rev 272 = $687.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND 4.0 MM MULTI FLUTE,272,RC,27200002,CDM,,,,,,both,,,1445.5100,216.8300,SENTARA HEALTH,SENTARA HEALTH,373.09,,,,,,,373.0900,1445.5100,percent of total billed charges,"25.81% of $1,445.51 in Billed Charges for Rev 272 = $373.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND 4.0 MM MULTI FLUTE,272,RC,27200002,CDM,,,,,,both,,,1445.5100,216.8300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1445.51,,,,,,,373.0900,1445.5100,percent of total billed charges,"100% of $1,445.51 in Billed Charges for Rev 272 = $1,445.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND 4.0 MM MULTI FLUTE,272,RC,27200002,CDM,,,,,,both,,,1445.5100,216.8300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,722.76,,,,,,,373.0900,1445.5100,percent of total billed charges,"Rev 272 $1,445.51 in Billed Charges at 50% = $722.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND 4.0 MM MULTI FLUTE,272,RC,27200002,CDM,,,,,,both,,,1445.5100,216.8300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,466.90,,,,,,,373.0900,1445.5100,other,"32.3% of $1,445.51 in Billed Charges for Rev 272 = $466.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BUR ROUND 4.0 MM MULTI FLUTE,272,RC,27200002,CDM,,,,,,both,,,1445.5100,216.8300,UNITED HEALTHCARE,UHC HERITAGE SELECT,443.77,,,,,,,373.0900,1445.5100,other,"30.7% of $1,445.51 in Billed Charges for Rev 272 = $443.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BUR ROUND 4.0 MM MULTI FLUTE,272,RC,27200002,CDM,,,,,,both,,,1445.5100,216.8300,UNITED HEALTHCARE,UNITED HEALTHCARE,466.90,,,,,,,373.0900,1445.5100,percent of total billed charges,"32.3% of $1,445.51 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND 4.0 MM MULTI FLUTE,272,RC,27200002,CDM,,,,,,both,,,1445.5100,216.8300,WELLCARE,WELLCARE MEDICAID,1445.51,,,,,,,373.0900,1445.5100,percent of total billed charges,"100% of $1,445.51 in Billed Charges for Rev 272 = $1,445.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
15.5MM REAMER HEAD FOR RIA 2,272,RC,27200002,CDM,,,,,,both,,,7370.6700,1105.6000,AETNA,AETNA,3147.28,,,,,,,1902.3700,7370.6700,percent of total billed charges,"42.7% of $7,370.67 in Billed Charges for Rev 272 = $3,147.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
15.5MM REAMER HEAD FOR RIA 2,272,RC,27200002,CDM,,,,,,both,,,7370.6700,1105.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5159.47,,,,,,,1902.3700,7370.6700,percent of total billed charges,"Rev 272 $7,370.67 in Billed Charges at 70% = $5,159.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
15.5MM REAMER HEAD FOR RIA 2,272,RC,27200002,CDM,,,,,,both,,,7370.6700,1105.6000,CIGNA HEALTHCARE,CIGNA HMO,3073.57,,,,,,,1902.3700,7370.6700,percent of total billed charges,"41.7% of $7,370.67 in Billed Charges for Rev 272 = $3,073.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
15.5MM REAMER HEAD FOR RIA 2,272,RC,27200002,CDM,,,,,,both,,,7370.6700,1105.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3419.99,,,,,,,1902.3700,7370.6700,percent of total billed charges,"46.4% of $7,370.67 in Billed Charges for Rev 272 = $3,419.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
15.5MM REAMER HEAD FOR RIA 2,272,RC,27200002,CDM,,,,,,both,,,7370.6700,1105.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3073.57,,,,,,,1902.3700,7370.6700,percent of total billed charges,"41.7% of $7,370.67 in Billed Charges for Rev 272 = $3,073.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
15.5MM REAMER HEAD FOR RIA 2,272,RC,27200002,CDM,,,,,,both,,,7370.6700,1105.6000,CIGNA HEALTHCARE,CIGNA PPO,3073.57,,,,,,,1902.3700,7370.6700,percent of total billed charges,"41.7% of $7,370.67 in Billed Charges for Rev 272 = $3,073.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
15.5MM REAMER HEAD FOR RIA 2,272,RC,27200002,CDM,,,,,,both,,,7370.6700,1105.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6633.60,,,,,,,1902.3700,7370.6700,percent of total billed charges,"90% of $7,370.67 in Billed Charges for Rev 272 = $6,633.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
15.5MM REAMER HEAD FOR RIA 2,272,RC,27200002,CDM,,,,,,both,,,7370.6700,1105.6000,MEDCOST,MEDCOST VHN,3507.70,,,,,,,1902.3700,7370.6700,percent of total billed charges,"47.59% of $7,370.67 in Billed Charges for Rev 272 = $3,507.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
15.5MM REAMER HEAD FOR RIA 2,272,RC,27200002,CDM,,,,,,both,,,7370.6700,1105.6000,SENTARA HEALTH,SENTARA HEALTH,1902.37,,,,,,,1902.3700,7370.6700,percent of total billed charges,"25.81% of $7,370.67 in Billed Charges for Rev 272 = $1,902.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
15.5MM REAMER HEAD FOR RIA 2,272,RC,27200002,CDM,,,,,,both,,,7370.6700,1105.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7370.67,,,,,,,1902.3700,7370.6700,percent of total billed charges,"100% of $7,370.67 in Billed Charges for Rev 272 = $7,370.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
15.5MM REAMER HEAD FOR RIA 2,272,RC,27200002,CDM,,,,,,both,,,7370.6700,1105.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3685.34,,,,,,,1902.3700,7370.6700,percent of total billed charges,"Rev 272 $7,370.67 in Billed Charges at 50% = $3,685.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
15.5MM REAMER HEAD FOR RIA 2,272,RC,27200002,CDM,,,,,,both,,,7370.6700,1105.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2380.73,,,,,,,1902.3700,7370.6700,other,"32.3% of $7,370.67 in Billed Charges for Rev 272 = $2,380.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
15.5MM REAMER HEAD FOR RIA 2,272,RC,27200002,CDM,,,,,,both,,,7370.6700,1105.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2262.80,,,,,,,1902.3700,7370.6700,other,"30.7% of $7,370.67 in Billed Charges for Rev 272 = $2,262.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
15.5MM REAMER HEAD FOR RIA 2,272,RC,27200002,CDM,,,,,,both,,,7370.6700,1105.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,2380.73,,,,,,,1902.3700,7370.6700,percent of total billed charges,"32.3% of $7,370.67 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
15.5MM REAMER HEAD FOR RIA 2,272,RC,27200002,CDM,,,,,,both,,,7370.6700,1105.6000,WELLCARE,WELLCARE MEDICAID,7370.67,,,,,,,1902.3700,7370.6700,percent of total billed charges,"100% of $7,370.67 in Billed Charges for Rev 272 = $7,370.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR APOLLO RF 90,272,RC,27200002,CDM,,,,,,both,,,3007.5900,451.1400,AETNA,AETNA,1284.24,,,,,,,776.2600,3007.5900,percent of total billed charges,"42.7% of $3,007.59 in Billed Charges for Rev 272 = $1,284.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR APOLLO RF 90,272,RC,27200002,CDM,,,,,,both,,,3007.5900,451.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2105.31,,,,,,,776.2600,3007.5900,percent of total billed charges,"Rev 272 $3,007.59 in Billed Charges at 70% = $2,105.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR APOLLO RF 90,272,RC,27200002,CDM,,,,,,both,,,3007.5900,451.1400,CIGNA HEALTHCARE,CIGNA HMO,1254.17,,,,,,,776.2600,3007.5900,percent of total billed charges,"41.7% of $3,007.59 in Billed Charges for Rev 272 = $1,254.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR APOLLO RF 90,272,RC,27200002,CDM,,,,,,both,,,3007.5900,451.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1395.52,,,,,,,776.2600,3007.5900,percent of total billed charges,"46.4% of $3,007.59 in Billed Charges for Rev 272 = $1,395.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR APOLLO RF 90,272,RC,27200002,CDM,,,,,,both,,,3007.5900,451.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1254.17,,,,,,,776.2600,3007.5900,percent of total billed charges,"41.7% of $3,007.59 in Billed Charges for Rev 272 = $1,254.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR APOLLO RF 90,272,RC,27200002,CDM,,,,,,both,,,3007.5900,451.1400,CIGNA HEALTHCARE,CIGNA PPO,1254.17,,,,,,,776.2600,3007.5900,percent of total billed charges,"41.7% of $3,007.59 in Billed Charges for Rev 272 = $1,254.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR APOLLO RF 90,272,RC,27200002,CDM,,,,,,both,,,3007.5900,451.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2706.83,,,,,,,776.2600,3007.5900,percent of total billed charges,"90% of $3,007.59 in Billed Charges for Rev 272 = $2,706.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR APOLLO RF 90,272,RC,27200002,CDM,,,,,,both,,,3007.5900,451.1400,MEDCOST,MEDCOST VHN,1431.31,,,,,,,776.2600,3007.5900,percent of total billed charges,"47.59% of $3,007.59 in Billed Charges for Rev 272 = $1,431.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR APOLLO RF 90,272,RC,27200002,CDM,,,,,,both,,,3007.5900,451.1400,SENTARA HEALTH,SENTARA HEALTH,776.26,,,,,,,776.2600,3007.5900,percent of total billed charges,"25.81% of $3,007.59 in Billed Charges for Rev 272 = $776.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR APOLLO RF 90,272,RC,27200002,CDM,,,,,,both,,,3007.5900,451.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3007.59,,,,,,,776.2600,3007.5900,percent of total billed charges,"100% of $3,007.59 in Billed Charges for Rev 272 = $3,007.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR APOLLO RF 90,272,RC,27200002,CDM,,,,,,both,,,3007.5900,451.1400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1503.80,,,,,,,776.2600,3007.5900,percent of total billed charges,"Rev 272 $3,007.59 in Billed Charges at 50% = $1,503.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR APOLLO RF 90,272,RC,27200002,CDM,,,,,,both,,,3007.5900,451.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,971.45,,,,,,,776.2600,3007.5900,other,"32.3% of $3,007.59 in Billed Charges for Rev 272 = $971.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ABLATOR APOLLO RF 90,272,RC,27200002,CDM,,,,,,both,,,3007.5900,451.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,923.33,,,,,,,776.2600,3007.5900,other,"30.7% of $3,007.59 in Billed Charges for Rev 272 = $923.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ABLATOR APOLLO RF 90,272,RC,27200002,CDM,,,,,,both,,,3007.5900,451.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,971.45,,,,,,,776.2600,3007.5900,percent of total billed charges,"32.3% of $3,007.59 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR APOLLO RF 90,272,RC,27200002,CDM,,,,,,both,,,3007.5900,451.1400,WELLCARE,WELLCARE MEDICAID,3007.59,,,,,,,776.2600,3007.5900,percent of total billed charges,"100% of $3,007.59 in Billed Charges for Rev 272 = $3,007.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR PRECISION ROUND 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2401.2000,360.1800,AETNA,AETNA,1025.31,,,,,,,619.7500,2401.2000,percent of total billed charges,"42.7% of $2,401.20 in Billed Charges for Rev 272 = $1,025.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR PRECISION ROUND 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2401.2000,360.1800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1680.84,,,,,,,619.7500,2401.2000,percent of total billed charges,"Rev 272 $2,401.20 in Billed Charges at 70% = $1,680.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR PRECISION ROUND 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2401.2000,360.1800,CIGNA HEALTHCARE,CIGNA HMO,1001.30,,,,,,,619.7500,2401.2000,percent of total billed charges,"41.7% of $2,401.20 in Billed Charges for Rev 272 = $1,001.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR PRECISION ROUND 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2401.2000,360.1800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1114.16,,,,,,,619.7500,2401.2000,percent of total billed charges,"46.4% of $2,401.20 in Billed Charges for Rev 272 = $1,114.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR PRECISION ROUND 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2401.2000,360.1800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1001.30,,,,,,,619.7500,2401.2000,percent of total billed charges,"41.7% of $2,401.20 in Billed Charges for Rev 272 = $1,001.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR PRECISION ROUND 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2401.2000,360.1800,CIGNA HEALTHCARE,CIGNA PPO,1001.30,,,,,,,619.7500,2401.2000,percent of total billed charges,"41.7% of $2,401.20 in Billed Charges for Rev 272 = $1,001.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR PRECISION ROUND 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2401.2000,360.1800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2161.08,,,,,,,619.7500,2401.2000,percent of total billed charges,"90% of $2,401.20 in Billed Charges for Rev 272 = $2,161.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR PRECISION ROUND 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2401.2000,360.1800,MEDCOST,MEDCOST VHN,1142.73,,,,,,,619.7500,2401.2000,percent of total billed charges,"47.59% of $2,401.20 in Billed Charges for Rev 272 = $1,142.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR PRECISION ROUND 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2401.2000,360.1800,SENTARA HEALTH,SENTARA HEALTH,619.75,,,,,,,619.7500,2401.2000,percent of total billed charges,"25.81% of $2,401.20 in Billed Charges for Rev 272 = $619.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR PRECISION ROUND 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2401.2000,360.1800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2401.20,,,,,,,619.7500,2401.2000,percent of total billed charges,"100% of $2,401.20 in Billed Charges for Rev 272 = $2,401.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR PRECISION ROUND 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2401.2000,360.1800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1200.60,,,,,,,619.7500,2401.2000,percent of total billed charges,"Rev 272 $2,401.20 in Billed Charges at 50% = $1,200.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR PRECISION ROUND 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2401.2000,360.1800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,775.59,,,,,,,619.7500,2401.2000,other,"32.3% of $2,401.20 in Billed Charges for Rev 272 = $775.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BUR PRECISION ROUND 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2401.2000,360.1800,UNITED HEALTHCARE,UHC HERITAGE SELECT,737.17,,,,,,,619.7500,2401.2000,other,"30.7% of $2,401.20 in Billed Charges for Rev 272 = $737.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BUR PRECISION ROUND 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2401.2000,360.1800,UNITED HEALTHCARE,UNITED HEALTHCARE,775.59,,,,,,,619.7500,2401.2000,percent of total billed charges,"32.3% of $2,401.20 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR PRECISION ROUND 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2401.2000,360.1800,WELLCARE,WELLCARE MEDICAID,2401.20,,,,,,,619.7500,2401.2000,percent of total billed charges,"100% of $2,401.20 in Billed Charges for Rev 272 = $2,401.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND COARSE DIAMOND EXTENDED 3.0MM,272,RC,,,,,,,,both,,,1591.6400,238.7500,AETNA,AETNA,679.63,,,,,,,410.8000,1591.6400,percent of total billed charges,"42.7% of $1,591.64 in Billed Charges for Rev 272 = $679.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND COARSE DIAMOND EXTENDED 3.0MM,272,RC,,,,,,,,both,,,1591.6400,238.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1114.15,,,,,,,410.8000,1591.6400,percent of total billed charges,"Rev 272 $1,591.64 in Billed Charges at 70% = $1,114.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND COARSE DIAMOND EXTENDED 3.0MM,272,RC,,,,,,,,both,,,1591.6400,238.7500,CIGNA HEALTHCARE,CIGNA HMO,663.71,,,,,,,410.8000,1591.6400,percent of total billed charges,"41.7% of $1,591.64 in Billed Charges for Rev 272 = $663.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND COARSE DIAMOND EXTENDED 3.0MM,272,RC,,,,,,,,both,,,1591.6400,238.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,738.52,,,,,,,410.8000,1591.6400,percent of total billed charges,"46.4% of $1,591.64 in Billed Charges for Rev 272 = $738.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND COARSE DIAMOND EXTENDED 3.0MM,272,RC,,,,,,,,both,,,1591.6400,238.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,663.71,,,,,,,410.8000,1591.6400,percent of total billed charges,"41.7% of $1,591.64 in Billed Charges for Rev 272 = $663.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND COARSE DIAMOND EXTENDED 3.0MM,272,RC,,,,,,,,both,,,1591.6400,238.7500,CIGNA HEALTHCARE,CIGNA PPO,663.71,,,,,,,410.8000,1591.6400,percent of total billed charges,"41.7% of $1,591.64 in Billed Charges for Rev 272 = $663.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND COARSE DIAMOND EXTENDED 3.0MM,272,RC,,,,,,,,both,,,1591.6400,238.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1432.48,,,,,,,410.8000,1591.6400,percent of total billed charges,"90% of $1,591.64 in Billed Charges for Rev 272 = $1,432.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND COARSE DIAMOND EXTENDED 3.0MM,272,RC,,,,,,,,both,,,1591.6400,238.7500,MEDCOST,MEDCOST VHN,757.46,,,,,,,410.8000,1591.6400,percent of total billed charges,"47.59% of $1,591.64 in Billed Charges for Rev 272 = $757.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND COARSE DIAMOND EXTENDED 3.0MM,272,RC,,,,,,,,both,,,1591.6400,238.7500,SENTARA HEALTH,SENTARA HEALTH,410.80,,,,,,,410.8000,1591.6400,percent of total billed charges,"25.81% of $1,591.64 in Billed Charges for Rev 272 = $410.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND COARSE DIAMOND EXTENDED 3.0MM,272,RC,,,,,,,,both,,,1591.6400,238.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1591.64,,,,,,,410.8000,1591.6400,percent of total billed charges,"100% of $1,591.64 in Billed Charges for Rev 272 = $1,591.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND COARSE DIAMOND EXTENDED 3.0MM,272,RC,,,,,,,,both,,,1591.6400,238.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,795.82,,,,,,,410.8000,1591.6400,percent of total billed charges,"Rev 272 $1,591.64 in Billed Charges at 50% = $795.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND COARSE DIAMOND EXTENDED 3.0MM,272,RC,,,,,,,,both,,,1591.6400,238.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,514.10,,,,,,,410.8000,1591.6400,other,"32.3% of $1,591.64 in Billed Charges for Rev 272 = $514.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BUR ROUND COARSE DIAMOND EXTENDED 3.0MM,272,RC,,,,,,,,both,,,1591.6400,238.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,488.63,,,,,,,410.8000,1591.6400,other,"30.7% of $1,591.64 in Billed Charges for Rev 272 = $488.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BUR ROUND COARSE DIAMOND EXTENDED 3.0MM,272,RC,,,,,,,,both,,,1591.6400,238.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,514.10,,,,,,,410.8000,1591.6400,percent of total billed charges,"32.3% of $1,591.64 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND COARSE DIAMOND EXTENDED 3.0MM,272,RC,,,,,,,,both,,,1591.6400,238.7500,WELLCARE,WELLCARE MEDICAID,1591.64,,,,,,,410.8000,1591.6400,percent of total billed charges,"100% of $1,591.64 in Billed Charges for Rev 272 = $1,591.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR 50,272,RC,27200002,CDM,,,,,,both,,,2063.8300,309.5700,AETNA,AETNA,881.26,,,,,,,532.6700,2063.8300,percent of total billed charges,"42.7% of $2,063.83 in Billed Charges for Rev 272 = $881.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR 50,272,RC,27200002,CDM,,,,,,both,,,2063.8300,309.5700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1444.68,,,,,,,532.6700,2063.8300,percent of total billed charges,"Rev 272 $2,063.83 in Billed Charges at 70% = $1,444.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR 50,272,RC,27200002,CDM,,,,,,both,,,2063.8300,309.5700,CIGNA HEALTHCARE,CIGNA HMO,860.62,,,,,,,532.6700,2063.8300,percent of total billed charges,"41.7% of $2,063.83 in Billed Charges for Rev 272 = $860.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR 50,272,RC,27200002,CDM,,,,,,both,,,2063.8300,309.5700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,957.62,,,,,,,532.6700,2063.8300,percent of total billed charges,"46.4% of $2,063.83 in Billed Charges for Rev 272 = $957.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR 50,272,RC,27200002,CDM,,,,,,both,,,2063.8300,309.5700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,860.62,,,,,,,532.6700,2063.8300,percent of total billed charges,"41.7% of $2,063.83 in Billed Charges for Rev 272 = $860.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR 50,272,RC,27200002,CDM,,,,,,both,,,2063.8300,309.5700,CIGNA HEALTHCARE,CIGNA PPO,860.62,,,,,,,532.6700,2063.8300,percent of total billed charges,"41.7% of $2,063.83 in Billed Charges for Rev 272 = $860.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR 50,272,RC,27200002,CDM,,,,,,both,,,2063.8300,309.5700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1857.45,,,,,,,532.6700,2063.8300,percent of total billed charges,"90% of $2,063.83 in Billed Charges for Rev 272 = $1,857.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR 50,272,RC,27200002,CDM,,,,,,both,,,2063.8300,309.5700,MEDCOST,MEDCOST VHN,982.18,,,,,,,532.6700,2063.8300,percent of total billed charges,"47.59% of $2,063.83 in Billed Charges for Rev 272 = $982.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR 50,272,RC,27200002,CDM,,,,,,both,,,2063.8300,309.5700,SENTARA HEALTH,SENTARA HEALTH,532.67,,,,,,,532.6700,2063.8300,percent of total billed charges,"25.81% of $2,063.83 in Billed Charges for Rev 272 = $532.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR 50,272,RC,27200002,CDM,,,,,,both,,,2063.8300,309.5700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2063.83,,,,,,,532.6700,2063.8300,percent of total billed charges,"100% of $2,063.83 in Billed Charges for Rev 272 = $2,063.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR 50,272,RC,27200002,CDM,,,,,,both,,,2063.8300,309.5700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1031.92,,,,,,,532.6700,2063.8300,percent of total billed charges,"Rev 272 $2,063.83 in Billed Charges at 50% = $1,031.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR 50,272,RC,27200002,CDM,,,,,,both,,,2063.8300,309.5700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,666.62,,,,,,,532.6700,2063.8300,other,"32.3% of $2,063.83 in Billed Charges for Rev 272 = $666.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ABLATOR 50,272,RC,27200002,CDM,,,,,,both,,,2063.8300,309.5700,UNITED HEALTHCARE,UHC HERITAGE SELECT,633.60,,,,,,,532.6700,2063.8300,other,"30.7% of $2,063.83 in Billed Charges for Rev 272 = $633.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ABLATOR 50,272,RC,27200002,CDM,,,,,,both,,,2063.8300,309.5700,UNITED HEALTHCARE,UNITED HEALTHCARE,666.62,,,,,,,532.6700,2063.8300,percent of total billed charges,"32.3% of $2,063.83 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR 50,272,RC,27200002,CDM,,,,,,both,,,2063.8300,309.5700,WELLCARE,WELLCARE MEDICAID,2063.83,,,,,,,532.6700,2063.8300,percent of total billed charges,"100% of $2,063.83 in Billed Charges for Rev 272 = $2,063.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCUMIX MIXING SYSTEM,272,RC,,,,,,,,both,,,2561.6400,384.2500,AETNA,AETNA,1093.82,,,,,,,661.1600,2561.6400,percent of total billed charges,"42.7% of $2,561.64 in Billed Charges for Rev 272 = $1,093.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCUMIX MIXING SYSTEM,272,RC,,,,,,,,both,,,2561.6400,384.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1793.15,,,,,,,661.1600,2561.6400,percent of total billed charges,"Rev 272 $2,561.64 in Billed Charges at 70% = $1,793.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCUMIX MIXING SYSTEM,272,RC,,,,,,,,both,,,2561.6400,384.2500,CIGNA HEALTHCARE,CIGNA HMO,1068.20,,,,,,,661.1600,2561.6400,percent of total billed charges,"41.7% of $2,561.64 in Billed Charges for Rev 272 = $1,068.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCUMIX MIXING SYSTEM,272,RC,,,,,,,,both,,,2561.6400,384.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1188.60,,,,,,,661.1600,2561.6400,percent of total billed charges,"46.4% of $2,561.64 in Billed Charges for Rev 272 = $1,188.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCUMIX MIXING SYSTEM,272,RC,,,,,,,,both,,,2561.6400,384.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1068.20,,,,,,,661.1600,2561.6400,percent of total billed charges,"41.7% of $2,561.64 in Billed Charges for Rev 272 = $1,068.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCUMIX MIXING SYSTEM,272,RC,,,,,,,,both,,,2561.6400,384.2500,CIGNA HEALTHCARE,CIGNA PPO,1068.20,,,,,,,661.1600,2561.6400,percent of total billed charges,"41.7% of $2,561.64 in Billed Charges for Rev 272 = $1,068.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCUMIX MIXING SYSTEM,272,RC,,,,,,,,both,,,2561.6400,384.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2305.48,,,,,,,661.1600,2561.6400,percent of total billed charges,"90% of $2,561.64 in Billed Charges for Rev 272 = $2,305.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCUMIX MIXING SYSTEM,272,RC,,,,,,,,both,,,2561.6400,384.2500,MEDCOST,MEDCOST VHN,1219.08,,,,,,,661.1600,2561.6400,percent of total billed charges,"47.59% of $2,561.64 in Billed Charges for Rev 272 = $1,219.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCUMIX MIXING SYSTEM,272,RC,,,,,,,,both,,,2561.6400,384.2500,SENTARA HEALTH,SENTARA HEALTH,661.16,,,,,,,661.1600,2561.6400,percent of total billed charges,"25.81% of $2,561.64 in Billed Charges for Rev 272 = $661.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCUMIX MIXING SYSTEM,272,RC,,,,,,,,both,,,2561.6400,384.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2561.64,,,,,,,661.1600,2561.6400,percent of total billed charges,"100% of $2,561.64 in Billed Charges for Rev 272 = $2,561.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCUMIX MIXING SYSTEM,272,RC,,,,,,,,both,,,2561.6400,384.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1280.82,,,,,,,661.1600,2561.6400,percent of total billed charges,"Rev 272 $2,561.64 in Billed Charges at 50% = $1,280.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCUMIX MIXING SYSTEM,272,RC,,,,,,,,both,,,2561.6400,384.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,827.41,,,,,,,661.1600,2561.6400,other,"32.3% of $2,561.64 in Billed Charges for Rev 272 = $827.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ACCUMIX MIXING SYSTEM,272,RC,,,,,,,,both,,,2561.6400,384.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,786.42,,,,,,,661.1600,2561.6400,other,"30.7% of $2,561.64 in Billed Charges for Rev 272 = $786.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ACCUMIX MIXING SYSTEM,272,RC,,,,,,,,both,,,2561.6400,384.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,827.41,,,,,,,661.1600,2561.6400,percent of total billed charges,"32.3% of $2,561.64 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCUMIX MIXING SYSTEM,272,RC,,,,,,,,both,,,2561.6400,384.2500,WELLCARE,WELLCARE MEDICAID,2561.64,,,,,,,661.1600,2561.6400,percent of total billed charges,"100% of $2,561.64 in Billed Charges for Rev 272 = $2,561.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACORN 9MM,272,RC,,,,,,,,both,,,1870.1000,280.5200,AETNA,AETNA,798.53,,,,,,,482.6700,1870.1000,percent of total billed charges,"42.7% of $1,870.10 in Billed Charges for Rev 272 = $798.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACORN 9MM,272,RC,,,,,,,,both,,,1870.1000,280.5200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1309.07,,,,,,,482.6700,1870.1000,percent of total billed charges,"Rev 272 $1,870.10 in Billed Charges at 70% = $1,309.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACORN 9MM,272,RC,,,,,,,,both,,,1870.1000,280.5200,CIGNA HEALTHCARE,CIGNA HMO,779.83,,,,,,,482.6700,1870.1000,percent of total billed charges,"41.7% of $1,870.10 in Billed Charges for Rev 272 = $779.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACORN 9MM,272,RC,,,,,,,,both,,,1870.1000,280.5200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,867.73,,,,,,,482.6700,1870.1000,percent of total billed charges,"46.4% of $1,870.10 in Billed Charges for Rev 272 = $867.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACORN 9MM,272,RC,,,,,,,,both,,,1870.1000,280.5200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,779.83,,,,,,,482.6700,1870.1000,percent of total billed charges,"41.7% of $1,870.10 in Billed Charges for Rev 272 = $779.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACORN 9MM,272,RC,,,,,,,,both,,,1870.1000,280.5200,CIGNA HEALTHCARE,CIGNA PPO,779.83,,,,,,,482.6700,1870.1000,percent of total billed charges,"41.7% of $1,870.10 in Billed Charges for Rev 272 = $779.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACORN 9MM,272,RC,,,,,,,,both,,,1870.1000,280.5200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1683.09,,,,,,,482.6700,1870.1000,percent of total billed charges,"90% of $1,870.10 in Billed Charges for Rev 272 = $1,683.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACORN 9MM,272,RC,,,,,,,,both,,,1870.1000,280.5200,MEDCOST,MEDCOST VHN,889.98,,,,,,,482.6700,1870.1000,percent of total billed charges,"47.59% of $1,870.10 in Billed Charges for Rev 272 = $889.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACORN 9MM,272,RC,,,,,,,,both,,,1870.1000,280.5200,SENTARA HEALTH,SENTARA HEALTH,482.67,,,,,,,482.6700,1870.1000,percent of total billed charges,"25.81% of $1,870.10 in Billed Charges for Rev 272 = $482.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACORN 9MM,272,RC,,,,,,,,both,,,1870.1000,280.5200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1870.10,,,,,,,482.6700,1870.1000,percent of total billed charges,"100% of $1,870.10 in Billed Charges for Rev 272 = $1,870.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACORN 9MM,272,RC,,,,,,,,both,,,1870.1000,280.5200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,935.05,,,,,,,482.6700,1870.1000,percent of total billed charges,"Rev 272 $1,870.10 in Billed Charges at 50% = $935.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACORN 9MM,272,RC,,,,,,,,both,,,1870.1000,280.5200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,604.04,,,,,,,482.6700,1870.1000,other,"32.3% of $1,870.10 in Billed Charges for Rev 272 = $604.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ACORN 9MM,272,RC,,,,,,,,both,,,1870.1000,280.5200,UNITED HEALTHCARE,UHC HERITAGE SELECT,574.12,,,,,,,482.6700,1870.1000,other,"30.7% of $1,870.10 in Billed Charges for Rev 272 = $574.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ACORN 9MM,272,RC,,,,,,,,both,,,1870.1000,280.5200,UNITED HEALTHCARE,UNITED HEALTHCARE,604.04,,,,,,,482.6700,1870.1000,percent of total billed charges,"32.3% of $1,870.10 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACORN 9MM,272,RC,,,,,,,,both,,,1870.1000,280.5200,WELLCARE,WELLCARE MEDICAID,1870.10,,,,,,,482.6700,1870.1000,percent of total billed charges,"100% of $1,870.10 in Billed Charges for Rev 272 = $1,870.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR ASPIRATING APOLLORF 50DEG,272,RC,27200002,CDM,,,,,,both,,,3132.0400,469.8100,AETNA,AETNA,1337.38,,,,,,,808.3800,3132.0400,percent of total billed charges,"42.7% of $3,132.04 in Billed Charges for Rev 272 = $1,337.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR ASPIRATING APOLLORF 50DEG,272,RC,27200002,CDM,,,,,,both,,,3132.0400,469.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2192.43,,,,,,,808.3800,3132.0400,percent of total billed charges,"Rev 272 $3,132.04 in Billed Charges at 70% = $2,192.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR ASPIRATING APOLLORF 50DEG,272,RC,27200002,CDM,,,,,,both,,,3132.0400,469.8100,CIGNA HEALTHCARE,CIGNA HMO,1306.06,,,,,,,808.3800,3132.0400,percent of total billed charges,"41.7% of $3,132.04 in Billed Charges for Rev 272 = $1,306.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR ASPIRATING APOLLORF 50DEG,272,RC,27200002,CDM,,,,,,both,,,3132.0400,469.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1453.27,,,,,,,808.3800,3132.0400,percent of total billed charges,"46.4% of $3,132.04 in Billed Charges for Rev 272 = $1,453.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR ASPIRATING APOLLORF 50DEG,272,RC,27200002,CDM,,,,,,both,,,3132.0400,469.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1306.06,,,,,,,808.3800,3132.0400,percent of total billed charges,"41.7% of $3,132.04 in Billed Charges for Rev 272 = $1,306.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR ASPIRATING APOLLORF 50DEG,272,RC,27200002,CDM,,,,,,both,,,3132.0400,469.8100,CIGNA HEALTHCARE,CIGNA PPO,1306.06,,,,,,,808.3800,3132.0400,percent of total billed charges,"41.7% of $3,132.04 in Billed Charges for Rev 272 = $1,306.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR ASPIRATING APOLLORF 50DEG,272,RC,27200002,CDM,,,,,,both,,,3132.0400,469.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2818.84,,,,,,,808.3800,3132.0400,percent of total billed charges,"90% of $3,132.04 in Billed Charges for Rev 272 = $2,818.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR ASPIRATING APOLLORF 50DEG,272,RC,27200002,CDM,,,,,,both,,,3132.0400,469.8100,MEDCOST,MEDCOST VHN,1490.54,,,,,,,808.3800,3132.0400,percent of total billed charges,"47.59% of $3,132.04 in Billed Charges for Rev 272 = $1,490.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR ASPIRATING APOLLORF 50DEG,272,RC,27200002,CDM,,,,,,both,,,3132.0400,469.8100,SENTARA HEALTH,SENTARA HEALTH,808.38,,,,,,,808.3800,3132.0400,percent of total billed charges,"25.81% of $3,132.04 in Billed Charges for Rev 272 = $808.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR ASPIRATING APOLLORF 50DEG,272,RC,27200002,CDM,,,,,,both,,,3132.0400,469.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3132.04,,,,,,,808.3800,3132.0400,percent of total billed charges,"100% of $3,132.04 in Billed Charges for Rev 272 = $3,132.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR ASPIRATING APOLLORF 50DEG,272,RC,27200002,CDM,,,,,,both,,,3132.0400,469.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1566.02,,,,,,,808.3800,3132.0400,percent of total billed charges,"Rev 272 $3,132.04 in Billed Charges at 50% = $1,566.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR ASPIRATING APOLLORF 50DEG,272,RC,27200002,CDM,,,,,,both,,,3132.0400,469.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1011.65,,,,,,,808.3800,3132.0400,other,"32.3% of $3,132.04 in Billed Charges for Rev 272 = $1,011.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ABLATOR ASPIRATING APOLLORF 50DEG,272,RC,27200002,CDM,,,,,,both,,,3132.0400,469.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,961.54,,,,,,,808.3800,3132.0400,other,"30.7% of $3,132.04 in Billed Charges for Rev 272 = $961.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ABLATOR ASPIRATING APOLLORF 50DEG,272,RC,27200002,CDM,,,,,,both,,,3132.0400,469.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,1011.65,,,,,,,808.3800,3132.0400,percent of total billed charges,"32.3% of $3,132.04 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ABLATOR ASPIRATING APOLLORF 50DEG,272,RC,27200002,CDM,,,,,,both,,,3132.0400,469.8100,WELLCARE,WELLCARE MEDICAID,3132.04,,,,,,,808.3800,3132.0400,percent of total billed charges,"100% of $3,132.04 in Billed Charges for Rev 272 = $3,132.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AC REPAIR LOW PROFILE,272,RC,,,,,,,,both,,,21115.3600,3167.3000,AETNA,AETNA,9016.26,,,,,,,5449.8700,21115.3600,percent of total billed charges,"42.7% of $21,115.36 in Billed Charges for Rev 272 = $9,016.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AC REPAIR LOW PROFILE,272,RC,,,,,,,,both,,,21115.3600,3167.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,14780.75,,,,,,,5449.8700,21115.3600,percent of total billed charges,"Rev 272 $21,115.36 in Billed Charges at 70% = $14,780.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AC REPAIR LOW PROFILE,272,RC,,,,,,,,both,,,21115.3600,3167.3000,CIGNA HEALTHCARE,CIGNA HMO,8805.11,,,,,,,5449.8700,21115.3600,percent of total billed charges,"41.7% of $21,115.36 in Billed Charges for Rev 272 = $8,805.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AC REPAIR LOW PROFILE,272,RC,,,,,,,,both,,,21115.3600,3167.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,9797.53,,,,,,,5449.8700,21115.3600,percent of total billed charges,"46.4% of $21,115.36 in Billed Charges for Rev 272 = $9,797.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AC REPAIR LOW PROFILE,272,RC,,,,,,,,both,,,21115.3600,3167.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8805.11,,,,,,,5449.8700,21115.3600,percent of total billed charges,"41.7% of $21,115.36 in Billed Charges for Rev 272 = $8,805.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AC REPAIR LOW PROFILE,272,RC,,,,,,,,both,,,21115.3600,3167.3000,CIGNA HEALTHCARE,CIGNA PPO,8805.11,,,,,,,5449.8700,21115.3600,percent of total billed charges,"41.7% of $21,115.36 in Billed Charges for Rev 272 = $8,805.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AC REPAIR LOW PROFILE,272,RC,,,,,,,,both,,,21115.3600,3167.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,19003.82,,,,,,,5449.8700,21115.3600,percent of total billed charges,"90% of $21,115.36 in Billed Charges for Rev 272 = $19,003.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AC REPAIR LOW PROFILE,272,RC,,,,,,,,both,,,21115.3600,3167.3000,MEDCOST,MEDCOST VHN,10048.80,,,,,,,5449.8700,21115.3600,percent of total billed charges,"47.59% of $21,115.36 in Billed Charges for Rev 272 = $10,048.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AC REPAIR LOW PROFILE,272,RC,,,,,,,,both,,,21115.3600,3167.3000,SENTARA HEALTH,SENTARA HEALTH,5449.87,,,,,,,5449.8700,21115.3600,percent of total billed charges,"25.81% of $21,115.36 in Billed Charges for Rev 272 = $5,449.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AC REPAIR LOW PROFILE,272,RC,,,,,,,,both,,,21115.3600,3167.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",21115.36,,,,,,,5449.8700,21115.3600,percent of total billed charges,"100% of $21,115.36 in Billed Charges for Rev 272 = $21,115.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AC REPAIR LOW PROFILE,272,RC,,,,,,,,both,,,21115.3600,3167.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,10557.68,,,,,,,5449.8700,21115.3600,percent of total billed charges,"Rev 272 $21,115.36 in Billed Charges at 50% = $10,557.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AC REPAIR LOW PROFILE,272,RC,,,,,,,,both,,,21115.3600,3167.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,6820.26,,,,,,,5449.8700,21115.3600,other,"32.3% of $21,115.36 in Billed Charges for Rev 272 = $6,820.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
AC REPAIR LOW PROFILE,272,RC,,,,,,,,both,,,21115.3600,3167.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,6482.42,,,,,,,5449.8700,21115.3600,other,"30.7% of $21,115.36 in Billed Charges for Rev 272 = $6,482.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
AC REPAIR LOW PROFILE,272,RC,,,,,,,,both,,,21115.3600,3167.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,6820.26,,,,,,,5449.8700,21115.3600,percent of total billed charges,"32.3% of $21,115.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AC REPAIR LOW PROFILE,272,RC,,,,,,,,both,,,21115.3600,3167.3000,WELLCARE,WELLCARE MEDICAID,21115.36,,,,,,,5449.8700,21115.3600,percent of total billed charges,"100% of $21,115.36 in Billed Charges for Rev 272 = $21,115.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESS SYSTEM OVERTUBE ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,3890.4700,583.5700,AETNA,AETNA,1661.23,,,,,,,1004.1300,3890.4700,percent of total billed charges,"42.7% of $3,890.47 in Billed Charges for Rev 272 = $1,661.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESS SYSTEM OVERTUBE ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,3890.4700,583.5700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2723.33,,,,,,,1004.1300,3890.4700,percent of total billed charges,"Rev 272 $3,890.47 in Billed Charges at 70% = $2,723.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESS SYSTEM OVERTUBE ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,3890.4700,583.5700,CIGNA HEALTHCARE,CIGNA HMO,1622.33,,,,,,,1004.1300,3890.4700,percent of total billed charges,"41.7% of $3,890.47 in Billed Charges for Rev 272 = $1,622.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESS SYSTEM OVERTUBE ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,3890.4700,583.5700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1805.18,,,,,,,1004.1300,3890.4700,percent of total billed charges,"46.4% of $3,890.47 in Billed Charges for Rev 272 = $1,805.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESS SYSTEM OVERTUBE ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,3890.4700,583.5700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1622.33,,,,,,,1004.1300,3890.4700,percent of total billed charges,"41.7% of $3,890.47 in Billed Charges for Rev 272 = $1,622.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESS SYSTEM OVERTUBE ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,3890.4700,583.5700,CIGNA HEALTHCARE,CIGNA PPO,1622.33,,,,,,,1004.1300,3890.4700,percent of total billed charges,"41.7% of $3,890.47 in Billed Charges for Rev 272 = $1,622.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESS SYSTEM OVERTUBE ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,3890.4700,583.5700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3501.42,,,,,,,1004.1300,3890.4700,percent of total billed charges,"90% of $3,890.47 in Billed Charges for Rev 272 = $3,501.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESS SYSTEM OVERTUBE ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,3890.4700,583.5700,MEDCOST,MEDCOST VHN,1851.47,,,,,,,1004.1300,3890.4700,percent of total billed charges,"47.59% of $3,890.47 in Billed Charges for Rev 272 = $1,851.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESS SYSTEM OVERTUBE ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,3890.4700,583.5700,SENTARA HEALTH,SENTARA HEALTH,1004.13,,,,,,,1004.1300,3890.4700,percent of total billed charges,"25.81% of $3,890.47 in Billed Charges for Rev 272 = $1,004.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESS SYSTEM OVERTUBE ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,3890.4700,583.5700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3890.47,,,,,,,1004.1300,3890.4700,percent of total billed charges,"100% of $3,890.47 in Billed Charges for Rev 272 = $3,890.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESS SYSTEM OVERTUBE ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,3890.4700,583.5700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1945.24,,,,,,,1004.1300,3890.4700,percent of total billed charges,"Rev 272 $3,890.47 in Billed Charges at 50% = $1,945.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESS SYSTEM OVERTUBE ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,3890.4700,583.5700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1256.62,,,,,,,1004.1300,3890.4700,other,"32.3% of $3,890.47 in Billed Charges for Rev 272 = $1,256.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ACCESS SYSTEM OVERTUBE ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,3890.4700,583.5700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1194.37,,,,,,,1004.1300,3890.4700,other,"30.7% of $3,890.47 in Billed Charges for Rev 272 = $1,194.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ACCESS SYSTEM OVERTUBE ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,3890.4700,583.5700,UNITED HEALTHCARE,UNITED HEALTHCARE,1256.62,,,,,,,1004.1300,3890.4700,percent of total billed charges,"32.3% of $3,890.47 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESS SYSTEM OVERTUBE ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,3890.4700,583.5700,WELLCARE,WELLCARE MEDICAID,3890.47,,,,,,,1004.1300,3890.4700,percent of total billed charges,"100% of $3,890.47 in Billed Charges for Rev 272 = $3,890.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESSORY KIT 3550-29,272,RC,,,,,,,,both,,,1555.6500,233.3500,AETNA,AETNA,664.26,,,,,,,401.5100,1555.6500,percent of total billed charges,"42.7% of $1,555.65 in Billed Charges for Rev 272 = $664.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESSORY KIT 3550-29,272,RC,,,,,,,,both,,,1555.6500,233.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1088.96,,,,,,,401.5100,1555.6500,percent of total billed charges,"Rev 272 $1,555.65 in Billed Charges at 70% = $1,088.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESSORY KIT 3550-29,272,RC,,,,,,,,both,,,1555.6500,233.3500,CIGNA HEALTHCARE,CIGNA HMO,648.71,,,,,,,401.5100,1555.6500,percent of total billed charges,"41.7% of $1,555.65 in Billed Charges for Rev 272 = $648.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESSORY KIT 3550-29,272,RC,,,,,,,,both,,,1555.6500,233.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,721.82,,,,,,,401.5100,1555.6500,percent of total billed charges,"46.4% of $1,555.65 in Billed Charges for Rev 272 = $721.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESSORY KIT 3550-29,272,RC,,,,,,,,both,,,1555.6500,233.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,648.71,,,,,,,401.5100,1555.6500,percent of total billed charges,"41.7% of $1,555.65 in Billed Charges for Rev 272 = $648.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESSORY KIT 3550-29,272,RC,,,,,,,,both,,,1555.6500,233.3500,CIGNA HEALTHCARE,CIGNA PPO,648.71,,,,,,,401.5100,1555.6500,percent of total billed charges,"41.7% of $1,555.65 in Billed Charges for Rev 272 = $648.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESSORY KIT 3550-29,272,RC,,,,,,,,both,,,1555.6500,233.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1400.09,,,,,,,401.5100,1555.6500,percent of total billed charges,"90% of $1,555.65 in Billed Charges for Rev 272 = $1,400.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESSORY KIT 3550-29,272,RC,,,,,,,,both,,,1555.6500,233.3500,MEDCOST,MEDCOST VHN,740.33,,,,,,,401.5100,1555.6500,percent of total billed charges,"47.59% of $1,555.65 in Billed Charges for Rev 272 = $740.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESSORY KIT 3550-29,272,RC,,,,,,,,both,,,1555.6500,233.3500,SENTARA HEALTH,SENTARA HEALTH,401.51,,,,,,,401.5100,1555.6500,percent of total billed charges,"25.81% of $1,555.65 in Billed Charges for Rev 272 = $401.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESSORY KIT 3550-29,272,RC,,,,,,,,both,,,1555.6500,233.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1555.65,,,,,,,401.5100,1555.6500,percent of total billed charges,"100% of $1,555.65 in Billed Charges for Rev 272 = $1,555.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESSORY KIT 3550-29,272,RC,,,,,,,,both,,,1555.6500,233.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,777.83,,,,,,,401.5100,1555.6500,percent of total billed charges,"Rev 272 $1,555.65 in Billed Charges at 50% = $777.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESSORY KIT 3550-29,272,RC,,,,,,,,both,,,1555.6500,233.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,502.48,,,,,,,401.5100,1555.6500,other,"32.3% of $1,555.65 in Billed Charges for Rev 272 = $502.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ACCESSORY KIT 3550-29,272,RC,,,,,,,,both,,,1555.6500,233.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,477.58,,,,,,,401.5100,1555.6500,other,"30.7% of $1,555.65 in Billed Charges for Rev 272 = $477.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ACCESSORY KIT 3550-29,272,RC,,,,,,,,both,,,1555.6500,233.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,502.48,,,,,,,401.5100,1555.6500,percent of total billed charges,"32.3% of $1,555.65 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACCESSORY KIT 3550-29,272,RC,,,,,,,,both,,,1555.6500,233.3500,WELLCARE,WELLCARE MEDICAID,1555.65,,,,,,,401.5100,1555.6500,percent of total billed charges,"100% of $1,555.65 in Billed Charges for Rev 272 = $1,555.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACHIEVE ELECTRICAL CABLE,272,RC,27200002,CDM,,,,,,both,,,2333.4800,350.0200,AETNA,AETNA,996.40,,,,,,,602.2700,2333.4800,percent of total billed charges,"42.7% of $2,333.48 in Billed Charges for Rev 272 = $996.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACHIEVE ELECTRICAL CABLE,272,RC,27200002,CDM,,,,,,both,,,2333.4800,350.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1633.44,,,,,,,602.2700,2333.4800,percent of total billed charges,"Rev 272 $2,333.48 in Billed Charges at 70% = $1,633.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACHIEVE ELECTRICAL CABLE,272,RC,27200002,CDM,,,,,,both,,,2333.4800,350.0200,CIGNA HEALTHCARE,CIGNA HMO,973.06,,,,,,,602.2700,2333.4800,percent of total billed charges,"41.7% of $2,333.48 in Billed Charges for Rev 272 = $973.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACHIEVE ELECTRICAL CABLE,272,RC,27200002,CDM,,,,,,both,,,2333.4800,350.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1082.73,,,,,,,602.2700,2333.4800,percent of total billed charges,"46.4% of $2,333.48 in Billed Charges for Rev 272 = $1,082.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACHIEVE ELECTRICAL CABLE,272,RC,27200002,CDM,,,,,,both,,,2333.4800,350.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,973.06,,,,,,,602.2700,2333.4800,percent of total billed charges,"41.7% of $2,333.48 in Billed Charges for Rev 272 = $973.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACHIEVE ELECTRICAL CABLE,272,RC,27200002,CDM,,,,,,both,,,2333.4800,350.0200,CIGNA HEALTHCARE,CIGNA PPO,973.06,,,,,,,602.2700,2333.4800,percent of total billed charges,"41.7% of $2,333.48 in Billed Charges for Rev 272 = $973.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACHIEVE ELECTRICAL CABLE,272,RC,27200002,CDM,,,,,,both,,,2333.4800,350.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2100.13,,,,,,,602.2700,2333.4800,percent of total billed charges,"90% of $2,333.48 in Billed Charges for Rev 272 = $2,100.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACHIEVE ELECTRICAL CABLE,272,RC,27200002,CDM,,,,,,both,,,2333.4800,350.0200,MEDCOST,MEDCOST VHN,1110.50,,,,,,,602.2700,2333.4800,percent of total billed charges,"47.59% of $2,333.48 in Billed Charges for Rev 272 = $1,110.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACHIEVE ELECTRICAL CABLE,272,RC,27200002,CDM,,,,,,both,,,2333.4800,350.0200,SENTARA HEALTH,SENTARA HEALTH,602.27,,,,,,,602.2700,2333.4800,percent of total billed charges,"25.81% of $2,333.48 in Billed Charges for Rev 272 = $602.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACHIEVE ELECTRICAL CABLE,272,RC,27200002,CDM,,,,,,both,,,2333.4800,350.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2333.48,,,,,,,602.2700,2333.4800,percent of total billed charges,"100% of $2,333.48 in Billed Charges for Rev 272 = $2,333.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACHIEVE ELECTRICAL CABLE,272,RC,27200002,CDM,,,,,,both,,,2333.4800,350.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1166.74,,,,,,,602.2700,2333.4800,percent of total billed charges,"Rev 272 $2,333.48 in Billed Charges at 50% = $1,166.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACHIEVE ELECTRICAL CABLE,272,RC,27200002,CDM,,,,,,both,,,2333.4800,350.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,753.71,,,,,,,602.2700,2333.4800,other,"32.3% of $2,333.48 in Billed Charges for Rev 272 = $753.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ACHIEVE ELECTRICAL CABLE,272,RC,27200002,CDM,,,,,,both,,,2333.4800,350.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,716.38,,,,,,,602.2700,2333.4800,other,"30.7% of $2,333.48 in Billed Charges for Rev 272 = $716.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ACHIEVE ELECTRICAL CABLE,272,RC,27200002,CDM,,,,,,both,,,2333.4800,350.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,753.71,,,,,,,602.2700,2333.4800,percent of total billed charges,"32.3% of $2,333.48 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ACHIEVE ELECTRICAL CABLE,272,RC,27200002,CDM,,,,,,both,,,2333.4800,350.0200,WELLCARE,WELLCARE MEDICAID,2333.48,,,,,,,602.2700,2333.4800,percent of total billed charges,"100% of $2,333.48 in Billed Charges for Rev 272 = $2,333.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIOBRUSH POWERED DEBRIDMENT DEVICE,272,RC,,,,,,,,both,,,10889.5500,1633.4300,AETNA,AETNA,4649.84,,,,,,,2810.5900,10889.5500,percent of total billed charges,"42.7% of $10,889.55 in Billed Charges for Rev 272 = $4,649.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIOBRUSH POWERED DEBRIDMENT DEVICE,272,RC,,,,,,,,both,,,10889.5500,1633.4300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7622.69,,,,,,,2810.5900,10889.5500,percent of total billed charges,"Rev 272 $10,889.55 in Billed Charges at 70% = $7,622.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIOBRUSH POWERED DEBRIDMENT DEVICE,272,RC,,,,,,,,both,,,10889.5500,1633.4300,CIGNA HEALTHCARE,CIGNA HMO,4540.94,,,,,,,2810.5900,10889.5500,percent of total billed charges,"41.7% of $10,889.55 in Billed Charges for Rev 272 = $4,540.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIOBRUSH POWERED DEBRIDMENT DEVICE,272,RC,,,,,,,,both,,,10889.5500,1633.4300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5052.75,,,,,,,2810.5900,10889.5500,percent of total billed charges,"46.4% of $10,889.55 in Billed Charges for Rev 272 = $5,052.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIOBRUSH POWERED DEBRIDMENT DEVICE,272,RC,,,,,,,,both,,,10889.5500,1633.4300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4540.94,,,,,,,2810.5900,10889.5500,percent of total billed charges,"41.7% of $10,889.55 in Billed Charges for Rev 272 = $4,540.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIOBRUSH POWERED DEBRIDMENT DEVICE,272,RC,,,,,,,,both,,,10889.5500,1633.4300,CIGNA HEALTHCARE,CIGNA PPO,4540.94,,,,,,,2810.5900,10889.5500,percent of total billed charges,"41.7% of $10,889.55 in Billed Charges for Rev 272 = $4,540.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIOBRUSH POWERED DEBRIDMENT DEVICE,272,RC,,,,,,,,both,,,10889.5500,1633.4300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9800.60,,,,,,,2810.5900,10889.5500,percent of total billed charges,"90% of $10,889.55 in Billed Charges for Rev 272 = $9,800.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIOBRUSH POWERED DEBRIDMENT DEVICE,272,RC,,,,,,,,both,,,10889.5500,1633.4300,MEDCOST,MEDCOST VHN,5182.34,,,,,,,2810.5900,10889.5500,percent of total billed charges,"47.59% of $10,889.55 in Billed Charges for Rev 272 = $5,182.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIOBRUSH POWERED DEBRIDMENT DEVICE,272,RC,,,,,,,,both,,,10889.5500,1633.4300,SENTARA HEALTH,SENTARA HEALTH,2810.59,,,,,,,2810.5900,10889.5500,percent of total billed charges,"25.81% of $10,889.55 in Billed Charges for Rev 272 = $2,810.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIOBRUSH POWERED DEBRIDMENT DEVICE,272,RC,,,,,,,,both,,,10889.5500,1633.4300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10889.55,,,,,,,2810.5900,10889.5500,percent of total billed charges,"100% of $10,889.55 in Billed Charges for Rev 272 = $10,889.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIOBRUSH POWERED DEBRIDMENT DEVICE,272,RC,,,,,,,,both,,,10889.5500,1633.4300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5444.78,,,,,,,2810.5900,10889.5500,percent of total billed charges,"Rev 272 $10,889.55 in Billed Charges at 50% = $5,444.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIOBRUSH POWERED DEBRIDMENT DEVICE,272,RC,,,,,,,,both,,,10889.5500,1633.4300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3517.32,,,,,,,2810.5900,10889.5500,other,"32.3% of $10,889.55 in Billed Charges for Rev 272 = $3,517.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIOBRUSH POWERED DEBRIDMENT DEVICE,272,RC,,,,,,,,both,,,10889.5500,1633.4300,UNITED HEALTHCARE,UHC HERITAGE SELECT,3343.09,,,,,,,2810.5900,10889.5500,other,"30.7% of $10,889.55 in Billed Charges for Rev 272 = $3,343.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIOBRUSH POWERED DEBRIDMENT DEVICE,272,RC,,,,,,,,both,,,10889.5500,1633.4300,UNITED HEALTHCARE,UNITED HEALTHCARE,3517.32,,,,,,,2810.5900,10889.5500,percent of total billed charges,"32.3% of $10,889.55 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIOBRUSH POWERED DEBRIDMENT DEVICE,272,RC,,,,,,,,both,,,10889.5500,1633.4300,WELLCARE,WELLCARE MEDICAID,10889.55,,,,,,,2810.5900,10889.5500,percent of total billed charges,"100% of $10,889.55 in Billed Charges for Rev 272 = $10,889.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIOPSY KIT 14G X 16CM DIS,272,RC,27200002,CDM,,,,,,both,,,767.4500,115.1200,AETNA,AETNA,327.70,,,,,,,198.0800,767.4500,percent of total billed charges,42.7% of $767.45 in Billed Charges for Rev 272 = $327.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY KIT 14G X 16CM DIS,272,RC,27200002,CDM,,,,,,both,,,767.4500,115.1200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,537.22,,,,,,,198.0800,767.4500,percent of total billed charges,Rev 272 $767.45 in Billed Charges at 70% = $537.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY KIT 14G X 16CM DIS,272,RC,27200002,CDM,,,,,,both,,,767.4500,115.1200,CIGNA HEALTHCARE,CIGNA HMO,320.03,,,,,,,198.0800,767.4500,percent of total billed charges,41.7% of $767.45 in Billed Charges for Rev 272 = $320.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY KIT 14G X 16CM DIS,272,RC,27200002,CDM,,,,,,both,,,767.4500,115.1200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,356.10,,,,,,,198.0800,767.4500,percent of total billed charges,46.4% of $767.45 in Billed Charges for Rev 272 = $356.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY KIT 14G X 16CM DIS,272,RC,27200002,CDM,,,,,,both,,,767.4500,115.1200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,320.03,,,,,,,198.0800,767.4500,percent of total billed charges,41.7% of $767.45 in Billed Charges for Rev 272 = $320.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY KIT 14G X 16CM DIS,272,RC,27200002,CDM,,,,,,both,,,767.4500,115.1200,CIGNA HEALTHCARE,CIGNA PPO,320.03,,,,,,,198.0800,767.4500,percent of total billed charges,41.7% of $767.45 in Billed Charges for Rev 272 = $320.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY KIT 14G X 16CM DIS,272,RC,27200002,CDM,,,,,,both,,,767.4500,115.1200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,690.71,,,,,,,198.0800,767.4500,percent of total billed charges,90% of $767.45 in Billed Charges for Rev 272 = $690.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY KIT 14G X 16CM DIS,272,RC,27200002,CDM,,,,,,both,,,767.4500,115.1200,MEDCOST,MEDCOST VHN,365.23,,,,,,,198.0800,767.4500,percent of total billed charges,47.59% of $767.45 in Billed Charges for Rev 272 = $365.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY KIT 14G X 16CM DIS,272,RC,27200002,CDM,,,,,,both,,,767.4500,115.1200,SENTARA HEALTH,SENTARA HEALTH,198.08,,,,,,,198.0800,767.4500,percent of total billed charges,25.81% of $767.45 in Billed Charges for Rev 272 = $198.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY KIT 14G X 16CM DIS,272,RC,27200002,CDM,,,,,,both,,,767.4500,115.1200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",767.45,,,,,,,198.0800,767.4500,percent of total billed charges,100% of $767.45 in Billed Charges for Rev 272 = $767.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY KIT 14G X 16CM DIS,272,RC,27200002,CDM,,,,,,both,,,767.4500,115.1200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,383.73,,,,,,,198.0800,767.4500,percent of total billed charges,Rev 272 $767.45 in Billed Charges at 50% = $383.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY KIT 14G X 16CM DIS,272,RC,27200002,CDM,,,,,,both,,,767.4500,115.1200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,247.89,,,,,,,198.0800,767.4500,other,32.3% of $767.45 in Billed Charges for Rev 272 = $247.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIOPSY KIT 14G X 16CM DIS,272,RC,27200002,CDM,,,,,,both,,,767.4500,115.1200,UNITED HEALTHCARE,UHC HERITAGE SELECT,235.61,,,,,,,198.0800,767.4500,other,30.7% of $767.45 in Billed Charges for Rev 272 = $235.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIOPSY KIT 14G X 16CM DIS,272,RC,27200002,CDM,,,,,,both,,,767.4500,115.1200,UNITED HEALTHCARE,UNITED HEALTHCARE,247.89,,,,,,,198.0800,767.4500,percent of total billed charges,32.3% of $767.45 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY KIT 14G X 16CM DIS,272,RC,27200002,CDM,,,,,,both,,,767.4500,115.1200,WELLCARE,WELLCARE MEDICAID,767.45,,,,,,,198.0800,767.4500,percent of total billed charges,100% of $767.45 in Billed Charges for Rev 272 = $767.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY MAX CORE BARD 18GAX25CM,272,RC,27200002,CDM,,,,,,both,,,497.8100,74.6700,AETNA,AETNA,212.56,,,,,,,128.4800,497.8100,percent of total billed charges,42.7% of $497.81 in Billed Charges for Rev 272 = $212.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY MAX CORE BARD 18GAX25CM,272,RC,27200002,CDM,,,,,,both,,,497.8100,74.6700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,348.47,,,,,,,128.4800,497.8100,percent of total billed charges,Rev 272 $497.81 in Billed Charges at 70% = $348.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY MAX CORE BARD 18GAX25CM,272,RC,27200002,CDM,,,,,,both,,,497.8100,74.6700,CIGNA HEALTHCARE,CIGNA HMO,207.59,,,,,,,128.4800,497.8100,percent of total billed charges,41.7% of $497.81 in Billed Charges for Rev 272 = $207.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY MAX CORE BARD 18GAX25CM,272,RC,27200002,CDM,,,,,,both,,,497.8100,74.6700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,230.98,,,,,,,128.4800,497.8100,percent of total billed charges,46.4% of $497.81 in Billed Charges for Rev 272 = $230.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY MAX CORE BARD 18GAX25CM,272,RC,27200002,CDM,,,,,,both,,,497.8100,74.6700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,207.59,,,,,,,128.4800,497.8100,percent of total billed charges,41.7% of $497.81 in Billed Charges for Rev 272 = $207.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY MAX CORE BARD 18GAX25CM,272,RC,27200002,CDM,,,,,,both,,,497.8100,74.6700,CIGNA HEALTHCARE,CIGNA PPO,207.59,,,,,,,128.4800,497.8100,percent of total billed charges,41.7% of $497.81 in Billed Charges for Rev 272 = $207.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY MAX CORE BARD 18GAX25CM,272,RC,27200002,CDM,,,,,,both,,,497.8100,74.6700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,448.03,,,,,,,128.4800,497.8100,percent of total billed charges,90% of $497.81 in Billed Charges for Rev 272 = $448.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY MAX CORE BARD 18GAX25CM,272,RC,27200002,CDM,,,,,,both,,,497.8100,74.6700,MEDCOST,MEDCOST VHN,236.91,,,,,,,128.4800,497.8100,percent of total billed charges,47.59% of $497.81 in Billed Charges for Rev 272 = $236.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY MAX CORE BARD 18GAX25CM,272,RC,27200002,CDM,,,,,,both,,,497.8100,74.6700,SENTARA HEALTH,SENTARA HEALTH,128.48,,,,,,,128.4800,497.8100,percent of total billed charges,25.81% of $497.81 in Billed Charges for Rev 272 = $128.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY MAX CORE BARD 18GAX25CM,272,RC,27200002,CDM,,,,,,both,,,497.8100,74.6700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",497.81,,,,,,,128.4800,497.8100,percent of total billed charges,100% of $497.81 in Billed Charges for Rev 272 = $497.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY MAX CORE BARD 18GAX25CM,272,RC,27200002,CDM,,,,,,both,,,497.8100,74.6700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,248.91,,,,,,,128.4800,497.8100,percent of total billed charges,Rev 272 $497.81 in Billed Charges at 50% = $248.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY MAX CORE BARD 18GAX25CM,272,RC,27200002,CDM,,,,,,both,,,497.8100,74.6700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,160.79,,,,,,,128.4800,497.8100,other,32.3% of $497.81 in Billed Charges for Rev 272 = $160.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIOPSY MAX CORE BARD 18GAX25CM,272,RC,27200002,CDM,,,,,,both,,,497.8100,74.6700,UNITED HEALTHCARE,UHC HERITAGE SELECT,152.83,,,,,,,128.4800,497.8100,other,30.7% of $497.81 in Billed Charges for Rev 272 = $152.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIOPSY MAX CORE BARD 18GAX25CM,272,RC,27200002,CDM,,,,,,both,,,497.8100,74.6700,UNITED HEALTHCARE,UNITED HEALTHCARE,160.79,,,,,,,128.4800,497.8100,percent of total billed charges,32.3% of $497.81 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY MAX CORE BARD 18GAX25CM,272,RC,27200002,CDM,,,,,,both,,,497.8100,74.6700,WELLCARE,WELLCARE MEDICAID,497.81,,,,,,,128.4800,497.8100,percent of total billed charges,100% of $497.81 in Billed Charges for Rev 272 = $497.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADAPTER ASPIRATION,272,RC,27200002,CDM,,,,,,both,,,1073.4000,161.0100,AETNA,AETNA,458.34,,,,,,,277.0400,1073.4000,percent of total billed charges,"42.7% of $1,073.40 in Billed Charges for Rev 272 = $458.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER ASPIRATION,272,RC,27200002,CDM,,,,,,both,,,1073.4000,161.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,751.38,,,,,,,277.0400,1073.4000,percent of total billed charges,"Rev 272 $1,073.40 in Billed Charges at 70% = $751.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER ASPIRATION,272,RC,27200002,CDM,,,,,,both,,,1073.4000,161.0100,CIGNA HEALTHCARE,CIGNA HMO,447.61,,,,,,,277.0400,1073.4000,percent of total billed charges,"41.7% of $1,073.40 in Billed Charges for Rev 272 = $447.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER ASPIRATION,272,RC,27200002,CDM,,,,,,both,,,1073.4000,161.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,498.06,,,,,,,277.0400,1073.4000,percent of total billed charges,"46.4% of $1,073.40 in Billed Charges for Rev 272 = $498.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER ASPIRATION,272,RC,27200002,CDM,,,,,,both,,,1073.4000,161.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,447.61,,,,,,,277.0400,1073.4000,percent of total billed charges,"41.7% of $1,073.40 in Billed Charges for Rev 272 = $447.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER ASPIRATION,272,RC,27200002,CDM,,,,,,both,,,1073.4000,161.0100,CIGNA HEALTHCARE,CIGNA PPO,447.61,,,,,,,277.0400,1073.4000,percent of total billed charges,"41.7% of $1,073.40 in Billed Charges for Rev 272 = $447.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER ASPIRATION,272,RC,27200002,CDM,,,,,,both,,,1073.4000,161.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,966.06,,,,,,,277.0400,1073.4000,percent of total billed charges,"90% of $1,073.40 in Billed Charges for Rev 272 = $966.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER ASPIRATION,272,RC,27200002,CDM,,,,,,both,,,1073.4000,161.0100,MEDCOST,MEDCOST VHN,510.83,,,,,,,277.0400,1073.4000,percent of total billed charges,"47.59% of $1,073.40 in Billed Charges for Rev 272 = $510.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER ASPIRATION,272,RC,27200002,CDM,,,,,,both,,,1073.4000,161.0100,SENTARA HEALTH,SENTARA HEALTH,277.04,,,,,,,277.0400,1073.4000,percent of total billed charges,"25.81% of $1,073.40 in Billed Charges for Rev 272 = $277.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER ASPIRATION,272,RC,27200002,CDM,,,,,,both,,,1073.4000,161.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1073.40,,,,,,,277.0400,1073.4000,percent of total billed charges,"100% of $1,073.40 in Billed Charges for Rev 272 = $1,073.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER ASPIRATION,272,RC,27200002,CDM,,,,,,both,,,1073.4000,161.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,536.70,,,,,,,277.0400,1073.4000,percent of total billed charges,"Rev 272 $1,073.40 in Billed Charges at 50% = $536.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER ASPIRATION,272,RC,27200002,CDM,,,,,,both,,,1073.4000,161.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,346.71,,,,,,,277.0400,1073.4000,other,"32.3% of $1,073.40 in Billed Charges for Rev 272 = $346.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ADAPTER ASPIRATION,272,RC,27200002,CDM,,,,,,both,,,1073.4000,161.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,329.53,,,,,,,277.0400,1073.4000,other,"30.7% of $1,073.40 in Billed Charges for Rev 272 = $329.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ADAPTER ASPIRATION,272,RC,27200002,CDM,,,,,,both,,,1073.4000,161.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,346.71,,,,,,,277.0400,1073.4000,percent of total billed charges,"32.3% of $1,073.40 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER ASPIRATION,272,RC,27200002,CDM,,,,,,both,,,1073.4000,161.0100,WELLCARE,WELLCARE MEDICAID,1073.40,,,,,,,277.0400,1073.4000,percent of total billed charges,"100% of $1,073.40 in Billed Charges for Rev 272 = $1,073.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER BRONCHOSCOPE ILLUMISITE USE W/OLYMPUS SCOPE,272,RC,27200002,CDM,,,,,,both,,,819.3100,122.9000,AETNA,AETNA,349.85,,,,,,,211.4600,819.3100,percent of total billed charges,42.7% of $819.31 in Billed Charges for Rev 272 = $349.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADAPTER BRONCHOSCOPE ILLUMISITE USE W/OLYMPUS SCOPE,272,RC,27200002,CDM,,,,,,both,,,819.3100,122.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,573.52,,,,,,,211.4600,819.3100,percent of total billed charges,Rev 272 $819.31 in Billed Charges at 70% = $573.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADAPTER BRONCHOSCOPE ILLUMISITE USE W/OLYMPUS SCOPE,272,RC,27200002,CDM,,,,,,both,,,819.3100,122.9000,CIGNA HEALTHCARE,CIGNA HMO,341.65,,,,,,,211.4600,819.3100,percent of total billed charges,41.7% of $819.31 in Billed Charges for Rev 272 = $341.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADAPTER BRONCHOSCOPE ILLUMISITE USE W/OLYMPUS SCOPE,272,RC,27200002,CDM,,,,,,both,,,819.3100,122.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,380.16,,,,,,,211.4600,819.3100,percent of total billed charges,46.4% of $819.31 in Billed Charges for Rev 272 = $380.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADAPTER BRONCHOSCOPE ILLUMISITE USE W/OLYMPUS SCOPE,272,RC,27200002,CDM,,,,,,both,,,819.3100,122.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,341.65,,,,,,,211.4600,819.3100,percent of total billed charges,41.7% of $819.31 in Billed Charges for Rev 272 = $341.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADAPTER BRONCHOSCOPE ILLUMISITE USE W/OLYMPUS SCOPE,272,RC,27200002,CDM,,,,,,both,,,819.3100,122.9000,CIGNA HEALTHCARE,CIGNA PPO,341.65,,,,,,,211.4600,819.3100,percent of total billed charges,41.7% of $819.31 in Billed Charges for Rev 272 = $341.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADAPTER BRONCHOSCOPE ILLUMISITE USE W/OLYMPUS SCOPE,272,RC,27200002,CDM,,,,,,both,,,819.3100,122.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,737.38,,,,,,,211.4600,819.3100,percent of total billed charges,90% of $819.31 in Billed Charges for Rev 272 = $737.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADAPTER BRONCHOSCOPE ILLUMISITE USE W/OLYMPUS SCOPE,272,RC,27200002,CDM,,,,,,both,,,819.3100,122.9000,MEDCOST,MEDCOST VHN,389.91,,,,,,,211.4600,819.3100,percent of total billed charges,47.59% of $819.31 in Billed Charges for Rev 272 = $389.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADAPTER BRONCHOSCOPE ILLUMISITE USE W/OLYMPUS SCOPE,272,RC,27200002,CDM,,,,,,both,,,819.3100,122.9000,SENTARA HEALTH,SENTARA HEALTH,211.46,,,,,,,211.4600,819.3100,percent of total billed charges,25.81% of $819.31 in Billed Charges for Rev 272 = $211.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADAPTER BRONCHOSCOPE ILLUMISITE USE W/OLYMPUS SCOPE,272,RC,27200002,CDM,,,,,,both,,,819.3100,122.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",819.31,,,,,,,211.4600,819.3100,percent of total billed charges,100% of $819.31 in Billed Charges for Rev 272 = $819.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADAPTER BRONCHOSCOPE ILLUMISITE USE W/OLYMPUS SCOPE,272,RC,27200002,CDM,,,,,,both,,,819.3100,122.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,409.66,,,,,,,211.4600,819.3100,percent of total billed charges,Rev 272 $819.31 in Billed Charges at 50% = $409.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADAPTER BRONCHOSCOPE ILLUMISITE USE W/OLYMPUS SCOPE,272,RC,27200002,CDM,,,,,,both,,,819.3100,122.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,264.64,,,,,,,211.4600,819.3100,other,32.3% of $819.31 in Billed Charges for Rev 272 = $264.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ADAPTER BRONCHOSCOPE ILLUMISITE USE W/OLYMPUS SCOPE,272,RC,27200002,CDM,,,,,,both,,,819.3100,122.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,251.53,,,,,,,211.4600,819.3100,other,30.7% of $819.31 in Billed Charges for Rev 272 = $251.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ADAPTER BRONCHOSCOPE ILLUMISITE USE W/OLYMPUS SCOPE,272,RC,27200002,CDM,,,,,,both,,,819.3100,122.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,264.64,,,,,,,211.4600,819.3100,percent of total billed charges,32.3% of $819.31 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADAPTER BRONCHOSCOPE ILLUMISITE USE W/OLYMPUS SCOPE,272,RC,27200002,CDM,,,,,,both,,,819.3100,122.9000,WELLCARE,WELLCARE MEDICAID,819.31,,,,,,,211.4600,819.3100,percent of total billed charges,100% of $819.31 in Billed Charges for Rev 272 = $819.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ADAPTER Y GATEWAY PLUS,272,RC,,,,,,,,both,,,2209.0200,331.3500,AETNA,AETNA,943.25,,,,,,,570.1500,2209.0200,percent of total billed charges,"42.7% of $2,209.02 in Billed Charges for Rev 272 = $943.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER Y GATEWAY PLUS,272,RC,,,,,,,,both,,,2209.0200,331.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1546.31,,,,,,,570.1500,2209.0200,percent of total billed charges,"Rev 272 $2,209.02 in Billed Charges at 70% = $1,546.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER Y GATEWAY PLUS,272,RC,,,,,,,,both,,,2209.0200,331.3500,CIGNA HEALTHCARE,CIGNA HMO,921.16,,,,,,,570.1500,2209.0200,percent of total billed charges,"41.7% of $2,209.02 in Billed Charges for Rev 272 = $921.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER Y GATEWAY PLUS,272,RC,,,,,,,,both,,,2209.0200,331.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1024.99,,,,,,,570.1500,2209.0200,percent of total billed charges,"46.4% of $2,209.02 in Billed Charges for Rev 272 = $1,024.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER Y GATEWAY PLUS,272,RC,,,,,,,,both,,,2209.0200,331.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,921.16,,,,,,,570.1500,2209.0200,percent of total billed charges,"41.7% of $2,209.02 in Billed Charges for Rev 272 = $921.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER Y GATEWAY PLUS,272,RC,,,,,,,,both,,,2209.0200,331.3500,CIGNA HEALTHCARE,CIGNA PPO,921.16,,,,,,,570.1500,2209.0200,percent of total billed charges,"41.7% of $2,209.02 in Billed Charges for Rev 272 = $921.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER Y GATEWAY PLUS,272,RC,,,,,,,,both,,,2209.0200,331.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1988.12,,,,,,,570.1500,2209.0200,percent of total billed charges,"90% of $2,209.02 in Billed Charges for Rev 272 = $1,988.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER Y GATEWAY PLUS,272,RC,,,,,,,,both,,,2209.0200,331.3500,MEDCOST,MEDCOST VHN,1051.27,,,,,,,570.1500,2209.0200,percent of total billed charges,"47.59% of $2,209.02 in Billed Charges for Rev 272 = $1,051.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER Y GATEWAY PLUS,272,RC,,,,,,,,both,,,2209.0200,331.3500,SENTARA HEALTH,SENTARA HEALTH,570.15,,,,,,,570.1500,2209.0200,percent of total billed charges,"25.81% of $2,209.02 in Billed Charges for Rev 272 = $570.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER Y GATEWAY PLUS,272,RC,,,,,,,,both,,,2209.0200,331.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2209.02,,,,,,,570.1500,2209.0200,percent of total billed charges,"100% of $2,209.02 in Billed Charges for Rev 272 = $2,209.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER Y GATEWAY PLUS,272,RC,,,,,,,,both,,,2209.0200,331.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1104.51,,,,,,,570.1500,2209.0200,percent of total billed charges,"Rev 272 $2,209.02 in Billed Charges at 50% = $1,104.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER Y GATEWAY PLUS,272,RC,,,,,,,,both,,,2209.0200,331.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,713.51,,,,,,,570.1500,2209.0200,other,"32.3% of $2,209.02 in Billed Charges for Rev 272 = $713.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ADAPTER Y GATEWAY PLUS,272,RC,,,,,,,,both,,,2209.0200,331.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,678.17,,,,,,,570.1500,2209.0200,other,"30.7% of $2,209.02 in Billed Charges for Rev 272 = $678.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ADAPTER Y GATEWAY PLUS,272,RC,,,,,,,,both,,,2209.0200,331.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,713.51,,,,,,,570.1500,2209.0200,percent of total billed charges,"32.3% of $2,209.02 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADAPTER Y GATEWAY PLUS,272,RC,,,,,,,,both,,,2209.0200,331.3500,WELLCARE,WELLCARE MEDICAID,2209.02,,,,,,,570.1500,2209.0200,percent of total billed charges,"100% of $2,209.02 in Billed Charges for Rev 272 = $2,209.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADHESIVE SKIN PRINEO W/TAPE,272,RC,27200002,CDM,,,,,,both,,,1270.1900,190.5300,AETNA,AETNA,542.37,,,,,,,327.8400,1270.1900,percent of total billed charges,"42.7% of $1,270.19 in Billed Charges for Rev 272 = $542.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADHESIVE SKIN PRINEO W/TAPE,272,RC,27200002,CDM,,,,,,both,,,1270.1900,190.5300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,889.13,,,,,,,327.8400,1270.1900,percent of total billed charges,"Rev 272 $1,270.19 in Billed Charges at 70% = $889.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADHESIVE SKIN PRINEO W/TAPE,272,RC,27200002,CDM,,,,,,both,,,1270.1900,190.5300,CIGNA HEALTHCARE,CIGNA HMO,529.67,,,,,,,327.8400,1270.1900,percent of total billed charges,"41.7% of $1,270.19 in Billed Charges for Rev 272 = $529.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADHESIVE SKIN PRINEO W/TAPE,272,RC,27200002,CDM,,,,,,both,,,1270.1900,190.5300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,589.37,,,,,,,327.8400,1270.1900,percent of total billed charges,"46.4% of $1,270.19 in Billed Charges for Rev 272 = $589.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADHESIVE SKIN PRINEO W/TAPE,272,RC,27200002,CDM,,,,,,both,,,1270.1900,190.5300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,529.67,,,,,,,327.8400,1270.1900,percent of total billed charges,"41.7% of $1,270.19 in Billed Charges for Rev 272 = $529.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADHESIVE SKIN PRINEO W/TAPE,272,RC,27200002,CDM,,,,,,both,,,1270.1900,190.5300,CIGNA HEALTHCARE,CIGNA PPO,529.67,,,,,,,327.8400,1270.1900,percent of total billed charges,"41.7% of $1,270.19 in Billed Charges for Rev 272 = $529.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADHESIVE SKIN PRINEO W/TAPE,272,RC,27200002,CDM,,,,,,both,,,1270.1900,190.5300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1143.17,,,,,,,327.8400,1270.1900,percent of total billed charges,"90% of $1,270.19 in Billed Charges for Rev 272 = $1,143.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADHESIVE SKIN PRINEO W/TAPE,272,RC,27200002,CDM,,,,,,both,,,1270.1900,190.5300,MEDCOST,MEDCOST VHN,604.48,,,,,,,327.8400,1270.1900,percent of total billed charges,"47.59% of $1,270.19 in Billed Charges for Rev 272 = $604.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADHESIVE SKIN PRINEO W/TAPE,272,RC,27200002,CDM,,,,,,both,,,1270.1900,190.5300,SENTARA HEALTH,SENTARA HEALTH,327.84,,,,,,,327.8400,1270.1900,percent of total billed charges,"25.81% of $1,270.19 in Billed Charges for Rev 272 = $327.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADHESIVE SKIN PRINEO W/TAPE,272,RC,27200002,CDM,,,,,,both,,,1270.1900,190.5300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1270.19,,,,,,,327.8400,1270.1900,percent of total billed charges,"100% of $1,270.19 in Billed Charges for Rev 272 = $1,270.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADHESIVE SKIN PRINEO W/TAPE,272,RC,27200002,CDM,,,,,,both,,,1270.1900,190.5300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,635.10,,,,,,,327.8400,1270.1900,percent of total billed charges,"Rev 272 $1,270.19 in Billed Charges at 50% = $635.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADHESIVE SKIN PRINEO W/TAPE,272,RC,27200002,CDM,,,,,,both,,,1270.1900,190.5300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,410.27,,,,,,,327.8400,1270.1900,other,"32.3% of $1,270.19 in Billed Charges for Rev 272 = $410.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ADHESIVE SKIN PRINEO W/TAPE,272,RC,27200002,CDM,,,,,,both,,,1270.1900,190.5300,UNITED HEALTHCARE,UHC HERITAGE SELECT,389.95,,,,,,,327.8400,1270.1900,other,"30.7% of $1,270.19 in Billed Charges for Rev 272 = $389.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ADHESIVE SKIN PRINEO W/TAPE,272,RC,27200002,CDM,,,,,,both,,,1270.1900,190.5300,UNITED HEALTHCARE,UNITED HEALTHCARE,410.27,,,,,,,327.8400,1270.1900,percent of total billed charges,"32.3% of $1,270.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ADHESIVE SKIN PRINEO W/TAPE,272,RC,27200002,CDM,,,,,,both,,,1270.1900,190.5300,WELLCARE,WELLCARE MEDICAID,1270.19,,,,,,,327.8400,1270.1900,percent of total billed charges,"100% of $1,270.19 in Billed Charges for Rev 272 = $1,270.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIOPSY PUNCH 2MM UNI-PUNCH DISPOSABLE STERILE SEAMLESS,272,RC,27200002,CDM,,,,,,both,,,557.9600,83.6900,AETNA,AETNA,238.25,,,,,,,144.0100,557.9600,percent of total billed charges,42.7% of $557.96 in Billed Charges for Rev 272 = $238.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 2MM UNI-PUNCH DISPOSABLE STERILE SEAMLESS,272,RC,27200002,CDM,,,,,,both,,,557.9600,83.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,390.57,,,,,,,144.0100,557.9600,percent of total billed charges,Rev 272 $557.96 in Billed Charges at 70% = $390.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 2MM UNI-PUNCH DISPOSABLE STERILE SEAMLESS,272,RC,27200002,CDM,,,,,,both,,,557.9600,83.6900,CIGNA HEALTHCARE,CIGNA HMO,232.67,,,,,,,144.0100,557.9600,percent of total billed charges,41.7% of $557.96 in Billed Charges for Rev 272 = $232.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 2MM UNI-PUNCH DISPOSABLE STERILE SEAMLESS,272,RC,27200002,CDM,,,,,,both,,,557.9600,83.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,258.89,,,,,,,144.0100,557.9600,percent of total billed charges,46.4% of $557.96 in Billed Charges for Rev 272 = $258.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 2MM UNI-PUNCH DISPOSABLE STERILE SEAMLESS,272,RC,27200002,CDM,,,,,,both,,,557.9600,83.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,232.67,,,,,,,144.0100,557.9600,percent of total billed charges,41.7% of $557.96 in Billed Charges for Rev 272 = $232.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 2MM UNI-PUNCH DISPOSABLE STERILE SEAMLESS,272,RC,27200002,CDM,,,,,,both,,,557.9600,83.6900,CIGNA HEALTHCARE,CIGNA PPO,232.67,,,,,,,144.0100,557.9600,percent of total billed charges,41.7% of $557.96 in Billed Charges for Rev 272 = $232.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 2MM UNI-PUNCH DISPOSABLE STERILE SEAMLESS,272,RC,27200002,CDM,,,,,,both,,,557.9600,83.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,502.16,,,,,,,144.0100,557.9600,percent of total billed charges,90% of $557.96 in Billed Charges for Rev 272 = $502.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 2MM UNI-PUNCH DISPOSABLE STERILE SEAMLESS,272,RC,27200002,CDM,,,,,,both,,,557.9600,83.6900,MEDCOST,MEDCOST VHN,265.53,,,,,,,144.0100,557.9600,percent of total billed charges,47.59% of $557.96 in Billed Charges for Rev 272 = $265.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 2MM UNI-PUNCH DISPOSABLE STERILE SEAMLESS,272,RC,27200002,CDM,,,,,,both,,,557.9600,83.6900,SENTARA HEALTH,SENTARA HEALTH,144.01,,,,,,,144.0100,557.9600,percent of total billed charges,25.81% of $557.96 in Billed Charges for Rev 272 = $144.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 2MM UNI-PUNCH DISPOSABLE STERILE SEAMLESS,272,RC,27200002,CDM,,,,,,both,,,557.9600,83.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",557.96,,,,,,,144.0100,557.9600,percent of total billed charges,100% of $557.96 in Billed Charges for Rev 272 = $557.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 2MM UNI-PUNCH DISPOSABLE STERILE SEAMLESS,272,RC,27200002,CDM,,,,,,both,,,557.9600,83.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,278.98,,,,,,,144.0100,557.9600,percent of total billed charges,Rev 272 $557.96 in Billed Charges at 50% = $278.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 2MM UNI-PUNCH DISPOSABLE STERILE SEAMLESS,272,RC,27200002,CDM,,,,,,both,,,557.9600,83.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,180.22,,,,,,,144.0100,557.9600,other,32.3% of $557.96 in Billed Charges for Rev 272 = $180.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIOPSY PUNCH 2MM UNI-PUNCH DISPOSABLE STERILE SEAMLESS,272,RC,27200002,CDM,,,,,,both,,,557.9600,83.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,171.29,,,,,,,144.0100,557.9600,other,30.7% of $557.96 in Billed Charges for Rev 272 = $171.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIOPSY PUNCH 2MM UNI-PUNCH DISPOSABLE STERILE SEAMLESS,272,RC,27200002,CDM,,,,,,both,,,557.9600,83.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,180.22,,,,,,,144.0100,557.9600,percent of total billed charges,32.3% of $557.96 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 2MM UNI-PUNCH DISPOSABLE STERILE SEAMLESS,272,RC,27200002,CDM,,,,,,both,,,557.9600,83.6900,WELLCARE,WELLCARE MEDICAID,557.96,,,,,,,144.0100,557.9600,percent of total billed charges,100% of $557.96 in Billed Charges for Rev 272 = $557.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 5MM DIAMETER DISPOSABLE STERILE,272,RC,,,,,,,,both,,,932.1500,139.8200,AETNA,AETNA,398.03,,,,,,,240.5900,932.1500,percent of total billed charges,42.7% of $932.15 in Billed Charges for Rev 272 = $398.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 5MM DIAMETER DISPOSABLE STERILE,272,RC,,,,,,,,both,,,932.1500,139.8200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,652.51,,,,,,,240.5900,932.1500,percent of total billed charges,Rev 272 $932.15 in Billed Charges at 70% = $652.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 5MM DIAMETER DISPOSABLE STERILE,272,RC,,,,,,,,both,,,932.1500,139.8200,CIGNA HEALTHCARE,CIGNA HMO,388.71,,,,,,,240.5900,932.1500,percent of total billed charges,41.7% of $932.15 in Billed Charges for Rev 272 = $388.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 5MM DIAMETER DISPOSABLE STERILE,272,RC,,,,,,,,both,,,932.1500,139.8200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,432.52,,,,,,,240.5900,932.1500,percent of total billed charges,46.4% of $932.15 in Billed Charges for Rev 272 = $432.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 5MM DIAMETER DISPOSABLE STERILE,272,RC,,,,,,,,both,,,932.1500,139.8200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,388.71,,,,,,,240.5900,932.1500,percent of total billed charges,41.7% of $932.15 in Billed Charges for Rev 272 = $388.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 5MM DIAMETER DISPOSABLE STERILE,272,RC,,,,,,,,both,,,932.1500,139.8200,CIGNA HEALTHCARE,CIGNA PPO,388.71,,,,,,,240.5900,932.1500,percent of total billed charges,41.7% of $932.15 in Billed Charges for Rev 272 = $388.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 5MM DIAMETER DISPOSABLE STERILE,272,RC,,,,,,,,both,,,932.1500,139.8200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,838.94,,,,,,,240.5900,932.1500,percent of total billed charges,90% of $932.15 in Billed Charges for Rev 272 = $838.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 5MM DIAMETER DISPOSABLE STERILE,272,RC,,,,,,,,both,,,932.1500,139.8200,MEDCOST,MEDCOST VHN,443.61,,,,,,,240.5900,932.1500,percent of total billed charges,47.59% of $932.15 in Billed Charges for Rev 272 = $443.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 5MM DIAMETER DISPOSABLE STERILE,272,RC,,,,,,,,both,,,932.1500,139.8200,SENTARA HEALTH,SENTARA HEALTH,240.59,,,,,,,240.5900,932.1500,percent of total billed charges,25.81% of $932.15 in Billed Charges for Rev 272 = $240.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 5MM DIAMETER DISPOSABLE STERILE,272,RC,,,,,,,,both,,,932.1500,139.8200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",932.15,,,,,,,240.5900,932.1500,percent of total billed charges,100% of $932.15 in Billed Charges for Rev 272 = $932.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 5MM DIAMETER DISPOSABLE STERILE,272,RC,,,,,,,,both,,,932.1500,139.8200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,466.08,,,,,,,240.5900,932.1500,percent of total billed charges,Rev 272 $932.15 in Billed Charges at 50% = $466.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 5MM DIAMETER DISPOSABLE STERILE,272,RC,,,,,,,,both,,,932.1500,139.8200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,301.08,,,,,,,240.5900,932.1500,other,32.3% of $932.15 in Billed Charges for Rev 272 = $301.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIOPSY PUNCH 5MM DIAMETER DISPOSABLE STERILE,272,RC,,,,,,,,both,,,932.1500,139.8200,UNITED HEALTHCARE,UHC HERITAGE SELECT,286.17,,,,,,,240.5900,932.1500,other,30.7% of $932.15 in Billed Charges for Rev 272 = $286.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIOPSY PUNCH 5MM DIAMETER DISPOSABLE STERILE,272,RC,,,,,,,,both,,,932.1500,139.8200,UNITED HEALTHCARE,UNITED HEALTHCARE,301.08,,,,,,,240.5900,932.1500,percent of total billed charges,32.3% of $932.15 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIOPSY PUNCH 5MM DIAMETER DISPOSABLE STERILE,272,RC,,,,,,,,both,,,932.1500,139.8200,WELLCARE,WELLCARE MEDICAID,932.15,,,,,,,240.5900,932.1500,percent of total billed charges,100% of $932.15 in Billed Charges for Rev 272 = $932.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL,272,RC,,,,,,,,both,,,827.6100,124.1400,AETNA,AETNA,353.39,,,,,,,213.6100,827.6100,percent of total billed charges,42.7% of $827.61 in Billed Charges for Rev 272 = $353.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL,272,RC,,,,,,,,both,,,827.6100,124.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,579.33,,,,,,,213.6100,827.6100,percent of total billed charges,Rev 272 $827.61 in Billed Charges at 70% = $579.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL,272,RC,,,,,,,,both,,,827.6100,124.1400,CIGNA HEALTHCARE,CIGNA HMO,345.11,,,,,,,213.6100,827.6100,percent of total billed charges,41.7% of $827.61 in Billed Charges for Rev 272 = $345.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL,272,RC,,,,,,,,both,,,827.6100,124.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,384.01,,,,,,,213.6100,827.6100,percent of total billed charges,46.4% of $827.61 in Billed Charges for Rev 272 = $384.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL,272,RC,,,,,,,,both,,,827.6100,124.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,345.11,,,,,,,213.6100,827.6100,percent of total billed charges,41.7% of $827.61 in Billed Charges for Rev 272 = $345.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL,272,RC,,,,,,,,both,,,827.6100,124.1400,CIGNA HEALTHCARE,CIGNA PPO,345.11,,,,,,,213.6100,827.6100,percent of total billed charges,41.7% of $827.61 in Billed Charges for Rev 272 = $345.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL,272,RC,,,,,,,,both,,,827.6100,124.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,744.85,,,,,,,213.6100,827.6100,percent of total billed charges,90% of $827.61 in Billed Charges for Rev 272 = $744.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL,272,RC,,,,,,,,both,,,827.6100,124.1400,MEDCOST,MEDCOST VHN,393.86,,,,,,,213.6100,827.6100,percent of total billed charges,47.59% of $827.61 in Billed Charges for Rev 272 = $393.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL,272,RC,,,,,,,,both,,,827.6100,124.1400,SENTARA HEALTH,SENTARA HEALTH,213.61,,,,,,,213.6100,827.6100,percent of total billed charges,25.81% of $827.61 in Billed Charges for Rev 272 = $213.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL,272,RC,,,,,,,,both,,,827.6100,124.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",827.61,,,,,,,213.6100,827.6100,percent of total billed charges,100% of $827.61 in Billed Charges for Rev 272 = $827.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL,272,RC,,,,,,,,both,,,827.6100,124.1400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,413.81,,,,,,,213.6100,827.6100,percent of total billed charges,Rev 272 $827.61 in Billed Charges at 50% = $413.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL,272,RC,,,,,,,,both,,,827.6100,124.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,267.32,,,,,,,213.6100,827.6100,other,32.3% of $827.61 in Billed Charges for Rev 272 = $267.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL,272,RC,,,,,,,,both,,,827.6100,124.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,254.08,,,,,,,213.6100,827.6100,other,30.7% of $827.61 in Billed Charges for Rev 272 = $254.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL,272,RC,,,,,,,,both,,,827.6100,124.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,267.32,,,,,,,213.6100,827.6100,percent of total billed charges,32.3% of $827.61 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL,272,RC,,,,,,,,both,,,827.6100,124.1400,WELLCARE,WELLCARE MEDICAID,827.61,,,,,,,213.6100,827.6100,percent of total billed charges,100% of $827.61 in Billed Charges for Rev 272 = $827.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1036.6900,155.5000,AETNA,AETNA,442.67,,,,,,,267.5700,1036.6900,percent of total billed charges,"42.7% of $1,036.69 in Billed Charges for Rev 272 = $442.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1036.6900,155.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,725.68,,,,,,,267.5700,1036.6900,percent of total billed charges,"Rev 272 $1,036.69 in Billed Charges at 70% = $725.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1036.6900,155.5000,CIGNA HEALTHCARE,CIGNA HMO,432.30,,,,,,,267.5700,1036.6900,percent of total billed charges,"41.7% of $1,036.69 in Billed Charges for Rev 272 = $432.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1036.6900,155.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,481.02,,,,,,,267.5700,1036.6900,percent of total billed charges,"46.4% of $1,036.69 in Billed Charges for Rev 272 = $481.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1036.6900,155.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,432.30,,,,,,,267.5700,1036.6900,percent of total billed charges,"41.7% of $1,036.69 in Billed Charges for Rev 272 = $432.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1036.6900,155.5000,CIGNA HEALTHCARE,CIGNA PPO,432.30,,,,,,,267.5700,1036.6900,percent of total billed charges,"41.7% of $1,036.69 in Billed Charges for Rev 272 = $432.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1036.6900,155.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,933.02,,,,,,,267.5700,1036.6900,percent of total billed charges,"90% of $1,036.69 in Billed Charges for Rev 272 = $933.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1036.6900,155.5000,MEDCOST,MEDCOST VHN,493.36,,,,,,,267.5700,1036.6900,percent of total billed charges,"47.59% of $1,036.69 in Billed Charges for Rev 272 = $493.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1036.6900,155.5000,SENTARA HEALTH,SENTARA HEALTH,267.57,,,,,,,267.5700,1036.6900,percent of total billed charges,"25.81% of $1,036.69 in Billed Charges for Rev 272 = $267.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1036.6900,155.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1036.69,,,,,,,267.5700,1036.6900,percent of total billed charges,"100% of $1,036.69 in Billed Charges for Rev 272 = $1,036.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1036.6900,155.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,518.35,,,,,,,267.5700,1036.6900,percent of total billed charges,"Rev 272 $1,036.69 in Billed Charges at 50% = $518.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1036.6900,155.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,334.85,,,,,,,267.5700,1036.6900,other,"32.3% of $1,036.69 in Billed Charges for Rev 272 = $334.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1036.6900,155.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,318.26,,,,,,,267.5700,1036.6900,other,"30.7% of $1,036.69 in Billed Charges for Rev 272 = $318.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1036.6900,155.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,334.85,,,,,,,267.5700,1036.6900,percent of total billed charges,"32.3% of $1,036.69 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1036.6900,155.5000,WELLCARE,WELLCARE MEDICAID,1036.69,,,,,,,267.5700,1036.6900,percent of total billed charges,"100% of $1,036.69 in Billed Charges for Rev 272 = $1,036.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.4MM,272,RC,,,,,,,,both,,,2499.4100,374.9100,AETNA,AETNA,1067.25,,,,,,,645.1000,2499.4100,percent of total billed charges,"42.7% of $2,499.41 in Billed Charges for Rev 272 = $1,067.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.4MM,272,RC,,,,,,,,both,,,2499.4100,374.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1749.59,,,,,,,645.1000,2499.4100,percent of total billed charges,"Rev 272 $2,499.41 in Billed Charges at 70% = $1,749.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.4MM,272,RC,,,,,,,,both,,,2499.4100,374.9100,CIGNA HEALTHCARE,CIGNA HMO,1042.25,,,,,,,645.1000,2499.4100,percent of total billed charges,"41.7% of $2,499.41 in Billed Charges for Rev 272 = $1,042.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.4MM,272,RC,,,,,,,,both,,,2499.4100,374.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1159.73,,,,,,,645.1000,2499.4100,percent of total billed charges,"46.4% of $2,499.41 in Billed Charges for Rev 272 = $1,159.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.4MM,272,RC,,,,,,,,both,,,2499.4100,374.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1042.25,,,,,,,645.1000,2499.4100,percent of total billed charges,"41.7% of $2,499.41 in Billed Charges for Rev 272 = $1,042.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.4MM,272,RC,,,,,,,,both,,,2499.4100,374.9100,CIGNA HEALTHCARE,CIGNA PPO,1042.25,,,,,,,645.1000,2499.4100,percent of total billed charges,"41.7% of $2,499.41 in Billed Charges for Rev 272 = $1,042.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.4MM,272,RC,,,,,,,,both,,,2499.4100,374.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2249.47,,,,,,,645.1000,2499.4100,percent of total billed charges,"90% of $2,499.41 in Billed Charges for Rev 272 = $2,249.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.4MM,272,RC,,,,,,,,both,,,2499.4100,374.9100,MEDCOST,MEDCOST VHN,1189.47,,,,,,,645.1000,2499.4100,percent of total billed charges,"47.59% of $2,499.41 in Billed Charges for Rev 272 = $1,189.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.4MM,272,RC,,,,,,,,both,,,2499.4100,374.9100,SENTARA HEALTH,SENTARA HEALTH,645.10,,,,,,,645.1000,2499.4100,percent of total billed charges,"25.81% of $2,499.41 in Billed Charges for Rev 272 = $645.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.4MM,272,RC,,,,,,,,both,,,2499.4100,374.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2499.41,,,,,,,645.1000,2499.4100,percent of total billed charges,"100% of $2,499.41 in Billed Charges for Rev 272 = $2,499.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.4MM,272,RC,,,,,,,,both,,,2499.4100,374.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1249.71,,,,,,,645.1000,2499.4100,percent of total billed charges,"Rev 272 $2,499.41 in Billed Charges at 50% = $1,249.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.4MM,272,RC,,,,,,,,both,,,2499.4100,374.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,807.31,,,,,,,645.1000,2499.4100,other,"32.3% of $2,499.41 in Billed Charges for Rev 272 = $807.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.4MM,272,RC,,,,,,,,both,,,2499.4100,374.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,767.32,,,,,,,645.1000,2499.4100,other,"30.7% of $2,499.41 in Billed Charges for Rev 272 = $767.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.4MM,272,RC,,,,,,,,both,,,2499.4100,374.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,807.31,,,,,,,645.1000,2499.4100,percent of total billed charges,"32.3% of $2,499.41 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.4MM,272,RC,,,,,,,,both,,,2499.4100,374.9100,WELLCARE,WELLCARE MEDICAID,2499.41,,,,,,,645.1000,2499.4100,percent of total billed charges,"100% of $2,499.41 in Billed Charges for Rev 272 = $2,499.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.4MM UNIV DIST RAD.,272,RC,,,,,,,,both,,,677.8500,101.6800,AETNA,AETNA,289.44,,,,,,,174.9500,677.8500,percent of total billed charges,42.7% of $677.85 in Billed Charges for Rev 272 = $289.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.4MM UNIV DIST RAD.,272,RC,,,,,,,,both,,,677.8500,101.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,474.50,,,,,,,174.9500,677.8500,percent of total billed charges,Rev 272 $677.85 in Billed Charges at 70% = $474.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.4MM UNIV DIST RAD.,272,RC,,,,,,,,both,,,677.8500,101.6800,CIGNA HEALTHCARE,CIGNA HMO,282.66,,,,,,,174.9500,677.8500,percent of total billed charges,41.7% of $677.85 in Billed Charges for Rev 272 = $282.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.4MM UNIV DIST RAD.,272,RC,,,,,,,,both,,,677.8500,101.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,314.52,,,,,,,174.9500,677.8500,percent of total billed charges,46.4% of $677.85 in Billed Charges for Rev 272 = $314.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.4MM UNIV DIST RAD.,272,RC,,,,,,,,both,,,677.8500,101.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,282.66,,,,,,,174.9500,677.8500,percent of total billed charges,41.7% of $677.85 in Billed Charges for Rev 272 = $282.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.4MM UNIV DIST RAD.,272,RC,,,,,,,,both,,,677.8500,101.6800,CIGNA HEALTHCARE,CIGNA PPO,282.66,,,,,,,174.9500,677.8500,percent of total billed charges,41.7% of $677.85 in Billed Charges for Rev 272 = $282.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.4MM UNIV DIST RAD.,272,RC,,,,,,,,both,,,677.8500,101.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,610.07,,,,,,,174.9500,677.8500,percent of total billed charges,90% of $677.85 in Billed Charges for Rev 272 = $610.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.4MM UNIV DIST RAD.,272,RC,,,,,,,,both,,,677.8500,101.6800,MEDCOST,MEDCOST VHN,322.59,,,,,,,174.9500,677.8500,percent of total billed charges,47.59% of $677.85 in Billed Charges for Rev 272 = $322.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.4MM UNIV DIST RAD.,272,RC,,,,,,,,both,,,677.8500,101.6800,SENTARA HEALTH,SENTARA HEALTH,174.95,,,,,,,174.9500,677.8500,percent of total billed charges,25.81% of $677.85 in Billed Charges for Rev 272 = $174.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.4MM UNIV DIST RAD.,272,RC,,,,,,,,both,,,677.8500,101.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",677.85,,,,,,,174.9500,677.8500,percent of total billed charges,100% of $677.85 in Billed Charges for Rev 272 = $677.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.4MM UNIV DIST RAD.,272,RC,,,,,,,,both,,,677.8500,101.6800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,338.93,,,,,,,174.9500,677.8500,percent of total billed charges,Rev 272 $677.85 in Billed Charges at 50% = $338.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.4MM UNIV DIST RAD.,272,RC,,,,,,,,both,,,677.8500,101.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,218.95,,,,,,,174.9500,677.8500,other,32.3% of $677.85 in Billed Charges for Rev 272 = $218.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 1.4MM UNIV DIST RAD.,272,RC,,,,,,,,both,,,677.8500,101.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,208.10,,,,,,,174.9500,677.8500,other,30.7% of $677.85 in Billed Charges for Rev 272 = $208.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 1.4MM UNIV DIST RAD.,272,RC,,,,,,,,both,,,677.8500,101.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,218.95,,,,,,,174.9500,677.8500,percent of total billed charges,32.3% of $677.85 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.4MM UNIV DIST RAD.,272,RC,,,,,,,,both,,,677.8500,101.6800,WELLCARE,WELLCARE MEDICAID,677.85,,,,,,,174.9500,677.8500,percent of total billed charges,100% of $677.85 in Billed Charges for Rev 272 = $677.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 38.8MM,272,RC,,,,,,,,both,,,912.6500,136.9000,AETNA,AETNA,389.70,,,,,,,235.5600,912.6500,percent of total billed charges,42.7% of $912.65 in Billed Charges for Rev 272 = $389.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 38.8MM,272,RC,,,,,,,,both,,,912.6500,136.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,638.86,,,,,,,235.5600,912.6500,percent of total billed charges,Rev 272 $912.65 in Billed Charges at 70% = $638.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 38.8MM,272,RC,,,,,,,,both,,,912.6500,136.9000,CIGNA HEALTHCARE,CIGNA HMO,380.58,,,,,,,235.5600,912.6500,percent of total billed charges,41.7% of $912.65 in Billed Charges for Rev 272 = $380.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 38.8MM,272,RC,,,,,,,,both,,,912.6500,136.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,423.47,,,,,,,235.5600,912.6500,percent of total billed charges,46.4% of $912.65 in Billed Charges for Rev 272 = $423.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 38.8MM,272,RC,,,,,,,,both,,,912.6500,136.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,380.58,,,,,,,235.5600,912.6500,percent of total billed charges,41.7% of $912.65 in Billed Charges for Rev 272 = $380.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 38.8MM,272,RC,,,,,,,,both,,,912.6500,136.9000,CIGNA HEALTHCARE,CIGNA PPO,380.58,,,,,,,235.5600,912.6500,percent of total billed charges,41.7% of $912.65 in Billed Charges for Rev 272 = $380.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 38.8MM,272,RC,,,,,,,,both,,,912.6500,136.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,821.39,,,,,,,235.5600,912.6500,percent of total billed charges,90% of $912.65 in Billed Charges for Rev 272 = $821.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 38.8MM,272,RC,,,,,,,,both,,,912.6500,136.9000,MEDCOST,MEDCOST VHN,434.33,,,,,,,235.5600,912.6500,percent of total billed charges,47.59% of $912.65 in Billed Charges for Rev 272 = $434.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 38.8MM,272,RC,,,,,,,,both,,,912.6500,136.9000,SENTARA HEALTH,SENTARA HEALTH,235.56,,,,,,,235.5600,912.6500,percent of total billed charges,25.81% of $912.65 in Billed Charges for Rev 272 = $235.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 38.8MM,272,RC,,,,,,,,both,,,912.6500,136.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",912.65,,,,,,,235.5600,912.6500,percent of total billed charges,100% of $912.65 in Billed Charges for Rev 272 = $912.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 38.8MM,272,RC,,,,,,,,both,,,912.6500,136.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,456.33,,,,,,,235.5600,912.6500,percent of total billed charges,Rev 272 $912.65 in Billed Charges at 50% = $456.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 38.8MM,272,RC,,,,,,,,both,,,912.6500,136.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,294.79,,,,,,,235.5600,912.6500,other,32.3% of $912.65 in Billed Charges for Rev 272 = $294.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 38.8MM,272,RC,,,,,,,,both,,,912.6500,136.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,280.18,,,,,,,235.5600,912.6500,other,30.7% of $912.65 in Billed Charges for Rev 272 = $280.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 38.8MM,272,RC,,,,,,,,both,,,912.6500,136.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,294.79,,,,,,,235.5600,912.6500,percent of total billed charges,32.3% of $912.65 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 38.8MM,272,RC,,,,,,,,both,,,912.6500,136.9000,WELLCARE,WELLCARE MEDICAID,912.65,,,,,,,235.5600,912.6500,percent of total billed charges,100% of $912.65 in Billed Charges for Rev 272 = $912.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1452.0400,217.8100,AETNA,AETNA,620.02,,,,,,,374.7700,1452.0400,percent of total billed charges,"42.7% of $1,452.04 in Billed Charges for Rev 272 = $620.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1452.0400,217.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1016.43,,,,,,,374.7700,1452.0400,percent of total billed charges,"Rev 272 $1,452.04 in Billed Charges at 70% = $1,016.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1452.0400,217.8100,CIGNA HEALTHCARE,CIGNA HMO,605.50,,,,,,,374.7700,1452.0400,percent of total billed charges,"41.7% of $1,452.04 in Billed Charges for Rev 272 = $605.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1452.0400,217.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,673.75,,,,,,,374.7700,1452.0400,percent of total billed charges,"46.4% of $1,452.04 in Billed Charges for Rev 272 = $673.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1452.0400,217.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,605.50,,,,,,,374.7700,1452.0400,percent of total billed charges,"41.7% of $1,452.04 in Billed Charges for Rev 272 = $605.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1452.0400,217.8100,CIGNA HEALTHCARE,CIGNA PPO,605.50,,,,,,,374.7700,1452.0400,percent of total billed charges,"41.7% of $1,452.04 in Billed Charges for Rev 272 = $605.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1452.0400,217.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1306.84,,,,,,,374.7700,1452.0400,percent of total billed charges,"90% of $1,452.04 in Billed Charges for Rev 272 = $1,306.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1452.0400,217.8100,MEDCOST,MEDCOST VHN,691.03,,,,,,,374.7700,1452.0400,percent of total billed charges,"47.59% of $1,452.04 in Billed Charges for Rev 272 = $691.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1452.0400,217.8100,SENTARA HEALTH,SENTARA HEALTH,374.77,,,,,,,374.7700,1452.0400,percent of total billed charges,"25.81% of $1,452.04 in Billed Charges for Rev 272 = $374.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1452.0400,217.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1452.04,,,,,,,374.7700,1452.0400,percent of total billed charges,"100% of $1,452.04 in Billed Charges for Rev 272 = $1,452.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1452.0400,217.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,726.02,,,,,,,374.7700,1452.0400,percent of total billed charges,"Rev 272 $1,452.04 in Billed Charges at 50% = $726.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1452.0400,217.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,469.01,,,,,,,374.7700,1452.0400,other,"32.3% of $1,452.04 in Billed Charges for Rev 272 = $469.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1452.0400,217.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,445.78,,,,,,,374.7700,1452.0400,other,"30.7% of $1,452.04 in Billed Charges for Rev 272 = $445.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1452.0400,217.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,469.01,,,,,,,374.7700,1452.0400,percent of total billed charges,"32.3% of $1,452.04 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM 74461500,272,RC,,,,,,,,both,,,1452.0400,217.8100,WELLCARE,WELLCARE MEDICAID,1452.04,,,,,,,374.7700,1452.0400,percent of total billed charges,"100% of $1,452.04 in Billed Charges for Rev 272 = $1,452.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3X 220MM,272,RC,,,,,,,,both,,,705.2300,105.7800,AETNA,AETNA,301.13,,,,,,,182.0200,705.2300,percent of total billed charges,42.7% of $705.23 in Billed Charges for Rev 272 = $301.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3X 220MM,272,RC,,,,,,,,both,,,705.2300,105.7800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,493.66,,,,,,,182.0200,705.2300,percent of total billed charges,Rev 272 $705.23 in Billed Charges at 70% = $493.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3X 220MM,272,RC,,,,,,,,both,,,705.2300,105.7800,CIGNA HEALTHCARE,CIGNA HMO,294.08,,,,,,,182.0200,705.2300,percent of total billed charges,41.7% of $705.23 in Billed Charges for Rev 272 = $294.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3X 220MM,272,RC,,,,,,,,both,,,705.2300,105.7800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,327.23,,,,,,,182.0200,705.2300,percent of total billed charges,46.4% of $705.23 in Billed Charges for Rev 272 = $327.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3X 220MM,272,RC,,,,,,,,both,,,705.2300,105.7800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,294.08,,,,,,,182.0200,705.2300,percent of total billed charges,41.7% of $705.23 in Billed Charges for Rev 272 = $294.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3X 220MM,272,RC,,,,,,,,both,,,705.2300,105.7800,CIGNA HEALTHCARE,CIGNA PPO,294.08,,,,,,,182.0200,705.2300,percent of total billed charges,41.7% of $705.23 in Billed Charges for Rev 272 = $294.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3X 220MM,272,RC,,,,,,,,both,,,705.2300,105.7800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,634.71,,,,,,,182.0200,705.2300,percent of total billed charges,90% of $705.23 in Billed Charges for Rev 272 = $634.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3X 220MM,272,RC,,,,,,,,both,,,705.2300,105.7800,MEDCOST,MEDCOST VHN,335.62,,,,,,,182.0200,705.2300,percent of total billed charges,47.59% of $705.23 in Billed Charges for Rev 272 = $335.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3X 220MM,272,RC,,,,,,,,both,,,705.2300,105.7800,SENTARA HEALTH,SENTARA HEALTH,182.02,,,,,,,182.0200,705.2300,percent of total billed charges,25.81% of $705.23 in Billed Charges for Rev 272 = $182.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3X 220MM,272,RC,,,,,,,,both,,,705.2300,105.7800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",705.23,,,,,,,182.0200,705.2300,percent of total billed charges,100% of $705.23 in Billed Charges for Rev 272 = $705.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3X 220MM,272,RC,,,,,,,,both,,,705.2300,105.7800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,352.62,,,,,,,182.0200,705.2300,percent of total billed charges,Rev 272 $705.23 in Billed Charges at 50% = $352.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3X 220MM,272,RC,,,,,,,,both,,,705.2300,105.7800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,227.79,,,,,,,182.0200,705.2300,other,32.3% of $705.23 in Billed Charges for Rev 272 = $227.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 3X 220MM,272,RC,,,,,,,,both,,,705.2300,105.7800,UNITED HEALTHCARE,UHC HERITAGE SELECT,216.51,,,,,,,182.0200,705.2300,other,30.7% of $705.23 in Billed Charges for Rev 272 = $216.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 3X 220MM,272,RC,,,,,,,,both,,,705.2300,105.7800,UNITED HEALTHCARE,UNITED HEALTHCARE,227.79,,,,,,,182.0200,705.2300,percent of total billed charges,32.3% of $705.23 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3X 220MM,272,RC,,,,,,,,both,,,705.2300,105.7800,WELLCARE,WELLCARE MEDICAID,705.23,,,,,,,182.0200,705.2300,percent of total billed charges,100% of $705.23 in Billed Charges for Rev 272 = $705.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3X41MM,272,RC,,,,,,,,both,,,1545.2800,231.7900,AETNA,AETNA,659.83,,,,,,,398.8400,1545.2800,percent of total billed charges,"42.7% of $1,545.28 in Billed Charges for Rev 272 = $659.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3X41MM,272,RC,,,,,,,,both,,,1545.2800,231.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1081.70,,,,,,,398.8400,1545.2800,percent of total billed charges,"Rev 272 $1,545.28 in Billed Charges at 70% = $1,081.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3X41MM,272,RC,,,,,,,,both,,,1545.2800,231.7900,CIGNA HEALTHCARE,CIGNA HMO,644.38,,,,,,,398.8400,1545.2800,percent of total billed charges,"41.7% of $1,545.28 in Billed Charges for Rev 272 = $644.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3X41MM,272,RC,,,,,,,,both,,,1545.2800,231.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,717.01,,,,,,,398.8400,1545.2800,percent of total billed charges,"46.4% of $1,545.28 in Billed Charges for Rev 272 = $717.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3X41MM,272,RC,,,,,,,,both,,,1545.2800,231.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,644.38,,,,,,,398.8400,1545.2800,percent of total billed charges,"41.7% of $1,545.28 in Billed Charges for Rev 272 = $644.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3X41MM,272,RC,,,,,,,,both,,,1545.2800,231.7900,CIGNA HEALTHCARE,CIGNA PPO,644.38,,,,,,,398.8400,1545.2800,percent of total billed charges,"41.7% of $1,545.28 in Billed Charges for Rev 272 = $644.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3X41MM,272,RC,,,,,,,,both,,,1545.2800,231.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1390.75,,,,,,,398.8400,1545.2800,percent of total billed charges,"90% of $1,545.28 in Billed Charges for Rev 272 = $1,390.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3X41MM,272,RC,,,,,,,,both,,,1545.2800,231.7900,MEDCOST,MEDCOST VHN,735.40,,,,,,,398.8400,1545.2800,percent of total billed charges,"47.59% of $1,545.28 in Billed Charges for Rev 272 = $735.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3X41MM,272,RC,,,,,,,,both,,,1545.2800,231.7900,SENTARA HEALTH,SENTARA HEALTH,398.84,,,,,,,398.8400,1545.2800,percent of total billed charges,"25.81% of $1,545.28 in Billed Charges for Rev 272 = $398.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3X41MM,272,RC,,,,,,,,both,,,1545.2800,231.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1545.28,,,,,,,398.8400,1545.2800,percent of total billed charges,"100% of $1,545.28 in Billed Charges for Rev 272 = $1,545.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3X41MM,272,RC,,,,,,,,both,,,1545.2800,231.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.64,,,,,,,398.8400,1545.2800,percent of total billed charges,"Rev 272 $1,545.28 in Billed Charges at 50% = $772.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3X41MM,272,RC,,,,,,,,both,,,1545.2800,231.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,499.13,,,,,,,398.8400,1545.2800,other,"32.3% of $1,545.28 in Billed Charges for Rev 272 = $499.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 3X41MM,272,RC,,,,,,,,both,,,1545.2800,231.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,474.40,,,,,,,398.8400,1545.2800,other,"30.7% of $1,545.28 in Billed Charges for Rev 272 = $474.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 3X41MM,272,RC,,,,,,,,both,,,1545.2800,231.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,499.13,,,,,,,398.8400,1545.2800,percent of total billed charges,"32.3% of $1,545.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3X41MM,272,RC,,,,,,,,both,,,1545.2800,231.7900,WELLCARE,WELLCARE MEDICAID,1545.28,,,,,,,398.8400,1545.2800,percent of total billed charges,"100% of $1,545.28 in Billed Charges for Rev 272 = $1,545.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0 CANNULATED,272,RC,,,,,,,,both,,,2033.5500,305.0300,AETNA,AETNA,868.33,,,,,,,524.8600,2033.5500,percent of total billed charges,"42.7% of $2,033.55 in Billed Charges for Rev 272 = $868.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0 CANNULATED,272,RC,,,,,,,,both,,,2033.5500,305.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1423.49,,,,,,,524.8600,2033.5500,percent of total billed charges,"Rev 272 $2,033.55 in Billed Charges at 70% = $1,423.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0 CANNULATED,272,RC,,,,,,,,both,,,2033.5500,305.0300,CIGNA HEALTHCARE,CIGNA HMO,847.99,,,,,,,524.8600,2033.5500,percent of total billed charges,"41.7% of $2,033.55 in Billed Charges for Rev 272 = $847.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0 CANNULATED,272,RC,,,,,,,,both,,,2033.5500,305.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,943.57,,,,,,,524.8600,2033.5500,percent of total billed charges,"46.4% of $2,033.55 in Billed Charges for Rev 272 = $943.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0 CANNULATED,272,RC,,,,,,,,both,,,2033.5500,305.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,847.99,,,,,,,524.8600,2033.5500,percent of total billed charges,"41.7% of $2,033.55 in Billed Charges for Rev 272 = $847.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0 CANNULATED,272,RC,,,,,,,,both,,,2033.5500,305.0300,CIGNA HEALTHCARE,CIGNA PPO,847.99,,,,,,,524.8600,2033.5500,percent of total billed charges,"41.7% of $2,033.55 in Billed Charges for Rev 272 = $847.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0 CANNULATED,272,RC,,,,,,,,both,,,2033.5500,305.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1830.20,,,,,,,524.8600,2033.5500,percent of total billed charges,"90% of $2,033.55 in Billed Charges for Rev 272 = $1,830.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0 CANNULATED,272,RC,,,,,,,,both,,,2033.5500,305.0300,MEDCOST,MEDCOST VHN,967.77,,,,,,,524.8600,2033.5500,percent of total billed charges,"47.59% of $2,033.55 in Billed Charges for Rev 272 = $967.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0 CANNULATED,272,RC,,,,,,,,both,,,2033.5500,305.0300,SENTARA HEALTH,SENTARA HEALTH,524.86,,,,,,,524.8600,2033.5500,percent of total billed charges,"25.81% of $2,033.55 in Billed Charges for Rev 272 = $524.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0 CANNULATED,272,RC,,,,,,,,both,,,2033.5500,305.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2033.55,,,,,,,524.8600,2033.5500,percent of total billed charges,"100% of $2,033.55 in Billed Charges for Rev 272 = $2,033.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0 CANNULATED,272,RC,,,,,,,,both,,,2033.5500,305.0300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1016.78,,,,,,,524.8600,2033.5500,percent of total billed charges,"Rev 272 $2,033.55 in Billed Charges at 50% = $1,016.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0 CANNULATED,272,RC,,,,,,,,both,,,2033.5500,305.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,656.84,,,,,,,524.8600,2033.5500,other,"32.3% of $2,033.55 in Billed Charges for Rev 272 = $656.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 4.0 CANNULATED,272,RC,,,,,,,,both,,,2033.5500,305.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,624.30,,,,,,,524.8600,2033.5500,other,"30.7% of $2,033.55 in Billed Charges for Rev 272 = $624.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 4.0 CANNULATED,272,RC,,,,,,,,both,,,2033.5500,305.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,656.84,,,,,,,524.8600,2033.5500,percent of total billed charges,"32.3% of $2,033.55 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0 CANNULATED,272,RC,,,,,,,,both,,,2033.5500,305.0300,WELLCARE,WELLCARE MEDICAID,2033.55,,,,,,,524.8600,2033.5500,percent of total billed charges,"100% of $2,033.55 in Billed Charges for Rev 272 = $2,033.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,,,,,,,,both,,,2673.2300,400.9800,AETNA,AETNA,1141.47,,,,,,,689.9600,2673.2300,percent of total billed charges,"42.7% of $2,673.23 in Billed Charges for Rev 272 = $1,141.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,,,,,,,,both,,,2673.2300,400.9800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1871.26,,,,,,,689.9600,2673.2300,percent of total billed charges,"Rev 272 $2,673.23 in Billed Charges at 70% = $1,871.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,,,,,,,,both,,,2673.2300,400.9800,CIGNA HEALTHCARE,CIGNA HMO,1114.74,,,,,,,689.9600,2673.2300,percent of total billed charges,"41.7% of $2,673.23 in Billed Charges for Rev 272 = $1,114.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,,,,,,,,both,,,2673.2300,400.9800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1240.38,,,,,,,689.9600,2673.2300,percent of total billed charges,"46.4% of $2,673.23 in Billed Charges for Rev 272 = $1,240.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,,,,,,,,both,,,2673.2300,400.9800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1114.74,,,,,,,689.9600,2673.2300,percent of total billed charges,"41.7% of $2,673.23 in Billed Charges for Rev 272 = $1,114.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,,,,,,,,both,,,2673.2300,400.9800,CIGNA HEALTHCARE,CIGNA PPO,1114.74,,,,,,,689.9600,2673.2300,percent of total billed charges,"41.7% of $2,673.23 in Billed Charges for Rev 272 = $1,114.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,,,,,,,,both,,,2673.2300,400.9800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2405.91,,,,,,,689.9600,2673.2300,percent of total billed charges,"90% of $2,673.23 in Billed Charges for Rev 272 = $2,405.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,,,,,,,,both,,,2673.2300,400.9800,MEDCOST,MEDCOST VHN,1272.19,,,,,,,689.9600,2673.2300,percent of total billed charges,"47.59% of $2,673.23 in Billed Charges for Rev 272 = $1,272.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,,,,,,,,both,,,2673.2300,400.9800,SENTARA HEALTH,SENTARA HEALTH,689.96,,,,,,,689.9600,2673.2300,percent of total billed charges,"25.81% of $2,673.23 in Billed Charges for Rev 272 = $689.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,,,,,,,,both,,,2673.2300,400.9800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2673.23,,,,,,,689.9600,2673.2300,percent of total billed charges,"100% of $2,673.23 in Billed Charges for Rev 272 = $2,673.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,,,,,,,,both,,,2673.2300,400.9800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1336.62,,,,,,,689.9600,2673.2300,percent of total billed charges,"Rev 272 $2,673.23 in Billed Charges at 50% = $1,336.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,,,,,,,,both,,,2673.2300,400.9800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,863.45,,,,,,,689.9600,2673.2300,other,"32.3% of $2,673.23 in Billed Charges for Rev 272 = $863.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 4.0MM,272,RC,,,,,,,,both,,,2673.2300,400.9800,UNITED HEALTHCARE,UHC HERITAGE SELECT,820.68,,,,,,,689.9600,2673.2300,other,"30.7% of $2,673.23 in Billed Charges for Rev 272 = $820.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 4.0MM,272,RC,,,,,,,,both,,,2673.2300,400.9800,UNITED HEALTHCARE,UNITED HEALTHCARE,863.45,,,,,,,689.9600,2673.2300,percent of total billed charges,"32.3% of $2,673.23 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,,,,,,,,both,,,2673.2300,400.9800,WELLCARE,WELLCARE MEDICAID,2673.23,,,,,,,689.9600,2673.2300,percent of total billed charges,"100% of $2,673.23 in Billed Charges for Rev 272 = $2,673.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL DISP 10MM 60-0034,272,RC,,,,,,,,both,,,777.8300,116.6700,AETNA,AETNA,332.13,,,,,,,200.7600,777.8300,percent of total billed charges,42.7% of $777.83 in Billed Charges for Rev 272 = $332.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL DISP 10MM 60-0034,272,RC,,,,,,,,both,,,777.8300,116.6700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,544.48,,,,,,,200.7600,777.8300,percent of total billed charges,Rev 272 $777.83 in Billed Charges at 70% = $544.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL DISP 10MM 60-0034,272,RC,,,,,,,,both,,,777.8300,116.6700,CIGNA HEALTHCARE,CIGNA HMO,324.36,,,,,,,200.7600,777.8300,percent of total billed charges,41.7% of $777.83 in Billed Charges for Rev 272 = $324.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL DISP 10MM 60-0034,272,RC,,,,,,,,both,,,777.8300,116.6700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,360.91,,,,,,,200.7600,777.8300,percent of total billed charges,46.4% of $777.83 in Billed Charges for Rev 272 = $360.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL DISP 10MM 60-0034,272,RC,,,,,,,,both,,,777.8300,116.6700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,324.36,,,,,,,200.7600,777.8300,percent of total billed charges,41.7% of $777.83 in Billed Charges for Rev 272 = $324.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL DISP 10MM 60-0034,272,RC,,,,,,,,both,,,777.8300,116.6700,CIGNA HEALTHCARE,CIGNA PPO,324.36,,,,,,,200.7600,777.8300,percent of total billed charges,41.7% of $777.83 in Billed Charges for Rev 272 = $324.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL DISP 10MM 60-0034,272,RC,,,,,,,,both,,,777.8300,116.6700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,700.05,,,,,,,200.7600,777.8300,percent of total billed charges,90% of $777.83 in Billed Charges for Rev 272 = $700.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL DISP 10MM 60-0034,272,RC,,,,,,,,both,,,777.8300,116.6700,MEDCOST,MEDCOST VHN,370.17,,,,,,,200.7600,777.8300,percent of total billed charges,47.59% of $777.83 in Billed Charges for Rev 272 = $370.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL DISP 10MM 60-0034,272,RC,,,,,,,,both,,,777.8300,116.6700,SENTARA HEALTH,SENTARA HEALTH,200.76,,,,,,,200.7600,777.8300,percent of total billed charges,25.81% of $777.83 in Billed Charges for Rev 272 = $200.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL DISP 10MM 60-0034,272,RC,,,,,,,,both,,,777.8300,116.6700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",777.83,,,,,,,200.7600,777.8300,percent of total billed charges,100% of $777.83 in Billed Charges for Rev 272 = $777.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL DISP 10MM 60-0034,272,RC,,,,,,,,both,,,777.8300,116.6700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,388.92,,,,,,,200.7600,777.8300,percent of total billed charges,Rev 272 $777.83 in Billed Charges at 50% = $388.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL DISP 10MM 60-0034,272,RC,,,,,,,,both,,,777.8300,116.6700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,251.24,,,,,,,200.7600,777.8300,other,32.3% of $777.83 in Billed Charges for Rev 272 = $251.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL DISP 10MM 60-0034,272,RC,,,,,,,,both,,,777.8300,116.6700,UNITED HEALTHCARE,UHC HERITAGE SELECT,238.79,,,,,,,200.7600,777.8300,other,30.7% of $777.83 in Billed Charges for Rev 272 = $238.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL DISP 10MM 60-0034,272,RC,,,,,,,,both,,,777.8300,116.6700,UNITED HEALTHCARE,UNITED HEALTHCARE,251.24,,,,,,,200.7600,777.8300,percent of total billed charges,32.3% of $777.83 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL DISP 10MM 60-0034,272,RC,,,,,,,,both,,,777.8300,116.6700,WELLCARE,WELLCARE MEDICAID,777.83,,,,,,,200.7600,777.8300,percent of total billed charges,100% of $777.83 in Billed Charges for Rev 272 = $777.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL DISTAL RADIUS 2.0MM,272,RC,,,,,,,,both,,,1140.8100,171.1200,AETNA,AETNA,487.13,,,,,,,294.4400,1140.8100,percent of total billed charges,"42.7% of $1,140.81 in Billed Charges for Rev 272 = $487.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL DISTAL RADIUS 2.0MM,272,RC,,,,,,,,both,,,1140.8100,171.1200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,798.57,,,,,,,294.4400,1140.8100,percent of total billed charges,"Rev 272 $1,140.81 in Billed Charges at 70% = $798.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL DISTAL RADIUS 2.0MM,272,RC,,,,,,,,both,,,1140.8100,171.1200,CIGNA HEALTHCARE,CIGNA HMO,475.72,,,,,,,294.4400,1140.8100,percent of total billed charges,"41.7% of $1,140.81 in Billed Charges for Rev 272 = $475.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL DISTAL RADIUS 2.0MM,272,RC,,,,,,,,both,,,1140.8100,171.1200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,529.34,,,,,,,294.4400,1140.8100,percent of total billed charges,"46.4% of $1,140.81 in Billed Charges for Rev 272 = $529.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL DISTAL RADIUS 2.0MM,272,RC,,,,,,,,both,,,1140.8100,171.1200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,475.72,,,,,,,294.4400,1140.8100,percent of total billed charges,"41.7% of $1,140.81 in Billed Charges for Rev 272 = $475.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL DISTAL RADIUS 2.0MM,272,RC,,,,,,,,both,,,1140.8100,171.1200,CIGNA HEALTHCARE,CIGNA PPO,475.72,,,,,,,294.4400,1140.8100,percent of total billed charges,"41.7% of $1,140.81 in Billed Charges for Rev 272 = $475.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL DISTAL RADIUS 2.0MM,272,RC,,,,,,,,both,,,1140.8100,171.1200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1026.73,,,,,,,294.4400,1140.8100,percent of total billed charges,"90% of $1,140.81 in Billed Charges for Rev 272 = $1,026.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL DISTAL RADIUS 2.0MM,272,RC,,,,,,,,both,,,1140.8100,171.1200,MEDCOST,MEDCOST VHN,542.91,,,,,,,294.4400,1140.8100,percent of total billed charges,"47.59% of $1,140.81 in Billed Charges for Rev 272 = $542.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL DISTAL RADIUS 2.0MM,272,RC,,,,,,,,both,,,1140.8100,171.1200,SENTARA HEALTH,SENTARA HEALTH,294.44,,,,,,,294.4400,1140.8100,percent of total billed charges,"25.81% of $1,140.81 in Billed Charges for Rev 272 = $294.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL DISTAL RADIUS 2.0MM,272,RC,,,,,,,,both,,,1140.8100,171.1200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1140.81,,,,,,,294.4400,1140.8100,percent of total billed charges,"100% of $1,140.81 in Billed Charges for Rev 272 = $1,140.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL DISTAL RADIUS 2.0MM,272,RC,,,,,,,,both,,,1140.8100,171.1200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,570.41,,,,,,,294.4400,1140.8100,percent of total billed charges,"Rev 272 $1,140.81 in Billed Charges at 50% = $570.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL DISTAL RADIUS 2.0MM,272,RC,,,,,,,,both,,,1140.8100,171.1200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,368.48,,,,,,,294.4400,1140.8100,other,"32.3% of $1,140.81 in Billed Charges for Rev 272 = $368.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL DISTAL RADIUS 2.0MM,272,RC,,,,,,,,both,,,1140.8100,171.1200,UNITED HEALTHCARE,UHC HERITAGE SELECT,350.23,,,,,,,294.4400,1140.8100,other,"30.7% of $1,140.81 in Billed Charges for Rev 272 = $350.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL DISTAL RADIUS 2.0MM,272,RC,,,,,,,,both,,,1140.8100,171.1200,UNITED HEALTHCARE,UNITED HEALTHCARE,368.48,,,,,,,294.4400,1140.8100,percent of total billed charges,"32.3% of $1,140.81 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL DISTAL RADIUS 2.0MM,272,RC,,,,,,,,both,,,1140.8100,171.1200,WELLCARE,WELLCARE MEDICAID,1140.81,,,,,,,294.4400,1140.8100,percent of total billed charges,"100% of $1,140.81 in Billed Charges for Rev 272 = $1,140.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM W/ STOP 4MM W/ HEX COUPLING,272,RC,,,,,,,,both,,,1931.7000,289.7600,AETNA,AETNA,824.84,,,,,,,498.5700,1931.7000,percent of total billed charges,"42.7% of $1,931.70 in Billed Charges for Rev 272 = $824.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM W/ STOP 4MM W/ HEX COUPLING,272,RC,,,,,,,,both,,,1931.7000,289.7600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1352.19,,,,,,,498.5700,1931.7000,percent of total billed charges,"Rev 272 $1,931.70 in Billed Charges at 70% = $1,352.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM W/ STOP 4MM W/ HEX COUPLING,272,RC,,,,,,,,both,,,1931.7000,289.7600,CIGNA HEALTHCARE,CIGNA HMO,805.52,,,,,,,498.5700,1931.7000,percent of total billed charges,"41.7% of $1,931.70 in Billed Charges for Rev 272 = $805.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM W/ STOP 4MM W/ HEX COUPLING,272,RC,,,,,,,,both,,,1931.7000,289.7600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,896.31,,,,,,,498.5700,1931.7000,percent of total billed charges,"46.4% of $1,931.70 in Billed Charges for Rev 272 = $896.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM W/ STOP 4MM W/ HEX COUPLING,272,RC,,,,,,,,both,,,1931.7000,289.7600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,805.52,,,,,,,498.5700,1931.7000,percent of total billed charges,"41.7% of $1,931.70 in Billed Charges for Rev 272 = $805.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM W/ STOP 4MM W/ HEX COUPLING,272,RC,,,,,,,,both,,,1931.7000,289.7600,CIGNA HEALTHCARE,CIGNA PPO,805.52,,,,,,,498.5700,1931.7000,percent of total billed charges,"41.7% of $1,931.70 in Billed Charges for Rev 272 = $805.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM W/ STOP 4MM W/ HEX COUPLING,272,RC,,,,,,,,both,,,1931.7000,289.7600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1738.53,,,,,,,498.5700,1931.7000,percent of total billed charges,"90% of $1,931.70 in Billed Charges for Rev 272 = $1,738.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM W/ STOP 4MM W/ HEX COUPLING,272,RC,,,,,,,,both,,,1931.7000,289.7600,MEDCOST,MEDCOST VHN,919.30,,,,,,,498.5700,1931.7000,percent of total billed charges,"47.59% of $1,931.70 in Billed Charges for Rev 272 = $919.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM W/ STOP 4MM W/ HEX COUPLING,272,RC,,,,,,,,both,,,1931.7000,289.7600,SENTARA HEALTH,SENTARA HEALTH,498.57,,,,,,,498.5700,1931.7000,percent of total billed charges,"25.81% of $1,931.70 in Billed Charges for Rev 272 = $498.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM W/ STOP 4MM W/ HEX COUPLING,272,RC,,,,,,,,both,,,1931.7000,289.7600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1931.70,,,,,,,498.5700,1931.7000,percent of total billed charges,"100% of $1,931.70 in Billed Charges for Rev 272 = $1,931.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM W/ STOP 4MM W/ HEX COUPLING,272,RC,,,,,,,,both,,,1931.7000,289.7600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,965.85,,,,,,,498.5700,1931.7000,percent of total billed charges,"Rev 272 $1,931.70 in Billed Charges at 50% = $965.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM W/ STOP 4MM W/ HEX COUPLING,272,RC,,,,,,,,both,,,1931.7000,289.7600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,623.94,,,,,,,498.5700,1931.7000,other,"32.3% of $1,931.70 in Billed Charges for Rev 272 = $623.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.1MM W/ STOP 4MM W/ HEX COUPLING,272,RC,,,,,,,,both,,,1931.7000,289.7600,UNITED HEALTHCARE,UHC HERITAGE SELECT,593.03,,,,,,,498.5700,1931.7000,other,"30.7% of $1,931.70 in Billed Charges for Rev 272 = $593.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.1MM W/ STOP 4MM W/ HEX COUPLING,272,RC,,,,,,,,both,,,1931.7000,289.7600,UNITED HEALTHCARE,UNITED HEALTHCARE,623.94,,,,,,,498.5700,1931.7000,percent of total billed charges,"32.3% of $1,931.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.1MM W/ STOP 4MM W/ HEX COUPLING,272,RC,,,,,,,,both,,,1931.7000,289.7600,WELLCARE,WELLCARE MEDICAID,1931.70,,,,,,,498.5700,1931.7000,percent of total billed charges,"100% of $1,931.70 in Billed Charges for Rev 272 = $1,931.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.25 X 80MM,272,RC,27200002,CDM,,,,,,both,,,2154.2600,323.1400,AETNA,AETNA,919.87,,,,,,,556.0100,2154.2600,percent of total billed charges,"42.7% of $2,154.26 in Billed Charges for Rev 272 = $919.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.25 X 80MM,272,RC,27200002,CDM,,,,,,both,,,2154.2600,323.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1507.98,,,,,,,556.0100,2154.2600,percent of total billed charges,"Rev 272 $2,154.26 in Billed Charges at 70% = $1,507.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.25 X 80MM,272,RC,27200002,CDM,,,,,,both,,,2154.2600,323.1400,CIGNA HEALTHCARE,CIGNA HMO,898.33,,,,,,,556.0100,2154.2600,percent of total billed charges,"41.7% of $2,154.26 in Billed Charges for Rev 272 = $898.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.25 X 80MM,272,RC,27200002,CDM,,,,,,both,,,2154.2600,323.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,999.58,,,,,,,556.0100,2154.2600,percent of total billed charges,"46.4% of $2,154.26 in Billed Charges for Rev 272 = $999.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.25 X 80MM,272,RC,27200002,CDM,,,,,,both,,,2154.2600,323.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,898.33,,,,,,,556.0100,2154.2600,percent of total billed charges,"41.7% of $2,154.26 in Billed Charges for Rev 272 = $898.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.25 X 80MM,272,RC,27200002,CDM,,,,,,both,,,2154.2600,323.1400,CIGNA HEALTHCARE,CIGNA PPO,898.33,,,,,,,556.0100,2154.2600,percent of total billed charges,"41.7% of $2,154.26 in Billed Charges for Rev 272 = $898.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.25 X 80MM,272,RC,27200002,CDM,,,,,,both,,,2154.2600,323.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1938.83,,,,,,,556.0100,2154.2600,percent of total billed charges,"90% of $2,154.26 in Billed Charges for Rev 272 = $1,938.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.25 X 80MM,272,RC,27200002,CDM,,,,,,both,,,2154.2600,323.1400,MEDCOST,MEDCOST VHN,1025.21,,,,,,,556.0100,2154.2600,percent of total billed charges,"47.59% of $2,154.26 in Billed Charges for Rev 272 = $1,025.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.25 X 80MM,272,RC,27200002,CDM,,,,,,both,,,2154.2600,323.1400,SENTARA HEALTH,SENTARA HEALTH,556.01,,,,,,,556.0100,2154.2600,percent of total billed charges,"25.81% of $2,154.26 in Billed Charges for Rev 272 = $556.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.25 X 80MM,272,RC,27200002,CDM,,,,,,both,,,2154.2600,323.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2154.26,,,,,,,556.0100,2154.2600,percent of total billed charges,"100% of $2,154.26 in Billed Charges for Rev 272 = $2,154.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.25 X 80MM,272,RC,27200002,CDM,,,,,,both,,,2154.2600,323.1400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1077.13,,,,,,,556.0100,2154.2600,percent of total billed charges,"Rev 272 $2,154.26 in Billed Charges at 50% = $1,077.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.25 X 80MM,272,RC,27200002,CDM,,,,,,both,,,2154.2600,323.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,695.83,,,,,,,556.0100,2154.2600,other,"32.3% of $2,154.26 in Billed Charges for Rev 272 = $695.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.25 X 80MM,272,RC,27200002,CDM,,,,,,both,,,2154.2600,323.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,661.36,,,,,,,556.0100,2154.2600,other,"30.7% of $2,154.26 in Billed Charges for Rev 272 = $661.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 1.25 X 80MM,272,RC,27200002,CDM,,,,,,both,,,2154.2600,323.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,695.83,,,,,,,556.0100,2154.2600,percent of total billed charges,"32.3% of $2,154.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 1.25 X 80MM,272,RC,27200002,CDM,,,,,,both,,,2154.2600,323.1400,WELLCARE,WELLCARE MEDICAID,2154.26,,,,,,,556.0100,2154.2600,percent of total billed charges,"100% of $2,154.26 in Billed Charges for Rev 272 = $2,154.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3.5MM,272,RC,,,,,,,,both,,,949.7800,142.4700,AETNA,AETNA,405.56,,,,,,,245.1400,949.7800,percent of total billed charges,42.7% of $949.78 in Billed Charges for Rev 272 = $405.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3.5MM,272,RC,,,,,,,,both,,,949.7800,142.4700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,664.85,,,,,,,245.1400,949.7800,percent of total billed charges,Rev 272 $949.78 in Billed Charges at 70% = $664.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3.5MM,272,RC,,,,,,,,both,,,949.7800,142.4700,CIGNA HEALTHCARE,CIGNA HMO,396.06,,,,,,,245.1400,949.7800,percent of total billed charges,41.7% of $949.78 in Billed Charges for Rev 272 = $396.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3.5MM,272,RC,,,,,,,,both,,,949.7800,142.4700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,440.70,,,,,,,245.1400,949.7800,percent of total billed charges,46.4% of $949.78 in Billed Charges for Rev 272 = $440.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3.5MM,272,RC,,,,,,,,both,,,949.7800,142.4700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,396.06,,,,,,,245.1400,949.7800,percent of total billed charges,41.7% of $949.78 in Billed Charges for Rev 272 = $396.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3.5MM,272,RC,,,,,,,,both,,,949.7800,142.4700,CIGNA HEALTHCARE,CIGNA PPO,396.06,,,,,,,245.1400,949.7800,percent of total billed charges,41.7% of $949.78 in Billed Charges for Rev 272 = $396.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3.5MM,272,RC,,,,,,,,both,,,949.7800,142.4700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,854.80,,,,,,,245.1400,949.7800,percent of total billed charges,90% of $949.78 in Billed Charges for Rev 272 = $854.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3.5MM,272,RC,,,,,,,,both,,,949.7800,142.4700,MEDCOST,MEDCOST VHN,452.00,,,,,,,245.1400,949.7800,percent of total billed charges,47.59% of $949.78 in Billed Charges for Rev 272 = $452.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3.5MM,272,RC,,,,,,,,both,,,949.7800,142.4700,SENTARA HEALTH,SENTARA HEALTH,245.14,,,,,,,245.1400,949.7800,percent of total billed charges,25.81% of $949.78 in Billed Charges for Rev 272 = $245.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3.5MM,272,RC,,,,,,,,both,,,949.7800,142.4700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",949.78,,,,,,,245.1400,949.7800,percent of total billed charges,100% of $949.78 in Billed Charges for Rev 272 = $949.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3.5MM,272,RC,,,,,,,,both,,,949.7800,142.4700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,474.89,,,,,,,245.1400,949.7800,percent of total billed charges,Rev 272 $949.78 in Billed Charges at 50% = $474.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3.5MM,272,RC,,,,,,,,both,,,949.7800,142.4700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,306.78,,,,,,,245.1400,949.7800,other,32.3% of $949.78 in Billed Charges for Rev 272 = $306.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 3.5MM,272,RC,,,,,,,,both,,,949.7800,142.4700,UNITED HEALTHCARE,UHC HERITAGE SELECT,291.58,,,,,,,245.1400,949.7800,other,30.7% of $949.78 in Billed Charges for Rev 272 = $291.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 3.5MM,272,RC,,,,,,,,both,,,949.7800,142.4700,UNITED HEALTHCARE,UNITED HEALTHCARE,306.78,,,,,,,245.1400,949.7800,percent of total billed charges,32.3% of $949.78 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3.5MM,272,RC,,,,,,,,both,,,949.7800,142.4700,WELLCARE,WELLCARE MEDICAID,949.78,,,,,,,245.1400,949.7800,percent of total billed charges,100% of $949.78 in Billed Charges for Rev 272 = $949.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 340MM,272,RC,27200002,CDM,,,,,,both,,,1213.8200,182.0700,AETNA,AETNA,518.30,,,,,,,313.2900,1213.8200,percent of total billed charges,"42.7% of $1,213.82 in Billed Charges for Rev 272 = $518.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 340MM,272,RC,27200002,CDM,,,,,,both,,,1213.8200,182.0700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,849.67,,,,,,,313.2900,1213.8200,percent of total billed charges,"Rev 272 $1,213.82 in Billed Charges at 70% = $849.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 340MM,272,RC,27200002,CDM,,,,,,both,,,1213.8200,182.0700,CIGNA HEALTHCARE,CIGNA HMO,506.16,,,,,,,313.2900,1213.8200,percent of total billed charges,"41.7% of $1,213.82 in Billed Charges for Rev 272 = $506.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 340MM,272,RC,27200002,CDM,,,,,,both,,,1213.8200,182.0700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,563.21,,,,,,,313.2900,1213.8200,percent of total billed charges,"46.4% of $1,213.82 in Billed Charges for Rev 272 = $563.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 340MM,272,RC,27200002,CDM,,,,,,both,,,1213.8200,182.0700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,506.16,,,,,,,313.2900,1213.8200,percent of total billed charges,"41.7% of $1,213.82 in Billed Charges for Rev 272 = $506.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 340MM,272,RC,27200002,CDM,,,,,,both,,,1213.8200,182.0700,CIGNA HEALTHCARE,CIGNA PPO,506.16,,,,,,,313.2900,1213.8200,percent of total billed charges,"41.7% of $1,213.82 in Billed Charges for Rev 272 = $506.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 340MM,272,RC,27200002,CDM,,,,,,both,,,1213.8200,182.0700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1092.44,,,,,,,313.2900,1213.8200,percent of total billed charges,"90% of $1,213.82 in Billed Charges for Rev 272 = $1,092.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 340MM,272,RC,27200002,CDM,,,,,,both,,,1213.8200,182.0700,MEDCOST,MEDCOST VHN,577.66,,,,,,,313.2900,1213.8200,percent of total billed charges,"47.59% of $1,213.82 in Billed Charges for Rev 272 = $577.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 340MM,272,RC,27200002,CDM,,,,,,both,,,1213.8200,182.0700,SENTARA HEALTH,SENTARA HEALTH,313.29,,,,,,,313.2900,1213.8200,percent of total billed charges,"25.81% of $1,213.82 in Billed Charges for Rev 272 = $313.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 340MM,272,RC,27200002,CDM,,,,,,both,,,1213.8200,182.0700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1213.82,,,,,,,313.2900,1213.8200,percent of total billed charges,"100% of $1,213.82 in Billed Charges for Rev 272 = $1,213.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 340MM,272,RC,27200002,CDM,,,,,,both,,,1213.8200,182.0700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,606.91,,,,,,,313.2900,1213.8200,percent of total billed charges,"Rev 272 $1,213.82 in Billed Charges at 50% = $606.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 340MM,272,RC,27200002,CDM,,,,,,both,,,1213.8200,182.0700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,392.06,,,,,,,313.2900,1213.8200,other,"32.3% of $1,213.82 in Billed Charges for Rev 272 = $392.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 340MM,272,RC,27200002,CDM,,,,,,both,,,1213.8200,182.0700,UNITED HEALTHCARE,UHC HERITAGE SELECT,372.64,,,,,,,313.2900,1213.8200,other,"30.7% of $1,213.82 in Billed Charges for Rev 272 = $372.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 340MM,272,RC,27200002,CDM,,,,,,both,,,1213.8200,182.0700,UNITED HEALTHCARE,UNITED HEALTHCARE,392.06,,,,,,,313.2900,1213.8200,percent of total billed charges,"32.3% of $1,213.82 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 340MM,272,RC,27200002,CDM,,,,,,both,,,1213.8200,182.0700,WELLCARE,WELLCARE MEDICAID,1213.82,,,,,,,313.2900,1213.8200,percent of total billed charges,"100% of $1,213.82 in Billed Charges for Rev 272 = $1,213.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL EXPERIENCE 3.2,272,RC,,,,,,,,both,,,21801.7100,3270.2600,AETNA,AETNA,9309.33,,,,,,,5627.0200,21801.7100,percent of total billed charges,"42.7% of $21,801.71 in Billed Charges for Rev 272 = $9,309.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL EXPERIENCE 3.2,272,RC,,,,,,,,both,,,21801.7100,3270.2600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,15261.20,,,,,,,5627.0200,21801.7100,percent of total billed charges,"Rev 272 $21,801.71 in Billed Charges at 70% = $15,261.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL EXPERIENCE 3.2,272,RC,,,,,,,,both,,,21801.7100,3270.2600,CIGNA HEALTHCARE,CIGNA HMO,9091.31,,,,,,,5627.0200,21801.7100,percent of total billed charges,"41.7% of $21,801.71 in Billed Charges for Rev 272 = $9,091.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL EXPERIENCE 3.2,272,RC,,,,,,,,both,,,21801.7100,3270.2600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10115.99,,,,,,,5627.0200,21801.7100,percent of total billed charges,"46.4% of $21,801.71 in Billed Charges for Rev 272 = $10,115.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL EXPERIENCE 3.2,272,RC,,,,,,,,both,,,21801.7100,3270.2600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9091.31,,,,,,,5627.0200,21801.7100,percent of total billed charges,"41.7% of $21,801.71 in Billed Charges for Rev 272 = $9,091.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL EXPERIENCE 3.2,272,RC,,,,,,,,both,,,21801.7100,3270.2600,CIGNA HEALTHCARE,CIGNA PPO,9091.31,,,,,,,5627.0200,21801.7100,percent of total billed charges,"41.7% of $21,801.71 in Billed Charges for Rev 272 = $9,091.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL EXPERIENCE 3.2,272,RC,,,,,,,,both,,,21801.7100,3270.2600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,19621.54,,,,,,,5627.0200,21801.7100,percent of total billed charges,"90% of $21,801.71 in Billed Charges for Rev 272 = $19,621.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL EXPERIENCE 3.2,272,RC,,,,,,,,both,,,21801.7100,3270.2600,MEDCOST,MEDCOST VHN,10375.43,,,,,,,5627.0200,21801.7100,percent of total billed charges,"47.59% of $21,801.71 in Billed Charges for Rev 272 = $10,375.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL EXPERIENCE 3.2,272,RC,,,,,,,,both,,,21801.7100,3270.2600,SENTARA HEALTH,SENTARA HEALTH,5627.02,,,,,,,5627.0200,21801.7100,percent of total billed charges,"25.81% of $21,801.71 in Billed Charges for Rev 272 = $5,627.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL EXPERIENCE 3.2,272,RC,,,,,,,,both,,,21801.7100,3270.2600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",21801.71,,,,,,,5627.0200,21801.7100,percent of total billed charges,"100% of $21,801.71 in Billed Charges for Rev 272 = $21,801.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL EXPERIENCE 3.2,272,RC,,,,,,,,both,,,21801.7100,3270.2600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,10900.86,,,,,,,5627.0200,21801.7100,percent of total billed charges,"Rev 272 $21,801.71 in Billed Charges at 50% = $10,900.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL EXPERIENCE 3.2,272,RC,,,,,,,,both,,,21801.7100,3270.2600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7041.95,,,,,,,5627.0200,21801.7100,other,"32.3% of $21,801.71 in Billed Charges for Rev 272 = $7,041.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL EXPERIENCE 3.2,272,RC,,,,,,,,both,,,21801.7100,3270.2600,UNITED HEALTHCARE,UHC HERITAGE SELECT,6693.13,,,,,,,5627.0200,21801.7100,other,"30.7% of $21,801.71 in Billed Charges for Rev 272 = $6,693.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL EXPERIENCE 3.2,272,RC,,,,,,,,both,,,21801.7100,3270.2600,UNITED HEALTHCARE,UNITED HEALTHCARE,7041.95,,,,,,,5627.0200,21801.7100,percent of total billed charges,"32.3% of $21,801.71 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL EXPERIENCE 3.2,272,RC,,,,,,,,both,,,21801.7100,3270.2600,WELLCARE,WELLCARE MEDICAID,21801.71,,,,,,,5627.0200,21801.7100,percent of total billed charges,"100% of $21,801.71 in Billed Charges for Rev 272 = $21,801.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLEXIBLE 50MM,272,RC,,,,,,,,both,,,2012.3900,301.8600,AETNA,AETNA,859.29,,,,,,,519.4000,2012.3900,percent of total billed charges,"42.7% of $2,012.39 in Billed Charges for Rev 272 = $859.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLEXIBLE 50MM,272,RC,,,,,,,,both,,,2012.3900,301.8600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1408.67,,,,,,,519.4000,2012.3900,percent of total billed charges,"Rev 272 $2,012.39 in Billed Charges at 70% = $1,408.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLEXIBLE 50MM,272,RC,,,,,,,,both,,,2012.3900,301.8600,CIGNA HEALTHCARE,CIGNA HMO,839.17,,,,,,,519.4000,2012.3900,percent of total billed charges,"41.7% of $2,012.39 in Billed Charges for Rev 272 = $839.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLEXIBLE 50MM,272,RC,,,,,,,,both,,,2012.3900,301.8600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,933.75,,,,,,,519.4000,2012.3900,percent of total billed charges,"46.4% of $2,012.39 in Billed Charges for Rev 272 = $933.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLEXIBLE 50MM,272,RC,,,,,,,,both,,,2012.3900,301.8600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,839.17,,,,,,,519.4000,2012.3900,percent of total billed charges,"41.7% of $2,012.39 in Billed Charges for Rev 272 = $839.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLEXIBLE 50MM,272,RC,,,,,,,,both,,,2012.3900,301.8600,CIGNA HEALTHCARE,CIGNA PPO,839.17,,,,,,,519.4000,2012.3900,percent of total billed charges,"41.7% of $2,012.39 in Billed Charges for Rev 272 = $839.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLEXIBLE 50MM,272,RC,,,,,,,,both,,,2012.3900,301.8600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1811.15,,,,,,,519.4000,2012.3900,percent of total billed charges,"90% of $2,012.39 in Billed Charges for Rev 272 = $1,811.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLEXIBLE 50MM,272,RC,,,,,,,,both,,,2012.3900,301.8600,MEDCOST,MEDCOST VHN,957.70,,,,,,,519.4000,2012.3900,percent of total billed charges,"47.59% of $2,012.39 in Billed Charges for Rev 272 = $957.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLEXIBLE 50MM,272,RC,,,,,,,,both,,,2012.3900,301.8600,SENTARA HEALTH,SENTARA HEALTH,519.40,,,,,,,519.4000,2012.3900,percent of total billed charges,"25.81% of $2,012.39 in Billed Charges for Rev 272 = $519.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLEXIBLE 50MM,272,RC,,,,,,,,both,,,2012.3900,301.8600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2012.39,,,,,,,519.4000,2012.3900,percent of total billed charges,"100% of $2,012.39 in Billed Charges for Rev 272 = $2,012.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLEXIBLE 50MM,272,RC,,,,,,,,both,,,2012.3900,301.8600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1006.20,,,,,,,519.4000,2012.3900,percent of total billed charges,"Rev 272 $2,012.39 in Billed Charges at 50% = $1,006.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLEXIBLE 50MM,272,RC,,,,,,,,both,,,2012.3900,301.8600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,650.00,,,,,,,519.4000,2012.3900,other,"32.3% of $2,012.39 in Billed Charges for Rev 272 = $650.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL FLEXIBLE 50MM,272,RC,,,,,,,,both,,,2012.3900,301.8600,UNITED HEALTHCARE,UHC HERITAGE SELECT,617.80,,,,,,,519.4000,2012.3900,other,"30.7% of $2,012.39 in Billed Charges for Rev 272 = $617.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL FLEXIBLE 50MM,272,RC,,,,,,,,both,,,2012.3900,301.8600,UNITED HEALTHCARE,UNITED HEALTHCARE,650.00,,,,,,,519.4000,2012.3900,percent of total billed charges,"32.3% of $2,012.39 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLEXIBLE 50MM,272,RC,,,,,,,,both,,,2012.3900,301.8600,WELLCARE,WELLCARE MEDICAID,2012.39,,,,,,,519.4000,2012.3900,percent of total billed charges,"100% of $2,012.39 in Billed Charges for Rev 272 = $2,012.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLUTED 2.5MM,272,RC,,,,,,,,both,,,1016.9800,152.5500,AETNA,AETNA,434.25,,,,,,,262.4800,1016.9800,percent of total billed charges,"42.7% of $1,016.98 in Billed Charges for Rev 272 = $434.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLUTED 2.5MM,272,RC,,,,,,,,both,,,1016.9800,152.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,711.89,,,,,,,262.4800,1016.9800,percent of total billed charges,"Rev 272 $1,016.98 in Billed Charges at 70% = $711.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLUTED 2.5MM,272,RC,,,,,,,,both,,,1016.9800,152.5500,CIGNA HEALTHCARE,CIGNA HMO,424.08,,,,,,,262.4800,1016.9800,percent of total billed charges,"41.7% of $1,016.98 in Billed Charges for Rev 272 = $424.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLUTED 2.5MM,272,RC,,,,,,,,both,,,1016.9800,152.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,471.88,,,,,,,262.4800,1016.9800,percent of total billed charges,"46.4% of $1,016.98 in Billed Charges for Rev 272 = $471.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLUTED 2.5MM,272,RC,,,,,,,,both,,,1016.9800,152.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,424.08,,,,,,,262.4800,1016.9800,percent of total billed charges,"41.7% of $1,016.98 in Billed Charges for Rev 272 = $424.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLUTED 2.5MM,272,RC,,,,,,,,both,,,1016.9800,152.5500,CIGNA HEALTHCARE,CIGNA PPO,424.08,,,,,,,262.4800,1016.9800,percent of total billed charges,"41.7% of $1,016.98 in Billed Charges for Rev 272 = $424.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLUTED 2.5MM,272,RC,,,,,,,,both,,,1016.9800,152.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,915.28,,,,,,,262.4800,1016.9800,percent of total billed charges,"90% of $1,016.98 in Billed Charges for Rev 272 = $915.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLUTED 2.5MM,272,RC,,,,,,,,both,,,1016.9800,152.5500,MEDCOST,MEDCOST VHN,483.98,,,,,,,262.4800,1016.9800,percent of total billed charges,"47.59% of $1,016.98 in Billed Charges for Rev 272 = $483.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLUTED 2.5MM,272,RC,,,,,,,,both,,,1016.9800,152.5500,SENTARA HEALTH,SENTARA HEALTH,262.48,,,,,,,262.4800,1016.9800,percent of total billed charges,"25.81% of $1,016.98 in Billed Charges for Rev 272 = $262.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLUTED 2.5MM,272,RC,,,,,,,,both,,,1016.9800,152.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1016.98,,,,,,,262.4800,1016.9800,percent of total billed charges,"100% of $1,016.98 in Billed Charges for Rev 272 = $1,016.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLUTED 2.5MM,272,RC,,,,,,,,both,,,1016.9800,152.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,508.49,,,,,,,262.4800,1016.9800,percent of total billed charges,"Rev 272 $1,016.98 in Billed Charges at 50% = $508.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLUTED 2.5MM,272,RC,,,,,,,,both,,,1016.9800,152.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,328.48,,,,,,,262.4800,1016.9800,other,"32.3% of $1,016.98 in Billed Charges for Rev 272 = $328.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL FLUTED 2.5MM,272,RC,,,,,,,,both,,,1016.9800,152.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,312.21,,,,,,,262.4800,1016.9800,other,"30.7% of $1,016.98 in Billed Charges for Rev 272 = $312.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL FLUTED 2.5MM,272,RC,,,,,,,,both,,,1016.9800,152.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,328.48,,,,,,,262.4800,1016.9800,percent of total billed charges,"32.3% of $1,016.98 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FLUTED 2.5MM,272,RC,,,,,,,,both,,,1016.9800,152.5500,WELLCARE,WELLCARE MEDICAID,1016.98,,,,,,,262.4800,1016.9800,percent of total billed charges,"100% of $1,016.98 in Billed Charges for Rev 272 = $1,016.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3FLUTE CAL3.2X21,272,RC,,,,,,,,both,,,1956.8000,293.5200,AETNA,AETNA,835.55,,,,,,,505.0500,1956.8000,percent of total billed charges,"42.7% of $1,956.80 in Billed Charges for Rev 272 = $835.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3FLUTE CAL3.2X21,272,RC,,,,,,,,both,,,1956.8000,293.5200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1369.76,,,,,,,505.0500,1956.8000,percent of total billed charges,"Rev 272 $1,956.80 in Billed Charges at 70% = $1,369.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3FLUTE CAL3.2X21,272,RC,,,,,,,,both,,,1956.8000,293.5200,CIGNA HEALTHCARE,CIGNA HMO,815.99,,,,,,,505.0500,1956.8000,percent of total billed charges,"41.7% of $1,956.80 in Billed Charges for Rev 272 = $815.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3FLUTE CAL3.2X21,272,RC,,,,,,,,both,,,1956.8000,293.5200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,907.96,,,,,,,505.0500,1956.8000,percent of total billed charges,"46.4% of $1,956.80 in Billed Charges for Rev 272 = $907.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3FLUTE CAL3.2X21,272,RC,,,,,,,,both,,,1956.8000,293.5200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,815.99,,,,,,,505.0500,1956.8000,percent of total billed charges,"41.7% of $1,956.80 in Billed Charges for Rev 272 = $815.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3FLUTE CAL3.2X21,272,RC,,,,,,,,both,,,1956.8000,293.5200,CIGNA HEALTHCARE,CIGNA PPO,815.99,,,,,,,505.0500,1956.8000,percent of total billed charges,"41.7% of $1,956.80 in Billed Charges for Rev 272 = $815.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3FLUTE CAL3.2X21,272,RC,,,,,,,,both,,,1956.8000,293.5200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1761.12,,,,,,,505.0500,1956.8000,percent of total billed charges,"90% of $1,956.80 in Billed Charges for Rev 272 = $1,761.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3FLUTE CAL3.2X21,272,RC,,,,,,,,both,,,1956.8000,293.5200,MEDCOST,MEDCOST VHN,931.24,,,,,,,505.0500,1956.8000,percent of total billed charges,"47.59% of $1,956.80 in Billed Charges for Rev 272 = $931.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3FLUTE CAL3.2X21,272,RC,,,,,,,,both,,,1956.8000,293.5200,SENTARA HEALTH,SENTARA HEALTH,505.05,,,,,,,505.0500,1956.8000,percent of total billed charges,"25.81% of $1,956.80 in Billed Charges for Rev 272 = $505.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3FLUTE CAL3.2X21,272,RC,,,,,,,,both,,,1956.8000,293.5200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1956.80,,,,,,,505.0500,1956.8000,percent of total billed charges,"100% of $1,956.80 in Billed Charges for Rev 272 = $1,956.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3FLUTE CAL3.2X21,272,RC,,,,,,,,both,,,1956.8000,293.5200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,978.40,,,,,,,505.0500,1956.8000,percent of total billed charges,"Rev 272 $1,956.80 in Billed Charges at 50% = $978.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3FLUTE CAL3.2X21,272,RC,,,,,,,,both,,,1956.8000,293.5200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,632.05,,,,,,,505.0500,1956.8000,other,"32.3% of $1,956.80 in Billed Charges for Rev 272 = $632.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 3FLUTE CAL3.2X21,272,RC,,,,,,,,both,,,1956.8000,293.5200,UNITED HEALTHCARE,UHC HERITAGE SELECT,600.74,,,,,,,505.0500,1956.8000,other,"30.7% of $1,956.80 in Billed Charges for Rev 272 = $600.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 3FLUTE CAL3.2X21,272,RC,,,,,,,,both,,,1956.8000,293.5200,UNITED HEALTHCARE,UNITED HEALTHCARE,632.05,,,,,,,505.0500,1956.8000,percent of total billed charges,"32.3% of $1,956.80 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3FLUTE CAL3.2X21,272,RC,,,,,,,,both,,,1956.8000,293.5200,WELLCARE,WELLCARE MEDICAID,1956.80,,,,,,,505.0500,1956.8000,percent of total billed charges,"100% of $1,956.80 in Billed Charges for Rev 272 = $1,956.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3FLUTE QC 3.2X145,272,RC,,,,,,,,both,,,844.4100,126.6600,AETNA,AETNA,360.56,,,,,,,217.9400,844.4100,percent of total billed charges,42.7% of $844.41 in Billed Charges for Rev 272 = $360.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3FLUTE QC 3.2X145,272,RC,,,,,,,,both,,,844.4100,126.6600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,591.09,,,,,,,217.9400,844.4100,percent of total billed charges,Rev 272 $844.41 in Billed Charges at 70% = $591.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3FLUTE QC 3.2X145,272,RC,,,,,,,,both,,,844.4100,126.6600,CIGNA HEALTHCARE,CIGNA HMO,352.12,,,,,,,217.9400,844.4100,percent of total billed charges,41.7% of $844.41 in Billed Charges for Rev 272 = $352.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3FLUTE QC 3.2X145,272,RC,,,,,,,,both,,,844.4100,126.6600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,391.81,,,,,,,217.9400,844.4100,percent of total billed charges,46.4% of $844.41 in Billed Charges for Rev 272 = $391.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3FLUTE QC 3.2X145,272,RC,,,,,,,,both,,,844.4100,126.6600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,352.12,,,,,,,217.9400,844.4100,percent of total billed charges,41.7% of $844.41 in Billed Charges for Rev 272 = $352.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3FLUTE QC 3.2X145,272,RC,,,,,,,,both,,,844.4100,126.6600,CIGNA HEALTHCARE,CIGNA PPO,352.12,,,,,,,217.9400,844.4100,percent of total billed charges,41.7% of $844.41 in Billed Charges for Rev 272 = $352.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3FLUTE QC 3.2X145,272,RC,,,,,,,,both,,,844.4100,126.6600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,759.97,,,,,,,217.9400,844.4100,percent of total billed charges,90% of $844.41 in Billed Charges for Rev 272 = $759.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3FLUTE QC 3.2X145,272,RC,,,,,,,,both,,,844.4100,126.6600,MEDCOST,MEDCOST VHN,401.85,,,,,,,217.9400,844.4100,percent of total billed charges,47.59% of $844.41 in Billed Charges for Rev 272 = $401.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3FLUTE QC 3.2X145,272,RC,,,,,,,,both,,,844.4100,126.6600,SENTARA HEALTH,SENTARA HEALTH,217.94,,,,,,,217.9400,844.4100,percent of total billed charges,25.81% of $844.41 in Billed Charges for Rev 272 = $217.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3FLUTE QC 3.2X145,272,RC,,,,,,,,both,,,844.4100,126.6600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",844.41,,,,,,,217.9400,844.4100,percent of total billed charges,100% of $844.41 in Billed Charges for Rev 272 = $844.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3FLUTE QC 3.2X145,272,RC,,,,,,,,both,,,844.4100,126.6600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,422.21,,,,,,,217.9400,844.4100,percent of total billed charges,Rev 272 $844.41 in Billed Charges at 50% = $422.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3FLUTE QC 3.2X145,272,RC,,,,,,,,both,,,844.4100,126.6600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,272.74,,,,,,,217.9400,844.4100,other,32.3% of $844.41 in Billed Charges for Rev 272 = $272.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 3FLUTE QC 3.2X145,272,RC,,,,,,,,both,,,844.4100,126.6600,UNITED HEALTHCARE,UHC HERITAGE SELECT,259.23,,,,,,,217.9400,844.4100,other,30.7% of $844.41 in Billed Charges for Rev 272 = $259.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 3FLUTE QC 3.2X145,272,RC,,,,,,,,both,,,844.4100,126.6600,UNITED HEALTHCARE,UNITED HEALTHCARE,272.74,,,,,,,217.9400,844.4100,percent of total billed charges,32.3% of $844.41 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3FLUTE QC 3.2X145,272,RC,,,,,,,,both,,,844.4100,126.6600,WELLCARE,WELLCARE MEDICAID,844.41,,,,,,,217.9400,844.4100,percent of total billed charges,100% of $844.41 in Billed Charges for Rev 272 = $844.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 3MM,272,RC,,,,,,,,both,,,1877.1500,281.5700,AETNA,AETNA,801.54,,,,,,,484.4900,1877.1500,percent of total billed charges,"42.7% of $1,877.15 in Billed Charges for Rev 272 = $801.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3MM,272,RC,,,,,,,,both,,,1877.1500,281.5700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1314.01,,,,,,,484.4900,1877.1500,percent of total billed charges,"Rev 272 $1,877.15 in Billed Charges at 70% = $1,314.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3MM,272,RC,,,,,,,,both,,,1877.1500,281.5700,CIGNA HEALTHCARE,CIGNA HMO,782.77,,,,,,,484.4900,1877.1500,percent of total billed charges,"41.7% of $1,877.15 in Billed Charges for Rev 272 = $782.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3MM,272,RC,,,,,,,,both,,,1877.1500,281.5700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,871.00,,,,,,,484.4900,1877.1500,percent of total billed charges,"46.4% of $1,877.15 in Billed Charges for Rev 272 = $871.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3MM,272,RC,,,,,,,,both,,,1877.1500,281.5700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,782.77,,,,,,,484.4900,1877.1500,percent of total billed charges,"41.7% of $1,877.15 in Billed Charges for Rev 272 = $782.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3MM,272,RC,,,,,,,,both,,,1877.1500,281.5700,CIGNA HEALTHCARE,CIGNA PPO,782.77,,,,,,,484.4900,1877.1500,percent of total billed charges,"41.7% of $1,877.15 in Billed Charges for Rev 272 = $782.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3MM,272,RC,,,,,,,,both,,,1877.1500,281.5700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1689.44,,,,,,,484.4900,1877.1500,percent of total billed charges,"90% of $1,877.15 in Billed Charges for Rev 272 = $1,689.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3MM,272,RC,,,,,,,,both,,,1877.1500,281.5700,MEDCOST,MEDCOST VHN,893.34,,,,,,,484.4900,1877.1500,percent of total billed charges,"47.59% of $1,877.15 in Billed Charges for Rev 272 = $893.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3MM,272,RC,,,,,,,,both,,,1877.1500,281.5700,SENTARA HEALTH,SENTARA HEALTH,484.49,,,,,,,484.4900,1877.1500,percent of total billed charges,"25.81% of $1,877.15 in Billed Charges for Rev 272 = $484.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3MM,272,RC,,,,,,,,both,,,1877.1500,281.5700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1877.15,,,,,,,484.4900,1877.1500,percent of total billed charges,"100% of $1,877.15 in Billed Charges for Rev 272 = $1,877.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3MM,272,RC,,,,,,,,both,,,1877.1500,281.5700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,938.58,,,,,,,484.4900,1877.1500,percent of total billed charges,"Rev 272 $1,877.15 in Billed Charges at 50% = $938.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3MM,272,RC,,,,,,,,both,,,1877.1500,281.5700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,606.32,,,,,,,484.4900,1877.1500,other,"32.3% of $1,877.15 in Billed Charges for Rev 272 = $606.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 3MM,272,RC,,,,,,,,both,,,1877.1500,281.5700,UNITED HEALTHCARE,UHC HERITAGE SELECT,576.29,,,,,,,484.4900,1877.1500,other,"30.7% of $1,877.15 in Billed Charges for Rev 272 = $576.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 3MM,272,RC,,,,,,,,both,,,1877.1500,281.5700,UNITED HEALTHCARE,UNITED HEALTHCARE,606.32,,,,,,,484.4900,1877.1500,percent of total billed charges,"32.3% of $1,877.15 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3MM,272,RC,,,,,,,,both,,,1877.1500,281.5700,WELLCARE,WELLCARE MEDICAID,1877.15,,,,,,,484.4900,1877.1500,percent of total billed charges,"100% of $1,877.15 in Billed Charges for Rev 272 = $1,877.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4 2 X 340MM,272,RC,27200002,CDM,,,,,,both,,,1127.1200,169.0700,AETNA,AETNA,481.28,,,,,,,290.9100,1127.1200,percent of total billed charges,"42.7% of $1,127.12 in Billed Charges for Rev 272 = $481.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4 2 X 340MM,272,RC,27200002,CDM,,,,,,both,,,1127.1200,169.0700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,788.98,,,,,,,290.9100,1127.1200,percent of total billed charges,"Rev 272 $1,127.12 in Billed Charges at 70% = $788.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4 2 X 340MM,272,RC,27200002,CDM,,,,,,both,,,1127.1200,169.0700,CIGNA HEALTHCARE,CIGNA HMO,470.01,,,,,,,290.9100,1127.1200,percent of total billed charges,"41.7% of $1,127.12 in Billed Charges for Rev 272 = $470.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4 2 X 340MM,272,RC,27200002,CDM,,,,,,both,,,1127.1200,169.0700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,522.98,,,,,,,290.9100,1127.1200,percent of total billed charges,"46.4% of $1,127.12 in Billed Charges for Rev 272 = $522.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4 2 X 340MM,272,RC,27200002,CDM,,,,,,both,,,1127.1200,169.0700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,470.01,,,,,,,290.9100,1127.1200,percent of total billed charges,"41.7% of $1,127.12 in Billed Charges for Rev 272 = $470.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4 2 X 340MM,272,RC,27200002,CDM,,,,,,both,,,1127.1200,169.0700,CIGNA HEALTHCARE,CIGNA PPO,470.01,,,,,,,290.9100,1127.1200,percent of total billed charges,"41.7% of $1,127.12 in Billed Charges for Rev 272 = $470.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4 2 X 340MM,272,RC,27200002,CDM,,,,,,both,,,1127.1200,169.0700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1014.41,,,,,,,290.9100,1127.1200,percent of total billed charges,"90% of $1,127.12 in Billed Charges for Rev 272 = $1,014.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4 2 X 340MM,272,RC,27200002,CDM,,,,,,both,,,1127.1200,169.0700,MEDCOST,MEDCOST VHN,536.40,,,,,,,290.9100,1127.1200,percent of total billed charges,"47.59% of $1,127.12 in Billed Charges for Rev 272 = $536.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4 2 X 340MM,272,RC,27200002,CDM,,,,,,both,,,1127.1200,169.0700,SENTARA HEALTH,SENTARA HEALTH,290.91,,,,,,,290.9100,1127.1200,percent of total billed charges,"25.81% of $1,127.12 in Billed Charges for Rev 272 = $290.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4 2 X 340MM,272,RC,27200002,CDM,,,,,,both,,,1127.1200,169.0700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1127.12,,,,,,,290.9100,1127.1200,percent of total billed charges,"100% of $1,127.12 in Billed Charges for Rev 272 = $1,127.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4 2 X 340MM,272,RC,27200002,CDM,,,,,,both,,,1127.1200,169.0700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,563.56,,,,,,,290.9100,1127.1200,percent of total billed charges,"Rev 272 $1,127.12 in Billed Charges at 50% = $563.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4 2 X 340MM,272,RC,27200002,CDM,,,,,,both,,,1127.1200,169.0700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,364.06,,,,,,,290.9100,1127.1200,other,"32.3% of $1,127.12 in Billed Charges for Rev 272 = $364.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 4 2 X 340MM,272,RC,27200002,CDM,,,,,,both,,,1127.1200,169.0700,UNITED HEALTHCARE,UHC HERITAGE SELECT,346.03,,,,,,,290.9100,1127.1200,other,"30.7% of $1,127.12 in Billed Charges for Rev 272 = $346.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 4 2 X 340MM,272,RC,27200002,CDM,,,,,,both,,,1127.1200,169.0700,UNITED HEALTHCARE,UNITED HEALTHCARE,364.06,,,,,,,290.9100,1127.1200,percent of total billed charges,"32.3% of $1,127.12 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4 2 X 340MM,272,RC,27200002,CDM,,,,,,both,,,1127.1200,169.0700,WELLCARE,WELLCARE MEDICAID,1127.12,,,,,,,290.9100,1127.1200,percent of total billed charges,"100% of $1,127.12 in Billed Charges for Rev 272 = $1,127.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 2.0MM QUICKFIX SCREW 1.3MM,272,RC,,,,,,,,both,,,2105.3100,315.8000,AETNA,AETNA,898.97,,,,,,,543.3800,2105.3100,percent of total billed charges,"42.7% of $2,105.31 in Billed Charges for Rev 272 = $898.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 2.0MM QUICKFIX SCREW 1.3MM,272,RC,,,,,,,,both,,,2105.3100,315.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1473.72,,,,,,,543.3800,2105.3100,percent of total billed charges,"Rev 272 $2,105.31 in Billed Charges at 70% = $1,473.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 2.0MM QUICKFIX SCREW 1.3MM,272,RC,,,,,,,,both,,,2105.3100,315.8000,CIGNA HEALTHCARE,CIGNA HMO,877.91,,,,,,,543.3800,2105.3100,percent of total billed charges,"41.7% of $2,105.31 in Billed Charges for Rev 272 = $877.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 2.0MM QUICKFIX SCREW 1.3MM,272,RC,,,,,,,,both,,,2105.3100,315.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,976.86,,,,,,,543.3800,2105.3100,percent of total billed charges,"46.4% of $2,105.31 in Billed Charges for Rev 272 = $976.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 2.0MM QUICKFIX SCREW 1.3MM,272,RC,,,,,,,,both,,,2105.3100,315.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,877.91,,,,,,,543.3800,2105.3100,percent of total billed charges,"41.7% of $2,105.31 in Billed Charges for Rev 272 = $877.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 2.0MM QUICKFIX SCREW 1.3MM,272,RC,,,,,,,,both,,,2105.3100,315.8000,CIGNA HEALTHCARE,CIGNA PPO,877.91,,,,,,,543.3800,2105.3100,percent of total billed charges,"41.7% of $2,105.31 in Billed Charges for Rev 272 = $877.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 2.0MM QUICKFIX SCREW 1.3MM,272,RC,,,,,,,,both,,,2105.3100,315.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1894.78,,,,,,,543.3800,2105.3100,percent of total billed charges,"90% of $2,105.31 in Billed Charges for Rev 272 = $1,894.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 2.0MM QUICKFIX SCREW 1.3MM,272,RC,,,,,,,,both,,,2105.3100,315.8000,MEDCOST,MEDCOST VHN,1001.92,,,,,,,543.3800,2105.3100,percent of total billed charges,"47.59% of $2,105.31 in Billed Charges for Rev 272 = $1,001.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 2.0MM QUICKFIX SCREW 1.3MM,272,RC,,,,,,,,both,,,2105.3100,315.8000,SENTARA HEALTH,SENTARA HEALTH,543.38,,,,,,,543.3800,2105.3100,percent of total billed charges,"25.81% of $2,105.31 in Billed Charges for Rev 272 = $543.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 2.0MM QUICKFIX SCREW 1.3MM,272,RC,,,,,,,,both,,,2105.3100,315.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2105.31,,,,,,,543.3800,2105.3100,percent of total billed charges,"100% of $2,105.31 in Billed Charges for Rev 272 = $2,105.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 2.0MM QUICKFIX SCREW 1.3MM,272,RC,,,,,,,,both,,,2105.3100,315.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1052.66,,,,,,,543.3800,2105.3100,percent of total billed charges,"Rev 272 $2,105.31 in Billed Charges at 50% = $1,052.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 2.0MM QUICKFIX SCREW 1.3MM,272,RC,,,,,,,,both,,,2105.3100,315.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,680.02,,,,,,,543.3800,2105.3100,other,"32.3% of $2,105.31 in Billed Charges for Rev 272 = $680.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL FOR 2.0MM QUICKFIX SCREW 1.3MM,272,RC,,,,,,,,both,,,2105.3100,315.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,646.33,,,,,,,543.3800,2105.3100,other,"30.7% of $2,105.31 in Billed Charges for Rev 272 = $646.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL FOR 2.0MM QUICKFIX SCREW 1.3MM,272,RC,,,,,,,,both,,,2105.3100,315.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,680.02,,,,,,,543.3800,2105.3100,percent of total billed charges,"32.3% of $2,105.31 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 2.0MM QUICKFIX SCREW 1.3MM,272,RC,,,,,,,,both,,,2105.3100,315.8000,WELLCARE,WELLCARE MEDICAID,2105.31,,,,,,,543.3800,2105.3100,percent of total billed charges,"100% of $2,105.31 in Billed Charges for Rev 272 = $2,105.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 90 DEGREE DRIVER 2.2 X 6MM,272,RC,,,,,,,,both,,,3314.8800,497.2300,AETNA,AETNA,1415.45,,,,,,,855.5700,3314.8800,percent of total billed charges,"42.7% of $3,314.88 in Billed Charges for Rev 272 = $1,415.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 90 DEGREE DRIVER 2.2 X 6MM,272,RC,,,,,,,,both,,,3314.8800,497.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2320.42,,,,,,,855.5700,3314.8800,percent of total billed charges,"Rev 272 $3,314.88 in Billed Charges at 70% = $2,320.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 90 DEGREE DRIVER 2.2 X 6MM,272,RC,,,,,,,,both,,,3314.8800,497.2300,CIGNA HEALTHCARE,CIGNA HMO,1382.31,,,,,,,855.5700,3314.8800,percent of total billed charges,"41.7% of $3,314.88 in Billed Charges for Rev 272 = $1,382.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 90 DEGREE DRIVER 2.2 X 6MM,272,RC,,,,,,,,both,,,3314.8800,497.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1538.10,,,,,,,855.5700,3314.8800,percent of total billed charges,"46.4% of $3,314.88 in Billed Charges for Rev 272 = $1,538.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 90 DEGREE DRIVER 2.2 X 6MM,272,RC,,,,,,,,both,,,3314.8800,497.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1382.31,,,,,,,855.5700,3314.8800,percent of total billed charges,"41.7% of $3,314.88 in Billed Charges for Rev 272 = $1,382.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 90 DEGREE DRIVER 2.2 X 6MM,272,RC,,,,,,,,both,,,3314.8800,497.2300,CIGNA HEALTHCARE,CIGNA PPO,1382.31,,,,,,,855.5700,3314.8800,percent of total billed charges,"41.7% of $3,314.88 in Billed Charges for Rev 272 = $1,382.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 90 DEGREE DRIVER 2.2 X 6MM,272,RC,,,,,,,,both,,,3314.8800,497.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2983.39,,,,,,,855.5700,3314.8800,percent of total billed charges,"90% of $3,314.88 in Billed Charges for Rev 272 = $2,983.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 90 DEGREE DRIVER 2.2 X 6MM,272,RC,,,,,,,,both,,,3314.8800,497.2300,MEDCOST,MEDCOST VHN,1577.55,,,,,,,855.5700,3314.8800,percent of total billed charges,"47.59% of $3,314.88 in Billed Charges for Rev 272 = $1,577.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 90 DEGREE DRIVER 2.2 X 6MM,272,RC,,,,,,,,both,,,3314.8800,497.2300,SENTARA HEALTH,SENTARA HEALTH,855.57,,,,,,,855.5700,3314.8800,percent of total billed charges,"25.81% of $3,314.88 in Billed Charges for Rev 272 = $855.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 90 DEGREE DRIVER 2.2 X 6MM,272,RC,,,,,,,,both,,,3314.8800,497.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3314.88,,,,,,,855.5700,3314.8800,percent of total billed charges,"100% of $3,314.88 in Billed Charges for Rev 272 = $3,314.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 90 DEGREE DRIVER 2.2 X 6MM,272,RC,,,,,,,,both,,,3314.8800,497.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1657.44,,,,,,,855.5700,3314.8800,percent of total billed charges,"Rev 272 $3,314.88 in Billed Charges at 50% = $1,657.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 90 DEGREE DRIVER 2.2 X 6MM,272,RC,,,,,,,,both,,,3314.8800,497.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1070.71,,,,,,,855.5700,3314.8800,other,"32.3% of $3,314.88 in Billed Charges for Rev 272 = $1,070.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL FOR 90 DEGREE DRIVER 2.2 X 6MM,272,RC,,,,,,,,both,,,3314.8800,497.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1017.67,,,,,,,855.5700,3314.8800,other,"30.7% of $3,314.88 in Billed Charges for Rev 272 = $1,017.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL FOR 90 DEGREE DRIVER 2.2 X 6MM,272,RC,,,,,,,,both,,,3314.8800,497.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,1070.71,,,,,,,855.5700,3314.8800,percent of total billed charges,"32.3% of $3,314.88 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR 90 DEGREE DRIVER 2.2 X 6MM,272,RC,,,,,,,,both,,,3314.8800,497.2300,WELLCARE,WELLCARE MEDICAID,3314.88,,,,,,,855.5700,3314.8800,percent of total billed charges,"100% of $3,314.88 in Billed Charges for Rev 272 = $3,314.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR ANTIROTATION SCREW 4.3 X 413MM,272,RC,27200002,CDM,,,,,,both,,,3949.6900,592.4500,AETNA,AETNA,1686.52,,,,,,,1019.4200,3949.6900,percent of total billed charges,"42.7% of $3,949.69 in Billed Charges for Rev 272 = $1,686.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR ANTIROTATION SCREW 4.3 X 413MM,272,RC,27200002,CDM,,,,,,both,,,3949.6900,592.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2764.78,,,,,,,1019.4200,3949.6900,percent of total billed charges,"Rev 272 $3,949.69 in Billed Charges at 70% = $2,764.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR ANTIROTATION SCREW 4.3 X 413MM,272,RC,27200002,CDM,,,,,,both,,,3949.6900,592.4500,CIGNA HEALTHCARE,CIGNA HMO,1647.02,,,,,,,1019.4200,3949.6900,percent of total billed charges,"41.7% of $3,949.69 in Billed Charges for Rev 272 = $1,647.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR ANTIROTATION SCREW 4.3 X 413MM,272,RC,27200002,CDM,,,,,,both,,,3949.6900,592.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1832.66,,,,,,,1019.4200,3949.6900,percent of total billed charges,"46.4% of $3,949.69 in Billed Charges for Rev 272 = $1,832.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR ANTIROTATION SCREW 4.3 X 413MM,272,RC,27200002,CDM,,,,,,both,,,3949.6900,592.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1647.02,,,,,,,1019.4200,3949.6900,percent of total billed charges,"41.7% of $3,949.69 in Billed Charges for Rev 272 = $1,647.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR ANTIROTATION SCREW 4.3 X 413MM,272,RC,27200002,CDM,,,,,,both,,,3949.6900,592.4500,CIGNA HEALTHCARE,CIGNA PPO,1647.02,,,,,,,1019.4200,3949.6900,percent of total billed charges,"41.7% of $3,949.69 in Billed Charges for Rev 272 = $1,647.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR ANTIROTATION SCREW 4.3 X 413MM,272,RC,27200002,CDM,,,,,,both,,,3949.6900,592.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3554.72,,,,,,,1019.4200,3949.6900,percent of total billed charges,"90% of $3,949.69 in Billed Charges for Rev 272 = $3,554.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR ANTIROTATION SCREW 4.3 X 413MM,272,RC,27200002,CDM,,,,,,both,,,3949.6900,592.4500,MEDCOST,MEDCOST VHN,1879.66,,,,,,,1019.4200,3949.6900,percent of total billed charges,"47.59% of $3,949.69 in Billed Charges for Rev 272 = $1,879.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR ANTIROTATION SCREW 4.3 X 413MM,272,RC,27200002,CDM,,,,,,both,,,3949.6900,592.4500,SENTARA HEALTH,SENTARA HEALTH,1019.42,,,,,,,1019.4200,3949.6900,percent of total billed charges,"25.81% of $3,949.69 in Billed Charges for Rev 272 = $1,019.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR ANTIROTATION SCREW 4.3 X 413MM,272,RC,27200002,CDM,,,,,,both,,,3949.6900,592.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3949.69,,,,,,,1019.4200,3949.6900,percent of total billed charges,"100% of $3,949.69 in Billed Charges for Rev 272 = $3,949.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR ANTIROTATION SCREW 4.3 X 413MM,272,RC,27200002,CDM,,,,,,both,,,3949.6900,592.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1974.85,,,,,,,1019.4200,3949.6900,percent of total billed charges,"Rev 272 $3,949.69 in Billed Charges at 50% = $1,974.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR ANTIROTATION SCREW 4.3 X 413MM,272,RC,27200002,CDM,,,,,,both,,,3949.6900,592.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1275.75,,,,,,,1019.4200,3949.6900,other,"32.3% of $3,949.69 in Billed Charges for Rev 272 = $1,275.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL FOR ANTIROTATION SCREW 4.3 X 413MM,272,RC,27200002,CDM,,,,,,both,,,3949.6900,592.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1212.55,,,,,,,1019.4200,3949.6900,other,"30.7% of $3,949.69 in Billed Charges for Rev 272 = $1,212.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL FOR ANTIROTATION SCREW 4.3 X 413MM,272,RC,27200002,CDM,,,,,,both,,,3949.6900,592.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,1275.75,,,,,,,1019.4200,3949.6900,percent of total billed charges,"32.3% of $3,949.69 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR ANTIROTATION SCREW 4.3 X 413MM,272,RC,27200002,CDM,,,,,,both,,,3949.6900,592.4500,WELLCARE,WELLCARE MEDICAID,3949.69,,,,,,,1019.4200,3949.6900,percent of total billed charges,"100% of $3,949.69 in Billed Charges for Rev 272 = $3,949.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR DHS/DCS 8M 33810,272,RC,,,,,,,,both,,,4962.2100,744.3300,AETNA,AETNA,2118.86,,,,,,,1280.7500,4962.2100,percent of total billed charges,"42.7% of $4,962.21 in Billed Charges for Rev 272 = $2,118.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR DHS/DCS 8M 33810,272,RC,,,,,,,,both,,,4962.2100,744.3300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3473.55,,,,,,,1280.7500,4962.2100,percent of total billed charges,"Rev 272 $4,962.21 in Billed Charges at 70% = $3,473.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR DHS/DCS 8M 33810,272,RC,,,,,,,,both,,,4962.2100,744.3300,CIGNA HEALTHCARE,CIGNA HMO,2069.24,,,,,,,1280.7500,4962.2100,percent of total billed charges,"41.7% of $4,962.21 in Billed Charges for Rev 272 = $2,069.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR DHS/DCS 8M 33810,272,RC,,,,,,,,both,,,4962.2100,744.3300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2302.47,,,,,,,1280.7500,4962.2100,percent of total billed charges,"46.4% of $4,962.21 in Billed Charges for Rev 272 = $2,302.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR DHS/DCS 8M 33810,272,RC,,,,,,,,both,,,4962.2100,744.3300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2069.24,,,,,,,1280.7500,4962.2100,percent of total billed charges,"41.7% of $4,962.21 in Billed Charges for Rev 272 = $2,069.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR DHS/DCS 8M 33810,272,RC,,,,,,,,both,,,4962.2100,744.3300,CIGNA HEALTHCARE,CIGNA PPO,2069.24,,,,,,,1280.7500,4962.2100,percent of total billed charges,"41.7% of $4,962.21 in Billed Charges for Rev 272 = $2,069.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR DHS/DCS 8M 33810,272,RC,,,,,,,,both,,,4962.2100,744.3300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4465.99,,,,,,,1280.7500,4962.2100,percent of total billed charges,"90% of $4,962.21 in Billed Charges for Rev 272 = $4,465.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR DHS/DCS 8M 33810,272,RC,,,,,,,,both,,,4962.2100,744.3300,MEDCOST,MEDCOST VHN,2361.52,,,,,,,1280.7500,4962.2100,percent of total billed charges,"47.59% of $4,962.21 in Billed Charges for Rev 272 = $2,361.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR DHS/DCS 8M 33810,272,RC,,,,,,,,both,,,4962.2100,744.3300,SENTARA HEALTH,SENTARA HEALTH,1280.75,,,,,,,1280.7500,4962.2100,percent of total billed charges,"25.81% of $4,962.21 in Billed Charges for Rev 272 = $1,280.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR DHS/DCS 8M 33810,272,RC,,,,,,,,both,,,4962.2100,744.3300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4962.21,,,,,,,1280.7500,4962.2100,percent of total billed charges,"100% of $4,962.21 in Billed Charges for Rev 272 = $4,962.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR DHS/DCS 8M 33810,272,RC,,,,,,,,both,,,4962.2100,744.3300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2481.11,,,,,,,1280.7500,4962.2100,percent of total billed charges,"Rev 272 $4,962.21 in Billed Charges at 50% = $2,481.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR DHS/DCS 8M 33810,272,RC,,,,,,,,both,,,4962.2100,744.3300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1602.79,,,,,,,1280.7500,4962.2100,other,"32.3% of $4,962.21 in Billed Charges for Rev 272 = $1,602.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL FOR DHS/DCS 8M 33810,272,RC,,,,,,,,both,,,4962.2100,744.3300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1523.40,,,,,,,1280.7500,4962.2100,other,"30.7% of $4,962.21 in Billed Charges for Rev 272 = $1,523.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL FOR DHS/DCS 8M 33810,272,RC,,,,,,,,both,,,4962.2100,744.3300,UNITED HEALTHCARE,UNITED HEALTHCARE,1602.79,,,,,,,1280.7500,4962.2100,percent of total billed charges,"32.3% of $4,962.21 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR DHS/DCS 8M 33810,272,RC,,,,,,,,both,,,4962.2100,744.3300,WELLCARE,WELLCARE MEDICAID,4962.21,,,,,,,1280.7500,4962.2100,percent of total billed charges,"100% of $4,962.21 in Billed Charges for Rev 272 = $4,962.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR TIT FEM NAIL 13.0 X 290 MM 351.27,272,RC,,,,,,,,both,,,4830.5000,724.5800,AETNA,AETNA,2062.62,,,,,,,1246.7500,4830.5000,percent of total billed charges,"42.7% of $4,830.50 in Billed Charges for Rev 272 = $2,062.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR TIT FEM NAIL 13.0 X 290 MM 351.27,272,RC,,,,,,,,both,,,4830.5000,724.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3381.35,,,,,,,1246.7500,4830.5000,percent of total billed charges,"Rev 272 $4,830.50 in Billed Charges at 70% = $3,381.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR TIT FEM NAIL 13.0 X 290 MM 351.27,272,RC,,,,,,,,both,,,4830.5000,724.5800,CIGNA HEALTHCARE,CIGNA HMO,2014.32,,,,,,,1246.7500,4830.5000,percent of total billed charges,"41.7% of $4,830.50 in Billed Charges for Rev 272 = $2,014.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR TIT FEM NAIL 13.0 X 290 MM 351.27,272,RC,,,,,,,,both,,,4830.5000,724.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2241.35,,,,,,,1246.7500,4830.5000,percent of total billed charges,"46.4% of $4,830.50 in Billed Charges for Rev 272 = $2,241.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR TIT FEM NAIL 13.0 X 290 MM 351.27,272,RC,,,,,,,,both,,,4830.5000,724.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2014.32,,,,,,,1246.7500,4830.5000,percent of total billed charges,"41.7% of $4,830.50 in Billed Charges for Rev 272 = $2,014.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR TIT FEM NAIL 13.0 X 290 MM 351.27,272,RC,,,,,,,,both,,,4830.5000,724.5800,CIGNA HEALTHCARE,CIGNA PPO,2014.32,,,,,,,1246.7500,4830.5000,percent of total billed charges,"41.7% of $4,830.50 in Billed Charges for Rev 272 = $2,014.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR TIT FEM NAIL 13.0 X 290 MM 351.27,272,RC,,,,,,,,both,,,4830.5000,724.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4347.45,,,,,,,1246.7500,4830.5000,percent of total billed charges,"90% of $4,830.50 in Billed Charges for Rev 272 = $4,347.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR TIT FEM NAIL 13.0 X 290 MM 351.27,272,RC,,,,,,,,both,,,4830.5000,724.5800,MEDCOST,MEDCOST VHN,2298.84,,,,,,,1246.7500,4830.5000,percent of total billed charges,"47.59% of $4,830.50 in Billed Charges for Rev 272 = $2,298.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR TIT FEM NAIL 13.0 X 290 MM 351.27,272,RC,,,,,,,,both,,,4830.5000,724.5800,SENTARA HEALTH,SENTARA HEALTH,1246.75,,,,,,,1246.7500,4830.5000,percent of total billed charges,"25.81% of $4,830.50 in Billed Charges for Rev 272 = $1,246.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR TIT FEM NAIL 13.0 X 290 MM 351.27,272,RC,,,,,,,,both,,,4830.5000,724.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4830.50,,,,,,,1246.7500,4830.5000,percent of total billed charges,"100% of $4,830.50 in Billed Charges for Rev 272 = $4,830.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR TIT FEM NAIL 13.0 X 290 MM 351.27,272,RC,,,,,,,,both,,,4830.5000,724.5800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2415.25,,,,,,,1246.7500,4830.5000,percent of total billed charges,"Rev 272 $4,830.50 in Billed Charges at 50% = $2,415.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR TIT FEM NAIL 13.0 X 290 MM 351.27,272,RC,,,,,,,,both,,,4830.5000,724.5800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1560.25,,,,,,,1246.7500,4830.5000,other,"32.3% of $4,830.50 in Billed Charges for Rev 272 = $1,560.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL FOR TIT FEM NAIL 13.0 X 290 MM 351.27,272,RC,,,,,,,,both,,,4830.5000,724.5800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1482.96,,,,,,,1246.7500,4830.5000,other,"30.7% of $4,830.50 in Billed Charges for Rev 272 = $1,482.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL FOR TIT FEM NAIL 13.0 X 290 MM 351.27,272,RC,,,,,,,,both,,,4830.5000,724.5800,UNITED HEALTHCARE,UNITED HEALTHCARE,1560.25,,,,,,,1246.7500,4830.5000,percent of total billed charges,"32.3% of $4,830.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR TIT FEM NAIL 13.0 X 290 MM 351.27,272,RC,,,,,,,,both,,,4830.5000,724.5800,WELLCARE,WELLCARE MEDICAID,4830.50,,,,,,,1246.7500,4830.5000,percent of total billed charges,"100% of $4,830.50 in Billed Charges for Rev 272 = $4,830.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FRAG-LOC 2.5MM,272,RC,27200002,CDM,,,,,,both,,,2924.6200,438.6900,AETNA,AETNA,1248.81,,,,,,,754.8400,2924.6200,percent of total billed charges,"42.7% of $2,924.62 in Billed Charges for Rev 272 = $1,248.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FRAG-LOC 2.5MM,272,RC,27200002,CDM,,,,,,both,,,2924.6200,438.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2047.23,,,,,,,754.8400,2924.6200,percent of total billed charges,"Rev 272 $2,924.62 in Billed Charges at 70% = $2,047.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FRAG-LOC 2.5MM,272,RC,27200002,CDM,,,,,,both,,,2924.6200,438.6900,CIGNA HEALTHCARE,CIGNA HMO,1219.57,,,,,,,754.8400,2924.6200,percent of total billed charges,"41.7% of $2,924.62 in Billed Charges for Rev 272 = $1,219.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FRAG-LOC 2.5MM,272,RC,27200002,CDM,,,,,,both,,,2924.6200,438.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1357.02,,,,,,,754.8400,2924.6200,percent of total billed charges,"46.4% of $2,924.62 in Billed Charges for Rev 272 = $1,357.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FRAG-LOC 2.5MM,272,RC,27200002,CDM,,,,,,both,,,2924.6200,438.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1219.57,,,,,,,754.8400,2924.6200,percent of total billed charges,"41.7% of $2,924.62 in Billed Charges for Rev 272 = $1,219.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FRAG-LOC 2.5MM,272,RC,27200002,CDM,,,,,,both,,,2924.6200,438.6900,CIGNA HEALTHCARE,CIGNA PPO,1219.57,,,,,,,754.8400,2924.6200,percent of total billed charges,"41.7% of $2,924.62 in Billed Charges for Rev 272 = $1,219.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FRAG-LOC 2.5MM,272,RC,27200002,CDM,,,,,,both,,,2924.6200,438.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2632.16,,,,,,,754.8400,2924.6200,percent of total billed charges,"90% of $2,924.62 in Billed Charges for Rev 272 = $2,632.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FRAG-LOC 2.5MM,272,RC,27200002,CDM,,,,,,both,,,2924.6200,438.6900,MEDCOST,MEDCOST VHN,1391.83,,,,,,,754.8400,2924.6200,percent of total billed charges,"47.59% of $2,924.62 in Billed Charges for Rev 272 = $1,391.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FRAG-LOC 2.5MM,272,RC,27200002,CDM,,,,,,both,,,2924.6200,438.6900,SENTARA HEALTH,SENTARA HEALTH,754.84,,,,,,,754.8400,2924.6200,percent of total billed charges,"25.81% of $2,924.62 in Billed Charges for Rev 272 = $754.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FRAG-LOC 2.5MM,272,RC,27200002,CDM,,,,,,both,,,2924.6200,438.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2924.62,,,,,,,754.8400,2924.6200,percent of total billed charges,"100% of $2,924.62 in Billed Charges for Rev 272 = $2,924.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FRAG-LOC 2.5MM,272,RC,27200002,CDM,,,,,,both,,,2924.6200,438.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1462.31,,,,,,,754.8400,2924.6200,percent of total billed charges,"Rev 272 $2,924.62 in Billed Charges at 50% = $1,462.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FRAG-LOC 2.5MM,272,RC,27200002,CDM,,,,,,both,,,2924.6200,438.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,944.65,,,,,,,754.8400,2924.6200,other,"32.3% of $2,924.62 in Billed Charges for Rev 272 = $944.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL FRAG-LOC 2.5MM,272,RC,27200002,CDM,,,,,,both,,,2924.6200,438.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,897.86,,,,,,,754.8400,2924.6200,other,"30.7% of $2,924.62 in Billed Charges for Rev 272 = $897.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL FRAG-LOC 2.5MM,272,RC,27200002,CDM,,,,,,both,,,2924.6200,438.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,944.65,,,,,,,754.8400,2924.6200,percent of total billed charges,"32.3% of $2,924.62 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FRAG-LOC 2.5MM,272,RC,27200002,CDM,,,,,,both,,,2924.6200,438.6900,WELLCARE,WELLCARE MEDICAID,2924.62,,,,,,,754.8400,2924.6200,percent of total billed charges,"100% of $2,924.62 in Billed Charges for Rev 272 = $2,924.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FUCHSIA 2.0 X 12MM,272,RC,,,,,,,,both,,,3588.3700,538.2600,AETNA,AETNA,1532.23,,,,,,,926.1600,3588.3700,percent of total billed charges,"42.7% of $3,588.37 in Billed Charges for Rev 272 = $1,532.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FUCHSIA 2.0 X 12MM,272,RC,,,,,,,,both,,,3588.3700,538.2600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2511.86,,,,,,,926.1600,3588.3700,percent of total billed charges,"Rev 272 $3,588.37 in Billed Charges at 70% = $2,511.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FUCHSIA 2.0 X 12MM,272,RC,,,,,,,,both,,,3588.3700,538.2600,CIGNA HEALTHCARE,CIGNA HMO,1496.35,,,,,,,926.1600,3588.3700,percent of total billed charges,"41.7% of $3,588.37 in Billed Charges for Rev 272 = $1,496.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FUCHSIA 2.0 X 12MM,272,RC,,,,,,,,both,,,3588.3700,538.2600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1665.00,,,,,,,926.1600,3588.3700,percent of total billed charges,"46.4% of $3,588.37 in Billed Charges for Rev 272 = $1,665.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FUCHSIA 2.0 X 12MM,272,RC,,,,,,,,both,,,3588.3700,538.2600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1496.35,,,,,,,926.1600,3588.3700,percent of total billed charges,"41.7% of $3,588.37 in Billed Charges for Rev 272 = $1,496.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FUCHSIA 2.0 X 12MM,272,RC,,,,,,,,both,,,3588.3700,538.2600,CIGNA HEALTHCARE,CIGNA PPO,1496.35,,,,,,,926.1600,3588.3700,percent of total billed charges,"41.7% of $3,588.37 in Billed Charges for Rev 272 = $1,496.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FUCHSIA 2.0 X 12MM,272,RC,,,,,,,,both,,,3588.3700,538.2600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3229.53,,,,,,,926.1600,3588.3700,percent of total billed charges,"90% of $3,588.37 in Billed Charges for Rev 272 = $3,229.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FUCHSIA 2.0 X 12MM,272,RC,,,,,,,,both,,,3588.3700,538.2600,MEDCOST,MEDCOST VHN,1707.71,,,,,,,926.1600,3588.3700,percent of total billed charges,"47.59% of $3,588.37 in Billed Charges for Rev 272 = $1,707.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FUCHSIA 2.0 X 12MM,272,RC,,,,,,,,both,,,3588.3700,538.2600,SENTARA HEALTH,SENTARA HEALTH,926.16,,,,,,,926.1600,3588.3700,percent of total billed charges,"25.81% of $3,588.37 in Billed Charges for Rev 272 = $926.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FUCHSIA 2.0 X 12MM,272,RC,,,,,,,,both,,,3588.3700,538.2600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3588.37,,,,,,,926.1600,3588.3700,percent of total billed charges,"100% of $3,588.37 in Billed Charges for Rev 272 = $3,588.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FUCHSIA 2.0 X 12MM,272,RC,,,,,,,,both,,,3588.3700,538.2600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1794.19,,,,,,,926.1600,3588.3700,percent of total billed charges,"Rev 272 $3,588.37 in Billed Charges at 50% = $1,794.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FUCHSIA 2.0 X 12MM,272,RC,,,,,,,,both,,,3588.3700,538.2600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1159.04,,,,,,,926.1600,3588.3700,other,"32.3% of $3,588.37 in Billed Charges for Rev 272 = $1,159.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL FUCHSIA 2.0 X 12MM,272,RC,,,,,,,,both,,,3588.3700,538.2600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1101.63,,,,,,,926.1600,3588.3700,other,"30.7% of $3,588.37 in Billed Charges for Rev 272 = $1,101.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL FUCHSIA 2.0 X 12MM,272,RC,,,,,,,,both,,,3588.3700,538.2600,UNITED HEALTHCARE,UNITED HEALTHCARE,1159.04,,,,,,,926.1600,3588.3700,percent of total billed charges,"32.3% of $3,588.37 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FUCHSIA 2.0 X 12MM,272,RC,,,,,,,,both,,,3588.3700,538.2600,WELLCARE,WELLCARE MEDICAID,3588.37,,,,,,,926.1600,3588.3700,percent of total billed charges,"100% of $3,588.37 in Billed Charges for Rev 272 = $3,588.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2167.5400,325.1300,AETNA,AETNA,925.54,,,,,,,559.4400,2167.5400,percent of total billed charges,"42.7% of $2,167.54 in Billed Charges for Rev 272 = $925.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2167.5400,325.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1517.28,,,,,,,559.4400,2167.5400,percent of total billed charges,"Rev 272 $2,167.54 in Billed Charges at 70% = $1,517.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2167.5400,325.1300,CIGNA HEALTHCARE,CIGNA HMO,903.86,,,,,,,559.4400,2167.5400,percent of total billed charges,"41.7% of $2,167.54 in Billed Charges for Rev 272 = $903.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2167.5400,325.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1005.74,,,,,,,559.4400,2167.5400,percent of total billed charges,"46.4% of $2,167.54 in Billed Charges for Rev 272 = $1,005.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2167.5400,325.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,903.86,,,,,,,559.4400,2167.5400,percent of total billed charges,"41.7% of $2,167.54 in Billed Charges for Rev 272 = $903.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2167.5400,325.1300,CIGNA HEALTHCARE,CIGNA PPO,903.86,,,,,,,559.4400,2167.5400,percent of total billed charges,"41.7% of $2,167.54 in Billed Charges for Rev 272 = $903.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2167.5400,325.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1950.79,,,,,,,559.4400,2167.5400,percent of total billed charges,"90% of $2,167.54 in Billed Charges for Rev 272 = $1,950.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2167.5400,325.1300,MEDCOST,MEDCOST VHN,1031.53,,,,,,,559.4400,2167.5400,percent of total billed charges,"47.59% of $2,167.54 in Billed Charges for Rev 272 = $1,031.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2167.5400,325.1300,SENTARA HEALTH,SENTARA HEALTH,559.44,,,,,,,559.4400,2167.5400,percent of total billed charges,"25.81% of $2,167.54 in Billed Charges for Rev 272 = $559.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2167.5400,325.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2167.54,,,,,,,559.4400,2167.5400,percent of total billed charges,"100% of $2,167.54 in Billed Charges for Rev 272 = $2,167.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2167.5400,325.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1083.77,,,,,,,559.4400,2167.5400,percent of total billed charges,"Rev 272 $2,167.54 in Billed Charges at 50% = $1,083.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2167.5400,325.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,700.12,,,,,,,559.4400,2167.5400,other,"32.3% of $2,167.54 in Billed Charges for Rev 272 = $700.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2167.5400,325.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,665.43,,,,,,,559.4400,2167.5400,other,"30.7% of $2,167.54 in Billed Charges for Rev 272 = $665.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2167.5400,325.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,700.12,,,,,,,559.4400,2167.5400,percent of total billed charges,"32.3% of $2,167.54 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2167.5400,325.1300,WELLCARE,WELLCARE MEDICAID,2167.54,,,,,,,559.4400,2167.5400,percent of total billed charges,"100% of $2,167.54 in Billed Charges for Rev 272 = $2,167.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.2 X-LONG,272,RC,27200002,CDM,,,,,,both,,,2270.0000,340.5000,AETNA,AETNA,969.29,,,,,,,585.8900,2270.0000,percent of total billed charges,"42.7% of $2,270.00 in Billed Charges for Rev 272 = $969.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.2 X-LONG,272,RC,27200002,CDM,,,,,,both,,,2270.0000,340.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1589.00,,,,,,,585.8900,2270.0000,percent of total billed charges,"Rev 272 $2,270.00 in Billed Charges at 70% = $1,589.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.2 X-LONG,272,RC,27200002,CDM,,,,,,both,,,2270.0000,340.5000,CIGNA HEALTHCARE,CIGNA HMO,946.59,,,,,,,585.8900,2270.0000,percent of total billed charges,"41.7% of $2,270.00 in Billed Charges for Rev 272 = $946.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.2 X-LONG,272,RC,27200002,CDM,,,,,,both,,,2270.0000,340.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1053.28,,,,,,,585.8900,2270.0000,percent of total billed charges,"46.4% of $2,270.00 in Billed Charges for Rev 272 = $1,053.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.2 X-LONG,272,RC,27200002,CDM,,,,,,both,,,2270.0000,340.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,946.59,,,,,,,585.8900,2270.0000,percent of total billed charges,"41.7% of $2,270.00 in Billed Charges for Rev 272 = $946.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.2 X-LONG,272,RC,27200002,CDM,,,,,,both,,,2270.0000,340.5000,CIGNA HEALTHCARE,CIGNA PPO,946.59,,,,,,,585.8900,2270.0000,percent of total billed charges,"41.7% of $2,270.00 in Billed Charges for Rev 272 = $946.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.2 X-LONG,272,RC,27200002,CDM,,,,,,both,,,2270.0000,340.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2043.00,,,,,,,585.8900,2270.0000,percent of total billed charges,"90% of $2,270.00 in Billed Charges for Rev 272 = $2,043.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.2 X-LONG,272,RC,27200002,CDM,,,,,,both,,,2270.0000,340.5000,MEDCOST,MEDCOST VHN,1080.29,,,,,,,585.8900,2270.0000,percent of total billed charges,"47.59% of $2,270.00 in Billed Charges for Rev 272 = $1,080.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.2 X-LONG,272,RC,27200002,CDM,,,,,,both,,,2270.0000,340.5000,SENTARA HEALTH,SENTARA HEALTH,585.89,,,,,,,585.8900,2270.0000,percent of total billed charges,"25.81% of $2,270.00 in Billed Charges for Rev 272 = $585.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.2 X-LONG,272,RC,27200002,CDM,,,,,,both,,,2270.0000,340.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2270.00,,,,,,,585.8900,2270.0000,percent of total billed charges,"100% of $2,270.00 in Billed Charges for Rev 272 = $2,270.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.2 X-LONG,272,RC,27200002,CDM,,,,,,both,,,2270.0000,340.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1135.00,,,,,,,585.8900,2270.0000,percent of total billed charges,"Rev 272 $2,270.00 in Billed Charges at 50% = $1,135.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.2 X-LONG,272,RC,27200002,CDM,,,,,,both,,,2270.0000,340.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,733.21,,,,,,,585.8900,2270.0000,other,"32.3% of $2,270.00 in Billed Charges for Rev 272 = $733.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 4.2 X-LONG,272,RC,27200002,CDM,,,,,,both,,,2270.0000,340.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,696.89,,,,,,,585.8900,2270.0000,other,"30.7% of $2,270.00 in Billed Charges for Rev 272 = $696.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 4.2 X-LONG,272,RC,27200002,CDM,,,,,,both,,,2270.0000,340.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,733.21,,,,,,,585.8900,2270.0000,percent of total billed charges,"32.3% of $2,270.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.2 X-LONG,272,RC,27200002,CDM,,,,,,both,,,2270.0000,340.5000,WELLCARE,WELLCARE MEDICAID,2270.00,,,,,,,585.8900,2270.0000,percent of total billed charges,"100% of $2,270.00 in Billed Charges for Rev 272 = $2,270.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3MM,272,RC,,,,,,,,both,,,2119.4200,317.9100,AETNA,AETNA,904.99,,,,,,,547.0200,2119.4200,percent of total billed charges,"42.7% of $2,119.42 in Billed Charges for Rev 272 = $904.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3MM,272,RC,,,,,,,,both,,,2119.4200,317.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1483.59,,,,,,,547.0200,2119.4200,percent of total billed charges,"Rev 272 $2,119.42 in Billed Charges at 70% = $1,483.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3MM,272,RC,,,,,,,,both,,,2119.4200,317.9100,CIGNA HEALTHCARE,CIGNA HMO,883.80,,,,,,,547.0200,2119.4200,percent of total billed charges,"41.7% of $2,119.42 in Billed Charges for Rev 272 = $883.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3MM,272,RC,,,,,,,,both,,,2119.4200,317.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,983.41,,,,,,,547.0200,2119.4200,percent of total billed charges,"46.4% of $2,119.42 in Billed Charges for Rev 272 = $983.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3MM,272,RC,,,,,,,,both,,,2119.4200,317.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,883.80,,,,,,,547.0200,2119.4200,percent of total billed charges,"41.7% of $2,119.42 in Billed Charges for Rev 272 = $883.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3MM,272,RC,,,,,,,,both,,,2119.4200,317.9100,CIGNA HEALTHCARE,CIGNA PPO,883.80,,,,,,,547.0200,2119.4200,percent of total billed charges,"41.7% of $2,119.42 in Billed Charges for Rev 272 = $883.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3MM,272,RC,,,,,,,,both,,,2119.4200,317.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1907.48,,,,,,,547.0200,2119.4200,percent of total billed charges,"90% of $2,119.42 in Billed Charges for Rev 272 = $1,907.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3MM,272,RC,,,,,,,,both,,,2119.4200,317.9100,MEDCOST,MEDCOST VHN,1008.63,,,,,,,547.0200,2119.4200,percent of total billed charges,"47.59% of $2,119.42 in Billed Charges for Rev 272 = $1,008.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3MM,272,RC,,,,,,,,both,,,2119.4200,317.9100,SENTARA HEALTH,SENTARA HEALTH,547.02,,,,,,,547.0200,2119.4200,percent of total billed charges,"25.81% of $2,119.42 in Billed Charges for Rev 272 = $547.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3MM,272,RC,,,,,,,,both,,,2119.4200,317.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2119.42,,,,,,,547.0200,2119.4200,percent of total billed charges,"100% of $2,119.42 in Billed Charges for Rev 272 = $2,119.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3MM,272,RC,,,,,,,,both,,,2119.4200,317.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1059.71,,,,,,,547.0200,2119.4200,percent of total billed charges,"Rev 272 $2,119.42 in Billed Charges at 50% = $1,059.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3MM,272,RC,,,,,,,,both,,,2119.4200,317.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,684.57,,,,,,,547.0200,2119.4200,other,"32.3% of $2,119.42 in Billed Charges for Rev 272 = $684.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 4.3MM,272,RC,,,,,,,,both,,,2119.4200,317.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.66,,,,,,,547.0200,2119.4200,other,"30.7% of $2,119.42 in Billed Charges for Rev 272 = $650.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 4.3MM,272,RC,,,,,,,,both,,,2119.4200,317.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,684.57,,,,,,,547.0200,2119.4200,percent of total billed charges,"32.3% of $2,119.42 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3MM,272,RC,,,,,,,,both,,,2119.4200,317.9100,WELLCARE,WELLCARE MEDICAID,2119.42,,,,,,,547.0200,2119.4200,percent of total billed charges,"100% of $2,119.42 in Billed Charges for Rev 272 = $2,119.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 110MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1248.5600,187.2800,AETNA,AETNA,533.14,,,,,,,322.2500,1248.5600,percent of total billed charges,"42.7% of $1,248.56 in Billed Charges for Rev 272 = $533.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 110MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1248.5600,187.2800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,873.99,,,,,,,322.2500,1248.5600,percent of total billed charges,"Rev 272 $1,248.56 in Billed Charges at 70% = $873.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 110MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1248.5600,187.2800,CIGNA HEALTHCARE,CIGNA HMO,520.65,,,,,,,322.2500,1248.5600,percent of total billed charges,"41.7% of $1,248.56 in Billed Charges for Rev 272 = $520.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 110MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1248.5600,187.2800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,579.33,,,,,,,322.2500,1248.5600,percent of total billed charges,"46.4% of $1,248.56 in Billed Charges for Rev 272 = $579.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 110MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1248.5600,187.2800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,520.65,,,,,,,322.2500,1248.5600,percent of total billed charges,"41.7% of $1,248.56 in Billed Charges for Rev 272 = $520.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 110MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1248.5600,187.2800,CIGNA HEALTHCARE,CIGNA PPO,520.65,,,,,,,322.2500,1248.5600,percent of total billed charges,"41.7% of $1,248.56 in Billed Charges for Rev 272 = $520.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 110MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1248.5600,187.2800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1123.70,,,,,,,322.2500,1248.5600,percent of total billed charges,"90% of $1,248.56 in Billed Charges for Rev 272 = $1,123.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 110MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1248.5600,187.2800,MEDCOST,MEDCOST VHN,594.19,,,,,,,322.2500,1248.5600,percent of total billed charges,"47.59% of $1,248.56 in Billed Charges for Rev 272 = $594.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 110MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1248.5600,187.2800,SENTARA HEALTH,SENTARA HEALTH,322.25,,,,,,,322.2500,1248.5600,percent of total billed charges,"25.81% of $1,248.56 in Billed Charges for Rev 272 = $322.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 110MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1248.5600,187.2800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1248.56,,,,,,,322.2500,1248.5600,percent of total billed charges,"100% of $1,248.56 in Billed Charges for Rev 272 = $1,248.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 110MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1248.5600,187.2800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,624.28,,,,,,,322.2500,1248.5600,percent of total billed charges,"Rev 272 $1,248.56 in Billed Charges at 50% = $624.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 110MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1248.5600,187.2800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,403.28,,,,,,,322.2500,1248.5600,other,"32.3% of $1,248.56 in Billed Charges for Rev 272 = $403.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK COUPLING 2.0 X 110MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1248.5600,187.2800,UNITED HEALTHCARE,UHC HERITAGE SELECT,383.31,,,,,,,322.2500,1248.5600,other,"30.7% of $1,248.56 in Billed Charges for Rev 272 = $383.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK COUPLING 2.0 X 110MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1248.5600,187.2800,UNITED HEALTHCARE,UNITED HEALTHCARE,403.28,,,,,,,322.2500,1248.5600,percent of total billed charges,"32.3% of $1,248.56 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 110MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1248.5600,187.2800,WELLCARE,WELLCARE MEDICAID,1248.56,,,,,,,322.2500,1248.5600,percent of total billed charges,"100% of $1,248.56 in Billed Charges for Rev 272 = $1,248.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 140MM 60MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1389.2000,208.3800,AETNA,AETNA,593.19,,,,,,,358.5500,1389.2000,percent of total billed charges,"42.7% of $1,389.20 in Billed Charges for Rev 272 = $593.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 140MM 60MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1389.2000,208.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,972.44,,,,,,,358.5500,1389.2000,percent of total billed charges,"Rev 272 $1,389.20 in Billed Charges at 70% = $972.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 140MM 60MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1389.2000,208.3800,CIGNA HEALTHCARE,CIGNA HMO,579.30,,,,,,,358.5500,1389.2000,percent of total billed charges,"41.7% of $1,389.20 in Billed Charges for Rev 272 = $579.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 140MM 60MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1389.2000,208.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,644.59,,,,,,,358.5500,1389.2000,percent of total billed charges,"46.4% of $1,389.20 in Billed Charges for Rev 272 = $644.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 140MM 60MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1389.2000,208.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,579.30,,,,,,,358.5500,1389.2000,percent of total billed charges,"41.7% of $1,389.20 in Billed Charges for Rev 272 = $579.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 140MM 60MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1389.2000,208.3800,CIGNA HEALTHCARE,CIGNA PPO,579.30,,,,,,,358.5500,1389.2000,percent of total billed charges,"41.7% of $1,389.20 in Billed Charges for Rev 272 = $579.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 140MM 60MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1389.2000,208.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1250.28,,,,,,,358.5500,1389.2000,percent of total billed charges,"90% of $1,389.20 in Billed Charges for Rev 272 = $1,250.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 140MM 60MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1389.2000,208.3800,MEDCOST,MEDCOST VHN,661.12,,,,,,,358.5500,1389.2000,percent of total billed charges,"47.59% of $1,389.20 in Billed Charges for Rev 272 = $661.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 140MM 60MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1389.2000,208.3800,SENTARA HEALTH,SENTARA HEALTH,358.55,,,,,,,358.5500,1389.2000,percent of total billed charges,"25.81% of $1,389.20 in Billed Charges for Rev 272 = $358.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 140MM 60MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1389.2000,208.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1389.20,,,,,,,358.5500,1389.2000,percent of total billed charges,"100% of $1,389.20 in Billed Charges for Rev 272 = $1,389.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 140MM 60MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1389.2000,208.3800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,694.60,,,,,,,358.5500,1389.2000,percent of total billed charges,"Rev 272 $1,389.20 in Billed Charges at 50% = $694.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 140MM 60MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1389.2000,208.3800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,448.71,,,,,,,358.5500,1389.2000,other,"32.3% of $1,389.20 in Billed Charges for Rev 272 = $448.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK COUPLING 2.0 X 140MM 60MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1389.2000,208.3800,UNITED HEALTHCARE,UHC HERITAGE SELECT,426.48,,,,,,,358.5500,1389.2000,other,"30.7% of $1,389.20 in Billed Charges for Rev 272 = $426.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK COUPLING 2.0 X 140MM 60MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1389.2000,208.3800,UNITED HEALTHCARE,UNITED HEALTHCARE,448.71,,,,,,,358.5500,1389.2000,percent of total billed charges,"32.3% of $1,389.20 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 140MM 60MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1389.2000,208.3800,WELLCARE,WELLCARE MEDICAID,1389.20,,,,,,,358.5500,1389.2000,percent of total billed charges,"100% of $1,389.20 in Billed Charges for Rev 272 = $1,389.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 150MM,272,RC,,,,,,,,both,,,3541.1800,531.1800,AETNA,AETNA,1512.08,,,,,,,913.9800,3541.1800,percent of total billed charges,"42.7% of $3,541.18 in Billed Charges for Rev 272 = $1,512.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 150MM,272,RC,,,,,,,,both,,,3541.1800,531.1800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2478.83,,,,,,,913.9800,3541.1800,percent of total billed charges,"Rev 272 $3,541.18 in Billed Charges at 70% = $2,478.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 150MM,272,RC,,,,,,,,both,,,3541.1800,531.1800,CIGNA HEALTHCARE,CIGNA HMO,1476.67,,,,,,,913.9800,3541.1800,percent of total billed charges,"41.7% of $3,541.18 in Billed Charges for Rev 272 = $1,476.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 150MM,272,RC,,,,,,,,both,,,3541.1800,531.1800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1643.11,,,,,,,913.9800,3541.1800,percent of total billed charges,"46.4% of $3,541.18 in Billed Charges for Rev 272 = $1,643.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 150MM,272,RC,,,,,,,,both,,,3541.1800,531.1800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1476.67,,,,,,,913.9800,3541.1800,percent of total billed charges,"41.7% of $3,541.18 in Billed Charges for Rev 272 = $1,476.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 150MM,272,RC,,,,,,,,both,,,3541.1800,531.1800,CIGNA HEALTHCARE,CIGNA PPO,1476.67,,,,,,,913.9800,3541.1800,percent of total billed charges,"41.7% of $3,541.18 in Billed Charges for Rev 272 = $1,476.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 150MM,272,RC,,,,,,,,both,,,3541.1800,531.1800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3187.06,,,,,,,913.9800,3541.1800,percent of total billed charges,"90% of $3,541.18 in Billed Charges for Rev 272 = $3,187.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 150MM,272,RC,,,,,,,,both,,,3541.1800,531.1800,MEDCOST,MEDCOST VHN,1685.25,,,,,,,913.9800,3541.1800,percent of total billed charges,"47.59% of $3,541.18 in Billed Charges for Rev 272 = $1,685.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 150MM,272,RC,,,,,,,,both,,,3541.1800,531.1800,SENTARA HEALTH,SENTARA HEALTH,913.98,,,,,,,913.9800,3541.1800,percent of total billed charges,"25.81% of $3,541.18 in Billed Charges for Rev 272 = $913.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 150MM,272,RC,,,,,,,,both,,,3541.1800,531.1800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3541.18,,,,,,,913.9800,3541.1800,percent of total billed charges,"100% of $3,541.18 in Billed Charges for Rev 272 = $3,541.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 150MM,272,RC,,,,,,,,both,,,3541.1800,531.1800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1770.59,,,,,,,913.9800,3541.1800,percent of total billed charges,"Rev 272 $3,541.18 in Billed Charges at 50% = $1,770.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 150MM,272,RC,,,,,,,,both,,,3541.1800,531.1800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1143.80,,,,,,,913.9800,3541.1800,other,"32.3% of $3,541.18 in Billed Charges for Rev 272 = $1,143.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK COUPLING 2.0 X 150MM,272,RC,,,,,,,,both,,,3541.1800,531.1800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1087.14,,,,,,,913.9800,3541.1800,other,"30.7% of $3,541.18 in Billed Charges for Rev 272 = $1,087.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK COUPLING 2.0 X 150MM,272,RC,,,,,,,,both,,,3541.1800,531.1800,UNITED HEALTHCARE,UNITED HEALTHCARE,1143.80,,,,,,,913.9800,3541.1800,percent of total billed charges,"32.3% of $3,541.18 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.0 X 150MM,272,RC,,,,,,,,both,,,3541.1800,531.1800,WELLCARE,WELLCARE MEDICAID,3541.18,,,,,,,913.9800,3541.1800,percent of total billed charges,"100% of $3,541.18 in Billed Charges for Rev 272 = $3,541.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 240MM 150MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1421.0300,213.1500,AETNA,AETNA,606.78,,,,,,,366.7700,1421.0300,percent of total billed charges,"42.7% of $1,421.03 in Billed Charges for Rev 272 = $606.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 240MM 150MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1421.0300,213.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,994.72,,,,,,,366.7700,1421.0300,percent of total billed charges,"Rev 272 $1,421.03 in Billed Charges at 70% = $994.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 240MM 150MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1421.0300,213.1500,CIGNA HEALTHCARE,CIGNA HMO,592.57,,,,,,,366.7700,1421.0300,percent of total billed charges,"41.7% of $1,421.03 in Billed Charges for Rev 272 = $592.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 240MM 150MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1421.0300,213.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,659.36,,,,,,,366.7700,1421.0300,percent of total billed charges,"46.4% of $1,421.03 in Billed Charges for Rev 272 = $659.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 240MM 150MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1421.0300,213.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,592.57,,,,,,,366.7700,1421.0300,percent of total billed charges,"41.7% of $1,421.03 in Billed Charges for Rev 272 = $592.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 240MM 150MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1421.0300,213.1500,CIGNA HEALTHCARE,CIGNA PPO,592.57,,,,,,,366.7700,1421.0300,percent of total billed charges,"41.7% of $1,421.03 in Billed Charges for Rev 272 = $592.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 240MM 150MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1421.0300,213.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1278.93,,,,,,,366.7700,1421.0300,percent of total billed charges,"90% of $1,421.03 in Billed Charges for Rev 272 = $1,278.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 240MM 150MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1421.0300,213.1500,MEDCOST,MEDCOST VHN,676.27,,,,,,,366.7700,1421.0300,percent of total billed charges,"47.59% of $1,421.03 in Billed Charges for Rev 272 = $676.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 240MM 150MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1421.0300,213.1500,SENTARA HEALTH,SENTARA HEALTH,366.77,,,,,,,366.7700,1421.0300,percent of total billed charges,"25.81% of $1,421.03 in Billed Charges for Rev 272 = $366.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 240MM 150MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1421.0300,213.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1421.03,,,,,,,366.7700,1421.0300,percent of total billed charges,"100% of $1,421.03 in Billed Charges for Rev 272 = $1,421.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 240MM 150MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1421.0300,213.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,710.52,,,,,,,366.7700,1421.0300,percent of total billed charges,"Rev 272 $1,421.03 in Billed Charges at 50% = $710.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 240MM 150MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1421.0300,213.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,458.99,,,,,,,366.7700,1421.0300,other,"32.3% of $1,421.03 in Billed Charges for Rev 272 = $458.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK COUPLING 2.5 X 240MM 150MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1421.0300,213.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,436.26,,,,,,,366.7700,1421.0300,other,"30.7% of $1,421.03 in Billed Charges for Rev 272 = $436.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK COUPLING 2.5 X 240MM 150MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1421.0300,213.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,458.99,,,,,,,366.7700,1421.0300,percent of total billed charges,"32.3% of $1,421.03 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 240MM 150MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1421.0300,213.1500,WELLCARE,WELLCARE MEDICAID,1421.03,,,,,,,366.7700,1421.0300,percent of total billed charges,"100% of $1,421.03 in Billed Charges for Rev 272 = $1,421.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 250MM 95MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1103.2700,165.4900,AETNA,AETNA,471.10,,,,,,,284.7500,1103.2700,percent of total billed charges,"42.7% of $1,103.27 in Billed Charges for Rev 272 = $471.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 250MM 95MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1103.2700,165.4900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,772.29,,,,,,,284.7500,1103.2700,percent of total billed charges,"Rev 272 $1,103.27 in Billed Charges at 70% = $772.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 250MM 95MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1103.2700,165.4900,CIGNA HEALTHCARE,CIGNA HMO,460.06,,,,,,,284.7500,1103.2700,percent of total billed charges,"41.7% of $1,103.27 in Billed Charges for Rev 272 = $460.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 250MM 95MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1103.2700,165.4900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,511.92,,,,,,,284.7500,1103.2700,percent of total billed charges,"46.4% of $1,103.27 in Billed Charges for Rev 272 = $511.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 250MM 95MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1103.2700,165.4900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,460.06,,,,,,,284.7500,1103.2700,percent of total billed charges,"41.7% of $1,103.27 in Billed Charges for Rev 272 = $460.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 250MM 95MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1103.2700,165.4900,CIGNA HEALTHCARE,CIGNA PPO,460.06,,,,,,,284.7500,1103.2700,percent of total billed charges,"41.7% of $1,103.27 in Billed Charges for Rev 272 = $460.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 250MM 95MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1103.2700,165.4900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,992.94,,,,,,,284.7500,1103.2700,percent of total billed charges,"90% of $1,103.27 in Billed Charges for Rev 272 = $992.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 250MM 95MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1103.2700,165.4900,MEDCOST,MEDCOST VHN,525.05,,,,,,,284.7500,1103.2700,percent of total billed charges,"47.59% of $1,103.27 in Billed Charges for Rev 272 = $525.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 250MM 95MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1103.2700,165.4900,SENTARA HEALTH,SENTARA HEALTH,284.75,,,,,,,284.7500,1103.2700,percent of total billed charges,"25.81% of $1,103.27 in Billed Charges for Rev 272 = $284.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 250MM 95MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1103.2700,165.4900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1103.27,,,,,,,284.7500,1103.2700,percent of total billed charges,"100% of $1,103.27 in Billed Charges for Rev 272 = $1,103.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 250MM 95MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1103.2700,165.4900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,551.64,,,,,,,284.7500,1103.2700,percent of total billed charges,"Rev 272 $1,103.27 in Billed Charges at 50% = $551.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 250MM 95MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1103.2700,165.4900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,356.36,,,,,,,284.7500,1103.2700,other,"32.3% of $1,103.27 in Billed Charges for Rev 272 = $356.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK COUPLING 2.5 X 250MM 95MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1103.2700,165.4900,UNITED HEALTHCARE,UHC HERITAGE SELECT,338.70,,,,,,,284.7500,1103.2700,other,"30.7% of $1,103.27 in Billed Charges for Rev 272 = $338.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK COUPLING 2.5 X 250MM 95MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1103.2700,165.4900,UNITED HEALTHCARE,UNITED HEALTHCARE,356.36,,,,,,,284.7500,1103.2700,percent of total billed charges,"32.3% of $1,103.27 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 250MM 95MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1103.2700,165.4900,WELLCARE,WELLCARE MEDICAID,1103.27,,,,,,,284.7500,1103.2700,percent of total billed charges,"100% of $1,103.27 in Billed Charges for Rev 272 = $1,103.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.7 X 100MM,272,RC,27200002,CDM,,,,,,both,,,658.3500,98.7500,AETNA,AETNA,281.12,,,,,,,169.9200,658.3500,percent of total billed charges,42.7% of $658.35 in Billed Charges for Rev 272 = $281.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 100MM,272,RC,27200002,CDM,,,,,,both,,,658.3500,98.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,460.85,,,,,,,169.9200,658.3500,percent of total billed charges,Rev 272 $658.35 in Billed Charges at 70% = $460.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 100MM,272,RC,27200002,CDM,,,,,,both,,,658.3500,98.7500,CIGNA HEALTHCARE,CIGNA HMO,274.53,,,,,,,169.9200,658.3500,percent of total billed charges,41.7% of $658.35 in Billed Charges for Rev 272 = $274.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 100MM,272,RC,27200002,CDM,,,,,,both,,,658.3500,98.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,305.47,,,,,,,169.9200,658.3500,percent of total billed charges,46.4% of $658.35 in Billed Charges for Rev 272 = $305.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 100MM,272,RC,27200002,CDM,,,,,,both,,,658.3500,98.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,274.53,,,,,,,169.9200,658.3500,percent of total billed charges,41.7% of $658.35 in Billed Charges for Rev 272 = $274.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 100MM,272,RC,27200002,CDM,,,,,,both,,,658.3500,98.7500,CIGNA HEALTHCARE,CIGNA PPO,274.53,,,,,,,169.9200,658.3500,percent of total billed charges,41.7% of $658.35 in Billed Charges for Rev 272 = $274.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 100MM,272,RC,27200002,CDM,,,,,,both,,,658.3500,98.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,592.52,,,,,,,169.9200,658.3500,percent of total billed charges,90% of $658.35 in Billed Charges for Rev 272 = $592.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 100MM,272,RC,27200002,CDM,,,,,,both,,,658.3500,98.7500,MEDCOST,MEDCOST VHN,313.31,,,,,,,169.9200,658.3500,percent of total billed charges,47.59% of $658.35 in Billed Charges for Rev 272 = $313.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 100MM,272,RC,27200002,CDM,,,,,,both,,,658.3500,98.7500,SENTARA HEALTH,SENTARA HEALTH,169.92,,,,,,,169.9200,658.3500,percent of total billed charges,25.81% of $658.35 in Billed Charges for Rev 272 = $169.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 100MM,272,RC,27200002,CDM,,,,,,both,,,658.3500,98.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",658.35,,,,,,,169.9200,658.3500,percent of total billed charges,100% of $658.35 in Billed Charges for Rev 272 = $658.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 100MM,272,RC,27200002,CDM,,,,,,both,,,658.3500,98.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,329.18,,,,,,,169.9200,658.3500,percent of total billed charges,Rev 272 $658.35 in Billed Charges at 50% = $329.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 100MM,272,RC,27200002,CDM,,,,,,both,,,658.3500,98.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,212.65,,,,,,,169.9200,658.3500,other,32.3% of $658.35 in Billed Charges for Rev 272 = $212.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL QUICK COUPLING 2.7 X 100MM,272,RC,27200002,CDM,,,,,,both,,,658.3500,98.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,202.11,,,,,,,169.9200,658.3500,other,30.7% of $658.35 in Billed Charges for Rev 272 = $202.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL QUICK COUPLING 2.7 X 100MM,272,RC,27200002,CDM,,,,,,both,,,658.3500,98.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,212.65,,,,,,,169.9200,658.3500,percent of total billed charges,32.3% of $658.35 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 100MM,272,RC,27200002,CDM,,,,,,both,,,658.3500,98.7500,WELLCARE,WELLCARE MEDICAID,658.35,,,,,,,169.9200,658.3500,percent of total billed charges,100% of $658.35 in Billed Charges for Rev 272 = $658.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,762.6800,114.4000,AETNA,AETNA,325.66,,,,,,,196.8500,762.6800,percent of total billed charges,42.7% of $762.68 in Billed Charges for Rev 272 = $325.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,762.6800,114.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,533.88,,,,,,,196.8500,762.6800,percent of total billed charges,Rev 272 $762.68 in Billed Charges at 70% = $533.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,762.6800,114.4000,CIGNA HEALTHCARE,CIGNA HMO,318.04,,,,,,,196.8500,762.6800,percent of total billed charges,41.7% of $762.68 in Billed Charges for Rev 272 = $318.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,762.6800,114.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,353.88,,,,,,,196.8500,762.6800,percent of total billed charges,46.4% of $762.68 in Billed Charges for Rev 272 = $353.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,762.6800,114.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,318.04,,,,,,,196.8500,762.6800,percent of total billed charges,41.7% of $762.68 in Billed Charges for Rev 272 = $318.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,762.6800,114.4000,CIGNA HEALTHCARE,CIGNA PPO,318.04,,,,,,,196.8500,762.6800,percent of total billed charges,41.7% of $762.68 in Billed Charges for Rev 272 = $318.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,762.6800,114.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,686.41,,,,,,,196.8500,762.6800,percent of total billed charges,90% of $762.68 in Billed Charges for Rev 272 = $686.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,762.6800,114.4000,MEDCOST,MEDCOST VHN,362.96,,,,,,,196.8500,762.6800,percent of total billed charges,47.59% of $762.68 in Billed Charges for Rev 272 = $362.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,762.6800,114.4000,SENTARA HEALTH,SENTARA HEALTH,196.85,,,,,,,196.8500,762.6800,percent of total billed charges,25.81% of $762.68 in Billed Charges for Rev 272 = $196.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,762.6800,114.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",762.68,,,,,,,196.8500,762.6800,percent of total billed charges,100% of $762.68 in Billed Charges for Rev 272 = $762.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,762.6800,114.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,381.34,,,,,,,196.8500,762.6800,percent of total billed charges,Rev 272 $762.68 in Billed Charges at 50% = $381.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,762.6800,114.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,246.35,,,,,,,196.8500,762.6800,other,32.3% of $762.68 in Billed Charges for Rev 272 = $246.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL QUICK COUPLING 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,762.6800,114.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,234.14,,,,,,,196.8500,762.6800,other,30.7% of $762.68 in Billed Charges for Rev 272 = $234.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL QUICK COUPLING 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,762.6800,114.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,246.35,,,,,,,196.8500,762.6800,percent of total billed charges,32.3% of $762.68 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.8 X 165MM,272,RC,27200002,CDM,,,,,,both,,,762.6800,114.4000,WELLCARE,WELLCARE MEDICAID,762.68,,,,,,,196.8500,762.6800,percent of total billed charges,100% of $762.68 in Billed Charges for Rev 272 = $762.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.8 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1312.0400,196.8100,AETNA,AETNA,560.24,,,,,,,338.6400,1312.0400,percent of total billed charges,"42.7% of $1,312.04 in Billed Charges for Rev 272 = $560.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1312.0400,196.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,918.43,,,,,,,338.6400,1312.0400,percent of total billed charges,"Rev 272 $1,312.04 in Billed Charges at 70% = $918.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1312.0400,196.8100,CIGNA HEALTHCARE,CIGNA HMO,547.12,,,,,,,338.6400,1312.0400,percent of total billed charges,"41.7% of $1,312.04 in Billed Charges for Rev 272 = $547.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1312.0400,196.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,608.79,,,,,,,338.6400,1312.0400,percent of total billed charges,"46.4% of $1,312.04 in Billed Charges for Rev 272 = $608.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1312.0400,196.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,547.12,,,,,,,338.6400,1312.0400,percent of total billed charges,"41.7% of $1,312.04 in Billed Charges for Rev 272 = $547.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1312.0400,196.8100,CIGNA HEALTHCARE,CIGNA PPO,547.12,,,,,,,338.6400,1312.0400,percent of total billed charges,"41.7% of $1,312.04 in Billed Charges for Rev 272 = $547.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1312.0400,196.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1180.84,,,,,,,338.6400,1312.0400,percent of total billed charges,"90% of $1,312.04 in Billed Charges for Rev 272 = $1,180.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1312.0400,196.8100,MEDCOST,MEDCOST VHN,624.40,,,,,,,338.6400,1312.0400,percent of total billed charges,"47.59% of $1,312.04 in Billed Charges for Rev 272 = $624.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1312.0400,196.8100,SENTARA HEALTH,SENTARA HEALTH,338.64,,,,,,,338.6400,1312.0400,percent of total billed charges,"25.81% of $1,312.04 in Billed Charges for Rev 272 = $338.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1312.0400,196.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1312.04,,,,,,,338.6400,1312.0400,percent of total billed charges,"100% of $1,312.04 in Billed Charges for Rev 272 = $1,312.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1312.0400,196.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,656.02,,,,,,,338.6400,1312.0400,percent of total billed charges,"Rev 272 $1,312.04 in Billed Charges at 50% = $656.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1312.0400,196.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,423.79,,,,,,,338.6400,1312.0400,other,"32.3% of $1,312.04 in Billed Charges for Rev 272 = $423.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK COUPLING 2.8 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1312.0400,196.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,402.80,,,,,,,338.6400,1312.0400,other,"30.7% of $1,312.04 in Billed Charges for Rev 272 = $402.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK COUPLING 2.8 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1312.0400,196.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,423.79,,,,,,,338.6400,1312.0400,percent of total billed charges,"32.3% of $1,312.04 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1312.0400,196.8100,WELLCARE,WELLCARE MEDICAID,1312.04,,,,,,,338.6400,1312.0400,percent of total billed charges,"100% of $1,312.04 in Billed Charges for Rev 272 = $1,312.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 200MM 110MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1402.8900,210.4300,AETNA,AETNA,599.03,,,,,,,362.0900,1402.8900,percent of total billed charges,"42.7% of $1,402.89 in Billed Charges for Rev 272 = $599.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 200MM 110MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1402.8900,210.4300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,982.02,,,,,,,362.0900,1402.8900,percent of total billed charges,"Rev 272 $1,402.89 in Billed Charges at 70% = $982.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 200MM 110MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1402.8900,210.4300,CIGNA HEALTHCARE,CIGNA HMO,585.01,,,,,,,362.0900,1402.8900,percent of total billed charges,"41.7% of $1,402.89 in Billed Charges for Rev 272 = $585.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 200MM 110MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1402.8900,210.4300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,650.94,,,,,,,362.0900,1402.8900,percent of total billed charges,"46.4% of $1,402.89 in Billed Charges for Rev 272 = $650.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 200MM 110MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1402.8900,210.4300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,585.01,,,,,,,362.0900,1402.8900,percent of total billed charges,"41.7% of $1,402.89 in Billed Charges for Rev 272 = $585.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 200MM 110MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1402.8900,210.4300,CIGNA HEALTHCARE,CIGNA PPO,585.01,,,,,,,362.0900,1402.8900,percent of total billed charges,"41.7% of $1,402.89 in Billed Charges for Rev 272 = $585.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 200MM 110MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1402.8900,210.4300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1262.60,,,,,,,362.0900,1402.8900,percent of total billed charges,"90% of $1,402.89 in Billed Charges for Rev 272 = $1,262.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 200MM 110MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1402.8900,210.4300,MEDCOST,MEDCOST VHN,667.64,,,,,,,362.0900,1402.8900,percent of total billed charges,"47.59% of $1,402.89 in Billed Charges for Rev 272 = $667.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 200MM 110MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1402.8900,210.4300,SENTARA HEALTH,SENTARA HEALTH,362.09,,,,,,,362.0900,1402.8900,percent of total billed charges,"25.81% of $1,402.89 in Billed Charges for Rev 272 = $362.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 200MM 110MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1402.8900,210.4300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1402.89,,,,,,,362.0900,1402.8900,percent of total billed charges,"100% of $1,402.89 in Billed Charges for Rev 272 = $1,402.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 200MM 110MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1402.8900,210.4300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,701.45,,,,,,,362.0900,1402.8900,percent of total billed charges,"Rev 272 $1,402.89 in Billed Charges at 50% = $701.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 200MM 110MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1402.8900,210.4300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,453.13,,,,,,,362.0900,1402.8900,other,"32.3% of $1,402.89 in Billed Charges for Rev 272 = $453.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK COUPLING 2.8 X 200MM 110MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1402.8900,210.4300,UNITED HEALTHCARE,UHC HERITAGE SELECT,430.69,,,,,,,362.0900,1402.8900,other,"30.7% of $1,402.89 in Billed Charges for Rev 272 = $430.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK COUPLING 2.8 X 200MM 110MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1402.8900,210.4300,UNITED HEALTHCARE,UNITED HEALTHCARE,453.13,,,,,,,362.0900,1402.8900,percent of total billed charges,"32.3% of $1,402.89 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.8 X 200MM 110MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1402.8900,210.4300,WELLCARE,WELLCARE MEDICAID,1402.89,,,,,,,362.0900,1402.8900,percent of total billed charges,"100% of $1,402.89 in Billed Charges for Rev 272 = $1,402.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3X195MM,272,RC,,,,,,,,both,,,1070.2900,160.5400,AETNA,AETNA,457.01,,,,,,,276.2400,1070.2900,percent of total billed charges,"42.7% of $1,070.29 in Billed Charges for Rev 272 = $457.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3X195MM,272,RC,,,,,,,,both,,,1070.2900,160.5400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,749.20,,,,,,,276.2400,1070.2900,percent of total billed charges,"Rev 272 $1,070.29 in Billed Charges at 70% = $749.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3X195MM,272,RC,,,,,,,,both,,,1070.2900,160.5400,CIGNA HEALTHCARE,CIGNA HMO,446.31,,,,,,,276.2400,1070.2900,percent of total billed charges,"41.7% of $1,070.29 in Billed Charges for Rev 272 = $446.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3X195MM,272,RC,,,,,,,,both,,,1070.2900,160.5400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,496.61,,,,,,,276.2400,1070.2900,percent of total billed charges,"46.4% of $1,070.29 in Billed Charges for Rev 272 = $496.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3X195MM,272,RC,,,,,,,,both,,,1070.2900,160.5400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,446.31,,,,,,,276.2400,1070.2900,percent of total billed charges,"41.7% of $1,070.29 in Billed Charges for Rev 272 = $446.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3X195MM,272,RC,,,,,,,,both,,,1070.2900,160.5400,CIGNA HEALTHCARE,CIGNA PPO,446.31,,,,,,,276.2400,1070.2900,percent of total billed charges,"41.7% of $1,070.29 in Billed Charges for Rev 272 = $446.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3X195MM,272,RC,,,,,,,,both,,,1070.2900,160.5400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,963.26,,,,,,,276.2400,1070.2900,percent of total billed charges,"90% of $1,070.29 in Billed Charges for Rev 272 = $963.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3X195MM,272,RC,,,,,,,,both,,,1070.2900,160.5400,MEDCOST,MEDCOST VHN,509.35,,,,,,,276.2400,1070.2900,percent of total billed charges,"47.59% of $1,070.29 in Billed Charges for Rev 272 = $509.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3X195MM,272,RC,,,,,,,,both,,,1070.2900,160.5400,SENTARA HEALTH,SENTARA HEALTH,276.24,,,,,,,276.2400,1070.2900,percent of total billed charges,"25.81% of $1,070.29 in Billed Charges for Rev 272 = $276.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3X195MM,272,RC,,,,,,,,both,,,1070.2900,160.5400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1070.29,,,,,,,276.2400,1070.2900,percent of total billed charges,"100% of $1,070.29 in Billed Charges for Rev 272 = $1,070.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3X195MM,272,RC,,,,,,,,both,,,1070.2900,160.5400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,535.15,,,,,,,276.2400,1070.2900,percent of total billed charges,"Rev 272 $1,070.29 in Billed Charges at 50% = $535.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3X195MM,272,RC,,,,,,,,both,,,1070.2900,160.5400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,345.70,,,,,,,276.2400,1070.2900,other,"32.3% of $1,070.29 in Billed Charges for Rev 272 = $345.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 4.3X195MM,272,RC,,,,,,,,both,,,1070.2900,160.5400,UNITED HEALTHCARE,UHC HERITAGE SELECT,328.58,,,,,,,276.2400,1070.2900,other,"30.7% of $1,070.29 in Billed Charges for Rev 272 = $328.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 4.3X195MM,272,RC,,,,,,,,both,,,1070.2900,160.5400,UNITED HEALTHCARE,UNITED HEALTHCARE,345.70,,,,,,,276.2400,1070.2900,percent of total billed charges,"32.3% of $1,070.29 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 4.3X195MM,272,RC,,,,,,,,both,,,1070.2900,160.5400,WELLCARE,WELLCARE MEDICAID,1070.29,,,,,,,276.2400,1070.2900,percent of total billed charges,"100% of $1,070.29 in Billed Charges for Rev 272 = $1,070.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REMOVABLE PENTALOBE,272,RC,,,,,,,,both,,,3059.4500,458.9200,AETNA,AETNA,1306.39,,,,,,,789.6400,3059.4500,percent of total billed charges,"42.7% of $3,059.45 in Billed Charges for Rev 272 = $1,306.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REMOVABLE PENTALOBE,272,RC,,,,,,,,both,,,3059.4500,458.9200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2141.62,,,,,,,789.6400,3059.4500,percent of total billed charges,"Rev 272 $3,059.45 in Billed Charges at 70% = $2,141.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REMOVABLE PENTALOBE,272,RC,,,,,,,,both,,,3059.4500,458.9200,CIGNA HEALTHCARE,CIGNA HMO,1275.79,,,,,,,789.6400,3059.4500,percent of total billed charges,"41.7% of $3,059.45 in Billed Charges for Rev 272 = $1,275.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REMOVABLE PENTALOBE,272,RC,,,,,,,,both,,,3059.4500,458.9200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1419.58,,,,,,,789.6400,3059.4500,percent of total billed charges,"46.4% of $3,059.45 in Billed Charges for Rev 272 = $1,419.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REMOVABLE PENTALOBE,272,RC,,,,,,,,both,,,3059.4500,458.9200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1275.79,,,,,,,789.6400,3059.4500,percent of total billed charges,"41.7% of $3,059.45 in Billed Charges for Rev 272 = $1,275.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REMOVABLE PENTALOBE,272,RC,,,,,,,,both,,,3059.4500,458.9200,CIGNA HEALTHCARE,CIGNA PPO,1275.79,,,,,,,789.6400,3059.4500,percent of total billed charges,"41.7% of $3,059.45 in Billed Charges for Rev 272 = $1,275.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REMOVABLE PENTALOBE,272,RC,,,,,,,,both,,,3059.4500,458.9200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2753.51,,,,,,,789.6400,3059.4500,percent of total billed charges,"90% of $3,059.45 in Billed Charges for Rev 272 = $2,753.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REMOVABLE PENTALOBE,272,RC,,,,,,,,both,,,3059.4500,458.9200,MEDCOST,MEDCOST VHN,1455.99,,,,,,,789.6400,3059.4500,percent of total billed charges,"47.59% of $3,059.45 in Billed Charges for Rev 272 = $1,455.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REMOVABLE PENTALOBE,272,RC,,,,,,,,both,,,3059.4500,458.9200,SENTARA HEALTH,SENTARA HEALTH,789.64,,,,,,,789.6400,3059.4500,percent of total billed charges,"25.81% of $3,059.45 in Billed Charges for Rev 272 = $789.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REMOVABLE PENTALOBE,272,RC,,,,,,,,both,,,3059.4500,458.9200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3059.45,,,,,,,789.6400,3059.4500,percent of total billed charges,"100% of $3,059.45 in Billed Charges for Rev 272 = $3,059.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REMOVABLE PENTALOBE,272,RC,,,,,,,,both,,,3059.4500,458.9200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1529.73,,,,,,,789.6400,3059.4500,percent of total billed charges,"Rev 272 $3,059.45 in Billed Charges at 50% = $1,529.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REMOVABLE PENTALOBE,272,RC,,,,,,,,both,,,3059.4500,458.9200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,988.20,,,,,,,789.6400,3059.4500,other,"32.3% of $3,059.45 in Billed Charges for Rev 272 = $988.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT REMOVABLE PENTALOBE,272,RC,,,,,,,,both,,,3059.4500,458.9200,UNITED HEALTHCARE,UHC HERITAGE SELECT,939.25,,,,,,,789.6400,3059.4500,other,"30.7% of $3,059.45 in Billed Charges for Rev 272 = $939.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT REMOVABLE PENTALOBE,272,RC,,,,,,,,both,,,3059.4500,458.9200,UNITED HEALTHCARE,UNITED HEALTHCARE,988.20,,,,,,,789.6400,3059.4500,percent of total billed charges,"32.3% of $3,059.45 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REMOVABLE PENTALOBE,272,RC,,,,,,,,both,,,3059.4500,458.9200,WELLCARE,WELLCARE MEDICAID,3059.45,,,,,,,789.6400,3059.4500,percent of total billed charges,"100% of $3,059.45 in Billed Charges for Rev 272 = $3,059.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT TRI LOBE,272,RC,27200002,CDM,,,,,,both,,,5040.3100,756.0500,AETNA,AETNA,2152.21,,,,,,,1300.9000,5040.3100,percent of total billed charges,"42.7% of $5,040.31 in Billed Charges for Rev 272 = $2,152.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT TRI LOBE,272,RC,27200002,CDM,,,,,,both,,,5040.3100,756.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3528.22,,,,,,,1300.9000,5040.3100,percent of total billed charges,"Rev 272 $5,040.31 in Billed Charges at 70% = $3,528.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT TRI LOBE,272,RC,27200002,CDM,,,,,,both,,,5040.3100,756.0500,CIGNA HEALTHCARE,CIGNA HMO,2101.81,,,,,,,1300.9000,5040.3100,percent of total billed charges,"41.7% of $5,040.31 in Billed Charges for Rev 272 = $2,101.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT TRI LOBE,272,RC,27200002,CDM,,,,,,both,,,5040.3100,756.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2338.70,,,,,,,1300.9000,5040.3100,percent of total billed charges,"46.4% of $5,040.31 in Billed Charges for Rev 272 = $2,338.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT TRI LOBE,272,RC,27200002,CDM,,,,,,both,,,5040.3100,756.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2101.81,,,,,,,1300.9000,5040.3100,percent of total billed charges,"41.7% of $5,040.31 in Billed Charges for Rev 272 = $2,101.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT TRI LOBE,272,RC,27200002,CDM,,,,,,both,,,5040.3100,756.0500,CIGNA HEALTHCARE,CIGNA PPO,2101.81,,,,,,,1300.9000,5040.3100,percent of total billed charges,"41.7% of $5,040.31 in Billed Charges for Rev 272 = $2,101.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT TRI LOBE,272,RC,27200002,CDM,,,,,,both,,,5040.3100,756.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4536.28,,,,,,,1300.9000,5040.3100,percent of total billed charges,"90% of $5,040.31 in Billed Charges for Rev 272 = $4,536.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT TRI LOBE,272,RC,27200002,CDM,,,,,,both,,,5040.3100,756.0500,MEDCOST,MEDCOST VHN,2398.68,,,,,,,1300.9000,5040.3100,percent of total billed charges,"47.59% of $5,040.31 in Billed Charges for Rev 272 = $2,398.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT TRI LOBE,272,RC,27200002,CDM,,,,,,both,,,5040.3100,756.0500,SENTARA HEALTH,SENTARA HEALTH,1300.90,,,,,,,1300.9000,5040.3100,percent of total billed charges,"25.81% of $5,040.31 in Billed Charges for Rev 272 = $1,300.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT TRI LOBE,272,RC,27200002,CDM,,,,,,both,,,5040.3100,756.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5040.31,,,,,,,1300.9000,5040.3100,percent of total billed charges,"100% of $5,040.31 in Billed Charges for Rev 272 = $5,040.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT TRI LOBE,272,RC,27200002,CDM,,,,,,both,,,5040.3100,756.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2520.16,,,,,,,1300.9000,5040.3100,percent of total billed charges,"Rev 272 $5,040.31 in Billed Charges at 50% = $2,520.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT TRI LOBE,272,RC,27200002,CDM,,,,,,both,,,5040.3100,756.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1628.02,,,,,,,1300.9000,5040.3100,other,"32.3% of $5,040.31 in Billed Charges for Rev 272 = $1,628.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT TRI LOBE,272,RC,27200002,CDM,,,,,,both,,,5040.3100,756.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1547.38,,,,,,,1300.9000,5040.3100,other,"30.7% of $5,040.31 in Billed Charges for Rev 272 = $1,547.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT TRI LOBE,272,RC,27200002,CDM,,,,,,both,,,5040.3100,756.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,1628.02,,,,,,,1300.9000,5040.3100,percent of total billed charges,"32.3% of $5,040.31 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT TRI LOBE,272,RC,27200002,CDM,,,,,,both,,,5040.3100,756.0500,WELLCARE,WELLCARE MEDICAID,5040.31,,,,,,,1300.9000,5040.3100,percent of total billed charges,"100% of $5,040.31 in Billed Charges for Rev 272 = $5,040.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT TWIST DRILL 2.4MM (3/32),272,RC,,,,,,,,both,,,605.0400,90.7600,AETNA,AETNA,258.35,,,,,,,156.1600,605.0400,percent of total billed charges,42.7% of $605.04 in Billed Charges for Rev 272 = $258.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT TWIST DRILL 2.4MM (3/32),272,RC,,,,,,,,both,,,605.0400,90.7600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,423.53,,,,,,,156.1600,605.0400,percent of total billed charges,Rev 272 $605.04 in Billed Charges at 70% = $423.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT TWIST DRILL 2.4MM (3/32),272,RC,,,,,,,,both,,,605.0400,90.7600,CIGNA HEALTHCARE,CIGNA HMO,252.30,,,,,,,156.1600,605.0400,percent of total billed charges,41.7% of $605.04 in Billed Charges for Rev 272 = $252.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT TWIST DRILL 2.4MM (3/32),272,RC,,,,,,,,both,,,605.0400,90.7600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,280.74,,,,,,,156.1600,605.0400,percent of total billed charges,46.4% of $605.04 in Billed Charges for Rev 272 = $280.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT TWIST DRILL 2.4MM (3/32),272,RC,,,,,,,,both,,,605.0400,90.7600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,252.30,,,,,,,156.1600,605.0400,percent of total billed charges,41.7% of $605.04 in Billed Charges for Rev 272 = $252.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT TWIST DRILL 2.4MM (3/32),272,RC,,,,,,,,both,,,605.0400,90.7600,CIGNA HEALTHCARE,CIGNA PPO,252.30,,,,,,,156.1600,605.0400,percent of total billed charges,41.7% of $605.04 in Billed Charges for Rev 272 = $252.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT TWIST DRILL 2.4MM (3/32),272,RC,,,,,,,,both,,,605.0400,90.7600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,544.54,,,,,,,156.1600,605.0400,percent of total billed charges,90% of $605.04 in Billed Charges for Rev 272 = $544.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT TWIST DRILL 2.4MM (3/32),272,RC,,,,,,,,both,,,605.0400,90.7600,MEDCOST,MEDCOST VHN,287.94,,,,,,,156.1600,605.0400,percent of total billed charges,47.59% of $605.04 in Billed Charges for Rev 272 = $287.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT TWIST DRILL 2.4MM (3/32),272,RC,,,,,,,,both,,,605.0400,90.7600,SENTARA HEALTH,SENTARA HEALTH,156.16,,,,,,,156.1600,605.0400,percent of total billed charges,25.81% of $605.04 in Billed Charges for Rev 272 = $156.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT TWIST DRILL 2.4MM (3/32),272,RC,,,,,,,,both,,,605.0400,90.7600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",605.04,,,,,,,156.1600,605.0400,percent of total billed charges,100% of $605.04 in Billed Charges for Rev 272 = $605.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT TWIST DRILL 2.4MM (3/32),272,RC,,,,,,,,both,,,605.0400,90.7600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,302.52,,,,,,,156.1600,605.0400,percent of total billed charges,Rev 272 $605.04 in Billed Charges at 50% = $302.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT TWIST DRILL 2.4MM (3/32),272,RC,,,,,,,,both,,,605.0400,90.7600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,195.43,,,,,,,156.1600,605.0400,other,32.3% of $605.04 in Billed Charges for Rev 272 = $195.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT TWIST DRILL 2.4MM (3/32),272,RC,,,,,,,,both,,,605.0400,90.7600,UNITED HEALTHCARE,UHC HERITAGE SELECT,185.75,,,,,,,156.1600,605.0400,other,30.7% of $605.04 in Billed Charges for Rev 272 = $185.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT TWIST DRILL 2.4MM (3/32),272,RC,,,,,,,,both,,,605.0400,90.7600,UNITED HEALTHCARE,UNITED HEALTHCARE,195.43,,,,,,,156.1600,605.0400,percent of total billed charges,32.3% of $605.04 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT TWIST DRILL 2.4MM (3/32),272,RC,,,,,,,,both,,,605.0400,90.7600,WELLCARE,WELLCARE MEDICAID,605.04,,,,,,,156.1600,605.0400,percent of total billed charges,100% of $605.04 in Billed Charges for Rev 272 = $605.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BITER NANO ELEVATOR ARTHROSCOPY 10CM X 130MM,272,RC,27200002,CDM,,,,,,both,,,4583.9800,687.6000,AETNA,AETNA,1957.36,,,,,,,1183.1300,4583.9800,percent of total billed charges,"42.7% of $4,583.98 in Billed Charges for Rev 272 = $1,957.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BITER NANO ELEVATOR ARTHROSCOPY 10CM X 130MM,272,RC,27200002,CDM,,,,,,both,,,4583.9800,687.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3208.79,,,,,,,1183.1300,4583.9800,percent of total billed charges,"Rev 272 $4,583.98 in Billed Charges at 70% = $3,208.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BITER NANO ELEVATOR ARTHROSCOPY 10CM X 130MM,272,RC,27200002,CDM,,,,,,both,,,4583.9800,687.6000,CIGNA HEALTHCARE,CIGNA HMO,1911.52,,,,,,,1183.1300,4583.9800,percent of total billed charges,"41.7% of $4,583.98 in Billed Charges for Rev 272 = $1,911.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BITER NANO ELEVATOR ARTHROSCOPY 10CM X 130MM,272,RC,27200002,CDM,,,,,,both,,,4583.9800,687.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2126.97,,,,,,,1183.1300,4583.9800,percent of total billed charges,"46.4% of $4,583.98 in Billed Charges for Rev 272 = $2,126.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BITER NANO ELEVATOR ARTHROSCOPY 10CM X 130MM,272,RC,27200002,CDM,,,,,,both,,,4583.9800,687.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1911.52,,,,,,,1183.1300,4583.9800,percent of total billed charges,"41.7% of $4,583.98 in Billed Charges for Rev 272 = $1,911.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BITER NANO ELEVATOR ARTHROSCOPY 10CM X 130MM,272,RC,27200002,CDM,,,,,,both,,,4583.9800,687.6000,CIGNA HEALTHCARE,CIGNA PPO,1911.52,,,,,,,1183.1300,4583.9800,percent of total billed charges,"41.7% of $4,583.98 in Billed Charges for Rev 272 = $1,911.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BITER NANO ELEVATOR ARTHROSCOPY 10CM X 130MM,272,RC,27200002,CDM,,,,,,both,,,4583.9800,687.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4125.58,,,,,,,1183.1300,4583.9800,percent of total billed charges,"90% of $4,583.98 in Billed Charges for Rev 272 = $4,125.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BITER NANO ELEVATOR ARTHROSCOPY 10CM X 130MM,272,RC,27200002,CDM,,,,,,both,,,4583.9800,687.6000,MEDCOST,MEDCOST VHN,2181.52,,,,,,,1183.1300,4583.9800,percent of total billed charges,"47.59% of $4,583.98 in Billed Charges for Rev 272 = $2,181.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BITER NANO ELEVATOR ARTHROSCOPY 10CM X 130MM,272,RC,27200002,CDM,,,,,,both,,,4583.9800,687.6000,SENTARA HEALTH,SENTARA HEALTH,1183.13,,,,,,,1183.1300,4583.9800,percent of total billed charges,"25.81% of $4,583.98 in Billed Charges for Rev 272 = $1,183.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BITER NANO ELEVATOR ARTHROSCOPY 10CM X 130MM,272,RC,27200002,CDM,,,,,,both,,,4583.9800,687.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4583.98,,,,,,,1183.1300,4583.9800,percent of total billed charges,"100% of $4,583.98 in Billed Charges for Rev 272 = $4,583.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BITER NANO ELEVATOR ARTHROSCOPY 10CM X 130MM,272,RC,27200002,CDM,,,,,,both,,,4583.9800,687.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2291.99,,,,,,,1183.1300,4583.9800,percent of total billed charges,"Rev 272 $4,583.98 in Billed Charges at 50% = $2,291.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BITER NANO ELEVATOR ARTHROSCOPY 10CM X 130MM,272,RC,27200002,CDM,,,,,,both,,,4583.9800,687.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1480.63,,,,,,,1183.1300,4583.9800,other,"32.3% of $4,583.98 in Billed Charges for Rev 272 = $1,480.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BITER NANO ELEVATOR ARTHROSCOPY 10CM X 130MM,272,RC,27200002,CDM,,,,,,both,,,4583.9800,687.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1407.28,,,,,,,1183.1300,4583.9800,other,"30.7% of $4,583.98 in Billed Charges for Rev 272 = $1,407.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BITER NANO ELEVATOR ARTHROSCOPY 10CM X 130MM,272,RC,27200002,CDM,,,,,,both,,,4583.9800,687.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,1480.63,,,,,,,1183.1300,4583.9800,percent of total billed charges,"32.3% of $4,583.98 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BITER NANO ELEVATOR ARTHROSCOPY 10CM X 130MM,272,RC,27200002,CDM,,,,,,both,,,4583.9800,687.6000,WELLCARE,WELLCARE MEDICAID,4583.98,,,,,,,1183.1300,4583.9800,percent of total billed charges,"100% of $4,583.98 in Billed Charges for Rev 272 = $4,583.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FIBERTAK KNEE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1648.9900,247.3500,AETNA,AETNA,704.12,,,,,,,425.6000,1648.9900,percent of total billed charges,"42.7% of $1,648.99 in Billed Charges for Rev 272 = $704.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FIBERTAK KNEE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1648.9900,247.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1154.29,,,,,,,425.6000,1648.9900,percent of total billed charges,"Rev 272 $1,648.99 in Billed Charges at 70% = $1,154.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FIBERTAK KNEE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1648.9900,247.3500,CIGNA HEALTHCARE,CIGNA HMO,687.63,,,,,,,425.6000,1648.9900,percent of total billed charges,"41.7% of $1,648.99 in Billed Charges for Rev 272 = $687.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FIBERTAK KNEE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1648.9900,247.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,765.13,,,,,,,425.6000,1648.9900,percent of total billed charges,"46.4% of $1,648.99 in Billed Charges for Rev 272 = $765.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FIBERTAK KNEE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1648.9900,247.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,687.63,,,,,,,425.6000,1648.9900,percent of total billed charges,"41.7% of $1,648.99 in Billed Charges for Rev 272 = $687.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FIBERTAK KNEE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1648.9900,247.3500,CIGNA HEALTHCARE,CIGNA PPO,687.63,,,,,,,425.6000,1648.9900,percent of total billed charges,"41.7% of $1,648.99 in Billed Charges for Rev 272 = $687.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FIBERTAK KNEE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1648.9900,247.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1484.09,,,,,,,425.6000,1648.9900,percent of total billed charges,"90% of $1,648.99 in Billed Charges for Rev 272 = $1,484.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FIBERTAK KNEE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1648.9900,247.3500,MEDCOST,MEDCOST VHN,784.75,,,,,,,425.6000,1648.9900,percent of total billed charges,"47.59% of $1,648.99 in Billed Charges for Rev 272 = $784.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FIBERTAK KNEE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1648.9900,247.3500,SENTARA HEALTH,SENTARA HEALTH,425.60,,,,,,,425.6000,1648.9900,percent of total billed charges,"25.81% of $1,648.99 in Billed Charges for Rev 272 = $425.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FIBERTAK KNEE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1648.9900,247.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1648.99,,,,,,,425.6000,1648.9900,percent of total billed charges,"100% of $1,648.99 in Billed Charges for Rev 272 = $1,648.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FIBERTAK KNEE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1648.9900,247.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,824.50,,,,,,,425.6000,1648.9900,percent of total billed charges,"Rev 272 $1,648.99 in Billed Charges at 50% = $824.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FIBERTAK KNEE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1648.9900,247.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,532.62,,,,,,,425.6000,1648.9900,other,"32.3% of $1,648.99 in Billed Charges for Rev 272 = $532.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL FIBERTAK KNEE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1648.9900,247.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,506.24,,,,,,,425.6000,1648.9900,other,"30.7% of $1,648.99 in Billed Charges for Rev 272 = $506.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL FIBERTAK KNEE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1648.9900,247.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,532.62,,,,,,,425.6000,1648.9900,percent of total billed charges,"32.3% of $1,648.99 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FIBERTAK KNEE 2.8MM,272,RC,27200002,CDM,,,,,,both,,,1648.9900,247.3500,WELLCARE,WELLCARE MEDICAID,1648.99,,,,,,,425.6000,1648.9900,percent of total billed charges,"100% of $1,648.99 in Billed Charges for Rev 272 = $1,648.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL FOR HTO TITANIUM SCREWS,272,RC,,,,,,,,both,,,891.9100,133.7900,AETNA,AETNA,380.85,,,,,,,230.2000,891.9100,percent of total billed charges,42.7% of $891.91 in Billed Charges for Rev 272 = $380.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL FOR HTO TITANIUM SCREWS,272,RC,,,,,,,,both,,,891.9100,133.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,624.34,,,,,,,230.2000,891.9100,percent of total billed charges,Rev 272 $891.91 in Billed Charges at 70% = $624.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL FOR HTO TITANIUM SCREWS,272,RC,,,,,,,,both,,,891.9100,133.7900,CIGNA HEALTHCARE,CIGNA HMO,371.93,,,,,,,230.2000,891.9100,percent of total billed charges,41.7% of $891.91 in Billed Charges for Rev 272 = $371.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL FOR HTO TITANIUM SCREWS,272,RC,,,,,,,,both,,,891.9100,133.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,413.85,,,,,,,230.2000,891.9100,percent of total billed charges,46.4% of $891.91 in Billed Charges for Rev 272 = $413.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL FOR HTO TITANIUM SCREWS,272,RC,,,,,,,,both,,,891.9100,133.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,371.93,,,,,,,230.2000,891.9100,percent of total billed charges,41.7% of $891.91 in Billed Charges for Rev 272 = $371.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL FOR HTO TITANIUM SCREWS,272,RC,,,,,,,,both,,,891.9100,133.7900,CIGNA HEALTHCARE,CIGNA PPO,371.93,,,,,,,230.2000,891.9100,percent of total billed charges,41.7% of $891.91 in Billed Charges for Rev 272 = $371.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL FOR HTO TITANIUM SCREWS,272,RC,,,,,,,,both,,,891.9100,133.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,802.72,,,,,,,230.2000,891.9100,percent of total billed charges,90% of $891.91 in Billed Charges for Rev 272 = $802.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL FOR HTO TITANIUM SCREWS,272,RC,,,,,,,,both,,,891.9100,133.7900,MEDCOST,MEDCOST VHN,424.46,,,,,,,230.2000,891.9100,percent of total billed charges,47.59% of $891.91 in Billed Charges for Rev 272 = $424.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL FOR HTO TITANIUM SCREWS,272,RC,,,,,,,,both,,,891.9100,133.7900,SENTARA HEALTH,SENTARA HEALTH,230.20,,,,,,,230.2000,891.9100,percent of total billed charges,25.81% of $891.91 in Billed Charges for Rev 272 = $230.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL FOR HTO TITANIUM SCREWS,272,RC,,,,,,,,both,,,891.9100,133.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",891.91,,,,,,,230.2000,891.9100,percent of total billed charges,100% of $891.91 in Billed Charges for Rev 272 = $891.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL FOR HTO TITANIUM SCREWS,272,RC,,,,,,,,both,,,891.9100,133.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,445.96,,,,,,,230.2000,891.9100,percent of total billed charges,Rev 272 $891.91 in Billed Charges at 50% = $445.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL FOR HTO TITANIUM SCREWS,272,RC,,,,,,,,both,,,891.9100,133.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,288.09,,,,,,,230.2000,891.9100,other,32.3% of $891.91 in Billed Charges for Rev 272 = $288.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL FOR HTO TITANIUM SCREWS,272,RC,,,,,,,,both,,,891.9100,133.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,273.82,,,,,,,230.2000,891.9100,other,30.7% of $891.91 in Billed Charges for Rev 272 = $273.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL FOR HTO TITANIUM SCREWS,272,RC,,,,,,,,both,,,891.9100,133.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,288.09,,,,,,,230.2000,891.9100,percent of total billed charges,32.3% of $891.91 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL FOR HTO TITANIUM SCREWS,272,RC,,,,,,,,both,,,891.9100,133.7900,WELLCARE,WELLCARE MEDICAID,891.91,,,,,,,230.2000,891.9100,percent of total billed charges,100% of $891.91 in Billed Charges for Rev 272 = $891.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 14AC60,272,RC,,,,,,,,both,,,1900.5900,285.0900,AETNA,AETNA,811.55,,,,,,,490.5400,1900.5900,percent of total billed charges,"42.7% of $1,900.59 in Billed Charges for Rev 272 = $811.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 14AC60,272,RC,,,,,,,,both,,,1900.5900,285.0900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1330.41,,,,,,,490.5400,1900.5900,percent of total billed charges,"Rev 272 $1,900.59 in Billed Charges at 70% = $1,330.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 14AC60,272,RC,,,,,,,,both,,,1900.5900,285.0900,CIGNA HEALTHCARE,CIGNA HMO,792.55,,,,,,,490.5400,1900.5900,percent of total billed charges,"41.7% of $1,900.59 in Billed Charges for Rev 272 = $792.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 14AC60,272,RC,,,,,,,,both,,,1900.5900,285.0900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,881.87,,,,,,,490.5400,1900.5900,percent of total billed charges,"46.4% of $1,900.59 in Billed Charges for Rev 272 = $881.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 14AC60,272,RC,,,,,,,,both,,,1900.5900,285.0900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,792.55,,,,,,,490.5400,1900.5900,percent of total billed charges,"41.7% of $1,900.59 in Billed Charges for Rev 272 = $792.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 14AC60,272,RC,,,,,,,,both,,,1900.5900,285.0900,CIGNA HEALTHCARE,CIGNA PPO,792.55,,,,,,,490.5400,1900.5900,percent of total billed charges,"41.7% of $1,900.59 in Billed Charges for Rev 272 = $792.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 14AC60,272,RC,,,,,,,,both,,,1900.5900,285.0900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1710.53,,,,,,,490.5400,1900.5900,percent of total billed charges,"90% of $1,900.59 in Billed Charges for Rev 272 = $1,710.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 14AC60,272,RC,,,,,,,,both,,,1900.5900,285.0900,MEDCOST,MEDCOST VHN,904.49,,,,,,,490.5400,1900.5900,percent of total billed charges,"47.59% of $1,900.59 in Billed Charges for Rev 272 = $904.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 14AC60,272,RC,,,,,,,,both,,,1900.5900,285.0900,SENTARA HEALTH,SENTARA HEALTH,490.54,,,,,,,490.5400,1900.5900,percent of total billed charges,"25.81% of $1,900.59 in Billed Charges for Rev 272 = $490.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 14AC60,272,RC,,,,,,,,both,,,1900.5900,285.0900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1900.59,,,,,,,490.5400,1900.5900,percent of total billed charges,"100% of $1,900.59 in Billed Charges for Rev 272 = $1,900.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 14AC60,272,RC,,,,,,,,both,,,1900.5900,285.0900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,950.30,,,,,,,490.5400,1900.5900,percent of total billed charges,"Rev 272 $1,900.59 in Billed Charges at 50% = $950.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 14AC60,272,RC,,,,,,,,both,,,1900.5900,285.0900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,613.89,,,,,,,490.5400,1900.5900,other,"32.3% of $1,900.59 in Billed Charges for Rev 272 = $613.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE 14AC60,272,RC,,,,,,,,both,,,1900.5900,285.0900,UNITED HEALTHCARE,UHC HERITAGE SELECT,583.48,,,,,,,490.5400,1900.5900,other,"30.7% of $1,900.59 in Billed Charges for Rev 272 = $583.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE 14AC60,272,RC,,,,,,,,both,,,1900.5900,285.0900,UNITED HEALTHCARE,UNITED HEALTHCARE,613.89,,,,,,,490.5400,1900.5900,percent of total billed charges,"32.3% of $1,900.59 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 14AC60,272,RC,,,,,,,,both,,,1900.5900,285.0900,WELLCARE,WELLCARE MEDICAID,1900.59,,,,,,,490.5400,1900.5900,percent of total billed charges,"100% of $1,900.59 in Billed Charges for Rev 272 = $1,900.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 3.5 MM RAD 12,272,RC,27200002,CDM,,,,,,both,,,3017.9600,452.6900,AETNA,AETNA,1288.67,,,,,,,778.9400,3017.9600,percent of total billed charges,"42.7% of $3,017.96 in Billed Charges for Rev 272 = $1,288.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 3.5 MM RAD 12,272,RC,27200002,CDM,,,,,,both,,,3017.9600,452.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2112.57,,,,,,,778.9400,3017.9600,percent of total billed charges,"Rev 272 $3,017.96 in Billed Charges at 70% = $2,112.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 3.5 MM RAD 12,272,RC,27200002,CDM,,,,,,both,,,3017.9600,452.6900,CIGNA HEALTHCARE,CIGNA HMO,1258.49,,,,,,,778.9400,3017.9600,percent of total billed charges,"41.7% of $3,017.96 in Billed Charges for Rev 272 = $1,258.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 3.5 MM RAD 12,272,RC,27200002,CDM,,,,,,both,,,3017.9600,452.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1400.33,,,,,,,778.9400,3017.9600,percent of total billed charges,"46.4% of $3,017.96 in Billed Charges for Rev 272 = $1,400.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 3.5 MM RAD 12,272,RC,27200002,CDM,,,,,,both,,,3017.9600,452.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1258.49,,,,,,,778.9400,3017.9600,percent of total billed charges,"41.7% of $3,017.96 in Billed Charges for Rev 272 = $1,258.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 3.5 MM RAD 12,272,RC,27200002,CDM,,,,,,both,,,3017.9600,452.6900,CIGNA HEALTHCARE,CIGNA PPO,1258.49,,,,,,,778.9400,3017.9600,percent of total billed charges,"41.7% of $3,017.96 in Billed Charges for Rev 272 = $1,258.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 3.5 MM RAD 12,272,RC,27200002,CDM,,,,,,both,,,3017.9600,452.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2716.16,,,,,,,778.9400,3017.9600,percent of total billed charges,"90% of $3,017.96 in Billed Charges for Rev 272 = $2,716.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 3.5 MM RAD 12,272,RC,27200002,CDM,,,,,,both,,,3017.9600,452.6900,MEDCOST,MEDCOST VHN,1436.25,,,,,,,778.9400,3017.9600,percent of total billed charges,"47.59% of $3,017.96 in Billed Charges for Rev 272 = $1,436.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 3.5 MM RAD 12,272,RC,27200002,CDM,,,,,,both,,,3017.9600,452.6900,SENTARA HEALTH,SENTARA HEALTH,778.94,,,,,,,778.9400,3017.9600,percent of total billed charges,"25.81% of $3,017.96 in Billed Charges for Rev 272 = $778.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 3.5 MM RAD 12,272,RC,27200002,CDM,,,,,,both,,,3017.9600,452.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3017.96,,,,,,,778.9400,3017.9600,percent of total billed charges,"100% of $3,017.96 in Billed Charges for Rev 272 = $3,017.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 3.5 MM RAD 12,272,RC,27200002,CDM,,,,,,both,,,3017.9600,452.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1508.98,,,,,,,778.9400,3017.9600,percent of total billed charges,"Rev 272 $3,017.96 in Billed Charges at 50% = $1,508.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 3.5 MM RAD 12,272,RC,27200002,CDM,,,,,,both,,,3017.9600,452.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,974.80,,,,,,,778.9400,3017.9600,other,"32.3% of $3,017.96 in Billed Charges for Rev 272 = $974.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE 3.5 MM RAD 12,272,RC,27200002,CDM,,,,,,both,,,3017.9600,452.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,926.51,,,,,,,778.9400,3017.9600,other,"30.7% of $3,017.96 in Billed Charges for Rev 272 = $926.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE 3.5 MM RAD 12,272,RC,27200002,CDM,,,,,,both,,,3017.9600,452.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,974.80,,,,,,,778.9400,3017.9600,percent of total billed charges,"32.3% of $3,017.96 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 3.5 MM RAD 12,272,RC,27200002,CDM,,,,,,both,,,3017.9600,452.6900,WELLCARE,WELLCARE MEDICAID,3017.96,,,,,,,778.9400,3017.9600,percent of total billed charges,"100% of $3,017.96 in Billed Charges for Rev 272 = $3,017.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 4.0 SHAVER 0375-544-000,272,RC,27200002,CDM,,,,,,both,,,656.9000,98.5400,AETNA,AETNA,280.50,,,,,,,169.5500,656.9000,percent of total billed charges,42.7% of $656.90 in Billed Charges for Rev 272 = $280.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 4.0 SHAVER 0375-544-000,272,RC,27200002,CDM,,,,,,both,,,656.9000,98.5400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,459.83,,,,,,,169.5500,656.9000,percent of total billed charges,Rev 272 $656.90 in Billed Charges at 70% = $459.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 4.0 SHAVER 0375-544-000,272,RC,27200002,CDM,,,,,,both,,,656.9000,98.5400,CIGNA HEALTHCARE,CIGNA HMO,273.93,,,,,,,169.5500,656.9000,percent of total billed charges,41.7% of $656.90 in Billed Charges for Rev 272 = $273.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 4.0 SHAVER 0375-544-000,272,RC,27200002,CDM,,,,,,both,,,656.9000,98.5400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,304.80,,,,,,,169.5500,656.9000,percent of total billed charges,46.4% of $656.90 in Billed Charges for Rev 272 = $304.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 4.0 SHAVER 0375-544-000,272,RC,27200002,CDM,,,,,,both,,,656.9000,98.5400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,273.93,,,,,,,169.5500,656.9000,percent of total billed charges,41.7% of $656.90 in Billed Charges for Rev 272 = $273.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 4.0 SHAVER 0375-544-000,272,RC,27200002,CDM,,,,,,both,,,656.9000,98.5400,CIGNA HEALTHCARE,CIGNA PPO,273.93,,,,,,,169.5500,656.9000,percent of total billed charges,41.7% of $656.90 in Billed Charges for Rev 272 = $273.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 4.0 SHAVER 0375-544-000,272,RC,27200002,CDM,,,,,,both,,,656.9000,98.5400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,591.21,,,,,,,169.5500,656.9000,percent of total billed charges,90% of $656.90 in Billed Charges for Rev 272 = $591.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 4.0 SHAVER 0375-544-000,272,RC,27200002,CDM,,,,,,both,,,656.9000,98.5400,MEDCOST,MEDCOST VHN,312.62,,,,,,,169.5500,656.9000,percent of total billed charges,47.59% of $656.90 in Billed Charges for Rev 272 = $312.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 4.0 SHAVER 0375-544-000,272,RC,27200002,CDM,,,,,,both,,,656.9000,98.5400,SENTARA HEALTH,SENTARA HEALTH,169.55,,,,,,,169.5500,656.9000,percent of total billed charges,25.81% of $656.90 in Billed Charges for Rev 272 = $169.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 4.0 SHAVER 0375-544-000,272,RC,27200002,CDM,,,,,,both,,,656.9000,98.5400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",656.90,,,,,,,169.5500,656.9000,percent of total billed charges,100% of $656.90 in Billed Charges for Rev 272 = $656.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 4.0 SHAVER 0375-544-000,272,RC,27200002,CDM,,,,,,both,,,656.9000,98.5400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,328.45,,,,,,,169.5500,656.9000,percent of total billed charges,Rev 272 $656.90 in Billed Charges at 50% = $328.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 4.0 SHAVER 0375-544-000,272,RC,27200002,CDM,,,,,,both,,,656.9000,98.5400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,212.18,,,,,,,169.5500,656.9000,other,32.3% of $656.90 in Billed Charges for Rev 272 = $212.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE 4.0 SHAVER 0375-544-000,272,RC,27200002,CDM,,,,,,both,,,656.9000,98.5400,UNITED HEALTHCARE,UHC HERITAGE SELECT,201.67,,,,,,,169.5500,656.9000,other,30.7% of $656.90 in Billed Charges for Rev 272 = $201.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE 4.0 SHAVER 0375-544-000,272,RC,27200002,CDM,,,,,,both,,,656.9000,98.5400,UNITED HEALTHCARE,UNITED HEALTHCARE,212.18,,,,,,,169.5500,656.9000,percent of total billed charges,32.3% of $656.90 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 4.0 SHAVER 0375-544-000,272,RC,27200002,CDM,,,,,,both,,,656.9000,98.5400,WELLCARE,WELLCARE MEDICAID,656.90,,,,,,,169.5500,656.9000,percent of total billed charges,100% of $656.90 in Billed Charges for Rev 272 = $656.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 8MM SHORT FLEX OSTEOTOME,272,RC,27200002,CDM,,,,,,both,,,570.4100,85.5600,AETNA,AETNA,243.57,,,,,,,147.2200,570.4100,percent of total billed charges,42.7% of $570.41 in Billed Charges for Rev 272 = $243.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 8MM SHORT FLEX OSTEOTOME,272,RC,27200002,CDM,,,,,,both,,,570.4100,85.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,399.29,,,,,,,147.2200,570.4100,percent of total billed charges,Rev 272 $570.41 in Billed Charges at 70% = $399.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 8MM SHORT FLEX OSTEOTOME,272,RC,27200002,CDM,,,,,,both,,,570.4100,85.5600,CIGNA HEALTHCARE,CIGNA HMO,237.86,,,,,,,147.2200,570.4100,percent of total billed charges,41.7% of $570.41 in Billed Charges for Rev 272 = $237.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 8MM SHORT FLEX OSTEOTOME,272,RC,27200002,CDM,,,,,,both,,,570.4100,85.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,264.67,,,,,,,147.2200,570.4100,percent of total billed charges,46.4% of $570.41 in Billed Charges for Rev 272 = $264.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 8MM SHORT FLEX OSTEOTOME,272,RC,27200002,CDM,,,,,,both,,,570.4100,85.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,237.86,,,,,,,147.2200,570.4100,percent of total billed charges,41.7% of $570.41 in Billed Charges for Rev 272 = $237.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 8MM SHORT FLEX OSTEOTOME,272,RC,27200002,CDM,,,,,,both,,,570.4100,85.5600,CIGNA HEALTHCARE,CIGNA PPO,237.86,,,,,,,147.2200,570.4100,percent of total billed charges,41.7% of $570.41 in Billed Charges for Rev 272 = $237.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 8MM SHORT FLEX OSTEOTOME,272,RC,27200002,CDM,,,,,,both,,,570.4100,85.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,513.37,,,,,,,147.2200,570.4100,percent of total billed charges,90% of $570.41 in Billed Charges for Rev 272 = $513.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 8MM SHORT FLEX OSTEOTOME,272,RC,27200002,CDM,,,,,,both,,,570.4100,85.5600,MEDCOST,MEDCOST VHN,271.46,,,,,,,147.2200,570.4100,percent of total billed charges,47.59% of $570.41 in Billed Charges for Rev 272 = $271.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 8MM SHORT FLEX OSTEOTOME,272,RC,27200002,CDM,,,,,,both,,,570.4100,85.5600,SENTARA HEALTH,SENTARA HEALTH,147.22,,,,,,,147.2200,570.4100,percent of total billed charges,25.81% of $570.41 in Billed Charges for Rev 272 = $147.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 8MM SHORT FLEX OSTEOTOME,272,RC,27200002,CDM,,,,,,both,,,570.4100,85.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",570.41,,,,,,,147.2200,570.4100,percent of total billed charges,100% of $570.41 in Billed Charges for Rev 272 = $570.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 8MM SHORT FLEX OSTEOTOME,272,RC,27200002,CDM,,,,,,both,,,570.4100,85.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,285.21,,,,,,,147.2200,570.4100,percent of total billed charges,Rev 272 $570.41 in Billed Charges at 50% = $285.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 8MM SHORT FLEX OSTEOTOME,272,RC,27200002,CDM,,,,,,both,,,570.4100,85.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,184.24,,,,,,,147.2200,570.4100,other,32.3% of $570.41 in Billed Charges for Rev 272 = $184.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE 8MM SHORT FLEX OSTEOTOME,272,RC,27200002,CDM,,,,,,both,,,570.4100,85.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,175.12,,,,,,,147.2200,570.4100,other,30.7% of $570.41 in Billed Charges for Rev 272 = $175.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE 8MM SHORT FLEX OSTEOTOME,272,RC,27200002,CDM,,,,,,both,,,570.4100,85.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,184.24,,,,,,,147.2200,570.4100,percent of total billed charges,32.3% of $570.41 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 8MM SHORT FLEX OSTEOTOME,272,RC,27200002,CDM,,,,,,both,,,570.4100,85.5600,WELLCARE,WELLCARE MEDICAID,570.41,,,,,,,147.2200,570.4100,percent of total billed charges,100% of $570.41 in Billed Charges for Rev 272 = $570.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.5 X 135MM 45MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1121.4200,168.2100,AETNA,AETNA,478.85,,,,,,,289.4400,1121.4200,percent of total billed charges,"42.7% of $1,121.42 in Billed Charges for Rev 272 = $478.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 135MM 45MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1121.4200,168.2100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,784.99,,,,,,,289.4400,1121.4200,percent of total billed charges,"Rev 272 $1,121.42 in Billed Charges at 70% = $784.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 135MM 45MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1121.4200,168.2100,CIGNA HEALTHCARE,CIGNA HMO,467.63,,,,,,,289.4400,1121.4200,percent of total billed charges,"41.7% of $1,121.42 in Billed Charges for Rev 272 = $467.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 135MM 45MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1121.4200,168.2100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,520.34,,,,,,,289.4400,1121.4200,percent of total billed charges,"46.4% of $1,121.42 in Billed Charges for Rev 272 = $520.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 135MM 45MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1121.4200,168.2100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,467.63,,,,,,,289.4400,1121.4200,percent of total billed charges,"41.7% of $1,121.42 in Billed Charges for Rev 272 = $467.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 135MM 45MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1121.4200,168.2100,CIGNA HEALTHCARE,CIGNA PPO,467.63,,,,,,,289.4400,1121.4200,percent of total billed charges,"41.7% of $1,121.42 in Billed Charges for Rev 272 = $467.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 135MM 45MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1121.4200,168.2100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1009.28,,,,,,,289.4400,1121.4200,percent of total billed charges,"90% of $1,121.42 in Billed Charges for Rev 272 = $1,009.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 135MM 45MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1121.4200,168.2100,MEDCOST,MEDCOST VHN,533.68,,,,,,,289.4400,1121.4200,percent of total billed charges,"47.59% of $1,121.42 in Billed Charges for Rev 272 = $533.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 135MM 45MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1121.4200,168.2100,SENTARA HEALTH,SENTARA HEALTH,289.44,,,,,,,289.4400,1121.4200,percent of total billed charges,"25.81% of $1,121.42 in Billed Charges for Rev 272 = $289.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 135MM 45MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1121.4200,168.2100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1121.42,,,,,,,289.4400,1121.4200,percent of total billed charges,"100% of $1,121.42 in Billed Charges for Rev 272 = $1,121.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 135MM 45MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1121.4200,168.2100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,560.71,,,,,,,289.4400,1121.4200,percent of total billed charges,"Rev 272 $1,121.42 in Billed Charges at 50% = $560.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 135MM 45MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1121.4200,168.2100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,362.22,,,,,,,289.4400,1121.4200,other,"32.3% of $1,121.42 in Billed Charges for Rev 272 = $362.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK COUPLING 2.5 X 135MM 45MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1121.4200,168.2100,UNITED HEALTHCARE,UHC HERITAGE SELECT,344.28,,,,,,,289.4400,1121.4200,other,"30.7% of $1,121.42 in Billed Charges for Rev 272 = $344.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK COUPLING 2.5 X 135MM 45MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1121.4200,168.2100,UNITED HEALTHCARE,UNITED HEALTHCARE,362.22,,,,,,,289.4400,1121.4200,percent of total billed charges,"32.3% of $1,121.42 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 135MM 45MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1121.4200,168.2100,WELLCARE,WELLCARE MEDICAID,1121.42,,,,,,,289.4400,1121.4200,percent of total billed charges,"100% of $1,121.42 in Billed Charges for Rev 272 = $1,121.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1325.6200,198.8400,AETNA,AETNA,566.04,,,,,,,342.1400,1325.6200,percent of total billed charges,"42.7% of $1,325.62 in Billed Charges for Rev 272 = $566.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1325.6200,198.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,927.93,,,,,,,342.1400,1325.6200,percent of total billed charges,"Rev 272 $1,325.62 in Billed Charges at 70% = $927.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1325.6200,198.8400,CIGNA HEALTHCARE,CIGNA HMO,552.78,,,,,,,342.1400,1325.6200,percent of total billed charges,"41.7% of $1,325.62 in Billed Charges for Rev 272 = $552.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1325.6200,198.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,615.09,,,,,,,342.1400,1325.6200,percent of total billed charges,"46.4% of $1,325.62 in Billed Charges for Rev 272 = $615.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1325.6200,198.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,552.78,,,,,,,342.1400,1325.6200,percent of total billed charges,"41.7% of $1,325.62 in Billed Charges for Rev 272 = $552.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1325.6200,198.8400,CIGNA HEALTHCARE,CIGNA PPO,552.78,,,,,,,342.1400,1325.6200,percent of total billed charges,"41.7% of $1,325.62 in Billed Charges for Rev 272 = $552.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1325.6200,198.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1193.06,,,,,,,342.1400,1325.6200,percent of total billed charges,"90% of $1,325.62 in Billed Charges for Rev 272 = $1,193.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1325.6200,198.8400,MEDCOST,MEDCOST VHN,630.86,,,,,,,342.1400,1325.6200,percent of total billed charges,"47.59% of $1,325.62 in Billed Charges for Rev 272 = $630.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1325.6200,198.8400,SENTARA HEALTH,SENTARA HEALTH,342.14,,,,,,,342.1400,1325.6200,percent of total billed charges,"25.81% of $1,325.62 in Billed Charges for Rev 272 = $342.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1325.6200,198.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1325.62,,,,,,,342.1400,1325.6200,percent of total billed charges,"100% of $1,325.62 in Billed Charges for Rev 272 = $1,325.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1325.6200,198.8400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,662.81,,,,,,,342.1400,1325.6200,percent of total billed charges,"Rev 272 $1,325.62 in Billed Charges at 50% = $662.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1325.6200,198.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,428.18,,,,,,,342.1400,1325.6200,other,"32.3% of $1,325.62 in Billed Charges for Rev 272 = $428.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK COUPLING 2.5 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1325.6200,198.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,406.97,,,,,,,342.1400,1325.6200,other,"30.7% of $1,325.62 in Billed Charges for Rev 272 = $406.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL QUICK COUPLING 2.5 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1325.6200,198.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,428.18,,,,,,,342.1400,1325.6200,percent of total billed charges,"32.3% of $1,325.62 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 2.5 X 170MM 80MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,1325.6200,198.8400,WELLCARE,WELLCARE MEDICAID,1325.62,,,,,,,342.1400,1325.6200,percent of total billed charges,"100% of $1,325.62 in Billed Charges for Rev 272 = $1,325.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE PLUS ANGLED 4.5MM,272,RC,,,,,,,,both,,,817.1300,122.5700,AETNA,AETNA,348.91,,,,,,,210.9000,817.1300,percent of total billed charges,42.7% of $817.13 in Billed Charges for Rev 272 = $348.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE AGGRESSIVE PLUS ANGLED 4.5MM,272,RC,,,,,,,,both,,,817.1300,122.5700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,571.99,,,,,,,210.9000,817.1300,percent of total billed charges,Rev 272 $817.13 in Billed Charges at 70% = $571.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE AGGRESSIVE PLUS ANGLED 4.5MM,272,RC,,,,,,,,both,,,817.1300,122.5700,CIGNA HEALTHCARE,CIGNA HMO,340.74,,,,,,,210.9000,817.1300,percent of total billed charges,41.7% of $817.13 in Billed Charges for Rev 272 = $340.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE AGGRESSIVE PLUS ANGLED 4.5MM,272,RC,,,,,,,,both,,,817.1300,122.5700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,379.15,,,,,,,210.9000,817.1300,percent of total billed charges,46.4% of $817.13 in Billed Charges for Rev 272 = $379.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE AGGRESSIVE PLUS ANGLED 4.5MM,272,RC,,,,,,,,both,,,817.1300,122.5700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,340.74,,,,,,,210.9000,817.1300,percent of total billed charges,41.7% of $817.13 in Billed Charges for Rev 272 = $340.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE AGGRESSIVE PLUS ANGLED 4.5MM,272,RC,,,,,,,,both,,,817.1300,122.5700,CIGNA HEALTHCARE,CIGNA PPO,340.74,,,,,,,210.9000,817.1300,percent of total billed charges,41.7% of $817.13 in Billed Charges for Rev 272 = $340.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE AGGRESSIVE PLUS ANGLED 4.5MM,272,RC,,,,,,,,both,,,817.1300,122.5700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,735.42,,,,,,,210.9000,817.1300,percent of total billed charges,90% of $817.13 in Billed Charges for Rev 272 = $735.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE AGGRESSIVE PLUS ANGLED 4.5MM,272,RC,,,,,,,,both,,,817.1300,122.5700,MEDCOST,MEDCOST VHN,388.87,,,,,,,210.9000,817.1300,percent of total billed charges,47.59% of $817.13 in Billed Charges for Rev 272 = $388.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE AGGRESSIVE PLUS ANGLED 4.5MM,272,RC,,,,,,,,both,,,817.1300,122.5700,SENTARA HEALTH,SENTARA HEALTH,210.90,,,,,,,210.9000,817.1300,percent of total billed charges,25.81% of $817.13 in Billed Charges for Rev 272 = $210.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE AGGRESSIVE PLUS ANGLED 4.5MM,272,RC,,,,,,,,both,,,817.1300,122.5700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",817.13,,,,,,,210.9000,817.1300,percent of total billed charges,100% of $817.13 in Billed Charges for Rev 272 = $817.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE AGGRESSIVE PLUS ANGLED 4.5MM,272,RC,,,,,,,,both,,,817.1300,122.5700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,408.57,,,,,,,210.9000,817.1300,percent of total billed charges,Rev 272 $817.13 in Billed Charges at 50% = $408.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE AGGRESSIVE PLUS ANGLED 4.5MM,272,RC,,,,,,,,both,,,817.1300,122.5700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,263.93,,,,,,,210.9000,817.1300,other,32.3% of $817.13 in Billed Charges for Rev 272 = $263.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE AGGRESSIVE PLUS ANGLED 4.5MM,272,RC,,,,,,,,both,,,817.1300,122.5700,UNITED HEALTHCARE,UHC HERITAGE SELECT,250.86,,,,,,,210.9000,817.1300,other,30.7% of $817.13 in Billed Charges for Rev 272 = $250.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE AGGRESSIVE PLUS ANGLED 4.5MM,272,RC,,,,,,,,both,,,817.1300,122.5700,UNITED HEALTHCARE,UNITED HEALTHCARE,263.93,,,,,,,210.9000,817.1300,percent of total billed charges,32.3% of $817.13 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE AGGRESSIVE PLUS ANGLED 4.5MM,272,RC,,,,,,,,both,,,817.1300,122.5700,WELLCARE,WELLCARE MEDICAID,817.13,,,,,,,210.9000,817.1300,percent of total billed charges,100% of $817.13 in Billed Charges for Rev 272 = $817.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE AGGRESSIVE SERRATED 3.5,272,RC,27200002,CDM,,,,,,both,,,1650.0900,247.5100,AETNA,AETNA,704.59,,,,,,,425.8900,1650.0900,percent of total billed charges,"42.7% of $1,650.09 in Billed Charges for Rev 272 = $704.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 3.5,272,RC,27200002,CDM,,,,,,both,,,1650.0900,247.5100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1155.06,,,,,,,425.8900,1650.0900,percent of total billed charges,"Rev 272 $1,650.09 in Billed Charges at 70% = $1,155.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 3.5,272,RC,27200002,CDM,,,,,,both,,,1650.0900,247.5100,CIGNA HEALTHCARE,CIGNA HMO,688.09,,,,,,,425.8900,1650.0900,percent of total billed charges,"41.7% of $1,650.09 in Billed Charges for Rev 272 = $688.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 3.5,272,RC,27200002,CDM,,,,,,both,,,1650.0900,247.5100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,765.64,,,,,,,425.8900,1650.0900,percent of total billed charges,"46.4% of $1,650.09 in Billed Charges for Rev 272 = $765.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 3.5,272,RC,27200002,CDM,,,,,,both,,,1650.0900,247.5100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,688.09,,,,,,,425.8900,1650.0900,percent of total billed charges,"41.7% of $1,650.09 in Billed Charges for Rev 272 = $688.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 3.5,272,RC,27200002,CDM,,,,,,both,,,1650.0900,247.5100,CIGNA HEALTHCARE,CIGNA PPO,688.09,,,,,,,425.8900,1650.0900,percent of total billed charges,"41.7% of $1,650.09 in Billed Charges for Rev 272 = $688.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 3.5,272,RC,27200002,CDM,,,,,,both,,,1650.0900,247.5100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1485.08,,,,,,,425.8900,1650.0900,percent of total billed charges,"90% of $1,650.09 in Billed Charges for Rev 272 = $1,485.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 3.5,272,RC,27200002,CDM,,,,,,both,,,1650.0900,247.5100,MEDCOST,MEDCOST VHN,785.28,,,,,,,425.8900,1650.0900,percent of total billed charges,"47.59% of $1,650.09 in Billed Charges for Rev 272 = $785.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 3.5,272,RC,27200002,CDM,,,,,,both,,,1650.0900,247.5100,SENTARA HEALTH,SENTARA HEALTH,425.89,,,,,,,425.8900,1650.0900,percent of total billed charges,"25.81% of $1,650.09 in Billed Charges for Rev 272 = $425.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 3.5,272,RC,27200002,CDM,,,,,,both,,,1650.0900,247.5100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1650.09,,,,,,,425.8900,1650.0900,percent of total billed charges,"100% of $1,650.09 in Billed Charges for Rev 272 = $1,650.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 3.5,272,RC,27200002,CDM,,,,,,both,,,1650.0900,247.5100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,825.05,,,,,,,425.8900,1650.0900,percent of total billed charges,"Rev 272 $1,650.09 in Billed Charges at 50% = $825.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 3.5,272,RC,27200002,CDM,,,,,,both,,,1650.0900,247.5100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,532.98,,,,,,,425.8900,1650.0900,other,"32.3% of $1,650.09 in Billed Charges for Rev 272 = $532.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE AGGRESSIVE SERRATED 3.5,272,RC,27200002,CDM,,,,,,both,,,1650.0900,247.5100,UNITED HEALTHCARE,UHC HERITAGE SELECT,506.58,,,,,,,425.8900,1650.0900,other,"30.7% of $1,650.09 in Billed Charges for Rev 272 = $506.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE AGGRESSIVE SERRATED 3.5,272,RC,27200002,CDM,,,,,,both,,,1650.0900,247.5100,UNITED HEALTHCARE,UNITED HEALTHCARE,532.98,,,,,,,425.8900,1650.0900,percent of total billed charges,"32.3% of $1,650.09 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 3.5,272,RC,27200002,CDM,,,,,,both,,,1650.0900,247.5100,WELLCARE,WELLCARE MEDICAID,1650.09,,,,,,,425.8900,1650.0900,percent of total billed charges,"100% of $1,650.09 in Billed Charges for Rev 272 = $1,650.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHO RESECTOR 5MM,272,RC,27200002,CDM,,,,,,both,,,3497.7200,524.6600,AETNA,AETNA,1493.53,,,,,,,902.7600,3497.7200,percent of total billed charges,"42.7% of $3,497.72 in Billed Charges for Rev 272 = $1,493.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHO RESECTOR 5MM,272,RC,27200002,CDM,,,,,,both,,,3497.7200,524.6600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2448.40,,,,,,,902.7600,3497.7200,percent of total billed charges,"Rev 272 $3,497.72 in Billed Charges at 70% = $2,448.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHO RESECTOR 5MM,272,RC,27200002,CDM,,,,,,both,,,3497.7200,524.6600,CIGNA HEALTHCARE,CIGNA HMO,1458.55,,,,,,,902.7600,3497.7200,percent of total billed charges,"41.7% of $3,497.72 in Billed Charges for Rev 272 = $1,458.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHO RESECTOR 5MM,272,RC,27200002,CDM,,,,,,both,,,3497.7200,524.6600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1622.94,,,,,,,902.7600,3497.7200,percent of total billed charges,"46.4% of $3,497.72 in Billed Charges for Rev 272 = $1,622.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHO RESECTOR 5MM,272,RC,27200002,CDM,,,,,,both,,,3497.7200,524.6600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1458.55,,,,,,,902.7600,3497.7200,percent of total billed charges,"41.7% of $3,497.72 in Billed Charges for Rev 272 = $1,458.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHO RESECTOR 5MM,272,RC,27200002,CDM,,,,,,both,,,3497.7200,524.6600,CIGNA HEALTHCARE,CIGNA PPO,1458.55,,,,,,,902.7600,3497.7200,percent of total billed charges,"41.7% of $3,497.72 in Billed Charges for Rev 272 = $1,458.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHO RESECTOR 5MM,272,RC,27200002,CDM,,,,,,both,,,3497.7200,524.6600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3147.95,,,,,,,902.7600,3497.7200,percent of total billed charges,"90% of $3,497.72 in Billed Charges for Rev 272 = $3,147.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHO RESECTOR 5MM,272,RC,27200002,CDM,,,,,,both,,,3497.7200,524.6600,MEDCOST,MEDCOST VHN,1664.56,,,,,,,902.7600,3497.7200,percent of total billed charges,"47.59% of $3,497.72 in Billed Charges for Rev 272 = $1,664.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHO RESECTOR 5MM,272,RC,27200002,CDM,,,,,,both,,,3497.7200,524.6600,SENTARA HEALTH,SENTARA HEALTH,902.76,,,,,,,902.7600,3497.7200,percent of total billed charges,"25.81% of $3,497.72 in Billed Charges for Rev 272 = $902.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHO RESECTOR 5MM,272,RC,27200002,CDM,,,,,,both,,,3497.7200,524.6600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3497.72,,,,,,,902.7600,3497.7200,percent of total billed charges,"100% of $3,497.72 in Billed Charges for Rev 272 = $3,497.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHO RESECTOR 5MM,272,RC,27200002,CDM,,,,,,both,,,3497.7200,524.6600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1748.86,,,,,,,902.7600,3497.7200,percent of total billed charges,"Rev 272 $3,497.72 in Billed Charges at 50% = $1,748.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHO RESECTOR 5MM,272,RC,27200002,CDM,,,,,,both,,,3497.7200,524.6600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1129.76,,,,,,,902.7600,3497.7200,other,"32.3% of $3,497.72 in Billed Charges for Rev 272 = $1,129.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE ARTHO RESECTOR 5MM,272,RC,27200002,CDM,,,,,,both,,,3497.7200,524.6600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1073.80,,,,,,,902.7600,3497.7200,other,"30.7% of $3,497.72 in Billed Charges for Rev 272 = $1,073.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE ARTHO RESECTOR 5MM,272,RC,27200002,CDM,,,,,,both,,,3497.7200,524.6600,UNITED HEALTHCARE,UNITED HEALTHCARE,1129.76,,,,,,,902.7600,3497.7200,percent of total billed charges,"32.3% of $3,497.72 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHO RESECTOR 5MM,272,RC,27200002,CDM,,,,,,both,,,3497.7200,524.6600,WELLCARE,WELLCARE MEDICAID,3497.72,,,,,,,902.7600,3497.7200,percent of total billed charges,"100% of $3,497.72 in Billed Charges for Rev 272 = $3,497.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE OSTEOTOME FLEXIBLE MRI NON STERILE 12MM,272,RC,,,,,,,,both,,,980.0600,147.0100,AETNA,AETNA,418.49,,,,,,,252.9500,980.0600,percent of total billed charges,42.7% of $980.06 in Billed Charges for Rev 272 = $418.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE OSTEOTOME FLEXIBLE MRI NON STERILE 12MM,272,RC,,,,,,,,both,,,980.0600,147.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,686.04,,,,,,,252.9500,980.0600,percent of total billed charges,Rev 272 $980.06 in Billed Charges at 70% = $686.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE OSTEOTOME FLEXIBLE MRI NON STERILE 12MM,272,RC,,,,,,,,both,,,980.0600,147.0100,CIGNA HEALTHCARE,CIGNA HMO,408.69,,,,,,,252.9500,980.0600,percent of total billed charges,41.7% of $980.06 in Billed Charges for Rev 272 = $408.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE OSTEOTOME FLEXIBLE MRI NON STERILE 12MM,272,RC,,,,,,,,both,,,980.0600,147.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,454.75,,,,,,,252.9500,980.0600,percent of total billed charges,46.4% of $980.06 in Billed Charges for Rev 272 = $454.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE OSTEOTOME FLEXIBLE MRI NON STERILE 12MM,272,RC,,,,,,,,both,,,980.0600,147.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,408.69,,,,,,,252.9500,980.0600,percent of total billed charges,41.7% of $980.06 in Billed Charges for Rev 272 = $408.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE OSTEOTOME FLEXIBLE MRI NON STERILE 12MM,272,RC,,,,,,,,both,,,980.0600,147.0100,CIGNA HEALTHCARE,CIGNA PPO,408.69,,,,,,,252.9500,980.0600,percent of total billed charges,41.7% of $980.06 in Billed Charges for Rev 272 = $408.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE OSTEOTOME FLEXIBLE MRI NON STERILE 12MM,272,RC,,,,,,,,both,,,980.0600,147.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,882.05,,,,,,,252.9500,980.0600,percent of total billed charges,90% of $980.06 in Billed Charges for Rev 272 = $882.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE OSTEOTOME FLEXIBLE MRI NON STERILE 12MM,272,RC,,,,,,,,both,,,980.0600,147.0100,MEDCOST,MEDCOST VHN,466.41,,,,,,,252.9500,980.0600,percent of total billed charges,47.59% of $980.06 in Billed Charges for Rev 272 = $466.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE OSTEOTOME FLEXIBLE MRI NON STERILE 12MM,272,RC,,,,,,,,both,,,980.0600,147.0100,SENTARA HEALTH,SENTARA HEALTH,252.95,,,,,,,252.9500,980.0600,percent of total billed charges,25.81% of $980.06 in Billed Charges for Rev 272 = $252.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE OSTEOTOME FLEXIBLE MRI NON STERILE 12MM,272,RC,,,,,,,,both,,,980.0600,147.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",980.06,,,,,,,252.9500,980.0600,percent of total billed charges,100% of $980.06 in Billed Charges for Rev 272 = $980.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE OSTEOTOME FLEXIBLE MRI NON STERILE 12MM,272,RC,,,,,,,,both,,,980.0600,147.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,490.03,,,,,,,252.9500,980.0600,percent of total billed charges,Rev 272 $980.06 in Billed Charges at 50% = $490.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE OSTEOTOME FLEXIBLE MRI NON STERILE 12MM,272,RC,,,,,,,,both,,,980.0600,147.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,316.56,,,,,,,252.9500,980.0600,other,32.3% of $980.06 in Billed Charges for Rev 272 = $316.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE OSTEOTOME FLEXIBLE MRI NON STERILE 12MM,272,RC,,,,,,,,both,,,980.0600,147.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,300.88,,,,,,,252.9500,980.0600,other,30.7% of $980.06 in Billed Charges for Rev 272 = $300.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE OSTEOTOME FLEXIBLE MRI NON STERILE 12MM,272,RC,,,,,,,,both,,,980.0600,147.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,316.56,,,,,,,252.9500,980.0600,percent of total billed charges,32.3% of $980.06 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE OSTEOTOME FLEXIBLE MRI NON STERILE 12MM,272,RC,,,,,,,,both,,,980.0600,147.0100,WELLCARE,WELLCARE MEDICAID,980.06,,,,,,,252.9500,980.0600,percent of total billed charges,100% of $980.06 in Billed Charges for Rev 272 = $980.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 125MM,272,RC,27200002,CDM,,,,,,both,,,976.1200,146.4200,AETNA,AETNA,416.80,,,,,,,251.9400,976.1200,percent of total billed charges,42.7% of $976.12 in Billed Charges for Rev 272 = $416.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 125MM,272,RC,27200002,CDM,,,,,,both,,,976.1200,146.4200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,683.28,,,,,,,251.9400,976.1200,percent of total billed charges,Rev 272 $976.12 in Billed Charges at 70% = $683.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 125MM,272,RC,27200002,CDM,,,,,,both,,,976.1200,146.4200,CIGNA HEALTHCARE,CIGNA HMO,407.04,,,,,,,251.9400,976.1200,percent of total billed charges,41.7% of $976.12 in Billed Charges for Rev 272 = $407.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 125MM,272,RC,27200002,CDM,,,,,,both,,,976.1200,146.4200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,452.92,,,,,,,251.9400,976.1200,percent of total billed charges,46.4% of $976.12 in Billed Charges for Rev 272 = $452.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 125MM,272,RC,27200002,CDM,,,,,,both,,,976.1200,146.4200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,407.04,,,,,,,251.9400,976.1200,percent of total billed charges,41.7% of $976.12 in Billed Charges for Rev 272 = $407.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 125MM,272,RC,27200002,CDM,,,,,,both,,,976.1200,146.4200,CIGNA HEALTHCARE,CIGNA PPO,407.04,,,,,,,251.9400,976.1200,percent of total billed charges,41.7% of $976.12 in Billed Charges for Rev 272 = $407.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 125MM,272,RC,27200002,CDM,,,,,,both,,,976.1200,146.4200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,878.51,,,,,,,251.9400,976.1200,percent of total billed charges,90% of $976.12 in Billed Charges for Rev 272 = $878.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 125MM,272,RC,27200002,CDM,,,,,,both,,,976.1200,146.4200,MEDCOST,MEDCOST VHN,464.54,,,,,,,251.9400,976.1200,percent of total billed charges,47.59% of $976.12 in Billed Charges for Rev 272 = $464.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 125MM,272,RC,27200002,CDM,,,,,,both,,,976.1200,146.4200,SENTARA HEALTH,SENTARA HEALTH,251.94,,,,,,,251.9400,976.1200,percent of total billed charges,25.81% of $976.12 in Billed Charges for Rev 272 = $251.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 125MM,272,RC,27200002,CDM,,,,,,both,,,976.1200,146.4200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",976.12,,,,,,,251.9400,976.1200,percent of total billed charges,100% of $976.12 in Billed Charges for Rev 272 = $976.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 125MM,272,RC,27200002,CDM,,,,,,both,,,976.1200,146.4200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,488.06,,,,,,,251.9400,976.1200,percent of total billed charges,Rev 272 $976.12 in Billed Charges at 50% = $488.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 125MM,272,RC,27200002,CDM,,,,,,both,,,976.1200,146.4200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,315.29,,,,,,,251.9400,976.1200,other,32.3% of $976.12 in Billed Charges for Rev 272 = $315.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL QUICK COUPLING 2.7 X 125MM,272,RC,27200002,CDM,,,,,,both,,,976.1200,146.4200,UNITED HEALTHCARE,UHC HERITAGE SELECT,299.67,,,,,,,251.9400,976.1200,other,30.7% of $976.12 in Billed Charges for Rev 272 = $299.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL QUICK COUPLING 2.7 X 125MM,272,RC,27200002,CDM,,,,,,both,,,976.1200,146.4200,UNITED HEALTHCARE,UNITED HEALTHCARE,315.29,,,,,,,251.9400,976.1200,percent of total billed charges,32.3% of $976.12 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 2.7 X 125MM,272,RC,27200002,CDM,,,,,,both,,,976.1200,146.4200,WELLCARE,WELLCARE MEDICAID,976.12,,,,,,,251.9400,976.1200,percent of total billed charges,100% of $976.12 in Billed Charges for Rev 272 = $976.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE PATELLA 51MM,272,RC,27200002,CDM,,,,,,both,,,1451.9400,217.7900,AETNA,AETNA,619.98,,,,,,,374.7500,1451.9400,percent of total billed charges,"42.7% of $1,451.94 in Billed Charges for Rev 272 = $619.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA 51MM,272,RC,27200002,CDM,,,,,,both,,,1451.9400,217.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1016.36,,,,,,,374.7500,1451.9400,percent of total billed charges,"Rev 272 $1,451.94 in Billed Charges at 70% = $1,016.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA 51MM,272,RC,27200002,CDM,,,,,,both,,,1451.9400,217.7900,CIGNA HEALTHCARE,CIGNA HMO,605.46,,,,,,,374.7500,1451.9400,percent of total billed charges,"41.7% of $1,451.94 in Billed Charges for Rev 272 = $605.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA 51MM,272,RC,27200002,CDM,,,,,,both,,,1451.9400,217.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,673.70,,,,,,,374.7500,1451.9400,percent of total billed charges,"46.4% of $1,451.94 in Billed Charges for Rev 272 = $673.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA 51MM,272,RC,27200002,CDM,,,,,,both,,,1451.9400,217.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,605.46,,,,,,,374.7500,1451.9400,percent of total billed charges,"41.7% of $1,451.94 in Billed Charges for Rev 272 = $605.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA 51MM,272,RC,27200002,CDM,,,,,,both,,,1451.9400,217.7900,CIGNA HEALTHCARE,CIGNA PPO,605.46,,,,,,,374.7500,1451.9400,percent of total billed charges,"41.7% of $1,451.94 in Billed Charges for Rev 272 = $605.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA 51MM,272,RC,27200002,CDM,,,,,,both,,,1451.9400,217.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1306.75,,,,,,,374.7500,1451.9400,percent of total billed charges,"90% of $1,451.94 in Billed Charges for Rev 272 = $1,306.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA 51MM,272,RC,27200002,CDM,,,,,,both,,,1451.9400,217.7900,MEDCOST,MEDCOST VHN,690.98,,,,,,,374.7500,1451.9400,percent of total billed charges,"47.59% of $1,451.94 in Billed Charges for Rev 272 = $690.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA 51MM,272,RC,27200002,CDM,,,,,,both,,,1451.9400,217.7900,SENTARA HEALTH,SENTARA HEALTH,374.75,,,,,,,374.7500,1451.9400,percent of total billed charges,"25.81% of $1,451.94 in Billed Charges for Rev 272 = $374.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA 51MM,272,RC,27200002,CDM,,,,,,both,,,1451.9400,217.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1451.94,,,,,,,374.7500,1451.9400,percent of total billed charges,"100% of $1,451.94 in Billed Charges for Rev 272 = $1,451.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA 51MM,272,RC,27200002,CDM,,,,,,both,,,1451.9400,217.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,725.97,,,,,,,374.7500,1451.9400,percent of total billed charges,"Rev 272 $1,451.94 in Billed Charges at 50% = $725.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA 51MM,272,RC,27200002,CDM,,,,,,both,,,1451.9400,217.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,468.98,,,,,,,374.7500,1451.9400,other,"32.3% of $1,451.94 in Billed Charges for Rev 272 = $468.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE PATELLA 51MM,272,RC,27200002,CDM,,,,,,both,,,1451.9400,217.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,445.75,,,,,,,374.7500,1451.9400,other,"30.7% of $1,451.94 in Billed Charges for Rev 272 = $445.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE PATELLA 51MM,272,RC,27200002,CDM,,,,,,both,,,1451.9400,217.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,468.98,,,,,,,374.7500,1451.9400,percent of total billed charges,"32.3% of $1,451.94 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA 51MM,272,RC,27200002,CDM,,,,,,both,,,1451.9400,217.7900,WELLCARE,WELLCARE MEDICAID,1451.94,,,,,,,374.7500,1451.9400,percent of total billed charges,"100% of $1,451.94 in Billed Charges for Rev 272 = $1,451.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3237.9300,485.6900,AETNA,AETNA,1382.60,,,,,,,835.7100,3237.9300,percent of total billed charges,"42.7% of $3,237.93 in Billed Charges for Rev 272 = $1,382.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3237.9300,485.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2266.55,,,,,,,835.7100,3237.9300,percent of total billed charges,"Rev 272 $3,237.93 in Billed Charges at 70% = $2,266.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3237.9300,485.6900,CIGNA HEALTHCARE,CIGNA HMO,1350.22,,,,,,,835.7100,3237.9300,percent of total billed charges,"41.7% of $3,237.93 in Billed Charges for Rev 272 = $1,350.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3237.9300,485.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1502.40,,,,,,,835.7100,3237.9300,percent of total billed charges,"46.4% of $3,237.93 in Billed Charges for Rev 272 = $1,502.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3237.9300,485.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1350.22,,,,,,,835.7100,3237.9300,percent of total billed charges,"41.7% of $3,237.93 in Billed Charges for Rev 272 = $1,350.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3237.9300,485.6900,CIGNA HEALTHCARE,CIGNA PPO,1350.22,,,,,,,835.7100,3237.9300,percent of total billed charges,"41.7% of $3,237.93 in Billed Charges for Rev 272 = $1,350.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3237.9300,485.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2914.14,,,,,,,835.7100,3237.9300,percent of total billed charges,"90% of $3,237.93 in Billed Charges for Rev 272 = $2,914.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3237.9300,485.6900,MEDCOST,MEDCOST VHN,1540.93,,,,,,,835.7100,3237.9300,percent of total billed charges,"47.59% of $3,237.93 in Billed Charges for Rev 272 = $1,540.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3237.9300,485.6900,SENTARA HEALTH,SENTARA HEALTH,835.71,,,,,,,835.7100,3237.9300,percent of total billed charges,"25.81% of $3,237.93 in Billed Charges for Rev 272 = $835.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3237.9300,485.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3237.93,,,,,,,835.7100,3237.9300,percent of total billed charges,"100% of $3,237.93 in Billed Charges for Rev 272 = $3,237.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3237.9300,485.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1618.97,,,,,,,835.7100,3237.9300,percent of total billed charges,"Rev 272 $3,237.93 in Billed Charges at 50% = $1,618.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3237.9300,485.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1045.85,,,,,,,835.7100,3237.9300,other,"32.3% of $3,237.93 in Billed Charges for Rev 272 = $1,045.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3237.9300,485.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,994.04,,,,,,,835.7100,3237.9300,other,"30.7% of $3,237.93 in Billed Charges for Rev 272 = $994.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3237.9300,485.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,1045.85,,,,,,,835.7100,3237.9300,percent of total billed charges,"32.3% of $3,237.93 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3237.9300,485.6900,WELLCARE,WELLCARE MEDICAID,3237.93,,,,,,,835.7100,3237.9300,percent of total billed charges,"100% of $3,237.93 in Billed Charges for Rev 272 = $3,237.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PERIOSTEAL ELEVATOR CURVED 6MM,272,RC,,,,,,,,both,,,1875.0800,281.2600,AETNA,AETNA,800.66,,,,,,,483.9600,1875.0800,percent of total billed charges,"42.7% of $1,875.08 in Billed Charges for Rev 272 = $800.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PERIOSTEAL ELEVATOR CURVED 6MM,272,RC,,,,,,,,both,,,1875.0800,281.2600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1312.56,,,,,,,483.9600,1875.0800,percent of total billed charges,"Rev 272 $1,875.08 in Billed Charges at 70% = $1,312.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PERIOSTEAL ELEVATOR CURVED 6MM,272,RC,,,,,,,,both,,,1875.0800,281.2600,CIGNA HEALTHCARE,CIGNA HMO,781.91,,,,,,,483.9600,1875.0800,percent of total billed charges,"41.7% of $1,875.08 in Billed Charges for Rev 272 = $781.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PERIOSTEAL ELEVATOR CURVED 6MM,272,RC,,,,,,,,both,,,1875.0800,281.2600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,870.04,,,,,,,483.9600,1875.0800,percent of total billed charges,"46.4% of $1,875.08 in Billed Charges for Rev 272 = $870.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PERIOSTEAL ELEVATOR CURVED 6MM,272,RC,,,,,,,,both,,,1875.0800,281.2600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,781.91,,,,,,,483.9600,1875.0800,percent of total billed charges,"41.7% of $1,875.08 in Billed Charges for Rev 272 = $781.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PERIOSTEAL ELEVATOR CURVED 6MM,272,RC,,,,,,,,both,,,1875.0800,281.2600,CIGNA HEALTHCARE,CIGNA PPO,781.91,,,,,,,483.9600,1875.0800,percent of total billed charges,"41.7% of $1,875.08 in Billed Charges for Rev 272 = $781.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PERIOSTEAL ELEVATOR CURVED 6MM,272,RC,,,,,,,,both,,,1875.0800,281.2600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1687.57,,,,,,,483.9600,1875.0800,percent of total billed charges,"90% of $1,875.08 in Billed Charges for Rev 272 = $1,687.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PERIOSTEAL ELEVATOR CURVED 6MM,272,RC,,,,,,,,both,,,1875.0800,281.2600,MEDCOST,MEDCOST VHN,892.35,,,,,,,483.9600,1875.0800,percent of total billed charges,"47.59% of $1,875.08 in Billed Charges for Rev 272 = $892.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PERIOSTEAL ELEVATOR CURVED 6MM,272,RC,,,,,,,,both,,,1875.0800,281.2600,SENTARA HEALTH,SENTARA HEALTH,483.96,,,,,,,483.9600,1875.0800,percent of total billed charges,"25.81% of $1,875.08 in Billed Charges for Rev 272 = $483.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PERIOSTEAL ELEVATOR CURVED 6MM,272,RC,,,,,,,,both,,,1875.0800,281.2600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1875.08,,,,,,,483.9600,1875.0800,percent of total billed charges,"100% of $1,875.08 in Billed Charges for Rev 272 = $1,875.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PERIOSTEAL ELEVATOR CURVED 6MM,272,RC,,,,,,,,both,,,1875.0800,281.2600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,937.54,,,,,,,483.9600,1875.0800,percent of total billed charges,"Rev 272 $1,875.08 in Billed Charges at 50% = $937.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PERIOSTEAL ELEVATOR CURVED 6MM,272,RC,,,,,,,,both,,,1875.0800,281.2600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,605.65,,,,,,,483.9600,1875.0800,other,"32.3% of $1,875.08 in Billed Charges for Rev 272 = $605.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE PERIOSTEAL ELEVATOR CURVED 6MM,272,RC,,,,,,,,both,,,1875.0800,281.2600,UNITED HEALTHCARE,UHC HERITAGE SELECT,575.65,,,,,,,483.9600,1875.0800,other,"30.7% of $1,875.08 in Billed Charges for Rev 272 = $575.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE PERIOSTEAL ELEVATOR CURVED 6MM,272,RC,,,,,,,,both,,,1875.0800,281.2600,UNITED HEALTHCARE,UNITED HEALTHCARE,605.65,,,,,,,483.9600,1875.0800,percent of total billed charges,"32.3% of $1,875.08 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PERIOSTEAL ELEVATOR CURVED 6MM,272,RC,,,,,,,,both,,,1875.0800,281.2600,WELLCARE,WELLCARE MEDICAID,1875.08,,,,,,,483.9600,1875.0800,percent of total billed charges,"100% of $1,875.08 in Billed Charges for Rev 272 = $1,875.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PLANTAR FASCIA RELEASE SYSTEM ENDOBLADE,272,RC,27200002,CDM,,,,,,both,,,11045.1200,1656.7700,AETNA,AETNA,4716.27,,,,,,,2850.7500,11045.1200,percent of total billed charges,"42.7% of $11,045.12 in Billed Charges for Rev 272 = $4,716.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PLANTAR FASCIA RELEASE SYSTEM ENDOBLADE,272,RC,27200002,CDM,,,,,,both,,,11045.1200,1656.7700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7731.58,,,,,,,2850.7500,11045.1200,percent of total billed charges,"Rev 272 $11,045.12 in Billed Charges at 70% = $7,731.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PLANTAR FASCIA RELEASE SYSTEM ENDOBLADE,272,RC,27200002,CDM,,,,,,both,,,11045.1200,1656.7700,CIGNA HEALTHCARE,CIGNA HMO,4605.82,,,,,,,2850.7500,11045.1200,percent of total billed charges,"41.7% of $11,045.12 in Billed Charges for Rev 272 = $4,605.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PLANTAR FASCIA RELEASE SYSTEM ENDOBLADE,272,RC,27200002,CDM,,,,,,both,,,11045.1200,1656.7700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5124.94,,,,,,,2850.7500,11045.1200,percent of total billed charges,"46.4% of $11,045.12 in Billed Charges for Rev 272 = $5,124.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PLANTAR FASCIA RELEASE SYSTEM ENDOBLADE,272,RC,27200002,CDM,,,,,,both,,,11045.1200,1656.7700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4605.82,,,,,,,2850.7500,11045.1200,percent of total billed charges,"41.7% of $11,045.12 in Billed Charges for Rev 272 = $4,605.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PLANTAR FASCIA RELEASE SYSTEM ENDOBLADE,272,RC,27200002,CDM,,,,,,both,,,11045.1200,1656.7700,CIGNA HEALTHCARE,CIGNA PPO,4605.82,,,,,,,2850.7500,11045.1200,percent of total billed charges,"41.7% of $11,045.12 in Billed Charges for Rev 272 = $4,605.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PLANTAR FASCIA RELEASE SYSTEM ENDOBLADE,272,RC,27200002,CDM,,,,,,both,,,11045.1200,1656.7700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9940.61,,,,,,,2850.7500,11045.1200,percent of total billed charges,"90% of $11,045.12 in Billed Charges for Rev 272 = $9,940.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PLANTAR FASCIA RELEASE SYSTEM ENDOBLADE,272,RC,27200002,CDM,,,,,,both,,,11045.1200,1656.7700,MEDCOST,MEDCOST VHN,5256.37,,,,,,,2850.7500,11045.1200,percent of total billed charges,"47.59% of $11,045.12 in Billed Charges for Rev 272 = $5,256.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PLANTAR FASCIA RELEASE SYSTEM ENDOBLADE,272,RC,27200002,CDM,,,,,,both,,,11045.1200,1656.7700,SENTARA HEALTH,SENTARA HEALTH,2850.75,,,,,,,2850.7500,11045.1200,percent of total billed charges,"25.81% of $11,045.12 in Billed Charges for Rev 272 = $2,850.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PLANTAR FASCIA RELEASE SYSTEM ENDOBLADE,272,RC,27200002,CDM,,,,,,both,,,11045.1200,1656.7700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11045.12,,,,,,,2850.7500,11045.1200,percent of total billed charges,"100% of $11,045.12 in Billed Charges for Rev 272 = $11,045.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PLANTAR FASCIA RELEASE SYSTEM ENDOBLADE,272,RC,27200002,CDM,,,,,,both,,,11045.1200,1656.7700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5522.56,,,,,,,2850.7500,11045.1200,percent of total billed charges,"Rev 272 $11,045.12 in Billed Charges at 50% = $5,522.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PLANTAR FASCIA RELEASE SYSTEM ENDOBLADE,272,RC,27200002,CDM,,,,,,both,,,11045.1200,1656.7700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3567.57,,,,,,,2850.7500,11045.1200,other,"32.3% of $11,045.12 in Billed Charges for Rev 272 = $3,567.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE PLANTAR FASCIA RELEASE SYSTEM ENDOBLADE,272,RC,27200002,CDM,,,,,,both,,,11045.1200,1656.7700,UNITED HEALTHCARE,UHC HERITAGE SELECT,3390.85,,,,,,,2850.7500,11045.1200,other,"30.7% of $11,045.12 in Billed Charges for Rev 272 = $3,390.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE PLANTAR FASCIA RELEASE SYSTEM ENDOBLADE,272,RC,27200002,CDM,,,,,,both,,,11045.1200,1656.7700,UNITED HEALTHCARE,UNITED HEALTHCARE,3567.57,,,,,,,2850.7500,11045.1200,percent of total billed charges,"32.3% of $11,045.12 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PLANTAR FASCIA RELEASE SYSTEM ENDOBLADE,272,RC,27200002,CDM,,,,,,both,,,11045.1200,1656.7700,WELLCARE,WELLCARE MEDICAID,11045.12,,,,,,,2850.7500,11045.1200,percent of total billed charges,"100% of $11,045.12 in Billed Charges for Rev 272 = $11,045.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION CARTRIDGE  6425-127-105,272,RC,27200002,CDM,,,,,,both,,,1866.7800,280.0200,AETNA,AETNA,797.12,,,,,,,481.8200,1866.7800,percent of total billed charges,"42.7% of $1,866.78 in Billed Charges for Rev 272 = $797.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION CARTRIDGE  6425-127-105,272,RC,27200002,CDM,,,,,,both,,,1866.7800,280.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1306.75,,,,,,,481.8200,1866.7800,percent of total billed charges,"Rev 272 $1,866.78 in Billed Charges at 70% = $1,306.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION CARTRIDGE  6425-127-105,272,RC,27200002,CDM,,,,,,both,,,1866.7800,280.0200,CIGNA HEALTHCARE,CIGNA HMO,778.45,,,,,,,481.8200,1866.7800,percent of total billed charges,"41.7% of $1,866.78 in Billed Charges for Rev 272 = $778.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION CARTRIDGE  6425-127-105,272,RC,27200002,CDM,,,,,,both,,,1866.7800,280.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,866.19,,,,,,,481.8200,1866.7800,percent of total billed charges,"46.4% of $1,866.78 in Billed Charges for Rev 272 = $866.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION CARTRIDGE  6425-127-105,272,RC,27200002,CDM,,,,,,both,,,1866.7800,280.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,778.45,,,,,,,481.8200,1866.7800,percent of total billed charges,"41.7% of $1,866.78 in Billed Charges for Rev 272 = $778.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION CARTRIDGE  6425-127-105,272,RC,27200002,CDM,,,,,,both,,,1866.7800,280.0200,CIGNA HEALTHCARE,CIGNA PPO,778.45,,,,,,,481.8200,1866.7800,percent of total billed charges,"41.7% of $1,866.78 in Billed Charges for Rev 272 = $778.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION CARTRIDGE  6425-127-105,272,RC,27200002,CDM,,,,,,both,,,1866.7800,280.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1680.10,,,,,,,481.8200,1866.7800,percent of total billed charges,"90% of $1,866.78 in Billed Charges for Rev 272 = $1,680.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION CARTRIDGE  6425-127-105,272,RC,27200002,CDM,,,,,,both,,,1866.7800,280.0200,MEDCOST,MEDCOST VHN,888.40,,,,,,,481.8200,1866.7800,percent of total billed charges,"47.59% of $1,866.78 in Billed Charges for Rev 272 = $888.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION CARTRIDGE  6425-127-105,272,RC,27200002,CDM,,,,,,both,,,1866.7800,280.0200,SENTARA HEALTH,SENTARA HEALTH,481.82,,,,,,,481.8200,1866.7800,percent of total billed charges,"25.81% of $1,866.78 in Billed Charges for Rev 272 = $481.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION CARTRIDGE  6425-127-105,272,RC,27200002,CDM,,,,,,both,,,1866.7800,280.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1866.78,,,,,,,481.8200,1866.7800,percent of total billed charges,"100% of $1,866.78 in Billed Charges for Rev 272 = $1,866.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION CARTRIDGE  6425-127-105,272,RC,27200002,CDM,,,,,,both,,,1866.7800,280.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,933.39,,,,,,,481.8200,1866.7800,percent of total billed charges,"Rev 272 $1,866.78 in Billed Charges at 50% = $933.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION CARTRIDGE  6425-127-105,272,RC,27200002,CDM,,,,,,both,,,1866.7800,280.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,602.97,,,,,,,481.8200,1866.7800,other,"32.3% of $1,866.78 in Billed Charges for Rev 272 = $602.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE PRECISION CARTRIDGE  6425-127-105,272,RC,27200002,CDM,,,,,,both,,,1866.7800,280.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,573.10,,,,,,,481.8200,1866.7800,other,"30.7% of $1,866.78 in Billed Charges for Rev 272 = $573.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE PRECISION CARTRIDGE  6425-127-105,272,RC,27200002,CDM,,,,,,both,,,1866.7800,280.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,602.97,,,,,,,481.8200,1866.7800,percent of total billed charges,"32.3% of $1,866.78 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION CARTRIDGE  6425-127-105,272,RC,27200002,CDM,,,,,,both,,,1866.7800,280.0200,WELLCARE,WELLCARE MEDICAID,1866.78,,,,,,,481.8200,1866.7800,percent of total billed charges,"100% of $1,866.78 in Billed Charges for Rev 272 = $1,866.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL QUICK COUPLING 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,603.9000,90.5900,AETNA,AETNA,257.87,,,,,,,155.8700,603.9000,percent of total billed charges,42.7% of $603.90 in Billed Charges for Rev 272 = $257.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,603.9000,90.5900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,422.73,,,,,,,155.8700,603.9000,percent of total billed charges,Rev 272 $603.90 in Billed Charges at 70% = $422.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,603.9000,90.5900,CIGNA HEALTHCARE,CIGNA HMO,251.83,,,,,,,155.8700,603.9000,percent of total billed charges,41.7% of $603.90 in Billed Charges for Rev 272 = $251.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,603.9000,90.5900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,280.21,,,,,,,155.8700,603.9000,percent of total billed charges,46.4% of $603.90 in Billed Charges for Rev 272 = $280.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,603.9000,90.5900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,251.83,,,,,,,155.8700,603.9000,percent of total billed charges,41.7% of $603.90 in Billed Charges for Rev 272 = $251.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,603.9000,90.5900,CIGNA HEALTHCARE,CIGNA PPO,251.83,,,,,,,155.8700,603.9000,percent of total billed charges,41.7% of $603.90 in Billed Charges for Rev 272 = $251.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,603.9000,90.5900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,543.51,,,,,,,155.8700,603.9000,percent of total billed charges,90% of $603.90 in Billed Charges for Rev 272 = $543.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,603.9000,90.5900,MEDCOST,MEDCOST VHN,287.40,,,,,,,155.8700,603.9000,percent of total billed charges,47.59% of $603.90 in Billed Charges for Rev 272 = $287.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,603.9000,90.5900,SENTARA HEALTH,SENTARA HEALTH,155.87,,,,,,,155.8700,603.9000,percent of total billed charges,25.81% of $603.90 in Billed Charges for Rev 272 = $155.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,603.9000,90.5900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",603.90,,,,,,,155.8700,603.9000,percent of total billed charges,100% of $603.90 in Billed Charges for Rev 272 = $603.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,603.9000,90.5900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,301.95,,,,,,,155.8700,603.9000,percent of total billed charges,Rev 272 $603.90 in Billed Charges at 50% = $301.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,603.9000,90.5900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,195.06,,,,,,,155.8700,603.9000,other,32.3% of $603.90 in Billed Charges for Rev 272 = $195.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL QUICK COUPLING 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,603.9000,90.5900,UNITED HEALTHCARE,UHC HERITAGE SELECT,185.40,,,,,,,155.8700,603.9000,other,30.7% of $603.90 in Billed Charges for Rev 272 = $185.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL QUICK COUPLING 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,603.9000,90.5900,UNITED HEALTHCARE,UNITED HEALTHCARE,195.06,,,,,,,155.8700,603.9000,percent of total billed charges,32.3% of $603.90 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL QUICK COUPLING 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,603.9000,90.5900,WELLCARE,WELLCARE MEDICAID,603.90,,,,,,,155.8700,603.9000,percent of total billed charges,100% of $603.90 in Billed Charges for Rev 272 = $603.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT HEX DRIVER T-10,272,RC,27200002,CDM,,,,,,both,,,4138.0300,620.7000,AETNA,AETNA,1766.94,,,,,,,1068.0300,4138.0300,percent of total billed charges,"42.7% of $4,138.03 in Billed Charges for Rev 272 = $1,766.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT HEX DRIVER T-10,272,RC,27200002,CDM,,,,,,both,,,4138.0300,620.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2896.62,,,,,,,1068.0300,4138.0300,percent of total billed charges,"Rev 272 $4,138.03 in Billed Charges at 70% = $2,896.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT HEX DRIVER T-10,272,RC,27200002,CDM,,,,,,both,,,4138.0300,620.7000,CIGNA HEALTHCARE,CIGNA HMO,1725.56,,,,,,,1068.0300,4138.0300,percent of total billed charges,"41.7% of $4,138.03 in Billed Charges for Rev 272 = $1,725.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT HEX DRIVER T-10,272,RC,27200002,CDM,,,,,,both,,,4138.0300,620.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1920.05,,,,,,,1068.0300,4138.0300,percent of total billed charges,"46.4% of $4,138.03 in Billed Charges for Rev 272 = $1,920.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT HEX DRIVER T-10,272,RC,27200002,CDM,,,,,,both,,,4138.0300,620.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1725.56,,,,,,,1068.0300,4138.0300,percent of total billed charges,"41.7% of $4,138.03 in Billed Charges for Rev 272 = $1,725.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT HEX DRIVER T-10,272,RC,27200002,CDM,,,,,,both,,,4138.0300,620.7000,CIGNA HEALTHCARE,CIGNA PPO,1725.56,,,,,,,1068.0300,4138.0300,percent of total billed charges,"41.7% of $4,138.03 in Billed Charges for Rev 272 = $1,725.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT HEX DRIVER T-10,272,RC,27200002,CDM,,,,,,both,,,4138.0300,620.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3724.23,,,,,,,1068.0300,4138.0300,percent of total billed charges,"90% of $4,138.03 in Billed Charges for Rev 272 = $3,724.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT HEX DRIVER T-10,272,RC,27200002,CDM,,,,,,both,,,4138.0300,620.7000,MEDCOST,MEDCOST VHN,1969.29,,,,,,,1068.0300,4138.0300,percent of total billed charges,"47.59% of $4,138.03 in Billed Charges for Rev 272 = $1,969.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT HEX DRIVER T-10,272,RC,27200002,CDM,,,,,,both,,,4138.0300,620.7000,SENTARA HEALTH,SENTARA HEALTH,1068.03,,,,,,,1068.0300,4138.0300,percent of total billed charges,"25.81% of $4,138.03 in Billed Charges for Rev 272 = $1,068.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT HEX DRIVER T-10,272,RC,27200002,CDM,,,,,,both,,,4138.0300,620.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4138.03,,,,,,,1068.0300,4138.0300,percent of total billed charges,"100% of $4,138.03 in Billed Charges for Rev 272 = $4,138.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT HEX DRIVER T-10,272,RC,27200002,CDM,,,,,,both,,,4138.0300,620.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2069.02,,,,,,,1068.0300,4138.0300,percent of total billed charges,"Rev 272 $4,138.03 in Billed Charges at 50% = $2,069.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT HEX DRIVER T-10,272,RC,27200002,CDM,,,,,,both,,,4138.0300,620.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1336.58,,,,,,,1068.0300,4138.0300,other,"32.3% of $4,138.03 in Billed Charges for Rev 272 = $1,336.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT HEX DRIVER T-10,272,RC,27200002,CDM,,,,,,both,,,4138.0300,620.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1270.38,,,,,,,1068.0300,4138.0300,other,"30.7% of $4,138.03 in Billed Charges for Rev 272 = $1,270.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT HEX DRIVER T-10,272,RC,27200002,CDM,,,,,,both,,,4138.0300,620.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,1336.58,,,,,,,1068.0300,4138.0300,percent of total billed charges,"32.3% of $4,138.03 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT HEX DRIVER T-10,272,RC,27200002,CDM,,,,,,both,,,4138.0300,620.7000,WELLCARE,WELLCARE MEDICAID,4138.03,,,,,,,1068.0300,4138.0300,percent of total billed charges,"100% of $4,138.03 in Billed Charges for Rev 272 = $4,138.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REDUCTION 3.5X77 SELF TAP,272,RC,,,,,,,,both,,,3084.3400,462.6500,AETNA,AETNA,1317.01,,,,,,,796.0700,3084.3400,percent of total billed charges,"42.7% of $3,084.34 in Billed Charges for Rev 272 = $1,317.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REDUCTION 3.5X77 SELF TAP,272,RC,,,,,,,,both,,,3084.3400,462.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2159.04,,,,,,,796.0700,3084.3400,percent of total billed charges,"Rev 272 $3,084.34 in Billed Charges at 70% = $2,159.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REDUCTION 3.5X77 SELF TAP,272,RC,,,,,,,,both,,,3084.3400,462.6500,CIGNA HEALTHCARE,CIGNA HMO,1286.17,,,,,,,796.0700,3084.3400,percent of total billed charges,"41.7% of $3,084.34 in Billed Charges for Rev 272 = $1,286.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REDUCTION 3.5X77 SELF TAP,272,RC,,,,,,,,both,,,3084.3400,462.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1431.13,,,,,,,796.0700,3084.3400,percent of total billed charges,"46.4% of $3,084.34 in Billed Charges for Rev 272 = $1,431.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REDUCTION 3.5X77 SELF TAP,272,RC,,,,,,,,both,,,3084.3400,462.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1286.17,,,,,,,796.0700,3084.3400,percent of total billed charges,"41.7% of $3,084.34 in Billed Charges for Rev 272 = $1,286.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REDUCTION 3.5X77 SELF TAP,272,RC,,,,,,,,both,,,3084.3400,462.6500,CIGNA HEALTHCARE,CIGNA PPO,1286.17,,,,,,,796.0700,3084.3400,percent of total billed charges,"41.7% of $3,084.34 in Billed Charges for Rev 272 = $1,286.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REDUCTION 3.5X77 SELF TAP,272,RC,,,,,,,,both,,,3084.3400,462.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2775.91,,,,,,,796.0700,3084.3400,percent of total billed charges,"90% of $3,084.34 in Billed Charges for Rev 272 = $2,775.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REDUCTION 3.5X77 SELF TAP,272,RC,,,,,,,,both,,,3084.3400,462.6500,MEDCOST,MEDCOST VHN,1467.84,,,,,,,796.0700,3084.3400,percent of total billed charges,"47.59% of $3,084.34 in Billed Charges for Rev 272 = $1,467.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REDUCTION 3.5X77 SELF TAP,272,RC,,,,,,,,both,,,3084.3400,462.6500,SENTARA HEALTH,SENTARA HEALTH,796.07,,,,,,,796.0700,3084.3400,percent of total billed charges,"25.81% of $3,084.34 in Billed Charges for Rev 272 = $796.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REDUCTION 3.5X77 SELF TAP,272,RC,,,,,,,,both,,,3084.3400,462.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3084.34,,,,,,,796.0700,3084.3400,percent of total billed charges,"100% of $3,084.34 in Billed Charges for Rev 272 = $3,084.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REDUCTION 3.5X77 SELF TAP,272,RC,,,,,,,,both,,,3084.3400,462.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1542.17,,,,,,,796.0700,3084.3400,percent of total billed charges,"Rev 272 $3,084.34 in Billed Charges at 50% = $1,542.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REDUCTION 3.5X77 SELF TAP,272,RC,,,,,,,,both,,,3084.3400,462.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,996.24,,,,,,,796.0700,3084.3400,other,"32.3% of $3,084.34 in Billed Charges for Rev 272 = $996.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT REDUCTION 3.5X77 SELF TAP,272,RC,,,,,,,,both,,,3084.3400,462.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,946.89,,,,,,,796.0700,3084.3400,other,"30.7% of $3,084.34 in Billed Charges for Rev 272 = $946.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT REDUCTION 3.5X77 SELF TAP,272,RC,,,,,,,,both,,,3084.3400,462.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,996.24,,,,,,,796.0700,3084.3400,percent of total billed charges,"32.3% of $3,084.34 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT REDUCTION 3.5X77 SELF TAP,272,RC,,,,,,,,both,,,3084.3400,462.6500,WELLCARE,WELLCARE MEDICAID,3084.34,,,,,,,796.0700,3084.3400,percent of total billed charges,"100% of $3,084.34 in Billed Charges for Rev 272 = $3,084.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT SCREWDRIVER HEXAGONAL 3.5 X 25MM,272,RC,27200002,CDM,,,,,,both,,,1068.2100,160.2300,AETNA,AETNA,456.13,,,,,,,275.7100,1068.2100,percent of total billed charges,"42.7% of $1,068.21 in Billed Charges for Rev 272 = $456.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT SCREWDRIVER HEXAGONAL 3.5 X 25MM,272,RC,27200002,CDM,,,,,,both,,,1068.2100,160.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,747.75,,,,,,,275.7100,1068.2100,percent of total billed charges,"Rev 272 $1,068.21 in Billed Charges at 70% = $747.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT SCREWDRIVER HEXAGONAL 3.5 X 25MM,272,RC,27200002,CDM,,,,,,both,,,1068.2100,160.2300,CIGNA HEALTHCARE,CIGNA HMO,445.44,,,,,,,275.7100,1068.2100,percent of total billed charges,"41.7% of $1,068.21 in Billed Charges for Rev 272 = $445.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT SCREWDRIVER HEXAGONAL 3.5 X 25MM,272,RC,27200002,CDM,,,,,,both,,,1068.2100,160.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,495.65,,,,,,,275.7100,1068.2100,percent of total billed charges,"46.4% of $1,068.21 in Billed Charges for Rev 272 = $495.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT SCREWDRIVER HEXAGONAL 3.5 X 25MM,272,RC,27200002,CDM,,,,,,both,,,1068.2100,160.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,445.44,,,,,,,275.7100,1068.2100,percent of total billed charges,"41.7% of $1,068.21 in Billed Charges for Rev 272 = $445.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT SCREWDRIVER HEXAGONAL 3.5 X 25MM,272,RC,27200002,CDM,,,,,,both,,,1068.2100,160.2300,CIGNA HEALTHCARE,CIGNA PPO,445.44,,,,,,,275.7100,1068.2100,percent of total billed charges,"41.7% of $1,068.21 in Billed Charges for Rev 272 = $445.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT SCREWDRIVER HEXAGONAL 3.5 X 25MM,272,RC,27200002,CDM,,,,,,both,,,1068.2100,160.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,961.39,,,,,,,275.7100,1068.2100,percent of total billed charges,"90% of $1,068.21 in Billed Charges for Rev 272 = $961.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT SCREWDRIVER HEXAGONAL 3.5 X 25MM,272,RC,27200002,CDM,,,,,,both,,,1068.2100,160.2300,MEDCOST,MEDCOST VHN,508.36,,,,,,,275.7100,1068.2100,percent of total billed charges,"47.59% of $1,068.21 in Billed Charges for Rev 272 = $508.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT SCREWDRIVER HEXAGONAL 3.5 X 25MM,272,RC,27200002,CDM,,,,,,both,,,1068.2100,160.2300,SENTARA HEALTH,SENTARA HEALTH,275.71,,,,,,,275.7100,1068.2100,percent of total billed charges,"25.81% of $1,068.21 in Billed Charges for Rev 272 = $275.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT SCREWDRIVER HEXAGONAL 3.5 X 25MM,272,RC,27200002,CDM,,,,,,both,,,1068.2100,160.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1068.21,,,,,,,275.7100,1068.2100,percent of total billed charges,"100% of $1,068.21 in Billed Charges for Rev 272 = $1,068.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT SCREWDRIVER HEXAGONAL 3.5 X 25MM,272,RC,27200002,CDM,,,,,,both,,,1068.2100,160.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,534.11,,,,,,,275.7100,1068.2100,percent of total billed charges,"Rev 272 $1,068.21 in Billed Charges at 50% = $534.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT SCREWDRIVER HEXAGONAL 3.5 X 25MM,272,RC,27200002,CDM,,,,,,both,,,1068.2100,160.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,345.03,,,,,,,275.7100,1068.2100,other,"32.3% of $1,068.21 in Billed Charges for Rev 272 = $345.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT SCREWDRIVER HEXAGONAL 3.5 X 25MM,272,RC,27200002,CDM,,,,,,both,,,1068.2100,160.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,327.94,,,,,,,275.7100,1068.2100,other,"30.7% of $1,068.21 in Billed Charges for Rev 272 = $327.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT SCREWDRIVER HEXAGONAL 3.5 X 25MM,272,RC,27200002,CDM,,,,,,both,,,1068.2100,160.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,345.03,,,,,,,275.7100,1068.2100,percent of total billed charges,"32.3% of $1,068.21 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT SCREWDRIVER HEXAGONAL 3.5 X 25MM,272,RC,27200002,CDM,,,,,,both,,,1068.2100,160.2300,WELLCARE,WELLCARE MEDICAID,1068.21,,,,,,,275.7100,1068.2100,percent of total billed charges,"100% of $1,068.21 in Billed Charges for Rev 272 = $1,068.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION FALCON,272,RC,27200002,CDM,,,,,,both,,,1904.1200,285.6200,AETNA,AETNA,813.06,,,,,,,491.4500,1904.1200,percent of total billed charges,"42.7% of $1,904.12 in Billed Charges for Rev 272 = $813.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION FALCON,272,RC,27200002,CDM,,,,,,both,,,1904.1200,285.6200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1332.88,,,,,,,491.4500,1904.1200,percent of total billed charges,"Rev 272 $1,904.12 in Billed Charges at 70% = $1,332.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION FALCON,272,RC,27200002,CDM,,,,,,both,,,1904.1200,285.6200,CIGNA HEALTHCARE,CIGNA HMO,794.02,,,,,,,491.4500,1904.1200,percent of total billed charges,"41.7% of $1,904.12 in Billed Charges for Rev 272 = $794.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION FALCON,272,RC,27200002,CDM,,,,,,both,,,1904.1200,285.6200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,883.51,,,,,,,491.4500,1904.1200,percent of total billed charges,"46.4% of $1,904.12 in Billed Charges for Rev 272 = $883.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION FALCON,272,RC,27200002,CDM,,,,,,both,,,1904.1200,285.6200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,794.02,,,,,,,491.4500,1904.1200,percent of total billed charges,"41.7% of $1,904.12 in Billed Charges for Rev 272 = $794.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION FALCON,272,RC,27200002,CDM,,,,,,both,,,1904.1200,285.6200,CIGNA HEALTHCARE,CIGNA PPO,794.02,,,,,,,491.4500,1904.1200,percent of total billed charges,"41.7% of $1,904.12 in Billed Charges for Rev 272 = $794.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION FALCON,272,RC,27200002,CDM,,,,,,both,,,1904.1200,285.6200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1713.71,,,,,,,491.4500,1904.1200,percent of total billed charges,"90% of $1,904.12 in Billed Charges for Rev 272 = $1,713.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION FALCON,272,RC,27200002,CDM,,,,,,both,,,1904.1200,285.6200,MEDCOST,MEDCOST VHN,906.17,,,,,,,491.4500,1904.1200,percent of total billed charges,"47.59% of $1,904.12 in Billed Charges for Rev 272 = $906.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION FALCON,272,RC,27200002,CDM,,,,,,both,,,1904.1200,285.6200,SENTARA HEALTH,SENTARA HEALTH,491.45,,,,,,,491.4500,1904.1200,percent of total billed charges,"25.81% of $1,904.12 in Billed Charges for Rev 272 = $491.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION FALCON,272,RC,27200002,CDM,,,,,,both,,,1904.1200,285.6200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1904.12,,,,,,,491.4500,1904.1200,percent of total billed charges,"100% of $1,904.12 in Billed Charges for Rev 272 = $1,904.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION FALCON,272,RC,27200002,CDM,,,,,,both,,,1904.1200,285.6200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,952.06,,,,,,,491.4500,1904.1200,percent of total billed charges,"Rev 272 $1,904.12 in Billed Charges at 50% = $952.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION FALCON,272,RC,27200002,CDM,,,,,,both,,,1904.1200,285.6200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,615.03,,,,,,,491.4500,1904.1200,other,"32.3% of $1,904.12 in Billed Charges for Rev 272 = $615.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE PRECISION FALCON,272,RC,27200002,CDM,,,,,,both,,,1904.1200,285.6200,UNITED HEALTHCARE,UHC HERITAGE SELECT,584.56,,,,,,,491.4500,1904.1200,other,"30.7% of $1,904.12 in Billed Charges for Rev 272 = $584.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE PRECISION FALCON,272,RC,27200002,CDM,,,,,,both,,,1904.1200,285.6200,UNITED HEALTHCARE,UNITED HEALTHCARE,615.03,,,,,,,491.4500,1904.1200,percent of total billed charges,"32.3% of $1,904.12 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION FALCON,272,RC,27200002,CDM,,,,,,both,,,1904.1200,285.6200,WELLCARE,WELLCARE MEDICAID,1904.12,,,,,,,491.4500,1904.1200,percent of total billed charges,"100% of $1,904.12 in Billed Charges for Rev 272 = $1,904.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PRECISION THIN,272,RC,27200002,CDM,,,,,,both,,,771.9100,115.7900,AETNA,AETNA,329.61,,,,,,,199.2300,771.9100,percent of total billed charges,42.7% of $771.91 in Billed Charges for Rev 272 = $329.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE PRECISION THIN,272,RC,27200002,CDM,,,,,,both,,,771.9100,115.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,540.34,,,,,,,199.2300,771.9100,percent of total billed charges,Rev 272 $771.91 in Billed Charges at 70% = $540.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE PRECISION THIN,272,RC,27200002,CDM,,,,,,both,,,771.9100,115.7900,CIGNA HEALTHCARE,CIGNA HMO,321.89,,,,,,,199.2300,771.9100,percent of total billed charges,41.7% of $771.91 in Billed Charges for Rev 272 = $321.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE PRECISION THIN,272,RC,27200002,CDM,,,,,,both,,,771.9100,115.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,358.17,,,,,,,199.2300,771.9100,percent of total billed charges,46.4% of $771.91 in Billed Charges for Rev 272 = $358.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE PRECISION THIN,272,RC,27200002,CDM,,,,,,both,,,771.9100,115.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,321.89,,,,,,,199.2300,771.9100,percent of total billed charges,41.7% of $771.91 in Billed Charges for Rev 272 = $321.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE PRECISION THIN,272,RC,27200002,CDM,,,,,,both,,,771.9100,115.7900,CIGNA HEALTHCARE,CIGNA PPO,321.89,,,,,,,199.2300,771.9100,percent of total billed charges,41.7% of $771.91 in Billed Charges for Rev 272 = $321.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE PRECISION THIN,272,RC,27200002,CDM,,,,,,both,,,771.9100,115.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,694.72,,,,,,,199.2300,771.9100,percent of total billed charges,90% of $771.91 in Billed Charges for Rev 272 = $694.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE PRECISION THIN,272,RC,27200002,CDM,,,,,,both,,,771.9100,115.7900,MEDCOST,MEDCOST VHN,367.35,,,,,,,199.2300,771.9100,percent of total billed charges,47.59% of $771.91 in Billed Charges for Rev 272 = $367.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE PRECISION THIN,272,RC,27200002,CDM,,,,,,both,,,771.9100,115.7900,SENTARA HEALTH,SENTARA HEALTH,199.23,,,,,,,199.2300,771.9100,percent of total billed charges,25.81% of $771.91 in Billed Charges for Rev 272 = $199.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE PRECISION THIN,272,RC,27200002,CDM,,,,,,both,,,771.9100,115.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",771.91,,,,,,,199.2300,771.9100,percent of total billed charges,100% of $771.91 in Billed Charges for Rev 272 = $771.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE PRECISION THIN,272,RC,27200002,CDM,,,,,,both,,,771.9100,115.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,385.96,,,,,,,199.2300,771.9100,percent of total billed charges,Rev 272 $771.91 in Billed Charges at 50% = $385.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE PRECISION THIN,272,RC,27200002,CDM,,,,,,both,,,771.9100,115.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,249.33,,,,,,,199.2300,771.9100,other,32.3% of $771.91 in Billed Charges for Rev 272 = $249.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE PRECISION THIN,272,RC,27200002,CDM,,,,,,both,,,771.9100,115.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,236.98,,,,,,,199.2300,771.9100,other,30.7% of $771.91 in Billed Charges for Rev 272 = $236.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE PRECISION THIN,272,RC,27200002,CDM,,,,,,both,,,771.9100,115.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,249.33,,,,,,,199.2300,771.9100,percent of total billed charges,32.3% of $771.91 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE PRECISION THIN,272,RC,27200002,CDM,,,,,,both,,,771.9100,115.7900,WELLCARE,WELLCARE MEDICAID,771.91,,,,,,,199.2300,771.9100,percent of total billed charges,100% of $771.91 in Billed Charges for Rev 272 = $771.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RAD 12 CURVED 4MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2802.2400,420.3400,AETNA,AETNA,1196.56,,,,,,,723.2600,2802.2400,percent of total billed charges,"42.7% of $2,802.24 in Billed Charges for Rev 272 = $1,196.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 12 CURVED 4MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2802.2400,420.3400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1961.57,,,,,,,723.2600,2802.2400,percent of total billed charges,"Rev 272 $2,802.24 in Billed Charges at 70% = $1,961.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 12 CURVED 4MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2802.2400,420.3400,CIGNA HEALTHCARE,CIGNA HMO,1168.53,,,,,,,723.2600,2802.2400,percent of total billed charges,"41.7% of $2,802.24 in Billed Charges for Rev 272 = $1,168.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 12 CURVED 4MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2802.2400,420.3400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1300.24,,,,,,,723.2600,2802.2400,percent of total billed charges,"46.4% of $2,802.24 in Billed Charges for Rev 272 = $1,300.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 12 CURVED 4MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2802.2400,420.3400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1168.53,,,,,,,723.2600,2802.2400,percent of total billed charges,"41.7% of $2,802.24 in Billed Charges for Rev 272 = $1,168.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 12 CURVED 4MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2802.2400,420.3400,CIGNA HEALTHCARE,CIGNA PPO,1168.53,,,,,,,723.2600,2802.2400,percent of total billed charges,"41.7% of $2,802.24 in Billed Charges for Rev 272 = $1,168.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 12 CURVED 4MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2802.2400,420.3400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2522.02,,,,,,,723.2600,2802.2400,percent of total billed charges,"90% of $2,802.24 in Billed Charges for Rev 272 = $2,522.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 12 CURVED 4MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2802.2400,420.3400,MEDCOST,MEDCOST VHN,1333.59,,,,,,,723.2600,2802.2400,percent of total billed charges,"47.59% of $2,802.24 in Billed Charges for Rev 272 = $1,333.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 12 CURVED 4MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2802.2400,420.3400,SENTARA HEALTH,SENTARA HEALTH,723.26,,,,,,,723.2600,2802.2400,percent of total billed charges,"25.81% of $2,802.24 in Billed Charges for Rev 272 = $723.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 12 CURVED 4MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2802.2400,420.3400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2802.24,,,,,,,723.2600,2802.2400,percent of total billed charges,"100% of $2,802.24 in Billed Charges for Rev 272 = $2,802.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 12 CURVED 4MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2802.2400,420.3400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1401.12,,,,,,,723.2600,2802.2400,percent of total billed charges,"Rev 272 $2,802.24 in Billed Charges at 50% = $1,401.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 12 CURVED 4MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2802.2400,420.3400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,905.12,,,,,,,723.2600,2802.2400,other,"32.3% of $2,802.24 in Billed Charges for Rev 272 = $905.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE RAD 12 CURVED 4MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2802.2400,420.3400,UNITED HEALTHCARE,UHC HERITAGE SELECT,860.29,,,,,,,723.2600,2802.2400,other,"30.7% of $2,802.24 in Billed Charges for Rev 272 = $860.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE RAD 12 CURVED 4MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2802.2400,420.3400,UNITED HEALTHCARE,UNITED HEALTHCARE,905.12,,,,,,,723.2600,2802.2400,percent of total billed charges,"32.3% of $2,802.24 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 12 CURVED 4MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2802.2400,420.3400,WELLCARE,WELLCARE MEDICAID,2802.24,,,,,,,723.2600,2802.2400,percent of total billed charges,"100% of $2,802.24 in Billed Charges for Rev 272 = $2,802.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 40 ROTATABLE 4MM M4,272,RC,27200002,CDM,,,,,,both,,,5092.1600,763.8200,AETNA,AETNA,2174.35,,,,,,,1314.2900,5092.1600,percent of total billed charges,"42.7% of $5,092.16 in Billed Charges for Rev 272 = $2,174.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 40 ROTATABLE 4MM M4,272,RC,27200002,CDM,,,,,,both,,,5092.1600,763.8200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3564.51,,,,,,,1314.2900,5092.1600,percent of total billed charges,"Rev 272 $5,092.16 in Billed Charges at 70% = $3,564.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 40 ROTATABLE 4MM M4,272,RC,27200002,CDM,,,,,,both,,,5092.1600,763.8200,CIGNA HEALTHCARE,CIGNA HMO,2123.43,,,,,,,1314.2900,5092.1600,percent of total billed charges,"41.7% of $5,092.16 in Billed Charges for Rev 272 = $2,123.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 40 ROTATABLE 4MM M4,272,RC,27200002,CDM,,,,,,both,,,5092.1600,763.8200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2362.76,,,,,,,1314.2900,5092.1600,percent of total billed charges,"46.4% of $5,092.16 in Billed Charges for Rev 272 = $2,362.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 40 ROTATABLE 4MM M4,272,RC,27200002,CDM,,,,,,both,,,5092.1600,763.8200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2123.43,,,,,,,1314.2900,5092.1600,percent of total billed charges,"41.7% of $5,092.16 in Billed Charges for Rev 272 = $2,123.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 40 ROTATABLE 4MM M4,272,RC,27200002,CDM,,,,,,both,,,5092.1600,763.8200,CIGNA HEALTHCARE,CIGNA PPO,2123.43,,,,,,,1314.2900,5092.1600,percent of total billed charges,"41.7% of $5,092.16 in Billed Charges for Rev 272 = $2,123.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 40 ROTATABLE 4MM M4,272,RC,27200002,CDM,,,,,,both,,,5092.1600,763.8200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4582.94,,,,,,,1314.2900,5092.1600,percent of total billed charges,"90% of $5,092.16 in Billed Charges for Rev 272 = $4,582.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 40 ROTATABLE 4MM M4,272,RC,27200002,CDM,,,,,,both,,,5092.1600,763.8200,MEDCOST,MEDCOST VHN,2423.36,,,,,,,1314.2900,5092.1600,percent of total billed charges,"47.59% of $5,092.16 in Billed Charges for Rev 272 = $2,423.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 40 ROTATABLE 4MM M4,272,RC,27200002,CDM,,,,,,both,,,5092.1600,763.8200,SENTARA HEALTH,SENTARA HEALTH,1314.29,,,,,,,1314.2900,5092.1600,percent of total billed charges,"25.81% of $5,092.16 in Billed Charges for Rev 272 = $1,314.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 40 ROTATABLE 4MM M4,272,RC,27200002,CDM,,,,,,both,,,5092.1600,763.8200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5092.16,,,,,,,1314.2900,5092.1600,percent of total billed charges,"100% of $5,092.16 in Billed Charges for Rev 272 = $5,092.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 40 ROTATABLE 4MM M4,272,RC,27200002,CDM,,,,,,both,,,5092.1600,763.8200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2546.08,,,,,,,1314.2900,5092.1600,percent of total billed charges,"Rev 272 $5,092.16 in Billed Charges at 50% = $2,546.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 40 ROTATABLE 4MM M4,272,RC,27200002,CDM,,,,,,both,,,5092.1600,763.8200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1644.77,,,,,,,1314.2900,5092.1600,other,"32.3% of $5,092.16 in Billed Charges for Rev 272 = $1,644.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE RAD 40 ROTATABLE 4MM M4,272,RC,27200002,CDM,,,,,,both,,,5092.1600,763.8200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1563.29,,,,,,,1314.2900,5092.1600,other,"30.7% of $5,092.16 in Billed Charges for Rev 272 = $1,563.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE RAD 40 ROTATABLE 4MM M4,272,RC,27200002,CDM,,,,,,both,,,5092.1600,763.8200,UNITED HEALTHCARE,UNITED HEALTHCARE,1644.77,,,,,,,1314.2900,5092.1600,percent of total billed charges,"32.3% of $5,092.16 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 40 ROTATABLE 4MM M4,272,RC,27200002,CDM,,,,,,both,,,5092.1600,763.8200,WELLCARE,WELLCARE MEDICAID,5092.16,,,,,,,1314.2900,5092.1600,percent of total billed charges,"100% of $5,092.16 in Billed Charges for Rev 272 = $5,092.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2806.0500,420.9100,AETNA,AETNA,1198.18,,,,,,,724.2400,2806.0500,percent of total billed charges,"42.7% of $2,806.05 in Billed Charges for Rev 272 = $1,198.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2806.0500,420.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1964.24,,,,,,,724.2400,2806.0500,percent of total billed charges,"Rev 272 $2,806.05 in Billed Charges at 70% = $1,964.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2806.0500,420.9100,CIGNA HEALTHCARE,CIGNA HMO,1170.12,,,,,,,724.2400,2806.0500,percent of total billed charges,"41.7% of $2,806.05 in Billed Charges for Rev 272 = $1,170.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2806.0500,420.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1302.01,,,,,,,724.2400,2806.0500,percent of total billed charges,"46.4% of $2,806.05 in Billed Charges for Rev 272 = $1,302.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2806.0500,420.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1170.12,,,,,,,724.2400,2806.0500,percent of total billed charges,"41.7% of $2,806.05 in Billed Charges for Rev 272 = $1,170.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2806.0500,420.9100,CIGNA HEALTHCARE,CIGNA PPO,1170.12,,,,,,,724.2400,2806.0500,percent of total billed charges,"41.7% of $2,806.05 in Billed Charges for Rev 272 = $1,170.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2806.0500,420.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2525.45,,,,,,,724.2400,2806.0500,percent of total billed charges,"90% of $2,806.05 in Billed Charges for Rev 272 = $2,525.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2806.0500,420.9100,MEDCOST,MEDCOST VHN,1335.40,,,,,,,724.2400,2806.0500,percent of total billed charges,"47.59% of $2,806.05 in Billed Charges for Rev 272 = $1,335.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2806.0500,420.9100,SENTARA HEALTH,SENTARA HEALTH,724.24,,,,,,,724.2400,2806.0500,percent of total billed charges,"25.81% of $2,806.05 in Billed Charges for Rev 272 = $724.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2806.0500,420.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2806.05,,,,,,,724.2400,2806.0500,percent of total billed charges,"100% of $2,806.05 in Billed Charges for Rev 272 = $2,806.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2806.0500,420.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1403.03,,,,,,,724.2400,2806.0500,percent of total billed charges,"Rev 272 $2,806.05 in Billed Charges at 50% = $1,403.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2806.0500,420.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,906.35,,,,,,,724.2400,2806.0500,other,"32.3% of $2,806.05 in Billed Charges for Rev 272 = $906.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2806.0500,420.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,861.46,,,,,,,724.2400,2806.0500,other,"30.7% of $2,806.05 in Billed Charges for Rev 272 = $861.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2806.0500,420.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,906.35,,,,,,,724.2400,2806.0500,percent of total billed charges,"32.3% of $2,806.05 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2806.0500,420.9100,WELLCARE,WELLCARE MEDICAID,2806.05,,,,,,,724.2400,2806.0500,percent of total billed charges,"100% of $2,806.05 in Billed Charges for Rev 272 = $2,806.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE 4MM ARTHRO-LOK MINI-MENISCUS,272,RC,27200002,CDM,,,,,,both,,,120.9100,18.1400,AETNA,AETNA,51.63,,,,,,,31.2100,120.9100,percent of total billed charges,42.7% of $120.91 in Billed Charges for Rev 272 = $51.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 4MM ARTHRO-LOK MINI-MENISCUS,272,RC,27200002,CDM,,,,,,both,,,120.9100,18.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,84.64,,,,,,,31.2100,120.9100,percent of total billed charges,Rev 272 $120.91 in Billed Charges at 70% = $84.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 4MM ARTHRO-LOK MINI-MENISCUS,272,RC,27200002,CDM,,,,,,both,,,120.9100,18.1400,CIGNA HEALTHCARE,CIGNA HMO,50.42,,,,,,,31.2100,120.9100,percent of total billed charges,41.7% of $120.91 in Billed Charges for Rev 272 = $50.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 4MM ARTHRO-LOK MINI-MENISCUS,272,RC,27200002,CDM,,,,,,both,,,120.9100,18.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,56.10,,,,,,,31.2100,120.9100,percent of total billed charges,46.4% of $120.91 in Billed Charges for Rev 272 = $56.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 4MM ARTHRO-LOK MINI-MENISCUS,272,RC,27200002,CDM,,,,,,both,,,120.9100,18.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,50.42,,,,,,,31.2100,120.9100,percent of total billed charges,41.7% of $120.91 in Billed Charges for Rev 272 = $50.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 4MM ARTHRO-LOK MINI-MENISCUS,272,RC,27200002,CDM,,,,,,both,,,120.9100,18.1400,CIGNA HEALTHCARE,CIGNA PPO,50.42,,,,,,,31.2100,120.9100,percent of total billed charges,41.7% of $120.91 in Billed Charges for Rev 272 = $50.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 4MM ARTHRO-LOK MINI-MENISCUS,272,RC,27200002,CDM,,,,,,both,,,120.9100,18.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,108.82,,,,,,,31.2100,120.9100,percent of total billed charges,90% of $120.91 in Billed Charges for Rev 272 = $108.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 4MM ARTHRO-LOK MINI-MENISCUS,272,RC,27200002,CDM,,,,,,both,,,120.9100,18.1400,MEDCOST,MEDCOST VHN,57.54,,,,,,,31.2100,120.9100,percent of total billed charges,47.59% of $120.91 in Billed Charges for Rev 272 = $57.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 4MM ARTHRO-LOK MINI-MENISCUS,272,RC,27200002,CDM,,,,,,both,,,120.9100,18.1400,SENTARA HEALTH,SENTARA HEALTH,31.21,,,,,,,31.2100,120.9100,percent of total billed charges,25.81% of $120.91 in Billed Charges for Rev 272 = $31.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 4MM ARTHRO-LOK MINI-MENISCUS,272,RC,27200002,CDM,,,,,,both,,,120.9100,18.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",120.91,,,,,,,31.2100,120.9100,percent of total billed charges,100% of $120.91 in Billed Charges for Rev 272 = $120.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 4MM ARTHRO-LOK MINI-MENISCUS,272,RC,27200002,CDM,,,,,,both,,,120.9100,18.1400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,60.46,,,,,,,31.2100,120.9100,percent of total billed charges,Rev 272 $120.91 in Billed Charges at 50% = $60.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 4MM ARTHRO-LOK MINI-MENISCUS,272,RC,27200002,CDM,,,,,,both,,,120.9100,18.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,39.05,,,,,,,31.2100,120.9100,other,32.3% of $120.91 in Billed Charges for Rev 272 = $39.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE 4MM ARTHRO-LOK MINI-MENISCUS,272,RC,27200002,CDM,,,,,,both,,,120.9100,18.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,37.12,,,,,,,31.2100,120.9100,other,30.7% of $120.91 in Billed Charges for Rev 272 = $37.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE 4MM ARTHRO-LOK MINI-MENISCUS,272,RC,27200002,CDM,,,,,,both,,,120.9100,18.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,39.05,,,,,,,31.2100,120.9100,percent of total billed charges,32.3% of $120.91 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE 4MM ARTHRO-LOK MINI-MENISCUS,272,RC,27200002,CDM,,,,,,both,,,120.9100,18.1400,WELLCARE,WELLCARE MEDICAID,120.91,,,,,,,31.2100,120.9100,percent of total billed charges,100% of $120.91 in Billed Charges for Rev 272 = $120.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE AGGRESSIVE 2.5 11 CM,272,RC,27200002,CDM,,,,,,both,,,1405.9300,210.8900,AETNA,AETNA,600.33,,,,,,,362.8700,1405.9300,percent of total billed charges,"42.7% of $1,405.93 in Billed Charges for Rev 272 = $600.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE 2.5 11 CM,272,RC,27200002,CDM,,,,,,both,,,1405.9300,210.8900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,984.15,,,,,,,362.8700,1405.9300,percent of total billed charges,"Rev 272 $1,405.93 in Billed Charges at 70% = $984.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE 2.5 11 CM,272,RC,27200002,CDM,,,,,,both,,,1405.9300,210.8900,CIGNA HEALTHCARE,CIGNA HMO,586.27,,,,,,,362.8700,1405.9300,percent of total billed charges,"41.7% of $1,405.93 in Billed Charges for Rev 272 = $586.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE 2.5 11 CM,272,RC,27200002,CDM,,,,,,both,,,1405.9300,210.8900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,652.35,,,,,,,362.8700,1405.9300,percent of total billed charges,"46.4% of $1,405.93 in Billed Charges for Rev 272 = $652.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE 2.5 11 CM,272,RC,27200002,CDM,,,,,,both,,,1405.9300,210.8900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,586.27,,,,,,,362.8700,1405.9300,percent of total billed charges,"41.7% of $1,405.93 in Billed Charges for Rev 272 = $586.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE 2.5 11 CM,272,RC,27200002,CDM,,,,,,both,,,1405.9300,210.8900,CIGNA HEALTHCARE,CIGNA PPO,586.27,,,,,,,362.8700,1405.9300,percent of total billed charges,"41.7% of $1,405.93 in Billed Charges for Rev 272 = $586.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE 2.5 11 CM,272,RC,27200002,CDM,,,,,,both,,,1405.9300,210.8900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1265.34,,,,,,,362.8700,1405.9300,percent of total billed charges,"90% of $1,405.93 in Billed Charges for Rev 272 = $1,265.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE 2.5 11 CM,272,RC,27200002,CDM,,,,,,both,,,1405.9300,210.8900,MEDCOST,MEDCOST VHN,669.08,,,,,,,362.8700,1405.9300,percent of total billed charges,"47.59% of $1,405.93 in Billed Charges for Rev 272 = $669.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE 2.5 11 CM,272,RC,27200002,CDM,,,,,,both,,,1405.9300,210.8900,SENTARA HEALTH,SENTARA HEALTH,362.87,,,,,,,362.8700,1405.9300,percent of total billed charges,"25.81% of $1,405.93 in Billed Charges for Rev 272 = $362.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE 2.5 11 CM,272,RC,27200002,CDM,,,,,,both,,,1405.9300,210.8900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1405.93,,,,,,,362.8700,1405.9300,percent of total billed charges,"100% of $1,405.93 in Billed Charges for Rev 272 = $1,405.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE 2.5 11 CM,272,RC,27200002,CDM,,,,,,both,,,1405.9300,210.8900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,702.97,,,,,,,362.8700,1405.9300,percent of total billed charges,"Rev 272 $1,405.93 in Billed Charges at 50% = $702.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE 2.5 11 CM,272,RC,27200002,CDM,,,,,,both,,,1405.9300,210.8900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,454.12,,,,,,,362.8700,1405.9300,other,"32.3% of $1,405.93 in Billed Charges for Rev 272 = $454.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE AGGRESSIVE 2.5 11 CM,272,RC,27200002,CDM,,,,,,both,,,1405.9300,210.8900,UNITED HEALTHCARE,UHC HERITAGE SELECT,431.62,,,,,,,362.8700,1405.9300,other,"30.7% of $1,405.93 in Billed Charges for Rev 272 = $431.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE AGGRESSIVE 2.5 11 CM,272,RC,27200002,CDM,,,,,,both,,,1405.9300,210.8900,UNITED HEALTHCARE,UNITED HEALTHCARE,454.12,,,,,,,362.8700,1405.9300,percent of total billed charges,"32.3% of $1,405.93 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE 2.5 11 CM,272,RC,27200002,CDM,,,,,,both,,,1405.9300,210.8900,WELLCARE,WELLCARE MEDICAID,1405.93,,,,,,,362.8700,1405.9300,percent of total billed charges,"100% of $1,405.93 in Billed Charges for Rev 272 = $1,405.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 4.0,272,RC,27200002,CDM,,,,,,both,,,1173.0400,175.9600,AETNA,AETNA,500.89,,,,,,,302.7600,1173.0400,percent of total billed charges,"42.7% of $1,173.04 in Billed Charges for Rev 272 = $500.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 4.0,272,RC,27200002,CDM,,,,,,both,,,1173.0400,175.9600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,821.13,,,,,,,302.7600,1173.0400,percent of total billed charges,"Rev 272 $1,173.04 in Billed Charges at 70% = $821.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 4.0,272,RC,27200002,CDM,,,,,,both,,,1173.0400,175.9600,CIGNA HEALTHCARE,CIGNA HMO,489.16,,,,,,,302.7600,1173.0400,percent of total billed charges,"41.7% of $1,173.04 in Billed Charges for Rev 272 = $489.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 4.0,272,RC,27200002,CDM,,,,,,both,,,1173.0400,175.9600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,544.29,,,,,,,302.7600,1173.0400,percent of total billed charges,"46.4% of $1,173.04 in Billed Charges for Rev 272 = $544.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 4.0,272,RC,27200002,CDM,,,,,,both,,,1173.0400,175.9600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,489.16,,,,,,,302.7600,1173.0400,percent of total billed charges,"41.7% of $1,173.04 in Billed Charges for Rev 272 = $489.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 4.0,272,RC,27200002,CDM,,,,,,both,,,1173.0400,175.9600,CIGNA HEALTHCARE,CIGNA PPO,489.16,,,,,,,302.7600,1173.0400,percent of total billed charges,"41.7% of $1,173.04 in Billed Charges for Rev 272 = $489.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 4.0,272,RC,27200002,CDM,,,,,,both,,,1173.0400,175.9600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1055.74,,,,,,,302.7600,1173.0400,percent of total billed charges,"90% of $1,173.04 in Billed Charges for Rev 272 = $1,055.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 4.0,272,RC,27200002,CDM,,,,,,both,,,1173.0400,175.9600,MEDCOST,MEDCOST VHN,558.25,,,,,,,302.7600,1173.0400,percent of total billed charges,"47.59% of $1,173.04 in Billed Charges for Rev 272 = $558.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 4.0,272,RC,27200002,CDM,,,,,,both,,,1173.0400,175.9600,SENTARA HEALTH,SENTARA HEALTH,302.76,,,,,,,302.7600,1173.0400,percent of total billed charges,"25.81% of $1,173.04 in Billed Charges for Rev 272 = $302.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 4.0,272,RC,27200002,CDM,,,,,,both,,,1173.0400,175.9600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1173.04,,,,,,,302.7600,1173.0400,percent of total billed charges,"100% of $1,173.04 in Billed Charges for Rev 272 = $1,173.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 4.0,272,RC,27200002,CDM,,,,,,both,,,1173.0400,175.9600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,586.52,,,,,,,302.7600,1173.0400,percent of total billed charges,"Rev 272 $1,173.04 in Billed Charges at 50% = $586.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 4.0,272,RC,27200002,CDM,,,,,,both,,,1173.0400,175.9600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,378.89,,,,,,,302.7600,1173.0400,other,"32.3% of $1,173.04 in Billed Charges for Rev 272 = $378.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE AGGRESSIVE SERRATED 4.0,272,RC,27200002,CDM,,,,,,both,,,1173.0400,175.9600,UNITED HEALTHCARE,UHC HERITAGE SELECT,360.12,,,,,,,302.7600,1173.0400,other,"30.7% of $1,173.04 in Billed Charges for Rev 272 = $360.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE AGGRESSIVE SERRATED 4.0,272,RC,27200002,CDM,,,,,,both,,,1173.0400,175.9600,UNITED HEALTHCARE,UNITED HEALTHCARE,378.89,,,,,,,302.7600,1173.0400,percent of total billed charges,"32.3% of $1,173.04 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE AGGRESSIVE SERRATED 4.0,272,RC,27200002,CDM,,,,,,both,,,1173.0400,175.9600,WELLCARE,WELLCARE MEDICAID,1173.04,,,,,,,302.7600,1173.0400,percent of total billed charges,"100% of $1,173.04 in Billed Charges for Rev 272 = $1,173.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHROSCOPY LONG AGGRESSIVE 5.0MM 0385-554-000,272,RC,,,,,,,,both,,,4942.9200,741.4400,AETNA,AETNA,2110.63,,,,,,,1275.7700,4942.9200,percent of total billed charges,"42.7% of $4,942.92 in Billed Charges for Rev 272 = $2,110.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHROSCOPY LONG AGGRESSIVE 5.0MM 0385-554-000,272,RC,,,,,,,,both,,,4942.9200,741.4400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3460.04,,,,,,,1275.7700,4942.9200,percent of total billed charges,"Rev 272 $4,942.92 in Billed Charges at 70% = $3,460.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHROSCOPY LONG AGGRESSIVE 5.0MM 0385-554-000,272,RC,,,,,,,,both,,,4942.9200,741.4400,CIGNA HEALTHCARE,CIGNA HMO,2061.20,,,,,,,1275.7700,4942.9200,percent of total billed charges,"41.7% of $4,942.92 in Billed Charges for Rev 272 = $2,061.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHROSCOPY LONG AGGRESSIVE 5.0MM 0385-554-000,272,RC,,,,,,,,both,,,4942.9200,741.4400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2293.51,,,,,,,1275.7700,4942.9200,percent of total billed charges,"46.4% of $4,942.92 in Billed Charges for Rev 272 = $2,293.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHROSCOPY LONG AGGRESSIVE 5.0MM 0385-554-000,272,RC,,,,,,,,both,,,4942.9200,741.4400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2061.20,,,,,,,1275.7700,4942.9200,percent of total billed charges,"41.7% of $4,942.92 in Billed Charges for Rev 272 = $2,061.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHROSCOPY LONG AGGRESSIVE 5.0MM 0385-554-000,272,RC,,,,,,,,both,,,4942.9200,741.4400,CIGNA HEALTHCARE,CIGNA PPO,2061.20,,,,,,,1275.7700,4942.9200,percent of total billed charges,"41.7% of $4,942.92 in Billed Charges for Rev 272 = $2,061.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHROSCOPY LONG AGGRESSIVE 5.0MM 0385-554-000,272,RC,,,,,,,,both,,,4942.9200,741.4400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4448.63,,,,,,,1275.7700,4942.9200,percent of total billed charges,"90% of $4,942.92 in Billed Charges for Rev 272 = $4,448.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHROSCOPY LONG AGGRESSIVE 5.0MM 0385-554-000,272,RC,,,,,,,,both,,,4942.9200,741.4400,MEDCOST,MEDCOST VHN,2352.34,,,,,,,1275.7700,4942.9200,percent of total billed charges,"47.59% of $4,942.92 in Billed Charges for Rev 272 = $2,352.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHROSCOPY LONG AGGRESSIVE 5.0MM 0385-554-000,272,RC,,,,,,,,both,,,4942.9200,741.4400,SENTARA HEALTH,SENTARA HEALTH,1275.77,,,,,,,1275.7700,4942.9200,percent of total billed charges,"25.81% of $4,942.92 in Billed Charges for Rev 272 = $1,275.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHROSCOPY LONG AGGRESSIVE 5.0MM 0385-554-000,272,RC,,,,,,,,both,,,4942.9200,741.4400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4942.92,,,,,,,1275.7700,4942.9200,percent of total billed charges,"100% of $4,942.92 in Billed Charges for Rev 272 = $4,942.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHROSCOPY LONG AGGRESSIVE 5.0MM 0385-554-000,272,RC,,,,,,,,both,,,4942.9200,741.4400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2471.46,,,,,,,1275.7700,4942.9200,percent of total billed charges,"Rev 272 $4,942.92 in Billed Charges at 50% = $2,471.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHROSCOPY LONG AGGRESSIVE 5.0MM 0385-554-000,272,RC,,,,,,,,both,,,4942.9200,741.4400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1596.56,,,,,,,1275.7700,4942.9200,other,"32.3% of $4,942.92 in Billed Charges for Rev 272 = $1,596.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE ARTHROSCOPY LONG AGGRESSIVE 5.0MM 0385-554-000,272,RC,,,,,,,,both,,,4942.9200,741.4400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1517.48,,,,,,,1275.7700,4942.9200,other,"30.7% of $4,942.92 in Billed Charges for Rev 272 = $1,517.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE ARTHROSCOPY LONG AGGRESSIVE 5.0MM 0385-554-000,272,RC,,,,,,,,both,,,4942.9200,741.4400,UNITED HEALTHCARE,UNITED HEALTHCARE,1596.56,,,,,,,1275.7700,4942.9200,percent of total billed charges,"32.3% of $4,942.92 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ARTHROSCOPY LONG AGGRESSIVE 5.0MM 0385-554-000,272,RC,,,,,,,,both,,,4942.9200,741.4400,WELLCARE,WELLCARE MEDICAID,4942.92,,,,,,,1275.7700,4942.9200,percent of total billed charges,"100% of $4,942.92 in Billed Charges for Rev 272 = $4,942.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA REAMER 41MM,272,RC,27200002,CDM,,,,,,both,,,1249.8100,187.4700,AETNA,AETNA,533.67,,,,,,,322.5800,1249.8100,percent of total billed charges,"42.7% of $1,249.81 in Billed Charges for Rev 272 = $533.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA REAMER 41MM,272,RC,27200002,CDM,,,,,,both,,,1249.8100,187.4700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,874.87,,,,,,,322.5800,1249.8100,percent of total billed charges,"Rev 272 $1,249.81 in Billed Charges at 70% = $874.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA REAMER 41MM,272,RC,27200002,CDM,,,,,,both,,,1249.8100,187.4700,CIGNA HEALTHCARE,CIGNA HMO,521.17,,,,,,,322.5800,1249.8100,percent of total billed charges,"41.7% of $1,249.81 in Billed Charges for Rev 272 = $521.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA REAMER 41MM,272,RC,27200002,CDM,,,,,,both,,,1249.8100,187.4700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,579.91,,,,,,,322.5800,1249.8100,percent of total billed charges,"46.4% of $1,249.81 in Billed Charges for Rev 272 = $579.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA REAMER 41MM,272,RC,27200002,CDM,,,,,,both,,,1249.8100,187.4700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,521.17,,,,,,,322.5800,1249.8100,percent of total billed charges,"41.7% of $1,249.81 in Billed Charges for Rev 272 = $521.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA REAMER 41MM,272,RC,27200002,CDM,,,,,,both,,,1249.8100,187.4700,CIGNA HEALTHCARE,CIGNA PPO,521.17,,,,,,,322.5800,1249.8100,percent of total billed charges,"41.7% of $1,249.81 in Billed Charges for Rev 272 = $521.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA REAMER 41MM,272,RC,27200002,CDM,,,,,,both,,,1249.8100,187.4700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1124.83,,,,,,,322.5800,1249.8100,percent of total billed charges,"90% of $1,249.81 in Billed Charges for Rev 272 = $1,124.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA REAMER 41MM,272,RC,27200002,CDM,,,,,,both,,,1249.8100,187.4700,MEDCOST,MEDCOST VHN,594.78,,,,,,,322.5800,1249.8100,percent of total billed charges,"47.59% of $1,249.81 in Billed Charges for Rev 272 = $594.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA REAMER 41MM,272,RC,27200002,CDM,,,,,,both,,,1249.8100,187.4700,SENTARA HEALTH,SENTARA HEALTH,322.58,,,,,,,322.5800,1249.8100,percent of total billed charges,"25.81% of $1,249.81 in Billed Charges for Rev 272 = $322.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA REAMER 41MM,272,RC,27200002,CDM,,,,,,both,,,1249.8100,187.4700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1249.81,,,,,,,322.5800,1249.8100,percent of total billed charges,"100% of $1,249.81 in Billed Charges for Rev 272 = $1,249.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA REAMER 41MM,272,RC,27200002,CDM,,,,,,both,,,1249.8100,187.4700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,624.91,,,,,,,322.5800,1249.8100,percent of total billed charges,"Rev 272 $1,249.81 in Billed Charges at 50% = $624.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA REAMER 41MM,272,RC,27200002,CDM,,,,,,both,,,1249.8100,187.4700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,403.69,,,,,,,322.5800,1249.8100,other,"32.3% of $1,249.81 in Billed Charges for Rev 272 = $403.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE PATELLA REAMER 41MM,272,RC,27200002,CDM,,,,,,both,,,1249.8100,187.4700,UNITED HEALTHCARE,UHC HERITAGE SELECT,383.69,,,,,,,322.5800,1249.8100,other,"30.7% of $1,249.81 in Billed Charges for Rev 272 = $383.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE PATELLA REAMER 41MM,272,RC,27200002,CDM,,,,,,both,,,1249.8100,187.4700,UNITED HEALTHCARE,UNITED HEALTHCARE,403.69,,,,,,,322.5800,1249.8100,percent of total billed charges,"32.3% of $1,249.81 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PATELLA REAMER 41MM,272,RC,27200002,CDM,,,,,,both,,,1249.8100,187.4700,WELLCARE,WELLCARE MEDICAID,1249.81,,,,,,,322.5800,1249.8100,percent of total billed charges,"100% of $1,249.81 in Billed Charges for Rev 272 = $1,249.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADENOID 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2476.5900,371.4900,AETNA,AETNA,1057.50,,,,,,,639.2100,2476.5900,percent of total billed charges,"42.7% of $2,476.59 in Billed Charges for Rev 272 = $1,057.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADENOID 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2476.5900,371.4900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1733.61,,,,,,,639.2100,2476.5900,percent of total billed charges,"Rev 272 $2,476.59 in Billed Charges at 70% = $1,733.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADENOID 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2476.5900,371.4900,CIGNA HEALTHCARE,CIGNA HMO,1032.74,,,,,,,639.2100,2476.5900,percent of total billed charges,"41.7% of $2,476.59 in Billed Charges for Rev 272 = $1,032.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADENOID 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2476.5900,371.4900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1149.14,,,,,,,639.2100,2476.5900,percent of total billed charges,"46.4% of $2,476.59 in Billed Charges for Rev 272 = $1,149.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADENOID 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2476.5900,371.4900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1032.74,,,,,,,639.2100,2476.5900,percent of total billed charges,"41.7% of $2,476.59 in Billed Charges for Rev 272 = $1,032.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADENOID 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2476.5900,371.4900,CIGNA HEALTHCARE,CIGNA PPO,1032.74,,,,,,,639.2100,2476.5900,percent of total billed charges,"41.7% of $2,476.59 in Billed Charges for Rev 272 = $1,032.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADENOID 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2476.5900,371.4900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2228.93,,,,,,,639.2100,2476.5900,percent of total billed charges,"90% of $2,476.59 in Billed Charges for Rev 272 = $2,228.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADENOID 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2476.5900,371.4900,MEDCOST,MEDCOST VHN,1178.61,,,,,,,639.2100,2476.5900,percent of total billed charges,"47.59% of $2,476.59 in Billed Charges for Rev 272 = $1,178.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADENOID 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2476.5900,371.4900,SENTARA HEALTH,SENTARA HEALTH,639.21,,,,,,,639.2100,2476.5900,percent of total billed charges,"25.81% of $2,476.59 in Billed Charges for Rev 272 = $639.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADENOID 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2476.5900,371.4900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2476.59,,,,,,,639.2100,2476.5900,percent of total billed charges,"100% of $2,476.59 in Billed Charges for Rev 272 = $2,476.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADENOID 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2476.5900,371.4900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1238.30,,,,,,,639.2100,2476.5900,percent of total billed charges,"Rev 272 $2,476.59 in Billed Charges at 50% = $1,238.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADENOID 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2476.5900,371.4900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,799.94,,,,,,,639.2100,2476.5900,other,"32.3% of $2,476.59 in Billed Charges for Rev 272 = $799.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE RADENOID 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2476.5900,371.4900,UNITED HEALTHCARE,UHC HERITAGE SELECT,760.31,,,,,,,639.2100,2476.5900,other,"30.7% of $2,476.59 in Billed Charges for Rev 272 = $760.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE RADENOID 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2476.5900,371.4900,UNITED HEALTHCARE,UNITED HEALTHCARE,799.94,,,,,,,639.2100,2476.5900,percent of total billed charges,"32.3% of $2,476.59 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RADENOID 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2476.5900,371.4900,WELLCARE,WELLCARE MEDICAID,2476.59,,,,,,,639.2100,2476.5900,percent of total billed charges,"100% of $2,476.59 in Billed Charges for Rev 272 = $2,476.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DIAMOND CVD HI-SP 2.5  11882569,272,RC,,,,,,,,both,,,11449.5800,1717.4400,AETNA,AETNA,4888.97,,,,,,,2955.1400,11449.5800,percent of total billed charges,"42.7% of $11,449.58 in Billed Charges for Rev 272 = $4,888.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DIAMOND CVD HI-SP 2.5  11882569,272,RC,,,,,,,,both,,,11449.5800,1717.4400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8014.71,,,,,,,2955.1400,11449.5800,percent of total billed charges,"Rev 272 $11,449.58 in Billed Charges at 70% = $8,014.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DIAMOND CVD HI-SP 2.5  11882569,272,RC,,,,,,,,both,,,11449.5800,1717.4400,CIGNA HEALTHCARE,CIGNA HMO,4774.47,,,,,,,2955.1400,11449.5800,percent of total billed charges,"41.7% of $11,449.58 in Billed Charges for Rev 272 = $4,774.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DIAMOND CVD HI-SP 2.5  11882569,272,RC,,,,,,,,both,,,11449.5800,1717.4400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5312.61,,,,,,,2955.1400,11449.5800,percent of total billed charges,"46.4% of $11,449.58 in Billed Charges for Rev 272 = $5,312.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DIAMOND CVD HI-SP 2.5  11882569,272,RC,,,,,,,,both,,,11449.5800,1717.4400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4774.47,,,,,,,2955.1400,11449.5800,percent of total billed charges,"41.7% of $11,449.58 in Billed Charges for Rev 272 = $4,774.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DIAMOND CVD HI-SP 2.5  11882569,272,RC,,,,,,,,both,,,11449.5800,1717.4400,CIGNA HEALTHCARE,CIGNA PPO,4774.47,,,,,,,2955.1400,11449.5800,percent of total billed charges,"41.7% of $11,449.58 in Billed Charges for Rev 272 = $4,774.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DIAMOND CVD HI-SP 2.5  11882569,272,RC,,,,,,,,both,,,11449.5800,1717.4400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10304.62,,,,,,,2955.1400,11449.5800,percent of total billed charges,"90% of $11,449.58 in Billed Charges for Rev 272 = $10,304.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DIAMOND CVD HI-SP 2.5  11882569,272,RC,,,,,,,,both,,,11449.5800,1717.4400,MEDCOST,MEDCOST VHN,5448.86,,,,,,,2955.1400,11449.5800,percent of total billed charges,"47.59% of $11,449.58 in Billed Charges for Rev 272 = $5,448.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DIAMOND CVD HI-SP 2.5  11882569,272,RC,,,,,,,,both,,,11449.5800,1717.4400,SENTARA HEALTH,SENTARA HEALTH,2955.14,,,,,,,2955.1400,11449.5800,percent of total billed charges,"25.81% of $11,449.58 in Billed Charges for Rev 272 = $2,955.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DIAMOND CVD HI-SP 2.5  11882569,272,RC,,,,,,,,both,,,11449.5800,1717.4400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11449.58,,,,,,,2955.1400,11449.5800,percent of total billed charges,"100% of $11,449.58 in Billed Charges for Rev 272 = $11,449.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DIAMOND CVD HI-SP 2.5  11882569,272,RC,,,,,,,,both,,,11449.5800,1717.4400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5724.79,,,,,,,2955.1400,11449.5800,percent of total billed charges,"Rev 272 $11,449.58 in Billed Charges at 50% = $5,724.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DIAMOND CVD HI-SP 2.5  11882569,272,RC,,,,,,,,both,,,11449.5800,1717.4400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3698.21,,,,,,,2955.1400,11449.5800,other,"32.3% of $11,449.58 in Billed Charges for Rev 272 = $3,698.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BUR DIAMOND CVD HI-SP 2.5  11882569,272,RC,,,,,,,,both,,,11449.5800,1717.4400,UNITED HEALTHCARE,UHC HERITAGE SELECT,3515.02,,,,,,,2955.1400,11449.5800,other,"30.7% of $11,449.58 in Billed Charges for Rev 272 = $3,515.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BUR DIAMOND CVD HI-SP 2.5  11882569,272,RC,,,,,,,,both,,,11449.5800,1717.4400,UNITED HEALTHCARE,UNITED HEALTHCARE,3698.21,,,,,,,2955.1400,11449.5800,percent of total billed charges,"32.3% of $11,449.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DIAMOND CVD HI-SP 2.5  11882569,272,RC,,,,,,,,both,,,11449.5800,1717.4400,WELLCARE,WELLCARE MEDICAID,11449.58,,,,,,,2955.1400,11449.5800,percent of total billed charges,"100% of $11,449.58 in Billed Charges for Rev 272 = $11,449.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DRUM 5.0 5130-020-047S1,272,RC,,,,,,,,both,,,2714.3000,407.1500,AETNA,AETNA,1159.01,,,,,,,700.5600,2714.3000,percent of total billed charges,"42.7% of $2,714.30 in Billed Charges for Rev 272 = $1,159.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DRUM 5.0 5130-020-047S1,272,RC,,,,,,,,both,,,2714.3000,407.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1900.01,,,,,,,700.5600,2714.3000,percent of total billed charges,"Rev 272 $2,714.30 in Billed Charges at 70% = $1,900.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DRUM 5.0 5130-020-047S1,272,RC,,,,,,,,both,,,2714.3000,407.1500,CIGNA HEALTHCARE,CIGNA HMO,1131.86,,,,,,,700.5600,2714.3000,percent of total billed charges,"41.7% of $2,714.30 in Billed Charges for Rev 272 = $1,131.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DRUM 5.0 5130-020-047S1,272,RC,,,,,,,,both,,,2714.3000,407.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1259.44,,,,,,,700.5600,2714.3000,percent of total billed charges,"46.4% of $2,714.30 in Billed Charges for Rev 272 = $1,259.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DRUM 5.0 5130-020-047S1,272,RC,,,,,,,,both,,,2714.3000,407.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1131.86,,,,,,,700.5600,2714.3000,percent of total billed charges,"41.7% of $2,714.30 in Billed Charges for Rev 272 = $1,131.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DRUM 5.0 5130-020-047S1,272,RC,,,,,,,,both,,,2714.3000,407.1500,CIGNA HEALTHCARE,CIGNA PPO,1131.86,,,,,,,700.5600,2714.3000,percent of total billed charges,"41.7% of $2,714.30 in Billed Charges for Rev 272 = $1,131.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DRUM 5.0 5130-020-047S1,272,RC,,,,,,,,both,,,2714.3000,407.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2442.87,,,,,,,700.5600,2714.3000,percent of total billed charges,"90% of $2,714.30 in Billed Charges for Rev 272 = $2,442.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DRUM 5.0 5130-020-047S1,272,RC,,,,,,,,both,,,2714.3000,407.1500,MEDCOST,MEDCOST VHN,1291.74,,,,,,,700.5600,2714.3000,percent of total billed charges,"47.59% of $2,714.30 in Billed Charges for Rev 272 = $1,291.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DRUM 5.0 5130-020-047S1,272,RC,,,,,,,,both,,,2714.3000,407.1500,SENTARA HEALTH,SENTARA HEALTH,700.56,,,,,,,700.5600,2714.3000,percent of total billed charges,"25.81% of $2,714.30 in Billed Charges for Rev 272 = $700.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DRUM 5.0 5130-020-047S1,272,RC,,,,,,,,both,,,2714.3000,407.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2714.30,,,,,,,700.5600,2714.3000,percent of total billed charges,"100% of $2,714.30 in Billed Charges for Rev 272 = $2,714.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DRUM 5.0 5130-020-047S1,272,RC,,,,,,,,both,,,2714.3000,407.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1357.15,,,,,,,700.5600,2714.3000,percent of total billed charges,"Rev 272 $2,714.30 in Billed Charges at 50% = $1,357.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DRUM 5.0 5130-020-047S1,272,RC,,,,,,,,both,,,2714.3000,407.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,876.72,,,,,,,700.5600,2714.3000,other,"32.3% of $2,714.30 in Billed Charges for Rev 272 = $876.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BUR DRUM 5.0 5130-020-047S1,272,RC,,,,,,,,both,,,2714.3000,407.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,833.29,,,,,,,700.5600,2714.3000,other,"30.7% of $2,714.30 in Billed Charges for Rev 272 = $833.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BUR DRUM 5.0 5130-020-047S1,272,RC,,,,,,,,both,,,2714.3000,407.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,876.72,,,,,,,700.5600,2714.3000,percent of total billed charges,"32.3% of $2,714.30 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR DRUM 5.0 5130-020-047S1,272,RC,,,,,,,,both,,,2714.3000,407.1500,WELLCARE,WELLCARE MEDICAID,2714.30,,,,,,,700.5600,2714.3000,percent of total billed charges,"100% of $2,714.30 in Billed Charges for Rev 272 = $2,714.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3813.6200,572.0400,AETNA,AETNA,1628.42,,,,,,,984.3000,3813.6200,percent of total billed charges,"42.7% of $3,813.62 in Billed Charges for Rev 272 = $1,628.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3813.6200,572.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2669.53,,,,,,,984.3000,3813.6200,percent of total billed charges,"Rev 272 $3,813.62 in Billed Charges at 70% = $2,669.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3813.6200,572.0400,CIGNA HEALTHCARE,CIGNA HMO,1590.28,,,,,,,984.3000,3813.6200,percent of total billed charges,"41.7% of $3,813.62 in Billed Charges for Rev 272 = $1,590.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3813.6200,572.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1769.52,,,,,,,984.3000,3813.6200,percent of total billed charges,"46.4% of $3,813.62 in Billed Charges for Rev 272 = $1,769.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3813.6200,572.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1590.28,,,,,,,984.3000,3813.6200,percent of total billed charges,"41.7% of $3,813.62 in Billed Charges for Rev 272 = $1,590.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3813.6200,572.0400,CIGNA HEALTHCARE,CIGNA PPO,1590.28,,,,,,,984.3000,3813.6200,percent of total billed charges,"41.7% of $3,813.62 in Billed Charges for Rev 272 = $1,590.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3813.6200,572.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3432.26,,,,,,,984.3000,3813.6200,percent of total billed charges,"90% of $3,813.62 in Billed Charges for Rev 272 = $3,432.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3813.6200,572.0400,MEDCOST,MEDCOST VHN,1814.90,,,,,,,984.3000,3813.6200,percent of total billed charges,"47.59% of $3,813.62 in Billed Charges for Rev 272 = $1,814.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3813.6200,572.0400,SENTARA HEALTH,SENTARA HEALTH,984.30,,,,,,,984.3000,3813.6200,percent of total billed charges,"25.81% of $3,813.62 in Billed Charges for Rev 272 = $984.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3813.6200,572.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3813.62,,,,,,,984.3000,3813.6200,percent of total billed charges,"100% of $3,813.62 in Billed Charges for Rev 272 = $3,813.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3813.6200,572.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1906.81,,,,,,,984.3000,3813.6200,percent of total billed charges,"Rev 272 $3,813.62 in Billed Charges at 50% = $1,906.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3813.6200,572.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1231.80,,,,,,,984.3000,3813.6200,other,"32.3% of $3,813.62 in Billed Charges for Rev 272 = $1,231.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3813.6200,572.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1170.78,,,,,,,984.3000,3813.6200,other,"30.7% of $3,813.62 in Billed Charges for Rev 272 = $1,170.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3813.6200,572.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,1231.80,,,,,,,984.3000,3813.6200,percent of total billed charges,"32.3% of $3,813.62 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE PEAK PLASMA W/SUCTION,272,RC,27200002,CDM,,,,,,both,,,3813.6200,572.0400,WELLCARE,WELLCARE MEDICAID,3813.62,,,,,,,984.3000,3813.6200,percent of total billed charges,"100% of $3,813.62 in Billed Charges for Rev 272 = $3,813.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR E8150LSO,272,RC,,,,,,,,both,,,715.6000,107.3400,AETNA,AETNA,305.56,,,,,,,184.7000,715.6000,percent of total billed charges,42.7% of $715.60 in Billed Charges for Rev 272 = $305.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8150LSO,272,RC,,,,,,,,both,,,715.6000,107.3400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,500.92,,,,,,,184.7000,715.6000,percent of total billed charges,Rev 272 $715.60 in Billed Charges at 70% = $500.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8150LSO,272,RC,,,,,,,,both,,,715.6000,107.3400,CIGNA HEALTHCARE,CIGNA HMO,298.41,,,,,,,184.7000,715.6000,percent of total billed charges,41.7% of $715.60 in Billed Charges for Rev 272 = $298.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8150LSO,272,RC,,,,,,,,both,,,715.6000,107.3400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,332.04,,,,,,,184.7000,715.6000,percent of total billed charges,46.4% of $715.60 in Billed Charges for Rev 272 = $332.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8150LSO,272,RC,,,,,,,,both,,,715.6000,107.3400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,298.41,,,,,,,184.7000,715.6000,percent of total billed charges,41.7% of $715.60 in Billed Charges for Rev 272 = $298.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8150LSO,272,RC,,,,,,,,both,,,715.6000,107.3400,CIGNA HEALTHCARE,CIGNA PPO,298.41,,,,,,,184.7000,715.6000,percent of total billed charges,41.7% of $715.60 in Billed Charges for Rev 272 = $298.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8150LSO,272,RC,,,,,,,,both,,,715.6000,107.3400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,644.04,,,,,,,184.7000,715.6000,percent of total billed charges,90% of $715.60 in Billed Charges for Rev 272 = $644.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8150LSO,272,RC,,,,,,,,both,,,715.6000,107.3400,MEDCOST,MEDCOST VHN,340.55,,,,,,,184.7000,715.6000,percent of total billed charges,47.59% of $715.60 in Billed Charges for Rev 272 = $340.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8150LSO,272,RC,,,,,,,,both,,,715.6000,107.3400,SENTARA HEALTH,SENTARA HEALTH,184.70,,,,,,,184.7000,715.6000,percent of total billed charges,25.81% of $715.60 in Billed Charges for Rev 272 = $184.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8150LSO,272,RC,,,,,,,,both,,,715.6000,107.3400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",715.60,,,,,,,184.7000,715.6000,percent of total billed charges,100% of $715.60 in Billed Charges for Rev 272 = $715.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8150LSO,272,RC,,,,,,,,both,,,715.6000,107.3400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,357.80,,,,,,,184.7000,715.6000,percent of total billed charges,Rev 272 $715.60 in Billed Charges at 50% = $357.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8150LSO,272,RC,,,,,,,,both,,,715.6000,107.3400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,231.14,,,,,,,184.7000,715.6000,other,32.3% of $715.60 in Billed Charges for Rev 272 = $231.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BUR E8150LSO,272,RC,,,,,,,,both,,,715.6000,107.3400,UNITED HEALTHCARE,UHC HERITAGE SELECT,219.69,,,,,,,184.7000,715.6000,other,30.7% of $715.60 in Billed Charges for Rev 272 = $219.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BUR E8150LSO,272,RC,,,,,,,,both,,,715.6000,107.3400,UNITED HEALTHCARE,UNITED HEALTHCARE,231.14,,,,,,,184.7000,715.6000,percent of total billed charges,32.3% of $715.60 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8150LSO,272,RC,,,,,,,,both,,,715.6000,107.3400,WELLCARE,WELLCARE MEDICAID,715.60,,,,,,,184.7000,715.6000,percent of total billed charges,100% of $715.60 in Billed Charges for Rev 272 = $715.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE RAD 120 CURVED 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4020.4900,603.0700,AETNA,AETNA,1716.75,,,,,,,1037.6900,4020.4900,percent of total billed charges,"42.7% of $4,020.49 in Billed Charges for Rev 272 = $1,716.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 120 CURVED 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4020.4900,603.0700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2814.34,,,,,,,1037.6900,4020.4900,percent of total billed charges,"Rev 272 $4,020.49 in Billed Charges at 70% = $2,814.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 120 CURVED 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4020.4900,603.0700,CIGNA HEALTHCARE,CIGNA HMO,1676.54,,,,,,,1037.6900,4020.4900,percent of total billed charges,"41.7% of $4,020.49 in Billed Charges for Rev 272 = $1,676.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 120 CURVED 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4020.4900,603.0700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1865.51,,,,,,,1037.6900,4020.4900,percent of total billed charges,"46.4% of $4,020.49 in Billed Charges for Rev 272 = $1,865.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 120 CURVED 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4020.4900,603.0700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1676.54,,,,,,,1037.6900,4020.4900,percent of total billed charges,"41.7% of $4,020.49 in Billed Charges for Rev 272 = $1,676.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 120 CURVED 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4020.4900,603.0700,CIGNA HEALTHCARE,CIGNA PPO,1676.54,,,,,,,1037.6900,4020.4900,percent of total billed charges,"41.7% of $4,020.49 in Billed Charges for Rev 272 = $1,676.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 120 CURVED 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4020.4900,603.0700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3618.44,,,,,,,1037.6900,4020.4900,percent of total billed charges,"90% of $4,020.49 in Billed Charges for Rev 272 = $3,618.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 120 CURVED 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4020.4900,603.0700,MEDCOST,MEDCOST VHN,1913.35,,,,,,,1037.6900,4020.4900,percent of total billed charges,"47.59% of $4,020.49 in Billed Charges for Rev 272 = $1,913.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 120 CURVED 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4020.4900,603.0700,SENTARA HEALTH,SENTARA HEALTH,1037.69,,,,,,,1037.6900,4020.4900,percent of total billed charges,"25.81% of $4,020.49 in Billed Charges for Rev 272 = $1,037.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 120 CURVED 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4020.4900,603.0700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4020.49,,,,,,,1037.6900,4020.4900,percent of total billed charges,"100% of $4,020.49 in Billed Charges for Rev 272 = $4,020.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 120 CURVED 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4020.4900,603.0700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2010.25,,,,,,,1037.6900,4020.4900,percent of total billed charges,"Rev 272 $4,020.49 in Billed Charges at 50% = $2,010.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 120 CURVED 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4020.4900,603.0700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1298.62,,,,,,,1037.6900,4020.4900,other,"32.3% of $4,020.49 in Billed Charges for Rev 272 = $1,298.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE RAD 120 CURVED 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4020.4900,603.0700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1234.29,,,,,,,1037.6900,4020.4900,other,"30.7% of $4,020.49 in Billed Charges for Rev 272 = $1,234.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE RAD 120 CURVED 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4020.4900,603.0700,UNITED HEALTHCARE,UNITED HEALTHCARE,1298.62,,,,,,,1037.6900,4020.4900,percent of total billed charges,"32.3% of $4,020.49 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 120 CURVED 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4020.4900,603.0700,WELLCARE,WELLCARE MEDICAID,4020.49,,,,,,,1037.6900,4020.4900,percent of total billed charges,"100% of $4,020.49 in Billed Charges for Rev 272 = $4,020.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4182.9700,627.4500,AETNA,AETNA,1786.13,,,,,,,1079.6200,4182.9700,percent of total billed charges,"42.7% of $4,182.97 in Billed Charges for Rev 272 = $1,786.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4182.9700,627.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2928.08,,,,,,,1079.6200,4182.9700,percent of total billed charges,"Rev 272 $4,182.97 in Billed Charges at 70% = $2,928.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4182.9700,627.4500,CIGNA HEALTHCARE,CIGNA HMO,1744.30,,,,,,,1079.6200,4182.9700,percent of total billed charges,"41.7% of $4,182.97 in Billed Charges for Rev 272 = $1,744.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4182.9700,627.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1940.90,,,,,,,1079.6200,4182.9700,percent of total billed charges,"46.4% of $4,182.97 in Billed Charges for Rev 272 = $1,940.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4182.9700,627.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1744.30,,,,,,,1079.6200,4182.9700,percent of total billed charges,"41.7% of $4,182.97 in Billed Charges for Rev 272 = $1,744.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4182.9700,627.4500,CIGNA HEALTHCARE,CIGNA PPO,1744.30,,,,,,,1079.6200,4182.9700,percent of total billed charges,"41.7% of $4,182.97 in Billed Charges for Rev 272 = $1,744.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4182.9700,627.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3764.67,,,,,,,1079.6200,4182.9700,percent of total billed charges,"90% of $4,182.97 in Billed Charges for Rev 272 = $3,764.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4182.9700,627.4500,MEDCOST,MEDCOST VHN,1990.68,,,,,,,1079.6200,4182.9700,percent of total billed charges,"47.59% of $4,182.97 in Billed Charges for Rev 272 = $1,990.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4182.9700,627.4500,SENTARA HEALTH,SENTARA HEALTH,1079.62,,,,,,,1079.6200,4182.9700,percent of total billed charges,"25.81% of $4,182.97 in Billed Charges for Rev 272 = $1,079.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4182.9700,627.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4182.97,,,,,,,1079.6200,4182.9700,percent of total billed charges,"100% of $4,182.97 in Billed Charges for Rev 272 = $4,182.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4182.9700,627.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2091.49,,,,,,,1079.6200,4182.9700,percent of total billed charges,"Rev 272 $4,182.97 in Billed Charges at 50% = $2,091.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4182.9700,627.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1351.10,,,,,,,1079.6200,4182.9700,other,"32.3% of $4,182.97 in Billed Charges for Rev 272 = $1,351.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4182.9700,627.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1284.17,,,,,,,1079.6200,4182.9700,other,"30.7% of $4,182.97 in Billed Charges for Rev 272 = $1,284.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4182.9700,627.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,1351.10,,,,,,,1079.6200,4182.9700,percent of total billed charges,"32.3% of $4,182.97 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE RAD 90 ROTATABLE 3.5MM,272,RC,27200002,CDM,,,,,,both,,,4182.9700,627.4500,WELLCARE,WELLCARE MEDICAID,4182.97,,,,,,,1079.6200,4182.9700,percent of total billed charges,"100% of $4,182.97 in Billed Charges for Rev 272 = $4,182.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ACORN 7.5 TPS   5220-30-75,272,RC,27200002,CDM,,,,,,both,,,847.9300,127.1900,AETNA,AETNA,362.07,,,,,,,218.8500,847.9300,percent of total billed charges,42.7% of $847.93 in Billed Charges for Rev 272 = $362.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR ACORN 7.5 TPS   5220-30-75,272,RC,27200002,CDM,,,,,,both,,,847.9300,127.1900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,593.55,,,,,,,218.8500,847.9300,percent of total billed charges,Rev 272 $847.93 in Billed Charges at 70% = $593.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR ACORN 7.5 TPS   5220-30-75,272,RC,27200002,CDM,,,,,,both,,,847.9300,127.1900,CIGNA HEALTHCARE,CIGNA HMO,353.59,,,,,,,218.8500,847.9300,percent of total billed charges,41.7% of $847.93 in Billed Charges for Rev 272 = $353.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR ACORN 7.5 TPS   5220-30-75,272,RC,27200002,CDM,,,,,,both,,,847.9300,127.1900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,393.44,,,,,,,218.8500,847.9300,percent of total billed charges,46.4% of $847.93 in Billed Charges for Rev 272 = $393.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR ACORN 7.5 TPS   5220-30-75,272,RC,27200002,CDM,,,,,,both,,,847.9300,127.1900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,353.59,,,,,,,218.8500,847.9300,percent of total billed charges,41.7% of $847.93 in Billed Charges for Rev 272 = $353.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR ACORN 7.5 TPS   5220-30-75,272,RC,27200002,CDM,,,,,,both,,,847.9300,127.1900,CIGNA HEALTHCARE,CIGNA PPO,353.59,,,,,,,218.8500,847.9300,percent of total billed charges,41.7% of $847.93 in Billed Charges for Rev 272 = $353.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR ACORN 7.5 TPS   5220-30-75,272,RC,27200002,CDM,,,,,,both,,,847.9300,127.1900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,763.14,,,,,,,218.8500,847.9300,percent of total billed charges,90% of $847.93 in Billed Charges for Rev 272 = $763.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR ACORN 7.5 TPS   5220-30-75,272,RC,27200002,CDM,,,,,,both,,,847.9300,127.1900,MEDCOST,MEDCOST VHN,403.53,,,,,,,218.8500,847.9300,percent of total billed charges,47.59% of $847.93 in Billed Charges for Rev 272 = $403.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR ACORN 7.5 TPS   5220-30-75,272,RC,27200002,CDM,,,,,,both,,,847.9300,127.1900,SENTARA HEALTH,SENTARA HEALTH,218.85,,,,,,,218.8500,847.9300,percent of total billed charges,25.81% of $847.93 in Billed Charges for Rev 272 = $218.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR ACORN 7.5 TPS   5220-30-75,272,RC,27200002,CDM,,,,,,both,,,847.9300,127.1900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",847.93,,,,,,,218.8500,847.9300,percent of total billed charges,100% of $847.93 in Billed Charges for Rev 272 = $847.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR ACORN 7.5 TPS   5220-30-75,272,RC,27200002,CDM,,,,,,both,,,847.9300,127.1900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,423.97,,,,,,,218.8500,847.9300,percent of total billed charges,Rev 272 $847.93 in Billed Charges at 50% = $423.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR ACORN 7.5 TPS   5220-30-75,272,RC,27200002,CDM,,,,,,both,,,847.9300,127.1900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,273.88,,,,,,,218.8500,847.9300,other,32.3% of $847.93 in Billed Charges for Rev 272 = $273.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BUR ACORN 7.5 TPS   5220-30-75,272,RC,27200002,CDM,,,,,,both,,,847.9300,127.1900,UNITED HEALTHCARE,UHC HERITAGE SELECT,260.31,,,,,,,218.8500,847.9300,other,30.7% of $847.93 in Billed Charges for Rev 272 = $260.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BUR ACORN 7.5 TPS   5220-30-75,272,RC,27200002,CDM,,,,,,both,,,847.9300,127.1900,UNITED HEALTHCARE,UNITED HEALTHCARE,273.88,,,,,,,218.8500,847.9300,percent of total billed charges,32.3% of $847.93 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR ACORN 7.5 TPS   5220-30-75,272,RC,27200002,CDM,,,,,,both,,,847.9300,127.1900,WELLCARE,WELLCARE MEDICAID,847.93,,,,,,,218.8500,847.9300,percent of total billed charges,100% of $847.93 in Billed Charges for Rev 272 = $847.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCISSOR ENDOWRIST HOT SHEARS DA VINCI,272,RC,27200002,CDM,,,,,,both,,,3484.6600,522.7000,AETNA,AETNA,1487.95,,,,,,,899.3900,3484.6600,percent of total billed charges,"42.7% of $3,484.66 in Billed Charges for Rev 272 = $1,487.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ENDOWRIST HOT SHEARS DA VINCI,272,RC,27200002,CDM,,,,,,both,,,3484.6600,522.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2439.26,,,,,,,899.3900,3484.6600,percent of total billed charges,"Rev 272 $3,484.66 in Billed Charges at 70% = $2,439.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ENDOWRIST HOT SHEARS DA VINCI,272,RC,27200002,CDM,,,,,,both,,,3484.6600,522.7000,CIGNA HEALTHCARE,CIGNA HMO,1453.10,,,,,,,899.3900,3484.6600,percent of total billed charges,"41.7% of $3,484.66 in Billed Charges for Rev 272 = $1,453.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ENDOWRIST HOT SHEARS DA VINCI,272,RC,27200002,CDM,,,,,,both,,,3484.6600,522.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1616.88,,,,,,,899.3900,3484.6600,percent of total billed charges,"46.4% of $3,484.66 in Billed Charges for Rev 272 = $1,616.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ENDOWRIST HOT SHEARS DA VINCI,272,RC,27200002,CDM,,,,,,both,,,3484.6600,522.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1453.10,,,,,,,899.3900,3484.6600,percent of total billed charges,"41.7% of $3,484.66 in Billed Charges for Rev 272 = $1,453.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ENDOWRIST HOT SHEARS DA VINCI,272,RC,27200002,CDM,,,,,,both,,,3484.6600,522.7000,CIGNA HEALTHCARE,CIGNA PPO,1453.10,,,,,,,899.3900,3484.6600,percent of total billed charges,"41.7% of $3,484.66 in Billed Charges for Rev 272 = $1,453.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ENDOWRIST HOT SHEARS DA VINCI,272,RC,27200002,CDM,,,,,,both,,,3484.6600,522.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3136.19,,,,,,,899.3900,3484.6600,percent of total billed charges,"90% of $3,484.66 in Billed Charges for Rev 272 = $3,136.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ENDOWRIST HOT SHEARS DA VINCI,272,RC,27200002,CDM,,,,,,both,,,3484.6600,522.7000,MEDCOST,MEDCOST VHN,1658.35,,,,,,,899.3900,3484.6600,percent of total billed charges,"47.59% of $3,484.66 in Billed Charges for Rev 272 = $1,658.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ENDOWRIST HOT SHEARS DA VINCI,272,RC,27200002,CDM,,,,,,both,,,3484.6600,522.7000,SENTARA HEALTH,SENTARA HEALTH,899.39,,,,,,,899.3900,3484.6600,percent of total billed charges,"25.81% of $3,484.66 in Billed Charges for Rev 272 = $899.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ENDOWRIST HOT SHEARS DA VINCI,272,RC,27200002,CDM,,,,,,both,,,3484.6600,522.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3484.66,,,,,,,899.3900,3484.6600,percent of total billed charges,"100% of $3,484.66 in Billed Charges for Rev 272 = $3,484.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ENDOWRIST HOT SHEARS DA VINCI,272,RC,27200002,CDM,,,,,,both,,,3484.6600,522.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1742.33,,,,,,,899.3900,3484.6600,percent of total billed charges,"Rev 272 $3,484.66 in Billed Charges at 50% = $1,742.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ENDOWRIST HOT SHEARS DA VINCI,272,RC,27200002,CDM,,,,,,both,,,3484.6600,522.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1125.55,,,,,,,899.3900,3484.6600,other,"32.3% of $3,484.66 in Billed Charges for Rev 272 = $1,125.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCISSOR ENDOWRIST HOT SHEARS DA VINCI,272,RC,27200002,CDM,,,,,,both,,,3484.6600,522.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1069.79,,,,,,,899.3900,3484.6600,other,"30.7% of $3,484.66 in Billed Charges for Rev 272 = $1,069.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCISSOR ENDOWRIST HOT SHEARS DA VINCI,272,RC,27200002,CDM,,,,,,both,,,3484.6600,522.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,1125.55,,,,,,,899.3900,3484.6600,percent of total billed charges,"32.3% of $3,484.66 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ENDOWRIST HOT SHEARS DA VINCI,272,RC,27200002,CDM,,,,,,both,,,3484.6600,522.7000,WELLCARE,WELLCARE MEDICAID,3484.66,,,,,,,899.3900,3484.6600,percent of total billed charges,"100% of $3,484.66 in Billed Charges for Rev 272 = $3,484.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ROUND TIP 8MM DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1633.4300,245.0100,AETNA,AETNA,697.47,,,,,,,421.5900,1633.4300,percent of total billed charges,"42.7% of $1,633.43 in Billed Charges for Rev 272 = $697.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ROUND TIP 8MM DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1633.4300,245.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1143.40,,,,,,,421.5900,1633.4300,percent of total billed charges,"Rev 272 $1,633.43 in Billed Charges at 70% = $1,143.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ROUND TIP 8MM DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1633.4300,245.0100,CIGNA HEALTHCARE,CIGNA HMO,681.14,,,,,,,421.5900,1633.4300,percent of total billed charges,"41.7% of $1,633.43 in Billed Charges for Rev 272 = $681.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ROUND TIP 8MM DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1633.4300,245.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,757.91,,,,,,,421.5900,1633.4300,percent of total billed charges,"46.4% of $1,633.43 in Billed Charges for Rev 272 = $757.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ROUND TIP 8MM DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1633.4300,245.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,681.14,,,,,,,421.5900,1633.4300,percent of total billed charges,"41.7% of $1,633.43 in Billed Charges for Rev 272 = $681.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ROUND TIP 8MM DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1633.4300,245.0100,CIGNA HEALTHCARE,CIGNA PPO,681.14,,,,,,,421.5900,1633.4300,percent of total billed charges,"41.7% of $1,633.43 in Billed Charges for Rev 272 = $681.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ROUND TIP 8MM DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1633.4300,245.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1470.09,,,,,,,421.5900,1633.4300,percent of total billed charges,"90% of $1,633.43 in Billed Charges for Rev 272 = $1,470.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ROUND TIP 8MM DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1633.4300,245.0100,MEDCOST,MEDCOST VHN,777.35,,,,,,,421.5900,1633.4300,percent of total billed charges,"47.59% of $1,633.43 in Billed Charges for Rev 272 = $777.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ROUND TIP 8MM DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1633.4300,245.0100,SENTARA HEALTH,SENTARA HEALTH,421.59,,,,,,,421.5900,1633.4300,percent of total billed charges,"25.81% of $1,633.43 in Billed Charges for Rev 272 = $421.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ROUND TIP 8MM DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1633.4300,245.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1633.43,,,,,,,421.5900,1633.4300,percent of total billed charges,"100% of $1,633.43 in Billed Charges for Rev 272 = $1,633.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ROUND TIP 8MM DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1633.4300,245.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,816.72,,,,,,,421.5900,1633.4300,percent of total billed charges,"Rev 272 $1,633.43 in Billed Charges at 50% = $816.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ROUND TIP 8MM DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1633.4300,245.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,527.60,,,,,,,421.5900,1633.4300,other,"32.3% of $1,633.43 in Billed Charges for Rev 272 = $527.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCISSOR ROUND TIP 8MM DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1633.4300,245.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,501.46,,,,,,,421.5900,1633.4300,other,"30.7% of $1,633.43 in Billed Charges for Rev 272 = $501.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCISSOR ROUND TIP 8MM DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1633.4300,245.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,527.60,,,,,,,421.5900,1633.4300,percent of total billed charges,"32.3% of $1,633.43 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSOR ROUND TIP 8MM DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1633.4300,245.0100,WELLCARE,WELLCARE MEDICAID,1633.43,,,,,,,421.5900,1633.4300,percent of total billed charges,"100% of $1,633.43 in Billed Charges for Rev 272 = $1,633.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS POTTS FOR DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2123.9800,318.6000,AETNA,AETNA,906.94,,,,,,,548.2000,2123.9800,percent of total billed charges,"42.7% of $2,123.98 in Billed Charges for Rev 272 = $906.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS POTTS FOR DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2123.9800,318.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1486.79,,,,,,,548.2000,2123.9800,percent of total billed charges,"Rev 272 $2,123.98 in Billed Charges at 70% = $1,486.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS POTTS FOR DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2123.9800,318.6000,CIGNA HEALTHCARE,CIGNA HMO,885.70,,,,,,,548.2000,2123.9800,percent of total billed charges,"41.7% of $2,123.98 in Billed Charges for Rev 272 = $885.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS POTTS FOR DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2123.9800,318.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,985.53,,,,,,,548.2000,2123.9800,percent of total billed charges,"46.4% of $2,123.98 in Billed Charges for Rev 272 = $985.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS POTTS FOR DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2123.9800,318.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,885.70,,,,,,,548.2000,2123.9800,percent of total billed charges,"41.7% of $2,123.98 in Billed Charges for Rev 272 = $885.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS POTTS FOR DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2123.9800,318.6000,CIGNA HEALTHCARE,CIGNA PPO,885.70,,,,,,,548.2000,2123.9800,percent of total billed charges,"41.7% of $2,123.98 in Billed Charges for Rev 272 = $885.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS POTTS FOR DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2123.9800,318.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1911.58,,,,,,,548.2000,2123.9800,percent of total billed charges,"90% of $2,123.98 in Billed Charges for Rev 272 = $1,911.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS POTTS FOR DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2123.9800,318.6000,MEDCOST,MEDCOST VHN,1010.80,,,,,,,548.2000,2123.9800,percent of total billed charges,"47.59% of $2,123.98 in Billed Charges for Rev 272 = $1,010.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS POTTS FOR DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2123.9800,318.6000,SENTARA HEALTH,SENTARA HEALTH,548.20,,,,,,,548.2000,2123.9800,percent of total billed charges,"25.81% of $2,123.98 in Billed Charges for Rev 272 = $548.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS POTTS FOR DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2123.9800,318.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2123.98,,,,,,,548.2000,2123.9800,percent of total billed charges,"100% of $2,123.98 in Billed Charges for Rev 272 = $2,123.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS POTTS FOR DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2123.9800,318.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1061.99,,,,,,,548.2000,2123.9800,percent of total billed charges,"Rev 272 $2,123.98 in Billed Charges at 50% = $1,061.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS POTTS FOR DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2123.9800,318.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,686.05,,,,,,,548.2000,2123.9800,other,"32.3% of $2,123.98 in Billed Charges for Rev 272 = $686.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCISSORS POTTS FOR DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2123.9800,318.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,652.06,,,,,,,548.2000,2123.9800,other,"30.7% of $2,123.98 in Billed Charges for Rev 272 = $652.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCISSORS POTTS FOR DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2123.9800,318.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,686.05,,,,,,,548.2000,2123.9800,percent of total billed charges,"32.3% of $2,123.98 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS POTTS FOR DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2123.9800,318.6000,WELLCARE,WELLCARE MEDICAID,2123.98,,,,,,,548.2000,2123.9800,percent of total billed charges,"100% of $2,123.98 in Billed Charges for Rev 272 = $2,123.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR BARREL LONG 4.7MM,272,RC,27200002,CDM,,,,,,both,,,3519.8100,527.9700,AETNA,AETNA,1502.96,,,,,,,908.4600,3519.8100,percent of total billed charges,"42.7% of $3,519.81 in Billed Charges for Rev 272 = $1,502.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR BARREL LONG 4.7MM,272,RC,27200002,CDM,,,,,,both,,,3519.8100,527.9700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2463.87,,,,,,,908.4600,3519.8100,percent of total billed charges,"Rev 272 $3,519.81 in Billed Charges at 70% = $2,463.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR BARREL LONG 4.7MM,272,RC,27200002,CDM,,,,,,both,,,3519.8100,527.9700,CIGNA HEALTHCARE,CIGNA HMO,1467.76,,,,,,,908.4600,3519.8100,percent of total billed charges,"41.7% of $3,519.81 in Billed Charges for Rev 272 = $1,467.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR BARREL LONG 4.7MM,272,RC,27200002,CDM,,,,,,both,,,3519.8100,527.9700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1633.19,,,,,,,908.4600,3519.8100,percent of total billed charges,"46.4% of $3,519.81 in Billed Charges for Rev 272 = $1,633.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR BARREL LONG 4.7MM,272,RC,27200002,CDM,,,,,,both,,,3519.8100,527.9700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1467.76,,,,,,,908.4600,3519.8100,percent of total billed charges,"41.7% of $3,519.81 in Billed Charges for Rev 272 = $1,467.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR BARREL LONG 4.7MM,272,RC,27200002,CDM,,,,,,both,,,3519.8100,527.9700,CIGNA HEALTHCARE,CIGNA PPO,1467.76,,,,,,,908.4600,3519.8100,percent of total billed charges,"41.7% of $3,519.81 in Billed Charges for Rev 272 = $1,467.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR BARREL LONG 4.7MM,272,RC,27200002,CDM,,,,,,both,,,3519.8100,527.9700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3167.83,,,,,,,908.4600,3519.8100,percent of total billed charges,"90% of $3,519.81 in Billed Charges for Rev 272 = $3,167.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR BARREL LONG 4.7MM,272,RC,27200002,CDM,,,,,,both,,,3519.8100,527.9700,MEDCOST,MEDCOST VHN,1675.08,,,,,,,908.4600,3519.8100,percent of total billed charges,"47.59% of $3,519.81 in Billed Charges for Rev 272 = $1,675.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR BARREL LONG 4.7MM,272,RC,27200002,CDM,,,,,,both,,,3519.8100,527.9700,SENTARA HEALTH,SENTARA HEALTH,908.46,,,,,,,908.4600,3519.8100,percent of total billed charges,"25.81% of $3,519.81 in Billed Charges for Rev 272 = $908.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR BARREL LONG 4.7MM,272,RC,27200002,CDM,,,,,,both,,,3519.8100,527.9700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3519.81,,,,,,,908.4600,3519.8100,percent of total billed charges,"100% of $3,519.81 in Billed Charges for Rev 272 = $3,519.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR BARREL LONG 4.7MM,272,RC,27200002,CDM,,,,,,both,,,3519.8100,527.9700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1759.91,,,,,,,908.4600,3519.8100,percent of total billed charges,"Rev 272 $3,519.81 in Billed Charges at 50% = $1,759.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR BARREL LONG 4.7MM,272,RC,27200002,CDM,,,,,,both,,,3519.8100,527.9700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1136.90,,,,,,,908.4600,3519.8100,other,"32.3% of $3,519.81 in Billed Charges for Rev 272 = $1,136.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BUR BARREL LONG 4.7MM,272,RC,27200002,CDM,,,,,,both,,,3519.8100,527.9700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1080.58,,,,,,,908.4600,3519.8100,other,"30.7% of $3,519.81 in Billed Charges for Rev 272 = $1,080.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BUR BARREL LONG 4.7MM,272,RC,27200002,CDM,,,,,,both,,,3519.8100,527.9700,UNITED HEALTHCARE,UNITED HEALTHCARE,1136.90,,,,,,,908.4600,3519.8100,percent of total billed charges,"32.3% of $3,519.81 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR BARREL LONG 4.7MM,272,RC,27200002,CDM,,,,,,both,,,3519.8100,527.9700,WELLCARE,WELLCARE MEDICAID,3519.81,,,,,,,908.4600,3519.8100,percent of total billed charges,"100% of $3,519.81 in Billed Charges for Rev 272 = $3,519.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR CROSSCUT 7021-119,272,RC,,,,,,,,both,,,552.7700,82.9200,AETNA,AETNA,236.03,,,,,,,142.6700,552.7700,percent of total billed charges,42.7% of $552.77 in Billed Charges for Rev 272 = $236.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR CROSSCUT 7021-119,272,RC,,,,,,,,both,,,552.7700,82.9200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,386.94,,,,,,,142.6700,552.7700,percent of total billed charges,Rev 272 $552.77 in Billed Charges at 70% = $386.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR CROSSCUT 7021-119,272,RC,,,,,,,,both,,,552.7700,82.9200,CIGNA HEALTHCARE,CIGNA HMO,230.51,,,,,,,142.6700,552.7700,percent of total billed charges,41.7% of $552.77 in Billed Charges for Rev 272 = $230.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR CROSSCUT 7021-119,272,RC,,,,,,,,both,,,552.7700,82.9200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,256.49,,,,,,,142.6700,552.7700,percent of total billed charges,46.4% of $552.77 in Billed Charges for Rev 272 = $256.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR CROSSCUT 7021-119,272,RC,,,,,,,,both,,,552.7700,82.9200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,230.51,,,,,,,142.6700,552.7700,percent of total billed charges,41.7% of $552.77 in Billed Charges for Rev 272 = $230.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR CROSSCUT 7021-119,272,RC,,,,,,,,both,,,552.7700,82.9200,CIGNA HEALTHCARE,CIGNA PPO,230.51,,,,,,,142.6700,552.7700,percent of total billed charges,41.7% of $552.77 in Billed Charges for Rev 272 = $230.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR CROSSCUT 7021-119,272,RC,,,,,,,,both,,,552.7700,82.9200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,497.49,,,,,,,142.6700,552.7700,percent of total billed charges,90% of $552.77 in Billed Charges for Rev 272 = $497.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR CROSSCUT 7021-119,272,RC,,,,,,,,both,,,552.7700,82.9200,MEDCOST,MEDCOST VHN,263.06,,,,,,,142.6700,552.7700,percent of total billed charges,47.59% of $552.77 in Billed Charges for Rev 272 = $263.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR CROSSCUT 7021-119,272,RC,,,,,,,,both,,,552.7700,82.9200,SENTARA HEALTH,SENTARA HEALTH,142.67,,,,,,,142.6700,552.7700,percent of total billed charges,25.81% of $552.77 in Billed Charges for Rev 272 = $142.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR CROSSCUT 7021-119,272,RC,,,,,,,,both,,,552.7700,82.9200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",552.77,,,,,,,142.6700,552.7700,percent of total billed charges,100% of $552.77 in Billed Charges for Rev 272 = $552.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR CROSSCUT 7021-119,272,RC,,,,,,,,both,,,552.7700,82.9200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,276.39,,,,,,,142.6700,552.7700,percent of total billed charges,Rev 272 $552.77 in Billed Charges at 50% = $276.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR CROSSCUT 7021-119,272,RC,,,,,,,,both,,,552.7700,82.9200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,178.54,,,,,,,142.6700,552.7700,other,32.3% of $552.77 in Billed Charges for Rev 272 = $178.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BUR CROSSCUT 7021-119,272,RC,,,,,,,,both,,,552.7700,82.9200,UNITED HEALTHCARE,UHC HERITAGE SELECT,169.70,,,,,,,142.6700,552.7700,other,30.7% of $552.77 in Billed Charges for Rev 272 = $169.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BUR CROSSCUT 7021-119,272,RC,,,,,,,,both,,,552.7700,82.9200,UNITED HEALTHCARE,UNITED HEALTHCARE,178.54,,,,,,,142.6700,552.7700,percent of total billed charges,32.3% of $552.77 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR CROSSCUT 7021-119,272,RC,,,,,,,,both,,,552.7700,82.9200,WELLCARE,WELLCARE MEDICAID,552.77,,,,,,,142.6700,552.7700,percent of total billed charges,100% of $552.77 in Billed Charges for Rev 272 = $552.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCOPE SLIDE ONE THD,272,RC,27200002,CDM,,,,,,both,,,6742.8100,1011.4200,AETNA,AETNA,2879.18,,,,,,,1740.3200,6742.8100,percent of total billed charges,"42.7% of $6,742.81 in Billed Charges for Rev 272 = $2,879.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE SLIDE ONE THD,272,RC,27200002,CDM,,,,,,both,,,6742.8100,1011.4200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4719.97,,,,,,,1740.3200,6742.8100,percent of total billed charges,"Rev 272 $6,742.81 in Billed Charges at 70% = $4,719.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE SLIDE ONE THD,272,RC,27200002,CDM,,,,,,both,,,6742.8100,1011.4200,CIGNA HEALTHCARE,CIGNA HMO,2811.75,,,,,,,1740.3200,6742.8100,percent of total billed charges,"41.7% of $6,742.81 in Billed Charges for Rev 272 = $2,811.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE SLIDE ONE THD,272,RC,27200002,CDM,,,,,,both,,,6742.8100,1011.4200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3128.66,,,,,,,1740.3200,6742.8100,percent of total billed charges,"46.4% of $6,742.81 in Billed Charges for Rev 272 = $3,128.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE SLIDE ONE THD,272,RC,27200002,CDM,,,,,,both,,,6742.8100,1011.4200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2811.75,,,,,,,1740.3200,6742.8100,percent of total billed charges,"41.7% of $6,742.81 in Billed Charges for Rev 272 = $2,811.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE SLIDE ONE THD,272,RC,27200002,CDM,,,,,,both,,,6742.8100,1011.4200,CIGNA HEALTHCARE,CIGNA PPO,2811.75,,,,,,,1740.3200,6742.8100,percent of total billed charges,"41.7% of $6,742.81 in Billed Charges for Rev 272 = $2,811.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE SLIDE ONE THD,272,RC,27200002,CDM,,,,,,both,,,6742.8100,1011.4200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6068.53,,,,,,,1740.3200,6742.8100,percent of total billed charges,"90% of $6,742.81 in Billed Charges for Rev 272 = $6,068.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE SLIDE ONE THD,272,RC,27200002,CDM,,,,,,both,,,6742.8100,1011.4200,MEDCOST,MEDCOST VHN,3208.90,,,,,,,1740.3200,6742.8100,percent of total billed charges,"47.59% of $6,742.81 in Billed Charges for Rev 272 = $3,208.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE SLIDE ONE THD,272,RC,27200002,CDM,,,,,,both,,,6742.8100,1011.4200,SENTARA HEALTH,SENTARA HEALTH,1740.32,,,,,,,1740.3200,6742.8100,percent of total billed charges,"25.81% of $6,742.81 in Billed Charges for Rev 272 = $1,740.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE SLIDE ONE THD,272,RC,27200002,CDM,,,,,,both,,,6742.8100,1011.4200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6742.81,,,,,,,1740.3200,6742.8100,percent of total billed charges,"100% of $6,742.81 in Billed Charges for Rev 272 = $6,742.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE SLIDE ONE THD,272,RC,27200002,CDM,,,,,,both,,,6742.8100,1011.4200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3371.41,,,,,,,1740.3200,6742.8100,percent of total billed charges,"Rev 272 $6,742.81 in Billed Charges at 50% = $3,371.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE SLIDE ONE THD,272,RC,27200002,CDM,,,,,,both,,,6742.8100,1011.4200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2177.93,,,,,,,1740.3200,6742.8100,other,"32.3% of $6,742.81 in Billed Charges for Rev 272 = $2,177.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCOPE SLIDE ONE THD,272,RC,27200002,CDM,,,,,,both,,,6742.8100,1011.4200,UNITED HEALTHCARE,UHC HERITAGE SELECT,2070.04,,,,,,,1740.3200,6742.8100,other,"30.7% of $6,742.81 in Billed Charges for Rev 272 = $2,070.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCOPE SLIDE ONE THD,272,RC,27200002,CDM,,,,,,both,,,6742.8100,1011.4200,UNITED HEALTHCARE,UNITED HEALTHCARE,2177.93,,,,,,,1740.3200,6742.8100,percent of total billed charges,"32.3% of $6,742.81 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE SLIDE ONE THD,272,RC,27200002,CDM,,,,,,both,,,6742.8100,1011.4200,WELLCARE,WELLCARE MEDICAID,6742.81,,,,,,,1740.3200,6742.8100,percent of total billed charges,"100% of $6,742.81 in Billed Charges for Rev 272 = $6,742.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE VIDEO BRONCH LG ASCOPE,272,RC,27200002,CDM,,,,,,both,,,2611.5800,391.7400,AETNA,AETNA,1115.14,,,,,,,674.0500,2611.5800,percent of total billed charges,"42.7% of $2,611.58 in Billed Charges for Rev 272 = $1,115.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE VIDEO BRONCH LG ASCOPE,272,RC,27200002,CDM,,,,,,both,,,2611.5800,391.7400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1828.11,,,,,,,674.0500,2611.5800,percent of total billed charges,"Rev 272 $2,611.58 in Billed Charges at 70% = $1,828.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE VIDEO BRONCH LG ASCOPE,272,RC,27200002,CDM,,,,,,both,,,2611.5800,391.7400,CIGNA HEALTHCARE,CIGNA HMO,1089.03,,,,,,,674.0500,2611.5800,percent of total billed charges,"41.7% of $2,611.58 in Billed Charges for Rev 272 = $1,089.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE VIDEO BRONCH LG ASCOPE,272,RC,27200002,CDM,,,,,,both,,,2611.5800,391.7400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1211.77,,,,,,,674.0500,2611.5800,percent of total billed charges,"46.4% of $2,611.58 in Billed Charges for Rev 272 = $1,211.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE VIDEO BRONCH LG ASCOPE,272,RC,27200002,CDM,,,,,,both,,,2611.5800,391.7400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1089.03,,,,,,,674.0500,2611.5800,percent of total billed charges,"41.7% of $2,611.58 in Billed Charges for Rev 272 = $1,089.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE VIDEO BRONCH LG ASCOPE,272,RC,27200002,CDM,,,,,,both,,,2611.5800,391.7400,CIGNA HEALTHCARE,CIGNA PPO,1089.03,,,,,,,674.0500,2611.5800,percent of total billed charges,"41.7% of $2,611.58 in Billed Charges for Rev 272 = $1,089.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE VIDEO BRONCH LG ASCOPE,272,RC,27200002,CDM,,,,,,both,,,2611.5800,391.7400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2350.42,,,,,,,674.0500,2611.5800,percent of total billed charges,"90% of $2,611.58 in Billed Charges for Rev 272 = $2,350.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE VIDEO BRONCH LG ASCOPE,272,RC,27200002,CDM,,,,,,both,,,2611.5800,391.7400,MEDCOST,MEDCOST VHN,1242.85,,,,,,,674.0500,2611.5800,percent of total billed charges,"47.59% of $2,611.58 in Billed Charges for Rev 272 = $1,242.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE VIDEO BRONCH LG ASCOPE,272,RC,27200002,CDM,,,,,,both,,,2611.5800,391.7400,SENTARA HEALTH,SENTARA HEALTH,674.05,,,,,,,674.0500,2611.5800,percent of total billed charges,"25.81% of $2,611.58 in Billed Charges for Rev 272 = $674.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE VIDEO BRONCH LG ASCOPE,272,RC,27200002,CDM,,,,,,both,,,2611.5800,391.7400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2611.58,,,,,,,674.0500,2611.5800,percent of total billed charges,"100% of $2,611.58 in Billed Charges for Rev 272 = $2,611.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE VIDEO BRONCH LG ASCOPE,272,RC,27200002,CDM,,,,,,both,,,2611.5800,391.7400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1305.79,,,,,,,674.0500,2611.5800,percent of total billed charges,"Rev 272 $2,611.58 in Billed Charges at 50% = $1,305.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE VIDEO BRONCH LG ASCOPE,272,RC,27200002,CDM,,,,,,both,,,2611.5800,391.7400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,843.54,,,,,,,674.0500,2611.5800,other,"32.3% of $2,611.58 in Billed Charges for Rev 272 = $843.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCOPE VIDEO BRONCH LG ASCOPE,272,RC,27200002,CDM,,,,,,both,,,2611.5800,391.7400,UNITED HEALTHCARE,UHC HERITAGE SELECT,801.76,,,,,,,674.0500,2611.5800,other,"30.7% of $2,611.58 in Billed Charges for Rev 272 = $801.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCOPE VIDEO BRONCH LG ASCOPE,272,RC,27200002,CDM,,,,,,both,,,2611.5800,391.7400,UNITED HEALTHCARE,UNITED HEALTHCARE,843.54,,,,,,,674.0500,2611.5800,percent of total billed charges,"32.3% of $2,611.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE VIDEO BRONCH LG ASCOPE,272,RC,27200002,CDM,,,,,,both,,,2611.5800,391.7400,WELLCARE,WELLCARE MEDICAID,2611.58,,,,,,,674.0500,2611.5800,percent of total billed charges,"100% of $2,611.58 in Billed Charges for Rev 272 = $2,611.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,788.2000,118.2300,AETNA,AETNA,336.56,,,,,,,203.4300,788.2000,percent of total billed charges,42.7% of $788.20 in Billed Charges for Rev 272 = $336.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,788.2000,118.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,551.74,,,,,,,203.4300,788.2000,percent of total billed charges,Rev 272 $788.20 in Billed Charges at 70% = $551.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,788.2000,118.2300,CIGNA HEALTHCARE,CIGNA HMO,328.68,,,,,,,203.4300,788.2000,percent of total billed charges,41.7% of $788.20 in Billed Charges for Rev 272 = $328.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,788.2000,118.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,365.72,,,,,,,203.4300,788.2000,percent of total billed charges,46.4% of $788.20 in Billed Charges for Rev 272 = $365.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,788.2000,118.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,328.68,,,,,,,203.4300,788.2000,percent of total billed charges,41.7% of $788.20 in Billed Charges for Rev 272 = $328.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,788.2000,118.2300,CIGNA HEALTHCARE,CIGNA PPO,328.68,,,,,,,203.4300,788.2000,percent of total billed charges,41.7% of $788.20 in Billed Charges for Rev 272 = $328.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,788.2000,118.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,709.38,,,,,,,203.4300,788.2000,percent of total billed charges,90% of $788.20 in Billed Charges for Rev 272 = $709.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,788.2000,118.2300,MEDCOST,MEDCOST VHN,375.10,,,,,,,203.4300,788.2000,percent of total billed charges,47.59% of $788.20 in Billed Charges for Rev 272 = $375.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,788.2000,118.2300,SENTARA HEALTH,SENTARA HEALTH,203.43,,,,,,,203.4300,788.2000,percent of total billed charges,25.81% of $788.20 in Billed Charges for Rev 272 = $203.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,788.2000,118.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",788.20,,,,,,,203.4300,788.2000,percent of total billed charges,100% of $788.20 in Billed Charges for Rev 272 = $788.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,788.2000,118.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,394.10,,,,,,,203.4300,788.2000,percent of total billed charges,Rev 272 $788.20 in Billed Charges at 50% = $394.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,788.2000,118.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,254.59,,,,,,,203.4300,788.2000,other,32.3% of $788.20 in Billed Charges for Rev 272 = $254.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,788.2000,118.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,241.98,,,,,,,203.4300,788.2000,other,30.7% of $788.20 in Billed Charges for Rev 272 = $241.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,788.2000,118.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,254.59,,,,,,,203.4300,788.2000,percent of total billed charges,32.3% of $788.20 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,788.2000,118.2300,WELLCARE,WELLCARE MEDICAID,788.20,,,,,,,203.4300,788.2000,percent of total billed charges,100% of $788.20 in Billed Charges for Rev 272 = $788.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCREW DRIVER 2.5MM DRVR-HCS-0915,272,RC,27200002,CDM,,,,,,both,,,3754.3000,563.1500,AETNA,AETNA,1603.09,,,,,,,968.9800,3754.3000,percent of total billed charges,"42.7% of $3,754.30 in Billed Charges for Rev 272 = $1,603.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER 2.5MM DRVR-HCS-0915,272,RC,27200002,CDM,,,,,,both,,,3754.3000,563.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2628.01,,,,,,,968.9800,3754.3000,percent of total billed charges,"Rev 272 $3,754.30 in Billed Charges at 70% = $2,628.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER 2.5MM DRVR-HCS-0915,272,RC,27200002,CDM,,,,,,both,,,3754.3000,563.1500,CIGNA HEALTHCARE,CIGNA HMO,1565.54,,,,,,,968.9800,3754.3000,percent of total billed charges,"41.7% of $3,754.30 in Billed Charges for Rev 272 = $1,565.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER 2.5MM DRVR-HCS-0915,272,RC,27200002,CDM,,,,,,both,,,3754.3000,563.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1742.00,,,,,,,968.9800,3754.3000,percent of total billed charges,"46.4% of $3,754.30 in Billed Charges for Rev 272 = $1,742.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER 2.5MM DRVR-HCS-0915,272,RC,27200002,CDM,,,,,,both,,,3754.3000,563.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1565.54,,,,,,,968.9800,3754.3000,percent of total billed charges,"41.7% of $3,754.30 in Billed Charges for Rev 272 = $1,565.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER 2.5MM DRVR-HCS-0915,272,RC,27200002,CDM,,,,,,both,,,3754.3000,563.1500,CIGNA HEALTHCARE,CIGNA PPO,1565.54,,,,,,,968.9800,3754.3000,percent of total billed charges,"41.7% of $3,754.30 in Billed Charges for Rev 272 = $1,565.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER 2.5MM DRVR-HCS-0915,272,RC,27200002,CDM,,,,,,both,,,3754.3000,563.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3378.87,,,,,,,968.9800,3754.3000,percent of total billed charges,"90% of $3,754.30 in Billed Charges for Rev 272 = $3,378.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER 2.5MM DRVR-HCS-0915,272,RC,27200002,CDM,,,,,,both,,,3754.3000,563.1500,MEDCOST,MEDCOST VHN,1786.67,,,,,,,968.9800,3754.3000,percent of total billed charges,"47.59% of $3,754.30 in Billed Charges for Rev 272 = $1,786.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER 2.5MM DRVR-HCS-0915,272,RC,27200002,CDM,,,,,,both,,,3754.3000,563.1500,SENTARA HEALTH,SENTARA HEALTH,968.98,,,,,,,968.9800,3754.3000,percent of total billed charges,"25.81% of $3,754.30 in Billed Charges for Rev 272 = $968.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER 2.5MM DRVR-HCS-0915,272,RC,27200002,CDM,,,,,,both,,,3754.3000,563.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3754.30,,,,,,,968.9800,3754.3000,percent of total billed charges,"100% of $3,754.30 in Billed Charges for Rev 272 = $3,754.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER 2.5MM DRVR-HCS-0915,272,RC,27200002,CDM,,,,,,both,,,3754.3000,563.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1877.15,,,,,,,968.9800,3754.3000,percent of total billed charges,"Rev 272 $3,754.30 in Billed Charges at 50% = $1,877.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER 2.5MM DRVR-HCS-0915,272,RC,27200002,CDM,,,,,,both,,,3754.3000,563.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1212.64,,,,,,,968.9800,3754.3000,other,"32.3% of $3,754.30 in Billed Charges for Rev 272 = $1,212.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCREW DRIVER 2.5MM DRVR-HCS-0915,272,RC,27200002,CDM,,,,,,both,,,3754.3000,563.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1152.57,,,,,,,968.9800,3754.3000,other,"30.7% of $3,754.30 in Billed Charges for Rev 272 = $1,152.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCREW DRIVER 2.5MM DRVR-HCS-0915,272,RC,27200002,CDM,,,,,,both,,,3754.3000,563.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,1212.64,,,,,,,968.9800,3754.3000,percent of total billed charges,"32.3% of $3,754.30 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER 2.5MM DRVR-HCS-0915,272,RC,27200002,CDM,,,,,,both,,,3754.3000,563.1500,WELLCARE,WELLCARE MEDICAID,3754.30,,,,,,,968.9800,3754.3000,percent of total billed charges,"100% of $3,754.30 in Billed Charges for Rev 272 = $3,754.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY 230CC,272,RC,,,,,,,,both,,,3318.7200,497.8100,AETNA,AETNA,1417.09,,,,,,,856.5600,3318.7200,percent of total billed charges,"42.7% of $3,318.72 in Billed Charges for Rev 272 = $1,417.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY 230CC,272,RC,,,,,,,,both,,,3318.7200,497.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2323.10,,,,,,,856.5600,3318.7200,percent of total billed charges,"Rev 272 $3,318.72 in Billed Charges at 70% = $2,323.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY 230CC,272,RC,,,,,,,,both,,,3318.7200,497.8100,CIGNA HEALTHCARE,CIGNA HMO,1383.91,,,,,,,856.5600,3318.7200,percent of total billed charges,"41.7% of $3,318.72 in Billed Charges for Rev 272 = $1,383.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY 230CC,272,RC,,,,,,,,both,,,3318.7200,497.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1539.89,,,,,,,856.5600,3318.7200,percent of total billed charges,"46.4% of $3,318.72 in Billed Charges for Rev 272 = $1,539.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY 230CC,272,RC,,,,,,,,both,,,3318.7200,497.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1383.91,,,,,,,856.5600,3318.7200,percent of total billed charges,"41.7% of $3,318.72 in Billed Charges for Rev 272 = $1,383.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY 230CC,272,RC,,,,,,,,both,,,3318.7200,497.8100,CIGNA HEALTHCARE,CIGNA PPO,1383.91,,,,,,,856.5600,3318.7200,percent of total billed charges,"41.7% of $3,318.72 in Billed Charges for Rev 272 = $1,383.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY 230CC,272,RC,,,,,,,,both,,,3318.7200,497.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2986.85,,,,,,,856.5600,3318.7200,percent of total billed charges,"90% of $3,318.72 in Billed Charges for Rev 272 = $2,986.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY 230CC,272,RC,,,,,,,,both,,,3318.7200,497.8100,MEDCOST,MEDCOST VHN,1579.38,,,,,,,856.5600,3318.7200,percent of total billed charges,"47.59% of $3,318.72 in Billed Charges for Rev 272 = $1,579.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY 230CC,272,RC,,,,,,,,both,,,3318.7200,497.8100,SENTARA HEALTH,SENTARA HEALTH,856.56,,,,,,,856.5600,3318.7200,percent of total billed charges,"25.81% of $3,318.72 in Billed Charges for Rev 272 = $856.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY 230CC,272,RC,,,,,,,,both,,,3318.7200,497.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3318.72,,,,,,,856.5600,3318.7200,percent of total billed charges,"100% of $3,318.72 in Billed Charges for Rev 272 = $3,318.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY 230CC,272,RC,,,,,,,,both,,,3318.7200,497.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1659.36,,,,,,,856.5600,3318.7200,percent of total billed charges,"Rev 272 $3,318.72 in Billed Charges at 50% = $1,659.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY 230CC,272,RC,,,,,,,,both,,,3318.7200,497.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1071.95,,,,,,,856.5600,3318.7200,other,"32.3% of $3,318.72 in Billed Charges for Rev 272 = $1,071.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SIZER MAMMARY 230CC,272,RC,,,,,,,,both,,,3318.7200,497.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1018.85,,,,,,,856.5600,3318.7200,other,"30.7% of $3,318.72 in Billed Charges for Rev 272 = $1,018.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SIZER MAMMARY 230CC,272,RC,,,,,,,,both,,,3318.7200,497.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,1071.95,,,,,,,856.5600,3318.7200,percent of total billed charges,"32.3% of $3,318.72 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY 230CC,272,RC,,,,,,,,both,,,3318.7200,497.8100,WELLCARE,WELLCARE MEDICAID,3318.72,,,,,,,856.5600,3318.7200,percent of total billed charges,"100% of $3,318.72 in Billed Charges for Rev 272 = $3,318.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR E5170 E5170,272,RC,,,,,,,,both,,,746.7100,112.0100,AETNA,AETNA,318.85,,,,,,,192.7300,746.7100,percent of total billed charges,42.7% of $746.71 in Billed Charges for Rev 272 = $318.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E5170 E5170,272,RC,,,,,,,,both,,,746.7100,112.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,522.70,,,,,,,192.7300,746.7100,percent of total billed charges,Rev 272 $746.71 in Billed Charges at 70% = $522.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E5170 E5170,272,RC,,,,,,,,both,,,746.7100,112.0100,CIGNA HEALTHCARE,CIGNA HMO,311.38,,,,,,,192.7300,746.7100,percent of total billed charges,41.7% of $746.71 in Billed Charges for Rev 272 = $311.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E5170 E5170,272,RC,,,,,,,,both,,,746.7100,112.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,346.47,,,,,,,192.7300,746.7100,percent of total billed charges,46.4% of $746.71 in Billed Charges for Rev 272 = $346.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E5170 E5170,272,RC,,,,,,,,both,,,746.7100,112.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,311.38,,,,,,,192.7300,746.7100,percent of total billed charges,41.7% of $746.71 in Billed Charges for Rev 272 = $311.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E5170 E5170,272,RC,,,,,,,,both,,,746.7100,112.0100,CIGNA HEALTHCARE,CIGNA PPO,311.38,,,,,,,192.7300,746.7100,percent of total billed charges,41.7% of $746.71 in Billed Charges for Rev 272 = $311.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E5170 E5170,272,RC,,,,,,,,both,,,746.7100,112.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,672.04,,,,,,,192.7300,746.7100,percent of total billed charges,90% of $746.71 in Billed Charges for Rev 272 = $672.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E5170 E5170,272,RC,,,,,,,,both,,,746.7100,112.0100,MEDCOST,MEDCOST VHN,355.36,,,,,,,192.7300,746.7100,percent of total billed charges,47.59% of $746.71 in Billed Charges for Rev 272 = $355.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E5170 E5170,272,RC,,,,,,,,both,,,746.7100,112.0100,SENTARA HEALTH,SENTARA HEALTH,192.73,,,,,,,192.7300,746.7100,percent of total billed charges,25.81% of $746.71 in Billed Charges for Rev 272 = $192.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E5170 E5170,272,RC,,,,,,,,both,,,746.7100,112.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",746.71,,,,,,,192.7300,746.7100,percent of total billed charges,100% of $746.71 in Billed Charges for Rev 272 = $746.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E5170 E5170,272,RC,,,,,,,,both,,,746.7100,112.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,373.36,,,,,,,192.7300,746.7100,percent of total billed charges,Rev 272 $746.71 in Billed Charges at 50% = $373.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E5170 E5170,272,RC,,,,,,,,both,,,746.7100,112.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,241.19,,,,,,,192.7300,746.7100,other,32.3% of $746.71 in Billed Charges for Rev 272 = $241.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BUR E5170 E5170,272,RC,,,,,,,,both,,,746.7100,112.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,229.24,,,,,,,192.7300,746.7100,other,30.7% of $746.71 in Billed Charges for Rev 272 = $229.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BUR E5170 E5170,272,RC,,,,,,,,both,,,746.7100,112.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,241.19,,,,,,,192.7300,746.7100,percent of total billed charges,32.3% of $746.71 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E5170 E5170,272,RC,,,,,,,,both,,,746.7100,112.0100,WELLCARE,WELLCARE MEDICAID,746.71,,,,,,,192.7300,746.7100,percent of total billed charges,100% of $746.71 in Billed Charges for Rev 272 = $746.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E6140 E6140,272,RC,,,,,,,,both,,,736.3400,110.4500,AETNA,AETNA,314.42,,,,,,,190.0500,736.3400,percent of total billed charges,42.7% of $736.34 in Billed Charges for Rev 272 = $314.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E6140 E6140,272,RC,,,,,,,,both,,,736.3400,110.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,515.44,,,,,,,190.0500,736.3400,percent of total billed charges,Rev 272 $736.34 in Billed Charges at 70% = $515.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E6140 E6140,272,RC,,,,,,,,both,,,736.3400,110.4500,CIGNA HEALTHCARE,CIGNA HMO,307.05,,,,,,,190.0500,736.3400,percent of total billed charges,41.7% of $736.34 in Billed Charges for Rev 272 = $307.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E6140 E6140,272,RC,,,,,,,,both,,,736.3400,110.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,341.66,,,,,,,190.0500,736.3400,percent of total billed charges,46.4% of $736.34 in Billed Charges for Rev 272 = $341.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E6140 E6140,272,RC,,,,,,,,both,,,736.3400,110.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,307.05,,,,,,,190.0500,736.3400,percent of total billed charges,41.7% of $736.34 in Billed Charges for Rev 272 = $307.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E6140 E6140,272,RC,,,,,,,,both,,,736.3400,110.4500,CIGNA HEALTHCARE,CIGNA PPO,307.05,,,,,,,190.0500,736.3400,percent of total billed charges,41.7% of $736.34 in Billed Charges for Rev 272 = $307.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E6140 E6140,272,RC,,,,,,,,both,,,736.3400,110.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,662.71,,,,,,,190.0500,736.3400,percent of total billed charges,90% of $736.34 in Billed Charges for Rev 272 = $662.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E6140 E6140,272,RC,,,,,,,,both,,,736.3400,110.4500,MEDCOST,MEDCOST VHN,350.42,,,,,,,190.0500,736.3400,percent of total billed charges,47.59% of $736.34 in Billed Charges for Rev 272 = $350.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E6140 E6140,272,RC,,,,,,,,both,,,736.3400,110.4500,SENTARA HEALTH,SENTARA HEALTH,190.05,,,,,,,190.0500,736.3400,percent of total billed charges,25.81% of $736.34 in Billed Charges for Rev 272 = $190.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E6140 E6140,272,RC,,,,,,,,both,,,736.3400,110.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",736.34,,,,,,,190.0500,736.3400,percent of total billed charges,100% of $736.34 in Billed Charges for Rev 272 = $736.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E6140 E6140,272,RC,,,,,,,,both,,,736.3400,110.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,368.17,,,,,,,190.0500,736.3400,percent of total billed charges,Rev 272 $736.34 in Billed Charges at 50% = $368.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E6140 E6140,272,RC,,,,,,,,both,,,736.3400,110.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,237.84,,,,,,,190.0500,736.3400,other,32.3% of $736.34 in Billed Charges for Rev 272 = $237.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BUR E6140 E6140,272,RC,,,,,,,,both,,,736.3400,110.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,226.06,,,,,,,190.0500,736.3400,other,30.7% of $736.34 in Billed Charges for Rev 272 = $226.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BUR E6140 E6140,272,RC,,,,,,,,both,,,736.3400,110.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,237.84,,,,,,,190.0500,736.3400,percent of total billed charges,32.3% of $736.34 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E6140 E6140,272,RC,,,,,,,,both,,,736.3400,110.4500,WELLCARE,WELLCARE MEDICAID,736.34,,,,,,,190.0500,736.3400,percent of total billed charges,100% of $736.34 in Billed Charges for Rev 272 = $736.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8020,272,RC,,,,,,,,both,,,570.6100,85.5900,AETNA,AETNA,243.65,,,,,,,147.2700,570.6100,percent of total billed charges,42.7% of $570.61 in Billed Charges for Rev 272 = $243.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8020,272,RC,,,,,,,,both,,,570.6100,85.5900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,399.43,,,,,,,147.2700,570.6100,percent of total billed charges,Rev 272 $570.61 in Billed Charges at 70% = $399.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8020,272,RC,,,,,,,,both,,,570.6100,85.5900,CIGNA HEALTHCARE,CIGNA HMO,237.94,,,,,,,147.2700,570.6100,percent of total billed charges,41.7% of $570.61 in Billed Charges for Rev 272 = $237.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8020,272,RC,,,,,,,,both,,,570.6100,85.5900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,264.76,,,,,,,147.2700,570.6100,percent of total billed charges,46.4% of $570.61 in Billed Charges for Rev 272 = $264.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8020,272,RC,,,,,,,,both,,,570.6100,85.5900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,237.94,,,,,,,147.2700,570.6100,percent of total billed charges,41.7% of $570.61 in Billed Charges for Rev 272 = $237.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8020,272,RC,,,,,,,,both,,,570.6100,85.5900,CIGNA HEALTHCARE,CIGNA PPO,237.94,,,,,,,147.2700,570.6100,percent of total billed charges,41.7% of $570.61 in Billed Charges for Rev 272 = $237.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8020,272,RC,,,,,,,,both,,,570.6100,85.5900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,513.55,,,,,,,147.2700,570.6100,percent of total billed charges,90% of $570.61 in Billed Charges for Rev 272 = $513.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8020,272,RC,,,,,,,,both,,,570.6100,85.5900,MEDCOST,MEDCOST VHN,271.55,,,,,,,147.2700,570.6100,percent of total billed charges,47.59% of $570.61 in Billed Charges for Rev 272 = $271.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8020,272,RC,,,,,,,,both,,,570.6100,85.5900,SENTARA HEALTH,SENTARA HEALTH,147.27,,,,,,,147.2700,570.6100,percent of total billed charges,25.81% of $570.61 in Billed Charges for Rev 272 = $147.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8020,272,RC,,,,,,,,both,,,570.6100,85.5900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",570.61,,,,,,,147.2700,570.6100,percent of total billed charges,100% of $570.61 in Billed Charges for Rev 272 = $570.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8020,272,RC,,,,,,,,both,,,570.6100,85.5900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,285.31,,,,,,,147.2700,570.6100,percent of total billed charges,Rev 272 $570.61 in Billed Charges at 50% = $285.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8020,272,RC,,,,,,,,both,,,570.6100,85.5900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,184.31,,,,,,,147.2700,570.6100,other,32.3% of $570.61 in Billed Charges for Rev 272 = $184.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BUR E8020,272,RC,,,,,,,,both,,,570.6100,85.5900,UNITED HEALTHCARE,UHC HERITAGE SELECT,175.18,,,,,,,147.2700,570.6100,other,30.7% of $570.61 in Billed Charges for Rev 272 = $175.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BUR E8020,272,RC,,,,,,,,both,,,570.6100,85.5900,UNITED HEALTHCARE,UNITED HEALTHCARE,184.31,,,,,,,147.2700,570.6100,percent of total billed charges,32.3% of $570.61 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR E8020,272,RC,,,,,,,,both,,,570.6100,85.5900,WELLCARE,WELLCARE MEDICAID,570.61,,,,,,,147.2700,570.6100,percent of total billed charges,100% of $570.61 in Billed Charges for Rev 272 = $570.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER MAMMARY MEMORYGEL ENHANCE SINGLE USE 1030CC,272,RC,27200002,CDM,,,,,,both,,,5081.7900,762.2700,AETNA,AETNA,2169.92,,,,,,,1311.6100,5081.7900,percent of total billed charges,"42.7% of $5,081.79 in Billed Charges for Rev 272 = $2,169.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY MEMORYGEL ENHANCE SINGLE USE 1030CC,272,RC,27200002,CDM,,,,,,both,,,5081.7900,762.2700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3557.25,,,,,,,1311.6100,5081.7900,percent of total billed charges,"Rev 272 $5,081.79 in Billed Charges at 70% = $3,557.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY MEMORYGEL ENHANCE SINGLE USE 1030CC,272,RC,27200002,CDM,,,,,,both,,,5081.7900,762.2700,CIGNA HEALTHCARE,CIGNA HMO,2119.11,,,,,,,1311.6100,5081.7900,percent of total billed charges,"41.7% of $5,081.79 in Billed Charges for Rev 272 = $2,119.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY MEMORYGEL ENHANCE SINGLE USE 1030CC,272,RC,27200002,CDM,,,,,,both,,,5081.7900,762.2700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2357.95,,,,,,,1311.6100,5081.7900,percent of total billed charges,"46.4% of $5,081.79 in Billed Charges for Rev 272 = $2,357.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY MEMORYGEL ENHANCE SINGLE USE 1030CC,272,RC,27200002,CDM,,,,,,both,,,5081.7900,762.2700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2119.11,,,,,,,1311.6100,5081.7900,percent of total billed charges,"41.7% of $5,081.79 in Billed Charges for Rev 272 = $2,119.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY MEMORYGEL ENHANCE SINGLE USE 1030CC,272,RC,27200002,CDM,,,,,,both,,,5081.7900,762.2700,CIGNA HEALTHCARE,CIGNA PPO,2119.11,,,,,,,1311.6100,5081.7900,percent of total billed charges,"41.7% of $5,081.79 in Billed Charges for Rev 272 = $2,119.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY MEMORYGEL ENHANCE SINGLE USE 1030CC,272,RC,27200002,CDM,,,,,,both,,,5081.7900,762.2700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4573.61,,,,,,,1311.6100,5081.7900,percent of total billed charges,"90% of $5,081.79 in Billed Charges for Rev 272 = $4,573.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY MEMORYGEL ENHANCE SINGLE USE 1030CC,272,RC,27200002,CDM,,,,,,both,,,5081.7900,762.2700,MEDCOST,MEDCOST VHN,2418.42,,,,,,,1311.6100,5081.7900,percent of total billed charges,"47.59% of $5,081.79 in Billed Charges for Rev 272 = $2,418.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY MEMORYGEL ENHANCE SINGLE USE 1030CC,272,RC,27200002,CDM,,,,,,both,,,5081.7900,762.2700,SENTARA HEALTH,SENTARA HEALTH,1311.61,,,,,,,1311.6100,5081.7900,percent of total billed charges,"25.81% of $5,081.79 in Billed Charges for Rev 272 = $1,311.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY MEMORYGEL ENHANCE SINGLE USE 1030CC,272,RC,27200002,CDM,,,,,,both,,,5081.7900,762.2700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5081.79,,,,,,,1311.6100,5081.7900,percent of total billed charges,"100% of $5,081.79 in Billed Charges for Rev 272 = $5,081.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY MEMORYGEL ENHANCE SINGLE USE 1030CC,272,RC,27200002,CDM,,,,,,both,,,5081.7900,762.2700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2540.90,,,,,,,1311.6100,5081.7900,percent of total billed charges,"Rev 272 $5,081.79 in Billed Charges at 50% = $2,540.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY MEMORYGEL ENHANCE SINGLE USE 1030CC,272,RC,27200002,CDM,,,,,,both,,,5081.7900,762.2700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1641.42,,,,,,,1311.6100,5081.7900,other,"32.3% of $5,081.79 in Billed Charges for Rev 272 = $1,641.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SIZER MAMMARY MEMORYGEL ENHANCE SINGLE USE 1030CC,272,RC,27200002,CDM,,,,,,both,,,5081.7900,762.2700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1560.11,,,,,,,1311.6100,5081.7900,other,"30.7% of $5,081.79 in Billed Charges for Rev 272 = $1,560.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SIZER MAMMARY MEMORYGEL ENHANCE SINGLE USE 1030CC,272,RC,27200002,CDM,,,,,,both,,,5081.7900,762.2700,UNITED HEALTHCARE,UNITED HEALTHCARE,1641.42,,,,,,,1311.6100,5081.7900,percent of total billed charges,"32.3% of $5,081.79 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY MEMORYGEL ENHANCE SINGLE USE 1030CC,272,RC,27200002,CDM,,,,,,both,,,5081.7900,762.2700,WELLCARE,WELLCARE MEDICAID,5081.79,,,,,,,1311.6100,5081.7900,percent of total billed charges,"100% of $5,081.79 in Billed Charges for Rev 272 = $5,081.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 3.0MM WHITE,272,RC,,,,,,,,both,,,1273.3500,191.0000,AETNA,AETNA,543.72,,,,,,,328.6500,1273.3500,percent of total billed charges,"42.7% of $1,273.35 in Billed Charges for Rev 272 = $543.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 3.0MM WHITE,272,RC,,,,,,,,both,,,1273.3500,191.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,891.35,,,,,,,328.6500,1273.3500,percent of total billed charges,"Rev 272 $1,273.35 in Billed Charges at 70% = $891.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 3.0MM WHITE,272,RC,,,,,,,,both,,,1273.3500,191.0000,CIGNA HEALTHCARE,CIGNA HMO,530.99,,,,,,,328.6500,1273.3500,percent of total billed charges,"41.7% of $1,273.35 in Billed Charges for Rev 272 = $530.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 3.0MM WHITE,272,RC,,,,,,,,both,,,1273.3500,191.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,590.83,,,,,,,328.6500,1273.3500,percent of total billed charges,"46.4% of $1,273.35 in Billed Charges for Rev 272 = $590.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 3.0MM WHITE,272,RC,,,,,,,,both,,,1273.3500,191.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,530.99,,,,,,,328.6500,1273.3500,percent of total billed charges,"41.7% of $1,273.35 in Billed Charges for Rev 272 = $530.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 3.0MM WHITE,272,RC,,,,,,,,both,,,1273.3500,191.0000,CIGNA HEALTHCARE,CIGNA PPO,530.99,,,,,,,328.6500,1273.3500,percent of total billed charges,"41.7% of $1,273.35 in Billed Charges for Rev 272 = $530.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 3.0MM WHITE,272,RC,,,,,,,,both,,,1273.3500,191.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1146.02,,,,,,,328.6500,1273.3500,percent of total billed charges,"90% of $1,273.35 in Billed Charges for Rev 272 = $1,146.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 3.0MM WHITE,272,RC,,,,,,,,both,,,1273.3500,191.0000,MEDCOST,MEDCOST VHN,605.99,,,,,,,328.6500,1273.3500,percent of total billed charges,"47.59% of $1,273.35 in Billed Charges for Rev 272 = $605.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 3.0MM WHITE,272,RC,,,,,,,,both,,,1273.3500,191.0000,SENTARA HEALTH,SENTARA HEALTH,328.65,,,,,,,328.6500,1273.3500,percent of total billed charges,"25.81% of $1,273.35 in Billed Charges for Rev 272 = $328.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 3.0MM WHITE,272,RC,,,,,,,,both,,,1273.3500,191.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1273.35,,,,,,,328.6500,1273.3500,percent of total billed charges,"100% of $1,273.35 in Billed Charges for Rev 272 = $1,273.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 3.0MM WHITE,272,RC,,,,,,,,both,,,1273.3500,191.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,636.68,,,,,,,328.6500,1273.3500,percent of total billed charges,"Rev 272 $1,273.35 in Billed Charges at 50% = $636.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 3.0MM WHITE,272,RC,,,,,,,,both,,,1273.3500,191.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,411.29,,,,,,,328.6500,1273.3500,other,"32.3% of $1,273.35 in Billed Charges for Rev 272 = $411.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ROUTER SPIRAL 3.0MM WHITE,272,RC,,,,,,,,both,,,1273.3500,191.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,390.92,,,,,,,328.6500,1273.3500,other,"30.7% of $1,273.35 in Billed Charges for Rev 272 = $390.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ROUTER SPIRAL 3.0MM WHITE,272,RC,,,,,,,,both,,,1273.3500,191.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,411.29,,,,,,,328.6500,1273.3500,percent of total billed charges,"32.3% of $1,273.35 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 3.0MM WHITE,272,RC,,,,,,,,both,,,1273.3500,191.0000,WELLCARE,WELLCARE MEDICAID,1273.35,,,,,,,328.6500,1273.3500,percent of total billed charges,"100% of $1,273.35 in Billed Charges for Rev 272 = $1,273.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SAW TREPHINE 14.5MM,272,RC,27200002,CDM,,,,,,both,,,10396.9300,1559.5400,AETNA,AETNA,4439.49,,,,,,,2683.4500,10396.9300,percent of total billed charges,"42.7% of $10,396.93 in Billed Charges for Rev 272 = $4,439.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SAW TREPHINE 14.5MM,272,RC,27200002,CDM,,,,,,both,,,10396.9300,1559.5400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7277.85,,,,,,,2683.4500,10396.9300,percent of total billed charges,"Rev 272 $10,396.93 in Billed Charges at 70% = $7,277.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SAW TREPHINE 14.5MM,272,RC,27200002,CDM,,,,,,both,,,10396.9300,1559.5400,CIGNA HEALTHCARE,CIGNA HMO,4335.52,,,,,,,2683.4500,10396.9300,percent of total billed charges,"41.7% of $10,396.93 in Billed Charges for Rev 272 = $4,335.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SAW TREPHINE 14.5MM,272,RC,27200002,CDM,,,,,,both,,,10396.9300,1559.5400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4824.18,,,,,,,2683.4500,10396.9300,percent of total billed charges,"46.4% of $10,396.93 in Billed Charges for Rev 272 = $4,824.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SAW TREPHINE 14.5MM,272,RC,27200002,CDM,,,,,,both,,,10396.9300,1559.5400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4335.52,,,,,,,2683.4500,10396.9300,percent of total billed charges,"41.7% of $10,396.93 in Billed Charges for Rev 272 = $4,335.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SAW TREPHINE 14.5MM,272,RC,27200002,CDM,,,,,,both,,,10396.9300,1559.5400,CIGNA HEALTHCARE,CIGNA PPO,4335.52,,,,,,,2683.4500,10396.9300,percent of total billed charges,"41.7% of $10,396.93 in Billed Charges for Rev 272 = $4,335.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SAW TREPHINE 14.5MM,272,RC,27200002,CDM,,,,,,both,,,10396.9300,1559.5400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9357.24,,,,,,,2683.4500,10396.9300,percent of total billed charges,"90% of $10,396.93 in Billed Charges for Rev 272 = $9,357.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SAW TREPHINE 14.5MM,272,RC,27200002,CDM,,,,,,both,,,10396.9300,1559.5400,MEDCOST,MEDCOST VHN,4947.90,,,,,,,2683.4500,10396.9300,percent of total billed charges,"47.59% of $10,396.93 in Billed Charges for Rev 272 = $4,947.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SAW TREPHINE 14.5MM,272,RC,27200002,CDM,,,,,,both,,,10396.9300,1559.5400,SENTARA HEALTH,SENTARA HEALTH,2683.45,,,,,,,2683.4500,10396.9300,percent of total billed charges,"25.81% of $10,396.93 in Billed Charges for Rev 272 = $2,683.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SAW TREPHINE 14.5MM,272,RC,27200002,CDM,,,,,,both,,,10396.9300,1559.5400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10396.93,,,,,,,2683.4500,10396.9300,percent of total billed charges,"100% of $10,396.93 in Billed Charges for Rev 272 = $10,396.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SAW TREPHINE 14.5MM,272,RC,27200002,CDM,,,,,,both,,,10396.9300,1559.5400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5198.47,,,,,,,2683.4500,10396.9300,percent of total billed charges,"Rev 272 $10,396.93 in Billed Charges at 50% = $5,198.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SAW TREPHINE 14.5MM,272,RC,27200002,CDM,,,,,,both,,,10396.9300,1559.5400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3358.21,,,,,,,2683.4500,10396.9300,other,"32.3% of $10,396.93 in Billed Charges for Rev 272 = $3,358.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SAW TREPHINE 14.5MM,272,RC,27200002,CDM,,,,,,both,,,10396.9300,1559.5400,UNITED HEALTHCARE,UHC HERITAGE SELECT,3191.86,,,,,,,2683.4500,10396.9300,other,"30.7% of $10,396.93 in Billed Charges for Rev 272 = $3,191.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SAW TREPHINE 14.5MM,272,RC,27200002,CDM,,,,,,both,,,10396.9300,1559.5400,UNITED HEALTHCARE,UNITED HEALTHCARE,3358.21,,,,,,,2683.4500,10396.9300,percent of total billed charges,"32.3% of $10,396.93 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SAW TREPHINE 14.5MM,272,RC,27200002,CDM,,,,,,both,,,10396.9300,1559.5400,WELLCARE,WELLCARE MEDICAID,10396.93,,,,,,,2683.4500,10396.9300,percent of total billed charges,"100% of $10,396.93 in Billed Charges for Rev 272 = $10,396.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS ENDOSCOPIC ENSIZOR,272,RC,,,,,,,,both,,,18388.7200,2758.3100,AETNA,AETNA,7851.98,,,,,,,4746.1300,18388.7200,percent of total billed charges,"42.7% of $18,388.72 in Billed Charges for Rev 272 = $7,851.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS ENDOSCOPIC ENSIZOR,272,RC,,,,,,,,both,,,18388.7200,2758.3100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,12872.10,,,,,,,4746.1300,18388.7200,percent of total billed charges,"Rev 272 $18,388.72 in Billed Charges at 70% = $12,872.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS ENDOSCOPIC ENSIZOR,272,RC,,,,,,,,both,,,18388.7200,2758.3100,CIGNA HEALTHCARE,CIGNA HMO,7668.10,,,,,,,4746.1300,18388.7200,percent of total billed charges,"41.7% of $18,388.72 in Billed Charges for Rev 272 = $7,668.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS ENDOSCOPIC ENSIZOR,272,RC,,,,,,,,both,,,18388.7200,2758.3100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8532.37,,,,,,,4746.1300,18388.7200,percent of total billed charges,"46.4% of $18,388.72 in Billed Charges for Rev 272 = $8,532.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS ENDOSCOPIC ENSIZOR,272,RC,,,,,,,,both,,,18388.7200,2758.3100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7668.10,,,,,,,4746.1300,18388.7200,percent of total billed charges,"41.7% of $18,388.72 in Billed Charges for Rev 272 = $7,668.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS ENDOSCOPIC ENSIZOR,272,RC,,,,,,,,both,,,18388.7200,2758.3100,CIGNA HEALTHCARE,CIGNA PPO,7668.10,,,,,,,4746.1300,18388.7200,percent of total billed charges,"41.7% of $18,388.72 in Billed Charges for Rev 272 = $7,668.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS ENDOSCOPIC ENSIZOR,272,RC,,,,,,,,both,,,18388.7200,2758.3100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,16549.85,,,,,,,4746.1300,18388.7200,percent of total billed charges,"90% of $18,388.72 in Billed Charges for Rev 272 = $16,549.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS ENDOSCOPIC ENSIZOR,272,RC,,,,,,,,both,,,18388.7200,2758.3100,MEDCOST,MEDCOST VHN,8751.19,,,,,,,4746.1300,18388.7200,percent of total billed charges,"47.59% of $18,388.72 in Billed Charges for Rev 272 = $8,751.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS ENDOSCOPIC ENSIZOR,272,RC,,,,,,,,both,,,18388.7200,2758.3100,SENTARA HEALTH,SENTARA HEALTH,4746.13,,,,,,,4746.1300,18388.7200,percent of total billed charges,"25.81% of $18,388.72 in Billed Charges for Rev 272 = $4,746.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS ENDOSCOPIC ENSIZOR,272,RC,,,,,,,,both,,,18388.7200,2758.3100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",18388.72,,,,,,,4746.1300,18388.7200,percent of total billed charges,"100% of $18,388.72 in Billed Charges for Rev 272 = $18,388.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS ENDOSCOPIC ENSIZOR,272,RC,,,,,,,,both,,,18388.7200,2758.3100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9194.36,,,,,,,4746.1300,18388.7200,percent of total billed charges,"Rev 272 $18,388.72 in Billed Charges at 50% = $9,194.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS ENDOSCOPIC ENSIZOR,272,RC,,,,,,,,both,,,18388.7200,2758.3100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5939.56,,,,,,,4746.1300,18388.7200,other,"32.3% of $18,388.72 in Billed Charges for Rev 272 = $5,939.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCISSORS ENDOSCOPIC ENSIZOR,272,RC,,,,,,,,both,,,18388.7200,2758.3100,UNITED HEALTHCARE,UHC HERITAGE SELECT,5645.34,,,,,,,4746.1300,18388.7200,other,"30.7% of $18,388.72 in Billed Charges for Rev 272 = $5,645.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCISSORS ENDOSCOPIC ENSIZOR,272,RC,,,,,,,,both,,,18388.7200,2758.3100,UNITED HEALTHCARE,UNITED HEALTHCARE,5939.56,,,,,,,4746.1300,18388.7200,percent of total billed charges,"32.3% of $18,388.72 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCISSORS ENDOSCOPIC ENSIZOR,272,RC,,,,,,,,both,,,18388.7200,2758.3100,WELLCARE,WELLCARE MEDICAID,18388.72,,,,,,,4746.1300,18388.7200,percent of total billed charges,"100% of $18,388.72 in Billed Charges for Rev 272 = $18,388.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE BRONCHOSCOPE BFLEX 2 SLIM 3.8 SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,2753.5000,413.0300,AETNA,AETNA,1175.74,,,,,,,710.6800,2753.5000,percent of total billed charges,"42.7% of $2,753.50 in Billed Charges for Rev 272 = $1,175.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE BRONCHOSCOPE BFLEX 2 SLIM 3.8 SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,2753.5000,413.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1927.45,,,,,,,710.6800,2753.5000,percent of total billed charges,"Rev 272 $2,753.50 in Billed Charges at 70% = $1,927.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE BRONCHOSCOPE BFLEX 2 SLIM 3.8 SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,2753.5000,413.0300,CIGNA HEALTHCARE,CIGNA HMO,1148.21,,,,,,,710.6800,2753.5000,percent of total billed charges,"41.7% of $2,753.50 in Billed Charges for Rev 272 = $1,148.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE BRONCHOSCOPE BFLEX 2 SLIM 3.8 SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,2753.5000,413.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1277.62,,,,,,,710.6800,2753.5000,percent of total billed charges,"46.4% of $2,753.50 in Billed Charges for Rev 272 = $1,277.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE BRONCHOSCOPE BFLEX 2 SLIM 3.8 SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,2753.5000,413.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1148.21,,,,,,,710.6800,2753.5000,percent of total billed charges,"41.7% of $2,753.50 in Billed Charges for Rev 272 = $1,148.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE BRONCHOSCOPE BFLEX 2 SLIM 3.8 SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,2753.5000,413.0300,CIGNA HEALTHCARE,CIGNA PPO,1148.21,,,,,,,710.6800,2753.5000,percent of total billed charges,"41.7% of $2,753.50 in Billed Charges for Rev 272 = $1,148.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE BRONCHOSCOPE BFLEX 2 SLIM 3.8 SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,2753.5000,413.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2478.15,,,,,,,710.6800,2753.5000,percent of total billed charges,"90% of $2,753.50 in Billed Charges for Rev 272 = $2,478.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE BRONCHOSCOPE BFLEX 2 SLIM 3.8 SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,2753.5000,413.0300,MEDCOST,MEDCOST VHN,1310.39,,,,,,,710.6800,2753.5000,percent of total billed charges,"47.59% of $2,753.50 in Billed Charges for Rev 272 = $1,310.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE BRONCHOSCOPE BFLEX 2 SLIM 3.8 SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,2753.5000,413.0300,SENTARA HEALTH,SENTARA HEALTH,710.68,,,,,,,710.6800,2753.5000,percent of total billed charges,"25.81% of $2,753.50 in Billed Charges for Rev 272 = $710.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE BRONCHOSCOPE BFLEX 2 SLIM 3.8 SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,2753.5000,413.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2753.50,,,,,,,710.6800,2753.5000,percent of total billed charges,"100% of $2,753.50 in Billed Charges for Rev 272 = $2,753.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE BRONCHOSCOPE BFLEX 2 SLIM 3.8 SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,2753.5000,413.0300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1376.75,,,,,,,710.6800,2753.5000,percent of total billed charges,"Rev 272 $2,753.50 in Billed Charges at 50% = $1,376.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE BRONCHOSCOPE BFLEX 2 SLIM 3.8 SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,2753.5000,413.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,889.38,,,,,,,710.6800,2753.5000,other,"32.3% of $2,753.50 in Billed Charges for Rev 272 = $889.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCOPE BRONCHOSCOPE BFLEX 2 SLIM 3.8 SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,2753.5000,413.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,845.32,,,,,,,710.6800,2753.5000,other,"30.7% of $2,753.50 in Billed Charges for Rev 272 = $845.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCOPE BRONCHOSCOPE BFLEX 2 SLIM 3.8 SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,2753.5000,413.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,889.38,,,,,,,710.6800,2753.5000,percent of total billed charges,"32.3% of $2,753.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE BRONCHOSCOPE BFLEX 2 SLIM 3.8 SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,2753.5000,413.0300,WELLCARE,WELLCARE MEDICAID,2753.50,,,,,,,710.6800,2753.5000,percent of total billed charges,"100% of $2,753.50 in Billed Charges for Rev 272 = $2,753.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE NANO NEEDLE 125 DEG,272,RC,27200002,CDM,,,,,,both,,,9074.6300,1361.1900,AETNA,AETNA,3874.87,,,,,,,2342.1600,9074.6300,percent of total billed charges,"42.7% of $9,074.63 in Billed Charges for Rev 272 = $3,874.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE NANO NEEDLE 125 DEG,272,RC,27200002,CDM,,,,,,both,,,9074.6300,1361.1900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6352.24,,,,,,,2342.1600,9074.6300,percent of total billed charges,"Rev 272 $9,074.63 in Billed Charges at 70% = $6,352.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE NANO NEEDLE 125 DEG,272,RC,27200002,CDM,,,,,,both,,,9074.6300,1361.1900,CIGNA HEALTHCARE,CIGNA HMO,3784.12,,,,,,,2342.1600,9074.6300,percent of total billed charges,"41.7% of $9,074.63 in Billed Charges for Rev 272 = $3,784.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE NANO NEEDLE 125 DEG,272,RC,27200002,CDM,,,,,,both,,,9074.6300,1361.1900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4210.63,,,,,,,2342.1600,9074.6300,percent of total billed charges,"46.4% of $9,074.63 in Billed Charges for Rev 272 = $4,210.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE NANO NEEDLE 125 DEG,272,RC,27200002,CDM,,,,,,both,,,9074.6300,1361.1900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3784.12,,,,,,,2342.1600,9074.6300,percent of total billed charges,"41.7% of $9,074.63 in Billed Charges for Rev 272 = $3,784.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE NANO NEEDLE 125 DEG,272,RC,27200002,CDM,,,,,,both,,,9074.6300,1361.1900,CIGNA HEALTHCARE,CIGNA PPO,3784.12,,,,,,,2342.1600,9074.6300,percent of total billed charges,"41.7% of $9,074.63 in Billed Charges for Rev 272 = $3,784.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE NANO NEEDLE 125 DEG,272,RC,27200002,CDM,,,,,,both,,,9074.6300,1361.1900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8167.17,,,,,,,2342.1600,9074.6300,percent of total billed charges,"90% of $9,074.63 in Billed Charges for Rev 272 = $8,167.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE NANO NEEDLE 125 DEG,272,RC,27200002,CDM,,,,,,both,,,9074.6300,1361.1900,MEDCOST,MEDCOST VHN,4318.62,,,,,,,2342.1600,9074.6300,percent of total billed charges,"47.59% of $9,074.63 in Billed Charges for Rev 272 = $4,318.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE NANO NEEDLE 125 DEG,272,RC,27200002,CDM,,,,,,both,,,9074.6300,1361.1900,SENTARA HEALTH,SENTARA HEALTH,2342.16,,,,,,,2342.1600,9074.6300,percent of total billed charges,"25.81% of $9,074.63 in Billed Charges for Rev 272 = $2,342.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE NANO NEEDLE 125 DEG,272,RC,27200002,CDM,,,,,,both,,,9074.6300,1361.1900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9074.63,,,,,,,2342.1600,9074.6300,percent of total billed charges,"100% of $9,074.63 in Billed Charges for Rev 272 = $9,074.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE NANO NEEDLE 125 DEG,272,RC,27200002,CDM,,,,,,both,,,9074.6300,1361.1900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4537.32,,,,,,,2342.1600,9074.6300,percent of total billed charges,"Rev 272 $9,074.63 in Billed Charges at 50% = $4,537.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE NANO NEEDLE 125 DEG,272,RC,27200002,CDM,,,,,,both,,,9074.6300,1361.1900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2931.11,,,,,,,2342.1600,9074.6300,other,"32.3% of $9,074.63 in Billed Charges for Rev 272 = $2,931.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCOPE NANO NEEDLE 125 DEG,272,RC,27200002,CDM,,,,,,both,,,9074.6300,1361.1900,UNITED HEALTHCARE,UHC HERITAGE SELECT,2785.91,,,,,,,2342.1600,9074.6300,other,"30.7% of $9,074.63 in Billed Charges for Rev 272 = $2,785.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCOPE NANO NEEDLE 125 DEG,272,RC,27200002,CDM,,,,,,both,,,9074.6300,1361.1900,UNITED HEALTHCARE,UNITED HEALTHCARE,2931.11,,,,,,,2342.1600,9074.6300,percent of total billed charges,"32.3% of $9,074.63 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCOPE NANO NEEDLE 125 DEG,272,RC,27200002,CDM,,,,,,both,,,9074.6300,1361.1900,WELLCARE,WELLCARE MEDICAID,9074.63,,,,,,,2342.1600,9074.6300,percent of total billed charges,"100% of $9,074.63 in Billed Charges for Rev 272 = $9,074.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 170CC,272,RC,27200002,CDM,,,,,,both,,,2332.8100,349.9200,AETNA,AETNA,996.11,,,,,,,602.1000,2332.8100,percent of total billed charges,"42.7% of $2,332.81 in Billed Charges for Rev 272 = $996.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 170CC,272,RC,27200002,CDM,,,,,,both,,,2332.8100,349.9200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1632.97,,,,,,,602.1000,2332.8100,percent of total billed charges,"Rev 272 $2,332.81 in Billed Charges at 70% = $1,632.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 170CC,272,RC,27200002,CDM,,,,,,both,,,2332.8100,349.9200,CIGNA HEALTHCARE,CIGNA HMO,972.78,,,,,,,602.1000,2332.8100,percent of total billed charges,"41.7% of $2,332.81 in Billed Charges for Rev 272 = $972.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 170CC,272,RC,27200002,CDM,,,,,,both,,,2332.8100,349.9200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1082.42,,,,,,,602.1000,2332.8100,percent of total billed charges,"46.4% of $2,332.81 in Billed Charges for Rev 272 = $1,082.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 170CC,272,RC,27200002,CDM,,,,,,both,,,2332.8100,349.9200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,972.78,,,,,,,602.1000,2332.8100,percent of total billed charges,"41.7% of $2,332.81 in Billed Charges for Rev 272 = $972.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 170CC,272,RC,27200002,CDM,,,,,,both,,,2332.8100,349.9200,CIGNA HEALTHCARE,CIGNA PPO,972.78,,,,,,,602.1000,2332.8100,percent of total billed charges,"41.7% of $2,332.81 in Billed Charges for Rev 272 = $972.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 170CC,272,RC,27200002,CDM,,,,,,both,,,2332.8100,349.9200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2099.53,,,,,,,602.1000,2332.8100,percent of total billed charges,"90% of $2,332.81 in Billed Charges for Rev 272 = $2,099.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 170CC,272,RC,27200002,CDM,,,,,,both,,,2332.8100,349.9200,MEDCOST,MEDCOST VHN,1110.18,,,,,,,602.1000,2332.8100,percent of total billed charges,"47.59% of $2,332.81 in Billed Charges for Rev 272 = $1,110.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 170CC,272,RC,27200002,CDM,,,,,,both,,,2332.8100,349.9200,SENTARA HEALTH,SENTARA HEALTH,602.10,,,,,,,602.1000,2332.8100,percent of total billed charges,"25.81% of $2,332.81 in Billed Charges for Rev 272 = $602.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 170CC,272,RC,27200002,CDM,,,,,,both,,,2332.8100,349.9200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2332.81,,,,,,,602.1000,2332.8100,percent of total billed charges,"100% of $2,332.81 in Billed Charges for Rev 272 = $2,332.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 170CC,272,RC,27200002,CDM,,,,,,both,,,2332.8100,349.9200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1166.41,,,,,,,602.1000,2332.8100,percent of total billed charges,"Rev 272 $2,332.81 in Billed Charges at 50% = $1,166.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 170CC,272,RC,27200002,CDM,,,,,,both,,,2332.8100,349.9200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,753.50,,,,,,,602.1000,2332.8100,other,"32.3% of $2,332.81 in Billed Charges for Rev 272 = $753.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 170CC,272,RC,27200002,CDM,,,,,,both,,,2332.8100,349.9200,UNITED HEALTHCARE,UHC HERITAGE SELECT,716.17,,,,,,,602.1000,2332.8100,other,"30.7% of $2,332.81 in Billed Charges for Rev 272 = $716.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 170CC,272,RC,27200002,CDM,,,,,,both,,,2332.8100,349.9200,UNITED HEALTHCARE,UNITED HEALTHCARE,753.50,,,,,,,602.1000,2332.8100,percent of total billed charges,"32.3% of $2,332.81 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 170CC,272,RC,27200002,CDM,,,,,,both,,,2332.8100,349.9200,WELLCARE,WELLCARE MEDICAID,2332.81,,,,,,,602.1000,2332.8100,percent of total billed charges,"100% of $2,332.81 in Billed Charges for Rev 272 = $2,332.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1389.7100,208.4600,AETNA,AETNA,593.41,,,,,,,358.6800,1389.7100,percent of total billed charges,"42.7% of $1,389.71 in Billed Charges for Rev 272 = $593.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1389.7100,208.4600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,972.80,,,,,,,358.6800,1389.7100,percent of total billed charges,"Rev 272 $1,389.71 in Billed Charges at 70% = $972.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1389.7100,208.4600,CIGNA HEALTHCARE,CIGNA HMO,579.51,,,,,,,358.6800,1389.7100,percent of total billed charges,"41.7% of $1,389.71 in Billed Charges for Rev 272 = $579.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1389.7100,208.4600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,644.83,,,,,,,358.6800,1389.7100,percent of total billed charges,"46.4% of $1,389.71 in Billed Charges for Rev 272 = $644.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1389.7100,208.4600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,579.51,,,,,,,358.6800,1389.7100,percent of total billed charges,"41.7% of $1,389.71 in Billed Charges for Rev 272 = $579.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1389.7100,208.4600,CIGNA HEALTHCARE,CIGNA PPO,579.51,,,,,,,358.6800,1389.7100,percent of total billed charges,"41.7% of $1,389.71 in Billed Charges for Rev 272 = $579.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1389.7100,208.4600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1250.74,,,,,,,358.6800,1389.7100,percent of total billed charges,"90% of $1,389.71 in Billed Charges for Rev 272 = $1,250.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1389.7100,208.4600,MEDCOST,MEDCOST VHN,661.36,,,,,,,358.6800,1389.7100,percent of total billed charges,"47.59% of $1,389.71 in Billed Charges for Rev 272 = $661.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1389.7100,208.4600,SENTARA HEALTH,SENTARA HEALTH,358.68,,,,,,,358.6800,1389.7100,percent of total billed charges,"25.81% of $1,389.71 in Billed Charges for Rev 272 = $358.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1389.7100,208.4600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1389.71,,,,,,,358.6800,1389.7100,percent of total billed charges,"100% of $1,389.71 in Billed Charges for Rev 272 = $1,389.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1389.7100,208.4600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,694.86,,,,,,,358.6800,1389.7100,percent of total billed charges,"Rev 272 $1,389.71 in Billed Charges at 50% = $694.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1389.7100,208.4600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,448.88,,,,,,,358.6800,1389.7100,other,"32.3% of $1,389.71 in Billed Charges for Rev 272 = $448.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1389.7100,208.4600,UNITED HEALTHCARE,UHC HERITAGE SELECT,426.64,,,,,,,358.6800,1389.7100,other,"30.7% of $1,389.71 in Billed Charges for Rev 272 = $426.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1389.7100,208.4600,UNITED HEALTHCARE,UNITED HEALTHCARE,448.88,,,,,,,358.6800,1389.7100,percent of total billed charges,"32.3% of $1,389.71 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1389.7100,208.4600,WELLCARE,WELLCARE MEDICAID,1389.71,,,,,,,358.6800,1389.7100,percent of total billed charges,"100% of $1,389.71 in Billed Charges for Rev 272 = $1,389.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1462.3100,219.3500,AETNA,AETNA,624.41,,,,,,,377.4200,1462.3100,percent of total billed charges,"42.7% of $1,462.31 in Billed Charges for Rev 272 = $624.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1462.3100,219.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1023.62,,,,,,,377.4200,1462.3100,percent of total billed charges,"Rev 272 $1,462.31 in Billed Charges at 70% = $1,023.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1462.3100,219.3500,CIGNA HEALTHCARE,CIGNA HMO,609.78,,,,,,,377.4200,1462.3100,percent of total billed charges,"41.7% of $1,462.31 in Billed Charges for Rev 272 = $609.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1462.3100,219.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,678.51,,,,,,,377.4200,1462.3100,percent of total billed charges,"46.4% of $1,462.31 in Billed Charges for Rev 272 = $678.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1462.3100,219.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,609.78,,,,,,,377.4200,1462.3100,percent of total billed charges,"41.7% of $1,462.31 in Billed Charges for Rev 272 = $609.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1462.3100,219.3500,CIGNA HEALTHCARE,CIGNA PPO,609.78,,,,,,,377.4200,1462.3100,percent of total billed charges,"41.7% of $1,462.31 in Billed Charges for Rev 272 = $609.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1462.3100,219.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1316.08,,,,,,,377.4200,1462.3100,percent of total billed charges,"90% of $1,462.31 in Billed Charges for Rev 272 = $1,316.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1462.3100,219.3500,MEDCOST,MEDCOST VHN,695.91,,,,,,,377.4200,1462.3100,percent of total billed charges,"47.59% of $1,462.31 in Billed Charges for Rev 272 = $695.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1462.3100,219.3500,SENTARA HEALTH,SENTARA HEALTH,377.42,,,,,,,377.4200,1462.3100,percent of total billed charges,"25.81% of $1,462.31 in Billed Charges for Rev 272 = $377.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1462.3100,219.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1462.31,,,,,,,377.4200,1462.3100,percent of total billed charges,"100% of $1,462.31 in Billed Charges for Rev 272 = $1,462.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1462.3100,219.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,731.16,,,,,,,377.4200,1462.3100,percent of total billed charges,"Rev 272 $1,462.31 in Billed Charges at 50% = $731.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1462.3100,219.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,472.33,,,,,,,377.4200,1462.3100,other,"32.3% of $1,462.31 in Billed Charges for Rev 272 = $472.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1462.3100,219.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,448.93,,,,,,,377.4200,1462.3100,other,"30.7% of $1,462.31 in Billed Charges for Rev 272 = $448.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1462.3100,219.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,472.33,,,,,,,377.4200,1462.3100,percent of total billed charges,"32.3% of $1,462.31 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER,272,RC,27200002,CDM,,,,,,both,,,1462.3100,219.3500,WELLCARE,WELLCARE MEDICAID,1462.31,,,,,,,377.4200,1462.3100,percent of total billed charges,"100% of $1,462.31 in Billed Charges for Rev 272 = $1,462.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER BREAST INSPIRA 650CC,272,RC,27200002,CDM,,,,,,both,,,2696.4600,404.4700,AETNA,AETNA,1151.39,,,,,,,695.9600,2696.4600,percent of total billed charges,"42.7% of $2,696.46 in Billed Charges for Rev 272 = $1,151.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER BREAST INSPIRA 650CC,272,RC,27200002,CDM,,,,,,both,,,2696.4600,404.4700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1887.52,,,,,,,695.9600,2696.4600,percent of total billed charges,"Rev 272 $2,696.46 in Billed Charges at 70% = $1,887.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER BREAST INSPIRA 650CC,272,RC,27200002,CDM,,,,,,both,,,2696.4600,404.4700,CIGNA HEALTHCARE,CIGNA HMO,1124.42,,,,,,,695.9600,2696.4600,percent of total billed charges,"41.7% of $2,696.46 in Billed Charges for Rev 272 = $1,124.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER BREAST INSPIRA 650CC,272,RC,27200002,CDM,,,,,,both,,,2696.4600,404.4700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1251.16,,,,,,,695.9600,2696.4600,percent of total billed charges,"46.4% of $2,696.46 in Billed Charges for Rev 272 = $1,251.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER BREAST INSPIRA 650CC,272,RC,27200002,CDM,,,,,,both,,,2696.4600,404.4700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1124.42,,,,,,,695.9600,2696.4600,percent of total billed charges,"41.7% of $2,696.46 in Billed Charges for Rev 272 = $1,124.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER BREAST INSPIRA 650CC,272,RC,27200002,CDM,,,,,,both,,,2696.4600,404.4700,CIGNA HEALTHCARE,CIGNA PPO,1124.42,,,,,,,695.9600,2696.4600,percent of total billed charges,"41.7% of $2,696.46 in Billed Charges for Rev 272 = $1,124.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER BREAST INSPIRA 650CC,272,RC,27200002,CDM,,,,,,both,,,2696.4600,404.4700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2426.81,,,,,,,695.9600,2696.4600,percent of total billed charges,"90% of $2,696.46 in Billed Charges for Rev 272 = $2,426.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER BREAST INSPIRA 650CC,272,RC,27200002,CDM,,,,,,both,,,2696.4600,404.4700,MEDCOST,MEDCOST VHN,1283.25,,,,,,,695.9600,2696.4600,percent of total billed charges,"47.59% of $2,696.46 in Billed Charges for Rev 272 = $1,283.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER BREAST INSPIRA 650CC,272,RC,27200002,CDM,,,,,,both,,,2696.4600,404.4700,SENTARA HEALTH,SENTARA HEALTH,695.96,,,,,,,695.9600,2696.4600,percent of total billed charges,"25.81% of $2,696.46 in Billed Charges for Rev 272 = $695.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER BREAST INSPIRA 650CC,272,RC,27200002,CDM,,,,,,both,,,2696.4600,404.4700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2696.46,,,,,,,695.9600,2696.4600,percent of total billed charges,"100% of $2,696.46 in Billed Charges for Rev 272 = $2,696.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER BREAST INSPIRA 650CC,272,RC,27200002,CDM,,,,,,both,,,2696.4600,404.4700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1348.23,,,,,,,695.9600,2696.4600,percent of total billed charges,"Rev 272 $2,696.46 in Billed Charges at 50% = $1,348.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER BREAST INSPIRA 650CC,272,RC,27200002,CDM,,,,,,both,,,2696.4600,404.4700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,870.96,,,,,,,695.9600,2696.4600,other,"32.3% of $2,696.46 in Billed Charges for Rev 272 = $870.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SIZER BREAST INSPIRA 650CC,272,RC,27200002,CDM,,,,,,both,,,2696.4600,404.4700,UNITED HEALTHCARE,UHC HERITAGE SELECT,827.81,,,,,,,695.9600,2696.4600,other,"30.7% of $2,696.46 in Billed Charges for Rev 272 = $827.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SIZER BREAST INSPIRA 650CC,272,RC,27200002,CDM,,,,,,both,,,2696.4600,404.4700,UNITED HEALTHCARE,UNITED HEALTHCARE,870.96,,,,,,,695.9600,2696.4600,percent of total billed charges,"32.3% of $2,696.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER BREAST INSPIRA 650CC,272,RC,27200002,CDM,,,,,,both,,,2696.4600,404.4700,WELLCARE,WELLCARE MEDICAID,2696.46,,,,,,,695.9600,2696.4600,percent of total billed charges,"100% of $2,696.46 in Billed Charges for Rev 272 = $2,696.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 435CC,272,RC,27200002,CDM,,,,,,both,,,2592.7500,388.9100,AETNA,AETNA,1107.10,,,,,,,669.1900,2592.7500,percent of total billed charges,"42.7% of $2,592.75 in Billed Charges for Rev 272 = $1,107.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 435CC,272,RC,27200002,CDM,,,,,,both,,,2592.7500,388.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1814.93,,,,,,,669.1900,2592.7500,percent of total billed charges,"Rev 272 $2,592.75 in Billed Charges at 70% = $1,814.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 435CC,272,RC,27200002,CDM,,,,,,both,,,2592.7500,388.9100,CIGNA HEALTHCARE,CIGNA HMO,1081.18,,,,,,,669.1900,2592.7500,percent of total billed charges,"41.7% of $2,592.75 in Billed Charges for Rev 272 = $1,081.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 435CC,272,RC,27200002,CDM,,,,,,both,,,2592.7500,388.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1203.04,,,,,,,669.1900,2592.7500,percent of total billed charges,"46.4% of $2,592.75 in Billed Charges for Rev 272 = $1,203.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 435CC,272,RC,27200002,CDM,,,,,,both,,,2592.7500,388.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1081.18,,,,,,,669.1900,2592.7500,percent of total billed charges,"41.7% of $2,592.75 in Billed Charges for Rev 272 = $1,081.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 435CC,272,RC,27200002,CDM,,,,,,both,,,2592.7500,388.9100,CIGNA HEALTHCARE,CIGNA PPO,1081.18,,,,,,,669.1900,2592.7500,percent of total billed charges,"41.7% of $2,592.75 in Billed Charges for Rev 272 = $1,081.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 435CC,272,RC,27200002,CDM,,,,,,both,,,2592.7500,388.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2333.48,,,,,,,669.1900,2592.7500,percent of total billed charges,"90% of $2,592.75 in Billed Charges for Rev 272 = $2,333.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 435CC,272,RC,27200002,CDM,,,,,,both,,,2592.7500,388.9100,MEDCOST,MEDCOST VHN,1233.89,,,,,,,669.1900,2592.7500,percent of total billed charges,"47.59% of $2,592.75 in Billed Charges for Rev 272 = $1,233.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 435CC,272,RC,27200002,CDM,,,,,,both,,,2592.7500,388.9100,SENTARA HEALTH,SENTARA HEALTH,669.19,,,,,,,669.1900,2592.7500,percent of total billed charges,"25.81% of $2,592.75 in Billed Charges for Rev 272 = $669.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 435CC,272,RC,27200002,CDM,,,,,,both,,,2592.7500,388.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2592.75,,,,,,,669.1900,2592.7500,percent of total billed charges,"100% of $2,592.75 in Billed Charges for Rev 272 = $2,592.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 435CC,272,RC,27200002,CDM,,,,,,both,,,2592.7500,388.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1296.38,,,,,,,669.1900,2592.7500,percent of total billed charges,"Rev 272 $2,592.75 in Billed Charges at 50% = $1,296.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 435CC,272,RC,27200002,CDM,,,,,,both,,,2592.7500,388.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,837.46,,,,,,,669.1900,2592.7500,other,"32.3% of $2,592.75 in Billed Charges for Rev 272 = $837.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 435CC,272,RC,27200002,CDM,,,,,,both,,,2592.7500,388.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,795.97,,,,,,,669.1900,2592.7500,other,"30.7% of $2,592.75 in Billed Charges for Rev 272 = $795.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 435CC,272,RC,27200002,CDM,,,,,,both,,,2592.7500,388.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,837.46,,,,,,,669.1900,2592.7500,percent of total billed charges,"32.3% of $2,592.75 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 435CC,272,RC,27200002,CDM,,,,,,both,,,2592.7500,388.9100,WELLCARE,WELLCARE MEDICAID,2592.75,,,,,,,669.1900,2592.7500,percent of total billed charges,"100% of $2,592.75 in Billed Charges for Rev 272 = $2,592.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY SSX 420CC,272,RC,,,,,,,,both,,,2478.6700,371.8000,AETNA,AETNA,1058.39,,,,,,,639.7400,2478.6700,percent of total billed charges,"42.7% of $2,478.67 in Billed Charges for Rev 272 = $1,058.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY SSX 420CC,272,RC,,,,,,,,both,,,2478.6700,371.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1735.07,,,,,,,639.7400,2478.6700,percent of total billed charges,"Rev 272 $2,478.67 in Billed Charges at 70% = $1,735.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY SSX 420CC,272,RC,,,,,,,,both,,,2478.6700,371.8000,CIGNA HEALTHCARE,CIGNA HMO,1033.61,,,,,,,639.7400,2478.6700,percent of total billed charges,"41.7% of $2,478.67 in Billed Charges for Rev 272 = $1,033.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY SSX 420CC,272,RC,,,,,,,,both,,,2478.6700,371.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1150.10,,,,,,,639.7400,2478.6700,percent of total billed charges,"46.4% of $2,478.67 in Billed Charges for Rev 272 = $1,150.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY SSX 420CC,272,RC,,,,,,,,both,,,2478.6700,371.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1033.61,,,,,,,639.7400,2478.6700,percent of total billed charges,"41.7% of $2,478.67 in Billed Charges for Rev 272 = $1,033.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY SSX 420CC,272,RC,,,,,,,,both,,,2478.6700,371.8000,CIGNA HEALTHCARE,CIGNA PPO,1033.61,,,,,,,639.7400,2478.6700,percent of total billed charges,"41.7% of $2,478.67 in Billed Charges for Rev 272 = $1,033.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY SSX 420CC,272,RC,,,,,,,,both,,,2478.6700,371.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2230.80,,,,,,,639.7400,2478.6700,percent of total billed charges,"90% of $2,478.67 in Billed Charges for Rev 272 = $2,230.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY SSX 420CC,272,RC,,,,,,,,both,,,2478.6700,371.8000,MEDCOST,MEDCOST VHN,1179.60,,,,,,,639.7400,2478.6700,percent of total billed charges,"47.59% of $2,478.67 in Billed Charges for Rev 272 = $1,179.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY SSX 420CC,272,RC,,,,,,,,both,,,2478.6700,371.8000,SENTARA HEALTH,SENTARA HEALTH,639.74,,,,,,,639.7400,2478.6700,percent of total billed charges,"25.81% of $2,478.67 in Billed Charges for Rev 272 = $639.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY SSX 420CC,272,RC,,,,,,,,both,,,2478.6700,371.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2478.67,,,,,,,639.7400,2478.6700,percent of total billed charges,"100% of $2,478.67 in Billed Charges for Rev 272 = $2,478.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY SSX 420CC,272,RC,,,,,,,,both,,,2478.6700,371.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1239.34,,,,,,,639.7400,2478.6700,percent of total billed charges,"Rev 272 $2,478.67 in Billed Charges at 50% = $1,239.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY SSX 420CC,272,RC,,,,,,,,both,,,2478.6700,371.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,800.61,,,,,,,639.7400,2478.6700,other,"32.3% of $2,478.67 in Billed Charges for Rev 272 = $800.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SIZER MAMMARY SSX 420CC,272,RC,,,,,,,,both,,,2478.6700,371.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,760.95,,,,,,,639.7400,2478.6700,other,"30.7% of $2,478.67 in Billed Charges for Rev 272 = $760.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SIZER MAMMARY SSX 420CC,272,RC,,,,,,,,both,,,2478.6700,371.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,800.61,,,,,,,639.7400,2478.6700,percent of total billed charges,"32.3% of $2,478.67 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER MAMMARY SSX 420CC,272,RC,,,,,,,,both,,,2478.6700,371.8000,WELLCARE,WELLCARE MEDICAID,2478.67,,,,,,,639.7400,2478.6700,percent of total billed charges,"100% of $2,478.67 in Billed Charges for Rev 272 = $2,478.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX PSEE45A,272,RC,27200002,CDM,,,,,,both,,,2730.3000,409.5500,AETNA,AETNA,1165.84,,,,,,,704.6900,2730.3000,percent of total billed charges,"42.7% of $2,730.30 in Billed Charges for Rev 272 = $1,165.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX PSEE45A,272,RC,27200002,CDM,,,,,,both,,,2730.3000,409.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1911.21,,,,,,,704.6900,2730.3000,percent of total billed charges,"Rev 272 $2,730.30 in Billed Charges at 70% = $1,911.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX PSEE45A,272,RC,27200002,CDM,,,,,,both,,,2730.3000,409.5500,CIGNA HEALTHCARE,CIGNA HMO,1138.54,,,,,,,704.6900,2730.3000,percent of total billed charges,"41.7% of $2,730.30 in Billed Charges for Rev 272 = $1,138.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX PSEE45A,272,RC,27200002,CDM,,,,,,both,,,2730.3000,409.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1266.86,,,,,,,704.6900,2730.3000,percent of total billed charges,"46.4% of $2,730.30 in Billed Charges for Rev 272 = $1,266.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX PSEE45A,272,RC,27200002,CDM,,,,,,both,,,2730.3000,409.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1138.54,,,,,,,704.6900,2730.3000,percent of total billed charges,"41.7% of $2,730.30 in Billed Charges for Rev 272 = $1,138.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX PSEE45A,272,RC,27200002,CDM,,,,,,both,,,2730.3000,409.5500,CIGNA HEALTHCARE,CIGNA PPO,1138.54,,,,,,,704.6900,2730.3000,percent of total billed charges,"41.7% of $2,730.30 in Billed Charges for Rev 272 = $1,138.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX PSEE45A,272,RC,27200002,CDM,,,,,,both,,,2730.3000,409.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2457.27,,,,,,,704.6900,2730.3000,percent of total billed charges,"90% of $2,730.30 in Billed Charges for Rev 272 = $2,457.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX PSEE45A,272,RC,27200002,CDM,,,,,,both,,,2730.3000,409.5500,MEDCOST,MEDCOST VHN,1299.35,,,,,,,704.6900,2730.3000,percent of total billed charges,"47.59% of $2,730.30 in Billed Charges for Rev 272 = $1,299.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX PSEE45A,272,RC,27200002,CDM,,,,,,both,,,2730.3000,409.5500,SENTARA HEALTH,SENTARA HEALTH,704.69,,,,,,,704.6900,2730.3000,percent of total billed charges,"25.81% of $2,730.30 in Billed Charges for Rev 272 = $704.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX PSEE45A,272,RC,27200002,CDM,,,,,,both,,,2730.3000,409.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2730.30,,,,,,,704.6900,2730.3000,percent of total billed charges,"100% of $2,730.30 in Billed Charges for Rev 272 = $2,730.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX PSEE45A,272,RC,27200002,CDM,,,,,,both,,,2730.3000,409.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1365.15,,,,,,,704.6900,2730.3000,percent of total billed charges,"Rev 272 $2,730.30 in Billed Charges at 50% = $1,365.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX PSEE45A,272,RC,27200002,CDM,,,,,,both,,,2730.3000,409.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,881.89,,,,,,,704.6900,2730.3000,other,"32.3% of $2,730.30 in Billed Charges for Rev 272 = $881.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ECHELON FLEX PSEE45A,272,RC,27200002,CDM,,,,,,both,,,2730.3000,409.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,838.20,,,,,,,704.6900,2730.3000,other,"30.7% of $2,730.30 in Billed Charges for Rev 272 = $838.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ECHELON FLEX PSEE45A,272,RC,27200002,CDM,,,,,,both,,,2730.3000,409.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,881.89,,,,,,,704.6900,2730.3000,percent of total billed charges,"32.3% of $2,730.30 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX PSEE45A,272,RC,27200002,CDM,,,,,,both,,,2730.3000,409.5500,WELLCARE,WELLCARE MEDICAID,2730.30,,,,,,,704.6900,2730.3000,percent of total billed charges,"100% of $2,730.30 in Billed Charges for Rev 272 = $2,730.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 45X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,3477.3300,521.6000,AETNA,AETNA,1484.82,,,,,,,897.5000,3477.3300,percent of total billed charges,"42.7% of $3,477.33 in Billed Charges for Rev 272 = $1,484.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 45X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,3477.3300,521.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2434.13,,,,,,,897.5000,3477.3300,percent of total billed charges,"Rev 272 $3,477.33 in Billed Charges at 70% = $2,434.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 45X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,3477.3300,521.6000,CIGNA HEALTHCARE,CIGNA HMO,1450.05,,,,,,,897.5000,3477.3300,percent of total billed charges,"41.7% of $3,477.33 in Billed Charges for Rev 272 = $1,450.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 45X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,3477.3300,521.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1613.48,,,,,,,897.5000,3477.3300,percent of total billed charges,"46.4% of $3,477.33 in Billed Charges for Rev 272 = $1,613.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 45X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,3477.3300,521.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1450.05,,,,,,,897.5000,3477.3300,percent of total billed charges,"41.7% of $3,477.33 in Billed Charges for Rev 272 = $1,450.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 45X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,3477.3300,521.6000,CIGNA HEALTHCARE,CIGNA PPO,1450.05,,,,,,,897.5000,3477.3300,percent of total billed charges,"41.7% of $3,477.33 in Billed Charges for Rev 272 = $1,450.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 45X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,3477.3300,521.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3129.60,,,,,,,897.5000,3477.3300,percent of total billed charges,"90% of $3,477.33 in Billed Charges for Rev 272 = $3,129.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 45X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,3477.3300,521.6000,MEDCOST,MEDCOST VHN,1654.86,,,,,,,897.5000,3477.3300,percent of total billed charges,"47.59% of $3,477.33 in Billed Charges for Rev 272 = $1,654.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 45X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,3477.3300,521.6000,SENTARA HEALTH,SENTARA HEALTH,897.50,,,,,,,897.5000,3477.3300,percent of total billed charges,"25.81% of $3,477.33 in Billed Charges for Rev 272 = $897.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 45X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,3477.3300,521.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3477.33,,,,,,,897.5000,3477.3300,percent of total billed charges,"100% of $3,477.33 in Billed Charges for Rev 272 = $3,477.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 45X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,3477.3300,521.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1738.67,,,,,,,897.5000,3477.3300,percent of total billed charges,"Rev 272 $3,477.33 in Billed Charges at 50% = $1,738.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 45X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,3477.3300,521.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1123.18,,,,,,,897.5000,3477.3300,other,"32.3% of $3,477.33 in Billed Charges for Rev 272 = $1,123.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ECHELON POWERED 3000 45X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,3477.3300,521.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1067.54,,,,,,,897.5000,3477.3300,other,"30.7% of $3,477.33 in Billed Charges for Rev 272 = $1,067.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ECHELON POWERED 3000 45X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,3477.3300,521.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,1123.18,,,,,,,897.5000,3477.3300,percent of total billed charges,"32.3% of $3,477.33 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 45X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,3477.3300,521.6000,WELLCARE,WELLCARE MEDICAID,3477.33,,,,,,,897.5000,3477.3300,percent of total billed charges,"100% of $3,477.33 in Billed Charges for Rev 272 = $3,477.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 385CC,272,RC,27200002,CDM,,,,,,both,,,2332.8500,349.9300,AETNA,AETNA,996.13,,,,,,,602.1100,2332.8500,percent of total billed charges,"42.7% of $2,332.85 in Billed Charges for Rev 272 = $996.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 385CC,272,RC,27200002,CDM,,,,,,both,,,2332.8500,349.9300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1633.00,,,,,,,602.1100,2332.8500,percent of total billed charges,"Rev 272 $2,332.85 in Billed Charges at 70% = $1,633.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 385CC,272,RC,27200002,CDM,,,,,,both,,,2332.8500,349.9300,CIGNA HEALTHCARE,CIGNA HMO,972.80,,,,,,,602.1100,2332.8500,percent of total billed charges,"41.7% of $2,332.85 in Billed Charges for Rev 272 = $972.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 385CC,272,RC,27200002,CDM,,,,,,both,,,2332.8500,349.9300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1082.44,,,,,,,602.1100,2332.8500,percent of total billed charges,"46.4% of $2,332.85 in Billed Charges for Rev 272 = $1,082.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 385CC,272,RC,27200002,CDM,,,,,,both,,,2332.8500,349.9300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,972.80,,,,,,,602.1100,2332.8500,percent of total billed charges,"41.7% of $2,332.85 in Billed Charges for Rev 272 = $972.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 385CC,272,RC,27200002,CDM,,,,,,both,,,2332.8500,349.9300,CIGNA HEALTHCARE,CIGNA PPO,972.80,,,,,,,602.1100,2332.8500,percent of total billed charges,"41.7% of $2,332.85 in Billed Charges for Rev 272 = $972.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 385CC,272,RC,27200002,CDM,,,,,,both,,,2332.8500,349.9300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2099.57,,,,,,,602.1100,2332.8500,percent of total billed charges,"90% of $2,332.85 in Billed Charges for Rev 272 = $2,099.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 385CC,272,RC,27200002,CDM,,,,,,both,,,2332.8500,349.9300,MEDCOST,MEDCOST VHN,1110.20,,,,,,,602.1100,2332.8500,percent of total billed charges,"47.59% of $2,332.85 in Billed Charges for Rev 272 = $1,110.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 385CC,272,RC,27200002,CDM,,,,,,both,,,2332.8500,349.9300,SENTARA HEALTH,SENTARA HEALTH,602.11,,,,,,,602.1100,2332.8500,percent of total billed charges,"25.81% of $2,332.85 in Billed Charges for Rev 272 = $602.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 385CC,272,RC,27200002,CDM,,,,,,both,,,2332.8500,349.9300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2332.85,,,,,,,602.1100,2332.8500,percent of total billed charges,"100% of $2,332.85 in Billed Charges for Rev 272 = $2,332.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 385CC,272,RC,27200002,CDM,,,,,,both,,,2332.8500,349.9300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1166.43,,,,,,,602.1100,2332.8500,percent of total billed charges,"Rev 272 $2,332.85 in Billed Charges at 50% = $1,166.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 385CC,272,RC,27200002,CDM,,,,,,both,,,2332.8500,349.9300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,753.51,,,,,,,602.1100,2332.8500,other,"32.3% of $2,332.85 in Billed Charges for Rev 272 = $753.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 385CC,272,RC,27200002,CDM,,,,,,both,,,2332.8500,349.9300,UNITED HEALTHCARE,UHC HERITAGE SELECT,716.19,,,,,,,602.1100,2332.8500,other,"30.7% of $2,332.85 in Billed Charges for Rev 272 = $716.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 385CC,272,RC,27200002,CDM,,,,,,both,,,2332.8500,349.9300,UNITED HEALTHCARE,UNITED HEALTHCARE,753.51,,,,,,,602.1100,2332.8500,percent of total billed charges,"32.3% of $2,332.85 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE CLASSIC PROFILE 385CC,272,RC,27200002,CDM,,,,,,both,,,2332.8500,349.9300,WELLCARE,WELLCARE MEDICAID,2332.85,,,,,,,602.1100,2332.8500,percent of total billed charges,"100% of $2,332.85 in Billed Charges for Rev 272 = $2,332.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 280CC,272,RC,27200002,CDM,,,,,,both,,,2594.4900,389.1700,AETNA,AETNA,1107.85,,,,,,,669.6400,2594.4900,percent of total billed charges,"42.7% of $2,594.49 in Billed Charges for Rev 272 = $1,107.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 280CC,272,RC,27200002,CDM,,,,,,both,,,2594.4900,389.1700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1816.14,,,,,,,669.6400,2594.4900,percent of total billed charges,"Rev 272 $2,594.49 in Billed Charges at 70% = $1,816.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 280CC,272,RC,27200002,CDM,,,,,,both,,,2594.4900,389.1700,CIGNA HEALTHCARE,CIGNA HMO,1081.90,,,,,,,669.6400,2594.4900,percent of total billed charges,"41.7% of $2,594.49 in Billed Charges for Rev 272 = $1,081.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 280CC,272,RC,27200002,CDM,,,,,,both,,,2594.4900,389.1700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1203.84,,,,,,,669.6400,2594.4900,percent of total billed charges,"46.4% of $2,594.49 in Billed Charges for Rev 272 = $1,203.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 280CC,272,RC,27200002,CDM,,,,,,both,,,2594.4900,389.1700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1081.90,,,,,,,669.6400,2594.4900,percent of total billed charges,"41.7% of $2,594.49 in Billed Charges for Rev 272 = $1,081.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 280CC,272,RC,27200002,CDM,,,,,,both,,,2594.4900,389.1700,CIGNA HEALTHCARE,CIGNA PPO,1081.90,,,,,,,669.6400,2594.4900,percent of total billed charges,"41.7% of $2,594.49 in Billed Charges for Rev 272 = $1,081.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 280CC,272,RC,27200002,CDM,,,,,,both,,,2594.4900,389.1700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2335.04,,,,,,,669.6400,2594.4900,percent of total billed charges,"90% of $2,594.49 in Billed Charges for Rev 272 = $2,335.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 280CC,272,RC,27200002,CDM,,,,,,both,,,2594.4900,389.1700,MEDCOST,MEDCOST VHN,1234.72,,,,,,,669.6400,2594.4900,percent of total billed charges,"47.59% of $2,594.49 in Billed Charges for Rev 272 = $1,234.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 280CC,272,RC,27200002,CDM,,,,,,both,,,2594.4900,389.1700,SENTARA HEALTH,SENTARA HEALTH,669.64,,,,,,,669.6400,2594.4900,percent of total billed charges,"25.81% of $2,594.49 in Billed Charges for Rev 272 = $669.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 280CC,272,RC,27200002,CDM,,,,,,both,,,2594.4900,389.1700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2594.49,,,,,,,669.6400,2594.4900,percent of total billed charges,"100% of $2,594.49 in Billed Charges for Rev 272 = $2,594.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 280CC,272,RC,27200002,CDM,,,,,,both,,,2594.4900,389.1700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1297.25,,,,,,,669.6400,2594.4900,percent of total billed charges,"Rev 272 $2,594.49 in Billed Charges at 50% = $1,297.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 280CC,272,RC,27200002,CDM,,,,,,both,,,2594.4900,389.1700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,838.02,,,,,,,669.6400,2594.4900,other,"32.3% of $2,594.49 in Billed Charges for Rev 272 = $838.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 280CC,272,RC,27200002,CDM,,,,,,both,,,2594.4900,389.1700,UNITED HEALTHCARE,UHC HERITAGE SELECT,796.51,,,,,,,669.6400,2594.4900,other,"30.7% of $2,594.49 in Billed Charges for Rev 272 = $796.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 280CC,272,RC,27200002,CDM,,,,,,both,,,2594.4900,389.1700,UNITED HEALTHCARE,UNITED HEALTHCARE,838.02,,,,,,,669.6400,2594.4900,percent of total billed charges,"32.3% of $2,594.49 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE BOOST GEL 280CC,272,RC,27200002,CDM,,,,,,both,,,2594.4900,389.1700,WELLCARE,WELLCARE MEDICAID,2594.49,,,,,,,669.6400,2594.4900,percent of total billed charges,"100% of $2,594.49 in Billed Charges for Rev 272 = $2,594.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEAXL 21MM SURPASS SEE LN 130016,272,RC,27200002,CDM,,,,,,both,,,15609.1600,2341.3700,AETNA,AETNA,6665.11,,,,,,,4028.7200,15609.1600,percent of total billed charges,"42.7% of $15,609.16 in Billed Charges for Rev 272 = $6,665.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEAXL 21MM SURPASS SEE LN 130016,272,RC,27200002,CDM,,,,,,both,,,15609.1600,2341.3700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,10926.41,,,,,,,4028.7200,15609.1600,percent of total billed charges,"Rev 272 $15,609.16 in Billed Charges at 70% = $10,926.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEAXL 21MM SURPASS SEE LN 130016,272,RC,27200002,CDM,,,,,,both,,,15609.1600,2341.3700,CIGNA HEALTHCARE,CIGNA HMO,6509.02,,,,,,,4028.7200,15609.1600,percent of total billed charges,"41.7% of $15,609.16 in Billed Charges for Rev 272 = $6,509.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEAXL 21MM SURPASS SEE LN 130016,272,RC,27200002,CDM,,,,,,both,,,15609.1600,2341.3700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7242.65,,,,,,,4028.7200,15609.1600,percent of total billed charges,"46.4% of $15,609.16 in Billed Charges for Rev 272 = $7,242.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEAXL 21MM SURPASS SEE LN 130016,272,RC,27200002,CDM,,,,,,both,,,15609.1600,2341.3700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6509.02,,,,,,,4028.7200,15609.1600,percent of total billed charges,"41.7% of $15,609.16 in Billed Charges for Rev 272 = $6,509.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEAXL 21MM SURPASS SEE LN 130016,272,RC,27200002,CDM,,,,,,both,,,15609.1600,2341.3700,CIGNA HEALTHCARE,CIGNA PPO,6509.02,,,,,,,4028.7200,15609.1600,percent of total billed charges,"41.7% of $15,609.16 in Billed Charges for Rev 272 = $6,509.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEAXL 21MM SURPASS SEE LN 130016,272,RC,27200002,CDM,,,,,,both,,,15609.1600,2341.3700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,14048.24,,,,,,,4028.7200,15609.1600,percent of total billed charges,"90% of $15,609.16 in Billed Charges for Rev 272 = $14,048.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEAXL 21MM SURPASS SEE LN 130016,272,RC,27200002,CDM,,,,,,both,,,15609.1600,2341.3700,MEDCOST,MEDCOST VHN,7428.40,,,,,,,4028.7200,15609.1600,percent of total billed charges,"47.59% of $15,609.16 in Billed Charges for Rev 272 = $7,428.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEAXL 21MM SURPASS SEE LN 130016,272,RC,27200002,CDM,,,,,,both,,,15609.1600,2341.3700,SENTARA HEALTH,SENTARA HEALTH,4028.72,,,,,,,4028.7200,15609.1600,percent of total billed charges,"25.81% of $15,609.16 in Billed Charges for Rev 272 = $4,028.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEAXL 21MM SURPASS SEE LN 130016,272,RC,27200002,CDM,,,,,,both,,,15609.1600,2341.3700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15609.16,,,,,,,4028.7200,15609.1600,percent of total billed charges,"100% of $15,609.16 in Billed Charges for Rev 272 = $15,609.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEAXL 21MM SURPASS SEE LN 130016,272,RC,27200002,CDM,,,,,,both,,,15609.1600,2341.3700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7804.58,,,,,,,4028.7200,15609.1600,percent of total billed charges,"Rev 272 $15,609.16 in Billed Charges at 50% = $7,804.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEAXL 21MM SURPASS SEE LN 130016,272,RC,27200002,CDM,,,,,,both,,,15609.1600,2341.3700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5041.76,,,,,,,4028.7200,15609.1600,other,"32.3% of $15,609.16 in Billed Charges for Rev 272 = $5,041.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER EEAXL 21MM SURPASS SEE LN 130016,272,RC,27200002,CDM,,,,,,both,,,15609.1600,2341.3700,UNITED HEALTHCARE,UHC HERITAGE SELECT,4792.01,,,,,,,4028.7200,15609.1600,other,"30.7% of $15,609.16 in Billed Charges for Rev 272 = $4,792.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER EEAXL 21MM SURPASS SEE LN 130016,272,RC,27200002,CDM,,,,,,both,,,15609.1600,2341.3700,UNITED HEALTHCARE,UNITED HEALTHCARE,5041.76,,,,,,,4028.7200,15609.1600,percent of total billed charges,"32.3% of $15,609.16 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEAXL 21MM SURPASS SEE LN 130016,272,RC,27200002,CDM,,,,,,both,,,15609.1600,2341.3700,WELLCARE,WELLCARE MEDICAID,15609.16,,,,,,,4028.7200,15609.1600,percent of total billed charges,"100% of $15,609.16 in Billed Charges for Rev 272 = $15,609.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO 5MM ABS 15 TACKS,272,RC,,,,,,,,both,,,7962.1700,1194.3300,AETNA,AETNA,3399.85,,,,,,,2055.0400,7962.1700,percent of total billed charges,"42.7% of $7,962.17 in Billed Charges for Rev 272 = $3,399.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO 5MM ABS 15 TACKS,272,RC,,,,,,,,both,,,7962.1700,1194.3300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5573.52,,,,,,,2055.0400,7962.1700,percent of total billed charges,"Rev 272 $7,962.17 in Billed Charges at 70% = $5,573.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO 5MM ABS 15 TACKS,272,RC,,,,,,,,both,,,7962.1700,1194.3300,CIGNA HEALTHCARE,CIGNA HMO,3320.22,,,,,,,2055.0400,7962.1700,percent of total billed charges,"41.7% of $7,962.17 in Billed Charges for Rev 272 = $3,320.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO 5MM ABS 15 TACKS,272,RC,,,,,,,,both,,,7962.1700,1194.3300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3694.45,,,,,,,2055.0400,7962.1700,percent of total billed charges,"46.4% of $7,962.17 in Billed Charges for Rev 272 = $3,694.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO 5MM ABS 15 TACKS,272,RC,,,,,,,,both,,,7962.1700,1194.3300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3320.22,,,,,,,2055.0400,7962.1700,percent of total billed charges,"41.7% of $7,962.17 in Billed Charges for Rev 272 = $3,320.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO 5MM ABS 15 TACKS,272,RC,,,,,,,,both,,,7962.1700,1194.3300,CIGNA HEALTHCARE,CIGNA PPO,3320.22,,,,,,,2055.0400,7962.1700,percent of total billed charges,"41.7% of $7,962.17 in Billed Charges for Rev 272 = $3,320.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO 5MM ABS 15 TACKS,272,RC,,,,,,,,both,,,7962.1700,1194.3300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7165.95,,,,,,,2055.0400,7962.1700,percent of total billed charges,"90% of $7,962.17 in Billed Charges for Rev 272 = $7,165.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO 5MM ABS 15 TACKS,272,RC,,,,,,,,both,,,7962.1700,1194.3300,MEDCOST,MEDCOST VHN,3789.20,,,,,,,2055.0400,7962.1700,percent of total billed charges,"47.59% of $7,962.17 in Billed Charges for Rev 272 = $3,789.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO 5MM ABS 15 TACKS,272,RC,,,,,,,,both,,,7962.1700,1194.3300,SENTARA HEALTH,SENTARA HEALTH,2055.04,,,,,,,2055.0400,7962.1700,percent of total billed charges,"25.81% of $7,962.17 in Billed Charges for Rev 272 = $2,055.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO 5MM ABS 15 TACKS,272,RC,,,,,,,,both,,,7962.1700,1194.3300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7962.17,,,,,,,2055.0400,7962.1700,percent of total billed charges,"100% of $7,962.17 in Billed Charges for Rev 272 = $7,962.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO 5MM ABS 15 TACKS,272,RC,,,,,,,,both,,,7962.1700,1194.3300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3981.09,,,,,,,2055.0400,7962.1700,percent of total billed charges,"Rev 272 $7,962.17 in Billed Charges at 50% = $3,981.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO 5MM ABS 15 TACKS,272,RC,,,,,,,,both,,,7962.1700,1194.3300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2571.78,,,,,,,2055.0400,7962.1700,other,"32.3% of $7,962.17 in Billed Charges for Rev 272 = $2,571.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ENDO 5MM ABS 15 TACKS,272,RC,,,,,,,,both,,,7962.1700,1194.3300,UNITED HEALTHCARE,UHC HERITAGE SELECT,2444.39,,,,,,,2055.0400,7962.1700,other,"30.7% of $7,962.17 in Billed Charges for Rev 272 = $2,444.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ENDO 5MM ABS 15 TACKS,272,RC,,,,,,,,both,,,7962.1700,1194.3300,UNITED HEALTHCARE,UNITED HEALTHCARE,2571.78,,,,,,,2055.0400,7962.1700,percent of total billed charges,"32.3% of $7,962.17 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO 5MM ABS 15 TACKS,272,RC,,,,,,,,both,,,7962.1700,1194.3300,WELLCARE,WELLCARE MEDICAID,7962.17,,,,,,,2055.0400,7962.1700,percent of total billed charges,"100% of $7,962.17 in Billed Charges for Rev 272 = $7,962.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO CIRC 33MM 37CML XL SEALED,272,RC,27200002,CDM,,,,,,both,,,2643.3300,396.5000,AETNA,AETNA,1128.70,,,,,,,682.2400,2643.3300,percent of total billed charges,"42.7% of $2,643.33 in Billed Charges for Rev 272 = $1,128.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO CIRC 33MM 37CML XL SEALED,272,RC,27200002,CDM,,,,,,both,,,2643.3300,396.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1850.33,,,,,,,682.2400,2643.3300,percent of total billed charges,"Rev 272 $2,643.33 in Billed Charges at 70% = $1,850.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO CIRC 33MM 37CML XL SEALED,272,RC,27200002,CDM,,,,,,both,,,2643.3300,396.5000,CIGNA HEALTHCARE,CIGNA HMO,1102.27,,,,,,,682.2400,2643.3300,percent of total billed charges,"41.7% of $2,643.33 in Billed Charges for Rev 272 = $1,102.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO CIRC 33MM 37CML XL SEALED,272,RC,27200002,CDM,,,,,,both,,,2643.3300,396.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1226.51,,,,,,,682.2400,2643.3300,percent of total billed charges,"46.4% of $2,643.33 in Billed Charges for Rev 272 = $1,226.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO CIRC 33MM 37CML XL SEALED,272,RC,27200002,CDM,,,,,,both,,,2643.3300,396.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1102.27,,,,,,,682.2400,2643.3300,percent of total billed charges,"41.7% of $2,643.33 in Billed Charges for Rev 272 = $1,102.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO CIRC 33MM 37CML XL SEALED,272,RC,27200002,CDM,,,,,,both,,,2643.3300,396.5000,CIGNA HEALTHCARE,CIGNA PPO,1102.27,,,,,,,682.2400,2643.3300,percent of total billed charges,"41.7% of $2,643.33 in Billed Charges for Rev 272 = $1,102.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO CIRC 33MM 37CML XL SEALED,272,RC,27200002,CDM,,,,,,both,,,2643.3300,396.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2379.00,,,,,,,682.2400,2643.3300,percent of total billed charges,"90% of $2,643.33 in Billed Charges for Rev 272 = $2,379.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO CIRC 33MM 37CML XL SEALED,272,RC,27200002,CDM,,,,,,both,,,2643.3300,396.5000,MEDCOST,MEDCOST VHN,1257.96,,,,,,,682.2400,2643.3300,percent of total billed charges,"47.59% of $2,643.33 in Billed Charges for Rev 272 = $1,257.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO CIRC 33MM 37CML XL SEALED,272,RC,27200002,CDM,,,,,,both,,,2643.3300,396.5000,SENTARA HEALTH,SENTARA HEALTH,682.24,,,,,,,682.2400,2643.3300,percent of total billed charges,"25.81% of $2,643.33 in Billed Charges for Rev 272 = $682.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO CIRC 33MM 37CML XL SEALED,272,RC,27200002,CDM,,,,,,both,,,2643.3300,396.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2643.33,,,,,,,682.2400,2643.3300,percent of total billed charges,"100% of $2,643.33 in Billed Charges for Rev 272 = $2,643.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO CIRC 33MM 37CML XL SEALED,272,RC,27200002,CDM,,,,,,both,,,2643.3300,396.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1321.67,,,,,,,682.2400,2643.3300,percent of total billed charges,"Rev 272 $2,643.33 in Billed Charges at 50% = $1,321.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO CIRC 33MM 37CML XL SEALED,272,RC,27200002,CDM,,,,,,both,,,2643.3300,396.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,853.80,,,,,,,682.2400,2643.3300,other,"32.3% of $2,643.33 in Billed Charges for Rev 272 = $853.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ENDO CIRC 33MM 37CML XL SEALED,272,RC,27200002,CDM,,,,,,both,,,2643.3300,396.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,811.50,,,,,,,682.2400,2643.3300,other,"30.7% of $2,643.33 in Billed Charges for Rev 272 = $811.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ENDO CIRC 33MM 37CML XL SEALED,272,RC,27200002,CDM,,,,,,both,,,2643.3300,396.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,853.80,,,,,,,682.2400,2643.3300,percent of total billed charges,"32.3% of $2,643.33 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO CIRC 33MM 37CML XL SEALED,272,RC,27200002,CDM,,,,,,both,,,2643.3300,396.5000,WELLCARE,WELLCARE MEDICAID,2643.33,,,,,,,682.2400,2643.3300,percent of total billed charges,"100% of $2,643.33 in Billed Charges for Rev 272 = $2,643.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO UNIVERSAL STAND SURPASS SEE LN 184176,272,RC,27200002,CDM,,,,,,both,,,5173.0600,775.9600,AETNA,AETNA,2208.90,,,,,,,1335.1700,5173.0600,percent of total billed charges,"42.7% of $5,173.06 in Billed Charges for Rev 272 = $2,208.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO UNIVERSAL STAND SURPASS SEE LN 184176,272,RC,27200002,CDM,,,,,,both,,,5173.0600,775.9600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3621.14,,,,,,,1335.1700,5173.0600,percent of total billed charges,"Rev 272 $5,173.06 in Billed Charges at 70% = $3,621.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO UNIVERSAL STAND SURPASS SEE LN 184176,272,RC,27200002,CDM,,,,,,both,,,5173.0600,775.9600,CIGNA HEALTHCARE,CIGNA HMO,2157.17,,,,,,,1335.1700,5173.0600,percent of total billed charges,"41.7% of $5,173.06 in Billed Charges for Rev 272 = $2,157.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO UNIVERSAL STAND SURPASS SEE LN 184176,272,RC,27200002,CDM,,,,,,both,,,5173.0600,775.9600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2400.30,,,,,,,1335.1700,5173.0600,percent of total billed charges,"46.4% of $5,173.06 in Billed Charges for Rev 272 = $2,400.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO UNIVERSAL STAND SURPASS SEE LN 184176,272,RC,27200002,CDM,,,,,,both,,,5173.0600,775.9600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2157.17,,,,,,,1335.1700,5173.0600,percent of total billed charges,"41.7% of $5,173.06 in Billed Charges for Rev 272 = $2,157.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO UNIVERSAL STAND SURPASS SEE LN 184176,272,RC,27200002,CDM,,,,,,both,,,5173.0600,775.9600,CIGNA HEALTHCARE,CIGNA PPO,2157.17,,,,,,,1335.1700,5173.0600,percent of total billed charges,"41.7% of $5,173.06 in Billed Charges for Rev 272 = $2,157.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO UNIVERSAL STAND SURPASS SEE LN 184176,272,RC,27200002,CDM,,,,,,both,,,5173.0600,775.9600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4655.75,,,,,,,1335.1700,5173.0600,percent of total billed charges,"90% of $5,173.06 in Billed Charges for Rev 272 = $4,655.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO UNIVERSAL STAND SURPASS SEE LN 184176,272,RC,27200002,CDM,,,,,,both,,,5173.0600,775.9600,MEDCOST,MEDCOST VHN,2461.86,,,,,,,1335.1700,5173.0600,percent of total billed charges,"47.59% of $5,173.06 in Billed Charges for Rev 272 = $2,461.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO UNIVERSAL STAND SURPASS SEE LN 184176,272,RC,27200002,CDM,,,,,,both,,,5173.0600,775.9600,SENTARA HEALTH,SENTARA HEALTH,1335.17,,,,,,,1335.1700,5173.0600,percent of total billed charges,"25.81% of $5,173.06 in Billed Charges for Rev 272 = $1,335.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO UNIVERSAL STAND SURPASS SEE LN 184176,272,RC,27200002,CDM,,,,,,both,,,5173.0600,775.9600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5173.06,,,,,,,1335.1700,5173.0600,percent of total billed charges,"100% of $5,173.06 in Billed Charges for Rev 272 = $5,173.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO UNIVERSAL STAND SURPASS SEE LN 184176,272,RC,27200002,CDM,,,,,,both,,,5173.0600,775.9600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2586.53,,,,,,,1335.1700,5173.0600,percent of total billed charges,"Rev 272 $5,173.06 in Billed Charges at 50% = $2,586.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO UNIVERSAL STAND SURPASS SEE LN 184176,272,RC,27200002,CDM,,,,,,both,,,5173.0600,775.9600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1670.90,,,,,,,1335.1700,5173.0600,other,"32.3% of $5,173.06 in Billed Charges for Rev 272 = $1,670.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ENDO UNIVERSAL STAND SURPASS SEE LN 184176,272,RC,27200002,CDM,,,,,,both,,,5173.0600,775.9600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1588.13,,,,,,,1335.1700,5173.0600,other,"30.7% of $5,173.06 in Billed Charges for Rev 272 = $1,588.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ENDO UNIVERSAL STAND SURPASS SEE LN 184176,272,RC,27200002,CDM,,,,,,both,,,5173.0600,775.9600,UNITED HEALTHCARE,UNITED HEALTHCARE,1670.90,,,,,,,1335.1700,5173.0600,percent of total billed charges,"32.3% of $5,173.06 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO UNIVERSAL STAND SURPASS SEE LN 184176,272,RC,27200002,CDM,,,,,,both,,,5173.0600,775.9600,WELLCARE,WELLCARE MEDICAID,5173.06,,,,,,,1335.1700,5173.0600,percent of total billed charges,"100% of $5,173.06 in Billed Charges for Rev 272 = $5,173.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 60-3.8 GIA6038S SURPASS SEE LN 106545,272,RC,27200002,CDM,,,,,,both,,,4421.7300,663.2600,AETNA,AETNA,1888.08,,,,,,,1141.2500,4421.7300,percent of total billed charges,"42.7% of $4,421.73 in Billed Charges for Rev 272 = $1,888.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 60-3.8 GIA6038S SURPASS SEE LN 106545,272,RC,27200002,CDM,,,,,,both,,,4421.7300,663.2600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3095.21,,,,,,,1141.2500,4421.7300,percent of total billed charges,"Rev 272 $4,421.73 in Billed Charges at 70% = $3,095.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 60-3.8 GIA6038S SURPASS SEE LN 106545,272,RC,27200002,CDM,,,,,,both,,,4421.7300,663.2600,CIGNA HEALTHCARE,CIGNA HMO,1843.86,,,,,,,1141.2500,4421.7300,percent of total billed charges,"41.7% of $4,421.73 in Billed Charges for Rev 272 = $1,843.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 60-3.8 GIA6038S SURPASS SEE LN 106545,272,RC,27200002,CDM,,,,,,both,,,4421.7300,663.2600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2051.68,,,,,,,1141.2500,4421.7300,percent of total billed charges,"46.4% of $4,421.73 in Billed Charges for Rev 272 = $2,051.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 60-3.8 GIA6038S SURPASS SEE LN 106545,272,RC,27200002,CDM,,,,,,both,,,4421.7300,663.2600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1843.86,,,,,,,1141.2500,4421.7300,percent of total billed charges,"41.7% of $4,421.73 in Billed Charges for Rev 272 = $1,843.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 60-3.8 GIA6038S SURPASS SEE LN 106545,272,RC,27200002,CDM,,,,,,both,,,4421.7300,663.2600,CIGNA HEALTHCARE,CIGNA PPO,1843.86,,,,,,,1141.2500,4421.7300,percent of total billed charges,"41.7% of $4,421.73 in Billed Charges for Rev 272 = $1,843.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 60-3.8 GIA6038S SURPASS SEE LN 106545,272,RC,27200002,CDM,,,,,,both,,,4421.7300,663.2600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3979.56,,,,,,,1141.2500,4421.7300,percent of total billed charges,"90% of $4,421.73 in Billed Charges for Rev 272 = $3,979.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 60-3.8 GIA6038S SURPASS SEE LN 106545,272,RC,27200002,CDM,,,,,,both,,,4421.7300,663.2600,MEDCOST,MEDCOST VHN,2104.30,,,,,,,1141.2500,4421.7300,percent of total billed charges,"47.59% of $4,421.73 in Billed Charges for Rev 272 = $2,104.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 60-3.8 GIA6038S SURPASS SEE LN 106545,272,RC,27200002,CDM,,,,,,both,,,4421.7300,663.2600,SENTARA HEALTH,SENTARA HEALTH,1141.25,,,,,,,1141.2500,4421.7300,percent of total billed charges,"25.81% of $4,421.73 in Billed Charges for Rev 272 = $1,141.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 60-3.8 GIA6038S SURPASS SEE LN 106545,272,RC,27200002,CDM,,,,,,both,,,4421.7300,663.2600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4421.73,,,,,,,1141.2500,4421.7300,percent of total billed charges,"100% of $4,421.73 in Billed Charges for Rev 272 = $4,421.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 60-3.8 GIA6038S SURPASS SEE LN 106545,272,RC,27200002,CDM,,,,,,both,,,4421.7300,663.2600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2210.87,,,,,,,1141.2500,4421.7300,percent of total billed charges,"Rev 272 $4,421.73 in Billed Charges at 50% = $2,210.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 60-3.8 GIA6038S SURPASS SEE LN 106545,272,RC,27200002,CDM,,,,,,both,,,4421.7300,663.2600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1428.22,,,,,,,1141.2500,4421.7300,other,"32.3% of $4,421.73 in Billed Charges for Rev 272 = $1,428.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER GIA 60-3.8 GIA6038S SURPASS SEE LN 106545,272,RC,27200002,CDM,,,,,,both,,,4421.7300,663.2600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1357.47,,,,,,,1141.2500,4421.7300,other,"30.7% of $4,421.73 in Billed Charges for Rev 272 = $1,357.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER GIA 60-3.8 GIA6038S SURPASS SEE LN 106545,272,RC,27200002,CDM,,,,,,both,,,4421.7300,663.2600,UNITED HEALTHCARE,UNITED HEALTHCARE,1428.22,,,,,,,1141.2500,4421.7300,percent of total billed charges,"32.3% of $4,421.73 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 60-3.8 GIA6038S SURPASS SEE LN 106545,272,RC,27200002,CDM,,,,,,both,,,4421.7300,663.2600,WELLCARE,WELLCARE MEDICAID,4421.73,,,,,,,1141.2500,4421.7300,percent of total billed charges,"100% of $4,421.73 in Billed Charges for Rev 272 = $4,421.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-4.8 GIA8048S SURPASS SEE LN 120320,272,RC,,,,,,,,both,,,6885.2900,1032.7900,AETNA,AETNA,2940.02,,,,,,,1777.0900,6885.2900,percent of total billed charges,"42.7% of $6,885.29 in Billed Charges for Rev 272 = $2,940.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-4.8 GIA8048S SURPASS SEE LN 120320,272,RC,,,,,,,,both,,,6885.2900,1032.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4819.70,,,,,,,1777.0900,6885.2900,percent of total billed charges,"Rev 272 $6,885.29 in Billed Charges at 70% = $4,819.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-4.8 GIA8048S SURPASS SEE LN 120320,272,RC,,,,,,,,both,,,6885.2900,1032.7900,CIGNA HEALTHCARE,CIGNA HMO,2871.17,,,,,,,1777.0900,6885.2900,percent of total billed charges,"41.7% of $6,885.29 in Billed Charges for Rev 272 = $2,871.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-4.8 GIA8048S SURPASS SEE LN 120320,272,RC,,,,,,,,both,,,6885.2900,1032.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3194.77,,,,,,,1777.0900,6885.2900,percent of total billed charges,"46.4% of $6,885.29 in Billed Charges for Rev 272 = $3,194.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-4.8 GIA8048S SURPASS SEE LN 120320,272,RC,,,,,,,,both,,,6885.2900,1032.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2871.17,,,,,,,1777.0900,6885.2900,percent of total billed charges,"41.7% of $6,885.29 in Billed Charges for Rev 272 = $2,871.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-4.8 GIA8048S SURPASS SEE LN 120320,272,RC,,,,,,,,both,,,6885.2900,1032.7900,CIGNA HEALTHCARE,CIGNA PPO,2871.17,,,,,,,1777.0900,6885.2900,percent of total billed charges,"41.7% of $6,885.29 in Billed Charges for Rev 272 = $2,871.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-4.8 GIA8048S SURPASS SEE LN 120320,272,RC,,,,,,,,both,,,6885.2900,1032.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6196.76,,,,,,,1777.0900,6885.2900,percent of total billed charges,"90% of $6,885.29 in Billed Charges for Rev 272 = $6,196.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-4.8 GIA8048S SURPASS SEE LN 120320,272,RC,,,,,,,,both,,,6885.2900,1032.7900,MEDCOST,MEDCOST VHN,3276.71,,,,,,,1777.0900,6885.2900,percent of total billed charges,"47.59% of $6,885.29 in Billed Charges for Rev 272 = $3,276.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-4.8 GIA8048S SURPASS SEE LN 120320,272,RC,,,,,,,,both,,,6885.2900,1032.7900,SENTARA HEALTH,SENTARA HEALTH,1777.09,,,,,,,1777.0900,6885.2900,percent of total billed charges,"25.81% of $6,885.29 in Billed Charges for Rev 272 = $1,777.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-4.8 GIA8048S SURPASS SEE LN 120320,272,RC,,,,,,,,both,,,6885.2900,1032.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6885.29,,,,,,,1777.0900,6885.2900,percent of total billed charges,"100% of $6,885.29 in Billed Charges for Rev 272 = $6,885.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-4.8 GIA8048S SURPASS SEE LN 120320,272,RC,,,,,,,,both,,,6885.2900,1032.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3442.65,,,,,,,1777.0900,6885.2900,percent of total billed charges,"Rev 272 $6,885.29 in Billed Charges at 50% = $3,442.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-4.8 GIA8048S SURPASS SEE LN 120320,272,RC,,,,,,,,both,,,6885.2900,1032.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2223.95,,,,,,,1777.0900,6885.2900,other,"32.3% of $6,885.29 in Billed Charges for Rev 272 = $2,223.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER GIA 80-4.8 GIA8048S SURPASS SEE LN 120320,272,RC,,,,,,,,both,,,6885.2900,1032.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,2113.78,,,,,,,1777.0900,6885.2900,other,"30.7% of $6,885.29 in Billed Charges for Rev 272 = $2,113.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER GIA 80-4.8 GIA8048S SURPASS SEE LN 120320,272,RC,,,,,,,,both,,,6885.2900,1032.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,2223.95,,,,,,,1777.0900,6885.2900,percent of total billed charges,"32.3% of $6,885.29 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-4.8 GIA8048S SURPASS SEE LN 120320,272,RC,,,,,,,,both,,,6885.2900,1032.7900,WELLCARE,WELLCARE MEDICAID,6885.29,,,,,,,1777.0900,6885.2900,percent of total billed charges,"100% of $6,885.29 in Billed Charges for Rev 272 = $6,885.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 60X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,4172.8400,625.9300,AETNA,AETNA,1781.80,,,,,,,1077.0100,4172.8400,percent of total billed charges,"42.7% of $4,172.84 in Billed Charges for Rev 272 = $1,781.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 60X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,4172.8400,625.9300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2920.99,,,,,,,1077.0100,4172.8400,percent of total billed charges,"Rev 272 $4,172.84 in Billed Charges at 70% = $2,920.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 60X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,4172.8400,625.9300,CIGNA HEALTHCARE,CIGNA HMO,1740.07,,,,,,,1077.0100,4172.8400,percent of total billed charges,"41.7% of $4,172.84 in Billed Charges for Rev 272 = $1,740.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 60X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,4172.8400,625.9300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1936.20,,,,,,,1077.0100,4172.8400,percent of total billed charges,"46.4% of $4,172.84 in Billed Charges for Rev 272 = $1,936.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 60X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,4172.8400,625.9300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1740.07,,,,,,,1077.0100,4172.8400,percent of total billed charges,"41.7% of $4,172.84 in Billed Charges for Rev 272 = $1,740.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 60X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,4172.8400,625.9300,CIGNA HEALTHCARE,CIGNA PPO,1740.07,,,,,,,1077.0100,4172.8400,percent of total billed charges,"41.7% of $4,172.84 in Billed Charges for Rev 272 = $1,740.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 60X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,4172.8400,625.9300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3755.56,,,,,,,1077.0100,4172.8400,percent of total billed charges,"90% of $4,172.84 in Billed Charges for Rev 272 = $3,755.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 60X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,4172.8400,625.9300,MEDCOST,MEDCOST VHN,1985.85,,,,,,,1077.0100,4172.8400,percent of total billed charges,"47.59% of $4,172.84 in Billed Charges for Rev 272 = $1,985.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 60X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,4172.8400,625.9300,SENTARA HEALTH,SENTARA HEALTH,1077.01,,,,,,,1077.0100,4172.8400,percent of total billed charges,"25.81% of $4,172.84 in Billed Charges for Rev 272 = $1,077.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 60X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,4172.8400,625.9300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4172.84,,,,,,,1077.0100,4172.8400,percent of total billed charges,"100% of $4,172.84 in Billed Charges for Rev 272 = $4,172.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 60X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,4172.8400,625.9300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2086.42,,,,,,,1077.0100,4172.8400,percent of total billed charges,"Rev 272 $4,172.84 in Billed Charges at 50% = $2,086.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 60X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,4172.8400,625.9300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1347.83,,,,,,,1077.0100,4172.8400,other,"32.3% of $4,172.84 in Billed Charges for Rev 272 = $1,347.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ECHELON POWERED 3000 60X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,4172.8400,625.9300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1281.06,,,,,,,1077.0100,4172.8400,other,"30.7% of $4,172.84 in Billed Charges for Rev 272 = $1,281.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ECHELON POWERED 3000 60X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,4172.8400,625.9300,UNITED HEALTHCARE,UNITED HEALTHCARE,1347.83,,,,,,,1077.0100,4172.8400,percent of total billed charges,"32.3% of $4,172.84 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON POWERED 3000 60X340MM STANDARD LENGTH,272,RC,27200002,CDM,,,,,,both,,,4172.8400,625.9300,WELLCARE,WELLCARE MEDICAID,4172.84,,,,,,,1077.0100,4172.8400,percent of total billed charges,"100% of $4,172.84 in Billed Charges for Rev 272 = $4,172.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEA XL 25MM SURPASS SEE LN 153985,272,RC,,,,,,,,both,,,15154.5100,2273.1800,AETNA,AETNA,6470.98,,,,,,,3911.3800,15154.5100,percent of total billed charges,"42.7% of $15,154.51 in Billed Charges for Rev 272 = $6,470.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEA XL 25MM SURPASS SEE LN 153985,272,RC,,,,,,,,both,,,15154.5100,2273.1800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,10608.16,,,,,,,3911.3800,15154.5100,percent of total billed charges,"Rev 272 $15,154.51 in Billed Charges at 70% = $10,608.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEA XL 25MM SURPASS SEE LN 153985,272,RC,,,,,,,,both,,,15154.5100,2273.1800,CIGNA HEALTHCARE,CIGNA HMO,6319.43,,,,,,,3911.3800,15154.5100,percent of total billed charges,"41.7% of $15,154.51 in Billed Charges for Rev 272 = $6,319.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEA XL 25MM SURPASS SEE LN 153985,272,RC,,,,,,,,both,,,15154.5100,2273.1800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7031.69,,,,,,,3911.3800,15154.5100,percent of total billed charges,"46.4% of $15,154.51 in Billed Charges for Rev 272 = $7,031.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEA XL 25MM SURPASS SEE LN 153985,272,RC,,,,,,,,both,,,15154.5100,2273.1800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6319.43,,,,,,,3911.3800,15154.5100,percent of total billed charges,"41.7% of $15,154.51 in Billed Charges for Rev 272 = $6,319.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEA XL 25MM SURPASS SEE LN 153985,272,RC,,,,,,,,both,,,15154.5100,2273.1800,CIGNA HEALTHCARE,CIGNA PPO,6319.43,,,,,,,3911.3800,15154.5100,percent of total billed charges,"41.7% of $15,154.51 in Billed Charges for Rev 272 = $6,319.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEA XL 25MM SURPASS SEE LN 153985,272,RC,,,,,,,,both,,,15154.5100,2273.1800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13639.06,,,,,,,3911.3800,15154.5100,percent of total billed charges,"90% of $15,154.51 in Billed Charges for Rev 272 = $13,639.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEA XL 25MM SURPASS SEE LN 153985,272,RC,,,,,,,,both,,,15154.5100,2273.1800,MEDCOST,MEDCOST VHN,7212.03,,,,,,,3911.3800,15154.5100,percent of total billed charges,"47.59% of $15,154.51 in Billed Charges for Rev 272 = $7,212.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEA XL 25MM SURPASS SEE LN 153985,272,RC,,,,,,,,both,,,15154.5100,2273.1800,SENTARA HEALTH,SENTARA HEALTH,3911.38,,,,,,,3911.3800,15154.5100,percent of total billed charges,"25.81% of $15,154.51 in Billed Charges for Rev 272 = $3,911.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEA XL 25MM SURPASS SEE LN 153985,272,RC,,,,,,,,both,,,15154.5100,2273.1800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15154.51,,,,,,,3911.3800,15154.5100,percent of total billed charges,"100% of $15,154.51 in Billed Charges for Rev 272 = $15,154.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEA XL 25MM SURPASS SEE LN 153985,272,RC,,,,,,,,both,,,15154.5100,2273.1800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7577.26,,,,,,,3911.3800,15154.5100,percent of total billed charges,"Rev 272 $15,154.51 in Billed Charges at 50% = $7,577.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEA XL 25MM SURPASS SEE LN 153985,272,RC,,,,,,,,both,,,15154.5100,2273.1800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4894.91,,,,,,,3911.3800,15154.5100,other,"32.3% of $15,154.51 in Billed Charges for Rev 272 = $4,894.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER EEA XL 25MM SURPASS SEE LN 153985,272,RC,,,,,,,,both,,,15154.5100,2273.1800,UNITED HEALTHCARE,UHC HERITAGE SELECT,4652.43,,,,,,,3911.3800,15154.5100,other,"30.7% of $15,154.51 in Billed Charges for Rev 272 = $4,652.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER EEA XL 25MM SURPASS SEE LN 153985,272,RC,,,,,,,,both,,,15154.5100,2273.1800,UNITED HEALTHCARE,UNITED HEALTHCARE,4894.91,,,,,,,3911.3800,15154.5100,percent of total billed charges,"32.3% of $15,154.51 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER EEA XL 25MM SURPASS SEE LN 153985,272,RC,,,,,,,,both,,,15154.5100,2273.1800,WELLCARE,WELLCARE MEDICAID,15154.51,,,,,,,3911.3800,15154.5100,percent of total billed charges,"100% of $15,154.51 in Billed Charges for Rev 272 = $15,154.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO POWER CURVE 23MM GST+3D,272,RC,,,,,,,,both,,,3564.5800,534.6900,AETNA,AETNA,1522.08,,,,,,,920.0200,3564.5800,percent of total billed charges,"42.7% of $3,564.58 in Billed Charges for Rev 272 = $1,522.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO POWER CURVE 23MM GST+3D,272,RC,,,,,,,,both,,,3564.5800,534.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2495.21,,,,,,,920.0200,3564.5800,percent of total billed charges,"Rev 272 $3,564.58 in Billed Charges at 70% = $2,495.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO POWER CURVE 23MM GST+3D,272,RC,,,,,,,,both,,,3564.5800,534.6900,CIGNA HEALTHCARE,CIGNA HMO,1486.43,,,,,,,920.0200,3564.5800,percent of total billed charges,"41.7% of $3,564.58 in Billed Charges for Rev 272 = $1,486.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO POWER CURVE 23MM GST+3D,272,RC,,,,,,,,both,,,3564.5800,534.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1653.97,,,,,,,920.0200,3564.5800,percent of total billed charges,"46.4% of $3,564.58 in Billed Charges for Rev 272 = $1,653.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO POWER CURVE 23MM GST+3D,272,RC,,,,,,,,both,,,3564.5800,534.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1486.43,,,,,,,920.0200,3564.5800,percent of total billed charges,"41.7% of $3,564.58 in Billed Charges for Rev 272 = $1,486.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO POWER CURVE 23MM GST+3D,272,RC,,,,,,,,both,,,3564.5800,534.6900,CIGNA HEALTHCARE,CIGNA PPO,1486.43,,,,,,,920.0200,3564.5800,percent of total billed charges,"41.7% of $3,564.58 in Billed Charges for Rev 272 = $1,486.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO POWER CURVE 23MM GST+3D,272,RC,,,,,,,,both,,,3564.5800,534.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3208.12,,,,,,,920.0200,3564.5800,percent of total billed charges,"90% of $3,564.58 in Billed Charges for Rev 272 = $3,208.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO POWER CURVE 23MM GST+3D,272,RC,,,,,,,,both,,,3564.5800,534.6900,MEDCOST,MEDCOST VHN,1696.38,,,,,,,920.0200,3564.5800,percent of total billed charges,"47.59% of $3,564.58 in Billed Charges for Rev 272 = $1,696.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO POWER CURVE 23MM GST+3D,272,RC,,,,,,,,both,,,3564.5800,534.6900,SENTARA HEALTH,SENTARA HEALTH,920.02,,,,,,,920.0200,3564.5800,percent of total billed charges,"25.81% of $3,564.58 in Billed Charges for Rev 272 = $920.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO POWER CURVE 23MM GST+3D,272,RC,,,,,,,,both,,,3564.5800,534.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3564.58,,,,,,,920.0200,3564.5800,percent of total billed charges,"100% of $3,564.58 in Billed Charges for Rev 272 = $3,564.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO POWER CURVE 23MM GST+3D,272,RC,,,,,,,,both,,,3564.5800,534.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1782.29,,,,,,,920.0200,3564.5800,percent of total billed charges,"Rev 272 $3,564.58 in Billed Charges at 50% = $1,782.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO POWER CURVE 23MM GST+3D,272,RC,,,,,,,,both,,,3564.5800,534.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1151.36,,,,,,,920.0200,3564.5800,other,"32.3% of $3,564.58 in Billed Charges for Rev 272 = $1,151.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ENDO POWER CURVE 23MM GST+3D,272,RC,,,,,,,,both,,,3564.5800,534.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1094.33,,,,,,,920.0200,3564.5800,other,"30.7% of $3,564.58 in Billed Charges for Rev 272 = $1,094.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ENDO POWER CURVE 23MM GST+3D,272,RC,,,,,,,,both,,,3564.5800,534.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,1151.36,,,,,,,920.0200,3564.5800,percent of total billed charges,"32.3% of $3,564.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ENDO POWER CURVE 23MM GST+3D,272,RC,,,,,,,,both,,,3564.5800,534.6900,WELLCARE,WELLCARE MEDICAID,3564.58,,,,,,,920.0200,3564.5800,percent of total billed charges,"100% of $3,564.58 in Billed Charges for Rev 272 = $3,564.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,1278.4500,191.7700,AETNA,AETNA,545.90,,,,,,,329.9700,1278.4500,percent of total billed charges,"42.7% of $1,278.45 in Billed Charges for Rev 272 = $545.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,1278.4500,191.7700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,894.92,,,,,,,329.9700,1278.4500,percent of total billed charges,"Rev 272 $1,278.45 in Billed Charges at 70% = $894.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,1278.4500,191.7700,CIGNA HEALTHCARE,CIGNA HMO,533.11,,,,,,,329.9700,1278.4500,percent of total billed charges,"41.7% of $1,278.45 in Billed Charges for Rev 272 = $533.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,1278.4500,191.7700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,593.20,,,,,,,329.9700,1278.4500,percent of total billed charges,"46.4% of $1,278.45 in Billed Charges for Rev 272 = $593.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,1278.4500,191.7700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,533.11,,,,,,,329.9700,1278.4500,percent of total billed charges,"41.7% of $1,278.45 in Billed Charges for Rev 272 = $533.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,1278.4500,191.7700,CIGNA HEALTHCARE,CIGNA PPO,533.11,,,,,,,329.9700,1278.4500,percent of total billed charges,"41.7% of $1,278.45 in Billed Charges for Rev 272 = $533.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,1278.4500,191.7700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1150.61,,,,,,,329.9700,1278.4500,percent of total billed charges,"90% of $1,278.45 in Billed Charges for Rev 272 = $1,150.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,1278.4500,191.7700,MEDCOST,MEDCOST VHN,608.41,,,,,,,329.9700,1278.4500,percent of total billed charges,"47.59% of $1,278.45 in Billed Charges for Rev 272 = $608.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,1278.4500,191.7700,SENTARA HEALTH,SENTARA HEALTH,329.97,,,,,,,329.9700,1278.4500,percent of total billed charges,"25.81% of $1,278.45 in Billed Charges for Rev 272 = $329.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,1278.4500,191.7700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1278.45,,,,,,,329.9700,1278.4500,percent of total billed charges,"100% of $1,278.45 in Billed Charges for Rev 272 = $1,278.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,1278.4500,191.7700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,639.23,,,,,,,329.9700,1278.4500,percent of total billed charges,"Rev 272 $1,278.45 in Billed Charges at 50% = $639.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,1278.4500,191.7700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,412.94,,,,,,,329.9700,1278.4500,other,"32.3% of $1,278.45 in Billed Charges for Rev 272 = $412.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,1278.4500,191.7700,UNITED HEALTHCARE,UHC HERITAGE SELECT,392.48,,,,,,,329.9700,1278.4500,other,"30.7% of $1,278.45 in Billed Charges for Rev 272 = $392.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,1278.4500,191.7700,UNITED HEALTHCARE,UNITED HEALTHCARE,412.94,,,,,,,329.9700,1278.4500,percent of total billed charges,"32.3% of $1,278.45 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,1278.4500,191.7700,WELLCARE,WELLCARE MEDICAID,1278.45,,,,,,,329.9700,1278.4500,percent of total billed charges,"100% of $1,278.45 in Billed Charges for Rev 272 = $1,278.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGICLIP II PREM MED 134051 SURPASS SEE LN 175925,272,RC,27200002,CDM,,,,,,both,,,1935.2200,290.2800,AETNA,AETNA,826.34,,,,,,,499.4800,1935.2200,percent of total billed charges,"42.7% of $1,935.22 in Billed Charges for Rev 272 = $826.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGICLIP II PREM MED 134051 SURPASS SEE LN 175925,272,RC,27200002,CDM,,,,,,both,,,1935.2200,290.2800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1354.65,,,,,,,499.4800,1935.2200,percent of total billed charges,"Rev 272 $1,935.22 in Billed Charges at 70% = $1,354.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGICLIP II PREM MED 134051 SURPASS SEE LN 175925,272,RC,27200002,CDM,,,,,,both,,,1935.2200,290.2800,CIGNA HEALTHCARE,CIGNA HMO,806.99,,,,,,,499.4800,1935.2200,percent of total billed charges,"41.7% of $1,935.22 in Billed Charges for Rev 272 = $806.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGICLIP II PREM MED 134051 SURPASS SEE LN 175925,272,RC,27200002,CDM,,,,,,both,,,1935.2200,290.2800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,897.94,,,,,,,499.4800,1935.2200,percent of total billed charges,"46.4% of $1,935.22 in Billed Charges for Rev 272 = $897.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGICLIP II PREM MED 134051 SURPASS SEE LN 175925,272,RC,27200002,CDM,,,,,,both,,,1935.2200,290.2800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,806.99,,,,,,,499.4800,1935.2200,percent of total billed charges,"41.7% of $1,935.22 in Billed Charges for Rev 272 = $806.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGICLIP II PREM MED 134051 SURPASS SEE LN 175925,272,RC,27200002,CDM,,,,,,both,,,1935.2200,290.2800,CIGNA HEALTHCARE,CIGNA PPO,806.99,,,,,,,499.4800,1935.2200,percent of total billed charges,"41.7% of $1,935.22 in Billed Charges for Rev 272 = $806.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGICLIP II PREM MED 134051 SURPASS SEE LN 175925,272,RC,27200002,CDM,,,,,,both,,,1935.2200,290.2800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1741.70,,,,,,,499.4800,1935.2200,percent of total billed charges,"90% of $1,935.22 in Billed Charges for Rev 272 = $1,741.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGICLIP II PREM MED 134051 SURPASS SEE LN 175925,272,RC,27200002,CDM,,,,,,both,,,1935.2200,290.2800,MEDCOST,MEDCOST VHN,920.97,,,,,,,499.4800,1935.2200,percent of total billed charges,"47.59% of $1,935.22 in Billed Charges for Rev 272 = $920.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGICLIP II PREM MED 134051 SURPASS SEE LN 175925,272,RC,27200002,CDM,,,,,,both,,,1935.2200,290.2800,SENTARA HEALTH,SENTARA HEALTH,499.48,,,,,,,499.4800,1935.2200,percent of total billed charges,"25.81% of $1,935.22 in Billed Charges for Rev 272 = $499.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGICLIP II PREM MED 134051 SURPASS SEE LN 175925,272,RC,27200002,CDM,,,,,,both,,,1935.2200,290.2800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1935.22,,,,,,,499.4800,1935.2200,percent of total billed charges,"100% of $1,935.22 in Billed Charges for Rev 272 = $1,935.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGICLIP II PREM MED 134051 SURPASS SEE LN 175925,272,RC,27200002,CDM,,,,,,both,,,1935.2200,290.2800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,967.61,,,,,,,499.4800,1935.2200,percent of total billed charges,"Rev 272 $1,935.22 in Billed Charges at 50% = $967.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGICLIP II PREM MED 134051 SURPASS SEE LN 175925,272,RC,27200002,CDM,,,,,,both,,,1935.2200,290.2800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,625.08,,,,,,,499.4800,1935.2200,other,"32.3% of $1,935.22 in Billed Charges for Rev 272 = $625.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SURGICLIP II PREM MED 134051 SURPASS SEE LN 175925,272,RC,27200002,CDM,,,,,,both,,,1935.2200,290.2800,UNITED HEALTHCARE,UHC HERITAGE SELECT,594.11,,,,,,,499.4800,1935.2200,other,"30.7% of $1,935.22 in Billed Charges for Rev 272 = $594.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SURGICLIP II PREM MED 134051 SURPASS SEE LN 175925,272,RC,27200002,CDM,,,,,,both,,,1935.2200,290.2800,UNITED HEALTHCARE,UNITED HEALTHCARE,625.08,,,,,,,499.4800,1935.2200,percent of total billed charges,"32.3% of $1,935.22 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SURGICLIP II PREM MED 134051 SURPASS SEE LN 175925,272,RC,27200002,CDM,,,,,,both,,,1935.2200,290.2800,WELLCARE,WELLCARE MEDICAID,1935.22,,,,,,,499.4800,1935.2200,percent of total billed charges,"100% of $1,935.22 in Billed Charges for Rev 272 = $1,935.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE 6.0 PROLENE M8706,272,RC,27200002,CDM,,,,,,both,,,498.0500,74.7100,AETNA,AETNA,212.67,,,,,,,128.5500,498.0500,percent of total billed charges,42.7% of $498.05 in Billed Charges for Rev 272 = $212.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 6.0 PROLENE M8706,272,RC,27200002,CDM,,,,,,both,,,498.0500,74.7100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,348.64,,,,,,,128.5500,498.0500,percent of total billed charges,Rev 272 $498.05 in Billed Charges at 70% = $348.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 6.0 PROLENE M8706,272,RC,27200002,CDM,,,,,,both,,,498.0500,74.7100,CIGNA HEALTHCARE,CIGNA HMO,207.69,,,,,,,128.5500,498.0500,percent of total billed charges,41.7% of $498.05 in Billed Charges for Rev 272 = $207.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 6.0 PROLENE M8706,272,RC,27200002,CDM,,,,,,both,,,498.0500,74.7100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,231.10,,,,,,,128.5500,498.0500,percent of total billed charges,46.4% of $498.05 in Billed Charges for Rev 272 = $231.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 6.0 PROLENE M8706,272,RC,27200002,CDM,,,,,,both,,,498.0500,74.7100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,207.69,,,,,,,128.5500,498.0500,percent of total billed charges,41.7% of $498.05 in Billed Charges for Rev 272 = $207.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 6.0 PROLENE M8706,272,RC,27200002,CDM,,,,,,both,,,498.0500,74.7100,CIGNA HEALTHCARE,CIGNA PPO,207.69,,,,,,,128.5500,498.0500,percent of total billed charges,41.7% of $498.05 in Billed Charges for Rev 272 = $207.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 6.0 PROLENE M8706,272,RC,27200002,CDM,,,,,,both,,,498.0500,74.7100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,448.25,,,,,,,128.5500,498.0500,percent of total billed charges,90% of $498.05 in Billed Charges for Rev 272 = $448.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 6.0 PROLENE M8706,272,RC,27200002,CDM,,,,,,both,,,498.0500,74.7100,MEDCOST,MEDCOST VHN,237.02,,,,,,,128.5500,498.0500,percent of total billed charges,47.59% of $498.05 in Billed Charges for Rev 272 = $237.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 6.0 PROLENE M8706,272,RC,27200002,CDM,,,,,,both,,,498.0500,74.7100,SENTARA HEALTH,SENTARA HEALTH,128.55,,,,,,,128.5500,498.0500,percent of total billed charges,25.81% of $498.05 in Billed Charges for Rev 272 = $128.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 6.0 PROLENE M8706,272,RC,27200002,CDM,,,,,,both,,,498.0500,74.7100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",498.05,,,,,,,128.5500,498.0500,percent of total billed charges,100% of $498.05 in Billed Charges for Rev 272 = $498.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 6.0 PROLENE M8706,272,RC,27200002,CDM,,,,,,both,,,498.0500,74.7100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,249.03,,,,,,,128.5500,498.0500,percent of total billed charges,Rev 272 $498.05 in Billed Charges at 50% = $249.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 6.0 PROLENE M8706,272,RC,27200002,CDM,,,,,,both,,,498.0500,74.7100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,160.87,,,,,,,128.5500,498.0500,other,32.3% of $498.05 in Billed Charges for Rev 272 = $160.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE 6.0 PROLENE M8706,272,RC,27200002,CDM,,,,,,both,,,498.0500,74.7100,UNITED HEALTHCARE,UHC HERITAGE SELECT,152.90,,,,,,,128.5500,498.0500,other,30.7% of $498.05 in Billed Charges for Rev 272 = $152.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE 6.0 PROLENE M8706,272,RC,27200002,CDM,,,,,,both,,,498.0500,74.7100,UNITED HEALTHCARE,UNITED HEALTHCARE,160.87,,,,,,,128.5500,498.0500,percent of total billed charges,32.3% of $498.05 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 6.0 PROLENE M8706,272,RC,27200002,CDM,,,,,,both,,,498.0500,74.7100,WELLCARE,WELLCARE MEDICAID,498.05,,,,,,,128.5500,498.0500,percent of total billed charges,100% of $498.05 in Billed Charges for Rev 272 = $498.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,7580.5800,1137.0900,AETNA,AETNA,3236.91,,,,,,,1956.5500,7580.5800,percent of total billed charges,"42.7% of $7,580.58 in Billed Charges for Rev 272 = $3,236.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,7580.5800,1137.0900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5306.41,,,,,,,1956.5500,7580.5800,percent of total billed charges,"Rev 272 $7,580.58 in Billed Charges at 70% = $5,306.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,7580.5800,1137.0900,CIGNA HEALTHCARE,CIGNA HMO,3161.10,,,,,,,1956.5500,7580.5800,percent of total billed charges,"41.7% of $7,580.58 in Billed Charges for Rev 272 = $3,161.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,7580.5800,1137.0900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3517.39,,,,,,,1956.5500,7580.5800,percent of total billed charges,"46.4% of $7,580.58 in Billed Charges for Rev 272 = $3,517.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,7580.5800,1137.0900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3161.10,,,,,,,1956.5500,7580.5800,percent of total billed charges,"41.7% of $7,580.58 in Billed Charges for Rev 272 = $3,161.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,7580.5800,1137.0900,CIGNA HEALTHCARE,CIGNA PPO,3161.10,,,,,,,1956.5500,7580.5800,percent of total billed charges,"41.7% of $7,580.58 in Billed Charges for Rev 272 = $3,161.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,7580.5800,1137.0900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6822.52,,,,,,,1956.5500,7580.5800,percent of total billed charges,"90% of $7,580.58 in Billed Charges for Rev 272 = $6,822.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,7580.5800,1137.0900,MEDCOST,MEDCOST VHN,3607.60,,,,,,,1956.5500,7580.5800,percent of total billed charges,"47.59% of $7,580.58 in Billed Charges for Rev 272 = $3,607.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,7580.5800,1137.0900,SENTARA HEALTH,SENTARA HEALTH,1956.55,,,,,,,1956.5500,7580.5800,percent of total billed charges,"25.81% of $7,580.58 in Billed Charges for Rev 272 = $1,956.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,7580.5800,1137.0900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7580.58,,,,,,,1956.5500,7580.5800,percent of total billed charges,"100% of $7,580.58 in Billed Charges for Rev 272 = $7,580.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,7580.5800,1137.0900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3790.29,,,,,,,1956.5500,7580.5800,percent of total billed charges,"Rev 272 $7,580.58 in Billed Charges at 50% = $3,790.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,7580.5800,1137.0900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2448.53,,,,,,,1956.5500,7580.5800,other,"32.3% of $7,580.58 in Billed Charges for Rev 272 = $2,448.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,7580.5800,1137.0900,UNITED HEALTHCARE,UHC HERITAGE SELECT,2327.24,,,,,,,1956.5500,7580.5800,other,"30.7% of $7,580.58 in Billed Charges for Rev 272 = $2,327.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,7580.5800,1137.0900,UNITED HEALTHCARE,UNITED HEALTHCARE,2448.53,,,,,,,1956.5500,7580.5800,percent of total billed charges,"32.3% of $7,580.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,7580.5800,1137.0900,WELLCARE,WELLCARE MEDICAID,7580.58,,,,,,,1956.5500,7580.5800,percent of total billed charges,"100% of $7,580.58 in Billed Charges for Rev 272 = $7,580.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,1872.9000,280.9400,AETNA,AETNA,799.73,,,,,,,483.4000,1872.9000,percent of total billed charges,"42.7% of $1,872.90 in Billed Charges for Rev 272 = $799.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,1872.9000,280.9400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1311.03,,,,,,,483.4000,1872.9000,percent of total billed charges,"Rev 272 $1,872.90 in Billed Charges at 70% = $1,311.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,1872.9000,280.9400,CIGNA HEALTHCARE,CIGNA HMO,781.00,,,,,,,483.4000,1872.9000,percent of total billed charges,"41.7% of $1,872.90 in Billed Charges for Rev 272 = $781.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,1872.9000,280.9400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,869.03,,,,,,,483.4000,1872.9000,percent of total billed charges,"46.4% of $1,872.90 in Billed Charges for Rev 272 = $869.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,1872.9000,280.9400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,781.00,,,,,,,483.4000,1872.9000,percent of total billed charges,"41.7% of $1,872.90 in Billed Charges for Rev 272 = $781.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,1872.9000,280.9400,CIGNA HEALTHCARE,CIGNA PPO,781.00,,,,,,,483.4000,1872.9000,percent of total billed charges,"41.7% of $1,872.90 in Billed Charges for Rev 272 = $781.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,1872.9000,280.9400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1685.61,,,,,,,483.4000,1872.9000,percent of total billed charges,"90% of $1,872.90 in Billed Charges for Rev 272 = $1,685.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,1872.9000,280.9400,MEDCOST,MEDCOST VHN,891.31,,,,,,,483.4000,1872.9000,percent of total billed charges,"47.59% of $1,872.90 in Billed Charges for Rev 272 = $891.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,1872.9000,280.9400,SENTARA HEALTH,SENTARA HEALTH,483.40,,,,,,,483.4000,1872.9000,percent of total billed charges,"25.81% of $1,872.90 in Billed Charges for Rev 272 = $483.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,1872.9000,280.9400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1872.90,,,,,,,483.4000,1872.9000,percent of total billed charges,"100% of $1,872.90 in Billed Charges for Rev 272 = $1,872.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,1872.9000,280.9400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,936.45,,,,,,,483.4000,1872.9000,percent of total billed charges,"Rev 272 $1,872.90 in Billed Charges at 50% = $936.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,1872.9000,280.9400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,604.95,,,,,,,483.4000,1872.9000,other,"32.3% of $1,872.90 in Billed Charges for Rev 272 = $604.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,1872.9000,280.9400,UNITED HEALTHCARE,UHC HERITAGE SELECT,574.98,,,,,,,483.4000,1872.9000,other,"30.7% of $1,872.90 in Billed Charges for Rev 272 = $574.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,1872.9000,280.9400,UNITED HEALTHCARE,UNITED HEALTHCARE,604.95,,,,,,,483.4000,1872.9000,percent of total billed charges,"32.3% of $1,872.90 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,1872.9000,280.9400,WELLCARE,WELLCARE MEDICAID,1872.90,,,,,,,483.4000,1872.9000,percent of total billed charges,"100% of $1,872.90 in Billed Charges for Rev 272 = $1,872.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,2187.4500,328.1200,AETNA,AETNA,934.04,,,,,,,564.5800,2187.4500,percent of total billed charges,"42.7% of $2,187.45 in Billed Charges for Rev 272 = $934.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,2187.4500,328.1200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1531.22,,,,,,,564.5800,2187.4500,percent of total billed charges,"Rev 272 $2,187.45 in Billed Charges at 70% = $1,531.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,2187.4500,328.1200,CIGNA HEALTHCARE,CIGNA HMO,912.17,,,,,,,564.5800,2187.4500,percent of total billed charges,"41.7% of $2,187.45 in Billed Charges for Rev 272 = $912.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,2187.4500,328.1200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1014.98,,,,,,,564.5800,2187.4500,percent of total billed charges,"46.4% of $2,187.45 in Billed Charges for Rev 272 = $1,014.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,2187.4500,328.1200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,912.17,,,,,,,564.5800,2187.4500,percent of total billed charges,"41.7% of $2,187.45 in Billed Charges for Rev 272 = $912.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,2187.4500,328.1200,CIGNA HEALTHCARE,CIGNA PPO,912.17,,,,,,,564.5800,2187.4500,percent of total billed charges,"41.7% of $2,187.45 in Billed Charges for Rev 272 = $912.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,2187.4500,328.1200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1968.71,,,,,,,564.5800,2187.4500,percent of total billed charges,"90% of $2,187.45 in Billed Charges for Rev 272 = $1,968.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,2187.4500,328.1200,MEDCOST,MEDCOST VHN,1041.01,,,,,,,564.5800,2187.4500,percent of total billed charges,"47.59% of $2,187.45 in Billed Charges for Rev 272 = $1,041.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,2187.4500,328.1200,SENTARA HEALTH,SENTARA HEALTH,564.58,,,,,,,564.5800,2187.4500,percent of total billed charges,"25.81% of $2,187.45 in Billed Charges for Rev 272 = $564.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,2187.4500,328.1200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2187.45,,,,,,,564.5800,2187.4500,percent of total billed charges,"100% of $2,187.45 in Billed Charges for Rev 272 = $2,187.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,2187.4500,328.1200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1093.73,,,,,,,564.5800,2187.4500,percent of total billed charges,"Rev 272 $2,187.45 in Billed Charges at 50% = $1,093.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,2187.4500,328.1200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,706.55,,,,,,,564.5800,2187.4500,other,"32.3% of $2,187.45 in Billed Charges for Rev 272 = $706.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,2187.4500,328.1200,UNITED HEALTHCARE,UHC HERITAGE SELECT,671.55,,,,,,,564.5800,2187.4500,other,"30.7% of $2,187.45 in Billed Charges for Rev 272 = $671.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,2187.4500,328.1200,UNITED HEALTHCARE,UNITED HEALTHCARE,706.55,,,,,,,564.5800,2187.4500,percent of total billed charges,"32.3% of $2,187.45 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ETS / ARTICICULATING LONG 45MM,272,RC,27200002,CDM,,,,,,both,,,2187.4500,328.1200,WELLCARE,WELLCARE MEDICAID,2187.45,,,,,,,564.5800,2187.4500,percent of total billed charges,"100% of $2,187.45 in Billed Charges for Rev 272 = $2,187.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-3.8 GIA8038S SURPASS SEE LN 106537,272,RC,27200002,CDM,,,,,,both,,,6557.4100,983.6100,AETNA,AETNA,2800.01,,,,,,,1692.4700,6557.4100,percent of total billed charges,"42.7% of $6,557.41 in Billed Charges for Rev 272 = $2,800.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-3.8 GIA8038S SURPASS SEE LN 106537,272,RC,27200002,CDM,,,,,,both,,,6557.4100,983.6100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4590.19,,,,,,,1692.4700,6557.4100,percent of total billed charges,"Rev 272 $6,557.41 in Billed Charges at 70% = $4,590.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-3.8 GIA8038S SURPASS SEE LN 106537,272,RC,27200002,CDM,,,,,,both,,,6557.4100,983.6100,CIGNA HEALTHCARE,CIGNA HMO,2734.44,,,,,,,1692.4700,6557.4100,percent of total billed charges,"41.7% of $6,557.41 in Billed Charges for Rev 272 = $2,734.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-3.8 GIA8038S SURPASS SEE LN 106537,272,RC,27200002,CDM,,,,,,both,,,6557.4100,983.6100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3042.64,,,,,,,1692.4700,6557.4100,percent of total billed charges,"46.4% of $6,557.41 in Billed Charges for Rev 272 = $3,042.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-3.8 GIA8038S SURPASS SEE LN 106537,272,RC,27200002,CDM,,,,,,both,,,6557.4100,983.6100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2734.44,,,,,,,1692.4700,6557.4100,percent of total billed charges,"41.7% of $6,557.41 in Billed Charges for Rev 272 = $2,734.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-3.8 GIA8038S SURPASS SEE LN 106537,272,RC,27200002,CDM,,,,,,both,,,6557.4100,983.6100,CIGNA HEALTHCARE,CIGNA PPO,2734.44,,,,,,,1692.4700,6557.4100,percent of total billed charges,"41.7% of $6,557.41 in Billed Charges for Rev 272 = $2,734.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-3.8 GIA8038S SURPASS SEE LN 106537,272,RC,27200002,CDM,,,,,,both,,,6557.4100,983.6100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5901.67,,,,,,,1692.4700,6557.4100,percent of total billed charges,"90% of $6,557.41 in Billed Charges for Rev 272 = $5,901.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-3.8 GIA8038S SURPASS SEE LN 106537,272,RC,27200002,CDM,,,,,,both,,,6557.4100,983.6100,MEDCOST,MEDCOST VHN,3120.67,,,,,,,1692.4700,6557.4100,percent of total billed charges,"47.59% of $6,557.41 in Billed Charges for Rev 272 = $3,120.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-3.8 GIA8038S SURPASS SEE LN 106537,272,RC,27200002,CDM,,,,,,both,,,6557.4100,983.6100,SENTARA HEALTH,SENTARA HEALTH,1692.47,,,,,,,1692.4700,6557.4100,percent of total billed charges,"25.81% of $6,557.41 in Billed Charges for Rev 272 = $1,692.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-3.8 GIA8038S SURPASS SEE LN 106537,272,RC,27200002,CDM,,,,,,both,,,6557.4100,983.6100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6557.41,,,,,,,1692.4700,6557.4100,percent of total billed charges,"100% of $6,557.41 in Billed Charges for Rev 272 = $6,557.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-3.8 GIA8038S SURPASS SEE LN 106537,272,RC,27200002,CDM,,,,,,both,,,6557.4100,983.6100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3278.71,,,,,,,1692.4700,6557.4100,percent of total billed charges,"Rev 272 $6,557.41 in Billed Charges at 50% = $3,278.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-3.8 GIA8038S SURPASS SEE LN 106537,272,RC,27200002,CDM,,,,,,both,,,6557.4100,983.6100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2118.04,,,,,,,1692.4700,6557.4100,other,"32.3% of $6,557.41 in Billed Charges for Rev 272 = $2,118.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER GIA 80-3.8 GIA8038S SURPASS SEE LN 106537,272,RC,27200002,CDM,,,,,,both,,,6557.4100,983.6100,UNITED HEALTHCARE,UHC HERITAGE SELECT,2013.12,,,,,,,1692.4700,6557.4100,other,"30.7% of $6,557.41 in Billed Charges for Rev 272 = $2,013.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER GIA 80-3.8 GIA8038S SURPASS SEE LN 106537,272,RC,27200002,CDM,,,,,,both,,,6557.4100,983.6100,UNITED HEALTHCARE,UNITED HEALTHCARE,2118.04,,,,,,,1692.4700,6557.4100,percent of total billed charges,"32.3% of $6,557.41 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80-3.8 GIA8038S SURPASS SEE LN 106537,272,RC,27200002,CDM,,,,,,both,,,6557.4100,983.6100,WELLCARE,WELLCARE MEDICAID,6557.41,,,,,,,1692.4700,6557.4100,percent of total billed charges,"100% of $6,557.41 in Billed Charges for Rev 272 = $6,557.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CARTRIDGE ETHIBOND FOR PROXISURE 2-0 48INCH 122CM,272,RC,,,,,,,,both,,,947.1800,142.0800,AETNA,AETNA,404.45,,,,,,,244.4700,947.1800,percent of total billed charges,42.7% of $947.18 in Billed Charges for Rev 272 = $404.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CARTRIDGE ETHIBOND FOR PROXISURE 2-0 48INCH 122CM,272,RC,,,,,,,,both,,,947.1800,142.0800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,663.03,,,,,,,244.4700,947.1800,percent of total billed charges,Rev 272 $947.18 in Billed Charges at 70% = $663.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CARTRIDGE ETHIBOND FOR PROXISURE 2-0 48INCH 122CM,272,RC,,,,,,,,both,,,947.1800,142.0800,CIGNA HEALTHCARE,CIGNA HMO,394.97,,,,,,,244.4700,947.1800,percent of total billed charges,41.7% of $947.18 in Billed Charges for Rev 272 = $394.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CARTRIDGE ETHIBOND FOR PROXISURE 2-0 48INCH 122CM,272,RC,,,,,,,,both,,,947.1800,142.0800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,439.49,,,,,,,244.4700,947.1800,percent of total billed charges,46.4% of $947.18 in Billed Charges for Rev 272 = $439.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CARTRIDGE ETHIBOND FOR PROXISURE 2-0 48INCH 122CM,272,RC,,,,,,,,both,,,947.1800,142.0800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,394.97,,,,,,,244.4700,947.1800,percent of total billed charges,41.7% of $947.18 in Billed Charges for Rev 272 = $394.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CARTRIDGE ETHIBOND FOR PROXISURE 2-0 48INCH 122CM,272,RC,,,,,,,,both,,,947.1800,142.0800,CIGNA HEALTHCARE,CIGNA PPO,394.97,,,,,,,244.4700,947.1800,percent of total billed charges,41.7% of $947.18 in Billed Charges for Rev 272 = $394.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CARTRIDGE ETHIBOND FOR PROXISURE 2-0 48INCH 122CM,272,RC,,,,,,,,both,,,947.1800,142.0800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,852.46,,,,,,,244.4700,947.1800,percent of total billed charges,90% of $947.18 in Billed Charges for Rev 272 = $852.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CARTRIDGE ETHIBOND FOR PROXISURE 2-0 48INCH 122CM,272,RC,,,,,,,,both,,,947.1800,142.0800,MEDCOST,MEDCOST VHN,450.76,,,,,,,244.4700,947.1800,percent of total billed charges,47.59% of $947.18 in Billed Charges for Rev 272 = $450.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CARTRIDGE ETHIBOND FOR PROXISURE 2-0 48INCH 122CM,272,RC,,,,,,,,both,,,947.1800,142.0800,SENTARA HEALTH,SENTARA HEALTH,244.47,,,,,,,244.4700,947.1800,percent of total billed charges,25.81% of $947.18 in Billed Charges for Rev 272 = $244.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CARTRIDGE ETHIBOND FOR PROXISURE 2-0 48INCH 122CM,272,RC,,,,,,,,both,,,947.1800,142.0800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",947.18,,,,,,,244.4700,947.1800,percent of total billed charges,100% of $947.18 in Billed Charges for Rev 272 = $947.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CARTRIDGE ETHIBOND FOR PROXISURE 2-0 48INCH 122CM,272,RC,,,,,,,,both,,,947.1800,142.0800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,473.59,,,,,,,244.4700,947.1800,percent of total billed charges,Rev 272 $947.18 in Billed Charges at 50% = $473.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CARTRIDGE ETHIBOND FOR PROXISURE 2-0 48INCH 122CM,272,RC,,,,,,,,both,,,947.1800,142.0800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,305.94,,,,,,,244.4700,947.1800,other,32.3% of $947.18 in Billed Charges for Rev 272 = $305.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE CARTRIDGE ETHIBOND FOR PROXISURE 2-0 48INCH 122CM,272,RC,,,,,,,,both,,,947.1800,142.0800,UNITED HEALTHCARE,UHC HERITAGE SELECT,290.78,,,,,,,244.4700,947.1800,other,30.7% of $947.18 in Billed Charges for Rev 272 = $290.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE CARTRIDGE ETHIBOND FOR PROXISURE 2-0 48INCH 122CM,272,RC,,,,,,,,both,,,947.1800,142.0800,UNITED HEALTHCARE,UNITED HEALTHCARE,305.94,,,,,,,244.4700,947.1800,percent of total billed charges,32.3% of $947.18 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CARTRIDGE ETHIBOND FOR PROXISURE 2-0 48INCH 122CM,272,RC,,,,,,,,both,,,947.1800,142.0800,WELLCARE,WELLCARE MEDICAID,947.18,,,,,,,244.4700,947.1800,percent of total billed charges,100% of $947.18 in Billed Charges for Rev 272 = $947.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2053.4600,308.0200,AETNA,AETNA,876.83,,,,,,,530.0000,2053.4600,percent of total billed charges,"42.7% of $2,053.46 in Billed Charges for Rev 272 = $876.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2053.4600,308.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1437.42,,,,,,,530.0000,2053.4600,percent of total billed charges,"Rev 272 $2,053.46 in Billed Charges at 70% = $1,437.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2053.4600,308.0200,CIGNA HEALTHCARE,CIGNA HMO,856.29,,,,,,,530.0000,2053.4600,percent of total billed charges,"41.7% of $2,053.46 in Billed Charges for Rev 272 = $856.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2053.4600,308.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,952.81,,,,,,,530.0000,2053.4600,percent of total billed charges,"46.4% of $2,053.46 in Billed Charges for Rev 272 = $952.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2053.4600,308.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,856.29,,,,,,,530.0000,2053.4600,percent of total billed charges,"41.7% of $2,053.46 in Billed Charges for Rev 272 = $856.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2053.4600,308.0200,CIGNA HEALTHCARE,CIGNA PPO,856.29,,,,,,,530.0000,2053.4600,percent of total billed charges,"41.7% of $2,053.46 in Billed Charges for Rev 272 = $856.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2053.4600,308.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1848.11,,,,,,,530.0000,2053.4600,percent of total billed charges,"90% of $2,053.46 in Billed Charges for Rev 272 = $1,848.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2053.4600,308.0200,MEDCOST,MEDCOST VHN,977.24,,,,,,,530.0000,2053.4600,percent of total billed charges,"47.59% of $2,053.46 in Billed Charges for Rev 272 = $977.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2053.4600,308.0200,SENTARA HEALTH,SENTARA HEALTH,530.00,,,,,,,530.0000,2053.4600,percent of total billed charges,"25.81% of $2,053.46 in Billed Charges for Rev 272 = $530.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2053.4600,308.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2053.46,,,,,,,530.0000,2053.4600,percent of total billed charges,"100% of $2,053.46 in Billed Charges for Rev 272 = $2,053.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2053.4600,308.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1026.73,,,,,,,530.0000,2053.4600,percent of total billed charges,"Rev 272 $2,053.46 in Billed Charges at 50% = $1,026.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2053.4600,308.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,663.27,,,,,,,530.0000,2053.4600,other,"32.3% of $2,053.46 in Billed Charges for Rev 272 = $663.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2053.4600,308.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,630.41,,,,,,,530.0000,2053.4600,other,"30.7% of $2,053.46 in Billed Charges for Rev 272 = $630.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2053.4600,308.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,663.27,,,,,,,530.0000,2053.4600,percent of total billed charges,"32.3% of $2,053.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2053.4600,308.0200,WELLCARE,WELLCARE MEDICAID,2053.46,,,,,,,530.0000,2053.4600,percent of total billed charges,"100% of $2,053.46 in Billed Charges for Rev 272 = $2,053.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD,272,RC,,,,,,,,both,,,23511.5800,3526.7400,AETNA,AETNA,10039.44,,,,,,,6068.3400,23511.5800,percent of total billed charges,"42.7% of $23,511.58 in Billed Charges for Rev 272 = $10,039.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD,272,RC,,,,,,,,both,,,23511.5800,3526.7400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,16458.11,,,,,,,6068.3400,23511.5800,percent of total billed charges,"Rev 272 $23,511.58 in Billed Charges at 70% = $16,458.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD,272,RC,,,,,,,,both,,,23511.5800,3526.7400,CIGNA HEALTHCARE,CIGNA HMO,9804.33,,,,,,,6068.3400,23511.5800,percent of total billed charges,"41.7% of $23,511.58 in Billed Charges for Rev 272 = $9,804.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD,272,RC,,,,,,,,both,,,23511.5800,3526.7400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10909.37,,,,,,,6068.3400,23511.5800,percent of total billed charges,"46.4% of $23,511.58 in Billed Charges for Rev 272 = $10,909.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD,272,RC,,,,,,,,both,,,23511.5800,3526.7400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9804.33,,,,,,,6068.3400,23511.5800,percent of total billed charges,"41.7% of $23,511.58 in Billed Charges for Rev 272 = $9,804.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD,272,RC,,,,,,,,both,,,23511.5800,3526.7400,CIGNA HEALTHCARE,CIGNA PPO,9804.33,,,,,,,6068.3400,23511.5800,percent of total billed charges,"41.7% of $23,511.58 in Billed Charges for Rev 272 = $9,804.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD,272,RC,,,,,,,,both,,,23511.5800,3526.7400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,21160.42,,,,,,,6068.3400,23511.5800,percent of total billed charges,"90% of $23,511.58 in Billed Charges for Rev 272 = $21,160.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD,272,RC,,,,,,,,both,,,23511.5800,3526.7400,MEDCOST,MEDCOST VHN,11189.16,,,,,,,6068.3400,23511.5800,percent of total billed charges,"47.59% of $23,511.58 in Billed Charges for Rev 272 = $11,189.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD,272,RC,,,,,,,,both,,,23511.5800,3526.7400,SENTARA HEALTH,SENTARA HEALTH,6068.34,,,,,,,6068.3400,23511.5800,percent of total billed charges,"25.81% of $23,511.58 in Billed Charges for Rev 272 = $6,068.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD,272,RC,,,,,,,,both,,,23511.5800,3526.7400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",23511.58,,,,,,,6068.3400,23511.5800,percent of total billed charges,"100% of $23,511.58 in Billed Charges for Rev 272 = $23,511.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD,272,RC,,,,,,,,both,,,23511.5800,3526.7400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11755.79,,,,,,,6068.3400,23511.5800,percent of total billed charges,"Rev 272 $23,511.58 in Billed Charges at 50% = $11,755.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD,272,RC,,,,,,,,both,,,23511.5800,3526.7400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7594.24,,,,,,,6068.3400,23511.5800,other,"32.3% of $23,511.58 in Billed Charges for Rev 272 = $7,594.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE DYNACORD,272,RC,,,,,,,,both,,,23511.5800,3526.7400,UNITED HEALTHCARE,UHC HERITAGE SELECT,7218.06,,,,,,,6068.3400,23511.5800,other,"30.7% of $23,511.58 in Billed Charges for Rev 272 = $7,218.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE DYNACORD,272,RC,,,,,,,,both,,,23511.5800,3526.7400,UNITED HEALTHCARE,UNITED HEALTHCARE,7594.24,,,,,,,6068.3400,23511.5800,percent of total billed charges,"32.3% of $23,511.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD,272,RC,,,,,,,,both,,,23511.5800,3526.7400,WELLCARE,WELLCARE MEDICAID,23511.58,,,,,,,6068.3400,23511.5800,percent of total billed charges,"100% of $23,511.58 in Billed Charges for Rev 272 = $23,511.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD W/OS-6 NEEDLES,272,RC,,,,,,,,both,,,1959.3000,293.9000,AETNA,AETNA,836.62,,,,,,,505.7000,1959.3000,percent of total billed charges,"42.7% of $1,959.30 in Billed Charges for Rev 272 = $836.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD W/OS-6 NEEDLES,272,RC,,,,,,,,both,,,1959.3000,293.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1371.51,,,,,,,505.7000,1959.3000,percent of total billed charges,"Rev 272 $1,959.30 in Billed Charges at 70% = $1,371.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD W/OS-6 NEEDLES,272,RC,,,,,,,,both,,,1959.3000,293.9000,CIGNA HEALTHCARE,CIGNA HMO,817.03,,,,,,,505.7000,1959.3000,percent of total billed charges,"41.7% of $1,959.30 in Billed Charges for Rev 272 = $817.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD W/OS-6 NEEDLES,272,RC,,,,,,,,both,,,1959.3000,293.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,909.12,,,,,,,505.7000,1959.3000,percent of total billed charges,"46.4% of $1,959.30 in Billed Charges for Rev 272 = $909.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD W/OS-6 NEEDLES,272,RC,,,,,,,,both,,,1959.3000,293.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,817.03,,,,,,,505.7000,1959.3000,percent of total billed charges,"41.7% of $1,959.30 in Billed Charges for Rev 272 = $817.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD W/OS-6 NEEDLES,272,RC,,,,,,,,both,,,1959.3000,293.9000,CIGNA HEALTHCARE,CIGNA PPO,817.03,,,,,,,505.7000,1959.3000,percent of total billed charges,"41.7% of $1,959.30 in Billed Charges for Rev 272 = $817.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD W/OS-6 NEEDLES,272,RC,,,,,,,,both,,,1959.3000,293.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1763.37,,,,,,,505.7000,1959.3000,percent of total billed charges,"90% of $1,959.30 in Billed Charges for Rev 272 = $1,763.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD W/OS-6 NEEDLES,272,RC,,,,,,,,both,,,1959.3000,293.9000,MEDCOST,MEDCOST VHN,932.43,,,,,,,505.7000,1959.3000,percent of total billed charges,"47.59% of $1,959.30 in Billed Charges for Rev 272 = $932.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD W/OS-6 NEEDLES,272,RC,,,,,,,,both,,,1959.3000,293.9000,SENTARA HEALTH,SENTARA HEALTH,505.70,,,,,,,505.7000,1959.3000,percent of total billed charges,"25.81% of $1,959.30 in Billed Charges for Rev 272 = $505.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD W/OS-6 NEEDLES,272,RC,,,,,,,,both,,,1959.3000,293.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1959.30,,,,,,,505.7000,1959.3000,percent of total billed charges,"100% of $1,959.30 in Billed Charges for Rev 272 = $1,959.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD W/OS-6 NEEDLES,272,RC,,,,,,,,both,,,1959.3000,293.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,979.65,,,,,,,505.7000,1959.3000,percent of total billed charges,"Rev 272 $1,959.30 in Billed Charges at 50% = $979.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD W/OS-6 NEEDLES,272,RC,,,,,,,,both,,,1959.3000,293.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,632.85,,,,,,,505.7000,1959.3000,other,"32.3% of $1,959.30 in Billed Charges for Rev 272 = $632.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE DYNACORD W/OS-6 NEEDLES,272,RC,,,,,,,,both,,,1959.3000,293.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,601.51,,,,,,,505.7000,1959.3000,other,"30.7% of $1,959.30 in Billed Charges for Rev 272 = $601.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE DYNACORD W/OS-6 NEEDLES,272,RC,,,,,,,,both,,,1959.3000,293.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,632.85,,,,,,,505.7000,1959.3000,percent of total billed charges,"32.3% of $1,959.30 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNACORD W/OS-6 NEEDLES,272,RC,,,,,,,,both,,,1959.3000,293.9000,WELLCARE,WELLCARE MEDICAID,1959.30,,,,,,,505.7000,1959.3000,percent of total billed charges,"100% of $1,959.30 in Billed Charges for Rev 272 = $1,959.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUPPORT ATHLETIC SM,270,RC,,,,,,,,both,,,126.0100,18.9000,AETNA,AETNA,53.81,,,,,,,32.5200,126.0100,percent of total billed charges,42.7% of $126.01 in Billed Charges for Rev 270 = $53.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUPPORT ATHLETIC SM,270,RC,,,,,,,,both,,,126.0100,18.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,88.21,,,,,,,32.5200,126.0100,percent of total billed charges,Rev 270 $126.01 in Billed Charges at 70% = $88.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUPPORT ATHLETIC SM,270,RC,,,,,,,,both,,,126.0100,18.9000,CIGNA HEALTHCARE,CIGNA HMO,52.55,,,,,,,32.5200,126.0100,percent of total billed charges,41.7% of $126.01 in Billed Charges for Rev 270 = $52.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUPPORT ATHLETIC SM,270,RC,,,,,,,,both,,,126.0100,18.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,58.47,,,,,,,32.5200,126.0100,percent of total billed charges,46.4% of $126.01 in Billed Charges for Rev 270 = $58.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUPPORT ATHLETIC SM,270,RC,,,,,,,,both,,,126.0100,18.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,52.55,,,,,,,32.5200,126.0100,percent of total billed charges,41.7% of $126.01 in Billed Charges for Rev 270 = $52.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUPPORT ATHLETIC SM,270,RC,,,,,,,,both,,,126.0100,18.9000,CIGNA HEALTHCARE,CIGNA PPO,52.55,,,,,,,32.5200,126.0100,percent of total billed charges,41.7% of $126.01 in Billed Charges for Rev 270 = $52.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUPPORT ATHLETIC SM,270,RC,,,,,,,,both,,,126.0100,18.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,113.41,,,,,,,32.5200,126.0100,percent of total billed charges,90% of $126.01 in Billed Charges for Rev 270 = $113.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUPPORT ATHLETIC SM,270,RC,,,,,,,,both,,,126.0100,18.9000,MEDCOST,MEDCOST VHN,59.97,,,,,,,32.5200,126.0100,percent of total billed charges,47.59% of $126.01 in Billed Charges for Rev 270 = $59.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUPPORT ATHLETIC SM,270,RC,,,,,,,,both,,,126.0100,18.9000,SENTARA HEALTH,SENTARA HEALTH,32.52,,,,,,,32.5200,126.0100,percent of total billed charges,25.81% of $126.01 in Billed Charges for Rev 270 = $32.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUPPORT ATHLETIC SM,270,RC,,,,,,,,both,,,126.0100,18.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",126.01,,,,,,,32.5200,126.0100,percent of total billed charges,100% of $126.01 in Billed Charges for Rev 270 = $126.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUPPORT ATHLETIC SM,270,RC,,,,,,,,both,,,126.0100,18.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,63.01,,,,,,,32.5200,126.0100,percent of total billed charges,Rev 270 $126.01 in Billed Charges at 50% = $63.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUPPORT ATHLETIC SM,270,RC,,,,,,,,both,,,126.0100,18.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,40.70,,,,,,,32.5200,126.0100,other,32.3% of $126.01 in Billed Charges for Rev 270 = $40.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUPPORT ATHLETIC SM,270,RC,,,,,,,,both,,,126.0100,18.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,38.69,,,,,,,32.5200,126.0100,other,30.7% of $126.01 in Billed Charges for Rev 270 = $38.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUPPORT ATHLETIC SM,270,RC,,,,,,,,both,,,126.0100,18.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,40.70,,,,,,,32.5200,126.0100,percent of total billed charges,32.3% of $126.01 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUPPORT ATHLETIC SM,270,RC,,,,,,,,both,,,126.0100,18.9000,WELLCARE,WELLCARE MEDICAID,126.01,,,,,,,32.5200,126.0100,percent of total billed charges,100% of $126.01 in Billed Charges for Rev 270 = $126.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,544.7900,81.7200,AETNA,AETNA,232.63,,,,,,,140.6100,544.7900,percent of total billed charges,42.7% of $544.79 in Billed Charges for Rev 272 = $232.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,544.7900,81.7200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,381.35,,,,,,,140.6100,544.7900,percent of total billed charges,Rev 272 $544.79 in Billed Charges at 70% = $381.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,544.7900,81.7200,CIGNA HEALTHCARE,CIGNA HMO,227.18,,,,,,,140.6100,544.7900,percent of total billed charges,41.7% of $544.79 in Billed Charges for Rev 272 = $227.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,544.7900,81.7200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,252.78,,,,,,,140.6100,544.7900,percent of total billed charges,46.4% of $544.79 in Billed Charges for Rev 272 = $252.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,544.7900,81.7200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,227.18,,,,,,,140.6100,544.7900,percent of total billed charges,41.7% of $544.79 in Billed Charges for Rev 272 = $227.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,544.7900,81.7200,CIGNA HEALTHCARE,CIGNA PPO,227.18,,,,,,,140.6100,544.7900,percent of total billed charges,41.7% of $544.79 in Billed Charges for Rev 272 = $227.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,544.7900,81.7200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,490.31,,,,,,,140.6100,544.7900,percent of total billed charges,90% of $544.79 in Billed Charges for Rev 272 = $490.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,544.7900,81.7200,MEDCOST,MEDCOST VHN,259.27,,,,,,,140.6100,544.7900,percent of total billed charges,47.59% of $544.79 in Billed Charges for Rev 272 = $259.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,544.7900,81.7200,SENTARA HEALTH,SENTARA HEALTH,140.61,,,,,,,140.6100,544.7900,percent of total billed charges,25.81% of $544.79 in Billed Charges for Rev 272 = $140.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,544.7900,81.7200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",544.79,,,,,,,140.6100,544.7900,percent of total billed charges,100% of $544.79 in Billed Charges for Rev 272 = $544.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,544.7900,81.7200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,272.40,,,,,,,140.6100,544.7900,percent of total billed charges,Rev 272 $544.79 in Billed Charges at 50% = $272.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,544.7900,81.7200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,175.97,,,,,,,140.6100,544.7900,other,32.3% of $544.79 in Billed Charges for Rev 272 = $175.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,544.7900,81.7200,UNITED HEALTHCARE,UHC HERITAGE SELECT,167.25,,,,,,,140.6100,544.7900,other,30.7% of $544.79 in Billed Charges for Rev 272 = $167.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,544.7900,81.7200,UNITED HEALTHCARE,UNITED HEALTHCARE,175.97,,,,,,,140.6100,544.7900,percent of total billed charges,32.3% of $544.79 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SURGFLO MATRIX,272,RC,27200002,CDM,,,,,,both,,,544.7900,81.7200,WELLCARE,WELLCARE MEDICAID,544.79,,,,,,,140.6100,544.7900,percent of total billed charges,100% of $544.79 in Billed Charges for Rev 272 = $544.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,558.0700,83.7100,AETNA,AETNA,238.30,,,,,,,144.0400,558.0700,percent of total billed charges,42.7% of $558.07 in Billed Charges for Rev 272 = $238.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,558.0700,83.7100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,390.65,,,,,,,144.0400,558.0700,percent of total billed charges,Rev 272 $558.07 in Billed Charges at 70% = $390.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,558.0700,83.7100,CIGNA HEALTHCARE,CIGNA HMO,232.72,,,,,,,144.0400,558.0700,percent of total billed charges,41.7% of $558.07 in Billed Charges for Rev 272 = $232.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,558.0700,83.7100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,258.94,,,,,,,144.0400,558.0700,percent of total billed charges,46.4% of $558.07 in Billed Charges for Rev 272 = $258.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,558.0700,83.7100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,232.72,,,,,,,144.0400,558.0700,percent of total billed charges,41.7% of $558.07 in Billed Charges for Rev 272 = $232.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,558.0700,83.7100,CIGNA HEALTHCARE,CIGNA PPO,232.72,,,,,,,144.0400,558.0700,percent of total billed charges,41.7% of $558.07 in Billed Charges for Rev 272 = $232.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,558.0700,83.7100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,502.26,,,,,,,144.0400,558.0700,percent of total billed charges,90% of $558.07 in Billed Charges for Rev 272 = $502.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,558.0700,83.7100,MEDCOST,MEDCOST VHN,265.59,,,,,,,144.0400,558.0700,percent of total billed charges,47.59% of $558.07 in Billed Charges for Rev 272 = $265.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,558.0700,83.7100,SENTARA HEALTH,SENTARA HEALTH,144.04,,,,,,,144.0400,558.0700,percent of total billed charges,25.81% of $558.07 in Billed Charges for Rev 272 = $144.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,558.0700,83.7100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",558.07,,,,,,,144.0400,558.0700,percent of total billed charges,100% of $558.07 in Billed Charges for Rev 272 = $558.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,558.0700,83.7100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,279.04,,,,,,,144.0400,558.0700,percent of total billed charges,Rev 272 $558.07 in Billed Charges at 50% = $279.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,558.0700,83.7100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,180.26,,,,,,,144.0400,558.0700,other,32.3% of $558.07 in Billed Charges for Rev 272 = $180.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,558.0700,83.7100,UNITED HEALTHCARE,UHC HERITAGE SELECT,171.33,,,,,,,144.0400,558.0700,other,30.7% of $558.07 in Billed Charges for Rev 272 = $171.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,558.0700,83.7100,UNITED HEALTHCARE,UNITED HEALTHCARE,180.26,,,,,,,144.0400,558.0700,percent of total billed charges,32.3% of $558.07 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE 7.0 PROLENE M8702,272,RC,27200002,CDM,,,,,,both,,,558.0700,83.7100,WELLCARE,WELLCARE MEDICAID,558.07,,,,,,,144.0400,558.0700,percent of total billed charges,100% of $558.07 in Billed Charges for Rev 272 = $558.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE VICRYL 6-0 S-14 18IN,272,RC,27200002,CDM,,,,,,both,,,1601.8500,240.2800,AETNA,AETNA,683.99,,,,,,,413.4400,1601.8500,percent of total billed charges,"42.7% of $1,601.85 in Billed Charges for Rev 272 = $683.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 6-0 S-14 18IN,272,RC,27200002,CDM,,,,,,both,,,1601.8500,240.2800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1121.30,,,,,,,413.4400,1601.8500,percent of total billed charges,"Rev 272 $1,601.85 in Billed Charges at 70% = $1,121.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 6-0 S-14 18IN,272,RC,27200002,CDM,,,,,,both,,,1601.8500,240.2800,CIGNA HEALTHCARE,CIGNA HMO,667.97,,,,,,,413.4400,1601.8500,percent of total billed charges,"41.7% of $1,601.85 in Billed Charges for Rev 272 = $667.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 6-0 S-14 18IN,272,RC,27200002,CDM,,,,,,both,,,1601.8500,240.2800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,743.26,,,,,,,413.4400,1601.8500,percent of total billed charges,"46.4% of $1,601.85 in Billed Charges for Rev 272 = $743.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 6-0 S-14 18IN,272,RC,27200002,CDM,,,,,,both,,,1601.8500,240.2800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,667.97,,,,,,,413.4400,1601.8500,percent of total billed charges,"41.7% of $1,601.85 in Billed Charges for Rev 272 = $667.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 6-0 S-14 18IN,272,RC,27200002,CDM,,,,,,both,,,1601.8500,240.2800,CIGNA HEALTHCARE,CIGNA PPO,667.97,,,,,,,413.4400,1601.8500,percent of total billed charges,"41.7% of $1,601.85 in Billed Charges for Rev 272 = $667.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 6-0 S-14 18IN,272,RC,27200002,CDM,,,,,,both,,,1601.8500,240.2800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1441.67,,,,,,,413.4400,1601.8500,percent of total billed charges,"90% of $1,601.85 in Billed Charges for Rev 272 = $1,441.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 6-0 S-14 18IN,272,RC,27200002,CDM,,,,,,both,,,1601.8500,240.2800,MEDCOST,MEDCOST VHN,762.32,,,,,,,413.4400,1601.8500,percent of total billed charges,"47.59% of $1,601.85 in Billed Charges for Rev 272 = $762.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 6-0 S-14 18IN,272,RC,27200002,CDM,,,,,,both,,,1601.8500,240.2800,SENTARA HEALTH,SENTARA HEALTH,413.44,,,,,,,413.4400,1601.8500,percent of total billed charges,"25.81% of $1,601.85 in Billed Charges for Rev 272 = $413.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 6-0 S-14 18IN,272,RC,27200002,CDM,,,,,,both,,,1601.8500,240.2800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1601.85,,,,,,,413.4400,1601.8500,percent of total billed charges,"100% of $1,601.85 in Billed Charges for Rev 272 = $1,601.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 6-0 S-14 18IN,272,RC,27200002,CDM,,,,,,both,,,1601.8500,240.2800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,800.93,,,,,,,413.4400,1601.8500,percent of total billed charges,"Rev 272 $1,601.85 in Billed Charges at 50% = $800.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 6-0 S-14 18IN,272,RC,27200002,CDM,,,,,,both,,,1601.8500,240.2800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,517.40,,,,,,,413.4400,1601.8500,other,"32.3% of $1,601.85 in Billed Charges for Rev 272 = $517.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE VICRYL 6-0 S-14 18IN,272,RC,27200002,CDM,,,,,,both,,,1601.8500,240.2800,UNITED HEALTHCARE,UHC HERITAGE SELECT,491.77,,,,,,,413.4400,1601.8500,other,"30.7% of $1,601.85 in Billed Charges for Rev 272 = $491.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE VICRYL 6-0 S-14 18IN,272,RC,27200002,CDM,,,,,,both,,,1601.8500,240.2800,UNITED HEALTHCARE,UNITED HEALTHCARE,517.40,,,,,,,413.4400,1601.8500,percent of total billed charges,"32.3% of $1,601.85 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 6-0 S-14 18IN,272,RC,27200002,CDM,,,,,,both,,,1601.8500,240.2800,WELLCARE,WELLCARE MEDICAID,1601.85,,,,,,,413.4400,1601.8500,percent of total billed charges,"100% of $1,601.85 in Billed Charges for Rev 272 = $1,601.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE MENISCUS REPAIR,272,RC,27200002,CDM,,,,,,both,,,1420.8300,213.1200,AETNA,AETNA,606.69,,,,,,,366.7200,1420.8300,percent of total billed charges,"42.7% of $1,420.83 in Billed Charges for Rev 272 = $606.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE MENISCUS REPAIR,272,RC,27200002,CDM,,,,,,both,,,1420.8300,213.1200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,994.58,,,,,,,366.7200,1420.8300,percent of total billed charges,"Rev 272 $1,420.83 in Billed Charges at 70% = $994.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE MENISCUS REPAIR,272,RC,27200002,CDM,,,,,,both,,,1420.8300,213.1200,CIGNA HEALTHCARE,CIGNA HMO,592.49,,,,,,,366.7200,1420.8300,percent of total billed charges,"41.7% of $1,420.83 in Billed Charges for Rev 272 = $592.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE MENISCUS REPAIR,272,RC,27200002,CDM,,,,,,both,,,1420.8300,213.1200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,659.27,,,,,,,366.7200,1420.8300,percent of total billed charges,"46.4% of $1,420.83 in Billed Charges for Rev 272 = $659.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE MENISCUS REPAIR,272,RC,27200002,CDM,,,,,,both,,,1420.8300,213.1200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,592.49,,,,,,,366.7200,1420.8300,percent of total billed charges,"41.7% of $1,420.83 in Billed Charges for Rev 272 = $592.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE MENISCUS REPAIR,272,RC,27200002,CDM,,,,,,both,,,1420.8300,213.1200,CIGNA HEALTHCARE,CIGNA PPO,592.49,,,,,,,366.7200,1420.8300,percent of total billed charges,"41.7% of $1,420.83 in Billed Charges for Rev 272 = $592.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE MENISCUS REPAIR,272,RC,27200002,CDM,,,,,,both,,,1420.8300,213.1200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1278.75,,,,,,,366.7200,1420.8300,percent of total billed charges,"90% of $1,420.83 in Billed Charges for Rev 272 = $1,278.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE MENISCUS REPAIR,272,RC,27200002,CDM,,,,,,both,,,1420.8300,213.1200,MEDCOST,MEDCOST VHN,676.17,,,,,,,366.7200,1420.8300,percent of total billed charges,"47.59% of $1,420.83 in Billed Charges for Rev 272 = $676.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE MENISCUS REPAIR,272,RC,27200002,CDM,,,,,,both,,,1420.8300,213.1200,SENTARA HEALTH,SENTARA HEALTH,366.72,,,,,,,366.7200,1420.8300,percent of total billed charges,"25.81% of $1,420.83 in Billed Charges for Rev 272 = $366.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE MENISCUS REPAIR,272,RC,27200002,CDM,,,,,,both,,,1420.8300,213.1200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1420.83,,,,,,,366.7200,1420.8300,percent of total billed charges,"100% of $1,420.83 in Billed Charges for Rev 272 = $1,420.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE MENISCUS REPAIR,272,RC,27200002,CDM,,,,,,both,,,1420.8300,213.1200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,710.42,,,,,,,366.7200,1420.8300,percent of total billed charges,"Rev 272 $1,420.83 in Billed Charges at 50% = $710.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE MENISCUS REPAIR,272,RC,27200002,CDM,,,,,,both,,,1420.8300,213.1200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,458.93,,,,,,,366.7200,1420.8300,other,"32.3% of $1,420.83 in Billed Charges for Rev 272 = $458.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURETAPE MENISCUS REPAIR,272,RC,27200002,CDM,,,,,,both,,,1420.8300,213.1200,UNITED HEALTHCARE,UHC HERITAGE SELECT,436.19,,,,,,,366.7200,1420.8300,other,"30.7% of $1,420.83 in Billed Charges for Rev 272 = $436.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURETAPE MENISCUS REPAIR,272,RC,27200002,CDM,,,,,,both,,,1420.8300,213.1200,UNITED HEALTHCARE,UNITED HEALTHCARE,458.93,,,,,,,366.7200,1420.8300,percent of total billed charges,"32.3% of $1,420.83 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE MENISCUS REPAIR,272,RC,27200002,CDM,,,,,,both,,,1420.8300,213.1200,WELLCARE,WELLCARE MEDICAID,1420.83,,,,,,,366.7200,1420.8300,percent of total billed charges,"100% of $1,420.83 in Billed Charges for Rev 272 = $1,420.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE TIGERLINK AR-7535T,272,RC,27200002,CDM,,,,,,both,,,1047.4700,157.1200,AETNA,AETNA,447.27,,,,,,,270.3500,1047.4700,percent of total billed charges,"42.7% of $1,047.47 in Billed Charges for Rev 272 = $447.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE TIGERLINK AR-7535T,272,RC,27200002,CDM,,,,,,both,,,1047.4700,157.1200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,733.23,,,,,,,270.3500,1047.4700,percent of total billed charges,"Rev 272 $1,047.47 in Billed Charges at 70% = $733.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE TIGERLINK AR-7535T,272,RC,27200002,CDM,,,,,,both,,,1047.4700,157.1200,CIGNA HEALTHCARE,CIGNA HMO,436.80,,,,,,,270.3500,1047.4700,percent of total billed charges,"41.7% of $1,047.47 in Billed Charges for Rev 272 = $436.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE TIGERLINK AR-7535T,272,RC,27200002,CDM,,,,,,both,,,1047.4700,157.1200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,486.03,,,,,,,270.3500,1047.4700,percent of total billed charges,"46.4% of $1,047.47 in Billed Charges for Rev 272 = $486.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE TIGERLINK AR-7535T,272,RC,27200002,CDM,,,,,,both,,,1047.4700,157.1200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,436.80,,,,,,,270.3500,1047.4700,percent of total billed charges,"41.7% of $1,047.47 in Billed Charges for Rev 272 = $436.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE TIGERLINK AR-7535T,272,RC,27200002,CDM,,,,,,both,,,1047.4700,157.1200,CIGNA HEALTHCARE,CIGNA PPO,436.80,,,,,,,270.3500,1047.4700,percent of total billed charges,"41.7% of $1,047.47 in Billed Charges for Rev 272 = $436.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE TIGERLINK AR-7535T,272,RC,27200002,CDM,,,,,,both,,,1047.4700,157.1200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,942.72,,,,,,,270.3500,1047.4700,percent of total billed charges,"90% of $1,047.47 in Billed Charges for Rev 272 = $942.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE TIGERLINK AR-7535T,272,RC,27200002,CDM,,,,,,both,,,1047.4700,157.1200,MEDCOST,MEDCOST VHN,498.49,,,,,,,270.3500,1047.4700,percent of total billed charges,"47.59% of $1,047.47 in Billed Charges for Rev 272 = $498.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE TIGERLINK AR-7535T,272,RC,27200002,CDM,,,,,,both,,,1047.4700,157.1200,SENTARA HEALTH,SENTARA HEALTH,270.35,,,,,,,270.3500,1047.4700,percent of total billed charges,"25.81% of $1,047.47 in Billed Charges for Rev 272 = $270.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE TIGERLINK AR-7535T,272,RC,27200002,CDM,,,,,,both,,,1047.4700,157.1200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1047.47,,,,,,,270.3500,1047.4700,percent of total billed charges,"100% of $1,047.47 in Billed Charges for Rev 272 = $1,047.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE TIGERLINK AR-7535T,272,RC,27200002,CDM,,,,,,both,,,1047.4700,157.1200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,523.74,,,,,,,270.3500,1047.4700,percent of total billed charges,"Rev 272 $1,047.47 in Billed Charges at 50% = $523.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE TIGERLINK AR-7535T,272,RC,27200002,CDM,,,,,,both,,,1047.4700,157.1200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,338.33,,,,,,,270.3500,1047.4700,other,"32.3% of $1,047.47 in Billed Charges for Rev 272 = $338.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURETAPE TIGERLINK AR-7535T,272,RC,27200002,CDM,,,,,,both,,,1047.4700,157.1200,UNITED HEALTHCARE,UHC HERITAGE SELECT,321.57,,,,,,,270.3500,1047.4700,other,"30.7% of $1,047.47 in Billed Charges for Rev 272 = $321.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURETAPE TIGERLINK AR-7535T,272,RC,27200002,CDM,,,,,,both,,,1047.4700,157.1200,UNITED HEALTHCARE,UNITED HEALTHCARE,338.33,,,,,,,270.3500,1047.4700,percent of total billed charges,"32.3% of $1,047.47 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE TIGERLINK AR-7535T,272,RC,27200002,CDM,,,,,,both,,,1047.4700,157.1200,WELLCARE,WELLCARE MEDICAID,1047.47,,,,,,,270.3500,1047.4700,percent of total billed charges,"100% of $1,047.47 in Billed Charges for Rev 272 = $1,047.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE AND NEEDLE FIRST PASS CAPTURE,272,RC,,,,,,,,both,,,12816.4800,1922.4700,AETNA,AETNA,5472.64,,,,,,,3307.9300,12816.4800,percent of total billed charges,"42.7% of $12,816.48 in Billed Charges for Rev 272 = $5,472.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE AND NEEDLE FIRST PASS CAPTURE,272,RC,,,,,,,,both,,,12816.4800,1922.4700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8971.54,,,,,,,3307.9300,12816.4800,percent of total billed charges,"Rev 272 $12,816.48 in Billed Charges at 70% = $8,971.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE AND NEEDLE FIRST PASS CAPTURE,272,RC,,,,,,,,both,,,12816.4800,1922.4700,CIGNA HEALTHCARE,CIGNA HMO,5344.47,,,,,,,3307.9300,12816.4800,percent of total billed charges,"41.7% of $12,816.48 in Billed Charges for Rev 272 = $5,344.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE AND NEEDLE FIRST PASS CAPTURE,272,RC,,,,,,,,both,,,12816.4800,1922.4700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5946.85,,,,,,,3307.9300,12816.4800,percent of total billed charges,"46.4% of $12,816.48 in Billed Charges for Rev 272 = $5,946.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE AND NEEDLE FIRST PASS CAPTURE,272,RC,,,,,,,,both,,,12816.4800,1922.4700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5344.47,,,,,,,3307.9300,12816.4800,percent of total billed charges,"41.7% of $12,816.48 in Billed Charges for Rev 272 = $5,344.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE AND NEEDLE FIRST PASS CAPTURE,272,RC,,,,,,,,both,,,12816.4800,1922.4700,CIGNA HEALTHCARE,CIGNA PPO,5344.47,,,,,,,3307.9300,12816.4800,percent of total billed charges,"41.7% of $12,816.48 in Billed Charges for Rev 272 = $5,344.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE AND NEEDLE FIRST PASS CAPTURE,272,RC,,,,,,,,both,,,12816.4800,1922.4700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11534.83,,,,,,,3307.9300,12816.4800,percent of total billed charges,"90% of $12,816.48 in Billed Charges for Rev 272 = $11,534.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE AND NEEDLE FIRST PASS CAPTURE,272,RC,,,,,,,,both,,,12816.4800,1922.4700,MEDCOST,MEDCOST VHN,6099.36,,,,,,,3307.9300,12816.4800,percent of total billed charges,"47.59% of $12,816.48 in Billed Charges for Rev 272 = $6,099.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE AND NEEDLE FIRST PASS CAPTURE,272,RC,,,,,,,,both,,,12816.4800,1922.4700,SENTARA HEALTH,SENTARA HEALTH,3307.93,,,,,,,3307.9300,12816.4800,percent of total billed charges,"25.81% of $12,816.48 in Billed Charges for Rev 272 = $3,307.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE AND NEEDLE FIRST PASS CAPTURE,272,RC,,,,,,,,both,,,12816.4800,1922.4700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12816.48,,,,,,,3307.9300,12816.4800,percent of total billed charges,"100% of $12,816.48 in Billed Charges for Rev 272 = $12,816.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE AND NEEDLE FIRST PASS CAPTURE,272,RC,,,,,,,,both,,,12816.4800,1922.4700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6408.24,,,,,,,3307.9300,12816.4800,percent of total billed charges,"Rev 272 $12,816.48 in Billed Charges at 50% = $6,408.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE AND NEEDLE FIRST PASS CAPTURE,272,RC,,,,,,,,both,,,12816.4800,1922.4700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4139.72,,,,,,,3307.9300,12816.4800,other,"32.3% of $12,816.48 in Billed Charges for Rev 272 = $4,139.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE AND NEEDLE FIRST PASS CAPTURE,272,RC,,,,,,,,both,,,12816.4800,1922.4700,UNITED HEALTHCARE,UHC HERITAGE SELECT,3934.66,,,,,,,3307.9300,12816.4800,other,"30.7% of $12,816.48 in Billed Charges for Rev 272 = $3,934.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE AND NEEDLE FIRST PASS CAPTURE,272,RC,,,,,,,,both,,,12816.4800,1922.4700,UNITED HEALTHCARE,UNITED HEALTHCARE,4139.72,,,,,,,3307.9300,12816.4800,percent of total billed charges,"32.3% of $12,816.48 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE AND NEEDLE FIRST PASS CAPTURE,272,RC,,,,,,,,both,,,12816.4800,1922.4700,WELLCARE,WELLCARE MEDICAID,12816.48,,,,,,,3307.9300,12816.4800,percent of total billed charges,"100% of $12,816.48 in Billed Charges for Rev 272 = $12,816.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CARTRIDGE PERFECTPASSER CO-BRAID BLACK,272,RC,,,,,,,,both,,,544.0800,81.6100,AETNA,AETNA,232.32,,,,,,,140.4300,544.0800,percent of total billed charges,42.7% of $544.08 in Billed Charges for Rev 272 = $232.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CARTRIDGE PERFECTPASSER CO-BRAID BLACK,272,RC,,,,,,,,both,,,544.0800,81.6100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,380.86,,,,,,,140.4300,544.0800,percent of total billed charges,Rev 272 $544.08 in Billed Charges at 70% = $380.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CARTRIDGE PERFECTPASSER CO-BRAID BLACK,272,RC,,,,,,,,both,,,544.0800,81.6100,CIGNA HEALTHCARE,CIGNA HMO,226.88,,,,,,,140.4300,544.0800,percent of total billed charges,41.7% of $544.08 in Billed Charges for Rev 272 = $226.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CARTRIDGE PERFECTPASSER CO-BRAID BLACK,272,RC,,,,,,,,both,,,544.0800,81.6100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,252.45,,,,,,,140.4300,544.0800,percent of total billed charges,46.4% of $544.08 in Billed Charges for Rev 272 = $252.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CARTRIDGE PERFECTPASSER CO-BRAID BLACK,272,RC,,,,,,,,both,,,544.0800,81.6100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,226.88,,,,,,,140.4300,544.0800,percent of total billed charges,41.7% of $544.08 in Billed Charges for Rev 272 = $226.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CARTRIDGE PERFECTPASSER CO-BRAID BLACK,272,RC,,,,,,,,both,,,544.0800,81.6100,CIGNA HEALTHCARE,CIGNA PPO,226.88,,,,,,,140.4300,544.0800,percent of total billed charges,41.7% of $544.08 in Billed Charges for Rev 272 = $226.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CARTRIDGE PERFECTPASSER CO-BRAID BLACK,272,RC,,,,,,,,both,,,544.0800,81.6100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,489.67,,,,,,,140.4300,544.0800,percent of total billed charges,90% of $544.08 in Billed Charges for Rev 272 = $489.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CARTRIDGE PERFECTPASSER CO-BRAID BLACK,272,RC,,,,,,,,both,,,544.0800,81.6100,MEDCOST,MEDCOST VHN,258.93,,,,,,,140.4300,544.0800,percent of total billed charges,47.59% of $544.08 in Billed Charges for Rev 272 = $258.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CARTRIDGE PERFECTPASSER CO-BRAID BLACK,272,RC,,,,,,,,both,,,544.0800,81.6100,SENTARA HEALTH,SENTARA HEALTH,140.43,,,,,,,140.4300,544.0800,percent of total billed charges,25.81% of $544.08 in Billed Charges for Rev 272 = $140.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CARTRIDGE PERFECTPASSER CO-BRAID BLACK,272,RC,,,,,,,,both,,,544.0800,81.6100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",544.08,,,,,,,140.4300,544.0800,percent of total billed charges,100% of $544.08 in Billed Charges for Rev 272 = $544.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CARTRIDGE PERFECTPASSER CO-BRAID BLACK,272,RC,,,,,,,,both,,,544.0800,81.6100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,272.04,,,,,,,140.4300,544.0800,percent of total billed charges,Rev 272 $544.08 in Billed Charges at 50% = $272.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CARTRIDGE PERFECTPASSER CO-BRAID BLACK,272,RC,,,,,,,,both,,,544.0800,81.6100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,175.74,,,,,,,140.4300,544.0800,other,32.3% of $544.08 in Billed Charges for Rev 272 = $175.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE CARTRIDGE PERFECTPASSER CO-BRAID BLACK,272,RC,,,,,,,,both,,,544.0800,81.6100,UNITED HEALTHCARE,UHC HERITAGE SELECT,167.03,,,,,,,140.4300,544.0800,other,30.7% of $544.08 in Billed Charges for Rev 272 = $167.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE CARTRIDGE PERFECTPASSER CO-BRAID BLACK,272,RC,,,,,,,,both,,,544.0800,81.6100,UNITED HEALTHCARE,UNITED HEALTHCARE,175.74,,,,,,,140.4300,544.0800,percent of total billed charges,32.3% of $544.08 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CARTRIDGE PERFECTPASSER CO-BRAID BLACK,272,RC,,,,,,,,both,,,544.0800,81.6100,WELLCARE,WELLCARE MEDICAID,544.08,,,,,,,140.4300,544.0800,percent of total billed charges,100% of $544.08 in Billed Charges for Rev 272 = $544.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CHROMIC GUT 4-0,272,RC,,,,,,,,both,,,685.5700,102.8400,AETNA,AETNA,292.74,,,,,,,176.9500,685.5700,percent of total billed charges,42.7% of $685.57 in Billed Charges for Rev 272 = $292.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CHROMIC GUT 4-0,272,RC,,,,,,,,both,,,685.5700,102.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,479.90,,,,,,,176.9500,685.5700,percent of total billed charges,Rev 272 $685.57 in Billed Charges at 70% = $479.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CHROMIC GUT 4-0,272,RC,,,,,,,,both,,,685.5700,102.8400,CIGNA HEALTHCARE,CIGNA HMO,285.88,,,,,,,176.9500,685.5700,percent of total billed charges,41.7% of $685.57 in Billed Charges for Rev 272 = $285.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CHROMIC GUT 4-0,272,RC,,,,,,,,both,,,685.5700,102.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,318.10,,,,,,,176.9500,685.5700,percent of total billed charges,46.4% of $685.57 in Billed Charges for Rev 272 = $318.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CHROMIC GUT 4-0,272,RC,,,,,,,,both,,,685.5700,102.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,285.88,,,,,,,176.9500,685.5700,percent of total billed charges,41.7% of $685.57 in Billed Charges for Rev 272 = $285.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CHROMIC GUT 4-0,272,RC,,,,,,,,both,,,685.5700,102.8400,CIGNA HEALTHCARE,CIGNA PPO,285.88,,,,,,,176.9500,685.5700,percent of total billed charges,41.7% of $685.57 in Billed Charges for Rev 272 = $285.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CHROMIC GUT 4-0,272,RC,,,,,,,,both,,,685.5700,102.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,617.01,,,,,,,176.9500,685.5700,percent of total billed charges,90% of $685.57 in Billed Charges for Rev 272 = $617.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CHROMIC GUT 4-0,272,RC,,,,,,,,both,,,685.5700,102.8400,MEDCOST,MEDCOST VHN,326.26,,,,,,,176.9500,685.5700,percent of total billed charges,47.59% of $685.57 in Billed Charges for Rev 272 = $326.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CHROMIC GUT 4-0,272,RC,,,,,,,,both,,,685.5700,102.8400,SENTARA HEALTH,SENTARA HEALTH,176.95,,,,,,,176.9500,685.5700,percent of total billed charges,25.81% of $685.57 in Billed Charges for Rev 272 = $176.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CHROMIC GUT 4-0,272,RC,,,,,,,,both,,,685.5700,102.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",685.57,,,,,,,176.9500,685.5700,percent of total billed charges,100% of $685.57 in Billed Charges for Rev 272 = $685.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CHROMIC GUT 4-0,272,RC,,,,,,,,both,,,685.5700,102.8400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,342.79,,,,,,,176.9500,685.5700,percent of total billed charges,Rev 272 $685.57 in Billed Charges at 50% = $342.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CHROMIC GUT 4-0,272,RC,,,,,,,,both,,,685.5700,102.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,221.44,,,,,,,176.9500,685.5700,other,32.3% of $685.57 in Billed Charges for Rev 272 = $221.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE CHROMIC GUT 4-0,272,RC,,,,,,,,both,,,685.5700,102.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,210.47,,,,,,,176.9500,685.5700,other,30.7% of $685.57 in Billed Charges for Rev 272 = $210.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE CHROMIC GUT 4-0,272,RC,,,,,,,,both,,,685.5700,102.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,221.44,,,,,,,176.9500,685.5700,percent of total billed charges,32.3% of $685.57 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CHROMIC GUT 4-0,272,RC,,,,,,,,both,,,685.5700,102.8400,WELLCARE,WELLCARE MEDICAID,685.57,,,,,,,176.9500,685.5700,percent of total billed charges,100% of $685.57 in Billed Charges for Rev 272 = $685.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2572.0100,385.8000,AETNA,AETNA,1098.25,,,,,,,663.8400,2572.0100,percent of total billed charges,"42.7% of $2,572.01 in Billed Charges for Rev 272 = $1,098.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2572.0100,385.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1800.41,,,,,,,663.8400,2572.0100,percent of total billed charges,"Rev 272 $2,572.01 in Billed Charges at 70% = $1,800.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2572.0100,385.8000,CIGNA HEALTHCARE,CIGNA HMO,1072.53,,,,,,,663.8400,2572.0100,percent of total billed charges,"41.7% of $2,572.01 in Billed Charges for Rev 272 = $1,072.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2572.0100,385.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1193.41,,,,,,,663.8400,2572.0100,percent of total billed charges,"46.4% of $2,572.01 in Billed Charges for Rev 272 = $1,193.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2572.0100,385.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1072.53,,,,,,,663.8400,2572.0100,percent of total billed charges,"41.7% of $2,572.01 in Billed Charges for Rev 272 = $1,072.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2572.0100,385.8000,CIGNA HEALTHCARE,CIGNA PPO,1072.53,,,,,,,663.8400,2572.0100,percent of total billed charges,"41.7% of $2,572.01 in Billed Charges for Rev 272 = $1,072.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2572.0100,385.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2314.81,,,,,,,663.8400,2572.0100,percent of total billed charges,"90% of $2,572.01 in Billed Charges for Rev 272 = $2,314.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2572.0100,385.8000,MEDCOST,MEDCOST VHN,1224.02,,,,,,,663.8400,2572.0100,percent of total billed charges,"47.59% of $2,572.01 in Billed Charges for Rev 272 = $1,224.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2572.0100,385.8000,SENTARA HEALTH,SENTARA HEALTH,663.84,,,,,,,663.8400,2572.0100,percent of total billed charges,"25.81% of $2,572.01 in Billed Charges for Rev 272 = $663.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2572.0100,385.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2572.01,,,,,,,663.8400,2572.0100,percent of total billed charges,"100% of $2,572.01 in Billed Charges for Rev 272 = $2,572.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2572.0100,385.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1286.01,,,,,,,663.8400,2572.0100,percent of total billed charges,"Rev 272 $2,572.01 in Billed Charges at 50% = $1,286.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2572.0100,385.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,830.76,,,,,,,663.8400,2572.0100,other,"32.3% of $2,572.01 in Billed Charges for Rev 272 = $830.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2572.0100,385.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,789.61,,,,,,,663.8400,2572.0100,other,"30.7% of $2,572.01 in Billed Charges for Rev 272 = $789.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2572.0100,385.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,830.76,,,,,,,663.8400,2572.0100,percent of total billed charges,"32.3% of $2,572.01 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE CLOSURE PERCLOSE PROSTYLE,272,RC,27200002,CDM,,,,,,both,,,2572.0100,385.8000,WELLCARE,WELLCARE MEDICAID,2572.01,,,,,,,663.8400,2572.0100,percent of total billed charges,"100% of $2,572.01 in Billed Charges for Rev 272 = $2,572.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURETAPE TIGERLOOP 1.3MM,272,RC,27200002,CDM,,,,,,both,,,860.7900,129.1200,AETNA,AETNA,367.56,,,,,,,222.1700,860.7900,percent of total billed charges,42.7% of $860.79 in Billed Charges for Rev 272 = $367.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURETAPE TIGERLOOP 1.3MM,272,RC,27200002,CDM,,,,,,both,,,860.7900,129.1200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,602.55,,,,,,,222.1700,860.7900,percent of total billed charges,Rev 272 $860.79 in Billed Charges at 70% = $602.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURETAPE TIGERLOOP 1.3MM,272,RC,27200002,CDM,,,,,,both,,,860.7900,129.1200,CIGNA HEALTHCARE,CIGNA HMO,358.95,,,,,,,222.1700,860.7900,percent of total billed charges,41.7% of $860.79 in Billed Charges for Rev 272 = $358.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURETAPE TIGERLOOP 1.3MM,272,RC,27200002,CDM,,,,,,both,,,860.7900,129.1200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,399.41,,,,,,,222.1700,860.7900,percent of total billed charges,46.4% of $860.79 in Billed Charges for Rev 272 = $399.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURETAPE TIGERLOOP 1.3MM,272,RC,27200002,CDM,,,,,,both,,,860.7900,129.1200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,358.95,,,,,,,222.1700,860.7900,percent of total billed charges,41.7% of $860.79 in Billed Charges for Rev 272 = $358.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURETAPE TIGERLOOP 1.3MM,272,RC,27200002,CDM,,,,,,both,,,860.7900,129.1200,CIGNA HEALTHCARE,CIGNA PPO,358.95,,,,,,,222.1700,860.7900,percent of total billed charges,41.7% of $860.79 in Billed Charges for Rev 272 = $358.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURETAPE TIGERLOOP 1.3MM,272,RC,27200002,CDM,,,,,,both,,,860.7900,129.1200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,774.71,,,,,,,222.1700,860.7900,percent of total billed charges,90% of $860.79 in Billed Charges for Rev 272 = $774.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURETAPE TIGERLOOP 1.3MM,272,RC,27200002,CDM,,,,,,both,,,860.7900,129.1200,MEDCOST,MEDCOST VHN,409.65,,,,,,,222.1700,860.7900,percent of total billed charges,47.59% of $860.79 in Billed Charges for Rev 272 = $409.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURETAPE TIGERLOOP 1.3MM,272,RC,27200002,CDM,,,,,,both,,,860.7900,129.1200,SENTARA HEALTH,SENTARA HEALTH,222.17,,,,,,,222.1700,860.7900,percent of total billed charges,25.81% of $860.79 in Billed Charges for Rev 272 = $222.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURETAPE TIGERLOOP 1.3MM,272,RC,27200002,CDM,,,,,,both,,,860.7900,129.1200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",860.79,,,,,,,222.1700,860.7900,percent of total billed charges,100% of $860.79 in Billed Charges for Rev 272 = $860.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURETAPE TIGERLOOP 1.3MM,272,RC,27200002,CDM,,,,,,both,,,860.7900,129.1200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,430.40,,,,,,,222.1700,860.7900,percent of total billed charges,Rev 272 $860.79 in Billed Charges at 50% = $430.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURETAPE TIGERLOOP 1.3MM,272,RC,27200002,CDM,,,,,,both,,,860.7900,129.1200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,278.04,,,,,,,222.1700,860.7900,other,32.3% of $860.79 in Billed Charges for Rev 272 = $278.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURETAPE TIGERLOOP 1.3MM,272,RC,27200002,CDM,,,,,,both,,,860.7900,129.1200,UNITED HEALTHCARE,UHC HERITAGE SELECT,264.26,,,,,,,222.1700,860.7900,other,30.7% of $860.79 in Billed Charges for Rev 272 = $264.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURETAPE TIGERLOOP 1.3MM,272,RC,27200002,CDM,,,,,,both,,,860.7900,129.1200,UNITED HEALTHCARE,UNITED HEALTHCARE,278.04,,,,,,,222.1700,860.7900,percent of total billed charges,32.3% of $860.79 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURETAPE TIGERLOOP 1.3MM,272,RC,27200002,CDM,,,,,,both,,,860.7900,129.1200,WELLCARE,WELLCARE MEDICAID,860.79,,,,,,,222.1700,860.7900,percent of total billed charges,100% of $860.79 in Billed Charges for Rev 272 = $860.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM ANCHOR RETIEVAL TISSUE 6000ML,272,RC,,,,,,,,both,,,2535.7100,380.3600,AETNA,AETNA,1082.75,,,,,,,654.4700,2535.7100,percent of total billed charges,"42.7% of $2,535.71 in Billed Charges for Rev 272 = $1,082.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM ANCHOR RETIEVAL TISSUE 6000ML,272,RC,,,,,,,,both,,,2535.7100,380.3600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1775.00,,,,,,,654.4700,2535.7100,percent of total billed charges,"Rev 272 $2,535.71 in Billed Charges at 70% = $1,775.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM ANCHOR RETIEVAL TISSUE 6000ML,272,RC,,,,,,,,both,,,2535.7100,380.3600,CIGNA HEALTHCARE,CIGNA HMO,1057.39,,,,,,,654.4700,2535.7100,percent of total billed charges,"41.7% of $2,535.71 in Billed Charges for Rev 272 = $1,057.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM ANCHOR RETIEVAL TISSUE 6000ML,272,RC,,,,,,,,both,,,2535.7100,380.3600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1176.57,,,,,,,654.4700,2535.7100,percent of total billed charges,"46.4% of $2,535.71 in Billed Charges for Rev 272 = $1,176.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM ANCHOR RETIEVAL TISSUE 6000ML,272,RC,,,,,,,,both,,,2535.7100,380.3600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1057.39,,,,,,,654.4700,2535.7100,percent of total billed charges,"41.7% of $2,535.71 in Billed Charges for Rev 272 = $1,057.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM ANCHOR RETIEVAL TISSUE 6000ML,272,RC,,,,,,,,both,,,2535.7100,380.3600,CIGNA HEALTHCARE,CIGNA PPO,1057.39,,,,,,,654.4700,2535.7100,percent of total billed charges,"41.7% of $2,535.71 in Billed Charges for Rev 272 = $1,057.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM ANCHOR RETIEVAL TISSUE 6000ML,272,RC,,,,,,,,both,,,2535.7100,380.3600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2282.14,,,,,,,654.4700,2535.7100,percent of total billed charges,"90% of $2,535.71 in Billed Charges for Rev 272 = $2,282.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM ANCHOR RETIEVAL TISSUE 6000ML,272,RC,,,,,,,,both,,,2535.7100,380.3600,MEDCOST,MEDCOST VHN,1206.74,,,,,,,654.4700,2535.7100,percent of total billed charges,"47.59% of $2,535.71 in Billed Charges for Rev 272 = $1,206.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM ANCHOR RETIEVAL TISSUE 6000ML,272,RC,,,,,,,,both,,,2535.7100,380.3600,SENTARA HEALTH,SENTARA HEALTH,654.47,,,,,,,654.4700,2535.7100,percent of total billed charges,"25.81% of $2,535.71 in Billed Charges for Rev 272 = $654.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM ANCHOR RETIEVAL TISSUE 6000ML,272,RC,,,,,,,,both,,,2535.7100,380.3600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2535.71,,,,,,,654.4700,2535.7100,percent of total billed charges,"100% of $2,535.71 in Billed Charges for Rev 272 = $2,535.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM ANCHOR RETIEVAL TISSUE 6000ML,272,RC,,,,,,,,both,,,2535.7100,380.3600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1267.86,,,,,,,654.4700,2535.7100,percent of total billed charges,"Rev 272 $2,535.71 in Billed Charges at 50% = $1,267.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM ANCHOR RETIEVAL TISSUE 6000ML,272,RC,,,,,,,,both,,,2535.7100,380.3600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,819.03,,,,,,,654.4700,2535.7100,other,"32.3% of $2,535.71 in Billed Charges for Rev 272 = $819.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM ANCHOR RETIEVAL TISSUE 6000ML,272,RC,,,,,,,,both,,,2535.7100,380.3600,UNITED HEALTHCARE,UHC HERITAGE SELECT,778.46,,,,,,,654.4700,2535.7100,other,"30.7% of $2,535.71 in Billed Charges for Rev 272 = $778.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM ANCHOR RETIEVAL TISSUE 6000ML,272,RC,,,,,,,,both,,,2535.7100,380.3600,UNITED HEALTHCARE,UNITED HEALTHCARE,819.03,,,,,,,654.4700,2535.7100,percent of total billed charges,"32.3% of $2,535.71 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM ANCHOR RETIEVAL TISSUE 6000ML,272,RC,,,,,,,,both,,,2535.7100,380.3600,WELLCARE,WELLCARE MEDICAID,2535.71,,,,,,,654.4700,2535.7100,percent of total billed charges,"100% of $2,535.71 in Billed Charges for Rev 272 = $2,535.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM ANCHOR RETRIEVAL TISSUE 125ML TRS-ROBO-8,272,RC,27200002,CDM,,,,,,both,,,684.4900,102.6700,AETNA,AETNA,292.28,,,,,,,176.6700,684.4900,percent of total billed charges,42.7% of $684.49 in Billed Charges for Rev 272 = $292.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM ANCHOR RETRIEVAL TISSUE 125ML TRS-ROBO-8,272,RC,27200002,CDM,,,,,,both,,,684.4900,102.6700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,479.14,,,,,,,176.6700,684.4900,percent of total billed charges,Rev 272 $684.49 in Billed Charges at 70% = $479.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM ANCHOR RETRIEVAL TISSUE 125ML TRS-ROBO-8,272,RC,27200002,CDM,,,,,,both,,,684.4900,102.6700,CIGNA HEALTHCARE,CIGNA HMO,285.43,,,,,,,176.6700,684.4900,percent of total billed charges,41.7% of $684.49 in Billed Charges for Rev 272 = $285.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM ANCHOR RETRIEVAL TISSUE 125ML TRS-ROBO-8,272,RC,27200002,CDM,,,,,,both,,,684.4900,102.6700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,317.60,,,,,,,176.6700,684.4900,percent of total billed charges,46.4% of $684.49 in Billed Charges for Rev 272 = $317.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM ANCHOR RETRIEVAL TISSUE 125ML TRS-ROBO-8,272,RC,27200002,CDM,,,,,,both,,,684.4900,102.6700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,285.43,,,,,,,176.6700,684.4900,percent of total billed charges,41.7% of $684.49 in Billed Charges for Rev 272 = $285.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM ANCHOR RETRIEVAL TISSUE 125ML TRS-ROBO-8,272,RC,27200002,CDM,,,,,,both,,,684.4900,102.6700,CIGNA HEALTHCARE,CIGNA PPO,285.43,,,,,,,176.6700,684.4900,percent of total billed charges,41.7% of $684.49 in Billed Charges for Rev 272 = $285.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM ANCHOR RETRIEVAL TISSUE 125ML TRS-ROBO-8,272,RC,27200002,CDM,,,,,,both,,,684.4900,102.6700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,616.04,,,,,,,176.6700,684.4900,percent of total billed charges,90% of $684.49 in Billed Charges for Rev 272 = $616.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM ANCHOR RETRIEVAL TISSUE 125ML TRS-ROBO-8,272,RC,27200002,CDM,,,,,,both,,,684.4900,102.6700,MEDCOST,MEDCOST VHN,325.75,,,,,,,176.6700,684.4900,percent of total billed charges,47.59% of $684.49 in Billed Charges for Rev 272 = $325.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM ANCHOR RETRIEVAL TISSUE 125ML TRS-ROBO-8,272,RC,27200002,CDM,,,,,,both,,,684.4900,102.6700,SENTARA HEALTH,SENTARA HEALTH,176.67,,,,,,,176.6700,684.4900,percent of total billed charges,25.81% of $684.49 in Billed Charges for Rev 272 = $176.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM ANCHOR RETRIEVAL TISSUE 125ML TRS-ROBO-8,272,RC,27200002,CDM,,,,,,both,,,684.4900,102.6700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",684.49,,,,,,,176.6700,684.4900,percent of total billed charges,100% of $684.49 in Billed Charges for Rev 272 = $684.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM ANCHOR RETRIEVAL TISSUE 125ML TRS-ROBO-8,272,RC,27200002,CDM,,,,,,both,,,684.4900,102.6700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,342.25,,,,,,,176.6700,684.4900,percent of total billed charges,Rev 272 $684.49 in Billed Charges at 50% = $342.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM ANCHOR RETRIEVAL TISSUE 125ML TRS-ROBO-8,272,RC,27200002,CDM,,,,,,both,,,684.4900,102.6700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,221.09,,,,,,,176.6700,684.4900,other,32.3% of $684.49 in Billed Charges for Rev 272 = $221.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SYSTEM ANCHOR RETRIEVAL TISSUE 125ML TRS-ROBO-8,272,RC,27200002,CDM,,,,,,both,,,684.4900,102.6700,UNITED HEALTHCARE,UHC HERITAGE SELECT,210.14,,,,,,,176.6700,684.4900,other,30.7% of $684.49 in Billed Charges for Rev 272 = $210.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SYSTEM ANCHOR RETRIEVAL TISSUE 125ML TRS-ROBO-8,272,RC,27200002,CDM,,,,,,both,,,684.4900,102.6700,UNITED HEALTHCARE,UNITED HEALTHCARE,221.09,,,,,,,176.6700,684.4900,percent of total billed charges,32.3% of $684.49 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM ANCHOR RETRIEVAL TISSUE 125ML TRS-ROBO-8,272,RC,27200002,CDM,,,,,,both,,,684.4900,102.6700,WELLCARE,WELLCARE MEDICAID,684.49,,,,,,,176.6700,684.4900,percent of total billed charges,100% of $684.49 in Billed Charges for Rev 272 = $684.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE DYNATAPE BLACK/BLUE,272,RC,27200002,CDM,,,,,,both,,,1569.7200,235.4600,AETNA,AETNA,670.27,,,,,,,405.1400,1569.7200,percent of total billed charges,"42.7% of $1,569.72 in Billed Charges for Rev 272 = $670.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNATAPE BLACK/BLUE,272,RC,27200002,CDM,,,,,,both,,,1569.7200,235.4600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1098.80,,,,,,,405.1400,1569.7200,percent of total billed charges,"Rev 272 $1,569.72 in Billed Charges at 70% = $1,098.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNATAPE BLACK/BLUE,272,RC,27200002,CDM,,,,,,both,,,1569.7200,235.4600,CIGNA HEALTHCARE,CIGNA HMO,654.57,,,,,,,405.1400,1569.7200,percent of total billed charges,"41.7% of $1,569.72 in Billed Charges for Rev 272 = $654.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNATAPE BLACK/BLUE,272,RC,27200002,CDM,,,,,,both,,,1569.7200,235.4600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,728.35,,,,,,,405.1400,1569.7200,percent of total billed charges,"46.4% of $1,569.72 in Billed Charges for Rev 272 = $728.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNATAPE BLACK/BLUE,272,RC,27200002,CDM,,,,,,both,,,1569.7200,235.4600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,654.57,,,,,,,405.1400,1569.7200,percent of total billed charges,"41.7% of $1,569.72 in Billed Charges for Rev 272 = $654.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNATAPE BLACK/BLUE,272,RC,27200002,CDM,,,,,,both,,,1569.7200,235.4600,CIGNA HEALTHCARE,CIGNA PPO,654.57,,,,,,,405.1400,1569.7200,percent of total billed charges,"41.7% of $1,569.72 in Billed Charges for Rev 272 = $654.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNATAPE BLACK/BLUE,272,RC,27200002,CDM,,,,,,both,,,1569.7200,235.4600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1412.75,,,,,,,405.1400,1569.7200,percent of total billed charges,"90% of $1,569.72 in Billed Charges for Rev 272 = $1,412.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNATAPE BLACK/BLUE,272,RC,27200002,CDM,,,,,,both,,,1569.7200,235.4600,MEDCOST,MEDCOST VHN,747.03,,,,,,,405.1400,1569.7200,percent of total billed charges,"47.59% of $1,569.72 in Billed Charges for Rev 272 = $747.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNATAPE BLACK/BLUE,272,RC,27200002,CDM,,,,,,both,,,1569.7200,235.4600,SENTARA HEALTH,SENTARA HEALTH,405.14,,,,,,,405.1400,1569.7200,percent of total billed charges,"25.81% of $1,569.72 in Billed Charges for Rev 272 = $405.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNATAPE BLACK/BLUE,272,RC,27200002,CDM,,,,,,both,,,1569.7200,235.4600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1569.72,,,,,,,405.1400,1569.7200,percent of total billed charges,"100% of $1,569.72 in Billed Charges for Rev 272 = $1,569.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNATAPE BLACK/BLUE,272,RC,27200002,CDM,,,,,,both,,,1569.7200,235.4600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,784.86,,,,,,,405.1400,1569.7200,percent of total billed charges,"Rev 272 $1,569.72 in Billed Charges at 50% = $784.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNATAPE BLACK/BLUE,272,RC,27200002,CDM,,,,,,both,,,1569.7200,235.4600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,507.02,,,,,,,405.1400,1569.7200,other,"32.3% of $1,569.72 in Billed Charges for Rev 272 = $507.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE DYNATAPE BLACK/BLUE,272,RC,27200002,CDM,,,,,,both,,,1569.7200,235.4600,UNITED HEALTHCARE,UHC HERITAGE SELECT,481.90,,,,,,,405.1400,1569.7200,other,"30.7% of $1,569.72 in Billed Charges for Rev 272 = $481.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE DYNATAPE BLACK/BLUE,272,RC,27200002,CDM,,,,,,both,,,1569.7200,235.4600,UNITED HEALTHCARE,UNITED HEALTHCARE,507.02,,,,,,,405.1400,1569.7200,percent of total billed charges,"32.3% of $1,569.72 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE DYNATAPE BLACK/BLUE,272,RC,27200002,CDM,,,,,,both,,,1569.7200,235.4600,WELLCARE,WELLCARE MEDICAID,1569.72,,,,,,,405.1400,1569.7200,percent of total billed charges,"100% of $1,569.72 in Billed Charges for Rev 272 = $1,569.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL PLUS 2-0 18IN D9911,272,RC,27200002,CDM,,,,,,both,,,1342.1400,201.3200,AETNA,AETNA,573.09,,,,,,,346.4100,1342.1400,percent of total billed charges,"42.7% of $1,342.14 in Billed Charges for Rev 272 = $573.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL PLUS 2-0 18IN D9911,272,RC,27200002,CDM,,,,,,both,,,1342.1400,201.3200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,939.50,,,,,,,346.4100,1342.1400,percent of total billed charges,"Rev 272 $1,342.14 in Billed Charges at 70% = $939.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL PLUS 2-0 18IN D9911,272,RC,27200002,CDM,,,,,,both,,,1342.1400,201.3200,CIGNA HEALTHCARE,CIGNA HMO,559.67,,,,,,,346.4100,1342.1400,percent of total billed charges,"41.7% of $1,342.14 in Billed Charges for Rev 272 = $559.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL PLUS 2-0 18IN D9911,272,RC,27200002,CDM,,,,,,both,,,1342.1400,201.3200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,622.75,,,,,,,346.4100,1342.1400,percent of total billed charges,"46.4% of $1,342.14 in Billed Charges for Rev 272 = $622.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL PLUS 2-0 18IN D9911,272,RC,27200002,CDM,,,,,,both,,,1342.1400,201.3200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,559.67,,,,,,,346.4100,1342.1400,percent of total billed charges,"41.7% of $1,342.14 in Billed Charges for Rev 272 = $559.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL PLUS 2-0 18IN D9911,272,RC,27200002,CDM,,,,,,both,,,1342.1400,201.3200,CIGNA HEALTHCARE,CIGNA PPO,559.67,,,,,,,346.4100,1342.1400,percent of total billed charges,"41.7% of $1,342.14 in Billed Charges for Rev 272 = $559.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL PLUS 2-0 18IN D9911,272,RC,27200002,CDM,,,,,,both,,,1342.1400,201.3200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1207.93,,,,,,,346.4100,1342.1400,percent of total billed charges,"90% of $1,342.14 in Billed Charges for Rev 272 = $1,207.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL PLUS 2-0 18IN D9911,272,RC,27200002,CDM,,,,,,both,,,1342.1400,201.3200,MEDCOST,MEDCOST VHN,638.72,,,,,,,346.4100,1342.1400,percent of total billed charges,"47.59% of $1,342.14 in Billed Charges for Rev 272 = $638.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL PLUS 2-0 18IN D9911,272,RC,27200002,CDM,,,,,,both,,,1342.1400,201.3200,SENTARA HEALTH,SENTARA HEALTH,346.41,,,,,,,346.4100,1342.1400,percent of total billed charges,"25.81% of $1,342.14 in Billed Charges for Rev 272 = $346.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL PLUS 2-0 18IN D9911,272,RC,27200002,CDM,,,,,,both,,,1342.1400,201.3200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1342.14,,,,,,,346.4100,1342.1400,percent of total billed charges,"100% of $1,342.14 in Billed Charges for Rev 272 = $1,342.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL PLUS 2-0 18IN D9911,272,RC,27200002,CDM,,,,,,both,,,1342.1400,201.3200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,671.07,,,,,,,346.4100,1342.1400,percent of total billed charges,"Rev 272 $1,342.14 in Billed Charges at 50% = $671.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL PLUS 2-0 18IN D9911,272,RC,27200002,CDM,,,,,,both,,,1342.1400,201.3200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,433.51,,,,,,,346.4100,1342.1400,other,"32.3% of $1,342.14 in Billed Charges for Rev 272 = $433.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE VICRYL PLUS 2-0 18IN D9911,272,RC,27200002,CDM,,,,,,both,,,1342.1400,201.3200,UNITED HEALTHCARE,UHC HERITAGE SELECT,412.04,,,,,,,346.4100,1342.1400,other,"30.7% of $1,342.14 in Billed Charges for Rev 272 = $412.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE VICRYL PLUS 2-0 18IN D9911,272,RC,27200002,CDM,,,,,,both,,,1342.1400,201.3200,UNITED HEALTHCARE,UNITED HEALTHCARE,433.51,,,,,,,346.4100,1342.1400,percent of total billed charges,"32.3% of $1,342.14 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL PLUS 2-0 18IN D9911,272,RC,27200002,CDM,,,,,,both,,,1342.1400,201.3200,WELLCARE,WELLCARE MEDICAID,1342.14,,,,,,,346.4100,1342.1400,percent of total billed charges,"100% of $1,342.14 in Billed Charges for Rev 272 = $1,342.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURING SYSTEM OVERSTITCH ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,31559.3700,4733.9100,AETNA,AETNA,13475.85,,,,,,,8145.4700,31559.3700,percent of total billed charges,"42.7% of $31,559.37 in Billed Charges for Rev 272 = $13,475.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURING SYSTEM OVERSTITCH ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,31559.3700,4733.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,22091.56,,,,,,,8145.4700,31559.3700,percent of total billed charges,"Rev 272 $31,559.37 in Billed Charges at 70% = $22,091.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURING SYSTEM OVERSTITCH ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,31559.3700,4733.9100,CIGNA HEALTHCARE,CIGNA HMO,13160.26,,,,,,,8145.4700,31559.3700,percent of total billed charges,"41.7% of $31,559.37 in Billed Charges for Rev 272 = $13,160.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURING SYSTEM OVERSTITCH ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,31559.3700,4733.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,14643.55,,,,,,,8145.4700,31559.3700,percent of total billed charges,"46.4% of $31,559.37 in Billed Charges for Rev 272 = $14,643.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURING SYSTEM OVERSTITCH ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,31559.3700,4733.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,13160.26,,,,,,,8145.4700,31559.3700,percent of total billed charges,"41.7% of $31,559.37 in Billed Charges for Rev 272 = $13,160.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURING SYSTEM OVERSTITCH ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,31559.3700,4733.9100,CIGNA HEALTHCARE,CIGNA PPO,13160.26,,,,,,,8145.4700,31559.3700,percent of total billed charges,"41.7% of $31,559.37 in Billed Charges for Rev 272 = $13,160.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURING SYSTEM OVERSTITCH ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,31559.3700,4733.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,28403.43,,,,,,,8145.4700,31559.3700,percent of total billed charges,"90% of $31,559.37 in Billed Charges for Rev 272 = $28,403.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURING SYSTEM OVERSTITCH ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,31559.3700,4733.9100,MEDCOST,MEDCOST VHN,15019.10,,,,,,,8145.4700,31559.3700,percent of total billed charges,"47.59% of $31,559.37 in Billed Charges for Rev 272 = $15,019.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURING SYSTEM OVERSTITCH ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,31559.3700,4733.9100,SENTARA HEALTH,SENTARA HEALTH,8145.47,,,,,,,8145.4700,31559.3700,percent of total billed charges,"25.81% of $31,559.37 in Billed Charges for Rev 272 = $8,145.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURING SYSTEM OVERSTITCH ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,31559.3700,4733.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",31559.37,,,,,,,8145.4700,31559.3700,percent of total billed charges,"100% of $31,559.37 in Billed Charges for Rev 272 = $31,559.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURING SYSTEM OVERSTITCH ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,31559.3700,4733.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,15779.69,,,,,,,8145.4700,31559.3700,percent of total billed charges,"Rev 272 $31,559.37 in Billed Charges at 50% = $15,779.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURING SYSTEM OVERSTITCH ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,31559.3700,4733.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,10193.68,,,,,,,8145.4700,31559.3700,other,"32.3% of $31,559.37 in Billed Charges for Rev 272 = $10,193.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURING SYSTEM OVERSTITCH ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,31559.3700,4733.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,9688.73,,,,,,,8145.4700,31559.3700,other,"30.7% of $31,559.37 in Billed Charges for Rev 272 = $9,688.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURING SYSTEM OVERSTITCH ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,31559.3700,4733.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,10193.68,,,,,,,8145.4700,31559.3700,percent of total billed charges,"32.3% of $31,559.37 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURING SYSTEM OVERSTITCH ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,31559.3700,4733.9100,WELLCARE,WELLCARE MEDICAID,31559.37,,,,,,,8145.4700,31559.3700,percent of total billed charges,"100% of $31,559.37 in Billed Charges for Rev 272 = $31,559.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYRINGE BIOGLUE 5MM (BX/5) BG3515-5-US,272,RC,27200002,CDM,,,,,,both,,,9696.8900,1454.5300,AETNA,AETNA,4140.57,,,,,,,2502.7700,9696.8900,percent of total billed charges,"42.7% of $9,696.89 in Billed Charges for Rev 272 = $4,140.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYRINGE BIOGLUE 5MM (BX/5) BG3515-5-US,272,RC,27200002,CDM,,,,,,both,,,9696.8900,1454.5300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6787.82,,,,,,,2502.7700,9696.8900,percent of total billed charges,"Rev 272 $9,696.89 in Billed Charges at 70% = $6,787.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYRINGE BIOGLUE 5MM (BX/5) BG3515-5-US,272,RC,27200002,CDM,,,,,,both,,,9696.8900,1454.5300,CIGNA HEALTHCARE,CIGNA HMO,4043.60,,,,,,,2502.7700,9696.8900,percent of total billed charges,"41.7% of $9,696.89 in Billed Charges for Rev 272 = $4,043.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYRINGE BIOGLUE 5MM (BX/5) BG3515-5-US,272,RC,27200002,CDM,,,,,,both,,,9696.8900,1454.5300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4499.36,,,,,,,2502.7700,9696.8900,percent of total billed charges,"46.4% of $9,696.89 in Billed Charges for Rev 272 = $4,499.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYRINGE BIOGLUE 5MM (BX/5) BG3515-5-US,272,RC,27200002,CDM,,,,,,both,,,9696.8900,1454.5300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4043.60,,,,,,,2502.7700,9696.8900,percent of total billed charges,"41.7% of $9,696.89 in Billed Charges for Rev 272 = $4,043.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYRINGE BIOGLUE 5MM (BX/5) BG3515-5-US,272,RC,27200002,CDM,,,,,,both,,,9696.8900,1454.5300,CIGNA HEALTHCARE,CIGNA PPO,4043.60,,,,,,,2502.7700,9696.8900,percent of total billed charges,"41.7% of $9,696.89 in Billed Charges for Rev 272 = $4,043.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYRINGE BIOGLUE 5MM (BX/5) BG3515-5-US,272,RC,27200002,CDM,,,,,,both,,,9696.8900,1454.5300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8727.20,,,,,,,2502.7700,9696.8900,percent of total billed charges,"90% of $9,696.89 in Billed Charges for Rev 272 = $8,727.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYRINGE BIOGLUE 5MM (BX/5) BG3515-5-US,272,RC,27200002,CDM,,,,,,both,,,9696.8900,1454.5300,MEDCOST,MEDCOST VHN,4614.75,,,,,,,2502.7700,9696.8900,percent of total billed charges,"47.59% of $9,696.89 in Billed Charges for Rev 272 = $4,614.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYRINGE BIOGLUE 5MM (BX/5) BG3515-5-US,272,RC,27200002,CDM,,,,,,both,,,9696.8900,1454.5300,SENTARA HEALTH,SENTARA HEALTH,2502.77,,,,,,,2502.7700,9696.8900,percent of total billed charges,"25.81% of $9,696.89 in Billed Charges for Rev 272 = $2,502.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYRINGE BIOGLUE 5MM (BX/5) BG3515-5-US,272,RC,27200002,CDM,,,,,,both,,,9696.8900,1454.5300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9696.89,,,,,,,2502.7700,9696.8900,percent of total billed charges,"100% of $9,696.89 in Billed Charges for Rev 272 = $9,696.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYRINGE BIOGLUE 5MM (BX/5) BG3515-5-US,272,RC,27200002,CDM,,,,,,both,,,9696.8900,1454.5300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4848.45,,,,,,,2502.7700,9696.8900,percent of total billed charges,"Rev 272 $9,696.89 in Billed Charges at 50% = $4,848.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYRINGE BIOGLUE 5MM (BX/5) BG3515-5-US,272,RC,27200002,CDM,,,,,,both,,,9696.8900,1454.5300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3132.10,,,,,,,2502.7700,9696.8900,other,"32.3% of $9,696.89 in Billed Charges for Rev 272 = $3,132.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYRINGE BIOGLUE 5MM (BX/5) BG3515-5-US,272,RC,27200002,CDM,,,,,,both,,,9696.8900,1454.5300,UNITED HEALTHCARE,UHC HERITAGE SELECT,2976.95,,,,,,,2502.7700,9696.8900,other,"30.7% of $9,696.89 in Billed Charges for Rev 272 = $2,976.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYRINGE BIOGLUE 5MM (BX/5) BG3515-5-US,272,RC,27200002,CDM,,,,,,both,,,9696.8900,1454.5300,UNITED HEALTHCARE,UNITED HEALTHCARE,3132.10,,,,,,,2502.7700,9696.8900,percent of total billed charges,"32.3% of $9,696.89 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYRINGE BIOGLUE 5MM (BX/5) BG3515-5-US,272,RC,27200002,CDM,,,,,,both,,,9696.8900,1454.5300,WELLCARE,WELLCARE MEDICAID,9696.89,,,,,,,2502.7700,9696.8900,percent of total billed charges,"100% of $9,696.89 in Billed Charges for Rev 272 = $9,696.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BYPASS CALIBRATION VISIGI 40FR,272,RC,27200002,CDM,,,,,,both,,,2126.0600,318.9100,AETNA,AETNA,907.83,,,,,,,548.7400,2126.0600,percent of total billed charges,"42.7% of $2,126.06 in Billed Charges for Rev 272 = $907.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BYPASS CALIBRATION VISIGI 40FR,272,RC,27200002,CDM,,,,,,both,,,2126.0600,318.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1488.24,,,,,,,548.7400,2126.0600,percent of total billed charges,"Rev 272 $2,126.06 in Billed Charges at 70% = $1,488.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BYPASS CALIBRATION VISIGI 40FR,272,RC,27200002,CDM,,,,,,both,,,2126.0600,318.9100,CIGNA HEALTHCARE,CIGNA HMO,886.57,,,,,,,548.7400,2126.0600,percent of total billed charges,"41.7% of $2,126.06 in Billed Charges for Rev 272 = $886.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BYPASS CALIBRATION VISIGI 40FR,272,RC,27200002,CDM,,,,,,both,,,2126.0600,318.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,986.49,,,,,,,548.7400,2126.0600,percent of total billed charges,"46.4% of $2,126.06 in Billed Charges for Rev 272 = $986.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BYPASS CALIBRATION VISIGI 40FR,272,RC,27200002,CDM,,,,,,both,,,2126.0600,318.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,886.57,,,,,,,548.7400,2126.0600,percent of total billed charges,"41.7% of $2,126.06 in Billed Charges for Rev 272 = $886.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BYPASS CALIBRATION VISIGI 40FR,272,RC,27200002,CDM,,,,,,both,,,2126.0600,318.9100,CIGNA HEALTHCARE,CIGNA PPO,886.57,,,,,,,548.7400,2126.0600,percent of total billed charges,"41.7% of $2,126.06 in Billed Charges for Rev 272 = $886.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BYPASS CALIBRATION VISIGI 40FR,272,RC,27200002,CDM,,,,,,both,,,2126.0600,318.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1913.45,,,,,,,548.7400,2126.0600,percent of total billed charges,"90% of $2,126.06 in Billed Charges for Rev 272 = $1,913.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BYPASS CALIBRATION VISIGI 40FR,272,RC,27200002,CDM,,,,,,both,,,2126.0600,318.9100,MEDCOST,MEDCOST VHN,1011.79,,,,,,,548.7400,2126.0600,percent of total billed charges,"47.59% of $2,126.06 in Billed Charges for Rev 272 = $1,011.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BYPASS CALIBRATION VISIGI 40FR,272,RC,27200002,CDM,,,,,,both,,,2126.0600,318.9100,SENTARA HEALTH,SENTARA HEALTH,548.74,,,,,,,548.7400,2126.0600,percent of total billed charges,"25.81% of $2,126.06 in Billed Charges for Rev 272 = $548.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BYPASS CALIBRATION VISIGI 40FR,272,RC,27200002,CDM,,,,,,both,,,2126.0600,318.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2126.06,,,,,,,548.7400,2126.0600,percent of total billed charges,"100% of $2,126.06 in Billed Charges for Rev 272 = $2,126.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BYPASS CALIBRATION VISIGI 40FR,272,RC,27200002,CDM,,,,,,both,,,2126.0600,318.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1063.03,,,,,,,548.7400,2126.0600,percent of total billed charges,"Rev 272 $2,126.06 in Billed Charges at 50% = $1,063.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BYPASS CALIBRATION VISIGI 40FR,272,RC,27200002,CDM,,,,,,both,,,2126.0600,318.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,686.72,,,,,,,548.7400,2126.0600,other,"32.3% of $2,126.06 in Billed Charges for Rev 272 = $686.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM BYPASS CALIBRATION VISIGI 40FR,272,RC,27200002,CDM,,,,,,both,,,2126.0600,318.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,652.70,,,,,,,548.7400,2126.0600,other,"30.7% of $2,126.06 in Billed Charges for Rev 272 = $652.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM BYPASS CALIBRATION VISIGI 40FR,272,RC,27200002,CDM,,,,,,both,,,2126.0600,318.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,686.72,,,,,,,548.7400,2126.0600,percent of total billed charges,"32.3% of $2,126.06 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BYPASS CALIBRATION VISIGI 40FR,272,RC,27200002,CDM,,,,,,both,,,2126.0600,318.9100,WELLCARE,WELLCARE MEDICAID,2126.06,,,,,,,548.7400,2126.0600,percent of total billed charges,"100% of $2,126.06 in Billed Charges for Rev 272 = $2,126.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CANNULA OPHTHALMIC OMNI SURGICAL,272,RC,27200002,CDM,,,,,,both,,,18657.4300,2798.6100,AETNA,AETNA,7966.72,,,,,,,4815.4800,18657.4300,percent of total billed charges,"42.7% of $18,657.43 in Billed Charges for Rev 272 = $7,966.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CANNULA OPHTHALMIC OMNI SURGICAL,272,RC,27200002,CDM,,,,,,both,,,18657.4300,2798.6100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,13060.20,,,,,,,4815.4800,18657.4300,percent of total billed charges,"Rev 272 $18,657.43 in Billed Charges at 70% = $13,060.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CANNULA OPHTHALMIC OMNI SURGICAL,272,RC,27200002,CDM,,,,,,both,,,18657.4300,2798.6100,CIGNA HEALTHCARE,CIGNA HMO,7780.15,,,,,,,4815.4800,18657.4300,percent of total billed charges,"41.7% of $18,657.43 in Billed Charges for Rev 272 = $7,780.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CANNULA OPHTHALMIC OMNI SURGICAL,272,RC,27200002,CDM,,,,,,both,,,18657.4300,2798.6100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8657.05,,,,,,,4815.4800,18657.4300,percent of total billed charges,"46.4% of $18,657.43 in Billed Charges for Rev 272 = $8,657.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CANNULA OPHTHALMIC OMNI SURGICAL,272,RC,27200002,CDM,,,,,,both,,,18657.4300,2798.6100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7780.15,,,,,,,4815.4800,18657.4300,percent of total billed charges,"41.7% of $18,657.43 in Billed Charges for Rev 272 = $7,780.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CANNULA OPHTHALMIC OMNI SURGICAL,272,RC,27200002,CDM,,,,,,both,,,18657.4300,2798.6100,CIGNA HEALTHCARE,CIGNA PPO,7780.15,,,,,,,4815.4800,18657.4300,percent of total billed charges,"41.7% of $18,657.43 in Billed Charges for Rev 272 = $7,780.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CANNULA OPHTHALMIC OMNI SURGICAL,272,RC,27200002,CDM,,,,,,both,,,18657.4300,2798.6100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,16791.69,,,,,,,4815.4800,18657.4300,percent of total billed charges,"90% of $18,657.43 in Billed Charges for Rev 272 = $16,791.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CANNULA OPHTHALMIC OMNI SURGICAL,272,RC,27200002,CDM,,,,,,both,,,18657.4300,2798.6100,MEDCOST,MEDCOST VHN,8879.07,,,,,,,4815.4800,18657.4300,percent of total billed charges,"47.59% of $18,657.43 in Billed Charges for Rev 272 = $8,879.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CANNULA OPHTHALMIC OMNI SURGICAL,272,RC,27200002,CDM,,,,,,both,,,18657.4300,2798.6100,SENTARA HEALTH,SENTARA HEALTH,4815.48,,,,,,,4815.4800,18657.4300,percent of total billed charges,"25.81% of $18,657.43 in Billed Charges for Rev 272 = $4,815.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CANNULA OPHTHALMIC OMNI SURGICAL,272,RC,27200002,CDM,,,,,,both,,,18657.4300,2798.6100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",18657.43,,,,,,,4815.4800,18657.4300,percent of total billed charges,"100% of $18,657.43 in Billed Charges for Rev 272 = $18,657.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CANNULA OPHTHALMIC OMNI SURGICAL,272,RC,27200002,CDM,,,,,,both,,,18657.4300,2798.6100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9328.72,,,,,,,4815.4800,18657.4300,percent of total billed charges,"Rev 272 $18,657.43 in Billed Charges at 50% = $9,328.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CANNULA OPHTHALMIC OMNI SURGICAL,272,RC,27200002,CDM,,,,,,both,,,18657.4300,2798.6100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,6026.35,,,,,,,4815.4800,18657.4300,other,"32.3% of $18,657.43 in Billed Charges for Rev 272 = $6,026.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM CANNULA OPHTHALMIC OMNI SURGICAL,272,RC,27200002,CDM,,,,,,both,,,18657.4300,2798.6100,UNITED HEALTHCARE,UHC HERITAGE SELECT,5727.83,,,,,,,4815.4800,18657.4300,other,"30.7% of $18,657.43 in Billed Charges for Rev 272 = $5,727.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM CANNULA OPHTHALMIC OMNI SURGICAL,272,RC,27200002,CDM,,,,,,both,,,18657.4300,2798.6100,UNITED HEALTHCARE,UNITED HEALTHCARE,6026.35,,,,,,,4815.4800,18657.4300,percent of total billed charges,"32.3% of $18,657.43 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CANNULA OPHTHALMIC OMNI SURGICAL,272,RC,27200002,CDM,,,,,,both,,,18657.4300,2798.6100,WELLCARE,WELLCARE MEDICAID,18657.43,,,,,,,4815.4800,18657.4300,percent of total billed charges,"100% of $18,657.43 in Billed Charges for Rev 272 = $18,657.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CRUCIFORM REMOVAL 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2769.0600,415.3600,AETNA,AETNA,1182.39,,,,,,,714.6900,2769.0600,percent of total billed charges,"42.7% of $2,769.06 in Billed Charges for Rev 272 = $1,182.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CRUCIFORM REMOVAL 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2769.0600,415.3600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1938.34,,,,,,,714.6900,2769.0600,percent of total billed charges,"Rev 272 $2,769.06 in Billed Charges at 70% = $1,938.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CRUCIFORM REMOVAL 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2769.0600,415.3600,CIGNA HEALTHCARE,CIGNA HMO,1154.70,,,,,,,714.6900,2769.0600,percent of total billed charges,"41.7% of $2,769.06 in Billed Charges for Rev 272 = $1,154.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CRUCIFORM REMOVAL 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2769.0600,415.3600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1284.84,,,,,,,714.6900,2769.0600,percent of total billed charges,"46.4% of $2,769.06 in Billed Charges for Rev 272 = $1,284.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CRUCIFORM REMOVAL 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2769.0600,415.3600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1154.70,,,,,,,714.6900,2769.0600,percent of total billed charges,"41.7% of $2,769.06 in Billed Charges for Rev 272 = $1,154.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CRUCIFORM REMOVAL 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2769.0600,415.3600,CIGNA HEALTHCARE,CIGNA PPO,1154.70,,,,,,,714.6900,2769.0600,percent of total billed charges,"41.7% of $2,769.06 in Billed Charges for Rev 272 = $1,154.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CRUCIFORM REMOVAL 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2769.0600,415.3600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2492.15,,,,,,,714.6900,2769.0600,percent of total billed charges,"90% of $2,769.06 in Billed Charges for Rev 272 = $2,492.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CRUCIFORM REMOVAL 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2769.0600,415.3600,MEDCOST,MEDCOST VHN,1317.80,,,,,,,714.6900,2769.0600,percent of total billed charges,"47.59% of $2,769.06 in Billed Charges for Rev 272 = $1,317.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CRUCIFORM REMOVAL 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2769.0600,415.3600,SENTARA HEALTH,SENTARA HEALTH,714.69,,,,,,,714.6900,2769.0600,percent of total billed charges,"25.81% of $2,769.06 in Billed Charges for Rev 272 = $714.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CRUCIFORM REMOVAL 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2769.0600,415.3600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2769.06,,,,,,,714.6900,2769.0600,percent of total billed charges,"100% of $2,769.06 in Billed Charges for Rev 272 = $2,769.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CRUCIFORM REMOVAL 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2769.0600,415.3600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1384.53,,,,,,,714.6900,2769.0600,percent of total billed charges,"Rev 272 $2,769.06 in Billed Charges at 50% = $1,384.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CRUCIFORM REMOVAL 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2769.0600,415.3600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,894.41,,,,,,,714.6900,2769.0600,other,"32.3% of $2,769.06 in Billed Charges for Rev 272 = $894.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP CRUCIFORM REMOVAL 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2769.0600,415.3600,UNITED HEALTHCARE,UHC HERITAGE SELECT,850.10,,,,,,,714.6900,2769.0600,other,"30.7% of $2,769.06 in Billed Charges for Rev 272 = $850.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP CRUCIFORM REMOVAL 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2769.0600,415.3600,UNITED HEALTHCARE,UNITED HEALTHCARE,894.41,,,,,,,714.6900,2769.0600,percent of total billed charges,"32.3% of $2,769.06 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CRUCIFORM REMOVAL 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2769.0600,415.3600,WELLCARE,WELLCARE MEDICAID,2769.06,,,,,,,714.6900,2769.0600,percent of total billed charges,"100% of $2,769.06 in Billed Charges for Rev 272 = $2,769.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP EXTRACTOR MALE 12-28,272,RC,27200002,CDM,,,,,,both,,,2955.7400,443.3600,AETNA,AETNA,1262.10,,,,,,,762.8800,2955.7400,percent of total billed charges,"42.7% of $2,955.74 in Billed Charges for Rev 272 = $1,262.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP EXTRACTOR MALE 12-28,272,RC,27200002,CDM,,,,,,both,,,2955.7400,443.3600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2069.02,,,,,,,762.8800,2955.7400,percent of total billed charges,"Rev 272 $2,955.74 in Billed Charges at 70% = $2,069.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP EXTRACTOR MALE 12-28,272,RC,27200002,CDM,,,,,,both,,,2955.7400,443.3600,CIGNA HEALTHCARE,CIGNA HMO,1232.54,,,,,,,762.8800,2955.7400,percent of total billed charges,"41.7% of $2,955.74 in Billed Charges for Rev 272 = $1,232.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP EXTRACTOR MALE 12-28,272,RC,27200002,CDM,,,,,,both,,,2955.7400,443.3600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1371.46,,,,,,,762.8800,2955.7400,percent of total billed charges,"46.4% of $2,955.74 in Billed Charges for Rev 272 = $1,371.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP EXTRACTOR MALE 12-28,272,RC,27200002,CDM,,,,,,both,,,2955.7400,443.3600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1232.54,,,,,,,762.8800,2955.7400,percent of total billed charges,"41.7% of $2,955.74 in Billed Charges for Rev 272 = $1,232.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP EXTRACTOR MALE 12-28,272,RC,27200002,CDM,,,,,,both,,,2955.7400,443.3600,CIGNA HEALTHCARE,CIGNA PPO,1232.54,,,,,,,762.8800,2955.7400,percent of total billed charges,"41.7% of $2,955.74 in Billed Charges for Rev 272 = $1,232.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP EXTRACTOR MALE 12-28,272,RC,27200002,CDM,,,,,,both,,,2955.7400,443.3600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2660.17,,,,,,,762.8800,2955.7400,percent of total billed charges,"90% of $2,955.74 in Billed Charges for Rev 272 = $2,660.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP EXTRACTOR MALE 12-28,272,RC,27200002,CDM,,,,,,both,,,2955.7400,443.3600,MEDCOST,MEDCOST VHN,1406.64,,,,,,,762.8800,2955.7400,percent of total billed charges,"47.59% of $2,955.74 in Billed Charges for Rev 272 = $1,406.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP EXTRACTOR MALE 12-28,272,RC,27200002,CDM,,,,,,both,,,2955.7400,443.3600,SENTARA HEALTH,SENTARA HEALTH,762.88,,,,,,,762.8800,2955.7400,percent of total billed charges,"25.81% of $2,955.74 in Billed Charges for Rev 272 = $762.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP EXTRACTOR MALE 12-28,272,RC,27200002,CDM,,,,,,both,,,2955.7400,443.3600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2955.74,,,,,,,762.8800,2955.7400,percent of total billed charges,"100% of $2,955.74 in Billed Charges for Rev 272 = $2,955.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP EXTRACTOR MALE 12-28,272,RC,27200002,CDM,,,,,,both,,,2955.7400,443.3600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1477.87,,,,,,,762.8800,2955.7400,percent of total billed charges,"Rev 272 $2,955.74 in Billed Charges at 50% = $1,477.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP EXTRACTOR MALE 12-28,272,RC,27200002,CDM,,,,,,both,,,2955.7400,443.3600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,954.70,,,,,,,762.8800,2955.7400,other,"32.3% of $2,955.74 in Billed Charges for Rev 272 = $954.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP EXTRACTOR MALE 12-28,272,RC,27200002,CDM,,,,,,both,,,2955.7400,443.3600,UNITED HEALTHCARE,UHC HERITAGE SELECT,907.41,,,,,,,762.8800,2955.7400,other,"30.7% of $2,955.74 in Billed Charges for Rev 272 = $907.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP EXTRACTOR MALE 12-28,272,RC,27200002,CDM,,,,,,both,,,2955.7400,443.3600,UNITED HEALTHCARE,UNITED HEALTHCARE,954.70,,,,,,,762.8800,2955.7400,percent of total billed charges,"32.3% of $2,955.74 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP EXTRACTOR MALE 12-28,272,RC,27200002,CDM,,,,,,both,,,2955.7400,443.3600,WELLCARE,WELLCARE MEDICAID,2955.74,,,,,,,762.8800,2955.7400,percent of total billed charges,"100% of $2,955.74 in Billed Charges for Rev 272 = $2,955.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP KELMAN MINI FLARED 45DEG,272,RC,,,,,,,,both,,,647.7100,97.1600,AETNA,AETNA,276.57,,,,,,,167.1700,647.7100,percent of total billed charges,42.7% of $647.71 in Billed Charges for Rev 272 = $276.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP KELMAN MINI FLARED 45DEG,272,RC,,,,,,,,both,,,647.7100,97.1600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,453.40,,,,,,,167.1700,647.7100,percent of total billed charges,Rev 272 $647.71 in Billed Charges at 70% = $453.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP KELMAN MINI FLARED 45DEG,272,RC,,,,,,,,both,,,647.7100,97.1600,CIGNA HEALTHCARE,CIGNA HMO,270.10,,,,,,,167.1700,647.7100,percent of total billed charges,41.7% of $647.71 in Billed Charges for Rev 272 = $270.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP KELMAN MINI FLARED 45DEG,272,RC,,,,,,,,both,,,647.7100,97.1600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,300.54,,,,,,,167.1700,647.7100,percent of total billed charges,46.4% of $647.71 in Billed Charges for Rev 272 = $300.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP KELMAN MINI FLARED 45DEG,272,RC,,,,,,,,both,,,647.7100,97.1600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,270.10,,,,,,,167.1700,647.7100,percent of total billed charges,41.7% of $647.71 in Billed Charges for Rev 272 = $270.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP KELMAN MINI FLARED 45DEG,272,RC,,,,,,,,both,,,647.7100,97.1600,CIGNA HEALTHCARE,CIGNA PPO,270.10,,,,,,,167.1700,647.7100,percent of total billed charges,41.7% of $647.71 in Billed Charges for Rev 272 = $270.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP KELMAN MINI FLARED 45DEG,272,RC,,,,,,,,both,,,647.7100,97.1600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,582.94,,,,,,,167.1700,647.7100,percent of total billed charges,90% of $647.71 in Billed Charges for Rev 272 = $582.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP KELMAN MINI FLARED 45DEG,272,RC,,,,,,,,both,,,647.7100,97.1600,MEDCOST,MEDCOST VHN,308.25,,,,,,,167.1700,647.7100,percent of total billed charges,47.59% of $647.71 in Billed Charges for Rev 272 = $308.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP KELMAN MINI FLARED 45DEG,272,RC,,,,,,,,both,,,647.7100,97.1600,SENTARA HEALTH,SENTARA HEALTH,167.17,,,,,,,167.1700,647.7100,percent of total billed charges,25.81% of $647.71 in Billed Charges for Rev 272 = $167.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP KELMAN MINI FLARED 45DEG,272,RC,,,,,,,,both,,,647.7100,97.1600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",647.71,,,,,,,167.1700,647.7100,percent of total billed charges,100% of $647.71 in Billed Charges for Rev 272 = $647.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP KELMAN MINI FLARED 45DEG,272,RC,,,,,,,,both,,,647.7100,97.1600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,323.86,,,,,,,167.1700,647.7100,percent of total billed charges,Rev 272 $647.71 in Billed Charges at 50% = $323.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP KELMAN MINI FLARED 45DEG,272,RC,,,,,,,,both,,,647.7100,97.1600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,209.21,,,,,,,167.1700,647.7100,other,32.3% of $647.71 in Billed Charges for Rev 272 = $209.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TIP KELMAN MINI FLARED 45DEG,272,RC,,,,,,,,both,,,647.7100,97.1600,UNITED HEALTHCARE,UHC HERITAGE SELECT,198.85,,,,,,,167.1700,647.7100,other,30.7% of $647.71 in Billed Charges for Rev 272 = $198.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TIP KELMAN MINI FLARED 45DEG,272,RC,,,,,,,,both,,,647.7100,97.1600,UNITED HEALTHCARE,UNITED HEALTHCARE,209.21,,,,,,,167.1700,647.7100,percent of total billed charges,32.3% of $647.71 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP KELMAN MINI FLARED 45DEG,272,RC,,,,,,,,both,,,647.7100,97.1600,WELLCARE,WELLCARE MEDICAID,647.71,,,,,,,167.1700,647.7100,percent of total billed charges,100% of $647.71 in Billed Charges for Rev 272 = $647.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM AUTO STRUT CONTROL,272,RC,27200002,CDM,,,,,,both,,,74774.9100,11216.2400,AETNA,AETNA,31928.89,,,,,,,19299.4000,74774.9100,percent of total billed charges,"42.7% of $74,774.91 in Billed Charges for Rev 272 = $31,928.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM AUTO STRUT CONTROL,272,RC,27200002,CDM,,,,,,both,,,74774.9100,11216.2400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,52342.44,,,,,,,19299.4000,74774.9100,percent of total billed charges,"Rev 272 $74,774.91 in Billed Charges at 70% = $52,342.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM AUTO STRUT CONTROL,272,RC,27200002,CDM,,,,,,both,,,74774.9100,11216.2400,CIGNA HEALTHCARE,CIGNA HMO,31181.14,,,,,,,19299.4000,74774.9100,percent of total billed charges,"41.7% of $74,774.91 in Billed Charges for Rev 272 = $31,181.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM AUTO STRUT CONTROL,272,RC,27200002,CDM,,,,,,both,,,74774.9100,11216.2400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,34695.56,,,,,,,19299.4000,74774.9100,percent of total billed charges,"46.4% of $74,774.91 in Billed Charges for Rev 272 = $34,695.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM AUTO STRUT CONTROL,272,RC,27200002,CDM,,,,,,both,,,74774.9100,11216.2400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,31181.14,,,,,,,19299.4000,74774.9100,percent of total billed charges,"41.7% of $74,774.91 in Billed Charges for Rev 272 = $31,181.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM AUTO STRUT CONTROL,272,RC,27200002,CDM,,,,,,both,,,74774.9100,11216.2400,CIGNA HEALTHCARE,CIGNA PPO,31181.14,,,,,,,19299.4000,74774.9100,percent of total billed charges,"41.7% of $74,774.91 in Billed Charges for Rev 272 = $31,181.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM AUTO STRUT CONTROL,272,RC,27200002,CDM,,,,,,both,,,74774.9100,11216.2400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,67297.42,,,,,,,19299.4000,74774.9100,percent of total billed charges,"90% of $74,774.91 in Billed Charges for Rev 272 = $67,297.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM AUTO STRUT CONTROL,272,RC,27200002,CDM,,,,,,both,,,74774.9100,11216.2400,MEDCOST,MEDCOST VHN,35585.38,,,,,,,19299.4000,74774.9100,percent of total billed charges,"47.59% of $74,774.91 in Billed Charges for Rev 272 = $35,585.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM AUTO STRUT CONTROL,272,RC,27200002,CDM,,,,,,both,,,74774.9100,11216.2400,SENTARA HEALTH,SENTARA HEALTH,19299.40,,,,,,,19299.4000,74774.9100,percent of total billed charges,"25.81% of $74,774.91 in Billed Charges for Rev 272 = $19,299.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM AUTO STRUT CONTROL,272,RC,27200002,CDM,,,,,,both,,,74774.9100,11216.2400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",74774.91,,,,,,,19299.4000,74774.9100,percent of total billed charges,"100% of $74,774.91 in Billed Charges for Rev 272 = $74,774.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM AUTO STRUT CONTROL,272,RC,27200002,CDM,,,,,,both,,,74774.9100,11216.2400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,37387.46,,,,,,,19299.4000,74774.9100,percent of total billed charges,"Rev 272 $74,774.91 in Billed Charges at 50% = $37,387.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM AUTO STRUT CONTROL,272,RC,27200002,CDM,,,,,,both,,,74774.9100,11216.2400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,24152.30,,,,,,,19299.4000,74774.9100,other,"32.3% of $74,774.91 in Billed Charges for Rev 272 = $24,152.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM AUTO STRUT CONTROL,272,RC,27200002,CDM,,,,,,both,,,74774.9100,11216.2400,UNITED HEALTHCARE,UHC HERITAGE SELECT,22955.90,,,,,,,19299.4000,74774.9100,other,"30.7% of $74,774.91 in Billed Charges for Rev 272 = $22,955.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM AUTO STRUT CONTROL,272,RC,27200002,CDM,,,,,,both,,,74774.9100,11216.2400,UNITED HEALTHCARE,UNITED HEALTHCARE,24152.30,,,,,,,19299.4000,74774.9100,percent of total billed charges,"32.3% of $74,774.91 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM AUTO STRUT CONTROL,272,RC,27200002,CDM,,,,,,both,,,74774.9100,11216.2400,WELLCARE,WELLCARE MEDICAID,74774.91,,,,,,,19299.4000,74774.9100,percent of total billed charges,"100% of $74,774.91 in Billed Charges for Rev 272 = $74,774.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOCUE PLATELET CONCENTRATION STANDARD,272,RC,,,,,,,,both,,,16023.2000,2403.4800,AETNA,AETNA,6841.91,,,,,,,4135.5900,16023.2000,percent of total billed charges,"42.7% of $16,023.20 in Billed Charges for Rev 272 = $6,841.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOCUE PLATELET CONCENTRATION STANDARD,272,RC,,,,,,,,both,,,16023.2000,2403.4800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11216.24,,,,,,,4135.5900,16023.2000,percent of total billed charges,"Rev 272 $16,023.20 in Billed Charges at 70% = $11,216.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOCUE PLATELET CONCENTRATION STANDARD,272,RC,,,,,,,,both,,,16023.2000,2403.4800,CIGNA HEALTHCARE,CIGNA HMO,6681.67,,,,,,,4135.5900,16023.2000,percent of total billed charges,"41.7% of $16,023.20 in Billed Charges for Rev 272 = $6,681.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOCUE PLATELET CONCENTRATION STANDARD,272,RC,,,,,,,,both,,,16023.2000,2403.4800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7434.76,,,,,,,4135.5900,16023.2000,percent of total billed charges,"46.4% of $16,023.20 in Billed Charges for Rev 272 = $7,434.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOCUE PLATELET CONCENTRATION STANDARD,272,RC,,,,,,,,both,,,16023.2000,2403.4800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6681.67,,,,,,,4135.5900,16023.2000,percent of total billed charges,"41.7% of $16,023.20 in Billed Charges for Rev 272 = $6,681.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOCUE PLATELET CONCENTRATION STANDARD,272,RC,,,,,,,,both,,,16023.2000,2403.4800,CIGNA HEALTHCARE,CIGNA PPO,6681.67,,,,,,,4135.5900,16023.2000,percent of total billed charges,"41.7% of $16,023.20 in Billed Charges for Rev 272 = $6,681.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOCUE PLATELET CONCENTRATION STANDARD,272,RC,,,,,,,,both,,,16023.2000,2403.4800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,14420.88,,,,,,,4135.5900,16023.2000,percent of total billed charges,"90% of $16,023.20 in Billed Charges for Rev 272 = $14,420.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOCUE PLATELET CONCENTRATION STANDARD,272,RC,,,,,,,,both,,,16023.2000,2403.4800,MEDCOST,MEDCOST VHN,7625.44,,,,,,,4135.5900,16023.2000,percent of total billed charges,"47.59% of $16,023.20 in Billed Charges for Rev 272 = $7,625.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOCUE PLATELET CONCENTRATION STANDARD,272,RC,,,,,,,,both,,,16023.2000,2403.4800,SENTARA HEALTH,SENTARA HEALTH,4135.59,,,,,,,4135.5900,16023.2000,percent of total billed charges,"25.81% of $16,023.20 in Billed Charges for Rev 272 = $4,135.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOCUE PLATELET CONCENTRATION STANDARD,272,RC,,,,,,,,both,,,16023.2000,2403.4800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",16023.20,,,,,,,4135.5900,16023.2000,percent of total billed charges,"100% of $16,023.20 in Billed Charges for Rev 272 = $16,023.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOCUE PLATELET CONCENTRATION STANDARD,272,RC,,,,,,,,both,,,16023.2000,2403.4800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8011.60,,,,,,,4135.5900,16023.2000,percent of total billed charges,"Rev 272 $16,023.20 in Billed Charges at 50% = $8,011.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOCUE PLATELET CONCENTRATION STANDARD,272,RC,,,,,,,,both,,,16023.2000,2403.4800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5175.49,,,,,,,4135.5900,16023.2000,other,"32.3% of $16,023.20 in Billed Charges for Rev 272 = $5,175.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM BIOCUE PLATELET CONCENTRATION STANDARD,272,RC,,,,,,,,both,,,16023.2000,2403.4800,UNITED HEALTHCARE,UHC HERITAGE SELECT,4919.12,,,,,,,4135.5900,16023.2000,other,"30.7% of $16,023.20 in Billed Charges for Rev 272 = $4,919.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM BIOCUE PLATELET CONCENTRATION STANDARD,272,RC,,,,,,,,both,,,16023.2000,2403.4800,UNITED HEALTHCARE,UNITED HEALTHCARE,5175.49,,,,,,,4135.5900,16023.2000,percent of total billed charges,"32.3% of $16,023.20 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOCUE PLATELET CONCENTRATION STANDARD,272,RC,,,,,,,,both,,,16023.2000,2403.4800,WELLCARE,WELLCARE MEDICAID,16023.20,,,,,,,4135.5900,16023.2000,percent of total billed charges,"100% of $16,023.20 in Billed Charges for Rev 272 = $16,023.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOPSY GENCUT CORE,272,RC,27200002,CDM,,,,,,both,,,5216.6100,782.4900,AETNA,AETNA,2227.49,,,,,,,1346.4100,5216.6100,percent of total billed charges,"42.7% of $5,216.61 in Billed Charges for Rev 272 = $2,227.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOPSY GENCUT CORE,272,RC,27200002,CDM,,,,,,both,,,5216.6100,782.4900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3651.63,,,,,,,1346.4100,5216.6100,percent of total billed charges,"Rev 272 $5,216.61 in Billed Charges at 70% = $3,651.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOPSY GENCUT CORE,272,RC,27200002,CDM,,,,,,both,,,5216.6100,782.4900,CIGNA HEALTHCARE,CIGNA HMO,2175.33,,,,,,,1346.4100,5216.6100,percent of total billed charges,"41.7% of $5,216.61 in Billed Charges for Rev 272 = $2,175.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOPSY GENCUT CORE,272,RC,27200002,CDM,,,,,,both,,,5216.6100,782.4900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2420.51,,,,,,,1346.4100,5216.6100,percent of total billed charges,"46.4% of $5,216.61 in Billed Charges for Rev 272 = $2,420.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOPSY GENCUT CORE,272,RC,27200002,CDM,,,,,,both,,,5216.6100,782.4900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2175.33,,,,,,,1346.4100,5216.6100,percent of total billed charges,"41.7% of $5,216.61 in Billed Charges for Rev 272 = $2,175.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOPSY GENCUT CORE,272,RC,27200002,CDM,,,,,,both,,,5216.6100,782.4900,CIGNA HEALTHCARE,CIGNA PPO,2175.33,,,,,,,1346.4100,5216.6100,percent of total billed charges,"41.7% of $5,216.61 in Billed Charges for Rev 272 = $2,175.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOPSY GENCUT CORE,272,RC,27200002,CDM,,,,,,both,,,5216.6100,782.4900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4694.95,,,,,,,1346.4100,5216.6100,percent of total billed charges,"90% of $5,216.61 in Billed Charges for Rev 272 = $4,694.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOPSY GENCUT CORE,272,RC,27200002,CDM,,,,,,both,,,5216.6100,782.4900,MEDCOST,MEDCOST VHN,2482.58,,,,,,,1346.4100,5216.6100,percent of total billed charges,"47.59% of $5,216.61 in Billed Charges for Rev 272 = $2,482.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOPSY GENCUT CORE,272,RC,27200002,CDM,,,,,,both,,,5216.6100,782.4900,SENTARA HEALTH,SENTARA HEALTH,1346.41,,,,,,,1346.4100,5216.6100,percent of total billed charges,"25.81% of $5,216.61 in Billed Charges for Rev 272 = $1,346.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOPSY GENCUT CORE,272,RC,27200002,CDM,,,,,,both,,,5216.6100,782.4900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5216.61,,,,,,,1346.4100,5216.6100,percent of total billed charges,"100% of $5,216.61 in Billed Charges for Rev 272 = $5,216.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOPSY GENCUT CORE,272,RC,27200002,CDM,,,,,,both,,,5216.6100,782.4900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2608.31,,,,,,,1346.4100,5216.6100,percent of total billed charges,"Rev 272 $5,216.61 in Billed Charges at 50% = $2,608.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOPSY GENCUT CORE,272,RC,27200002,CDM,,,,,,both,,,5216.6100,782.4900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1684.97,,,,,,,1346.4100,5216.6100,other,"32.3% of $5,216.61 in Billed Charges for Rev 272 = $1,684.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM BIOPSY GENCUT CORE,272,RC,27200002,CDM,,,,,,both,,,5216.6100,782.4900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1601.50,,,,,,,1346.4100,5216.6100,other,"30.7% of $5,216.61 in Billed Charges for Rev 272 = $1,601.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM BIOPSY GENCUT CORE,272,RC,27200002,CDM,,,,,,both,,,5216.6100,782.4900,UNITED HEALTHCARE,UNITED HEALTHCARE,1684.97,,,,,,,1346.4100,5216.6100,percent of total billed charges,"32.3% of $5,216.61 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM BIOPSY GENCUT CORE,272,RC,27200002,CDM,,,,,,both,,,5216.6100,782.4900,WELLCARE,WELLCARE MEDICAID,5216.61,,,,,,,1346.4100,5216.6100,percent of total billed charges,"100% of $5,216.61 in Billed Charges for Rev 272 = $5,216.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 20CM APEX 360,272,RC,27200002,CDM,,,,,,both,,,13708.3400,2056.2500,AETNA,AETNA,5853.46,,,,,,,3538.1200,13708.3400,percent of total billed charges,"42.7% of $13,708.34 in Billed Charges for Rev 272 = $5,853.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 20CM APEX 360,272,RC,27200002,CDM,,,,,,both,,,13708.3400,2056.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9595.84,,,,,,,3538.1200,13708.3400,percent of total billed charges,"Rev 272 $13,708.34 in Billed Charges at 70% = $9,595.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 20CM APEX 360,272,RC,27200002,CDM,,,,,,both,,,13708.3400,2056.2500,CIGNA HEALTHCARE,CIGNA HMO,5716.38,,,,,,,3538.1200,13708.3400,percent of total billed charges,"41.7% of $13,708.34 in Billed Charges for Rev 272 = $5,716.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 20CM APEX 360,272,RC,27200002,CDM,,,,,,both,,,13708.3400,2056.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6360.67,,,,,,,3538.1200,13708.3400,percent of total billed charges,"46.4% of $13,708.34 in Billed Charges for Rev 272 = $6,360.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 20CM APEX 360,272,RC,27200002,CDM,,,,,,both,,,13708.3400,2056.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5716.38,,,,,,,3538.1200,13708.3400,percent of total billed charges,"41.7% of $13,708.34 in Billed Charges for Rev 272 = $5,716.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 20CM APEX 360,272,RC,27200002,CDM,,,,,,both,,,13708.3400,2056.2500,CIGNA HEALTHCARE,CIGNA PPO,5716.38,,,,,,,3538.1200,13708.3400,percent of total billed charges,"41.7% of $13,708.34 in Billed Charges for Rev 272 = $5,716.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 20CM APEX 360,272,RC,27200002,CDM,,,,,,both,,,13708.3400,2056.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12337.51,,,,,,,3538.1200,13708.3400,percent of total billed charges,"90% of $13,708.34 in Billed Charges for Rev 272 = $12,337.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 20CM APEX 360,272,RC,27200002,CDM,,,,,,both,,,13708.3400,2056.2500,MEDCOST,MEDCOST VHN,6523.80,,,,,,,3538.1200,13708.3400,percent of total billed charges,"47.59% of $13,708.34 in Billed Charges for Rev 272 = $6,523.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 20CM APEX 360,272,RC,27200002,CDM,,,,,,both,,,13708.3400,2056.2500,SENTARA HEALTH,SENTARA HEALTH,3538.12,,,,,,,3538.1200,13708.3400,percent of total billed charges,"25.81% of $13,708.34 in Billed Charges for Rev 272 = $3,538.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 20CM APEX 360,272,RC,27200002,CDM,,,,,,both,,,13708.3400,2056.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13708.34,,,,,,,3538.1200,13708.3400,percent of total billed charges,"100% of $13,708.34 in Billed Charges for Rev 272 = $13,708.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 20CM APEX 360,272,RC,27200002,CDM,,,,,,both,,,13708.3400,2056.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6854.17,,,,,,,3538.1200,13708.3400,percent of total billed charges,"Rev 272 $13,708.34 in Billed Charges at 50% = $6,854.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 20CM APEX 360,272,RC,27200002,CDM,,,,,,both,,,13708.3400,2056.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4427.79,,,,,,,3538.1200,13708.3400,other,"32.3% of $13,708.34 in Billed Charges for Rev 272 = $4,427.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP BONE CUTTING 20CM APEX 360,272,RC,27200002,CDM,,,,,,both,,,13708.3400,2056.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,4208.46,,,,,,,3538.1200,13708.3400,other,"30.7% of $13,708.34 in Billed Charges for Rev 272 = $4,208.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP BONE CUTTING 20CM APEX 360,272,RC,27200002,CDM,,,,,,both,,,13708.3400,2056.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,4427.79,,,,,,,3538.1200,13708.3400,percent of total billed charges,"32.3% of $13,708.34 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 20CM APEX 360,272,RC,27200002,CDM,,,,,,both,,,13708.3400,2056.2500,WELLCARE,WELLCARE MEDICAID,13708.34,,,,,,,3538.1200,13708.3400,percent of total billed charges,"100% of $13,708.34 in Billed Charges for Rev 272 = $13,708.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CONICAL INSTAFILL,272,RC,27200002,CDM,,,,,,both,,,6678.9200,1001.8400,AETNA,AETNA,2851.90,,,,,,,1723.8300,6678.9200,percent of total billed charges,"42.7% of $6,678.92 in Billed Charges for Rev 272 = $2,851.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CONICAL INSTAFILL,272,RC,27200002,CDM,,,,,,both,,,6678.9200,1001.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4675.24,,,,,,,1723.8300,6678.9200,percent of total billed charges,"Rev 272 $6,678.92 in Billed Charges at 70% = $4,675.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CONICAL INSTAFILL,272,RC,27200002,CDM,,,,,,both,,,6678.9200,1001.8400,CIGNA HEALTHCARE,CIGNA HMO,2785.11,,,,,,,1723.8300,6678.9200,percent of total billed charges,"41.7% of $6,678.92 in Billed Charges for Rev 272 = $2,785.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CONICAL INSTAFILL,272,RC,27200002,CDM,,,,,,both,,,6678.9200,1001.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3099.02,,,,,,,1723.8300,6678.9200,percent of total billed charges,"46.4% of $6,678.92 in Billed Charges for Rev 272 = $3,099.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CONICAL INSTAFILL,272,RC,27200002,CDM,,,,,,both,,,6678.9200,1001.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2785.11,,,,,,,1723.8300,6678.9200,percent of total billed charges,"41.7% of $6,678.92 in Billed Charges for Rev 272 = $2,785.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CONICAL INSTAFILL,272,RC,27200002,CDM,,,,,,both,,,6678.9200,1001.8400,CIGNA HEALTHCARE,CIGNA PPO,2785.11,,,,,,,1723.8300,6678.9200,percent of total billed charges,"41.7% of $6,678.92 in Billed Charges for Rev 272 = $2,785.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CONICAL INSTAFILL,272,RC,27200002,CDM,,,,,,both,,,6678.9200,1001.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6011.03,,,,,,,1723.8300,6678.9200,percent of total billed charges,"90% of $6,678.92 in Billed Charges for Rev 272 = $6,011.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CONICAL INSTAFILL,272,RC,27200002,CDM,,,,,,both,,,6678.9200,1001.8400,MEDCOST,MEDCOST VHN,3178.50,,,,,,,1723.8300,6678.9200,percent of total billed charges,"47.59% of $6,678.92 in Billed Charges for Rev 272 = $3,178.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CONICAL INSTAFILL,272,RC,27200002,CDM,,,,,,both,,,6678.9200,1001.8400,SENTARA HEALTH,SENTARA HEALTH,1723.83,,,,,,,1723.8300,6678.9200,percent of total billed charges,"25.81% of $6,678.92 in Billed Charges for Rev 272 = $1,723.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CONICAL INSTAFILL,272,RC,27200002,CDM,,,,,,both,,,6678.9200,1001.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6678.92,,,,,,,1723.8300,6678.9200,percent of total billed charges,"100% of $6,678.92 in Billed Charges for Rev 272 = $6,678.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CONICAL INSTAFILL,272,RC,27200002,CDM,,,,,,both,,,6678.9200,1001.8400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3339.46,,,,,,,1723.8300,6678.9200,percent of total billed charges,"Rev 272 $6,678.92 in Billed Charges at 50% = $3,339.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CONICAL INSTAFILL,272,RC,27200002,CDM,,,,,,both,,,6678.9200,1001.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2157.29,,,,,,,1723.8300,6678.9200,other,"32.3% of $6,678.92 in Billed Charges for Rev 272 = $2,157.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP CONICAL INSTAFILL,272,RC,27200002,CDM,,,,,,both,,,6678.9200,1001.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,2050.43,,,,,,,1723.8300,6678.9200,other,"30.7% of $6,678.92 in Billed Charges for Rev 272 = $2,050.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP CONICAL INSTAFILL,272,RC,27200002,CDM,,,,,,both,,,6678.9200,1001.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,2157.29,,,,,,,1723.8300,6678.9200,percent of total billed charges,"32.3% of $6,678.92 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP CONICAL INSTAFILL,272,RC,27200002,CDM,,,,,,both,,,6678.9200,1001.8400,WELLCARE,WELLCARE MEDICAID,6678.92,,,,,,,1723.8300,6678.9200,percent of total billed charges,"100% of $6,678.92 in Billed Charges for Rev 272 = $6,678.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO 12CM IQ SONOPET,272,RC,27200002,CDM,,,,,,both,,,9728.1000,1459.2200,AETNA,AETNA,4153.90,,,,,,,2510.8200,9728.1000,percent of total billed charges,"42.7% of $9,728.10 in Billed Charges for Rev 272 = $4,153.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO 12CM IQ SONOPET,272,RC,27200002,CDM,,,,,,both,,,9728.1000,1459.2200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6809.67,,,,,,,2510.8200,9728.1000,percent of total billed charges,"Rev 272 $9,728.10 in Billed Charges at 70% = $6,809.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO 12CM IQ SONOPET,272,RC,27200002,CDM,,,,,,both,,,9728.1000,1459.2200,CIGNA HEALTHCARE,CIGNA HMO,4056.62,,,,,,,2510.8200,9728.1000,percent of total billed charges,"41.7% of $9,728.10 in Billed Charges for Rev 272 = $4,056.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO 12CM IQ SONOPET,272,RC,27200002,CDM,,,,,,both,,,9728.1000,1459.2200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4513.84,,,,,,,2510.8200,9728.1000,percent of total billed charges,"46.4% of $9,728.10 in Billed Charges for Rev 272 = $4,513.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO 12CM IQ SONOPET,272,RC,27200002,CDM,,,,,,both,,,9728.1000,1459.2200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4056.62,,,,,,,2510.8200,9728.1000,percent of total billed charges,"41.7% of $9,728.10 in Billed Charges for Rev 272 = $4,056.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO 12CM IQ SONOPET,272,RC,27200002,CDM,,,,,,both,,,9728.1000,1459.2200,CIGNA HEALTHCARE,CIGNA PPO,4056.62,,,,,,,2510.8200,9728.1000,percent of total billed charges,"41.7% of $9,728.10 in Billed Charges for Rev 272 = $4,056.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO 12CM IQ SONOPET,272,RC,27200002,CDM,,,,,,both,,,9728.1000,1459.2200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8755.29,,,,,,,2510.8200,9728.1000,percent of total billed charges,"90% of $9,728.10 in Billed Charges for Rev 272 = $8,755.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO 12CM IQ SONOPET,272,RC,27200002,CDM,,,,,,both,,,9728.1000,1459.2200,MEDCOST,MEDCOST VHN,4629.60,,,,,,,2510.8200,9728.1000,percent of total billed charges,"47.59% of $9,728.10 in Billed Charges for Rev 272 = $4,629.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO 12CM IQ SONOPET,272,RC,27200002,CDM,,,,,,both,,,9728.1000,1459.2200,SENTARA HEALTH,SENTARA HEALTH,2510.82,,,,,,,2510.8200,9728.1000,percent of total billed charges,"25.81% of $9,728.10 in Billed Charges for Rev 272 = $2,510.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO 12CM IQ SONOPET,272,RC,27200002,CDM,,,,,,both,,,9728.1000,1459.2200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9728.10,,,,,,,2510.8200,9728.1000,percent of total billed charges,"100% of $9,728.10 in Billed Charges for Rev 272 = $9,728.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO 12CM IQ SONOPET,272,RC,27200002,CDM,,,,,,both,,,9728.1000,1459.2200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4864.05,,,,,,,2510.8200,9728.1000,percent of total billed charges,"Rev 272 $9,728.10 in Billed Charges at 50% = $4,864.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO 12CM IQ SONOPET,272,RC,27200002,CDM,,,,,,both,,,9728.1000,1459.2200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3142.18,,,,,,,2510.8200,9728.1000,other,"32.3% of $9,728.10 in Billed Charges for Rev 272 = $3,142.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP MICRO 12CM IQ SONOPET,272,RC,27200002,CDM,,,,,,both,,,9728.1000,1459.2200,UNITED HEALTHCARE,UHC HERITAGE SELECT,2986.53,,,,,,,2510.8200,9728.1000,other,"30.7% of $9,728.10 in Billed Charges for Rev 272 = $2,986.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP MICRO 12CM IQ SONOPET,272,RC,27200002,CDM,,,,,,both,,,9728.1000,1459.2200,UNITED HEALTHCARE,UNITED HEALTHCARE,3142.18,,,,,,,2510.8200,9728.1000,percent of total billed charges,"32.3% of $9,728.10 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO 12CM IQ SONOPET,272,RC,27200002,CDM,,,,,,both,,,9728.1000,1459.2200,WELLCARE,WELLCARE MEDICAID,9728.10,,,,,,,2510.8200,9728.1000,percent of total billed charges,"100% of $9,728.10 in Billed Charges for Rev 272 = $9,728.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO KELMAN PHACO 30D,272,RC,,,,,,,,both,,,1001.8400,150.2800,AETNA,AETNA,427.79,,,,,,,258.5700,1001.8400,percent of total billed charges,"42.7% of $1,001.84 in Billed Charges for Rev 272 = $427.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO KELMAN PHACO 30D,272,RC,,,,,,,,both,,,1001.8400,150.2800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,701.29,,,,,,,258.5700,1001.8400,percent of total billed charges,"Rev 272 $1,001.84 in Billed Charges at 70% = $701.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO KELMAN PHACO 30D,272,RC,,,,,,,,both,,,1001.8400,150.2800,CIGNA HEALTHCARE,CIGNA HMO,417.77,,,,,,,258.5700,1001.8400,percent of total billed charges,"41.7% of $1,001.84 in Billed Charges for Rev 272 = $417.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO KELMAN PHACO 30D,272,RC,,,,,,,,both,,,1001.8400,150.2800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,464.85,,,,,,,258.5700,1001.8400,percent of total billed charges,"46.4% of $1,001.84 in Billed Charges for Rev 272 = $464.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO KELMAN PHACO 30D,272,RC,,,,,,,,both,,,1001.8400,150.2800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,417.77,,,,,,,258.5700,1001.8400,percent of total billed charges,"41.7% of $1,001.84 in Billed Charges for Rev 272 = $417.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO KELMAN PHACO 30D,272,RC,,,,,,,,both,,,1001.8400,150.2800,CIGNA HEALTHCARE,CIGNA PPO,417.77,,,,,,,258.5700,1001.8400,percent of total billed charges,"41.7% of $1,001.84 in Billed Charges for Rev 272 = $417.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO KELMAN PHACO 30D,272,RC,,,,,,,,both,,,1001.8400,150.2800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,901.66,,,,,,,258.5700,1001.8400,percent of total billed charges,"90% of $1,001.84 in Billed Charges for Rev 272 = $901.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO KELMAN PHACO 30D,272,RC,,,,,,,,both,,,1001.8400,150.2800,MEDCOST,MEDCOST VHN,476.78,,,,,,,258.5700,1001.8400,percent of total billed charges,"47.59% of $1,001.84 in Billed Charges for Rev 272 = $476.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO KELMAN PHACO 30D,272,RC,,,,,,,,both,,,1001.8400,150.2800,SENTARA HEALTH,SENTARA HEALTH,258.57,,,,,,,258.5700,1001.8400,percent of total billed charges,"25.81% of $1,001.84 in Billed Charges for Rev 272 = $258.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO KELMAN PHACO 30D,272,RC,,,,,,,,both,,,1001.8400,150.2800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1001.84,,,,,,,258.5700,1001.8400,percent of total billed charges,"100% of $1,001.84 in Billed Charges for Rev 272 = $1,001.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO KELMAN PHACO 30D,272,RC,,,,,,,,both,,,1001.8400,150.2800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,500.92,,,,,,,258.5700,1001.8400,percent of total billed charges,"Rev 272 $1,001.84 in Billed Charges at 50% = $500.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO KELMAN PHACO 30D,272,RC,,,,,,,,both,,,1001.8400,150.2800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,323.59,,,,,,,258.5700,1001.8400,other,"32.3% of $1,001.84 in Billed Charges for Rev 272 = $323.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP MICRO KELMAN PHACO 30D,272,RC,,,,,,,,both,,,1001.8400,150.2800,UNITED HEALTHCARE,UHC HERITAGE SELECT,307.56,,,,,,,258.5700,1001.8400,other,"30.7% of $1,001.84 in Billed Charges for Rev 272 = $307.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP MICRO KELMAN PHACO 30D,272,RC,,,,,,,,both,,,1001.8400,150.2800,UNITED HEALTHCARE,UNITED HEALTHCARE,323.59,,,,,,,258.5700,1001.8400,percent of total billed charges,"32.3% of $1,001.84 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO KELMAN PHACO 30D,272,RC,,,,,,,,both,,,1001.8400,150.2800,WELLCARE,WELLCARE MEDICAID,1001.84,,,,,,,258.5700,1001.8400,percent of total billed charges,"100% of $1,001.84 in Billed Charges for Rev 272 = $1,001.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP MICRO OZIL PHACO 30D,272,RC,27200002,CDM,,,,,,both,,,819.2100,122.8800,AETNA,AETNA,349.80,,,,,,,211.4400,819.2100,percent of total billed charges,42.7% of $819.21 in Billed Charges for Rev 272 = $349.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP MICRO OZIL PHACO 30D,272,RC,27200002,CDM,,,,,,both,,,819.2100,122.8800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,573.45,,,,,,,211.4400,819.2100,percent of total billed charges,Rev 272 $819.21 in Billed Charges at 70% = $573.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP MICRO OZIL PHACO 30D,272,RC,27200002,CDM,,,,,,both,,,819.2100,122.8800,CIGNA HEALTHCARE,CIGNA HMO,341.61,,,,,,,211.4400,819.2100,percent of total billed charges,41.7% of $819.21 in Billed Charges for Rev 272 = $341.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP MICRO OZIL PHACO 30D,272,RC,27200002,CDM,,,,,,both,,,819.2100,122.8800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,380.11,,,,,,,211.4400,819.2100,percent of total billed charges,46.4% of $819.21 in Billed Charges for Rev 272 = $380.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP MICRO OZIL PHACO 30D,272,RC,27200002,CDM,,,,,,both,,,819.2100,122.8800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,341.61,,,,,,,211.4400,819.2100,percent of total billed charges,41.7% of $819.21 in Billed Charges for Rev 272 = $341.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP MICRO OZIL PHACO 30D,272,RC,27200002,CDM,,,,,,both,,,819.2100,122.8800,CIGNA HEALTHCARE,CIGNA PPO,341.61,,,,,,,211.4400,819.2100,percent of total billed charges,41.7% of $819.21 in Billed Charges for Rev 272 = $341.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP MICRO OZIL PHACO 30D,272,RC,27200002,CDM,,,,,,both,,,819.2100,122.8800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,737.29,,,,,,,211.4400,819.2100,percent of total billed charges,90% of $819.21 in Billed Charges for Rev 272 = $737.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP MICRO OZIL PHACO 30D,272,RC,27200002,CDM,,,,,,both,,,819.2100,122.8800,MEDCOST,MEDCOST VHN,389.86,,,,,,,211.4400,819.2100,percent of total billed charges,47.59% of $819.21 in Billed Charges for Rev 272 = $389.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP MICRO OZIL PHACO 30D,272,RC,27200002,CDM,,,,,,both,,,819.2100,122.8800,SENTARA HEALTH,SENTARA HEALTH,211.44,,,,,,,211.4400,819.2100,percent of total billed charges,25.81% of $819.21 in Billed Charges for Rev 272 = $211.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP MICRO OZIL PHACO 30D,272,RC,27200002,CDM,,,,,,both,,,819.2100,122.8800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",819.21,,,,,,,211.4400,819.2100,percent of total billed charges,100% of $819.21 in Billed Charges for Rev 272 = $819.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP MICRO OZIL PHACO 30D,272,RC,27200002,CDM,,,,,,both,,,819.2100,122.8800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,409.61,,,,,,,211.4400,819.2100,percent of total billed charges,Rev 272 $819.21 in Billed Charges at 50% = $409.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP MICRO OZIL PHACO 30D,272,RC,27200002,CDM,,,,,,both,,,819.2100,122.8800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,264.60,,,,,,,211.4400,819.2100,other,32.3% of $819.21 in Billed Charges for Rev 272 = $264.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TIP MICRO OZIL PHACO 30D,272,RC,27200002,CDM,,,,,,both,,,819.2100,122.8800,UNITED HEALTHCARE,UHC HERITAGE SELECT,251.50,,,,,,,211.4400,819.2100,other,30.7% of $819.21 in Billed Charges for Rev 272 = $251.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TIP MICRO OZIL PHACO 30D,272,RC,27200002,CDM,,,,,,both,,,819.2100,122.8800,UNITED HEALTHCARE,UNITED HEALTHCARE,264.60,,,,,,,211.4400,819.2100,percent of total billed charges,32.3% of $819.21 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP MICRO OZIL PHACO 30D,272,RC,27200002,CDM,,,,,,both,,,819.2100,122.8800,WELLCARE,WELLCARE MEDICAID,819.21,,,,,,,211.4400,819.2100,percent of total billed charges,100% of $819.21 in Billed Charges for Rev 272 = $819.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP PHACO,272,RC,27200002,CDM,,,,,,both,,,764.0300,114.6000,AETNA,AETNA,326.24,,,,,,,197.2000,764.0300,percent of total billed charges,42.7% of $764.03 in Billed Charges for Rev 272 = $326.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP PHACO,272,RC,27200002,CDM,,,,,,both,,,764.0300,114.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,534.82,,,,,,,197.2000,764.0300,percent of total billed charges,Rev 272 $764.03 in Billed Charges at 70% = $534.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP PHACO,272,RC,27200002,CDM,,,,,,both,,,764.0300,114.6000,CIGNA HEALTHCARE,CIGNA HMO,318.60,,,,,,,197.2000,764.0300,percent of total billed charges,41.7% of $764.03 in Billed Charges for Rev 272 = $318.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP PHACO,272,RC,27200002,CDM,,,,,,both,,,764.0300,114.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,354.51,,,,,,,197.2000,764.0300,percent of total billed charges,46.4% of $764.03 in Billed Charges for Rev 272 = $354.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP PHACO,272,RC,27200002,CDM,,,,,,both,,,764.0300,114.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,318.60,,,,,,,197.2000,764.0300,percent of total billed charges,41.7% of $764.03 in Billed Charges for Rev 272 = $318.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP PHACO,272,RC,27200002,CDM,,,,,,both,,,764.0300,114.6000,CIGNA HEALTHCARE,CIGNA PPO,318.60,,,,,,,197.2000,764.0300,percent of total billed charges,41.7% of $764.03 in Billed Charges for Rev 272 = $318.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP PHACO,272,RC,27200002,CDM,,,,,,both,,,764.0300,114.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,687.63,,,,,,,197.2000,764.0300,percent of total billed charges,90% of $764.03 in Billed Charges for Rev 272 = $687.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP PHACO,272,RC,27200002,CDM,,,,,,both,,,764.0300,114.6000,MEDCOST,MEDCOST VHN,363.60,,,,,,,197.2000,764.0300,percent of total billed charges,47.59% of $764.03 in Billed Charges for Rev 272 = $363.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP PHACO,272,RC,27200002,CDM,,,,,,both,,,764.0300,114.6000,SENTARA HEALTH,SENTARA HEALTH,197.20,,,,,,,197.2000,764.0300,percent of total billed charges,25.81% of $764.03 in Billed Charges for Rev 272 = $197.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP PHACO,272,RC,27200002,CDM,,,,,,both,,,764.0300,114.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",764.03,,,,,,,197.2000,764.0300,percent of total billed charges,100% of $764.03 in Billed Charges for Rev 272 = $764.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP PHACO,272,RC,27200002,CDM,,,,,,both,,,764.0300,114.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,382.02,,,,,,,197.2000,764.0300,percent of total billed charges,Rev 272 $764.03 in Billed Charges at 50% = $382.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP PHACO,272,RC,27200002,CDM,,,,,,both,,,764.0300,114.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,246.78,,,,,,,197.2000,764.0300,other,32.3% of $764.03 in Billed Charges for Rev 272 = $246.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TIP PHACO,272,RC,27200002,CDM,,,,,,both,,,764.0300,114.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,234.56,,,,,,,197.2000,764.0300,other,30.7% of $764.03 in Billed Charges for Rev 272 = $234.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TIP PHACO,272,RC,27200002,CDM,,,,,,both,,,764.0300,114.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,246.78,,,,,,,197.2000,764.0300,percent of total billed charges,32.3% of $764.03 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP PHACO,272,RC,27200002,CDM,,,,,,both,,,764.0300,114.6000,WELLCARE,WELLCARE MEDICAID,764.03,,,,,,,197.2000,764.0300,percent of total billed charges,100% of $764.03 in Billed Charges for Rev 272 = $764.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP REMOVAL T-15 654.329,272,RC,,,,,,,,both,,,3992.8400,598.9300,AETNA,AETNA,1704.94,,,,,,,1030.5500,3992.8400,percent of total billed charges,"42.7% of $3,992.84 in Billed Charges for Rev 272 = $1,704.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15 654.329,272,RC,,,,,,,,both,,,3992.8400,598.9300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2794.99,,,,,,,1030.5500,3992.8400,percent of total billed charges,"Rev 272 $3,992.84 in Billed Charges at 70% = $2,794.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15 654.329,272,RC,,,,,,,,both,,,3992.8400,598.9300,CIGNA HEALTHCARE,CIGNA HMO,1665.01,,,,,,,1030.5500,3992.8400,percent of total billed charges,"41.7% of $3,992.84 in Billed Charges for Rev 272 = $1,665.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15 654.329,272,RC,,,,,,,,both,,,3992.8400,598.9300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1852.68,,,,,,,1030.5500,3992.8400,percent of total billed charges,"46.4% of $3,992.84 in Billed Charges for Rev 272 = $1,852.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15 654.329,272,RC,,,,,,,,both,,,3992.8400,598.9300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1665.01,,,,,,,1030.5500,3992.8400,percent of total billed charges,"41.7% of $3,992.84 in Billed Charges for Rev 272 = $1,665.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15 654.329,272,RC,,,,,,,,both,,,3992.8400,598.9300,CIGNA HEALTHCARE,CIGNA PPO,1665.01,,,,,,,1030.5500,3992.8400,percent of total billed charges,"41.7% of $3,992.84 in Billed Charges for Rev 272 = $1,665.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15 654.329,272,RC,,,,,,,,both,,,3992.8400,598.9300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3593.56,,,,,,,1030.5500,3992.8400,percent of total billed charges,"90% of $3,992.84 in Billed Charges for Rev 272 = $3,593.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15 654.329,272,RC,,,,,,,,both,,,3992.8400,598.9300,MEDCOST,MEDCOST VHN,1900.19,,,,,,,1030.5500,3992.8400,percent of total billed charges,"47.59% of $3,992.84 in Billed Charges for Rev 272 = $1,900.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15 654.329,272,RC,,,,,,,,both,,,3992.8400,598.9300,SENTARA HEALTH,SENTARA HEALTH,1030.55,,,,,,,1030.5500,3992.8400,percent of total billed charges,"25.81% of $3,992.84 in Billed Charges for Rev 272 = $1,030.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15 654.329,272,RC,,,,,,,,both,,,3992.8400,598.9300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3992.84,,,,,,,1030.5500,3992.8400,percent of total billed charges,"100% of $3,992.84 in Billed Charges for Rev 272 = $3,992.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15 654.329,272,RC,,,,,,,,both,,,3992.8400,598.9300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1996.42,,,,,,,1030.5500,3992.8400,percent of total billed charges,"Rev 272 $3,992.84 in Billed Charges at 50% = $1,996.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15 654.329,272,RC,,,,,,,,both,,,3992.8400,598.9300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1289.69,,,,,,,1030.5500,3992.8400,other,"32.3% of $3,992.84 in Billed Charges for Rev 272 = $1,289.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP REMOVAL T-15 654.329,272,RC,,,,,,,,both,,,3992.8400,598.9300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1225.80,,,,,,,1030.5500,3992.8400,other,"30.7% of $3,992.84 in Billed Charges for Rev 272 = $1,225.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP REMOVAL T-15 654.329,272,RC,,,,,,,,both,,,3992.8400,598.9300,UNITED HEALTHCARE,UNITED HEALTHCARE,1289.69,,,,,,,1030.5500,3992.8400,percent of total billed charges,"32.3% of $3,992.84 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15 654.329,272,RC,,,,,,,,both,,,3992.8400,598.9300,WELLCARE,WELLCARE MEDICAID,3992.84,,,,,,,1030.5500,3992.8400,percent of total billed charges,"100% of $3,992.84 in Billed Charges for Rev 272 = $3,992.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP KNIFE 10CM IQ,272,RC,27200002,CDM,,,,,,both,,,11174.3400,1676.1500,AETNA,AETNA,4771.44,,,,,,,2884.1000,11174.3400,percent of total billed charges,"42.7% of $11,174.34 in Billed Charges for Rev 272 = $4,771.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP KNIFE 10CM IQ,272,RC,27200002,CDM,,,,,,both,,,11174.3400,1676.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7822.04,,,,,,,2884.1000,11174.3400,percent of total billed charges,"Rev 272 $11,174.34 in Billed Charges at 70% = $7,822.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP KNIFE 10CM IQ,272,RC,27200002,CDM,,,,,,both,,,11174.3400,1676.1500,CIGNA HEALTHCARE,CIGNA HMO,4659.70,,,,,,,2884.1000,11174.3400,percent of total billed charges,"41.7% of $11,174.34 in Billed Charges for Rev 272 = $4,659.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP KNIFE 10CM IQ,272,RC,27200002,CDM,,,,,,both,,,11174.3400,1676.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5184.89,,,,,,,2884.1000,11174.3400,percent of total billed charges,"46.4% of $11,174.34 in Billed Charges for Rev 272 = $5,184.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP KNIFE 10CM IQ,272,RC,27200002,CDM,,,,,,both,,,11174.3400,1676.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4659.70,,,,,,,2884.1000,11174.3400,percent of total billed charges,"41.7% of $11,174.34 in Billed Charges for Rev 272 = $4,659.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP KNIFE 10CM IQ,272,RC,27200002,CDM,,,,,,both,,,11174.3400,1676.1500,CIGNA HEALTHCARE,CIGNA PPO,4659.70,,,,,,,2884.1000,11174.3400,percent of total billed charges,"41.7% of $11,174.34 in Billed Charges for Rev 272 = $4,659.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP KNIFE 10CM IQ,272,RC,27200002,CDM,,,,,,both,,,11174.3400,1676.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10056.91,,,,,,,2884.1000,11174.3400,percent of total billed charges,"90% of $11,174.34 in Billed Charges for Rev 272 = $10,056.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP KNIFE 10CM IQ,272,RC,27200002,CDM,,,,,,both,,,11174.3400,1676.1500,MEDCOST,MEDCOST VHN,5317.87,,,,,,,2884.1000,11174.3400,percent of total billed charges,"47.59% of $11,174.34 in Billed Charges for Rev 272 = $5,317.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP KNIFE 10CM IQ,272,RC,27200002,CDM,,,,,,both,,,11174.3400,1676.1500,SENTARA HEALTH,SENTARA HEALTH,2884.10,,,,,,,2884.1000,11174.3400,percent of total billed charges,"25.81% of $11,174.34 in Billed Charges for Rev 272 = $2,884.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP KNIFE 10CM IQ,272,RC,27200002,CDM,,,,,,both,,,11174.3400,1676.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11174.34,,,,,,,2884.1000,11174.3400,percent of total billed charges,"100% of $11,174.34 in Billed Charges for Rev 272 = $11,174.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP KNIFE 10CM IQ,272,RC,27200002,CDM,,,,,,both,,,11174.3400,1676.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5587.17,,,,,,,2884.1000,11174.3400,percent of total billed charges,"Rev 272 $11,174.34 in Billed Charges at 50% = $5,587.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP KNIFE 10CM IQ,272,RC,27200002,CDM,,,,,,both,,,11174.3400,1676.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3609.31,,,,,,,2884.1000,11174.3400,other,"32.3% of $11,174.34 in Billed Charges for Rev 272 = $3,609.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP KNIFE 10CM IQ,272,RC,27200002,CDM,,,,,,both,,,11174.3400,1676.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3430.52,,,,,,,2884.1000,11174.3400,other,"30.7% of $11,174.34 in Billed Charges for Rev 272 = $3,430.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP KNIFE 10CM IQ,272,RC,27200002,CDM,,,,,,both,,,11174.3400,1676.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,3609.31,,,,,,,2884.1000,11174.3400,percent of total billed charges,"32.3% of $11,174.34 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP KNIFE 10CM IQ,272,RC,27200002,CDM,,,,,,both,,,11174.3400,1676.1500,WELLCARE,WELLCARE MEDICAID,11174.34,,,,,,,2884.1000,11174.3400,percent of total billed charges,"100% of $11,174.34 in Billed Charges for Rev 272 = $11,174.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15,272,RC,27200002,CDM,,,,,,both,,,5558.8600,833.8300,AETNA,AETNA,2373.63,,,,,,,1434.7400,5558.8600,percent of total billed charges,"42.7% of $5,558.86 in Billed Charges for Rev 272 = $2,373.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15,272,RC,27200002,CDM,,,,,,both,,,5558.8600,833.8300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3891.20,,,,,,,1434.7400,5558.8600,percent of total billed charges,"Rev 272 $5,558.86 in Billed Charges at 70% = $3,891.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15,272,RC,27200002,CDM,,,,,,both,,,5558.8600,833.8300,CIGNA HEALTHCARE,CIGNA HMO,2318.04,,,,,,,1434.7400,5558.8600,percent of total billed charges,"41.7% of $5,558.86 in Billed Charges for Rev 272 = $2,318.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15,272,RC,27200002,CDM,,,,,,both,,,5558.8600,833.8300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2579.31,,,,,,,1434.7400,5558.8600,percent of total billed charges,"46.4% of $5,558.86 in Billed Charges for Rev 272 = $2,579.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15,272,RC,27200002,CDM,,,,,,both,,,5558.8600,833.8300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2318.04,,,,,,,1434.7400,5558.8600,percent of total billed charges,"41.7% of $5,558.86 in Billed Charges for Rev 272 = $2,318.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15,272,RC,27200002,CDM,,,,,,both,,,5558.8600,833.8300,CIGNA HEALTHCARE,CIGNA PPO,2318.04,,,,,,,1434.7400,5558.8600,percent of total billed charges,"41.7% of $5,558.86 in Billed Charges for Rev 272 = $2,318.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15,272,RC,27200002,CDM,,,,,,both,,,5558.8600,833.8300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5002.97,,,,,,,1434.7400,5558.8600,percent of total billed charges,"90% of $5,558.86 in Billed Charges for Rev 272 = $5,002.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15,272,RC,27200002,CDM,,,,,,both,,,5558.8600,833.8300,MEDCOST,MEDCOST VHN,2645.46,,,,,,,1434.7400,5558.8600,percent of total billed charges,"47.59% of $5,558.86 in Billed Charges for Rev 272 = $2,645.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15,272,RC,27200002,CDM,,,,,,both,,,5558.8600,833.8300,SENTARA HEALTH,SENTARA HEALTH,1434.74,,,,,,,1434.7400,5558.8600,percent of total billed charges,"25.81% of $5,558.86 in Billed Charges for Rev 272 = $1,434.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15,272,RC,27200002,CDM,,,,,,both,,,5558.8600,833.8300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5558.86,,,,,,,1434.7400,5558.8600,percent of total billed charges,"100% of $5,558.86 in Billed Charges for Rev 272 = $5,558.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15,272,RC,27200002,CDM,,,,,,both,,,5558.8600,833.8300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2779.43,,,,,,,1434.7400,5558.8600,percent of total billed charges,"Rev 272 $5,558.86 in Billed Charges at 50% = $2,779.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15,272,RC,27200002,CDM,,,,,,both,,,5558.8600,833.8300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1795.51,,,,,,,1434.7400,5558.8600,other,"32.3% of $5,558.86 in Billed Charges for Rev 272 = $1,795.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP REMOVAL T-15,272,RC,27200002,CDM,,,,,,both,,,5558.8600,833.8300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1706.57,,,,,,,1434.7400,5558.8600,other,"30.7% of $5,558.86 in Billed Charges for Rev 272 = $1,706.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP REMOVAL T-15,272,RC,27200002,CDM,,,,,,both,,,5558.8600,833.8300,UNITED HEALTHCARE,UNITED HEALTHCARE,1795.51,,,,,,,1434.7400,5558.8600,percent of total billed charges,"32.3% of $5,558.86 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP REMOVAL T-15,272,RC,27200002,CDM,,,,,,both,,,5558.8600,833.8300,WELLCARE,WELLCARE MEDICAID,5558.86,,,,,,,1434.7400,5558.8600,percent of total billed charges,"100% of $5,558.86 in Billed Charges for Rev 272 = $5,558.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RETRIEVE 10MM X 30MM,272,RC,27200002,CDM,,,,,,both,,,1534.9100,230.2400,AETNA,AETNA,655.41,,,,,,,396.1600,1534.9100,percent of total billed charges,"42.7% of $1,534.91 in Billed Charges for Rev 272 = $655.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RETRIEVE 10MM X 30MM,272,RC,27200002,CDM,,,,,,both,,,1534.9100,230.2400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1074.44,,,,,,,396.1600,1534.9100,percent of total billed charges,"Rev 272 $1,534.91 in Billed Charges at 70% = $1,074.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RETRIEVE 10MM X 30MM,272,RC,27200002,CDM,,,,,,both,,,1534.9100,230.2400,CIGNA HEALTHCARE,CIGNA HMO,640.06,,,,,,,396.1600,1534.9100,percent of total billed charges,"41.7% of $1,534.91 in Billed Charges for Rev 272 = $640.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RETRIEVE 10MM X 30MM,272,RC,27200002,CDM,,,,,,both,,,1534.9100,230.2400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,712.20,,,,,,,396.1600,1534.9100,percent of total billed charges,"46.4% of $1,534.91 in Billed Charges for Rev 272 = $712.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RETRIEVE 10MM X 30MM,272,RC,27200002,CDM,,,,,,both,,,1534.9100,230.2400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,640.06,,,,,,,396.1600,1534.9100,percent of total billed charges,"41.7% of $1,534.91 in Billed Charges for Rev 272 = $640.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RETRIEVE 10MM X 30MM,272,RC,27200002,CDM,,,,,,both,,,1534.9100,230.2400,CIGNA HEALTHCARE,CIGNA PPO,640.06,,,,,,,396.1600,1534.9100,percent of total billed charges,"41.7% of $1,534.91 in Billed Charges for Rev 272 = $640.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RETRIEVE 10MM X 30MM,272,RC,27200002,CDM,,,,,,both,,,1534.9100,230.2400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1381.42,,,,,,,396.1600,1534.9100,percent of total billed charges,"90% of $1,534.91 in Billed Charges for Rev 272 = $1,381.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RETRIEVE 10MM X 30MM,272,RC,27200002,CDM,,,,,,both,,,1534.9100,230.2400,MEDCOST,MEDCOST VHN,730.46,,,,,,,396.1600,1534.9100,percent of total billed charges,"47.59% of $1,534.91 in Billed Charges for Rev 272 = $730.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RETRIEVE 10MM X 30MM,272,RC,27200002,CDM,,,,,,both,,,1534.9100,230.2400,SENTARA HEALTH,SENTARA HEALTH,396.16,,,,,,,396.1600,1534.9100,percent of total billed charges,"25.81% of $1,534.91 in Billed Charges for Rev 272 = $396.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RETRIEVE 10MM X 30MM,272,RC,27200002,CDM,,,,,,both,,,1534.9100,230.2400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1534.91,,,,,,,396.1600,1534.9100,percent of total billed charges,"100% of $1,534.91 in Billed Charges for Rev 272 = $1,534.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RETRIEVE 10MM X 30MM,272,RC,27200002,CDM,,,,,,both,,,1534.9100,230.2400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,767.46,,,,,,,396.1600,1534.9100,percent of total billed charges,"Rev 272 $1,534.91 in Billed Charges at 50% = $767.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RETRIEVE 10MM X 30MM,272,RC,27200002,CDM,,,,,,both,,,1534.9100,230.2400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,495.78,,,,,,,396.1600,1534.9100,other,"32.3% of $1,534.91 in Billed Charges for Rev 272 = $495.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP RETRIEVE 10MM X 30MM,272,RC,27200002,CDM,,,,,,both,,,1534.9100,230.2400,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.22,,,,,,,396.1600,1534.9100,other,"30.7% of $1,534.91 in Billed Charges for Rev 272 = $471.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP RETRIEVE 10MM X 30MM,272,RC,27200002,CDM,,,,,,both,,,1534.9100,230.2400,UNITED HEALTHCARE,UNITED HEALTHCARE,495.78,,,,,,,396.1600,1534.9100,percent of total billed charges,"32.3% of $1,534.91 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RETRIEVE 10MM X 30MM,272,RC,27200002,CDM,,,,,,both,,,1534.9100,230.2400,WELLCARE,WELLCARE MEDICAID,1534.91,,,,,,,396.1600,1534.9100,percent of total billed charges,"100% of $1,534.91 in Billed Charges for Rev 272 = $1,534.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RUMI YELLOW 3.75CM,272,RC,27200002,CDM,,,,,,both,,,3380.0100,507.0000,AETNA,AETNA,1443.26,,,,,,,872.3800,3380.0100,percent of total billed charges,"42.7% of $3,380.01 in Billed Charges for Rev 272 = $1,443.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RUMI YELLOW 3.75CM,272,RC,27200002,CDM,,,,,,both,,,3380.0100,507.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2366.01,,,,,,,872.3800,3380.0100,percent of total billed charges,"Rev 272 $3,380.01 in Billed Charges at 70% = $2,366.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RUMI YELLOW 3.75CM,272,RC,27200002,CDM,,,,,,both,,,3380.0100,507.0000,CIGNA HEALTHCARE,CIGNA HMO,1409.46,,,,,,,872.3800,3380.0100,percent of total billed charges,"41.7% of $3,380.01 in Billed Charges for Rev 272 = $1,409.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RUMI YELLOW 3.75CM,272,RC,27200002,CDM,,,,,,both,,,3380.0100,507.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1568.32,,,,,,,872.3800,3380.0100,percent of total billed charges,"46.4% of $3,380.01 in Billed Charges for Rev 272 = $1,568.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RUMI YELLOW 3.75CM,272,RC,27200002,CDM,,,,,,both,,,3380.0100,507.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1409.46,,,,,,,872.3800,3380.0100,percent of total billed charges,"41.7% of $3,380.01 in Billed Charges for Rev 272 = $1,409.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RUMI YELLOW 3.75CM,272,RC,27200002,CDM,,,,,,both,,,3380.0100,507.0000,CIGNA HEALTHCARE,CIGNA PPO,1409.46,,,,,,,872.3800,3380.0100,percent of total billed charges,"41.7% of $3,380.01 in Billed Charges for Rev 272 = $1,409.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RUMI YELLOW 3.75CM,272,RC,27200002,CDM,,,,,,both,,,3380.0100,507.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3042.01,,,,,,,872.3800,3380.0100,percent of total billed charges,"90% of $3,380.01 in Billed Charges for Rev 272 = $3,042.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RUMI YELLOW 3.75CM,272,RC,27200002,CDM,,,,,,both,,,3380.0100,507.0000,MEDCOST,MEDCOST VHN,1608.55,,,,,,,872.3800,3380.0100,percent of total billed charges,"47.59% of $3,380.01 in Billed Charges for Rev 272 = $1,608.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RUMI YELLOW 3.75CM,272,RC,27200002,CDM,,,,,,both,,,3380.0100,507.0000,SENTARA HEALTH,SENTARA HEALTH,872.38,,,,,,,872.3800,3380.0100,percent of total billed charges,"25.81% of $3,380.01 in Billed Charges for Rev 272 = $872.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RUMI YELLOW 3.75CM,272,RC,27200002,CDM,,,,,,both,,,3380.0100,507.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3380.01,,,,,,,872.3800,3380.0100,percent of total billed charges,"100% of $3,380.01 in Billed Charges for Rev 272 = $3,380.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RUMI YELLOW 3.75CM,272,RC,27200002,CDM,,,,,,both,,,3380.0100,507.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1690.01,,,,,,,872.3800,3380.0100,percent of total billed charges,"Rev 272 $3,380.01 in Billed Charges at 50% = $1,690.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RUMI YELLOW 3.75CM,272,RC,27200002,CDM,,,,,,both,,,3380.0100,507.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1091.74,,,,,,,872.3800,3380.0100,other,"32.3% of $3,380.01 in Billed Charges for Rev 272 = $1,091.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP RUMI YELLOW 3.75CM,272,RC,27200002,CDM,,,,,,both,,,3380.0100,507.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1037.66,,,,,,,872.3800,3380.0100,other,"30.7% of $3,380.01 in Billed Charges for Rev 272 = $1,037.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP RUMI YELLOW 3.75CM,272,RC,27200002,CDM,,,,,,both,,,3380.0100,507.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,1091.74,,,,,,,872.3800,3380.0100,percent of total billed charges,"32.3% of $3,380.01 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP RUMI YELLOW 3.75CM,272,RC,27200002,CDM,,,,,,both,,,3380.0100,507.0000,WELLCARE,WELLCARE MEDICAID,3380.01,,,,,,,872.3800,3380.0100,percent of total billed charges,"100% of $3,380.01 in Billed Charges for Rev 272 = $3,380.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SOFT TISSUE BARRACUDA IQ 12 CM,272,RC,27200002,CDM,,,,,,both,,,9933.2900,1489.9900,AETNA,AETNA,4241.51,,,,,,,2563.7800,9933.2900,percent of total billed charges,"42.7% of $9,933.29 in Billed Charges for Rev 272 = $4,241.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SOFT TISSUE BARRACUDA IQ 12 CM,272,RC,27200002,CDM,,,,,,both,,,9933.2900,1489.9900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6953.30,,,,,,,2563.7800,9933.2900,percent of total billed charges,"Rev 272 $9,933.29 in Billed Charges at 70% = $6,953.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SOFT TISSUE BARRACUDA IQ 12 CM,272,RC,27200002,CDM,,,,,,both,,,9933.2900,1489.9900,CIGNA HEALTHCARE,CIGNA HMO,4142.18,,,,,,,2563.7800,9933.2900,percent of total billed charges,"41.7% of $9,933.29 in Billed Charges for Rev 272 = $4,142.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SOFT TISSUE BARRACUDA IQ 12 CM,272,RC,27200002,CDM,,,,,,both,,,9933.2900,1489.9900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4609.05,,,,,,,2563.7800,9933.2900,percent of total billed charges,"46.4% of $9,933.29 in Billed Charges for Rev 272 = $4,609.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SOFT TISSUE BARRACUDA IQ 12 CM,272,RC,27200002,CDM,,,,,,both,,,9933.2900,1489.9900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4142.18,,,,,,,2563.7800,9933.2900,percent of total billed charges,"41.7% of $9,933.29 in Billed Charges for Rev 272 = $4,142.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SOFT TISSUE BARRACUDA IQ 12 CM,272,RC,27200002,CDM,,,,,,both,,,9933.2900,1489.9900,CIGNA HEALTHCARE,CIGNA PPO,4142.18,,,,,,,2563.7800,9933.2900,percent of total billed charges,"41.7% of $9,933.29 in Billed Charges for Rev 272 = $4,142.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SOFT TISSUE BARRACUDA IQ 12 CM,272,RC,27200002,CDM,,,,,,both,,,9933.2900,1489.9900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8939.96,,,,,,,2563.7800,9933.2900,percent of total billed charges,"90% of $9,933.29 in Billed Charges for Rev 272 = $8,939.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SOFT TISSUE BARRACUDA IQ 12 CM,272,RC,27200002,CDM,,,,,,both,,,9933.2900,1489.9900,MEDCOST,MEDCOST VHN,4727.25,,,,,,,2563.7800,9933.2900,percent of total billed charges,"47.59% of $9,933.29 in Billed Charges for Rev 272 = $4,727.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SOFT TISSUE BARRACUDA IQ 12 CM,272,RC,27200002,CDM,,,,,,both,,,9933.2900,1489.9900,SENTARA HEALTH,SENTARA HEALTH,2563.78,,,,,,,2563.7800,9933.2900,percent of total billed charges,"25.81% of $9,933.29 in Billed Charges for Rev 272 = $2,563.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SOFT TISSUE BARRACUDA IQ 12 CM,272,RC,27200002,CDM,,,,,,both,,,9933.2900,1489.9900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9933.29,,,,,,,2563.7800,9933.2900,percent of total billed charges,"100% of $9,933.29 in Billed Charges for Rev 272 = $9,933.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SOFT TISSUE BARRACUDA IQ 12 CM,272,RC,27200002,CDM,,,,,,both,,,9933.2900,1489.9900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4966.65,,,,,,,2563.7800,9933.2900,percent of total billed charges,"Rev 272 $9,933.29 in Billed Charges at 50% = $4,966.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SOFT TISSUE BARRACUDA IQ 12 CM,272,RC,27200002,CDM,,,,,,both,,,9933.2900,1489.9900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3208.45,,,,,,,2563.7800,9933.2900,other,"32.3% of $9,933.29 in Billed Charges for Rev 272 = $3,208.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP SOFT TISSUE BARRACUDA IQ 12 CM,272,RC,27200002,CDM,,,,,,both,,,9933.2900,1489.9900,UNITED HEALTHCARE,UHC HERITAGE SELECT,3049.52,,,,,,,2563.7800,9933.2900,other,"30.7% of $9,933.29 in Billed Charges for Rev 272 = $3,049.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP SOFT TISSUE BARRACUDA IQ 12 CM,272,RC,27200002,CDM,,,,,,both,,,9933.2900,1489.9900,UNITED HEALTHCARE,UNITED HEALTHCARE,3208.45,,,,,,,2563.7800,9933.2900,percent of total billed charges,"32.3% of $9,933.29 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SOFT TISSUE BARRACUDA IQ 12 CM,272,RC,27200002,CDM,,,,,,both,,,9933.2900,1489.9900,WELLCARE,WELLCARE MEDICAID,9933.29,,,,,,,2563.7800,9933.2900,percent of total billed charges,"100% of $9,933.29 in Billed Charges for Rev 272 = $9,933.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SCREWDRIVER TRI-LOBE REMOVAL,272,RC,27200002,CDM,,,,,,both,,,2634.2300,395.1300,AETNA,AETNA,1124.82,,,,,,,679.8900,2634.2300,percent of total billed charges,"42.7% of $2,634.23 in Billed Charges for Rev 272 = $1,124.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SCREWDRIVER TRI-LOBE REMOVAL,272,RC,27200002,CDM,,,,,,both,,,2634.2300,395.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1843.96,,,,,,,679.8900,2634.2300,percent of total billed charges,"Rev 272 $2,634.23 in Billed Charges at 70% = $1,843.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SCREWDRIVER TRI-LOBE REMOVAL,272,RC,27200002,CDM,,,,,,both,,,2634.2300,395.1300,CIGNA HEALTHCARE,CIGNA HMO,1098.47,,,,,,,679.8900,2634.2300,percent of total billed charges,"41.7% of $2,634.23 in Billed Charges for Rev 272 = $1,098.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SCREWDRIVER TRI-LOBE REMOVAL,272,RC,27200002,CDM,,,,,,both,,,2634.2300,395.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1222.28,,,,,,,679.8900,2634.2300,percent of total billed charges,"46.4% of $2,634.23 in Billed Charges for Rev 272 = $1,222.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SCREWDRIVER TRI-LOBE REMOVAL,272,RC,27200002,CDM,,,,,,both,,,2634.2300,395.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1098.47,,,,,,,679.8900,2634.2300,percent of total billed charges,"41.7% of $2,634.23 in Billed Charges for Rev 272 = $1,098.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SCREWDRIVER TRI-LOBE REMOVAL,272,RC,27200002,CDM,,,,,,both,,,2634.2300,395.1300,CIGNA HEALTHCARE,CIGNA PPO,1098.47,,,,,,,679.8900,2634.2300,percent of total billed charges,"41.7% of $2,634.23 in Billed Charges for Rev 272 = $1,098.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SCREWDRIVER TRI-LOBE REMOVAL,272,RC,27200002,CDM,,,,,,both,,,2634.2300,395.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2370.81,,,,,,,679.8900,2634.2300,percent of total billed charges,"90% of $2,634.23 in Billed Charges for Rev 272 = $2,370.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SCREWDRIVER TRI-LOBE REMOVAL,272,RC,27200002,CDM,,,,,,both,,,2634.2300,395.1300,MEDCOST,MEDCOST VHN,1253.63,,,,,,,679.8900,2634.2300,percent of total billed charges,"47.59% of $2,634.23 in Billed Charges for Rev 272 = $1,253.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SCREWDRIVER TRI-LOBE REMOVAL,272,RC,27200002,CDM,,,,,,both,,,2634.2300,395.1300,SENTARA HEALTH,SENTARA HEALTH,679.89,,,,,,,679.8900,2634.2300,percent of total billed charges,"25.81% of $2,634.23 in Billed Charges for Rev 272 = $679.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SCREWDRIVER TRI-LOBE REMOVAL,272,RC,27200002,CDM,,,,,,both,,,2634.2300,395.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2634.23,,,,,,,679.8900,2634.2300,percent of total billed charges,"100% of $2,634.23 in Billed Charges for Rev 272 = $2,634.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SCREWDRIVER TRI-LOBE REMOVAL,272,RC,27200002,CDM,,,,,,both,,,2634.2300,395.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1317.12,,,,,,,679.8900,2634.2300,percent of total billed charges,"Rev 272 $2,634.23 in Billed Charges at 50% = $1,317.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SCREWDRIVER TRI-LOBE REMOVAL,272,RC,27200002,CDM,,,,,,both,,,2634.2300,395.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,850.86,,,,,,,679.8900,2634.2300,other,"32.3% of $2,634.23 in Billed Charges for Rev 272 = $850.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP SCREWDRIVER TRI-LOBE REMOVAL,272,RC,27200002,CDM,,,,,,both,,,2634.2300,395.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,808.71,,,,,,,679.8900,2634.2300,other,"30.7% of $2,634.23 in Billed Charges for Rev 272 = $808.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP SCREWDRIVER TRI-LOBE REMOVAL,272,RC,27200002,CDM,,,,,,both,,,2634.2300,395.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,850.86,,,,,,,679.8900,2634.2300,percent of total billed charges,"32.3% of $2,634.23 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SCREWDRIVER TRI-LOBE REMOVAL,272,RC,27200002,CDM,,,,,,both,,,2634.2300,395.1300,WELLCARE,WELLCARE MEDICAID,2634.23,,,,,,,679.8900,2634.2300,percent of total billed charges,"100% of $2,634.23 in Billed Charges for Rev 272 = $2,634.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET 12CM IQ STD,272,RC,27200002,CDM,,,,,,both,,,9079.1400,1361.8700,AETNA,AETNA,3876.79,,,,,,,2343.3300,9079.1400,percent of total billed charges,"42.7% of $9,079.14 in Billed Charges for Rev 272 = $3,876.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET 12CM IQ STD,272,RC,27200002,CDM,,,,,,both,,,9079.1400,1361.8700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6355.40,,,,,,,2343.3300,9079.1400,percent of total billed charges,"Rev 272 $9,079.14 in Billed Charges at 70% = $6,355.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET 12CM IQ STD,272,RC,27200002,CDM,,,,,,both,,,9079.1400,1361.8700,CIGNA HEALTHCARE,CIGNA HMO,3786.00,,,,,,,2343.3300,9079.1400,percent of total billed charges,"41.7% of $9,079.14 in Billed Charges for Rev 272 = $3,786.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET 12CM IQ STD,272,RC,27200002,CDM,,,,,,both,,,9079.1400,1361.8700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4212.72,,,,,,,2343.3300,9079.1400,percent of total billed charges,"46.4% of $9,079.14 in Billed Charges for Rev 272 = $4,212.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET 12CM IQ STD,272,RC,27200002,CDM,,,,,,both,,,9079.1400,1361.8700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3786.00,,,,,,,2343.3300,9079.1400,percent of total billed charges,"41.7% of $9,079.14 in Billed Charges for Rev 272 = $3,786.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET 12CM IQ STD,272,RC,27200002,CDM,,,,,,both,,,9079.1400,1361.8700,CIGNA HEALTHCARE,CIGNA PPO,3786.00,,,,,,,2343.3300,9079.1400,percent of total billed charges,"41.7% of $9,079.14 in Billed Charges for Rev 272 = $3,786.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET 12CM IQ STD,272,RC,27200002,CDM,,,,,,both,,,9079.1400,1361.8700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8171.23,,,,,,,2343.3300,9079.1400,percent of total billed charges,"90% of $9,079.14 in Billed Charges for Rev 272 = $8,171.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET 12CM IQ STD,272,RC,27200002,CDM,,,,,,both,,,9079.1400,1361.8700,MEDCOST,MEDCOST VHN,4320.76,,,,,,,2343.3300,9079.1400,percent of total billed charges,"47.59% of $9,079.14 in Billed Charges for Rev 272 = $4,320.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET 12CM IQ STD,272,RC,27200002,CDM,,,,,,both,,,9079.1400,1361.8700,SENTARA HEALTH,SENTARA HEALTH,2343.33,,,,,,,2343.3300,9079.1400,percent of total billed charges,"25.81% of $9,079.14 in Billed Charges for Rev 272 = $2,343.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET 12CM IQ STD,272,RC,27200002,CDM,,,,,,both,,,9079.1400,1361.8700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9079.14,,,,,,,2343.3300,9079.1400,percent of total billed charges,"100% of $9,079.14 in Billed Charges for Rev 272 = $9,079.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET 12CM IQ STD,272,RC,27200002,CDM,,,,,,both,,,9079.1400,1361.8700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4539.57,,,,,,,2343.3300,9079.1400,percent of total billed charges,"Rev 272 $9,079.14 in Billed Charges at 50% = $4,539.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET 12CM IQ STD,272,RC,27200002,CDM,,,,,,both,,,9079.1400,1361.8700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2932.56,,,,,,,2343.3300,9079.1400,other,"32.3% of $9,079.14 in Billed Charges for Rev 272 = $2,932.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP SONOPET 12CM IQ STD,272,RC,27200002,CDM,,,,,,both,,,9079.1400,1361.8700,UNITED HEALTHCARE,UHC HERITAGE SELECT,2787.30,,,,,,,2343.3300,9079.1400,other,"30.7% of $9,079.14 in Billed Charges for Rev 272 = $2,787.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP SONOPET 12CM IQ STD,272,RC,27200002,CDM,,,,,,both,,,9079.1400,1361.8700,UNITED HEALTHCARE,UNITED HEALTHCARE,2932.56,,,,,,,2343.3300,9079.1400,percent of total billed charges,"32.3% of $9,079.14 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET 12CM IQ STD,272,RC,27200002,CDM,,,,,,both,,,9079.1400,1361.8700,WELLCARE,WELLCARE MEDICAID,9079.14,,,,,,,2343.3300,9079.1400,percent of total billed charges,"100% of $9,079.14 in Billed Charges for Rev 272 = $9,079.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ LARGE 37CM,272,RC,,,,,,,,both,,,22812.6000,3421.8900,AETNA,AETNA,9740.98,,,,,,,5887.9300,22812.6000,percent of total billed charges,"42.7% of $22,812.60 in Billed Charges for Rev 272 = $9,740.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ LARGE 37CM,272,RC,,,,,,,,both,,,22812.6000,3421.8900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,15968.82,,,,,,,5887.9300,22812.6000,percent of total billed charges,"Rev 272 $22,812.60 in Billed Charges at 70% = $15,968.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ LARGE 37CM,272,RC,,,,,,,,both,,,22812.6000,3421.8900,CIGNA HEALTHCARE,CIGNA HMO,9512.85,,,,,,,5887.9300,22812.6000,percent of total billed charges,"41.7% of $22,812.60 in Billed Charges for Rev 272 = $9,512.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ LARGE 37CM,272,RC,,,,,,,,both,,,22812.6000,3421.8900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10585.05,,,,,,,5887.9300,22812.6000,percent of total billed charges,"46.4% of $22,812.60 in Billed Charges for Rev 272 = $10,585.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ LARGE 37CM,272,RC,,,,,,,,both,,,22812.6000,3421.8900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9512.85,,,,,,,5887.9300,22812.6000,percent of total billed charges,"41.7% of $22,812.60 in Billed Charges for Rev 272 = $9,512.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ LARGE 37CM,272,RC,,,,,,,,both,,,22812.6000,3421.8900,CIGNA HEALTHCARE,CIGNA PPO,9512.85,,,,,,,5887.9300,22812.6000,percent of total billed charges,"41.7% of $22,812.60 in Billed Charges for Rev 272 = $9,512.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ LARGE 37CM,272,RC,,,,,,,,both,,,22812.6000,3421.8900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,20531.34,,,,,,,5887.9300,22812.6000,percent of total billed charges,"90% of $22,812.60 in Billed Charges for Rev 272 = $20,531.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ LARGE 37CM,272,RC,,,,,,,,both,,,22812.6000,3421.8900,MEDCOST,MEDCOST VHN,10856.52,,,,,,,5887.9300,22812.6000,percent of total billed charges,"47.59% of $22,812.60 in Billed Charges for Rev 272 = $10,856.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ LARGE 37CM,272,RC,,,,,,,,both,,,22812.6000,3421.8900,SENTARA HEALTH,SENTARA HEALTH,5887.93,,,,,,,5887.9300,22812.6000,percent of total billed charges,"25.81% of $22,812.60 in Billed Charges for Rev 272 = $5,887.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ LARGE 37CM,272,RC,,,,,,,,both,,,22812.6000,3421.8900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",22812.60,,,,,,,5887.9300,22812.6000,percent of total billed charges,"100% of $22,812.60 in Billed Charges for Rev 272 = $22,812.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ LARGE 37CM,272,RC,,,,,,,,both,,,22812.6000,3421.8900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11406.30,,,,,,,5887.9300,22812.6000,percent of total billed charges,"Rev 272 $22,812.60 in Billed Charges at 50% = $11,406.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ LARGE 37CM,272,RC,,,,,,,,both,,,22812.6000,3421.8900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7368.47,,,,,,,5887.9300,22812.6000,other,"32.3% of $22,812.60 in Billed Charges for Rev 272 = $7,368.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP SONOPET IQ LARGE 37CM,272,RC,,,,,,,,both,,,22812.6000,3421.8900,UNITED HEALTHCARE,UHC HERITAGE SELECT,7003.47,,,,,,,5887.9300,22812.6000,other,"30.7% of $22,812.60 in Billed Charges for Rev 272 = $7,003.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP SONOPET IQ LARGE 37CM,272,RC,,,,,,,,both,,,22812.6000,3421.8900,UNITED HEALTHCARE,UNITED HEALTHCARE,7368.47,,,,,,,5887.9300,22812.6000,percent of total billed charges,"32.3% of $22,812.60 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ LARGE 37CM,272,RC,,,,,,,,both,,,22812.6000,3421.8900,WELLCARE,WELLCARE MEDICAID,22812.60,,,,,,,5887.9300,22812.6000,percent of total billed charges,"100% of $22,812.60 in Billed Charges for Rev 272 = $22,812.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ STANDARD 20CM,272,RC,27200002,CDM,,,,,,both,,,11211.3600,1681.7000,AETNA,AETNA,4787.25,,,,,,,2893.6500,11211.3600,percent of total billed charges,"42.7% of $11,211.36 in Billed Charges for Rev 272 = $4,787.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ STANDARD 20CM,272,RC,27200002,CDM,,,,,,both,,,11211.3600,1681.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7847.95,,,,,,,2893.6500,11211.3600,percent of total billed charges,"Rev 272 $11,211.36 in Billed Charges at 70% = $7,847.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ STANDARD 20CM,272,RC,27200002,CDM,,,,,,both,,,11211.3600,1681.7000,CIGNA HEALTHCARE,CIGNA HMO,4675.14,,,,,,,2893.6500,11211.3600,percent of total billed charges,"41.7% of $11,211.36 in Billed Charges for Rev 272 = $4,675.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ STANDARD 20CM,272,RC,27200002,CDM,,,,,,both,,,11211.3600,1681.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5202.07,,,,,,,2893.6500,11211.3600,percent of total billed charges,"46.4% of $11,211.36 in Billed Charges for Rev 272 = $5,202.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ STANDARD 20CM,272,RC,27200002,CDM,,,,,,both,,,11211.3600,1681.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4675.14,,,,,,,2893.6500,11211.3600,percent of total billed charges,"41.7% of $11,211.36 in Billed Charges for Rev 272 = $4,675.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ STANDARD 20CM,272,RC,27200002,CDM,,,,,,both,,,11211.3600,1681.7000,CIGNA HEALTHCARE,CIGNA PPO,4675.14,,,,,,,2893.6500,11211.3600,percent of total billed charges,"41.7% of $11,211.36 in Billed Charges for Rev 272 = $4,675.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ STANDARD 20CM,272,RC,27200002,CDM,,,,,,both,,,11211.3600,1681.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10090.22,,,,,,,2893.6500,11211.3600,percent of total billed charges,"90% of $11,211.36 in Billed Charges for Rev 272 = $10,090.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ STANDARD 20CM,272,RC,27200002,CDM,,,,,,both,,,11211.3600,1681.7000,MEDCOST,MEDCOST VHN,5335.49,,,,,,,2893.6500,11211.3600,percent of total billed charges,"47.59% of $11,211.36 in Billed Charges for Rev 272 = $5,335.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ STANDARD 20CM,272,RC,27200002,CDM,,,,,,both,,,11211.3600,1681.7000,SENTARA HEALTH,SENTARA HEALTH,2893.65,,,,,,,2893.6500,11211.3600,percent of total billed charges,"25.81% of $11,211.36 in Billed Charges for Rev 272 = $2,893.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ STANDARD 20CM,272,RC,27200002,CDM,,,,,,both,,,11211.3600,1681.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11211.36,,,,,,,2893.6500,11211.3600,percent of total billed charges,"100% of $11,211.36 in Billed Charges for Rev 272 = $11,211.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ STANDARD 20CM,272,RC,27200002,CDM,,,,,,both,,,11211.3600,1681.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5605.68,,,,,,,2893.6500,11211.3600,percent of total billed charges,"Rev 272 $11,211.36 in Billed Charges at 50% = $5,605.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ STANDARD 20CM,272,RC,27200002,CDM,,,,,,both,,,11211.3600,1681.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3621.27,,,,,,,2893.6500,11211.3600,other,"32.3% of $11,211.36 in Billed Charges for Rev 272 = $3,621.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP SONOPET IQ STANDARD 20CM,272,RC,27200002,CDM,,,,,,both,,,11211.3600,1681.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3441.89,,,,,,,2893.6500,11211.3600,other,"30.7% of $11,211.36 in Billed Charges for Rev 272 = $3,441.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP SONOPET IQ STANDARD 20CM,272,RC,27200002,CDM,,,,,,both,,,11211.3600,1681.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,3621.27,,,,,,,2893.6500,11211.3600,percent of total billed charges,"32.3% of $11,211.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SONOPET IQ STANDARD 20CM,272,RC,27200002,CDM,,,,,,both,,,11211.3600,1681.7000,WELLCARE,WELLCARE MEDICAID,11211.36,,,,,,,2893.6500,11211.3600,percent of total billed charges,"100% of $11,211.36 in Billed Charges for Rev 272 = $11,211.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GASTROSTOMY 26FR,272,RC,,,,,,,,both,,,178.7800,26.8200,AETNA,AETNA,76.34,,,,,,,46.1400,178.7800,percent of total billed charges,42.7% of $178.78 in Billed Charges for Rev 272 = $76.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEEDING GASTROSTOMY 26FR,272,RC,,,,,,,,both,,,178.7800,26.8200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,125.15,,,,,,,46.1400,178.7800,percent of total billed charges,Rev 272 $178.78 in Billed Charges at 70% = $125.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEEDING GASTROSTOMY 26FR,272,RC,,,,,,,,both,,,178.7800,26.8200,CIGNA HEALTHCARE,CIGNA HMO,74.55,,,,,,,46.1400,178.7800,percent of total billed charges,41.7% of $178.78 in Billed Charges for Rev 272 = $74.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEEDING GASTROSTOMY 26FR,272,RC,,,,,,,,both,,,178.7800,26.8200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,82.95,,,,,,,46.1400,178.7800,percent of total billed charges,46.4% of $178.78 in Billed Charges for Rev 272 = $82.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEEDING GASTROSTOMY 26FR,272,RC,,,,,,,,both,,,178.7800,26.8200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,74.55,,,,,,,46.1400,178.7800,percent of total billed charges,41.7% of $178.78 in Billed Charges for Rev 272 = $74.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEEDING GASTROSTOMY 26FR,272,RC,,,,,,,,both,,,178.7800,26.8200,CIGNA HEALTHCARE,CIGNA PPO,74.55,,,,,,,46.1400,178.7800,percent of total billed charges,41.7% of $178.78 in Billed Charges for Rev 272 = $74.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEEDING GASTROSTOMY 26FR,272,RC,,,,,,,,both,,,178.7800,26.8200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,160.90,,,,,,,46.1400,178.7800,percent of total billed charges,90% of $178.78 in Billed Charges for Rev 272 = $160.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEEDING GASTROSTOMY 26FR,272,RC,,,,,,,,both,,,178.7800,26.8200,MEDCOST,MEDCOST VHN,85.08,,,,,,,46.1400,178.7800,percent of total billed charges,47.59% of $178.78 in Billed Charges for Rev 272 = $85.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEEDING GASTROSTOMY 26FR,272,RC,,,,,,,,both,,,178.7800,26.8200,SENTARA HEALTH,SENTARA HEALTH,46.14,,,,,,,46.1400,178.7800,percent of total billed charges,25.81% of $178.78 in Billed Charges for Rev 272 = $46.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEEDING GASTROSTOMY 26FR,272,RC,,,,,,,,both,,,178.7800,26.8200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",178.78,,,,,,,46.1400,178.7800,percent of total billed charges,100% of $178.78 in Billed Charges for Rev 272 = $178.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEEDING GASTROSTOMY 26FR,272,RC,,,,,,,,both,,,178.7800,26.8200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,89.39,,,,,,,46.1400,178.7800,percent of total billed charges,Rev 272 $178.78 in Billed Charges at 50% = $89.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEEDING GASTROSTOMY 26FR,272,RC,,,,,,,,both,,,178.7800,26.8200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,57.75,,,,,,,46.1400,178.7800,other,32.3% of $178.78 in Billed Charges for Rev 272 = $57.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE FEEDING GASTROSTOMY 26FR,272,RC,,,,,,,,both,,,178.7800,26.8200,UNITED HEALTHCARE,UHC HERITAGE SELECT,54.89,,,,,,,46.1400,178.7800,other,30.7% of $178.78 in Billed Charges for Rev 272 = $54.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE FEEDING GASTROSTOMY 26FR,272,RC,,,,,,,,both,,,178.7800,26.8200,UNITED HEALTHCARE,UNITED HEALTHCARE,57.75,,,,,,,46.1400,178.7800,percent of total billed charges,32.3% of $178.78 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEEDING GASTROSTOMY 26FR,272,RC,,,,,,,,both,,,178.7800,26.8200,WELLCARE,WELLCARE MEDICAID,178.78,,,,,,,46.1400,178.7800,percent of total billed charges,100% of $178.78 in Billed Charges for Rev 272 = $178.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEEDING GASTROSTOMY MIC KEY 24FR 3.5  0120-24-3.5,272,RC,27200002,CDM,,,,,,both,,,1002.8800,150.4300,AETNA,AETNA,428.23,,,,,,,258.8400,1002.8800,percent of total billed charges,"42.7% of $1,002.88 in Billed Charges for Rev 272 = $428.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GASTROSTOMY MIC KEY 24FR 3.5  0120-24-3.5,272,RC,27200002,CDM,,,,,,both,,,1002.8800,150.4300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,702.02,,,,,,,258.8400,1002.8800,percent of total billed charges,"Rev 272 $1,002.88 in Billed Charges at 70% = $702.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GASTROSTOMY MIC KEY 24FR 3.5  0120-24-3.5,272,RC,27200002,CDM,,,,,,both,,,1002.8800,150.4300,CIGNA HEALTHCARE,CIGNA HMO,418.20,,,,,,,258.8400,1002.8800,percent of total billed charges,"41.7% of $1,002.88 in Billed Charges for Rev 272 = $418.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GASTROSTOMY MIC KEY 24FR 3.5  0120-24-3.5,272,RC,27200002,CDM,,,,,,both,,,1002.8800,150.4300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,465.34,,,,,,,258.8400,1002.8800,percent of total billed charges,"46.4% of $1,002.88 in Billed Charges for Rev 272 = $465.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GASTROSTOMY MIC KEY 24FR 3.5  0120-24-3.5,272,RC,27200002,CDM,,,,,,both,,,1002.8800,150.4300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,418.20,,,,,,,258.8400,1002.8800,percent of total billed charges,"41.7% of $1,002.88 in Billed Charges for Rev 272 = $418.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GASTROSTOMY MIC KEY 24FR 3.5  0120-24-3.5,272,RC,27200002,CDM,,,,,,both,,,1002.8800,150.4300,CIGNA HEALTHCARE,CIGNA PPO,418.20,,,,,,,258.8400,1002.8800,percent of total billed charges,"41.7% of $1,002.88 in Billed Charges for Rev 272 = $418.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GASTROSTOMY MIC KEY 24FR 3.5  0120-24-3.5,272,RC,27200002,CDM,,,,,,both,,,1002.8800,150.4300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,902.59,,,,,,,258.8400,1002.8800,percent of total billed charges,"90% of $1,002.88 in Billed Charges for Rev 272 = $902.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GASTROSTOMY MIC KEY 24FR 3.5  0120-24-3.5,272,RC,27200002,CDM,,,,,,both,,,1002.8800,150.4300,MEDCOST,MEDCOST VHN,477.27,,,,,,,258.8400,1002.8800,percent of total billed charges,"47.59% of $1,002.88 in Billed Charges for Rev 272 = $477.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GASTROSTOMY MIC KEY 24FR 3.5  0120-24-3.5,272,RC,27200002,CDM,,,,,,both,,,1002.8800,150.4300,SENTARA HEALTH,SENTARA HEALTH,258.84,,,,,,,258.8400,1002.8800,percent of total billed charges,"25.81% of $1,002.88 in Billed Charges for Rev 272 = $258.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GASTROSTOMY MIC KEY 24FR 3.5  0120-24-3.5,272,RC,27200002,CDM,,,,,,both,,,1002.8800,150.4300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1002.88,,,,,,,258.8400,1002.8800,percent of total billed charges,"100% of $1,002.88 in Billed Charges for Rev 272 = $1,002.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GASTROSTOMY MIC KEY 24FR 3.5  0120-24-3.5,272,RC,27200002,CDM,,,,,,both,,,1002.8800,150.4300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,501.44,,,,,,,258.8400,1002.8800,percent of total billed charges,"Rev 272 $1,002.88 in Billed Charges at 50% = $501.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GASTROSTOMY MIC KEY 24FR 3.5  0120-24-3.5,272,RC,27200002,CDM,,,,,,both,,,1002.8800,150.4300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,323.93,,,,,,,258.8400,1002.8800,other,"32.3% of $1,002.88 in Billed Charges for Rev 272 = $323.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE FEEDING GASTROSTOMY MIC KEY 24FR 3.5  0120-24-3.5,272,RC,27200002,CDM,,,,,,both,,,1002.8800,150.4300,UNITED HEALTHCARE,UHC HERITAGE SELECT,307.88,,,,,,,258.8400,1002.8800,other,"30.7% of $1,002.88 in Billed Charges for Rev 272 = $307.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE FEEDING GASTROSTOMY MIC KEY 24FR 3.5  0120-24-3.5,272,RC,27200002,CDM,,,,,,both,,,1002.8800,150.4300,UNITED HEALTHCARE,UNITED HEALTHCARE,323.93,,,,,,,258.8400,1002.8800,percent of total billed charges,"32.3% of $1,002.88 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GASTROSTOMY MIC KEY 24FR 3.5  0120-24-3.5,272,RC,27200002,CDM,,,,,,both,,,1002.8800,150.4300,WELLCARE,WELLCARE MEDICAID,1002.88,,,,,,,258.8400,1002.8800,percent of total billed charges,"100% of $1,002.88 in Billed Charges for Rev 272 = $1,002.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FISCH PISTON 140444,272,RC,,,,,,,,both,,,935.6700,140.3500,AETNA,AETNA,399.53,,,,,,,241.5000,935.6700,percent of total billed charges,42.7% of $935.67 in Billed Charges for Rev 272 = $399.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FISCH PISTON 140444,272,RC,,,,,,,,both,,,935.6700,140.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,654.97,,,,,,,241.5000,935.6700,percent of total billed charges,Rev 272 $935.67 in Billed Charges at 70% = $654.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FISCH PISTON 140444,272,RC,,,,,,,,both,,,935.6700,140.3500,CIGNA HEALTHCARE,CIGNA HMO,390.17,,,,,,,241.5000,935.6700,percent of total billed charges,41.7% of $935.67 in Billed Charges for Rev 272 = $390.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FISCH PISTON 140444,272,RC,,,,,,,,both,,,935.6700,140.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,434.15,,,,,,,241.5000,935.6700,percent of total billed charges,46.4% of $935.67 in Billed Charges for Rev 272 = $434.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FISCH PISTON 140444,272,RC,,,,,,,,both,,,935.6700,140.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,390.17,,,,,,,241.5000,935.6700,percent of total billed charges,41.7% of $935.67 in Billed Charges for Rev 272 = $390.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FISCH PISTON 140444,272,RC,,,,,,,,both,,,935.6700,140.3500,CIGNA HEALTHCARE,CIGNA PPO,390.17,,,,,,,241.5000,935.6700,percent of total billed charges,41.7% of $935.67 in Billed Charges for Rev 272 = $390.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FISCH PISTON 140444,272,RC,,,,,,,,both,,,935.6700,140.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,842.10,,,,,,,241.5000,935.6700,percent of total billed charges,90% of $935.67 in Billed Charges for Rev 272 = $842.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FISCH PISTON 140444,272,RC,,,,,,,,both,,,935.6700,140.3500,MEDCOST,MEDCOST VHN,445.29,,,,,,,241.5000,935.6700,percent of total billed charges,47.59% of $935.67 in Billed Charges for Rev 272 = $445.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FISCH PISTON 140444,272,RC,,,,,,,,both,,,935.6700,140.3500,SENTARA HEALTH,SENTARA HEALTH,241.50,,,,,,,241.5000,935.6700,percent of total billed charges,25.81% of $935.67 in Billed Charges for Rev 272 = $241.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FISCH PISTON 140444,272,RC,,,,,,,,both,,,935.6700,140.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",935.67,,,,,,,241.5000,935.6700,percent of total billed charges,100% of $935.67 in Billed Charges for Rev 272 = $935.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FISCH PISTON 140444,272,RC,,,,,,,,both,,,935.6700,140.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,467.84,,,,,,,241.5000,935.6700,percent of total billed charges,Rev 272 $935.67 in Billed Charges at 50% = $467.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FISCH PISTON 140444,272,RC,,,,,,,,both,,,935.6700,140.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,302.22,,,,,,,241.5000,935.6700,other,32.3% of $935.67 in Billed Charges for Rev 272 = $302.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE FISCH PISTON 140444,272,RC,,,,,,,,both,,,935.6700,140.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,287.25,,,,,,,241.5000,935.6700,other,30.7% of $935.67 in Billed Charges for Rev 272 = $287.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE FISCH PISTON 140444,272,RC,,,,,,,,both,,,935.6700,140.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,302.22,,,,,,,241.5000,935.6700,percent of total billed charges,32.3% of $935.67 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FISCH PISTON 140444,272,RC,,,,,,,,both,,,935.6700,140.3500,WELLCARE,WELLCARE MEDICAID,935.67,,,,,,,241.5000,935.6700,percent of total billed charges,100% of $935.67 in Billed Charges for Rev 272 = $935.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE GASTRO ENTERIC 24FR,272,RC,27200002,CDM,,,,,,both,,,1857.3400,278.6000,AETNA,AETNA,793.08,,,,,,,479.3800,1857.3400,percent of total billed charges,"42.7% of $1,857.34 in Billed Charges for Rev 272 = $793.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTRO ENTERIC 24FR,272,RC,27200002,CDM,,,,,,both,,,1857.3400,278.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1300.14,,,,,,,479.3800,1857.3400,percent of total billed charges,"Rev 272 $1,857.34 in Billed Charges at 70% = $1,300.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTRO ENTERIC 24FR,272,RC,27200002,CDM,,,,,,both,,,1857.3400,278.6000,CIGNA HEALTHCARE,CIGNA HMO,774.51,,,,,,,479.3800,1857.3400,percent of total billed charges,"41.7% of $1,857.34 in Billed Charges for Rev 272 = $774.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTRO ENTERIC 24FR,272,RC,27200002,CDM,,,,,,both,,,1857.3400,278.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,861.81,,,,,,,479.3800,1857.3400,percent of total billed charges,"46.4% of $1,857.34 in Billed Charges for Rev 272 = $861.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTRO ENTERIC 24FR,272,RC,27200002,CDM,,,,,,both,,,1857.3400,278.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,774.51,,,,,,,479.3800,1857.3400,percent of total billed charges,"41.7% of $1,857.34 in Billed Charges for Rev 272 = $774.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTRO ENTERIC 24FR,272,RC,27200002,CDM,,,,,,both,,,1857.3400,278.6000,CIGNA HEALTHCARE,CIGNA PPO,774.51,,,,,,,479.3800,1857.3400,percent of total billed charges,"41.7% of $1,857.34 in Billed Charges for Rev 272 = $774.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTRO ENTERIC 24FR,272,RC,27200002,CDM,,,,,,both,,,1857.3400,278.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1671.61,,,,,,,479.3800,1857.3400,percent of total billed charges,"90% of $1,857.34 in Billed Charges for Rev 272 = $1,671.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTRO ENTERIC 24FR,272,RC,27200002,CDM,,,,,,both,,,1857.3400,278.6000,MEDCOST,MEDCOST VHN,883.91,,,,,,,479.3800,1857.3400,percent of total billed charges,"47.59% of $1,857.34 in Billed Charges for Rev 272 = $883.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTRO ENTERIC 24FR,272,RC,27200002,CDM,,,,,,both,,,1857.3400,278.6000,SENTARA HEALTH,SENTARA HEALTH,479.38,,,,,,,479.3800,1857.3400,percent of total billed charges,"25.81% of $1,857.34 in Billed Charges for Rev 272 = $479.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTRO ENTERIC 24FR,272,RC,27200002,CDM,,,,,,both,,,1857.3400,278.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1857.34,,,,,,,479.3800,1857.3400,percent of total billed charges,"100% of $1,857.34 in Billed Charges for Rev 272 = $1,857.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTRO ENTERIC 24FR,272,RC,27200002,CDM,,,,,,both,,,1857.3400,278.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,928.67,,,,,,,479.3800,1857.3400,percent of total billed charges,"Rev 272 $1,857.34 in Billed Charges at 50% = $928.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTRO ENTERIC 24FR,272,RC,27200002,CDM,,,,,,both,,,1857.3400,278.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,599.92,,,,,,,479.3800,1857.3400,other,"32.3% of $1,857.34 in Billed Charges for Rev 272 = $599.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE GASTRO ENTERIC 24FR,272,RC,27200002,CDM,,,,,,both,,,1857.3400,278.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,570.20,,,,,,,479.3800,1857.3400,other,"30.7% of $1,857.34 in Billed Charges for Rev 272 = $570.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE GASTRO ENTERIC 24FR,272,RC,27200002,CDM,,,,,,both,,,1857.3400,278.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,599.92,,,,,,,479.3800,1857.3400,percent of total billed charges,"32.3% of $1,857.34 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTRO ENTERIC 24FR,272,RC,27200002,CDM,,,,,,both,,,1857.3400,278.6000,WELLCARE,WELLCARE MEDICAID,1857.34,,,,,,,479.3800,1857.3400,percent of total billed charges,"100% of $1,857.34 in Billed Charges for Rev 272 = $1,857.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTROSTOMY MIC 12FR,270,RC,27099990,CDM,,,,,,both,,,1237.4700,185.6200,AETNA,AETNA,528.40,,,,,,,319.3900,1237.4700,percent of total billed charges,"42.7% of $1,237.47 in Billed Charges for Rev 270 = $528.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTROSTOMY MIC 12FR,270,RC,27099990,CDM,,,,,,both,,,1237.4700,185.6200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,866.23,,,,,,,319.3900,1237.4700,percent of total billed charges,"Rev 270 $1,237.47 in Billed Charges at 70% = $866.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTROSTOMY MIC 12FR,270,RC,27099990,CDM,,,,,,both,,,1237.4700,185.6200,CIGNA HEALTHCARE,CIGNA HMO,516.03,,,,,,,319.3900,1237.4700,percent of total billed charges,"41.7% of $1,237.47 in Billed Charges for Rev 270 = $516.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTROSTOMY MIC 12FR,270,RC,27099990,CDM,,,,,,both,,,1237.4700,185.6200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,574.19,,,,,,,319.3900,1237.4700,percent of total billed charges,"46.4% of $1,237.47 in Billed Charges for Rev 270 = $574.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTROSTOMY MIC 12FR,270,RC,27099990,CDM,,,,,,both,,,1237.4700,185.6200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,516.03,,,,,,,319.3900,1237.4700,percent of total billed charges,"41.7% of $1,237.47 in Billed Charges for Rev 270 = $516.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTROSTOMY MIC 12FR,270,RC,27099990,CDM,,,,,,both,,,1237.4700,185.6200,CIGNA HEALTHCARE,CIGNA PPO,516.03,,,,,,,319.3900,1237.4700,percent of total billed charges,"41.7% of $1,237.47 in Billed Charges for Rev 270 = $516.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTROSTOMY MIC 12FR,270,RC,27099990,CDM,,,,,,both,,,1237.4700,185.6200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1113.72,,,,,,,319.3900,1237.4700,percent of total billed charges,"90% of $1,237.47 in Billed Charges for Rev 270 = $1,113.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTROSTOMY MIC 12FR,270,RC,27099990,CDM,,,,,,both,,,1237.4700,185.6200,MEDCOST,MEDCOST VHN,588.91,,,,,,,319.3900,1237.4700,percent of total billed charges,"47.59% of $1,237.47 in Billed Charges for Rev 270 = $588.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTROSTOMY MIC 12FR,270,RC,27099990,CDM,,,,,,both,,,1237.4700,185.6200,SENTARA HEALTH,SENTARA HEALTH,319.39,,,,,,,319.3900,1237.4700,percent of total billed charges,"25.81% of $1,237.47 in Billed Charges for Rev 270 = $319.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTROSTOMY MIC 12FR,270,RC,27099990,CDM,,,,,,both,,,1237.4700,185.6200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1237.47,,,,,,,319.3900,1237.4700,percent of total billed charges,"100% of $1,237.47 in Billed Charges for Rev 270 = $1,237.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTROSTOMY MIC 12FR,270,RC,27099990,CDM,,,,,,both,,,1237.4700,185.6200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,618.74,,,,,,,319.3900,1237.4700,percent of total billed charges,"Rev 270 $1,237.47 in Billed Charges at 50% = $618.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTROSTOMY MIC 12FR,270,RC,27099990,CDM,,,,,,both,,,1237.4700,185.6200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,399.70,,,,,,,319.3900,1237.4700,other,"32.3% of $1,237.47 in Billed Charges for Rev 270 = $399.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE GASTROSTOMY MIC 12FR,270,RC,27099990,CDM,,,,,,both,,,1237.4700,185.6200,UNITED HEALTHCARE,UHC HERITAGE SELECT,379.90,,,,,,,319.3900,1237.4700,other,"30.7% of $1,237.47 in Billed Charges for Rev 270 = $379.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE GASTROSTOMY MIC 12FR,270,RC,27099990,CDM,,,,,,both,,,1237.4700,185.6200,UNITED HEALTHCARE,UNITED HEALTHCARE,399.70,,,,,,,319.3900,1237.4700,percent of total billed charges,"32.3% of $1,237.47 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE GASTROSTOMY MIC 12FR,270,RC,27099990,CDM,,,,,,both,,,1237.4700,185.6200,WELLCARE,WELLCARE MEDICAID,1237.47,,,,,,,319.3900,1237.4700,percent of total billed charges,"100% of $1,237.47 in Billed Charges for Rev 270 = $1,237.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYDROXYLENT 140906 140906,272,RC,,,,,,,,both,,,1907.8500,286.1800,AETNA,AETNA,814.65,,,,,,,492.4200,1907.8500,percent of total billed charges,"42.7% of $1,907.85 in Billed Charges for Rev 272 = $814.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYDROXYLENT 140906 140906,272,RC,,,,,,,,both,,,1907.8500,286.1800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1335.50,,,,,,,492.4200,1907.8500,percent of total billed charges,"Rev 272 $1,907.85 in Billed Charges at 70% = $1,335.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYDROXYLENT 140906 140906,272,RC,,,,,,,,both,,,1907.8500,286.1800,CIGNA HEALTHCARE,CIGNA HMO,795.57,,,,,,,492.4200,1907.8500,percent of total billed charges,"41.7% of $1,907.85 in Billed Charges for Rev 272 = $795.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYDROXYLENT 140906 140906,272,RC,,,,,,,,both,,,1907.8500,286.1800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,885.24,,,,,,,492.4200,1907.8500,percent of total billed charges,"46.4% of $1,907.85 in Billed Charges for Rev 272 = $885.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYDROXYLENT 140906 140906,272,RC,,,,,,,,both,,,1907.8500,286.1800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,795.57,,,,,,,492.4200,1907.8500,percent of total billed charges,"41.7% of $1,907.85 in Billed Charges for Rev 272 = $795.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYDROXYLENT 140906 140906,272,RC,,,,,,,,both,,,1907.8500,286.1800,CIGNA HEALTHCARE,CIGNA PPO,795.57,,,,,,,492.4200,1907.8500,percent of total billed charges,"41.7% of $1,907.85 in Billed Charges for Rev 272 = $795.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYDROXYLENT 140906 140906,272,RC,,,,,,,,both,,,1907.8500,286.1800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1717.07,,,,,,,492.4200,1907.8500,percent of total billed charges,"90% of $1,907.85 in Billed Charges for Rev 272 = $1,717.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYDROXYLENT 140906 140906,272,RC,,,,,,,,both,,,1907.8500,286.1800,MEDCOST,MEDCOST VHN,907.95,,,,,,,492.4200,1907.8500,percent of total billed charges,"47.59% of $1,907.85 in Billed Charges for Rev 272 = $907.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYDROXYLENT 140906 140906,272,RC,,,,,,,,both,,,1907.8500,286.1800,SENTARA HEALTH,SENTARA HEALTH,492.42,,,,,,,492.4200,1907.8500,percent of total billed charges,"25.81% of $1,907.85 in Billed Charges for Rev 272 = $492.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYDROXYLENT 140906 140906,272,RC,,,,,,,,both,,,1907.8500,286.1800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1907.85,,,,,,,492.4200,1907.8500,percent of total billed charges,"100% of $1,907.85 in Billed Charges for Rev 272 = $1,907.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYDROXYLENT 140906 140906,272,RC,,,,,,,,both,,,1907.8500,286.1800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,953.93,,,,,,,492.4200,1907.8500,percent of total billed charges,"Rev 272 $1,907.85 in Billed Charges at 50% = $953.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYDROXYLENT 140906 140906,272,RC,,,,,,,,both,,,1907.8500,286.1800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,616.24,,,,,,,492.4200,1907.8500,other,"32.3% of $1,907.85 in Billed Charges for Rev 272 = $616.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE HYDROXYLENT 140906 140906,272,RC,,,,,,,,both,,,1907.8500,286.1800,UNITED HEALTHCARE,UHC HERITAGE SELECT,585.71,,,,,,,492.4200,1907.8500,other,"30.7% of $1,907.85 in Billed Charges for Rev 272 = $585.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE HYDROXYLENT 140906 140906,272,RC,,,,,,,,both,,,1907.8500,286.1800,UNITED HEALTHCARE,UNITED HEALTHCARE,616.24,,,,,,,492.4200,1907.8500,percent of total billed charges,"32.3% of $1,907.85 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYDROXYLENT 140906 140906,272,RC,,,,,,,,both,,,1907.8500,286.1800,WELLCARE,WELLCARE MEDICAID,1907.85,,,,,,,492.4200,1907.8500,percent of total billed charges,"100% of $1,907.85 in Billed Charges for Rev 272 = $1,907.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GJET ENFIT 2.5X45,272,RC,,,,,,,,both,,,5828.5000,874.2800,AETNA,AETNA,2488.77,,,,,,,1504.3400,5828.5000,percent of total billed charges,"42.7% of $5,828.50 in Billed Charges for Rev 272 = $2,488.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GJET ENFIT 2.5X45,272,RC,,,,,,,,both,,,5828.5000,874.2800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4079.95,,,,,,,1504.3400,5828.5000,percent of total billed charges,"Rev 272 $5,828.50 in Billed Charges at 70% = $4,079.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GJET ENFIT 2.5X45,272,RC,,,,,,,,both,,,5828.5000,874.2800,CIGNA HEALTHCARE,CIGNA HMO,2430.48,,,,,,,1504.3400,5828.5000,percent of total billed charges,"41.7% of $5,828.50 in Billed Charges for Rev 272 = $2,430.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GJET ENFIT 2.5X45,272,RC,,,,,,,,both,,,5828.5000,874.2800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2704.42,,,,,,,1504.3400,5828.5000,percent of total billed charges,"46.4% of $5,828.50 in Billed Charges for Rev 272 = $2,704.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GJET ENFIT 2.5X45,272,RC,,,,,,,,both,,,5828.5000,874.2800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2430.48,,,,,,,1504.3400,5828.5000,percent of total billed charges,"41.7% of $5,828.50 in Billed Charges for Rev 272 = $2,430.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GJET ENFIT 2.5X45,272,RC,,,,,,,,both,,,5828.5000,874.2800,CIGNA HEALTHCARE,CIGNA PPO,2430.48,,,,,,,1504.3400,5828.5000,percent of total billed charges,"41.7% of $5,828.50 in Billed Charges for Rev 272 = $2,430.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GJET ENFIT 2.5X45,272,RC,,,,,,,,both,,,5828.5000,874.2800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5245.65,,,,,,,1504.3400,5828.5000,percent of total billed charges,"90% of $5,828.50 in Billed Charges for Rev 272 = $5,245.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GJET ENFIT 2.5X45,272,RC,,,,,,,,both,,,5828.5000,874.2800,MEDCOST,MEDCOST VHN,2773.78,,,,,,,1504.3400,5828.5000,percent of total billed charges,"47.59% of $5,828.50 in Billed Charges for Rev 272 = $2,773.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GJET ENFIT 2.5X45,272,RC,,,,,,,,both,,,5828.5000,874.2800,SENTARA HEALTH,SENTARA HEALTH,1504.34,,,,,,,1504.3400,5828.5000,percent of total billed charges,"25.81% of $5,828.50 in Billed Charges for Rev 272 = $1,504.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GJET ENFIT 2.5X45,272,RC,,,,,,,,both,,,5828.5000,874.2800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5828.50,,,,,,,1504.3400,5828.5000,percent of total billed charges,"100% of $5,828.50 in Billed Charges for Rev 272 = $5,828.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GJET ENFIT 2.5X45,272,RC,,,,,,,,both,,,5828.5000,874.2800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2914.25,,,,,,,1504.3400,5828.5000,percent of total billed charges,"Rev 272 $5,828.50 in Billed Charges at 50% = $2,914.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GJET ENFIT 2.5X45,272,RC,,,,,,,,both,,,5828.5000,874.2800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1882.61,,,,,,,1504.3400,5828.5000,other,"32.3% of $5,828.50 in Billed Charges for Rev 272 = $1,882.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE FEEDING GJET ENFIT 2.5X45,272,RC,,,,,,,,both,,,5828.5000,874.2800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1789.35,,,,,,,1504.3400,5828.5000,other,"30.7% of $5,828.50 in Billed Charges for Rev 272 = $1,789.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE FEEDING GJET ENFIT 2.5X45,272,RC,,,,,,,,both,,,5828.5000,874.2800,UNITED HEALTHCARE,UNITED HEALTHCARE,1882.61,,,,,,,1504.3400,5828.5000,percent of total billed charges,"32.3% of $5,828.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING GJET ENFIT 2.5X45,272,RC,,,,,,,,both,,,5828.5000,874.2800,WELLCARE,WELLCARE MEDICAID,5828.50,,,,,,,1504.3400,5828.5000,percent of total billed charges,"100% of $5,828.50 in Billed Charges for Rev 272 = $5,828.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING MIC KEY 14FR 5MM,272,RC,27200002,CDM,,,,,,both,,,1022.4800,153.3700,AETNA,AETNA,436.60,,,,,,,263.9000,1022.4800,percent of total billed charges,"42.7% of $1,022.48 in Billed Charges for Rev 272 = $436.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING MIC KEY 14FR 5MM,272,RC,27200002,CDM,,,,,,both,,,1022.4800,153.3700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,715.74,,,,,,,263.9000,1022.4800,percent of total billed charges,"Rev 272 $1,022.48 in Billed Charges at 70% = $715.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING MIC KEY 14FR 5MM,272,RC,27200002,CDM,,,,,,both,,,1022.4800,153.3700,CIGNA HEALTHCARE,CIGNA HMO,426.37,,,,,,,263.9000,1022.4800,percent of total billed charges,"41.7% of $1,022.48 in Billed Charges for Rev 272 = $426.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING MIC KEY 14FR 5MM,272,RC,27200002,CDM,,,,,,both,,,1022.4800,153.3700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,474.43,,,,,,,263.9000,1022.4800,percent of total billed charges,"46.4% of $1,022.48 in Billed Charges for Rev 272 = $474.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING MIC KEY 14FR 5MM,272,RC,27200002,CDM,,,,,,both,,,1022.4800,153.3700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,426.37,,,,,,,263.9000,1022.4800,percent of total billed charges,"41.7% of $1,022.48 in Billed Charges for Rev 272 = $426.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING MIC KEY 14FR 5MM,272,RC,27200002,CDM,,,,,,both,,,1022.4800,153.3700,CIGNA HEALTHCARE,CIGNA PPO,426.37,,,,,,,263.9000,1022.4800,percent of total billed charges,"41.7% of $1,022.48 in Billed Charges for Rev 272 = $426.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING MIC KEY 14FR 5MM,272,RC,27200002,CDM,,,,,,both,,,1022.4800,153.3700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,920.23,,,,,,,263.9000,1022.4800,percent of total billed charges,"90% of $1,022.48 in Billed Charges for Rev 272 = $920.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING MIC KEY 14FR 5MM,272,RC,27200002,CDM,,,,,,both,,,1022.4800,153.3700,MEDCOST,MEDCOST VHN,486.60,,,,,,,263.9000,1022.4800,percent of total billed charges,"47.59% of $1,022.48 in Billed Charges for Rev 272 = $486.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING MIC KEY 14FR 5MM,272,RC,27200002,CDM,,,,,,both,,,1022.4800,153.3700,SENTARA HEALTH,SENTARA HEALTH,263.90,,,,,,,263.9000,1022.4800,percent of total billed charges,"25.81% of $1,022.48 in Billed Charges for Rev 272 = $263.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING MIC KEY 14FR 5MM,272,RC,27200002,CDM,,,,,,both,,,1022.4800,153.3700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1022.48,,,,,,,263.9000,1022.4800,percent of total billed charges,"100% of $1,022.48 in Billed Charges for Rev 272 = $1,022.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING MIC KEY 14FR 5MM,272,RC,27200002,CDM,,,,,,both,,,1022.4800,153.3700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,511.24,,,,,,,263.9000,1022.4800,percent of total billed charges,"Rev 272 $1,022.48 in Billed Charges at 50% = $511.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING MIC KEY 14FR 5MM,272,RC,27200002,CDM,,,,,,both,,,1022.4800,153.3700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,330.26,,,,,,,263.9000,1022.4800,other,"32.3% of $1,022.48 in Billed Charges for Rev 272 = $330.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE FEEDING MIC KEY 14FR 5MM,272,RC,27200002,CDM,,,,,,both,,,1022.4800,153.3700,UNITED HEALTHCARE,UHC HERITAGE SELECT,313.90,,,,,,,263.9000,1022.4800,other,"30.7% of $1,022.48 in Billed Charges for Rev 272 = $313.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE FEEDING MIC KEY 14FR 5MM,272,RC,27200002,CDM,,,,,,both,,,1022.4800,153.3700,UNITED HEALTHCARE,UNITED HEALTHCARE,330.26,,,,,,,263.9000,1022.4800,percent of total billed charges,"32.3% of $1,022.48 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING MIC KEY 14FR 5MM,272,RC,27200002,CDM,,,,,,both,,,1022.4800,153.3700,WELLCARE,WELLCARE MEDICAID,1022.48,,,,,,,263.9000,1022.4800,percent of total billed charges,"100% of $1,022.48 in Billed Charges for Rev 272 = $1,022.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION ADVANIX LITHOTRIPSY G48278,272,RC,27200002,CDM,,,,,,both,,,3422.4300,513.3600,AETNA,AETNA,1461.38,,,,,,,883.3300,3422.4300,percent of total billed charges,"42.7% of $3,422.43 in Billed Charges for Rev 272 = $1,461.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION ADVANIX LITHOTRIPSY G48278,272,RC,27200002,CDM,,,,,,both,,,3422.4300,513.3600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2395.70,,,,,,,883.3300,3422.4300,percent of total billed charges,"Rev 272 $3,422.43 in Billed Charges at 70% = $2,395.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION ADVANIX LITHOTRIPSY G48278,272,RC,27200002,CDM,,,,,,both,,,3422.4300,513.3600,CIGNA HEALTHCARE,CIGNA HMO,1427.15,,,,,,,883.3300,3422.4300,percent of total billed charges,"41.7% of $3,422.43 in Billed Charges for Rev 272 = $1,427.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION ADVANIX LITHOTRIPSY G48278,272,RC,27200002,CDM,,,,,,both,,,3422.4300,513.3600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1588.01,,,,,,,883.3300,3422.4300,percent of total billed charges,"46.4% of $3,422.43 in Billed Charges for Rev 272 = $1,588.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION ADVANIX LITHOTRIPSY G48278,272,RC,27200002,CDM,,,,,,both,,,3422.4300,513.3600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1427.15,,,,,,,883.3300,3422.4300,percent of total billed charges,"41.7% of $3,422.43 in Billed Charges for Rev 272 = $1,427.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION ADVANIX LITHOTRIPSY G48278,272,RC,27200002,CDM,,,,,,both,,,3422.4300,513.3600,CIGNA HEALTHCARE,CIGNA PPO,1427.15,,,,,,,883.3300,3422.4300,percent of total billed charges,"41.7% of $3,422.43 in Billed Charges for Rev 272 = $1,427.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION ADVANIX LITHOTRIPSY G48278,272,RC,27200002,CDM,,,,,,both,,,3422.4300,513.3600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3080.19,,,,,,,883.3300,3422.4300,percent of total billed charges,"90% of $3,422.43 in Billed Charges for Rev 272 = $3,080.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION ADVANIX LITHOTRIPSY G48278,272,RC,27200002,CDM,,,,,,both,,,3422.4300,513.3600,MEDCOST,MEDCOST VHN,1628.73,,,,,,,883.3300,3422.4300,percent of total billed charges,"47.59% of $3,422.43 in Billed Charges for Rev 272 = $1,628.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION ADVANIX LITHOTRIPSY G48278,272,RC,27200002,CDM,,,,,,both,,,3422.4300,513.3600,SENTARA HEALTH,SENTARA HEALTH,883.33,,,,,,,883.3300,3422.4300,percent of total billed charges,"25.81% of $3,422.43 in Billed Charges for Rev 272 = $883.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION ADVANIX LITHOTRIPSY G48278,272,RC,27200002,CDM,,,,,,both,,,3422.4300,513.3600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3422.43,,,,,,,883.3300,3422.4300,percent of total billed charges,"100% of $3,422.43 in Billed Charges for Rev 272 = $3,422.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION ADVANIX LITHOTRIPSY G48278,272,RC,27200002,CDM,,,,,,both,,,3422.4300,513.3600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1711.22,,,,,,,883.3300,3422.4300,percent of total billed charges,"Rev 272 $3,422.43 in Billed Charges at 50% = $1,711.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION ADVANIX LITHOTRIPSY G48278,272,RC,27200002,CDM,,,,,,both,,,3422.4300,513.3600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1105.44,,,,,,,883.3300,3422.4300,other,"32.3% of $3,422.43 in Billed Charges for Rev 272 = $1,105.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET EXTRACTION ADVANIX LITHOTRIPSY G48278,272,RC,27200002,CDM,,,,,,both,,,3422.4300,513.3600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1050.69,,,,,,,883.3300,3422.4300,other,"30.7% of $3,422.43 in Billed Charges for Rev 272 = $1,050.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET EXTRACTION ADVANIX LITHOTRIPSY G48278,272,RC,27200002,CDM,,,,,,both,,,3422.4300,513.3600,UNITED HEALTHCARE,UNITED HEALTHCARE,1105.44,,,,,,,883.3300,3422.4300,percent of total billed charges,"32.3% of $3,422.43 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION ADVANIX LITHOTRIPSY G48278,272,RC,27200002,CDM,,,,,,both,,,3422.4300,513.3600,WELLCARE,WELLCARE MEDICAID,3422.43,,,,,,,883.3300,3422.4300,percent of total billed charges,"100% of $3,422.43 in Billed Charges for Rev 272 = $3,422.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION FUSION LITHOTRIPSY G48277,272,RC,27200002,CDM,,,,,,both,,,3297.9800,494.7000,AETNA,AETNA,1408.24,,,,,,,851.2100,3297.9800,percent of total billed charges,"42.7% of $3,297.98 in Billed Charges for Rev 272 = $1,408.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION FUSION LITHOTRIPSY G48277,272,RC,27200002,CDM,,,,,,both,,,3297.9800,494.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2308.59,,,,,,,851.2100,3297.9800,percent of total billed charges,"Rev 272 $3,297.98 in Billed Charges at 70% = $2,308.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION FUSION LITHOTRIPSY G48277,272,RC,27200002,CDM,,,,,,both,,,3297.9800,494.7000,CIGNA HEALTHCARE,CIGNA HMO,1375.26,,,,,,,851.2100,3297.9800,percent of total billed charges,"41.7% of $3,297.98 in Billed Charges for Rev 272 = $1,375.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION FUSION LITHOTRIPSY G48277,272,RC,27200002,CDM,,,,,,both,,,3297.9800,494.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1530.26,,,,,,,851.2100,3297.9800,percent of total billed charges,"46.4% of $3,297.98 in Billed Charges for Rev 272 = $1,530.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION FUSION LITHOTRIPSY G48277,272,RC,27200002,CDM,,,,,,both,,,3297.9800,494.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1375.26,,,,,,,851.2100,3297.9800,percent of total billed charges,"41.7% of $3,297.98 in Billed Charges for Rev 272 = $1,375.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION FUSION LITHOTRIPSY G48277,272,RC,27200002,CDM,,,,,,both,,,3297.9800,494.7000,CIGNA HEALTHCARE,CIGNA PPO,1375.26,,,,,,,851.2100,3297.9800,percent of total billed charges,"41.7% of $3,297.98 in Billed Charges for Rev 272 = $1,375.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION FUSION LITHOTRIPSY G48277,272,RC,27200002,CDM,,,,,,both,,,3297.9800,494.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2968.18,,,,,,,851.2100,3297.9800,percent of total billed charges,"90% of $3,297.98 in Billed Charges for Rev 272 = $2,968.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION FUSION LITHOTRIPSY G48277,272,RC,27200002,CDM,,,,,,both,,,3297.9800,494.7000,MEDCOST,MEDCOST VHN,1569.51,,,,,,,851.2100,3297.9800,percent of total billed charges,"47.59% of $3,297.98 in Billed Charges for Rev 272 = $1,569.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION FUSION LITHOTRIPSY G48277,272,RC,27200002,CDM,,,,,,both,,,3297.9800,494.7000,SENTARA HEALTH,SENTARA HEALTH,851.21,,,,,,,851.2100,3297.9800,percent of total billed charges,"25.81% of $3,297.98 in Billed Charges for Rev 272 = $851.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION FUSION LITHOTRIPSY G48277,272,RC,27200002,CDM,,,,,,both,,,3297.9800,494.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3297.98,,,,,,,851.2100,3297.9800,percent of total billed charges,"100% of $3,297.98 in Billed Charges for Rev 272 = $3,297.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION FUSION LITHOTRIPSY G48277,272,RC,27200002,CDM,,,,,,both,,,3297.9800,494.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1648.99,,,,,,,851.2100,3297.9800,percent of total billed charges,"Rev 272 $3,297.98 in Billed Charges at 50% = $1,648.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION FUSION LITHOTRIPSY G48277,272,RC,27200002,CDM,,,,,,both,,,3297.9800,494.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1065.25,,,,,,,851.2100,3297.9800,other,"32.3% of $3,297.98 in Billed Charges for Rev 272 = $1,065.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET EXTRACTION FUSION LITHOTRIPSY G48277,272,RC,27200002,CDM,,,,,,both,,,3297.9800,494.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1012.48,,,,,,,851.2100,3297.9800,other,"30.7% of $3,297.98 in Billed Charges for Rev 272 = $1,012.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET EXTRACTION FUSION LITHOTRIPSY G48277,272,RC,27200002,CDM,,,,,,both,,,3297.9800,494.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,1065.25,,,,,,,851.2100,3297.9800,percent of total billed charges,"32.3% of $3,297.98 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET EXTRACTION FUSION LITHOTRIPSY G48277,272,RC,27200002,CDM,,,,,,both,,,3297.9800,494.7000,WELLCARE,WELLCARE MEDICAID,3297.98,,,,,,,851.2100,3297.9800,percent of total billed charges,"100% of $3,297.98 in Billed Charges for Rev 272 = $3,297.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET NITINOL ULTRA-CATCH,272,RC,27200002,CDM,,,,,,both,,,1772.0900,265.8100,AETNA,AETNA,756.68,,,,,,,457.3800,1772.0900,percent of total billed charges,"42.7% of $1,772.09 in Billed Charges for Rev 272 = $756.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET NITINOL ULTRA-CATCH,272,RC,27200002,CDM,,,,,,both,,,1772.0900,265.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1240.46,,,,,,,457.3800,1772.0900,percent of total billed charges,"Rev 272 $1,772.09 in Billed Charges at 70% = $1,240.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET NITINOL ULTRA-CATCH,272,RC,27200002,CDM,,,,,,both,,,1772.0900,265.8100,CIGNA HEALTHCARE,CIGNA HMO,738.96,,,,,,,457.3800,1772.0900,percent of total billed charges,"41.7% of $1,772.09 in Billed Charges for Rev 272 = $738.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET NITINOL ULTRA-CATCH,272,RC,27200002,CDM,,,,,,both,,,1772.0900,265.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,822.25,,,,,,,457.3800,1772.0900,percent of total billed charges,"46.4% of $1,772.09 in Billed Charges for Rev 272 = $822.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET NITINOL ULTRA-CATCH,272,RC,27200002,CDM,,,,,,both,,,1772.0900,265.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,738.96,,,,,,,457.3800,1772.0900,percent of total billed charges,"41.7% of $1,772.09 in Billed Charges for Rev 272 = $738.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET NITINOL ULTRA-CATCH,272,RC,27200002,CDM,,,,,,both,,,1772.0900,265.8100,CIGNA HEALTHCARE,CIGNA PPO,738.96,,,,,,,457.3800,1772.0900,percent of total billed charges,"41.7% of $1,772.09 in Billed Charges for Rev 272 = $738.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET NITINOL ULTRA-CATCH,272,RC,27200002,CDM,,,,,,both,,,1772.0900,265.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1594.88,,,,,,,457.3800,1772.0900,percent of total billed charges,"90% of $1,772.09 in Billed Charges for Rev 272 = $1,594.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET NITINOL ULTRA-CATCH,272,RC,27200002,CDM,,,,,,both,,,1772.0900,265.8100,MEDCOST,MEDCOST VHN,843.34,,,,,,,457.3800,1772.0900,percent of total billed charges,"47.59% of $1,772.09 in Billed Charges for Rev 272 = $843.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET NITINOL ULTRA-CATCH,272,RC,27200002,CDM,,,,,,both,,,1772.0900,265.8100,SENTARA HEALTH,SENTARA HEALTH,457.38,,,,,,,457.3800,1772.0900,percent of total billed charges,"25.81% of $1,772.09 in Billed Charges for Rev 272 = $457.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET NITINOL ULTRA-CATCH,272,RC,27200002,CDM,,,,,,both,,,1772.0900,265.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1772.09,,,,,,,457.3800,1772.0900,percent of total billed charges,"100% of $1,772.09 in Billed Charges for Rev 272 = $1,772.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET NITINOL ULTRA-CATCH,272,RC,27200002,CDM,,,,,,both,,,1772.0900,265.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,886.05,,,,,,,457.3800,1772.0900,percent of total billed charges,"Rev 272 $1,772.09 in Billed Charges at 50% = $886.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET NITINOL ULTRA-CATCH,272,RC,27200002,CDM,,,,,,both,,,1772.0900,265.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,572.39,,,,,,,457.3800,1772.0900,other,"32.3% of $1,772.09 in Billed Charges for Rev 272 = $572.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET NITINOL ULTRA-CATCH,272,RC,27200002,CDM,,,,,,both,,,1772.0900,265.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,544.03,,,,,,,457.3800,1772.0900,other,"30.7% of $1,772.09 in Billed Charges for Rev 272 = $544.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET NITINOL ULTRA-CATCH,272,RC,27200002,CDM,,,,,,both,,,1772.0900,265.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,572.39,,,,,,,457.3800,1772.0900,percent of total billed charges,"32.3% of $1,772.09 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET NITINOL ULTRA-CATCH,272,RC,27200002,CDM,,,,,,both,,,1772.0900,265.8100,WELLCARE,WELLCARE MEDICAID,1772.09,,,,,,,457.3800,1772.0900,percent of total billed charges,"100% of $1,772.09 in Billed Charges for Rev 272 = $1,772.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL 3WIRE SPIRAL,272,RC,27200002,CDM,,,,,,both,,,2046.6100,306.9900,AETNA,AETNA,873.90,,,,,,,528.2300,2046.6100,percent of total billed charges,"42.7% of $2,046.61 in Billed Charges for Rev 272 = $873.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL 3WIRE SPIRAL,272,RC,27200002,CDM,,,,,,both,,,2046.6100,306.9900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1432.63,,,,,,,528.2300,2046.6100,percent of total billed charges,"Rev 272 $2,046.61 in Billed Charges at 70% = $1,432.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL 3WIRE SPIRAL,272,RC,27200002,CDM,,,,,,both,,,2046.6100,306.9900,CIGNA HEALTHCARE,CIGNA HMO,853.44,,,,,,,528.2300,2046.6100,percent of total billed charges,"41.7% of $2,046.61 in Billed Charges for Rev 272 = $853.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL 3WIRE SPIRAL,272,RC,27200002,CDM,,,,,,both,,,2046.6100,306.9900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,949.63,,,,,,,528.2300,2046.6100,percent of total billed charges,"46.4% of $2,046.61 in Billed Charges for Rev 272 = $949.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL 3WIRE SPIRAL,272,RC,27200002,CDM,,,,,,both,,,2046.6100,306.9900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,853.44,,,,,,,528.2300,2046.6100,percent of total billed charges,"41.7% of $2,046.61 in Billed Charges for Rev 272 = $853.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL 3WIRE SPIRAL,272,RC,27200002,CDM,,,,,,both,,,2046.6100,306.9900,CIGNA HEALTHCARE,CIGNA PPO,853.44,,,,,,,528.2300,2046.6100,percent of total billed charges,"41.7% of $2,046.61 in Billed Charges for Rev 272 = $853.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL 3WIRE SPIRAL,272,RC,27200002,CDM,,,,,,both,,,2046.6100,306.9900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1841.95,,,,,,,528.2300,2046.6100,percent of total billed charges,"90% of $2,046.61 in Billed Charges for Rev 272 = $1,841.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL 3WIRE SPIRAL,272,RC,27200002,CDM,,,,,,both,,,2046.6100,306.9900,MEDCOST,MEDCOST VHN,973.98,,,,,,,528.2300,2046.6100,percent of total billed charges,"47.59% of $2,046.61 in Billed Charges for Rev 272 = $973.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL 3WIRE SPIRAL,272,RC,27200002,CDM,,,,,,both,,,2046.6100,306.9900,SENTARA HEALTH,SENTARA HEALTH,528.23,,,,,,,528.2300,2046.6100,percent of total billed charges,"25.81% of $2,046.61 in Billed Charges for Rev 272 = $528.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL 3WIRE SPIRAL,272,RC,27200002,CDM,,,,,,both,,,2046.6100,306.9900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2046.61,,,,,,,528.2300,2046.6100,percent of total billed charges,"100% of $2,046.61 in Billed Charges for Rev 272 = $2,046.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL 3WIRE SPIRAL,272,RC,27200002,CDM,,,,,,both,,,2046.6100,306.9900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1023.31,,,,,,,528.2300,2046.6100,percent of total billed charges,"Rev 272 $2,046.61 in Billed Charges at 50% = $1,023.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL 3WIRE SPIRAL,272,RC,27200002,CDM,,,,,,both,,,2046.6100,306.9900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,661.06,,,,,,,528.2300,2046.6100,other,"32.3% of $2,046.61 in Billed Charges for Rev 272 = $661.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET RETRIEVAL 3WIRE SPIRAL,272,RC,27200002,CDM,,,,,,both,,,2046.6100,306.9900,UNITED HEALTHCARE,UHC HERITAGE SELECT,628.31,,,,,,,528.2300,2046.6100,other,"30.7% of $2,046.61 in Billed Charges for Rev 272 = $628.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET RETRIEVAL 3WIRE SPIRAL,272,RC,27200002,CDM,,,,,,both,,,2046.6100,306.9900,UNITED HEALTHCARE,UNITED HEALTHCARE,661.06,,,,,,,528.2300,2046.6100,percent of total billed charges,"32.3% of $2,046.61 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL 3WIRE SPIRAL,272,RC,27200002,CDM,,,,,,both,,,2046.6100,306.9900,WELLCARE,WELLCARE MEDICAID,2046.61,,,,,,,528.2300,2046.6100,percent of total billed charges,"100% of $2,046.61 in Billed Charges for Rev 272 = $2,046.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING TRANSGASTIC 22FR,272,RC,27200002,CDM,,,,,,both,,,2436.2500,365.4400,AETNA,AETNA,1040.28,,,,,,,628.8000,2436.2500,percent of total billed charges,"42.7% of $2,436.25 in Billed Charges for Rev 272 = $1,040.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING TRANSGASTIC 22FR,272,RC,27200002,CDM,,,,,,both,,,2436.2500,365.4400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1705.38,,,,,,,628.8000,2436.2500,percent of total billed charges,"Rev 272 $2,436.25 in Billed Charges at 70% = $1,705.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING TRANSGASTIC 22FR,272,RC,27200002,CDM,,,,,,both,,,2436.2500,365.4400,CIGNA HEALTHCARE,CIGNA HMO,1015.92,,,,,,,628.8000,2436.2500,percent of total billed charges,"41.7% of $2,436.25 in Billed Charges for Rev 272 = $1,015.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING TRANSGASTIC 22FR,272,RC,27200002,CDM,,,,,,both,,,2436.2500,365.4400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1130.42,,,,,,,628.8000,2436.2500,percent of total billed charges,"46.4% of $2,436.25 in Billed Charges for Rev 272 = $1,130.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING TRANSGASTIC 22FR,272,RC,27200002,CDM,,,,,,both,,,2436.2500,365.4400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1015.92,,,,,,,628.8000,2436.2500,percent of total billed charges,"41.7% of $2,436.25 in Billed Charges for Rev 272 = $1,015.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING TRANSGASTIC 22FR,272,RC,27200002,CDM,,,,,,both,,,2436.2500,365.4400,CIGNA HEALTHCARE,CIGNA PPO,1015.92,,,,,,,628.8000,2436.2500,percent of total billed charges,"41.7% of $2,436.25 in Billed Charges for Rev 272 = $1,015.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING TRANSGASTIC 22FR,272,RC,27200002,CDM,,,,,,both,,,2436.2500,365.4400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2192.63,,,,,,,628.8000,2436.2500,percent of total billed charges,"90% of $2,436.25 in Billed Charges for Rev 272 = $2,192.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING TRANSGASTIC 22FR,272,RC,27200002,CDM,,,,,,both,,,2436.2500,365.4400,MEDCOST,MEDCOST VHN,1159.41,,,,,,,628.8000,2436.2500,percent of total billed charges,"47.59% of $2,436.25 in Billed Charges for Rev 272 = $1,159.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING TRANSGASTIC 22FR,272,RC,27200002,CDM,,,,,,both,,,2436.2500,365.4400,SENTARA HEALTH,SENTARA HEALTH,628.80,,,,,,,628.8000,2436.2500,percent of total billed charges,"25.81% of $2,436.25 in Billed Charges for Rev 272 = $628.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING TRANSGASTIC 22FR,272,RC,27200002,CDM,,,,,,both,,,2436.2500,365.4400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2436.25,,,,,,,628.8000,2436.2500,percent of total billed charges,"100% of $2,436.25 in Billed Charges for Rev 272 = $2,436.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING TRANSGASTIC 22FR,272,RC,27200002,CDM,,,,,,both,,,2436.2500,365.4400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1218.13,,,,,,,628.8000,2436.2500,percent of total billed charges,"Rev 272 $2,436.25 in Billed Charges at 50% = $1,218.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING TRANSGASTIC 22FR,272,RC,27200002,CDM,,,,,,both,,,2436.2500,365.4400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,786.91,,,,,,,628.8000,2436.2500,other,"32.3% of $2,436.25 in Billed Charges for Rev 272 = $786.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE FEEDING TRANSGASTIC 22FR,272,RC,27200002,CDM,,,,,,both,,,2436.2500,365.4400,UNITED HEALTHCARE,UHC HERITAGE SELECT,747.93,,,,,,,628.8000,2436.2500,other,"30.7% of $2,436.25 in Billed Charges for Rev 272 = $747.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE FEEDING TRANSGASTIC 22FR,272,RC,27200002,CDM,,,,,,both,,,2436.2500,365.4400,UNITED HEALTHCARE,UNITED HEALTHCARE,786.91,,,,,,,628.8000,2436.2500,percent of total billed charges,"32.3% of $2,436.25 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING TRANSGASTIC 22FR,272,RC,27200002,CDM,,,,,,both,,,2436.2500,365.4400,WELLCARE,WELLCARE MEDICAID,2436.25,,,,,,,628.8000,2436.2500,percent of total billed charges,"100% of $2,436.25 in Billed Charges for Rev 272 = $2,436.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYSTEROLUX HYSTEROSCOPIC INFLOW SET,272,RC,27200002,CDM,,,,,,both,,,1665.7900,249.8700,AETNA,AETNA,711.29,,,,,,,429.9400,1665.7900,percent of total billed charges,"42.7% of $1,665.79 in Billed Charges for Rev 272 = $711.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYSTEROLUX HYSTEROSCOPIC INFLOW SET,272,RC,27200002,CDM,,,,,,both,,,1665.7900,249.8700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1166.05,,,,,,,429.9400,1665.7900,percent of total billed charges,"Rev 272 $1,665.79 in Billed Charges at 70% = $1,166.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYSTEROLUX HYSTEROSCOPIC INFLOW SET,272,RC,27200002,CDM,,,,,,both,,,1665.7900,249.8700,CIGNA HEALTHCARE,CIGNA HMO,694.63,,,,,,,429.9400,1665.7900,percent of total billed charges,"41.7% of $1,665.79 in Billed Charges for Rev 272 = $694.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYSTEROLUX HYSTEROSCOPIC INFLOW SET,272,RC,27200002,CDM,,,,,,both,,,1665.7900,249.8700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,772.93,,,,,,,429.9400,1665.7900,percent of total billed charges,"46.4% of $1,665.79 in Billed Charges for Rev 272 = $772.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYSTEROLUX HYSTEROSCOPIC INFLOW SET,272,RC,27200002,CDM,,,,,,both,,,1665.7900,249.8700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,694.63,,,,,,,429.9400,1665.7900,percent of total billed charges,"41.7% of $1,665.79 in Billed Charges for Rev 272 = $694.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYSTEROLUX HYSTEROSCOPIC INFLOW SET,272,RC,27200002,CDM,,,,,,both,,,1665.7900,249.8700,CIGNA HEALTHCARE,CIGNA PPO,694.63,,,,,,,429.9400,1665.7900,percent of total billed charges,"41.7% of $1,665.79 in Billed Charges for Rev 272 = $694.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYSTEROLUX HYSTEROSCOPIC INFLOW SET,272,RC,27200002,CDM,,,,,,both,,,1665.7900,249.8700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1499.21,,,,,,,429.9400,1665.7900,percent of total billed charges,"90% of $1,665.79 in Billed Charges for Rev 272 = $1,499.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYSTEROLUX HYSTEROSCOPIC INFLOW SET,272,RC,27200002,CDM,,,,,,both,,,1665.7900,249.8700,MEDCOST,MEDCOST VHN,792.75,,,,,,,429.9400,1665.7900,percent of total billed charges,"47.59% of $1,665.79 in Billed Charges for Rev 272 = $792.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYSTEROLUX HYSTEROSCOPIC INFLOW SET,272,RC,27200002,CDM,,,,,,both,,,1665.7900,249.8700,SENTARA HEALTH,SENTARA HEALTH,429.94,,,,,,,429.9400,1665.7900,percent of total billed charges,"25.81% of $1,665.79 in Billed Charges for Rev 272 = $429.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYSTEROLUX HYSTEROSCOPIC INFLOW SET,272,RC,27200002,CDM,,,,,,both,,,1665.7900,249.8700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1665.79,,,,,,,429.9400,1665.7900,percent of total billed charges,"100% of $1,665.79 in Billed Charges for Rev 272 = $1,665.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYSTEROLUX HYSTEROSCOPIC INFLOW SET,272,RC,27200002,CDM,,,,,,both,,,1665.7900,249.8700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,832.90,,,,,,,429.9400,1665.7900,percent of total billed charges,"Rev 272 $1,665.79 in Billed Charges at 50% = $832.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYSTEROLUX HYSTEROSCOPIC INFLOW SET,272,RC,27200002,CDM,,,,,,both,,,1665.7900,249.8700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,538.05,,,,,,,429.9400,1665.7900,other,"32.3% of $1,665.79 in Billed Charges for Rev 272 = $538.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE HYSTEROLUX HYSTEROSCOPIC INFLOW SET,272,RC,27200002,CDM,,,,,,both,,,1665.7900,249.8700,UNITED HEALTHCARE,UHC HERITAGE SELECT,511.40,,,,,,,429.9400,1665.7900,other,"30.7% of $1,665.79 in Billed Charges for Rev 272 = $511.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE HYSTEROLUX HYSTEROSCOPIC INFLOW SET,272,RC,27200002,CDM,,,,,,both,,,1665.7900,249.8700,UNITED HEALTHCARE,UNITED HEALTHCARE,538.05,,,,,,,429.9400,1665.7900,percent of total billed charges,"32.3% of $1,665.79 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE HYSTEROLUX HYSTEROSCOPIC INFLOW SET,272,RC,27200002,CDM,,,,,,both,,,1665.7900,249.8700,WELLCARE,WELLCARE MEDICAID,1665.79,,,,,,,429.9400,1665.7900,percent of total billed charges,"100% of $1,665.79 in Billed Charges for Rev 272 = $1,665.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE IRRIGATION HF MAKO,272,RC,27200002,CDM,,,,,,both,,,1055.2500,158.2900,AETNA,AETNA,450.59,,,,,,,272.3600,1055.2500,percent of total billed charges,"42.7% of $1,055.25 in Billed Charges for Rev 272 = $450.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE IRRIGATION HF MAKO,272,RC,27200002,CDM,,,,,,both,,,1055.2500,158.2900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,738.68,,,,,,,272.3600,1055.2500,percent of total billed charges,"Rev 272 $1,055.25 in Billed Charges at 70% = $738.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE IRRIGATION HF MAKO,272,RC,27200002,CDM,,,,,,both,,,1055.2500,158.2900,CIGNA HEALTHCARE,CIGNA HMO,440.04,,,,,,,272.3600,1055.2500,percent of total billed charges,"41.7% of $1,055.25 in Billed Charges for Rev 272 = $440.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE IRRIGATION HF MAKO,272,RC,27200002,CDM,,,,,,both,,,1055.2500,158.2900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,489.64,,,,,,,272.3600,1055.2500,percent of total billed charges,"46.4% of $1,055.25 in Billed Charges for Rev 272 = $489.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE IRRIGATION HF MAKO,272,RC,27200002,CDM,,,,,,both,,,1055.2500,158.2900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,440.04,,,,,,,272.3600,1055.2500,percent of total billed charges,"41.7% of $1,055.25 in Billed Charges for Rev 272 = $440.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE IRRIGATION HF MAKO,272,RC,27200002,CDM,,,,,,both,,,1055.2500,158.2900,CIGNA HEALTHCARE,CIGNA PPO,440.04,,,,,,,272.3600,1055.2500,percent of total billed charges,"41.7% of $1,055.25 in Billed Charges for Rev 272 = $440.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE IRRIGATION HF MAKO,272,RC,27200002,CDM,,,,,,both,,,1055.2500,158.2900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,949.73,,,,,,,272.3600,1055.2500,percent of total billed charges,"90% of $1,055.25 in Billed Charges for Rev 272 = $949.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE IRRIGATION HF MAKO,272,RC,27200002,CDM,,,,,,both,,,1055.2500,158.2900,MEDCOST,MEDCOST VHN,502.19,,,,,,,272.3600,1055.2500,percent of total billed charges,"47.59% of $1,055.25 in Billed Charges for Rev 272 = $502.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE IRRIGATION HF MAKO,272,RC,27200002,CDM,,,,,,both,,,1055.2500,158.2900,SENTARA HEALTH,SENTARA HEALTH,272.36,,,,,,,272.3600,1055.2500,percent of total billed charges,"25.81% of $1,055.25 in Billed Charges for Rev 272 = $272.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE IRRIGATION HF MAKO,272,RC,27200002,CDM,,,,,,both,,,1055.2500,158.2900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1055.25,,,,,,,272.3600,1055.2500,percent of total billed charges,"100% of $1,055.25 in Billed Charges for Rev 272 = $1,055.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE IRRIGATION HF MAKO,272,RC,27200002,CDM,,,,,,both,,,1055.2500,158.2900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,527.63,,,,,,,272.3600,1055.2500,percent of total billed charges,"Rev 272 $1,055.25 in Billed Charges at 50% = $527.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE IRRIGATION HF MAKO,272,RC,27200002,CDM,,,,,,both,,,1055.2500,158.2900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,340.85,,,,,,,272.3600,1055.2500,other,"32.3% of $1,055.25 in Billed Charges for Rev 272 = $340.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE IRRIGATION HF MAKO,272,RC,27200002,CDM,,,,,,both,,,1055.2500,158.2900,UNITED HEALTHCARE,UHC HERITAGE SELECT,323.96,,,,,,,272.3600,1055.2500,other,"30.7% of $1,055.25 in Billed Charges for Rev 272 = $323.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE IRRIGATION HF MAKO,272,RC,27200002,CDM,,,,,,both,,,1055.2500,158.2900,UNITED HEALTHCARE,UNITED HEALTHCARE,340.85,,,,,,,272.3600,1055.2500,percent of total billed charges,"32.3% of $1,055.25 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE IRRIGATION HF MAKO,272,RC,27200002,CDM,,,,,,both,,,1055.2500,158.2900,WELLCARE,WELLCARE MEDICAID,1055.25,,,,,,,272.3600,1055.2500,percent of total billed charges,"100% of $1,055.25 in Billed Charges for Rev 272 = $1,055.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL GEMINI 3 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,,,,,,,,both,,,2572.5300,385.8800,AETNA,AETNA,1098.47,,,,,,,663.9700,2572.5300,percent of total billed charges,"42.7% of $2,572.53 in Billed Charges for Rev 272 = $1,098.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL GEMINI 3 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,,,,,,,,both,,,2572.5300,385.8800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1800.77,,,,,,,663.9700,2572.5300,percent of total billed charges,"Rev 272 $2,572.53 in Billed Charges at 70% = $1,800.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL GEMINI 3 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,,,,,,,,both,,,2572.5300,385.8800,CIGNA HEALTHCARE,CIGNA HMO,1072.75,,,,,,,663.9700,2572.5300,percent of total billed charges,"41.7% of $2,572.53 in Billed Charges for Rev 272 = $1,072.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL GEMINI 3 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,,,,,,,,both,,,2572.5300,385.8800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1193.65,,,,,,,663.9700,2572.5300,percent of total billed charges,"46.4% of $2,572.53 in Billed Charges for Rev 272 = $1,193.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL GEMINI 3 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,,,,,,,,both,,,2572.5300,385.8800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1072.75,,,,,,,663.9700,2572.5300,percent of total billed charges,"41.7% of $2,572.53 in Billed Charges for Rev 272 = $1,072.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL GEMINI 3 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,,,,,,,,both,,,2572.5300,385.8800,CIGNA HEALTHCARE,CIGNA PPO,1072.75,,,,,,,663.9700,2572.5300,percent of total billed charges,"41.7% of $2,572.53 in Billed Charges for Rev 272 = $1,072.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL GEMINI 3 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,,,,,,,,both,,,2572.5300,385.8800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2315.28,,,,,,,663.9700,2572.5300,percent of total billed charges,"90% of $2,572.53 in Billed Charges for Rev 272 = $2,315.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL GEMINI 3 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,,,,,,,,both,,,2572.5300,385.8800,MEDCOST,MEDCOST VHN,1224.27,,,,,,,663.9700,2572.5300,percent of total billed charges,"47.59% of $2,572.53 in Billed Charges for Rev 272 = $1,224.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL GEMINI 3 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,,,,,,,,both,,,2572.5300,385.8800,SENTARA HEALTH,SENTARA HEALTH,663.97,,,,,,,663.9700,2572.5300,percent of total billed charges,"25.81% of $2,572.53 in Billed Charges for Rev 272 = $663.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL GEMINI 3 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,,,,,,,,both,,,2572.5300,385.8800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2572.53,,,,,,,663.9700,2572.5300,percent of total billed charges,"100% of $2,572.53 in Billed Charges for Rev 272 = $2,572.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL GEMINI 3 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,,,,,,,,both,,,2572.5300,385.8800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1286.27,,,,,,,663.9700,2572.5300,percent of total billed charges,"Rev 272 $2,572.53 in Billed Charges at 50% = $1,286.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL GEMINI 3 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,,,,,,,,both,,,2572.5300,385.8800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,830.93,,,,,,,663.9700,2572.5300,other,"32.3% of $2,572.53 in Billed Charges for Rev 272 = $830.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET RETRIEVAL GEMINI 3 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,,,,,,,,both,,,2572.5300,385.8800,UNITED HEALTHCARE,UHC HERITAGE SELECT,789.77,,,,,,,663.9700,2572.5300,other,"30.7% of $2,572.53 in Billed Charges for Rev 272 = $789.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET RETRIEVAL GEMINI 3 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,,,,,,,,both,,,2572.5300,385.8800,UNITED HEALTHCARE,UNITED HEALTHCARE,830.93,,,,,,,663.9700,2572.5300,percent of total billed charges,"32.3% of $2,572.53 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL GEMINI 3 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,,,,,,,,both,,,2572.5300,385.8800,WELLCARE,WELLCARE MEDICAID,2572.53,,,,,,,663.9700,2572.5300,percent of total billed charges,"100% of $2,572.53 in Billed Charges for Rev 272 = $2,572.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4269.4300,640.4100,AETNA,AETNA,1823.05,,,,,,,1101.9400,4269.4300,percent of total billed charges,"42.7% of $4,269.43 in Billed Charges for Rev 272 = $1,823.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4269.4300,640.4100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2988.60,,,,,,,1101.9400,4269.4300,percent of total billed charges,"Rev 272 $4,269.43 in Billed Charges at 70% = $2,988.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4269.4300,640.4100,CIGNA HEALTHCARE,CIGNA HMO,1780.35,,,,,,,1101.9400,4269.4300,percent of total billed charges,"41.7% of $4,269.43 in Billed Charges for Rev 272 = $1,780.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4269.4300,640.4100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1981.02,,,,,,,1101.9400,4269.4300,percent of total billed charges,"46.4% of $4,269.43 in Billed Charges for Rev 272 = $1,981.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4269.4300,640.4100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1780.35,,,,,,,1101.9400,4269.4300,percent of total billed charges,"41.7% of $4,269.43 in Billed Charges for Rev 272 = $1,780.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4269.4300,640.4100,CIGNA HEALTHCARE,CIGNA PPO,1780.35,,,,,,,1101.9400,4269.4300,percent of total billed charges,"41.7% of $4,269.43 in Billed Charges for Rev 272 = $1,780.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4269.4300,640.4100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3842.49,,,,,,,1101.9400,4269.4300,percent of total billed charges,"90% of $4,269.43 in Billed Charges for Rev 272 = $3,842.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4269.4300,640.4100,MEDCOST,MEDCOST VHN,2031.82,,,,,,,1101.9400,4269.4300,percent of total billed charges,"47.59% of $4,269.43 in Billed Charges for Rev 272 = $2,031.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4269.4300,640.4100,SENTARA HEALTH,SENTARA HEALTH,1101.94,,,,,,,1101.9400,4269.4300,percent of total billed charges,"25.81% of $4,269.43 in Billed Charges for Rev 272 = $1,101.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4269.4300,640.4100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4269.43,,,,,,,1101.9400,4269.4300,percent of total billed charges,"100% of $4,269.43 in Billed Charges for Rev 272 = $4,269.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4269.4300,640.4100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2134.72,,,,,,,1101.9400,4269.4300,percent of total billed charges,"Rev 272 $4,269.43 in Billed Charges at 50% = $2,134.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4269.4300,640.4100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1379.03,,,,,,,1101.9400,4269.4300,other,"32.3% of $4,269.43 in Billed Charges for Rev 272 = $1,379.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4269.4300,640.4100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1310.72,,,,,,,1101.9400,4269.4300,other,"30.7% of $4,269.43 in Billed Charges for Rev 272 = $1,310.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4269.4300,640.4100,UNITED HEALTHCARE,UNITED HEALTHCARE,1379.03,,,,,,,1101.9400,4269.4300,percent of total billed charges,"32.3% of $4,269.43 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4269.4300,640.4100,WELLCARE,WELLCARE MEDICAID,4269.43,,,,,,,1101.9400,4269.4300,percent of total billed charges,"100% of $4,269.43 in Billed Charges for Rev 272 = $4,269.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNAL GASTRIC 16FR 2X45CM,272,RC,27200002,CDM,,,,,,both,,,3589.7100,538.4600,AETNA,AETNA,1532.81,,,,,,,926.5000,3589.7100,percent of total billed charges,"42.7% of $3,589.71 in Billed Charges for Rev 272 = $1,532.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNAL GASTRIC 16FR 2X45CM,272,RC,27200002,CDM,,,,,,both,,,3589.7100,538.4600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2512.80,,,,,,,926.5000,3589.7100,percent of total billed charges,"Rev 272 $3,589.71 in Billed Charges at 70% = $2,512.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNAL GASTRIC 16FR 2X45CM,272,RC,27200002,CDM,,,,,,both,,,3589.7100,538.4600,CIGNA HEALTHCARE,CIGNA HMO,1496.91,,,,,,,926.5000,3589.7100,percent of total billed charges,"41.7% of $3,589.71 in Billed Charges for Rev 272 = $1,496.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNAL GASTRIC 16FR 2X45CM,272,RC,27200002,CDM,,,,,,both,,,3589.7100,538.4600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1665.63,,,,,,,926.5000,3589.7100,percent of total billed charges,"46.4% of $3,589.71 in Billed Charges for Rev 272 = $1,665.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNAL GASTRIC 16FR 2X45CM,272,RC,27200002,CDM,,,,,,both,,,3589.7100,538.4600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1496.91,,,,,,,926.5000,3589.7100,percent of total billed charges,"41.7% of $3,589.71 in Billed Charges for Rev 272 = $1,496.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNAL GASTRIC 16FR 2X45CM,272,RC,27200002,CDM,,,,,,both,,,3589.7100,538.4600,CIGNA HEALTHCARE,CIGNA PPO,1496.91,,,,,,,926.5000,3589.7100,percent of total billed charges,"41.7% of $3,589.71 in Billed Charges for Rev 272 = $1,496.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNAL GASTRIC 16FR 2X45CM,272,RC,27200002,CDM,,,,,,both,,,3589.7100,538.4600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3230.74,,,,,,,926.5000,3589.7100,percent of total billed charges,"90% of $3,589.71 in Billed Charges for Rev 272 = $3,230.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNAL GASTRIC 16FR 2X45CM,272,RC,27200002,CDM,,,,,,both,,,3589.7100,538.4600,MEDCOST,MEDCOST VHN,1708.34,,,,,,,926.5000,3589.7100,percent of total billed charges,"47.59% of $3,589.71 in Billed Charges for Rev 272 = $1,708.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNAL GASTRIC 16FR 2X45CM,272,RC,27200002,CDM,,,,,,both,,,3589.7100,538.4600,SENTARA HEALTH,SENTARA HEALTH,926.50,,,,,,,926.5000,3589.7100,percent of total billed charges,"25.81% of $3,589.71 in Billed Charges for Rev 272 = $926.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNAL GASTRIC 16FR 2X45CM,272,RC,27200002,CDM,,,,,,both,,,3589.7100,538.4600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3589.71,,,,,,,926.5000,3589.7100,percent of total billed charges,"100% of $3,589.71 in Billed Charges for Rev 272 = $3,589.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNAL GASTRIC 16FR 2X45CM,272,RC,27200002,CDM,,,,,,both,,,3589.7100,538.4600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1794.86,,,,,,,926.5000,3589.7100,percent of total billed charges,"Rev 272 $3,589.71 in Billed Charges at 50% = $1,794.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNAL GASTRIC 16FR 2X45CM,272,RC,27200002,CDM,,,,,,both,,,3589.7100,538.4600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1159.48,,,,,,,926.5000,3589.7100,other,"32.3% of $3,589.71 in Billed Charges for Rev 272 = $1,159.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE JEJUNAL GASTRIC 16FR 2X45CM,272,RC,27200002,CDM,,,,,,both,,,3589.7100,538.4600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1102.04,,,,,,,926.5000,3589.7100,other,"30.7% of $3,589.71 in Billed Charges for Rev 272 = $1,102.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE JEJUNAL GASTRIC 16FR 2X45CM,272,RC,27200002,CDM,,,,,,both,,,3589.7100,538.4600,UNITED HEALTHCARE,UNITED HEALTHCARE,1159.48,,,,,,,926.5000,3589.7100,percent of total billed charges,"32.3% of $3,589.71 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNAL GASTRIC 16FR 2X45CM,272,RC,27200002,CDM,,,,,,both,,,3589.7100,538.4600,WELLCARE,WELLCARE MEDICAID,3589.71,,,,,,,926.5000,3589.7100,percent of total billed charges,"100% of $3,589.71 in Billed Charges for Rev 272 = $3,589.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2904.5000,435.6800,AETNA,AETNA,1240.22,,,,,,,749.6500,2904.5000,percent of total billed charges,"42.7% of $2,904.50 in Billed Charges for Rev 272 = $1,240.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2904.5000,435.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2033.15,,,,,,,749.6500,2904.5000,percent of total billed charges,"Rev 272 $2,904.50 in Billed Charges at 70% = $2,033.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2904.5000,435.6800,CIGNA HEALTHCARE,CIGNA HMO,1211.18,,,,,,,749.6500,2904.5000,percent of total billed charges,"41.7% of $2,904.50 in Billed Charges for Rev 272 = $1,211.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2904.5000,435.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1347.69,,,,,,,749.6500,2904.5000,percent of total billed charges,"46.4% of $2,904.50 in Billed Charges for Rev 272 = $1,347.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2904.5000,435.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1211.18,,,,,,,749.6500,2904.5000,percent of total billed charges,"41.7% of $2,904.50 in Billed Charges for Rev 272 = $1,211.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2904.5000,435.6800,CIGNA HEALTHCARE,CIGNA PPO,1211.18,,,,,,,749.6500,2904.5000,percent of total billed charges,"41.7% of $2,904.50 in Billed Charges for Rev 272 = $1,211.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2904.5000,435.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2614.05,,,,,,,749.6500,2904.5000,percent of total billed charges,"90% of $2,904.50 in Billed Charges for Rev 272 = $2,614.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2904.5000,435.6800,MEDCOST,MEDCOST VHN,1382.25,,,,,,,749.6500,2904.5000,percent of total billed charges,"47.59% of $2,904.50 in Billed Charges for Rev 272 = $1,382.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2904.5000,435.6800,SENTARA HEALTH,SENTARA HEALTH,749.65,,,,,,,749.6500,2904.5000,percent of total billed charges,"25.81% of $2,904.50 in Billed Charges for Rev 272 = $749.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2904.5000,435.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2904.50,,,,,,,749.6500,2904.5000,percent of total billed charges,"100% of $2,904.50 in Billed Charges for Rev 272 = $2,904.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2904.5000,435.6800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1452.25,,,,,,,749.6500,2904.5000,percent of total billed charges,"Rev 272 $2,904.50 in Billed Charges at 50% = $1,452.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2904.5000,435.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,938.15,,,,,,,749.6500,2904.5000,other,"32.3% of $2,904.50 in Billed Charges for Rev 272 = $938.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2904.5000,435.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,891.68,,,,,,,749.6500,2904.5000,other,"30.7% of $2,904.50 in Billed Charges for Rev 272 = $891.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2904.5000,435.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,938.15,,,,,,,749.6500,2904.5000,percent of total billed charges,"32.3% of $2,904.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 3.0FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2904.5000,435.6800,WELLCARE,WELLCARE MEDICAID,2904.50,,,,,,,749.6500,2904.5000,percent of total billed charges,"100% of $2,904.50 in Billed Charges for Rev 272 = $2,904.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL DAKOTA 1.9FR X 8MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3395.4700,509.3200,AETNA,AETNA,1449.87,,,,,,,876.3700,3395.4700,percent of total billed charges,"42.7% of $3,395.47 in Billed Charges for Rev 272 = $1,449.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL DAKOTA 1.9FR X 8MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3395.4700,509.3200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2376.83,,,,,,,876.3700,3395.4700,percent of total billed charges,"Rev 272 $3,395.47 in Billed Charges at 70% = $2,376.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL DAKOTA 1.9FR X 8MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3395.4700,509.3200,CIGNA HEALTHCARE,CIGNA HMO,1415.91,,,,,,,876.3700,3395.4700,percent of total billed charges,"41.7% of $3,395.47 in Billed Charges for Rev 272 = $1,415.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL DAKOTA 1.9FR X 8MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3395.4700,509.3200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1575.50,,,,,,,876.3700,3395.4700,percent of total billed charges,"46.4% of $3,395.47 in Billed Charges for Rev 272 = $1,575.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL DAKOTA 1.9FR X 8MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3395.4700,509.3200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1415.91,,,,,,,876.3700,3395.4700,percent of total billed charges,"41.7% of $3,395.47 in Billed Charges for Rev 272 = $1,415.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL DAKOTA 1.9FR X 8MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3395.4700,509.3200,CIGNA HEALTHCARE,CIGNA PPO,1415.91,,,,,,,876.3700,3395.4700,percent of total billed charges,"41.7% of $3,395.47 in Billed Charges for Rev 272 = $1,415.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL DAKOTA 1.9FR X 8MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3395.4700,509.3200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3055.92,,,,,,,876.3700,3395.4700,percent of total billed charges,"90% of $3,395.47 in Billed Charges for Rev 272 = $3,055.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL DAKOTA 1.9FR X 8MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3395.4700,509.3200,MEDCOST,MEDCOST VHN,1615.90,,,,,,,876.3700,3395.4700,percent of total billed charges,"47.59% of $3,395.47 in Billed Charges for Rev 272 = $1,615.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL DAKOTA 1.9FR X 8MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3395.4700,509.3200,SENTARA HEALTH,SENTARA HEALTH,876.37,,,,,,,876.3700,3395.4700,percent of total billed charges,"25.81% of $3,395.47 in Billed Charges for Rev 272 = $876.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL DAKOTA 1.9FR X 8MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3395.4700,509.3200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3395.47,,,,,,,876.3700,3395.4700,percent of total billed charges,"100% of $3,395.47 in Billed Charges for Rev 272 = $3,395.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL DAKOTA 1.9FR X 8MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3395.4700,509.3200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1697.74,,,,,,,876.3700,3395.4700,percent of total billed charges,"Rev 272 $3,395.47 in Billed Charges at 50% = $1,697.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL DAKOTA 1.9FR X 8MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3395.4700,509.3200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1096.74,,,,,,,876.3700,3395.4700,other,"32.3% of $3,395.47 in Billed Charges for Rev 272 = $1,096.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET RETRIEVAL NITINOL DAKOTA 1.9FR X 8MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3395.4700,509.3200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1042.41,,,,,,,876.3700,3395.4700,other,"30.7% of $3,395.47 in Billed Charges for Rev 272 = $1,042.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET RETRIEVAL NITINOL DAKOTA 1.9FR X 8MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3395.4700,509.3200,UNITED HEALTHCARE,UNITED HEALTHCARE,1096.74,,,,,,,876.3700,3395.4700,percent of total billed charges,"32.3% of $3,395.47 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL DAKOTA 1.9FR X 8MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3395.4700,509.3200,WELLCARE,WELLCARE MEDICAID,3395.47,,,,,,,876.3700,3395.4700,percent of total billed charges,"100% of $3,395.47 in Billed Charges for Rev 272 = $3,395.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7 CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1093.1000,163.9700,AETNA,AETNA,466.75,,,,,,,282.1300,1093.1000,percent of total billed charges,"42.7% of $1,093.10 in Billed Charges for Rev 272 = $466.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7 CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1093.1000,163.9700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,765.17,,,,,,,282.1300,1093.1000,percent of total billed charges,"Rev 272 $1,093.10 in Billed Charges at 70% = $765.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7 CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1093.1000,163.9700,CIGNA HEALTHCARE,CIGNA HMO,455.82,,,,,,,282.1300,1093.1000,percent of total billed charges,"41.7% of $1,093.10 in Billed Charges for Rev 272 = $455.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7 CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1093.1000,163.9700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,507.20,,,,,,,282.1300,1093.1000,percent of total billed charges,"46.4% of $1,093.10 in Billed Charges for Rev 272 = $507.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7 CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1093.1000,163.9700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,455.82,,,,,,,282.1300,1093.1000,percent of total billed charges,"41.7% of $1,093.10 in Billed Charges for Rev 272 = $455.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7 CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1093.1000,163.9700,CIGNA HEALTHCARE,CIGNA PPO,455.82,,,,,,,282.1300,1093.1000,percent of total billed charges,"41.7% of $1,093.10 in Billed Charges for Rev 272 = $455.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7 CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1093.1000,163.9700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,983.79,,,,,,,282.1300,1093.1000,percent of total billed charges,"90% of $1,093.10 in Billed Charges for Rev 272 = $983.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7 CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1093.1000,163.9700,MEDCOST,MEDCOST VHN,520.21,,,,,,,282.1300,1093.1000,percent of total billed charges,"47.59% of $1,093.10 in Billed Charges for Rev 272 = $520.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7 CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1093.1000,163.9700,SENTARA HEALTH,SENTARA HEALTH,282.13,,,,,,,282.1300,1093.1000,percent of total billed charges,"25.81% of $1,093.10 in Billed Charges for Rev 272 = $282.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7 CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1093.1000,163.9700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1093.10,,,,,,,282.1300,1093.1000,percent of total billed charges,"100% of $1,093.10 in Billed Charges for Rev 272 = $1,093.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7 CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1093.1000,163.9700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,546.55,,,,,,,282.1300,1093.1000,percent of total billed charges,"Rev 272 $1,093.10 in Billed Charges at 50% = $546.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7 CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1093.1000,163.9700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,353.07,,,,,,,282.1300,1093.1000,other,"32.3% of $1,093.10 in Billed Charges for Rev 272 = $353.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.7 CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1093.1000,163.9700,UNITED HEALTHCARE,UHC HERITAGE SELECT,335.58,,,,,,,282.1300,1093.1000,other,"30.7% of $1,093.10 in Billed Charges for Rev 272 = $335.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.7 CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1093.1000,163.9700,UNITED HEALTHCARE,UNITED HEALTHCARE,353.07,,,,,,,282.1300,1093.1000,percent of total billed charges,"32.3% of $1,093.10 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7 CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1093.1000,163.9700,WELLCARE,WELLCARE MEDICAID,1093.10,,,,,,,282.1300,1093.1000,percent of total billed charges,"100% of $1,093.10 in Billed Charges for Rev 272 = $1,093.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1229.3800,184.4100,AETNA,AETNA,524.95,,,,,,,317.3000,1229.3800,percent of total billed charges,"42.7% of $1,229.38 in Billed Charges for Rev 272 = $524.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1229.3800,184.4100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,860.57,,,,,,,317.3000,1229.3800,percent of total billed charges,"Rev 272 $1,229.38 in Billed Charges at 70% = $860.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1229.3800,184.4100,CIGNA HEALTHCARE,CIGNA HMO,512.65,,,,,,,317.3000,1229.3800,percent of total billed charges,"41.7% of $1,229.38 in Billed Charges for Rev 272 = $512.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1229.3800,184.4100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,570.43,,,,,,,317.3000,1229.3800,percent of total billed charges,"46.4% of $1,229.38 in Billed Charges for Rev 272 = $570.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1229.3800,184.4100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,512.65,,,,,,,317.3000,1229.3800,percent of total billed charges,"41.7% of $1,229.38 in Billed Charges for Rev 272 = $512.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1229.3800,184.4100,CIGNA HEALTHCARE,CIGNA PPO,512.65,,,,,,,317.3000,1229.3800,percent of total billed charges,"41.7% of $1,229.38 in Billed Charges for Rev 272 = $512.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1229.3800,184.4100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1106.44,,,,,,,317.3000,1229.3800,percent of total billed charges,"90% of $1,229.38 in Billed Charges for Rev 272 = $1,106.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1229.3800,184.4100,MEDCOST,MEDCOST VHN,585.06,,,,,,,317.3000,1229.3800,percent of total billed charges,"47.59% of $1,229.38 in Billed Charges for Rev 272 = $585.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1229.3800,184.4100,SENTARA HEALTH,SENTARA HEALTH,317.30,,,,,,,317.3000,1229.3800,percent of total billed charges,"25.81% of $1,229.38 in Billed Charges for Rev 272 = $317.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1229.3800,184.4100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1229.38,,,,,,,317.3000,1229.3800,percent of total billed charges,"100% of $1,229.38 in Billed Charges for Rev 272 = $1,229.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1229.3800,184.4100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,614.69,,,,,,,317.3000,1229.3800,percent of total billed charges,"Rev 272 $1,229.38 in Billed Charges at 50% = $614.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1229.3800,184.4100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,397.09,,,,,,,317.3000,1229.3800,other,"32.3% of $1,229.38 in Billed Charges for Rev 272 = $397.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1229.3800,184.4100,UNITED HEALTHCARE,UHC HERITAGE SELECT,377.42,,,,,,,317.3000,1229.3800,other,"30.7% of $1,229.38 in Billed Charges for Rev 272 = $377.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1229.3800,184.4100,UNITED HEALTHCARE,UNITED HEALTHCARE,397.09,,,,,,,317.3000,1229.3800,percent of total billed charges,"32.3% of $1,229.38 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1229.3800,184.4100,WELLCARE,WELLCARE MEDICAID,1229.38,,,,,,,317.3000,1229.3800,percent of total billed charges,"100% of $1,229.38 in Billed Charges for Rev 272 = $1,229.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1666.8300,250.0200,AETNA,AETNA,711.74,,,,,,,430.2100,1666.8300,percent of total billed charges,"42.7% of $1,666.83 in Billed Charges for Rev 272 = $711.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1666.8300,250.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1166.78,,,,,,,430.2100,1666.8300,percent of total billed charges,"Rev 272 $1,666.83 in Billed Charges at 70% = $1,166.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1666.8300,250.0200,CIGNA HEALTHCARE,CIGNA HMO,695.07,,,,,,,430.2100,1666.8300,percent of total billed charges,"41.7% of $1,666.83 in Billed Charges for Rev 272 = $695.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1666.8300,250.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,773.41,,,,,,,430.2100,1666.8300,percent of total billed charges,"46.4% of $1,666.83 in Billed Charges for Rev 272 = $773.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1666.8300,250.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,695.07,,,,,,,430.2100,1666.8300,percent of total billed charges,"41.7% of $1,666.83 in Billed Charges for Rev 272 = $695.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1666.8300,250.0200,CIGNA HEALTHCARE,CIGNA PPO,695.07,,,,,,,430.2100,1666.8300,percent of total billed charges,"41.7% of $1,666.83 in Billed Charges for Rev 272 = $695.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1666.8300,250.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1500.15,,,,,,,430.2100,1666.8300,percent of total billed charges,"90% of $1,666.83 in Billed Charges for Rev 272 = $1,500.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1666.8300,250.0200,MEDCOST,MEDCOST VHN,793.24,,,,,,,430.2100,1666.8300,percent of total billed charges,"47.59% of $1,666.83 in Billed Charges for Rev 272 = $793.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1666.8300,250.0200,SENTARA HEALTH,SENTARA HEALTH,430.21,,,,,,,430.2100,1666.8300,percent of total billed charges,"25.81% of $1,666.83 in Billed Charges for Rev 272 = $430.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1666.8300,250.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1666.83,,,,,,,430.2100,1666.8300,percent of total billed charges,"100% of $1,666.83 in Billed Charges for Rev 272 = $1,666.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1666.8300,250.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,833.42,,,,,,,430.2100,1666.8300,percent of total billed charges,"Rev 272 $1,666.83 in Billed Charges at 50% = $833.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1666.8300,250.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,538.39,,,,,,,430.2100,1666.8300,other,"32.3% of $1,666.83 in Billed Charges for Rev 272 = $538.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1666.8300,250.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,511.72,,,,,,,430.2100,1666.8300,other,"30.7% of $1,666.83 in Billed Charges for Rev 272 = $511.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1666.8300,250.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,538.39,,,,,,,430.2100,1666.8300,percent of total billed charges,"32.3% of $1,666.83 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1666.8300,250.0200,WELLCARE,WELLCARE MEDICAID,1666.83,,,,,,,430.2100,1666.8300,percent of total billed charges,"100% of $1,666.83 in Billed Charges for Rev 272 = $1,666.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL,272,RC,27200002,CDM,,,,,,both,,,3157.9700,473.7000,AETNA,AETNA,1348.45,,,,,,,815.0700,3157.9700,percent of total billed charges,"42.7% of $3,157.97 in Billed Charges for Rev 272 = $1,348.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL,272,RC,27200002,CDM,,,,,,both,,,3157.9700,473.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2210.58,,,,,,,815.0700,3157.9700,percent of total billed charges,"Rev 272 $3,157.97 in Billed Charges at 70% = $2,210.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL,272,RC,27200002,CDM,,,,,,both,,,3157.9700,473.7000,CIGNA HEALTHCARE,CIGNA HMO,1316.87,,,,,,,815.0700,3157.9700,percent of total billed charges,"41.7% of $3,157.97 in Billed Charges for Rev 272 = $1,316.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL,272,RC,27200002,CDM,,,,,,both,,,3157.9700,473.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1465.30,,,,,,,815.0700,3157.9700,percent of total billed charges,"46.4% of $3,157.97 in Billed Charges for Rev 272 = $1,465.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL,272,RC,27200002,CDM,,,,,,both,,,3157.9700,473.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1316.87,,,,,,,815.0700,3157.9700,percent of total billed charges,"41.7% of $3,157.97 in Billed Charges for Rev 272 = $1,316.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL,272,RC,27200002,CDM,,,,,,both,,,3157.9700,473.7000,CIGNA HEALTHCARE,CIGNA PPO,1316.87,,,,,,,815.0700,3157.9700,percent of total billed charges,"41.7% of $3,157.97 in Billed Charges for Rev 272 = $1,316.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL,272,RC,27200002,CDM,,,,,,both,,,3157.9700,473.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2842.17,,,,,,,815.0700,3157.9700,percent of total billed charges,"90% of $3,157.97 in Billed Charges for Rev 272 = $2,842.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL,272,RC,27200002,CDM,,,,,,both,,,3157.9700,473.7000,MEDCOST,MEDCOST VHN,1502.88,,,,,,,815.0700,3157.9700,percent of total billed charges,"47.59% of $3,157.97 in Billed Charges for Rev 272 = $1,502.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL,272,RC,27200002,CDM,,,,,,both,,,3157.9700,473.7000,SENTARA HEALTH,SENTARA HEALTH,815.07,,,,,,,815.0700,3157.9700,percent of total billed charges,"25.81% of $3,157.97 in Billed Charges for Rev 272 = $815.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL,272,RC,27200002,CDM,,,,,,both,,,3157.9700,473.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3157.97,,,,,,,815.0700,3157.9700,percent of total billed charges,"100% of $3,157.97 in Billed Charges for Rev 272 = $3,157.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL,272,RC,27200002,CDM,,,,,,both,,,3157.9700,473.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1578.99,,,,,,,815.0700,3157.9700,percent of total billed charges,"Rev 272 $3,157.97 in Billed Charges at 50% = $1,578.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL,272,RC,27200002,CDM,,,,,,both,,,3157.9700,473.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1020.02,,,,,,,815.0700,3157.9700,other,"32.3% of $3,157.97 in Billed Charges for Rev 272 = $1,020.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET RETRIEVAL NITINOL,272,RC,27200002,CDM,,,,,,both,,,3157.9700,473.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,969.50,,,,,,,815.0700,3157.9700,other,"30.7% of $3,157.97 in Billed Charges for Rev 272 = $969.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET RETRIEVAL NITINOL,272,RC,27200002,CDM,,,,,,both,,,3157.9700,473.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,1020.02,,,,,,,815.0700,3157.9700,percent of total billed charges,"32.3% of $3,157.97 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL,272,RC,27200002,CDM,,,,,,both,,,3157.9700,473.7000,WELLCARE,WELLCARE MEDICAID,3157.97,,,,,,,815.0700,3157.9700,percent of total billed charges,"100% of $3,157.97 in Billed Charges for Rev 272 = $3,157.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2800.2700,420.0400,AETNA,AETNA,1195.72,,,,,,,722.7500,2800.2700,percent of total billed charges,"42.7% of $2,800.27 in Billed Charges for Rev 272 = $1,195.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2800.2700,420.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1960.19,,,,,,,722.7500,2800.2700,percent of total billed charges,"Rev 272 $2,800.27 in Billed Charges at 70% = $1,960.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2800.2700,420.0400,CIGNA HEALTHCARE,CIGNA HMO,1167.71,,,,,,,722.7500,2800.2700,percent of total billed charges,"41.7% of $2,800.27 in Billed Charges for Rev 272 = $1,167.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2800.2700,420.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1299.33,,,,,,,722.7500,2800.2700,percent of total billed charges,"46.4% of $2,800.27 in Billed Charges for Rev 272 = $1,299.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2800.2700,420.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1167.71,,,,,,,722.7500,2800.2700,percent of total billed charges,"41.7% of $2,800.27 in Billed Charges for Rev 272 = $1,167.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2800.2700,420.0400,CIGNA HEALTHCARE,CIGNA PPO,1167.71,,,,,,,722.7500,2800.2700,percent of total billed charges,"41.7% of $2,800.27 in Billed Charges for Rev 272 = $1,167.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2800.2700,420.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2520.24,,,,,,,722.7500,2800.2700,percent of total billed charges,"90% of $2,800.27 in Billed Charges for Rev 272 = $2,520.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2800.2700,420.0400,MEDCOST,MEDCOST VHN,1332.65,,,,,,,722.7500,2800.2700,percent of total billed charges,"47.59% of $2,800.27 in Billed Charges for Rev 272 = $1,332.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2800.2700,420.0400,SENTARA HEALTH,SENTARA HEALTH,722.75,,,,,,,722.7500,2800.2700,percent of total billed charges,"25.81% of $2,800.27 in Billed Charges for Rev 272 = $722.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2800.2700,420.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2800.27,,,,,,,722.7500,2800.2700,percent of total billed charges,"100% of $2,800.27 in Billed Charges for Rev 272 = $2,800.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2800.2700,420.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1400.14,,,,,,,722.7500,2800.2700,percent of total billed charges,"Rev 272 $2,800.27 in Billed Charges at 50% = $1,400.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2800.2700,420.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,904.49,,,,,,,722.7500,2800.2700,other,"32.3% of $2,800.27 in Billed Charges for Rev 272 = $904.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2800.2700,420.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,859.68,,,,,,,722.7500,2800.2700,other,"30.7% of $2,800.27 in Billed Charges for Rev 272 = $859.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2800.2700,420.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,904.49,,,,,,,722.7500,2800.2700,percent of total billed charges,"32.3% of $2,800.27 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2800.2700,420.0400,WELLCARE,WELLCARE MEDICAID,2800.27,,,,,,,722.7500,2800.2700,percent of total billed charges,"100% of $2,800.27 in Billed Charges for Rev 272 = $2,800.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2963.8200,444.5700,AETNA,AETNA,1265.55,,,,,,,764.9600,2963.8200,percent of total billed charges,"42.7% of $2,963.82 in Billed Charges for Rev 272 = $1,265.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2963.8200,444.5700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2074.67,,,,,,,764.9600,2963.8200,percent of total billed charges,"Rev 272 $2,963.82 in Billed Charges at 70% = $2,074.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2963.8200,444.5700,CIGNA HEALTHCARE,CIGNA HMO,1235.91,,,,,,,764.9600,2963.8200,percent of total billed charges,"41.7% of $2,963.82 in Billed Charges for Rev 272 = $1,235.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2963.8200,444.5700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1375.21,,,,,,,764.9600,2963.8200,percent of total billed charges,"46.4% of $2,963.82 in Billed Charges for Rev 272 = $1,375.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2963.8200,444.5700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1235.91,,,,,,,764.9600,2963.8200,percent of total billed charges,"41.7% of $2,963.82 in Billed Charges for Rev 272 = $1,235.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2963.8200,444.5700,CIGNA HEALTHCARE,CIGNA PPO,1235.91,,,,,,,764.9600,2963.8200,percent of total billed charges,"41.7% of $2,963.82 in Billed Charges for Rev 272 = $1,235.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2963.8200,444.5700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2667.44,,,,,,,764.9600,2963.8200,percent of total billed charges,"90% of $2,963.82 in Billed Charges for Rev 272 = $2,667.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2963.8200,444.5700,MEDCOST,MEDCOST VHN,1410.48,,,,,,,764.9600,2963.8200,percent of total billed charges,"47.59% of $2,963.82 in Billed Charges for Rev 272 = $1,410.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2963.8200,444.5700,SENTARA HEALTH,SENTARA HEALTH,764.96,,,,,,,764.9600,2963.8200,percent of total billed charges,"25.81% of $2,963.82 in Billed Charges for Rev 272 = $764.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2963.8200,444.5700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2963.82,,,,,,,764.9600,2963.8200,percent of total billed charges,"100% of $2,963.82 in Billed Charges for Rev 272 = $2,963.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2963.8200,444.5700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1481.91,,,,,,,764.9600,2963.8200,percent of total billed charges,"Rev 272 $2,963.82 in Billed Charges at 50% = $1,481.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2963.8200,444.5700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,957.31,,,,,,,764.9600,2963.8200,other,"32.3% of $2,963.82 in Billed Charges for Rev 272 = $957.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2963.8200,444.5700,UNITED HEALTHCARE,UHC HERITAGE SELECT,909.89,,,,,,,764.9600,2963.8200,other,"30.7% of $2,963.82 in Billed Charges for Rev 272 = $909.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2963.8200,444.5700,UNITED HEALTHCARE,UNITED HEALTHCARE,957.31,,,,,,,764.9600,2963.8200,percent of total billed charges,"32.3% of $2,963.82 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2963.8200,444.5700,WELLCARE,WELLCARE MEDICAID,2963.82,,,,,,,764.9600,2963.8200,percent of total billed charges,"100% of $2,963.82 in Billed Charges for Rev 272 = $2,963.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4386.4100,657.9600,AETNA,AETNA,1873.00,,,,,,,1132.1300,4386.4100,percent of total billed charges,"42.7% of $4,386.41 in Billed Charges for Rev 272 = $1,873.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4386.4100,657.9600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3070.49,,,,,,,1132.1300,4386.4100,percent of total billed charges,"Rev 272 $4,386.41 in Billed Charges at 70% = $3,070.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4386.4100,657.9600,CIGNA HEALTHCARE,CIGNA HMO,1829.13,,,,,,,1132.1300,4386.4100,percent of total billed charges,"41.7% of $4,386.41 in Billed Charges for Rev 272 = $1,829.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4386.4100,657.9600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2035.29,,,,,,,1132.1300,4386.4100,percent of total billed charges,"46.4% of $4,386.41 in Billed Charges for Rev 272 = $2,035.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4386.4100,657.9600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1829.13,,,,,,,1132.1300,4386.4100,percent of total billed charges,"41.7% of $4,386.41 in Billed Charges for Rev 272 = $1,829.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4386.4100,657.9600,CIGNA HEALTHCARE,CIGNA PPO,1829.13,,,,,,,1132.1300,4386.4100,percent of total billed charges,"41.7% of $4,386.41 in Billed Charges for Rev 272 = $1,829.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4386.4100,657.9600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3947.77,,,,,,,1132.1300,4386.4100,percent of total billed charges,"90% of $4,386.41 in Billed Charges for Rev 272 = $3,947.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4386.4100,657.9600,MEDCOST,MEDCOST VHN,2087.49,,,,,,,1132.1300,4386.4100,percent of total billed charges,"47.59% of $4,386.41 in Billed Charges for Rev 272 = $2,087.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4386.4100,657.9600,SENTARA HEALTH,SENTARA HEALTH,1132.13,,,,,,,1132.1300,4386.4100,percent of total billed charges,"25.81% of $4,386.41 in Billed Charges for Rev 272 = $1,132.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4386.4100,657.9600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4386.41,,,,,,,1132.1300,4386.4100,percent of total billed charges,"100% of $4,386.41 in Billed Charges for Rev 272 = $4,386.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4386.4100,657.9600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2193.21,,,,,,,1132.1300,4386.4100,percent of total billed charges,"Rev 272 $4,386.41 in Billed Charges at 50% = $2,193.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4386.4100,657.9600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1416.81,,,,,,,1132.1300,4386.4100,other,"32.3% of $4,386.41 in Billed Charges for Rev 272 = $1,416.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4386.4100,657.9600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1346.63,,,,,,,1132.1300,4386.4100,other,"30.7% of $4,386.41 in Billed Charges for Rev 272 = $1,346.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4386.4100,657.9600,UNITED HEALTHCARE,UNITED HEALTHCARE,1416.81,,,,,,,1132.1300,4386.4100,percent of total billed charges,"32.3% of $4,386.41 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 1.9FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,4386.4100,657.9600,WELLCARE,WELLCARE MEDICAID,4386.41,,,,,,,1132.1300,4386.4100,percent of total billed charges,"100% of $4,386.41 in Billed Charges for Rev 272 = $4,386.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2744.1700,411.6300,AETNA,AETNA,1171.76,,,,,,,708.2700,2744.1700,percent of total billed charges,"42.7% of $2,744.17 in Billed Charges for Rev 272 = $1,171.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2744.1700,411.6300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1920.92,,,,,,,708.2700,2744.1700,percent of total billed charges,"Rev 272 $2,744.17 in Billed Charges at 70% = $1,920.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2744.1700,411.6300,CIGNA HEALTHCARE,CIGNA HMO,1144.32,,,,,,,708.2700,2744.1700,percent of total billed charges,"41.7% of $2,744.17 in Billed Charges for Rev 272 = $1,144.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2744.1700,411.6300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1273.29,,,,,,,708.2700,2744.1700,percent of total billed charges,"46.4% of $2,744.17 in Billed Charges for Rev 272 = $1,273.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2744.1700,411.6300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1144.32,,,,,,,708.2700,2744.1700,percent of total billed charges,"41.7% of $2,744.17 in Billed Charges for Rev 272 = $1,144.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2744.1700,411.6300,CIGNA HEALTHCARE,CIGNA PPO,1144.32,,,,,,,708.2700,2744.1700,percent of total billed charges,"41.7% of $2,744.17 in Billed Charges for Rev 272 = $1,144.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2744.1700,411.6300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2469.75,,,,,,,708.2700,2744.1700,percent of total billed charges,"90% of $2,744.17 in Billed Charges for Rev 272 = $2,469.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2744.1700,411.6300,MEDCOST,MEDCOST VHN,1305.95,,,,,,,708.2700,2744.1700,percent of total billed charges,"47.59% of $2,744.17 in Billed Charges for Rev 272 = $1,305.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2744.1700,411.6300,SENTARA HEALTH,SENTARA HEALTH,708.27,,,,,,,708.2700,2744.1700,percent of total billed charges,"25.81% of $2,744.17 in Billed Charges for Rev 272 = $708.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2744.1700,411.6300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2744.17,,,,,,,708.2700,2744.1700,percent of total billed charges,"100% of $2,744.17 in Billed Charges for Rev 272 = $2,744.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2744.1700,411.6300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1372.09,,,,,,,708.2700,2744.1700,percent of total billed charges,"Rev 272 $2,744.17 in Billed Charges at 50% = $1,372.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2744.1700,411.6300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,886.37,,,,,,,708.2700,2744.1700,other,"32.3% of $2,744.17 in Billed Charges for Rev 272 = $886.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2744.1700,411.6300,UNITED HEALTHCARE,UHC HERITAGE SELECT,842.46,,,,,,,708.2700,2744.1700,other,"30.7% of $2,744.17 in Billed Charges for Rev 272 = $842.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2744.1700,411.6300,UNITED HEALTHCARE,UNITED HEALTHCARE,886.37,,,,,,,708.2700,2744.1700,percent of total billed charges,"32.3% of $2,744.17 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BASKET RETRIEVAL NITINOL 4 WIRE BASKET 0 TIP 2.4FR X 120CM,272,RC,27200002,CDM,,,,,,both,,,2744.1700,411.6300,WELLCARE,WELLCARE MEDICAID,2744.17,,,,,,,708.2700,2744.1700,percent of total billed charges,"100% of $2,744.17 in Billed Charges for Rev 272 = $2,744.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM CANN,272,RC,,,,,,,,both,,,6015.1800,902.2800,AETNA,AETNA,2568.48,,,,,,,1552.5200,6015.1800,percent of total billed charges,"42.7% of $6,015.18 in Billed Charges for Rev 272 = $2,568.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM CANN,272,RC,,,,,,,,both,,,6015.1800,902.2800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4210.63,,,,,,,1552.5200,6015.1800,percent of total billed charges,"Rev 272 $6,015.18 in Billed Charges at 70% = $4,210.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM CANN,272,RC,,,,,,,,both,,,6015.1800,902.2800,CIGNA HEALTHCARE,CIGNA HMO,2508.33,,,,,,,1552.5200,6015.1800,percent of total billed charges,"41.7% of $6,015.18 in Billed Charges for Rev 272 = $2,508.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM CANN,272,RC,,,,,,,,both,,,6015.1800,902.2800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2791.04,,,,,,,1552.5200,6015.1800,percent of total billed charges,"46.4% of $6,015.18 in Billed Charges for Rev 272 = $2,791.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM CANN,272,RC,,,,,,,,both,,,6015.1800,902.2800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2508.33,,,,,,,1552.5200,6015.1800,percent of total billed charges,"41.7% of $6,015.18 in Billed Charges for Rev 272 = $2,508.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM CANN,272,RC,,,,,,,,both,,,6015.1800,902.2800,CIGNA HEALTHCARE,CIGNA PPO,2508.33,,,,,,,1552.5200,6015.1800,percent of total billed charges,"41.7% of $6,015.18 in Billed Charges for Rev 272 = $2,508.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM CANN,272,RC,,,,,,,,both,,,6015.1800,902.2800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5413.66,,,,,,,1552.5200,6015.1800,percent of total billed charges,"90% of $6,015.18 in Billed Charges for Rev 272 = $5,413.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM CANN,272,RC,,,,,,,,both,,,6015.1800,902.2800,MEDCOST,MEDCOST VHN,2862.62,,,,,,,1552.5200,6015.1800,percent of total billed charges,"47.59% of $6,015.18 in Billed Charges for Rev 272 = $2,862.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM CANN,272,RC,,,,,,,,both,,,6015.1800,902.2800,SENTARA HEALTH,SENTARA HEALTH,1552.52,,,,,,,1552.5200,6015.1800,percent of total billed charges,"25.81% of $6,015.18 in Billed Charges for Rev 272 = $1,552.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM CANN,272,RC,,,,,,,,both,,,6015.1800,902.2800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6015.18,,,,,,,1552.5200,6015.1800,percent of total billed charges,"100% of $6,015.18 in Billed Charges for Rev 272 = $6,015.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM CANN,272,RC,,,,,,,,both,,,6015.1800,902.2800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3007.59,,,,,,,1552.5200,6015.1800,percent of total billed charges,"Rev 272 $6,015.18 in Billed Charges at 50% = $3,007.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM CANN,272,RC,,,,,,,,both,,,6015.1800,902.2800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1942.90,,,,,,,1552.5200,6015.1800,other,"32.3% of $6,015.18 in Billed Charges for Rev 272 = $1,942.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.7MM CANN,272,RC,,,,,,,,both,,,6015.1800,902.2800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1846.66,,,,,,,1552.5200,6015.1800,other,"30.7% of $6,015.18 in Billed Charges for Rev 272 = $1,846.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.7MM CANN,272,RC,,,,,,,,both,,,6015.1800,902.2800,UNITED HEALTHCARE,UNITED HEALTHCARE,1942.90,,,,,,,1552.5200,6015.1800,percent of total billed charges,"32.3% of $6,015.18 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM CANN,272,RC,,,,,,,,both,,,6015.1800,902.2800,WELLCARE,WELLCARE MEDICAID,6015.18,,,,,,,1552.5200,6015.1800,percent of total billed charges,"100% of $6,015.18 in Billed Charges for Rev 272 = $6,015.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 3.2MM X 330MM,272,RC,27200002,CDM,,,,,,both,,,2006.6800,301.0000,AETNA,AETNA,856.85,,,,,,,517.9200,2006.6800,percent of total billed charges,"42.7% of $2,006.68 in Billed Charges for Rev 272 = $856.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 3.2MM X 330MM,272,RC,27200002,CDM,,,,,,both,,,2006.6800,301.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1404.68,,,,,,,517.9200,2006.6800,percent of total billed charges,"Rev 272 $2,006.68 in Billed Charges at 70% = $1,404.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 3.2MM X 330MM,272,RC,27200002,CDM,,,,,,both,,,2006.6800,301.0000,CIGNA HEALTHCARE,CIGNA HMO,836.79,,,,,,,517.9200,2006.6800,percent of total billed charges,"41.7% of $2,006.68 in Billed Charges for Rev 272 = $836.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 3.2MM X 330MM,272,RC,27200002,CDM,,,,,,both,,,2006.6800,301.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,931.10,,,,,,,517.9200,2006.6800,percent of total billed charges,"46.4% of $2,006.68 in Billed Charges for Rev 272 = $931.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 3.2MM X 330MM,272,RC,27200002,CDM,,,,,,both,,,2006.6800,301.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,836.79,,,,,,,517.9200,2006.6800,percent of total billed charges,"41.7% of $2,006.68 in Billed Charges for Rev 272 = $836.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 3.2MM X 330MM,272,RC,27200002,CDM,,,,,,both,,,2006.6800,301.0000,CIGNA HEALTHCARE,CIGNA PPO,836.79,,,,,,,517.9200,2006.6800,percent of total billed charges,"41.7% of $2,006.68 in Billed Charges for Rev 272 = $836.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 3.2MM X 330MM,272,RC,27200002,CDM,,,,,,both,,,2006.6800,301.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1806.01,,,,,,,517.9200,2006.6800,percent of total billed charges,"90% of $2,006.68 in Billed Charges for Rev 272 = $1,806.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 3.2MM X 330MM,272,RC,27200002,CDM,,,,,,both,,,2006.6800,301.0000,MEDCOST,MEDCOST VHN,954.98,,,,,,,517.9200,2006.6800,percent of total billed charges,"47.59% of $2,006.68 in Billed Charges for Rev 272 = $954.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 3.2MM X 330MM,272,RC,27200002,CDM,,,,,,both,,,2006.6800,301.0000,SENTARA HEALTH,SENTARA HEALTH,517.92,,,,,,,517.9200,2006.6800,percent of total billed charges,"25.81% of $2,006.68 in Billed Charges for Rev 272 = $517.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 3.2MM X 330MM,272,RC,27200002,CDM,,,,,,both,,,2006.6800,301.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2006.68,,,,,,,517.9200,2006.6800,percent of total billed charges,"100% of $2,006.68 in Billed Charges for Rev 272 = $2,006.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 3.2MM X 330MM,272,RC,27200002,CDM,,,,,,both,,,2006.6800,301.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1003.34,,,,,,,517.9200,2006.6800,percent of total billed charges,"Rev 272 $2,006.68 in Billed Charges at 50% = $1,003.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 3.2MM X 330MM,272,RC,27200002,CDM,,,,,,both,,,2006.6800,301.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,648.16,,,,,,,517.9200,2006.6800,other,"32.3% of $2,006.68 in Billed Charges for Rev 272 = $648.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 3 FLUTED 3.2MM X 330MM,272,RC,27200002,CDM,,,,,,both,,,2006.6800,301.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,616.05,,,,,,,517.9200,2006.6800,other,"30.7% of $2,006.68 in Billed Charges for Rev 272 = $616.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 3 FLUTED 3.2MM X 330MM,272,RC,27200002,CDM,,,,,,both,,,2006.6800,301.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,648.16,,,,,,,517.9200,2006.6800,percent of total billed charges,"32.3% of $2,006.68 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 3.2MM X 330MM,272,RC,27200002,CDM,,,,,,both,,,2006.6800,301.0000,WELLCARE,WELLCARE MEDICAID,2006.68,,,,,,,517.9200,2006.6800,percent of total billed charges,"100% of $2,006.68 in Billed Charges for Rev 272 = $2,006.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRIVE,272,RC,27200002,CDM,,,,,,both,,,2147.4200,322.1100,AETNA,AETNA,916.95,,,,,,,554.2500,2147.4200,percent of total billed charges,"42.7% of $2,147.42 in Billed Charges for Rev 272 = $916.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRIVE,272,RC,27200002,CDM,,,,,,both,,,2147.4200,322.1100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1503.19,,,,,,,554.2500,2147.4200,percent of total billed charges,"Rev 272 $2,147.42 in Billed Charges at 70% = $1,503.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRIVE,272,RC,27200002,CDM,,,,,,both,,,2147.4200,322.1100,CIGNA HEALTHCARE,CIGNA HMO,895.47,,,,,,,554.2500,2147.4200,percent of total billed charges,"41.7% of $2,147.42 in Billed Charges for Rev 272 = $895.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRIVE,272,RC,27200002,CDM,,,,,,both,,,2147.4200,322.1100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,996.40,,,,,,,554.2500,2147.4200,percent of total billed charges,"46.4% of $2,147.42 in Billed Charges for Rev 272 = $996.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRIVE,272,RC,27200002,CDM,,,,,,both,,,2147.4200,322.1100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,895.47,,,,,,,554.2500,2147.4200,percent of total billed charges,"41.7% of $2,147.42 in Billed Charges for Rev 272 = $895.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRIVE,272,RC,27200002,CDM,,,,,,both,,,2147.4200,322.1100,CIGNA HEALTHCARE,CIGNA PPO,895.47,,,,,,,554.2500,2147.4200,percent of total billed charges,"41.7% of $2,147.42 in Billed Charges for Rev 272 = $895.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRIVE,272,RC,27200002,CDM,,,,,,both,,,2147.4200,322.1100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1932.68,,,,,,,554.2500,2147.4200,percent of total billed charges,"90% of $2,147.42 in Billed Charges for Rev 272 = $1,932.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRIVE,272,RC,27200002,CDM,,,,,,both,,,2147.4200,322.1100,MEDCOST,MEDCOST VHN,1021.96,,,,,,,554.2500,2147.4200,percent of total billed charges,"47.59% of $2,147.42 in Billed Charges for Rev 272 = $1,021.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRIVE,272,RC,27200002,CDM,,,,,,both,,,2147.4200,322.1100,SENTARA HEALTH,SENTARA HEALTH,554.25,,,,,,,554.2500,2147.4200,percent of total billed charges,"25.81% of $2,147.42 in Billed Charges for Rev 272 = $554.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRIVE,272,RC,27200002,CDM,,,,,,both,,,2147.4200,322.1100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2147.42,,,,,,,554.2500,2147.4200,percent of total billed charges,"100% of $2,147.42 in Billed Charges for Rev 272 = $2,147.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRIVE,272,RC,27200002,CDM,,,,,,both,,,2147.4200,322.1100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1073.71,,,,,,,554.2500,2147.4200,percent of total billed charges,"Rev 272 $2,147.42 in Billed Charges at 50% = $1,073.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRIVE,272,RC,27200002,CDM,,,,,,both,,,2147.4200,322.1100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,693.62,,,,,,,554.2500,2147.4200,other,"32.3% of $2,147.42 in Billed Charges for Rev 272 = $693.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRIVE,272,RC,27200002,CDM,,,,,,both,,,2147.4200,322.1100,UNITED HEALTHCARE,UHC HERITAGE SELECT,659.26,,,,,,,554.2500,2147.4200,other,"30.7% of $2,147.42 in Billed Charges for Rev 272 = $659.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRIVE,272,RC,27200002,CDM,,,,,,both,,,2147.4200,322.1100,UNITED HEALTHCARE,UNITED HEALTHCARE,693.62,,,,,,,554.2500,2147.4200,percent of total billed charges,"32.3% of $2,147.42 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRIVE,272,RC,27200002,CDM,,,,,,both,,,2147.4200,322.1100,WELLCARE,WELLCARE MEDICAID,2147.42,,,,,,,554.2500,2147.4200,percent of total billed charges,"100% of $2,147.42 in Billed Charges for Rev 272 = $2,147.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2MM X 330MM 100MM CALIBRATION STERILE,272,RC,27200002,CDM,,,,,,both,,,2424.3200,363.6500,AETNA,AETNA,1035.18,,,,,,,625.7200,2424.3200,percent of total billed charges,"42.7% of $2,424.32 in Billed Charges for Rev 272 = $1,035.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2MM X 330MM 100MM CALIBRATION STERILE,272,RC,27200002,CDM,,,,,,both,,,2424.3200,363.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1697.02,,,,,,,625.7200,2424.3200,percent of total billed charges,"Rev 272 $2,424.32 in Billed Charges at 70% = $1,697.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2MM X 330MM 100MM CALIBRATION STERILE,272,RC,27200002,CDM,,,,,,both,,,2424.3200,363.6500,CIGNA HEALTHCARE,CIGNA HMO,1010.94,,,,,,,625.7200,2424.3200,percent of total billed charges,"41.7% of $2,424.32 in Billed Charges for Rev 272 = $1,010.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2MM X 330MM 100MM CALIBRATION STERILE,272,RC,27200002,CDM,,,,,,both,,,2424.3200,363.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1124.88,,,,,,,625.7200,2424.3200,percent of total billed charges,"46.4% of $2,424.32 in Billed Charges for Rev 272 = $1,124.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2MM X 330MM 100MM CALIBRATION STERILE,272,RC,27200002,CDM,,,,,,both,,,2424.3200,363.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1010.94,,,,,,,625.7200,2424.3200,percent of total billed charges,"41.7% of $2,424.32 in Billed Charges for Rev 272 = $1,010.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2MM X 330MM 100MM CALIBRATION STERILE,272,RC,27200002,CDM,,,,,,both,,,2424.3200,363.6500,CIGNA HEALTHCARE,CIGNA PPO,1010.94,,,,,,,625.7200,2424.3200,percent of total billed charges,"41.7% of $2,424.32 in Billed Charges for Rev 272 = $1,010.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2MM X 330MM 100MM CALIBRATION STERILE,272,RC,27200002,CDM,,,,,,both,,,2424.3200,363.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2181.89,,,,,,,625.7200,2424.3200,percent of total billed charges,"90% of $2,424.32 in Billed Charges for Rev 272 = $2,181.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2MM X 330MM 100MM CALIBRATION STERILE,272,RC,27200002,CDM,,,,,,both,,,2424.3200,363.6500,MEDCOST,MEDCOST VHN,1153.73,,,,,,,625.7200,2424.3200,percent of total billed charges,"47.59% of $2,424.32 in Billed Charges for Rev 272 = $1,153.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2MM X 330MM 100MM CALIBRATION STERILE,272,RC,27200002,CDM,,,,,,both,,,2424.3200,363.6500,SENTARA HEALTH,SENTARA HEALTH,625.72,,,,,,,625.7200,2424.3200,percent of total billed charges,"25.81% of $2,424.32 in Billed Charges for Rev 272 = $625.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2MM X 330MM 100MM CALIBRATION STERILE,272,RC,27200002,CDM,,,,,,both,,,2424.3200,363.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2424.32,,,,,,,625.7200,2424.3200,percent of total billed charges,"100% of $2,424.32 in Billed Charges for Rev 272 = $2,424.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2MM X 330MM 100MM CALIBRATION STERILE,272,RC,27200002,CDM,,,,,,both,,,2424.3200,363.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1212.16,,,,,,,625.7200,2424.3200,percent of total billed charges,"Rev 272 $2,424.32 in Billed Charges at 50% = $1,212.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2MM X 330MM 100MM CALIBRATION STERILE,272,RC,27200002,CDM,,,,,,both,,,2424.3200,363.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,783.06,,,,,,,625.7200,2424.3200,other,"32.3% of $2,424.32 in Billed Charges for Rev 272 = $783.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 3 FLUTED 4.2MM X 330MM 100MM CALIBRATION STERILE,272,RC,27200002,CDM,,,,,,both,,,2424.3200,363.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,744.27,,,,,,,625.7200,2424.3200,other,"30.7% of $2,424.32 in Billed Charges for Rev 272 = $744.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 3 FLUTED 4.2MM X 330MM 100MM CALIBRATION STERILE,272,RC,27200002,CDM,,,,,,both,,,2424.3200,363.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,783.06,,,,,,,625.7200,2424.3200,percent of total billed charges,"32.3% of $2,424.32 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2MM X 330MM 100MM CALIBRATION STERILE,272,RC,27200002,CDM,,,,,,both,,,2424.3200,363.6500,WELLCARE,WELLCARE MEDICAID,2424.32,,,,,,,625.7200,2424.3200,percent of total billed charges,"100% of $2,424.32 in Billed Charges for Rev 272 = $2,424.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 5.0MM X 330MM 100MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2156.5500,323.4800,AETNA,AETNA,920.85,,,,,,,556.6100,2156.5500,percent of total billed charges,"42.7% of $2,156.55 in Billed Charges for Rev 272 = $920.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 5.0MM X 330MM 100MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2156.5500,323.4800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1509.59,,,,,,,556.6100,2156.5500,percent of total billed charges,"Rev 272 $2,156.55 in Billed Charges at 70% = $1,509.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 5.0MM X 330MM 100MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2156.5500,323.4800,CIGNA HEALTHCARE,CIGNA HMO,899.28,,,,,,,556.6100,2156.5500,percent of total billed charges,"41.7% of $2,156.55 in Billed Charges for Rev 272 = $899.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 5.0MM X 330MM 100MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2156.5500,323.4800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1000.64,,,,,,,556.6100,2156.5500,percent of total billed charges,"46.4% of $2,156.55 in Billed Charges for Rev 272 = $1,000.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 5.0MM X 330MM 100MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2156.5500,323.4800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,899.28,,,,,,,556.6100,2156.5500,percent of total billed charges,"41.7% of $2,156.55 in Billed Charges for Rev 272 = $899.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 5.0MM X 330MM 100MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2156.5500,323.4800,CIGNA HEALTHCARE,CIGNA PPO,899.28,,,,,,,556.6100,2156.5500,percent of total billed charges,"41.7% of $2,156.55 in Billed Charges for Rev 272 = $899.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 5.0MM X 330MM 100MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2156.5500,323.4800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1940.90,,,,,,,556.6100,2156.5500,percent of total billed charges,"90% of $2,156.55 in Billed Charges for Rev 272 = $1,940.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 5.0MM X 330MM 100MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2156.5500,323.4800,MEDCOST,MEDCOST VHN,1026.30,,,,,,,556.6100,2156.5500,percent of total billed charges,"47.59% of $2,156.55 in Billed Charges for Rev 272 = $1,026.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 5.0MM X 330MM 100MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2156.5500,323.4800,SENTARA HEALTH,SENTARA HEALTH,556.61,,,,,,,556.6100,2156.5500,percent of total billed charges,"25.81% of $2,156.55 in Billed Charges for Rev 272 = $556.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 5.0MM X 330MM 100MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2156.5500,323.4800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2156.55,,,,,,,556.6100,2156.5500,percent of total billed charges,"100% of $2,156.55 in Billed Charges for Rev 272 = $2,156.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 5.0MM X 330MM 100MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2156.5500,323.4800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1078.28,,,,,,,556.6100,2156.5500,percent of total billed charges,"Rev 272 $2,156.55 in Billed Charges at 50% = $1,078.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 5.0MM X 330MM 100MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2156.5500,323.4800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,696.57,,,,,,,556.6100,2156.5500,other,"32.3% of $2,156.55 in Billed Charges for Rev 272 = $696.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 3 FLUTED 5.0MM X 330MM 100MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2156.5500,323.4800,UNITED HEALTHCARE,UHC HERITAGE SELECT,662.06,,,,,,,556.6100,2156.5500,other,"30.7% of $2,156.55 in Billed Charges for Rev 272 = $662.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 3 FLUTED 5.0MM X 330MM 100MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2156.5500,323.4800,UNITED HEALTHCARE,UNITED HEALTHCARE,696.57,,,,,,,556.6100,2156.5500,percent of total billed charges,"32.3% of $2,156.55 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 5.0MM X 330MM 100MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2156.5500,323.4800,WELLCARE,WELLCARE MEDICAID,2156.55,,,,,,,556.6100,2156.5500,percent of total billed charges,"100% of $2,156.55 in Billed Charges for Rev 272 = $2,156.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED NEEDLE POINT TIP 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,1430.1600,214.5200,AETNA,AETNA,610.68,,,,,,,369.1200,1430.1600,percent of total billed charges,"42.7% of $1,430.16 in Billed Charges for Rev 272 = $610.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED NEEDLE POINT TIP 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,1430.1600,214.5200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1001.11,,,,,,,369.1200,1430.1600,percent of total billed charges,"Rev 272 $1,430.16 in Billed Charges at 70% = $1,001.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED NEEDLE POINT TIP 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,1430.1600,214.5200,CIGNA HEALTHCARE,CIGNA HMO,596.38,,,,,,,369.1200,1430.1600,percent of total billed charges,"41.7% of $1,430.16 in Billed Charges for Rev 272 = $596.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED NEEDLE POINT TIP 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,1430.1600,214.5200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,663.59,,,,,,,369.1200,1430.1600,percent of total billed charges,"46.4% of $1,430.16 in Billed Charges for Rev 272 = $663.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED NEEDLE POINT TIP 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,1430.1600,214.5200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,596.38,,,,,,,369.1200,1430.1600,percent of total billed charges,"41.7% of $1,430.16 in Billed Charges for Rev 272 = $596.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED NEEDLE POINT TIP 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,1430.1600,214.5200,CIGNA HEALTHCARE,CIGNA PPO,596.38,,,,,,,369.1200,1430.1600,percent of total billed charges,"41.7% of $1,430.16 in Billed Charges for Rev 272 = $596.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED NEEDLE POINT TIP 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,1430.1600,214.5200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1287.14,,,,,,,369.1200,1430.1600,percent of total billed charges,"90% of $1,430.16 in Billed Charges for Rev 272 = $1,287.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED NEEDLE POINT TIP 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,1430.1600,214.5200,MEDCOST,MEDCOST VHN,680.61,,,,,,,369.1200,1430.1600,percent of total billed charges,"47.59% of $1,430.16 in Billed Charges for Rev 272 = $680.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED NEEDLE POINT TIP 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,1430.1600,214.5200,SENTARA HEALTH,SENTARA HEALTH,369.12,,,,,,,369.1200,1430.1600,percent of total billed charges,"25.81% of $1,430.16 in Billed Charges for Rev 272 = $369.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED NEEDLE POINT TIP 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,1430.1600,214.5200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1430.16,,,,,,,369.1200,1430.1600,percent of total billed charges,"100% of $1,430.16 in Billed Charges for Rev 272 = $1,430.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED NEEDLE POINT TIP 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,1430.1600,214.5200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,715.08,,,,,,,369.1200,1430.1600,percent of total billed charges,"Rev 272 $1,430.16 in Billed Charges at 50% = $715.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED NEEDLE POINT TIP 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,1430.1600,214.5200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,461.94,,,,,,,369.1200,1430.1600,other,"32.3% of $1,430.16 in Billed Charges for Rev 272 = $461.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 3 FLUTED NEEDLE POINT TIP 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,1430.1600,214.5200,UNITED HEALTHCARE,UHC HERITAGE SELECT,439.06,,,,,,,369.1200,1430.1600,other,"30.7% of $1,430.16 in Billed Charges for Rev 272 = $439.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 3 FLUTED NEEDLE POINT TIP 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,1430.1600,214.5200,UNITED HEALTHCARE,UNITED HEALTHCARE,461.94,,,,,,,369.1200,1430.1600,percent of total billed charges,"32.3% of $1,430.16 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED NEEDLE POINT TIP 3.2 X 145MM,272,RC,27200002,CDM,,,,,,both,,,1430.1600,214.5200,WELLCARE,WELLCARE MEDICAID,1430.16,,,,,,,369.1200,1430.1600,percent of total billed charges,"100% of $1,430.16 in Billed Charges for Rev 272 = $1,430.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM,272,RC,,,,,,,,both,,,3917.9600,587.6900,AETNA,AETNA,1672.97,,,,,,,1011.2300,3917.9600,percent of total billed charges,"42.7% of $3,917.96 in Billed Charges for Rev 272 = $1,672.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM,272,RC,,,,,,,,both,,,3917.9600,587.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2742.57,,,,,,,1011.2300,3917.9600,percent of total billed charges,"Rev 272 $3,917.96 in Billed Charges at 70% = $2,742.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM,272,RC,,,,,,,,both,,,3917.9600,587.6900,CIGNA HEALTHCARE,CIGNA HMO,1633.79,,,,,,,1011.2300,3917.9600,percent of total billed charges,"41.7% of $3,917.96 in Billed Charges for Rev 272 = $1,633.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM,272,RC,,,,,,,,both,,,3917.9600,587.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1817.93,,,,,,,1011.2300,3917.9600,percent of total billed charges,"46.4% of $3,917.96 in Billed Charges for Rev 272 = $1,817.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM,272,RC,,,,,,,,both,,,3917.9600,587.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1633.79,,,,,,,1011.2300,3917.9600,percent of total billed charges,"41.7% of $3,917.96 in Billed Charges for Rev 272 = $1,633.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM,272,RC,,,,,,,,both,,,3917.9600,587.6900,CIGNA HEALTHCARE,CIGNA PPO,1633.79,,,,,,,1011.2300,3917.9600,percent of total billed charges,"41.7% of $3,917.96 in Billed Charges for Rev 272 = $1,633.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM,272,RC,,,,,,,,both,,,3917.9600,587.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3526.16,,,,,,,1011.2300,3917.9600,percent of total billed charges,"90% of $3,917.96 in Billed Charges for Rev 272 = $3,526.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM,272,RC,,,,,,,,both,,,3917.9600,587.6900,MEDCOST,MEDCOST VHN,1864.56,,,,,,,1011.2300,3917.9600,percent of total billed charges,"47.59% of $3,917.96 in Billed Charges for Rev 272 = $1,864.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM,272,RC,,,,,,,,both,,,3917.9600,587.6900,SENTARA HEALTH,SENTARA HEALTH,1011.23,,,,,,,1011.2300,3917.9600,percent of total billed charges,"25.81% of $3,917.96 in Billed Charges for Rev 272 = $1,011.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM,272,RC,,,,,,,,both,,,3917.9600,587.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3917.96,,,,,,,1011.2300,3917.9600,percent of total billed charges,"100% of $3,917.96 in Billed Charges for Rev 272 = $3,917.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM,272,RC,,,,,,,,both,,,3917.9600,587.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1958.98,,,,,,,1011.2300,3917.9600,percent of total billed charges,"Rev 272 $3,917.96 in Billed Charges at 50% = $1,958.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM,272,RC,,,,,,,,both,,,3917.9600,587.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1265.50,,,,,,,1011.2300,3917.9600,other,"32.3% of $3,917.96 in Billed Charges for Rev 272 = $1,265.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED 4.0MM,272,RC,,,,,,,,both,,,3917.9600,587.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1202.81,,,,,,,1011.2300,3917.9600,other,"30.7% of $3,917.96 in Billed Charges for Rev 272 = $1,202.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED 4.0MM,272,RC,,,,,,,,both,,,3917.9600,587.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,1265.50,,,,,,,1011.2300,3917.9600,percent of total billed charges,"32.3% of $3,917.96 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM,272,RC,,,,,,,,both,,,3917.9600,587.6900,WELLCARE,WELLCARE MEDICAID,3917.96,,,,,,,1011.2300,3917.9600,percent of total billed charges,"100% of $3,917.96 in Billed Charges for Rev 272 = $3,917.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,3463.9100,519.5900,AETNA,AETNA,1479.09,,,,,,,894.0400,3463.9100,percent of total billed charges,"42.7% of $3,463.91 in Billed Charges for Rev 272 = $1,479.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,3463.9100,519.5900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2424.74,,,,,,,894.0400,3463.9100,percent of total billed charges,"Rev 272 $3,463.91 in Billed Charges at 70% = $2,424.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,3463.9100,519.5900,CIGNA HEALTHCARE,CIGNA HMO,1444.45,,,,,,,894.0400,3463.9100,percent of total billed charges,"41.7% of $3,463.91 in Billed Charges for Rev 272 = $1,444.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,3463.9100,519.5900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1607.25,,,,,,,894.0400,3463.9100,percent of total billed charges,"46.4% of $3,463.91 in Billed Charges for Rev 272 = $1,607.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,3463.9100,519.5900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1444.45,,,,,,,894.0400,3463.9100,percent of total billed charges,"41.7% of $3,463.91 in Billed Charges for Rev 272 = $1,444.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,3463.9100,519.5900,CIGNA HEALTHCARE,CIGNA PPO,1444.45,,,,,,,894.0400,3463.9100,percent of total billed charges,"41.7% of $3,463.91 in Billed Charges for Rev 272 = $1,444.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,3463.9100,519.5900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3117.52,,,,,,,894.0400,3463.9100,percent of total billed charges,"90% of $3,463.91 in Billed Charges for Rev 272 = $3,117.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,3463.9100,519.5900,MEDCOST,MEDCOST VHN,1648.47,,,,,,,894.0400,3463.9100,percent of total billed charges,"47.59% of $3,463.91 in Billed Charges for Rev 272 = $1,648.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,3463.9100,519.5900,SENTARA HEALTH,SENTARA HEALTH,894.04,,,,,,,894.0400,3463.9100,percent of total billed charges,"25.81% of $3,463.91 in Billed Charges for Rev 272 = $894.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,3463.9100,519.5900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3463.91,,,,,,,894.0400,3463.9100,percent of total billed charges,"100% of $3,463.91 in Billed Charges for Rev 272 = $3,463.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,3463.9100,519.5900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1731.96,,,,,,,894.0400,3463.9100,percent of total billed charges,"Rev 272 $3,463.91 in Billed Charges at 50% = $1,731.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,3463.9100,519.5900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1118.84,,,,,,,894.0400,3463.9100,other,"32.3% of $3,463.91 in Billed Charges for Rev 272 = $1,118.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED 4.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,3463.9100,519.5900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1063.42,,,,,,,894.0400,3463.9100,other,"30.7% of $3,463.91 in Billed Charges for Rev 272 = $1,063.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED 4.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,3463.9100,519.5900,UNITED HEALTHCARE,UNITED HEALTHCARE,1118.84,,,,,,,894.0400,3463.9100,percent of total billed charges,"32.3% of $3,463.91 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,3463.9100,519.5900,WELLCARE,WELLCARE MEDICAID,3463.91,,,,,,,894.0400,3463.9100,percent of total billed charges,"100% of $3,463.91 in Billed Charges for Rev 272 = $3,463.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1576.3900,236.4600,AETNA,AETNA,673.12,,,,,,,406.8700,1576.3900,percent of total billed charges,"42.7% of $1,576.39 in Billed Charges for Rev 272 = $673.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1576.3900,236.4600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1103.47,,,,,,,406.8700,1576.3900,percent of total billed charges,"Rev 272 $1,576.39 in Billed Charges at 70% = $1,103.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1576.3900,236.4600,CIGNA HEALTHCARE,CIGNA HMO,657.35,,,,,,,406.8700,1576.3900,percent of total billed charges,"41.7% of $1,576.39 in Billed Charges for Rev 272 = $657.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1576.3900,236.4600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,731.45,,,,,,,406.8700,1576.3900,percent of total billed charges,"46.4% of $1,576.39 in Billed Charges for Rev 272 = $731.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1576.3900,236.4600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,657.35,,,,,,,406.8700,1576.3900,percent of total billed charges,"41.7% of $1,576.39 in Billed Charges for Rev 272 = $657.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1576.3900,236.4600,CIGNA HEALTHCARE,CIGNA PPO,657.35,,,,,,,406.8700,1576.3900,percent of total billed charges,"41.7% of $1,576.39 in Billed Charges for Rev 272 = $657.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1576.3900,236.4600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1418.75,,,,,,,406.8700,1576.3900,percent of total billed charges,"90% of $1,576.39 in Billed Charges for Rev 272 = $1,418.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1576.3900,236.4600,MEDCOST,MEDCOST VHN,750.20,,,,,,,406.8700,1576.3900,percent of total billed charges,"47.59% of $1,576.39 in Billed Charges for Rev 272 = $750.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1576.3900,236.4600,SENTARA HEALTH,SENTARA HEALTH,406.87,,,,,,,406.8700,1576.3900,percent of total billed charges,"25.81% of $1,576.39 in Billed Charges for Rev 272 = $406.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1576.3900,236.4600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1576.39,,,,,,,406.8700,1576.3900,percent of total billed charges,"100% of $1,576.39 in Billed Charges for Rev 272 = $1,576.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1576.3900,236.4600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,788.20,,,,,,,406.8700,1576.3900,percent of total billed charges,"Rev 272 $1,576.39 in Billed Charges at 50% = $788.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1576.3900,236.4600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,509.17,,,,,,,406.8700,1576.3900,other,"32.3% of $1,576.39 in Billed Charges for Rev 272 = $509.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1576.3900,236.4600,UNITED HEALTHCARE,UHC HERITAGE SELECT,483.95,,,,,,,406.8700,1576.3900,other,"30.7% of $1,576.39 in Billed Charges for Rev 272 = $483.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1576.3900,236.4600,UNITED HEALTHCARE,UNITED HEALTHCARE,509.17,,,,,,,406.8700,1576.3900,percent of total billed charges,"32.3% of $1,576.39 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.7MM,272,RC,,,,,,,,both,,,1576.3900,236.4600,WELLCARE,WELLCARE MEDICAID,1576.39,,,,,,,406.8700,1576.3900,percent of total billed charges,"100% of $1,576.39 in Billed Charges for Rev 272 = $1,576.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.9,272,RC,,,,,,,,both,,,2017.2900,302.5900,AETNA,AETNA,861.38,,,,,,,520.6600,2017.2900,percent of total billed charges,"42.7% of $2,017.29 in Billed Charges for Rev 272 = $861.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.9,272,RC,,,,,,,,both,,,2017.2900,302.5900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1412.10,,,,,,,520.6600,2017.2900,percent of total billed charges,"Rev 272 $2,017.29 in Billed Charges at 70% = $1,412.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.9,272,RC,,,,,,,,both,,,2017.2900,302.5900,CIGNA HEALTHCARE,CIGNA HMO,841.21,,,,,,,520.6600,2017.2900,percent of total billed charges,"41.7% of $2,017.29 in Billed Charges for Rev 272 = $841.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.9,272,RC,,,,,,,,both,,,2017.2900,302.5900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,936.02,,,,,,,520.6600,2017.2900,percent of total billed charges,"46.4% of $2,017.29 in Billed Charges for Rev 272 = $936.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.9,272,RC,,,,,,,,both,,,2017.2900,302.5900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,841.21,,,,,,,520.6600,2017.2900,percent of total billed charges,"41.7% of $2,017.29 in Billed Charges for Rev 272 = $841.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.9,272,RC,,,,,,,,both,,,2017.2900,302.5900,CIGNA HEALTHCARE,CIGNA PPO,841.21,,,,,,,520.6600,2017.2900,percent of total billed charges,"41.7% of $2,017.29 in Billed Charges for Rev 272 = $841.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.9,272,RC,,,,,,,,both,,,2017.2900,302.5900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1815.56,,,,,,,520.6600,2017.2900,percent of total billed charges,"90% of $2,017.29 in Billed Charges for Rev 272 = $1,815.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.9,272,RC,,,,,,,,both,,,2017.2900,302.5900,MEDCOST,MEDCOST VHN,960.03,,,,,,,520.6600,2017.2900,percent of total billed charges,"47.59% of $2,017.29 in Billed Charges for Rev 272 = $960.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.9,272,RC,,,,,,,,both,,,2017.2900,302.5900,SENTARA HEALTH,SENTARA HEALTH,520.66,,,,,,,520.6600,2017.2900,percent of total billed charges,"25.81% of $2,017.29 in Billed Charges for Rev 272 = $520.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.9,272,RC,,,,,,,,both,,,2017.2900,302.5900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2017.29,,,,,,,520.6600,2017.2900,percent of total billed charges,"100% of $2,017.29 in Billed Charges for Rev 272 = $2,017.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.9,272,RC,,,,,,,,both,,,2017.2900,302.5900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1008.65,,,,,,,520.6600,2017.2900,percent of total billed charges,"Rev 272 $2,017.29 in Billed Charges at 50% = $1,008.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.9,272,RC,,,,,,,,both,,,2017.2900,302.5900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,651.58,,,,,,,520.6600,2017.2900,other,"32.3% of $2,017.29 in Billed Charges for Rev 272 = $651.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED 4.9,272,RC,,,,,,,,both,,,2017.2900,302.5900,UNITED HEALTHCARE,UHC HERITAGE SELECT,619.31,,,,,,,520.6600,2017.2900,other,"30.7% of $2,017.29 in Billed Charges for Rev 272 = $619.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED 4.9,272,RC,,,,,,,,both,,,2017.2900,302.5900,UNITED HEALTHCARE,UNITED HEALTHCARE,651.58,,,,,,,520.6600,2017.2900,percent of total billed charges,"32.3% of $2,017.29 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.9,272,RC,,,,,,,,both,,,2017.2900,302.5900,WELLCARE,WELLCARE MEDICAID,2017.29,,,,,,,520.6600,2017.2900,percent of total billed charges,"100% of $2,017.29 in Billed Charges for Rev 272 = $2,017.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED FLEXIBLE 16MM,272,RC,,,,,,,,both,,,8193.6100,1229.0400,AETNA,AETNA,3498.67,,,,,,,2114.7700,8193.6100,percent of total billed charges,"42.7% of $8,193.61 in Billed Charges for Rev 272 = $3,498.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED FLEXIBLE 16MM,272,RC,,,,,,,,both,,,8193.6100,1229.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5735.53,,,,,,,2114.7700,8193.6100,percent of total billed charges,"Rev 272 $8,193.61 in Billed Charges at 70% = $5,735.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED FLEXIBLE 16MM,272,RC,,,,,,,,both,,,8193.6100,1229.0400,CIGNA HEALTHCARE,CIGNA HMO,3416.74,,,,,,,2114.7700,8193.6100,percent of total billed charges,"41.7% of $8,193.61 in Billed Charges for Rev 272 = $3,416.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED FLEXIBLE 16MM,272,RC,,,,,,,,both,,,8193.6100,1229.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3801.84,,,,,,,2114.7700,8193.6100,percent of total billed charges,"46.4% of $8,193.61 in Billed Charges for Rev 272 = $3,801.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED FLEXIBLE 16MM,272,RC,,,,,,,,both,,,8193.6100,1229.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3416.74,,,,,,,2114.7700,8193.6100,percent of total billed charges,"41.7% of $8,193.61 in Billed Charges for Rev 272 = $3,416.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED FLEXIBLE 16MM,272,RC,,,,,,,,both,,,8193.6100,1229.0400,CIGNA HEALTHCARE,CIGNA PPO,3416.74,,,,,,,2114.7700,8193.6100,percent of total billed charges,"41.7% of $8,193.61 in Billed Charges for Rev 272 = $3,416.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED FLEXIBLE 16MM,272,RC,,,,,,,,both,,,8193.6100,1229.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7374.25,,,,,,,2114.7700,8193.6100,percent of total billed charges,"90% of $8,193.61 in Billed Charges for Rev 272 = $7,374.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED FLEXIBLE 16MM,272,RC,,,,,,,,both,,,8193.6100,1229.0400,MEDCOST,MEDCOST VHN,3899.34,,,,,,,2114.7700,8193.6100,percent of total billed charges,"47.59% of $8,193.61 in Billed Charges for Rev 272 = $3,899.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED FLEXIBLE 16MM,272,RC,,,,,,,,both,,,8193.6100,1229.0400,SENTARA HEALTH,SENTARA HEALTH,2114.77,,,,,,,2114.7700,8193.6100,percent of total billed charges,"25.81% of $8,193.61 in Billed Charges for Rev 272 = $2,114.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED FLEXIBLE 16MM,272,RC,,,,,,,,both,,,8193.6100,1229.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8193.61,,,,,,,2114.7700,8193.6100,percent of total billed charges,"100% of $8,193.61 in Billed Charges for Rev 272 = $8,193.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED FLEXIBLE 16MM,272,RC,,,,,,,,both,,,8193.6100,1229.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4096.81,,,,,,,2114.7700,8193.6100,percent of total billed charges,"Rev 272 $8,193.61 in Billed Charges at 50% = $4,096.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED FLEXIBLE 16MM,272,RC,,,,,,,,both,,,8193.6100,1229.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2646.54,,,,,,,2114.7700,8193.6100,other,"32.3% of $8,193.61 in Billed Charges for Rev 272 = $2,646.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED FLEXIBLE 16MM,272,RC,,,,,,,,both,,,8193.6100,1229.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,2515.44,,,,,,,2114.7700,8193.6100,other,"30.7% of $8,193.61 in Billed Charges for Rev 272 = $2,515.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED FLEXIBLE 16MM,272,RC,,,,,,,,both,,,8193.6100,1229.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,2646.54,,,,,,,2114.7700,8193.6100,percent of total billed charges,"32.3% of $8,193.61 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED FLEXIBLE 16MM,272,RC,,,,,,,,both,,,8193.6100,1229.0400,WELLCARE,WELLCARE MEDICAID,8193.61,,,,,,,2114.7700,8193.6100,percent of total billed charges,"100% of $8,193.61 in Billed Charges for Rev 272 = $8,193.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8MM 324.214,272,RC,27200002,CDM,,,,,,both,,,1461.9000,219.2900,AETNA,AETNA,624.23,,,,,,,377.3200,1461.9000,percent of total billed charges,"42.7% of $1,461.90 in Billed Charges for Rev 272 = $624.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8MM 324.214,272,RC,27200002,CDM,,,,,,both,,,1461.9000,219.2900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1023.33,,,,,,,377.3200,1461.9000,percent of total billed charges,"Rev 272 $1,461.90 in Billed Charges at 70% = $1,023.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8MM 324.214,272,RC,27200002,CDM,,,,,,both,,,1461.9000,219.2900,CIGNA HEALTHCARE,CIGNA HMO,609.61,,,,,,,377.3200,1461.9000,percent of total billed charges,"41.7% of $1,461.90 in Billed Charges for Rev 272 = $609.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8MM 324.214,272,RC,27200002,CDM,,,,,,both,,,1461.9000,219.2900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,678.32,,,,,,,377.3200,1461.9000,percent of total billed charges,"46.4% of $1,461.90 in Billed Charges for Rev 272 = $678.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8MM 324.214,272,RC,27200002,CDM,,,,,,both,,,1461.9000,219.2900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,609.61,,,,,,,377.3200,1461.9000,percent of total billed charges,"41.7% of $1,461.90 in Billed Charges for Rev 272 = $609.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8MM 324.214,272,RC,27200002,CDM,,,,,,both,,,1461.9000,219.2900,CIGNA HEALTHCARE,CIGNA PPO,609.61,,,,,,,377.3200,1461.9000,percent of total billed charges,"41.7% of $1,461.90 in Billed Charges for Rev 272 = $609.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8MM 324.214,272,RC,27200002,CDM,,,,,,both,,,1461.9000,219.2900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1315.71,,,,,,,377.3200,1461.9000,percent of total billed charges,"90% of $1,461.90 in Billed Charges for Rev 272 = $1,315.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8MM 324.214,272,RC,27200002,CDM,,,,,,both,,,1461.9000,219.2900,MEDCOST,MEDCOST VHN,695.72,,,,,,,377.3200,1461.9000,percent of total billed charges,"47.59% of $1,461.90 in Billed Charges for Rev 272 = $695.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8MM 324.214,272,RC,27200002,CDM,,,,,,both,,,1461.9000,219.2900,SENTARA HEALTH,SENTARA HEALTH,377.32,,,,,,,377.3200,1461.9000,percent of total billed charges,"25.81% of $1,461.90 in Billed Charges for Rev 272 = $377.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8MM 324.214,272,RC,27200002,CDM,,,,,,both,,,1461.9000,219.2900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1461.90,,,,,,,377.3200,1461.9000,percent of total billed charges,"100% of $1,461.90 in Billed Charges for Rev 272 = $1,461.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8MM 324.214,272,RC,27200002,CDM,,,,,,both,,,1461.9000,219.2900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,730.95,,,,,,,377.3200,1461.9000,percent of total billed charges,"Rev 272 $1,461.90 in Billed Charges at 50% = $730.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8MM 324.214,272,RC,27200002,CDM,,,,,,both,,,1461.9000,219.2900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,472.19,,,,,,,377.3200,1461.9000,other,"32.3% of $1,461.90 in Billed Charges for Rev 272 = $472.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.8MM 324.214,272,RC,27200002,CDM,,,,,,both,,,1461.9000,219.2900,UNITED HEALTHCARE,UHC HERITAGE SELECT,448.80,,,,,,,377.3200,1461.9000,other,"30.7% of $1,461.90 in Billed Charges for Rev 272 = $448.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.8MM 324.214,272,RC,27200002,CDM,,,,,,both,,,1461.9000,219.2900,UNITED HEALTHCARE,UNITED HEALTHCARE,472.19,,,,,,,377.3200,1461.9000,percent of total billed charges,"32.3% of $1,461.90 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8MM 324.214,272,RC,27200002,CDM,,,,,,both,,,1461.9000,219.2900,WELLCARE,WELLCARE MEDICAID,1461.90,,,,,,,377.3200,1461.9000,percent of total billed charges,"100% of $1,461.90 in Billed Charges for Rev 272 = $1,461.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8X300/200MM 324.211,272,RC,,,,,,,,both,,,1697.9400,254.6900,AETNA,AETNA,725.02,,,,,,,438.2400,1697.9400,percent of total billed charges,"42.7% of $1,697.94 in Billed Charges for Rev 272 = $725.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8X300/200MM 324.211,272,RC,,,,,,,,both,,,1697.9400,254.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1188.56,,,,,,,438.2400,1697.9400,percent of total billed charges,"Rev 272 $1,697.94 in Billed Charges at 70% = $1,188.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8X300/200MM 324.211,272,RC,,,,,,,,both,,,1697.9400,254.6900,CIGNA HEALTHCARE,CIGNA HMO,708.04,,,,,,,438.2400,1697.9400,percent of total billed charges,"41.7% of $1,697.94 in Billed Charges for Rev 272 = $708.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8X300/200MM 324.211,272,RC,,,,,,,,both,,,1697.9400,254.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,787.84,,,,,,,438.2400,1697.9400,percent of total billed charges,"46.4% of $1,697.94 in Billed Charges for Rev 272 = $787.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8X300/200MM 324.211,272,RC,,,,,,,,both,,,1697.9400,254.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,708.04,,,,,,,438.2400,1697.9400,percent of total billed charges,"41.7% of $1,697.94 in Billed Charges for Rev 272 = $708.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8X300/200MM 324.211,272,RC,,,,,,,,both,,,1697.9400,254.6900,CIGNA HEALTHCARE,CIGNA PPO,708.04,,,,,,,438.2400,1697.9400,percent of total billed charges,"41.7% of $1,697.94 in Billed Charges for Rev 272 = $708.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8X300/200MM 324.211,272,RC,,,,,,,,both,,,1697.9400,254.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1528.15,,,,,,,438.2400,1697.9400,percent of total billed charges,"90% of $1,697.94 in Billed Charges for Rev 272 = $1,528.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8X300/200MM 324.211,272,RC,,,,,,,,both,,,1697.9400,254.6900,MEDCOST,MEDCOST VHN,808.05,,,,,,,438.2400,1697.9400,percent of total billed charges,"47.59% of $1,697.94 in Billed Charges for Rev 272 = $808.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8X300/200MM 324.211,272,RC,,,,,,,,both,,,1697.9400,254.6900,SENTARA HEALTH,SENTARA HEALTH,438.24,,,,,,,438.2400,1697.9400,percent of total billed charges,"25.81% of $1,697.94 in Billed Charges for Rev 272 = $438.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8X300/200MM 324.211,272,RC,,,,,,,,both,,,1697.9400,254.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1697.94,,,,,,,438.2400,1697.9400,percent of total billed charges,"100% of $1,697.94 in Billed Charges for Rev 272 = $1,697.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8X300/200MM 324.211,272,RC,,,,,,,,both,,,1697.9400,254.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,848.97,,,,,,,438.2400,1697.9400,percent of total billed charges,"Rev 272 $1,697.94 in Billed Charges at 50% = $848.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8X300/200MM 324.211,272,RC,,,,,,,,both,,,1697.9400,254.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,548.43,,,,,,,438.2400,1697.9400,other,"32.3% of $1,697.94 in Billed Charges for Rev 272 = $548.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.8X300/200MM 324.211,272,RC,,,,,,,,both,,,1697.9400,254.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,521.27,,,,,,,438.2400,1697.9400,other,"30.7% of $1,697.94 in Billed Charges for Rev 272 = $521.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.8X300/200MM 324.211,272,RC,,,,,,,,both,,,1697.9400,254.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,548.43,,,,,,,438.2400,1697.9400,percent of total billed charges,"32.3% of $1,697.94 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.8X300/200MM 324.211,272,RC,,,,,,,,both,,,1697.9400,254.6900,WELLCARE,WELLCARE MEDICAID,1697.94,,,,,,,438.2400,1697.9400,percent of total billed charges,"100% of $1,697.94 in Billed Charges for Rev 272 = $1,697.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.9MM STERILE,272,RC,,,,,,,,both,,,1347.1900,202.0800,AETNA,AETNA,575.25,,,,,,,347.7100,1347.1900,percent of total billed charges,"42.7% of $1,347.19 in Billed Charges for Rev 272 = $575.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.9MM STERILE,272,RC,,,,,,,,both,,,1347.1900,202.0800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,943.03,,,,,,,347.7100,1347.1900,percent of total billed charges,"Rev 272 $1,347.19 in Billed Charges at 70% = $943.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.9MM STERILE,272,RC,,,,,,,,both,,,1347.1900,202.0800,CIGNA HEALTHCARE,CIGNA HMO,561.78,,,,,,,347.7100,1347.1900,percent of total billed charges,"41.7% of $1,347.19 in Billed Charges for Rev 272 = $561.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.9MM STERILE,272,RC,,,,,,,,both,,,1347.1900,202.0800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,625.10,,,,,,,347.7100,1347.1900,percent of total billed charges,"46.4% of $1,347.19 in Billed Charges for Rev 272 = $625.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.9MM STERILE,272,RC,,,,,,,,both,,,1347.1900,202.0800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,561.78,,,,,,,347.7100,1347.1900,percent of total billed charges,"41.7% of $1,347.19 in Billed Charges for Rev 272 = $561.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.9MM STERILE,272,RC,,,,,,,,both,,,1347.1900,202.0800,CIGNA HEALTHCARE,CIGNA PPO,561.78,,,,,,,347.7100,1347.1900,percent of total billed charges,"41.7% of $1,347.19 in Billed Charges for Rev 272 = $561.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.9MM STERILE,272,RC,,,,,,,,both,,,1347.1900,202.0800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1212.47,,,,,,,347.7100,1347.1900,percent of total billed charges,"90% of $1,347.19 in Billed Charges for Rev 272 = $1,212.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.9MM STERILE,272,RC,,,,,,,,both,,,1347.1900,202.0800,MEDCOST,MEDCOST VHN,641.13,,,,,,,347.7100,1347.1900,percent of total billed charges,"47.59% of $1,347.19 in Billed Charges for Rev 272 = $641.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.9MM STERILE,272,RC,,,,,,,,both,,,1347.1900,202.0800,SENTARA HEALTH,SENTARA HEALTH,347.71,,,,,,,347.7100,1347.1900,percent of total billed charges,"25.81% of $1,347.19 in Billed Charges for Rev 272 = $347.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.9MM STERILE,272,RC,,,,,,,,both,,,1347.1900,202.0800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1347.19,,,,,,,347.7100,1347.1900,percent of total billed charges,"100% of $1,347.19 in Billed Charges for Rev 272 = $1,347.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.9MM STERILE,272,RC,,,,,,,,both,,,1347.1900,202.0800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,673.60,,,,,,,347.7100,1347.1900,percent of total billed charges,"Rev 272 $1,347.19 in Billed Charges at 50% = $673.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.9MM STERILE,272,RC,,,,,,,,both,,,1347.1900,202.0800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.14,,,,,,,347.7100,1347.1900,other,"32.3% of $1,347.19 in Billed Charges for Rev 272 = $435.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.9MM STERILE,272,RC,,,,,,,,both,,,1347.1900,202.0800,UNITED HEALTHCARE,UHC HERITAGE SELECT,413.59,,,,,,,347.7100,1347.1900,other,"30.7% of $1,347.19 in Billed Charges for Rev 272 = $413.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.9MM STERILE,272,RC,,,,,,,,both,,,1347.1900,202.0800,UNITED HEALTHCARE,UNITED HEALTHCARE,435.14,,,,,,,347.7100,1347.1900,percent of total billed charges,"32.3% of $1,347.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.9MM STERILE,272,RC,,,,,,,,both,,,1347.1900,202.0800,WELLCARE,WELLCARE MEDICAID,1347.19,,,,,,,347.7100,1347.1900,percent of total billed charges,"100% of $1,347.19 in Billed Charges for Rev 272 = $1,347.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 22MM 1/4 Q IN,272,RC,,,,,,,,both,,,2115.6800,317.3500,AETNA,AETNA,903.40,,,,,,,546.0600,2115.6800,percent of total billed charges,"42.7% of $2,115.68 in Billed Charges for Rev 272 = $903.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 22MM 1/4 Q IN,272,RC,,,,,,,,both,,,2115.6800,317.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1480.98,,,,,,,546.0600,2115.6800,percent of total billed charges,"Rev 272 $2,115.68 in Billed Charges at 70% = $1,480.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 22MM 1/4 Q IN,272,RC,,,,,,,,both,,,2115.6800,317.3500,CIGNA HEALTHCARE,CIGNA HMO,882.24,,,,,,,546.0600,2115.6800,percent of total billed charges,"41.7% of $2,115.68 in Billed Charges for Rev 272 = $882.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 22MM 1/4 Q IN,272,RC,,,,,,,,both,,,2115.6800,317.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,981.68,,,,,,,546.0600,2115.6800,percent of total billed charges,"46.4% of $2,115.68 in Billed Charges for Rev 272 = $981.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 22MM 1/4 Q IN,272,RC,,,,,,,,both,,,2115.6800,317.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,882.24,,,,,,,546.0600,2115.6800,percent of total billed charges,"41.7% of $2,115.68 in Billed Charges for Rev 272 = $882.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 22MM 1/4 Q IN,272,RC,,,,,,,,both,,,2115.6800,317.3500,CIGNA HEALTHCARE,CIGNA PPO,882.24,,,,,,,546.0600,2115.6800,percent of total billed charges,"41.7% of $2,115.68 in Billed Charges for Rev 272 = $882.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 22MM 1/4 Q IN,272,RC,,,,,,,,both,,,2115.6800,317.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1904.11,,,,,,,546.0600,2115.6800,percent of total billed charges,"90% of $2,115.68 in Billed Charges for Rev 272 = $1,904.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 22MM 1/4 Q IN,272,RC,,,,,,,,both,,,2115.6800,317.3500,MEDCOST,MEDCOST VHN,1006.85,,,,,,,546.0600,2115.6800,percent of total billed charges,"47.59% of $2,115.68 in Billed Charges for Rev 272 = $1,006.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 22MM 1/4 Q IN,272,RC,,,,,,,,both,,,2115.6800,317.3500,SENTARA HEALTH,SENTARA HEALTH,546.06,,,,,,,546.0600,2115.6800,percent of total billed charges,"25.81% of $2,115.68 in Billed Charges for Rev 272 = $546.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 22MM 1/4 Q IN,272,RC,,,,,,,,both,,,2115.6800,317.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2115.68,,,,,,,546.0600,2115.6800,percent of total billed charges,"100% of $2,115.68 in Billed Charges for Rev 272 = $2,115.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 22MM 1/4 Q IN,272,RC,,,,,,,,both,,,2115.6800,317.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1057.84,,,,,,,546.0600,2115.6800,percent of total billed charges,"Rev 272 $2,115.68 in Billed Charges at 50% = $1,057.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 22MM 1/4 Q IN,272,RC,,,,,,,,both,,,2115.6800,317.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,683.36,,,,,,,546.0600,2115.6800,other,"32.3% of $2,115.68 in Billed Charges for Rev 272 = $683.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 22MM 1/4 Q IN,272,RC,,,,,,,,both,,,2115.6800,317.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,649.51,,,,,,,546.0600,2115.6800,other,"30.7% of $2,115.68 in Billed Charges for Rev 272 = $649.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 22MM 1/4 Q IN,272,RC,,,,,,,,both,,,2115.6800,317.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,683.36,,,,,,,546.0600,2115.6800,percent of total billed charges,"32.3% of $2,115.68 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 22MM 1/4 Q IN,272,RC,,,,,,,,both,,,2115.6800,317.3500,WELLCARE,WELLCARE MEDICAID,2115.68,,,,,,,546.0600,2115.6800,percent of total billed charges,"100% of $2,115.68 in Billed Charges for Rev 272 = $2,115.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRVE STERILE,272,RC,27200002,CDM,,,,,,both,,,2587.7700,388.1700,AETNA,AETNA,1104.98,,,,,,,667.9000,2587.7700,percent of total billed charges,"42.7% of $2,587.77 in Billed Charges for Rev 272 = $1,104.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRVE STERILE,272,RC,27200002,CDM,,,,,,both,,,2587.7700,388.1700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1811.44,,,,,,,667.9000,2587.7700,percent of total billed charges,"Rev 272 $2,587.77 in Billed Charges at 70% = $1,811.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRVE STERILE,272,RC,27200002,CDM,,,,,,both,,,2587.7700,388.1700,CIGNA HEALTHCARE,CIGNA HMO,1079.10,,,,,,,667.9000,2587.7700,percent of total billed charges,"41.7% of $2,587.77 in Billed Charges for Rev 272 = $1,079.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRVE STERILE,272,RC,27200002,CDM,,,,,,both,,,2587.7700,388.1700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1200.73,,,,,,,667.9000,2587.7700,percent of total billed charges,"46.4% of $2,587.77 in Billed Charges for Rev 272 = $1,200.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRVE STERILE,272,RC,27200002,CDM,,,,,,both,,,2587.7700,388.1700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1079.10,,,,,,,667.9000,2587.7700,percent of total billed charges,"41.7% of $2,587.77 in Billed Charges for Rev 272 = $1,079.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRVE STERILE,272,RC,27200002,CDM,,,,,,both,,,2587.7700,388.1700,CIGNA HEALTHCARE,CIGNA PPO,1079.10,,,,,,,667.9000,2587.7700,percent of total billed charges,"41.7% of $2,587.77 in Billed Charges for Rev 272 = $1,079.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRVE STERILE,272,RC,27200002,CDM,,,,,,both,,,2587.7700,388.1700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2328.99,,,,,,,667.9000,2587.7700,percent of total billed charges,"90% of $2,587.77 in Billed Charges for Rev 272 = $2,328.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRVE STERILE,272,RC,27200002,CDM,,,,,,both,,,2587.7700,388.1700,MEDCOST,MEDCOST VHN,1231.52,,,,,,,667.9000,2587.7700,percent of total billed charges,"47.59% of $2,587.77 in Billed Charges for Rev 272 = $1,231.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRVE STERILE,272,RC,27200002,CDM,,,,,,both,,,2587.7700,388.1700,SENTARA HEALTH,SENTARA HEALTH,667.90,,,,,,,667.9000,2587.7700,percent of total billed charges,"25.81% of $2,587.77 in Billed Charges for Rev 272 = $667.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRVE STERILE,272,RC,27200002,CDM,,,,,,both,,,2587.7700,388.1700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2587.77,,,,,,,667.9000,2587.7700,percent of total billed charges,"100% of $2,587.77 in Billed Charges for Rev 272 = $2,587.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRVE STERILE,272,RC,27200002,CDM,,,,,,both,,,2587.7700,388.1700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1293.89,,,,,,,667.9000,2587.7700,percent of total billed charges,"Rev 272 $2,587.77 in Billed Charges at 50% = $1,293.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRVE STERILE,272,RC,27200002,CDM,,,,,,both,,,2587.7700,388.1700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,835.85,,,,,,,667.9000,2587.7700,other,"32.3% of $2,587.77 in Billed Charges for Rev 272 = $835.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRVE STERILE,272,RC,27200002,CDM,,,,,,both,,,2587.7700,388.1700,UNITED HEALTHCARE,UHC HERITAGE SELECT,794.45,,,,,,,667.9000,2587.7700,other,"30.7% of $2,587.77 in Billed Charges for Rev 272 = $794.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRVE STERILE,272,RC,27200002,CDM,,,,,,both,,,2587.7700,388.1700,UNITED HEALTHCARE,UNITED HEALTHCARE,835.85,,,,,,,667.9000,2587.7700,percent of total billed charges,"32.3% of $2,587.77 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4.2 145MM FOR RADIOLUCENT DRVE STERILE,272,RC,27200002,CDM,,,,,,both,,,2587.7700,388.1700,WELLCARE,WELLCARE MEDICAID,2587.77,,,,,,,667.9000,2587.7700,percent of total billed charges,"100% of $2,587.77 in Billed Charges for Rev 272 = $2,587.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4249.3100,637.4000,AETNA,AETNA,1814.46,,,,,,,1096.7500,4249.3100,percent of total billed charges,"42.7% of $4,249.31 in Billed Charges for Rev 272 = $1,814.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4249.3100,637.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2974.52,,,,,,,1096.7500,4249.3100,percent of total billed charges,"Rev 272 $4,249.31 in Billed Charges at 70% = $2,974.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4249.3100,637.4000,CIGNA HEALTHCARE,CIGNA HMO,1771.96,,,,,,,1096.7500,4249.3100,percent of total billed charges,"41.7% of $4,249.31 in Billed Charges for Rev 272 = $1,771.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4249.3100,637.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1971.68,,,,,,,1096.7500,4249.3100,percent of total billed charges,"46.4% of $4,249.31 in Billed Charges for Rev 272 = $1,971.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4249.3100,637.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1771.96,,,,,,,1096.7500,4249.3100,percent of total billed charges,"41.7% of $4,249.31 in Billed Charges for Rev 272 = $1,771.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4249.3100,637.4000,CIGNA HEALTHCARE,CIGNA PPO,1771.96,,,,,,,1096.7500,4249.3100,percent of total billed charges,"41.7% of $4,249.31 in Billed Charges for Rev 272 = $1,771.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4249.3100,637.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3824.38,,,,,,,1096.7500,4249.3100,percent of total billed charges,"90% of $4,249.31 in Billed Charges for Rev 272 = $3,824.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4249.3100,637.4000,MEDCOST,MEDCOST VHN,2022.25,,,,,,,1096.7500,4249.3100,percent of total billed charges,"47.59% of $4,249.31 in Billed Charges for Rev 272 = $2,022.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4249.3100,637.4000,SENTARA HEALTH,SENTARA HEALTH,1096.75,,,,,,,1096.7500,4249.3100,percent of total billed charges,"25.81% of $4,249.31 in Billed Charges for Rev 272 = $1,096.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4249.3100,637.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4249.31,,,,,,,1096.7500,4249.3100,percent of total billed charges,"100% of $4,249.31 in Billed Charges for Rev 272 = $4,249.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4249.3100,637.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2124.66,,,,,,,1096.7500,4249.3100,percent of total billed charges,"Rev 272 $4,249.31 in Billed Charges at 50% = $2,124.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4249.3100,637.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1372.53,,,,,,,1096.7500,4249.3100,other,"32.3% of $4,249.31 in Billed Charges for Rev 272 = $1,372.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED QUICK CONNECT 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4249.3100,637.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1304.54,,,,,,,1096.7500,4249.3100,other,"30.7% of $4,249.31 in Billed Charges for Rev 272 = $1,304.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED QUICK CONNECT 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4249.3100,637.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,1372.53,,,,,,,1096.7500,4249.3100,percent of total billed charges,"32.3% of $4,249.31 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4249.3100,637.4000,WELLCARE,WELLCARE MEDICAID,4249.31,,,,,,,1096.7500,4249.3100,percent of total billed charges,"100% of $4,249.31 in Billed Charges for Rev 272 = $4,249.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4X260,272,RC,,,,,,,,both,,,1706.9600,256.0400,AETNA,AETNA,728.87,,,,,,,440.5700,1706.9600,percent of total billed charges,"42.7% of $1,706.96 in Billed Charges for Rev 272 = $728.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4X260,272,RC,,,,,,,,both,,,1706.9600,256.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1194.87,,,,,,,440.5700,1706.9600,percent of total billed charges,"Rev 272 $1,706.96 in Billed Charges at 70% = $1,194.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4X260,272,RC,,,,,,,,both,,,1706.9600,256.0400,CIGNA HEALTHCARE,CIGNA HMO,711.80,,,,,,,440.5700,1706.9600,percent of total billed charges,"41.7% of $1,706.96 in Billed Charges for Rev 272 = $711.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4X260,272,RC,,,,,,,,both,,,1706.9600,256.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,792.03,,,,,,,440.5700,1706.9600,percent of total billed charges,"46.4% of $1,706.96 in Billed Charges for Rev 272 = $792.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4X260,272,RC,,,,,,,,both,,,1706.9600,256.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,711.80,,,,,,,440.5700,1706.9600,percent of total billed charges,"41.7% of $1,706.96 in Billed Charges for Rev 272 = $711.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4X260,272,RC,,,,,,,,both,,,1706.9600,256.0400,CIGNA HEALTHCARE,CIGNA PPO,711.80,,,,,,,440.5700,1706.9600,percent of total billed charges,"41.7% of $1,706.96 in Billed Charges for Rev 272 = $711.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4X260,272,RC,,,,,,,,both,,,1706.9600,256.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1536.26,,,,,,,440.5700,1706.9600,percent of total billed charges,"90% of $1,706.96 in Billed Charges for Rev 272 = $1,536.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4X260,272,RC,,,,,,,,both,,,1706.9600,256.0400,MEDCOST,MEDCOST VHN,812.34,,,,,,,440.5700,1706.9600,percent of total billed charges,"47.59% of $1,706.96 in Billed Charges for Rev 272 = $812.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4X260,272,RC,,,,,,,,both,,,1706.9600,256.0400,SENTARA HEALTH,SENTARA HEALTH,440.57,,,,,,,440.5700,1706.9600,percent of total billed charges,"25.81% of $1,706.96 in Billed Charges for Rev 272 = $440.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4X260,272,RC,,,,,,,,both,,,1706.9600,256.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1706.96,,,,,,,440.5700,1706.9600,percent of total billed charges,"100% of $1,706.96 in Billed Charges for Rev 272 = $1,706.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4X260,272,RC,,,,,,,,both,,,1706.9600,256.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,853.48,,,,,,,440.5700,1706.9600,percent of total billed charges,"Rev 272 $1,706.96 in Billed Charges at 50% = $853.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4X260,272,RC,,,,,,,,both,,,1706.9600,256.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,551.35,,,,,,,440.5700,1706.9600,other,"32.3% of $1,706.96 in Billed Charges for Rev 272 = $551.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 3 FLUTED 4X260,272,RC,,,,,,,,both,,,1706.9600,256.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,524.04,,,,,,,440.5700,1706.9600,other,"30.7% of $1,706.96 in Billed Charges for Rev 272 = $524.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 3 FLUTED 4X260,272,RC,,,,,,,,both,,,1706.9600,256.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,551.35,,,,,,,440.5700,1706.9600,percent of total billed charges,"32.3% of $1,706.96 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 3 FLUTED 4X260,272,RC,,,,,,,,both,,,1706.9600,256.0400,WELLCARE,WELLCARE MEDICAID,1706.96,,,,,,,440.5700,1706.9600,percent of total billed charges,"100% of $1,706.96 in Billed Charges for Rev 272 = $1,706.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.5MM,272,RC,,,,,,,,both,,,2834.2900,425.1400,AETNA,AETNA,1210.24,,,,,,,731.5300,2834.2900,percent of total billed charges,"42.7% of $2,834.29 in Billed Charges for Rev 272 = $1,210.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.5MM,272,RC,,,,,,,,both,,,2834.2900,425.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1984.00,,,,,,,731.5300,2834.2900,percent of total billed charges,"Rev 272 $2,834.29 in Billed Charges at 70% = $1,984.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.5MM,272,RC,,,,,,,,both,,,2834.2900,425.1400,CIGNA HEALTHCARE,CIGNA HMO,1181.90,,,,,,,731.5300,2834.2900,percent of total billed charges,"41.7% of $2,834.29 in Billed Charges for Rev 272 = $1,181.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.5MM,272,RC,,,,,,,,both,,,2834.2900,425.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1315.11,,,,,,,731.5300,2834.2900,percent of total billed charges,"46.4% of $2,834.29 in Billed Charges for Rev 272 = $1,315.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.5MM,272,RC,,,,,,,,both,,,2834.2900,425.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1181.90,,,,,,,731.5300,2834.2900,percent of total billed charges,"41.7% of $2,834.29 in Billed Charges for Rev 272 = $1,181.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.5MM,272,RC,,,,,,,,both,,,2834.2900,425.1400,CIGNA HEALTHCARE,CIGNA PPO,1181.90,,,,,,,731.5300,2834.2900,percent of total billed charges,"41.7% of $2,834.29 in Billed Charges for Rev 272 = $1,181.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.5MM,272,RC,,,,,,,,both,,,2834.2900,425.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2550.86,,,,,,,731.5300,2834.2900,percent of total billed charges,"90% of $2,834.29 in Billed Charges for Rev 272 = $2,550.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.5MM,272,RC,,,,,,,,both,,,2834.2900,425.1400,MEDCOST,MEDCOST VHN,1348.84,,,,,,,731.5300,2834.2900,percent of total billed charges,"47.59% of $2,834.29 in Billed Charges for Rev 272 = $1,348.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.5MM,272,RC,,,,,,,,both,,,2834.2900,425.1400,SENTARA HEALTH,SENTARA HEALTH,731.53,,,,,,,731.5300,2834.2900,percent of total billed charges,"25.81% of $2,834.29 in Billed Charges for Rev 272 = $731.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.5MM,272,RC,,,,,,,,both,,,2834.2900,425.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2834.29,,,,,,,731.5300,2834.2900,percent of total billed charges,"100% of $2,834.29 in Billed Charges for Rev 272 = $2,834.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.5MM,272,RC,,,,,,,,both,,,2834.2900,425.1400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1417.15,,,,,,,731.5300,2834.2900,percent of total billed charges,"Rev 272 $2,834.29 in Billed Charges at 50% = $1,417.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.5MM,272,RC,,,,,,,,both,,,2834.2900,425.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,915.48,,,,,,,731.5300,2834.2900,other,"32.3% of $2,834.29 in Billed Charges for Rev 272 = $915.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED 4.5MM,272,RC,,,,,,,,both,,,2834.2900,425.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,870.13,,,,,,,731.5300,2834.2900,other,"30.7% of $2,834.29 in Billed Charges for Rev 272 = $870.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED 4.5MM,272,RC,,,,,,,,both,,,2834.2900,425.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,915.48,,,,,,,731.5300,2834.2900,percent of total billed charges,"32.3% of $2,834.29 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4.5MM,272,RC,,,,,,,,both,,,2834.2900,425.1400,WELLCARE,WELLCARE MEDICAID,2834.29,,,,,,,731.5300,2834.2900,percent of total billed charges,"100% of $2,834.29 in Billed Charges for Rev 272 = $2,834.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4MM,272,RC,27200002,CDM,,,,,,both,,,2291.9900,343.8000,AETNA,AETNA,978.68,,,,,,,591.5600,2291.9900,percent of total billed charges,"42.7% of $2,291.99 in Billed Charges for Rev 272 = $978.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4MM,272,RC,27200002,CDM,,,,,,both,,,2291.9900,343.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1604.39,,,,,,,591.5600,2291.9900,percent of total billed charges,"Rev 272 $2,291.99 in Billed Charges at 70% = $1,604.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4MM,272,RC,27200002,CDM,,,,,,both,,,2291.9900,343.8000,CIGNA HEALTHCARE,CIGNA HMO,955.76,,,,,,,591.5600,2291.9900,percent of total billed charges,"41.7% of $2,291.99 in Billed Charges for Rev 272 = $955.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4MM,272,RC,27200002,CDM,,,,,,both,,,2291.9900,343.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1063.48,,,,,,,591.5600,2291.9900,percent of total billed charges,"46.4% of $2,291.99 in Billed Charges for Rev 272 = $1,063.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4MM,272,RC,27200002,CDM,,,,,,both,,,2291.9900,343.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,955.76,,,,,,,591.5600,2291.9900,percent of total billed charges,"41.7% of $2,291.99 in Billed Charges for Rev 272 = $955.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4MM,272,RC,27200002,CDM,,,,,,both,,,2291.9900,343.8000,CIGNA HEALTHCARE,CIGNA PPO,955.76,,,,,,,591.5600,2291.9900,percent of total billed charges,"41.7% of $2,291.99 in Billed Charges for Rev 272 = $955.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4MM,272,RC,27200002,CDM,,,,,,both,,,2291.9900,343.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2062.79,,,,,,,591.5600,2291.9900,percent of total billed charges,"90% of $2,291.99 in Billed Charges for Rev 272 = $2,062.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4MM,272,RC,27200002,CDM,,,,,,both,,,2291.9900,343.8000,MEDCOST,MEDCOST VHN,1090.76,,,,,,,591.5600,2291.9900,percent of total billed charges,"47.59% of $2,291.99 in Billed Charges for Rev 272 = $1,090.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4MM,272,RC,27200002,CDM,,,,,,both,,,2291.9900,343.8000,SENTARA HEALTH,SENTARA HEALTH,591.56,,,,,,,591.5600,2291.9900,percent of total billed charges,"25.81% of $2,291.99 in Billed Charges for Rev 272 = $591.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4MM,272,RC,27200002,CDM,,,,,,both,,,2291.9900,343.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2291.99,,,,,,,591.5600,2291.9900,percent of total billed charges,"100% of $2,291.99 in Billed Charges for Rev 272 = $2,291.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4MM,272,RC,27200002,CDM,,,,,,both,,,2291.9900,343.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1146.00,,,,,,,591.5600,2291.9900,percent of total billed charges,"Rev 272 $2,291.99 in Billed Charges at 50% = $1,146.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4MM,272,RC,27200002,CDM,,,,,,both,,,2291.9900,343.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,740.31,,,,,,,591.5600,2291.9900,other,"32.3% of $2,291.99 in Billed Charges for Rev 272 = $740.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED 4MM,272,RC,27200002,CDM,,,,,,both,,,2291.9900,343.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,703.64,,,,,,,591.5600,2291.9900,other,"30.7% of $2,291.99 in Billed Charges for Rev 272 = $703.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED 4MM,272,RC,27200002,CDM,,,,,,both,,,2291.9900,343.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,740.31,,,,,,,591.5600,2291.9900,percent of total billed charges,"32.3% of $2,291.99 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 4MM,272,RC,27200002,CDM,,,,,,both,,,2291.9900,343.8000,WELLCARE,WELLCARE MEDICAID,2291.99,,,,,,,591.5600,2291.9900,percent of total billed charges,"100% of $2,291.99 in Billed Charges for Rev 272 = $2,291.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,1458.1600,218.7200,AETNA,AETNA,622.63,,,,,,,376.3500,1458.1600,percent of total billed charges,"42.7% of $1,458.16 in Billed Charges for Rev 272 = $622.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,1458.1600,218.7200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1020.71,,,,,,,376.3500,1458.1600,percent of total billed charges,"Rev 272 $1,458.16 in Billed Charges at 70% = $1,020.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,1458.1600,218.7200,CIGNA HEALTHCARE,CIGNA HMO,608.05,,,,,,,376.3500,1458.1600,percent of total billed charges,"41.7% of $1,458.16 in Billed Charges for Rev 272 = $608.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,1458.1600,218.7200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,676.59,,,,,,,376.3500,1458.1600,percent of total billed charges,"46.4% of $1,458.16 in Billed Charges for Rev 272 = $676.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,1458.1600,218.7200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,608.05,,,,,,,376.3500,1458.1600,percent of total billed charges,"41.7% of $1,458.16 in Billed Charges for Rev 272 = $608.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,1458.1600,218.7200,CIGNA HEALTHCARE,CIGNA PPO,608.05,,,,,,,376.3500,1458.1600,percent of total billed charges,"41.7% of $1,458.16 in Billed Charges for Rev 272 = $608.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,1458.1600,218.7200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1312.34,,,,,,,376.3500,1458.1600,percent of total billed charges,"90% of $1,458.16 in Billed Charges for Rev 272 = $1,312.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,1458.1600,218.7200,MEDCOST,MEDCOST VHN,693.94,,,,,,,376.3500,1458.1600,percent of total billed charges,"47.59% of $1,458.16 in Billed Charges for Rev 272 = $693.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,1458.1600,218.7200,SENTARA HEALTH,SENTARA HEALTH,376.35,,,,,,,376.3500,1458.1600,percent of total billed charges,"25.81% of $1,458.16 in Billed Charges for Rev 272 = $376.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,1458.1600,218.7200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1458.16,,,,,,,376.3500,1458.1600,percent of total billed charges,"100% of $1,458.16 in Billed Charges for Rev 272 = $1,458.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,1458.1600,218.7200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,729.08,,,,,,,376.3500,1458.1600,percent of total billed charges,"Rev 272 $1,458.16 in Billed Charges at 50% = $729.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,1458.1600,218.7200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,470.99,,,,,,,376.3500,1458.1600,other,"32.3% of $1,458.16 in Billed Charges for Rev 272 = $470.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,1458.1600,218.7200,UNITED HEALTHCARE,UHC HERITAGE SELECT,447.66,,,,,,,376.3500,1458.1600,other,"30.7% of $1,458.16 in Billed Charges for Rev 272 = $447.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,1458.1600,218.7200,UNITED HEALTHCARE,UNITED HEALTHCARE,470.99,,,,,,,376.3500,1458.1600,percent of total billed charges,"32.3% of $1,458.16 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,1458.1600,218.7200,WELLCARE,WELLCARE MEDICAID,1458.16,,,,,,,376.3500,1458.1600,percent of total billed charges,"100% of $1,458.16 in Billed Charges for Rev 272 = $1,458.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED MINI HUDSON 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2157.1700,323.5800,AETNA,AETNA,921.11,,,,,,,556.7700,2157.1700,percent of total billed charges,"42.7% of $2,157.17 in Billed Charges for Rev 272 = $921.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED MINI HUDSON 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2157.1700,323.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1510.02,,,,,,,556.7700,2157.1700,percent of total billed charges,"Rev 272 $2,157.17 in Billed Charges at 70% = $1,510.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED MINI HUDSON 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2157.1700,323.5800,CIGNA HEALTHCARE,CIGNA HMO,899.54,,,,,,,556.7700,2157.1700,percent of total billed charges,"41.7% of $2,157.17 in Billed Charges for Rev 272 = $899.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED MINI HUDSON 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2157.1700,323.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1000.93,,,,,,,556.7700,2157.1700,percent of total billed charges,"46.4% of $2,157.17 in Billed Charges for Rev 272 = $1,000.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED MINI HUDSON 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2157.1700,323.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,899.54,,,,,,,556.7700,2157.1700,percent of total billed charges,"41.7% of $2,157.17 in Billed Charges for Rev 272 = $899.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED MINI HUDSON 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2157.1700,323.5800,CIGNA HEALTHCARE,CIGNA PPO,899.54,,,,,,,556.7700,2157.1700,percent of total billed charges,"41.7% of $2,157.17 in Billed Charges for Rev 272 = $899.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED MINI HUDSON 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2157.1700,323.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1941.45,,,,,,,556.7700,2157.1700,percent of total billed charges,"90% of $2,157.17 in Billed Charges for Rev 272 = $1,941.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED MINI HUDSON 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2157.1700,323.5800,MEDCOST,MEDCOST VHN,1026.60,,,,,,,556.7700,2157.1700,percent of total billed charges,"47.59% of $2,157.17 in Billed Charges for Rev 272 = $1,026.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED MINI HUDSON 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2157.1700,323.5800,SENTARA HEALTH,SENTARA HEALTH,556.77,,,,,,,556.7700,2157.1700,percent of total billed charges,"25.81% of $2,157.17 in Billed Charges for Rev 272 = $556.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED MINI HUDSON 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2157.1700,323.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2157.17,,,,,,,556.7700,2157.1700,percent of total billed charges,"100% of $2,157.17 in Billed Charges for Rev 272 = $2,157.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED MINI HUDSON 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2157.1700,323.5800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1078.59,,,,,,,556.7700,2157.1700,percent of total billed charges,"Rev 272 $2,157.17 in Billed Charges at 50% = $1,078.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED MINI HUDSON 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2157.1700,323.5800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,696.77,,,,,,,556.7700,2157.1700,other,"32.3% of $2,157.17 in Billed Charges for Rev 272 = $696.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED MINI HUDSON 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2157.1700,323.5800,UNITED HEALTHCARE,UHC HERITAGE SELECT,662.25,,,,,,,556.7700,2157.1700,other,"30.7% of $2,157.17 in Billed Charges for Rev 272 = $662.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED MINI HUDSON 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2157.1700,323.5800,UNITED HEALTHCARE,UNITED HEALTHCARE,696.77,,,,,,,556.7700,2157.1700,percent of total billed charges,"32.3% of $2,157.17 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED MINI HUDSON 3.0MM,272,RC,27200002,CDM,,,,,,both,,,2157.1700,323.5800,WELLCARE,WELLCARE MEDICAID,2157.17,,,,,,,556.7700,2157.1700,percent of total billed charges,"100% of $2,157.17 in Billed Charges for Rev 272 = $2,157.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NEURO 30 X 3.8MM,272,RC,27200002,CDM,,,,,,both,,,3574.4700,536.1700,AETNA,AETNA,1526.30,,,,,,,922.5700,3574.4700,percent of total billed charges,"42.7% of $3,574.47 in Billed Charges for Rev 272 = $1,526.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NEURO 30 X 3.8MM,272,RC,27200002,CDM,,,,,,both,,,3574.4700,536.1700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2502.13,,,,,,,922.5700,3574.4700,percent of total billed charges,"Rev 272 $3,574.47 in Billed Charges at 70% = $2,502.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NEURO 30 X 3.8MM,272,RC,27200002,CDM,,,,,,both,,,3574.4700,536.1700,CIGNA HEALTHCARE,CIGNA HMO,1490.55,,,,,,,922.5700,3574.4700,percent of total billed charges,"41.7% of $3,574.47 in Billed Charges for Rev 272 = $1,490.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NEURO 30 X 3.8MM,272,RC,27200002,CDM,,,,,,both,,,3574.4700,536.1700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1658.55,,,,,,,922.5700,3574.4700,percent of total billed charges,"46.4% of $3,574.47 in Billed Charges for Rev 272 = $1,658.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NEURO 30 X 3.8MM,272,RC,27200002,CDM,,,,,,both,,,3574.4700,536.1700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1490.55,,,,,,,922.5700,3574.4700,percent of total billed charges,"41.7% of $3,574.47 in Billed Charges for Rev 272 = $1,490.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NEURO 30 X 3.8MM,272,RC,27200002,CDM,,,,,,both,,,3574.4700,536.1700,CIGNA HEALTHCARE,CIGNA PPO,1490.55,,,,,,,922.5700,3574.4700,percent of total billed charges,"41.7% of $3,574.47 in Billed Charges for Rev 272 = $1,490.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NEURO 30 X 3.8MM,272,RC,27200002,CDM,,,,,,both,,,3574.4700,536.1700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3217.02,,,,,,,922.5700,3574.4700,percent of total billed charges,"90% of $3,574.47 in Billed Charges for Rev 272 = $3,217.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NEURO 30 X 3.8MM,272,RC,27200002,CDM,,,,,,both,,,3574.4700,536.1700,MEDCOST,MEDCOST VHN,1701.09,,,,,,,922.5700,3574.4700,percent of total billed charges,"47.59% of $3,574.47 in Billed Charges for Rev 272 = $1,701.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NEURO 30 X 3.8MM,272,RC,27200002,CDM,,,,,,both,,,3574.4700,536.1700,SENTARA HEALTH,SENTARA HEALTH,922.57,,,,,,,922.5700,3574.4700,percent of total billed charges,"25.81% of $3,574.47 in Billed Charges for Rev 272 = $922.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NEURO 30 X 3.8MM,272,RC,27200002,CDM,,,,,,both,,,3574.4700,536.1700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3574.47,,,,,,,922.5700,3574.4700,percent of total billed charges,"100% of $3,574.47 in Billed Charges for Rev 272 = $3,574.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NEURO 30 X 3.8MM,272,RC,27200002,CDM,,,,,,both,,,3574.4700,536.1700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1787.24,,,,,,,922.5700,3574.4700,percent of total billed charges,"Rev 272 $3,574.47 in Billed Charges at 50% = $1,787.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NEURO 30 X 3.8MM,272,RC,27200002,CDM,,,,,,both,,,3574.4700,536.1700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1154.55,,,,,,,922.5700,3574.4700,other,"32.3% of $3,574.47 in Billed Charges for Rev 272 = $1,154.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL NEURO 30 X 3.8MM,272,RC,27200002,CDM,,,,,,both,,,3574.4700,536.1700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1097.36,,,,,,,922.5700,3574.4700,other,"30.7% of $3,574.47 in Billed Charges for Rev 272 = $1,097.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL NEURO 30 X 3.8MM,272,RC,27200002,CDM,,,,,,both,,,3574.4700,536.1700,UNITED HEALTHCARE,UNITED HEALTHCARE,1154.55,,,,,,,922.5700,3574.4700,percent of total billed charges,"32.3% of $3,574.47 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NEURO 30 X 3.8MM,272,RC,27200002,CDM,,,,,,both,,,3574.4700,536.1700,WELLCARE,WELLCARE MEDICAID,3574.47,,,,,,,922.5700,3574.4700,percent of total billed charges,"100% of $3,574.47 in Billed Charges for Rev 272 = $3,574.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NON-LOCKING SHORT 3.2 X 216MM 705032,272,RC,,,,,,,,both,,,2009.9000,301.4900,AETNA,AETNA,858.23,,,,,,,518.7600,2009.9000,percent of total billed charges,"42.7% of $2,009.90 in Billed Charges for Rev 272 = $858.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NON-LOCKING SHORT 3.2 X 216MM 705032,272,RC,,,,,,,,both,,,2009.9000,301.4900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1406.93,,,,,,,518.7600,2009.9000,percent of total billed charges,"Rev 272 $2,009.90 in Billed Charges at 70% = $1,406.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NON-LOCKING SHORT 3.2 X 216MM 705032,272,RC,,,,,,,,both,,,2009.9000,301.4900,CIGNA HEALTHCARE,CIGNA HMO,838.13,,,,,,,518.7600,2009.9000,percent of total billed charges,"41.7% of $2,009.90 in Billed Charges for Rev 272 = $838.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NON-LOCKING SHORT 3.2 X 216MM 705032,272,RC,,,,,,,,both,,,2009.9000,301.4900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,932.59,,,,,,,518.7600,2009.9000,percent of total billed charges,"46.4% of $2,009.90 in Billed Charges for Rev 272 = $932.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NON-LOCKING SHORT 3.2 X 216MM 705032,272,RC,,,,,,,,both,,,2009.9000,301.4900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,838.13,,,,,,,518.7600,2009.9000,percent of total billed charges,"41.7% of $2,009.90 in Billed Charges for Rev 272 = $838.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NON-LOCKING SHORT 3.2 X 216MM 705032,272,RC,,,,,,,,both,,,2009.9000,301.4900,CIGNA HEALTHCARE,CIGNA PPO,838.13,,,,,,,518.7600,2009.9000,percent of total billed charges,"41.7% of $2,009.90 in Billed Charges for Rev 272 = $838.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NON-LOCKING SHORT 3.2 X 216MM 705032,272,RC,,,,,,,,both,,,2009.9000,301.4900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1808.91,,,,,,,518.7600,2009.9000,percent of total billed charges,"90% of $2,009.90 in Billed Charges for Rev 272 = $1,808.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NON-LOCKING SHORT 3.2 X 216MM 705032,272,RC,,,,,,,,both,,,2009.9000,301.4900,MEDCOST,MEDCOST VHN,956.51,,,,,,,518.7600,2009.9000,percent of total billed charges,"47.59% of $2,009.90 in Billed Charges for Rev 272 = $956.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NON-LOCKING SHORT 3.2 X 216MM 705032,272,RC,,,,,,,,both,,,2009.9000,301.4900,SENTARA HEALTH,SENTARA HEALTH,518.76,,,,,,,518.7600,2009.9000,percent of total billed charges,"25.81% of $2,009.90 in Billed Charges for Rev 272 = $518.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NON-LOCKING SHORT 3.2 X 216MM 705032,272,RC,,,,,,,,both,,,2009.9000,301.4900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2009.90,,,,,,,518.7600,2009.9000,percent of total billed charges,"100% of $2,009.90 in Billed Charges for Rev 272 = $2,009.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NON-LOCKING SHORT 3.2 X 216MM 705032,272,RC,,,,,,,,both,,,2009.9000,301.4900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1004.95,,,,,,,518.7600,2009.9000,percent of total billed charges,"Rev 272 $2,009.90 in Billed Charges at 50% = $1,004.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NON-LOCKING SHORT 3.2 X 216MM 705032,272,RC,,,,,,,,both,,,2009.9000,301.4900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,649.20,,,,,,,518.7600,2009.9000,other,"32.3% of $2,009.90 in Billed Charges for Rev 272 = $649.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL NON-LOCKING SHORT 3.2 X 216MM 705032,272,RC,,,,,,,,both,,,2009.9000,301.4900,UNITED HEALTHCARE,UHC HERITAGE SELECT,617.04,,,,,,,518.7600,2009.9000,other,"30.7% of $2,009.90 in Billed Charges for Rev 272 = $617.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL NON-LOCKING SHORT 3.2 X 216MM 705032,272,RC,,,,,,,,both,,,2009.9000,301.4900,UNITED HEALTHCARE,UNITED HEALTHCARE,649.20,,,,,,,518.7600,2009.9000,percent of total billed charges,"32.3% of $2,009.90 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NON-LOCKING SHORT 3.2 X 216MM 705032,272,RC,,,,,,,,both,,,2009.9000,301.4900,WELLCARE,WELLCARE MEDICAID,2009.90,,,,,,,518.7600,2009.9000,percent of total billed charges,"100% of $2,009.90 in Billed Charges for Rev 272 = $2,009.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED POLY LOCKING 2.0MM,272,RC,,,,,,,,both,,,1493.4200,224.0100,AETNA,AETNA,637.69,,,,,,,385.4500,1493.4200,percent of total billed charges,"42.7% of $1,493.42 in Billed Charges for Rev 272 = $637.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED POLY LOCKING 2.0MM,272,RC,,,,,,,,both,,,1493.4200,224.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1045.39,,,,,,,385.4500,1493.4200,percent of total billed charges,"Rev 272 $1,493.42 in Billed Charges at 70% = $1,045.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED POLY LOCKING 2.0MM,272,RC,,,,,,,,both,,,1493.4200,224.0100,CIGNA HEALTHCARE,CIGNA HMO,622.76,,,,,,,385.4500,1493.4200,percent of total billed charges,"41.7% of $1,493.42 in Billed Charges for Rev 272 = $622.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED POLY LOCKING 2.0MM,272,RC,,,,,,,,both,,,1493.4200,224.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,692.95,,,,,,,385.4500,1493.4200,percent of total billed charges,"46.4% of $1,493.42 in Billed Charges for Rev 272 = $692.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED POLY LOCKING 2.0MM,272,RC,,,,,,,,both,,,1493.4200,224.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,622.76,,,,,,,385.4500,1493.4200,percent of total billed charges,"41.7% of $1,493.42 in Billed Charges for Rev 272 = $622.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED POLY LOCKING 2.0MM,272,RC,,,,,,,,both,,,1493.4200,224.0100,CIGNA HEALTHCARE,CIGNA PPO,622.76,,,,,,,385.4500,1493.4200,percent of total billed charges,"41.7% of $1,493.42 in Billed Charges for Rev 272 = $622.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED POLY LOCKING 2.0MM,272,RC,,,,,,,,both,,,1493.4200,224.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1344.08,,,,,,,385.4500,1493.4200,percent of total billed charges,"90% of $1,493.42 in Billed Charges for Rev 272 = $1,344.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED POLY LOCKING 2.0MM,272,RC,,,,,,,,both,,,1493.4200,224.0100,MEDCOST,MEDCOST VHN,710.72,,,,,,,385.4500,1493.4200,percent of total billed charges,"47.59% of $1,493.42 in Billed Charges for Rev 272 = $710.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED POLY LOCKING 2.0MM,272,RC,,,,,,,,both,,,1493.4200,224.0100,SENTARA HEALTH,SENTARA HEALTH,385.45,,,,,,,385.4500,1493.4200,percent of total billed charges,"25.81% of $1,493.42 in Billed Charges for Rev 272 = $385.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED POLY LOCKING 2.0MM,272,RC,,,,,,,,both,,,1493.4200,224.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1493.42,,,,,,,385.4500,1493.4200,percent of total billed charges,"100% of $1,493.42 in Billed Charges for Rev 272 = $1,493.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED POLY LOCKING 2.0MM,272,RC,,,,,,,,both,,,1493.4200,224.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,746.71,,,,,,,385.4500,1493.4200,percent of total billed charges,"Rev 272 $1,493.42 in Billed Charges at 50% = $746.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED POLY LOCKING 2.0MM,272,RC,,,,,,,,both,,,1493.4200,224.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,482.37,,,,,,,385.4500,1493.4200,other,"32.3% of $1,493.42 in Billed Charges for Rev 272 = $482.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED POLY LOCKING 2.0MM,272,RC,,,,,,,,both,,,1493.4200,224.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,458.48,,,,,,,385.4500,1493.4200,other,"30.7% of $1,493.42 in Billed Charges for Rev 272 = $458.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED POLY LOCKING 2.0MM,272,RC,,,,,,,,both,,,1493.4200,224.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,482.37,,,,,,,385.4500,1493.4200,percent of total billed charges,"32.3% of $1,493.42 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED POLY LOCKING 2.0MM,272,RC,,,,,,,,both,,,1493.4200,224.0100,WELLCARE,WELLCARE MEDICAID,1493.42,,,,,,,385.4500,1493.4200,percent of total billed charges,"100% of $1,493.42 in Billed Charges for Rev 272 = $1,493.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 1.6MM,272,RC,27200002,CDM,,,,,,both,,,4238.4200,635.7600,AETNA,AETNA,1809.81,,,,,,,1093.9400,4238.4200,percent of total billed charges,"42.7% of $4,238.42 in Billed Charges for Rev 272 = $1,809.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 1.6MM,272,RC,27200002,CDM,,,,,,both,,,4238.4200,635.7600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2966.89,,,,,,,1093.9400,4238.4200,percent of total billed charges,"Rev 272 $4,238.42 in Billed Charges at 70% = $2,966.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 1.6MM,272,RC,27200002,CDM,,,,,,both,,,4238.4200,635.7600,CIGNA HEALTHCARE,CIGNA HMO,1767.42,,,,,,,1093.9400,4238.4200,percent of total billed charges,"41.7% of $4,238.42 in Billed Charges for Rev 272 = $1,767.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 1.6MM,272,RC,27200002,CDM,,,,,,both,,,4238.4200,635.7600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1966.63,,,,,,,1093.9400,4238.4200,percent of total billed charges,"46.4% of $4,238.42 in Billed Charges for Rev 272 = $1,966.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 1.6MM,272,RC,27200002,CDM,,,,,,both,,,4238.4200,635.7600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1767.42,,,,,,,1093.9400,4238.4200,percent of total billed charges,"41.7% of $4,238.42 in Billed Charges for Rev 272 = $1,767.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 1.6MM,272,RC,27200002,CDM,,,,,,both,,,4238.4200,635.7600,CIGNA HEALTHCARE,CIGNA PPO,1767.42,,,,,,,1093.9400,4238.4200,percent of total billed charges,"41.7% of $4,238.42 in Billed Charges for Rev 272 = $1,767.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 1.6MM,272,RC,27200002,CDM,,,,,,both,,,4238.4200,635.7600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3814.58,,,,,,,1093.9400,4238.4200,percent of total billed charges,"90% of $4,238.42 in Billed Charges for Rev 272 = $3,814.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 1.6MM,272,RC,27200002,CDM,,,,,,both,,,4238.4200,635.7600,MEDCOST,MEDCOST VHN,2017.06,,,,,,,1093.9400,4238.4200,percent of total billed charges,"47.59% of $4,238.42 in Billed Charges for Rev 272 = $2,017.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 1.6MM,272,RC,27200002,CDM,,,,,,both,,,4238.4200,635.7600,SENTARA HEALTH,SENTARA HEALTH,1093.94,,,,,,,1093.9400,4238.4200,percent of total billed charges,"25.81% of $4,238.42 in Billed Charges for Rev 272 = $1,093.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 1.6MM,272,RC,27200002,CDM,,,,,,both,,,4238.4200,635.7600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4238.42,,,,,,,1093.9400,4238.4200,percent of total billed charges,"100% of $4,238.42 in Billed Charges for Rev 272 = $4,238.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 1.6MM,272,RC,27200002,CDM,,,,,,both,,,4238.4200,635.7600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2119.21,,,,,,,1093.9400,4238.4200,percent of total billed charges,"Rev 272 $4,238.42 in Billed Charges at 50% = $2,119.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 1.6MM,272,RC,27200002,CDM,,,,,,both,,,4238.4200,635.7600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1369.01,,,,,,,1093.9400,4238.4200,other,"32.3% of $4,238.42 in Billed Charges for Rev 272 = $1,369.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED QUICK CONNECT 1.6MM,272,RC,27200002,CDM,,,,,,both,,,4238.4200,635.7600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1301.19,,,,,,,1093.9400,4238.4200,other,"30.7% of $4,238.42 in Billed Charges for Rev 272 = $1,301.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED QUICK CONNECT 1.6MM,272,RC,27200002,CDM,,,,,,both,,,4238.4200,635.7600,UNITED HEALTHCARE,UNITED HEALTHCARE,1369.01,,,,,,,1093.9400,4238.4200,percent of total billed charges,"32.3% of $4,238.42 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 1.6MM,272,RC,27200002,CDM,,,,,,both,,,4238.4200,635.7600,WELLCARE,WELLCARE MEDICAID,4238.42,,,,,,,1093.9400,4238.4200,percent of total billed charges,"100% of $4,238.42 in Billed Charges for Rev 272 = $4,238.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.7MM,272,RC,27200002,CDM,,,,,,both,,,4494.4800,674.1700,AETNA,AETNA,1919.14,,,,,,,1160.0300,4494.4800,percent of total billed charges,"42.7% of $4,494.48 in Billed Charges for Rev 272 = $1,919.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.7MM,272,RC,27200002,CDM,,,,,,both,,,4494.4800,674.1700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3146.14,,,,,,,1160.0300,4494.4800,percent of total billed charges,"Rev 272 $4,494.48 in Billed Charges at 70% = $3,146.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.7MM,272,RC,27200002,CDM,,,,,,both,,,4494.4800,674.1700,CIGNA HEALTHCARE,CIGNA HMO,1874.20,,,,,,,1160.0300,4494.4800,percent of total billed charges,"41.7% of $4,494.48 in Billed Charges for Rev 272 = $1,874.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.7MM,272,RC,27200002,CDM,,,,,,both,,,4494.4800,674.1700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2085.44,,,,,,,1160.0300,4494.4800,percent of total billed charges,"46.4% of $4,494.48 in Billed Charges for Rev 272 = $2,085.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.7MM,272,RC,27200002,CDM,,,,,,both,,,4494.4800,674.1700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1874.20,,,,,,,1160.0300,4494.4800,percent of total billed charges,"41.7% of $4,494.48 in Billed Charges for Rev 272 = $1,874.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.7MM,272,RC,27200002,CDM,,,,,,both,,,4494.4800,674.1700,CIGNA HEALTHCARE,CIGNA PPO,1874.20,,,,,,,1160.0300,4494.4800,percent of total billed charges,"41.7% of $4,494.48 in Billed Charges for Rev 272 = $1,874.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.7MM,272,RC,27200002,CDM,,,,,,both,,,4494.4800,674.1700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4045.03,,,,,,,1160.0300,4494.4800,percent of total billed charges,"90% of $4,494.48 in Billed Charges for Rev 272 = $4,045.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.7MM,272,RC,27200002,CDM,,,,,,both,,,4494.4800,674.1700,MEDCOST,MEDCOST VHN,2138.92,,,,,,,1160.0300,4494.4800,percent of total billed charges,"47.59% of $4,494.48 in Billed Charges for Rev 272 = $2,138.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.7MM,272,RC,27200002,CDM,,,,,,both,,,4494.4800,674.1700,SENTARA HEALTH,SENTARA HEALTH,1160.03,,,,,,,1160.0300,4494.4800,percent of total billed charges,"25.81% of $4,494.48 in Billed Charges for Rev 272 = $1,160.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.7MM,272,RC,27200002,CDM,,,,,,both,,,4494.4800,674.1700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4494.48,,,,,,,1160.0300,4494.4800,percent of total billed charges,"100% of $4,494.48 in Billed Charges for Rev 272 = $4,494.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.7MM,272,RC,27200002,CDM,,,,,,both,,,4494.4800,674.1700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2247.24,,,,,,,1160.0300,4494.4800,percent of total billed charges,"Rev 272 $4,494.48 in Billed Charges at 50% = $2,247.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.7MM,272,RC,27200002,CDM,,,,,,both,,,4494.4800,674.1700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1451.72,,,,,,,1160.0300,4494.4800,other,"32.3% of $4,494.48 in Billed Charges for Rev 272 = $1,451.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED QUICK CONNECT 2.7MM,272,RC,27200002,CDM,,,,,,both,,,4494.4800,674.1700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1379.81,,,,,,,1160.0300,4494.4800,other,"30.7% of $4,494.48 in Billed Charges for Rev 272 = $1,379.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED QUICK CONNECT 2.7MM,272,RC,27200002,CDM,,,,,,both,,,4494.4800,674.1700,UNITED HEALTHCARE,UNITED HEALTHCARE,1451.72,,,,,,,1160.0300,4494.4800,percent of total billed charges,"32.3% of $4,494.48 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 2.7MM,272,RC,27200002,CDM,,,,,,both,,,4494.4800,674.1700,WELLCARE,WELLCARE MEDICAID,4494.48,,,,,,,1160.0300,4494.4800,percent of total billed charges,"100% of $4,494.48 in Billed Charges for Rev 272 = $4,494.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 3.0MM,272,RC,27200002,CDM,,,,,,both,,,4407.3600,661.1000,AETNA,AETNA,1881.94,,,,,,,1137.5400,4407.3600,percent of total billed charges,"42.7% of $4,407.36 in Billed Charges for Rev 272 = $1,881.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 3.0MM,272,RC,27200002,CDM,,,,,,both,,,4407.3600,661.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3085.15,,,,,,,1137.5400,4407.3600,percent of total billed charges,"Rev 272 $4,407.36 in Billed Charges at 70% = $3,085.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 3.0MM,272,RC,27200002,CDM,,,,,,both,,,4407.3600,661.1000,CIGNA HEALTHCARE,CIGNA HMO,1837.87,,,,,,,1137.5400,4407.3600,percent of total billed charges,"41.7% of $4,407.36 in Billed Charges for Rev 272 = $1,837.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 3.0MM,272,RC,27200002,CDM,,,,,,both,,,4407.3600,661.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2045.02,,,,,,,1137.5400,4407.3600,percent of total billed charges,"46.4% of $4,407.36 in Billed Charges for Rev 272 = $2,045.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 3.0MM,272,RC,27200002,CDM,,,,,,both,,,4407.3600,661.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1837.87,,,,,,,1137.5400,4407.3600,percent of total billed charges,"41.7% of $4,407.36 in Billed Charges for Rev 272 = $1,837.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 3.0MM,272,RC,27200002,CDM,,,,,,both,,,4407.3600,661.1000,CIGNA HEALTHCARE,CIGNA PPO,1837.87,,,,,,,1137.5400,4407.3600,percent of total billed charges,"41.7% of $4,407.36 in Billed Charges for Rev 272 = $1,837.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 3.0MM,272,RC,27200002,CDM,,,,,,both,,,4407.3600,661.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3966.62,,,,,,,1137.5400,4407.3600,percent of total billed charges,"90% of $4,407.36 in Billed Charges for Rev 272 = $3,966.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 3.0MM,272,RC,27200002,CDM,,,,,,both,,,4407.3600,661.1000,MEDCOST,MEDCOST VHN,2097.46,,,,,,,1137.5400,4407.3600,percent of total billed charges,"47.59% of $4,407.36 in Billed Charges for Rev 272 = $2,097.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 3.0MM,272,RC,27200002,CDM,,,,,,both,,,4407.3600,661.1000,SENTARA HEALTH,SENTARA HEALTH,1137.54,,,,,,,1137.5400,4407.3600,percent of total billed charges,"25.81% of $4,407.36 in Billed Charges for Rev 272 = $1,137.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 3.0MM,272,RC,27200002,CDM,,,,,,both,,,4407.3600,661.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4407.36,,,,,,,1137.5400,4407.3600,percent of total billed charges,"100% of $4,407.36 in Billed Charges for Rev 272 = $4,407.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 3.0MM,272,RC,27200002,CDM,,,,,,both,,,4407.3600,661.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2203.68,,,,,,,1137.5400,4407.3600,percent of total billed charges,"Rev 272 $4,407.36 in Billed Charges at 50% = $2,203.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 3.0MM,272,RC,27200002,CDM,,,,,,both,,,4407.3600,661.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1423.58,,,,,,,1137.5400,4407.3600,other,"32.3% of $4,407.36 in Billed Charges for Rev 272 = $1,423.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED QUICK CONNECT 3.0MM,272,RC,27200002,CDM,,,,,,both,,,4407.3600,661.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1353.06,,,,,,,1137.5400,4407.3600,other,"30.7% of $4,407.36 in Billed Charges for Rev 272 = $1,353.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED QUICK CONNECT 3.0MM,272,RC,27200002,CDM,,,,,,both,,,4407.3600,661.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,1423.58,,,,,,,1137.5400,4407.3600,percent of total billed charges,"32.3% of $4,407.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 3.0MM,272,RC,27200002,CDM,,,,,,both,,,4407.3600,661.1000,WELLCARE,WELLCARE MEDICAID,4407.36,,,,,,,1137.5400,4407.3600,percent of total billed charges,"100% of $4,407.36 in Billed Charges for Rev 272 = $4,407.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 5.0MM,272,RC,27200002,CDM,,,,,,both,,,4434.5400,665.1800,AETNA,AETNA,1893.55,,,,,,,1144.5500,4434.5400,percent of total billed charges,"42.7% of $4,434.54 in Billed Charges for Rev 272 = $1,893.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 5.0MM,272,RC,27200002,CDM,,,,,,both,,,4434.5400,665.1800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3104.18,,,,,,,1144.5500,4434.5400,percent of total billed charges,"Rev 272 $4,434.54 in Billed Charges at 70% = $3,104.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 5.0MM,272,RC,27200002,CDM,,,,,,both,,,4434.5400,665.1800,CIGNA HEALTHCARE,CIGNA HMO,1849.20,,,,,,,1144.5500,4434.5400,percent of total billed charges,"41.7% of $4,434.54 in Billed Charges for Rev 272 = $1,849.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 5.0MM,272,RC,27200002,CDM,,,,,,both,,,4434.5400,665.1800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2057.63,,,,,,,1144.5500,4434.5400,percent of total billed charges,"46.4% of $4,434.54 in Billed Charges for Rev 272 = $2,057.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 5.0MM,272,RC,27200002,CDM,,,,,,both,,,4434.5400,665.1800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1849.20,,,,,,,1144.5500,4434.5400,percent of total billed charges,"41.7% of $4,434.54 in Billed Charges for Rev 272 = $1,849.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 5.0MM,272,RC,27200002,CDM,,,,,,both,,,4434.5400,665.1800,CIGNA HEALTHCARE,CIGNA PPO,1849.20,,,,,,,1144.5500,4434.5400,percent of total billed charges,"41.7% of $4,434.54 in Billed Charges for Rev 272 = $1,849.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 5.0MM,272,RC,27200002,CDM,,,,,,both,,,4434.5400,665.1800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3991.09,,,,,,,1144.5500,4434.5400,percent of total billed charges,"90% of $4,434.54 in Billed Charges for Rev 272 = $3,991.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 5.0MM,272,RC,27200002,CDM,,,,,,both,,,4434.5400,665.1800,MEDCOST,MEDCOST VHN,2110.40,,,,,,,1144.5500,4434.5400,percent of total billed charges,"47.59% of $4,434.54 in Billed Charges for Rev 272 = $2,110.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 5.0MM,272,RC,27200002,CDM,,,,,,both,,,4434.5400,665.1800,SENTARA HEALTH,SENTARA HEALTH,1144.55,,,,,,,1144.5500,4434.5400,percent of total billed charges,"25.81% of $4,434.54 in Billed Charges for Rev 272 = $1,144.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 5.0MM,272,RC,27200002,CDM,,,,,,both,,,4434.5400,665.1800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4434.54,,,,,,,1144.5500,4434.5400,percent of total billed charges,"100% of $4,434.54 in Billed Charges for Rev 272 = $4,434.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 5.0MM,272,RC,27200002,CDM,,,,,,both,,,4434.5400,665.1800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2217.27,,,,,,,1144.5500,4434.5400,percent of total billed charges,"Rev 272 $4,434.54 in Billed Charges at 50% = $2,217.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 5.0MM,272,RC,27200002,CDM,,,,,,both,,,4434.5400,665.1800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1432.36,,,,,,,1144.5500,4434.5400,other,"32.3% of $4,434.54 in Billed Charges for Rev 272 = $1,432.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED QUICK CONNECT 5.0MM,272,RC,27200002,CDM,,,,,,both,,,4434.5400,665.1800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1361.40,,,,,,,1144.5500,4434.5400,other,"30.7% of $4,434.54 in Billed Charges for Rev 272 = $1,361.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED QUICK CONNECT 5.0MM,272,RC,27200002,CDM,,,,,,both,,,4434.5400,665.1800,UNITED HEALTHCARE,UNITED HEALTHCARE,1432.36,,,,,,,1144.5500,4434.5400,percent of total billed charges,"32.3% of $4,434.54 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT 5.0MM,272,RC,27200002,CDM,,,,,,both,,,4434.5400,665.1800,WELLCARE,WELLCARE MEDICAID,4434.54,,,,,,,1144.5500,4434.5400,percent of total billed charges,"100% of $4,434.54 in Billed Charges for Rev 272 = $4,434.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT LARGE 11.2MM,272,RC,,,,,,,,both,,,6051.7900,907.7700,AETNA,AETNA,2584.11,,,,,,,1561.9700,6051.7900,percent of total billed charges,"42.7% of $6,051.79 in Billed Charges for Rev 272 = $2,584.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT LARGE 11.2MM,272,RC,,,,,,,,both,,,6051.7900,907.7700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4236.25,,,,,,,1561.9700,6051.7900,percent of total billed charges,"Rev 272 $6,051.79 in Billed Charges at 70% = $4,236.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT LARGE 11.2MM,272,RC,,,,,,,,both,,,6051.7900,907.7700,CIGNA HEALTHCARE,CIGNA HMO,2523.60,,,,,,,1561.9700,6051.7900,percent of total billed charges,"41.7% of $6,051.79 in Billed Charges for Rev 272 = $2,523.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT LARGE 11.2MM,272,RC,,,,,,,,both,,,6051.7900,907.7700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2808.03,,,,,,,1561.9700,6051.7900,percent of total billed charges,"46.4% of $6,051.79 in Billed Charges for Rev 272 = $2,808.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT LARGE 11.2MM,272,RC,,,,,,,,both,,,6051.7900,907.7700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2523.60,,,,,,,1561.9700,6051.7900,percent of total billed charges,"41.7% of $6,051.79 in Billed Charges for Rev 272 = $2,523.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT LARGE 11.2MM,272,RC,,,,,,,,both,,,6051.7900,907.7700,CIGNA HEALTHCARE,CIGNA PPO,2523.60,,,,,,,1561.9700,6051.7900,percent of total billed charges,"41.7% of $6,051.79 in Billed Charges for Rev 272 = $2,523.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT LARGE 11.2MM,272,RC,,,,,,,,both,,,6051.7900,907.7700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5446.61,,,,,,,1561.9700,6051.7900,percent of total billed charges,"90% of $6,051.79 in Billed Charges for Rev 272 = $5,446.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT LARGE 11.2MM,272,RC,,,,,,,,both,,,6051.7900,907.7700,MEDCOST,MEDCOST VHN,2880.05,,,,,,,1561.9700,6051.7900,percent of total billed charges,"47.59% of $6,051.79 in Billed Charges for Rev 272 = $2,880.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT LARGE 11.2MM,272,RC,,,,,,,,both,,,6051.7900,907.7700,SENTARA HEALTH,SENTARA HEALTH,1561.97,,,,,,,1561.9700,6051.7900,percent of total billed charges,"25.81% of $6,051.79 in Billed Charges for Rev 272 = $1,561.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT LARGE 11.2MM,272,RC,,,,,,,,both,,,6051.7900,907.7700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6051.79,,,,,,,1561.9700,6051.7900,percent of total billed charges,"100% of $6,051.79 in Billed Charges for Rev 272 = $6,051.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT LARGE 11.2MM,272,RC,,,,,,,,both,,,6051.7900,907.7700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3025.90,,,,,,,1561.9700,6051.7900,percent of total billed charges,"Rev 272 $6,051.79 in Billed Charges at 50% = $3,025.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT LARGE 11.2MM,272,RC,,,,,,,,both,,,6051.7900,907.7700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1954.73,,,,,,,1561.9700,6051.7900,other,"32.3% of $6,051.79 in Billed Charges for Rev 272 = $1,954.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED QUICK CONNECT LARGE 11.2MM,272,RC,,,,,,,,both,,,6051.7900,907.7700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1857.90,,,,,,,1561.9700,6051.7900,other,"30.7% of $6,051.79 in Billed Charges for Rev 272 = $1,857.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED QUICK CONNECT LARGE 11.2MM,272,RC,,,,,,,,both,,,6051.7900,907.7700,UNITED HEALTHCARE,UNITED HEALTHCARE,1954.73,,,,,,,1561.9700,6051.7900,percent of total billed charges,"32.3% of $6,051.79 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED QUICK CONNECT LARGE 11.2MM,272,RC,,,,,,,,both,,,6051.7900,907.7700,WELLCARE,WELLCARE MEDICAID,6051.79,,,,,,,1561.9700,6051.7900,percent of total billed charges,"100% of $6,051.79 in Billed Charges for Rev 272 = $6,051.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL,272,RC,,,,,,,,both,,,2090.7900,313.6200,AETNA,AETNA,892.77,,,,,,,539.6300,2090.7900,percent of total billed charges,"42.7% of $2,090.79 in Billed Charges for Rev 272 = $892.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL,272,RC,,,,,,,,both,,,2090.7900,313.6200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1463.55,,,,,,,539.6300,2090.7900,percent of total billed charges,"Rev 272 $2,090.79 in Billed Charges at 70% = $1,463.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL,272,RC,,,,,,,,both,,,2090.7900,313.6200,CIGNA HEALTHCARE,CIGNA HMO,871.86,,,,,,,539.6300,2090.7900,percent of total billed charges,"41.7% of $2,090.79 in Billed Charges for Rev 272 = $871.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL,272,RC,,,,,,,,both,,,2090.7900,313.6200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,970.13,,,,,,,539.6300,2090.7900,percent of total billed charges,"46.4% of $2,090.79 in Billed Charges for Rev 272 = $970.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL,272,RC,,,,,,,,both,,,2090.7900,313.6200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,871.86,,,,,,,539.6300,2090.7900,percent of total billed charges,"41.7% of $2,090.79 in Billed Charges for Rev 272 = $871.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL,272,RC,,,,,,,,both,,,2090.7900,313.6200,CIGNA HEALTHCARE,CIGNA PPO,871.86,,,,,,,539.6300,2090.7900,percent of total billed charges,"41.7% of $2,090.79 in Billed Charges for Rev 272 = $871.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL,272,RC,,,,,,,,both,,,2090.7900,313.6200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1881.71,,,,,,,539.6300,2090.7900,percent of total billed charges,"90% of $2,090.79 in Billed Charges for Rev 272 = $1,881.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL,272,RC,,,,,,,,both,,,2090.7900,313.6200,MEDCOST,MEDCOST VHN,995.01,,,,,,,539.6300,2090.7900,percent of total billed charges,"47.59% of $2,090.79 in Billed Charges for Rev 272 = $995.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL,272,RC,,,,,,,,both,,,2090.7900,313.6200,SENTARA HEALTH,SENTARA HEALTH,539.63,,,,,,,539.6300,2090.7900,percent of total billed charges,"25.81% of $2,090.79 in Billed Charges for Rev 272 = $539.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL,272,RC,,,,,,,,both,,,2090.7900,313.6200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2090.79,,,,,,,539.6300,2090.7900,percent of total billed charges,"100% of $2,090.79 in Billed Charges for Rev 272 = $2,090.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL,272,RC,,,,,,,,both,,,2090.7900,313.6200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1045.40,,,,,,,539.6300,2090.7900,percent of total billed charges,"Rev 272 $2,090.79 in Billed Charges at 50% = $1,045.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL,272,RC,,,,,,,,both,,,2090.7900,313.6200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,675.33,,,,,,,539.6300,2090.7900,other,"32.3% of $2,090.79 in Billed Charges for Rev 272 = $675.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL PERIPHERAL,272,RC,,,,,,,,both,,,2090.7900,313.6200,UNITED HEALTHCARE,UHC HERITAGE SELECT,641.87,,,,,,,539.6300,2090.7900,other,"30.7% of $2,090.79 in Billed Charges for Rev 272 = $641.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL PERIPHERAL,272,RC,,,,,,,,both,,,2090.7900,313.6200,UNITED HEALTHCARE,UNITED HEALTHCARE,675.33,,,,,,,539.6300,2090.7900,percent of total billed charges,"32.3% of $2,090.79 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL,272,RC,,,,,,,,both,,,2090.7900,313.6200,WELLCARE,WELLCARE MEDICAID,2090.79,,,,,,,539.6300,2090.7900,percent of total billed charges,"100% of $2,090.79 in Billed Charges for Rev 272 = $2,090.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X8-18MM 317.876,272,RC,,,,,,,,both,,,2170.1300,325.5200,AETNA,AETNA,926.65,,,,,,,560.1100,2170.1300,percent of total billed charges,"42.7% of $2,170.13 in Billed Charges for Rev 272 = $926.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X8-18MM 317.876,272,RC,,,,,,,,both,,,2170.1300,325.5200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1519.09,,,,,,,560.1100,2170.1300,percent of total billed charges,"Rev 272 $2,170.13 in Billed Charges at 70% = $1,519.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X8-18MM 317.876,272,RC,,,,,,,,both,,,2170.1300,325.5200,CIGNA HEALTHCARE,CIGNA HMO,904.94,,,,,,,560.1100,2170.1300,percent of total billed charges,"41.7% of $2,170.13 in Billed Charges for Rev 272 = $904.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X8-18MM 317.876,272,RC,,,,,,,,both,,,2170.1300,325.5200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1006.94,,,,,,,560.1100,2170.1300,percent of total billed charges,"46.4% of $2,170.13 in Billed Charges for Rev 272 = $1,006.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X8-18MM 317.876,272,RC,,,,,,,,both,,,2170.1300,325.5200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,904.94,,,,,,,560.1100,2170.1300,percent of total billed charges,"41.7% of $2,170.13 in Billed Charges for Rev 272 = $904.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X8-18MM 317.876,272,RC,,,,,,,,both,,,2170.1300,325.5200,CIGNA HEALTHCARE,CIGNA PPO,904.94,,,,,,,560.1100,2170.1300,percent of total billed charges,"41.7% of $2,170.13 in Billed Charges for Rev 272 = $904.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X8-18MM 317.876,272,RC,,,,,,,,both,,,2170.1300,325.5200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1953.12,,,,,,,560.1100,2170.1300,percent of total billed charges,"90% of $2,170.13 in Billed Charges for Rev 272 = $1,953.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X8-18MM 317.876,272,RC,,,,,,,,both,,,2170.1300,325.5200,MEDCOST,MEDCOST VHN,1032.76,,,,,,,560.1100,2170.1300,percent of total billed charges,"47.59% of $2,170.13 in Billed Charges for Rev 272 = $1,032.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X8-18MM 317.876,272,RC,,,,,,,,both,,,2170.1300,325.5200,SENTARA HEALTH,SENTARA HEALTH,560.11,,,,,,,560.1100,2170.1300,percent of total billed charges,"25.81% of $2,170.13 in Billed Charges for Rev 272 = $560.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X8-18MM 317.876,272,RC,,,,,,,,both,,,2170.1300,325.5200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2170.13,,,,,,,560.1100,2170.1300,percent of total billed charges,"100% of $2,170.13 in Billed Charges for Rev 272 = $2,170.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X8-18MM 317.876,272,RC,,,,,,,,both,,,2170.1300,325.5200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1085.07,,,,,,,560.1100,2170.1300,percent of total billed charges,"Rev 272 $2,170.13 in Billed Charges at 50% = $1,085.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X8-18MM 317.876,272,RC,,,,,,,,both,,,2170.1300,325.5200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,700.95,,,,,,,560.1100,2170.1300,other,"32.3% of $2,170.13 in Billed Charges for Rev 272 = $700.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL TROC 1.5X8-18MM 317.876,272,RC,,,,,,,,both,,,2170.1300,325.5200,UNITED HEALTHCARE,UHC HERITAGE SELECT,666.23,,,,,,,560.1100,2170.1300,other,"30.7% of $2,170.13 in Billed Charges for Rev 272 = $666.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL TROC 1.5X8-18MM 317.876,272,RC,,,,,,,,both,,,2170.1300,325.5200,UNITED HEALTHCARE,UNITED HEALTHCARE,700.95,,,,,,,560.1100,2170.1300,percent of total billed charges,"32.3% of $2,170.13 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X8-18MM 317.876,272,RC,,,,,,,,both,,,2170.1300,325.5200,WELLCARE,WELLCARE MEDICAID,2170.13,,,,,,,560.1100,2170.1300,percent of total billed charges,"100% of $2,170.13 in Billed Charges for Rev 272 = $2,170.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 1.9MM X 115MM,272,RC,27200002,CDM,,,,,,both,,,1903.1800,285.4800,AETNA,AETNA,812.66,,,,,,,491.2100,1903.1800,percent of total billed charges,"42.7% of $1,903.18 in Billed Charges for Rev 272 = $812.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 1.9MM X 115MM,272,RC,27200002,CDM,,,,,,both,,,1903.1800,285.4800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1332.23,,,,,,,491.2100,1903.1800,percent of total billed charges,"Rev 272 $1,903.18 in Billed Charges at 70% = $1,332.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 1.9MM X 115MM,272,RC,27200002,CDM,,,,,,both,,,1903.1800,285.4800,CIGNA HEALTHCARE,CIGNA HMO,793.63,,,,,,,491.2100,1903.1800,percent of total billed charges,"41.7% of $1,903.18 in Billed Charges for Rev 272 = $793.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 1.9MM X 115MM,272,RC,27200002,CDM,,,,,,both,,,1903.1800,285.4800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,883.08,,,,,,,491.2100,1903.1800,percent of total billed charges,"46.4% of $1,903.18 in Billed Charges for Rev 272 = $883.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 1.9MM X 115MM,272,RC,27200002,CDM,,,,,,both,,,1903.1800,285.4800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,793.63,,,,,,,491.2100,1903.1800,percent of total billed charges,"41.7% of $1,903.18 in Billed Charges for Rev 272 = $793.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 1.9MM X 115MM,272,RC,27200002,CDM,,,,,,both,,,1903.1800,285.4800,CIGNA HEALTHCARE,CIGNA PPO,793.63,,,,,,,491.2100,1903.1800,percent of total billed charges,"41.7% of $1,903.18 in Billed Charges for Rev 272 = $793.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 1.9MM X 115MM,272,RC,27200002,CDM,,,,,,both,,,1903.1800,285.4800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1712.86,,,,,,,491.2100,1903.1800,percent of total billed charges,"90% of $1,903.18 in Billed Charges for Rev 272 = $1,712.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 1.9MM X 115MM,272,RC,27200002,CDM,,,,,,both,,,1903.1800,285.4800,MEDCOST,MEDCOST VHN,905.72,,,,,,,491.2100,1903.1800,percent of total billed charges,"47.59% of $1,903.18 in Billed Charges for Rev 272 = $905.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 1.9MM X 115MM,272,RC,27200002,CDM,,,,,,both,,,1903.1800,285.4800,SENTARA HEALTH,SENTARA HEALTH,491.21,,,,,,,491.2100,1903.1800,percent of total billed charges,"25.81% of $1,903.18 in Billed Charges for Rev 272 = $491.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 1.9MM X 115MM,272,RC,27200002,CDM,,,,,,both,,,1903.1800,285.4800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1903.18,,,,,,,491.2100,1903.1800,percent of total billed charges,"100% of $1,903.18 in Billed Charges for Rev 272 = $1,903.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 1.9MM X 115MM,272,RC,27200002,CDM,,,,,,both,,,1903.1800,285.4800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,951.59,,,,,,,491.2100,1903.1800,percent of total billed charges,"Rev 272 $1,903.18 in Billed Charges at 50% = $951.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 1.9MM X 115MM,272,RC,27200002,CDM,,,,,,both,,,1903.1800,285.4800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,614.73,,,,,,,491.2100,1903.1800,other,"32.3% of $1,903.18 in Billed Charges for Rev 272 = $614.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL TWIST 1.9MM X 115MM,272,RC,27200002,CDM,,,,,,both,,,1903.1800,285.4800,UNITED HEALTHCARE,UHC HERITAGE SELECT,584.28,,,,,,,491.2100,1903.1800,other,"30.7% of $1,903.18 in Billed Charges for Rev 272 = $584.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL TWIST 1.9MM X 115MM,272,RC,27200002,CDM,,,,,,both,,,1903.1800,285.4800,UNITED HEALTHCARE,UNITED HEALTHCARE,614.73,,,,,,,491.2100,1903.1800,percent of total billed charges,"32.3% of $1,903.18 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 1.9MM X 115MM,272,RC,27200002,CDM,,,,,,both,,,1903.1800,285.4800,WELLCARE,WELLCARE MEDICAID,1903.18,,,,,,,491.2100,1903.1800,percent of total billed charges,"100% of $1,903.18 in Billed Charges for Rev 272 = $1,903.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 3X30MM,272,RC,,,,,,,,both,,,2524.6100,378.6900,AETNA,AETNA,1078.01,,,,,,,651.6000,2524.6100,percent of total billed charges,"42.7% of $2,524.61 in Billed Charges for Rev 272 = $1,078.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 3X30MM,272,RC,,,,,,,,both,,,2524.6100,378.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1767.23,,,,,,,651.6000,2524.6100,percent of total billed charges,"Rev 272 $2,524.61 in Billed Charges at 70% = $1,767.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 3X30MM,272,RC,,,,,,,,both,,,2524.6100,378.6900,CIGNA HEALTHCARE,CIGNA HMO,1052.76,,,,,,,651.6000,2524.6100,percent of total billed charges,"41.7% of $2,524.61 in Billed Charges for Rev 272 = $1,052.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 3X30MM,272,RC,,,,,,,,both,,,2524.6100,378.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1171.42,,,,,,,651.6000,2524.6100,percent of total billed charges,"46.4% of $2,524.61 in Billed Charges for Rev 272 = $1,171.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 3X30MM,272,RC,,,,,,,,both,,,2524.6100,378.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1052.76,,,,,,,651.6000,2524.6100,percent of total billed charges,"41.7% of $2,524.61 in Billed Charges for Rev 272 = $1,052.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 3X30MM,272,RC,,,,,,,,both,,,2524.6100,378.6900,CIGNA HEALTHCARE,CIGNA PPO,1052.76,,,,,,,651.6000,2524.6100,percent of total billed charges,"41.7% of $2,524.61 in Billed Charges for Rev 272 = $1,052.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 3X30MM,272,RC,,,,,,,,both,,,2524.6100,378.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2272.15,,,,,,,651.6000,2524.6100,percent of total billed charges,"90% of $2,524.61 in Billed Charges for Rev 272 = $2,272.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 3X30MM,272,RC,,,,,,,,both,,,2524.6100,378.6900,MEDCOST,MEDCOST VHN,1201.46,,,,,,,651.6000,2524.6100,percent of total billed charges,"47.59% of $2,524.61 in Billed Charges for Rev 272 = $1,201.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 3X30MM,272,RC,,,,,,,,both,,,2524.6100,378.6900,SENTARA HEALTH,SENTARA HEALTH,651.60,,,,,,,651.6000,2524.6100,percent of total billed charges,"25.81% of $2,524.61 in Billed Charges for Rev 272 = $651.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 3X30MM,272,RC,,,,,,,,both,,,2524.6100,378.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2524.61,,,,,,,651.6000,2524.6100,percent of total billed charges,"100% of $2,524.61 in Billed Charges for Rev 272 = $2,524.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 3X30MM,272,RC,,,,,,,,both,,,2524.6100,378.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1262.31,,,,,,,651.6000,2524.6100,percent of total billed charges,"Rev 272 $2,524.61 in Billed Charges at 50% = $1,262.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 3X30MM,272,RC,,,,,,,,both,,,2524.6100,378.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,815.45,,,,,,,651.6000,2524.6100,other,"32.3% of $2,524.61 in Billed Charges for Rev 272 = $815.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL TWIST 3X30MM,272,RC,,,,,,,,both,,,2524.6100,378.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,775.06,,,,,,,651.6000,2524.6100,other,"30.7% of $2,524.61 in Billed Charges for Rev 272 = $775.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL TWIST 3X30MM,272,RC,,,,,,,,both,,,2524.6100,378.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,815.45,,,,,,,651.6000,2524.6100,percent of total billed charges,"32.3% of $2,524.61 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 3X30MM,272,RC,,,,,,,,both,,,2524.6100,378.6900,WELLCARE,WELLCARE MEDICAID,2524.61,,,,,,,651.6000,2524.6100,percent of total billed charges,"100% of $2,524.61 in Billed Charges for Rev 272 = $2,524.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 5MM STOP,272,RC,27200002,CDM,,,,,,both,,,1388.2600,208.2400,AETNA,AETNA,592.79,,,,,,,358.3100,1388.2600,percent of total billed charges,"42.7% of $1,388.26 in Billed Charges for Rev 272 = $592.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 5MM STOP,272,RC,27200002,CDM,,,,,,both,,,1388.2600,208.2400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,971.78,,,,,,,358.3100,1388.2600,percent of total billed charges,"Rev 272 $1,388.26 in Billed Charges at 70% = $971.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 5MM STOP,272,RC,27200002,CDM,,,,,,both,,,1388.2600,208.2400,CIGNA HEALTHCARE,CIGNA HMO,578.90,,,,,,,358.3100,1388.2600,percent of total billed charges,"41.7% of $1,388.26 in Billed Charges for Rev 272 = $578.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 5MM STOP,272,RC,27200002,CDM,,,,,,both,,,1388.2600,208.2400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,644.15,,,,,,,358.3100,1388.2600,percent of total billed charges,"46.4% of $1,388.26 in Billed Charges for Rev 272 = $644.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 5MM STOP,272,RC,27200002,CDM,,,,,,both,,,1388.2600,208.2400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,578.90,,,,,,,358.3100,1388.2600,percent of total billed charges,"41.7% of $1,388.26 in Billed Charges for Rev 272 = $578.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 5MM STOP,272,RC,27200002,CDM,,,,,,both,,,1388.2600,208.2400,CIGNA HEALTHCARE,CIGNA PPO,578.90,,,,,,,358.3100,1388.2600,percent of total billed charges,"41.7% of $1,388.26 in Billed Charges for Rev 272 = $578.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 5MM STOP,272,RC,27200002,CDM,,,,,,both,,,1388.2600,208.2400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1249.43,,,,,,,358.3100,1388.2600,percent of total billed charges,"90% of $1,388.26 in Billed Charges for Rev 272 = $1,249.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 5MM STOP,272,RC,27200002,CDM,,,,,,both,,,1388.2600,208.2400,MEDCOST,MEDCOST VHN,660.67,,,,,,,358.3100,1388.2600,percent of total billed charges,"47.59% of $1,388.26 in Billed Charges for Rev 272 = $660.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 5MM STOP,272,RC,27200002,CDM,,,,,,both,,,1388.2600,208.2400,SENTARA HEALTH,SENTARA HEALTH,358.31,,,,,,,358.3100,1388.2600,percent of total billed charges,"25.81% of $1,388.26 in Billed Charges for Rev 272 = $358.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 5MM STOP,272,RC,27200002,CDM,,,,,,both,,,1388.2600,208.2400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1388.26,,,,,,,358.3100,1388.2600,percent of total billed charges,"100% of $1,388.26 in Billed Charges for Rev 272 = $1,388.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 5MM STOP,272,RC,27200002,CDM,,,,,,both,,,1388.2600,208.2400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,694.13,,,,,,,358.3100,1388.2600,percent of total billed charges,"Rev 272 $1,388.26 in Billed Charges at 50% = $694.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 5MM STOP,272,RC,27200002,CDM,,,,,,both,,,1388.2600,208.2400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,448.41,,,,,,,358.3100,1388.2600,other,"32.3% of $1,388.26 in Billed Charges for Rev 272 = $448.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL TWIST 5MM STOP,272,RC,27200002,CDM,,,,,,both,,,1388.2600,208.2400,UNITED HEALTHCARE,UHC HERITAGE SELECT,426.20,,,,,,,358.3100,1388.2600,other,"30.7% of $1,388.26 in Billed Charges for Rev 272 = $426.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL TWIST 5MM STOP,272,RC,27200002,CDM,,,,,,both,,,1388.2600,208.2400,UNITED HEALTHCARE,UNITED HEALTHCARE,448.41,,,,,,,358.3100,1388.2600,percent of total billed charges,"32.3% of $1,388.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TWIST 5MM STOP,272,RC,27200002,CDM,,,,,,both,,,1388.2600,208.2400,WELLCARE,WELLCARE MEDICAID,1388.26,,,,,,,358.3100,1388.2600,percent of total billed charges,"100% of $1,388.26 in Billed Charges for Rev 272 = $1,388.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,4511.3900,676.7100,AETNA,AETNA,1926.36,,,,,,,1164.3900,4511.3900,percent of total billed charges,"42.7% of $4,511.39 in Billed Charges for Rev 272 = $1,926.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,4511.3900,676.7100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3157.97,,,,,,,1164.3900,4511.3900,percent of total billed charges,"Rev 272 $4,511.39 in Billed Charges at 70% = $3,157.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,4511.3900,676.7100,CIGNA HEALTHCARE,CIGNA HMO,1881.25,,,,,,,1164.3900,4511.3900,percent of total billed charges,"41.7% of $4,511.39 in Billed Charges for Rev 272 = $1,881.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,4511.3900,676.7100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2093.29,,,,,,,1164.3900,4511.3900,percent of total billed charges,"46.4% of $4,511.39 in Billed Charges for Rev 272 = $2,093.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,4511.3900,676.7100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1881.25,,,,,,,1164.3900,4511.3900,percent of total billed charges,"41.7% of $4,511.39 in Billed Charges for Rev 272 = $1,881.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,4511.3900,676.7100,CIGNA HEALTHCARE,CIGNA PPO,1881.25,,,,,,,1164.3900,4511.3900,percent of total billed charges,"41.7% of $4,511.39 in Billed Charges for Rev 272 = $1,881.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,4511.3900,676.7100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4060.25,,,,,,,1164.3900,4511.3900,percent of total billed charges,"90% of $4,511.39 in Billed Charges for Rev 272 = $4,060.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,4511.3900,676.7100,MEDCOST,MEDCOST VHN,2146.97,,,,,,,1164.3900,4511.3900,percent of total billed charges,"47.59% of $4,511.39 in Billed Charges for Rev 272 = $2,146.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,4511.3900,676.7100,SENTARA HEALTH,SENTARA HEALTH,1164.39,,,,,,,1164.3900,4511.3900,percent of total billed charges,"25.81% of $4,511.39 in Billed Charges for Rev 272 = $1,164.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,4511.3900,676.7100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4511.39,,,,,,,1164.3900,4511.3900,percent of total billed charges,"100% of $4,511.39 in Billed Charges for Rev 272 = $4,511.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,4511.3900,676.7100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2255.70,,,,,,,1164.3900,4511.3900,percent of total billed charges,"Rev 272 $4,511.39 in Billed Charges at 50% = $2,255.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,4511.3900,676.7100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1457.18,,,,,,,1164.3900,4511.3900,other,"32.3% of $4,511.39 in Billed Charges for Rev 272 = $1,457.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,4511.3900,676.7100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1385.00,,,,,,,1164.3900,4511.3900,other,"30.7% of $4,511.39 in Billed Charges for Rev 272 = $1,385.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,4511.3900,676.7100,UNITED HEALTHCARE,UNITED HEALTHCARE,1457.18,,,,,,,1164.3900,4511.3900,percent of total billed charges,"32.3% of $4,511.39 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,4511.3900,676.7100,WELLCARE,WELLCARE MEDICAID,4511.39,,,,,,,1164.3900,4511.3900,percent of total billed charges,"100% of $4,511.39 in Billed Charges for Rev 272 = $4,511.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL V LATCH 1.5MMX12MM,272,RC,,,,,,,,both,,,1899.4500,284.9200,AETNA,AETNA,811.07,,,,,,,490.2500,1899.4500,percent of total billed charges,"42.7% of $1,899.45 in Billed Charges for Rev 272 = $811.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL V LATCH 1.5MMX12MM,272,RC,,,,,,,,both,,,1899.4500,284.9200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1329.62,,,,,,,490.2500,1899.4500,percent of total billed charges,"Rev 272 $1,899.45 in Billed Charges at 70% = $1,329.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL V LATCH 1.5MMX12MM,272,RC,,,,,,,,both,,,1899.4500,284.9200,CIGNA HEALTHCARE,CIGNA HMO,792.07,,,,,,,490.2500,1899.4500,percent of total billed charges,"41.7% of $1,899.45 in Billed Charges for Rev 272 = $792.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL V LATCH 1.5MMX12MM,272,RC,,,,,,,,both,,,1899.4500,284.9200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,881.34,,,,,,,490.2500,1899.4500,percent of total billed charges,"46.4% of $1,899.45 in Billed Charges for Rev 272 = $881.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL V LATCH 1.5MMX12MM,272,RC,,,,,,,,both,,,1899.4500,284.9200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,792.07,,,,,,,490.2500,1899.4500,percent of total billed charges,"41.7% of $1,899.45 in Billed Charges for Rev 272 = $792.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL V LATCH 1.5MMX12MM,272,RC,,,,,,,,both,,,1899.4500,284.9200,CIGNA HEALTHCARE,CIGNA PPO,792.07,,,,,,,490.2500,1899.4500,percent of total billed charges,"41.7% of $1,899.45 in Billed Charges for Rev 272 = $792.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL V LATCH 1.5MMX12MM,272,RC,,,,,,,,both,,,1899.4500,284.9200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1709.51,,,,,,,490.2500,1899.4500,percent of total billed charges,"90% of $1,899.45 in Billed Charges for Rev 272 = $1,709.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL V LATCH 1.5MMX12MM,272,RC,,,,,,,,both,,,1899.4500,284.9200,MEDCOST,MEDCOST VHN,903.95,,,,,,,490.2500,1899.4500,percent of total billed charges,"47.59% of $1,899.45 in Billed Charges for Rev 272 = $903.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL V LATCH 1.5MMX12MM,272,RC,,,,,,,,both,,,1899.4500,284.9200,SENTARA HEALTH,SENTARA HEALTH,490.25,,,,,,,490.2500,1899.4500,percent of total billed charges,"25.81% of $1,899.45 in Billed Charges for Rev 272 = $490.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL V LATCH 1.5MMX12MM,272,RC,,,,,,,,both,,,1899.4500,284.9200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1899.45,,,,,,,490.2500,1899.4500,percent of total billed charges,"100% of $1,899.45 in Billed Charges for Rev 272 = $1,899.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL V LATCH 1.5MMX12MM,272,RC,,,,,,,,both,,,1899.4500,284.9200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,949.73,,,,,,,490.2500,1899.4500,percent of total billed charges,"Rev 272 $1,899.45 in Billed Charges at 50% = $949.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL V LATCH 1.5MMX12MM,272,RC,,,,,,,,both,,,1899.4500,284.9200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,613.52,,,,,,,490.2500,1899.4500,other,"32.3% of $1,899.45 in Billed Charges for Rev 272 = $613.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL V LATCH 1.5MMX12MM,272,RC,,,,,,,,both,,,1899.4500,284.9200,UNITED HEALTHCARE,UHC HERITAGE SELECT,583.13,,,,,,,490.2500,1899.4500,other,"30.7% of $1,899.45 in Billed Charges for Rev 272 = $583.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL V LATCH 1.5MMX12MM,272,RC,,,,,,,,both,,,1899.4500,284.9200,UNITED HEALTHCARE,UNITED HEALTHCARE,613.52,,,,,,,490.2500,1899.4500,percent of total billed charges,"32.3% of $1,899.45 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL V LATCH 1.5MMX12MM,272,RC,,,,,,,,both,,,1899.4500,284.9200,WELLCARE,WELLCARE MEDICAID,1899.45,,,,,,,490.2500,1899.4500,percent of total billed charges,"100% of $1,899.45 in Billed Charges for Rev 272 = $1,899.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL OC 3.2MM FLEX STERILE,272,RC,,,,,,,,both,,,2595.3400,389.3000,AETNA,AETNA,1108.21,,,,,,,669.8600,2595.3400,percent of total billed charges,"42.7% of $2,595.34 in Billed Charges for Rev 272 = $1,108.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL OC 3.2MM FLEX STERILE,272,RC,,,,,,,,both,,,2595.3400,389.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1816.74,,,,,,,669.8600,2595.3400,percent of total billed charges,"Rev 272 $2,595.34 in Billed Charges at 70% = $1,816.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL OC 3.2MM FLEX STERILE,272,RC,,,,,,,,both,,,2595.3400,389.3000,CIGNA HEALTHCARE,CIGNA HMO,1082.26,,,,,,,669.8600,2595.3400,percent of total billed charges,"41.7% of $2,595.34 in Billed Charges for Rev 272 = $1,082.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL OC 3.2MM FLEX STERILE,272,RC,,,,,,,,both,,,2595.3400,389.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1204.24,,,,,,,669.8600,2595.3400,percent of total billed charges,"46.4% of $2,595.34 in Billed Charges for Rev 272 = $1,204.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL OC 3.2MM FLEX STERILE,272,RC,,,,,,,,both,,,2595.3400,389.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1082.26,,,,,,,669.8600,2595.3400,percent of total billed charges,"41.7% of $2,595.34 in Billed Charges for Rev 272 = $1,082.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL OC 3.2MM FLEX STERILE,272,RC,,,,,,,,both,,,2595.3400,389.3000,CIGNA HEALTHCARE,CIGNA PPO,1082.26,,,,,,,669.8600,2595.3400,percent of total billed charges,"41.7% of $2,595.34 in Billed Charges for Rev 272 = $1,082.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL OC 3.2MM FLEX STERILE,272,RC,,,,,,,,both,,,2595.3400,389.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2335.81,,,,,,,669.8600,2595.3400,percent of total billed charges,"90% of $2,595.34 in Billed Charges for Rev 272 = $2,335.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL OC 3.2MM FLEX STERILE,272,RC,,,,,,,,both,,,2595.3400,389.3000,MEDCOST,MEDCOST VHN,1235.12,,,,,,,669.8600,2595.3400,percent of total billed charges,"47.59% of $2,595.34 in Billed Charges for Rev 272 = $1,235.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL OC 3.2MM FLEX STERILE,272,RC,,,,,,,,both,,,2595.3400,389.3000,SENTARA HEALTH,SENTARA HEALTH,669.86,,,,,,,669.8600,2595.3400,percent of total billed charges,"25.81% of $2,595.34 in Billed Charges for Rev 272 = $669.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL OC 3.2MM FLEX STERILE,272,RC,,,,,,,,both,,,2595.3400,389.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2595.34,,,,,,,669.8600,2595.3400,percent of total billed charges,"100% of $2,595.34 in Billed Charges for Rev 272 = $2,595.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL OC 3.2MM FLEX STERILE,272,RC,,,,,,,,both,,,2595.3400,389.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1297.67,,,,,,,669.8600,2595.3400,percent of total billed charges,"Rev 272 $2,595.34 in Billed Charges at 50% = $1,297.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL OC 3.2MM FLEX STERILE,272,RC,,,,,,,,both,,,2595.3400,389.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,838.29,,,,,,,669.8600,2595.3400,other,"32.3% of $2,595.34 in Billed Charges for Rev 272 = $838.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL OC 3.2MM FLEX STERILE,272,RC,,,,,,,,both,,,2595.3400,389.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,796.77,,,,,,,669.8600,2595.3400,other,"30.7% of $2,595.34 in Billed Charges for Rev 272 = $796.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL OC 3.2MM FLEX STERILE,272,RC,,,,,,,,both,,,2595.3400,389.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,838.29,,,,,,,669.8600,2595.3400,percent of total billed charges,"32.3% of $2,595.34 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL OC 3.2MM FLEX STERILE,272,RC,,,,,,,,both,,,2595.3400,389.3000,WELLCARE,WELLCARE MEDICAID,2595.34,,,,,,,669.8600,2595.3400,percent of total billed charges,"100% of $2,595.34 in Billed Charges for Rev 272 = $2,595.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL SCREW 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1382.4500,207.3700,AETNA,AETNA,590.31,,,,,,,356.8100,1382.4500,percent of total billed charges,"42.7% of $1,382.45 in Billed Charges for Rev 272 = $590.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL SCREW 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1382.4500,207.3700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,967.72,,,,,,,356.8100,1382.4500,percent of total billed charges,"Rev 272 $1,382.45 in Billed Charges at 70% = $967.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL SCREW 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1382.4500,207.3700,CIGNA HEALTHCARE,CIGNA HMO,576.48,,,,,,,356.8100,1382.4500,percent of total billed charges,"41.7% of $1,382.45 in Billed Charges for Rev 272 = $576.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL SCREW 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1382.4500,207.3700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,641.46,,,,,,,356.8100,1382.4500,percent of total billed charges,"46.4% of $1,382.45 in Billed Charges for Rev 272 = $641.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL SCREW 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1382.4500,207.3700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,576.48,,,,,,,356.8100,1382.4500,percent of total billed charges,"41.7% of $1,382.45 in Billed Charges for Rev 272 = $576.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL SCREW 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1382.4500,207.3700,CIGNA HEALTHCARE,CIGNA PPO,576.48,,,,,,,356.8100,1382.4500,percent of total billed charges,"41.7% of $1,382.45 in Billed Charges for Rev 272 = $576.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL SCREW 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1382.4500,207.3700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1244.21,,,,,,,356.8100,1382.4500,percent of total billed charges,"90% of $1,382.45 in Billed Charges for Rev 272 = $1,244.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL SCREW 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1382.4500,207.3700,MEDCOST,MEDCOST VHN,657.91,,,,,,,356.8100,1382.4500,percent of total billed charges,"47.59% of $1,382.45 in Billed Charges for Rev 272 = $657.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL SCREW 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1382.4500,207.3700,SENTARA HEALTH,SENTARA HEALTH,356.81,,,,,,,356.8100,1382.4500,percent of total billed charges,"25.81% of $1,382.45 in Billed Charges for Rev 272 = $356.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL SCREW 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1382.4500,207.3700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1382.45,,,,,,,356.8100,1382.4500,percent of total billed charges,"100% of $1,382.45 in Billed Charges for Rev 272 = $1,382.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL SCREW 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1382.4500,207.3700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,691.23,,,,,,,356.8100,1382.4500,percent of total billed charges,"Rev 272 $1,382.45 in Billed Charges at 50% = $691.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL SCREW 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1382.4500,207.3700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,446.53,,,,,,,356.8100,1382.4500,other,"32.3% of $1,382.45 in Billed Charges for Rev 272 = $446.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL PERIPHERAL SCREW 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1382.4500,207.3700,UNITED HEALTHCARE,UHC HERITAGE SELECT,424.41,,,,,,,356.8100,1382.4500,other,"30.7% of $1,382.45 in Billed Charges for Rev 272 = $424.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL PERIPHERAL SCREW 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1382.4500,207.3700,UNITED HEALTHCARE,UNITED HEALTHCARE,446.53,,,,,,,356.8100,1382.4500,percent of total billed charges,"32.3% of $1,382.45 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL PERIPHERAL SCREW 2.7MM,272,RC,27200002,CDM,,,,,,both,,,1382.4500,207.3700,WELLCARE,WELLCARE MEDICAID,1382.45,,,,,,,356.8100,1382.4500,percent of total billed charges,"100% of $1,382.45 in Billed Charges for Rev 272 = $1,382.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FLEXIBLE OSTEOTOME 10MM,272,RC,27200002,CDM,,,,,,both,,,1009.5100,151.4300,AETNA,AETNA,431.06,,,,,,,260.5500,1009.5100,percent of total billed charges,"42.7% of $1,009.51 in Billed Charges for Rev 272 = $431.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FLEXIBLE OSTEOTOME 10MM,272,RC,27200002,CDM,,,,,,both,,,1009.5100,151.4300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,706.66,,,,,,,260.5500,1009.5100,percent of total billed charges,"Rev 272 $1,009.51 in Billed Charges at 70% = $706.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FLEXIBLE OSTEOTOME 10MM,272,RC,27200002,CDM,,,,,,both,,,1009.5100,151.4300,CIGNA HEALTHCARE,CIGNA HMO,420.97,,,,,,,260.5500,1009.5100,percent of total billed charges,"41.7% of $1,009.51 in Billed Charges for Rev 272 = $420.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FLEXIBLE OSTEOTOME 10MM,272,RC,27200002,CDM,,,,,,both,,,1009.5100,151.4300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,468.41,,,,,,,260.5500,1009.5100,percent of total billed charges,"46.4% of $1,009.51 in Billed Charges for Rev 272 = $468.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FLEXIBLE OSTEOTOME 10MM,272,RC,27200002,CDM,,,,,,both,,,1009.5100,151.4300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,420.97,,,,,,,260.5500,1009.5100,percent of total billed charges,"41.7% of $1,009.51 in Billed Charges for Rev 272 = $420.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FLEXIBLE OSTEOTOME 10MM,272,RC,27200002,CDM,,,,,,both,,,1009.5100,151.4300,CIGNA HEALTHCARE,CIGNA PPO,420.97,,,,,,,260.5500,1009.5100,percent of total billed charges,"41.7% of $1,009.51 in Billed Charges for Rev 272 = $420.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FLEXIBLE OSTEOTOME 10MM,272,RC,27200002,CDM,,,,,,both,,,1009.5100,151.4300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,908.56,,,,,,,260.5500,1009.5100,percent of total billed charges,"90% of $1,009.51 in Billed Charges for Rev 272 = $908.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FLEXIBLE OSTEOTOME 10MM,272,RC,27200002,CDM,,,,,,both,,,1009.5100,151.4300,MEDCOST,MEDCOST VHN,480.43,,,,,,,260.5500,1009.5100,percent of total billed charges,"47.59% of $1,009.51 in Billed Charges for Rev 272 = $480.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FLEXIBLE OSTEOTOME 10MM,272,RC,27200002,CDM,,,,,,both,,,1009.5100,151.4300,SENTARA HEALTH,SENTARA HEALTH,260.55,,,,,,,260.5500,1009.5100,percent of total billed charges,"25.81% of $1,009.51 in Billed Charges for Rev 272 = $260.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FLEXIBLE OSTEOTOME 10MM,272,RC,27200002,CDM,,,,,,both,,,1009.5100,151.4300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1009.51,,,,,,,260.5500,1009.5100,percent of total billed charges,"100% of $1,009.51 in Billed Charges for Rev 272 = $1,009.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FLEXIBLE OSTEOTOME 10MM,272,RC,27200002,CDM,,,,,,both,,,1009.5100,151.4300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,504.76,,,,,,,260.5500,1009.5100,percent of total billed charges,"Rev 272 $1,009.51 in Billed Charges at 50% = $504.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FLEXIBLE OSTEOTOME 10MM,272,RC,27200002,CDM,,,,,,both,,,1009.5100,151.4300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,326.07,,,,,,,260.5500,1009.5100,other,"32.3% of $1,009.51 in Billed Charges for Rev 272 = $326.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE FLEXIBLE OSTEOTOME 10MM,272,RC,27200002,CDM,,,,,,both,,,1009.5100,151.4300,UNITED HEALTHCARE,UHC HERITAGE SELECT,309.92,,,,,,,260.5500,1009.5100,other,"30.7% of $1,009.51 in Billed Charges for Rev 272 = $309.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE FLEXIBLE OSTEOTOME 10MM,272,RC,27200002,CDM,,,,,,both,,,1009.5100,151.4300,UNITED HEALTHCARE,UNITED HEALTHCARE,326.07,,,,,,,260.5500,1009.5100,percent of total billed charges,"32.3% of $1,009.51 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FLEXIBLE OSTEOTOME 10MM,272,RC,27200002,CDM,,,,,,both,,,1009.5100,151.4300,WELLCARE,WELLCARE MEDICAID,1009.51,,,,,,,260.5500,1009.5100,percent of total billed charges,"100% of $1,009.51 in Billed Charges for Rev 272 = $1,009.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE GUIDE SLEEVE FOR TROCHANTERIC NAIL,272,RC,,,,,,,,both,,,11853.7400,1778.0600,AETNA,AETNA,5061.55,,,,,,,3059.4500,11853.7400,percent of total billed charges,"42.7% of $11,853.74 in Billed Charges for Rev 272 = $5,061.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE GUIDE SLEEVE FOR TROCHANTERIC NAIL,272,RC,,,,,,,,both,,,11853.7400,1778.0600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8297.62,,,,,,,3059.4500,11853.7400,percent of total billed charges,"Rev 272 $11,853.74 in Billed Charges at 70% = $8,297.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE GUIDE SLEEVE FOR TROCHANTERIC NAIL,272,RC,,,,,,,,both,,,11853.7400,1778.0600,CIGNA HEALTHCARE,CIGNA HMO,4943.01,,,,,,,3059.4500,11853.7400,percent of total billed charges,"41.7% of $11,853.74 in Billed Charges for Rev 272 = $4,943.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE GUIDE SLEEVE FOR TROCHANTERIC NAIL,272,RC,,,,,,,,both,,,11853.7400,1778.0600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5500.14,,,,,,,3059.4500,11853.7400,percent of total billed charges,"46.4% of $11,853.74 in Billed Charges for Rev 272 = $5,500.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE GUIDE SLEEVE FOR TROCHANTERIC NAIL,272,RC,,,,,,,,both,,,11853.7400,1778.0600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4943.01,,,,,,,3059.4500,11853.7400,percent of total billed charges,"41.7% of $11,853.74 in Billed Charges for Rev 272 = $4,943.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE GUIDE SLEEVE FOR TROCHANTERIC NAIL,272,RC,,,,,,,,both,,,11853.7400,1778.0600,CIGNA HEALTHCARE,CIGNA PPO,4943.01,,,,,,,3059.4500,11853.7400,percent of total billed charges,"41.7% of $11,853.74 in Billed Charges for Rev 272 = $4,943.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE GUIDE SLEEVE FOR TROCHANTERIC NAIL,272,RC,,,,,,,,both,,,11853.7400,1778.0600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10668.37,,,,,,,3059.4500,11853.7400,percent of total billed charges,"90% of $11,853.74 in Billed Charges for Rev 272 = $10,668.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE GUIDE SLEEVE FOR TROCHANTERIC NAIL,272,RC,,,,,,,,both,,,11853.7400,1778.0600,MEDCOST,MEDCOST VHN,5641.19,,,,,,,3059.4500,11853.7400,percent of total billed charges,"47.59% of $11,853.74 in Billed Charges for Rev 272 = $5,641.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE GUIDE SLEEVE FOR TROCHANTERIC NAIL,272,RC,,,,,,,,both,,,11853.7400,1778.0600,SENTARA HEALTH,SENTARA HEALTH,3059.45,,,,,,,3059.4500,11853.7400,percent of total billed charges,"25.81% of $11,853.74 in Billed Charges for Rev 272 = $3,059.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE GUIDE SLEEVE FOR TROCHANTERIC NAIL,272,RC,,,,,,,,both,,,11853.7400,1778.0600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11853.74,,,,,,,3059.4500,11853.7400,percent of total billed charges,"100% of $11,853.74 in Billed Charges for Rev 272 = $11,853.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE GUIDE SLEEVE FOR TROCHANTERIC NAIL,272,RC,,,,,,,,both,,,11853.7400,1778.0600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5926.87,,,,,,,3059.4500,11853.7400,percent of total billed charges,"Rev 272 $11,853.74 in Billed Charges at 50% = $5,926.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE GUIDE SLEEVE FOR TROCHANTERIC NAIL,272,RC,,,,,,,,both,,,11853.7400,1778.0600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3828.76,,,,,,,3059.4500,11853.7400,other,"32.3% of $11,853.74 in Billed Charges for Rev 272 = $3,828.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE GUIDE SLEEVE FOR TROCHANTERIC NAIL,272,RC,,,,,,,,both,,,11853.7400,1778.0600,UNITED HEALTHCARE,UHC HERITAGE SELECT,3639.10,,,,,,,3059.4500,11853.7400,other,"30.7% of $11,853.74 in Billed Charges for Rev 272 = $3,639.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE GUIDE SLEEVE FOR TROCHANTERIC NAIL,272,RC,,,,,,,,both,,,11853.7400,1778.0600,UNITED HEALTHCARE,UNITED HEALTHCARE,3828.76,,,,,,,3059.4500,11853.7400,percent of total billed charges,"32.3% of $11,853.74 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE GUIDE SLEEVE FOR TROCHANTERIC NAIL,272,RC,,,,,,,,both,,,11853.7400,1778.0600,WELLCARE,WELLCARE MEDICAID,11853.74,,,,,,,3059.4500,11853.7400,percent of total billed charges,"100% of $11,853.74 in Billed Charges for Rev 272 = $11,853.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 1.8 X 115MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2540.9000,381.1400,AETNA,AETNA,1084.96,,,,,,,655.8100,2540.9000,percent of total billed charges,"42.7% of $2,540.90 in Billed Charges for Rev 272 = $1,084.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 1.8 X 115MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2540.9000,381.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1778.63,,,,,,,655.8100,2540.9000,percent of total billed charges,"Rev 272 $2,540.90 in Billed Charges at 70% = $1,778.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 1.8 X 115MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2540.9000,381.1400,CIGNA HEALTHCARE,CIGNA HMO,1059.56,,,,,,,655.8100,2540.9000,percent of total billed charges,"41.7% of $2,540.90 in Billed Charges for Rev 272 = $1,059.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 1.8 X 115MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2540.9000,381.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1178.98,,,,,,,655.8100,2540.9000,percent of total billed charges,"46.4% of $2,540.90 in Billed Charges for Rev 272 = $1,178.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 1.8 X 115MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2540.9000,381.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1059.56,,,,,,,655.8100,2540.9000,percent of total billed charges,"41.7% of $2,540.90 in Billed Charges for Rev 272 = $1,059.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 1.8 X 115MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2540.9000,381.1400,CIGNA HEALTHCARE,CIGNA PPO,1059.56,,,,,,,655.8100,2540.9000,percent of total billed charges,"41.7% of $2,540.90 in Billed Charges for Rev 272 = $1,059.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 1.8 X 115MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2540.9000,381.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2286.81,,,,,,,655.8100,2540.9000,percent of total billed charges,"90% of $2,540.90 in Billed Charges for Rev 272 = $2,286.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 1.8 X 115MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2540.9000,381.1400,MEDCOST,MEDCOST VHN,1209.21,,,,,,,655.8100,2540.9000,percent of total billed charges,"47.59% of $2,540.90 in Billed Charges for Rev 272 = $1,209.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 1.8 X 115MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2540.9000,381.1400,SENTARA HEALTH,SENTARA HEALTH,655.81,,,,,,,655.8100,2540.9000,percent of total billed charges,"25.81% of $2,540.90 in Billed Charges for Rev 272 = $655.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 1.8 X 115MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2540.9000,381.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2540.90,,,,,,,655.8100,2540.9000,percent of total billed charges,"100% of $2,540.90 in Billed Charges for Rev 272 = $2,540.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 1.8 X 115MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2540.9000,381.1400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1270.45,,,,,,,655.8100,2540.9000,percent of total billed charges,"Rev 272 $2,540.90 in Billed Charges at 50% = $1,270.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 1.8 X 115MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2540.9000,381.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,820.71,,,,,,,655.8100,2540.9000,other,"32.3% of $2,540.90 in Billed Charges for Rev 272 = $820.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL VOLT 1.8 X 115MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2540.9000,381.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,780.06,,,,,,,655.8100,2540.9000,other,"30.7% of $2,540.90 in Billed Charges for Rev 272 = $780.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL VOLT 1.8 X 115MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2540.9000,381.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,820.71,,,,,,,655.8100,2540.9000,percent of total billed charges,"32.3% of $2,540.90 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 1.8 X 115MM 30MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2540.9000,381.1400,WELLCARE,WELLCARE MEDICAID,2540.90,,,,,,,655.8100,2540.9000,percent of total billed charges,"100% of $2,540.90 in Billed Charges for Rev 272 = $2,540.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TUBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3064.8400,459.7300,AETNA,AETNA,1308.69,,,,,,,791.0400,3064.8400,percent of total billed charges,"42.7% of $3,064.84 in Billed Charges for Rev 272 = $1,308.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TUBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3064.8400,459.7300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2145.39,,,,,,,791.0400,3064.8400,percent of total billed charges,"Rev 272 $3,064.84 in Billed Charges at 70% = $2,145.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TUBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3064.8400,459.7300,CIGNA HEALTHCARE,CIGNA HMO,1278.04,,,,,,,791.0400,3064.8400,percent of total billed charges,"41.7% of $3,064.84 in Billed Charges for Rev 272 = $1,278.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TUBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3064.8400,459.7300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1422.09,,,,,,,791.0400,3064.8400,percent of total billed charges,"46.4% of $3,064.84 in Billed Charges for Rev 272 = $1,422.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TUBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3064.8400,459.7300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1278.04,,,,,,,791.0400,3064.8400,percent of total billed charges,"41.7% of $3,064.84 in Billed Charges for Rev 272 = $1,278.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TUBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3064.8400,459.7300,CIGNA HEALTHCARE,CIGNA PPO,1278.04,,,,,,,791.0400,3064.8400,percent of total billed charges,"41.7% of $3,064.84 in Billed Charges for Rev 272 = $1,278.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TUBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3064.8400,459.7300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2758.36,,,,,,,791.0400,3064.8400,percent of total billed charges,"90% of $3,064.84 in Billed Charges for Rev 272 = $2,758.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TUBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3064.8400,459.7300,MEDCOST,MEDCOST VHN,1458.56,,,,,,,791.0400,3064.8400,percent of total billed charges,"47.59% of $3,064.84 in Billed Charges for Rev 272 = $1,458.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TUBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3064.8400,459.7300,SENTARA HEALTH,SENTARA HEALTH,791.04,,,,,,,791.0400,3064.8400,percent of total billed charges,"25.81% of $3,064.84 in Billed Charges for Rev 272 = $791.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TUBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3064.8400,459.7300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3064.84,,,,,,,791.0400,3064.8400,percent of total billed charges,"100% of $3,064.84 in Billed Charges for Rev 272 = $3,064.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TUBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3064.8400,459.7300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1532.42,,,,,,,791.0400,3064.8400,percent of total billed charges,"Rev 272 $3,064.84 in Billed Charges at 50% = $1,532.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TUBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3064.8400,459.7300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,989.94,,,,,,,791.0400,3064.8400,other,"32.3% of $3,064.84 in Billed Charges for Rev 272 = $989.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE INFERIOR TUBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3064.8400,459.7300,UNITED HEALTHCARE,UHC HERITAGE SELECT,940.91,,,,,,,791.0400,3064.8400,other,"30.7% of $3,064.84 in Billed Charges for Rev 272 = $940.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE INFERIOR TUBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3064.8400,459.7300,UNITED HEALTHCARE,UNITED HEALTHCARE,989.94,,,,,,,791.0400,3064.8400,percent of total billed charges,"32.3% of $3,064.84 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TUBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3064.8400,459.7300,WELLCARE,WELLCARE MEDICAID,3064.84,,,,,,,791.0400,3064.8400,percent of total billed charges,"100% of $3,064.84 in Billed Charges for Rev 272 = $3,064.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2.9MM,272,RC,27200002,CDM,,,,,,both,,,3553.1000,532.9700,AETNA,AETNA,1517.17,,,,,,,917.0600,3553.1000,percent of total billed charges,"42.7% of $3,553.10 in Billed Charges for Rev 272 = $1,517.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2.9MM,272,RC,27200002,CDM,,,,,,both,,,3553.1000,532.9700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2487.17,,,,,,,917.0600,3553.1000,percent of total billed charges,"Rev 272 $3,553.10 in Billed Charges at 70% = $2,487.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2.9MM,272,RC,27200002,CDM,,,,,,both,,,3553.1000,532.9700,CIGNA HEALTHCARE,CIGNA HMO,1481.64,,,,,,,917.0600,3553.1000,percent of total billed charges,"41.7% of $3,553.10 in Billed Charges for Rev 272 = $1,481.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2.9MM,272,RC,27200002,CDM,,,,,,both,,,3553.1000,532.9700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1648.64,,,,,,,917.0600,3553.1000,percent of total billed charges,"46.4% of $3,553.10 in Billed Charges for Rev 272 = $1,648.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2.9MM,272,RC,27200002,CDM,,,,,,both,,,3553.1000,532.9700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1481.64,,,,,,,917.0600,3553.1000,percent of total billed charges,"41.7% of $3,553.10 in Billed Charges for Rev 272 = $1,481.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2.9MM,272,RC,27200002,CDM,,,,,,both,,,3553.1000,532.9700,CIGNA HEALTHCARE,CIGNA PPO,1481.64,,,,,,,917.0600,3553.1000,percent of total billed charges,"41.7% of $3,553.10 in Billed Charges for Rev 272 = $1,481.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2.9MM,272,RC,27200002,CDM,,,,,,both,,,3553.1000,532.9700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3197.79,,,,,,,917.0600,3553.1000,percent of total billed charges,"90% of $3,553.10 in Billed Charges for Rev 272 = $3,197.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2.9MM,272,RC,27200002,CDM,,,,,,both,,,3553.1000,532.9700,MEDCOST,MEDCOST VHN,1690.92,,,,,,,917.0600,3553.1000,percent of total billed charges,"47.59% of $3,553.10 in Billed Charges for Rev 272 = $1,690.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2.9MM,272,RC,27200002,CDM,,,,,,both,,,3553.1000,532.9700,SENTARA HEALTH,SENTARA HEALTH,917.06,,,,,,,917.0600,3553.1000,percent of total billed charges,"25.81% of $3,553.10 in Billed Charges for Rev 272 = $917.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2.9MM,272,RC,27200002,CDM,,,,,,both,,,3553.1000,532.9700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3553.10,,,,,,,917.0600,3553.1000,percent of total billed charges,"100% of $3,553.10 in Billed Charges for Rev 272 = $3,553.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2.9MM,272,RC,27200002,CDM,,,,,,both,,,3553.1000,532.9700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1776.55,,,,,,,917.0600,3553.1000,percent of total billed charges,"Rev 272 $3,553.10 in Billed Charges at 50% = $1,776.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2.9MM,272,RC,27200002,CDM,,,,,,both,,,3553.1000,532.9700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1147.65,,,,,,,917.0600,3553.1000,other,"32.3% of $3,553.10 in Billed Charges for Rev 272 = $1,147.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE INFERIOR TURBINATE 2.9MM,272,RC,27200002,CDM,,,,,,both,,,3553.1000,532.9700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1090.80,,,,,,,917.0600,3553.1000,other,"30.7% of $3,553.10 in Billed Charges for Rev 272 = $1,090.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE INFERIOR TURBINATE 2.9MM,272,RC,27200002,CDM,,,,,,both,,,3553.1000,532.9700,UNITED HEALTHCARE,UNITED HEALTHCARE,1147.65,,,,,,,917.0600,3553.1000,percent of total billed charges,"32.3% of $3,553.10 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2.9MM,272,RC,27200002,CDM,,,,,,both,,,3553.1000,532.9700,WELLCARE,WELLCARE MEDICAID,3553.10,,,,,,,917.0600,3553.1000,percent of total billed charges,"100% of $3,553.10 in Billed Charges for Rev 272 = $3,553.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3293.8300,494.0700,AETNA,AETNA,1406.47,,,,,,,850.1400,3293.8300,percent of total billed charges,"42.7% of $3,293.83 in Billed Charges for Rev 272 = $1,406.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3293.8300,494.0700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2305.68,,,,,,,850.1400,3293.8300,percent of total billed charges,"Rev 272 $3,293.83 in Billed Charges at 70% = $2,305.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3293.8300,494.0700,CIGNA HEALTHCARE,CIGNA HMO,1373.53,,,,,,,850.1400,3293.8300,percent of total billed charges,"41.7% of $3,293.83 in Billed Charges for Rev 272 = $1,373.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3293.8300,494.0700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1528.34,,,,,,,850.1400,3293.8300,percent of total billed charges,"46.4% of $3,293.83 in Billed Charges for Rev 272 = $1,528.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3293.8300,494.0700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1373.53,,,,,,,850.1400,3293.8300,percent of total billed charges,"41.7% of $3,293.83 in Billed Charges for Rev 272 = $1,373.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3293.8300,494.0700,CIGNA HEALTHCARE,CIGNA PPO,1373.53,,,,,,,850.1400,3293.8300,percent of total billed charges,"41.7% of $3,293.83 in Billed Charges for Rev 272 = $1,373.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3293.8300,494.0700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2964.45,,,,,,,850.1400,3293.8300,percent of total billed charges,"90% of $3,293.83 in Billed Charges for Rev 272 = $2,964.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3293.8300,494.0700,MEDCOST,MEDCOST VHN,1567.53,,,,,,,850.1400,3293.8300,percent of total billed charges,"47.59% of $3,293.83 in Billed Charges for Rev 272 = $1,567.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3293.8300,494.0700,SENTARA HEALTH,SENTARA HEALTH,850.14,,,,,,,850.1400,3293.8300,percent of total billed charges,"25.81% of $3,293.83 in Billed Charges for Rev 272 = $850.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3293.8300,494.0700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3293.83,,,,,,,850.1400,3293.8300,percent of total billed charges,"100% of $3,293.83 in Billed Charges for Rev 272 = $3,293.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3293.8300,494.0700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1646.92,,,,,,,850.1400,3293.8300,percent of total billed charges,"Rev 272 $3,293.83 in Billed Charges at 50% = $1,646.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3293.8300,494.0700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1063.91,,,,,,,850.1400,3293.8300,other,"32.3% of $3,293.83 in Billed Charges for Rev 272 = $1,063.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE INFERIOR TURBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3293.8300,494.0700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1011.21,,,,,,,850.1400,3293.8300,other,"30.7% of $3,293.83 in Billed Charges for Rev 272 = $1,011.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE INFERIOR TURBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3293.8300,494.0700,UNITED HEALTHCARE,UNITED HEALTHCARE,1063.91,,,,,,,850.1400,3293.8300,percent of total billed charges,"32.3% of $3,293.83 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE INFERIOR TURBINATE 2MM,272,RC,27200002,CDM,,,,,,both,,,3293.8300,494.0700,WELLCARE,WELLCARE MEDICAID,3293.83,,,,,,,850.1400,3293.8300,percent of total billed charges,"100% of $3,293.83 in Billed Charges for Rev 272 = $3,293.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE JAGUAR 4.0,272,RC,,,,,,,,both,,,1813.6600,272.0500,AETNA,AETNA,774.43,,,,,,,468.1100,1813.6600,percent of total billed charges,"42.7% of $1,813.66 in Billed Charges for Rev 272 = $774.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE JAGUAR 4.0,272,RC,,,,,,,,both,,,1813.6600,272.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1269.56,,,,,,,468.1100,1813.6600,percent of total billed charges,"Rev 272 $1,813.66 in Billed Charges at 70% = $1,269.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE JAGUAR 4.0,272,RC,,,,,,,,both,,,1813.6600,272.0500,CIGNA HEALTHCARE,CIGNA HMO,756.30,,,,,,,468.1100,1813.6600,percent of total billed charges,"41.7% of $1,813.66 in Billed Charges for Rev 272 = $756.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE JAGUAR 4.0,272,RC,,,,,,,,both,,,1813.6600,272.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,841.54,,,,,,,468.1100,1813.6600,percent of total billed charges,"46.4% of $1,813.66 in Billed Charges for Rev 272 = $841.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE JAGUAR 4.0,272,RC,,,,,,,,both,,,1813.6600,272.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,756.30,,,,,,,468.1100,1813.6600,percent of total billed charges,"41.7% of $1,813.66 in Billed Charges for Rev 272 = $756.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE JAGUAR 4.0,272,RC,,,,,,,,both,,,1813.6600,272.0500,CIGNA HEALTHCARE,CIGNA PPO,756.30,,,,,,,468.1100,1813.6600,percent of total billed charges,"41.7% of $1,813.66 in Billed Charges for Rev 272 = $756.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE JAGUAR 4.0,272,RC,,,,,,,,both,,,1813.6600,272.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1632.29,,,,,,,468.1100,1813.6600,percent of total billed charges,"90% of $1,813.66 in Billed Charges for Rev 272 = $1,632.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE JAGUAR 4.0,272,RC,,,,,,,,both,,,1813.6600,272.0500,MEDCOST,MEDCOST VHN,863.12,,,,,,,468.1100,1813.6600,percent of total billed charges,"47.59% of $1,813.66 in Billed Charges for Rev 272 = $863.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE JAGUAR 4.0,272,RC,,,,,,,,both,,,1813.6600,272.0500,SENTARA HEALTH,SENTARA HEALTH,468.11,,,,,,,468.1100,1813.6600,percent of total billed charges,"25.81% of $1,813.66 in Billed Charges for Rev 272 = $468.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE JAGUAR 4.0,272,RC,,,,,,,,both,,,1813.6600,272.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1813.66,,,,,,,468.1100,1813.6600,percent of total billed charges,"100% of $1,813.66 in Billed Charges for Rev 272 = $1,813.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE JAGUAR 4.0,272,RC,,,,,,,,both,,,1813.6600,272.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,906.83,,,,,,,468.1100,1813.6600,percent of total billed charges,"Rev 272 $1,813.66 in Billed Charges at 50% = $906.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE JAGUAR 4.0,272,RC,,,,,,,,both,,,1813.6600,272.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,585.81,,,,,,,468.1100,1813.6600,other,"32.3% of $1,813.66 in Billed Charges for Rev 272 = $585.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE JAGUAR 4.0,272,RC,,,,,,,,both,,,1813.6600,272.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,556.79,,,,,,,468.1100,1813.6600,other,"30.7% of $1,813.66 in Billed Charges for Rev 272 = $556.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE JAGUAR 4.0,272,RC,,,,,,,,both,,,1813.6600,272.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,585.81,,,,,,,468.1100,1813.6600,percent of total billed charges,"32.3% of $1,813.66 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE JAGUAR 4.0,272,RC,,,,,,,,both,,,1813.6600,272.0500,WELLCARE,WELLCARE MEDICAID,1813.66,,,,,,,468.1100,1813.6600,percent of total billed charges,"100% of $1,813.66 in Billed Charges for Rev 272 = $1,813.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 2.0 X 175MM 90MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2627.2900,394.0900,AETNA,AETNA,1121.85,,,,,,,678.1000,2627.2900,percent of total billed charges,"42.7% of $2,627.29 in Billed Charges for Rev 272 = $1,121.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 2.0 X 175MM 90MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2627.2900,394.0900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1839.10,,,,,,,678.1000,2627.2900,percent of total billed charges,"Rev 272 $2,627.29 in Billed Charges at 70% = $1,839.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 2.0 X 175MM 90MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2627.2900,394.0900,CIGNA HEALTHCARE,CIGNA HMO,1095.58,,,,,,,678.1000,2627.2900,percent of total billed charges,"41.7% of $2,627.29 in Billed Charges for Rev 272 = $1,095.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 2.0 X 175MM 90MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2627.2900,394.0900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1219.06,,,,,,,678.1000,2627.2900,percent of total billed charges,"46.4% of $2,627.29 in Billed Charges for Rev 272 = $1,219.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 2.0 X 175MM 90MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2627.2900,394.0900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1095.58,,,,,,,678.1000,2627.2900,percent of total billed charges,"41.7% of $2,627.29 in Billed Charges for Rev 272 = $1,095.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 2.0 X 175MM 90MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2627.2900,394.0900,CIGNA HEALTHCARE,CIGNA PPO,1095.58,,,,,,,678.1000,2627.2900,percent of total billed charges,"41.7% of $2,627.29 in Billed Charges for Rev 272 = $1,095.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 2.0 X 175MM 90MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2627.2900,394.0900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2364.56,,,,,,,678.1000,2627.2900,percent of total billed charges,"90% of $2,627.29 in Billed Charges for Rev 272 = $2,364.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 2.0 X 175MM 90MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2627.2900,394.0900,MEDCOST,MEDCOST VHN,1250.33,,,,,,,678.1000,2627.2900,percent of total billed charges,"47.59% of $2,627.29 in Billed Charges for Rev 272 = $1,250.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 2.0 X 175MM 90MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2627.2900,394.0900,SENTARA HEALTH,SENTARA HEALTH,678.10,,,,,,,678.1000,2627.2900,percent of total billed charges,"25.81% of $2,627.29 in Billed Charges for Rev 272 = $678.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 2.0 X 175MM 90MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2627.2900,394.0900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2627.29,,,,,,,678.1000,2627.2900,percent of total billed charges,"100% of $2,627.29 in Billed Charges for Rev 272 = $2,627.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 2.0 X 175MM 90MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2627.2900,394.0900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1313.65,,,,,,,678.1000,2627.2900,percent of total billed charges,"Rev 272 $2,627.29 in Billed Charges at 50% = $1,313.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 2.0 X 175MM 90MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2627.2900,394.0900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,848.61,,,,,,,678.1000,2627.2900,other,"32.3% of $2,627.29 in Billed Charges for Rev 272 = $848.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL VOLT 2.0 X 175MM 90MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2627.2900,394.0900,UNITED HEALTHCARE,UHC HERITAGE SELECT,806.58,,,,,,,678.1000,2627.2900,other,"30.7% of $2,627.29 in Billed Charges for Rev 272 = $806.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL VOLT 2.0 X 175MM 90MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2627.2900,394.0900,UNITED HEALTHCARE,UNITED HEALTHCARE,848.61,,,,,,,678.1000,2627.2900,percent of total billed charges,"32.3% of $2,627.29 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL VOLT 2.0 X 175MM 90MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2627.2900,394.0900,WELLCARE,WELLCARE MEDICAID,2627.29,,,,,,,678.1000,2627.2900,percent of total billed charges,"100% of $2,627.29 in Billed Charges for Rev 272 = $2,627.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TOMCAT SHAVER 4.0MM,272,RC,27200002,CDM,,,,,,both,,,3453.8500,518.0800,AETNA,AETNA,1474.79,,,,,,,891.4400,3453.8500,percent of total billed charges,"42.7% of $3,453.85 in Billed Charges for Rev 272 = $1,474.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TOMCAT SHAVER 4.0MM,272,RC,27200002,CDM,,,,,,both,,,3453.8500,518.0800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2417.70,,,,,,,891.4400,3453.8500,percent of total billed charges,"Rev 272 $3,453.85 in Billed Charges at 70% = $2,417.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TOMCAT SHAVER 4.0MM,272,RC,27200002,CDM,,,,,,both,,,3453.8500,518.0800,CIGNA HEALTHCARE,CIGNA HMO,1440.26,,,,,,,891.4400,3453.8500,percent of total billed charges,"41.7% of $3,453.85 in Billed Charges for Rev 272 = $1,440.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TOMCAT SHAVER 4.0MM,272,RC,27200002,CDM,,,,,,both,,,3453.8500,518.0800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1602.59,,,,,,,891.4400,3453.8500,percent of total billed charges,"46.4% of $3,453.85 in Billed Charges for Rev 272 = $1,602.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TOMCAT SHAVER 4.0MM,272,RC,27200002,CDM,,,,,,both,,,3453.8500,518.0800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1440.26,,,,,,,891.4400,3453.8500,percent of total billed charges,"41.7% of $3,453.85 in Billed Charges for Rev 272 = $1,440.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TOMCAT SHAVER 4.0MM,272,RC,27200002,CDM,,,,,,both,,,3453.8500,518.0800,CIGNA HEALTHCARE,CIGNA PPO,1440.26,,,,,,,891.4400,3453.8500,percent of total billed charges,"41.7% of $3,453.85 in Billed Charges for Rev 272 = $1,440.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TOMCAT SHAVER 4.0MM,272,RC,27200002,CDM,,,,,,both,,,3453.8500,518.0800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3108.47,,,,,,,891.4400,3453.8500,percent of total billed charges,"90% of $3,453.85 in Billed Charges for Rev 272 = $3,108.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TOMCAT SHAVER 4.0MM,272,RC,27200002,CDM,,,,,,both,,,3453.8500,518.0800,MEDCOST,MEDCOST VHN,1643.69,,,,,,,891.4400,3453.8500,percent of total billed charges,"47.59% of $3,453.85 in Billed Charges for Rev 272 = $1,643.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TOMCAT SHAVER 4.0MM,272,RC,27200002,CDM,,,,,,both,,,3453.8500,518.0800,SENTARA HEALTH,SENTARA HEALTH,891.44,,,,,,,891.4400,3453.8500,percent of total billed charges,"25.81% of $3,453.85 in Billed Charges for Rev 272 = $891.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TOMCAT SHAVER 4.0MM,272,RC,27200002,CDM,,,,,,both,,,3453.8500,518.0800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3453.85,,,,,,,891.4400,3453.8500,percent of total billed charges,"100% of $3,453.85 in Billed Charges for Rev 272 = $3,453.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TOMCAT SHAVER 4.0MM,272,RC,27200002,CDM,,,,,,both,,,3453.8500,518.0800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1726.93,,,,,,,891.4400,3453.8500,percent of total billed charges,"Rev 272 $3,453.85 in Billed Charges at 50% = $1,726.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TOMCAT SHAVER 4.0MM,272,RC,27200002,CDM,,,,,,both,,,3453.8500,518.0800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1115.59,,,,,,,891.4400,3453.8500,other,"32.3% of $3,453.85 in Billed Charges for Rev 272 = $1,115.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE TOMCAT SHAVER 4.0MM,272,RC,27200002,CDM,,,,,,both,,,3453.8500,518.0800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1060.33,,,,,,,891.4400,3453.8500,other,"30.7% of $3,453.85 in Billed Charges for Rev 272 = $1,060.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE TOMCAT SHAVER 4.0MM,272,RC,27200002,CDM,,,,,,both,,,3453.8500,518.0800,UNITED HEALTHCARE,UNITED HEALTHCARE,1115.59,,,,,,,891.4400,3453.8500,percent of total billed charges,"32.3% of $3,453.85 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TOMCAT SHAVER 4.0MM,272,RC,27200002,CDM,,,,,,both,,,3453.8500,518.0800,WELLCARE,WELLCARE MEDICAID,3453.85,,,,,,,891.4400,3453.8500,percent of total billed charges,"100% of $3,453.85 in Billed Charges for Rev 272 = $3,453.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TURBINATE ROATABLE INFERIOR 11.0CM X 2.9MM,272,RC,27200002,CDM,,,,,,both,,,2842.4800,426.3700,AETNA,AETNA,1213.74,,,,,,,733.6400,2842.4800,percent of total billed charges,"42.7% of $2,842.48 in Billed Charges for Rev 272 = $1,213.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TURBINATE ROATABLE INFERIOR 11.0CM X 2.9MM,272,RC,27200002,CDM,,,,,,both,,,2842.4800,426.3700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1989.74,,,,,,,733.6400,2842.4800,percent of total billed charges,"Rev 272 $2,842.48 in Billed Charges at 70% = $1,989.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TURBINATE ROATABLE INFERIOR 11.0CM X 2.9MM,272,RC,27200002,CDM,,,,,,both,,,2842.4800,426.3700,CIGNA HEALTHCARE,CIGNA HMO,1185.31,,,,,,,733.6400,2842.4800,percent of total billed charges,"41.7% of $2,842.48 in Billed Charges for Rev 272 = $1,185.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TURBINATE ROATABLE INFERIOR 11.0CM X 2.9MM,272,RC,27200002,CDM,,,,,,both,,,2842.4800,426.3700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1318.91,,,,,,,733.6400,2842.4800,percent of total billed charges,"46.4% of $2,842.48 in Billed Charges for Rev 272 = $1,318.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TURBINATE ROATABLE INFERIOR 11.0CM X 2.9MM,272,RC,27200002,CDM,,,,,,both,,,2842.4800,426.3700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1185.31,,,,,,,733.6400,2842.4800,percent of total billed charges,"41.7% of $2,842.48 in Billed Charges for Rev 272 = $1,185.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TURBINATE ROATABLE INFERIOR 11.0CM X 2.9MM,272,RC,27200002,CDM,,,,,,both,,,2842.4800,426.3700,CIGNA HEALTHCARE,CIGNA PPO,1185.31,,,,,,,733.6400,2842.4800,percent of total billed charges,"41.7% of $2,842.48 in Billed Charges for Rev 272 = $1,185.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TURBINATE ROATABLE INFERIOR 11.0CM X 2.9MM,272,RC,27200002,CDM,,,,,,both,,,2842.4800,426.3700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2558.23,,,,,,,733.6400,2842.4800,percent of total billed charges,"90% of $2,842.48 in Billed Charges for Rev 272 = $2,558.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TURBINATE ROATABLE INFERIOR 11.0CM X 2.9MM,272,RC,27200002,CDM,,,,,,both,,,2842.4800,426.3700,MEDCOST,MEDCOST VHN,1352.74,,,,,,,733.6400,2842.4800,percent of total billed charges,"47.59% of $2,842.48 in Billed Charges for Rev 272 = $1,352.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TURBINATE ROATABLE INFERIOR 11.0CM X 2.9MM,272,RC,27200002,CDM,,,,,,both,,,2842.4800,426.3700,SENTARA HEALTH,SENTARA HEALTH,733.64,,,,,,,733.6400,2842.4800,percent of total billed charges,"25.81% of $2,842.48 in Billed Charges for Rev 272 = $733.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TURBINATE ROATABLE INFERIOR 11.0CM X 2.9MM,272,RC,27200002,CDM,,,,,,both,,,2842.4800,426.3700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2842.48,,,,,,,733.6400,2842.4800,percent of total billed charges,"100% of $2,842.48 in Billed Charges for Rev 272 = $2,842.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TURBINATE ROATABLE INFERIOR 11.0CM X 2.9MM,272,RC,27200002,CDM,,,,,,both,,,2842.4800,426.3700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1421.24,,,,,,,733.6400,2842.4800,percent of total billed charges,"Rev 272 $2,842.48 in Billed Charges at 50% = $1,421.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TURBINATE ROATABLE INFERIOR 11.0CM X 2.9MM,272,RC,27200002,CDM,,,,,,both,,,2842.4800,426.3700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,918.12,,,,,,,733.6400,2842.4800,other,"32.3% of $2,842.48 in Billed Charges for Rev 272 = $918.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE TURBINATE ROATABLE INFERIOR 11.0CM X 2.9MM,272,RC,27200002,CDM,,,,,,both,,,2842.4800,426.3700,UNITED HEALTHCARE,UHC HERITAGE SELECT,872.64,,,,,,,733.6400,2842.4800,other,"30.7% of $2,842.48 in Billed Charges for Rev 272 = $872.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE TURBINATE ROATABLE INFERIOR 11.0CM X 2.9MM,272,RC,27200002,CDM,,,,,,both,,,2842.4800,426.3700,UNITED HEALTHCARE,UNITED HEALTHCARE,918.12,,,,,,,733.6400,2842.4800,percent of total billed charges,"32.3% of $2,842.48 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TURBINATE ROATABLE INFERIOR 11.0CM X 2.9MM,272,RC,27200002,CDM,,,,,,both,,,2842.4800,426.3700,WELLCARE,WELLCARE MEDICAID,2842.48,,,,,,,733.6400,2842.4800,percent of total billed charges,"100% of $2,842.48 in Billed Charges for Rev 272 = $2,842.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ZYGOMA REDUCTION DEVICE DRILL FREE 65MM,272,RC,,,,,,,,both,,,5268.4700,790.2700,AETNA,AETNA,2249.64,,,,,,,1359.7900,5268.4700,percent of total billed charges,"42.7% of $5,268.47 in Billed Charges for Rev 272 = $2,249.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ZYGOMA REDUCTION DEVICE DRILL FREE 65MM,272,RC,,,,,,,,both,,,5268.4700,790.2700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3687.93,,,,,,,1359.7900,5268.4700,percent of total billed charges,"Rev 272 $5,268.47 in Billed Charges at 70% = $3,687.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ZYGOMA REDUCTION DEVICE DRILL FREE 65MM,272,RC,,,,,,,,both,,,5268.4700,790.2700,CIGNA HEALTHCARE,CIGNA HMO,2196.95,,,,,,,1359.7900,5268.4700,percent of total billed charges,"41.7% of $5,268.47 in Billed Charges for Rev 272 = $2,196.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ZYGOMA REDUCTION DEVICE DRILL FREE 65MM,272,RC,,,,,,,,both,,,5268.4700,790.2700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2444.57,,,,,,,1359.7900,5268.4700,percent of total billed charges,"46.4% of $5,268.47 in Billed Charges for Rev 272 = $2,444.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ZYGOMA REDUCTION DEVICE DRILL FREE 65MM,272,RC,,,,,,,,both,,,5268.4700,790.2700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2196.95,,,,,,,1359.7900,5268.4700,percent of total billed charges,"41.7% of $5,268.47 in Billed Charges for Rev 272 = $2,196.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ZYGOMA REDUCTION DEVICE DRILL FREE 65MM,272,RC,,,,,,,,both,,,5268.4700,790.2700,CIGNA HEALTHCARE,CIGNA PPO,2196.95,,,,,,,1359.7900,5268.4700,percent of total billed charges,"41.7% of $5,268.47 in Billed Charges for Rev 272 = $2,196.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ZYGOMA REDUCTION DEVICE DRILL FREE 65MM,272,RC,,,,,,,,both,,,5268.4700,790.2700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4741.62,,,,,,,1359.7900,5268.4700,percent of total billed charges,"90% of $5,268.47 in Billed Charges for Rev 272 = $4,741.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ZYGOMA REDUCTION DEVICE DRILL FREE 65MM,272,RC,,,,,,,,both,,,5268.4700,790.2700,MEDCOST,MEDCOST VHN,2507.26,,,,,,,1359.7900,5268.4700,percent of total billed charges,"47.59% of $5,268.47 in Billed Charges for Rev 272 = $2,507.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ZYGOMA REDUCTION DEVICE DRILL FREE 65MM,272,RC,,,,,,,,both,,,5268.4700,790.2700,SENTARA HEALTH,SENTARA HEALTH,1359.79,,,,,,,1359.7900,5268.4700,percent of total billed charges,"25.81% of $5,268.47 in Billed Charges for Rev 272 = $1,359.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ZYGOMA REDUCTION DEVICE DRILL FREE 65MM,272,RC,,,,,,,,both,,,5268.4700,790.2700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5268.47,,,,,,,1359.7900,5268.4700,percent of total billed charges,"100% of $5,268.47 in Billed Charges for Rev 272 = $5,268.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ZYGOMA REDUCTION DEVICE DRILL FREE 65MM,272,RC,,,,,,,,both,,,5268.4700,790.2700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2634.24,,,,,,,1359.7900,5268.4700,percent of total billed charges,"Rev 272 $5,268.47 in Billed Charges at 50% = $2,634.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ZYGOMA REDUCTION DEVICE DRILL FREE 65MM,272,RC,,,,,,,,both,,,5268.4700,790.2700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1701.72,,,,,,,1359.7900,5268.4700,other,"32.3% of $5,268.47 in Billed Charges for Rev 272 = $1,701.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE ZYGOMA REDUCTION DEVICE DRILL FREE 65MM,272,RC,,,,,,,,both,,,5268.4700,790.2700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1617.42,,,,,,,1359.7900,5268.4700,other,"30.7% of $5,268.47 in Billed Charges for Rev 272 = $1,617.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE ZYGOMA REDUCTION DEVICE DRILL FREE 65MM,272,RC,,,,,,,,both,,,5268.4700,790.2700,UNITED HEALTHCARE,UNITED HEALTHCARE,1701.72,,,,,,,1359.7900,5268.4700,percent of total billed charges,"32.3% of $5,268.47 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ZYGOMA REDUCTION DEVICE DRILL FREE 65MM,272,RC,,,,,,,,both,,,5268.4700,790.2700,WELLCARE,WELLCARE MEDICAID,5268.47,,,,,,,1359.7900,5268.4700,percent of total billed charges,"100% of $5,268.47 in Billed Charges for Rev 272 = $5,268.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE-WHEEL DIAMOND METAL CUT,272,RC,,,,,,,,both,,,1138.2200,170.7300,AETNA,AETNA,486.02,,,,,,,293.7700,1138.2200,percent of total billed charges,"42.7% of $1,138.22 in Billed Charges for Rev 272 = $486.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE-WHEEL DIAMOND METAL CUT,272,RC,,,,,,,,both,,,1138.2200,170.7300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,796.75,,,,,,,293.7700,1138.2200,percent of total billed charges,"Rev 272 $1,138.22 in Billed Charges at 70% = $796.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE-WHEEL DIAMOND METAL CUT,272,RC,,,,,,,,both,,,1138.2200,170.7300,CIGNA HEALTHCARE,CIGNA HMO,474.64,,,,,,,293.7700,1138.2200,percent of total billed charges,"41.7% of $1,138.22 in Billed Charges for Rev 272 = $474.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE-WHEEL DIAMOND METAL CUT,272,RC,,,,,,,,both,,,1138.2200,170.7300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,528.13,,,,,,,293.7700,1138.2200,percent of total billed charges,"46.4% of $1,138.22 in Billed Charges for Rev 272 = $528.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE-WHEEL DIAMOND METAL CUT,272,RC,,,,,,,,both,,,1138.2200,170.7300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,474.64,,,,,,,293.7700,1138.2200,percent of total billed charges,"41.7% of $1,138.22 in Billed Charges for Rev 272 = $474.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE-WHEEL DIAMOND METAL CUT,272,RC,,,,,,,,both,,,1138.2200,170.7300,CIGNA HEALTHCARE,CIGNA PPO,474.64,,,,,,,293.7700,1138.2200,percent of total billed charges,"41.7% of $1,138.22 in Billed Charges for Rev 272 = $474.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE-WHEEL DIAMOND METAL CUT,272,RC,,,,,,,,both,,,1138.2200,170.7300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1024.40,,,,,,,293.7700,1138.2200,percent of total billed charges,"90% of $1,138.22 in Billed Charges for Rev 272 = $1,024.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE-WHEEL DIAMOND METAL CUT,272,RC,,,,,,,,both,,,1138.2200,170.7300,MEDCOST,MEDCOST VHN,541.68,,,,,,,293.7700,1138.2200,percent of total billed charges,"47.59% of $1,138.22 in Billed Charges for Rev 272 = $541.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE-WHEEL DIAMOND METAL CUT,272,RC,,,,,,,,both,,,1138.2200,170.7300,SENTARA HEALTH,SENTARA HEALTH,293.77,,,,,,,293.7700,1138.2200,percent of total billed charges,"25.81% of $1,138.22 in Billed Charges for Rev 272 = $293.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE-WHEEL DIAMOND METAL CUT,272,RC,,,,,,,,both,,,1138.2200,170.7300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1138.22,,,,,,,293.7700,1138.2200,percent of total billed charges,"100% of $1,138.22 in Billed Charges for Rev 272 = $1,138.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE-WHEEL DIAMOND METAL CUT,272,RC,,,,,,,,both,,,1138.2200,170.7300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,569.11,,,,,,,293.7700,1138.2200,percent of total billed charges,"Rev 272 $1,138.22 in Billed Charges at 50% = $569.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE-WHEEL DIAMOND METAL CUT,272,RC,,,,,,,,both,,,1138.2200,170.7300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,367.65,,,,,,,293.7700,1138.2200,other,"32.3% of $1,138.22 in Billed Charges for Rev 272 = $367.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE-WHEEL DIAMOND METAL CUT,272,RC,,,,,,,,both,,,1138.2200,170.7300,UNITED HEALTHCARE,UHC HERITAGE SELECT,349.43,,,,,,,293.7700,1138.2200,other,"30.7% of $1,138.22 in Billed Charges for Rev 272 = $349.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE-WHEEL DIAMOND METAL CUT,272,RC,,,,,,,,both,,,1138.2200,170.7300,UNITED HEALTHCARE,UNITED HEALTHCARE,367.65,,,,,,,293.7700,1138.2200,percent of total billed charges,"32.3% of $1,138.22 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE-WHEEL DIAMOND METAL CUT,272,RC,,,,,,,,both,,,1138.2200,170.7300,WELLCARE,WELLCARE MEDICAID,1138.22,,,,,,,293.7700,1138.2200,percent of total billed charges,"100% of $1,138.22 in Billed Charges for Rev 272 = $1,138.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLOWER MISTER AXIUS,272,RC,27200002,CDM,,,,,,both,,,645.3700,96.8100,AETNA,AETNA,275.57,,,,,,,166.5700,645.3700,percent of total billed charges,42.7% of $645.37 in Billed Charges for Rev 272 = $275.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLOWER MISTER AXIUS,272,RC,27200002,CDM,,,,,,both,,,645.3700,96.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,451.76,,,,,,,166.5700,645.3700,percent of total billed charges,Rev 272 $645.37 in Billed Charges at 70% = $451.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLOWER MISTER AXIUS,272,RC,27200002,CDM,,,,,,both,,,645.3700,96.8100,CIGNA HEALTHCARE,CIGNA HMO,269.12,,,,,,,166.5700,645.3700,percent of total billed charges,41.7% of $645.37 in Billed Charges for Rev 272 = $269.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLOWER MISTER AXIUS,272,RC,27200002,CDM,,,,,,both,,,645.3700,96.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,299.45,,,,,,,166.5700,645.3700,percent of total billed charges,46.4% of $645.37 in Billed Charges for Rev 272 = $299.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLOWER MISTER AXIUS,272,RC,27200002,CDM,,,,,,both,,,645.3700,96.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,269.12,,,,,,,166.5700,645.3700,percent of total billed charges,41.7% of $645.37 in Billed Charges for Rev 272 = $269.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLOWER MISTER AXIUS,272,RC,27200002,CDM,,,,,,both,,,645.3700,96.8100,CIGNA HEALTHCARE,CIGNA PPO,269.12,,,,,,,166.5700,645.3700,percent of total billed charges,41.7% of $645.37 in Billed Charges for Rev 272 = $269.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLOWER MISTER AXIUS,272,RC,27200002,CDM,,,,,,both,,,645.3700,96.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,580.83,,,,,,,166.5700,645.3700,percent of total billed charges,90% of $645.37 in Billed Charges for Rev 272 = $580.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLOWER MISTER AXIUS,272,RC,27200002,CDM,,,,,,both,,,645.3700,96.8100,MEDCOST,MEDCOST VHN,307.13,,,,,,,166.5700,645.3700,percent of total billed charges,47.59% of $645.37 in Billed Charges for Rev 272 = $307.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLOWER MISTER AXIUS,272,RC,27200002,CDM,,,,,,both,,,645.3700,96.8100,SENTARA HEALTH,SENTARA HEALTH,166.57,,,,,,,166.5700,645.3700,percent of total billed charges,25.81% of $645.37 in Billed Charges for Rev 272 = $166.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLOWER MISTER AXIUS,272,RC,27200002,CDM,,,,,,both,,,645.3700,96.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",645.37,,,,,,,166.5700,645.3700,percent of total billed charges,100% of $645.37 in Billed Charges for Rev 272 = $645.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLOWER MISTER AXIUS,272,RC,27200002,CDM,,,,,,both,,,645.3700,96.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,322.69,,,,,,,166.5700,645.3700,percent of total billed charges,Rev 272 $645.37 in Billed Charges at 50% = $322.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLOWER MISTER AXIUS,272,RC,27200002,CDM,,,,,,both,,,645.3700,96.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,208.45,,,,,,,166.5700,645.3700,other,32.3% of $645.37 in Billed Charges for Rev 272 = $208.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLOWER MISTER AXIUS,272,RC,27200002,CDM,,,,,,both,,,645.3700,96.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,198.13,,,,,,,166.5700,645.3700,other,30.7% of $645.37 in Billed Charges for Rev 272 = $198.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLOWER MISTER AXIUS,272,RC,27200002,CDM,,,,,,both,,,645.3700,96.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,208.45,,,,,,,166.5700,645.3700,percent of total billed charges,32.3% of $645.37 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLOWER MISTER AXIUS,272,RC,27200002,CDM,,,,,,both,,,645.3700,96.8100,WELLCARE,WELLCARE MEDICAID,645.37,,,,,,,166.5700,645.3700,percent of total billed charges,100% of $645.37 in Billed Charges for Rev 272 = $645.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BOLT ATTACHMENT,272,RC,,,,,,,,both,,,5250.0100,787.5000,AETNA,AETNA,2241.75,,,,,,,1355.0300,5250.0100,percent of total billed charges,"42.7% of $5,250.01 in Billed Charges for Rev 272 = $2,241.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BOLT ATTACHMENT,272,RC,,,,,,,,both,,,5250.0100,787.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3675.01,,,,,,,1355.0300,5250.0100,percent of total billed charges,"Rev 272 $5,250.01 in Billed Charges at 70% = $3,675.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BOLT ATTACHMENT,272,RC,,,,,,,,both,,,5250.0100,787.5000,CIGNA HEALTHCARE,CIGNA HMO,2189.25,,,,,,,1355.0300,5250.0100,percent of total billed charges,"41.7% of $5,250.01 in Billed Charges for Rev 272 = $2,189.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BOLT ATTACHMENT,272,RC,,,,,,,,both,,,5250.0100,787.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2436.00,,,,,,,1355.0300,5250.0100,percent of total billed charges,"46.4% of $5,250.01 in Billed Charges for Rev 272 = $2,436.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BOLT ATTACHMENT,272,RC,,,,,,,,both,,,5250.0100,787.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2189.25,,,,,,,1355.0300,5250.0100,percent of total billed charges,"41.7% of $5,250.01 in Billed Charges for Rev 272 = $2,189.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BOLT ATTACHMENT,272,RC,,,,,,,,both,,,5250.0100,787.5000,CIGNA HEALTHCARE,CIGNA PPO,2189.25,,,,,,,1355.0300,5250.0100,percent of total billed charges,"41.7% of $5,250.01 in Billed Charges for Rev 272 = $2,189.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BOLT ATTACHMENT,272,RC,,,,,,,,both,,,5250.0100,787.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4725.01,,,,,,,1355.0300,5250.0100,percent of total billed charges,"90% of $5,250.01 in Billed Charges for Rev 272 = $4,725.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BOLT ATTACHMENT,272,RC,,,,,,,,both,,,5250.0100,787.5000,MEDCOST,MEDCOST VHN,2498.48,,,,,,,1355.0300,5250.0100,percent of total billed charges,"47.59% of $5,250.01 in Billed Charges for Rev 272 = $2,498.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BOLT ATTACHMENT,272,RC,,,,,,,,both,,,5250.0100,787.5000,SENTARA HEALTH,SENTARA HEALTH,1355.03,,,,,,,1355.0300,5250.0100,percent of total billed charges,"25.81% of $5,250.01 in Billed Charges for Rev 272 = $1,355.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BOLT ATTACHMENT,272,RC,,,,,,,,both,,,5250.0100,787.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5250.01,,,,,,,1355.0300,5250.0100,percent of total billed charges,"100% of $5,250.01 in Billed Charges for Rev 272 = $5,250.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BOLT ATTACHMENT,272,RC,,,,,,,,both,,,5250.0100,787.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2625.01,,,,,,,1355.0300,5250.0100,percent of total billed charges,"Rev 272 $5,250.01 in Billed Charges at 50% = $2,625.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BOLT ATTACHMENT,272,RC,,,,,,,,both,,,5250.0100,787.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1695.75,,,,,,,1355.0300,5250.0100,other,"32.3% of $5,250.01 in Billed Charges for Rev 272 = $1,695.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BOLT ATTACHMENT,272,RC,,,,,,,,both,,,5250.0100,787.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1611.75,,,,,,,1355.0300,5250.0100,other,"30.7% of $5,250.01 in Billed Charges for Rev 272 = $1,611.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BOLT ATTACHMENT,272,RC,,,,,,,,both,,,5250.0100,787.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,1695.75,,,,,,,1355.0300,5250.0100,percent of total billed charges,"32.3% of $5,250.01 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BOLT ATTACHMENT,272,RC,,,,,,,,both,,,5250.0100,787.5000,WELLCARE,WELLCARE MEDICAID,5250.01,,,,,,,1355.0300,5250.0100,percent of total billed charges,"100% of $5,250.01 in Billed Charges for Rev 272 = $5,250.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BOLT EXTRACT 6.5/7.0MM SCREWS,272,RC,,,,,,,,both,,,934.4300,140.1600,AETNA,AETNA,399.00,,,,,,,241.1800,934.4300,percent of total billed charges,42.7% of $934.43 in Billed Charges for Rev 272 = $399.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BOLT EXTRACT 6.5/7.0MM SCREWS,272,RC,,,,,,,,both,,,934.4300,140.1600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,654.10,,,,,,,241.1800,934.4300,percent of total billed charges,Rev 272 $934.43 in Billed Charges at 70% = $654.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BOLT EXTRACT 6.5/7.0MM SCREWS,272,RC,,,,,,,,both,,,934.4300,140.1600,CIGNA HEALTHCARE,CIGNA HMO,389.66,,,,,,,241.1800,934.4300,percent of total billed charges,41.7% of $934.43 in Billed Charges for Rev 272 = $389.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BOLT EXTRACT 6.5/7.0MM SCREWS,272,RC,,,,,,,,both,,,934.4300,140.1600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,433.58,,,,,,,241.1800,934.4300,percent of total billed charges,46.4% of $934.43 in Billed Charges for Rev 272 = $433.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BOLT EXTRACT 6.5/7.0MM SCREWS,272,RC,,,,,,,,both,,,934.4300,140.1600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,389.66,,,,,,,241.1800,934.4300,percent of total billed charges,41.7% of $934.43 in Billed Charges for Rev 272 = $389.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BOLT EXTRACT 6.5/7.0MM SCREWS,272,RC,,,,,,,,both,,,934.4300,140.1600,CIGNA HEALTHCARE,CIGNA PPO,389.66,,,,,,,241.1800,934.4300,percent of total billed charges,41.7% of $934.43 in Billed Charges for Rev 272 = $389.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BOLT EXTRACT 6.5/7.0MM SCREWS,272,RC,,,,,,,,both,,,934.4300,140.1600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,840.99,,,,,,,241.1800,934.4300,percent of total billed charges,90% of $934.43 in Billed Charges for Rev 272 = $840.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BOLT EXTRACT 6.5/7.0MM SCREWS,272,RC,,,,,,,,both,,,934.4300,140.1600,MEDCOST,MEDCOST VHN,444.70,,,,,,,241.1800,934.4300,percent of total billed charges,47.59% of $934.43 in Billed Charges for Rev 272 = $444.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BOLT EXTRACT 6.5/7.0MM SCREWS,272,RC,,,,,,,,both,,,934.4300,140.1600,SENTARA HEALTH,SENTARA HEALTH,241.18,,,,,,,241.1800,934.4300,percent of total billed charges,25.81% of $934.43 in Billed Charges for Rev 272 = $241.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BOLT EXTRACT 6.5/7.0MM SCREWS,272,RC,,,,,,,,both,,,934.4300,140.1600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",934.43,,,,,,,241.1800,934.4300,percent of total billed charges,100% of $934.43 in Billed Charges for Rev 272 = $934.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BOLT EXTRACT 6.5/7.0MM SCREWS,272,RC,,,,,,,,both,,,934.4300,140.1600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,467.22,,,,,,,241.1800,934.4300,percent of total billed charges,Rev 272 $934.43 in Billed Charges at 50% = $467.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BOLT EXTRACT 6.5/7.0MM SCREWS,272,RC,,,,,,,,both,,,934.4300,140.1600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,301.82,,,,,,,241.1800,934.4300,other,32.3% of $934.43 in Billed Charges for Rev 272 = $301.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BOLT EXTRACT 6.5/7.0MM SCREWS,272,RC,,,,,,,,both,,,934.4300,140.1600,UNITED HEALTHCARE,UHC HERITAGE SELECT,286.87,,,,,,,241.1800,934.4300,other,30.7% of $934.43 in Billed Charges for Rev 272 = $286.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BOLT EXTRACT 6.5/7.0MM SCREWS,272,RC,,,,,,,,both,,,934.4300,140.1600,UNITED HEALTHCARE,UNITED HEALTHCARE,301.82,,,,,,,241.1800,934.4300,percent of total billed charges,32.3% of $934.43 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BOLT EXTRACT 6.5/7.0MM SCREWS,272,RC,,,,,,,,both,,,934.4300,140.1600,WELLCARE,WELLCARE MEDICAID,934.43,,,,,,,241.1800,934.4300,percent of total billed charges,100% of $934.43 in Billed Charges for Rev 272 = $934.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BONE GRAFT HARVESTER OSTEOAUGER 8MM,272,RC,27200002,CDM,,,,,,both,,,6803.3800,1020.5100,AETNA,AETNA,2905.04,,,,,,,1755.9500,6803.3800,percent of total billed charges,"42.7% of $6,803.38 in Billed Charges for Rev 272 = $2,905.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT HARVESTER OSTEOAUGER 8MM,272,RC,27200002,CDM,,,,,,both,,,6803.3800,1020.5100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4762.37,,,,,,,1755.9500,6803.3800,percent of total billed charges,"Rev 272 $6,803.38 in Billed Charges at 70% = $4,762.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT HARVESTER OSTEOAUGER 8MM,272,RC,27200002,CDM,,,,,,both,,,6803.3800,1020.5100,CIGNA HEALTHCARE,CIGNA HMO,2837.01,,,,,,,1755.9500,6803.3800,percent of total billed charges,"41.7% of $6,803.38 in Billed Charges for Rev 272 = $2,837.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT HARVESTER OSTEOAUGER 8MM,272,RC,27200002,CDM,,,,,,both,,,6803.3800,1020.5100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3156.77,,,,,,,1755.9500,6803.3800,percent of total billed charges,"46.4% of $6,803.38 in Billed Charges for Rev 272 = $3,156.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT HARVESTER OSTEOAUGER 8MM,272,RC,27200002,CDM,,,,,,both,,,6803.3800,1020.5100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2837.01,,,,,,,1755.9500,6803.3800,percent of total billed charges,"41.7% of $6,803.38 in Billed Charges for Rev 272 = $2,837.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT HARVESTER OSTEOAUGER 8MM,272,RC,27200002,CDM,,,,,,both,,,6803.3800,1020.5100,CIGNA HEALTHCARE,CIGNA PPO,2837.01,,,,,,,1755.9500,6803.3800,percent of total billed charges,"41.7% of $6,803.38 in Billed Charges for Rev 272 = $2,837.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT HARVESTER OSTEOAUGER 8MM,272,RC,27200002,CDM,,,,,,both,,,6803.3800,1020.5100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6123.04,,,,,,,1755.9500,6803.3800,percent of total billed charges,"90% of $6,803.38 in Billed Charges for Rev 272 = $6,123.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT HARVESTER OSTEOAUGER 8MM,272,RC,27200002,CDM,,,,,,both,,,6803.3800,1020.5100,MEDCOST,MEDCOST VHN,3237.73,,,,,,,1755.9500,6803.3800,percent of total billed charges,"47.59% of $6,803.38 in Billed Charges for Rev 272 = $3,237.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT HARVESTER OSTEOAUGER 8MM,272,RC,27200002,CDM,,,,,,both,,,6803.3800,1020.5100,SENTARA HEALTH,SENTARA HEALTH,1755.95,,,,,,,1755.9500,6803.3800,percent of total billed charges,"25.81% of $6,803.38 in Billed Charges for Rev 272 = $1,755.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT HARVESTER OSTEOAUGER 8MM,272,RC,27200002,CDM,,,,,,both,,,6803.3800,1020.5100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6803.38,,,,,,,1755.9500,6803.3800,percent of total billed charges,"100% of $6,803.38 in Billed Charges for Rev 272 = $6,803.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT HARVESTER OSTEOAUGER 8MM,272,RC,27200002,CDM,,,,,,both,,,6803.3800,1020.5100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3401.69,,,,,,,1755.9500,6803.3800,percent of total billed charges,"Rev 272 $6,803.38 in Billed Charges at 50% = $3,401.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT HARVESTER OSTEOAUGER 8MM,272,RC,27200002,CDM,,,,,,both,,,6803.3800,1020.5100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2197.49,,,,,,,1755.9500,6803.3800,other,"32.3% of $6,803.38 in Billed Charges for Rev 272 = $2,197.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BONE GRAFT HARVESTER OSTEOAUGER 8MM,272,RC,27200002,CDM,,,,,,both,,,6803.3800,1020.5100,UNITED HEALTHCARE,UHC HERITAGE SELECT,2088.64,,,,,,,1755.9500,6803.3800,other,"30.7% of $6,803.38 in Billed Charges for Rev 272 = $2,088.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BONE GRAFT HARVESTER OSTEOAUGER 8MM,272,RC,27200002,CDM,,,,,,both,,,6803.3800,1020.5100,UNITED HEALTHCARE,UNITED HEALTHCARE,2197.49,,,,,,,1755.9500,6803.3800,percent of total billed charges,"32.3% of $6,803.38 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT HARVESTER OSTEOAUGER 8MM,272,RC,27200002,CDM,,,,,,both,,,6803.3800,1020.5100,WELLCARE,WELLCARE MEDICAID,6803.38,,,,,,,1755.9500,6803.3800,percent of total billed charges,"100% of $6,803.38 in Billed Charges for Rev 272 = $6,803.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FUSTION ROTATABLE QUADCUT 4.3 X 13CM,272,RC,27200002,CDM,,,,,,both,,,5185.5000,777.8300,AETNA,AETNA,2214.21,,,,,,,1338.3800,5185.5000,percent of total billed charges,"42.7% of $5,185.50 in Billed Charges for Rev 272 = $2,214.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FUSTION ROTATABLE QUADCUT 4.3 X 13CM,272,RC,27200002,CDM,,,,,,both,,,5185.5000,777.8300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3629.85,,,,,,,1338.3800,5185.5000,percent of total billed charges,"Rev 272 $5,185.50 in Billed Charges at 70% = $3,629.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FUSTION ROTATABLE QUADCUT 4.3 X 13CM,272,RC,27200002,CDM,,,,,,both,,,5185.5000,777.8300,CIGNA HEALTHCARE,CIGNA HMO,2162.35,,,,,,,1338.3800,5185.5000,percent of total billed charges,"41.7% of $5,185.50 in Billed Charges for Rev 272 = $2,162.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FUSTION ROTATABLE QUADCUT 4.3 X 13CM,272,RC,27200002,CDM,,,,,,both,,,5185.5000,777.8300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2406.07,,,,,,,1338.3800,5185.5000,percent of total billed charges,"46.4% of $5,185.50 in Billed Charges for Rev 272 = $2,406.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FUSTION ROTATABLE QUADCUT 4.3 X 13CM,272,RC,27200002,CDM,,,,,,both,,,5185.5000,777.8300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2162.35,,,,,,,1338.3800,5185.5000,percent of total billed charges,"41.7% of $5,185.50 in Billed Charges for Rev 272 = $2,162.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FUSTION ROTATABLE QUADCUT 4.3 X 13CM,272,RC,27200002,CDM,,,,,,both,,,5185.5000,777.8300,CIGNA HEALTHCARE,CIGNA PPO,2162.35,,,,,,,1338.3800,5185.5000,percent of total billed charges,"41.7% of $5,185.50 in Billed Charges for Rev 272 = $2,162.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FUSTION ROTATABLE QUADCUT 4.3 X 13CM,272,RC,27200002,CDM,,,,,,both,,,5185.5000,777.8300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4666.95,,,,,,,1338.3800,5185.5000,percent of total billed charges,"90% of $5,185.50 in Billed Charges for Rev 272 = $4,666.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FUSTION ROTATABLE QUADCUT 4.3 X 13CM,272,RC,27200002,CDM,,,,,,both,,,5185.5000,777.8300,MEDCOST,MEDCOST VHN,2467.78,,,,,,,1338.3800,5185.5000,percent of total billed charges,"47.59% of $5,185.50 in Billed Charges for Rev 272 = $2,467.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FUSTION ROTATABLE QUADCUT 4.3 X 13CM,272,RC,27200002,CDM,,,,,,both,,,5185.5000,777.8300,SENTARA HEALTH,SENTARA HEALTH,1338.38,,,,,,,1338.3800,5185.5000,percent of total billed charges,"25.81% of $5,185.50 in Billed Charges for Rev 272 = $1,338.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FUSTION ROTATABLE QUADCUT 4.3 X 13CM,272,RC,27200002,CDM,,,,,,both,,,5185.5000,777.8300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5185.50,,,,,,,1338.3800,5185.5000,percent of total billed charges,"100% of $5,185.50 in Billed Charges for Rev 272 = $5,185.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FUSTION ROTATABLE QUADCUT 4.3 X 13CM,272,RC,27200002,CDM,,,,,,both,,,5185.5000,777.8300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2592.75,,,,,,,1338.3800,5185.5000,percent of total billed charges,"Rev 272 $5,185.50 in Billed Charges at 50% = $2,592.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FUSTION ROTATABLE QUADCUT 4.3 X 13CM,272,RC,27200002,CDM,,,,,,both,,,5185.5000,777.8300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1674.92,,,,,,,1338.3800,5185.5000,other,"32.3% of $5,185.50 in Billed Charges for Rev 272 = $1,674.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE FUSTION ROTATABLE QUADCUT 4.3 X 13CM,272,RC,27200002,CDM,,,,,,both,,,5185.5000,777.8300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1591.95,,,,,,,1338.3800,5185.5000,other,"30.7% of $5,185.50 in Billed Charges for Rev 272 = $1,591.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE FUSTION ROTATABLE QUADCUT 4.3 X 13CM,272,RC,27200002,CDM,,,,,,both,,,5185.5000,777.8300,UNITED HEALTHCARE,UNITED HEALTHCARE,1674.92,,,,,,,1338.3800,5185.5000,percent of total billed charges,"32.3% of $5,185.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE FUSTION ROTATABLE QUADCUT 4.3 X 13CM,272,RC,27200002,CDM,,,,,,both,,,5185.5000,777.8300,WELLCARE,WELLCARE MEDICAID,5185.50,,,,,,,1338.3800,5185.5000,percent of total billed charges,"100% of $5,185.50 in Billed Charges for Rev 272 = $5,185.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE HARMONIC SYNERGY DISSECTING HOOK SNGHK,272,RC,27200002,CDM,,,,,,both,,,2662.6500,399.4000,AETNA,AETNA,1136.95,,,,,,,687.2300,2662.6500,percent of total billed charges,"42.7% of $2,662.65 in Billed Charges for Rev 272 = $1,136.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE HARMONIC SYNERGY DISSECTING HOOK SNGHK,272,RC,27200002,CDM,,,,,,both,,,2662.6500,399.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1863.86,,,,,,,687.2300,2662.6500,percent of total billed charges,"Rev 272 $2,662.65 in Billed Charges at 70% = $1,863.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE HARMONIC SYNERGY DISSECTING HOOK SNGHK,272,RC,27200002,CDM,,,,,,both,,,2662.6500,399.4000,CIGNA HEALTHCARE,CIGNA HMO,1110.33,,,,,,,687.2300,2662.6500,percent of total billed charges,"41.7% of $2,662.65 in Billed Charges for Rev 272 = $1,110.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE HARMONIC SYNERGY DISSECTING HOOK SNGHK,272,RC,27200002,CDM,,,,,,both,,,2662.6500,399.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1235.47,,,,,,,687.2300,2662.6500,percent of total billed charges,"46.4% of $2,662.65 in Billed Charges for Rev 272 = $1,235.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE HARMONIC SYNERGY DISSECTING HOOK SNGHK,272,RC,27200002,CDM,,,,,,both,,,2662.6500,399.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1110.33,,,,,,,687.2300,2662.6500,percent of total billed charges,"41.7% of $2,662.65 in Billed Charges for Rev 272 = $1,110.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE HARMONIC SYNERGY DISSECTING HOOK SNGHK,272,RC,27200002,CDM,,,,,,both,,,2662.6500,399.4000,CIGNA HEALTHCARE,CIGNA PPO,1110.33,,,,,,,687.2300,2662.6500,percent of total billed charges,"41.7% of $2,662.65 in Billed Charges for Rev 272 = $1,110.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE HARMONIC SYNERGY DISSECTING HOOK SNGHK,272,RC,27200002,CDM,,,,,,both,,,2662.6500,399.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2396.39,,,,,,,687.2300,2662.6500,percent of total billed charges,"90% of $2,662.65 in Billed Charges for Rev 272 = $2,396.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE HARMONIC SYNERGY DISSECTING HOOK SNGHK,272,RC,27200002,CDM,,,,,,both,,,2662.6500,399.4000,MEDCOST,MEDCOST VHN,1267.16,,,,,,,687.2300,2662.6500,percent of total billed charges,"47.59% of $2,662.65 in Billed Charges for Rev 272 = $1,267.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE HARMONIC SYNERGY DISSECTING HOOK SNGHK,272,RC,27200002,CDM,,,,,,both,,,2662.6500,399.4000,SENTARA HEALTH,SENTARA HEALTH,687.23,,,,,,,687.2300,2662.6500,percent of total billed charges,"25.81% of $2,662.65 in Billed Charges for Rev 272 = $687.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE HARMONIC SYNERGY DISSECTING HOOK SNGHK,272,RC,27200002,CDM,,,,,,both,,,2662.6500,399.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2662.65,,,,,,,687.2300,2662.6500,percent of total billed charges,"100% of $2,662.65 in Billed Charges for Rev 272 = $2,662.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE HARMONIC SYNERGY DISSECTING HOOK SNGHK,272,RC,27200002,CDM,,,,,,both,,,2662.6500,399.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1331.33,,,,,,,687.2300,2662.6500,percent of total billed charges,"Rev 272 $2,662.65 in Billed Charges at 50% = $1,331.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE HARMONIC SYNERGY DISSECTING HOOK SNGHK,272,RC,27200002,CDM,,,,,,both,,,2662.6500,399.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,860.04,,,,,,,687.2300,2662.6500,other,"32.3% of $2,662.65 in Billed Charges for Rev 272 = $860.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE HARMONIC SYNERGY DISSECTING HOOK SNGHK,272,RC,27200002,CDM,,,,,,both,,,2662.6500,399.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,817.43,,,,,,,687.2300,2662.6500,other,"30.7% of $2,662.65 in Billed Charges for Rev 272 = $817.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE HARMONIC SYNERGY DISSECTING HOOK SNGHK,272,RC,27200002,CDM,,,,,,both,,,2662.6500,399.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,860.04,,,,,,,687.2300,2662.6500,percent of total billed charges,"32.3% of $2,662.65 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE HARMONIC SYNERGY DISSECTING HOOK SNGHK,272,RC,27200002,CDM,,,,,,both,,,2662.6500,399.4000,WELLCARE,WELLCARE MEDICAID,2662.65,,,,,,,687.2300,2662.6500,percent of total billed charges,"100% of $2,662.65 in Billed Charges for Rev 272 = $2,662.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD,272,RC,,,,,,,,both,,,2354.2200,353.1300,AETNA,AETNA,1005.25,,,,,,,607.6200,2354.2200,percent of total billed charges,"42.7% of $2,354.22 in Billed Charges for Rev 272 = $1,005.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD,272,RC,,,,,,,,both,,,2354.2200,353.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1647.95,,,,,,,607.6200,2354.2200,percent of total billed charges,"Rev 272 $2,354.22 in Billed Charges at 70% = $1,647.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD,272,RC,,,,,,,,both,,,2354.2200,353.1300,CIGNA HEALTHCARE,CIGNA HMO,981.71,,,,,,,607.6200,2354.2200,percent of total billed charges,"41.7% of $2,354.22 in Billed Charges for Rev 272 = $981.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD,272,RC,,,,,,,,both,,,2354.2200,353.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1092.36,,,,,,,607.6200,2354.2200,percent of total billed charges,"46.4% of $2,354.22 in Billed Charges for Rev 272 = $1,092.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD,272,RC,,,,,,,,both,,,2354.2200,353.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,981.71,,,,,,,607.6200,2354.2200,percent of total billed charges,"41.7% of $2,354.22 in Billed Charges for Rev 272 = $981.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD,272,RC,,,,,,,,both,,,2354.2200,353.1300,CIGNA HEALTHCARE,CIGNA PPO,981.71,,,,,,,607.6200,2354.2200,percent of total billed charges,"41.7% of $2,354.22 in Billed Charges for Rev 272 = $981.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD,272,RC,,,,,,,,both,,,2354.2200,353.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2118.80,,,,,,,607.6200,2354.2200,percent of total billed charges,"90% of $2,354.22 in Billed Charges for Rev 272 = $2,118.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD,272,RC,,,,,,,,both,,,2354.2200,353.1300,MEDCOST,MEDCOST VHN,1120.37,,,,,,,607.6200,2354.2200,percent of total billed charges,"47.59% of $2,354.22 in Billed Charges for Rev 272 = $1,120.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD,272,RC,,,,,,,,both,,,2354.2200,353.1300,SENTARA HEALTH,SENTARA HEALTH,607.62,,,,,,,607.6200,2354.2200,percent of total billed charges,"25.81% of $2,354.22 in Billed Charges for Rev 272 = $607.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD,272,RC,,,,,,,,both,,,2354.2200,353.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2354.22,,,,,,,607.6200,2354.2200,percent of total billed charges,"100% of $2,354.22 in Billed Charges for Rev 272 = $2,354.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD,272,RC,,,,,,,,both,,,2354.2200,353.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1177.11,,,,,,,607.6200,2354.2200,percent of total billed charges,"Rev 272 $2,354.22 in Billed Charges at 50% = $1,177.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD,272,RC,,,,,,,,both,,,2354.2200,353.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,760.41,,,,,,,607.6200,2354.2200,other,"32.3% of $2,354.22 in Billed Charges for Rev 272 = $760.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR DIAMOND BALL STD,272,RC,,,,,,,,both,,,2354.2200,353.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,722.75,,,,,,,607.6200,2354.2200,other,"30.7% of $2,354.22 in Billed Charges for Rev 272 = $722.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR DIAMOND BALL STD,272,RC,,,,,,,,both,,,2354.2200,353.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,760.41,,,,,,,607.6200,2354.2200,percent of total billed charges,"32.3% of $2,354.22 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD,272,RC,,,,,,,,both,,,2354.2200,353.1300,WELLCARE,WELLCARE MEDICAID,2354.22,,,,,,,607.6200,2354.2200,percent of total billed charges,"100% of $2,354.22 in Billed Charges for Rev 272 = $2,354.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD 2MM,272,RC,,,,,,,,both,,,2094.9400,314.2400,AETNA,AETNA,894.54,,,,,,,540.7000,2094.9400,percent of total billed charges,"42.7% of $2,094.94 in Billed Charges for Rev 272 = $894.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD 2MM,272,RC,,,,,,,,both,,,2094.9400,314.2400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1466.46,,,,,,,540.7000,2094.9400,percent of total billed charges,"Rev 272 $2,094.94 in Billed Charges at 70% = $1,466.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD 2MM,272,RC,,,,,,,,both,,,2094.9400,314.2400,CIGNA HEALTHCARE,CIGNA HMO,873.59,,,,,,,540.7000,2094.9400,percent of total billed charges,"41.7% of $2,094.94 in Billed Charges for Rev 272 = $873.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD 2MM,272,RC,,,,,,,,both,,,2094.9400,314.2400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,972.05,,,,,,,540.7000,2094.9400,percent of total billed charges,"46.4% of $2,094.94 in Billed Charges for Rev 272 = $972.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD 2MM,272,RC,,,,,,,,both,,,2094.9400,314.2400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,873.59,,,,,,,540.7000,2094.9400,percent of total billed charges,"41.7% of $2,094.94 in Billed Charges for Rev 272 = $873.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD 2MM,272,RC,,,,,,,,both,,,2094.9400,314.2400,CIGNA HEALTHCARE,CIGNA PPO,873.59,,,,,,,540.7000,2094.9400,percent of total billed charges,"41.7% of $2,094.94 in Billed Charges for Rev 272 = $873.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD 2MM,272,RC,,,,,,,,both,,,2094.9400,314.2400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1885.45,,,,,,,540.7000,2094.9400,percent of total billed charges,"90% of $2,094.94 in Billed Charges for Rev 272 = $1,885.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD 2MM,272,RC,,,,,,,,both,,,2094.9400,314.2400,MEDCOST,MEDCOST VHN,996.98,,,,,,,540.7000,2094.9400,percent of total billed charges,"47.59% of $2,094.94 in Billed Charges for Rev 272 = $996.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD 2MM,272,RC,,,,,,,,both,,,2094.9400,314.2400,SENTARA HEALTH,SENTARA HEALTH,540.70,,,,,,,540.7000,2094.9400,percent of total billed charges,"25.81% of $2,094.94 in Billed Charges for Rev 272 = $540.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD 2MM,272,RC,,,,,,,,both,,,2094.9400,314.2400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2094.94,,,,,,,540.7000,2094.9400,percent of total billed charges,"100% of $2,094.94 in Billed Charges for Rev 272 = $2,094.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD 2MM,272,RC,,,,,,,,both,,,2094.9400,314.2400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1047.47,,,,,,,540.7000,2094.9400,percent of total billed charges,"Rev 272 $2,094.94 in Billed Charges at 50% = $1,047.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD 2MM,272,RC,,,,,,,,both,,,2094.9400,314.2400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,676.67,,,,,,,540.7000,2094.9400,other,"32.3% of $2,094.94 in Billed Charges for Rev 272 = $676.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR DIAMOND BALL STD 2MM,272,RC,,,,,,,,both,,,2094.9400,314.2400,UNITED HEALTHCARE,UHC HERITAGE SELECT,643.15,,,,,,,540.7000,2094.9400,other,"30.7% of $2,094.94 in Billed Charges for Rev 272 = $643.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR DIAMOND BALL STD 2MM,272,RC,,,,,,,,both,,,2094.9400,314.2400,UNITED HEALTHCARE,UNITED HEALTHCARE,676.67,,,,,,,540.7000,2094.9400,percent of total billed charges,"32.3% of $2,094.94 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND BALL STD 2MM,272,RC,,,,,,,,both,,,2094.9400,314.2400,WELLCARE,WELLCARE MEDICAID,2094.94,,,,,,,540.7000,2094.9400,percent of total billed charges,"100% of $2,094.94 in Billed Charges for Rev 272 = $2,094.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR EGG 4.0MM,272,RC,27200002,CDM,,,,,,both,,,559.7200,83.9600,AETNA,AETNA,239.00,,,,,,,144.4600,559.7200,percent of total billed charges,42.7% of $559.72 in Billed Charges for Rev 272 = $239.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR EGG 4.0MM,272,RC,27200002,CDM,,,,,,both,,,559.7200,83.9600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,391.80,,,,,,,144.4600,559.7200,percent of total billed charges,Rev 272 $559.72 in Billed Charges at 70% = $391.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR EGG 4.0MM,272,RC,27200002,CDM,,,,,,both,,,559.7200,83.9600,CIGNA HEALTHCARE,CIGNA HMO,233.40,,,,,,,144.4600,559.7200,percent of total billed charges,41.7% of $559.72 in Billed Charges for Rev 272 = $233.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR EGG 4.0MM,272,RC,27200002,CDM,,,,,,both,,,559.7200,83.9600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,259.71,,,,,,,144.4600,559.7200,percent of total billed charges,46.4% of $559.72 in Billed Charges for Rev 272 = $259.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR EGG 4.0MM,272,RC,27200002,CDM,,,,,,both,,,559.7200,83.9600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,233.40,,,,,,,144.4600,559.7200,percent of total billed charges,41.7% of $559.72 in Billed Charges for Rev 272 = $233.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR EGG 4.0MM,272,RC,27200002,CDM,,,,,,both,,,559.7200,83.9600,CIGNA HEALTHCARE,CIGNA PPO,233.40,,,,,,,144.4600,559.7200,percent of total billed charges,41.7% of $559.72 in Billed Charges for Rev 272 = $233.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR EGG 4.0MM,272,RC,27200002,CDM,,,,,,both,,,559.7200,83.9600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,503.75,,,,,,,144.4600,559.7200,percent of total billed charges,90% of $559.72 in Billed Charges for Rev 272 = $503.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR EGG 4.0MM,272,RC,27200002,CDM,,,,,,both,,,559.7200,83.9600,MEDCOST,MEDCOST VHN,266.37,,,,,,,144.4600,559.7200,percent of total billed charges,47.59% of $559.72 in Billed Charges for Rev 272 = $266.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR EGG 4.0MM,272,RC,27200002,CDM,,,,,,both,,,559.7200,83.9600,SENTARA HEALTH,SENTARA HEALTH,144.46,,,,,,,144.4600,559.7200,percent of total billed charges,25.81% of $559.72 in Billed Charges for Rev 272 = $144.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR EGG 4.0MM,272,RC,27200002,CDM,,,,,,both,,,559.7200,83.9600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",559.72,,,,,,,144.4600,559.7200,percent of total billed charges,100% of $559.72 in Billed Charges for Rev 272 = $559.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR EGG 4.0MM,272,RC,27200002,CDM,,,,,,both,,,559.7200,83.9600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,279.86,,,,,,,144.4600,559.7200,percent of total billed charges,Rev 272 $559.72 in Billed Charges at 50% = $279.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR EGG 4.0MM,272,RC,27200002,CDM,,,,,,both,,,559.7200,83.9600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,180.79,,,,,,,144.4600,559.7200,other,32.3% of $559.72 in Billed Charges for Rev 272 = $180.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BURR EGG 4.0MM,272,RC,27200002,CDM,,,,,,both,,,559.7200,83.9600,UNITED HEALTHCARE,UHC HERITAGE SELECT,171.83,,,,,,,144.4600,559.7200,other,30.7% of $559.72 in Billed Charges for Rev 272 = $171.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BURR EGG 4.0MM,272,RC,27200002,CDM,,,,,,both,,,559.7200,83.9600,UNITED HEALTHCARE,UNITED HEALTHCARE,180.79,,,,,,,144.4600,559.7200,percent of total billed charges,32.3% of $559.72 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR EGG 4.0MM,272,RC,27200002,CDM,,,,,,both,,,559.7200,83.9600,WELLCARE,WELLCARE MEDICAID,559.72,,,,,,,144.4600,559.7200,percent of total billed charges,100% of $559.72 in Billed Charges for Rev 272 = $559.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR HOLE 12MM RESORVOIR,272,RC,,,,,,,,both,,,5308.7100,796.3100,AETNA,AETNA,2266.82,,,,,,,1370.1800,5308.7100,percent of total billed charges,"42.7% of $5,308.71 in Billed Charges for Rev 272 = $2,266.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR HOLE 12MM RESORVOIR,272,RC,,,,,,,,both,,,5308.7100,796.3100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3716.10,,,,,,,1370.1800,5308.7100,percent of total billed charges,"Rev 272 $5,308.71 in Billed Charges at 70% = $3,716.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR HOLE 12MM RESORVOIR,272,RC,,,,,,,,both,,,5308.7100,796.3100,CIGNA HEALTHCARE,CIGNA HMO,2213.73,,,,,,,1370.1800,5308.7100,percent of total billed charges,"41.7% of $5,308.71 in Billed Charges for Rev 272 = $2,213.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR HOLE 12MM RESORVOIR,272,RC,,,,,,,,both,,,5308.7100,796.3100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2463.24,,,,,,,1370.1800,5308.7100,percent of total billed charges,"46.4% of $5,308.71 in Billed Charges for Rev 272 = $2,463.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR HOLE 12MM RESORVOIR,272,RC,,,,,,,,both,,,5308.7100,796.3100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2213.73,,,,,,,1370.1800,5308.7100,percent of total billed charges,"41.7% of $5,308.71 in Billed Charges for Rev 272 = $2,213.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR HOLE 12MM RESORVOIR,272,RC,,,,,,,,both,,,5308.7100,796.3100,CIGNA HEALTHCARE,CIGNA PPO,2213.73,,,,,,,1370.1800,5308.7100,percent of total billed charges,"41.7% of $5,308.71 in Billed Charges for Rev 272 = $2,213.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR HOLE 12MM RESORVOIR,272,RC,,,,,,,,both,,,5308.7100,796.3100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4777.84,,,,,,,1370.1800,5308.7100,percent of total billed charges,"90% of $5,308.71 in Billed Charges for Rev 272 = $4,777.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR HOLE 12MM RESORVOIR,272,RC,,,,,,,,both,,,5308.7100,796.3100,MEDCOST,MEDCOST VHN,2526.42,,,,,,,1370.1800,5308.7100,percent of total billed charges,"47.59% of $5,308.71 in Billed Charges for Rev 272 = $2,526.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR HOLE 12MM RESORVOIR,272,RC,,,,,,,,both,,,5308.7100,796.3100,SENTARA HEALTH,SENTARA HEALTH,1370.18,,,,,,,1370.1800,5308.7100,percent of total billed charges,"25.81% of $5,308.71 in Billed Charges for Rev 272 = $1,370.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR HOLE 12MM RESORVOIR,272,RC,,,,,,,,both,,,5308.7100,796.3100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5308.71,,,,,,,1370.1800,5308.7100,percent of total billed charges,"100% of $5,308.71 in Billed Charges for Rev 272 = $5,308.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR HOLE 12MM RESORVOIR,272,RC,,,,,,,,both,,,5308.7100,796.3100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2654.36,,,,,,,1370.1800,5308.7100,percent of total billed charges,"Rev 272 $5,308.71 in Billed Charges at 50% = $2,654.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR HOLE 12MM RESORVOIR,272,RC,,,,,,,,both,,,5308.7100,796.3100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1714.71,,,,,,,1370.1800,5308.7100,other,"32.3% of $5,308.71 in Billed Charges for Rev 272 = $1,714.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR HOLE 12MM RESORVOIR,272,RC,,,,,,,,both,,,5308.7100,796.3100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1629.77,,,,,,,1370.1800,5308.7100,other,"30.7% of $5,308.71 in Billed Charges for Rev 272 = $1,629.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR HOLE 12MM RESORVOIR,272,RC,,,,,,,,both,,,5308.7100,796.3100,UNITED HEALTHCARE,UNITED HEALTHCARE,1714.71,,,,,,,1370.1800,5308.7100,percent of total billed charges,"32.3% of $5,308.71 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR HOLE 12MM RESORVOIR,272,RC,,,,,,,,both,,,5308.7100,796.3100,WELLCARE,WELLCARE MEDICAID,5308.71,,,,,,,1370.1800,5308.7100,percent of total billed charges,"100% of $5,308.71 in Billed Charges for Rev 272 = $5,308.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT 3.5MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2702.6800,405.4000,AETNA,AETNA,1154.04,,,,,,,697.5600,2702.6800,percent of total billed charges,"42.7% of $2,702.68 in Billed Charges for Rev 272 = $1,154.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT 3.5MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2702.6800,405.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1891.88,,,,,,,697.5600,2702.6800,percent of total billed charges,"Rev 272 $2,702.68 in Billed Charges at 70% = $1,891.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT 3.5MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2702.6800,405.4000,CIGNA HEALTHCARE,CIGNA HMO,1127.02,,,,,,,697.5600,2702.6800,percent of total billed charges,"41.7% of $2,702.68 in Billed Charges for Rev 272 = $1,127.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT 3.5MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2702.6800,405.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1254.04,,,,,,,697.5600,2702.6800,percent of total billed charges,"46.4% of $2,702.68 in Billed Charges for Rev 272 = $1,254.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT 3.5MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2702.6800,405.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1127.02,,,,,,,697.5600,2702.6800,percent of total billed charges,"41.7% of $2,702.68 in Billed Charges for Rev 272 = $1,127.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT 3.5MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2702.6800,405.4000,CIGNA HEALTHCARE,CIGNA PPO,1127.02,,,,,,,697.5600,2702.6800,percent of total billed charges,"41.7% of $2,702.68 in Billed Charges for Rev 272 = $1,127.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT 3.5MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2702.6800,405.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2432.41,,,,,,,697.5600,2702.6800,percent of total billed charges,"90% of $2,702.68 in Billed Charges for Rev 272 = $2,432.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT 3.5MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2702.6800,405.4000,MEDCOST,MEDCOST VHN,1286.21,,,,,,,697.5600,2702.6800,percent of total billed charges,"47.59% of $2,702.68 in Billed Charges for Rev 272 = $1,286.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT 3.5MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2702.6800,405.4000,SENTARA HEALTH,SENTARA HEALTH,697.56,,,,,,,697.5600,2702.6800,percent of total billed charges,"25.81% of $2,702.68 in Billed Charges for Rev 272 = $697.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT 3.5MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2702.6800,405.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2702.68,,,,,,,697.5600,2702.6800,percent of total billed charges,"100% of $2,702.68 in Billed Charges for Rev 272 = $2,702.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT 3.5MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2702.6800,405.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1351.34,,,,,,,697.5600,2702.6800,percent of total billed charges,"Rev 272 $2,702.68 in Billed Charges at 50% = $1,351.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT 3.5MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2702.6800,405.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,872.97,,,,,,,697.5600,2702.6800,other,"32.3% of $2,702.68 in Billed Charges for Rev 272 = $872.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE TRICUT 3.5MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2702.6800,405.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,829.72,,,,,,,697.5600,2702.6800,other,"30.7% of $2,702.68 in Billed Charges for Rev 272 = $829.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE TRICUT 3.5MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2702.6800,405.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,872.97,,,,,,,697.5600,2702.6800,percent of total billed charges,"32.3% of $2,702.68 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT 3.5MM X 11CM,272,RC,27200002,CDM,,,,,,both,,,2702.6800,405.4000,WELLCARE,WELLCARE MEDICAID,2702.68,,,,,,,697.5600,2702.6800,percent of total billed charges,"100% of $2,702.68 in Billed Charges for Rev 272 = $2,702.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2829.2100,424.3800,AETNA,AETNA,1208.07,,,,,,,730.2200,2829.2100,percent of total billed charges,"42.7% of $2,829.21 in Billed Charges for Rev 272 = $1,208.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2829.2100,424.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1980.45,,,,,,,730.2200,2829.2100,percent of total billed charges,"Rev 272 $2,829.21 in Billed Charges at 70% = $1,980.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2829.2100,424.3800,CIGNA HEALTHCARE,CIGNA HMO,1179.78,,,,,,,730.2200,2829.2100,percent of total billed charges,"41.7% of $2,829.21 in Billed Charges for Rev 272 = $1,179.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2829.2100,424.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1312.75,,,,,,,730.2200,2829.2100,percent of total billed charges,"46.4% of $2,829.21 in Billed Charges for Rev 272 = $1,312.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2829.2100,424.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1179.78,,,,,,,730.2200,2829.2100,percent of total billed charges,"41.7% of $2,829.21 in Billed Charges for Rev 272 = $1,179.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2829.2100,424.3800,CIGNA HEALTHCARE,CIGNA PPO,1179.78,,,,,,,730.2200,2829.2100,percent of total billed charges,"41.7% of $2,829.21 in Billed Charges for Rev 272 = $1,179.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2829.2100,424.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2546.29,,,,,,,730.2200,2829.2100,percent of total billed charges,"90% of $2,829.21 in Billed Charges for Rev 272 = $2,546.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2829.2100,424.3800,MEDCOST,MEDCOST VHN,1346.42,,,,,,,730.2200,2829.2100,percent of total billed charges,"47.59% of $2,829.21 in Billed Charges for Rev 272 = $1,346.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2829.2100,424.3800,SENTARA HEALTH,SENTARA HEALTH,730.22,,,,,,,730.2200,2829.2100,percent of total billed charges,"25.81% of $2,829.21 in Billed Charges for Rev 272 = $730.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2829.2100,424.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2829.21,,,,,,,730.2200,2829.2100,percent of total billed charges,"100% of $2,829.21 in Billed Charges for Rev 272 = $2,829.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2829.2100,424.3800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1414.61,,,,,,,730.2200,2829.2100,percent of total billed charges,"Rev 272 $2,829.21 in Billed Charges at 50% = $1,414.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2829.2100,424.3800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,913.83,,,,,,,730.2200,2829.2100,other,"32.3% of $2,829.21 in Billed Charges for Rev 272 = $913.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE TRICUT ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2829.2100,424.3800,UNITED HEALTHCARE,UHC HERITAGE SELECT,868.57,,,,,,,730.2200,2829.2100,other,"30.7% of $2,829.21 in Billed Charges for Rev 272 = $868.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE TRICUT ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2829.2100,424.3800,UNITED HEALTHCARE,UNITED HEALTHCARE,913.83,,,,,,,730.2200,2829.2100,percent of total billed charges,"32.3% of $2,829.21 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT ROTATABLE 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2829.2100,424.3800,WELLCARE,WELLCARE MEDICAID,2829.21,,,,,,,730.2200,2829.2100,percent of total billed charges,"100% of $2,829.21 in Billed Charges for Rev 272 = $2,829.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT4.0 MM,272,RC,27200002,CDM,,,,,,both,,,2482.4000,372.3600,AETNA,AETNA,1059.98,,,,,,,640.7100,2482.4000,percent of total billed charges,"42.7% of $2,482.40 in Billed Charges for Rev 272 = $1,059.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT4.0 MM,272,RC,27200002,CDM,,,,,,both,,,2482.4000,372.3600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1737.68,,,,,,,640.7100,2482.4000,percent of total billed charges,"Rev 272 $2,482.40 in Billed Charges at 70% = $1,737.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT4.0 MM,272,RC,27200002,CDM,,,,,,both,,,2482.4000,372.3600,CIGNA HEALTHCARE,CIGNA HMO,1035.16,,,,,,,640.7100,2482.4000,percent of total billed charges,"41.7% of $2,482.40 in Billed Charges for Rev 272 = $1,035.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT4.0 MM,272,RC,27200002,CDM,,,,,,both,,,2482.4000,372.3600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1151.83,,,,,,,640.7100,2482.4000,percent of total billed charges,"46.4% of $2,482.40 in Billed Charges for Rev 272 = $1,151.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT4.0 MM,272,RC,27200002,CDM,,,,,,both,,,2482.4000,372.3600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1035.16,,,,,,,640.7100,2482.4000,percent of total billed charges,"41.7% of $2,482.40 in Billed Charges for Rev 272 = $1,035.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT4.0 MM,272,RC,27200002,CDM,,,,,,both,,,2482.4000,372.3600,CIGNA HEALTHCARE,CIGNA PPO,1035.16,,,,,,,640.7100,2482.4000,percent of total billed charges,"41.7% of $2,482.40 in Billed Charges for Rev 272 = $1,035.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT4.0 MM,272,RC,27200002,CDM,,,,,,both,,,2482.4000,372.3600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2234.16,,,,,,,640.7100,2482.4000,percent of total billed charges,"90% of $2,482.40 in Billed Charges for Rev 272 = $2,234.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT4.0 MM,272,RC,27200002,CDM,,,,,,both,,,2482.4000,372.3600,MEDCOST,MEDCOST VHN,1181.37,,,,,,,640.7100,2482.4000,percent of total billed charges,"47.59% of $2,482.40 in Billed Charges for Rev 272 = $1,181.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT4.0 MM,272,RC,27200002,CDM,,,,,,both,,,2482.4000,372.3600,SENTARA HEALTH,SENTARA HEALTH,640.71,,,,,,,640.7100,2482.4000,percent of total billed charges,"25.81% of $2,482.40 in Billed Charges for Rev 272 = $640.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT4.0 MM,272,RC,27200002,CDM,,,,,,both,,,2482.4000,372.3600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2482.40,,,,,,,640.7100,2482.4000,percent of total billed charges,"100% of $2,482.40 in Billed Charges for Rev 272 = $2,482.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT4.0 MM,272,RC,27200002,CDM,,,,,,both,,,2482.4000,372.3600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1241.20,,,,,,,640.7100,2482.4000,percent of total billed charges,"Rev 272 $2,482.40 in Billed Charges at 50% = $1,241.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT4.0 MM,272,RC,27200002,CDM,,,,,,both,,,2482.4000,372.3600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,801.82,,,,,,,640.7100,2482.4000,other,"32.3% of $2,482.40 in Billed Charges for Rev 272 = $801.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE TRICUT4.0 MM,272,RC,27200002,CDM,,,,,,both,,,2482.4000,372.3600,UNITED HEALTHCARE,UHC HERITAGE SELECT,762.10,,,,,,,640.7100,2482.4000,other,"30.7% of $2,482.40 in Billed Charges for Rev 272 = $762.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE TRICUT4.0 MM,272,RC,27200002,CDM,,,,,,both,,,2482.4000,372.3600,UNITED HEALTHCARE,UNITED HEALTHCARE,801.82,,,,,,,640.7100,2482.4000,percent of total billed charges,"32.3% of $2,482.40 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE TRICUT4.0 MM,272,RC,27200002,CDM,,,,,,both,,,2482.4000,372.3600,WELLCARE,WELLCARE MEDICAID,2482.40,,,,,,,640.7100,2482.4000,percent of total billed charges,"100% of $2,482.40 in Billed Charges for Rev 272 = $2,482.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCH HEAD 2.5MM PRECISION,272,RC,,,,,,,,both,,,3717.5900,557.6400,AETNA,AETNA,1587.41,,,,,,,959.5100,3717.5900,percent of total billed charges,"42.7% of $3,717.59 in Billed Charges for Rev 272 = $1,587.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCH HEAD 2.5MM PRECISION,272,RC,,,,,,,,both,,,3717.5900,557.6400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2602.31,,,,,,,959.5100,3717.5900,percent of total billed charges,"Rev 272 $3,717.59 in Billed Charges at 70% = $2,602.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCH HEAD 2.5MM PRECISION,272,RC,,,,,,,,both,,,3717.5900,557.6400,CIGNA HEALTHCARE,CIGNA HMO,1550.24,,,,,,,959.5100,3717.5900,percent of total billed charges,"41.7% of $3,717.59 in Billed Charges for Rev 272 = $1,550.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCH HEAD 2.5MM PRECISION,272,RC,,,,,,,,both,,,3717.5900,557.6400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1724.96,,,,,,,959.5100,3717.5900,percent of total billed charges,"46.4% of $3,717.59 in Billed Charges for Rev 272 = $1,724.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCH HEAD 2.5MM PRECISION,272,RC,,,,,,,,both,,,3717.5900,557.6400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1550.24,,,,,,,959.5100,3717.5900,percent of total billed charges,"41.7% of $3,717.59 in Billed Charges for Rev 272 = $1,550.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCH HEAD 2.5MM PRECISION,272,RC,,,,,,,,both,,,3717.5900,557.6400,CIGNA HEALTHCARE,CIGNA PPO,1550.24,,,,,,,959.5100,3717.5900,percent of total billed charges,"41.7% of $3,717.59 in Billed Charges for Rev 272 = $1,550.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCH HEAD 2.5MM PRECISION,272,RC,,,,,,,,both,,,3717.5900,557.6400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3345.83,,,,,,,959.5100,3717.5900,percent of total billed charges,"90% of $3,717.59 in Billed Charges for Rev 272 = $3,345.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCH HEAD 2.5MM PRECISION,272,RC,,,,,,,,both,,,3717.5900,557.6400,MEDCOST,MEDCOST VHN,1769.20,,,,,,,959.5100,3717.5900,percent of total billed charges,"47.59% of $3,717.59 in Billed Charges for Rev 272 = $1,769.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCH HEAD 2.5MM PRECISION,272,RC,,,,,,,,both,,,3717.5900,557.6400,SENTARA HEALTH,SENTARA HEALTH,959.51,,,,,,,959.5100,3717.5900,percent of total billed charges,"25.81% of $3,717.59 in Billed Charges for Rev 272 = $959.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCH HEAD 2.5MM PRECISION,272,RC,,,,,,,,both,,,3717.5900,557.6400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3717.59,,,,,,,959.5100,3717.5900,percent of total billed charges,"100% of $3,717.59 in Billed Charges for Rev 272 = $3,717.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCH HEAD 2.5MM PRECISION,272,RC,,,,,,,,both,,,3717.5900,557.6400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1858.80,,,,,,,959.5100,3717.5900,percent of total billed charges,"Rev 272 $3,717.59 in Billed Charges at 50% = $1,858.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCH HEAD 2.5MM PRECISION,272,RC,,,,,,,,both,,,3717.5900,557.6400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1200.78,,,,,,,959.5100,3717.5900,other,"32.3% of $3,717.59 in Billed Charges for Rev 272 = $1,200.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR MATCH HEAD 2.5MM PRECISION,272,RC,,,,,,,,both,,,3717.5900,557.6400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1141.30,,,,,,,959.5100,3717.5900,other,"30.7% of $3,717.59 in Billed Charges for Rev 272 = $1,141.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR MATCH HEAD 2.5MM PRECISION,272,RC,,,,,,,,both,,,3717.5900,557.6400,UNITED HEALTHCARE,UNITED HEALTHCARE,1200.78,,,,,,,959.5100,3717.5900,percent of total billed charges,"32.3% of $3,717.59 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCH HEAD 2.5MM PRECISION,272,RC,,,,,,,,both,,,3717.5900,557.6400,WELLCARE,WELLCARE MEDICAID,3717.59,,,,,,,959.5100,3717.5900,percent of total billed charges,"100% of $3,717.59 in Billed Charges for Rev 272 = $3,717.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHHEAD 3MM,272,RC,27200002,CDM,,,,,,both,,,1565.1900,234.7800,AETNA,AETNA,668.34,,,,,,,403.9800,1565.1900,percent of total billed charges,"42.7% of $1,565.19 in Billed Charges for Rev 272 = $668.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHHEAD 3MM,272,RC,27200002,CDM,,,,,,both,,,1565.1900,234.7800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1095.63,,,,,,,403.9800,1565.1900,percent of total billed charges,"Rev 272 $1,565.19 in Billed Charges at 70% = $1,095.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHHEAD 3MM,272,RC,27200002,CDM,,,,,,both,,,1565.1900,234.7800,CIGNA HEALTHCARE,CIGNA HMO,652.68,,,,,,,403.9800,1565.1900,percent of total billed charges,"41.7% of $1,565.19 in Billed Charges for Rev 272 = $652.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHHEAD 3MM,272,RC,27200002,CDM,,,,,,both,,,1565.1900,234.7800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,726.25,,,,,,,403.9800,1565.1900,percent of total billed charges,"46.4% of $1,565.19 in Billed Charges for Rev 272 = $726.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHHEAD 3MM,272,RC,27200002,CDM,,,,,,both,,,1565.1900,234.7800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,652.68,,,,,,,403.9800,1565.1900,percent of total billed charges,"41.7% of $1,565.19 in Billed Charges for Rev 272 = $652.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHHEAD 3MM,272,RC,27200002,CDM,,,,,,both,,,1565.1900,234.7800,CIGNA HEALTHCARE,CIGNA PPO,652.68,,,,,,,403.9800,1565.1900,percent of total billed charges,"41.7% of $1,565.19 in Billed Charges for Rev 272 = $652.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHHEAD 3MM,272,RC,27200002,CDM,,,,,,both,,,1565.1900,234.7800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1408.67,,,,,,,403.9800,1565.1900,percent of total billed charges,"90% of $1,565.19 in Billed Charges for Rev 272 = $1,408.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHHEAD 3MM,272,RC,27200002,CDM,,,,,,both,,,1565.1900,234.7800,MEDCOST,MEDCOST VHN,744.87,,,,,,,403.9800,1565.1900,percent of total billed charges,"47.59% of $1,565.19 in Billed Charges for Rev 272 = $744.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHHEAD 3MM,272,RC,27200002,CDM,,,,,,both,,,1565.1900,234.7800,SENTARA HEALTH,SENTARA HEALTH,403.98,,,,,,,403.9800,1565.1900,percent of total billed charges,"25.81% of $1,565.19 in Billed Charges for Rev 272 = $403.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHHEAD 3MM,272,RC,27200002,CDM,,,,,,both,,,1565.1900,234.7800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1565.19,,,,,,,403.9800,1565.1900,percent of total billed charges,"100% of $1,565.19 in Billed Charges for Rev 272 = $1,565.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHHEAD 3MM,272,RC,27200002,CDM,,,,,,both,,,1565.1900,234.7800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,782.60,,,,,,,403.9800,1565.1900,percent of total billed charges,"Rev 272 $1,565.19 in Billed Charges at 50% = $782.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHHEAD 3MM,272,RC,27200002,CDM,,,,,,both,,,1565.1900,234.7800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,505.56,,,,,,,403.9800,1565.1900,other,"32.3% of $1,565.19 in Billed Charges for Rev 272 = $505.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR MATCHHEAD 3MM,272,RC,27200002,CDM,,,,,,both,,,1565.1900,234.7800,UNITED HEALTHCARE,UHC HERITAGE SELECT,480.51,,,,,,,403.9800,1565.1900,other,"30.7% of $1,565.19 in Billed Charges for Rev 272 = $480.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR MATCHHEAD 3MM,272,RC,27200002,CDM,,,,,,both,,,1565.1900,234.7800,UNITED HEALTHCARE,UNITED HEALTHCARE,505.56,,,,,,,403.9800,1565.1900,percent of total billed charges,"32.3% of $1,565.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHHEAD 3MM,272,RC,27200002,CDM,,,,,,both,,,1565.1900,234.7800,WELLCARE,WELLCARE MEDICAID,1565.19,,,,,,,403.9800,1565.1900,percent of total billed charges,"100% of $1,565.19 in Billed Charges for Rev 272 = $1,565.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON DILATOR EZDILATE FIXED WIRE 13.5/14.5/15.5MM,272,RC,27200002,CDM,,,,,,both,,,1500.3700,225.0600,AETNA,AETNA,640.66,,,,,,,387.2500,1500.3700,percent of total billed charges,"42.7% of $1,500.37 in Billed Charges for Rev 272 = $640.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON DILATOR EZDILATE FIXED WIRE 13.5/14.5/15.5MM,272,RC,27200002,CDM,,,,,,both,,,1500.3700,225.0600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1050.26,,,,,,,387.2500,1500.3700,percent of total billed charges,"Rev 272 $1,500.37 in Billed Charges at 70% = $1,050.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON DILATOR EZDILATE FIXED WIRE 13.5/14.5/15.5MM,272,RC,27200002,CDM,,,,,,both,,,1500.3700,225.0600,CIGNA HEALTHCARE,CIGNA HMO,625.65,,,,,,,387.2500,1500.3700,percent of total billed charges,"41.7% of $1,500.37 in Billed Charges for Rev 272 = $625.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON DILATOR EZDILATE FIXED WIRE 13.5/14.5/15.5MM,272,RC,27200002,CDM,,,,,,both,,,1500.3700,225.0600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,696.17,,,,,,,387.2500,1500.3700,percent of total billed charges,"46.4% of $1,500.37 in Billed Charges for Rev 272 = $696.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON DILATOR EZDILATE FIXED WIRE 13.5/14.5/15.5MM,272,RC,27200002,CDM,,,,,,both,,,1500.3700,225.0600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,625.65,,,,,,,387.2500,1500.3700,percent of total billed charges,"41.7% of $1,500.37 in Billed Charges for Rev 272 = $625.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON DILATOR EZDILATE FIXED WIRE 13.5/14.5/15.5MM,272,RC,27200002,CDM,,,,,,both,,,1500.3700,225.0600,CIGNA HEALTHCARE,CIGNA PPO,625.65,,,,,,,387.2500,1500.3700,percent of total billed charges,"41.7% of $1,500.37 in Billed Charges for Rev 272 = $625.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON DILATOR EZDILATE FIXED WIRE 13.5/14.5/15.5MM,272,RC,27200002,CDM,,,,,,both,,,1500.3700,225.0600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1350.33,,,,,,,387.2500,1500.3700,percent of total billed charges,"90% of $1,500.37 in Billed Charges for Rev 272 = $1,350.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON DILATOR EZDILATE FIXED WIRE 13.5/14.5/15.5MM,272,RC,27200002,CDM,,,,,,both,,,1500.3700,225.0600,MEDCOST,MEDCOST VHN,714.03,,,,,,,387.2500,1500.3700,percent of total billed charges,"47.59% of $1,500.37 in Billed Charges for Rev 272 = $714.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON DILATOR EZDILATE FIXED WIRE 13.5/14.5/15.5MM,272,RC,27200002,CDM,,,,,,both,,,1500.3700,225.0600,SENTARA HEALTH,SENTARA HEALTH,387.25,,,,,,,387.2500,1500.3700,percent of total billed charges,"25.81% of $1,500.37 in Billed Charges for Rev 272 = $387.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON DILATOR EZDILATE FIXED WIRE 13.5/14.5/15.5MM,272,RC,27200002,CDM,,,,,,both,,,1500.3700,225.0600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1500.37,,,,,,,387.2500,1500.3700,percent of total billed charges,"100% of $1,500.37 in Billed Charges for Rev 272 = $1,500.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON DILATOR EZDILATE FIXED WIRE 13.5/14.5/15.5MM,272,RC,27200002,CDM,,,,,,both,,,1500.3700,225.0600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,750.19,,,,,,,387.2500,1500.3700,percent of total billed charges,"Rev 272 $1,500.37 in Billed Charges at 50% = $750.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON DILATOR EZDILATE FIXED WIRE 13.5/14.5/15.5MM,272,RC,27200002,CDM,,,,,,both,,,1500.3700,225.0600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,484.62,,,,,,,387.2500,1500.3700,other,"32.3% of $1,500.37 in Billed Charges for Rev 272 = $484.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BALLOON DILATOR EZDILATE FIXED WIRE 13.5/14.5/15.5MM,272,RC,27200002,CDM,,,,,,both,,,1500.3700,225.0600,UNITED HEALTHCARE,UHC HERITAGE SELECT,460.61,,,,,,,387.2500,1500.3700,other,"30.7% of $1,500.37 in Billed Charges for Rev 272 = $460.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BALLOON DILATOR EZDILATE FIXED WIRE 13.5/14.5/15.5MM,272,RC,27200002,CDM,,,,,,both,,,1500.3700,225.0600,UNITED HEALTHCARE,UNITED HEALTHCARE,484.62,,,,,,,387.2500,1500.3700,percent of total billed charges,"32.3% of $1,500.37 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON DILATOR EZDILATE FIXED WIRE 13.5/14.5/15.5MM,272,RC,27200002,CDM,,,,,,both,,,1500.3700,225.0600,WELLCARE,WELLCARE MEDICAID,1500.37,,,,,,,387.2500,1500.3700,percent of total billed charges,"100% of $1,500.37 in Billed Charges for Rev 272 = $1,500.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1566.0200,234.9000,AETNA,AETNA,668.69,,,,,,,404.1900,1566.0200,percent of total billed charges,"42.7% of $1,566.02 in Billed Charges for Rev 272 = $668.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1566.0200,234.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1096.21,,,,,,,404.1900,1566.0200,percent of total billed charges,"Rev 272 $1,566.02 in Billed Charges at 70% = $1,096.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1566.0200,234.9000,CIGNA HEALTHCARE,CIGNA HMO,653.03,,,,,,,404.1900,1566.0200,percent of total billed charges,"41.7% of $1,566.02 in Billed Charges for Rev 272 = $653.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1566.0200,234.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,726.63,,,,,,,404.1900,1566.0200,percent of total billed charges,"46.4% of $1,566.02 in Billed Charges for Rev 272 = $726.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1566.0200,234.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,653.03,,,,,,,404.1900,1566.0200,percent of total billed charges,"41.7% of $1,566.02 in Billed Charges for Rev 272 = $653.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1566.0200,234.9000,CIGNA HEALTHCARE,CIGNA PPO,653.03,,,,,,,404.1900,1566.0200,percent of total billed charges,"41.7% of $1,566.02 in Billed Charges for Rev 272 = $653.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1566.0200,234.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1409.42,,,,,,,404.1900,1566.0200,percent of total billed charges,"90% of $1,566.02 in Billed Charges for Rev 272 = $1,409.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1566.0200,234.9000,MEDCOST,MEDCOST VHN,745.27,,,,,,,404.1900,1566.0200,percent of total billed charges,"47.59% of $1,566.02 in Billed Charges for Rev 272 = $745.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1566.0200,234.9000,SENTARA HEALTH,SENTARA HEALTH,404.19,,,,,,,404.1900,1566.0200,percent of total billed charges,"25.81% of $1,566.02 in Billed Charges for Rev 272 = $404.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1566.0200,234.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1566.02,,,,,,,404.1900,1566.0200,percent of total billed charges,"100% of $1,566.02 in Billed Charges for Rev 272 = $1,566.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1566.0200,234.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,783.01,,,,,,,404.1900,1566.0200,percent of total billed charges,"Rev 272 $1,566.02 in Billed Charges at 50% = $783.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1566.0200,234.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,505.82,,,,,,,404.1900,1566.0200,other,"32.3% of $1,566.02 in Billed Charges for Rev 272 = $505.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1566.0200,234.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,480.77,,,,,,,404.1900,1566.0200,other,"30.7% of $1,566.02 in Billed Charges for Rev 272 = $480.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1566.0200,234.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,505.82,,,,,,,404.1900,1566.0200,percent of total billed charges,"32.3% of $1,566.02 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1566.0200,234.9000,WELLCARE,WELLCARE MEDICAID,1566.02,,,,,,,404.1900,1566.0200,percent of total billed charges,"100% of $1,566.02 in Billed Charges for Rev 272 = $1,566.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1731.9600,259.7900,AETNA,AETNA,739.55,,,,,,,447.0200,1731.9600,percent of total billed charges,"42.7% of $1,731.96 in Billed Charges for Rev 272 = $739.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1731.9600,259.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1212.37,,,,,,,447.0200,1731.9600,percent of total billed charges,"Rev 272 $1,731.96 in Billed Charges at 70% = $1,212.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1731.9600,259.7900,CIGNA HEALTHCARE,CIGNA HMO,722.23,,,,,,,447.0200,1731.9600,percent of total billed charges,"41.7% of $1,731.96 in Billed Charges for Rev 272 = $722.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1731.9600,259.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,803.63,,,,,,,447.0200,1731.9600,percent of total billed charges,"46.4% of $1,731.96 in Billed Charges for Rev 272 = $803.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1731.9600,259.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,722.23,,,,,,,447.0200,1731.9600,percent of total billed charges,"41.7% of $1,731.96 in Billed Charges for Rev 272 = $722.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1731.9600,259.7900,CIGNA HEALTHCARE,CIGNA PPO,722.23,,,,,,,447.0200,1731.9600,percent of total billed charges,"41.7% of $1,731.96 in Billed Charges for Rev 272 = $722.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1731.9600,259.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1558.76,,,,,,,447.0200,1731.9600,percent of total billed charges,"90% of $1,731.96 in Billed Charges for Rev 272 = $1,558.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1731.9600,259.7900,MEDCOST,MEDCOST VHN,824.24,,,,,,,447.0200,1731.9600,percent of total billed charges,"47.59% of $1,731.96 in Billed Charges for Rev 272 = $824.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1731.9600,259.7900,SENTARA HEALTH,SENTARA HEALTH,447.02,,,,,,,447.0200,1731.9600,percent of total billed charges,"25.81% of $1,731.96 in Billed Charges for Rev 272 = $447.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1731.9600,259.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1731.96,,,,,,,447.0200,1731.9600,percent of total billed charges,"100% of $1,731.96 in Billed Charges for Rev 272 = $1,731.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1731.9600,259.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,865.98,,,,,,,447.0200,1731.9600,percent of total billed charges,"Rev 272 $1,731.96 in Billed Charges at 50% = $865.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1731.9600,259.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,559.42,,,,,,,447.0200,1731.9600,other,"32.3% of $1,731.96 in Billed Charges for Rev 272 = $559.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1731.9600,259.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,531.71,,,,,,,447.0200,1731.9600,other,"30.7% of $1,731.96 in Billed Charges for Rev 272 = $531.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1731.9600,259.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,559.42,,,,,,,447.0200,1731.9600,percent of total billed charges,"32.3% of $1,731.96 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON ERCP FUSION,272,RC,27200002,CDM,,,,,,both,,,1731.9600,259.7900,WELLCARE,WELLCARE MEDICAID,1731.96,,,,,,,447.0200,1731.9600,percent of total billed charges,"100% of $1,731.96 in Billed Charges for Rev 272 = $1,731.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON EXTRACTION 15MM 1950MM 3 LUMEN DISTAL WIRE GUIDED SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1114.2600,167.1400,AETNA,AETNA,475.79,,,,,,,287.5900,1114.2600,percent of total billed charges,"42.7% of $1,114.26 in Billed Charges for Rev 272 = $475.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON EXTRACTION 15MM 1950MM 3 LUMEN DISTAL WIRE GUIDED SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1114.2600,167.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,779.98,,,,,,,287.5900,1114.2600,percent of total billed charges,"Rev 272 $1,114.26 in Billed Charges at 70% = $779.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON EXTRACTION 15MM 1950MM 3 LUMEN DISTAL WIRE GUIDED SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1114.2600,167.1400,CIGNA HEALTHCARE,CIGNA HMO,464.65,,,,,,,287.5900,1114.2600,percent of total billed charges,"41.7% of $1,114.26 in Billed Charges for Rev 272 = $464.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON EXTRACTION 15MM 1950MM 3 LUMEN DISTAL WIRE GUIDED SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1114.2600,167.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,517.02,,,,,,,287.5900,1114.2600,percent of total billed charges,"46.4% of $1,114.26 in Billed Charges for Rev 272 = $517.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON EXTRACTION 15MM 1950MM 3 LUMEN DISTAL WIRE GUIDED SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1114.2600,167.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,464.65,,,,,,,287.5900,1114.2600,percent of total billed charges,"41.7% of $1,114.26 in Billed Charges for Rev 272 = $464.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON EXTRACTION 15MM 1950MM 3 LUMEN DISTAL WIRE GUIDED SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1114.2600,167.1400,CIGNA HEALTHCARE,CIGNA PPO,464.65,,,,,,,287.5900,1114.2600,percent of total billed charges,"41.7% of $1,114.26 in Billed Charges for Rev 272 = $464.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON EXTRACTION 15MM 1950MM 3 LUMEN DISTAL WIRE GUIDED SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1114.2600,167.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1002.83,,,,,,,287.5900,1114.2600,percent of total billed charges,"90% of $1,114.26 in Billed Charges for Rev 272 = $1,002.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON EXTRACTION 15MM 1950MM 3 LUMEN DISTAL WIRE GUIDED SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1114.2600,167.1400,MEDCOST,MEDCOST VHN,530.28,,,,,,,287.5900,1114.2600,percent of total billed charges,"47.59% of $1,114.26 in Billed Charges for Rev 272 = $530.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON EXTRACTION 15MM 1950MM 3 LUMEN DISTAL WIRE GUIDED SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1114.2600,167.1400,SENTARA HEALTH,SENTARA HEALTH,287.59,,,,,,,287.5900,1114.2600,percent of total billed charges,"25.81% of $1,114.26 in Billed Charges for Rev 272 = $287.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON EXTRACTION 15MM 1950MM 3 LUMEN DISTAL WIRE GUIDED SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1114.2600,167.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1114.26,,,,,,,287.5900,1114.2600,percent of total billed charges,"100% of $1,114.26 in Billed Charges for Rev 272 = $1,114.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON EXTRACTION 15MM 1950MM 3 LUMEN DISTAL WIRE GUIDED SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1114.2600,167.1400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,557.13,,,,,,,287.5900,1114.2600,percent of total billed charges,"Rev 272 $1,114.26 in Billed Charges at 50% = $557.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON EXTRACTION 15MM 1950MM 3 LUMEN DISTAL WIRE GUIDED SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1114.2600,167.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,359.91,,,,,,,287.5900,1114.2600,other,"32.3% of $1,114.26 in Billed Charges for Rev 272 = $359.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BALLOON EXTRACTION 15MM 1950MM 3 LUMEN DISTAL WIRE GUIDED SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1114.2600,167.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,342.08,,,,,,,287.5900,1114.2600,other,"30.7% of $1,114.26 in Billed Charges for Rev 272 = $342.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BALLOON EXTRACTION 15MM 1950MM 3 LUMEN DISTAL WIRE GUIDED SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1114.2600,167.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,359.91,,,,,,,287.5900,1114.2600,percent of total billed charges,"32.3% of $1,114.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON EXTRACTION 15MM 1950MM 3 LUMEN DISTAL WIRE GUIDED SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1114.2600,167.1400,WELLCARE,WELLCARE MEDICAID,1114.26,,,,,,,287.5900,1114.2600,percent of total billed charges,"100% of $1,114.26 in Billed Charges for Rev 272 = $1,114.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON INFLATOR KIT,272,RC,27200002,CDM,,,,,,both,,,2318.9600,347.8400,AETNA,AETNA,990.20,,,,,,,598.5200,2318.9600,percent of total billed charges,"42.7% of $2,318.96 in Billed Charges for Rev 272 = $990.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON INFLATOR KIT,272,RC,27200002,CDM,,,,,,both,,,2318.9600,347.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1623.27,,,,,,,598.5200,2318.9600,percent of total billed charges,"Rev 272 $2,318.96 in Billed Charges at 70% = $1,623.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON INFLATOR KIT,272,RC,27200002,CDM,,,,,,both,,,2318.9600,347.8400,CIGNA HEALTHCARE,CIGNA HMO,967.01,,,,,,,598.5200,2318.9600,percent of total billed charges,"41.7% of $2,318.96 in Billed Charges for Rev 272 = $967.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON INFLATOR KIT,272,RC,27200002,CDM,,,,,,both,,,2318.9600,347.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1076.00,,,,,,,598.5200,2318.9600,percent of total billed charges,"46.4% of $2,318.96 in Billed Charges for Rev 272 = $1,076.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON INFLATOR KIT,272,RC,27200002,CDM,,,,,,both,,,2318.9600,347.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,967.01,,,,,,,598.5200,2318.9600,percent of total billed charges,"41.7% of $2,318.96 in Billed Charges for Rev 272 = $967.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON INFLATOR KIT,272,RC,27200002,CDM,,,,,,both,,,2318.9600,347.8400,CIGNA HEALTHCARE,CIGNA PPO,967.01,,,,,,,598.5200,2318.9600,percent of total billed charges,"41.7% of $2,318.96 in Billed Charges for Rev 272 = $967.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON INFLATOR KIT,272,RC,27200002,CDM,,,,,,both,,,2318.9600,347.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2087.06,,,,,,,598.5200,2318.9600,percent of total billed charges,"90% of $2,318.96 in Billed Charges for Rev 272 = $2,087.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON INFLATOR KIT,272,RC,27200002,CDM,,,,,,both,,,2318.9600,347.8400,MEDCOST,MEDCOST VHN,1103.59,,,,,,,598.5200,2318.9600,percent of total billed charges,"47.59% of $2,318.96 in Billed Charges for Rev 272 = $1,103.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON INFLATOR KIT,272,RC,27200002,CDM,,,,,,both,,,2318.9600,347.8400,SENTARA HEALTH,SENTARA HEALTH,598.52,,,,,,,598.5200,2318.9600,percent of total billed charges,"25.81% of $2,318.96 in Billed Charges for Rev 272 = $598.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON INFLATOR KIT,272,RC,27200002,CDM,,,,,,both,,,2318.9600,347.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2318.96,,,,,,,598.5200,2318.9600,percent of total billed charges,"100% of $2,318.96 in Billed Charges for Rev 272 = $2,318.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON INFLATOR KIT,272,RC,27200002,CDM,,,,,,both,,,2318.9600,347.8400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1159.48,,,,,,,598.5200,2318.9600,percent of total billed charges,"Rev 272 $2,318.96 in Billed Charges at 50% = $1,159.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON INFLATOR KIT,272,RC,27200002,CDM,,,,,,both,,,2318.9600,347.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,749.02,,,,,,,598.5200,2318.9600,other,"32.3% of $2,318.96 in Billed Charges for Rev 272 = $749.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BALLOON INFLATOR KIT,272,RC,27200002,CDM,,,,,,both,,,2318.9600,347.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,711.92,,,,,,,598.5200,2318.9600,other,"30.7% of $2,318.96 in Billed Charges for Rev 272 = $711.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BALLOON INFLATOR KIT,272,RC,27200002,CDM,,,,,,both,,,2318.9600,347.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,749.02,,,,,,,598.5200,2318.9600,percent of total billed charges,"32.3% of $2,318.96 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON INFLATOR KIT,272,RC,27200002,CDM,,,,,,both,,,2318.9600,347.8400,WELLCARE,WELLCARE MEDICAID,2318.96,,,,,,,598.5200,2318.9600,percent of total billed charges,"100% of $2,318.96 in Billed Charges for Rev 272 = $2,318.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON SYNFLATE MEDIUM ST,272,RC,,,,,,,,both,,,9458.3500,1418.7500,AETNA,AETNA,4038.72,,,,,,,2441.2000,9458.3500,percent of total billed charges,"42.7% of $9,458.35 in Billed Charges for Rev 272 = $4,038.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON SYNFLATE MEDIUM ST,272,RC,,,,,,,,both,,,9458.3500,1418.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6620.85,,,,,,,2441.2000,9458.3500,percent of total billed charges,"Rev 272 $9,458.35 in Billed Charges at 70% = $6,620.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON SYNFLATE MEDIUM ST,272,RC,,,,,,,,both,,,9458.3500,1418.7500,CIGNA HEALTHCARE,CIGNA HMO,3944.13,,,,,,,2441.2000,9458.3500,percent of total billed charges,"41.7% of $9,458.35 in Billed Charges for Rev 272 = $3,944.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON SYNFLATE MEDIUM ST,272,RC,,,,,,,,both,,,9458.3500,1418.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4388.67,,,,,,,2441.2000,9458.3500,percent of total billed charges,"46.4% of $9,458.35 in Billed Charges for Rev 272 = $4,388.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON SYNFLATE MEDIUM ST,272,RC,,,,,,,,both,,,9458.3500,1418.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3944.13,,,,,,,2441.2000,9458.3500,percent of total billed charges,"41.7% of $9,458.35 in Billed Charges for Rev 272 = $3,944.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON SYNFLATE MEDIUM ST,272,RC,,,,,,,,both,,,9458.3500,1418.7500,CIGNA HEALTHCARE,CIGNA PPO,3944.13,,,,,,,2441.2000,9458.3500,percent of total billed charges,"41.7% of $9,458.35 in Billed Charges for Rev 272 = $3,944.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON SYNFLATE MEDIUM ST,272,RC,,,,,,,,both,,,9458.3500,1418.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8512.52,,,,,,,2441.2000,9458.3500,percent of total billed charges,"90% of $9,458.35 in Billed Charges for Rev 272 = $8,512.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON SYNFLATE MEDIUM ST,272,RC,,,,,,,,both,,,9458.3500,1418.7500,MEDCOST,MEDCOST VHN,4501.23,,,,,,,2441.2000,9458.3500,percent of total billed charges,"47.59% of $9,458.35 in Billed Charges for Rev 272 = $4,501.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON SYNFLATE MEDIUM ST,272,RC,,,,,,,,both,,,9458.3500,1418.7500,SENTARA HEALTH,SENTARA HEALTH,2441.20,,,,,,,2441.2000,9458.3500,percent of total billed charges,"25.81% of $9,458.35 in Billed Charges for Rev 272 = $2,441.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON SYNFLATE MEDIUM ST,272,RC,,,,,,,,both,,,9458.3500,1418.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9458.35,,,,,,,2441.2000,9458.3500,percent of total billed charges,"100% of $9,458.35 in Billed Charges for Rev 272 = $9,458.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON SYNFLATE MEDIUM ST,272,RC,,,,,,,,both,,,9458.3500,1418.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4729.18,,,,,,,2441.2000,9458.3500,percent of total billed charges,"Rev 272 $9,458.35 in Billed Charges at 50% = $4,729.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON SYNFLATE MEDIUM ST,272,RC,,,,,,,,both,,,9458.3500,1418.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3055.05,,,,,,,2441.2000,9458.3500,other,"32.3% of $9,458.35 in Billed Charges for Rev 272 = $3,055.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BALLOON SYNFLATE MEDIUM ST,272,RC,,,,,,,,both,,,9458.3500,1418.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2903.71,,,,,,,2441.2000,9458.3500,other,"30.7% of $9,458.35 in Billed Charges for Rev 272 = $2,903.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BALLOON SYNFLATE MEDIUM ST,272,RC,,,,,,,,both,,,9458.3500,1418.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,3055.05,,,,,,,2441.2000,9458.3500,percent of total billed charges,"32.3% of $9,458.35 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON SYNFLATE MEDIUM ST,272,RC,,,,,,,,both,,,9458.3500,1418.7500,WELLCARE,WELLCARE MEDICAID,9458.35,,,,,,,2441.2000,9458.3500,percent of total billed charges,"100% of $9,458.35 in Billed Charges for Rev 272 = $9,458.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TRAPPER EXCHANGE,272,RC,27200002,CDM,,,,,,both,,,2852.0300,427.8000,AETNA,AETNA,1217.82,,,,,,,736.1100,2852.0300,percent of total billed charges,"42.7% of $2,852.03 in Billed Charges for Rev 272 = $1,217.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TRAPPER EXCHANGE,272,RC,27200002,CDM,,,,,,both,,,2852.0300,427.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1996.42,,,,,,,736.1100,2852.0300,percent of total billed charges,"Rev 272 $2,852.03 in Billed Charges at 70% = $1,996.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TRAPPER EXCHANGE,272,RC,27200002,CDM,,,,,,both,,,2852.0300,427.8000,CIGNA HEALTHCARE,CIGNA HMO,1189.30,,,,,,,736.1100,2852.0300,percent of total billed charges,"41.7% of $2,852.03 in Billed Charges for Rev 272 = $1,189.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TRAPPER EXCHANGE,272,RC,27200002,CDM,,,,,,both,,,2852.0300,427.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1323.34,,,,,,,736.1100,2852.0300,percent of total billed charges,"46.4% of $2,852.03 in Billed Charges for Rev 272 = $1,323.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TRAPPER EXCHANGE,272,RC,27200002,CDM,,,,,,both,,,2852.0300,427.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1189.30,,,,,,,736.1100,2852.0300,percent of total billed charges,"41.7% of $2,852.03 in Billed Charges for Rev 272 = $1,189.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TRAPPER EXCHANGE,272,RC,27200002,CDM,,,,,,both,,,2852.0300,427.8000,CIGNA HEALTHCARE,CIGNA PPO,1189.30,,,,,,,736.1100,2852.0300,percent of total billed charges,"41.7% of $2,852.03 in Billed Charges for Rev 272 = $1,189.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TRAPPER EXCHANGE,272,RC,27200002,CDM,,,,,,both,,,2852.0300,427.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2566.83,,,,,,,736.1100,2852.0300,percent of total billed charges,"90% of $2,852.03 in Billed Charges for Rev 272 = $2,566.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TRAPPER EXCHANGE,272,RC,27200002,CDM,,,,,,both,,,2852.0300,427.8000,MEDCOST,MEDCOST VHN,1357.28,,,,,,,736.1100,2852.0300,percent of total billed charges,"47.59% of $2,852.03 in Billed Charges for Rev 272 = $1,357.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TRAPPER EXCHANGE,272,RC,27200002,CDM,,,,,,both,,,2852.0300,427.8000,SENTARA HEALTH,SENTARA HEALTH,736.11,,,,,,,736.1100,2852.0300,percent of total billed charges,"25.81% of $2,852.03 in Billed Charges for Rev 272 = $736.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TRAPPER EXCHANGE,272,RC,27200002,CDM,,,,,,both,,,2852.0300,427.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2852.03,,,,,,,736.1100,2852.0300,percent of total billed charges,"100% of $2,852.03 in Billed Charges for Rev 272 = $2,852.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TRAPPER EXCHANGE,272,RC,27200002,CDM,,,,,,both,,,2852.0300,427.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1426.02,,,,,,,736.1100,2852.0300,percent of total billed charges,"Rev 272 $2,852.03 in Billed Charges at 50% = $1,426.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TRAPPER EXCHANGE,272,RC,27200002,CDM,,,,,,both,,,2852.0300,427.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,921.21,,,,,,,736.1100,2852.0300,other,"32.3% of $2,852.03 in Billed Charges for Rev 272 = $921.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BALLOON TRAPPER EXCHANGE,272,RC,27200002,CDM,,,,,,both,,,2852.0300,427.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,875.57,,,,,,,736.1100,2852.0300,other,"30.7% of $2,852.03 in Billed Charges for Rev 272 = $875.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BALLOON TRAPPER EXCHANGE,272,RC,27200002,CDM,,,,,,both,,,2852.0300,427.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,921.21,,,,,,,736.1100,2852.0300,percent of total billed charges,"32.3% of $2,852.03 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TRAPPER EXCHANGE,272,RC,27200002,CDM,,,,,,both,,,2852.0300,427.8000,WELLCARE,WELLCARE MEDICAID,2852.03,,,,,,,736.1100,2852.0300,percent of total billed charges,"100% of $2,852.03 in Billed Charges for Rev 272 = $2,852.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND TENSION FIBERTAPE CERCLEAGE SYSTEM,272,RC,27200002,CDM,,,,,,both,,,17205.4900,2580.8200,AETNA,AETNA,7346.74,,,,,,,4440.7400,17205.4900,percent of total billed charges,"42.7% of $17,205.49 in Billed Charges for Rev 272 = $7,346.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND TENSION FIBERTAPE CERCLEAGE SYSTEM,272,RC,27200002,CDM,,,,,,both,,,17205.4900,2580.8200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,12043.84,,,,,,,4440.7400,17205.4900,percent of total billed charges,"Rev 272 $17,205.49 in Billed Charges at 70% = $12,043.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND TENSION FIBERTAPE CERCLEAGE SYSTEM,272,RC,27200002,CDM,,,,,,both,,,17205.4900,2580.8200,CIGNA HEALTHCARE,CIGNA HMO,7174.69,,,,,,,4440.7400,17205.4900,percent of total billed charges,"41.7% of $17,205.49 in Billed Charges for Rev 272 = $7,174.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND TENSION FIBERTAPE CERCLEAGE SYSTEM,272,RC,27200002,CDM,,,,,,both,,,17205.4900,2580.8200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7983.35,,,,,,,4440.7400,17205.4900,percent of total billed charges,"46.4% of $17,205.49 in Billed Charges for Rev 272 = $7,983.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND TENSION FIBERTAPE CERCLEAGE SYSTEM,272,RC,27200002,CDM,,,,,,both,,,17205.4900,2580.8200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7174.69,,,,,,,4440.7400,17205.4900,percent of total billed charges,"41.7% of $17,205.49 in Billed Charges for Rev 272 = $7,174.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND TENSION FIBERTAPE CERCLEAGE SYSTEM,272,RC,27200002,CDM,,,,,,both,,,17205.4900,2580.8200,CIGNA HEALTHCARE,CIGNA PPO,7174.69,,,,,,,4440.7400,17205.4900,percent of total billed charges,"41.7% of $17,205.49 in Billed Charges for Rev 272 = $7,174.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND TENSION FIBERTAPE CERCLEAGE SYSTEM,272,RC,27200002,CDM,,,,,,both,,,17205.4900,2580.8200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,15484.94,,,,,,,4440.7400,17205.4900,percent of total billed charges,"90% of $17,205.49 in Billed Charges for Rev 272 = $15,484.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND TENSION FIBERTAPE CERCLEAGE SYSTEM,272,RC,27200002,CDM,,,,,,both,,,17205.4900,2580.8200,MEDCOST,MEDCOST VHN,8188.09,,,,,,,4440.7400,17205.4900,percent of total billed charges,"47.59% of $17,205.49 in Billed Charges for Rev 272 = $8,188.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND TENSION FIBERTAPE CERCLEAGE SYSTEM,272,RC,27200002,CDM,,,,,,both,,,17205.4900,2580.8200,SENTARA HEALTH,SENTARA HEALTH,4440.74,,,,,,,4440.7400,17205.4900,percent of total billed charges,"25.81% of $17,205.49 in Billed Charges for Rev 272 = $4,440.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND TENSION FIBERTAPE CERCLEAGE SYSTEM,272,RC,27200002,CDM,,,,,,both,,,17205.4900,2580.8200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",17205.49,,,,,,,4440.7400,17205.4900,percent of total billed charges,"100% of $17,205.49 in Billed Charges for Rev 272 = $17,205.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND TENSION FIBERTAPE CERCLEAGE SYSTEM,272,RC,27200002,CDM,,,,,,both,,,17205.4900,2580.8200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8602.75,,,,,,,4440.7400,17205.4900,percent of total billed charges,"Rev 272 $17,205.49 in Billed Charges at 50% = $8,602.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND TENSION FIBERTAPE CERCLEAGE SYSTEM,272,RC,27200002,CDM,,,,,,both,,,17205.4900,2580.8200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5557.37,,,,,,,4440.7400,17205.4900,other,"32.3% of $17,205.49 in Billed Charges for Rev 272 = $5,557.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BAND TENSION FIBERTAPE CERCLEAGE SYSTEM,272,RC,27200002,CDM,,,,,,both,,,17205.4900,2580.8200,UNITED HEALTHCARE,UHC HERITAGE SELECT,5282.09,,,,,,,4440.7400,17205.4900,other,"30.7% of $17,205.49 in Billed Charges for Rev 272 = $5,282.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BAND TENSION FIBERTAPE CERCLEAGE SYSTEM,272,RC,27200002,CDM,,,,,,both,,,17205.4900,2580.8200,UNITED HEALTHCARE,UNITED HEALTHCARE,5557.37,,,,,,,4440.7400,17205.4900,percent of total billed charges,"32.3% of $17,205.49 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND TENSION FIBERTAPE CERCLEAGE SYSTEM,272,RC,27200002,CDM,,,,,,both,,,17205.4900,2580.8200,WELLCARE,WELLCARE MEDICAID,17205.49,,,,,,,4440.7400,17205.4900,percent of total billed charges,"100% of $17,205.49 in Billed Charges for Rev 272 = $17,205.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLAZER 4MM LARGE CURVE,272,RC,,,,,,,,both,,,8898.3200,1334.7500,AETNA,AETNA,3799.58,,,,,,,2296.6600,8898.3200,percent of total billed charges,"42.7% of $8,898.32 in Billed Charges for Rev 272 = $3,799.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLAZER 4MM LARGE CURVE,272,RC,,,,,,,,both,,,8898.3200,1334.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6228.82,,,,,,,2296.6600,8898.3200,percent of total billed charges,"Rev 272 $8,898.32 in Billed Charges at 70% = $6,228.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLAZER 4MM LARGE CURVE,272,RC,,,,,,,,both,,,8898.3200,1334.7500,CIGNA HEALTHCARE,CIGNA HMO,3710.60,,,,,,,2296.6600,8898.3200,percent of total billed charges,"41.7% of $8,898.32 in Billed Charges for Rev 272 = $3,710.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLAZER 4MM LARGE CURVE,272,RC,,,,,,,,both,,,8898.3200,1334.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4128.82,,,,,,,2296.6600,8898.3200,percent of total billed charges,"46.4% of $8,898.32 in Billed Charges for Rev 272 = $4,128.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLAZER 4MM LARGE CURVE,272,RC,,,,,,,,both,,,8898.3200,1334.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3710.60,,,,,,,2296.6600,8898.3200,percent of total billed charges,"41.7% of $8,898.32 in Billed Charges for Rev 272 = $3,710.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLAZER 4MM LARGE CURVE,272,RC,,,,,,,,both,,,8898.3200,1334.7500,CIGNA HEALTHCARE,CIGNA PPO,3710.60,,,,,,,2296.6600,8898.3200,percent of total billed charges,"41.7% of $8,898.32 in Billed Charges for Rev 272 = $3,710.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLAZER 4MM LARGE CURVE,272,RC,,,,,,,,both,,,8898.3200,1334.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8008.49,,,,,,,2296.6600,8898.3200,percent of total billed charges,"90% of $8,898.32 in Billed Charges for Rev 272 = $8,008.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLAZER 4MM LARGE CURVE,272,RC,,,,,,,,both,,,8898.3200,1334.7500,MEDCOST,MEDCOST VHN,4234.71,,,,,,,2296.6600,8898.3200,percent of total billed charges,"47.59% of $8,898.32 in Billed Charges for Rev 272 = $4,234.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLAZER 4MM LARGE CURVE,272,RC,,,,,,,,both,,,8898.3200,1334.7500,SENTARA HEALTH,SENTARA HEALTH,2296.66,,,,,,,2296.6600,8898.3200,percent of total billed charges,"25.81% of $8,898.32 in Billed Charges for Rev 272 = $2,296.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLAZER 4MM LARGE CURVE,272,RC,,,,,,,,both,,,8898.3200,1334.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8898.32,,,,,,,2296.6600,8898.3200,percent of total billed charges,"100% of $8,898.32 in Billed Charges for Rev 272 = $8,898.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLAZER 4MM LARGE CURVE,272,RC,,,,,,,,both,,,8898.3200,1334.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4449.16,,,,,,,2296.6600,8898.3200,percent of total billed charges,"Rev 272 $8,898.32 in Billed Charges at 50% = $4,449.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLAZER 4MM LARGE CURVE,272,RC,,,,,,,,both,,,8898.3200,1334.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2874.16,,,,,,,2296.6600,8898.3200,other,"32.3% of $8,898.32 in Billed Charges for Rev 272 = $2,874.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLAZER 4MM LARGE CURVE,272,RC,,,,,,,,both,,,8898.3200,1334.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2731.78,,,,,,,2296.6600,8898.3200,other,"30.7% of $8,898.32 in Billed Charges for Rev 272 = $2,731.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLAZER 4MM LARGE CURVE,272,RC,,,,,,,,both,,,8898.3200,1334.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,2874.16,,,,,,,2296.6600,8898.3200,percent of total billed charges,"32.3% of $8,898.32 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLAZER 4MM LARGE CURVE,272,RC,,,,,,,,both,,,8898.3200,1334.7500,WELLCARE,WELLCARE MEDICAID,8898.32,,,,,,,2296.6600,8898.3200,percent of total billed charges,"100% of $8,898.32 in Billed Charges for Rev 272 = $8,898.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLOWER POWDER NOVATECH TALCAIR,272,RC,,,,,,,,both,,,544.4800,81.6700,AETNA,AETNA,232.49,,,,,,,140.5300,544.4800,percent of total billed charges,42.7% of $544.48 in Billed Charges for Rev 272 = $232.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLOWER POWDER NOVATECH TALCAIR,272,RC,,,,,,,,both,,,544.4800,81.6700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,381.14,,,,,,,140.5300,544.4800,percent of total billed charges,Rev 272 $544.48 in Billed Charges at 70% = $381.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLOWER POWDER NOVATECH TALCAIR,272,RC,,,,,,,,both,,,544.4800,81.6700,CIGNA HEALTHCARE,CIGNA HMO,227.05,,,,,,,140.5300,544.4800,percent of total billed charges,41.7% of $544.48 in Billed Charges for Rev 272 = $227.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLOWER POWDER NOVATECH TALCAIR,272,RC,,,,,,,,both,,,544.4800,81.6700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,252.64,,,,,,,140.5300,544.4800,percent of total billed charges,46.4% of $544.48 in Billed Charges for Rev 272 = $252.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLOWER POWDER NOVATECH TALCAIR,272,RC,,,,,,,,both,,,544.4800,81.6700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,227.05,,,,,,,140.5300,544.4800,percent of total billed charges,41.7% of $544.48 in Billed Charges for Rev 272 = $227.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLOWER POWDER NOVATECH TALCAIR,272,RC,,,,,,,,both,,,544.4800,81.6700,CIGNA HEALTHCARE,CIGNA PPO,227.05,,,,,,,140.5300,544.4800,percent of total billed charges,41.7% of $544.48 in Billed Charges for Rev 272 = $227.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLOWER POWDER NOVATECH TALCAIR,272,RC,,,,,,,,both,,,544.4800,81.6700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,490.03,,,,,,,140.5300,544.4800,percent of total billed charges,90% of $544.48 in Billed Charges for Rev 272 = $490.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLOWER POWDER NOVATECH TALCAIR,272,RC,,,,,,,,both,,,544.4800,81.6700,MEDCOST,MEDCOST VHN,259.12,,,,,,,140.5300,544.4800,percent of total billed charges,47.59% of $544.48 in Billed Charges for Rev 272 = $259.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLOWER POWDER NOVATECH TALCAIR,272,RC,,,,,,,,both,,,544.4800,81.6700,SENTARA HEALTH,SENTARA HEALTH,140.53,,,,,,,140.5300,544.4800,percent of total billed charges,25.81% of $544.48 in Billed Charges for Rev 272 = $140.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLOWER POWDER NOVATECH TALCAIR,272,RC,,,,,,,,both,,,544.4800,81.6700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",544.48,,,,,,,140.5300,544.4800,percent of total billed charges,100% of $544.48 in Billed Charges for Rev 272 = $544.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLOWER POWDER NOVATECH TALCAIR,272,RC,,,,,,,,both,,,544.4800,81.6700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,272.24,,,,,,,140.5300,544.4800,percent of total billed charges,Rev 272 $544.48 in Billed Charges at 50% = $272.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLOWER POWDER NOVATECH TALCAIR,272,RC,,,,,,,,both,,,544.4800,81.6700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,175.87,,,,,,,140.5300,544.4800,other,32.3% of $544.48 in Billed Charges for Rev 272 = $175.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLOWER POWDER NOVATECH TALCAIR,272,RC,,,,,,,,both,,,544.4800,81.6700,UNITED HEALTHCARE,UHC HERITAGE SELECT,167.16,,,,,,,140.5300,544.4800,other,30.7% of $544.48 in Billed Charges for Rev 272 = $167.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLOWER POWDER NOVATECH TALCAIR,272,RC,,,,,,,,both,,,544.4800,81.6700,UNITED HEALTHCARE,UNITED HEALTHCARE,175.87,,,,,,,140.5300,544.4800,percent of total billed charges,32.3% of $544.48 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLOWER POWDER NOVATECH TALCAIR,272,RC,,,,,,,,both,,,544.4800,81.6700,WELLCARE,WELLCARE MEDICAID,544.48,,,,,,,140.5300,544.4800,percent of total billed charges,100% of $544.48 in Billed Charges for Rev 272 = $544.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLUNT TIP SEALER DIVIDER LIGASURE 23CM,272,RC,27200002,CDM,,,,,,both,,,4394.7600,659.2100,AETNA,AETNA,1876.56,,,,,,,1134.2900,4394.7600,percent of total billed charges,"42.7% of $4,394.76 in Billed Charges for Rev 272 = $1,876.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLUNT TIP SEALER DIVIDER LIGASURE 23CM,272,RC,27200002,CDM,,,,,,both,,,4394.7600,659.2100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3076.33,,,,,,,1134.2900,4394.7600,percent of total billed charges,"Rev 272 $4,394.76 in Billed Charges at 70% = $3,076.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLUNT TIP SEALER DIVIDER LIGASURE 23CM,272,RC,27200002,CDM,,,,,,both,,,4394.7600,659.2100,CIGNA HEALTHCARE,CIGNA HMO,1832.61,,,,,,,1134.2900,4394.7600,percent of total billed charges,"41.7% of $4,394.76 in Billed Charges for Rev 272 = $1,832.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLUNT TIP SEALER DIVIDER LIGASURE 23CM,272,RC,27200002,CDM,,,,,,both,,,4394.7600,659.2100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2039.17,,,,,,,1134.2900,4394.7600,percent of total billed charges,"46.4% of $4,394.76 in Billed Charges for Rev 272 = $2,039.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLUNT TIP SEALER DIVIDER LIGASURE 23CM,272,RC,27200002,CDM,,,,,,both,,,4394.7600,659.2100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1832.61,,,,,,,1134.2900,4394.7600,percent of total billed charges,"41.7% of $4,394.76 in Billed Charges for Rev 272 = $1,832.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLUNT TIP SEALER DIVIDER LIGASURE 23CM,272,RC,27200002,CDM,,,,,,both,,,4394.7600,659.2100,CIGNA HEALTHCARE,CIGNA PPO,1832.61,,,,,,,1134.2900,4394.7600,percent of total billed charges,"41.7% of $4,394.76 in Billed Charges for Rev 272 = $1,832.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLUNT TIP SEALER DIVIDER LIGASURE 23CM,272,RC,27200002,CDM,,,,,,both,,,4394.7600,659.2100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3955.28,,,,,,,1134.2900,4394.7600,percent of total billed charges,"90% of $4,394.76 in Billed Charges for Rev 272 = $3,955.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLUNT TIP SEALER DIVIDER LIGASURE 23CM,272,RC,27200002,CDM,,,,,,both,,,4394.7600,659.2100,MEDCOST,MEDCOST VHN,2091.47,,,,,,,1134.2900,4394.7600,percent of total billed charges,"47.59% of $4,394.76 in Billed Charges for Rev 272 = $2,091.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLUNT TIP SEALER DIVIDER LIGASURE 23CM,272,RC,27200002,CDM,,,,,,both,,,4394.7600,659.2100,SENTARA HEALTH,SENTARA HEALTH,1134.29,,,,,,,1134.2900,4394.7600,percent of total billed charges,"25.81% of $4,394.76 in Billed Charges for Rev 272 = $1,134.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLUNT TIP SEALER DIVIDER LIGASURE 23CM,272,RC,27200002,CDM,,,,,,both,,,4394.7600,659.2100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4394.76,,,,,,,1134.2900,4394.7600,percent of total billed charges,"100% of $4,394.76 in Billed Charges for Rev 272 = $4,394.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLUNT TIP SEALER DIVIDER LIGASURE 23CM,272,RC,27200002,CDM,,,,,,both,,,4394.7600,659.2100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2197.38,,,,,,,1134.2900,4394.7600,percent of total billed charges,"Rev 272 $4,394.76 in Billed Charges at 50% = $2,197.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLUNT TIP SEALER DIVIDER LIGASURE 23CM,272,RC,27200002,CDM,,,,,,both,,,4394.7600,659.2100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1419.51,,,,,,,1134.2900,4394.7600,other,"32.3% of $4,394.76 in Billed Charges for Rev 272 = $1,419.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLUNT TIP SEALER DIVIDER LIGASURE 23CM,272,RC,27200002,CDM,,,,,,both,,,4394.7600,659.2100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1349.19,,,,,,,1134.2900,4394.7600,other,"30.7% of $4,394.76 in Billed Charges for Rev 272 = $1,349.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLUNT TIP SEALER DIVIDER LIGASURE 23CM,272,RC,27200002,CDM,,,,,,both,,,4394.7600,659.2100,UNITED HEALTHCARE,UNITED HEALTHCARE,1419.51,,,,,,,1134.2900,4394.7600,percent of total billed charges,"32.3% of $4,394.76 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLUNT TIP SEALER DIVIDER LIGASURE 23CM,272,RC,27200002,CDM,,,,,,both,,,4394.7600,659.2100,WELLCARE,WELLCARE MEDICAID,4394.76,,,,,,,1134.2900,4394.7600,percent of total billed charges,"100% of $4,394.76 in Billed Charges for Rev 272 = $4,394.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE CELLULAR VIVIGEN 15CC,278,RC,,,,,,,,both,,,43869.3300,6580.4000,AETNA,AETNA,21057.28,,,,,,,3114.7200,43869.3300,percent of total billed charges,"48% of $43,869.33 in Billed Charges for Rev 278 = $21,057.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE CELLULAR VIVIGEN 15CC,278,RC,,,,,,,,both,,,43869.3300,6580.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,21934.67,,,,,,,3114.7200,43869.3300,percent of total billed charges,"50% of $43,869.33 in Billed Charges for Rev 278 = $21,934.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE CELLULAR VIVIGEN 15CC,278,RC,,,,,,,,both,,,43869.3300,6580.4000,CIGNA HEALTHCARE,CIGNA HMO,18293.51,,,,,,,3114.7200,43869.3300,percent of total billed charges,"41.7% of $43,869.33 in Billed Charges for Rev 278 = $18,293.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE CELLULAR VIVIGEN 15CC,278,RC,,,,,,,,both,,,43869.3300,6580.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,17547.73,,,,,,,3114.7200,43869.3300,percent of total billed charges,"40% of $43,869.33 in Billed Charges for Rev 278 = $17,547.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE CELLULAR VIVIGEN 15CC,278,RC,,,,,,,,both,,,43869.3300,6580.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,18293.51,,,,,,,3114.7200,43869.3300,percent of total billed charges,"41.7% of $43,869.33 in Billed Charges for Rev 278 = $18,293.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE CELLULAR VIVIGEN 15CC,278,RC,,,,,,,,both,,,43869.3300,6580.4000,CIGNA HEALTHCARE,CIGNA PPO,18293.51,,,,,,,3114.7200,43869.3300,percent of total billed charges,"41.7% of $43,869.33 in Billed Charges for Rev 278 = $18,293.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE CELLULAR VIVIGEN 15CC,278,RC,,,,,,,,both,,,43869.3300,6580.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,39482.40,,,,,,,3114.7200,43869.3300,percent of total billed charges,"90% of $43,869.33 in Billed Charges for Rev 278 = $39,482.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE CELLULAR VIVIGEN 15CC,278,RC,,,,,,,,both,,,43869.3300,6580.4000,MEDCOST,MEDCOST VHN,20877.41,,,,,,,3114.7200,43869.3300,percent of total billed charges,"47.59% of $43,869.33 in Billed Charges for Rev 278 = $20,877.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE CELLULAR VIVIGEN 15CC,278,RC,,,,,,,,both,,,43869.3300,6580.4000,SENTARA HEALTH,SENTARA HEALTH,11322.67,,,,,,,3114.7200,43869.3300,percent of total billed charges,"25.81% of $43,869.33 in Billed Charges for Rev 278 = $11,322.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE CELLULAR VIVIGEN 15CC,278,RC,,,,,,,,both,,,43869.3300,6580.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",43869.33,,,,,,,3114.7200,43869.3300,percent of total billed charges,"100% of $43,869.33 in Billed Charges for Rev 278 = $43,869.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE CELLULAR VIVIGEN 15CC,278,RC,,,,,,,,both,,,43869.3300,6580.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,21934.67,,,,,,,3114.7200,43869.3300,percent of total billed charges,"Rev 278 $43,869.33 in Billed Charges at 50% = $21,934.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE CELLULAR VIVIGEN 15CC,278,RC,,,,,,,,both,,,43869.3300,6580.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3290.20,,,,,,,3114.7200,43869.3300,percent of total billed charges,"7.5% of $43,869.33 in Billed Charges for Rev 278 = $3,290.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE CELLULAR VIVIGEN 15CC,278,RC,,,,,,,,both,,,43869.3300,6580.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3114.72,,,,,,,3114.7200,43869.3300,percent of total billed charges,"7.1% of $43,869.33 in Billed Charges for Rev 278 = $3,114.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE CELLULAR VIVIGEN 15CC,278,RC,,,,,,,,both,,,43869.3300,6580.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,3114.72,,,,,,,3114.7200,43869.3300,percent of total billed charges,"7.1% of $43,869.33 in Billed Charges for Rev 278 = $3,114.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE CELLULAR VIVIGEN 15CC,278,RC,,,,,,,,both,,,43869.3300,6580.4000,WELLCARE,WELLCARE MEDICAID,43869.33,,,,,,,3114.7200,43869.3300,percent of total billed charges,"100% of $43,869.33 in Billed Charges for Rev 278 = $43,869.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4152.5500,622.8800,AETNA,AETNA,1773.14,,,,,,,1071.7700,4152.5500,percent of total billed charges,"42.7% of $4,152.55 in Billed Charges for Rev 272 = $1,773.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4152.5500,622.8800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2906.79,,,,,,,1071.7700,4152.5500,percent of total billed charges,"Rev 272 $4,152.55 in Billed Charges at 70% = $2,906.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4152.5500,622.8800,CIGNA HEALTHCARE,CIGNA HMO,1731.61,,,,,,,1071.7700,4152.5500,percent of total billed charges,"41.7% of $4,152.55 in Billed Charges for Rev 272 = $1,731.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4152.5500,622.8800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1926.78,,,,,,,1071.7700,4152.5500,percent of total billed charges,"46.4% of $4,152.55 in Billed Charges for Rev 272 = $1,926.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4152.5500,622.8800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1731.61,,,,,,,1071.7700,4152.5500,percent of total billed charges,"41.7% of $4,152.55 in Billed Charges for Rev 272 = $1,731.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4152.5500,622.8800,CIGNA HEALTHCARE,CIGNA PPO,1731.61,,,,,,,1071.7700,4152.5500,percent of total billed charges,"41.7% of $4,152.55 in Billed Charges for Rev 272 = $1,731.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4152.5500,622.8800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3737.30,,,,,,,1071.7700,4152.5500,percent of total billed charges,"90% of $4,152.55 in Billed Charges for Rev 272 = $3,737.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4152.5500,622.8800,MEDCOST,MEDCOST VHN,1976.20,,,,,,,1071.7700,4152.5500,percent of total billed charges,"47.59% of $4,152.55 in Billed Charges for Rev 272 = $1,976.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4152.5500,622.8800,SENTARA HEALTH,SENTARA HEALTH,1071.77,,,,,,,1071.7700,4152.5500,percent of total billed charges,"25.81% of $4,152.55 in Billed Charges for Rev 272 = $1,071.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4152.5500,622.8800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4152.55,,,,,,,1071.7700,4152.5500,percent of total billed charges,"100% of $4,152.55 in Billed Charges for Rev 272 = $4,152.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4152.5500,622.8800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2076.28,,,,,,,1071.7700,4152.5500,percent of total billed charges,"Rev 272 $4,152.55 in Billed Charges at 50% = $2,076.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4152.5500,622.8800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1341.27,,,,,,,1071.7700,4152.5500,other,"32.3% of $4,152.55 in Billed Charges for Rev 272 = $1,341.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4152.5500,622.8800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1274.83,,,,,,,1071.7700,4152.5500,other,"30.7% of $4,152.55 in Billed Charges for Rev 272 = $1,274.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4152.5500,622.8800,UNITED HEALTHCARE,UNITED HEALTHCARE,1341.27,,,,,,,1071.7700,4152.5500,percent of total billed charges,"32.3% of $4,152.55 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,4152.5500,622.8800,WELLCARE,WELLCARE MEDICAID,4152.55,,,,,,,1071.7700,4152.5500,percent of total billed charges,"100% of $4,152.55 in Billed Charges for Rev 272 = $4,152.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.2MM,272,RC,,,,,,,,both,,,974.1500,146.1200,AETNA,AETNA,415.96,,,,,,,251.4300,974.1500,percent of total billed charges,42.7% of $974.15 in Billed Charges for Rev 272 = $415.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.2MM,272,RC,,,,,,,,both,,,974.1500,146.1200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,681.91,,,,,,,251.4300,974.1500,percent of total billed charges,Rev 272 $974.15 in Billed Charges at 70% = $681.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.2MM,272,RC,,,,,,,,both,,,974.1500,146.1200,CIGNA HEALTHCARE,CIGNA HMO,406.22,,,,,,,251.4300,974.1500,percent of total billed charges,41.7% of $974.15 in Billed Charges for Rev 272 = $406.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.2MM,272,RC,,,,,,,,both,,,974.1500,146.1200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,452.01,,,,,,,251.4300,974.1500,percent of total billed charges,46.4% of $974.15 in Billed Charges for Rev 272 = $452.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.2MM,272,RC,,,,,,,,both,,,974.1500,146.1200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,406.22,,,,,,,251.4300,974.1500,percent of total billed charges,41.7% of $974.15 in Billed Charges for Rev 272 = $406.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.2MM,272,RC,,,,,,,,both,,,974.1500,146.1200,CIGNA HEALTHCARE,CIGNA PPO,406.22,,,,,,,251.4300,974.1500,percent of total billed charges,41.7% of $974.15 in Billed Charges for Rev 272 = $406.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.2MM,272,RC,,,,,,,,both,,,974.1500,146.1200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,876.74,,,,,,,251.4300,974.1500,percent of total billed charges,90% of $974.15 in Billed Charges for Rev 272 = $876.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.2MM,272,RC,,,,,,,,both,,,974.1500,146.1200,MEDCOST,MEDCOST VHN,463.60,,,,,,,251.4300,974.1500,percent of total billed charges,47.59% of $974.15 in Billed Charges for Rev 272 = $463.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.2MM,272,RC,,,,,,,,both,,,974.1500,146.1200,SENTARA HEALTH,SENTARA HEALTH,251.43,,,,,,,251.4300,974.1500,percent of total billed charges,25.81% of $974.15 in Billed Charges for Rev 272 = $251.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.2MM,272,RC,,,,,,,,both,,,974.1500,146.1200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",974.15,,,,,,,251.4300,974.1500,percent of total billed charges,100% of $974.15 in Billed Charges for Rev 272 = $974.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.2MM,272,RC,,,,,,,,both,,,974.1500,146.1200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,487.08,,,,,,,251.4300,974.1500,percent of total billed charges,Rev 272 $974.15 in Billed Charges at 50% = $487.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.2MM,272,RC,,,,,,,,both,,,974.1500,146.1200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,314.65,,,,,,,251.4300,974.1500,other,32.3% of $974.15 in Billed Charges for Rev 272 = $314.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 2.2MM,272,RC,,,,,,,,both,,,974.1500,146.1200,UNITED HEALTHCARE,UHC HERITAGE SELECT,299.06,,,,,,,251.4300,974.1500,other,30.7% of $974.15 in Billed Charges for Rev 272 = $299.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 2.2MM,272,RC,,,,,,,,both,,,974.1500,146.1200,UNITED HEALTHCARE,UNITED HEALTHCARE,314.65,,,,,,,251.4300,974.1500,percent of total billed charges,32.3% of $974.15 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.2MM,272,RC,,,,,,,,both,,,974.1500,146.1200,WELLCARE,WELLCARE MEDICAID,974.15,,,,,,,251.4300,974.1500,percent of total billed charges,100% of $974.15 in Billed Charges for Rev 272 = $974.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.3X10MM,272,RC,27200002,CDM,,,,,,both,,,1706.0300,255.9000,AETNA,AETNA,728.47,,,,,,,440.3300,1706.0300,percent of total billed charges,"42.7% of $1,706.03 in Billed Charges for Rev 272 = $728.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3X10MM,272,RC,27200002,CDM,,,,,,both,,,1706.0300,255.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1194.22,,,,,,,440.3300,1706.0300,percent of total billed charges,"Rev 272 $1,706.03 in Billed Charges at 70% = $1,194.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3X10MM,272,RC,27200002,CDM,,,,,,both,,,1706.0300,255.9000,CIGNA HEALTHCARE,CIGNA HMO,711.41,,,,,,,440.3300,1706.0300,percent of total billed charges,"41.7% of $1,706.03 in Billed Charges for Rev 272 = $711.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3X10MM,272,RC,27200002,CDM,,,,,,both,,,1706.0300,255.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,791.60,,,,,,,440.3300,1706.0300,percent of total billed charges,"46.4% of $1,706.03 in Billed Charges for Rev 272 = $791.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3X10MM,272,RC,27200002,CDM,,,,,,both,,,1706.0300,255.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,711.41,,,,,,,440.3300,1706.0300,percent of total billed charges,"41.7% of $1,706.03 in Billed Charges for Rev 272 = $711.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3X10MM,272,RC,27200002,CDM,,,,,,both,,,1706.0300,255.9000,CIGNA HEALTHCARE,CIGNA PPO,711.41,,,,,,,440.3300,1706.0300,percent of total billed charges,"41.7% of $1,706.03 in Billed Charges for Rev 272 = $711.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3X10MM,272,RC,27200002,CDM,,,,,,both,,,1706.0300,255.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1535.43,,,,,,,440.3300,1706.0300,percent of total billed charges,"90% of $1,706.03 in Billed Charges for Rev 272 = $1,535.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3X10MM,272,RC,27200002,CDM,,,,,,both,,,1706.0300,255.9000,MEDCOST,MEDCOST VHN,811.90,,,,,,,440.3300,1706.0300,percent of total billed charges,"47.59% of $1,706.03 in Billed Charges for Rev 272 = $811.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3X10MM,272,RC,27200002,CDM,,,,,,both,,,1706.0300,255.9000,SENTARA HEALTH,SENTARA HEALTH,440.33,,,,,,,440.3300,1706.0300,percent of total billed charges,"25.81% of $1,706.03 in Billed Charges for Rev 272 = $440.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3X10MM,272,RC,27200002,CDM,,,,,,both,,,1706.0300,255.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1706.03,,,,,,,440.3300,1706.0300,percent of total billed charges,"100% of $1,706.03 in Billed Charges for Rev 272 = $1,706.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3X10MM,272,RC,27200002,CDM,,,,,,both,,,1706.0300,255.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,853.02,,,,,,,440.3300,1706.0300,percent of total billed charges,"Rev 272 $1,706.03 in Billed Charges at 50% = $853.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3X10MM,272,RC,27200002,CDM,,,,,,both,,,1706.0300,255.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,551.05,,,,,,,440.3300,1706.0300,other,"32.3% of $1,706.03 in Billed Charges for Rev 272 = $551.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.3X10MM,272,RC,27200002,CDM,,,,,,both,,,1706.0300,255.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,523.75,,,,,,,440.3300,1706.0300,other,"30.7% of $1,706.03 in Billed Charges for Rev 272 = $523.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.3X10MM,272,RC,27200002,CDM,,,,,,both,,,1706.0300,255.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,551.05,,,,,,,440.3300,1706.0300,percent of total billed charges,"32.3% of $1,706.03 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3X10MM,272,RC,27200002,CDM,,,,,,both,,,1706.0300,255.9000,WELLCARE,WELLCARE MEDICAID,1706.03,,,,,,,440.3300,1706.0300,percent of total billed charges,"100% of $1,706.03 in Billed Charges for Rev 272 = $1,706.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2407.0100,361.0500,AETNA,AETNA,1027.79,,,,,,,621.2500,2407.0100,percent of total billed charges,"42.7% of $2,407.01 in Billed Charges for Rev 272 = $1,027.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2407.0100,361.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1684.91,,,,,,,621.2500,2407.0100,percent of total billed charges,"Rev 272 $2,407.01 in Billed Charges at 70% = $1,684.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2407.0100,361.0500,CIGNA HEALTHCARE,CIGNA HMO,1003.72,,,,,,,621.2500,2407.0100,percent of total billed charges,"41.7% of $2,407.01 in Billed Charges for Rev 272 = $1,003.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2407.0100,361.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1116.85,,,,,,,621.2500,2407.0100,percent of total billed charges,"46.4% of $2,407.01 in Billed Charges for Rev 272 = $1,116.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2407.0100,361.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1003.72,,,,,,,621.2500,2407.0100,percent of total billed charges,"41.7% of $2,407.01 in Billed Charges for Rev 272 = $1,003.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2407.0100,361.0500,CIGNA HEALTHCARE,CIGNA PPO,1003.72,,,,,,,621.2500,2407.0100,percent of total billed charges,"41.7% of $2,407.01 in Billed Charges for Rev 272 = $1,003.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2407.0100,361.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2166.31,,,,,,,621.2500,2407.0100,percent of total billed charges,"90% of $2,407.01 in Billed Charges for Rev 272 = $2,166.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2407.0100,361.0500,MEDCOST,MEDCOST VHN,1145.50,,,,,,,621.2500,2407.0100,percent of total billed charges,"47.59% of $2,407.01 in Billed Charges for Rev 272 = $1,145.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2407.0100,361.0500,SENTARA HEALTH,SENTARA HEALTH,621.25,,,,,,,621.2500,2407.0100,percent of total billed charges,"25.81% of $2,407.01 in Billed Charges for Rev 272 = $621.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2407.0100,361.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2407.01,,,,,,,621.2500,2407.0100,percent of total billed charges,"100% of $2,407.01 in Billed Charges for Rev 272 = $2,407.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2407.0100,361.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1203.51,,,,,,,621.2500,2407.0100,percent of total billed charges,"Rev 272 $2,407.01 in Billed Charges at 50% = $1,203.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2407.0100,361.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,777.46,,,,,,,621.2500,2407.0100,other,"32.3% of $2,407.01 in Billed Charges for Rev 272 = $777.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR DIAMOND MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2407.0100,361.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,738.95,,,,,,,621.2500,2407.0100,other,"30.7% of $2,407.01 in Billed Charges for Rev 272 = $738.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR DIAMOND MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2407.0100,361.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,777.46,,,,,,,621.2500,2407.0100,percent of total billed charges,"32.3% of $2,407.01 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR DIAMOND MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2407.0100,361.0500,WELLCARE,WELLCARE MEDICAID,2407.01,,,,,,,621.2500,2407.0100,percent of total billed charges,"100% of $2,407.01 in Billed Charges for Rev 272 = $2,407.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X 50MM,272,RC,27200002,CDM,,,,,,both,,,1109.7000,166.4600,AETNA,AETNA,473.84,,,,,,,286.4100,1109.7000,percent of total billed charges,"42.7% of $1,109.70 in Billed Charges for Rev 272 = $473.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X 50MM,272,RC,27200002,CDM,,,,,,both,,,1109.7000,166.4600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,776.79,,,,,,,286.4100,1109.7000,percent of total billed charges,"Rev 272 $1,109.70 in Billed Charges at 70% = $776.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X 50MM,272,RC,27200002,CDM,,,,,,both,,,1109.7000,166.4600,CIGNA HEALTHCARE,CIGNA HMO,462.74,,,,,,,286.4100,1109.7000,percent of total billed charges,"41.7% of $1,109.70 in Billed Charges for Rev 272 = $462.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X 50MM,272,RC,27200002,CDM,,,,,,both,,,1109.7000,166.4600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,514.90,,,,,,,286.4100,1109.7000,percent of total billed charges,"46.4% of $1,109.70 in Billed Charges for Rev 272 = $514.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X 50MM,272,RC,27200002,CDM,,,,,,both,,,1109.7000,166.4600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,462.74,,,,,,,286.4100,1109.7000,percent of total billed charges,"41.7% of $1,109.70 in Billed Charges for Rev 272 = $462.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X 50MM,272,RC,27200002,CDM,,,,,,both,,,1109.7000,166.4600,CIGNA HEALTHCARE,CIGNA PPO,462.74,,,,,,,286.4100,1109.7000,percent of total billed charges,"41.7% of $1,109.70 in Billed Charges for Rev 272 = $462.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X 50MM,272,RC,27200002,CDM,,,,,,both,,,1109.7000,166.4600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,998.73,,,,,,,286.4100,1109.7000,percent of total billed charges,"90% of $1,109.70 in Billed Charges for Rev 272 = $998.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X 50MM,272,RC,27200002,CDM,,,,,,both,,,1109.7000,166.4600,MEDCOST,MEDCOST VHN,528.11,,,,,,,286.4100,1109.7000,percent of total billed charges,"47.59% of $1,109.70 in Billed Charges for Rev 272 = $528.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X 50MM,272,RC,27200002,CDM,,,,,,both,,,1109.7000,166.4600,SENTARA HEALTH,SENTARA HEALTH,286.41,,,,,,,286.4100,1109.7000,percent of total billed charges,"25.81% of $1,109.70 in Billed Charges for Rev 272 = $286.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X 50MM,272,RC,27200002,CDM,,,,,,both,,,1109.7000,166.4600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1109.70,,,,,,,286.4100,1109.7000,percent of total billed charges,"100% of $1,109.70 in Billed Charges for Rev 272 = $1,109.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X 50MM,272,RC,27200002,CDM,,,,,,both,,,1109.7000,166.4600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,554.85,,,,,,,286.4100,1109.7000,percent of total billed charges,"Rev 272 $1,109.70 in Billed Charges at 50% = $554.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X 50MM,272,RC,27200002,CDM,,,,,,both,,,1109.7000,166.4600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,358.43,,,,,,,286.4100,1109.7000,other,"32.3% of $1,109.70 in Billed Charges for Rev 272 = $358.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.5 X 50MM,272,RC,27200002,CDM,,,,,,both,,,1109.7000,166.4600,UNITED HEALTHCARE,UHC HERITAGE SELECT,340.68,,,,,,,286.4100,1109.7000,other,"30.7% of $1,109.70 in Billed Charges for Rev 272 = $340.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.5 X 50MM,272,RC,27200002,CDM,,,,,,both,,,1109.7000,166.4600,UNITED HEALTHCARE,UNITED HEALTHCARE,358.43,,,,,,,286.4100,1109.7000,percent of total billed charges,"32.3% of $1,109.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X 50MM,272,RC,27200002,CDM,,,,,,both,,,1109.7000,166.4600,WELLCARE,WELLCARE MEDICAID,1109.70,,,,,,,286.4100,1109.7000,percent of total billed charges,"100% of $1,109.70 in Billed Charges for Rev 272 = $1,109.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1119.0300,167.8500,AETNA,AETNA,477.83,,,,,,,288.8200,1119.0300,percent of total billed charges,"42.7% of $1,119.03 in Billed Charges for Rev 272 = $477.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1119.0300,167.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,783.32,,,,,,,288.8200,1119.0300,percent of total billed charges,"Rev 272 $1,119.03 in Billed Charges at 70% = $783.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1119.0300,167.8500,CIGNA HEALTHCARE,CIGNA HMO,466.64,,,,,,,288.8200,1119.0300,percent of total billed charges,"41.7% of $1,119.03 in Billed Charges for Rev 272 = $466.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1119.0300,167.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,519.23,,,,,,,288.8200,1119.0300,percent of total billed charges,"46.4% of $1,119.03 in Billed Charges for Rev 272 = $519.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1119.0300,167.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,466.64,,,,,,,288.8200,1119.0300,percent of total billed charges,"41.7% of $1,119.03 in Billed Charges for Rev 272 = $466.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1119.0300,167.8500,CIGNA HEALTHCARE,CIGNA PPO,466.64,,,,,,,288.8200,1119.0300,percent of total billed charges,"41.7% of $1,119.03 in Billed Charges for Rev 272 = $466.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1119.0300,167.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1007.13,,,,,,,288.8200,1119.0300,percent of total billed charges,"90% of $1,119.03 in Billed Charges for Rev 272 = $1,007.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1119.0300,167.8500,MEDCOST,MEDCOST VHN,532.55,,,,,,,288.8200,1119.0300,percent of total billed charges,"47.59% of $1,119.03 in Billed Charges for Rev 272 = $532.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1119.0300,167.8500,SENTARA HEALTH,SENTARA HEALTH,288.82,,,,,,,288.8200,1119.0300,percent of total billed charges,"25.81% of $1,119.03 in Billed Charges for Rev 272 = $288.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1119.0300,167.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1119.03,,,,,,,288.8200,1119.0300,percent of total billed charges,"100% of $1,119.03 in Billed Charges for Rev 272 = $1,119.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1119.0300,167.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,559.52,,,,,,,288.8200,1119.0300,percent of total billed charges,"Rev 272 $1,119.03 in Billed Charges at 50% = $559.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1119.0300,167.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,361.45,,,,,,,288.8200,1119.0300,other,"32.3% of $1,119.03 in Billed Charges for Rev 272 = $361.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1119.0300,167.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,343.54,,,,,,,288.8200,1119.0300,other,"30.7% of $1,119.03 in Billed Charges for Rev 272 = $343.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1119.0300,167.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,361.45,,,,,,,288.8200,1119.0300,percent of total billed charges,"32.3% of $1,119.03 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1119.0300,167.8500,WELLCARE,WELLCARE MEDICAID,1119.03,,,,,,,288.8200,1119.0300,percent of total billed charges,"100% of $1,119.03 in Billed Charges for Rev 272 = $1,119.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,,,,,,,,both,,,1218.9000,182.8400,AETNA,AETNA,520.47,,,,,,,314.6000,1218.9000,percent of total billed charges,"42.7% of $1,218.90 in Billed Charges for Rev 272 = $520.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,,,,,,,,both,,,1218.9000,182.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,853.23,,,,,,,314.6000,1218.9000,percent of total billed charges,"Rev 272 $1,218.90 in Billed Charges at 70% = $853.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,,,,,,,,both,,,1218.9000,182.8400,CIGNA HEALTHCARE,CIGNA HMO,508.28,,,,,,,314.6000,1218.9000,percent of total billed charges,"41.7% of $1,218.90 in Billed Charges for Rev 272 = $508.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,,,,,,,,both,,,1218.9000,182.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,565.57,,,,,,,314.6000,1218.9000,percent of total billed charges,"46.4% of $1,218.90 in Billed Charges for Rev 272 = $565.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,,,,,,,,both,,,1218.9000,182.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,508.28,,,,,,,314.6000,1218.9000,percent of total billed charges,"41.7% of $1,218.90 in Billed Charges for Rev 272 = $508.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,,,,,,,,both,,,1218.9000,182.8400,CIGNA HEALTHCARE,CIGNA PPO,508.28,,,,,,,314.6000,1218.9000,percent of total billed charges,"41.7% of $1,218.90 in Billed Charges for Rev 272 = $508.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,,,,,,,,both,,,1218.9000,182.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1097.01,,,,,,,314.6000,1218.9000,percent of total billed charges,"90% of $1,218.90 in Billed Charges for Rev 272 = $1,097.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,,,,,,,,both,,,1218.9000,182.8400,MEDCOST,MEDCOST VHN,580.07,,,,,,,314.6000,1218.9000,percent of total billed charges,"47.59% of $1,218.90 in Billed Charges for Rev 272 = $580.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,,,,,,,,both,,,1218.9000,182.8400,SENTARA HEALTH,SENTARA HEALTH,314.60,,,,,,,314.6000,1218.9000,percent of total billed charges,"25.81% of $1,218.90 in Billed Charges for Rev 272 = $314.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,,,,,,,,both,,,1218.9000,182.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1218.90,,,,,,,314.6000,1218.9000,percent of total billed charges,"100% of $1,218.90 in Billed Charges for Rev 272 = $1,218.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,,,,,,,,both,,,1218.9000,182.8400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,609.45,,,,,,,314.6000,1218.9000,percent of total billed charges,"Rev 272 $1,218.90 in Billed Charges at 50% = $609.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,,,,,,,,both,,,1218.9000,182.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,393.70,,,,,,,314.6000,1218.9000,other,"32.3% of $1,218.90 in Billed Charges for Rev 272 = $393.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.5MM,272,RC,,,,,,,,both,,,1218.9000,182.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,374.20,,,,,,,314.6000,1218.9000,other,"30.7% of $1,218.90 in Billed Charges for Rev 272 = $374.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.5MM,272,RC,,,,,,,,both,,,1218.9000,182.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,393.70,,,,,,,314.6000,1218.9000,percent of total billed charges,"32.3% of $1,218.90 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5MM,272,RC,,,,,,,,both,,,1218.9000,182.8400,WELLCARE,WELLCARE MEDICAID,1218.90,,,,,,,314.6000,1218.9000,percent of total billed charges,"100% of $1,218.90 in Billed Charges for Rev 272 = $1,218.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 2.7MM,272,RC,,,,,,,,both,,,3149.9800,472.5000,AETNA,AETNA,1345.04,,,,,,,813.0100,3149.9800,percent of total billed charges,"42.7% of $3,149.98 in Billed Charges for Rev 272 = $1,345.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 2.7MM,272,RC,,,,,,,,both,,,3149.9800,472.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2204.99,,,,,,,813.0100,3149.9800,percent of total billed charges,"Rev 272 $3,149.98 in Billed Charges at 70% = $2,204.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 2.7MM,272,RC,,,,,,,,both,,,3149.9800,472.5000,CIGNA HEALTHCARE,CIGNA HMO,1313.54,,,,,,,813.0100,3149.9800,percent of total billed charges,"41.7% of $3,149.98 in Billed Charges for Rev 272 = $1,313.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 2.7MM,272,RC,,,,,,,,both,,,3149.9800,472.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1461.59,,,,,,,813.0100,3149.9800,percent of total billed charges,"46.4% of $3,149.98 in Billed Charges for Rev 272 = $1,461.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 2.7MM,272,RC,,,,,,,,both,,,3149.9800,472.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1313.54,,,,,,,813.0100,3149.9800,percent of total billed charges,"41.7% of $3,149.98 in Billed Charges for Rev 272 = $1,313.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 2.7MM,272,RC,,,,,,,,both,,,3149.9800,472.5000,CIGNA HEALTHCARE,CIGNA PPO,1313.54,,,,,,,813.0100,3149.9800,percent of total billed charges,"41.7% of $3,149.98 in Billed Charges for Rev 272 = $1,313.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 2.7MM,272,RC,,,,,,,,both,,,3149.9800,472.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2834.98,,,,,,,813.0100,3149.9800,percent of total billed charges,"90% of $3,149.98 in Billed Charges for Rev 272 = $2,834.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 2.7MM,272,RC,,,,,,,,both,,,3149.9800,472.5000,MEDCOST,MEDCOST VHN,1499.08,,,,,,,813.0100,3149.9800,percent of total billed charges,"47.59% of $3,149.98 in Billed Charges for Rev 272 = $1,499.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 2.7MM,272,RC,,,,,,,,both,,,3149.9800,472.5000,SENTARA HEALTH,SENTARA HEALTH,813.01,,,,,,,813.0100,3149.9800,percent of total billed charges,"25.81% of $3,149.98 in Billed Charges for Rev 272 = $813.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 2.7MM,272,RC,,,,,,,,both,,,3149.9800,472.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3149.98,,,,,,,813.0100,3149.9800,percent of total billed charges,"100% of $3,149.98 in Billed Charges for Rev 272 = $3,149.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 2.7MM,272,RC,,,,,,,,both,,,3149.9800,472.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1574.99,,,,,,,813.0100,3149.9800,percent of total billed charges,"Rev 272 $3,149.98 in Billed Charges at 50% = $1,574.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 2.7MM,272,RC,,,,,,,,both,,,3149.9800,472.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1017.44,,,,,,,813.0100,3149.9800,other,"32.3% of $3,149.98 in Billed Charges for Rev 272 = $1,017.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANN 2.7MM,272,RC,,,,,,,,both,,,3149.9800,472.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,967.04,,,,,,,813.0100,3149.9800,other,"30.7% of $3,149.98 in Billed Charges for Rev 272 = $967.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANN 2.7MM,272,RC,,,,,,,,both,,,3149.9800,472.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,1017.44,,,,,,,813.0100,3149.9800,percent of total billed charges,"32.3% of $3,149.98 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 2.7MM,272,RC,,,,,,,,both,,,3149.9800,472.5000,WELLCARE,WELLCARE MEDICAID,3149.98,,,,,,,813.0100,3149.9800,percent of total billed charges,"100% of $3,149.98 in Billed Charges for Rev 272 = $3,149.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 5.0,272,RC,27200002,CDM,,,,,,both,,,6437.0700,965.5600,AETNA,AETNA,2748.63,,,,,,,1661.4100,6437.0700,percent of total billed charges,"42.7% of $6,437.07 in Billed Charges for Rev 272 = $2,748.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 5.0,272,RC,27200002,CDM,,,,,,both,,,6437.0700,965.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4505.95,,,,,,,1661.4100,6437.0700,percent of total billed charges,"Rev 272 $6,437.07 in Billed Charges at 70% = $4,505.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 5.0,272,RC,27200002,CDM,,,,,,both,,,6437.0700,965.5600,CIGNA HEALTHCARE,CIGNA HMO,2684.26,,,,,,,1661.4100,6437.0700,percent of total billed charges,"41.7% of $6,437.07 in Billed Charges for Rev 272 = $2,684.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 5.0,272,RC,27200002,CDM,,,,,,both,,,6437.0700,965.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2986.80,,,,,,,1661.4100,6437.0700,percent of total billed charges,"46.4% of $6,437.07 in Billed Charges for Rev 272 = $2,986.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 5.0,272,RC,27200002,CDM,,,,,,both,,,6437.0700,965.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2684.26,,,,,,,1661.4100,6437.0700,percent of total billed charges,"41.7% of $6,437.07 in Billed Charges for Rev 272 = $2,684.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 5.0,272,RC,27200002,CDM,,,,,,both,,,6437.0700,965.5600,CIGNA HEALTHCARE,CIGNA PPO,2684.26,,,,,,,1661.4100,6437.0700,percent of total billed charges,"41.7% of $6,437.07 in Billed Charges for Rev 272 = $2,684.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 5.0,272,RC,27200002,CDM,,,,,,both,,,6437.0700,965.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5793.36,,,,,,,1661.4100,6437.0700,percent of total billed charges,"90% of $6,437.07 in Billed Charges for Rev 272 = $5,793.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 5.0,272,RC,27200002,CDM,,,,,,both,,,6437.0700,965.5600,MEDCOST,MEDCOST VHN,3063.40,,,,,,,1661.4100,6437.0700,percent of total billed charges,"47.59% of $6,437.07 in Billed Charges for Rev 272 = $3,063.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 5.0,272,RC,27200002,CDM,,,,,,both,,,6437.0700,965.5600,SENTARA HEALTH,SENTARA HEALTH,1661.41,,,,,,,1661.4100,6437.0700,percent of total billed charges,"25.81% of $6,437.07 in Billed Charges for Rev 272 = $1,661.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 5.0,272,RC,27200002,CDM,,,,,,both,,,6437.0700,965.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6437.07,,,,,,,1661.4100,6437.0700,percent of total billed charges,"100% of $6,437.07 in Billed Charges for Rev 272 = $6,437.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 5.0,272,RC,27200002,CDM,,,,,,both,,,6437.0700,965.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3218.54,,,,,,,1661.4100,6437.0700,percent of total billed charges,"Rev 272 $6,437.07 in Billed Charges at 50% = $3,218.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 5.0,272,RC,27200002,CDM,,,,,,both,,,6437.0700,965.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2079.17,,,,,,,1661.4100,6437.0700,other,"32.3% of $6,437.07 in Billed Charges for Rev 272 = $2,079.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANN 5.0,272,RC,27200002,CDM,,,,,,both,,,6437.0700,965.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1976.18,,,,,,,1661.4100,6437.0700,other,"30.7% of $6,437.07 in Billed Charges for Rev 272 = $1,976.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANN 5.0,272,RC,27200002,CDM,,,,,,both,,,6437.0700,965.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,2079.17,,,,,,,1661.4100,6437.0700,percent of total billed charges,"32.3% of $6,437.07 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 5.0,272,RC,27200002,CDM,,,,,,both,,,6437.0700,965.5600,WELLCARE,WELLCARE MEDICAID,6437.07,,,,,,,1661.4100,6437.0700,percent of total billed charges,"100% of $6,437.07 in Billed Charges for Rev 272 = $6,437.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR EXCALIBUR 5.0MM X 13CM,272,RC,27200002,CDM,,,,,,both,,,611.8900,91.7800,AETNA,AETNA,261.28,,,,,,,157.9300,611.8900,percent of total billed charges,42.7% of $611.89 in Billed Charges for Rev 272 = $261.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR EXCALIBUR 5.0MM X 13CM,272,RC,27200002,CDM,,,,,,both,,,611.8900,91.7800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,428.32,,,,,,,157.9300,611.8900,percent of total billed charges,Rev 272 $611.89 in Billed Charges at 70% = $428.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR EXCALIBUR 5.0MM X 13CM,272,RC,27200002,CDM,,,,,,both,,,611.8900,91.7800,CIGNA HEALTHCARE,CIGNA HMO,255.16,,,,,,,157.9300,611.8900,percent of total billed charges,41.7% of $611.89 in Billed Charges for Rev 272 = $255.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR EXCALIBUR 5.0MM X 13CM,272,RC,27200002,CDM,,,,,,both,,,611.8900,91.7800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,283.92,,,,,,,157.9300,611.8900,percent of total billed charges,46.4% of $611.89 in Billed Charges for Rev 272 = $283.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR EXCALIBUR 5.0MM X 13CM,272,RC,27200002,CDM,,,,,,both,,,611.8900,91.7800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,255.16,,,,,,,157.9300,611.8900,percent of total billed charges,41.7% of $611.89 in Billed Charges for Rev 272 = $255.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR EXCALIBUR 5.0MM X 13CM,272,RC,27200002,CDM,,,,,,both,,,611.8900,91.7800,CIGNA HEALTHCARE,CIGNA PPO,255.16,,,,,,,157.9300,611.8900,percent of total billed charges,41.7% of $611.89 in Billed Charges for Rev 272 = $255.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR EXCALIBUR 5.0MM X 13CM,272,RC,27200002,CDM,,,,,,both,,,611.8900,91.7800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,550.70,,,,,,,157.9300,611.8900,percent of total billed charges,90% of $611.89 in Billed Charges for Rev 272 = $550.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR EXCALIBUR 5.0MM X 13CM,272,RC,27200002,CDM,,,,,,both,,,611.8900,91.7800,MEDCOST,MEDCOST VHN,291.20,,,,,,,157.9300,611.8900,percent of total billed charges,47.59% of $611.89 in Billed Charges for Rev 272 = $291.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR EXCALIBUR 5.0MM X 13CM,272,RC,27200002,CDM,,,,,,both,,,611.8900,91.7800,SENTARA HEALTH,SENTARA HEALTH,157.93,,,,,,,157.9300,611.8900,percent of total billed charges,25.81% of $611.89 in Billed Charges for Rev 272 = $157.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR EXCALIBUR 5.0MM X 13CM,272,RC,27200002,CDM,,,,,,both,,,611.8900,91.7800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",611.89,,,,,,,157.9300,611.8900,percent of total billed charges,100% of $611.89 in Billed Charges for Rev 272 = $611.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR EXCALIBUR 5.0MM X 13CM,272,RC,27200002,CDM,,,,,,both,,,611.8900,91.7800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,305.95,,,,,,,157.9300,611.8900,percent of total billed charges,Rev 272 $611.89 in Billed Charges at 50% = $305.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR EXCALIBUR 5.0MM X 13CM,272,RC,27200002,CDM,,,,,,both,,,611.8900,91.7800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,197.64,,,,,,,157.9300,611.8900,other,32.3% of $611.89 in Billed Charges for Rev 272 = $197.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BURR EXCALIBUR 5.0MM X 13CM,272,RC,27200002,CDM,,,,,,both,,,611.8900,91.7800,UNITED HEALTHCARE,UHC HERITAGE SELECT,187.85,,,,,,,157.9300,611.8900,other,30.7% of $611.89 in Billed Charges for Rev 272 = $187.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BURR EXCALIBUR 5.0MM X 13CM,272,RC,27200002,CDM,,,,,,both,,,611.8900,91.7800,UNITED HEALTHCARE,UNITED HEALTHCARE,197.64,,,,,,,157.9300,611.8900,percent of total billed charges,32.3% of $611.89 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR EXCALIBUR 5.0MM X 13CM,272,RC,27200002,CDM,,,,,,both,,,611.8900,91.7800,WELLCARE,WELLCARE MEDICAID,611.89,,,,,,,157.9300,611.8900,percent of total billed charges,100% of $611.89 in Billed Charges for Rev 272 = $611.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR INCISOR PLUS ELITE LG 4.5MM,272,RC,,,,,,,,both,,,663.1200,99.4700,AETNA,AETNA,283.15,,,,,,,171.1500,663.1200,percent of total billed charges,42.7% of $663.12 in Billed Charges for Rev 272 = $283.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR INCISOR PLUS ELITE LG 4.5MM,272,RC,,,,,,,,both,,,663.1200,99.4700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,464.18,,,,,,,171.1500,663.1200,percent of total billed charges,Rev 272 $663.12 in Billed Charges at 70% = $464.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR INCISOR PLUS ELITE LG 4.5MM,272,RC,,,,,,,,both,,,663.1200,99.4700,CIGNA HEALTHCARE,CIGNA HMO,276.52,,,,,,,171.1500,663.1200,percent of total billed charges,41.7% of $663.12 in Billed Charges for Rev 272 = $276.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR INCISOR PLUS ELITE LG 4.5MM,272,RC,,,,,,,,both,,,663.1200,99.4700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,307.69,,,,,,,171.1500,663.1200,percent of total billed charges,46.4% of $663.12 in Billed Charges for Rev 272 = $307.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR INCISOR PLUS ELITE LG 4.5MM,272,RC,,,,,,,,both,,,663.1200,99.4700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,276.52,,,,,,,171.1500,663.1200,percent of total billed charges,41.7% of $663.12 in Billed Charges for Rev 272 = $276.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR INCISOR PLUS ELITE LG 4.5MM,272,RC,,,,,,,,both,,,663.1200,99.4700,CIGNA HEALTHCARE,CIGNA PPO,276.52,,,,,,,171.1500,663.1200,percent of total billed charges,41.7% of $663.12 in Billed Charges for Rev 272 = $276.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR INCISOR PLUS ELITE LG 4.5MM,272,RC,,,,,,,,both,,,663.1200,99.4700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,596.81,,,,,,,171.1500,663.1200,percent of total billed charges,90% of $663.12 in Billed Charges for Rev 272 = $596.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR INCISOR PLUS ELITE LG 4.5MM,272,RC,,,,,,,,both,,,663.1200,99.4700,MEDCOST,MEDCOST VHN,315.58,,,,,,,171.1500,663.1200,percent of total billed charges,47.59% of $663.12 in Billed Charges for Rev 272 = $315.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR INCISOR PLUS ELITE LG 4.5MM,272,RC,,,,,,,,both,,,663.1200,99.4700,SENTARA HEALTH,SENTARA HEALTH,171.15,,,,,,,171.1500,663.1200,percent of total billed charges,25.81% of $663.12 in Billed Charges for Rev 272 = $171.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR INCISOR PLUS ELITE LG 4.5MM,272,RC,,,,,,,,both,,,663.1200,99.4700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",663.12,,,,,,,171.1500,663.1200,percent of total billed charges,100% of $663.12 in Billed Charges for Rev 272 = $663.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR INCISOR PLUS ELITE LG 4.5MM,272,RC,,,,,,,,both,,,663.1200,99.4700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,331.56,,,,,,,171.1500,663.1200,percent of total billed charges,Rev 272 $663.12 in Billed Charges at 50% = $331.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR INCISOR PLUS ELITE LG 4.5MM,272,RC,,,,,,,,both,,,663.1200,99.4700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,214.19,,,,,,,171.1500,663.1200,other,32.3% of $663.12 in Billed Charges for Rev 272 = $214.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BURR INCISOR PLUS ELITE LG 4.5MM,272,RC,,,,,,,,both,,,663.1200,99.4700,UNITED HEALTHCARE,UHC HERITAGE SELECT,203.58,,,,,,,171.1500,663.1200,other,30.7% of $663.12 in Billed Charges for Rev 272 = $203.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BURR INCISOR PLUS ELITE LG 4.5MM,272,RC,,,,,,,,both,,,663.1200,99.4700,UNITED HEALTHCARE,UNITED HEALTHCARE,214.19,,,,,,,171.1500,663.1200,percent of total billed charges,32.3% of $663.12 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR INCISOR PLUS ELITE LG 4.5MM,272,RC,,,,,,,,both,,,663.1200,99.4700,WELLCARE,WELLCARE MEDICAID,663.12,,,,,,,171.1500,663.1200,percent of total billed charges,100% of $663.12 in Billed Charges for Rev 272 = $663.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL CANNNULATED JACOBS CHUCK COUPLING 4.5 X 233MM,272,RC,,,,,,,,both,,,3945.2300,591.7800,AETNA,AETNA,1684.61,,,,,,,1018.2600,3945.2300,percent of total billed charges,"42.7% of $3,945.23 in Billed Charges for Rev 272 = $1,684.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNNULATED JACOBS CHUCK COUPLING 4.5 X 233MM,272,RC,,,,,,,,both,,,3945.2300,591.7800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2761.66,,,,,,,1018.2600,3945.2300,percent of total billed charges,"Rev 272 $3,945.23 in Billed Charges at 70% = $2,761.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNNULATED JACOBS CHUCK COUPLING 4.5 X 233MM,272,RC,,,,,,,,both,,,3945.2300,591.7800,CIGNA HEALTHCARE,CIGNA HMO,1645.16,,,,,,,1018.2600,3945.2300,percent of total billed charges,"41.7% of $3,945.23 in Billed Charges for Rev 272 = $1,645.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNNULATED JACOBS CHUCK COUPLING 4.5 X 233MM,272,RC,,,,,,,,both,,,3945.2300,591.7800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1830.59,,,,,,,1018.2600,3945.2300,percent of total billed charges,"46.4% of $3,945.23 in Billed Charges for Rev 272 = $1,830.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNNULATED JACOBS CHUCK COUPLING 4.5 X 233MM,272,RC,,,,,,,,both,,,3945.2300,591.7800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1645.16,,,,,,,1018.2600,3945.2300,percent of total billed charges,"41.7% of $3,945.23 in Billed Charges for Rev 272 = $1,645.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNNULATED JACOBS CHUCK COUPLING 4.5 X 233MM,272,RC,,,,,,,,both,,,3945.2300,591.7800,CIGNA HEALTHCARE,CIGNA PPO,1645.16,,,,,,,1018.2600,3945.2300,percent of total billed charges,"41.7% of $3,945.23 in Billed Charges for Rev 272 = $1,645.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNNULATED JACOBS CHUCK COUPLING 4.5 X 233MM,272,RC,,,,,,,,both,,,3945.2300,591.7800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3550.71,,,,,,,1018.2600,3945.2300,percent of total billed charges,"90% of $3,945.23 in Billed Charges for Rev 272 = $3,550.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNNULATED JACOBS CHUCK COUPLING 4.5 X 233MM,272,RC,,,,,,,,both,,,3945.2300,591.7800,MEDCOST,MEDCOST VHN,1877.54,,,,,,,1018.2600,3945.2300,percent of total billed charges,"47.59% of $3,945.23 in Billed Charges for Rev 272 = $1,877.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNNULATED JACOBS CHUCK COUPLING 4.5 X 233MM,272,RC,,,,,,,,both,,,3945.2300,591.7800,SENTARA HEALTH,SENTARA HEALTH,1018.26,,,,,,,1018.2600,3945.2300,percent of total billed charges,"25.81% of $3,945.23 in Billed Charges for Rev 272 = $1,018.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNNULATED JACOBS CHUCK COUPLING 4.5 X 233MM,272,RC,,,,,,,,both,,,3945.2300,591.7800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3945.23,,,,,,,1018.2600,3945.2300,percent of total billed charges,"100% of $3,945.23 in Billed Charges for Rev 272 = $3,945.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNNULATED JACOBS CHUCK COUPLING 4.5 X 233MM,272,RC,,,,,,,,both,,,3945.2300,591.7800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1972.62,,,,,,,1018.2600,3945.2300,percent of total billed charges,"Rev 272 $3,945.23 in Billed Charges at 50% = $1,972.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNNULATED JACOBS CHUCK COUPLING 4.5 X 233MM,272,RC,,,,,,,,both,,,3945.2300,591.7800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1274.31,,,,,,,1018.2600,3945.2300,other,"32.3% of $3,945.23 in Billed Charges for Rev 272 = $1,274.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNNULATED JACOBS CHUCK COUPLING 4.5 X 233MM,272,RC,,,,,,,,both,,,3945.2300,591.7800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1211.19,,,,,,,1018.2600,3945.2300,other,"30.7% of $3,945.23 in Billed Charges for Rev 272 = $1,211.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNNULATED JACOBS CHUCK COUPLING 4.5 X 233MM,272,RC,,,,,,,,both,,,3945.2300,591.7800,UNITED HEALTHCARE,UNITED HEALTHCARE,1274.31,,,,,,,1018.2600,3945.2300,percent of total billed charges,"32.3% of $3,945.23 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNNULATED JACOBS CHUCK COUPLING 4.5 X 233MM,272,RC,,,,,,,,both,,,3945.2300,591.7800,WELLCARE,WELLCARE MEDICAID,3945.23,,,,,,,1018.2600,3945.2300,percent of total billed charges,"100% of $3,945.23 in Billed Charges for Rev 272 = $3,945.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 2.1MM,272,RC,27200002,CDM,,,,,,both,,,1592.1600,238.8200,AETNA,AETNA,679.85,,,,,,,410.9400,1592.1600,percent of total billed charges,"42.7% of $1,592.16 in Billed Charges for Rev 272 = $679.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 2.1MM,272,RC,27200002,CDM,,,,,,both,,,1592.1600,238.8200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1114.51,,,,,,,410.9400,1592.1600,percent of total billed charges,"Rev 272 $1,592.16 in Billed Charges at 70% = $1,114.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 2.1MM,272,RC,27200002,CDM,,,,,,both,,,1592.1600,238.8200,CIGNA HEALTHCARE,CIGNA HMO,663.93,,,,,,,410.9400,1592.1600,percent of total billed charges,"41.7% of $1,592.16 in Billed Charges for Rev 272 = $663.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 2.1MM,272,RC,27200002,CDM,,,,,,both,,,1592.1600,238.8200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,738.76,,,,,,,410.9400,1592.1600,percent of total billed charges,"46.4% of $1,592.16 in Billed Charges for Rev 272 = $738.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 2.1MM,272,RC,27200002,CDM,,,,,,both,,,1592.1600,238.8200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,663.93,,,,,,,410.9400,1592.1600,percent of total billed charges,"41.7% of $1,592.16 in Billed Charges for Rev 272 = $663.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 2.1MM,272,RC,27200002,CDM,,,,,,both,,,1592.1600,238.8200,CIGNA HEALTHCARE,CIGNA PPO,663.93,,,,,,,410.9400,1592.1600,percent of total billed charges,"41.7% of $1,592.16 in Billed Charges for Rev 272 = $663.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 2.1MM,272,RC,27200002,CDM,,,,,,both,,,1592.1600,238.8200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1432.94,,,,,,,410.9400,1592.1600,percent of total billed charges,"90% of $1,592.16 in Billed Charges for Rev 272 = $1,432.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 2.1MM,272,RC,27200002,CDM,,,,,,both,,,1592.1600,238.8200,MEDCOST,MEDCOST VHN,757.71,,,,,,,410.9400,1592.1600,percent of total billed charges,"47.59% of $1,592.16 in Billed Charges for Rev 272 = $757.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 2.1MM,272,RC,27200002,CDM,,,,,,both,,,1592.1600,238.8200,SENTARA HEALTH,SENTARA HEALTH,410.94,,,,,,,410.9400,1592.1600,percent of total billed charges,"25.81% of $1,592.16 in Billed Charges for Rev 272 = $410.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 2.1MM,272,RC,27200002,CDM,,,,,,both,,,1592.1600,238.8200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1592.16,,,,,,,410.9400,1592.1600,percent of total billed charges,"100% of $1,592.16 in Billed Charges for Rev 272 = $1,592.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 2.1MM,272,RC,27200002,CDM,,,,,,both,,,1592.1600,238.8200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,796.08,,,,,,,410.9400,1592.1600,percent of total billed charges,"Rev 272 $1,592.16 in Billed Charges at 50% = $796.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 2.1MM,272,RC,27200002,CDM,,,,,,both,,,1592.1600,238.8200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,514.27,,,,,,,410.9400,1592.1600,other,"32.3% of $1,592.16 in Billed Charges for Rev 272 = $514.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED 2.1MM,272,RC,27200002,CDM,,,,,,both,,,1592.1600,238.8200,UNITED HEALTHCARE,UHC HERITAGE SELECT,488.79,,,,,,,410.9400,1592.1600,other,"30.7% of $1,592.16 in Billed Charges for Rev 272 = $488.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED 2.1MM,272,RC,27200002,CDM,,,,,,both,,,1592.1600,238.8200,UNITED HEALTHCARE,UNITED HEALTHCARE,514.27,,,,,,,410.9400,1592.1600,percent of total billed charges,"32.3% of $1,592.16 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 2.1MM,272,RC,27200002,CDM,,,,,,both,,,1592.1600,238.8200,WELLCARE,WELLCARE MEDICAID,1592.16,,,,,,,410.9400,1592.1600,percent of total billed charges,"100% of $1,592.16 in Billed Charges for Rev 272 = $1,592.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MGS 3.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,5102.5300,765.3800,AETNA,AETNA,2178.78,,,,,,,1316.9600,5102.5300,percent of total billed charges,"42.7% of $5,102.53 in Billed Charges for Rev 272 = $2,178.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MGS 3.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,5102.5300,765.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3571.77,,,,,,,1316.9600,5102.5300,percent of total billed charges,"Rev 272 $5,102.53 in Billed Charges at 70% = $3,571.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MGS 3.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,5102.5300,765.3800,CIGNA HEALTHCARE,CIGNA HMO,2127.76,,,,,,,1316.9600,5102.5300,percent of total billed charges,"41.7% of $5,102.53 in Billed Charges for Rev 272 = $2,127.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MGS 3.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,5102.5300,765.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2367.57,,,,,,,1316.9600,5102.5300,percent of total billed charges,"46.4% of $5,102.53 in Billed Charges for Rev 272 = $2,367.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MGS 3.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,5102.5300,765.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2127.76,,,,,,,1316.9600,5102.5300,percent of total billed charges,"41.7% of $5,102.53 in Billed Charges for Rev 272 = $2,127.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MGS 3.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,5102.5300,765.3800,CIGNA HEALTHCARE,CIGNA PPO,2127.76,,,,,,,1316.9600,5102.5300,percent of total billed charges,"41.7% of $5,102.53 in Billed Charges for Rev 272 = $2,127.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MGS 3.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,5102.5300,765.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4592.28,,,,,,,1316.9600,5102.5300,percent of total billed charges,"90% of $5,102.53 in Billed Charges for Rev 272 = $4,592.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MGS 3.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,5102.5300,765.3800,MEDCOST,MEDCOST VHN,2428.29,,,,,,,1316.9600,5102.5300,percent of total billed charges,"47.59% of $5,102.53 in Billed Charges for Rev 272 = $2,428.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MGS 3.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,5102.5300,765.3800,SENTARA HEALTH,SENTARA HEALTH,1316.96,,,,,,,1316.9600,5102.5300,percent of total billed charges,"25.81% of $5,102.53 in Billed Charges for Rev 272 = $1,316.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MGS 3.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,5102.5300,765.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5102.53,,,,,,,1316.9600,5102.5300,percent of total billed charges,"100% of $5,102.53 in Billed Charges for Rev 272 = $5,102.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MGS 3.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,5102.5300,765.3800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2551.27,,,,,,,1316.9600,5102.5300,percent of total billed charges,"Rev 272 $5,102.53 in Billed Charges at 50% = $2,551.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MGS 3.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,5102.5300,765.3800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1648.12,,,,,,,1316.9600,5102.5300,other,"32.3% of $5,102.53 in Billed Charges for Rev 272 = $1,648.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL MGS 3.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,5102.5300,765.3800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1566.48,,,,,,,1316.9600,5102.5300,other,"30.7% of $5,102.53 in Billed Charges for Rev 272 = $1,566.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL MGS 3.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,5102.5300,765.3800,UNITED HEALTHCARE,UNITED HEALTHCARE,1648.12,,,,,,,1316.9600,5102.5300,percent of total billed charges,"32.3% of $5,102.53 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MGS 3.0MM STERILE,272,RC,27200002,CDM,,,,,,both,,,5102.5300,765.3800,WELLCARE,WELLCARE MEDICAID,5102.53,,,,,,,1316.9600,5102.5300,percent of total billed charges,"100% of $5,102.53 in Billed Charges for Rev 272 = $5,102.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2 LONG,272,RC,,,,,,,,both,,,3889.1300,583.3700,AETNA,AETNA,1660.66,,,,,,,1003.7800,3889.1300,percent of total billed charges,"42.7% of $3,889.13 in Billed Charges for Rev 272 = $1,660.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2 LONG,272,RC,,,,,,,,both,,,3889.1300,583.3700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2722.39,,,,,,,1003.7800,3889.1300,percent of total billed charges,"Rev 272 $3,889.13 in Billed Charges at 70% = $2,722.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2 LONG,272,RC,,,,,,,,both,,,3889.1300,583.3700,CIGNA HEALTHCARE,CIGNA HMO,1621.77,,,,,,,1003.7800,3889.1300,percent of total billed charges,"41.7% of $3,889.13 in Billed Charges for Rev 272 = $1,621.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2 LONG,272,RC,,,,,,,,both,,,3889.1300,583.3700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1804.56,,,,,,,1003.7800,3889.1300,percent of total billed charges,"46.4% of $3,889.13 in Billed Charges for Rev 272 = $1,804.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2 LONG,272,RC,,,,,,,,both,,,3889.1300,583.3700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1621.77,,,,,,,1003.7800,3889.1300,percent of total billed charges,"41.7% of $3,889.13 in Billed Charges for Rev 272 = $1,621.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2 LONG,272,RC,,,,,,,,both,,,3889.1300,583.3700,CIGNA HEALTHCARE,CIGNA PPO,1621.77,,,,,,,1003.7800,3889.1300,percent of total billed charges,"41.7% of $3,889.13 in Billed Charges for Rev 272 = $1,621.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2 LONG,272,RC,,,,,,,,both,,,3889.1300,583.3700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3500.22,,,,,,,1003.7800,3889.1300,percent of total billed charges,"90% of $3,889.13 in Billed Charges for Rev 272 = $3,500.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2 LONG,272,RC,,,,,,,,both,,,3889.1300,583.3700,MEDCOST,MEDCOST VHN,1850.84,,,,,,,1003.7800,3889.1300,percent of total billed charges,"47.59% of $3,889.13 in Billed Charges for Rev 272 = $1,850.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2 LONG,272,RC,,,,,,,,both,,,3889.1300,583.3700,SENTARA HEALTH,SENTARA HEALTH,1003.78,,,,,,,1003.7800,3889.1300,percent of total billed charges,"25.81% of $3,889.13 in Billed Charges for Rev 272 = $1,003.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2 LONG,272,RC,,,,,,,,both,,,3889.1300,583.3700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3889.13,,,,,,,1003.7800,3889.1300,percent of total billed charges,"100% of $3,889.13 in Billed Charges for Rev 272 = $3,889.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2 LONG,272,RC,,,,,,,,both,,,3889.1300,583.3700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1944.57,,,,,,,1003.7800,3889.1300,percent of total billed charges,"Rev 272 $3,889.13 in Billed Charges at 50% = $1,944.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2 LONG,272,RC,,,,,,,,both,,,3889.1300,583.3700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1256.19,,,,,,,1003.7800,3889.1300,other,"32.3% of $3,889.13 in Billed Charges for Rev 272 = $1,256.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL MINI ACUTRAK 2 LONG,272,RC,,,,,,,,both,,,3889.1300,583.3700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1193.96,,,,,,,1003.7800,3889.1300,other,"30.7% of $3,889.13 in Billed Charges for Rev 272 = $1,193.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL MINI ACUTRAK 2 LONG,272,RC,,,,,,,,both,,,3889.1300,583.3700,UNITED HEALTHCARE,UNITED HEALTHCARE,1256.19,,,,,,,1003.7800,3889.1300,percent of total billed charges,"32.3% of $3,889.13 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2 LONG,272,RC,,,,,,,,both,,,3889.1300,583.3700,WELLCARE,WELLCARE MEDICAID,3889.13,,,,,,,1003.7800,3889.1300,percent of total billed charges,"100% of $3,889.13 in Billed Charges for Rev 272 = $3,889.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHEAD 4.0 CUSTOM,272,RC,,,,,,,,both,,,2739.1900,410.8800,AETNA,AETNA,1169.63,,,,,,,706.9800,2739.1900,percent of total billed charges,"42.7% of $2,739.19 in Billed Charges for Rev 272 = $1,169.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHEAD 4.0 CUSTOM,272,RC,,,,,,,,both,,,2739.1900,410.8800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1917.43,,,,,,,706.9800,2739.1900,percent of total billed charges,"Rev 272 $2,739.19 in Billed Charges at 70% = $1,917.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHEAD 4.0 CUSTOM,272,RC,,,,,,,,both,,,2739.1900,410.8800,CIGNA HEALTHCARE,CIGNA HMO,1142.24,,,,,,,706.9800,2739.1900,percent of total billed charges,"41.7% of $2,739.19 in Billed Charges for Rev 272 = $1,142.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHEAD 4.0 CUSTOM,272,RC,,,,,,,,both,,,2739.1900,410.8800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1270.98,,,,,,,706.9800,2739.1900,percent of total billed charges,"46.4% of $2,739.19 in Billed Charges for Rev 272 = $1,270.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHEAD 4.0 CUSTOM,272,RC,,,,,,,,both,,,2739.1900,410.8800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1142.24,,,,,,,706.9800,2739.1900,percent of total billed charges,"41.7% of $2,739.19 in Billed Charges for Rev 272 = $1,142.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHEAD 4.0 CUSTOM,272,RC,,,,,,,,both,,,2739.1900,410.8800,CIGNA HEALTHCARE,CIGNA PPO,1142.24,,,,,,,706.9800,2739.1900,percent of total billed charges,"41.7% of $2,739.19 in Billed Charges for Rev 272 = $1,142.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHEAD 4.0 CUSTOM,272,RC,,,,,,,,both,,,2739.1900,410.8800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2465.27,,,,,,,706.9800,2739.1900,percent of total billed charges,"90% of $2,739.19 in Billed Charges for Rev 272 = $2,465.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHEAD 4.0 CUSTOM,272,RC,,,,,,,,both,,,2739.1900,410.8800,MEDCOST,MEDCOST VHN,1303.58,,,,,,,706.9800,2739.1900,percent of total billed charges,"47.59% of $2,739.19 in Billed Charges for Rev 272 = $1,303.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHEAD 4.0 CUSTOM,272,RC,,,,,,,,both,,,2739.1900,410.8800,SENTARA HEALTH,SENTARA HEALTH,706.98,,,,,,,706.9800,2739.1900,percent of total billed charges,"25.81% of $2,739.19 in Billed Charges for Rev 272 = $706.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHEAD 4.0 CUSTOM,272,RC,,,,,,,,both,,,2739.1900,410.8800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2739.19,,,,,,,706.9800,2739.1900,percent of total billed charges,"100% of $2,739.19 in Billed Charges for Rev 272 = $2,739.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHEAD 4.0 CUSTOM,272,RC,,,,,,,,both,,,2739.1900,410.8800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1369.60,,,,,,,706.9800,2739.1900,percent of total billed charges,"Rev 272 $2,739.19 in Billed Charges at 50% = $1,369.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHEAD 4.0 CUSTOM,272,RC,,,,,,,,both,,,2739.1900,410.8800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,884.76,,,,,,,706.9800,2739.1900,other,"32.3% of $2,739.19 in Billed Charges for Rev 272 = $884.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR MATCHEAD 4.0 CUSTOM,272,RC,,,,,,,,both,,,2739.1900,410.8800,UNITED HEALTHCARE,UHC HERITAGE SELECT,840.93,,,,,,,706.9800,2739.1900,other,"30.7% of $2,739.19 in Billed Charges for Rev 272 = $840.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR MATCHEAD 4.0 CUSTOM,272,RC,,,,,,,,both,,,2739.1900,410.8800,UNITED HEALTHCARE,UNITED HEALTHCARE,884.76,,,,,,,706.9800,2739.1900,percent of total billed charges,"32.3% of $2,739.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR MATCHEAD 4.0 CUSTOM,272,RC,,,,,,,,both,,,2739.1900,410.8800,WELLCARE,WELLCARE MEDICAID,2739.19,,,,,,,706.9800,2739.1900,percent of total billed charges,"100% of $2,739.19 in Billed Charges for Rev 272 = $2,739.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI QUICK COUPLING 0.76 MM X 10 MM STOP 316.290,272,RC,,,,,,,,both,,,1348.4400,202.2700,AETNA,AETNA,575.78,,,,,,,348.0300,1348.4400,percent of total billed charges,"42.7% of $1,348.44 in Billed Charges for Rev 272 = $575.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI QUICK COUPLING 0.76 MM X 10 MM STOP 316.290,272,RC,,,,,,,,both,,,1348.4400,202.2700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,943.91,,,,,,,348.0300,1348.4400,percent of total billed charges,"Rev 272 $1,348.44 in Billed Charges at 70% = $943.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI QUICK COUPLING 0.76 MM X 10 MM STOP 316.290,272,RC,,,,,,,,both,,,1348.4400,202.2700,CIGNA HEALTHCARE,CIGNA HMO,562.30,,,,,,,348.0300,1348.4400,percent of total billed charges,"41.7% of $1,348.44 in Billed Charges for Rev 272 = $562.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI QUICK COUPLING 0.76 MM X 10 MM STOP 316.290,272,RC,,,,,,,,both,,,1348.4400,202.2700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,625.68,,,,,,,348.0300,1348.4400,percent of total billed charges,"46.4% of $1,348.44 in Billed Charges for Rev 272 = $625.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI QUICK COUPLING 0.76 MM X 10 MM STOP 316.290,272,RC,,,,,,,,both,,,1348.4400,202.2700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,562.30,,,,,,,348.0300,1348.4400,percent of total billed charges,"41.7% of $1,348.44 in Billed Charges for Rev 272 = $562.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI QUICK COUPLING 0.76 MM X 10 MM STOP 316.290,272,RC,,,,,,,,both,,,1348.4400,202.2700,CIGNA HEALTHCARE,CIGNA PPO,562.30,,,,,,,348.0300,1348.4400,percent of total billed charges,"41.7% of $1,348.44 in Billed Charges for Rev 272 = $562.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI QUICK COUPLING 0.76 MM X 10 MM STOP 316.290,272,RC,,,,,,,,both,,,1348.4400,202.2700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1213.60,,,,,,,348.0300,1348.4400,percent of total billed charges,"90% of $1,348.44 in Billed Charges for Rev 272 = $1,213.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI QUICK COUPLING 0.76 MM X 10 MM STOP 316.290,272,RC,,,,,,,,both,,,1348.4400,202.2700,MEDCOST,MEDCOST VHN,641.72,,,,,,,348.0300,1348.4400,percent of total billed charges,"47.59% of $1,348.44 in Billed Charges for Rev 272 = $641.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI QUICK COUPLING 0.76 MM X 10 MM STOP 316.290,272,RC,,,,,,,,both,,,1348.4400,202.2700,SENTARA HEALTH,SENTARA HEALTH,348.03,,,,,,,348.0300,1348.4400,percent of total billed charges,"25.81% of $1,348.44 in Billed Charges for Rev 272 = $348.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI QUICK COUPLING 0.76 MM X 10 MM STOP 316.290,272,RC,,,,,,,,both,,,1348.4400,202.2700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1348.44,,,,,,,348.0300,1348.4400,percent of total billed charges,"100% of $1,348.44 in Billed Charges for Rev 272 = $1,348.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI QUICK COUPLING 0.76 MM X 10 MM STOP 316.290,272,RC,,,,,,,,both,,,1348.4400,202.2700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,674.22,,,,,,,348.0300,1348.4400,percent of total billed charges,"Rev 272 $1,348.44 in Billed Charges at 50% = $674.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI QUICK COUPLING 0.76 MM X 10 MM STOP 316.290,272,RC,,,,,,,,both,,,1348.4400,202.2700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.55,,,,,,,348.0300,1348.4400,other,"32.3% of $1,348.44 in Billed Charges for Rev 272 = $435.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL MINI QUICK COUPLING 0.76 MM X 10 MM STOP 316.290,272,RC,,,,,,,,both,,,1348.4400,202.2700,UNITED HEALTHCARE,UHC HERITAGE SELECT,413.97,,,,,,,348.0300,1348.4400,other,"30.7% of $1,348.44 in Billed Charges for Rev 272 = $413.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL MINI QUICK COUPLING 0.76 MM X 10 MM STOP 316.290,272,RC,,,,,,,,both,,,1348.4400,202.2700,UNITED HEALTHCARE,UNITED HEALTHCARE,435.55,,,,,,,348.0300,1348.4400,percent of total billed charges,"32.3% of $1,348.44 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI QUICK COUPLING 0.76 MM X 10 MM STOP 316.290,272,RC,,,,,,,,both,,,1348.4400,202.2700,WELLCARE,WELLCARE MEDICAID,1348.44,,,,,,,348.0300,1348.4400,percent of total billed charges,"100% of $1,348.44 in Billed Charges for Rev 272 = $1,348.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON PREPERITONEAL,272,RC,,,,,,,,both,,,5666.9400,850.0400,AETNA,AETNA,2419.78,,,,,,,1462.6400,5666.9400,percent of total billed charges,"42.7% of $5,666.94 in Billed Charges for Rev 272 = $2,419.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON PREPERITONEAL,272,RC,,,,,,,,both,,,5666.9400,850.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3966.86,,,,,,,1462.6400,5666.9400,percent of total billed charges,"Rev 272 $5,666.94 in Billed Charges at 70% = $3,966.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON PREPERITONEAL,272,RC,,,,,,,,both,,,5666.9400,850.0400,CIGNA HEALTHCARE,CIGNA HMO,2363.11,,,,,,,1462.6400,5666.9400,percent of total billed charges,"41.7% of $5,666.94 in Billed Charges for Rev 272 = $2,363.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON PREPERITONEAL,272,RC,,,,,,,,both,,,5666.9400,850.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2629.46,,,,,,,1462.6400,5666.9400,percent of total billed charges,"46.4% of $5,666.94 in Billed Charges for Rev 272 = $2,629.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON PREPERITONEAL,272,RC,,,,,,,,both,,,5666.9400,850.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2363.11,,,,,,,1462.6400,5666.9400,percent of total billed charges,"41.7% of $5,666.94 in Billed Charges for Rev 272 = $2,363.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON PREPERITONEAL,272,RC,,,,,,,,both,,,5666.9400,850.0400,CIGNA HEALTHCARE,CIGNA PPO,2363.11,,,,,,,1462.6400,5666.9400,percent of total billed charges,"41.7% of $5,666.94 in Billed Charges for Rev 272 = $2,363.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON PREPERITONEAL,272,RC,,,,,,,,both,,,5666.9400,850.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5100.25,,,,,,,1462.6400,5666.9400,percent of total billed charges,"90% of $5,666.94 in Billed Charges for Rev 272 = $5,100.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON PREPERITONEAL,272,RC,,,,,,,,both,,,5666.9400,850.0400,MEDCOST,MEDCOST VHN,2696.90,,,,,,,1462.6400,5666.9400,percent of total billed charges,"47.59% of $5,666.94 in Billed Charges for Rev 272 = $2,696.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON PREPERITONEAL,272,RC,,,,,,,,both,,,5666.9400,850.0400,SENTARA HEALTH,SENTARA HEALTH,1462.64,,,,,,,1462.6400,5666.9400,percent of total billed charges,"25.81% of $5,666.94 in Billed Charges for Rev 272 = $1,462.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON PREPERITONEAL,272,RC,,,,,,,,both,,,5666.9400,850.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5666.94,,,,,,,1462.6400,5666.9400,percent of total billed charges,"100% of $5,666.94 in Billed Charges for Rev 272 = $5,666.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON PREPERITONEAL,272,RC,,,,,,,,both,,,5666.9400,850.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2833.47,,,,,,,1462.6400,5666.9400,percent of total billed charges,"Rev 272 $5,666.94 in Billed Charges at 50% = $2,833.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON PREPERITONEAL,272,RC,,,,,,,,both,,,5666.9400,850.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1830.42,,,,,,,1462.6400,5666.9400,other,"32.3% of $5,666.94 in Billed Charges for Rev 272 = $1,830.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BALLOON PREPERITONEAL,272,RC,,,,,,,,both,,,5666.9400,850.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1739.75,,,,,,,1462.6400,5666.9400,other,"30.7% of $5,666.94 in Billed Charges for Rev 272 = $1,739.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BALLOON PREPERITONEAL,272,RC,,,,,,,,both,,,5666.9400,850.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,1830.42,,,,,,,1462.6400,5666.9400,percent of total billed charges,"32.3% of $5,666.94 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON PREPERITONEAL,272,RC,,,,,,,,both,,,5666.9400,850.0400,WELLCARE,WELLCARE MEDICAID,5666.94,,,,,,,1462.6400,5666.9400,percent of total billed charges,"100% of $5,666.94 in Billed Charges for Rev 272 = $5,666.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON SPHERE INFLATION DEVICE CID-20-30-NG,272,RC,,,,,,,,both,,,710.3100,106.5500,AETNA,AETNA,303.30,,,,,,,183.3300,710.3100,percent of total billed charges,42.7% of $710.31 in Billed Charges for Rev 272 = $303.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON SPHERE INFLATION DEVICE CID-20-30-NG,272,RC,,,,,,,,both,,,710.3100,106.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,497.22,,,,,,,183.3300,710.3100,percent of total billed charges,Rev 272 $710.31 in Billed Charges at 70% = $497.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON SPHERE INFLATION DEVICE CID-20-30-NG,272,RC,,,,,,,,both,,,710.3100,106.5500,CIGNA HEALTHCARE,CIGNA HMO,296.20,,,,,,,183.3300,710.3100,percent of total billed charges,41.7% of $710.31 in Billed Charges for Rev 272 = $296.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON SPHERE INFLATION DEVICE CID-20-30-NG,272,RC,,,,,,,,both,,,710.3100,106.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,329.58,,,,,,,183.3300,710.3100,percent of total billed charges,46.4% of $710.31 in Billed Charges for Rev 272 = $329.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON SPHERE INFLATION DEVICE CID-20-30-NG,272,RC,,,,,,,,both,,,710.3100,106.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,296.20,,,,,,,183.3300,710.3100,percent of total billed charges,41.7% of $710.31 in Billed Charges for Rev 272 = $296.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON SPHERE INFLATION DEVICE CID-20-30-NG,272,RC,,,,,,,,both,,,710.3100,106.5500,CIGNA HEALTHCARE,CIGNA PPO,296.20,,,,,,,183.3300,710.3100,percent of total billed charges,41.7% of $710.31 in Billed Charges for Rev 272 = $296.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON SPHERE INFLATION DEVICE CID-20-30-NG,272,RC,,,,,,,,both,,,710.3100,106.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,639.28,,,,,,,183.3300,710.3100,percent of total billed charges,90% of $710.31 in Billed Charges for Rev 272 = $639.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON SPHERE INFLATION DEVICE CID-20-30-NG,272,RC,,,,,,,,both,,,710.3100,106.5500,MEDCOST,MEDCOST VHN,338.04,,,,,,,183.3300,710.3100,percent of total billed charges,47.59% of $710.31 in Billed Charges for Rev 272 = $338.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON SPHERE INFLATION DEVICE CID-20-30-NG,272,RC,,,,,,,,both,,,710.3100,106.5500,SENTARA HEALTH,SENTARA HEALTH,183.33,,,,,,,183.3300,710.3100,percent of total billed charges,25.81% of $710.31 in Billed Charges for Rev 272 = $183.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON SPHERE INFLATION DEVICE CID-20-30-NG,272,RC,,,,,,,,both,,,710.3100,106.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",710.31,,,,,,,183.3300,710.3100,percent of total billed charges,100% of $710.31 in Billed Charges for Rev 272 = $710.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON SPHERE INFLATION DEVICE CID-20-30-NG,272,RC,,,,,,,,both,,,710.3100,106.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,355.16,,,,,,,183.3300,710.3100,percent of total billed charges,Rev 272 $710.31 in Billed Charges at 50% = $355.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON SPHERE INFLATION DEVICE CID-20-30-NG,272,RC,,,,,,,,both,,,710.3100,106.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,229.43,,,,,,,183.3300,710.3100,other,32.3% of $710.31 in Billed Charges for Rev 272 = $229.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BALLOON SPHERE INFLATION DEVICE CID-20-30-NG,272,RC,,,,,,,,both,,,710.3100,106.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,218.07,,,,,,,183.3300,710.3100,other,30.7% of $710.31 in Billed Charges for Rev 272 = $218.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BALLOON SPHERE INFLATION DEVICE CID-20-30-NG,272,RC,,,,,,,,both,,,710.3100,106.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,229.43,,,,,,,183.3300,710.3100,percent of total billed charges,32.3% of $710.31 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON SPHERE INFLATION DEVICE CID-20-30-NG,272,RC,,,,,,,,both,,,710.3100,106.5500,WELLCARE,WELLCARE MEDICAID,710.31,,,,,,,183.3300,710.3100,percent of total billed charges,100% of $710.31 in Billed Charges for Rev 272 = $710.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,811.3000,121.7000,AETNA,AETNA,346.43,,,,,,,209.4000,811.3000,percent of total billed charges,42.7% of $811.30 in Billed Charges for Rev 272 = $346.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,811.3000,121.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,567.91,,,,,,,209.4000,811.3000,percent of total billed charges,Rev 272 $811.30 in Billed Charges at 70% = $567.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,811.3000,121.7000,CIGNA HEALTHCARE,CIGNA HMO,338.31,,,,,,,209.4000,811.3000,percent of total billed charges,41.7% of $811.30 in Billed Charges for Rev 272 = $338.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,811.3000,121.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,376.44,,,,,,,209.4000,811.3000,percent of total billed charges,46.4% of $811.30 in Billed Charges for Rev 272 = $376.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,811.3000,121.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,338.31,,,,,,,209.4000,811.3000,percent of total billed charges,41.7% of $811.30 in Billed Charges for Rev 272 = $338.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,811.3000,121.7000,CIGNA HEALTHCARE,CIGNA PPO,338.31,,,,,,,209.4000,811.3000,percent of total billed charges,41.7% of $811.30 in Billed Charges for Rev 272 = $338.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,811.3000,121.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,730.17,,,,,,,209.4000,811.3000,percent of total billed charges,90% of $811.30 in Billed Charges for Rev 272 = $730.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,811.3000,121.7000,MEDCOST,MEDCOST VHN,386.10,,,,,,,209.4000,811.3000,percent of total billed charges,47.59% of $811.30 in Billed Charges for Rev 272 = $386.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,811.3000,121.7000,SENTARA HEALTH,SENTARA HEALTH,209.40,,,,,,,209.4000,811.3000,percent of total billed charges,25.81% of $811.30 in Billed Charges for Rev 272 = $209.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,811.3000,121.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",811.30,,,,,,,209.4000,811.3000,percent of total billed charges,100% of $811.30 in Billed Charges for Rev 272 = $811.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,811.3000,121.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,405.65,,,,,,,209.4000,811.3000,percent of total billed charges,Rev 272 $811.30 in Billed Charges at 50% = $405.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,811.3000,121.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,262.05,,,,,,,209.4000,811.3000,other,32.3% of $811.30 in Billed Charges for Rev 272 = $262.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,811.3000,121.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,249.07,,,,,,,209.4000,811.3000,other,30.7% of $811.30 in Billed Charges for Rev 272 = $249.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,811.3000,121.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,262.05,,,,,,,209.4000,811.3000,percent of total billed charges,32.3% of $811.30 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,811.3000,121.7000,WELLCARE,WELLCARE MEDICAID,811.30,,,,,,,209.4000,811.3000,percent of total billed charges,100% of $811.30 in Billed Charges for Rev 272 = $811.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,843.7600,126.5600,AETNA,AETNA,360.29,,,,,,,217.7700,843.7600,percent of total billed charges,42.7% of $843.76 in Billed Charges for Rev 272 = $360.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,843.7600,126.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,590.63,,,,,,,217.7700,843.7600,percent of total billed charges,Rev 272 $843.76 in Billed Charges at 70% = $590.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,843.7600,126.5600,CIGNA HEALTHCARE,CIGNA HMO,351.85,,,,,,,217.7700,843.7600,percent of total billed charges,41.7% of $843.76 in Billed Charges for Rev 272 = $351.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,843.7600,126.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,391.50,,,,,,,217.7700,843.7600,percent of total billed charges,46.4% of $843.76 in Billed Charges for Rev 272 = $391.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,843.7600,126.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,351.85,,,,,,,217.7700,843.7600,percent of total billed charges,41.7% of $843.76 in Billed Charges for Rev 272 = $351.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,843.7600,126.5600,CIGNA HEALTHCARE,CIGNA PPO,351.85,,,,,,,217.7700,843.7600,percent of total billed charges,41.7% of $843.76 in Billed Charges for Rev 272 = $351.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,843.7600,126.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,759.38,,,,,,,217.7700,843.7600,percent of total billed charges,90% of $843.76 in Billed Charges for Rev 272 = $759.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,843.7600,126.5600,MEDCOST,MEDCOST VHN,401.55,,,,,,,217.7700,843.7600,percent of total billed charges,47.59% of $843.76 in Billed Charges for Rev 272 = $401.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,843.7600,126.5600,SENTARA HEALTH,SENTARA HEALTH,217.77,,,,,,,217.7700,843.7600,percent of total billed charges,25.81% of $843.76 in Billed Charges for Rev 272 = $217.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,843.7600,126.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",843.76,,,,,,,217.7700,843.7600,percent of total billed charges,100% of $843.76 in Billed Charges for Rev 272 = $843.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,843.7600,126.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,421.88,,,,,,,217.7700,843.7600,percent of total billed charges,Rev 272 $843.76 in Billed Charges at 50% = $421.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,843.7600,126.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,272.53,,,,,,,217.7700,843.7600,other,32.3% of $843.76 in Billed Charges for Rev 272 = $272.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,843.7600,126.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,259.03,,,,,,,217.7700,843.7600,other,30.7% of $843.76 in Billed Charges for Rev 272 = $259.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,843.7600,126.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,272.53,,,,,,,217.7700,843.7600,percent of total billed charges,32.3% of $843.76 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUBCHONDRAL 1.5,272,RC,27200002,CDM,,,,,,both,,,843.7600,126.5600,WELLCARE,WELLCARE MEDICAID,843.76,,,,,,,217.7700,843.7600,percent of total billed charges,100% of $843.76 in Billed Charges for Rev 272 = $843.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SYNDESMOSIS 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1348.2300,202.2300,AETNA,AETNA,575.69,,,,,,,347.9800,1348.2300,percent of total billed charges,"42.7% of $1,348.23 in Billed Charges for Rev 272 = $575.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SYNDESMOSIS 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1348.2300,202.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,943.76,,,,,,,347.9800,1348.2300,percent of total billed charges,"Rev 272 $1,348.23 in Billed Charges at 70% = $943.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SYNDESMOSIS 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1348.2300,202.2300,CIGNA HEALTHCARE,CIGNA HMO,562.21,,,,,,,347.9800,1348.2300,percent of total billed charges,"41.7% of $1,348.23 in Billed Charges for Rev 272 = $562.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SYNDESMOSIS 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1348.2300,202.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,625.58,,,,,,,347.9800,1348.2300,percent of total billed charges,"46.4% of $1,348.23 in Billed Charges for Rev 272 = $625.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SYNDESMOSIS 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1348.2300,202.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,562.21,,,,,,,347.9800,1348.2300,percent of total billed charges,"41.7% of $1,348.23 in Billed Charges for Rev 272 = $562.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SYNDESMOSIS 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1348.2300,202.2300,CIGNA HEALTHCARE,CIGNA PPO,562.21,,,,,,,347.9800,1348.2300,percent of total billed charges,"41.7% of $1,348.23 in Billed Charges for Rev 272 = $562.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SYNDESMOSIS 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1348.2300,202.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1213.41,,,,,,,347.9800,1348.2300,percent of total billed charges,"90% of $1,348.23 in Billed Charges for Rev 272 = $1,213.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SYNDESMOSIS 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1348.2300,202.2300,MEDCOST,MEDCOST VHN,641.62,,,,,,,347.9800,1348.2300,percent of total billed charges,"47.59% of $1,348.23 in Billed Charges for Rev 272 = $641.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SYNDESMOSIS 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1348.2300,202.2300,SENTARA HEALTH,SENTARA HEALTH,347.98,,,,,,,347.9800,1348.2300,percent of total billed charges,"25.81% of $1,348.23 in Billed Charges for Rev 272 = $347.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SYNDESMOSIS 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1348.2300,202.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1348.23,,,,,,,347.9800,1348.2300,percent of total billed charges,"100% of $1,348.23 in Billed Charges for Rev 272 = $1,348.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SYNDESMOSIS 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1348.2300,202.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,674.12,,,,,,,347.9800,1348.2300,percent of total billed charges,"Rev 272 $1,348.23 in Billed Charges at 50% = $674.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SYNDESMOSIS 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1348.2300,202.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.48,,,,,,,347.9800,1348.2300,other,"32.3% of $1,348.23 in Billed Charges for Rev 272 = $435.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL SYNDESMOSIS 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1348.2300,202.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,413.91,,,,,,,347.9800,1348.2300,other,"30.7% of $1,348.23 in Billed Charges for Rev 272 = $413.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL SYNDESMOSIS 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1348.2300,202.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,435.48,,,,,,,347.9800,1348.2300,percent of total billed charges,"32.3% of $1,348.23 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SYNDESMOSIS 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1348.2300,202.2300,WELLCARE,WELLCARE MEDICAID,1348.23,,,,,,,347.9800,1348.2300,percent of total billed charges,"100% of $1,348.23 in Billed Charges for Rev 272 = $1,348.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TROCAR KII 12X130 GEL,272,RC,27200002,CDM,,,,,,both,,,1244.5200,186.6800,AETNA,AETNA,531.41,,,,,,,321.2100,1244.5200,percent of total billed charges,"42.7% of $1,244.52 in Billed Charges for Rev 272 = $531.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TROCAR KII 12X130 GEL,272,RC,27200002,CDM,,,,,,both,,,1244.5200,186.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,871.16,,,,,,,321.2100,1244.5200,percent of total billed charges,"Rev 272 $1,244.52 in Billed Charges at 70% = $871.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TROCAR KII 12X130 GEL,272,RC,27200002,CDM,,,,,,both,,,1244.5200,186.6800,CIGNA HEALTHCARE,CIGNA HMO,518.96,,,,,,,321.2100,1244.5200,percent of total billed charges,"41.7% of $1,244.52 in Billed Charges for Rev 272 = $518.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TROCAR KII 12X130 GEL,272,RC,27200002,CDM,,,,,,both,,,1244.5200,186.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,577.46,,,,,,,321.2100,1244.5200,percent of total billed charges,"46.4% of $1,244.52 in Billed Charges for Rev 272 = $577.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TROCAR KII 12X130 GEL,272,RC,27200002,CDM,,,,,,both,,,1244.5200,186.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,518.96,,,,,,,321.2100,1244.5200,percent of total billed charges,"41.7% of $1,244.52 in Billed Charges for Rev 272 = $518.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TROCAR KII 12X130 GEL,272,RC,27200002,CDM,,,,,,both,,,1244.5200,186.6800,CIGNA HEALTHCARE,CIGNA PPO,518.96,,,,,,,321.2100,1244.5200,percent of total billed charges,"41.7% of $1,244.52 in Billed Charges for Rev 272 = $518.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TROCAR KII 12X130 GEL,272,RC,27200002,CDM,,,,,,both,,,1244.5200,186.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1120.07,,,,,,,321.2100,1244.5200,percent of total billed charges,"90% of $1,244.52 in Billed Charges for Rev 272 = $1,120.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TROCAR KII 12X130 GEL,272,RC,27200002,CDM,,,,,,both,,,1244.5200,186.6800,MEDCOST,MEDCOST VHN,592.27,,,,,,,321.2100,1244.5200,percent of total billed charges,"47.59% of $1,244.52 in Billed Charges for Rev 272 = $592.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TROCAR KII 12X130 GEL,272,RC,27200002,CDM,,,,,,both,,,1244.5200,186.6800,SENTARA HEALTH,SENTARA HEALTH,321.21,,,,,,,321.2100,1244.5200,percent of total billed charges,"25.81% of $1,244.52 in Billed Charges for Rev 272 = $321.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TROCAR KII 12X130 GEL,272,RC,27200002,CDM,,,,,,both,,,1244.5200,186.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1244.52,,,,,,,321.2100,1244.5200,percent of total billed charges,"100% of $1,244.52 in Billed Charges for Rev 272 = $1,244.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TROCAR KII 12X130 GEL,272,RC,27200002,CDM,,,,,,both,,,1244.5200,186.6800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,622.26,,,,,,,321.2100,1244.5200,percent of total billed charges,"Rev 272 $1,244.52 in Billed Charges at 50% = $622.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TROCAR KII 12X130 GEL,272,RC,27200002,CDM,,,,,,both,,,1244.5200,186.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,401.98,,,,,,,321.2100,1244.5200,other,"32.3% of $1,244.52 in Billed Charges for Rev 272 = $401.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BALLOON TROCAR KII 12X130 GEL,272,RC,27200002,CDM,,,,,,both,,,1244.5200,186.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,382.07,,,,,,,321.2100,1244.5200,other,"30.7% of $1,244.52 in Billed Charges for Rev 272 = $382.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BALLOON TROCAR KII 12X130 GEL,272,RC,27200002,CDM,,,,,,both,,,1244.5200,186.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,401.98,,,,,,,321.2100,1244.5200,percent of total billed charges,"32.3% of $1,244.52 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON TROCAR KII 12X130 GEL,272,RC,27200002,CDM,,,,,,both,,,1244.5200,186.6800,WELLCARE,WELLCARE MEDICAID,1244.52,,,,,,,321.2100,1244.5200,percent of total billed charges,"100% of $1,244.52 in Billed Charges for Rev 272 = $1,244.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND GASTRIC REALIZED ADJUSTABLE RLZB32D1,278,RC,,,,,,,,both,,,29961.8200,4494.2700,AETNA,AETNA,14381.67,,,,,,,2127.2900,29961.8200,percent of total billed charges,"48% of $29,961.82 in Billed Charges for Rev 278 = $14,381.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND GASTRIC REALIZED ADJUSTABLE RLZB32D1,278,RC,,,,,,,,both,,,29961.8200,4494.2700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,14980.91,,,,,,,2127.2900,29961.8200,percent of total billed charges,"50% of $29,961.82 in Billed Charges for Rev 278 = $14,980.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND GASTRIC REALIZED ADJUSTABLE RLZB32D1,278,RC,,,,,,,,both,,,29961.8200,4494.2700,CIGNA HEALTHCARE,CIGNA HMO,12494.08,,,,,,,2127.2900,29961.8200,percent of total billed charges,"41.7% of $29,961.82 in Billed Charges for Rev 278 = $12,494.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND GASTRIC REALIZED ADJUSTABLE RLZB32D1,278,RC,,,,,,,,both,,,29961.8200,4494.2700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11984.73,,,,,,,2127.2900,29961.8200,percent of total billed charges,"40% of $29,961.82 in Billed Charges for Rev 278 = $11,984.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND GASTRIC REALIZED ADJUSTABLE RLZB32D1,278,RC,,,,,,,,both,,,29961.8200,4494.2700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,12494.08,,,,,,,2127.2900,29961.8200,percent of total billed charges,"41.7% of $29,961.82 in Billed Charges for Rev 278 = $12,494.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND GASTRIC REALIZED ADJUSTABLE RLZB32D1,278,RC,,,,,,,,both,,,29961.8200,4494.2700,CIGNA HEALTHCARE,CIGNA PPO,12494.08,,,,,,,2127.2900,29961.8200,percent of total billed charges,"41.7% of $29,961.82 in Billed Charges for Rev 278 = $12,494.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND GASTRIC REALIZED ADJUSTABLE RLZB32D1,278,RC,,,,,,,,both,,,29961.8200,4494.2700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,26965.64,,,,,,,2127.2900,29961.8200,percent of total billed charges,"90% of $29,961.82 in Billed Charges for Rev 278 = $26,965.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND GASTRIC REALIZED ADJUSTABLE RLZB32D1,278,RC,,,,,,,,both,,,29961.8200,4494.2700,MEDCOST,MEDCOST VHN,14258.83,,,,,,,2127.2900,29961.8200,percent of total billed charges,"47.59% of $29,961.82 in Billed Charges for Rev 278 = $14,258.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND GASTRIC REALIZED ADJUSTABLE RLZB32D1,278,RC,,,,,,,,both,,,29961.8200,4494.2700,SENTARA HEALTH,SENTARA HEALTH,7733.15,,,,,,,2127.2900,29961.8200,percent of total billed charges,"25.81% of $29,961.82 in Billed Charges for Rev 278 = $7,733.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND GASTRIC REALIZED ADJUSTABLE RLZB32D1,278,RC,,,,,,,,both,,,29961.8200,4494.2700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",29961.82,,,,,,,2127.2900,29961.8200,percent of total billed charges,"100% of $29,961.82 in Billed Charges for Rev 278 = $29,961.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND GASTRIC REALIZED ADJUSTABLE RLZB32D1,278,RC,,,,,,,,both,,,29961.8200,4494.2700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14980.91,,,,,,,2127.2900,29961.8200,percent of total billed charges,"Rev 278 $29,961.82 in Billed Charges at 50% = $14,980.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND GASTRIC REALIZED ADJUSTABLE RLZB32D1,278,RC,,,,,,,,both,,,29961.8200,4494.2700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2247.14,,,,,,,2127.2900,29961.8200,percent of total billed charges,"7.5% of $29,961.82 in Billed Charges for Rev 278 = $2,247.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND GASTRIC REALIZED ADJUSTABLE RLZB32D1,278,RC,,,,,,,,both,,,29961.8200,4494.2700,UNITED HEALTHCARE,UHC HERITAGE SELECT,2127.29,,,,,,,2127.2900,29961.8200,percent of total billed charges,"7.1% of $29,961.82 in Billed Charges for Rev 278 = $2,127.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND GASTRIC REALIZED ADJUSTABLE RLZB32D1,278,RC,,,,,,,,both,,,29961.8200,4494.2700,UNITED HEALTHCARE,UNITED HEALTHCARE,2127.29,,,,,,,2127.2900,29961.8200,percent of total billed charges,"7.1% of $29,961.82 in Billed Charges for Rev 278 = $2,127.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND GASTRIC REALIZED ADJUSTABLE RLZB32D1,278,RC,,,,,,,,both,,,29961.8200,4494.2700,WELLCARE,WELLCARE MEDICAID,29961.82,,,,,,,2127.2900,29961.8200,percent of total billed charges,"100% of $29,961.82 in Billed Charges for Rev 278 = $29,961.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAND UNIVERSAL FACIAL,272,RC,27200002,CDM,,,,,,both,,,838.6000,125.7900,AETNA,AETNA,358.08,,,,,,,216.4400,838.6000,percent of total billed charges,42.7% of $838.60 in Billed Charges for Rev 272 = $358.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BAND UNIVERSAL FACIAL,272,RC,27200002,CDM,,,,,,both,,,838.6000,125.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,587.02,,,,,,,216.4400,838.6000,percent of total billed charges,Rev 272 $838.60 in Billed Charges at 70% = $587.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BAND UNIVERSAL FACIAL,272,RC,27200002,CDM,,,,,,both,,,838.6000,125.7900,CIGNA HEALTHCARE,CIGNA HMO,349.70,,,,,,,216.4400,838.6000,percent of total billed charges,41.7% of $838.60 in Billed Charges for Rev 272 = $349.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BAND UNIVERSAL FACIAL,272,RC,27200002,CDM,,,,,,both,,,838.6000,125.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,389.11,,,,,,,216.4400,838.6000,percent of total billed charges,46.4% of $838.60 in Billed Charges for Rev 272 = $389.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BAND UNIVERSAL FACIAL,272,RC,27200002,CDM,,,,,,both,,,838.6000,125.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,349.70,,,,,,,216.4400,838.6000,percent of total billed charges,41.7% of $838.60 in Billed Charges for Rev 272 = $349.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BAND UNIVERSAL FACIAL,272,RC,27200002,CDM,,,,,,both,,,838.6000,125.7900,CIGNA HEALTHCARE,CIGNA PPO,349.70,,,,,,,216.4400,838.6000,percent of total billed charges,41.7% of $838.60 in Billed Charges for Rev 272 = $349.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BAND UNIVERSAL FACIAL,272,RC,27200002,CDM,,,,,,both,,,838.6000,125.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,754.74,,,,,,,216.4400,838.6000,percent of total billed charges,90% of $838.60 in Billed Charges for Rev 272 = $754.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BAND UNIVERSAL FACIAL,272,RC,27200002,CDM,,,,,,both,,,838.6000,125.7900,MEDCOST,MEDCOST VHN,399.09,,,,,,,216.4400,838.6000,percent of total billed charges,47.59% of $838.60 in Billed Charges for Rev 272 = $399.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BAND UNIVERSAL FACIAL,272,RC,27200002,CDM,,,,,,both,,,838.6000,125.7900,SENTARA HEALTH,SENTARA HEALTH,216.44,,,,,,,216.4400,838.6000,percent of total billed charges,25.81% of $838.60 in Billed Charges for Rev 272 = $216.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BAND UNIVERSAL FACIAL,272,RC,27200002,CDM,,,,,,both,,,838.6000,125.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",838.60,,,,,,,216.4400,838.6000,percent of total billed charges,100% of $838.60 in Billed Charges for Rev 272 = $838.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BAND UNIVERSAL FACIAL,272,RC,27200002,CDM,,,,,,both,,,838.6000,125.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,419.30,,,,,,,216.4400,838.6000,percent of total billed charges,Rev 272 $838.60 in Billed Charges at 50% = $419.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BAND UNIVERSAL FACIAL,272,RC,27200002,CDM,,,,,,both,,,838.6000,125.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,270.87,,,,,,,216.4400,838.6000,other,32.3% of $838.60 in Billed Charges for Rev 272 = $270.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BAND UNIVERSAL FACIAL,272,RC,27200002,CDM,,,,,,both,,,838.6000,125.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,257.45,,,,,,,216.4400,838.6000,other,30.7% of $838.60 in Billed Charges for Rev 272 = $257.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BAND UNIVERSAL FACIAL,272,RC,27200002,CDM,,,,,,both,,,838.6000,125.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,270.87,,,,,,,216.4400,838.6000,percent of total billed charges,32.3% of $838.60 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BAND UNIVERSAL FACIAL,272,RC,27200002,CDM,,,,,,both,,,838.6000,125.7900,WELLCARE,WELLCARE MEDICAID,838.60,,,,,,,216.4400,838.6000,percent of total billed charges,100% of $838.60 in Billed Charges for Rev 272 = $838.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BARREL BUR 6 FLUTE 5.0,272,RC,27200002,CDM,,,,,,both,,,694.9600,104.2400,AETNA,AETNA,296.75,,,,,,,179.3700,694.9600,percent of total billed charges,42.7% of $694.96 in Billed Charges for Rev 272 = $296.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BARREL BUR 6 FLUTE 5.0,272,RC,27200002,CDM,,,,,,both,,,694.9600,104.2400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,486.47,,,,,,,179.3700,694.9600,percent of total billed charges,Rev 272 $694.96 in Billed Charges at 70% = $486.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BARREL BUR 6 FLUTE 5.0,272,RC,27200002,CDM,,,,,,both,,,694.9600,104.2400,CIGNA HEALTHCARE,CIGNA HMO,289.80,,,,,,,179.3700,694.9600,percent of total billed charges,41.7% of $694.96 in Billed Charges for Rev 272 = $289.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BARREL BUR 6 FLUTE 5.0,272,RC,27200002,CDM,,,,,,both,,,694.9600,104.2400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,322.46,,,,,,,179.3700,694.9600,percent of total billed charges,46.4% of $694.96 in Billed Charges for Rev 272 = $322.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BARREL BUR 6 FLUTE 5.0,272,RC,27200002,CDM,,,,,,both,,,694.9600,104.2400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,289.80,,,,,,,179.3700,694.9600,percent of total billed charges,41.7% of $694.96 in Billed Charges for Rev 272 = $289.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BARREL BUR 6 FLUTE 5.0,272,RC,27200002,CDM,,,,,,both,,,694.9600,104.2400,CIGNA HEALTHCARE,CIGNA PPO,289.80,,,,,,,179.3700,694.9600,percent of total billed charges,41.7% of $694.96 in Billed Charges for Rev 272 = $289.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BARREL BUR 6 FLUTE 5.0,272,RC,27200002,CDM,,,,,,both,,,694.9600,104.2400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,625.46,,,,,,,179.3700,694.9600,percent of total billed charges,90% of $694.96 in Billed Charges for Rev 272 = $625.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BARREL BUR 6 FLUTE 5.0,272,RC,27200002,CDM,,,,,,both,,,694.9600,104.2400,MEDCOST,MEDCOST VHN,330.73,,,,,,,179.3700,694.9600,percent of total billed charges,47.59% of $694.96 in Billed Charges for Rev 272 = $330.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BARREL BUR 6 FLUTE 5.0,272,RC,27200002,CDM,,,,,,both,,,694.9600,104.2400,SENTARA HEALTH,SENTARA HEALTH,179.37,,,,,,,179.3700,694.9600,percent of total billed charges,25.81% of $694.96 in Billed Charges for Rev 272 = $179.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BARREL BUR 6 FLUTE 5.0,272,RC,27200002,CDM,,,,,,both,,,694.9600,104.2400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",694.96,,,,,,,179.3700,694.9600,percent of total billed charges,100% of $694.96 in Billed Charges for Rev 272 = $694.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BARREL BUR 6 FLUTE 5.0,272,RC,27200002,CDM,,,,,,both,,,694.9600,104.2400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,347.48,,,,,,,179.3700,694.9600,percent of total billed charges,Rev 272 $694.96 in Billed Charges at 50% = $347.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BARREL BUR 6 FLUTE 5.0,272,RC,27200002,CDM,,,,,,both,,,694.9600,104.2400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,224.47,,,,,,,179.3700,694.9600,other,32.3% of $694.96 in Billed Charges for Rev 272 = $224.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BARREL BUR 6 FLUTE 5.0,272,RC,27200002,CDM,,,,,,both,,,694.9600,104.2400,UNITED HEALTHCARE,UHC HERITAGE SELECT,213.35,,,,,,,179.3700,694.9600,other,30.7% of $694.96 in Billed Charges for Rev 272 = $213.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BARREL BUR 6 FLUTE 5.0,272,RC,27200002,CDM,,,,,,both,,,694.9600,104.2400,UNITED HEALTHCARE,UNITED HEALTHCARE,224.47,,,,,,,179.3700,694.9600,percent of total billed charges,32.3% of $694.96 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BARREL BUR 6 FLUTE 5.0,272,RC,27200002,CDM,,,,,,both,,,694.9600,104.2400,WELLCARE,WELLCARE MEDICAID,694.96,,,,,,,179.3700,694.9600,percent of total billed charges,100% of $694.96 in Billed Charges for Rev 272 = $694.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE EZX SIZE 58,272,RC,,,,,,,,both,,,10360.6300,1554.0900,AETNA,AETNA,4423.99,,,,,,,2674.0800,10360.6300,percent of total billed charges,"42.7% of $10,360.63 in Billed Charges for Rev 272 = $4,423.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZX SIZE 58,272,RC,,,,,,,,both,,,10360.6300,1554.0900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7252.44,,,,,,,2674.0800,10360.6300,percent of total billed charges,"Rev 272 $10,360.63 in Billed Charges at 70% = $7,252.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZX SIZE 58,272,RC,,,,,,,,both,,,10360.6300,1554.0900,CIGNA HEALTHCARE,CIGNA HMO,4320.38,,,,,,,2674.0800,10360.6300,percent of total billed charges,"41.7% of $10,360.63 in Billed Charges for Rev 272 = $4,320.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZX SIZE 58,272,RC,,,,,,,,both,,,10360.6300,1554.0900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4807.33,,,,,,,2674.0800,10360.6300,percent of total billed charges,"46.4% of $10,360.63 in Billed Charges for Rev 272 = $4,807.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZX SIZE 58,272,RC,,,,,,,,both,,,10360.6300,1554.0900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4320.38,,,,,,,2674.0800,10360.6300,percent of total billed charges,"41.7% of $10,360.63 in Billed Charges for Rev 272 = $4,320.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZX SIZE 58,272,RC,,,,,,,,both,,,10360.6300,1554.0900,CIGNA HEALTHCARE,CIGNA PPO,4320.38,,,,,,,2674.0800,10360.6300,percent of total billed charges,"41.7% of $10,360.63 in Billed Charges for Rev 272 = $4,320.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZX SIZE 58,272,RC,,,,,,,,both,,,10360.6300,1554.0900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9324.57,,,,,,,2674.0800,10360.6300,percent of total billed charges,"90% of $10,360.63 in Billed Charges for Rev 272 = $9,324.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZX SIZE 58,272,RC,,,,,,,,both,,,10360.6300,1554.0900,MEDCOST,MEDCOST VHN,4930.62,,,,,,,2674.0800,10360.6300,percent of total billed charges,"47.59% of $10,360.63 in Billed Charges for Rev 272 = $4,930.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZX SIZE 58,272,RC,,,,,,,,both,,,10360.6300,1554.0900,SENTARA HEALTH,SENTARA HEALTH,2674.08,,,,,,,2674.0800,10360.6300,percent of total billed charges,"25.81% of $10,360.63 in Billed Charges for Rev 272 = $2,674.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZX SIZE 58,272,RC,,,,,,,,both,,,10360.6300,1554.0900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10360.63,,,,,,,2674.0800,10360.6300,percent of total billed charges,"100% of $10,360.63 in Billed Charges for Rev 272 = $10,360.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZX SIZE 58,272,RC,,,,,,,,both,,,10360.6300,1554.0900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5180.32,,,,,,,2674.0800,10360.6300,percent of total billed charges,"Rev 272 $10,360.63 in Billed Charges at 50% = $5,180.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZX SIZE 58,272,RC,,,,,,,,both,,,10360.6300,1554.0900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3346.48,,,,,,,2674.0800,10360.6300,other,"32.3% of $10,360.63 in Billed Charges for Rev 272 = $3,346.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE EZX SIZE 58,272,RC,,,,,,,,both,,,10360.6300,1554.0900,UNITED HEALTHCARE,UHC HERITAGE SELECT,3180.71,,,,,,,2674.0800,10360.6300,other,"30.7% of $10,360.63 in Billed Charges for Rev 272 = $3,180.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE EZX SIZE 58,272,RC,,,,,,,,both,,,10360.6300,1554.0900,UNITED HEALTHCARE,UNITED HEALTHCARE,3346.48,,,,,,,2674.0800,10360.6300,percent of total billed charges,"32.3% of $10,360.63 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZX SIZE 58,272,RC,,,,,,,,both,,,10360.6300,1554.0900,WELLCARE,WELLCARE MEDICAID,10360.63,,,,,,,2674.0800,10360.6300,percent of total billed charges,"100% of $10,360.63 in Billed Charges for Rev 272 = $10,360.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHAVER JT 3.5MM TOMCAT S,272,RC,27200002,CDM,,,,,,both,,,824.6000,123.6900,AETNA,AETNA,352.10,,,,,,,212.8300,824.6000,percent of total billed charges,42.7% of $824.60 in Billed Charges for Rev 272 = $352.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER JT 3.5MM TOMCAT S,272,RC,27200002,CDM,,,,,,both,,,824.6000,123.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,577.22,,,,,,,212.8300,824.6000,percent of total billed charges,Rev 272 $824.60 in Billed Charges at 70% = $577.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER JT 3.5MM TOMCAT S,272,RC,27200002,CDM,,,,,,both,,,824.6000,123.6900,CIGNA HEALTHCARE,CIGNA HMO,343.86,,,,,,,212.8300,824.6000,percent of total billed charges,41.7% of $824.60 in Billed Charges for Rev 272 = $343.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER JT 3.5MM TOMCAT S,272,RC,27200002,CDM,,,,,,both,,,824.6000,123.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,382.61,,,,,,,212.8300,824.6000,percent of total billed charges,46.4% of $824.60 in Billed Charges for Rev 272 = $382.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER JT 3.5MM TOMCAT S,272,RC,27200002,CDM,,,,,,both,,,824.6000,123.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,343.86,,,,,,,212.8300,824.6000,percent of total billed charges,41.7% of $824.60 in Billed Charges for Rev 272 = $343.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER JT 3.5MM TOMCAT S,272,RC,27200002,CDM,,,,,,both,,,824.6000,123.6900,CIGNA HEALTHCARE,CIGNA PPO,343.86,,,,,,,212.8300,824.6000,percent of total billed charges,41.7% of $824.60 in Billed Charges for Rev 272 = $343.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER JT 3.5MM TOMCAT S,272,RC,27200002,CDM,,,,,,both,,,824.6000,123.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,742.14,,,,,,,212.8300,824.6000,percent of total billed charges,90% of $824.60 in Billed Charges for Rev 272 = $742.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER JT 3.5MM TOMCAT S,272,RC,27200002,CDM,,,,,,both,,,824.6000,123.6900,MEDCOST,MEDCOST VHN,392.43,,,,,,,212.8300,824.6000,percent of total billed charges,47.59% of $824.60 in Billed Charges for Rev 272 = $392.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER JT 3.5MM TOMCAT S,272,RC,27200002,CDM,,,,,,both,,,824.6000,123.6900,SENTARA HEALTH,SENTARA HEALTH,212.83,,,,,,,212.8300,824.6000,percent of total billed charges,25.81% of $824.60 in Billed Charges for Rev 272 = $212.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER JT 3.5MM TOMCAT S,272,RC,27200002,CDM,,,,,,both,,,824.6000,123.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",824.60,,,,,,,212.8300,824.6000,percent of total billed charges,100% of $824.60 in Billed Charges for Rev 272 = $824.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER JT 3.5MM TOMCAT S,272,RC,27200002,CDM,,,,,,both,,,824.6000,123.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,412.30,,,,,,,212.8300,824.6000,percent of total billed charges,Rev 272 $824.60 in Billed Charges at 50% = $412.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER JT 3.5MM TOMCAT S,272,RC,27200002,CDM,,,,,,both,,,824.6000,123.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,266.35,,,,,,,212.8300,824.6000,other,32.3% of $824.60 in Billed Charges for Rev 272 = $266.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE SHAVER JT 3.5MM TOMCAT S,272,RC,27200002,CDM,,,,,,both,,,824.6000,123.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,253.15,,,,,,,212.8300,824.6000,other,30.7% of $824.60 in Billed Charges for Rev 272 = $253.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE SHAVER JT 3.5MM TOMCAT S,272,RC,27200002,CDM,,,,,,both,,,824.6000,123.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,266.35,,,,,,,212.8300,824.6000,percent of total billed charges,32.3% of $824.60 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER JT 3.5MM TOMCAT S,272,RC,27200002,CDM,,,,,,both,,,824.6000,123.6900,WELLCARE,WELLCARE MEDICAID,824.60,,,,,,,212.8300,824.6000,percent of total billed charges,100% of $824.60 in Billed Charges for Rev 272 = $824.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1130.7500,169.6100,AETNA,AETNA,482.83,,,,,,,291.8500,1130.7500,percent of total billed charges,"42.7% of $1,130.75 in Billed Charges for Rev 272 = $482.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1130.7500,169.6100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,791.53,,,,,,,291.8500,1130.7500,percent of total billed charges,"Rev 272 $1,130.75 in Billed Charges at 70% = $791.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1130.7500,169.6100,CIGNA HEALTHCARE,CIGNA HMO,471.52,,,,,,,291.8500,1130.7500,percent of total billed charges,"41.7% of $1,130.75 in Billed Charges for Rev 272 = $471.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1130.7500,169.6100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,524.67,,,,,,,291.8500,1130.7500,percent of total billed charges,"46.4% of $1,130.75 in Billed Charges for Rev 272 = $524.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1130.7500,169.6100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,471.52,,,,,,,291.8500,1130.7500,percent of total billed charges,"41.7% of $1,130.75 in Billed Charges for Rev 272 = $471.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1130.7500,169.6100,CIGNA HEALTHCARE,CIGNA PPO,471.52,,,,,,,291.8500,1130.7500,percent of total billed charges,"41.7% of $1,130.75 in Billed Charges for Rev 272 = $471.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1130.7500,169.6100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1017.68,,,,,,,291.8500,1130.7500,percent of total billed charges,"90% of $1,130.75 in Billed Charges for Rev 272 = $1,017.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1130.7500,169.6100,MEDCOST,MEDCOST VHN,538.12,,,,,,,291.8500,1130.7500,percent of total billed charges,"47.59% of $1,130.75 in Billed Charges for Rev 272 = $538.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1130.7500,169.6100,SENTARA HEALTH,SENTARA HEALTH,291.85,,,,,,,291.8500,1130.7500,percent of total billed charges,"25.81% of $1,130.75 in Billed Charges for Rev 272 = $291.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1130.7500,169.6100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1130.75,,,,,,,291.8500,1130.7500,percent of total billed charges,"100% of $1,130.75 in Billed Charges for Rev 272 = $1,130.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1130.7500,169.6100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,565.38,,,,,,,291.8500,1130.7500,percent of total billed charges,"Rev 272 $1,130.75 in Billed Charges at 50% = $565.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1130.7500,169.6100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,365.23,,,,,,,291.8500,1130.7500,other,"32.3% of $1,130.75 in Billed Charges for Rev 272 = $365.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1130.7500,169.6100,UNITED HEALTHCARE,UHC HERITAGE SELECT,347.14,,,,,,,291.8500,1130.7500,other,"30.7% of $1,130.75 in Billed Charges for Rev 272 = $347.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1130.7500,169.6100,UNITED HEALTHCARE,UNITED HEALTHCARE,365.23,,,,,,,291.8500,1130.7500,percent of total billed charges,"32.3% of $1,130.75 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1130.7500,169.6100,WELLCARE,WELLCARE MEDICAID,1130.75,,,,,,,291.8500,1130.7500,percent of total billed charges,"100% of $1,130.75 in Billed Charges for Rev 272 = $1,130.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3 FIXED 12MM,272,RC,,,,,,,,both,,,1539.0600,230.8600,AETNA,AETNA,657.18,,,,,,,397.2300,1539.0600,percent of total billed charges,"42.7% of $1,539.06 in Billed Charges for Rev 272 = $657.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3 FIXED 12MM,272,RC,,,,,,,,both,,,1539.0600,230.8600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1077.34,,,,,,,397.2300,1539.0600,percent of total billed charges,"Rev 272 $1,539.06 in Billed Charges at 70% = $1,077.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3 FIXED 12MM,272,RC,,,,,,,,both,,,1539.0600,230.8600,CIGNA HEALTHCARE,CIGNA HMO,641.79,,,,,,,397.2300,1539.0600,percent of total billed charges,"41.7% of $1,539.06 in Billed Charges for Rev 272 = $641.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3 FIXED 12MM,272,RC,,,,,,,,both,,,1539.0600,230.8600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,714.12,,,,,,,397.2300,1539.0600,percent of total billed charges,"46.4% of $1,539.06 in Billed Charges for Rev 272 = $714.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3 FIXED 12MM,272,RC,,,,,,,,both,,,1539.0600,230.8600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,641.79,,,,,,,397.2300,1539.0600,percent of total billed charges,"41.7% of $1,539.06 in Billed Charges for Rev 272 = $641.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3 FIXED 12MM,272,RC,,,,,,,,both,,,1539.0600,230.8600,CIGNA HEALTHCARE,CIGNA PPO,641.79,,,,,,,397.2300,1539.0600,percent of total billed charges,"41.7% of $1,539.06 in Billed Charges for Rev 272 = $641.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3 FIXED 12MM,272,RC,,,,,,,,both,,,1539.0600,230.8600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1385.15,,,,,,,397.2300,1539.0600,percent of total billed charges,"90% of $1,539.06 in Billed Charges for Rev 272 = $1,385.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3 FIXED 12MM,272,RC,,,,,,,,both,,,1539.0600,230.8600,MEDCOST,MEDCOST VHN,732.44,,,,,,,397.2300,1539.0600,percent of total billed charges,"47.59% of $1,539.06 in Billed Charges for Rev 272 = $732.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3 FIXED 12MM,272,RC,,,,,,,,both,,,1539.0600,230.8600,SENTARA HEALTH,SENTARA HEALTH,397.23,,,,,,,397.2300,1539.0600,percent of total billed charges,"25.81% of $1,539.06 in Billed Charges for Rev 272 = $397.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3 FIXED 12MM,272,RC,,,,,,,,both,,,1539.0600,230.8600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1539.06,,,,,,,397.2300,1539.0600,percent of total billed charges,"100% of $1,539.06 in Billed Charges for Rev 272 = $1,539.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3 FIXED 12MM,272,RC,,,,,,,,both,,,1539.0600,230.8600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,769.53,,,,,,,397.2300,1539.0600,percent of total billed charges,"Rev 272 $1,539.06 in Billed Charges at 50% = $769.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3 FIXED 12MM,272,RC,,,,,,,,both,,,1539.0600,230.8600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,497.12,,,,,,,397.2300,1539.0600,other,"32.3% of $1,539.06 in Billed Charges for Rev 272 = $497.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.3 FIXED 12MM,272,RC,,,,,,,,both,,,1539.0600,230.8600,UNITED HEALTHCARE,UHC HERITAGE SELECT,472.49,,,,,,,397.2300,1539.0600,other,"30.7% of $1,539.06 in Billed Charges for Rev 272 = $472.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.3 FIXED 12MM,272,RC,,,,,,,,both,,,1539.0600,230.8600,UNITED HEALTHCARE,UNITED HEALTHCARE,497.12,,,,,,,397.2300,1539.0600,percent of total billed charges,"32.3% of $1,539.06 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.3 FIXED 12MM,272,RC,,,,,,,,both,,,1539.0600,230.8600,WELLCARE,WELLCARE MEDICAID,1539.06,,,,,,,397.2300,1539.0600,percent of total billed charges,"100% of $1,539.06 in Billed Charges for Rev 272 = $1,539.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHAVER PLUS 5.0MM,272,RC,27200002,CDM,,,,,,both,,,843.4900,126.5200,AETNA,AETNA,360.17,,,,,,,217.7000,843.4900,percent of total billed charges,42.7% of $843.49 in Billed Charges for Rev 272 = $360.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER PLUS 5.0MM,272,RC,27200002,CDM,,,,,,both,,,843.4900,126.5200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,590.44,,,,,,,217.7000,843.4900,percent of total billed charges,Rev 272 $843.49 in Billed Charges at 70% = $590.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER PLUS 5.0MM,272,RC,27200002,CDM,,,,,,both,,,843.4900,126.5200,CIGNA HEALTHCARE,CIGNA HMO,351.74,,,,,,,217.7000,843.4900,percent of total billed charges,41.7% of $843.49 in Billed Charges for Rev 272 = $351.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER PLUS 5.0MM,272,RC,27200002,CDM,,,,,,both,,,843.4900,126.5200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,391.38,,,,,,,217.7000,843.4900,percent of total billed charges,46.4% of $843.49 in Billed Charges for Rev 272 = $391.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER PLUS 5.0MM,272,RC,27200002,CDM,,,,,,both,,,843.4900,126.5200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,351.74,,,,,,,217.7000,843.4900,percent of total billed charges,41.7% of $843.49 in Billed Charges for Rev 272 = $351.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER PLUS 5.0MM,272,RC,27200002,CDM,,,,,,both,,,843.4900,126.5200,CIGNA HEALTHCARE,CIGNA PPO,351.74,,,,,,,217.7000,843.4900,percent of total billed charges,41.7% of $843.49 in Billed Charges for Rev 272 = $351.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER PLUS 5.0MM,272,RC,27200002,CDM,,,,,,both,,,843.4900,126.5200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,759.14,,,,,,,217.7000,843.4900,percent of total billed charges,90% of $843.49 in Billed Charges for Rev 272 = $759.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER PLUS 5.0MM,272,RC,27200002,CDM,,,,,,both,,,843.4900,126.5200,MEDCOST,MEDCOST VHN,401.42,,,,,,,217.7000,843.4900,percent of total billed charges,47.59% of $843.49 in Billed Charges for Rev 272 = $401.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER PLUS 5.0MM,272,RC,27200002,CDM,,,,,,both,,,843.4900,126.5200,SENTARA HEALTH,SENTARA HEALTH,217.70,,,,,,,217.7000,843.4900,percent of total billed charges,25.81% of $843.49 in Billed Charges for Rev 272 = $217.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER PLUS 5.0MM,272,RC,27200002,CDM,,,,,,both,,,843.4900,126.5200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",843.49,,,,,,,217.7000,843.4900,percent of total billed charges,100% of $843.49 in Billed Charges for Rev 272 = $843.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER PLUS 5.0MM,272,RC,27200002,CDM,,,,,,both,,,843.4900,126.5200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,421.75,,,,,,,217.7000,843.4900,percent of total billed charges,Rev 272 $843.49 in Billed Charges at 50% = $421.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER PLUS 5.0MM,272,RC,27200002,CDM,,,,,,both,,,843.4900,126.5200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,272.45,,,,,,,217.7000,843.4900,other,32.3% of $843.49 in Billed Charges for Rev 272 = $272.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE SHAVER PLUS 5.0MM,272,RC,27200002,CDM,,,,,,both,,,843.4900,126.5200,UNITED HEALTHCARE,UHC HERITAGE SELECT,258.95,,,,,,,217.7000,843.4900,other,30.7% of $843.49 in Billed Charges for Rev 272 = $258.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE SHAVER PLUS 5.0MM,272,RC,27200002,CDM,,,,,,both,,,843.4900,126.5200,UNITED HEALTHCARE,UNITED HEALTHCARE,272.45,,,,,,,217.7000,843.4900,percent of total billed charges,32.3% of $843.49 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER PLUS 5.0MM,272,RC,27200002,CDM,,,,,,both,,,843.4900,126.5200,WELLCARE,WELLCARE MEDICAID,843.49,,,,,,,217.7000,843.4900,percent of total billed charges,100% of $843.49 in Billed Charges for Rev 272 = $843.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SINUS RAD 40 4.0 MM 18-84006 CVD,272,RC,27200002,CDM,,,,,,both,,,2432.6200,364.8900,AETNA,AETNA,1038.73,,,,,,,627.8600,2432.6200,percent of total billed charges,"42.7% of $2,432.62 in Billed Charges for Rev 272 = $1,038.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SINUS RAD 40 4.0 MM 18-84006 CVD,272,RC,27200002,CDM,,,,,,both,,,2432.6200,364.8900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1702.83,,,,,,,627.8600,2432.6200,percent of total billed charges,"Rev 272 $2,432.62 in Billed Charges at 70% = $1,702.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SINUS RAD 40 4.0 MM 18-84006 CVD,272,RC,27200002,CDM,,,,,,both,,,2432.6200,364.8900,CIGNA HEALTHCARE,CIGNA HMO,1014.40,,,,,,,627.8600,2432.6200,percent of total billed charges,"41.7% of $2,432.62 in Billed Charges for Rev 272 = $1,014.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SINUS RAD 40 4.0 MM 18-84006 CVD,272,RC,27200002,CDM,,,,,,both,,,2432.6200,364.8900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1128.74,,,,,,,627.8600,2432.6200,percent of total billed charges,"46.4% of $2,432.62 in Billed Charges for Rev 272 = $1,128.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SINUS RAD 40 4.0 MM 18-84006 CVD,272,RC,27200002,CDM,,,,,,both,,,2432.6200,364.8900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1014.40,,,,,,,627.8600,2432.6200,percent of total billed charges,"41.7% of $2,432.62 in Billed Charges for Rev 272 = $1,014.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SINUS RAD 40 4.0 MM 18-84006 CVD,272,RC,27200002,CDM,,,,,,both,,,2432.6200,364.8900,CIGNA HEALTHCARE,CIGNA PPO,1014.40,,,,,,,627.8600,2432.6200,percent of total billed charges,"41.7% of $2,432.62 in Billed Charges for Rev 272 = $1,014.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SINUS RAD 40 4.0 MM 18-84006 CVD,272,RC,27200002,CDM,,,,,,both,,,2432.6200,364.8900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2189.36,,,,,,,627.8600,2432.6200,percent of total billed charges,"90% of $2,432.62 in Billed Charges for Rev 272 = $2,189.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SINUS RAD 40 4.0 MM 18-84006 CVD,272,RC,27200002,CDM,,,,,,both,,,2432.6200,364.8900,MEDCOST,MEDCOST VHN,1157.68,,,,,,,627.8600,2432.6200,percent of total billed charges,"47.59% of $2,432.62 in Billed Charges for Rev 272 = $1,157.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SINUS RAD 40 4.0 MM 18-84006 CVD,272,RC,27200002,CDM,,,,,,both,,,2432.6200,364.8900,SENTARA HEALTH,SENTARA HEALTH,627.86,,,,,,,627.8600,2432.6200,percent of total billed charges,"25.81% of $2,432.62 in Billed Charges for Rev 272 = $627.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SINUS RAD 40 4.0 MM 18-84006 CVD,272,RC,27200002,CDM,,,,,,both,,,2432.6200,364.8900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2432.62,,,,,,,627.8600,2432.6200,percent of total billed charges,"100% of $2,432.62 in Billed Charges for Rev 272 = $2,432.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SINUS RAD 40 4.0 MM 18-84006 CVD,272,RC,27200002,CDM,,,,,,both,,,2432.6200,364.8900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1216.31,,,,,,,627.8600,2432.6200,percent of total billed charges,"Rev 272 $2,432.62 in Billed Charges at 50% = $1,216.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SINUS RAD 40 4.0 MM 18-84006 CVD,272,RC,27200002,CDM,,,,,,both,,,2432.6200,364.8900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,785.74,,,,,,,627.8600,2432.6200,other,"32.3% of $2,432.62 in Billed Charges for Rev 272 = $785.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SINUS RAD 40 4.0 MM 18-84006 CVD,272,RC,27200002,CDM,,,,,,both,,,2432.6200,364.8900,UNITED HEALTHCARE,UHC HERITAGE SELECT,746.81,,,,,,,627.8600,2432.6200,other,"30.7% of $2,432.62 in Billed Charges for Rev 272 = $746.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SINUS RAD 40 4.0 MM 18-84006 CVD,272,RC,27200002,CDM,,,,,,both,,,2432.6200,364.8900,UNITED HEALTHCARE,UNITED HEALTHCARE,785.74,,,,,,,627.8600,2432.6200,percent of total billed charges,"32.3% of $2,432.62 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SINUS RAD 40 4.0 MM 18-84006 CVD,272,RC,27200002,CDM,,,,,,both,,,2432.6200,364.8900,WELLCARE,WELLCARE MEDICAID,2432.62,,,,,,,627.8600,2432.6200,percent of total billed charges,"100% of $2,432.62 in Billed Charges for Rev 272 = $2,432.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPIRAL RETROGRADE FEMORAL NAILS 100MM,272,RC,,,,,,,,both,,,4485.4600,672.8200,AETNA,AETNA,1915.29,,,,,,,1157.7000,4485.4600,percent of total billed charges,"42.7% of $4,485.46 in Billed Charges for Rev 272 = $1,915.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPIRAL RETROGRADE FEMORAL NAILS 100MM,272,RC,,,,,,,,both,,,4485.4600,672.8200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3139.82,,,,,,,1157.7000,4485.4600,percent of total billed charges,"Rev 272 $4,485.46 in Billed Charges at 70% = $3,139.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPIRAL RETROGRADE FEMORAL NAILS 100MM,272,RC,,,,,,,,both,,,4485.4600,672.8200,CIGNA HEALTHCARE,CIGNA HMO,1870.44,,,,,,,1157.7000,4485.4600,percent of total billed charges,"41.7% of $4,485.46 in Billed Charges for Rev 272 = $1,870.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPIRAL RETROGRADE FEMORAL NAILS 100MM,272,RC,,,,,,,,both,,,4485.4600,672.8200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2081.25,,,,,,,1157.7000,4485.4600,percent of total billed charges,"46.4% of $4,485.46 in Billed Charges for Rev 272 = $2,081.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPIRAL RETROGRADE FEMORAL NAILS 100MM,272,RC,,,,,,,,both,,,4485.4600,672.8200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1870.44,,,,,,,1157.7000,4485.4600,percent of total billed charges,"41.7% of $4,485.46 in Billed Charges for Rev 272 = $1,870.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPIRAL RETROGRADE FEMORAL NAILS 100MM,272,RC,,,,,,,,both,,,4485.4600,672.8200,CIGNA HEALTHCARE,CIGNA PPO,1870.44,,,,,,,1157.7000,4485.4600,percent of total billed charges,"41.7% of $4,485.46 in Billed Charges for Rev 272 = $1,870.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPIRAL RETROGRADE FEMORAL NAILS 100MM,272,RC,,,,,,,,both,,,4485.4600,672.8200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4036.91,,,,,,,1157.7000,4485.4600,percent of total billed charges,"90% of $4,485.46 in Billed Charges for Rev 272 = $4,036.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPIRAL RETROGRADE FEMORAL NAILS 100MM,272,RC,,,,,,,,both,,,4485.4600,672.8200,MEDCOST,MEDCOST VHN,2134.63,,,,,,,1157.7000,4485.4600,percent of total billed charges,"47.59% of $4,485.46 in Billed Charges for Rev 272 = $2,134.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPIRAL RETROGRADE FEMORAL NAILS 100MM,272,RC,,,,,,,,both,,,4485.4600,672.8200,SENTARA HEALTH,SENTARA HEALTH,1157.70,,,,,,,1157.7000,4485.4600,percent of total billed charges,"25.81% of $4,485.46 in Billed Charges for Rev 272 = $1,157.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPIRAL RETROGRADE FEMORAL NAILS 100MM,272,RC,,,,,,,,both,,,4485.4600,672.8200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4485.46,,,,,,,1157.7000,4485.4600,percent of total billed charges,"100% of $4,485.46 in Billed Charges for Rev 272 = $4,485.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPIRAL RETROGRADE FEMORAL NAILS 100MM,272,RC,,,,,,,,both,,,4485.4600,672.8200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2242.73,,,,,,,1157.7000,4485.4600,percent of total billed charges,"Rev 272 $4,485.46 in Billed Charges at 50% = $2,242.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPIRAL RETROGRADE FEMORAL NAILS 100MM,272,RC,,,,,,,,both,,,4485.4600,672.8200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1448.80,,,,,,,1157.7000,4485.4600,other,"32.3% of $4,485.46 in Billed Charges for Rev 272 = $1,448.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SPIRAL RETROGRADE FEMORAL NAILS 100MM,272,RC,,,,,,,,both,,,4485.4600,672.8200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1377.04,,,,,,,1157.7000,4485.4600,other,"30.7% of $4,485.46 in Billed Charges for Rev 272 = $1,377.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SPIRAL RETROGRADE FEMORAL NAILS 100MM,272,RC,,,,,,,,both,,,4485.4600,672.8200,UNITED HEALTHCARE,UNITED HEALTHCARE,1448.80,,,,,,,1157.7000,4485.4600,percent of total billed charges,"32.3% of $4,485.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPIRAL RETROGRADE FEMORAL NAILS 100MM,272,RC,,,,,,,,both,,,4485.4600,672.8200,WELLCARE,WELLCARE MEDICAID,4485.46,,,,,,,1157.7000,4485.4600,percent of total billed charges,"100% of $4,485.46 in Billed Charges for Rev 272 = $4,485.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X110,272,RC,27200002,CDM,,,,,,both,,,1079.8300,161.9700,AETNA,AETNA,461.09,,,,,,,278.7000,1079.8300,percent of total billed charges,"42.7% of $1,079.83 in Billed Charges for Rev 272 = $461.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X110,272,RC,27200002,CDM,,,,,,both,,,1079.8300,161.9700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,755.88,,,,,,,278.7000,1079.8300,percent of total billed charges,"Rev 272 $1,079.83 in Billed Charges at 70% = $755.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X110,272,RC,27200002,CDM,,,,,,both,,,1079.8300,161.9700,CIGNA HEALTHCARE,CIGNA HMO,450.29,,,,,,,278.7000,1079.8300,percent of total billed charges,"41.7% of $1,079.83 in Billed Charges for Rev 272 = $450.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X110,272,RC,27200002,CDM,,,,,,both,,,1079.8300,161.9700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,501.04,,,,,,,278.7000,1079.8300,percent of total billed charges,"46.4% of $1,079.83 in Billed Charges for Rev 272 = $501.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X110,272,RC,27200002,CDM,,,,,,both,,,1079.8300,161.9700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,450.29,,,,,,,278.7000,1079.8300,percent of total billed charges,"41.7% of $1,079.83 in Billed Charges for Rev 272 = $450.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X110,272,RC,27200002,CDM,,,,,,both,,,1079.8300,161.9700,CIGNA HEALTHCARE,CIGNA PPO,450.29,,,,,,,278.7000,1079.8300,percent of total billed charges,"41.7% of $1,079.83 in Billed Charges for Rev 272 = $450.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X110,272,RC,27200002,CDM,,,,,,both,,,1079.8300,161.9700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,971.85,,,,,,,278.7000,1079.8300,percent of total billed charges,"90% of $1,079.83 in Billed Charges for Rev 272 = $971.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X110,272,RC,27200002,CDM,,,,,,both,,,1079.8300,161.9700,MEDCOST,MEDCOST VHN,513.89,,,,,,,278.7000,1079.8300,percent of total billed charges,"47.59% of $1,079.83 in Billed Charges for Rev 272 = $513.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X110,272,RC,27200002,CDM,,,,,,both,,,1079.8300,161.9700,SENTARA HEALTH,SENTARA HEALTH,278.70,,,,,,,278.7000,1079.8300,percent of total billed charges,"25.81% of $1,079.83 in Billed Charges for Rev 272 = $278.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X110,272,RC,27200002,CDM,,,,,,both,,,1079.8300,161.9700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1079.83,,,,,,,278.7000,1079.8300,percent of total billed charges,"100% of $1,079.83 in Billed Charges for Rev 272 = $1,079.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X110,272,RC,27200002,CDM,,,,,,both,,,1079.8300,161.9700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,539.92,,,,,,,278.7000,1079.8300,percent of total billed charges,"Rev 272 $1,079.83 in Billed Charges at 50% = $539.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X110,272,RC,27200002,CDM,,,,,,both,,,1079.8300,161.9700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,348.79,,,,,,,278.7000,1079.8300,other,"32.3% of $1,079.83 in Billed Charges for Rev 272 = $348.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.5 X110,272,RC,27200002,CDM,,,,,,both,,,1079.8300,161.9700,UNITED HEALTHCARE,UHC HERITAGE SELECT,331.51,,,,,,,278.7000,1079.8300,other,"30.7% of $1,079.83 in Billed Charges for Rev 272 = $331.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.5 X110,272,RC,27200002,CDM,,,,,,both,,,1079.8300,161.9700,UNITED HEALTHCARE,UNITED HEALTHCARE,348.79,,,,,,,278.7000,1079.8300,percent of total billed charges,"32.3% of $1,079.83 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.5 X110,272,RC,27200002,CDM,,,,,,both,,,1079.8300,161.9700,WELLCARE,WELLCARE MEDICAID,1079.83,,,,,,,278.7000,1079.8300,percent of total billed charges,"100% of $1,079.83 in Billed Charges for Rev 272 = $1,079.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR BALL MAKO,272,RC,27200002,CDM,,,,,,both,,,678.7800,101.8200,AETNA,AETNA,289.84,,,,,,,175.1900,678.7800,percent of total billed charges,42.7% of $678.78 in Billed Charges for Rev 272 = $289.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR BALL MAKO,272,RC,27200002,CDM,,,,,,both,,,678.7800,101.8200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,475.15,,,,,,,175.1900,678.7800,percent of total billed charges,Rev 272 $678.78 in Billed Charges at 70% = $475.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR BALL MAKO,272,RC,27200002,CDM,,,,,,both,,,678.7800,101.8200,CIGNA HEALTHCARE,CIGNA HMO,283.05,,,,,,,175.1900,678.7800,percent of total billed charges,41.7% of $678.78 in Billed Charges for Rev 272 = $283.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR BALL MAKO,272,RC,27200002,CDM,,,,,,both,,,678.7800,101.8200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,314.95,,,,,,,175.1900,678.7800,percent of total billed charges,46.4% of $678.78 in Billed Charges for Rev 272 = $314.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR BALL MAKO,272,RC,27200002,CDM,,,,,,both,,,678.7800,101.8200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,283.05,,,,,,,175.1900,678.7800,percent of total billed charges,41.7% of $678.78 in Billed Charges for Rev 272 = $283.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR BALL MAKO,272,RC,27200002,CDM,,,,,,both,,,678.7800,101.8200,CIGNA HEALTHCARE,CIGNA PPO,283.05,,,,,,,175.1900,678.7800,percent of total billed charges,41.7% of $678.78 in Billed Charges for Rev 272 = $283.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR BALL MAKO,272,RC,27200002,CDM,,,,,,both,,,678.7800,101.8200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,610.90,,,,,,,175.1900,678.7800,percent of total billed charges,90% of $678.78 in Billed Charges for Rev 272 = $610.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR BALL MAKO,272,RC,27200002,CDM,,,,,,both,,,678.7800,101.8200,MEDCOST,MEDCOST VHN,323.03,,,,,,,175.1900,678.7800,percent of total billed charges,47.59% of $678.78 in Billed Charges for Rev 272 = $323.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR BALL MAKO,272,RC,27200002,CDM,,,,,,both,,,678.7800,101.8200,SENTARA HEALTH,SENTARA HEALTH,175.19,,,,,,,175.1900,678.7800,percent of total billed charges,25.81% of $678.78 in Billed Charges for Rev 272 = $175.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR BALL MAKO,272,RC,27200002,CDM,,,,,,both,,,678.7800,101.8200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",678.78,,,,,,,175.1900,678.7800,percent of total billed charges,100% of $678.78 in Billed Charges for Rev 272 = $678.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR BALL MAKO,272,RC,27200002,CDM,,,,,,both,,,678.7800,101.8200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,339.39,,,,,,,175.1900,678.7800,percent of total billed charges,Rev 272 $678.78 in Billed Charges at 50% = $339.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR BALL MAKO,272,RC,27200002,CDM,,,,,,both,,,678.7800,101.8200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,219.25,,,,,,,175.1900,678.7800,other,32.3% of $678.78 in Billed Charges for Rev 272 = $219.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BURR BALL MAKO,272,RC,27200002,CDM,,,,,,both,,,678.7800,101.8200,UNITED HEALTHCARE,UHC HERITAGE SELECT,208.39,,,,,,,175.1900,678.7800,other,30.7% of $678.78 in Billed Charges for Rev 272 = $208.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BURR BALL MAKO,272,RC,27200002,CDM,,,,,,both,,,678.7800,101.8200,UNITED HEALTHCARE,UNITED HEALTHCARE,219.25,,,,,,,175.1900,678.7800,percent of total billed charges,32.3% of $678.78 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR BALL MAKO,272,RC,27200002,CDM,,,,,,both,,,678.7800,101.8200,WELLCARE,WELLCARE MEDICAID,678.78,,,,,,,175.1900,678.7800,percent of total billed charges,100% of $678.78 in Billed Charges for Rev 272 = $678.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR BARRELL 6.5MM,272,RC,,,,,,,,both,,,2177.7000,326.6600,AETNA,AETNA,929.88,,,,,,,562.0600,2177.7000,percent of total billed charges,"42.7% of $2,177.70 in Billed Charges for Rev 272 = $929.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR BARRELL 6.5MM,272,RC,,,,,,,,both,,,2177.7000,326.6600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1524.39,,,,,,,562.0600,2177.7000,percent of total billed charges,"Rev 272 $2,177.70 in Billed Charges at 70% = $1,524.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR BARRELL 6.5MM,272,RC,,,,,,,,both,,,2177.7000,326.6600,CIGNA HEALTHCARE,CIGNA HMO,908.10,,,,,,,562.0600,2177.7000,percent of total billed charges,"41.7% of $2,177.70 in Billed Charges for Rev 272 = $908.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR BARRELL 6.5MM,272,RC,,,,,,,,both,,,2177.7000,326.6600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1010.45,,,,,,,562.0600,2177.7000,percent of total billed charges,"46.4% of $2,177.70 in Billed Charges for Rev 272 = $1,010.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR BARRELL 6.5MM,272,RC,,,,,,,,both,,,2177.7000,326.6600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,908.10,,,,,,,562.0600,2177.7000,percent of total billed charges,"41.7% of $2,177.70 in Billed Charges for Rev 272 = $908.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR BARRELL 6.5MM,272,RC,,,,,,,,both,,,2177.7000,326.6600,CIGNA HEALTHCARE,CIGNA PPO,908.10,,,,,,,562.0600,2177.7000,percent of total billed charges,"41.7% of $2,177.70 in Billed Charges for Rev 272 = $908.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR BARRELL 6.5MM,272,RC,,,,,,,,both,,,2177.7000,326.6600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1959.93,,,,,,,562.0600,2177.7000,percent of total billed charges,"90% of $2,177.70 in Billed Charges for Rev 272 = $1,959.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR BARRELL 6.5MM,272,RC,,,,,,,,both,,,2177.7000,326.6600,MEDCOST,MEDCOST VHN,1036.37,,,,,,,562.0600,2177.7000,percent of total billed charges,"47.59% of $2,177.70 in Billed Charges for Rev 272 = $1,036.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR BARRELL 6.5MM,272,RC,,,,,,,,both,,,2177.7000,326.6600,SENTARA HEALTH,SENTARA HEALTH,562.06,,,,,,,562.0600,2177.7000,percent of total billed charges,"25.81% of $2,177.70 in Billed Charges for Rev 272 = $562.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR BARRELL 6.5MM,272,RC,,,,,,,,both,,,2177.7000,326.6600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2177.70,,,,,,,562.0600,2177.7000,percent of total billed charges,"100% of $2,177.70 in Billed Charges for Rev 272 = $2,177.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR BARRELL 6.5MM,272,RC,,,,,,,,both,,,2177.7000,326.6600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1088.85,,,,,,,562.0600,2177.7000,percent of total billed charges,"Rev 272 $2,177.70 in Billed Charges at 50% = $1,088.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR BARRELL 6.5MM,272,RC,,,,,,,,both,,,2177.7000,326.6600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,703.40,,,,,,,562.0600,2177.7000,other,"32.3% of $2,177.70 in Billed Charges for Rev 272 = $703.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR BARRELL 6.5MM,272,RC,,,,,,,,both,,,2177.7000,326.6600,UNITED HEALTHCARE,UHC HERITAGE SELECT,668.55,,,,,,,562.0600,2177.7000,other,"30.7% of $2,177.70 in Billed Charges for Rev 272 = $668.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR BARRELL 6.5MM,272,RC,,,,,,,,both,,,2177.7000,326.6600,UNITED HEALTHCARE,UNITED HEALTHCARE,703.40,,,,,,,562.0600,2177.7000,percent of total billed charges,"32.3% of $2,177.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR BARRELL 6.5MM,272,RC,,,,,,,,both,,,2177.7000,326.6600,WELLCARE,WELLCARE MEDICAID,2177.70,,,,,,,562.0600,2177.7000,percent of total billed charges,"100% of $2,177.70 in Billed Charges for Rev 272 = $2,177.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.6MM CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1483.0500,222.4600,AETNA,AETNA,633.26,,,,,,,382.7800,1483.0500,percent of total billed charges,"42.7% of $1,483.05 in Billed Charges for Rev 272 = $633.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.6MM CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1483.0500,222.4600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1038.14,,,,,,,382.7800,1483.0500,percent of total billed charges,"Rev 272 $1,483.05 in Billed Charges at 70% = $1,038.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.6MM CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1483.0500,222.4600,CIGNA HEALTHCARE,CIGNA HMO,618.43,,,,,,,382.7800,1483.0500,percent of total billed charges,"41.7% of $1,483.05 in Billed Charges for Rev 272 = $618.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.6MM CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1483.0500,222.4600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,688.14,,,,,,,382.7800,1483.0500,percent of total billed charges,"46.4% of $1,483.05 in Billed Charges for Rev 272 = $688.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.6MM CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1483.0500,222.4600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,618.43,,,,,,,382.7800,1483.0500,percent of total billed charges,"41.7% of $1,483.05 in Billed Charges for Rev 272 = $618.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.6MM CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1483.0500,222.4600,CIGNA HEALTHCARE,CIGNA PPO,618.43,,,,,,,382.7800,1483.0500,percent of total billed charges,"41.7% of $1,483.05 in Billed Charges for Rev 272 = $618.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.6MM CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1483.0500,222.4600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1334.75,,,,,,,382.7800,1483.0500,percent of total billed charges,"90% of $1,483.05 in Billed Charges for Rev 272 = $1,334.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.6MM CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1483.0500,222.4600,MEDCOST,MEDCOST VHN,705.78,,,,,,,382.7800,1483.0500,percent of total billed charges,"47.59% of $1,483.05 in Billed Charges for Rev 272 = $705.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.6MM CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1483.0500,222.4600,SENTARA HEALTH,SENTARA HEALTH,382.78,,,,,,,382.7800,1483.0500,percent of total billed charges,"25.81% of $1,483.05 in Billed Charges for Rev 272 = $382.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.6MM CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1483.0500,222.4600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1483.05,,,,,,,382.7800,1483.0500,percent of total billed charges,"100% of $1,483.05 in Billed Charges for Rev 272 = $1,483.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.6MM CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1483.0500,222.4600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,741.53,,,,,,,382.7800,1483.0500,percent of total billed charges,"Rev 272 $1,483.05 in Billed Charges at 50% = $741.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.6MM CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1483.0500,222.4600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,479.03,,,,,,,382.7800,1483.0500,other,"32.3% of $1,483.05 in Billed Charges for Rev 272 = $479.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.6MM CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1483.0500,222.4600,UNITED HEALTHCARE,UHC HERITAGE SELECT,455.30,,,,,,,382.7800,1483.0500,other,"30.7% of $1,483.05 in Billed Charges for Rev 272 = $455.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.6MM CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1483.0500,222.4600,UNITED HEALTHCARE,UNITED HEALTHCARE,479.03,,,,,,,382.7800,1483.0500,percent of total billed charges,"32.3% of $1,483.05 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.6MM CALIBRATED,272,RC,27200002,CDM,,,,,,both,,,1483.0500,222.4600,WELLCARE,WELLCARE MEDICAID,1483.05,,,,,,,382.7800,1483.0500,percent of total billed charges,"100% of $1,483.05 in Billed Charges for Rev 272 = $1,483.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE GASTRO SCOPE,272,RC,27200002,CDM,,,,,,both,,,4666.9500,700.0400,AETNA,AETNA,1992.79,,,,,,,1204.5400,4666.9500,percent of total billed charges,"42.7% of $4,666.95 in Billed Charges for Rev 272 = $1,992.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE GASTRO SCOPE,272,RC,27200002,CDM,,,,,,both,,,4666.9500,700.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3266.87,,,,,,,1204.5400,4666.9500,percent of total billed charges,"Rev 272 $4,666.95 in Billed Charges at 70% = $3,266.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE GASTRO SCOPE,272,RC,27200002,CDM,,,,,,both,,,4666.9500,700.0400,CIGNA HEALTHCARE,CIGNA HMO,1946.12,,,,,,,1204.5400,4666.9500,percent of total billed charges,"41.7% of $4,666.95 in Billed Charges for Rev 272 = $1,946.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE GASTRO SCOPE,272,RC,27200002,CDM,,,,,,both,,,4666.9500,700.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2165.46,,,,,,,1204.5400,4666.9500,percent of total billed charges,"46.4% of $4,666.95 in Billed Charges for Rev 272 = $2,165.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE GASTRO SCOPE,272,RC,27200002,CDM,,,,,,both,,,4666.9500,700.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1946.12,,,,,,,1204.5400,4666.9500,percent of total billed charges,"41.7% of $4,666.95 in Billed Charges for Rev 272 = $1,946.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE GASTRO SCOPE,272,RC,27200002,CDM,,,,,,both,,,4666.9500,700.0400,CIGNA HEALTHCARE,CIGNA PPO,1946.12,,,,,,,1204.5400,4666.9500,percent of total billed charges,"41.7% of $4,666.95 in Billed Charges for Rev 272 = $1,946.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE GASTRO SCOPE,272,RC,27200002,CDM,,,,,,both,,,4666.9500,700.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4200.26,,,,,,,1204.5400,4666.9500,percent of total billed charges,"90% of $4,666.95 in Billed Charges for Rev 272 = $4,200.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE GASTRO SCOPE,272,RC,27200002,CDM,,,,,,both,,,4666.9500,700.0400,MEDCOST,MEDCOST VHN,2221.00,,,,,,,1204.5400,4666.9500,percent of total billed charges,"47.59% of $4,666.95 in Billed Charges for Rev 272 = $2,221.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE GASTRO SCOPE,272,RC,27200002,CDM,,,,,,both,,,4666.9500,700.0400,SENTARA HEALTH,SENTARA HEALTH,1204.54,,,,,,,1204.5400,4666.9500,percent of total billed charges,"25.81% of $4,666.95 in Billed Charges for Rev 272 = $1,204.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE GASTRO SCOPE,272,RC,27200002,CDM,,,,,,both,,,4666.9500,700.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4666.95,,,,,,,1204.5400,4666.9500,percent of total billed charges,"100% of $4,666.95 in Billed Charges for Rev 272 = $4,666.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE GASTRO SCOPE,272,RC,27200002,CDM,,,,,,both,,,4666.9500,700.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2333.48,,,,,,,1204.5400,4666.9500,percent of total billed charges,"Rev 272 $4,666.95 in Billed Charges at 50% = $2,333.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE GASTRO SCOPE,272,RC,27200002,CDM,,,,,,both,,,4666.9500,700.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1507.42,,,,,,,1204.5400,4666.9500,other,"32.3% of $4,666.95 in Billed Charges for Rev 272 = $1,507.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ASCOPE GASTRO SCOPE,272,RC,27200002,CDM,,,,,,both,,,4666.9500,700.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1432.75,,,,,,,1204.5400,4666.9500,other,"30.7% of $4,666.95 in Billed Charges for Rev 272 = $1,432.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ASCOPE GASTRO SCOPE,272,RC,27200002,CDM,,,,,,both,,,4666.9500,700.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,1507.42,,,,,,,1204.5400,4666.9500,percent of total billed charges,"32.3% of $4,666.95 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE GASTRO SCOPE,272,RC,27200002,CDM,,,,,,both,,,4666.9500,700.0400,WELLCARE,WELLCARE MEDICAID,4666.95,,,,,,,1204.5400,4666.9500,percent of total billed charges,"100% of $4,666.95 in Billed Charges for Rev 272 = $4,666.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2022.3500,303.3500,AETNA,AETNA,863.54,,,,,,,521.9700,2022.3500,percent of total billed charges,"42.7% of $2,022.35 in Billed Charges for Rev 272 = $863.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2022.3500,303.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1415.65,,,,,,,521.9700,2022.3500,percent of total billed charges,"Rev 272 $2,022.35 in Billed Charges at 70% = $1,415.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2022.3500,303.3500,CIGNA HEALTHCARE,CIGNA HMO,843.32,,,,,,,521.9700,2022.3500,percent of total billed charges,"41.7% of $2,022.35 in Billed Charges for Rev 272 = $843.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2022.3500,303.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,938.37,,,,,,,521.9700,2022.3500,percent of total billed charges,"46.4% of $2,022.35 in Billed Charges for Rev 272 = $938.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2022.3500,303.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,843.32,,,,,,,521.9700,2022.3500,percent of total billed charges,"41.7% of $2,022.35 in Billed Charges for Rev 272 = $843.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2022.3500,303.3500,CIGNA HEALTHCARE,CIGNA PPO,843.32,,,,,,,521.9700,2022.3500,percent of total billed charges,"41.7% of $2,022.35 in Billed Charges for Rev 272 = $843.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2022.3500,303.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1820.12,,,,,,,521.9700,2022.3500,percent of total billed charges,"90% of $2,022.35 in Billed Charges for Rev 272 = $1,820.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2022.3500,303.3500,MEDCOST,MEDCOST VHN,962.44,,,,,,,521.9700,2022.3500,percent of total billed charges,"47.59% of $2,022.35 in Billed Charges for Rev 272 = $962.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2022.3500,303.3500,SENTARA HEALTH,SENTARA HEALTH,521.97,,,,,,,521.9700,2022.3500,percent of total billed charges,"25.81% of $2,022.35 in Billed Charges for Rev 272 = $521.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2022.3500,303.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2022.35,,,,,,,521.9700,2022.3500,percent of total billed charges,"100% of $2,022.35 in Billed Charges for Rev 272 = $2,022.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2022.3500,303.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1011.18,,,,,,,521.9700,2022.3500,percent of total billed charges,"Rev 272 $2,022.35 in Billed Charges at 50% = $1,011.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2022.3500,303.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,653.22,,,,,,,521.9700,2022.3500,other,"32.3% of $2,022.35 in Billed Charges for Rev 272 = $653.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2022.3500,303.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,620.86,,,,,,,521.9700,2022.3500,other,"30.7% of $2,022.35 in Billed Charges for Rev 272 = $620.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2022.3500,303.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,653.22,,,,,,,521.9700,2022.3500,percent of total billed charges,"32.3% of $2,022.35 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2022.3500,303.3500,WELLCARE,WELLCARE MEDICAID,2022.35,,,,,,,521.9700,2022.3500,percent of total billed charges,"100% of $2,022.35 in Billed Charges for Rev 272 = $2,022.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2146.8000,322.0200,AETNA,AETNA,916.68,,,,,,,554.0900,2146.8000,percent of total billed charges,"42.7% of $2,146.80 in Billed Charges for Rev 272 = $916.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2146.8000,322.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1502.76,,,,,,,554.0900,2146.8000,percent of total billed charges,"Rev 272 $2,146.80 in Billed Charges at 70% = $1,502.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2146.8000,322.0200,CIGNA HEALTHCARE,CIGNA HMO,895.22,,,,,,,554.0900,2146.8000,percent of total billed charges,"41.7% of $2,146.80 in Billed Charges for Rev 272 = $895.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2146.8000,322.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,996.12,,,,,,,554.0900,2146.8000,percent of total billed charges,"46.4% of $2,146.80 in Billed Charges for Rev 272 = $996.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2146.8000,322.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,895.22,,,,,,,554.0900,2146.8000,percent of total billed charges,"41.7% of $2,146.80 in Billed Charges for Rev 272 = $895.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2146.8000,322.0200,CIGNA HEALTHCARE,CIGNA PPO,895.22,,,,,,,554.0900,2146.8000,percent of total billed charges,"41.7% of $2,146.80 in Billed Charges for Rev 272 = $895.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2146.8000,322.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1932.12,,,,,,,554.0900,2146.8000,percent of total billed charges,"90% of $2,146.80 in Billed Charges for Rev 272 = $1,932.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2146.8000,322.0200,MEDCOST,MEDCOST VHN,1021.66,,,,,,,554.0900,2146.8000,percent of total billed charges,"47.59% of $2,146.80 in Billed Charges for Rev 272 = $1,021.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2146.8000,322.0200,SENTARA HEALTH,SENTARA HEALTH,554.09,,,,,,,554.0900,2146.8000,percent of total billed charges,"25.81% of $2,146.80 in Billed Charges for Rev 272 = $554.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2146.8000,322.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2146.80,,,,,,,554.0900,2146.8000,percent of total billed charges,"100% of $2,146.80 in Billed Charges for Rev 272 = $2,146.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2146.8000,322.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1073.40,,,,,,,554.0900,2146.8000,percent of total billed charges,"Rev 272 $2,146.80 in Billed Charges at 50% = $1,073.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2146.8000,322.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,693.42,,,,,,,554.0900,2146.8000,other,"32.3% of $2,146.80 in Billed Charges for Rev 272 = $693.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2146.8000,322.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,659.07,,,,,,,554.0900,2146.8000,other,"30.7% of $2,146.80 in Billed Charges for Rev 272 = $659.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2146.8000,322.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,693.42,,,,,,,554.0900,2146.8000,percent of total billed charges,"32.3% of $2,146.80 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,2146.8000,322.0200,WELLCARE,WELLCARE MEDICAID,2146.80,,,,,,,554.0900,2146.8000,percent of total billed charges,"100% of $2,146.80 in Billed Charges for Rev 272 = $2,146.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSMBLY RIA TUBE MIN 520MM F/,272,RC,,,,,,,,both,,,5382.5500,807.3800,AETNA,AETNA,2298.35,,,,,,,1389.2400,5382.5500,percent of total billed charges,"42.7% of $5,382.55 in Billed Charges for Rev 272 = $2,298.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSMBLY RIA TUBE MIN 520MM F/,272,RC,,,,,,,,both,,,5382.5500,807.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3767.79,,,,,,,1389.2400,5382.5500,percent of total billed charges,"Rev 272 $5,382.55 in Billed Charges at 70% = $3,767.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSMBLY RIA TUBE MIN 520MM F/,272,RC,,,,,,,,both,,,5382.5500,807.3800,CIGNA HEALTHCARE,CIGNA HMO,2244.52,,,,,,,1389.2400,5382.5500,percent of total billed charges,"41.7% of $5,382.55 in Billed Charges for Rev 272 = $2,244.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSMBLY RIA TUBE MIN 520MM F/,272,RC,,,,,,,,both,,,5382.5500,807.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2497.50,,,,,,,1389.2400,5382.5500,percent of total billed charges,"46.4% of $5,382.55 in Billed Charges for Rev 272 = $2,497.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSMBLY RIA TUBE MIN 520MM F/,272,RC,,,,,,,,both,,,5382.5500,807.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2244.52,,,,,,,1389.2400,5382.5500,percent of total billed charges,"41.7% of $5,382.55 in Billed Charges for Rev 272 = $2,244.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSMBLY RIA TUBE MIN 520MM F/,272,RC,,,,,,,,both,,,5382.5500,807.3800,CIGNA HEALTHCARE,CIGNA PPO,2244.52,,,,,,,1389.2400,5382.5500,percent of total billed charges,"41.7% of $5,382.55 in Billed Charges for Rev 272 = $2,244.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSMBLY RIA TUBE MIN 520MM F/,272,RC,,,,,,,,both,,,5382.5500,807.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4844.30,,,,,,,1389.2400,5382.5500,percent of total billed charges,"90% of $5,382.55 in Billed Charges for Rev 272 = $4,844.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSMBLY RIA TUBE MIN 520MM F/,272,RC,,,,,,,,both,,,5382.5500,807.3800,MEDCOST,MEDCOST VHN,2561.56,,,,,,,1389.2400,5382.5500,percent of total billed charges,"47.59% of $5,382.55 in Billed Charges for Rev 272 = $2,561.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSMBLY RIA TUBE MIN 520MM F/,272,RC,,,,,,,,both,,,5382.5500,807.3800,SENTARA HEALTH,SENTARA HEALTH,1389.24,,,,,,,1389.2400,5382.5500,percent of total billed charges,"25.81% of $5,382.55 in Billed Charges for Rev 272 = $1,389.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSMBLY RIA TUBE MIN 520MM F/,272,RC,,,,,,,,both,,,5382.5500,807.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5382.55,,,,,,,1389.2400,5382.5500,percent of total billed charges,"100% of $5,382.55 in Billed Charges for Rev 272 = $5,382.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSMBLY RIA TUBE MIN 520MM F/,272,RC,,,,,,,,both,,,5382.5500,807.3800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2691.28,,,,,,,1389.2400,5382.5500,percent of total billed charges,"Rev 272 $5,382.55 in Billed Charges at 50% = $2,691.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSMBLY RIA TUBE MIN 520MM F/,272,RC,,,,,,,,both,,,5382.5500,807.3800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1738.56,,,,,,,1389.2400,5382.5500,other,"32.3% of $5,382.55 in Billed Charges for Rev 272 = $1,738.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ASSMBLY RIA TUBE MIN 520MM F/,272,RC,,,,,,,,both,,,5382.5500,807.3800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1652.44,,,,,,,1389.2400,5382.5500,other,"30.7% of $5,382.55 in Billed Charges for Rev 272 = $1,652.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ASSMBLY RIA TUBE MIN 520MM F/,272,RC,,,,,,,,both,,,5382.5500,807.3800,UNITED HEALTHCARE,UNITED HEALTHCARE,1738.56,,,,,,,1389.2400,5382.5500,percent of total billed charges,"32.3% of $5,382.55 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSMBLY RIA TUBE MIN 520MM F/,272,RC,,,,,,,,both,,,5382.5500,807.3800,WELLCARE,WELLCARE MEDICAID,5382.55,,,,,,,1389.2400,5382.5500,percent of total billed charges,"100% of $5,382.55 in Billed Charges for Rev 272 = $5,382.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,3149.5700,472.4400,AETNA,AETNA,1344.87,,,,,,,812.9000,3149.5700,percent of total billed charges,"42.7% of $3,149.57 in Billed Charges for Rev 272 = $1,344.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,3149.5700,472.4400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2204.70,,,,,,,812.9000,3149.5700,percent of total billed charges,"Rev 272 $3,149.57 in Billed Charges at 70% = $2,204.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,3149.5700,472.4400,CIGNA HEALTHCARE,CIGNA HMO,1313.37,,,,,,,812.9000,3149.5700,percent of total billed charges,"41.7% of $3,149.57 in Billed Charges for Rev 272 = $1,313.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,3149.5700,472.4400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1461.40,,,,,,,812.9000,3149.5700,percent of total billed charges,"46.4% of $3,149.57 in Billed Charges for Rev 272 = $1,461.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,3149.5700,472.4400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1313.37,,,,,,,812.9000,3149.5700,percent of total billed charges,"41.7% of $3,149.57 in Billed Charges for Rev 272 = $1,313.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,3149.5700,472.4400,CIGNA HEALTHCARE,CIGNA PPO,1313.37,,,,,,,812.9000,3149.5700,percent of total billed charges,"41.7% of $3,149.57 in Billed Charges for Rev 272 = $1,313.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,3149.5700,472.4400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2834.61,,,,,,,812.9000,3149.5700,percent of total billed charges,"90% of $3,149.57 in Billed Charges for Rev 272 = $2,834.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,3149.5700,472.4400,MEDCOST,MEDCOST VHN,1498.88,,,,,,,812.9000,3149.5700,percent of total billed charges,"47.59% of $3,149.57 in Billed Charges for Rev 272 = $1,498.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,3149.5700,472.4400,SENTARA HEALTH,SENTARA HEALTH,812.90,,,,,,,812.9000,3149.5700,percent of total billed charges,"25.81% of $3,149.57 in Billed Charges for Rev 272 = $812.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,3149.5700,472.4400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3149.57,,,,,,,812.9000,3149.5700,percent of total billed charges,"100% of $3,149.57 in Billed Charges for Rev 272 = $3,149.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,3149.5700,472.4400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1574.79,,,,,,,812.9000,3149.5700,percent of total billed charges,"Rev 272 $3,149.57 in Billed Charges at 50% = $1,574.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,3149.5700,472.4400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1017.31,,,,,,,812.9000,3149.5700,other,"32.3% of $3,149.57 in Billed Charges for Rev 272 = $1,017.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,3149.5700,472.4400,UNITED HEALTHCARE,UHC HERITAGE SELECT,966.92,,,,,,,812.9000,3149.5700,other,"30.7% of $3,149.57 in Billed Charges for Rev 272 = $966.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,3149.5700,472.4400,UNITED HEALTHCARE,UNITED HEALTHCARE,1017.31,,,,,,,812.9000,3149.5700,percent of total billed charges,"32.3% of $3,149.57 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,3149.5700,472.4400,WELLCARE,WELLCARE MEDICAID,3149.57,,,,,,,812.9000,3149.5700,percent of total billed charges,"100% of $3,149.57 in Billed Charges for Rev 272 = $3,149.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 12MM LONG,272,RC,27200002,CDM,,,,,,both,,,9406.7000,1411.0100,AETNA,AETNA,4016.66,,,,,,,2427.8700,9406.7000,percent of total billed charges,"42.7% of $9,406.70 in Billed Charges for Rev 272 = $4,016.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 12MM LONG,272,RC,27200002,CDM,,,,,,both,,,9406.7000,1411.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6584.69,,,,,,,2427.8700,9406.7000,percent of total billed charges,"Rev 272 $9,406.70 in Billed Charges at 70% = $6,584.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 12MM LONG,272,RC,27200002,CDM,,,,,,both,,,9406.7000,1411.0100,CIGNA HEALTHCARE,CIGNA HMO,3922.59,,,,,,,2427.8700,9406.7000,percent of total billed charges,"41.7% of $9,406.70 in Billed Charges for Rev 272 = $3,922.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 12MM LONG,272,RC,27200002,CDM,,,,,,both,,,9406.7000,1411.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4364.71,,,,,,,2427.8700,9406.7000,percent of total billed charges,"46.4% of $9,406.70 in Billed Charges for Rev 272 = $4,364.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 12MM LONG,272,RC,27200002,CDM,,,,,,both,,,9406.7000,1411.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3922.59,,,,,,,2427.8700,9406.7000,percent of total billed charges,"41.7% of $9,406.70 in Billed Charges for Rev 272 = $3,922.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 12MM LONG,272,RC,27200002,CDM,,,,,,both,,,9406.7000,1411.0100,CIGNA HEALTHCARE,CIGNA PPO,3922.59,,,,,,,2427.8700,9406.7000,percent of total billed charges,"41.7% of $9,406.70 in Billed Charges for Rev 272 = $3,922.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 12MM LONG,272,RC,27200002,CDM,,,,,,both,,,9406.7000,1411.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8466.03,,,,,,,2427.8700,9406.7000,percent of total billed charges,"90% of $9,406.70 in Billed Charges for Rev 272 = $8,466.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 12MM LONG,272,RC,27200002,CDM,,,,,,both,,,9406.7000,1411.0100,MEDCOST,MEDCOST VHN,4476.65,,,,,,,2427.8700,9406.7000,percent of total billed charges,"47.59% of $9,406.70 in Billed Charges for Rev 272 = $4,476.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 12MM LONG,272,RC,27200002,CDM,,,,,,both,,,9406.7000,1411.0100,SENTARA HEALTH,SENTARA HEALTH,2427.87,,,,,,,2427.8700,9406.7000,percent of total billed charges,"25.81% of $9,406.70 in Billed Charges for Rev 272 = $2,427.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 12MM LONG,272,RC,27200002,CDM,,,,,,both,,,9406.7000,1411.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9406.70,,,,,,,2427.8700,9406.7000,percent of total billed charges,"100% of $9,406.70 in Billed Charges for Rev 272 = $9,406.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 12MM LONG,272,RC,27200002,CDM,,,,,,both,,,9406.7000,1411.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4703.35,,,,,,,2427.8700,9406.7000,percent of total billed charges,"Rev 272 $9,406.70 in Billed Charges at 50% = $4,703.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 12MM LONG,272,RC,27200002,CDM,,,,,,both,,,9406.7000,1411.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3038.36,,,,,,,2427.8700,9406.7000,other,"32.3% of $9,406.70 in Billed Charges for Rev 272 = $3,038.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 12MM LONG,272,RC,27200002,CDM,,,,,,both,,,9406.7000,1411.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,2887.86,,,,,,,2427.8700,9406.7000,other,"30.7% of $9,406.70 in Billed Charges for Rev 272 = $2,887.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 12MM LONG,272,RC,27200002,CDM,,,,,,both,,,9406.7000,1411.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,3038.36,,,,,,,2427.8700,9406.7000,percent of total billed charges,"32.3% of $9,406.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 12MM LONG,272,RC,27200002,CDM,,,,,,both,,,9406.7000,1411.0100,WELLCARE,WELLCARE MEDICAID,9406.70,,,,,,,2427.8700,9406.7000,percent of total billed charges,"100% of $9,406.70 in Billed Charges for Rev 272 = $9,406.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 3.2MM,272,RC,,,,,,,,both,,,3645.6100,546.8400,AETNA,AETNA,1556.68,,,,,,,940.9300,3645.6100,percent of total billed charges,"42.7% of $3,645.61 in Billed Charges for Rev 272 = $1,556.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 3.2MM,272,RC,,,,,,,,both,,,3645.6100,546.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2551.93,,,,,,,940.9300,3645.6100,percent of total billed charges,"Rev 272 $3,645.61 in Billed Charges at 70% = $2,551.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 3.2MM,272,RC,,,,,,,,both,,,3645.6100,546.8400,CIGNA HEALTHCARE,CIGNA HMO,1520.22,,,,,,,940.9300,3645.6100,percent of total billed charges,"41.7% of $3,645.61 in Billed Charges for Rev 272 = $1,520.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 3.2MM,272,RC,,,,,,,,both,,,3645.6100,546.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1691.56,,,,,,,940.9300,3645.6100,percent of total billed charges,"46.4% of $3,645.61 in Billed Charges for Rev 272 = $1,691.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 3.2MM,272,RC,,,,,,,,both,,,3645.6100,546.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1520.22,,,,,,,940.9300,3645.6100,percent of total billed charges,"41.7% of $3,645.61 in Billed Charges for Rev 272 = $1,520.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 3.2MM,272,RC,,,,,,,,both,,,3645.6100,546.8400,CIGNA HEALTHCARE,CIGNA PPO,1520.22,,,,,,,940.9300,3645.6100,percent of total billed charges,"41.7% of $3,645.61 in Billed Charges for Rev 272 = $1,520.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 3.2MM,272,RC,,,,,,,,both,,,3645.6100,546.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3281.05,,,,,,,940.9300,3645.6100,percent of total billed charges,"90% of $3,645.61 in Billed Charges for Rev 272 = $3,281.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 3.2MM,272,RC,,,,,,,,both,,,3645.6100,546.8400,MEDCOST,MEDCOST VHN,1734.95,,,,,,,940.9300,3645.6100,percent of total billed charges,"47.59% of $3,645.61 in Billed Charges for Rev 272 = $1,734.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 3.2MM,272,RC,,,,,,,,both,,,3645.6100,546.8400,SENTARA HEALTH,SENTARA HEALTH,940.93,,,,,,,940.9300,3645.6100,percent of total billed charges,"25.81% of $3,645.61 in Billed Charges for Rev 272 = $940.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 3.2MM,272,RC,,,,,,,,both,,,3645.6100,546.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3645.61,,,,,,,940.9300,3645.6100,percent of total billed charges,"100% of $3,645.61 in Billed Charges for Rev 272 = $3,645.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 3.2MM,272,RC,,,,,,,,both,,,3645.6100,546.8400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1822.81,,,,,,,940.9300,3645.6100,percent of total billed charges,"Rev 272 $3,645.61 in Billed Charges at 50% = $1,822.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 3.2MM,272,RC,,,,,,,,both,,,3645.6100,546.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1177.53,,,,,,,940.9300,3645.6100,other,"32.3% of $3,645.61 in Billed Charges for Rev 272 = $1,177.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED 3.2MM,272,RC,,,,,,,,both,,,3645.6100,546.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1119.20,,,,,,,940.9300,3645.6100,other,"30.7% of $3,645.61 in Billed Charges for Rev 272 = $1,119.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANNULATED 3.2MM,272,RC,,,,,,,,both,,,3645.6100,546.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,1177.53,,,,,,,940.9300,3645.6100,percent of total billed charges,"32.3% of $3,645.61 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANNULATED 3.2MM,272,RC,,,,,,,,both,,,3645.6100,546.8400,WELLCARE,WELLCARE MEDICAID,3645.61,,,,,,,940.9300,3645.6100,percent of total billed charges,"100% of $3,645.61 in Billed Charges for Rev 272 = $3,645.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MATRIX 1.8 X 125MM 0,272,RC,,,,,,,,both,,,2384.8100,357.7200,AETNA,AETNA,1018.31,,,,,,,615.5200,2384.8100,percent of total billed charges,"42.7% of $2,384.81 in Billed Charges for Rev 272 = $1,018.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MATRIX 1.8 X 125MM 0,272,RC,,,,,,,,both,,,2384.8100,357.7200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1669.37,,,,,,,615.5200,2384.8100,percent of total billed charges,"Rev 272 $2,384.81 in Billed Charges at 70% = $1,669.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MATRIX 1.8 X 125MM 0,272,RC,,,,,,,,both,,,2384.8100,357.7200,CIGNA HEALTHCARE,CIGNA HMO,994.47,,,,,,,615.5200,2384.8100,percent of total billed charges,"41.7% of $2,384.81 in Billed Charges for Rev 272 = $994.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MATRIX 1.8 X 125MM 0,272,RC,,,,,,,,both,,,2384.8100,357.7200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1106.55,,,,,,,615.5200,2384.8100,percent of total billed charges,"46.4% of $2,384.81 in Billed Charges for Rev 272 = $1,106.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MATRIX 1.8 X 125MM 0,272,RC,,,,,,,,both,,,2384.8100,357.7200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,994.47,,,,,,,615.5200,2384.8100,percent of total billed charges,"41.7% of $2,384.81 in Billed Charges for Rev 272 = $994.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MATRIX 1.8 X 125MM 0,272,RC,,,,,,,,both,,,2384.8100,357.7200,CIGNA HEALTHCARE,CIGNA PPO,994.47,,,,,,,615.5200,2384.8100,percent of total billed charges,"41.7% of $2,384.81 in Billed Charges for Rev 272 = $994.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MATRIX 1.8 X 125MM 0,272,RC,,,,,,,,both,,,2384.8100,357.7200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2146.33,,,,,,,615.5200,2384.8100,percent of total billed charges,"90% of $2,384.81 in Billed Charges for Rev 272 = $2,146.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MATRIX 1.8 X 125MM 0,272,RC,,,,,,,,both,,,2384.8100,357.7200,MEDCOST,MEDCOST VHN,1134.93,,,,,,,615.5200,2384.8100,percent of total billed charges,"47.59% of $2,384.81 in Billed Charges for Rev 272 = $1,134.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MATRIX 1.8 X 125MM 0,272,RC,,,,,,,,both,,,2384.8100,357.7200,SENTARA HEALTH,SENTARA HEALTH,615.52,,,,,,,615.5200,2384.8100,percent of total billed charges,"25.81% of $2,384.81 in Billed Charges for Rev 272 = $615.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MATRIX 1.8 X 125MM 0,272,RC,,,,,,,,both,,,2384.8100,357.7200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2384.81,,,,,,,615.5200,2384.8100,percent of total billed charges,"100% of $2,384.81 in Billed Charges for Rev 272 = $2,384.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MATRIX 1.8 X 125MM 0,272,RC,,,,,,,,both,,,2384.8100,357.7200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1192.41,,,,,,,615.5200,2384.8100,percent of total billed charges,"Rev 272 $2,384.81 in Billed Charges at 50% = $1,192.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MATRIX 1.8 X 125MM 0,272,RC,,,,,,,,both,,,2384.8100,357.7200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,770.29,,,,,,,615.5200,2384.8100,other,"32.3% of $2,384.81 in Billed Charges for Rev 272 = $770.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL MATRIX 1.8 X 125MM 0,272,RC,,,,,,,,both,,,2384.8100,357.7200,UNITED HEALTHCARE,UHC HERITAGE SELECT,732.14,,,,,,,615.5200,2384.8100,other,"30.7% of $2,384.81 in Billed Charges for Rev 272 = $732.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL MATRIX 1.8 X 125MM 0,272,RC,,,,,,,,both,,,2384.8100,357.7200,UNITED HEALTHCARE,UNITED HEALTHCARE,770.29,,,,,,,615.5200,2384.8100,percent of total billed charges,"32.3% of $2,384.81 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MATRIX 1.8 X 125MM 0,272,RC,,,,,,,,both,,,2384.8100,357.7200,WELLCARE,WELLCARE MEDICAID,2384.81,,,,,,,615.5200,2384.8100,percent of total billed charges,"100% of $2,384.81 in Billed Charges for Rev 272 = $2,384.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANN PERC,272,RC,27200002,CDM,,,,,,both,,,10182.1400,1527.3200,AETNA,AETNA,4347.77,,,,,,,2628.0100,10182.1400,percent of total billed charges,"42.7% of $10,182.14 in Billed Charges for Rev 272 = $4,347.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANN PERC,272,RC,27200002,CDM,,,,,,both,,,10182.1400,1527.3200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7127.50,,,,,,,2628.0100,10182.1400,percent of total billed charges,"Rev 272 $10,182.14 in Billed Charges at 70% = $7,127.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANN PERC,272,RC,27200002,CDM,,,,,,both,,,10182.1400,1527.3200,CIGNA HEALTHCARE,CIGNA HMO,4245.95,,,,,,,2628.0100,10182.1400,percent of total billed charges,"41.7% of $10,182.14 in Billed Charges for Rev 272 = $4,245.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANN PERC,272,RC,27200002,CDM,,,,,,both,,,10182.1400,1527.3200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4724.51,,,,,,,2628.0100,10182.1400,percent of total billed charges,"46.4% of $10,182.14 in Billed Charges for Rev 272 = $4,724.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANN PERC,272,RC,27200002,CDM,,,,,,both,,,10182.1400,1527.3200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4245.95,,,,,,,2628.0100,10182.1400,percent of total billed charges,"41.7% of $10,182.14 in Billed Charges for Rev 272 = $4,245.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANN PERC,272,RC,27200002,CDM,,,,,,both,,,10182.1400,1527.3200,CIGNA HEALTHCARE,CIGNA PPO,4245.95,,,,,,,2628.0100,10182.1400,percent of total billed charges,"41.7% of $10,182.14 in Billed Charges for Rev 272 = $4,245.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANN PERC,272,RC,27200002,CDM,,,,,,both,,,10182.1400,1527.3200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9163.93,,,,,,,2628.0100,10182.1400,percent of total billed charges,"90% of $10,182.14 in Billed Charges for Rev 272 = $9,163.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANN PERC,272,RC,27200002,CDM,,,,,,both,,,10182.1400,1527.3200,MEDCOST,MEDCOST VHN,4845.68,,,,,,,2628.0100,10182.1400,percent of total billed charges,"47.59% of $10,182.14 in Billed Charges for Rev 272 = $4,845.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANN PERC,272,RC,27200002,CDM,,,,,,both,,,10182.1400,1527.3200,SENTARA HEALTH,SENTARA HEALTH,2628.01,,,,,,,2628.0100,10182.1400,percent of total billed charges,"25.81% of $10,182.14 in Billed Charges for Rev 272 = $2,628.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANN PERC,272,RC,27200002,CDM,,,,,,both,,,10182.1400,1527.3200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10182.14,,,,,,,2628.0100,10182.1400,percent of total billed charges,"100% of $10,182.14 in Billed Charges for Rev 272 = $10,182.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANN PERC,272,RC,27200002,CDM,,,,,,both,,,10182.1400,1527.3200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5091.07,,,,,,,2628.0100,10182.1400,percent of total billed charges,"Rev 272 $10,182.14 in Billed Charges at 50% = $5,091.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANN PERC,272,RC,27200002,CDM,,,,,,both,,,10182.1400,1527.3200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3288.83,,,,,,,2628.0100,10182.1400,other,"32.3% of $10,182.14 in Billed Charges for Rev 272 = $3,288.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 16MM CANN PERC,272,RC,27200002,CDM,,,,,,both,,,10182.1400,1527.3200,UNITED HEALTHCARE,UHC HERITAGE SELECT,3125.92,,,,,,,2628.0100,10182.1400,other,"30.7% of $10,182.14 in Billed Charges for Rev 272 = $3,125.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 16MM CANN PERC,272,RC,27200002,CDM,,,,,,both,,,10182.1400,1527.3200,UNITED HEALTHCARE,UNITED HEALTHCARE,3288.83,,,,,,,2628.0100,10182.1400,percent of total billed charges,"32.3% of $10,182.14 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANN PERC,272,RC,27200002,CDM,,,,,,both,,,10182.1400,1527.3200,WELLCARE,WELLCARE MEDICAID,10182.14,,,,,,,2628.0100,10182.1400,percent of total billed charges,"100% of $10,182.14 in Billed Charges for Rev 272 = $10,182.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,8858.2900,1328.7400,AETNA,AETNA,3782.49,,,,,,,2286.3200,8858.2900,percent of total billed charges,"42.7% of $8,858.29 in Billed Charges for Rev 272 = $3,782.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,8858.2900,1328.7400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6200.80,,,,,,,2286.3200,8858.2900,percent of total billed charges,"Rev 272 $8,858.29 in Billed Charges at 70% = $6,200.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,8858.2900,1328.7400,CIGNA HEALTHCARE,CIGNA HMO,3693.91,,,,,,,2286.3200,8858.2900,percent of total billed charges,"41.7% of $8,858.29 in Billed Charges for Rev 272 = $3,693.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,8858.2900,1328.7400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4110.25,,,,,,,2286.3200,8858.2900,percent of total billed charges,"46.4% of $8,858.29 in Billed Charges for Rev 272 = $4,110.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,8858.2900,1328.7400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3693.91,,,,,,,2286.3200,8858.2900,percent of total billed charges,"41.7% of $8,858.29 in Billed Charges for Rev 272 = $3,693.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,8858.2900,1328.7400,CIGNA HEALTHCARE,CIGNA PPO,3693.91,,,,,,,2286.3200,8858.2900,percent of total billed charges,"41.7% of $8,858.29 in Billed Charges for Rev 272 = $3,693.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,8858.2900,1328.7400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7972.46,,,,,,,2286.3200,8858.2900,percent of total billed charges,"90% of $8,858.29 in Billed Charges for Rev 272 = $7,972.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,8858.2900,1328.7400,MEDCOST,MEDCOST VHN,4215.66,,,,,,,2286.3200,8858.2900,percent of total billed charges,"47.59% of $8,858.29 in Billed Charges for Rev 272 = $4,215.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,8858.2900,1328.7400,SENTARA HEALTH,SENTARA HEALTH,2286.32,,,,,,,2286.3200,8858.2900,percent of total billed charges,"25.81% of $8,858.29 in Billed Charges for Rev 272 = $2,286.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,8858.2900,1328.7400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8858.29,,,,,,,2286.3200,8858.2900,percent of total billed charges,"100% of $8,858.29 in Billed Charges for Rev 272 = $8,858.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,8858.2900,1328.7400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4429.15,,,,,,,2286.3200,8858.2900,percent of total billed charges,"Rev 272 $8,858.29 in Billed Charges at 50% = $4,429.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,8858.2900,1328.7400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2861.23,,,,,,,2286.3200,8858.2900,other,"32.3% of $8,858.29 in Billed Charges for Rev 272 = $2,861.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,8858.2900,1328.7400,UNITED HEALTHCARE,UHC HERITAGE SELECT,2719.50,,,,,,,2286.3200,8858.2900,other,"30.7% of $8,858.29 in Billed Charges for Rev 272 = $2,719.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,8858.2900,1328.7400,UNITED HEALTHCARE,UNITED HEALTHCARE,2861.23,,,,,,,2286.3200,8858.2900,percent of total billed charges,"32.3% of $8,858.29 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,8858.2900,1328.7400,WELLCARE,WELLCARE MEDICAID,8858.29,,,,,,,2286.3200,8858.2900,percent of total billed charges,"100% of $8,858.29 in Billed Charges for Rev 272 = $8,858.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM PERCUTANEOUS,272,RC,,,,,,,,both,,,9016.2400,1352.4400,AETNA,AETNA,3849.93,,,,,,,2327.0900,9016.2400,percent of total billed charges,"42.7% of $9,016.24 in Billed Charges for Rev 272 = $3,849.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM PERCUTANEOUS,272,RC,,,,,,,,both,,,9016.2400,1352.4400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6311.37,,,,,,,2327.0900,9016.2400,percent of total billed charges,"Rev 272 $9,016.24 in Billed Charges at 70% = $6,311.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM PERCUTANEOUS,272,RC,,,,,,,,both,,,9016.2400,1352.4400,CIGNA HEALTHCARE,CIGNA HMO,3759.77,,,,,,,2327.0900,9016.2400,percent of total billed charges,"41.7% of $9,016.24 in Billed Charges for Rev 272 = $3,759.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM PERCUTANEOUS,272,RC,,,,,,,,both,,,9016.2400,1352.4400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4183.54,,,,,,,2327.0900,9016.2400,percent of total billed charges,"46.4% of $9,016.24 in Billed Charges for Rev 272 = $4,183.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM PERCUTANEOUS,272,RC,,,,,,,,both,,,9016.2400,1352.4400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3759.77,,,,,,,2327.0900,9016.2400,percent of total billed charges,"41.7% of $9,016.24 in Billed Charges for Rev 272 = $3,759.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM PERCUTANEOUS,272,RC,,,,,,,,both,,,9016.2400,1352.4400,CIGNA HEALTHCARE,CIGNA PPO,3759.77,,,,,,,2327.0900,9016.2400,percent of total billed charges,"41.7% of $9,016.24 in Billed Charges for Rev 272 = $3,759.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM PERCUTANEOUS,272,RC,,,,,,,,both,,,9016.2400,1352.4400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8114.62,,,,,,,2327.0900,9016.2400,percent of total billed charges,"90% of $9,016.24 in Billed Charges for Rev 272 = $8,114.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM PERCUTANEOUS,272,RC,,,,,,,,both,,,9016.2400,1352.4400,MEDCOST,MEDCOST VHN,4290.83,,,,,,,2327.0900,9016.2400,percent of total billed charges,"47.59% of $9,016.24 in Billed Charges for Rev 272 = $4,290.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM PERCUTANEOUS,272,RC,,,,,,,,both,,,9016.2400,1352.4400,SENTARA HEALTH,SENTARA HEALTH,2327.09,,,,,,,2327.0900,9016.2400,percent of total billed charges,"25.81% of $9,016.24 in Billed Charges for Rev 272 = $2,327.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM PERCUTANEOUS,272,RC,,,,,,,,both,,,9016.2400,1352.4400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9016.24,,,,,,,2327.0900,9016.2400,percent of total billed charges,"100% of $9,016.24 in Billed Charges for Rev 272 = $9,016.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM PERCUTANEOUS,272,RC,,,,,,,,both,,,9016.2400,1352.4400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4508.12,,,,,,,2327.0900,9016.2400,percent of total billed charges,"Rev 272 $9,016.24 in Billed Charges at 50% = $4,508.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM PERCUTANEOUS,272,RC,,,,,,,,both,,,9016.2400,1352.4400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2912.25,,,,,,,2327.0900,9016.2400,other,"32.3% of $9,016.24 in Billed Charges for Rev 272 = $2,912.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 16MM PERCUTANEOUS,272,RC,,,,,,,,both,,,9016.2400,1352.4400,UNITED HEALTHCARE,UHC HERITAGE SELECT,2767.99,,,,,,,2327.0900,9016.2400,other,"30.7% of $9,016.24 in Billed Charges for Rev 272 = $2,767.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 16MM PERCUTANEOUS,272,RC,,,,,,,,both,,,9016.2400,1352.4400,UNITED HEALTHCARE,UNITED HEALTHCARE,2912.25,,,,,,,2327.0900,9016.2400,percent of total billed charges,"32.3% of $9,016.24 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 16MM PERCUTANEOUS,272,RC,,,,,,,,both,,,9016.2400,1352.4400,WELLCARE,WELLCARE MEDICAID,9016.24,,,,,,,2327.0900,9016.2400,percent of total billed charges,"100% of $9,016.24 in Billed Charges for Rev 272 = $9,016.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 17.0MM CANN 300MM,272,RC,,,,,,,,both,,,6546.5900,981.9900,AETNA,AETNA,2795.39,,,,,,,1689.6700,6546.5900,percent of total billed charges,"42.7% of $6,546.59 in Billed Charges for Rev 272 = $2,795.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 17.0MM CANN 300MM,272,RC,,,,,,,,both,,,6546.5900,981.9900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4582.61,,,,,,,1689.6700,6546.5900,percent of total billed charges,"Rev 272 $6,546.59 in Billed Charges at 70% = $4,582.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 17.0MM CANN 300MM,272,RC,,,,,,,,both,,,6546.5900,981.9900,CIGNA HEALTHCARE,CIGNA HMO,2729.93,,,,,,,1689.6700,6546.5900,percent of total billed charges,"41.7% of $6,546.59 in Billed Charges for Rev 272 = $2,729.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 17.0MM CANN 300MM,272,RC,,,,,,,,both,,,6546.5900,981.9900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3037.62,,,,,,,1689.6700,6546.5900,percent of total billed charges,"46.4% of $6,546.59 in Billed Charges for Rev 272 = $3,037.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 17.0MM CANN 300MM,272,RC,,,,,,,,both,,,6546.5900,981.9900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2729.93,,,,,,,1689.6700,6546.5900,percent of total billed charges,"41.7% of $6,546.59 in Billed Charges for Rev 272 = $2,729.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 17.0MM CANN 300MM,272,RC,,,,,,,,both,,,6546.5900,981.9900,CIGNA HEALTHCARE,CIGNA PPO,2729.93,,,,,,,1689.6700,6546.5900,percent of total billed charges,"41.7% of $6,546.59 in Billed Charges for Rev 272 = $2,729.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 17.0MM CANN 300MM,272,RC,,,,,,,,both,,,6546.5900,981.9900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5891.93,,,,,,,1689.6700,6546.5900,percent of total billed charges,"90% of $6,546.59 in Billed Charges for Rev 272 = $5,891.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 17.0MM CANN 300MM,272,RC,,,,,,,,both,,,6546.5900,981.9900,MEDCOST,MEDCOST VHN,3115.52,,,,,,,1689.6700,6546.5900,percent of total billed charges,"47.59% of $6,546.59 in Billed Charges for Rev 272 = $3,115.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 17.0MM CANN 300MM,272,RC,,,,,,,,both,,,6546.5900,981.9900,SENTARA HEALTH,SENTARA HEALTH,1689.67,,,,,,,1689.6700,6546.5900,percent of total billed charges,"25.81% of $6,546.59 in Billed Charges for Rev 272 = $1,689.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 17.0MM CANN 300MM,272,RC,,,,,,,,both,,,6546.5900,981.9900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6546.59,,,,,,,1689.6700,6546.5900,percent of total billed charges,"100% of $6,546.59 in Billed Charges for Rev 272 = $6,546.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 17.0MM CANN 300MM,272,RC,,,,,,,,both,,,6546.5900,981.9900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3273.30,,,,,,,1689.6700,6546.5900,percent of total billed charges,"Rev 272 $6,546.59 in Billed Charges at 50% = $3,273.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 17.0MM CANN 300MM,272,RC,,,,,,,,both,,,6546.5900,981.9900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2114.55,,,,,,,1689.6700,6546.5900,other,"32.3% of $6,546.59 in Billed Charges for Rev 272 = $2,114.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 17.0MM CANN 300MM,272,RC,,,,,,,,both,,,6546.5900,981.9900,UNITED HEALTHCARE,UHC HERITAGE SELECT,2009.80,,,,,,,1689.6700,6546.5900,other,"30.7% of $6,546.59 in Billed Charges for Rev 272 = $2,009.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 17.0MM CANN 300MM,272,RC,,,,,,,,both,,,6546.5900,981.9900,UNITED HEALTHCARE,UNITED HEALTHCARE,2114.55,,,,,,,1689.6700,6546.5900,percent of total billed charges,"32.3% of $6,546.59 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 17.0MM CANN 300MM,272,RC,,,,,,,,both,,,6546.5900,981.9900,WELLCARE,WELLCARE MEDICAID,6546.59,,,,,,,1689.6700,6546.5900,percent of total billed charges,"100% of $6,546.59 in Billed Charges for Rev 272 = $6,546.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2,272,RC,,,,,,,,both,,,3495.0300,524.2500,AETNA,AETNA,1492.38,,,,,,,902.0700,3495.0300,percent of total billed charges,"42.7% of $3,495.03 in Billed Charges for Rev 272 = $1,492.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2,272,RC,,,,,,,,both,,,3495.0300,524.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2446.52,,,,,,,902.0700,3495.0300,percent of total billed charges,"Rev 272 $3,495.03 in Billed Charges at 70% = $2,446.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2,272,RC,,,,,,,,both,,,3495.0300,524.2500,CIGNA HEALTHCARE,CIGNA HMO,1457.43,,,,,,,902.0700,3495.0300,percent of total billed charges,"41.7% of $3,495.03 in Billed Charges for Rev 272 = $1,457.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2,272,RC,,,,,,,,both,,,3495.0300,524.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1621.69,,,,,,,902.0700,3495.0300,percent of total billed charges,"46.4% of $3,495.03 in Billed Charges for Rev 272 = $1,621.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2,272,RC,,,,,,,,both,,,3495.0300,524.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1457.43,,,,,,,902.0700,3495.0300,percent of total billed charges,"41.7% of $3,495.03 in Billed Charges for Rev 272 = $1,457.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2,272,RC,,,,,,,,both,,,3495.0300,524.2500,CIGNA HEALTHCARE,CIGNA PPO,1457.43,,,,,,,902.0700,3495.0300,percent of total billed charges,"41.7% of $3,495.03 in Billed Charges for Rev 272 = $1,457.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2,272,RC,,,,,,,,both,,,3495.0300,524.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3145.53,,,,,,,902.0700,3495.0300,percent of total billed charges,"90% of $3,495.03 in Billed Charges for Rev 272 = $3,145.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2,272,RC,,,,,,,,both,,,3495.0300,524.2500,MEDCOST,MEDCOST VHN,1663.28,,,,,,,902.0700,3495.0300,percent of total billed charges,"47.59% of $3,495.03 in Billed Charges for Rev 272 = $1,663.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2,272,RC,,,,,,,,both,,,3495.0300,524.2500,SENTARA HEALTH,SENTARA HEALTH,902.07,,,,,,,902.0700,3495.0300,percent of total billed charges,"25.81% of $3,495.03 in Billed Charges for Rev 272 = $902.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2,272,RC,,,,,,,,both,,,3495.0300,524.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3495.03,,,,,,,902.0700,3495.0300,percent of total billed charges,"100% of $3,495.03 in Billed Charges for Rev 272 = $3,495.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2,272,RC,,,,,,,,both,,,3495.0300,524.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1747.52,,,,,,,902.0700,3495.0300,percent of total billed charges,"Rev 272 $3,495.03 in Billed Charges at 50% = $1,747.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2,272,RC,,,,,,,,both,,,3495.0300,524.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1128.89,,,,,,,902.0700,3495.0300,other,"32.3% of $3,495.03 in Billed Charges for Rev 272 = $1,128.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL MINI ACUTRAK 2,272,RC,,,,,,,,both,,,3495.0300,524.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1072.97,,,,,,,902.0700,3495.0300,other,"30.7% of $3,495.03 in Billed Charges for Rev 272 = $1,072.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL MINI ACUTRAK 2,272,RC,,,,,,,,both,,,3495.0300,524.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1128.89,,,,,,,902.0700,3495.0300,percent of total billed charges,"32.3% of $3,495.03 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI ACUTRAK 2,272,RC,,,,,,,,both,,,3495.0300,524.2500,WELLCARE,WELLCARE MEDICAID,3495.03,,,,,,,902.0700,3495.0300,percent of total billed charges,"100% of $3,495.03 in Billed Charges for Rev 272 = $3,495.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0     315.19,272,RC,,,,,,,,both,,,939.8200,140.9700,AETNA,AETNA,401.30,,,,,,,242.5700,939.8200,percent of total billed charges,42.7% of $939.82 in Billed Charges for Rev 272 = $401.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.0     315.19,272,RC,,,,,,,,both,,,939.8200,140.9700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,657.87,,,,,,,242.5700,939.8200,percent of total billed charges,Rev 272 $939.82 in Billed Charges at 70% = $657.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.0     315.19,272,RC,,,,,,,,both,,,939.8200,140.9700,CIGNA HEALTHCARE,CIGNA HMO,391.90,,,,,,,242.5700,939.8200,percent of total billed charges,41.7% of $939.82 in Billed Charges for Rev 272 = $391.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.0     315.19,272,RC,,,,,,,,both,,,939.8200,140.9700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,436.08,,,,,,,242.5700,939.8200,percent of total billed charges,46.4% of $939.82 in Billed Charges for Rev 272 = $436.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.0     315.19,272,RC,,,,,,,,both,,,939.8200,140.9700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,391.90,,,,,,,242.5700,939.8200,percent of total billed charges,41.7% of $939.82 in Billed Charges for Rev 272 = $391.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.0     315.19,272,RC,,,,,,,,both,,,939.8200,140.9700,CIGNA HEALTHCARE,CIGNA PPO,391.90,,,,,,,242.5700,939.8200,percent of total billed charges,41.7% of $939.82 in Billed Charges for Rev 272 = $391.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.0     315.19,272,RC,,,,,,,,both,,,939.8200,140.9700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,845.84,,,,,,,242.5700,939.8200,percent of total billed charges,90% of $939.82 in Billed Charges for Rev 272 = $845.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.0     315.19,272,RC,,,,,,,,both,,,939.8200,140.9700,MEDCOST,MEDCOST VHN,447.26,,,,,,,242.5700,939.8200,percent of total billed charges,47.59% of $939.82 in Billed Charges for Rev 272 = $447.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.0     315.19,272,RC,,,,,,,,both,,,939.8200,140.9700,SENTARA HEALTH,SENTARA HEALTH,242.57,,,,,,,242.5700,939.8200,percent of total billed charges,25.81% of $939.82 in Billed Charges for Rev 272 = $242.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.0     315.19,272,RC,,,,,,,,both,,,939.8200,140.9700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",939.82,,,,,,,242.5700,939.8200,percent of total billed charges,100% of $939.82 in Billed Charges for Rev 272 = $939.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.0     315.19,272,RC,,,,,,,,both,,,939.8200,140.9700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,469.91,,,,,,,242.5700,939.8200,percent of total billed charges,Rev 272 $939.82 in Billed Charges at 50% = $469.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.0     315.19,272,RC,,,,,,,,both,,,939.8200,140.9700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,303.56,,,,,,,242.5700,939.8200,other,32.3% of $939.82 in Billed Charges for Rev 272 = $303.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 2.0     315.19,272,RC,,,,,,,,both,,,939.8200,140.9700,UNITED HEALTHCARE,UHC HERITAGE SELECT,288.52,,,,,,,242.5700,939.8200,other,30.7% of $939.82 in Billed Charges for Rev 272 = $288.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL 2.0     315.19,272,RC,,,,,,,,both,,,939.8200,140.9700,UNITED HEALTHCARE,UNITED HEALTHCARE,303.56,,,,,,,242.5700,939.8200,percent of total billed charges,32.3% of $939.82 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.0     315.19,272,RC,,,,,,,,both,,,939.8200,140.9700,WELLCARE,WELLCARE MEDICAID,939.82,,,,,,,242.5700,939.8200,percent of total billed charges,100% of $939.82 in Billed Charges for Rev 272 = $939.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1220.9800,183.1500,AETNA,AETNA,521.36,,,,,,,315.1300,1220.9800,percent of total billed charges,"42.7% of $1,220.98 in Billed Charges for Rev 272 = $521.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1220.9800,183.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,854.69,,,,,,,315.1300,1220.9800,percent of total billed charges,"Rev 272 $1,220.98 in Billed Charges at 70% = $854.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1220.9800,183.1500,CIGNA HEALTHCARE,CIGNA HMO,509.15,,,,,,,315.1300,1220.9800,percent of total billed charges,"41.7% of $1,220.98 in Billed Charges for Rev 272 = $509.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1220.9800,183.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,566.53,,,,,,,315.1300,1220.9800,percent of total billed charges,"46.4% of $1,220.98 in Billed Charges for Rev 272 = $566.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1220.9800,183.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,509.15,,,,,,,315.1300,1220.9800,percent of total billed charges,"41.7% of $1,220.98 in Billed Charges for Rev 272 = $509.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1220.9800,183.1500,CIGNA HEALTHCARE,CIGNA PPO,509.15,,,,,,,315.1300,1220.9800,percent of total billed charges,"41.7% of $1,220.98 in Billed Charges for Rev 272 = $509.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1220.9800,183.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1098.88,,,,,,,315.1300,1220.9800,percent of total billed charges,"90% of $1,220.98 in Billed Charges for Rev 272 = $1,098.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1220.9800,183.1500,MEDCOST,MEDCOST VHN,581.06,,,,,,,315.1300,1220.9800,percent of total billed charges,"47.59% of $1,220.98 in Billed Charges for Rev 272 = $581.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1220.9800,183.1500,SENTARA HEALTH,SENTARA HEALTH,315.13,,,,,,,315.1300,1220.9800,percent of total billed charges,"25.81% of $1,220.98 in Billed Charges for Rev 272 = $315.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1220.9800,183.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1220.98,,,,,,,315.1300,1220.9800,percent of total billed charges,"100% of $1,220.98 in Billed Charges for Rev 272 = $1,220.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1220.9800,183.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,610.49,,,,,,,315.1300,1220.9800,percent of total billed charges,"Rev 272 $1,220.98 in Billed Charges at 50% = $610.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1220.9800,183.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,394.38,,,,,,,315.1300,1220.9800,other,"32.3% of $1,220.98 in Billed Charges for Rev 272 = $394.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1220.9800,183.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,374.84,,,,,,,315.1300,1220.9800,other,"30.7% of $1,220.98 in Billed Charges for Rev 272 = $374.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1220.9800,183.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,394.38,,,,,,,315.1300,1220.9800,percent of total billed charges,"32.3% of $1,220.98 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1220.9800,183.1500,WELLCARE,WELLCARE MEDICAID,1220.98,,,,,,,315.1300,1220.9800,percent of total billed charges,"100% of $1,220.98 in Billed Charges for Rev 272 = $1,220.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 X 125MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2210.5800,331.5900,AETNA,AETNA,943.92,,,,,,,570.5500,2210.5800,percent of total billed charges,"42.7% of $2,210.58 in Billed Charges for Rev 272 = $943.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 X 125MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2210.5800,331.5900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1547.41,,,,,,,570.5500,2210.5800,percent of total billed charges,"Rev 272 $2,210.58 in Billed Charges at 70% = $1,547.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 X 125MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2210.5800,331.5900,CIGNA HEALTHCARE,CIGNA HMO,921.81,,,,,,,570.5500,2210.5800,percent of total billed charges,"41.7% of $2,210.58 in Billed Charges for Rev 272 = $921.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 X 125MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2210.5800,331.5900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1025.71,,,,,,,570.5500,2210.5800,percent of total billed charges,"46.4% of $2,210.58 in Billed Charges for Rev 272 = $1,025.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 X 125MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2210.5800,331.5900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,921.81,,,,,,,570.5500,2210.5800,percent of total billed charges,"41.7% of $2,210.58 in Billed Charges for Rev 272 = $921.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 X 125MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2210.5800,331.5900,CIGNA HEALTHCARE,CIGNA PPO,921.81,,,,,,,570.5500,2210.5800,percent of total billed charges,"41.7% of $2,210.58 in Billed Charges for Rev 272 = $921.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 X 125MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2210.5800,331.5900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1989.52,,,,,,,570.5500,2210.5800,percent of total billed charges,"90% of $2,210.58 in Billed Charges for Rev 272 = $1,989.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 X 125MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2210.5800,331.5900,MEDCOST,MEDCOST VHN,1052.02,,,,,,,570.5500,2210.5800,percent of total billed charges,"47.59% of $2,210.58 in Billed Charges for Rev 272 = $1,052.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 X 125MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2210.5800,331.5900,SENTARA HEALTH,SENTARA HEALTH,570.55,,,,,,,570.5500,2210.5800,percent of total billed charges,"25.81% of $2,210.58 in Billed Charges for Rev 272 = $570.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 X 125MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2210.5800,331.5900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2210.58,,,,,,,570.5500,2210.5800,percent of total billed charges,"100% of $2,210.58 in Billed Charges for Rev 272 = $2,210.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 X 125MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2210.5800,331.5900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1105.29,,,,,,,570.5500,2210.5800,percent of total billed charges,"Rev 272 $2,210.58 in Billed Charges at 50% = $1,105.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 X 125MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2210.5800,331.5900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,714.02,,,,,,,570.5500,2210.5800,other,"32.3% of $2,210.58 in Billed Charges for Rev 272 = $714.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.0 X 125MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2210.5800,331.5900,UNITED HEALTHCARE,UHC HERITAGE SELECT,678.65,,,,,,,570.5500,2210.5800,other,"30.7% of $2,210.58 in Billed Charges for Rev 272 = $678.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.0 X 125MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2210.5800,331.5900,UNITED HEALTHCARE,UNITED HEALTHCARE,714.02,,,,,,,570.5500,2210.5800,percent of total billed charges,"32.3% of $2,210.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 X 125MM CALIBRATION,272,RC,27200002,CDM,,,,,,both,,,2210.5800,331.5900,WELLCARE,WELLCARE MEDICAID,2210.58,,,,,,,570.5500,2210.5800,percent of total billed charges,"100% of $2,210.58 in Billed Charges for Rev 272 = $2,210.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL MINI QUICK COUPLING 1.1 X 75MM,272,RC,27200002,CDM,,,,,,both,,,798.9800,119.8500,AETNA,AETNA,341.16,,,,,,,206.2200,798.9800,percent of total billed charges,42.7% of $798.98 in Billed Charges for Rev 272 = $341.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL MINI QUICK COUPLING 1.1 X 75MM,272,RC,27200002,CDM,,,,,,both,,,798.9800,119.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,559.29,,,,,,,206.2200,798.9800,percent of total billed charges,Rev 272 $798.98 in Billed Charges at 70% = $559.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL MINI QUICK COUPLING 1.1 X 75MM,272,RC,27200002,CDM,,,,,,both,,,798.9800,119.8500,CIGNA HEALTHCARE,CIGNA HMO,333.17,,,,,,,206.2200,798.9800,percent of total billed charges,41.7% of $798.98 in Billed Charges for Rev 272 = $333.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL MINI QUICK COUPLING 1.1 X 75MM,272,RC,27200002,CDM,,,,,,both,,,798.9800,119.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,370.73,,,,,,,206.2200,798.9800,percent of total billed charges,46.4% of $798.98 in Billed Charges for Rev 272 = $370.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL MINI QUICK COUPLING 1.1 X 75MM,272,RC,27200002,CDM,,,,,,both,,,798.9800,119.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,333.17,,,,,,,206.2200,798.9800,percent of total billed charges,41.7% of $798.98 in Billed Charges for Rev 272 = $333.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL MINI QUICK COUPLING 1.1 X 75MM,272,RC,27200002,CDM,,,,,,both,,,798.9800,119.8500,CIGNA HEALTHCARE,CIGNA PPO,333.17,,,,,,,206.2200,798.9800,percent of total billed charges,41.7% of $798.98 in Billed Charges for Rev 272 = $333.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL MINI QUICK COUPLING 1.1 X 75MM,272,RC,27200002,CDM,,,,,,both,,,798.9800,119.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,719.08,,,,,,,206.2200,798.9800,percent of total billed charges,90% of $798.98 in Billed Charges for Rev 272 = $719.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL MINI QUICK COUPLING 1.1 X 75MM,272,RC,27200002,CDM,,,,,,both,,,798.9800,119.8500,MEDCOST,MEDCOST VHN,380.23,,,,,,,206.2200,798.9800,percent of total billed charges,47.59% of $798.98 in Billed Charges for Rev 272 = $380.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL MINI QUICK COUPLING 1.1 X 75MM,272,RC,27200002,CDM,,,,,,both,,,798.9800,119.8500,SENTARA HEALTH,SENTARA HEALTH,206.22,,,,,,,206.2200,798.9800,percent of total billed charges,25.81% of $798.98 in Billed Charges for Rev 272 = $206.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL MINI QUICK COUPLING 1.1 X 75MM,272,RC,27200002,CDM,,,,,,both,,,798.9800,119.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",798.98,,,,,,,206.2200,798.9800,percent of total billed charges,100% of $798.98 in Billed Charges for Rev 272 = $798.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL MINI QUICK COUPLING 1.1 X 75MM,272,RC,27200002,CDM,,,,,,both,,,798.9800,119.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,399.49,,,,,,,206.2200,798.9800,percent of total billed charges,Rev 272 $798.98 in Billed Charges at 50% = $399.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL MINI QUICK COUPLING 1.1 X 75MM,272,RC,27200002,CDM,,,,,,both,,,798.9800,119.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,258.07,,,,,,,206.2200,798.9800,other,32.3% of $798.98 in Billed Charges for Rev 272 = $258.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL MINI QUICK COUPLING 1.1 X 75MM,272,RC,27200002,CDM,,,,,,both,,,798.9800,119.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,245.29,,,,,,,206.2200,798.9800,other,30.7% of $798.98 in Billed Charges for Rev 272 = $245.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL MINI QUICK COUPLING 1.1 X 75MM,272,RC,27200002,CDM,,,,,,both,,,798.9800,119.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,258.07,,,,,,,206.2200,798.9800,percent of total billed charges,32.3% of $798.98 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL MINI QUICK COUPLING 1.1 X 75MM,272,RC,27200002,CDM,,,,,,both,,,798.9800,119.8500,WELLCARE,WELLCARE MEDICAID,798.98,,,,,,,206.2200,798.9800,percent of total billed charges,100% of $798.98 in Billed Charges for Rev 272 = $798.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL 2.0MM,272,RC,,,,,,,,both,,,1035.7500,155.3600,AETNA,AETNA,442.27,,,,,,,267.3300,1035.7500,percent of total billed charges,"42.7% of $1,035.75 in Billed Charges for Rev 272 = $442.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,,,,,,,,both,,,1035.7500,155.3600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,725.03,,,,,,,267.3300,1035.7500,percent of total billed charges,"Rev 272 $1,035.75 in Billed Charges at 70% = $725.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,,,,,,,,both,,,1035.7500,155.3600,CIGNA HEALTHCARE,CIGNA HMO,431.91,,,,,,,267.3300,1035.7500,percent of total billed charges,"41.7% of $1,035.75 in Billed Charges for Rev 272 = $431.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,,,,,,,,both,,,1035.7500,155.3600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,480.59,,,,,,,267.3300,1035.7500,percent of total billed charges,"46.4% of $1,035.75 in Billed Charges for Rev 272 = $480.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,,,,,,,,both,,,1035.7500,155.3600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,431.91,,,,,,,267.3300,1035.7500,percent of total billed charges,"41.7% of $1,035.75 in Billed Charges for Rev 272 = $431.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,,,,,,,,both,,,1035.7500,155.3600,CIGNA HEALTHCARE,CIGNA PPO,431.91,,,,,,,267.3300,1035.7500,percent of total billed charges,"41.7% of $1,035.75 in Billed Charges for Rev 272 = $431.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,,,,,,,,both,,,1035.7500,155.3600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,932.18,,,,,,,267.3300,1035.7500,percent of total billed charges,"90% of $1,035.75 in Billed Charges for Rev 272 = $932.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,,,,,,,,both,,,1035.7500,155.3600,MEDCOST,MEDCOST VHN,492.91,,,,,,,267.3300,1035.7500,percent of total billed charges,"47.59% of $1,035.75 in Billed Charges for Rev 272 = $492.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,,,,,,,,both,,,1035.7500,155.3600,SENTARA HEALTH,SENTARA HEALTH,267.33,,,,,,,267.3300,1035.7500,percent of total billed charges,"25.81% of $1,035.75 in Billed Charges for Rev 272 = $267.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,,,,,,,,both,,,1035.7500,155.3600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1035.75,,,,,,,267.3300,1035.7500,percent of total billed charges,"100% of $1,035.75 in Billed Charges for Rev 272 = $1,035.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,,,,,,,,both,,,1035.7500,155.3600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,517.88,,,,,,,267.3300,1035.7500,percent of total billed charges,"Rev 272 $1,035.75 in Billed Charges at 50% = $517.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,,,,,,,,both,,,1035.7500,155.3600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,334.55,,,,,,,267.3300,1035.7500,other,"32.3% of $1,035.75 in Billed Charges for Rev 272 = $334.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.0MM,272,RC,,,,,,,,both,,,1035.7500,155.3600,UNITED HEALTHCARE,UHC HERITAGE SELECT,317.98,,,,,,,267.3300,1035.7500,other,"30.7% of $1,035.75 in Billed Charges for Rev 272 = $317.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.0MM,272,RC,,,,,,,,both,,,1035.7500,155.3600,UNITED HEALTHCARE,UNITED HEALTHCARE,334.55,,,,,,,267.3300,1035.7500,percent of total billed charges,"32.3% of $1,035.75 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0MM,272,RC,,,,,,,,both,,,1035.7500,155.3600,WELLCARE,WELLCARE MEDICAID,1035.75,,,,,,,267.3300,1035.7500,percent of total billed charges,"100% of $1,035.75 in Billed Charges for Rev 272 = $1,035.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRL 3.5 X 130ML,272,RC,,,,,,,,both,,,1154.7100,173.2100,AETNA,AETNA,493.06,,,,,,,298.0300,1154.7100,percent of total billed charges,"42.7% of $1,154.71 in Billed Charges for Rev 272 = $493.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRL 3.5 X 130ML,272,RC,,,,,,,,both,,,1154.7100,173.2100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,808.30,,,,,,,298.0300,1154.7100,percent of total billed charges,"Rev 272 $1,154.71 in Billed Charges at 70% = $808.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRL 3.5 X 130ML,272,RC,,,,,,,,both,,,1154.7100,173.2100,CIGNA HEALTHCARE,CIGNA HMO,481.51,,,,,,,298.0300,1154.7100,percent of total billed charges,"41.7% of $1,154.71 in Billed Charges for Rev 272 = $481.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRL 3.5 X 130ML,272,RC,,,,,,,,both,,,1154.7100,173.2100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,535.79,,,,,,,298.0300,1154.7100,percent of total billed charges,"46.4% of $1,154.71 in Billed Charges for Rev 272 = $535.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRL 3.5 X 130ML,272,RC,,,,,,,,both,,,1154.7100,173.2100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,481.51,,,,,,,298.0300,1154.7100,percent of total billed charges,"41.7% of $1,154.71 in Billed Charges for Rev 272 = $481.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRL 3.5 X 130ML,272,RC,,,,,,,,both,,,1154.7100,173.2100,CIGNA HEALTHCARE,CIGNA PPO,481.51,,,,,,,298.0300,1154.7100,percent of total billed charges,"41.7% of $1,154.71 in Billed Charges for Rev 272 = $481.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRL 3.5 X 130ML,272,RC,,,,,,,,both,,,1154.7100,173.2100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1039.24,,,,,,,298.0300,1154.7100,percent of total billed charges,"90% of $1,154.71 in Billed Charges for Rev 272 = $1,039.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRL 3.5 X 130ML,272,RC,,,,,,,,both,,,1154.7100,173.2100,MEDCOST,MEDCOST VHN,549.53,,,,,,,298.0300,1154.7100,percent of total billed charges,"47.59% of $1,154.71 in Billed Charges for Rev 272 = $549.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRL 3.5 X 130ML,272,RC,,,,,,,,both,,,1154.7100,173.2100,SENTARA HEALTH,SENTARA HEALTH,298.03,,,,,,,298.0300,1154.7100,percent of total billed charges,"25.81% of $1,154.71 in Billed Charges for Rev 272 = $298.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRL 3.5 X 130ML,272,RC,,,,,,,,both,,,1154.7100,173.2100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1154.71,,,,,,,298.0300,1154.7100,percent of total billed charges,"100% of $1,154.71 in Billed Charges for Rev 272 = $1,154.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRL 3.5 X 130ML,272,RC,,,,,,,,both,,,1154.7100,173.2100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,577.36,,,,,,,298.0300,1154.7100,percent of total billed charges,"Rev 272 $1,154.71 in Billed Charges at 50% = $577.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRL 3.5 X 130ML,272,RC,,,,,,,,both,,,1154.7100,173.2100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,372.97,,,,,,,298.0300,1154.7100,other,"32.3% of $1,154.71 in Billed Charges for Rev 272 = $372.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL STRL 3.5 X 130ML,272,RC,,,,,,,,both,,,1154.7100,173.2100,UNITED HEALTHCARE,UHC HERITAGE SELECT,354.50,,,,,,,298.0300,1154.7100,other,"30.7% of $1,154.71 in Billed Charges for Rev 272 = $354.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL STRL 3.5 X 130ML,272,RC,,,,,,,,both,,,1154.7100,173.2100,UNITED HEALTHCARE,UNITED HEALTHCARE,372.97,,,,,,,298.0300,1154.7100,percent of total billed charges,"32.3% of $1,154.71 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRL 3.5 X 130ML,272,RC,,,,,,,,both,,,1154.7100,173.2100,WELLCARE,WELLCARE MEDICAID,1154.71,,,,,,,298.0300,1154.7100,percent of total billed charges,"100% of $1,154.71 in Billed Charges for Rev 272 = $1,154.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,1607.5100,241.1300,AETNA,AETNA,686.41,,,,,,,414.9000,1607.5100,percent of total billed charges,"42.7% of $1,607.51 in Billed Charges for Rev 272 = $686.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,1607.5100,241.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1125.26,,,,,,,414.9000,1607.5100,percent of total billed charges,"Rev 272 $1,607.51 in Billed Charges at 70% = $1,125.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,1607.5100,241.1300,CIGNA HEALTHCARE,CIGNA HMO,670.33,,,,,,,414.9000,1607.5100,percent of total billed charges,"41.7% of $1,607.51 in Billed Charges for Rev 272 = $670.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,1607.5100,241.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,745.88,,,,,,,414.9000,1607.5100,percent of total billed charges,"46.4% of $1,607.51 in Billed Charges for Rev 272 = $745.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,1607.5100,241.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,670.33,,,,,,,414.9000,1607.5100,percent of total billed charges,"41.7% of $1,607.51 in Billed Charges for Rev 272 = $670.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,1607.5100,241.1300,CIGNA HEALTHCARE,CIGNA PPO,670.33,,,,,,,414.9000,1607.5100,percent of total billed charges,"41.7% of $1,607.51 in Billed Charges for Rev 272 = $670.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,1607.5100,241.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1446.76,,,,,,,414.9000,1607.5100,percent of total billed charges,"90% of $1,607.51 in Billed Charges for Rev 272 = $1,446.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,1607.5100,241.1300,MEDCOST,MEDCOST VHN,765.01,,,,,,,414.9000,1607.5100,percent of total billed charges,"47.59% of $1,607.51 in Billed Charges for Rev 272 = $765.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,1607.5100,241.1300,SENTARA HEALTH,SENTARA HEALTH,414.90,,,,,,,414.9000,1607.5100,percent of total billed charges,"25.81% of $1,607.51 in Billed Charges for Rev 272 = $414.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,1607.5100,241.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1607.51,,,,,,,414.9000,1607.5100,percent of total billed charges,"100% of $1,607.51 in Billed Charges for Rev 272 = $1,607.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,1607.5100,241.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,803.76,,,,,,,414.9000,1607.5100,percent of total billed charges,"Rev 272 $1,607.51 in Billed Charges at 50% = $803.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,1607.5100,241.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,519.23,,,,,,,414.9000,1607.5100,other,"32.3% of $1,607.51 in Billed Charges for Rev 272 = $519.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,1607.5100,241.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,493.51,,,,,,,414.9000,1607.5100,other,"30.7% of $1,607.51 in Billed Charges for Rev 272 = $493.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,1607.5100,241.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,519.23,,,,,,,414.9000,1607.5100,percent of total billed charges,"32.3% of $1,607.51 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,1607.5100,241.1300,WELLCARE,WELLCARE MEDICAID,1607.51,,,,,,,414.9000,1607.5100,percent of total billed charges,"100% of $1,607.51 in Billed Charges for Rev 272 = $1,607.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1472.6800,220.9000,AETNA,AETNA,628.83,,,,,,,380.1000,1472.6800,percent of total billed charges,"42.7% of $1,472.68 in Billed Charges for Rev 272 = $628.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1472.6800,220.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1030.88,,,,,,,380.1000,1472.6800,percent of total billed charges,"Rev 272 $1,472.68 in Billed Charges at 70% = $1,030.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1472.6800,220.9000,CIGNA HEALTHCARE,CIGNA HMO,614.11,,,,,,,380.1000,1472.6800,percent of total billed charges,"41.7% of $1,472.68 in Billed Charges for Rev 272 = $614.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1472.6800,220.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,683.32,,,,,,,380.1000,1472.6800,percent of total billed charges,"46.4% of $1,472.68 in Billed Charges for Rev 272 = $683.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1472.6800,220.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,614.11,,,,,,,380.1000,1472.6800,percent of total billed charges,"41.7% of $1,472.68 in Billed Charges for Rev 272 = $614.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1472.6800,220.9000,CIGNA HEALTHCARE,CIGNA PPO,614.11,,,,,,,380.1000,1472.6800,percent of total billed charges,"41.7% of $1,472.68 in Billed Charges for Rev 272 = $614.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1472.6800,220.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1325.41,,,,,,,380.1000,1472.6800,percent of total billed charges,"90% of $1,472.68 in Billed Charges for Rev 272 = $1,325.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1472.6800,220.9000,MEDCOST,MEDCOST VHN,700.85,,,,,,,380.1000,1472.6800,percent of total billed charges,"47.59% of $1,472.68 in Billed Charges for Rev 272 = $700.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1472.6800,220.9000,SENTARA HEALTH,SENTARA HEALTH,380.10,,,,,,,380.1000,1472.6800,percent of total billed charges,"25.81% of $1,472.68 in Billed Charges for Rev 272 = $380.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1472.6800,220.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1472.68,,,,,,,380.1000,1472.6800,percent of total billed charges,"100% of $1,472.68 in Billed Charges for Rev 272 = $1,472.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1472.6800,220.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,736.34,,,,,,,380.1000,1472.6800,percent of total billed charges,"Rev 272 $1,472.68 in Billed Charges at 50% = $736.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1472.6800,220.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,475.68,,,,,,,380.1000,1472.6800,other,"32.3% of $1,472.68 in Billed Charges for Rev 272 = $475.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CALIBRATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1472.6800,220.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,452.11,,,,,,,380.1000,1472.6800,other,"30.7% of $1,472.68 in Billed Charges for Rev 272 = $452.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CALIBRATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1472.6800,220.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,475.68,,,,,,,380.1000,1472.6800,percent of total billed charges,"32.3% of $1,472.68 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,27200002,CDM,,,,,,both,,,1472.6800,220.9000,WELLCARE,WELLCARE MEDICAID,1472.68,,,,,,,380.1000,1472.6800,percent of total billed charges,"100% of $1,472.68 in Billed Charges for Rev 272 = $1,472.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,,,,,,,,both,,,1798.9500,269.8400,AETNA,AETNA,768.15,,,,,,,464.3100,1798.9500,percent of total billed charges,"42.7% of $1,798.95 in Billed Charges for Rev 272 = $768.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,,,,,,,,both,,,1798.9500,269.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1259.27,,,,,,,464.3100,1798.9500,percent of total billed charges,"Rev 272 $1,798.95 in Billed Charges at 70% = $1,259.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,,,,,,,,both,,,1798.9500,269.8400,CIGNA HEALTHCARE,CIGNA HMO,750.16,,,,,,,464.3100,1798.9500,percent of total billed charges,"41.7% of $1,798.95 in Billed Charges for Rev 272 = $750.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,,,,,,,,both,,,1798.9500,269.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,834.71,,,,,,,464.3100,1798.9500,percent of total billed charges,"46.4% of $1,798.95 in Billed Charges for Rev 272 = $834.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,,,,,,,,both,,,1798.9500,269.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,750.16,,,,,,,464.3100,1798.9500,percent of total billed charges,"41.7% of $1,798.95 in Billed Charges for Rev 272 = $750.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,,,,,,,,both,,,1798.9500,269.8400,CIGNA HEALTHCARE,CIGNA PPO,750.16,,,,,,,464.3100,1798.9500,percent of total billed charges,"41.7% of $1,798.95 in Billed Charges for Rev 272 = $750.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,,,,,,,,both,,,1798.9500,269.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1619.06,,,,,,,464.3100,1798.9500,percent of total billed charges,"90% of $1,798.95 in Billed Charges for Rev 272 = $1,619.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,,,,,,,,both,,,1798.9500,269.8400,MEDCOST,MEDCOST VHN,856.12,,,,,,,464.3100,1798.9500,percent of total billed charges,"47.59% of $1,798.95 in Billed Charges for Rev 272 = $856.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,,,,,,,,both,,,1798.9500,269.8400,SENTARA HEALTH,SENTARA HEALTH,464.31,,,,,,,464.3100,1798.9500,percent of total billed charges,"25.81% of $1,798.95 in Billed Charges for Rev 272 = $464.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,,,,,,,,both,,,1798.9500,269.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1798.95,,,,,,,464.3100,1798.9500,percent of total billed charges,"100% of $1,798.95 in Billed Charges for Rev 272 = $1,798.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,,,,,,,,both,,,1798.9500,269.8400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,899.48,,,,,,,464.3100,1798.9500,percent of total billed charges,"Rev 272 $1,798.95 in Billed Charges at 50% = $899.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,,,,,,,,both,,,1798.9500,269.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,581.06,,,,,,,464.3100,1798.9500,other,"32.3% of $1,798.95 in Billed Charges for Rev 272 = $581.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CALIBRATED 2.5MM,272,RC,,,,,,,,both,,,1798.9500,269.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,552.28,,,,,,,464.3100,1798.9500,other,"30.7% of $1,798.95 in Billed Charges for Rev 272 = $552.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CALIBRATED 2.5MM,272,RC,,,,,,,,both,,,1798.9500,269.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,581.06,,,,,,,464.3100,1798.9500,percent of total billed charges,"32.3% of $1,798.95 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.5MM,272,RC,,,,,,,,both,,,1798.9500,269.8400,WELLCARE,WELLCARE MEDICAID,1798.95,,,,,,,464.3100,1798.9500,percent of total billed charges,"100% of $1,798.95 in Billed Charges for Rev 272 = $1,798.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,10319.1500,1547.8700,AETNA,AETNA,4406.28,,,,,,,2663.3700,10319.1500,percent of total billed charges,"42.7% of $10,319.15 in Billed Charges for Rev 272 = $4,406.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,10319.1500,1547.8700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7223.41,,,,,,,2663.3700,10319.1500,percent of total billed charges,"Rev 272 $10,319.15 in Billed Charges at 70% = $7,223.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,10319.1500,1547.8700,CIGNA HEALTHCARE,CIGNA HMO,4303.09,,,,,,,2663.3700,10319.1500,percent of total billed charges,"41.7% of $10,319.15 in Billed Charges for Rev 272 = $4,303.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,10319.1500,1547.8700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4788.09,,,,,,,2663.3700,10319.1500,percent of total billed charges,"46.4% of $10,319.15 in Billed Charges for Rev 272 = $4,788.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,10319.1500,1547.8700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4303.09,,,,,,,2663.3700,10319.1500,percent of total billed charges,"41.7% of $10,319.15 in Billed Charges for Rev 272 = $4,303.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,10319.1500,1547.8700,CIGNA HEALTHCARE,CIGNA PPO,4303.09,,,,,,,2663.3700,10319.1500,percent of total billed charges,"41.7% of $10,319.15 in Billed Charges for Rev 272 = $4,303.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,10319.1500,1547.8700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9287.24,,,,,,,2663.3700,10319.1500,percent of total billed charges,"90% of $10,319.15 in Billed Charges for Rev 272 = $9,287.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,10319.1500,1547.8700,MEDCOST,MEDCOST VHN,4910.88,,,,,,,2663.3700,10319.1500,percent of total billed charges,"47.59% of $10,319.15 in Billed Charges for Rev 272 = $4,910.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,10319.1500,1547.8700,SENTARA HEALTH,SENTARA HEALTH,2663.37,,,,,,,2663.3700,10319.1500,percent of total billed charges,"25.81% of $10,319.15 in Billed Charges for Rev 272 = $2,663.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,10319.1500,1547.8700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10319.15,,,,,,,2663.3700,10319.1500,percent of total billed charges,"100% of $10,319.15 in Billed Charges for Rev 272 = $10,319.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,10319.1500,1547.8700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5159.58,,,,,,,2663.3700,10319.1500,percent of total billed charges,"Rev 272 $10,319.15 in Billed Charges at 50% = $5,159.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,10319.1500,1547.8700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3333.09,,,,,,,2663.3700,10319.1500,other,"32.3% of $10,319.15 in Billed Charges for Rev 272 = $3,333.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,10319.1500,1547.8700,UNITED HEALTHCARE,UHC HERITAGE SELECT,3167.98,,,,,,,2663.3700,10319.1500,other,"30.7% of $10,319.15 in Billed Charges for Rev 272 = $3,167.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,10319.1500,1547.8700,UNITED HEALTHCARE,UNITED HEALTHCARE,3333.09,,,,,,,2663.3700,10319.1500,percent of total billed charges,"32.3% of $10,319.15 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SURGIBIT 2.0 X 35MM,272,RC,,,,,,,,both,,,10319.1500,1547.8700,WELLCARE,WELLCARE MEDICAID,10319.15,,,,,,,2663.3700,10319.1500,percent of total billed charges,"100% of $10,319.15 in Billed Charges for Rev 272 = $10,319.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SUTURTAK 3.0MM AR-1250LT,272,RC,27200002,CDM,,,,,,both,,,829.6800,124.4500,AETNA,AETNA,354.27,,,,,,,214.1400,829.6800,percent of total billed charges,42.7% of $829.68 in Billed Charges for Rev 272 = $354.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUTURTAK 3.0MM AR-1250LT,272,RC,27200002,CDM,,,,,,both,,,829.6800,124.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,580.78,,,,,,,214.1400,829.6800,percent of total billed charges,Rev 272 $829.68 in Billed Charges at 70% = $580.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUTURTAK 3.0MM AR-1250LT,272,RC,27200002,CDM,,,,,,both,,,829.6800,124.4500,CIGNA HEALTHCARE,CIGNA HMO,345.98,,,,,,,214.1400,829.6800,percent of total billed charges,41.7% of $829.68 in Billed Charges for Rev 272 = $345.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUTURTAK 3.0MM AR-1250LT,272,RC,27200002,CDM,,,,,,both,,,829.6800,124.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,384.97,,,,,,,214.1400,829.6800,percent of total billed charges,46.4% of $829.68 in Billed Charges for Rev 272 = $384.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUTURTAK 3.0MM AR-1250LT,272,RC,27200002,CDM,,,,,,both,,,829.6800,124.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,345.98,,,,,,,214.1400,829.6800,percent of total billed charges,41.7% of $829.68 in Billed Charges for Rev 272 = $345.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUTURTAK 3.0MM AR-1250LT,272,RC,27200002,CDM,,,,,,both,,,829.6800,124.4500,CIGNA HEALTHCARE,CIGNA PPO,345.98,,,,,,,214.1400,829.6800,percent of total billed charges,41.7% of $829.68 in Billed Charges for Rev 272 = $345.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUTURTAK 3.0MM AR-1250LT,272,RC,27200002,CDM,,,,,,both,,,829.6800,124.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,746.71,,,,,,,214.1400,829.6800,percent of total billed charges,90% of $829.68 in Billed Charges for Rev 272 = $746.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUTURTAK 3.0MM AR-1250LT,272,RC,27200002,CDM,,,,,,both,,,829.6800,124.4500,MEDCOST,MEDCOST VHN,394.84,,,,,,,214.1400,829.6800,percent of total billed charges,47.59% of $829.68 in Billed Charges for Rev 272 = $394.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUTURTAK 3.0MM AR-1250LT,272,RC,27200002,CDM,,,,,,both,,,829.6800,124.4500,SENTARA HEALTH,SENTARA HEALTH,214.14,,,,,,,214.1400,829.6800,percent of total billed charges,25.81% of $829.68 in Billed Charges for Rev 272 = $214.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUTURTAK 3.0MM AR-1250LT,272,RC,27200002,CDM,,,,,,both,,,829.6800,124.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",829.68,,,,,,,214.1400,829.6800,percent of total billed charges,100% of $829.68 in Billed Charges for Rev 272 = $829.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUTURTAK 3.0MM AR-1250LT,272,RC,27200002,CDM,,,,,,both,,,829.6800,124.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,414.84,,,,,,,214.1400,829.6800,percent of total billed charges,Rev 272 $829.68 in Billed Charges at 50% = $414.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUTURTAK 3.0MM AR-1250LT,272,RC,27200002,CDM,,,,,,both,,,829.6800,124.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,267.99,,,,,,,214.1400,829.6800,other,32.3% of $829.68 in Billed Charges for Rev 272 = $267.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL SUTURTAK 3.0MM AR-1250LT,272,RC,27200002,CDM,,,,,,both,,,829.6800,124.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,254.71,,,,,,,214.1400,829.6800,other,30.7% of $829.68 in Billed Charges for Rev 272 = $254.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL SUTURTAK 3.0MM AR-1250LT,272,RC,27200002,CDM,,,,,,both,,,829.6800,124.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,267.99,,,,,,,214.1400,829.6800,percent of total billed charges,32.3% of $829.68 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SUTURTAK 3.0MM AR-1250LT,272,RC,27200002,CDM,,,,,,both,,,829.6800,124.4500,WELLCARE,WELLCARE MEDICAID,829.68,,,,,,,214.1400,829.6800,percent of total billed charges,100% of $829.68 in Billed Charges for Rev 272 = $829.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL T4.3MM DIA 152.5MML,272,RC,,,,,,,,both,,,1001.3200,150.2000,AETNA,AETNA,427.56,,,,,,,258.4400,1001.3200,percent of total billed charges,"42.7% of $1,001.32 in Billed Charges for Rev 272 = $427.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL T4.3MM DIA 152.5MML,272,RC,,,,,,,,both,,,1001.3200,150.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,700.92,,,,,,,258.4400,1001.3200,percent of total billed charges,"Rev 272 $1,001.32 in Billed Charges at 70% = $700.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL T4.3MM DIA 152.5MML,272,RC,,,,,,,,both,,,1001.3200,150.2000,CIGNA HEALTHCARE,CIGNA HMO,417.55,,,,,,,258.4400,1001.3200,percent of total billed charges,"41.7% of $1,001.32 in Billed Charges for Rev 272 = $417.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL T4.3MM DIA 152.5MML,272,RC,,,,,,,,both,,,1001.3200,150.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,464.61,,,,,,,258.4400,1001.3200,percent of total billed charges,"46.4% of $1,001.32 in Billed Charges for Rev 272 = $464.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL T4.3MM DIA 152.5MML,272,RC,,,,,,,,both,,,1001.3200,150.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,417.55,,,,,,,258.4400,1001.3200,percent of total billed charges,"41.7% of $1,001.32 in Billed Charges for Rev 272 = $417.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL T4.3MM DIA 152.5MML,272,RC,,,,,,,,both,,,1001.3200,150.2000,CIGNA HEALTHCARE,CIGNA PPO,417.55,,,,,,,258.4400,1001.3200,percent of total billed charges,"41.7% of $1,001.32 in Billed Charges for Rev 272 = $417.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL T4.3MM DIA 152.5MML,272,RC,,,,,,,,both,,,1001.3200,150.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,901.19,,,,,,,258.4400,1001.3200,percent of total billed charges,"90% of $1,001.32 in Billed Charges for Rev 272 = $901.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL T4.3MM DIA 152.5MML,272,RC,,,,,,,,both,,,1001.3200,150.2000,MEDCOST,MEDCOST VHN,476.53,,,,,,,258.4400,1001.3200,percent of total billed charges,"47.59% of $1,001.32 in Billed Charges for Rev 272 = $476.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL T4.3MM DIA 152.5MML,272,RC,,,,,,,,both,,,1001.3200,150.2000,SENTARA HEALTH,SENTARA HEALTH,258.44,,,,,,,258.4400,1001.3200,percent of total billed charges,"25.81% of $1,001.32 in Billed Charges for Rev 272 = $258.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL T4.3MM DIA 152.5MML,272,RC,,,,,,,,both,,,1001.3200,150.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1001.32,,,,,,,258.4400,1001.3200,percent of total billed charges,"100% of $1,001.32 in Billed Charges for Rev 272 = $1,001.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL T4.3MM DIA 152.5MML,272,RC,,,,,,,,both,,,1001.3200,150.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,500.66,,,,,,,258.4400,1001.3200,percent of total billed charges,"Rev 272 $1,001.32 in Billed Charges at 50% = $500.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL T4.3MM DIA 152.5MML,272,RC,,,,,,,,both,,,1001.3200,150.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,323.43,,,,,,,258.4400,1001.3200,other,"32.3% of $1,001.32 in Billed Charges for Rev 272 = $323.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL T4.3MM DIA 152.5MML,272,RC,,,,,,,,both,,,1001.3200,150.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,307.41,,,,,,,258.4400,1001.3200,other,"30.7% of $1,001.32 in Billed Charges for Rev 272 = $307.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL T4.3MM DIA 152.5MML,272,RC,,,,,,,,both,,,1001.3200,150.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,323.43,,,,,,,258.4400,1001.3200,percent of total billed charges,"32.3% of $1,001.32 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL T4.3MM DIA 152.5MML,272,RC,,,,,,,,both,,,1001.3200,150.2000,WELLCARE,WELLCARE MEDICAID,1001.32,,,,,,,258.4400,1001.3200,percent of total billed charges,"100% of $1,001.32 in Billed Charges for Rev 272 = $1,001.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL THREADED GUIDE WITH DEPTH GAUGE1.5MM,272,RC,,,,,,,,both,,,5416.1500,812.4200,AETNA,AETNA,2312.70,,,,,,,1397.9100,5416.1500,percent of total billed charges,"42.7% of $5,416.15 in Billed Charges for Rev 272 = $2,312.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL THREADED GUIDE WITH DEPTH GAUGE1.5MM,272,RC,,,,,,,,both,,,5416.1500,812.4200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3791.31,,,,,,,1397.9100,5416.1500,percent of total billed charges,"Rev 272 $5,416.15 in Billed Charges at 70% = $3,791.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL THREADED GUIDE WITH DEPTH GAUGE1.5MM,272,RC,,,,,,,,both,,,5416.1500,812.4200,CIGNA HEALTHCARE,CIGNA HMO,2258.53,,,,,,,1397.9100,5416.1500,percent of total billed charges,"41.7% of $5,416.15 in Billed Charges for Rev 272 = $2,258.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL THREADED GUIDE WITH DEPTH GAUGE1.5MM,272,RC,,,,,,,,both,,,5416.1500,812.4200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2513.09,,,,,,,1397.9100,5416.1500,percent of total billed charges,"46.4% of $5,416.15 in Billed Charges for Rev 272 = $2,513.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL THREADED GUIDE WITH DEPTH GAUGE1.5MM,272,RC,,,,,,,,both,,,5416.1500,812.4200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2258.53,,,,,,,1397.9100,5416.1500,percent of total billed charges,"41.7% of $5,416.15 in Billed Charges for Rev 272 = $2,258.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL THREADED GUIDE WITH DEPTH GAUGE1.5MM,272,RC,,,,,,,,both,,,5416.1500,812.4200,CIGNA HEALTHCARE,CIGNA PPO,2258.53,,,,,,,1397.9100,5416.1500,percent of total billed charges,"41.7% of $5,416.15 in Billed Charges for Rev 272 = $2,258.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL THREADED GUIDE WITH DEPTH GAUGE1.5MM,272,RC,,,,,,,,both,,,5416.1500,812.4200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4874.54,,,,,,,1397.9100,5416.1500,percent of total billed charges,"90% of $5,416.15 in Billed Charges for Rev 272 = $4,874.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL THREADED GUIDE WITH DEPTH GAUGE1.5MM,272,RC,,,,,,,,both,,,5416.1500,812.4200,MEDCOST,MEDCOST VHN,2577.55,,,,,,,1397.9100,5416.1500,percent of total billed charges,"47.59% of $5,416.15 in Billed Charges for Rev 272 = $2,577.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL THREADED GUIDE WITH DEPTH GAUGE1.5MM,272,RC,,,,,,,,both,,,5416.1500,812.4200,SENTARA HEALTH,SENTARA HEALTH,1397.91,,,,,,,1397.9100,5416.1500,percent of total billed charges,"25.81% of $5,416.15 in Billed Charges for Rev 272 = $1,397.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL THREADED GUIDE WITH DEPTH GAUGE1.5MM,272,RC,,,,,,,,both,,,5416.1500,812.4200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5416.15,,,,,,,1397.9100,5416.1500,percent of total billed charges,"100% of $5,416.15 in Billed Charges for Rev 272 = $5,416.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL THREADED GUIDE WITH DEPTH GAUGE1.5MM,272,RC,,,,,,,,both,,,5416.1500,812.4200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2708.08,,,,,,,1397.9100,5416.1500,percent of total billed charges,"Rev 272 $5,416.15 in Billed Charges at 50% = $2,708.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL THREADED GUIDE WITH DEPTH GAUGE1.5MM,272,RC,,,,,,,,both,,,5416.1500,812.4200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1749.42,,,,,,,1397.9100,5416.1500,other,"32.3% of $5,416.15 in Billed Charges for Rev 272 = $1,749.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL THREADED GUIDE WITH DEPTH GAUGE1.5MM,272,RC,,,,,,,,both,,,5416.1500,812.4200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1662.76,,,,,,,1397.9100,5416.1500,other,"30.7% of $5,416.15 in Billed Charges for Rev 272 = $1,662.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL THREADED GUIDE WITH DEPTH GAUGE1.5MM,272,RC,,,,,,,,both,,,5416.1500,812.4200,UNITED HEALTHCARE,UNITED HEALTHCARE,1749.42,,,,,,,1397.9100,5416.1500,percent of total billed charges,"32.3% of $5,416.15 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL THREADED GUIDE WITH DEPTH GAUGE1.5MM,272,RC,,,,,,,,both,,,5416.1500,812.4200,WELLCARE,WELLCARE MEDICAID,5416.15,,,,,,,1397.9100,5416.1500,percent of total billed charges,"100% of $5,416.15 in Billed Charges for Rev 272 = $5,416.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 4.2MM XTR-LG,272,RC,27200002,CDM,,,,,,both,,,2633.2000,394.9800,AETNA,AETNA,1124.38,,,,,,,679.6300,2633.2000,percent of total billed charges,"42.7% of $2,633.20 in Billed Charges for Rev 272 = $1,124.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 4.2MM XTR-LG,272,RC,27200002,CDM,,,,,,both,,,2633.2000,394.9800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1843.24,,,,,,,679.6300,2633.2000,percent of total billed charges,"Rev 272 $2,633.20 in Billed Charges at 70% = $1,843.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 4.2MM XTR-LG,272,RC,27200002,CDM,,,,,,both,,,2633.2000,394.9800,CIGNA HEALTHCARE,CIGNA HMO,1098.04,,,,,,,679.6300,2633.2000,percent of total billed charges,"41.7% of $2,633.20 in Billed Charges for Rev 272 = $1,098.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 4.2MM XTR-LG,272,RC,27200002,CDM,,,,,,both,,,2633.2000,394.9800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1221.80,,,,,,,679.6300,2633.2000,percent of total billed charges,"46.4% of $2,633.20 in Billed Charges for Rev 272 = $1,221.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 4.2MM XTR-LG,272,RC,27200002,CDM,,,,,,both,,,2633.2000,394.9800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1098.04,,,,,,,679.6300,2633.2000,percent of total billed charges,"41.7% of $2,633.20 in Billed Charges for Rev 272 = $1,098.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 4.2MM XTR-LG,272,RC,27200002,CDM,,,,,,both,,,2633.2000,394.9800,CIGNA HEALTHCARE,CIGNA PPO,1098.04,,,,,,,679.6300,2633.2000,percent of total billed charges,"41.7% of $2,633.20 in Billed Charges for Rev 272 = $1,098.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 4.2MM XTR-LG,272,RC,27200002,CDM,,,,,,both,,,2633.2000,394.9800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2369.88,,,,,,,679.6300,2633.2000,percent of total billed charges,"90% of $2,633.20 in Billed Charges for Rev 272 = $2,369.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 4.2MM XTR-LG,272,RC,27200002,CDM,,,,,,both,,,2633.2000,394.9800,MEDCOST,MEDCOST VHN,1253.14,,,,,,,679.6300,2633.2000,percent of total billed charges,"47.59% of $2,633.20 in Billed Charges for Rev 272 = $1,253.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 4.2MM XTR-LG,272,RC,27200002,CDM,,,,,,both,,,2633.2000,394.9800,SENTARA HEALTH,SENTARA HEALTH,679.63,,,,,,,679.6300,2633.2000,percent of total billed charges,"25.81% of $2,633.20 in Billed Charges for Rev 272 = $679.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 4.2MM XTR-LG,272,RC,27200002,CDM,,,,,,both,,,2633.2000,394.9800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2633.20,,,,,,,679.6300,2633.2000,percent of total billed charges,"100% of $2,633.20 in Billed Charges for Rev 272 = $2,633.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 4.2MM XTR-LG,272,RC,27200002,CDM,,,,,,both,,,2633.2000,394.9800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1316.60,,,,,,,679.6300,2633.2000,percent of total billed charges,"Rev 272 $2,633.20 in Billed Charges at 50% = $1,316.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 4.2MM XTR-LG,272,RC,27200002,CDM,,,,,,both,,,2633.2000,394.9800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,850.52,,,,,,,679.6300,2633.2000,other,"32.3% of $2,633.20 in Billed Charges for Rev 272 = $850.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CALIBRATED 4.2MM XTR-LG,272,RC,27200002,CDM,,,,,,both,,,2633.2000,394.9800,UNITED HEALTHCARE,UHC HERITAGE SELECT,808.39,,,,,,,679.6300,2633.2000,other,"30.7% of $2,633.20 in Billed Charges for Rev 272 = $808.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CALIBRATED 4.2MM XTR-LG,272,RC,27200002,CDM,,,,,,both,,,2633.2000,394.9800,UNITED HEALTHCARE,UNITED HEALTHCARE,850.52,,,,,,,679.6300,2633.2000,percent of total billed charges,"32.3% of $2,633.20 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 4.2MM XTR-LG,272,RC,27200002,CDM,,,,,,both,,,2633.2000,394.9800,WELLCARE,WELLCARE MEDICAID,2633.20,,,,,,,679.6300,2633.2000,percent of total billed charges,"100% of $2,633.20 in Billed Charges for Rev 272 = $2,633.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CAN 11MM 360.06,272,RC,,,,,,,,both,,,5180.1100,777.0200,AETNA,AETNA,2211.91,,,,,,,1336.9900,5180.1100,percent of total billed charges,"42.7% of $5,180.11 in Billed Charges for Rev 272 = $2,211.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CAN 11MM 360.06,272,RC,,,,,,,,both,,,5180.1100,777.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3626.08,,,,,,,1336.9900,5180.1100,percent of total billed charges,"Rev 272 $5,180.11 in Billed Charges at 70% = $3,626.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CAN 11MM 360.06,272,RC,,,,,,,,both,,,5180.1100,777.0200,CIGNA HEALTHCARE,CIGNA HMO,2160.11,,,,,,,1336.9900,5180.1100,percent of total billed charges,"41.7% of $5,180.11 in Billed Charges for Rev 272 = $2,160.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CAN 11MM 360.06,272,RC,,,,,,,,both,,,5180.1100,777.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2403.57,,,,,,,1336.9900,5180.1100,percent of total billed charges,"46.4% of $5,180.11 in Billed Charges for Rev 272 = $2,403.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CAN 11MM 360.06,272,RC,,,,,,,,both,,,5180.1100,777.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2160.11,,,,,,,1336.9900,5180.1100,percent of total billed charges,"41.7% of $5,180.11 in Billed Charges for Rev 272 = $2,160.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CAN 11MM 360.06,272,RC,,,,,,,,both,,,5180.1100,777.0200,CIGNA HEALTHCARE,CIGNA PPO,2160.11,,,,,,,1336.9900,5180.1100,percent of total billed charges,"41.7% of $5,180.11 in Billed Charges for Rev 272 = $2,160.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CAN 11MM 360.06,272,RC,,,,,,,,both,,,5180.1100,777.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4662.10,,,,,,,1336.9900,5180.1100,percent of total billed charges,"90% of $5,180.11 in Billed Charges for Rev 272 = $4,662.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CAN 11MM 360.06,272,RC,,,,,,,,both,,,5180.1100,777.0200,MEDCOST,MEDCOST VHN,2465.21,,,,,,,1336.9900,5180.1100,percent of total billed charges,"47.59% of $5,180.11 in Billed Charges for Rev 272 = $2,465.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CAN 11MM 360.06,272,RC,,,,,,,,both,,,5180.1100,777.0200,SENTARA HEALTH,SENTARA HEALTH,1336.99,,,,,,,1336.9900,5180.1100,percent of total billed charges,"25.81% of $5,180.11 in Billed Charges for Rev 272 = $1,336.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CAN 11MM 360.06,272,RC,,,,,,,,both,,,5180.1100,777.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5180.11,,,,,,,1336.9900,5180.1100,percent of total billed charges,"100% of $5,180.11 in Billed Charges for Rev 272 = $5,180.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CAN 11MM 360.06,272,RC,,,,,,,,both,,,5180.1100,777.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2590.06,,,,,,,1336.9900,5180.1100,percent of total billed charges,"Rev 272 $5,180.11 in Billed Charges at 50% = $2,590.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CAN 11MM 360.06,272,RC,,,,,,,,both,,,5180.1100,777.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1673.18,,,,,,,1336.9900,5180.1100,other,"32.3% of $5,180.11 in Billed Charges for Rev 272 = $1,673.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CAN 11MM 360.06,272,RC,,,,,,,,both,,,5180.1100,777.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1590.29,,,,,,,1336.9900,5180.1100,other,"30.7% of $5,180.11 in Billed Charges for Rev 272 = $1,590.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CAN 11MM 360.06,272,RC,,,,,,,,both,,,5180.1100,777.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,1673.18,,,,,,,1336.9900,5180.1100,percent of total billed charges,"32.3% of $5,180.11 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CAN 11MM 360.06,272,RC,,,,,,,,both,,,5180.1100,777.0200,WELLCARE,WELLCARE MEDICAID,5180.11,,,,,,,1336.9900,5180.1100,percent of total billed charges,"100% of $5,180.11 in Billed Charges for Rev 272 = $5,180.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X6MM 317.875,272,RC,,,,,,,,both,,,1915.8300,287.3700,AETNA,AETNA,818.06,,,,,,,494.4800,1915.8300,percent of total billed charges,"42.7% of $1,915.83 in Billed Charges for Rev 272 = $818.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X6MM 317.875,272,RC,,,,,,,,both,,,1915.8300,287.3700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1341.08,,,,,,,494.4800,1915.8300,percent of total billed charges,"Rev 272 $1,915.83 in Billed Charges at 70% = $1,341.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X6MM 317.875,272,RC,,,,,,,,both,,,1915.8300,287.3700,CIGNA HEALTHCARE,CIGNA HMO,798.90,,,,,,,494.4800,1915.8300,percent of total billed charges,"41.7% of $1,915.83 in Billed Charges for Rev 272 = $798.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X6MM 317.875,272,RC,,,,,,,,both,,,1915.8300,287.3700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,888.95,,,,,,,494.4800,1915.8300,percent of total billed charges,"46.4% of $1,915.83 in Billed Charges for Rev 272 = $888.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X6MM 317.875,272,RC,,,,,,,,both,,,1915.8300,287.3700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,798.90,,,,,,,494.4800,1915.8300,percent of total billed charges,"41.7% of $1,915.83 in Billed Charges for Rev 272 = $798.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X6MM 317.875,272,RC,,,,,,,,both,,,1915.8300,287.3700,CIGNA HEALTHCARE,CIGNA PPO,798.90,,,,,,,494.4800,1915.8300,percent of total billed charges,"41.7% of $1,915.83 in Billed Charges for Rev 272 = $798.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X6MM 317.875,272,RC,,,,,,,,both,,,1915.8300,287.3700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1724.25,,,,,,,494.4800,1915.8300,percent of total billed charges,"90% of $1,915.83 in Billed Charges for Rev 272 = $1,724.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X6MM 317.875,272,RC,,,,,,,,both,,,1915.8300,287.3700,MEDCOST,MEDCOST VHN,911.74,,,,,,,494.4800,1915.8300,percent of total billed charges,"47.59% of $1,915.83 in Billed Charges for Rev 272 = $911.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X6MM 317.875,272,RC,,,,,,,,both,,,1915.8300,287.3700,SENTARA HEALTH,SENTARA HEALTH,494.48,,,,,,,494.4800,1915.8300,percent of total billed charges,"25.81% of $1,915.83 in Billed Charges for Rev 272 = $494.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X6MM 317.875,272,RC,,,,,,,,both,,,1915.8300,287.3700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1915.83,,,,,,,494.4800,1915.8300,percent of total billed charges,"100% of $1,915.83 in Billed Charges for Rev 272 = $1,915.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X6MM 317.875,272,RC,,,,,,,,both,,,1915.8300,287.3700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,957.92,,,,,,,494.4800,1915.8300,percent of total billed charges,"Rev 272 $1,915.83 in Billed Charges at 50% = $957.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X6MM 317.875,272,RC,,,,,,,,both,,,1915.8300,287.3700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,618.81,,,,,,,494.4800,1915.8300,other,"32.3% of $1,915.83 in Billed Charges for Rev 272 = $618.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL TROC 1.5X6MM 317.875,272,RC,,,,,,,,both,,,1915.8300,287.3700,UNITED HEALTHCARE,UHC HERITAGE SELECT,588.16,,,,,,,494.4800,1915.8300,other,"30.7% of $1,915.83 in Billed Charges for Rev 272 = $588.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL TROC 1.5X6MM 317.875,272,RC,,,,,,,,both,,,1915.8300,287.3700,UNITED HEALTHCARE,UNITED HEALTHCARE,618.81,,,,,,,494.4800,1915.8300,percent of total billed charges,"32.3% of $1,915.83 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL TROC 1.5X6MM 317.875,272,RC,,,,,,,,both,,,1915.8300,287.3700,WELLCARE,WELLCARE MEDICAID,1915.83,,,,,,,494.4800,1915.8300,percent of total billed charges,"100% of $1,915.83 in Billed Charges for Rev 272 = $1,915.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 60MM SHORT 7053-60-10,272,RC,,,,,,,,both,,,5880.3600,882.0500,AETNA,AETNA,2510.91,,,,,,,1517.7200,5880.3600,percent of total billed charges,"42.7% of $5,880.36 in Billed Charges for Rev 272 = $2,510.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 60MM SHORT 7053-60-10,272,RC,,,,,,,,both,,,5880.3600,882.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4116.25,,,,,,,1517.7200,5880.3600,percent of total billed charges,"Rev 272 $5,880.36 in Billed Charges at 70% = $4,116.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 60MM SHORT 7053-60-10,272,RC,,,,,,,,both,,,5880.3600,882.0500,CIGNA HEALTHCARE,CIGNA HMO,2452.11,,,,,,,1517.7200,5880.3600,percent of total billed charges,"41.7% of $5,880.36 in Billed Charges for Rev 272 = $2,452.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 60MM SHORT 7053-60-10,272,RC,,,,,,,,both,,,5880.3600,882.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2728.49,,,,,,,1517.7200,5880.3600,percent of total billed charges,"46.4% of $5,880.36 in Billed Charges for Rev 272 = $2,728.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 60MM SHORT 7053-60-10,272,RC,,,,,,,,both,,,5880.3600,882.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2452.11,,,,,,,1517.7200,5880.3600,percent of total billed charges,"41.7% of $5,880.36 in Billed Charges for Rev 272 = $2,452.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 60MM SHORT 7053-60-10,272,RC,,,,,,,,both,,,5880.3600,882.0500,CIGNA HEALTHCARE,CIGNA PPO,2452.11,,,,,,,1517.7200,5880.3600,percent of total billed charges,"41.7% of $5,880.36 in Billed Charges for Rev 272 = $2,452.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 60MM SHORT 7053-60-10,272,RC,,,,,,,,both,,,5880.3600,882.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5292.32,,,,,,,1517.7200,5880.3600,percent of total billed charges,"90% of $5,880.36 in Billed Charges for Rev 272 = $5,292.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 60MM SHORT 7053-60-10,272,RC,,,,,,,,both,,,5880.3600,882.0500,MEDCOST,MEDCOST VHN,2798.46,,,,,,,1517.7200,5880.3600,percent of total billed charges,"47.59% of $5,880.36 in Billed Charges for Rev 272 = $2,798.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 60MM SHORT 7053-60-10,272,RC,,,,,,,,both,,,5880.3600,882.0500,SENTARA HEALTH,SENTARA HEALTH,1517.72,,,,,,,1517.7200,5880.3600,percent of total billed charges,"25.81% of $5,880.36 in Billed Charges for Rev 272 = $1,517.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 60MM SHORT 7053-60-10,272,RC,,,,,,,,both,,,5880.3600,882.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5880.36,,,,,,,1517.7200,5880.3600,percent of total billed charges,"100% of $5,880.36 in Billed Charges for Rev 272 = $5,880.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 60MM SHORT 7053-60-10,272,RC,,,,,,,,both,,,5880.3600,882.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2940.18,,,,,,,1517.7200,5880.3600,percent of total billed charges,"Rev 272 $5,880.36 in Billed Charges at 50% = $2,940.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 60MM SHORT 7053-60-10,272,RC,,,,,,,,both,,,5880.3600,882.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1899.36,,,,,,,1517.7200,5880.3600,other,"32.3% of $5,880.36 in Billed Charges for Rev 272 = $1,899.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE EXPLANT 60MM SHORT 7053-60-10,272,RC,,,,,,,,both,,,5880.3600,882.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1805.27,,,,,,,1517.7200,5880.3600,other,"30.7% of $5,880.36 in Billed Charges for Rev 272 = $1,805.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE EXPLANT 60MM SHORT 7053-60-10,272,RC,,,,,,,,both,,,5880.3600,882.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,1899.36,,,,,,,1517.7200,5880.3600,percent of total billed charges,"32.3% of $5,880.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 60MM SHORT 7053-60-10,272,RC,,,,,,,,both,,,5880.3600,882.0500,WELLCARE,WELLCARE MEDICAID,5880.36,,,,,,,1517.7200,5880.3600,percent of total billed charges,"100% of $5,880.36 in Billed Charges for Rev 272 = $5,880.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL JACOBS CHUCK 3.2 X 180MM,272,RC,,,,,,,,both,,,826.2600,123.9400,AETNA,AETNA,352.81,,,,,,,213.2600,826.2600,percent of total billed charges,42.7% of $826.26 in Billed Charges for Rev 272 = $352.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 180MM,272,RC,,,,,,,,both,,,826.2600,123.9400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,578.38,,,,,,,213.2600,826.2600,percent of total billed charges,Rev 272 $826.26 in Billed Charges at 70% = $578.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 180MM,272,RC,,,,,,,,both,,,826.2600,123.9400,CIGNA HEALTHCARE,CIGNA HMO,344.55,,,,,,,213.2600,826.2600,percent of total billed charges,41.7% of $826.26 in Billed Charges for Rev 272 = $344.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 180MM,272,RC,,,,,,,,both,,,826.2600,123.9400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,383.38,,,,,,,213.2600,826.2600,percent of total billed charges,46.4% of $826.26 in Billed Charges for Rev 272 = $383.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 180MM,272,RC,,,,,,,,both,,,826.2600,123.9400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,344.55,,,,,,,213.2600,826.2600,percent of total billed charges,41.7% of $826.26 in Billed Charges for Rev 272 = $344.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 180MM,272,RC,,,,,,,,both,,,826.2600,123.9400,CIGNA HEALTHCARE,CIGNA PPO,344.55,,,,,,,213.2600,826.2600,percent of total billed charges,41.7% of $826.26 in Billed Charges for Rev 272 = $344.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 180MM,272,RC,,,,,,,,both,,,826.2600,123.9400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,743.63,,,,,,,213.2600,826.2600,percent of total billed charges,90% of $826.26 in Billed Charges for Rev 272 = $743.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 180MM,272,RC,,,,,,,,both,,,826.2600,123.9400,MEDCOST,MEDCOST VHN,393.22,,,,,,,213.2600,826.2600,percent of total billed charges,47.59% of $826.26 in Billed Charges for Rev 272 = $393.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 180MM,272,RC,,,,,,,,both,,,826.2600,123.9400,SENTARA HEALTH,SENTARA HEALTH,213.26,,,,,,,213.2600,826.2600,percent of total billed charges,25.81% of $826.26 in Billed Charges for Rev 272 = $213.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 180MM,272,RC,,,,,,,,both,,,826.2600,123.9400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",826.26,,,,,,,213.2600,826.2600,percent of total billed charges,100% of $826.26 in Billed Charges for Rev 272 = $826.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 180MM,272,RC,,,,,,,,both,,,826.2600,123.9400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,413.13,,,,,,,213.2600,826.2600,percent of total billed charges,Rev 272 $826.26 in Billed Charges at 50% = $413.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 180MM,272,RC,,,,,,,,both,,,826.2600,123.9400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,266.88,,,,,,,213.2600,826.2600,other,32.3% of $826.26 in Billed Charges for Rev 272 = $266.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL JACOBS CHUCK 3.2 X 180MM,272,RC,,,,,,,,both,,,826.2600,123.9400,UNITED HEALTHCARE,UHC HERITAGE SELECT,253.66,,,,,,,213.2600,826.2600,other,30.7% of $826.26 in Billed Charges for Rev 272 = $253.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL JACOBS CHUCK 3.2 X 180MM,272,RC,,,,,,,,both,,,826.2600,123.9400,UNITED HEALTHCARE,UNITED HEALTHCARE,266.88,,,,,,,213.2600,826.2600,percent of total billed charges,32.3% of $826.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 180MM,272,RC,,,,,,,,both,,,826.2600,123.9400,WELLCARE,WELLCARE MEDICAID,826.26,,,,,,,213.2600,826.2600,percent of total billed charges,100% of $826.26 in Billed Charges for Rev 272 = $826.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL LARGE QUICK COUPLING 5.0 X 300MM,272,RC,27200002,CDM,,,,,,both,,,3695.5000,554.3300,AETNA,AETNA,1577.98,,,,,,,953.8100,3695.5000,percent of total billed charges,"42.7% of $3,695.50 in Billed Charges for Rev 272 = $1,577.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LARGE QUICK COUPLING 5.0 X 300MM,272,RC,27200002,CDM,,,,,,both,,,3695.5000,554.3300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2586.85,,,,,,,953.8100,3695.5000,percent of total billed charges,"Rev 272 $3,695.50 in Billed Charges at 70% = $2,586.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LARGE QUICK COUPLING 5.0 X 300MM,272,RC,27200002,CDM,,,,,,both,,,3695.5000,554.3300,CIGNA HEALTHCARE,CIGNA HMO,1541.02,,,,,,,953.8100,3695.5000,percent of total billed charges,"41.7% of $3,695.50 in Billed Charges for Rev 272 = $1,541.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LARGE QUICK COUPLING 5.0 X 300MM,272,RC,27200002,CDM,,,,,,both,,,3695.5000,554.3300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1714.71,,,,,,,953.8100,3695.5000,percent of total billed charges,"46.4% of $3,695.50 in Billed Charges for Rev 272 = $1,714.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LARGE QUICK COUPLING 5.0 X 300MM,272,RC,27200002,CDM,,,,,,both,,,3695.5000,554.3300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1541.02,,,,,,,953.8100,3695.5000,percent of total billed charges,"41.7% of $3,695.50 in Billed Charges for Rev 272 = $1,541.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LARGE QUICK COUPLING 5.0 X 300MM,272,RC,27200002,CDM,,,,,,both,,,3695.5000,554.3300,CIGNA HEALTHCARE,CIGNA PPO,1541.02,,,,,,,953.8100,3695.5000,percent of total billed charges,"41.7% of $3,695.50 in Billed Charges for Rev 272 = $1,541.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LARGE QUICK COUPLING 5.0 X 300MM,272,RC,27200002,CDM,,,,,,both,,,3695.5000,554.3300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3325.95,,,,,,,953.8100,3695.5000,percent of total billed charges,"90% of $3,695.50 in Billed Charges for Rev 272 = $3,325.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LARGE QUICK COUPLING 5.0 X 300MM,272,RC,27200002,CDM,,,,,,both,,,3695.5000,554.3300,MEDCOST,MEDCOST VHN,1758.69,,,,,,,953.8100,3695.5000,percent of total billed charges,"47.59% of $3,695.50 in Billed Charges for Rev 272 = $1,758.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LARGE QUICK COUPLING 5.0 X 300MM,272,RC,27200002,CDM,,,,,,both,,,3695.5000,554.3300,SENTARA HEALTH,SENTARA HEALTH,953.81,,,,,,,953.8100,3695.5000,percent of total billed charges,"25.81% of $3,695.50 in Billed Charges for Rev 272 = $953.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LARGE QUICK COUPLING 5.0 X 300MM,272,RC,27200002,CDM,,,,,,both,,,3695.5000,554.3300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3695.50,,,,,,,953.8100,3695.5000,percent of total billed charges,"100% of $3,695.50 in Billed Charges for Rev 272 = $3,695.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LARGE QUICK COUPLING 5.0 X 300MM,272,RC,27200002,CDM,,,,,,both,,,3695.5000,554.3300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1847.75,,,,,,,953.8100,3695.5000,percent of total billed charges,"Rev 272 $3,695.50 in Billed Charges at 50% = $1,847.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LARGE QUICK COUPLING 5.0 X 300MM,272,RC,27200002,CDM,,,,,,both,,,3695.5000,554.3300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1193.65,,,,,,,953.8100,3695.5000,other,"32.3% of $3,695.50 in Billed Charges for Rev 272 = $1,193.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL LARGE QUICK COUPLING 5.0 X 300MM,272,RC,27200002,CDM,,,,,,both,,,3695.5000,554.3300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1134.52,,,,,,,953.8100,3695.5000,other,"30.7% of $3,695.50 in Billed Charges for Rev 272 = $1,134.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL LARGE QUICK COUPLING 5.0 X 300MM,272,RC,27200002,CDM,,,,,,both,,,3695.5000,554.3300,UNITED HEALTHCARE,UNITED HEALTHCARE,1193.65,,,,,,,953.8100,3695.5000,percent of total billed charges,"32.3% of $3,695.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LARGE QUICK COUPLING 5.0 X 300MM,272,RC,27200002,CDM,,,,,,both,,,3695.5000,554.3300,WELLCARE,WELLCARE MEDICAID,3695.50,,,,,,,953.8100,3695.5000,percent of total billed charges,"100% of $3,695.50 in Billed Charges for Rev 272 = $3,695.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LOCKING MEDIUM 4.3 X 296MM 705078,272,RC,,,,,,,,both,,,2183.3000,327.5000,AETNA,AETNA,932.27,,,,,,,563.5100,2183.3000,percent of total billed charges,"42.7% of $2,183.30 in Billed Charges for Rev 272 = $932.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LOCKING MEDIUM 4.3 X 296MM 705078,272,RC,,,,,,,,both,,,2183.3000,327.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1528.31,,,,,,,563.5100,2183.3000,percent of total billed charges,"Rev 272 $2,183.30 in Billed Charges at 70% = $1,528.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LOCKING MEDIUM 4.3 X 296MM 705078,272,RC,,,,,,,,both,,,2183.3000,327.5000,CIGNA HEALTHCARE,CIGNA HMO,910.44,,,,,,,563.5100,2183.3000,percent of total billed charges,"41.7% of $2,183.30 in Billed Charges for Rev 272 = $910.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LOCKING MEDIUM 4.3 X 296MM 705078,272,RC,,,,,,,,both,,,2183.3000,327.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1013.05,,,,,,,563.5100,2183.3000,percent of total billed charges,"46.4% of $2,183.30 in Billed Charges for Rev 272 = $1,013.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LOCKING MEDIUM 4.3 X 296MM 705078,272,RC,,,,,,,,both,,,2183.3000,327.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,910.44,,,,,,,563.5100,2183.3000,percent of total billed charges,"41.7% of $2,183.30 in Billed Charges for Rev 272 = $910.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LOCKING MEDIUM 4.3 X 296MM 705078,272,RC,,,,,,,,both,,,2183.3000,327.5000,CIGNA HEALTHCARE,CIGNA PPO,910.44,,,,,,,563.5100,2183.3000,percent of total billed charges,"41.7% of $2,183.30 in Billed Charges for Rev 272 = $910.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LOCKING MEDIUM 4.3 X 296MM 705078,272,RC,,,,,,,,both,,,2183.3000,327.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1964.97,,,,,,,563.5100,2183.3000,percent of total billed charges,"90% of $2,183.30 in Billed Charges for Rev 272 = $1,964.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LOCKING MEDIUM 4.3 X 296MM 705078,272,RC,,,,,,,,both,,,2183.3000,327.5000,MEDCOST,MEDCOST VHN,1039.03,,,,,,,563.5100,2183.3000,percent of total billed charges,"47.59% of $2,183.30 in Billed Charges for Rev 272 = $1,039.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LOCKING MEDIUM 4.3 X 296MM 705078,272,RC,,,,,,,,both,,,2183.3000,327.5000,SENTARA HEALTH,SENTARA HEALTH,563.51,,,,,,,563.5100,2183.3000,percent of total billed charges,"25.81% of $2,183.30 in Billed Charges for Rev 272 = $563.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LOCKING MEDIUM 4.3 X 296MM 705078,272,RC,,,,,,,,both,,,2183.3000,327.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2183.30,,,,,,,563.5100,2183.3000,percent of total billed charges,"100% of $2,183.30 in Billed Charges for Rev 272 = $2,183.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LOCKING MEDIUM 4.3 X 296MM 705078,272,RC,,,,,,,,both,,,2183.3000,327.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1091.65,,,,,,,563.5100,2183.3000,percent of total billed charges,"Rev 272 $2,183.30 in Billed Charges at 50% = $1,091.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LOCKING MEDIUM 4.3 X 296MM 705078,272,RC,,,,,,,,both,,,2183.3000,327.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,705.21,,,,,,,563.5100,2183.3000,other,"32.3% of $2,183.30 in Billed Charges for Rev 272 = $705.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL LOCKING MEDIUM 4.3 X 296MM 705078,272,RC,,,,,,,,both,,,2183.3000,327.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,670.27,,,,,,,563.5100,2183.3000,other,"30.7% of $2,183.30 in Billed Charges for Rev 272 = $670.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL LOCKING MEDIUM 4.3 X 296MM 705078,272,RC,,,,,,,,both,,,2183.3000,327.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,705.21,,,,,,,563.5100,2183.3000,percent of total billed charges,"32.3% of $2,183.30 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LOCKING MEDIUM 4.3 X 296MM 705078,272,RC,,,,,,,,both,,,2183.3000,327.5000,WELLCARE,WELLCARE MEDICAID,2183.30,,,,,,,563.5100,2183.3000,percent of total billed charges,"100% of $2,183.30 in Billed Charges for Rev 272 = $2,183.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXTENDER NARROW 26MM SIGMA LTP,272,RC,27200002,CDM,,,,,,both,,,12160.0000,1824.0000,AETNA,AETNA,5192.32,,,,,,,3138.5000,12160.0000,percent of total billed charges,"42.7% of $12,160.00 in Billed Charges for Rev 272 = $5,192.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXTENDER NARROW 26MM SIGMA LTP,272,RC,27200002,CDM,,,,,,both,,,12160.0000,1824.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8512.00,,,,,,,3138.5000,12160.0000,percent of total billed charges,"Rev 272 $12,160.00 in Billed Charges at 70% = $8,512.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXTENDER NARROW 26MM SIGMA LTP,272,RC,27200002,CDM,,,,,,both,,,12160.0000,1824.0000,CIGNA HEALTHCARE,CIGNA HMO,5070.72,,,,,,,3138.5000,12160.0000,percent of total billed charges,"41.7% of $12,160.00 in Billed Charges for Rev 272 = $5,070.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXTENDER NARROW 26MM SIGMA LTP,272,RC,27200002,CDM,,,,,,both,,,12160.0000,1824.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5642.24,,,,,,,3138.5000,12160.0000,percent of total billed charges,"46.4% of $12,160.00 in Billed Charges for Rev 272 = $5,642.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXTENDER NARROW 26MM SIGMA LTP,272,RC,27200002,CDM,,,,,,both,,,12160.0000,1824.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5070.72,,,,,,,3138.5000,12160.0000,percent of total billed charges,"41.7% of $12,160.00 in Billed Charges for Rev 272 = $5,070.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXTENDER NARROW 26MM SIGMA LTP,272,RC,27200002,CDM,,,,,,both,,,12160.0000,1824.0000,CIGNA HEALTHCARE,CIGNA PPO,5070.72,,,,,,,3138.5000,12160.0000,percent of total billed charges,"41.7% of $12,160.00 in Billed Charges for Rev 272 = $5,070.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXTENDER NARROW 26MM SIGMA LTP,272,RC,27200002,CDM,,,,,,both,,,12160.0000,1824.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10944.00,,,,,,,3138.5000,12160.0000,percent of total billed charges,"90% of $12,160.00 in Billed Charges for Rev 272 = $10,944.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXTENDER NARROW 26MM SIGMA LTP,272,RC,27200002,CDM,,,,,,both,,,12160.0000,1824.0000,MEDCOST,MEDCOST VHN,5786.94,,,,,,,3138.5000,12160.0000,percent of total billed charges,"47.59% of $12,160.00 in Billed Charges for Rev 272 = $5,786.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXTENDER NARROW 26MM SIGMA LTP,272,RC,27200002,CDM,,,,,,both,,,12160.0000,1824.0000,SENTARA HEALTH,SENTARA HEALTH,3138.50,,,,,,,3138.5000,12160.0000,percent of total billed charges,"25.81% of $12,160.00 in Billed Charges for Rev 272 = $3,138.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXTENDER NARROW 26MM SIGMA LTP,272,RC,27200002,CDM,,,,,,both,,,12160.0000,1824.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12160.00,,,,,,,3138.5000,12160.0000,percent of total billed charges,"100% of $12,160.00 in Billed Charges for Rev 272 = $12,160.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXTENDER NARROW 26MM SIGMA LTP,272,RC,27200002,CDM,,,,,,both,,,12160.0000,1824.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6080.00,,,,,,,3138.5000,12160.0000,percent of total billed charges,"Rev 272 $12,160.00 in Billed Charges at 50% = $6,080.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXTENDER NARROW 26MM SIGMA LTP,272,RC,27200002,CDM,,,,,,both,,,12160.0000,1824.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3927.68,,,,,,,3138.5000,12160.0000,other,"32.3% of $12,160.00 in Billed Charges for Rev 272 = $3,927.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE EXTENDER NARROW 26MM SIGMA LTP,272,RC,27200002,CDM,,,,,,both,,,12160.0000,1824.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3733.12,,,,,,,3138.5000,12160.0000,other,"30.7% of $12,160.00 in Billed Charges for Rev 272 = $3,733.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE EXTENDER NARROW 26MM SIGMA LTP,272,RC,27200002,CDM,,,,,,both,,,12160.0000,1824.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,3927.68,,,,,,,3138.5000,12160.0000,percent of total billed charges,"32.3% of $12,160.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXTENDER NARROW 26MM SIGMA LTP,272,RC,27200002,CDM,,,,,,both,,,12160.0000,1824.0000,WELLCARE,WELLCARE MEDICAID,12160.00,,,,,,,3138.5000,12160.0000,percent of total billed charges,"100% of $12,160.00 in Billed Charges for Rev 272 = $12,160.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZOUT 48MM,272,RC,27200002,CDM,,,,,,both,,,11924.9900,1788.7500,AETNA,AETNA,5091.97,,,,,,,3077.8400,11924.9900,percent of total billed charges,"42.7% of $11,924.99 in Billed Charges for Rev 272 = $5,091.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZOUT 48MM,272,RC,27200002,CDM,,,,,,both,,,11924.9900,1788.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8347.49,,,,,,,3077.8400,11924.9900,percent of total billed charges,"Rev 272 $11,924.99 in Billed Charges at 70% = $8,347.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZOUT 48MM,272,RC,27200002,CDM,,,,,,both,,,11924.9900,1788.7500,CIGNA HEALTHCARE,CIGNA HMO,4972.72,,,,,,,3077.8400,11924.9900,percent of total billed charges,"41.7% of $11,924.99 in Billed Charges for Rev 272 = $4,972.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZOUT 48MM,272,RC,27200002,CDM,,,,,,both,,,11924.9900,1788.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5533.20,,,,,,,3077.8400,11924.9900,percent of total billed charges,"46.4% of $11,924.99 in Billed Charges for Rev 272 = $5,533.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZOUT 48MM,272,RC,27200002,CDM,,,,,,both,,,11924.9900,1788.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4972.72,,,,,,,3077.8400,11924.9900,percent of total billed charges,"41.7% of $11,924.99 in Billed Charges for Rev 272 = $4,972.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZOUT 48MM,272,RC,27200002,CDM,,,,,,both,,,11924.9900,1788.7500,CIGNA HEALTHCARE,CIGNA PPO,4972.72,,,,,,,3077.8400,11924.9900,percent of total billed charges,"41.7% of $11,924.99 in Billed Charges for Rev 272 = $4,972.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZOUT 48MM,272,RC,27200002,CDM,,,,,,both,,,11924.9900,1788.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10732.49,,,,,,,3077.8400,11924.9900,percent of total billed charges,"90% of $11,924.99 in Billed Charges for Rev 272 = $10,732.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZOUT 48MM,272,RC,27200002,CDM,,,,,,both,,,11924.9900,1788.7500,MEDCOST,MEDCOST VHN,5675.10,,,,,,,3077.8400,11924.9900,percent of total billed charges,"47.59% of $11,924.99 in Billed Charges for Rev 272 = $5,675.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZOUT 48MM,272,RC,27200002,CDM,,,,,,both,,,11924.9900,1788.7500,SENTARA HEALTH,SENTARA HEALTH,3077.84,,,,,,,3077.8400,11924.9900,percent of total billed charges,"25.81% of $11,924.99 in Billed Charges for Rev 272 = $3,077.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZOUT 48MM,272,RC,27200002,CDM,,,,,,both,,,11924.9900,1788.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11924.99,,,,,,,3077.8400,11924.9900,percent of total billed charges,"100% of $11,924.99 in Billed Charges for Rev 272 = $11,924.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZOUT 48MM,272,RC,27200002,CDM,,,,,,both,,,11924.9900,1788.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5962.50,,,,,,,3077.8400,11924.9900,percent of total billed charges,"Rev 272 $11,924.99 in Billed Charges at 50% = $5,962.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZOUT 48MM,272,RC,27200002,CDM,,,,,,both,,,11924.9900,1788.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3851.77,,,,,,,3077.8400,11924.9900,other,"32.3% of $11,924.99 in Billed Charges for Rev 272 = $3,851.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE EZOUT 48MM,272,RC,27200002,CDM,,,,,,both,,,11924.9900,1788.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3660.97,,,,,,,3077.8400,11924.9900,other,"30.7% of $11,924.99 in Billed Charges for Rev 272 = $3,660.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE EZOUT 48MM,272,RC,27200002,CDM,,,,,,both,,,11924.9900,1788.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,3851.77,,,,,,,3077.8400,11924.9900,percent of total billed charges,"32.3% of $11,924.99 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EZOUT 48MM,272,RC,27200002,CDM,,,,,,both,,,11924.9900,1788.7500,WELLCARE,WELLCARE MEDICAID,11924.99,,,,,,,3077.8400,11924.9900,percent of total billed charges,"100% of $11,924.99 in Billed Charges for Rev 272 = $11,924.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 4.7MM,272,RC,,,,,,,,both,,,5061.0500,759.1600,AETNA,AETNA,2161.07,,,,,,,1306.2600,5061.0500,percent of total billed charges,"42.7% of $5,061.05 in Billed Charges for Rev 272 = $2,161.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 4.7MM,272,RC,,,,,,,,both,,,5061.0500,759.1600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3542.74,,,,,,,1306.2600,5061.0500,percent of total billed charges,"Rev 272 $5,061.05 in Billed Charges at 70% = $3,542.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 4.7MM,272,RC,,,,,,,,both,,,5061.0500,759.1600,CIGNA HEALTHCARE,CIGNA HMO,2110.46,,,,,,,1306.2600,5061.0500,percent of total billed charges,"41.7% of $5,061.05 in Billed Charges for Rev 272 = $2,110.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 4.7MM,272,RC,,,,,,,,both,,,5061.0500,759.1600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2348.33,,,,,,,1306.2600,5061.0500,percent of total billed charges,"46.4% of $5,061.05 in Billed Charges for Rev 272 = $2,348.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 4.7MM,272,RC,,,,,,,,both,,,5061.0500,759.1600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2110.46,,,,,,,1306.2600,5061.0500,percent of total billed charges,"41.7% of $5,061.05 in Billed Charges for Rev 272 = $2,110.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 4.7MM,272,RC,,,,,,,,both,,,5061.0500,759.1600,CIGNA HEALTHCARE,CIGNA PPO,2110.46,,,,,,,1306.2600,5061.0500,percent of total billed charges,"41.7% of $5,061.05 in Billed Charges for Rev 272 = $2,110.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 4.7MM,272,RC,,,,,,,,both,,,5061.0500,759.1600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4554.95,,,,,,,1306.2600,5061.0500,percent of total billed charges,"90% of $5,061.05 in Billed Charges for Rev 272 = $4,554.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 4.7MM,272,RC,,,,,,,,both,,,5061.0500,759.1600,MEDCOST,MEDCOST VHN,2408.55,,,,,,,1306.2600,5061.0500,percent of total billed charges,"47.59% of $5,061.05 in Billed Charges for Rev 272 = $2,408.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 4.7MM,272,RC,,,,,,,,both,,,5061.0500,759.1600,SENTARA HEALTH,SENTARA HEALTH,1306.26,,,,,,,1306.2600,5061.0500,percent of total billed charges,"25.81% of $5,061.05 in Billed Charges for Rev 272 = $1,306.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 4.7MM,272,RC,,,,,,,,both,,,5061.0500,759.1600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5061.05,,,,,,,1306.2600,5061.0500,percent of total billed charges,"100% of $5,061.05 in Billed Charges for Rev 272 = $5,061.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 4.7MM,272,RC,,,,,,,,both,,,5061.0500,759.1600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2530.53,,,,,,,1306.2600,5061.0500,percent of total billed charges,"Rev 272 $5,061.05 in Billed Charges at 50% = $2,530.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 4.7MM,272,RC,,,,,,,,both,,,5061.0500,759.1600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1634.72,,,,,,,1306.2600,5061.0500,other,"32.3% of $5,061.05 in Billed Charges for Rev 272 = $1,634.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL LONG 4.7MM,272,RC,,,,,,,,both,,,5061.0500,759.1600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1553.74,,,,,,,1306.2600,5061.0500,other,"30.7% of $5,061.05 in Billed Charges for Rev 272 = $1,553.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL LONG 4.7MM,272,RC,,,,,,,,both,,,5061.0500,759.1600,UNITED HEALTHCARE,UNITED HEALTHCARE,1634.72,,,,,,,1306.2600,5061.0500,percent of total billed charges,"32.3% of $5,061.05 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 4.7MM,272,RC,,,,,,,,both,,,5061.0500,759.1600,WELLCARE,WELLCARE MEDICAID,5061.05,,,,,,,1306.2600,5061.0500,percent of total billed charges,"100% of $5,061.05 in Billed Charges for Rev 272 = $5,061.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG SPINE 2.4MM,272,RC,,,,,,,,both,,,1724.1800,258.6300,AETNA,AETNA,736.22,,,,,,,445.0100,1724.1800,percent of total billed charges,"42.7% of $1,724.18 in Billed Charges for Rev 272 = $736.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG SPINE 2.4MM,272,RC,,,,,,,,both,,,1724.1800,258.6300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1206.93,,,,,,,445.0100,1724.1800,percent of total billed charges,"Rev 272 $1,724.18 in Billed Charges at 70% = $1,206.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG SPINE 2.4MM,272,RC,,,,,,,,both,,,1724.1800,258.6300,CIGNA HEALTHCARE,CIGNA HMO,718.98,,,,,,,445.0100,1724.1800,percent of total billed charges,"41.7% of $1,724.18 in Billed Charges for Rev 272 = $718.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG SPINE 2.4MM,272,RC,,,,,,,,both,,,1724.1800,258.6300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,800.02,,,,,,,445.0100,1724.1800,percent of total billed charges,"46.4% of $1,724.18 in Billed Charges for Rev 272 = $800.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG SPINE 2.4MM,272,RC,,,,,,,,both,,,1724.1800,258.6300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,718.98,,,,,,,445.0100,1724.1800,percent of total billed charges,"41.7% of $1,724.18 in Billed Charges for Rev 272 = $718.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG SPINE 2.4MM,272,RC,,,,,,,,both,,,1724.1800,258.6300,CIGNA HEALTHCARE,CIGNA PPO,718.98,,,,,,,445.0100,1724.1800,percent of total billed charges,"41.7% of $1,724.18 in Billed Charges for Rev 272 = $718.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG SPINE 2.4MM,272,RC,,,,,,,,both,,,1724.1800,258.6300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1551.76,,,,,,,445.0100,1724.1800,percent of total billed charges,"90% of $1,724.18 in Billed Charges for Rev 272 = $1,551.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG SPINE 2.4MM,272,RC,,,,,,,,both,,,1724.1800,258.6300,MEDCOST,MEDCOST VHN,820.54,,,,,,,445.0100,1724.1800,percent of total billed charges,"47.59% of $1,724.18 in Billed Charges for Rev 272 = $820.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG SPINE 2.4MM,272,RC,,,,,,,,both,,,1724.1800,258.6300,SENTARA HEALTH,SENTARA HEALTH,445.01,,,,,,,445.0100,1724.1800,percent of total billed charges,"25.81% of $1,724.18 in Billed Charges for Rev 272 = $445.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG SPINE 2.4MM,272,RC,,,,,,,,both,,,1724.1800,258.6300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1724.18,,,,,,,445.0100,1724.1800,percent of total billed charges,"100% of $1,724.18 in Billed Charges for Rev 272 = $1,724.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG SPINE 2.4MM,272,RC,,,,,,,,both,,,1724.1800,258.6300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,862.09,,,,,,,445.0100,1724.1800,percent of total billed charges,"Rev 272 $1,724.18 in Billed Charges at 50% = $862.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG SPINE 2.4MM,272,RC,,,,,,,,both,,,1724.1800,258.6300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,556.91,,,,,,,445.0100,1724.1800,other,"32.3% of $1,724.18 in Billed Charges for Rev 272 = $556.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL LONG SPINE 2.4MM,272,RC,,,,,,,,both,,,1724.1800,258.6300,UNITED HEALTHCARE,UHC HERITAGE SELECT,529.32,,,,,,,445.0100,1724.1800,other,"30.7% of $1,724.18 in Billed Charges for Rev 272 = $529.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL LONG SPINE 2.4MM,272,RC,,,,,,,,both,,,1724.1800,258.6300,UNITED HEALTHCARE,UNITED HEALTHCARE,556.91,,,,,,,445.0100,1724.1800,percent of total billed charges,"32.3% of $1,724.18 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG SPINE 2.4MM,272,RC,,,,,,,,both,,,1724.1800,258.6300,WELLCARE,WELLCARE MEDICAID,1724.18,,,,,,,445.0100,1724.1800,percent of total billed charges,"100% of $1,724.18 in Billed Charges for Rev 272 = $1,724.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REAMER DYNAFORCE 3.2 MM,272,RC,27200002,CDM,,,,,,both,,,1931.3900,289.7100,AETNA,AETNA,824.70,,,,,,,498.4900,1931.3900,percent of total billed charges,"42.7% of $1,931.39 in Billed Charges for Rev 272 = $824.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REAMER DYNAFORCE 3.2 MM,272,RC,27200002,CDM,,,,,,both,,,1931.3900,289.7100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1351.97,,,,,,,498.4900,1931.3900,percent of total billed charges,"Rev 272 $1,931.39 in Billed Charges at 70% = $1,351.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REAMER DYNAFORCE 3.2 MM,272,RC,27200002,CDM,,,,,,both,,,1931.3900,289.7100,CIGNA HEALTHCARE,CIGNA HMO,805.39,,,,,,,498.4900,1931.3900,percent of total billed charges,"41.7% of $1,931.39 in Billed Charges for Rev 272 = $805.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REAMER DYNAFORCE 3.2 MM,272,RC,27200002,CDM,,,,,,both,,,1931.3900,289.7100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,896.17,,,,,,,498.4900,1931.3900,percent of total billed charges,"46.4% of $1,931.39 in Billed Charges for Rev 272 = $896.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REAMER DYNAFORCE 3.2 MM,272,RC,27200002,CDM,,,,,,both,,,1931.3900,289.7100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,805.39,,,,,,,498.4900,1931.3900,percent of total billed charges,"41.7% of $1,931.39 in Billed Charges for Rev 272 = $805.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REAMER DYNAFORCE 3.2 MM,272,RC,27200002,CDM,,,,,,both,,,1931.3900,289.7100,CIGNA HEALTHCARE,CIGNA PPO,805.39,,,,,,,498.4900,1931.3900,percent of total billed charges,"41.7% of $1,931.39 in Billed Charges for Rev 272 = $805.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REAMER DYNAFORCE 3.2 MM,272,RC,27200002,CDM,,,,,,both,,,1931.3900,289.7100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1738.25,,,,,,,498.4900,1931.3900,percent of total billed charges,"90% of $1,931.39 in Billed Charges for Rev 272 = $1,738.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REAMER DYNAFORCE 3.2 MM,272,RC,27200002,CDM,,,,,,both,,,1931.3900,289.7100,MEDCOST,MEDCOST VHN,919.15,,,,,,,498.4900,1931.3900,percent of total billed charges,"47.59% of $1,931.39 in Billed Charges for Rev 272 = $919.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REAMER DYNAFORCE 3.2 MM,272,RC,27200002,CDM,,,,,,both,,,1931.3900,289.7100,SENTARA HEALTH,SENTARA HEALTH,498.49,,,,,,,498.4900,1931.3900,percent of total billed charges,"25.81% of $1,931.39 in Billed Charges for Rev 272 = $498.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REAMER DYNAFORCE 3.2 MM,272,RC,27200002,CDM,,,,,,both,,,1931.3900,289.7100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1931.39,,,,,,,498.4900,1931.3900,percent of total billed charges,"100% of $1,931.39 in Billed Charges for Rev 272 = $1,931.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REAMER DYNAFORCE 3.2 MM,272,RC,27200002,CDM,,,,,,both,,,1931.3900,289.7100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,965.70,,,,,,,498.4900,1931.3900,percent of total billed charges,"Rev 272 $1,931.39 in Billed Charges at 50% = $965.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REAMER DYNAFORCE 3.2 MM,272,RC,27200002,CDM,,,,,,both,,,1931.3900,289.7100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,623.84,,,,,,,498.4900,1931.3900,other,"32.3% of $1,931.39 in Billed Charges for Rev 272 = $623.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL REAMER DYNAFORCE 3.2 MM,272,RC,27200002,CDM,,,,,,both,,,1931.3900,289.7100,UNITED HEALTHCARE,UHC HERITAGE SELECT,592.94,,,,,,,498.4900,1931.3900,other,"30.7% of $1,931.39 in Billed Charges for Rev 272 = $592.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL REAMER DYNAFORCE 3.2 MM,272,RC,27200002,CDM,,,,,,both,,,1931.3900,289.7100,UNITED HEALTHCARE,UNITED HEALTHCARE,623.84,,,,,,,498.4900,1931.3900,percent of total billed charges,"32.3% of $1,931.39 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REAMER DYNAFORCE 3.2 MM,272,RC,27200002,CDM,,,,,,both,,,1931.3900,289.7100,WELLCARE,WELLCARE MEDICAID,1931.39,,,,,,,498.4900,1931.3900,percent of total billed charges,"100% of $1,931.39 in Billed Charges for Rev 272 = $1,931.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REVERSE 2.5MM,272,RC,,,,,,,,both,,,1605.4300,240.8100,AETNA,AETNA,685.52,,,,,,,414.3600,1605.4300,percent of total billed charges,"42.7% of $1,605.43 in Billed Charges for Rev 272 = $685.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REVERSE 2.5MM,272,RC,,,,,,,,both,,,1605.4300,240.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1123.80,,,,,,,414.3600,1605.4300,percent of total billed charges,"Rev 272 $1,605.43 in Billed Charges at 70% = $1,123.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REVERSE 2.5MM,272,RC,,,,,,,,both,,,1605.4300,240.8100,CIGNA HEALTHCARE,CIGNA HMO,669.46,,,,,,,414.3600,1605.4300,percent of total billed charges,"41.7% of $1,605.43 in Billed Charges for Rev 272 = $669.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REVERSE 2.5MM,272,RC,,,,,,,,both,,,1605.4300,240.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,744.92,,,,,,,414.3600,1605.4300,percent of total billed charges,"46.4% of $1,605.43 in Billed Charges for Rev 272 = $744.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REVERSE 2.5MM,272,RC,,,,,,,,both,,,1605.4300,240.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,669.46,,,,,,,414.3600,1605.4300,percent of total billed charges,"41.7% of $1,605.43 in Billed Charges for Rev 272 = $669.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REVERSE 2.5MM,272,RC,,,,,,,,both,,,1605.4300,240.8100,CIGNA HEALTHCARE,CIGNA PPO,669.46,,,,,,,414.3600,1605.4300,percent of total billed charges,"41.7% of $1,605.43 in Billed Charges for Rev 272 = $669.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REVERSE 2.5MM,272,RC,,,,,,,,both,,,1605.4300,240.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1444.89,,,,,,,414.3600,1605.4300,percent of total billed charges,"90% of $1,605.43 in Billed Charges for Rev 272 = $1,444.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REVERSE 2.5MM,272,RC,,,,,,,,both,,,1605.4300,240.8100,MEDCOST,MEDCOST VHN,764.02,,,,,,,414.3600,1605.4300,percent of total billed charges,"47.59% of $1,605.43 in Billed Charges for Rev 272 = $764.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REVERSE 2.5MM,272,RC,,,,,,,,both,,,1605.4300,240.8100,SENTARA HEALTH,SENTARA HEALTH,414.36,,,,,,,414.3600,1605.4300,percent of total billed charges,"25.81% of $1,605.43 in Billed Charges for Rev 272 = $414.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REVERSE 2.5MM,272,RC,,,,,,,,both,,,1605.4300,240.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1605.43,,,,,,,414.3600,1605.4300,percent of total billed charges,"100% of $1,605.43 in Billed Charges for Rev 272 = $1,605.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REVERSE 2.5MM,272,RC,,,,,,,,both,,,1605.4300,240.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,802.72,,,,,,,414.3600,1605.4300,percent of total billed charges,"Rev 272 $1,605.43 in Billed Charges at 50% = $802.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REVERSE 2.5MM,272,RC,,,,,,,,both,,,1605.4300,240.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,518.55,,,,,,,414.3600,1605.4300,other,"32.3% of $1,605.43 in Billed Charges for Rev 272 = $518.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL REVERSE 2.5MM,272,RC,,,,,,,,both,,,1605.4300,240.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,492.87,,,,,,,414.3600,1605.4300,other,"30.7% of $1,605.43 in Billed Charges for Rev 272 = $492.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL REVERSE 2.5MM,272,RC,,,,,,,,both,,,1605.4300,240.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,518.55,,,,,,,414.3600,1605.4300,percent of total billed charges,"32.3% of $1,605.43 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL REVERSE 2.5MM,272,RC,,,,,,,,both,,,1605.4300,240.8100,WELLCARE,WELLCARE MEDICAID,1605.43,,,,,,,414.3600,1605.4300,percent of total billed charges,"100% of $1,605.43 in Billed Charges for Rev 272 = $1,605.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHAVER ANGLED AGGR + 4.0,272,RC,27200002,CDM,,,,,,both,,,800.6400,120.1000,AETNA,AETNA,341.87,,,,,,,206.6500,800.6400,percent of total billed charges,42.7% of $800.64 in Billed Charges for Rev 272 = $341.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER ANGLED AGGR + 4.0,272,RC,27200002,CDM,,,,,,both,,,800.6400,120.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,560.45,,,,,,,206.6500,800.6400,percent of total billed charges,Rev 272 $800.64 in Billed Charges at 70% = $560.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER ANGLED AGGR + 4.0,272,RC,27200002,CDM,,,,,,both,,,800.6400,120.1000,CIGNA HEALTHCARE,CIGNA HMO,333.87,,,,,,,206.6500,800.6400,percent of total billed charges,41.7% of $800.64 in Billed Charges for Rev 272 = $333.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER ANGLED AGGR + 4.0,272,RC,27200002,CDM,,,,,,both,,,800.6400,120.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,371.50,,,,,,,206.6500,800.6400,percent of total billed charges,46.4% of $800.64 in Billed Charges for Rev 272 = $371.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER ANGLED AGGR + 4.0,272,RC,27200002,CDM,,,,,,both,,,800.6400,120.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,333.87,,,,,,,206.6500,800.6400,percent of total billed charges,41.7% of $800.64 in Billed Charges for Rev 272 = $333.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER ANGLED AGGR + 4.0,272,RC,27200002,CDM,,,,,,both,,,800.6400,120.1000,CIGNA HEALTHCARE,CIGNA PPO,333.87,,,,,,,206.6500,800.6400,percent of total billed charges,41.7% of $800.64 in Billed Charges for Rev 272 = $333.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER ANGLED AGGR + 4.0,272,RC,27200002,CDM,,,,,,both,,,800.6400,120.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,720.58,,,,,,,206.6500,800.6400,percent of total billed charges,90% of $800.64 in Billed Charges for Rev 272 = $720.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER ANGLED AGGR + 4.0,272,RC,27200002,CDM,,,,,,both,,,800.6400,120.1000,MEDCOST,MEDCOST VHN,381.02,,,,,,,206.6500,800.6400,percent of total billed charges,47.59% of $800.64 in Billed Charges for Rev 272 = $381.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER ANGLED AGGR + 4.0,272,RC,27200002,CDM,,,,,,both,,,800.6400,120.1000,SENTARA HEALTH,SENTARA HEALTH,206.65,,,,,,,206.6500,800.6400,percent of total billed charges,25.81% of $800.64 in Billed Charges for Rev 272 = $206.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER ANGLED AGGR + 4.0,272,RC,27200002,CDM,,,,,,both,,,800.6400,120.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",800.64,,,,,,,206.6500,800.6400,percent of total billed charges,100% of $800.64 in Billed Charges for Rev 272 = $800.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER ANGLED AGGR + 4.0,272,RC,27200002,CDM,,,,,,both,,,800.6400,120.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,400.32,,,,,,,206.6500,800.6400,percent of total billed charges,Rev 272 $800.64 in Billed Charges at 50% = $400.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER ANGLED AGGR + 4.0,272,RC,27200002,CDM,,,,,,both,,,800.6400,120.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,258.61,,,,,,,206.6500,800.6400,other,32.3% of $800.64 in Billed Charges for Rev 272 = $258.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE SHAVER ANGLED AGGR + 4.0,272,RC,27200002,CDM,,,,,,both,,,800.6400,120.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,245.80,,,,,,,206.6500,800.6400,other,30.7% of $800.64 in Billed Charges for Rev 272 = $245.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE SHAVER ANGLED AGGR + 4.0,272,RC,27200002,CDM,,,,,,both,,,800.6400,120.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,258.61,,,,,,,206.6500,800.6400,percent of total billed charges,32.3% of $800.64 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER ANGLED AGGR + 4.0,272,RC,27200002,CDM,,,,,,both,,,800.6400,120.1000,WELLCARE,WELLCARE MEDICAID,800.64,,,,,,,206.6500,800.6400,percent of total billed charges,100% of $800.64 in Billed Charges for Rev 272 = $800.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SHORT PROFILE,272,RC,27200002,CDM,,,,,,both,,,1856.4100,278.4600,AETNA,AETNA,792.69,,,,,,,479.1400,1856.4100,percent of total billed charges,"42.7% of $1,856.41 in Billed Charges for Rev 272 = $792.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT PROFILE,272,RC,27200002,CDM,,,,,,both,,,1856.4100,278.4600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1299.49,,,,,,,479.1400,1856.4100,percent of total billed charges,"Rev 272 $1,856.41 in Billed Charges at 70% = $1,299.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT PROFILE,272,RC,27200002,CDM,,,,,,both,,,1856.4100,278.4600,CIGNA HEALTHCARE,CIGNA HMO,774.12,,,,,,,479.1400,1856.4100,percent of total billed charges,"41.7% of $1,856.41 in Billed Charges for Rev 272 = $774.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT PROFILE,272,RC,27200002,CDM,,,,,,both,,,1856.4100,278.4600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,861.37,,,,,,,479.1400,1856.4100,percent of total billed charges,"46.4% of $1,856.41 in Billed Charges for Rev 272 = $861.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT PROFILE,272,RC,27200002,CDM,,,,,,both,,,1856.4100,278.4600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,774.12,,,,,,,479.1400,1856.4100,percent of total billed charges,"41.7% of $1,856.41 in Billed Charges for Rev 272 = $774.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT PROFILE,272,RC,27200002,CDM,,,,,,both,,,1856.4100,278.4600,CIGNA HEALTHCARE,CIGNA PPO,774.12,,,,,,,479.1400,1856.4100,percent of total billed charges,"41.7% of $1,856.41 in Billed Charges for Rev 272 = $774.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT PROFILE,272,RC,27200002,CDM,,,,,,both,,,1856.4100,278.4600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1670.77,,,,,,,479.1400,1856.4100,percent of total billed charges,"90% of $1,856.41 in Billed Charges for Rev 272 = $1,670.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT PROFILE,272,RC,27200002,CDM,,,,,,both,,,1856.4100,278.4600,MEDCOST,MEDCOST VHN,883.47,,,,,,,479.1400,1856.4100,percent of total billed charges,"47.59% of $1,856.41 in Billed Charges for Rev 272 = $883.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT PROFILE,272,RC,27200002,CDM,,,,,,both,,,1856.4100,278.4600,SENTARA HEALTH,SENTARA HEALTH,479.14,,,,,,,479.1400,1856.4100,percent of total billed charges,"25.81% of $1,856.41 in Billed Charges for Rev 272 = $479.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT PROFILE,272,RC,27200002,CDM,,,,,,both,,,1856.4100,278.4600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1856.41,,,,,,,479.1400,1856.4100,percent of total billed charges,"100% of $1,856.41 in Billed Charges for Rev 272 = $1,856.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT PROFILE,272,RC,27200002,CDM,,,,,,both,,,1856.4100,278.4600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,928.21,,,,,,,479.1400,1856.4100,percent of total billed charges,"Rev 272 $1,856.41 in Billed Charges at 50% = $928.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT PROFILE,272,RC,27200002,CDM,,,,,,both,,,1856.4100,278.4600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,599.62,,,,,,,479.1400,1856.4100,other,"32.3% of $1,856.41 in Billed Charges for Rev 272 = $599.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL SHORT PROFILE,272,RC,27200002,CDM,,,,,,both,,,1856.4100,278.4600,UNITED HEALTHCARE,UHC HERITAGE SELECT,569.92,,,,,,,479.1400,1856.4100,other,"30.7% of $1,856.41 in Billed Charges for Rev 272 = $569.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL SHORT PROFILE,272,RC,27200002,CDM,,,,,,both,,,1856.4100,278.4600,UNITED HEALTHCARE,UNITED HEALTHCARE,599.62,,,,,,,479.1400,1856.4100,percent of total billed charges,"32.3% of $1,856.41 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT PROFILE,272,RC,27200002,CDM,,,,,,both,,,1856.4100,278.4600,WELLCARE,WELLCARE MEDICAID,1856.41,,,,,,,479.1400,1856.4100,percent of total billed charges,"100% of $1,856.41 in Billed Charges for Rev 272 = $1,856.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHORT 2.0MM 313.922,272,RC,,,,,,,,both,,,7146.4500,1071.9700,AETNA,AETNA,3051.53,,,,,,,1844.5000,7146.4500,percent of total billed charges,"42.7% of $7,146.45 in Billed Charges for Rev 272 = $3,051.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHORT 2.0MM 313.922,272,RC,,,,,,,,both,,,7146.4500,1071.9700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5002.52,,,,,,,1844.5000,7146.4500,percent of total billed charges,"Rev 272 $7,146.45 in Billed Charges at 70% = $5,002.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHORT 2.0MM 313.922,272,RC,,,,,,,,both,,,7146.4500,1071.9700,CIGNA HEALTHCARE,CIGNA HMO,2980.07,,,,,,,1844.5000,7146.4500,percent of total billed charges,"41.7% of $7,146.45 in Billed Charges for Rev 272 = $2,980.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHORT 2.0MM 313.922,272,RC,,,,,,,,both,,,7146.4500,1071.9700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3315.95,,,,,,,1844.5000,7146.4500,percent of total billed charges,"46.4% of $7,146.45 in Billed Charges for Rev 272 = $3,315.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHORT 2.0MM 313.922,272,RC,,,,,,,,both,,,7146.4500,1071.9700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2980.07,,,,,,,1844.5000,7146.4500,percent of total billed charges,"41.7% of $7,146.45 in Billed Charges for Rev 272 = $2,980.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHORT 2.0MM 313.922,272,RC,,,,,,,,both,,,7146.4500,1071.9700,CIGNA HEALTHCARE,CIGNA PPO,2980.07,,,,,,,1844.5000,7146.4500,percent of total billed charges,"41.7% of $7,146.45 in Billed Charges for Rev 272 = $2,980.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHORT 2.0MM 313.922,272,RC,,,,,,,,both,,,7146.4500,1071.9700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6431.81,,,,,,,1844.5000,7146.4500,percent of total billed charges,"90% of $7,146.45 in Billed Charges for Rev 272 = $6,431.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHORT 2.0MM 313.922,272,RC,,,,,,,,both,,,7146.4500,1071.9700,MEDCOST,MEDCOST VHN,3401.00,,,,,,,1844.5000,7146.4500,percent of total billed charges,"47.59% of $7,146.45 in Billed Charges for Rev 272 = $3,401.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHORT 2.0MM 313.922,272,RC,,,,,,,,both,,,7146.4500,1071.9700,SENTARA HEALTH,SENTARA HEALTH,1844.50,,,,,,,1844.5000,7146.4500,percent of total billed charges,"25.81% of $7,146.45 in Billed Charges for Rev 272 = $1,844.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHORT 2.0MM 313.922,272,RC,,,,,,,,both,,,7146.4500,1071.9700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7146.45,,,,,,,1844.5000,7146.4500,percent of total billed charges,"100% of $7,146.45 in Billed Charges for Rev 272 = $7,146.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHORT 2.0MM 313.922,272,RC,,,,,,,,both,,,7146.4500,1071.9700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3573.23,,,,,,,1844.5000,7146.4500,percent of total billed charges,"Rev 272 $7,146.45 in Billed Charges at 50% = $3,573.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHORT 2.0MM 313.922,272,RC,,,,,,,,both,,,7146.4500,1071.9700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2308.30,,,,,,,1844.5000,7146.4500,other,"32.3% of $7,146.45 in Billed Charges for Rev 272 = $2,308.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SHORT 2.0MM 313.922,272,RC,,,,,,,,both,,,7146.4500,1071.9700,UNITED HEALTHCARE,UHC HERITAGE SELECT,2193.96,,,,,,,1844.5000,7146.4500,other,"30.7% of $7,146.45 in Billed Charges for Rev 272 = $2,193.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SHORT 2.0MM 313.922,272,RC,,,,,,,,both,,,7146.4500,1071.9700,UNITED HEALTHCARE,UNITED HEALTHCARE,2308.30,,,,,,,1844.5000,7146.4500,percent of total billed charges,"32.3% of $7,146.45 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHORT 2.0MM 313.922,272,RC,,,,,,,,both,,,7146.4500,1071.9700,WELLCARE,WELLCARE MEDICAID,7146.45,,,,,,,1844.5000,7146.4500,percent of total billed charges,"100% of $7,146.45 in Billed Charges for Rev 272 = $7,146.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER ANGLE TIP 27CM,272,RC,27200002,CDM,,,,,,both,,,7249.3300,1087.4000,AETNA,AETNA,3095.46,,,,,,,1871.0500,7249.3300,percent of total billed charges,"42.7% of $7,249.33 in Billed Charges for Rev 272 = $3,095.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER ANGLE TIP 27CM,272,RC,27200002,CDM,,,,,,both,,,7249.3300,1087.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5074.53,,,,,,,1871.0500,7249.3300,percent of total billed charges,"Rev 272 $7,249.33 in Billed Charges at 70% = $5,074.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER ANGLE TIP 27CM,272,RC,27200002,CDM,,,,,,both,,,7249.3300,1087.4000,CIGNA HEALTHCARE,CIGNA HMO,3022.97,,,,,,,1871.0500,7249.3300,percent of total billed charges,"41.7% of $7,249.33 in Billed Charges for Rev 272 = $3,022.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER ANGLE TIP 27CM,272,RC,27200002,CDM,,,,,,both,,,7249.3300,1087.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3363.69,,,,,,,1871.0500,7249.3300,percent of total billed charges,"46.4% of $7,249.33 in Billed Charges for Rev 272 = $3,363.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER ANGLE TIP 27CM,272,RC,27200002,CDM,,,,,,both,,,7249.3300,1087.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3022.97,,,,,,,1871.0500,7249.3300,percent of total billed charges,"41.7% of $7,249.33 in Billed Charges for Rev 272 = $3,022.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER ANGLE TIP 27CM,272,RC,27200002,CDM,,,,,,both,,,7249.3300,1087.4000,CIGNA HEALTHCARE,CIGNA PPO,3022.97,,,,,,,1871.0500,7249.3300,percent of total billed charges,"41.7% of $7,249.33 in Billed Charges for Rev 272 = $3,022.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER ANGLE TIP 27CM,272,RC,27200002,CDM,,,,,,both,,,7249.3300,1087.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6524.40,,,,,,,1871.0500,7249.3300,percent of total billed charges,"90% of $7,249.33 in Billed Charges for Rev 272 = $6,524.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER ANGLE TIP 27CM,272,RC,27200002,CDM,,,,,,both,,,7249.3300,1087.4000,MEDCOST,MEDCOST VHN,3449.96,,,,,,,1871.0500,7249.3300,percent of total billed charges,"47.59% of $7,249.33 in Billed Charges for Rev 272 = $3,449.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER ANGLE TIP 27CM,272,RC,27200002,CDM,,,,,,both,,,7249.3300,1087.4000,SENTARA HEALTH,SENTARA HEALTH,1871.05,,,,,,,1871.0500,7249.3300,percent of total billed charges,"25.81% of $7,249.33 in Billed Charges for Rev 272 = $1,871.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER ANGLE TIP 27CM,272,RC,27200002,CDM,,,,,,both,,,7249.3300,1087.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7249.33,,,,,,,1871.0500,7249.3300,percent of total billed charges,"100% of $7,249.33 in Billed Charges for Rev 272 = $7,249.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER ANGLE TIP 27CM,272,RC,27200002,CDM,,,,,,both,,,7249.3300,1087.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3624.67,,,,,,,1871.0500,7249.3300,percent of total billed charges,"Rev 272 $7,249.33 in Billed Charges at 50% = $3,624.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER ANGLE TIP 27CM,272,RC,27200002,CDM,,,,,,both,,,7249.3300,1087.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2341.53,,,,,,,1871.0500,7249.3300,other,"32.3% of $7,249.33 in Billed Charges for Rev 272 = $2,341.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SKIMMER ANGLE TIP 27CM,272,RC,27200002,CDM,,,,,,both,,,7249.3300,1087.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2225.54,,,,,,,1871.0500,7249.3300,other,"30.7% of $7,249.33 in Billed Charges for Rev 272 = $2,225.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SKIMMER ANGLE TIP 27CM,272,RC,27200002,CDM,,,,,,both,,,7249.3300,1087.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,2341.53,,,,,,,1871.0500,7249.3300,percent of total billed charges,"32.3% of $7,249.33 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER ANGLE TIP 27CM,272,RC,27200002,CDM,,,,,,both,,,7249.3300,1087.4000,WELLCARE,WELLCARE MEDICAID,7249.33,,,,,,,1871.0500,7249.3300,percent of total billed charges,"100% of $7,249.33 in Billed Charges for Rev 272 = $7,249.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER SUBGLOTTIC 4 X 27.5MM,272,RC,,,,,,,,both,,,4414.9300,662.2400,AETNA,AETNA,1885.18,,,,,,,1139.4900,4414.9300,percent of total billed charges,"42.7% of $4,414.93 in Billed Charges for Rev 272 = $1,885.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER SUBGLOTTIC 4 X 27.5MM,272,RC,,,,,,,,both,,,4414.9300,662.2400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3090.45,,,,,,,1139.4900,4414.9300,percent of total billed charges,"Rev 272 $4,414.93 in Billed Charges at 70% = $3,090.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER SUBGLOTTIC 4 X 27.5MM,272,RC,,,,,,,,both,,,4414.9300,662.2400,CIGNA HEALTHCARE,CIGNA HMO,1841.03,,,,,,,1139.4900,4414.9300,percent of total billed charges,"41.7% of $4,414.93 in Billed Charges for Rev 272 = $1,841.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER SUBGLOTTIC 4 X 27.5MM,272,RC,,,,,,,,both,,,4414.9300,662.2400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2048.53,,,,,,,1139.4900,4414.9300,percent of total billed charges,"46.4% of $4,414.93 in Billed Charges for Rev 272 = $2,048.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER SUBGLOTTIC 4 X 27.5MM,272,RC,,,,,,,,both,,,4414.9300,662.2400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1841.03,,,,,,,1139.4900,4414.9300,percent of total billed charges,"41.7% of $4,414.93 in Billed Charges for Rev 272 = $1,841.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER SUBGLOTTIC 4 X 27.5MM,272,RC,,,,,,,,both,,,4414.9300,662.2400,CIGNA HEALTHCARE,CIGNA PPO,1841.03,,,,,,,1139.4900,4414.9300,percent of total billed charges,"41.7% of $4,414.93 in Billed Charges for Rev 272 = $1,841.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER SUBGLOTTIC 4 X 27.5MM,272,RC,,,,,,,,both,,,4414.9300,662.2400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3973.44,,,,,,,1139.4900,4414.9300,percent of total billed charges,"90% of $4,414.93 in Billed Charges for Rev 272 = $3,973.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER SUBGLOTTIC 4 X 27.5MM,272,RC,,,,,,,,both,,,4414.9300,662.2400,MEDCOST,MEDCOST VHN,2101.07,,,,,,,1139.4900,4414.9300,percent of total billed charges,"47.59% of $4,414.93 in Billed Charges for Rev 272 = $2,101.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER SUBGLOTTIC 4 X 27.5MM,272,RC,,,,,,,,both,,,4414.9300,662.2400,SENTARA HEALTH,SENTARA HEALTH,1139.49,,,,,,,1139.4900,4414.9300,percent of total billed charges,"25.81% of $4,414.93 in Billed Charges for Rev 272 = $1,139.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER SUBGLOTTIC 4 X 27.5MM,272,RC,,,,,,,,both,,,4414.9300,662.2400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4414.93,,,,,,,1139.4900,4414.9300,percent of total billed charges,"100% of $4,414.93 in Billed Charges for Rev 272 = $4,414.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER SUBGLOTTIC 4 X 27.5MM,272,RC,,,,,,,,both,,,4414.9300,662.2400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2207.47,,,,,,,1139.4900,4414.9300,percent of total billed charges,"Rev 272 $4,414.93 in Billed Charges at 50% = $2,207.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER SUBGLOTTIC 4 X 27.5MM,272,RC,,,,,,,,both,,,4414.9300,662.2400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1426.02,,,,,,,1139.4900,4414.9300,other,"32.3% of $4,414.93 in Billed Charges for Rev 272 = $1,426.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SKIMMER SUBGLOTTIC 4 X 27.5MM,272,RC,,,,,,,,both,,,4414.9300,662.2400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1355.38,,,,,,,1139.4900,4414.9300,other,"30.7% of $4,414.93 in Billed Charges for Rev 272 = $1,355.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SKIMMER SUBGLOTTIC 4 X 27.5MM,272,RC,,,,,,,,both,,,4414.9300,662.2400,UNITED HEALTHCARE,UNITED HEALTHCARE,1426.02,,,,,,,1139.4900,4414.9300,percent of total billed charges,"32.3% of $4,414.93 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SKIMMER SUBGLOTTIC 4 X 27.5MM,272,RC,,,,,,,,both,,,4414.9300,662.2400,WELLCARE,WELLCARE MEDICAID,4414.93,,,,,,,1139.4900,4414.9300,percent of total billed charges,"100% of $4,414.93 in Billed Charges for Rev 272 = $4,414.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPINE EXCALIBUR 20MM,272,RC,27200002,CDM,,,,,,both,,,2758.6900,413.8000,AETNA,AETNA,1177.96,,,,,,,712.0200,2758.6900,percent of total billed charges,"42.7% of $2,758.69 in Billed Charges for Rev 272 = $1,177.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPINE EXCALIBUR 20MM,272,RC,27200002,CDM,,,,,,both,,,2758.6900,413.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1931.08,,,,,,,712.0200,2758.6900,percent of total billed charges,"Rev 272 $2,758.69 in Billed Charges at 70% = $1,931.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPINE EXCALIBUR 20MM,272,RC,27200002,CDM,,,,,,both,,,2758.6900,413.8000,CIGNA HEALTHCARE,CIGNA HMO,1150.37,,,,,,,712.0200,2758.6900,percent of total billed charges,"41.7% of $2,758.69 in Billed Charges for Rev 272 = $1,150.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPINE EXCALIBUR 20MM,272,RC,27200002,CDM,,,,,,both,,,2758.6900,413.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1280.03,,,,,,,712.0200,2758.6900,percent of total billed charges,"46.4% of $2,758.69 in Billed Charges for Rev 272 = $1,280.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPINE EXCALIBUR 20MM,272,RC,27200002,CDM,,,,,,both,,,2758.6900,413.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1150.37,,,,,,,712.0200,2758.6900,percent of total billed charges,"41.7% of $2,758.69 in Billed Charges for Rev 272 = $1,150.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPINE EXCALIBUR 20MM,272,RC,27200002,CDM,,,,,,both,,,2758.6900,413.8000,CIGNA HEALTHCARE,CIGNA PPO,1150.37,,,,,,,712.0200,2758.6900,percent of total billed charges,"41.7% of $2,758.69 in Billed Charges for Rev 272 = $1,150.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPINE EXCALIBUR 20MM,272,RC,27200002,CDM,,,,,,both,,,2758.6900,413.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2482.82,,,,,,,712.0200,2758.6900,percent of total billed charges,"90% of $2,758.69 in Billed Charges for Rev 272 = $2,482.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPINE EXCALIBUR 20MM,272,RC,27200002,CDM,,,,,,both,,,2758.6900,413.8000,MEDCOST,MEDCOST VHN,1312.86,,,,,,,712.0200,2758.6900,percent of total billed charges,"47.59% of $2,758.69 in Billed Charges for Rev 272 = $1,312.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPINE EXCALIBUR 20MM,272,RC,27200002,CDM,,,,,,both,,,2758.6900,413.8000,SENTARA HEALTH,SENTARA HEALTH,712.02,,,,,,,712.0200,2758.6900,percent of total billed charges,"25.81% of $2,758.69 in Billed Charges for Rev 272 = $712.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPINE EXCALIBUR 20MM,272,RC,27200002,CDM,,,,,,both,,,2758.6900,413.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2758.69,,,,,,,712.0200,2758.6900,percent of total billed charges,"100% of $2,758.69 in Billed Charges for Rev 272 = $2,758.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPINE EXCALIBUR 20MM,272,RC,27200002,CDM,,,,,,both,,,2758.6900,413.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1379.35,,,,,,,712.0200,2758.6900,percent of total billed charges,"Rev 272 $2,758.69 in Billed Charges at 50% = $1,379.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPINE EXCALIBUR 20MM,272,RC,27200002,CDM,,,,,,both,,,2758.6900,413.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,891.06,,,,,,,712.0200,2758.6900,other,"32.3% of $2,758.69 in Billed Charges for Rev 272 = $891.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SPINE EXCALIBUR 20MM,272,RC,27200002,CDM,,,,,,both,,,2758.6900,413.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,846.92,,,,,,,712.0200,2758.6900,other,"30.7% of $2,758.69 in Billed Charges for Rev 272 = $846.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SPINE EXCALIBUR 20MM,272,RC,27200002,CDM,,,,,,both,,,2758.6900,413.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,891.06,,,,,,,712.0200,2758.6900,percent of total billed charges,"32.3% of $2,758.69 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SPINE EXCALIBUR 20MM,272,RC,27200002,CDM,,,,,,both,,,2758.6900,413.8000,WELLCARE,WELLCARE MEDICAID,2758.69,,,,,,,712.0200,2758.6900,percent of total billed charges,"100% of $2,758.69 in Billed Charges for Rev 272 = $2,758.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SOLID AO COUPLING 2.1MM,272,RC,,,,,,,,both,,,468.9800,70.3500,AETNA,AETNA,200.25,,,,,,,121.0400,468.9800,percent of total billed charges,42.7% of $468.98 in Billed Charges for Rev 272 = $200.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SOLID AO COUPLING 2.1MM,272,RC,,,,,,,,both,,,468.9800,70.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,328.29,,,,,,,121.0400,468.9800,percent of total billed charges,Rev 272 $468.98 in Billed Charges at 70% = $328.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SOLID AO COUPLING 2.1MM,272,RC,,,,,,,,both,,,468.9800,70.3500,CIGNA HEALTHCARE,CIGNA HMO,195.56,,,,,,,121.0400,468.9800,percent of total billed charges,41.7% of $468.98 in Billed Charges for Rev 272 = $195.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SOLID AO COUPLING 2.1MM,272,RC,,,,,,,,both,,,468.9800,70.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,217.61,,,,,,,121.0400,468.9800,percent of total billed charges,46.4% of $468.98 in Billed Charges for Rev 272 = $217.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SOLID AO COUPLING 2.1MM,272,RC,,,,,,,,both,,,468.9800,70.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,195.56,,,,,,,121.0400,468.9800,percent of total billed charges,41.7% of $468.98 in Billed Charges for Rev 272 = $195.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SOLID AO COUPLING 2.1MM,272,RC,,,,,,,,both,,,468.9800,70.3500,CIGNA HEALTHCARE,CIGNA PPO,195.56,,,,,,,121.0400,468.9800,percent of total billed charges,41.7% of $468.98 in Billed Charges for Rev 272 = $195.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SOLID AO COUPLING 2.1MM,272,RC,,,,,,,,both,,,468.9800,70.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,422.08,,,,,,,121.0400,468.9800,percent of total billed charges,90% of $468.98 in Billed Charges for Rev 272 = $422.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SOLID AO COUPLING 2.1MM,272,RC,,,,,,,,both,,,468.9800,70.3500,MEDCOST,MEDCOST VHN,223.19,,,,,,,121.0400,468.9800,percent of total billed charges,47.59% of $468.98 in Billed Charges for Rev 272 = $223.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SOLID AO COUPLING 2.1MM,272,RC,,,,,,,,both,,,468.9800,70.3500,SENTARA HEALTH,SENTARA HEALTH,121.04,,,,,,,121.0400,468.9800,percent of total billed charges,25.81% of $468.98 in Billed Charges for Rev 272 = $121.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SOLID AO COUPLING 2.1MM,272,RC,,,,,,,,both,,,468.9800,70.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",468.98,,,,,,,121.0400,468.9800,percent of total billed charges,100% of $468.98 in Billed Charges for Rev 272 = $468.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SOLID AO COUPLING 2.1MM,272,RC,,,,,,,,both,,,468.9800,70.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,234.49,,,,,,,121.0400,468.9800,percent of total billed charges,Rev 272 $468.98 in Billed Charges at 50% = $234.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SOLID AO COUPLING 2.1MM,272,RC,,,,,,,,both,,,468.9800,70.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,151.48,,,,,,,121.0400,468.9800,other,32.3% of $468.98 in Billed Charges for Rev 272 = $151.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL SOLID AO COUPLING 2.1MM,272,RC,,,,,,,,both,,,468.9800,70.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,143.98,,,,,,,121.0400,468.9800,other,30.7% of $468.98 in Billed Charges for Rev 272 = $143.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL SOLID AO COUPLING 2.1MM,272,RC,,,,,,,,both,,,468.9800,70.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,151.48,,,,,,,121.0400,468.9800,percent of total billed charges,32.3% of $468.98 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SOLID AO COUPLING 2.1MM,272,RC,,,,,,,,both,,,468.9800,70.3500,WELLCARE,WELLCARE MEDICAID,468.98,,,,,,,121.0400,468.9800,percent of total billed charges,100% of $468.98 in Billed Charges for Rev 272 = $468.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SPINE SUB AXIAL 2.1MM,272,RC,,,,,,,,both,,,1920.1900,288.0300,AETNA,AETNA,819.92,,,,,,,495.6000,1920.1900,percent of total billed charges,"42.7% of $1,920.19 in Billed Charges for Rev 272 = $819.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SPINE SUB AXIAL 2.1MM,272,RC,,,,,,,,both,,,1920.1900,288.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1344.13,,,,,,,495.6000,1920.1900,percent of total billed charges,"Rev 272 $1,920.19 in Billed Charges at 70% = $1,344.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SPINE SUB AXIAL 2.1MM,272,RC,,,,,,,,both,,,1920.1900,288.0300,CIGNA HEALTHCARE,CIGNA HMO,800.72,,,,,,,495.6000,1920.1900,percent of total billed charges,"41.7% of $1,920.19 in Billed Charges for Rev 272 = $800.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SPINE SUB AXIAL 2.1MM,272,RC,,,,,,,,both,,,1920.1900,288.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,890.97,,,,,,,495.6000,1920.1900,percent of total billed charges,"46.4% of $1,920.19 in Billed Charges for Rev 272 = $890.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SPINE SUB AXIAL 2.1MM,272,RC,,,,,,,,both,,,1920.1900,288.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,800.72,,,,,,,495.6000,1920.1900,percent of total billed charges,"41.7% of $1,920.19 in Billed Charges for Rev 272 = $800.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SPINE SUB AXIAL 2.1MM,272,RC,,,,,,,,both,,,1920.1900,288.0300,CIGNA HEALTHCARE,CIGNA PPO,800.72,,,,,,,495.6000,1920.1900,percent of total billed charges,"41.7% of $1,920.19 in Billed Charges for Rev 272 = $800.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SPINE SUB AXIAL 2.1MM,272,RC,,,,,,,,both,,,1920.1900,288.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1728.17,,,,,,,495.6000,1920.1900,percent of total billed charges,"90% of $1,920.19 in Billed Charges for Rev 272 = $1,728.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SPINE SUB AXIAL 2.1MM,272,RC,,,,,,,,both,,,1920.1900,288.0300,MEDCOST,MEDCOST VHN,913.82,,,,,,,495.6000,1920.1900,percent of total billed charges,"47.59% of $1,920.19 in Billed Charges for Rev 272 = $913.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SPINE SUB AXIAL 2.1MM,272,RC,,,,,,,,both,,,1920.1900,288.0300,SENTARA HEALTH,SENTARA HEALTH,495.60,,,,,,,495.6000,1920.1900,percent of total billed charges,"25.81% of $1,920.19 in Billed Charges for Rev 272 = $495.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SPINE SUB AXIAL 2.1MM,272,RC,,,,,,,,both,,,1920.1900,288.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1920.19,,,,,,,495.6000,1920.1900,percent of total billed charges,"100% of $1,920.19 in Billed Charges for Rev 272 = $1,920.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SPINE SUB AXIAL 2.1MM,272,RC,,,,,,,,both,,,1920.1900,288.0300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,960.10,,,,,,,495.6000,1920.1900,percent of total billed charges,"Rev 272 $1,920.19 in Billed Charges at 50% = $960.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SPINE SUB AXIAL 2.1MM,272,RC,,,,,,,,both,,,1920.1900,288.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,620.22,,,,,,,495.6000,1920.1900,other,"32.3% of $1,920.19 in Billed Charges for Rev 272 = $620.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL SPINE SUB AXIAL 2.1MM,272,RC,,,,,,,,both,,,1920.1900,288.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,589.50,,,,,,,495.6000,1920.1900,other,"30.7% of $1,920.19 in Billed Charges for Rev 272 = $589.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL SPINE SUB AXIAL 2.1MM,272,RC,,,,,,,,both,,,1920.1900,288.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,620.22,,,,,,,495.6000,1920.1900,percent of total billed charges,"32.3% of $1,920.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SPINE SUB AXIAL 2.1MM,272,RC,,,,,,,,both,,,1920.1900,288.0300,WELLCARE,WELLCARE MEDICAID,1920.19,,,,,,,495.6000,1920.1900,percent of total billed charges,"100% of $1,920.19 in Billed Charges for Rev 272 = $1,920.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STANDARD THREAD 3.5MM,272,RC,27200002,CDM,,,,,,both,,,1661.6400,249.2500,AETNA,AETNA,709.52,,,,,,,428.8700,1661.6400,percent of total billed charges,"42.7% of $1,661.64 in Billed Charges for Rev 272 = $709.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STANDARD THREAD 3.5MM,272,RC,27200002,CDM,,,,,,both,,,1661.6400,249.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1163.15,,,,,,,428.8700,1661.6400,percent of total billed charges,"Rev 272 $1,661.64 in Billed Charges at 70% = $1,163.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STANDARD THREAD 3.5MM,272,RC,27200002,CDM,,,,,,both,,,1661.6400,249.2500,CIGNA HEALTHCARE,CIGNA HMO,692.90,,,,,,,428.8700,1661.6400,percent of total billed charges,"41.7% of $1,661.64 in Billed Charges for Rev 272 = $692.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STANDARD THREAD 3.5MM,272,RC,27200002,CDM,,,,,,both,,,1661.6400,249.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,771.00,,,,,,,428.8700,1661.6400,percent of total billed charges,"46.4% of $1,661.64 in Billed Charges for Rev 272 = $771.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STANDARD THREAD 3.5MM,272,RC,27200002,CDM,,,,,,both,,,1661.6400,249.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,692.90,,,,,,,428.8700,1661.6400,percent of total billed charges,"41.7% of $1,661.64 in Billed Charges for Rev 272 = $692.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STANDARD THREAD 3.5MM,272,RC,27200002,CDM,,,,,,both,,,1661.6400,249.2500,CIGNA HEALTHCARE,CIGNA PPO,692.90,,,,,,,428.8700,1661.6400,percent of total billed charges,"41.7% of $1,661.64 in Billed Charges for Rev 272 = $692.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STANDARD THREAD 3.5MM,272,RC,27200002,CDM,,,,,,both,,,1661.6400,249.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1495.48,,,,,,,428.8700,1661.6400,percent of total billed charges,"90% of $1,661.64 in Billed Charges for Rev 272 = $1,495.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STANDARD THREAD 3.5MM,272,RC,27200002,CDM,,,,,,both,,,1661.6400,249.2500,MEDCOST,MEDCOST VHN,790.77,,,,,,,428.8700,1661.6400,percent of total billed charges,"47.59% of $1,661.64 in Billed Charges for Rev 272 = $790.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STANDARD THREAD 3.5MM,272,RC,27200002,CDM,,,,,,both,,,1661.6400,249.2500,SENTARA HEALTH,SENTARA HEALTH,428.87,,,,,,,428.8700,1661.6400,percent of total billed charges,"25.81% of $1,661.64 in Billed Charges for Rev 272 = $428.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STANDARD THREAD 3.5MM,272,RC,27200002,CDM,,,,,,both,,,1661.6400,249.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1661.64,,,,,,,428.8700,1661.6400,percent of total billed charges,"100% of $1,661.64 in Billed Charges for Rev 272 = $1,661.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STANDARD THREAD 3.5MM,272,RC,27200002,CDM,,,,,,both,,,1661.6400,249.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,830.82,,,,,,,428.8700,1661.6400,percent of total billed charges,"Rev 272 $1,661.64 in Billed Charges at 50% = $830.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STANDARD THREAD 3.5MM,272,RC,27200002,CDM,,,,,,both,,,1661.6400,249.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,536.71,,,,,,,428.8700,1661.6400,other,"32.3% of $1,661.64 in Billed Charges for Rev 272 = $536.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL STANDARD THREAD 3.5MM,272,RC,27200002,CDM,,,,,,both,,,1661.6400,249.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,510.12,,,,,,,428.8700,1661.6400,other,"30.7% of $1,661.64 in Billed Charges for Rev 272 = $510.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL STANDARD THREAD 3.5MM,272,RC,27200002,CDM,,,,,,both,,,1661.6400,249.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,536.71,,,,,,,428.8700,1661.6400,percent of total billed charges,"32.3% of $1,661.64 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STANDARD THREAD 3.5MM,272,RC,27200002,CDM,,,,,,both,,,1661.6400,249.2500,WELLCARE,WELLCARE MEDICAID,1661.64,,,,,,,428.8700,1661.6400,percent of total billed charges,"100% of $1,661.64 in Billed Charges for Rev 272 = $1,661.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO TURB SMTH STR 2MM,272,RC,,,,,,,,both,,,1420.1900,213.0300,AETNA,AETNA,606.42,,,,,,,366.5500,1420.1900,percent of total billed charges,"42.7% of $1,420.19 in Billed Charges for Rev 272 = $606.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO TURB SMTH STR 2MM,272,RC,,,,,,,,both,,,1420.1900,213.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,994.13,,,,,,,366.5500,1420.1900,percent of total billed charges,"Rev 272 $1,420.19 in Billed Charges at 70% = $994.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO TURB SMTH STR 2MM,272,RC,,,,,,,,both,,,1420.1900,213.0300,CIGNA HEALTHCARE,CIGNA HMO,592.22,,,,,,,366.5500,1420.1900,percent of total billed charges,"41.7% of $1,420.19 in Billed Charges for Rev 272 = $592.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO TURB SMTH STR 2MM,272,RC,,,,,,,,both,,,1420.1900,213.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,658.97,,,,,,,366.5500,1420.1900,percent of total billed charges,"46.4% of $1,420.19 in Billed Charges for Rev 272 = $658.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO TURB SMTH STR 2MM,272,RC,,,,,,,,both,,,1420.1900,213.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,592.22,,,,,,,366.5500,1420.1900,percent of total billed charges,"41.7% of $1,420.19 in Billed Charges for Rev 272 = $592.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO TURB SMTH STR 2MM,272,RC,,,,,,,,both,,,1420.1900,213.0300,CIGNA HEALTHCARE,CIGNA PPO,592.22,,,,,,,366.5500,1420.1900,percent of total billed charges,"41.7% of $1,420.19 in Billed Charges for Rev 272 = $592.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO TURB SMTH STR 2MM,272,RC,,,,,,,,both,,,1420.1900,213.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1278.17,,,,,,,366.5500,1420.1900,percent of total billed charges,"90% of $1,420.19 in Billed Charges for Rev 272 = $1,278.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO TURB SMTH STR 2MM,272,RC,,,,,,,,both,,,1420.1900,213.0300,MEDCOST,MEDCOST VHN,675.87,,,,,,,366.5500,1420.1900,percent of total billed charges,"47.59% of $1,420.19 in Billed Charges for Rev 272 = $675.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO TURB SMTH STR 2MM,272,RC,,,,,,,,both,,,1420.1900,213.0300,SENTARA HEALTH,SENTARA HEALTH,366.55,,,,,,,366.5500,1420.1900,percent of total billed charges,"25.81% of $1,420.19 in Billed Charges for Rev 272 = $366.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO TURB SMTH STR 2MM,272,RC,,,,,,,,both,,,1420.1900,213.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1420.19,,,,,,,366.5500,1420.1900,percent of total billed charges,"100% of $1,420.19 in Billed Charges for Rev 272 = $1,420.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO TURB SMTH STR 2MM,272,RC,,,,,,,,both,,,1420.1900,213.0300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,710.10,,,,,,,366.5500,1420.1900,percent of total billed charges,"Rev 272 $1,420.19 in Billed Charges at 50% = $710.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO TURB SMTH STR 2MM,272,RC,,,,,,,,both,,,1420.1900,213.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,458.72,,,,,,,366.5500,1420.1900,other,"32.3% of $1,420.19 in Billed Charges for Rev 272 = $458.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE DIEGO TURB SMTH STR 2MM,272,RC,,,,,,,,both,,,1420.1900,213.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,436.00,,,,,,,366.5500,1420.1900,other,"30.7% of $1,420.19 in Billed Charges for Rev 272 = $436.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE DIEGO TURB SMTH STR 2MM,272,RC,,,,,,,,both,,,1420.1900,213.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,458.72,,,,,,,366.5500,1420.1900,percent of total billed charges,"32.3% of $1,420.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO TURB SMTH STR 2MM,272,RC,,,,,,,,both,,,1420.1900,213.0300,WELLCARE,WELLCARE MEDICAID,1420.19,,,,,,,366.5500,1420.1900,percent of total billed charges,"100% of $1,420.19 in Billed Charges for Rev 272 = $1,420.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DUAL CUT SAGITTAL 90LX18W MM,272,RC,27200002,CDM,,,,,,both,,,537.2200,80.5800,AETNA,AETNA,229.39,,,,,,,138.6600,537.2200,percent of total billed charges,42.7% of $537.22 in Billed Charges for Rev 272 = $229.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DUAL CUT SAGITTAL 90LX18W MM,272,RC,27200002,CDM,,,,,,both,,,537.2200,80.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,376.05,,,,,,,138.6600,537.2200,percent of total billed charges,Rev 272 $537.22 in Billed Charges at 70% = $376.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DUAL CUT SAGITTAL 90LX18W MM,272,RC,27200002,CDM,,,,,,both,,,537.2200,80.5800,CIGNA HEALTHCARE,CIGNA HMO,224.02,,,,,,,138.6600,537.2200,percent of total billed charges,41.7% of $537.22 in Billed Charges for Rev 272 = $224.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DUAL CUT SAGITTAL 90LX18W MM,272,RC,27200002,CDM,,,,,,both,,,537.2200,80.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,249.27,,,,,,,138.6600,537.2200,percent of total billed charges,46.4% of $537.22 in Billed Charges for Rev 272 = $249.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DUAL CUT SAGITTAL 90LX18W MM,272,RC,27200002,CDM,,,,,,both,,,537.2200,80.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,224.02,,,,,,,138.6600,537.2200,percent of total billed charges,41.7% of $537.22 in Billed Charges for Rev 272 = $224.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DUAL CUT SAGITTAL 90LX18W MM,272,RC,27200002,CDM,,,,,,both,,,537.2200,80.5800,CIGNA HEALTHCARE,CIGNA PPO,224.02,,,,,,,138.6600,537.2200,percent of total billed charges,41.7% of $537.22 in Billed Charges for Rev 272 = $224.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DUAL CUT SAGITTAL 90LX18W MM,272,RC,27200002,CDM,,,,,,both,,,537.2200,80.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,483.50,,,,,,,138.6600,537.2200,percent of total billed charges,90% of $537.22 in Billed Charges for Rev 272 = $483.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DUAL CUT SAGITTAL 90LX18W MM,272,RC,27200002,CDM,,,,,,both,,,537.2200,80.5800,MEDCOST,MEDCOST VHN,255.66,,,,,,,138.6600,537.2200,percent of total billed charges,47.59% of $537.22 in Billed Charges for Rev 272 = $255.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DUAL CUT SAGITTAL 90LX18W MM,272,RC,27200002,CDM,,,,,,both,,,537.2200,80.5800,SENTARA HEALTH,SENTARA HEALTH,138.66,,,,,,,138.6600,537.2200,percent of total billed charges,25.81% of $537.22 in Billed Charges for Rev 272 = $138.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DUAL CUT SAGITTAL 90LX18W MM,272,RC,27200002,CDM,,,,,,both,,,537.2200,80.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",537.22,,,,,,,138.6600,537.2200,percent of total billed charges,100% of $537.22 in Billed Charges for Rev 272 = $537.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DUAL CUT SAGITTAL 90LX18W MM,272,RC,27200002,CDM,,,,,,both,,,537.2200,80.5800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,268.61,,,,,,,138.6600,537.2200,percent of total billed charges,Rev 272 $537.22 in Billed Charges at 50% = $268.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DUAL CUT SAGITTAL 90LX18W MM,272,RC,27200002,CDM,,,,,,both,,,537.2200,80.5800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,173.52,,,,,,,138.6600,537.2200,other,32.3% of $537.22 in Billed Charges for Rev 272 = $173.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE DUAL CUT SAGITTAL 90LX18W MM,272,RC,27200002,CDM,,,,,,both,,,537.2200,80.5800,UNITED HEALTHCARE,UHC HERITAGE SELECT,164.93,,,,,,,138.6600,537.2200,other,30.7% of $537.22 in Billed Charges for Rev 272 = $164.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE DUAL CUT SAGITTAL 90LX18W MM,272,RC,27200002,CDM,,,,,,both,,,537.2200,80.5800,UNITED HEALTHCARE,UNITED HEALTHCARE,173.52,,,,,,,138.6600,537.2200,percent of total billed charges,32.3% of $537.22 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE DUAL CUT SAGITTAL 90LX18W MM,272,RC,27200002,CDM,,,,,,both,,,537.2200,80.5800,WELLCARE,WELLCARE MEDICAID,537.22,,,,,,,138.6600,537.2200,percent of total billed charges,100% of $537.22 in Billed Charges for Rev 272 = $537.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE THIN OSTEO 10MMX3,272,RC,,,,,,,,both,,,8286.4300,1242.9600,AETNA,AETNA,3538.31,,,,,,,2138.7300,8286.4300,percent of total billed charges,"42.7% of $8,286.43 in Billed Charges for Rev 272 = $3,538.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE THIN OSTEO 10MMX3,272,RC,,,,,,,,both,,,8286.4300,1242.9600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5800.50,,,,,,,2138.7300,8286.4300,percent of total billed charges,"Rev 272 $8,286.43 in Billed Charges at 70% = $5,800.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE THIN OSTEO 10MMX3,272,RC,,,,,,,,both,,,8286.4300,1242.9600,CIGNA HEALTHCARE,CIGNA HMO,3455.44,,,,,,,2138.7300,8286.4300,percent of total billed charges,"41.7% of $8,286.43 in Billed Charges for Rev 272 = $3,455.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE THIN OSTEO 10MMX3,272,RC,,,,,,,,both,,,8286.4300,1242.9600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3844.90,,,,,,,2138.7300,8286.4300,percent of total billed charges,"46.4% of $8,286.43 in Billed Charges for Rev 272 = $3,844.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE THIN OSTEO 10MMX3,272,RC,,,,,,,,both,,,8286.4300,1242.9600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3455.44,,,,,,,2138.7300,8286.4300,percent of total billed charges,"41.7% of $8,286.43 in Billed Charges for Rev 272 = $3,455.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE THIN OSTEO 10MMX3,272,RC,,,,,,,,both,,,8286.4300,1242.9600,CIGNA HEALTHCARE,CIGNA PPO,3455.44,,,,,,,2138.7300,8286.4300,percent of total billed charges,"41.7% of $8,286.43 in Billed Charges for Rev 272 = $3,455.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE THIN OSTEO 10MMX3,272,RC,,,,,,,,both,,,8286.4300,1242.9600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7457.79,,,,,,,2138.7300,8286.4300,percent of total billed charges,"90% of $8,286.43 in Billed Charges for Rev 272 = $7,457.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE THIN OSTEO 10MMX3,272,RC,,,,,,,,both,,,8286.4300,1242.9600,MEDCOST,MEDCOST VHN,3943.51,,,,,,,2138.7300,8286.4300,percent of total billed charges,"47.59% of $8,286.43 in Billed Charges for Rev 272 = $3,943.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE THIN OSTEO 10MMX3,272,RC,,,,,,,,both,,,8286.4300,1242.9600,SENTARA HEALTH,SENTARA HEALTH,2138.73,,,,,,,2138.7300,8286.4300,percent of total billed charges,"25.81% of $8,286.43 in Billed Charges for Rev 272 = $2,138.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE THIN OSTEO 10MMX3,272,RC,,,,,,,,both,,,8286.4300,1242.9600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8286.43,,,,,,,2138.7300,8286.4300,percent of total billed charges,"100% of $8,286.43 in Billed Charges for Rev 272 = $8,286.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE THIN OSTEO 10MMX3,272,RC,,,,,,,,both,,,8286.4300,1242.9600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4143.22,,,,,,,2138.7300,8286.4300,percent of total billed charges,"Rev 272 $8,286.43 in Billed Charges at 50% = $4,143.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE THIN OSTEO 10MMX3,272,RC,,,,,,,,both,,,8286.4300,1242.9600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2676.52,,,,,,,2138.7300,8286.4300,other,"32.3% of $8,286.43 in Billed Charges for Rev 272 = $2,676.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE THIN OSTEO 10MMX3,272,RC,,,,,,,,both,,,8286.4300,1242.9600,UNITED HEALTHCARE,UHC HERITAGE SELECT,2543.93,,,,,,,2138.7300,8286.4300,other,"30.7% of $8,286.43 in Billed Charges for Rev 272 = $2,543.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE THIN OSTEO 10MMX3,272,RC,,,,,,,,both,,,8286.4300,1242.9600,UNITED HEALTHCARE,UNITED HEALTHCARE,2676.52,,,,,,,2138.7300,8286.4300,percent of total billed charges,"32.3% of $8,286.43 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE THIN OSTEO 10MMX3,272,RC,,,,,,,,both,,,8286.4300,1242.9600,WELLCARE,WELLCARE MEDICAID,8286.43,,,,,,,2138.7300,8286.4300,percent of total billed charges,"100% of $8,286.43 in Billed Charges for Rev 272 = $8,286.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 2.0MM 5820-110-020C,272,RC,,,,,,,,both,,,2577.9200,386.6900,AETNA,AETNA,1100.77,,,,,,,665.3600,2577.9200,percent of total billed charges,"42.7% of $2,577.92 in Billed Charges for Rev 272 = $1,100.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 2.0MM 5820-110-020C,272,RC,,,,,,,,both,,,2577.9200,386.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1804.54,,,,,,,665.3600,2577.9200,percent of total billed charges,"Rev 272 $2,577.92 in Billed Charges at 70% = $1,804.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 2.0MM 5820-110-020C,272,RC,,,,,,,,both,,,2577.9200,386.6900,CIGNA HEALTHCARE,CIGNA HMO,1074.99,,,,,,,665.3600,2577.9200,percent of total billed charges,"41.7% of $2,577.92 in Billed Charges for Rev 272 = $1,074.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 2.0MM 5820-110-020C,272,RC,,,,,,,,both,,,2577.9200,386.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1196.15,,,,,,,665.3600,2577.9200,percent of total billed charges,"46.4% of $2,577.92 in Billed Charges for Rev 272 = $1,196.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 2.0MM 5820-110-020C,272,RC,,,,,,,,both,,,2577.9200,386.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1074.99,,,,,,,665.3600,2577.9200,percent of total billed charges,"41.7% of $2,577.92 in Billed Charges for Rev 272 = $1,074.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 2.0MM 5820-110-020C,272,RC,,,,,,,,both,,,2577.9200,386.6900,CIGNA HEALTHCARE,CIGNA PPO,1074.99,,,,,,,665.3600,2577.9200,percent of total billed charges,"41.7% of $2,577.92 in Billed Charges for Rev 272 = $1,074.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 2.0MM 5820-110-020C,272,RC,,,,,,,,both,,,2577.9200,386.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2320.13,,,,,,,665.3600,2577.9200,percent of total billed charges,"90% of $2,577.92 in Billed Charges for Rev 272 = $2,320.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 2.0MM 5820-110-020C,272,RC,,,,,,,,both,,,2577.9200,386.6900,MEDCOST,MEDCOST VHN,1226.83,,,,,,,665.3600,2577.9200,percent of total billed charges,"47.59% of $2,577.92 in Billed Charges for Rev 272 = $1,226.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 2.0MM 5820-110-020C,272,RC,,,,,,,,both,,,2577.9200,386.6900,SENTARA HEALTH,SENTARA HEALTH,665.36,,,,,,,665.3600,2577.9200,percent of total billed charges,"25.81% of $2,577.92 in Billed Charges for Rev 272 = $665.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 2.0MM 5820-110-020C,272,RC,,,,,,,,both,,,2577.9200,386.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2577.92,,,,,,,665.3600,2577.9200,percent of total billed charges,"100% of $2,577.92 in Billed Charges for Rev 272 = $2,577.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 2.0MM 5820-110-020C,272,RC,,,,,,,,both,,,2577.9200,386.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1288.96,,,,,,,665.3600,2577.9200,percent of total billed charges,"Rev 272 $2,577.92 in Billed Charges at 50% = $1,288.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 2.0MM 5820-110-020C,272,RC,,,,,,,,both,,,2577.9200,386.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,832.67,,,,,,,665.3600,2577.9200,other,"32.3% of $2,577.92 in Billed Charges for Rev 272 = $832.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR CARBIDE ROUND 2.0MM 5820-110-020C,272,RC,,,,,,,,both,,,2577.9200,386.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,791.42,,,,,,,665.3600,2577.9200,other,"30.7% of $2,577.92 in Billed Charges for Rev 272 = $791.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR CARBIDE ROUND 2.0MM 5820-110-020C,272,RC,,,,,,,,both,,,2577.9200,386.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,832.67,,,,,,,665.3600,2577.9200,percent of total billed charges,"32.3% of $2,577.92 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 2.0MM 5820-110-020C,272,RC,,,,,,,,both,,,2577.9200,386.6900,WELLCARE,WELLCARE MEDICAID,2577.92,,,,,,,665.3600,2577.9200,percent of total billed charges,"100% of $2,577.92 in Billed Charges for Rev 272 = $2,577.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXODUS HIP STEM REMOVAL,272,RC,27200002,CDM,,,,,,both,,,25767.1600,3865.0700,AETNA,AETNA,11002.58,,,,,,,6650.5000,25767.1600,percent of total billed charges,"42.7% of $25,767.16 in Billed Charges for Rev 272 = $11,002.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXODUS HIP STEM REMOVAL,272,RC,27200002,CDM,,,,,,both,,,25767.1600,3865.0700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,18037.01,,,,,,,6650.5000,25767.1600,percent of total billed charges,"Rev 272 $25,767.16 in Billed Charges at 70% = $18,037.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXODUS HIP STEM REMOVAL,272,RC,27200002,CDM,,,,,,both,,,25767.1600,3865.0700,CIGNA HEALTHCARE,CIGNA HMO,10744.91,,,,,,,6650.5000,25767.1600,percent of total billed charges,"41.7% of $25,767.16 in Billed Charges for Rev 272 = $10,744.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXODUS HIP STEM REMOVAL,272,RC,27200002,CDM,,,,,,both,,,25767.1600,3865.0700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11955.96,,,,,,,6650.5000,25767.1600,percent of total billed charges,"46.4% of $25,767.16 in Billed Charges for Rev 272 = $11,955.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXODUS HIP STEM REMOVAL,272,RC,27200002,CDM,,,,,,both,,,25767.1600,3865.0700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,10744.91,,,,,,,6650.5000,25767.1600,percent of total billed charges,"41.7% of $25,767.16 in Billed Charges for Rev 272 = $10,744.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXODUS HIP STEM REMOVAL,272,RC,27200002,CDM,,,,,,both,,,25767.1600,3865.0700,CIGNA HEALTHCARE,CIGNA PPO,10744.91,,,,,,,6650.5000,25767.1600,percent of total billed charges,"41.7% of $25,767.16 in Billed Charges for Rev 272 = $10,744.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXODUS HIP STEM REMOVAL,272,RC,27200002,CDM,,,,,,both,,,25767.1600,3865.0700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,23190.44,,,,,,,6650.5000,25767.1600,percent of total billed charges,"90% of $25,767.16 in Billed Charges for Rev 272 = $23,190.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXODUS HIP STEM REMOVAL,272,RC,27200002,CDM,,,,,,both,,,25767.1600,3865.0700,MEDCOST,MEDCOST VHN,12262.59,,,,,,,6650.5000,25767.1600,percent of total billed charges,"47.59% of $25,767.16 in Billed Charges for Rev 272 = $12,262.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXODUS HIP STEM REMOVAL,272,RC,27200002,CDM,,,,,,both,,,25767.1600,3865.0700,SENTARA HEALTH,SENTARA HEALTH,6650.50,,,,,,,6650.5000,25767.1600,percent of total billed charges,"25.81% of $25,767.16 in Billed Charges for Rev 272 = $6,650.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXODUS HIP STEM REMOVAL,272,RC,27200002,CDM,,,,,,both,,,25767.1600,3865.0700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",25767.16,,,,,,,6650.5000,25767.1600,percent of total billed charges,"100% of $25,767.16 in Billed Charges for Rev 272 = $25,767.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXODUS HIP STEM REMOVAL,272,RC,27200002,CDM,,,,,,both,,,25767.1600,3865.0700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,12883.58,,,,,,,6650.5000,25767.1600,percent of total billed charges,"Rev 272 $25,767.16 in Billed Charges at 50% = $12,883.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXODUS HIP STEM REMOVAL,272,RC,27200002,CDM,,,,,,both,,,25767.1600,3865.0700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,8322.79,,,,,,,6650.5000,25767.1600,other,"32.3% of $25,767.16 in Billed Charges for Rev 272 = $8,322.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE EXODUS HIP STEM REMOVAL,272,RC,27200002,CDM,,,,,,both,,,25767.1600,3865.0700,UNITED HEALTHCARE,UHC HERITAGE SELECT,7910.52,,,,,,,6650.5000,25767.1600,other,"30.7% of $25,767.16 in Billed Charges for Rev 272 = $7,910.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE EXODUS HIP STEM REMOVAL,272,RC,27200002,CDM,,,,,,both,,,25767.1600,3865.0700,UNITED HEALTHCARE,UNITED HEALTHCARE,8322.79,,,,,,,6650.5000,25767.1600,percent of total billed charges,"32.3% of $25,767.16 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXODUS HIP STEM REMOVAL,272,RC,27200002,CDM,,,,,,both,,,25767.1600,3865.0700,WELLCARE,WELLCARE MEDICAID,25767.16,,,,,,,6650.5000,25767.1600,percent of total billed charges,"100% of $25,767.16 in Billed Charges for Rev 272 = $25,767.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 56MM LONG FULL BLADE 7053-56-20,272,RC,27200002,CDM,,,,,,both,,,6056.7700,908.5200,AETNA,AETNA,2586.24,,,,,,,1563.2500,6056.7700,percent of total billed charges,"42.7% of $6,056.77 in Billed Charges for Rev 272 = $2,586.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 56MM LONG FULL BLADE 7053-56-20,272,RC,27200002,CDM,,,,,,both,,,6056.7700,908.5200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4239.74,,,,,,,1563.2500,6056.7700,percent of total billed charges,"Rev 272 $6,056.77 in Billed Charges at 70% = $4,239.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 56MM LONG FULL BLADE 7053-56-20,272,RC,27200002,CDM,,,,,,both,,,6056.7700,908.5200,CIGNA HEALTHCARE,CIGNA HMO,2525.67,,,,,,,1563.2500,6056.7700,percent of total billed charges,"41.7% of $6,056.77 in Billed Charges for Rev 272 = $2,525.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 56MM LONG FULL BLADE 7053-56-20,272,RC,27200002,CDM,,,,,,both,,,6056.7700,908.5200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2810.34,,,,,,,1563.2500,6056.7700,percent of total billed charges,"46.4% of $6,056.77 in Billed Charges for Rev 272 = $2,810.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 56MM LONG FULL BLADE 7053-56-20,272,RC,27200002,CDM,,,,,,both,,,6056.7700,908.5200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2525.67,,,,,,,1563.2500,6056.7700,percent of total billed charges,"41.7% of $6,056.77 in Billed Charges for Rev 272 = $2,525.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 56MM LONG FULL BLADE 7053-56-20,272,RC,27200002,CDM,,,,,,both,,,6056.7700,908.5200,CIGNA HEALTHCARE,CIGNA PPO,2525.67,,,,,,,1563.2500,6056.7700,percent of total billed charges,"41.7% of $6,056.77 in Billed Charges for Rev 272 = $2,525.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 56MM LONG FULL BLADE 7053-56-20,272,RC,27200002,CDM,,,,,,both,,,6056.7700,908.5200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5451.09,,,,,,,1563.2500,6056.7700,percent of total billed charges,"90% of $6,056.77 in Billed Charges for Rev 272 = $5,451.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 56MM LONG FULL BLADE 7053-56-20,272,RC,27200002,CDM,,,,,,both,,,6056.7700,908.5200,MEDCOST,MEDCOST VHN,2882.42,,,,,,,1563.2500,6056.7700,percent of total billed charges,"47.59% of $6,056.77 in Billed Charges for Rev 272 = $2,882.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 56MM LONG FULL BLADE 7053-56-20,272,RC,27200002,CDM,,,,,,both,,,6056.7700,908.5200,SENTARA HEALTH,SENTARA HEALTH,1563.25,,,,,,,1563.2500,6056.7700,percent of total billed charges,"25.81% of $6,056.77 in Billed Charges for Rev 272 = $1,563.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 56MM LONG FULL BLADE 7053-56-20,272,RC,27200002,CDM,,,,,,both,,,6056.7700,908.5200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6056.77,,,,,,,1563.2500,6056.7700,percent of total billed charges,"100% of $6,056.77 in Billed Charges for Rev 272 = $6,056.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 56MM LONG FULL BLADE 7053-56-20,272,RC,27200002,CDM,,,,,,both,,,6056.7700,908.5200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3028.39,,,,,,,1563.2500,6056.7700,percent of total billed charges,"Rev 272 $6,056.77 in Billed Charges at 50% = $3,028.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 56MM LONG FULL BLADE 7053-56-20,272,RC,27200002,CDM,,,,,,both,,,6056.7700,908.5200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1956.34,,,,,,,1563.2500,6056.7700,other,"32.3% of $6,056.77 in Billed Charges for Rev 272 = $1,956.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE EXPLANT 56MM LONG FULL BLADE 7053-56-20,272,RC,27200002,CDM,,,,,,both,,,6056.7700,908.5200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1859.43,,,,,,,1563.2500,6056.7700,other,"30.7% of $6,056.77 in Billed Charges for Rev 272 = $1,859.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE EXPLANT 56MM LONG FULL BLADE 7053-56-20,272,RC,27200002,CDM,,,,,,both,,,6056.7700,908.5200,UNITED HEALTHCARE,UNITED HEALTHCARE,1956.34,,,,,,,1563.2500,6056.7700,percent of total billed charges,"32.3% of $6,056.77 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE EXPLANT 56MM LONG FULL BLADE 7053-56-20,272,RC,27200002,CDM,,,,,,both,,,6056.7700,908.5200,WELLCARE,WELLCARE MEDICAID,6056.77,,,,,,,1563.2500,6056.7700,percent of total billed charges,"100% of $6,056.77 in Billed Charges for Rev 272 = $6,056.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,2411.3600,361.7000,AETNA,AETNA,1029.65,,,,,,,622.3700,2411.3600,percent of total billed charges,"42.7% of $2,411.36 in Billed Charges for Rev 272 = $1,029.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,2411.3600,361.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1687.95,,,,,,,622.3700,2411.3600,percent of total billed charges,"Rev 272 $2,411.36 in Billed Charges at 70% = $1,687.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,2411.3600,361.7000,CIGNA HEALTHCARE,CIGNA HMO,1005.54,,,,,,,622.3700,2411.3600,percent of total billed charges,"41.7% of $2,411.36 in Billed Charges for Rev 272 = $1,005.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,2411.3600,361.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1118.87,,,,,,,622.3700,2411.3600,percent of total billed charges,"46.4% of $2,411.36 in Billed Charges for Rev 272 = $1,118.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,2411.3600,361.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1005.54,,,,,,,622.3700,2411.3600,percent of total billed charges,"41.7% of $2,411.36 in Billed Charges for Rev 272 = $1,005.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,2411.3600,361.7000,CIGNA HEALTHCARE,CIGNA PPO,1005.54,,,,,,,622.3700,2411.3600,percent of total billed charges,"41.7% of $2,411.36 in Billed Charges for Rev 272 = $1,005.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,2411.3600,361.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2170.22,,,,,,,622.3700,2411.3600,percent of total billed charges,"90% of $2,411.36 in Billed Charges for Rev 272 = $2,170.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,2411.3600,361.7000,MEDCOST,MEDCOST VHN,1147.57,,,,,,,622.3700,2411.3600,percent of total billed charges,"47.59% of $2,411.36 in Billed Charges for Rev 272 = $1,147.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,2411.3600,361.7000,SENTARA HEALTH,SENTARA HEALTH,622.37,,,,,,,622.3700,2411.3600,percent of total billed charges,"25.81% of $2,411.36 in Billed Charges for Rev 272 = $622.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,2411.3600,361.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2411.36,,,,,,,622.3700,2411.3600,percent of total billed charges,"100% of $2,411.36 in Billed Charges for Rev 272 = $2,411.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,2411.3600,361.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1205.68,,,,,,,622.3700,2411.3600,percent of total billed charges,"Rev 272 $2,411.36 in Billed Charges at 50% = $1,205.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,2411.3600,361.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,778.87,,,,,,,622.3700,2411.3600,other,"32.3% of $2,411.36 in Billed Charges for Rev 272 = $778.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR CARBIDE ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,2411.3600,361.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,740.29,,,,,,,622.3700,2411.3600,other,"30.7% of $2,411.36 in Billed Charges for Rev 272 = $740.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR CARBIDE ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,2411.3600,361.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,778.87,,,,,,,622.3700,2411.3600,percent of total billed charges,"32.3% of $2,411.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CARBIDE ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,2411.3600,361.7000,WELLCARE,WELLCARE MEDICAID,2411.36,,,,,,,622.3700,2411.3600,percent of total billed charges,"100% of $2,411.36 in Billed Charges for Rev 272 = $2,411.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CONICAL 4.3MM X 13MM,272,RC,27200002,CDM,,,,,,both,,,4324.7100,648.7100,AETNA,AETNA,1846.65,,,,,,,1116.2100,4324.7100,percent of total billed charges,"42.7% of $4,324.71 in Billed Charges for Rev 272 = $1,846.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CONICAL 4.3MM X 13MM,272,RC,27200002,CDM,,,,,,both,,,4324.7100,648.7100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3027.30,,,,,,,1116.2100,4324.7100,percent of total billed charges,"Rev 272 $4,324.71 in Billed Charges at 70% = $3,027.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CONICAL 4.3MM X 13MM,272,RC,27200002,CDM,,,,,,both,,,4324.7100,648.7100,CIGNA HEALTHCARE,CIGNA HMO,1803.40,,,,,,,1116.2100,4324.7100,percent of total billed charges,"41.7% of $4,324.71 in Billed Charges for Rev 272 = $1,803.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CONICAL 4.3MM X 13MM,272,RC,27200002,CDM,,,,,,both,,,4324.7100,648.7100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2006.67,,,,,,,1116.2100,4324.7100,percent of total billed charges,"46.4% of $4,324.71 in Billed Charges for Rev 272 = $2,006.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CONICAL 4.3MM X 13MM,272,RC,27200002,CDM,,,,,,both,,,4324.7100,648.7100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1803.40,,,,,,,1116.2100,4324.7100,percent of total billed charges,"41.7% of $4,324.71 in Billed Charges for Rev 272 = $1,803.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CONICAL 4.3MM X 13MM,272,RC,27200002,CDM,,,,,,both,,,4324.7100,648.7100,CIGNA HEALTHCARE,CIGNA PPO,1803.40,,,,,,,1116.2100,4324.7100,percent of total billed charges,"41.7% of $4,324.71 in Billed Charges for Rev 272 = $1,803.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CONICAL 4.3MM X 13MM,272,RC,27200002,CDM,,,,,,both,,,4324.7100,648.7100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3892.24,,,,,,,1116.2100,4324.7100,percent of total billed charges,"90% of $4,324.71 in Billed Charges for Rev 272 = $3,892.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CONICAL 4.3MM X 13MM,272,RC,27200002,CDM,,,,,,both,,,4324.7100,648.7100,MEDCOST,MEDCOST VHN,2058.13,,,,,,,1116.2100,4324.7100,percent of total billed charges,"47.59% of $4,324.71 in Billed Charges for Rev 272 = $2,058.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CONICAL 4.3MM X 13MM,272,RC,27200002,CDM,,,,,,both,,,4324.7100,648.7100,SENTARA HEALTH,SENTARA HEALTH,1116.21,,,,,,,1116.2100,4324.7100,percent of total billed charges,"25.81% of $4,324.71 in Billed Charges for Rev 272 = $1,116.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CONICAL 4.3MM X 13MM,272,RC,27200002,CDM,,,,,,both,,,4324.7100,648.7100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4324.71,,,,,,,1116.2100,4324.7100,percent of total billed charges,"100% of $4,324.71 in Billed Charges for Rev 272 = $4,324.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CONICAL 4.3MM X 13MM,272,RC,27200002,CDM,,,,,,both,,,4324.7100,648.7100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2162.36,,,,,,,1116.2100,4324.7100,percent of total billed charges,"Rev 272 $4,324.71 in Billed Charges at 50% = $2,162.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CONICAL 4.3MM X 13MM,272,RC,27200002,CDM,,,,,,both,,,4324.7100,648.7100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1396.88,,,,,,,1116.2100,4324.7100,other,"32.3% of $4,324.71 in Billed Charges for Rev 272 = $1,396.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR CONICAL 4.3MM X 13MM,272,RC,27200002,CDM,,,,,,both,,,4324.7100,648.7100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1327.69,,,,,,,1116.2100,4324.7100,other,"30.7% of $4,324.71 in Billed Charges for Rev 272 = $1,327.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR CONICAL 4.3MM X 13MM,272,RC,27200002,CDM,,,,,,both,,,4324.7100,648.7100,UNITED HEALTHCARE,UNITED HEALTHCARE,1396.88,,,,,,,1116.2100,4324.7100,percent of total billed charges,"32.3% of $4,324.71 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CONICAL 4.3MM X 13MM,272,RC,27200002,CDM,,,,,,both,,,4324.7100,648.7100,WELLCARE,WELLCARE MEDICAID,4324.71,,,,,,,1116.2100,4324.7100,percent of total billed charges,"100% of $4,324.71 in Billed Charges for Rev 272 = $4,324.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING 10CM,272,RC,27200002,CDM,,,,,,both,,,2077.2100,311.5800,AETNA,AETNA,886.97,,,,,,,536.1300,2077.2100,percent of total billed charges,"42.7% of $2,077.21 in Billed Charges for Rev 272 = $886.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING 10CM,272,RC,27200002,CDM,,,,,,both,,,2077.2100,311.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1454.05,,,,,,,536.1300,2077.2100,percent of total billed charges,"Rev 272 $2,077.21 in Billed Charges at 70% = $1,454.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING 10CM,272,RC,27200002,CDM,,,,,,both,,,2077.2100,311.5800,CIGNA HEALTHCARE,CIGNA HMO,866.20,,,,,,,536.1300,2077.2100,percent of total billed charges,"41.7% of $2,077.21 in Billed Charges for Rev 272 = $866.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING 10CM,272,RC,27200002,CDM,,,,,,both,,,2077.2100,311.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,963.83,,,,,,,536.1300,2077.2100,percent of total billed charges,"46.4% of $2,077.21 in Billed Charges for Rev 272 = $963.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING 10CM,272,RC,27200002,CDM,,,,,,both,,,2077.2100,311.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,866.20,,,,,,,536.1300,2077.2100,percent of total billed charges,"41.7% of $2,077.21 in Billed Charges for Rev 272 = $866.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING 10CM,272,RC,27200002,CDM,,,,,,both,,,2077.2100,311.5800,CIGNA HEALTHCARE,CIGNA PPO,866.20,,,,,,,536.1300,2077.2100,percent of total billed charges,"41.7% of $2,077.21 in Billed Charges for Rev 272 = $866.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING 10CM,272,RC,27200002,CDM,,,,,,both,,,2077.2100,311.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1869.49,,,,,,,536.1300,2077.2100,percent of total billed charges,"90% of $2,077.21 in Billed Charges for Rev 272 = $1,869.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING 10CM,272,RC,27200002,CDM,,,,,,both,,,2077.2100,311.5800,MEDCOST,MEDCOST VHN,988.54,,,,,,,536.1300,2077.2100,percent of total billed charges,"47.59% of $2,077.21 in Billed Charges for Rev 272 = $988.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING 10CM,272,RC,27200002,CDM,,,,,,both,,,2077.2100,311.5800,SENTARA HEALTH,SENTARA HEALTH,536.13,,,,,,,536.1300,2077.2100,percent of total billed charges,"25.81% of $2,077.21 in Billed Charges for Rev 272 = $536.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING 10CM,272,RC,27200002,CDM,,,,,,both,,,2077.2100,311.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2077.21,,,,,,,536.1300,2077.2100,percent of total billed charges,"100% of $2,077.21 in Billed Charges for Rev 272 = $2,077.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING 10CM,272,RC,27200002,CDM,,,,,,both,,,2077.2100,311.5800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1038.61,,,,,,,536.1300,2077.2100,percent of total billed charges,"Rev 272 $2,077.21 in Billed Charges at 50% = $1,038.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING 10CM,272,RC,27200002,CDM,,,,,,both,,,2077.2100,311.5800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,670.94,,,,,,,536.1300,2077.2100,other,"32.3% of $2,077.21 in Billed Charges for Rev 272 = $670.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR CUTTING 10CM,272,RC,27200002,CDM,,,,,,both,,,2077.2100,311.5800,UNITED HEALTHCARE,UHC HERITAGE SELECT,637.70,,,,,,,536.1300,2077.2100,other,"30.7% of $2,077.21 in Billed Charges for Rev 272 = $637.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR CUTTING 10CM,272,RC,27200002,CDM,,,,,,both,,,2077.2100,311.5800,UNITED HEALTHCARE,UNITED HEALTHCARE,670.94,,,,,,,536.1300,2077.2100,percent of total billed charges,"32.3% of $2,077.21 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING 10CM,272,RC,27200002,CDM,,,,,,both,,,2077.2100,311.5800,WELLCARE,WELLCARE MEDICAID,2077.21,,,,,,,536.1300,2077.2100,percent of total billed charges,"100% of $2,077.21 in Billed Charges for Rev 272 = $2,077.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2210.1600,331.5200,AETNA,AETNA,943.74,,,,,,,570.4400,2210.1600,percent of total billed charges,"42.7% of $2,210.16 in Billed Charges for Rev 272 = $943.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2210.1600,331.5200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1547.11,,,,,,,570.4400,2210.1600,percent of total billed charges,"Rev 272 $2,210.16 in Billed Charges at 70% = $1,547.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2210.1600,331.5200,CIGNA HEALTHCARE,CIGNA HMO,921.64,,,,,,,570.4400,2210.1600,percent of total billed charges,"41.7% of $2,210.16 in Billed Charges for Rev 272 = $921.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2210.1600,331.5200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1025.51,,,,,,,570.4400,2210.1600,percent of total billed charges,"46.4% of $2,210.16 in Billed Charges for Rev 272 = $1,025.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2210.1600,331.5200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,921.64,,,,,,,570.4400,2210.1600,percent of total billed charges,"41.7% of $2,210.16 in Billed Charges for Rev 272 = $921.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2210.1600,331.5200,CIGNA HEALTHCARE,CIGNA PPO,921.64,,,,,,,570.4400,2210.1600,percent of total billed charges,"41.7% of $2,210.16 in Billed Charges for Rev 272 = $921.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2210.1600,331.5200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1989.14,,,,,,,570.4400,2210.1600,percent of total billed charges,"90% of $2,210.16 in Billed Charges for Rev 272 = $1,989.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2210.1600,331.5200,MEDCOST,MEDCOST VHN,1051.82,,,,,,,570.4400,2210.1600,percent of total billed charges,"47.59% of $2,210.16 in Billed Charges for Rev 272 = $1,051.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2210.1600,331.5200,SENTARA HEALTH,SENTARA HEALTH,570.44,,,,,,,570.4400,2210.1600,percent of total billed charges,"25.81% of $2,210.16 in Billed Charges for Rev 272 = $570.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2210.1600,331.5200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2210.16,,,,,,,570.4400,2210.1600,percent of total billed charges,"100% of $2,210.16 in Billed Charges for Rev 272 = $2,210.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2210.1600,331.5200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1105.08,,,,,,,570.4400,2210.1600,percent of total billed charges,"Rev 272 $2,210.16 in Billed Charges at 50% = $1,105.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2210.1600,331.5200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,713.88,,,,,,,570.4400,2210.1600,other,"32.3% of $2,210.16 in Billed Charges for Rev 272 = $713.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR CUTTING MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2210.1600,331.5200,UNITED HEALTHCARE,UHC HERITAGE SELECT,678.52,,,,,,,570.4400,2210.1600,other,"30.7% of $2,210.16 in Billed Charges for Rev 272 = $678.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR CUTTING MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2210.1600,331.5200,UNITED HEALTHCARE,UNITED HEALTHCARE,713.88,,,,,,,570.4400,2210.1600,percent of total billed charges,"32.3% of $2,210.16 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR CUTTING MATCHEAD 2.5MM,272,RC,,,,,,,,both,,,2210.1600,331.5200,WELLCARE,WELLCARE MEDICAID,2210.16,,,,,,,570.4400,2210.1600,percent of total billed charges,"100% of $2,210.16 in Billed Charges for Rev 272 = $2,210.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW MAKO MICS NARROW STERILE,272,RC,27200002,CDM,,,,,,both,,,1581.5800,237.2400,AETNA,AETNA,675.33,,,,,,,408.2100,1581.5800,percent of total billed charges,"42.7% of $1,581.58 in Billed Charges for Rev 272 = $675.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW MAKO MICS NARROW STERILE,272,RC,27200002,CDM,,,,,,both,,,1581.5800,237.2400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1107.11,,,,,,,408.2100,1581.5800,percent of total billed charges,"Rev 272 $1,581.58 in Billed Charges at 70% = $1,107.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW MAKO MICS NARROW STERILE,272,RC,27200002,CDM,,,,,,both,,,1581.5800,237.2400,CIGNA HEALTHCARE,CIGNA HMO,659.52,,,,,,,408.2100,1581.5800,percent of total billed charges,"41.7% of $1,581.58 in Billed Charges for Rev 272 = $659.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW MAKO MICS NARROW STERILE,272,RC,27200002,CDM,,,,,,both,,,1581.5800,237.2400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,733.85,,,,,,,408.2100,1581.5800,percent of total billed charges,"46.4% of $1,581.58 in Billed Charges for Rev 272 = $733.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW MAKO MICS NARROW STERILE,272,RC,27200002,CDM,,,,,,both,,,1581.5800,237.2400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,659.52,,,,,,,408.2100,1581.5800,percent of total billed charges,"41.7% of $1,581.58 in Billed Charges for Rev 272 = $659.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW MAKO MICS NARROW STERILE,272,RC,27200002,CDM,,,,,,both,,,1581.5800,237.2400,CIGNA HEALTHCARE,CIGNA PPO,659.52,,,,,,,408.2100,1581.5800,percent of total billed charges,"41.7% of $1,581.58 in Billed Charges for Rev 272 = $659.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW MAKO MICS NARROW STERILE,272,RC,27200002,CDM,,,,,,both,,,1581.5800,237.2400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1423.42,,,,,,,408.2100,1581.5800,percent of total billed charges,"90% of $1,581.58 in Billed Charges for Rev 272 = $1,423.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW MAKO MICS NARROW STERILE,272,RC,27200002,CDM,,,,,,both,,,1581.5800,237.2400,MEDCOST,MEDCOST VHN,752.67,,,,,,,408.2100,1581.5800,percent of total billed charges,"47.59% of $1,581.58 in Billed Charges for Rev 272 = $752.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW MAKO MICS NARROW STERILE,272,RC,27200002,CDM,,,,,,both,,,1581.5800,237.2400,SENTARA HEALTH,SENTARA HEALTH,408.21,,,,,,,408.2100,1581.5800,percent of total billed charges,"25.81% of $1,581.58 in Billed Charges for Rev 272 = $408.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW MAKO MICS NARROW STERILE,272,RC,27200002,CDM,,,,,,both,,,1581.5800,237.2400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1581.58,,,,,,,408.2100,1581.5800,percent of total billed charges,"100% of $1,581.58 in Billed Charges for Rev 272 = $1,581.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW MAKO MICS NARROW STERILE,272,RC,27200002,CDM,,,,,,both,,,1581.5800,237.2400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,790.79,,,,,,,408.2100,1581.5800,percent of total billed charges,"Rev 272 $1,581.58 in Billed Charges at 50% = $790.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW MAKO MICS NARROW STERILE,272,RC,27200002,CDM,,,,,,both,,,1581.5800,237.2400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,510.85,,,,,,,408.2100,1581.5800,other,"32.3% of $1,581.58 in Billed Charges for Rev 272 = $510.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SAW MAKO MICS NARROW STERILE,272,RC,27200002,CDM,,,,,,both,,,1581.5800,237.2400,UNITED HEALTHCARE,UHC HERITAGE SELECT,485.55,,,,,,,408.2100,1581.5800,other,"30.7% of $1,581.58 in Billed Charges for Rev 272 = $485.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SAW MAKO MICS NARROW STERILE,272,RC,27200002,CDM,,,,,,both,,,1581.5800,237.2400,UNITED HEALTHCARE,UNITED HEALTHCARE,510.85,,,,,,,408.2100,1581.5800,percent of total billed charges,"32.3% of $1,581.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW MAKO MICS NARROW STERILE,272,RC,27200002,CDM,,,,,,both,,,1581.5800,237.2400,WELLCARE,WELLCARE MEDICAID,1581.58,,,,,,,408.2100,1581.5800,percent of total billed charges,"100% of $1,581.58 in Billed Charges for Rev 272 = $1,581.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AQUAMANTYS 2.3 BIPOLAR SEALER,272,RC,27200002,CDM,,,,,,both,,,8390.1400,1258.5200,AETNA,AETNA,3582.59,,,,,,,2165.5000,8390.1400,percent of total billed charges,"42.7% of $8,390.14 in Billed Charges for Rev 272 = $3,582.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AQUAMANTYS 2.3 BIPOLAR SEALER,272,RC,27200002,CDM,,,,,,both,,,8390.1400,1258.5200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5873.10,,,,,,,2165.5000,8390.1400,percent of total billed charges,"Rev 272 $8,390.14 in Billed Charges at 70% = $5,873.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AQUAMANTYS 2.3 BIPOLAR SEALER,272,RC,27200002,CDM,,,,,,both,,,8390.1400,1258.5200,CIGNA HEALTHCARE,CIGNA HMO,3498.69,,,,,,,2165.5000,8390.1400,percent of total billed charges,"41.7% of $8,390.14 in Billed Charges for Rev 272 = $3,498.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AQUAMANTYS 2.3 BIPOLAR SEALER,272,RC,27200002,CDM,,,,,,both,,,8390.1400,1258.5200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3893.03,,,,,,,2165.5000,8390.1400,percent of total billed charges,"46.4% of $8,390.14 in Billed Charges for Rev 272 = $3,893.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AQUAMANTYS 2.3 BIPOLAR SEALER,272,RC,27200002,CDM,,,,,,both,,,8390.1400,1258.5200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3498.69,,,,,,,2165.5000,8390.1400,percent of total billed charges,"41.7% of $8,390.14 in Billed Charges for Rev 272 = $3,498.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AQUAMANTYS 2.3 BIPOLAR SEALER,272,RC,27200002,CDM,,,,,,both,,,8390.1400,1258.5200,CIGNA HEALTHCARE,CIGNA PPO,3498.69,,,,,,,2165.5000,8390.1400,percent of total billed charges,"41.7% of $8,390.14 in Billed Charges for Rev 272 = $3,498.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AQUAMANTYS 2.3 BIPOLAR SEALER,272,RC,27200002,CDM,,,,,,both,,,8390.1400,1258.5200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7551.13,,,,,,,2165.5000,8390.1400,percent of total billed charges,"90% of $8,390.14 in Billed Charges for Rev 272 = $7,551.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AQUAMANTYS 2.3 BIPOLAR SEALER,272,RC,27200002,CDM,,,,,,both,,,8390.1400,1258.5200,MEDCOST,MEDCOST VHN,3992.87,,,,,,,2165.5000,8390.1400,percent of total billed charges,"47.59% of $8,390.14 in Billed Charges for Rev 272 = $3,992.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AQUAMANTYS 2.3 BIPOLAR SEALER,272,RC,27200002,CDM,,,,,,both,,,8390.1400,1258.5200,SENTARA HEALTH,SENTARA HEALTH,2165.50,,,,,,,2165.5000,8390.1400,percent of total billed charges,"25.81% of $8,390.14 in Billed Charges for Rev 272 = $2,165.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AQUAMANTYS 2.3 BIPOLAR SEALER,272,RC,27200002,CDM,,,,,,both,,,8390.1400,1258.5200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8390.14,,,,,,,2165.5000,8390.1400,percent of total billed charges,"100% of $8,390.14 in Billed Charges for Rev 272 = $8,390.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AQUAMANTYS 2.3 BIPOLAR SEALER,272,RC,27200002,CDM,,,,,,both,,,8390.1400,1258.5200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4195.07,,,,,,,2165.5000,8390.1400,percent of total billed charges,"Rev 272 $8,390.14 in Billed Charges at 50% = $4,195.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AQUAMANTYS 2.3 BIPOLAR SEALER,272,RC,27200002,CDM,,,,,,both,,,8390.1400,1258.5200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2710.02,,,,,,,2165.5000,8390.1400,other,"32.3% of $8,390.14 in Billed Charges for Rev 272 = $2,710.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
AQUAMANTYS 2.3 BIPOLAR SEALER,272,RC,27200002,CDM,,,,,,both,,,8390.1400,1258.5200,UNITED HEALTHCARE,UHC HERITAGE SELECT,2575.77,,,,,,,2165.5000,8390.1400,other,"30.7% of $8,390.14 in Billed Charges for Rev 272 = $2,575.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
AQUAMANTYS 2.3 BIPOLAR SEALER,272,RC,27200002,CDM,,,,,,both,,,8390.1400,1258.5200,UNITED HEALTHCARE,UNITED HEALTHCARE,2710.02,,,,,,,2165.5000,8390.1400,percent of total billed charges,"32.3% of $8,390.14 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AQUAMANTYS 2.3 BIPOLAR SEALER,272,RC,27200002,CDM,,,,,,both,,,8390.1400,1258.5200,WELLCARE,WELLCARE MEDICAID,8390.14,,,,,,,2165.5000,8390.1400,percent of total billed charges,"100% of $8,390.14 in Billed Charges for Rev 272 = $8,390.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW UNI 5627-89-501,272,RC,,,,,,,,both,,,863.3900,129.5100,AETNA,AETNA,368.67,,,,,,,222.8400,863.3900,percent of total billed charges,42.7% of $863.39 in Billed Charges for Rev 272 = $368.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW UNI 5627-89-501,272,RC,,,,,,,,both,,,863.3900,129.5100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,604.37,,,,,,,222.8400,863.3900,percent of total billed charges,Rev 272 $863.39 in Billed Charges at 70% = $604.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW UNI 5627-89-501,272,RC,,,,,,,,both,,,863.3900,129.5100,CIGNA HEALTHCARE,CIGNA HMO,360.03,,,,,,,222.8400,863.3900,percent of total billed charges,41.7% of $863.39 in Billed Charges for Rev 272 = $360.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW UNI 5627-89-501,272,RC,,,,,,,,both,,,863.3900,129.5100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,400.61,,,,,,,222.8400,863.3900,percent of total billed charges,46.4% of $863.39 in Billed Charges for Rev 272 = $400.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW UNI 5627-89-501,272,RC,,,,,,,,both,,,863.3900,129.5100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,360.03,,,,,,,222.8400,863.3900,percent of total billed charges,41.7% of $863.39 in Billed Charges for Rev 272 = $360.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW UNI 5627-89-501,272,RC,,,,,,,,both,,,863.3900,129.5100,CIGNA HEALTHCARE,CIGNA PPO,360.03,,,,,,,222.8400,863.3900,percent of total billed charges,41.7% of $863.39 in Billed Charges for Rev 272 = $360.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW UNI 5627-89-501,272,RC,,,,,,,,both,,,863.3900,129.5100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,777.05,,,,,,,222.8400,863.3900,percent of total billed charges,90% of $863.39 in Billed Charges for Rev 272 = $777.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW UNI 5627-89-501,272,RC,,,,,,,,both,,,863.3900,129.5100,MEDCOST,MEDCOST VHN,410.89,,,,,,,222.8400,863.3900,percent of total billed charges,47.59% of $863.39 in Billed Charges for Rev 272 = $410.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW UNI 5627-89-501,272,RC,,,,,,,,both,,,863.3900,129.5100,SENTARA HEALTH,SENTARA HEALTH,222.84,,,,,,,222.8400,863.3900,percent of total billed charges,25.81% of $863.39 in Billed Charges for Rev 272 = $222.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW UNI 5627-89-501,272,RC,,,,,,,,both,,,863.3900,129.5100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",863.39,,,,,,,222.8400,863.3900,percent of total billed charges,100% of $863.39 in Billed Charges for Rev 272 = $863.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW UNI 5627-89-501,272,RC,,,,,,,,both,,,863.3900,129.5100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,431.70,,,,,,,222.8400,863.3900,percent of total billed charges,Rev 272 $863.39 in Billed Charges at 50% = $431.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW UNI 5627-89-501,272,RC,,,,,,,,both,,,863.3900,129.5100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,278.88,,,,,,,222.8400,863.3900,other,32.3% of $863.39 in Billed Charges for Rev 272 = $278.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE SAW UNI 5627-89-501,272,RC,,,,,,,,both,,,863.3900,129.5100,UNITED HEALTHCARE,UHC HERITAGE SELECT,265.06,,,,,,,222.8400,863.3900,other,30.7% of $863.39 in Billed Charges for Rev 272 = $265.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE SAW UNI 5627-89-501,272,RC,,,,,,,,both,,,863.3900,129.5100,UNITED HEALTHCARE,UNITED HEALTHCARE,278.88,,,,,,,222.8400,863.3900,percent of total billed charges,32.3% of $863.39 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW UNI 5627-89-501,272,RC,,,,,,,,both,,,863.3900,129.5100,WELLCARE,WELLCARE MEDICAID,863.39,,,,,,,222.8400,863.3900,percent of total billed charges,100% of $863.39 in Billed Charges for Rev 272 = $863.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SCREWDRIVER,272,RC,,,,,,,,both,,,3573.4800,536.0200,AETNA,AETNA,1525.88,,,,,,,922.3200,3573.4800,percent of total billed charges,"42.7% of $3,573.48 in Billed Charges for Rev 272 = $1,525.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER,272,RC,,,,,,,,both,,,3573.4800,536.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2501.44,,,,,,,922.3200,3573.4800,percent of total billed charges,"Rev 272 $3,573.48 in Billed Charges at 70% = $2,501.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER,272,RC,,,,,,,,both,,,3573.4800,536.0200,CIGNA HEALTHCARE,CIGNA HMO,1490.14,,,,,,,922.3200,3573.4800,percent of total billed charges,"41.7% of $3,573.48 in Billed Charges for Rev 272 = $1,490.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER,272,RC,,,,,,,,both,,,3573.4800,536.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1658.09,,,,,,,922.3200,3573.4800,percent of total billed charges,"46.4% of $3,573.48 in Billed Charges for Rev 272 = $1,658.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER,272,RC,,,,,,,,both,,,3573.4800,536.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1490.14,,,,,,,922.3200,3573.4800,percent of total billed charges,"41.7% of $3,573.48 in Billed Charges for Rev 272 = $1,490.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER,272,RC,,,,,,,,both,,,3573.4800,536.0200,CIGNA HEALTHCARE,CIGNA PPO,1490.14,,,,,,,922.3200,3573.4800,percent of total billed charges,"41.7% of $3,573.48 in Billed Charges for Rev 272 = $1,490.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER,272,RC,,,,,,,,both,,,3573.4800,536.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3216.13,,,,,,,922.3200,3573.4800,percent of total billed charges,"90% of $3,573.48 in Billed Charges for Rev 272 = $3,216.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER,272,RC,,,,,,,,both,,,3573.4800,536.0200,MEDCOST,MEDCOST VHN,1700.62,,,,,,,922.3200,3573.4800,percent of total billed charges,"47.59% of $3,573.48 in Billed Charges for Rev 272 = $1,700.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER,272,RC,,,,,,,,both,,,3573.4800,536.0200,SENTARA HEALTH,SENTARA HEALTH,922.32,,,,,,,922.3200,3573.4800,percent of total billed charges,"25.81% of $3,573.48 in Billed Charges for Rev 272 = $922.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER,272,RC,,,,,,,,both,,,3573.4800,536.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3573.48,,,,,,,922.3200,3573.4800,percent of total billed charges,"100% of $3,573.48 in Billed Charges for Rev 272 = $3,573.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER,272,RC,,,,,,,,both,,,3573.4800,536.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1786.74,,,,,,,922.3200,3573.4800,percent of total billed charges,"Rev 272 $3,573.48 in Billed Charges at 50% = $1,786.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER,272,RC,,,,,,,,both,,,3573.4800,536.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1154.23,,,,,,,922.3200,3573.4800,other,"32.3% of $3,573.48 in Billed Charges for Rev 272 = $1,154.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SCREWDRIVER,272,RC,,,,,,,,both,,,3573.4800,536.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1097.06,,,,,,,922.3200,3573.4800,other,"30.7% of $3,573.48 in Billed Charges for Rev 272 = $1,097.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SCREWDRIVER,272,RC,,,,,,,,both,,,3573.4800,536.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,1154.23,,,,,,,922.3200,3573.4800,percent of total billed charges,"32.3% of $3,573.48 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER,272,RC,,,,,,,,both,,,3573.4800,536.0200,WELLCARE,WELLCARE MEDICAID,3573.48,,,,,,,922.3200,3573.4800,percent of total billed charges,"100% of $3,573.48 in Billed Charges for Rev 272 = $3,573.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ARTHROWAND ENT PROCISE XP CBL EICA8872-01,272,RC,27200002,CDM,,,,,,both,,,3531.7400,529.7600,AETNA,AETNA,1508.05,,,,,,,911.5400,3531.7400,percent of total billed charges,"42.7% of $3,531.74 in Billed Charges for Rev 272 = $1,508.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ARTHROWAND ENT PROCISE XP CBL EICA8872-01,272,RC,27200002,CDM,,,,,,both,,,3531.7400,529.7600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2472.22,,,,,,,911.5400,3531.7400,percent of total billed charges,"Rev 272 $3,531.74 in Billed Charges at 70% = $2,472.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ARTHROWAND ENT PROCISE XP CBL EICA8872-01,272,RC,27200002,CDM,,,,,,both,,,3531.7400,529.7600,CIGNA HEALTHCARE,CIGNA HMO,1472.74,,,,,,,911.5400,3531.7400,percent of total billed charges,"41.7% of $3,531.74 in Billed Charges for Rev 272 = $1,472.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ARTHROWAND ENT PROCISE XP CBL EICA8872-01,272,RC,27200002,CDM,,,,,,both,,,3531.7400,529.7600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1638.73,,,,,,,911.5400,3531.7400,percent of total billed charges,"46.4% of $3,531.74 in Billed Charges for Rev 272 = $1,638.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ARTHROWAND ENT PROCISE XP CBL EICA8872-01,272,RC,27200002,CDM,,,,,,both,,,3531.7400,529.7600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1472.74,,,,,,,911.5400,3531.7400,percent of total billed charges,"41.7% of $3,531.74 in Billed Charges for Rev 272 = $1,472.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ARTHROWAND ENT PROCISE XP CBL EICA8872-01,272,RC,27200002,CDM,,,,,,both,,,3531.7400,529.7600,CIGNA HEALTHCARE,CIGNA PPO,1472.74,,,,,,,911.5400,3531.7400,percent of total billed charges,"41.7% of $3,531.74 in Billed Charges for Rev 272 = $1,472.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ARTHROWAND ENT PROCISE XP CBL EICA8872-01,272,RC,27200002,CDM,,,,,,both,,,3531.7400,529.7600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3178.57,,,,,,,911.5400,3531.7400,percent of total billed charges,"90% of $3,531.74 in Billed Charges for Rev 272 = $3,178.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ARTHROWAND ENT PROCISE XP CBL EICA8872-01,272,RC,27200002,CDM,,,,,,both,,,3531.7400,529.7600,MEDCOST,MEDCOST VHN,1680.76,,,,,,,911.5400,3531.7400,percent of total billed charges,"47.59% of $3,531.74 in Billed Charges for Rev 272 = $1,680.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ARTHROWAND ENT PROCISE XP CBL EICA8872-01,272,RC,27200002,CDM,,,,,,both,,,3531.7400,529.7600,SENTARA HEALTH,SENTARA HEALTH,911.54,,,,,,,911.5400,3531.7400,percent of total billed charges,"25.81% of $3,531.74 in Billed Charges for Rev 272 = $911.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ARTHROWAND ENT PROCISE XP CBL EICA8872-01,272,RC,27200002,CDM,,,,,,both,,,3531.7400,529.7600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3531.74,,,,,,,911.5400,3531.7400,percent of total billed charges,"100% of $3,531.74 in Billed Charges for Rev 272 = $3,531.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ARTHROWAND ENT PROCISE XP CBL EICA8872-01,272,RC,27200002,CDM,,,,,,both,,,3531.7400,529.7600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1765.87,,,,,,,911.5400,3531.7400,percent of total billed charges,"Rev 272 $3,531.74 in Billed Charges at 50% = $1,765.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ARTHROWAND ENT PROCISE XP CBL EICA8872-01,272,RC,27200002,CDM,,,,,,both,,,3531.7400,529.7600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1140.75,,,,,,,911.5400,3531.7400,other,"32.3% of $3,531.74 in Billed Charges for Rev 272 = $1,140.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ARTHROWAND ENT PROCISE XP CBL EICA8872-01,272,RC,27200002,CDM,,,,,,both,,,3531.7400,529.7600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1084.24,,,,,,,911.5400,3531.7400,other,"30.7% of $3,531.74 in Billed Charges for Rev 272 = $1,084.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ARTHROWAND ENT PROCISE XP CBL EICA8872-01,272,RC,27200002,CDM,,,,,,both,,,3531.7400,529.7600,UNITED HEALTHCARE,UNITED HEALTHCARE,1140.75,,,,,,,911.5400,3531.7400,percent of total billed charges,"32.3% of $3,531.74 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ARTHROWAND ENT PROCISE XP CBL EICA8872-01,272,RC,27200002,CDM,,,,,,both,,,3531.7400,529.7600,WELLCARE,WELLCARE MEDICAID,3531.74,,,,,,,911.5400,3531.7400,percent of total billed charges,"100% of $3,531.74 in Billed Charges for Rev 272 = $3,531.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE 4 BRONCHO SAMP SET LG,272,RC,,,,,,,,both,,,2644.6100,396.6900,AETNA,AETNA,1129.25,,,,,,,682.5700,2644.6100,percent of total billed charges,"42.7% of $2,644.61 in Billed Charges for Rev 272 = $1,129.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE 4 BRONCHO SAMP SET LG,272,RC,,,,,,,,both,,,2644.6100,396.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1851.23,,,,,,,682.5700,2644.6100,percent of total billed charges,"Rev 272 $2,644.61 in Billed Charges at 70% = $1,851.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE 4 BRONCHO SAMP SET LG,272,RC,,,,,,,,both,,,2644.6100,396.6900,CIGNA HEALTHCARE,CIGNA HMO,1102.80,,,,,,,682.5700,2644.6100,percent of total billed charges,"41.7% of $2,644.61 in Billed Charges for Rev 272 = $1,102.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE 4 BRONCHO SAMP SET LG,272,RC,,,,,,,,both,,,2644.6100,396.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1227.10,,,,,,,682.5700,2644.6100,percent of total billed charges,"46.4% of $2,644.61 in Billed Charges for Rev 272 = $1,227.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE 4 BRONCHO SAMP SET LG,272,RC,,,,,,,,both,,,2644.6100,396.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1102.80,,,,,,,682.5700,2644.6100,percent of total billed charges,"41.7% of $2,644.61 in Billed Charges for Rev 272 = $1,102.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE 4 BRONCHO SAMP SET LG,272,RC,,,,,,,,both,,,2644.6100,396.6900,CIGNA HEALTHCARE,CIGNA PPO,1102.80,,,,,,,682.5700,2644.6100,percent of total billed charges,"41.7% of $2,644.61 in Billed Charges for Rev 272 = $1,102.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE 4 BRONCHO SAMP SET LG,272,RC,,,,,,,,both,,,2644.6100,396.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2380.15,,,,,,,682.5700,2644.6100,percent of total billed charges,"90% of $2,644.61 in Billed Charges for Rev 272 = $2,380.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE 4 BRONCHO SAMP SET LG,272,RC,,,,,,,,both,,,2644.6100,396.6900,MEDCOST,MEDCOST VHN,1258.57,,,,,,,682.5700,2644.6100,percent of total billed charges,"47.59% of $2,644.61 in Billed Charges for Rev 272 = $1,258.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE 4 BRONCHO SAMP SET LG,272,RC,,,,,,,,both,,,2644.6100,396.6900,SENTARA HEALTH,SENTARA HEALTH,682.57,,,,,,,682.5700,2644.6100,percent of total billed charges,"25.81% of $2,644.61 in Billed Charges for Rev 272 = $682.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE 4 BRONCHO SAMP SET LG,272,RC,,,,,,,,both,,,2644.6100,396.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2644.61,,,,,,,682.5700,2644.6100,percent of total billed charges,"100% of $2,644.61 in Billed Charges for Rev 272 = $2,644.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE 4 BRONCHO SAMP SET LG,272,RC,,,,,,,,both,,,2644.6100,396.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1322.31,,,,,,,682.5700,2644.6100,percent of total billed charges,"Rev 272 $2,644.61 in Billed Charges at 50% = $1,322.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE 4 BRONCHO SAMP SET LG,272,RC,,,,,,,,both,,,2644.6100,396.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,854.21,,,,,,,682.5700,2644.6100,other,"32.3% of $2,644.61 in Billed Charges for Rev 272 = $854.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ASCOPE 4 BRONCHO SAMP SET LG,272,RC,,,,,,,,both,,,2644.6100,396.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,811.90,,,,,,,682.5700,2644.6100,other,"30.7% of $2,644.61 in Billed Charges for Rev 272 = $811.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ASCOPE 4 BRONCHO SAMP SET LG,272,RC,,,,,,,,both,,,2644.6100,396.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,854.21,,,,,,,682.5700,2644.6100,percent of total billed charges,"32.3% of $2,644.61 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASCOPE 4 BRONCHO SAMP SET LG,272,RC,,,,,,,,both,,,2644.6100,396.6900,WELLCARE,WELLCARE MEDICAID,2644.61,,,,,,,682.5700,2644.6100,percent of total billed charges,"100% of $2,644.61 in Billed Charges for Rev 272 = $2,644.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,427.5400,64.1300,AETNA,AETNA,182.56,,,,,,,110.3500,427.5400,percent of total billed charges,42.7% of $427.54 in Billed Charges for Rev 272 = $182.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,427.5400,64.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,299.28,,,,,,,110.3500,427.5400,percent of total billed charges,Rev 272 $427.54 in Billed Charges at 70% = $299.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,427.5400,64.1300,CIGNA HEALTHCARE,CIGNA HMO,178.28,,,,,,,110.3500,427.5400,percent of total billed charges,41.7% of $427.54 in Billed Charges for Rev 272 = $178.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,427.5400,64.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,198.38,,,,,,,110.3500,427.5400,percent of total billed charges,46.4% of $427.54 in Billed Charges for Rev 272 = $198.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,427.5400,64.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,178.28,,,,,,,110.3500,427.5400,percent of total billed charges,41.7% of $427.54 in Billed Charges for Rev 272 = $178.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,427.5400,64.1300,CIGNA HEALTHCARE,CIGNA PPO,178.28,,,,,,,110.3500,427.5400,percent of total billed charges,41.7% of $427.54 in Billed Charges for Rev 272 = $178.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,427.5400,64.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,384.79,,,,,,,110.3500,427.5400,percent of total billed charges,90% of $427.54 in Billed Charges for Rev 272 = $384.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,427.5400,64.1300,MEDCOST,MEDCOST VHN,203.47,,,,,,,110.3500,427.5400,percent of total billed charges,47.59% of $427.54 in Billed Charges for Rev 272 = $203.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,427.5400,64.1300,SENTARA HEALTH,SENTARA HEALTH,110.35,,,,,,,110.3500,427.5400,percent of total billed charges,25.81% of $427.54 in Billed Charges for Rev 272 = $110.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,427.5400,64.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",427.54,,,,,,,110.3500,427.5400,percent of total billed charges,100% of $427.54 in Billed Charges for Rev 272 = $427.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,427.5400,64.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,213.77,,,,,,,110.3500,427.5400,percent of total billed charges,Rev 272 $427.54 in Billed Charges at 50% = $213.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,427.5400,64.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,138.10,,,,,,,110.3500,427.5400,other,32.3% of $427.54 in Billed Charges for Rev 272 = $138.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,427.5400,64.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,131.25,,,,,,,110.3500,427.5400,other,30.7% of $427.54 in Billed Charges for Rev 272 = $131.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,427.5400,64.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,138.10,,,,,,,110.3500,427.5400,percent of total billed charges,32.3% of $427.54 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ASSAY BRK TRANSSEPTAL 71CM,272,RC,27200002,CDM,,,,,,both,,,427.5400,64.1300,WELLCARE,WELLCARE MEDICAID,427.54,,,,,,,110.3500,427.5400,percent of total billed charges,100% of $427.54 in Billed Charges for Rev 272 = $427.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SHAVER 4MM STRAIGHT,272,RC,,,,,,,,both,,,1380.4800,207.0700,AETNA,AETNA,589.47,,,,,,,356.3000,1380.4800,percent of total billed charges,"42.7% of $1,380.48 in Billed Charges for Rev 272 = $589.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHAVER 4MM STRAIGHT,272,RC,,,,,,,,both,,,1380.4800,207.0700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,966.34,,,,,,,356.3000,1380.4800,percent of total billed charges,"Rev 272 $1,380.48 in Billed Charges at 70% = $966.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHAVER 4MM STRAIGHT,272,RC,,,,,,,,both,,,1380.4800,207.0700,CIGNA HEALTHCARE,CIGNA HMO,575.66,,,,,,,356.3000,1380.4800,percent of total billed charges,"41.7% of $1,380.48 in Billed Charges for Rev 272 = $575.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHAVER 4MM STRAIGHT,272,RC,,,,,,,,both,,,1380.4800,207.0700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,640.54,,,,,,,356.3000,1380.4800,percent of total billed charges,"46.4% of $1,380.48 in Billed Charges for Rev 272 = $640.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHAVER 4MM STRAIGHT,272,RC,,,,,,,,both,,,1380.4800,207.0700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,575.66,,,,,,,356.3000,1380.4800,percent of total billed charges,"41.7% of $1,380.48 in Billed Charges for Rev 272 = $575.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHAVER 4MM STRAIGHT,272,RC,,,,,,,,both,,,1380.4800,207.0700,CIGNA HEALTHCARE,CIGNA PPO,575.66,,,,,,,356.3000,1380.4800,percent of total billed charges,"41.7% of $1,380.48 in Billed Charges for Rev 272 = $575.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHAVER 4MM STRAIGHT,272,RC,,,,,,,,both,,,1380.4800,207.0700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1242.43,,,,,,,356.3000,1380.4800,percent of total billed charges,"90% of $1,380.48 in Billed Charges for Rev 272 = $1,242.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHAVER 4MM STRAIGHT,272,RC,,,,,,,,both,,,1380.4800,207.0700,MEDCOST,MEDCOST VHN,656.97,,,,,,,356.3000,1380.4800,percent of total billed charges,"47.59% of $1,380.48 in Billed Charges for Rev 272 = $656.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHAVER 4MM STRAIGHT,272,RC,,,,,,,,both,,,1380.4800,207.0700,SENTARA HEALTH,SENTARA HEALTH,356.30,,,,,,,356.3000,1380.4800,percent of total billed charges,"25.81% of $1,380.48 in Billed Charges for Rev 272 = $356.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHAVER 4MM STRAIGHT,272,RC,,,,,,,,both,,,1380.4800,207.0700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1380.48,,,,,,,356.3000,1380.4800,percent of total billed charges,"100% of $1,380.48 in Billed Charges for Rev 272 = $1,380.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHAVER 4MM STRAIGHT,272,RC,,,,,,,,both,,,1380.4800,207.0700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,690.24,,,,,,,356.3000,1380.4800,percent of total billed charges,"Rev 272 $1,380.48 in Billed Charges at 50% = $690.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHAVER 4MM STRAIGHT,272,RC,,,,,,,,both,,,1380.4800,207.0700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,445.90,,,,,,,356.3000,1380.4800,other,"32.3% of $1,380.48 in Billed Charges for Rev 272 = $445.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SHAVER 4MM STRAIGHT,272,RC,,,,,,,,both,,,1380.4800,207.0700,UNITED HEALTHCARE,UHC HERITAGE SELECT,423.81,,,,,,,356.3000,1380.4800,other,"30.7% of $1,380.48 in Billed Charges for Rev 272 = $423.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SHAVER 4MM STRAIGHT,272,RC,,,,,,,,both,,,1380.4800,207.0700,UNITED HEALTHCARE,UNITED HEALTHCARE,445.90,,,,,,,356.3000,1380.4800,percent of total billed charges,"32.3% of $1,380.48 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SHAVER 4MM STRAIGHT,272,RC,,,,,,,,both,,,1380.4800,207.0700,WELLCARE,WELLCARE MEDICAID,1380.48,,,,,,,356.3000,1380.4800,percent of total billed charges,"100% of $1,380.48 in Billed Charges for Rev 272 = $1,380.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUR ROUND DIAMOND E6207,272,RC,,,,,,,,both,,,558.6900,83.8000,AETNA,AETNA,238.56,,,,,,,144.2000,558.6900,percent of total billed charges,42.7% of $558.69 in Billed Charges for Rev 272 = $238.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR ROUND DIAMOND E6207,272,RC,,,,,,,,both,,,558.6900,83.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,391.08,,,,,,,144.2000,558.6900,percent of total billed charges,Rev 272 $558.69 in Billed Charges at 70% = $391.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR ROUND DIAMOND E6207,272,RC,,,,,,,,both,,,558.6900,83.8000,CIGNA HEALTHCARE,CIGNA HMO,232.97,,,,,,,144.2000,558.6900,percent of total billed charges,41.7% of $558.69 in Billed Charges for Rev 272 = $232.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR ROUND DIAMOND E6207,272,RC,,,,,,,,both,,,558.6900,83.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,259.23,,,,,,,144.2000,558.6900,percent of total billed charges,46.4% of $558.69 in Billed Charges for Rev 272 = $259.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR ROUND DIAMOND E6207,272,RC,,,,,,,,both,,,558.6900,83.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,232.97,,,,,,,144.2000,558.6900,percent of total billed charges,41.7% of $558.69 in Billed Charges for Rev 272 = $232.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR ROUND DIAMOND E6207,272,RC,,,,,,,,both,,,558.6900,83.8000,CIGNA HEALTHCARE,CIGNA PPO,232.97,,,,,,,144.2000,558.6900,percent of total billed charges,41.7% of $558.69 in Billed Charges for Rev 272 = $232.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR ROUND DIAMOND E6207,272,RC,,,,,,,,both,,,558.6900,83.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,502.82,,,,,,,144.2000,558.6900,percent of total billed charges,90% of $558.69 in Billed Charges for Rev 272 = $502.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR ROUND DIAMOND E6207,272,RC,,,,,,,,both,,,558.6900,83.8000,MEDCOST,MEDCOST VHN,265.88,,,,,,,144.2000,558.6900,percent of total billed charges,47.59% of $558.69 in Billed Charges for Rev 272 = $265.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR ROUND DIAMOND E6207,272,RC,,,,,,,,both,,,558.6900,83.8000,SENTARA HEALTH,SENTARA HEALTH,144.20,,,,,,,144.2000,558.6900,percent of total billed charges,25.81% of $558.69 in Billed Charges for Rev 272 = $144.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR ROUND DIAMOND E6207,272,RC,,,,,,,,both,,,558.6900,83.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",558.69,,,,,,,144.2000,558.6900,percent of total billed charges,100% of $558.69 in Billed Charges for Rev 272 = $558.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR ROUND DIAMOND E6207,272,RC,,,,,,,,both,,,558.6900,83.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,279.35,,,,,,,144.2000,558.6900,percent of total billed charges,Rev 272 $558.69 in Billed Charges at 50% = $279.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR ROUND DIAMOND E6207,272,RC,,,,,,,,both,,,558.6900,83.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,180.46,,,,,,,144.2000,558.6900,other,32.3% of $558.69 in Billed Charges for Rev 272 = $180.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BUR ROUND DIAMOND E6207,272,RC,,,,,,,,both,,,558.6900,83.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,171.52,,,,,,,144.2000,558.6900,other,30.7% of $558.69 in Billed Charges for Rev 272 = $171.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BUR ROUND DIAMOND E6207,272,RC,,,,,,,,both,,,558.6900,83.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,180.46,,,,,,,144.2000,558.6900,percent of total billed charges,32.3% of $558.69 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BUR ROUND DIAMOND E6207,272,RC,,,,,,,,both,,,558.6900,83.8000,WELLCARE,WELLCARE MEDICAID,558.69,,,,,,,144.2000,558.6900,percent of total billed charges,100% of $558.69 in Billed Charges for Rev 272 = $558.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ASSEMBLY T-HANDLE FOR SPIKE PLATE,272,RC,27200002,CDM,,,,,,both,,,7155.9900,1073.4000,AETNA,AETNA,3055.61,,,,,,,1846.9600,7155.9900,percent of total billed charges,"42.7% of $7,155.99 in Billed Charges for Rev 272 = $3,055.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSEMBLY T-HANDLE FOR SPIKE PLATE,272,RC,27200002,CDM,,,,,,both,,,7155.9900,1073.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5009.19,,,,,,,1846.9600,7155.9900,percent of total billed charges,"Rev 272 $7,155.99 in Billed Charges at 70% = $5,009.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSEMBLY T-HANDLE FOR SPIKE PLATE,272,RC,27200002,CDM,,,,,,both,,,7155.9900,1073.4000,CIGNA HEALTHCARE,CIGNA HMO,2984.05,,,,,,,1846.9600,7155.9900,percent of total billed charges,"41.7% of $7,155.99 in Billed Charges for Rev 272 = $2,984.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSEMBLY T-HANDLE FOR SPIKE PLATE,272,RC,27200002,CDM,,,,,,both,,,7155.9900,1073.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3320.38,,,,,,,1846.9600,7155.9900,percent of total billed charges,"46.4% of $7,155.99 in Billed Charges for Rev 272 = $3,320.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSEMBLY T-HANDLE FOR SPIKE PLATE,272,RC,27200002,CDM,,,,,,both,,,7155.9900,1073.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2984.05,,,,,,,1846.9600,7155.9900,percent of total billed charges,"41.7% of $7,155.99 in Billed Charges for Rev 272 = $2,984.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSEMBLY T-HANDLE FOR SPIKE PLATE,272,RC,27200002,CDM,,,,,,both,,,7155.9900,1073.4000,CIGNA HEALTHCARE,CIGNA PPO,2984.05,,,,,,,1846.9600,7155.9900,percent of total billed charges,"41.7% of $7,155.99 in Billed Charges for Rev 272 = $2,984.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSEMBLY T-HANDLE FOR SPIKE PLATE,272,RC,27200002,CDM,,,,,,both,,,7155.9900,1073.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6440.39,,,,,,,1846.9600,7155.9900,percent of total billed charges,"90% of $7,155.99 in Billed Charges for Rev 272 = $6,440.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSEMBLY T-HANDLE FOR SPIKE PLATE,272,RC,27200002,CDM,,,,,,both,,,7155.9900,1073.4000,MEDCOST,MEDCOST VHN,3405.54,,,,,,,1846.9600,7155.9900,percent of total billed charges,"47.59% of $7,155.99 in Billed Charges for Rev 272 = $3,405.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSEMBLY T-HANDLE FOR SPIKE PLATE,272,RC,27200002,CDM,,,,,,both,,,7155.9900,1073.4000,SENTARA HEALTH,SENTARA HEALTH,1846.96,,,,,,,1846.9600,7155.9900,percent of total billed charges,"25.81% of $7,155.99 in Billed Charges for Rev 272 = $1,846.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSEMBLY T-HANDLE FOR SPIKE PLATE,272,RC,27200002,CDM,,,,,,both,,,7155.9900,1073.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7155.99,,,,,,,1846.9600,7155.9900,percent of total billed charges,"100% of $7,155.99 in Billed Charges for Rev 272 = $7,155.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSEMBLY T-HANDLE FOR SPIKE PLATE,272,RC,27200002,CDM,,,,,,both,,,7155.9900,1073.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3578.00,,,,,,,1846.9600,7155.9900,percent of total billed charges,"Rev 272 $7,155.99 in Billed Charges at 50% = $3,578.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSEMBLY T-HANDLE FOR SPIKE PLATE,272,RC,27200002,CDM,,,,,,both,,,7155.9900,1073.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2311.38,,,,,,,1846.9600,7155.9900,other,"32.3% of $7,155.99 in Billed Charges for Rev 272 = $2,311.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ASSEMBLY T-HANDLE FOR SPIKE PLATE,272,RC,27200002,CDM,,,,,,both,,,7155.9900,1073.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2196.89,,,,,,,1846.9600,7155.9900,other,"30.7% of $7,155.99 in Billed Charges for Rev 272 = $2,196.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ASSEMBLY T-HANDLE FOR SPIKE PLATE,272,RC,27200002,CDM,,,,,,both,,,7155.9900,1073.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,2311.38,,,,,,,1846.9600,7155.9900,percent of total billed charges,"32.3% of $7,155.99 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ASSEMBLY T-HANDLE FOR SPIKE PLATE,272,RC,27200002,CDM,,,,,,both,,,7155.9900,1073.4000,WELLCARE,WELLCARE MEDICAID,7155.99,,,,,,,1846.9600,7155.9900,percent of total billed charges,"100% of $7,155.99 in Billed Charges for Rev 272 = $7,155.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,478.0300,71.7000,AETNA,AETNA,204.12,,,,,,,123.3800,478.0300,percent of total billed charges,42.7% of $478.03 in Billed Charges for Rev 272 = $204.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,478.0300,71.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,334.62,,,,,,,123.3800,478.0300,percent of total billed charges,Rev 272 $478.03 in Billed Charges at 70% = $334.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,478.0300,71.7000,CIGNA HEALTHCARE,CIGNA HMO,199.34,,,,,,,123.3800,478.0300,percent of total billed charges,41.7% of $478.03 in Billed Charges for Rev 272 = $199.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,478.0300,71.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,221.81,,,,,,,123.3800,478.0300,percent of total billed charges,46.4% of $478.03 in Billed Charges for Rev 272 = $221.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,478.0300,71.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,199.34,,,,,,,123.3800,478.0300,percent of total billed charges,41.7% of $478.03 in Billed Charges for Rev 272 = $199.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,478.0300,71.7000,CIGNA HEALTHCARE,CIGNA PPO,199.34,,,,,,,123.3800,478.0300,percent of total billed charges,41.7% of $478.03 in Billed Charges for Rev 272 = $199.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,478.0300,71.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,430.23,,,,,,,123.3800,478.0300,percent of total billed charges,90% of $478.03 in Billed Charges for Rev 272 = $430.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,478.0300,71.7000,MEDCOST,MEDCOST VHN,227.49,,,,,,,123.3800,478.0300,percent of total billed charges,47.59% of $478.03 in Billed Charges for Rev 272 = $227.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,478.0300,71.7000,SENTARA HEALTH,SENTARA HEALTH,123.38,,,,,,,123.3800,478.0300,percent of total billed charges,25.81% of $478.03 in Billed Charges for Rev 272 = $123.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,478.0300,71.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",478.03,,,,,,,123.3800,478.0300,percent of total billed charges,100% of $478.03 in Billed Charges for Rev 272 = $478.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,478.0300,71.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,239.02,,,,,,,123.3800,478.0300,percent of total billed charges,Rev 272 $478.03 in Billed Charges at 50% = $239.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,478.0300,71.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,154.40,,,,,,,123.3800,478.0300,other,32.3% of $478.03 in Billed Charges for Rev 272 = $154.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,478.0300,71.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,146.76,,,,,,,123.3800,478.0300,other,30.7% of $478.03 in Billed Charges for Rev 272 = $146.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,478.0300,71.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,154.40,,,,,,,123.3800,478.0300,percent of total billed charges,32.3% of $478.03 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BABCOCK 5MM,272,RC,27200002,CDM,,,,,,both,,,478.0300,71.7000,WELLCARE,WELLCARE MEDICAID,478.03,,,,,,,123.3800,478.0300,percent of total billed charges,100% of $478.03 in Billed Charges for Rev 272 = $478.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BAG TRANFER W/ SPIKE 4R2023,270,RC,,,,,,,,both,,,1948.1900,292.2300,AETNA,AETNA,831.88,,,,,,,502.8300,1948.1900,percent of total billed charges,"42.7% of $1,948.19 in Billed Charges for Rev 270 = $831.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAG TRANFER W/ SPIKE 4R2023,270,RC,,,,,,,,both,,,1948.1900,292.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1363.73,,,,,,,502.8300,1948.1900,percent of total billed charges,"Rev 270 $1,948.19 in Billed Charges at 70% = $1,363.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAG TRANFER W/ SPIKE 4R2023,270,RC,,,,,,,,both,,,1948.1900,292.2300,CIGNA HEALTHCARE,CIGNA HMO,812.40,,,,,,,502.8300,1948.1900,percent of total billed charges,"41.7% of $1,948.19 in Billed Charges for Rev 270 = $812.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAG TRANFER W/ SPIKE 4R2023,270,RC,,,,,,,,both,,,1948.1900,292.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,903.96,,,,,,,502.8300,1948.1900,percent of total billed charges,"46.4% of $1,948.19 in Billed Charges for Rev 270 = $903.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAG TRANFER W/ SPIKE 4R2023,270,RC,,,,,,,,both,,,1948.1900,292.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,812.40,,,,,,,502.8300,1948.1900,percent of total billed charges,"41.7% of $1,948.19 in Billed Charges for Rev 270 = $812.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAG TRANFER W/ SPIKE 4R2023,270,RC,,,,,,,,both,,,1948.1900,292.2300,CIGNA HEALTHCARE,CIGNA PPO,812.40,,,,,,,502.8300,1948.1900,percent of total billed charges,"41.7% of $1,948.19 in Billed Charges for Rev 270 = $812.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAG TRANFER W/ SPIKE 4R2023,270,RC,,,,,,,,both,,,1948.1900,292.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1753.37,,,,,,,502.8300,1948.1900,percent of total billed charges,"90% of $1,948.19 in Billed Charges for Rev 270 = $1,753.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAG TRANFER W/ SPIKE 4R2023,270,RC,,,,,,,,both,,,1948.1900,292.2300,MEDCOST,MEDCOST VHN,927.14,,,,,,,502.8300,1948.1900,percent of total billed charges,"47.59% of $1,948.19 in Billed Charges for Rev 270 = $927.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAG TRANFER W/ SPIKE 4R2023,270,RC,,,,,,,,both,,,1948.1900,292.2300,SENTARA HEALTH,SENTARA HEALTH,502.83,,,,,,,502.8300,1948.1900,percent of total billed charges,"25.81% of $1,948.19 in Billed Charges for Rev 270 = $502.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAG TRANFER W/ SPIKE 4R2023,270,RC,,,,,,,,both,,,1948.1900,292.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1948.19,,,,,,,502.8300,1948.1900,percent of total billed charges,"100% of $1,948.19 in Billed Charges for Rev 270 = $1,948.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAG TRANFER W/ SPIKE 4R2023,270,RC,,,,,,,,both,,,1948.1900,292.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,974.10,,,,,,,502.8300,1948.1900,percent of total billed charges,"Rev 270 $1,948.19 in Billed Charges at 50% = $974.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAG TRANFER W/ SPIKE 4R2023,270,RC,,,,,,,,both,,,1948.1900,292.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,629.27,,,,,,,502.8300,1948.1900,other,"32.3% of $1,948.19 in Billed Charges for Rev 270 = $629.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BAG TRANFER W/ SPIKE 4R2023,270,RC,,,,,,,,both,,,1948.1900,292.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,598.09,,,,,,,502.8300,1948.1900,other,"30.7% of $1,948.19 in Billed Charges for Rev 270 = $598.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BAG TRANFER W/ SPIKE 4R2023,270,RC,,,,,,,,both,,,1948.1900,292.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,629.27,,,,,,,502.8300,1948.1900,percent of total billed charges,"32.3% of $1,948.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAG TRANFER W/ SPIKE 4R2023,270,RC,,,,,,,,both,,,1948.1900,292.2300,WELLCARE,WELLCARE MEDICAID,1948.19,,,,,,,502.8300,1948.1900,percent of total billed charges,"100% of $1,948.19 in Billed Charges for Rev 270 = $1,948.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALL ELECTRODE 5MM,272,RC,27200002,CDM,,,,,,both,,,145.0900,21.7600,AETNA,AETNA,61.95,,,,,,,37.4500,145.0900,percent of total billed charges,42.7% of $145.09 in Billed Charges for Rev 272 = $61.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALL ELECTRODE 5MM,272,RC,27200002,CDM,,,,,,both,,,145.0900,21.7600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,101.56,,,,,,,37.4500,145.0900,percent of total billed charges,Rev 272 $145.09 in Billed Charges at 70% = $101.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALL ELECTRODE 5MM,272,RC,27200002,CDM,,,,,,both,,,145.0900,21.7600,CIGNA HEALTHCARE,CIGNA HMO,60.50,,,,,,,37.4500,145.0900,percent of total billed charges,41.7% of $145.09 in Billed Charges for Rev 272 = $60.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALL ELECTRODE 5MM,272,RC,27200002,CDM,,,,,,both,,,145.0900,21.7600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,67.32,,,,,,,37.4500,145.0900,percent of total billed charges,46.4% of $145.09 in Billed Charges for Rev 272 = $67.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALL ELECTRODE 5MM,272,RC,27200002,CDM,,,,,,both,,,145.0900,21.7600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,60.50,,,,,,,37.4500,145.0900,percent of total billed charges,41.7% of $145.09 in Billed Charges for Rev 272 = $60.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALL ELECTRODE 5MM,272,RC,27200002,CDM,,,,,,both,,,145.0900,21.7600,CIGNA HEALTHCARE,CIGNA PPO,60.50,,,,,,,37.4500,145.0900,percent of total billed charges,41.7% of $145.09 in Billed Charges for Rev 272 = $60.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALL ELECTRODE 5MM,272,RC,27200002,CDM,,,,,,both,,,145.0900,21.7600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,130.58,,,,,,,37.4500,145.0900,percent of total billed charges,90% of $145.09 in Billed Charges for Rev 272 = $130.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALL ELECTRODE 5MM,272,RC,27200002,CDM,,,,,,both,,,145.0900,21.7600,MEDCOST,MEDCOST VHN,69.05,,,,,,,37.4500,145.0900,percent of total billed charges,47.59% of $145.09 in Billed Charges for Rev 272 = $69.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALL ELECTRODE 5MM,272,RC,27200002,CDM,,,,,,both,,,145.0900,21.7600,SENTARA HEALTH,SENTARA HEALTH,37.45,,,,,,,37.4500,145.0900,percent of total billed charges,25.81% of $145.09 in Billed Charges for Rev 272 = $37.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALL ELECTRODE 5MM,272,RC,27200002,CDM,,,,,,both,,,145.0900,21.7600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",145.09,,,,,,,37.4500,145.0900,percent of total billed charges,100% of $145.09 in Billed Charges for Rev 272 = $145.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALL ELECTRODE 5MM,272,RC,27200002,CDM,,,,,,both,,,145.0900,21.7600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,72.55,,,,,,,37.4500,145.0900,percent of total billed charges,Rev 272 $145.09 in Billed Charges at 50% = $72.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALL ELECTRODE 5MM,272,RC,27200002,CDM,,,,,,both,,,145.0900,21.7600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,46.86,,,,,,,37.4500,145.0900,other,32.3% of $145.09 in Billed Charges for Rev 272 = $46.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BALL ELECTRODE 5MM,272,RC,27200002,CDM,,,,,,both,,,145.0900,21.7600,UNITED HEALTHCARE,UHC HERITAGE SELECT,44.54,,,,,,,37.4500,145.0900,other,30.7% of $145.09 in Billed Charges for Rev 272 = $44.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BALL ELECTRODE 5MM,272,RC,27200002,CDM,,,,,,both,,,145.0900,21.7600,UNITED HEALTHCARE,UNITED HEALTHCARE,46.86,,,,,,,37.4500,145.0900,percent of total billed charges,32.3% of $145.09 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALL ELECTRODE 5MM,272,RC,27200002,CDM,,,,,,both,,,145.0900,21.7600,WELLCARE,WELLCARE MEDICAID,145.09,,,,,,,37.4500,145.0900,percent of total billed charges,100% of $145.09 in Billed Charges for Rev 272 = $145.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON 13G 10MM 1021-310-000,272,RC,27200002,CDM,,,,,,both,,,14420.8800,2163.1300,AETNA,AETNA,6157.72,,,,,,,3722.0300,14420.8800,percent of total billed charges,"42.7% of $14,420.88 in Billed Charges for Rev 272 = $6,157.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON 13G 10MM 1021-310-000,272,RC,27200002,CDM,,,,,,both,,,14420.8800,2163.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,10094.62,,,,,,,3722.0300,14420.8800,percent of total billed charges,"Rev 272 $14,420.88 in Billed Charges at 70% = $10,094.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON 13G 10MM 1021-310-000,272,RC,27200002,CDM,,,,,,both,,,14420.8800,2163.1300,CIGNA HEALTHCARE,CIGNA HMO,6013.51,,,,,,,3722.0300,14420.8800,percent of total billed charges,"41.7% of $14,420.88 in Billed Charges for Rev 272 = $6,013.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON 13G 10MM 1021-310-000,272,RC,27200002,CDM,,,,,,both,,,14420.8800,2163.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6691.29,,,,,,,3722.0300,14420.8800,percent of total billed charges,"46.4% of $14,420.88 in Billed Charges for Rev 272 = $6,691.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON 13G 10MM 1021-310-000,272,RC,27200002,CDM,,,,,,both,,,14420.8800,2163.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6013.51,,,,,,,3722.0300,14420.8800,percent of total billed charges,"41.7% of $14,420.88 in Billed Charges for Rev 272 = $6,013.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON 13G 10MM 1021-310-000,272,RC,27200002,CDM,,,,,,both,,,14420.8800,2163.1300,CIGNA HEALTHCARE,CIGNA PPO,6013.51,,,,,,,3722.0300,14420.8800,percent of total billed charges,"41.7% of $14,420.88 in Billed Charges for Rev 272 = $6,013.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON 13G 10MM 1021-310-000,272,RC,27200002,CDM,,,,,,both,,,14420.8800,2163.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12978.79,,,,,,,3722.0300,14420.8800,percent of total billed charges,"90% of $14,420.88 in Billed Charges for Rev 272 = $12,978.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON 13G 10MM 1021-310-000,272,RC,27200002,CDM,,,,,,both,,,14420.8800,2163.1300,MEDCOST,MEDCOST VHN,6862.90,,,,,,,3722.0300,14420.8800,percent of total billed charges,"47.59% of $14,420.88 in Billed Charges for Rev 272 = $6,862.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON 13G 10MM 1021-310-000,272,RC,27200002,CDM,,,,,,both,,,14420.8800,2163.1300,SENTARA HEALTH,SENTARA HEALTH,3722.03,,,,,,,3722.0300,14420.8800,percent of total billed charges,"25.81% of $14,420.88 in Billed Charges for Rev 272 = $3,722.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON 13G 10MM 1021-310-000,272,RC,27200002,CDM,,,,,,both,,,14420.8800,2163.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",14420.88,,,,,,,3722.0300,14420.8800,percent of total billed charges,"100% of $14,420.88 in Billed Charges for Rev 272 = $14,420.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON 13G 10MM 1021-310-000,272,RC,27200002,CDM,,,,,,both,,,14420.8800,2163.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7210.44,,,,,,,3722.0300,14420.8800,percent of total billed charges,"Rev 272 $14,420.88 in Billed Charges at 50% = $7,210.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON 13G 10MM 1021-310-000,272,RC,27200002,CDM,,,,,,both,,,14420.8800,2163.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4657.94,,,,,,,3722.0300,14420.8800,other,"32.3% of $14,420.88 in Billed Charges for Rev 272 = $4,657.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BALLOON 13G 10MM 1021-310-000,272,RC,27200002,CDM,,,,,,both,,,14420.8800,2163.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,4427.21,,,,,,,3722.0300,14420.8800,other,"30.7% of $14,420.88 in Billed Charges for Rev 272 = $4,427.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BALLOON 13G 10MM 1021-310-000,272,RC,27200002,CDM,,,,,,both,,,14420.8800,2163.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,4657.94,,,,,,,3722.0300,14420.8800,percent of total billed charges,"32.3% of $14,420.88 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON 13G 10MM 1021-310-000,272,RC,27200002,CDM,,,,,,both,,,14420.8800,2163.1300,WELLCARE,WELLCARE MEDICAID,14420.88,,,,,,,3722.0300,14420.8800,percent of total billed charges,"100% of $14,420.88 in Billed Charges for Rev 272 = $14,420.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BALLOON DILATOR BILIARY MAXPASS 20ML 15ATM,272,RC,27200002,CDM,,,,,,both,,,729.5000,109.4300,AETNA,AETNA,311.50,,,,,,,188.2800,729.5000,percent of total billed charges,42.7% of $729.50 in Billed Charges for Rev 272 = $311.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON DILATOR BILIARY MAXPASS 20ML 15ATM,272,RC,27200002,CDM,,,,,,both,,,729.5000,109.4300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,510.65,,,,,,,188.2800,729.5000,percent of total billed charges,Rev 272 $729.50 in Billed Charges at 70% = $510.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON DILATOR BILIARY MAXPASS 20ML 15ATM,272,RC,27200002,CDM,,,,,,both,,,729.5000,109.4300,CIGNA HEALTHCARE,CIGNA HMO,304.20,,,,,,,188.2800,729.5000,percent of total billed charges,41.7% of $729.50 in Billed Charges for Rev 272 = $304.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON DILATOR BILIARY MAXPASS 20ML 15ATM,272,RC,27200002,CDM,,,,,,both,,,729.5000,109.4300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,338.49,,,,,,,188.2800,729.5000,percent of total billed charges,46.4% of $729.50 in Billed Charges for Rev 272 = $338.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON DILATOR BILIARY MAXPASS 20ML 15ATM,272,RC,27200002,CDM,,,,,,both,,,729.5000,109.4300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,304.20,,,,,,,188.2800,729.5000,percent of total billed charges,41.7% of $729.50 in Billed Charges for Rev 272 = $304.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON DILATOR BILIARY MAXPASS 20ML 15ATM,272,RC,27200002,CDM,,,,,,both,,,729.5000,109.4300,CIGNA HEALTHCARE,CIGNA PPO,304.20,,,,,,,188.2800,729.5000,percent of total billed charges,41.7% of $729.50 in Billed Charges for Rev 272 = $304.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON DILATOR BILIARY MAXPASS 20ML 15ATM,272,RC,27200002,CDM,,,,,,both,,,729.5000,109.4300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,656.55,,,,,,,188.2800,729.5000,percent of total billed charges,90% of $729.50 in Billed Charges for Rev 272 = $656.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON DILATOR BILIARY MAXPASS 20ML 15ATM,272,RC,27200002,CDM,,,,,,both,,,729.5000,109.4300,MEDCOST,MEDCOST VHN,347.17,,,,,,,188.2800,729.5000,percent of total billed charges,47.59% of $729.50 in Billed Charges for Rev 272 = $347.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON DILATOR BILIARY MAXPASS 20ML 15ATM,272,RC,27200002,CDM,,,,,,both,,,729.5000,109.4300,SENTARA HEALTH,SENTARA HEALTH,188.28,,,,,,,188.2800,729.5000,percent of total billed charges,25.81% of $729.50 in Billed Charges for Rev 272 = $188.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON DILATOR BILIARY MAXPASS 20ML 15ATM,272,RC,27200002,CDM,,,,,,both,,,729.5000,109.4300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",729.50,,,,,,,188.2800,729.5000,percent of total billed charges,100% of $729.50 in Billed Charges for Rev 272 = $729.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON DILATOR BILIARY MAXPASS 20ML 15ATM,272,RC,27200002,CDM,,,,,,both,,,729.5000,109.4300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,364.75,,,,,,,188.2800,729.5000,percent of total billed charges,Rev 272 $729.50 in Billed Charges at 50% = $364.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON DILATOR BILIARY MAXPASS 20ML 15ATM,272,RC,27200002,CDM,,,,,,both,,,729.5000,109.4300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,235.63,,,,,,,188.2800,729.5000,other,32.3% of $729.50 in Billed Charges for Rev 272 = $235.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BALLOON DILATOR BILIARY MAXPASS 20ML 15ATM,272,RC,27200002,CDM,,,,,,both,,,729.5000,109.4300,UNITED HEALTHCARE,UHC HERITAGE SELECT,223.96,,,,,,,188.2800,729.5000,other,30.7% of $729.50 in Billed Charges for Rev 272 = $223.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BALLOON DILATOR BILIARY MAXPASS 20ML 15ATM,272,RC,27200002,CDM,,,,,,both,,,729.5000,109.4300,UNITED HEALTHCARE,UNITED HEALTHCARE,235.63,,,,,,,188.2800,729.5000,percent of total billed charges,32.3% of $729.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BALLOON DILATOR BILIARY MAXPASS 20ML 15ATM,272,RC,27200002,CDM,,,,,,both,,,729.5000,109.4300,WELLCARE,WELLCARE MEDICAID,729.50,,,,,,,188.2800,729.5000,percent of total billed charges,100% of $729.50 in Billed Charges for Rev 272 = $729.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR 6MM DIAMOND ROUND FINE,272,RC,27200002,CDM,,,,,,both,,,2043.0900,306.4600,AETNA,AETNA,872.40,,,,,,,527.3200,2043.0900,percent of total billed charges,"42.7% of $2,043.09 in Billed Charges for Rev 272 = $872.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 6MM DIAMOND ROUND FINE,272,RC,27200002,CDM,,,,,,both,,,2043.0900,306.4600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1430.16,,,,,,,527.3200,2043.0900,percent of total billed charges,"Rev 272 $2,043.09 in Billed Charges at 70% = $1,430.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 6MM DIAMOND ROUND FINE,272,RC,27200002,CDM,,,,,,both,,,2043.0900,306.4600,CIGNA HEALTHCARE,CIGNA HMO,851.97,,,,,,,527.3200,2043.0900,percent of total billed charges,"41.7% of $2,043.09 in Billed Charges for Rev 272 = $851.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 6MM DIAMOND ROUND FINE,272,RC,27200002,CDM,,,,,,both,,,2043.0900,306.4600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,947.99,,,,,,,527.3200,2043.0900,percent of total billed charges,"46.4% of $2,043.09 in Billed Charges for Rev 272 = $947.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 6MM DIAMOND ROUND FINE,272,RC,27200002,CDM,,,,,,both,,,2043.0900,306.4600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,851.97,,,,,,,527.3200,2043.0900,percent of total billed charges,"41.7% of $2,043.09 in Billed Charges for Rev 272 = $851.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 6MM DIAMOND ROUND FINE,272,RC,27200002,CDM,,,,,,both,,,2043.0900,306.4600,CIGNA HEALTHCARE,CIGNA PPO,851.97,,,,,,,527.3200,2043.0900,percent of total billed charges,"41.7% of $2,043.09 in Billed Charges for Rev 272 = $851.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 6MM DIAMOND ROUND FINE,272,RC,27200002,CDM,,,,,,both,,,2043.0900,306.4600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1838.78,,,,,,,527.3200,2043.0900,percent of total billed charges,"90% of $2,043.09 in Billed Charges for Rev 272 = $1,838.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 6MM DIAMOND ROUND FINE,272,RC,27200002,CDM,,,,,,both,,,2043.0900,306.4600,MEDCOST,MEDCOST VHN,972.31,,,,,,,527.3200,2043.0900,percent of total billed charges,"47.59% of $2,043.09 in Billed Charges for Rev 272 = $972.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 6MM DIAMOND ROUND FINE,272,RC,27200002,CDM,,,,,,both,,,2043.0900,306.4600,SENTARA HEALTH,SENTARA HEALTH,527.32,,,,,,,527.3200,2043.0900,percent of total billed charges,"25.81% of $2,043.09 in Billed Charges for Rev 272 = $527.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 6MM DIAMOND ROUND FINE,272,RC,27200002,CDM,,,,,,both,,,2043.0900,306.4600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2043.09,,,,,,,527.3200,2043.0900,percent of total billed charges,"100% of $2,043.09 in Billed Charges for Rev 272 = $2,043.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 6MM DIAMOND ROUND FINE,272,RC,27200002,CDM,,,,,,both,,,2043.0900,306.4600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1021.55,,,,,,,527.3200,2043.0900,percent of total billed charges,"Rev 272 $2,043.09 in Billed Charges at 50% = $1,021.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 6MM DIAMOND ROUND FINE,272,RC,27200002,CDM,,,,,,both,,,2043.0900,306.4600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,659.92,,,,,,,527.3200,2043.0900,other,"32.3% of $2,043.09 in Billed Charges for Rev 272 = $659.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR 6MM DIAMOND ROUND FINE,272,RC,27200002,CDM,,,,,,both,,,2043.0900,306.4600,UNITED HEALTHCARE,UHC HERITAGE SELECT,627.23,,,,,,,527.3200,2043.0900,other,"30.7% of $2,043.09 in Billed Charges for Rev 272 = $627.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR 6MM DIAMOND ROUND FINE,272,RC,27200002,CDM,,,,,,both,,,2043.0900,306.4600,UNITED HEALTHCARE,UNITED HEALTHCARE,659.92,,,,,,,527.3200,2043.0900,percent of total billed charges,"32.3% of $2,043.09 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 6MM DIAMOND ROUND FINE,272,RC,27200002,CDM,,,,,,both,,,2043.0900,306.4600,WELLCARE,WELLCARE MEDICAID,2043.09,,,,,,,527.3200,2043.0900,percent of total billed charges,"100% of $2,043.09 in Billed Charges for Rev 272 = $2,043.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,1011.1700,151.6800,AETNA,AETNA,431.77,,,,,,,260.9800,1011.1700,percent of total billed charges,"42.7% of $1,011.17 in Billed Charges for Rev 272 = $431.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,1011.1700,151.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,707.82,,,,,,,260.9800,1011.1700,percent of total billed charges,"Rev 272 $1,011.17 in Billed Charges at 70% = $707.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,1011.1700,151.6800,CIGNA HEALTHCARE,CIGNA HMO,421.66,,,,,,,260.9800,1011.1700,percent of total billed charges,"41.7% of $1,011.17 in Billed Charges for Rev 272 = $421.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,1011.1700,151.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,469.18,,,,,,,260.9800,1011.1700,percent of total billed charges,"46.4% of $1,011.17 in Billed Charges for Rev 272 = $469.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,1011.1700,151.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,421.66,,,,,,,260.9800,1011.1700,percent of total billed charges,"41.7% of $1,011.17 in Billed Charges for Rev 272 = $421.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,1011.1700,151.6800,CIGNA HEALTHCARE,CIGNA PPO,421.66,,,,,,,260.9800,1011.1700,percent of total billed charges,"41.7% of $1,011.17 in Billed Charges for Rev 272 = $421.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,1011.1700,151.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,910.05,,,,,,,260.9800,1011.1700,percent of total billed charges,"90% of $1,011.17 in Billed Charges for Rev 272 = $910.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,1011.1700,151.6800,MEDCOST,MEDCOST VHN,481.22,,,,,,,260.9800,1011.1700,percent of total billed charges,"47.59% of $1,011.17 in Billed Charges for Rev 272 = $481.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,1011.1700,151.6800,SENTARA HEALTH,SENTARA HEALTH,260.98,,,,,,,260.9800,1011.1700,percent of total billed charges,"25.81% of $1,011.17 in Billed Charges for Rev 272 = $260.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,1011.1700,151.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1011.17,,,,,,,260.9800,1011.1700,percent of total billed charges,"100% of $1,011.17 in Billed Charges for Rev 272 = $1,011.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,1011.1700,151.6800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,505.59,,,,,,,260.9800,1011.1700,percent of total billed charges,"Rev 272 $1,011.17 in Billed Charges at 50% = $505.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,1011.1700,151.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,326.61,,,,,,,260.9800,1011.1700,other,"32.3% of $1,011.17 in Billed Charges for Rev 272 = $326.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,1011.1700,151.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,310.43,,,,,,,260.9800,1011.1700,other,"30.7% of $1,011.17 in Billed Charges for Rev 272 = $310.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,1011.1700,151.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,326.61,,,,,,,260.9800,1011.1700,percent of total billed charges,"32.3% of $1,011.17 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,1011.1700,151.6800,WELLCARE,WELLCARE MEDICAID,1011.17,,,,,,,260.9800,1011.1700,percent of total billed charges,"100% of $1,011.17 in Billed Charges for Rev 272 = $1,011.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON NASAL SEPTO 15-24105,272,RC,,,,,,,,both,,,2468.3000,370.2500,AETNA,AETNA,1053.96,,,,,,,637.0700,2468.3000,percent of total billed charges,"42.7% of $2,468.30 in Billed Charges for Rev 272 = $1,053.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON NASAL SEPTO 15-24105,272,RC,,,,,,,,both,,,2468.3000,370.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1727.81,,,,,,,637.0700,2468.3000,percent of total billed charges,"Rev 272 $2,468.30 in Billed Charges at 70% = $1,727.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON NASAL SEPTO 15-24105,272,RC,,,,,,,,both,,,2468.3000,370.2500,CIGNA HEALTHCARE,CIGNA HMO,1029.28,,,,,,,637.0700,2468.3000,percent of total billed charges,"41.7% of $2,468.30 in Billed Charges for Rev 272 = $1,029.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON NASAL SEPTO 15-24105,272,RC,,,,,,,,both,,,2468.3000,370.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1145.29,,,,,,,637.0700,2468.3000,percent of total billed charges,"46.4% of $2,468.30 in Billed Charges for Rev 272 = $1,145.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON NASAL SEPTO 15-24105,272,RC,,,,,,,,both,,,2468.3000,370.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1029.28,,,,,,,637.0700,2468.3000,percent of total billed charges,"41.7% of $2,468.30 in Billed Charges for Rev 272 = $1,029.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON NASAL SEPTO 15-24105,272,RC,,,,,,,,both,,,2468.3000,370.2500,CIGNA HEALTHCARE,CIGNA PPO,1029.28,,,,,,,637.0700,2468.3000,percent of total billed charges,"41.7% of $2,468.30 in Billed Charges for Rev 272 = $1,029.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON NASAL SEPTO 15-24105,272,RC,,,,,,,,both,,,2468.3000,370.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2221.47,,,,,,,637.0700,2468.3000,percent of total billed charges,"90% of $2,468.30 in Billed Charges for Rev 272 = $2,221.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON NASAL SEPTO 15-24105,272,RC,,,,,,,,both,,,2468.3000,370.2500,MEDCOST,MEDCOST VHN,1174.66,,,,,,,637.0700,2468.3000,percent of total billed charges,"47.59% of $2,468.30 in Billed Charges for Rev 272 = $1,174.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON NASAL SEPTO 15-24105,272,RC,,,,,,,,both,,,2468.3000,370.2500,SENTARA HEALTH,SENTARA HEALTH,637.07,,,,,,,637.0700,2468.3000,percent of total billed charges,"25.81% of $2,468.30 in Billed Charges for Rev 272 = $637.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON NASAL SEPTO 15-24105,272,RC,,,,,,,,both,,,2468.3000,370.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2468.30,,,,,,,637.0700,2468.3000,percent of total billed charges,"100% of $2,468.30 in Billed Charges for Rev 272 = $2,468.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON NASAL SEPTO 15-24105,272,RC,,,,,,,,both,,,2468.3000,370.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1234.15,,,,,,,637.0700,2468.3000,percent of total billed charges,"Rev 272 $2,468.30 in Billed Charges at 50% = $1,234.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON NASAL SEPTO 15-24105,272,RC,,,,,,,,both,,,2468.3000,370.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,797.26,,,,,,,637.0700,2468.3000,other,"32.3% of $2,468.30 in Billed Charges for Rev 272 = $797.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BUTTON NASAL SEPTO 15-24105,272,RC,,,,,,,,both,,,2468.3000,370.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,757.77,,,,,,,637.0700,2468.3000,other,"30.7% of $2,468.30 in Billed Charges for Rev 272 = $757.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BUTTON NASAL SEPTO 15-24105,272,RC,,,,,,,,both,,,2468.3000,370.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,797.26,,,,,,,637.0700,2468.3000,percent of total billed charges,"32.3% of $2,468.30 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON NASAL SEPTO 15-24105,272,RC,,,,,,,,both,,,2468.3000,370.2500,WELLCARE,WELLCARE MEDICAID,2468.30,,,,,,,637.0700,2468.3000,percent of total billed charges,"100% of $2,468.30 in Billed Charges for Rev 272 = $2,468.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1257.5900,188.6400,AETNA,AETNA,536.99,,,,,,,324.5800,1257.5900,percent of total billed charges,"42.7% of $1,257.59 in Billed Charges for Rev 272 = $536.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1257.5900,188.6400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,880.31,,,,,,,324.5800,1257.5900,percent of total billed charges,"Rev 272 $1,257.59 in Billed Charges at 70% = $880.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1257.5900,188.6400,CIGNA HEALTHCARE,CIGNA HMO,524.42,,,,,,,324.5800,1257.5900,percent of total billed charges,"41.7% of $1,257.59 in Billed Charges for Rev 272 = $524.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1257.5900,188.6400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,583.52,,,,,,,324.5800,1257.5900,percent of total billed charges,"46.4% of $1,257.59 in Billed Charges for Rev 272 = $583.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1257.5900,188.6400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,524.42,,,,,,,324.5800,1257.5900,percent of total billed charges,"41.7% of $1,257.59 in Billed Charges for Rev 272 = $524.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1257.5900,188.6400,CIGNA HEALTHCARE,CIGNA PPO,524.42,,,,,,,324.5800,1257.5900,percent of total billed charges,"41.7% of $1,257.59 in Billed Charges for Rev 272 = $524.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1257.5900,188.6400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1131.83,,,,,,,324.5800,1257.5900,percent of total billed charges,"90% of $1,257.59 in Billed Charges for Rev 272 = $1,131.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1257.5900,188.6400,MEDCOST,MEDCOST VHN,598.49,,,,,,,324.5800,1257.5900,percent of total billed charges,"47.59% of $1,257.59 in Billed Charges for Rev 272 = $598.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1257.5900,188.6400,SENTARA HEALTH,SENTARA HEALTH,324.58,,,,,,,324.5800,1257.5900,percent of total billed charges,"25.81% of $1,257.59 in Billed Charges for Rev 272 = $324.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1257.5900,188.6400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1257.59,,,,,,,324.5800,1257.5900,percent of total billed charges,"100% of $1,257.59 in Billed Charges for Rev 272 = $1,257.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1257.5900,188.6400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,628.80,,,,,,,324.5800,1257.5900,percent of total billed charges,"Rev 272 $1,257.59 in Billed Charges at 50% = $628.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1257.5900,188.6400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,406.20,,,,,,,324.5800,1257.5900,other,"32.3% of $1,257.59 in Billed Charges for Rev 272 = $406.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1257.5900,188.6400,UNITED HEALTHCARE,UHC HERITAGE SELECT,386.08,,,,,,,324.5800,1257.5900,other,"30.7% of $1,257.59 in Billed Charges for Rev 272 = $386.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1257.5900,188.6400,UNITED HEALTHCARE,UNITED HEALTHCARE,406.20,,,,,,,324.5800,1257.5900,percent of total billed charges,"32.3% of $1,257.59 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL 2.0 W/DEPTH MARK Q/C 323.062,272,RC,27200002,CDM,,,,,,both,,,1257.5900,188.6400,WELLCARE,WELLCARE MEDICAID,1257.59,,,,,,,324.5800,1257.5900,percent of total billed charges,"100% of $1,257.59 in Billed Charges for Rev 272 = $1,257.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ECG 5 LEAD ASSEMBLY AHA,272,RC,,,,,,,,both,,,11428.8400,1714.3300,AETNA,AETNA,4880.11,,,,,,,2949.7800,11428.8400,percent of total billed charges,"42.7% of $11,428.84 in Billed Charges for Rev 272 = $4,880.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ECG 5 LEAD ASSEMBLY AHA,272,RC,,,,,,,,both,,,11428.8400,1714.3300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8000.19,,,,,,,2949.7800,11428.8400,percent of total billed charges,"Rev 272 $11,428.84 in Billed Charges at 70% = $8,000.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ECG 5 LEAD ASSEMBLY AHA,272,RC,,,,,,,,both,,,11428.8400,1714.3300,CIGNA HEALTHCARE,CIGNA HMO,4765.83,,,,,,,2949.7800,11428.8400,percent of total billed charges,"41.7% of $11,428.84 in Billed Charges for Rev 272 = $4,765.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ECG 5 LEAD ASSEMBLY AHA,272,RC,,,,,,,,both,,,11428.8400,1714.3300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5302.98,,,,,,,2949.7800,11428.8400,percent of total billed charges,"46.4% of $11,428.84 in Billed Charges for Rev 272 = $5,302.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ECG 5 LEAD ASSEMBLY AHA,272,RC,,,,,,,,both,,,11428.8400,1714.3300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4765.83,,,,,,,2949.7800,11428.8400,percent of total billed charges,"41.7% of $11,428.84 in Billed Charges for Rev 272 = $4,765.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ECG 5 LEAD ASSEMBLY AHA,272,RC,,,,,,,,both,,,11428.8400,1714.3300,CIGNA HEALTHCARE,CIGNA PPO,4765.83,,,,,,,2949.7800,11428.8400,percent of total billed charges,"41.7% of $11,428.84 in Billed Charges for Rev 272 = $4,765.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ECG 5 LEAD ASSEMBLY AHA,272,RC,,,,,,,,both,,,11428.8400,1714.3300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10285.96,,,,,,,2949.7800,11428.8400,percent of total billed charges,"90% of $11,428.84 in Billed Charges for Rev 272 = $10,285.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ECG 5 LEAD ASSEMBLY AHA,272,RC,,,,,,,,both,,,11428.8400,1714.3300,MEDCOST,MEDCOST VHN,5438.99,,,,,,,2949.7800,11428.8400,percent of total billed charges,"47.59% of $11,428.84 in Billed Charges for Rev 272 = $5,438.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ECG 5 LEAD ASSEMBLY AHA,272,RC,,,,,,,,both,,,11428.8400,1714.3300,SENTARA HEALTH,SENTARA HEALTH,2949.78,,,,,,,2949.7800,11428.8400,percent of total billed charges,"25.81% of $11,428.84 in Billed Charges for Rev 272 = $2,949.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ECG 5 LEAD ASSEMBLY AHA,272,RC,,,,,,,,both,,,11428.8400,1714.3300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11428.84,,,,,,,2949.7800,11428.8400,percent of total billed charges,"100% of $11,428.84 in Billed Charges for Rev 272 = $11,428.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ECG 5 LEAD ASSEMBLY AHA,272,RC,,,,,,,,both,,,11428.8400,1714.3300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5714.42,,,,,,,2949.7800,11428.8400,percent of total billed charges,"Rev 272 $11,428.84 in Billed Charges at 50% = $5,714.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ECG 5 LEAD ASSEMBLY AHA,272,RC,,,,,,,,both,,,11428.8400,1714.3300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3691.52,,,,,,,2949.7800,11428.8400,other,"32.3% of $11,428.84 in Billed Charges for Rev 272 = $3,691.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CABLE ECG 5 LEAD ASSEMBLY AHA,272,RC,,,,,,,,both,,,11428.8400,1714.3300,UNITED HEALTHCARE,UHC HERITAGE SELECT,3508.65,,,,,,,2949.7800,11428.8400,other,"30.7% of $11,428.84 in Billed Charges for Rev 272 = $3,508.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CABLE ECG 5 LEAD ASSEMBLY AHA,272,RC,,,,,,,,both,,,11428.8400,1714.3300,UNITED HEALTHCARE,UNITED HEALTHCARE,3691.52,,,,,,,2949.7800,11428.8400,percent of total billed charges,"32.3% of $11,428.84 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ECG 5 LEAD ASSEMBLY AHA,272,RC,,,,,,,,both,,,11428.8400,1714.3300,WELLCARE,WELLCARE MEDICAID,11428.84,,,,,,,2949.7800,11428.8400,percent of total billed charges,"100% of $11,428.84 in Billed Charges for Rev 272 = $11,428.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE HD GRID DIRECT,272,RC,27200002,CDM,,,,,,both,,,5838.8700,875.8300,AETNA,AETNA,2493.20,,,,,,,1507.0100,5838.8700,percent of total billed charges,"42.7% of $5,838.87 in Billed Charges for Rev 272 = $2,493.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE HD GRID DIRECT,272,RC,27200002,CDM,,,,,,both,,,5838.8700,875.8300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4087.21,,,,,,,1507.0100,5838.8700,percent of total billed charges,"Rev 272 $5,838.87 in Billed Charges at 70% = $4,087.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE HD GRID DIRECT,272,RC,27200002,CDM,,,,,,both,,,5838.8700,875.8300,CIGNA HEALTHCARE,CIGNA HMO,2434.81,,,,,,,1507.0100,5838.8700,percent of total billed charges,"41.7% of $5,838.87 in Billed Charges for Rev 272 = $2,434.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE HD GRID DIRECT,272,RC,27200002,CDM,,,,,,both,,,5838.8700,875.8300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2709.24,,,,,,,1507.0100,5838.8700,percent of total billed charges,"46.4% of $5,838.87 in Billed Charges for Rev 272 = $2,709.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE HD GRID DIRECT,272,RC,27200002,CDM,,,,,,both,,,5838.8700,875.8300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2434.81,,,,,,,1507.0100,5838.8700,percent of total billed charges,"41.7% of $5,838.87 in Billed Charges for Rev 272 = $2,434.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE HD GRID DIRECT,272,RC,27200002,CDM,,,,,,both,,,5838.8700,875.8300,CIGNA HEALTHCARE,CIGNA PPO,2434.81,,,,,,,1507.0100,5838.8700,percent of total billed charges,"41.7% of $5,838.87 in Billed Charges for Rev 272 = $2,434.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE HD GRID DIRECT,272,RC,27200002,CDM,,,,,,both,,,5838.8700,875.8300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5254.98,,,,,,,1507.0100,5838.8700,percent of total billed charges,"90% of $5,838.87 in Billed Charges for Rev 272 = $5,254.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE HD GRID DIRECT,272,RC,27200002,CDM,,,,,,both,,,5838.8700,875.8300,MEDCOST,MEDCOST VHN,2778.72,,,,,,,1507.0100,5838.8700,percent of total billed charges,"47.59% of $5,838.87 in Billed Charges for Rev 272 = $2,778.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE HD GRID DIRECT,272,RC,27200002,CDM,,,,,,both,,,5838.8700,875.8300,SENTARA HEALTH,SENTARA HEALTH,1507.01,,,,,,,1507.0100,5838.8700,percent of total billed charges,"25.81% of $5,838.87 in Billed Charges for Rev 272 = $1,507.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE HD GRID DIRECT,272,RC,27200002,CDM,,,,,,both,,,5838.8700,875.8300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5838.87,,,,,,,1507.0100,5838.8700,percent of total billed charges,"100% of $5,838.87 in Billed Charges for Rev 272 = $5,838.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE HD GRID DIRECT,272,RC,27200002,CDM,,,,,,both,,,5838.8700,875.8300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2919.44,,,,,,,1507.0100,5838.8700,percent of total billed charges,"Rev 272 $5,838.87 in Billed Charges at 50% = $2,919.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE HD GRID DIRECT,272,RC,27200002,CDM,,,,,,both,,,5838.8700,875.8300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1885.96,,,,,,,1507.0100,5838.8700,other,"32.3% of $5,838.87 in Billed Charges for Rev 272 = $1,885.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CABLE HD GRID DIRECT,272,RC,27200002,CDM,,,,,,both,,,5838.8700,875.8300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1792.53,,,,,,,1507.0100,5838.8700,other,"30.7% of $5,838.87 in Billed Charges for Rev 272 = $1,792.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CABLE HD GRID DIRECT,272,RC,27200002,CDM,,,,,,both,,,5838.8700,875.8300,UNITED HEALTHCARE,UNITED HEALTHCARE,1885.96,,,,,,,1507.0100,5838.8700,percent of total billed charges,"32.3% of $5,838.87 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE HD GRID DIRECT,272,RC,27200002,CDM,,,,,,both,,,5838.8700,875.8300,WELLCARE,WELLCARE MEDICAID,5838.87,,,,,,,1507.0100,5838.8700,percent of total billed charges,"100% of $5,838.87 in Billed Charges for Rev 272 = $5,838.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4459.5300,668.9300,AETNA,AETNA,1904.22,,,,,,,1151.0000,4459.5300,percent of total billed charges,"42.7% of $4,459.53 in Billed Charges for Rev 272 = $1,904.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4459.5300,668.9300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3121.67,,,,,,,1151.0000,4459.5300,percent of total billed charges,"Rev 272 $4,459.53 in Billed Charges at 70% = $3,121.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4459.5300,668.9300,CIGNA HEALTHCARE,CIGNA HMO,1859.62,,,,,,,1151.0000,4459.5300,percent of total billed charges,"41.7% of $4,459.53 in Billed Charges for Rev 272 = $1,859.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4459.5300,668.9300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2069.22,,,,,,,1151.0000,4459.5300,percent of total billed charges,"46.4% of $4,459.53 in Billed Charges for Rev 272 = $2,069.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4459.5300,668.9300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1859.62,,,,,,,1151.0000,4459.5300,percent of total billed charges,"41.7% of $4,459.53 in Billed Charges for Rev 272 = $1,859.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4459.5300,668.9300,CIGNA HEALTHCARE,CIGNA PPO,1859.62,,,,,,,1151.0000,4459.5300,percent of total billed charges,"41.7% of $4,459.53 in Billed Charges for Rev 272 = $1,859.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4459.5300,668.9300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4013.58,,,,,,,1151.0000,4459.5300,percent of total billed charges,"90% of $4,459.53 in Billed Charges for Rev 272 = $4,013.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4459.5300,668.9300,MEDCOST,MEDCOST VHN,2122.29,,,,,,,1151.0000,4459.5300,percent of total billed charges,"47.59% of $4,459.53 in Billed Charges for Rev 272 = $2,122.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4459.5300,668.9300,SENTARA HEALTH,SENTARA HEALTH,1151.00,,,,,,,1151.0000,4459.5300,percent of total billed charges,"25.81% of $4,459.53 in Billed Charges for Rev 272 = $1,151.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4459.5300,668.9300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4459.53,,,,,,,1151.0000,4459.5300,percent of total billed charges,"100% of $4,459.53 in Billed Charges for Rev 272 = $4,459.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4459.5300,668.9300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2229.77,,,,,,,1151.0000,4459.5300,percent of total billed charges,"Rev 272 $4,459.53 in Billed Charges at 50% = $2,229.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4459.5300,668.9300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1440.43,,,,,,,1151.0000,4459.5300,other,"32.3% of $4,459.53 in Billed Charges for Rev 272 = $1,440.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CABLE LIVEWIRE 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4459.5300,668.9300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1369.08,,,,,,,1151.0000,4459.5300,other,"30.7% of $4,459.53 in Billed Charges for Rev 272 = $1,369.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CABLE LIVEWIRE 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4459.5300,668.9300,UNITED HEALTHCARE,UNITED HEALTHCARE,1440.43,,,,,,,1151.0000,4459.5300,percent of total billed charges,"32.3% of $4,459.53 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4459.5300,668.9300,WELLCARE,WELLCARE MEDICAID,4459.53,,,,,,,1151.0000,4459.5300,percent of total billed charges,"100% of $4,459.53 in Billed Charges for Rev 272 = $4,459.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL BIO COMPRESSION SCREW 16MM,272,RC,27200002,CDM,,,,,,both,,,2426.8100,364.0200,AETNA,AETNA,1036.25,,,,,,,626.3600,2426.8100,percent of total billed charges,"42.7% of $2,426.81 in Billed Charges for Rev 272 = $1,036.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL BIO COMPRESSION SCREW 16MM,272,RC,27200002,CDM,,,,,,both,,,2426.8100,364.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1698.77,,,,,,,626.3600,2426.8100,percent of total billed charges,"Rev 272 $2,426.81 in Billed Charges at 70% = $1,698.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL BIO COMPRESSION SCREW 16MM,272,RC,27200002,CDM,,,,,,both,,,2426.8100,364.0200,CIGNA HEALTHCARE,CIGNA HMO,1011.98,,,,,,,626.3600,2426.8100,percent of total billed charges,"41.7% of $2,426.81 in Billed Charges for Rev 272 = $1,011.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL BIO COMPRESSION SCREW 16MM,272,RC,27200002,CDM,,,,,,both,,,2426.8100,364.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1126.04,,,,,,,626.3600,2426.8100,percent of total billed charges,"46.4% of $2,426.81 in Billed Charges for Rev 272 = $1,126.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL BIO COMPRESSION SCREW 16MM,272,RC,27200002,CDM,,,,,,both,,,2426.8100,364.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1011.98,,,,,,,626.3600,2426.8100,percent of total billed charges,"41.7% of $2,426.81 in Billed Charges for Rev 272 = $1,011.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL BIO COMPRESSION SCREW 16MM,272,RC,27200002,CDM,,,,,,both,,,2426.8100,364.0200,CIGNA HEALTHCARE,CIGNA PPO,1011.98,,,,,,,626.3600,2426.8100,percent of total billed charges,"41.7% of $2,426.81 in Billed Charges for Rev 272 = $1,011.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL BIO COMPRESSION SCREW 16MM,272,RC,27200002,CDM,,,,,,both,,,2426.8100,364.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2184.13,,,,,,,626.3600,2426.8100,percent of total billed charges,"90% of $2,426.81 in Billed Charges for Rev 272 = $2,184.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL BIO COMPRESSION SCREW 16MM,272,RC,27200002,CDM,,,,,,both,,,2426.8100,364.0200,MEDCOST,MEDCOST VHN,1154.92,,,,,,,626.3600,2426.8100,percent of total billed charges,"47.59% of $2,426.81 in Billed Charges for Rev 272 = $1,154.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL BIO COMPRESSION SCREW 16MM,272,RC,27200002,CDM,,,,,,both,,,2426.8100,364.0200,SENTARA HEALTH,SENTARA HEALTH,626.36,,,,,,,626.3600,2426.8100,percent of total billed charges,"25.81% of $2,426.81 in Billed Charges for Rev 272 = $626.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL BIO COMPRESSION SCREW 16MM,272,RC,27200002,CDM,,,,,,both,,,2426.8100,364.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2426.81,,,,,,,626.3600,2426.8100,percent of total billed charges,"100% of $2,426.81 in Billed Charges for Rev 272 = $2,426.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL BIO COMPRESSION SCREW 16MM,272,RC,27200002,CDM,,,,,,both,,,2426.8100,364.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1213.41,,,,,,,626.3600,2426.8100,percent of total billed charges,"Rev 272 $2,426.81 in Billed Charges at 50% = $1,213.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL BIO COMPRESSION SCREW 16MM,272,RC,27200002,CDM,,,,,,both,,,2426.8100,364.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,783.86,,,,,,,626.3600,2426.8100,other,"32.3% of $2,426.81 in Billed Charges for Rev 272 = $783.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL BIO COMPRESSION SCREW 16MM,272,RC,27200002,CDM,,,,,,both,,,2426.8100,364.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,745.03,,,,,,,626.3600,2426.8100,other,"30.7% of $2,426.81 in Billed Charges for Rev 272 = $745.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL BIO COMPRESSION SCREW 16MM,272,RC,27200002,CDM,,,,,,both,,,2426.8100,364.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,783.86,,,,,,,626.3600,2426.8100,percent of total billed charges,"32.3% of $2,426.81 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL BIO COMPRESSION SCREW 16MM,272,RC,27200002,CDM,,,,,,both,,,2426.8100,364.0200,WELLCARE,WELLCARE MEDICAID,2426.81,,,,,,,626.3600,2426.8100,percent of total billed charges,"100% of $2,426.81 in Billed Charges for Rev 272 = $2,426.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1171.9200,175.7900,AETNA,AETNA,500.41,,,,,,,302.4700,1171.9200,percent of total billed charges,"42.7% of $1,171.92 in Billed Charges for Rev 272 = $500.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1171.9200,175.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,820.34,,,,,,,302.4700,1171.9200,percent of total billed charges,"Rev 272 $1,171.92 in Billed Charges at 70% = $820.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1171.9200,175.7900,CIGNA HEALTHCARE,CIGNA HMO,488.69,,,,,,,302.4700,1171.9200,percent of total billed charges,"41.7% of $1,171.92 in Billed Charges for Rev 272 = $488.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1171.9200,175.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,543.77,,,,,,,302.4700,1171.9200,percent of total billed charges,"46.4% of $1,171.92 in Billed Charges for Rev 272 = $543.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1171.9200,175.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,488.69,,,,,,,302.4700,1171.9200,percent of total billed charges,"41.7% of $1,171.92 in Billed Charges for Rev 272 = $488.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1171.9200,175.7900,CIGNA HEALTHCARE,CIGNA PPO,488.69,,,,,,,302.4700,1171.9200,percent of total billed charges,"41.7% of $1,171.92 in Billed Charges for Rev 272 = $488.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1171.9200,175.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1054.73,,,,,,,302.4700,1171.9200,percent of total billed charges,"90% of $1,171.92 in Billed Charges for Rev 272 = $1,054.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1171.9200,175.7900,MEDCOST,MEDCOST VHN,557.72,,,,,,,302.4700,1171.9200,percent of total billed charges,"47.59% of $1,171.92 in Billed Charges for Rev 272 = $557.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1171.9200,175.7900,SENTARA HEALTH,SENTARA HEALTH,302.47,,,,,,,302.4700,1171.9200,percent of total billed charges,"25.81% of $1,171.92 in Billed Charges for Rev 272 = $302.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1171.9200,175.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1171.92,,,,,,,302.4700,1171.9200,percent of total billed charges,"100% of $1,171.92 in Billed Charges for Rev 272 = $1,171.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1171.9200,175.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,585.96,,,,,,,302.4700,1171.9200,percent of total billed charges,"Rev 272 $1,171.92 in Billed Charges at 50% = $585.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1171.9200,175.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,378.53,,,,,,,302.4700,1171.9200,other,"32.3% of $1,171.92 in Billed Charges for Rev 272 = $378.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CALIBRATED 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1171.9200,175.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,359.78,,,,,,,302.4700,1171.9200,other,"30.7% of $1,171.92 in Billed Charges for Rev 272 = $359.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CALIBRATED 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1171.9200,175.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,378.53,,,,,,,302.4700,1171.9200,percent of total billed charges,"32.3% of $1,171.92 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1171.9200,175.7900,WELLCARE,WELLCARE MEDICAID,1171.92,,,,,,,302.4700,1171.9200,percent of total billed charges,"100% of $1,171.92 in Billed Charges for Rev 272 = $1,171.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,,,,,,,,both,,,1681.4500,252.2200,AETNA,AETNA,717.98,,,,,,,433.9800,1681.4500,percent of total billed charges,"42.7% of $1,681.45 in Billed Charges for Rev 272 = $717.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,,,,,,,,both,,,1681.4500,252.2200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1177.02,,,,,,,433.9800,1681.4500,percent of total billed charges,"Rev 272 $1,681.45 in Billed Charges at 70% = $1,177.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,,,,,,,,both,,,1681.4500,252.2200,CIGNA HEALTHCARE,CIGNA HMO,701.16,,,,,,,433.9800,1681.4500,percent of total billed charges,"41.7% of $1,681.45 in Billed Charges for Rev 272 = $701.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,,,,,,,,both,,,1681.4500,252.2200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,780.19,,,,,,,433.9800,1681.4500,percent of total billed charges,"46.4% of $1,681.45 in Billed Charges for Rev 272 = $780.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,,,,,,,,both,,,1681.4500,252.2200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,701.16,,,,,,,433.9800,1681.4500,percent of total billed charges,"41.7% of $1,681.45 in Billed Charges for Rev 272 = $701.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,,,,,,,,both,,,1681.4500,252.2200,CIGNA HEALTHCARE,CIGNA PPO,701.16,,,,,,,433.9800,1681.4500,percent of total billed charges,"41.7% of $1,681.45 in Billed Charges for Rev 272 = $701.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,,,,,,,,both,,,1681.4500,252.2200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1513.31,,,,,,,433.9800,1681.4500,percent of total billed charges,"90% of $1,681.45 in Billed Charges for Rev 272 = $1,513.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,,,,,,,,both,,,1681.4500,252.2200,MEDCOST,MEDCOST VHN,800.20,,,,,,,433.9800,1681.4500,percent of total billed charges,"47.59% of $1,681.45 in Billed Charges for Rev 272 = $800.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,,,,,,,,both,,,1681.4500,252.2200,SENTARA HEALTH,SENTARA HEALTH,433.98,,,,,,,433.9800,1681.4500,percent of total billed charges,"25.81% of $1,681.45 in Billed Charges for Rev 272 = $433.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,,,,,,,,both,,,1681.4500,252.2200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1681.45,,,,,,,433.9800,1681.4500,percent of total billed charges,"100% of $1,681.45 in Billed Charges for Rev 272 = $1,681.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,,,,,,,,both,,,1681.4500,252.2200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,840.73,,,,,,,433.9800,1681.4500,percent of total billed charges,"Rev 272 $1,681.45 in Billed Charges at 50% = $840.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,,,,,,,,both,,,1681.4500,252.2200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,543.11,,,,,,,433.9800,1681.4500,other,"32.3% of $1,681.45 in Billed Charges for Rev 272 = $543.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CALIBRATED 2.0MM,272,RC,,,,,,,,both,,,1681.4500,252.2200,UNITED HEALTHCARE,UHC HERITAGE SELECT,516.21,,,,,,,433.9800,1681.4500,other,"30.7% of $1,681.45 in Billed Charges for Rev 272 = $516.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CALIBRATED 2.0MM,272,RC,,,,,,,,both,,,1681.4500,252.2200,UNITED HEALTHCARE,UNITED HEALTHCARE,543.11,,,,,,,433.9800,1681.4500,percent of total billed charges,"32.3% of $1,681.45 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 2.0MM,272,RC,,,,,,,,both,,,1681.4500,252.2200,WELLCARE,WELLCARE MEDICAID,1681.45,,,,,,,433.9800,1681.4500,percent of total billed charges,"100% of $1,681.45 in Billed Charges for Rev 272 = $1,681.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE SUPREME 4 PIN DIRECT/ONE COLOR,272,RC,27200002,CDM,,,,,,both,,,3681.7100,552.2600,AETNA,AETNA,1572.09,,,,,,,950.2500,3681.7100,percent of total billed charges,"42.7% of $3,681.71 in Billed Charges for Rev 272 = $1,572.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE SUPREME 4 PIN DIRECT/ONE COLOR,272,RC,27200002,CDM,,,,,,both,,,3681.7100,552.2600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2577.20,,,,,,,950.2500,3681.7100,percent of total billed charges,"Rev 272 $3,681.71 in Billed Charges at 70% = $2,577.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE SUPREME 4 PIN DIRECT/ONE COLOR,272,RC,27200002,CDM,,,,,,both,,,3681.7100,552.2600,CIGNA HEALTHCARE,CIGNA HMO,1535.27,,,,,,,950.2500,3681.7100,percent of total billed charges,"41.7% of $3,681.71 in Billed Charges for Rev 272 = $1,535.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE SUPREME 4 PIN DIRECT/ONE COLOR,272,RC,27200002,CDM,,,,,,both,,,3681.7100,552.2600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1708.31,,,,,,,950.2500,3681.7100,percent of total billed charges,"46.4% of $3,681.71 in Billed Charges for Rev 272 = $1,708.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE SUPREME 4 PIN DIRECT/ONE COLOR,272,RC,27200002,CDM,,,,,,both,,,3681.7100,552.2600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1535.27,,,,,,,950.2500,3681.7100,percent of total billed charges,"41.7% of $3,681.71 in Billed Charges for Rev 272 = $1,535.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE SUPREME 4 PIN DIRECT/ONE COLOR,272,RC,27200002,CDM,,,,,,both,,,3681.7100,552.2600,CIGNA HEALTHCARE,CIGNA PPO,1535.27,,,,,,,950.2500,3681.7100,percent of total billed charges,"41.7% of $3,681.71 in Billed Charges for Rev 272 = $1,535.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE SUPREME 4 PIN DIRECT/ONE COLOR,272,RC,27200002,CDM,,,,,,both,,,3681.7100,552.2600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3313.54,,,,,,,950.2500,3681.7100,percent of total billed charges,"90% of $3,681.71 in Billed Charges for Rev 272 = $3,313.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE SUPREME 4 PIN DIRECT/ONE COLOR,272,RC,27200002,CDM,,,,,,both,,,3681.7100,552.2600,MEDCOST,MEDCOST VHN,1752.13,,,,,,,950.2500,3681.7100,percent of total billed charges,"47.59% of $3,681.71 in Billed Charges for Rev 272 = $1,752.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE SUPREME 4 PIN DIRECT/ONE COLOR,272,RC,27200002,CDM,,,,,,both,,,3681.7100,552.2600,SENTARA HEALTH,SENTARA HEALTH,950.25,,,,,,,950.2500,3681.7100,percent of total billed charges,"25.81% of $3,681.71 in Billed Charges for Rev 272 = $950.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE SUPREME 4 PIN DIRECT/ONE COLOR,272,RC,27200002,CDM,,,,,,both,,,3681.7100,552.2600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3681.71,,,,,,,950.2500,3681.7100,percent of total billed charges,"100% of $3,681.71 in Billed Charges for Rev 272 = $3,681.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE SUPREME 4 PIN DIRECT/ONE COLOR,272,RC,27200002,CDM,,,,,,both,,,3681.7100,552.2600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1840.86,,,,,,,950.2500,3681.7100,percent of total billed charges,"Rev 272 $3,681.71 in Billed Charges at 50% = $1,840.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE SUPREME 4 PIN DIRECT/ONE COLOR,272,RC,27200002,CDM,,,,,,both,,,3681.7100,552.2600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1189.19,,,,,,,950.2500,3681.7100,other,"32.3% of $3,681.71 in Billed Charges for Rev 272 = $1,189.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CABLE SUPREME 4 PIN DIRECT/ONE COLOR,272,RC,27200002,CDM,,,,,,both,,,3681.7100,552.2600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1130.29,,,,,,,950.2500,3681.7100,other,"30.7% of $3,681.71 in Billed Charges for Rev 272 = $1,130.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CABLE SUPREME 4 PIN DIRECT/ONE COLOR,272,RC,27200002,CDM,,,,,,both,,,3681.7100,552.2600,UNITED HEALTHCARE,UNITED HEALTHCARE,1189.19,,,,,,,950.2500,3681.7100,percent of total billed charges,"32.3% of $3,681.71 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE SUPREME 4 PIN DIRECT/ONE COLOR,272,RC,27200002,CDM,,,,,,both,,,3681.7100,552.2600,WELLCARE,WELLCARE MEDICAID,3681.71,,,,,,,950.2500,3681.7100,percent of total billed charges,"100% of $3,681.71 in Billed Charges for Rev 272 = $3,681.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH RETROGRADE CARDIOPLEGIA,272,RC,27200002,CDM,,,,,,both,,,1338.1700,200.7300,AETNA,AETNA,571.40,,,,,,,345.3800,1338.1700,percent of total billed charges,"42.7% of $1,338.17 in Billed Charges for Rev 272 = $571.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH RETROGRADE CARDIOPLEGIA,272,RC,27200002,CDM,,,,,,both,,,1338.1700,200.7300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,936.72,,,,,,,345.3800,1338.1700,percent of total billed charges,"Rev 272 $1,338.17 in Billed Charges at 70% = $936.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH RETROGRADE CARDIOPLEGIA,272,RC,27200002,CDM,,,,,,both,,,1338.1700,200.7300,CIGNA HEALTHCARE,CIGNA HMO,558.02,,,,,,,345.3800,1338.1700,percent of total billed charges,"41.7% of $1,338.17 in Billed Charges for Rev 272 = $558.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH RETROGRADE CARDIOPLEGIA,272,RC,27200002,CDM,,,,,,both,,,1338.1700,200.7300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,620.91,,,,,,,345.3800,1338.1700,percent of total billed charges,"46.4% of $1,338.17 in Billed Charges for Rev 272 = $620.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH RETROGRADE CARDIOPLEGIA,272,RC,27200002,CDM,,,,,,both,,,1338.1700,200.7300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,558.02,,,,,,,345.3800,1338.1700,percent of total billed charges,"41.7% of $1,338.17 in Billed Charges for Rev 272 = $558.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH RETROGRADE CARDIOPLEGIA,272,RC,27200002,CDM,,,,,,both,,,1338.1700,200.7300,CIGNA HEALTHCARE,CIGNA PPO,558.02,,,,,,,345.3800,1338.1700,percent of total billed charges,"41.7% of $1,338.17 in Billed Charges for Rev 272 = $558.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH RETROGRADE CARDIOPLEGIA,272,RC,27200002,CDM,,,,,,both,,,1338.1700,200.7300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1204.35,,,,,,,345.3800,1338.1700,percent of total billed charges,"90% of $1,338.17 in Billed Charges for Rev 272 = $1,204.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH RETROGRADE CARDIOPLEGIA,272,RC,27200002,CDM,,,,,,both,,,1338.1700,200.7300,MEDCOST,MEDCOST VHN,636.84,,,,,,,345.3800,1338.1700,percent of total billed charges,"47.59% of $1,338.17 in Billed Charges for Rev 272 = $636.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH RETROGRADE CARDIOPLEGIA,272,RC,27200002,CDM,,,,,,both,,,1338.1700,200.7300,SENTARA HEALTH,SENTARA HEALTH,345.38,,,,,,,345.3800,1338.1700,percent of total billed charges,"25.81% of $1,338.17 in Billed Charges for Rev 272 = $345.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH RETROGRADE CARDIOPLEGIA,272,RC,27200002,CDM,,,,,,both,,,1338.1700,200.7300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1338.17,,,,,,,345.3800,1338.1700,percent of total billed charges,"100% of $1,338.17 in Billed Charges for Rev 272 = $1,338.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH RETROGRADE CARDIOPLEGIA,272,RC,27200002,CDM,,,,,,both,,,1338.1700,200.7300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,669.09,,,,,,,345.3800,1338.1700,percent of total billed charges,"Rev 272 $1,338.17 in Billed Charges at 50% = $669.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH RETROGRADE CARDIOPLEGIA,272,RC,27200002,CDM,,,,,,both,,,1338.1700,200.7300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,432.23,,,,,,,345.3800,1338.1700,other,"32.3% of $1,338.17 in Billed Charges for Rev 272 = $432.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH RETROGRADE CARDIOPLEGIA,272,RC,27200002,CDM,,,,,,both,,,1338.1700,200.7300,UNITED HEALTHCARE,UHC HERITAGE SELECT,410.82,,,,,,,345.3800,1338.1700,other,"30.7% of $1,338.17 in Billed Charges for Rev 272 = $410.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH RETROGRADE CARDIOPLEGIA,272,RC,27200002,CDM,,,,,,both,,,1338.1700,200.7300,UNITED HEALTHCARE,UNITED HEALTHCARE,432.23,,,,,,,345.3800,1338.1700,percent of total billed charges,"32.3% of $1,338.17 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH RETROGRADE CARDIOPLEGIA,272,RC,27200002,CDM,,,,,,both,,,1338.1700,200.7300,WELLCARE,WELLCARE MEDICAID,1338.17,,,,,,,345.3800,1338.1700,percent of total billed charges,"100% of $1,338.17 in Billed Charges for Rev 272 = $1,338.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH SIZING OMNI 035/100CM 13709703,272,RC,27200002,CDM,,,,,,both,,,1557.7200,233.6600,AETNA,AETNA,665.15,,,,,,,402.0500,1557.7200,percent of total billed charges,"42.7% of $1,557.72 in Billed Charges for Rev 272 = $665.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH SIZING OMNI 035/100CM 13709703,272,RC,27200002,CDM,,,,,,both,,,1557.7200,233.6600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1090.40,,,,,,,402.0500,1557.7200,percent of total billed charges,"Rev 272 $1,557.72 in Billed Charges at 70% = $1,090.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH SIZING OMNI 035/100CM 13709703,272,RC,27200002,CDM,,,,,,both,,,1557.7200,233.6600,CIGNA HEALTHCARE,CIGNA HMO,649.57,,,,,,,402.0500,1557.7200,percent of total billed charges,"41.7% of $1,557.72 in Billed Charges for Rev 272 = $649.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH SIZING OMNI 035/100CM 13709703,272,RC,27200002,CDM,,,,,,both,,,1557.7200,233.6600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,722.78,,,,,,,402.0500,1557.7200,percent of total billed charges,"46.4% of $1,557.72 in Billed Charges for Rev 272 = $722.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH SIZING OMNI 035/100CM 13709703,272,RC,27200002,CDM,,,,,,both,,,1557.7200,233.6600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,649.57,,,,,,,402.0500,1557.7200,percent of total billed charges,"41.7% of $1,557.72 in Billed Charges for Rev 272 = $649.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH SIZING OMNI 035/100CM 13709703,272,RC,27200002,CDM,,,,,,both,,,1557.7200,233.6600,CIGNA HEALTHCARE,CIGNA PPO,649.57,,,,,,,402.0500,1557.7200,percent of total billed charges,"41.7% of $1,557.72 in Billed Charges for Rev 272 = $649.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH SIZING OMNI 035/100CM 13709703,272,RC,27200002,CDM,,,,,,both,,,1557.7200,233.6600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1401.95,,,,,,,402.0500,1557.7200,percent of total billed charges,"90% of $1,557.72 in Billed Charges for Rev 272 = $1,401.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH SIZING OMNI 035/100CM 13709703,272,RC,27200002,CDM,,,,,,both,,,1557.7200,233.6600,MEDCOST,MEDCOST VHN,741.32,,,,,,,402.0500,1557.7200,percent of total billed charges,"47.59% of $1,557.72 in Billed Charges for Rev 272 = $741.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH SIZING OMNI 035/100CM 13709703,272,RC,27200002,CDM,,,,,,both,,,1557.7200,233.6600,SENTARA HEALTH,SENTARA HEALTH,402.05,,,,,,,402.0500,1557.7200,percent of total billed charges,"25.81% of $1,557.72 in Billed Charges for Rev 272 = $402.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH SIZING OMNI 035/100CM 13709703,272,RC,27200002,CDM,,,,,,both,,,1557.7200,233.6600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1557.72,,,,,,,402.0500,1557.7200,percent of total billed charges,"100% of $1,557.72 in Billed Charges for Rev 272 = $1,557.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH SIZING OMNI 035/100CM 13709703,272,RC,27200002,CDM,,,,,,both,,,1557.7200,233.6600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,778.86,,,,,,,402.0500,1557.7200,percent of total billed charges,"Rev 272 $1,557.72 in Billed Charges at 50% = $778.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH SIZING OMNI 035/100CM 13709703,272,RC,27200002,CDM,,,,,,both,,,1557.7200,233.6600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,503.14,,,,,,,402.0500,1557.7200,other,"32.3% of $1,557.72 in Billed Charges for Rev 272 = $503.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH SIZING OMNI 035/100CM 13709703,272,RC,27200002,CDM,,,,,,both,,,1557.7200,233.6600,UNITED HEALTHCARE,UHC HERITAGE SELECT,478.22,,,,,,,402.0500,1557.7200,other,"30.7% of $1,557.72 in Billed Charges for Rev 272 = $478.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH SIZING OMNI 035/100CM 13709703,272,RC,27200002,CDM,,,,,,both,,,1557.7200,233.6600,UNITED HEALTHCARE,UNITED HEALTHCARE,503.14,,,,,,,402.0500,1557.7200,percent of total billed charges,"32.3% of $1,557.72 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH SIZING OMNI 035/100CM 13709703,272,RC,27200002,CDM,,,,,,both,,,1557.7200,233.6600,WELLCARE,WELLCARE MEDICAID,1557.72,,,,,,,402.0500,1557.7200,percent of total billed charges,"100% of $1,557.72 in Billed Charges for Rev 272 = $1,557.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH SIZING PIG TIP 5FR X 100CM,272,RC,,,,,,,,both,,,951.0000,142.6500,AETNA,AETNA,406.08,,,,,,,245.4500,951.0000,percent of total billed charges,42.7% of $951.00 in Billed Charges for Rev 272 = $406.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH SIZING PIG TIP 5FR X 100CM,272,RC,,,,,,,,both,,,951.0000,142.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,665.70,,,,,,,245.4500,951.0000,percent of total billed charges,Rev 272 $951.00 in Billed Charges at 70% = $665.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH SIZING PIG TIP 5FR X 100CM,272,RC,,,,,,,,both,,,951.0000,142.6500,CIGNA HEALTHCARE,CIGNA HMO,396.57,,,,,,,245.4500,951.0000,percent of total billed charges,41.7% of $951.00 in Billed Charges for Rev 272 = $396.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH SIZING PIG TIP 5FR X 100CM,272,RC,,,,,,,,both,,,951.0000,142.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,441.26,,,,,,,245.4500,951.0000,percent of total billed charges,46.4% of $951.00 in Billed Charges for Rev 272 = $441.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH SIZING PIG TIP 5FR X 100CM,272,RC,,,,,,,,both,,,951.0000,142.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,396.57,,,,,,,245.4500,951.0000,percent of total billed charges,41.7% of $951.00 in Billed Charges for Rev 272 = $396.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH SIZING PIG TIP 5FR X 100CM,272,RC,,,,,,,,both,,,951.0000,142.6500,CIGNA HEALTHCARE,CIGNA PPO,396.57,,,,,,,245.4500,951.0000,percent of total billed charges,41.7% of $951.00 in Billed Charges for Rev 272 = $396.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH SIZING PIG TIP 5FR X 100CM,272,RC,,,,,,,,both,,,951.0000,142.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,855.90,,,,,,,245.4500,951.0000,percent of total billed charges,90% of $951.00 in Billed Charges for Rev 272 = $855.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH SIZING PIG TIP 5FR X 100CM,272,RC,,,,,,,,both,,,951.0000,142.6500,MEDCOST,MEDCOST VHN,452.58,,,,,,,245.4500,951.0000,percent of total billed charges,47.59% of $951.00 in Billed Charges for Rev 272 = $452.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH SIZING PIG TIP 5FR X 100CM,272,RC,,,,,,,,both,,,951.0000,142.6500,SENTARA HEALTH,SENTARA HEALTH,245.45,,,,,,,245.4500,951.0000,percent of total billed charges,25.81% of $951.00 in Billed Charges for Rev 272 = $245.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH SIZING PIG TIP 5FR X 100CM,272,RC,,,,,,,,both,,,951.0000,142.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",951.00,,,,,,,245.4500,951.0000,percent of total billed charges,100% of $951.00 in Billed Charges for Rev 272 = $951.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH SIZING PIG TIP 5FR X 100CM,272,RC,,,,,,,,both,,,951.0000,142.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,475.50,,,,,,,245.4500,951.0000,percent of total billed charges,Rev 272 $951.00 in Billed Charges at 50% = $475.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH SIZING PIG TIP 5FR X 100CM,272,RC,,,,,,,,both,,,951.0000,142.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,307.17,,,,,,,245.4500,951.0000,other,32.3% of $951.00 in Billed Charges for Rev 272 = $307.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATH SIZING PIG TIP 5FR X 100CM,272,RC,,,,,,,,both,,,951.0000,142.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,291.96,,,,,,,245.4500,951.0000,other,30.7% of $951.00 in Billed Charges for Rev 272 = $291.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATH SIZING PIG TIP 5FR X 100CM,272,RC,,,,,,,,both,,,951.0000,142.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,307.17,,,,,,,245.4500,951.0000,percent of total billed charges,32.3% of $951.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH SIZING PIG TIP 5FR X 100CM,272,RC,,,,,,,,both,,,951.0000,142.6500,WELLCARE,WELLCARE MEDICAID,951.00,,,,,,,245.4500,951.0000,percent of total billed charges,100% of $951.00 in Billed Charges for Rev 272 = $951.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL CALIBRATED 3.2,272,RC,,,,,,,,both,,,1644.7400,246.7100,AETNA,AETNA,702.30,,,,,,,424.5100,1644.7400,percent of total billed charges,"42.7% of $1,644.74 in Billed Charges for Rev 272 = $702.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2,272,RC,,,,,,,,both,,,1644.7400,246.7100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1151.32,,,,,,,424.5100,1644.7400,percent of total billed charges,"Rev 272 $1,644.74 in Billed Charges at 70% = $1,151.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2,272,RC,,,,,,,,both,,,1644.7400,246.7100,CIGNA HEALTHCARE,CIGNA HMO,685.86,,,,,,,424.5100,1644.7400,percent of total billed charges,"41.7% of $1,644.74 in Billed Charges for Rev 272 = $685.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2,272,RC,,,,,,,,both,,,1644.7400,246.7100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,763.16,,,,,,,424.5100,1644.7400,percent of total billed charges,"46.4% of $1,644.74 in Billed Charges for Rev 272 = $763.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2,272,RC,,,,,,,,both,,,1644.7400,246.7100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,685.86,,,,,,,424.5100,1644.7400,percent of total billed charges,"41.7% of $1,644.74 in Billed Charges for Rev 272 = $685.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2,272,RC,,,,,,,,both,,,1644.7400,246.7100,CIGNA HEALTHCARE,CIGNA PPO,685.86,,,,,,,424.5100,1644.7400,percent of total billed charges,"41.7% of $1,644.74 in Billed Charges for Rev 272 = $685.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2,272,RC,,,,,,,,both,,,1644.7400,246.7100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1480.27,,,,,,,424.5100,1644.7400,percent of total billed charges,"90% of $1,644.74 in Billed Charges for Rev 272 = $1,480.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2,272,RC,,,,,,,,both,,,1644.7400,246.7100,MEDCOST,MEDCOST VHN,782.73,,,,,,,424.5100,1644.7400,percent of total billed charges,"47.59% of $1,644.74 in Billed Charges for Rev 272 = $782.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2,272,RC,,,,,,,,both,,,1644.7400,246.7100,SENTARA HEALTH,SENTARA HEALTH,424.51,,,,,,,424.5100,1644.7400,percent of total billed charges,"25.81% of $1,644.74 in Billed Charges for Rev 272 = $424.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2,272,RC,,,,,,,,both,,,1644.7400,246.7100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1644.74,,,,,,,424.5100,1644.7400,percent of total billed charges,"100% of $1,644.74 in Billed Charges for Rev 272 = $1,644.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2,272,RC,,,,,,,,both,,,1644.7400,246.7100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,822.37,,,,,,,424.5100,1644.7400,percent of total billed charges,"Rev 272 $1,644.74 in Billed Charges at 50% = $822.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2,272,RC,,,,,,,,both,,,1644.7400,246.7100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,531.25,,,,,,,424.5100,1644.7400,other,"32.3% of $1,644.74 in Billed Charges for Rev 272 = $531.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CALIBRATED 3.2,272,RC,,,,,,,,both,,,1644.7400,246.7100,UNITED HEALTHCARE,UHC HERITAGE SELECT,504.94,,,,,,,424.5100,1644.7400,other,"30.7% of $1,644.74 in Billed Charges for Rev 272 = $504.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CALIBRATED 3.2,272,RC,,,,,,,,both,,,1644.7400,246.7100,UNITED HEALTHCARE,UNITED HEALTHCARE,531.25,,,,,,,424.5100,1644.7400,percent of total billed charges,"32.3% of $1,644.74 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2,272,RC,,,,,,,,both,,,1644.7400,246.7100,WELLCARE,WELLCARE MEDICAID,1644.74,,,,,,,424.5100,1644.7400,percent of total billed charges,"100% of $1,644.74 in Billed Charges for Rev 272 = $1,644.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2MM,272,RC,,,,,,,,both,,,2062.7900,309.4200,AETNA,AETNA,880.81,,,,,,,532.4100,2062.7900,percent of total billed charges,"42.7% of $2,062.79 in Billed Charges for Rev 272 = $880.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2MM,272,RC,,,,,,,,both,,,2062.7900,309.4200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1443.95,,,,,,,532.4100,2062.7900,percent of total billed charges,"Rev 272 $2,062.79 in Billed Charges at 70% = $1,443.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2MM,272,RC,,,,,,,,both,,,2062.7900,309.4200,CIGNA HEALTHCARE,CIGNA HMO,860.18,,,,,,,532.4100,2062.7900,percent of total billed charges,"41.7% of $2,062.79 in Billed Charges for Rev 272 = $860.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2MM,272,RC,,,,,,,,both,,,2062.7900,309.4200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,957.13,,,,,,,532.4100,2062.7900,percent of total billed charges,"46.4% of $2,062.79 in Billed Charges for Rev 272 = $957.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2MM,272,RC,,,,,,,,both,,,2062.7900,309.4200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,860.18,,,,,,,532.4100,2062.7900,percent of total billed charges,"41.7% of $2,062.79 in Billed Charges for Rev 272 = $860.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2MM,272,RC,,,,,,,,both,,,2062.7900,309.4200,CIGNA HEALTHCARE,CIGNA PPO,860.18,,,,,,,532.4100,2062.7900,percent of total billed charges,"41.7% of $2,062.79 in Billed Charges for Rev 272 = $860.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2MM,272,RC,,,,,,,,both,,,2062.7900,309.4200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1856.51,,,,,,,532.4100,2062.7900,percent of total billed charges,"90% of $2,062.79 in Billed Charges for Rev 272 = $1,856.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2MM,272,RC,,,,,,,,both,,,2062.7900,309.4200,MEDCOST,MEDCOST VHN,981.68,,,,,,,532.4100,2062.7900,percent of total billed charges,"47.59% of $2,062.79 in Billed Charges for Rev 272 = $981.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2MM,272,RC,,,,,,,,both,,,2062.7900,309.4200,SENTARA HEALTH,SENTARA HEALTH,532.41,,,,,,,532.4100,2062.7900,percent of total billed charges,"25.81% of $2,062.79 in Billed Charges for Rev 272 = $532.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2MM,272,RC,,,,,,,,both,,,2062.7900,309.4200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2062.79,,,,,,,532.4100,2062.7900,percent of total billed charges,"100% of $2,062.79 in Billed Charges for Rev 272 = $2,062.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2MM,272,RC,,,,,,,,both,,,2062.7900,309.4200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1031.40,,,,,,,532.4100,2062.7900,percent of total billed charges,"Rev 272 $2,062.79 in Billed Charges at 50% = $1,031.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2MM,272,RC,,,,,,,,both,,,2062.7900,309.4200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,666.28,,,,,,,532.4100,2062.7900,other,"32.3% of $2,062.79 in Billed Charges for Rev 272 = $666.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CALIBRATED 3.2MM,272,RC,,,,,,,,both,,,2062.7900,309.4200,UNITED HEALTHCARE,UHC HERITAGE SELECT,633.28,,,,,,,532.4100,2062.7900,other,"30.7% of $2,062.79 in Billed Charges for Rev 272 = $633.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CALIBRATED 3.2MM,272,RC,,,,,,,,both,,,2062.7900,309.4200,UNITED HEALTHCARE,UNITED HEALTHCARE,666.28,,,,,,,532.4100,2062.7900,percent of total billed charges,"32.3% of $2,062.79 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CALIBRATED 3.2MM,272,RC,,,,,,,,both,,,2062.7900,309.4200,WELLCARE,WELLCARE MEDICAID,2062.79,,,,,,,532.4100,2062.7900,percent of total billed charges,"100% of $2,062.79 in Billed Charges for Rev 272 = $2,062.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 1.9MM,272,RC,,,,,,,,both,,,2235.1600,335.2700,AETNA,AETNA,954.41,,,,,,,576.8900,2235.1600,percent of total billed charges,"42.7% of $2,235.16 in Billed Charges for Rev 272 = $954.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 1.9MM,272,RC,,,,,,,,both,,,2235.1600,335.2700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1564.61,,,,,,,576.8900,2235.1600,percent of total billed charges,"Rev 272 $2,235.16 in Billed Charges at 70% = $1,564.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 1.9MM,272,RC,,,,,,,,both,,,2235.1600,335.2700,CIGNA HEALTHCARE,CIGNA HMO,932.06,,,,,,,576.8900,2235.1600,percent of total billed charges,"41.7% of $2,235.16 in Billed Charges for Rev 272 = $932.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 1.9MM,272,RC,,,,,,,,both,,,2235.1600,335.2700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1037.11,,,,,,,576.8900,2235.1600,percent of total billed charges,"46.4% of $2,235.16 in Billed Charges for Rev 272 = $1,037.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 1.9MM,272,RC,,,,,,,,both,,,2235.1600,335.2700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,932.06,,,,,,,576.8900,2235.1600,percent of total billed charges,"41.7% of $2,235.16 in Billed Charges for Rev 272 = $932.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 1.9MM,272,RC,,,,,,,,both,,,2235.1600,335.2700,CIGNA HEALTHCARE,CIGNA PPO,932.06,,,,,,,576.8900,2235.1600,percent of total billed charges,"41.7% of $2,235.16 in Billed Charges for Rev 272 = $932.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 1.9MM,272,RC,,,,,,,,both,,,2235.1600,335.2700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2011.64,,,,,,,576.8900,2235.1600,percent of total billed charges,"90% of $2,235.16 in Billed Charges for Rev 272 = $2,011.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 1.9MM,272,RC,,,,,,,,both,,,2235.1600,335.2700,MEDCOST,MEDCOST VHN,1063.71,,,,,,,576.8900,2235.1600,percent of total billed charges,"47.59% of $2,235.16 in Billed Charges for Rev 272 = $1,063.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 1.9MM,272,RC,,,,,,,,both,,,2235.1600,335.2700,SENTARA HEALTH,SENTARA HEALTH,576.89,,,,,,,576.8900,2235.1600,percent of total billed charges,"25.81% of $2,235.16 in Billed Charges for Rev 272 = $576.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 1.9MM,272,RC,,,,,,,,both,,,2235.1600,335.2700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2235.16,,,,,,,576.8900,2235.1600,percent of total billed charges,"100% of $2,235.16 in Billed Charges for Rev 272 = $2,235.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 1.9MM,272,RC,,,,,,,,both,,,2235.1600,335.2700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1117.58,,,,,,,576.8900,2235.1600,percent of total billed charges,"Rev 272 $2,235.16 in Billed Charges at 50% = $1,117.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 1.9MM,272,RC,,,,,,,,both,,,2235.1600,335.2700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,721.96,,,,,,,576.8900,2235.1600,other,"32.3% of $2,235.16 in Billed Charges for Rev 272 = $721.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANN 1.9MM,272,RC,,,,,,,,both,,,2235.1600,335.2700,UNITED HEALTHCARE,UHC HERITAGE SELECT,686.19,,,,,,,576.8900,2235.1600,other,"30.7% of $2,235.16 in Billed Charges for Rev 272 = $686.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL CANN 1.9MM,272,RC,,,,,,,,both,,,2235.1600,335.2700,UNITED HEALTHCARE,UNITED HEALTHCARE,721.96,,,,,,,576.8900,2235.1600,percent of total billed charges,"32.3% of $2,235.16 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL CANN 1.9MM,272,RC,,,,,,,,both,,,2235.1600,335.2700,WELLCARE,WELLCARE MEDICAID,2235.16,,,,,,,576.8900,2235.1600,percent of total billed charges,"100% of $2,235.16 in Billed Charges for Rev 272 = $2,235.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIPLE LUMEN LICOX,272,RC,,,,,,,,both,,,9589.5500,1438.4300,AETNA,AETNA,4094.74,,,,,,,2475.0600,9589.5500,percent of total billed charges,"42.7% of $9,589.55 in Billed Charges for Rev 272 = $4,094.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIPLE LUMEN LICOX,272,RC,,,,,,,,both,,,9589.5500,1438.4300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6712.69,,,,,,,2475.0600,9589.5500,percent of total billed charges,"Rev 272 $9,589.55 in Billed Charges at 70% = $6,712.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIPLE LUMEN LICOX,272,RC,,,,,,,,both,,,9589.5500,1438.4300,CIGNA HEALTHCARE,CIGNA HMO,3998.84,,,,,,,2475.0600,9589.5500,percent of total billed charges,"41.7% of $9,589.55 in Billed Charges for Rev 272 = $3,998.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIPLE LUMEN LICOX,272,RC,,,,,,,,both,,,9589.5500,1438.4300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4449.55,,,,,,,2475.0600,9589.5500,percent of total billed charges,"46.4% of $9,589.55 in Billed Charges for Rev 272 = $4,449.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIPLE LUMEN LICOX,272,RC,,,,,,,,both,,,9589.5500,1438.4300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3998.84,,,,,,,2475.0600,9589.5500,percent of total billed charges,"41.7% of $9,589.55 in Billed Charges for Rev 272 = $3,998.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIPLE LUMEN LICOX,272,RC,,,,,,,,both,,,9589.5500,1438.4300,CIGNA HEALTHCARE,CIGNA PPO,3998.84,,,,,,,2475.0600,9589.5500,percent of total billed charges,"41.7% of $9,589.55 in Billed Charges for Rev 272 = $3,998.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIPLE LUMEN LICOX,272,RC,,,,,,,,both,,,9589.5500,1438.4300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8630.60,,,,,,,2475.0600,9589.5500,percent of total billed charges,"90% of $9,589.55 in Billed Charges for Rev 272 = $8,630.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIPLE LUMEN LICOX,272,RC,,,,,,,,both,,,9589.5500,1438.4300,MEDCOST,MEDCOST VHN,4563.67,,,,,,,2475.0600,9589.5500,percent of total billed charges,"47.59% of $9,589.55 in Billed Charges for Rev 272 = $4,563.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIPLE LUMEN LICOX,272,RC,,,,,,,,both,,,9589.5500,1438.4300,SENTARA HEALTH,SENTARA HEALTH,2475.06,,,,,,,2475.0600,9589.5500,percent of total billed charges,"25.81% of $9,589.55 in Billed Charges for Rev 272 = $2,475.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIPLE LUMEN LICOX,272,RC,,,,,,,,both,,,9589.5500,1438.4300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9589.55,,,,,,,2475.0600,9589.5500,percent of total billed charges,"100% of $9,589.55 in Billed Charges for Rev 272 = $9,589.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIPLE LUMEN LICOX,272,RC,,,,,,,,both,,,9589.5500,1438.4300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4794.78,,,,,,,2475.0600,9589.5500,percent of total billed charges,"Rev 272 $9,589.55 in Billed Charges at 50% = $4,794.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIPLE LUMEN LICOX,272,RC,,,,,,,,both,,,9589.5500,1438.4300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3097.42,,,,,,,2475.0600,9589.5500,other,"32.3% of $9,589.55 in Billed Charges for Rev 272 = $3,097.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH TRIPLE LUMEN LICOX,272,RC,,,,,,,,both,,,9589.5500,1438.4300,UNITED HEALTHCARE,UHC HERITAGE SELECT,2943.99,,,,,,,2475.0600,9589.5500,other,"30.7% of $9,589.55 in Billed Charges for Rev 272 = $2,943.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH TRIPLE LUMEN LICOX,272,RC,,,,,,,,both,,,9589.5500,1438.4300,UNITED HEALTHCARE,UNITED HEALTHCARE,3097.42,,,,,,,2475.0600,9589.5500,percent of total billed charges,"32.3% of $9,589.55 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIPLE LUMEN LICOX,272,RC,,,,,,,,both,,,9589.5500,1438.4300,WELLCARE,WELLCARE MEDICAID,9589.55,,,,,,,2475.0600,9589.5500,percent of total billed charges,"100% of $9,589.55 in Billed Charges for Rev 272 = $9,589.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH ULTRASOUND STINGRAY CORONARY RE ENTRY 6FR,272,RC,27200002,CDM,,,,,,both,,,26166.0300,3924.9000,AETNA,AETNA,11172.89,,,,,,,6753.4500,26166.0300,percent of total billed charges,"42.7% of $26,166.03 in Billed Charges for Rev 272 = $11,172.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH ULTRASOUND STINGRAY CORONARY RE ENTRY 6FR,272,RC,27200002,CDM,,,,,,both,,,26166.0300,3924.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,18316.22,,,,,,,6753.4500,26166.0300,percent of total billed charges,"Rev 272 $26,166.03 in Billed Charges at 70% = $18,316.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH ULTRASOUND STINGRAY CORONARY RE ENTRY 6FR,272,RC,27200002,CDM,,,,,,both,,,26166.0300,3924.9000,CIGNA HEALTHCARE,CIGNA HMO,10911.23,,,,,,,6753.4500,26166.0300,percent of total billed charges,"41.7% of $26,166.03 in Billed Charges for Rev 272 = $10,911.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH ULTRASOUND STINGRAY CORONARY RE ENTRY 6FR,272,RC,27200002,CDM,,,,,,both,,,26166.0300,3924.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12141.04,,,,,,,6753.4500,26166.0300,percent of total billed charges,"46.4% of $26,166.03 in Billed Charges for Rev 272 = $12,141.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH ULTRASOUND STINGRAY CORONARY RE ENTRY 6FR,272,RC,27200002,CDM,,,,,,both,,,26166.0300,3924.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,10911.23,,,,,,,6753.4500,26166.0300,percent of total billed charges,"41.7% of $26,166.03 in Billed Charges for Rev 272 = $10,911.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH ULTRASOUND STINGRAY CORONARY RE ENTRY 6FR,272,RC,27200002,CDM,,,,,,both,,,26166.0300,3924.9000,CIGNA HEALTHCARE,CIGNA PPO,10911.23,,,,,,,6753.4500,26166.0300,percent of total billed charges,"41.7% of $26,166.03 in Billed Charges for Rev 272 = $10,911.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH ULTRASOUND STINGRAY CORONARY RE ENTRY 6FR,272,RC,27200002,CDM,,,,,,both,,,26166.0300,3924.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,23549.43,,,,,,,6753.4500,26166.0300,percent of total billed charges,"90% of $26,166.03 in Billed Charges for Rev 272 = $23,549.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH ULTRASOUND STINGRAY CORONARY RE ENTRY 6FR,272,RC,27200002,CDM,,,,,,both,,,26166.0300,3924.9000,MEDCOST,MEDCOST VHN,12452.41,,,,,,,6753.4500,26166.0300,percent of total billed charges,"47.59% of $26,166.03 in Billed Charges for Rev 272 = $12,452.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH ULTRASOUND STINGRAY CORONARY RE ENTRY 6FR,272,RC,27200002,CDM,,,,,,both,,,26166.0300,3924.9000,SENTARA HEALTH,SENTARA HEALTH,6753.45,,,,,,,6753.4500,26166.0300,percent of total billed charges,"25.81% of $26,166.03 in Billed Charges for Rev 272 = $6,753.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH ULTRASOUND STINGRAY CORONARY RE ENTRY 6FR,272,RC,27200002,CDM,,,,,,both,,,26166.0300,3924.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",26166.03,,,,,,,6753.4500,26166.0300,percent of total billed charges,"100% of $26,166.03 in Billed Charges for Rev 272 = $26,166.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH ULTRASOUND STINGRAY CORONARY RE ENTRY 6FR,272,RC,27200002,CDM,,,,,,both,,,26166.0300,3924.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,13083.02,,,,,,,6753.4500,26166.0300,percent of total billed charges,"Rev 272 $26,166.03 in Billed Charges at 50% = $13,083.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH ULTRASOUND STINGRAY CORONARY RE ENTRY 6FR,272,RC,27200002,CDM,,,,,,both,,,26166.0300,3924.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,8451.63,,,,,,,6753.4500,26166.0300,other,"32.3% of $26,166.03 in Billed Charges for Rev 272 = $8,451.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH ULTRASOUND STINGRAY CORONARY RE ENTRY 6FR,272,RC,27200002,CDM,,,,,,both,,,26166.0300,3924.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,8032.97,,,,,,,6753.4500,26166.0300,other,"30.7% of $26,166.03 in Billed Charges for Rev 272 = $8,032.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH ULTRASOUND STINGRAY CORONARY RE ENTRY 6FR,272,RC,27200002,CDM,,,,,,both,,,26166.0300,3924.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,8451.63,,,,,,,6753.4500,26166.0300,percent of total billed charges,"32.3% of $26,166.03 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH ULTRASOUND STINGRAY CORONARY RE ENTRY 6FR,272,RC,27200002,CDM,,,,,,both,,,26166.0300,3924.9000,WELLCARE,WELLCARE MEDICAID,26166.03,,,,,,,6753.4500,26166.0300,percent of total billed charges,"100% of $26,166.03 in Billed Charges for Rev 272 = $26,166.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH URET FOL 22FR-DIA 5ML-BALLOON LATEX STER SU,272,RC,27200002,CDM,,,,,,both,,,164.6300,24.6900,AETNA,AETNA,70.30,,,,,,,42.4900,164.6300,percent of total billed charges,42.7% of $164.63 in Billed Charges for Rev 272 = $70.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH URET FOL 22FR-DIA 5ML-BALLOON LATEX STER SU,272,RC,27200002,CDM,,,,,,both,,,164.6300,24.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,115.24,,,,,,,42.4900,164.6300,percent of total billed charges,Rev 272 $164.63 in Billed Charges at 70% = $115.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH URET FOL 22FR-DIA 5ML-BALLOON LATEX STER SU,272,RC,27200002,CDM,,,,,,both,,,164.6300,24.6900,CIGNA HEALTHCARE,CIGNA HMO,68.65,,,,,,,42.4900,164.6300,percent of total billed charges,41.7% of $164.63 in Billed Charges for Rev 272 = $68.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH URET FOL 22FR-DIA 5ML-BALLOON LATEX STER SU,272,RC,27200002,CDM,,,,,,both,,,164.6300,24.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,76.39,,,,,,,42.4900,164.6300,percent of total billed charges,46.4% of $164.63 in Billed Charges for Rev 272 = $76.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH URET FOL 22FR-DIA 5ML-BALLOON LATEX STER SU,272,RC,27200002,CDM,,,,,,both,,,164.6300,24.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,68.65,,,,,,,42.4900,164.6300,percent of total billed charges,41.7% of $164.63 in Billed Charges for Rev 272 = $68.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH URET FOL 22FR-DIA 5ML-BALLOON LATEX STER SU,272,RC,27200002,CDM,,,,,,both,,,164.6300,24.6900,CIGNA HEALTHCARE,CIGNA PPO,68.65,,,,,,,42.4900,164.6300,percent of total billed charges,41.7% of $164.63 in Billed Charges for Rev 272 = $68.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH URET FOL 22FR-DIA 5ML-BALLOON LATEX STER SU,272,RC,27200002,CDM,,,,,,both,,,164.6300,24.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,148.17,,,,,,,42.4900,164.6300,percent of total billed charges,90% of $164.63 in Billed Charges for Rev 272 = $148.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH URET FOL 22FR-DIA 5ML-BALLOON LATEX STER SU,272,RC,27200002,CDM,,,,,,both,,,164.6300,24.6900,MEDCOST,MEDCOST VHN,78.35,,,,,,,42.4900,164.6300,percent of total billed charges,47.59% of $164.63 in Billed Charges for Rev 272 = $78.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH URET FOL 22FR-DIA 5ML-BALLOON LATEX STER SU,272,RC,27200002,CDM,,,,,,both,,,164.6300,24.6900,SENTARA HEALTH,SENTARA HEALTH,42.49,,,,,,,42.4900,164.6300,percent of total billed charges,25.81% of $164.63 in Billed Charges for Rev 272 = $42.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH URET FOL 22FR-DIA 5ML-BALLOON LATEX STER SU,272,RC,27200002,CDM,,,,,,both,,,164.6300,24.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",164.63,,,,,,,42.4900,164.6300,percent of total billed charges,100% of $164.63 in Billed Charges for Rev 272 = $164.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH URET FOL 22FR-DIA 5ML-BALLOON LATEX STER SU,272,RC,27200002,CDM,,,,,,both,,,164.6300,24.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,82.32,,,,,,,42.4900,164.6300,percent of total billed charges,Rev 272 $164.63 in Billed Charges at 50% = $82.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH URET FOL 22FR-DIA 5ML-BALLOON LATEX STER SU,272,RC,27200002,CDM,,,,,,both,,,164.6300,24.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,53.18,,,,,,,42.4900,164.6300,other,32.3% of $164.63 in Billed Charges for Rev 272 = $53.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATH URET FOL 22FR-DIA 5ML-BALLOON LATEX STER SU,272,RC,27200002,CDM,,,,,,both,,,164.6300,24.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,50.54,,,,,,,42.4900,164.6300,other,30.7% of $164.63 in Billed Charges for Rev 272 = $50.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATH URET FOL 22FR-DIA 5ML-BALLOON LATEX STER SU,272,RC,27200002,CDM,,,,,,both,,,164.6300,24.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,53.18,,,,,,,42.4900,164.6300,percent of total billed charges,32.3% of $164.63 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH URET FOL 22FR-DIA 5ML-BALLOON LATEX STER SU,272,RC,27200002,CDM,,,,,,both,,,164.6300,24.6900,WELLCARE,WELLCARE MEDICAID,164.63,,,,,,,42.4900,164.6300,percent of total billed charges,100% of $164.63 in Billed Charges for Rev 272 = $164.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 130MM,272,RC,27200002,CDM,,,,,,both,,,640.2000,96.0300,AETNA,AETNA,273.37,,,,,,,165.2400,640.2000,percent of total billed charges,42.7% of $640.20 in Billed Charges for Rev 272 = $273.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 130MM,272,RC,27200002,CDM,,,,,,both,,,640.2000,96.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,448.14,,,,,,,165.2400,640.2000,percent of total billed charges,Rev 272 $640.20 in Billed Charges at 70% = $448.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 130MM,272,RC,27200002,CDM,,,,,,both,,,640.2000,96.0300,CIGNA HEALTHCARE,CIGNA HMO,266.96,,,,,,,165.2400,640.2000,percent of total billed charges,41.7% of $640.20 in Billed Charges for Rev 272 = $266.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 130MM,272,RC,27200002,CDM,,,,,,both,,,640.2000,96.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,297.05,,,,,,,165.2400,640.2000,percent of total billed charges,46.4% of $640.20 in Billed Charges for Rev 272 = $297.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 130MM,272,RC,27200002,CDM,,,,,,both,,,640.2000,96.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,266.96,,,,,,,165.2400,640.2000,percent of total billed charges,41.7% of $640.20 in Billed Charges for Rev 272 = $266.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 130MM,272,RC,27200002,CDM,,,,,,both,,,640.2000,96.0300,CIGNA HEALTHCARE,CIGNA PPO,266.96,,,,,,,165.2400,640.2000,percent of total billed charges,41.7% of $640.20 in Billed Charges for Rev 272 = $266.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 130MM,272,RC,27200002,CDM,,,,,,both,,,640.2000,96.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,576.18,,,,,,,165.2400,640.2000,percent of total billed charges,90% of $640.20 in Billed Charges for Rev 272 = $576.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 130MM,272,RC,27200002,CDM,,,,,,both,,,640.2000,96.0300,MEDCOST,MEDCOST VHN,304.67,,,,,,,165.2400,640.2000,percent of total billed charges,47.59% of $640.20 in Billed Charges for Rev 272 = $304.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 130MM,272,RC,27200002,CDM,,,,,,both,,,640.2000,96.0300,SENTARA HEALTH,SENTARA HEALTH,165.24,,,,,,,165.2400,640.2000,percent of total billed charges,25.81% of $640.20 in Billed Charges for Rev 272 = $165.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 130MM,272,RC,27200002,CDM,,,,,,both,,,640.2000,96.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",640.20,,,,,,,165.2400,640.2000,percent of total billed charges,100% of $640.20 in Billed Charges for Rev 272 = $640.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 130MM,272,RC,27200002,CDM,,,,,,both,,,640.2000,96.0300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,320.10,,,,,,,165.2400,640.2000,percent of total billed charges,Rev 272 $640.20 in Billed Charges at 50% = $320.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 130MM,272,RC,27200002,CDM,,,,,,both,,,640.2000,96.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,206.78,,,,,,,165.2400,640.2000,other,32.3% of $640.20 in Billed Charges for Rev 272 = $206.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL JACOBS CHUCK 3.2 X 130MM,272,RC,27200002,CDM,,,,,,both,,,640.2000,96.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,196.54,,,,,,,165.2400,640.2000,other,30.7% of $640.20 in Billed Charges for Rev 272 = $196.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL JACOBS CHUCK 3.2 X 130MM,272,RC,27200002,CDM,,,,,,both,,,640.2000,96.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,206.78,,,,,,,165.2400,640.2000,percent of total billed charges,32.3% of $640.20 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL JACOBS CHUCK 3.2 X 130MM,272,RC,27200002,CDM,,,,,,both,,,640.2000,96.0300,WELLCARE,WELLCARE MEDICAID,640.20,,,,,,,165.2400,640.2000,percent of total billed charges,100% of $640.20 in Billed Charges for Rev 272 = $640.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER AINTREE INTUBATION,272,RC,,,,,,,,both,,,843.1600,126.4700,AETNA,AETNA,360.03,,,,,,,217.6200,843.1600,percent of total billed charges,42.7% of $843.16 in Billed Charges for Rev 272 = $360.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER AINTREE INTUBATION,272,RC,,,,,,,,both,,,843.1600,126.4700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,590.21,,,,,,,217.6200,843.1600,percent of total billed charges,Rev 272 $843.16 in Billed Charges at 70% = $590.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER AINTREE INTUBATION,272,RC,,,,,,,,both,,,843.1600,126.4700,CIGNA HEALTHCARE,CIGNA HMO,351.60,,,,,,,217.6200,843.1600,percent of total billed charges,41.7% of $843.16 in Billed Charges for Rev 272 = $351.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER AINTREE INTUBATION,272,RC,,,,,,,,both,,,843.1600,126.4700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,391.23,,,,,,,217.6200,843.1600,percent of total billed charges,46.4% of $843.16 in Billed Charges for Rev 272 = $391.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER AINTREE INTUBATION,272,RC,,,,,,,,both,,,843.1600,126.4700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,351.60,,,,,,,217.6200,843.1600,percent of total billed charges,41.7% of $843.16 in Billed Charges for Rev 272 = $351.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER AINTREE INTUBATION,272,RC,,,,,,,,both,,,843.1600,126.4700,CIGNA HEALTHCARE,CIGNA PPO,351.60,,,,,,,217.6200,843.1600,percent of total billed charges,41.7% of $843.16 in Billed Charges for Rev 272 = $351.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER AINTREE INTUBATION,272,RC,,,,,,,,both,,,843.1600,126.4700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,758.84,,,,,,,217.6200,843.1600,percent of total billed charges,90% of $843.16 in Billed Charges for Rev 272 = $758.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER AINTREE INTUBATION,272,RC,,,,,,,,both,,,843.1600,126.4700,MEDCOST,MEDCOST VHN,401.26,,,,,,,217.6200,843.1600,percent of total billed charges,47.59% of $843.16 in Billed Charges for Rev 272 = $401.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER AINTREE INTUBATION,272,RC,,,,,,,,both,,,843.1600,126.4700,SENTARA HEALTH,SENTARA HEALTH,217.62,,,,,,,217.6200,843.1600,percent of total billed charges,25.81% of $843.16 in Billed Charges for Rev 272 = $217.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER AINTREE INTUBATION,272,RC,,,,,,,,both,,,843.1600,126.4700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",843.16,,,,,,,217.6200,843.1600,percent of total billed charges,100% of $843.16 in Billed Charges for Rev 272 = $843.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER AINTREE INTUBATION,272,RC,,,,,,,,both,,,843.1600,126.4700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,421.58,,,,,,,217.6200,843.1600,percent of total billed charges,Rev 272 $843.16 in Billed Charges at 50% = $421.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER AINTREE INTUBATION,272,RC,,,,,,,,both,,,843.1600,126.4700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,272.34,,,,,,,217.6200,843.1600,other,32.3% of $843.16 in Billed Charges for Rev 272 = $272.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATHETER AINTREE INTUBATION,272,RC,,,,,,,,both,,,843.1600,126.4700,UNITED HEALTHCARE,UHC HERITAGE SELECT,258.85,,,,,,,217.6200,843.1600,other,30.7% of $843.16 in Billed Charges for Rev 272 = $258.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATHETER AINTREE INTUBATION,272,RC,,,,,,,,both,,,843.1600,126.4700,UNITED HEALTHCARE,UNITED HEALTHCARE,272.34,,,,,,,217.6200,843.1600,percent of total billed charges,32.3% of $843.16 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER AINTREE INTUBATION,272,RC,,,,,,,,both,,,843.1600,126.4700,WELLCARE,WELLCARE MEDICAID,843.16,,,,,,,217.6200,843.1600,percent of total billed charges,100% of $843.16 in Billed Charges for Rev 272 = $843.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER BEACON TIP ANGIOGRAPHIC CATHETER 5.0FR VANSCHIE 125CM,272,RC,27200002,CDM,,,,,,both,,,717.6500,107.6500,AETNA,AETNA,306.44,,,,,,,185.2300,717.6500,percent of total billed charges,42.7% of $717.65 in Billed Charges for Rev 272 = $306.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER BEACON TIP ANGIOGRAPHIC CATHETER 5.0FR VANSCHIE 125CM,272,RC,27200002,CDM,,,,,,both,,,717.6500,107.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,502.36,,,,,,,185.2300,717.6500,percent of total billed charges,Rev 272 $717.65 in Billed Charges at 70% = $502.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER BEACON TIP ANGIOGRAPHIC CATHETER 5.0FR VANSCHIE 125CM,272,RC,27200002,CDM,,,,,,both,,,717.6500,107.6500,CIGNA HEALTHCARE,CIGNA HMO,299.26,,,,,,,185.2300,717.6500,percent of total billed charges,41.7% of $717.65 in Billed Charges for Rev 272 = $299.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER BEACON TIP ANGIOGRAPHIC CATHETER 5.0FR VANSCHIE 125CM,272,RC,27200002,CDM,,,,,,both,,,717.6500,107.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,332.99,,,,,,,185.2300,717.6500,percent of total billed charges,46.4% of $717.65 in Billed Charges for Rev 272 = $332.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER BEACON TIP ANGIOGRAPHIC CATHETER 5.0FR VANSCHIE 125CM,272,RC,27200002,CDM,,,,,,both,,,717.6500,107.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,299.26,,,,,,,185.2300,717.6500,percent of total billed charges,41.7% of $717.65 in Billed Charges for Rev 272 = $299.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER BEACON TIP ANGIOGRAPHIC CATHETER 5.0FR VANSCHIE 125CM,272,RC,27200002,CDM,,,,,,both,,,717.6500,107.6500,CIGNA HEALTHCARE,CIGNA PPO,299.26,,,,,,,185.2300,717.6500,percent of total billed charges,41.7% of $717.65 in Billed Charges for Rev 272 = $299.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER BEACON TIP ANGIOGRAPHIC CATHETER 5.0FR VANSCHIE 125CM,272,RC,27200002,CDM,,,,,,both,,,717.6500,107.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,645.89,,,,,,,185.2300,717.6500,percent of total billed charges,90% of $717.65 in Billed Charges for Rev 272 = $645.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER BEACON TIP ANGIOGRAPHIC CATHETER 5.0FR VANSCHIE 125CM,272,RC,27200002,CDM,,,,,,both,,,717.6500,107.6500,MEDCOST,MEDCOST VHN,341.53,,,,,,,185.2300,717.6500,percent of total billed charges,47.59% of $717.65 in Billed Charges for Rev 272 = $341.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER BEACON TIP ANGIOGRAPHIC CATHETER 5.0FR VANSCHIE 125CM,272,RC,27200002,CDM,,,,,,both,,,717.6500,107.6500,SENTARA HEALTH,SENTARA HEALTH,185.23,,,,,,,185.2300,717.6500,percent of total billed charges,25.81% of $717.65 in Billed Charges for Rev 272 = $185.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER BEACON TIP ANGIOGRAPHIC CATHETER 5.0FR VANSCHIE 125CM,272,RC,27200002,CDM,,,,,,both,,,717.6500,107.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",717.65,,,,,,,185.2300,717.6500,percent of total billed charges,100% of $717.65 in Billed Charges for Rev 272 = $717.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER BEACON TIP ANGIOGRAPHIC CATHETER 5.0FR VANSCHIE 125CM,272,RC,27200002,CDM,,,,,,both,,,717.6500,107.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,358.83,,,,,,,185.2300,717.6500,percent of total billed charges,Rev 272 $717.65 in Billed Charges at 50% = $358.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER BEACON TIP ANGIOGRAPHIC CATHETER 5.0FR VANSCHIE 125CM,272,RC,27200002,CDM,,,,,,both,,,717.6500,107.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,231.80,,,,,,,185.2300,717.6500,other,32.3% of $717.65 in Billed Charges for Rev 272 = $231.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATHETER BEACON TIP ANGIOGRAPHIC CATHETER 5.0FR VANSCHIE 125CM,272,RC,27200002,CDM,,,,,,both,,,717.6500,107.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,220.32,,,,,,,185.2300,717.6500,other,30.7% of $717.65 in Billed Charges for Rev 272 = $220.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATHETER BEACON TIP ANGIOGRAPHIC CATHETER 5.0FR VANSCHIE 125CM,272,RC,27200002,CDM,,,,,,both,,,717.6500,107.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,231.80,,,,,,,185.2300,717.6500,percent of total billed charges,32.3% of $717.65 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER BEACON TIP ANGIOGRAPHIC CATHETER 5.0FR VANSCHIE 125CM,272,RC,27200002,CDM,,,,,,both,,,717.6500,107.6500,WELLCARE,WELLCARE MEDICAID,717.65,,,,,,,185.2300,717.6500,percent of total billed charges,100% of $717.65 in Billed Charges for Rev 272 = $717.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
COUPLER FLOW 2.5MM,272,RC,27200002,CDM,,,,,,both,,,11376.9900,1706.5500,AETNA,AETNA,4857.97,,,,,,,2936.4000,11376.9900,percent of total billed charges,"42.7% of $11,376.99 in Billed Charges for Rev 272 = $4,857.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER FLOW 2.5MM,272,RC,27200002,CDM,,,,,,both,,,11376.9900,1706.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7963.89,,,,,,,2936.4000,11376.9900,percent of total billed charges,"Rev 272 $11,376.99 in Billed Charges at 70% = $7,963.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER FLOW 2.5MM,272,RC,27200002,CDM,,,,,,both,,,11376.9900,1706.5500,CIGNA HEALTHCARE,CIGNA HMO,4744.20,,,,,,,2936.4000,11376.9900,percent of total billed charges,"41.7% of $11,376.99 in Billed Charges for Rev 272 = $4,744.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER FLOW 2.5MM,272,RC,27200002,CDM,,,,,,both,,,11376.9900,1706.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5278.92,,,,,,,2936.4000,11376.9900,percent of total billed charges,"46.4% of $11,376.99 in Billed Charges for Rev 272 = $5,278.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER FLOW 2.5MM,272,RC,27200002,CDM,,,,,,both,,,11376.9900,1706.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4744.20,,,,,,,2936.4000,11376.9900,percent of total billed charges,"41.7% of $11,376.99 in Billed Charges for Rev 272 = $4,744.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER FLOW 2.5MM,272,RC,27200002,CDM,,,,,,both,,,11376.9900,1706.5500,CIGNA HEALTHCARE,CIGNA PPO,4744.20,,,,,,,2936.4000,11376.9900,percent of total billed charges,"41.7% of $11,376.99 in Billed Charges for Rev 272 = $4,744.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER FLOW 2.5MM,272,RC,27200002,CDM,,,,,,both,,,11376.9900,1706.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10239.29,,,,,,,2936.4000,11376.9900,percent of total billed charges,"90% of $11,376.99 in Billed Charges for Rev 272 = $10,239.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER FLOW 2.5MM,272,RC,27200002,CDM,,,,,,both,,,11376.9900,1706.5500,MEDCOST,MEDCOST VHN,5414.31,,,,,,,2936.4000,11376.9900,percent of total billed charges,"47.59% of $11,376.99 in Billed Charges for Rev 272 = $5,414.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER FLOW 2.5MM,272,RC,27200002,CDM,,,,,,both,,,11376.9900,1706.5500,SENTARA HEALTH,SENTARA HEALTH,2936.40,,,,,,,2936.4000,11376.9900,percent of total billed charges,"25.81% of $11,376.99 in Billed Charges for Rev 272 = $2,936.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER FLOW 2.5MM,272,RC,27200002,CDM,,,,,,both,,,11376.9900,1706.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11376.99,,,,,,,2936.4000,11376.9900,percent of total billed charges,"100% of $11,376.99 in Billed Charges for Rev 272 = $11,376.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER FLOW 2.5MM,272,RC,27200002,CDM,,,,,,both,,,11376.9900,1706.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5688.50,,,,,,,2936.4000,11376.9900,percent of total billed charges,"Rev 272 $11,376.99 in Billed Charges at 50% = $5,688.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER FLOW 2.5MM,272,RC,27200002,CDM,,,,,,both,,,11376.9900,1706.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3674.77,,,,,,,2936.4000,11376.9900,other,"32.3% of $11,376.99 in Billed Charges for Rev 272 = $3,674.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
COUPLER FLOW 2.5MM,272,RC,27200002,CDM,,,,,,both,,,11376.9900,1706.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3492.74,,,,,,,2936.4000,11376.9900,other,"30.7% of $11,376.99 in Billed Charges for Rev 272 = $3,492.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
COUPLER FLOW 2.5MM,272,RC,27200002,CDM,,,,,,both,,,11376.9900,1706.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,3674.77,,,,,,,2936.4000,11376.9900,percent of total billed charges,"32.3% of $11,376.99 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER FLOW 2.5MM,272,RC,27200002,CDM,,,,,,both,,,11376.9900,1706.5500,WELLCARE,WELLCARE MEDICAID,11376.99,,,,,,,2936.4000,11376.9900,percent of total billed charges,"100% of $11,376.99 in Billed Charges for Rev 272 = $11,376.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 2.0MM CALIBRATED,272,RC,,,,,,,,both,,,1358.6000,203.7900,AETNA,AETNA,580.12,,,,,,,350.6500,1358.6000,percent of total billed charges,"42.7% of $1,358.60 in Billed Charges for Rev 272 = $580.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 2.0MM CALIBRATED,272,RC,,,,,,,,both,,,1358.6000,203.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,951.02,,,,,,,350.6500,1358.6000,percent of total billed charges,"Rev 272 $1,358.60 in Billed Charges at 70% = $951.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 2.0MM CALIBRATED,272,RC,,,,,,,,both,,,1358.6000,203.7900,CIGNA HEALTHCARE,CIGNA HMO,566.54,,,,,,,350.6500,1358.6000,percent of total billed charges,"41.7% of $1,358.60 in Billed Charges for Rev 272 = $566.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 2.0MM CALIBRATED,272,RC,,,,,,,,both,,,1358.6000,203.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,630.39,,,,,,,350.6500,1358.6000,percent of total billed charges,"46.4% of $1,358.60 in Billed Charges for Rev 272 = $630.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 2.0MM CALIBRATED,272,RC,,,,,,,,both,,,1358.6000,203.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,566.54,,,,,,,350.6500,1358.6000,percent of total billed charges,"41.7% of $1,358.60 in Billed Charges for Rev 272 = $566.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 2.0MM CALIBRATED,272,RC,,,,,,,,both,,,1358.6000,203.7900,CIGNA HEALTHCARE,CIGNA PPO,566.54,,,,,,,350.6500,1358.6000,percent of total billed charges,"41.7% of $1,358.60 in Billed Charges for Rev 272 = $566.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 2.0MM CALIBRATED,272,RC,,,,,,,,both,,,1358.6000,203.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1222.74,,,,,,,350.6500,1358.6000,percent of total billed charges,"90% of $1,358.60 in Billed Charges for Rev 272 = $1,222.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 2.0MM CALIBRATED,272,RC,,,,,,,,both,,,1358.6000,203.7900,MEDCOST,MEDCOST VHN,646.56,,,,,,,350.6500,1358.6000,percent of total billed charges,"47.59% of $1,358.60 in Billed Charges for Rev 272 = $646.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 2.0MM CALIBRATED,272,RC,,,,,,,,both,,,1358.6000,203.7900,SENTARA HEALTH,SENTARA HEALTH,350.65,,,,,,,350.6500,1358.6000,percent of total billed charges,"25.81% of $1,358.60 in Billed Charges for Rev 272 = $350.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 2.0MM CALIBRATED,272,RC,,,,,,,,both,,,1358.6000,203.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1358.60,,,,,,,350.6500,1358.6000,percent of total billed charges,"100% of $1,358.60 in Billed Charges for Rev 272 = $1,358.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 2.0MM CALIBRATED,272,RC,,,,,,,,both,,,1358.6000,203.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,679.30,,,,,,,350.6500,1358.6000,percent of total billed charges,"Rev 272 $1,358.60 in Billed Charges at 50% = $679.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 2.0MM CALIBRATED,272,RC,,,,,,,,both,,,1358.6000,203.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,438.83,,,,,,,350.6500,1358.6000,other,"32.3% of $1,358.60 in Billed Charges for Rev 272 = $438.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL LONG 2.0MM CALIBRATED,272,RC,,,,,,,,both,,,1358.6000,203.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.09,,,,,,,350.6500,1358.6000,other,"30.7% of $1,358.60 in Billed Charges for Rev 272 = $417.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL LONG 2.0MM CALIBRATED,272,RC,,,,,,,,both,,,1358.6000,203.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,438.83,,,,,,,350.6500,1358.6000,percent of total billed charges,"32.3% of $1,358.60 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL LONG 2.0MM CALIBRATED,272,RC,,,,,,,,both,,,1358.6000,203.7900,WELLCARE,WELLCARE MEDICAID,1358.60,,,,,,,350.6500,1358.6000,percent of total billed charges,"100% of $1,358.60 in Billed Charges for Rev 272 = $1,358.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER NON FLO 1.5MM,272,RC,27200002,CDM,,,,,,both,,,3621.2100,543.1800,AETNA,AETNA,1546.26,,,,,,,934.6300,3621.2100,percent of total billed charges,"42.7% of $3,621.21 in Billed Charges for Rev 272 = $1,546.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER NON FLO 1.5MM,272,RC,27200002,CDM,,,,,,both,,,3621.2100,543.1800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2534.85,,,,,,,934.6300,3621.2100,percent of total billed charges,"Rev 272 $3,621.21 in Billed Charges at 70% = $2,534.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER NON FLO 1.5MM,272,RC,27200002,CDM,,,,,,both,,,3621.2100,543.1800,CIGNA HEALTHCARE,CIGNA HMO,1510.04,,,,,,,934.6300,3621.2100,percent of total billed charges,"41.7% of $3,621.21 in Billed Charges for Rev 272 = $1,510.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER NON FLO 1.5MM,272,RC,27200002,CDM,,,,,,both,,,3621.2100,543.1800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1680.24,,,,,,,934.6300,3621.2100,percent of total billed charges,"46.4% of $3,621.21 in Billed Charges for Rev 272 = $1,680.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER NON FLO 1.5MM,272,RC,27200002,CDM,,,,,,both,,,3621.2100,543.1800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1510.04,,,,,,,934.6300,3621.2100,percent of total billed charges,"41.7% of $3,621.21 in Billed Charges for Rev 272 = $1,510.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER NON FLO 1.5MM,272,RC,27200002,CDM,,,,,,both,,,3621.2100,543.1800,CIGNA HEALTHCARE,CIGNA PPO,1510.04,,,,,,,934.6300,3621.2100,percent of total billed charges,"41.7% of $3,621.21 in Billed Charges for Rev 272 = $1,510.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER NON FLO 1.5MM,272,RC,27200002,CDM,,,,,,both,,,3621.2100,543.1800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3259.09,,,,,,,934.6300,3621.2100,percent of total billed charges,"90% of $3,621.21 in Billed Charges for Rev 272 = $3,259.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER NON FLO 1.5MM,272,RC,27200002,CDM,,,,,,both,,,3621.2100,543.1800,MEDCOST,MEDCOST VHN,1723.33,,,,,,,934.6300,3621.2100,percent of total billed charges,"47.59% of $3,621.21 in Billed Charges for Rev 272 = $1,723.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER NON FLO 1.5MM,272,RC,27200002,CDM,,,,,,both,,,3621.2100,543.1800,SENTARA HEALTH,SENTARA HEALTH,934.63,,,,,,,934.6300,3621.2100,percent of total billed charges,"25.81% of $3,621.21 in Billed Charges for Rev 272 = $934.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER NON FLO 1.5MM,272,RC,27200002,CDM,,,,,,both,,,3621.2100,543.1800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3621.21,,,,,,,934.6300,3621.2100,percent of total billed charges,"100% of $3,621.21 in Billed Charges for Rev 272 = $3,621.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER NON FLO 1.5MM,272,RC,27200002,CDM,,,,,,both,,,3621.2100,543.1800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1810.61,,,,,,,934.6300,3621.2100,percent of total billed charges,"Rev 272 $3,621.21 in Billed Charges at 50% = $1,810.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER NON FLO 1.5MM,272,RC,27200002,CDM,,,,,,both,,,3621.2100,543.1800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1169.65,,,,,,,934.6300,3621.2100,other,"32.3% of $3,621.21 in Billed Charges for Rev 272 = $1,169.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
COUPLER NON FLO 1.5MM,272,RC,27200002,CDM,,,,,,both,,,3621.2100,543.1800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1111.71,,,,,,,934.6300,3621.2100,other,"30.7% of $3,621.21 in Billed Charges for Rev 272 = $1,111.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
COUPLER NON FLO 1.5MM,272,RC,27200002,CDM,,,,,,both,,,3621.2100,543.1800,UNITED HEALTHCARE,UNITED HEALTHCARE,1169.65,,,,,,,934.6300,3621.2100,percent of total billed charges,"32.3% of $3,621.21 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER NON FLO 1.5MM,272,RC,27200002,CDM,,,,,,both,,,3621.2100,543.1800,WELLCARE,WELLCARE MEDICAID,3621.21,,,,,,,934.6300,3621.2100,percent of total billed charges,"100% of $3,621.21 in Billed Charges for Rev 272 = $3,621.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL RECON LARGE QUICK COUPLING 5.0MM,272,RC,,,,,,,,both,,,3995.1200,599.2700,AETNA,AETNA,1705.92,,,,,,,1031.1400,3995.1200,percent of total billed charges,"42.7% of $3,995.12 in Billed Charges for Rev 272 = $1,705.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL RECON LARGE QUICK COUPLING 5.0MM,272,RC,,,,,,,,both,,,3995.1200,599.2700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2796.58,,,,,,,1031.1400,3995.1200,percent of total billed charges,"Rev 272 $3,995.12 in Billed Charges at 70% = $2,796.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL RECON LARGE QUICK COUPLING 5.0MM,272,RC,,,,,,,,both,,,3995.1200,599.2700,CIGNA HEALTHCARE,CIGNA HMO,1665.97,,,,,,,1031.1400,3995.1200,percent of total billed charges,"41.7% of $3,995.12 in Billed Charges for Rev 272 = $1,665.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL RECON LARGE QUICK COUPLING 5.0MM,272,RC,,,,,,,,both,,,3995.1200,599.2700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1853.74,,,,,,,1031.1400,3995.1200,percent of total billed charges,"46.4% of $3,995.12 in Billed Charges for Rev 272 = $1,853.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL RECON LARGE QUICK COUPLING 5.0MM,272,RC,,,,,,,,both,,,3995.1200,599.2700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1665.97,,,,,,,1031.1400,3995.1200,percent of total billed charges,"41.7% of $3,995.12 in Billed Charges for Rev 272 = $1,665.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL RECON LARGE QUICK COUPLING 5.0MM,272,RC,,,,,,,,both,,,3995.1200,599.2700,CIGNA HEALTHCARE,CIGNA PPO,1665.97,,,,,,,1031.1400,3995.1200,percent of total billed charges,"41.7% of $3,995.12 in Billed Charges for Rev 272 = $1,665.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL RECON LARGE QUICK COUPLING 5.0MM,272,RC,,,,,,,,both,,,3995.1200,599.2700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3595.61,,,,,,,1031.1400,3995.1200,percent of total billed charges,"90% of $3,995.12 in Billed Charges for Rev 272 = $3,595.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL RECON LARGE QUICK COUPLING 5.0MM,272,RC,,,,,,,,both,,,3995.1200,599.2700,MEDCOST,MEDCOST VHN,1901.28,,,,,,,1031.1400,3995.1200,percent of total billed charges,"47.59% of $3,995.12 in Billed Charges for Rev 272 = $1,901.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL RECON LARGE QUICK COUPLING 5.0MM,272,RC,,,,,,,,both,,,3995.1200,599.2700,SENTARA HEALTH,SENTARA HEALTH,1031.14,,,,,,,1031.1400,3995.1200,percent of total billed charges,"25.81% of $3,995.12 in Billed Charges for Rev 272 = $1,031.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL RECON LARGE QUICK COUPLING 5.0MM,272,RC,,,,,,,,both,,,3995.1200,599.2700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3995.12,,,,,,,1031.1400,3995.1200,percent of total billed charges,"100% of $3,995.12 in Billed Charges for Rev 272 = $3,995.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL RECON LARGE QUICK COUPLING 5.0MM,272,RC,,,,,,,,both,,,3995.1200,599.2700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1997.56,,,,,,,1031.1400,3995.1200,percent of total billed charges,"Rev 272 $3,995.12 in Billed Charges at 50% = $1,997.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL RECON LARGE QUICK COUPLING 5.0MM,272,RC,,,,,,,,both,,,3995.1200,599.2700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1290.42,,,,,,,1031.1400,3995.1200,other,"32.3% of $3,995.12 in Billed Charges for Rev 272 = $1,290.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL RECON LARGE QUICK COUPLING 5.0MM,272,RC,,,,,,,,both,,,3995.1200,599.2700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1226.50,,,,,,,1031.1400,3995.1200,other,"30.7% of $3,995.12 in Billed Charges for Rev 272 = $1,226.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL RECON LARGE QUICK COUPLING 5.0MM,272,RC,,,,,,,,both,,,3995.1200,599.2700,UNITED HEALTHCARE,UNITED HEALTHCARE,1290.42,,,,,,,1031.1400,3995.1200,percent of total billed charges,"32.3% of $3,995.12 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL RECON LARGE QUICK COUPLING 5.0MM,272,RC,,,,,,,,both,,,3995.1200,599.2700,WELLCARE,WELLCARE MEDICAID,3995.12,,,,,,,1031.1400,3995.1200,percent of total billed charges,"100% of $3,995.12 in Billed Charges for Rev 272 = $3,995.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SCOPE,272,RC,,,,,,,,both,,,1742.3300,261.3500,AETNA,AETNA,743.97,,,,,,,449.7000,1742.3300,percent of total billed charges,"42.7% of $1,742.33 in Billed Charges for Rev 272 = $743.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SCOPE,272,RC,,,,,,,,both,,,1742.3300,261.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1219.63,,,,,,,449.7000,1742.3300,percent of total billed charges,"Rev 272 $1,742.33 in Billed Charges at 70% = $1,219.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SCOPE,272,RC,,,,,,,,both,,,1742.3300,261.3500,CIGNA HEALTHCARE,CIGNA HMO,726.55,,,,,,,449.7000,1742.3300,percent of total billed charges,"41.7% of $1,742.33 in Billed Charges for Rev 272 = $726.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SCOPE,272,RC,,,,,,,,both,,,1742.3300,261.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,808.44,,,,,,,449.7000,1742.3300,percent of total billed charges,"46.4% of $1,742.33 in Billed Charges for Rev 272 = $808.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SCOPE,272,RC,,,,,,,,both,,,1742.3300,261.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,726.55,,,,,,,449.7000,1742.3300,percent of total billed charges,"41.7% of $1,742.33 in Billed Charges for Rev 272 = $726.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SCOPE,272,RC,,,,,,,,both,,,1742.3300,261.3500,CIGNA HEALTHCARE,CIGNA PPO,726.55,,,,,,,449.7000,1742.3300,percent of total billed charges,"41.7% of $1,742.33 in Billed Charges for Rev 272 = $726.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SCOPE,272,RC,,,,,,,,both,,,1742.3300,261.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1568.10,,,,,,,449.7000,1742.3300,percent of total billed charges,"90% of $1,742.33 in Billed Charges for Rev 272 = $1,568.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SCOPE,272,RC,,,,,,,,both,,,1742.3300,261.3500,MEDCOST,MEDCOST VHN,829.17,,,,,,,449.7000,1742.3300,percent of total billed charges,"47.59% of $1,742.33 in Billed Charges for Rev 272 = $829.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SCOPE,272,RC,,,,,,,,both,,,1742.3300,261.3500,SENTARA HEALTH,SENTARA HEALTH,449.70,,,,,,,449.7000,1742.3300,percent of total billed charges,"25.81% of $1,742.33 in Billed Charges for Rev 272 = $449.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SCOPE,272,RC,,,,,,,,both,,,1742.3300,261.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1742.33,,,,,,,449.7000,1742.3300,percent of total billed charges,"100% of $1,742.33 in Billed Charges for Rev 272 = $1,742.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SCOPE,272,RC,,,,,,,,both,,,1742.3300,261.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,871.17,,,,,,,449.7000,1742.3300,percent of total billed charges,"Rev 272 $1,742.33 in Billed Charges at 50% = $871.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SCOPE,272,RC,,,,,,,,both,,,1742.3300,261.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,562.77,,,,,,,449.7000,1742.3300,other,"32.3% of $1,742.33 in Billed Charges for Rev 272 = $562.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL SCOPE,272,RC,,,,,,,,both,,,1742.3300,261.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,534.90,,,,,,,449.7000,1742.3300,other,"30.7% of $1,742.33 in Billed Charges for Rev 272 = $534.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL SCOPE,272,RC,,,,,,,,both,,,1742.3300,261.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,562.77,,,,,,,449.7000,1742.3300,percent of total billed charges,"32.3% of $1,742.33 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SCOPE,272,RC,,,,,,,,both,,,1742.3300,261.3500,WELLCARE,WELLCARE MEDICAID,1742.33,,,,,,,449.7000,1742.3300,percent of total billed charges,"100% of $1,742.33 in Billed Charges for Rev 272 = $1,742.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT 3.2MM,272,RC,,,,,,,,both,,,2014.2600,302.1400,AETNA,AETNA,860.09,,,,,,,519.8800,2014.2600,percent of total billed charges,"42.7% of $2,014.26 in Billed Charges for Rev 272 = $860.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT 3.2MM,272,RC,,,,,,,,both,,,2014.2600,302.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1409.98,,,,,,,519.8800,2014.2600,percent of total billed charges,"Rev 272 $2,014.26 in Billed Charges at 70% = $1,409.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT 3.2MM,272,RC,,,,,,,,both,,,2014.2600,302.1400,CIGNA HEALTHCARE,CIGNA HMO,839.95,,,,,,,519.8800,2014.2600,percent of total billed charges,"41.7% of $2,014.26 in Billed Charges for Rev 272 = $839.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT 3.2MM,272,RC,,,,,,,,both,,,2014.2600,302.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,934.62,,,,,,,519.8800,2014.2600,percent of total billed charges,"46.4% of $2,014.26 in Billed Charges for Rev 272 = $934.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT 3.2MM,272,RC,,,,,,,,both,,,2014.2600,302.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,839.95,,,,,,,519.8800,2014.2600,percent of total billed charges,"41.7% of $2,014.26 in Billed Charges for Rev 272 = $839.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT 3.2MM,272,RC,,,,,,,,both,,,2014.2600,302.1400,CIGNA HEALTHCARE,CIGNA PPO,839.95,,,,,,,519.8800,2014.2600,percent of total billed charges,"41.7% of $2,014.26 in Billed Charges for Rev 272 = $839.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT 3.2MM,272,RC,,,,,,,,both,,,2014.2600,302.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1812.83,,,,,,,519.8800,2014.2600,percent of total billed charges,"90% of $2,014.26 in Billed Charges for Rev 272 = $1,812.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT 3.2MM,272,RC,,,,,,,,both,,,2014.2600,302.1400,MEDCOST,MEDCOST VHN,958.59,,,,,,,519.8800,2014.2600,percent of total billed charges,"47.59% of $2,014.26 in Billed Charges for Rev 272 = $958.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT 3.2MM,272,RC,,,,,,,,both,,,2014.2600,302.1400,SENTARA HEALTH,SENTARA HEALTH,519.88,,,,,,,519.8800,2014.2600,percent of total billed charges,"25.81% of $2,014.26 in Billed Charges for Rev 272 = $519.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT 3.2MM,272,RC,,,,,,,,both,,,2014.2600,302.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2014.26,,,,,,,519.8800,2014.2600,percent of total billed charges,"100% of $2,014.26 in Billed Charges for Rev 272 = $2,014.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT 3.2MM,272,RC,,,,,,,,both,,,2014.2600,302.1400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1007.13,,,,,,,519.8800,2014.2600,percent of total billed charges,"Rev 272 $2,014.26 in Billed Charges at 50% = $1,007.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT 3.2MM,272,RC,,,,,,,,both,,,2014.2600,302.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,650.61,,,,,,,519.8800,2014.2600,other,"32.3% of $2,014.26 in Billed Charges for Rev 272 = $650.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL SHORT 3.2MM,272,RC,,,,,,,,both,,,2014.2600,302.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,618.38,,,,,,,519.8800,2014.2600,other,"30.7% of $2,014.26 in Billed Charges for Rev 272 = $618.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL SHORT 3.2MM,272,RC,,,,,,,,both,,,2014.2600,302.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,650.61,,,,,,,519.8800,2014.2600,percent of total billed charges,"32.3% of $2,014.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SHORT 3.2MM,272,RC,,,,,,,,both,,,2014.2600,302.1400,WELLCARE,WELLCARE MEDICAID,2014.26,,,,,,,519.8800,2014.2600,percent of total billed charges,"100% of $2,014.26 in Billed Charges for Rev 272 = $2,014.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUP CERVICAL SMALL 32MM VCARE 2ND GENERATION,272,RC,27200002,CDM,,,,,,both,,,672.1400,100.8200,AETNA,AETNA,287.00,,,,,,,173.4800,672.1400,percent of total billed charges,42.7% of $672.14 in Billed Charges for Rev 272 = $287.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUP CERVICAL SMALL 32MM VCARE 2ND GENERATION,272,RC,27200002,CDM,,,,,,both,,,672.1400,100.8200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,470.50,,,,,,,173.4800,672.1400,percent of total billed charges,Rev 272 $672.14 in Billed Charges at 70% = $470.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUP CERVICAL SMALL 32MM VCARE 2ND GENERATION,272,RC,27200002,CDM,,,,,,both,,,672.1400,100.8200,CIGNA HEALTHCARE,CIGNA HMO,280.28,,,,,,,173.4800,672.1400,percent of total billed charges,41.7% of $672.14 in Billed Charges for Rev 272 = $280.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUP CERVICAL SMALL 32MM VCARE 2ND GENERATION,272,RC,27200002,CDM,,,,,,both,,,672.1400,100.8200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,311.87,,,,,,,173.4800,672.1400,percent of total billed charges,46.4% of $672.14 in Billed Charges for Rev 272 = $311.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUP CERVICAL SMALL 32MM VCARE 2ND GENERATION,272,RC,27200002,CDM,,,,,,both,,,672.1400,100.8200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,280.28,,,,,,,173.4800,672.1400,percent of total billed charges,41.7% of $672.14 in Billed Charges for Rev 272 = $280.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUP CERVICAL SMALL 32MM VCARE 2ND GENERATION,272,RC,27200002,CDM,,,,,,both,,,672.1400,100.8200,CIGNA HEALTHCARE,CIGNA PPO,280.28,,,,,,,173.4800,672.1400,percent of total billed charges,41.7% of $672.14 in Billed Charges for Rev 272 = $280.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUP CERVICAL SMALL 32MM VCARE 2ND GENERATION,272,RC,27200002,CDM,,,,,,both,,,672.1400,100.8200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,604.93,,,,,,,173.4800,672.1400,percent of total billed charges,90% of $672.14 in Billed Charges for Rev 272 = $604.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUP CERVICAL SMALL 32MM VCARE 2ND GENERATION,272,RC,27200002,CDM,,,,,,both,,,672.1400,100.8200,MEDCOST,MEDCOST VHN,319.87,,,,,,,173.4800,672.1400,percent of total billed charges,47.59% of $672.14 in Billed Charges for Rev 272 = $319.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUP CERVICAL SMALL 32MM VCARE 2ND GENERATION,272,RC,27200002,CDM,,,,,,both,,,672.1400,100.8200,SENTARA HEALTH,SENTARA HEALTH,173.48,,,,,,,173.4800,672.1400,percent of total billed charges,25.81% of $672.14 in Billed Charges for Rev 272 = $173.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUP CERVICAL SMALL 32MM VCARE 2ND GENERATION,272,RC,27200002,CDM,,,,,,both,,,672.1400,100.8200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",672.14,,,,,,,173.4800,672.1400,percent of total billed charges,100% of $672.14 in Billed Charges for Rev 272 = $672.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUP CERVICAL SMALL 32MM VCARE 2ND GENERATION,272,RC,27200002,CDM,,,,,,both,,,672.1400,100.8200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,336.07,,,,,,,173.4800,672.1400,percent of total billed charges,Rev 272 $672.14 in Billed Charges at 50% = $336.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUP CERVICAL SMALL 32MM VCARE 2ND GENERATION,272,RC,27200002,CDM,,,,,,both,,,672.1400,100.8200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,217.10,,,,,,,173.4800,672.1400,other,32.3% of $672.14 in Billed Charges for Rev 272 = $217.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CUP CERVICAL SMALL 32MM VCARE 2ND GENERATION,272,RC,27200002,CDM,,,,,,both,,,672.1400,100.8200,UNITED HEALTHCARE,UHC HERITAGE SELECT,206.35,,,,,,,173.4800,672.1400,other,30.7% of $672.14 in Billed Charges for Rev 272 = $206.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CUP CERVICAL SMALL 32MM VCARE 2ND GENERATION,272,RC,27200002,CDM,,,,,,both,,,672.1400,100.8200,UNITED HEALTHCARE,UNITED HEALTHCARE,217.10,,,,,,,173.4800,672.1400,percent of total billed charges,32.3% of $672.14 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUP CERVICAL SMALL 32MM VCARE 2ND GENERATION,272,RC,27200002,CDM,,,,,,both,,,672.1400,100.8200,WELLCARE,WELLCARE MEDICAID,672.14,,,,,,,173.4800,672.1400,percent of total billed charges,100% of $672.14 in Billed Charges for Rev 272 = $672.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CURETTE EXPRESS,272,RC,,,,,,,,both,,,3211.5900,481.7400,AETNA,AETNA,1371.35,,,,,,,828.9100,3211.5900,percent of total billed charges,"42.7% of $3,211.59 in Billed Charges for Rev 272 = $1,371.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURETTE EXPRESS,272,RC,,,,,,,,both,,,3211.5900,481.7400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2248.11,,,,,,,828.9100,3211.5900,percent of total billed charges,"Rev 272 $3,211.59 in Billed Charges at 70% = $2,248.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURETTE EXPRESS,272,RC,,,,,,,,both,,,3211.5900,481.7400,CIGNA HEALTHCARE,CIGNA HMO,1339.23,,,,,,,828.9100,3211.5900,percent of total billed charges,"41.7% of $3,211.59 in Billed Charges for Rev 272 = $1,339.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURETTE EXPRESS,272,RC,,,,,,,,both,,,3211.5900,481.7400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1490.18,,,,,,,828.9100,3211.5900,percent of total billed charges,"46.4% of $3,211.59 in Billed Charges for Rev 272 = $1,490.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURETTE EXPRESS,272,RC,,,,,,,,both,,,3211.5900,481.7400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1339.23,,,,,,,828.9100,3211.5900,percent of total billed charges,"41.7% of $3,211.59 in Billed Charges for Rev 272 = $1,339.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURETTE EXPRESS,272,RC,,,,,,,,both,,,3211.5900,481.7400,CIGNA HEALTHCARE,CIGNA PPO,1339.23,,,,,,,828.9100,3211.5900,percent of total billed charges,"41.7% of $3,211.59 in Billed Charges for Rev 272 = $1,339.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURETTE EXPRESS,272,RC,,,,,,,,both,,,3211.5900,481.7400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2890.43,,,,,,,828.9100,3211.5900,percent of total billed charges,"90% of $3,211.59 in Billed Charges for Rev 272 = $2,890.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURETTE EXPRESS,272,RC,,,,,,,,both,,,3211.5900,481.7400,MEDCOST,MEDCOST VHN,1528.40,,,,,,,828.9100,3211.5900,percent of total billed charges,"47.59% of $3,211.59 in Billed Charges for Rev 272 = $1,528.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURETTE EXPRESS,272,RC,,,,,,,,both,,,3211.5900,481.7400,SENTARA HEALTH,SENTARA HEALTH,828.91,,,,,,,828.9100,3211.5900,percent of total billed charges,"25.81% of $3,211.59 in Billed Charges for Rev 272 = $828.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURETTE EXPRESS,272,RC,,,,,,,,both,,,3211.5900,481.7400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3211.59,,,,,,,828.9100,3211.5900,percent of total billed charges,"100% of $3,211.59 in Billed Charges for Rev 272 = $3,211.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURETTE EXPRESS,272,RC,,,,,,,,both,,,3211.5900,481.7400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1605.80,,,,,,,828.9100,3211.5900,percent of total billed charges,"Rev 272 $3,211.59 in Billed Charges at 50% = $1,605.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURETTE EXPRESS,272,RC,,,,,,,,both,,,3211.5900,481.7400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1037.34,,,,,,,828.9100,3211.5900,other,"32.3% of $3,211.59 in Billed Charges for Rev 272 = $1,037.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CURETTE EXPRESS,272,RC,,,,,,,,both,,,3211.5900,481.7400,UNITED HEALTHCARE,UHC HERITAGE SELECT,985.96,,,,,,,828.9100,3211.5900,other,"30.7% of $3,211.59 in Billed Charges for Rev 272 = $985.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CURETTE EXPRESS,272,RC,,,,,,,,both,,,3211.5900,481.7400,UNITED HEALTHCARE,UNITED HEALTHCARE,1037.34,,,,,,,828.9100,3211.5900,percent of total billed charges,"32.3% of $3,211.59 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURETTE EXPRESS,272,RC,,,,,,,,both,,,3211.5900,481.7400,WELLCARE,WELLCARE MEDICAID,3211.59,,,,,,,828.9100,3211.5900,percent of total billed charges,"100% of $3,211.59 in Billed Charges for Rev 272 = $3,211.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL SOLID AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,461.0900,69.1600,AETNA,AETNA,196.89,,,,,,,119.0100,461.0900,percent of total billed charges,42.7% of $461.09 in Billed Charges for Rev 272 = $196.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SOLID AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,461.0900,69.1600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,322.76,,,,,,,119.0100,461.0900,percent of total billed charges,Rev 272 $461.09 in Billed Charges at 70% = $322.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SOLID AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,461.0900,69.1600,CIGNA HEALTHCARE,CIGNA HMO,192.27,,,,,,,119.0100,461.0900,percent of total billed charges,41.7% of $461.09 in Billed Charges for Rev 272 = $192.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SOLID AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,461.0900,69.1600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,213.95,,,,,,,119.0100,461.0900,percent of total billed charges,46.4% of $461.09 in Billed Charges for Rev 272 = $213.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SOLID AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,461.0900,69.1600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,192.27,,,,,,,119.0100,461.0900,percent of total billed charges,41.7% of $461.09 in Billed Charges for Rev 272 = $192.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SOLID AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,461.0900,69.1600,CIGNA HEALTHCARE,CIGNA PPO,192.27,,,,,,,119.0100,461.0900,percent of total billed charges,41.7% of $461.09 in Billed Charges for Rev 272 = $192.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SOLID AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,461.0900,69.1600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,414.98,,,,,,,119.0100,461.0900,percent of total billed charges,90% of $461.09 in Billed Charges for Rev 272 = $414.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SOLID AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,461.0900,69.1600,MEDCOST,MEDCOST VHN,219.43,,,,,,,119.0100,461.0900,percent of total billed charges,47.59% of $461.09 in Billed Charges for Rev 272 = $219.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SOLID AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,461.0900,69.1600,SENTARA HEALTH,SENTARA HEALTH,119.01,,,,,,,119.0100,461.0900,percent of total billed charges,25.81% of $461.09 in Billed Charges for Rev 272 = $119.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SOLID AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,461.0900,69.1600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",461.09,,,,,,,119.0100,461.0900,percent of total billed charges,100% of $461.09 in Billed Charges for Rev 272 = $461.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SOLID AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,461.0900,69.1600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,230.55,,,,,,,119.0100,461.0900,percent of total billed charges,Rev 272 $461.09 in Billed Charges at 50% = $230.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SOLID AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,461.0900,69.1600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,148.93,,,,,,,119.0100,461.0900,other,32.3% of $461.09 in Billed Charges for Rev 272 = $148.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL SOLID AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,461.0900,69.1600,UNITED HEALTHCARE,UHC HERITAGE SELECT,141.55,,,,,,,119.0100,461.0900,other,30.7% of $461.09 in Billed Charges for Rev 272 = $141.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BIT DRILL SOLID AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,461.0900,69.1600,UNITED HEALTHCARE,UNITED HEALTHCARE,148.93,,,,,,,119.0100,461.0900,percent of total billed charges,32.3% of $461.09 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BIT DRILL SOLID AO COUPLING 1.7MM,272,RC,,,,,,,,both,,,461.0900,69.1600,WELLCARE,WELLCARE MEDICAID,461.09,,,,,,,119.0100,461.0900,percent of total billed charges,100% of $461.09 in Billed Charges for Rev 272 = $461.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISSECTOR BIPOLAR CURVED ROBOT DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2940.1800,441.0300,AETNA,AETNA,1255.46,,,,,,,758.8600,2940.1800,percent of total billed charges,"42.7% of $2,940.18 in Billed Charges for Rev 272 = $1,255.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BIPOLAR CURVED ROBOT DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2940.1800,441.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2058.13,,,,,,,758.8600,2940.1800,percent of total billed charges,"Rev 272 $2,940.18 in Billed Charges at 70% = $2,058.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BIPOLAR CURVED ROBOT DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2940.1800,441.0300,CIGNA HEALTHCARE,CIGNA HMO,1226.06,,,,,,,758.8600,2940.1800,percent of total billed charges,"41.7% of $2,940.18 in Billed Charges for Rev 272 = $1,226.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BIPOLAR CURVED ROBOT DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2940.1800,441.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1364.24,,,,,,,758.8600,2940.1800,percent of total billed charges,"46.4% of $2,940.18 in Billed Charges for Rev 272 = $1,364.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BIPOLAR CURVED ROBOT DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2940.1800,441.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1226.06,,,,,,,758.8600,2940.1800,percent of total billed charges,"41.7% of $2,940.18 in Billed Charges for Rev 272 = $1,226.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BIPOLAR CURVED ROBOT DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2940.1800,441.0300,CIGNA HEALTHCARE,CIGNA PPO,1226.06,,,,,,,758.8600,2940.1800,percent of total billed charges,"41.7% of $2,940.18 in Billed Charges for Rev 272 = $1,226.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BIPOLAR CURVED ROBOT DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2940.1800,441.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2646.16,,,,,,,758.8600,2940.1800,percent of total billed charges,"90% of $2,940.18 in Billed Charges for Rev 272 = $2,646.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BIPOLAR CURVED ROBOT DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2940.1800,441.0300,MEDCOST,MEDCOST VHN,1399.23,,,,,,,758.8600,2940.1800,percent of total billed charges,"47.59% of $2,940.18 in Billed Charges for Rev 272 = $1,399.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BIPOLAR CURVED ROBOT DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2940.1800,441.0300,SENTARA HEALTH,SENTARA HEALTH,758.86,,,,,,,758.8600,2940.1800,percent of total billed charges,"25.81% of $2,940.18 in Billed Charges for Rev 272 = $758.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BIPOLAR CURVED ROBOT DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2940.1800,441.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2940.18,,,,,,,758.8600,2940.1800,percent of total billed charges,"100% of $2,940.18 in Billed Charges for Rev 272 = $2,940.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BIPOLAR CURVED ROBOT DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2940.1800,441.0300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1470.09,,,,,,,758.8600,2940.1800,percent of total billed charges,"Rev 272 $2,940.18 in Billed Charges at 50% = $1,470.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BIPOLAR CURVED ROBOT DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2940.1800,441.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,949.68,,,,,,,758.8600,2940.1800,other,"32.3% of $2,940.18 in Billed Charges for Rev 272 = $949.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DISSECTOR BIPOLAR CURVED ROBOT DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2940.1800,441.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,902.64,,,,,,,758.8600,2940.1800,other,"30.7% of $2,940.18 in Billed Charges for Rev 272 = $902.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DISSECTOR BIPOLAR CURVED ROBOT DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2940.1800,441.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,949.68,,,,,,,758.8600,2940.1800,percent of total billed charges,"32.3% of $2,940.18 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BIPOLAR CURVED ROBOT DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2940.1800,441.0300,WELLCARE,WELLCARE MEDICAID,2940.18,,,,,,,758.8600,2940.1800,percent of total billed charges,"100% of $2,940.18 in Billed Charges for Rev 272 = $2,940.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STEPPED TIP 5/7.3 X 10MM,272,RC,,,,,,,,both,,,4104.1200,615.6200,AETNA,AETNA,1752.46,,,,,,,1059.2700,4104.1200,percent of total billed charges,"42.7% of $4,104.12 in Billed Charges for Rev 272 = $1,752.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STEPPED TIP 5/7.3 X 10MM,272,RC,,,,,,,,both,,,4104.1200,615.6200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2872.88,,,,,,,1059.2700,4104.1200,percent of total billed charges,"Rev 272 $4,104.12 in Billed Charges at 70% = $2,872.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STEPPED TIP 5/7.3 X 10MM,272,RC,,,,,,,,both,,,4104.1200,615.6200,CIGNA HEALTHCARE,CIGNA HMO,1711.42,,,,,,,1059.2700,4104.1200,percent of total billed charges,"41.7% of $4,104.12 in Billed Charges for Rev 272 = $1,711.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STEPPED TIP 5/7.3 X 10MM,272,RC,,,,,,,,both,,,4104.1200,615.6200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1904.31,,,,,,,1059.2700,4104.1200,percent of total billed charges,"46.4% of $4,104.12 in Billed Charges for Rev 272 = $1,904.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STEPPED TIP 5/7.3 X 10MM,272,RC,,,,,,,,both,,,4104.1200,615.6200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1711.42,,,,,,,1059.2700,4104.1200,percent of total billed charges,"41.7% of $4,104.12 in Billed Charges for Rev 272 = $1,711.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STEPPED TIP 5/7.3 X 10MM,272,RC,,,,,,,,both,,,4104.1200,615.6200,CIGNA HEALTHCARE,CIGNA PPO,1711.42,,,,,,,1059.2700,4104.1200,percent of total billed charges,"41.7% of $4,104.12 in Billed Charges for Rev 272 = $1,711.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STEPPED TIP 5/7.3 X 10MM,272,RC,,,,,,,,both,,,4104.1200,615.6200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3693.71,,,,,,,1059.2700,4104.1200,percent of total billed charges,"90% of $4,104.12 in Billed Charges for Rev 272 = $3,693.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STEPPED TIP 5/7.3 X 10MM,272,RC,,,,,,,,both,,,4104.1200,615.6200,MEDCOST,MEDCOST VHN,1953.15,,,,,,,1059.2700,4104.1200,percent of total billed charges,"47.59% of $4,104.12 in Billed Charges for Rev 272 = $1,953.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STEPPED TIP 5/7.3 X 10MM,272,RC,,,,,,,,both,,,4104.1200,615.6200,SENTARA HEALTH,SENTARA HEALTH,1059.27,,,,,,,1059.2700,4104.1200,percent of total billed charges,"25.81% of $4,104.12 in Billed Charges for Rev 272 = $1,059.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STEPPED TIP 5/7.3 X 10MM,272,RC,,,,,,,,both,,,4104.1200,615.6200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4104.12,,,,,,,1059.2700,4104.1200,percent of total billed charges,"100% of $4,104.12 in Billed Charges for Rev 272 = $4,104.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STEPPED TIP 5/7.3 X 10MM,272,RC,,,,,,,,both,,,4104.1200,615.6200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2052.06,,,,,,,1059.2700,4104.1200,percent of total billed charges,"Rev 272 $4,104.12 in Billed Charges at 50% = $2,052.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STEPPED TIP 5/7.3 X 10MM,272,RC,,,,,,,,both,,,4104.1200,615.6200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1325.63,,,,,,,1059.2700,4104.1200,other,"32.3% of $4,104.12 in Billed Charges for Rev 272 = $1,325.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL STEPPED TIP 5/7.3 X 10MM,272,RC,,,,,,,,both,,,4104.1200,615.6200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1259.96,,,,,,,1059.2700,4104.1200,other,"30.7% of $4,104.12 in Billed Charges for Rev 272 = $1,259.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL STEPPED TIP 5/7.3 X 10MM,272,RC,,,,,,,,both,,,4104.1200,615.6200,UNITED HEALTHCARE,UNITED HEALTHCARE,1325.63,,,,,,,1059.2700,4104.1200,percent of total billed charges,"32.3% of $4,104.12 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STEPPED TIP 5/7.3 X 10MM,272,RC,,,,,,,,both,,,4104.1200,615.6200,WELLCARE,WELLCARE MEDICAID,4104.12,,,,,,,1059.2700,4104.1200,percent of total billed charges,"100% of $4,104.12 in Billed Charges for Rev 272 = $4,104.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STERILE KIT 2.0MM,272,RC,,,,,,,,both,,,2718.4500,407.7700,AETNA,AETNA,1160.78,,,,,,,701.6300,2718.4500,percent of total billed charges,"42.7% of $2,718.45 in Billed Charges for Rev 272 = $1,160.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STERILE KIT 2.0MM,272,RC,,,,,,,,both,,,2718.4500,407.7700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1902.92,,,,,,,701.6300,2718.4500,percent of total billed charges,"Rev 272 $2,718.45 in Billed Charges at 70% = $1,902.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STERILE KIT 2.0MM,272,RC,,,,,,,,both,,,2718.4500,407.7700,CIGNA HEALTHCARE,CIGNA HMO,1133.59,,,,,,,701.6300,2718.4500,percent of total billed charges,"41.7% of $2,718.45 in Billed Charges for Rev 272 = $1,133.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STERILE KIT 2.0MM,272,RC,,,,,,,,both,,,2718.4500,407.7700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1261.36,,,,,,,701.6300,2718.4500,percent of total billed charges,"46.4% of $2,718.45 in Billed Charges for Rev 272 = $1,261.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STERILE KIT 2.0MM,272,RC,,,,,,,,both,,,2718.4500,407.7700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1133.59,,,,,,,701.6300,2718.4500,percent of total billed charges,"41.7% of $2,718.45 in Billed Charges for Rev 272 = $1,133.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STERILE KIT 2.0MM,272,RC,,,,,,,,both,,,2718.4500,407.7700,CIGNA HEALTHCARE,CIGNA PPO,1133.59,,,,,,,701.6300,2718.4500,percent of total billed charges,"41.7% of $2,718.45 in Billed Charges for Rev 272 = $1,133.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STERILE KIT 2.0MM,272,RC,,,,,,,,both,,,2718.4500,407.7700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2446.61,,,,,,,701.6300,2718.4500,percent of total billed charges,"90% of $2,718.45 in Billed Charges for Rev 272 = $2,446.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STERILE KIT 2.0MM,272,RC,,,,,,,,both,,,2718.4500,407.7700,MEDCOST,MEDCOST VHN,1293.71,,,,,,,701.6300,2718.4500,percent of total billed charges,"47.59% of $2,718.45 in Billed Charges for Rev 272 = $1,293.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STERILE KIT 2.0MM,272,RC,,,,,,,,both,,,2718.4500,407.7700,SENTARA HEALTH,SENTARA HEALTH,701.63,,,,,,,701.6300,2718.4500,percent of total billed charges,"25.81% of $2,718.45 in Billed Charges for Rev 272 = $701.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STERILE KIT 2.0MM,272,RC,,,,,,,,both,,,2718.4500,407.7700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2718.45,,,,,,,701.6300,2718.4500,percent of total billed charges,"100% of $2,718.45 in Billed Charges for Rev 272 = $2,718.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STERILE KIT 2.0MM,272,RC,,,,,,,,both,,,2718.4500,407.7700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1359.23,,,,,,,701.6300,2718.4500,percent of total billed charges,"Rev 272 $2,718.45 in Billed Charges at 50% = $1,359.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STERILE KIT 2.0MM,272,RC,,,,,,,,both,,,2718.4500,407.7700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,878.06,,,,,,,701.6300,2718.4500,other,"32.3% of $2,718.45 in Billed Charges for Rev 272 = $878.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL STERILE KIT 2.0MM,272,RC,,,,,,,,both,,,2718.4500,407.7700,UNITED HEALTHCARE,UHC HERITAGE SELECT,834.56,,,,,,,701.6300,2718.4500,other,"30.7% of $2,718.45 in Billed Charges for Rev 272 = $834.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL STERILE KIT 2.0MM,272,RC,,,,,,,,both,,,2718.4500,407.7700,UNITED HEALTHCARE,UNITED HEALTHCARE,878.06,,,,,,,701.6300,2718.4500,percent of total billed charges,"32.3% of $2,718.45 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STERILE KIT 2.0MM,272,RC,,,,,,,,both,,,2718.4500,407.7700,WELLCARE,WELLCARE MEDICAID,2718.45,,,,,,,701.6300,2718.4500,percent of total billed charges,"100% of $2,718.45 in Billed Charges for Rev 272 = $2,718.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRAIGHT WITH SELF-CENTERING SLEEVE 18MM,272,RC,27200002,CDM,,,,,,both,,,1711.2200,256.6800,AETNA,AETNA,730.69,,,,,,,441.6700,1711.2200,percent of total billed charges,"42.7% of $1,711.22 in Billed Charges for Rev 272 = $730.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRAIGHT WITH SELF-CENTERING SLEEVE 18MM,272,RC,27200002,CDM,,,,,,both,,,1711.2200,256.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1197.85,,,,,,,441.6700,1711.2200,percent of total billed charges,"Rev 272 $1,711.22 in Billed Charges at 70% = $1,197.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRAIGHT WITH SELF-CENTERING SLEEVE 18MM,272,RC,27200002,CDM,,,,,,both,,,1711.2200,256.6800,CIGNA HEALTHCARE,CIGNA HMO,713.58,,,,,,,441.6700,1711.2200,percent of total billed charges,"41.7% of $1,711.22 in Billed Charges for Rev 272 = $713.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRAIGHT WITH SELF-CENTERING SLEEVE 18MM,272,RC,27200002,CDM,,,,,,both,,,1711.2200,256.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,794.01,,,,,,,441.6700,1711.2200,percent of total billed charges,"46.4% of $1,711.22 in Billed Charges for Rev 272 = $794.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRAIGHT WITH SELF-CENTERING SLEEVE 18MM,272,RC,27200002,CDM,,,,,,both,,,1711.2200,256.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,713.58,,,,,,,441.6700,1711.2200,percent of total billed charges,"41.7% of $1,711.22 in Billed Charges for Rev 272 = $713.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRAIGHT WITH SELF-CENTERING SLEEVE 18MM,272,RC,27200002,CDM,,,,,,both,,,1711.2200,256.6800,CIGNA HEALTHCARE,CIGNA PPO,713.58,,,,,,,441.6700,1711.2200,percent of total billed charges,"41.7% of $1,711.22 in Billed Charges for Rev 272 = $713.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRAIGHT WITH SELF-CENTERING SLEEVE 18MM,272,RC,27200002,CDM,,,,,,both,,,1711.2200,256.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1540.10,,,,,,,441.6700,1711.2200,percent of total billed charges,"90% of $1,711.22 in Billed Charges for Rev 272 = $1,540.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRAIGHT WITH SELF-CENTERING SLEEVE 18MM,272,RC,27200002,CDM,,,,,,both,,,1711.2200,256.6800,MEDCOST,MEDCOST VHN,814.37,,,,,,,441.6700,1711.2200,percent of total billed charges,"47.59% of $1,711.22 in Billed Charges for Rev 272 = $814.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRAIGHT WITH SELF-CENTERING SLEEVE 18MM,272,RC,27200002,CDM,,,,,,both,,,1711.2200,256.6800,SENTARA HEALTH,SENTARA HEALTH,441.67,,,,,,,441.6700,1711.2200,percent of total billed charges,"25.81% of $1,711.22 in Billed Charges for Rev 272 = $441.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRAIGHT WITH SELF-CENTERING SLEEVE 18MM,272,RC,27200002,CDM,,,,,,both,,,1711.2200,256.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1711.22,,,,,,,441.6700,1711.2200,percent of total billed charges,"100% of $1,711.22 in Billed Charges for Rev 272 = $1,711.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRAIGHT WITH SELF-CENTERING SLEEVE 18MM,272,RC,27200002,CDM,,,,,,both,,,1711.2200,256.6800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,855.61,,,,,,,441.6700,1711.2200,percent of total billed charges,"Rev 272 $1,711.22 in Billed Charges at 50% = $855.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRAIGHT WITH SELF-CENTERING SLEEVE 18MM,272,RC,27200002,CDM,,,,,,both,,,1711.2200,256.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,552.72,,,,,,,441.6700,1711.2200,other,"32.3% of $1,711.22 in Billed Charges for Rev 272 = $552.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL STRAIGHT WITH SELF-CENTERING SLEEVE 18MM,272,RC,27200002,CDM,,,,,,both,,,1711.2200,256.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,525.34,,,,,,,441.6700,1711.2200,other,"30.7% of $1,711.22 in Billed Charges for Rev 272 = $525.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BIT DRILL STRAIGHT WITH SELF-CENTERING SLEEVE 18MM,272,RC,27200002,CDM,,,,,,both,,,1711.2200,256.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,552.72,,,,,,,441.6700,1711.2200,percent of total billed charges,"32.3% of $1,711.22 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BIT DRILL STRAIGHT WITH SELF-CENTERING SLEEVE 18MM,272,RC,27200002,CDM,,,,,,both,,,1711.2200,256.6800,WELLCARE,WELLCARE MEDICAID,1711.22,,,,,,,441.6700,1711.2200,percent of total billed charges,"100% of $1,711.22 in Billed Charges for Rev 272 = $1,711.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM CONCAVE,272,RC,,,,,,,,both,,,1444.4700,216.6700,AETNA,AETNA,616.79,,,,,,,372.8200,1444.4700,percent of total billed charges,"42.7% of $1,444.47 in Billed Charges for Rev 272 = $616.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM CONCAVE,272,RC,,,,,,,,both,,,1444.4700,216.6700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1011.13,,,,,,,372.8200,1444.4700,percent of total billed charges,"Rev 272 $1,444.47 in Billed Charges at 70% = $1,011.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM CONCAVE,272,RC,,,,,,,,both,,,1444.4700,216.6700,CIGNA HEALTHCARE,CIGNA HMO,602.34,,,,,,,372.8200,1444.4700,percent of total billed charges,"41.7% of $1,444.47 in Billed Charges for Rev 272 = $602.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM CONCAVE,272,RC,,,,,,,,both,,,1444.4700,216.6700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,670.23,,,,,,,372.8200,1444.4700,percent of total billed charges,"46.4% of $1,444.47 in Billed Charges for Rev 272 = $670.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM CONCAVE,272,RC,,,,,,,,both,,,1444.4700,216.6700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,602.34,,,,,,,372.8200,1444.4700,percent of total billed charges,"41.7% of $1,444.47 in Billed Charges for Rev 272 = $602.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM CONCAVE,272,RC,,,,,,,,both,,,1444.4700,216.6700,CIGNA HEALTHCARE,CIGNA PPO,602.34,,,,,,,372.8200,1444.4700,percent of total billed charges,"41.7% of $1,444.47 in Billed Charges for Rev 272 = $602.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM CONCAVE,272,RC,,,,,,,,both,,,1444.4700,216.6700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1300.02,,,,,,,372.8200,1444.4700,percent of total billed charges,"90% of $1,444.47 in Billed Charges for Rev 272 = $1,300.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM CONCAVE,272,RC,,,,,,,,both,,,1444.4700,216.6700,MEDCOST,MEDCOST VHN,687.42,,,,,,,372.8200,1444.4700,percent of total billed charges,"47.59% of $1,444.47 in Billed Charges for Rev 272 = $687.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM CONCAVE,272,RC,,,,,,,,both,,,1444.4700,216.6700,SENTARA HEALTH,SENTARA HEALTH,372.82,,,,,,,372.8200,1444.4700,percent of total billed charges,"25.81% of $1,444.47 in Billed Charges for Rev 272 = $372.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM CONCAVE,272,RC,,,,,,,,both,,,1444.4700,216.6700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1444.47,,,,,,,372.8200,1444.4700,percent of total billed charges,"100% of $1,444.47 in Billed Charges for Rev 272 = $1,444.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM CONCAVE,272,RC,,,,,,,,both,,,1444.4700,216.6700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,722.24,,,,,,,372.8200,1444.4700,percent of total billed charges,"Rev 272 $1,444.47 in Billed Charges at 50% = $722.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM CONCAVE,272,RC,,,,,,,,both,,,1444.4700,216.6700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,466.56,,,,,,,372.8200,1444.4700,other,"32.3% of $1,444.47 in Billed Charges for Rev 272 = $466.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE DIEGO SHAVER 4MM CONCAVE,272,RC,,,,,,,,both,,,1444.4700,216.6700,UNITED HEALTHCARE,UHC HERITAGE SELECT,443.45,,,,,,,372.8200,1444.4700,other,"30.7% of $1,444.47 in Billed Charges for Rev 272 = $443.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE DIEGO SHAVER 4MM CONCAVE,272,RC,,,,,,,,both,,,1444.4700,216.6700,UNITED HEALTHCARE,UNITED HEALTHCARE,466.56,,,,,,,372.8200,1444.4700,percent of total billed charges,"32.3% of $1,444.47 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE DIEGO SHAVER 4MM CONCAVE,272,RC,,,,,,,,both,,,1444.4700,216.6700,WELLCARE,WELLCARE MEDICAID,1444.47,,,,,,,372.8200,1444.4700,percent of total billed charges,"100% of $1,444.47 in Billed Charges for Rev 272 = $1,444.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR STICK ENDO 5X400MM,272,RC,27200002,CDM,,,,,,both,,,5413.6600,812.0500,AETNA,AETNA,2311.63,,,,,,,1397.2700,5413.6600,percent of total billed charges,"42.7% of $5,413.66 in Billed Charges for Rev 272 = $2,311.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR STICK ENDO 5X400MM,272,RC,27200002,CDM,,,,,,both,,,5413.6600,812.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3789.56,,,,,,,1397.2700,5413.6600,percent of total billed charges,"Rev 272 $5,413.66 in Billed Charges at 70% = $3,789.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR STICK ENDO 5X400MM,272,RC,27200002,CDM,,,,,,both,,,5413.6600,812.0500,CIGNA HEALTHCARE,CIGNA HMO,2257.50,,,,,,,1397.2700,5413.6600,percent of total billed charges,"41.7% of $5,413.66 in Billed Charges for Rev 272 = $2,257.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR STICK ENDO 5X400MM,272,RC,27200002,CDM,,,,,,both,,,5413.6600,812.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2511.94,,,,,,,1397.2700,5413.6600,percent of total billed charges,"46.4% of $5,413.66 in Billed Charges for Rev 272 = $2,511.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR STICK ENDO 5X400MM,272,RC,27200002,CDM,,,,,,both,,,5413.6600,812.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2257.50,,,,,,,1397.2700,5413.6600,percent of total billed charges,"41.7% of $5,413.66 in Billed Charges for Rev 272 = $2,257.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR STICK ENDO 5X400MM,272,RC,27200002,CDM,,,,,,both,,,5413.6600,812.0500,CIGNA HEALTHCARE,CIGNA PPO,2257.50,,,,,,,1397.2700,5413.6600,percent of total billed charges,"41.7% of $5,413.66 in Billed Charges for Rev 272 = $2,257.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR STICK ENDO 5X400MM,272,RC,27200002,CDM,,,,,,both,,,5413.6600,812.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4872.29,,,,,,,1397.2700,5413.6600,percent of total billed charges,"90% of $5,413.66 in Billed Charges for Rev 272 = $4,872.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR STICK ENDO 5X400MM,272,RC,27200002,CDM,,,,,,both,,,5413.6600,812.0500,MEDCOST,MEDCOST VHN,2576.36,,,,,,,1397.2700,5413.6600,percent of total billed charges,"47.59% of $5,413.66 in Billed Charges for Rev 272 = $2,576.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR STICK ENDO 5X400MM,272,RC,27200002,CDM,,,,,,both,,,5413.6600,812.0500,SENTARA HEALTH,SENTARA HEALTH,1397.27,,,,,,,1397.2700,5413.6600,percent of total billed charges,"25.81% of $5,413.66 in Billed Charges for Rev 272 = $1,397.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR STICK ENDO 5X400MM,272,RC,27200002,CDM,,,,,,both,,,5413.6600,812.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5413.66,,,,,,,1397.2700,5413.6600,percent of total billed charges,"100% of $5,413.66 in Billed Charges for Rev 272 = $5,413.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR STICK ENDO 5X400MM,272,RC,27200002,CDM,,,,,,both,,,5413.6600,812.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2706.83,,,,,,,1397.2700,5413.6600,percent of total billed charges,"Rev 272 $5,413.66 in Billed Charges at 50% = $2,706.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR STICK ENDO 5X400MM,272,RC,27200002,CDM,,,,,,both,,,5413.6600,812.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1748.61,,,,,,,1397.2700,5413.6600,other,"32.3% of $5,413.66 in Billed Charges for Rev 272 = $1,748.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DISSECTOR STICK ENDO 5X400MM,272,RC,27200002,CDM,,,,,,both,,,5413.6600,812.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1661.99,,,,,,,1397.2700,5413.6600,other,"30.7% of $5,413.66 in Billed Charges for Rev 272 = $1,661.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DISSECTOR STICK ENDO 5X400MM,272,RC,27200002,CDM,,,,,,both,,,5413.6600,812.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,1748.61,,,,,,,1397.2700,5413.6600,percent of total billed charges,"32.3% of $5,413.66 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR STICK ENDO 5X400MM,272,RC,27200002,CDM,,,,,,both,,,5413.6600,812.0500,WELLCARE,WELLCARE MEDICAID,5413.66,,,,,,,1397.2700,5413.6600,percent of total billed charges,"100% of $5,413.66 in Billed Charges for Rev 272 = $5,413.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRAIN SAHARA PE DRY SUCTION ADULT/PEDS,272,RC,27200002,CDM,,,,,,both,,,603.2500,90.4900,AETNA,AETNA,257.59,,,,,,,155.7000,603.2500,percent of total billed charges,42.7% of $603.25 in Billed Charges for Rev 272 = $257.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SAHARA PE DRY SUCTION ADULT/PEDS,272,RC,27200002,CDM,,,,,,both,,,603.2500,90.4900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,422.28,,,,,,,155.7000,603.2500,percent of total billed charges,Rev 272 $603.25 in Billed Charges at 70% = $422.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SAHARA PE DRY SUCTION ADULT/PEDS,272,RC,27200002,CDM,,,,,,both,,,603.2500,90.4900,CIGNA HEALTHCARE,CIGNA HMO,251.56,,,,,,,155.7000,603.2500,percent of total billed charges,41.7% of $603.25 in Billed Charges for Rev 272 = $251.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SAHARA PE DRY SUCTION ADULT/PEDS,272,RC,27200002,CDM,,,,,,both,,,603.2500,90.4900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,279.91,,,,,,,155.7000,603.2500,percent of total billed charges,46.4% of $603.25 in Billed Charges for Rev 272 = $279.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SAHARA PE DRY SUCTION ADULT/PEDS,272,RC,27200002,CDM,,,,,,both,,,603.2500,90.4900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,251.56,,,,,,,155.7000,603.2500,percent of total billed charges,41.7% of $603.25 in Billed Charges for Rev 272 = $251.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SAHARA PE DRY SUCTION ADULT/PEDS,272,RC,27200002,CDM,,,,,,both,,,603.2500,90.4900,CIGNA HEALTHCARE,CIGNA PPO,251.56,,,,,,,155.7000,603.2500,percent of total billed charges,41.7% of $603.25 in Billed Charges for Rev 272 = $251.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SAHARA PE DRY SUCTION ADULT/PEDS,272,RC,27200002,CDM,,,,,,both,,,603.2500,90.4900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,542.93,,,,,,,155.7000,603.2500,percent of total billed charges,90% of $603.25 in Billed Charges for Rev 272 = $542.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SAHARA PE DRY SUCTION ADULT/PEDS,272,RC,27200002,CDM,,,,,,both,,,603.2500,90.4900,MEDCOST,MEDCOST VHN,287.09,,,,,,,155.7000,603.2500,percent of total billed charges,47.59% of $603.25 in Billed Charges for Rev 272 = $287.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SAHARA PE DRY SUCTION ADULT/PEDS,272,RC,27200002,CDM,,,,,,both,,,603.2500,90.4900,SENTARA HEALTH,SENTARA HEALTH,155.70,,,,,,,155.7000,603.2500,percent of total billed charges,25.81% of $603.25 in Billed Charges for Rev 272 = $155.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SAHARA PE DRY SUCTION ADULT/PEDS,272,RC,27200002,CDM,,,,,,both,,,603.2500,90.4900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",603.25,,,,,,,155.7000,603.2500,percent of total billed charges,100% of $603.25 in Billed Charges for Rev 272 = $603.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SAHARA PE DRY SUCTION ADULT/PEDS,272,RC,27200002,CDM,,,,,,both,,,603.2500,90.4900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,301.63,,,,,,,155.7000,603.2500,percent of total billed charges,Rev 272 $603.25 in Billed Charges at 50% = $301.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SAHARA PE DRY SUCTION ADULT/PEDS,272,RC,27200002,CDM,,,,,,both,,,603.2500,90.4900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,194.85,,,,,,,155.7000,603.2500,other,32.3% of $603.25 in Billed Charges for Rev 272 = $194.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRAIN SAHARA PE DRY SUCTION ADULT/PEDS,272,RC,27200002,CDM,,,,,,both,,,603.2500,90.4900,UNITED HEALTHCARE,UHC HERITAGE SELECT,185.20,,,,,,,155.7000,603.2500,other,30.7% of $603.25 in Billed Charges for Rev 272 = $185.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRAIN SAHARA PE DRY SUCTION ADULT/PEDS,272,RC,27200002,CDM,,,,,,both,,,603.2500,90.4900,UNITED HEALTHCARE,UNITED HEALTHCARE,194.85,,,,,,,155.7000,603.2500,percent of total billed charges,32.3% of $603.25 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SAHARA PE DRY SUCTION ADULT/PEDS,272,RC,27200002,CDM,,,,,,both,,,603.2500,90.4900,WELLCARE,WELLCARE MEDICAID,603.25,,,,,,,155.7000,603.2500,percent of total billed charges,100% of $603.25 in Billed Charges for Rev 272 = $603.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SURGICAL JACKSON PRATT FLAT W/TROCAR HUBLESS 10MM X 2OCM,270,RC,,,,,,,,both,,,687.2900,103.0900,AETNA,AETNA,293.47,,,,,,,177.3900,687.2900,percent of total billed charges,42.7% of $687.29 in Billed Charges for Rev 270 = $293.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SURGICAL JACKSON PRATT FLAT W/TROCAR HUBLESS 10MM X 2OCM,270,RC,,,,,,,,both,,,687.2900,103.0900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,481.10,,,,,,,177.3900,687.2900,percent of total billed charges,Rev 270 $687.29 in Billed Charges at 70% = $481.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SURGICAL JACKSON PRATT FLAT W/TROCAR HUBLESS 10MM X 2OCM,270,RC,,,,,,,,both,,,687.2900,103.0900,CIGNA HEALTHCARE,CIGNA HMO,286.60,,,,,,,177.3900,687.2900,percent of total billed charges,41.7% of $687.29 in Billed Charges for Rev 270 = $286.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SURGICAL JACKSON PRATT FLAT W/TROCAR HUBLESS 10MM X 2OCM,270,RC,,,,,,,,both,,,687.2900,103.0900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,318.90,,,,,,,177.3900,687.2900,percent of total billed charges,46.4% of $687.29 in Billed Charges for Rev 270 = $318.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SURGICAL JACKSON PRATT FLAT W/TROCAR HUBLESS 10MM X 2OCM,270,RC,,,,,,,,both,,,687.2900,103.0900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,286.60,,,,,,,177.3900,687.2900,percent of total billed charges,41.7% of $687.29 in Billed Charges for Rev 270 = $286.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SURGICAL JACKSON PRATT FLAT W/TROCAR HUBLESS 10MM X 2OCM,270,RC,,,,,,,,both,,,687.2900,103.0900,CIGNA HEALTHCARE,CIGNA PPO,286.60,,,,,,,177.3900,687.2900,percent of total billed charges,41.7% of $687.29 in Billed Charges for Rev 270 = $286.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SURGICAL JACKSON PRATT FLAT W/TROCAR HUBLESS 10MM X 2OCM,270,RC,,,,,,,,both,,,687.2900,103.0900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,618.56,,,,,,,177.3900,687.2900,percent of total billed charges,90% of $687.29 in Billed Charges for Rev 270 = $618.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SURGICAL JACKSON PRATT FLAT W/TROCAR HUBLESS 10MM X 2OCM,270,RC,,,,,,,,both,,,687.2900,103.0900,MEDCOST,MEDCOST VHN,327.08,,,,,,,177.3900,687.2900,percent of total billed charges,47.59% of $687.29 in Billed Charges for Rev 270 = $327.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SURGICAL JACKSON PRATT FLAT W/TROCAR HUBLESS 10MM X 2OCM,270,RC,,,,,,,,both,,,687.2900,103.0900,SENTARA HEALTH,SENTARA HEALTH,177.39,,,,,,,177.3900,687.2900,percent of total billed charges,25.81% of $687.29 in Billed Charges for Rev 270 = $177.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SURGICAL JACKSON PRATT FLAT W/TROCAR HUBLESS 10MM X 2OCM,270,RC,,,,,,,,both,,,687.2900,103.0900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",687.29,,,,,,,177.3900,687.2900,percent of total billed charges,100% of $687.29 in Billed Charges for Rev 270 = $687.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SURGICAL JACKSON PRATT FLAT W/TROCAR HUBLESS 10MM X 2OCM,270,RC,,,,,,,,both,,,687.2900,103.0900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,343.65,,,,,,,177.3900,687.2900,percent of total billed charges,Rev 270 $687.29 in Billed Charges at 50% = $343.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SURGICAL JACKSON PRATT FLAT W/TROCAR HUBLESS 10MM X 2OCM,270,RC,,,,,,,,both,,,687.2900,103.0900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,221.99,,,,,,,177.3900,687.2900,other,32.3% of $687.29 in Billed Charges for Rev 270 = $221.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRAIN SURGICAL JACKSON PRATT FLAT W/TROCAR HUBLESS 10MM X 2OCM,270,RC,,,,,,,,both,,,687.2900,103.0900,UNITED HEALTHCARE,UHC HERITAGE SELECT,211.00,,,,,,,177.3900,687.2900,other,30.7% of $687.29 in Billed Charges for Rev 270 = $211.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRAIN SURGICAL JACKSON PRATT FLAT W/TROCAR HUBLESS 10MM X 2OCM,270,RC,,,,,,,,both,,,687.2900,103.0900,UNITED HEALTHCARE,UNITED HEALTHCARE,221.99,,,,,,,177.3900,687.2900,percent of total billed charges,32.3% of $687.29 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRAIN SURGICAL JACKSON PRATT FLAT W/TROCAR HUBLESS 10MM X 2OCM,270,RC,,,,,,,,both,,,687.2900,103.0900,WELLCARE,WELLCARE MEDICAID,687.29,,,,,,,177.3900,687.2900,percent of total billed charges,100% of $687.29 in Billed Charges for Rev 270 = $687.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING DOYLE NASAL,272,RC,27200002,CDM,,,,,,both,,,416.9100,62.5400,AETNA,AETNA,178.02,,,,,,,107.6000,416.9100,percent of total billed charges,42.7% of $416.91 in Billed Charges for Rev 272 = $178.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING DOYLE NASAL,272,RC,27200002,CDM,,,,,,both,,,416.9100,62.5400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,291.84,,,,,,,107.6000,416.9100,percent of total billed charges,Rev 272 $416.91 in Billed Charges at 70% = $291.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING DOYLE NASAL,272,RC,27200002,CDM,,,,,,both,,,416.9100,62.5400,CIGNA HEALTHCARE,CIGNA HMO,173.85,,,,,,,107.6000,416.9100,percent of total billed charges,41.7% of $416.91 in Billed Charges for Rev 272 = $173.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING DOYLE NASAL,272,RC,27200002,CDM,,,,,,both,,,416.9100,62.5400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,193.45,,,,,,,107.6000,416.9100,percent of total billed charges,46.4% of $416.91 in Billed Charges for Rev 272 = $193.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING DOYLE NASAL,272,RC,27200002,CDM,,,,,,both,,,416.9100,62.5400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,173.85,,,,,,,107.6000,416.9100,percent of total billed charges,41.7% of $416.91 in Billed Charges for Rev 272 = $173.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING DOYLE NASAL,272,RC,27200002,CDM,,,,,,both,,,416.9100,62.5400,CIGNA HEALTHCARE,CIGNA PPO,173.85,,,,,,,107.6000,416.9100,percent of total billed charges,41.7% of $416.91 in Billed Charges for Rev 272 = $173.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING DOYLE NASAL,272,RC,27200002,CDM,,,,,,both,,,416.9100,62.5400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,375.22,,,,,,,107.6000,416.9100,percent of total billed charges,90% of $416.91 in Billed Charges for Rev 272 = $375.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING DOYLE NASAL,272,RC,27200002,CDM,,,,,,both,,,416.9100,62.5400,MEDCOST,MEDCOST VHN,198.41,,,,,,,107.6000,416.9100,percent of total billed charges,47.59% of $416.91 in Billed Charges for Rev 272 = $198.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING DOYLE NASAL,272,RC,27200002,CDM,,,,,,both,,,416.9100,62.5400,SENTARA HEALTH,SENTARA HEALTH,107.60,,,,,,,107.6000,416.9100,percent of total billed charges,25.81% of $416.91 in Billed Charges for Rev 272 = $107.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING DOYLE NASAL,272,RC,27200002,CDM,,,,,,both,,,416.9100,62.5400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",416.91,,,,,,,107.6000,416.9100,percent of total billed charges,100% of $416.91 in Billed Charges for Rev 272 = $416.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING DOYLE NASAL,272,RC,27200002,CDM,,,,,,both,,,416.9100,62.5400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,208.46,,,,,,,107.6000,416.9100,percent of total billed charges,Rev 272 $416.91 in Billed Charges at 50% = $208.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING DOYLE NASAL,272,RC,27200002,CDM,,,,,,both,,,416.9100,62.5400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,134.66,,,,,,,107.6000,416.9100,other,32.3% of $416.91 in Billed Charges for Rev 272 = $134.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING DOYLE NASAL,272,RC,27200002,CDM,,,,,,both,,,416.9100,62.5400,UNITED HEALTHCARE,UHC HERITAGE SELECT,127.99,,,,,,,107.6000,416.9100,other,30.7% of $416.91 in Billed Charges for Rev 272 = $127.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING DOYLE NASAL,272,RC,27200002,CDM,,,,,,both,,,416.9100,62.5400,UNITED HEALTHCARE,UNITED HEALTHCARE,134.66,,,,,,,107.6000,416.9100,percent of total billed charges,32.3% of $416.91 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING DOYLE NASAL,272,RC,27200002,CDM,,,,,,both,,,416.9100,62.5400,WELLCARE,WELLCARE MEDICAID,416.91,,,,,,,107.6000,416.9100,percent of total billed charges,100% of $416.91 in Billed Charges for Rev 272 = $416.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE ENDOSCOPY RAD 60 CURVED 3.5MM STRAIGHT SHOT,272,RC,,,,,,,,both,,,2762.8300,414.4200,AETNA,AETNA,1179.73,,,,,,,713.0900,2762.8300,percent of total billed charges,"42.7% of $2,762.83 in Billed Charges for Rev 272 = $1,179.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ENDOSCOPY RAD 60 CURVED 3.5MM STRAIGHT SHOT,272,RC,,,,,,,,both,,,2762.8300,414.4200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1933.98,,,,,,,713.0900,2762.8300,percent of total billed charges,"Rev 272 $2,762.83 in Billed Charges at 70% = $1,933.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ENDOSCOPY RAD 60 CURVED 3.5MM STRAIGHT SHOT,272,RC,,,,,,,,both,,,2762.8300,414.4200,CIGNA HEALTHCARE,CIGNA HMO,1152.10,,,,,,,713.0900,2762.8300,percent of total billed charges,"41.7% of $2,762.83 in Billed Charges for Rev 272 = $1,152.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ENDOSCOPY RAD 60 CURVED 3.5MM STRAIGHT SHOT,272,RC,,,,,,,,both,,,2762.8300,414.4200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1281.95,,,,,,,713.0900,2762.8300,percent of total billed charges,"46.4% of $2,762.83 in Billed Charges for Rev 272 = $1,281.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ENDOSCOPY RAD 60 CURVED 3.5MM STRAIGHT SHOT,272,RC,,,,,,,,both,,,2762.8300,414.4200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1152.10,,,,,,,713.0900,2762.8300,percent of total billed charges,"41.7% of $2,762.83 in Billed Charges for Rev 272 = $1,152.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ENDOSCOPY RAD 60 CURVED 3.5MM STRAIGHT SHOT,272,RC,,,,,,,,both,,,2762.8300,414.4200,CIGNA HEALTHCARE,CIGNA PPO,1152.10,,,,,,,713.0900,2762.8300,percent of total billed charges,"41.7% of $2,762.83 in Billed Charges for Rev 272 = $1,152.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ENDOSCOPY RAD 60 CURVED 3.5MM STRAIGHT SHOT,272,RC,,,,,,,,both,,,2762.8300,414.4200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2486.55,,,,,,,713.0900,2762.8300,percent of total billed charges,"90% of $2,762.83 in Billed Charges for Rev 272 = $2,486.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ENDOSCOPY RAD 60 CURVED 3.5MM STRAIGHT SHOT,272,RC,,,,,,,,both,,,2762.8300,414.4200,MEDCOST,MEDCOST VHN,1314.83,,,,,,,713.0900,2762.8300,percent of total billed charges,"47.59% of $2,762.83 in Billed Charges for Rev 272 = $1,314.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ENDOSCOPY RAD 60 CURVED 3.5MM STRAIGHT SHOT,272,RC,,,,,,,,both,,,2762.8300,414.4200,SENTARA HEALTH,SENTARA HEALTH,713.09,,,,,,,713.0900,2762.8300,percent of total billed charges,"25.81% of $2,762.83 in Billed Charges for Rev 272 = $713.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ENDOSCOPY RAD 60 CURVED 3.5MM STRAIGHT SHOT,272,RC,,,,,,,,both,,,2762.8300,414.4200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2762.83,,,,,,,713.0900,2762.8300,percent of total billed charges,"100% of $2,762.83 in Billed Charges for Rev 272 = $2,762.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ENDOSCOPY RAD 60 CURVED 3.5MM STRAIGHT SHOT,272,RC,,,,,,,,both,,,2762.8300,414.4200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1381.42,,,,,,,713.0900,2762.8300,percent of total billed charges,"Rev 272 $2,762.83 in Billed Charges at 50% = $1,381.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ENDOSCOPY RAD 60 CURVED 3.5MM STRAIGHT SHOT,272,RC,,,,,,,,both,,,2762.8300,414.4200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,892.39,,,,,,,713.0900,2762.8300,other,"32.3% of $2,762.83 in Billed Charges for Rev 272 = $892.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE ENDOSCOPY RAD 60 CURVED 3.5MM STRAIGHT SHOT,272,RC,,,,,,,,both,,,2762.8300,414.4200,UNITED HEALTHCARE,UHC HERITAGE SELECT,848.19,,,,,,,713.0900,2762.8300,other,"30.7% of $2,762.83 in Billed Charges for Rev 272 = $848.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE ENDOSCOPY RAD 60 CURVED 3.5MM STRAIGHT SHOT,272,RC,,,,,,,,both,,,2762.8300,414.4200,UNITED HEALTHCARE,UNITED HEALTHCARE,892.39,,,,,,,713.0900,2762.8300,percent of total billed charges,"32.3% of $2,762.83 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE ENDOSCOPY RAD 60 CURVED 3.5MM STRAIGHT SHOT,272,RC,,,,,,,,both,,,2762.8300,414.4200,WELLCARE,WELLCARE MEDICAID,2762.83,,,,,,,713.0900,2762.8300,percent of total billed charges,"100% of $2,762.83 in Billed Charges for Rev 272 = $2,762.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING MEPILEX AG 8X20IN FOAM ANTIMICROBIAL SILVER,272,RC,27200002,CDM,,,,,,both,,,616.7600,92.5100,AETNA,AETNA,263.36,,,,,,,159.1900,616.7600,percent of total billed charges,42.7% of $616.76 in Billed Charges for Rev 272 = $263.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING MEPILEX AG 8X20IN FOAM ANTIMICROBIAL SILVER,272,RC,27200002,CDM,,,,,,both,,,616.7600,92.5100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,431.73,,,,,,,159.1900,616.7600,percent of total billed charges,Rev 272 $616.76 in Billed Charges at 70% = $431.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING MEPILEX AG 8X20IN FOAM ANTIMICROBIAL SILVER,272,RC,27200002,CDM,,,,,,both,,,616.7600,92.5100,CIGNA HEALTHCARE,CIGNA HMO,257.19,,,,,,,159.1900,616.7600,percent of total billed charges,41.7% of $616.76 in Billed Charges for Rev 272 = $257.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING MEPILEX AG 8X20IN FOAM ANTIMICROBIAL SILVER,272,RC,27200002,CDM,,,,,,both,,,616.7600,92.5100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,286.18,,,,,,,159.1900,616.7600,percent of total billed charges,46.4% of $616.76 in Billed Charges for Rev 272 = $286.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING MEPILEX AG 8X20IN FOAM ANTIMICROBIAL SILVER,272,RC,27200002,CDM,,,,,,both,,,616.7600,92.5100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,257.19,,,,,,,159.1900,616.7600,percent of total billed charges,41.7% of $616.76 in Billed Charges for Rev 272 = $257.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING MEPILEX AG 8X20IN FOAM ANTIMICROBIAL SILVER,272,RC,27200002,CDM,,,,,,both,,,616.7600,92.5100,CIGNA HEALTHCARE,CIGNA PPO,257.19,,,,,,,159.1900,616.7600,percent of total billed charges,41.7% of $616.76 in Billed Charges for Rev 272 = $257.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING MEPILEX AG 8X20IN FOAM ANTIMICROBIAL SILVER,272,RC,27200002,CDM,,,,,,both,,,616.7600,92.5100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,555.08,,,,,,,159.1900,616.7600,percent of total billed charges,90% of $616.76 in Billed Charges for Rev 272 = $555.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING MEPILEX AG 8X20IN FOAM ANTIMICROBIAL SILVER,272,RC,27200002,CDM,,,,,,both,,,616.7600,92.5100,MEDCOST,MEDCOST VHN,293.52,,,,,,,159.1900,616.7600,percent of total billed charges,47.59% of $616.76 in Billed Charges for Rev 272 = $293.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING MEPILEX AG 8X20IN FOAM ANTIMICROBIAL SILVER,272,RC,27200002,CDM,,,,,,both,,,616.7600,92.5100,SENTARA HEALTH,SENTARA HEALTH,159.19,,,,,,,159.1900,616.7600,percent of total billed charges,25.81% of $616.76 in Billed Charges for Rev 272 = $159.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING MEPILEX AG 8X20IN FOAM ANTIMICROBIAL SILVER,272,RC,27200002,CDM,,,,,,both,,,616.7600,92.5100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",616.76,,,,,,,159.1900,616.7600,percent of total billed charges,100% of $616.76 in Billed Charges for Rev 272 = $616.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING MEPILEX AG 8X20IN FOAM ANTIMICROBIAL SILVER,272,RC,27200002,CDM,,,,,,both,,,616.7600,92.5100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,308.38,,,,,,,159.1900,616.7600,percent of total billed charges,Rev 272 $616.76 in Billed Charges at 50% = $308.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING MEPILEX AG 8X20IN FOAM ANTIMICROBIAL SILVER,272,RC,27200002,CDM,,,,,,both,,,616.7600,92.5100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,199.21,,,,,,,159.1900,616.7600,other,32.3% of $616.76 in Billed Charges for Rev 272 = $199.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING MEPILEX AG 8X20IN FOAM ANTIMICROBIAL SILVER,272,RC,27200002,CDM,,,,,,both,,,616.7600,92.5100,UNITED HEALTHCARE,UHC HERITAGE SELECT,189.35,,,,,,,159.1900,616.7600,other,30.7% of $616.76 in Billed Charges for Rev 272 = $189.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING MEPILEX AG 8X20IN FOAM ANTIMICROBIAL SILVER,272,RC,27200002,CDM,,,,,,both,,,616.7600,92.5100,UNITED HEALTHCARE,UNITED HEALTHCARE,199.21,,,,,,,159.1900,616.7600,percent of total billed charges,32.3% of $616.76 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING MEPILEX AG 8X20IN FOAM ANTIMICROBIAL SILVER,272,RC,27200002,CDM,,,,,,both,,,616.7600,92.5100,WELLCARE,WELLCARE MEDICAID,616.76,,,,,,,159.1900,616.7600,percent of total billed charges,100% of $616.76 in Billed Charges for Rev 272 = $616.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 41010,272,RC,,,,,,,,both,,,1980.8600,297.1300,AETNA,AETNA,845.83,,,,,,,511.2600,1980.8600,percent of total billed charges,"42.7% of $1,980.86 in Billed Charges for Rev 272 = $845.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 41010,272,RC,,,,,,,,both,,,1980.8600,297.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1386.60,,,,,,,511.2600,1980.8600,percent of total billed charges,"Rev 272 $1,980.86 in Billed Charges at 70% = $1,386.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 41010,272,RC,,,,,,,,both,,,1980.8600,297.1300,CIGNA HEALTHCARE,CIGNA HMO,826.02,,,,,,,511.2600,1980.8600,percent of total billed charges,"41.7% of $1,980.86 in Billed Charges for Rev 272 = $826.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 41010,272,RC,,,,,,,,both,,,1980.8600,297.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,919.12,,,,,,,511.2600,1980.8600,percent of total billed charges,"46.4% of $1,980.86 in Billed Charges for Rev 272 = $919.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 41010,272,RC,,,,,,,,both,,,1980.8600,297.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,826.02,,,,,,,511.2600,1980.8600,percent of total billed charges,"41.7% of $1,980.86 in Billed Charges for Rev 272 = $826.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 41010,272,RC,,,,,,,,both,,,1980.8600,297.1300,CIGNA HEALTHCARE,CIGNA PPO,826.02,,,,,,,511.2600,1980.8600,percent of total billed charges,"41.7% of $1,980.86 in Billed Charges for Rev 272 = $826.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 41010,272,RC,,,,,,,,both,,,1980.8600,297.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1782.77,,,,,,,511.2600,1980.8600,percent of total billed charges,"90% of $1,980.86 in Billed Charges for Rev 272 = $1,782.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 41010,272,RC,,,,,,,,both,,,1980.8600,297.1300,MEDCOST,MEDCOST VHN,942.69,,,,,,,511.2600,1980.8600,percent of total billed charges,"47.59% of $1,980.86 in Billed Charges for Rev 272 = $942.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 41010,272,RC,,,,,,,,both,,,1980.8600,297.1300,SENTARA HEALTH,SENTARA HEALTH,511.26,,,,,,,511.2600,1980.8600,percent of total billed charges,"25.81% of $1,980.86 in Billed Charges for Rev 272 = $511.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 41010,272,RC,,,,,,,,both,,,1980.8600,297.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1980.86,,,,,,,511.2600,1980.8600,percent of total billed charges,"100% of $1,980.86 in Billed Charges for Rev 272 = $1,980.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 41010,272,RC,,,,,,,,both,,,1980.8600,297.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,990.43,,,,,,,511.2600,1980.8600,percent of total billed charges,"Rev 272 $1,980.86 in Billed Charges at 50% = $990.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 41010,272,RC,,,,,,,,both,,,1980.8600,297.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,639.82,,,,,,,511.2600,1980.8600,other,"32.3% of $1,980.86 in Billed Charges for Rev 272 = $639.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 41010,272,RC,,,,,,,,both,,,1980.8600,297.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,608.12,,,,,,,511.2600,1980.8600,other,"30.7% of $1,980.86 in Billed Charges for Rev 272 = $608.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 41010,272,RC,,,,,,,,both,,,1980.8600,297.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,639.82,,,,,,,511.2600,1980.8600,percent of total billed charges,"32.3% of $1,980.86 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 41010,272,RC,,,,,,,,both,,,1980.8600,297.1300,WELLCARE,WELLCARE MEDICAID,1980.86,,,,,,,511.2600,1980.8600,percent of total billed charges,"100% of $1,980.86 in Billed Charges for Rev 272 = $1,980.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 5.0MM,272,RC,,,,,,,,both,,,5199.6000,779.9400,AETNA,AETNA,2220.23,,,,,,,1342.0200,5199.6000,percent of total billed charges,"42.7% of $5,199.60 in Billed Charges for Rev 272 = $2,220.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 5.0MM,272,RC,,,,,,,,both,,,5199.6000,779.9400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3639.72,,,,,,,1342.0200,5199.6000,percent of total billed charges,"Rev 272 $5,199.60 in Billed Charges at 70% = $3,639.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 5.0MM,272,RC,,,,,,,,both,,,5199.6000,779.9400,CIGNA HEALTHCARE,CIGNA HMO,2168.23,,,,,,,1342.0200,5199.6000,percent of total billed charges,"41.7% of $5,199.60 in Billed Charges for Rev 272 = $2,168.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 5.0MM,272,RC,,,,,,,,both,,,5199.6000,779.9400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2412.61,,,,,,,1342.0200,5199.6000,percent of total billed charges,"46.4% of $5,199.60 in Billed Charges for Rev 272 = $2,412.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 5.0MM,272,RC,,,,,,,,both,,,5199.6000,779.9400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2168.23,,,,,,,1342.0200,5199.6000,percent of total billed charges,"41.7% of $5,199.60 in Billed Charges for Rev 272 = $2,168.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 5.0MM,272,RC,,,,,,,,both,,,5199.6000,779.9400,CIGNA HEALTHCARE,CIGNA PPO,2168.23,,,,,,,1342.0200,5199.6000,percent of total billed charges,"41.7% of $5,199.60 in Billed Charges for Rev 272 = $2,168.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 5.0MM,272,RC,,,,,,,,both,,,5199.6000,779.9400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4679.64,,,,,,,1342.0200,5199.6000,percent of total billed charges,"90% of $5,199.60 in Billed Charges for Rev 272 = $4,679.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 5.0MM,272,RC,,,,,,,,both,,,5199.6000,779.9400,MEDCOST,MEDCOST VHN,2474.49,,,,,,,1342.0200,5199.6000,percent of total billed charges,"47.59% of $5,199.60 in Billed Charges for Rev 272 = $2,474.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 5.0MM,272,RC,,,,,,,,both,,,5199.6000,779.9400,SENTARA HEALTH,SENTARA HEALTH,1342.02,,,,,,,1342.0200,5199.6000,percent of total billed charges,"25.81% of $5,199.60 in Billed Charges for Rev 272 = $1,342.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 5.0MM,272,RC,,,,,,,,both,,,5199.6000,779.9400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5199.60,,,,,,,1342.0200,5199.6000,percent of total billed charges,"100% of $5,199.60 in Billed Charges for Rev 272 = $5,199.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 5.0MM,272,RC,,,,,,,,both,,,5199.6000,779.9400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2599.80,,,,,,,1342.0200,5199.6000,percent of total billed charges,"Rev 272 $5,199.60 in Billed Charges at 50% = $2,599.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 5.0MM,272,RC,,,,,,,,both,,,5199.6000,779.9400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1679.47,,,,,,,1342.0200,5199.6000,other,"32.3% of $5,199.60 in Billed Charges for Rev 272 = $1,679.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 5.0MM,272,RC,,,,,,,,both,,,5199.6000,779.9400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1596.28,,,,,,,1342.0200,5199.6000,other,"30.7% of $5,199.60 in Billed Charges for Rev 272 = $1,596.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 5.0MM,272,RC,,,,,,,,both,,,5199.6000,779.9400,UNITED HEALTHCARE,UNITED HEALTHCARE,1679.47,,,,,,,1342.0200,5199.6000,percent of total billed charges,"32.3% of $5,199.60 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 5.0MM,272,RC,,,,,,,,both,,,5199.6000,779.9400,WELLCARE,WELLCARE MEDICAID,5199.60,,,,,,,1342.0200,5199.6000,percent of total billed charges,"100% of $5,199.60 in Billed Charges for Rev 272 = $5,199.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 5/64 NON-STERILE,272,RC,,,,,,,,both,,,683.6600,102.5500,AETNA,AETNA,291.92,,,,,,,176.4500,683.6600,percent of total billed charges,42.7% of $683.66 in Billed Charges for Rev 272 = $291.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 5/64 NON-STERILE,272,RC,,,,,,,,both,,,683.6600,102.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,478.56,,,,,,,176.4500,683.6600,percent of total billed charges,Rev 272 $683.66 in Billed Charges at 70% = $478.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 5/64 NON-STERILE,272,RC,,,,,,,,both,,,683.6600,102.5500,CIGNA HEALTHCARE,CIGNA HMO,285.09,,,,,,,176.4500,683.6600,percent of total billed charges,41.7% of $683.66 in Billed Charges for Rev 272 = $285.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 5/64 NON-STERILE,272,RC,,,,,,,,both,,,683.6600,102.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,317.22,,,,,,,176.4500,683.6600,percent of total billed charges,46.4% of $683.66 in Billed Charges for Rev 272 = $317.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 5/64 NON-STERILE,272,RC,,,,,,,,both,,,683.6600,102.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,285.09,,,,,,,176.4500,683.6600,percent of total billed charges,41.7% of $683.66 in Billed Charges for Rev 272 = $285.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 5/64 NON-STERILE,272,RC,,,,,,,,both,,,683.6600,102.5500,CIGNA HEALTHCARE,CIGNA PPO,285.09,,,,,,,176.4500,683.6600,percent of total billed charges,41.7% of $683.66 in Billed Charges for Rev 272 = $285.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 5/64 NON-STERILE,272,RC,,,,,,,,both,,,683.6600,102.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,615.29,,,,,,,176.4500,683.6600,percent of total billed charges,90% of $683.66 in Billed Charges for Rev 272 = $615.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 5/64 NON-STERILE,272,RC,,,,,,,,both,,,683.6600,102.5500,MEDCOST,MEDCOST VHN,325.35,,,,,,,176.4500,683.6600,percent of total billed charges,47.59% of $683.66 in Billed Charges for Rev 272 = $325.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 5/64 NON-STERILE,272,RC,,,,,,,,both,,,683.6600,102.5500,SENTARA HEALTH,SENTARA HEALTH,176.45,,,,,,,176.4500,683.6600,percent of total billed charges,25.81% of $683.66 in Billed Charges for Rev 272 = $176.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 5/64 NON-STERILE,272,RC,,,,,,,,both,,,683.6600,102.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",683.66,,,,,,,176.4500,683.6600,percent of total billed charges,100% of $683.66 in Billed Charges for Rev 272 = $683.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 5/64 NON-STERILE,272,RC,,,,,,,,both,,,683.6600,102.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,341.83,,,,,,,176.4500,683.6600,percent of total billed charges,Rev 272 $683.66 in Billed Charges at 50% = $341.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 5/64 NON-STERILE,272,RC,,,,,,,,both,,,683.6600,102.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,220.82,,,,,,,176.4500,683.6600,other,32.3% of $683.66 in Billed Charges for Rev 272 = $220.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRILL BIT 5/64 NON-STERILE,272,RC,,,,,,,,both,,,683.6600,102.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,209.88,,,,,,,176.4500,683.6600,other,30.7% of $683.66 in Billed Charges for Rev 272 = $209.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRILL BIT 5/64 NON-STERILE,272,RC,,,,,,,,both,,,683.6600,102.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,220.82,,,,,,,176.4500,683.6600,percent of total billed charges,32.3% of $683.66 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 5/64 NON-STERILE,272,RC,,,,,,,,both,,,683.6600,102.5500,WELLCARE,WELLCARE MEDICAID,683.66,,,,,,,176.4500,683.6600,percent of total billed charges,100% of $683.66 in Billed Charges for Rev 272 = $683.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 702611 702611,272,RC,,,,,,,,both,,,2723.2200,408.4800,AETNA,AETNA,1162.81,,,,,,,702.8600,2723.2200,percent of total billed charges,"42.7% of $2,723.22 in Billed Charges for Rev 272 = $1,162.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702611 702611,272,RC,,,,,,,,both,,,2723.2200,408.4800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1906.25,,,,,,,702.8600,2723.2200,percent of total billed charges,"Rev 272 $2,723.22 in Billed Charges at 70% = $1,906.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702611 702611,272,RC,,,,,,,,both,,,2723.2200,408.4800,CIGNA HEALTHCARE,CIGNA HMO,1135.58,,,,,,,702.8600,2723.2200,percent of total billed charges,"41.7% of $2,723.22 in Billed Charges for Rev 272 = $1,135.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702611 702611,272,RC,,,,,,,,both,,,2723.2200,408.4800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1263.57,,,,,,,702.8600,2723.2200,percent of total billed charges,"46.4% of $2,723.22 in Billed Charges for Rev 272 = $1,263.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702611 702611,272,RC,,,,,,,,both,,,2723.2200,408.4800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1135.58,,,,,,,702.8600,2723.2200,percent of total billed charges,"41.7% of $2,723.22 in Billed Charges for Rev 272 = $1,135.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702611 702611,272,RC,,,,,,,,both,,,2723.2200,408.4800,CIGNA HEALTHCARE,CIGNA PPO,1135.58,,,,,,,702.8600,2723.2200,percent of total billed charges,"41.7% of $2,723.22 in Billed Charges for Rev 272 = $1,135.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702611 702611,272,RC,,,,,,,,both,,,2723.2200,408.4800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2450.90,,,,,,,702.8600,2723.2200,percent of total billed charges,"90% of $2,723.22 in Billed Charges for Rev 272 = $2,450.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702611 702611,272,RC,,,,,,,,both,,,2723.2200,408.4800,MEDCOST,MEDCOST VHN,1295.98,,,,,,,702.8600,2723.2200,percent of total billed charges,"47.59% of $2,723.22 in Billed Charges for Rev 272 = $1,295.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702611 702611,272,RC,,,,,,,,both,,,2723.2200,408.4800,SENTARA HEALTH,SENTARA HEALTH,702.86,,,,,,,702.8600,2723.2200,percent of total billed charges,"25.81% of $2,723.22 in Billed Charges for Rev 272 = $702.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702611 702611,272,RC,,,,,,,,both,,,2723.2200,408.4800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2723.22,,,,,,,702.8600,2723.2200,percent of total billed charges,"100% of $2,723.22 in Billed Charges for Rev 272 = $2,723.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702611 702611,272,RC,,,,,,,,both,,,2723.2200,408.4800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1361.61,,,,,,,702.8600,2723.2200,percent of total billed charges,"Rev 272 $2,723.22 in Billed Charges at 50% = $1,361.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702611 702611,272,RC,,,,,,,,both,,,2723.2200,408.4800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,879.60,,,,,,,702.8600,2723.2200,other,"32.3% of $2,723.22 in Billed Charges for Rev 272 = $879.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 702611 702611,272,RC,,,,,,,,both,,,2723.2200,408.4800,UNITED HEALTHCARE,UHC HERITAGE SELECT,836.03,,,,,,,702.8600,2723.2200,other,"30.7% of $2,723.22 in Billed Charges for Rev 272 = $836.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 702611 702611,272,RC,,,,,,,,both,,,2723.2200,408.4800,UNITED HEALTHCARE,UNITED HEALTHCARE,879.60,,,,,,,702.8600,2723.2200,percent of total billed charges,"32.3% of $2,723.22 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702611 702611,272,RC,,,,,,,,both,,,2723.2200,408.4800,WELLCARE,WELLCARE MEDICAID,2723.22,,,,,,,702.8600,2723.2200,percent of total billed charges,"100% of $2,723.22 in Billed Charges for Rev 272 = $2,723.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7080510,272,RC,27200002,CDM,,,,,,both,,,1039.1700,155.8800,AETNA,AETNA,443.73,,,,,,,268.2100,1039.1700,percent of total billed charges,"42.7% of $1,039.17 in Billed Charges for Rev 272 = $443.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7080510,272,RC,27200002,CDM,,,,,,both,,,1039.1700,155.8800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,727.42,,,,,,,268.2100,1039.1700,percent of total billed charges,"Rev 272 $1,039.17 in Billed Charges at 70% = $727.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7080510,272,RC,27200002,CDM,,,,,,both,,,1039.1700,155.8800,CIGNA HEALTHCARE,CIGNA HMO,433.33,,,,,,,268.2100,1039.1700,percent of total billed charges,"41.7% of $1,039.17 in Billed Charges for Rev 272 = $433.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7080510,272,RC,27200002,CDM,,,,,,both,,,1039.1700,155.8800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,482.17,,,,,,,268.2100,1039.1700,percent of total billed charges,"46.4% of $1,039.17 in Billed Charges for Rev 272 = $482.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7080510,272,RC,27200002,CDM,,,,,,both,,,1039.1700,155.8800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,433.33,,,,,,,268.2100,1039.1700,percent of total billed charges,"41.7% of $1,039.17 in Billed Charges for Rev 272 = $433.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7080510,272,RC,27200002,CDM,,,,,,both,,,1039.1700,155.8800,CIGNA HEALTHCARE,CIGNA PPO,433.33,,,,,,,268.2100,1039.1700,percent of total billed charges,"41.7% of $1,039.17 in Billed Charges for Rev 272 = $433.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7080510,272,RC,27200002,CDM,,,,,,both,,,1039.1700,155.8800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,935.25,,,,,,,268.2100,1039.1700,percent of total billed charges,"90% of $1,039.17 in Billed Charges for Rev 272 = $935.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7080510,272,RC,27200002,CDM,,,,,,both,,,1039.1700,155.8800,MEDCOST,MEDCOST VHN,494.54,,,,,,,268.2100,1039.1700,percent of total billed charges,"47.59% of $1,039.17 in Billed Charges for Rev 272 = $494.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7080510,272,RC,27200002,CDM,,,,,,both,,,1039.1700,155.8800,SENTARA HEALTH,SENTARA HEALTH,268.21,,,,,,,268.2100,1039.1700,percent of total billed charges,"25.81% of $1,039.17 in Billed Charges for Rev 272 = $268.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7080510,272,RC,27200002,CDM,,,,,,both,,,1039.1700,155.8800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1039.17,,,,,,,268.2100,1039.1700,percent of total billed charges,"100% of $1,039.17 in Billed Charges for Rev 272 = $1,039.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7080510,272,RC,27200002,CDM,,,,,,both,,,1039.1700,155.8800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,519.59,,,,,,,268.2100,1039.1700,percent of total billed charges,"Rev 272 $1,039.17 in Billed Charges at 50% = $519.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7080510,272,RC,27200002,CDM,,,,,,both,,,1039.1700,155.8800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,335.65,,,,,,,268.2100,1039.1700,other,"32.3% of $1,039.17 in Billed Charges for Rev 272 = $335.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 7080510,272,RC,27200002,CDM,,,,,,both,,,1039.1700,155.8800,UNITED HEALTHCARE,UHC HERITAGE SELECT,319.03,,,,,,,268.2100,1039.1700,other,"30.7% of $1,039.17 in Billed Charges for Rev 272 = $319.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 7080510,272,RC,27200002,CDM,,,,,,both,,,1039.1700,155.8800,UNITED HEALTHCARE,UNITED HEALTHCARE,335.65,,,,,,,268.2100,1039.1700,percent of total billed charges,"32.3% of $1,039.17 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7080510,272,RC,27200002,CDM,,,,,,both,,,1039.1700,155.8800,WELLCARE,WELLCARE MEDICAID,1039.17,,,,,,,268.2100,1039.1700,percent of total billed charges,"100% of $1,039.17 in Billed Charges for Rev 272 = $1,039.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW NARROW,272,RC,,,,,,,,both,,,1680.1000,252.0200,AETNA,AETNA,717.40,,,,,,,433.6300,1680.1000,percent of total billed charges,"42.7% of $1,680.10 in Billed Charges for Rev 272 = $717.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW NARROW,272,RC,,,,,,,,both,,,1680.1000,252.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1176.07,,,,,,,433.6300,1680.1000,percent of total billed charges,"Rev 272 $1,680.10 in Billed Charges at 70% = $1,176.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW NARROW,272,RC,,,,,,,,both,,,1680.1000,252.0200,CIGNA HEALTHCARE,CIGNA HMO,700.60,,,,,,,433.6300,1680.1000,percent of total billed charges,"41.7% of $1,680.10 in Billed Charges for Rev 272 = $700.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW NARROW,272,RC,,,,,,,,both,,,1680.1000,252.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,779.57,,,,,,,433.6300,1680.1000,percent of total billed charges,"46.4% of $1,680.10 in Billed Charges for Rev 272 = $779.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW NARROW,272,RC,,,,,,,,both,,,1680.1000,252.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,700.60,,,,,,,433.6300,1680.1000,percent of total billed charges,"41.7% of $1,680.10 in Billed Charges for Rev 272 = $700.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW NARROW,272,RC,,,,,,,,both,,,1680.1000,252.0200,CIGNA HEALTHCARE,CIGNA PPO,700.60,,,,,,,433.6300,1680.1000,percent of total billed charges,"41.7% of $1,680.10 in Billed Charges for Rev 272 = $700.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW NARROW,272,RC,,,,,,,,both,,,1680.1000,252.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1512.09,,,,,,,433.6300,1680.1000,percent of total billed charges,"90% of $1,680.10 in Billed Charges for Rev 272 = $1,512.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW NARROW,272,RC,,,,,,,,both,,,1680.1000,252.0200,MEDCOST,MEDCOST VHN,799.56,,,,,,,433.6300,1680.1000,percent of total billed charges,"47.59% of $1,680.10 in Billed Charges for Rev 272 = $799.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW NARROW,272,RC,,,,,,,,both,,,1680.1000,252.0200,SENTARA HEALTH,SENTARA HEALTH,433.63,,,,,,,433.6300,1680.1000,percent of total billed charges,"25.81% of $1,680.10 in Billed Charges for Rev 272 = $433.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW NARROW,272,RC,,,,,,,,both,,,1680.1000,252.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1680.10,,,,,,,433.6300,1680.1000,percent of total billed charges,"100% of $1,680.10 in Billed Charges for Rev 272 = $1,680.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW NARROW,272,RC,,,,,,,,both,,,1680.1000,252.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,840.05,,,,,,,433.6300,1680.1000,percent of total billed charges,"Rev 272 $1,680.10 in Billed Charges at 50% = $840.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW NARROW,272,RC,,,,,,,,both,,,1680.1000,252.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,542.67,,,,,,,433.6300,1680.1000,other,"32.3% of $1,680.10 in Billed Charges for Rev 272 = $542.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SAW NARROW,272,RC,,,,,,,,both,,,1680.1000,252.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,515.79,,,,,,,433.6300,1680.1000,other,"30.7% of $1,680.10 in Billed Charges for Rev 272 = $515.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SAW NARROW,272,RC,,,,,,,,both,,,1680.1000,252.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,542.67,,,,,,,433.6300,1680.1000,percent of total billed charges,"32.3% of $1,680.10 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW NARROW,272,RC,,,,,,,,both,,,1680.1000,252.0200,WELLCARE,WELLCARE MEDICAID,1680.10,,,,,,,433.6300,1680.1000,percent of total billed charges,"100% of $1,680.10 in Billed Charges for Rev 272 = $1,680.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SAW SAG 18MMX90MM 1.27MM,272,RC,27200002,CDM,,,,,,both,,,541.3700,81.2100,AETNA,AETNA,231.17,,,,,,,139.7300,541.3700,percent of total billed charges,42.7% of $541.37 in Billed Charges for Rev 272 = $231.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW SAG 18MMX90MM 1.27MM,272,RC,27200002,CDM,,,,,,both,,,541.3700,81.2100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,378.96,,,,,,,139.7300,541.3700,percent of total billed charges,Rev 272 $541.37 in Billed Charges at 70% = $378.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW SAG 18MMX90MM 1.27MM,272,RC,27200002,CDM,,,,,,both,,,541.3700,81.2100,CIGNA HEALTHCARE,CIGNA HMO,225.75,,,,,,,139.7300,541.3700,percent of total billed charges,41.7% of $541.37 in Billed Charges for Rev 272 = $225.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW SAG 18MMX90MM 1.27MM,272,RC,27200002,CDM,,,,,,both,,,541.3700,81.2100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,251.20,,,,,,,139.7300,541.3700,percent of total billed charges,46.4% of $541.37 in Billed Charges for Rev 272 = $251.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW SAG 18MMX90MM 1.27MM,272,RC,27200002,CDM,,,,,,both,,,541.3700,81.2100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,225.75,,,,,,,139.7300,541.3700,percent of total billed charges,41.7% of $541.37 in Billed Charges for Rev 272 = $225.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW SAG 18MMX90MM 1.27MM,272,RC,27200002,CDM,,,,,,both,,,541.3700,81.2100,CIGNA HEALTHCARE,CIGNA PPO,225.75,,,,,,,139.7300,541.3700,percent of total billed charges,41.7% of $541.37 in Billed Charges for Rev 272 = $225.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW SAG 18MMX90MM 1.27MM,272,RC,27200002,CDM,,,,,,both,,,541.3700,81.2100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,487.23,,,,,,,139.7300,541.3700,percent of total billed charges,90% of $541.37 in Billed Charges for Rev 272 = $487.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW SAG 18MMX90MM 1.27MM,272,RC,27200002,CDM,,,,,,both,,,541.3700,81.2100,MEDCOST,MEDCOST VHN,257.64,,,,,,,139.7300,541.3700,percent of total billed charges,47.59% of $541.37 in Billed Charges for Rev 272 = $257.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW SAG 18MMX90MM 1.27MM,272,RC,27200002,CDM,,,,,,both,,,541.3700,81.2100,SENTARA HEALTH,SENTARA HEALTH,139.73,,,,,,,139.7300,541.3700,percent of total billed charges,25.81% of $541.37 in Billed Charges for Rev 272 = $139.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW SAG 18MMX90MM 1.27MM,272,RC,27200002,CDM,,,,,,both,,,541.3700,81.2100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",541.37,,,,,,,139.7300,541.3700,percent of total billed charges,100% of $541.37 in Billed Charges for Rev 272 = $541.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW SAG 18MMX90MM 1.27MM,272,RC,27200002,CDM,,,,,,both,,,541.3700,81.2100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,270.69,,,,,,,139.7300,541.3700,percent of total billed charges,Rev 272 $541.37 in Billed Charges at 50% = $270.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW SAG 18MMX90MM 1.27MM,272,RC,27200002,CDM,,,,,,both,,,541.3700,81.2100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,174.86,,,,,,,139.7300,541.3700,other,32.3% of $541.37 in Billed Charges for Rev 272 = $174.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE SAW SAG 18MMX90MM 1.27MM,272,RC,27200002,CDM,,,,,,both,,,541.3700,81.2100,UNITED HEALTHCARE,UHC HERITAGE SELECT,166.20,,,,,,,139.7300,541.3700,other,30.7% of $541.37 in Billed Charges for Rev 272 = $166.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BLADE SAW SAG 18MMX90MM 1.27MM,272,RC,27200002,CDM,,,,,,both,,,541.3700,81.2100,UNITED HEALTHCARE,UNITED HEALTHCARE,174.86,,,,,,,139.7300,541.3700,percent of total billed charges,32.3% of $541.37 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BLADE SAW SAG 18MMX90MM 1.27MM,272,RC,27200002,CDM,,,,,,both,,,541.3700,81.2100,WELLCARE,WELLCARE MEDICAID,541.37,,,,,,,139.7300,541.3700,percent of total billed charges,100% of $541.37 in Billed Charges for Rev 272 = $541.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT CARBIDE 309.006S,272,RC,,,,,,,,both,,,2837.5100,425.6300,AETNA,AETNA,1211.62,,,,,,,732.3600,2837.5100,percent of total billed charges,"42.7% of $2,837.51 in Billed Charges for Rev 272 = $1,211.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CARBIDE 309.006S,272,RC,,,,,,,,both,,,2837.5100,425.6300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1986.26,,,,,,,732.3600,2837.5100,percent of total billed charges,"Rev 272 $2,837.51 in Billed Charges at 70% = $1,986.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CARBIDE 309.006S,272,RC,,,,,,,,both,,,2837.5100,425.6300,CIGNA HEALTHCARE,CIGNA HMO,1183.24,,,,,,,732.3600,2837.5100,percent of total billed charges,"41.7% of $2,837.51 in Billed Charges for Rev 272 = $1,183.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CARBIDE 309.006S,272,RC,,,,,,,,both,,,2837.5100,425.6300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1316.60,,,,,,,732.3600,2837.5100,percent of total billed charges,"46.4% of $2,837.51 in Billed Charges for Rev 272 = $1,316.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CARBIDE 309.006S,272,RC,,,,,,,,both,,,2837.5100,425.6300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1183.24,,,,,,,732.3600,2837.5100,percent of total billed charges,"41.7% of $2,837.51 in Billed Charges for Rev 272 = $1,183.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CARBIDE 309.006S,272,RC,,,,,,,,both,,,2837.5100,425.6300,CIGNA HEALTHCARE,CIGNA PPO,1183.24,,,,,,,732.3600,2837.5100,percent of total billed charges,"41.7% of $2,837.51 in Billed Charges for Rev 272 = $1,183.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CARBIDE 309.006S,272,RC,,,,,,,,both,,,2837.5100,425.6300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2553.76,,,,,,,732.3600,2837.5100,percent of total billed charges,"90% of $2,837.51 in Billed Charges for Rev 272 = $2,553.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CARBIDE 309.006S,272,RC,,,,,,,,both,,,2837.5100,425.6300,MEDCOST,MEDCOST VHN,1350.37,,,,,,,732.3600,2837.5100,percent of total billed charges,"47.59% of $2,837.51 in Billed Charges for Rev 272 = $1,350.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CARBIDE 309.006S,272,RC,,,,,,,,both,,,2837.5100,425.6300,SENTARA HEALTH,SENTARA HEALTH,732.36,,,,,,,732.3600,2837.5100,percent of total billed charges,"25.81% of $2,837.51 in Billed Charges for Rev 272 = $732.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CARBIDE 309.006S,272,RC,,,,,,,,both,,,2837.5100,425.6300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2837.51,,,,,,,732.3600,2837.5100,percent of total billed charges,"100% of $2,837.51 in Billed Charges for Rev 272 = $2,837.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CARBIDE 309.006S,272,RC,,,,,,,,both,,,2837.5100,425.6300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1418.76,,,,,,,732.3600,2837.5100,percent of total billed charges,"Rev 272 $2,837.51 in Billed Charges at 50% = $1,418.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CARBIDE 309.006S,272,RC,,,,,,,,both,,,2837.5100,425.6300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,916.52,,,,,,,732.3600,2837.5100,other,"32.3% of $2,837.51 in Billed Charges for Rev 272 = $916.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT CARBIDE 309.006S,272,RC,,,,,,,,both,,,2837.5100,425.6300,UNITED HEALTHCARE,UHC HERITAGE SELECT,871.12,,,,,,,732.3600,2837.5100,other,"30.7% of $2,837.51 in Billed Charges for Rev 272 = $871.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT CARBIDE 309.006S,272,RC,,,,,,,,both,,,2837.5100,425.6300,UNITED HEALTHCARE,UNITED HEALTHCARE,916.52,,,,,,,732.3600,2837.5100,percent of total billed charges,"32.3% of $2,837.51 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CARBIDE 309.006S,272,RC,,,,,,,,both,,,2837.5100,425.6300,WELLCARE,WELLCARE MEDICAID,2837.51,,,,,,,732.3600,2837.5100,percent of total billed charges,"100% of $2,837.51 in Billed Charges for Rev 272 = $2,837.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXABLE,272,RC,,,,,,,,both,,,4174.3300,626.1500,AETNA,AETNA,1782.44,,,,,,,1077.3900,4174.3300,percent of total billed charges,"42.7% of $4,174.33 in Billed Charges for Rev 272 = $1,782.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXABLE,272,RC,,,,,,,,both,,,4174.3300,626.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2922.03,,,,,,,1077.3900,4174.3300,percent of total billed charges,"Rev 272 $4,174.33 in Billed Charges at 70% = $2,922.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXABLE,272,RC,,,,,,,,both,,,4174.3300,626.1500,CIGNA HEALTHCARE,CIGNA HMO,1740.70,,,,,,,1077.3900,4174.3300,percent of total billed charges,"41.7% of $4,174.33 in Billed Charges for Rev 272 = $1,740.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXABLE,272,RC,,,,,,,,both,,,4174.3300,626.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1936.89,,,,,,,1077.3900,4174.3300,percent of total billed charges,"46.4% of $4,174.33 in Billed Charges for Rev 272 = $1,936.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXABLE,272,RC,,,,,,,,both,,,4174.3300,626.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1740.70,,,,,,,1077.3900,4174.3300,percent of total billed charges,"41.7% of $4,174.33 in Billed Charges for Rev 272 = $1,740.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXABLE,272,RC,,,,,,,,both,,,4174.3300,626.1500,CIGNA HEALTHCARE,CIGNA PPO,1740.70,,,,,,,1077.3900,4174.3300,percent of total billed charges,"41.7% of $4,174.33 in Billed Charges for Rev 272 = $1,740.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXABLE,272,RC,,,,,,,,both,,,4174.3300,626.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3756.90,,,,,,,1077.3900,4174.3300,percent of total billed charges,"90% of $4,174.33 in Billed Charges for Rev 272 = $3,756.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXABLE,272,RC,,,,,,,,both,,,4174.3300,626.1500,MEDCOST,MEDCOST VHN,1986.56,,,,,,,1077.3900,4174.3300,percent of total billed charges,"47.59% of $4,174.33 in Billed Charges for Rev 272 = $1,986.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXABLE,272,RC,,,,,,,,both,,,4174.3300,626.1500,SENTARA HEALTH,SENTARA HEALTH,1077.39,,,,,,,1077.3900,4174.3300,percent of total billed charges,"25.81% of $4,174.33 in Billed Charges for Rev 272 = $1,077.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXABLE,272,RC,,,,,,,,both,,,4174.3300,626.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4174.33,,,,,,,1077.3900,4174.3300,percent of total billed charges,"100% of $4,174.33 in Billed Charges for Rev 272 = $4,174.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXABLE,272,RC,,,,,,,,both,,,4174.3300,626.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2087.17,,,,,,,1077.3900,4174.3300,percent of total billed charges,"Rev 272 $4,174.33 in Billed Charges at 50% = $2,087.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXABLE,272,RC,,,,,,,,both,,,4174.3300,626.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1348.31,,,,,,,1077.3900,4174.3300,other,"32.3% of $4,174.33 in Billed Charges for Rev 272 = $1,348.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT FLEXABLE,272,RC,,,,,,,,both,,,4174.3300,626.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1281.52,,,,,,,1077.3900,4174.3300,other,"30.7% of $4,174.33 in Billed Charges for Rev 272 = $1,281.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT FLEXABLE,272,RC,,,,,,,,both,,,4174.3300,626.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,1348.31,,,,,,,1077.3900,4174.3300,percent of total billed charges,"32.3% of $4,174.33 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXABLE,272,RC,,,,,,,,both,,,4174.3300,626.1500,WELLCARE,WELLCARE MEDICAID,4174.33,,,,,,,1077.3900,4174.3300,percent of total billed charges,"100% of $4,174.33 in Billed Charges for Rev 272 = $4,174.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 24FR,272,RC,27200002,CDM,,,,,,both,,,1282.4600,192.3700,AETNA,AETNA,547.61,,,,,,,331.0000,1282.4600,percent of total billed charges,"42.7% of $1,282.46 in Billed Charges for Rev 272 = $547.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 24FR,272,RC,27200002,CDM,,,,,,both,,,1282.4600,192.3700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,897.72,,,,,,,331.0000,1282.4600,percent of total billed charges,"Rev 272 $1,282.46 in Billed Charges at 70% = $897.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 24FR,272,RC,27200002,CDM,,,,,,both,,,1282.4600,192.3700,CIGNA HEALTHCARE,CIGNA HMO,534.79,,,,,,,331.0000,1282.4600,percent of total billed charges,"41.7% of $1,282.46 in Billed Charges for Rev 272 = $534.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 24FR,272,RC,27200002,CDM,,,,,,both,,,1282.4600,192.3700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,595.06,,,,,,,331.0000,1282.4600,percent of total billed charges,"46.4% of $1,282.46 in Billed Charges for Rev 272 = $595.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 24FR,272,RC,27200002,CDM,,,,,,both,,,1282.4600,192.3700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,534.79,,,,,,,331.0000,1282.4600,percent of total billed charges,"41.7% of $1,282.46 in Billed Charges for Rev 272 = $534.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 24FR,272,RC,27200002,CDM,,,,,,both,,,1282.4600,192.3700,CIGNA HEALTHCARE,CIGNA PPO,534.79,,,,,,,331.0000,1282.4600,percent of total billed charges,"41.7% of $1,282.46 in Billed Charges for Rev 272 = $534.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 24FR,272,RC,27200002,CDM,,,,,,both,,,1282.4600,192.3700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1154.21,,,,,,,331.0000,1282.4600,percent of total billed charges,"90% of $1,282.46 in Billed Charges for Rev 272 = $1,154.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 24FR,272,RC,27200002,CDM,,,,,,both,,,1282.4600,192.3700,MEDCOST,MEDCOST VHN,610.32,,,,,,,331.0000,1282.4600,percent of total billed charges,"47.59% of $1,282.46 in Billed Charges for Rev 272 = $610.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 24FR,272,RC,27200002,CDM,,,,,,both,,,1282.4600,192.3700,SENTARA HEALTH,SENTARA HEALTH,331.00,,,,,,,331.0000,1282.4600,percent of total billed charges,"25.81% of $1,282.46 in Billed Charges for Rev 272 = $331.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 24FR,272,RC,27200002,CDM,,,,,,both,,,1282.4600,192.3700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1282.46,,,,,,,331.0000,1282.4600,percent of total billed charges,"100% of $1,282.46 in Billed Charges for Rev 272 = $1,282.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 24FR,272,RC,27200002,CDM,,,,,,both,,,1282.4600,192.3700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,641.23,,,,,,,331.0000,1282.4600,percent of total billed charges,"Rev 272 $1,282.46 in Billed Charges at 50% = $641.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 24FR,272,RC,27200002,CDM,,,,,,both,,,1282.4600,192.3700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,414.23,,,,,,,331.0000,1282.4600,other,"32.3% of $1,282.46 in Billed Charges for Rev 272 = $414.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE LOOP HF-RESECT 24FR,272,RC,27200002,CDM,,,,,,both,,,1282.4600,192.3700,UNITED HEALTHCARE,UHC HERITAGE SELECT,393.72,,,,,,,331.0000,1282.4600,other,"30.7% of $1,282.46 in Billed Charges for Rev 272 = $393.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE LOOP HF-RESECT 24FR,272,RC,27200002,CDM,,,,,,both,,,1282.4600,192.3700,UNITED HEALTHCARE,UNITED HEALTHCARE,414.23,,,,,,,331.0000,1282.4600,percent of total billed charges,"32.3% of $1,282.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 24FR,272,RC,27200002,CDM,,,,,,both,,,1282.4600,192.3700,WELLCARE,WELLCARE MEDICAID,1282.46,,,,,,,331.0000,1282.4600,percent of total billed charges,"100% of $1,282.46 in Billed Charges for Rev 272 = $1,282.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREW GOLD 2.0/2.3 MM,272,RC,27200002,CDM,,,,,,both,,,1521.0100,228.1500,AETNA,AETNA,649.47,,,,,,,392.5700,1521.0100,percent of total billed charges,"42.7% of $1,521.01 in Billed Charges for Rev 272 = $649.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREW GOLD 2.0/2.3 MM,272,RC,27200002,CDM,,,,,,both,,,1521.0100,228.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1064.71,,,,,,,392.5700,1521.0100,percent of total billed charges,"Rev 272 $1,521.01 in Billed Charges at 70% = $1,064.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREW GOLD 2.0/2.3 MM,272,RC,27200002,CDM,,,,,,both,,,1521.0100,228.1500,CIGNA HEALTHCARE,CIGNA HMO,634.26,,,,,,,392.5700,1521.0100,percent of total billed charges,"41.7% of $1,521.01 in Billed Charges for Rev 272 = $634.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREW GOLD 2.0/2.3 MM,272,RC,27200002,CDM,,,,,,both,,,1521.0100,228.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,705.75,,,,,,,392.5700,1521.0100,percent of total billed charges,"46.4% of $1,521.01 in Billed Charges for Rev 272 = $705.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREW GOLD 2.0/2.3 MM,272,RC,27200002,CDM,,,,,,both,,,1521.0100,228.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,634.26,,,,,,,392.5700,1521.0100,percent of total billed charges,"41.7% of $1,521.01 in Billed Charges for Rev 272 = $634.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREW GOLD 2.0/2.3 MM,272,RC,27200002,CDM,,,,,,both,,,1521.0100,228.1500,CIGNA HEALTHCARE,CIGNA PPO,634.26,,,,,,,392.5700,1521.0100,percent of total billed charges,"41.7% of $1,521.01 in Billed Charges for Rev 272 = $634.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREW GOLD 2.0/2.3 MM,272,RC,27200002,CDM,,,,,,both,,,1521.0100,228.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1368.91,,,,,,,392.5700,1521.0100,percent of total billed charges,"90% of $1,521.01 in Billed Charges for Rev 272 = $1,368.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREW GOLD 2.0/2.3 MM,272,RC,27200002,CDM,,,,,,both,,,1521.0100,228.1500,MEDCOST,MEDCOST VHN,723.85,,,,,,,392.5700,1521.0100,percent of total billed charges,"47.59% of $1,521.01 in Billed Charges for Rev 272 = $723.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREW GOLD 2.0/2.3 MM,272,RC,27200002,CDM,,,,,,both,,,1521.0100,228.1500,SENTARA HEALTH,SENTARA HEALTH,392.57,,,,,,,392.5700,1521.0100,percent of total billed charges,"25.81% of $1,521.01 in Billed Charges for Rev 272 = $392.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREW GOLD 2.0/2.3 MM,272,RC,27200002,CDM,,,,,,both,,,1521.0100,228.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1521.01,,,,,,,392.5700,1521.0100,percent of total billed charges,"100% of $1,521.01 in Billed Charges for Rev 272 = $1,521.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREW GOLD 2.0/2.3 MM,272,RC,27200002,CDM,,,,,,both,,,1521.0100,228.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,760.51,,,,,,,392.5700,1521.0100,percent of total billed charges,"Rev 272 $1,521.01 in Billed Charges at 50% = $760.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREW GOLD 2.0/2.3 MM,272,RC,27200002,CDM,,,,,,both,,,1521.0100,228.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.29,,,,,,,392.5700,1521.0100,other,"32.3% of $1,521.01 in Billed Charges for Rev 272 = $491.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SCREW GOLD 2.0/2.3 MM,272,RC,27200002,CDM,,,,,,both,,,1521.0100,228.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,466.95,,,,,,,392.5700,1521.0100,other,"30.7% of $1,521.01 in Billed Charges for Rev 272 = $466.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SCREW GOLD 2.0/2.3 MM,272,RC,27200002,CDM,,,,,,both,,,1521.0100,228.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,491.29,,,,,,,392.5700,1521.0100,percent of total billed charges,"32.3% of $1,521.01 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREW GOLD 2.0/2.3 MM,272,RC,27200002,CDM,,,,,,both,,,1521.0100,228.1500,WELLCARE,WELLCARE MEDICAID,1521.01,,,,,,,392.5700,1521.0100,percent of total billed charges,"100% of $1,521.01 in Billed Charges for Rev 272 = $1,521.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER  2.0  313848,272,RC,,,,,,,,both,,,6462.7900,969.4200,AETNA,AETNA,2759.61,,,,,,,1668.0500,6462.7900,percent of total billed charges,"42.7% of $6,462.79 in Billed Charges for Rev 272 = $2,759.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER  2.0  313848,272,RC,,,,,,,,both,,,6462.7900,969.4200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4523.95,,,,,,,1668.0500,6462.7900,percent of total billed charges,"Rev 272 $6,462.79 in Billed Charges at 70% = $4,523.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER  2.0  313848,272,RC,,,,,,,,both,,,6462.7900,969.4200,CIGNA HEALTHCARE,CIGNA HMO,2694.98,,,,,,,1668.0500,6462.7900,percent of total billed charges,"41.7% of $6,462.79 in Billed Charges for Rev 272 = $2,694.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER  2.0  313848,272,RC,,,,,,,,both,,,6462.7900,969.4200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2998.73,,,,,,,1668.0500,6462.7900,percent of total billed charges,"46.4% of $6,462.79 in Billed Charges for Rev 272 = $2,998.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER  2.0  313848,272,RC,,,,,,,,both,,,6462.7900,969.4200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2694.98,,,,,,,1668.0500,6462.7900,percent of total billed charges,"41.7% of $6,462.79 in Billed Charges for Rev 272 = $2,694.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER  2.0  313848,272,RC,,,,,,,,both,,,6462.7900,969.4200,CIGNA HEALTHCARE,CIGNA PPO,2694.98,,,,,,,1668.0500,6462.7900,percent of total billed charges,"41.7% of $6,462.79 in Billed Charges for Rev 272 = $2,694.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER  2.0  313848,272,RC,,,,,,,,both,,,6462.7900,969.4200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5816.51,,,,,,,1668.0500,6462.7900,percent of total billed charges,"90% of $6,462.79 in Billed Charges for Rev 272 = $5,816.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER  2.0  313848,272,RC,,,,,,,,both,,,6462.7900,969.4200,MEDCOST,MEDCOST VHN,3075.64,,,,,,,1668.0500,6462.7900,percent of total billed charges,"47.59% of $6,462.79 in Billed Charges for Rev 272 = $3,075.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER  2.0  313848,272,RC,,,,,,,,both,,,6462.7900,969.4200,SENTARA HEALTH,SENTARA HEALTH,1668.05,,,,,,,1668.0500,6462.7900,percent of total billed charges,"25.81% of $6,462.79 in Billed Charges for Rev 272 = $1,668.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER  2.0  313848,272,RC,,,,,,,,both,,,6462.7900,969.4200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6462.79,,,,,,,1668.0500,6462.7900,percent of total billed charges,"100% of $6,462.79 in Billed Charges for Rev 272 = $6,462.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER  2.0  313848,272,RC,,,,,,,,both,,,6462.7900,969.4200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3231.40,,,,,,,1668.0500,6462.7900,percent of total billed charges,"Rev 272 $6,462.79 in Billed Charges at 50% = $3,231.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER  2.0  313848,272,RC,,,,,,,,both,,,6462.7900,969.4200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2087.48,,,,,,,1668.0500,6462.7900,other,"32.3% of $6,462.79 in Billed Charges for Rev 272 = $2,087.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SCREWDRIVER  2.0  313848,272,RC,,,,,,,,both,,,6462.7900,969.4200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1984.08,,,,,,,1668.0500,6462.7900,other,"30.7% of $6,462.79 in Billed Charges for Rev 272 = $1,984.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SCREWDRIVER  2.0  313848,272,RC,,,,,,,,both,,,6462.7900,969.4200,UNITED HEALTHCARE,UNITED HEALTHCARE,2087.48,,,,,,,1668.0500,6462.7900,percent of total billed charges,"32.3% of $6,462.79 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER  2.0  313848,272,RC,,,,,,,,both,,,6462.7900,969.4200,WELLCARE,WELLCARE MEDICAID,6462.79,,,,,,,1668.0500,6462.7900,percent of total billed charges,"100% of $6,462.79 in Billed Charges for Rev 272 = $6,462.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER MATRIX MIDFACE 03.503.202,272,RC,,,,,,,,both,,,7949.3700,1192.4100,AETNA,AETNA,3394.38,,,,,,,2051.7300,7949.3700,percent of total billed charges,"42.7% of $7,949.37 in Billed Charges for Rev 272 = $3,394.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER MATRIX MIDFACE 03.503.202,272,RC,,,,,,,,both,,,7949.3700,1192.4100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5564.56,,,,,,,2051.7300,7949.3700,percent of total billed charges,"Rev 272 $7,949.37 in Billed Charges at 70% = $5,564.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER MATRIX MIDFACE 03.503.202,272,RC,,,,,,,,both,,,7949.3700,1192.4100,CIGNA HEALTHCARE,CIGNA HMO,3314.89,,,,,,,2051.7300,7949.3700,percent of total billed charges,"41.7% of $7,949.37 in Billed Charges for Rev 272 = $3,314.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER MATRIX MIDFACE 03.503.202,272,RC,,,,,,,,both,,,7949.3700,1192.4100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3688.51,,,,,,,2051.7300,7949.3700,percent of total billed charges,"46.4% of $7,949.37 in Billed Charges for Rev 272 = $3,688.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER MATRIX MIDFACE 03.503.202,272,RC,,,,,,,,both,,,7949.3700,1192.4100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3314.89,,,,,,,2051.7300,7949.3700,percent of total billed charges,"41.7% of $7,949.37 in Billed Charges for Rev 272 = $3,314.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER MATRIX MIDFACE 03.503.202,272,RC,,,,,,,,both,,,7949.3700,1192.4100,CIGNA HEALTHCARE,CIGNA PPO,3314.89,,,,,,,2051.7300,7949.3700,percent of total billed charges,"41.7% of $7,949.37 in Billed Charges for Rev 272 = $3,314.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER MATRIX MIDFACE 03.503.202,272,RC,,,,,,,,both,,,7949.3700,1192.4100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7154.43,,,,,,,2051.7300,7949.3700,percent of total billed charges,"90% of $7,949.37 in Billed Charges for Rev 272 = $7,154.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER MATRIX MIDFACE 03.503.202,272,RC,,,,,,,,both,,,7949.3700,1192.4100,MEDCOST,MEDCOST VHN,3783.11,,,,,,,2051.7300,7949.3700,percent of total billed charges,"47.59% of $7,949.37 in Billed Charges for Rev 272 = $3,783.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER MATRIX MIDFACE 03.503.202,272,RC,,,,,,,,both,,,7949.3700,1192.4100,SENTARA HEALTH,SENTARA HEALTH,2051.73,,,,,,,2051.7300,7949.3700,percent of total billed charges,"25.81% of $7,949.37 in Billed Charges for Rev 272 = $2,051.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER MATRIX MIDFACE 03.503.202,272,RC,,,,,,,,both,,,7949.3700,1192.4100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7949.37,,,,,,,2051.7300,7949.3700,percent of total billed charges,"100% of $7,949.37 in Billed Charges for Rev 272 = $7,949.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER MATRIX MIDFACE 03.503.202,272,RC,,,,,,,,both,,,7949.3700,1192.4100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3974.69,,,,,,,2051.7300,7949.3700,percent of total billed charges,"Rev 272 $7,949.37 in Billed Charges at 50% = $3,974.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER MATRIX MIDFACE 03.503.202,272,RC,,,,,,,,both,,,7949.3700,1192.4100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2567.65,,,,,,,2051.7300,7949.3700,other,"32.3% of $7,949.37 in Billed Charges for Rev 272 = $2,567.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SCREWDRIVER MATRIX MIDFACE 03.503.202,272,RC,,,,,,,,both,,,7949.3700,1192.4100,UNITED HEALTHCARE,UHC HERITAGE SELECT,2440.46,,,,,,,2051.7300,7949.3700,other,"30.7% of $7,949.37 in Billed Charges for Rev 272 = $2,440.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BLADE SCREWDRIVER MATRIX MIDFACE 03.503.202,272,RC,,,,,,,,both,,,7949.3700,1192.4100,UNITED HEALTHCARE,UNITED HEALTHCARE,2567.65,,,,,,,2051.7300,7949.3700,percent of total billed charges,"32.3% of $7,949.37 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BLADE SCREWDRIVER MATRIX MIDFACE 03.503.202,272,RC,,,,,,,,both,,,7949.3700,1192.4100,WELLCARE,WELLCARE MEDICAID,7949.37,,,,,,,2051.7300,7949.3700,percent of total billed charges,"100% of $7,949.37 in Billed Charges for Rev 272 = $7,949.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABAND 12DEG WA22721S,272,RC,,,,,,,,both,,,4658.3000,698.7500,AETNA,AETNA,1989.09,,,,,,,1202.3100,4658.3000,percent of total billed charges,"42.7% of $4,658.30 in Billed Charges for Rev 272 = $1,989.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABAND 12DEG WA22721S,272,RC,,,,,,,,both,,,4658.3000,698.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3260.81,,,,,,,1202.3100,4658.3000,percent of total billed charges,"Rev 272 $4,658.30 in Billed Charges at 70% = $3,260.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABAND 12DEG WA22721S,272,RC,,,,,,,,both,,,4658.3000,698.7500,CIGNA HEALTHCARE,CIGNA HMO,1942.51,,,,,,,1202.3100,4658.3000,percent of total billed charges,"41.7% of $4,658.30 in Billed Charges for Rev 272 = $1,942.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABAND 12DEG WA22721S,272,RC,,,,,,,,both,,,4658.3000,698.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2161.45,,,,,,,1202.3100,4658.3000,percent of total billed charges,"46.4% of $4,658.30 in Billed Charges for Rev 272 = $2,161.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABAND 12DEG WA22721S,272,RC,,,,,,,,both,,,4658.3000,698.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1942.51,,,,,,,1202.3100,4658.3000,percent of total billed charges,"41.7% of $4,658.30 in Billed Charges for Rev 272 = $1,942.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABAND 12DEG WA22721S,272,RC,,,,,,,,both,,,4658.3000,698.7500,CIGNA HEALTHCARE,CIGNA PPO,1942.51,,,,,,,1202.3100,4658.3000,percent of total billed charges,"41.7% of $4,658.30 in Billed Charges for Rev 272 = $1,942.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABAND 12DEG WA22721S,272,RC,,,,,,,,both,,,4658.3000,698.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4192.47,,,,,,,1202.3100,4658.3000,percent of total billed charges,"90% of $4,658.30 in Billed Charges for Rev 272 = $4,192.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABAND 12DEG WA22721S,272,RC,,,,,,,,both,,,4658.3000,698.7500,MEDCOST,MEDCOST VHN,2216.89,,,,,,,1202.3100,4658.3000,percent of total billed charges,"47.59% of $4,658.30 in Billed Charges for Rev 272 = $2,216.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABAND 12DEG WA22721S,272,RC,,,,,,,,both,,,4658.3000,698.7500,SENTARA HEALTH,SENTARA HEALTH,1202.31,,,,,,,1202.3100,4658.3000,percent of total billed charges,"25.81% of $4,658.30 in Billed Charges for Rev 272 = $1,202.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABAND 12DEG WA22721S,272,RC,,,,,,,,both,,,4658.3000,698.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4658.30,,,,,,,1202.3100,4658.3000,percent of total billed charges,"100% of $4,658.30 in Billed Charges for Rev 272 = $4,658.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABAND 12DEG WA22721S,272,RC,,,,,,,,both,,,4658.3000,698.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2329.15,,,,,,,1202.3100,4658.3000,percent of total billed charges,"Rev 272 $4,658.30 in Billed Charges at 50% = $2,329.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABAND 12DEG WA22721S,272,RC,,,,,,,,both,,,4658.3000,698.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1504.63,,,,,,,1202.3100,4658.3000,other,"32.3% of $4,658.30 in Billed Charges for Rev 272 = $1,504.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE PLASMABAND 12DEG WA22721S,272,RC,,,,,,,,both,,,4658.3000,698.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1430.10,,,,,,,1202.3100,4658.3000,other,"30.7% of $4,658.30 in Billed Charges for Rev 272 = $1,430.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE PLASMABAND 12DEG WA22721S,272,RC,,,,,,,,both,,,4658.3000,698.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,1504.63,,,,,,,1202.3100,4658.3000,percent of total billed charges,"32.3% of $4,658.30 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABAND 12DEG WA22721S,272,RC,,,,,,,,both,,,4658.3000,698.7500,WELLCARE,WELLCARE MEDICAID,4658.30,,,,,,,1202.3100,4658.3000,percent of total billed charges,"100% of $4,658.30 in Billed Charges for Rev 272 = $4,658.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABUTTON WA22760S,272,RC,27200002,CDM,,,,,,both,,,4871.2600,730.6900,AETNA,AETNA,2080.03,,,,,,,1257.2700,4871.2600,percent of total billed charges,"42.7% of $4,871.26 in Billed Charges for Rev 272 = $2,080.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABUTTON WA22760S,272,RC,27200002,CDM,,,,,,both,,,4871.2600,730.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3409.88,,,,,,,1257.2700,4871.2600,percent of total billed charges,"Rev 272 $4,871.26 in Billed Charges at 70% = $3,409.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABUTTON WA22760S,272,RC,27200002,CDM,,,,,,both,,,4871.2600,730.6900,CIGNA HEALTHCARE,CIGNA HMO,2031.32,,,,,,,1257.2700,4871.2600,percent of total billed charges,"41.7% of $4,871.26 in Billed Charges for Rev 272 = $2,031.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABUTTON WA22760S,272,RC,27200002,CDM,,,,,,both,,,4871.2600,730.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2260.26,,,,,,,1257.2700,4871.2600,percent of total billed charges,"46.4% of $4,871.26 in Billed Charges for Rev 272 = $2,260.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABUTTON WA22760S,272,RC,27200002,CDM,,,,,,both,,,4871.2600,730.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2031.32,,,,,,,1257.2700,4871.2600,percent of total billed charges,"41.7% of $4,871.26 in Billed Charges for Rev 272 = $2,031.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABUTTON WA22760S,272,RC,27200002,CDM,,,,,,both,,,4871.2600,730.6900,CIGNA HEALTHCARE,CIGNA PPO,2031.32,,,,,,,1257.2700,4871.2600,percent of total billed charges,"41.7% of $4,871.26 in Billed Charges for Rev 272 = $2,031.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABUTTON WA22760S,272,RC,27200002,CDM,,,,,,both,,,4871.2600,730.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4384.13,,,,,,,1257.2700,4871.2600,percent of total billed charges,"90% of $4,871.26 in Billed Charges for Rev 272 = $4,384.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABUTTON WA22760S,272,RC,27200002,CDM,,,,,,both,,,4871.2600,730.6900,MEDCOST,MEDCOST VHN,2318.23,,,,,,,1257.2700,4871.2600,percent of total billed charges,"47.59% of $4,871.26 in Billed Charges for Rev 272 = $2,318.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABUTTON WA22760S,272,RC,27200002,CDM,,,,,,both,,,4871.2600,730.6900,SENTARA HEALTH,SENTARA HEALTH,1257.27,,,,,,,1257.2700,4871.2600,percent of total billed charges,"25.81% of $4,871.26 in Billed Charges for Rev 272 = $1,257.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABUTTON WA22760S,272,RC,27200002,CDM,,,,,,both,,,4871.2600,730.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4871.26,,,,,,,1257.2700,4871.2600,percent of total billed charges,"100% of $4,871.26 in Billed Charges for Rev 272 = $4,871.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABUTTON WA22760S,272,RC,27200002,CDM,,,,,,both,,,4871.2600,730.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2435.63,,,,,,,1257.2700,4871.2600,percent of total billed charges,"Rev 272 $4,871.26 in Billed Charges at 50% = $2,435.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABUTTON WA22760S,272,RC,27200002,CDM,,,,,,both,,,4871.2600,730.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1573.42,,,,,,,1257.2700,4871.2600,other,"32.3% of $4,871.26 in Billed Charges for Rev 272 = $1,573.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE PLASMABUTTON WA22760S,272,RC,27200002,CDM,,,,,,both,,,4871.2600,730.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1495.48,,,,,,,1257.2700,4871.2600,other,"30.7% of $4,871.26 in Billed Charges for Rev 272 = $1,495.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE PLASMABUTTON WA22760S,272,RC,27200002,CDM,,,,,,both,,,4871.2600,730.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,1573.42,,,,,,,1257.2700,4871.2600,percent of total billed charges,"32.3% of $4,871.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMABUTTON WA22760S,272,RC,27200002,CDM,,,,,,both,,,4871.2600,730.6900,WELLCARE,WELLCARE MEDICAID,4871.26,,,,,,,1257.2700,4871.2600,percent of total billed charges,"100% of $4,871.26 in Billed Charges for Rev 272 = $4,871.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 1.0MM FIND ROUND DIAMOND,272,RC,,,,,,,,both,,,1391.2700,208.6900,AETNA,AETNA,594.07,,,,,,,359.0900,1391.2700,percent of total billed charges,"42.7% of $1,391.27 in Billed Charges for Rev 272 = $594.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 1.0MM FIND ROUND DIAMOND,272,RC,,,,,,,,both,,,1391.2700,208.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,973.89,,,,,,,359.0900,1391.2700,percent of total billed charges,"Rev 272 $1,391.27 in Billed Charges at 70% = $973.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 1.0MM FIND ROUND DIAMOND,272,RC,,,,,,,,both,,,1391.2700,208.6900,CIGNA HEALTHCARE,CIGNA HMO,580.16,,,,,,,359.0900,1391.2700,percent of total billed charges,"41.7% of $1,391.27 in Billed Charges for Rev 272 = $580.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 1.0MM FIND ROUND DIAMOND,272,RC,,,,,,,,both,,,1391.2700,208.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,645.55,,,,,,,359.0900,1391.2700,percent of total billed charges,"46.4% of $1,391.27 in Billed Charges for Rev 272 = $645.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 1.0MM FIND ROUND DIAMOND,272,RC,,,,,,,,both,,,1391.2700,208.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,580.16,,,,,,,359.0900,1391.2700,percent of total billed charges,"41.7% of $1,391.27 in Billed Charges for Rev 272 = $580.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 1.0MM FIND ROUND DIAMOND,272,RC,,,,,,,,both,,,1391.2700,208.6900,CIGNA HEALTHCARE,CIGNA PPO,580.16,,,,,,,359.0900,1391.2700,percent of total billed charges,"41.7% of $1,391.27 in Billed Charges for Rev 272 = $580.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 1.0MM FIND ROUND DIAMOND,272,RC,,,,,,,,both,,,1391.2700,208.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1252.14,,,,,,,359.0900,1391.2700,percent of total billed charges,"90% of $1,391.27 in Billed Charges for Rev 272 = $1,252.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 1.0MM FIND ROUND DIAMOND,272,RC,,,,,,,,both,,,1391.2700,208.6900,MEDCOST,MEDCOST VHN,662.11,,,,,,,359.0900,1391.2700,percent of total billed charges,"47.59% of $1,391.27 in Billed Charges for Rev 272 = $662.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 1.0MM FIND ROUND DIAMOND,272,RC,,,,,,,,both,,,1391.2700,208.6900,SENTARA HEALTH,SENTARA HEALTH,359.09,,,,,,,359.0900,1391.2700,percent of total billed charges,"25.81% of $1,391.27 in Billed Charges for Rev 272 = $359.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 1.0MM FIND ROUND DIAMOND,272,RC,,,,,,,,both,,,1391.2700,208.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1391.27,,,,,,,359.0900,1391.2700,percent of total billed charges,"100% of $1,391.27 in Billed Charges for Rev 272 = $1,391.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 1.0MM FIND ROUND DIAMOND,272,RC,,,,,,,,both,,,1391.2700,208.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,695.64,,,,,,,359.0900,1391.2700,percent of total billed charges,"Rev 272 $1,391.27 in Billed Charges at 50% = $695.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 1.0MM FIND ROUND DIAMOND,272,RC,,,,,,,,both,,,1391.2700,208.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,449.38,,,,,,,359.0900,1391.2700,other,"32.3% of $1,391.27 in Billed Charges for Rev 272 = $449.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR 1.0MM FIND ROUND DIAMOND,272,RC,,,,,,,,both,,,1391.2700,208.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,427.12,,,,,,,359.0900,1391.2700,other,"30.7% of $1,391.27 in Billed Charges for Rev 272 = $427.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR 1.0MM FIND ROUND DIAMOND,272,RC,,,,,,,,both,,,1391.2700,208.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,449.38,,,,,,,359.0900,1391.2700,percent of total billed charges,"32.3% of $1,391.27 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 1.0MM FIND ROUND DIAMOND,272,RC,,,,,,,,both,,,1391.2700,208.6900,WELLCARE,WELLCARE MEDICAID,1391.27,,,,,,,359.0900,1391.2700,percent of total billed charges,"100% of $1,391.27 in Billed Charges for Rev 272 = $1,391.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMAROLLER LONG WA22737S,272,RC,27200002,CDM,,,,,,both,,,4679.4000,701.9100,AETNA,AETNA,1998.10,,,,,,,1207.7500,4679.4000,percent of total billed charges,"42.7% of $4,679.40 in Billed Charges for Rev 272 = $1,998.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMAROLLER LONG WA22737S,272,RC,27200002,CDM,,,,,,both,,,4679.4000,701.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3275.58,,,,,,,1207.7500,4679.4000,percent of total billed charges,"Rev 272 $4,679.40 in Billed Charges at 70% = $3,275.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMAROLLER LONG WA22737S,272,RC,27200002,CDM,,,,,,both,,,4679.4000,701.9100,CIGNA HEALTHCARE,CIGNA HMO,1951.31,,,,,,,1207.7500,4679.4000,percent of total billed charges,"41.7% of $4,679.40 in Billed Charges for Rev 272 = $1,951.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMAROLLER LONG WA22737S,272,RC,27200002,CDM,,,,,,both,,,4679.4000,701.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2171.24,,,,,,,1207.7500,4679.4000,percent of total billed charges,"46.4% of $4,679.40 in Billed Charges for Rev 272 = $2,171.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMAROLLER LONG WA22737S,272,RC,27200002,CDM,,,,,,both,,,4679.4000,701.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1951.31,,,,,,,1207.7500,4679.4000,percent of total billed charges,"41.7% of $4,679.40 in Billed Charges for Rev 272 = $1,951.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMAROLLER LONG WA22737S,272,RC,27200002,CDM,,,,,,both,,,4679.4000,701.9100,CIGNA HEALTHCARE,CIGNA PPO,1951.31,,,,,,,1207.7500,4679.4000,percent of total billed charges,"41.7% of $4,679.40 in Billed Charges for Rev 272 = $1,951.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMAROLLER LONG WA22737S,272,RC,27200002,CDM,,,,,,both,,,4679.4000,701.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4211.46,,,,,,,1207.7500,4679.4000,percent of total billed charges,"90% of $4,679.40 in Billed Charges for Rev 272 = $4,211.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMAROLLER LONG WA22737S,272,RC,27200002,CDM,,,,,,both,,,4679.4000,701.9100,MEDCOST,MEDCOST VHN,2226.93,,,,,,,1207.7500,4679.4000,percent of total billed charges,"47.59% of $4,679.40 in Billed Charges for Rev 272 = $2,226.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMAROLLER LONG WA22737S,272,RC,27200002,CDM,,,,,,both,,,4679.4000,701.9100,SENTARA HEALTH,SENTARA HEALTH,1207.75,,,,,,,1207.7500,4679.4000,percent of total billed charges,"25.81% of $4,679.40 in Billed Charges for Rev 272 = $1,207.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMAROLLER LONG WA22737S,272,RC,27200002,CDM,,,,,,both,,,4679.4000,701.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4679.40,,,,,,,1207.7500,4679.4000,percent of total billed charges,"100% of $4,679.40 in Billed Charges for Rev 272 = $4,679.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMAROLLER LONG WA22737S,272,RC,27200002,CDM,,,,,,both,,,4679.4000,701.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2339.70,,,,,,,1207.7500,4679.4000,percent of total billed charges,"Rev 272 $4,679.40 in Billed Charges at 50% = $2,339.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMAROLLER LONG WA22737S,272,RC,27200002,CDM,,,,,,both,,,4679.4000,701.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1511.45,,,,,,,1207.7500,4679.4000,other,"32.3% of $4,679.40 in Billed Charges for Rev 272 = $1,511.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE PLASMAROLLER LONG WA22737S,272,RC,27200002,CDM,,,,,,both,,,4679.4000,701.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1436.58,,,,,,,1207.7500,4679.4000,other,"30.7% of $4,679.40 in Billed Charges for Rev 272 = $1,436.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE PLASMAROLLER LONG WA22737S,272,RC,27200002,CDM,,,,,,both,,,4679.4000,701.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,1511.45,,,,,,,1207.7500,4679.4000,percent of total billed charges,"32.3% of $4,679.40 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMAROLLER LONG WA22737S,272,RC,27200002,CDM,,,,,,both,,,4679.4000,701.9100,WELLCARE,WELLCARE MEDICAID,4679.40,,,,,,,1207.7500,4679.4000,percent of total billed charges,"100% of $4,679.40 in Billed Charges for Rev 272 = $4,679.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 100UM CORE BARE,272,RC,,,,,,,,both,,,9333.9000,1400.0900,AETNA,AETNA,3985.58,,,,,,,2409.0800,9333.9000,percent of total billed charges,"42.7% of $9,333.90 in Billed Charges for Rev 272 = $3,985.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 100UM CORE BARE,272,RC,,,,,,,,both,,,9333.9000,1400.0900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6533.73,,,,,,,2409.0800,9333.9000,percent of total billed charges,"Rev 272 $9,333.90 in Billed Charges at 70% = $6,533.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 100UM CORE BARE,272,RC,,,,,,,,both,,,9333.9000,1400.0900,CIGNA HEALTHCARE,CIGNA HMO,3892.24,,,,,,,2409.0800,9333.9000,percent of total billed charges,"41.7% of $9,333.90 in Billed Charges for Rev 272 = $3,892.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 100UM CORE BARE,272,RC,,,,,,,,both,,,9333.9000,1400.0900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4330.93,,,,,,,2409.0800,9333.9000,percent of total billed charges,"46.4% of $9,333.90 in Billed Charges for Rev 272 = $4,330.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 100UM CORE BARE,272,RC,,,,,,,,both,,,9333.9000,1400.0900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3892.24,,,,,,,2409.0800,9333.9000,percent of total billed charges,"41.7% of $9,333.90 in Billed Charges for Rev 272 = $3,892.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 100UM CORE BARE,272,RC,,,,,,,,both,,,9333.9000,1400.0900,CIGNA HEALTHCARE,CIGNA PPO,3892.24,,,,,,,2409.0800,9333.9000,percent of total billed charges,"41.7% of $9,333.90 in Billed Charges for Rev 272 = $3,892.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 100UM CORE BARE,272,RC,,,,,,,,both,,,9333.9000,1400.0900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8400.51,,,,,,,2409.0800,9333.9000,percent of total billed charges,"90% of $9,333.90 in Billed Charges for Rev 272 = $8,400.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 100UM CORE BARE,272,RC,,,,,,,,both,,,9333.9000,1400.0900,MEDCOST,MEDCOST VHN,4442.00,,,,,,,2409.0800,9333.9000,percent of total billed charges,"47.59% of $9,333.90 in Billed Charges for Rev 272 = $4,442.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 100UM CORE BARE,272,RC,,,,,,,,both,,,9333.9000,1400.0900,SENTARA HEALTH,SENTARA HEALTH,2409.08,,,,,,,2409.0800,9333.9000,percent of total billed charges,"25.81% of $9,333.90 in Billed Charges for Rev 272 = $2,409.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 100UM CORE BARE,272,RC,,,,,,,,both,,,9333.9000,1400.0900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9333.90,,,,,,,2409.0800,9333.9000,percent of total billed charges,"100% of $9,333.90 in Billed Charges for Rev 272 = $9,333.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 100UM CORE BARE,272,RC,,,,,,,,both,,,9333.9000,1400.0900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4666.95,,,,,,,2409.0800,9333.9000,percent of total billed charges,"Rev 272 $9,333.90 in Billed Charges at 50% = $4,666.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 100UM CORE BARE,272,RC,,,,,,,,both,,,9333.9000,1400.0900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3014.85,,,,,,,2409.0800,9333.9000,other,"32.3% of $9,333.90 in Billed Charges for Rev 272 = $3,014.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER OPTICAL 100UM CORE BARE,272,RC,,,,,,,,both,,,9333.9000,1400.0900,UNITED HEALTHCARE,UHC HERITAGE SELECT,2865.51,,,,,,,2409.0800,9333.9000,other,"30.7% of $9,333.90 in Billed Charges for Rev 272 = $2,865.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER OPTICAL 100UM CORE BARE,272,RC,,,,,,,,both,,,9333.9000,1400.0900,UNITED HEALTHCARE,UNITED HEALTHCARE,3014.85,,,,,,,2409.0800,9333.9000,percent of total billed charges,"32.3% of $9,333.90 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 100UM CORE BARE,272,RC,,,,,,,,both,,,9333.9000,1400.0900,WELLCARE,WELLCARE MEDICAID,9333.90,,,,,,,2409.0800,9333.9000,percent of total billed charges,"100% of $9,333.90 in Billed Charges for Rev 272 = $9,333.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 272UM,272,RC,27200002,CDM,,,,,,both,,,2361.4800,354.2200,AETNA,AETNA,1008.35,,,,,,,609.5000,2361.4800,percent of total billed charges,"42.7% of $2,361.48 in Billed Charges for Rev 272 = $1,008.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 272UM,272,RC,27200002,CDM,,,,,,both,,,2361.4800,354.2200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1653.04,,,,,,,609.5000,2361.4800,percent of total billed charges,"Rev 272 $2,361.48 in Billed Charges at 70% = $1,653.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 272UM,272,RC,27200002,CDM,,,,,,both,,,2361.4800,354.2200,CIGNA HEALTHCARE,CIGNA HMO,984.74,,,,,,,609.5000,2361.4800,percent of total billed charges,"41.7% of $2,361.48 in Billed Charges for Rev 272 = $984.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 272UM,272,RC,27200002,CDM,,,,,,both,,,2361.4800,354.2200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1095.73,,,,,,,609.5000,2361.4800,percent of total billed charges,"46.4% of $2,361.48 in Billed Charges for Rev 272 = $1,095.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 272UM,272,RC,27200002,CDM,,,,,,both,,,2361.4800,354.2200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,984.74,,,,,,,609.5000,2361.4800,percent of total billed charges,"41.7% of $2,361.48 in Billed Charges for Rev 272 = $984.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 272UM,272,RC,27200002,CDM,,,,,,both,,,2361.4800,354.2200,CIGNA HEALTHCARE,CIGNA PPO,984.74,,,,,,,609.5000,2361.4800,percent of total billed charges,"41.7% of $2,361.48 in Billed Charges for Rev 272 = $984.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 272UM,272,RC,27200002,CDM,,,,,,both,,,2361.4800,354.2200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2125.33,,,,,,,609.5000,2361.4800,percent of total billed charges,"90% of $2,361.48 in Billed Charges for Rev 272 = $2,125.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 272UM,272,RC,27200002,CDM,,,,,,both,,,2361.4800,354.2200,MEDCOST,MEDCOST VHN,1123.83,,,,,,,609.5000,2361.4800,percent of total billed charges,"47.59% of $2,361.48 in Billed Charges for Rev 272 = $1,123.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 272UM,272,RC,27200002,CDM,,,,,,both,,,2361.4800,354.2200,SENTARA HEALTH,SENTARA HEALTH,609.50,,,,,,,609.5000,2361.4800,percent of total billed charges,"25.81% of $2,361.48 in Billed Charges for Rev 272 = $609.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 272UM,272,RC,27200002,CDM,,,,,,both,,,2361.4800,354.2200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2361.48,,,,,,,609.5000,2361.4800,percent of total billed charges,"100% of $2,361.48 in Billed Charges for Rev 272 = $2,361.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 272UM,272,RC,27200002,CDM,,,,,,both,,,2361.4800,354.2200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1180.74,,,,,,,609.5000,2361.4800,percent of total billed charges,"Rev 272 $2,361.48 in Billed Charges at 50% = $1,180.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 272UM,272,RC,27200002,CDM,,,,,,both,,,2361.4800,354.2200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,762.76,,,,,,,609.5000,2361.4800,other,"32.3% of $2,361.48 in Billed Charges for Rev 272 = $762.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER OPTICAL 272UM,272,RC,27200002,CDM,,,,,,both,,,2361.4800,354.2200,UNITED HEALTHCARE,UHC HERITAGE SELECT,724.97,,,,,,,609.5000,2361.4800,other,"30.7% of $2,361.48 in Billed Charges for Rev 272 = $724.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER OPTICAL 272UM,272,RC,27200002,CDM,,,,,,both,,,2361.4800,354.2200,UNITED HEALTHCARE,UNITED HEALTHCARE,762.76,,,,,,,609.5000,2361.4800,percent of total billed charges,"32.3% of $2,361.48 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 272UM,272,RC,27200002,CDM,,,,,,both,,,2361.4800,354.2200,WELLCARE,WELLCARE MEDICAID,2361.48,,,,,,,609.5000,2361.4800,percent of total billed charges,"100% of $2,361.48 in Billed Charges for Rev 272 = $2,361.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 550UM,272,RC,27200002,CDM,,,,,,both,,,3488.6000,523.2900,AETNA,AETNA,1489.63,,,,,,,900.4100,3488.6000,percent of total billed charges,"42.7% of $3,488.60 in Billed Charges for Rev 272 = $1,489.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 550UM,272,RC,27200002,CDM,,,,,,both,,,3488.6000,523.2900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2442.02,,,,,,,900.4100,3488.6000,percent of total billed charges,"Rev 272 $3,488.60 in Billed Charges at 70% = $2,442.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 550UM,272,RC,27200002,CDM,,,,,,both,,,3488.6000,523.2900,CIGNA HEALTHCARE,CIGNA HMO,1454.75,,,,,,,900.4100,3488.6000,percent of total billed charges,"41.7% of $3,488.60 in Billed Charges for Rev 272 = $1,454.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 550UM,272,RC,27200002,CDM,,,,,,both,,,3488.6000,523.2900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1618.71,,,,,,,900.4100,3488.6000,percent of total billed charges,"46.4% of $3,488.60 in Billed Charges for Rev 272 = $1,618.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 550UM,272,RC,27200002,CDM,,,,,,both,,,3488.6000,523.2900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1454.75,,,,,,,900.4100,3488.6000,percent of total billed charges,"41.7% of $3,488.60 in Billed Charges for Rev 272 = $1,454.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 550UM,272,RC,27200002,CDM,,,,,,both,,,3488.6000,523.2900,CIGNA HEALTHCARE,CIGNA PPO,1454.75,,,,,,,900.4100,3488.6000,percent of total billed charges,"41.7% of $3,488.60 in Billed Charges for Rev 272 = $1,454.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 550UM,272,RC,27200002,CDM,,,,,,both,,,3488.6000,523.2900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3139.74,,,,,,,900.4100,3488.6000,percent of total billed charges,"90% of $3,488.60 in Billed Charges for Rev 272 = $3,139.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 550UM,272,RC,27200002,CDM,,,,,,both,,,3488.6000,523.2900,MEDCOST,MEDCOST VHN,1660.22,,,,,,,900.4100,3488.6000,percent of total billed charges,"47.59% of $3,488.60 in Billed Charges for Rev 272 = $1,660.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 550UM,272,RC,27200002,CDM,,,,,,both,,,3488.6000,523.2900,SENTARA HEALTH,SENTARA HEALTH,900.41,,,,,,,900.4100,3488.6000,percent of total billed charges,"25.81% of $3,488.60 in Billed Charges for Rev 272 = $900.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 550UM,272,RC,27200002,CDM,,,,,,both,,,3488.6000,523.2900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3488.60,,,,,,,900.4100,3488.6000,percent of total billed charges,"100% of $3,488.60 in Billed Charges for Rev 272 = $3,488.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 550UM,272,RC,27200002,CDM,,,,,,both,,,3488.6000,523.2900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1744.30,,,,,,,900.4100,3488.6000,percent of total billed charges,"Rev 272 $3,488.60 in Billed Charges at 50% = $1,744.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 550UM,272,RC,27200002,CDM,,,,,,both,,,3488.6000,523.2900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1126.82,,,,,,,900.4100,3488.6000,other,"32.3% of $3,488.60 in Billed Charges for Rev 272 = $1,126.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER OPTICAL 550UM,272,RC,27200002,CDM,,,,,,both,,,3488.6000,523.2900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1071.00,,,,,,,900.4100,3488.6000,other,"30.7% of $3,488.60 in Billed Charges for Rev 272 = $1,071.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER OPTICAL 550UM,272,RC,27200002,CDM,,,,,,both,,,3488.6000,523.2900,UNITED HEALTHCARE,UNITED HEALTHCARE,1126.82,,,,,,,900.4100,3488.6000,percent of total billed charges,"32.3% of $3,488.60 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 550UM,272,RC,27200002,CDM,,,,,,both,,,3488.6000,523.2900,WELLCARE,WELLCARE MEDICAID,3488.60,,,,,,,900.4100,3488.6000,percent of total billed charges,"100% of $3,488.60 in Billed Charges for Rev 272 = $3,488.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 3MM ULTRA RND STEEL CUT,272,RC,,,,,,,,both,,,1035.0300,155.2500,AETNA,AETNA,441.96,,,,,,,267.1400,1035.0300,percent of total billed charges,"42.7% of $1,035.03 in Billed Charges for Rev 272 = $441.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 3MM ULTRA RND STEEL CUT,272,RC,,,,,,,,both,,,1035.0300,155.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,724.52,,,,,,,267.1400,1035.0300,percent of total billed charges,"Rev 272 $1,035.03 in Billed Charges at 70% = $724.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 3MM ULTRA RND STEEL CUT,272,RC,,,,,,,,both,,,1035.0300,155.2500,CIGNA HEALTHCARE,CIGNA HMO,431.61,,,,,,,267.1400,1035.0300,percent of total billed charges,"41.7% of $1,035.03 in Billed Charges for Rev 272 = $431.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 3MM ULTRA RND STEEL CUT,272,RC,,,,,,,,both,,,1035.0300,155.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,480.25,,,,,,,267.1400,1035.0300,percent of total billed charges,"46.4% of $1,035.03 in Billed Charges for Rev 272 = $480.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 3MM ULTRA RND STEEL CUT,272,RC,,,,,,,,both,,,1035.0300,155.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,431.61,,,,,,,267.1400,1035.0300,percent of total billed charges,"41.7% of $1,035.03 in Billed Charges for Rev 272 = $431.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 3MM ULTRA RND STEEL CUT,272,RC,,,,,,,,both,,,1035.0300,155.2500,CIGNA HEALTHCARE,CIGNA PPO,431.61,,,,,,,267.1400,1035.0300,percent of total billed charges,"41.7% of $1,035.03 in Billed Charges for Rev 272 = $431.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 3MM ULTRA RND STEEL CUT,272,RC,,,,,,,,both,,,1035.0300,155.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,931.53,,,,,,,267.1400,1035.0300,percent of total billed charges,"90% of $1,035.03 in Billed Charges for Rev 272 = $931.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 3MM ULTRA RND STEEL CUT,272,RC,,,,,,,,both,,,1035.0300,155.2500,MEDCOST,MEDCOST VHN,492.57,,,,,,,267.1400,1035.0300,percent of total billed charges,"47.59% of $1,035.03 in Billed Charges for Rev 272 = $492.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 3MM ULTRA RND STEEL CUT,272,RC,,,,,,,,both,,,1035.0300,155.2500,SENTARA HEALTH,SENTARA HEALTH,267.14,,,,,,,267.1400,1035.0300,percent of total billed charges,"25.81% of $1,035.03 in Billed Charges for Rev 272 = $267.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 3MM ULTRA RND STEEL CUT,272,RC,,,,,,,,both,,,1035.0300,155.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1035.03,,,,,,,267.1400,1035.0300,percent of total billed charges,"100% of $1,035.03 in Billed Charges for Rev 272 = $1,035.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 3MM ULTRA RND STEEL CUT,272,RC,,,,,,,,both,,,1035.0300,155.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,517.52,,,,,,,267.1400,1035.0300,percent of total billed charges,"Rev 272 $1,035.03 in Billed Charges at 50% = $517.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 3MM ULTRA RND STEEL CUT,272,RC,,,,,,,,both,,,1035.0300,155.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,334.31,,,,,,,267.1400,1035.0300,other,"32.3% of $1,035.03 in Billed Charges for Rev 272 = $334.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR 3MM ULTRA RND STEEL CUT,272,RC,,,,,,,,both,,,1035.0300,155.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,317.75,,,,,,,267.1400,1035.0300,other,"30.7% of $1,035.03 in Billed Charges for Rev 272 = $317.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR 3MM ULTRA RND STEEL CUT,272,RC,,,,,,,,both,,,1035.0300,155.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,334.31,,,,,,,267.1400,1035.0300,percent of total billed charges,"32.3% of $1,035.03 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR 3MM ULTRA RND STEEL CUT,272,RC,,,,,,,,both,,,1035.0300,155.2500,WELLCARE,WELLCARE MEDICAID,1035.03,,,,,,,267.1400,1035.0300,percent of total billed charges,"100% of $1,035.03 in Billed Charges for Rev 272 = $1,035.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ACORN 6.1X8MM XLONG,272,RC,,,,,,,,both,,,1229.9000,184.4900,AETNA,AETNA,525.17,,,,,,,317.4400,1229.9000,percent of total billed charges,"42.7% of $1,229.90 in Billed Charges for Rev 272 = $525.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ACORN 6.1X8MM XLONG,272,RC,,,,,,,,both,,,1229.9000,184.4900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,860.93,,,,,,,317.4400,1229.9000,percent of total billed charges,"Rev 272 $1,229.90 in Billed Charges at 70% = $860.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ACORN 6.1X8MM XLONG,272,RC,,,,,,,,both,,,1229.9000,184.4900,CIGNA HEALTHCARE,CIGNA HMO,512.87,,,,,,,317.4400,1229.9000,percent of total billed charges,"41.7% of $1,229.90 in Billed Charges for Rev 272 = $512.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ACORN 6.1X8MM XLONG,272,RC,,,,,,,,both,,,1229.9000,184.4900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,570.67,,,,,,,317.4400,1229.9000,percent of total billed charges,"46.4% of $1,229.90 in Billed Charges for Rev 272 = $570.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ACORN 6.1X8MM XLONG,272,RC,,,,,,,,both,,,1229.9000,184.4900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,512.87,,,,,,,317.4400,1229.9000,percent of total billed charges,"41.7% of $1,229.90 in Billed Charges for Rev 272 = $512.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ACORN 6.1X8MM XLONG,272,RC,,,,,,,,both,,,1229.9000,184.4900,CIGNA HEALTHCARE,CIGNA PPO,512.87,,,,,,,317.4400,1229.9000,percent of total billed charges,"41.7% of $1,229.90 in Billed Charges for Rev 272 = $512.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ACORN 6.1X8MM XLONG,272,RC,,,,,,,,both,,,1229.9000,184.4900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1106.91,,,,,,,317.4400,1229.9000,percent of total billed charges,"90% of $1,229.90 in Billed Charges for Rev 272 = $1,106.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ACORN 6.1X8MM XLONG,272,RC,,,,,,,,both,,,1229.9000,184.4900,MEDCOST,MEDCOST VHN,585.31,,,,,,,317.4400,1229.9000,percent of total billed charges,"47.59% of $1,229.90 in Billed Charges for Rev 272 = $585.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ACORN 6.1X8MM XLONG,272,RC,,,,,,,,both,,,1229.9000,184.4900,SENTARA HEALTH,SENTARA HEALTH,317.44,,,,,,,317.4400,1229.9000,percent of total billed charges,"25.81% of $1,229.90 in Billed Charges for Rev 272 = $317.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ACORN 6.1X8MM XLONG,272,RC,,,,,,,,both,,,1229.9000,184.4900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1229.90,,,,,,,317.4400,1229.9000,percent of total billed charges,"100% of $1,229.90 in Billed Charges for Rev 272 = $1,229.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ACORN 6.1X8MM XLONG,272,RC,,,,,,,,both,,,1229.9000,184.4900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,614.95,,,,,,,317.4400,1229.9000,percent of total billed charges,"Rev 272 $1,229.90 in Billed Charges at 50% = $614.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ACORN 6.1X8MM XLONG,272,RC,,,,,,,,both,,,1229.9000,184.4900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,397.26,,,,,,,317.4400,1229.9000,other,"32.3% of $1,229.90 in Billed Charges for Rev 272 = $397.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR ACORN 6.1X8MM XLONG,272,RC,,,,,,,,both,,,1229.9000,184.4900,UNITED HEALTHCARE,UHC HERITAGE SELECT,377.58,,,,,,,317.4400,1229.9000,other,"30.7% of $1,229.90 in Billed Charges for Rev 272 = $377.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR ACORN 6.1X8MM XLONG,272,RC,,,,,,,,both,,,1229.9000,184.4900,UNITED HEALTHCARE,UNITED HEALTHCARE,397.26,,,,,,,317.4400,1229.9000,percent of total billed charges,"32.3% of $1,229.90 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ACORN 6.1X8MM XLONG,272,RC,,,,,,,,both,,,1229.9000,184.4900,WELLCARE,WELLCARE MEDICAID,1229.90,,,,,,,317.4400,1229.9000,percent of total billed charges,"100% of $1,229.90 in Billed Charges for Rev 272 = $1,229.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR WIREPASS 1.5,272,RC,27200002,CDM,,,,,,both,,,557.6500,83.6500,AETNA,AETNA,238.12,,,,,,,143.9300,557.6500,percent of total billed charges,42.7% of $557.65 in Billed Charges for Rev 272 = $238.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR WIREPASS 1.5,272,RC,27200002,CDM,,,,,,both,,,557.6500,83.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,390.36,,,,,,,143.9300,557.6500,percent of total billed charges,Rev 272 $557.65 in Billed Charges at 70% = $390.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR WIREPASS 1.5,272,RC,27200002,CDM,,,,,,both,,,557.6500,83.6500,CIGNA HEALTHCARE,CIGNA HMO,232.54,,,,,,,143.9300,557.6500,percent of total billed charges,41.7% of $557.65 in Billed Charges for Rev 272 = $232.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR WIREPASS 1.5,272,RC,27200002,CDM,,,,,,both,,,557.6500,83.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,258.75,,,,,,,143.9300,557.6500,percent of total billed charges,46.4% of $557.65 in Billed Charges for Rev 272 = $258.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR WIREPASS 1.5,272,RC,27200002,CDM,,,,,,both,,,557.6500,83.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,232.54,,,,,,,143.9300,557.6500,percent of total billed charges,41.7% of $557.65 in Billed Charges for Rev 272 = $232.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR WIREPASS 1.5,272,RC,27200002,CDM,,,,,,both,,,557.6500,83.6500,CIGNA HEALTHCARE,CIGNA PPO,232.54,,,,,,,143.9300,557.6500,percent of total billed charges,41.7% of $557.65 in Billed Charges for Rev 272 = $232.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR WIREPASS 1.5,272,RC,27200002,CDM,,,,,,both,,,557.6500,83.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,501.89,,,,,,,143.9300,557.6500,percent of total billed charges,90% of $557.65 in Billed Charges for Rev 272 = $501.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR WIREPASS 1.5,272,RC,27200002,CDM,,,,,,both,,,557.6500,83.6500,MEDCOST,MEDCOST VHN,265.39,,,,,,,143.9300,557.6500,percent of total billed charges,47.59% of $557.65 in Billed Charges for Rev 272 = $265.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR WIREPASS 1.5,272,RC,27200002,CDM,,,,,,both,,,557.6500,83.6500,SENTARA HEALTH,SENTARA HEALTH,143.93,,,,,,,143.9300,557.6500,percent of total billed charges,25.81% of $557.65 in Billed Charges for Rev 272 = $143.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR WIREPASS 1.5,272,RC,27200002,CDM,,,,,,both,,,557.6500,83.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",557.65,,,,,,,143.9300,557.6500,percent of total billed charges,100% of $557.65 in Billed Charges for Rev 272 = $557.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR WIREPASS 1.5,272,RC,27200002,CDM,,,,,,both,,,557.6500,83.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,278.83,,,,,,,143.9300,557.6500,percent of total billed charges,Rev 272 $557.65 in Billed Charges at 50% = $278.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR WIREPASS 1.5,272,RC,27200002,CDM,,,,,,both,,,557.6500,83.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,180.12,,,,,,,143.9300,557.6500,other,32.3% of $557.65 in Billed Charges for Rev 272 = $180.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BURR WIREPASS 1.5,272,RC,27200002,CDM,,,,,,both,,,557.6500,83.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,171.20,,,,,,,143.9300,557.6500,other,30.7% of $557.65 in Billed Charges for Rev 272 = $171.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BURR WIREPASS 1.5,272,RC,27200002,CDM,,,,,,both,,,557.6500,83.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,180.12,,,,,,,143.9300,557.6500,percent of total billed charges,32.3% of $557.65 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BURR WIREPASS 1.5,272,RC,27200002,CDM,,,,,,both,,,557.6500,83.6500,WELLCARE,WELLCARE MEDICAID,557.65,,,,,,,143.9300,557.6500,percent of total billed charges,100% of $557.65 in Billed Charges for Rev 272 = $557.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBER SIDEFIRE SINGLE USE DUO,272,RC,,,,,,,,both,,,8815.3500,1322.3000,AETNA,AETNA,3764.15,,,,,,,2275.2400,8815.3500,percent of total billed charges,"42.7% of $8,815.35 in Billed Charges for Rev 272 = $3,764.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDEFIRE SINGLE USE DUO,272,RC,,,,,,,,both,,,8815.3500,1322.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6170.75,,,,,,,2275.2400,8815.3500,percent of total billed charges,"Rev 272 $8,815.35 in Billed Charges at 70% = $6,170.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDEFIRE SINGLE USE DUO,272,RC,,,,,,,,both,,,8815.3500,1322.3000,CIGNA HEALTHCARE,CIGNA HMO,3676.00,,,,,,,2275.2400,8815.3500,percent of total billed charges,"41.7% of $8,815.35 in Billed Charges for Rev 272 = $3,676.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDEFIRE SINGLE USE DUO,272,RC,,,,,,,,both,,,8815.3500,1322.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4090.32,,,,,,,2275.2400,8815.3500,percent of total billed charges,"46.4% of $8,815.35 in Billed Charges for Rev 272 = $4,090.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDEFIRE SINGLE USE DUO,272,RC,,,,,,,,both,,,8815.3500,1322.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3676.00,,,,,,,2275.2400,8815.3500,percent of total billed charges,"41.7% of $8,815.35 in Billed Charges for Rev 272 = $3,676.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDEFIRE SINGLE USE DUO,272,RC,,,,,,,,both,,,8815.3500,1322.3000,CIGNA HEALTHCARE,CIGNA PPO,3676.00,,,,,,,2275.2400,8815.3500,percent of total billed charges,"41.7% of $8,815.35 in Billed Charges for Rev 272 = $3,676.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDEFIRE SINGLE USE DUO,272,RC,,,,,,,,both,,,8815.3500,1322.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7933.82,,,,,,,2275.2400,8815.3500,percent of total billed charges,"90% of $8,815.35 in Billed Charges for Rev 272 = $7,933.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDEFIRE SINGLE USE DUO,272,RC,,,,,,,,both,,,8815.3500,1322.3000,MEDCOST,MEDCOST VHN,4195.23,,,,,,,2275.2400,8815.3500,percent of total billed charges,"47.59% of $8,815.35 in Billed Charges for Rev 272 = $4,195.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDEFIRE SINGLE USE DUO,272,RC,,,,,,,,both,,,8815.3500,1322.3000,SENTARA HEALTH,SENTARA HEALTH,2275.24,,,,,,,2275.2400,8815.3500,percent of total billed charges,"25.81% of $8,815.35 in Billed Charges for Rev 272 = $2,275.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDEFIRE SINGLE USE DUO,272,RC,,,,,,,,both,,,8815.3500,1322.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8815.35,,,,,,,2275.2400,8815.3500,percent of total billed charges,"100% of $8,815.35 in Billed Charges for Rev 272 = $8,815.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDEFIRE SINGLE USE DUO,272,RC,,,,,,,,both,,,8815.3500,1322.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4407.68,,,,,,,2275.2400,8815.3500,percent of total billed charges,"Rev 272 $8,815.35 in Billed Charges at 50% = $4,407.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDEFIRE SINGLE USE DUO,272,RC,,,,,,,,both,,,8815.3500,1322.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2847.36,,,,,,,2275.2400,8815.3500,other,"32.3% of $8,815.35 in Billed Charges for Rev 272 = $2,847.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER SIDEFIRE SINGLE USE DUO,272,RC,,,,,,,,both,,,8815.3500,1322.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2706.31,,,,,,,2275.2400,8815.3500,other,"30.7% of $8,815.35 in Billed Charges for Rev 272 = $2,706.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER SIDEFIRE SINGLE USE DUO,272,RC,,,,,,,,both,,,8815.3500,1322.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,2847.36,,,,,,,2275.2400,8815.3500,percent of total billed charges,"32.3% of $8,815.35 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDEFIRE SINGLE USE DUO,272,RC,,,,,,,,both,,,8815.3500,1322.3000,WELLCARE,WELLCARE MEDICAID,8815.35,,,,,,,2275.2400,8815.3500,percent of total billed charges,"100% of $8,815.35 in Billed Charges for Rev 272 = $8,815.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIMLINE 365,272,RC,27200002,CDM,,,,,,both,,,7778.2500,1166.7400,AETNA,AETNA,3321.31,,,,,,,2007.5700,7778.2500,percent of total billed charges,"42.7% of $7,778.25 in Billed Charges for Rev 272 = $3,321.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIMLINE 365,272,RC,27200002,CDM,,,,,,both,,,7778.2500,1166.7400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5444.78,,,,,,,2007.5700,7778.2500,percent of total billed charges,"Rev 272 $7,778.25 in Billed Charges at 70% = $5,444.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIMLINE 365,272,RC,27200002,CDM,,,,,,both,,,7778.2500,1166.7400,CIGNA HEALTHCARE,CIGNA HMO,3243.53,,,,,,,2007.5700,7778.2500,percent of total billed charges,"41.7% of $7,778.25 in Billed Charges for Rev 272 = $3,243.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIMLINE 365,272,RC,27200002,CDM,,,,,,both,,,7778.2500,1166.7400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3609.11,,,,,,,2007.5700,7778.2500,percent of total billed charges,"46.4% of $7,778.25 in Billed Charges for Rev 272 = $3,609.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIMLINE 365,272,RC,27200002,CDM,,,,,,both,,,7778.2500,1166.7400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3243.53,,,,,,,2007.5700,7778.2500,percent of total billed charges,"41.7% of $7,778.25 in Billed Charges for Rev 272 = $3,243.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIMLINE 365,272,RC,27200002,CDM,,,,,,both,,,7778.2500,1166.7400,CIGNA HEALTHCARE,CIGNA PPO,3243.53,,,,,,,2007.5700,7778.2500,percent of total billed charges,"41.7% of $7,778.25 in Billed Charges for Rev 272 = $3,243.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIMLINE 365,272,RC,27200002,CDM,,,,,,both,,,7778.2500,1166.7400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7000.43,,,,,,,2007.5700,7778.2500,percent of total billed charges,"90% of $7,778.25 in Billed Charges for Rev 272 = $7,000.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIMLINE 365,272,RC,27200002,CDM,,,,,,both,,,7778.2500,1166.7400,MEDCOST,MEDCOST VHN,3701.67,,,,,,,2007.5700,7778.2500,percent of total billed charges,"47.59% of $7,778.25 in Billed Charges for Rev 272 = $3,701.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIMLINE 365,272,RC,27200002,CDM,,,,,,both,,,7778.2500,1166.7400,SENTARA HEALTH,SENTARA HEALTH,2007.57,,,,,,,2007.5700,7778.2500,percent of total billed charges,"25.81% of $7,778.25 in Billed Charges for Rev 272 = $2,007.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIMLINE 365,272,RC,27200002,CDM,,,,,,both,,,7778.2500,1166.7400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7778.25,,,,,,,2007.5700,7778.2500,percent of total billed charges,"100% of $7,778.25 in Billed Charges for Rev 272 = $7,778.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIMLINE 365,272,RC,27200002,CDM,,,,,,both,,,7778.2500,1166.7400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3889.13,,,,,,,2007.5700,7778.2500,percent of total billed charges,"Rev 272 $7,778.25 in Billed Charges at 50% = $3,889.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIMLINE 365,272,RC,27200002,CDM,,,,,,both,,,7778.2500,1166.7400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2512.37,,,,,,,2007.5700,7778.2500,other,"32.3% of $7,778.25 in Billed Charges for Rev 272 = $2,512.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER SLIMLINE 365,272,RC,27200002,CDM,,,,,,both,,,7778.2500,1166.7400,UNITED HEALTHCARE,UHC HERITAGE SELECT,2387.92,,,,,,,2007.5700,7778.2500,other,"30.7% of $7,778.25 in Billed Charges for Rev 272 = $2,387.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER SLIMLINE 365,272,RC,27200002,CDM,,,,,,both,,,7778.2500,1166.7400,UNITED HEALTHCARE,UNITED HEALTHCARE,2512.37,,,,,,,2007.5700,7778.2500,percent of total billed charges,"32.3% of $7,778.25 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIMLINE 365,272,RC,27200002,CDM,,,,,,both,,,7778.2500,1166.7400,WELLCARE,WELLCARE MEDICAID,7778.25,,,,,,,2007.5700,7778.2500,percent of total billed charges,"100% of $7,778.25 in Billed Charges for Rev 272 = $7,778.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,2989.0300,448.3500,AETNA,AETNA,1276.32,,,,,,,771.4700,2989.0300,percent of total billed charges,"42.7% of $2,989.03 in Billed Charges for Rev 272 = $1,276.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,2989.0300,448.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2092.32,,,,,,,771.4700,2989.0300,percent of total billed charges,"Rev 272 $2,989.03 in Billed Charges at 70% = $2,092.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,2989.0300,448.3500,CIGNA HEALTHCARE,CIGNA HMO,1246.43,,,,,,,771.4700,2989.0300,percent of total billed charges,"41.7% of $2,989.03 in Billed Charges for Rev 272 = $1,246.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,2989.0300,448.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1386.91,,,,,,,771.4700,2989.0300,percent of total billed charges,"46.4% of $2,989.03 in Billed Charges for Rev 272 = $1,386.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,2989.0300,448.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1246.43,,,,,,,771.4700,2989.0300,percent of total billed charges,"41.7% of $2,989.03 in Billed Charges for Rev 272 = $1,246.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,2989.0300,448.3500,CIGNA HEALTHCARE,CIGNA PPO,1246.43,,,,,,,771.4700,2989.0300,percent of total billed charges,"41.7% of $2,989.03 in Billed Charges for Rev 272 = $1,246.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,2989.0300,448.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2690.13,,,,,,,771.4700,2989.0300,percent of total billed charges,"90% of $2,989.03 in Billed Charges for Rev 272 = $2,690.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,2989.0300,448.3500,MEDCOST,MEDCOST VHN,1422.48,,,,,,,771.4700,2989.0300,percent of total billed charges,"47.59% of $2,989.03 in Billed Charges for Rev 272 = $1,422.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,2989.0300,448.3500,SENTARA HEALTH,SENTARA HEALTH,771.47,,,,,,,771.4700,2989.0300,percent of total billed charges,"25.81% of $2,989.03 in Billed Charges for Rev 272 = $771.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,2989.0300,448.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2989.03,,,,,,,771.4700,2989.0300,percent of total billed charges,"100% of $2,989.03 in Billed Charges for Rev 272 = $2,989.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,2989.0300,448.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1494.52,,,,,,,771.4700,2989.0300,percent of total billed charges,"Rev 272 $2,989.03 in Billed Charges at 50% = $1,494.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,2989.0300,448.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,965.46,,,,,,,771.4700,2989.0300,other,"32.3% of $2,989.03 in Billed Charges for Rev 272 = $965.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,2989.0300,448.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,917.63,,,,,,,771.4700,2989.0300,other,"30.7% of $2,989.03 in Billed Charges for Rev 272 = $917.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,2989.0300,448.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,965.46,,,,,,,771.4700,2989.0300,percent of total billed charges,"32.3% of $2,989.03 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR XL CROSSBLADE DIAMOND 0485-860-000,272,RC,,,,,,,,both,,,2989.0300,448.3500,WELLCARE,WELLCARE MEDICAID,2989.03,,,,,,,771.4700,2989.0300,percent of total billed charges,"100% of $2,989.03 in Billed Charges for Rev 272 = $2,989.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON BICEPS,272,RC,27200002,CDM,,,,,,both,,,3640.2200,546.0300,AETNA,AETNA,1554.37,,,,,,,939.5400,3640.2200,percent of total billed charges,"42.7% of $3,640.22 in Billed Charges for Rev 272 = $1,554.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON BICEPS,272,RC,27200002,CDM,,,,,,both,,,3640.2200,546.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2548.15,,,,,,,939.5400,3640.2200,percent of total billed charges,"Rev 272 $3,640.22 in Billed Charges at 70% = $2,548.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON BICEPS,272,RC,27200002,CDM,,,,,,both,,,3640.2200,546.0300,CIGNA HEALTHCARE,CIGNA HMO,1517.97,,,,,,,939.5400,3640.2200,percent of total billed charges,"41.7% of $3,640.22 in Billed Charges for Rev 272 = $1,517.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON BICEPS,272,RC,27200002,CDM,,,,,,both,,,3640.2200,546.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1689.06,,,,,,,939.5400,3640.2200,percent of total billed charges,"46.4% of $3,640.22 in Billed Charges for Rev 272 = $1,689.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON BICEPS,272,RC,27200002,CDM,,,,,,both,,,3640.2200,546.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1517.97,,,,,,,939.5400,3640.2200,percent of total billed charges,"41.7% of $3,640.22 in Billed Charges for Rev 272 = $1,517.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON BICEPS,272,RC,27200002,CDM,,,,,,both,,,3640.2200,546.0300,CIGNA HEALTHCARE,CIGNA PPO,1517.97,,,,,,,939.5400,3640.2200,percent of total billed charges,"41.7% of $3,640.22 in Billed Charges for Rev 272 = $1,517.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON BICEPS,272,RC,27200002,CDM,,,,,,both,,,3640.2200,546.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3276.20,,,,,,,939.5400,3640.2200,percent of total billed charges,"90% of $3,640.22 in Billed Charges for Rev 272 = $3,276.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON BICEPS,272,RC,27200002,CDM,,,,,,both,,,3640.2200,546.0300,MEDCOST,MEDCOST VHN,1732.38,,,,,,,939.5400,3640.2200,percent of total billed charges,"47.59% of $3,640.22 in Billed Charges for Rev 272 = $1,732.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON BICEPS,272,RC,27200002,CDM,,,,,,both,,,3640.2200,546.0300,SENTARA HEALTH,SENTARA HEALTH,939.54,,,,,,,939.5400,3640.2200,percent of total billed charges,"25.81% of $3,640.22 in Billed Charges for Rev 272 = $939.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON BICEPS,272,RC,27200002,CDM,,,,,,both,,,3640.2200,546.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3640.22,,,,,,,939.5400,3640.2200,percent of total billed charges,"100% of $3,640.22 in Billed Charges for Rev 272 = $3,640.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON BICEPS,272,RC,27200002,CDM,,,,,,both,,,3640.2200,546.0300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1820.11,,,,,,,939.5400,3640.2200,percent of total billed charges,"Rev 272 $3,640.22 in Billed Charges at 50% = $1,820.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON BICEPS,272,RC,27200002,CDM,,,,,,both,,,3640.2200,546.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1175.79,,,,,,,939.5400,3640.2200,other,"32.3% of $3,640.22 in Billed Charges for Rev 272 = $1,175.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BUTTON BICEPS,272,RC,27200002,CDM,,,,,,both,,,3640.2200,546.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1117.55,,,,,,,939.5400,3640.2200,other,"30.7% of $3,640.22 in Billed Charges for Rev 272 = $1,117.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BUTTON BICEPS,272,RC,27200002,CDM,,,,,,both,,,3640.2200,546.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,1175.79,,,,,,,939.5400,3640.2200,percent of total billed charges,"32.3% of $3,640.22 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BUTTON BICEPS,272,RC,27200002,CDM,,,,,,both,,,3640.2200,546.0300,WELLCARE,WELLCARE MEDICAID,3640.22,,,,,,,939.5400,3640.2200,percent of total billed charges,"100% of $3,640.22 in Billed Charges for Rev 272 = $3,640.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ABLATION FLEXCATH,272,RC,27200002,CDM,,,,,,both,,,3038.7000,455.8100,AETNA,AETNA,1297.52,,,,,,,784.2900,3038.7000,percent of total billed charges,"42.7% of $3,038.70 in Billed Charges for Rev 272 = $1,297.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ABLATION FLEXCATH,272,RC,27200002,CDM,,,,,,both,,,3038.7000,455.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2127.09,,,,,,,784.2900,3038.7000,percent of total billed charges,"Rev 272 $3,038.70 in Billed Charges at 70% = $2,127.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ABLATION FLEXCATH,272,RC,27200002,CDM,,,,,,both,,,3038.7000,455.8100,CIGNA HEALTHCARE,CIGNA HMO,1267.14,,,,,,,784.2900,3038.7000,percent of total billed charges,"41.7% of $3,038.70 in Billed Charges for Rev 272 = $1,267.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ABLATION FLEXCATH,272,RC,27200002,CDM,,,,,,both,,,3038.7000,455.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1409.96,,,,,,,784.2900,3038.7000,percent of total billed charges,"46.4% of $3,038.70 in Billed Charges for Rev 272 = $1,409.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ABLATION FLEXCATH,272,RC,27200002,CDM,,,,,,both,,,3038.7000,455.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1267.14,,,,,,,784.2900,3038.7000,percent of total billed charges,"41.7% of $3,038.70 in Billed Charges for Rev 272 = $1,267.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ABLATION FLEXCATH,272,RC,27200002,CDM,,,,,,both,,,3038.7000,455.8100,CIGNA HEALTHCARE,CIGNA PPO,1267.14,,,,,,,784.2900,3038.7000,percent of total billed charges,"41.7% of $3,038.70 in Billed Charges for Rev 272 = $1,267.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ABLATION FLEXCATH,272,RC,27200002,CDM,,,,,,both,,,3038.7000,455.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2734.83,,,,,,,784.2900,3038.7000,percent of total billed charges,"90% of $3,038.70 in Billed Charges for Rev 272 = $2,734.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ABLATION FLEXCATH,272,RC,27200002,CDM,,,,,,both,,,3038.7000,455.8100,MEDCOST,MEDCOST VHN,1446.12,,,,,,,784.2900,3038.7000,percent of total billed charges,"47.59% of $3,038.70 in Billed Charges for Rev 272 = $1,446.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ABLATION FLEXCATH,272,RC,27200002,CDM,,,,,,both,,,3038.7000,455.8100,SENTARA HEALTH,SENTARA HEALTH,784.29,,,,,,,784.2900,3038.7000,percent of total billed charges,"25.81% of $3,038.70 in Billed Charges for Rev 272 = $784.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ABLATION FLEXCATH,272,RC,27200002,CDM,,,,,,both,,,3038.7000,455.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3038.70,,,,,,,784.2900,3038.7000,percent of total billed charges,"100% of $3,038.70 in Billed Charges for Rev 272 = $3,038.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ABLATION FLEXCATH,272,RC,27200002,CDM,,,,,,both,,,3038.7000,455.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1519.35,,,,,,,784.2900,3038.7000,percent of total billed charges,"Rev 272 $3,038.70 in Billed Charges at 50% = $1,519.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ABLATION FLEXCATH,272,RC,27200002,CDM,,,,,,both,,,3038.7000,455.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,981.50,,,,,,,784.2900,3038.7000,other,"32.3% of $3,038.70 in Billed Charges for Rev 272 = $981.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CABLE ABLATION FLEXCATH,272,RC,27200002,CDM,,,,,,both,,,3038.7000,455.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,932.88,,,,,,,784.2900,3038.7000,other,"30.7% of $3,038.70 in Billed Charges for Rev 272 = $932.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CABLE ABLATION FLEXCATH,272,RC,27200002,CDM,,,,,,both,,,3038.7000,455.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,981.50,,,,,,,784.2900,3038.7000,percent of total billed charges,"32.3% of $3,038.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE ABLATION FLEXCATH,272,RC,27200002,CDM,,,,,,both,,,3038.7000,455.8100,WELLCARE,WELLCARE MEDICAID,3038.70,,,,,,,784.2900,3038.7000,percent of total billed charges,"100% of $3,038.70 in Billed Charges for Rev 272 = $3,038.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,487.6100,73.1400,AETNA,AETNA,208.21,,,,,,,125.8500,487.6100,percent of total billed charges,42.7% of $487.61 in Billed Charges for Rev 272 = $208.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,487.6100,73.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,341.33,,,,,,,125.8500,487.6100,percent of total billed charges,Rev 272 $487.61 in Billed Charges at 70% = $341.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,487.6100,73.1400,CIGNA HEALTHCARE,CIGNA HMO,203.33,,,,,,,125.8500,487.6100,percent of total billed charges,41.7% of $487.61 in Billed Charges for Rev 272 = $203.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,487.6100,73.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,226.25,,,,,,,125.8500,487.6100,percent of total billed charges,46.4% of $487.61 in Billed Charges for Rev 272 = $226.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,487.6100,73.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,203.33,,,,,,,125.8500,487.6100,percent of total billed charges,41.7% of $487.61 in Billed Charges for Rev 272 = $203.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,487.6100,73.1400,CIGNA HEALTHCARE,CIGNA PPO,203.33,,,,,,,125.8500,487.6100,percent of total billed charges,41.7% of $487.61 in Billed Charges for Rev 272 = $203.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,487.6100,73.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,438.85,,,,,,,125.8500,487.6100,percent of total billed charges,90% of $487.61 in Billed Charges for Rev 272 = $438.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,487.6100,73.1400,MEDCOST,MEDCOST VHN,232.05,,,,,,,125.8500,487.6100,percent of total billed charges,47.59% of $487.61 in Billed Charges for Rev 272 = $232.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,487.6100,73.1400,SENTARA HEALTH,SENTARA HEALTH,125.85,,,,,,,125.8500,487.6100,percent of total billed charges,25.81% of $487.61 in Billed Charges for Rev 272 = $125.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,487.6100,73.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",487.61,,,,,,,125.8500,487.6100,percent of total billed charges,100% of $487.61 in Billed Charges for Rev 272 = $487.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,487.6100,73.1400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,243.81,,,,,,,125.8500,487.6100,percent of total billed charges,Rev 272 $487.61 in Billed Charges at 50% = $243.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,487.6100,73.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,157.50,,,,,,,125.8500,487.6100,other,32.3% of $487.61 in Billed Charges for Rev 272 = $157.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,487.6100,73.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,149.70,,,,,,,125.8500,487.6100,other,30.7% of $487.61 in Billed Charges for Rev 272 = $149.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,487.6100,73.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,157.50,,,,,,,125.8500,487.6100,percent of total billed charges,32.3% of $487.61 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,487.6100,73.1400,WELLCARE,WELLCARE MEDICAID,487.61,,,,,,,125.8500,487.6100,percent of total billed charges,100% of $487.61 in Billed Charges for Rev 272 = $487.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,675.8800,101.3800,AETNA,AETNA,288.60,,,,,,,174.4400,675.8800,percent of total billed charges,42.7% of $675.88 in Billed Charges for Rev 272 = $288.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,675.8800,101.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,473.12,,,,,,,174.4400,675.8800,percent of total billed charges,Rev 272 $675.88 in Billed Charges at 70% = $473.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,675.8800,101.3800,CIGNA HEALTHCARE,CIGNA HMO,281.84,,,,,,,174.4400,675.8800,percent of total billed charges,41.7% of $675.88 in Billed Charges for Rev 272 = $281.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,675.8800,101.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,313.61,,,,,,,174.4400,675.8800,percent of total billed charges,46.4% of $675.88 in Billed Charges for Rev 272 = $313.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,675.8800,101.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,281.84,,,,,,,174.4400,675.8800,percent of total billed charges,41.7% of $675.88 in Billed Charges for Rev 272 = $281.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,675.8800,101.3800,CIGNA HEALTHCARE,CIGNA PPO,281.84,,,,,,,174.4400,675.8800,percent of total billed charges,41.7% of $675.88 in Billed Charges for Rev 272 = $281.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,675.8800,101.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,608.29,,,,,,,174.4400,675.8800,percent of total billed charges,90% of $675.88 in Billed Charges for Rev 272 = $608.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,675.8800,101.3800,MEDCOST,MEDCOST VHN,321.65,,,,,,,174.4400,675.8800,percent of total billed charges,47.59% of $675.88 in Billed Charges for Rev 272 = $321.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,675.8800,101.3800,SENTARA HEALTH,SENTARA HEALTH,174.44,,,,,,,174.4400,675.8800,percent of total billed charges,25.81% of $675.88 in Billed Charges for Rev 272 = $174.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,675.8800,101.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",675.88,,,,,,,174.4400,675.8800,percent of total billed charges,100% of $675.88 in Billed Charges for Rev 272 = $675.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,675.8800,101.3800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,337.94,,,,,,,174.4400,675.8800,percent of total billed charges,Rev 272 $675.88 in Billed Charges at 50% = $337.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,675.8800,101.3800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,218.31,,,,,,,174.4400,675.8800,other,32.3% of $675.88 in Billed Charges for Rev 272 = $218.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,675.8800,101.3800,UNITED HEALTHCARE,UHC HERITAGE SELECT,207.50,,,,,,,174.4400,675.8800,other,30.7% of $675.88 in Billed Charges for Rev 272 = $207.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,675.8800,101.3800,UNITED HEALTHCARE,UNITED HEALTHCARE,218.31,,,,,,,174.4400,675.8800,percent of total billed charges,32.3% of $675.88 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOPATH 10MM 10BB,272,RC,27200002,CDM,,,,,,both,,,675.8800,101.3800,WELLCARE,WELLCARE MEDICAID,675.88,,,,,,,174.4400,675.8800,percent of total billed charges,100% of $675.88 in Billed Charges for Rev 272 = $675.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CABLE DALL MILES VITALLIUM 2MM,272,RC,,,,,,,,both,,,2834.9100,425.2400,AETNA,AETNA,1210.51,,,,,,,731.6900,2834.9100,percent of total billed charges,"42.7% of $2,834.91 in Billed Charges for Rev 272 = $1,210.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DALL MILES VITALLIUM 2MM,272,RC,,,,,,,,both,,,2834.9100,425.2400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1984.44,,,,,,,731.6900,2834.9100,percent of total billed charges,"Rev 272 $2,834.91 in Billed Charges at 70% = $1,984.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DALL MILES VITALLIUM 2MM,272,RC,,,,,,,,both,,,2834.9100,425.2400,CIGNA HEALTHCARE,CIGNA HMO,1182.16,,,,,,,731.6900,2834.9100,percent of total billed charges,"41.7% of $2,834.91 in Billed Charges for Rev 272 = $1,182.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DALL MILES VITALLIUM 2MM,272,RC,,,,,,,,both,,,2834.9100,425.2400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1315.40,,,,,,,731.6900,2834.9100,percent of total billed charges,"46.4% of $2,834.91 in Billed Charges for Rev 272 = $1,315.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DALL MILES VITALLIUM 2MM,272,RC,,,,,,,,both,,,2834.9100,425.2400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1182.16,,,,,,,731.6900,2834.9100,percent of total billed charges,"41.7% of $2,834.91 in Billed Charges for Rev 272 = $1,182.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DALL MILES VITALLIUM 2MM,272,RC,,,,,,,,both,,,2834.9100,425.2400,CIGNA HEALTHCARE,CIGNA PPO,1182.16,,,,,,,731.6900,2834.9100,percent of total billed charges,"41.7% of $2,834.91 in Billed Charges for Rev 272 = $1,182.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DALL MILES VITALLIUM 2MM,272,RC,,,,,,,,both,,,2834.9100,425.2400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2551.42,,,,,,,731.6900,2834.9100,percent of total billed charges,"90% of $2,834.91 in Billed Charges for Rev 272 = $2,551.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DALL MILES VITALLIUM 2MM,272,RC,,,,,,,,both,,,2834.9100,425.2400,MEDCOST,MEDCOST VHN,1349.13,,,,,,,731.6900,2834.9100,percent of total billed charges,"47.59% of $2,834.91 in Billed Charges for Rev 272 = $1,349.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DALL MILES VITALLIUM 2MM,272,RC,,,,,,,,both,,,2834.9100,425.2400,SENTARA HEALTH,SENTARA HEALTH,731.69,,,,,,,731.6900,2834.9100,percent of total billed charges,"25.81% of $2,834.91 in Billed Charges for Rev 272 = $731.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DALL MILES VITALLIUM 2MM,272,RC,,,,,,,,both,,,2834.9100,425.2400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2834.91,,,,,,,731.6900,2834.9100,percent of total billed charges,"100% of $2,834.91 in Billed Charges for Rev 272 = $2,834.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DALL MILES VITALLIUM 2MM,272,RC,,,,,,,,both,,,2834.9100,425.2400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1417.46,,,,,,,731.6900,2834.9100,percent of total billed charges,"Rev 272 $2,834.91 in Billed Charges at 50% = $1,417.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DALL MILES VITALLIUM 2MM,272,RC,,,,,,,,both,,,2834.9100,425.2400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,915.68,,,,,,,731.6900,2834.9100,other,"32.3% of $2,834.91 in Billed Charges for Rev 272 = $915.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CABLE DALL MILES VITALLIUM 2MM,272,RC,,,,,,,,both,,,2834.9100,425.2400,UNITED HEALTHCARE,UHC HERITAGE SELECT,870.32,,,,,,,731.6900,2834.9100,other,"30.7% of $2,834.91 in Billed Charges for Rev 272 = $870.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CABLE DALL MILES VITALLIUM 2MM,272,RC,,,,,,,,both,,,2834.9100,425.2400,UNITED HEALTHCARE,UNITED HEALTHCARE,915.68,,,,,,,731.6900,2834.9100,percent of total billed charges,"32.3% of $2,834.91 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DALL MILES VITALLIUM 2MM,272,RC,,,,,,,,both,,,2834.9100,425.2400,WELLCARE,WELLCARE MEDICAID,2834.91,,,,,,,731.6900,2834.9100,percent of total billed charges,"100% of $2,834.91 in Billed Charges for Rev 272 = $2,834.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DOPPLER EXT,272,RC,27200002,CDM,,,,,,both,,,1296.3800,194.4600,AETNA,AETNA,553.55,,,,,,,334.6000,1296.3800,percent of total billed charges,"42.7% of $1,296.38 in Billed Charges for Rev 272 = $553.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DOPPLER EXT,272,RC,27200002,CDM,,,,,,both,,,1296.3800,194.4600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,907.47,,,,,,,334.6000,1296.3800,percent of total billed charges,"Rev 272 $1,296.38 in Billed Charges at 70% = $907.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DOPPLER EXT,272,RC,27200002,CDM,,,,,,both,,,1296.3800,194.4600,CIGNA HEALTHCARE,CIGNA HMO,540.59,,,,,,,334.6000,1296.3800,percent of total billed charges,"41.7% of $1,296.38 in Billed Charges for Rev 272 = $540.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DOPPLER EXT,272,RC,27200002,CDM,,,,,,both,,,1296.3800,194.4600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,601.52,,,,,,,334.6000,1296.3800,percent of total billed charges,"46.4% of $1,296.38 in Billed Charges for Rev 272 = $601.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DOPPLER EXT,272,RC,27200002,CDM,,,,,,both,,,1296.3800,194.4600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,540.59,,,,,,,334.6000,1296.3800,percent of total billed charges,"41.7% of $1,296.38 in Billed Charges for Rev 272 = $540.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DOPPLER EXT,272,RC,27200002,CDM,,,,,,both,,,1296.3800,194.4600,CIGNA HEALTHCARE,CIGNA PPO,540.59,,,,,,,334.6000,1296.3800,percent of total billed charges,"41.7% of $1,296.38 in Billed Charges for Rev 272 = $540.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DOPPLER EXT,272,RC,27200002,CDM,,,,,,both,,,1296.3800,194.4600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1166.74,,,,,,,334.6000,1296.3800,percent of total billed charges,"90% of $1,296.38 in Billed Charges for Rev 272 = $1,166.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DOPPLER EXT,272,RC,27200002,CDM,,,,,,both,,,1296.3800,194.4600,MEDCOST,MEDCOST VHN,616.95,,,,,,,334.6000,1296.3800,percent of total billed charges,"47.59% of $1,296.38 in Billed Charges for Rev 272 = $616.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DOPPLER EXT,272,RC,27200002,CDM,,,,,,both,,,1296.3800,194.4600,SENTARA HEALTH,SENTARA HEALTH,334.60,,,,,,,334.6000,1296.3800,percent of total billed charges,"25.81% of $1,296.38 in Billed Charges for Rev 272 = $334.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DOPPLER EXT,272,RC,27200002,CDM,,,,,,both,,,1296.3800,194.4600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1296.38,,,,,,,334.6000,1296.3800,percent of total billed charges,"100% of $1,296.38 in Billed Charges for Rev 272 = $1,296.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DOPPLER EXT,272,RC,27200002,CDM,,,,,,both,,,1296.3800,194.4600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,648.19,,,,,,,334.6000,1296.3800,percent of total billed charges,"Rev 272 $1,296.38 in Billed Charges at 50% = $648.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DOPPLER EXT,272,RC,27200002,CDM,,,,,,both,,,1296.3800,194.4600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,418.73,,,,,,,334.6000,1296.3800,other,"32.3% of $1,296.38 in Billed Charges for Rev 272 = $418.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CABLE DOPPLER EXT,272,RC,27200002,CDM,,,,,,both,,,1296.3800,194.4600,UNITED HEALTHCARE,UHC HERITAGE SELECT,397.99,,,,,,,334.6000,1296.3800,other,"30.7% of $1,296.38 in Billed Charges for Rev 272 = $397.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CABLE DOPPLER EXT,272,RC,27200002,CDM,,,,,,both,,,1296.3800,194.4600,UNITED HEALTHCARE,UNITED HEALTHCARE,418.73,,,,,,,334.6000,1296.3800,percent of total billed charges,"32.3% of $1,296.38 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE DOPPLER EXT,272,RC,27200002,CDM,,,,,,both,,,1296.3800,194.4600,WELLCARE,WELLCARE MEDICAID,1296.38,,,,,,,334.6000,1296.3800,percent of total billed charges,"100% of $1,296.38 in Billed Charges for Rev 272 = $1,296.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE INQUIRY 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4988.4500,748.2700,AETNA,AETNA,2130.07,,,,,,,1287.5200,4988.4500,percent of total billed charges,"42.7% of $4,988.45 in Billed Charges for Rev 272 = $2,130.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE INQUIRY 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4988.4500,748.2700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3491.92,,,,,,,1287.5200,4988.4500,percent of total billed charges,"Rev 272 $4,988.45 in Billed Charges at 70% = $3,491.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE INQUIRY 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4988.4500,748.2700,CIGNA HEALTHCARE,CIGNA HMO,2080.18,,,,,,,1287.5200,4988.4500,percent of total billed charges,"41.7% of $4,988.45 in Billed Charges for Rev 272 = $2,080.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE INQUIRY 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4988.4500,748.2700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2314.64,,,,,,,1287.5200,4988.4500,percent of total billed charges,"46.4% of $4,988.45 in Billed Charges for Rev 272 = $2,314.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE INQUIRY 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4988.4500,748.2700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2080.18,,,,,,,1287.5200,4988.4500,percent of total billed charges,"41.7% of $4,988.45 in Billed Charges for Rev 272 = $2,080.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE INQUIRY 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4988.4500,748.2700,CIGNA HEALTHCARE,CIGNA PPO,2080.18,,,,,,,1287.5200,4988.4500,percent of total billed charges,"41.7% of $4,988.45 in Billed Charges for Rev 272 = $2,080.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE INQUIRY 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4988.4500,748.2700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4489.61,,,,,,,1287.5200,4988.4500,percent of total billed charges,"90% of $4,988.45 in Billed Charges for Rev 272 = $4,489.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE INQUIRY 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4988.4500,748.2700,MEDCOST,MEDCOST VHN,2374.00,,,,,,,1287.5200,4988.4500,percent of total billed charges,"47.59% of $4,988.45 in Billed Charges for Rev 272 = $2,374.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE INQUIRY 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4988.4500,748.2700,SENTARA HEALTH,SENTARA HEALTH,1287.52,,,,,,,1287.5200,4988.4500,percent of total billed charges,"25.81% of $4,988.45 in Billed Charges for Rev 272 = $1,287.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE INQUIRY 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4988.4500,748.2700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4988.45,,,,,,,1287.5200,4988.4500,percent of total billed charges,"100% of $4,988.45 in Billed Charges for Rev 272 = $4,988.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE INQUIRY 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4988.4500,748.2700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2494.23,,,,,,,1287.5200,4988.4500,percent of total billed charges,"Rev 272 $4,988.45 in Billed Charges at 50% = $2,494.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE INQUIRY 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4988.4500,748.2700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1611.27,,,,,,,1287.5200,4988.4500,other,"32.3% of $4,988.45 in Billed Charges for Rev 272 = $1,611.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CABLE INQUIRY 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4988.4500,748.2700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1531.45,,,,,,,1287.5200,4988.4500,other,"30.7% of $4,988.45 in Billed Charges for Rev 272 = $1,531.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CABLE INQUIRY 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4988.4500,748.2700,UNITED HEALTHCARE,UNITED HEALTHCARE,1611.27,,,,,,,1287.5200,4988.4500,percent of total billed charges,"32.3% of $4,988.45 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE INQUIRY 10 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,4988.4500,748.2700,WELLCARE,WELLCARE MEDICAID,4988.45,,,,,,,1287.5200,4988.4500,percent of total billed charges,"100% of $4,988.45 in Billed Charges for Rev 272 = $4,988.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 20 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,5278.8400,791.8300,AETNA,AETNA,2254.06,,,,,,,1362.4700,5278.8400,percent of total billed charges,"42.7% of $5,278.84 in Billed Charges for Rev 272 = $2,254.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 20 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,5278.8400,791.8300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3695.19,,,,,,,1362.4700,5278.8400,percent of total billed charges,"Rev 272 $5,278.84 in Billed Charges at 70% = $3,695.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 20 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,5278.8400,791.8300,CIGNA HEALTHCARE,CIGNA HMO,2201.28,,,,,,,1362.4700,5278.8400,percent of total billed charges,"41.7% of $5,278.84 in Billed Charges for Rev 272 = $2,201.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 20 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,5278.8400,791.8300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2449.38,,,,,,,1362.4700,5278.8400,percent of total billed charges,"46.4% of $5,278.84 in Billed Charges for Rev 272 = $2,449.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 20 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,5278.8400,791.8300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2201.28,,,,,,,1362.4700,5278.8400,percent of total billed charges,"41.7% of $5,278.84 in Billed Charges for Rev 272 = $2,201.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 20 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,5278.8400,791.8300,CIGNA HEALTHCARE,CIGNA PPO,2201.28,,,,,,,1362.4700,5278.8400,percent of total billed charges,"41.7% of $5,278.84 in Billed Charges for Rev 272 = $2,201.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 20 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,5278.8400,791.8300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4750.96,,,,,,,1362.4700,5278.8400,percent of total billed charges,"90% of $5,278.84 in Billed Charges for Rev 272 = $4,750.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 20 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,5278.8400,791.8300,MEDCOST,MEDCOST VHN,2512.20,,,,,,,1362.4700,5278.8400,percent of total billed charges,"47.59% of $5,278.84 in Billed Charges for Rev 272 = $2,512.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 20 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,5278.8400,791.8300,SENTARA HEALTH,SENTARA HEALTH,1362.47,,,,,,,1362.4700,5278.8400,percent of total billed charges,"25.81% of $5,278.84 in Billed Charges for Rev 272 = $1,362.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 20 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,5278.8400,791.8300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5278.84,,,,,,,1362.4700,5278.8400,percent of total billed charges,"100% of $5,278.84 in Billed Charges for Rev 272 = $5,278.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 20 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,5278.8400,791.8300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2639.42,,,,,,,1362.4700,5278.8400,percent of total billed charges,"Rev 272 $5,278.84 in Billed Charges at 50% = $2,639.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 20 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,5278.8400,791.8300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1705.07,,,,,,,1362.4700,5278.8400,other,"32.3% of $5,278.84 in Billed Charges for Rev 272 = $1,705.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CABLE LIVEWIRE 20 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,5278.8400,791.8300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1620.60,,,,,,,1362.4700,5278.8400,other,"30.7% of $5,278.84 in Billed Charges for Rev 272 = $1,620.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CABLE LIVEWIRE 20 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,5278.8400,791.8300,UNITED HEALTHCARE,UNITED HEALTHCARE,1705.07,,,,,,,1362.4700,5278.8400,percent of total billed charges,"32.3% of $5,278.84 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CABLE LIVEWIRE 20 PIN DIRECT,272,RC,27200002,CDM,,,,,,both,,,5278.8400,791.8300,WELLCARE,WELLCARE MEDICAID,5278.84,,,,,,,1362.4700,5278.8400,percent of total billed charges,"100% of $5,278.84 in Billed Charges for Rev 272 = $5,278.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER LAPAROSCOPIC EPIX LATIS PAD HANDLE DISPOSABLE 5MMX45CM,272,RC,27200002,CDM,,,,,,both,,,933.3900,140.0100,AETNA,AETNA,398.56,,,,,,,240.9100,933.3900,percent of total billed charges,42.7% of $933.39 in Billed Charges for Rev 272 = $398.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER LAPAROSCOPIC EPIX LATIS PAD HANDLE DISPOSABLE 5MMX45CM,272,RC,27200002,CDM,,,,,,both,,,933.3900,140.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,653.37,,,,,,,240.9100,933.3900,percent of total billed charges,Rev 272 $933.39 in Billed Charges at 70% = $653.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER LAPAROSCOPIC EPIX LATIS PAD HANDLE DISPOSABLE 5MMX45CM,272,RC,27200002,CDM,,,,,,both,,,933.3900,140.0100,CIGNA HEALTHCARE,CIGNA HMO,389.22,,,,,,,240.9100,933.3900,percent of total billed charges,41.7% of $933.39 in Billed Charges for Rev 272 = $389.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER LAPAROSCOPIC EPIX LATIS PAD HANDLE DISPOSABLE 5MMX45CM,272,RC,27200002,CDM,,,,,,both,,,933.3900,140.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,433.09,,,,,,,240.9100,933.3900,percent of total billed charges,46.4% of $933.39 in Billed Charges for Rev 272 = $433.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER LAPAROSCOPIC EPIX LATIS PAD HANDLE DISPOSABLE 5MMX45CM,272,RC,27200002,CDM,,,,,,both,,,933.3900,140.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,389.22,,,,,,,240.9100,933.3900,percent of total billed charges,41.7% of $933.39 in Billed Charges for Rev 272 = $389.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER LAPAROSCOPIC EPIX LATIS PAD HANDLE DISPOSABLE 5MMX45CM,272,RC,27200002,CDM,,,,,,both,,,933.3900,140.0100,CIGNA HEALTHCARE,CIGNA PPO,389.22,,,,,,,240.9100,933.3900,percent of total billed charges,41.7% of $933.39 in Billed Charges for Rev 272 = $389.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER LAPAROSCOPIC EPIX LATIS PAD HANDLE DISPOSABLE 5MMX45CM,272,RC,27200002,CDM,,,,,,both,,,933.3900,140.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,840.05,,,,,,,240.9100,933.3900,percent of total billed charges,90% of $933.39 in Billed Charges for Rev 272 = $840.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER LAPAROSCOPIC EPIX LATIS PAD HANDLE DISPOSABLE 5MMX45CM,272,RC,27200002,CDM,,,,,,both,,,933.3900,140.0100,MEDCOST,MEDCOST VHN,444.20,,,,,,,240.9100,933.3900,percent of total billed charges,47.59% of $933.39 in Billed Charges for Rev 272 = $444.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER LAPAROSCOPIC EPIX LATIS PAD HANDLE DISPOSABLE 5MMX45CM,272,RC,27200002,CDM,,,,,,both,,,933.3900,140.0100,SENTARA HEALTH,SENTARA HEALTH,240.91,,,,,,,240.9100,933.3900,percent of total billed charges,25.81% of $933.39 in Billed Charges for Rev 272 = $240.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER LAPAROSCOPIC EPIX LATIS PAD HANDLE DISPOSABLE 5MMX45CM,272,RC,27200002,CDM,,,,,,both,,,933.3900,140.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",933.39,,,,,,,240.9100,933.3900,percent of total billed charges,100% of $933.39 in Billed Charges for Rev 272 = $933.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER LAPAROSCOPIC EPIX LATIS PAD HANDLE DISPOSABLE 5MMX45CM,272,RC,27200002,CDM,,,,,,both,,,933.3900,140.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,466.70,,,,,,,240.9100,933.3900,percent of total billed charges,Rev 272 $933.39 in Billed Charges at 50% = $466.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER LAPAROSCOPIC EPIX LATIS PAD HANDLE DISPOSABLE 5MMX45CM,272,RC,27200002,CDM,,,,,,both,,,933.3900,140.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,301.49,,,,,,,240.9100,933.3900,other,32.3% of $933.39 in Billed Charges for Rev 272 = $301.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GRASPER LAPAROSCOPIC EPIX LATIS PAD HANDLE DISPOSABLE 5MMX45CM,272,RC,27200002,CDM,,,,,,both,,,933.3900,140.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,286.55,,,,,,,240.9100,933.3900,other,30.7% of $933.39 in Billed Charges for Rev 272 = $286.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GRASPER LAPAROSCOPIC EPIX LATIS PAD HANDLE DISPOSABLE 5MMX45CM,272,RC,27200002,CDM,,,,,,both,,,933.3900,140.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,301.49,,,,,,,240.9100,933.3900,percent of total billed charges,32.3% of $933.39 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER LAPAROSCOPIC EPIX LATIS PAD HANDLE DISPOSABLE 5MMX45CM,272,RC,27200002,CDM,,,,,,both,,,933.3900,140.0100,WELLCARE,WELLCARE MEDICAID,933.39,,,,,,,240.9100,933.3900,percent of total billed charges,100% of $933.39 in Billed Charges for Rev 272 = $933.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3266.8700,490.0300,AETNA,AETNA,1394.95,,,,,,,843.1800,3266.8700,percent of total billed charges,"42.7% of $3,266.87 in Billed Charges for Rev 272 = $1,394.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3266.8700,490.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2286.81,,,,,,,843.1800,3266.8700,percent of total billed charges,"Rev 272 $3,266.87 in Billed Charges at 70% = $2,286.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3266.8700,490.0300,CIGNA HEALTHCARE,CIGNA HMO,1362.28,,,,,,,843.1800,3266.8700,percent of total billed charges,"41.7% of $3,266.87 in Billed Charges for Rev 272 = $1,362.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3266.8700,490.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1515.83,,,,,,,843.1800,3266.8700,percent of total billed charges,"46.4% of $3,266.87 in Billed Charges for Rev 272 = $1,515.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3266.8700,490.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1362.28,,,,,,,843.1800,3266.8700,percent of total billed charges,"41.7% of $3,266.87 in Billed Charges for Rev 272 = $1,362.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3266.8700,490.0300,CIGNA HEALTHCARE,CIGNA PPO,1362.28,,,,,,,843.1800,3266.8700,percent of total billed charges,"41.7% of $3,266.87 in Billed Charges for Rev 272 = $1,362.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3266.8700,490.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2940.18,,,,,,,843.1800,3266.8700,percent of total billed charges,"90% of $3,266.87 in Billed Charges for Rev 272 = $2,940.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3266.8700,490.0300,MEDCOST,MEDCOST VHN,1554.70,,,,,,,843.1800,3266.8700,percent of total billed charges,"47.59% of $3,266.87 in Billed Charges for Rev 272 = $1,554.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3266.8700,490.0300,SENTARA HEALTH,SENTARA HEALTH,843.18,,,,,,,843.1800,3266.8700,percent of total billed charges,"25.81% of $3,266.87 in Billed Charges for Rev 272 = $843.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3266.8700,490.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3266.87,,,,,,,843.1800,3266.8700,percent of total billed charges,"100% of $3,266.87 in Billed Charges for Rev 272 = $3,266.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3266.8700,490.0300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1633.44,,,,,,,843.1800,3266.8700,percent of total billed charges,"Rev 272 $3,266.87 in Billed Charges at 50% = $1,633.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3266.8700,490.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1055.20,,,,,,,843.1800,3266.8700,other,"32.3% of $3,266.87 in Billed Charges for Rev 272 = $1,055.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3266.8700,490.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1002.93,,,,,,,843.1800,3266.8700,other,"30.7% of $3,266.87 in Billed Charges for Rev 272 = $1,002.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3266.8700,490.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,1055.20,,,,,,,843.1800,3266.8700,percent of total billed charges,"32.3% of $3,266.87 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3266.8700,490.0300,WELLCARE,WELLCARE MEDICAID,3266.87,,,,,,,843.1800,3266.8700,percent of total billed charges,"100% of $3,266.87 in Billed Charges for Rev 272 = $3,266.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RAT TOOTH 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1260.2800,189.0400,AETNA,AETNA,538.14,,,,,,,325.2800,1260.2800,percent of total billed charges,"42.7% of $1,260.28 in Billed Charges for Rev 272 = $538.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RAT TOOTH 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1260.2800,189.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,882.20,,,,,,,325.2800,1260.2800,percent of total billed charges,"Rev 272 $1,260.28 in Billed Charges at 70% = $882.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RAT TOOTH 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1260.2800,189.0400,CIGNA HEALTHCARE,CIGNA HMO,525.54,,,,,,,325.2800,1260.2800,percent of total billed charges,"41.7% of $1,260.28 in Billed Charges for Rev 272 = $525.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RAT TOOTH 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1260.2800,189.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,584.77,,,,,,,325.2800,1260.2800,percent of total billed charges,"46.4% of $1,260.28 in Billed Charges for Rev 272 = $584.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RAT TOOTH 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1260.2800,189.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,525.54,,,,,,,325.2800,1260.2800,percent of total billed charges,"41.7% of $1,260.28 in Billed Charges for Rev 272 = $525.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RAT TOOTH 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1260.2800,189.0400,CIGNA HEALTHCARE,CIGNA PPO,525.54,,,,,,,325.2800,1260.2800,percent of total billed charges,"41.7% of $1,260.28 in Billed Charges for Rev 272 = $525.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RAT TOOTH 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1260.2800,189.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1134.25,,,,,,,325.2800,1260.2800,percent of total billed charges,"90% of $1,260.28 in Billed Charges for Rev 272 = $1,134.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RAT TOOTH 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1260.2800,189.0400,MEDCOST,MEDCOST VHN,599.77,,,,,,,325.2800,1260.2800,percent of total billed charges,"47.59% of $1,260.28 in Billed Charges for Rev 272 = $599.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RAT TOOTH 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1260.2800,189.0400,SENTARA HEALTH,SENTARA HEALTH,325.28,,,,,,,325.2800,1260.2800,percent of total billed charges,"25.81% of $1,260.28 in Billed Charges for Rev 272 = $325.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RAT TOOTH 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1260.2800,189.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1260.28,,,,,,,325.2800,1260.2800,percent of total billed charges,"100% of $1,260.28 in Billed Charges for Rev 272 = $1,260.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RAT TOOTH 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1260.2800,189.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,630.14,,,,,,,325.2800,1260.2800,percent of total billed charges,"Rev 272 $1,260.28 in Billed Charges at 50% = $630.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RAT TOOTH 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1260.2800,189.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,407.07,,,,,,,325.2800,1260.2800,other,"32.3% of $1,260.28 in Billed Charges for Rev 272 = $407.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GRASPER RAT TOOTH 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1260.2800,189.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,386.91,,,,,,,325.2800,1260.2800,other,"30.7% of $1,260.28 in Billed Charges for Rev 272 = $386.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GRASPER RAT TOOTH 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1260.2800,189.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,407.07,,,,,,,325.2800,1260.2800,percent of total billed charges,"32.3% of $1,260.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RAT TOOTH 2.0MM,272,RC,27200002,CDM,,,,,,both,,,1260.2800,189.0400,WELLCARE,WELLCARE MEDICAID,1260.28,,,,,,,325.2800,1260.2800,percent of total billed charges,"100% of $1,260.28 in Billed Charges for Rev 272 = $1,260.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RUBBER TIP 2.0MM RET,272,RC,27200002,CDM,,,,,,both,,,1463.5600,219.5300,AETNA,AETNA,624.94,,,,,,,377.7400,1463.5600,percent of total billed charges,"42.7% of $1,463.56 in Billed Charges for Rev 272 = $624.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RUBBER TIP 2.0MM RET,272,RC,27200002,CDM,,,,,,both,,,1463.5600,219.5300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1024.49,,,,,,,377.7400,1463.5600,percent of total billed charges,"Rev 272 $1,463.56 in Billed Charges at 70% = $1,024.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RUBBER TIP 2.0MM RET,272,RC,27200002,CDM,,,,,,both,,,1463.5600,219.5300,CIGNA HEALTHCARE,CIGNA HMO,610.30,,,,,,,377.7400,1463.5600,percent of total billed charges,"41.7% of $1,463.56 in Billed Charges for Rev 272 = $610.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RUBBER TIP 2.0MM RET,272,RC,27200002,CDM,,,,,,both,,,1463.5600,219.5300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,679.09,,,,,,,377.7400,1463.5600,percent of total billed charges,"46.4% of $1,463.56 in Billed Charges for Rev 272 = $679.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RUBBER TIP 2.0MM RET,272,RC,27200002,CDM,,,,,,both,,,1463.5600,219.5300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,610.30,,,,,,,377.7400,1463.5600,percent of total billed charges,"41.7% of $1,463.56 in Billed Charges for Rev 272 = $610.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RUBBER TIP 2.0MM RET,272,RC,27200002,CDM,,,,,,both,,,1463.5600,219.5300,CIGNA HEALTHCARE,CIGNA PPO,610.30,,,,,,,377.7400,1463.5600,percent of total billed charges,"41.7% of $1,463.56 in Billed Charges for Rev 272 = $610.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RUBBER TIP 2.0MM RET,272,RC,27200002,CDM,,,,,,both,,,1463.5600,219.5300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1317.20,,,,,,,377.7400,1463.5600,percent of total billed charges,"90% of $1,463.56 in Billed Charges for Rev 272 = $1,317.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RUBBER TIP 2.0MM RET,272,RC,27200002,CDM,,,,,,both,,,1463.5600,219.5300,MEDCOST,MEDCOST VHN,696.51,,,,,,,377.7400,1463.5600,percent of total billed charges,"47.59% of $1,463.56 in Billed Charges for Rev 272 = $696.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RUBBER TIP 2.0MM RET,272,RC,27200002,CDM,,,,,,both,,,1463.5600,219.5300,SENTARA HEALTH,SENTARA HEALTH,377.74,,,,,,,377.7400,1463.5600,percent of total billed charges,"25.81% of $1,463.56 in Billed Charges for Rev 272 = $377.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RUBBER TIP 2.0MM RET,272,RC,27200002,CDM,,,,,,both,,,1463.5600,219.5300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1463.56,,,,,,,377.7400,1463.5600,percent of total billed charges,"100% of $1,463.56 in Billed Charges for Rev 272 = $1,463.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RUBBER TIP 2.0MM RET,272,RC,27200002,CDM,,,,,,both,,,1463.5600,219.5300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,731.78,,,,,,,377.7400,1463.5600,percent of total billed charges,"Rev 272 $1,463.56 in Billed Charges at 50% = $731.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RUBBER TIP 2.0MM RET,272,RC,27200002,CDM,,,,,,both,,,1463.5600,219.5300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,472.73,,,,,,,377.7400,1463.5600,other,"32.3% of $1,463.56 in Billed Charges for Rev 272 = $472.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GRASPER RUBBER TIP 2.0MM RET,272,RC,27200002,CDM,,,,,,both,,,1463.5600,219.5300,UNITED HEALTHCARE,UHC HERITAGE SELECT,449.31,,,,,,,377.7400,1463.5600,other,"30.7% of $1,463.56 in Billed Charges for Rev 272 = $449.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GRASPER RUBBER TIP 2.0MM RET,272,RC,27200002,CDM,,,,,,both,,,1463.5600,219.5300,UNITED HEALTHCARE,UNITED HEALTHCARE,472.73,,,,,,,377.7400,1463.5600,percent of total billed charges,"32.3% of $1,463.56 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER RUBBER TIP 2.0MM RET,272,RC,27200002,CDM,,,,,,both,,,1463.5600,219.5300,WELLCARE,WELLCARE MEDICAID,1463.56,,,,,,,377.7400,1463.5600,percent of total billed charges,"100% of $1,463.56 in Billed Charges for Rev 272 = $1,463.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH THERMODILUTION,272,RC,27200002,CDM,,,,,,both,,,654.7000,98.2100,AETNA,AETNA,279.56,,,,,,,168.9800,654.7000,percent of total billed charges,42.7% of $654.70 in Billed Charges for Rev 272 = $279.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION,272,RC,27200002,CDM,,,,,,both,,,654.7000,98.2100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,458.29,,,,,,,168.9800,654.7000,percent of total billed charges,Rev 272 $654.70 in Billed Charges at 70% = $458.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION,272,RC,27200002,CDM,,,,,,both,,,654.7000,98.2100,CIGNA HEALTHCARE,CIGNA HMO,273.01,,,,,,,168.9800,654.7000,percent of total billed charges,41.7% of $654.70 in Billed Charges for Rev 272 = $273.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION,272,RC,27200002,CDM,,,,,,both,,,654.7000,98.2100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,303.78,,,,,,,168.9800,654.7000,percent of total billed charges,46.4% of $654.70 in Billed Charges for Rev 272 = $303.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION,272,RC,27200002,CDM,,,,,,both,,,654.7000,98.2100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,273.01,,,,,,,168.9800,654.7000,percent of total billed charges,41.7% of $654.70 in Billed Charges for Rev 272 = $273.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION,272,RC,27200002,CDM,,,,,,both,,,654.7000,98.2100,CIGNA HEALTHCARE,CIGNA PPO,273.01,,,,,,,168.9800,654.7000,percent of total billed charges,41.7% of $654.70 in Billed Charges for Rev 272 = $273.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION,272,RC,27200002,CDM,,,,,,both,,,654.7000,98.2100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,589.23,,,,,,,168.9800,654.7000,percent of total billed charges,90% of $654.70 in Billed Charges for Rev 272 = $589.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION,272,RC,27200002,CDM,,,,,,both,,,654.7000,98.2100,MEDCOST,MEDCOST VHN,311.57,,,,,,,168.9800,654.7000,percent of total billed charges,47.59% of $654.70 in Billed Charges for Rev 272 = $311.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION,272,RC,27200002,CDM,,,,,,both,,,654.7000,98.2100,SENTARA HEALTH,SENTARA HEALTH,168.98,,,,,,,168.9800,654.7000,percent of total billed charges,25.81% of $654.70 in Billed Charges for Rev 272 = $168.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION,272,RC,27200002,CDM,,,,,,both,,,654.7000,98.2100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",654.70,,,,,,,168.9800,654.7000,percent of total billed charges,100% of $654.70 in Billed Charges for Rev 272 = $654.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION,272,RC,27200002,CDM,,,,,,both,,,654.7000,98.2100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,327.35,,,,,,,168.9800,654.7000,percent of total billed charges,Rev 272 $654.70 in Billed Charges at 50% = $327.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION,272,RC,27200002,CDM,,,,,,both,,,654.7000,98.2100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,211.47,,,,,,,168.9800,654.7000,other,32.3% of $654.70 in Billed Charges for Rev 272 = $211.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATH THERMODILUTION,272,RC,27200002,CDM,,,,,,both,,,654.7000,98.2100,UNITED HEALTHCARE,UHC HERITAGE SELECT,200.99,,,,,,,168.9800,654.7000,other,30.7% of $654.70 in Billed Charges for Rev 272 = $200.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATH THERMODILUTION,272,RC,27200002,CDM,,,,,,both,,,654.7000,98.2100,UNITED HEALTHCARE,UNITED HEALTHCARE,211.47,,,,,,,168.9800,654.7000,percent of total billed charges,32.3% of $654.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION,272,RC,27200002,CDM,,,,,,both,,,654.7000,98.2100,WELLCARE,WELLCARE MEDICAID,654.70,,,,,,,168.9800,654.7000,percent of total billed charges,100% of $654.70 in Billed Charges for Rev 272 = $654.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION 3.8FRX110CM,272,RC,27200002,CDM,,,,,,both,,,663.7400,99.5600,AETNA,AETNA,283.42,,,,,,,171.3100,663.7400,percent of total billed charges,42.7% of $663.74 in Billed Charges for Rev 272 = $283.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION 3.8FRX110CM,272,RC,27200002,CDM,,,,,,both,,,663.7400,99.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,464.62,,,,,,,171.3100,663.7400,percent of total billed charges,Rev 272 $663.74 in Billed Charges at 70% = $464.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION 3.8FRX110CM,272,RC,27200002,CDM,,,,,,both,,,663.7400,99.5600,CIGNA HEALTHCARE,CIGNA HMO,276.78,,,,,,,171.3100,663.7400,percent of total billed charges,41.7% of $663.74 in Billed Charges for Rev 272 = $276.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION 3.8FRX110CM,272,RC,27200002,CDM,,,,,,both,,,663.7400,99.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,307.98,,,,,,,171.3100,663.7400,percent of total billed charges,46.4% of $663.74 in Billed Charges for Rev 272 = $307.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION 3.8FRX110CM,272,RC,27200002,CDM,,,,,,both,,,663.7400,99.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,276.78,,,,,,,171.3100,663.7400,percent of total billed charges,41.7% of $663.74 in Billed Charges for Rev 272 = $276.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION 3.8FRX110CM,272,RC,27200002,CDM,,,,,,both,,,663.7400,99.5600,CIGNA HEALTHCARE,CIGNA PPO,276.78,,,,,,,171.3100,663.7400,percent of total billed charges,41.7% of $663.74 in Billed Charges for Rev 272 = $276.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION 3.8FRX110CM,272,RC,27200002,CDM,,,,,,both,,,663.7400,99.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,597.37,,,,,,,171.3100,663.7400,percent of total billed charges,90% of $663.74 in Billed Charges for Rev 272 = $597.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION 3.8FRX110CM,272,RC,27200002,CDM,,,,,,both,,,663.7400,99.5600,MEDCOST,MEDCOST VHN,315.87,,,,,,,171.3100,663.7400,percent of total billed charges,47.59% of $663.74 in Billed Charges for Rev 272 = $315.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION 3.8FRX110CM,272,RC,27200002,CDM,,,,,,both,,,663.7400,99.5600,SENTARA HEALTH,SENTARA HEALTH,171.31,,,,,,,171.3100,663.7400,percent of total billed charges,25.81% of $663.74 in Billed Charges for Rev 272 = $171.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION 3.8FRX110CM,272,RC,27200002,CDM,,,,,,both,,,663.7400,99.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",663.74,,,,,,,171.3100,663.7400,percent of total billed charges,100% of $663.74 in Billed Charges for Rev 272 = $663.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION 3.8FRX110CM,272,RC,27200002,CDM,,,,,,both,,,663.7400,99.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,331.87,,,,,,,171.3100,663.7400,percent of total billed charges,Rev 272 $663.74 in Billed Charges at 50% = $331.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION 3.8FRX110CM,272,RC,27200002,CDM,,,,,,both,,,663.7400,99.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,214.39,,,,,,,171.3100,663.7400,other,32.3% of $663.74 in Billed Charges for Rev 272 = $214.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATH THERMODILUTION 3.8FRX110CM,272,RC,27200002,CDM,,,,,,both,,,663.7400,99.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,203.77,,,,,,,171.3100,663.7400,other,30.7% of $663.74 in Billed Charges for Rev 272 = $203.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATH THERMODILUTION 3.8FRX110CM,272,RC,27200002,CDM,,,,,,both,,,663.7400,99.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,214.39,,,,,,,171.3100,663.7400,percent of total billed charges,32.3% of $663.74 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH THERMODILUTION 3.8FRX110CM,272,RC,27200002,CDM,,,,,,both,,,663.7400,99.5600,WELLCARE,WELLCARE MEDICAID,663.74,,,,,,,171.3100,663.7400,percent of total billed charges,100% of $663.74 in Billed Charges for Rev 272 = $663.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER SUTURE 30 DEG 251721,272,RC,,,,,,,,both,,,5507.9300,826.1900,AETNA,AETNA,2351.89,,,,,,,1421.6000,5507.9300,percent of total billed charges,"42.7% of $5,507.93 in Billed Charges for Rev 272 = $2,351.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER SUTURE 30 DEG 251721,272,RC,,,,,,,,both,,,5507.9300,826.1900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3855.55,,,,,,,1421.6000,5507.9300,percent of total billed charges,"Rev 272 $5,507.93 in Billed Charges at 70% = $3,855.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER SUTURE 30 DEG 251721,272,RC,,,,,,,,both,,,5507.9300,826.1900,CIGNA HEALTHCARE,CIGNA HMO,2296.81,,,,,,,1421.6000,5507.9300,percent of total billed charges,"41.7% of $5,507.93 in Billed Charges for Rev 272 = $2,296.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER SUTURE 30 DEG 251721,272,RC,,,,,,,,both,,,5507.9300,826.1900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2555.68,,,,,,,1421.6000,5507.9300,percent of total billed charges,"46.4% of $5,507.93 in Billed Charges for Rev 272 = $2,555.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER SUTURE 30 DEG 251721,272,RC,,,,,,,,both,,,5507.9300,826.1900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2296.81,,,,,,,1421.6000,5507.9300,percent of total billed charges,"41.7% of $5,507.93 in Billed Charges for Rev 272 = $2,296.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER SUTURE 30 DEG 251721,272,RC,,,,,,,,both,,,5507.9300,826.1900,CIGNA HEALTHCARE,CIGNA PPO,2296.81,,,,,,,1421.6000,5507.9300,percent of total billed charges,"41.7% of $5,507.93 in Billed Charges for Rev 272 = $2,296.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER SUTURE 30 DEG 251721,272,RC,,,,,,,,both,,,5507.9300,826.1900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4957.14,,,,,,,1421.6000,5507.9300,percent of total billed charges,"90% of $5,507.93 in Billed Charges for Rev 272 = $4,957.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER SUTURE 30 DEG 251721,272,RC,,,,,,,,both,,,5507.9300,826.1900,MEDCOST,MEDCOST VHN,2621.22,,,,,,,1421.6000,5507.9300,percent of total billed charges,"47.59% of $5,507.93 in Billed Charges for Rev 272 = $2,621.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER SUTURE 30 DEG 251721,272,RC,,,,,,,,both,,,5507.9300,826.1900,SENTARA HEALTH,SENTARA HEALTH,1421.60,,,,,,,1421.6000,5507.9300,percent of total billed charges,"25.81% of $5,507.93 in Billed Charges for Rev 272 = $1,421.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER SUTURE 30 DEG 251721,272,RC,,,,,,,,both,,,5507.9300,826.1900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5507.93,,,,,,,1421.6000,5507.9300,percent of total billed charges,"100% of $5,507.93 in Billed Charges for Rev 272 = $5,507.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER SUTURE 30 DEG 251721,272,RC,,,,,,,,both,,,5507.9300,826.1900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2753.97,,,,,,,1421.6000,5507.9300,percent of total billed charges,"Rev 272 $5,507.93 in Billed Charges at 50% = $2,753.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER SUTURE 30 DEG 251721,272,RC,,,,,,,,both,,,5507.9300,826.1900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1779.06,,,,,,,1421.6000,5507.9300,other,"32.3% of $5,507.93 in Billed Charges for Rev 272 = $1,779.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GRASPER SUTURE 30 DEG 251721,272,RC,,,,,,,,both,,,5507.9300,826.1900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1690.93,,,,,,,1421.6000,5507.9300,other,"30.7% of $5,507.93 in Billed Charges for Rev 272 = $1,690.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GRASPER SUTURE 30 DEG 251721,272,RC,,,,,,,,both,,,5507.9300,826.1900,UNITED HEALTHCARE,UNITED HEALTHCARE,1779.06,,,,,,,1421.6000,5507.9300,percent of total billed charges,"32.3% of $5,507.93 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER SUTURE 30 DEG 251721,272,RC,,,,,,,,both,,,5507.9300,826.1900,WELLCARE,WELLCARE MEDICAID,5507.93,,,,,,,1421.6000,5507.9300,percent of total billed charges,"100% of $5,507.93 in Billed Charges for Rev 272 = $5,507.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIOX SV02/CC0 PA 8F J TIP LF,272,RC,,,,,,,,both,,,13306.4100,1995.9600,AETNA,AETNA,5681.84,,,,,,,3434.3800,13306.4100,percent of total billed charges,"42.7% of $13,306.41 in Billed Charges for Rev 272 = $5,681.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIOX SV02/CC0 PA 8F J TIP LF,272,RC,,,,,,,,both,,,13306.4100,1995.9600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9314.49,,,,,,,3434.3800,13306.4100,percent of total billed charges,"Rev 272 $13,306.41 in Billed Charges at 70% = $9,314.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIOX SV02/CC0 PA 8F J TIP LF,272,RC,,,,,,,,both,,,13306.4100,1995.9600,CIGNA HEALTHCARE,CIGNA HMO,5548.77,,,,,,,3434.3800,13306.4100,percent of total billed charges,"41.7% of $13,306.41 in Billed Charges for Rev 272 = $5,548.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIOX SV02/CC0 PA 8F J TIP LF,272,RC,,,,,,,,both,,,13306.4100,1995.9600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6174.17,,,,,,,3434.3800,13306.4100,percent of total billed charges,"46.4% of $13,306.41 in Billed Charges for Rev 272 = $6,174.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIOX SV02/CC0 PA 8F J TIP LF,272,RC,,,,,,,,both,,,13306.4100,1995.9600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5548.77,,,,,,,3434.3800,13306.4100,percent of total billed charges,"41.7% of $13,306.41 in Billed Charges for Rev 272 = $5,548.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIOX SV02/CC0 PA 8F J TIP LF,272,RC,,,,,,,,both,,,13306.4100,1995.9600,CIGNA HEALTHCARE,CIGNA PPO,5548.77,,,,,,,3434.3800,13306.4100,percent of total billed charges,"41.7% of $13,306.41 in Billed Charges for Rev 272 = $5,548.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIOX SV02/CC0 PA 8F J TIP LF,272,RC,,,,,,,,both,,,13306.4100,1995.9600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11975.77,,,,,,,3434.3800,13306.4100,percent of total billed charges,"90% of $13,306.41 in Billed Charges for Rev 272 = $11,975.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIOX SV02/CC0 PA 8F J TIP LF,272,RC,,,,,,,,both,,,13306.4100,1995.9600,MEDCOST,MEDCOST VHN,6332.52,,,,,,,3434.3800,13306.4100,percent of total billed charges,"47.59% of $13,306.41 in Billed Charges for Rev 272 = $6,332.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIOX SV02/CC0 PA 8F J TIP LF,272,RC,,,,,,,,both,,,13306.4100,1995.9600,SENTARA HEALTH,SENTARA HEALTH,3434.38,,,,,,,3434.3800,13306.4100,percent of total billed charges,"25.81% of $13,306.41 in Billed Charges for Rev 272 = $3,434.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIOX SV02/CC0 PA 8F J TIP LF,272,RC,,,,,,,,both,,,13306.4100,1995.9600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13306.41,,,,,,,3434.3800,13306.4100,percent of total billed charges,"100% of $13,306.41 in Billed Charges for Rev 272 = $13,306.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIOX SV02/CC0 PA 8F J TIP LF,272,RC,,,,,,,,both,,,13306.4100,1995.9600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6653.21,,,,,,,3434.3800,13306.4100,percent of total billed charges,"Rev 272 $13,306.41 in Billed Charges at 50% = $6,653.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIOX SV02/CC0 PA 8F J TIP LF,272,RC,,,,,,,,both,,,13306.4100,1995.9600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4297.97,,,,,,,3434.3800,13306.4100,other,"32.3% of $13,306.41 in Billed Charges for Rev 272 = $4,297.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH TRIOX SV02/CC0 PA 8F J TIP LF,272,RC,,,,,,,,both,,,13306.4100,1995.9600,UNITED HEALTHCARE,UHC HERITAGE SELECT,4085.07,,,,,,,3434.3800,13306.4100,other,"30.7% of $13,306.41 in Billed Charges for Rev 272 = $4,085.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH TRIOX SV02/CC0 PA 8F J TIP LF,272,RC,,,,,,,,both,,,13306.4100,1995.9600,UNITED HEALTHCARE,UNITED HEALTHCARE,4297.97,,,,,,,3434.3800,13306.4100,percent of total billed charges,"32.3% of $13,306.41 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH TRIOX SV02/CC0 PA 8F J TIP LF,272,RC,,,,,,,,both,,,13306.4100,1995.9600,WELLCARE,WELLCARE MEDICAID,13306.41,,,,,,,3434.3800,13306.4100,percent of total billed charges,"100% of $13,306.41 in Billed Charges for Rev 272 = $13,306.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 140MM,272,RC,27200002,CDM,,,,,,both,,,7052.2800,1057.8400,AETNA,AETNA,3011.32,,,,,,,1820.1900,7052.2800,percent of total billed charges,"42.7% of $7,052.28 in Billed Charges for Rev 272 = $3,011.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 140MM,272,RC,27200002,CDM,,,,,,both,,,7052.2800,1057.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4936.60,,,,,,,1820.1900,7052.2800,percent of total billed charges,"Rev 272 $7,052.28 in Billed Charges at 70% = $4,936.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 140MM,272,RC,27200002,CDM,,,,,,both,,,7052.2800,1057.8400,CIGNA HEALTHCARE,CIGNA HMO,2940.80,,,,,,,1820.1900,7052.2800,percent of total billed charges,"41.7% of $7,052.28 in Billed Charges for Rev 272 = $2,940.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 140MM,272,RC,27200002,CDM,,,,,,both,,,7052.2800,1057.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3272.26,,,,,,,1820.1900,7052.2800,percent of total billed charges,"46.4% of $7,052.28 in Billed Charges for Rev 272 = $3,272.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 140MM,272,RC,27200002,CDM,,,,,,both,,,7052.2800,1057.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2940.80,,,,,,,1820.1900,7052.2800,percent of total billed charges,"41.7% of $7,052.28 in Billed Charges for Rev 272 = $2,940.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 140MM,272,RC,27200002,CDM,,,,,,both,,,7052.2800,1057.8400,CIGNA HEALTHCARE,CIGNA PPO,2940.80,,,,,,,1820.1900,7052.2800,percent of total billed charges,"41.7% of $7,052.28 in Billed Charges for Rev 272 = $2,940.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 140MM,272,RC,27200002,CDM,,,,,,both,,,7052.2800,1057.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6347.05,,,,,,,1820.1900,7052.2800,percent of total billed charges,"90% of $7,052.28 in Billed Charges for Rev 272 = $6,347.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 140MM,272,RC,27200002,CDM,,,,,,both,,,7052.2800,1057.8400,MEDCOST,MEDCOST VHN,3356.18,,,,,,,1820.1900,7052.2800,percent of total billed charges,"47.59% of $7,052.28 in Billed Charges for Rev 272 = $3,356.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 140MM,272,RC,27200002,CDM,,,,,,both,,,7052.2800,1057.8400,SENTARA HEALTH,SENTARA HEALTH,1820.19,,,,,,,1820.1900,7052.2800,percent of total billed charges,"25.81% of $7,052.28 in Billed Charges for Rev 272 = $1,820.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 140MM,272,RC,27200002,CDM,,,,,,both,,,7052.2800,1057.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7052.28,,,,,,,1820.1900,7052.2800,percent of total billed charges,"100% of $7,052.28 in Billed Charges for Rev 272 = $7,052.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 140MM,272,RC,27200002,CDM,,,,,,both,,,7052.2800,1057.8400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3526.14,,,,,,,1820.1900,7052.2800,percent of total billed charges,"Rev 272 $7,052.28 in Billed Charges at 50% = $3,526.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 140MM,272,RC,27200002,CDM,,,,,,both,,,7052.2800,1057.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2277.89,,,,,,,1820.1900,7052.2800,other,"32.3% of $7,052.28 in Billed Charges for Rev 272 = $2,277.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATHETER 140MM,272,RC,27200002,CDM,,,,,,both,,,7052.2800,1057.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,2165.05,,,,,,,1820.1900,7052.2800,other,"30.7% of $7,052.28 in Billed Charges for Rev 272 = $2,165.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATHETER 140MM,272,RC,27200002,CDM,,,,,,both,,,7052.2800,1057.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,2277.89,,,,,,,1820.1900,7052.2800,percent of total billed charges,"32.3% of $7,052.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 140MM,272,RC,27200002,CDM,,,,,,both,,,7052.2800,1057.8400,WELLCARE,WELLCARE MEDICAID,7052.28,,,,,,,1820.1900,7052.2800,percent of total billed charges,"100% of $7,052.28 in Billed Charges for Rev 272 = $7,052.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 5F X 135 X 30 UNIFUSE,272,RC,27200002,CDM,,,,,,both,,,3443.1700,516.4800,AETNA,AETNA,1470.23,,,,,,,888.6800,3443.1700,percent of total billed charges,"42.7% of $3,443.17 in Billed Charges for Rev 272 = $1,470.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 5F X 135 X 30 UNIFUSE,272,RC,27200002,CDM,,,,,,both,,,3443.1700,516.4800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2410.22,,,,,,,888.6800,3443.1700,percent of total billed charges,"Rev 272 $3,443.17 in Billed Charges at 70% = $2,410.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 5F X 135 X 30 UNIFUSE,272,RC,27200002,CDM,,,,,,both,,,3443.1700,516.4800,CIGNA HEALTHCARE,CIGNA HMO,1435.80,,,,,,,888.6800,3443.1700,percent of total billed charges,"41.7% of $3,443.17 in Billed Charges for Rev 272 = $1,435.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 5F X 135 X 30 UNIFUSE,272,RC,27200002,CDM,,,,,,both,,,3443.1700,516.4800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1597.63,,,,,,,888.6800,3443.1700,percent of total billed charges,"46.4% of $3,443.17 in Billed Charges for Rev 272 = $1,597.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 5F X 135 X 30 UNIFUSE,272,RC,27200002,CDM,,,,,,both,,,3443.1700,516.4800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1435.80,,,,,,,888.6800,3443.1700,percent of total billed charges,"41.7% of $3,443.17 in Billed Charges for Rev 272 = $1,435.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 5F X 135 X 30 UNIFUSE,272,RC,27200002,CDM,,,,,,both,,,3443.1700,516.4800,CIGNA HEALTHCARE,CIGNA PPO,1435.80,,,,,,,888.6800,3443.1700,percent of total billed charges,"41.7% of $3,443.17 in Billed Charges for Rev 272 = $1,435.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 5F X 135 X 30 UNIFUSE,272,RC,27200002,CDM,,,,,,both,,,3443.1700,516.4800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3098.85,,,,,,,888.6800,3443.1700,percent of total billed charges,"90% of $3,443.17 in Billed Charges for Rev 272 = $3,098.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 5F X 135 X 30 UNIFUSE,272,RC,27200002,CDM,,,,,,both,,,3443.1700,516.4800,MEDCOST,MEDCOST VHN,1638.60,,,,,,,888.6800,3443.1700,percent of total billed charges,"47.59% of $3,443.17 in Billed Charges for Rev 272 = $1,638.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 5F X 135 X 30 UNIFUSE,272,RC,27200002,CDM,,,,,,both,,,3443.1700,516.4800,SENTARA HEALTH,SENTARA HEALTH,888.68,,,,,,,888.6800,3443.1700,percent of total billed charges,"25.81% of $3,443.17 in Billed Charges for Rev 272 = $888.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 5F X 135 X 30 UNIFUSE,272,RC,27200002,CDM,,,,,,both,,,3443.1700,516.4800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3443.17,,,,,,,888.6800,3443.1700,percent of total billed charges,"100% of $3,443.17 in Billed Charges for Rev 272 = $3,443.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 5F X 135 X 30 UNIFUSE,272,RC,27200002,CDM,,,,,,both,,,3443.1700,516.4800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1721.59,,,,,,,888.6800,3443.1700,percent of total billed charges,"Rev 272 $3,443.17 in Billed Charges at 50% = $1,721.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 5F X 135 X 30 UNIFUSE,272,RC,27200002,CDM,,,,,,both,,,3443.1700,516.4800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1112.14,,,,,,,888.6800,3443.1700,other,"32.3% of $3,443.17 in Billed Charges for Rev 272 = $1,112.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATHETER 5F X 135 X 30 UNIFUSE,272,RC,27200002,CDM,,,,,,both,,,3443.1700,516.4800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1057.05,,,,,,,888.6800,3443.1700,other,"30.7% of $3,443.17 in Billed Charges for Rev 272 = $1,057.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATHETER 5F X 135 X 30 UNIFUSE,272,RC,27200002,CDM,,,,,,both,,,3443.1700,516.4800,UNITED HEALTHCARE,UNITED HEALTHCARE,1112.14,,,,,,,888.6800,3443.1700,percent of total billed charges,"32.3% of $3,443.17 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER 5F X 135 X 30 UNIFUSE,272,RC,27200002,CDM,,,,,,both,,,3443.1700,516.4800,WELLCARE,WELLCARE MEDICAID,3443.17,,,,,,,888.6800,3443.1700,percent of total billed charges,"100% of $3,443.17 in Billed Charges for Rev 272 = $3,443.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER ENDO BRONCH DBL 37R,272,RC,,,,,,,,both,,,560.3500,84.0500,AETNA,AETNA,239.27,,,,,,,144.6300,560.3500,percent of total billed charges,42.7% of $560.35 in Billed Charges for Rev 272 = $239.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ENDO BRONCH DBL 37R,272,RC,,,,,,,,both,,,560.3500,84.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,392.25,,,,,,,144.6300,560.3500,percent of total billed charges,Rev 272 $560.35 in Billed Charges at 70% = $392.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ENDO BRONCH DBL 37R,272,RC,,,,,,,,both,,,560.3500,84.0500,CIGNA HEALTHCARE,CIGNA HMO,233.67,,,,,,,144.6300,560.3500,percent of total billed charges,41.7% of $560.35 in Billed Charges for Rev 272 = $233.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ENDO BRONCH DBL 37R,272,RC,,,,,,,,both,,,560.3500,84.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,260.00,,,,,,,144.6300,560.3500,percent of total billed charges,46.4% of $560.35 in Billed Charges for Rev 272 = $260.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ENDO BRONCH DBL 37R,272,RC,,,,,,,,both,,,560.3500,84.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,233.67,,,,,,,144.6300,560.3500,percent of total billed charges,41.7% of $560.35 in Billed Charges for Rev 272 = $233.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ENDO BRONCH DBL 37R,272,RC,,,,,,,,both,,,560.3500,84.0500,CIGNA HEALTHCARE,CIGNA PPO,233.67,,,,,,,144.6300,560.3500,percent of total billed charges,41.7% of $560.35 in Billed Charges for Rev 272 = $233.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ENDO BRONCH DBL 37R,272,RC,,,,,,,,both,,,560.3500,84.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,504.32,,,,,,,144.6300,560.3500,percent of total billed charges,90% of $560.35 in Billed Charges for Rev 272 = $504.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ENDO BRONCH DBL 37R,272,RC,,,,,,,,both,,,560.3500,84.0500,MEDCOST,MEDCOST VHN,266.67,,,,,,,144.6300,560.3500,percent of total billed charges,47.59% of $560.35 in Billed Charges for Rev 272 = $266.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ENDO BRONCH DBL 37R,272,RC,,,,,,,,both,,,560.3500,84.0500,SENTARA HEALTH,SENTARA HEALTH,144.63,,,,,,,144.6300,560.3500,percent of total billed charges,25.81% of $560.35 in Billed Charges for Rev 272 = $144.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ENDO BRONCH DBL 37R,272,RC,,,,,,,,both,,,560.3500,84.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",560.35,,,,,,,144.6300,560.3500,percent of total billed charges,100% of $560.35 in Billed Charges for Rev 272 = $560.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ENDO BRONCH DBL 37R,272,RC,,,,,,,,both,,,560.3500,84.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,280.18,,,,,,,144.6300,560.3500,percent of total billed charges,Rev 272 $560.35 in Billed Charges at 50% = $280.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ENDO BRONCH DBL 37R,272,RC,,,,,,,,both,,,560.3500,84.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,180.99,,,,,,,144.6300,560.3500,other,32.3% of $560.35 in Billed Charges for Rev 272 = $180.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATHETER ENDO BRONCH DBL 37R,272,RC,,,,,,,,both,,,560.3500,84.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,172.03,,,,,,,144.6300,560.3500,other,30.7% of $560.35 in Billed Charges for Rev 272 = $172.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATHETER ENDO BRONCH DBL 37R,272,RC,,,,,,,,both,,,560.3500,84.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,180.99,,,,,,,144.6300,560.3500,percent of total billed charges,32.3% of $560.35 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ENDO BRONCH DBL 37R,272,RC,,,,,,,,both,,,560.3500,84.0500,WELLCARE,WELLCARE MEDICAID,560.35,,,,,,,144.6300,560.3500,percent of total billed charges,100% of $560.35 in Billed Charges for Rev 272 = $560.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER GLO-TIP ERCP,272,RC,27200002,CDM,,,,,,both,,,643.0000,96.4500,AETNA,AETNA,274.56,,,,,,,165.9600,643.0000,percent of total billed charges,42.7% of $643.00 in Billed Charges for Rev 272 = $274.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER GLO-TIP ERCP,272,RC,27200002,CDM,,,,,,both,,,643.0000,96.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,450.10,,,,,,,165.9600,643.0000,percent of total billed charges,Rev 272 $643.00 in Billed Charges at 70% = $450.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER GLO-TIP ERCP,272,RC,27200002,CDM,,,,,,both,,,643.0000,96.4500,CIGNA HEALTHCARE,CIGNA HMO,268.13,,,,,,,165.9600,643.0000,percent of total billed charges,41.7% of $643.00 in Billed Charges for Rev 272 = $268.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER GLO-TIP ERCP,272,RC,27200002,CDM,,,,,,both,,,643.0000,96.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,298.35,,,,,,,165.9600,643.0000,percent of total billed charges,46.4% of $643.00 in Billed Charges for Rev 272 = $298.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER GLO-TIP ERCP,272,RC,27200002,CDM,,,,,,both,,,643.0000,96.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,268.13,,,,,,,165.9600,643.0000,percent of total billed charges,41.7% of $643.00 in Billed Charges for Rev 272 = $268.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER GLO-TIP ERCP,272,RC,27200002,CDM,,,,,,both,,,643.0000,96.4500,CIGNA HEALTHCARE,CIGNA PPO,268.13,,,,,,,165.9600,643.0000,percent of total billed charges,41.7% of $643.00 in Billed Charges for Rev 272 = $268.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER GLO-TIP ERCP,272,RC,27200002,CDM,,,,,,both,,,643.0000,96.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,578.70,,,,,,,165.9600,643.0000,percent of total billed charges,90% of $643.00 in Billed Charges for Rev 272 = $578.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER GLO-TIP ERCP,272,RC,27200002,CDM,,,,,,both,,,643.0000,96.4500,MEDCOST,MEDCOST VHN,306.00,,,,,,,165.9600,643.0000,percent of total billed charges,47.59% of $643.00 in Billed Charges for Rev 272 = $306.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER GLO-TIP ERCP,272,RC,27200002,CDM,,,,,,both,,,643.0000,96.4500,SENTARA HEALTH,SENTARA HEALTH,165.96,,,,,,,165.9600,643.0000,percent of total billed charges,25.81% of $643.00 in Billed Charges for Rev 272 = $165.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER GLO-TIP ERCP,272,RC,27200002,CDM,,,,,,both,,,643.0000,96.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",643.00,,,,,,,165.9600,643.0000,percent of total billed charges,100% of $643.00 in Billed Charges for Rev 272 = $643.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER GLO-TIP ERCP,272,RC,27200002,CDM,,,,,,both,,,643.0000,96.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,321.50,,,,,,,165.9600,643.0000,percent of total billed charges,Rev 272 $643.00 in Billed Charges at 50% = $321.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER GLO-TIP ERCP,272,RC,27200002,CDM,,,,,,both,,,643.0000,96.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,207.69,,,,,,,165.9600,643.0000,other,32.3% of $643.00 in Billed Charges for Rev 272 = $207.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATHETER GLO-TIP ERCP,272,RC,27200002,CDM,,,,,,both,,,643.0000,96.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,197.40,,,,,,,165.9600,643.0000,other,30.7% of $643.00 in Billed Charges for Rev 272 = $197.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATHETER GLO-TIP ERCP,272,RC,27200002,CDM,,,,,,both,,,643.0000,96.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,207.69,,,,,,,165.9600,643.0000,percent of total billed charges,32.3% of $643.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER GLO-TIP ERCP,272,RC,27200002,CDM,,,,,,both,,,643.0000,96.4500,WELLCARE,WELLCARE MEDICAID,643.00,,,,,,,165.9600,643.0000,percent of total billed charges,100% of $643.00 in Billed Charges for Rev 272 = $643.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
COUPLER FLOW 4.0,272,RC,27200002,CDM,,,,,,both,,,10837.7000,1625.6600,AETNA,AETNA,4627.70,,,,,,,2797.2100,10837.7000,percent of total billed charges,"42.7% of $10,837.70 in Billed Charges for Rev 272 = $4,627.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER FLOW 4.0,272,RC,27200002,CDM,,,,,,both,,,10837.7000,1625.6600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7586.39,,,,,,,2797.2100,10837.7000,percent of total billed charges,"Rev 272 $10,837.70 in Billed Charges at 70% = $7,586.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER FLOW 4.0,272,RC,27200002,CDM,,,,,,both,,,10837.7000,1625.6600,CIGNA HEALTHCARE,CIGNA HMO,4519.32,,,,,,,2797.2100,10837.7000,percent of total billed charges,"41.7% of $10,837.70 in Billed Charges for Rev 272 = $4,519.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER FLOW 4.0,272,RC,27200002,CDM,,,,,,both,,,10837.7000,1625.6600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5028.69,,,,,,,2797.2100,10837.7000,percent of total billed charges,"46.4% of $10,837.70 in Billed Charges for Rev 272 = $5,028.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER FLOW 4.0,272,RC,27200002,CDM,,,,,,both,,,10837.7000,1625.6600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4519.32,,,,,,,2797.2100,10837.7000,percent of total billed charges,"41.7% of $10,837.70 in Billed Charges for Rev 272 = $4,519.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER FLOW 4.0,272,RC,27200002,CDM,,,,,,both,,,10837.7000,1625.6600,CIGNA HEALTHCARE,CIGNA PPO,4519.32,,,,,,,2797.2100,10837.7000,percent of total billed charges,"41.7% of $10,837.70 in Billed Charges for Rev 272 = $4,519.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER FLOW 4.0,272,RC,27200002,CDM,,,,,,both,,,10837.7000,1625.6600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9753.93,,,,,,,2797.2100,10837.7000,percent of total billed charges,"90% of $10,837.70 in Billed Charges for Rev 272 = $9,753.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER FLOW 4.0,272,RC,27200002,CDM,,,,,,both,,,10837.7000,1625.6600,MEDCOST,MEDCOST VHN,5157.66,,,,,,,2797.2100,10837.7000,percent of total billed charges,"47.59% of $10,837.70 in Billed Charges for Rev 272 = $5,157.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER FLOW 4.0,272,RC,27200002,CDM,,,,,,both,,,10837.7000,1625.6600,SENTARA HEALTH,SENTARA HEALTH,2797.21,,,,,,,2797.2100,10837.7000,percent of total billed charges,"25.81% of $10,837.70 in Billed Charges for Rev 272 = $2,797.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER FLOW 4.0,272,RC,27200002,CDM,,,,,,both,,,10837.7000,1625.6600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10837.70,,,,,,,2797.2100,10837.7000,percent of total billed charges,"100% of $10,837.70 in Billed Charges for Rev 272 = $10,837.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER FLOW 4.0,272,RC,27200002,CDM,,,,,,both,,,10837.7000,1625.6600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5418.85,,,,,,,2797.2100,10837.7000,percent of total billed charges,"Rev 272 $10,837.70 in Billed Charges at 50% = $5,418.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER FLOW 4.0,272,RC,27200002,CDM,,,,,,both,,,10837.7000,1625.6600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3500.58,,,,,,,2797.2100,10837.7000,other,"32.3% of $10,837.70 in Billed Charges for Rev 272 = $3,500.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
COUPLER FLOW 4.0,272,RC,27200002,CDM,,,,,,both,,,10837.7000,1625.6600,UNITED HEALTHCARE,UHC HERITAGE SELECT,3327.17,,,,,,,2797.2100,10837.7000,other,"30.7% of $10,837.70 in Billed Charges for Rev 272 = $3,327.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
COUPLER FLOW 4.0,272,RC,27200002,CDM,,,,,,both,,,10837.7000,1625.6600,UNITED HEALTHCARE,UNITED HEALTHCARE,3500.58,,,,,,,2797.2100,10837.7000,percent of total billed charges,"32.3% of $10,837.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUPLER FLOW 4.0,272,RC,27200002,CDM,,,,,,both,,,10837.7000,1625.6600,WELLCARE,WELLCARE MEDICAID,10837.70,,,,,,,2797.2100,10837.7000,percent of total billed charges,"100% of $10,837.70 in Billed Charges for Rev 272 = $10,837.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE 6 HOLE 12MM,272,RC,,,,,,,,both,,,2323.1000,348.4700,AETNA,AETNA,991.96,,,,,,,599.5900,2323.1000,percent of total billed charges,"42.7% of $2,323.10 in Billed Charges for Rev 272 = $991.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE 6 HOLE 12MM,272,RC,,,,,,,,both,,,2323.1000,348.4700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1626.17,,,,,,,599.5900,2323.1000,percent of total billed charges,"Rev 272 $2,323.10 in Billed Charges at 70% = $1,626.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE 6 HOLE 12MM,272,RC,,,,,,,,both,,,2323.1000,348.4700,CIGNA HEALTHCARE,CIGNA HMO,968.73,,,,,,,599.5900,2323.1000,percent of total billed charges,"41.7% of $2,323.10 in Billed Charges for Rev 272 = $968.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE 6 HOLE 12MM,272,RC,,,,,,,,both,,,2323.1000,348.4700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1077.92,,,,,,,599.5900,2323.1000,percent of total billed charges,"46.4% of $2,323.10 in Billed Charges for Rev 272 = $1,077.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE 6 HOLE 12MM,272,RC,,,,,,,,both,,,2323.1000,348.4700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,968.73,,,,,,,599.5900,2323.1000,percent of total billed charges,"41.7% of $2,323.10 in Billed Charges for Rev 272 = $968.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE 6 HOLE 12MM,272,RC,,,,,,,,both,,,2323.1000,348.4700,CIGNA HEALTHCARE,CIGNA PPO,968.73,,,,,,,599.5900,2323.1000,percent of total billed charges,"41.7% of $2,323.10 in Billed Charges for Rev 272 = $968.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE 6 HOLE 12MM,272,RC,,,,,,,,both,,,2323.1000,348.4700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2090.79,,,,,,,599.5900,2323.1000,percent of total billed charges,"90% of $2,323.10 in Billed Charges for Rev 272 = $2,090.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE 6 HOLE 12MM,272,RC,,,,,,,,both,,,2323.1000,348.4700,MEDCOST,MEDCOST VHN,1105.56,,,,,,,599.5900,2323.1000,percent of total billed charges,"47.59% of $2,323.10 in Billed Charges for Rev 272 = $1,105.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE 6 HOLE 12MM,272,RC,,,,,,,,both,,,2323.1000,348.4700,SENTARA HEALTH,SENTARA HEALTH,599.59,,,,,,,599.5900,2323.1000,percent of total billed charges,"25.81% of $2,323.10 in Billed Charges for Rev 272 = $599.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE 6 HOLE 12MM,272,RC,,,,,,,,both,,,2323.1000,348.4700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2323.10,,,,,,,599.5900,2323.1000,percent of total billed charges,"100% of $2,323.10 in Billed Charges for Rev 272 = $2,323.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE 6 HOLE 12MM,272,RC,,,,,,,,both,,,2323.1000,348.4700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1161.55,,,,,,,599.5900,2323.1000,percent of total billed charges,"Rev 272 $2,323.10 in Billed Charges at 50% = $1,161.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE 6 HOLE 12MM,272,RC,,,,,,,,both,,,2323.1000,348.4700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,750.36,,,,,,,599.5900,2323.1000,other,"32.3% of $2,323.10 in Billed Charges for Rev 272 = $750.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
COVER BURR HOLE 6 HOLE 12MM,272,RC,,,,,,,,both,,,2323.1000,348.4700,UNITED HEALTHCARE,UHC HERITAGE SELECT,713.19,,,,,,,599.5900,2323.1000,other,"30.7% of $2,323.10 in Billed Charges for Rev 272 = $713.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
COVER BURR HOLE 6 HOLE 12MM,272,RC,,,,,,,,both,,,2323.1000,348.4700,UNITED HEALTHCARE,UNITED HEALTHCARE,750.36,,,,,,,599.5900,2323.1000,percent of total billed charges,"32.3% of $2,323.10 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE 6 HOLE 12MM,272,RC,,,,,,,,both,,,2323.1000,348.4700,WELLCARE,WELLCARE MEDICAID,2323.10,,,,,,,599.5900,2323.1000,percent of total billed charges,"100% of $2,323.10 in Billed Charges for Rev 272 = $2,323.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE TITANIUM MATRIX 12MM,272,RC,27200002,CDM,,,,,,both,,,3108.1900,466.2300,AETNA,AETNA,1327.20,,,,,,,802.2200,3108.1900,percent of total billed charges,"42.7% of $3,108.19 in Billed Charges for Rev 272 = $1,327.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE TITANIUM MATRIX 12MM,272,RC,27200002,CDM,,,,,,both,,,3108.1900,466.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2175.73,,,,,,,802.2200,3108.1900,percent of total billed charges,"Rev 272 $3,108.19 in Billed Charges at 70% = $2,175.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE TITANIUM MATRIX 12MM,272,RC,27200002,CDM,,,,,,both,,,3108.1900,466.2300,CIGNA HEALTHCARE,CIGNA HMO,1296.12,,,,,,,802.2200,3108.1900,percent of total billed charges,"41.7% of $3,108.19 in Billed Charges for Rev 272 = $1,296.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE TITANIUM MATRIX 12MM,272,RC,27200002,CDM,,,,,,both,,,3108.1900,466.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1442.20,,,,,,,802.2200,3108.1900,percent of total billed charges,"46.4% of $3,108.19 in Billed Charges for Rev 272 = $1,442.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE TITANIUM MATRIX 12MM,272,RC,27200002,CDM,,,,,,both,,,3108.1900,466.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1296.12,,,,,,,802.2200,3108.1900,percent of total billed charges,"41.7% of $3,108.19 in Billed Charges for Rev 272 = $1,296.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE TITANIUM MATRIX 12MM,272,RC,27200002,CDM,,,,,,both,,,3108.1900,466.2300,CIGNA HEALTHCARE,CIGNA PPO,1296.12,,,,,,,802.2200,3108.1900,percent of total billed charges,"41.7% of $3,108.19 in Billed Charges for Rev 272 = $1,296.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE TITANIUM MATRIX 12MM,272,RC,27200002,CDM,,,,,,both,,,3108.1900,466.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2797.37,,,,,,,802.2200,3108.1900,percent of total billed charges,"90% of $3,108.19 in Billed Charges for Rev 272 = $2,797.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE TITANIUM MATRIX 12MM,272,RC,27200002,CDM,,,,,,both,,,3108.1900,466.2300,MEDCOST,MEDCOST VHN,1479.19,,,,,,,802.2200,3108.1900,percent of total billed charges,"47.59% of $3,108.19 in Billed Charges for Rev 272 = $1,479.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE TITANIUM MATRIX 12MM,272,RC,27200002,CDM,,,,,,both,,,3108.1900,466.2300,SENTARA HEALTH,SENTARA HEALTH,802.22,,,,,,,802.2200,3108.1900,percent of total billed charges,"25.81% of $3,108.19 in Billed Charges for Rev 272 = $802.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE TITANIUM MATRIX 12MM,272,RC,27200002,CDM,,,,,,both,,,3108.1900,466.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3108.19,,,,,,,802.2200,3108.1900,percent of total billed charges,"100% of $3,108.19 in Billed Charges for Rev 272 = $3,108.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE TITANIUM MATRIX 12MM,272,RC,27200002,CDM,,,,,,both,,,3108.1900,466.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1554.10,,,,,,,802.2200,3108.1900,percent of total billed charges,"Rev 272 $3,108.19 in Billed Charges at 50% = $1,554.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE TITANIUM MATRIX 12MM,272,RC,27200002,CDM,,,,,,both,,,3108.1900,466.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1003.95,,,,,,,802.2200,3108.1900,other,"32.3% of $3,108.19 in Billed Charges for Rev 272 = $1,003.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
COVER BURR HOLE TITANIUM MATRIX 12MM,272,RC,27200002,CDM,,,,,,both,,,3108.1900,466.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,954.21,,,,,,,802.2200,3108.1900,other,"30.7% of $3,108.19 in Billed Charges for Rev 272 = $954.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
COVER BURR HOLE TITANIUM MATRIX 12MM,272,RC,27200002,CDM,,,,,,both,,,3108.1900,466.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,1003.95,,,,,,,802.2200,3108.1900,percent of total billed charges,"32.3% of $3,108.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE TITANIUM MATRIX 12MM,272,RC,27200002,CDM,,,,,,both,,,3108.1900,466.2300,WELLCARE,WELLCARE MEDICAID,3108.19,,,,,,,802.2200,3108.1900,percent of total billed charges,"100% of $3,108.19 in Billed Charges for Rev 272 = $3,108.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIALMAP C4C Single Case License,272,RC,,,,,,,,both,,,9789.3900,1468.4100,AETNA,AETNA,4180.07,,,,,,,2526.6400,9789.3900,percent of total billed charges,"42.7% of $9,789.39 in Billed Charges for Rev 272 = $4,180.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIALMAP C4C Single Case License,272,RC,,,,,,,,both,,,9789.3900,1468.4100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6852.57,,,,,,,2526.6400,9789.3900,percent of total billed charges,"Rev 272 $9,789.39 in Billed Charges at 70% = $6,852.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIALMAP C4C Single Case License,272,RC,,,,,,,,both,,,9789.3900,1468.4100,CIGNA HEALTHCARE,CIGNA HMO,4082.18,,,,,,,2526.6400,9789.3900,percent of total billed charges,"41.7% of $9,789.39 in Billed Charges for Rev 272 = $4,082.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIALMAP C4C Single Case License,272,RC,,,,,,,,both,,,9789.3900,1468.4100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4542.28,,,,,,,2526.6400,9789.3900,percent of total billed charges,"46.4% of $9,789.39 in Billed Charges for Rev 272 = $4,542.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIALMAP C4C Single Case License,272,RC,,,,,,,,both,,,9789.3900,1468.4100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4082.18,,,,,,,2526.6400,9789.3900,percent of total billed charges,"41.7% of $9,789.39 in Billed Charges for Rev 272 = $4,082.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIALMAP C4C Single Case License,272,RC,,,,,,,,both,,,9789.3900,1468.4100,CIGNA HEALTHCARE,CIGNA PPO,4082.18,,,,,,,2526.6400,9789.3900,percent of total billed charges,"41.7% of $9,789.39 in Billed Charges for Rev 272 = $4,082.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIALMAP C4C Single Case License,272,RC,,,,,,,,both,,,9789.3900,1468.4100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8810.45,,,,,,,2526.6400,9789.3900,percent of total billed charges,"90% of $9,789.39 in Billed Charges for Rev 272 = $8,810.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIALMAP C4C Single Case License,272,RC,,,,,,,,both,,,9789.3900,1468.4100,MEDCOST,MEDCOST VHN,4658.77,,,,,,,2526.6400,9789.3900,percent of total billed charges,"47.59% of $9,789.39 in Billed Charges for Rev 272 = $4,658.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIALMAP C4C Single Case License,272,RC,,,,,,,,both,,,9789.3900,1468.4100,SENTARA HEALTH,SENTARA HEALTH,2526.64,,,,,,,2526.6400,9789.3900,percent of total billed charges,"25.81% of $9,789.39 in Billed Charges for Rev 272 = $2,526.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIALMAP C4C Single Case License,272,RC,,,,,,,,both,,,9789.3900,1468.4100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9789.39,,,,,,,2526.6400,9789.3900,percent of total billed charges,"100% of $9,789.39 in Billed Charges for Rev 272 = $9,789.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIALMAP C4C Single Case License,272,RC,,,,,,,,both,,,9789.3900,1468.4100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4894.70,,,,,,,2526.6400,9789.3900,percent of total billed charges,"Rev 272 $9,789.39 in Billed Charges at 50% = $4,894.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIALMAP C4C Single Case License,272,RC,,,,,,,,both,,,9789.3900,1468.4100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3161.97,,,,,,,2526.6400,9789.3900,other,"32.3% of $9,789.39 in Billed Charges for Rev 272 = $3,161.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CRANIALMAP C4C Single Case License,272,RC,,,,,,,,both,,,9789.3900,1468.4100,UNITED HEALTHCARE,UHC HERITAGE SELECT,3005.34,,,,,,,2526.6400,9789.3900,other,"30.7% of $9,789.39 in Billed Charges for Rev 272 = $3,005.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CRANIALMAP C4C Single Case License,272,RC,,,,,,,,both,,,9789.3900,1468.4100,UNITED HEALTHCARE,UNITED HEALTHCARE,3161.97,,,,,,,2526.6400,9789.3900,percent of total billed charges,"32.3% of $9,789.39 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIALMAP C4C Single Case License,272,RC,,,,,,,,both,,,9789.3900,1468.4100,WELLCARE,WELLCARE MEDICAID,9789.39,,,,,,,2526.6400,9789.3900,percent of total billed charges,"100% of $9,789.39 in Billed Charges for Rev 272 = $9,789.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRYOPROBE CRYOSPHERE II,272,RC,27200002,CDM,,,,,,both,,,26446.0500,3966.9100,AETNA,AETNA,11292.46,,,,,,,6825.7300,26446.0500,percent of total billed charges,"42.7% of $26,446.05 in Billed Charges for Rev 272 = $11,292.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRYOPROBE CRYOSPHERE II,272,RC,27200002,CDM,,,,,,both,,,26446.0500,3966.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,18512.24,,,,,,,6825.7300,26446.0500,percent of total billed charges,"Rev 272 $26,446.05 in Billed Charges at 70% = $18,512.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRYOPROBE CRYOSPHERE II,272,RC,27200002,CDM,,,,,,both,,,26446.0500,3966.9100,CIGNA HEALTHCARE,CIGNA HMO,11028.00,,,,,,,6825.7300,26446.0500,percent of total billed charges,"41.7% of $26,446.05 in Billed Charges for Rev 272 = $11,028.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRYOPROBE CRYOSPHERE II,272,RC,27200002,CDM,,,,,,both,,,26446.0500,3966.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12270.97,,,,,,,6825.7300,26446.0500,percent of total billed charges,"46.4% of $26,446.05 in Billed Charges for Rev 272 = $12,270.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRYOPROBE CRYOSPHERE II,272,RC,27200002,CDM,,,,,,both,,,26446.0500,3966.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11028.00,,,,,,,6825.7300,26446.0500,percent of total billed charges,"41.7% of $26,446.05 in Billed Charges for Rev 272 = $11,028.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRYOPROBE CRYOSPHERE II,272,RC,27200002,CDM,,,,,,both,,,26446.0500,3966.9100,CIGNA HEALTHCARE,CIGNA PPO,11028.00,,,,,,,6825.7300,26446.0500,percent of total billed charges,"41.7% of $26,446.05 in Billed Charges for Rev 272 = $11,028.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRYOPROBE CRYOSPHERE II,272,RC,27200002,CDM,,,,,,both,,,26446.0500,3966.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,23801.45,,,,,,,6825.7300,26446.0500,percent of total billed charges,"90% of $26,446.05 in Billed Charges for Rev 272 = $23,801.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRYOPROBE CRYOSPHERE II,272,RC,27200002,CDM,,,,,,both,,,26446.0500,3966.9100,MEDCOST,MEDCOST VHN,12585.68,,,,,,,6825.7300,26446.0500,percent of total billed charges,"47.59% of $26,446.05 in Billed Charges for Rev 272 = $12,585.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRYOPROBE CRYOSPHERE II,272,RC,27200002,CDM,,,,,,both,,,26446.0500,3966.9100,SENTARA HEALTH,SENTARA HEALTH,6825.73,,,,,,,6825.7300,26446.0500,percent of total billed charges,"25.81% of $26,446.05 in Billed Charges for Rev 272 = $6,825.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRYOPROBE CRYOSPHERE II,272,RC,27200002,CDM,,,,,,both,,,26446.0500,3966.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",26446.05,,,,,,,6825.7300,26446.0500,percent of total billed charges,"100% of $26,446.05 in Billed Charges for Rev 272 = $26,446.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRYOPROBE CRYOSPHERE II,272,RC,27200002,CDM,,,,,,both,,,26446.0500,3966.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,13223.03,,,,,,,6825.7300,26446.0500,percent of total billed charges,"Rev 272 $26,446.05 in Billed Charges at 50% = $13,223.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRYOPROBE CRYOSPHERE II,272,RC,27200002,CDM,,,,,,both,,,26446.0500,3966.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,8542.07,,,,,,,6825.7300,26446.0500,other,"32.3% of $26,446.05 in Billed Charges for Rev 272 = $8,542.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CRYOPROBE CRYOSPHERE II,272,RC,27200002,CDM,,,,,,both,,,26446.0500,3966.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,8118.94,,,,,,,6825.7300,26446.0500,other,"30.7% of $26,446.05 in Billed Charges for Rev 272 = $8,118.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CRYOPROBE CRYOSPHERE II,272,RC,27200002,CDM,,,,,,both,,,26446.0500,3966.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,8542.07,,,,,,,6825.7300,26446.0500,percent of total billed charges,"32.3% of $26,446.05 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRYOPROBE CRYOSPHERE II,272,RC,27200002,CDM,,,,,,both,,,26446.0500,3966.9100,WELLCARE,WELLCARE MEDICAID,26446.05,,,,,,,6825.7300,26446.0500,percent of total billed charges,"100% of $26,446.05 in Billed Charges for Rev 272 = $26,446.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURRETTE T TIP 8.0MM,272,RC,,,,,,,,both,,,1349.7900,202.4700,AETNA,AETNA,576.36,,,,,,,348.3800,1349.7900,percent of total billed charges,"42.7% of $1,349.79 in Billed Charges for Rev 272 = $576.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURRETTE T TIP 8.0MM,272,RC,,,,,,,,both,,,1349.7900,202.4700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,944.85,,,,,,,348.3800,1349.7900,percent of total billed charges,"Rev 272 $1,349.79 in Billed Charges at 70% = $944.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURRETTE T TIP 8.0MM,272,RC,,,,,,,,both,,,1349.7900,202.4700,CIGNA HEALTHCARE,CIGNA HMO,562.86,,,,,,,348.3800,1349.7900,percent of total billed charges,"41.7% of $1,349.79 in Billed Charges for Rev 272 = $562.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURRETTE T TIP 8.0MM,272,RC,,,,,,,,both,,,1349.7900,202.4700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,626.30,,,,,,,348.3800,1349.7900,percent of total billed charges,"46.4% of $1,349.79 in Billed Charges for Rev 272 = $626.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURRETTE T TIP 8.0MM,272,RC,,,,,,,,both,,,1349.7900,202.4700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,562.86,,,,,,,348.3800,1349.7900,percent of total billed charges,"41.7% of $1,349.79 in Billed Charges for Rev 272 = $562.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURRETTE T TIP 8.0MM,272,RC,,,,,,,,both,,,1349.7900,202.4700,CIGNA HEALTHCARE,CIGNA PPO,562.86,,,,,,,348.3800,1349.7900,percent of total billed charges,"41.7% of $1,349.79 in Billed Charges for Rev 272 = $562.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURRETTE T TIP 8.0MM,272,RC,,,,,,,,both,,,1349.7900,202.4700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1214.81,,,,,,,348.3800,1349.7900,percent of total billed charges,"90% of $1,349.79 in Billed Charges for Rev 272 = $1,214.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURRETTE T TIP 8.0MM,272,RC,,,,,,,,both,,,1349.7900,202.4700,MEDCOST,MEDCOST VHN,642.37,,,,,,,348.3800,1349.7900,percent of total billed charges,"47.59% of $1,349.79 in Billed Charges for Rev 272 = $642.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURRETTE T TIP 8.0MM,272,RC,,,,,,,,both,,,1349.7900,202.4700,SENTARA HEALTH,SENTARA HEALTH,348.38,,,,,,,348.3800,1349.7900,percent of total billed charges,"25.81% of $1,349.79 in Billed Charges for Rev 272 = $348.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURRETTE T TIP 8.0MM,272,RC,,,,,,,,both,,,1349.7900,202.4700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1349.79,,,,,,,348.3800,1349.7900,percent of total billed charges,"100% of $1,349.79 in Billed Charges for Rev 272 = $1,349.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURRETTE T TIP 8.0MM,272,RC,,,,,,,,both,,,1349.7900,202.4700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,674.90,,,,,,,348.3800,1349.7900,percent of total billed charges,"Rev 272 $1,349.79 in Billed Charges at 50% = $674.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURRETTE T TIP 8.0MM,272,RC,,,,,,,,both,,,1349.7900,202.4700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.98,,,,,,,348.3800,1349.7900,other,"32.3% of $1,349.79 in Billed Charges for Rev 272 = $435.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CURRETTE T TIP 8.0MM,272,RC,,,,,,,,both,,,1349.7900,202.4700,UNITED HEALTHCARE,UHC HERITAGE SELECT,414.39,,,,,,,348.3800,1349.7900,other,"30.7% of $1,349.79 in Billed Charges for Rev 272 = $414.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CURRETTE T TIP 8.0MM,272,RC,,,,,,,,both,,,1349.7900,202.4700,UNITED HEALTHCARE,UNITED HEALTHCARE,435.98,,,,,,,348.3800,1349.7900,percent of total billed charges,"32.3% of $1,349.79 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURRETTE T TIP 8.0MM,272,RC,,,,,,,,both,,,1349.7900,202.4700,WELLCARE,WELLCARE MEDICAID,1349.79,,,,,,,348.3800,1349.7900,percent of total billed charges,"100% of $1,349.79 in Billed Charges for Rev 272 = $1,349.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LUMBAR 80CM,272,RC,27200002,CDM,,,,,,both,,,2666.0700,399.9100,AETNA,AETNA,1138.41,,,,,,,688.1100,2666.0700,percent of total billed charges,"42.7% of $2,666.07 in Billed Charges for Rev 272 = $1,138.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LUMBAR 80CM,272,RC,27200002,CDM,,,,,,both,,,2666.0700,399.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1866.25,,,,,,,688.1100,2666.0700,percent of total billed charges,"Rev 272 $2,666.07 in Billed Charges at 70% = $1,866.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LUMBAR 80CM,272,RC,27200002,CDM,,,,,,both,,,2666.0700,399.9100,CIGNA HEALTHCARE,CIGNA HMO,1111.75,,,,,,,688.1100,2666.0700,percent of total billed charges,"41.7% of $2,666.07 in Billed Charges for Rev 272 = $1,111.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LUMBAR 80CM,272,RC,27200002,CDM,,,,,,both,,,2666.0700,399.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1237.06,,,,,,,688.1100,2666.0700,percent of total billed charges,"46.4% of $2,666.07 in Billed Charges for Rev 272 = $1,237.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LUMBAR 80CM,272,RC,27200002,CDM,,,,,,both,,,2666.0700,399.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1111.75,,,,,,,688.1100,2666.0700,percent of total billed charges,"41.7% of $2,666.07 in Billed Charges for Rev 272 = $1,111.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LUMBAR 80CM,272,RC,27200002,CDM,,,,,,both,,,2666.0700,399.9100,CIGNA HEALTHCARE,CIGNA PPO,1111.75,,,,,,,688.1100,2666.0700,percent of total billed charges,"41.7% of $2,666.07 in Billed Charges for Rev 272 = $1,111.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LUMBAR 80CM,272,RC,27200002,CDM,,,,,,both,,,2666.0700,399.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2399.46,,,,,,,688.1100,2666.0700,percent of total billed charges,"90% of $2,666.07 in Billed Charges for Rev 272 = $2,399.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LUMBAR 80CM,272,RC,27200002,CDM,,,,,,both,,,2666.0700,399.9100,MEDCOST,MEDCOST VHN,1268.78,,,,,,,688.1100,2666.0700,percent of total billed charges,"47.59% of $2,666.07 in Billed Charges for Rev 272 = $1,268.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LUMBAR 80CM,272,RC,27200002,CDM,,,,,,both,,,2666.0700,399.9100,SENTARA HEALTH,SENTARA HEALTH,688.11,,,,,,,688.1100,2666.0700,percent of total billed charges,"25.81% of $2,666.07 in Billed Charges for Rev 272 = $688.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LUMBAR 80CM,272,RC,27200002,CDM,,,,,,both,,,2666.0700,399.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2666.07,,,,,,,688.1100,2666.0700,percent of total billed charges,"100% of $2,666.07 in Billed Charges for Rev 272 = $2,666.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LUMBAR 80CM,272,RC,27200002,CDM,,,,,,both,,,2666.0700,399.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1333.04,,,,,,,688.1100,2666.0700,percent of total billed charges,"Rev 272 $2,666.07 in Billed Charges at 50% = $1,333.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LUMBAR 80CM,272,RC,27200002,CDM,,,,,,both,,,2666.0700,399.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,861.14,,,,,,,688.1100,2666.0700,other,"32.3% of $2,666.07 in Billed Charges for Rev 272 = $861.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH LUMBAR 80CM,272,RC,27200002,CDM,,,,,,both,,,2666.0700,399.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,818.48,,,,,,,688.1100,2666.0700,other,"30.7% of $2,666.07 in Billed Charges for Rev 272 = $818.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH LUMBAR 80CM,272,RC,27200002,CDM,,,,,,both,,,2666.0700,399.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,861.14,,,,,,,688.1100,2666.0700,percent of total billed charges,"32.3% of $2,666.07 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LUMBAR 80CM,272,RC,27200002,CDM,,,,,,both,,,2666.0700,399.9100,WELLCARE,WELLCARE MEDICAID,2666.07,,,,,,,688.1100,2666.0700,percent of total billed charges,"100% of $2,666.07 in Billed Charges for Rev 272 = $2,666.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTICATH OXIMETRY 8FR,272,RC,,,,,,,,both,,,1279.8900,191.9800,AETNA,AETNA,546.51,,,,,,,330.3400,1279.8900,percent of total billed charges,"42.7% of $1,279.89 in Billed Charges for Rev 272 = $546.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTICATH OXIMETRY 8FR,272,RC,,,,,,,,both,,,1279.8900,191.9800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,895.92,,,,,,,330.3400,1279.8900,percent of total billed charges,"Rev 272 $1,279.89 in Billed Charges at 70% = $895.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTICATH OXIMETRY 8FR,272,RC,,,,,,,,both,,,1279.8900,191.9800,CIGNA HEALTHCARE,CIGNA HMO,533.71,,,,,,,330.3400,1279.8900,percent of total billed charges,"41.7% of $1,279.89 in Billed Charges for Rev 272 = $533.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTICATH OXIMETRY 8FR,272,RC,,,,,,,,both,,,1279.8900,191.9800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,593.87,,,,,,,330.3400,1279.8900,percent of total billed charges,"46.4% of $1,279.89 in Billed Charges for Rev 272 = $593.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTICATH OXIMETRY 8FR,272,RC,,,,,,,,both,,,1279.8900,191.9800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,533.71,,,,,,,330.3400,1279.8900,percent of total billed charges,"41.7% of $1,279.89 in Billed Charges for Rev 272 = $533.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTICATH OXIMETRY 8FR,272,RC,,,,,,,,both,,,1279.8900,191.9800,CIGNA HEALTHCARE,CIGNA PPO,533.71,,,,,,,330.3400,1279.8900,percent of total billed charges,"41.7% of $1,279.89 in Billed Charges for Rev 272 = $533.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTICATH OXIMETRY 8FR,272,RC,,,,,,,,both,,,1279.8900,191.9800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1151.90,,,,,,,330.3400,1279.8900,percent of total billed charges,"90% of $1,279.89 in Billed Charges for Rev 272 = $1,151.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTICATH OXIMETRY 8FR,272,RC,,,,,,,,both,,,1279.8900,191.9800,MEDCOST,MEDCOST VHN,609.10,,,,,,,330.3400,1279.8900,percent of total billed charges,"47.59% of $1,279.89 in Billed Charges for Rev 272 = $609.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTICATH OXIMETRY 8FR,272,RC,,,,,,,,both,,,1279.8900,191.9800,SENTARA HEALTH,SENTARA HEALTH,330.34,,,,,,,330.3400,1279.8900,percent of total billed charges,"25.81% of $1,279.89 in Billed Charges for Rev 272 = $330.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTICATH OXIMETRY 8FR,272,RC,,,,,,,,both,,,1279.8900,191.9800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1279.89,,,,,,,330.3400,1279.8900,percent of total billed charges,"100% of $1,279.89 in Billed Charges for Rev 272 = $1,279.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTICATH OXIMETRY 8FR,272,RC,,,,,,,,both,,,1279.8900,191.9800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,639.95,,,,,,,330.3400,1279.8900,percent of total billed charges,"Rev 272 $1,279.89 in Billed Charges at 50% = $639.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTICATH OXIMETRY 8FR,272,RC,,,,,,,,both,,,1279.8900,191.9800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,413.40,,,,,,,330.3400,1279.8900,other,"32.3% of $1,279.89 in Billed Charges for Rev 272 = $413.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH OPTICATH OXIMETRY 8FR,272,RC,,,,,,,,both,,,1279.8900,191.9800,UNITED HEALTHCARE,UHC HERITAGE SELECT,392.93,,,,,,,330.3400,1279.8900,other,"30.7% of $1,279.89 in Billed Charges for Rev 272 = $392.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH OPTICATH OXIMETRY 8FR,272,RC,,,,,,,,both,,,1279.8900,191.9800,UNITED HEALTHCARE,UNITED HEALTHCARE,413.40,,,,,,,330.3400,1279.8900,percent of total billed charges,"32.3% of $1,279.89 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTICATH OXIMETRY 8FR,272,RC,,,,,,,,both,,,1279.8900,191.9800,WELLCARE,WELLCARE MEDICAID,1279.89,,,,,,,330.3400,1279.8900,percent of total billed charges,"100% of $1,279.89 in Billed Charges for Rev 272 = $1,279.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1982.4200,297.3600,AETNA,AETNA,846.49,,,,,,,511.6600,1982.4200,percent of total billed charges,"42.7% of $1,982.42 in Billed Charges for Rev 272 = $846.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1982.4200,297.3600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1387.69,,,,,,,511.6600,1982.4200,percent of total billed charges,"Rev 272 $1,982.42 in Billed Charges at 70% = $1,387.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1982.4200,297.3600,CIGNA HEALTHCARE,CIGNA HMO,826.67,,,,,,,511.6600,1982.4200,percent of total billed charges,"41.7% of $1,982.42 in Billed Charges for Rev 272 = $826.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1982.4200,297.3600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,919.84,,,,,,,511.6600,1982.4200,percent of total billed charges,"46.4% of $1,982.42 in Billed Charges for Rev 272 = $919.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1982.4200,297.3600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,826.67,,,,,,,511.6600,1982.4200,percent of total billed charges,"41.7% of $1,982.42 in Billed Charges for Rev 272 = $826.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1982.4200,297.3600,CIGNA HEALTHCARE,CIGNA PPO,826.67,,,,,,,511.6600,1982.4200,percent of total billed charges,"41.7% of $1,982.42 in Billed Charges for Rev 272 = $826.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1982.4200,297.3600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1784.18,,,,,,,511.6600,1982.4200,percent of total billed charges,"90% of $1,982.42 in Billed Charges for Rev 272 = $1,784.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1982.4200,297.3600,MEDCOST,MEDCOST VHN,943.43,,,,,,,511.6600,1982.4200,percent of total billed charges,"47.59% of $1,982.42 in Billed Charges for Rev 272 = $943.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1982.4200,297.3600,SENTARA HEALTH,SENTARA HEALTH,511.66,,,,,,,511.6600,1982.4200,percent of total billed charges,"25.81% of $1,982.42 in Billed Charges for Rev 272 = $511.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1982.4200,297.3600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1982.42,,,,,,,511.6600,1982.4200,percent of total billed charges,"100% of $1,982.42 in Billed Charges for Rev 272 = $1,982.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1982.4200,297.3600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,991.21,,,,,,,511.6600,1982.4200,percent of total billed charges,"Rev 272 $1,982.42 in Billed Charges at 50% = $991.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1982.4200,297.3600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,640.32,,,,,,,511.6600,1982.4200,other,"32.3% of $1,982.42 in Billed Charges for Rev 272 = $640.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1982.4200,297.3600,UNITED HEALTHCARE,UHC HERITAGE SELECT,608.60,,,,,,,511.6600,1982.4200,other,"30.7% of $1,982.42 in Billed Charges for Rev 272 = $608.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1982.4200,297.3600,UNITED HEALTHCARE,UNITED HEALTHCARE,640.32,,,,,,,511.6600,1982.4200,percent of total billed charges,"32.3% of $1,982.42 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1982.4200,297.3600,WELLCARE,WELLCARE MEDICAID,1982.42,,,,,,,511.6600,1982.4200,percent of total billed charges,"100% of $1,982.42 in Billed Charges for Rev 272 = $1,982.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BLADE DIEGO POWER 70138025,272,RC,,,,,,,,both,,,10208.4900,1531.2700,AETNA,AETNA,4359.03,,,,,,,2634.8100,10208.4900,percent of total billed charges,"42.7% of $10,208.49 in Billed Charges for Rev 272 = $4,359.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BLADE DIEGO POWER 70138025,272,RC,,,,,,,,both,,,10208.4900,1531.2700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7145.94,,,,,,,2634.8100,10208.4900,percent of total billed charges,"Rev 272 $10,208.49 in Billed Charges at 70% = $7,145.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BLADE DIEGO POWER 70138025,272,RC,,,,,,,,both,,,10208.4900,1531.2700,CIGNA HEALTHCARE,CIGNA HMO,4256.94,,,,,,,2634.8100,10208.4900,percent of total billed charges,"41.7% of $10,208.49 in Billed Charges for Rev 272 = $4,256.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BLADE DIEGO POWER 70138025,272,RC,,,,,,,,both,,,10208.4900,1531.2700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4736.74,,,,,,,2634.8100,10208.4900,percent of total billed charges,"46.4% of $10,208.49 in Billed Charges for Rev 272 = $4,736.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BLADE DIEGO POWER 70138025,272,RC,,,,,,,,both,,,10208.4900,1531.2700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4256.94,,,,,,,2634.8100,10208.4900,percent of total billed charges,"41.7% of $10,208.49 in Billed Charges for Rev 272 = $4,256.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BLADE DIEGO POWER 70138025,272,RC,,,,,,,,both,,,10208.4900,1531.2700,CIGNA HEALTHCARE,CIGNA PPO,4256.94,,,,,,,2634.8100,10208.4900,percent of total billed charges,"41.7% of $10,208.49 in Billed Charges for Rev 272 = $4,256.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BLADE DIEGO POWER 70138025,272,RC,,,,,,,,both,,,10208.4900,1531.2700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9187.64,,,,,,,2634.8100,10208.4900,percent of total billed charges,"90% of $10,208.49 in Billed Charges for Rev 272 = $9,187.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BLADE DIEGO POWER 70138025,272,RC,,,,,,,,both,,,10208.4900,1531.2700,MEDCOST,MEDCOST VHN,4858.22,,,,,,,2634.8100,10208.4900,percent of total billed charges,"47.59% of $10,208.49 in Billed Charges for Rev 272 = $4,858.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BLADE DIEGO POWER 70138025,272,RC,,,,,,,,both,,,10208.4900,1531.2700,SENTARA HEALTH,SENTARA HEALTH,2634.81,,,,,,,2634.8100,10208.4900,percent of total billed charges,"25.81% of $10,208.49 in Billed Charges for Rev 272 = $2,634.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BLADE DIEGO POWER 70138025,272,RC,,,,,,,,both,,,10208.4900,1531.2700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10208.49,,,,,,,2634.8100,10208.4900,percent of total billed charges,"100% of $10,208.49 in Billed Charges for Rev 272 = $10,208.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BLADE DIEGO POWER 70138025,272,RC,,,,,,,,both,,,10208.4900,1531.2700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5104.25,,,,,,,2634.8100,10208.4900,percent of total billed charges,"Rev 272 $10,208.49 in Billed Charges at 50% = $5,104.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BLADE DIEGO POWER 70138025,272,RC,,,,,,,,both,,,10208.4900,1531.2700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3297.34,,,,,,,2634.8100,10208.4900,other,"32.3% of $10,208.49 in Billed Charges for Rev 272 = $3,297.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DISSECTOR BLADE DIEGO POWER 70138025,272,RC,,,,,,,,both,,,10208.4900,1531.2700,UNITED HEALTHCARE,UHC HERITAGE SELECT,3134.01,,,,,,,2634.8100,10208.4900,other,"30.7% of $10,208.49 in Billed Charges for Rev 272 = $3,134.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DISSECTOR BLADE DIEGO POWER 70138025,272,RC,,,,,,,,both,,,10208.4900,1531.2700,UNITED HEALTHCARE,UNITED HEALTHCARE,3297.34,,,,,,,2634.8100,10208.4900,percent of total billed charges,"32.3% of $10,208.49 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR BLADE DIEGO POWER 70138025,272,RC,,,,,,,,both,,,10208.4900,1531.2700,WELLCARE,WELLCARE MEDICAID,10208.49,,,,,,,2634.8100,10208.4900,percent of total billed charges,"100% of $10,208.49 in Billed Charges for Rev 272 = $10,208.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR LIGASURE EXACT,272,RC,27200002,CDM,,,,,,both,,,5172.5400,775.8800,AETNA,AETNA,2208.67,,,,,,,1335.0300,5172.5400,percent of total billed charges,"42.7% of $5,172.54 in Billed Charges for Rev 272 = $2,208.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR LIGASURE EXACT,272,RC,27200002,CDM,,,,,,both,,,5172.5400,775.8800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3620.78,,,,,,,1335.0300,5172.5400,percent of total billed charges,"Rev 272 $5,172.54 in Billed Charges at 70% = $3,620.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR LIGASURE EXACT,272,RC,27200002,CDM,,,,,,both,,,5172.5400,775.8800,CIGNA HEALTHCARE,CIGNA HMO,2156.95,,,,,,,1335.0300,5172.5400,percent of total billed charges,"41.7% of $5,172.54 in Billed Charges for Rev 272 = $2,156.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR LIGASURE EXACT,272,RC,27200002,CDM,,,,,,both,,,5172.5400,775.8800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2400.06,,,,,,,1335.0300,5172.5400,percent of total billed charges,"46.4% of $5,172.54 in Billed Charges for Rev 272 = $2,400.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR LIGASURE EXACT,272,RC,27200002,CDM,,,,,,both,,,5172.5400,775.8800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2156.95,,,,,,,1335.0300,5172.5400,percent of total billed charges,"41.7% of $5,172.54 in Billed Charges for Rev 272 = $2,156.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR LIGASURE EXACT,272,RC,27200002,CDM,,,,,,both,,,5172.5400,775.8800,CIGNA HEALTHCARE,CIGNA PPO,2156.95,,,,,,,1335.0300,5172.5400,percent of total billed charges,"41.7% of $5,172.54 in Billed Charges for Rev 272 = $2,156.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR LIGASURE EXACT,272,RC,27200002,CDM,,,,,,both,,,5172.5400,775.8800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4655.29,,,,,,,1335.0300,5172.5400,percent of total billed charges,"90% of $5,172.54 in Billed Charges for Rev 272 = $4,655.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR LIGASURE EXACT,272,RC,27200002,CDM,,,,,,both,,,5172.5400,775.8800,MEDCOST,MEDCOST VHN,2461.61,,,,,,,1335.0300,5172.5400,percent of total billed charges,"47.59% of $5,172.54 in Billed Charges for Rev 272 = $2,461.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR LIGASURE EXACT,272,RC,27200002,CDM,,,,,,both,,,5172.5400,775.8800,SENTARA HEALTH,SENTARA HEALTH,1335.03,,,,,,,1335.0300,5172.5400,percent of total billed charges,"25.81% of $5,172.54 in Billed Charges for Rev 272 = $1,335.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR LIGASURE EXACT,272,RC,27200002,CDM,,,,,,both,,,5172.5400,775.8800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5172.54,,,,,,,1335.0300,5172.5400,percent of total billed charges,"100% of $5,172.54 in Billed Charges for Rev 272 = $5,172.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR LIGASURE EXACT,272,RC,27200002,CDM,,,,,,both,,,5172.5400,775.8800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2586.27,,,,,,,1335.0300,5172.5400,percent of total billed charges,"Rev 272 $5,172.54 in Billed Charges at 50% = $2,586.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR LIGASURE EXACT,272,RC,27200002,CDM,,,,,,both,,,5172.5400,775.8800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1670.73,,,,,,,1335.0300,5172.5400,other,"32.3% of $5,172.54 in Billed Charges for Rev 272 = $1,670.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DISSECTOR LIGASURE EXACT,272,RC,27200002,CDM,,,,,,both,,,5172.5400,775.8800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1587.97,,,,,,,1335.0300,5172.5400,other,"30.7% of $5,172.54 in Billed Charges for Rev 272 = $1,587.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DISSECTOR LIGASURE EXACT,272,RC,27200002,CDM,,,,,,both,,,5172.5400,775.8800,UNITED HEALTHCARE,UNITED HEALTHCARE,1670.73,,,,,,,1335.0300,5172.5400,percent of total billed charges,"32.3% of $5,172.54 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR LIGASURE EXACT,272,RC,27200002,CDM,,,,,,both,,,5172.5400,775.8800,WELLCARE,WELLCARE MEDICAID,5172.54,,,,,,,1335.0300,5172.5400,percent of total billed charges,"100% of $5,172.54 in Billed Charges for Rev 272 = $5,172.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR LOGICUT 320MM,272,RC,27200002,CDM,,,,,,both,,,773.9300,116.0900,AETNA,AETNA,330.47,,,,,,,199.7500,773.9300,percent of total billed charges,42.7% of $773.93 in Billed Charges for Rev 272 = $330.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISSECTOR LOGICUT 320MM,272,RC,27200002,CDM,,,,,,both,,,773.9300,116.0900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,541.75,,,,,,,199.7500,773.9300,percent of total billed charges,Rev 272 $773.93 in Billed Charges at 70% = $541.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISSECTOR LOGICUT 320MM,272,RC,27200002,CDM,,,,,,both,,,773.9300,116.0900,CIGNA HEALTHCARE,CIGNA HMO,322.73,,,,,,,199.7500,773.9300,percent of total billed charges,41.7% of $773.93 in Billed Charges for Rev 272 = $322.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISSECTOR LOGICUT 320MM,272,RC,27200002,CDM,,,,,,both,,,773.9300,116.0900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,359.10,,,,,,,199.7500,773.9300,percent of total billed charges,46.4% of $773.93 in Billed Charges for Rev 272 = $359.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISSECTOR LOGICUT 320MM,272,RC,27200002,CDM,,,,,,both,,,773.9300,116.0900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,322.73,,,,,,,199.7500,773.9300,percent of total billed charges,41.7% of $773.93 in Billed Charges for Rev 272 = $322.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISSECTOR LOGICUT 320MM,272,RC,27200002,CDM,,,,,,both,,,773.9300,116.0900,CIGNA HEALTHCARE,CIGNA PPO,322.73,,,,,,,199.7500,773.9300,percent of total billed charges,41.7% of $773.93 in Billed Charges for Rev 272 = $322.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISSECTOR LOGICUT 320MM,272,RC,27200002,CDM,,,,,,both,,,773.9300,116.0900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,696.54,,,,,,,199.7500,773.9300,percent of total billed charges,90% of $773.93 in Billed Charges for Rev 272 = $696.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISSECTOR LOGICUT 320MM,272,RC,27200002,CDM,,,,,,both,,,773.9300,116.0900,MEDCOST,MEDCOST VHN,368.31,,,,,,,199.7500,773.9300,percent of total billed charges,47.59% of $773.93 in Billed Charges for Rev 272 = $368.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISSECTOR LOGICUT 320MM,272,RC,27200002,CDM,,,,,,both,,,773.9300,116.0900,SENTARA HEALTH,SENTARA HEALTH,199.75,,,,,,,199.7500,773.9300,percent of total billed charges,25.81% of $773.93 in Billed Charges for Rev 272 = $199.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISSECTOR LOGICUT 320MM,272,RC,27200002,CDM,,,,,,both,,,773.9300,116.0900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",773.93,,,,,,,199.7500,773.9300,percent of total billed charges,100% of $773.93 in Billed Charges for Rev 272 = $773.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISSECTOR LOGICUT 320MM,272,RC,27200002,CDM,,,,,,both,,,773.9300,116.0900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,386.97,,,,,,,199.7500,773.9300,percent of total billed charges,Rev 272 $773.93 in Billed Charges at 50% = $386.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISSECTOR LOGICUT 320MM,272,RC,27200002,CDM,,,,,,both,,,773.9300,116.0900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,249.98,,,,,,,199.7500,773.9300,other,32.3% of $773.93 in Billed Charges for Rev 272 = $249.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DISSECTOR LOGICUT 320MM,272,RC,27200002,CDM,,,,,,both,,,773.9300,116.0900,UNITED HEALTHCARE,UHC HERITAGE SELECT,237.60,,,,,,,199.7500,773.9300,other,30.7% of $773.93 in Billed Charges for Rev 272 = $237.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DISSECTOR LOGICUT 320MM,272,RC,27200002,CDM,,,,,,both,,,773.9300,116.0900,UNITED HEALTHCARE,UNITED HEALTHCARE,249.98,,,,,,,199.7500,773.9300,percent of total billed charges,32.3% of $773.93 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISSECTOR LOGICUT 320MM,272,RC,27200002,CDM,,,,,,both,,,773.9300,116.0900,WELLCARE,WELLCARE MEDICAID,773.93,,,,,,,199.7500,773.9300,percent of total billed charges,100% of $773.93 in Billed Charges for Rev 272 = $773.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISSECTOR MARYLAND DAVINCI,272,RC,27200002,CDM,,,,,,both,,,1415.6400,212.3500,AETNA,AETNA,604.48,,,,,,,365.3800,1415.6400,percent of total billed charges,"42.7% of $1,415.64 in Billed Charges for Rev 272 = $604.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR MARYLAND DAVINCI,272,RC,27200002,CDM,,,,,,both,,,1415.6400,212.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,990.95,,,,,,,365.3800,1415.6400,percent of total billed charges,"Rev 272 $1,415.64 in Billed Charges at 70% = $990.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR MARYLAND DAVINCI,272,RC,27200002,CDM,,,,,,both,,,1415.6400,212.3500,CIGNA HEALTHCARE,CIGNA HMO,590.32,,,,,,,365.3800,1415.6400,percent of total billed charges,"41.7% of $1,415.64 in Billed Charges for Rev 272 = $590.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR MARYLAND DAVINCI,272,RC,27200002,CDM,,,,,,both,,,1415.6400,212.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,656.86,,,,,,,365.3800,1415.6400,percent of total billed charges,"46.4% of $1,415.64 in Billed Charges for Rev 272 = $656.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR MARYLAND DAVINCI,272,RC,27200002,CDM,,,,,,both,,,1415.6400,212.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,590.32,,,,,,,365.3800,1415.6400,percent of total billed charges,"41.7% of $1,415.64 in Billed Charges for Rev 272 = $590.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR MARYLAND DAVINCI,272,RC,27200002,CDM,,,,,,both,,,1415.6400,212.3500,CIGNA HEALTHCARE,CIGNA PPO,590.32,,,,,,,365.3800,1415.6400,percent of total billed charges,"41.7% of $1,415.64 in Billed Charges for Rev 272 = $590.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR MARYLAND DAVINCI,272,RC,27200002,CDM,,,,,,both,,,1415.6400,212.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1274.08,,,,,,,365.3800,1415.6400,percent of total billed charges,"90% of $1,415.64 in Billed Charges for Rev 272 = $1,274.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR MARYLAND DAVINCI,272,RC,27200002,CDM,,,,,,both,,,1415.6400,212.3500,MEDCOST,MEDCOST VHN,673.70,,,,,,,365.3800,1415.6400,percent of total billed charges,"47.59% of $1,415.64 in Billed Charges for Rev 272 = $673.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR MARYLAND DAVINCI,272,RC,27200002,CDM,,,,,,both,,,1415.6400,212.3500,SENTARA HEALTH,SENTARA HEALTH,365.38,,,,,,,365.3800,1415.6400,percent of total billed charges,"25.81% of $1,415.64 in Billed Charges for Rev 272 = $365.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR MARYLAND DAVINCI,272,RC,27200002,CDM,,,,,,both,,,1415.6400,212.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1415.64,,,,,,,365.3800,1415.6400,percent of total billed charges,"100% of $1,415.64 in Billed Charges for Rev 272 = $1,415.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR MARYLAND DAVINCI,272,RC,27200002,CDM,,,,,,both,,,1415.6400,212.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,707.82,,,,,,,365.3800,1415.6400,percent of total billed charges,"Rev 272 $1,415.64 in Billed Charges at 50% = $707.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR MARYLAND DAVINCI,272,RC,27200002,CDM,,,,,,both,,,1415.6400,212.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,457.25,,,,,,,365.3800,1415.6400,other,"32.3% of $1,415.64 in Billed Charges for Rev 272 = $457.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DISSECTOR MARYLAND DAVINCI,272,RC,27200002,CDM,,,,,,both,,,1415.6400,212.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,434.60,,,,,,,365.3800,1415.6400,other,"30.7% of $1,415.64 in Billed Charges for Rev 272 = $434.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DISSECTOR MARYLAND DAVINCI,272,RC,27200002,CDM,,,,,,both,,,1415.6400,212.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,457.25,,,,,,,365.3800,1415.6400,percent of total billed charges,"32.3% of $1,415.64 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISSECTOR MARYLAND DAVINCI,272,RC,27200002,CDM,,,,,,both,,,1415.6400,212.3500,WELLCARE,WELLCARE MEDICAID,1415.64,,,,,,,365.3800,1415.6400,percent of total billed charges,"100% of $1,415.64 in Billed Charges for Rev 272 = $1,415.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLABLE 60CM,272,RC,,,,,,,,both,,,1433.5300,215.0300,AETNA,AETNA,612.12,,,,,,,369.9900,1433.5300,percent of total billed charges,"42.7% of $1,433.53 in Billed Charges for Rev 272 = $612.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLABLE 60CM,272,RC,,,,,,,,both,,,1433.5300,215.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1003.47,,,,,,,369.9900,1433.5300,percent of total billed charges,"Rev 272 $1,433.53 in Billed Charges at 70% = $1,003.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLABLE 60CM,272,RC,,,,,,,,both,,,1433.5300,215.0300,CIGNA HEALTHCARE,CIGNA HMO,597.78,,,,,,,369.9900,1433.5300,percent of total billed charges,"41.7% of $1,433.53 in Billed Charges for Rev 272 = $597.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLABLE 60CM,272,RC,,,,,,,,both,,,1433.5300,215.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,665.16,,,,,,,369.9900,1433.5300,percent of total billed charges,"46.4% of $1,433.53 in Billed Charges for Rev 272 = $665.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLABLE 60CM,272,RC,,,,,,,,both,,,1433.5300,215.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,597.78,,,,,,,369.9900,1433.5300,percent of total billed charges,"41.7% of $1,433.53 in Billed Charges for Rev 272 = $597.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLABLE 60CM,272,RC,,,,,,,,both,,,1433.5300,215.0300,CIGNA HEALTHCARE,CIGNA PPO,597.78,,,,,,,369.9900,1433.5300,percent of total billed charges,"41.7% of $1,433.53 in Billed Charges for Rev 272 = $597.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLABLE 60CM,272,RC,,,,,,,,both,,,1433.5300,215.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1290.18,,,,,,,369.9900,1433.5300,percent of total billed charges,"90% of $1,433.53 in Billed Charges for Rev 272 = $1,290.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLABLE 60CM,272,RC,,,,,,,,both,,,1433.5300,215.0300,MEDCOST,MEDCOST VHN,682.22,,,,,,,369.9900,1433.5300,percent of total billed charges,"47.59% of $1,433.53 in Billed Charges for Rev 272 = $682.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLABLE 60CM,272,RC,,,,,,,,both,,,1433.5300,215.0300,SENTARA HEALTH,SENTARA HEALTH,369.99,,,,,,,369.9900,1433.5300,percent of total billed charges,"25.81% of $1,433.53 in Billed Charges for Rev 272 = $369.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLABLE 60CM,272,RC,,,,,,,,both,,,1433.5300,215.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1433.53,,,,,,,369.9900,1433.5300,percent of total billed charges,"100% of $1,433.53 in Billed Charges for Rev 272 = $1,433.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLABLE 60CM,272,RC,,,,,,,,both,,,1433.5300,215.0300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,716.77,,,,,,,369.9900,1433.5300,percent of total billed charges,"Rev 272 $1,433.53 in Billed Charges at 50% = $716.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLABLE 60CM,272,RC,,,,,,,,both,,,1433.5300,215.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,463.03,,,,,,,369.9900,1433.5300,other,"32.3% of $1,433.53 in Billed Charges for Rev 272 = $463.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH PASSER MALLABLE 60CM,272,RC,,,,,,,,both,,,1433.5300,215.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,440.09,,,,,,,369.9900,1433.5300,other,"30.7% of $1,433.53 in Billed Charges for Rev 272 = $440.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH PASSER MALLABLE 60CM,272,RC,,,,,,,,both,,,1433.5300,215.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,463.03,,,,,,,369.9900,1433.5300,percent of total billed charges,"32.3% of $1,433.53 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLABLE 60CM,272,RC,,,,,,,,both,,,1433.5300,215.0300,WELLCARE,WELLCARE MEDICAID,1433.53,,,,,,,369.9900,1433.5300,percent of total billed charges,"100% of $1,433.53 in Billed Charges for Rev 272 = $1,433.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,866.1900,129.9300,AETNA,AETNA,369.86,,,,,,,223.5600,866.1900,percent of total billed charges,42.7% of $866.19 in Billed Charges for Rev 272 = $369.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,866.1900,129.9300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,606.33,,,,,,,223.5600,866.1900,percent of total billed charges,Rev 272 $866.19 in Billed Charges at 70% = $606.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,866.1900,129.9300,CIGNA HEALTHCARE,CIGNA HMO,361.20,,,,,,,223.5600,866.1900,percent of total billed charges,41.7% of $866.19 in Billed Charges for Rev 272 = $361.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,866.1900,129.9300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,401.91,,,,,,,223.5600,866.1900,percent of total billed charges,46.4% of $866.19 in Billed Charges for Rev 272 = $401.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,866.1900,129.9300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,361.20,,,,,,,223.5600,866.1900,percent of total billed charges,41.7% of $866.19 in Billed Charges for Rev 272 = $361.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,866.1900,129.9300,CIGNA HEALTHCARE,CIGNA PPO,361.20,,,,,,,223.5600,866.1900,percent of total billed charges,41.7% of $866.19 in Billed Charges for Rev 272 = $361.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,866.1900,129.9300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,779.57,,,,,,,223.5600,866.1900,percent of total billed charges,90% of $866.19 in Billed Charges for Rev 272 = $779.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,866.1900,129.9300,MEDCOST,MEDCOST VHN,412.22,,,,,,,223.5600,866.1900,percent of total billed charges,47.59% of $866.19 in Billed Charges for Rev 272 = $412.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,866.1900,129.9300,SENTARA HEALTH,SENTARA HEALTH,223.56,,,,,,,223.5600,866.1900,percent of total billed charges,25.81% of $866.19 in Billed Charges for Rev 272 = $223.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,866.1900,129.9300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",866.19,,,,,,,223.5600,866.1900,percent of total billed charges,100% of $866.19 in Billed Charges for Rev 272 = $866.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,866.1900,129.9300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,433.10,,,,,,,223.5600,866.1900,percent of total billed charges,Rev 272 $866.19 in Billed Charges at 50% = $433.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,866.1900,129.9300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,279.78,,,,,,,223.5600,866.1900,other,32.3% of $866.19 in Billed Charges for Rev 272 = $279.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,866.1900,129.9300,UNITED HEALTHCARE,UHC HERITAGE SELECT,265.92,,,,,,,223.5600,866.1900,other,30.7% of $866.19 in Billed Charges for Rev 272 = $265.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,866.1900,129.9300,UNITED HEALTHCARE,UNITED HEALTHCARE,279.78,,,,,,,223.5600,866.1900,percent of total billed charges,32.3% of $866.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,866.1900,129.9300,WELLCARE,WELLCARE MEDICAID,866.19,,,,,,,223.5600,866.1900,percent of total billed charges,100% of $866.19 in Billed Charges for Rev 272 = $866.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR VERSACROSS FARADRIVE 180J,272,RC,27200002,CDM,,,,,,both,,,6199.7800,929.9700,AETNA,AETNA,2647.31,,,,,,,1600.1600,6199.7800,percent of total billed charges,"42.7% of $6,199.78 in Billed Charges for Rev 272 = $2,647.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR VERSACROSS FARADRIVE 180J,272,RC,27200002,CDM,,,,,,both,,,6199.7800,929.9700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4339.85,,,,,,,1600.1600,6199.7800,percent of total billed charges,"Rev 272 $6,199.78 in Billed Charges at 70% = $4,339.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR VERSACROSS FARADRIVE 180J,272,RC,27200002,CDM,,,,,,both,,,6199.7800,929.9700,CIGNA HEALTHCARE,CIGNA HMO,2585.31,,,,,,,1600.1600,6199.7800,percent of total billed charges,"41.7% of $6,199.78 in Billed Charges for Rev 272 = $2,585.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR VERSACROSS FARADRIVE 180J,272,RC,27200002,CDM,,,,,,both,,,6199.7800,929.9700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2876.70,,,,,,,1600.1600,6199.7800,percent of total billed charges,"46.4% of $6,199.78 in Billed Charges for Rev 272 = $2,876.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR VERSACROSS FARADRIVE 180J,272,RC,27200002,CDM,,,,,,both,,,6199.7800,929.9700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2585.31,,,,,,,1600.1600,6199.7800,percent of total billed charges,"41.7% of $6,199.78 in Billed Charges for Rev 272 = $2,585.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR VERSACROSS FARADRIVE 180J,272,RC,27200002,CDM,,,,,,both,,,6199.7800,929.9700,CIGNA HEALTHCARE,CIGNA PPO,2585.31,,,,,,,1600.1600,6199.7800,percent of total billed charges,"41.7% of $6,199.78 in Billed Charges for Rev 272 = $2,585.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR VERSACROSS FARADRIVE 180J,272,RC,27200002,CDM,,,,,,both,,,6199.7800,929.9700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5579.80,,,,,,,1600.1600,6199.7800,percent of total billed charges,"90% of $6,199.78 in Billed Charges for Rev 272 = $5,579.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR VERSACROSS FARADRIVE 180J,272,RC,27200002,CDM,,,,,,both,,,6199.7800,929.9700,MEDCOST,MEDCOST VHN,2950.48,,,,,,,1600.1600,6199.7800,percent of total billed charges,"47.59% of $6,199.78 in Billed Charges for Rev 272 = $2,950.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR VERSACROSS FARADRIVE 180J,272,RC,27200002,CDM,,,,,,both,,,6199.7800,929.9700,SENTARA HEALTH,SENTARA HEALTH,1600.16,,,,,,,1600.1600,6199.7800,percent of total billed charges,"25.81% of $6,199.78 in Billed Charges for Rev 272 = $1,600.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR VERSACROSS FARADRIVE 180J,272,RC,27200002,CDM,,,,,,both,,,6199.7800,929.9700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6199.78,,,,,,,1600.1600,6199.7800,percent of total billed charges,"100% of $6,199.78 in Billed Charges for Rev 272 = $6,199.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR VERSACROSS FARADRIVE 180J,272,RC,27200002,CDM,,,,,,both,,,6199.7800,929.9700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3099.89,,,,,,,1600.1600,6199.7800,percent of total billed charges,"Rev 272 $6,199.78 in Billed Charges at 50% = $3,099.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR VERSACROSS FARADRIVE 180J,272,RC,27200002,CDM,,,,,,both,,,6199.7800,929.9700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2002.53,,,,,,,1600.1600,6199.7800,other,"32.3% of $6,199.78 in Billed Charges for Rev 272 = $2,002.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CONNECTOR VERSACROSS FARADRIVE 180J,272,RC,27200002,CDM,,,,,,both,,,6199.7800,929.9700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1903.33,,,,,,,1600.1600,6199.7800,other,"30.7% of $6,199.78 in Billed Charges for Rev 272 = $1,903.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CONNECTOR VERSACROSS FARADRIVE 180J,272,RC,27200002,CDM,,,,,,both,,,6199.7800,929.9700,UNITED HEALTHCARE,UNITED HEALTHCARE,2002.53,,,,,,,1600.1600,6199.7800,percent of total billed charges,"32.3% of $6,199.78 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR VERSACROSS FARADRIVE 180J,272,RC,27200002,CDM,,,,,,both,,,6199.7800,929.9700,WELLCARE,WELLCARE MEDICAID,6199.78,,,,,,,1600.1600,6199.7800,percent of total billed charges,"100% of $6,199.78 in Billed Charges for Rev 272 = $6,199.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING  PREVENA RESTOR 46 X 30 CM INCISION MANAGEMENT SYSTEM WITH ARTHRO-FORM,272,RC,27200002,CDM,,,,,,both,,,7700.4700,1155.0700,AETNA,AETNA,3288.10,,,,,,,1987.4900,7700.4700,percent of total billed charges,"42.7% of $7,700.47 in Billed Charges for Rev 272 = $3,288.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING  PREVENA RESTOR 46 X 30 CM INCISION MANAGEMENT SYSTEM WITH ARTHRO-FORM,272,RC,27200002,CDM,,,,,,both,,,7700.4700,1155.0700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5390.33,,,,,,,1987.4900,7700.4700,percent of total billed charges,"Rev 272 $7,700.47 in Billed Charges at 70% = $5,390.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING  PREVENA RESTOR 46 X 30 CM INCISION MANAGEMENT SYSTEM WITH ARTHRO-FORM,272,RC,27200002,CDM,,,,,,both,,,7700.4700,1155.0700,CIGNA HEALTHCARE,CIGNA HMO,3211.10,,,,,,,1987.4900,7700.4700,percent of total billed charges,"41.7% of $7,700.47 in Billed Charges for Rev 272 = $3,211.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING  PREVENA RESTOR 46 X 30 CM INCISION MANAGEMENT SYSTEM WITH ARTHRO-FORM,272,RC,27200002,CDM,,,,,,both,,,7700.4700,1155.0700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3573.02,,,,,,,1987.4900,7700.4700,percent of total billed charges,"46.4% of $7,700.47 in Billed Charges for Rev 272 = $3,573.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING  PREVENA RESTOR 46 X 30 CM INCISION MANAGEMENT SYSTEM WITH ARTHRO-FORM,272,RC,27200002,CDM,,,,,,both,,,7700.4700,1155.0700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3211.10,,,,,,,1987.4900,7700.4700,percent of total billed charges,"41.7% of $7,700.47 in Billed Charges for Rev 272 = $3,211.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING  PREVENA RESTOR 46 X 30 CM INCISION MANAGEMENT SYSTEM WITH ARTHRO-FORM,272,RC,27200002,CDM,,,,,,both,,,7700.4700,1155.0700,CIGNA HEALTHCARE,CIGNA PPO,3211.10,,,,,,,1987.4900,7700.4700,percent of total billed charges,"41.7% of $7,700.47 in Billed Charges for Rev 272 = $3,211.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING  PREVENA RESTOR 46 X 30 CM INCISION MANAGEMENT SYSTEM WITH ARTHRO-FORM,272,RC,27200002,CDM,,,,,,both,,,7700.4700,1155.0700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6930.42,,,,,,,1987.4900,7700.4700,percent of total billed charges,"90% of $7,700.47 in Billed Charges for Rev 272 = $6,930.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING  PREVENA RESTOR 46 X 30 CM INCISION MANAGEMENT SYSTEM WITH ARTHRO-FORM,272,RC,27200002,CDM,,,,,,both,,,7700.4700,1155.0700,MEDCOST,MEDCOST VHN,3664.65,,,,,,,1987.4900,7700.4700,percent of total billed charges,"47.59% of $7,700.47 in Billed Charges for Rev 272 = $3,664.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING  PREVENA RESTOR 46 X 30 CM INCISION MANAGEMENT SYSTEM WITH ARTHRO-FORM,272,RC,27200002,CDM,,,,,,both,,,7700.4700,1155.0700,SENTARA HEALTH,SENTARA HEALTH,1987.49,,,,,,,1987.4900,7700.4700,percent of total billed charges,"25.81% of $7,700.47 in Billed Charges for Rev 272 = $1,987.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING  PREVENA RESTOR 46 X 30 CM INCISION MANAGEMENT SYSTEM WITH ARTHRO-FORM,272,RC,27200002,CDM,,,,,,both,,,7700.4700,1155.0700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7700.47,,,,,,,1987.4900,7700.4700,percent of total billed charges,"100% of $7,700.47 in Billed Charges for Rev 272 = $7,700.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING  PREVENA RESTOR 46 X 30 CM INCISION MANAGEMENT SYSTEM WITH ARTHRO-FORM,272,RC,27200002,CDM,,,,,,both,,,7700.4700,1155.0700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3850.24,,,,,,,1987.4900,7700.4700,percent of total billed charges,"Rev 272 $7,700.47 in Billed Charges at 50% = $3,850.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING  PREVENA RESTOR 46 X 30 CM INCISION MANAGEMENT SYSTEM WITH ARTHRO-FORM,272,RC,27200002,CDM,,,,,,both,,,7700.4700,1155.0700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2487.25,,,,,,,1987.4900,7700.4700,other,"32.3% of $7,700.47 in Billed Charges for Rev 272 = $2,487.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING  PREVENA RESTOR 46 X 30 CM INCISION MANAGEMENT SYSTEM WITH ARTHRO-FORM,272,RC,27200002,CDM,,,,,,both,,,7700.4700,1155.0700,UNITED HEALTHCARE,UHC HERITAGE SELECT,2364.04,,,,,,,1987.4900,7700.4700,other,"30.7% of $7,700.47 in Billed Charges for Rev 272 = $2,364.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING  PREVENA RESTOR 46 X 30 CM INCISION MANAGEMENT SYSTEM WITH ARTHRO-FORM,272,RC,27200002,CDM,,,,,,both,,,7700.4700,1155.0700,UNITED HEALTHCARE,UNITED HEALTHCARE,2487.25,,,,,,,1987.4900,7700.4700,percent of total billed charges,"32.3% of $7,700.47 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING  PREVENA RESTOR 46 X 30 CM INCISION MANAGEMENT SYSTEM WITH ARTHRO-FORM,272,RC,27200002,CDM,,,,,,both,,,7700.4700,1155.0700,WELLCARE,WELLCARE MEDICAID,7700.47,,,,,,,1987.4900,7700.4700,percent of total billed charges,"100% of $7,700.47 in Billed Charges for Rev 272 = $7,700.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING ABDOMINAL V.A.C M8275080/5,272,RC,27200002,CDM,,,,,,both,,,3292.0700,493.8100,AETNA,AETNA,1405.71,,,,,,,849.6800,3292.0700,percent of total billed charges,"42.7% of $3,292.07 in Billed Charges for Rev 272 = $1,405.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING ABDOMINAL V.A.C M8275080/5,272,RC,27200002,CDM,,,,,,both,,,3292.0700,493.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2304.45,,,,,,,849.6800,3292.0700,percent of total billed charges,"Rev 272 $3,292.07 in Billed Charges at 70% = $2,304.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING ABDOMINAL V.A.C M8275080/5,272,RC,27200002,CDM,,,,,,both,,,3292.0700,493.8100,CIGNA HEALTHCARE,CIGNA HMO,1372.79,,,,,,,849.6800,3292.0700,percent of total billed charges,"41.7% of $3,292.07 in Billed Charges for Rev 272 = $1,372.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING ABDOMINAL V.A.C M8275080/5,272,RC,27200002,CDM,,,,,,both,,,3292.0700,493.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1527.52,,,,,,,849.6800,3292.0700,percent of total billed charges,"46.4% of $3,292.07 in Billed Charges for Rev 272 = $1,527.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING ABDOMINAL V.A.C M8275080/5,272,RC,27200002,CDM,,,,,,both,,,3292.0700,493.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1372.79,,,,,,,849.6800,3292.0700,percent of total billed charges,"41.7% of $3,292.07 in Billed Charges for Rev 272 = $1,372.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING ABDOMINAL V.A.C M8275080/5,272,RC,27200002,CDM,,,,,,both,,,3292.0700,493.8100,CIGNA HEALTHCARE,CIGNA PPO,1372.79,,,,,,,849.6800,3292.0700,percent of total billed charges,"41.7% of $3,292.07 in Billed Charges for Rev 272 = $1,372.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING ABDOMINAL V.A.C M8275080/5,272,RC,27200002,CDM,,,,,,both,,,3292.0700,493.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2962.86,,,,,,,849.6800,3292.0700,percent of total billed charges,"90% of $3,292.07 in Billed Charges for Rev 272 = $2,962.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING ABDOMINAL V.A.C M8275080/5,272,RC,27200002,CDM,,,,,,both,,,3292.0700,493.8100,MEDCOST,MEDCOST VHN,1566.70,,,,,,,849.6800,3292.0700,percent of total billed charges,"47.59% of $3,292.07 in Billed Charges for Rev 272 = $1,566.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING ABDOMINAL V.A.C M8275080/5,272,RC,27200002,CDM,,,,,,both,,,3292.0700,493.8100,SENTARA HEALTH,SENTARA HEALTH,849.68,,,,,,,849.6800,3292.0700,percent of total billed charges,"25.81% of $3,292.07 in Billed Charges for Rev 272 = $849.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING ABDOMINAL V.A.C M8275080/5,272,RC,27200002,CDM,,,,,,both,,,3292.0700,493.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3292.07,,,,,,,849.6800,3292.0700,percent of total billed charges,"100% of $3,292.07 in Billed Charges for Rev 272 = $3,292.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING ABDOMINAL V.A.C M8275080/5,272,RC,27200002,CDM,,,,,,both,,,3292.0700,493.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1646.04,,,,,,,849.6800,3292.0700,percent of total billed charges,"Rev 272 $3,292.07 in Billed Charges at 50% = $1,646.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING ABDOMINAL V.A.C M8275080/5,272,RC,27200002,CDM,,,,,,both,,,3292.0700,493.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1063.34,,,,,,,849.6800,3292.0700,other,"32.3% of $3,292.07 in Billed Charges for Rev 272 = $1,063.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING ABDOMINAL V.A.C M8275080/5,272,RC,27200002,CDM,,,,,,both,,,3292.0700,493.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1010.67,,,,,,,849.6800,3292.0700,other,"30.7% of $3,292.07 in Billed Charges for Rev 272 = $1,010.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING ABDOMINAL V.A.C M8275080/5,272,RC,27200002,CDM,,,,,,both,,,3292.0700,493.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,1063.34,,,,,,,849.6800,3292.0700,percent of total billed charges,"32.3% of $3,292.07 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING ABDOMINAL V.A.C M8275080/5,272,RC,27200002,CDM,,,,,,both,,,3292.0700,493.8100,WELLCARE,WELLCARE MEDICAID,3292.07,,,,,,,849.6800,3292.0700,percent of total billed charges,"100% of $3,292.07 in Billed Charges for Rev 272 = $3,292.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 23X100CM,272,RC,27200002,CDM,,,,,,both,,,2407.5200,361.1300,AETNA,AETNA,1028.01,,,,,,,621.3800,2407.5200,percent of total billed charges,"42.7% of $2,407.52 in Billed Charges for Rev 272 = $1,028.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 23X100CM,272,RC,27200002,CDM,,,,,,both,,,2407.5200,361.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1685.26,,,,,,,621.3800,2407.5200,percent of total billed charges,"Rev 272 $2,407.52 in Billed Charges at 70% = $1,685.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 23X100CM,272,RC,27200002,CDM,,,,,,both,,,2407.5200,361.1300,CIGNA HEALTHCARE,CIGNA HMO,1003.94,,,,,,,621.3800,2407.5200,percent of total billed charges,"41.7% of $2,407.52 in Billed Charges for Rev 272 = $1,003.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 23X100CM,272,RC,27200002,CDM,,,,,,both,,,2407.5200,361.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1117.09,,,,,,,621.3800,2407.5200,percent of total billed charges,"46.4% of $2,407.52 in Billed Charges for Rev 272 = $1,117.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 23X100CM,272,RC,27200002,CDM,,,,,,both,,,2407.5200,361.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1003.94,,,,,,,621.3800,2407.5200,percent of total billed charges,"41.7% of $2,407.52 in Billed Charges for Rev 272 = $1,003.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 23X100CM,272,RC,27200002,CDM,,,,,,both,,,2407.5200,361.1300,CIGNA HEALTHCARE,CIGNA PPO,1003.94,,,,,,,621.3800,2407.5200,percent of total billed charges,"41.7% of $2,407.52 in Billed Charges for Rev 272 = $1,003.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 23X100CM,272,RC,27200002,CDM,,,,,,both,,,2407.5200,361.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2166.77,,,,,,,621.3800,2407.5200,percent of total billed charges,"90% of $2,407.52 in Billed Charges for Rev 272 = $2,166.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 23X100CM,272,RC,27200002,CDM,,,,,,both,,,2407.5200,361.1300,MEDCOST,MEDCOST VHN,1145.74,,,,,,,621.3800,2407.5200,percent of total billed charges,"47.59% of $2,407.52 in Billed Charges for Rev 272 = $1,145.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 23X100CM,272,RC,27200002,CDM,,,,,,both,,,2407.5200,361.1300,SENTARA HEALTH,SENTARA HEALTH,621.38,,,,,,,621.3800,2407.5200,percent of total billed charges,"25.81% of $2,407.52 in Billed Charges for Rev 272 = $621.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 23X100CM,272,RC,27200002,CDM,,,,,,both,,,2407.5200,361.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2407.52,,,,,,,621.3800,2407.5200,percent of total billed charges,"100% of $2,407.52 in Billed Charges for Rev 272 = $2,407.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 23X100CM,272,RC,27200002,CDM,,,,,,both,,,2407.5200,361.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1203.76,,,,,,,621.3800,2407.5200,percent of total billed charges,"Rev 272 $2,407.52 in Billed Charges at 50% = $1,203.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 23X100CM,272,RC,27200002,CDM,,,,,,both,,,2407.5200,361.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,777.63,,,,,,,621.3800,2407.5200,other,"32.3% of $2,407.52 in Billed Charges for Rev 272 = $777.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING AQUACEL AG BURN 23X100CM,272,RC,27200002,CDM,,,,,,both,,,2407.5200,361.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,739.11,,,,,,,621.3800,2407.5200,other,"30.7% of $2,407.52 in Billed Charges for Rev 272 = $739.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING AQUACEL AG BURN 23X100CM,272,RC,27200002,CDM,,,,,,both,,,2407.5200,361.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,777.63,,,,,,,621.3800,2407.5200,percent of total billed charges,"32.3% of $2,407.52 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 23X100CM,272,RC,27200002,CDM,,,,,,both,,,2407.5200,361.1300,WELLCARE,WELLCARE MEDICAID,2407.52,,,,,,,621.3800,2407.5200,percent of total billed charges,"100% of $2,407.52 in Billed Charges for Rev 272 = $2,407.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 23X30CM,272,RC,27200002,CDM,,,,,,both,,,535.0000,80.2500,AETNA,AETNA,228.45,,,,,,,138.0800,535.0000,percent of total billed charges,42.7% of $535.00 in Billed Charges for Rev 272 = $228.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING AQUACEL AG BURN 23X30CM,272,RC,27200002,CDM,,,,,,both,,,535.0000,80.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,374.50,,,,,,,138.0800,535.0000,percent of total billed charges,Rev 272 $535.00 in Billed Charges at 70% = $374.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING AQUACEL AG BURN 23X30CM,272,RC,27200002,CDM,,,,,,both,,,535.0000,80.2500,CIGNA HEALTHCARE,CIGNA HMO,223.10,,,,,,,138.0800,535.0000,percent of total billed charges,41.7% of $535.00 in Billed Charges for Rev 272 = $223.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING AQUACEL AG BURN 23X30CM,272,RC,27200002,CDM,,,,,,both,,,535.0000,80.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,248.24,,,,,,,138.0800,535.0000,percent of total billed charges,46.4% of $535.00 in Billed Charges for Rev 272 = $248.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING AQUACEL AG BURN 23X30CM,272,RC,27200002,CDM,,,,,,both,,,535.0000,80.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,223.10,,,,,,,138.0800,535.0000,percent of total billed charges,41.7% of $535.00 in Billed Charges for Rev 272 = $223.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING AQUACEL AG BURN 23X30CM,272,RC,27200002,CDM,,,,,,both,,,535.0000,80.2500,CIGNA HEALTHCARE,CIGNA PPO,223.10,,,,,,,138.0800,535.0000,percent of total billed charges,41.7% of $535.00 in Billed Charges for Rev 272 = $223.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING AQUACEL AG BURN 23X30CM,272,RC,27200002,CDM,,,,,,both,,,535.0000,80.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,481.50,,,,,,,138.0800,535.0000,percent of total billed charges,90% of $535.00 in Billed Charges for Rev 272 = $481.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING AQUACEL AG BURN 23X30CM,272,RC,27200002,CDM,,,,,,both,,,535.0000,80.2500,MEDCOST,MEDCOST VHN,254.61,,,,,,,138.0800,535.0000,percent of total billed charges,47.59% of $535.00 in Billed Charges for Rev 272 = $254.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING AQUACEL AG BURN 23X30CM,272,RC,27200002,CDM,,,,,,both,,,535.0000,80.2500,SENTARA HEALTH,SENTARA HEALTH,138.08,,,,,,,138.0800,535.0000,percent of total billed charges,25.81% of $535.00 in Billed Charges for Rev 272 = $138.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING AQUACEL AG BURN 23X30CM,272,RC,27200002,CDM,,,,,,both,,,535.0000,80.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",535.00,,,,,,,138.0800,535.0000,percent of total billed charges,100% of $535.00 in Billed Charges for Rev 272 = $535.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING AQUACEL AG BURN 23X30CM,272,RC,27200002,CDM,,,,,,both,,,535.0000,80.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,267.50,,,,,,,138.0800,535.0000,percent of total billed charges,Rev 272 $535.00 in Billed Charges at 50% = $267.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING AQUACEL AG BURN 23X30CM,272,RC,27200002,CDM,,,,,,both,,,535.0000,80.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,172.81,,,,,,,138.0800,535.0000,other,32.3% of $535.00 in Billed Charges for Rev 272 = $172.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING AQUACEL AG BURN 23X30CM,272,RC,27200002,CDM,,,,,,both,,,535.0000,80.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,164.25,,,,,,,138.0800,535.0000,other,30.7% of $535.00 in Billed Charges for Rev 272 = $164.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING AQUACEL AG BURN 23X30CM,272,RC,27200002,CDM,,,,,,both,,,535.0000,80.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,172.81,,,,,,,138.0800,535.0000,percent of total billed charges,32.3% of $535.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING AQUACEL AG BURN 23X30CM,272,RC,27200002,CDM,,,,,,both,,,535.0000,80.2500,WELLCARE,WELLCARE MEDICAID,535.00,,,,,,,138.0800,535.0000,percent of total billed charges,100% of $535.00 in Billed Charges for Rev 272 = $535.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING AQUACEL AG BURN 54X45CM,272,RC,,,,,,,,both,,,2610.8300,391.6200,AETNA,AETNA,1114.82,,,,,,,673.8600,2610.8300,percent of total billed charges,"42.7% of $2,610.83 in Billed Charges for Rev 272 = $1,114.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 54X45CM,272,RC,,,,,,,,both,,,2610.8300,391.6200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1827.58,,,,,,,673.8600,2610.8300,percent of total billed charges,"Rev 272 $2,610.83 in Billed Charges at 70% = $1,827.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 54X45CM,272,RC,,,,,,,,both,,,2610.8300,391.6200,CIGNA HEALTHCARE,CIGNA HMO,1088.72,,,,,,,673.8600,2610.8300,percent of total billed charges,"41.7% of $2,610.83 in Billed Charges for Rev 272 = $1,088.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 54X45CM,272,RC,,,,,,,,both,,,2610.8300,391.6200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1211.43,,,,,,,673.8600,2610.8300,percent of total billed charges,"46.4% of $2,610.83 in Billed Charges for Rev 272 = $1,211.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 54X45CM,272,RC,,,,,,,,both,,,2610.8300,391.6200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1088.72,,,,,,,673.8600,2610.8300,percent of total billed charges,"41.7% of $2,610.83 in Billed Charges for Rev 272 = $1,088.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 54X45CM,272,RC,,,,,,,,both,,,2610.8300,391.6200,CIGNA HEALTHCARE,CIGNA PPO,1088.72,,,,,,,673.8600,2610.8300,percent of total billed charges,"41.7% of $2,610.83 in Billed Charges for Rev 272 = $1,088.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 54X45CM,272,RC,,,,,,,,both,,,2610.8300,391.6200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2349.75,,,,,,,673.8600,2610.8300,percent of total billed charges,"90% of $2,610.83 in Billed Charges for Rev 272 = $2,349.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 54X45CM,272,RC,,,,,,,,both,,,2610.8300,391.6200,MEDCOST,MEDCOST VHN,1242.49,,,,,,,673.8600,2610.8300,percent of total billed charges,"47.59% of $2,610.83 in Billed Charges for Rev 272 = $1,242.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 54X45CM,272,RC,,,,,,,,both,,,2610.8300,391.6200,SENTARA HEALTH,SENTARA HEALTH,673.86,,,,,,,673.8600,2610.8300,percent of total billed charges,"25.81% of $2,610.83 in Billed Charges for Rev 272 = $673.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 54X45CM,272,RC,,,,,,,,both,,,2610.8300,391.6200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2610.83,,,,,,,673.8600,2610.8300,percent of total billed charges,"100% of $2,610.83 in Billed Charges for Rev 272 = $2,610.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 54X45CM,272,RC,,,,,,,,both,,,2610.8300,391.6200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1305.42,,,,,,,673.8600,2610.8300,percent of total billed charges,"Rev 272 $2,610.83 in Billed Charges at 50% = $1,305.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 54X45CM,272,RC,,,,,,,,both,,,2610.8300,391.6200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,843.30,,,,,,,673.8600,2610.8300,other,"32.3% of $2,610.83 in Billed Charges for Rev 272 = $843.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING AQUACEL AG BURN 54X45CM,272,RC,,,,,,,,both,,,2610.8300,391.6200,UNITED HEALTHCARE,UHC HERITAGE SELECT,801.52,,,,,,,673.8600,2610.8300,other,"30.7% of $2,610.83 in Billed Charges for Rev 272 = $801.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING AQUACEL AG BURN 54X45CM,272,RC,,,,,,,,both,,,2610.8300,391.6200,UNITED HEALTHCARE,UNITED HEALTHCARE,843.30,,,,,,,673.8600,2610.8300,percent of total billed charges,"32.3% of $2,610.83 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING AQUACEL AG BURN 54X45CM,272,RC,,,,,,,,both,,,2610.8300,391.6200,WELLCARE,WELLCARE MEDICAID,2610.83,,,,,,,673.8600,2610.8300,percent of total billed charges,"100% of $2,610.83 in Billed Charges for Rev 272 = $2,610.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING FOAM OPTIFOAM AG 3.5X6,272,RC,27200002,CDM,,,,,,both,,,228.1700,34.2300,AETNA,AETNA,97.43,,,,,,,58.8900,228.1700,percent of total billed charges,42.7% of $228.17 in Billed Charges for Rev 272 = $97.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING FOAM OPTIFOAM AG 3.5X6,272,RC,27200002,CDM,,,,,,both,,,228.1700,34.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,159.72,,,,,,,58.8900,228.1700,percent of total billed charges,Rev 272 $228.17 in Billed Charges at 70% = $159.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING FOAM OPTIFOAM AG 3.5X6,272,RC,27200002,CDM,,,,,,both,,,228.1700,34.2300,CIGNA HEALTHCARE,CIGNA HMO,95.15,,,,,,,58.8900,228.1700,percent of total billed charges,41.7% of $228.17 in Billed Charges for Rev 272 = $95.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING FOAM OPTIFOAM AG 3.5X6,272,RC,27200002,CDM,,,,,,both,,,228.1700,34.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,105.87,,,,,,,58.8900,228.1700,percent of total billed charges,46.4% of $228.17 in Billed Charges for Rev 272 = $105.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING FOAM OPTIFOAM AG 3.5X6,272,RC,27200002,CDM,,,,,,both,,,228.1700,34.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,95.15,,,,,,,58.8900,228.1700,percent of total billed charges,41.7% of $228.17 in Billed Charges for Rev 272 = $95.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING FOAM OPTIFOAM AG 3.5X6,272,RC,27200002,CDM,,,,,,both,,,228.1700,34.2300,CIGNA HEALTHCARE,CIGNA PPO,95.15,,,,,,,58.8900,228.1700,percent of total billed charges,41.7% of $228.17 in Billed Charges for Rev 272 = $95.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING FOAM OPTIFOAM AG 3.5X6,272,RC,27200002,CDM,,,,,,both,,,228.1700,34.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,205.35,,,,,,,58.8900,228.1700,percent of total billed charges,90% of $228.17 in Billed Charges for Rev 272 = $205.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING FOAM OPTIFOAM AG 3.5X6,272,RC,27200002,CDM,,,,,,both,,,228.1700,34.2300,MEDCOST,MEDCOST VHN,108.59,,,,,,,58.8900,228.1700,percent of total billed charges,47.59% of $228.17 in Billed Charges for Rev 272 = $108.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING FOAM OPTIFOAM AG 3.5X6,272,RC,27200002,CDM,,,,,,both,,,228.1700,34.2300,SENTARA HEALTH,SENTARA HEALTH,58.89,,,,,,,58.8900,228.1700,percent of total billed charges,25.81% of $228.17 in Billed Charges for Rev 272 = $58.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING FOAM OPTIFOAM AG 3.5X6,272,RC,27200002,CDM,,,,,,both,,,228.1700,34.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",228.17,,,,,,,58.8900,228.1700,percent of total billed charges,100% of $228.17 in Billed Charges for Rev 272 = $228.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING FOAM OPTIFOAM AG 3.5X6,272,RC,27200002,CDM,,,,,,both,,,228.1700,34.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,114.09,,,,,,,58.8900,228.1700,percent of total billed charges,Rev 272 $228.17 in Billed Charges at 50% = $114.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING FOAM OPTIFOAM AG 3.5X6,272,RC,27200002,CDM,,,,,,both,,,228.1700,34.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,73.70,,,,,,,58.8900,228.1700,other,32.3% of $228.17 in Billed Charges for Rev 272 = $73.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING FOAM OPTIFOAM AG 3.5X6,272,RC,27200002,CDM,,,,,,both,,,228.1700,34.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,70.05,,,,,,,58.8900,228.1700,other,30.7% of $228.17 in Billed Charges for Rev 272 = $70.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING FOAM OPTIFOAM AG 3.5X6,272,RC,27200002,CDM,,,,,,both,,,228.1700,34.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,73.70,,,,,,,58.8900,228.1700,percent of total billed charges,32.3% of $228.17 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING FOAM OPTIFOAM AG 3.5X6,272,RC,27200002,CDM,,,,,,both,,,228.1700,34.2300,WELLCARE,WELLCARE MEDICAID,228.17,,,,,,,58.8900,228.1700,percent of total billed charges,100% of $228.17 in Billed Charges for Rev 272 = $228.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR VERSACROSS FARADRIVE 180P,272,RC,27200002,CDM,,,,,,both,,,11356.2500,1703.4400,AETNA,AETNA,4849.12,,,,,,,2931.0500,11356.2500,percent of total billed charges,"42.7% of $11,356.25 in Billed Charges for Rev 272 = $4,849.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR VERSACROSS FARADRIVE 180P,272,RC,27200002,CDM,,,,,,both,,,11356.2500,1703.4400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7949.38,,,,,,,2931.0500,11356.2500,percent of total billed charges,"Rev 272 $11,356.25 in Billed Charges at 70% = $7,949.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR VERSACROSS FARADRIVE 180P,272,RC,27200002,CDM,,,,,,both,,,11356.2500,1703.4400,CIGNA HEALTHCARE,CIGNA HMO,4735.56,,,,,,,2931.0500,11356.2500,percent of total billed charges,"41.7% of $11,356.25 in Billed Charges for Rev 272 = $4,735.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR VERSACROSS FARADRIVE 180P,272,RC,27200002,CDM,,,,,,both,,,11356.2500,1703.4400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5269.30,,,,,,,2931.0500,11356.2500,percent of total billed charges,"46.4% of $11,356.25 in Billed Charges for Rev 272 = $5,269.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR VERSACROSS FARADRIVE 180P,272,RC,27200002,CDM,,,,,,both,,,11356.2500,1703.4400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4735.56,,,,,,,2931.0500,11356.2500,percent of total billed charges,"41.7% of $11,356.25 in Billed Charges for Rev 272 = $4,735.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR VERSACROSS FARADRIVE 180P,272,RC,27200002,CDM,,,,,,both,,,11356.2500,1703.4400,CIGNA HEALTHCARE,CIGNA PPO,4735.56,,,,,,,2931.0500,11356.2500,percent of total billed charges,"41.7% of $11,356.25 in Billed Charges for Rev 272 = $4,735.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR VERSACROSS FARADRIVE 180P,272,RC,27200002,CDM,,,,,,both,,,11356.2500,1703.4400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10220.63,,,,,,,2931.0500,11356.2500,percent of total billed charges,"90% of $11,356.25 in Billed Charges for Rev 272 = $10,220.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR VERSACROSS FARADRIVE 180P,272,RC,27200002,CDM,,,,,,both,,,11356.2500,1703.4400,MEDCOST,MEDCOST VHN,5404.44,,,,,,,2931.0500,11356.2500,percent of total billed charges,"47.59% of $11,356.25 in Billed Charges for Rev 272 = $5,404.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR VERSACROSS FARADRIVE 180P,272,RC,27200002,CDM,,,,,,both,,,11356.2500,1703.4400,SENTARA HEALTH,SENTARA HEALTH,2931.05,,,,,,,2931.0500,11356.2500,percent of total billed charges,"25.81% of $11,356.25 in Billed Charges for Rev 272 = $2,931.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR VERSACROSS FARADRIVE 180P,272,RC,27200002,CDM,,,,,,both,,,11356.2500,1703.4400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11356.25,,,,,,,2931.0500,11356.2500,percent of total billed charges,"100% of $11,356.25 in Billed Charges for Rev 272 = $11,356.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR VERSACROSS FARADRIVE 180P,272,RC,27200002,CDM,,,,,,both,,,11356.2500,1703.4400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5678.13,,,,,,,2931.0500,11356.2500,percent of total billed charges,"Rev 272 $11,356.25 in Billed Charges at 50% = $5,678.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR VERSACROSS FARADRIVE 180P,272,RC,27200002,CDM,,,,,,both,,,11356.2500,1703.4400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3668.07,,,,,,,2931.0500,11356.2500,other,"32.3% of $11,356.25 in Billed Charges for Rev 272 = $3,668.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CONNECTOR VERSACROSS FARADRIVE 180P,272,RC,27200002,CDM,,,,,,both,,,11356.2500,1703.4400,UNITED HEALTHCARE,UHC HERITAGE SELECT,3486.37,,,,,,,2931.0500,11356.2500,other,"30.7% of $11,356.25 in Billed Charges for Rev 272 = $3,486.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CONNECTOR VERSACROSS FARADRIVE 180P,272,RC,27200002,CDM,,,,,,both,,,11356.2500,1703.4400,UNITED HEALTHCARE,UNITED HEALTHCARE,3668.07,,,,,,,2931.0500,11356.2500,percent of total billed charges,"32.3% of $11,356.25 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR VERSACROSS FARADRIVE 180P,272,RC,27200002,CDM,,,,,,both,,,11356.2500,1703.4400,WELLCARE,WELLCARE MEDICAID,11356.25,,,,,,,2931.0500,11356.2500,percent of total billed charges,"100% of $11,356.25 in Billed Charges for Rev 272 = $11,356.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTRAST GASTROGRAFIN 12 X 120ML 44540,270,RC,,,,,,,,both,,,163.1400,24.4700,AETNA,AETNA,69.66,,,,,,,42.1100,163.1400,percent of total billed charges,42.7% of $163.14 in Billed Charges for Rev 270 = $69.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTRAST GASTROGRAFIN 12 X 120ML 44540,270,RC,,,,,,,,both,,,163.1400,24.4700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,114.20,,,,,,,42.1100,163.1400,percent of total billed charges,Rev 270 $163.14 in Billed Charges at 70% = $114.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTRAST GASTROGRAFIN 12 X 120ML 44540,270,RC,,,,,,,,both,,,163.1400,24.4700,CIGNA HEALTHCARE,CIGNA HMO,68.03,,,,,,,42.1100,163.1400,percent of total billed charges,41.7% of $163.14 in Billed Charges for Rev 270 = $68.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTRAST GASTROGRAFIN 12 X 120ML 44540,270,RC,,,,,,,,both,,,163.1400,24.4700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,75.70,,,,,,,42.1100,163.1400,percent of total billed charges,46.4% of $163.14 in Billed Charges for Rev 270 = $75.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTRAST GASTROGRAFIN 12 X 120ML 44540,270,RC,,,,,,,,both,,,163.1400,24.4700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,68.03,,,,,,,42.1100,163.1400,percent of total billed charges,41.7% of $163.14 in Billed Charges for Rev 270 = $68.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTRAST GASTROGRAFIN 12 X 120ML 44540,270,RC,,,,,,,,both,,,163.1400,24.4700,CIGNA HEALTHCARE,CIGNA PPO,68.03,,,,,,,42.1100,163.1400,percent of total billed charges,41.7% of $163.14 in Billed Charges for Rev 270 = $68.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTRAST GASTROGRAFIN 12 X 120ML 44540,270,RC,,,,,,,,both,,,163.1400,24.4700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,146.83,,,,,,,42.1100,163.1400,percent of total billed charges,90% of $163.14 in Billed Charges for Rev 270 = $146.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTRAST GASTROGRAFIN 12 X 120ML 44540,270,RC,,,,,,,,both,,,163.1400,24.4700,MEDCOST,MEDCOST VHN,77.64,,,,,,,42.1100,163.1400,percent of total billed charges,47.59% of $163.14 in Billed Charges for Rev 270 = $77.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTRAST GASTROGRAFIN 12 X 120ML 44540,270,RC,,,,,,,,both,,,163.1400,24.4700,SENTARA HEALTH,SENTARA HEALTH,42.11,,,,,,,42.1100,163.1400,percent of total billed charges,25.81% of $163.14 in Billed Charges for Rev 270 = $42.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTRAST GASTROGRAFIN 12 X 120ML 44540,270,RC,,,,,,,,both,,,163.1400,24.4700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",163.14,,,,,,,42.1100,163.1400,percent of total billed charges,100% of $163.14 in Billed Charges for Rev 270 = $163.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTRAST GASTROGRAFIN 12 X 120ML 44540,270,RC,,,,,,,,both,,,163.1400,24.4700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,81.57,,,,,,,42.1100,163.1400,percent of total billed charges,Rev 270 $163.14 in Billed Charges at 50% = $81.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTRAST GASTROGRAFIN 12 X 120ML 44540,270,RC,,,,,,,,both,,,163.1400,24.4700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,52.69,,,,,,,42.1100,163.1400,other,32.3% of $163.14 in Billed Charges for Rev 270 = $52.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CONTRAST GASTROGRAFIN 12 X 120ML 44540,270,RC,,,,,,,,both,,,163.1400,24.4700,UNITED HEALTHCARE,UHC HERITAGE SELECT,50.08,,,,,,,42.1100,163.1400,other,30.7% of $163.14 in Billed Charges for Rev 270 = $50.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CONTRAST GASTROGRAFIN 12 X 120ML 44540,270,RC,,,,,,,,both,,,163.1400,24.4700,UNITED HEALTHCARE,UNITED HEALTHCARE,52.69,,,,,,,42.1100,163.1400,percent of total billed charges,32.3% of $163.14 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTRAST GASTROGRAFIN 12 X 120ML 44540,270,RC,,,,,,,,both,,,163.1400,24.4700,WELLCARE,WELLCARE MEDICAID,163.14,,,,,,,42.1100,163.1400,percent of total billed charges,100% of $163.14 in Billed Charges for Rev 270 = $163.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTROL CABLE&SHEEVE-COBALT CHROME 1.8MMX24IN,272,RC,,,,,,,,both,,,5280.9100,792.1400,AETNA,AETNA,2254.95,,,,,,,1363.0000,5280.9100,percent of total billed charges,"42.7% of $5,280.91 in Billed Charges for Rev 272 = $2,254.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROL CABLE&SHEEVE-COBALT CHROME 1.8MMX24IN,272,RC,,,,,,,,both,,,5280.9100,792.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3696.64,,,,,,,1363.0000,5280.9100,percent of total billed charges,"Rev 272 $5,280.91 in Billed Charges at 70% = $3,696.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROL CABLE&SHEEVE-COBALT CHROME 1.8MMX24IN,272,RC,,,,,,,,both,,,5280.9100,792.1400,CIGNA HEALTHCARE,CIGNA HMO,2202.14,,,,,,,1363.0000,5280.9100,percent of total billed charges,"41.7% of $5,280.91 in Billed Charges for Rev 272 = $2,202.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROL CABLE&SHEEVE-COBALT CHROME 1.8MMX24IN,272,RC,,,,,,,,both,,,5280.9100,792.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2450.34,,,,,,,1363.0000,5280.9100,percent of total billed charges,"46.4% of $5,280.91 in Billed Charges for Rev 272 = $2,450.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROL CABLE&SHEEVE-COBALT CHROME 1.8MMX24IN,272,RC,,,,,,,,both,,,5280.9100,792.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2202.14,,,,,,,1363.0000,5280.9100,percent of total billed charges,"41.7% of $5,280.91 in Billed Charges for Rev 272 = $2,202.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROL CABLE&SHEEVE-COBALT CHROME 1.8MMX24IN,272,RC,,,,,,,,both,,,5280.9100,792.1400,CIGNA HEALTHCARE,CIGNA PPO,2202.14,,,,,,,1363.0000,5280.9100,percent of total billed charges,"41.7% of $5,280.91 in Billed Charges for Rev 272 = $2,202.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROL CABLE&SHEEVE-COBALT CHROME 1.8MMX24IN,272,RC,,,,,,,,both,,,5280.9100,792.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4752.82,,,,,,,1363.0000,5280.9100,percent of total billed charges,"90% of $5,280.91 in Billed Charges for Rev 272 = $4,752.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROL CABLE&SHEEVE-COBALT CHROME 1.8MMX24IN,272,RC,,,,,,,,both,,,5280.9100,792.1400,MEDCOST,MEDCOST VHN,2513.19,,,,,,,1363.0000,5280.9100,percent of total billed charges,"47.59% of $5,280.91 in Billed Charges for Rev 272 = $2,513.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROL CABLE&SHEEVE-COBALT CHROME 1.8MMX24IN,272,RC,,,,,,,,both,,,5280.9100,792.1400,SENTARA HEALTH,SENTARA HEALTH,1363.00,,,,,,,1363.0000,5280.9100,percent of total billed charges,"25.81% of $5,280.91 in Billed Charges for Rev 272 = $1,363.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROL CABLE&SHEEVE-COBALT CHROME 1.8MMX24IN,272,RC,,,,,,,,both,,,5280.9100,792.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5280.91,,,,,,,1363.0000,5280.9100,percent of total billed charges,"100% of $5,280.91 in Billed Charges for Rev 272 = $5,280.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROL CABLE&SHEEVE-COBALT CHROME 1.8MMX24IN,272,RC,,,,,,,,both,,,5280.9100,792.1400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2640.46,,,,,,,1363.0000,5280.9100,percent of total billed charges,"Rev 272 $5,280.91 in Billed Charges at 50% = $2,640.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROL CABLE&SHEEVE-COBALT CHROME 1.8MMX24IN,272,RC,,,,,,,,both,,,5280.9100,792.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1705.73,,,,,,,1363.0000,5280.9100,other,"32.3% of $5,280.91 in Billed Charges for Rev 272 = $1,705.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CONTROL CABLE&SHEEVE-COBALT CHROME 1.8MMX24IN,272,RC,,,,,,,,both,,,5280.9100,792.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1621.24,,,,,,,1363.0000,5280.9100,other,"30.7% of $5,280.91 in Billed Charges for Rev 272 = $1,621.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CONTROL CABLE&SHEEVE-COBALT CHROME 1.8MMX24IN,272,RC,,,,,,,,both,,,5280.9100,792.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,1705.73,,,,,,,1363.0000,5280.9100,percent of total billed charges,"32.3% of $5,280.91 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROL CABLE&SHEEVE-COBALT CHROME 1.8MMX24IN,272,RC,,,,,,,,both,,,5280.9100,792.1400,WELLCARE,WELLCARE MEDICAID,5280.91,,,,,,,1363.0000,5280.9100,percent of total billed charges,"100% of $5,280.91 in Billed Charges for Rev 272 = $5,280.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLER PATIENT INTERSTIM,270,RC,27000002,CDM,,,,,,both,,,22810.9100,3421.6400,AETNA,AETNA,9740.26,,,,,,,5887.5000,22810.9100,percent of total billed charges,"42.7% of $22,810.91 in Billed Charges for Rev 270 = $9,740.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLER PATIENT INTERSTIM,270,RC,27000002,CDM,,,,,,both,,,22810.9100,3421.6400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,15967.64,,,,,,,5887.5000,22810.9100,percent of total billed charges,"Rev 270 $22,810.91 in Billed Charges at 70% = $15,967.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLER PATIENT INTERSTIM,270,RC,27000002,CDM,,,,,,both,,,22810.9100,3421.6400,CIGNA HEALTHCARE,CIGNA HMO,9512.15,,,,,,,5887.5000,22810.9100,percent of total billed charges,"41.7% of $22,810.91 in Billed Charges for Rev 270 = $9,512.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLER PATIENT INTERSTIM,270,RC,27000002,CDM,,,,,,both,,,22810.9100,3421.6400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10584.26,,,,,,,5887.5000,22810.9100,percent of total billed charges,"46.4% of $22,810.91 in Billed Charges for Rev 270 = $10,584.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLER PATIENT INTERSTIM,270,RC,27000002,CDM,,,,,,both,,,22810.9100,3421.6400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9512.15,,,,,,,5887.5000,22810.9100,percent of total billed charges,"41.7% of $22,810.91 in Billed Charges for Rev 270 = $9,512.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLER PATIENT INTERSTIM,270,RC,27000002,CDM,,,,,,both,,,22810.9100,3421.6400,CIGNA HEALTHCARE,CIGNA PPO,9512.15,,,,,,,5887.5000,22810.9100,percent of total billed charges,"41.7% of $22,810.91 in Billed Charges for Rev 270 = $9,512.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLER PATIENT INTERSTIM,270,RC,27000002,CDM,,,,,,both,,,22810.9100,3421.6400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,20529.82,,,,,,,5887.5000,22810.9100,percent of total billed charges,"90% of $22,810.91 in Billed Charges for Rev 270 = $20,529.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLER PATIENT INTERSTIM,270,RC,27000002,CDM,,,,,,both,,,22810.9100,3421.6400,MEDCOST,MEDCOST VHN,10855.71,,,,,,,5887.5000,22810.9100,percent of total billed charges,"47.59% of $22,810.91 in Billed Charges for Rev 270 = $10,855.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLER PATIENT INTERSTIM,270,RC,27000002,CDM,,,,,,both,,,22810.9100,3421.6400,SENTARA HEALTH,SENTARA HEALTH,5887.50,,,,,,,5887.5000,22810.9100,percent of total billed charges,"25.81% of $22,810.91 in Billed Charges for Rev 270 = $5,887.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLER PATIENT INTERSTIM,270,RC,27000002,CDM,,,,,,both,,,22810.9100,3421.6400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",22810.91,,,,,,,5887.5000,22810.9100,percent of total billed charges,"100% of $22,810.91 in Billed Charges for Rev 270 = $22,810.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLER PATIENT INTERSTIM,270,RC,27000002,CDM,,,,,,both,,,22810.9100,3421.6400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11405.46,,,,,,,5887.5000,22810.9100,percent of total billed charges,"Rev 270 $22,810.91 in Billed Charges at 50% = $11,405.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLER PATIENT INTERSTIM,270,RC,27000002,CDM,,,,,,both,,,22810.9100,3421.6400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7367.92,,,,,,,5887.5000,22810.9100,other,"32.3% of $22,810.91 in Billed Charges for Rev 270 = $7,367.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CONTROLER PATIENT INTERSTIM,270,RC,27000002,CDM,,,,,,both,,,22810.9100,3421.6400,UNITED HEALTHCARE,UHC HERITAGE SELECT,7002.95,,,,,,,5887.5000,22810.9100,other,"30.7% of $22,810.91 in Billed Charges for Rev 270 = $7,002.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CONTROLER PATIENT INTERSTIM,270,RC,27000002,CDM,,,,,,both,,,22810.9100,3421.6400,UNITED HEALTHCARE,UNITED HEALTHCARE,7367.92,,,,,,,5887.5000,22810.9100,percent of total billed charges,"32.3% of $22,810.91 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLER PATIENT INTERSTIM,270,RC,27000002,CDM,,,,,,both,,,22810.9100,3421.6400,WELLCARE,WELLCARE MEDICAID,22810.91,,,,,,,5887.5000,22810.9100,percent of total billed charges,"100% of $22,810.91 in Billed Charges for Rev 270 = $22,810.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLLER PERFUSION VAVD VACUUM AND VACPAC,272,RC,27200002,CDM,,,,,,both,,,522.7000,78.4100,AETNA,AETNA,223.19,,,,,,,134.9100,522.7000,percent of total billed charges,42.7% of $522.70 in Billed Charges for Rev 272 = $223.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTROLLER PERFUSION VAVD VACUUM AND VACPAC,272,RC,27200002,CDM,,,,,,both,,,522.7000,78.4100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,365.89,,,,,,,134.9100,522.7000,percent of total billed charges,Rev 272 $522.70 in Billed Charges at 70% = $365.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTROLLER PERFUSION VAVD VACUUM AND VACPAC,272,RC,27200002,CDM,,,,,,both,,,522.7000,78.4100,CIGNA HEALTHCARE,CIGNA HMO,217.97,,,,,,,134.9100,522.7000,percent of total billed charges,41.7% of $522.70 in Billed Charges for Rev 272 = $217.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTROLLER PERFUSION VAVD VACUUM AND VACPAC,272,RC,27200002,CDM,,,,,,both,,,522.7000,78.4100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,242.53,,,,,,,134.9100,522.7000,percent of total billed charges,46.4% of $522.70 in Billed Charges for Rev 272 = $242.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTROLLER PERFUSION VAVD VACUUM AND VACPAC,272,RC,27200002,CDM,,,,,,both,,,522.7000,78.4100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,217.97,,,,,,,134.9100,522.7000,percent of total billed charges,41.7% of $522.70 in Billed Charges for Rev 272 = $217.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTROLLER PERFUSION VAVD VACUUM AND VACPAC,272,RC,27200002,CDM,,,,,,both,,,522.7000,78.4100,CIGNA HEALTHCARE,CIGNA PPO,217.97,,,,,,,134.9100,522.7000,percent of total billed charges,41.7% of $522.70 in Billed Charges for Rev 272 = $217.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTROLLER PERFUSION VAVD VACUUM AND VACPAC,272,RC,27200002,CDM,,,,,,both,,,522.7000,78.4100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,470.43,,,,,,,134.9100,522.7000,percent of total billed charges,90% of $522.70 in Billed Charges for Rev 272 = $470.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTROLLER PERFUSION VAVD VACUUM AND VACPAC,272,RC,27200002,CDM,,,,,,both,,,522.7000,78.4100,MEDCOST,MEDCOST VHN,248.75,,,,,,,134.9100,522.7000,percent of total billed charges,47.59% of $522.70 in Billed Charges for Rev 272 = $248.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTROLLER PERFUSION VAVD VACUUM AND VACPAC,272,RC,27200002,CDM,,,,,,both,,,522.7000,78.4100,SENTARA HEALTH,SENTARA HEALTH,134.91,,,,,,,134.9100,522.7000,percent of total billed charges,25.81% of $522.70 in Billed Charges for Rev 272 = $134.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTROLLER PERFUSION VAVD VACUUM AND VACPAC,272,RC,27200002,CDM,,,,,,both,,,522.7000,78.4100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",522.70,,,,,,,134.9100,522.7000,percent of total billed charges,100% of $522.70 in Billed Charges for Rev 272 = $522.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTROLLER PERFUSION VAVD VACUUM AND VACPAC,272,RC,27200002,CDM,,,,,,both,,,522.7000,78.4100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,261.35,,,,,,,134.9100,522.7000,percent of total billed charges,Rev 272 $522.70 in Billed Charges at 50% = $261.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTROLLER PERFUSION VAVD VACUUM AND VACPAC,272,RC,27200002,CDM,,,,,,both,,,522.7000,78.4100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,168.83,,,,,,,134.9100,522.7000,other,32.3% of $522.70 in Billed Charges for Rev 272 = $168.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CONTROLLER PERFUSION VAVD VACUUM AND VACPAC,272,RC,27200002,CDM,,,,,,both,,,522.7000,78.4100,UNITED HEALTHCARE,UHC HERITAGE SELECT,160.47,,,,,,,134.9100,522.7000,other,30.7% of $522.70 in Billed Charges for Rev 272 = $160.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CONTROLLER PERFUSION VAVD VACUUM AND VACPAC,272,RC,27200002,CDM,,,,,,both,,,522.7000,78.4100,UNITED HEALTHCARE,UNITED HEALTHCARE,168.83,,,,,,,134.9100,522.7000,percent of total billed charges,32.3% of $522.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONTROLLER PERFUSION VAVD VACUUM AND VACPAC,272,RC,27200002,CDM,,,,,,both,,,522.7000,78.4100,WELLCARE,WELLCARE MEDICAID,522.70,,,,,,,134.9100,522.7000,percent of total billed charges,100% of $522.70 in Billed Charges for Rev 272 = $522.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING KIT FOR INFO VAC LG.,272,RC,27200002,CDM,,,,,,both,,,542.3800,81.3600,AETNA,AETNA,231.60,,,,,,,139.9900,542.3800,percent of total billed charges,42.7% of $542.38 in Billed Charges for Rev 272 = $231.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING KIT FOR INFO VAC LG.,272,RC,27200002,CDM,,,,,,both,,,542.3800,81.3600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,379.67,,,,,,,139.9900,542.3800,percent of total billed charges,Rev 272 $542.38 in Billed Charges at 70% = $379.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING KIT FOR INFO VAC LG.,272,RC,27200002,CDM,,,,,,both,,,542.3800,81.3600,CIGNA HEALTHCARE,CIGNA HMO,226.17,,,,,,,139.9900,542.3800,percent of total billed charges,41.7% of $542.38 in Billed Charges for Rev 272 = $226.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING KIT FOR INFO VAC LG.,272,RC,27200002,CDM,,,,,,both,,,542.3800,81.3600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,251.66,,,,,,,139.9900,542.3800,percent of total billed charges,46.4% of $542.38 in Billed Charges for Rev 272 = $251.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING KIT FOR INFO VAC LG.,272,RC,27200002,CDM,,,,,,both,,,542.3800,81.3600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,226.17,,,,,,,139.9900,542.3800,percent of total billed charges,41.7% of $542.38 in Billed Charges for Rev 272 = $226.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING KIT FOR INFO VAC LG.,272,RC,27200002,CDM,,,,,,both,,,542.3800,81.3600,CIGNA HEALTHCARE,CIGNA PPO,226.17,,,,,,,139.9900,542.3800,percent of total billed charges,41.7% of $542.38 in Billed Charges for Rev 272 = $226.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING KIT FOR INFO VAC LG.,272,RC,27200002,CDM,,,,,,both,,,542.3800,81.3600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,488.14,,,,,,,139.9900,542.3800,percent of total billed charges,90% of $542.38 in Billed Charges for Rev 272 = $488.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING KIT FOR INFO VAC LG.,272,RC,27200002,CDM,,,,,,both,,,542.3800,81.3600,MEDCOST,MEDCOST VHN,258.12,,,,,,,139.9900,542.3800,percent of total billed charges,47.59% of $542.38 in Billed Charges for Rev 272 = $258.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING KIT FOR INFO VAC LG.,272,RC,27200002,CDM,,,,,,both,,,542.3800,81.3600,SENTARA HEALTH,SENTARA HEALTH,139.99,,,,,,,139.9900,542.3800,percent of total billed charges,25.81% of $542.38 in Billed Charges for Rev 272 = $139.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING KIT FOR INFO VAC LG.,272,RC,27200002,CDM,,,,,,both,,,542.3800,81.3600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",542.38,,,,,,,139.9900,542.3800,percent of total billed charges,100% of $542.38 in Billed Charges for Rev 272 = $542.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING KIT FOR INFO VAC LG.,272,RC,27200002,CDM,,,,,,both,,,542.3800,81.3600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,271.19,,,,,,,139.9900,542.3800,percent of total billed charges,Rev 272 $542.38 in Billed Charges at 50% = $271.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING KIT FOR INFO VAC LG.,272,RC,27200002,CDM,,,,,,both,,,542.3800,81.3600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,175.19,,,,,,,139.9900,542.3800,other,32.3% of $542.38 in Billed Charges for Rev 272 = $175.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING KIT FOR INFO VAC LG.,272,RC,27200002,CDM,,,,,,both,,,542.3800,81.3600,UNITED HEALTHCARE,UHC HERITAGE SELECT,166.51,,,,,,,139.9900,542.3800,other,30.7% of $542.38 in Billed Charges for Rev 272 = $166.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING KIT FOR INFO VAC LG.,272,RC,27200002,CDM,,,,,,both,,,542.3800,81.3600,UNITED HEALTHCARE,UNITED HEALTHCARE,175.19,,,,,,,139.9900,542.3800,percent of total billed charges,32.3% of $542.38 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING KIT FOR INFO VAC LG.,272,RC,27200002,CDM,,,,,,both,,,542.3800,81.3600,WELLCARE,WELLCARE MEDICAID,542.38,,,,,,,139.9900,542.3800,percent of total billed charges,100% of $542.38 in Billed Charges for Rev 272 = $542.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 40/44,272,RC,,,,,,,,both,,,2044.1200,306.6200,AETNA,AETNA,872.84,,,,,,,527.5900,2044.1200,percent of total billed charges,"42.7% of $2,044.12 in Billed Charges for Rev 272 = $872.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 40/44,272,RC,,,,,,,,both,,,2044.1200,306.6200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1430.88,,,,,,,527.5900,2044.1200,percent of total billed charges,"Rev 272 $2,044.12 in Billed Charges at 70% = $1,430.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 40/44,272,RC,,,,,,,,both,,,2044.1200,306.6200,CIGNA HEALTHCARE,CIGNA HMO,852.40,,,,,,,527.5900,2044.1200,percent of total billed charges,"41.7% of $2,044.12 in Billed Charges for Rev 272 = $852.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 40/44,272,RC,,,,,,,,both,,,2044.1200,306.6200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,948.47,,,,,,,527.5900,2044.1200,percent of total billed charges,"46.4% of $2,044.12 in Billed Charges for Rev 272 = $948.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 40/44,272,RC,,,,,,,,both,,,2044.1200,306.6200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,852.40,,,,,,,527.5900,2044.1200,percent of total billed charges,"41.7% of $2,044.12 in Billed Charges for Rev 272 = $852.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 40/44,272,RC,,,,,,,,both,,,2044.1200,306.6200,CIGNA HEALTHCARE,CIGNA PPO,852.40,,,,,,,527.5900,2044.1200,percent of total billed charges,"41.7% of $2,044.12 in Billed Charges for Rev 272 = $852.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 40/44,272,RC,,,,,,,,both,,,2044.1200,306.6200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1839.71,,,,,,,527.5900,2044.1200,percent of total billed charges,"90% of $2,044.12 in Billed Charges for Rev 272 = $1,839.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 40/44,272,RC,,,,,,,,both,,,2044.1200,306.6200,MEDCOST,MEDCOST VHN,972.80,,,,,,,527.5900,2044.1200,percent of total billed charges,"47.59% of $2,044.12 in Billed Charges for Rev 272 = $972.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 40/44,272,RC,,,,,,,,both,,,2044.1200,306.6200,SENTARA HEALTH,SENTARA HEALTH,527.59,,,,,,,527.5900,2044.1200,percent of total billed charges,"25.81% of $2,044.12 in Billed Charges for Rev 272 = $527.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 40/44,272,RC,,,,,,,,both,,,2044.1200,306.6200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2044.12,,,,,,,527.5900,2044.1200,percent of total billed charges,"100% of $2,044.12 in Billed Charges for Rev 272 = $2,044.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 40/44,272,RC,,,,,,,,both,,,2044.1200,306.6200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1022.06,,,,,,,527.5900,2044.1200,percent of total billed charges,"Rev 272 $2,044.12 in Billed Charges at 50% = $1,022.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 40/44,272,RC,,,,,,,,both,,,2044.1200,306.6200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,660.25,,,,,,,527.5900,2044.1200,other,"32.3% of $2,044.12 in Billed Charges for Rev 272 = $660.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 40/44,272,RC,,,,,,,,both,,,2044.1200,306.6200,UNITED HEALTHCARE,UHC HERITAGE SELECT,627.54,,,,,,,527.5900,2044.1200,other,"30.7% of $2,044.12 in Billed Charges for Rev 272 = $627.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 40/44,272,RC,,,,,,,,both,,,2044.1200,306.6200,UNITED HEALTHCARE,UNITED HEALTHCARE,660.25,,,,,,,527.5900,2044.1200,percent of total billed charges,"32.3% of $2,044.12 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 40/44,272,RC,,,,,,,,both,,,2044.1200,306.6200,WELLCARE,WELLCARE MEDICAID,2044.12,,,,,,,527.5900,2044.1200,percent of total billed charges,"100% of $2,044.12 in Billed Charges for Rev 272 = $2,044.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702453,272,RC,,,,,,,,both,,,1071.9500,160.7900,AETNA,AETNA,457.72,,,,,,,276.6700,1071.9500,percent of total billed charges,"42.7% of $1,071.95 in Billed Charges for Rev 272 = $457.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702453,272,RC,,,,,,,,both,,,1071.9500,160.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,750.37,,,,,,,276.6700,1071.9500,percent of total billed charges,"Rev 272 $1,071.95 in Billed Charges at 70% = $750.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702453,272,RC,,,,,,,,both,,,1071.9500,160.7900,CIGNA HEALTHCARE,CIGNA HMO,447.00,,,,,,,276.6700,1071.9500,percent of total billed charges,"41.7% of $1,071.95 in Billed Charges for Rev 272 = $447.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702453,272,RC,,,,,,,,both,,,1071.9500,160.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,497.38,,,,,,,276.6700,1071.9500,percent of total billed charges,"46.4% of $1,071.95 in Billed Charges for Rev 272 = $497.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702453,272,RC,,,,,,,,both,,,1071.9500,160.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,447.00,,,,,,,276.6700,1071.9500,percent of total billed charges,"41.7% of $1,071.95 in Billed Charges for Rev 272 = $447.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702453,272,RC,,,,,,,,both,,,1071.9500,160.7900,CIGNA HEALTHCARE,CIGNA PPO,447.00,,,,,,,276.6700,1071.9500,percent of total billed charges,"41.7% of $1,071.95 in Billed Charges for Rev 272 = $447.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702453,272,RC,,,,,,,,both,,,1071.9500,160.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,964.76,,,,,,,276.6700,1071.9500,percent of total billed charges,"90% of $1,071.95 in Billed Charges for Rev 272 = $964.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702453,272,RC,,,,,,,,both,,,1071.9500,160.7900,MEDCOST,MEDCOST VHN,510.14,,,,,,,276.6700,1071.9500,percent of total billed charges,"47.59% of $1,071.95 in Billed Charges for Rev 272 = $510.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702453,272,RC,,,,,,,,both,,,1071.9500,160.7900,SENTARA HEALTH,SENTARA HEALTH,276.67,,,,,,,276.6700,1071.9500,percent of total billed charges,"25.81% of $1,071.95 in Billed Charges for Rev 272 = $276.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702453,272,RC,,,,,,,,both,,,1071.9500,160.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1071.95,,,,,,,276.6700,1071.9500,percent of total billed charges,"100% of $1,071.95 in Billed Charges for Rev 272 = $1,071.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702453,272,RC,,,,,,,,both,,,1071.9500,160.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,535.98,,,,,,,276.6700,1071.9500,percent of total billed charges,"Rev 272 $1,071.95 in Billed Charges at 50% = $535.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702453,272,RC,,,,,,,,both,,,1071.9500,160.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,346.24,,,,,,,276.6700,1071.9500,other,"32.3% of $1,071.95 in Billed Charges for Rev 272 = $346.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 702453,272,RC,,,,,,,,both,,,1071.9500,160.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,329.09,,,,,,,276.6700,1071.9500,other,"30.7% of $1,071.95 in Billed Charges for Rev 272 = $329.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 702453,272,RC,,,,,,,,both,,,1071.9500,160.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,346.24,,,,,,,276.6700,1071.9500,percent of total billed charges,"32.3% of $1,071.95 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 702453,272,RC,,,,,,,,both,,,1071.9500,160.7900,WELLCARE,WELLCARE MEDICAID,1071.95,,,,,,,276.6700,1071.9500,percent of total billed charges,"100% of $1,071.95 in Billed Charges for Rev 272 = $1,071.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTERSINK CANNULATED AO COUPLING 3.8MM STERILE,272,RC,,,,,,,,both,,,1493.6300,224.0400,AETNA,AETNA,637.78,,,,,,,385.5100,1493.6300,percent of total billed charges,"42.7% of $1,493.63 in Billed Charges for Rev 272 = $637.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTERSINK CANNULATED AO COUPLING 3.8MM STERILE,272,RC,,,,,,,,both,,,1493.6300,224.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1045.54,,,,,,,385.5100,1493.6300,percent of total billed charges,"Rev 272 $1,493.63 in Billed Charges at 70% = $1,045.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTERSINK CANNULATED AO COUPLING 3.8MM STERILE,272,RC,,,,,,,,both,,,1493.6300,224.0400,CIGNA HEALTHCARE,CIGNA HMO,622.84,,,,,,,385.5100,1493.6300,percent of total billed charges,"41.7% of $1,493.63 in Billed Charges for Rev 272 = $622.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTERSINK CANNULATED AO COUPLING 3.8MM STERILE,272,RC,,,,,,,,both,,,1493.6300,224.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,693.04,,,,,,,385.5100,1493.6300,percent of total billed charges,"46.4% of $1,493.63 in Billed Charges for Rev 272 = $693.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTERSINK CANNULATED AO COUPLING 3.8MM STERILE,272,RC,,,,,,,,both,,,1493.6300,224.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,622.84,,,,,,,385.5100,1493.6300,percent of total billed charges,"41.7% of $1,493.63 in Billed Charges for Rev 272 = $622.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTERSINK CANNULATED AO COUPLING 3.8MM STERILE,272,RC,,,,,,,,both,,,1493.6300,224.0400,CIGNA HEALTHCARE,CIGNA PPO,622.84,,,,,,,385.5100,1493.6300,percent of total billed charges,"41.7% of $1,493.63 in Billed Charges for Rev 272 = $622.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTERSINK CANNULATED AO COUPLING 3.8MM STERILE,272,RC,,,,,,,,both,,,1493.6300,224.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1344.27,,,,,,,385.5100,1493.6300,percent of total billed charges,"90% of $1,493.63 in Billed Charges for Rev 272 = $1,344.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTERSINK CANNULATED AO COUPLING 3.8MM STERILE,272,RC,,,,,,,,both,,,1493.6300,224.0400,MEDCOST,MEDCOST VHN,710.82,,,,,,,385.5100,1493.6300,percent of total billed charges,"47.59% of $1,493.63 in Billed Charges for Rev 272 = $710.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTERSINK CANNULATED AO COUPLING 3.8MM STERILE,272,RC,,,,,,,,both,,,1493.6300,224.0400,SENTARA HEALTH,SENTARA HEALTH,385.51,,,,,,,385.5100,1493.6300,percent of total billed charges,"25.81% of $1,493.63 in Billed Charges for Rev 272 = $385.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTERSINK CANNULATED AO COUPLING 3.8MM STERILE,272,RC,,,,,,,,both,,,1493.6300,224.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1493.63,,,,,,,385.5100,1493.6300,percent of total billed charges,"100% of $1,493.63 in Billed Charges for Rev 272 = $1,493.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTERSINK CANNULATED AO COUPLING 3.8MM STERILE,272,RC,,,,,,,,both,,,1493.6300,224.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,746.82,,,,,,,385.5100,1493.6300,percent of total billed charges,"Rev 272 $1,493.63 in Billed Charges at 50% = $746.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTERSINK CANNULATED AO COUPLING 3.8MM STERILE,272,RC,,,,,,,,both,,,1493.6300,224.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,482.44,,,,,,,385.5100,1493.6300,other,"32.3% of $1,493.63 in Billed Charges for Rev 272 = $482.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
COUNTERSINK CANNULATED AO COUPLING 3.8MM STERILE,272,RC,,,,,,,,both,,,1493.6300,224.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,458.54,,,,,,,385.5100,1493.6300,other,"30.7% of $1,493.63 in Billed Charges for Rev 272 = $458.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
COUNTERSINK CANNULATED AO COUPLING 3.8MM STERILE,272,RC,,,,,,,,both,,,1493.6300,224.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,482.44,,,,,,,385.5100,1493.6300,percent of total billed charges,"32.3% of $1,493.63 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTERSINK CANNULATED AO COUPLING 3.8MM STERILE,272,RC,,,,,,,,both,,,1493.6300,224.0400,WELLCARE,WELLCARE MEDICAID,1493.63,,,,,,,385.5100,1493.6300,percent of total billed charges,"100% of $1,493.63 in Billed Charges for Rev 272 = $1,493.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE WOUND CLOSURE V-LOC #1 PBT TAPER POINT 12IN BLUE 1/2 CIRCLE GS21 NEEDLE,272,RC,,,,,,,,both,,,664.5700,99.6900,AETNA,AETNA,283.77,,,,,,,171.5300,664.5700,percent of total billed charges,42.7% of $664.57 in Billed Charges for Rev 272 = $283.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE WOUND CLOSURE V-LOC #1 PBT TAPER POINT 12IN BLUE 1/2 CIRCLE GS21 NEEDLE,272,RC,,,,,,,,both,,,664.5700,99.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,465.20,,,,,,,171.5300,664.5700,percent of total billed charges,Rev 272 $664.57 in Billed Charges at 70% = $465.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE WOUND CLOSURE V-LOC #1 PBT TAPER POINT 12IN BLUE 1/2 CIRCLE GS21 NEEDLE,272,RC,,,,,,,,both,,,664.5700,99.6900,CIGNA HEALTHCARE,CIGNA HMO,277.13,,,,,,,171.5300,664.5700,percent of total billed charges,41.7% of $664.57 in Billed Charges for Rev 272 = $277.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE WOUND CLOSURE V-LOC #1 PBT TAPER POINT 12IN BLUE 1/2 CIRCLE GS21 NEEDLE,272,RC,,,,,,,,both,,,664.5700,99.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,308.36,,,,,,,171.5300,664.5700,percent of total billed charges,46.4% of $664.57 in Billed Charges for Rev 272 = $308.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE WOUND CLOSURE V-LOC #1 PBT TAPER POINT 12IN BLUE 1/2 CIRCLE GS21 NEEDLE,272,RC,,,,,,,,both,,,664.5700,99.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,277.13,,,,,,,171.5300,664.5700,percent of total billed charges,41.7% of $664.57 in Billed Charges for Rev 272 = $277.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE WOUND CLOSURE V-LOC #1 PBT TAPER POINT 12IN BLUE 1/2 CIRCLE GS21 NEEDLE,272,RC,,,,,,,,both,,,664.5700,99.6900,CIGNA HEALTHCARE,CIGNA PPO,277.13,,,,,,,171.5300,664.5700,percent of total billed charges,41.7% of $664.57 in Billed Charges for Rev 272 = $277.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE WOUND CLOSURE V-LOC #1 PBT TAPER POINT 12IN BLUE 1/2 CIRCLE GS21 NEEDLE,272,RC,,,,,,,,both,,,664.5700,99.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,598.11,,,,,,,171.5300,664.5700,percent of total billed charges,90% of $664.57 in Billed Charges for Rev 272 = $598.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE WOUND CLOSURE V-LOC #1 PBT TAPER POINT 12IN BLUE 1/2 CIRCLE GS21 NEEDLE,272,RC,,,,,,,,both,,,664.5700,99.6900,MEDCOST,MEDCOST VHN,316.27,,,,,,,171.5300,664.5700,percent of total billed charges,47.59% of $664.57 in Billed Charges for Rev 272 = $316.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE WOUND CLOSURE V-LOC #1 PBT TAPER POINT 12IN BLUE 1/2 CIRCLE GS21 NEEDLE,272,RC,,,,,,,,both,,,664.5700,99.6900,SENTARA HEALTH,SENTARA HEALTH,171.53,,,,,,,171.5300,664.5700,percent of total billed charges,25.81% of $664.57 in Billed Charges for Rev 272 = $171.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE WOUND CLOSURE V-LOC #1 PBT TAPER POINT 12IN BLUE 1/2 CIRCLE GS21 NEEDLE,272,RC,,,,,,,,both,,,664.5700,99.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",664.57,,,,,,,171.5300,664.5700,percent of total billed charges,100% of $664.57 in Billed Charges for Rev 272 = $664.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE WOUND CLOSURE V-LOC #1 PBT TAPER POINT 12IN BLUE 1/2 CIRCLE GS21 NEEDLE,272,RC,,,,,,,,both,,,664.5700,99.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,332.29,,,,,,,171.5300,664.5700,percent of total billed charges,Rev 272 $664.57 in Billed Charges at 50% = $332.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE WOUND CLOSURE V-LOC #1 PBT TAPER POINT 12IN BLUE 1/2 CIRCLE GS21 NEEDLE,272,RC,,,,,,,,both,,,664.5700,99.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,214.66,,,,,,,171.5300,664.5700,other,32.3% of $664.57 in Billed Charges for Rev 272 = $214.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DEVICE WOUND CLOSURE V-LOC #1 PBT TAPER POINT 12IN BLUE 1/2 CIRCLE GS21 NEEDLE,272,RC,,,,,,,,both,,,664.5700,99.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,204.02,,,,,,,171.5300,664.5700,other,30.7% of $664.57 in Billed Charges for Rev 272 = $204.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DEVICE WOUND CLOSURE V-LOC #1 PBT TAPER POINT 12IN BLUE 1/2 CIRCLE GS21 NEEDLE,272,RC,,,,,,,,both,,,664.5700,99.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,214.66,,,,,,,171.5300,664.5700,percent of total billed charges,32.3% of $664.57 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE WOUND CLOSURE V-LOC #1 PBT TAPER POINT 12IN BLUE 1/2 CIRCLE GS21 NEEDLE,272,RC,,,,,,,,both,,,664.5700,99.6900,WELLCARE,WELLCARE MEDICAID,664.57,,,,,,,171.5300,664.5700,percent of total billed charges,100% of $664.57 in Billed Charges for Rev 272 = $664.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 7756131,272,RC,,,,,,,,both,,,1403.2000,210.4800,AETNA,AETNA,599.17,,,,,,,362.1700,1403.2000,percent of total billed charges,"42.7% of $1,403.20 in Billed Charges for Rev 272 = $599.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7756131,272,RC,,,,,,,,both,,,1403.2000,210.4800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,982.24,,,,,,,362.1700,1403.2000,percent of total billed charges,"Rev 272 $1,403.20 in Billed Charges at 70% = $982.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7756131,272,RC,,,,,,,,both,,,1403.2000,210.4800,CIGNA HEALTHCARE,CIGNA HMO,585.13,,,,,,,362.1700,1403.2000,percent of total billed charges,"41.7% of $1,403.20 in Billed Charges for Rev 272 = $585.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7756131,272,RC,,,,,,,,both,,,1403.2000,210.4800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,651.08,,,,,,,362.1700,1403.2000,percent of total billed charges,"46.4% of $1,403.20 in Billed Charges for Rev 272 = $651.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7756131,272,RC,,,,,,,,both,,,1403.2000,210.4800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,585.13,,,,,,,362.1700,1403.2000,percent of total billed charges,"41.7% of $1,403.20 in Billed Charges for Rev 272 = $585.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7756131,272,RC,,,,,,,,both,,,1403.2000,210.4800,CIGNA HEALTHCARE,CIGNA PPO,585.13,,,,,,,362.1700,1403.2000,percent of total billed charges,"41.7% of $1,403.20 in Billed Charges for Rev 272 = $585.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7756131,272,RC,,,,,,,,both,,,1403.2000,210.4800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1262.88,,,,,,,362.1700,1403.2000,percent of total billed charges,"90% of $1,403.20 in Billed Charges for Rev 272 = $1,262.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7756131,272,RC,,,,,,,,both,,,1403.2000,210.4800,MEDCOST,MEDCOST VHN,667.78,,,,,,,362.1700,1403.2000,percent of total billed charges,"47.59% of $1,403.20 in Billed Charges for Rev 272 = $667.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7756131,272,RC,,,,,,,,both,,,1403.2000,210.4800,SENTARA HEALTH,SENTARA HEALTH,362.17,,,,,,,362.1700,1403.2000,percent of total billed charges,"25.81% of $1,403.20 in Billed Charges for Rev 272 = $362.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7756131,272,RC,,,,,,,,both,,,1403.2000,210.4800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1403.20,,,,,,,362.1700,1403.2000,percent of total billed charges,"100% of $1,403.20 in Billed Charges for Rev 272 = $1,403.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7756131,272,RC,,,,,,,,both,,,1403.2000,210.4800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,701.60,,,,,,,362.1700,1403.2000,percent of total billed charges,"Rev 272 $1,403.20 in Billed Charges at 50% = $701.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7756131,272,RC,,,,,,,,both,,,1403.2000,210.4800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,453.23,,,,,,,362.1700,1403.2000,other,"32.3% of $1,403.20 in Billed Charges for Rev 272 = $453.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 7756131,272,RC,,,,,,,,both,,,1403.2000,210.4800,UNITED HEALTHCARE,UHC HERITAGE SELECT,430.78,,,,,,,362.1700,1403.2000,other,"30.7% of $1,403.20 in Billed Charges for Rev 272 = $430.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 7756131,272,RC,,,,,,,,both,,,1403.2000,210.4800,UNITED HEALTHCARE,UNITED HEALTHCARE,453.23,,,,,,,362.1700,1403.2000,percent of total billed charges,"32.3% of $1,403.20 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7756131,272,RC,,,,,,,,both,,,1403.2000,210.4800,WELLCARE,WELLCARE MEDICAID,1403.20,,,,,,,362.1700,1403.2000,percent of total billed charges,"100% of $1,403.20 in Billed Charges for Rev 272 = $1,403.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,2229.7700,334.4700,AETNA,AETNA,952.11,,,,,,,575.5000,2229.7700,percent of total billed charges,"42.7% of $2,229.77 in Billed Charges for Rev 272 = $952.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,2229.7700,334.4700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1560.84,,,,,,,575.5000,2229.7700,percent of total billed charges,"Rev 272 $2,229.77 in Billed Charges at 70% = $1,560.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,2229.7700,334.4700,CIGNA HEALTHCARE,CIGNA HMO,929.81,,,,,,,575.5000,2229.7700,percent of total billed charges,"41.7% of $2,229.77 in Billed Charges for Rev 272 = $929.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,2229.7700,334.4700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1034.61,,,,,,,575.5000,2229.7700,percent of total billed charges,"46.4% of $2,229.77 in Billed Charges for Rev 272 = $1,034.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,2229.7700,334.4700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,929.81,,,,,,,575.5000,2229.7700,percent of total billed charges,"41.7% of $2,229.77 in Billed Charges for Rev 272 = $929.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,2229.7700,334.4700,CIGNA HEALTHCARE,CIGNA PPO,929.81,,,,,,,575.5000,2229.7700,percent of total billed charges,"41.7% of $2,229.77 in Billed Charges for Rev 272 = $929.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,2229.7700,334.4700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2006.79,,,,,,,575.5000,2229.7700,percent of total billed charges,"90% of $2,229.77 in Billed Charges for Rev 272 = $2,006.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,2229.7700,334.4700,MEDCOST,MEDCOST VHN,1061.15,,,,,,,575.5000,2229.7700,percent of total billed charges,"47.59% of $2,229.77 in Billed Charges for Rev 272 = $1,061.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,2229.7700,334.4700,SENTARA HEALTH,SENTARA HEALTH,575.50,,,,,,,575.5000,2229.7700,percent of total billed charges,"25.81% of $2,229.77 in Billed Charges for Rev 272 = $575.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,2229.7700,334.4700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2229.77,,,,,,,575.5000,2229.7700,percent of total billed charges,"100% of $2,229.77 in Billed Charges for Rev 272 = $2,229.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,2229.7700,334.4700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1114.89,,,,,,,575.5000,2229.7700,percent of total billed charges,"Rev 272 $2,229.77 in Billed Charges at 50% = $1,114.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,2229.7700,334.4700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,720.22,,,,,,,575.5000,2229.7700,other,"32.3% of $2,229.77 in Billed Charges for Rev 272 = $720.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,2229.7700,334.4700,UNITED HEALTHCARE,UHC HERITAGE SELECT,684.54,,,,,,,575.5000,2229.7700,other,"30.7% of $2,229.77 in Billed Charges for Rev 272 = $684.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,2229.7700,334.4700,UNITED HEALTHCARE,UNITED HEALTHCARE,720.22,,,,,,,575.5000,2229.7700,percent of total billed charges,"32.3% of $2,229.77 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,2229.7700,334.4700,WELLCARE,WELLCARE MEDICAID,2229.77,,,,,,,575.5000,2229.7700,percent of total billed charges,"100% of $2,229.77 in Billed Charges for Rev 272 = $2,229.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,3723.1900,558.4800,AETNA,AETNA,1589.80,,,,,,,960.9600,3723.1900,percent of total billed charges,"42.7% of $3,723.19 in Billed Charges for Rev 272 = $1,589.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,3723.1900,558.4800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2606.23,,,,,,,960.9600,3723.1900,percent of total billed charges,"Rev 272 $3,723.19 in Billed Charges at 70% = $2,606.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,3723.1900,558.4800,CIGNA HEALTHCARE,CIGNA HMO,1552.57,,,,,,,960.9600,3723.1900,percent of total billed charges,"41.7% of $3,723.19 in Billed Charges for Rev 272 = $1,552.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,3723.1900,558.4800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1727.56,,,,,,,960.9600,3723.1900,percent of total billed charges,"46.4% of $3,723.19 in Billed Charges for Rev 272 = $1,727.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,3723.1900,558.4800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1552.57,,,,,,,960.9600,3723.1900,percent of total billed charges,"41.7% of $3,723.19 in Billed Charges for Rev 272 = $1,552.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,3723.1900,558.4800,CIGNA HEALTHCARE,CIGNA PPO,1552.57,,,,,,,960.9600,3723.1900,percent of total billed charges,"41.7% of $3,723.19 in Billed Charges for Rev 272 = $1,552.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,3723.1900,558.4800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3350.87,,,,,,,960.9600,3723.1900,percent of total billed charges,"90% of $3,723.19 in Billed Charges for Rev 272 = $3,350.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,3723.1900,558.4800,MEDCOST,MEDCOST VHN,1771.87,,,,,,,960.9600,3723.1900,percent of total billed charges,"47.59% of $3,723.19 in Billed Charges for Rev 272 = $1,771.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,3723.1900,558.4800,SENTARA HEALTH,SENTARA HEALTH,960.96,,,,,,,960.9600,3723.1900,percent of total billed charges,"25.81% of $3,723.19 in Billed Charges for Rev 272 = $960.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,3723.1900,558.4800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3723.19,,,,,,,960.9600,3723.1900,percent of total billed charges,"100% of $3,723.19 in Billed Charges for Rev 272 = $3,723.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,3723.1900,558.4800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1861.60,,,,,,,960.9600,3723.1900,percent of total billed charges,"Rev 272 $3,723.19 in Billed Charges at 50% = $1,861.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,3723.1900,558.4800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1202.59,,,,,,,960.9600,3723.1900,other,"32.3% of $3,723.19 in Billed Charges for Rev 272 = $1,202.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,3723.1900,558.4800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1143.02,,,,,,,960.9600,3723.1900,other,"30.7% of $3,723.19 in Billed Charges for Rev 272 = $1,143.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,3723.1900,558.4800,UNITED HEALTHCARE,UNITED HEALTHCARE,1202.59,,,,,,,960.9600,3723.1900,percent of total billed charges,"32.3% of $3,723.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 7MM AR-1407 AR-1407,272,RC,27200002,CDM,,,,,,both,,,3723.1900,558.4800,WELLCARE,WELLCARE MEDICAID,3723.19,,,,,,,960.9600,3723.1900,percent of total billed charges,"100% of $3,723.19 in Billed Charges for Rev 272 = $3,723.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 8730006,272,RC,,,,,,,,both,,,2280.5800,342.0900,AETNA,AETNA,973.81,,,,,,,588.6200,2280.5800,percent of total billed charges,"42.7% of $2,280.58 in Billed Charges for Rev 272 = $973.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 8730006,272,RC,,,,,,,,both,,,2280.5800,342.0900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1596.41,,,,,,,588.6200,2280.5800,percent of total billed charges,"Rev 272 $2,280.58 in Billed Charges at 70% = $1,596.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 8730006,272,RC,,,,,,,,both,,,2280.5800,342.0900,CIGNA HEALTHCARE,CIGNA HMO,951.00,,,,,,,588.6200,2280.5800,percent of total billed charges,"41.7% of $2,280.58 in Billed Charges for Rev 272 = $951.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 8730006,272,RC,,,,,,,,both,,,2280.5800,342.0900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1058.19,,,,,,,588.6200,2280.5800,percent of total billed charges,"46.4% of $2,280.58 in Billed Charges for Rev 272 = $1,058.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 8730006,272,RC,,,,,,,,both,,,2280.5800,342.0900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,951.00,,,,,,,588.6200,2280.5800,percent of total billed charges,"41.7% of $2,280.58 in Billed Charges for Rev 272 = $951.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 8730006,272,RC,,,,,,,,both,,,2280.5800,342.0900,CIGNA HEALTHCARE,CIGNA PPO,951.00,,,,,,,588.6200,2280.5800,percent of total billed charges,"41.7% of $2,280.58 in Billed Charges for Rev 272 = $951.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 8730006,272,RC,,,,,,,,both,,,2280.5800,342.0900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2052.52,,,,,,,588.6200,2280.5800,percent of total billed charges,"90% of $2,280.58 in Billed Charges for Rev 272 = $2,052.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 8730006,272,RC,,,,,,,,both,,,2280.5800,342.0900,MEDCOST,MEDCOST VHN,1085.33,,,,,,,588.6200,2280.5800,percent of total billed charges,"47.59% of $2,280.58 in Billed Charges for Rev 272 = $1,085.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 8730006,272,RC,,,,,,,,both,,,2280.5800,342.0900,SENTARA HEALTH,SENTARA HEALTH,588.62,,,,,,,588.6200,2280.5800,percent of total billed charges,"25.81% of $2,280.58 in Billed Charges for Rev 272 = $588.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 8730006,272,RC,,,,,,,,both,,,2280.5800,342.0900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2280.58,,,,,,,588.6200,2280.5800,percent of total billed charges,"100% of $2,280.58 in Billed Charges for Rev 272 = $2,280.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 8730006,272,RC,,,,,,,,both,,,2280.5800,342.0900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1140.29,,,,,,,588.6200,2280.5800,percent of total billed charges,"Rev 272 $2,280.58 in Billed Charges at 50% = $1,140.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 8730006,272,RC,,,,,,,,both,,,2280.5800,342.0900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,736.63,,,,,,,588.6200,2280.5800,other,"32.3% of $2,280.58 in Billed Charges for Rev 272 = $736.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 8730006,272,RC,,,,,,,,both,,,2280.5800,342.0900,UNITED HEALTHCARE,UHC HERITAGE SELECT,700.14,,,,,,,588.6200,2280.5800,other,"30.7% of $2,280.58 in Billed Charges for Rev 272 = $700.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 8730006,272,RC,,,,,,,,both,,,2280.5800,342.0900,UNITED HEALTHCARE,UNITED HEALTHCARE,736.63,,,,,,,588.6200,2280.5800,percent of total billed charges,"32.3% of $2,280.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 8730006,272,RC,,,,,,,,both,,,2280.5800,342.0900,WELLCARE,WELLCARE MEDICAID,2280.58,,,,,,,588.6200,2280.5800,percent of total billed charges,"100% of $2,280.58 in Billed Charges for Rev 272 = $2,280.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CANN TAPERED 10MM,272,RC,27200002,CDM,,,,,,both,,,4843.1500,726.4700,AETNA,AETNA,2068.03,,,,,,,1250.0200,4843.1500,percent of total billed charges,"42.7% of $4,843.15 in Billed Charges for Rev 272 = $2,068.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CANN TAPERED 10MM,272,RC,27200002,CDM,,,,,,both,,,4843.1500,726.4700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3390.21,,,,,,,1250.0200,4843.1500,percent of total billed charges,"Rev 272 $4,843.15 in Billed Charges at 70% = $3,390.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CANN TAPERED 10MM,272,RC,27200002,CDM,,,,,,both,,,4843.1500,726.4700,CIGNA HEALTHCARE,CIGNA HMO,2019.59,,,,,,,1250.0200,4843.1500,percent of total billed charges,"41.7% of $4,843.15 in Billed Charges for Rev 272 = $2,019.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CANN TAPERED 10MM,272,RC,27200002,CDM,,,,,,both,,,4843.1500,726.4700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2247.22,,,,,,,1250.0200,4843.1500,percent of total billed charges,"46.4% of $4,843.15 in Billed Charges for Rev 272 = $2,247.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CANN TAPERED 10MM,272,RC,27200002,CDM,,,,,,both,,,4843.1500,726.4700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2019.59,,,,,,,1250.0200,4843.1500,percent of total billed charges,"41.7% of $4,843.15 in Billed Charges for Rev 272 = $2,019.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CANN TAPERED 10MM,272,RC,27200002,CDM,,,,,,both,,,4843.1500,726.4700,CIGNA HEALTHCARE,CIGNA PPO,2019.59,,,,,,,1250.0200,4843.1500,percent of total billed charges,"41.7% of $4,843.15 in Billed Charges for Rev 272 = $2,019.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CANN TAPERED 10MM,272,RC,27200002,CDM,,,,,,both,,,4843.1500,726.4700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4358.84,,,,,,,1250.0200,4843.1500,percent of total billed charges,"90% of $4,843.15 in Billed Charges for Rev 272 = $4,358.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CANN TAPERED 10MM,272,RC,27200002,CDM,,,,,,both,,,4843.1500,726.4700,MEDCOST,MEDCOST VHN,2304.86,,,,,,,1250.0200,4843.1500,percent of total billed charges,"47.59% of $4,843.15 in Billed Charges for Rev 272 = $2,304.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CANN TAPERED 10MM,272,RC,27200002,CDM,,,,,,both,,,4843.1500,726.4700,SENTARA HEALTH,SENTARA HEALTH,1250.02,,,,,,,1250.0200,4843.1500,percent of total billed charges,"25.81% of $4,843.15 in Billed Charges for Rev 272 = $1,250.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CANN TAPERED 10MM,272,RC,27200002,CDM,,,,,,both,,,4843.1500,726.4700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4843.15,,,,,,,1250.0200,4843.1500,percent of total billed charges,"100% of $4,843.15 in Billed Charges for Rev 272 = $4,843.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CANN TAPERED 10MM,272,RC,27200002,CDM,,,,,,both,,,4843.1500,726.4700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2421.58,,,,,,,1250.0200,4843.1500,percent of total billed charges,"Rev 272 $4,843.15 in Billed Charges at 50% = $2,421.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CANN TAPERED 10MM,272,RC,27200002,CDM,,,,,,both,,,4843.1500,726.4700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1564.34,,,,,,,1250.0200,4843.1500,other,"32.3% of $4,843.15 in Billed Charges for Rev 272 = $1,564.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT CANN TAPERED 10MM,272,RC,27200002,CDM,,,,,,both,,,4843.1500,726.4700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1486.85,,,,,,,1250.0200,4843.1500,other,"30.7% of $4,843.15 in Billed Charges for Rev 272 = $1,486.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT CANN TAPERED 10MM,272,RC,27200002,CDM,,,,,,both,,,4843.1500,726.4700,UNITED HEALTHCARE,UNITED HEALTHCARE,1564.34,,,,,,,1250.0200,4843.1500,percent of total billed charges,"32.3% of $4,843.15 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT CANN TAPERED 10MM,272,RC,27200002,CDM,,,,,,both,,,4843.1500,726.4700,WELLCARE,WELLCARE MEDICAID,4843.15,,,,,,,1250.0200,4843.1500,percent of total billed charges,"100% of $4,843.15 in Billed Charges for Rev 272 = $4,843.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 16.0/18.0FR X 45CM,272,RC,27200002,CDM,,,,,,both,,,2520.9800,378.1500,AETNA,AETNA,1076.46,,,,,,,650.6600,2520.9800,percent of total billed charges,"42.7% of $2,520.98 in Billed Charges for Rev 272 = $1,076.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 16.0/18.0FR X 45CM,272,RC,27200002,CDM,,,,,,both,,,2520.9800,378.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1764.69,,,,,,,650.6600,2520.9800,percent of total billed charges,"Rev 272 $2,520.98 in Billed Charges at 70% = $1,764.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 16.0/18.0FR X 45CM,272,RC,27200002,CDM,,,,,,both,,,2520.9800,378.1500,CIGNA HEALTHCARE,CIGNA HMO,1051.25,,,,,,,650.6600,2520.9800,percent of total billed charges,"41.7% of $2,520.98 in Billed Charges for Rev 272 = $1,051.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 16.0/18.0FR X 45CM,272,RC,27200002,CDM,,,,,,both,,,2520.9800,378.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1169.73,,,,,,,650.6600,2520.9800,percent of total billed charges,"46.4% of $2,520.98 in Billed Charges for Rev 272 = $1,169.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 16.0/18.0FR X 45CM,272,RC,27200002,CDM,,,,,,both,,,2520.9800,378.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1051.25,,,,,,,650.6600,2520.9800,percent of total billed charges,"41.7% of $2,520.98 in Billed Charges for Rev 272 = $1,051.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 16.0/18.0FR X 45CM,272,RC,27200002,CDM,,,,,,both,,,2520.9800,378.1500,CIGNA HEALTHCARE,CIGNA PPO,1051.25,,,,,,,650.6600,2520.9800,percent of total billed charges,"41.7% of $2,520.98 in Billed Charges for Rev 272 = $1,051.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 16.0/18.0FR X 45CM,272,RC,27200002,CDM,,,,,,both,,,2520.9800,378.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2268.88,,,,,,,650.6600,2520.9800,percent of total billed charges,"90% of $2,520.98 in Billed Charges for Rev 272 = $2,268.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 16.0/18.0FR X 45CM,272,RC,27200002,CDM,,,,,,both,,,2520.9800,378.1500,MEDCOST,MEDCOST VHN,1199.73,,,,,,,650.6600,2520.9800,percent of total billed charges,"47.59% of $2,520.98 in Billed Charges for Rev 272 = $1,199.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 16.0/18.0FR X 45CM,272,RC,27200002,CDM,,,,,,both,,,2520.9800,378.1500,SENTARA HEALTH,SENTARA HEALTH,650.66,,,,,,,650.6600,2520.9800,percent of total billed charges,"25.81% of $2,520.98 in Billed Charges for Rev 272 = $650.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 16.0/18.0FR X 45CM,272,RC,27200002,CDM,,,,,,both,,,2520.9800,378.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2520.98,,,,,,,650.6600,2520.9800,percent of total billed charges,"100% of $2,520.98 in Billed Charges for Rev 272 = $2,520.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 16.0/18.0FR X 45CM,272,RC,27200002,CDM,,,,,,both,,,2520.9800,378.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1260.49,,,,,,,650.6600,2520.9800,percent of total billed charges,"Rev 272 $2,520.98 in Billed Charges at 50% = $1,260.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 16.0/18.0FR X 45CM,272,RC,27200002,CDM,,,,,,both,,,2520.9800,378.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,814.28,,,,,,,650.6600,2520.9800,other,"32.3% of $2,520.98 in Billed Charges for Rev 272 = $814.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DILATOR ENDOVASCULAR 16.0/18.0FR X 45CM,272,RC,27200002,CDM,,,,,,both,,,2520.9800,378.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,773.94,,,,,,,650.6600,2520.9800,other,"30.7% of $2,520.98 in Billed Charges for Rev 272 = $773.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DILATOR ENDOVASCULAR 16.0/18.0FR X 45CM,272,RC,27200002,CDM,,,,,,both,,,2520.9800,378.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,814.28,,,,,,,650.6600,2520.9800,percent of total billed charges,"32.3% of $2,520.98 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 16.0/18.0FR X 45CM,272,RC,27200002,CDM,,,,,,both,,,2520.9800,378.1500,WELLCARE,WELLCARE MEDICAID,2520.98,,,,,,,650.6600,2520.9800,percent of total billed charges,"100% of $2,520.98 in Billed Charges for Rev 272 = $2,520.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 24.0/26.0 X 45CM,272,RC,,,,,,,,both,,,2447.5600,367.1300,AETNA,AETNA,1045.11,,,,,,,631.7200,2447.5600,percent of total billed charges,"42.7% of $2,447.56 in Billed Charges for Rev 272 = $1,045.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 24.0/26.0 X 45CM,272,RC,,,,,,,,both,,,2447.5600,367.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1713.29,,,,,,,631.7200,2447.5600,percent of total billed charges,"Rev 272 $2,447.56 in Billed Charges at 70% = $1,713.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 24.0/26.0 X 45CM,272,RC,,,,,,,,both,,,2447.5600,367.1300,CIGNA HEALTHCARE,CIGNA HMO,1020.63,,,,,,,631.7200,2447.5600,percent of total billed charges,"41.7% of $2,447.56 in Billed Charges for Rev 272 = $1,020.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 24.0/26.0 X 45CM,272,RC,,,,,,,,both,,,2447.5600,367.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1135.67,,,,,,,631.7200,2447.5600,percent of total billed charges,"46.4% of $2,447.56 in Billed Charges for Rev 272 = $1,135.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 24.0/26.0 X 45CM,272,RC,,,,,,,,both,,,2447.5600,367.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1020.63,,,,,,,631.7200,2447.5600,percent of total billed charges,"41.7% of $2,447.56 in Billed Charges for Rev 272 = $1,020.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 24.0/26.0 X 45CM,272,RC,,,,,,,,both,,,2447.5600,367.1300,CIGNA HEALTHCARE,CIGNA PPO,1020.63,,,,,,,631.7200,2447.5600,percent of total billed charges,"41.7% of $2,447.56 in Billed Charges for Rev 272 = $1,020.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 24.0/26.0 X 45CM,272,RC,,,,,,,,both,,,2447.5600,367.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2202.80,,,,,,,631.7200,2447.5600,percent of total billed charges,"90% of $2,447.56 in Billed Charges for Rev 272 = $2,202.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 24.0/26.0 X 45CM,272,RC,,,,,,,,both,,,2447.5600,367.1300,MEDCOST,MEDCOST VHN,1164.79,,,,,,,631.7200,2447.5600,percent of total billed charges,"47.59% of $2,447.56 in Billed Charges for Rev 272 = $1,164.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 24.0/26.0 X 45CM,272,RC,,,,,,,,both,,,2447.5600,367.1300,SENTARA HEALTH,SENTARA HEALTH,631.72,,,,,,,631.7200,2447.5600,percent of total billed charges,"25.81% of $2,447.56 in Billed Charges for Rev 272 = $631.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 24.0/26.0 X 45CM,272,RC,,,,,,,,both,,,2447.5600,367.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2447.56,,,,,,,631.7200,2447.5600,percent of total billed charges,"100% of $2,447.56 in Billed Charges for Rev 272 = $2,447.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 24.0/26.0 X 45CM,272,RC,,,,,,,,both,,,2447.5600,367.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1223.78,,,,,,,631.7200,2447.5600,percent of total billed charges,"Rev 272 $2,447.56 in Billed Charges at 50% = $1,223.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 24.0/26.0 X 45CM,272,RC,,,,,,,,both,,,2447.5600,367.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,790.56,,,,,,,631.7200,2447.5600,other,"32.3% of $2,447.56 in Billed Charges for Rev 272 = $790.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DILATOR ENDOVASCULAR 24.0/26.0 X 45CM,272,RC,,,,,,,,both,,,2447.5600,367.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,751.40,,,,,,,631.7200,2447.5600,other,"30.7% of $2,447.56 in Billed Charges for Rev 272 = $751.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DILATOR ENDOVASCULAR 24.0/26.0 X 45CM,272,RC,,,,,,,,both,,,2447.5600,367.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,790.56,,,,,,,631.7200,2447.5600,percent of total billed charges,"32.3% of $2,447.56 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR ENDOVASCULAR 24.0/26.0 X 45CM,272,RC,,,,,,,,both,,,2447.5600,367.1300,WELLCARE,WELLCARE MEDICAID,2447.56,,,,,,,631.7200,2447.5600,percent of total billed charges,"100% of $2,447.56 in Billed Charges for Rev 272 = $2,447.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR HEYMAN 10FR,270,RC,,,,,,,,both,,,14225.9000,2133.8900,AETNA,AETNA,6074.46,,,,,,,3671.7000,14225.9000,percent of total billed charges,"42.7% of $14,225.90 in Billed Charges for Rev 270 = $6,074.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR HEYMAN 10FR,270,RC,,,,,,,,both,,,14225.9000,2133.8900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9958.13,,,,,,,3671.7000,14225.9000,percent of total billed charges,"Rev 270 $14,225.90 in Billed Charges at 70% = $9,958.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR HEYMAN 10FR,270,RC,,,,,,,,both,,,14225.9000,2133.8900,CIGNA HEALTHCARE,CIGNA HMO,5932.20,,,,,,,3671.7000,14225.9000,percent of total billed charges,"41.7% of $14,225.90 in Billed Charges for Rev 270 = $5,932.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR HEYMAN 10FR,270,RC,,,,,,,,both,,,14225.9000,2133.8900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6600.82,,,,,,,3671.7000,14225.9000,percent of total billed charges,"46.4% of $14,225.90 in Billed Charges for Rev 270 = $6,600.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR HEYMAN 10FR,270,RC,,,,,,,,both,,,14225.9000,2133.8900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5932.20,,,,,,,3671.7000,14225.9000,percent of total billed charges,"41.7% of $14,225.90 in Billed Charges for Rev 270 = $5,932.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR HEYMAN 10FR,270,RC,,,,,,,,both,,,14225.9000,2133.8900,CIGNA HEALTHCARE,CIGNA PPO,5932.20,,,,,,,3671.7000,14225.9000,percent of total billed charges,"41.7% of $14,225.90 in Billed Charges for Rev 270 = $5,932.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR HEYMAN 10FR,270,RC,,,,,,,,both,,,14225.9000,2133.8900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12803.31,,,,,,,3671.7000,14225.9000,percent of total billed charges,"90% of $14,225.90 in Billed Charges for Rev 270 = $12,803.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR HEYMAN 10FR,270,RC,,,,,,,,both,,,14225.9000,2133.8900,MEDCOST,MEDCOST VHN,6770.11,,,,,,,3671.7000,14225.9000,percent of total billed charges,"47.59% of $14,225.90 in Billed Charges for Rev 270 = $6,770.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR HEYMAN 10FR,270,RC,,,,,,,,both,,,14225.9000,2133.8900,SENTARA HEALTH,SENTARA HEALTH,3671.70,,,,,,,3671.7000,14225.9000,percent of total billed charges,"25.81% of $14,225.90 in Billed Charges for Rev 270 = $3,671.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR HEYMAN 10FR,270,RC,,,,,,,,both,,,14225.9000,2133.8900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",14225.90,,,,,,,3671.7000,14225.9000,percent of total billed charges,"100% of $14,225.90 in Billed Charges for Rev 270 = $14,225.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR HEYMAN 10FR,270,RC,,,,,,,,both,,,14225.9000,2133.8900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7112.95,,,,,,,3671.7000,14225.9000,percent of total billed charges,"Rev 270 $14,225.90 in Billed Charges at 50% = $7,112.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR HEYMAN 10FR,270,RC,,,,,,,,both,,,14225.9000,2133.8900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4594.97,,,,,,,3671.7000,14225.9000,other,"32.3% of $14,225.90 in Billed Charges for Rev 270 = $4,594.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DILATOR HEYMAN 10FR,270,RC,,,,,,,,both,,,14225.9000,2133.8900,UNITED HEALTHCARE,UHC HERITAGE SELECT,4367.35,,,,,,,3671.7000,14225.9000,other,"30.7% of $14,225.90 in Billed Charges for Rev 270 = $4,367.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DILATOR HEYMAN 10FR,270,RC,,,,,,,,both,,,14225.9000,2133.8900,UNITED HEALTHCARE,UNITED HEALTHCARE,4594.97,,,,,,,3671.7000,14225.9000,percent of total billed charges,"32.3% of $14,225.90 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR HEYMAN 10FR,270,RC,,,,,,,,both,,,14225.9000,2133.8900,WELLCARE,WELLCARE MEDICAID,14225.90,,,,,,,3671.7000,14225.9000,percent of total billed charges,"100% of $14,225.90 in Billed Charges for Rev 270 = $14,225.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR SET ENDOSCOPIC 8-20FR DIA 37CML HYDROPHILIC COAT URETH W/SIDEPORT S-CURVE LF NON-RAD STER,272,RC,27200002,CDM,,,,,,both,,,3145.6300,471.8400,AETNA,AETNA,1343.18,,,,,,,811.8900,3145.6300,percent of total billed charges,"42.7% of $3,145.63 in Billed Charges for Rev 272 = $1,343.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR SET ENDOSCOPIC 8-20FR DIA 37CML HYDROPHILIC COAT URETH W/SIDEPORT S-CURVE LF NON-RAD STER,272,RC,27200002,CDM,,,,,,both,,,3145.6300,471.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2201.94,,,,,,,811.8900,3145.6300,percent of total billed charges,"Rev 272 $3,145.63 in Billed Charges at 70% = $2,201.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR SET ENDOSCOPIC 8-20FR DIA 37CML HYDROPHILIC COAT URETH W/SIDEPORT S-CURVE LF NON-RAD STER,272,RC,27200002,CDM,,,,,,both,,,3145.6300,471.8400,CIGNA HEALTHCARE,CIGNA HMO,1311.73,,,,,,,811.8900,3145.6300,percent of total billed charges,"41.7% of $3,145.63 in Billed Charges for Rev 272 = $1,311.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR SET ENDOSCOPIC 8-20FR DIA 37CML HYDROPHILIC COAT URETH W/SIDEPORT S-CURVE LF NON-RAD STER,272,RC,27200002,CDM,,,,,,both,,,3145.6300,471.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1459.57,,,,,,,811.8900,3145.6300,percent of total billed charges,"46.4% of $3,145.63 in Billed Charges for Rev 272 = $1,459.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR SET ENDOSCOPIC 8-20FR DIA 37CML HYDROPHILIC COAT URETH W/SIDEPORT S-CURVE LF NON-RAD STER,272,RC,27200002,CDM,,,,,,both,,,3145.6300,471.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1311.73,,,,,,,811.8900,3145.6300,percent of total billed charges,"41.7% of $3,145.63 in Billed Charges for Rev 272 = $1,311.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR SET ENDOSCOPIC 8-20FR DIA 37CML HYDROPHILIC COAT URETH W/SIDEPORT S-CURVE LF NON-RAD STER,272,RC,27200002,CDM,,,,,,both,,,3145.6300,471.8400,CIGNA HEALTHCARE,CIGNA PPO,1311.73,,,,,,,811.8900,3145.6300,percent of total billed charges,"41.7% of $3,145.63 in Billed Charges for Rev 272 = $1,311.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR SET ENDOSCOPIC 8-20FR DIA 37CML HYDROPHILIC COAT URETH W/SIDEPORT S-CURVE LF NON-RAD STER,272,RC,27200002,CDM,,,,,,both,,,3145.6300,471.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2831.07,,,,,,,811.8900,3145.6300,percent of total billed charges,"90% of $3,145.63 in Billed Charges for Rev 272 = $2,831.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR SET ENDOSCOPIC 8-20FR DIA 37CML HYDROPHILIC COAT URETH W/SIDEPORT S-CURVE LF NON-RAD STER,272,RC,27200002,CDM,,,,,,both,,,3145.6300,471.8400,MEDCOST,MEDCOST VHN,1497.01,,,,,,,811.8900,3145.6300,percent of total billed charges,"47.59% of $3,145.63 in Billed Charges for Rev 272 = $1,497.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR SET ENDOSCOPIC 8-20FR DIA 37CML HYDROPHILIC COAT URETH W/SIDEPORT S-CURVE LF NON-RAD STER,272,RC,27200002,CDM,,,,,,both,,,3145.6300,471.8400,SENTARA HEALTH,SENTARA HEALTH,811.89,,,,,,,811.8900,3145.6300,percent of total billed charges,"25.81% of $3,145.63 in Billed Charges for Rev 272 = $811.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR SET ENDOSCOPIC 8-20FR DIA 37CML HYDROPHILIC COAT URETH W/SIDEPORT S-CURVE LF NON-RAD STER,272,RC,27200002,CDM,,,,,,both,,,3145.6300,471.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3145.63,,,,,,,811.8900,3145.6300,percent of total billed charges,"100% of $3,145.63 in Billed Charges for Rev 272 = $3,145.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR SET ENDOSCOPIC 8-20FR DIA 37CML HYDROPHILIC COAT URETH W/SIDEPORT S-CURVE LF NON-RAD STER,272,RC,27200002,CDM,,,,,,both,,,3145.6300,471.8400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1572.82,,,,,,,811.8900,3145.6300,percent of total billed charges,"Rev 272 $3,145.63 in Billed Charges at 50% = $1,572.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR SET ENDOSCOPIC 8-20FR DIA 37CML HYDROPHILIC COAT URETH W/SIDEPORT S-CURVE LF NON-RAD STER,272,RC,27200002,CDM,,,,,,both,,,3145.6300,471.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1016.04,,,,,,,811.8900,3145.6300,other,"32.3% of $3,145.63 in Billed Charges for Rev 272 = $1,016.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DILATOR SET ENDOSCOPIC 8-20FR DIA 37CML HYDROPHILIC COAT URETH W/SIDEPORT S-CURVE LF NON-RAD STER,272,RC,27200002,CDM,,,,,,both,,,3145.6300,471.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,965.71,,,,,,,811.8900,3145.6300,other,"30.7% of $3,145.63 in Billed Charges for Rev 272 = $965.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DILATOR SET ENDOSCOPIC 8-20FR DIA 37CML HYDROPHILIC COAT URETH W/SIDEPORT S-CURVE LF NON-RAD STER,272,RC,27200002,CDM,,,,,,both,,,3145.6300,471.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,1016.04,,,,,,,811.8900,3145.6300,percent of total billed charges,"32.3% of $3,145.63 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR SET ENDOSCOPIC 8-20FR DIA 37CML HYDROPHILIC COAT URETH W/SIDEPORT S-CURVE LF NON-RAD STER,272,RC,27200002,CDM,,,,,,both,,,3145.6300,471.8400,WELLCARE,WELLCARE MEDICAID,3145.63,,,,,,,811.8900,3145.6300,percent of total billed charges,"100% of $3,145.63 in Billed Charges for Rev 272 = $3,145.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR TERTIARY ELLIPTICAL,272,RC,,,,,,,,both,,,12704.4800,1905.6700,AETNA,AETNA,5424.81,,,,,,,3279.0300,12704.4800,percent of total billed charges,"42.7% of $12,704.48 in Billed Charges for Rev 272 = $5,424.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR TERTIARY ELLIPTICAL,272,RC,,,,,,,,both,,,12704.4800,1905.6700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8893.14,,,,,,,3279.0300,12704.4800,percent of total billed charges,"Rev 272 $12,704.48 in Billed Charges at 70% = $8,893.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR TERTIARY ELLIPTICAL,272,RC,,,,,,,,both,,,12704.4800,1905.6700,CIGNA HEALTHCARE,CIGNA HMO,5297.77,,,,,,,3279.0300,12704.4800,percent of total billed charges,"41.7% of $12,704.48 in Billed Charges for Rev 272 = $5,297.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR TERTIARY ELLIPTICAL,272,RC,,,,,,,,both,,,12704.4800,1905.6700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5894.88,,,,,,,3279.0300,12704.4800,percent of total billed charges,"46.4% of $12,704.48 in Billed Charges for Rev 272 = $5,894.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR TERTIARY ELLIPTICAL,272,RC,,,,,,,,both,,,12704.4800,1905.6700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5297.77,,,,,,,3279.0300,12704.4800,percent of total billed charges,"41.7% of $12,704.48 in Billed Charges for Rev 272 = $5,297.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR TERTIARY ELLIPTICAL,272,RC,,,,,,,,both,,,12704.4800,1905.6700,CIGNA HEALTHCARE,CIGNA PPO,5297.77,,,,,,,3279.0300,12704.4800,percent of total billed charges,"41.7% of $12,704.48 in Billed Charges for Rev 272 = $5,297.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR TERTIARY ELLIPTICAL,272,RC,,,,,,,,both,,,12704.4800,1905.6700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11434.03,,,,,,,3279.0300,12704.4800,percent of total billed charges,"90% of $12,704.48 in Billed Charges for Rev 272 = $11,434.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR TERTIARY ELLIPTICAL,272,RC,,,,,,,,both,,,12704.4800,1905.6700,MEDCOST,MEDCOST VHN,6046.06,,,,,,,3279.0300,12704.4800,percent of total billed charges,"47.59% of $12,704.48 in Billed Charges for Rev 272 = $6,046.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR TERTIARY ELLIPTICAL,272,RC,,,,,,,,both,,,12704.4800,1905.6700,SENTARA HEALTH,SENTARA HEALTH,3279.03,,,,,,,3279.0300,12704.4800,percent of total billed charges,"25.81% of $12,704.48 in Billed Charges for Rev 272 = $3,279.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR TERTIARY ELLIPTICAL,272,RC,,,,,,,,both,,,12704.4800,1905.6700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12704.48,,,,,,,3279.0300,12704.4800,percent of total billed charges,"100% of $12,704.48 in Billed Charges for Rev 272 = $12,704.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR TERTIARY ELLIPTICAL,272,RC,,,,,,,,both,,,12704.4800,1905.6700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6352.24,,,,,,,3279.0300,12704.4800,percent of total billed charges,"Rev 272 $12,704.48 in Billed Charges at 50% = $6,352.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR TERTIARY ELLIPTICAL,272,RC,,,,,,,,both,,,12704.4800,1905.6700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4103.55,,,,,,,3279.0300,12704.4800,other,"32.3% of $12,704.48 in Billed Charges for Rev 272 = $4,103.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DILATOR TERTIARY ELLIPTICAL,272,RC,,,,,,,,both,,,12704.4800,1905.6700,UNITED HEALTHCARE,UHC HERITAGE SELECT,3900.28,,,,,,,3279.0300,12704.4800,other,"30.7% of $12,704.48 in Billed Charges for Rev 272 = $3,900.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DILATOR TERTIARY ELLIPTICAL,272,RC,,,,,,,,both,,,12704.4800,1905.6700,UNITED HEALTHCARE,UNITED HEALTHCARE,4103.55,,,,,,,3279.0300,12704.4800,percent of total billed charges,"32.3% of $12,704.48 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DILATOR TERTIARY ELLIPTICAL,272,RC,,,,,,,,both,,,12704.4800,1905.6700,WELLCARE,WELLCARE MEDICAID,12704.48,,,,,,,3279.0300,12704.4800,percent of total billed charges,"100% of $12,704.48 in Billed Charges for Rev 272 = $12,704.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXIBLE 1.8MM,272,RC,,,,,,,,both,,,4889.1000,733.3700,AETNA,AETNA,2087.65,,,,,,,1261.8800,4889.1000,percent of total billed charges,"42.7% of $4,889.10 in Billed Charges for Rev 272 = $2,087.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXIBLE 1.8MM,272,RC,,,,,,,,both,,,4889.1000,733.3700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3422.37,,,,,,,1261.8800,4889.1000,percent of total billed charges,"Rev 272 $4,889.10 in Billed Charges at 70% = $3,422.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXIBLE 1.8MM,272,RC,,,,,,,,both,,,4889.1000,733.3700,CIGNA HEALTHCARE,CIGNA HMO,2038.75,,,,,,,1261.8800,4889.1000,percent of total billed charges,"41.7% of $4,889.10 in Billed Charges for Rev 272 = $2,038.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXIBLE 1.8MM,272,RC,,,,,,,,both,,,4889.1000,733.3700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2268.54,,,,,,,1261.8800,4889.1000,percent of total billed charges,"46.4% of $4,889.10 in Billed Charges for Rev 272 = $2,268.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXIBLE 1.8MM,272,RC,,,,,,,,both,,,4889.1000,733.3700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2038.75,,,,,,,1261.8800,4889.1000,percent of total billed charges,"41.7% of $4,889.10 in Billed Charges for Rev 272 = $2,038.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXIBLE 1.8MM,272,RC,,,,,,,,both,,,4889.1000,733.3700,CIGNA HEALTHCARE,CIGNA PPO,2038.75,,,,,,,1261.8800,4889.1000,percent of total billed charges,"41.7% of $4,889.10 in Billed Charges for Rev 272 = $2,038.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXIBLE 1.8MM,272,RC,,,,,,,,both,,,4889.1000,733.3700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4400.19,,,,,,,1261.8800,4889.1000,percent of total billed charges,"90% of $4,889.10 in Billed Charges for Rev 272 = $4,400.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXIBLE 1.8MM,272,RC,,,,,,,,both,,,4889.1000,733.3700,MEDCOST,MEDCOST VHN,2326.72,,,,,,,1261.8800,4889.1000,percent of total billed charges,"47.59% of $4,889.10 in Billed Charges for Rev 272 = $2,326.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXIBLE 1.8MM,272,RC,,,,,,,,both,,,4889.1000,733.3700,SENTARA HEALTH,SENTARA HEALTH,1261.88,,,,,,,1261.8800,4889.1000,percent of total billed charges,"25.81% of $4,889.10 in Billed Charges for Rev 272 = $1,261.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXIBLE 1.8MM,272,RC,,,,,,,,both,,,4889.1000,733.3700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4889.10,,,,,,,1261.8800,4889.1000,percent of total billed charges,"100% of $4,889.10 in Billed Charges for Rev 272 = $4,889.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXIBLE 1.8MM,272,RC,,,,,,,,both,,,4889.1000,733.3700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2444.55,,,,,,,1261.8800,4889.1000,percent of total billed charges,"Rev 272 $4,889.10 in Billed Charges at 50% = $2,444.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXIBLE 1.8MM,272,RC,,,,,,,,both,,,4889.1000,733.3700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1579.18,,,,,,,1261.8800,4889.1000,other,"32.3% of $4,889.10 in Billed Charges for Rev 272 = $1,579.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT FLEXIBLE 1.8MM,272,RC,,,,,,,,both,,,4889.1000,733.3700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1500.95,,,,,,,1261.8800,4889.1000,other,"30.7% of $4,889.10 in Billed Charges for Rev 272 = $1,500.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT FLEXIBLE 1.8MM,272,RC,,,,,,,,both,,,4889.1000,733.3700,UNITED HEALTHCARE,UNITED HEALTHCARE,1579.18,,,,,,,1261.8800,4889.1000,percent of total billed charges,"32.3% of $4,889.10 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT FLEXIBLE 1.8MM,272,RC,,,,,,,,both,,,4889.1000,733.3700,WELLCARE,WELLCARE MEDICAID,4889.10,,,,,,,1261.8800,4889.1000,percent of total billed charges,"100% of $4,889.10 in Billed Charges for Rev 272 = $4,889.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 26FR,272,RC,,,,,,,,both,,,1374.5000,206.1800,AETNA,AETNA,586.91,,,,,,,354.7600,1374.5000,percent of total billed charges,"42.7% of $1,374.50 in Billed Charges for Rev 272 = $586.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 26FR,272,RC,,,,,,,,both,,,1374.5000,206.1800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,962.15,,,,,,,354.7600,1374.5000,percent of total billed charges,"Rev 272 $1,374.50 in Billed Charges at 70% = $962.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 26FR,272,RC,,,,,,,,both,,,1374.5000,206.1800,CIGNA HEALTHCARE,CIGNA HMO,573.17,,,,,,,354.7600,1374.5000,percent of total billed charges,"41.7% of $1,374.50 in Billed Charges for Rev 272 = $573.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 26FR,272,RC,,,,,,,,both,,,1374.5000,206.1800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,637.77,,,,,,,354.7600,1374.5000,percent of total billed charges,"46.4% of $1,374.50 in Billed Charges for Rev 272 = $637.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 26FR,272,RC,,,,,,,,both,,,1374.5000,206.1800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,573.17,,,,,,,354.7600,1374.5000,percent of total billed charges,"41.7% of $1,374.50 in Billed Charges for Rev 272 = $573.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 26FR,272,RC,,,,,,,,both,,,1374.5000,206.1800,CIGNA HEALTHCARE,CIGNA PPO,573.17,,,,,,,354.7600,1374.5000,percent of total billed charges,"41.7% of $1,374.50 in Billed Charges for Rev 272 = $573.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 26FR,272,RC,,,,,,,,both,,,1374.5000,206.1800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1237.05,,,,,,,354.7600,1374.5000,percent of total billed charges,"90% of $1,374.50 in Billed Charges for Rev 272 = $1,237.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 26FR,272,RC,,,,,,,,both,,,1374.5000,206.1800,MEDCOST,MEDCOST VHN,654.12,,,,,,,354.7600,1374.5000,percent of total billed charges,"47.59% of $1,374.50 in Billed Charges for Rev 272 = $654.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 26FR,272,RC,,,,,,,,both,,,1374.5000,206.1800,SENTARA HEALTH,SENTARA HEALTH,354.76,,,,,,,354.7600,1374.5000,percent of total billed charges,"25.81% of $1,374.50 in Billed Charges for Rev 272 = $354.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 26FR,272,RC,,,,,,,,both,,,1374.5000,206.1800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1374.50,,,,,,,354.7600,1374.5000,percent of total billed charges,"100% of $1,374.50 in Billed Charges for Rev 272 = $1,374.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 26FR,272,RC,,,,,,,,both,,,1374.5000,206.1800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,687.25,,,,,,,354.7600,1374.5000,percent of total billed charges,"Rev 272 $1,374.50 in Billed Charges at 50% = $687.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 26FR,272,RC,,,,,,,,both,,,1374.5000,206.1800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,443.96,,,,,,,354.7600,1374.5000,other,"32.3% of $1,374.50 in Billed Charges for Rev 272 = $443.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE LOOP HF-RESECT 26FR,272,RC,,,,,,,,both,,,1374.5000,206.1800,UNITED HEALTHCARE,UHC HERITAGE SELECT,421.97,,,,,,,354.7600,1374.5000,other,"30.7% of $1,374.50 in Billed Charges for Rev 272 = $421.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE LOOP HF-RESECT 26FR,272,RC,,,,,,,,both,,,1374.5000,206.1800,UNITED HEALTHCARE,UNITED HEALTHCARE,443.96,,,,,,,354.7600,1374.5000,percent of total billed charges,"32.3% of $1,374.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP HF-RESECT 26FR,272,RC,,,,,,,,both,,,1374.5000,206.1800,WELLCARE,WELLCARE MEDICAID,1374.50,,,,,,,354.7600,1374.5000,percent of total billed charges,"100% of $1,374.50 in Billed Charges for Rev 272 = $1,374.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISPOSABLE GRASPING FORCEPS,272,RC,,,,,,,,both,,,2183.5100,327.5300,AETNA,AETNA,932.36,,,,,,,563.5600,2183.5100,percent of total billed charges,"42.7% of $2,183.51 in Billed Charges for Rev 272 = $932.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISPOSABLE GRASPING FORCEPS,272,RC,,,,,,,,both,,,2183.5100,327.5300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1528.46,,,,,,,563.5600,2183.5100,percent of total billed charges,"Rev 272 $2,183.51 in Billed Charges at 70% = $1,528.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISPOSABLE GRASPING FORCEPS,272,RC,,,,,,,,both,,,2183.5100,327.5300,CIGNA HEALTHCARE,CIGNA HMO,910.52,,,,,,,563.5600,2183.5100,percent of total billed charges,"41.7% of $2,183.51 in Billed Charges for Rev 272 = $910.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISPOSABLE GRASPING FORCEPS,272,RC,,,,,,,,both,,,2183.5100,327.5300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1013.15,,,,,,,563.5600,2183.5100,percent of total billed charges,"46.4% of $2,183.51 in Billed Charges for Rev 272 = $1,013.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISPOSABLE GRASPING FORCEPS,272,RC,,,,,,,,both,,,2183.5100,327.5300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,910.52,,,,,,,563.5600,2183.5100,percent of total billed charges,"41.7% of $2,183.51 in Billed Charges for Rev 272 = $910.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISPOSABLE GRASPING FORCEPS,272,RC,,,,,,,,both,,,2183.5100,327.5300,CIGNA HEALTHCARE,CIGNA PPO,910.52,,,,,,,563.5600,2183.5100,percent of total billed charges,"41.7% of $2,183.51 in Billed Charges for Rev 272 = $910.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISPOSABLE GRASPING FORCEPS,272,RC,,,,,,,,both,,,2183.5100,327.5300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1965.16,,,,,,,563.5600,2183.5100,percent of total billed charges,"90% of $2,183.51 in Billed Charges for Rev 272 = $1,965.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISPOSABLE GRASPING FORCEPS,272,RC,,,,,,,,both,,,2183.5100,327.5300,MEDCOST,MEDCOST VHN,1039.13,,,,,,,563.5600,2183.5100,percent of total billed charges,"47.59% of $2,183.51 in Billed Charges for Rev 272 = $1,039.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISPOSABLE GRASPING FORCEPS,272,RC,,,,,,,,both,,,2183.5100,327.5300,SENTARA HEALTH,SENTARA HEALTH,563.56,,,,,,,563.5600,2183.5100,percent of total billed charges,"25.81% of $2,183.51 in Billed Charges for Rev 272 = $563.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISPOSABLE GRASPING FORCEPS,272,RC,,,,,,,,both,,,2183.5100,327.5300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2183.51,,,,,,,563.5600,2183.5100,percent of total billed charges,"100% of $2,183.51 in Billed Charges for Rev 272 = $2,183.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISPOSABLE GRASPING FORCEPS,272,RC,,,,,,,,both,,,2183.5100,327.5300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1091.76,,,,,,,563.5600,2183.5100,percent of total billed charges,"Rev 272 $2,183.51 in Billed Charges at 50% = $1,091.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISPOSABLE GRASPING FORCEPS,272,RC,,,,,,,,both,,,2183.5100,327.5300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,705.27,,,,,,,563.5600,2183.5100,other,"32.3% of $2,183.51 in Billed Charges for Rev 272 = $705.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DISPOSABLE GRASPING FORCEPS,272,RC,,,,,,,,both,,,2183.5100,327.5300,UNITED HEALTHCARE,UHC HERITAGE SELECT,670.34,,,,,,,563.5600,2183.5100,other,"30.7% of $2,183.51 in Billed Charges for Rev 272 = $670.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DISPOSABLE GRASPING FORCEPS,272,RC,,,,,,,,both,,,2183.5100,327.5300,UNITED HEALTHCARE,UNITED HEALTHCARE,705.27,,,,,,,563.5600,2183.5100,percent of total billed charges,"32.3% of $2,183.51 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISPOSABLE GRASPING FORCEPS,272,RC,,,,,,,,both,,,2183.5100,327.5300,WELLCARE,WELLCARE MEDICAID,2183.51,,,,,,,563.5600,2183.5100,percent of total billed charges,"100% of $2,183.51 in Billed Charges for Rev 272 = $2,183.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP YELLOW,272,RC,,,,,,,,both,,,1568.8000,235.3200,AETNA,AETNA,669.88,,,,,,,404.9100,1568.8000,percent of total billed charges,"42.7% of $1,568.80 in Billed Charges for Rev 272 = $669.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP YELLOW,272,RC,,,,,,,,both,,,1568.8000,235.3200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1098.16,,,,,,,404.9100,1568.8000,percent of total billed charges,"Rev 272 $1,568.80 in Billed Charges at 70% = $1,098.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP YELLOW,272,RC,,,,,,,,both,,,1568.8000,235.3200,CIGNA HEALTHCARE,CIGNA HMO,654.19,,,,,,,404.9100,1568.8000,percent of total billed charges,"41.7% of $1,568.80 in Billed Charges for Rev 272 = $654.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP YELLOW,272,RC,,,,,,,,both,,,1568.8000,235.3200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,727.92,,,,,,,404.9100,1568.8000,percent of total billed charges,"46.4% of $1,568.80 in Billed Charges for Rev 272 = $727.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP YELLOW,272,RC,,,,,,,,both,,,1568.8000,235.3200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,654.19,,,,,,,404.9100,1568.8000,percent of total billed charges,"41.7% of $1,568.80 in Billed Charges for Rev 272 = $654.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP YELLOW,272,RC,,,,,,,,both,,,1568.8000,235.3200,CIGNA HEALTHCARE,CIGNA PPO,654.19,,,,,,,404.9100,1568.8000,percent of total billed charges,"41.7% of $1,568.80 in Billed Charges for Rev 272 = $654.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP YELLOW,272,RC,,,,,,,,both,,,1568.8000,235.3200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1411.92,,,,,,,404.9100,1568.8000,percent of total billed charges,"90% of $1,568.80 in Billed Charges for Rev 272 = $1,411.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP YELLOW,272,RC,,,,,,,,both,,,1568.8000,235.3200,MEDCOST,MEDCOST VHN,746.59,,,,,,,404.9100,1568.8000,percent of total billed charges,"47.59% of $1,568.80 in Billed Charges for Rev 272 = $746.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP YELLOW,272,RC,,,,,,,,both,,,1568.8000,235.3200,SENTARA HEALTH,SENTARA HEALTH,404.91,,,,,,,404.9100,1568.8000,percent of total billed charges,"25.81% of $1,568.80 in Billed Charges for Rev 272 = $404.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP YELLOW,272,RC,,,,,,,,both,,,1568.8000,235.3200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1568.80,,,,,,,404.9100,1568.8000,percent of total billed charges,"100% of $1,568.80 in Billed Charges for Rev 272 = $1,568.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP YELLOW,272,RC,,,,,,,,both,,,1568.8000,235.3200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,784.40,,,,,,,404.9100,1568.8000,percent of total billed charges,"Rev 272 $1,568.80 in Billed Charges at 50% = $784.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP YELLOW,272,RC,,,,,,,,both,,,1568.8000,235.3200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,506.72,,,,,,,404.9100,1568.8000,other,"32.3% of $1,568.80 in Billed Charges for Rev 272 = $506.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE LOOP YELLOW,272,RC,,,,,,,,both,,,1568.8000,235.3200,UNITED HEALTHCARE,UHC HERITAGE SELECT,481.62,,,,,,,404.9100,1568.8000,other,"30.7% of $1,568.80 in Billed Charges for Rev 272 = $481.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE LOOP YELLOW,272,RC,,,,,,,,both,,,1568.8000,235.3200,UNITED HEALTHCARE,UNITED HEALTHCARE,506.72,,,,,,,404.9100,1568.8000,percent of total billed charges,"32.3% of $1,568.80 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP YELLOW,272,RC,,,,,,,,both,,,1568.8000,235.3200,WELLCARE,WELLCARE MEDICAID,1568.80,,,,,,,404.9100,1568.8000,percent of total billed charges,"100% of $1,568.80 in Billed Charges for Rev 272 = $1,568.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE NEEDLE 90 DEG HF RESECTION 24FR,272,RC,27200002,CDM,,,,,,both,,,1227.2300,184.0800,AETNA,AETNA,524.03,,,,,,,316.7500,1227.2300,percent of total billed charges,"42.7% of $1,227.23 in Billed Charges for Rev 272 = $524.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE NEEDLE 90 DEG HF RESECTION 24FR,272,RC,27200002,CDM,,,,,,both,,,1227.2300,184.0800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,859.06,,,,,,,316.7500,1227.2300,percent of total billed charges,"Rev 272 $1,227.23 in Billed Charges at 70% = $859.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE NEEDLE 90 DEG HF RESECTION 24FR,272,RC,27200002,CDM,,,,,,both,,,1227.2300,184.0800,CIGNA HEALTHCARE,CIGNA HMO,511.75,,,,,,,316.7500,1227.2300,percent of total billed charges,"41.7% of $1,227.23 in Billed Charges for Rev 272 = $511.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE NEEDLE 90 DEG HF RESECTION 24FR,272,RC,27200002,CDM,,,,,,both,,,1227.2300,184.0800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,569.43,,,,,,,316.7500,1227.2300,percent of total billed charges,"46.4% of $1,227.23 in Billed Charges for Rev 272 = $569.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE NEEDLE 90 DEG HF RESECTION 24FR,272,RC,27200002,CDM,,,,,,both,,,1227.2300,184.0800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,511.75,,,,,,,316.7500,1227.2300,percent of total billed charges,"41.7% of $1,227.23 in Billed Charges for Rev 272 = $511.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE NEEDLE 90 DEG HF RESECTION 24FR,272,RC,27200002,CDM,,,,,,both,,,1227.2300,184.0800,CIGNA HEALTHCARE,CIGNA PPO,511.75,,,,,,,316.7500,1227.2300,percent of total billed charges,"41.7% of $1,227.23 in Billed Charges for Rev 272 = $511.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE NEEDLE 90 DEG HF RESECTION 24FR,272,RC,27200002,CDM,,,,,,both,,,1227.2300,184.0800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1104.51,,,,,,,316.7500,1227.2300,percent of total billed charges,"90% of $1,227.23 in Billed Charges for Rev 272 = $1,104.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE NEEDLE 90 DEG HF RESECTION 24FR,272,RC,27200002,CDM,,,,,,both,,,1227.2300,184.0800,MEDCOST,MEDCOST VHN,584.04,,,,,,,316.7500,1227.2300,percent of total billed charges,"47.59% of $1,227.23 in Billed Charges for Rev 272 = $584.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE NEEDLE 90 DEG HF RESECTION 24FR,272,RC,27200002,CDM,,,,,,both,,,1227.2300,184.0800,SENTARA HEALTH,SENTARA HEALTH,316.75,,,,,,,316.7500,1227.2300,percent of total billed charges,"25.81% of $1,227.23 in Billed Charges for Rev 272 = $316.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE NEEDLE 90 DEG HF RESECTION 24FR,272,RC,27200002,CDM,,,,,,both,,,1227.2300,184.0800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1227.23,,,,,,,316.7500,1227.2300,percent of total billed charges,"100% of $1,227.23 in Billed Charges for Rev 272 = $1,227.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE NEEDLE 90 DEG HF RESECTION 24FR,272,RC,27200002,CDM,,,,,,both,,,1227.2300,184.0800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,613.62,,,,,,,316.7500,1227.2300,percent of total billed charges,"Rev 272 $1,227.23 in Billed Charges at 50% = $613.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE NEEDLE 90 DEG HF RESECTION 24FR,272,RC,27200002,CDM,,,,,,both,,,1227.2300,184.0800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,396.40,,,,,,,316.7500,1227.2300,other,"32.3% of $1,227.23 in Billed Charges for Rev 272 = $396.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE NEEDLE 90 DEG HF RESECTION 24FR,272,RC,27200002,CDM,,,,,,both,,,1227.2300,184.0800,UNITED HEALTHCARE,UHC HERITAGE SELECT,376.76,,,,,,,316.7500,1227.2300,other,"30.7% of $1,227.23 in Billed Charges for Rev 272 = $376.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE NEEDLE 90 DEG HF RESECTION 24FR,272,RC,27200002,CDM,,,,,,both,,,1227.2300,184.0800,UNITED HEALTHCARE,UNITED HEALTHCARE,396.40,,,,,,,316.7500,1227.2300,percent of total billed charges,"32.3% of $1,227.23 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE NEEDLE 90 DEG HF RESECTION 24FR,272,RC,27200002,CDM,,,,,,both,,,1227.2300,184.0800,WELLCARE,WELLCARE MEDICAID,1227.23,,,,,,,316.7500,1227.2300,percent of total billed charges,"100% of $1,227.23 in Billed Charges for Rev 272 = $1,227.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMA RESECTION BUTTON  OVAL  24FR 12DEG,272,RC,27200002,CDM,,,,,,both,,,5390.3300,808.5500,AETNA,AETNA,2301.67,,,,,,,1391.2400,5390.3300,percent of total billed charges,"42.7% of $5,390.33 in Billed Charges for Rev 272 = $2,301.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMA RESECTION BUTTON  OVAL  24FR 12DEG,272,RC,27200002,CDM,,,,,,both,,,5390.3300,808.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3773.23,,,,,,,1391.2400,5390.3300,percent of total billed charges,"Rev 272 $5,390.33 in Billed Charges at 70% = $3,773.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMA RESECTION BUTTON  OVAL  24FR 12DEG,272,RC,27200002,CDM,,,,,,both,,,5390.3300,808.5500,CIGNA HEALTHCARE,CIGNA HMO,2247.77,,,,,,,1391.2400,5390.3300,percent of total billed charges,"41.7% of $5,390.33 in Billed Charges for Rev 272 = $2,247.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMA RESECTION BUTTON  OVAL  24FR 12DEG,272,RC,27200002,CDM,,,,,,both,,,5390.3300,808.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2501.11,,,,,,,1391.2400,5390.3300,percent of total billed charges,"46.4% of $5,390.33 in Billed Charges for Rev 272 = $2,501.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMA RESECTION BUTTON  OVAL  24FR 12DEG,272,RC,27200002,CDM,,,,,,both,,,5390.3300,808.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2247.77,,,,,,,1391.2400,5390.3300,percent of total billed charges,"41.7% of $5,390.33 in Billed Charges for Rev 272 = $2,247.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMA RESECTION BUTTON  OVAL  24FR 12DEG,272,RC,27200002,CDM,,,,,,both,,,5390.3300,808.5500,CIGNA HEALTHCARE,CIGNA PPO,2247.77,,,,,,,1391.2400,5390.3300,percent of total billed charges,"41.7% of $5,390.33 in Billed Charges for Rev 272 = $2,247.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMA RESECTION BUTTON  OVAL  24FR 12DEG,272,RC,27200002,CDM,,,,,,both,,,5390.3300,808.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4851.30,,,,,,,1391.2400,5390.3300,percent of total billed charges,"90% of $5,390.33 in Billed Charges for Rev 272 = $4,851.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMA RESECTION BUTTON  OVAL  24FR 12DEG,272,RC,27200002,CDM,,,,,,both,,,5390.3300,808.5500,MEDCOST,MEDCOST VHN,2565.26,,,,,,,1391.2400,5390.3300,percent of total billed charges,"47.59% of $5,390.33 in Billed Charges for Rev 272 = $2,565.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMA RESECTION BUTTON  OVAL  24FR 12DEG,272,RC,27200002,CDM,,,,,,both,,,5390.3300,808.5500,SENTARA HEALTH,SENTARA HEALTH,1391.24,,,,,,,1391.2400,5390.3300,percent of total billed charges,"25.81% of $5,390.33 in Billed Charges for Rev 272 = $1,391.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMA RESECTION BUTTON  OVAL  24FR 12DEG,272,RC,27200002,CDM,,,,,,both,,,5390.3300,808.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5390.33,,,,,,,1391.2400,5390.3300,percent of total billed charges,"100% of $5,390.33 in Billed Charges for Rev 272 = $5,390.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMA RESECTION BUTTON  OVAL  24FR 12DEG,272,RC,27200002,CDM,,,,,,both,,,5390.3300,808.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2695.17,,,,,,,1391.2400,5390.3300,percent of total billed charges,"Rev 272 $5,390.33 in Billed Charges at 50% = $2,695.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMA RESECTION BUTTON  OVAL  24FR 12DEG,272,RC,27200002,CDM,,,,,,both,,,5390.3300,808.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1741.08,,,,,,,1391.2400,5390.3300,other,"32.3% of $5,390.33 in Billed Charges for Rev 272 = $1,741.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE PLASMA RESECTION BUTTON  OVAL  24FR 12DEG,272,RC,27200002,CDM,,,,,,both,,,5390.3300,808.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1654.83,,,,,,,1391.2400,5390.3300,other,"30.7% of $5,390.33 in Billed Charges for Rev 272 = $1,654.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE PLASMA RESECTION BUTTON  OVAL  24FR 12DEG,272,RC,27200002,CDM,,,,,,both,,,5390.3300,808.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,1741.08,,,,,,,1391.2400,5390.3300,percent of total billed charges,"32.3% of $5,390.33 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMA RESECTION BUTTON  OVAL  24FR 12DEG,272,RC,27200002,CDM,,,,,,both,,,5390.3300,808.5500,WELLCARE,WELLCARE MEDICAID,5390.33,,,,,,,1391.2400,5390.3300,percent of total billed charges,"100% of $5,390.33 in Billed Charges for Rev 272 = $5,390.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM 05015 5015,272,RC,,,,,,,,both,,,1306.7500,196.0100,AETNA,AETNA,557.98,,,,,,,337.2700,1306.7500,percent of total billed charges,"42.7% of $1,306.75 in Billed Charges for Rev 272 = $557.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM 05015 5015,272,RC,,,,,,,,both,,,1306.7500,196.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,914.73,,,,,,,337.2700,1306.7500,percent of total billed charges,"Rev 272 $1,306.75 in Billed Charges at 70% = $914.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM 05015 5015,272,RC,,,,,,,,both,,,1306.7500,196.0100,CIGNA HEALTHCARE,CIGNA HMO,544.91,,,,,,,337.2700,1306.7500,percent of total billed charges,"41.7% of $1,306.75 in Billed Charges for Rev 272 = $544.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM 05015 5015,272,RC,,,,,,,,both,,,1306.7500,196.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,606.33,,,,,,,337.2700,1306.7500,percent of total billed charges,"46.4% of $1,306.75 in Billed Charges for Rev 272 = $606.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM 05015 5015,272,RC,,,,,,,,both,,,1306.7500,196.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,544.91,,,,,,,337.2700,1306.7500,percent of total billed charges,"41.7% of $1,306.75 in Billed Charges for Rev 272 = $544.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM 05015 5015,272,RC,,,,,,,,both,,,1306.7500,196.0100,CIGNA HEALTHCARE,CIGNA PPO,544.91,,,,,,,337.2700,1306.7500,percent of total billed charges,"41.7% of $1,306.75 in Billed Charges for Rev 272 = $544.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM 05015 5015,272,RC,,,,,,,,both,,,1306.7500,196.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1176.08,,,,,,,337.2700,1306.7500,percent of total billed charges,"90% of $1,306.75 in Billed Charges for Rev 272 = $1,176.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM 05015 5015,272,RC,,,,,,,,both,,,1306.7500,196.0100,MEDCOST,MEDCOST VHN,621.88,,,,,,,337.2700,1306.7500,percent of total billed charges,"47.59% of $1,306.75 in Billed Charges for Rev 272 = $621.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM 05015 5015,272,RC,,,,,,,,both,,,1306.7500,196.0100,SENTARA HEALTH,SENTARA HEALTH,337.27,,,,,,,337.2700,1306.7500,percent of total billed charges,"25.81% of $1,306.75 in Billed Charges for Rev 272 = $337.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM 05015 5015,272,RC,,,,,,,,both,,,1306.7500,196.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1306.75,,,,,,,337.2700,1306.7500,percent of total billed charges,"100% of $1,306.75 in Billed Charges for Rev 272 = $1,306.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM 05015 5015,272,RC,,,,,,,,both,,,1306.7500,196.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,653.38,,,,,,,337.2700,1306.7500,percent of total billed charges,"Rev 272 $1,306.75 in Billed Charges at 50% = $653.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM 05015 5015,272,RC,,,,,,,,both,,,1306.7500,196.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,422.08,,,,,,,337.2700,1306.7500,other,"32.3% of $1,306.75 in Billed Charges for Rev 272 = $422.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 2.7MM 05015 5015,272,RC,,,,,,,,both,,,1306.7500,196.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,401.17,,,,,,,337.2700,1306.7500,other,"30.7% of $1,306.75 in Billed Charges for Rev 272 = $401.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 2.7MM 05015 5015,272,RC,,,,,,,,both,,,1306.7500,196.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,422.08,,,,,,,337.2700,1306.7500,percent of total billed charges,"32.3% of $1,306.75 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM 05015 5015,272,RC,,,,,,,,both,,,1306.7500,196.0100,WELLCARE,WELLCARE MEDICAID,1306.75,,,,,,,337.2700,1306.7500,percent of total billed charges,"100% of $1,306.75 in Billed Charges for Rev 272 = $1,306.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM FLUTE,272,RC,27200002,CDM,,,,,,both,,,1253.0200,187.9500,AETNA,AETNA,535.04,,,,,,,323.4000,1253.0200,percent of total billed charges,"42.7% of $1,253.02 in Billed Charges for Rev 272 = $535.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM FLUTE,272,RC,27200002,CDM,,,,,,both,,,1253.0200,187.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,877.11,,,,,,,323.4000,1253.0200,percent of total billed charges,"Rev 272 $1,253.02 in Billed Charges at 70% = $877.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM FLUTE,272,RC,27200002,CDM,,,,,,both,,,1253.0200,187.9500,CIGNA HEALTHCARE,CIGNA HMO,522.51,,,,,,,323.4000,1253.0200,percent of total billed charges,"41.7% of $1,253.02 in Billed Charges for Rev 272 = $522.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM FLUTE,272,RC,27200002,CDM,,,,,,both,,,1253.0200,187.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,581.40,,,,,,,323.4000,1253.0200,percent of total billed charges,"46.4% of $1,253.02 in Billed Charges for Rev 272 = $581.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM FLUTE,272,RC,27200002,CDM,,,,,,both,,,1253.0200,187.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,522.51,,,,,,,323.4000,1253.0200,percent of total billed charges,"41.7% of $1,253.02 in Billed Charges for Rev 272 = $522.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM FLUTE,272,RC,27200002,CDM,,,,,,both,,,1253.0200,187.9500,CIGNA HEALTHCARE,CIGNA PPO,522.51,,,,,,,323.4000,1253.0200,percent of total billed charges,"41.7% of $1,253.02 in Billed Charges for Rev 272 = $522.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM FLUTE,272,RC,27200002,CDM,,,,,,both,,,1253.0200,187.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1127.72,,,,,,,323.4000,1253.0200,percent of total billed charges,"90% of $1,253.02 in Billed Charges for Rev 272 = $1,127.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM FLUTE,272,RC,27200002,CDM,,,,,,both,,,1253.0200,187.9500,MEDCOST,MEDCOST VHN,596.31,,,,,,,323.4000,1253.0200,percent of total billed charges,"47.59% of $1,253.02 in Billed Charges for Rev 272 = $596.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM FLUTE,272,RC,27200002,CDM,,,,,,both,,,1253.0200,187.9500,SENTARA HEALTH,SENTARA HEALTH,323.40,,,,,,,323.4000,1253.0200,percent of total billed charges,"25.81% of $1,253.02 in Billed Charges for Rev 272 = $323.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM FLUTE,272,RC,27200002,CDM,,,,,,both,,,1253.0200,187.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1253.02,,,,,,,323.4000,1253.0200,percent of total billed charges,"100% of $1,253.02 in Billed Charges for Rev 272 = $1,253.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM FLUTE,272,RC,27200002,CDM,,,,,,both,,,1253.0200,187.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,626.51,,,,,,,323.4000,1253.0200,percent of total billed charges,"Rev 272 $1,253.02 in Billed Charges at 50% = $626.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM FLUTE,272,RC,27200002,CDM,,,,,,both,,,1253.0200,187.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,404.73,,,,,,,323.4000,1253.0200,other,"32.3% of $1,253.02 in Billed Charges for Rev 272 = $404.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 3.2MM FLUTE,272,RC,27200002,CDM,,,,,,both,,,1253.0200,187.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,384.68,,,,,,,323.4000,1253.0200,other,"30.7% of $1,253.02 in Billed Charges for Rev 272 = $384.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 3.2MM FLUTE,272,RC,27200002,CDM,,,,,,both,,,1253.0200,187.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,404.73,,,,,,,323.4000,1253.0200,percent of total billed charges,"32.3% of $1,253.02 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM FLUTE,272,RC,27200002,CDM,,,,,,both,,,1253.0200,187.9500,WELLCARE,WELLCARE MEDICAID,1253.02,,,,,,,323.4000,1253.0200,percent of total billed charges,"100% of $1,253.02 in Billed Charges for Rev 272 = $1,253.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM THREE FLUTED,272,RC,,,,,,,,both,,,2605.9200,390.8900,AETNA,AETNA,1112.73,,,,,,,672.5900,2605.9200,percent of total billed charges,"42.7% of $2,605.92 in Billed Charges for Rev 272 = $1,112.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM THREE FLUTED,272,RC,,,,,,,,both,,,2605.9200,390.8900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1824.14,,,,,,,672.5900,2605.9200,percent of total billed charges,"Rev 272 $2,605.92 in Billed Charges at 70% = $1,824.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM THREE FLUTED,272,RC,,,,,,,,both,,,2605.9200,390.8900,CIGNA HEALTHCARE,CIGNA HMO,1086.67,,,,,,,672.5900,2605.9200,percent of total billed charges,"41.7% of $2,605.92 in Billed Charges for Rev 272 = $1,086.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM THREE FLUTED,272,RC,,,,,,,,both,,,2605.9200,390.8900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1209.15,,,,,,,672.5900,2605.9200,percent of total billed charges,"46.4% of $2,605.92 in Billed Charges for Rev 272 = $1,209.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM THREE FLUTED,272,RC,,,,,,,,both,,,2605.9200,390.8900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1086.67,,,,,,,672.5900,2605.9200,percent of total billed charges,"41.7% of $2,605.92 in Billed Charges for Rev 272 = $1,086.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM THREE FLUTED,272,RC,,,,,,,,both,,,2605.9200,390.8900,CIGNA HEALTHCARE,CIGNA PPO,1086.67,,,,,,,672.5900,2605.9200,percent of total billed charges,"41.7% of $2,605.92 in Billed Charges for Rev 272 = $1,086.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM THREE FLUTED,272,RC,,,,,,,,both,,,2605.9200,390.8900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2345.33,,,,,,,672.5900,2605.9200,percent of total billed charges,"90% of $2,605.92 in Billed Charges for Rev 272 = $2,345.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM THREE FLUTED,272,RC,,,,,,,,both,,,2605.9200,390.8900,MEDCOST,MEDCOST VHN,1240.16,,,,,,,672.5900,2605.9200,percent of total billed charges,"47.59% of $2,605.92 in Billed Charges for Rev 272 = $1,240.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM THREE FLUTED,272,RC,,,,,,,,both,,,2605.9200,390.8900,SENTARA HEALTH,SENTARA HEALTH,672.59,,,,,,,672.5900,2605.9200,percent of total billed charges,"25.81% of $2,605.92 in Billed Charges for Rev 272 = $672.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM THREE FLUTED,272,RC,,,,,,,,both,,,2605.9200,390.8900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2605.92,,,,,,,672.5900,2605.9200,percent of total billed charges,"100% of $2,605.92 in Billed Charges for Rev 272 = $2,605.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM THREE FLUTED,272,RC,,,,,,,,both,,,2605.9200,390.8900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1302.96,,,,,,,672.5900,2605.9200,percent of total billed charges,"Rev 272 $2,605.92 in Billed Charges at 50% = $1,302.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM THREE FLUTED,272,RC,,,,,,,,both,,,2605.9200,390.8900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,841.71,,,,,,,672.5900,2605.9200,other,"32.3% of $2,605.92 in Billed Charges for Rev 272 = $841.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 3.2MM THREE FLUTED,272,RC,,,,,,,,both,,,2605.9200,390.8900,UNITED HEALTHCARE,UHC HERITAGE SELECT,800.02,,,,,,,672.5900,2605.9200,other,"30.7% of $2,605.92 in Billed Charges for Rev 272 = $800.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 3.2MM THREE FLUTED,272,RC,,,,,,,,both,,,2605.9200,390.8900,UNITED HEALTHCARE,UNITED HEALTHCARE,841.71,,,,,,,672.5900,2605.9200,percent of total billed charges,"32.3% of $2,605.92 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.2MM THREE FLUTED,272,RC,,,,,,,,both,,,2605.9200,390.8900,WELLCARE,WELLCARE MEDICAID,2605.92,,,,,,,672.5900,2605.9200,percent of total billed charges,"100% of $2,605.92 in Billed Charges for Rev 272 = $2,605.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMALOOP SMALL 30,272,RC,27200002,CDM,,,,,,both,,,4671.6200,700.7400,AETNA,AETNA,1994.78,,,,,,,1205.7500,4671.6200,percent of total billed charges,"42.7% of $4,671.62 in Billed Charges for Rev 272 = $1,994.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMALOOP SMALL 30,272,RC,27200002,CDM,,,,,,both,,,4671.6200,700.7400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3270.13,,,,,,,1205.7500,4671.6200,percent of total billed charges,"Rev 272 $4,671.62 in Billed Charges at 70% = $3,270.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMALOOP SMALL 30,272,RC,27200002,CDM,,,,,,both,,,4671.6200,700.7400,CIGNA HEALTHCARE,CIGNA HMO,1948.07,,,,,,,1205.7500,4671.6200,percent of total billed charges,"41.7% of $4,671.62 in Billed Charges for Rev 272 = $1,948.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMALOOP SMALL 30,272,RC,27200002,CDM,,,,,,both,,,4671.6200,700.7400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2167.63,,,,,,,1205.7500,4671.6200,percent of total billed charges,"46.4% of $4,671.62 in Billed Charges for Rev 272 = $2,167.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMALOOP SMALL 30,272,RC,27200002,CDM,,,,,,both,,,4671.6200,700.7400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1948.07,,,,,,,1205.7500,4671.6200,percent of total billed charges,"41.7% of $4,671.62 in Billed Charges for Rev 272 = $1,948.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMALOOP SMALL 30,272,RC,27200002,CDM,,,,,,both,,,4671.6200,700.7400,CIGNA HEALTHCARE,CIGNA PPO,1948.07,,,,,,,1205.7500,4671.6200,percent of total billed charges,"41.7% of $4,671.62 in Billed Charges for Rev 272 = $1,948.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMALOOP SMALL 30,272,RC,27200002,CDM,,,,,,both,,,4671.6200,700.7400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4204.46,,,,,,,1205.7500,4671.6200,percent of total billed charges,"90% of $4,671.62 in Billed Charges for Rev 272 = $4,204.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMALOOP SMALL 30,272,RC,27200002,CDM,,,,,,both,,,4671.6200,700.7400,MEDCOST,MEDCOST VHN,2223.22,,,,,,,1205.7500,4671.6200,percent of total billed charges,"47.59% of $4,671.62 in Billed Charges for Rev 272 = $2,223.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMALOOP SMALL 30,272,RC,27200002,CDM,,,,,,both,,,4671.6200,700.7400,SENTARA HEALTH,SENTARA HEALTH,1205.75,,,,,,,1205.7500,4671.6200,percent of total billed charges,"25.81% of $4,671.62 in Billed Charges for Rev 272 = $1,205.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMALOOP SMALL 30,272,RC,27200002,CDM,,,,,,both,,,4671.6200,700.7400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4671.62,,,,,,,1205.7500,4671.6200,percent of total billed charges,"100% of $4,671.62 in Billed Charges for Rev 272 = $4,671.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMALOOP SMALL 30,272,RC,27200002,CDM,,,,,,both,,,4671.6200,700.7400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2335.81,,,,,,,1205.7500,4671.6200,percent of total billed charges,"Rev 272 $4,671.62 in Billed Charges at 50% = $2,335.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMALOOP SMALL 30,272,RC,27200002,CDM,,,,,,both,,,4671.6200,700.7400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1508.93,,,,,,,1205.7500,4671.6200,other,"32.3% of $4,671.62 in Billed Charges for Rev 272 = $1,508.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE PLASMALOOP SMALL 30,272,RC,27200002,CDM,,,,,,both,,,4671.6200,700.7400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1434.19,,,,,,,1205.7500,4671.6200,other,"30.7% of $4,671.62 in Billed Charges for Rev 272 = $1,434.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE PLASMALOOP SMALL 30,272,RC,27200002,CDM,,,,,,both,,,4671.6200,700.7400,UNITED HEALTHCARE,UNITED HEALTHCARE,1508.93,,,,,,,1205.7500,4671.6200,percent of total billed charges,"32.3% of $4,671.62 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PLASMALOOP SMALL 30,272,RC,27200002,CDM,,,,,,both,,,4671.6200,700.7400,WELLCARE,WELLCARE MEDICAID,4671.62,,,,,,,1205.7500,4671.6200,percent of total billed charges,"100% of $4,671.62 in Billed Charges for Rev 272 = $4,671.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.0MM CARBIDE,272,RC,,,,,,,,both,,,2492.4600,373.8700,AETNA,AETNA,1064.28,,,,,,,643.3000,2492.4600,percent of total billed charges,"42.7% of $2,492.46 in Billed Charges for Rev 272 = $1,064.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.0MM CARBIDE,272,RC,,,,,,,,both,,,2492.4600,373.8700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1744.72,,,,,,,643.3000,2492.4600,percent of total billed charges,"Rev 272 $2,492.46 in Billed Charges at 70% = $1,744.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.0MM CARBIDE,272,RC,,,,,,,,both,,,2492.4600,373.8700,CIGNA HEALTHCARE,CIGNA HMO,1039.36,,,,,,,643.3000,2492.4600,percent of total billed charges,"41.7% of $2,492.46 in Billed Charges for Rev 272 = $1,039.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.0MM CARBIDE,272,RC,,,,,,,,both,,,2492.4600,373.8700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1156.50,,,,,,,643.3000,2492.4600,percent of total billed charges,"46.4% of $2,492.46 in Billed Charges for Rev 272 = $1,156.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.0MM CARBIDE,272,RC,,,,,,,,both,,,2492.4600,373.8700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1039.36,,,,,,,643.3000,2492.4600,percent of total billed charges,"41.7% of $2,492.46 in Billed Charges for Rev 272 = $1,039.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.0MM CARBIDE,272,RC,,,,,,,,both,,,2492.4600,373.8700,CIGNA HEALTHCARE,CIGNA PPO,1039.36,,,,,,,643.3000,2492.4600,percent of total billed charges,"41.7% of $2,492.46 in Billed Charges for Rev 272 = $1,039.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.0MM CARBIDE,272,RC,,,,,,,,both,,,2492.4600,373.8700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2243.21,,,,,,,643.3000,2492.4600,percent of total billed charges,"90% of $2,492.46 in Billed Charges for Rev 272 = $2,243.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.0MM CARBIDE,272,RC,,,,,,,,both,,,2492.4600,373.8700,MEDCOST,MEDCOST VHN,1186.16,,,,,,,643.3000,2492.4600,percent of total billed charges,"47.59% of $2,492.46 in Billed Charges for Rev 272 = $1,186.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.0MM CARBIDE,272,RC,,,,,,,,both,,,2492.4600,373.8700,SENTARA HEALTH,SENTARA HEALTH,643.30,,,,,,,643.3000,2492.4600,percent of total billed charges,"25.81% of $2,492.46 in Billed Charges for Rev 272 = $643.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.0MM CARBIDE,272,RC,,,,,,,,both,,,2492.4600,373.8700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2492.46,,,,,,,643.3000,2492.4600,percent of total billed charges,"100% of $2,492.46 in Billed Charges for Rev 272 = $2,492.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.0MM CARBIDE,272,RC,,,,,,,,both,,,2492.4600,373.8700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1246.23,,,,,,,643.3000,2492.4600,percent of total billed charges,"Rev 272 $2,492.46 in Billed Charges at 50% = $1,246.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.0MM CARBIDE,272,RC,,,,,,,,both,,,2492.4600,373.8700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,805.06,,,,,,,643.3000,2492.4600,other,"32.3% of $2,492.46 in Billed Charges for Rev 272 = $805.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 4.0MM CARBIDE,272,RC,,,,,,,,both,,,2492.4600,373.8700,UNITED HEALTHCARE,UHC HERITAGE SELECT,765.19,,,,,,,643.3000,2492.4600,other,"30.7% of $2,492.46 in Billed Charges for Rev 272 = $765.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 4.0MM CARBIDE,272,RC,,,,,,,,both,,,2492.4600,373.8700,UNITED HEALTHCARE,UNITED HEALTHCARE,805.06,,,,,,,643.3000,2492.4600,percent of total billed charges,"32.3% of $2,492.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.0MM CARBIDE,272,RC,,,,,,,,both,,,2492.4600,373.8700,WELLCARE,WELLCARE MEDICAID,2492.46,,,,,,,643.3000,2492.4600,percent of total billed charges,"100% of $2,492.46 in Billed Charges for Rev 272 = $2,492.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM,272,RC,,,,,,,,both,,,4025.3000,603.8000,AETNA,AETNA,1718.80,,,,,,,1038.9300,4025.3000,percent of total billed charges,"42.7% of $4,025.30 in Billed Charges for Rev 272 = $1,718.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM,272,RC,,,,,,,,both,,,4025.3000,603.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2817.71,,,,,,,1038.9300,4025.3000,percent of total billed charges,"Rev 272 $4,025.30 in Billed Charges at 70% = $2,817.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM,272,RC,,,,,,,,both,,,4025.3000,603.8000,CIGNA HEALTHCARE,CIGNA HMO,1678.55,,,,,,,1038.9300,4025.3000,percent of total billed charges,"41.7% of $4,025.30 in Billed Charges for Rev 272 = $1,678.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM,272,RC,,,,,,,,both,,,4025.3000,603.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1867.74,,,,,,,1038.9300,4025.3000,percent of total billed charges,"46.4% of $4,025.30 in Billed Charges for Rev 272 = $1,867.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM,272,RC,,,,,,,,both,,,4025.3000,603.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1678.55,,,,,,,1038.9300,4025.3000,percent of total billed charges,"41.7% of $4,025.30 in Billed Charges for Rev 272 = $1,678.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM,272,RC,,,,,,,,both,,,4025.3000,603.8000,CIGNA HEALTHCARE,CIGNA PPO,1678.55,,,,,,,1038.9300,4025.3000,percent of total billed charges,"41.7% of $4,025.30 in Billed Charges for Rev 272 = $1,678.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM,272,RC,,,,,,,,both,,,4025.3000,603.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3622.77,,,,,,,1038.9300,4025.3000,percent of total billed charges,"90% of $4,025.30 in Billed Charges for Rev 272 = $3,622.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM,272,RC,,,,,,,,both,,,4025.3000,603.8000,MEDCOST,MEDCOST VHN,1915.64,,,,,,,1038.9300,4025.3000,percent of total billed charges,"47.59% of $4,025.30 in Billed Charges for Rev 272 = $1,915.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM,272,RC,,,,,,,,both,,,4025.3000,603.8000,SENTARA HEALTH,SENTARA HEALTH,1038.93,,,,,,,1038.9300,4025.3000,percent of total billed charges,"25.81% of $4,025.30 in Billed Charges for Rev 272 = $1,038.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM,272,RC,,,,,,,,both,,,4025.3000,603.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4025.30,,,,,,,1038.9300,4025.3000,percent of total billed charges,"100% of $4,025.30 in Billed Charges for Rev 272 = $4,025.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM,272,RC,,,,,,,,both,,,4025.3000,603.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2012.65,,,,,,,1038.9300,4025.3000,percent of total billed charges,"Rev 272 $4,025.30 in Billed Charges at 50% = $2,012.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM,272,RC,,,,,,,,both,,,4025.3000,603.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1300.17,,,,,,,1038.9300,4025.3000,other,"32.3% of $4,025.30 in Billed Charges for Rev 272 = $1,300.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER OPTICAL 800UM,272,RC,,,,,,,,both,,,4025.3000,603.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1235.77,,,,,,,1038.9300,4025.3000,other,"30.7% of $4,025.30 in Billed Charges for Rev 272 = $1,235.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER OPTICAL 800UM,272,RC,,,,,,,,both,,,4025.3000,603.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,1300.17,,,,,,,1038.9300,4025.3000,percent of total billed charges,"32.3% of $4,025.30 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM,272,RC,,,,,,,,both,,,4025.3000,603.8000,WELLCARE,WELLCARE MEDICAID,4025.30,,,,,,,1038.9300,4025.3000,percent of total billed charges,"100% of $4,025.30 in Billed Charges for Rev 272 = $4,025.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM CORE BARE,272,RC,,,,,,,,both,,,7207.8500,1081.1800,AETNA,AETNA,3077.75,,,,,,,1860.3500,7207.8500,percent of total billed charges,"42.7% of $7,207.85 in Billed Charges for Rev 272 = $3,077.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM CORE BARE,272,RC,,,,,,,,both,,,7207.8500,1081.1800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5045.50,,,,,,,1860.3500,7207.8500,percent of total billed charges,"Rev 272 $7,207.85 in Billed Charges at 70% = $5,045.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM CORE BARE,272,RC,,,,,,,,both,,,7207.8500,1081.1800,CIGNA HEALTHCARE,CIGNA HMO,3005.67,,,,,,,1860.3500,7207.8500,percent of total billed charges,"41.7% of $7,207.85 in Billed Charges for Rev 272 = $3,005.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM CORE BARE,272,RC,,,,,,,,both,,,7207.8500,1081.1800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3344.44,,,,,,,1860.3500,7207.8500,percent of total billed charges,"46.4% of $7,207.85 in Billed Charges for Rev 272 = $3,344.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM CORE BARE,272,RC,,,,,,,,both,,,7207.8500,1081.1800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3005.67,,,,,,,1860.3500,7207.8500,percent of total billed charges,"41.7% of $7,207.85 in Billed Charges for Rev 272 = $3,005.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM CORE BARE,272,RC,,,,,,,,both,,,7207.8500,1081.1800,CIGNA HEALTHCARE,CIGNA PPO,3005.67,,,,,,,1860.3500,7207.8500,percent of total billed charges,"41.7% of $7,207.85 in Billed Charges for Rev 272 = $3,005.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM CORE BARE,272,RC,,,,,,,,both,,,7207.8500,1081.1800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6487.07,,,,,,,1860.3500,7207.8500,percent of total billed charges,"90% of $7,207.85 in Billed Charges for Rev 272 = $6,487.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM CORE BARE,272,RC,,,,,,,,both,,,7207.8500,1081.1800,MEDCOST,MEDCOST VHN,3430.22,,,,,,,1860.3500,7207.8500,percent of total billed charges,"47.59% of $7,207.85 in Billed Charges for Rev 272 = $3,430.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM CORE BARE,272,RC,,,,,,,,both,,,7207.8500,1081.1800,SENTARA HEALTH,SENTARA HEALTH,1860.35,,,,,,,1860.3500,7207.8500,percent of total billed charges,"25.81% of $7,207.85 in Billed Charges for Rev 272 = $1,860.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM CORE BARE,272,RC,,,,,,,,both,,,7207.8500,1081.1800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7207.85,,,,,,,1860.3500,7207.8500,percent of total billed charges,"100% of $7,207.85 in Billed Charges for Rev 272 = $7,207.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM CORE BARE,272,RC,,,,,,,,both,,,7207.8500,1081.1800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3603.93,,,,,,,1860.3500,7207.8500,percent of total billed charges,"Rev 272 $7,207.85 in Billed Charges at 50% = $3,603.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM CORE BARE,272,RC,,,,,,,,both,,,7207.8500,1081.1800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2328.14,,,,,,,1860.3500,7207.8500,other,"32.3% of $7,207.85 in Billed Charges for Rev 272 = $2,328.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER OPTICAL 800UM CORE BARE,272,RC,,,,,,,,both,,,7207.8500,1081.1800,UNITED HEALTHCARE,UHC HERITAGE SELECT,2212.81,,,,,,,1860.3500,7207.8500,other,"30.7% of $7,207.85 in Billed Charges for Rev 272 = $2,212.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER OPTICAL 800UM CORE BARE,272,RC,,,,,,,,both,,,7207.8500,1081.1800,UNITED HEALTHCARE,UNITED HEALTHCARE,2328.14,,,,,,,1860.3500,7207.8500,percent of total billed charges,"32.3% of $7,207.85 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 800UM CORE BARE,272,RC,,,,,,,,both,,,7207.8500,1081.1800,WELLCARE,WELLCARE MEDICAID,7207.85,,,,,,,1860.3500,7207.8500,percent of total billed charges,"100% of $7,207.85 in Billed Charges for Rev 272 = $7,207.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE FIRE 550UM,272,RC,27200002,CDM,,,,,,both,,,13578.5400,2036.7800,AETNA,AETNA,5798.04,,,,,,,3504.6200,13578.5400,percent of total billed charges,"42.7% of $13,578.54 in Billed Charges for Rev 272 = $5,798.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE FIRE 550UM,272,RC,27200002,CDM,,,,,,both,,,13578.5400,2036.7800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9504.98,,,,,,,3504.6200,13578.5400,percent of total billed charges,"Rev 272 $13,578.54 in Billed Charges at 70% = $9,504.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE FIRE 550UM,272,RC,27200002,CDM,,,,,,both,,,13578.5400,2036.7800,CIGNA HEALTHCARE,CIGNA HMO,5662.25,,,,,,,3504.6200,13578.5400,percent of total billed charges,"41.7% of $13,578.54 in Billed Charges for Rev 272 = $5,662.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE FIRE 550UM,272,RC,27200002,CDM,,,,,,both,,,13578.5400,2036.7800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6300.44,,,,,,,3504.6200,13578.5400,percent of total billed charges,"46.4% of $13,578.54 in Billed Charges for Rev 272 = $6,300.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE FIRE 550UM,272,RC,27200002,CDM,,,,,,both,,,13578.5400,2036.7800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5662.25,,,,,,,3504.6200,13578.5400,percent of total billed charges,"41.7% of $13,578.54 in Billed Charges for Rev 272 = $5,662.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE FIRE 550UM,272,RC,27200002,CDM,,,,,,both,,,13578.5400,2036.7800,CIGNA HEALTHCARE,CIGNA PPO,5662.25,,,,,,,3504.6200,13578.5400,percent of total billed charges,"41.7% of $13,578.54 in Billed Charges for Rev 272 = $5,662.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE FIRE 550UM,272,RC,27200002,CDM,,,,,,both,,,13578.5400,2036.7800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12220.69,,,,,,,3504.6200,13578.5400,percent of total billed charges,"90% of $13,578.54 in Billed Charges for Rev 272 = $12,220.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE FIRE 550UM,272,RC,27200002,CDM,,,,,,both,,,13578.5400,2036.7800,MEDCOST,MEDCOST VHN,6462.03,,,,,,,3504.6200,13578.5400,percent of total billed charges,"47.59% of $13,578.54 in Billed Charges for Rev 272 = $6,462.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE FIRE 550UM,272,RC,27200002,CDM,,,,,,both,,,13578.5400,2036.7800,SENTARA HEALTH,SENTARA HEALTH,3504.62,,,,,,,3504.6200,13578.5400,percent of total billed charges,"25.81% of $13,578.54 in Billed Charges for Rev 272 = $3,504.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE FIRE 550UM,272,RC,27200002,CDM,,,,,,both,,,13578.5400,2036.7800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13578.54,,,,,,,3504.6200,13578.5400,percent of total billed charges,"100% of $13,578.54 in Billed Charges for Rev 272 = $13,578.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE FIRE 550UM,272,RC,27200002,CDM,,,,,,both,,,13578.5400,2036.7800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6789.27,,,,,,,3504.6200,13578.5400,percent of total billed charges,"Rev 272 $13,578.54 in Billed Charges at 50% = $6,789.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE FIRE 550UM,272,RC,27200002,CDM,,,,,,both,,,13578.5400,2036.7800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4385.87,,,,,,,3504.6200,13578.5400,other,"32.3% of $13,578.54 in Billed Charges for Rev 272 = $4,385.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER SIDE FIRE 550UM,272,RC,27200002,CDM,,,,,,both,,,13578.5400,2036.7800,UNITED HEALTHCARE,UHC HERITAGE SELECT,4168.61,,,,,,,3504.6200,13578.5400,other,"30.7% of $13,578.54 in Billed Charges for Rev 272 = $4,168.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER SIDE FIRE 550UM,272,RC,27200002,CDM,,,,,,both,,,13578.5400,2036.7800,UNITED HEALTHCARE,UNITED HEALTHCARE,4385.87,,,,,,,3504.6200,13578.5400,percent of total billed charges,"32.3% of $13,578.54 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE FIRE 550UM,272,RC,27200002,CDM,,,,,,both,,,13578.5400,2036.7800,WELLCARE,WELLCARE MEDICAID,13578.54,,,,,,,3504.6200,13578.5400,percent of total billed charges,"100% of $13,578.54 in Billed Charges for Rev 272 = $13,578.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE-FIRING XPEEDA 550,272,RC,,,,,,,,both,,,13119.3200,1967.9000,AETNA,AETNA,5601.95,,,,,,,3386.1000,13119.3200,percent of total billed charges,"42.7% of $13,119.32 in Billed Charges for Rev 272 = $5,601.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE-FIRING XPEEDA 550,272,RC,,,,,,,,both,,,13119.3200,1967.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9183.52,,,,,,,3386.1000,13119.3200,percent of total billed charges,"Rev 272 $13,119.32 in Billed Charges at 70% = $9,183.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE-FIRING XPEEDA 550,272,RC,,,,,,,,both,,,13119.3200,1967.9000,CIGNA HEALTHCARE,CIGNA HMO,5470.76,,,,,,,3386.1000,13119.3200,percent of total billed charges,"41.7% of $13,119.32 in Billed Charges for Rev 272 = $5,470.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE-FIRING XPEEDA 550,272,RC,,,,,,,,both,,,13119.3200,1967.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6087.36,,,,,,,3386.1000,13119.3200,percent of total billed charges,"46.4% of $13,119.32 in Billed Charges for Rev 272 = $6,087.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE-FIRING XPEEDA 550,272,RC,,,,,,,,both,,,13119.3200,1967.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5470.76,,,,,,,3386.1000,13119.3200,percent of total billed charges,"41.7% of $13,119.32 in Billed Charges for Rev 272 = $5,470.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE-FIRING XPEEDA 550,272,RC,,,,,,,,both,,,13119.3200,1967.9000,CIGNA HEALTHCARE,CIGNA PPO,5470.76,,,,,,,3386.1000,13119.3200,percent of total billed charges,"41.7% of $13,119.32 in Billed Charges for Rev 272 = $5,470.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE-FIRING XPEEDA 550,272,RC,,,,,,,,both,,,13119.3200,1967.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11807.39,,,,,,,3386.1000,13119.3200,percent of total billed charges,"90% of $13,119.32 in Billed Charges for Rev 272 = $11,807.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE-FIRING XPEEDA 550,272,RC,,,,,,,,both,,,13119.3200,1967.9000,MEDCOST,MEDCOST VHN,6243.48,,,,,,,3386.1000,13119.3200,percent of total billed charges,"47.59% of $13,119.32 in Billed Charges for Rev 272 = $6,243.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE-FIRING XPEEDA 550,272,RC,,,,,,,,both,,,13119.3200,1967.9000,SENTARA HEALTH,SENTARA HEALTH,3386.10,,,,,,,3386.1000,13119.3200,percent of total billed charges,"25.81% of $13,119.32 in Billed Charges for Rev 272 = $3,386.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE-FIRING XPEEDA 550,272,RC,,,,,,,,both,,,13119.3200,1967.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13119.32,,,,,,,3386.1000,13119.3200,percent of total billed charges,"100% of $13,119.32 in Billed Charges for Rev 272 = $13,119.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE-FIRING XPEEDA 550,272,RC,,,,,,,,both,,,13119.3200,1967.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6559.66,,,,,,,3386.1000,13119.3200,percent of total billed charges,"Rev 272 $13,119.32 in Billed Charges at 50% = $6,559.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE-FIRING XPEEDA 550,272,RC,,,,,,,,both,,,13119.3200,1967.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4237.54,,,,,,,3386.1000,13119.3200,other,"32.3% of $13,119.32 in Billed Charges for Rev 272 = $4,237.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER SIDE-FIRING XPEEDA 550,272,RC,,,,,,,,both,,,13119.3200,1967.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,4027.63,,,,,,,3386.1000,13119.3200,other,"30.7% of $13,119.32 in Billed Charges for Rev 272 = $4,027.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER SIDE-FIRING XPEEDA 550,272,RC,,,,,,,,both,,,13119.3200,1967.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,4237.54,,,,,,,3386.1000,13119.3200,percent of total billed charges,"32.3% of $13,119.32 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SIDE-FIRING XPEEDA 550,272,RC,,,,,,,,both,,,13119.3200,1967.9000,WELLCARE,WELLCARE MEDICAID,13119.32,,,,,,,3386.1000,13119.3200,percent of total billed charges,"100% of $13,119.32 in Billed Charges for Rev 272 = $13,119.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3,272,RC,,,,,,,,both,,,1898.8300,284.8200,AETNA,AETNA,810.80,,,,,,,490.0900,1898.8300,percent of total billed charges,"42.7% of $1,898.83 in Billed Charges for Rev 272 = $810.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3,272,RC,,,,,,,,both,,,1898.8300,284.8200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1329.18,,,,,,,490.0900,1898.8300,percent of total billed charges,"Rev 272 $1,898.83 in Billed Charges at 70% = $1,329.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3,272,RC,,,,,,,,both,,,1898.8300,284.8200,CIGNA HEALTHCARE,CIGNA HMO,791.81,,,,,,,490.0900,1898.8300,percent of total billed charges,"41.7% of $1,898.83 in Billed Charges for Rev 272 = $791.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3,272,RC,,,,,,,,both,,,1898.8300,284.8200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,881.06,,,,,,,490.0900,1898.8300,percent of total billed charges,"46.4% of $1,898.83 in Billed Charges for Rev 272 = $881.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3,272,RC,,,,,,,,both,,,1898.8300,284.8200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,791.81,,,,,,,490.0900,1898.8300,percent of total billed charges,"41.7% of $1,898.83 in Billed Charges for Rev 272 = $791.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3,272,RC,,,,,,,,both,,,1898.8300,284.8200,CIGNA HEALTHCARE,CIGNA PPO,791.81,,,,,,,490.0900,1898.8300,percent of total billed charges,"41.7% of $1,898.83 in Billed Charges for Rev 272 = $791.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3,272,RC,,,,,,,,both,,,1898.8300,284.8200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1708.95,,,,,,,490.0900,1898.8300,percent of total billed charges,"90% of $1,898.83 in Billed Charges for Rev 272 = $1,708.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3,272,RC,,,,,,,,both,,,1898.8300,284.8200,MEDCOST,MEDCOST VHN,903.65,,,,,,,490.0900,1898.8300,percent of total billed charges,"47.59% of $1,898.83 in Billed Charges for Rev 272 = $903.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3,272,RC,,,,,,,,both,,,1898.8300,284.8200,SENTARA HEALTH,SENTARA HEALTH,490.09,,,,,,,490.0900,1898.8300,percent of total billed charges,"25.81% of $1,898.83 in Billed Charges for Rev 272 = $490.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3,272,RC,,,,,,,,both,,,1898.8300,284.8200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1898.83,,,,,,,490.0900,1898.8300,percent of total billed charges,"100% of $1,898.83 in Billed Charges for Rev 272 = $1,898.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3,272,RC,,,,,,,,both,,,1898.8300,284.8200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,949.42,,,,,,,490.0900,1898.8300,percent of total billed charges,"Rev 272 $1,898.83 in Billed Charges at 50% = $949.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3,272,RC,,,,,,,,both,,,1898.8300,284.8200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,613.32,,,,,,,490.0900,1898.8300,other,"32.3% of $1,898.83 in Billed Charges for Rev 272 = $613.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 4.3,272,RC,,,,,,,,both,,,1898.8300,284.8200,UNITED HEALTHCARE,UHC HERITAGE SELECT,582.94,,,,,,,490.0900,1898.8300,other,"30.7% of $1,898.83 in Billed Charges for Rev 272 = $582.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 4.3,272,RC,,,,,,,,both,,,1898.8300,284.8200,UNITED HEALTHCARE,UNITED HEALTHCARE,613.32,,,,,,,490.0900,1898.8300,percent of total billed charges,"32.3% of $1,898.83 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3,272,RC,,,,,,,,both,,,1898.8300,284.8200,WELLCARE,WELLCARE MEDICAID,1898.83,,,,,,,490.0900,1898.8300,percent of total billed charges,"100% of $1,898.83 in Billed Charges for Rev 272 = $1,898.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3 PERC 300MM CANN,272,RC,27200002,CDM,,,,,,both,,,1579.9200,236.9900,AETNA,AETNA,674.63,,,,,,,407.7800,1579.9200,percent of total billed charges,"42.7% of $1,579.92 in Billed Charges for Rev 272 = $674.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3 PERC 300MM CANN,272,RC,27200002,CDM,,,,,,both,,,1579.9200,236.9900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1105.94,,,,,,,407.7800,1579.9200,percent of total billed charges,"Rev 272 $1,579.92 in Billed Charges at 70% = $1,105.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3 PERC 300MM CANN,272,RC,27200002,CDM,,,,,,both,,,1579.9200,236.9900,CIGNA HEALTHCARE,CIGNA HMO,658.83,,,,,,,407.7800,1579.9200,percent of total billed charges,"41.7% of $1,579.92 in Billed Charges for Rev 272 = $658.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3 PERC 300MM CANN,272,RC,27200002,CDM,,,,,,both,,,1579.9200,236.9900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,733.08,,,,,,,407.7800,1579.9200,percent of total billed charges,"46.4% of $1,579.92 in Billed Charges for Rev 272 = $733.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3 PERC 300MM CANN,272,RC,27200002,CDM,,,,,,both,,,1579.9200,236.9900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,658.83,,,,,,,407.7800,1579.9200,percent of total billed charges,"41.7% of $1,579.92 in Billed Charges for Rev 272 = $658.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3 PERC 300MM CANN,272,RC,27200002,CDM,,,,,,both,,,1579.9200,236.9900,CIGNA HEALTHCARE,CIGNA PPO,658.83,,,,,,,407.7800,1579.9200,percent of total billed charges,"41.7% of $1,579.92 in Billed Charges for Rev 272 = $658.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3 PERC 300MM CANN,272,RC,27200002,CDM,,,,,,both,,,1579.9200,236.9900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1421.93,,,,,,,407.7800,1579.9200,percent of total billed charges,"90% of $1,579.92 in Billed Charges for Rev 272 = $1,421.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3 PERC 300MM CANN,272,RC,27200002,CDM,,,,,,both,,,1579.9200,236.9900,MEDCOST,MEDCOST VHN,751.88,,,,,,,407.7800,1579.9200,percent of total billed charges,"47.59% of $1,579.92 in Billed Charges for Rev 272 = $751.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3 PERC 300MM CANN,272,RC,27200002,CDM,,,,,,both,,,1579.9200,236.9900,SENTARA HEALTH,SENTARA HEALTH,407.78,,,,,,,407.7800,1579.9200,percent of total billed charges,"25.81% of $1,579.92 in Billed Charges for Rev 272 = $407.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3 PERC 300MM CANN,272,RC,27200002,CDM,,,,,,both,,,1579.9200,236.9900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1579.92,,,,,,,407.7800,1579.9200,percent of total billed charges,"100% of $1,579.92 in Billed Charges for Rev 272 = $1,579.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3 PERC 300MM CANN,272,RC,27200002,CDM,,,,,,both,,,1579.9200,236.9900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,789.96,,,,,,,407.7800,1579.9200,percent of total billed charges,"Rev 272 $1,579.92 in Billed Charges at 50% = $789.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3 PERC 300MM CANN,272,RC,27200002,CDM,,,,,,both,,,1579.9200,236.9900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,510.31,,,,,,,407.7800,1579.9200,other,"32.3% of $1,579.92 in Billed Charges for Rev 272 = $510.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 4.3 PERC 300MM CANN,272,RC,27200002,CDM,,,,,,both,,,1579.9200,236.9900,UNITED HEALTHCARE,UHC HERITAGE SELECT,485.04,,,,,,,407.7800,1579.9200,other,"30.7% of $1,579.92 in Billed Charges for Rev 272 = $485.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 4.3 PERC 300MM CANN,272,RC,27200002,CDM,,,,,,both,,,1579.9200,236.9900,UNITED HEALTHCARE,UNITED HEALTHCARE,510.31,,,,,,,407.7800,1579.9200,percent of total billed charges,"32.3% of $1,579.92 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 4.3 PERC 300MM CANN,272,RC,27200002,CDM,,,,,,both,,,1579.9200,236.9900,WELLCARE,WELLCARE MEDICAID,1579.92,,,,,,,407.7800,1579.9200,percent of total billed charges,"100% of $1,579.92 in Billed Charges for Rev 272 = $1,579.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIM BARREL ROUND TIP 200,272,RC,,,,,,,,both,,,2281.6200,342.2400,AETNA,AETNA,974.25,,,,,,,588.8900,2281.6200,percent of total billed charges,"42.7% of $2,281.62 in Billed Charges for Rev 272 = $974.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIM BARREL ROUND TIP 200,272,RC,,,,,,,,both,,,2281.6200,342.2400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1597.13,,,,,,,588.8900,2281.6200,percent of total billed charges,"Rev 272 $2,281.62 in Billed Charges at 70% = $1,597.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIM BARREL ROUND TIP 200,272,RC,,,,,,,,both,,,2281.6200,342.2400,CIGNA HEALTHCARE,CIGNA HMO,951.44,,,,,,,588.8900,2281.6200,percent of total billed charges,"41.7% of $2,281.62 in Billed Charges for Rev 272 = $951.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIM BARREL ROUND TIP 200,272,RC,,,,,,,,both,,,2281.6200,342.2400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1058.67,,,,,,,588.8900,2281.6200,percent of total billed charges,"46.4% of $2,281.62 in Billed Charges for Rev 272 = $1,058.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIM BARREL ROUND TIP 200,272,RC,,,,,,,,both,,,2281.6200,342.2400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,951.44,,,,,,,588.8900,2281.6200,percent of total billed charges,"41.7% of $2,281.62 in Billed Charges for Rev 272 = $951.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIM BARREL ROUND TIP 200,272,RC,,,,,,,,both,,,2281.6200,342.2400,CIGNA HEALTHCARE,CIGNA PPO,951.44,,,,,,,588.8900,2281.6200,percent of total billed charges,"41.7% of $2,281.62 in Billed Charges for Rev 272 = $951.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIM BARREL ROUND TIP 200,272,RC,,,,,,,,both,,,2281.6200,342.2400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2053.46,,,,,,,588.8900,2281.6200,percent of total billed charges,"90% of $2,281.62 in Billed Charges for Rev 272 = $2,053.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIM BARREL ROUND TIP 200,272,RC,,,,,,,,both,,,2281.6200,342.2400,MEDCOST,MEDCOST VHN,1085.82,,,,,,,588.8900,2281.6200,percent of total billed charges,"47.59% of $2,281.62 in Billed Charges for Rev 272 = $1,085.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIM BARREL ROUND TIP 200,272,RC,,,,,,,,both,,,2281.6200,342.2400,SENTARA HEALTH,SENTARA HEALTH,588.89,,,,,,,588.8900,2281.6200,percent of total billed charges,"25.81% of $2,281.62 in Billed Charges for Rev 272 = $588.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIM BARREL ROUND TIP 200,272,RC,,,,,,,,both,,,2281.6200,342.2400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2281.62,,,,,,,588.8900,2281.6200,percent of total billed charges,"100% of $2,281.62 in Billed Charges for Rev 272 = $2,281.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIM BARREL ROUND TIP 200,272,RC,,,,,,,,both,,,2281.6200,342.2400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1140.81,,,,,,,588.8900,2281.6200,percent of total billed charges,"Rev 272 $2,281.62 in Billed Charges at 50% = $1,140.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIM BARREL ROUND TIP 200,272,RC,,,,,,,,both,,,2281.6200,342.2400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,736.96,,,,,,,588.8900,2281.6200,other,"32.3% of $2,281.62 in Billed Charges for Rev 272 = $736.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER SLIM BARREL ROUND TIP 200,272,RC,,,,,,,,both,,,2281.6200,342.2400,UNITED HEALTHCARE,UHC HERITAGE SELECT,700.46,,,,,,,588.8900,2281.6200,other,"30.7% of $2,281.62 in Billed Charges for Rev 272 = $700.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER SLIM BARREL ROUND TIP 200,272,RC,,,,,,,,both,,,2281.6200,342.2400,UNITED HEALTHCARE,UNITED HEALTHCARE,736.96,,,,,,,588.8900,2281.6200,percent of total billed charges,"32.3% of $2,281.62 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER SLIM BARREL ROUND TIP 200,272,RC,,,,,,,,both,,,2281.6200,342.2400,WELLCARE,WELLCARE MEDICAID,2281.62,,,,,,,588.8900,2281.6200,percent of total billed charges,"100% of $2,281.62 in Billed Charges for Rev 272 = $2,281.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER UROGENITAL 940 LASER SINGLE,272,RC,27200002,CDM,,,,,,both,,,4148.4000,622.2600,AETNA,AETNA,1771.37,,,,,,,1070.7000,4148.4000,percent of total billed charges,"42.7% of $4,148.40 in Billed Charges for Rev 272 = $1,771.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER UROGENITAL 940 LASER SINGLE,272,RC,27200002,CDM,,,,,,both,,,4148.4000,622.2600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2903.88,,,,,,,1070.7000,4148.4000,percent of total billed charges,"Rev 272 $4,148.40 in Billed Charges at 70% = $2,903.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER UROGENITAL 940 LASER SINGLE,272,RC,27200002,CDM,,,,,,both,,,4148.4000,622.2600,CIGNA HEALTHCARE,CIGNA HMO,1729.88,,,,,,,1070.7000,4148.4000,percent of total billed charges,"41.7% of $4,148.40 in Billed Charges for Rev 272 = $1,729.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER UROGENITAL 940 LASER SINGLE,272,RC,27200002,CDM,,,,,,both,,,4148.4000,622.2600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1924.86,,,,,,,1070.7000,4148.4000,percent of total billed charges,"46.4% of $4,148.40 in Billed Charges for Rev 272 = $1,924.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER UROGENITAL 940 LASER SINGLE,272,RC,27200002,CDM,,,,,,both,,,4148.4000,622.2600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1729.88,,,,,,,1070.7000,4148.4000,percent of total billed charges,"41.7% of $4,148.40 in Billed Charges for Rev 272 = $1,729.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER UROGENITAL 940 LASER SINGLE,272,RC,27200002,CDM,,,,,,both,,,4148.4000,622.2600,CIGNA HEALTHCARE,CIGNA PPO,1729.88,,,,,,,1070.7000,4148.4000,percent of total billed charges,"41.7% of $4,148.40 in Billed Charges for Rev 272 = $1,729.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER UROGENITAL 940 LASER SINGLE,272,RC,27200002,CDM,,,,,,both,,,4148.4000,622.2600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3733.56,,,,,,,1070.7000,4148.4000,percent of total billed charges,"90% of $4,148.40 in Billed Charges for Rev 272 = $3,733.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER UROGENITAL 940 LASER SINGLE,272,RC,27200002,CDM,,,,,,both,,,4148.4000,622.2600,MEDCOST,MEDCOST VHN,1974.22,,,,,,,1070.7000,4148.4000,percent of total billed charges,"47.59% of $4,148.40 in Billed Charges for Rev 272 = $1,974.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER UROGENITAL 940 LASER SINGLE,272,RC,27200002,CDM,,,,,,both,,,4148.4000,622.2600,SENTARA HEALTH,SENTARA HEALTH,1070.70,,,,,,,1070.7000,4148.4000,percent of total billed charges,"25.81% of $4,148.40 in Billed Charges for Rev 272 = $1,070.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER UROGENITAL 940 LASER SINGLE,272,RC,27200002,CDM,,,,,,both,,,4148.4000,622.2600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4148.40,,,,,,,1070.7000,4148.4000,percent of total billed charges,"100% of $4,148.40 in Billed Charges for Rev 272 = $4,148.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER UROGENITAL 940 LASER SINGLE,272,RC,27200002,CDM,,,,,,both,,,4148.4000,622.2600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2074.20,,,,,,,1070.7000,4148.4000,percent of total billed charges,"Rev 272 $4,148.40 in Billed Charges at 50% = $2,074.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER UROGENITAL 940 LASER SINGLE,272,RC,27200002,CDM,,,,,,both,,,4148.4000,622.2600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1339.93,,,,,,,1070.7000,4148.4000,other,"32.3% of $4,148.40 in Billed Charges for Rev 272 = $1,339.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER UROGENITAL 940 LASER SINGLE,272,RC,27200002,CDM,,,,,,both,,,4148.4000,622.2600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1273.56,,,,,,,1070.7000,4148.4000,other,"30.7% of $4,148.40 in Billed Charges for Rev 272 = $1,273.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER UROGENITAL 940 LASER SINGLE,272,RC,27200002,CDM,,,,,,both,,,4148.4000,622.2600,UNITED HEALTHCARE,UNITED HEALTHCARE,1339.93,,,,,,,1070.7000,4148.4000,percent of total billed charges,"32.3% of $4,148.40 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER UROGENITAL 940 LASER SINGLE,272,RC,27200002,CDM,,,,,,both,,,4148.4000,622.2600,WELLCARE,WELLCARE MEDICAID,4148.40,,,,,,,1070.7000,4148.4000,percent of total billed charges,"100% of $4,148.40 in Billed Charges for Rev 272 = $4,148.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE BUGBEE 5FR X 58CM,272,RC,27200002,CDM,,,,,,both,,,637.0400,95.5600,AETNA,AETNA,272.02,,,,,,,164.4200,637.0400,percent of total billed charges,42.7% of $637.04 in Billed Charges for Rev 272 = $272.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE BUGBEE 5FR X 58CM,272,RC,27200002,CDM,,,,,,both,,,637.0400,95.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,445.93,,,,,,,164.4200,637.0400,percent of total billed charges,Rev 272 $637.04 in Billed Charges at 70% = $445.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE BUGBEE 5FR X 58CM,272,RC,27200002,CDM,,,,,,both,,,637.0400,95.5600,CIGNA HEALTHCARE,CIGNA HMO,265.65,,,,,,,164.4200,637.0400,percent of total billed charges,41.7% of $637.04 in Billed Charges for Rev 272 = $265.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE BUGBEE 5FR X 58CM,272,RC,27200002,CDM,,,,,,both,,,637.0400,95.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,295.59,,,,,,,164.4200,637.0400,percent of total billed charges,46.4% of $637.04 in Billed Charges for Rev 272 = $295.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE BUGBEE 5FR X 58CM,272,RC,27200002,CDM,,,,,,both,,,637.0400,95.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,265.65,,,,,,,164.4200,637.0400,percent of total billed charges,41.7% of $637.04 in Billed Charges for Rev 272 = $265.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE BUGBEE 5FR X 58CM,272,RC,27200002,CDM,,,,,,both,,,637.0400,95.5600,CIGNA HEALTHCARE,CIGNA PPO,265.65,,,,,,,164.4200,637.0400,percent of total billed charges,41.7% of $637.04 in Billed Charges for Rev 272 = $265.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE BUGBEE 5FR X 58CM,272,RC,27200002,CDM,,,,,,both,,,637.0400,95.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,573.34,,,,,,,164.4200,637.0400,percent of total billed charges,90% of $637.04 in Billed Charges for Rev 272 = $573.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE BUGBEE 5FR X 58CM,272,RC,27200002,CDM,,,,,,both,,,637.0400,95.5600,MEDCOST,MEDCOST VHN,303.17,,,,,,,164.4200,637.0400,percent of total billed charges,47.59% of $637.04 in Billed Charges for Rev 272 = $303.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE BUGBEE 5FR X 58CM,272,RC,27200002,CDM,,,,,,both,,,637.0400,95.5600,SENTARA HEALTH,SENTARA HEALTH,164.42,,,,,,,164.4200,637.0400,percent of total billed charges,25.81% of $637.04 in Billed Charges for Rev 272 = $164.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE BUGBEE 5FR X 58CM,272,RC,27200002,CDM,,,,,,both,,,637.0400,95.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",637.04,,,,,,,164.4200,637.0400,percent of total billed charges,100% of $637.04 in Billed Charges for Rev 272 = $637.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE BUGBEE 5FR X 58CM,272,RC,27200002,CDM,,,,,,both,,,637.0400,95.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,318.52,,,,,,,164.4200,637.0400,percent of total billed charges,Rev 272 $637.04 in Billed Charges at 50% = $318.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE BUGBEE 5FR X 58CM,272,RC,27200002,CDM,,,,,,both,,,637.0400,95.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,205.76,,,,,,,164.4200,637.0400,other,32.3% of $637.04 in Billed Charges for Rev 272 = $205.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ELECTRODE BUGBEE 5FR X 58CM,272,RC,27200002,CDM,,,,,,both,,,637.0400,95.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,195.57,,,,,,,164.4200,637.0400,other,30.7% of $637.04 in Billed Charges for Rev 272 = $195.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ELECTRODE BUGBEE 5FR X 58CM,272,RC,27200002,CDM,,,,,,both,,,637.0400,95.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,205.76,,,,,,,164.4200,637.0400,percent of total billed charges,32.3% of $637.04 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE BUGBEE 5FR X 58CM,272,RC,27200002,CDM,,,,,,both,,,637.0400,95.5600,WELLCARE,WELLCARE MEDICAID,637.04,,,,,,,164.4200,637.0400,percent of total billed charges,100% of $637.04 in Billed Charges for Rev 272 = $637.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE CUTTING LOOP BIPOLOR DIAMETER 0.35MM 27040GP1-S,272,RC,27200002,CDM,,,,,,both,,,5659.5400,848.9300,AETNA,AETNA,2416.62,,,,,,,1460.7300,5659.5400,percent of total billed charges,"42.7% of $5,659.54 in Billed Charges for Rev 272 = $2,416.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE CUTTING LOOP BIPOLOR DIAMETER 0.35MM 27040GP1-S,272,RC,27200002,CDM,,,,,,both,,,5659.5400,848.9300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3961.68,,,,,,,1460.7300,5659.5400,percent of total billed charges,"Rev 272 $5,659.54 in Billed Charges at 70% = $3,961.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE CUTTING LOOP BIPOLOR DIAMETER 0.35MM 27040GP1-S,272,RC,27200002,CDM,,,,,,both,,,5659.5400,848.9300,CIGNA HEALTHCARE,CIGNA HMO,2360.03,,,,,,,1460.7300,5659.5400,percent of total billed charges,"41.7% of $5,659.54 in Billed Charges for Rev 272 = $2,360.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE CUTTING LOOP BIPOLOR DIAMETER 0.35MM 27040GP1-S,272,RC,27200002,CDM,,,,,,both,,,5659.5400,848.9300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2626.03,,,,,,,1460.7300,5659.5400,percent of total billed charges,"46.4% of $5,659.54 in Billed Charges for Rev 272 = $2,626.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE CUTTING LOOP BIPOLOR DIAMETER 0.35MM 27040GP1-S,272,RC,27200002,CDM,,,,,,both,,,5659.5400,848.9300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2360.03,,,,,,,1460.7300,5659.5400,percent of total billed charges,"41.7% of $5,659.54 in Billed Charges for Rev 272 = $2,360.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE CUTTING LOOP BIPOLOR DIAMETER 0.35MM 27040GP1-S,272,RC,27200002,CDM,,,,,,both,,,5659.5400,848.9300,CIGNA HEALTHCARE,CIGNA PPO,2360.03,,,,,,,1460.7300,5659.5400,percent of total billed charges,"41.7% of $5,659.54 in Billed Charges for Rev 272 = $2,360.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE CUTTING LOOP BIPOLOR DIAMETER 0.35MM 27040GP1-S,272,RC,27200002,CDM,,,,,,both,,,5659.5400,848.9300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5093.59,,,,,,,1460.7300,5659.5400,percent of total billed charges,"90% of $5,659.54 in Billed Charges for Rev 272 = $5,093.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE CUTTING LOOP BIPOLOR DIAMETER 0.35MM 27040GP1-S,272,RC,27200002,CDM,,,,,,both,,,5659.5400,848.9300,MEDCOST,MEDCOST VHN,2693.38,,,,,,,1460.7300,5659.5400,percent of total billed charges,"47.59% of $5,659.54 in Billed Charges for Rev 272 = $2,693.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE CUTTING LOOP BIPOLOR DIAMETER 0.35MM 27040GP1-S,272,RC,27200002,CDM,,,,,,both,,,5659.5400,848.9300,SENTARA HEALTH,SENTARA HEALTH,1460.73,,,,,,,1460.7300,5659.5400,percent of total billed charges,"25.81% of $5,659.54 in Billed Charges for Rev 272 = $1,460.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE CUTTING LOOP BIPOLOR DIAMETER 0.35MM 27040GP1-S,272,RC,27200002,CDM,,,,,,both,,,5659.5400,848.9300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5659.54,,,,,,,1460.7300,5659.5400,percent of total billed charges,"100% of $5,659.54 in Billed Charges for Rev 272 = $5,659.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE CUTTING LOOP BIPOLOR DIAMETER 0.35MM 27040GP1-S,272,RC,27200002,CDM,,,,,,both,,,5659.5400,848.9300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2829.77,,,,,,,1460.7300,5659.5400,percent of total billed charges,"Rev 272 $5,659.54 in Billed Charges at 50% = $2,829.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE CUTTING LOOP BIPOLOR DIAMETER 0.35MM 27040GP1-S,272,RC,27200002,CDM,,,,,,both,,,5659.5400,848.9300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1828.03,,,,,,,1460.7300,5659.5400,other,"32.3% of $5,659.54 in Billed Charges for Rev 272 = $1,828.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE CUTTING LOOP BIPOLOR DIAMETER 0.35MM 27040GP1-S,272,RC,27200002,CDM,,,,,,both,,,5659.5400,848.9300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1737.48,,,,,,,1460.7300,5659.5400,other,"30.7% of $5,659.54 in Billed Charges for Rev 272 = $1,737.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE CUTTING LOOP BIPOLOR DIAMETER 0.35MM 27040GP1-S,272,RC,27200002,CDM,,,,,,both,,,5659.5400,848.9300,UNITED HEALTHCARE,UNITED HEALTHCARE,1828.03,,,,,,,1460.7300,5659.5400,percent of total billed charges,"32.3% of $5,659.54 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE CUTTING LOOP BIPOLOR DIAMETER 0.35MM 27040GP1-S,272,RC,27200002,CDM,,,,,,both,,,5659.5400,848.9300,WELLCARE,WELLCARE MEDICAID,5659.54,,,,,,,1460.7300,5659.5400,percent of total billed charges,"100% of $5,659.54 in Billed Charges for Rev 272 = $5,659.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE EMG AIX1202A,272,RC,,,,,,,,both,,,8711.6400,1306.7500,AETNA,AETNA,3719.87,,,,,,,2248.4700,8711.6400,percent of total billed charges,"42.7% of $8,711.64 in Billed Charges for Rev 272 = $3,719.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE EMG AIX1202A,272,RC,,,,,,,,both,,,8711.6400,1306.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6098.15,,,,,,,2248.4700,8711.6400,percent of total billed charges,"Rev 272 $8,711.64 in Billed Charges at 70% = $6,098.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE EMG AIX1202A,272,RC,,,,,,,,both,,,8711.6400,1306.7500,CIGNA HEALTHCARE,CIGNA HMO,3632.75,,,,,,,2248.4700,8711.6400,percent of total billed charges,"41.7% of $8,711.64 in Billed Charges for Rev 272 = $3,632.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE EMG AIX1202A,272,RC,,,,,,,,both,,,8711.6400,1306.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4042.20,,,,,,,2248.4700,8711.6400,percent of total billed charges,"46.4% of $8,711.64 in Billed Charges for Rev 272 = $4,042.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE EMG AIX1202A,272,RC,,,,,,,,both,,,8711.6400,1306.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3632.75,,,,,,,2248.4700,8711.6400,percent of total billed charges,"41.7% of $8,711.64 in Billed Charges for Rev 272 = $3,632.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE EMG AIX1202A,272,RC,,,,,,,,both,,,8711.6400,1306.7500,CIGNA HEALTHCARE,CIGNA PPO,3632.75,,,,,,,2248.4700,8711.6400,percent of total billed charges,"41.7% of $8,711.64 in Billed Charges for Rev 272 = $3,632.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE EMG AIX1202A,272,RC,,,,,,,,both,,,8711.6400,1306.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7840.48,,,,,,,2248.4700,8711.6400,percent of total billed charges,"90% of $8,711.64 in Billed Charges for Rev 272 = $7,840.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE EMG AIX1202A,272,RC,,,,,,,,both,,,8711.6400,1306.7500,MEDCOST,MEDCOST VHN,4145.87,,,,,,,2248.4700,8711.6400,percent of total billed charges,"47.59% of $8,711.64 in Billed Charges for Rev 272 = $4,145.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE EMG AIX1202A,272,RC,,,,,,,,both,,,8711.6400,1306.7500,SENTARA HEALTH,SENTARA HEALTH,2248.47,,,,,,,2248.4700,8711.6400,percent of total billed charges,"25.81% of $8,711.64 in Billed Charges for Rev 272 = $2,248.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE EMG AIX1202A,272,RC,,,,,,,,both,,,8711.6400,1306.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8711.64,,,,,,,2248.4700,8711.6400,percent of total billed charges,"100% of $8,711.64 in Billed Charges for Rev 272 = $8,711.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE EMG AIX1202A,272,RC,,,,,,,,both,,,8711.6400,1306.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4355.82,,,,,,,2248.4700,8711.6400,percent of total billed charges,"Rev 272 $8,711.64 in Billed Charges at 50% = $4,355.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE EMG AIX1202A,272,RC,,,,,,,,both,,,8711.6400,1306.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2813.86,,,,,,,2248.4700,8711.6400,other,"32.3% of $8,711.64 in Billed Charges for Rev 272 = $2,813.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE EMG AIX1202A,272,RC,,,,,,,,both,,,8711.6400,1306.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2674.47,,,,,,,2248.4700,8711.6400,other,"30.7% of $8,711.64 in Billed Charges for Rev 272 = $2,674.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE EMG AIX1202A,272,RC,,,,,,,,both,,,8711.6400,1306.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,2813.86,,,,,,,2248.4700,8711.6400,percent of total billed charges,"32.3% of $8,711.64 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE EMG AIX1202A,272,RC,,,,,,,,both,,,8711.6400,1306.7500,WELLCARE,WELLCARE MEDICAID,8711.64,,,,,,,2248.4700,8711.6400,percent of total billed charges,"100% of $8,711.64 in Billed Charges for Rev 272 = $8,711.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER WAVEGUIDE SINGLE 500 2/3,272,RC,,,,,,,,both,,,7259.7000,1088.9600,AETNA,AETNA,3099.89,,,,,,,1873.7300,7259.7000,percent of total billed charges,"42.7% of $7,259.70 in Billed Charges for Rev 272 = $3,099.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER WAVEGUIDE SINGLE 500 2/3,272,RC,,,,,,,,both,,,7259.7000,1088.9600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5081.79,,,,,,,1873.7300,7259.7000,percent of total billed charges,"Rev 272 $7,259.70 in Billed Charges at 70% = $5,081.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER WAVEGUIDE SINGLE 500 2/3,272,RC,,,,,,,,both,,,7259.7000,1088.9600,CIGNA HEALTHCARE,CIGNA HMO,3027.29,,,,,,,1873.7300,7259.7000,percent of total billed charges,"41.7% of $7,259.70 in Billed Charges for Rev 272 = $3,027.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER WAVEGUIDE SINGLE 500 2/3,272,RC,,,,,,,,both,,,7259.7000,1088.9600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3368.50,,,,,,,1873.7300,7259.7000,percent of total billed charges,"46.4% of $7,259.70 in Billed Charges for Rev 272 = $3,368.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER WAVEGUIDE SINGLE 500 2/3,272,RC,,,,,,,,both,,,7259.7000,1088.9600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3027.29,,,,,,,1873.7300,7259.7000,percent of total billed charges,"41.7% of $7,259.70 in Billed Charges for Rev 272 = $3,027.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER WAVEGUIDE SINGLE 500 2/3,272,RC,,,,,,,,both,,,7259.7000,1088.9600,CIGNA HEALTHCARE,CIGNA PPO,3027.29,,,,,,,1873.7300,7259.7000,percent of total billed charges,"41.7% of $7,259.70 in Billed Charges for Rev 272 = $3,027.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER WAVEGUIDE SINGLE 500 2/3,272,RC,,,,,,,,both,,,7259.7000,1088.9600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6533.73,,,,,,,1873.7300,7259.7000,percent of total billed charges,"90% of $7,259.70 in Billed Charges for Rev 272 = $6,533.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER WAVEGUIDE SINGLE 500 2/3,272,RC,,,,,,,,both,,,7259.7000,1088.9600,MEDCOST,MEDCOST VHN,3454.89,,,,,,,1873.7300,7259.7000,percent of total billed charges,"47.59% of $7,259.70 in Billed Charges for Rev 272 = $3,454.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER WAVEGUIDE SINGLE 500 2/3,272,RC,,,,,,,,both,,,7259.7000,1088.9600,SENTARA HEALTH,SENTARA HEALTH,1873.73,,,,,,,1873.7300,7259.7000,percent of total billed charges,"25.81% of $7,259.70 in Billed Charges for Rev 272 = $1,873.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER WAVEGUIDE SINGLE 500 2/3,272,RC,,,,,,,,both,,,7259.7000,1088.9600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7259.70,,,,,,,1873.7300,7259.7000,percent of total billed charges,"100% of $7,259.70 in Billed Charges for Rev 272 = $7,259.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER WAVEGUIDE SINGLE 500 2/3,272,RC,,,,,,,,both,,,7259.7000,1088.9600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3629.85,,,,,,,1873.7300,7259.7000,percent of total billed charges,"Rev 272 $7,259.70 in Billed Charges at 50% = $3,629.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER WAVEGUIDE SINGLE 500 2/3,272,RC,,,,,,,,both,,,7259.7000,1088.9600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2344.88,,,,,,,1873.7300,7259.7000,other,"32.3% of $7,259.70 in Billed Charges for Rev 272 = $2,344.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER WAVEGUIDE SINGLE 500 2/3,272,RC,,,,,,,,both,,,7259.7000,1088.9600,UNITED HEALTHCARE,UHC HERITAGE SELECT,2228.73,,,,,,,1873.7300,7259.7000,other,"30.7% of $7,259.70 in Billed Charges for Rev 272 = $2,228.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER WAVEGUIDE SINGLE 500 2/3,272,RC,,,,,,,,both,,,7259.7000,1088.9600,UNITED HEALTHCARE,UNITED HEALTHCARE,2344.88,,,,,,,1873.7300,7259.7000,percent of total billed charges,"32.3% of $7,259.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER WAVEGUIDE SINGLE 500 2/3,272,RC,,,,,,,,both,,,7259.7000,1088.9600,WELLCARE,WELLCARE MEDICAID,7259.70,,,,,,,1873.7300,7259.7000,percent of total billed charges,"100% of $7,259.70 in Billed Charges for Rev 272 = $7,259.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,413.0100,61.9500,AETNA,AETNA,176.36,,,,,,,106.6000,413.0100,percent of total billed charges,42.7% of $413.01 in Billed Charges for Rev 272 = $176.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,413.0100,61.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,289.11,,,,,,,106.6000,413.0100,percent of total billed charges,Rev 272 $413.01 in Billed Charges at 70% = $289.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,413.0100,61.9500,CIGNA HEALTHCARE,CIGNA HMO,172.23,,,,,,,106.6000,413.0100,percent of total billed charges,41.7% of $413.01 in Billed Charges for Rev 272 = $172.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,413.0100,61.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,191.64,,,,,,,106.6000,413.0100,percent of total billed charges,46.4% of $413.01 in Billed Charges for Rev 272 = $191.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,413.0100,61.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,172.23,,,,,,,106.6000,413.0100,percent of total billed charges,41.7% of $413.01 in Billed Charges for Rev 272 = $172.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,413.0100,61.9500,CIGNA HEALTHCARE,CIGNA PPO,172.23,,,,,,,106.6000,413.0100,percent of total billed charges,41.7% of $413.01 in Billed Charges for Rev 272 = $172.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,413.0100,61.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,371.71,,,,,,,106.6000,413.0100,percent of total billed charges,90% of $413.01 in Billed Charges for Rev 272 = $371.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,413.0100,61.9500,MEDCOST,MEDCOST VHN,196.55,,,,,,,106.6000,413.0100,percent of total billed charges,47.59% of $413.01 in Billed Charges for Rev 272 = $196.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,413.0100,61.9500,SENTARA HEALTH,SENTARA HEALTH,106.60,,,,,,,106.6000,413.0100,percent of total billed charges,25.81% of $413.01 in Billed Charges for Rev 272 = $106.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,413.0100,61.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",413.01,,,,,,,106.6000,413.0100,percent of total billed charges,100% of $413.01 in Billed Charges for Rev 272 = $413.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,413.0100,61.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,206.51,,,,,,,106.6000,413.0100,percent of total billed charges,Rev 272 $413.01 in Billed Charges at 50% = $206.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,413.0100,61.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,133.40,,,,,,,106.6000,413.0100,other,32.3% of $413.01 in Billed Charges for Rev 272 = $133.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,413.0100,61.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,126.79,,,,,,,106.6000,413.0100,other,30.7% of $413.01 in Billed Charges for Rev 272 = $126.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,413.0100,61.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,133.40,,,,,,,106.6000,413.0100,percent of total billed charges,32.3% of $413.01 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,413.0100,61.9500,WELLCARE,WELLCARE MEDICAID,413.01,,,,,,,106.6000,413.0100,percent of total billed charges,100% of $413.01 in Billed Charges for Rev 272 = $413.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,514.8200,77.2200,AETNA,AETNA,219.83,,,,,,,132.8800,514.8200,percent of total billed charges,42.7% of $514.82 in Billed Charges for Rev 272 = $219.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,514.8200,77.2200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,360.37,,,,,,,132.8800,514.8200,percent of total billed charges,Rev 272 $514.82 in Billed Charges at 70% = $360.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,514.8200,77.2200,CIGNA HEALTHCARE,CIGNA HMO,214.68,,,,,,,132.8800,514.8200,percent of total billed charges,41.7% of $514.82 in Billed Charges for Rev 272 = $214.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,514.8200,77.2200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,238.88,,,,,,,132.8800,514.8200,percent of total billed charges,46.4% of $514.82 in Billed Charges for Rev 272 = $238.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,514.8200,77.2200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,214.68,,,,,,,132.8800,514.8200,percent of total billed charges,41.7% of $514.82 in Billed Charges for Rev 272 = $214.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,514.8200,77.2200,CIGNA HEALTHCARE,CIGNA PPO,214.68,,,,,,,132.8800,514.8200,percent of total billed charges,41.7% of $514.82 in Billed Charges for Rev 272 = $214.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,514.8200,77.2200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,463.34,,,,,,,132.8800,514.8200,percent of total billed charges,90% of $514.82 in Billed Charges for Rev 272 = $463.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,514.8200,77.2200,MEDCOST,MEDCOST VHN,245.00,,,,,,,132.8800,514.8200,percent of total billed charges,47.59% of $514.82 in Billed Charges for Rev 272 = $245.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,514.8200,77.2200,SENTARA HEALTH,SENTARA HEALTH,132.88,,,,,,,132.8800,514.8200,percent of total billed charges,25.81% of $514.82 in Billed Charges for Rev 272 = $132.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,514.8200,77.2200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",514.82,,,,,,,132.8800,514.8200,percent of total billed charges,100% of $514.82 in Billed Charges for Rev 272 = $514.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,514.8200,77.2200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,257.41,,,,,,,132.8800,514.8200,percent of total billed charges,Rev 272 $514.82 in Billed Charges at 50% = $257.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,514.8200,77.2200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,166.29,,,,,,,132.8800,514.8200,other,32.3% of $514.82 in Billed Charges for Rev 272 = $166.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,514.8200,77.2200,UNITED HEALTHCARE,UHC HERITAGE SELECT,158.05,,,,,,,132.8800,514.8200,other,30.7% of $514.82 in Billed Charges for Rev 272 = $158.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,514.8200,77.2200,UNITED HEALTHCARE,UNITED HEALTHCARE,166.29,,,,,,,132.8800,514.8200,percent of total billed charges,32.3% of $514.82 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDO 5MM 5DSG,272,RC,27200002,CDM,,,,,,both,,,514.8200,77.2200,WELLCARE,WELLCARE MEDICAID,514.82,,,,,,,132.8800,514.8200,percent of total billed charges,100% of $514.82 in Billed Charges for Rev 272 = $514.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPER ENDOSCOPIC SILS CLINCH 5MM 36CML,272,RC,,,,,,,,both,,,2656.2200,398.4300,AETNA,AETNA,1134.21,,,,,,,685.5700,2656.2200,percent of total billed charges,"42.7% of $2,656.22 in Billed Charges for Rev 272 = $1,134.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER ENDOSCOPIC SILS CLINCH 5MM 36CML,272,RC,,,,,,,,both,,,2656.2200,398.4300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1859.35,,,,,,,685.5700,2656.2200,percent of total billed charges,"Rev 272 $2,656.22 in Billed Charges at 70% = $1,859.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER ENDOSCOPIC SILS CLINCH 5MM 36CML,272,RC,,,,,,,,both,,,2656.2200,398.4300,CIGNA HEALTHCARE,CIGNA HMO,1107.64,,,,,,,685.5700,2656.2200,percent of total billed charges,"41.7% of $2,656.22 in Billed Charges for Rev 272 = $1,107.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER ENDOSCOPIC SILS CLINCH 5MM 36CML,272,RC,,,,,,,,both,,,2656.2200,398.4300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1232.49,,,,,,,685.5700,2656.2200,percent of total billed charges,"46.4% of $2,656.22 in Billed Charges for Rev 272 = $1,232.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER ENDOSCOPIC SILS CLINCH 5MM 36CML,272,RC,,,,,,,,both,,,2656.2200,398.4300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1107.64,,,,,,,685.5700,2656.2200,percent of total billed charges,"41.7% of $2,656.22 in Billed Charges for Rev 272 = $1,107.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER ENDOSCOPIC SILS CLINCH 5MM 36CML,272,RC,,,,,,,,both,,,2656.2200,398.4300,CIGNA HEALTHCARE,CIGNA PPO,1107.64,,,,,,,685.5700,2656.2200,percent of total billed charges,"41.7% of $2,656.22 in Billed Charges for Rev 272 = $1,107.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER ENDOSCOPIC SILS CLINCH 5MM 36CML,272,RC,,,,,,,,both,,,2656.2200,398.4300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2390.60,,,,,,,685.5700,2656.2200,percent of total billed charges,"90% of $2,656.22 in Billed Charges for Rev 272 = $2,390.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER ENDOSCOPIC SILS CLINCH 5MM 36CML,272,RC,,,,,,,,both,,,2656.2200,398.4300,MEDCOST,MEDCOST VHN,1264.10,,,,,,,685.5700,2656.2200,percent of total billed charges,"47.59% of $2,656.22 in Billed Charges for Rev 272 = $1,264.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER ENDOSCOPIC SILS CLINCH 5MM 36CML,272,RC,,,,,,,,both,,,2656.2200,398.4300,SENTARA HEALTH,SENTARA HEALTH,685.57,,,,,,,685.5700,2656.2200,percent of total billed charges,"25.81% of $2,656.22 in Billed Charges for Rev 272 = $685.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER ENDOSCOPIC SILS CLINCH 5MM 36CML,272,RC,,,,,,,,both,,,2656.2200,398.4300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2656.22,,,,,,,685.5700,2656.2200,percent of total billed charges,"100% of $2,656.22 in Billed Charges for Rev 272 = $2,656.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER ENDOSCOPIC SILS CLINCH 5MM 36CML,272,RC,,,,,,,,both,,,2656.2200,398.4300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1328.11,,,,,,,685.5700,2656.2200,percent of total billed charges,"Rev 272 $2,656.22 in Billed Charges at 50% = $1,328.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER ENDOSCOPIC SILS CLINCH 5MM 36CML,272,RC,,,,,,,,both,,,2656.2200,398.4300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,857.96,,,,,,,685.5700,2656.2200,other,"32.3% of $2,656.22 in Billed Charges for Rev 272 = $857.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GRASPER ENDOSCOPIC SILS CLINCH 5MM 36CML,272,RC,,,,,,,,both,,,2656.2200,398.4300,UNITED HEALTHCARE,UHC HERITAGE SELECT,815.46,,,,,,,685.5700,2656.2200,other,"30.7% of $2,656.22 in Billed Charges for Rev 272 = $815.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GRASPER ENDOSCOPIC SILS CLINCH 5MM 36CML,272,RC,,,,,,,,both,,,2656.2200,398.4300,UNITED HEALTHCARE,UNITED HEALTHCARE,857.96,,,,,,,685.5700,2656.2200,percent of total billed charges,"32.3% of $2,656.22 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER ENDOSCOPIC SILS CLINCH 5MM 36CML,272,RC,,,,,,,,both,,,2656.2200,398.4300,WELLCARE,WELLCARE MEDICAID,2656.22,,,,,,,685.5700,2656.2200,percent of total billed charges,"100% of $2,656.22 in Billed Charges for Rev 272 = $2,656.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER FENESTRATED TIP-UP DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2395.7000,359.3600,AETNA,AETNA,1022.96,,,,,,,618.3300,2395.7000,percent of total billed charges,"42.7% of $2,395.70 in Billed Charges for Rev 272 = $1,022.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER FENESTRATED TIP-UP DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2395.7000,359.3600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1676.99,,,,,,,618.3300,2395.7000,percent of total billed charges,"Rev 272 $2,395.70 in Billed Charges at 70% = $1,676.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER FENESTRATED TIP-UP DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2395.7000,359.3600,CIGNA HEALTHCARE,CIGNA HMO,999.01,,,,,,,618.3300,2395.7000,percent of total billed charges,"41.7% of $2,395.70 in Billed Charges for Rev 272 = $999.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER FENESTRATED TIP-UP DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2395.7000,359.3600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1111.60,,,,,,,618.3300,2395.7000,percent of total billed charges,"46.4% of $2,395.70 in Billed Charges for Rev 272 = $1,111.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER FENESTRATED TIP-UP DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2395.7000,359.3600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,999.01,,,,,,,618.3300,2395.7000,percent of total billed charges,"41.7% of $2,395.70 in Billed Charges for Rev 272 = $999.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER FENESTRATED TIP-UP DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2395.7000,359.3600,CIGNA HEALTHCARE,CIGNA PPO,999.01,,,,,,,618.3300,2395.7000,percent of total billed charges,"41.7% of $2,395.70 in Billed Charges for Rev 272 = $999.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER FENESTRATED TIP-UP DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2395.7000,359.3600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2156.13,,,,,,,618.3300,2395.7000,percent of total billed charges,"90% of $2,395.70 in Billed Charges for Rev 272 = $2,156.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER FENESTRATED TIP-UP DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2395.7000,359.3600,MEDCOST,MEDCOST VHN,1140.11,,,,,,,618.3300,2395.7000,percent of total billed charges,"47.59% of $2,395.70 in Billed Charges for Rev 272 = $1,140.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER FENESTRATED TIP-UP DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2395.7000,359.3600,SENTARA HEALTH,SENTARA HEALTH,618.33,,,,,,,618.3300,2395.7000,percent of total billed charges,"25.81% of $2,395.70 in Billed Charges for Rev 272 = $618.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER FENESTRATED TIP-UP DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2395.7000,359.3600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2395.70,,,,,,,618.3300,2395.7000,percent of total billed charges,"100% of $2,395.70 in Billed Charges for Rev 272 = $2,395.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER FENESTRATED TIP-UP DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2395.7000,359.3600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1197.85,,,,,,,618.3300,2395.7000,percent of total billed charges,"Rev 272 $2,395.70 in Billed Charges at 50% = $1,197.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER FENESTRATED TIP-UP DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2395.7000,359.3600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,773.81,,,,,,,618.3300,2395.7000,other,"32.3% of $2,395.70 in Billed Charges for Rev 272 = $773.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GRASPER FENESTRATED TIP-UP DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2395.7000,359.3600,UNITED HEALTHCARE,UHC HERITAGE SELECT,735.48,,,,,,,618.3300,2395.7000,other,"30.7% of $2,395.70 in Billed Charges for Rev 272 = $735.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GRASPER FENESTRATED TIP-UP DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2395.7000,359.3600,UNITED HEALTHCARE,UNITED HEALTHCARE,773.81,,,,,,,618.3300,2395.7000,percent of total billed charges,"32.3% of $2,395.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER FENESTRATED TIP-UP DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2395.7000,359.3600,WELLCARE,WELLCARE MEDICAID,2395.70,,,,,,,618.3300,2395.7000,percent of total billed charges,"100% of $2,395.70 in Billed Charges for Rev 272 = $2,395.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,290.1800,43.5300,AETNA,AETNA,123.91,,,,,,,74.9000,290.1800,percent of total billed charges,42.7% of $290.18 in Billed Charges for Rev 272 = $123.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,290.1800,43.5300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,203.13,,,,,,,74.9000,290.1800,percent of total billed charges,Rev 272 $290.18 in Billed Charges at 70% = $203.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,290.1800,43.5300,CIGNA HEALTHCARE,CIGNA HMO,121.01,,,,,,,74.9000,290.1800,percent of total billed charges,41.7% of $290.18 in Billed Charges for Rev 272 = $121.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,290.1800,43.5300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,134.64,,,,,,,74.9000,290.1800,percent of total billed charges,46.4% of $290.18 in Billed Charges for Rev 272 = $134.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,290.1800,43.5300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,121.01,,,,,,,74.9000,290.1800,percent of total billed charges,41.7% of $290.18 in Billed Charges for Rev 272 = $121.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,290.1800,43.5300,CIGNA HEALTHCARE,CIGNA PPO,121.01,,,,,,,74.9000,290.1800,percent of total billed charges,41.7% of $290.18 in Billed Charges for Rev 272 = $121.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,290.1800,43.5300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,261.16,,,,,,,74.9000,290.1800,percent of total billed charges,90% of $290.18 in Billed Charges for Rev 272 = $261.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,290.1800,43.5300,MEDCOST,MEDCOST VHN,138.10,,,,,,,74.9000,290.1800,percent of total billed charges,47.59% of $290.18 in Billed Charges for Rev 272 = $138.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,290.1800,43.5300,SENTARA HEALTH,SENTARA HEALTH,74.90,,,,,,,74.9000,290.1800,percent of total billed charges,25.81% of $290.18 in Billed Charges for Rev 272 = $74.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,290.1800,43.5300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",290.18,,,,,,,74.9000,290.1800,percent of total billed charges,100% of $290.18 in Billed Charges for Rev 272 = $290.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,290.1800,43.5300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,145.09,,,,,,,74.9000,290.1800,percent of total billed charges,Rev 272 $290.18 in Billed Charges at 50% = $145.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,290.1800,43.5300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,93.73,,,,,,,74.9000,290.1800,other,32.3% of $290.18 in Billed Charges for Rev 272 = $93.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,290.1800,43.5300,UNITED HEALTHCARE,UHC HERITAGE SELECT,89.09,,,,,,,74.9000,290.1800,other,30.7% of $290.18 in Billed Charges for Rev 272 = $89.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,290.1800,43.5300,UNITED HEALTHCARE,UNITED HEALTHCARE,93.73,,,,,,,74.9000,290.1800,percent of total billed charges,32.3% of $290.18 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,290.1800,43.5300,WELLCARE,WELLCARE MEDICAID,290.18,,,,,,,74.9000,290.1800,percent of total billed charges,100% of $290.18 in Billed Charges for Rev 272 = $290.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,295.8400,44.3800,AETNA,AETNA,126.32,,,,,,,76.3600,295.8400,percent of total billed charges,42.7% of $295.84 in Billed Charges for Rev 272 = $126.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,295.8400,44.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,207.09,,,,,,,76.3600,295.8400,percent of total billed charges,Rev 272 $295.84 in Billed Charges at 70% = $207.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,295.8400,44.3800,CIGNA HEALTHCARE,CIGNA HMO,123.37,,,,,,,76.3600,295.8400,percent of total billed charges,41.7% of $295.84 in Billed Charges for Rev 272 = $123.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,295.8400,44.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,137.27,,,,,,,76.3600,295.8400,percent of total billed charges,46.4% of $295.84 in Billed Charges for Rev 272 = $137.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,295.8400,44.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,123.37,,,,,,,76.3600,295.8400,percent of total billed charges,41.7% of $295.84 in Billed Charges for Rev 272 = $123.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,295.8400,44.3800,CIGNA HEALTHCARE,CIGNA PPO,123.37,,,,,,,76.3600,295.8400,percent of total billed charges,41.7% of $295.84 in Billed Charges for Rev 272 = $123.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,295.8400,44.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,266.26,,,,,,,76.3600,295.8400,percent of total billed charges,90% of $295.84 in Billed Charges for Rev 272 = $266.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,295.8400,44.3800,MEDCOST,MEDCOST VHN,140.79,,,,,,,76.3600,295.8400,percent of total billed charges,47.59% of $295.84 in Billed Charges for Rev 272 = $140.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,295.8400,44.3800,SENTARA HEALTH,SENTARA HEALTH,76.36,,,,,,,76.3600,295.8400,percent of total billed charges,25.81% of $295.84 in Billed Charges for Rev 272 = $76.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,295.8400,44.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",295.84,,,,,,,76.3600,295.8400,percent of total billed charges,100% of $295.84 in Billed Charges for Rev 272 = $295.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,295.8400,44.3800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,147.92,,,,,,,76.3600,295.8400,percent of total billed charges,Rev 272 $295.84 in Billed Charges at 50% = $147.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,295.8400,44.3800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,95.56,,,,,,,76.3600,295.8400,other,32.3% of $295.84 in Billed Charges for Rev 272 = $95.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,295.8400,44.3800,UNITED HEALTHCARE,UHC HERITAGE SELECT,90.82,,,,,,,76.3600,295.8400,other,30.7% of $295.84 in Billed Charges for Rev 272 = $90.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,295.8400,44.3800,UNITED HEALTHCARE,UNITED HEALTHCARE,95.56,,,,,,,76.3600,295.8400,percent of total billed charges,32.3% of $295.84 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE FLAT L HOOK,272,RC,27200002,CDM,,,,,,both,,,295.8400,44.3800,WELLCARE,WELLCARE MEDICAID,295.84,,,,,,,76.3600,295.8400,percent of total billed charges,100% of $295.84 in Billed Charges for Rev 272 = $295.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE HF LOOP 24FR .35 WIRE 30 DEG,272,RC,27200002,CDM,,,,,,both,,,3077.9100,461.6900,AETNA,AETNA,1314.27,,,,,,,794.4100,3077.9100,percent of total billed charges,"42.7% of $3,077.91 in Billed Charges for Rev 272 = $1,314.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE HF LOOP 24FR .35 WIRE 30 DEG,272,RC,27200002,CDM,,,,,,both,,,3077.9100,461.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2154.54,,,,,,,794.4100,3077.9100,percent of total billed charges,"Rev 272 $3,077.91 in Billed Charges at 70% = $2,154.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE HF LOOP 24FR .35 WIRE 30 DEG,272,RC,27200002,CDM,,,,,,both,,,3077.9100,461.6900,CIGNA HEALTHCARE,CIGNA HMO,1283.49,,,,,,,794.4100,3077.9100,percent of total billed charges,"41.7% of $3,077.91 in Billed Charges for Rev 272 = $1,283.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE HF LOOP 24FR .35 WIRE 30 DEG,272,RC,27200002,CDM,,,,,,both,,,3077.9100,461.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1428.15,,,,,,,794.4100,3077.9100,percent of total billed charges,"46.4% of $3,077.91 in Billed Charges for Rev 272 = $1,428.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE HF LOOP 24FR .35 WIRE 30 DEG,272,RC,27200002,CDM,,,,,,both,,,3077.9100,461.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1283.49,,,,,,,794.4100,3077.9100,percent of total billed charges,"41.7% of $3,077.91 in Billed Charges for Rev 272 = $1,283.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE HF LOOP 24FR .35 WIRE 30 DEG,272,RC,27200002,CDM,,,,,,both,,,3077.9100,461.6900,CIGNA HEALTHCARE,CIGNA PPO,1283.49,,,,,,,794.4100,3077.9100,percent of total billed charges,"41.7% of $3,077.91 in Billed Charges for Rev 272 = $1,283.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE HF LOOP 24FR .35 WIRE 30 DEG,272,RC,27200002,CDM,,,,,,both,,,3077.9100,461.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2770.12,,,,,,,794.4100,3077.9100,percent of total billed charges,"90% of $3,077.91 in Billed Charges for Rev 272 = $2,770.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE HF LOOP 24FR .35 WIRE 30 DEG,272,RC,27200002,CDM,,,,,,both,,,3077.9100,461.6900,MEDCOST,MEDCOST VHN,1464.78,,,,,,,794.4100,3077.9100,percent of total billed charges,"47.59% of $3,077.91 in Billed Charges for Rev 272 = $1,464.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE HF LOOP 24FR .35 WIRE 30 DEG,272,RC,27200002,CDM,,,,,,both,,,3077.9100,461.6900,SENTARA HEALTH,SENTARA HEALTH,794.41,,,,,,,794.4100,3077.9100,percent of total billed charges,"25.81% of $3,077.91 in Billed Charges for Rev 272 = $794.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE HF LOOP 24FR .35 WIRE 30 DEG,272,RC,27200002,CDM,,,,,,both,,,3077.9100,461.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3077.91,,,,,,,794.4100,3077.9100,percent of total billed charges,"100% of $3,077.91 in Billed Charges for Rev 272 = $3,077.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE HF LOOP 24FR .35 WIRE 30 DEG,272,RC,27200002,CDM,,,,,,both,,,3077.9100,461.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1538.96,,,,,,,794.4100,3077.9100,percent of total billed charges,"Rev 272 $3,077.91 in Billed Charges at 50% = $1,538.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE HF LOOP 24FR .35 WIRE 30 DEG,272,RC,27200002,CDM,,,,,,both,,,3077.9100,461.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,994.16,,,,,,,794.4100,3077.9100,other,"32.3% of $3,077.91 in Billed Charges for Rev 272 = $994.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE HF LOOP 24FR .35 WIRE 30 DEG,272,RC,27200002,CDM,,,,,,both,,,3077.9100,461.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,944.92,,,,,,,794.4100,3077.9100,other,"30.7% of $3,077.91 in Billed Charges for Rev 272 = $944.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE HF LOOP 24FR .35 WIRE 30 DEG,272,RC,27200002,CDM,,,,,,both,,,3077.9100,461.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,994.16,,,,,,,794.4100,3077.9100,percent of total billed charges,"32.3% of $3,077.91 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE HF LOOP 24FR .35 WIRE 30 DEG,272,RC,27200002,CDM,,,,,,both,,,3077.9100,461.6900,WELLCARE,WELLCARE MEDICAID,3077.91,,,,,,,794.4100,3077.9100,percent of total billed charges,"100% of $3,077.91 in Billed Charges for Rev 272 = $3,077.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE KIT SO3 PTP LTP EMG SSEP,272,RC,27200002,CDM,,,,,,both,,,17695.5200,2654.3300,AETNA,AETNA,7555.99,,,,,,,4567.2100,17695.5200,percent of total billed charges,"42.7% of $17,695.52 in Billed Charges for Rev 272 = $7,555.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE KIT SO3 PTP LTP EMG SSEP,272,RC,27200002,CDM,,,,,,both,,,17695.5200,2654.3300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,12386.86,,,,,,,4567.2100,17695.5200,percent of total billed charges,"Rev 272 $17,695.52 in Billed Charges at 70% = $12,386.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE KIT SO3 PTP LTP EMG SSEP,272,RC,27200002,CDM,,,,,,both,,,17695.5200,2654.3300,CIGNA HEALTHCARE,CIGNA HMO,7379.03,,,,,,,4567.2100,17695.5200,percent of total billed charges,"41.7% of $17,695.52 in Billed Charges for Rev 272 = $7,379.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE KIT SO3 PTP LTP EMG SSEP,272,RC,27200002,CDM,,,,,,both,,,17695.5200,2654.3300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8210.72,,,,,,,4567.2100,17695.5200,percent of total billed charges,"46.4% of $17,695.52 in Billed Charges for Rev 272 = $8,210.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE KIT SO3 PTP LTP EMG SSEP,272,RC,27200002,CDM,,,,,,both,,,17695.5200,2654.3300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7379.03,,,,,,,4567.2100,17695.5200,percent of total billed charges,"41.7% of $17,695.52 in Billed Charges for Rev 272 = $7,379.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE KIT SO3 PTP LTP EMG SSEP,272,RC,27200002,CDM,,,,,,both,,,17695.5200,2654.3300,CIGNA HEALTHCARE,CIGNA PPO,7379.03,,,,,,,4567.2100,17695.5200,percent of total billed charges,"41.7% of $17,695.52 in Billed Charges for Rev 272 = $7,379.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE KIT SO3 PTP LTP EMG SSEP,272,RC,27200002,CDM,,,,,,both,,,17695.5200,2654.3300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,15925.97,,,,,,,4567.2100,17695.5200,percent of total billed charges,"90% of $17,695.52 in Billed Charges for Rev 272 = $15,925.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE KIT SO3 PTP LTP EMG SSEP,272,RC,27200002,CDM,,,,,,both,,,17695.5200,2654.3300,MEDCOST,MEDCOST VHN,8421.30,,,,,,,4567.2100,17695.5200,percent of total billed charges,"47.59% of $17,695.52 in Billed Charges for Rev 272 = $8,421.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE KIT SO3 PTP LTP EMG SSEP,272,RC,27200002,CDM,,,,,,both,,,17695.5200,2654.3300,SENTARA HEALTH,SENTARA HEALTH,4567.21,,,,,,,4567.2100,17695.5200,percent of total billed charges,"25.81% of $17,695.52 in Billed Charges for Rev 272 = $4,567.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE KIT SO3 PTP LTP EMG SSEP,272,RC,27200002,CDM,,,,,,both,,,17695.5200,2654.3300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",17695.52,,,,,,,4567.2100,17695.5200,percent of total billed charges,"100% of $17,695.52 in Billed Charges for Rev 272 = $17,695.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE KIT SO3 PTP LTP EMG SSEP,272,RC,27200002,CDM,,,,,,both,,,17695.5200,2654.3300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8847.76,,,,,,,4567.2100,17695.5200,percent of total billed charges,"Rev 272 $17,695.52 in Billed Charges at 50% = $8,847.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE KIT SO3 PTP LTP EMG SSEP,272,RC,27200002,CDM,,,,,,both,,,17695.5200,2654.3300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5715.65,,,,,,,4567.2100,17695.5200,other,"32.3% of $17,695.52 in Billed Charges for Rev 272 = $5,715.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE KIT SO3 PTP LTP EMG SSEP,272,RC,27200002,CDM,,,,,,both,,,17695.5200,2654.3300,UNITED HEALTHCARE,UHC HERITAGE SELECT,5432.52,,,,,,,4567.2100,17695.5200,other,"30.7% of $17,695.52 in Billed Charges for Rev 272 = $5,432.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE KIT SO3 PTP LTP EMG SSEP,272,RC,27200002,CDM,,,,,,both,,,17695.5200,2654.3300,UNITED HEALTHCARE,UNITED HEALTHCARE,5715.65,,,,,,,4567.2100,17695.5200,percent of total billed charges,"32.3% of $17,695.52 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE KIT SO3 PTP LTP EMG SSEP,272,RC,27200002,CDM,,,,,,both,,,17695.5200,2654.3300,WELLCARE,WELLCARE MEDICAID,17695.52,,,,,,,4567.2100,17695.5200,percent of total billed charges,"100% of $17,695.52 in Billed Charges for Rev 272 = $17,695.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP  24FRX.012 ACMI,272,RC,27200002,CDM,,,,,,both,,,669.2800,100.3900,AETNA,AETNA,285.78,,,,,,,172.7400,669.2800,percent of total billed charges,42.7% of $669.28 in Billed Charges for Rev 272 = $285.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE LOOP  24FRX.012 ACMI,272,RC,27200002,CDM,,,,,,both,,,669.2800,100.3900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,468.50,,,,,,,172.7400,669.2800,percent of total billed charges,Rev 272 $669.28 in Billed Charges at 70% = $468.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE LOOP  24FRX.012 ACMI,272,RC,27200002,CDM,,,,,,both,,,669.2800,100.3900,CIGNA HEALTHCARE,CIGNA HMO,279.09,,,,,,,172.7400,669.2800,percent of total billed charges,41.7% of $669.28 in Billed Charges for Rev 272 = $279.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE LOOP  24FRX.012 ACMI,272,RC,27200002,CDM,,,,,,both,,,669.2800,100.3900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,310.55,,,,,,,172.7400,669.2800,percent of total billed charges,46.4% of $669.28 in Billed Charges for Rev 272 = $310.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE LOOP  24FRX.012 ACMI,272,RC,27200002,CDM,,,,,,both,,,669.2800,100.3900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,279.09,,,,,,,172.7400,669.2800,percent of total billed charges,41.7% of $669.28 in Billed Charges for Rev 272 = $279.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE LOOP  24FRX.012 ACMI,272,RC,27200002,CDM,,,,,,both,,,669.2800,100.3900,CIGNA HEALTHCARE,CIGNA PPO,279.09,,,,,,,172.7400,669.2800,percent of total billed charges,41.7% of $669.28 in Billed Charges for Rev 272 = $279.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE LOOP  24FRX.012 ACMI,272,RC,27200002,CDM,,,,,,both,,,669.2800,100.3900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,602.35,,,,,,,172.7400,669.2800,percent of total billed charges,90% of $669.28 in Billed Charges for Rev 272 = $602.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE LOOP  24FRX.012 ACMI,272,RC,27200002,CDM,,,,,,both,,,669.2800,100.3900,MEDCOST,MEDCOST VHN,318.51,,,,,,,172.7400,669.2800,percent of total billed charges,47.59% of $669.28 in Billed Charges for Rev 272 = $318.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE LOOP  24FRX.012 ACMI,272,RC,27200002,CDM,,,,,,both,,,669.2800,100.3900,SENTARA HEALTH,SENTARA HEALTH,172.74,,,,,,,172.7400,669.2800,percent of total billed charges,25.81% of $669.28 in Billed Charges for Rev 272 = $172.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE LOOP  24FRX.012 ACMI,272,RC,27200002,CDM,,,,,,both,,,669.2800,100.3900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",669.28,,,,,,,172.7400,669.2800,percent of total billed charges,100% of $669.28 in Billed Charges for Rev 272 = $669.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE LOOP  24FRX.012 ACMI,272,RC,27200002,CDM,,,,,,both,,,669.2800,100.3900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,334.64,,,,,,,172.7400,669.2800,percent of total billed charges,Rev 272 $669.28 in Billed Charges at 50% = $334.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE LOOP  24FRX.012 ACMI,272,RC,27200002,CDM,,,,,,both,,,669.2800,100.3900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,216.18,,,,,,,172.7400,669.2800,other,32.3% of $669.28 in Billed Charges for Rev 272 = $216.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ELECTRODE LOOP  24FRX.012 ACMI,272,RC,27200002,CDM,,,,,,both,,,669.2800,100.3900,UNITED HEALTHCARE,UHC HERITAGE SELECT,205.47,,,,,,,172.7400,669.2800,other,30.7% of $669.28 in Billed Charges for Rev 272 = $205.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ELECTRODE LOOP  24FRX.012 ACMI,272,RC,27200002,CDM,,,,,,both,,,669.2800,100.3900,UNITED HEALTHCARE,UNITED HEALTHCARE,216.18,,,,,,,172.7400,669.2800,percent of total billed charges,32.3% of $669.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE LOOP  24FRX.012 ACMI,272,RC,27200002,CDM,,,,,,both,,,669.2800,100.3900,WELLCARE,WELLCARE MEDICAID,669.28,,,,,,,172.7400,669.2800,percent of total billed charges,100% of $669.28 in Billed Charges for Rev 272 = $669.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE LOOP 24FR LONG HIGH FREQUENCY 12DEG,272,RC,27200002,CDM,,,,,,both,,,1564.7200,234.7100,AETNA,AETNA,668.14,,,,,,,403.8500,1564.7200,percent of total billed charges,"42.7% of $1,564.72 in Billed Charges for Rev 272 = $668.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP 24FR LONG HIGH FREQUENCY 12DEG,272,RC,27200002,CDM,,,,,,both,,,1564.7200,234.7100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1095.30,,,,,,,403.8500,1564.7200,percent of total billed charges,"Rev 272 $1,564.72 in Billed Charges at 70% = $1,095.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP 24FR LONG HIGH FREQUENCY 12DEG,272,RC,27200002,CDM,,,,,,both,,,1564.7200,234.7100,CIGNA HEALTHCARE,CIGNA HMO,652.49,,,,,,,403.8500,1564.7200,percent of total billed charges,"41.7% of $1,564.72 in Billed Charges for Rev 272 = $652.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP 24FR LONG HIGH FREQUENCY 12DEG,272,RC,27200002,CDM,,,,,,both,,,1564.7200,234.7100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,726.03,,,,,,,403.8500,1564.7200,percent of total billed charges,"46.4% of $1,564.72 in Billed Charges for Rev 272 = $726.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP 24FR LONG HIGH FREQUENCY 12DEG,272,RC,27200002,CDM,,,,,,both,,,1564.7200,234.7100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,652.49,,,,,,,403.8500,1564.7200,percent of total billed charges,"41.7% of $1,564.72 in Billed Charges for Rev 272 = $652.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP 24FR LONG HIGH FREQUENCY 12DEG,272,RC,27200002,CDM,,,,,,both,,,1564.7200,234.7100,CIGNA HEALTHCARE,CIGNA PPO,652.49,,,,,,,403.8500,1564.7200,percent of total billed charges,"41.7% of $1,564.72 in Billed Charges for Rev 272 = $652.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP 24FR LONG HIGH FREQUENCY 12DEG,272,RC,27200002,CDM,,,,,,both,,,1564.7200,234.7100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1408.25,,,,,,,403.8500,1564.7200,percent of total billed charges,"90% of $1,564.72 in Billed Charges for Rev 272 = $1,408.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP 24FR LONG HIGH FREQUENCY 12DEG,272,RC,27200002,CDM,,,,,,both,,,1564.7200,234.7100,MEDCOST,MEDCOST VHN,744.65,,,,,,,403.8500,1564.7200,percent of total billed charges,"47.59% of $1,564.72 in Billed Charges for Rev 272 = $744.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP 24FR LONG HIGH FREQUENCY 12DEG,272,RC,27200002,CDM,,,,,,both,,,1564.7200,234.7100,SENTARA HEALTH,SENTARA HEALTH,403.85,,,,,,,403.8500,1564.7200,percent of total billed charges,"25.81% of $1,564.72 in Billed Charges for Rev 272 = $403.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP 24FR LONG HIGH FREQUENCY 12DEG,272,RC,27200002,CDM,,,,,,both,,,1564.7200,234.7100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1564.72,,,,,,,403.8500,1564.7200,percent of total billed charges,"100% of $1,564.72 in Billed Charges for Rev 272 = $1,564.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP 24FR LONG HIGH FREQUENCY 12DEG,272,RC,27200002,CDM,,,,,,both,,,1564.7200,234.7100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,782.36,,,,,,,403.8500,1564.7200,percent of total billed charges,"Rev 272 $1,564.72 in Billed Charges at 50% = $782.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP 24FR LONG HIGH FREQUENCY 12DEG,272,RC,27200002,CDM,,,,,,both,,,1564.7200,234.7100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,505.40,,,,,,,403.8500,1564.7200,other,"32.3% of $1,564.72 in Billed Charges for Rev 272 = $505.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE LOOP 24FR LONG HIGH FREQUENCY 12DEG,272,RC,27200002,CDM,,,,,,both,,,1564.7200,234.7100,UNITED HEALTHCARE,UHC HERITAGE SELECT,480.37,,,,,,,403.8500,1564.7200,other,"30.7% of $1,564.72 in Billed Charges for Rev 272 = $480.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE LOOP 24FR LONG HIGH FREQUENCY 12DEG,272,RC,27200002,CDM,,,,,,both,,,1564.7200,234.7100,UNITED HEALTHCARE,UNITED HEALTHCARE,505.40,,,,,,,403.8500,1564.7200,percent of total billed charges,"32.3% of $1,564.72 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE LOOP 24FR LONG HIGH FREQUENCY 12DEG,272,RC,27200002,CDM,,,,,,both,,,1564.7200,234.7100,WELLCARE,WELLCARE MEDICAID,1564.72,,,,,,,403.8500,1564.7200,percent of total billed charges,"100% of $1,564.72 in Billed Charges for Rev 272 = $1,564.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3930.6100,589.5900,AETNA,AETNA,1678.37,,,,,,,1014.4900,3930.6100,percent of total billed charges,"42.7% of $3,930.61 in Billed Charges for Rev 272 = $1,678.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3930.6100,589.5900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2751.43,,,,,,,1014.4900,3930.6100,percent of total billed charges,"Rev 272 $3,930.61 in Billed Charges at 70% = $2,751.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3930.6100,589.5900,CIGNA HEALTHCARE,CIGNA HMO,1639.06,,,,,,,1014.4900,3930.6100,percent of total billed charges,"41.7% of $3,930.61 in Billed Charges for Rev 272 = $1,639.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3930.6100,589.5900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1823.80,,,,,,,1014.4900,3930.6100,percent of total billed charges,"46.4% of $3,930.61 in Billed Charges for Rev 272 = $1,823.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3930.6100,589.5900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1639.06,,,,,,,1014.4900,3930.6100,percent of total billed charges,"41.7% of $3,930.61 in Billed Charges for Rev 272 = $1,639.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3930.6100,589.5900,CIGNA HEALTHCARE,CIGNA PPO,1639.06,,,,,,,1014.4900,3930.6100,percent of total billed charges,"41.7% of $3,930.61 in Billed Charges for Rev 272 = $1,639.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3930.6100,589.5900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3537.55,,,,,,,1014.4900,3930.6100,percent of total billed charges,"90% of $3,930.61 in Billed Charges for Rev 272 = $3,537.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3930.6100,589.5900,MEDCOST,MEDCOST VHN,1870.58,,,,,,,1014.4900,3930.6100,percent of total billed charges,"47.59% of $3,930.61 in Billed Charges for Rev 272 = $1,870.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3930.6100,589.5900,SENTARA HEALTH,SENTARA HEALTH,1014.49,,,,,,,1014.4900,3930.6100,percent of total billed charges,"25.81% of $3,930.61 in Billed Charges for Rev 272 = $1,014.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3930.6100,589.5900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3930.61,,,,,,,1014.4900,3930.6100,percent of total billed charges,"100% of $3,930.61 in Billed Charges for Rev 272 = $3,930.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3930.6100,589.5900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1965.31,,,,,,,1014.4900,3930.6100,percent of total billed charges,"Rev 272 $3,930.61 in Billed Charges at 50% = $1,965.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3930.6100,589.5900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1269.59,,,,,,,1014.4900,3930.6100,other,"32.3% of $3,930.61 in Billed Charges for Rev 272 = $1,269.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3930.6100,589.5900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1206.70,,,,,,,1014.4900,3930.6100,other,"30.7% of $3,930.61 in Billed Charges for Rev 272 = $1,206.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3930.6100,589.5900,UNITED HEALTHCARE,UNITED HEALTHCARE,1269.59,,,,,,,1014.4900,3930.6100,percent of total billed charges,"32.3% of $3,930.61 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPER NANO,272,RC,27200002,CDM,,,,,,both,,,3930.6100,589.5900,WELLCARE,WELLCARE MEDICAID,3930.61,,,,,,,1014.4900,3930.6100,percent of total billed charges,"100% of $3,930.61 in Billed Charges for Rev 272 = $3,930.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER GAS COOLED SHEATHED SINGLE USE -60,272,RC,27200002,CDM,,,,,,both,,,2250.5100,337.5800,AETNA,AETNA,960.97,,,,,,,580.8600,2250.5100,percent of total billed charges,"42.7% of $2,250.51 in Billed Charges for Rev 272 = $960.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER GAS COOLED SHEATHED SINGLE USE -60,272,RC,27200002,CDM,,,,,,both,,,2250.5100,337.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1575.36,,,,,,,580.8600,2250.5100,percent of total billed charges,"Rev 272 $2,250.51 in Billed Charges at 70% = $1,575.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER GAS COOLED SHEATHED SINGLE USE -60,272,RC,27200002,CDM,,,,,,both,,,2250.5100,337.5800,CIGNA HEALTHCARE,CIGNA HMO,938.46,,,,,,,580.8600,2250.5100,percent of total billed charges,"41.7% of $2,250.51 in Billed Charges for Rev 272 = $938.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER GAS COOLED SHEATHED SINGLE USE -60,272,RC,27200002,CDM,,,,,,both,,,2250.5100,337.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1044.24,,,,,,,580.8600,2250.5100,percent of total billed charges,"46.4% of $2,250.51 in Billed Charges for Rev 272 = $1,044.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER GAS COOLED SHEATHED SINGLE USE -60,272,RC,27200002,CDM,,,,,,both,,,2250.5100,337.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,938.46,,,,,,,580.8600,2250.5100,percent of total billed charges,"41.7% of $2,250.51 in Billed Charges for Rev 272 = $938.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER GAS COOLED SHEATHED SINGLE USE -60,272,RC,27200002,CDM,,,,,,both,,,2250.5100,337.5800,CIGNA HEALTHCARE,CIGNA PPO,938.46,,,,,,,580.8600,2250.5100,percent of total billed charges,"41.7% of $2,250.51 in Billed Charges for Rev 272 = $938.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER GAS COOLED SHEATHED SINGLE USE -60,272,RC,27200002,CDM,,,,,,both,,,2250.5100,337.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2025.46,,,,,,,580.8600,2250.5100,percent of total billed charges,"90% of $2,250.51 in Billed Charges for Rev 272 = $2,025.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER GAS COOLED SHEATHED SINGLE USE -60,272,RC,27200002,CDM,,,,,,both,,,2250.5100,337.5800,MEDCOST,MEDCOST VHN,1071.02,,,,,,,580.8600,2250.5100,percent of total billed charges,"47.59% of $2,250.51 in Billed Charges for Rev 272 = $1,071.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER GAS COOLED SHEATHED SINGLE USE -60,272,RC,27200002,CDM,,,,,,both,,,2250.5100,337.5800,SENTARA HEALTH,SENTARA HEALTH,580.86,,,,,,,580.8600,2250.5100,percent of total billed charges,"25.81% of $2,250.51 in Billed Charges for Rev 272 = $580.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER GAS COOLED SHEATHED SINGLE USE -60,272,RC,27200002,CDM,,,,,,both,,,2250.5100,337.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2250.51,,,,,,,580.8600,2250.5100,percent of total billed charges,"100% of $2,250.51 in Billed Charges for Rev 272 = $2,250.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER GAS COOLED SHEATHED SINGLE USE -60,272,RC,27200002,CDM,,,,,,both,,,2250.5100,337.5800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1125.26,,,,,,,580.8600,2250.5100,percent of total billed charges,"Rev 272 $2,250.51 in Billed Charges at 50% = $1,125.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER GAS COOLED SHEATHED SINGLE USE -60,272,RC,27200002,CDM,,,,,,both,,,2250.5100,337.5800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,726.91,,,,,,,580.8600,2250.5100,other,"32.3% of $2,250.51 in Billed Charges for Rev 272 = $726.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER LASER GAS COOLED SHEATHED SINGLE USE -60,272,RC,27200002,CDM,,,,,,both,,,2250.5100,337.5800,UNITED HEALTHCARE,UHC HERITAGE SELECT,690.91,,,,,,,580.8600,2250.5100,other,"30.7% of $2,250.51 in Billed Charges for Rev 272 = $690.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER LASER GAS COOLED SHEATHED SINGLE USE -60,272,RC,27200002,CDM,,,,,,both,,,2250.5100,337.5800,UNITED HEALTHCARE,UNITED HEALTHCARE,726.91,,,,,,,580.8600,2250.5100,percent of total billed charges,"32.3% of $2,250.51 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER GAS COOLED SHEATHED SINGLE USE -60,272,RC,27200002,CDM,,,,,,both,,,2250.5100,337.5800,WELLCARE,WELLCARE MEDICAID,2250.51,,,,,,,580.8600,2250.5100,percent of total billed charges,"100% of $2,250.51 in Billed Charges for Rev 272 = $2,250.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER QUANTA SYSTEM 200UM,272,RC,27200002,CDM,,,,,,both,,,2790.8400,418.6300,AETNA,AETNA,1191.69,,,,,,,720.3200,2790.8400,percent of total billed charges,"42.7% of $2,790.84 in Billed Charges for Rev 272 = $1,191.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER QUANTA SYSTEM 200UM,272,RC,27200002,CDM,,,,,,both,,,2790.8400,418.6300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1953.59,,,,,,,720.3200,2790.8400,percent of total billed charges,"Rev 272 $2,790.84 in Billed Charges at 70% = $1,953.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER QUANTA SYSTEM 200UM,272,RC,27200002,CDM,,,,,,both,,,2790.8400,418.6300,CIGNA HEALTHCARE,CIGNA HMO,1163.78,,,,,,,720.3200,2790.8400,percent of total billed charges,"41.7% of $2,790.84 in Billed Charges for Rev 272 = $1,163.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER QUANTA SYSTEM 200UM,272,RC,27200002,CDM,,,,,,both,,,2790.8400,418.6300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1294.95,,,,,,,720.3200,2790.8400,percent of total billed charges,"46.4% of $2,790.84 in Billed Charges for Rev 272 = $1,294.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER QUANTA SYSTEM 200UM,272,RC,27200002,CDM,,,,,,both,,,2790.8400,418.6300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1163.78,,,,,,,720.3200,2790.8400,percent of total billed charges,"41.7% of $2,790.84 in Billed Charges for Rev 272 = $1,163.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER QUANTA SYSTEM 200UM,272,RC,27200002,CDM,,,,,,both,,,2790.8400,418.6300,CIGNA HEALTHCARE,CIGNA PPO,1163.78,,,,,,,720.3200,2790.8400,percent of total billed charges,"41.7% of $2,790.84 in Billed Charges for Rev 272 = $1,163.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER QUANTA SYSTEM 200UM,272,RC,27200002,CDM,,,,,,both,,,2790.8400,418.6300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2511.76,,,,,,,720.3200,2790.8400,percent of total billed charges,"90% of $2,790.84 in Billed Charges for Rev 272 = $2,511.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER QUANTA SYSTEM 200UM,272,RC,27200002,CDM,,,,,,both,,,2790.8400,418.6300,MEDCOST,MEDCOST VHN,1328.16,,,,,,,720.3200,2790.8400,percent of total billed charges,"47.59% of $2,790.84 in Billed Charges for Rev 272 = $1,328.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER QUANTA SYSTEM 200UM,272,RC,27200002,CDM,,,,,,both,,,2790.8400,418.6300,SENTARA HEALTH,SENTARA HEALTH,720.32,,,,,,,720.3200,2790.8400,percent of total billed charges,"25.81% of $2,790.84 in Billed Charges for Rev 272 = $720.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER QUANTA SYSTEM 200UM,272,RC,27200002,CDM,,,,,,both,,,2790.8400,418.6300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2790.84,,,,,,,720.3200,2790.8400,percent of total billed charges,"100% of $2,790.84 in Billed Charges for Rev 272 = $2,790.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER QUANTA SYSTEM 200UM,272,RC,27200002,CDM,,,,,,both,,,2790.8400,418.6300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1395.42,,,,,,,720.3200,2790.8400,percent of total billed charges,"Rev 272 $2,790.84 in Billed Charges at 50% = $1,395.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER QUANTA SYSTEM 200UM,272,RC,27200002,CDM,,,,,,both,,,2790.8400,418.6300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,901.44,,,,,,,720.3200,2790.8400,other,"32.3% of $2,790.84 in Billed Charges for Rev 272 = $901.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER LASER QUANTA SYSTEM 200UM,272,RC,27200002,CDM,,,,,,both,,,2790.8400,418.6300,UNITED HEALTHCARE,UHC HERITAGE SELECT,856.79,,,,,,,720.3200,2790.8400,other,"30.7% of $2,790.84 in Billed Charges for Rev 272 = $856.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER LASER QUANTA SYSTEM 200UM,272,RC,27200002,CDM,,,,,,both,,,2790.8400,418.6300,UNITED HEALTHCARE,UNITED HEALTHCARE,901.44,,,,,,,720.3200,2790.8400,percent of total billed charges,"32.3% of $2,790.84 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER QUANTA SYSTEM 200UM,272,RC,27200002,CDM,,,,,,both,,,2790.8400,418.6300,WELLCARE,WELLCARE MEDICAID,2790.84,,,,,,,720.3200,2790.8400,percent of total billed charges,"100% of $2,790.84 in Billed Charges for Rev 272 = $2,790.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRASPING FORCEPS BRONCH,272,RC,27200002,CDM,,,,,,both,,,560.8200,84.1200,AETNA,AETNA,239.47,,,,,,,144.7500,560.8200,percent of total billed charges,42.7% of $560.82 in Billed Charges for Rev 272 = $239.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPING FORCEPS BRONCH,272,RC,27200002,CDM,,,,,,both,,,560.8200,84.1200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,392.57,,,,,,,144.7500,560.8200,percent of total billed charges,Rev 272 $560.82 in Billed Charges at 70% = $392.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPING FORCEPS BRONCH,272,RC,27200002,CDM,,,,,,both,,,560.8200,84.1200,CIGNA HEALTHCARE,CIGNA HMO,233.86,,,,,,,144.7500,560.8200,percent of total billed charges,41.7% of $560.82 in Billed Charges for Rev 272 = $233.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPING FORCEPS BRONCH,272,RC,27200002,CDM,,,,,,both,,,560.8200,84.1200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,260.22,,,,,,,144.7500,560.8200,percent of total billed charges,46.4% of $560.82 in Billed Charges for Rev 272 = $260.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPING FORCEPS BRONCH,272,RC,27200002,CDM,,,,,,both,,,560.8200,84.1200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,233.86,,,,,,,144.7500,560.8200,percent of total billed charges,41.7% of $560.82 in Billed Charges for Rev 272 = $233.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPING FORCEPS BRONCH,272,RC,27200002,CDM,,,,,,both,,,560.8200,84.1200,CIGNA HEALTHCARE,CIGNA PPO,233.86,,,,,,,144.7500,560.8200,percent of total billed charges,41.7% of $560.82 in Billed Charges for Rev 272 = $233.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPING FORCEPS BRONCH,272,RC,27200002,CDM,,,,,,both,,,560.8200,84.1200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,504.74,,,,,,,144.7500,560.8200,percent of total billed charges,90% of $560.82 in Billed Charges for Rev 272 = $504.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPING FORCEPS BRONCH,272,RC,27200002,CDM,,,,,,both,,,560.8200,84.1200,MEDCOST,MEDCOST VHN,266.89,,,,,,,144.7500,560.8200,percent of total billed charges,47.59% of $560.82 in Billed Charges for Rev 272 = $266.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPING FORCEPS BRONCH,272,RC,27200002,CDM,,,,,,both,,,560.8200,84.1200,SENTARA HEALTH,SENTARA HEALTH,144.75,,,,,,,144.7500,560.8200,percent of total billed charges,25.81% of $560.82 in Billed Charges for Rev 272 = $144.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPING FORCEPS BRONCH,272,RC,27200002,CDM,,,,,,both,,,560.8200,84.1200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",560.82,,,,,,,144.7500,560.8200,percent of total billed charges,100% of $560.82 in Billed Charges for Rev 272 = $560.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPING FORCEPS BRONCH,272,RC,27200002,CDM,,,,,,both,,,560.8200,84.1200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,280.41,,,,,,,144.7500,560.8200,percent of total billed charges,Rev 272 $560.82 in Billed Charges at 50% = $280.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPING FORCEPS BRONCH,272,RC,27200002,CDM,,,,,,both,,,560.8200,84.1200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,181.14,,,,,,,144.7500,560.8200,other,32.3% of $560.82 in Billed Charges for Rev 272 = $181.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GRASPING FORCEPS BRONCH,272,RC,27200002,CDM,,,,,,both,,,560.8200,84.1200,UNITED HEALTHCARE,UHC HERITAGE SELECT,172.17,,,,,,,144.7500,560.8200,other,30.7% of $560.82 in Billed Charges for Rev 272 = $172.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GRASPING FORCEPS BRONCH,272,RC,27200002,CDM,,,,,,both,,,560.8200,84.1200,UNITED HEALTHCARE,UNITED HEALTHCARE,181.14,,,,,,,144.7500,560.8200,percent of total billed charges,32.3% of $560.82 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRASPING FORCEPS BRONCH,272,RC,27200002,CDM,,,,,,both,,,560.8200,84.1200,WELLCARE,WELLCARE MEDICAID,560.82,,,,,,,144.7500,560.8200,percent of total billed charges,100% of $560.82 in Billed Charges for Rev 272 = $560.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GREENLIGHT AMS XPS,272,RC,27200002,CDM,,,,,,both,,,5903.6900,885.5500,AETNA,AETNA,2520.88,,,,,,,1523.7400,5903.6900,percent of total billed charges,"42.7% of $5,903.69 in Billed Charges for Rev 272 = $2,520.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GREENLIGHT AMS XPS,272,RC,27200002,CDM,,,,,,both,,,5903.6900,885.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4132.58,,,,,,,1523.7400,5903.6900,percent of total billed charges,"Rev 272 $5,903.69 in Billed Charges at 70% = $4,132.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GREENLIGHT AMS XPS,272,RC,27200002,CDM,,,,,,both,,,5903.6900,885.5500,CIGNA HEALTHCARE,CIGNA HMO,2461.84,,,,,,,1523.7400,5903.6900,percent of total billed charges,"41.7% of $5,903.69 in Billed Charges for Rev 272 = $2,461.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GREENLIGHT AMS XPS,272,RC,27200002,CDM,,,,,,both,,,5903.6900,885.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2739.31,,,,,,,1523.7400,5903.6900,percent of total billed charges,"46.4% of $5,903.69 in Billed Charges for Rev 272 = $2,739.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GREENLIGHT AMS XPS,272,RC,27200002,CDM,,,,,,both,,,5903.6900,885.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2461.84,,,,,,,1523.7400,5903.6900,percent of total billed charges,"41.7% of $5,903.69 in Billed Charges for Rev 272 = $2,461.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GREENLIGHT AMS XPS,272,RC,27200002,CDM,,,,,,both,,,5903.6900,885.5500,CIGNA HEALTHCARE,CIGNA PPO,2461.84,,,,,,,1523.7400,5903.6900,percent of total billed charges,"41.7% of $5,903.69 in Billed Charges for Rev 272 = $2,461.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GREENLIGHT AMS XPS,272,RC,27200002,CDM,,,,,,both,,,5903.6900,885.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5313.32,,,,,,,1523.7400,5903.6900,percent of total billed charges,"90% of $5,903.69 in Billed Charges for Rev 272 = $5,313.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GREENLIGHT AMS XPS,272,RC,27200002,CDM,,,,,,both,,,5903.6900,885.5500,MEDCOST,MEDCOST VHN,2809.57,,,,,,,1523.7400,5903.6900,percent of total billed charges,"47.59% of $5,903.69 in Billed Charges for Rev 272 = $2,809.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GREENLIGHT AMS XPS,272,RC,27200002,CDM,,,,,,both,,,5903.6900,885.5500,SENTARA HEALTH,SENTARA HEALTH,1523.74,,,,,,,1523.7400,5903.6900,percent of total billed charges,"25.81% of $5,903.69 in Billed Charges for Rev 272 = $1,523.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GREENLIGHT AMS XPS,272,RC,27200002,CDM,,,,,,both,,,5903.6900,885.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5903.69,,,,,,,1523.7400,5903.6900,percent of total billed charges,"100% of $5,903.69 in Billed Charges for Rev 272 = $5,903.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GREENLIGHT AMS XPS,272,RC,27200002,CDM,,,,,,both,,,5903.6900,885.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2951.85,,,,,,,1523.7400,5903.6900,percent of total billed charges,"Rev 272 $5,903.69 in Billed Charges at 50% = $2,951.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GREENLIGHT AMS XPS,272,RC,27200002,CDM,,,,,,both,,,5903.6900,885.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1906.89,,,,,,,1523.7400,5903.6900,other,"32.3% of $5,903.69 in Billed Charges for Rev 272 = $1,906.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GREENLIGHT AMS XPS,272,RC,27200002,CDM,,,,,,both,,,5903.6900,885.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1812.43,,,,,,,1523.7400,5903.6900,other,"30.7% of $5,903.69 in Billed Charges for Rev 272 = $1,812.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GREENLIGHT AMS XPS,272,RC,27200002,CDM,,,,,,both,,,5903.6900,885.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,1906.89,,,,,,,1523.7400,5903.6900,percent of total billed charges,"32.3% of $5,903.69 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GREENLIGHT AMS XPS,272,RC,27200002,CDM,,,,,,both,,,5903.6900,885.5500,WELLCARE,WELLCARE MEDICAID,5903.69,,,,,,,1523.7400,5903.6900,percent of total billed charges,"100% of $5,903.69 in Billed Charges for Rev 272 = $5,903.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR RD RETRACTABLE 5.0MM  HIP,272,RC,,,,,,,,both,,,1752.7000,262.9100,AETNA,AETNA,748.40,,,,,,,452.3700,1752.7000,percent of total billed charges,"42.7% of $1,752.70 in Billed Charges for Rev 272 = $748.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR RD RETRACTABLE 5.0MM  HIP,272,RC,,,,,,,,both,,,1752.7000,262.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1226.89,,,,,,,452.3700,1752.7000,percent of total billed charges,"Rev 272 $1,752.70 in Billed Charges at 70% = $1,226.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR RD RETRACTABLE 5.0MM  HIP,272,RC,,,,,,,,both,,,1752.7000,262.9100,CIGNA HEALTHCARE,CIGNA HMO,730.88,,,,,,,452.3700,1752.7000,percent of total billed charges,"41.7% of $1,752.70 in Billed Charges for Rev 272 = $730.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR RD RETRACTABLE 5.0MM  HIP,272,RC,,,,,,,,both,,,1752.7000,262.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,813.25,,,,,,,452.3700,1752.7000,percent of total billed charges,"46.4% of $1,752.70 in Billed Charges for Rev 272 = $813.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR RD RETRACTABLE 5.0MM  HIP,272,RC,,,,,,,,both,,,1752.7000,262.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,730.88,,,,,,,452.3700,1752.7000,percent of total billed charges,"41.7% of $1,752.70 in Billed Charges for Rev 272 = $730.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR RD RETRACTABLE 5.0MM  HIP,272,RC,,,,,,,,both,,,1752.7000,262.9100,CIGNA HEALTHCARE,CIGNA PPO,730.88,,,,,,,452.3700,1752.7000,percent of total billed charges,"41.7% of $1,752.70 in Billed Charges for Rev 272 = $730.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR RD RETRACTABLE 5.0MM  HIP,272,RC,,,,,,,,both,,,1752.7000,262.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1577.43,,,,,,,452.3700,1752.7000,percent of total billed charges,"90% of $1,752.70 in Billed Charges for Rev 272 = $1,577.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR RD RETRACTABLE 5.0MM  HIP,272,RC,,,,,,,,both,,,1752.7000,262.9100,MEDCOST,MEDCOST VHN,834.11,,,,,,,452.3700,1752.7000,percent of total billed charges,"47.59% of $1,752.70 in Billed Charges for Rev 272 = $834.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR RD RETRACTABLE 5.0MM  HIP,272,RC,,,,,,,,both,,,1752.7000,262.9100,SENTARA HEALTH,SENTARA HEALTH,452.37,,,,,,,452.3700,1752.7000,percent of total billed charges,"25.81% of $1,752.70 in Billed Charges for Rev 272 = $452.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR RD RETRACTABLE 5.0MM  HIP,272,RC,,,,,,,,both,,,1752.7000,262.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1752.70,,,,,,,452.3700,1752.7000,percent of total billed charges,"100% of $1,752.70 in Billed Charges for Rev 272 = $1,752.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR RD RETRACTABLE 5.0MM  HIP,272,RC,,,,,,,,both,,,1752.7000,262.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,876.35,,,,,,,452.3700,1752.7000,percent of total billed charges,"Rev 272 $1,752.70 in Billed Charges at 50% = $876.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR RD RETRACTABLE 5.0MM  HIP,272,RC,,,,,,,,both,,,1752.7000,262.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,566.12,,,,,,,452.3700,1752.7000,other,"32.3% of $1,752.70 in Billed Charges for Rev 272 = $566.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR RD RETRACTABLE 5.0MM  HIP,272,RC,,,,,,,,both,,,1752.7000,262.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,538.08,,,,,,,452.3700,1752.7000,other,"30.7% of $1,752.70 in Billed Charges for Rev 272 = $538.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR RD RETRACTABLE 5.0MM  HIP,272,RC,,,,,,,,both,,,1752.7000,262.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,566.12,,,,,,,452.3700,1752.7000,percent of total billed charges,"32.3% of $1,752.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR RD RETRACTABLE 5.0MM  HIP,272,RC,,,,,,,,both,,,1752.7000,262.9100,WELLCARE,WELLCARE MEDICAID,1752.70,,,,,,,452.3700,1752.7000,percent of total billed charges,"100% of $1,752.70 in Billed Charges for Rev 272 = $1,752.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5784.4300,867.6600,AETNA,AETNA,2469.95,,,,,,,1492.9600,5784.4300,percent of total billed charges,"42.7% of $5,784.43 in Billed Charges for Rev 272 = $2,469.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5784.4300,867.6600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4049.10,,,,,,,1492.9600,5784.4300,percent of total billed charges,"Rev 272 $5,784.43 in Billed Charges at 70% = $4,049.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5784.4300,867.6600,CIGNA HEALTHCARE,CIGNA HMO,2412.11,,,,,,,1492.9600,5784.4300,percent of total billed charges,"41.7% of $5,784.43 in Billed Charges for Rev 272 = $2,412.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5784.4300,867.6600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2683.98,,,,,,,1492.9600,5784.4300,percent of total billed charges,"46.4% of $5,784.43 in Billed Charges for Rev 272 = $2,683.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5784.4300,867.6600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2412.11,,,,,,,1492.9600,5784.4300,percent of total billed charges,"41.7% of $5,784.43 in Billed Charges for Rev 272 = $2,412.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5784.4300,867.6600,CIGNA HEALTHCARE,CIGNA PPO,2412.11,,,,,,,1492.9600,5784.4300,percent of total billed charges,"41.7% of $5,784.43 in Billed Charges for Rev 272 = $2,412.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5784.4300,867.6600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5205.99,,,,,,,1492.9600,5784.4300,percent of total billed charges,"90% of $5,784.43 in Billed Charges for Rev 272 = $5,205.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5784.4300,867.6600,MEDCOST,MEDCOST VHN,2752.81,,,,,,,1492.9600,5784.4300,percent of total billed charges,"47.59% of $5,784.43 in Billed Charges for Rev 272 = $2,752.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5784.4300,867.6600,SENTARA HEALTH,SENTARA HEALTH,1492.96,,,,,,,1492.9600,5784.4300,percent of total billed charges,"25.81% of $5,784.43 in Billed Charges for Rev 272 = $1,492.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5784.4300,867.6600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5784.43,,,,,,,1492.9600,5784.4300,percent of total billed charges,"100% of $5,784.43 in Billed Charges for Rev 272 = $5,784.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5784.4300,867.6600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2892.22,,,,,,,1492.9600,5784.4300,percent of total billed charges,"Rev 272 $5,784.43 in Billed Charges at 50% = $2,892.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5784.4300,867.6600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1868.37,,,,,,,1492.9600,5784.4300,other,"32.3% of $5,784.43 in Billed Charges for Rev 272 = $1,868.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5784.4300,867.6600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1775.82,,,,,,,1492.9600,5784.4300,other,"30.7% of $5,784.43 in Billed Charges for Rev 272 = $1,775.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5784.4300,867.6600,UNITED HEALTHCARE,UNITED HEALTHCARE,1868.37,,,,,,,1492.9600,5784.4300,percent of total billed charges,"32.3% of $5,784.43 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5784.4300,867.6600,WELLCARE,WELLCARE MEDICAID,5784.43,,,,,,,1492.9600,5784.4300,percent of total billed charges,"100% of $5,784.43 in Billed Charges for Rev 272 = $5,784.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,1026.7300,154.0100,AETNA,AETNA,438.41,,,,,,,265.0000,1026.7300,percent of total billed charges,"42.7% of $1,026.73 in Billed Charges for Rev 272 = $438.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,1026.7300,154.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,718.71,,,,,,,265.0000,1026.7300,percent of total billed charges,"Rev 272 $1,026.73 in Billed Charges at 70% = $718.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,1026.7300,154.0100,CIGNA HEALTHCARE,CIGNA HMO,428.15,,,,,,,265.0000,1026.7300,percent of total billed charges,"41.7% of $1,026.73 in Billed Charges for Rev 272 = $428.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,1026.7300,154.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,476.40,,,,,,,265.0000,1026.7300,percent of total billed charges,"46.4% of $1,026.73 in Billed Charges for Rev 272 = $476.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,1026.7300,154.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,428.15,,,,,,,265.0000,1026.7300,percent of total billed charges,"41.7% of $1,026.73 in Billed Charges for Rev 272 = $428.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,1026.7300,154.0100,CIGNA HEALTHCARE,CIGNA PPO,428.15,,,,,,,265.0000,1026.7300,percent of total billed charges,"41.7% of $1,026.73 in Billed Charges for Rev 272 = $428.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,1026.7300,154.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,924.06,,,,,,,265.0000,1026.7300,percent of total billed charges,"90% of $1,026.73 in Billed Charges for Rev 272 = $924.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,1026.7300,154.0100,MEDCOST,MEDCOST VHN,488.62,,,,,,,265.0000,1026.7300,percent of total billed charges,"47.59% of $1,026.73 in Billed Charges for Rev 272 = $488.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,1026.7300,154.0100,SENTARA HEALTH,SENTARA HEALTH,265.00,,,,,,,265.0000,1026.7300,percent of total billed charges,"25.81% of $1,026.73 in Billed Charges for Rev 272 = $265.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,1026.7300,154.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1026.73,,,,,,,265.0000,1026.7300,percent of total billed charges,"100% of $1,026.73 in Billed Charges for Rev 272 = $1,026.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,1026.7300,154.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,513.37,,,,,,,265.0000,1026.7300,percent of total billed charges,"Rev 272 $1,026.73 in Billed Charges at 50% = $513.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,1026.7300,154.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,331.63,,,,,,,265.0000,1026.7300,other,"32.3% of $1,026.73 in Billed Charges for Rev 272 = $331.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,1026.7300,154.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,315.21,,,,,,,265.0000,1026.7300,other,"30.7% of $1,026.73 in Billed Charges for Rev 272 = $315.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,1026.7300,154.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,331.63,,,,,,,265.0000,1026.7300,percent of total billed charges,"32.3% of $1,026.73 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUND 6.0MM,272,RC,27200002,CDM,,,,,,both,,,1026.7300,154.0100,WELLCARE,WELLCARE MEDICAID,1026.73,,,,,,,265.0000,1026.7300,percent of total billed charges,"100% of $1,026.73 in Billed Charges for Rev 272 = $1,026.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUTER,272,RC,,,,,,,,both,,,1575.3500,236.3000,AETNA,AETNA,672.67,,,,,,,406.6000,1575.3500,percent of total billed charges,"42.7% of $1,575.35 in Billed Charges for Rev 272 = $672.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUTER,272,RC,,,,,,,,both,,,1575.3500,236.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1102.75,,,,,,,406.6000,1575.3500,percent of total billed charges,"Rev 272 $1,575.35 in Billed Charges at 70% = $1,102.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUTER,272,RC,,,,,,,,both,,,1575.3500,236.3000,CIGNA HEALTHCARE,CIGNA HMO,656.92,,,,,,,406.6000,1575.3500,percent of total billed charges,"41.7% of $1,575.35 in Billed Charges for Rev 272 = $656.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUTER,272,RC,,,,,,,,both,,,1575.3500,236.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,730.96,,,,,,,406.6000,1575.3500,percent of total billed charges,"46.4% of $1,575.35 in Billed Charges for Rev 272 = $730.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUTER,272,RC,,,,,,,,both,,,1575.3500,236.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,656.92,,,,,,,406.6000,1575.3500,percent of total billed charges,"41.7% of $1,575.35 in Billed Charges for Rev 272 = $656.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUTER,272,RC,,,,,,,,both,,,1575.3500,236.3000,CIGNA HEALTHCARE,CIGNA PPO,656.92,,,,,,,406.6000,1575.3500,percent of total billed charges,"41.7% of $1,575.35 in Billed Charges for Rev 272 = $656.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUTER,272,RC,,,,,,,,both,,,1575.3500,236.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1417.82,,,,,,,406.6000,1575.3500,percent of total billed charges,"90% of $1,575.35 in Billed Charges for Rev 272 = $1,417.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUTER,272,RC,,,,,,,,both,,,1575.3500,236.3000,MEDCOST,MEDCOST VHN,749.71,,,,,,,406.6000,1575.3500,percent of total billed charges,"47.59% of $1,575.35 in Billed Charges for Rev 272 = $749.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUTER,272,RC,,,,,,,,both,,,1575.3500,236.3000,SENTARA HEALTH,SENTARA HEALTH,406.60,,,,,,,406.6000,1575.3500,percent of total billed charges,"25.81% of $1,575.35 in Billed Charges for Rev 272 = $406.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUTER,272,RC,,,,,,,,both,,,1575.3500,236.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1575.35,,,,,,,406.6000,1575.3500,percent of total billed charges,"100% of $1,575.35 in Billed Charges for Rev 272 = $1,575.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUTER,272,RC,,,,,,,,both,,,1575.3500,236.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,787.68,,,,,,,406.6000,1575.3500,percent of total billed charges,"Rev 272 $1,575.35 in Billed Charges at 50% = $787.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUTER,272,RC,,,,,,,,both,,,1575.3500,236.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,508.84,,,,,,,406.6000,1575.3500,other,"32.3% of $1,575.35 in Billed Charges for Rev 272 = $508.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR ROUTER,272,RC,,,,,,,,both,,,1575.3500,236.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,483.63,,,,,,,406.6000,1575.3500,other,"30.7% of $1,575.35 in Billed Charges for Rev 272 = $483.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR ROUTER,272,RC,,,,,,,,both,,,1575.3500,236.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,508.84,,,,,,,406.6000,1575.3500,percent of total billed charges,"32.3% of $1,575.35 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR ROUTER,272,RC,,,,,,,,both,,,1575.3500,236.3000,WELLCARE,WELLCARE MEDICAID,1575.35,,,,,,,406.6000,1575.3500,percent of total billed charges,"100% of $1,575.35 in Billed Charges for Rev 272 = $1,575.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR SHAVER 3.2MM DIA 12.5CML,272,RC,,,,,,,,both,,,3570.3900,535.5600,AETNA,AETNA,1524.56,,,,,,,921.5200,3570.3900,percent of total billed charges,"42.7% of $3,570.39 in Billed Charges for Rev 272 = $1,524.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR SHAVER 3.2MM DIA 12.5CML,272,RC,,,,,,,,both,,,3570.3900,535.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2499.27,,,,,,,921.5200,3570.3900,percent of total billed charges,"Rev 272 $3,570.39 in Billed Charges at 70% = $2,499.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR SHAVER 3.2MM DIA 12.5CML,272,RC,,,,,,,,both,,,3570.3900,535.5600,CIGNA HEALTHCARE,CIGNA HMO,1488.85,,,,,,,921.5200,3570.3900,percent of total billed charges,"41.7% of $3,570.39 in Billed Charges for Rev 272 = $1,488.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR SHAVER 3.2MM DIA 12.5CML,272,RC,,,,,,,,both,,,3570.3900,535.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1656.66,,,,,,,921.5200,3570.3900,percent of total billed charges,"46.4% of $3,570.39 in Billed Charges for Rev 272 = $1,656.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR SHAVER 3.2MM DIA 12.5CML,272,RC,,,,,,,,both,,,3570.3900,535.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1488.85,,,,,,,921.5200,3570.3900,percent of total billed charges,"41.7% of $3,570.39 in Billed Charges for Rev 272 = $1,488.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR SHAVER 3.2MM DIA 12.5CML,272,RC,,,,,,,,both,,,3570.3900,535.5600,CIGNA HEALTHCARE,CIGNA PPO,1488.85,,,,,,,921.5200,3570.3900,percent of total billed charges,"41.7% of $3,570.39 in Billed Charges for Rev 272 = $1,488.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR SHAVER 3.2MM DIA 12.5CML,272,RC,,,,,,,,both,,,3570.3900,535.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3213.35,,,,,,,921.5200,3570.3900,percent of total billed charges,"90% of $3,570.39 in Billed Charges for Rev 272 = $3,213.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR SHAVER 3.2MM DIA 12.5CML,272,RC,,,,,,,,both,,,3570.3900,535.5600,MEDCOST,MEDCOST VHN,1699.15,,,,,,,921.5200,3570.3900,percent of total billed charges,"47.59% of $3,570.39 in Billed Charges for Rev 272 = $1,699.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR SHAVER 3.2MM DIA 12.5CML,272,RC,,,,,,,,both,,,3570.3900,535.5600,SENTARA HEALTH,SENTARA HEALTH,921.52,,,,,,,921.5200,3570.3900,percent of total billed charges,"25.81% of $3,570.39 in Billed Charges for Rev 272 = $921.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR SHAVER 3.2MM DIA 12.5CML,272,RC,,,,,,,,both,,,3570.3900,535.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3570.39,,,,,,,921.5200,3570.3900,percent of total billed charges,"100% of $3,570.39 in Billed Charges for Rev 272 = $3,570.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR SHAVER 3.2MM DIA 12.5CML,272,RC,,,,,,,,both,,,3570.3900,535.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1785.20,,,,,,,921.5200,3570.3900,percent of total billed charges,"Rev 272 $3,570.39 in Billed Charges at 50% = $1,785.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR SHAVER 3.2MM DIA 12.5CML,272,RC,,,,,,,,both,,,3570.3900,535.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1153.24,,,,,,,921.5200,3570.3900,other,"32.3% of $3,570.39 in Billed Charges for Rev 272 = $1,153.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR SHAVER 3.2MM DIA 12.5CML,272,RC,,,,,,,,both,,,3570.3900,535.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1096.11,,,,,,,921.5200,3570.3900,other,"30.7% of $3,570.39 in Billed Charges for Rev 272 = $1,096.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
BURR SHAVER 3.2MM DIA 12.5CML,272,RC,,,,,,,,both,,,3570.3900,535.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,1153.24,,,,,,,921.5200,3570.3900,percent of total billed charges,"32.3% of $3,570.39 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BURR SHAVER 3.2MM DIA 12.5CML,272,RC,,,,,,,,both,,,3570.3900,535.5600,WELLCARE,WELLCARE MEDICAID,3570.39,,,,,,,921.5200,3570.3900,percent of total billed charges,"100% of $3,570.39 in Billed Charges for Rev 272 = $3,570.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 1000UM,272,RC,27200002,CDM,,,,,,both,,,4830.2900,724.5400,AETNA,AETNA,2062.53,,,,,,,1246.7000,4830.2900,percent of total billed charges,"42.7% of $4,830.29 in Billed Charges for Rev 272 = $2,062.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 1000UM,272,RC,27200002,CDM,,,,,,both,,,4830.2900,724.5400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3381.20,,,,,,,1246.7000,4830.2900,percent of total billed charges,"Rev 272 $4,830.29 in Billed Charges at 70% = $3,381.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 1000UM,272,RC,27200002,CDM,,,,,,both,,,4830.2900,724.5400,CIGNA HEALTHCARE,CIGNA HMO,2014.23,,,,,,,1246.7000,4830.2900,percent of total billed charges,"41.7% of $4,830.29 in Billed Charges for Rev 272 = $2,014.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 1000UM,272,RC,27200002,CDM,,,,,,both,,,4830.2900,724.5400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2241.25,,,,,,,1246.7000,4830.2900,percent of total billed charges,"46.4% of $4,830.29 in Billed Charges for Rev 272 = $2,241.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 1000UM,272,RC,27200002,CDM,,,,,,both,,,4830.2900,724.5400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2014.23,,,,,,,1246.7000,4830.2900,percent of total billed charges,"41.7% of $4,830.29 in Billed Charges for Rev 272 = $2,014.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 1000UM,272,RC,27200002,CDM,,,,,,both,,,4830.2900,724.5400,CIGNA HEALTHCARE,CIGNA PPO,2014.23,,,,,,,1246.7000,4830.2900,percent of total billed charges,"41.7% of $4,830.29 in Billed Charges for Rev 272 = $2,014.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 1000UM,272,RC,27200002,CDM,,,,,,both,,,4830.2900,724.5400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4347.26,,,,,,,1246.7000,4830.2900,percent of total billed charges,"90% of $4,830.29 in Billed Charges for Rev 272 = $4,347.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 1000UM,272,RC,27200002,CDM,,,,,,both,,,4830.2900,724.5400,MEDCOST,MEDCOST VHN,2298.74,,,,,,,1246.7000,4830.2900,percent of total billed charges,"47.59% of $4,830.29 in Billed Charges for Rev 272 = $2,298.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 1000UM,272,RC,27200002,CDM,,,,,,both,,,4830.2900,724.5400,SENTARA HEALTH,SENTARA HEALTH,1246.70,,,,,,,1246.7000,4830.2900,percent of total billed charges,"25.81% of $4,830.29 in Billed Charges for Rev 272 = $1,246.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 1000UM,272,RC,27200002,CDM,,,,,,both,,,4830.2900,724.5400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4830.29,,,,,,,1246.7000,4830.2900,percent of total billed charges,"100% of $4,830.29 in Billed Charges for Rev 272 = $4,830.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 1000UM,272,RC,27200002,CDM,,,,,,both,,,4830.2900,724.5400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2415.15,,,,,,,1246.7000,4830.2900,percent of total billed charges,"Rev 272 $4,830.29 in Billed Charges at 50% = $2,415.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 1000UM,272,RC,27200002,CDM,,,,,,both,,,4830.2900,724.5400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1560.18,,,,,,,1246.7000,4830.2900,other,"32.3% of $4,830.29 in Billed Charges for Rev 272 = $1,560.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER OPTICAL 1000UM,272,RC,27200002,CDM,,,,,,both,,,4830.2900,724.5400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1482.90,,,,,,,1246.7000,4830.2900,other,"30.7% of $4,830.29 in Billed Charges for Rev 272 = $1,482.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER OPTICAL 1000UM,272,RC,27200002,CDM,,,,,,both,,,4830.2900,724.5400,UNITED HEALTHCARE,UNITED HEALTHCARE,1560.18,,,,,,,1246.7000,4830.2900,percent of total billed charges,"32.3% of $4,830.29 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER OPTICAL 1000UM,272,RC,27200002,CDM,,,,,,both,,,4830.2900,724.5400,WELLCARE,WELLCARE MEDICAID,4830.29,,,,,,,1246.7000,4830.2900,percent of total billed charges,"100% of $4,830.29 in Billed Charges for Rev 272 = $4,830.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE SLIM 3.8,272,RC,27200002,CDM,,,,,,both,,,7493.0500,1123.9600,AETNA,AETNA,3199.53,,,,,,,1933.9600,7493.0500,percent of total billed charges,"42.7% of $7,493.05 in Billed Charges for Rev 272 = $3,199.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE SLIM 3.8,272,RC,27200002,CDM,,,,,,both,,,7493.0500,1123.9600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5245.14,,,,,,,1933.9600,7493.0500,percent of total billed charges,"Rev 272 $7,493.05 in Billed Charges at 70% = $5,245.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE SLIM 3.8,272,RC,27200002,CDM,,,,,,both,,,7493.0500,1123.9600,CIGNA HEALTHCARE,CIGNA HMO,3124.60,,,,,,,1933.9600,7493.0500,percent of total billed charges,"41.7% of $7,493.05 in Billed Charges for Rev 272 = $3,124.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE SLIM 3.8,272,RC,27200002,CDM,,,,,,both,,,7493.0500,1123.9600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3476.78,,,,,,,1933.9600,7493.0500,percent of total billed charges,"46.4% of $7,493.05 in Billed Charges for Rev 272 = $3,476.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE SLIM 3.8,272,RC,27200002,CDM,,,,,,both,,,7493.0500,1123.9600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3124.60,,,,,,,1933.9600,7493.0500,percent of total billed charges,"41.7% of $7,493.05 in Billed Charges for Rev 272 = $3,124.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE SLIM 3.8,272,RC,27200002,CDM,,,,,,both,,,7493.0500,1123.9600,CIGNA HEALTHCARE,CIGNA PPO,3124.60,,,,,,,1933.9600,7493.0500,percent of total billed charges,"41.7% of $7,493.05 in Billed Charges for Rev 272 = $3,124.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE SLIM 3.8,272,RC,27200002,CDM,,,,,,both,,,7493.0500,1123.9600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6743.75,,,,,,,1933.9600,7493.0500,percent of total billed charges,"90% of $7,493.05 in Billed Charges for Rev 272 = $6,743.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE SLIM 3.8,272,RC,27200002,CDM,,,,,,both,,,7493.0500,1123.9600,MEDCOST,MEDCOST VHN,3565.94,,,,,,,1933.9600,7493.0500,percent of total billed charges,"47.59% of $7,493.05 in Billed Charges for Rev 272 = $3,565.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE SLIM 3.8,272,RC,27200002,CDM,,,,,,both,,,7493.0500,1123.9600,SENTARA HEALTH,SENTARA HEALTH,1933.96,,,,,,,1933.9600,7493.0500,percent of total billed charges,"25.81% of $7,493.05 in Billed Charges for Rev 272 = $1,933.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE SLIM 3.8,272,RC,27200002,CDM,,,,,,both,,,7493.0500,1123.9600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7493.05,,,,,,,1933.9600,7493.0500,percent of total billed charges,"100% of $7,493.05 in Billed Charges for Rev 272 = $7,493.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE SLIM 3.8,272,RC,27200002,CDM,,,,,,both,,,7493.0500,1123.9600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3746.53,,,,,,,1933.9600,7493.0500,percent of total billed charges,"Rev 272 $7,493.05 in Billed Charges at 50% = $3,746.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE SLIM 3.8,272,RC,27200002,CDM,,,,,,both,,,7493.0500,1123.9600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2420.26,,,,,,,1933.9600,7493.0500,other,"32.3% of $7,493.05 in Billed Charges for Rev 272 = $2,420.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GLIDESCOPE SLIM 3.8,272,RC,27200002,CDM,,,,,,both,,,7493.0500,1123.9600,UNITED HEALTHCARE,UHC HERITAGE SELECT,2300.37,,,,,,,1933.9600,7493.0500,other,"30.7% of $7,493.05 in Billed Charges for Rev 272 = $2,300.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GLIDESCOPE SLIM 3.8,272,RC,27200002,CDM,,,,,,both,,,7493.0500,1123.9600,UNITED HEALTHCARE,UNITED HEALTHCARE,2420.26,,,,,,,1933.9600,7493.0500,percent of total billed charges,"32.3% of $7,493.05 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE SLIM 3.8,272,RC,27200002,CDM,,,,,,both,,,7493.0500,1123.9600,WELLCARE,WELLCARE MEDICAID,7493.05,,,,,,,1933.9600,7493.0500,percent of total billed charges,"100% of $7,493.05 in Billed Charges for Rev 272 = $7,493.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT VALSALVA CONDUIT 21MM CP021,278,RC,,,,,,,,both,,,51855.0000,7778.2500,AETNA,AETNA,24890.40,,,,,,,3681.7100,51855.0000,percent of total billed charges,"48% of $51,855.00 in Billed Charges for Rev 278 = $24,890.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT VALSALVA CONDUIT 21MM CP021,278,RC,,,,,,,,both,,,51855.0000,7778.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,25927.50,,,,,,,3681.7100,51855.0000,percent of total billed charges,"50% of $51,855.00 in Billed Charges for Rev 278 = $25,927.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT VALSALVA CONDUIT 21MM CP021,278,RC,,,,,,,,both,,,51855.0000,7778.2500,CIGNA HEALTHCARE,CIGNA HMO,21623.54,,,,,,,3681.7100,51855.0000,percent of total billed charges,"41.7% of $51,855.00 in Billed Charges for Rev 278 = $21,623.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT VALSALVA CONDUIT 21MM CP021,278,RC,,,,,,,,both,,,51855.0000,7778.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,20742.00,,,,,,,3681.7100,51855.0000,percent of total billed charges,"40% of $51,855.00 in Billed Charges for Rev 278 = $20,742.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT VALSALVA CONDUIT 21MM CP021,278,RC,,,,,,,,both,,,51855.0000,7778.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,21623.54,,,,,,,3681.7100,51855.0000,percent of total billed charges,"41.7% of $51,855.00 in Billed Charges for Rev 278 = $21,623.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT VALSALVA CONDUIT 21MM CP021,278,RC,,,,,,,,both,,,51855.0000,7778.2500,CIGNA HEALTHCARE,CIGNA PPO,21623.54,,,,,,,3681.7100,51855.0000,percent of total billed charges,"41.7% of $51,855.00 in Billed Charges for Rev 278 = $21,623.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT VALSALVA CONDUIT 21MM CP021,278,RC,,,,,,,,both,,,51855.0000,7778.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,46669.50,,,,,,,3681.7100,51855.0000,percent of total billed charges,"90% of $51,855.00 in Billed Charges for Rev 278 = $46,669.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT VALSALVA CONDUIT 21MM CP021,278,RC,,,,,,,,both,,,51855.0000,7778.2500,MEDCOST,MEDCOST VHN,24677.79,,,,,,,3681.7100,51855.0000,percent of total billed charges,"47.59% of $51,855.00 in Billed Charges for Rev 278 = $24,677.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT VALSALVA CONDUIT 21MM CP021,278,RC,,,,,,,,both,,,51855.0000,7778.2500,SENTARA HEALTH,SENTARA HEALTH,13383.78,,,,,,,3681.7100,51855.0000,percent of total billed charges,"25.81% of $51,855.00 in Billed Charges for Rev 278 = $13,383.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT VALSALVA CONDUIT 21MM CP021,278,RC,,,,,,,,both,,,51855.0000,7778.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",51855.00,,,,,,,3681.7100,51855.0000,percent of total billed charges,"100% of $51,855.00 in Billed Charges for Rev 278 = $51,855.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT VALSALVA CONDUIT 21MM CP021,278,RC,,,,,,,,both,,,51855.0000,7778.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,25927.50,,,,,,,3681.7100,51855.0000,percent of total billed charges,"Rev 278 $51,855.00 in Billed Charges at 50% = $25,927.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT VALSALVA CONDUIT 21MM CP021,278,RC,,,,,,,,both,,,51855.0000,7778.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3889.13,,,,,,,3681.7100,51855.0000,percent of total billed charges,"7.5% of $51,855.00 in Billed Charges for Rev 278 = $3,889.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT VALSALVA CONDUIT 21MM CP021,278,RC,,,,,,,,both,,,51855.0000,7778.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3681.71,,,,,,,3681.7100,51855.0000,percent of total billed charges,"7.1% of $51,855.00 in Billed Charges for Rev 278 = $3,681.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT VALSALVA CONDUIT 21MM CP021,278,RC,,,,,,,,both,,,51855.0000,7778.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,3681.71,,,,,,,3681.7100,51855.0000,percent of total billed charges,"7.1% of $51,855.00 in Billed Charges for Rev 278 = $3,681.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT VALSALVA CONDUIT 21MM CP021,278,RC,,,,,,,,both,,,51855.0000,7778.2500,WELLCARE,WELLCARE MEDICAID,51855.00,,,,,,,3681.7100,51855.0000,percent of total billed charges,"100% of $51,855.00 in Billed Charges for Rev 278 = $51,855.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,85.3500,12.8000,AETNA,AETNA,36.44,,,,,,,22.0300,85.3500,percent of total billed charges,42.7% of $85.35 in Billed Charges for Rev 272 = $36.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,85.3500,12.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,59.75,,,,,,,22.0300,85.3500,percent of total billed charges,Rev 272 $85.35 in Billed Charges at 70% = $59.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,85.3500,12.8000,CIGNA HEALTHCARE,CIGNA HMO,35.59,,,,,,,22.0300,85.3500,percent of total billed charges,41.7% of $85.35 in Billed Charges for Rev 272 = $35.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,85.3500,12.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,39.60,,,,,,,22.0300,85.3500,percent of total billed charges,46.4% of $85.35 in Billed Charges for Rev 272 = $39.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,85.3500,12.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,35.59,,,,,,,22.0300,85.3500,percent of total billed charges,41.7% of $85.35 in Billed Charges for Rev 272 = $35.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,85.3500,12.8000,CIGNA HEALTHCARE,CIGNA PPO,35.59,,,,,,,22.0300,85.3500,percent of total billed charges,41.7% of $85.35 in Billed Charges for Rev 272 = $35.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,85.3500,12.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,76.82,,,,,,,22.0300,85.3500,percent of total billed charges,90% of $85.35 in Billed Charges for Rev 272 = $76.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,85.3500,12.8000,MEDCOST,MEDCOST VHN,40.62,,,,,,,22.0300,85.3500,percent of total billed charges,47.59% of $85.35 in Billed Charges for Rev 272 = $40.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,85.3500,12.8000,SENTARA HEALTH,SENTARA HEALTH,22.03,,,,,,,22.0300,85.3500,percent of total billed charges,25.81% of $85.35 in Billed Charges for Rev 272 = $22.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,85.3500,12.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",85.35,,,,,,,22.0300,85.3500,percent of total billed charges,100% of $85.35 in Billed Charges for Rev 272 = $85.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,85.3500,12.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,42.68,,,,,,,22.0300,85.3500,percent of total billed charges,Rev 272 $85.35 in Billed Charges at 50% = $42.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,85.3500,12.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,27.57,,,,,,,22.0300,85.3500,other,32.3% of $85.35 in Billed Charges for Rev 272 = $27.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,85.3500,12.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,26.20,,,,,,,22.0300,85.3500,other,30.7% of $85.35 in Billed Charges for Rev 272 = $26.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,85.3500,12.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,27.57,,,,,,,22.0300,85.3500,percent of total billed charges,32.3% of $85.35 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,85.3500,12.8000,WELLCARE,WELLCARE MEDICAID,85.35,,,,,,,22.0300,85.3500,percent of total billed charges,100% of $85.35 in Billed Charges for Rev 272 = $85.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,87.0100,13.0500,AETNA,AETNA,37.15,,,,,,,22.4600,87.0100,percent of total billed charges,42.7% of $87.01 in Billed Charges for Rev 272 = $37.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,87.0100,13.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,60.91,,,,,,,22.4600,87.0100,percent of total billed charges,Rev 272 $87.01 in Billed Charges at 70% = $60.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,87.0100,13.0500,CIGNA HEALTHCARE,CIGNA HMO,36.28,,,,,,,22.4600,87.0100,percent of total billed charges,41.7% of $87.01 in Billed Charges for Rev 272 = $36.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,87.0100,13.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,40.37,,,,,,,22.4600,87.0100,percent of total billed charges,46.4% of $87.01 in Billed Charges for Rev 272 = $40.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,87.0100,13.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,36.28,,,,,,,22.4600,87.0100,percent of total billed charges,41.7% of $87.01 in Billed Charges for Rev 272 = $36.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,87.0100,13.0500,CIGNA HEALTHCARE,CIGNA PPO,36.28,,,,,,,22.4600,87.0100,percent of total billed charges,41.7% of $87.01 in Billed Charges for Rev 272 = $36.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,87.0100,13.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,78.31,,,,,,,22.4600,87.0100,percent of total billed charges,90% of $87.01 in Billed Charges for Rev 272 = $78.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,87.0100,13.0500,MEDCOST,MEDCOST VHN,41.41,,,,,,,22.4600,87.0100,percent of total billed charges,47.59% of $87.01 in Billed Charges for Rev 272 = $41.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,87.0100,13.0500,SENTARA HEALTH,SENTARA HEALTH,22.46,,,,,,,22.4600,87.0100,percent of total billed charges,25.81% of $87.01 in Billed Charges for Rev 272 = $22.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,87.0100,13.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",87.01,,,,,,,22.4600,87.0100,percent of total billed charges,100% of $87.01 in Billed Charges for Rev 272 = $87.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,87.0100,13.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,43.51,,,,,,,22.4600,87.0100,percent of total billed charges,Rev 272 $87.01 in Billed Charges at 50% = $43.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,87.0100,13.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,28.10,,,,,,,22.4600,87.0100,other,32.3% of $87.01 in Billed Charges for Rev 272 = $28.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,87.0100,13.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,26.71,,,,,,,22.4600,87.0100,other,30.7% of $87.01 in Billed Charges for Rev 272 = $26.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,87.0100,13.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,28.10,,,,,,,22.4600,87.0100,percent of total billed charges,32.3% of $87.01 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FOLEY 3WAY 16X30CC,272,RC,27200002,CDM,,,,,,both,,,87.0100,13.0500,WELLCARE,WELLCARE MEDICAID,87.01,,,,,,,22.4600,87.0100,percent of total billed charges,100% of $87.01 in Billed Charges for Rev 272 = $87.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH FUSION BILIARY DILATION,272,RC,27200002,CDM,,,,,,both,,,1327.4900,199.1200,AETNA,AETNA,566.84,,,,,,,342.6300,1327.4900,percent of total billed charges,"42.7% of $1,327.49 in Billed Charges for Rev 272 = $566.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH FUSION BILIARY DILATION,272,RC,27200002,CDM,,,,,,both,,,1327.4900,199.1200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,929.24,,,,,,,342.6300,1327.4900,percent of total billed charges,"Rev 272 $1,327.49 in Billed Charges at 70% = $929.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH FUSION BILIARY DILATION,272,RC,27200002,CDM,,,,,,both,,,1327.4900,199.1200,CIGNA HEALTHCARE,CIGNA HMO,553.56,,,,,,,342.6300,1327.4900,percent of total billed charges,"41.7% of $1,327.49 in Billed Charges for Rev 272 = $553.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH FUSION BILIARY DILATION,272,RC,27200002,CDM,,,,,,both,,,1327.4900,199.1200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,615.96,,,,,,,342.6300,1327.4900,percent of total billed charges,"46.4% of $1,327.49 in Billed Charges for Rev 272 = $615.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH FUSION BILIARY DILATION,272,RC,27200002,CDM,,,,,,both,,,1327.4900,199.1200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,553.56,,,,,,,342.6300,1327.4900,percent of total billed charges,"41.7% of $1,327.49 in Billed Charges for Rev 272 = $553.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH FUSION BILIARY DILATION,272,RC,27200002,CDM,,,,,,both,,,1327.4900,199.1200,CIGNA HEALTHCARE,CIGNA PPO,553.56,,,,,,,342.6300,1327.4900,percent of total billed charges,"41.7% of $1,327.49 in Billed Charges for Rev 272 = $553.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH FUSION BILIARY DILATION,272,RC,27200002,CDM,,,,,,both,,,1327.4900,199.1200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1194.74,,,,,,,342.6300,1327.4900,percent of total billed charges,"90% of $1,327.49 in Billed Charges for Rev 272 = $1,194.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH FUSION BILIARY DILATION,272,RC,27200002,CDM,,,,,,both,,,1327.4900,199.1200,MEDCOST,MEDCOST VHN,631.75,,,,,,,342.6300,1327.4900,percent of total billed charges,"47.59% of $1,327.49 in Billed Charges for Rev 272 = $631.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH FUSION BILIARY DILATION,272,RC,27200002,CDM,,,,,,both,,,1327.4900,199.1200,SENTARA HEALTH,SENTARA HEALTH,342.63,,,,,,,342.6300,1327.4900,percent of total billed charges,"25.81% of $1,327.49 in Billed Charges for Rev 272 = $342.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH FUSION BILIARY DILATION,272,RC,27200002,CDM,,,,,,both,,,1327.4900,199.1200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1327.49,,,,,,,342.6300,1327.4900,percent of total billed charges,"100% of $1,327.49 in Billed Charges for Rev 272 = $1,327.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH FUSION BILIARY DILATION,272,RC,27200002,CDM,,,,,,both,,,1327.4900,199.1200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,663.75,,,,,,,342.6300,1327.4900,percent of total billed charges,"Rev 272 $1,327.49 in Billed Charges at 50% = $663.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH FUSION BILIARY DILATION,272,RC,27200002,CDM,,,,,,both,,,1327.4900,199.1200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,428.78,,,,,,,342.6300,1327.4900,other,"32.3% of $1,327.49 in Billed Charges for Rev 272 = $428.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH FUSION BILIARY DILATION,272,RC,27200002,CDM,,,,,,both,,,1327.4900,199.1200,UNITED HEALTHCARE,UHC HERITAGE SELECT,407.54,,,,,,,342.6300,1327.4900,other,"30.7% of $1,327.49 in Billed Charges for Rev 272 = $407.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH FUSION BILIARY DILATION,272,RC,27200002,CDM,,,,,,both,,,1327.4900,199.1200,UNITED HEALTHCARE,UNITED HEALTHCARE,428.78,,,,,,,342.6300,1327.4900,percent of total billed charges,"32.3% of $1,327.49 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH FUSION BILIARY DILATION,272,RC,27200002,CDM,,,,,,both,,,1327.4900,199.1200,WELLCARE,WELLCARE MEDICAID,1327.49,,,,,,,342.6300,1327.4900,percent of total billed charges,"100% of $1,327.49 in Billed Charges for Rev 272 = $1,327.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH IV AUTOGUARD 20X1 1/8 WNG,270,RC,,,,,,,,both,,,2168.5800,325.2900,AETNA,AETNA,925.98,,,,,,,559.7100,2168.5800,percent of total billed charges,"42.7% of $2,168.58 in Billed Charges for Rev 270 = $925.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH IV AUTOGUARD 20X1 1/8 WNG,270,RC,,,,,,,,both,,,2168.5800,325.2900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1518.01,,,,,,,559.7100,2168.5800,percent of total billed charges,"Rev 270 $2,168.58 in Billed Charges at 70% = $1,518.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH IV AUTOGUARD 20X1 1/8 WNG,270,RC,,,,,,,,both,,,2168.5800,325.2900,CIGNA HEALTHCARE,CIGNA HMO,904.30,,,,,,,559.7100,2168.5800,percent of total billed charges,"41.7% of $2,168.58 in Billed Charges for Rev 270 = $904.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH IV AUTOGUARD 20X1 1/8 WNG,270,RC,,,,,,,,both,,,2168.5800,325.2900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1006.22,,,,,,,559.7100,2168.5800,percent of total billed charges,"46.4% of $2,168.58 in Billed Charges for Rev 270 = $1,006.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH IV AUTOGUARD 20X1 1/8 WNG,270,RC,,,,,,,,both,,,2168.5800,325.2900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,904.30,,,,,,,559.7100,2168.5800,percent of total billed charges,"41.7% of $2,168.58 in Billed Charges for Rev 270 = $904.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH IV AUTOGUARD 20X1 1/8 WNG,270,RC,,,,,,,,both,,,2168.5800,325.2900,CIGNA HEALTHCARE,CIGNA PPO,904.30,,,,,,,559.7100,2168.5800,percent of total billed charges,"41.7% of $2,168.58 in Billed Charges for Rev 270 = $904.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH IV AUTOGUARD 20X1 1/8 WNG,270,RC,,,,,,,,both,,,2168.5800,325.2900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1951.72,,,,,,,559.7100,2168.5800,percent of total billed charges,"90% of $2,168.58 in Billed Charges for Rev 270 = $1,951.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH IV AUTOGUARD 20X1 1/8 WNG,270,RC,,,,,,,,both,,,2168.5800,325.2900,MEDCOST,MEDCOST VHN,1032.03,,,,,,,559.7100,2168.5800,percent of total billed charges,"47.59% of $2,168.58 in Billed Charges for Rev 270 = $1,032.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH IV AUTOGUARD 20X1 1/8 WNG,270,RC,,,,,,,,both,,,2168.5800,325.2900,SENTARA HEALTH,SENTARA HEALTH,559.71,,,,,,,559.7100,2168.5800,percent of total billed charges,"25.81% of $2,168.58 in Billed Charges for Rev 270 = $559.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH IV AUTOGUARD 20X1 1/8 WNG,270,RC,,,,,,,,both,,,2168.5800,325.2900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2168.58,,,,,,,559.7100,2168.5800,percent of total billed charges,"100% of $2,168.58 in Billed Charges for Rev 270 = $2,168.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH IV AUTOGUARD 20X1 1/8 WNG,270,RC,,,,,,,,both,,,2168.5800,325.2900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1084.29,,,,,,,559.7100,2168.5800,percent of total billed charges,"Rev 270 $2,168.58 in Billed Charges at 50% = $1,084.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH IV AUTOGUARD 20X1 1/8 WNG,270,RC,,,,,,,,both,,,2168.5800,325.2900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,700.45,,,,,,,559.7100,2168.5800,other,"32.3% of $2,168.58 in Billed Charges for Rev 270 = $700.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH IV AUTOGUARD 20X1 1/8 WNG,270,RC,,,,,,,,both,,,2168.5800,325.2900,UNITED HEALTHCARE,UHC HERITAGE SELECT,665.75,,,,,,,559.7100,2168.5800,other,"30.7% of $2,168.58 in Billed Charges for Rev 270 = $665.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH IV AUTOGUARD 20X1 1/8 WNG,270,RC,,,,,,,,both,,,2168.5800,325.2900,UNITED HEALTHCARE,UNITED HEALTHCARE,700.45,,,,,,,559.7100,2168.5800,percent of total billed charges,"32.3% of $2,168.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH IV AUTOGUARD 20X1 1/8 WNG,270,RC,,,,,,,,both,,,2168.5800,325.2900,WELLCARE,WELLCARE MEDICAID,2168.58,,,,,,,559.7100,2168.5800,percent of total billed charges,"100% of $2,168.58 in Billed Charges for Rev 270 = $2,168.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LIBERATOR HCS ET TUBE CLEANING SYSTEM W MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,641.0000,96.1500,AETNA,AETNA,273.71,,,,,,,165.4400,641.0000,percent of total billed charges,42.7% of $641.00 in Billed Charges for Rev 272 = $273.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEANING SYSTEM W MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,641.0000,96.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,448.70,,,,,,,165.4400,641.0000,percent of total billed charges,Rev 272 $641.00 in Billed Charges at 70% = $448.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEANING SYSTEM W MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,641.0000,96.1500,CIGNA HEALTHCARE,CIGNA HMO,267.30,,,,,,,165.4400,641.0000,percent of total billed charges,41.7% of $641.00 in Billed Charges for Rev 272 = $267.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEANING SYSTEM W MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,641.0000,96.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,297.42,,,,,,,165.4400,641.0000,percent of total billed charges,46.4% of $641.00 in Billed Charges for Rev 272 = $297.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEANING SYSTEM W MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,641.0000,96.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,267.30,,,,,,,165.4400,641.0000,percent of total billed charges,41.7% of $641.00 in Billed Charges for Rev 272 = $267.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEANING SYSTEM W MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,641.0000,96.1500,CIGNA HEALTHCARE,CIGNA PPO,267.30,,,,,,,165.4400,641.0000,percent of total billed charges,41.7% of $641.00 in Billed Charges for Rev 272 = $267.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEANING SYSTEM W MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,641.0000,96.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,576.90,,,,,,,165.4400,641.0000,percent of total billed charges,90% of $641.00 in Billed Charges for Rev 272 = $576.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEANING SYSTEM W MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,641.0000,96.1500,MEDCOST,MEDCOST VHN,305.05,,,,,,,165.4400,641.0000,percent of total billed charges,47.59% of $641.00 in Billed Charges for Rev 272 = $305.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEANING SYSTEM W MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,641.0000,96.1500,SENTARA HEALTH,SENTARA HEALTH,165.44,,,,,,,165.4400,641.0000,percent of total billed charges,25.81% of $641.00 in Billed Charges for Rev 272 = $165.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEANING SYSTEM W MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,641.0000,96.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",641.00,,,,,,,165.4400,641.0000,percent of total billed charges,100% of $641.00 in Billed Charges for Rev 272 = $641.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEANING SYSTEM W MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,641.0000,96.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,320.50,,,,,,,165.4400,641.0000,percent of total billed charges,Rev 272 $641.00 in Billed Charges at 50% = $320.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEANING SYSTEM W MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,641.0000,96.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,207.04,,,,,,,165.4400,641.0000,other,32.3% of $641.00 in Billed Charges for Rev 272 = $207.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATH LIBERATOR HCS ET TUBE CLEANING SYSTEM W MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,641.0000,96.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,196.79,,,,,,,165.4400,641.0000,other,30.7% of $641.00 in Billed Charges for Rev 272 = $196.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATH LIBERATOR HCS ET TUBE CLEANING SYSTEM W MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,641.0000,96.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,207.04,,,,,,,165.4400,641.0000,percent of total billed charges,32.3% of $641.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEANING SYSTEM W MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,641.0000,96.1500,WELLCARE,WELLCARE MEDICAID,641.00,,,,,,,165.4400,641.0000,percent of total billed charges,100% of $641.00 in Billed Charges for Rev 272 = $641.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEARING SYSTEM WO MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,589.7300,88.4600,AETNA,AETNA,251.81,,,,,,,152.2100,589.7300,percent of total billed charges,42.7% of $589.73 in Billed Charges for Rev 272 = $251.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEARING SYSTEM WO MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,589.7300,88.4600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,412.81,,,,,,,152.2100,589.7300,percent of total billed charges,Rev 272 $589.73 in Billed Charges at 70% = $412.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEARING SYSTEM WO MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,589.7300,88.4600,CIGNA HEALTHCARE,CIGNA HMO,245.92,,,,,,,152.2100,589.7300,percent of total billed charges,41.7% of $589.73 in Billed Charges for Rev 272 = $245.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEARING SYSTEM WO MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,589.7300,88.4600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,273.63,,,,,,,152.2100,589.7300,percent of total billed charges,46.4% of $589.73 in Billed Charges for Rev 272 = $273.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEARING SYSTEM WO MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,589.7300,88.4600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,245.92,,,,,,,152.2100,589.7300,percent of total billed charges,41.7% of $589.73 in Billed Charges for Rev 272 = $245.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEARING SYSTEM WO MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,589.7300,88.4600,CIGNA HEALTHCARE,CIGNA PPO,245.92,,,,,,,152.2100,589.7300,percent of total billed charges,41.7% of $589.73 in Billed Charges for Rev 272 = $245.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEARING SYSTEM WO MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,589.7300,88.4600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,530.76,,,,,,,152.2100,589.7300,percent of total billed charges,90% of $589.73 in Billed Charges for Rev 272 = $530.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEARING SYSTEM WO MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,589.7300,88.4600,MEDCOST,MEDCOST VHN,280.65,,,,,,,152.2100,589.7300,percent of total billed charges,47.59% of $589.73 in Billed Charges for Rev 272 = $280.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEARING SYSTEM WO MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,589.7300,88.4600,SENTARA HEALTH,SENTARA HEALTH,152.21,,,,,,,152.2100,589.7300,percent of total billed charges,25.81% of $589.73 in Billed Charges for Rev 272 = $152.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEARING SYSTEM WO MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,589.7300,88.4600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",589.73,,,,,,,152.2100,589.7300,percent of total billed charges,100% of $589.73 in Billed Charges for Rev 272 = $589.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEARING SYSTEM WO MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,589.7300,88.4600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,294.87,,,,,,,152.2100,589.7300,percent of total billed charges,Rev 272 $589.73 in Billed Charges at 50% = $294.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEARING SYSTEM WO MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,589.7300,88.4600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,190.48,,,,,,,152.2100,589.7300,other,32.3% of $589.73 in Billed Charges for Rev 272 = $190.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATH LIBERATOR HCS ET TUBE CLEARING SYSTEM WO MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,589.7300,88.4600,UNITED HEALTHCARE,UHC HERITAGE SELECT,181.05,,,,,,,152.2100,589.7300,other,30.7% of $589.73 in Billed Charges for Rev 272 = $181.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATH LIBERATOR HCS ET TUBE CLEARING SYSTEM WO MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,589.7300,88.4600,UNITED HEALTHCARE,UNITED HEALTHCARE,190.48,,,,,,,152.2100,589.7300,percent of total billed charges,32.3% of $589.73 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LIBERATOR HCS ET TUBE CLEARING SYSTEM WO MANIFOLD 7-7.5 12FR,272,RC,,,,,,,,both,,,589.7300,88.4600,WELLCARE,WELLCARE MEDICAID,589.73,,,,,,,152.2100,589.7300,percent of total billed charges,100% of $589.73 in Billed Charges for Rev 272 = $589.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH LINEAR 7.5FR 40CC IABP,272,RC,,,,,,,,both,,,9983.1200,1497.4700,AETNA,AETNA,4262.79,,,,,,,2576.6400,9983.1200,percent of total billed charges,"42.7% of $9,983.12 in Billed Charges for Rev 272 = $4,262.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LINEAR 7.5FR 40CC IABP,272,RC,,,,,,,,both,,,9983.1200,1497.4700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6988.18,,,,,,,2576.6400,9983.1200,percent of total billed charges,"Rev 272 $9,983.12 in Billed Charges at 70% = $6,988.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LINEAR 7.5FR 40CC IABP,272,RC,,,,,,,,both,,,9983.1200,1497.4700,CIGNA HEALTHCARE,CIGNA HMO,4162.96,,,,,,,2576.6400,9983.1200,percent of total billed charges,"41.7% of $9,983.12 in Billed Charges for Rev 272 = $4,162.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LINEAR 7.5FR 40CC IABP,272,RC,,,,,,,,both,,,9983.1200,1497.4700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4632.17,,,,,,,2576.6400,9983.1200,percent of total billed charges,"46.4% of $9,983.12 in Billed Charges for Rev 272 = $4,632.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LINEAR 7.5FR 40CC IABP,272,RC,,,,,,,,both,,,9983.1200,1497.4700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4162.96,,,,,,,2576.6400,9983.1200,percent of total billed charges,"41.7% of $9,983.12 in Billed Charges for Rev 272 = $4,162.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LINEAR 7.5FR 40CC IABP,272,RC,,,,,,,,both,,,9983.1200,1497.4700,CIGNA HEALTHCARE,CIGNA PPO,4162.96,,,,,,,2576.6400,9983.1200,percent of total billed charges,"41.7% of $9,983.12 in Billed Charges for Rev 272 = $4,162.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LINEAR 7.5FR 40CC IABP,272,RC,,,,,,,,both,,,9983.1200,1497.4700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8984.81,,,,,,,2576.6400,9983.1200,percent of total billed charges,"90% of $9,983.12 in Billed Charges for Rev 272 = $8,984.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LINEAR 7.5FR 40CC IABP,272,RC,,,,,,,,both,,,9983.1200,1497.4700,MEDCOST,MEDCOST VHN,4750.97,,,,,,,2576.6400,9983.1200,percent of total billed charges,"47.59% of $9,983.12 in Billed Charges for Rev 272 = $4,750.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LINEAR 7.5FR 40CC IABP,272,RC,,,,,,,,both,,,9983.1200,1497.4700,SENTARA HEALTH,SENTARA HEALTH,2576.64,,,,,,,2576.6400,9983.1200,percent of total billed charges,"25.81% of $9,983.12 in Billed Charges for Rev 272 = $2,576.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LINEAR 7.5FR 40CC IABP,272,RC,,,,,,,,both,,,9983.1200,1497.4700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9983.12,,,,,,,2576.6400,9983.1200,percent of total billed charges,"100% of $9,983.12 in Billed Charges for Rev 272 = $9,983.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LINEAR 7.5FR 40CC IABP,272,RC,,,,,,,,both,,,9983.1200,1497.4700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4991.56,,,,,,,2576.6400,9983.1200,percent of total billed charges,"Rev 272 $9,983.12 in Billed Charges at 50% = $4,991.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LINEAR 7.5FR 40CC IABP,272,RC,,,,,,,,both,,,9983.1200,1497.4700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3224.55,,,,,,,2576.6400,9983.1200,other,"32.3% of $9,983.12 in Billed Charges for Rev 272 = $3,224.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH LINEAR 7.5FR 40CC IABP,272,RC,,,,,,,,both,,,9983.1200,1497.4700,UNITED HEALTHCARE,UHC HERITAGE SELECT,3064.82,,,,,,,2576.6400,9983.1200,other,"30.7% of $9,983.12 in Billed Charges for Rev 272 = $3,064.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH LINEAR 7.5FR 40CC IABP,272,RC,,,,,,,,both,,,9983.1200,1497.4700,UNITED HEALTHCARE,UNITED HEALTHCARE,3224.55,,,,,,,2576.6400,9983.1200,percent of total billed charges,"32.3% of $9,983.12 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH LINEAR 7.5FR 40CC IABP,272,RC,,,,,,,,both,,,9983.1200,1497.4700,WELLCARE,WELLCARE MEDICAID,9983.12,,,,,,,2576.6400,9983.1200,percent of total billed charges,"100% of $9,983.12 in Billed Charges for Rev 272 = $9,983.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,AETNA,AETNA,1456.50,,,,,,,50.9300,5337.8600,percent of total billed charges,"42.7% of $3,411.00 in Billed Charges for Rev 310 Proc 0276U = $1,456.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,51.42,,,,,,,50.9300,5337.8600,fee schedule,APG 00385 Proc 0276U at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 104% = $51.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2448.56,,,,,,,50.9300,5337.8600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,AETNA,AETNA HEALTHCARE MEDICARE,2448.56,,,,,,,50.9300,5337.8600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,2448.56,,,,,,,50.9300,5337.8600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,AMBETTER,AMBETTER,5337.86,,,,,,,50.9300,5337.8600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,AMERIGROUP,AMERIGROUP,1224.28,,,,,,,50.9300,5337.8600,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2546.50,,,,,,,50.9300,5337.8600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,BLUE CROSS,ANTHEM EXCHANGE,2448.56,,,,,,,50.9300,5337.8600,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,50.93,,,,,,,50.9300,5337.8600,fee schedule,APG 00385 Proc 0276U at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 103% = $50.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,BLUE CROSS,ANTHEM HMO,2448.56,,,,,,,50.9300,5337.8600,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2522.02,,,,,,,50.9300,5337.8600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2448.56,,,,,,,50.9300,5337.8600,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2387.70,,,,,,,50.9300,5337.8600,percent of total billed charges,"Rev 310 Proc 0276U $3,411.00 in Billed Charges at 70% = $2,387.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,BLUE CROSS,BLUE CROSS E NETWORK,3411.00,,,,,,,50.9300,5337.8600,fee schedule,"$2,448.56 from Fee Schedule BCFSB for Rev 310 Proc 0276U * Qty 1 = $2,448.56 at 320% = $7,835.39 (Service Line reduced to $3,411.00, claim capped at $3,411.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,BLUE CROSS,BLUE CROSS MEDICARE,2546.50,,,,,,,50.9300,5337.8600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,BLUE CROSS,BLUE CROSS P NETWORK,3411.00,,,,,,,50.9300,5337.8600,fee schedule,"$2,448.56 from Fee Schedule BCFSB for Rev 310 Proc 0276U * Qty 1 = $2,448.56 at 327% = $8,006.79 (Service Line reduced to $3,411.00, claim capped at $3,411.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,BLUE CROSS,BLUE CROSS S NETWORK,3411.00,,,,,,,50.9300,5337.8600,fee schedule,"$2,448.56 from Fee Schedule BCFSB for Rev 310 Proc 0276U * Qty 1 = $2,448.56 at 327% = $8,006.79 (Service Line reduced to $3,411.00, claim capped at $3,411.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,CIGNA HEALTHCARE,CIGNA HMO,1422.39,,,,,,,50.9300,5337.8600,percent of total billed charges,"Rev 310 Proc 0276U $3,411.00 in Billed Charges at 41.7% = $1,422.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3411.00,,,,,,,50.9300,5337.8600,fee schedule,"$5,397.47 from Fee Schedule CGIFP_25LR for Rev 310 Proc 0276U * Qty 1 = $5,397.47 at 100% = $5,397.47 (Limited to $3,411.00 in Billed Charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,2570.99,,,,,,,50.9300,5337.8600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1422.39,,,,,,,50.9300,5337.8600,percent of total billed charges,"Rev 310 Proc 0276U $3,411.00 in Billed Charges at 41.7% = $1,422.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,CIGNA HEALTHCARE,CIGNA PPO,1422.39,,,,,,,50.9300,5337.8600,percent of total billed charges,"Rev 310 Proc 0276U $3,411.00 in Billed Charges at 41.7% = $1,422.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,2570.99,,,,,,,50.9300,5337.8600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3069.90,,,,,,,50.9300,5337.8600,percent of total billed charges,"90% of $3,411.00 in Billed Charges for Rev 310 Proc 0276U = $3,069.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,HUMANA,HUMANA MEDICARE,2448.56,,,,,,,50.9300,5337.8600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2448.56,,,,,,,50.9300,5337.8600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,MEDCOST,MEDCOST VHN,1623.29,,,,,,,50.9300,5337.8600,percent of total billed charges,"47.59% of $3,411.00 in Billed Charges for Rev 310 Proc 0276U = $1,623.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,51.91,,,,,,,50.9300,5337.8600,fee schedule,APG 00385 Proc 0276U at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 100% = $49.44... $49.44 at 105% = $51.91 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,2570.99,,,,,,,50.9300,5337.8600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,2570.99,,,,,,,50.9300,5337.8600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,NHC ADVANTAGE,NHC ADVANTAGE,2570.99,,,,,,,50.9300,5337.8600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,50.97,,,,,,,50.9300,5337.8600,fee schedule,APG 00385 Proc 0276U at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 100% = $49.44... $49.44 at 103.1% = $50.97 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,SENTARA HEALTH,SENTARA HEALTH,880.38,,,,,,,50.9300,5337.8600,percent of total billed charges,"25.81% of $3,411.00 in Billed Charges for Rev 310 Proc 0276U = $880.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,SENTARA HEALTH,SENTARA MEDICARE,2448.56,,,,,,,50.9300,5337.8600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3411.00,,,,,,,50.9300,5337.8600,percent of total billed charges,"100% of $3,411.00 in Billed Charges for Rev 310 Proc 0276U = $3,411.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1224.28,,,,,,,50.9300,5337.8600,fee schedule,"$2,448.56 from Fee Schedule TCUHC24 for Rev 310 Proc 0276U * Qty 1 = $2,448.56 at 50% = $1,224.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2546.50,,,,,,,50.9300,5337.8600,fee schedule,"$2,448.56 from Fee Schedule UHC_31910 for Rev 310 Proc 0276U * Qty 1 = $2,448.56 at 104% = $2,546.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2448.56,,,,,,,50.9300,5337.8600,fee schedule,"$2,448.56 from Fee Schedule UHC_31910 for Rev 310 Proc 0276U * Qty 1 = $2,448.56 at 100% = $2,448.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,2448.56,,,,,,,50.9300,5337.8600,fee schedule,"$2,448.56 from Fee Schedule UHC_31910 for Rev 310 Proc 0276U * Qty 1 = $2,448.56 at 100% = $2,448.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,50.93,,,,,,,50.9300,5337.8600,fee schedule,APG 00385 Proc 0276U at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 103% = $50.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2448.56,,,,,,,50.9300,5337.8600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2448.56,,,,,,,50.9300,5337.8600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,WELLCARE,WELLCARE MEDICAID,3411.00,,,,,,,50.9300,5337.8600,percent of total billed charges,"100% of $3,411.00 in Billed Charges for Rev 310 Proc 0276U = $3,411.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEM INH THROMBOCYTOPENIA GEN SEQ ALYS 42 GENES,0276U,CPT,310,RC,31000056,CDM,,,,both,,,3411.0000,511.6500,WELLCARE,WELLCARE MEDICARE,2595.47,,,,,,,50.9300,5337.8600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,AETNA,AETNA,175.07,,,,,,,68.0700,893.8000,percent of total billed charges,42.7% of $410.00 in Billed Charges for Rev 306 Proc 0330U = $175.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,68.74,,,,,,,68.0700,893.8000,fee schedule,APG 00397 Proc 0330U at $836.60 (Base Rate) * 0.079 (Relative Weight) = $66.09 (Total Line Payment) at 104% = $68.74. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,410.00,,,,,,,68.0700,893.8000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,AETNA,AETNA HEALTHCARE MEDICARE,410.00,,,,,,,68.0700,893.8000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,410.00,,,,,,,68.0700,893.8000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,AMBETTER,AMBETTER,893.80,,,,,,,68.0700,893.8000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,AMERIGROUP,AMERIGROUP,205.00,,,,,,,68.0700,893.8000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,410.00,,,,,,,68.0700,893.8000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,BLUE CROSS,ANTHEM EXCHANGE,410.00,,,,,,,68.0700,893.8000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,68.07,,,,,,,68.0700,893.8000,fee schedule,APG 00397 Proc 0330U at $836.60 (Base Rate) * 0.079 (Relative Weight) = $66.09 (Total Line Payment) at 103% = $68.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,BLUE CROSS,ANTHEM HMO,410.00,,,,,,,68.0700,893.8000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,410.00,,,,,,,68.0700,893.8000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",410.00,,,,,,,68.0700,893.8000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,287.00,,,,,,,68.0700,893.8000,percent of total billed charges,Rev 306 Proc 0330U $410.00 in Billed Charges at 70% = $287.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,BLUE CROSS,BLUE CROSS E NETWORK,410.00,,,,,,,68.0700,893.8000,fee schedule,"$416.78 from Fee Schedule BCFSB for Rev 306 Proc 0330U * Qty 1 = $416.78 at 320% = $1,333.70 (Service Line reduced to $410.00, claim capped at $410.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,BLUE CROSS,BLUE CROSS MEDICARE,426.40,,,,,,,68.0700,893.8000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,BLUE CROSS,BLUE CROSS P NETWORK,410.00,,,,,,,68.0700,893.8000,fee schedule,"$416.78 from Fee Schedule BCFSB for Rev 306 Proc 0330U * Qty 1 = $416.78 at 327% = $1,362.87 (Service Line reduced to $410.00, claim capped at $410.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,BLUE CROSS,BLUE CROSS S NETWORK,410.00,,,,,,,68.0700,893.8000,fee schedule,"$416.78 from Fee Schedule BCFSB for Rev 306 Proc 0330U * Qty 1 = $416.78 at 327% = $1,362.87 (Service Line reduced to $410.00, claim capped at $410.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,CIGNA HEALTHCARE,CIGNA HMO,170.97,,,,,,,68.0700,893.8000,percent of total billed charges,Rev 306 Proc 0330U $410.00 in Billed Charges at 41.7% = $170.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,410.00,,,,,,,68.0700,893.8000,fee schedule,$918.83 from Fee Schedule CGIFP_25LR for Rev 306 Proc 0330U * Qty 1 = $918.83 at 100% = $918.83 (Limited to $410.00 in Billed Charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,410.00,,,,,,,68.0700,893.8000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,170.97,,,,,,,68.0700,893.8000,percent of total billed charges,Rev 306 Proc 0330U $410.00 in Billed Charges at 41.7% = $170.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,CIGNA HEALTHCARE,CIGNA PPO,170.97,,,,,,,68.0700,893.8000,percent of total billed charges,Rev 306 Proc 0330U $410.00 in Billed Charges at 41.7% = $170.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,410.00,,,,,,,68.0700,893.8000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,369.00,,,,,,,68.0700,893.8000,percent of total billed charges,90% of $410.00 in Billed Charges for Rev 306 Proc 0330U = $369.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,HUMANA,HUMANA MEDICARE,410.00,,,,,,,68.0700,893.8000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,410.00,,,,,,,68.0700,893.8000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,MEDCOST,MEDCOST VHN,195.12,,,,,,,68.0700,893.8000,percent of total billed charges,47.59% of $410.00 in Billed Charges for Rev 306 Proc 0330U = $195.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,69.39,,,,,,,68.0700,893.8000,fee schedule,APG 00397 Proc 0330U at $836.60 (Base Rate) * 0.079 (Relative Weight) = $66.09 (Total Line Payment) at 100% = $66.09... $66.09 at 105% = $69.39 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,410.00,,,,,,,68.0700,893.8000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,410.00,,,,,,,68.0700,893.8000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,NHC ADVANTAGE,NHC ADVANTAGE,410.00,,,,,,,68.0700,893.8000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,68.14,,,,,,,68.0700,893.8000,fee schedule,APG 00397 Proc 0330U at $836.60 (Base Rate) * 0.079 (Relative Weight) = $66.09 (Total Line Payment) at 100% = $66.09... $66.09 at 103.1% = $68.14 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,SENTARA HEALTH,SENTARA HEALTH,105.82,,,,,,,68.0700,893.8000,percent of total billed charges,25.81% of $410.00 in Billed Charges for Rev 306 Proc 0330U = $105.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,SENTARA HEALTH,SENTARA MEDICARE,410.00,,,,,,,68.0700,893.8000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",410.00,,,,,,,68.0700,893.8000,percent of total billed charges,100% of $410.00 in Billed Charges for Rev 306 Proc 0330U = $410.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,208.39,,,,,,,68.0700,893.8000,fee schedule,$416.78 from Fee Schedule TCUHC24 for Rev 306 Proc 0330U * Qty 1 = $416.78 at 50% = $208.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,410.00,,,,,,,68.0700,893.8000,fee schedule,"$416.78 from Fee Schedule UHC_31910 for Rev 306 Proc 0330U * Qty 1 = $416.78 at 104% = $433.45 (Service Line reduced to $410.00, claim capped at $410.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,410.00,,,,,,,68.0700,893.8000,fee schedule,"$416.78 from Fee Schedule UHC_31910 for Rev 306 Proc 0330U * Qty 1 = $416.78 at 100% = $416.78 (Service Line reduced to $410.00, claim capped at $410.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,410.00,,,,,,,68.0700,893.8000,fee schedule,"$416.78 from Fee Schedule UHC_31910 for Rev 306 Proc 0330U * Qty 1 = $416.78 at 100% = $416.78 (Service Line reduced to $410.00, claim capped at $410.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,68.07,,,,,,,68.0700,893.8000,fee schedule,APG 00397 Proc 0330U at $836.60 (Base Rate) * 0.079 (Relative Weight) = $66.09 (Total Line Payment) at 103% = $68.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,410.00,,,,,,,68.0700,893.8000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,410.00,,,,,,,68.0700,893.8000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,WELLCARE,WELLCARE MEDICAID,410.00,,,,,,,68.0700,893.8000,percent of total billed charges,100% of $410.00 in Billed Charges for Rev 306 Proc 0330U = $410.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IADNA VAG PTHGN PNL 27 ORG AMP PROBE VAG SWAB,0330U,CPT,306,RC,30600198,CDM,,,,both,,,410.0000,61.5000,WELLCARE,WELLCARE MEDICARE,434.60,,,,,,,68.0700,893.8000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,AETNA,AETNA,7145.42,,,,,,,890.0000,22390.4700,percent of total billed charges,"42.7% of $16,734.00 in Billed Charges for Rev 361 Proc 0338T = $7,145.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,22177.24,,,,,,,890.0000,22390.4700,fee schedule,"APG 00122 Proc 0338T at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 104% = $22,177.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5163.81,,,,,,,890.0000,22390.4700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,AETNA,AETNA HEALTHCARE MEDICARE,5163.81,,,,,,,890.0000,22390.4700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,5163.81,,,,,,,890.0000,22390.4700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,AMBETTER,AMBETTER,11257.11,,,,,,,890.0000,22390.4700,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,5370.36,,,,,,,890.0000,22390.4700,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,BLUE CROSS,ANTHEM EXCHANGE,12713.57,,,,,,,890.0000,22390.4700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,16734.00,,,,,,,890.0000,22390.4700,fee schedule,"APG 00122 Proc 0338T at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99 (Service Line reduced to $16,734.00, claim capped at $16,734.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,BLUE CROSS,ANTHEM HMO,13507.41,,,,,,,890.0000,22390.4700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5318.72,,,,,,,890.0000,22390.4700,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",15890.21,,,,,,,890.0000,22390.4700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,890.0000,22390.4700,case rate,"Rev 361 Proc 0338T ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,BLUE CROSS,BLUE CROSS MEDICARE,5370.36,,,,,,,890.0000,22390.4700,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,890.0000,22390.4700,case rate,"Rev 361 Proc 0338T ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,890.0000,22390.4700,case rate,"Rev 361 Proc 0338T ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,BLUE CROSS,TENNCARE BLUE CARE,890.00,,,,,,,890.0000,22390.4700,case rate,Rev 361 Proc 0338T ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,BLUE CROSS,TENNCARE BLUE SELECT,890.00,,,,,,,890.0000,22390.4700,case rate,Rev 361 Proc 0338T ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,CIGNA HEALTHCARE,CIGNA HMO,8003.00,,,,,,,890.0000,22390.4700,case rate,"Rev 361 Proc 0338T ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6048.00,,,,,,,890.0000,22390.4700,case rate,"Rev 361 Proc 0338T ASG Rate of $6,048.00 at 100% of $6,048.00 = $6,048.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,5422.00,,,,,,,890.0000,22390.4700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8003.00,,,,,,,890.0000,22390.4700,case rate,"Rev 361 Proc 0338T ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,CIGNA HEALTHCARE,CIGNA PPO,8003.00,,,,,,,890.0000,22390.4700,case rate,"Rev 361 Proc 0338T ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,5422.00,,,,,,,890.0000,22390.4700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,15060.60,,,,,,,890.0000,22390.4700,percent of total billed charges,"90% of $16,734.00 in Billed Charges for Rev 361 Proc 0338T = $15,060.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,HUMANA,HUMANA MEDICARE,5163.81,,,,,,,890.0000,22390.4700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5163.81,,,,,,,890.0000,22390.4700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,MEDCOST,MEDCOST VHN,7963.71,,,,,,,890.0000,22390.4700,percent of total billed charges,"47.59% of $16,734.00 in Billed Charges for Rev 361 Proc 0338T = $7,963.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,22390.47,,,,,,,890.0000,22390.4700,fee schedule,"APG 00122 Proc 0338T at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 105% = $22,390.47 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,5422.00,,,,,,,890.0000,22390.4700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,5422.00,,,,,,,890.0000,22390.4700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,NHC ADVANTAGE,NHC ADVANTAGE,5422.00,,,,,,,890.0000,22390.4700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,21985.31,,,,,,,890.0000,22390.4700,fee schedule,"APG 00122 Proc 0338T at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 103.1% = $21,985.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,SENTARA HEALTH,SENTARA HEALTH,4319.05,,,,,,,890.0000,22390.4700,percent of total billed charges,"25.81% of $16,734.00 in Billed Charges for Rev 361 Proc 0338T = $4,319.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,SENTARA HEALTH,SENTARA MEDICARE,5163.81,,,,,,,890.0000,22390.4700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",16734.00,,,,,,,890.0000,22390.4700,percent of total billed charges,"100% of $16,734.00 in Billed Charges for Rev 361 Proc 0338T = $16,734.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,890.0000,22390.4700,case rate,"Rev 361 Proc 0338T ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,890.0000,22390.4700,case rate,"Rev 361 Proc 0338T ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,890.0000,22390.4700,case rate,"Rev 361 Proc 0338T ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,890.0000,22390.4700,case rate,"Rev 361 Proc 0338T ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,21963.99,,,,,,,890.0000,22390.4700,fee schedule,"APG 00122 Proc 0338T at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5163.81,,,,,,,890.0000,22390.4700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5163.81,,,,,,,890.0000,22390.4700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,WELLCARE,WELLCARE MEDICAID,16734.00,,,,,,,890.0000,22390.4700,percent of total billed charges,"100% of $16,734.00 in Billed Charges for Rev 361 Proc 0338T = $16,734.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH RENAL SYMPATH DENERVATION UNILATERAL,0338T,CPT,361,RC,36100330,CDM,,,,both,,,16734.0000,2510.1000,WELLCARE,WELLCARE MEDICARE,5473.64,,,,,,,890.0000,22390.4700,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATH OMIFLUSH 5FR 65CM,272,RC,27200002,CDM,,,,,,both,,,576.6300,86.4900,AETNA,AETNA,246.22,,,,,,,148.8300,576.6300,percent of total billed charges,42.7% of $576.63 in Billed Charges for Rev 272 = $246.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH OMIFLUSH 5FR 65CM,272,RC,27200002,CDM,,,,,,both,,,576.6300,86.4900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,403.64,,,,,,,148.8300,576.6300,percent of total billed charges,Rev 272 $576.63 in Billed Charges at 70% = $403.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH OMIFLUSH 5FR 65CM,272,RC,27200002,CDM,,,,,,both,,,576.6300,86.4900,CIGNA HEALTHCARE,CIGNA HMO,240.45,,,,,,,148.8300,576.6300,percent of total billed charges,41.7% of $576.63 in Billed Charges for Rev 272 = $240.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH OMIFLUSH 5FR 65CM,272,RC,27200002,CDM,,,,,,both,,,576.6300,86.4900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,267.56,,,,,,,148.8300,576.6300,percent of total billed charges,46.4% of $576.63 in Billed Charges for Rev 272 = $267.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH OMIFLUSH 5FR 65CM,272,RC,27200002,CDM,,,,,,both,,,576.6300,86.4900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,240.45,,,,,,,148.8300,576.6300,percent of total billed charges,41.7% of $576.63 in Billed Charges for Rev 272 = $240.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH OMIFLUSH 5FR 65CM,272,RC,27200002,CDM,,,,,,both,,,576.6300,86.4900,CIGNA HEALTHCARE,CIGNA PPO,240.45,,,,,,,148.8300,576.6300,percent of total billed charges,41.7% of $576.63 in Billed Charges for Rev 272 = $240.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH OMIFLUSH 5FR 65CM,272,RC,27200002,CDM,,,,,,both,,,576.6300,86.4900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,518.97,,,,,,,148.8300,576.6300,percent of total billed charges,90% of $576.63 in Billed Charges for Rev 272 = $518.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH OMIFLUSH 5FR 65CM,272,RC,27200002,CDM,,,,,,both,,,576.6300,86.4900,MEDCOST,MEDCOST VHN,274.42,,,,,,,148.8300,576.6300,percent of total billed charges,47.59% of $576.63 in Billed Charges for Rev 272 = $274.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH OMIFLUSH 5FR 65CM,272,RC,27200002,CDM,,,,,,both,,,576.6300,86.4900,SENTARA HEALTH,SENTARA HEALTH,148.83,,,,,,,148.8300,576.6300,percent of total billed charges,25.81% of $576.63 in Billed Charges for Rev 272 = $148.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH OMIFLUSH 5FR 65CM,272,RC,27200002,CDM,,,,,,both,,,576.6300,86.4900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",576.63,,,,,,,148.8300,576.6300,percent of total billed charges,100% of $576.63 in Billed Charges for Rev 272 = $576.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH OMIFLUSH 5FR 65CM,272,RC,27200002,CDM,,,,,,both,,,576.6300,86.4900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,288.32,,,,,,,148.8300,576.6300,percent of total billed charges,Rev 272 $576.63 in Billed Charges at 50% = $288.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH OMIFLUSH 5FR 65CM,272,RC,27200002,CDM,,,,,,both,,,576.6300,86.4900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,186.25,,,,,,,148.8300,576.6300,other,32.3% of $576.63 in Billed Charges for Rev 272 = $186.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATH OMIFLUSH 5FR 65CM,272,RC,27200002,CDM,,,,,,both,,,576.6300,86.4900,UNITED HEALTHCARE,UHC HERITAGE SELECT,177.03,,,,,,,148.8300,576.6300,other,30.7% of $576.63 in Billed Charges for Rev 272 = $177.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATH OMIFLUSH 5FR 65CM,272,RC,27200002,CDM,,,,,,both,,,576.6300,86.4900,UNITED HEALTHCARE,UNITED HEALTHCARE,186.25,,,,,,,148.8300,576.6300,percent of total billed charges,32.3% of $576.63 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH OMIFLUSH 5FR 65CM,272,RC,27200002,CDM,,,,,,both,,,576.6300,86.4900,WELLCARE,WELLCARE MEDICAID,576.63,,,,,,,148.8300,576.6300,percent of total billed charges,100% of $576.63 in Billed Charges for Rev 272 = $576.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATH OPTI-Q 8FR J-TIP SV02/CCO,272,RC,27200002,CDM,,,,,,both,,,2195.7500,329.3600,AETNA,AETNA,937.59,,,,,,,566.7200,2195.7500,percent of total billed charges,"42.7% of $2,195.75 in Billed Charges for Rev 272 = $937.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTI-Q 8FR J-TIP SV02/CCO,272,RC,27200002,CDM,,,,,,both,,,2195.7500,329.3600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1537.03,,,,,,,566.7200,2195.7500,percent of total billed charges,"Rev 272 $2,195.75 in Billed Charges at 70% = $1,537.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTI-Q 8FR J-TIP SV02/CCO,272,RC,27200002,CDM,,,,,,both,,,2195.7500,329.3600,CIGNA HEALTHCARE,CIGNA HMO,915.63,,,,,,,566.7200,2195.7500,percent of total billed charges,"41.7% of $2,195.75 in Billed Charges for Rev 272 = $915.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTI-Q 8FR J-TIP SV02/CCO,272,RC,27200002,CDM,,,,,,both,,,2195.7500,329.3600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1018.83,,,,,,,566.7200,2195.7500,percent of total billed charges,"46.4% of $2,195.75 in Billed Charges for Rev 272 = $1,018.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTI-Q 8FR J-TIP SV02/CCO,272,RC,27200002,CDM,,,,,,both,,,2195.7500,329.3600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,915.63,,,,,,,566.7200,2195.7500,percent of total billed charges,"41.7% of $2,195.75 in Billed Charges for Rev 272 = $915.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTI-Q 8FR J-TIP SV02/CCO,272,RC,27200002,CDM,,,,,,both,,,2195.7500,329.3600,CIGNA HEALTHCARE,CIGNA PPO,915.63,,,,,,,566.7200,2195.7500,percent of total billed charges,"41.7% of $2,195.75 in Billed Charges for Rev 272 = $915.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTI-Q 8FR J-TIP SV02/CCO,272,RC,27200002,CDM,,,,,,both,,,2195.7500,329.3600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1976.18,,,,,,,566.7200,2195.7500,percent of total billed charges,"90% of $2,195.75 in Billed Charges for Rev 272 = $1,976.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTI-Q 8FR J-TIP SV02/CCO,272,RC,27200002,CDM,,,,,,both,,,2195.7500,329.3600,MEDCOST,MEDCOST VHN,1044.96,,,,,,,566.7200,2195.7500,percent of total billed charges,"47.59% of $2,195.75 in Billed Charges for Rev 272 = $1,044.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTI-Q 8FR J-TIP SV02/CCO,272,RC,27200002,CDM,,,,,,both,,,2195.7500,329.3600,SENTARA HEALTH,SENTARA HEALTH,566.72,,,,,,,566.7200,2195.7500,percent of total billed charges,"25.81% of $2,195.75 in Billed Charges for Rev 272 = $566.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTI-Q 8FR J-TIP SV02/CCO,272,RC,27200002,CDM,,,,,,both,,,2195.7500,329.3600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2195.75,,,,,,,566.7200,2195.7500,percent of total billed charges,"100% of $2,195.75 in Billed Charges for Rev 272 = $2,195.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTI-Q 8FR J-TIP SV02/CCO,272,RC,27200002,CDM,,,,,,both,,,2195.7500,329.3600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1097.88,,,,,,,566.7200,2195.7500,percent of total billed charges,"Rev 272 $2,195.75 in Billed Charges at 50% = $1,097.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTI-Q 8FR J-TIP SV02/CCO,272,RC,27200002,CDM,,,,,,both,,,2195.7500,329.3600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,709.23,,,,,,,566.7200,2195.7500,other,"32.3% of $2,195.75 in Billed Charges for Rev 272 = $709.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH OPTI-Q 8FR J-TIP SV02/CCO,272,RC,27200002,CDM,,,,,,both,,,2195.7500,329.3600,UNITED HEALTHCARE,UHC HERITAGE SELECT,674.10,,,,,,,566.7200,2195.7500,other,"30.7% of $2,195.75 in Billed Charges for Rev 272 = $674.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH OPTI-Q 8FR J-TIP SV02/CCO,272,RC,27200002,CDM,,,,,,both,,,2195.7500,329.3600,UNITED HEALTHCARE,UNITED HEALTHCARE,709.23,,,,,,,566.7200,2195.7500,percent of total billed charges,"32.3% of $2,195.75 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OPTI-Q 8FR J-TIP SV02/CCO,272,RC,27200002,CDM,,,,,,both,,,2195.7500,329.3600,WELLCARE,WELLCARE MEDICAID,2195.75,,,,,,,566.7200,2195.7500,percent of total billed charges,"100% of $2,195.75 in Billed Charges for Rev 272 = $2,195.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OUTBACK LTD RE-ENTRY OTB59120A,272,RC,27200002,CDM,,,,,,both,,,17423.2800,2613.4900,AETNA,AETNA,7439.74,,,,,,,4496.9500,17423.2800,percent of total billed charges,"42.7% of $17,423.28 in Billed Charges for Rev 272 = $7,439.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OUTBACK LTD RE-ENTRY OTB59120A,272,RC,27200002,CDM,,,,,,both,,,17423.2800,2613.4900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,12196.30,,,,,,,4496.9500,17423.2800,percent of total billed charges,"Rev 272 $17,423.28 in Billed Charges at 70% = $12,196.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OUTBACK LTD RE-ENTRY OTB59120A,272,RC,27200002,CDM,,,,,,both,,,17423.2800,2613.4900,CIGNA HEALTHCARE,CIGNA HMO,7265.51,,,,,,,4496.9500,17423.2800,percent of total billed charges,"41.7% of $17,423.28 in Billed Charges for Rev 272 = $7,265.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OUTBACK LTD RE-ENTRY OTB59120A,272,RC,27200002,CDM,,,,,,both,,,17423.2800,2613.4900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8084.40,,,,,,,4496.9500,17423.2800,percent of total billed charges,"46.4% of $17,423.28 in Billed Charges for Rev 272 = $8,084.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OUTBACK LTD RE-ENTRY OTB59120A,272,RC,27200002,CDM,,,,,,both,,,17423.2800,2613.4900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7265.51,,,,,,,4496.9500,17423.2800,percent of total billed charges,"41.7% of $17,423.28 in Billed Charges for Rev 272 = $7,265.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OUTBACK LTD RE-ENTRY OTB59120A,272,RC,27200002,CDM,,,,,,both,,,17423.2800,2613.4900,CIGNA HEALTHCARE,CIGNA PPO,7265.51,,,,,,,4496.9500,17423.2800,percent of total billed charges,"41.7% of $17,423.28 in Billed Charges for Rev 272 = $7,265.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OUTBACK LTD RE-ENTRY OTB59120A,272,RC,27200002,CDM,,,,,,both,,,17423.2800,2613.4900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,15680.95,,,,,,,4496.9500,17423.2800,percent of total billed charges,"90% of $17,423.28 in Billed Charges for Rev 272 = $15,680.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OUTBACK LTD RE-ENTRY OTB59120A,272,RC,27200002,CDM,,,,,,both,,,17423.2800,2613.4900,MEDCOST,MEDCOST VHN,8291.74,,,,,,,4496.9500,17423.2800,percent of total billed charges,"47.59% of $17,423.28 in Billed Charges for Rev 272 = $8,291.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OUTBACK LTD RE-ENTRY OTB59120A,272,RC,27200002,CDM,,,,,,both,,,17423.2800,2613.4900,SENTARA HEALTH,SENTARA HEALTH,4496.95,,,,,,,4496.9500,17423.2800,percent of total billed charges,"25.81% of $17,423.28 in Billed Charges for Rev 272 = $4,496.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OUTBACK LTD RE-ENTRY OTB59120A,272,RC,27200002,CDM,,,,,,both,,,17423.2800,2613.4900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",17423.28,,,,,,,4496.9500,17423.2800,percent of total billed charges,"100% of $17,423.28 in Billed Charges for Rev 272 = $17,423.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OUTBACK LTD RE-ENTRY OTB59120A,272,RC,27200002,CDM,,,,,,both,,,17423.2800,2613.4900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8711.64,,,,,,,4496.9500,17423.2800,percent of total billed charges,"Rev 272 $17,423.28 in Billed Charges at 50% = $8,711.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OUTBACK LTD RE-ENTRY OTB59120A,272,RC,27200002,CDM,,,,,,both,,,17423.2800,2613.4900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5627.72,,,,,,,4496.9500,17423.2800,other,"32.3% of $17,423.28 in Billed Charges for Rev 272 = $5,627.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH OUTBACK LTD RE-ENTRY OTB59120A,272,RC,27200002,CDM,,,,,,both,,,17423.2800,2613.4900,UNITED HEALTHCARE,UHC HERITAGE SELECT,5348.95,,,,,,,4496.9500,17423.2800,other,"30.7% of $17,423.28 in Billed Charges for Rev 272 = $5,348.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH OUTBACK LTD RE-ENTRY OTB59120A,272,RC,27200002,CDM,,,,,,both,,,17423.2800,2613.4900,UNITED HEALTHCARE,UNITED HEALTHCARE,5627.72,,,,,,,4496.9500,17423.2800,percent of total billed charges,"32.3% of $17,423.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH OUTBACK LTD RE-ENTRY OTB59120A,272,RC,27200002,CDM,,,,,,both,,,17423.2800,2613.4900,WELLCARE,WELLCARE MEDICAID,17423.28,,,,,,,4496.9500,17423.2800,percent of total billed charges,"100% of $17,423.28 in Billed Charges for Rev 272 = $17,423.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1662.6800,249.4000,AETNA,AETNA,709.96,,,,,,,429.1400,1662.6800,percent of total billed charges,"42.7% of $1,662.68 in Billed Charges for Rev 272 = $709.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1662.6800,249.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1163.88,,,,,,,429.1400,1662.6800,percent of total billed charges,"Rev 272 $1,662.68 in Billed Charges at 70% = $1,163.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1662.6800,249.4000,CIGNA HEALTHCARE,CIGNA HMO,693.34,,,,,,,429.1400,1662.6800,percent of total billed charges,"41.7% of $1,662.68 in Billed Charges for Rev 272 = $693.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1662.6800,249.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,771.48,,,,,,,429.1400,1662.6800,percent of total billed charges,"46.4% of $1,662.68 in Billed Charges for Rev 272 = $771.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1662.6800,249.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,693.34,,,,,,,429.1400,1662.6800,percent of total billed charges,"41.7% of $1,662.68 in Billed Charges for Rev 272 = $693.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1662.6800,249.4000,CIGNA HEALTHCARE,CIGNA PPO,693.34,,,,,,,429.1400,1662.6800,percent of total billed charges,"41.7% of $1,662.68 in Billed Charges for Rev 272 = $693.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1662.6800,249.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1496.41,,,,,,,429.1400,1662.6800,percent of total billed charges,"90% of $1,662.68 in Billed Charges for Rev 272 = $1,496.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1662.6800,249.4000,MEDCOST,MEDCOST VHN,791.27,,,,,,,429.1400,1662.6800,percent of total billed charges,"47.59% of $1,662.68 in Billed Charges for Rev 272 = $791.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1662.6800,249.4000,SENTARA HEALTH,SENTARA HEALTH,429.14,,,,,,,429.1400,1662.6800,percent of total billed charges,"25.81% of $1,662.68 in Billed Charges for Rev 272 = $429.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1662.6800,249.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1662.68,,,,,,,429.1400,1662.6800,percent of total billed charges,"100% of $1,662.68 in Billed Charges for Rev 272 = $1,662.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1662.6800,249.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,831.34,,,,,,,429.1400,1662.6800,percent of total billed charges,"Rev 272 $1,662.68 in Billed Charges at 50% = $831.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1662.6800,249.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,537.05,,,,,,,429.1400,1662.6800,other,"32.3% of $1,662.68 in Billed Charges for Rev 272 = $537.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1662.6800,249.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,510.44,,,,,,,429.1400,1662.6800,other,"30.7% of $1,662.68 in Billed Charges for Rev 272 = $510.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1662.6800,249.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,537.05,,,,,,,429.1400,1662.6800,percent of total billed charges,"32.3% of $1,662.68 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 38CM,272,RC,27200002,CDM,,,,,,both,,,1662.6800,249.4000,WELLCARE,WELLCARE MEDICAID,1662.68,,,,,,,429.1400,1662.6800,percent of total billed charges,"100% of $1,662.68 in Billed Charges for Rev 272 = $1,662.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,AETNA,AETNA,44.41,,,,,,,26.2400,104.0000,percent of total billed charges,42.7% of $104.00 in Billed Charges for Rev 510 Proc 0358T = $44.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,84.05,,,,,,,26.2400,104.0000,fee schedule,APG 00418 Proc 0358T at $836.60 (Base Rate) * 0.0966 (Relative Weight) = $80.82 (Total Line Payment) at 104% = $84.05. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,26.24,,,,,,,26.2400,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,AETNA,AETNA HEALTHCARE MEDICARE,26.24,,,,,,,26.2400,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,26.24,,,,,,,26.2400,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,AMBETTER,AMBETTER,57.21,,,,,,,26.2400,104.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,27.29,,,,,,,26.2400,104.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,ANTHEM EXCHANGE,64.60,,,,,,,26.2400,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,83.24,,,,,,,26.2400,104.0000,fee schedule,APG 00418 Proc 0358T at $836.60 (Base Rate) * 0.0966 (Relative Weight) = $80.82 (Total Line Payment) at 103% = $83.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,ANTHEM HMO,68.63,,,,,,,26.2400,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,27.03,,,,,,,26.2400,104.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",80.74,,,,,,,26.2400,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,72.80,,,,,,,26.2400,104.0000,percent of total billed charges,Rev 510 Proc 0358T $104.00 in Billed Charges at 70% = $72.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,BLUE CROSS MEDICARE,27.29,,,,,,,26.2400,104.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,CIGNA HEALTHCARE,CIGNA HMO,43.37,,,,,,,26.2400,104.0000,percent of total billed charges,41.7% of $104.00 in Billed Charges for Rev 510 Proc 0358T = $43.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,48.26,,,,,,,26.2400,104.0000,percent of total billed charges,46.4% of $104.00 in Billed Charges for Rev 510 Proc 0358T = $48.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,27.55,,,,,,,26.2400,104.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,43.37,,,,,,,26.2400,104.0000,percent of total billed charges,41.7% of $104.00 in Billed Charges for Rev 510 Proc 0358T = $43.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,CIGNA HEALTHCARE,CIGNA PPO,43.37,,,,,,,26.2400,104.0000,percent of total billed charges,41.7% of $104.00 in Billed Charges for Rev 510 Proc 0358T = $43.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,27.55,,,,,,,26.2400,104.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,93.60,,,,,,,26.2400,104.0000,percent of total billed charges,90% of $104.00 in Billed Charges for Rev 510 Proc 0358T = $93.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,HUMANA,HUMANA MEDICARE,26.24,,,,,,,26.2400,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,26.24,,,,,,,26.2400,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,MEDCOST,MEDCOST VHN,49.49,,,,,,,26.2400,104.0000,percent of total billed charges,47.59% of $104.00 in Billed Charges for Rev 510 Proc 0358T = $49.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,84.86,,,,,,,26.2400,104.0000,fee schedule,APG 00418 Proc 0358T at $836.60 (Base Rate) * 0.0966 (Relative Weight) = $80.82 (Total Line Payment) at 100% = $80.82... $80.82 at 105% = $84.86 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,27.55,,,,,,,26.2400,104.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,27.55,,,,,,,26.2400,104.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,NHC ADVANTAGE,NHC ADVANTAGE,27.55,,,,,,,26.2400,104.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,83.33,,,,,,,26.2400,104.0000,fee schedule,APG 00418 Proc 0358T at $836.60 (Base Rate) * 0.0966 (Relative Weight) = $80.82 (Total Line Payment) at 100% = $80.82... $80.82 at 103.1% = $83.33 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,SENTARA HEALTH,SENTARA HEALTH,26.84,,,,,,,26.2400,104.0000,percent of total billed charges,25.81% of $104.00 in Billed Charges for Rev 510 Proc 0358T = $26.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,SENTARA HEALTH,SENTARA MEDICARE,26.24,,,,,,,26.2400,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",104.00,,,,,,,26.2400,104.0000,percent of total billed charges,100% of $104.00 in Billed Charges for Rev 510 Proc 0358T = $104.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,26.72,,,,,,,26.2400,104.0000,fee schedule,$53.44 from Fee Schedule TCUHC24 for Rev 510 Proc 0358T * Qty 1 = $53.44 at 50% = $26.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,33.59,,,,,,,26.2400,104.0000,other,32.3% of $104.00 in Billed Charges for Rev 510 Proc 0358T = $33.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,31.93,,,,,,,26.2400,104.0000,other,30.7% of $104.00 in Billed Charges for Rev 510 Proc 0358T = $31.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,33.59,,,,,,,26.2400,104.0000,percent of total billed charges,32.3% of $104.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,83.24,,,,,,,26.2400,104.0000,fee schedule,APG 00418 Proc 0358T at $836.60 (Base Rate) * 0.0966 (Relative Weight) = $80.82 (Total Line Payment) at 103% = $83.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,26.24,,,,,,,26.2400,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,26.24,,,,,,,26.2400,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,WELLCARE,WELLCARE MEDICAID,104.00,,,,,,,26.2400,104.0000,percent of total billed charges,100% of $104.00 in Billed Charges for Rev 510 Proc 0358T = $104.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIA WHOLE BODY,0358T,CPT,510,RC,51000188,CDM,,,,both,,,104.0000,15.6000,WELLCARE,WELLCARE MEDICARE,27.82,,,,,,,26.2400,104.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,AETNA,AETNA,44.84,,,,,,,14.1300,105.0000,percent of total billed charges,42.7% of $105.00 in Billed Charges for Rev 302 Proc 0432U = $44.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,14.27,,,,,,,14.1300,105.0000,fee schedule,APG 00400 Proc 0432U at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 104% = $14.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,36.57,,,,,,,14.1300,105.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,AETNA,AETNA HEALTHCARE MEDICARE,36.57,,,,,,,14.1300,105.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,36.57,,,,,,,14.1300,105.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,AMBETTER,AMBETTER,79.72,,,,,,,14.1300,105.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,AMERIGROUP,AMERIGROUP,18.29,,,,,,,14.1300,105.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,38.03,,,,,,,14.1300,105.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,BLUE CROSS,ANTHEM EXCHANGE,36.57,,,,,,,14.1300,105.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,14.13,,,,,,,14.1300,105.0000,fee schedule,APG 00400 Proc 0432U at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,BLUE CROSS,ANTHEM HMO,36.57,,,,,,,14.1300,105.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,37.67,,,,,,,14.1300,105.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",36.57,,,,,,,14.1300,105.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,73.50,,,,,,,14.1300,105.0000,percent of total billed charges,Rev 302 Proc 0432U $105.00 in Billed Charges at 70% = $73.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,BLUE CROSS,BLUE CROSS E NETWORK,105.00,,,,,,,14.1300,105.0000,fee schedule,"$36.57 from Fee Schedule BCFSB for Rev 302 Proc 0432U * Qty 1 = $36.57 at 320% = $117.02 (Service Line reduced to $105.00, claim capped at $105.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,BLUE CROSS,BLUE CROSS MEDICARE,38.03,,,,,,,14.1300,105.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,BLUE CROSS,BLUE CROSS P NETWORK,105.00,,,,,,,14.1300,105.0000,fee schedule,"$36.57 from Fee Schedule BCFSB for Rev 302 Proc 0432U * Qty 1 = $36.57 at 327% = $119.58 (Service Line reduced to $105.00, claim capped at $105.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,BLUE CROSS,BLUE CROSS S NETWORK,105.00,,,,,,,14.1300,105.0000,fee schedule,"$36.57 from Fee Schedule BCFSB for Rev 302 Proc 0432U * Qty 1 = $36.57 at 327% = $119.58 (Service Line reduced to $105.00, claim capped at $105.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,CIGNA HEALTHCARE,CIGNA HMO,43.79,,,,,,,14.1300,105.0000,percent of total billed charges,Rev 302 Proc 0432U $105.00 in Billed Charges at 41.7% = $43.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,44.94,,,,,,,14.1300,105.0000,percent of total billed charges,Rev 302 Proc 0432U $105.00 in Billed Charges at 42.8% = $44.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,38.40,,,,,,,14.1300,105.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,43.79,,,,,,,14.1300,105.0000,percent of total billed charges,Rev 302 Proc 0432U $105.00 in Billed Charges at 41.7% = $43.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,CIGNA HEALTHCARE,CIGNA PPO,43.79,,,,,,,14.1300,105.0000,percent of total billed charges,Rev 302 Proc 0432U $105.00 in Billed Charges at 41.7% = $43.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,38.40,,,,,,,14.1300,105.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,94.50,,,,,,,14.1300,105.0000,percent of total billed charges,90% of $105.00 in Billed Charges for Rev 302 Proc 0432U = $94.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,HUMANA,HUMANA MEDICARE,36.57,,,,,,,14.1300,105.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,36.57,,,,,,,14.1300,105.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,MEDCOST,MEDCOST VHN,49.97,,,,,,,14.1300,105.0000,percent of total billed charges,47.59% of $105.00 in Billed Charges for Rev 302 Proc 0432U = $49.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,14.41,,,,,,,14.1300,105.0000,fee schedule,APG 00400 Proc 0432U at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 105% = $14.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,38.40,,,,,,,14.1300,105.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,38.40,,,,,,,14.1300,105.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,NHC ADVANTAGE,NHC ADVANTAGE,38.40,,,,,,,14.1300,105.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,14.15,,,,,,,14.1300,105.0000,fee schedule,APG 00400 Proc 0432U at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 103.1% = $14.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,SENTARA HEALTH,SENTARA HEALTH,27.10,,,,,,,14.1300,105.0000,percent of total billed charges,25.81% of $105.00 in Billed Charges for Rev 302 Proc 0432U = $27.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,SENTARA HEALTH,SENTARA MEDICARE,36.57,,,,,,,14.1300,105.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",105.00,,,,,,,14.1300,105.0000,percent of total billed charges,100% of $105.00 in Billed Charges for Rev 302 Proc 0432U = $105.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,18.29,,,,,,,14.1300,105.0000,fee schedule,$36.57 from Fee Schedule TCUHC24 for Rev 302 Proc 0432U * Qty 1 = $36.57 at 50% = $18.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,38.03,,,,,,,14.1300,105.0000,fee schedule,$36.57 from Fee Schedule UHC_31910 for Rev 302 Proc 0432U * Qty 1 = $36.57 at 104% = $38.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,36.57,,,,,,,14.1300,105.0000,fee schedule,$36.57 from Fee Schedule UHC_31910 for Rev 302 Proc 0432U * Qty 1 = $36.57 at 100% = $36.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,36.57,,,,,,,14.1300,105.0000,fee schedule,$36.57 from Fee Schedule UHC_31910 for Rev 302 Proc 0432U * Qty 1 = $36.57 at 100% = $36.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,14.13,,,,,,,14.1300,105.0000,fee schedule,APG 00400 Proc 0432U at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,36.57,,,,,,,14.1300,105.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,36.57,,,,,,,14.1300,105.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,WELLCARE,WELLCARE MEDICAID,105.00,,,,,,,14.1300,105.0000,percent of total billed charges,100% of $105.00 in Billed Charges for Rev 302 Proc 0432U = $105.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KLHL11 ANTB SERUM/CSF CELL BINDING ASSAY QUAL,0432U,CPT,302,RC,30200163,CDM,,,,both,,,105.0000,15.7500,WELLCARE,WELLCARE MEDICARE,38.76,,,,,,,14.1300,105.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,AETNA,AETNA,10937.18,,,,,,,2155.7100,25614.0000,percent of total billed charges,"42.7% of $25,614.00 in Billed Charges for Rev 481 Proc 0572T = $10,937.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2176.64,,,,,,,2155.7100,25614.0000,fee schedule,"APG 00074 Proc 0572T at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 104% = $2,176.64. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,7508.05,,,,,,,2155.7100,25614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,AETNA,AETNA HEALTHCARE MEDICARE,7508.05,,,,,,,2155.7100,25614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,7508.05,,,,,,,2155.7100,25614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,AMBETTER,AMBETTER,16367.55,,,,,,,2155.7100,25614.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,7808.37,,,,,,,2155.7100,25614.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,BLUE CROSS,ANTHEM EXCHANGE,18485.22,,,,,,,2155.7100,25614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2155.71,,,,,,,2155.7100,25614.0000,fee schedule,"APG 00074 Proc 0572T at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,BLUE CROSS,ANTHEM HMO,19639.44,,,,,,,2155.7100,25614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,7733.29,,,,,,,2155.7100,25614.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",23103.98,,,,,,,2155.7100,25614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,17929.80,,,,,,,2155.7100,25614.0000,percent of total billed charges,"Rev 481 Proc 0572T $25,614.00 in Billed Charges at 70% = $17,929.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,2155.7100,25614.0000,case rate,"Rev 481 Proc 0572T ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,BLUE CROSS,BLUE CROSS MEDICARE,7808.37,,,,,,,2155.7100,25614.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,2155.7100,25614.0000,case rate,"Rev 481 Proc 0572T ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,2155.7100,25614.0000,case rate,"Rev 481 Proc 0572T ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,CIGNA HEALTHCARE,CIGNA HMO,10681.04,,,,,,,2155.7100,25614.0000,percent of total billed charges,"41.7% of $25,614.00 in Billed Charges for Rev 481 Proc 0572T = $10,681.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11884.90,,,,,,,2155.7100,25614.0000,percent of total billed charges,"46.4% of $25,614.00 in Billed Charges for Rev 481 Proc 0572T = $11,884.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,7883.45,,,,,,,2155.7100,25614.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,10681.04,,,,,,,2155.7100,25614.0000,percent of total billed charges,"41.7% of $25,614.00 in Billed Charges for Rev 481 Proc 0572T = $10,681.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,CIGNA HEALTHCARE,CIGNA PPO,10681.04,,,,,,,2155.7100,25614.0000,percent of total billed charges,"41.7% of $25,614.00 in Billed Charges for Rev 481 Proc 0572T = $10,681.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,7883.45,,,,,,,2155.7100,25614.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,23052.60,,,,,,,2155.7100,25614.0000,percent of total billed charges,"90% of $25,614.00 in Billed Charges for Rev 481 Proc 0572T = $23,052.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,HUMANA,HUMANA MEDICARE,7508.05,,,,,,,2155.7100,25614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,7508.05,,,,,,,2155.7100,25614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,MEDCOST,MEDCOST VHN,12189.70,,,,,,,2155.7100,25614.0000,percent of total billed charges,"47.59% of $25,614.00 in Billed Charges for Rev 481 Proc 0572T = $12,189.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2197.57,,,,,,,2155.7100,25614.0000,fee schedule,"APG 00074 Proc 0572T at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 100% = $2,092.92... $2,092.92 at 105% = $2,197.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,7883.45,,,,,,,2155.7100,25614.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,7883.45,,,,,,,2155.7100,25614.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,NHC ADVANTAGE,NHC ADVANTAGE,7883.45,,,,,,,2155.7100,25614.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2157.80,,,,,,,2155.7100,25614.0000,fee schedule,"APG 00074 Proc 0572T at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 100% = $2,092.92... $2,092.92 at 103.1% = $2,157.80 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,SENTARA HEALTH,SENTARA HEALTH,6610.97,,,,,,,2155.7100,25614.0000,percent of total billed charges,"25.81% of $25,614.00 in Billed Charges for Rev 481 Proc 0572T = $6,610.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,SENTARA HEALTH,SENTARA MEDICARE,7508.05,,,,,,,2155.7100,25614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",25614.00,,,,,,,2155.7100,25614.0000,percent of total billed charges,"100% of $25,614.00 in Billed Charges for Rev 481 Proc 0572T = $25,614.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,2155.7100,25614.0000,case rate,"Rev 481 Proc 0572T ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,2155.7100,25614.0000,case rate,"Rev 481 Proc 0572T ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,2155.7100,25614.0000,case rate,"Rev 481 Proc 0572T ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,20054.00,,,,,,,2155.7100,25614.0000,case rate,"Rev 481 Proc 0572T ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2155.71,,,,,,,2155.7100,25614.0000,fee schedule,"APG 00074 Proc 0572T at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,7508.05,,,,,,,2155.7100,25614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,7508.05,,,,,,,2155.7100,25614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,WELLCARE,WELLCARE MEDICAID,25614.00,,,,,,,2155.7100,25614.0000,percent of total billed charges,"100% of $25,614.00 in Billed Charges for Rev 481 Proc 0572T = $25,614.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0572T,CPT,481,RC,48100231,CDM,,,,both,,,25614.0000,3842.1000,WELLCARE,WELLCARE MEDICARE,7958.53,,,,,,,2155.7100,25614.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,AETNA,AETNA,5055.25,,,,,,,1881.0000,11839.0000,percent of total billed charges,"42.7% of $11,839.00 in Billed Charges for Rev 481 Proc 0573T = $5,055.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2176.64,,,,,,,1881.0000,11839.0000,fee schedule,"APG 00074 Proc 0573T at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 104% = $2,176.64. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3390.45,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,AETNA,AETNA HEALTHCARE MEDICARE,3390.45,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,3390.45,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,AMBETTER,AMBETTER,7391.18,,,,,,,1881.0000,11839.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3526.07,,,,,,,1881.0000,11839.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,ANTHEM EXCHANGE,8347.47,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2155.71,,,,,,,1881.0000,11839.0000,fee schedule,"APG 00074 Proc 0573T at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,ANTHEM HMO,8868.69,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3492.16,,,,,,,1881.0000,11839.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",10433.19,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8287.30,,,,,,,1881.0000,11839.0000,percent of total billed charges,"Rev 481 Proc 0573T $11,839.00 in Billed Charges at 70% = $8,287.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,1881.0000,11839.0000,case rate,"Rev 481 Proc 0573T ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,BLUE CROSS MEDICARE,3526.07,,,,,,,1881.0000,11839.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,1881.0000,11839.0000,case rate,"Rev 481 Proc 0573T ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,1881.0000,11839.0000,case rate,"Rev 481 Proc 0573T ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,CIGNA HEALTHCARE,CIGNA HMO,4936.86,,,,,,,1881.0000,11839.0000,percent of total billed charges,"41.7% of $11,839.00 in Billed Charges for Rev 481 Proc 0573T = $4,936.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5493.30,,,,,,,1881.0000,11839.0000,percent of total billed charges,"46.4% of $11,839.00 in Billed Charges for Rev 481 Proc 0573T = $5,493.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,3559.97,,,,,,,1881.0000,11839.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4936.86,,,,,,,1881.0000,11839.0000,percent of total billed charges,"41.7% of $11,839.00 in Billed Charges for Rev 481 Proc 0573T = $4,936.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,CIGNA HEALTHCARE,CIGNA PPO,4936.86,,,,,,,1881.0000,11839.0000,percent of total billed charges,"41.7% of $11,839.00 in Billed Charges for Rev 481 Proc 0573T = $4,936.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3559.97,,,,,,,1881.0000,11839.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10655.10,,,,,,,1881.0000,11839.0000,percent of total billed charges,"90% of $11,839.00 in Billed Charges for Rev 481 Proc 0573T = $10,655.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,HUMANA,HUMANA MEDICARE,3390.45,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3390.45,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,MEDCOST,MEDCOST VHN,5634.18,,,,,,,1881.0000,11839.0000,percent of total billed charges,"47.59% of $11,839.00 in Billed Charges for Rev 481 Proc 0573T = $5,634.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2197.57,,,,,,,1881.0000,11839.0000,fee schedule,"APG 00074 Proc 0573T at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 105% = $2,197.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3559.97,,,,,,,1881.0000,11839.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3559.97,,,,,,,1881.0000,11839.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,NHC ADVANTAGE,NHC ADVANTAGE,3559.97,,,,,,,1881.0000,11839.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2157.80,,,,,,,1881.0000,11839.0000,fee schedule,"APG 00074 Proc 0573T at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 103.1% = $2,157.80 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,SENTARA HEALTH,SENTARA HEALTH,3055.65,,,,,,,1881.0000,11839.0000,percent of total billed charges,"25.81% of $11,839.00 in Billed Charges for Rev 481 Proc 0573T = $3,055.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,SENTARA HEALTH,SENTARA MEDICARE,3390.45,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11839.00,,,,,,,1881.0000,11839.0000,percent of total billed charges,"100% of $11,839.00 in Billed Charges for Rev 481 Proc 0573T = $11,839.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,1881.0000,11839.0000,case rate,"Rev 481 Proc 0573T ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,1881.0000,11839.0000,case rate,"Rev 481 Proc 0573T ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,1881.0000,11839.0000,case rate,"Rev 481 Proc 0573T ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,1881.0000,11839.0000,case rate,"Rev 481 Proc 0573T ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2155.71,,,,,,,1881.0000,11839.0000,fee schedule,"APG 00074 Proc 0573T at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3390.45,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3390.45,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,WELLCARE,WELLCARE MEDICAID,11839.00,,,,,,,1881.0000,11839.0000,percent of total billed charges,"100% of $11,839.00 in Billed Charges for Rev 481 Proc 0573T = $11,839.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELTRD,0573T,CPT,481,RC,48100232,CDM,,,,both,,,11839.0000,1775.8500,WELLCARE,WELLCARE MEDICARE,3593.87,,,,,,,1881.0000,11839.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,AETNA,AETNA,48.25,,,,,,,29.1700,113.0000,percent of total billed charges,42.7% of $113.00 in Billed Charges for Rev 481 Proc 0575T = $48.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,51.42,,,,,,,29.1700,113.0000,fee schedule,APG 00488 Proc 0575T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 104% = $51.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,33.86,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,AETNA,AETNA HEALTHCARE MEDICARE,33.86,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,33.86,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,AMBETTER,AMBETTER,73.82,,,,,,,29.1700,113.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,35.22,,,,,,,29.1700,113.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,ANTHEM EXCHANGE,83.37,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,50.93,,,,,,,29.1700,113.0000,fee schedule,APG 00488 Proc 0575T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 103% = $50.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,ANTHEM HMO,88.57,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,34.88,,,,,,,29.1700,113.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",104.20,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,79.10,,,,,,,29.1700,113.0000,percent of total billed charges,Rev 481 Proc 0575T $113.00 in Billed Charges at 70% = $79.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,BLUE CROSS MEDICARE,35.22,,,,,,,29.1700,113.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA HMO,47.12,,,,,,,29.1700,113.0000,percent of total billed charges,41.7% of $113.00 in Billed Charges for Rev 481 Proc 0575T = $47.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,52.43,,,,,,,29.1700,113.0000,percent of total billed charges,46.4% of $113.00 in Billed Charges for Rev 481 Proc 0575T = $52.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,35.55,,,,,,,29.1700,113.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,47.12,,,,,,,29.1700,113.0000,percent of total billed charges,41.7% of $113.00 in Billed Charges for Rev 481 Proc 0575T = $47.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA PPO,47.12,,,,,,,29.1700,113.0000,percent of total billed charges,41.7% of $113.00 in Billed Charges for Rev 481 Proc 0575T = $47.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,35.55,,,,,,,29.1700,113.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,101.70,,,,,,,29.1700,113.0000,percent of total billed charges,90% of $113.00 in Billed Charges for Rev 481 Proc 0575T = $101.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,HUMANA,HUMANA MEDICARE,33.86,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,33.86,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,MEDCOST,MEDCOST VHN,53.78,,,,,,,29.1700,113.0000,percent of total billed charges,47.59% of $113.00 in Billed Charges for Rev 481 Proc 0575T = $53.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,51.91,,,,,,,29.1700,113.0000,fee schedule,APG 00488 Proc 0575T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 100% = $49.44... $49.44 at 105% = $51.91 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,35.55,,,,,,,29.1700,113.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,35.55,,,,,,,29.1700,113.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,NHC ADVANTAGE,NHC ADVANTAGE,35.55,,,,,,,29.1700,113.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,50.97,,,,,,,29.1700,113.0000,fee schedule,APG 00488 Proc 0575T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 100% = $49.44... $49.44 at 103.1% = $50.97 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,SENTARA HEALTH,SENTARA HEALTH,29.17,,,,,,,29.1700,113.0000,percent of total billed charges,25.81% of $113.00 in Billed Charges for Rev 481 Proc 0575T = $29.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,SENTARA HEALTH,SENTARA MEDICARE,33.86,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",113.00,,,,,,,29.1700,113.0000,percent of total billed charges,100% of $113.00 in Billed Charges for Rev 481 Proc 0575T = $113.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,50.93,,,,,,,29.1700,113.0000,fee schedule,APG 00488 Proc 0575T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 103% = $50.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,33.86,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,33.86,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,WELLCARE,WELLCARE MEDICAID,113.00,,,,,,,29.1700,113.0000,percent of total billed charges,100% of $113.00 in Billed Charges for Rev 481 Proc 0575T = $113.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON,0575T,CPT,481,RC,48100237,CDM,,,,both,,,113.0000,16.9500,WELLCARE,WELLCARE MEDICARE,35.89,,,,,,,29.1700,113.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,AETNA,AETNA,1532.08,,,,,,,926.0600,9855.9800,percent of total billed charges,"42.7% of $3,588.00 in Billed Charges for Rev 481 Proc 0577T = $1,532.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,9762.12,,,,,,,926.0600,9855.9800,fee schedule,"APG 00096 Proc 0577T at $836.60 (Base Rate) * 11.22 (Relative Weight) = $9,386.65 (Total Line Payment) at 104% = $9,762.12. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1104.64,,,,,,,926.0600,9855.9800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,AETNA,AETNA HEALTHCARE MEDICARE,1104.64,,,,,,,926.0600,9855.9800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,1104.64,,,,,,,926.0600,9855.9800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,AMBETTER,AMBETTER,2408.12,,,,,,,926.0600,9855.9800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1148.83,,,,,,,926.0600,9855.9800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,BLUE CROSS,ANTHEM EXCHANGE,2719.69,,,,,,,926.0600,9855.9800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3588.00,,,,,,,926.0600,9855.9800,fee schedule,"APG 00096 Proc 0577T at $836.60 (Base Rate) * 11.22 (Relative Weight) = $9,386.65 (Total Line Payment) at 103% = $9,668.25 (Service Line reduced to $3,588.00, claim capped at $3,588.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,BLUE CROSS,ANTHEM HMO,2889.51,,,,,,,926.0600,9855.9800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1137.78,,,,,,,926.0600,9855.9800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3399.24,,,,,,,926.0600,9855.9800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2511.60,,,,,,,926.0600,9855.9800,percent of total billed charges,"Rev 481 Proc 0577T $3,588.00 in Billed Charges at 70% = $2,511.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,BLUE CROSS,BLUE CROSS MEDICARE,1148.83,,,,,,,926.0600,9855.9800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,CIGNA HEALTHCARE,CIGNA HMO,1496.20,,,,,,,926.0600,9855.9800,percent of total billed charges,"41.7% of $3,588.00 in Billed Charges for Rev 481 Proc 0577T = $1,496.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1664.83,,,,,,,926.0600,9855.9800,percent of total billed charges,"46.4% of $3,588.00 in Billed Charges for Rev 481 Proc 0577T = $1,664.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,1159.87,,,,,,,926.0600,9855.9800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1496.20,,,,,,,926.0600,9855.9800,percent of total billed charges,"41.7% of $3,588.00 in Billed Charges for Rev 481 Proc 0577T = $1,496.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,CIGNA HEALTHCARE,CIGNA PPO,1496.20,,,,,,,926.0600,9855.9800,percent of total billed charges,"41.7% of $3,588.00 in Billed Charges for Rev 481 Proc 0577T = $1,496.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1159.87,,,,,,,926.0600,9855.9800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3229.20,,,,,,,926.0600,9855.9800,percent of total billed charges,"90% of $3,588.00 in Billed Charges for Rev 481 Proc 0577T = $3,229.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,HUMANA,HUMANA MEDICARE,1104.64,,,,,,,926.0600,9855.9800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1104.64,,,,,,,926.0600,9855.9800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,MEDCOST,MEDCOST VHN,1707.53,,,,,,,926.0600,9855.9800,percent of total billed charges,"47.59% of $3,588.00 in Billed Charges for Rev 481 Proc 0577T = $1,707.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,9855.98,,,,,,,926.0600,9855.9800,fee schedule,"APG 00096 Proc 0577T at $836.60 (Base Rate) * 11.22 (Relative Weight) = $9,386.65 (Total Line Payment) at 100% = $9,386.65... $9,386.65 at 105% = $9,855.98 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1159.87,,,,,,,926.0600,9855.9800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1159.87,,,,,,,926.0600,9855.9800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,NHC ADVANTAGE,NHC ADVANTAGE,1159.87,,,,,,,926.0600,9855.9800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,9677.64,,,,,,,926.0600,9855.9800,fee schedule,"APG 00096 Proc 0577T at $836.60 (Base Rate) * 11.22 (Relative Weight) = $9,386.65 (Total Line Payment) at 100% = $9,386.65... $9,386.65 at 103.1% = $9,677.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,SENTARA HEALTH,SENTARA HEALTH,926.06,,,,,,,926.0600,9855.9800,percent of total billed charges,"25.81% of $3,588.00 in Billed Charges for Rev 481 Proc 0577T = $926.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,SENTARA HEALTH,SENTARA MEDICARE,1104.64,,,,,,,926.0600,9855.9800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3588.00,,,,,,,926.0600,9855.9800,percent of total billed charges,"100% of $3,588.00 in Billed Charges for Rev 481 Proc 0577T = $3,588.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,9668.25,,,,,,,926.0600,9855.9800,fee schedule,"APG 00096 Proc 0577T at $836.60 (Base Rate) * 11.22 (Relative Weight) = $9,386.65 (Total Line Payment) at 103% = $9,668.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1104.64,,,,,,,926.0600,9855.9800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1104.64,,,,,,,926.0600,9855.9800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,WELLCARE,WELLCARE MEDICAID,3588.00,,,,,,,926.0600,9855.9800,percent of total billed charges,"100% of $3,588.00 in Billed Charges for Rev 481 Proc 0577T = $3,588.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ELECTROPHYSIOLOGIC EVAL ICDS W/SS ELECTRODE,0577T,CPT,481,RC,48100234,CDM,,,,both,,,3588.0000,538.2000,WELLCARE,WELLCARE MEDICARE,1170.92,,,,,,,926.0600,9855.9800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D PHY/QHP,0578T,CPT,481,RC,48100239,CDM,,,,both,,,113.0000,16.9500,AETNA,AETNA,48.25,,,,,,,29.1700,113.0000,percent of total billed charges,42.7% of $113.00 in Billed Charges for Rev 481 Proc 0578T = $48.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REM INTERROG DEV EVAL SS LD ICDS <90D PHY/QHP,0578T,CPT,481,RC,48100239,CDM,,,,both,,,113.0000,16.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,51.42,,,,,,,29.1700,113.0000,fee schedule,APG 00488 Proc 0578T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 104% = $51.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D PHY/QHP,0578T,CPT,481,RC,48100239,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,50.93,,,,,,,29.1700,113.0000,fee schedule,APG 00488 Proc 0578T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 103% = $50.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D PHY/QHP,0578T,CPT,481,RC,48100239,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,79.10,,,,,,,29.1700,113.0000,percent of total billed charges,Rev 481 Proc 0578T $113.00 in Billed Charges at 70% = $79.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REM INTERROG DEV EVAL SS LD ICDS <90D PHY/QHP,0578T,CPT,481,RC,48100239,CDM,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA HMO,47.12,,,,,,,29.1700,113.0000,percent of total billed charges,41.7% of $113.00 in Billed Charges for Rev 481 Proc 0578T = $47.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REM INTERROG DEV EVAL SS LD ICDS <90D PHY/QHP,0578T,CPT,481,RC,48100239,CDM,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,52.43,,,,,,,29.1700,113.0000,percent of total billed charges,46.4% of $113.00 in Billed Charges for Rev 481 Proc 0578T = $52.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REM INTERROG DEV EVAL SS LD ICDS <90D PHY/QHP,0578T,CPT,481,RC,48100239,CDM,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,47.12,,,,,,,29.1700,113.0000,percent of total billed charges,41.7% of $113.00 in Billed Charges for Rev 481 Proc 0578T = $47.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REM INTERROG DEV EVAL SS LD ICDS <90D PHY/QHP,0578T,CPT,481,RC,48100239,CDM,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA PPO,47.12,,,,,,,29.1700,113.0000,percent of total billed charges,41.7% of $113.00 in Billed Charges for Rev 481 Proc 0578T = $47.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REM INTERROG DEV EVAL SS LD ICDS <90D PHY/QHP,0578T,CPT,481,RC,48100239,CDM,,,,both,,,113.0000,16.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,101.70,,,,,,,29.1700,113.0000,percent of total billed charges,90% of $113.00 in Billed Charges for Rev 481 Proc 0578T = $101.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REM INTERROG DEV EVAL SS LD ICDS <90D PHY/QHP,0578T,CPT,481,RC,48100239,CDM,,,,both,,,113.0000,16.9500,MEDCOST,MEDCOST VHN,53.78,,,,,,,29.1700,113.0000,percent of total billed charges,47.59% of $113.00 in Billed Charges for Rev 481 Proc 0578T = $53.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REM INTERROG DEV EVAL SS LD ICDS <90D PHY/QHP,0578T,CPT,481,RC,48100239,CDM,,,,both,,,113.0000,16.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,51.91,,,,,,,29.1700,113.0000,fee schedule,APG 00488 Proc 0578T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 100% = $49.44... $49.44 at 105% = $51.91 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D PHY/QHP,0578T,CPT,481,RC,48100239,CDM,,,,both,,,113.0000,16.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,50.97,,,,,,,29.1700,113.0000,fee schedule,APG 00488 Proc 0578T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 100% = $49.44... $49.44 at 103.1% = $50.97 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D PHY/QHP,0578T,CPT,481,RC,48100239,CDM,,,,both,,,113.0000,16.9500,SENTARA HEALTH,SENTARA HEALTH,29.17,,,,,,,29.1700,113.0000,percent of total billed charges,25.81% of $113.00 in Billed Charges for Rev 481 Proc 0578T = $29.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REM INTERROG DEV EVAL SS LD ICDS <90D PHY/QHP,0578T,CPT,481,RC,48100239,CDM,,,,both,,,113.0000,16.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",113.00,,,,,,,29.1700,113.0000,percent of total billed charges,100% of $113.00 in Billed Charges for Rev 481 Proc 0578T = $113.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REM INTERROG DEV EVAL SS LD ICDS <90D PHY/QHP,0578T,CPT,481,RC,48100239,CDM,,,,both,,,113.0000,16.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,50.93,,,,,,,29.1700,113.0000,fee schedule,APG 00488 Proc 0578T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 103% = $50.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D PHY/QHP,0578T,CPT,481,RC,48100239,CDM,,,,both,,,113.0000,16.9500,WELLCARE,WELLCARE MEDICAID,113.00,,,,,,,29.1700,113.0000,percent of total billed charges,100% of $113.00 in Billed Charges for Rev 481 Proc 0578T = $113.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,AETNA,AETNA,48.25,,,,,,,29.1700,113.0000,percent of total billed charges,42.7% of $113.00 in Billed Charges for Rev 481 Proc 0579T = $48.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,51.42,,,,,,,29.1700,113.0000,fee schedule,APG 00488 Proc 0579T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 104% = $51.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,33.86,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,AETNA,AETNA HEALTHCARE MEDICARE,33.86,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,33.86,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,AMBETTER,AMBETTER,73.82,,,,,,,29.1700,113.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,35.22,,,,,,,29.1700,113.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,ANTHEM EXCHANGE,83.37,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,50.93,,,,,,,29.1700,113.0000,fee schedule,APG 00488 Proc 0579T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 103% = $50.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,ANTHEM HMO,88.57,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,34.88,,,,,,,29.1700,113.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",104.20,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,79.10,,,,,,,29.1700,113.0000,percent of total billed charges,Rev 481 Proc 0579T $113.00 in Billed Charges at 70% = $79.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,BLUE CROSS MEDICARE,35.22,,,,,,,29.1700,113.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA HMO,47.12,,,,,,,29.1700,113.0000,percent of total billed charges,41.7% of $113.00 in Billed Charges for Rev 481 Proc 0579T = $47.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,52.43,,,,,,,29.1700,113.0000,percent of total billed charges,46.4% of $113.00 in Billed Charges for Rev 481 Proc 0579T = $52.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,35.55,,,,,,,29.1700,113.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,47.12,,,,,,,29.1700,113.0000,percent of total billed charges,41.7% of $113.00 in Billed Charges for Rev 481 Proc 0579T = $47.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA PPO,47.12,,,,,,,29.1700,113.0000,percent of total billed charges,41.7% of $113.00 in Billed Charges for Rev 481 Proc 0579T = $47.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,35.55,,,,,,,29.1700,113.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,101.70,,,,,,,29.1700,113.0000,percent of total billed charges,90% of $113.00 in Billed Charges for Rev 481 Proc 0579T = $101.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,HUMANA,HUMANA MEDICARE,33.86,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,33.86,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,MEDCOST,MEDCOST VHN,53.78,,,,,,,29.1700,113.0000,percent of total billed charges,47.59% of $113.00 in Billed Charges for Rev 481 Proc 0579T = $53.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,51.91,,,,,,,29.1700,113.0000,fee schedule,APG 00488 Proc 0579T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 100% = $49.44... $49.44 at 105% = $51.91 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,35.55,,,,,,,29.1700,113.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,35.55,,,,,,,29.1700,113.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,NHC ADVANTAGE,NHC ADVANTAGE,35.55,,,,,,,29.1700,113.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,50.97,,,,,,,29.1700,113.0000,fee schedule,APG 00488 Proc 0579T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 100% = $49.44... $49.44 at 103.1% = $50.97 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,SENTARA HEALTH,SENTARA HEALTH,29.17,,,,,,,29.1700,113.0000,percent of total billed charges,25.81% of $113.00 in Billed Charges for Rev 481 Proc 0579T = $29.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,SENTARA HEALTH,SENTARA MEDICARE,33.86,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",113.00,,,,,,,29.1700,113.0000,percent of total billed charges,100% of $113.00 in Billed Charges for Rev 481 Proc 0579T = $113.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,50.93,,,,,,,29.1700,113.0000,fee schedule,APG 00488 Proc 0579T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 103% = $50.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,33.86,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,33.86,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,WELLCARE,WELLCARE MEDICAID,113.00,,,,,,,29.1700,113.0000,percent of total billed charges,100% of $113.00 in Billed Charges for Rev 481 Proc 0579T = $113.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REM INTERROG DEV EVAL SS LD ICDS <90D TECH,0579T,CPT,481,RC,48100240,CDM,,,,both,,,113.0000,16.9500,WELLCARE,WELLCARE MEDICARE,35.89,,,,,,,29.1700,113.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,AETNA,AETNA,5055.25,,,,,,,1881.0000,11839.0000,percent of total billed charges,"42.7% of $11,839.00 in Billed Charges for Rev 481 Proc 0580T = $5,055.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2176.64,,,,,,,1881.0000,11839.0000,fee schedule,"APG 00074 Proc 0580T at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 104% = $2,176.64. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3390.45,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,AETNA,AETNA HEALTHCARE MEDICARE,3390.45,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,3390.45,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,AMBETTER,AMBETTER,7391.18,,,,,,,1881.0000,11839.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3526.07,,,,,,,1881.0000,11839.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,ANTHEM EXCHANGE,8347.47,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2155.71,,,,,,,1881.0000,11839.0000,fee schedule,"APG 00074 Proc 0580T at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,ANTHEM HMO,8868.69,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3492.16,,,,,,,1881.0000,11839.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",10433.19,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8287.30,,,,,,,1881.0000,11839.0000,percent of total billed charges,"Rev 481 Proc 0580T $11,839.00 in Billed Charges at 70% = $8,287.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,1881.0000,11839.0000,case rate,"Rev 481 Proc 0580T ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,BLUE CROSS MEDICARE,3526.07,,,,,,,1881.0000,11839.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,1881.0000,11839.0000,case rate,"Rev 481 Proc 0580T ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,1881.0000,11839.0000,case rate,"Rev 481 Proc 0580T ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,CIGNA HEALTHCARE,CIGNA HMO,4936.86,,,,,,,1881.0000,11839.0000,percent of total billed charges,"41.7% of $11,839.00 in Billed Charges for Rev 481 Proc 0580T = $4,936.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5493.30,,,,,,,1881.0000,11839.0000,percent of total billed charges,"46.4% of $11,839.00 in Billed Charges for Rev 481 Proc 0580T = $5,493.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,3559.97,,,,,,,1881.0000,11839.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4936.86,,,,,,,1881.0000,11839.0000,percent of total billed charges,"41.7% of $11,839.00 in Billed Charges for Rev 481 Proc 0580T = $4,936.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,CIGNA HEALTHCARE,CIGNA PPO,4936.86,,,,,,,1881.0000,11839.0000,percent of total billed charges,"41.7% of $11,839.00 in Billed Charges for Rev 481 Proc 0580T = $4,936.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3559.97,,,,,,,1881.0000,11839.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10655.10,,,,,,,1881.0000,11839.0000,percent of total billed charges,"90% of $11,839.00 in Billed Charges for Rev 481 Proc 0580T = $10,655.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,HUMANA,HUMANA MEDICARE,3390.45,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3390.45,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,MEDCOST,MEDCOST VHN,5634.18,,,,,,,1881.0000,11839.0000,percent of total billed charges,"47.59% of $11,839.00 in Billed Charges for Rev 481 Proc 0580T = $5,634.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2197.57,,,,,,,1881.0000,11839.0000,fee schedule,"APG 00074 Proc 0580T at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 105% = $2,197.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3559.97,,,,,,,1881.0000,11839.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3559.97,,,,,,,1881.0000,11839.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,NHC ADVANTAGE,NHC ADVANTAGE,3559.97,,,,,,,1881.0000,11839.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2157.80,,,,,,,1881.0000,11839.0000,fee schedule,"APG 00074 Proc 0580T at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 103.1% = $2,157.80 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,SENTARA HEALTH,SENTARA HEALTH,3055.65,,,,,,,1881.0000,11839.0000,percent of total billed charges,"25.81% of $11,839.00 in Billed Charges for Rev 481 Proc 0580T = $3,055.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,SENTARA HEALTH,SENTARA MEDICARE,3390.45,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11839.00,,,,,,,1881.0000,11839.0000,percent of total billed charges,"100% of $11,839.00 in Billed Charges for Rev 481 Proc 0580T = $11,839.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,1881.0000,11839.0000,case rate,"Rev 481 Proc 0580T ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,1881.0000,11839.0000,case rate,"Rev 481 Proc 0580T ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,1881.0000,11839.0000,case rate,"Rev 481 Proc 0580T ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,1881.0000,11839.0000,case rate,"Rev 481 Proc 0580T ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2155.71,,,,,,,1881.0000,11839.0000,fee schedule,"APG 00074 Proc 0580T at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3390.45,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3390.45,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,WELLCARE,WELLCARE MEDICAID,11839.00,,,,,,,1881.0000,11839.0000,percent of total billed charges,"100% of $11,839.00 in Billed Charges for Rev 481 Proc 0580T = $11,839.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL SUBSTERNAL IMPLTBL DFB PULSE GENERATOR ONLY,0580T,CPT,481,RC,48100235,CDM,,,,both,,,11839.0000,1775.8500,WELLCARE,WELLCARE MEDICARE,3593.87,,,,,,,1881.0000,11839.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATH PASSER 60CM,272,RC,27200002,CDM,,,,,,both,,,2114.5400,317.1800,AETNA,AETNA,902.91,,,,,,,545.7600,2114.5400,percent of total billed charges,"42.7% of $2,114.54 in Billed Charges for Rev 272 = $902.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 60CM,272,RC,27200002,CDM,,,,,,both,,,2114.5400,317.1800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1480.18,,,,,,,545.7600,2114.5400,percent of total billed charges,"Rev 272 $2,114.54 in Billed Charges at 70% = $1,480.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 60CM,272,RC,27200002,CDM,,,,,,both,,,2114.5400,317.1800,CIGNA HEALTHCARE,CIGNA HMO,881.76,,,,,,,545.7600,2114.5400,percent of total billed charges,"41.7% of $2,114.54 in Billed Charges for Rev 272 = $881.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 60CM,272,RC,27200002,CDM,,,,,,both,,,2114.5400,317.1800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,981.15,,,,,,,545.7600,2114.5400,percent of total billed charges,"46.4% of $2,114.54 in Billed Charges for Rev 272 = $981.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 60CM,272,RC,27200002,CDM,,,,,,both,,,2114.5400,317.1800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,881.76,,,,,,,545.7600,2114.5400,percent of total billed charges,"41.7% of $2,114.54 in Billed Charges for Rev 272 = $881.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 60CM,272,RC,27200002,CDM,,,,,,both,,,2114.5400,317.1800,CIGNA HEALTHCARE,CIGNA PPO,881.76,,,,,,,545.7600,2114.5400,percent of total billed charges,"41.7% of $2,114.54 in Billed Charges for Rev 272 = $881.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 60CM,272,RC,27200002,CDM,,,,,,both,,,2114.5400,317.1800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1903.09,,,,,,,545.7600,2114.5400,percent of total billed charges,"90% of $2,114.54 in Billed Charges for Rev 272 = $1,903.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 60CM,272,RC,27200002,CDM,,,,,,both,,,2114.5400,317.1800,MEDCOST,MEDCOST VHN,1006.31,,,,,,,545.7600,2114.5400,percent of total billed charges,"47.59% of $2,114.54 in Billed Charges for Rev 272 = $1,006.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 60CM,272,RC,27200002,CDM,,,,,,both,,,2114.5400,317.1800,SENTARA HEALTH,SENTARA HEALTH,545.76,,,,,,,545.7600,2114.5400,percent of total billed charges,"25.81% of $2,114.54 in Billed Charges for Rev 272 = $545.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 60CM,272,RC,27200002,CDM,,,,,,both,,,2114.5400,317.1800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2114.54,,,,,,,545.7600,2114.5400,percent of total billed charges,"100% of $2,114.54 in Billed Charges for Rev 272 = $2,114.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 60CM,272,RC,27200002,CDM,,,,,,both,,,2114.5400,317.1800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1057.27,,,,,,,545.7600,2114.5400,percent of total billed charges,"Rev 272 $2,114.54 in Billed Charges at 50% = $1,057.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 60CM,272,RC,27200002,CDM,,,,,,both,,,2114.5400,317.1800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,683.00,,,,,,,545.7600,2114.5400,other,"32.3% of $2,114.54 in Billed Charges for Rev 272 = $683.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH PASSER 60CM,272,RC,27200002,CDM,,,,,,both,,,2114.5400,317.1800,UNITED HEALTHCARE,UHC HERITAGE SELECT,649.16,,,,,,,545.7600,2114.5400,other,"30.7% of $2,114.54 in Billed Charges for Rev 272 = $649.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH PASSER 60CM,272,RC,27200002,CDM,,,,,,both,,,2114.5400,317.1800,UNITED HEALTHCARE,UNITED HEALTHCARE,683.00,,,,,,,545.7600,2114.5400,percent of total billed charges,"32.3% of $2,114.54 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER 60CM,272,RC,27200002,CDM,,,,,,both,,,2114.5400,317.1800,WELLCARE,WELLCARE MEDICAID,2114.54,,,,,,,545.7600,2114.5400,percent of total billed charges,"100% of $2,114.54 in Billed Charges for Rev 272 = $2,114.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLEABLE SHORT CO,272,RC,27200002,CDM,,,,,,both,,,1313.6300,197.0400,AETNA,AETNA,560.92,,,,,,,339.0500,1313.6300,percent of total billed charges,"42.7% of $1,313.63 in Billed Charges for Rev 272 = $560.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLEABLE SHORT CO,272,RC,27200002,CDM,,,,,,both,,,1313.6300,197.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,919.54,,,,,,,339.0500,1313.6300,percent of total billed charges,"Rev 272 $1,313.63 in Billed Charges at 70% = $919.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLEABLE SHORT CO,272,RC,27200002,CDM,,,,,,both,,,1313.6300,197.0400,CIGNA HEALTHCARE,CIGNA HMO,547.78,,,,,,,339.0500,1313.6300,percent of total billed charges,"41.7% of $1,313.63 in Billed Charges for Rev 272 = $547.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLEABLE SHORT CO,272,RC,27200002,CDM,,,,,,both,,,1313.6300,197.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,609.52,,,,,,,339.0500,1313.6300,percent of total billed charges,"46.4% of $1,313.63 in Billed Charges for Rev 272 = $609.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLEABLE SHORT CO,272,RC,27200002,CDM,,,,,,both,,,1313.6300,197.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,547.78,,,,,,,339.0500,1313.6300,percent of total billed charges,"41.7% of $1,313.63 in Billed Charges for Rev 272 = $547.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLEABLE SHORT CO,272,RC,27200002,CDM,,,,,,both,,,1313.6300,197.0400,CIGNA HEALTHCARE,CIGNA PPO,547.78,,,,,,,339.0500,1313.6300,percent of total billed charges,"41.7% of $1,313.63 in Billed Charges for Rev 272 = $547.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLEABLE SHORT CO,272,RC,27200002,CDM,,,,,,both,,,1313.6300,197.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1182.27,,,,,,,339.0500,1313.6300,percent of total billed charges,"90% of $1,313.63 in Billed Charges for Rev 272 = $1,182.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLEABLE SHORT CO,272,RC,27200002,CDM,,,,,,both,,,1313.6300,197.0400,MEDCOST,MEDCOST VHN,625.16,,,,,,,339.0500,1313.6300,percent of total billed charges,"47.59% of $1,313.63 in Billed Charges for Rev 272 = $625.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLEABLE SHORT CO,272,RC,27200002,CDM,,,,,,both,,,1313.6300,197.0400,SENTARA HEALTH,SENTARA HEALTH,339.05,,,,,,,339.0500,1313.6300,percent of total billed charges,"25.81% of $1,313.63 in Billed Charges for Rev 272 = $339.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLEABLE SHORT CO,272,RC,27200002,CDM,,,,,,both,,,1313.6300,197.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1313.63,,,,,,,339.0500,1313.6300,percent of total billed charges,"100% of $1,313.63 in Billed Charges for Rev 272 = $1,313.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLEABLE SHORT CO,272,RC,27200002,CDM,,,,,,both,,,1313.6300,197.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,656.82,,,,,,,339.0500,1313.6300,percent of total billed charges,"Rev 272 $1,313.63 in Billed Charges at 50% = $656.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLEABLE SHORT CO,272,RC,27200002,CDM,,,,,,both,,,1313.6300,197.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,424.30,,,,,,,339.0500,1313.6300,other,"32.3% of $1,313.63 in Billed Charges for Rev 272 = $424.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH PASSER MALLEABLE SHORT CO,272,RC,27200002,CDM,,,,,,both,,,1313.6300,197.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,403.28,,,,,,,339.0500,1313.6300,other,"30.7% of $1,313.63 in Billed Charges for Rev 272 = $403.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATH PASSER MALLEABLE SHORT CO,272,RC,27200002,CDM,,,,,,both,,,1313.6300,197.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,424.30,,,,,,,339.0500,1313.6300,percent of total billed charges,"32.3% of $1,313.63 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATH PASSER MALLEABLE SHORT CO,272,RC,27200002,CDM,,,,,,both,,,1313.6300,197.0400,WELLCARE,WELLCARE MEDICAID,1313.63,,,,,,,339.0500,1313.6300,percent of total billed charges,"100% of $1,313.63 in Billed Charges for Rev 272 = $1,313.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,993.3300,149.0000,AETNA,AETNA,424.15,,,,,,,256.3800,993.3300,percent of total billed charges,42.7% of $993.33 in Billed Charges for Rev 272 = $424.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,993.3300,149.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,695.33,,,,,,,256.3800,993.3300,percent of total billed charges,Rev 272 $993.33 in Billed Charges at 70% = $695.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,993.3300,149.0000,CIGNA HEALTHCARE,CIGNA HMO,414.22,,,,,,,256.3800,993.3300,percent of total billed charges,41.7% of $993.33 in Billed Charges for Rev 272 = $414.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,993.3300,149.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,460.91,,,,,,,256.3800,993.3300,percent of total billed charges,46.4% of $993.33 in Billed Charges for Rev 272 = $460.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,993.3300,149.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,414.22,,,,,,,256.3800,993.3300,percent of total billed charges,41.7% of $993.33 in Billed Charges for Rev 272 = $414.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,993.3300,149.0000,CIGNA HEALTHCARE,CIGNA PPO,414.22,,,,,,,256.3800,993.3300,percent of total billed charges,41.7% of $993.33 in Billed Charges for Rev 272 = $414.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,993.3300,149.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,894.00,,,,,,,256.3800,993.3300,percent of total billed charges,90% of $993.33 in Billed Charges for Rev 272 = $894.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,993.3300,149.0000,MEDCOST,MEDCOST VHN,472.73,,,,,,,256.3800,993.3300,percent of total billed charges,47.59% of $993.33 in Billed Charges for Rev 272 = $472.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,993.3300,149.0000,SENTARA HEALTH,SENTARA HEALTH,256.38,,,,,,,256.3800,993.3300,percent of total billed charges,25.81% of $993.33 in Billed Charges for Rev 272 = $256.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,993.3300,149.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",993.33,,,,,,,256.3800,993.3300,percent of total billed charges,100% of $993.33 in Billed Charges for Rev 272 = $993.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,993.3300,149.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,496.67,,,,,,,256.3800,993.3300,percent of total billed charges,Rev 272 $993.33 in Billed Charges at 50% = $496.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,993.3300,149.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,320.85,,,,,,,256.3800,993.3300,other,32.3% of $993.33 in Billed Charges for Rev 272 = $320.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,993.3300,149.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,304.95,,,,,,,256.3800,993.3300,other,30.7% of $993.33 in Billed Charges for Rev 272 = $304.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,993.3300,149.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,320.85,,,,,,,256.3800,993.3300,percent of total billed charges,32.3% of $993.33 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR CSF CATH NEURO STRAIGHT,272,RC,,,,,,,,both,,,993.3300,149.0000,WELLCARE,WELLCARE MEDICAID,993.33,,,,,,,256.3800,993.3300,percent of total billed charges,100% of $993.33 in Billed Charges for Rev 272 = $993.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,AETNA,AETNA,11458.12,,,,,,,1571.0000,38096.9000,percent of total billed charges,"42.7% of $26,834.00 in Billed Charges for Rev 480 Proc 0823T = $11,458.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11330.93,,,,,,,1571.0000,38096.9000,fee schedule,"APG 00086 Proc 0823T at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 104% = $11,330.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,17475.64,,,,,,,1571.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,AETNA,AETNA HEALTHCARE MEDICARE,17475.64,,,,,,,1571.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,17475.64,,,,,,,1571.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,AMBETTER,AMBETTER,38096.90,,,,,,,1571.0000,38096.9000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,18174.67,,,,,,,1571.0000,38096.9000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,ANTHEM EXCHANGE,26834.00,,,,,,,1571.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11221.98,,,,,,,1571.0000,38096.9000,fee schedule,"APG 00086 Proc 0823T at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,ANTHEM HMO,26834.00,,,,,,,1571.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,17999.91,,,,,,,1571.0000,38096.9000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",26834.00,,,,,,,1571.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,18783.80,,,,,,,1571.0000,38096.9000,percent of total billed charges,"Rev 480 Proc 0823T $26,834.00 in Billed Charges at 70% = $18,783.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,BLUE CROSS E NETWORK,11219.00,,,,,,,1571.0000,38096.9000,case rate,"Rev 480 Proc 0823T ASG Rate of $11,219.00 at 100% of $11,219.00 = $11,219.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,BLUE CROSS MEDICARE,18174.67,,,,,,,1571.0000,38096.9000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,BLUE CROSS P NETWORK,11472.00,,,,,,,1571.0000,38096.9000,case rate,"Rev 480 Proc 0823T ASG Rate of $11,472.00 at 100% of $11,472.00 = $11,472.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,BLUE CROSS S NETWORK,11472.00,,,,,,,1571.0000,38096.9000,case rate,"Rev 480 Proc 0823T ASG Rate of $11,472.00 at 100% of $11,472.00 = $11,472.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,CIGNA HEALTHCARE,CIGNA HMO,11189.78,,,,,,,1571.0000,38096.9000,percent of total billed charges,"41.7% of $26,834.00 in Billed Charges for Rev 480 Proc 0823T = $11,189.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12450.98,,,,,,,1571.0000,38096.9000,percent of total billed charges,"46.4% of $26,834.00 in Billed Charges for Rev 480 Proc 0823T = $12,450.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,18349.42,,,,,,,1571.0000,38096.9000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11189.78,,,,,,,1571.0000,38096.9000,percent of total billed charges,"41.7% of $26,834.00 in Billed Charges for Rev 480 Proc 0823T = $11,189.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,CIGNA HEALTHCARE,CIGNA PPO,11189.78,,,,,,,1571.0000,38096.9000,percent of total billed charges,"41.7% of $26,834.00 in Billed Charges for Rev 480 Proc 0823T = $11,189.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,18349.42,,,,,,,1571.0000,38096.9000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,24150.60,,,,,,,1571.0000,38096.9000,percent of total billed charges,"90% of $26,834.00 in Billed Charges for Rev 480 Proc 0823T = $24,150.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,HUMANA,HUMANA MEDICARE,17475.64,,,,,,,1571.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,17475.64,,,,,,,1571.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,MEDCOST,MEDCOST VHN,12770.30,,,,,,,1571.0000,38096.9000,percent of total billed charges,"47.59% of $26,834.00 in Billed Charges for Rev 480 Proc 0823T = $12,770.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11439.89,,,,,,,1571.0000,38096.9000,fee schedule,"APG 00086 Proc 0823T at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 105% = $11,439.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,18349.42,,,,,,,1571.0000,38096.9000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,18349.42,,,,,,,1571.0000,38096.9000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,NHC ADVANTAGE,NHC ADVANTAGE,18349.42,,,,,,,1571.0000,38096.9000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11232.88,,,,,,,1571.0000,38096.9000,fee schedule,"APG 00086 Proc 0823T at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 103.1% = $11,232.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,SENTARA HEALTH,SENTARA HEALTH,6925.86,,,,,,,1571.0000,38096.9000,percent of total billed charges,"25.81% of $26,834.00 in Billed Charges for Rev 480 Proc 0823T = $6,925.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,SENTARA HEALTH,SENTARA MEDICARE,17475.64,,,,,,,1571.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",26834.00,,,,,,,1571.0000,38096.9000,percent of total billed charges,"100% of $26,834.00 in Billed Charges for Rev 480 Proc 0823T = $26,834.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9282.68,,,,,,,1571.0000,38096.9000,fee schedule,"$18,565.35 from Fee Schedule TCUHC24 for Rev 480 Proc 0823T * Qty 1 = $18,565.35 at 50% = $9,282.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1642.00,,,,,,,1571.0000,38096.9000,other,"Rev 480 Proc 0823T 1 Visit at $1,642.00 per Visit = $1,642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1571.00,,,,,,,1571.0000,38096.9000,other,"Rev 480 Proc 0823T 1 Visit at $1,571.00 per Visit = $1,571.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,3097.00,,,,,,,1571.0000,38096.9000,other,"Rev 480 Proc 0823T 1 Visit at $3,097.00 per Visit = $3,097.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11221.98,,,,,,,1571.0000,38096.9000,fee schedule,"APG 00086 Proc 0823T at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,17475.64,,,,,,,1571.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,17475.64,,,,,,,1571.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,WELLCARE,WELLCARE MEDICAID,26834.00,,,,,,,1571.0000,38096.9000,percent of total billed charges,"100% of $26,834.00 in Billed Charges for Rev 480 Proc 0823T = $26,834.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT INSJ PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0823T,CPT,480,RC,48000082,CDM,,,,both,,,26834.0000,4025.1000,WELLCARE,WELLCARE MEDICARE,18524.18,,,,,,,1571.0000,38096.9000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,AETNA,AETNA,4025.33,,,,,,,1518.5100,10420.9900,percent of total billed charges,"42.7% of $9,427.00 in Billed Charges for Rev 480 Proc 0824T = $4,025.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,10321.74,,,,,,,1518.5100,10420.9900,fee schedule,"APG 00087 Proc 0824T at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 104% = $10,321.74. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2864.70,,,,,,,1518.5100,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,AETNA,AETNA HEALTHCARE MEDICARE,2864.70,,,,,,,1518.5100,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,2864.70,,,,,,,1518.5100,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,AMBETTER,AMBETTER,6245.05,,,,,,,1518.5100,10420.9900,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2979.29,,,,,,,1518.5100,10420.9900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,BLUE CROSS,ANTHEM EXCHANGE,7053.05,,,,,,,1518.5100,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,9427.00,,,,,,,1518.5100,10420.9900,fee schedule,"APG 00087 Proc 0824T at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 103% = $10,222.50 (Service Line reduced to $9,427.00, claim capped at $9,427.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,BLUE CROSS,ANTHEM HMO,7493.45,,,,,,,1518.5100,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2950.64,,,,,,,1518.5100,10420.9900,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8815.35,,,,,,,1518.5100,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6598.90,,,,,,,1518.5100,10420.9900,percent of total billed charges,"Rev 480 Proc 0824T $9,427.00 in Billed Charges at 70% = $6,598.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,1518.5100,10420.9900,case rate,"Rev 480 Proc 0824T ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,BLUE CROSS,BLUE CROSS MEDICARE,2979.29,,,,,,,1518.5100,10420.9900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,1518.5100,10420.9900,case rate,"Rev 480 Proc 0824T ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,1518.5100,10420.9900,case rate,"Rev 480 Proc 0824T ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,CIGNA HEALTHCARE,CIGNA HMO,3931.06,,,,,,,1518.5100,10420.9900,percent of total billed charges,"41.7% of $9,427.00 in Billed Charges for Rev 480 Proc 0824T = $3,931.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4374.13,,,,,,,1518.5100,10420.9900,percent of total billed charges,"46.4% of $9,427.00 in Billed Charges for Rev 480 Proc 0824T = $4,374.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,3007.94,,,,,,,1518.5100,10420.9900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3931.06,,,,,,,1518.5100,10420.9900,percent of total billed charges,"41.7% of $9,427.00 in Billed Charges for Rev 480 Proc 0824T = $3,931.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,CIGNA HEALTHCARE,CIGNA PPO,3931.06,,,,,,,1518.5100,10420.9900,percent of total billed charges,"41.7% of $9,427.00 in Billed Charges for Rev 480 Proc 0824T = $3,931.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3007.94,,,,,,,1518.5100,10420.9900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8484.30,,,,,,,1518.5100,10420.9900,percent of total billed charges,"90% of $9,427.00 in Billed Charges for Rev 480 Proc 0824T = $8,484.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,HUMANA,HUMANA MEDICARE,2864.70,,,,,,,1518.5100,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2864.70,,,,,,,1518.5100,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,MEDCOST,MEDCOST VHN,4486.31,,,,,,,1518.5100,10420.9900,percent of total billed charges,"47.59% of $9,427.00 in Billed Charges for Rev 480 Proc 0824T = $4,486.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,10420.99,,,,,,,1518.5100,10420.9900,fee schedule,"APG 00087 Proc 0824T at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 100% = $9,924.75... $9,924.75 at 105% = $10,420.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3007.94,,,,,,,1518.5100,10420.9900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3007.94,,,,,,,1518.5100,10420.9900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,NHC ADVANTAGE,NHC ADVANTAGE,3007.94,,,,,,,1518.5100,10420.9900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,10232.42,,,,,,,1518.5100,10420.9900,fee schedule,"APG 00087 Proc 0824T at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 100% = $9,924.75... $9,924.75 at 103.1% = $10,232.42 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,SENTARA HEALTH,SENTARA HEALTH,2433.11,,,,,,,1518.5100,10420.9900,percent of total billed charges,"25.81% of $9,427.00 in Billed Charges for Rev 480 Proc 0824T = $2,433.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,SENTARA HEALTH,SENTARA MEDICARE,2864.70,,,,,,,1518.5100,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9427.00,,,,,,,1518.5100,10420.9900,percent of total billed charges,"100% of $9,427.00 in Billed Charges for Rev 480 Proc 0824T = $9,427.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1518.51,,,,,,,1518.5100,10420.9900,fee schedule,"$3,037.01 from Fee Schedule TCUHC24 for Rev 480 Proc 0824T * Qty 1 = $3,037.01 at 50% = $1,518.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1642.00,,,,,,,1518.5100,10420.9900,other,"Rev 480 Proc 0824T 1 Visit at $1,642.00 per Visit = $1,642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1571.00,,,,,,,1518.5100,10420.9900,other,"Rev 480 Proc 0824T 1 Visit at $1,571.00 per Visit = $1,571.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,3097.00,,,,,,,1518.5100,10420.9900,other,"Rev 480 Proc 0824T 1 Visit at $3,097.00 per Visit = $3,097.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,10222.50,,,,,,,1518.5100,10420.9900,fee schedule,"APG 00087 Proc 0824T at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 103% = $10,222.50. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2864.70,,,,,,,1518.5100,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2864.70,,,,,,,1518.5100,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,WELLCARE,WELLCARE MEDICAID,9427.00,,,,,,,1518.5100,10420.9900,percent of total billed charges,"100% of $9,427.00 in Billed Charges for Rev 480 Proc 0824T = $9,427.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL PERM 1CHMBR LDLS PACEMAKER R ATRIAL,0824T,CPT,480,RC,48000083,CDM,,,,both,,,9427.0000,1414.0500,WELLCARE,WELLCARE MEDICARE,3036.58,,,,,,,1518.5100,10420.9900,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NCNTC NR IFR SPECTRSC OTH/THN PAD EA ANTMC SITE,0859T,CPT,510,RC,51000251,CDM,,,,both,,,252.0000,37.8000,AETNA,AETNA,107.60,,,,,,,65.0400,252.0000,percent of total billed charges,42.7% of $252.00 in Billed Charges for Rev 510 Proc 0859T = $107.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCNTC NR IFR SPECTRSC OTH/THN PAD EA ANTMC SITE,0859T,CPT,510,RC,51000251,CDM,,,,both,,,252.0000,37.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,176.40,,,,,,,65.0400,252.0000,percent of total billed charges,Rev 510 Proc 0859T $252.00 in Billed Charges at 70% = $176.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCNTC NR IFR SPECTRSC OTH/THN PAD EA ANTMC SITE,0859T,CPT,510,RC,51000251,CDM,,,,both,,,252.0000,37.8000,CIGNA HEALTHCARE,CIGNA HMO,105.08,,,,,,,65.0400,252.0000,percent of total billed charges,41.7% of $252.00 in Billed Charges for Rev 510 Proc 0859T = $105.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCNTC NR IFR SPECTRSC OTH/THN PAD EA ANTMC SITE,0859T,CPT,510,RC,51000251,CDM,,,,both,,,252.0000,37.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,116.93,,,,,,,65.0400,252.0000,percent of total billed charges,46.4% of $252.00 in Billed Charges for Rev 510 Proc 0859T = $116.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCNTC NR IFR SPECTRSC OTH/THN PAD EA ANTMC SITE,0859T,CPT,510,RC,51000251,CDM,,,,both,,,252.0000,37.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,105.08,,,,,,,65.0400,252.0000,percent of total billed charges,41.7% of $252.00 in Billed Charges for Rev 510 Proc 0859T = $105.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCNTC NR IFR SPECTRSC OTH/THN PAD EA ANTMC SITE,0859T,CPT,510,RC,51000251,CDM,,,,both,,,252.0000,37.8000,CIGNA HEALTHCARE,CIGNA PPO,105.08,,,,,,,65.0400,252.0000,percent of total billed charges,41.7% of $252.00 in Billed Charges for Rev 510 Proc 0859T = $105.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCNTC NR IFR SPECTRSC OTH/THN PAD EA ANTMC SITE,0859T,CPT,510,RC,51000251,CDM,,,,both,,,252.0000,37.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,226.80,,,,,,,65.0400,252.0000,percent of total billed charges,90% of $252.00 in Billed Charges for Rev 510 Proc 0859T = $226.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCNTC NR IFR SPECTRSC OTH/THN PAD EA ANTMC SITE,0859T,CPT,510,RC,51000251,CDM,,,,both,,,252.0000,37.8000,MEDCOST,MEDCOST VHN,119.93,,,,,,,65.0400,252.0000,percent of total billed charges,47.59% of $252.00 in Billed Charges for Rev 510 Proc 0859T = $119.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCNTC NR IFR SPECTRSC OTH/THN PAD EA ANTMC SITE,0859T,CPT,510,RC,51000251,CDM,,,,both,,,252.0000,37.8000,SENTARA HEALTH,SENTARA HEALTH,65.04,,,,,,,65.0400,252.0000,percent of total billed charges,25.81% of $252.00 in Billed Charges for Rev 510 Proc 0859T = $65.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCNTC NR IFR SPECTRSC OTH/THN PAD EA ANTMC SITE,0859T,CPT,510,RC,51000251,CDM,,,,both,,,252.0000,37.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",252.00,,,,,,,65.0400,252.0000,percent of total billed charges,100% of $252.00 in Billed Charges for Rev 510 Proc 0859T = $252.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCNTC NR IFR SPECTRSC OTH/THN PAD EA ANTMC SITE,0859T,CPT,510,RC,51000251,CDM,,,,both,,,252.0000,37.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,81.40,,,,,,,65.0400,252.0000,other,32.3% of $252.00 in Billed Charges for Rev 510 Proc 0859T = $81.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NCNTC NR IFR SPECTRSC OTH/THN PAD EA ANTMC SITE,0859T,CPT,510,RC,51000251,CDM,,,,both,,,252.0000,37.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,77.36,,,,,,,65.0400,252.0000,other,30.7% of $252.00 in Billed Charges for Rev 510 Proc 0859T = $77.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NCNTC NR IFR SPECTRSC OTH/THN PAD EA ANTMC SITE,0859T,CPT,510,RC,51000251,CDM,,,,both,,,252.0000,37.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,81.40,,,,,,,65.0400,252.0000,percent of total billed charges,32.3% of $252.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCNTC NR IFR SPECTRSC OTH/THN PAD EA ANTMC SITE,0859T,CPT,510,RC,51000251,CDM,,,,both,,,252.0000,37.8000,WELLCARE,WELLCARE MEDICAID,252.00,,,,,,,65.0400,252.0000,percent of total billed charges,100% of $252.00 in Billed Charges for Rev 510 Proc 0859T = $252.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCNTC NR IFR SPECTRSC SCR PAD Q/PROV MANEUVERS,0860T,CPT,510,RC,51000252,CDM,,,,both,,,252.0000,37.8000,AETNA,AETNA,107.60,,,,,,,65.0400,252.0000,percent of total billed charges,42.7% of $252.00 in Billed Charges for Rev 510 Proc 0860T = $107.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCNTC NR IFR SPECTRSC SCR PAD Q/PROV MANEUVERS,0860T,CPT,510,RC,51000252,CDM,,,,both,,,252.0000,37.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,176.40,,,,,,,65.0400,252.0000,percent of total billed charges,Rev 510 Proc 0860T $252.00 in Billed Charges at 70% = $176.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCNTC NR IFR SPECTRSC SCR PAD Q/PROV MANEUVERS,0860T,CPT,510,RC,51000252,CDM,,,,both,,,252.0000,37.8000,CIGNA HEALTHCARE,CIGNA HMO,105.08,,,,,,,65.0400,252.0000,percent of total billed charges,41.7% of $252.00 in Billed Charges for Rev 510 Proc 0860T = $105.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCNTC NR IFR SPECTRSC SCR PAD Q/PROV MANEUVERS,0860T,CPT,510,RC,51000252,CDM,,,,both,,,252.0000,37.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,116.93,,,,,,,65.0400,252.0000,percent of total billed charges,46.4% of $252.00 in Billed Charges for Rev 510 Proc 0860T = $116.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCNTC NR IFR SPECTRSC SCR PAD Q/PROV MANEUVERS,0860T,CPT,510,RC,51000252,CDM,,,,both,,,252.0000,37.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,105.08,,,,,,,65.0400,252.0000,percent of total billed charges,41.7% of $252.00 in Billed Charges for Rev 510 Proc 0860T = $105.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCNTC NR IFR SPECTRSC SCR PAD Q/PROV MANEUVERS,0860T,CPT,510,RC,51000252,CDM,,,,both,,,252.0000,37.8000,CIGNA HEALTHCARE,CIGNA PPO,105.08,,,,,,,65.0400,252.0000,percent of total billed charges,41.7% of $252.00 in Billed Charges for Rev 510 Proc 0860T = $105.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCNTC NR IFR SPECTRSC SCR PAD Q/PROV MANEUVERS,0860T,CPT,510,RC,51000252,CDM,,,,both,,,252.0000,37.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,226.80,,,,,,,65.0400,252.0000,percent of total billed charges,90% of $252.00 in Billed Charges for Rev 510 Proc 0860T = $226.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCNTC NR IFR SPECTRSC SCR PAD Q/PROV MANEUVERS,0860T,CPT,510,RC,51000252,CDM,,,,both,,,252.0000,37.8000,MEDCOST,MEDCOST VHN,119.93,,,,,,,65.0400,252.0000,percent of total billed charges,47.59% of $252.00 in Billed Charges for Rev 510 Proc 0860T = $119.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCNTC NR IFR SPECTRSC SCR PAD Q/PROV MANEUVERS,0860T,CPT,510,RC,51000252,CDM,,,,both,,,252.0000,37.8000,SENTARA HEALTH,SENTARA HEALTH,65.04,,,,,,,65.0400,252.0000,percent of total billed charges,25.81% of $252.00 in Billed Charges for Rev 510 Proc 0860T = $65.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCNTC NR IFR SPECTRSC SCR PAD Q/PROV MANEUVERS,0860T,CPT,510,RC,51000252,CDM,,,,both,,,252.0000,37.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",252.00,,,,,,,65.0400,252.0000,percent of total billed charges,100% of $252.00 in Billed Charges for Rev 510 Proc 0860T = $252.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCNTC NR IFR SPECTRSC SCR PAD Q/PROV MANEUVERS,0860T,CPT,510,RC,51000252,CDM,,,,both,,,252.0000,37.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,126.00,,,,,,,65.0400,252.0000,percent of total billed charges,Rev 510 Proc 0860T $252.00 in Billed Charges at 50% = $126.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCNTC NR IFR SPECTRSC SCR PAD Q/PROV MANEUVERS,0860T,CPT,510,RC,51000252,CDM,,,,both,,,252.0000,37.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,81.40,,,,,,,65.0400,252.0000,other,32.3% of $252.00 in Billed Charges for Rev 510 Proc 0860T = $81.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NCNTC NR IFR SPECTRSC SCR PAD Q/PROV MANEUVERS,0860T,CPT,510,RC,51000252,CDM,,,,both,,,252.0000,37.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,77.36,,,,,,,65.0400,252.0000,other,30.7% of $252.00 in Billed Charges for Rev 510 Proc 0860T = $77.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NCNTC NR IFR SPECTRSC SCR PAD Q/PROV MANEUVERS,0860T,CPT,510,RC,51000252,CDM,,,,both,,,252.0000,37.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,81.40,,,,,,,65.0400,252.0000,percent of total billed charges,32.3% of $252.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCNTC NR IFR SPECTRSC SCR PAD Q/PROV MANEUVERS,0860T,CPT,510,RC,51000252,CDM,,,,both,,,252.0000,37.8000,WELLCARE,WELLCARE MEDICAID,252.00,,,,,,,65.0400,252.0000,percent of total billed charges,100% of $252.00 in Billed Charges for Rev 510 Proc 0860T = $252.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,AETNA,AETNA,1812.62,,,,,,,116.7400,4245.0000,percent of total billed charges,"42.7% of $4,245.00 in Billed Charges for Rev 610 Proc 0865T = $1,812.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,343.24,,,,,,,116.7400,4245.0000,fee schedule,APG 00293 Proc 0865T at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 104% = $343.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,216.48,,,,,,,116.7400,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,AETNA,AETNA HEALTHCARE MEDICARE,216.48,,,,,,,116.7400,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,216.48,,,,,,,116.7400,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,AMBETTER,AMBETTER,471.92,,,,,,,116.7400,4245.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,225.14,,,,,,,116.7400,4245.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,ANTHEM EXCHANGE,532.97,,,,,,,116.7400,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,339.94,,,,,,,116.7400,4245.0000,fee schedule,APG 00293 Proc 0865T at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 103% = $339.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,ANTHEM HMO,566.25,,,,,,,116.7400,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,222.97,,,,,,,116.7400,4245.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",666.14,,,,,,,116.7400,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2971.50,,,,,,,116.7400,4245.0000,percent of total billed charges,"Rev 610 Proc 0865T $4,245.00 in Billed Charges at 70% = $2,971.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,BLUE CROSS E NETWORK,747.10,,,,,,,116.7400,4245.0000,fee schedule,$233.47 from Fee Schedule BCFSD for Rev 610 Proc 0865T * Qty 1 = $233.47 at 320% = $747.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,BLUE CROSS MEDICARE,225.14,,,,,,,116.7400,4245.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,BLUE CROSS P NETWORK,763.45,,,,,,,116.7400,4245.0000,fee schedule,$233.47 from Fee Schedule BCFSD for Rev 610 Proc 0865T * Qty 1 = $233.47 at 327% = $763.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,BLUE CROSS S NETWORK,763.45,,,,,,,116.7400,4245.0000,fee schedule,$233.47 from Fee Schedule BCFSD for Rev 610 Proc 0865T * Qty 1 = $233.47 at 327% = $763.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,CIGNA HEALTHCARE,CIGNA HMO,1215.00,,,,,,,116.7400,4245.0000,other,"Rev 610 Proc 0865T Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,786.00,,,,,,,116.7400,4245.0000,other,Rev 610 Proc 0865T Qty 1 * $786.00 = $786.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,227.30,,,,,,,116.7400,4245.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1215.00,,,,,,,116.7400,4245.0000,other,"Rev 610 Proc 0865T Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,CIGNA HEALTHCARE,CIGNA PPO,1215.00,,,,,,,116.7400,4245.0000,other,"Rev 610 Proc 0865T Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,227.30,,,,,,,116.7400,4245.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3820.50,,,,,,,116.7400,4245.0000,percent of total billed charges,"90% of $4,245.00 in Billed Charges for Rev 610 Proc 0865T = $3,820.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,HUMANA,HUMANA MEDICARE,216.48,,,,,,,116.7400,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,216.48,,,,,,,116.7400,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,MEDCOST,MEDCOST VHN,2020.20,,,,,,,116.7400,4245.0000,percent of total billed charges,"47.59% of $4,245.00 in Billed Charges for Rev 610 Proc 0865T = $2,020.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,346.54,,,,,,,116.7400,4245.0000,fee schedule,APG 00293 Proc 0865T at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 100% = $330.04... $330.04 at 105% = $346.54 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,227.30,,,,,,,116.7400,4245.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,227.30,,,,,,,116.7400,4245.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,NHC ADVANTAGE,NHC ADVANTAGE,227.30,,,,,,,116.7400,4245.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,340.27,,,,,,,116.7400,4245.0000,fee schedule,APG 00293 Proc 0865T at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 100% = $330.04... $330.04 at 103.1% = $340.27 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,SENTARA HEALTH,SENTARA HEALTH,1095.63,,,,,,,116.7400,4245.0000,percent of total billed charges,"25.81% of $4,245.00 in Billed Charges for Rev 610 Proc 0865T = $1,095.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,SENTARA HEALTH,SENTARA MEDICARE,216.48,,,,,,,116.7400,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4245.00,,,,,,,116.7400,4245.0000,percent of total billed charges,"100% of $4,245.00 in Billed Charges for Rev 610 Proc 0865T = $4,245.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,116.74,,,,,,,116.7400,4245.0000,fee schedule,$233.47 from Fee Schedule TCUHC24 for Rev 610 Proc 0865T * Qty 1 = $233.47 at 50% = $116.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2559.00,,,,,,,116.7400,4245.0000,other,"Rev 610 Proc 0865T 1 Visit at $2,559.00 per Visit = $2,559.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2448.00,,,,,,,116.7400,4245.0000,other,"Rev 610 Proc 0865T 1 Visit at $2,448.00 per Visit = $2,448.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,4035.00,,,,,,,116.7400,4245.0000,other,"Rev 610 Proc 0865T 1 Visit at $4,035.00 per Visit = $4,035.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,339.94,,,,,,,116.7400,4245.0000,fee schedule,APG 00293 Proc 0865T at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 103% = $339.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,216.48,,,,,,,116.7400,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,216.48,,,,,,,116.7400,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,WELLCARE,WELLCARE MEDICAID,4245.00,,,,,,,116.7400,4245.0000,percent of total billed charges,"100% of $4,245.00 in Billed Charges for Rev 610 Proc 0865T = $4,245.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC QUAN MRI ALYS BRAIN W/O DIAGNOSTIC MRI SAME SESS,0865T,CPT,610,RC,61000080,CDM,,,,both,,,4245.0000,636.7500,WELLCARE,WELLCARE MEDICARE,229.47,,,,,,,116.7400,4245.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,AETNA,AETNA,254.49,,,,,,,47.0800,596.0000,percent of total billed charges,42.7% of $596.00 in Billed Charges for Rev 450 Proc 12011 = $254.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,272.07,,,,,,,47.0800,596.0000,fee schedule,"APG 00016 Proc 12011 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 104% = $272.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,47.0800,596.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,47.0800,596.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,47.0800,596.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,AMBETTER,AMBETTER,396.83,,,,,,,47.0800,596.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,47.0800,596.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,47.0800,596.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,269.45,,,,,,,47.0800,596.0000,fee schedule,"APG 00016 Proc 12011 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,47.0800,596.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,47.0800,596.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",560.15,,,,,,,47.0800,596.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,107.43,,,,,,,47.0800,596.0000,fee schedule,$107.43 from Fee Schedule BLDTM_23 for Rev 450 Proc 12011 * Qty 1 = $107.43 at 100% = $107.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,47.0800,596.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,BLUE CROSS,TENNCARE BLUE CARE,47.08,,,,,,,47.0800,596.0000,fee schedule,$40.59 from Fee Schedule TC_24 for Rev 450 Proc 12011 * Qty 1 = $40.59 at 116% = $47.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,BLUE CROSS,TENNCARE BLUE SELECT,47.08,,,,,,,47.0800,596.0000,fee schedule,$40.59 from Fee Schedule TC_24 for Rev 450 Proc 12011 * Qty 1 = $40.59 at 116% = $47.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,47.0800,596.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,47.0800,596.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,536.40,,,,,,,47.0800,596.0000,percent of total billed charges,90% of $596.00 in Billed Charges for Rev 450 Proc 12011 = $536.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,HUMANA,HUMANA MEDICARE,182.03,,,,,,,47.0800,596.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,47.0800,596.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,MEDCOST,MEDCOST VHN,283.64,,,,,,,47.0800,596.0000,percent of total billed charges,47.59% of $596.00 in Billed Charges for Rev 450 Proc 12011 = $283.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,274.68,,,,,,,47.0800,596.0000,fee schedule,"APG 00016 Proc 12011 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 105% = $274.68 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,47.0800,596.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,47.0800,596.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,47.0800,596.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,269.71,,,,,,,47.0800,596.0000,fee schedule,"APG 00016 Proc 12011 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 103.1% = $269.71 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,SENTARA HEALTH,SENTARA HEALTH,153.83,,,,,,,47.0800,596.0000,percent of total billed charges,25.81% of $596.00 in Billed Charges for Rev 450 Proc 12011 = $153.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,47.0800,596.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",596.00,,,,,,,47.0800,596.0000,percent of total billed charges,100% of $596.00 in Billed Charges for Rev 450 Proc 12011 = $596.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,47.0800,596.0000,case rate,Rev 450 Proc 12011 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,47.0800,596.0000,case rate,Rev 450 Proc 12011 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,47.0800,596.0000,case rate,Rev 450 Proc 12011 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,596.00,,,,,,,47.0800,596.0000,case rate,"Rev 450 Proc 12011 at Case Rate $847.00 (Service Line reduced to $596.00, claim capped at $596.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,269.45,,,,,,,47.0800,596.0000,fee schedule,"APG 00016 Proc 12011 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,47.0800,596.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,47.0800,596.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,WELLCARE,WELLCARE MEDICAID,596.00,,,,,,,47.0800,596.0000,percent of total billed charges,100% of $596.00 in Billed Charges for Rev 450 Proc 12011 = $596.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIMP REP FACE MUCOUS LESS 2.5,12011,CPT,450,RC,45000043,CDM,,,,both,,,596.0000,89.4000,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,47.0800,596.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,AETNA,AETNA,267.73,,,,,,,56.5000,627.0000,percent of total billed charges,42.7% of $627.00 in Billed Charges for Rev 450 Proc 12013 = $267.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,272.07,,,,,,,56.5000,627.0000,fee schedule,"APG 00016 Proc 12013 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 104% = $272.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,56.5000,627.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,56.5000,627.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,56.5000,627.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,AMBETTER,AMBETTER,396.83,,,,,,,56.5000,627.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,56.5000,627.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,56.5000,627.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,269.45,,,,,,,56.5000,627.0000,fee schedule,"APG 00016 Proc 12013 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,56.5000,627.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,56.5000,627.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",560.15,,,,,,,56.5000,627.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,129.80,,,,,,,56.5000,627.0000,fee schedule,$129.80 from Fee Schedule BLDTM_23 for Rev 450 Proc 12013 * Qty 1 = $129.80 at 100% = $129.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,56.5000,627.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,BLUE CROSS,TENNCARE BLUE CARE,56.50,,,,,,,56.5000,627.0000,fee schedule,$48.71 from Fee Schedule TC_24 for Rev 450 Proc 12013 * Qty 1 = $48.71 at 116% = $56.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,BLUE CROSS,TENNCARE BLUE SELECT,56.50,,,,,,,56.5000,627.0000,fee schedule,$48.71 from Fee Schedule TC_24 for Rev 450 Proc 12013 * Qty 1 = $48.71 at 116% = $56.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,56.5000,627.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,56.5000,627.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,564.30,,,,,,,56.5000,627.0000,percent of total billed charges,90% of $627.00 in Billed Charges for Rev 450 Proc 12013 = $564.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,56.5000,627.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,56.5000,627.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,MEDCOST,MEDCOST VHN,298.39,,,,,,,56.5000,627.0000,percent of total billed charges,47.59% of $627.00 in Billed Charges for Rev 450 Proc 12013 = $298.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,274.68,,,,,,,56.5000,627.0000,fee schedule,"APG 00016 Proc 12013 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 105% = $274.68 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,56.5000,627.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,56.5000,627.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,56.5000,627.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,269.71,,,,,,,56.5000,627.0000,fee schedule,"APG 00016 Proc 12013 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 103.1% = $269.71 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,SENTARA HEALTH,SENTARA HEALTH,161.83,,,,,,,56.5000,627.0000,percent of total billed charges,25.81% of $627.00 in Billed Charges for Rev 450 Proc 12013 = $161.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,56.5000,627.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",627.00,,,,,,,56.5000,627.0000,percent of total billed charges,100% of $627.00 in Billed Charges for Rev 450 Proc 12013 = $627.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,56.5000,627.0000,case rate,Rev 450 Proc 12013 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,56.5000,627.0000,case rate,Rev 450 Proc 12013 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,56.5000,627.0000,case rate,Rev 450 Proc 12013 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,627.00,,,,,,,56.5000,627.0000,case rate,"Rev 450 Proc 12013 at Case Rate $847.00 (Service Line reduced to $627.00, claim capped at $627.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,269.45,,,,,,,56.5000,627.0000,fee schedule,"APG 00016 Proc 12013 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,56.5000,627.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,56.5000,627.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,WELLCARE,WELLCARE MEDICAID,627.00,,,,,,,56.5000,627.0000,percent of total billed charges,100% of $627.00 in Billed Charges for Rev 450 Proc 12013 = $627.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIMP REP FACE MUCOUS 2.6-5,12013,CPT,450,RC,45000044,CDM,,,,both,,,627.0000,94.0500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,56.5000,627.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CONNECTOR PERITONEAL CATH RIGH,272,RC,,,,,,,,both,,,966.1600,144.9200,AETNA,AETNA,412.55,,,,,,,249.3700,966.1600,percent of total billed charges,42.7% of $966.16 in Billed Charges for Rev 272 = $412.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR PERITONEAL CATH RIGH,272,RC,,,,,,,,both,,,966.1600,144.9200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,676.31,,,,,,,249.3700,966.1600,percent of total billed charges,Rev 272 $966.16 in Billed Charges at 70% = $676.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR PERITONEAL CATH RIGH,272,RC,,,,,,,,both,,,966.1600,144.9200,CIGNA HEALTHCARE,CIGNA HMO,402.89,,,,,,,249.3700,966.1600,percent of total billed charges,41.7% of $966.16 in Billed Charges for Rev 272 = $402.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR PERITONEAL CATH RIGH,272,RC,,,,,,,,both,,,966.1600,144.9200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,448.30,,,,,,,249.3700,966.1600,percent of total billed charges,46.4% of $966.16 in Billed Charges for Rev 272 = $448.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR PERITONEAL CATH RIGH,272,RC,,,,,,,,both,,,966.1600,144.9200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,402.89,,,,,,,249.3700,966.1600,percent of total billed charges,41.7% of $966.16 in Billed Charges for Rev 272 = $402.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR PERITONEAL CATH RIGH,272,RC,,,,,,,,both,,,966.1600,144.9200,CIGNA HEALTHCARE,CIGNA PPO,402.89,,,,,,,249.3700,966.1600,percent of total billed charges,41.7% of $966.16 in Billed Charges for Rev 272 = $402.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR PERITONEAL CATH RIGH,272,RC,,,,,,,,both,,,966.1600,144.9200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,869.54,,,,,,,249.3700,966.1600,percent of total billed charges,90% of $966.16 in Billed Charges for Rev 272 = $869.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR PERITONEAL CATH RIGH,272,RC,,,,,,,,both,,,966.1600,144.9200,MEDCOST,MEDCOST VHN,459.80,,,,,,,249.3700,966.1600,percent of total billed charges,47.59% of $966.16 in Billed Charges for Rev 272 = $459.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR PERITONEAL CATH RIGH,272,RC,,,,,,,,both,,,966.1600,144.9200,SENTARA HEALTH,SENTARA HEALTH,249.37,,,,,,,249.3700,966.1600,percent of total billed charges,25.81% of $966.16 in Billed Charges for Rev 272 = $249.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR PERITONEAL CATH RIGH,272,RC,,,,,,,,both,,,966.1600,144.9200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",966.16,,,,,,,249.3700,966.1600,percent of total billed charges,100% of $966.16 in Billed Charges for Rev 272 = $966.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR PERITONEAL CATH RIGH,272,RC,,,,,,,,both,,,966.1600,144.9200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,483.08,,,,,,,249.3700,966.1600,percent of total billed charges,Rev 272 $966.16 in Billed Charges at 50% = $483.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR PERITONEAL CATH RIGH,272,RC,,,,,,,,both,,,966.1600,144.9200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,312.07,,,,,,,249.3700,966.1600,other,32.3% of $966.16 in Billed Charges for Rev 272 = $312.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CONNECTOR PERITONEAL CATH RIGH,272,RC,,,,,,,,both,,,966.1600,144.9200,UNITED HEALTHCARE,UHC HERITAGE SELECT,296.61,,,,,,,249.3700,966.1600,other,30.7% of $966.16 in Billed Charges for Rev 272 = $296.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CONNECTOR PERITONEAL CATH RIGH,272,RC,,,,,,,,both,,,966.1600,144.9200,UNITED HEALTHCARE,UNITED HEALTHCARE,312.07,,,,,,,249.3700,966.1600,percent of total billed charges,32.3% of $966.16 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONNECTOR PERITONEAL CATH RIGH,272,RC,,,,,,,,both,,,966.1600,144.9200,WELLCARE,WELLCARE MEDICAID,966.16,,,,,,,249.3700,966.1600,percent of total billed charges,100% of $966.16 in Billed Charges for Rev 272 = $966.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONS BURR HOLE COVER 22MM,272,RC,27200002,CDM,,,,,,both,,,1918.6400,287.8000,AETNA,AETNA,819.26,,,,,,,495.2000,1918.6400,percent of total billed charges,"42.7% of $1,918.64 in Billed Charges for Rev 272 = $819.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONS BURR HOLE COVER 22MM,272,RC,27200002,CDM,,,,,,both,,,1918.6400,287.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1343.05,,,,,,,495.2000,1918.6400,percent of total billed charges,"Rev 272 $1,918.64 in Billed Charges at 70% = $1,343.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONS BURR HOLE COVER 22MM,272,RC,27200002,CDM,,,,,,both,,,1918.6400,287.8000,CIGNA HEALTHCARE,CIGNA HMO,800.07,,,,,,,495.2000,1918.6400,percent of total billed charges,"41.7% of $1,918.64 in Billed Charges for Rev 272 = $800.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONS BURR HOLE COVER 22MM,272,RC,27200002,CDM,,,,,,both,,,1918.6400,287.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,890.25,,,,,,,495.2000,1918.6400,percent of total billed charges,"46.4% of $1,918.64 in Billed Charges for Rev 272 = $890.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONS BURR HOLE COVER 22MM,272,RC,27200002,CDM,,,,,,both,,,1918.6400,287.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,800.07,,,,,,,495.2000,1918.6400,percent of total billed charges,"41.7% of $1,918.64 in Billed Charges for Rev 272 = $800.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONS BURR HOLE COVER 22MM,272,RC,27200002,CDM,,,,,,both,,,1918.6400,287.8000,CIGNA HEALTHCARE,CIGNA PPO,800.07,,,,,,,495.2000,1918.6400,percent of total billed charges,"41.7% of $1,918.64 in Billed Charges for Rev 272 = $800.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONS BURR HOLE COVER 22MM,272,RC,27200002,CDM,,,,,,both,,,1918.6400,287.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1726.78,,,,,,,495.2000,1918.6400,percent of total billed charges,"90% of $1,918.64 in Billed Charges for Rev 272 = $1,726.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONS BURR HOLE COVER 22MM,272,RC,27200002,CDM,,,,,,both,,,1918.6400,287.8000,MEDCOST,MEDCOST VHN,913.08,,,,,,,495.2000,1918.6400,percent of total billed charges,"47.59% of $1,918.64 in Billed Charges for Rev 272 = $913.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONS BURR HOLE COVER 22MM,272,RC,27200002,CDM,,,,,,both,,,1918.6400,287.8000,SENTARA HEALTH,SENTARA HEALTH,495.20,,,,,,,495.2000,1918.6400,percent of total billed charges,"25.81% of $1,918.64 in Billed Charges for Rev 272 = $495.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONS BURR HOLE COVER 22MM,272,RC,27200002,CDM,,,,,,both,,,1918.6400,287.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1918.64,,,,,,,495.2000,1918.6400,percent of total billed charges,"100% of $1,918.64 in Billed Charges for Rev 272 = $1,918.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONS BURR HOLE COVER 22MM,272,RC,27200002,CDM,,,,,,both,,,1918.6400,287.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,959.32,,,,,,,495.2000,1918.6400,percent of total billed charges,"Rev 272 $1,918.64 in Billed Charges at 50% = $959.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONS BURR HOLE COVER 22MM,272,RC,27200002,CDM,,,,,,both,,,1918.6400,287.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,619.72,,,,,,,495.2000,1918.6400,other,"32.3% of $1,918.64 in Billed Charges for Rev 272 = $619.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CONS BURR HOLE COVER 22MM,272,RC,27200002,CDM,,,,,,both,,,1918.6400,287.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,589.02,,,,,,,495.2000,1918.6400,other,"30.7% of $1,918.64 in Billed Charges for Rev 272 = $589.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CONS BURR HOLE COVER 22MM,272,RC,27200002,CDM,,,,,,both,,,1918.6400,287.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,619.72,,,,,,,495.2000,1918.6400,percent of total billed charges,"32.3% of $1,918.64 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONS BURR HOLE COVER 22MM,272,RC,27200002,CDM,,,,,,both,,,1918.6400,287.8000,WELLCARE,WELLCARE MEDICAID,1918.64,,,,,,,495.2000,1918.6400,percent of total billed charges,"100% of $1,918.64 in Billed Charges for Rev 272 = $1,918.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA,808.31,,,,,,,109.0000,1893.0000,percent of total billed charges,"42.7% of $1,893.00 in Billed Charges for Rev 450 Proc 12017 = $808.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,272.07,,,,,,,109.0000,1893.0000,fee schedule,"APG 00016 Proc 12017 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 104% = $272.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,109.0000,1893.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,1893.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,109.0000,1893.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,AMBETTER,AMBETTER,804.03,,,,,,,109.0000,1893.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,109.0000,1893.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,109.0000,1893.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,269.45,,,,,,,109.0000,1893.0000,fee schedule,"APG 00016 Proc 12017 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,109.0000,1893.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,109.0000,1893.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1134.94,,,,,,,109.0000,1893.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,319.00,,,,,,,109.0000,1893.0000,fee schedule,$319.00 from Fee Schedule BLDTM_23 for Rev 450 Proc 12017 * Qty 1 = $319.00 at 100% = $319.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,109.0000,1893.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,109.0000,1893.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,109.0000,1893.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1703.70,,,,,,,109.0000,1893.0000,percent of total billed charges,"90% of $1,893.00 in Billed Charges for Rev 450 Proc 12017 = $1,703.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,109.0000,1893.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,109.0000,1893.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,MEDCOST,MEDCOST VHN,900.88,,,,,,,109.0000,1893.0000,percent of total billed charges,"47.59% of $1,893.00 in Billed Charges for Rev 450 Proc 12017 = $900.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,274.68,,,,,,,109.0000,1893.0000,fee schedule,"APG 00016 Proc 12017 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 105% = $274.68 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,109.0000,1893.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,109.0000,1893.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,109.0000,1893.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,269.71,,,,,,,109.0000,1893.0000,fee schedule,"APG 00016 Proc 12017 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 103.1% = $269.71 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,SENTARA HEALTH,SENTARA HEALTH,488.58,,,,,,,109.0000,1893.0000,percent of total billed charges,"25.81% of $1,893.00 in Billed Charges for Rev 450 Proc 12017 = $488.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,109.0000,1893.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1893.00,,,,,,,109.0000,1893.0000,percent of total billed charges,"100% of $1,893.00 in Billed Charges for Rev 450 Proc 12017 = $1,893.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1893.0000,case rate,Rev 450 Proc 12017 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1893.0000,case rate,Rev 450 Proc 12017 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1893.0000,case rate,Rev 450 Proc 12017 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1893.0000,case rate,Rev 450 Proc 12017 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,269.45,,,,,,,109.0000,1893.0000,fee schedule,"APG 00016 Proc 12017 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,1893.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,109.0000,1893.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,WELLCARE,WELLCARE MEDICAID,1893.00,,,,,,,109.0000,1893.0000,percent of total billed charges,"100% of $1,893.00 in Billed Charges for Rev 450 Proc 12017 = $1,893.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIM REP FACE MM 20.1-30,12017,CPT,450,RC,45000307,CDM,,,,both,,,1893.0000,283.9500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,109.0000,1893.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,AETNA,AETNA,388.57,,,,,,,109.0000,910.0000,percent of total billed charges,42.7% of $910.00 in Billed Charges for Rev 450 Proc 12018 = $388.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,272.07,,,,,,,109.0000,910.0000,fee schedule,"APG 00016 Proc 12018 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 104% = $272.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,109.0000,910.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,109.0000,910.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,109.0000,910.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,AMBETTER,AMBETTER,396.83,,,,,,,109.0000,910.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,109.0000,910.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,109.0000,910.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,269.45,,,,,,,109.0000,910.0000,fee schedule,"APG 00016 Proc 12018 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,109.0000,910.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,109.0000,910.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",560.15,,,,,,,109.0000,910.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,411.02,,,,,,,109.0000,910.0000,fee schedule,$411.02 from Fee Schedule BLDTM_23 for Rev 450 Proc 12018 * Qty 1 = $411.02 at 100% = $411.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,109.0000,910.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,109.0000,910.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,109.0000,910.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,819.00,,,,,,,109.0000,910.0000,percent of total billed charges,90% of $910.00 in Billed Charges for Rev 450 Proc 12018 = $819.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,HUMANA,HUMANA MEDICARE,182.03,,,,,,,109.0000,910.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,109.0000,910.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,MEDCOST,MEDCOST VHN,433.07,,,,,,,109.0000,910.0000,percent of total billed charges,47.59% of $910.00 in Billed Charges for Rev 450 Proc 12018 = $433.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,274.68,,,,,,,109.0000,910.0000,fee schedule,"APG 00016 Proc 12018 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 105% = $274.68 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,109.0000,910.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,109.0000,910.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,109.0000,910.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,269.71,,,,,,,109.0000,910.0000,fee schedule,"APG 00016 Proc 12018 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 103.1% = $269.71 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,SENTARA HEALTH,SENTARA HEALTH,234.87,,,,,,,109.0000,910.0000,percent of total billed charges,25.81% of $910.00 in Billed Charges for Rev 450 Proc 12018 = $234.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,109.0000,910.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",910.00,,,,,,,109.0000,910.0000,percent of total billed charges,100% of $910.00 in Billed Charges for Rev 450 Proc 12018 = $910.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,910.0000,case rate,Rev 450 Proc 12018 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,910.0000,case rate,Rev 450 Proc 12018 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,910.0000,case rate,Rev 450 Proc 12018 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,910.0000,case rate,Rev 450 Proc 12018 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,269.45,,,,,,,109.0000,910.0000,fee schedule,"APG 00016 Proc 12018 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,109.0000,910.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,109.0000,910.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,WELLCARE,WELLCARE MEDICAID,910.00,,,,,,,109.0000,910.0000,percent of total billed charges,100% of $910.00 in Billed Charges for Rev 450 Proc 12018 = $910.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMPL REPR SUPERFIC WND >30.0CM,12018,CPT,450,RC,45000308,CDM,,,,both,,,910.0000,136.5000,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,109.0000,910.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,AETNA,AETNA,633.24,,,,,,,47.0800,1483.0000,percent of total billed charges,"42.7% of $1,483.00 in Billed Charges for Rev 450 Proc 12021 = $633.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,47.0800,1483.0000,fee schedule,"APG 00017 Proc 12021 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,47.0800,1483.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,47.0800,1483.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,47.0800,1483.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,AMBETTER,AMBETTER,804.03,,,,,,,47.0800,1483.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,47.0800,1483.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,47.0800,1483.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,47.0800,1483.0000,fee schedule,"APG 00017 Proc 12021 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,47.0800,1483.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,47.0800,1483.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1134.94,,,,,,,47.0800,1483.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,105.14,,,,,,,47.0800,1483.0000,fee schedule,$105.14 from Fee Schedule BLDTM_23 for Rev 450 Proc 12021 * Qty 1 = $105.14 at 100% = $105.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,47.0800,1483.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,BLUE CROSS,TENNCARE BLUE CARE,47.08,,,,,,,47.0800,1483.0000,fee schedule,$40.59 from Fee Schedule TC_24 for Rev 450 Proc 12021 * Qty 1 = $40.59 at 116% = $47.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,BLUE CROSS,TENNCARE BLUE SELECT,47.08,,,,,,,47.0800,1483.0000,fee schedule,$40.59 from Fee Schedule TC_24 for Rev 450 Proc 12021 * Qty 1 = $40.59 at 116% = $47.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,47.0800,1483.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,47.0800,1483.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1334.70,,,,,,,47.0800,1483.0000,percent of total billed charges,"90% of $1,483.00 in Billed Charges for Rev 450 Proc 12021 = $1,334.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,47.0800,1483.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,47.0800,1483.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,MEDCOST,MEDCOST VHN,705.76,,,,,,,47.0800,1483.0000,percent of total billed charges,"47.59% of $1,483.00 in Billed Charges for Rev 450 Proc 12021 = $705.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,47.0800,1483.0000,fee schedule,"APG 00017 Proc 12021 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,47.0800,1483.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,47.0800,1483.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,47.0800,1483.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,47.0800,1483.0000,fee schedule,"APG 00017 Proc 12021 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,SENTARA HEALTH,SENTARA HEALTH,382.76,,,,,,,47.0800,1483.0000,percent of total billed charges,"25.81% of $1,483.00 in Billed Charges for Rev 450 Proc 12021 = $382.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,47.0800,1483.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1483.00,,,,,,,47.0800,1483.0000,percent of total billed charges,"100% of $1,483.00 in Billed Charges for Rev 450 Proc 12021 = $1,483.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,47.0800,1483.0000,case rate,Rev 450 Proc 12021 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,47.0800,1483.0000,case rate,Rev 450 Proc 12021 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,47.0800,1483.0000,case rate,Rev 450 Proc 12021 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,47.0800,1483.0000,case rate,Rev 450 Proc 12021 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,47.0800,1483.0000,fee schedule,"APG 00017 Proc 12021 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,47.0800,1483.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,47.0800,1483.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,WELLCARE,WELLCARE MEDICAID,1483.00,,,,,,,47.0800,1483.0000,percent of total billed charges,"100% of $1,483.00 in Billed Charges for Rev 450 Proc 12021 = $1,483.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX SUP WOUND DEHIS PACKING,12021,CPT,450,RC,45000049,CDM,,,,both,,,1483.0000,222.4500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,47.0800,1483.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,AETNA,AETNA,844.18,,,,,,,109.0000,1977.0000,percent of total billed charges,"42.7% of $1,977.00 in Billed Charges for Rev 450 Proc 12034 = $844.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,109.0000,1977.0000,fee schedule,"APG 00017 Proc 12034 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,109.0000,1977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,1977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,109.0000,1977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,AMBETTER,AMBETTER,804.03,,,,,,,109.0000,1977.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,109.0000,1977.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,109.0000,1977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,109.0000,1977.0000,fee schedule,"APG 00017 Proc 12034 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,109.0000,1977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,109.0000,1977.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1134.94,,,,,,,109.0000,1977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,177.75,,,,,,,109.0000,1977.0000,fee schedule,$177.75 from Fee Schedule BLDTM_23 for Rev 450 Proc 12034 * Qty 1 = $177.75 at 100% = $177.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,109.0000,1977.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,109.0000,1977.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,109.0000,1977.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1779.30,,,,,,,109.0000,1977.0000,percent of total billed charges,"90% of $1,977.00 in Billed Charges for Rev 450 Proc 12034 = $1,779.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,109.0000,1977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,109.0000,1977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,MEDCOST,MEDCOST VHN,940.85,,,,,,,109.0000,1977.0000,percent of total billed charges,"47.59% of $1,977.00 in Billed Charges for Rev 450 Proc 12034 = $940.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,109.0000,1977.0000,fee schedule,"APG 00017 Proc 12034 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,109.0000,1977.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,109.0000,1977.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,109.0000,1977.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,109.0000,1977.0000,fee schedule,"APG 00017 Proc 12034 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,SENTARA HEALTH,SENTARA HEALTH,510.26,,,,,,,109.0000,1977.0000,percent of total billed charges,"25.81% of $1,977.00 in Billed Charges for Rev 450 Proc 12034 = $510.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,109.0000,1977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1977.00,,,,,,,109.0000,1977.0000,percent of total billed charges,"100% of $1,977.00 in Billed Charges for Rev 450 Proc 12034 = $1,977.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1977.0000,case rate,Rev 450 Proc 12034 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1977.0000,case rate,Rev 450 Proc 12034 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1977.0000,case rate,Rev 450 Proc 12034 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1977.0000,case rate,Rev 450 Proc 12034 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,109.0000,1977.0000,fee schedule,"APG 00017 Proc 12034 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,1977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,109.0000,1977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,WELLCARE,WELLCARE MEDICAID,1977.00,,,,,,,109.0000,1977.0000,percent of total billed charges,"100% of $1,977.00 in Billed Charges for Rev 450 Proc 12034 = $1,977.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTERMED SCLP TRUNK 7.6-12.5,12034,CPT,450,RC,45000052,CDM,,,,both,,,1977.0000,296.5500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,109.0000,1977.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CONTROLLER COIL AZUR,272,RC,27200002,CDM,,,,,,both,,,2165.7800,324.8700,AETNA,AETNA,924.79,,,,,,,558.9900,2165.7800,percent of total billed charges,"42.7% of $2,165.78 in Billed Charges for Rev 272 = $924.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLLER COIL AZUR,272,RC,27200002,CDM,,,,,,both,,,2165.7800,324.8700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1516.05,,,,,,,558.9900,2165.7800,percent of total billed charges,"Rev 272 $2,165.78 in Billed Charges at 70% = $1,516.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLLER COIL AZUR,272,RC,27200002,CDM,,,,,,both,,,2165.7800,324.8700,CIGNA HEALTHCARE,CIGNA HMO,903.13,,,,,,,558.9900,2165.7800,percent of total billed charges,"41.7% of $2,165.78 in Billed Charges for Rev 272 = $903.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLLER COIL AZUR,272,RC,27200002,CDM,,,,,,both,,,2165.7800,324.8700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1004.92,,,,,,,558.9900,2165.7800,percent of total billed charges,"46.4% of $2,165.78 in Billed Charges for Rev 272 = $1,004.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLLER COIL AZUR,272,RC,27200002,CDM,,,,,,both,,,2165.7800,324.8700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,903.13,,,,,,,558.9900,2165.7800,percent of total billed charges,"41.7% of $2,165.78 in Billed Charges for Rev 272 = $903.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLLER COIL AZUR,272,RC,27200002,CDM,,,,,,both,,,2165.7800,324.8700,CIGNA HEALTHCARE,CIGNA PPO,903.13,,,,,,,558.9900,2165.7800,percent of total billed charges,"41.7% of $2,165.78 in Billed Charges for Rev 272 = $903.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLLER COIL AZUR,272,RC,27200002,CDM,,,,,,both,,,2165.7800,324.8700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1949.20,,,,,,,558.9900,2165.7800,percent of total billed charges,"90% of $2,165.78 in Billed Charges for Rev 272 = $1,949.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLLER COIL AZUR,272,RC,27200002,CDM,,,,,,both,,,2165.7800,324.8700,MEDCOST,MEDCOST VHN,1030.69,,,,,,,558.9900,2165.7800,percent of total billed charges,"47.59% of $2,165.78 in Billed Charges for Rev 272 = $1,030.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLLER COIL AZUR,272,RC,27200002,CDM,,,,,,both,,,2165.7800,324.8700,SENTARA HEALTH,SENTARA HEALTH,558.99,,,,,,,558.9900,2165.7800,percent of total billed charges,"25.81% of $2,165.78 in Billed Charges for Rev 272 = $558.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLLER COIL AZUR,272,RC,27200002,CDM,,,,,,both,,,2165.7800,324.8700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2165.78,,,,,,,558.9900,2165.7800,percent of total billed charges,"100% of $2,165.78 in Billed Charges for Rev 272 = $2,165.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLLER COIL AZUR,272,RC,27200002,CDM,,,,,,both,,,2165.7800,324.8700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1082.89,,,,,,,558.9900,2165.7800,percent of total billed charges,"Rev 272 $2,165.78 in Billed Charges at 50% = $1,082.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLLER COIL AZUR,272,RC,27200002,CDM,,,,,,both,,,2165.7800,324.8700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,699.55,,,,,,,558.9900,2165.7800,other,"32.3% of $2,165.78 in Billed Charges for Rev 272 = $699.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CONTROLLER COIL AZUR,272,RC,27200002,CDM,,,,,,both,,,2165.7800,324.8700,UNITED HEALTHCARE,UHC HERITAGE SELECT,664.89,,,,,,,558.9900,2165.7800,other,"30.7% of $2,165.78 in Billed Charges for Rev 272 = $664.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CONTROLLER COIL AZUR,272,RC,27200002,CDM,,,,,,both,,,2165.7800,324.8700,UNITED HEALTHCARE,UNITED HEALTHCARE,699.55,,,,,,,558.9900,2165.7800,percent of total billed charges,"32.3% of $2,165.78 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONTROLLER COIL AZUR,272,RC,27200002,CDM,,,,,,both,,,2165.7800,324.8700,WELLCARE,WELLCARE MEDICAID,2165.78,,,,,,,558.9900,2165.7800,percent of total billed charges,"100% of $2,165.78 in Billed Charges for Rev 272 = $2,165.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTER 4POINT DISTRACTION/COMPRESSION SST 10MM SQ HEAD,272,RC,,,,,,,,both,,,1139.4600,170.9200,AETNA,AETNA,486.55,,,,,,,294.0900,1139.4600,percent of total billed charges,"42.7% of $1,139.46 in Billed Charges for Rev 272 = $486.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTER 4POINT DISTRACTION/COMPRESSION SST 10MM SQ HEAD,272,RC,,,,,,,,both,,,1139.4600,170.9200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,797.62,,,,,,,294.0900,1139.4600,percent of total billed charges,"Rev 272 $1,139.46 in Billed Charges at 70% = $797.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTER 4POINT DISTRACTION/COMPRESSION SST 10MM SQ HEAD,272,RC,,,,,,,,both,,,1139.4600,170.9200,CIGNA HEALTHCARE,CIGNA HMO,475.15,,,,,,,294.0900,1139.4600,percent of total billed charges,"41.7% of $1,139.46 in Billed Charges for Rev 272 = $475.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTER 4POINT DISTRACTION/COMPRESSION SST 10MM SQ HEAD,272,RC,,,,,,,,both,,,1139.4600,170.9200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,528.71,,,,,,,294.0900,1139.4600,percent of total billed charges,"46.4% of $1,139.46 in Billed Charges for Rev 272 = $528.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTER 4POINT DISTRACTION/COMPRESSION SST 10MM SQ HEAD,272,RC,,,,,,,,both,,,1139.4600,170.9200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,475.15,,,,,,,294.0900,1139.4600,percent of total billed charges,"41.7% of $1,139.46 in Billed Charges for Rev 272 = $475.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTER 4POINT DISTRACTION/COMPRESSION SST 10MM SQ HEAD,272,RC,,,,,,,,both,,,1139.4600,170.9200,CIGNA HEALTHCARE,CIGNA PPO,475.15,,,,,,,294.0900,1139.4600,percent of total billed charges,"41.7% of $1,139.46 in Billed Charges for Rev 272 = $475.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTER 4POINT DISTRACTION/COMPRESSION SST 10MM SQ HEAD,272,RC,,,,,,,,both,,,1139.4600,170.9200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1025.51,,,,,,,294.0900,1139.4600,percent of total billed charges,"90% of $1,139.46 in Billed Charges for Rev 272 = $1,025.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTER 4POINT DISTRACTION/COMPRESSION SST 10MM SQ HEAD,272,RC,,,,,,,,both,,,1139.4600,170.9200,MEDCOST,MEDCOST VHN,542.27,,,,,,,294.0900,1139.4600,percent of total billed charges,"47.59% of $1,139.46 in Billed Charges for Rev 272 = $542.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTER 4POINT DISTRACTION/COMPRESSION SST 10MM SQ HEAD,272,RC,,,,,,,,both,,,1139.4600,170.9200,SENTARA HEALTH,SENTARA HEALTH,294.09,,,,,,,294.0900,1139.4600,percent of total billed charges,"25.81% of $1,139.46 in Billed Charges for Rev 272 = $294.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTER 4POINT DISTRACTION/COMPRESSION SST 10MM SQ HEAD,272,RC,,,,,,,,both,,,1139.4600,170.9200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1139.46,,,,,,,294.0900,1139.4600,percent of total billed charges,"100% of $1,139.46 in Billed Charges for Rev 272 = $1,139.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTER 4POINT DISTRACTION/COMPRESSION SST 10MM SQ HEAD,272,RC,,,,,,,,both,,,1139.4600,170.9200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,569.73,,,,,,,294.0900,1139.4600,percent of total billed charges,"Rev 272 $1,139.46 in Billed Charges at 50% = $569.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTER 4POINT DISTRACTION/COMPRESSION SST 10MM SQ HEAD,272,RC,,,,,,,,both,,,1139.4600,170.9200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,368.05,,,,,,,294.0900,1139.4600,other,"32.3% of $1,139.46 in Billed Charges for Rev 272 = $368.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
COUNTER 4POINT DISTRACTION/COMPRESSION SST 10MM SQ HEAD,272,RC,,,,,,,,both,,,1139.4600,170.9200,UNITED HEALTHCARE,UHC HERITAGE SELECT,349.81,,,,,,,294.0900,1139.4600,other,"30.7% of $1,139.46 in Billed Charges for Rev 272 = $349.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
COUNTER 4POINT DISTRACTION/COMPRESSION SST 10MM SQ HEAD,272,RC,,,,,,,,both,,,1139.4600,170.9200,UNITED HEALTHCARE,UNITED HEALTHCARE,368.05,,,,,,,294.0900,1139.4600,percent of total billed charges,"32.3% of $1,139.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COUNTER 4POINT DISTRACTION/COMPRESSION SST 10MM SQ HEAD,272,RC,,,,,,,,both,,,1139.4600,170.9200,WELLCARE,WELLCARE MEDICAID,1139.46,,,,,,,294.0900,1139.4600,percent of total billed charges,"100% of $1,139.46 in Billed Charges for Rev 272 = $1,139.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE TRUCLEAR ULTRA PLUS,272,RC,27200002,CDM,,,,,,both,,,9229.7800,1384.4700,AETNA,AETNA,3941.12,,,,,,,2382.2100,9229.7800,percent of total billed charges,"42.7% of $9,229.78 in Billed Charges for Rev 272 = $3,941.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE TRUCLEAR ULTRA PLUS,272,RC,27200002,CDM,,,,,,both,,,9229.7800,1384.4700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6460.85,,,,,,,2382.2100,9229.7800,percent of total billed charges,"Rev 272 $9,229.78 in Billed Charges at 70% = $6,460.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE TRUCLEAR ULTRA PLUS,272,RC,27200002,CDM,,,,,,both,,,9229.7800,1384.4700,CIGNA HEALTHCARE,CIGNA HMO,3848.82,,,,,,,2382.2100,9229.7800,percent of total billed charges,"41.7% of $9,229.78 in Billed Charges for Rev 272 = $3,848.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE TRUCLEAR ULTRA PLUS,272,RC,27200002,CDM,,,,,,both,,,9229.7800,1384.4700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4282.62,,,,,,,2382.2100,9229.7800,percent of total billed charges,"46.4% of $9,229.78 in Billed Charges for Rev 272 = $4,282.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE TRUCLEAR ULTRA PLUS,272,RC,27200002,CDM,,,,,,both,,,9229.7800,1384.4700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3848.82,,,,,,,2382.2100,9229.7800,percent of total billed charges,"41.7% of $9,229.78 in Billed Charges for Rev 272 = $3,848.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE TRUCLEAR ULTRA PLUS,272,RC,27200002,CDM,,,,,,both,,,9229.7800,1384.4700,CIGNA HEALTHCARE,CIGNA PPO,3848.82,,,,,,,2382.2100,9229.7800,percent of total billed charges,"41.7% of $9,229.78 in Billed Charges for Rev 272 = $3,848.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE TRUCLEAR ULTRA PLUS,272,RC,27200002,CDM,,,,,,both,,,9229.7800,1384.4700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8306.80,,,,,,,2382.2100,9229.7800,percent of total billed charges,"90% of $9,229.78 in Billed Charges for Rev 272 = $8,306.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE TRUCLEAR ULTRA PLUS,272,RC,27200002,CDM,,,,,,both,,,9229.7800,1384.4700,MEDCOST,MEDCOST VHN,4392.45,,,,,,,2382.2100,9229.7800,percent of total billed charges,"47.59% of $9,229.78 in Billed Charges for Rev 272 = $4,392.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE TRUCLEAR ULTRA PLUS,272,RC,27200002,CDM,,,,,,both,,,9229.7800,1384.4700,SENTARA HEALTH,SENTARA HEALTH,2382.21,,,,,,,2382.2100,9229.7800,percent of total billed charges,"25.81% of $9,229.78 in Billed Charges for Rev 272 = $2,382.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE TRUCLEAR ULTRA PLUS,272,RC,27200002,CDM,,,,,,both,,,9229.7800,1384.4700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9229.78,,,,,,,2382.2100,9229.7800,percent of total billed charges,"100% of $9,229.78 in Billed Charges for Rev 272 = $9,229.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE TRUCLEAR ULTRA PLUS,272,RC,27200002,CDM,,,,,,both,,,9229.7800,1384.4700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4614.89,,,,,,,2382.2100,9229.7800,percent of total billed charges,"Rev 272 $9,229.78 in Billed Charges at 50% = $4,614.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE TRUCLEAR ULTRA PLUS,272,RC,27200002,CDM,,,,,,both,,,9229.7800,1384.4700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2981.22,,,,,,,2382.2100,9229.7800,other,"32.3% of $9,229.78 in Billed Charges for Rev 272 = $2,981.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE TRUCLEAR ULTRA PLUS,272,RC,27200002,CDM,,,,,,both,,,9229.7800,1384.4700,UNITED HEALTHCARE,UHC HERITAGE SELECT,2833.54,,,,,,,2382.2100,9229.7800,other,"30.7% of $9,229.78 in Billed Charges for Rev 272 = $2,833.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE TRUCLEAR ULTRA PLUS,272,RC,27200002,CDM,,,,,,both,,,9229.7800,1384.4700,UNITED HEALTHCARE,UNITED HEALTHCARE,2981.22,,,,,,,2382.2100,9229.7800,percent of total billed charges,"32.3% of $9,229.78 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE TRUCLEAR ULTRA PLUS,272,RC,27200002,CDM,,,,,,both,,,9229.7800,1384.4700,WELLCARE,WELLCARE MEDICAID,9229.78,,,,,,,2382.2100,9229.7800,percent of total billed charges,"100% of $9,229.78 in Billed Charges for Rev 272 = $9,229.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,AETNA,AETNA,715.65,,,,,,,109.0000,1676.0000,percent of total billed charges,"42.7% of $1,676.00 in Billed Charges for Rev 450 Proc 12044 = $715.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,109.0000,1676.0000,fee schedule,"APG 00017 Proc 12044 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,670.54,,,,,,,109.0000,1676.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,AETNA,AETNA HEALTHCARE MEDICARE,670.54,,,,,,,109.0000,1676.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,670.54,,,,,,,109.0000,1676.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,AMBETTER,AMBETTER,1461.78,,,,,,,109.0000,1676.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,697.36,,,,,,,109.0000,1676.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,BLUE CROSS,ANTHEM EXCHANGE,1650.91,,,,,,,109.0000,1676.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,109.0000,1676.0000,fee schedule,"APG 00017 Proc 12044 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,BLUE CROSS,ANTHEM HMO,1676.00,,,,,,,109.0000,1676.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,690.66,,,,,,,109.0000,1676.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1676.00,,,,,,,109.0000,1676.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,191.54,,,,,,,109.0000,1676.0000,fee schedule,$191.54 from Fee Schedule BLDTM_23 for Rev 450 Proc 12044 * Qty 1 = $191.54 at 100% = $191.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,BLUE CROSS,BLUE CROSS MEDICARE,697.36,,,,,,,109.0000,1676.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,704.07,,,,,,,109.0000,1676.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,704.07,,,,,,,109.0000,1676.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1508.40,,,,,,,109.0000,1676.0000,percent of total billed charges,"90% of $1,676.00 in Billed Charges for Rev 450 Proc 12044 = $1,508.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,HUMANA,HUMANA MEDICARE,670.54,,,,,,,109.0000,1676.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,670.54,,,,,,,109.0000,1676.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,MEDCOST,MEDCOST VHN,797.61,,,,,,,109.0000,1676.0000,percent of total billed charges,"47.59% of $1,676.00 in Billed Charges for Rev 450 Proc 12044 = $797.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,109.0000,1676.0000,fee schedule,"APG 00017 Proc 12044 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,704.07,,,,,,,109.0000,1676.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,704.07,,,,,,,109.0000,1676.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,NHC ADVANTAGE,NHC ADVANTAGE,704.07,,,,,,,109.0000,1676.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,109.0000,1676.0000,fee schedule,"APG 00017 Proc 12044 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,SENTARA HEALTH,SENTARA HEALTH,432.58,,,,,,,109.0000,1676.0000,percent of total billed charges,"25.81% of $1,676.00 in Billed Charges for Rev 450 Proc 12044 = $432.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,SENTARA HEALTH,SENTARA MEDICARE,670.54,,,,,,,109.0000,1676.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1676.00,,,,,,,109.0000,1676.0000,percent of total billed charges,"100% of $1,676.00 in Billed Charges for Rev 450 Proc 12044 = $1,676.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1676.0000,case rate,Rev 450 Proc 12044 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1676.0000,case rate,Rev 450 Proc 12044 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1676.0000,case rate,Rev 450 Proc 12044 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1676.0000,case rate,Rev 450 Proc 12044 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,109.0000,1676.0000,fee schedule,"APG 00017 Proc 12044 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,670.54,,,,,,,109.0000,1676.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,670.54,,,,,,,109.0000,1676.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,WELLCARE,WELLCARE MEDICAID,1676.00,,,,,,,109.0000,1676.0000,percent of total billed charges,"100% of $1,676.00 in Billed Charges for Rev 450 Proc 12044 = $1,676.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WNDS N/H/F 7.6-12.5,12044,CPT,450,RC,45000057,CDM,,,,both,,,1676.0000,251.4000,WELLCARE,WELLCARE MEDICARE,710.77,,,,,,,109.0000,1676.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,AETNA,AETNA,880.90,,,,,,,109.0000,2063.0000,percent of total billed charges,"42.7% of $2,063.00 in Billed Charges for Rev 450 Proc 12045 = $880.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,109.0000,2063.0000,fee schedule,"APG 00017 Proc 12045 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,670.54,,,,,,,109.0000,2063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,AETNA,AETNA HEALTHCARE MEDICARE,670.54,,,,,,,109.0000,2063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,670.54,,,,,,,109.0000,2063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,AMBETTER,AMBETTER,1461.78,,,,,,,109.0000,2063.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,697.36,,,,,,,109.0000,2063.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,BLUE CROSS,ANTHEM EXCHANGE,1650.91,,,,,,,109.0000,2063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,109.0000,2063.0000,fee schedule,"APG 00017 Proc 12045 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,BLUE CROSS,ANTHEM HMO,1753.99,,,,,,,109.0000,2063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,690.66,,,,,,,109.0000,2063.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2063.00,,,,,,,109.0000,2063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,229.02,,,,,,,109.0000,2063.0000,fee schedule,$229.02 from Fee Schedule BLDTM_23 for Rev 450 Proc 12045 * Qty 1 = $229.02 at 100% = $229.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,BLUE CROSS,BLUE CROSS MEDICARE,697.36,,,,,,,109.0000,2063.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,704.07,,,,,,,109.0000,2063.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,704.07,,,,,,,109.0000,2063.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1856.70,,,,,,,109.0000,2063.0000,percent of total billed charges,"90% of $2,063.00 in Billed Charges for Rev 450 Proc 12045 = $1,856.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,HUMANA,HUMANA MEDICARE,670.54,,,,,,,109.0000,2063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,670.54,,,,,,,109.0000,2063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,MEDCOST,MEDCOST VHN,981.78,,,,,,,109.0000,2063.0000,percent of total billed charges,"47.59% of $2,063.00 in Billed Charges for Rev 450 Proc 12045 = $981.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,109.0000,2063.0000,fee schedule,"APG 00017 Proc 12045 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,704.07,,,,,,,109.0000,2063.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,704.07,,,,,,,109.0000,2063.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,NHC ADVANTAGE,NHC ADVANTAGE,704.07,,,,,,,109.0000,2063.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,109.0000,2063.0000,fee schedule,"APG 00017 Proc 12045 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,SENTARA HEALTH,SENTARA HEALTH,532.46,,,,,,,109.0000,2063.0000,percent of total billed charges,"25.81% of $2,063.00 in Billed Charges for Rev 450 Proc 12045 = $532.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,SENTARA HEALTH,SENTARA MEDICARE,670.54,,,,,,,109.0000,2063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2063.00,,,,,,,109.0000,2063.0000,percent of total billed charges,"100% of $2,063.00 in Billed Charges for Rev 450 Proc 12045 = $2,063.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,2063.0000,case rate,Rev 450 Proc 12045 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,2063.0000,case rate,Rev 450 Proc 12045 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,2063.0000,case rate,Rev 450 Proc 12045 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,2063.0000,case rate,Rev 450 Proc 12045 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,109.0000,2063.0000,fee schedule,"APG 00017 Proc 12045 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,670.54,,,,,,,109.0000,2063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,670.54,,,,,,,109.0000,2063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,WELLCARE,WELLCARE MEDICAID,2063.00,,,,,,,109.0000,2063.0000,percent of total billed charges,"100% of $2,063.00 in Billed Charges for Rev 450 Proc 12045 = $2,063.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND N/H/F 12.6-20.0,12045,CPT,450,RC,45000058,CDM,,,,both,,,2063.0000,309.4500,WELLCARE,WELLCARE MEDICARE,710.77,,,,,,,109.0000,2063.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,AETNA,AETNA,1442.41,,,,,,,109.0000,6471.5500,percent of total billed charges,"42.7% of $3,378.00 in Billed Charges for Rev 450 Proc 20650 = $1,442.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3426.31,,,,,,,109.0000,6471.5500,fee schedule,"APG 00054 Proc 20650 at $836.60 (Base Rate) * 3.938 (Relative Weight) = $3,294.53 (Total Line Payment) at 104% = $3,426.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2968.60,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,AETNA,AETNA HEALTHCARE MEDICARE,2968.60,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,2968.60,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,AMBETTER,AMBETTER,6471.55,,,,,,,109.0000,6471.5500,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3087.35,,,,,,,109.0000,6471.5500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,BLUE CROSS,ANTHEM EXCHANGE,3378.00,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3378.00,,,,,,,109.0000,6471.5500,fee schedule,"APG 00054 Proc 20650 at $836.60 (Base Rate) * 3.938 (Relative Weight) = $3,294.53 (Total Line Payment) at 103% = $3,393.37 (Service Line reduced to $3,378.00, claim capped at $3,378.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,BLUE CROSS,ANTHEM HMO,3378.00,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3057.66,,,,,,,109.0000,6471.5500,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3378.00,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,130.45,,,,,,,109.0000,6471.5500,fee schedule,$130.45 from Fee Schedule BLDTM_23 for Rev 450 Proc 20650 * Qty 1 = $130.45 at 100% = $130.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,BLUE CROSS,BLUE CROSS MEDICARE,3087.35,,,,,,,109.0000,6471.5500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,3117.03,,,,,,,109.0000,6471.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3117.03,,,,,,,109.0000,6471.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3040.20,,,,,,,109.0000,6471.5500,percent of total billed charges,"90% of $3,378.00 in Billed Charges for Rev 450 Proc 20650 = $3,040.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,HUMANA,HUMANA MEDICARE,2968.60,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2968.60,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,MEDCOST,MEDCOST VHN,1607.59,,,,,,,109.0000,6471.5500,percent of total billed charges,"47.59% of $3,378.00 in Billed Charges for Rev 450 Proc 20650 = $1,607.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3459.26,,,,,,,109.0000,6471.5500,fee schedule,"APG 00054 Proc 20650 at $836.60 (Base Rate) * 3.938 (Relative Weight) = $3,294.53 (Total Line Payment) at 100% = $3,294.53... $3,294.53 at 105% = $3,459.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3117.03,,,,,,,109.0000,6471.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3117.03,,,,,,,109.0000,6471.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,NHC ADVANTAGE,NHC ADVANTAGE,3117.03,,,,,,,109.0000,6471.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3396.66,,,,,,,109.0000,6471.5500,fee schedule,"APG 00054 Proc 20650 at $836.60 (Base Rate) * 3.938 (Relative Weight) = $3,294.53 (Total Line Payment) at 100% = $3,294.53... $3,294.53 at 103.1% = $3,396.66 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,SENTARA HEALTH,SENTARA HEALTH,871.86,,,,,,,109.0000,6471.5500,percent of total billed charges,"25.81% of $3,378.00 in Billed Charges for Rev 450 Proc 20650 = $871.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,SENTARA HEALTH,SENTARA MEDICARE,2968.60,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3378.00,,,,,,,109.0000,6471.5500,percent of total billed charges,"100% of $3,378.00 in Billed Charges for Rev 450 Proc 20650 = $3,378.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,6471.5500,case rate,Rev 450 Proc 20650 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,6471.5500,case rate,Rev 450 Proc 20650 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,6471.5500,case rate,Rev 450 Proc 20650 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,6471.5500,case rate,Rev 450 Proc 20650 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3393.37,,,,,,,109.0000,6471.5500,fee schedule,"APG 00054 Proc 20650 at $836.60 (Base Rate) * 3.938 (Relative Weight) = $3,294.53 (Total Line Payment) at 103% = $3,393.37. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2968.60,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2968.60,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,WELLCARE,WELLCARE MEDICAID,3378.00,,,,,,,109.0000,6471.5500,percent of total billed charges,"100% of $3,378.00 in Billed Charges for Rev 450 Proc 20650 = $3,378.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INS OF WIRE/PIN W/APPL SKEL TRAC,20650,CPT,450,RC,45000094,CDM,,,,both,,,3378.0000,506.7000,WELLCARE,WELLCARE MEDICARE,3146.72,,,,,,,109.0000,6471.5500,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,AETNA,AETNA,39666.59,,,,,,,890.0000,92896.0000,percent of total billed charges,"42.7% of $92,896.00 in Billed Charges for Rev 361 Proc 20983 = $39,666.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2612.63,,,,,,,890.0000,92896.0000,fee schedule,"APG 00051 Proc 20983 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 104% = $2,612.63. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,7418.54,,,,,,,890.0000,92896.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,AETNA,AETNA HEALTHCARE MEDICARE,7418.54,,,,,,,890.0000,92896.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,7418.54,,,,,,,890.0000,92896.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,AMBETTER,AMBETTER,16172.41,,,,,,,890.0000,92896.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,7715.28,,,,,,,890.0000,92896.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,BLUE CROSS,ANTHEM EXCHANGE,16208.64,,,,,,,890.0000,92896.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2587.51,,,,,,,890.0000,92896.0000,fee schedule,"APG 00051 Proc 20983 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,BLUE CROSS,ANTHEM HMO,17220.71,,,,,,,890.0000,92896.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,7641.09,,,,,,,890.0000,92896.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",20258.57,,,,,,,890.0000,92896.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,890.0000,92896.0000,case rate,"Rev 361 Proc 20983 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,890.0000,92896.0000,case rate,"Rev 361 Proc 20983 ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,BLUE CROSS,BLUE CROSS MEDICARE,7715.28,,,,,,,890.0000,92896.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,890.0000,92896.0000,case rate,"Rev 361 Proc 20983 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,890.0000,92896.0000,case rate,"Rev 361 Proc 20983 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,BLUE CROSS,TENNCARE BLUE CARE,890.00,,,,,,,890.0000,92896.0000,case rate,Rev 361 Proc 20983 ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,BLUE CROSS,TENNCARE BLUE SELECT,890.00,,,,,,,890.0000,92896.0000,case rate,Rev 361 Proc 20983 ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,890.0000,92896.0000,case rate,"Rev 361 Proc 20983 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,890.0000,92896.0000,case rate,"Rev 361 Proc 20983 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,7789.46,,,,,,,890.0000,92896.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,890.0000,92896.0000,case rate,"Rev 361 Proc 20983 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,890.0000,92896.0000,case rate,"Rev 361 Proc 20983 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,7789.46,,,,,,,890.0000,92896.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,83606.40,,,,,,,890.0000,92896.0000,percent of total billed charges,"90% of $92,896.00 in Billed Charges for Rev 361 Proc 20983 = $83,606.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,HUMANA,HUMANA MEDICARE,7418.54,,,,,,,890.0000,92896.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,7418.54,,,,,,,890.0000,92896.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,MEDCOST,MEDCOST VHN,44209.21,,,,,,,890.0000,92896.0000,percent of total billed charges,"47.59% of $92,896.00 in Billed Charges for Rev 361 Proc 20983 = $44,209.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2637.75,,,,,,,890.0000,92896.0000,fee schedule,"APG 00051 Proc 20983 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 105% = $2,637.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,7789.46,,,,,,,890.0000,92896.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,7789.46,,,,,,,890.0000,92896.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,NHC ADVANTAGE,NHC ADVANTAGE,7789.46,,,,,,,890.0000,92896.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2590.02,,,,,,,890.0000,92896.0000,fee schedule,"APG 00051 Proc 20983 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 103.1% = $2,590.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,SENTARA HEALTH,SENTARA HEALTH,23976.46,,,,,,,890.0000,92896.0000,percent of total billed charges,"25.81% of $92,896.00 in Billed Charges for Rev 361 Proc 20983 = $23,976.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,SENTARA HEALTH,SENTARA MEDICARE,7418.54,,,,,,,890.0000,92896.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",92896.00,,,,,,,890.0000,92896.0000,percent of total billed charges,"100% of $92,896.00 in Billed Charges for Rev 361 Proc 20983 = $92,896.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,890.0000,92896.0000,case rate,"Rev 361 Proc 20983 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,890.0000,92896.0000,case rate,"Rev 361 Proc 20983 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,890.0000,92896.0000,case rate,"Rev 361 Proc 20983 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,890.0000,92896.0000,case rate,"Rev 361 Proc 20983 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2587.51,,,,,,,890.0000,92896.0000,fee schedule,"APG 00051 Proc 20983 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,7418.54,,,,,,,890.0000,92896.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,7418.54,,,,,,,890.0000,92896.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,WELLCARE,WELLCARE MEDICAID,92896.00,,,,,,,890.0000,92896.0000,percent of total billed charges,"100% of $92,896.00 in Billed Charges for Rev 361 Proc 20983 = $92,896.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLATION BONE TUMOR(S) CRYO PERQ W IMG GUID WHEN PRFMD,20983,CPT,361,RC,36100540,CDM,,,,both,,,92896.0000,13934.4000,WELLCARE,WELLCARE MEDICARE,7863.65,,,,,,,890.0000,92896.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DILATOR 5FR .38 20CM,272,RC,,,,,,,,both,,,88.0500,13.2100,AETNA,AETNA,37.60,,,,,,,22.7300,88.0500,percent of total billed charges,42.7% of $88.05 in Billed Charges for Rev 272 = $37.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DILATOR 5FR .38 20CM,272,RC,,,,,,,,both,,,88.0500,13.2100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,61.64,,,,,,,22.7300,88.0500,percent of total billed charges,Rev 272 $88.05 in Billed Charges at 70% = $61.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DILATOR 5FR .38 20CM,272,RC,,,,,,,,both,,,88.0500,13.2100,CIGNA HEALTHCARE,CIGNA HMO,36.72,,,,,,,22.7300,88.0500,percent of total billed charges,41.7% of $88.05 in Billed Charges for Rev 272 = $36.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DILATOR 5FR .38 20CM,272,RC,,,,,,,,both,,,88.0500,13.2100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,40.86,,,,,,,22.7300,88.0500,percent of total billed charges,46.4% of $88.05 in Billed Charges for Rev 272 = $40.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DILATOR 5FR .38 20CM,272,RC,,,,,,,,both,,,88.0500,13.2100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,36.72,,,,,,,22.7300,88.0500,percent of total billed charges,41.7% of $88.05 in Billed Charges for Rev 272 = $36.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DILATOR 5FR .38 20CM,272,RC,,,,,,,,both,,,88.0500,13.2100,CIGNA HEALTHCARE,CIGNA PPO,36.72,,,,,,,22.7300,88.0500,percent of total billed charges,41.7% of $88.05 in Billed Charges for Rev 272 = $36.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DILATOR 5FR .38 20CM,272,RC,,,,,,,,both,,,88.0500,13.2100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,79.25,,,,,,,22.7300,88.0500,percent of total billed charges,90% of $88.05 in Billed Charges for Rev 272 = $79.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DILATOR 5FR .38 20CM,272,RC,,,,,,,,both,,,88.0500,13.2100,MEDCOST,MEDCOST VHN,41.90,,,,,,,22.7300,88.0500,percent of total billed charges,47.59% of $88.05 in Billed Charges for Rev 272 = $41.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DILATOR 5FR .38 20CM,272,RC,,,,,,,,both,,,88.0500,13.2100,SENTARA HEALTH,SENTARA HEALTH,22.73,,,,,,,22.7300,88.0500,percent of total billed charges,25.81% of $88.05 in Billed Charges for Rev 272 = $22.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DILATOR 5FR .38 20CM,272,RC,,,,,,,,both,,,88.0500,13.2100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",88.05,,,,,,,22.7300,88.0500,percent of total billed charges,100% of $88.05 in Billed Charges for Rev 272 = $88.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DILATOR 5FR .38 20CM,272,RC,,,,,,,,both,,,88.0500,13.2100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,44.03,,,,,,,22.7300,88.0500,percent of total billed charges,Rev 272 $88.05 in Billed Charges at 50% = $44.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DILATOR 5FR .38 20CM,272,RC,,,,,,,,both,,,88.0500,13.2100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,28.44,,,,,,,22.7300,88.0500,other,32.3% of $88.05 in Billed Charges for Rev 272 = $28.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DILATOR 5FR .38 20CM,272,RC,,,,,,,,both,,,88.0500,13.2100,UNITED HEALTHCARE,UHC HERITAGE SELECT,27.03,,,,,,,22.7300,88.0500,other,30.7% of $88.05 in Billed Charges for Rev 272 = $27.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DILATOR 5FR .38 20CM,272,RC,,,,,,,,both,,,88.0500,13.2100,UNITED HEALTHCARE,UNITED HEALTHCARE,28.44,,,,,,,22.7300,88.0500,percent of total billed charges,32.3% of $88.05 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DILATOR 5FR .38 20CM,272,RC,,,,,,,,both,,,88.0500,13.2100,WELLCARE,WELLCARE MEDICAID,88.05,,,,,,,22.7300,88.0500,percent of total billed charges,100% of $88.05 in Billed Charges for Rev 272 = $88.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,AETNA,AETNA,727.61,,,,,,,61.2100,3068.8100,percent of total billed charges,"42.7% of $1,704.00 in Billed Charges for Rev 450 Proc 21315 = $727.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,61.2100,3068.8100,fee schedule,APG 00041 Proc 21315 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1407.71,,,,,,,61.2100,3068.8100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,AETNA,AETNA HEALTHCARE MEDICARE,1407.71,,,,,,,61.2100,3068.8100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,1407.71,,,,,,,61.2100,3068.8100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,AMBETTER,AMBETTER,3068.81,,,,,,,61.2100,3068.8100,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1464.02,,,,,,,61.2100,3068.8100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,BLUE CROSS,ANTHEM EXCHANGE,1704.00,,,,,,,61.2100,3068.8100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,61.2100,3068.8100,fee schedule,APG 00041 Proc 21315 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,BLUE CROSS,ANTHEM HMO,1704.00,,,,,,,61.2100,3068.8100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1449.94,,,,,,,61.2100,3068.8100,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1704.00,,,,,,,61.2100,3068.8100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,158.42,,,,,,,61.2100,3068.8100,fee schedule,$158.42 from Fee Schedule BLDTM_23 for Rev 450 Proc 21315 * Qty 1 = $158.42 at 100% = $158.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,BLUE CROSS,BLUE CROSS MEDICARE,1464.02,,,,,,,61.2100,3068.8100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,BLUE CROSS,TENNCARE BLUE CARE,61.21,,,,,,,61.2100,3068.8100,fee schedule,$52.77 from Fee Schedule TC_24 for Rev 450 Proc 21315 * Qty 1 = $52.77 at 116% = $61.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,BLUE CROSS,TENNCARE BLUE SELECT,61.21,,,,,,,61.2100,3068.8100,fee schedule,$52.77 from Fee Schedule TC_24 for Rev 450 Proc 21315 * Qty 1 = $52.77 at 116% = $61.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,1478.10,,,,,,,61.2100,3068.8100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1478.10,,,,,,,61.2100,3068.8100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1533.60,,,,,,,61.2100,3068.8100,percent of total billed charges,"90% of $1,704.00 in Billed Charges for Rev 450 Proc 21315 = $1,533.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,HUMANA,HUMANA MEDICARE,1407.71,,,,,,,61.2100,3068.8100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1407.71,,,,,,,61.2100,3068.8100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,MEDCOST,MEDCOST VHN,810.93,,,,,,,61.2100,3068.8100,percent of total billed charges,"47.59% of $1,704.00 in Billed Charges for Rev 450 Proc 21315 = $810.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,61.2100,3068.8100,fee schedule,APG 00041 Proc 21315 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1478.10,,,,,,,61.2100,3068.8100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1478.10,,,,,,,61.2100,3068.8100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,NHC ADVANTAGE,NHC ADVANTAGE,1478.10,,,,,,,61.2100,3068.8100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,61.2100,3068.8100,fee schedule,APG 00041 Proc 21315 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,SENTARA HEALTH,SENTARA HEALTH,439.80,,,,,,,61.2100,3068.8100,percent of total billed charges,"25.81% of $1,704.00 in Billed Charges for Rev 450 Proc 21315 = $439.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,SENTARA HEALTH,SENTARA MEDICARE,1407.71,,,,,,,61.2100,3068.8100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1704.00,,,,,,,61.2100,3068.8100,percent of total billed charges,"100% of $1,704.00 in Billed Charges for Rev 450 Proc 21315 = $1,704.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,61.2100,3068.8100,case rate,Rev 450 Proc 21315 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,61.2100,3068.8100,case rate,Rev 450 Proc 21315 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,61.2100,3068.8100,case rate,Rev 450 Proc 21315 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,61.2100,3068.8100,case rate,Rev 450 Proc 21315 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,61.2100,3068.8100,fee schedule,APG 00041 Proc 21315 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1407.71,,,,,,,61.2100,3068.8100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1407.71,,,,,,,61.2100,3068.8100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,WELLCARE,WELLCARE MEDICAID,1704.00,,,,,,,61.2100,3068.8100,percent of total billed charges,"100% of $1,704.00 in Billed Charges for Rev 450 Proc 21315 = $1,704.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TX NASAL FRACTURE W/O STABILIZATION,21315,CPT,450,RC,45000097,CDM,,,,both,,,1704.0000,255.6000,WELLCARE,WELLCARE MEDICARE,1492.17,,,,,,,61.2100,3068.8100,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,AETNA,AETNA,3498.84,,,,,,,109.0000,8194.0000,percent of total billed charges,"42.7% of $8,194.00 in Billed Charges for Rev 450 Proc 21440 = $3,498.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3794.70,,,,,,,109.0000,8194.0000,fee schedule,"APG 00227 Proc 21440 at $836.60 (Base Rate) * 4.3614 (Relative Weight) = $3,648.75 (Total Line Payment) at 104% = $3,794.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3008.03,,,,,,,109.0000,8194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,AETNA,AETNA HEALTHCARE MEDICARE,3008.03,,,,,,,109.0000,8194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,3008.03,,,,,,,109.0000,8194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,AMBETTER,AMBETTER,6557.51,,,,,,,109.0000,8194.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3128.35,,,,,,,109.0000,8194.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,BLUE CROSS,ANTHEM EXCHANGE,7405.94,,,,,,,109.0000,8194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3758.21,,,,,,,109.0000,8194.0000,fee schedule,"APG 00227 Proc 21440 at $836.60 (Base Rate) * 4.3614 (Relative Weight) = $3,648.75 (Total Line Payment) at 103% = $3,758.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,BLUE CROSS,ANTHEM HMO,7868.37,,,,,,,109.0000,8194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3098.27,,,,,,,109.0000,8194.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8194.00,,,,,,,109.0000,8194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,257.73,,,,,,,109.0000,8194.0000,fee schedule,$257.73 from Fee Schedule BLDTM_23 for Rev 450 Proc 21440 * Qty 1 = $257.73 at 100% = $257.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,BLUE CROSS,BLUE CROSS MEDICARE,3128.35,,,,,,,109.0000,8194.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,3158.43,,,,,,,109.0000,8194.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3158.43,,,,,,,109.0000,8194.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7374.60,,,,,,,109.0000,8194.0000,percent of total billed charges,"90% of $8,194.00 in Billed Charges for Rev 450 Proc 21440 = $7,374.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,HUMANA,HUMANA MEDICARE,3008.03,,,,,,,109.0000,8194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3008.03,,,,,,,109.0000,8194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,MEDCOST,MEDCOST VHN,3899.52,,,,,,,109.0000,8194.0000,percent of total billed charges,"47.59% of $8,194.00 in Billed Charges for Rev 450 Proc 21440 = $3,899.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3831.19,,,,,,,109.0000,8194.0000,fee schedule,"APG 00227 Proc 21440 at $836.60 (Base Rate) * 4.3614 (Relative Weight) = $3,648.75 (Total Line Payment) at 100% = $3,648.75... $3,648.75 at 105% = $3,831.19 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3158.43,,,,,,,109.0000,8194.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3158.43,,,,,,,109.0000,8194.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,NHC ADVANTAGE,NHC ADVANTAGE,3158.43,,,,,,,109.0000,8194.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3761.86,,,,,,,109.0000,8194.0000,fee schedule,"APG 00227 Proc 21440 at $836.60 (Base Rate) * 4.3614 (Relative Weight) = $3,648.75 (Total Line Payment) at 100% = $3,648.75... $3,648.75 at 103.1% = $3,761.86 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,SENTARA HEALTH,SENTARA HEALTH,2114.87,,,,,,,109.0000,8194.0000,percent of total billed charges,"25.81% of $8,194.00 in Billed Charges for Rev 450 Proc 21440 = $2,114.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,SENTARA HEALTH,SENTARA MEDICARE,3008.03,,,,,,,109.0000,8194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8194.00,,,,,,,109.0000,8194.0000,percent of total billed charges,"100% of $8,194.00 in Billed Charges for Rev 450 Proc 21440 = $8,194.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,8194.0000,case rate,Rev 450 Proc 21440 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,8194.0000,case rate,Rev 450 Proc 21440 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,8194.0000,case rate,Rev 450 Proc 21440 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,8194.0000,case rate,Rev 450 Proc 21440 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3758.21,,,,,,,109.0000,8194.0000,fee schedule,"APG 00227 Proc 21440 at $836.60 (Base Rate) * 4.3614 (Relative Weight) = $3,648.75 (Total Line Payment) at 103% = $3,758.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3008.03,,,,,,,109.0000,8194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3008.03,,,,,,,109.0000,8194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,WELLCARE,WELLCARE MEDICAID,8194.00,,,,,,,109.0000,8194.0000,percent of total billed charges,"100% of $8,194.00 in Billed Charges for Rev 450 Proc 21440 = $8,194.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MANDIBULAR MAXILLARY ALVEOLAR RIDGE FX,21440,CPT,450,RC,45000363,CDM,,,,both,,,8194.0000,1229.1000,WELLCARE,WELLCARE MEDICARE,3188.51,,,,,,,109.0000,8194.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,AETNA,AETNA,2005.62,,,,,,,109.0000,4697.0000,percent of total billed charges,"42.7% of $4,697.00 in Billed Charges for Rev 450 Proc 21451 = $2,005.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,4697.0000,fee schedule,APG 00041 Proc 21451 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1407.71,,,,,,,109.0000,4697.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,AETNA,AETNA HEALTHCARE MEDICARE,1407.71,,,,,,,109.0000,4697.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,1407.71,,,,,,,109.0000,4697.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,AMBETTER,AMBETTER,3068.81,,,,,,,109.0000,4697.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1464.02,,,,,,,109.0000,4697.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,BLUE CROSS,ANTHEM EXCHANGE,3465.87,,,,,,,109.0000,4697.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,4697.0000,fee schedule,APG 00041 Proc 21451 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,BLUE CROSS,ANTHEM HMO,3682.28,,,,,,,109.0000,4697.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1449.94,,,,,,,109.0000,4697.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4331.86,,,,,,,109.0000,4697.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,449.12,,,,,,,109.0000,4697.0000,fee schedule,$449.12 from Fee Schedule BLDTM_23 for Rev 450 Proc 21451 * Qty 1 = $449.12 at 100% = $449.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,BLUE CROSS,BLUE CROSS MEDICARE,1464.02,,,,,,,109.0000,4697.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,1478.10,,,,,,,109.0000,4697.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1478.10,,,,,,,109.0000,4697.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4227.30,,,,,,,109.0000,4697.0000,percent of total billed charges,"90% of $4,697.00 in Billed Charges for Rev 450 Proc 21451 = $4,227.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,HUMANA,HUMANA MEDICARE,1407.71,,,,,,,109.0000,4697.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1407.71,,,,,,,109.0000,4697.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,MEDCOST,MEDCOST VHN,2235.30,,,,,,,109.0000,4697.0000,percent of total billed charges,"47.59% of $4,697.00 in Billed Charges for Rev 450 Proc 21451 = $2,235.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,4697.0000,fee schedule,APG 00041 Proc 21451 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1478.10,,,,,,,109.0000,4697.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1478.10,,,,,,,109.0000,4697.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,NHC ADVANTAGE,NHC ADVANTAGE,1478.10,,,,,,,109.0000,4697.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,4697.0000,fee schedule,APG 00041 Proc 21451 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,SENTARA HEALTH,SENTARA HEALTH,1212.30,,,,,,,109.0000,4697.0000,percent of total billed charges,"25.81% of $4,697.00 in Billed Charges for Rev 450 Proc 21451 = $1,212.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,SENTARA HEALTH,SENTARA MEDICARE,1407.71,,,,,,,109.0000,4697.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4697.00,,,,,,,109.0000,4697.0000,percent of total billed charges,"100% of $4,697.00 in Billed Charges for Rev 450 Proc 21451 = $4,697.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,4697.0000,case rate,Rev 450 Proc 21451 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,4697.0000,case rate,Rev 450 Proc 21451 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,4697.0000,case rate,Rev 450 Proc 21451 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,4697.0000,case rate,Rev 450 Proc 21451 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,4697.0000,fee schedule,APG 00041 Proc 21451 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1407.71,,,,,,,109.0000,4697.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1407.71,,,,,,,109.0000,4697.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,WELLCARE,WELLCARE MEDICAID,4697.00,,,,,,,109.0000,4697.0000,percent of total billed charges,"100% of $4,697.00 in Billed Charges for Rev 450 Proc 21451 = $4,697.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MANDIBULAR FX W MANIP,21451,CPT,450,RC,45000365,CDM,,,,both,,,4697.0000,704.5500,WELLCARE,WELLCARE MEDICARE,1492.17,,,,,,,109.0000,4697.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,AETNA,AETNA,322.81,,,,,,,109.0000,3831.1900,percent of total billed charges,42.7% of $756.00 in Billed Charges for Rev 450 Proc 21499 = $322.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3794.70,,,,,,,109.0000,3831.1900,fee schedule,"APG 00227 Proc 21499 at $836.60 (Base Rate) * 4.3614 (Relative Weight) = $3,648.75 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $3,648.75 at 104% = $3,794.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,214.89,,,,,,,109.0000,3831.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,AETNA,AETNA HEALTHCARE MEDICARE,214.89,,,,,,,109.0000,3831.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,214.89,,,,,,,109.0000,3831.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,AMBETTER,AMBETTER,468.46,,,,,,,109.0000,3831.1900,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,223.48,,,,,,,109.0000,3831.1900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,BLUE CROSS,ANTHEM EXCHANGE,529.08,,,,,,,109.0000,3831.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,756.00,,,,,,,109.0000,3831.1900,fee schedule,"APG 00227 Proc 21499 at $836.60 (Base Rate) * 4.3614 (Relative Weight) = $3,648.75 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $3,648.75 at 103% = $3,758.21 (Service Line reduced to $756.00, claim capped at $756.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,BLUE CROSS,ANTHEM HMO,562.11,,,,,,,109.0000,3831.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,221.33,,,,,,,109.0000,3831.1900,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",661.27,,,,,,,109.0000,3831.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,BLUE CROSS,BLUE CROSS MEDICARE,223.48,,,,,,,109.0000,3831.1900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,225.63,,,,,,,109.0000,3831.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,225.63,,,,,,,109.0000,3831.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,680.40,,,,,,,109.0000,3831.1900,percent of total billed charges,90% of $756.00 in Billed Charges for Rev 450 Proc 21499 = $680.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,HUMANA,HUMANA MEDICARE,214.89,,,,,,,109.0000,3831.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,214.89,,,,,,,109.0000,3831.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,MEDCOST,MEDCOST VHN,359.78,,,,,,,109.0000,3831.1900,percent of total billed charges,47.59% of $756.00 in Billed Charges for Rev 450 Proc 21499 = $359.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3831.19,,,,,,,109.0000,3831.1900,fee schedule,"APG 00227 Proc 21499 at $836.60 (Base Rate) * 4.3614 (Relative Weight) = $3,648.75 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $3,648.75 at 100% = $3,648.75... $3,648.75 at 105% = $3,831.19 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,225.63,,,,,,,109.0000,3831.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,225.63,,,,,,,109.0000,3831.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,NHC ADVANTAGE,NHC ADVANTAGE,225.63,,,,,,,109.0000,3831.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3761.86,,,,,,,109.0000,3831.1900,fee schedule,"APG 00227 Proc 21499 at $836.60 (Base Rate) * 4.3614 (Relative Weight) = $3,648.75 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $3,648.75 at 100% = $3,648.75... $3,648.75 at 103.1% = $3,761.86 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,SENTARA HEALTH,SENTARA HEALTH,195.12,,,,,,,109.0000,3831.1900,percent of total billed charges,25.81% of $756.00 in Billed Charges for Rev 450 Proc 21499 = $195.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,SENTARA HEALTH,SENTARA MEDICARE,214.89,,,,,,,109.0000,3831.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",756.00,,,,,,,109.0000,3831.1900,percent of total billed charges,100% of $756.00 in Billed Charges for Rev 450 Proc 21499 = $756.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3831.1900,case rate,Rev 450 Proc 21499 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3831.1900,case rate,Rev 450 Proc 21499 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3831.1900,case rate,Rev 450 Proc 21499 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,756.00,,,,,,,109.0000,3831.1900,case rate,"Rev 450 Proc 21499 at Case Rate $847.00 (Service Line reduced to $756.00, claim capped at $756.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3758.21,,,,,,,109.0000,3831.1900,fee schedule,"APG 00227 Proc 21499 at $836.60 (Base Rate) * 4.3614 (Relative Weight) = $3,648.75 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $3,648.75 at 103% = $3,758.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,214.89,,,,,,,109.0000,3831.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,214.89,,,,,,,109.0000,3831.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,WELLCARE,WELLCARE MEDICAID,756.00,,,,,,,109.0000,3831.1900,percent of total billed charges,100% of $756.00 in Billed Charges for Rev 450 Proc 21499 = $756.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED MUSCULOSKELETAL PROC HEAD,21499,CPT,450,RC,45000366,CDM,,,,both,,,756.0000,113.4000,WELLCARE,WELLCARE MEDICARE,227.78,,,,,,,109.0000,3831.1900,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,AETNA,AETNA,937.27,,,,,,,566.5300,3341.9800,percent of total billed charges,"42.7% of $2,195.00 in Billed Charges for Rev 361 Proc 21550 = $937.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3310.16,,,,,,,566.5300,3341.9800,fee schedule,"APG 00069 Proc 21550 at $836.60 (Base Rate) * 3.8045 (Relative Weight) = $3,182.84 (Total Line Payment) at 104% = $3,310.16. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,566.5300,3341.9800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,566.5300,3341.9800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,566.5300,3341.9800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,AMBETTER,AMBETTER,3266.63,,,,,,,566.5300,3341.9800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,566.5300,3341.9800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,BLUE CROSS,ANTHEM EXCHANGE,2195.00,,,,,,,566.5300,3341.9800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2195.00,,,,,,,566.5300,3341.9800,fee schedule,"APG 00069 Proc 21550 at $836.60 (Base Rate) * 3.8045 (Relative Weight) = $3,182.84 (Total Line Payment) at 103% = $3,278.33 (Service Line reduced to $2,195.00, claim capped at $2,195.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,BLUE CROSS,ANTHEM HMO,2195.00,,,,,,,566.5300,3341.9800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,566.5300,3341.9800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2195.00,,,,,,,566.5300,3341.9800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,566.5300,3341.9800,case rate,Rev 361 Proc 21550 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,566.5300,3341.9800,case rate,"Rev 361 Proc 21550 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,566.5300,3341.9800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,566.5300,3341.9800,case rate,"Rev 361 Proc 21550 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,566.5300,3341.9800,case rate,"Rev 361 Proc 21550 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,566.5300,3341.9800,case rate,Rev 361 Proc 21550 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,566.5300,3341.9800,case rate,Rev 361 Proc 21550 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,566.5300,3341.9800,case rate,"Rev 361 Proc 21550 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,566.5300,3341.9800,case rate,"Rev 361 Proc 21550 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,566.5300,3341.9800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,566.5300,3341.9800,case rate,"Rev 361 Proc 21550 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,566.5300,3341.9800,case rate,"Rev 361 Proc 21550 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,566.5300,3341.9800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1975.50,,,,,,,566.5300,3341.9800,percent of total billed charges,"90% of $2,195.00 in Billed Charges for Rev 361 Proc 21550 = $1,975.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,566.5300,3341.9800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,566.5300,3341.9800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,MEDCOST,MEDCOST VHN,1044.60,,,,,,,566.5300,3341.9800,percent of total billed charges,"47.59% of $2,195.00 in Billed Charges for Rev 361 Proc 21550 = $1,044.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3341.98,,,,,,,566.5300,3341.9800,fee schedule,"APG 00069 Proc 21550 at $836.60 (Base Rate) * 3.8045 (Relative Weight) = $3,182.84 (Total Line Payment) at 100% = $3,182.84... $3,182.84 at 105% = $3,341.98 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,566.5300,3341.9800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,566.5300,3341.9800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,566.5300,3341.9800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3281.51,,,,,,,566.5300,3341.9800,fee schedule,"APG 00069 Proc 21550 at $836.60 (Base Rate) * 3.8045 (Relative Weight) = $3,182.84 (Total Line Payment) at 100% = $3,182.84... $3,182.84 at 103.1% = $3,281.51 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,SENTARA HEALTH,SENTARA HEALTH,566.53,,,,,,,566.5300,3341.9800,percent of total billed charges,"25.81% of $2,195.00 in Billed Charges for Rev 361 Proc 21550 = $566.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,566.5300,3341.9800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2195.00,,,,,,,566.5300,3341.9800,percent of total billed charges,"100% of $2,195.00 in Billed Charges for Rev 361 Proc 21550 = $2,195.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,566.5300,3341.9800,case rate,Rev 361 Proc 21550 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,566.5300,3341.9800,case rate,"Rev 361 Proc 21550 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,566.5300,3341.9800,case rate,"Rev 361 Proc 21550 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,566.5300,3341.9800,case rate,"Rev 361 Proc 21550 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3278.33,,,,,,,566.5300,3341.9800,fee schedule,"APG 00069 Proc 21550 at $836.60 (Base Rate) * 3.8045 (Relative Weight) = $3,182.84 (Total Line Payment) at 103% = $3,278.33. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,566.5300,3341.9800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,566.5300,3341.9800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,WELLCARE,WELLCARE MEDICAID,2195.00,,,,,,,566.5300,3341.9800,percent of total billed charges,"100% of $2,195.00 in Billed Charges for Rev 361 Proc 21550 = $2,195.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE NECK OR THORAX,21550,CPT,361,RC,36100073,CDM,,,,both,,,2195.0000,329.2500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,566.5300,3341.9800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA,353.13,,,,,,,109.0000,827.0000,percent of total billed charges,42.7% of $827.00 in Billed Charges for Rev 450 Proc 21820 = $353.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 21820 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,827.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 21820 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,827.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,110.71,,,,,,,109.0000,827.0000,fee schedule,$110.71 from Fee Schedule BLDTM_23 for Rev 450 Proc 21820 * Qty 1 = $110.71 at 100% = $110.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,744.30,,,,,,,109.0000,827.0000,percent of total billed charges,90% of $827.00 in Billed Charges for Rev 450 Proc 21820 = $744.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,MEDCOST,MEDCOST VHN,393.57,,,,,,,109.0000,827.0000,percent of total billed charges,47.59% of $827.00 in Billed Charges for Rev 450 Proc 21820 = $393.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 21820 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 21820 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA HEALTH,213.45,,,,,,,109.0000,827.0000,percent of total billed charges,25.81% of $827.00 in Billed Charges for Rev 450 Proc 21820 = $213.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",827.00,,,,,,,109.0000,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 21820 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 21820 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 21820 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 21820 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,827.00,,,,,,,109.0000,827.0000,case rate,"Rev 450 Proc 21820 at Case Rate $847.00 (Service Line reduced to $827.00, claim capped at $827.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 21820 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICAID,827.00,,,,,,,109.0000,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 21820 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX STERNUM FX,21820,CPT,450,RC,45000368,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,827.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,AETNA,AETNA,946.66,,,,,,,54.9400,3266.6300,percent of total billed charges,"42.7% of $2,217.00 in Billed Charges for Rev 361 Proc 21920 = $946.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2612.63,,,,,,,54.9400,3266.6300,fee schedule,"APG 00051 Proc 21920 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 104% = $2,612.63. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,54.9400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,54.9400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,54.9400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,AMBETTER,AMBETTER,3266.63,,,,,,,54.9400,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,54.9400,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,BLUE CROSS,ANTHEM EXCHANGE,2217.00,,,,,,,54.9400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2217.00,,,,,,,54.9400,3266.6300,fee schedule,"APG 00051 Proc 21920 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51 (Service Line reduced to $2,217.00, claim capped at $2,217.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,BLUE CROSS,ANTHEM HMO,2217.00,,,,,,,54.9400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,54.9400,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2217.00,,,,,,,54.9400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,54.9400,3266.6300,case rate,Rev 361 Proc 21920 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,54.9400,3266.6300,case rate,"Rev 361 Proc 21920 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,54.9400,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,54.9400,3266.6300,case rate,"Rev 361 Proc 21920 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,54.9400,3266.6300,case rate,"Rev 361 Proc 21920 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,BLUE CROSS,TENNCARE BLUE CARE,54.94,,,,,,,54.9400,3266.6300,fee schedule,$47.36 from Fee Schedule TC_24 for Rev 361 Proc 21920 * Qty 1 = $47.36 at 116% = $54.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,BLUE CROSS,TENNCARE BLUE SELECT,54.94,,,,,,,54.9400,3266.6300,fee schedule,$47.36 from Fee Schedule TC_24 for Rev 361 Proc 21920 * Qty 1 = $47.36 at 116% = $54.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,54.9400,3266.6300,case rate,"Rev 361 Proc 21920 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,54.9400,3266.6300,case rate,"Rev 361 Proc 21920 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,54.9400,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,54.9400,3266.6300,case rate,"Rev 361 Proc 21920 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,54.9400,3266.6300,case rate,"Rev 361 Proc 21920 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,54.9400,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1995.30,,,,,,,54.9400,3266.6300,percent of total billed charges,"90% of $2,217.00 in Billed Charges for Rev 361 Proc 21920 = $1,995.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,54.9400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,54.9400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,MEDCOST,MEDCOST VHN,1055.07,,,,,,,54.9400,3266.6300,percent of total billed charges,"47.59% of $2,217.00 in Billed Charges for Rev 361 Proc 21920 = $1,055.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2637.75,,,,,,,54.9400,3266.6300,fee schedule,"APG 00051 Proc 21920 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 105% = $2,637.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,54.9400,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,54.9400,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,54.9400,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2590.02,,,,,,,54.9400,3266.6300,fee schedule,"APG 00051 Proc 21920 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 103.1% = $2,590.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,SENTARA HEALTH,SENTARA HEALTH,572.21,,,,,,,54.9400,3266.6300,percent of total billed charges,"25.81% of $2,217.00 in Billed Charges for Rev 361 Proc 21920 = $572.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,54.9400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2217.00,,,,,,,54.9400,3266.6300,percent of total billed charges,"100% of $2,217.00 in Billed Charges for Rev 361 Proc 21920 = $2,217.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,54.9400,3266.6300,case rate,Rev 361 Proc 21920 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,54.9400,3266.6300,case rate,Rev 361 Proc 21920 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,54.9400,3266.6300,case rate,Rev 361 Proc 21920 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,54.9400,3266.6300,case rate,"Rev 361 Proc 21920 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2587.51,,,,,,,54.9400,3266.6300,fee schedule,"APG 00051 Proc 21920 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,54.9400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,54.9400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,WELLCARE,WELLCARE MEDICAID,2217.00,,,,,,,54.9400,3266.6300,percent of total billed charges,"100% of $2,217.00 in Billed Charges for Rev 361 Proc 21920 = $2,217.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE BACK/FLANK SUP,21920,CPT,361,RC,36100074,CDM,,,,both,,,2217.0000,332.5500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,54.9400,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,AETNA,AETNA,2584.63,,,,,,,775.0000,6053.0000,percent of total billed charges,"42.7% of $6,053.00 in Billed Charges for Rev 361 Proc 21925 = $2,584.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2612.63,,,,,,,775.0000,6053.0000,fee schedule,"APG 00051 Proc 21925 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 104% = $2,612.63. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,775.0000,6053.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,775.0000,6053.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,775.0000,6053.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,AMBETTER,AMBETTER,3266.63,,,,,,,775.0000,6053.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,775.0000,6053.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,BLUE CROSS,ANTHEM EXCHANGE,3689.28,,,,,,,775.0000,6053.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2587.51,,,,,,,775.0000,6053.0000,fee schedule,"APG 00051 Proc 21925 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,BLUE CROSS,ANTHEM HMO,3919.64,,,,,,,775.0000,6053.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,775.0000,6053.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4611.09,,,,,,,775.0000,6053.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,948.00,,,,,,,775.0000,6053.0000,case rate,Rev 361 Proc 21925 ASG Rate of $948.00 at 100% of $948.00 = $948.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,775.0000,6053.0000,case rate,"Rev 361 Proc 21925 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,775.0000,6053.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,775.0000,6053.0000,case rate,"Rev 361 Proc 21925 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,775.0000,6053.0000,case rate,"Rev 361 Proc 21925 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,6053.0000,case rate,Rev 361 Proc 21925 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,6053.0000,case rate,Rev 361 Proc 21925 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,CIGNA HEALTHCARE,CIGNA HMO,2588.00,,,,,,,775.0000,6053.0000,case rate,"Rev 361 Proc 21925 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1956.00,,,,,,,775.0000,6053.0000,case rate,"Rev 361 Proc 21925 ASG Rate of $1,956.00 at 100% of $1,956.00 = $1,956.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,775.0000,6053.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2588.00,,,,,,,775.0000,6053.0000,case rate,"Rev 361 Proc 21925 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,CIGNA HEALTHCARE,CIGNA PPO,2588.00,,,,,,,775.0000,6053.0000,case rate,"Rev 361 Proc 21925 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,775.0000,6053.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5447.70,,,,,,,775.0000,6053.0000,percent of total billed charges,"90% of $6,053.00 in Billed Charges for Rev 361 Proc 21925 = $5,447.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,775.0000,6053.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,775.0000,6053.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,MEDCOST,MEDCOST VHN,2880.62,,,,,,,775.0000,6053.0000,percent of total billed charges,"47.59% of $6,053.00 in Billed Charges for Rev 361 Proc 21925 = $2,880.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2637.75,,,,,,,775.0000,6053.0000,fee schedule,"APG 00051 Proc 21925 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 105% = $2,637.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,775.0000,6053.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,775.0000,6053.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,775.0000,6053.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2590.02,,,,,,,775.0000,6053.0000,fee schedule,"APG 00051 Proc 21925 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 103.1% = $2,590.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,SENTARA HEALTH,SENTARA HEALTH,1562.28,,,,,,,775.0000,6053.0000,percent of total billed charges,"25.81% of $6,053.00 in Billed Charges for Rev 361 Proc 21925 = $1,562.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,775.0000,6053.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6053.00,,,,,,,775.0000,6053.0000,percent of total billed charges,"100% of $6,053.00 in Billed Charges for Rev 361 Proc 21925 = $6,053.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1418.00,,,,,,,775.0000,6053.0000,case rate,"Rev 361 Proc 21925 ASG Rate of $1,418.00 at 100% of $1,418.00 = $1,418.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2547.00,,,,,,,775.0000,6053.0000,case rate,"Rev 361 Proc 21925 ASG Rate of $2,547.00 at 100% of $2,547.00 = $2,547.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2436.00,,,,,,,775.0000,6053.0000,case rate,"Rev 361 Proc 21925 ASG Rate of $2,436.00 at 100% of $2,436.00 = $2,436.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,4296.00,,,,,,,775.0000,6053.0000,case rate,"Rev 361 Proc 21925 ASG Rate of $4,296.00 at 100% of $4,296.00 = $4,296.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2587.51,,,,,,,775.0000,6053.0000,fee schedule,"APG 00051 Proc 21925 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,775.0000,6053.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,775.0000,6053.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,WELLCARE,WELLCARE MEDICAID,6053.00,,,,,,,775.0000,6053.0000,percent of total billed charges,"100% of $6,053.00 in Billed Charges for Rev 361 Proc 21925 = $6,053.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE BACK/FLNK DEEP,21925,CPT,361,RC,36100199,CDM,,,,both,,,6053.0000,907.9500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,775.0000,6053.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,AETNA,AETNA,4047.11,,,,,,,890.0000,9478.0000,percent of total billed charges,"42.7% of $9,478.00 in Billed Charges for Rev 361 Proc 22510 = $4,047.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,7174.98,,,,,,,890.0000,9478.0000,fee schedule,"APG 00028 Proc 22510 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 104% = $7,174.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2968.60,,,,,,,890.0000,9478.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,AETNA,AETNA HEALTHCARE MEDICARE,2968.60,,,,,,,890.0000,9478.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,2968.60,,,,,,,890.0000,9478.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,AMBETTER,AMBETTER,6471.55,,,,,,,890.0000,9478.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3087.35,,,,,,,890.0000,9478.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,ANTHEM EXCHANGE,7308.87,,,,,,,890.0000,9478.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,7105.99,,,,,,,890.0000,9478.0000,fee schedule,"APG 00028 Proc 22510 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 103% = $7,105.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,ANTHEM HMO,7765.24,,,,,,,890.0000,9478.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3057.66,,,,,,,890.0000,9478.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9135.08,,,,,,,890.0000,9478.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,890.0000,9478.0000,case rate,"Rev 361 Proc 22510 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,890.0000,9478.0000,case rate,"Rev 361 Proc 22510 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,BLUE CROSS MEDICARE,3087.35,,,,,,,890.0000,9478.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,890.0000,9478.0000,case rate,"Rev 361 Proc 22510 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,890.0000,9478.0000,case rate,"Rev 361 Proc 22510 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,TENNCARE BLUE CARE,890.00,,,,,,,890.0000,9478.0000,case rate,Rev 361 Proc 22510 ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,TENNCARE BLUE SELECT,890.00,,,,,,,890.0000,9478.0000,case rate,Rev 361 Proc 22510 ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,CIGNA HEALTHCARE,CIGNA HMO,8003.00,,,,,,,890.0000,9478.0000,case rate,"Rev 361 Proc 22510 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6048.00,,,,,,,890.0000,9478.0000,case rate,"Rev 361 Proc 22510 ASG Rate of $6,048.00 at 100% of $6,048.00 = $6,048.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,3117.03,,,,,,,890.0000,9478.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8003.00,,,,,,,890.0000,9478.0000,case rate,"Rev 361 Proc 22510 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,CIGNA HEALTHCARE,CIGNA PPO,8003.00,,,,,,,890.0000,9478.0000,case rate,"Rev 361 Proc 22510 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3117.03,,,,,,,890.0000,9478.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8530.20,,,,,,,890.0000,9478.0000,percent of total billed charges,"90% of $9,478.00 in Billed Charges for Rev 361 Proc 22510 = $8,530.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,HUMANA,HUMANA MEDICARE,2968.60,,,,,,,890.0000,9478.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2968.60,,,,,,,890.0000,9478.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,MEDCOST,MEDCOST VHN,4510.58,,,,,,,890.0000,9478.0000,percent of total billed charges,"47.59% of $9,478.00 in Billed Charges for Rev 361 Proc 22510 = $4,510.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,7243.97,,,,,,,890.0000,9478.0000,fee schedule,"APG 00028 Proc 22510 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 100% = $6,899.02... $6,899.02 at 105% = $7,243.97 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3117.03,,,,,,,890.0000,9478.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3117.03,,,,,,,890.0000,9478.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,NHC ADVANTAGE,NHC ADVANTAGE,3117.03,,,,,,,890.0000,9478.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,7112.89,,,,,,,890.0000,9478.0000,fee schedule,"APG 00028 Proc 22510 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 100% = $6,899.02... $6,899.02 at 103.1% = $7,112.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,SENTARA HEALTH,SENTARA HEALTH,2446.27,,,,,,,890.0000,9478.0000,percent of total billed charges,"25.81% of $9,478.00 in Billed Charges for Rev 361 Proc 22510 = $2,446.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,SENTARA HEALTH,SENTARA MEDICARE,2968.60,,,,,,,890.0000,9478.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9478.00,,,,,,,890.0000,9478.0000,percent of total billed charges,"100% of $9,478.00 in Billed Charges for Rev 361 Proc 22510 = $9,478.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,890.0000,9478.0000,case rate,"Rev 361 Proc 22510 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,890.0000,9478.0000,case rate,"Rev 361 Proc 22510 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,890.0000,9478.0000,case rate,"Rev 361 Proc 22510 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,890.0000,9478.0000,case rate,"Rev 361 Proc 22510 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,7105.99,,,,,,,890.0000,9478.0000,fee schedule,"APG 00028 Proc 22510 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 103% = $7,105.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2968.60,,,,,,,890.0000,9478.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2968.60,,,,,,,890.0000,9478.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,WELLCARE,WELLCARE MEDICAID,9478.00,,,,,,,890.0000,9478.0000,percent of total billed charges,"100% of $9,478.00 in Billed Charges for Rev 361 Proc 22510 = $9,478.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL CERV/TH,22510,CPT,361,RC,36100268,CDM,,,,both,,,9478.0000,1421.7000,WELLCARE,WELLCARE MEDICARE,3146.72,,,,,,,890.0000,9478.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY EA ADDL CERV/TH/LS,22512,CPT,361,RC,36100270,CDM,,,,both,,,5026.0000,753.9000,AETNA,AETNA,2146.10,,,,,,,148.0000,7243.9700,percent of total billed charges,"42.7% of $5,026.00 in Billed Charges for Rev 361 Proc 22512 = $2,146.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERTEBROPLASTY EA ADDL CERV/TH/LS,22512,CPT,361,RC,36100270,CDM,,,,both,,,5026.0000,753.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,7174.98,,,,,,,148.0000,7243.9700,fee schedule,"APG 00028 Proc 22512 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 104% = $7,174.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY EA ADDL CERV/TH/LS,22512,CPT,361,RC,36100270,CDM,,,,both,,,5026.0000,753.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,5026.00,,,,,,,148.0000,7243.9700,fee schedule,"APG 00028 Proc 22512 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 103% = $7,105.99 (Service Line reduced to $5,026.00, claim capped at $5,026.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY EA ADDL CERV/TH/LS,22512,CPT,361,RC,36100270,CDM,,,,both,,,5026.0000,753.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,148.0000,7243.9700,case rate,"Rev 361 Proc 22512 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY EA ADDL CERV/TH/LS,22512,CPT,361,RC,36100270,CDM,,,,both,,,5026.0000,753.9000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,7243.9700,case rate,Rev 361 Proc 22512 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY EA ADDL CERV/TH/LS,22512,CPT,361,RC,36100270,CDM,,,,both,,,5026.0000,753.9000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,7243.9700,case rate,Rev 361 Proc 22512 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY EA ADDL CERV/TH/LS,22512,CPT,361,RC,36100270,CDM,,,,both,,,5026.0000,753.9000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,7243.9700,case rate,Rev 361 Proc 22512 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY EA ADDL CERV/TH/LS,22512,CPT,361,RC,36100270,CDM,,,,both,,,5026.0000,753.9000,CIGNA HEALTHCARE,CIGNA HMO,5026.00,,,,,,,148.0000,7243.9700,case rate,"Rev 361 Proc 22512 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total (Limited to $5,026.00 in Billed Charges - $0.00 in ASG Allowed Amount = $5,026.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY EA ADDL CERV/TH/LS,22512,CPT,361,RC,36100270,CDM,,,,both,,,5026.0000,753.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5026.00,,,,,,,148.0000,7243.9700,case rate,"Rev 361 Proc 22512 ASG Rate of $6,048.00 at 100% of $6,048.00 = $6,048.00 Total (Limited to $5,026.00 in Billed Charges - $0.00 in ASG Allowed Amount = $5,026.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY EA ADDL CERV/TH/LS,22512,CPT,361,RC,36100270,CDM,,,,both,,,5026.0000,753.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5026.00,,,,,,,148.0000,7243.9700,case rate,"Rev 361 Proc 22512 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total (Limited to $5,026.00 in Billed Charges - $0.00 in ASG Allowed Amount = $5,026.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY EA ADDL CERV/TH/LS,22512,CPT,361,RC,36100270,CDM,,,,both,,,5026.0000,753.9000,CIGNA HEALTHCARE,CIGNA PPO,5026.00,,,,,,,148.0000,7243.9700,case rate,"Rev 361 Proc 22512 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total (Limited to $5,026.00 in Billed Charges - $0.00 in ASG Allowed Amount = $5,026.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY EA ADDL CERV/TH/LS,22512,CPT,361,RC,36100270,CDM,,,,both,,,5026.0000,753.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4523.40,,,,,,,148.0000,7243.9700,percent of total billed charges,"90% of $5,026.00 in Billed Charges for Rev 361 Proc 22512 = $4,523.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERTEBROPLASTY EA ADDL CERV/TH/LS,22512,CPT,361,RC,36100270,CDM,,,,both,,,5026.0000,753.9000,MEDCOST,MEDCOST VHN,2391.87,,,,,,,148.0000,7243.9700,percent of total billed charges,"47.59% of $5,026.00 in Billed Charges for Rev 361 Proc 22512 = $2,391.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERTEBROPLASTY EA ADDL CERV/TH/LS,22512,CPT,361,RC,36100270,CDM,,,,both,,,5026.0000,753.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,7243.97,,,,,,,148.0000,7243.9700,fee schedule,"APG 00028 Proc 22512 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 100% = $6,899.02... $6,899.02 at 105% = $7,243.97 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY EA ADDL CERV/TH/LS,22512,CPT,361,RC,36100270,CDM,,,,both,,,5026.0000,753.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,7112.89,,,,,,,148.0000,7243.9700,fee schedule,"APG 00028 Proc 22512 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 100% = $6,899.02... $6,899.02 at 103.1% = $7,112.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY EA ADDL CERV/TH/LS,22512,CPT,361,RC,36100270,CDM,,,,both,,,5026.0000,753.9000,SENTARA HEALTH,SENTARA HEALTH,1297.21,,,,,,,148.0000,7243.9700,percent of total billed charges,"25.81% of $5,026.00 in Billed Charges for Rev 361 Proc 22512 = $1,297.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERTEBROPLASTY EA ADDL CERV/TH/LS,22512,CPT,361,RC,36100270,CDM,,,,both,,,5026.0000,753.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5026.00,,,,,,,148.0000,7243.9700,percent of total billed charges,"100% of $5,026.00 in Billed Charges for Rev 361 Proc 22512 = $5,026.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERTEBROPLASTY EA ADDL CERV/TH/LS,22512,CPT,361,RC,36100270,CDM,,,,both,,,5026.0000,753.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,148.0000,7243.9700,case rate,Rev 361 Proc 22512 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY EA ADDL CERV/TH/LS,22512,CPT,361,RC,36100270,CDM,,,,both,,,5026.0000,753.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,148.0000,7243.9700,case rate,Rev 361 Proc 22512 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY EA ADDL CERV/TH/LS,22512,CPT,361,RC,36100270,CDM,,,,both,,,5026.0000,753.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,148.0000,7243.9700,case rate,Rev 361 Proc 22512 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY EA ADDL CERV/TH/LS,22512,CPT,361,RC,36100270,CDM,,,,both,,,5026.0000,753.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,148.0000,7243.9700,case rate,Rev 361 Proc 22512 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY EA ADDL CERV/TH/LS,22512,CPT,361,RC,36100270,CDM,,,,both,,,5026.0000,753.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,7105.99,,,,,,,148.0000,7243.9700,fee schedule,"APG 00028 Proc 22512 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 103% = $7,105.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY EA ADDL CERV/TH/LS,22512,CPT,361,RC,36100270,CDM,,,,both,,,5026.0000,753.9000,WELLCARE,WELLCARE MEDICAID,5026.00,,,,,,,148.0000,7243.9700,percent of total billed charges,"100% of $5,026.00 in Billed Charges for Rev 361 Proc 22512 = $5,026.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,AETNA,AETNA,9833.81,,,,,,,890.0000,23030.0000,percent of total billed charges,"42.7% of $23,030.00 in Billed Charges for Rev 361 Proc 22514 = $9,833.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,7174.98,,,,,,,890.0000,23030.0000,fee schedule,"APG 00028 Proc 22514 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 104% = $7,174.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,6583.38,,,,,,,890.0000,23030.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,AETNA,AETNA HEALTHCARE MEDICARE,6583.38,,,,,,,890.0000,23030.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,6583.38,,,,,,,890.0000,23030.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,AMBETTER,AMBETTER,14351.76,,,,,,,890.0000,23030.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,6846.71,,,,,,,890.0000,23030.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,BLUE CROSS,ANTHEM EXCHANGE,16208.64,,,,,,,890.0000,23030.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,7105.99,,,,,,,890.0000,23030.0000,fee schedule,"APG 00028 Proc 22514 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 103% = $7,105.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,BLUE CROSS,ANTHEM HMO,17220.71,,,,,,,890.0000,23030.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,6780.88,,,,,,,890.0000,23030.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",20258.57,,,,,,,890.0000,23030.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,890.0000,23030.0000,case rate,"Rev 361 Proc 22514 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,890.0000,23030.0000,case rate,"Rev 361 Proc 22514 ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,BLUE CROSS,BLUE CROSS MEDICARE,6846.71,,,,,,,890.0000,23030.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,890.0000,23030.0000,case rate,"Rev 361 Proc 22514 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,890.0000,23030.0000,case rate,"Rev 361 Proc 22514 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,BLUE CROSS,TENNCARE BLUE CARE,890.00,,,,,,,890.0000,23030.0000,case rate,Rev 361 Proc 22514 ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,BLUE CROSS,TENNCARE BLUE SELECT,890.00,,,,,,,890.0000,23030.0000,case rate,Rev 361 Proc 22514 ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,890.0000,23030.0000,case rate,"Rev 361 Proc 22514 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,890.0000,23030.0000,case rate,"Rev 361 Proc 22514 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,6912.55,,,,,,,890.0000,23030.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,890.0000,23030.0000,case rate,"Rev 361 Proc 22514 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,890.0000,23030.0000,case rate,"Rev 361 Proc 22514 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,6912.55,,,,,,,890.0000,23030.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,20727.00,,,,,,,890.0000,23030.0000,percent of total billed charges,"90% of $23,030.00 in Billed Charges for Rev 361 Proc 22514 = $20,727.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,HUMANA,HUMANA MEDICARE,6583.38,,,,,,,890.0000,23030.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,6583.38,,,,,,,890.0000,23030.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,MEDCOST,MEDCOST VHN,10959.98,,,,,,,890.0000,23030.0000,percent of total billed charges,"47.59% of $23,030.00 in Billed Charges for Rev 361 Proc 22514 = $10,959.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,7243.97,,,,,,,890.0000,23030.0000,fee schedule,"APG 00028 Proc 22514 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 100% = $6,899.02... $6,899.02 at 105% = $7,243.97 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,6912.55,,,,,,,890.0000,23030.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,6912.55,,,,,,,890.0000,23030.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,NHC ADVANTAGE,NHC ADVANTAGE,6912.55,,,,,,,890.0000,23030.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,7112.89,,,,,,,890.0000,23030.0000,fee schedule,"APG 00028 Proc 22514 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 100% = $6,899.02... $6,899.02 at 103.1% = $7,112.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,SENTARA HEALTH,SENTARA HEALTH,5944.04,,,,,,,890.0000,23030.0000,percent of total billed charges,"25.81% of $23,030.00 in Billed Charges for Rev 361 Proc 22514 = $5,944.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,SENTARA HEALTH,SENTARA MEDICARE,6583.38,,,,,,,890.0000,23030.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",23030.00,,,,,,,890.0000,23030.0000,percent of total billed charges,"100% of $23,030.00 in Billed Charges for Rev 361 Proc 22514 = $23,030.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,890.0000,23030.0000,case rate,"Rev 361 Proc 22514 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,890.0000,23030.0000,case rate,"Rev 361 Proc 22514 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,890.0000,23030.0000,case rate,"Rev 361 Proc 22514 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,890.0000,23030.0000,case rate,"Rev 361 Proc 22514 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,7105.99,,,,,,,890.0000,23030.0000,fee schedule,"APG 00028 Proc 22514 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 103% = $7,105.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,6583.38,,,,,,,890.0000,23030.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,6583.38,,,,,,,890.0000,23030.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,WELLCARE,WELLCARE MEDICAID,23030.00,,,,,,,890.0000,23030.0000,percent of total billed charges,"100% of $23,030.00 in Billed Charges for Rev 361 Proc 22514 = $23,030.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL LUMBAR,22514,CPT,361,RC,36100272,CDM,,,,both,,,23030.0000,3454.5000,WELLCARE,WELLCARE MEDICARE,6978.38,,,,,,,890.0000,23030.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DISC SHIM ALUMINUM,272,RC,27200002,CDM,,,,,,both,,,3194.2700,479.1400,AETNA,AETNA,1363.95,,,,,,,824.4400,3194.2700,percent of total billed charges,"42.7% of $3,194.27 in Billed Charges for Rev 272 = $1,363.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISC SHIM ALUMINUM,272,RC,27200002,CDM,,,,,,both,,,3194.2700,479.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2235.99,,,,,,,824.4400,3194.2700,percent of total billed charges,"Rev 272 $3,194.27 in Billed Charges at 70% = $2,235.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISC SHIM ALUMINUM,272,RC,27200002,CDM,,,,,,both,,,3194.2700,479.1400,CIGNA HEALTHCARE,CIGNA HMO,1332.01,,,,,,,824.4400,3194.2700,percent of total billed charges,"41.7% of $3,194.27 in Billed Charges for Rev 272 = $1,332.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISC SHIM ALUMINUM,272,RC,27200002,CDM,,,,,,both,,,3194.2700,479.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1482.14,,,,,,,824.4400,3194.2700,percent of total billed charges,"46.4% of $3,194.27 in Billed Charges for Rev 272 = $1,482.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISC SHIM ALUMINUM,272,RC,27200002,CDM,,,,,,both,,,3194.2700,479.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1332.01,,,,,,,824.4400,3194.2700,percent of total billed charges,"41.7% of $3,194.27 in Billed Charges for Rev 272 = $1,332.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISC SHIM ALUMINUM,272,RC,27200002,CDM,,,,,,both,,,3194.2700,479.1400,CIGNA HEALTHCARE,CIGNA PPO,1332.01,,,,,,,824.4400,3194.2700,percent of total billed charges,"41.7% of $3,194.27 in Billed Charges for Rev 272 = $1,332.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISC SHIM ALUMINUM,272,RC,27200002,CDM,,,,,,both,,,3194.2700,479.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2874.84,,,,,,,824.4400,3194.2700,percent of total billed charges,"90% of $3,194.27 in Billed Charges for Rev 272 = $2,874.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISC SHIM ALUMINUM,272,RC,27200002,CDM,,,,,,both,,,3194.2700,479.1400,MEDCOST,MEDCOST VHN,1520.15,,,,,,,824.4400,3194.2700,percent of total billed charges,"47.59% of $3,194.27 in Billed Charges for Rev 272 = $1,520.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISC SHIM ALUMINUM,272,RC,27200002,CDM,,,,,,both,,,3194.2700,479.1400,SENTARA HEALTH,SENTARA HEALTH,824.44,,,,,,,824.4400,3194.2700,percent of total billed charges,"25.81% of $3,194.27 in Billed Charges for Rev 272 = $824.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISC SHIM ALUMINUM,272,RC,27200002,CDM,,,,,,both,,,3194.2700,479.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3194.27,,,,,,,824.4400,3194.2700,percent of total billed charges,"100% of $3,194.27 in Billed Charges for Rev 272 = $3,194.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISC SHIM ALUMINUM,272,RC,27200002,CDM,,,,,,both,,,3194.2700,479.1400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1597.14,,,,,,,824.4400,3194.2700,percent of total billed charges,"Rev 272 $3,194.27 in Billed Charges at 50% = $1,597.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISC SHIM ALUMINUM,272,RC,27200002,CDM,,,,,,both,,,3194.2700,479.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1031.75,,,,,,,824.4400,3194.2700,other,"32.3% of $3,194.27 in Billed Charges for Rev 272 = $1,031.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DISC SHIM ALUMINUM,272,RC,27200002,CDM,,,,,,both,,,3194.2700,479.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,980.64,,,,,,,824.4400,3194.2700,other,"30.7% of $3,194.27 in Billed Charges for Rev 272 = $980.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DISC SHIM ALUMINUM,272,RC,27200002,CDM,,,,,,both,,,3194.2700,479.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,1031.75,,,,,,,824.4400,3194.2700,percent of total billed charges,"32.3% of $3,194.27 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISC SHIM ALUMINUM,272,RC,27200002,CDM,,,,,,both,,,3194.2700,479.1400,WELLCARE,WELLCARE MEDICAID,3194.27,,,,,,,824.4400,3194.2700,percent of total billed charges,"100% of $3,194.27 in Billed Charges for Rev 272 = $3,194.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISK TIRAL 42MM,272,RC,,,,,,,,both,,,1624.1000,243.6200,AETNA,AETNA,693.49,,,,,,,419.1800,1624.1000,percent of total billed charges,"42.7% of $1,624.10 in Billed Charges for Rev 272 = $693.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISK TIRAL 42MM,272,RC,,,,,,,,both,,,1624.1000,243.6200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1136.87,,,,,,,419.1800,1624.1000,percent of total billed charges,"Rev 272 $1,624.10 in Billed Charges at 70% = $1,136.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISK TIRAL 42MM,272,RC,,,,,,,,both,,,1624.1000,243.6200,CIGNA HEALTHCARE,CIGNA HMO,677.25,,,,,,,419.1800,1624.1000,percent of total billed charges,"41.7% of $1,624.10 in Billed Charges for Rev 272 = $677.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISK TIRAL 42MM,272,RC,,,,,,,,both,,,1624.1000,243.6200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,753.58,,,,,,,419.1800,1624.1000,percent of total billed charges,"46.4% of $1,624.10 in Billed Charges for Rev 272 = $753.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISK TIRAL 42MM,272,RC,,,,,,,,both,,,1624.1000,243.6200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,677.25,,,,,,,419.1800,1624.1000,percent of total billed charges,"41.7% of $1,624.10 in Billed Charges for Rev 272 = $677.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISK TIRAL 42MM,272,RC,,,,,,,,both,,,1624.1000,243.6200,CIGNA HEALTHCARE,CIGNA PPO,677.25,,,,,,,419.1800,1624.1000,percent of total billed charges,"41.7% of $1,624.10 in Billed Charges for Rev 272 = $677.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISK TIRAL 42MM,272,RC,,,,,,,,both,,,1624.1000,243.6200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1461.69,,,,,,,419.1800,1624.1000,percent of total billed charges,"90% of $1,624.10 in Billed Charges for Rev 272 = $1,461.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISK TIRAL 42MM,272,RC,,,,,,,,both,,,1624.1000,243.6200,MEDCOST,MEDCOST VHN,772.91,,,,,,,419.1800,1624.1000,percent of total billed charges,"47.59% of $1,624.10 in Billed Charges for Rev 272 = $772.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISK TIRAL 42MM,272,RC,,,,,,,,both,,,1624.1000,243.6200,SENTARA HEALTH,SENTARA HEALTH,419.18,,,,,,,419.1800,1624.1000,percent of total billed charges,"25.81% of $1,624.10 in Billed Charges for Rev 272 = $419.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISK TIRAL 42MM,272,RC,,,,,,,,both,,,1624.1000,243.6200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1624.10,,,,,,,419.1800,1624.1000,percent of total billed charges,"100% of $1,624.10 in Billed Charges for Rev 272 = $1,624.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISK TIRAL 42MM,272,RC,,,,,,,,both,,,1624.1000,243.6200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,812.05,,,,,,,419.1800,1624.1000,percent of total billed charges,"Rev 272 $1,624.10 in Billed Charges at 50% = $812.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISK TIRAL 42MM,272,RC,,,,,,,,both,,,1624.1000,243.6200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,524.58,,,,,,,419.1800,1624.1000,other,"32.3% of $1,624.10 in Billed Charges for Rev 272 = $524.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DISK TIRAL 42MM,272,RC,,,,,,,,both,,,1624.1000,243.6200,UNITED HEALTHCARE,UHC HERITAGE SELECT,498.60,,,,,,,419.1800,1624.1000,other,"30.7% of $1,624.10 in Billed Charges for Rev 272 = $498.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DISK TIRAL 42MM,272,RC,,,,,,,,both,,,1624.1000,243.6200,UNITED HEALTHCARE,UNITED HEALTHCARE,524.58,,,,,,,419.1800,1624.1000,percent of total billed charges,"32.3% of $1,624.10 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISK TIRAL 42MM,272,RC,,,,,,,,both,,,1624.1000,243.6200,WELLCARE,WELLCARE MEDICAID,1624.10,,,,,,,419.1800,1624.1000,percent of total billed charges,"100% of $1,624.10 in Billed Charges for Rev 272 = $1,624.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DISPENSER EMESIS BAG 6.5IN X 15IN WALL HANGING F/ER ONCOLOGY RADIOLOGY LF,270,RC,,,,,,,,both,,,980.0600,147.0100,AETNA,AETNA,418.49,,,,,,,252.9500,980.0600,percent of total billed charges,42.7% of $980.06 in Billed Charges for Rev 270 = $418.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISPENSER EMESIS BAG 6.5IN X 15IN WALL HANGING F/ER ONCOLOGY RADIOLOGY LF,270,RC,,,,,,,,both,,,980.0600,147.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,686.04,,,,,,,252.9500,980.0600,percent of total billed charges,Rev 270 $980.06 in Billed Charges at 70% = $686.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISPENSER EMESIS BAG 6.5IN X 15IN WALL HANGING F/ER ONCOLOGY RADIOLOGY LF,270,RC,,,,,,,,both,,,980.0600,147.0100,CIGNA HEALTHCARE,CIGNA HMO,408.69,,,,,,,252.9500,980.0600,percent of total billed charges,41.7% of $980.06 in Billed Charges for Rev 270 = $408.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISPENSER EMESIS BAG 6.5IN X 15IN WALL HANGING F/ER ONCOLOGY RADIOLOGY LF,270,RC,,,,,,,,both,,,980.0600,147.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,454.75,,,,,,,252.9500,980.0600,percent of total billed charges,46.4% of $980.06 in Billed Charges for Rev 270 = $454.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISPENSER EMESIS BAG 6.5IN X 15IN WALL HANGING F/ER ONCOLOGY RADIOLOGY LF,270,RC,,,,,,,,both,,,980.0600,147.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,408.69,,,,,,,252.9500,980.0600,percent of total billed charges,41.7% of $980.06 in Billed Charges for Rev 270 = $408.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISPENSER EMESIS BAG 6.5IN X 15IN WALL HANGING F/ER ONCOLOGY RADIOLOGY LF,270,RC,,,,,,,,both,,,980.0600,147.0100,CIGNA HEALTHCARE,CIGNA PPO,408.69,,,,,,,252.9500,980.0600,percent of total billed charges,41.7% of $980.06 in Billed Charges for Rev 270 = $408.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISPENSER EMESIS BAG 6.5IN X 15IN WALL HANGING F/ER ONCOLOGY RADIOLOGY LF,270,RC,,,,,,,,both,,,980.0600,147.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,882.05,,,,,,,252.9500,980.0600,percent of total billed charges,90% of $980.06 in Billed Charges for Rev 270 = $882.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISPENSER EMESIS BAG 6.5IN X 15IN WALL HANGING F/ER ONCOLOGY RADIOLOGY LF,270,RC,,,,,,,,both,,,980.0600,147.0100,MEDCOST,MEDCOST VHN,466.41,,,,,,,252.9500,980.0600,percent of total billed charges,47.59% of $980.06 in Billed Charges for Rev 270 = $466.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISPENSER EMESIS BAG 6.5IN X 15IN WALL HANGING F/ER ONCOLOGY RADIOLOGY LF,270,RC,,,,,,,,both,,,980.0600,147.0100,SENTARA HEALTH,SENTARA HEALTH,252.95,,,,,,,252.9500,980.0600,percent of total billed charges,25.81% of $980.06 in Billed Charges for Rev 270 = $252.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISPENSER EMESIS BAG 6.5IN X 15IN WALL HANGING F/ER ONCOLOGY RADIOLOGY LF,270,RC,,,,,,,,both,,,980.0600,147.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",980.06,,,,,,,252.9500,980.0600,percent of total billed charges,100% of $980.06 in Billed Charges for Rev 270 = $980.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISPENSER EMESIS BAG 6.5IN X 15IN WALL HANGING F/ER ONCOLOGY RADIOLOGY LF,270,RC,,,,,,,,both,,,980.0600,147.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,490.03,,,,,,,252.9500,980.0600,percent of total billed charges,Rev 270 $980.06 in Billed Charges at 50% = $490.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISPENSER EMESIS BAG 6.5IN X 15IN WALL HANGING F/ER ONCOLOGY RADIOLOGY LF,270,RC,,,,,,,,both,,,980.0600,147.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,316.56,,,,,,,252.9500,980.0600,other,32.3% of $980.06 in Billed Charges for Rev 270 = $316.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DISPENSER EMESIS BAG 6.5IN X 15IN WALL HANGING F/ER ONCOLOGY RADIOLOGY LF,270,RC,,,,,,,,both,,,980.0600,147.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,300.88,,,,,,,252.9500,980.0600,other,30.7% of $980.06 in Billed Charges for Rev 270 = $300.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DISPENSER EMESIS BAG 6.5IN X 15IN WALL HANGING F/ER ONCOLOGY RADIOLOGY LF,270,RC,,,,,,,,both,,,980.0600,147.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,316.56,,,,,,,252.9500,980.0600,percent of total billed charges,32.3% of $980.06 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DISPENSER EMESIS BAG 6.5IN X 15IN WALL HANGING F/ER ONCOLOGY RADIOLOGY LF,270,RC,,,,,,,,both,,,980.0600,147.0100,WELLCARE,WELLCARE MEDICAID,980.06,,,,,,,252.9500,980.0600,percent of total billed charges,100% of $980.06 in Billed Charges for Rev 270 = $980.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,AETNA,AETNA,801.05,,,,,,,484.2000,3266.6300,percent of total billed charges,"42.7% of $1,876.00 in Billed Charges for Rev 361 Proc 23065 = $801.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2612.63,,,,,,,484.2000,3266.6300,fee schedule,"APG 00051 Proc 23065 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 104% = $2,612.63. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,484.2000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,484.2000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,484.2000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,AMBETTER,AMBETTER,3266.63,,,,,,,484.2000,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,484.2000,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,BLUE CROSS,ANTHEM EXCHANGE,1876.00,,,,,,,484.2000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1876.00,,,,,,,484.2000,3266.6300,fee schedule,"APG 00051 Proc 23065 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51 (Service Line reduced to $1,876.00, claim capped at $1,876.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,BLUE CROSS,ANTHEM HMO,1876.00,,,,,,,484.2000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,484.2000,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1876.00,,,,,,,484.2000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,484.2000,3266.6300,case rate,Rev 361 Proc 23065 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,484.2000,3266.6300,case rate,"Rev 361 Proc 23065 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,484.2000,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,BLUE CROSS,BLUE CROSS P NETWORK,1876.00,,,,,,,484.2000,3266.6300,case rate,"Rev 361 Proc 23065 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total (Service Line reduced to $1,876.00, claim capped at $1,876.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,BLUE CROSS,BLUE CROSS S NETWORK,1876.00,,,,,,,484.2000,3266.6300,case rate,"Rev 361 Proc 23065 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total (Service Line reduced to $1,876.00, claim capped at $1,876.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,484.2000,3266.6300,case rate,Rev 361 Proc 23065 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,484.2000,3266.6300,case rate,Rev 361 Proc 23065 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,CIGNA HEALTHCARE,CIGNA HMO,1876.00,,,,,,,484.2000,3266.6300,case rate,"Rev 361 Proc 23065 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,876.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,876.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,484.2000,3266.6300,case rate,"Rev 361 Proc 23065 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,484.2000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1876.00,,,,,,,484.2000,3266.6300,case rate,"Rev 361 Proc 23065 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,876.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,876.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,CIGNA HEALTHCARE,CIGNA PPO,1876.00,,,,,,,484.2000,3266.6300,case rate,"Rev 361 Proc 23065 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,876.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,876.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,484.2000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1688.40,,,,,,,484.2000,3266.6300,percent of total billed charges,"90% of $1,876.00 in Billed Charges for Rev 361 Proc 23065 = $1,688.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,484.2000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,484.2000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,MEDCOST,MEDCOST VHN,892.79,,,,,,,484.2000,3266.6300,percent of total billed charges,"47.59% of $1,876.00 in Billed Charges for Rev 361 Proc 23065 = $892.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2637.75,,,,,,,484.2000,3266.6300,fee schedule,"APG 00051 Proc 23065 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 105% = $2,637.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,484.2000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,484.2000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,484.2000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2590.02,,,,,,,484.2000,3266.6300,fee schedule,"APG 00051 Proc 23065 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 103.1% = $2,590.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,SENTARA HEALTH,SENTARA HEALTH,484.20,,,,,,,484.2000,3266.6300,percent of total billed charges,"25.81% of $1,876.00 in Billed Charges for Rev 361 Proc 23065 = $484.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,484.2000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1876.00,,,,,,,484.2000,3266.6300,percent of total billed charges,"100% of $1,876.00 in Billed Charges for Rev 361 Proc 23065 = $1,876.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,484.2000,3266.6300,case rate,Rev 361 Proc 23065 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,484.2000,3266.6300,case rate,Rev 361 Proc 23065 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,484.2000,3266.6300,case rate,Rev 361 Proc 23065 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,484.2000,3266.6300,case rate,"Rev 361 Proc 23065 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2587.51,,,,,,,484.2000,3266.6300,fee schedule,"APG 00051 Proc 23065 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,484.2000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,484.2000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,WELLCARE,WELLCARE MEDICAID,1876.00,,,,,,,484.2000,3266.6300,percent of total billed charges,"100% of $1,876.00 in Billed Charges for Rev 361 Proc 23065 = $1,876.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE SHOULDER SUPF,23065,CPT,361,RC,36100076,CDM,,,,both,,,1876.0000,281.4000,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,484.2000,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM SHOULDER,23350,CPT,361,RC,36100078,CDM,,,,both,,,1316.0000,197.4000,AETNA,AETNA,561.93,,,,,,,148.0000,1316.0000,percent of total billed charges,"42.7% of $1,316.00 in Billed Charges for Rev 361 Proc 23350 = $561.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ARTHROGRAM SHOULDER,23350,CPT,361,RC,36100078,CDM,,,,both,,,1316.0000,197.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,495.24,,,,,,,148.0000,1316.0000,fee schedule,APG 00278 Proc 23350 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 104% = $495.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM SHOULDER,23350,CPT,361,RC,36100078,CDM,,,,both,,,1316.0000,197.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,490.48,,,,,,,148.0000,1316.0000,fee schedule,APG 00278 Proc 23350 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 103% = $490.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM SHOULDER,23350,CPT,361,RC,36100078,CDM,,,,both,,,1316.0000,197.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1316.00,,,,,,,148.0000,1316.0000,case rate,"Rev 361 Proc 23350 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $1,316.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,316.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ARTHROGRAM SHOULDER,23350,CPT,361,RC,36100078,CDM,,,,both,,,1316.0000,197.4000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,1316.0000,case rate,Rev 361 Proc 23350 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM SHOULDER,23350,CPT,361,RC,36100078,CDM,,,,both,,,1316.0000,197.4000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,1316.0000,case rate,Rev 361 Proc 23350 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM SHOULDER,23350,CPT,361,RC,36100078,CDM,,,,both,,,1316.0000,197.4000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,1316.0000,case rate,Rev 361 Proc 23350 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM SHOULDER,23350,CPT,361,RC,36100078,CDM,,,,both,,,1316.0000,197.4000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,148.0000,1316.0000,case rate,Rev 361 Proc 23350 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM SHOULDER,23350,CPT,361,RC,36100078,CDM,,,,both,,,1316.0000,197.4000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,148.0000,1316.0000,case rate,Rev 361 Proc 23350 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM SHOULDER,23350,CPT,361,RC,36100078,CDM,,,,both,,,1316.0000,197.4000,CIGNA HEALTHCARE,CIGNA HMO,1316.00,,,,,,,148.0000,1316.0000,case rate,"Rev 361 Proc 23350 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,316.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,316.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ARTHROGRAM SHOULDER,23350,CPT,361,RC,36100078,CDM,,,,both,,,1316.0000,197.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1316.00,,,,,,,148.0000,1316.0000,case rate,"Rev 361 Proc 23350 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,316.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,316.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ARTHROGRAM SHOULDER,23350,CPT,361,RC,36100078,CDM,,,,both,,,1316.0000,197.4000,CIGNA HEALTHCARE,CIGNA PPO,1316.00,,,,,,,148.0000,1316.0000,case rate,"Rev 361 Proc 23350 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,316.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,316.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ARTHROGRAM SHOULDER,23350,CPT,361,RC,36100078,CDM,,,,both,,,1316.0000,197.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1184.40,,,,,,,148.0000,1316.0000,percent of total billed charges,"90% of $1,316.00 in Billed Charges for Rev 361 Proc 23350 = $1,184.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ARTHROGRAM SHOULDER,23350,CPT,361,RC,36100078,CDM,,,,both,,,1316.0000,197.4000,MEDCOST,MEDCOST VHN,626.28,,,,,,,148.0000,1316.0000,percent of total billed charges,"47.59% of $1,316.00 in Billed Charges for Rev 361 Proc 23350 = $626.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ARTHROGRAM SHOULDER,23350,CPT,361,RC,36100078,CDM,,,,both,,,1316.0000,197.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,500.00,,,,,,,148.0000,1316.0000,fee schedule,APG 00278 Proc 23350 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 100% = $476.19... $476.19 at 105% = $500.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM SHOULDER,23350,CPT,361,RC,36100078,CDM,,,,both,,,1316.0000,197.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,490.95,,,,,,,148.0000,1316.0000,fee schedule,APG 00278 Proc 23350 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 100% = $476.19... $476.19 at 103.1% = $490.95 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM SHOULDER,23350,CPT,361,RC,36100078,CDM,,,,both,,,1316.0000,197.4000,SENTARA HEALTH,SENTARA HEALTH,339.66,,,,,,,148.0000,1316.0000,percent of total billed charges,"25.81% of $1,316.00 in Billed Charges for Rev 361 Proc 23350 = $339.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ARTHROGRAM SHOULDER,23350,CPT,361,RC,36100078,CDM,,,,both,,,1316.0000,197.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1316.00,,,,,,,148.0000,1316.0000,percent of total billed charges,"100% of $1,316.00 in Billed Charges for Rev 361 Proc 23350 = $1,316.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ARTHROGRAM SHOULDER,23350,CPT,361,RC,36100078,CDM,,,,both,,,1316.0000,197.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,148.0000,1316.0000,case rate,Rev 361 Proc 23350 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM SHOULDER,23350,CPT,361,RC,36100078,CDM,,,,both,,,1316.0000,197.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,148.0000,1316.0000,case rate,Rev 361 Proc 23350 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM SHOULDER,23350,CPT,361,RC,36100078,CDM,,,,both,,,1316.0000,197.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,148.0000,1316.0000,case rate,Rev 361 Proc 23350 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM SHOULDER,23350,CPT,361,RC,36100078,CDM,,,,both,,,1316.0000,197.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,148.0000,1316.0000,case rate,Rev 361 Proc 23350 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM SHOULDER,23350,CPT,361,RC,36100078,CDM,,,,both,,,1316.0000,197.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,490.48,,,,,,,148.0000,1316.0000,fee schedule,APG 00278 Proc 23350 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 103% = $490.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM SHOULDER,23350,CPT,361,RC,36100078,CDM,,,,both,,,1316.0000,197.4000,WELLCARE,WELLCARE MEDICAID,1316.00,,,,,,,148.0000,1316.0000,percent of total billed charges,"100% of $1,316.00 in Billed Charges for Rev 361 Proc 23350 = $1,316.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA,180.19,,,,,,,69.0500,703.3600,percent of total billed charges,42.7% of $422.00 in Billed Charges for Rev 450 Proc 23500 = $180.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,69.0500,703.3600,fee schedule,"APG 00041 Proc 23500 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,69.0500,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,69.0500,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,69.0500,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,AMBETTER,AMBETTER,487.87,,,,,,,69.0500,703.3600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,69.0500,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM EXCHANGE,422.00,,,,,,,69.0500,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,422.00,,,,,,,69.0500,703.3600,fee schedule,"APG 00041 Proc 23500 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HMO,422.00,,,,,,,69.0500,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,69.0500,703.3600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",422.00,,,,,,,69.0500,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,134.14,,,,,,,69.0500,703.3600,fee schedule,$134.14 from Fee Schedule BLDTM_23 for Rev 450 Proc 23500 * Qty 1 = $134.14 at 100% = $134.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,69.0500,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,TENNCARE BLUE CARE,69.05,,,,,,,69.0500,703.3600,fee schedule,$59.53 from Fee Schedule TC_24 for Rev 450 Proc 23500 * Qty 1 = $59.53 at 116% = $69.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,TENNCARE BLUE SELECT,69.05,,,,,,,69.0500,703.3600,fee schedule,$59.53 from Fee Schedule TC_24 for Rev 450 Proc 23500 * Qty 1 = $59.53 at 116% = $69.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,69.0500,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,69.0500,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,379.80,,,,,,,69.0500,703.3600,percent of total billed charges,90% of $422.00 in Billed Charges for Rev 450 Proc 23500 = $379.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,69.0500,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,69.0500,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,MEDCOST,MEDCOST VHN,200.83,,,,,,,69.0500,703.3600,percent of total billed charges,47.59% of $422.00 in Billed Charges for Rev 450 Proc 23500 = $200.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,69.0500,703.3600,fee schedule,"APG 00041 Proc 23500 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,69.0500,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,69.0500,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,69.0500,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,69.0500,703.3600,fee schedule,"APG 00041 Proc 23500 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA HEALTH,108.92,,,,,,,69.0500,703.3600,percent of total billed charges,25.81% of $422.00 in Billed Charges for Rev 450 Proc 23500 = $108.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,69.0500,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",422.00,,,,,,,69.0500,703.3600,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 23500 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,69.0500,703.3600,case rate,Rev 450 Proc 23500 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,422.00,,,,,,,69.0500,703.3600,case rate,"Rev 450 Proc 23500 at Case Rate $491.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,422.00,,,,,,,69.0500,703.3600,case rate,"Rev 450 Proc 23500 at Case Rate $471.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,422.00,,,,,,,69.0500,703.3600,case rate,"Rev 450 Proc 23500 at Case Rate $847.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,69.0500,703.3600,fee schedule,"APG 00041 Proc 23500 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,69.0500,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,69.0500,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICAID,422.00,,,,,,,69.0500,703.3600,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 23500 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLAVICLE FRACT W/O MANIP,23500,CPT,450,RC,45000101,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,69.0500,703.3600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA,603.35,,,,,,,109.0000,1413.0000,percent of total billed charges,"42.7% of $1,413.00 in Billed Charges for Rev 450 Proc 23525 = $603.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 23525 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,1413.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,1413.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 23525 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,1413.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,199.16,,,,,,,109.0000,1413.0000,fee schedule,$199.16 from Fee Schedule BLDTM_23 for Rev 450 Proc 23525 * Qty 1 = $199.16 at 100% = $199.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,1413.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1271.70,,,,,,,109.0000,1413.0000,percent of total billed charges,"90% of $1,413.00 in Billed Charges for Rev 450 Proc 23525 = $1,271.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,MEDCOST,MEDCOST VHN,672.45,,,,,,,109.0000,1413.0000,percent of total billed charges,"47.59% of $1,413.00 in Billed Charges for Rev 450 Proc 23525 = $672.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 23525 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 23525 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA HEALTH,364.70,,,,,,,109.0000,1413.0000,percent of total billed charges,"25.81% of $1,413.00 in Billed Charges for Rev 450 Proc 23525 = $364.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1413.00,,,,,,,109.0000,1413.0000,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 23525 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 23525 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 23525 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 23525 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 23525 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 23525 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICAID,1413.00,,,,,,,109.0000,1413.0000,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 23525 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX STERNOCALV DISLOC W MA,23525,CPT,450,RC,45000105,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,1413.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA,180.19,,,,,,,108.9200,703.3600,percent of total billed charges,42.7% of $422.00 in Billed Charges for Rev 450 Proc 23540 = $180.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 23540 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,AMBETTER,AMBETTER,487.87,,,,,,,108.9200,703.3600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,108.9200,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM EXCHANGE,422.00,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,422.00,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 23540 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HMO,422.00,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,108.9200,703.3600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",422.00,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,135.16,,,,,,,108.9200,703.3600,fee schedule,$135.16 from Fee Schedule BLDTM_23 for Rev 450 Proc 23540 * Qty 1 = $135.16 at 100% = $135.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,108.9200,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,379.80,,,,,,,108.9200,703.3600,percent of total billed charges,90% of $422.00 in Billed Charges for Rev 450 Proc 23540 = $379.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,MEDCOST,MEDCOST VHN,200.83,,,,,,,108.9200,703.3600,percent of total billed charges,47.59% of $422.00 in Billed Charges for Rev 450 Proc 23540 = $200.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 23540 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 23540 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA HEALTH,108.92,,,,,,,108.9200,703.3600,percent of total billed charges,25.81% of $422.00 in Billed Charges for Rev 450 Proc 23540 = $108.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",422.00,,,,,,,108.9200,703.3600,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 23540 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,108.9200,703.3600,case rate,Rev 450 Proc 23540 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,422.00,,,,,,,108.9200,703.3600,case rate,"Rev 450 Proc 23540 at Case Rate $491.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,422.00,,,,,,,108.9200,703.3600,case rate,"Rev 450 Proc 23540 at Case Rate $471.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,422.00,,,,,,,108.9200,703.3600,case rate,"Rev 450 Proc 23540 at Case Rate $847.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 23540 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICAID,422.00,,,,,,,108.9200,703.3600,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 23540 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACROMIOCLAVIC DISLOC W/O MANIP,23540,CPT,450,RC,45000106,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,108.9200,703.3600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA,353.13,,,,,,,109.0000,827.0000,percent of total billed charges,42.7% of $827.00 in Billed Charges for Rev 450 Proc 23570 = $353.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 23570 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,827.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 23570 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,827.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,142.31,,,,,,,109.0000,827.0000,fee schedule,$142.31 from Fee Schedule BLDTM_23 for Rev 450 Proc 23570 * Qty 1 = $142.31 at 100% = $142.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,744.30,,,,,,,109.0000,827.0000,percent of total billed charges,90% of $827.00 in Billed Charges for Rev 450 Proc 23570 = $744.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,MEDCOST,MEDCOST VHN,393.57,,,,,,,109.0000,827.0000,percent of total billed charges,47.59% of $827.00 in Billed Charges for Rev 450 Proc 23570 = $393.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 23570 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 23570 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA HEALTH,213.45,,,,,,,109.0000,827.0000,percent of total billed charges,25.81% of $827.00 in Billed Charges for Rev 450 Proc 23570 = $213.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",827.00,,,,,,,109.0000,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 23570 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 23570 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 23570 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 23570 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,827.00,,,,,,,109.0000,827.0000,case rate,"Rev 450 Proc 23570 at Case Rate $847.00 (Service Line reduced to $827.00, claim capped at $827.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 23570 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICAID,827.00,,,,,,,109.0000,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 23570 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX SCAPULAR FX W/O MANIP,23570,CPT,450,RC,45000371,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,827.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA,353.13,,,,,,,109.0000,827.0000,percent of total billed charges,42.7% of $827.00 in Billed Charges for Rev 450 Proc 23600 = $353.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 23600 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,827.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 23600 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,827.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,213.12,,,,,,,109.0000,827.0000,fee schedule,$213.12 from Fee Schedule BLDTM_23 for Rev 450 Proc 23600 * Qty 1 = $213.12 at 100% = $213.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,TENNCARE BLUE CARE,109.86,,,,,,,109.0000,827.0000,fee schedule,$94.71 from Fee Schedule TC_24 for Rev 450 Proc 23600 * Qty 1 = $94.71 at 116% = $109.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,TENNCARE BLUE SELECT,109.86,,,,,,,109.0000,827.0000,fee schedule,$94.71 from Fee Schedule TC_24 for Rev 450 Proc 23600 * Qty 1 = $94.71 at 116% = $109.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,744.30,,,,,,,109.0000,827.0000,percent of total billed charges,90% of $827.00 in Billed Charges for Rev 450 Proc 23600 = $744.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,MEDCOST,MEDCOST VHN,393.57,,,,,,,109.0000,827.0000,percent of total billed charges,47.59% of $827.00 in Billed Charges for Rev 450 Proc 23600 = $393.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 23600 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 23600 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA HEALTH,213.45,,,,,,,109.0000,827.0000,percent of total billed charges,25.81% of $827.00 in Billed Charges for Rev 450 Proc 23600 = $213.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",827.00,,,,,,,109.0000,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 23600 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 23600 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 23600 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 23600 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,827.00,,,,,,,109.0000,827.0000,case rate,"Rev 450 Proc 23600 at Case Rate $847.00 (Service Line reduced to $827.00, claim capped at $827.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 23600 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICAID,827.00,,,,,,,109.0000,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 23600 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX PROX HUMERUS FX W/O MANIP,23600,CPT,450,RC,45000373,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,827.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRILL BIT 2.7MM,272,RC,,,,,,,,both,,,1163.0000,174.4500,AETNA,AETNA,496.60,,,,,,,300.1700,1163.0000,percent of total billed charges,"42.7% of $1,163.00 in Billed Charges for Rev 272 = $496.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM,272,RC,,,,,,,,both,,,1163.0000,174.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,814.10,,,,,,,300.1700,1163.0000,percent of total billed charges,"Rev 272 $1,163.00 in Billed Charges at 70% = $814.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM,272,RC,,,,,,,,both,,,1163.0000,174.4500,CIGNA HEALTHCARE,CIGNA HMO,484.97,,,,,,,300.1700,1163.0000,percent of total billed charges,"41.7% of $1,163.00 in Billed Charges for Rev 272 = $484.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM,272,RC,,,,,,,,both,,,1163.0000,174.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,539.63,,,,,,,300.1700,1163.0000,percent of total billed charges,"46.4% of $1,163.00 in Billed Charges for Rev 272 = $539.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM,272,RC,,,,,,,,both,,,1163.0000,174.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,484.97,,,,,,,300.1700,1163.0000,percent of total billed charges,"41.7% of $1,163.00 in Billed Charges for Rev 272 = $484.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM,272,RC,,,,,,,,both,,,1163.0000,174.4500,CIGNA HEALTHCARE,CIGNA PPO,484.97,,,,,,,300.1700,1163.0000,percent of total billed charges,"41.7% of $1,163.00 in Billed Charges for Rev 272 = $484.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM,272,RC,,,,,,,,both,,,1163.0000,174.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1046.70,,,,,,,300.1700,1163.0000,percent of total billed charges,"90% of $1,163.00 in Billed Charges for Rev 272 = $1,046.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM,272,RC,,,,,,,,both,,,1163.0000,174.4500,MEDCOST,MEDCOST VHN,553.47,,,,,,,300.1700,1163.0000,percent of total billed charges,"47.59% of $1,163.00 in Billed Charges for Rev 272 = $553.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM,272,RC,,,,,,,,both,,,1163.0000,174.4500,SENTARA HEALTH,SENTARA HEALTH,300.17,,,,,,,300.1700,1163.0000,percent of total billed charges,"25.81% of $1,163.00 in Billed Charges for Rev 272 = $300.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM,272,RC,,,,,,,,both,,,1163.0000,174.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1163.00,,,,,,,300.1700,1163.0000,percent of total billed charges,"100% of $1,163.00 in Billed Charges for Rev 272 = $1,163.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM,272,RC,,,,,,,,both,,,1163.0000,174.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,581.50,,,,,,,300.1700,1163.0000,percent of total billed charges,"Rev 272 $1,163.00 in Billed Charges at 50% = $581.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM,272,RC,,,,,,,,both,,,1163.0000,174.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,375.65,,,,,,,300.1700,1163.0000,other,"32.3% of $1,163.00 in Billed Charges for Rev 272 = $375.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 2.7MM,272,RC,,,,,,,,both,,,1163.0000,174.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,357.04,,,,,,,300.1700,1163.0000,other,"30.7% of $1,163.00 in Billed Charges for Rev 272 = $357.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 2.7MM,272,RC,,,,,,,,both,,,1163.0000,174.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,375.65,,,,,,,300.1700,1163.0000,percent of total billed charges,"32.3% of $1,163.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 2.7MM,272,RC,,,,,,,,both,,,1163.0000,174.4500,WELLCARE,WELLCARE MEDICAID,1163.00,,,,,,,300.1700,1163.0000,percent of total billed charges,"100% of $1,163.00 in Billed Charges for Rev 272 = $1,163.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.0X204,272,RC,,,,,,,,both,,,685.7300,102.8600,AETNA,AETNA,292.81,,,,,,,176.9900,685.7300,percent of total billed charges,42.7% of $685.73 in Billed Charges for Rev 272 = $292.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 3.0X204,272,RC,,,,,,,,both,,,685.7300,102.8600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,480.01,,,,,,,176.9900,685.7300,percent of total billed charges,Rev 272 $685.73 in Billed Charges at 70% = $480.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 3.0X204,272,RC,,,,,,,,both,,,685.7300,102.8600,CIGNA HEALTHCARE,CIGNA HMO,285.95,,,,,,,176.9900,685.7300,percent of total billed charges,41.7% of $685.73 in Billed Charges for Rev 272 = $285.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 3.0X204,272,RC,,,,,,,,both,,,685.7300,102.8600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,318.18,,,,,,,176.9900,685.7300,percent of total billed charges,46.4% of $685.73 in Billed Charges for Rev 272 = $318.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 3.0X204,272,RC,,,,,,,,both,,,685.7300,102.8600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,285.95,,,,,,,176.9900,685.7300,percent of total billed charges,41.7% of $685.73 in Billed Charges for Rev 272 = $285.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 3.0X204,272,RC,,,,,,,,both,,,685.7300,102.8600,CIGNA HEALTHCARE,CIGNA PPO,285.95,,,,,,,176.9900,685.7300,percent of total billed charges,41.7% of $685.73 in Billed Charges for Rev 272 = $285.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 3.0X204,272,RC,,,,,,,,both,,,685.7300,102.8600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,617.16,,,,,,,176.9900,685.7300,percent of total billed charges,90% of $685.73 in Billed Charges for Rev 272 = $617.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 3.0X204,272,RC,,,,,,,,both,,,685.7300,102.8600,MEDCOST,MEDCOST VHN,326.34,,,,,,,176.9900,685.7300,percent of total billed charges,47.59% of $685.73 in Billed Charges for Rev 272 = $326.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 3.0X204,272,RC,,,,,,,,both,,,685.7300,102.8600,SENTARA HEALTH,SENTARA HEALTH,176.99,,,,,,,176.9900,685.7300,percent of total billed charges,25.81% of $685.73 in Billed Charges for Rev 272 = $176.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 3.0X204,272,RC,,,,,,,,both,,,685.7300,102.8600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",685.73,,,,,,,176.9900,685.7300,percent of total billed charges,100% of $685.73 in Billed Charges for Rev 272 = $685.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 3.0X204,272,RC,,,,,,,,both,,,685.7300,102.8600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,342.87,,,,,,,176.9900,685.7300,percent of total billed charges,Rev 272 $685.73 in Billed Charges at 50% = $342.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 3.0X204,272,RC,,,,,,,,both,,,685.7300,102.8600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,221.49,,,,,,,176.9900,685.7300,other,32.3% of $685.73 in Billed Charges for Rev 272 = $221.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRILL BIT 3.0X204,272,RC,,,,,,,,both,,,685.7300,102.8600,UNITED HEALTHCARE,UHC HERITAGE SELECT,210.52,,,,,,,176.9900,685.7300,other,30.7% of $685.73 in Billed Charges for Rev 272 = $210.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRILL BIT 3.0X204,272,RC,,,,,,,,both,,,685.7300,102.8600,UNITED HEALTHCARE,UNITED HEALTHCARE,221.49,,,,,,,176.9900,685.7300,percent of total billed charges,32.3% of $685.73 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 3.0X204,272,RC,,,,,,,,both,,,685.7300,102.8600,WELLCARE,WELLCARE MEDICAID,685.73,,,,,,,176.9900,685.7300,percent of total billed charges,100% of $685.73 in Billed Charges for Rev 272 = $685.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT 3.1 X 216MM  705031,272,RC,,,,,,,,both,,,1923.2000,288.4800,AETNA,AETNA,821.21,,,,,,,496.3800,1923.2000,percent of total billed charges,"42.7% of $1,923.20 in Billed Charges for Rev 272 = $821.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1 X 216MM  705031,272,RC,,,,,,,,both,,,1923.2000,288.4800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1346.24,,,,,,,496.3800,1923.2000,percent of total billed charges,"Rev 272 $1,923.20 in Billed Charges at 70% = $1,346.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1 X 216MM  705031,272,RC,,,,,,,,both,,,1923.2000,288.4800,CIGNA HEALTHCARE,CIGNA HMO,801.97,,,,,,,496.3800,1923.2000,percent of total billed charges,"41.7% of $1,923.20 in Billed Charges for Rev 272 = $801.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1 X 216MM  705031,272,RC,,,,,,,,both,,,1923.2000,288.4800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,892.36,,,,,,,496.3800,1923.2000,percent of total billed charges,"46.4% of $1,923.20 in Billed Charges for Rev 272 = $892.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1 X 216MM  705031,272,RC,,,,,,,,both,,,1923.2000,288.4800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,801.97,,,,,,,496.3800,1923.2000,percent of total billed charges,"41.7% of $1,923.20 in Billed Charges for Rev 272 = $801.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1 X 216MM  705031,272,RC,,,,,,,,both,,,1923.2000,288.4800,CIGNA HEALTHCARE,CIGNA PPO,801.97,,,,,,,496.3800,1923.2000,percent of total billed charges,"41.7% of $1,923.20 in Billed Charges for Rev 272 = $801.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1 X 216MM  705031,272,RC,,,,,,,,both,,,1923.2000,288.4800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1730.88,,,,,,,496.3800,1923.2000,percent of total billed charges,"90% of $1,923.20 in Billed Charges for Rev 272 = $1,730.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1 X 216MM  705031,272,RC,,,,,,,,both,,,1923.2000,288.4800,MEDCOST,MEDCOST VHN,915.25,,,,,,,496.3800,1923.2000,percent of total billed charges,"47.59% of $1,923.20 in Billed Charges for Rev 272 = $915.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1 X 216MM  705031,272,RC,,,,,,,,both,,,1923.2000,288.4800,SENTARA HEALTH,SENTARA HEALTH,496.38,,,,,,,496.3800,1923.2000,percent of total billed charges,"25.81% of $1,923.20 in Billed Charges for Rev 272 = $496.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1 X 216MM  705031,272,RC,,,,,,,,both,,,1923.2000,288.4800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1923.20,,,,,,,496.3800,1923.2000,percent of total billed charges,"100% of $1,923.20 in Billed Charges for Rev 272 = $1,923.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1 X 216MM  705031,272,RC,,,,,,,,both,,,1923.2000,288.4800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,961.60,,,,,,,496.3800,1923.2000,percent of total billed charges,"Rev 272 $1,923.20 in Billed Charges at 50% = $961.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1 X 216MM  705031,272,RC,,,,,,,,both,,,1923.2000,288.4800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,621.19,,,,,,,496.3800,1923.2000,other,"32.3% of $1,923.20 in Billed Charges for Rev 272 = $621.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 3.1 X 216MM  705031,272,RC,,,,,,,,both,,,1923.2000,288.4800,UNITED HEALTHCARE,UHC HERITAGE SELECT,590.42,,,,,,,496.3800,1923.2000,other,"30.7% of $1,923.20 in Billed Charges for Rev 272 = $590.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 3.1 X 216MM  705031,272,RC,,,,,,,,both,,,1923.2000,288.4800,UNITED HEALTHCARE,UNITED HEALTHCARE,621.19,,,,,,,496.3800,1923.2000,percent of total billed charges,"32.3% of $1,923.20 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1 X 216MM  705031,272,RC,,,,,,,,both,,,1923.2000,288.4800,WELLCARE,WELLCARE MEDICAID,1923.20,,,,,,,496.3800,1923.2000,percent of total billed charges,"100% of $1,923.20 in Billed Charges for Rev 272 = $1,923.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1MM,272,RC,,,,,,,,both,,,1272.9400,190.9400,AETNA,AETNA,543.55,,,,,,,328.5500,1272.9400,percent of total billed charges,"42.7% of $1,272.94 in Billed Charges for Rev 272 = $543.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1MM,272,RC,,,,,,,,both,,,1272.9400,190.9400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,891.06,,,,,,,328.5500,1272.9400,percent of total billed charges,"Rev 272 $1,272.94 in Billed Charges at 70% = $891.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1MM,272,RC,,,,,,,,both,,,1272.9400,190.9400,CIGNA HEALTHCARE,CIGNA HMO,530.82,,,,,,,328.5500,1272.9400,percent of total billed charges,"41.7% of $1,272.94 in Billed Charges for Rev 272 = $530.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1MM,272,RC,,,,,,,,both,,,1272.9400,190.9400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,590.64,,,,,,,328.5500,1272.9400,percent of total billed charges,"46.4% of $1,272.94 in Billed Charges for Rev 272 = $590.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1MM,272,RC,,,,,,,,both,,,1272.9400,190.9400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,530.82,,,,,,,328.5500,1272.9400,percent of total billed charges,"41.7% of $1,272.94 in Billed Charges for Rev 272 = $530.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1MM,272,RC,,,,,,,,both,,,1272.9400,190.9400,CIGNA HEALTHCARE,CIGNA PPO,530.82,,,,,,,328.5500,1272.9400,percent of total billed charges,"41.7% of $1,272.94 in Billed Charges for Rev 272 = $530.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1MM,272,RC,,,,,,,,both,,,1272.9400,190.9400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1145.65,,,,,,,328.5500,1272.9400,percent of total billed charges,"90% of $1,272.94 in Billed Charges for Rev 272 = $1,145.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1MM,272,RC,,,,,,,,both,,,1272.9400,190.9400,MEDCOST,MEDCOST VHN,605.79,,,,,,,328.5500,1272.9400,percent of total billed charges,"47.59% of $1,272.94 in Billed Charges for Rev 272 = $605.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1MM,272,RC,,,,,,,,both,,,1272.9400,190.9400,SENTARA HEALTH,SENTARA HEALTH,328.55,,,,,,,328.5500,1272.9400,percent of total billed charges,"25.81% of $1,272.94 in Billed Charges for Rev 272 = $328.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1MM,272,RC,,,,,,,,both,,,1272.9400,190.9400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1272.94,,,,,,,328.5500,1272.9400,percent of total billed charges,"100% of $1,272.94 in Billed Charges for Rev 272 = $1,272.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1MM,272,RC,,,,,,,,both,,,1272.9400,190.9400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,636.47,,,,,,,328.5500,1272.9400,percent of total billed charges,"Rev 272 $1,272.94 in Billed Charges at 50% = $636.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1MM,272,RC,,,,,,,,both,,,1272.9400,190.9400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,411.16,,,,,,,328.5500,1272.9400,other,"32.3% of $1,272.94 in Billed Charges for Rev 272 = $411.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 3.1MM,272,RC,,,,,,,,both,,,1272.9400,190.9400,UNITED HEALTHCARE,UHC HERITAGE SELECT,390.79,,,,,,,328.5500,1272.9400,other,"30.7% of $1,272.94 in Billed Charges for Rev 272 = $390.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 3.1MM,272,RC,,,,,,,,both,,,1272.9400,190.9400,UNITED HEALTHCARE,UNITED HEALTHCARE,411.16,,,,,,,328.5500,1272.9400,percent of total billed charges,"32.3% of $1,272.94 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.1MM,272,RC,,,,,,,,both,,,1272.9400,190.9400,WELLCARE,WELLCARE MEDICAID,1272.94,,,,,,,328.5500,1272.9400,percent of total billed charges,"100% of $1,272.94 in Billed Charges for Rev 272 = $1,272.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,AETNA,AETNA,2145.25,,,,,,,775.0000,5024.0000,percent of total billed charges,"42.7% of $5,024.00 in Billed Charges for Rev 361 Proc 28010 = $2,145.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3128.66,,,,,,,775.0000,5024.0000,fee schedule,"APG 00035 Proc 28010 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 104% = $3,128.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,775.0000,5024.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,775.0000,5024.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,775.0000,5024.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,AMBETTER,AMBETTER,3180.38,,,,,,,775.0000,5024.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,775.0000,5024.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,775.0000,5024.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3098.58,,,,,,,775.0000,5024.0000,fee schedule,"APG 00035 Proc 28010 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 103% = $3,098.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,775.0000,5024.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,775.0000,5024.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4489.34,,,,,,,775.0000,5024.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,948.00,,,,,,,775.0000,5024.0000,case rate,Rev 361 Proc 28010 ASG Rate of $948.00 at 100% of $948.00 = $948.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,775.0000,5024.0000,case rate,"Rev 361 Proc 28010 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,775.0000,5024.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,775.0000,5024.0000,case rate,"Rev 361 Proc 28010 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,775.0000,5024.0000,case rate,"Rev 361 Proc 28010 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,5024.0000,case rate,Rev 361 Proc 28010 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,5024.0000,case rate,Rev 361 Proc 28010 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,775.0000,5024.0000,case rate,"Rev 361 Proc 28010 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,775.0000,5024.0000,case rate,"Rev 361 Proc 28010 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,775.0000,5024.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,775.0000,5024.0000,case rate,"Rev 361 Proc 28010 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,775.0000,5024.0000,case rate,"Rev 361 Proc 28010 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,775.0000,5024.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4521.60,,,,,,,775.0000,5024.0000,percent of total billed charges,"90% of $5,024.00 in Billed Charges for Rev 361 Proc 28010 = $4,521.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,775.0000,5024.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,775.0000,5024.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,MEDCOST,MEDCOST VHN,2390.92,,,,,,,775.0000,5024.0000,percent of total billed charges,"47.59% of $5,024.00 in Billed Charges for Rev 361 Proc 28010 = $2,390.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3158.75,,,,,,,775.0000,5024.0000,fee schedule,"APG 00035 Proc 28010 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 100% = $3,008.33... $3,008.33 at 105% = $3,158.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,775.0000,5024.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,775.0000,5024.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,775.0000,5024.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3101.59,,,,,,,775.0000,5024.0000,fee schedule,"APG 00035 Proc 28010 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 100% = $3,008.33... $3,008.33 at 103.1% = $3,101.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,SENTARA HEALTH,SENTARA HEALTH,1296.69,,,,,,,775.0000,5024.0000,percent of total billed charges,"25.81% of $5,024.00 in Billed Charges for Rev 361 Proc 28010 = $1,296.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,775.0000,5024.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5024.00,,,,,,,775.0000,5024.0000,percent of total billed charges,"100% of $5,024.00 in Billed Charges for Rev 361 Proc 28010 = $5,024.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1418.00,,,,,,,775.0000,5024.0000,case rate,"Rev 361 Proc 28010 ASG Rate of $1,418.00 at 100% of $1,418.00 = $1,418.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2547.00,,,,,,,775.0000,5024.0000,case rate,"Rev 361 Proc 28010 ASG Rate of $2,547.00 at 100% of $2,547.00 = $2,547.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2436.00,,,,,,,775.0000,5024.0000,case rate,"Rev 361 Proc 28010 ASG Rate of $2,436.00 at 100% of $2,436.00 = $2,436.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,4296.00,,,,,,,775.0000,5024.0000,case rate,"Rev 361 Proc 28010 ASG Rate of $4,296.00 at 100% of $4,296.00 = $4,296.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3098.58,,,,,,,775.0000,5024.0000,fee schedule,"APG 00035 Proc 28010 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 103% = $3,098.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,775.0000,5024.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,775.0000,5024.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,WELLCARE,WELLCARE MEDICAID,5024.00,,,,,,,775.0000,5024.0000,percent of total billed charges,"100% of $5,024.00 in Billed Charges for Rev 361 Proc 28010 = $5,024.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TENOTOMY SINGLE TENDON,28010,CPT,361,RC,36100090,CDM,,,,both,,,5024.0000,753.6000,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,775.0000,5024.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,AETNA,AETNA,3907.90,,,,,,,775.0000,9152.0000,percent of total billed charges,"42.7% of $9,152.00 in Billed Charges for Rev 361 Proc 28060 = $3,907.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3128.66,,,,,,,775.0000,9152.0000,fee schedule,"APG 00035 Proc 28060 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 104% = $3,128.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2968.60,,,,,,,775.0000,9152.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,AETNA,AETNA HEALTHCARE MEDICARE,2968.60,,,,,,,775.0000,9152.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,2968.60,,,,,,,775.0000,9152.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,AMBETTER,AMBETTER,6471.55,,,,,,,775.0000,9152.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3087.35,,,,,,,775.0000,9152.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,BLUE CROSS,ANTHEM EXCHANGE,7308.87,,,,,,,775.0000,9152.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3098.58,,,,,,,775.0000,9152.0000,fee schedule,"APG 00035 Proc 28060 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 103% = $3,098.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,BLUE CROSS,ANTHEM HMO,7765.24,,,,,,,775.0000,9152.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3057.66,,,,,,,775.0000,9152.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9135.08,,,,,,,775.0000,9152.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,948.00,,,,,,,775.0000,9152.0000,case rate,Rev 361 Proc 28060 ASG Rate of $948.00 at 100% of $948.00 = $948.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,775.0000,9152.0000,case rate,"Rev 361 Proc 28060 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,BLUE CROSS,BLUE CROSS MEDICARE,3087.35,,,,,,,775.0000,9152.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,775.0000,9152.0000,case rate,"Rev 361 Proc 28060 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,775.0000,9152.0000,case rate,"Rev 361 Proc 28060 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,9152.0000,case rate,Rev 361 Proc 28060 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,9152.0000,case rate,Rev 361 Proc 28060 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,CIGNA HEALTHCARE,CIGNA HMO,2588.00,,,,,,,775.0000,9152.0000,case rate,"Rev 361 Proc 28060 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1956.00,,,,,,,775.0000,9152.0000,case rate,"Rev 361 Proc 28060 ASG Rate of $1,956.00 at 100% of $1,956.00 = $1,956.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,3117.03,,,,,,,775.0000,9152.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2588.00,,,,,,,775.0000,9152.0000,case rate,"Rev 361 Proc 28060 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,CIGNA HEALTHCARE,CIGNA PPO,2588.00,,,,,,,775.0000,9152.0000,case rate,"Rev 361 Proc 28060 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3117.03,,,,,,,775.0000,9152.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8236.80,,,,,,,775.0000,9152.0000,percent of total billed charges,"90% of $9,152.00 in Billed Charges for Rev 361 Proc 28060 = $8,236.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,HUMANA,HUMANA MEDICARE,2968.60,,,,,,,775.0000,9152.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2968.60,,,,,,,775.0000,9152.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,MEDCOST,MEDCOST VHN,4355.44,,,,,,,775.0000,9152.0000,percent of total billed charges,"47.59% of $9,152.00 in Billed Charges for Rev 361 Proc 28060 = $4,355.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3158.75,,,,,,,775.0000,9152.0000,fee schedule,"APG 00035 Proc 28060 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 100% = $3,008.33... $3,008.33 at 105% = $3,158.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3117.03,,,,,,,775.0000,9152.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3117.03,,,,,,,775.0000,9152.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,NHC ADVANTAGE,NHC ADVANTAGE,3117.03,,,,,,,775.0000,9152.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3101.59,,,,,,,775.0000,9152.0000,fee schedule,"APG 00035 Proc 28060 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 100% = $3,008.33... $3,008.33 at 103.1% = $3,101.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,SENTARA HEALTH,SENTARA HEALTH,2362.13,,,,,,,775.0000,9152.0000,percent of total billed charges,"25.81% of $9,152.00 in Billed Charges for Rev 361 Proc 28060 = $2,362.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,SENTARA HEALTH,SENTARA MEDICARE,2968.60,,,,,,,775.0000,9152.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9152.00,,,,,,,775.0000,9152.0000,percent of total billed charges,"100% of $9,152.00 in Billed Charges for Rev 361 Proc 28060 = $9,152.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1418.00,,,,,,,775.0000,9152.0000,case rate,"Rev 361 Proc 28060 ASG Rate of $1,418.00 at 100% of $1,418.00 = $1,418.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2547.00,,,,,,,775.0000,9152.0000,case rate,"Rev 361 Proc 28060 ASG Rate of $2,547.00 at 100% of $2,547.00 = $2,547.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2436.00,,,,,,,775.0000,9152.0000,case rate,"Rev 361 Proc 28060 ASG Rate of $2,436.00 at 100% of $2,436.00 = $2,436.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,4296.00,,,,,,,775.0000,9152.0000,case rate,"Rev 361 Proc 28060 ASG Rate of $4,296.00 at 100% of $4,296.00 = $4,296.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3098.58,,,,,,,775.0000,9152.0000,fee schedule,"APG 00035 Proc 28060 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 103% = $3,098.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2968.60,,,,,,,775.0000,9152.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2968.60,,,,,,,775.0000,9152.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,WELLCARE,WELLCARE MEDICAID,9152.00,,,,,,,775.0000,9152.0000,percent of total billed charges,"100% of $9,152.00 in Billed Charges for Rev 361 Proc 28060 = $9,152.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FASCIECTOMY PLANTAR FASCIA PARTIAL SPX,28060,CPT,361,RC,36100526,CDM,,,,both,,,9152.0000,1372.8000,WELLCARE,WELLCARE MEDICARE,3146.72,,,,,,,775.0000,9152.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,AETNA,AETNA,1192.61,,,,,,,109.0000,3266.6300,percent of total billed charges,"42.7% of $2,793.00 in Billed Charges for Rev 450 Proc 28192 = $1,192.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2612.63,,,,,,,109.0000,3266.6300,fee schedule,"APG 00051 Proc 28192 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 104% = $2,612.63. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,AMBETTER,AMBETTER,3266.63,,,,,,,109.0000,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,109.0000,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,BLUE CROSS,ANTHEM EXCHANGE,2793.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2587.51,,,,,,,109.0000,3266.6300,fee schedule,"APG 00051 Proc 28192 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,BLUE CROSS,ANTHEM HMO,2793.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,109.0000,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2793.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,268.45,,,,,,,109.0000,3266.6300,fee schedule,$268.45 from Fee Schedule BLDTM_23 for Rev 450 Proc 28192 * Qty 1 = $268.45 at 100% = $268.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,109.0000,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,109.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,109.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2513.70,,,,,,,109.0000,3266.6300,percent of total billed charges,"90% of $2,793.00 in Billed Charges for Rev 450 Proc 28192 = $2,513.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,MEDCOST,MEDCOST VHN,1329.19,,,,,,,109.0000,3266.6300,percent of total billed charges,"47.59% of $2,793.00 in Billed Charges for Rev 450 Proc 28192 = $1,329.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2637.75,,,,,,,109.0000,3266.6300,fee schedule,"APG 00051 Proc 28192 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 105% = $2,637.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,109.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,109.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,109.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2590.02,,,,,,,109.0000,3266.6300,fee schedule,"APG 00051 Proc 28192 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 103.1% = $2,590.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,SENTARA HEALTH,SENTARA HEALTH,720.87,,,,,,,109.0000,3266.6300,percent of total billed charges,"25.81% of $2,793.00 in Billed Charges for Rev 450 Proc 28192 = $720.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2793.00,,,,,,,109.0000,3266.6300,percent of total billed charges,"100% of $2,793.00 in Billed Charges for Rev 450 Proc 28192 = $2,793.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3266.6300,case rate,Rev 450 Proc 28192 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3266.6300,case rate,Rev 450 Proc 28192 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3266.6300,case rate,Rev 450 Proc 28192 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3266.6300,case rate,Rev 450 Proc 28192 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2587.51,,,,,,,109.0000,3266.6300,fee schedule,"APG 00051 Proc 28192 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,WELLCARE,WELLCARE MEDICAID,2793.00,,,,,,,109.0000,3266.6300,percent of total billed charges,"100% of $2,793.00 in Billed Charges for Rev 450 Proc 28192 = $2,793.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FOREIGN BODY FOOT DEEP,28192,CPT,450,RC,45000179,CDM,,,,both,,,2793.0000,418.9500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,109.0000,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,AETNA,AETNA,3779.38,,,,,,,109.0000,8851.0000,percent of total billed charges,"42.7% of $8,851.00 in Billed Charges for Rev 450 Proc 28208 = $3,779.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3128.66,,,,,,,109.0000,8851.0000,fee schedule,"APG 00035 Proc 28208 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 104% = $3,128.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2968.60,,,,,,,109.0000,8851.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,AETNA,AETNA HEALTHCARE MEDICARE,2968.60,,,,,,,109.0000,8851.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,2968.60,,,,,,,109.0000,8851.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,AMBETTER,AMBETTER,6471.55,,,,,,,109.0000,8851.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3087.35,,,,,,,109.0000,8851.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,BLUE CROSS,ANTHEM EXCHANGE,7308.87,,,,,,,109.0000,8851.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3098.58,,,,,,,109.0000,8851.0000,fee schedule,"APG 00035 Proc 28208 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 103% = $3,098.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,BLUE CROSS,ANTHEM HMO,7765.24,,,,,,,109.0000,8851.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3057.66,,,,,,,109.0000,8851.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8851.00,,,,,,,109.0000,8851.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,220.51,,,,,,,109.0000,8851.0000,fee schedule,$220.51 from Fee Schedule BLDTM_23 for Rev 450 Proc 28208 * Qty 1 = $220.51 at 100% = $220.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,BLUE CROSS,BLUE CROSS MEDICARE,3087.35,,,,,,,109.0000,8851.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,3117.03,,,,,,,109.0000,8851.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3117.03,,,,,,,109.0000,8851.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7965.90,,,,,,,109.0000,8851.0000,percent of total billed charges,"90% of $8,851.00 in Billed Charges for Rev 450 Proc 28208 = $7,965.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,HUMANA,HUMANA MEDICARE,2968.60,,,,,,,109.0000,8851.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2968.60,,,,,,,109.0000,8851.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,MEDCOST,MEDCOST VHN,4212.19,,,,,,,109.0000,8851.0000,percent of total billed charges,"47.59% of $8,851.00 in Billed Charges for Rev 450 Proc 28208 = $4,212.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3158.75,,,,,,,109.0000,8851.0000,fee schedule,"APG 00035 Proc 28208 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 100% = $3,008.33... $3,008.33 at 105% = $3,158.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3117.03,,,,,,,109.0000,8851.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3117.03,,,,,,,109.0000,8851.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,NHC ADVANTAGE,NHC ADVANTAGE,3117.03,,,,,,,109.0000,8851.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3101.59,,,,,,,109.0000,8851.0000,fee schedule,"APG 00035 Proc 28208 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 100% = $3,008.33... $3,008.33 at 103.1% = $3,101.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,SENTARA HEALTH,SENTARA HEALTH,2284.44,,,,,,,109.0000,8851.0000,percent of total billed charges,"25.81% of $8,851.00 in Billed Charges for Rev 450 Proc 28208 = $2,284.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,SENTARA HEALTH,SENTARA MEDICARE,2968.60,,,,,,,109.0000,8851.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8851.00,,,,,,,109.0000,8851.0000,percent of total billed charges,"100% of $8,851.00 in Billed Charges for Rev 450 Proc 28208 = $8,851.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,8851.0000,case rate,Rev 450 Proc 28208 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,8851.0000,case rate,Rev 450 Proc 28208 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,8851.0000,case rate,Rev 450 Proc 28208 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,8851.0000,case rate,Rev 450 Proc 28208 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3098.58,,,,,,,109.0000,8851.0000,fee schedule,"APG 00035 Proc 28208 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 103% = $3,098.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2968.60,,,,,,,109.0000,8851.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2968.60,,,,,,,109.0000,8851.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,WELLCARE,WELLCARE MEDICAID,8851.00,,,,,,,109.0000,8851.0000,percent of total billed charges,"100% of $8,851.00 in Billed Charges for Rev 450 Proc 28208 = $8,851.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON,28208,CPT,450,RC,45000422,CDM,,,,both,,,8851.0000,1327.6500,WELLCARE,WELLCARE MEDICARE,3146.72,,,,,,,109.0000,8851.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRILL BIT 3.8MM,272,RC,,,,,,,,both,,,2341.2500,351.1900,AETNA,AETNA,999.71,,,,,,,604.2800,2341.2500,percent of total billed charges,"42.7% of $2,341.25 in Billed Charges for Rev 272 = $999.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.8MM,272,RC,,,,,,,,both,,,2341.2500,351.1900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1638.88,,,,,,,604.2800,2341.2500,percent of total billed charges,"Rev 272 $2,341.25 in Billed Charges at 70% = $1,638.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.8MM,272,RC,,,,,,,,both,,,2341.2500,351.1900,CIGNA HEALTHCARE,CIGNA HMO,976.30,,,,,,,604.2800,2341.2500,percent of total billed charges,"41.7% of $2,341.25 in Billed Charges for Rev 272 = $976.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.8MM,272,RC,,,,,,,,both,,,2341.2500,351.1900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1086.34,,,,,,,604.2800,2341.2500,percent of total billed charges,"46.4% of $2,341.25 in Billed Charges for Rev 272 = $1,086.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.8MM,272,RC,,,,,,,,both,,,2341.2500,351.1900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,976.30,,,,,,,604.2800,2341.2500,percent of total billed charges,"41.7% of $2,341.25 in Billed Charges for Rev 272 = $976.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.8MM,272,RC,,,,,,,,both,,,2341.2500,351.1900,CIGNA HEALTHCARE,CIGNA PPO,976.30,,,,,,,604.2800,2341.2500,percent of total billed charges,"41.7% of $2,341.25 in Billed Charges for Rev 272 = $976.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.8MM,272,RC,,,,,,,,both,,,2341.2500,351.1900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2107.13,,,,,,,604.2800,2341.2500,percent of total billed charges,"90% of $2,341.25 in Billed Charges for Rev 272 = $2,107.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.8MM,272,RC,,,,,,,,both,,,2341.2500,351.1900,MEDCOST,MEDCOST VHN,1114.20,,,,,,,604.2800,2341.2500,percent of total billed charges,"47.59% of $2,341.25 in Billed Charges for Rev 272 = $1,114.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.8MM,272,RC,,,,,,,,both,,,2341.2500,351.1900,SENTARA HEALTH,SENTARA HEALTH,604.28,,,,,,,604.2800,2341.2500,percent of total billed charges,"25.81% of $2,341.25 in Billed Charges for Rev 272 = $604.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.8MM,272,RC,,,,,,,,both,,,2341.2500,351.1900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2341.25,,,,,,,604.2800,2341.2500,percent of total billed charges,"100% of $2,341.25 in Billed Charges for Rev 272 = $2,341.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.8MM,272,RC,,,,,,,,both,,,2341.2500,351.1900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1170.63,,,,,,,604.2800,2341.2500,percent of total billed charges,"Rev 272 $2,341.25 in Billed Charges at 50% = $1,170.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.8MM,272,RC,,,,,,,,both,,,2341.2500,351.1900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,756.22,,,,,,,604.2800,2341.2500,other,"32.3% of $2,341.25 in Billed Charges for Rev 272 = $756.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 3.8MM,272,RC,,,,,,,,both,,,2341.2500,351.1900,UNITED HEALTHCARE,UHC HERITAGE SELECT,718.76,,,,,,,604.2800,2341.2500,other,"30.7% of $2,341.25 in Billed Charges for Rev 272 = $718.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 3.8MM,272,RC,,,,,,,,both,,,2341.2500,351.1900,UNITED HEALTHCARE,UNITED HEALTHCARE,756.22,,,,,,,604.2800,2341.2500,percent of total billed charges,"32.3% of $2,341.25 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 3.8MM,272,RC,,,,,,,,both,,,2341.2500,351.1900,WELLCARE,WELLCARE MEDICAID,2341.25,,,,,,,604.2800,2341.2500,percent of total billed charges,"100% of $2,341.25 in Billed Charges for Rev 272 = $2,341.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA,180.19,,,,,,,108.9200,703.3600,percent of total billed charges,42.7% of $422.00 in Billed Charges for Rev 450 Proc 28450 = $180.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 28450 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,AMBETTER,AMBETTER,487.87,,,,,,,108.9200,703.3600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,108.9200,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM EXCHANGE,422.00,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,422.00,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 28450 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HMO,422.00,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,108.9200,703.3600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",422.00,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,167.67,,,,,,,108.9200,703.3600,fee schedule,$167.67 from Fee Schedule BLDTM_23 for Rev 450 Proc 28450 * Qty 1 = $167.67 at 100% = $167.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,108.9200,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,379.80,,,,,,,108.9200,703.3600,percent of total billed charges,90% of $422.00 in Billed Charges for Rev 450 Proc 28450 = $379.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,MEDCOST,MEDCOST VHN,200.83,,,,,,,108.9200,703.3600,percent of total billed charges,47.59% of $422.00 in Billed Charges for Rev 450 Proc 28450 = $200.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 28450 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 28450 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA HEALTH,108.92,,,,,,,108.9200,703.3600,percent of total billed charges,25.81% of $422.00 in Billed Charges for Rev 450 Proc 28450 = $108.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",422.00,,,,,,,108.9200,703.3600,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 28450 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,108.9200,703.3600,case rate,Rev 450 Proc 28450 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,422.00,,,,,,,108.9200,703.3600,case rate,"Rev 450 Proc 28450 at Case Rate $491.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,422.00,,,,,,,108.9200,703.3600,case rate,"Rev 450 Proc 28450 at Case Rate $471.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,422.00,,,,,,,108.9200,703.3600,case rate,"Rev 450 Proc 28450 at Case Rate $847.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 28450 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICAID,422.00,,,,,,,108.9200,703.3600,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 28450 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TX TARSAL FX WO MANIP EA,28450,CPT,450,RC,45000181,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,108.9200,703.3600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,AETNA,AETNA,216.49,,,,,,,109.0000,3180.3800,percent of total billed charges,42.7% of $507.00 in Billed Charges for Rev 450 Proc 28455 = $216.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 28455 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,507.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,AETNA,AETNA HEALTHCARE MEDICARE,507.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,507.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,3180.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,507.00,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,BLUE CROSS,ANTHEM EXCHANGE,507.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,507.00,,,,,,,109.0000,3180.3800,fee schedule,"APG 00041 Proc 28455 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96 (Service Line reduced to $507.00, claim capped at $507.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,BLUE CROSS,ANTHEM HMO,507.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,507.00,,,,,,,109.0000,3180.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",507.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,177.32,,,,,,,109.0000,3180.3800,fee schedule,$177.32 from Fee Schedule BLDTM_23 for Rev 450 Proc 28455 * Qty 1 = $177.32 at 100% = $177.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,507.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,507.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,456.30,,,,,,,109.0000,3180.3800,percent of total billed charges,90% of $507.00 in Billed Charges for Rev 450 Proc 28455 = $456.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,HUMANA,HUMANA MEDICARE,507.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,507.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,MEDCOST,MEDCOST VHN,241.28,,,,,,,109.0000,3180.3800,percent of total billed charges,47.59% of $507.00 in Billed Charges for Rev 450 Proc 28455 = $241.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 28455 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,507.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,507.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,NHC ADVANTAGE,NHC ADVANTAGE,507.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 28455 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,SENTARA HEALTH,SENTARA HEALTH,130.86,,,,,,,109.0000,3180.3800,percent of total billed charges,25.81% of $507.00 in Billed Charges for Rev 450 Proc 28455 = $130.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,SENTARA HEALTH,SENTARA MEDICARE,507.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",507.00,,,,,,,109.0000,3180.3800,percent of total billed charges,100% of $507.00 in Billed Charges for Rev 450 Proc 28455 = $507.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 28455 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 28455 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 28455 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,507.00,,,,,,,109.0000,3180.3800,case rate,"Rev 450 Proc 28455 at Case Rate $847.00 (Service Line reduced to $507.00, claim capped at $507.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 28455 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,507.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,507.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,WELLCARE,WELLCARE MEDICAID,507.00,,,,,,,109.0000,3180.3800,percent of total billed charges,100% of $507.00 in Billed Charges for Rev 450 Proc 28455 = $507.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TX TARSAL FX W MANIP EA,28455,CPT,450,RC,45000182,CDM,,,,both,,,507.0000,76.0500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,3180.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,AETNA,AETNA,189.59,,,,,,,62.9700,703.3600,percent of total billed charges,42.7% of $444.00 in Billed Charges for Rev 450 Proc 28490 = $189.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,62.9700,703.3600,fee schedule,"APG 00041 Proc 28490 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,62.9700,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,62.9700,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,62.9700,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,AMBETTER,AMBETTER,487.87,,,,,,,62.9700,703.3600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,62.9700,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,BLUE CROSS,ANTHEM EXCHANGE,444.00,,,,,,,62.9700,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,444.00,,,,,,,62.9700,703.3600,fee schedule,"APG 00041 Proc 28490 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96 (Service Line reduced to $444.00, claim capped at $444.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,BLUE CROSS,ANTHEM HMO,444.00,,,,,,,62.9700,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,62.9700,703.3600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",444.00,,,,,,,62.9700,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,62.97,,,,,,,62.9700,703.3600,fee schedule,$62.97 from Fee Schedule BLDTM_23 for Rev 450 Proc 28490 * Qty 1 = $62.97 at 100% = $62.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,62.9700,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,62.9700,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,62.9700,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,399.60,,,,,,,62.9700,703.3600,percent of total billed charges,90% of $444.00 in Billed Charges for Rev 450 Proc 28490 = $399.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,62.9700,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,62.9700,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,MEDCOST,MEDCOST VHN,211.30,,,,,,,62.9700,703.3600,percent of total billed charges,47.59% of $444.00 in Billed Charges for Rev 450 Proc 28490 = $211.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,62.9700,703.3600,fee schedule,"APG 00041 Proc 28490 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,62.9700,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,62.9700,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,62.9700,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,62.9700,703.3600,fee schedule,"APG 00041 Proc 28490 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,SENTARA HEALTH,SENTARA HEALTH,114.60,,,,,,,62.9700,703.3600,percent of total billed charges,25.81% of $444.00 in Billed Charges for Rev 450 Proc 28490 = $114.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,62.9700,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",444.00,,,,,,,62.9700,703.3600,percent of total billed charges,100% of $444.00 in Billed Charges for Rev 450 Proc 28490 = $444.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,62.9700,703.3600,case rate,Rev 450 Proc 28490 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,444.00,,,,,,,62.9700,703.3600,case rate,"Rev 450 Proc 28490 at Case Rate $491.00 (Service Line reduced to $444.00, claim capped at $444.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,444.00,,,,,,,62.9700,703.3600,case rate,"Rev 450 Proc 28490 at Case Rate $471.00 (Service Line reduced to $444.00, claim capped at $444.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,444.00,,,,,,,62.9700,703.3600,case rate,"Rev 450 Proc 28490 at Case Rate $847.00 (Service Line reduced to $444.00, claim capped at $444.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,62.9700,703.3600,fee schedule,"APG 00041 Proc 28490 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,62.9700,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,62.9700,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,WELLCARE,WELLCARE MEDICAID,444.00,,,,,,,62.9700,703.3600,percent of total billed charges,100% of $444.00 in Billed Charges for Rev 450 Proc 28490 = $444.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GREAT TOE FX WO MANIP,28490,CPT,450,RC,45000185,CDM,,,,both,,,444.0000,66.6000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,62.9700,703.3600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA,289.08,,,,,,,173.0000,703.3600,percent of total billed charges,42.7% of $677.00 in Billed Charges for Rev 360 Proc 28570 = $289.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,173.0000,703.3600,fee schedule,"APG 00041 Proc 28570 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,173.0000,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,173.0000,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,173.0000,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,AMBETTER,AMBETTER,487.87,,,,,,,173.0000,703.3600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,173.0000,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,173.0000,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,677.00,,,,,,,173.0000,703.3600,fee schedule,"APG 00041 Proc 28570 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96 (Service Line reduced to $677.00, claim capped at $677.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,173.0000,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,173.0000,703.3600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",677.00,,,,,,,173.0000,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,677.00,,,,,,,173.0000,703.3600,case rate,"Rev 360 Proc 28570 ASG Rate of $1,082.00 at 100% of $1,082.00 = $1,082.00 Total (Limited to $677.00 in Billed Charges - $0.00 in ASG Allowed Amount = $677.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,173.0000,703.3600,case rate,Rev 360 Proc 28570 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,173.0000,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS P NETWORK,677.00,,,,,,,173.0000,703.3600,case rate,"Rev 360 Proc 28570 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total (Service Line reduced to $677.00, claim capped at $677.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS S NETWORK,677.00,,,,,,,173.0000,703.3600,case rate,"Rev 360 Proc 28570 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total (Service Line reduced to $677.00, claim capped at $677.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA HMO,228.00,,,,,,,173.0000,703.3600,case rate,Rev 360 Proc 28570 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.00,,,,,,,173.0000,703.3600,case rate,Rev 360 Proc 28570 ASG Rate of $175.00 at 100% of $175.00 = $175.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,173.0000,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.00,,,,,,,173.0000,703.3600,case rate,Rev 360 Proc 28570 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA PPO,228.00,,,,,,,173.0000,703.3600,case rate,Rev 360 Proc 28570 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,173.0000,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,609.30,,,,,,,173.0000,703.3600,percent of total billed charges,90% of $677.00 in Billed Charges for Rev 360 Proc 28570 = $609.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,173.0000,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,173.0000,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,MEDCOST,MEDCOST VHN,322.18,,,,,,,173.0000,703.3600,percent of total billed charges,47.59% of $677.00 in Billed Charges for Rev 360 Proc 28570 = $322.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,173.0000,703.3600,fee schedule,"APG 00041 Proc 28570 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,173.0000,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,173.0000,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,173.0000,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,173.0000,703.3600,fee schedule,"APG 00041 Proc 28570 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,SENTARA HEALTH,SENTARA HEALTH,174.73,,,,,,,173.0000,703.3600,percent of total billed charges,25.81% of $677.00 in Billed Charges for Rev 360 Proc 28570 = $174.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,173.0000,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",677.00,,,,,,,173.0000,703.3600,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 360 Proc 28570 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,173.0000,703.3600,case rate,Rev 360 Proc 28570 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,173.0000,703.3600,case rate,Rev 360 Proc 28570 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,173.0000,703.3600,case rate,Rev 360 Proc 28570 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,173.0000,703.3600,case rate,Rev 360 Proc 28570 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,173.0000,703.3600,fee schedule,"APG 00041 Proc 28570 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,173.0000,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,173.0000,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,WELLCARE,WELLCARE MEDICAID,677.00,,,,,,,173.0000,703.3600,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 360 Proc 28570 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOSED TX TALOTARSAL JOINT DISLC W/O ANES,28570,CPT,360,RC,36000269,CDM,,,,both,,,677.0000,101.5500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,173.0000,703.3600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ELECTROBE NEEDLE HF RESECTION,272,RC,27200002,CDM,,,,,,both,,,4679.6000,701.9400,AETNA,AETNA,1998.19,,,,,,,1207.8000,4679.6000,percent of total billed charges,"42.7% of $4,679.60 in Billed Charges for Rev 272 = $1,998.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTROBE NEEDLE HF RESECTION,272,RC,27200002,CDM,,,,,,both,,,4679.6000,701.9400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3275.72,,,,,,,1207.8000,4679.6000,percent of total billed charges,"Rev 272 $4,679.60 in Billed Charges at 70% = $3,275.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTROBE NEEDLE HF RESECTION,272,RC,27200002,CDM,,,,,,both,,,4679.6000,701.9400,CIGNA HEALTHCARE,CIGNA HMO,1951.39,,,,,,,1207.8000,4679.6000,percent of total billed charges,"41.7% of $4,679.60 in Billed Charges for Rev 272 = $1,951.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTROBE NEEDLE HF RESECTION,272,RC,27200002,CDM,,,,,,both,,,4679.6000,701.9400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2171.33,,,,,,,1207.8000,4679.6000,percent of total billed charges,"46.4% of $4,679.60 in Billed Charges for Rev 272 = $2,171.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTROBE NEEDLE HF RESECTION,272,RC,27200002,CDM,,,,,,both,,,4679.6000,701.9400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1951.39,,,,,,,1207.8000,4679.6000,percent of total billed charges,"41.7% of $4,679.60 in Billed Charges for Rev 272 = $1,951.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTROBE NEEDLE HF RESECTION,272,RC,27200002,CDM,,,,,,both,,,4679.6000,701.9400,CIGNA HEALTHCARE,CIGNA PPO,1951.39,,,,,,,1207.8000,4679.6000,percent of total billed charges,"41.7% of $4,679.60 in Billed Charges for Rev 272 = $1,951.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTROBE NEEDLE HF RESECTION,272,RC,27200002,CDM,,,,,,both,,,4679.6000,701.9400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4211.64,,,,,,,1207.8000,4679.6000,percent of total billed charges,"90% of $4,679.60 in Billed Charges for Rev 272 = $4,211.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTROBE NEEDLE HF RESECTION,272,RC,27200002,CDM,,,,,,both,,,4679.6000,701.9400,MEDCOST,MEDCOST VHN,2227.02,,,,,,,1207.8000,4679.6000,percent of total billed charges,"47.59% of $4,679.60 in Billed Charges for Rev 272 = $2,227.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTROBE NEEDLE HF RESECTION,272,RC,27200002,CDM,,,,,,both,,,4679.6000,701.9400,SENTARA HEALTH,SENTARA HEALTH,1207.80,,,,,,,1207.8000,4679.6000,percent of total billed charges,"25.81% of $4,679.60 in Billed Charges for Rev 272 = $1,207.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTROBE NEEDLE HF RESECTION,272,RC,27200002,CDM,,,,,,both,,,4679.6000,701.9400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4679.60,,,,,,,1207.8000,4679.6000,percent of total billed charges,"100% of $4,679.60 in Billed Charges for Rev 272 = $4,679.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTROBE NEEDLE HF RESECTION,272,RC,27200002,CDM,,,,,,both,,,4679.6000,701.9400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2339.80,,,,,,,1207.8000,4679.6000,percent of total billed charges,"Rev 272 $4,679.60 in Billed Charges at 50% = $2,339.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTROBE NEEDLE HF RESECTION,272,RC,27200002,CDM,,,,,,both,,,4679.6000,701.9400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1511.51,,,,,,,1207.8000,4679.6000,other,"32.3% of $4,679.60 in Billed Charges for Rev 272 = $1,511.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTROBE NEEDLE HF RESECTION,272,RC,27200002,CDM,,,,,,both,,,4679.6000,701.9400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1436.64,,,,,,,1207.8000,4679.6000,other,"30.7% of $4,679.60 in Billed Charges for Rev 272 = $1,436.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTROBE NEEDLE HF RESECTION,272,RC,27200002,CDM,,,,,,both,,,4679.6000,701.9400,UNITED HEALTHCARE,UNITED HEALTHCARE,1511.51,,,,,,,1207.8000,4679.6000,percent of total billed charges,"32.3% of $4,679.60 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTROBE NEEDLE HF RESECTION,272,RC,27200002,CDM,,,,,,both,,,4679.6000,701.9400,WELLCARE,WELLCARE MEDICAID,4679.60,,,,,,,1207.8000,4679.6000,percent of total billed charges,"100% of $4,679.60 in Billed Charges for Rev 272 = $4,679.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE BIPOLAR COAGULATION 24FR BALL YELLOW,272,RC,27200002,CDM,,,,,,both,,,5231.2700,784.6900,AETNA,AETNA,2233.75,,,,,,,1350.1900,5231.2700,percent of total billed charges,"42.7% of $5,231.27 in Billed Charges for Rev 272 = $2,233.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE BIPOLAR COAGULATION 24FR BALL YELLOW,272,RC,27200002,CDM,,,,,,both,,,5231.2700,784.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3661.89,,,,,,,1350.1900,5231.2700,percent of total billed charges,"Rev 272 $5,231.27 in Billed Charges at 70% = $3,661.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE BIPOLAR COAGULATION 24FR BALL YELLOW,272,RC,27200002,CDM,,,,,,both,,,5231.2700,784.6900,CIGNA HEALTHCARE,CIGNA HMO,2181.44,,,,,,,1350.1900,5231.2700,percent of total billed charges,"41.7% of $5,231.27 in Billed Charges for Rev 272 = $2,181.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE BIPOLAR COAGULATION 24FR BALL YELLOW,272,RC,27200002,CDM,,,,,,both,,,5231.2700,784.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2427.31,,,,,,,1350.1900,5231.2700,percent of total billed charges,"46.4% of $5,231.27 in Billed Charges for Rev 272 = $2,427.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE BIPOLAR COAGULATION 24FR BALL YELLOW,272,RC,27200002,CDM,,,,,,both,,,5231.2700,784.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2181.44,,,,,,,1350.1900,5231.2700,percent of total billed charges,"41.7% of $5,231.27 in Billed Charges for Rev 272 = $2,181.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE BIPOLAR COAGULATION 24FR BALL YELLOW,272,RC,27200002,CDM,,,,,,both,,,5231.2700,784.6900,CIGNA HEALTHCARE,CIGNA PPO,2181.44,,,,,,,1350.1900,5231.2700,percent of total billed charges,"41.7% of $5,231.27 in Billed Charges for Rev 272 = $2,181.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE BIPOLAR COAGULATION 24FR BALL YELLOW,272,RC,27200002,CDM,,,,,,both,,,5231.2700,784.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4708.14,,,,,,,1350.1900,5231.2700,percent of total billed charges,"90% of $5,231.27 in Billed Charges for Rev 272 = $4,708.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE BIPOLAR COAGULATION 24FR BALL YELLOW,272,RC,27200002,CDM,,,,,,both,,,5231.2700,784.6900,MEDCOST,MEDCOST VHN,2489.56,,,,,,,1350.1900,5231.2700,percent of total billed charges,"47.59% of $5,231.27 in Billed Charges for Rev 272 = $2,489.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE BIPOLAR COAGULATION 24FR BALL YELLOW,272,RC,27200002,CDM,,,,,,both,,,5231.2700,784.6900,SENTARA HEALTH,SENTARA HEALTH,1350.19,,,,,,,1350.1900,5231.2700,percent of total billed charges,"25.81% of $5,231.27 in Billed Charges for Rev 272 = $1,350.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE BIPOLAR COAGULATION 24FR BALL YELLOW,272,RC,27200002,CDM,,,,,,both,,,5231.2700,784.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5231.27,,,,,,,1350.1900,5231.2700,percent of total billed charges,"100% of $5,231.27 in Billed Charges for Rev 272 = $5,231.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE BIPOLAR COAGULATION 24FR BALL YELLOW,272,RC,27200002,CDM,,,,,,both,,,5231.2700,784.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2615.64,,,,,,,1350.1900,5231.2700,percent of total billed charges,"Rev 272 $5,231.27 in Billed Charges at 50% = $2,615.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE BIPOLAR COAGULATION 24FR BALL YELLOW,272,RC,27200002,CDM,,,,,,both,,,5231.2700,784.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1689.70,,,,,,,1350.1900,5231.2700,other,"32.3% of $5,231.27 in Billed Charges for Rev 272 = $1,689.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE BIPOLAR COAGULATION 24FR BALL YELLOW,272,RC,27200002,CDM,,,,,,both,,,5231.2700,784.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1606.00,,,,,,,1350.1900,5231.2700,other,"30.7% of $5,231.27 in Billed Charges for Rev 272 = $1,606.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE BIPOLAR COAGULATION 24FR BALL YELLOW,272,RC,27200002,CDM,,,,,,both,,,5231.2700,784.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,1689.70,,,,,,,1350.1900,5231.2700,percent of total billed charges,"32.3% of $5,231.27 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE BIPOLAR COAGULATION 24FR BALL YELLOW,272,RC,27200002,CDM,,,,,,both,,,5231.2700,784.6900,WELLCARE,WELLCARE MEDICAID,5231.27,,,,,,,1350.1900,5231.2700,percent of total billed charges,"100% of $5,231.27 in Billed Charges for Rev 272 = $5,231.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE BUGBEE 3.0,272,RC,27200002,CDM,,,,,,both,,,874.6200,131.1900,AETNA,AETNA,373.46,,,,,,,225.7400,874.6200,percent of total billed charges,42.7% of $874.62 in Billed Charges for Rev 272 = $373.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE BUGBEE 3.0,272,RC,27200002,CDM,,,,,,both,,,874.6200,131.1900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,612.23,,,,,,,225.7400,874.6200,percent of total billed charges,Rev 272 $874.62 in Billed Charges at 70% = $612.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE BUGBEE 3.0,272,RC,27200002,CDM,,,,,,both,,,874.6200,131.1900,CIGNA HEALTHCARE,CIGNA HMO,364.72,,,,,,,225.7400,874.6200,percent of total billed charges,41.7% of $874.62 in Billed Charges for Rev 272 = $364.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE BUGBEE 3.0,272,RC,27200002,CDM,,,,,,both,,,874.6200,131.1900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,405.82,,,,,,,225.7400,874.6200,percent of total billed charges,46.4% of $874.62 in Billed Charges for Rev 272 = $405.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE BUGBEE 3.0,272,RC,27200002,CDM,,,,,,both,,,874.6200,131.1900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,364.72,,,,,,,225.7400,874.6200,percent of total billed charges,41.7% of $874.62 in Billed Charges for Rev 272 = $364.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE BUGBEE 3.0,272,RC,27200002,CDM,,,,,,both,,,874.6200,131.1900,CIGNA HEALTHCARE,CIGNA PPO,364.72,,,,,,,225.7400,874.6200,percent of total billed charges,41.7% of $874.62 in Billed Charges for Rev 272 = $364.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE BUGBEE 3.0,272,RC,27200002,CDM,,,,,,both,,,874.6200,131.1900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,787.16,,,,,,,225.7400,874.6200,percent of total billed charges,90% of $874.62 in Billed Charges for Rev 272 = $787.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE BUGBEE 3.0,272,RC,27200002,CDM,,,,,,both,,,874.6200,131.1900,MEDCOST,MEDCOST VHN,416.23,,,,,,,225.7400,874.6200,percent of total billed charges,47.59% of $874.62 in Billed Charges for Rev 272 = $416.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE BUGBEE 3.0,272,RC,27200002,CDM,,,,,,both,,,874.6200,131.1900,SENTARA HEALTH,SENTARA HEALTH,225.74,,,,,,,225.7400,874.6200,percent of total billed charges,25.81% of $874.62 in Billed Charges for Rev 272 = $225.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE BUGBEE 3.0,272,RC,27200002,CDM,,,,,,both,,,874.6200,131.1900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",874.62,,,,,,,225.7400,874.6200,percent of total billed charges,100% of $874.62 in Billed Charges for Rev 272 = $874.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE BUGBEE 3.0,272,RC,27200002,CDM,,,,,,both,,,874.6200,131.1900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,437.31,,,,,,,225.7400,874.6200,percent of total billed charges,Rev 272 $874.62 in Billed Charges at 50% = $437.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE BUGBEE 3.0,272,RC,27200002,CDM,,,,,,both,,,874.6200,131.1900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,282.50,,,,,,,225.7400,874.6200,other,32.3% of $874.62 in Billed Charges for Rev 272 = $282.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ELECTRODE BUGBEE 3.0,272,RC,27200002,CDM,,,,,,both,,,874.6200,131.1900,UNITED HEALTHCARE,UHC HERITAGE SELECT,268.51,,,,,,,225.7400,874.6200,other,30.7% of $874.62 in Billed Charges for Rev 272 = $268.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ELECTRODE BUGBEE 3.0,272,RC,27200002,CDM,,,,,,both,,,874.6200,131.1900,UNITED HEALTHCARE,UNITED HEALTHCARE,282.50,,,,,,,225.7400,874.6200,percent of total billed charges,32.3% of $874.62 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE BUGBEE 3.0,272,RC,27200002,CDM,,,,,,both,,,874.6200,131.1900,WELLCARE,WELLCARE MEDICAID,874.62,,,,,,,225.7400,874.6200,percent of total billed charges,100% of $874.62 in Billed Charges for Rev 272 = $874.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,AETNA,AETNA,39782.74,,,,,,,11895.0000,93168.0000,percent of total billed charges,"42.7% of $93,168.00 in Billed Charges for Rev 481 Proc 33287 = $39,782.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,27743.30,,,,,,,11895.0000,93168.0000,fee schedule,"APG 00224 Proc 33287 at $836.60 (Base Rate) * 31.8865 (Relative Weight) = $26,676.25 (Total Line Payment) at 104% = $27,743.30. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,27996.40,,,,,,,11895.0000,93168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,AETNA,AETNA HEALTHCARE MEDICARE,27996.40,,,,,,,11895.0000,93168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,27996.40,,,,,,,11895.0000,93168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,AMBETTER,AMBETTER,61032.16,,,,,,,11895.0000,93168.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,29116.26,,,,,,,11895.0000,93168.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,BLUE CROSS,ANTHEM EXCHANGE,68928.67,,,,,,,11895.0000,93168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,27476.53,,,,,,,11895.0000,93168.0000,fee schedule,"APG 00224 Proc 33287 at $836.60 (Base Rate) * 31.8865 (Relative Weight) = $26,676.25 (Total Line Payment) at 103% = $27,476.53. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,BLUE CROSS,ANTHEM HMO,73232.61,,,,,,,11895.0000,93168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,28836.29,,,,,,,11895.0000,93168.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",86151.35,,,,,,,11895.0000,93168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,65217.60,,,,,,,11895.0000,93168.0000,percent of total billed charges,"Rev 481 Proc 33287 $93,168.00 in Billed Charges at 70% = $65,217.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,BLUE CROSS,BLUE CROSS E NETWORK,12398.00,,,,,,,11895.0000,93168.0000,case rate,"Rev 481 Proc 33287 ASG Rate of $12,398.00 at 100% of $12,398.00 = $12,398.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,BLUE CROSS,BLUE CROSS MEDICARE,29116.26,,,,,,,11895.0000,93168.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,BLUE CROSS,BLUE CROSS P NETWORK,12677.00,,,,,,,11895.0000,93168.0000,case rate,"Rev 481 Proc 33287 ASG Rate of $12,677.00 at 100% of $12,677.00 = $12,677.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,BLUE CROSS,BLUE CROSS S NETWORK,12677.00,,,,,,,11895.0000,93168.0000,case rate,"Rev 481 Proc 33287 ASG Rate of $12,677.00 at 100% of $12,677.00 = $12,677.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,CIGNA HEALTHCARE,CIGNA HMO,38851.06,,,,,,,11895.0000,93168.0000,percent of total billed charges,"41.7% of $93,168.00 in Billed Charges for Rev 481 Proc 33287 = $38,851.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,43229.95,,,,,,,11895.0000,93168.0000,percent of total billed charges,"46.4% of $93,168.00 in Billed Charges for Rev 481 Proc 33287 = $43,229.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,29396.22,,,,,,,11895.0000,93168.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,38851.06,,,,,,,11895.0000,93168.0000,percent of total billed charges,"41.7% of $93,168.00 in Billed Charges for Rev 481 Proc 33287 = $38,851.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,CIGNA HEALTHCARE,CIGNA PPO,38851.06,,,,,,,11895.0000,93168.0000,percent of total billed charges,"41.7% of $93,168.00 in Billed Charges for Rev 481 Proc 33287 = $38,851.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,29396.22,,,,,,,11895.0000,93168.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,83851.20,,,,,,,11895.0000,93168.0000,percent of total billed charges,"90% of $93,168.00 in Billed Charges for Rev 481 Proc 33287 = $83,851.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,HUMANA,HUMANA MEDICARE,27996.40,,,,,,,11895.0000,93168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,27996.40,,,,,,,11895.0000,93168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,MEDCOST,MEDCOST VHN,44338.65,,,,,,,11895.0000,93168.0000,percent of total billed charges,"47.59% of $93,168.00 in Billed Charges for Rev 481 Proc 33287 = $44,338.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,28010.06,,,,,,,11895.0000,93168.0000,fee schedule,"APG 00224 Proc 33287 at $836.60 (Base Rate) * 31.8865 (Relative Weight) = $26,676.25 (Total Line Payment) at 100% = $26,676.25... $26,676.25 at 105% = $28,010.06 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,29396.22,,,,,,,11895.0000,93168.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,29396.22,,,,,,,11895.0000,93168.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,NHC ADVANTAGE,NHC ADVANTAGE,29396.22,,,,,,,11895.0000,93168.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,27503.21,,,,,,,11895.0000,93168.0000,fee schedule,"APG 00224 Proc 33287 at $836.60 (Base Rate) * 31.8865 (Relative Weight) = $26,676.25 (Total Line Payment) at 100% = $26,676.25... $26,676.25 at 103.1% = $27,503.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,SENTARA HEALTH,SENTARA HEALTH,24046.66,,,,,,,11895.0000,93168.0000,percent of total billed charges,"25.81% of $93,168.00 in Billed Charges for Rev 481 Proc 33287 = $24,046.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,SENTARA HEALTH,SENTARA MEDICARE,27996.40,,,,,,,11895.0000,93168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",93168.00,,,,,,,11895.0000,93168.0000,percent of total billed charges,"100% of $93,168.00 in Billed Charges for Rev 481 Proc 33287 = $93,168.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11895.00,,,,,,,11895.0000,93168.0000,case rate,"Rev 481 Proc 33287 ASG Rate of $11,895.00 at 100% of $11,895.00 = $11,895.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13136.00,,,,,,,11895.0000,93168.0000,case rate,"Rev 481 Proc 33287 ASG Rate of $13,136.00 at 100% of $13,136.00 = $13,136.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,12568.00,,,,,,,11895.0000,93168.0000,case rate,"Rev 481 Proc 33287 ASG Rate of $12,568.00 at 100% of $12,568.00 = $12,568.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,21337.00,,,,,,,11895.0000,93168.0000,case rate,"Rev 481 Proc 33287 ASG Rate of $21,337.00 at 100% of $21,337.00 = $21,337.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,27476.53,,,,,,,11895.0000,93168.0000,fee schedule,"APG 00224 Proc 33287 at $836.60 (Base Rate) * 31.8865 (Relative Weight) = $26,676.25 (Total Line Payment) at 103% = $27,476.53. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,27996.40,,,,,,,11895.0000,93168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,27996.40,,,,,,,11895.0000,93168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,WELLCARE,WELLCARE MEDICAID,93168.00,,,,,,,11895.0000,93168.0000,percent of total billed charges,"100% of $93,168.00 in Billed Charges for Rev 481 Proc 33287 = $93,168.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR,33287,CPT,481,RC,48100228,CDM,,,,both,,,93168.0000,13975.2000,WELLCARE,WELLCARE MEDICARE,29676.19,,,,,,,11895.0000,93168.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,AETNA,AETNA,15181.13,,,,,,,6290.0000,35553.0000,percent of total billed charges,"42.7% of $35,553.00 in Billed Charges for Rev 481 Proc 33288 = $15,181.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,8926.60,,,,,,,6290.0000,35553.0000,fee schedule,"APG 00223 Proc 33288 at $836.60 (Base Rate) * 10.2597 (Relative Weight) = $8,583.27 (Total Line Payment) at 104% = $8,926.60. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,10109.48,,,,,,,6290.0000,35553.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,AETNA,AETNA HEALTHCARE MEDICARE,10109.48,,,,,,,6290.0000,35553.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,10109.48,,,,,,,6290.0000,35553.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,AMBETTER,AMBETTER,22038.67,,,,,,,6290.0000,35553.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,10513.86,,,,,,,6290.0000,35553.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,BLUE CROSS,ANTHEM EXCHANGE,24890.09,,,,,,,6290.0000,35553.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,8840.76,,,,,,,6290.0000,35553.0000,fee schedule,"APG 00223 Proc 33288 at $836.60 (Base Rate) * 10.2597 (Relative Weight) = $8,583.27 (Total Line Payment) at 103% = $8,840.76. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,BLUE CROSS,ANTHEM HMO,26444.24,,,,,,,6290.0000,35553.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,10412.77,,,,,,,6290.0000,35553.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",31109.19,,,,,,,6290.0000,35553.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,24887.10,,,,,,,6290.0000,35553.0000,percent of total billed charges,"Rev 481 Proc 33288 $35,553.00 in Billed Charges at 70% = $24,887.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,BLUE CROSS,BLUE CROSS E NETWORK,8571.00,,,,,,,6290.0000,35553.0000,case rate,"Rev 481 Proc 33288 ASG Rate of $8,571.00 at 100% of $8,571.00 = $8,571.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,BLUE CROSS,BLUE CROSS MEDICARE,10513.86,,,,,,,6290.0000,35553.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,BLUE CROSS,BLUE CROSS P NETWORK,8764.00,,,,,,,6290.0000,35553.0000,case rate,"Rev 481 Proc 33288 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,BLUE CROSS,BLUE CROSS S NETWORK,8764.00,,,,,,,6290.0000,35553.0000,case rate,"Rev 481 Proc 33288 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,CIGNA HEALTHCARE,CIGNA HMO,14825.60,,,,,,,6290.0000,35553.0000,percent of total billed charges,"41.7% of $35,553.00 in Billed Charges for Rev 481 Proc 33288 = $14,825.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,16496.59,,,,,,,6290.0000,35553.0000,percent of total billed charges,"46.4% of $35,553.00 in Billed Charges for Rev 481 Proc 33288 = $16,496.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,10614.96,,,,,,,6290.0000,35553.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,14825.60,,,,,,,6290.0000,35553.0000,percent of total billed charges,"41.7% of $35,553.00 in Billed Charges for Rev 481 Proc 33288 = $14,825.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,CIGNA HEALTHCARE,CIGNA PPO,14825.60,,,,,,,6290.0000,35553.0000,percent of total billed charges,"41.7% of $35,553.00 in Billed Charges for Rev 481 Proc 33288 = $14,825.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,10614.96,,,,,,,6290.0000,35553.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,31997.70,,,,,,,6290.0000,35553.0000,percent of total billed charges,"90% of $35,553.00 in Billed Charges for Rev 481 Proc 33288 = $31,997.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,HUMANA,HUMANA MEDICARE,10109.48,,,,,,,6290.0000,35553.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,10109.48,,,,,,,6290.0000,35553.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,MEDCOST,MEDCOST VHN,16919.67,,,,,,,6290.0000,35553.0000,percent of total billed charges,"47.59% of $35,553.00 in Billed Charges for Rev 481 Proc 33288 = $16,919.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,9012.43,,,,,,,6290.0000,35553.0000,fee schedule,"APG 00223 Proc 33288 at $836.60 (Base Rate) * 10.2597 (Relative Weight) = $8,583.27 (Total Line Payment) at 100% = $8,583.27... $8,583.27 at 105% = $9,012.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,10614.96,,,,,,,6290.0000,35553.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,10614.96,,,,,,,6290.0000,35553.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,NHC ADVANTAGE,NHC ADVANTAGE,10614.96,,,,,,,6290.0000,35553.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,8849.35,,,,,,,6290.0000,35553.0000,fee schedule,"APG 00223 Proc 33288 at $836.60 (Base Rate) * 10.2597 (Relative Weight) = $8,583.27 (Total Line Payment) at 100% = $8,583.27... $8,583.27 at 103.1% = $8,849.35 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,SENTARA HEALTH,SENTARA HEALTH,9176.23,,,,,,,6290.0000,35553.0000,percent of total billed charges,"25.81% of $35,553.00 in Billed Charges for Rev 481 Proc 33288 = $9,176.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,SENTARA HEALTH,SENTARA MEDICARE,10109.48,,,,,,,6290.0000,35553.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",35553.00,,,,,,,6290.0000,35553.0000,percent of total billed charges,"100% of $35,553.00 in Billed Charges for Rev 481 Proc 33288 = $35,553.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,6290.0000,35553.0000,case rate,"Rev 481 Proc 33288 ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,6290.0000,35553.0000,case rate,"Rev 481 Proc 33288 ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,6290.0000,35553.0000,case rate,"Rev 481 Proc 33288 ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,20054.00,,,,,,,6290.0000,35553.0000,case rate,"Rev 481 Proc 33288 ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,8840.76,,,,,,,6290.0000,35553.0000,fee schedule,"APG 00223 Proc 33288 at $836.60 (Base Rate) * 10.2597 (Relative Weight) = $8,583.27 (Total Line Payment) at 103% = $8,840.76. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,10109.48,,,,,,,6290.0000,35553.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,10109.48,,,,,,,6290.0000,35553.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,WELLCARE,WELLCARE MEDICAID,35553.00,,,,,,,6290.0000,35553.0000,percent of total billed charges,"100% of $35,553.00 in Billed Charges for Rev 481 Proc 33288 = $35,553.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD,33288,CPT,481,RC,48100229,CDM,,,,both,,,35553.0000,5332.9500,WELLCARE,WELLCARE MEDICARE,10716.05,,,,,,,6290.0000,35553.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,AETNA,AETNA,6441.30,,,,,,,968.0000,21084.6100,percent of total billed charges,"42.7% of $15,085.00 in Billed Charges for Rev 360 Proc 33340 = $6,441.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,20883.80,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33340 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 104% = $20,883.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15085.00,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33340 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99 (Service Line reduced to $15,085.00, claim capped at $15,085.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33340 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS E NETWORK,15085.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33340 ASG Rate of $26,847.00 at 100% of $26,847.00 = $26,847.00 Total (Service Line reduced to $15,085.00, claim capped at $15,085.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS P NETWORK,15085.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33340 ASG Rate of $27,452.00 at 100% of $27,452.00 = $27,452.00 Total (Service Line reduced to $15,085.00, claim capped at $15,085.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS S NETWORK,15085.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33340 ASG Rate of $27,452.00 at 100% of $27,452.00 = $27,452.00 Total (Service Line reduced to $15,085.00, claim capped at $15,085.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,TENNCARE BLUE CARE,1093.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33340 ASG Rate of $1,093.00 at 100% of $1,093.00 = $1,093.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,TENNCARE BLUE SELECT,1093.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33340 ASG Rate of $1,093.00 at 100% of $1,093.00 = $1,093.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33340 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33340 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33340 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33340 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13576.50,,,,,,,968.0000,21084.6100,percent of total billed charges,"90% of $15,085.00 in Billed Charges for Rev 360 Proc 33340 = $13,576.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,MEDCOST,MEDCOST VHN,7178.95,,,,,,,968.0000,21084.6100,percent of total billed charges,"47.59% of $15,085.00 in Billed Charges for Rev 360 Proc 33340 = $7,178.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,21084.61,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33340 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 105% = $21,084.61 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,20703.08,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33340 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 103.1% = $20,703.08 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,SENTARA HEALTH,SENTARA HEALTH,3893.44,,,,,,,968.0000,21084.6100,percent of total billed charges,"25.81% of $15,085.00 in Billed Charges for Rev 360 Proc 33340 = $3,893.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15085.00,,,,,,,968.0000,21084.6100,percent of total billed charges,"100% of $15,085.00 in Billed Charges for Rev 360 Proc 33340 = $15,085.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,968.0000,21084.6100,case rate,Rev 360 Proc 33340 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33340 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33340 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33340 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,20682.99,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33340 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ CLSR TRANSCATH LT ATR APNDGE W ENDOCARDIAL IMPLNT,33340,CPT,360,RC,36000118,CDM,,,,both,,,15085.0000,2262.7500,WELLCARE,WELLCARE MEDICAID,15085.00,,,,,,,968.0000,21084.6100,percent of total billed charges,"100% of $15,085.00 in Billed Charges for Rev 360 Proc 33340 = $15,085.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,AETNA,AETNA,6441.30,,,,,,,968.0000,21084.6100,percent of total billed charges,"42.7% of $15,085.00 in Billed Charges for Rev 360 Proc 33361 = $6,441.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,20883.80,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33361 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 104% = $20,883.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,ANTHEM EXCHANGE,15085.00,,,,,,,968.0000,21084.6100,fee schedule,"$11,736.51 from Fee Schedule ANT_C_APC for Rev 360 Proc 33361 * Qty 1 = $11,736.51 at 199.87% = $23,457.76 (Service Line reduced to $15,085.00, claim capped at $15,085.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15085.00,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33361 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99 (Service Line reduced to $15,085.00, claim capped at $15,085.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,ANTHEM HMO,15085.00,,,,,,,968.0000,21084.6100,fee schedule,"$11,736.51 from Fee Schedule ANT_C_APC for Rev 360 Proc 33361 * Qty 1 = $11,736.51 at 212.35% = $24,922.48 (Service Line reduced to $15,085.00, claim capped at $15,085.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",15085.00,,,,,,,968.0000,21084.6100,fee schedule,"$11,736.51 from Fee Schedule ANT_C_APC for Rev 360 Proc 33361 * Qty 1 = $11,736.51 at 249.81% = $29,318.98 (Service Line reduced to $15,085.00, claim capped at $15,085.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33361 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS E NETWORK,9347.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33361 ASG Rate of $9,347.00 at 100% of $9,347.00 = $9,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS P NETWORK,9558.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33361 ASG Rate of $9,558.00 at 100% of $9,558.00 = $9,558.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS S NETWORK,9558.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33361 ASG Rate of $9,558.00 at 100% of $9,558.00 = $9,558.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33361 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33361 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33361 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33361 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13576.50,,,,,,,968.0000,21084.6100,percent of total billed charges,"90% of $15,085.00 in Billed Charges for Rev 360 Proc 33361 = $13,576.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,MEDCOST,MEDCOST VHN,7178.95,,,,,,,968.0000,21084.6100,percent of total billed charges,"47.59% of $15,085.00 in Billed Charges for Rev 360 Proc 33361 = $7,178.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,21084.61,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33361 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 105% = $21,084.61 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,20703.08,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33361 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 103.1% = $20,703.08 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,SENTARA HEALTH,SENTARA HEALTH,3893.44,,,,,,,968.0000,21084.6100,percent of total billed charges,"25.81% of $15,085.00 in Billed Charges for Rev 360 Proc 33361 = $3,893.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15085.00,,,,,,,968.0000,21084.6100,percent of total billed charges,"100% of $15,085.00 in Billed Charges for Rev 360 Proc 33361 = $15,085.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,968.0000,21084.6100,case rate,Rev 360 Proc 33361 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33361 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33361 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33361 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,20682.99,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33361 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR PERQ FEMORAL APPROACH,33361,CPT,360,RC,48100034,CDM,,,,both,,,15085.0000,2262.7500,WELLCARE,WELLCARE MEDICAID,15085.00,,,,,,,968.0000,21084.6100,percent of total billed charges,"100% of $15,085.00 in Billed Charges for Rev 360 Proc 33361 = $15,085.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,AETNA,AETNA,6441.30,,,,,,,968.0000,21084.6100,percent of total billed charges,"42.7% of $15,085.00 in Billed Charges for Rev 481 Proc 33418 = $6,441.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,20883.80,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33418 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 104% = $20,883.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,ANTHEM EXCHANGE,1385.82,,,,,,,968.0000,21084.6100,fee schedule,"$693.36 from Fee Schedule ANT_C_APC for Rev 481 Proc 33418 * Qty 1 = $693.36 at 199.87% = $1,385.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15085.00,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33418 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99 (Service Line reduced to $15,085.00, claim capped at $15,085.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,ANTHEM HMO,1472.35,,,,,,,968.0000,21084.6100,fee schedule,"$693.36 from Fee Schedule ANT_C_APC for Rev 481 Proc 33418 * Qty 1 = $693.36 at 212.35% = $1,472.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1732.08,,,,,,,968.0000,21084.6100,fee schedule,"$693.36 from Fee Schedule ANT_C_APC for Rev 481 Proc 33418 * Qty 1 = $693.36 at 249.81% = $1,732.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,10559.50,,,,,,,968.0000,21084.6100,percent of total billed charges,"Rev 481 Proc 33418 $15,085.00 in Billed Charges at 70% = $10,559.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,968.0000,21084.6100,case rate,"Rev 481 Proc 33418 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,968.0000,21084.6100,case rate,"Rev 481 Proc 33418 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,968.0000,21084.6100,case rate,"Rev 481 Proc 33418 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,CIGNA HEALTHCARE,CIGNA HMO,6290.45,,,,,,,968.0000,21084.6100,percent of total billed charges,"41.7% of $15,085.00 in Billed Charges for Rev 481 Proc 33418 = $6,290.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6999.44,,,,,,,968.0000,21084.6100,percent of total billed charges,"46.4% of $15,085.00 in Billed Charges for Rev 481 Proc 33418 = $6,999.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6290.45,,,,,,,968.0000,21084.6100,percent of total billed charges,"41.7% of $15,085.00 in Billed Charges for Rev 481 Proc 33418 = $6,290.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,CIGNA HEALTHCARE,CIGNA PPO,6290.45,,,,,,,968.0000,21084.6100,percent of total billed charges,"41.7% of $15,085.00 in Billed Charges for Rev 481 Proc 33418 = $6,290.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13576.50,,,,,,,968.0000,21084.6100,percent of total billed charges,"90% of $15,085.00 in Billed Charges for Rev 481 Proc 33418 = $13,576.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,MEDCOST,MEDCOST VHN,7178.95,,,,,,,968.0000,21084.6100,percent of total billed charges,"47.59% of $15,085.00 in Billed Charges for Rev 481 Proc 33418 = $7,178.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,21084.61,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33418 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 105% = $21,084.61 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,20703.08,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33418 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 103.1% = $20,703.08 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,SENTARA HEALTH,SENTARA HEALTH,3893.44,,,,,,,968.0000,21084.6100,percent of total billed charges,"25.81% of $15,085.00 in Billed Charges for Rev 481 Proc 33418 = $3,893.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15085.00,,,,,,,968.0000,21084.6100,percent of total billed charges,"100% of $15,085.00 in Billed Charges for Rev 481 Proc 33418 = $15,085.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,968.0000,21084.6100,case rate,Rev 481 Proc 33418 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,968.0000,21084.6100,case rate,"Rev 481 Proc 33418 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,968.0000,21084.6100,case rate,"Rev 481 Proc 33418 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,968.0000,21084.6100,case rate,"Rev 481 Proc 33418 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,20682.99,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33418 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVR PERQ APPROACH INITIAL PROSTHESIS,33418,CPT,481,RC,48100153,CDM,,,,both,,,15085.0000,2262.7500,WELLCARE,WELLCARE MEDICAID,15085.00,,,,,,,968.0000,21084.6100,percent of total billed charges,"100% of $15,085.00 in Billed Charges for Rev 481 Proc 33418 = $15,085.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOVASC REPR TAA W/O SUBCL INIT ENDOPROSTHESIS,33881,CPT,360,RC,36000112,CDM,,,,both,,,8732.0000,1309.8000,AETNA,AETNA,3728.56,,,,,,,968.0000,22390.4700,percent of total billed charges,"42.7% of $8,732.00 in Billed Charges for Rev 360 Proc 33881 = $3,728.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOVASC REPR TAA W/O SUBCL INIT ENDOPROSTHESIS,33881,CPT,360,RC,36000112,CDM,,,,both,,,8732.0000,1309.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,22177.24,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 33881 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 104% = $22,177.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVASC REPR TAA W/O SUBCL INIT ENDOPROSTHESIS,33881,CPT,360,RC,36000112,CDM,,,,both,,,8732.0000,1309.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,8732.00,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 33881 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99 (Service Line reduced to $8,732.00, claim capped at $8,732.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVASC REPR TAA W/O SUBCL INIT ENDOPROSTHESIS,33881,CPT,360,RC,36000112,CDM,,,,both,,,8732.0000,1309.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1336.00,,,,,,,968.0000,22390.4700,case rate,"Rev 360 Proc 33881 ASG Rate of $1,336.00 at 100% of $1,336.00 = $1,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVASC REPR TAA W/O SUBCL INIT ENDOPROSTHESIS,33881,CPT,360,RC,36000112,CDM,,,,both,,,8732.0000,1309.8000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,968.0000,22390.4700,case rate,"Rev 360 Proc 33881 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVASC REPR TAA W/O SUBCL INIT ENDOPROSTHESIS,33881,CPT,360,RC,36000112,CDM,,,,both,,,8732.0000,1309.8000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,968.0000,22390.4700,case rate,"Rev 360 Proc 33881 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVASC REPR TAA W/O SUBCL INIT ENDOPROSTHESIS,33881,CPT,360,RC,36000112,CDM,,,,both,,,8732.0000,1309.8000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,968.0000,22390.4700,case rate,"Rev 360 Proc 33881 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVASC REPR TAA W/O SUBCL INIT ENDOPROSTHESIS,33881,CPT,360,RC,36000112,CDM,,,,both,,,8732.0000,1309.8000,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,968.0000,22390.4700,case rate,"Rev 360 Proc 33881 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVASC REPR TAA W/O SUBCL INIT ENDOPROSTHESIS,33881,CPT,360,RC,36000112,CDM,,,,both,,,8732.0000,1309.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,968.0000,22390.4700,case rate,"Rev 360 Proc 33881 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVASC REPR TAA W/O SUBCL INIT ENDOPROSTHESIS,33881,CPT,360,RC,36000112,CDM,,,,both,,,8732.0000,1309.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,968.0000,22390.4700,case rate,"Rev 360 Proc 33881 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVASC REPR TAA W/O SUBCL INIT ENDOPROSTHESIS,33881,CPT,360,RC,36000112,CDM,,,,both,,,8732.0000,1309.8000,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,968.0000,22390.4700,case rate,"Rev 360 Proc 33881 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVASC REPR TAA W/O SUBCL INIT ENDOPROSTHESIS,33881,CPT,360,RC,36000112,CDM,,,,both,,,8732.0000,1309.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7858.80,,,,,,,968.0000,22390.4700,percent of total billed charges,"90% of $8,732.00 in Billed Charges for Rev 360 Proc 33881 = $7,858.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOVASC REPR TAA W/O SUBCL INIT ENDOPROSTHESIS,33881,CPT,360,RC,36000112,CDM,,,,both,,,8732.0000,1309.8000,MEDCOST,MEDCOST VHN,4155.56,,,,,,,968.0000,22390.4700,percent of total billed charges,"47.59% of $8,732.00 in Billed Charges for Rev 360 Proc 33881 = $4,155.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOVASC REPR TAA W/O SUBCL INIT ENDOPROSTHESIS,33881,CPT,360,RC,36000112,CDM,,,,both,,,8732.0000,1309.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,22390.47,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 33881 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 105% = $22,390.47 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVASC REPR TAA W/O SUBCL INIT ENDOPROSTHESIS,33881,CPT,360,RC,36000112,CDM,,,,both,,,8732.0000,1309.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,21985.31,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 33881 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 103.1% = $21,985.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVASC REPR TAA W/O SUBCL INIT ENDOPROSTHESIS,33881,CPT,360,RC,36000112,CDM,,,,both,,,8732.0000,1309.8000,SENTARA HEALTH,SENTARA HEALTH,2253.73,,,,,,,968.0000,22390.4700,percent of total billed charges,"25.81% of $8,732.00 in Billed Charges for Rev 360 Proc 33881 = $2,253.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOVASC REPR TAA W/O SUBCL INIT ENDOPROSTHESIS,33881,CPT,360,RC,36000112,CDM,,,,both,,,8732.0000,1309.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8732.00,,,,,,,968.0000,22390.4700,percent of total billed charges,"100% of $8,732.00 in Billed Charges for Rev 360 Proc 33881 = $8,732.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOVASC REPR TAA W/O SUBCL INIT ENDOPROSTHESIS,33881,CPT,360,RC,36000112,CDM,,,,both,,,8732.0000,1309.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,968.0000,22390.4700,case rate,Rev 360 Proc 33881 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOVASC REPR TAA W/O SUBCL INIT ENDOPROSTHESIS,33881,CPT,360,RC,36000112,CDM,,,,both,,,8732.0000,1309.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,968.0000,22390.4700,case rate,"Rev 360 Proc 33881 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVASC REPR TAA W/O SUBCL INIT ENDOPROSTHESIS,33881,CPT,360,RC,36000112,CDM,,,,both,,,8732.0000,1309.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,968.0000,22390.4700,case rate,"Rev 360 Proc 33881 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVASC REPR TAA W/O SUBCL INIT ENDOPROSTHESIS,33881,CPT,360,RC,36000112,CDM,,,,both,,,8732.0000,1309.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,968.0000,22390.4700,case rate,"Rev 360 Proc 33881 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVASC REPR TAA W/O SUBCL INIT ENDOPROSTHESIS,33881,CPT,360,RC,36000112,CDM,,,,both,,,8732.0000,1309.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,21963.99,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 33881 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVASC REPR TAA W/O SUBCL INIT ENDOPROSTHESIS,33881,CPT,360,RC,36000112,CDM,,,,both,,,8732.0000,1309.8000,WELLCARE,WELLCARE MEDICAID,8732.00,,,,,,,968.0000,22390.4700,percent of total billed charges,"100% of $8,732.00 in Billed Charges for Rev 360 Proc 33881 = $8,732.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLCMT PROX EXT PROSTH ENDOVASC REPR TAA INIT EXT,33883,CPT,360,RC,36000113,CDM,,,,both,,,5488.0000,823.2000,AETNA,AETNA,2343.38,,,,,,,968.0000,22390.4700,percent of total billed charges,"42.7% of $5,488.00 in Billed Charges for Rev 360 Proc 33883 = $2,343.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLCMT PROX EXT PROSTH ENDOVASC REPR TAA INIT EXT,33883,CPT,360,RC,36000113,CDM,,,,both,,,5488.0000,823.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,22177.24,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 33883 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 104% = $22,177.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLCMT PROX EXT PROSTH ENDOVASC REPR TAA INIT EXT,33883,CPT,360,RC,36000113,CDM,,,,both,,,5488.0000,823.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,5488.00,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 33883 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99 (Service Line reduced to $5,488.00, claim capped at $5,488.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLCMT PROX EXT PROSTH ENDOVASC REPR TAA INIT EXT,33883,CPT,360,RC,36000113,CDM,,,,both,,,5488.0000,823.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1336.00,,,,,,,968.0000,22390.4700,case rate,"Rev 360 Proc 33883 ASG Rate of $1,336.00 at 100% of $1,336.00 = $1,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLCMT PROX EXT PROSTH ENDOVASC REPR TAA INIT EXT,33883,CPT,360,RC,36000113,CDM,,,,both,,,5488.0000,823.2000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,968.0000,22390.4700,case rate,"Rev 360 Proc 33883 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLCMT PROX EXT PROSTH ENDOVASC REPR TAA INIT EXT,33883,CPT,360,RC,36000113,CDM,,,,both,,,5488.0000,823.2000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,968.0000,22390.4700,case rate,"Rev 360 Proc 33883 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLCMT PROX EXT PROSTH ENDOVASC REPR TAA INIT EXT,33883,CPT,360,RC,36000113,CDM,,,,both,,,5488.0000,823.2000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,968.0000,22390.4700,case rate,"Rev 360 Proc 33883 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLCMT PROX EXT PROSTH ENDOVASC REPR TAA INIT EXT,33883,CPT,360,RC,36000113,CDM,,,,both,,,5488.0000,823.2000,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,968.0000,22390.4700,case rate,"Rev 360 Proc 33883 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLCMT PROX EXT PROSTH ENDOVASC REPR TAA INIT EXT,33883,CPT,360,RC,36000113,CDM,,,,both,,,5488.0000,823.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,968.0000,22390.4700,case rate,"Rev 360 Proc 33883 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLCMT PROX EXT PROSTH ENDOVASC REPR TAA INIT EXT,33883,CPT,360,RC,36000113,CDM,,,,both,,,5488.0000,823.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,968.0000,22390.4700,case rate,"Rev 360 Proc 33883 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLCMT PROX EXT PROSTH ENDOVASC REPR TAA INIT EXT,33883,CPT,360,RC,36000113,CDM,,,,both,,,5488.0000,823.2000,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,968.0000,22390.4700,case rate,"Rev 360 Proc 33883 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLCMT PROX EXT PROSTH ENDOVASC REPR TAA INIT EXT,33883,CPT,360,RC,36000113,CDM,,,,both,,,5488.0000,823.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4939.20,,,,,,,968.0000,22390.4700,percent of total billed charges,"90% of $5,488.00 in Billed Charges for Rev 360 Proc 33883 = $4,939.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLCMT PROX EXT PROSTH ENDOVASC REPR TAA INIT EXT,33883,CPT,360,RC,36000113,CDM,,,,both,,,5488.0000,823.2000,MEDCOST,MEDCOST VHN,2611.74,,,,,,,968.0000,22390.4700,percent of total billed charges,"47.59% of $5,488.00 in Billed Charges for Rev 360 Proc 33883 = $2,611.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLCMT PROX EXT PROSTH ENDOVASC REPR TAA INIT EXT,33883,CPT,360,RC,36000113,CDM,,,,both,,,5488.0000,823.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,22390.47,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 33883 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 105% = $22,390.47 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLCMT PROX EXT PROSTH ENDOVASC REPR TAA INIT EXT,33883,CPT,360,RC,36000113,CDM,,,,both,,,5488.0000,823.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,21985.31,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 33883 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 103.1% = $21,985.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLCMT PROX EXT PROSTH ENDOVASC REPR TAA INIT EXT,33883,CPT,360,RC,36000113,CDM,,,,both,,,5488.0000,823.2000,SENTARA HEALTH,SENTARA HEALTH,1416.45,,,,,,,968.0000,22390.4700,percent of total billed charges,"25.81% of $5,488.00 in Billed Charges for Rev 360 Proc 33883 = $1,416.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLCMT PROX EXT PROSTH ENDOVASC REPR TAA INIT EXT,33883,CPT,360,RC,36000113,CDM,,,,both,,,5488.0000,823.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5488.00,,,,,,,968.0000,22390.4700,percent of total billed charges,"100% of $5,488.00 in Billed Charges for Rev 360 Proc 33883 = $5,488.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLCMT PROX EXT PROSTH ENDOVASC REPR TAA INIT EXT,33883,CPT,360,RC,36000113,CDM,,,,both,,,5488.0000,823.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,968.0000,22390.4700,case rate,Rev 360 Proc 33883 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLCMT PROX EXT PROSTH ENDOVASC REPR TAA INIT EXT,33883,CPT,360,RC,36000113,CDM,,,,both,,,5488.0000,823.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,968.0000,22390.4700,case rate,"Rev 360 Proc 33883 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLCMT PROX EXT PROSTH ENDOVASC REPR TAA INIT EXT,33883,CPT,360,RC,36000113,CDM,,,,both,,,5488.0000,823.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,968.0000,22390.4700,case rate,"Rev 360 Proc 33883 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLCMT PROX EXT PROSTH ENDOVASC REPR TAA INIT EXT,33883,CPT,360,RC,36000113,CDM,,,,both,,,5488.0000,823.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,968.0000,22390.4700,case rate,"Rev 360 Proc 33883 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLCMT PROX EXT PROSTH ENDOVASC REPR TAA INIT EXT,33883,CPT,360,RC,36000113,CDM,,,,both,,,5488.0000,823.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,21963.99,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 33883 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLCMT PROX EXT PROSTH ENDOVASC REPR TAA INIT EXT,33883,CPT,360,RC,36000113,CDM,,,,both,,,5488.0000,823.2000,WELLCARE,WELLCARE MEDICAID,5488.00,,,,,,,968.0000,22390.4700,percent of total billed charges,"100% of $5,488.00 in Billed Charges for Rev 360 Proc 33883 = $5,488.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INITIATION VENO-VENOUS,33946,CPT,360,RC,36000235,CDM,,,,both,,,1714.0000,257.1000,AETNA,AETNA,731.88,,,,,,,442.3800,11503.0400,percent of total billed charges,"42.7% of $1,714.00 in Billed Charges for Rev 360 Proc 33946 = $731.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INITIATION VENO-VENOUS,33946,CPT,360,RC,36000235,CDM,,,,both,,,1714.0000,257.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11393.49,,,,,,,442.3800,11503.0400,fee schedule,"APG 03070 Proc 33946 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 104% = $11,393.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-VENOUS,33946,CPT,360,RC,36000235,CDM,,,,both,,,1714.0000,257.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1714.00,,,,,,,442.3800,11503.0400,fee schedule,"APG 03070 Proc 33946 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94 (Service Line reduced to $1,714.00, claim capped at $1,714.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-VENOUS,33946,CPT,360,RC,36000235,CDM,,,,both,,,1714.0000,257.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,442.3800,11503.0400,case rate,"Rev 360 Proc 33946 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-VENOUS,33946,CPT,360,RC,36000235,CDM,,,,both,,,1714.0000,257.1000,BLUE CROSS,BLUE CROSS E NETWORK,1714.00,,,,,,,442.3800,11503.0400,case rate,"Rev 360 Proc 33946 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total (Service Line reduced to $1,714.00, claim capped at $1,714.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-VENOUS,33946,CPT,360,RC,36000235,CDM,,,,both,,,1714.0000,257.1000,BLUE CROSS,BLUE CROSS P NETWORK,1714.00,,,,,,,442.3800,11503.0400,case rate,"Rev 360 Proc 33946 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total (Service Line reduced to $1,714.00, claim capped at $1,714.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-VENOUS,33946,CPT,360,RC,36000235,CDM,,,,both,,,1714.0000,257.1000,BLUE CROSS,BLUE CROSS S NETWORK,1714.00,,,,,,,442.3800,11503.0400,case rate,"Rev 360 Proc 33946 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total (Service Line reduced to $1,714.00, claim capped at $1,714.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-VENOUS,33946,CPT,360,RC,36000235,CDM,,,,both,,,1714.0000,257.1000,CIGNA HEALTHCARE,CIGNA HMO,1714.00,,,,,,,442.3800,11503.0400,case rate,"Rev 360 Proc 33946 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,714.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,714.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-VENOUS,33946,CPT,360,RC,36000235,CDM,,,,both,,,1714.0000,257.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1714.00,,,,,,,442.3800,11503.0400,case rate,"Rev 360 Proc 33946 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $1,714.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,714.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-VENOUS,33946,CPT,360,RC,36000235,CDM,,,,both,,,1714.0000,257.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1714.00,,,,,,,442.3800,11503.0400,case rate,"Rev 360 Proc 33946 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,714.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,714.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-VENOUS,33946,CPT,360,RC,36000235,CDM,,,,both,,,1714.0000,257.1000,CIGNA HEALTHCARE,CIGNA PPO,1714.00,,,,,,,442.3800,11503.0400,case rate,"Rev 360 Proc 33946 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,714.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,714.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-VENOUS,33946,CPT,360,RC,36000235,CDM,,,,both,,,1714.0000,257.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1542.60,,,,,,,442.3800,11503.0400,percent of total billed charges,"90% of $1,714.00 in Billed Charges for Rev 360 Proc 33946 = $1,542.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INITIATION VENO-VENOUS,33946,CPT,360,RC,36000235,CDM,,,,both,,,1714.0000,257.1000,MEDCOST,MEDCOST VHN,815.69,,,,,,,442.3800,11503.0400,percent of total billed charges,"47.59% of $1,714.00 in Billed Charges for Rev 360 Proc 33946 = $815.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INITIATION VENO-VENOUS,33946,CPT,360,RC,36000235,CDM,,,,both,,,1714.0000,257.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11503.04,,,,,,,442.3800,11503.0400,fee schedule,"APG 03070 Proc 33946 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 105% = $11,503.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-VENOUS,33946,CPT,360,RC,36000235,CDM,,,,both,,,1714.0000,257.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11294.89,,,,,,,442.3800,11503.0400,fee schedule,"APG 03070 Proc 33946 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 103.1% = $11,294.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-VENOUS,33946,CPT,360,RC,36000235,CDM,,,,both,,,1714.0000,257.1000,SENTARA HEALTH,SENTARA HEALTH,442.38,,,,,,,442.3800,11503.0400,percent of total billed charges,"25.81% of $1,714.00 in Billed Charges for Rev 360 Proc 33946 = $442.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INITIATION VENO-VENOUS,33946,CPT,360,RC,36000235,CDM,,,,both,,,1714.0000,257.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1714.00,,,,,,,442.3800,11503.0400,percent of total billed charges,"100% of $1,714.00 in Billed Charges for Rev 360 Proc 33946 = $1,714.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INITIATION VENO-VENOUS,33946,CPT,360,RC,36000235,CDM,,,,both,,,1714.0000,257.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,442.3800,11503.0400,case rate,Rev 360 Proc 33946 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ECMO/ECLS INITIATION VENO-VENOUS,33946,CPT,360,RC,36000235,CDM,,,,both,,,1714.0000,257.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,442.3800,11503.0400,case rate,"Rev 360 Proc 33946 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-VENOUS,33946,CPT,360,RC,36000235,CDM,,,,both,,,1714.0000,257.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,442.3800,11503.0400,case rate,"Rev 360 Proc 33946 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-VENOUS,33946,CPT,360,RC,36000235,CDM,,,,both,,,1714.0000,257.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,1714.00,,,,,,,442.3800,11503.0400,case rate,"Rev 360 Proc 33946 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total (Service Line reduced to $1,714.00, claim capped at $1,714.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-VENOUS,33946,CPT,360,RC,36000235,CDM,,,,both,,,1714.0000,257.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11283.94,,,,,,,442.3800,11503.0400,fee schedule,"APG 03070 Proc 33946 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-VENOUS,33946,CPT,360,RC,36000235,CDM,,,,both,,,1714.0000,257.1000,WELLCARE,WELLCARE MEDICAID,1714.00,,,,,,,442.3800,11503.0400,percent of total billed charges,"100% of $1,714.00 in Billed Charges for Rev 360 Proc 33946 = $1,714.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INITIATION VENO-ARTERIAL,33947,CPT,360,RC,36000236,CDM,,,,both,,,5513.0000,826.9500,AETNA,AETNA,2354.05,,,,,,,968.0000,11503.0400,percent of total billed charges,"42.7% of $5,513.00 in Billed Charges for Rev 360 Proc 33947 = $2,354.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INITIATION VENO-ARTERIAL,33947,CPT,360,RC,36000236,CDM,,,,both,,,5513.0000,826.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11393.49,,,,,,,968.0000,11503.0400,fee schedule,"APG 03070 Proc 33947 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 104% = $11,393.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-ARTERIAL,33947,CPT,360,RC,36000236,CDM,,,,both,,,5513.0000,826.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,5513.00,,,,,,,968.0000,11503.0400,fee schedule,"APG 03070 Proc 33947 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94 (Service Line reduced to $5,513.00, claim capped at $5,513.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-ARTERIAL,33947,CPT,360,RC,36000236,CDM,,,,both,,,5513.0000,826.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,968.0000,11503.0400,case rate,"Rev 360 Proc 33947 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-ARTERIAL,33947,CPT,360,RC,36000236,CDM,,,,both,,,5513.0000,826.9500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,968.0000,11503.0400,case rate,"Rev 360 Proc 33947 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-ARTERIAL,33947,CPT,360,RC,36000236,CDM,,,,both,,,5513.0000,826.9500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,968.0000,11503.0400,case rate,"Rev 360 Proc 33947 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-ARTERIAL,33947,CPT,360,RC,36000236,CDM,,,,both,,,5513.0000,826.9500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,968.0000,11503.0400,case rate,"Rev 360 Proc 33947 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-ARTERIAL,33947,CPT,360,RC,36000236,CDM,,,,both,,,5513.0000,826.9500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,968.0000,11503.0400,case rate,"Rev 360 Proc 33947 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-ARTERIAL,33947,CPT,360,RC,36000236,CDM,,,,both,,,5513.0000,826.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,968.0000,11503.0400,case rate,"Rev 360 Proc 33947 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-ARTERIAL,33947,CPT,360,RC,36000236,CDM,,,,both,,,5513.0000,826.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,968.0000,11503.0400,case rate,"Rev 360 Proc 33947 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-ARTERIAL,33947,CPT,360,RC,36000236,CDM,,,,both,,,5513.0000,826.9500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,968.0000,11503.0400,case rate,"Rev 360 Proc 33947 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-ARTERIAL,33947,CPT,360,RC,36000236,CDM,,,,both,,,5513.0000,826.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4961.70,,,,,,,968.0000,11503.0400,percent of total billed charges,"90% of $5,513.00 in Billed Charges for Rev 360 Proc 33947 = $4,961.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INITIATION VENO-ARTERIAL,33947,CPT,360,RC,36000236,CDM,,,,both,,,5513.0000,826.9500,MEDCOST,MEDCOST VHN,2623.64,,,,,,,968.0000,11503.0400,percent of total billed charges,"47.59% of $5,513.00 in Billed Charges for Rev 360 Proc 33947 = $2,623.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INITIATION VENO-ARTERIAL,33947,CPT,360,RC,36000236,CDM,,,,both,,,5513.0000,826.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11503.04,,,,,,,968.0000,11503.0400,fee schedule,"APG 03070 Proc 33947 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 105% = $11,503.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-ARTERIAL,33947,CPT,360,RC,36000236,CDM,,,,both,,,5513.0000,826.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11294.89,,,,,,,968.0000,11503.0400,fee schedule,"APG 03070 Proc 33947 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 103.1% = $11,294.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-ARTERIAL,33947,CPT,360,RC,36000236,CDM,,,,both,,,5513.0000,826.9500,SENTARA HEALTH,SENTARA HEALTH,1422.91,,,,,,,968.0000,11503.0400,percent of total billed charges,"25.81% of $5,513.00 in Billed Charges for Rev 360 Proc 33947 = $1,422.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INITIATION VENO-ARTERIAL,33947,CPT,360,RC,36000236,CDM,,,,both,,,5513.0000,826.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5513.00,,,,,,,968.0000,11503.0400,percent of total billed charges,"100% of $5,513.00 in Billed Charges for Rev 360 Proc 33947 = $5,513.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INITIATION VENO-ARTERIAL,33947,CPT,360,RC,36000236,CDM,,,,both,,,5513.0000,826.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,968.0000,11503.0400,case rate,Rev 360 Proc 33947 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ECMO/ECLS INITIATION VENO-ARTERIAL,33947,CPT,360,RC,36000236,CDM,,,,both,,,5513.0000,826.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,968.0000,11503.0400,case rate,"Rev 360 Proc 33947 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-ARTERIAL,33947,CPT,360,RC,36000236,CDM,,,,both,,,5513.0000,826.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,968.0000,11503.0400,case rate,"Rev 360 Proc 33947 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-ARTERIAL,33947,CPT,360,RC,36000236,CDM,,,,both,,,5513.0000,826.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,968.0000,11503.0400,case rate,"Rev 360 Proc 33947 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-ARTERIAL,33947,CPT,360,RC,36000236,CDM,,,,both,,,5513.0000,826.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11283.94,,,,,,,968.0000,11503.0400,fee schedule,"APG 03070 Proc 33947 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INITIATION VENO-ARTERIAL,33947,CPT,360,RC,36000236,CDM,,,,both,,,5513.0000,826.9500,WELLCARE,WELLCARE MEDICAID,5513.00,,,,,,,968.0000,11503.0400,percent of total billed charges,"100% of $5,513.00 in Billed Charges for Rev 360 Proc 33947 = $5,513.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,AETNA,AETNA,1412.52,,,,,,,578.0000,3308.0000,percent of total billed charges,"42.7% of $3,308.00 in Billed Charges for Rev 361 Proc 36584 = $1,412.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1685.84,,,,,,,578.0000,3308.0000,fee schedule,"APG 00075 Proc 36584 at $836.60 (Base Rate) * 1.9376 (Relative Weight) = $1,621.00 (Total Line Payment) at 104% = $1,685.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1428.19,,,,,,,578.0000,3308.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,AETNA,AETNA HEALTHCARE MEDICARE,1428.19,,,,,,,578.0000,3308.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,1428.19,,,,,,,578.0000,3308.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,AMBETTER,AMBETTER,3113.45,,,,,,,578.0000,3308.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1485.32,,,,,,,578.0000,3308.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,BLUE CROSS,ANTHEM EXCHANGE,3308.00,,,,,,,578.0000,3308.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1669.63,,,,,,,578.0000,3308.0000,fee schedule,"APG 00075 Proc 36584 at $836.60 (Base Rate) * 1.9376 (Relative Weight) = $1,621.00 (Total Line Payment) at 103% = $1,669.63. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,BLUE CROSS,ANTHEM HMO,3308.00,,,,,,,578.0000,3308.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1471.04,,,,,,,578.0000,3308.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3308.00,,,,,,,578.0000,3308.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,578.0000,3308.0000,case rate,Rev 361 Proc 36584 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,578.0000,3308.0000,case rate,"Rev 361 Proc 36584 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,BLUE CROSS,BLUE CROSS MEDICARE,1485.32,,,,,,,578.0000,3308.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,578.0000,3308.0000,case rate,"Rev 361 Proc 36584 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,578.0000,3308.0000,case rate,"Rev 361 Proc 36584 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,3308.0000,case rate,Rev 361 Proc 36584 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,3308.0000,case rate,Rev 361 Proc 36584 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,578.0000,3308.0000,case rate,"Rev 361 Proc 36584 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,578.0000,3308.0000,case rate,"Rev 361 Proc 36584 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,1499.60,,,,,,,578.0000,3308.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,578.0000,3308.0000,case rate,"Rev 361 Proc 36584 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,578.0000,3308.0000,case rate,"Rev 361 Proc 36584 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1499.60,,,,,,,578.0000,3308.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2977.20,,,,,,,578.0000,3308.0000,percent of total billed charges,"90% of $3,308.00 in Billed Charges for Rev 361 Proc 36584 = $2,977.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,HUMANA,HUMANA MEDICARE,1428.19,,,,,,,578.0000,3308.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1428.19,,,,,,,578.0000,3308.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,MEDCOST,MEDCOST VHN,1574.28,,,,,,,578.0000,3308.0000,percent of total billed charges,"47.59% of $3,308.00 in Billed Charges for Rev 361 Proc 36584 = $1,574.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1702.05,,,,,,,578.0000,3308.0000,fee schedule,"APG 00075 Proc 36584 at $836.60 (Base Rate) * 1.9376 (Relative Weight) = $1,621.00 (Total Line Payment) at 100% = $1,621.00... $1,621.00 at 105% = $1,702.05 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1499.60,,,,,,,578.0000,3308.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1499.60,,,,,,,578.0000,3308.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,NHC ADVANTAGE,NHC ADVANTAGE,1499.60,,,,,,,578.0000,3308.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1671.25,,,,,,,578.0000,3308.0000,fee schedule,"APG 00075 Proc 36584 at $836.60 (Base Rate) * 1.9376 (Relative Weight) = $1,621.00 (Total Line Payment) at 100% = $1,621.00... $1,621.00 at 103.1% = $1,671.25 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,SENTARA HEALTH,SENTARA HEALTH,853.79,,,,,,,578.0000,3308.0000,percent of total billed charges,"25.81% of $3,308.00 in Billed Charges for Rev 361 Proc 36584 = $853.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,SENTARA HEALTH,SENTARA MEDICARE,1428.19,,,,,,,578.0000,3308.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3308.00,,,,,,,578.0000,3308.0000,percent of total billed charges,"100% of $3,308.00 in Billed Charges for Rev 361 Proc 36584 = $3,308.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,578.0000,3308.0000,case rate,Rev 361 Proc 36584 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,578.0000,3308.0000,case rate,Rev 361 Proc 36584 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,578.0000,3308.0000,case rate,Rev 361 Proc 36584 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,578.0000,3308.0000,case rate,"Rev 361 Proc 36584 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1669.63,,,,,,,578.0000,3308.0000,fee schedule,"APG 00075 Proc 36584 at $836.60 (Base Rate) * 1.9376 (Relative Weight) = $1,621.00 (Total Line Payment) at 103% = $1,669.63. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1428.19,,,,,,,578.0000,3308.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1428.19,,,,,,,578.0000,3308.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,WELLCARE,WELLCARE MEDICAID,3308.00,,,,,,,578.0000,3308.0000,percent of total billed charges,"100% of $3,308.00 in Billed Charges for Rev 361 Proc 36584 = $3,308.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PICC REPLACE COMPLETE SAME ACCESS INCL IMG GUID,36584,CPT,361,RC,36100088,CDM,,,,both,,,3308.0000,496.2000,WELLCARE,WELLCARE MEDICARE,1513.88,,,,,,,578.0000,3308.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,AETNA,AETNA,1936.02,,,,,,,578.0000,4534.0000,percent of total billed charges,"42.7% of $4,534.00 in Billed Charges for Rev 361 Proc 36590 = $1,936.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1057.13,,,,,,,578.0000,4534.0000,fee schedule,"APG 00076 Proc 36590 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment) at 104% = $1,057.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1428.19,,,,,,,578.0000,4534.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,AETNA,AETNA HEALTHCARE MEDICARE,1428.19,,,,,,,578.0000,4534.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,1428.19,,,,,,,578.0000,4534.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,AMBETTER,AMBETTER,3113.45,,,,,,,578.0000,4534.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1485.32,,,,,,,578.0000,4534.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,BLUE CROSS,ANTHEM EXCHANGE,3516.27,,,,,,,578.0000,4534.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1046.96,,,,,,,578.0000,4534.0000,fee schedule,"APG 00076 Proc 36590 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment) at 103% = $1,046.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,BLUE CROSS,ANTHEM HMO,3735.83,,,,,,,578.0000,4534.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1471.04,,,,,,,578.0000,4534.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4394.86,,,,,,,578.0000,4534.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,578.0000,4534.0000,case rate,Rev 361 Proc 36590 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,578.0000,4534.0000,case rate,"Rev 361 Proc 36590 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,BLUE CROSS,BLUE CROSS MEDICARE,1485.32,,,,,,,578.0000,4534.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,578.0000,4534.0000,case rate,"Rev 361 Proc 36590 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,578.0000,4534.0000,case rate,"Rev 361 Proc 36590 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,4534.0000,case rate,Rev 361 Proc 36590 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,4534.0000,case rate,Rev 361 Proc 36590 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,578.0000,4534.0000,case rate,"Rev 361 Proc 36590 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,578.0000,4534.0000,case rate,"Rev 361 Proc 36590 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,1499.60,,,,,,,578.0000,4534.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,578.0000,4534.0000,case rate,"Rev 361 Proc 36590 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,578.0000,4534.0000,case rate,"Rev 361 Proc 36590 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1499.60,,,,,,,578.0000,4534.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4080.60,,,,,,,578.0000,4534.0000,percent of total billed charges,"90% of $4,534.00 in Billed Charges for Rev 361 Proc 36590 = $4,080.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,HUMANA,HUMANA MEDICARE,1428.19,,,,,,,578.0000,4534.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1428.19,,,,,,,578.0000,4534.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,MEDCOST,MEDCOST VHN,2157.73,,,,,,,578.0000,4534.0000,percent of total billed charges,"47.59% of $4,534.00 in Billed Charges for Rev 361 Proc 36590 = $2,157.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1067.29,,,,,,,578.0000,4534.0000,fee schedule,"APG 00076 Proc 36590 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment) at 100% = $1,016.47... $1,016.47 at 105% = $1,067.29 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1499.60,,,,,,,578.0000,4534.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1499.60,,,,,,,578.0000,4534.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,NHC ADVANTAGE,NHC ADVANTAGE,1499.60,,,,,,,578.0000,4534.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1047.98,,,,,,,578.0000,4534.0000,fee schedule,"APG 00076 Proc 36590 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment) at 100% = $1,016.47... $1,016.47 at 103.1% = $1,047.98 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,SENTARA HEALTH,SENTARA HEALTH,1170.23,,,,,,,578.0000,4534.0000,percent of total billed charges,"25.81% of $4,534.00 in Billed Charges for Rev 361 Proc 36590 = $1,170.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,SENTARA HEALTH,SENTARA MEDICARE,1428.19,,,,,,,578.0000,4534.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4534.00,,,,,,,578.0000,4534.0000,percent of total billed charges,"100% of $4,534.00 in Billed Charges for Rev 361 Proc 36590 = $4,534.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,578.0000,4534.0000,case rate,Rev 361 Proc 36590 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,578.0000,4534.0000,case rate,"Rev 361 Proc 36590 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,578.0000,4534.0000,case rate,"Rev 361 Proc 36590 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,578.0000,4534.0000,case rate,"Rev 361 Proc 36590 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1046.96,,,,,,,578.0000,4534.0000,fee schedule,"APG 00076 Proc 36590 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment) at 103% = $1,046.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1428.19,,,,,,,578.0000,4534.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1428.19,,,,,,,578.0000,4534.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,WELLCARE,WELLCARE MEDICAID,4534.00,,,,,,,578.0000,4534.0000,percent of total billed charges,"100% of $4,534.00 in Billed Charges for Rev 361 Proc 36590 = $4,534.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REM CENTL ACCESS DEV W/SQ PRT,36590,CPT,361,RC,36100089,CDM,,,,both,,,4534.0000,680.1000,WELLCARE,WELLCARE MEDICARE,1513.88,,,,,,,578.0000,4534.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,AETNA,AETNA,2336.97,,,,,,,578.0000,6245.0500,percent of total billed charges,"42.7% of $5,473.00 in Billed Charges for Rev 361 Proc 36595 = $2,336.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1057.13,,,,,,,578.0000,6245.0500,fee schedule,"APG 00076 Proc 36595 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment) at 104% = $1,057.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2864.70,,,,,,,578.0000,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,AETNA,AETNA HEALTHCARE MEDICARE,2864.70,,,,,,,578.0000,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,2864.70,,,,,,,578.0000,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,AMBETTER,AMBETTER,6245.05,,,,,,,578.0000,6245.0500,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2979.29,,,,,,,578.0000,6245.0500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,BLUE CROSS,ANTHEM EXCHANGE,5473.00,,,,,,,578.0000,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1046.96,,,,,,,578.0000,6245.0500,fee schedule,"APG 00076 Proc 36595 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment) at 103% = $1,046.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,BLUE CROSS,ANTHEM HMO,5473.00,,,,,,,578.0000,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2950.64,,,,,,,578.0000,6245.0500,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5473.00,,,,,,,578.0000,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,578.0000,6245.0500,case rate,Rev 361 Proc 36595 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,578.0000,6245.0500,case rate,"Rev 361 Proc 36595 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,BLUE CROSS,BLUE CROSS MEDICARE,2979.29,,,,,,,578.0000,6245.0500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,578.0000,6245.0500,case rate,"Rev 361 Proc 36595 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,578.0000,6245.0500,case rate,"Rev 361 Proc 36595 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,6245.0500,case rate,Rev 361 Proc 36595 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,6245.0500,case rate,Rev 361 Proc 36595 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,578.0000,6245.0500,case rate,"Rev 361 Proc 36595 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,578.0000,6245.0500,case rate,"Rev 361 Proc 36595 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,3007.94,,,,,,,578.0000,6245.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,578.0000,6245.0500,case rate,"Rev 361 Proc 36595 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,578.0000,6245.0500,case rate,"Rev 361 Proc 36595 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3007.94,,,,,,,578.0000,6245.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4925.70,,,,,,,578.0000,6245.0500,percent of total billed charges,"90% of $5,473.00 in Billed Charges for Rev 361 Proc 36595 = $4,925.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,HUMANA,HUMANA MEDICARE,2864.70,,,,,,,578.0000,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2864.70,,,,,,,578.0000,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,MEDCOST,MEDCOST VHN,2604.60,,,,,,,578.0000,6245.0500,percent of total billed charges,"47.59% of $5,473.00 in Billed Charges for Rev 361 Proc 36595 = $2,604.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1067.29,,,,,,,578.0000,6245.0500,fee schedule,"APG 00076 Proc 36595 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment) at 100% = $1,016.47... $1,016.47 at 105% = $1,067.29 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3007.94,,,,,,,578.0000,6245.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3007.94,,,,,,,578.0000,6245.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,NHC ADVANTAGE,NHC ADVANTAGE,3007.94,,,,,,,578.0000,6245.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1047.98,,,,,,,578.0000,6245.0500,fee schedule,"APG 00076 Proc 36595 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment) at 100% = $1,016.47... $1,016.47 at 103.1% = $1,047.98 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,SENTARA HEALTH,SENTARA HEALTH,1412.58,,,,,,,578.0000,6245.0500,percent of total billed charges,"25.81% of $5,473.00 in Billed Charges for Rev 361 Proc 36595 = $1,412.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,SENTARA HEALTH,SENTARA MEDICARE,2864.70,,,,,,,578.0000,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5473.00,,,,,,,578.0000,6245.0500,percent of total billed charges,"100% of $5,473.00 in Billed Charges for Rev 361 Proc 36595 = $5,473.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,578.0000,6245.0500,case rate,"Rev 361 Proc 36595 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,578.0000,6245.0500,case rate,"Rev 361 Proc 36595 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,578.0000,6245.0500,case rate,"Rev 361 Proc 36595 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,5473.00,,,,,,,578.0000,6245.0500,case rate,"Rev 361 Proc 36595 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total (Service Line reduced to $5,473.00, claim capped at $5,473.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1046.96,,,,,,,578.0000,6245.0500,fee schedule,"APG 00076 Proc 36595 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment) at 103% = $1,046.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2864.70,,,,,,,578.0000,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2864.70,,,,,,,578.0000,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,WELLCARE,WELLCARE MEDICAID,5473.00,,,,,,,578.0000,6245.0500,percent of total billed charges,"100% of $5,473.00 in Billed Charges for Rev 361 Proc 36595 = $5,473.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IR REMOVAL PERICATH OBSTR MATERIAL,36595,CPT,361,RC,36100284,CDM,,,,both,,,5473.0000,820.9500,WELLCARE,WELLCARE MEDICARE,3036.58,,,,,,,578.0000,6245.0500,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,AETNA,AETNA,687.47,,,,,,,173.0000,1610.0000,percent of total billed charges,"42.7% of $1,610.00 in Billed Charges for Rev 361 Proc 36598 = $687.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,495.24,,,,,,,173.0000,1610.0000,fee schedule,"APG 00278 Proc 36598 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $476.19 at 104% = $495.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,192.98,,,,,,,173.0000,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,AETNA,AETNA HEALTHCARE MEDICARE,192.98,,,,,,,173.0000,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,192.98,,,,,,,173.0000,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,AMBETTER,AMBETTER,420.70,,,,,,,173.0000,1610.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,200.70,,,,,,,173.0000,1610.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,ANTHEM EXCHANGE,475.13,,,,,,,173.0000,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,490.48,,,,,,,173.0000,1610.0000,fee schedule,"APG 00278 Proc 36598 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $476.19 at 103% = $490.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,ANTHEM HMO,504.80,,,,,,,173.0000,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,198.77,,,,,,,173.0000,1610.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",593.85,,,,,,,173.0000,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,948.00,,,,,,,173.0000,1610.0000,case rate,Rev 361 Proc 36598 ASG Rate of $948.00 at 100% of $948.00 = $948.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,173.0000,1610.0000,case rate,Rev 361 Proc 36598 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,BLUE CROSS MEDICARE,200.70,,,,,,,173.0000,1610.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,173.0000,1610.0000,case rate,Rev 361 Proc 36598 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,173.0000,1610.0000,case rate,Rev 361 Proc 36598 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,173.0000,1610.0000,case rate,Rev 361 Proc 36598 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,173.0000,1610.0000,case rate,Rev 361 Proc 36598 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,CIGNA HEALTHCARE,CIGNA HMO,1610.00,,,,,,,173.0000,1610.0000,case rate,"Rev 361 Proc 36598 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,610.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,610.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,173.0000,1610.0000,case rate,"Rev 361 Proc 36598 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,202.63,,,,,,,173.0000,1610.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1610.00,,,,,,,173.0000,1610.0000,case rate,"Rev 361 Proc 36598 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,610.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,610.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,CIGNA HEALTHCARE,CIGNA PPO,1610.00,,,,,,,173.0000,1610.0000,case rate,"Rev 361 Proc 36598 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,610.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,610.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,202.63,,,,,,,173.0000,1610.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1449.00,,,,,,,173.0000,1610.0000,percent of total billed charges,"90% of $1,610.00 in Billed Charges for Rev 361 Proc 36598 = $1,449.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,HUMANA,HUMANA MEDICARE,192.98,,,,,,,173.0000,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,192.98,,,,,,,173.0000,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,MEDCOST,MEDCOST VHN,766.20,,,,,,,173.0000,1610.0000,percent of total billed charges,"47.59% of $1,610.00 in Billed Charges for Rev 361 Proc 36598 = $766.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,500.00,,,,,,,173.0000,1610.0000,fee schedule,"APG 00278 Proc 36598 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $476.19 at 100% = $476.19... $476.19 at 105% = $500.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,202.63,,,,,,,173.0000,1610.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,202.63,,,,,,,173.0000,1610.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,NHC ADVANTAGE,NHC ADVANTAGE,202.63,,,,,,,173.0000,1610.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,490.95,,,,,,,173.0000,1610.0000,fee schedule,"APG 00278 Proc 36598 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $476.19 at 100% = $476.19... $476.19 at 103.1% = $490.95 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,SENTARA HEALTH,SENTARA HEALTH,415.54,,,,,,,173.0000,1610.0000,percent of total billed charges,"25.81% of $1,610.00 in Billed Charges for Rev 361 Proc 36598 = $415.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,SENTARA HEALTH,SENTARA MEDICARE,192.98,,,,,,,173.0000,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1610.00,,,,,,,173.0000,1610.0000,percent of total billed charges,"100% of $1,610.00 in Billed Charges for Rev 361 Proc 36598 = $1,610.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,173.0000,1610.0000,case rate,Rev 361 Proc 36598 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,173.0000,1610.0000,case rate,Rev 361 Proc 36598 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,173.0000,1610.0000,case rate,Rev 361 Proc 36598 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,173.0000,1610.0000,case rate,Rev 361 Proc 36598 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,490.48,,,,,,,173.0000,1610.0000,fee schedule,"APG 00278 Proc 36598 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $476.19 at 103% = $490.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,192.98,,,,,,,173.0000,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,192.98,,,,,,,173.0000,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,WELLCARE,WELLCARE MEDICAID,1610.00,,,,,,,173.0000,1610.0000,percent of total billed charges,"100% of $1,610.00 in Billed Charges for Rev 361 Proc 36598 = $1,610.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PATENCY CHECK INDWELL VEN CATH,36598,CPT,361,RC,36100096,CDM,,,,both,,,1610.0000,241.5000,WELLCARE,WELLCARE MEDICARE,204.56,,,,,,,173.0000,1610.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
FIBER LASER 940UM,272,RC,27200002,CDM,,,,,,both,,,4293.5900,644.0400,AETNA,AETNA,1833.36,,,,,,,1108.1800,4293.5900,percent of total billed charges,"42.7% of $4,293.59 in Billed Charges for Rev 272 = $1,833.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER 940UM,272,RC,27200002,CDM,,,,,,both,,,4293.5900,644.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3005.51,,,,,,,1108.1800,4293.5900,percent of total billed charges,"Rev 272 $4,293.59 in Billed Charges at 70% = $3,005.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER 940UM,272,RC,27200002,CDM,,,,,,both,,,4293.5900,644.0400,CIGNA HEALTHCARE,CIGNA HMO,1790.43,,,,,,,1108.1800,4293.5900,percent of total billed charges,"41.7% of $4,293.59 in Billed Charges for Rev 272 = $1,790.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER 940UM,272,RC,27200002,CDM,,,,,,both,,,4293.5900,644.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1992.23,,,,,,,1108.1800,4293.5900,percent of total billed charges,"46.4% of $4,293.59 in Billed Charges for Rev 272 = $1,992.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER 940UM,272,RC,27200002,CDM,,,,,,both,,,4293.5900,644.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1790.43,,,,,,,1108.1800,4293.5900,percent of total billed charges,"41.7% of $4,293.59 in Billed Charges for Rev 272 = $1,790.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER 940UM,272,RC,27200002,CDM,,,,,,both,,,4293.5900,644.0400,CIGNA HEALTHCARE,CIGNA PPO,1790.43,,,,,,,1108.1800,4293.5900,percent of total billed charges,"41.7% of $4,293.59 in Billed Charges for Rev 272 = $1,790.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER 940UM,272,RC,27200002,CDM,,,,,,both,,,4293.5900,644.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3864.23,,,,,,,1108.1800,4293.5900,percent of total billed charges,"90% of $4,293.59 in Billed Charges for Rev 272 = $3,864.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER 940UM,272,RC,27200002,CDM,,,,,,both,,,4293.5900,644.0400,MEDCOST,MEDCOST VHN,2043.32,,,,,,,1108.1800,4293.5900,percent of total billed charges,"47.59% of $4,293.59 in Billed Charges for Rev 272 = $2,043.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER 940UM,272,RC,27200002,CDM,,,,,,both,,,4293.5900,644.0400,SENTARA HEALTH,SENTARA HEALTH,1108.18,,,,,,,1108.1800,4293.5900,percent of total billed charges,"25.81% of $4,293.59 in Billed Charges for Rev 272 = $1,108.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER 940UM,272,RC,27200002,CDM,,,,,,both,,,4293.5900,644.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4293.59,,,,,,,1108.1800,4293.5900,percent of total billed charges,"100% of $4,293.59 in Billed Charges for Rev 272 = $4,293.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER 940UM,272,RC,27200002,CDM,,,,,,both,,,4293.5900,644.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2146.80,,,,,,,1108.1800,4293.5900,percent of total billed charges,"Rev 272 $4,293.59 in Billed Charges at 50% = $2,146.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER 940UM,272,RC,27200002,CDM,,,,,,both,,,4293.5900,644.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1386.83,,,,,,,1108.1800,4293.5900,other,"32.3% of $4,293.59 in Billed Charges for Rev 272 = $1,386.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER LASER 940UM,272,RC,27200002,CDM,,,,,,both,,,4293.5900,644.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1318.13,,,,,,,1108.1800,4293.5900,other,"30.7% of $4,293.59 in Billed Charges for Rev 272 = $1,318.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER LASER 940UM,272,RC,27200002,CDM,,,,,,both,,,4293.5900,644.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,1386.83,,,,,,,1108.1800,4293.5900,percent of total billed charges,"32.3% of $4,293.59 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LASER 940UM,272,RC,27200002,CDM,,,,,,both,,,4293.5900,644.0400,WELLCARE,WELLCARE MEDICAID,4293.59,,,,,,,1108.1800,4293.5900,percent of total billed charges,"100% of $4,293.59 in Billed Charges for Rev 272 = $4,293.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LUMENIS XPEEDA LASER,272,RC,,,,,,,,both,,,14157.9700,2123.7000,AETNA,AETNA,6045.45,,,,,,,3654.1700,14157.9700,percent of total billed charges,"42.7% of $14,157.97 in Billed Charges for Rev 272 = $6,045.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LUMENIS XPEEDA LASER,272,RC,,,,,,,,both,,,14157.9700,2123.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9910.58,,,,,,,3654.1700,14157.9700,percent of total billed charges,"Rev 272 $14,157.97 in Billed Charges at 70% = $9,910.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LUMENIS XPEEDA LASER,272,RC,,,,,,,,both,,,14157.9700,2123.7000,CIGNA HEALTHCARE,CIGNA HMO,5903.87,,,,,,,3654.1700,14157.9700,percent of total billed charges,"41.7% of $14,157.97 in Billed Charges for Rev 272 = $5,903.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LUMENIS XPEEDA LASER,272,RC,,,,,,,,both,,,14157.9700,2123.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6569.30,,,,,,,3654.1700,14157.9700,percent of total billed charges,"46.4% of $14,157.97 in Billed Charges for Rev 272 = $6,569.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LUMENIS XPEEDA LASER,272,RC,,,,,,,,both,,,14157.9700,2123.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5903.87,,,,,,,3654.1700,14157.9700,percent of total billed charges,"41.7% of $14,157.97 in Billed Charges for Rev 272 = $5,903.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LUMENIS XPEEDA LASER,272,RC,,,,,,,,both,,,14157.9700,2123.7000,CIGNA HEALTHCARE,CIGNA PPO,5903.87,,,,,,,3654.1700,14157.9700,percent of total billed charges,"41.7% of $14,157.97 in Billed Charges for Rev 272 = $5,903.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LUMENIS XPEEDA LASER,272,RC,,,,,,,,both,,,14157.9700,2123.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12742.17,,,,,,,3654.1700,14157.9700,percent of total billed charges,"90% of $14,157.97 in Billed Charges for Rev 272 = $12,742.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LUMENIS XPEEDA LASER,272,RC,,,,,,,,both,,,14157.9700,2123.7000,MEDCOST,MEDCOST VHN,6737.78,,,,,,,3654.1700,14157.9700,percent of total billed charges,"47.59% of $14,157.97 in Billed Charges for Rev 272 = $6,737.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LUMENIS XPEEDA LASER,272,RC,,,,,,,,both,,,14157.9700,2123.7000,SENTARA HEALTH,SENTARA HEALTH,3654.17,,,,,,,3654.1700,14157.9700,percent of total billed charges,"25.81% of $14,157.97 in Billed Charges for Rev 272 = $3,654.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LUMENIS XPEEDA LASER,272,RC,,,,,,,,both,,,14157.9700,2123.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",14157.97,,,,,,,3654.1700,14157.9700,percent of total billed charges,"100% of $14,157.97 in Billed Charges for Rev 272 = $14,157.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LUMENIS XPEEDA LASER,272,RC,,,,,,,,both,,,14157.9700,2123.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7078.99,,,,,,,3654.1700,14157.9700,percent of total billed charges,"Rev 272 $14,157.97 in Billed Charges at 50% = $7,078.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LUMENIS XPEEDA LASER,272,RC,,,,,,,,both,,,14157.9700,2123.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4573.02,,,,,,,3654.1700,14157.9700,other,"32.3% of $14,157.97 in Billed Charges for Rev 272 = $4,573.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER LUMENIS XPEEDA LASER,272,RC,,,,,,,,both,,,14157.9700,2123.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,4346.50,,,,,,,3654.1700,14157.9700,other,"30.7% of $14,157.97 in Billed Charges for Rev 272 = $4,346.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER LUMENIS XPEEDA LASER,272,RC,,,,,,,,both,,,14157.9700,2123.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,4573.02,,,,,,,3654.1700,14157.9700,percent of total billed charges,"32.3% of $14,157.97 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER LUMENIS XPEEDA LASER,272,RC,,,,,,,,both,,,14157.9700,2123.7000,WELLCARE,WELLCARE MEDICAID,14157.97,,,,,,,3654.1700,14157.9700,percent of total billed charges,"100% of $14,157.97 in Billed Charges for Rev 272 = $14,157.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE ARTERIAL CATHETER,36620,CPT,450,RC,45000246,CDM,,,,both,,,1224.0000,183.6000,AETNA,AETNA,522.65,,,,,,,82.4600,1224.0000,percent of total billed charges,"42.7% of $1,224.00 in Billed Charges for Rev 450 Proc 36620 = $522.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE ARTERIAL CATHETER,36620,CPT,450,RC,45000246,CDM,,,,both,,,1224.0000,183.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,962.29,,,,,,,82.4600,1224.0000,fee schedule,APG 00423 Proc 36620 at $836.60 (Base Rate) * 1.106 (Relative Weight) = $925.28 (Total Line Payment) at 104% = $962.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE ARTERIAL CATHETER,36620,CPT,450,RC,45000246,CDM,,,,both,,,1224.0000,183.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,953.04,,,,,,,82.4600,1224.0000,fee schedule,APG 00423 Proc 36620 at $836.60 (Base Rate) * 1.106 (Relative Weight) = $925.28 (Total Line Payment) at 103% = $953.04. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE ARTERIAL CATHETER,36620,CPT,450,RC,45000246,CDM,,,,both,,,1224.0000,183.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,82.46,,,,,,,82.4600,1224.0000,fee schedule,$82.46 from Fee Schedule BLDTM_23 for Rev 450 Proc 36620 * Qty 1 = $82.46 at 100% = $82.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE ARTERIAL CATHETER,36620,CPT,450,RC,45000246,CDM,,,,both,,,1224.0000,183.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1101.60,,,,,,,82.4600,1224.0000,percent of total billed charges,"90% of $1,224.00 in Billed Charges for Rev 450 Proc 36620 = $1,101.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE ARTERIAL CATHETER,36620,CPT,450,RC,45000246,CDM,,,,both,,,1224.0000,183.6000,MEDCOST,MEDCOST VHN,582.50,,,,,,,82.4600,1224.0000,percent of total billed charges,"47.59% of $1,224.00 in Billed Charges for Rev 450 Proc 36620 = $582.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE ARTERIAL CATHETER,36620,CPT,450,RC,45000246,CDM,,,,both,,,1224.0000,183.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,971.54,,,,,,,82.4600,1224.0000,fee schedule,APG 00423 Proc 36620 at $836.60 (Base Rate) * 1.106 (Relative Weight) = $925.28 (Total Line Payment) at 100% = $925.28... $925.28 at 105% = $971.54 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE ARTERIAL CATHETER,36620,CPT,450,RC,45000246,CDM,,,,both,,,1224.0000,183.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,953.96,,,,,,,82.4600,1224.0000,fee schedule,APG 00423 Proc 36620 at $836.60 (Base Rate) * 1.106 (Relative Weight) = $925.28 (Total Line Payment) at 100% = $925.28... $925.28 at 103.1% = $953.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE ARTERIAL CATHETER,36620,CPT,450,RC,45000246,CDM,,,,both,,,1224.0000,183.6000,SENTARA HEALTH,SENTARA HEALTH,315.91,,,,,,,82.4600,1224.0000,percent of total billed charges,"25.81% of $1,224.00 in Billed Charges for Rev 450 Proc 36620 = $315.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE ARTERIAL CATHETER,36620,CPT,450,RC,45000246,CDM,,,,both,,,1224.0000,183.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1224.00,,,,,,,82.4600,1224.0000,percent of total billed charges,"100% of $1,224.00 in Billed Charges for Rev 450 Proc 36620 = $1,224.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE ARTERIAL CATHETER,36620,CPT,450,RC,45000246,CDM,,,,both,,,1224.0000,183.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,82.4600,1224.0000,case rate,Rev 450 Proc 36620 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE ARTERIAL CATHETER,36620,CPT,450,RC,45000246,CDM,,,,both,,,1224.0000,183.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,82.4600,1224.0000,case rate,Rev 450 Proc 36620 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE ARTERIAL CATHETER,36620,CPT,450,RC,45000246,CDM,,,,both,,,1224.0000,183.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,82.4600,1224.0000,case rate,Rev 450 Proc 36620 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE ARTERIAL CATHETER,36620,CPT,450,RC,45000246,CDM,,,,both,,,1224.0000,183.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,82.4600,1224.0000,case rate,Rev 450 Proc 36620 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE ARTERIAL CATHETER,36620,CPT,450,RC,45000246,CDM,,,,both,,,1224.0000,183.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,953.04,,,,,,,82.4600,1224.0000,fee schedule,APG 00423 Proc 36620 at $836.60 (Base Rate) * 1.106 (Relative Weight) = $925.28 (Total Line Payment) at 103% = $953.04. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE ARTERIAL CATHETER,36620,CPT,450,RC,45000246,CDM,,,,both,,,1224.0000,183.6000,WELLCARE,WELLCARE MEDICAID,1224.00,,,,,,,82.4600,1224.0000,percent of total billed charges,"100% of $1,224.00 in Billed Charges for Rev 450 Proc 36620 = $1,224.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,AETNA,AETNA,179.34,,,,,,,105.4800,883.5600,percent of total billed charges,42.7% of $420.00 in Billed Charges for Rev 450 Proc 36680 = $179.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,354.99,,,,,,,105.4800,883.5600,fee schedule,APG 00049 Proc 36680 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment) at 104% = $354.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,405.30,,,,,,,105.4800,883.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,AETNA,AETNA HEALTHCARE MEDICARE,405.30,,,,,,,105.4800,883.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,ALLCARE MEDICARE,ALLCARE MEDICARE,405.30,,,,,,,105.4800,883.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,AMBETTER,AMBETTER,883.56,,,,,,,105.4800,883.5600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,420.00,,,,,,,105.4800,883.5600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,BLUE CROSS,ANTHEM EXCHANGE,420.00,,,,,,,105.4800,883.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,351.57,,,,,,,105.4800,883.5600,fee schedule,APG 00049 Proc 36680 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment) at 103% = $351.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,BLUE CROSS,ANTHEM HMO,420.00,,,,,,,105.4800,883.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,417.46,,,,,,,105.4800,883.5600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",420.00,,,,,,,105.4800,883.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,105.48,,,,,,,105.4800,883.5600,fee schedule,$105.48 from Fee Schedule BLDTM_23 for Rev 450 Proc 36680 * Qty 1 = $105.48 at 100% = $105.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,BLUE CROSS,BLUE CROSS MEDICARE,421.51,,,,,,,105.4800,883.5600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,CIGNA HEALTHCARE,CIGNA MEDICARE,420.00,,,,,,,105.4800,883.5600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,420.00,,,,,,,105.4800,883.5600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,378.00,,,,,,,105.4800,883.5600,percent of total billed charges,90% of $420.00 in Billed Charges for Rev 450 Proc 36680 = $378.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,HUMANA,HUMANA MEDICARE,405.30,,,,,,,105.4800,883.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,405.30,,,,,,,105.4800,883.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,MEDCOST,MEDCOST VHN,199.88,,,,,,,105.4800,883.5600,percent of total billed charges,47.59% of $420.00 in Billed Charges for Rev 450 Proc 36680 = $199.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,358.40,,,,,,,105.4800,883.5600,fee schedule,APG 00049 Proc 36680 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment) at 100% = $341.33... $341.33 at 105% = $358.40 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,420.00,,,,,,,105.4800,883.5600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,420.00,,,,,,,105.4800,883.5600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,NHC ADVANTAGE,NHC ADVANTAGE,420.00,,,,,,,105.4800,883.5600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,351.91,,,,,,,105.4800,883.5600,fee schedule,APG 00049 Proc 36680 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment) at 100% = $341.33... $341.33 at 103.1% = $351.91 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,SENTARA HEALTH,SENTARA HEALTH,108.40,,,,,,,105.4800,883.5600,percent of total billed charges,25.81% of $420.00 in Billed Charges for Rev 450 Proc 36680 = $108.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,SENTARA HEALTH,SENTARA MEDICARE,405.30,,,,,,,105.4800,883.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",420.00,,,,,,,105.4800,883.5600,percent of total billed charges,100% of $420.00 in Billed Charges for Rev 450 Proc 36680 = $420.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,105.4800,883.5600,case rate,Rev 450 Proc 36680 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,420.00,,,,,,,105.4800,883.5600,case rate,"Rev 450 Proc 36680 at Case Rate $491.00 (Service Line reduced to $420.00, claim capped at $420.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,420.00,,,,,,,105.4800,883.5600,case rate,"Rev 450 Proc 36680 at Case Rate $471.00 (Service Line reduced to $420.00, claim capped at $420.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,420.00,,,,,,,105.4800,883.5600,case rate,"Rev 450 Proc 36680 at Case Rate $847.00 (Service Line reduced to $420.00, claim capped at $420.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,351.57,,,,,,,105.4800,883.5600,fee schedule,APG 00049 Proc 36680 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment) at 103% = $351.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,405.30,,,,,,,105.4800,883.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,405.30,,,,,,,105.4800,883.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,WELLCARE,WELLCARE MEDICAID,420.00,,,,,,,105.4800,883.5600,percent of total billed charges,100% of $420.00 in Billed Charges for Rev 450 Proc 36680 = $420.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLACE NEEDLE INTRAOSSEOUS INFUSIO,36680,CPT,450,RC,45000247,CDM,,,,both,,,420.0000,63.0000,WELLCARE,WELLCARE MEDICARE,429.62,,,,,,,105.4800,883.5600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,AETNA,AETNA,9657.89,,,,,,,578.0000,36257.3800,percent of total billed charges,"42.7% of $22,618.00 in Billed Charges for Rev 361 Proc 36836 = $9,657.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,5150.08,,,,,,,578.0000,36257.3800,fee schedule,"APG 00059 Proc 36836 at $836.60 (Base Rate) * 5.9192 (Relative Weight) = $4,952.00 (Total Line Payment) at 104% = $5,150.08. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,16631.83,,,,,,,578.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,AETNA,AETNA HEALTHCARE MEDICARE,16631.83,,,,,,,578.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,16631.83,,,,,,,578.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,AMBETTER,AMBETTER,36257.38,,,,,,,578.0000,36257.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,17297.10,,,,,,,578.0000,36257.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,BLUE CROSS,ANTHEM EXCHANGE,22618.00,,,,,,,578.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,5100.56,,,,,,,578.0000,36257.3800,fee schedule,"APG 00059 Proc 36836 at $836.60 (Base Rate) * 5.9192 (Relative Weight) = $4,952.00 (Total Line Payment) at 103% = $5,100.56. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,BLUE CROSS,ANTHEM HMO,22618.00,,,,,,,578.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,17130.78,,,,,,,578.0000,36257.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",22618.00,,,,,,,578.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,578.0000,36257.3800,case rate,"Rev 361 Proc 36836 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,BLUE CROSS,BLUE CROSS MEDICARE,17297.10,,,,,,,578.0000,36257.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,36257.3800,case rate,Rev 361 Proc 36836 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,36257.3800,case rate,Rev 361 Proc 36836 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,578.0000,36257.3800,case rate,"Rev 361 Proc 36836 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,578.0000,36257.3800,case rate,"Rev 361 Proc 36836 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,17463.42,,,,,,,578.0000,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,578.0000,36257.3800,case rate,"Rev 361 Proc 36836 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,578.0000,36257.3800,case rate,"Rev 361 Proc 36836 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,17463.42,,,,,,,578.0000,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,20356.20,,,,,,,578.0000,36257.3800,percent of total billed charges,"90% of $22,618.00 in Billed Charges for Rev 361 Proc 36836 = $20,356.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,HUMANA,HUMANA MEDICARE,16631.83,,,,,,,578.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,16631.83,,,,,,,578.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,MEDCOST,MEDCOST VHN,10763.91,,,,,,,578.0000,36257.3800,percent of total billed charges,"47.59% of $22,618.00 in Billed Charges for Rev 361 Proc 36836 = $10,763.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,5199.60,,,,,,,578.0000,36257.3800,fee schedule,"APG 00059 Proc 36836 at $836.60 (Base Rate) * 5.9192 (Relative Weight) = $4,952.00 (Total Line Payment) at 100% = $4,952.00... $4,952.00 at 105% = $5,199.60 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,17463.42,,,,,,,578.0000,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,17463.42,,,,,,,578.0000,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,NHC ADVANTAGE,NHC ADVANTAGE,17463.42,,,,,,,578.0000,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,5105.51,,,,,,,578.0000,36257.3800,fee schedule,"APG 00059 Proc 36836 at $836.60 (Base Rate) * 5.9192 (Relative Weight) = $4,952.00 (Total Line Payment) at 100% = $4,952.00... $4,952.00 at 103.1% = $5,105.51 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,SENTARA HEALTH,SENTARA HEALTH,5837.71,,,,,,,578.0000,36257.3800,percent of total billed charges,"25.81% of $22,618.00 in Billed Charges for Rev 361 Proc 36836 = $5,837.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,SENTARA HEALTH,SENTARA MEDICARE,16631.83,,,,,,,578.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",22618.00,,,,,,,578.0000,36257.3800,percent of total billed charges,"100% of $22,618.00 in Billed Charges for Rev 361 Proc 36836 = $22,618.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,578.0000,36257.3800,case rate,"Rev 361 Proc 36836 ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,578.0000,36257.3800,case rate,"Rev 361 Proc 36836 ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,578.0000,36257.3800,case rate,"Rev 361 Proc 36836 ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,20054.00,,,,,,,578.0000,36257.3800,case rate,"Rev 361 Proc 36836 ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,5100.56,,,,,,,578.0000,36257.3800,fee schedule,"APG 00059 Proc 36836 at $836.60 (Base Rate) * 5.9192 (Relative Weight) = $4,952.00 (Total Line Payment) at 103% = $5,100.56. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,16631.83,,,,,,,578.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,16631.83,,,,,,,578.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,WELLCARE,WELLCARE MEDICAID,22618.00,,,,,,,578.0000,36257.3800,percent of total billed charges,"100% of $22,618.00 in Billed Charges for Rev 361 Proc 36836 = $22,618.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ AV FISTULA CREATION UXTR SINGLE ACCESS,36836,CPT,361,RC,36100532,CDM,,,,both,,,22618.0000,3392.7000,WELLCARE,WELLCARE MEDICARE,17629.74,,,,,,,578.0000,36257.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,AETNA,AETNA,2097.00,,,,,,,175.0000,4911.0000,percent of total billed charges,"42.7% of $4,911.00 in Billed Charges for Rev 361 Proc 36901 = $2,097.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2491.25,,,,,,,175.0000,4911.0000,fee schedule,"APG 00279 Proc 36901 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 104% = $2,491.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1428.19,,,,,,,175.0000,4911.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,AETNA,AETNA HEALTHCARE MEDICARE,1428.19,,,,,,,175.0000,4911.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,1428.19,,,,,,,175.0000,4911.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,AMBETTER,AMBETTER,3113.45,,,,,,,175.0000,4911.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1485.32,,,,,,,175.0000,4911.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,BLUE CROSS,ANTHEM EXCHANGE,3516.27,,,,,,,175.0000,4911.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2467.30,,,,,,,175.0000,4911.0000,fee schedule,"APG 00279 Proc 36901 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 103% = $2,467.30. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,BLUE CROSS,ANTHEM HMO,3735.83,,,,,,,175.0000,4911.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1471.04,,,,,,,175.0000,4911.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4394.86,,,,,,,175.0000,4911.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,175.0000,4911.0000,case rate,"Rev 361 Proc 36901 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,175.0000,4911.0000,case rate,"Rev 361 Proc 36901 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,BLUE CROSS,BLUE CROSS MEDICARE,1485.32,,,,,,,175.0000,4911.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,175.0000,4911.0000,case rate,"Rev 361 Proc 36901 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,175.0000,4911.0000,case rate,"Rev 361 Proc 36901 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,175.0000,4911.0000,case rate,Rev 361 Proc 36901 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,175.0000,4911.0000,case rate,Rev 361 Proc 36901 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,CIGNA HEALTHCARE,CIGNA HMO,228.00,,,,,,,175.0000,4911.0000,case rate,Rev 361 Proc 36901 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.00,,,,,,,175.0000,4911.0000,case rate,Rev 361 Proc 36901 ASG Rate of $175.00 at 100% of $175.00 = $175.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,1499.60,,,,,,,175.0000,4911.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.00,,,,,,,175.0000,4911.0000,case rate,Rev 361 Proc 36901 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,CIGNA HEALTHCARE,CIGNA PPO,228.00,,,,,,,175.0000,4911.0000,case rate,Rev 361 Proc 36901 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1499.60,,,,,,,175.0000,4911.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4419.90,,,,,,,175.0000,4911.0000,percent of total billed charges,"90% of $4,911.00 in Billed Charges for Rev 361 Proc 36901 = $4,419.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,HUMANA,HUMANA MEDICARE,1428.19,,,,,,,175.0000,4911.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1428.19,,,,,,,175.0000,4911.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,MEDCOST,MEDCOST VHN,2337.14,,,,,,,175.0000,4911.0000,percent of total billed charges,"47.59% of $4,911.00 in Billed Charges for Rev 361 Proc 36901 = $2,337.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2515.21,,,,,,,175.0000,4911.0000,fee schedule,"APG 00279 Proc 36901 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 100% = $2,395.44... $2,395.44 at 105% = $2,515.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1499.60,,,,,,,175.0000,4911.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1499.60,,,,,,,175.0000,4911.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,NHC ADVANTAGE,NHC ADVANTAGE,1499.60,,,,,,,175.0000,4911.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2469.70,,,,,,,175.0000,4911.0000,fee schedule,"APG 00279 Proc 36901 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 100% = $2,395.44... $2,395.44 at 103.1% = $2,469.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,SENTARA HEALTH,SENTARA HEALTH,1267.53,,,,,,,175.0000,4911.0000,percent of total billed charges,"25.81% of $4,911.00 in Billed Charges for Rev 361 Proc 36901 = $1,267.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,SENTARA HEALTH,SENTARA MEDICARE,1428.19,,,,,,,175.0000,4911.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4911.00,,,,,,,175.0000,4911.0000,percent of total billed charges,"100% of $4,911.00 in Billed Charges for Rev 361 Proc 36901 = $4,911.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,175.0000,4911.0000,case rate,Rev 361 Proc 36901 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,175.0000,4911.0000,case rate,"Rev 361 Proc 36901 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,175.0000,4911.0000,case rate,"Rev 361 Proc 36901 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,175.0000,4911.0000,case rate,"Rev 361 Proc 36901 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2467.30,,,,,,,175.0000,4911.0000,fee schedule,"APG 00279 Proc 36901 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 103% = $2,467.30. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1428.19,,,,,,,175.0000,4911.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1428.19,,,,,,,175.0000,4911.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,WELLCARE,WELLCARE MEDICAID,4911.00,,,,,,,175.0000,4911.0000,percent of total billed charges,"100% of $4,911.00 in Billed Charges for Rev 361 Proc 36901 = $4,911.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRO NDL/CATH DIALYSIS CIRCUIT W DX ANGIO,36901,CPT,361,RC,36100336,CDM,,,,both,,,4911.0000,736.6500,WELLCARE,WELLCARE MEDICARE,1513.88,,,,,,,175.0000,4911.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,AETNA,AETNA,7538.69,,,,,,,775.0000,17655.0000,percent of total billed charges,"42.7% of $17,655.00 in Billed Charges for Rev 361 Proc 36902 = $7,538.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,5490.10,,,,,,,775.0000,17655.0000,fee schedule,"APG 00077 Proc 36902 at $836.60 (Base Rate) * 6.31 (Relative Weight) = $5,278.95 (Total Line Payment) at 104% = $5,490.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5163.81,,,,,,,775.0000,17655.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,AETNA,AETNA HEALTHCARE MEDICARE,5163.81,,,,,,,775.0000,17655.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,5163.81,,,,,,,775.0000,17655.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,AMBETTER,AMBETTER,11257.11,,,,,,,775.0000,17655.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,5370.36,,,,,,,775.0000,17655.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,BLUE CROSS,ANTHEM EXCHANGE,12713.57,,,,,,,775.0000,17655.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,5437.31,,,,,,,775.0000,17655.0000,fee schedule,"APG 00077 Proc 36902 at $836.60 (Base Rate) * 6.31 (Relative Weight) = $5,278.95 (Total Line Payment) at 103% = $5,437.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,BLUE CROSS,ANTHEM HMO,13507.41,,,,,,,775.0000,17655.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5318.72,,,,,,,775.0000,17655.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",15890.21,,,,,,,775.0000,17655.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,775.0000,17655.0000,case rate,"Rev 361 Proc 36902 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,775.0000,17655.0000,case rate,"Rev 361 Proc 36902 ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,BLUE CROSS,BLUE CROSS MEDICARE,5370.36,,,,,,,775.0000,17655.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,775.0000,17655.0000,case rate,"Rev 361 Proc 36902 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,775.0000,17655.0000,case rate,"Rev 361 Proc 36902 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,17655.0000,case rate,Rev 361 Proc 36902 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,17655.0000,case rate,Rev 361 Proc 36902 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,775.0000,17655.0000,case rate,"Rev 361 Proc 36902 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,775.0000,17655.0000,case rate,"Rev 361 Proc 36902 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,5422.00,,,,,,,775.0000,17655.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,775.0000,17655.0000,case rate,"Rev 361 Proc 36902 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,775.0000,17655.0000,case rate,"Rev 361 Proc 36902 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,5422.00,,,,,,,775.0000,17655.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,15889.50,,,,,,,775.0000,17655.0000,percent of total billed charges,"90% of $17,655.00 in Billed Charges for Rev 361 Proc 36902 = $15,889.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,HUMANA,HUMANA MEDICARE,5163.81,,,,,,,775.0000,17655.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5163.81,,,,,,,775.0000,17655.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,MEDCOST,MEDCOST VHN,8402.01,,,,,,,775.0000,17655.0000,percent of total billed charges,"47.59% of $17,655.00 in Billed Charges for Rev 361 Proc 36902 = $8,402.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,5542.90,,,,,,,775.0000,17655.0000,fee schedule,"APG 00077 Proc 36902 at $836.60 (Base Rate) * 6.31 (Relative Weight) = $5,278.95 (Total Line Payment) at 100% = $5,278.95... $5,278.95 at 105% = $5,542.90 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,5422.00,,,,,,,775.0000,17655.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,5422.00,,,,,,,775.0000,17655.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,NHC ADVANTAGE,NHC ADVANTAGE,5422.00,,,,,,,775.0000,17655.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,5442.60,,,,,,,775.0000,17655.0000,fee schedule,"APG 00077 Proc 36902 at $836.60 (Base Rate) * 6.31 (Relative Weight) = $5,278.95 (Total Line Payment) at 100% = $5,278.95... $5,278.95 at 103.1% = $5,442.60 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,SENTARA HEALTH,SENTARA HEALTH,4556.76,,,,,,,775.0000,17655.0000,percent of total billed charges,"25.81% of $17,655.00 in Billed Charges for Rev 361 Proc 36902 = $4,556.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,SENTARA HEALTH,SENTARA MEDICARE,5163.81,,,,,,,775.0000,17655.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",17655.00,,,,,,,775.0000,17655.0000,percent of total billed charges,"100% of $17,655.00 in Billed Charges for Rev 361 Proc 36902 = $17,655.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,775.0000,17655.0000,case rate,"Rev 361 Proc 36902 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,775.0000,17655.0000,case rate,"Rev 361 Proc 36902 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,775.0000,17655.0000,case rate,"Rev 361 Proc 36902 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,775.0000,17655.0000,case rate,"Rev 361 Proc 36902 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,5437.31,,,,,,,775.0000,17655.0000,fee schedule,"APG 00077 Proc 36902 at $836.60 (Base Rate) * 6.31 (Relative Weight) = $5,278.95 (Total Line Payment) at 103% = $5,437.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5163.81,,,,,,,775.0000,17655.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5163.81,,,,,,,775.0000,17655.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,WELLCARE,WELLCARE MEDICAID,17655.00,,,,,,,775.0000,17655.0000,percent of total billed charges,"100% of $17,655.00 in Billed Charges for Rev 361 Proc 36902 = $17,655.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRO NDL/CATH DIALYSIS CIRC W DX ANGIO W TRNSLML BALL ANGIOPLASTY,36902,CPT,361,RC,36100337,CDM,,,,both,,,17655.0000,2648.2500,WELLCARE,WELLCARE MEDICARE,5473.64,,,,,,,775.0000,17655.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,AETNA,AETNA,7538.69,,,,,,,775.0000,17655.0000,percent of total billed charges,"42.7% of $17,655.00 in Billed Charges for Rev 361 Proc 36904 = $7,538.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,5490.10,,,,,,,775.0000,17655.0000,fee schedule,"APG 00077 Proc 36904 at $836.60 (Base Rate) * 6.31 (Relative Weight) = $5,278.95 (Total Line Payment) at 104% = $5,490.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5163.81,,,,,,,775.0000,17655.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,AETNA,AETNA HEALTHCARE MEDICARE,5163.81,,,,,,,775.0000,17655.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,5163.81,,,,,,,775.0000,17655.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,AMBETTER,AMBETTER,11257.11,,,,,,,775.0000,17655.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,5370.36,,,,,,,775.0000,17655.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,BLUE CROSS,ANTHEM EXCHANGE,12713.57,,,,,,,775.0000,17655.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,5437.31,,,,,,,775.0000,17655.0000,fee schedule,"APG 00077 Proc 36904 at $836.60 (Base Rate) * 6.31 (Relative Weight) = $5,278.95 (Total Line Payment) at 103% = $5,437.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,BLUE CROSS,ANTHEM HMO,13507.41,,,,,,,775.0000,17655.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5318.72,,,,,,,775.0000,17655.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",15890.21,,,,,,,775.0000,17655.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,775.0000,17655.0000,case rate,"Rev 361 Proc 36904 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,775.0000,17655.0000,case rate,"Rev 361 Proc 36904 ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,BLUE CROSS,BLUE CROSS MEDICARE,5370.36,,,,,,,775.0000,17655.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,775.0000,17655.0000,case rate,"Rev 361 Proc 36904 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,775.0000,17655.0000,case rate,"Rev 361 Proc 36904 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,17655.0000,case rate,Rev 361 Proc 36904 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,17655.0000,case rate,Rev 361 Proc 36904 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,775.0000,17655.0000,case rate,"Rev 361 Proc 36904 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,775.0000,17655.0000,case rate,"Rev 361 Proc 36904 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,5422.00,,,,,,,775.0000,17655.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,775.0000,17655.0000,case rate,"Rev 361 Proc 36904 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,775.0000,17655.0000,case rate,"Rev 361 Proc 36904 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,5422.00,,,,,,,775.0000,17655.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,15889.50,,,,,,,775.0000,17655.0000,percent of total billed charges,"90% of $17,655.00 in Billed Charges for Rev 361 Proc 36904 = $15,889.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,HUMANA,HUMANA MEDICARE,5163.81,,,,,,,775.0000,17655.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5163.81,,,,,,,775.0000,17655.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,MEDCOST,MEDCOST VHN,8402.01,,,,,,,775.0000,17655.0000,percent of total billed charges,"47.59% of $17,655.00 in Billed Charges for Rev 361 Proc 36904 = $8,402.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,5542.90,,,,,,,775.0000,17655.0000,fee schedule,"APG 00077 Proc 36904 at $836.60 (Base Rate) * 6.31 (Relative Weight) = $5,278.95 (Total Line Payment) at 100% = $5,278.95... $5,278.95 at 105% = $5,542.90 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,5422.00,,,,,,,775.0000,17655.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,5422.00,,,,,,,775.0000,17655.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,NHC ADVANTAGE,NHC ADVANTAGE,5422.00,,,,,,,775.0000,17655.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,5442.60,,,,,,,775.0000,17655.0000,fee schedule,"APG 00077 Proc 36904 at $836.60 (Base Rate) * 6.31 (Relative Weight) = $5,278.95 (Total Line Payment) at 100% = $5,278.95... $5,278.95 at 103.1% = $5,442.60 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,SENTARA HEALTH,SENTARA HEALTH,4556.76,,,,,,,775.0000,17655.0000,percent of total billed charges,"25.81% of $17,655.00 in Billed Charges for Rev 361 Proc 36904 = $4,556.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,SENTARA HEALTH,SENTARA MEDICARE,5163.81,,,,,,,775.0000,17655.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",17655.00,,,,,,,775.0000,17655.0000,percent of total billed charges,"100% of $17,655.00 in Billed Charges for Rev 361 Proc 36904 = $17,655.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,775.0000,17655.0000,case rate,"Rev 361 Proc 36904 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,775.0000,17655.0000,case rate,"Rev 361 Proc 36904 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,775.0000,17655.0000,case rate,"Rev 361 Proc 36904 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,775.0000,17655.0000,case rate,"Rev 361 Proc 36904 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,5437.31,,,,,,,775.0000,17655.0000,fee schedule,"APG 00077 Proc 36904 at $836.60 (Base Rate) * 6.31 (Relative Weight) = $5,278.95 (Total Line Payment) at 103% = $5,437.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5163.81,,,,,,,775.0000,17655.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5163.81,,,,,,,775.0000,17655.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,WELLCARE,WELLCARE MEDICAID,17655.00,,,,,,,775.0000,17655.0000,percent of total billed charges,"100% of $17,655.00 in Billed Charges for Rev 361 Proc 36904 = $17,655.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU TRNSLML MECH THROMBECTOMY/INF THROMBOLYSIS DIALYSIS CIRCUIT,36904,CPT,361,RC,36100339,CDM,,,,both,,,17655.0000,2648.2500,WELLCARE,WELLCARE MEDICARE,5473.64,,,,,,,775.0000,17655.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6462.9000,969.4400,AETNA,AETNA,2759.66,,,,,,,1668.0700,6462.9000,percent of total billed charges,"42.7% of $6,462.90 in Billed Charges for Rev 272 = $2,759.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6462.9000,969.4400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4524.03,,,,,,,1668.0700,6462.9000,percent of total billed charges,"Rev 272 $6,462.90 in Billed Charges at 70% = $4,524.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6462.9000,969.4400,CIGNA HEALTHCARE,CIGNA HMO,2695.03,,,,,,,1668.0700,6462.9000,percent of total billed charges,"41.7% of $6,462.90 in Billed Charges for Rev 272 = $2,695.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6462.9000,969.4400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2998.79,,,,,,,1668.0700,6462.9000,percent of total billed charges,"46.4% of $6,462.90 in Billed Charges for Rev 272 = $2,998.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6462.9000,969.4400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2695.03,,,,,,,1668.0700,6462.9000,percent of total billed charges,"41.7% of $6,462.90 in Billed Charges for Rev 272 = $2,695.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6462.9000,969.4400,CIGNA HEALTHCARE,CIGNA PPO,2695.03,,,,,,,1668.0700,6462.9000,percent of total billed charges,"41.7% of $6,462.90 in Billed Charges for Rev 272 = $2,695.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6462.9000,969.4400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5816.61,,,,,,,1668.0700,6462.9000,percent of total billed charges,"90% of $6,462.90 in Billed Charges for Rev 272 = $5,816.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6462.9000,969.4400,MEDCOST,MEDCOST VHN,3075.69,,,,,,,1668.0700,6462.9000,percent of total billed charges,"47.59% of $6,462.90 in Billed Charges for Rev 272 = $3,075.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6462.9000,969.4400,SENTARA HEALTH,SENTARA HEALTH,1668.07,,,,,,,1668.0700,6462.9000,percent of total billed charges,"25.81% of $6,462.90 in Billed Charges for Rev 272 = $1,668.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6462.9000,969.4400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6462.90,,,,,,,1668.0700,6462.9000,percent of total billed charges,"100% of $6,462.90 in Billed Charges for Rev 272 = $6,462.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6462.9000,969.4400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3231.45,,,,,,,1668.0700,6462.9000,percent of total billed charges,"Rev 272 $6,462.90 in Billed Charges at 50% = $3,231.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6462.9000,969.4400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2087.52,,,,,,,1668.0700,6462.9000,other,"32.3% of $6,462.90 in Billed Charges for Rev 272 = $2,087.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6462.9000,969.4400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1984.11,,,,,,,1668.0700,6462.9000,other,"30.7% of $6,462.90 in Billed Charges for Rev 272 = $1,984.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6462.9000,969.4400,UNITED HEALTHCARE,UNITED HEALTHCARE,2087.52,,,,,,,1668.0700,6462.9000,percent of total billed charges,"32.3% of $6,462.90 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6462.9000,969.4400,WELLCARE,WELLCARE MEDICAID,6462.90,,,,,,,1668.0700,6462.9000,percent of total billed charges,"100% of $6,462.90 in Billed Charges for Rev 272 = $6,462.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,11076.7500,1661.5100,AETNA,AETNA,4729.77,,,,,,,2858.9100,11076.7500,percent of total billed charges,"42.7% of $11,076.75 in Billed Charges for Rev 272 = $4,729.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,11076.7500,1661.5100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7753.73,,,,,,,2858.9100,11076.7500,percent of total billed charges,"Rev 272 $11,076.75 in Billed Charges at 70% = $7,753.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,11076.7500,1661.5100,CIGNA HEALTHCARE,CIGNA HMO,4619.00,,,,,,,2858.9100,11076.7500,percent of total billed charges,"41.7% of $11,076.75 in Billed Charges for Rev 272 = $4,619.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,11076.7500,1661.5100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5139.61,,,,,,,2858.9100,11076.7500,percent of total billed charges,"46.4% of $11,076.75 in Billed Charges for Rev 272 = $5,139.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,11076.7500,1661.5100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4619.00,,,,,,,2858.9100,11076.7500,percent of total billed charges,"41.7% of $11,076.75 in Billed Charges for Rev 272 = $4,619.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,11076.7500,1661.5100,CIGNA HEALTHCARE,CIGNA PPO,4619.00,,,,,,,2858.9100,11076.7500,percent of total billed charges,"41.7% of $11,076.75 in Billed Charges for Rev 272 = $4,619.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,11076.7500,1661.5100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9969.08,,,,,,,2858.9100,11076.7500,percent of total billed charges,"90% of $11,076.75 in Billed Charges for Rev 272 = $9,969.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,11076.7500,1661.5100,MEDCOST,MEDCOST VHN,5271.43,,,,,,,2858.9100,11076.7500,percent of total billed charges,"47.59% of $11,076.75 in Billed Charges for Rev 272 = $5,271.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,11076.7500,1661.5100,SENTARA HEALTH,SENTARA HEALTH,2858.91,,,,,,,2858.9100,11076.7500,percent of total billed charges,"25.81% of $11,076.75 in Billed Charges for Rev 272 = $2,858.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,11076.7500,1661.5100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11076.75,,,,,,,2858.9100,11076.7500,percent of total billed charges,"100% of $11,076.75 in Billed Charges for Rev 272 = $11,076.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,11076.7500,1661.5100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5538.38,,,,,,,2858.9100,11076.7500,percent of total billed charges,"Rev 272 $11,076.75 in Billed Charges at 50% = $5,538.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,11076.7500,1661.5100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3577.79,,,,,,,2858.9100,11076.7500,other,"32.3% of $11,076.75 in Billed Charges for Rev 272 = $3,577.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,11076.7500,1661.5100,UNITED HEALTHCARE,UHC HERITAGE SELECT,3400.56,,,,,,,2858.9100,11076.7500,other,"30.7% of $11,076.75 in Billed Charges for Rev 272 = $3,400.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,11076.7500,1661.5100,UNITED HEALTHCARE,UNITED HEALTHCARE,3577.79,,,,,,,2858.9100,11076.7500,percent of total billed charges,"32.3% of $11,076.75 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 200 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,11076.7500,1661.5100,WELLCARE,WELLCARE MEDICAID,11076.75,,,,,,,2858.9100,11076.7500,percent of total billed charges,"100% of $11,076.75 in Billed Charges for Rev 272 = $11,076.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5254.8800,788.2300,AETNA,AETNA,2243.83,,,,,,,1356.2800,5254.8800,percent of total billed charges,"42.7% of $5,254.88 in Billed Charges for Rev 272 = $2,243.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5254.8800,788.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3678.42,,,,,,,1356.2800,5254.8800,percent of total billed charges,"Rev 272 $5,254.88 in Billed Charges at 70% = $3,678.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5254.8800,788.2300,CIGNA HEALTHCARE,CIGNA HMO,2191.29,,,,,,,1356.2800,5254.8800,percent of total billed charges,"41.7% of $5,254.88 in Billed Charges for Rev 272 = $2,191.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5254.8800,788.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2438.26,,,,,,,1356.2800,5254.8800,percent of total billed charges,"46.4% of $5,254.88 in Billed Charges for Rev 272 = $2,438.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5254.8800,788.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2191.29,,,,,,,1356.2800,5254.8800,percent of total billed charges,"41.7% of $5,254.88 in Billed Charges for Rev 272 = $2,191.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5254.8800,788.2300,CIGNA HEALTHCARE,CIGNA PPO,2191.29,,,,,,,1356.2800,5254.8800,percent of total billed charges,"41.7% of $5,254.88 in Billed Charges for Rev 272 = $2,191.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5254.8800,788.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4729.39,,,,,,,1356.2800,5254.8800,percent of total billed charges,"90% of $5,254.88 in Billed Charges for Rev 272 = $4,729.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5254.8800,788.2300,MEDCOST,MEDCOST VHN,2500.80,,,,,,,1356.2800,5254.8800,percent of total billed charges,"47.59% of $5,254.88 in Billed Charges for Rev 272 = $2,500.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5254.8800,788.2300,SENTARA HEALTH,SENTARA HEALTH,1356.28,,,,,,,1356.2800,5254.8800,percent of total billed charges,"25.81% of $5,254.88 in Billed Charges for Rev 272 = $1,356.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5254.8800,788.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5254.88,,,,,,,1356.2800,5254.8800,percent of total billed charges,"100% of $5,254.88 in Billed Charges for Rev 272 = $5,254.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5254.8800,788.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2627.44,,,,,,,1356.2800,5254.8800,percent of total billed charges,"Rev 272 $5,254.88 in Billed Charges at 50% = $2,627.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5254.8800,788.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1697.33,,,,,,,1356.2800,5254.8800,other,"32.3% of $5,254.88 in Billed Charges for Rev 272 = $1,697.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5254.8800,788.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1613.25,,,,,,,1356.2800,5254.8800,other,"30.7% of $5,254.88 in Billed Charges for Rev 272 = $1,613.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5254.8800,788.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,1697.33,,,,,,,1356.2800,5254.8800,percent of total billed charges,"32.3% of $5,254.88 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 365 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,5254.8800,788.2300,WELLCARE,WELLCARE MEDICAID,5254.88,,,,,,,1356.2800,5254.8800,percent of total billed charges,"100% of $5,254.88 in Billed Charges for Rev 272 = $5,254.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6825.2600,1023.7900,AETNA,AETNA,2914.39,,,,,,,1761.6000,6825.2600,percent of total billed charges,"42.7% of $6,825.26 in Billed Charges for Rev 272 = $2,914.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6825.2600,1023.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4777.68,,,,,,,1761.6000,6825.2600,percent of total billed charges,"Rev 272 $6,825.26 in Billed Charges at 70% = $4,777.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6825.2600,1023.7900,CIGNA HEALTHCARE,CIGNA HMO,2846.13,,,,,,,1761.6000,6825.2600,percent of total billed charges,"41.7% of $6,825.26 in Billed Charges for Rev 272 = $2,846.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6825.2600,1023.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3166.92,,,,,,,1761.6000,6825.2600,percent of total billed charges,"46.4% of $6,825.26 in Billed Charges for Rev 272 = $3,166.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6825.2600,1023.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2846.13,,,,,,,1761.6000,6825.2600,percent of total billed charges,"41.7% of $6,825.26 in Billed Charges for Rev 272 = $2,846.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6825.2600,1023.7900,CIGNA HEALTHCARE,CIGNA PPO,2846.13,,,,,,,1761.6000,6825.2600,percent of total billed charges,"41.7% of $6,825.26 in Billed Charges for Rev 272 = $2,846.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6825.2600,1023.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6142.73,,,,,,,1761.6000,6825.2600,percent of total billed charges,"90% of $6,825.26 in Billed Charges for Rev 272 = $6,142.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6825.2600,1023.7900,MEDCOST,MEDCOST VHN,3248.14,,,,,,,1761.6000,6825.2600,percent of total billed charges,"47.59% of $6,825.26 in Billed Charges for Rev 272 = $3,248.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6825.2600,1023.7900,SENTARA HEALTH,SENTARA HEALTH,1761.60,,,,,,,1761.6000,6825.2600,percent of total billed charges,"25.81% of $6,825.26 in Billed Charges for Rev 272 = $1,761.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6825.2600,1023.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6825.26,,,,,,,1761.6000,6825.2600,percent of total billed charges,"100% of $6,825.26 in Billed Charges for Rev 272 = $6,825.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6825.2600,1023.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3412.63,,,,,,,1761.6000,6825.2600,percent of total billed charges,"Rev 272 $6,825.26 in Billed Charges at 50% = $3,412.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6825.2600,1023.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2204.56,,,,,,,1761.6000,6825.2600,other,"32.3% of $6,825.26 in Billed Charges for Rev 272 = $2,204.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6825.2600,1023.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,2095.35,,,,,,,1761.6000,6825.2600,other,"30.7% of $6,825.26 in Billed Charges for Rev 272 = $2,095.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6825.2600,1023.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,2204.56,,,,,,,1761.6000,6825.2600,percent of total billed charges,"32.3% of $6,825.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,6825.2600,1023.7900,WELLCARE,WELLCARE MEDICAID,6825.26,,,,,,,1761.6000,6825.2600,percent of total billed charges,"100% of $6,825.26 in Billed Charges for Rev 272 = $6,825.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,9061.0400,1359.1600,AETNA,AETNA,3869.06,,,,,,,2338.6500,9061.0400,percent of total billed charges,"42.7% of $9,061.04 in Billed Charges for Rev 272 = $3,869.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,9061.0400,1359.1600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6342.73,,,,,,,2338.6500,9061.0400,percent of total billed charges,"Rev 272 $9,061.04 in Billed Charges at 70% = $6,342.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,9061.0400,1359.1600,CIGNA HEALTHCARE,CIGNA HMO,3778.45,,,,,,,2338.6500,9061.0400,percent of total billed charges,"41.7% of $9,061.04 in Billed Charges for Rev 272 = $3,778.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,9061.0400,1359.1600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4204.32,,,,,,,2338.6500,9061.0400,percent of total billed charges,"46.4% of $9,061.04 in Billed Charges for Rev 272 = $4,204.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,9061.0400,1359.1600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3778.45,,,,,,,2338.6500,9061.0400,percent of total billed charges,"41.7% of $9,061.04 in Billed Charges for Rev 272 = $3,778.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,9061.0400,1359.1600,CIGNA HEALTHCARE,CIGNA PPO,3778.45,,,,,,,2338.6500,9061.0400,percent of total billed charges,"41.7% of $9,061.04 in Billed Charges for Rev 272 = $3,778.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,9061.0400,1359.1600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8154.94,,,,,,,2338.6500,9061.0400,percent of total billed charges,"90% of $9,061.04 in Billed Charges for Rev 272 = $8,154.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,9061.0400,1359.1600,MEDCOST,MEDCOST VHN,4312.15,,,,,,,2338.6500,9061.0400,percent of total billed charges,"47.59% of $9,061.04 in Billed Charges for Rev 272 = $4,312.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,9061.0400,1359.1600,SENTARA HEALTH,SENTARA HEALTH,2338.65,,,,,,,2338.6500,9061.0400,percent of total billed charges,"25.81% of $9,061.04 in Billed Charges for Rev 272 = $2,338.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,9061.0400,1359.1600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9061.04,,,,,,,2338.6500,9061.0400,percent of total billed charges,"100% of $9,061.04 in Billed Charges for Rev 272 = $9,061.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,9061.0400,1359.1600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4530.52,,,,,,,2338.6500,9061.0400,percent of total billed charges,"Rev 272 $9,061.04 in Billed Charges at 50% = $4,530.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,9061.0400,1359.1600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2926.72,,,,,,,2338.6500,9061.0400,other,"32.3% of $9,061.04 in Billed Charges for Rev 272 = $2,926.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,9061.0400,1359.1600,UNITED HEALTHCARE,UHC HERITAGE SELECT,2781.74,,,,,,,2338.6500,9061.0400,other,"30.7% of $9,061.04 in Billed Charges for Rev 272 = $2,781.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,9061.0400,1359.1600,UNITED HEALTHCARE,UNITED HEALTHCARE,2926.72,,,,,,,2338.6500,9061.0400,percent of total billed charges,"32.3% of $9,061.04 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBER MOSES 550 HOLMIUM LASER,272,RC,27200002,CDM,,,,,,both,,,9061.0400,1359.1600,WELLCARE,WELLCARE MEDICAID,9061.04,,,,,,,2338.6500,9061.0400,percent of total billed charges,"100% of $9,061.04 in Billed Charges for Rev 272 = $9,061.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GENESYS HTA PROCERVA PROCEDURE,272,RC,27200002,CDM,,,,,,both,,,15761.8500,2364.2800,AETNA,AETNA,6730.31,,,,,,,4068.1300,15761.8500,percent of total billed charges,"42.7% of $15,761.85 in Billed Charges for Rev 272 = $6,730.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GENESYS HTA PROCERVA PROCEDURE,272,RC,27200002,CDM,,,,,,both,,,15761.8500,2364.2800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11033.30,,,,,,,4068.1300,15761.8500,percent of total billed charges,"Rev 272 $15,761.85 in Billed Charges at 70% = $11,033.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GENESYS HTA PROCERVA PROCEDURE,272,RC,27200002,CDM,,,,,,both,,,15761.8500,2364.2800,CIGNA HEALTHCARE,CIGNA HMO,6572.69,,,,,,,4068.1300,15761.8500,percent of total billed charges,"41.7% of $15,761.85 in Billed Charges for Rev 272 = $6,572.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GENESYS HTA PROCERVA PROCEDURE,272,RC,27200002,CDM,,,,,,both,,,15761.8500,2364.2800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7313.50,,,,,,,4068.1300,15761.8500,percent of total billed charges,"46.4% of $15,761.85 in Billed Charges for Rev 272 = $7,313.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GENESYS HTA PROCERVA PROCEDURE,272,RC,27200002,CDM,,,,,,both,,,15761.8500,2364.2800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6572.69,,,,,,,4068.1300,15761.8500,percent of total billed charges,"41.7% of $15,761.85 in Billed Charges for Rev 272 = $6,572.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GENESYS HTA PROCERVA PROCEDURE,272,RC,27200002,CDM,,,,,,both,,,15761.8500,2364.2800,CIGNA HEALTHCARE,CIGNA PPO,6572.69,,,,,,,4068.1300,15761.8500,percent of total billed charges,"41.7% of $15,761.85 in Billed Charges for Rev 272 = $6,572.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GENESYS HTA PROCERVA PROCEDURE,272,RC,27200002,CDM,,,,,,both,,,15761.8500,2364.2800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,14185.67,,,,,,,4068.1300,15761.8500,percent of total billed charges,"90% of $15,761.85 in Billed Charges for Rev 272 = $14,185.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GENESYS HTA PROCERVA PROCEDURE,272,RC,27200002,CDM,,,,,,both,,,15761.8500,2364.2800,MEDCOST,MEDCOST VHN,7501.06,,,,,,,4068.1300,15761.8500,percent of total billed charges,"47.59% of $15,761.85 in Billed Charges for Rev 272 = $7,501.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GENESYS HTA PROCERVA PROCEDURE,272,RC,27200002,CDM,,,,,,both,,,15761.8500,2364.2800,SENTARA HEALTH,SENTARA HEALTH,4068.13,,,,,,,4068.1300,15761.8500,percent of total billed charges,"25.81% of $15,761.85 in Billed Charges for Rev 272 = $4,068.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GENESYS HTA PROCERVA PROCEDURE,272,RC,27200002,CDM,,,,,,both,,,15761.8500,2364.2800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15761.85,,,,,,,4068.1300,15761.8500,percent of total billed charges,"100% of $15,761.85 in Billed Charges for Rev 272 = $15,761.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GENESYS HTA PROCERVA PROCEDURE,272,RC,27200002,CDM,,,,,,both,,,15761.8500,2364.2800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7880.93,,,,,,,4068.1300,15761.8500,percent of total billed charges,"Rev 272 $15,761.85 in Billed Charges at 50% = $7,880.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GENESYS HTA PROCERVA PROCEDURE,272,RC,27200002,CDM,,,,,,both,,,15761.8500,2364.2800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5091.08,,,,,,,4068.1300,15761.8500,other,"32.3% of $15,761.85 in Billed Charges for Rev 272 = $5,091.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GENESYS HTA PROCERVA PROCEDURE,272,RC,27200002,CDM,,,,,,both,,,15761.8500,2364.2800,UNITED HEALTHCARE,UHC HERITAGE SELECT,4838.89,,,,,,,4068.1300,15761.8500,other,"30.7% of $15,761.85 in Billed Charges for Rev 272 = $4,838.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GENESYS HTA PROCERVA PROCEDURE,272,RC,27200002,CDM,,,,,,both,,,15761.8500,2364.2800,UNITED HEALTHCARE,UNITED HEALTHCARE,5091.08,,,,,,,4068.1300,15761.8500,percent of total billed charges,"32.3% of $15,761.85 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GENESYS HTA PROCERVA PROCEDURE,272,RC,27200002,CDM,,,,,,both,,,15761.8500,2364.2800,WELLCARE,WELLCARE MEDICAID,15761.85,,,,,,,4068.1300,15761.8500,percent of total billed charges,"100% of $15,761.85 in Billed Charges for Rev 272 = $15,761.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,AETNA,AETNA,1969.32,,,,,,,704.0000,4612.0000,percent of total billed charges,"42.7% of $4,612.00 in Billed Charges for Rev 361 Proc 47000 = $1,969.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1054.26,,,,,,,704.0000,4612.0000,fee schedule,"APG 00150 Proc 47000 at $836.60 (Base Rate) * 1.2117 (Relative Weight) = $1,013.71 (Total Line Payment) at 104% = $1,054.26. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,704.0000,4612.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,704.0000,4612.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,704.0000,4612.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,AMBETTER,AMBETTER,3266.63,,,,,,,704.0000,4612.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,704.0000,4612.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,BLUE CROSS,ANTHEM EXCHANGE,3689.28,,,,,,,704.0000,4612.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1044.12,,,,,,,704.0000,4612.0000,fee schedule,"APG 00150 Proc 47000 at $836.60 (Base Rate) * 1.2117 (Relative Weight) = $1,013.71 (Total Line Payment) at 103% = $1,044.12. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,BLUE CROSS,ANTHEM HMO,3919.64,,,,,,,704.0000,4612.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,704.0000,4612.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4611.09,,,,,,,704.0000,4612.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,704.0000,4612.0000,case rate,Rev 361 Proc 47000 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,704.0000,4612.0000,case rate,"Rev 361 Proc 47000 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,704.0000,4612.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,704.0000,4612.0000,case rate,"Rev 361 Proc 47000 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,704.0000,4612.0000,case rate,"Rev 361 Proc 47000 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,704.0000,4612.0000,case rate,Rev 361 Proc 47000 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,704.0000,4612.0000,case rate,Rev 361 Proc 47000 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,704.0000,4612.0000,case rate,"Rev 361 Proc 47000 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,704.0000,4612.0000,case rate,"Rev 361 Proc 47000 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,704.0000,4612.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,704.0000,4612.0000,case rate,"Rev 361 Proc 47000 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,704.0000,4612.0000,case rate,"Rev 361 Proc 47000 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,704.0000,4612.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4150.80,,,,,,,704.0000,4612.0000,percent of total billed charges,"90% of $4,612.00 in Billed Charges for Rev 361 Proc 47000 = $4,150.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,704.0000,4612.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,704.0000,4612.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,MEDCOST,MEDCOST VHN,2194.85,,,,,,,704.0000,4612.0000,percent of total billed charges,"47.59% of $4,612.00 in Billed Charges for Rev 361 Proc 47000 = $2,194.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1064.40,,,,,,,704.0000,4612.0000,fee schedule,"APG 00150 Proc 47000 at $836.60 (Base Rate) * 1.2117 (Relative Weight) = $1,013.71 (Total Line Payment) at 100% = $1,013.71... $1,013.71 at 105% = $1,064.40 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,704.0000,4612.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,704.0000,4612.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,704.0000,4612.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1045.14,,,,,,,704.0000,4612.0000,fee schedule,"APG 00150 Proc 47000 at $836.60 (Base Rate) * 1.2117 (Relative Weight) = $1,013.71 (Total Line Payment) at 100% = $1,013.71... $1,013.71 at 103.1% = $1,045.14 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,SENTARA HEALTH,SENTARA HEALTH,1190.36,,,,,,,704.0000,4612.0000,percent of total billed charges,"25.81% of $4,612.00 in Billed Charges for Rev 361 Proc 47000 = $1,190.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,704.0000,4612.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4612.00,,,,,,,704.0000,4612.0000,percent of total billed charges,"100% of $4,612.00 in Billed Charges for Rev 361 Proc 47000 = $4,612.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,704.0000,4612.0000,case rate,Rev 361 Proc 47000 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,704.0000,4612.0000,case rate,"Rev 361 Proc 47000 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,704.0000,4612.0000,case rate,"Rev 361 Proc 47000 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,704.0000,4612.0000,case rate,"Rev 361 Proc 47000 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1044.12,,,,,,,704.0000,4612.0000,fee schedule,"APG 00150 Proc 47000 at $836.60 (Base Rate) * 1.2117 (Relative Weight) = $1,013.71 (Total Line Payment) at 103% = $1,044.12. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,704.0000,4612.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,704.0000,4612.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,WELLCARE,WELLCARE MEDICAID,4612.00,,,,,,,704.0000,4612.0000,percent of total billed charges,"100% of $4,612.00 in Billed Charges for Rev 361 Proc 47000 = $4,612.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX LIVER PERC,47000,CPT,361,RC,36100105,CDM,,,,both,,,4612.0000,691.8000,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,704.0000,4612.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,AETNA,AETNA,2924.10,,,,,,,578.0000,7081.5200,percent of total billed charges,"42.7% of $6,848.00 in Billed Charges for Rev 361 Proc 47531 = $2,924.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2491.25,,,,,,,578.0000,7081.5200,fee schedule,"APG 00279 Proc 47531 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 104% = $2,491.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3248.41,,,,,,,578.0000,7081.5200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,AETNA,AETNA HEALTHCARE MEDICARE,3248.41,,,,,,,578.0000,7081.5200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,3248.41,,,,,,,578.0000,7081.5200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,AMBETTER,AMBETTER,7081.52,,,,,,,578.0000,7081.5200,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3378.34,,,,,,,578.0000,7081.5200,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,BLUE CROSS,ANTHEM EXCHANGE,6848.00,,,,,,,578.0000,7081.5200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2467.30,,,,,,,578.0000,7081.5200,fee schedule,"APG 00279 Proc 47531 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 103% = $2,467.30. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,BLUE CROSS,ANTHEM HMO,6848.00,,,,,,,578.0000,7081.5200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3345.86,,,,,,,578.0000,7081.5200,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",6848.00,,,,,,,578.0000,7081.5200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,578.0000,7081.5200,case rate,"Rev 361 Proc 47531 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,578.0000,7081.5200,case rate,"Rev 361 Proc 47531 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,BLUE CROSS,BLUE CROSS MEDICARE,3378.34,,,,,,,578.0000,7081.5200,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,578.0000,7081.5200,case rate,"Rev 361 Proc 47531 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,578.0000,7081.5200,case rate,"Rev 361 Proc 47531 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,7081.5200,case rate,Rev 361 Proc 47531 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,7081.5200,case rate,Rev 361 Proc 47531 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,578.0000,7081.5200,case rate,"Rev 361 Proc 47531 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,578.0000,7081.5200,case rate,"Rev 361 Proc 47531 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,3410.83,,,,,,,578.0000,7081.5200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,578.0000,7081.5200,case rate,"Rev 361 Proc 47531 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,578.0000,7081.5200,case rate,"Rev 361 Proc 47531 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3410.83,,,,,,,578.0000,7081.5200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6163.20,,,,,,,578.0000,7081.5200,percent of total billed charges,"90% of $6,848.00 in Billed Charges for Rev 361 Proc 47531 = $6,163.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,HUMANA,HUMANA MEDICARE,3248.41,,,,,,,578.0000,7081.5200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3248.41,,,,,,,578.0000,7081.5200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,MEDCOST,MEDCOST VHN,3258.96,,,,,,,578.0000,7081.5200,percent of total billed charges,"47.59% of $6,848.00 in Billed Charges for Rev 361 Proc 47531 = $3,258.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2515.21,,,,,,,578.0000,7081.5200,fee schedule,"APG 00279 Proc 47531 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 100% = $2,395.44... $2,395.44 at 105% = $2,515.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3410.83,,,,,,,578.0000,7081.5200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3410.83,,,,,,,578.0000,7081.5200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,NHC ADVANTAGE,NHC ADVANTAGE,3410.83,,,,,,,578.0000,7081.5200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2469.70,,,,,,,578.0000,7081.5200,fee schedule,"APG 00279 Proc 47531 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 100% = $2,395.44... $2,395.44 at 103.1% = $2,469.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,SENTARA HEALTH,SENTARA HEALTH,1767.47,,,,,,,578.0000,7081.5200,percent of total billed charges,"25.81% of $6,848.00 in Billed Charges for Rev 361 Proc 47531 = $1,767.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,SENTARA HEALTH,SENTARA MEDICARE,3248.41,,,,,,,578.0000,7081.5200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6848.00,,,,,,,578.0000,7081.5200,percent of total billed charges,"100% of $6,848.00 in Billed Charges for Rev 361 Proc 47531 = $6,848.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,578.0000,7081.5200,case rate,"Rev 361 Proc 47531 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,578.0000,7081.5200,case rate,"Rev 361 Proc 47531 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,578.0000,7081.5200,case rate,"Rev 361 Proc 47531 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,578.0000,7081.5200,case rate,"Rev 361 Proc 47531 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2467.30,,,,,,,578.0000,7081.5200,fee schedule,"APG 00279 Proc 47531 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 103% = $2,467.30. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3248.41,,,,,,,578.0000,7081.5200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3248.41,,,,,,,578.0000,7081.5200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,WELLCARE,WELLCARE MEDICAID,6848.00,,,,,,,578.0000,7081.5200,percent of total billed charges,"100% of $6,848.00 in Billed Charges for Rev 361 Proc 47531 = $6,848.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ CHOLANGIOGRAM PERCU INCL IMG RAD S&I EXISTING ACCESS,47531,CPT,361,RC,36100301,CDM,,,,both,,,6848.0000,1027.2000,WELLCARE,WELLCARE MEDICARE,3443.31,,,,,,,578.0000,7081.5200,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,AETNA,AETNA,3147.84,,,,,,,775.0000,7372.0000,percent of total billed charges,"42.7% of $7,372.00 in Billed Charges for Rev 361 Proc 47535 = $3,147.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3288.49,,,,,,,775.0000,7372.0000,fee schedule,"APG 00151 Proc 47535 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 104% = $3,288.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3248.41,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,AETNA,AETNA HEALTHCARE MEDICARE,3248.41,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,3248.41,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,AMBETTER,AMBETTER,7081.52,,,,,,,775.0000,7372.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3378.34,,,,,,,775.0000,7372.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,ANTHEM EXCHANGE,7372.00,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3256.87,,,,,,,775.0000,7372.0000,fee schedule,"APG 00151 Proc 47535 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 103% = $3,256.87. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,ANTHEM HMO,7372.00,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3345.86,,,,,,,775.0000,7372.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",7372.00,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 47535 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 47535 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,BLUE CROSS MEDICARE,3378.34,,,,,,,775.0000,7372.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 47535 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 47535 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,7372.0000,case rate,Rev 361 Proc 47535 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,7372.0000,case rate,Rev 361 Proc 47535 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,CIGNA HEALTHCARE,CIGNA HMO,7372.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 47535 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total (Limited to $7,372.00 in Billed Charges - $0.00 in ASG Allowed Amount = $7,372.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6048.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 47535 ASG Rate of $6,048.00 at 100% of $6,048.00 = $6,048.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,3410.83,,,,,,,775.0000,7372.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7372.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 47535 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total (Limited to $7,372.00 in Billed Charges - $0.00 in ASG Allowed Amount = $7,372.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,CIGNA HEALTHCARE,CIGNA PPO,7372.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 47535 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total (Limited to $7,372.00 in Billed Charges - $0.00 in ASG Allowed Amount = $7,372.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3410.83,,,,,,,775.0000,7372.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6634.80,,,,,,,775.0000,7372.0000,percent of total billed charges,"90% of $7,372.00 in Billed Charges for Rev 361 Proc 47535 = $6,634.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,HUMANA,HUMANA MEDICARE,3248.41,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3248.41,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,MEDCOST,MEDCOST VHN,3508.33,,,,,,,775.0000,7372.0000,percent of total billed charges,"47.59% of $7,372.00 in Billed Charges for Rev 361 Proc 47535 = $3,508.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3320.11,,,,,,,775.0000,7372.0000,fee schedule,"APG 00151 Proc 47535 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 100% = $3,162.01... $3,162.01 at 105% = $3,320.11 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3410.83,,,,,,,775.0000,7372.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3410.83,,,,,,,775.0000,7372.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,NHC ADVANTAGE,NHC ADVANTAGE,3410.83,,,,,,,775.0000,7372.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3260.03,,,,,,,775.0000,7372.0000,fee schedule,"APG 00151 Proc 47535 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 100% = $3,162.01... $3,162.01 at 103.1% = $3,260.03 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,SENTARA HEALTH,SENTARA HEALTH,1902.71,,,,,,,775.0000,7372.0000,percent of total billed charges,"25.81% of $7,372.00 in Billed Charges for Rev 361 Proc 47535 = $1,902.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,SENTARA HEALTH,SENTARA MEDICARE,3248.41,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7372.00,,,,,,,775.0000,7372.0000,percent of total billed charges,"100% of $7,372.00 in Billed Charges for Rev 361 Proc 47535 = $7,372.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 47535 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 47535 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 47535 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 47535 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3256.87,,,,,,,775.0000,7372.0000,fee schedule,"APG 00151 Proc 47535 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 103% = $3,256.87. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3248.41,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3248.41,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,WELLCARE,WELLCARE MEDICAID,7372.00,,,,,,,775.0000,7372.0000,percent of total billed charges,"100% of $7,372.00 in Billed Charges for Rev 361 Proc 47535 = $7,372.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONVERS BILIARY DRAIN CATH EXT TO INT-EXT INCL IMG RAD S&I,47535,CPT,361,RC,36100304,CDM,,,,both,,,7372.0000,1105.8000,WELLCARE,WELLCARE MEDICARE,3443.31,,,,,,,775.0000,7372.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GLIDESCOPE ULTRASLIM LINE 2.8,272,RC,27200002,CDM,,,,,,both,,,3173.5300,476.0300,AETNA,AETNA,1355.10,,,,,,,819.0900,3173.5300,percent of total billed charges,"42.7% of $3,173.53 in Billed Charges for Rev 272 = $1,355.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE ULTRASLIM LINE 2.8,272,RC,27200002,CDM,,,,,,both,,,3173.5300,476.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2221.47,,,,,,,819.0900,3173.5300,percent of total billed charges,"Rev 272 $3,173.53 in Billed Charges at 70% = $2,221.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE ULTRASLIM LINE 2.8,272,RC,27200002,CDM,,,,,,both,,,3173.5300,476.0300,CIGNA HEALTHCARE,CIGNA HMO,1323.36,,,,,,,819.0900,3173.5300,percent of total billed charges,"41.7% of $3,173.53 in Billed Charges for Rev 272 = $1,323.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE ULTRASLIM LINE 2.8,272,RC,27200002,CDM,,,,,,both,,,3173.5300,476.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1472.52,,,,,,,819.0900,3173.5300,percent of total billed charges,"46.4% of $3,173.53 in Billed Charges for Rev 272 = $1,472.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE ULTRASLIM LINE 2.8,272,RC,27200002,CDM,,,,,,both,,,3173.5300,476.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1323.36,,,,,,,819.0900,3173.5300,percent of total billed charges,"41.7% of $3,173.53 in Billed Charges for Rev 272 = $1,323.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE ULTRASLIM LINE 2.8,272,RC,27200002,CDM,,,,,,both,,,3173.5300,476.0300,CIGNA HEALTHCARE,CIGNA PPO,1323.36,,,,,,,819.0900,3173.5300,percent of total billed charges,"41.7% of $3,173.53 in Billed Charges for Rev 272 = $1,323.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE ULTRASLIM LINE 2.8,272,RC,27200002,CDM,,,,,,both,,,3173.5300,476.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2856.18,,,,,,,819.0900,3173.5300,percent of total billed charges,"90% of $3,173.53 in Billed Charges for Rev 272 = $2,856.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE ULTRASLIM LINE 2.8,272,RC,27200002,CDM,,,,,,both,,,3173.5300,476.0300,MEDCOST,MEDCOST VHN,1510.28,,,,,,,819.0900,3173.5300,percent of total billed charges,"47.59% of $3,173.53 in Billed Charges for Rev 272 = $1,510.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE ULTRASLIM LINE 2.8,272,RC,27200002,CDM,,,,,,both,,,3173.5300,476.0300,SENTARA HEALTH,SENTARA HEALTH,819.09,,,,,,,819.0900,3173.5300,percent of total billed charges,"25.81% of $3,173.53 in Billed Charges for Rev 272 = $819.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE ULTRASLIM LINE 2.8,272,RC,27200002,CDM,,,,,,both,,,3173.5300,476.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3173.53,,,,,,,819.0900,3173.5300,percent of total billed charges,"100% of $3,173.53 in Billed Charges for Rev 272 = $3,173.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE ULTRASLIM LINE 2.8,272,RC,27200002,CDM,,,,,,both,,,3173.5300,476.0300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1586.77,,,,,,,819.0900,3173.5300,percent of total billed charges,"Rev 272 $3,173.53 in Billed Charges at 50% = $1,586.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE ULTRASLIM LINE 2.8,272,RC,27200002,CDM,,,,,,both,,,3173.5300,476.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1025.05,,,,,,,819.0900,3173.5300,other,"32.3% of $3,173.53 in Billed Charges for Rev 272 = $1,025.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GLIDESCOPE ULTRASLIM LINE 2.8,272,RC,27200002,CDM,,,,,,both,,,3173.5300,476.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,974.27,,,,,,,819.0900,3173.5300,other,"30.7% of $3,173.53 in Billed Charges for Rev 272 = $974.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GLIDESCOPE ULTRASLIM LINE 2.8,272,RC,27200002,CDM,,,,,,both,,,3173.5300,476.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,1025.05,,,,,,,819.0900,3173.5300,percent of total billed charges,"32.3% of $3,173.53 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESCOPE ULTRASLIM LINE 2.8,272,RC,27200002,CDM,,,,,,both,,,3173.5300,476.0300,WELLCARE,WELLCARE MEDICAID,3173.53,,,,,,,819.0900,3173.5300,percent of total billed charges,"100% of $3,173.53 in Billed Charges for Rev 272 = $3,173.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLIDESHEATH SLENDER SS 6FR 16CM 021GW,272,RC,27200002,CDM,,,,,,both,,,711.8700,106.7800,AETNA,AETNA,303.97,,,,,,,183.7300,711.8700,percent of total billed charges,42.7% of $711.87 in Billed Charges for Rev 272 = $303.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GLIDESHEATH SLENDER SS 6FR 16CM 021GW,272,RC,27200002,CDM,,,,,,both,,,711.8700,106.7800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,498.31,,,,,,,183.7300,711.8700,percent of total billed charges,Rev 272 $711.87 in Billed Charges at 70% = $498.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GLIDESHEATH SLENDER SS 6FR 16CM 021GW,272,RC,27200002,CDM,,,,,,both,,,711.8700,106.7800,CIGNA HEALTHCARE,CIGNA HMO,296.85,,,,,,,183.7300,711.8700,percent of total billed charges,41.7% of $711.87 in Billed Charges for Rev 272 = $296.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GLIDESHEATH SLENDER SS 6FR 16CM 021GW,272,RC,27200002,CDM,,,,,,both,,,711.8700,106.7800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,330.31,,,,,,,183.7300,711.8700,percent of total billed charges,46.4% of $711.87 in Billed Charges for Rev 272 = $330.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GLIDESHEATH SLENDER SS 6FR 16CM 021GW,272,RC,27200002,CDM,,,,,,both,,,711.8700,106.7800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,296.85,,,,,,,183.7300,711.8700,percent of total billed charges,41.7% of $711.87 in Billed Charges for Rev 272 = $296.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GLIDESHEATH SLENDER SS 6FR 16CM 021GW,272,RC,27200002,CDM,,,,,,both,,,711.8700,106.7800,CIGNA HEALTHCARE,CIGNA PPO,296.85,,,,,,,183.7300,711.8700,percent of total billed charges,41.7% of $711.87 in Billed Charges for Rev 272 = $296.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GLIDESHEATH SLENDER SS 6FR 16CM 021GW,272,RC,27200002,CDM,,,,,,both,,,711.8700,106.7800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,640.68,,,,,,,183.7300,711.8700,percent of total billed charges,90% of $711.87 in Billed Charges for Rev 272 = $640.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GLIDESHEATH SLENDER SS 6FR 16CM 021GW,272,RC,27200002,CDM,,,,,,both,,,711.8700,106.7800,MEDCOST,MEDCOST VHN,338.78,,,,,,,183.7300,711.8700,percent of total billed charges,47.59% of $711.87 in Billed Charges for Rev 272 = $338.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GLIDESHEATH SLENDER SS 6FR 16CM 021GW,272,RC,27200002,CDM,,,,,,both,,,711.8700,106.7800,SENTARA HEALTH,SENTARA HEALTH,183.73,,,,,,,183.7300,711.8700,percent of total billed charges,25.81% of $711.87 in Billed Charges for Rev 272 = $183.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GLIDESHEATH SLENDER SS 6FR 16CM 021GW,272,RC,27200002,CDM,,,,,,both,,,711.8700,106.7800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",711.87,,,,,,,183.7300,711.8700,percent of total billed charges,100% of $711.87 in Billed Charges for Rev 272 = $711.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GLIDESHEATH SLENDER SS 6FR 16CM 021GW,272,RC,27200002,CDM,,,,,,both,,,711.8700,106.7800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,355.94,,,,,,,183.7300,711.8700,percent of total billed charges,Rev 272 $711.87 in Billed Charges at 50% = $355.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GLIDESHEATH SLENDER SS 6FR 16CM 021GW,272,RC,27200002,CDM,,,,,,both,,,711.8700,106.7800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,229.93,,,,,,,183.7300,711.8700,other,32.3% of $711.87 in Billed Charges for Rev 272 = $229.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GLIDESHEATH SLENDER SS 6FR 16CM 021GW,272,RC,27200002,CDM,,,,,,both,,,711.8700,106.7800,UNITED HEALTHCARE,UHC HERITAGE SELECT,218.54,,,,,,,183.7300,711.8700,other,30.7% of $711.87 in Billed Charges for Rev 272 = $218.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GLIDESHEATH SLENDER SS 6FR 16CM 021GW,272,RC,27200002,CDM,,,,,,both,,,711.8700,106.7800,UNITED HEALTHCARE,UNITED HEALTHCARE,229.93,,,,,,,183.7300,711.8700,percent of total billed charges,32.3% of $711.87 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GLIDESHEATH SLENDER SS 6FR 16CM 021GW,272,RC,27200002,CDM,,,,,,both,,,711.8700,106.7800,WELLCARE,WELLCARE MEDICAID,711.87,,,,,,,183.7300,711.8700,percent of total billed charges,100% of $711.87 in Billed Charges for Rev 272 = $711.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GLOVE DRESSING WOUND BURN SZ5,272,RC,,,,,,,,both,,,3218.7400,482.8100,AETNA,AETNA,1374.40,,,,,,,830.7600,3218.7400,percent of total billed charges,"42.7% of $3,218.74 in Billed Charges for Rev 272 = $1,374.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLOVE DRESSING WOUND BURN SZ5,272,RC,,,,,,,,both,,,3218.7400,482.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2253.12,,,,,,,830.7600,3218.7400,percent of total billed charges,"Rev 272 $3,218.74 in Billed Charges at 70% = $2,253.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLOVE DRESSING WOUND BURN SZ5,272,RC,,,,,,,,both,,,3218.7400,482.8100,CIGNA HEALTHCARE,CIGNA HMO,1342.21,,,,,,,830.7600,3218.7400,percent of total billed charges,"41.7% of $3,218.74 in Billed Charges for Rev 272 = $1,342.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLOVE DRESSING WOUND BURN SZ5,272,RC,,,,,,,,both,,,3218.7400,482.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1493.50,,,,,,,830.7600,3218.7400,percent of total billed charges,"46.4% of $3,218.74 in Billed Charges for Rev 272 = $1,493.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLOVE DRESSING WOUND BURN SZ5,272,RC,,,,,,,,both,,,3218.7400,482.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1342.21,,,,,,,830.7600,3218.7400,percent of total billed charges,"41.7% of $3,218.74 in Billed Charges for Rev 272 = $1,342.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLOVE DRESSING WOUND BURN SZ5,272,RC,,,,,,,,both,,,3218.7400,482.8100,CIGNA HEALTHCARE,CIGNA PPO,1342.21,,,,,,,830.7600,3218.7400,percent of total billed charges,"41.7% of $3,218.74 in Billed Charges for Rev 272 = $1,342.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLOVE DRESSING WOUND BURN SZ5,272,RC,,,,,,,,both,,,3218.7400,482.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2896.87,,,,,,,830.7600,3218.7400,percent of total billed charges,"90% of $3,218.74 in Billed Charges for Rev 272 = $2,896.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLOVE DRESSING WOUND BURN SZ5,272,RC,,,,,,,,both,,,3218.7400,482.8100,MEDCOST,MEDCOST VHN,1531.80,,,,,,,830.7600,3218.7400,percent of total billed charges,"47.59% of $3,218.74 in Billed Charges for Rev 272 = $1,531.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLOVE DRESSING WOUND BURN SZ5,272,RC,,,,,,,,both,,,3218.7400,482.8100,SENTARA HEALTH,SENTARA HEALTH,830.76,,,,,,,830.7600,3218.7400,percent of total billed charges,"25.81% of $3,218.74 in Billed Charges for Rev 272 = $830.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLOVE DRESSING WOUND BURN SZ5,272,RC,,,,,,,,both,,,3218.7400,482.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3218.74,,,,,,,830.7600,3218.7400,percent of total billed charges,"100% of $3,218.74 in Billed Charges for Rev 272 = $3,218.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLOVE DRESSING WOUND BURN SZ5,272,RC,,,,,,,,both,,,3218.7400,482.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1609.37,,,,,,,830.7600,3218.7400,percent of total billed charges,"Rev 272 $3,218.74 in Billed Charges at 50% = $1,609.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLOVE DRESSING WOUND BURN SZ5,272,RC,,,,,,,,both,,,3218.7400,482.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1039.65,,,,,,,830.7600,3218.7400,other,"32.3% of $3,218.74 in Billed Charges for Rev 272 = $1,039.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GLOVE DRESSING WOUND BURN SZ5,272,RC,,,,,,,,both,,,3218.7400,482.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,988.15,,,,,,,830.7600,3218.7400,other,"30.7% of $3,218.74 in Billed Charges for Rev 272 = $988.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GLOVE DRESSING WOUND BURN SZ5,272,RC,,,,,,,,both,,,3218.7400,482.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,1039.65,,,,,,,830.7600,3218.7400,percent of total billed charges,"32.3% of $3,218.74 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GLOVE DRESSING WOUND BURN SZ5,272,RC,,,,,,,,both,,,3218.7400,482.8100,WELLCARE,WELLCARE MEDICAID,3218.74,,,,,,,830.7600,3218.7400,percent of total billed charges,"100% of $3,218.74 in Billed Charges for Rev 272 = $3,218.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT 8X30 FEM ERS EXT 673008P,278,RC,,,,,,,,both,,,176825.5500,26523.8300,AETNA,AETNA,84876.26,,,,,,,12554.6100,176825.5500,percent of total billed charges,"48% of $176,825.55 in Billed Charges for Rev 278 = $84,876.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT 8X30 FEM ERS EXT 673008P,278,RC,,,,,,,,both,,,176825.5500,26523.8300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,88412.78,,,,,,,12554.6100,176825.5500,percent of total billed charges,"50% of $176,825.55 in Billed Charges for Rev 278 = $88,412.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT 8X30 FEM ERS EXT 673008P,278,RC,,,,,,,,both,,,176825.5500,26523.8300,CIGNA HEALTHCARE,CIGNA HMO,73736.25,,,,,,,12554.6100,176825.5500,percent of total billed charges,"41.7% of $176,825.55 in Billed Charges for Rev 278 = $73,736.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT 8X30 FEM ERS EXT 673008P,278,RC,,,,,,,,both,,,176825.5500,26523.8300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,70730.22,,,,,,,12554.6100,176825.5500,percent of total billed charges,"40% of $176,825.55 in Billed Charges for Rev 278 = $70,730.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT 8X30 FEM ERS EXT 673008P,278,RC,,,,,,,,both,,,176825.5500,26523.8300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,73736.25,,,,,,,12554.6100,176825.5500,percent of total billed charges,"41.7% of $176,825.55 in Billed Charges for Rev 278 = $73,736.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT 8X30 FEM ERS EXT 673008P,278,RC,,,,,,,,both,,,176825.5500,26523.8300,CIGNA HEALTHCARE,CIGNA PPO,73736.25,,,,,,,12554.6100,176825.5500,percent of total billed charges,"41.7% of $176,825.55 in Billed Charges for Rev 278 = $73,736.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT 8X30 FEM ERS EXT 673008P,278,RC,,,,,,,,both,,,176825.5500,26523.8300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,159143.00,,,,,,,12554.6100,176825.5500,percent of total billed charges,"90% of $176,825.55 in Billed Charges for Rev 278 = $159,143.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT 8X30 FEM ERS EXT 673008P,278,RC,,,,,,,,both,,,176825.5500,26523.8300,MEDCOST,MEDCOST VHN,84151.28,,,,,,,12554.6100,176825.5500,percent of total billed charges,"47.59% of $176,825.55 in Billed Charges for Rev 278 = $84,151.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT 8X30 FEM ERS EXT 673008P,278,RC,,,,,,,,both,,,176825.5500,26523.8300,SENTARA HEALTH,SENTARA HEALTH,45638.67,,,,,,,12554.6100,176825.5500,percent of total billed charges,"25.81% of $176,825.55 in Billed Charges for Rev 278 = $45,638.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT 8X30 FEM ERS EXT 673008P,278,RC,,,,,,,,both,,,176825.5500,26523.8300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",176825.55,,,,,,,12554.6100,176825.5500,percent of total billed charges,"100% of $176,825.55 in Billed Charges for Rev 278 = $176,825.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT 8X30 FEM ERS EXT 673008P,278,RC,,,,,,,,both,,,176825.5500,26523.8300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,88412.78,,,,,,,12554.6100,176825.5500,percent of total billed charges,"Rev 278 $176,825.55 in Billed Charges at 50% = $88,412.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT 8X30 FEM ERS EXT 673008P,278,RC,,,,,,,,both,,,176825.5500,26523.8300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13261.92,,,,,,,12554.6100,176825.5500,percent of total billed charges,"7.5% of $176,825.55 in Billed Charges for Rev 278 = $13,261.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT 8X30 FEM ERS EXT 673008P,278,RC,,,,,,,,both,,,176825.5500,26523.8300,UNITED HEALTHCARE,UHC HERITAGE SELECT,12554.61,,,,,,,12554.6100,176825.5500,percent of total billed charges,"7.1% of $176,825.55 in Billed Charges for Rev 278 = $12,554.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT 8X30 FEM ERS EXT 673008P,278,RC,,,,,,,,both,,,176825.5500,26523.8300,UNITED HEALTHCARE,UNITED HEALTHCARE,12554.61,,,,,,,12554.6100,176825.5500,percent of total billed charges,"7.1% of $176,825.55 in Billed Charges for Rev 278 = $12,554.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT 8X30 FEM ERS EXT 673008P,278,RC,,,,,,,,both,,,176825.5500,26523.8300,WELLCARE,WELLCARE MEDICAID,176825.55,,,,,,,12554.6100,176825.5500,percent of total billed charges,"100% of $176,825.55 in Billed Charges for Rev 278 = $176,825.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,57040.5000,8556.0800,AETNA,AETNA,27379.44,,,,,,,4049.8800,57040.5000,percent of total billed charges,"48% of $57,040.50 in Billed Charges for Rev 278 = $27,379.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,57040.5000,8556.0800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,28520.25,,,,,,,4049.8800,57040.5000,percent of total billed charges,"50% of $57,040.50 in Billed Charges for Rev 278 = $28,520.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,57040.5000,8556.0800,CIGNA HEALTHCARE,CIGNA HMO,23785.89,,,,,,,4049.8800,57040.5000,percent of total billed charges,"41.7% of $57,040.50 in Billed Charges for Rev 278 = $23,785.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,57040.5000,8556.0800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,22816.20,,,,,,,4049.8800,57040.5000,percent of total billed charges,"40% of $57,040.50 in Billed Charges for Rev 278 = $22,816.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,57040.5000,8556.0800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,23785.89,,,,,,,4049.8800,57040.5000,percent of total billed charges,"41.7% of $57,040.50 in Billed Charges for Rev 278 = $23,785.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,57040.5000,8556.0800,CIGNA HEALTHCARE,CIGNA PPO,23785.89,,,,,,,4049.8800,57040.5000,percent of total billed charges,"41.7% of $57,040.50 in Billed Charges for Rev 278 = $23,785.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,57040.5000,8556.0800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,51336.45,,,,,,,4049.8800,57040.5000,percent of total billed charges,"90% of $57,040.50 in Billed Charges for Rev 278 = $51,336.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,57040.5000,8556.0800,MEDCOST,MEDCOST VHN,27145.57,,,,,,,4049.8800,57040.5000,percent of total billed charges,"47.59% of $57,040.50 in Billed Charges for Rev 278 = $27,145.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,57040.5000,8556.0800,SENTARA HEALTH,SENTARA HEALTH,14722.15,,,,,,,4049.8800,57040.5000,percent of total billed charges,"25.81% of $57,040.50 in Billed Charges for Rev 278 = $14,722.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,57040.5000,8556.0800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",57040.50,,,,,,,4049.8800,57040.5000,percent of total billed charges,"100% of $57,040.50 in Billed Charges for Rev 278 = $57,040.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,57040.5000,8556.0800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,28520.25,,,,,,,4049.8800,57040.5000,percent of total billed charges,"Rev 278 $57,040.50 in Billed Charges at 50% = $28,520.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,57040.5000,8556.0800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4278.04,,,,,,,4049.8800,57040.5000,percent of total billed charges,"7.5% of $57,040.50 in Billed Charges for Rev 278 = $4,278.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,57040.5000,8556.0800,UNITED HEALTHCARE,UHC HERITAGE SELECT,4049.88,,,,,,,4049.8800,57040.5000,percent of total billed charges,"7.1% of $57,040.50 in Billed Charges for Rev 278 = $4,049.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,57040.5000,8556.0800,UNITED HEALTHCARE,UNITED HEALTHCARE,4049.88,,,,,,,4049.8800,57040.5000,percent of total billed charges,"7.1% of $57,040.50 in Billed Charges for Rev 278 = $4,049.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,57040.5000,8556.0800,WELLCARE,WELLCARE MEDICAID,57040.50,,,,,,,4049.8800,57040.5000,percent of total billed charges,"100% of $57,040.50 in Billed Charges for Rev 278 = $57,040.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,60748.1300,9112.2200,AETNA,AETNA,29159.10,,,,,,,4313.1200,60748.1300,percent of total billed charges,"48% of $60,748.13 in Billed Charges for Rev 278 = $29,159.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,60748.1300,9112.2200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,30374.07,,,,,,,4313.1200,60748.1300,percent of total billed charges,"50% of $60,748.13 in Billed Charges for Rev 278 = $30,374.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,60748.1300,9112.2200,CIGNA HEALTHCARE,CIGNA HMO,25331.97,,,,,,,4313.1200,60748.1300,percent of total billed charges,"41.7% of $60,748.13 in Billed Charges for Rev 278 = $25,331.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,60748.1300,9112.2200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,24299.25,,,,,,,4313.1200,60748.1300,percent of total billed charges,"40% of $60,748.13 in Billed Charges for Rev 278 = $24,299.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,60748.1300,9112.2200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,25331.97,,,,,,,4313.1200,60748.1300,percent of total billed charges,"41.7% of $60,748.13 in Billed Charges for Rev 278 = $25,331.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,60748.1300,9112.2200,CIGNA HEALTHCARE,CIGNA PPO,25331.97,,,,,,,4313.1200,60748.1300,percent of total billed charges,"41.7% of $60,748.13 in Billed Charges for Rev 278 = $25,331.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,60748.1300,9112.2200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,54673.32,,,,,,,4313.1200,60748.1300,percent of total billed charges,"90% of $60,748.13 in Billed Charges for Rev 278 = $54,673.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,60748.1300,9112.2200,MEDCOST,MEDCOST VHN,28910.04,,,,,,,4313.1200,60748.1300,percent of total billed charges,"47.59% of $60,748.13 in Billed Charges for Rev 278 = $28,910.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,60748.1300,9112.2200,SENTARA HEALTH,SENTARA HEALTH,15679.09,,,,,,,4313.1200,60748.1300,percent of total billed charges,"25.81% of $60,748.13 in Billed Charges for Rev 278 = $15,679.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,60748.1300,9112.2200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",60748.13,,,,,,,4313.1200,60748.1300,percent of total billed charges,"100% of $60,748.13 in Billed Charges for Rev 278 = $60,748.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,60748.1300,9112.2200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,30374.07,,,,,,,4313.1200,60748.1300,percent of total billed charges,"Rev 278 $60,748.13 in Billed Charges at 50% = $30,374.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,60748.1300,9112.2200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4556.11,,,,,,,4313.1200,60748.1300,percent of total billed charges,"7.5% of $60,748.13 in Billed Charges for Rev 278 = $4,556.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,60748.1300,9112.2200,UNITED HEALTHCARE,UHC HERITAGE SELECT,4313.12,,,,,,,4313.1200,60748.1300,percent of total billed charges,"7.1% of $60,748.13 in Billed Charges for Rev 278 = $4,313.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,60748.1300,9112.2200,UNITED HEALTHCARE,UNITED HEALTHCARE,4313.12,,,,,,,4313.1200,60748.1300,percent of total billed charges,"7.1% of $60,748.13 in Billed Charges for Rev 278 = $4,313.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT AORTIC VALVE 33MM 33CAVGJ-514,278,RC,27800001,CDM,,,,,,both,,,60748.1300,9112.2200,WELLCARE,WELLCARE MEDICAID,60748.13,,,,,,,4313.1200,60748.1300,percent of total billed charges,"100% of $60,748.13 in Billed Charges for Rev 278 = $60,748.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT DELIVERY SYSTEM LS-1015-15OZ,272,RC,27200002,CDM,,,,,,both,,,2903.8800,435.5800,AETNA,AETNA,1239.96,,,,,,,749.4900,2903.8800,percent of total billed charges,"42.7% of $2,903.88 in Billed Charges for Rev 272 = $1,239.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT DELIVERY SYSTEM LS-1015-15OZ,272,RC,27200002,CDM,,,,,,both,,,2903.8800,435.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2032.72,,,,,,,749.4900,2903.8800,percent of total billed charges,"Rev 272 $2,903.88 in Billed Charges at 70% = $2,032.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT DELIVERY SYSTEM LS-1015-15OZ,272,RC,27200002,CDM,,,,,,both,,,2903.8800,435.5800,CIGNA HEALTHCARE,CIGNA HMO,1210.92,,,,,,,749.4900,2903.8800,percent of total billed charges,"41.7% of $2,903.88 in Billed Charges for Rev 272 = $1,210.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT DELIVERY SYSTEM LS-1015-15OZ,272,RC,27200002,CDM,,,,,,both,,,2903.8800,435.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1347.40,,,,,,,749.4900,2903.8800,percent of total billed charges,"46.4% of $2,903.88 in Billed Charges for Rev 272 = $1,347.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT DELIVERY SYSTEM LS-1015-15OZ,272,RC,27200002,CDM,,,,,,both,,,2903.8800,435.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1210.92,,,,,,,749.4900,2903.8800,percent of total billed charges,"41.7% of $2,903.88 in Billed Charges for Rev 272 = $1,210.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT DELIVERY SYSTEM LS-1015-15OZ,272,RC,27200002,CDM,,,,,,both,,,2903.8800,435.5800,CIGNA HEALTHCARE,CIGNA PPO,1210.92,,,,,,,749.4900,2903.8800,percent of total billed charges,"41.7% of $2,903.88 in Billed Charges for Rev 272 = $1,210.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT DELIVERY SYSTEM LS-1015-15OZ,272,RC,27200002,CDM,,,,,,both,,,2903.8800,435.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2613.49,,,,,,,749.4900,2903.8800,percent of total billed charges,"90% of $2,903.88 in Billed Charges for Rev 272 = $2,613.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT DELIVERY SYSTEM LS-1015-15OZ,272,RC,27200002,CDM,,,,,,both,,,2903.8800,435.5800,MEDCOST,MEDCOST VHN,1381.96,,,,,,,749.4900,2903.8800,percent of total billed charges,"47.59% of $2,903.88 in Billed Charges for Rev 272 = $1,381.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT DELIVERY SYSTEM LS-1015-15OZ,272,RC,27200002,CDM,,,,,,both,,,2903.8800,435.5800,SENTARA HEALTH,SENTARA HEALTH,749.49,,,,,,,749.4900,2903.8800,percent of total billed charges,"25.81% of $2,903.88 in Billed Charges for Rev 272 = $749.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT DELIVERY SYSTEM LS-1015-15OZ,272,RC,27200002,CDM,,,,,,both,,,2903.8800,435.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2903.88,,,,,,,749.4900,2903.8800,percent of total billed charges,"100% of $2,903.88 in Billed Charges for Rev 272 = $2,903.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT DELIVERY SYSTEM LS-1015-15OZ,272,RC,27200002,CDM,,,,,,both,,,2903.8800,435.5800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1451.94,,,,,,,749.4900,2903.8800,percent of total billed charges,"Rev 272 $2,903.88 in Billed Charges at 50% = $1,451.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT DELIVERY SYSTEM LS-1015-15OZ,272,RC,27200002,CDM,,,,,,both,,,2903.8800,435.5800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,937.95,,,,,,,749.4900,2903.8800,other,"32.3% of $2,903.88 in Billed Charges for Rev 272 = $937.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GRAFT DELIVERY SYSTEM LS-1015-15OZ,272,RC,27200002,CDM,,,,,,both,,,2903.8800,435.5800,UNITED HEALTHCARE,UHC HERITAGE SELECT,891.49,,,,,,,749.4900,2903.8800,other,"30.7% of $2,903.88 in Billed Charges for Rev 272 = $891.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GRAFT DELIVERY SYSTEM LS-1015-15OZ,272,RC,27200002,CDM,,,,,,both,,,2903.8800,435.5800,UNITED HEALTHCARE,UNITED HEALTHCARE,937.95,,,,,,,749.4900,2903.8800,percent of total billed charges,"32.3% of $2,903.88 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT DELIVERY SYSTEM LS-1015-15OZ,272,RC,27200002,CDM,,,,,,both,,,2903.8800,435.5800,WELLCARE,WELLCARE MEDICAID,2903.88,,,,,,,749.4900,2903.8800,percent of total billed charges,"100% of $2,903.88 in Billed Charges for Rev 272 = $2,903.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,AETNA,AETNA,986.80,,,,,,,508.8300,2311.0000,percent of total billed charges,"42.7% of $2,311.00 in Billed Charges for Rev 361 Proc 47537 = $986.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,513.77,,,,,,,508.8300,2311.0000,fee schedule,"APG 00130 Proc 47537 at $836.60 (Base Rate) * 0.5905 (Relative Weight) = $494.01 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $494.01 at 104% = $513.77. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,822.88,,,,,,,508.8300,2311.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,AETNA,AETNA HEALTHCARE MEDICARE,822.88,,,,,,,508.8300,2311.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,822.88,,,,,,,508.8300,2311.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,AMBETTER,AMBETTER,1793.89,,,,,,,508.8300,2311.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,855.80,,,,,,,508.8300,2311.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,BLUE CROSS,ANTHEM EXCHANGE,2025.98,,,,,,,508.8300,2311.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,508.83,,,,,,,508.8300,2311.0000,fee schedule,"APG 00130 Proc 47537 at $836.60 (Base Rate) * 0.5905 (Relative Weight) = $494.01 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $494.01 at 103% = $508.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,BLUE CROSS,ANTHEM HMO,2152.49,,,,,,,508.8300,2311.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,847.57,,,,,,,508.8300,2311.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2311.00,,,,,,,508.8300,2311.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,508.8300,2311.0000,case rate,"Rev 361 Proc 47537 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,508.8300,2311.0000,case rate,Rev 361 Proc 47537 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,BLUE CROSS,BLUE CROSS MEDICARE,855.80,,,,,,,508.8300,2311.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,508.8300,2311.0000,case rate,Rev 361 Proc 47537 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,508.8300,2311.0000,case rate,Rev 361 Proc 47537 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,508.8300,2311.0000,case rate,Rev 361 Proc 47537 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,508.8300,2311.0000,case rate,Rev 361 Proc 47537 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,508.8300,2311.0000,case rate,"Rev 361 Proc 47537 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,508.8300,2311.0000,case rate,"Rev 361 Proc 47537 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,864.03,,,,,,,508.8300,2311.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,508.8300,2311.0000,case rate,"Rev 361 Proc 47537 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,508.8300,2311.0000,case rate,"Rev 361 Proc 47537 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,864.03,,,,,,,508.8300,2311.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2079.90,,,,,,,508.8300,2311.0000,percent of total billed charges,"90% of $2,311.00 in Billed Charges for Rev 361 Proc 47537 = $2,079.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,HUMANA,HUMANA MEDICARE,822.88,,,,,,,508.8300,2311.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,822.88,,,,,,,508.8300,2311.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,MEDCOST,MEDCOST VHN,1099.80,,,,,,,508.8300,2311.0000,percent of total billed charges,"47.59% of $2,311.00 in Billed Charges for Rev 361 Proc 47537 = $1,099.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,518.71,,,,,,,508.8300,2311.0000,fee schedule,"APG 00130 Proc 47537 at $836.60 (Base Rate) * 0.5905 (Relative Weight) = $494.01 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $494.01 at 100% = $494.01... $494.01 at 105% = $518.71 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,864.03,,,,,,,508.8300,2311.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,864.03,,,,,,,508.8300,2311.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,NHC ADVANTAGE,NHC ADVANTAGE,864.03,,,,,,,508.8300,2311.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,509.32,,,,,,,508.8300,2311.0000,fee schedule,"APG 00130 Proc 47537 at $836.60 (Base Rate) * 0.5905 (Relative Weight) = $494.01 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $494.01 at 100% = $494.01... $494.01 at 103.1% = $509.32 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,SENTARA HEALTH,SENTARA HEALTH,596.47,,,,,,,508.8300,2311.0000,percent of total billed charges,"25.81% of $2,311.00 in Billed Charges for Rev 361 Proc 47537 = $596.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,SENTARA HEALTH,SENTARA MEDICARE,822.88,,,,,,,508.8300,2311.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2311.00,,,,,,,508.8300,2311.0000,percent of total billed charges,"100% of $2,311.00 in Billed Charges for Rev 361 Proc 47537 = $2,311.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,508.8300,2311.0000,case rate,Rev 361 Proc 47537 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,508.8300,2311.0000,case rate,"Rev 361 Proc 47537 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,508.8300,2311.0000,case rate,"Rev 361 Proc 47537 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,508.8300,2311.0000,case rate,"Rev 361 Proc 47537 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,508.83,,,,,,,508.8300,2311.0000,fee schedule,"APG 00130 Proc 47537 at $836.60 (Base Rate) * 0.5905 (Relative Weight) = $494.01 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $494.01 at 103% = $508.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,822.88,,,,,,,508.8300,2311.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,822.88,,,,,,,508.8300,2311.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,WELLCARE,WELLCARE MEDICAID,2311.00,,,,,,,508.8300,2311.0000,percent of total billed charges,"100% of $2,311.00 in Billed Charges for Rev 361 Proc 47537 = $2,311.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47537,CPT,361,RC,36100306,CDM,,,,both,,,2311.0000,346.6500,WELLCARE,WELLCARE MEDICARE,872.26,,,,,,,508.8300,2311.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,AETNA,AETNA,5623.59,,,,,,,775.0000,13170.0000,percent of total billed charges,"42.7% of $13,170.00 in Billed Charges for Rev 361 Proc 47538 = $5,623.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3288.49,,,,,,,775.0000,13170.0000,fee schedule,"APG 00151 Proc 47538 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 104% = $3,288.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5484.95,,,,,,,775.0000,13170.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,AETNA,AETNA HEALTHCARE MEDICARE,5484.95,,,,,,,775.0000,13170.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,5484.95,,,,,,,775.0000,13170.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,AMBETTER,AMBETTER,11957.20,,,,,,,775.0000,13170.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,5704.35,,,,,,,775.0000,13170.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,BLUE CROSS,ANTHEM EXCHANGE,13170.00,,,,,,,775.0000,13170.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3256.87,,,,,,,775.0000,13170.0000,fee schedule,"APG 00151 Proc 47538 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 103% = $3,256.87. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,BLUE CROSS,ANTHEM HMO,13170.00,,,,,,,775.0000,13170.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5649.50,,,,,,,775.0000,13170.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",13170.00,,,,,,,775.0000,13170.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,775.0000,13170.0000,case rate,"Rev 361 Proc 47538 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,775.0000,13170.0000,case rate,"Rev 361 Proc 47538 ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,BLUE CROSS,BLUE CROSS MEDICARE,5704.35,,,,,,,775.0000,13170.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,775.0000,13170.0000,case rate,"Rev 361 Proc 47538 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,775.0000,13170.0000,case rate,"Rev 361 Proc 47538 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,13170.0000,case rate,Rev 361 Proc 47538 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,13170.0000,case rate,Rev 361 Proc 47538 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,CIGNA HEALTHCARE,CIGNA HMO,8003.00,,,,,,,775.0000,13170.0000,case rate,"Rev 361 Proc 47538 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6048.00,,,,,,,775.0000,13170.0000,case rate,"Rev 361 Proc 47538 ASG Rate of $6,048.00 at 100% of $6,048.00 = $6,048.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,5759.20,,,,,,,775.0000,13170.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8003.00,,,,,,,775.0000,13170.0000,case rate,"Rev 361 Proc 47538 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,CIGNA HEALTHCARE,CIGNA PPO,8003.00,,,,,,,775.0000,13170.0000,case rate,"Rev 361 Proc 47538 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,5759.20,,,,,,,775.0000,13170.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11853.00,,,,,,,775.0000,13170.0000,percent of total billed charges,"90% of $13,170.00 in Billed Charges for Rev 361 Proc 47538 = $11,853.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,HUMANA,HUMANA MEDICARE,5484.95,,,,,,,775.0000,13170.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5484.95,,,,,,,775.0000,13170.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,MEDCOST,MEDCOST VHN,6267.60,,,,,,,775.0000,13170.0000,percent of total billed charges,"47.59% of $13,170.00 in Billed Charges for Rev 361 Proc 47538 = $6,267.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3320.11,,,,,,,775.0000,13170.0000,fee schedule,"APG 00151 Proc 47538 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 100% = $3,162.01... $3,162.01 at 105% = $3,320.11 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,5759.20,,,,,,,775.0000,13170.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,5759.20,,,,,,,775.0000,13170.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,NHC ADVANTAGE,NHC ADVANTAGE,5759.20,,,,,,,775.0000,13170.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3260.03,,,,,,,775.0000,13170.0000,fee schedule,"APG 00151 Proc 47538 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 100% = $3,162.01... $3,162.01 at 103.1% = $3,260.03 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,SENTARA HEALTH,SENTARA HEALTH,3399.18,,,,,,,775.0000,13170.0000,percent of total billed charges,"25.81% of $13,170.00 in Billed Charges for Rev 361 Proc 47538 = $3,399.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,SENTARA HEALTH,SENTARA MEDICARE,5484.95,,,,,,,775.0000,13170.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13170.00,,,,,,,775.0000,13170.0000,percent of total billed charges,"100% of $13,170.00 in Billed Charges for Rev 361 Proc 47538 = $13,170.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,775.0000,13170.0000,case rate,"Rev 361 Proc 47538 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,775.0000,13170.0000,case rate,"Rev 361 Proc 47538 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,775.0000,13170.0000,case rate,"Rev 361 Proc 47538 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,775.0000,13170.0000,case rate,"Rev 361 Proc 47538 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3256.87,,,,,,,775.0000,13170.0000,fee schedule,"APG 00151 Proc 47538 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 103% = $3,256.87. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5484.95,,,,,,,775.0000,13170.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5484.95,,,,,,,775.0000,13170.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,WELLCARE,WELLCARE MEDICAID,13170.00,,,,,,,775.0000,13170.0000,percent of total billed charges,"100% of $13,170.00 in Billed Charges for Rev 361 Proc 47538 = $13,170.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE STENT BILE DUCT PERCU INCL IMG EXISTING ACCESS,47538,CPT,361,RC,36100307,CDM,,,,both,,,13170.0000,1975.5000,WELLCARE,WELLCARE MEDICARE,5814.05,,,,,,,775.0000,13170.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BALLOON DIL BIL BUCT OR AMPULLA PERCU INCL IMG RAD S&I,47542,CPT,361,RC,36100310,CDM,,,,both,,,5607.0000,841.0500,AETNA,AETNA,2394.19,,,,,,,148.0000,8228.4300,percent of total billed charges,"42.7% of $5,607.00 in Billed Charges for Rev 361 Proc 47542 = $2,394.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BALLOON DIL BIL BUCT OR AMPULLA PERCU INCL IMG RAD S&I,47542,CPT,361,RC,36100310,CDM,,,,both,,,5607.0000,841.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,8150.06,,,,,,,148.0000,8228.4300,fee schedule,"APG 00152 Proc 47542 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 104% = $8,150.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BALLOON DIL BIL BUCT OR AMPULLA PERCU INCL IMG RAD S&I,47542,CPT,361,RC,36100310,CDM,,,,both,,,5607.0000,841.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,5607.00,,,,,,,148.0000,8228.4300,fee schedule,"APG 00152 Proc 47542 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 103% = $8,071.70 (Service Line reduced to $5,607.00, claim capped at $5,607.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BALLOON DIL BIL BUCT OR AMPULLA PERCU INCL IMG RAD S&I,47542,CPT,361,RC,36100310,CDM,,,,both,,,5607.0000,841.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,148.0000,8228.4300,case rate,"Rev 361 Proc 47542 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BALLOON DIL BIL BUCT OR AMPULLA PERCU INCL IMG RAD S&I,47542,CPT,361,RC,36100310,CDM,,,,both,,,5607.0000,841.0500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47542 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BALLOON DIL BIL BUCT OR AMPULLA PERCU INCL IMG RAD S&I,47542,CPT,361,RC,36100310,CDM,,,,both,,,5607.0000,841.0500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47542 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BALLOON DIL BIL BUCT OR AMPULLA PERCU INCL IMG RAD S&I,47542,CPT,361,RC,36100310,CDM,,,,both,,,5607.0000,841.0500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47542 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BALLOON DIL BIL BUCT OR AMPULLA PERCU INCL IMG RAD S&I,47542,CPT,361,RC,36100310,CDM,,,,both,,,5607.0000,841.0500,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47542 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BALLOON DIL BIL BUCT OR AMPULLA PERCU INCL IMG RAD S&I,47542,CPT,361,RC,36100310,CDM,,,,both,,,5607.0000,841.0500,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47542 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BALLOON DIL BIL BUCT OR AMPULLA PERCU INCL IMG RAD S&I,47542,CPT,361,RC,36100310,CDM,,,,both,,,5607.0000,841.0500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,148.0000,8228.4300,case rate,"Rev 361 Proc 47542 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BALLOON DIL BIL BUCT OR AMPULLA PERCU INCL IMG RAD S&I,47542,CPT,361,RC,36100310,CDM,,,,both,,,5607.0000,841.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,148.0000,8228.4300,case rate,"Rev 361 Proc 47542 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BALLOON DIL BIL BUCT OR AMPULLA PERCU INCL IMG RAD S&I,47542,CPT,361,RC,36100310,CDM,,,,both,,,5607.0000,841.0500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,148.0000,8228.4300,case rate,"Rev 361 Proc 47542 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BALLOON DIL BIL BUCT OR AMPULLA PERCU INCL IMG RAD S&I,47542,CPT,361,RC,36100310,CDM,,,,both,,,5607.0000,841.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5046.30,,,,,,,148.0000,8228.4300,percent of total billed charges,"90% of $5,607.00 in Billed Charges for Rev 361 Proc 47542 = $5,046.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BALLOON DIL BIL BUCT OR AMPULLA PERCU INCL IMG RAD S&I,47542,CPT,361,RC,36100310,CDM,,,,both,,,5607.0000,841.0500,MEDCOST,MEDCOST VHN,2668.37,,,,,,,148.0000,8228.4300,percent of total billed charges,"47.59% of $5,607.00 in Billed Charges for Rev 361 Proc 47542 = $2,668.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BALLOON DIL BIL BUCT OR AMPULLA PERCU INCL IMG RAD S&I,47542,CPT,361,RC,36100310,CDM,,,,both,,,5607.0000,841.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,8228.43,,,,,,,148.0000,8228.4300,fee schedule,"APG 00152 Proc 47542 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 100% = $7,836.60... $7,836.60 at 105% = $8,228.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BALLOON DIL BIL BUCT OR AMPULLA PERCU INCL IMG RAD S&I,47542,CPT,361,RC,36100310,CDM,,,,both,,,5607.0000,841.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,8079.53,,,,,,,148.0000,8228.4300,fee schedule,"APG 00152 Proc 47542 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 100% = $7,836.60... $7,836.60 at 103.1% = $8,079.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BALLOON DIL BIL BUCT OR AMPULLA PERCU INCL IMG RAD S&I,47542,CPT,361,RC,36100310,CDM,,,,both,,,5607.0000,841.0500,SENTARA HEALTH,SENTARA HEALTH,1447.17,,,,,,,148.0000,8228.4300,percent of total billed charges,"25.81% of $5,607.00 in Billed Charges for Rev 361 Proc 47542 = $1,447.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BALLOON DIL BIL BUCT OR AMPULLA PERCU INCL IMG RAD S&I,47542,CPT,361,RC,36100310,CDM,,,,both,,,5607.0000,841.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5607.00,,,,,,,148.0000,8228.4300,percent of total billed charges,"100% of $5,607.00 in Billed Charges for Rev 361 Proc 47542 = $5,607.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BALLOON DIL BIL BUCT OR AMPULLA PERCU INCL IMG RAD S&I,47542,CPT,361,RC,36100310,CDM,,,,both,,,5607.0000,841.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47542 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BALLOON DIL BIL BUCT OR AMPULLA PERCU INCL IMG RAD S&I,47542,CPT,361,RC,36100310,CDM,,,,both,,,5607.0000,841.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47542 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BALLOON DIL BIL BUCT OR AMPULLA PERCU INCL IMG RAD S&I,47542,CPT,361,RC,36100310,CDM,,,,both,,,5607.0000,841.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47542 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BALLOON DIL BIL BUCT OR AMPULLA PERCU INCL IMG RAD S&I,47542,CPT,361,RC,36100310,CDM,,,,both,,,5607.0000,841.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47542 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BALLOON DIL BIL BUCT OR AMPULLA PERCU INCL IMG RAD S&I,47542,CPT,361,RC,36100310,CDM,,,,both,,,5607.0000,841.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,8071.70,,,,,,,148.0000,8228.4300,fee schedule,"APG 00152 Proc 47542 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 103% = $8,071.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BALLOON DIL BIL BUCT OR AMPULLA PERCU INCL IMG RAD S&I,47542,CPT,361,RC,36100310,CDM,,,,both,,,5607.0000,841.0500,WELLCARE,WELLCARE MEDICAID,5607.00,,,,,,,148.0000,8228.4300,percent of total billed charges,"100% of $5,607.00 in Billed Charges for Rev 361 Proc 47542 = $5,607.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,AETNA,AETNA,1103.80,,,,,,,578.0000,3266.6300,percent of total billed charges,"42.7% of $2,585.00 in Billed Charges for Rev 361 Proc 48102 = $1,103.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1054.26,,,,,,,578.0000,3266.6300,fee schedule,"APG 00150 Proc 48102 at $836.60 (Base Rate) * 1.2117 (Relative Weight) = $1,013.71 (Total Line Payment) at 104% = $1,054.26. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,AMBETTER,AMBETTER,3266.63,,,,,,,578.0000,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,578.0000,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,BLUE CROSS,ANTHEM EXCHANGE,2585.00,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1044.12,,,,,,,578.0000,3266.6300,fee schedule,"APG 00150 Proc 48102 at $836.60 (Base Rate) * 1.2117 (Relative Weight) = $1,013.71 (Total Line Payment) at 103% = $1,044.12. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,BLUE CROSS,ANTHEM HMO,2585.00,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,578.0000,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2585.00,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,578.0000,3266.6300,case rate,Rev 361 Proc 48102 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 48102 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,578.0000,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 48102 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 48102 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,3266.6300,case rate,Rev 361 Proc 48102 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,3266.6300,case rate,Rev 361 Proc 48102 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 48102 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 48102 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,578.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 48102 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 48102 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,578.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2326.50,,,,,,,578.0000,3266.6300,percent of total billed charges,"90% of $2,585.00 in Billed Charges for Rev 361 Proc 48102 = $2,326.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,MEDCOST,MEDCOST VHN,1230.20,,,,,,,578.0000,3266.6300,percent of total billed charges,"47.59% of $2,585.00 in Billed Charges for Rev 361 Proc 48102 = $1,230.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1064.40,,,,,,,578.0000,3266.6300,fee schedule,"APG 00150 Proc 48102 at $836.60 (Base Rate) * 1.2117 (Relative Weight) = $1,013.71 (Total Line Payment) at 100% = $1,013.71... $1,013.71 at 105% = $1,064.40 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,578.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,578.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,578.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1045.14,,,,,,,578.0000,3266.6300,fee schedule,"APG 00150 Proc 48102 at $836.60 (Base Rate) * 1.2117 (Relative Weight) = $1,013.71 (Total Line Payment) at 100% = $1,013.71... $1,013.71 at 103.1% = $1,045.14 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,SENTARA HEALTH,SENTARA HEALTH,667.19,,,,,,,578.0000,3266.6300,percent of total billed charges,"25.81% of $2,585.00 in Billed Charges for Rev 361 Proc 48102 = $667.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2585.00,,,,,,,578.0000,3266.6300,percent of total billed charges,"100% of $2,585.00 in Billed Charges for Rev 361 Proc 48102 = $2,585.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,578.0000,3266.6300,case rate,Rev 361 Proc 48102 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 48102 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 48102 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 48102 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1044.12,,,,,,,578.0000,3266.6300,fee schedule,"APG 00150 Proc 48102 at $836.60 (Base Rate) * 1.2117 (Relative Weight) = $1,013.71 (Total Line Payment) at 103% = $1,044.12. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,WELLCARE,WELLCARE MEDICAID,2585.00,,,,,,,578.0000,3266.6300,percent of total billed charges,"100% of $2,585.00 in Billed Charges for Rev 361 Proc 48102 = $2,585.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX PANCREAS PERC NEEDLE,48102,CPT,361,RC,36100158,CDM,,,,both,,,2585.0000,387.7500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,578.0000,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,AETNA,AETNA,1159.31,,,,,,,109.0000,2715.0000,percent of total billed charges,"42.7% of $2,715.00 in Billed Charges for Rev 450 Proc 49082 = $1,159.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1054.26,,,,,,,109.0000,2715.0000,fee schedule,"APG 00150 Proc 49082 at $836.60 (Base Rate) * 1.2117 (Relative Weight) = $1,013.71 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,013.71 at 104% = $1,054.26. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,822.88,,,,,,,109.0000,2715.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,AETNA,AETNA HEALTHCARE MEDICARE,822.88,,,,,,,109.0000,2715.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,822.88,,,,,,,109.0000,2715.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,AMBETTER,AMBETTER,1793.89,,,,,,,109.0000,2715.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,855.80,,,,,,,109.0000,2715.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,BLUE CROSS,ANTHEM EXCHANGE,2025.98,,,,,,,109.0000,2715.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1044.12,,,,,,,109.0000,2715.0000,fee schedule,"APG 00150 Proc 49082 at $836.60 (Base Rate) * 1.2117 (Relative Weight) = $1,013.71 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,013.71 at 103% = $1,044.12. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,BLUE CROSS,ANTHEM HMO,2152.49,,,,,,,109.0000,2715.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,847.57,,,,,,,109.0000,2715.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2532.20,,,,,,,109.0000,2715.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1900.50,,,,,,,109.0000,2715.0000,percent of total billed charges,"Rev 450 Proc 49082 $2,715.00 in Billed Charges at 70% = $1,900.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,BLUE CROSS,BLUE CROSS MEDICARE,855.80,,,,,,,109.0000,2715.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,864.03,,,,,,,109.0000,2715.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,864.03,,,,,,,109.0000,2715.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2443.50,,,,,,,109.0000,2715.0000,percent of total billed charges,"90% of $2,715.00 in Billed Charges for Rev 450 Proc 49082 = $2,443.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,HUMANA,HUMANA MEDICARE,822.88,,,,,,,109.0000,2715.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,822.88,,,,,,,109.0000,2715.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,MEDCOST,MEDCOST VHN,1292.07,,,,,,,109.0000,2715.0000,percent of total billed charges,"47.59% of $2,715.00 in Billed Charges for Rev 450 Proc 49082 = $1,292.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1064.40,,,,,,,109.0000,2715.0000,fee schedule,"APG 00150 Proc 49082 at $836.60 (Base Rate) * 1.2117 (Relative Weight) = $1,013.71 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,013.71 at 100% = $1,013.71... $1,013.71 at 105% = $1,064.40 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,864.03,,,,,,,109.0000,2715.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,864.03,,,,,,,109.0000,2715.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,NHC ADVANTAGE,NHC ADVANTAGE,864.03,,,,,,,109.0000,2715.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1045.14,,,,,,,109.0000,2715.0000,fee schedule,"APG 00150 Proc 49082 at $836.60 (Base Rate) * 1.2117 (Relative Weight) = $1,013.71 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,013.71 at 100% = $1,013.71... $1,013.71 at 103.1% = $1,045.14 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,SENTARA HEALTH,SENTARA HEALTH,700.74,,,,,,,109.0000,2715.0000,percent of total billed charges,"25.81% of $2,715.00 in Billed Charges for Rev 450 Proc 49082 = $700.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,SENTARA HEALTH,SENTARA MEDICARE,822.88,,,,,,,109.0000,2715.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2715.00,,,,,,,109.0000,2715.0000,percent of total billed charges,"100% of $2,715.00 in Billed Charges for Rev 450 Proc 49082 = $2,715.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,2715.0000,case rate,Rev 450 Proc 49082 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,2715.0000,case rate,Rev 450 Proc 49082 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,2715.0000,case rate,Rev 450 Proc 49082 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,2715.0000,case rate,Rev 450 Proc 49082 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1044.12,,,,,,,109.0000,2715.0000,fee schedule,"APG 00150 Proc 49082 at $836.60 (Base Rate) * 1.2117 (Relative Weight) = $1,013.71 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,013.71 at 103% = $1,044.12. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,822.88,,,,,,,109.0000,2715.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,822.88,,,,,,,109.0000,2715.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,WELLCARE,WELLCARE MEDICAID,2715.00,,,,,,,109.0000,2715.0000,percent of total billed charges,"100% of $2,715.00 in Billed Charges for Rev 450 Proc 49082 = $2,715.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABD PARACENTESIS W/O IMG GUID,49082,CPT,450,RC,45000265,CDM,,,,both,,,2715.0000,407.2500,WELLCARE,WELLCARE MEDICARE,872.26,,,,,,,109.0000,2715.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,AETNA,AETNA,924.03,,,,,,,558.5300,2164.0000,percent of total billed charges,"42.7% of $2,164.00 in Billed Charges for Rev 361 Proc 49083 = $924.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1054.26,,,,,,,558.5300,2164.0000,fee schedule,"APG 00150 Proc 49083 at $836.60 (Base Rate) * 1.2117 (Relative Weight) = $1,013.71 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,013.71 at 104% = $1,054.26. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,822.88,,,,,,,558.5300,2164.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,AETNA,AETNA HEALTHCARE MEDICARE,822.88,,,,,,,558.5300,2164.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,822.88,,,,,,,558.5300,2164.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,AMBETTER,AMBETTER,1793.89,,,,,,,558.5300,2164.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,855.80,,,,,,,558.5300,2164.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,BLUE CROSS,ANTHEM EXCHANGE,2025.98,,,,,,,558.5300,2164.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1044.12,,,,,,,558.5300,2164.0000,fee schedule,"APG 00150 Proc 49083 at $836.60 (Base Rate) * 1.2117 (Relative Weight) = $1,013.71 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,013.71 at 103% = $1,044.12. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,BLUE CROSS,ANTHEM HMO,2152.49,,,,,,,558.5300,2164.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,847.57,,,,,,,558.5300,2164.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2164.00,,,,,,,558.5300,2164.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,558.5300,2164.0000,case rate,"Rev 361 Proc 49083 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,558.5300,2164.0000,case rate,Rev 361 Proc 49083 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,BLUE CROSS,BLUE CROSS MEDICARE,855.80,,,,,,,558.5300,2164.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,558.5300,2164.0000,case rate,Rev 361 Proc 49083 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,558.5300,2164.0000,case rate,Rev 361 Proc 49083 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,558.5300,2164.0000,case rate,Rev 361 Proc 49083 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,558.5300,2164.0000,case rate,Rev 361 Proc 49083 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,558.5300,2164.0000,case rate,"Rev 361 Proc 49083 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,558.5300,2164.0000,case rate,"Rev 361 Proc 49083 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,864.03,,,,,,,558.5300,2164.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,558.5300,2164.0000,case rate,"Rev 361 Proc 49083 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,558.5300,2164.0000,case rate,"Rev 361 Proc 49083 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,864.03,,,,,,,558.5300,2164.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1947.60,,,,,,,558.5300,2164.0000,percent of total billed charges,"90% of $2,164.00 in Billed Charges for Rev 361 Proc 49083 = $1,947.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,HUMANA,HUMANA MEDICARE,822.88,,,,,,,558.5300,2164.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,822.88,,,,,,,558.5300,2164.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,MEDCOST,MEDCOST VHN,1029.85,,,,,,,558.5300,2164.0000,percent of total billed charges,"47.59% of $2,164.00 in Billed Charges for Rev 361 Proc 49083 = $1,029.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1064.40,,,,,,,558.5300,2164.0000,fee schedule,"APG 00150 Proc 49083 at $836.60 (Base Rate) * 1.2117 (Relative Weight) = $1,013.71 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,013.71 at 100% = $1,013.71... $1,013.71 at 105% = $1,064.40 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,864.03,,,,,,,558.5300,2164.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,864.03,,,,,,,558.5300,2164.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,NHC ADVANTAGE,NHC ADVANTAGE,864.03,,,,,,,558.5300,2164.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1045.14,,,,,,,558.5300,2164.0000,fee schedule,"APG 00150 Proc 49083 at $836.60 (Base Rate) * 1.2117 (Relative Weight) = $1,013.71 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,013.71 at 100% = $1,013.71... $1,013.71 at 103.1% = $1,045.14 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,SENTARA HEALTH,SENTARA HEALTH,558.53,,,,,,,558.5300,2164.0000,percent of total billed charges,"25.81% of $2,164.00 in Billed Charges for Rev 361 Proc 49083 = $558.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,SENTARA HEALTH,SENTARA MEDICARE,822.88,,,,,,,558.5300,2164.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2164.00,,,,,,,558.5300,2164.0000,percent of total billed charges,"100% of $2,164.00 in Billed Charges for Rev 361 Proc 49083 = $2,164.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,558.5300,2164.0000,case rate,Rev 361 Proc 49083 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,558.5300,2164.0000,case rate,"Rev 361 Proc 49083 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,558.5300,2164.0000,case rate,"Rev 361 Proc 49083 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,558.5300,2164.0000,case rate,"Rev 361 Proc 49083 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1044.12,,,,,,,558.5300,2164.0000,fee schedule,"APG 00150 Proc 49083 at $836.60 (Base Rate) * 1.2117 (Relative Weight) = $1,013.71 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,013.71 at 103% = $1,044.12. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,822.88,,,,,,,558.5300,2164.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,822.88,,,,,,,558.5300,2164.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,WELLCARE,WELLCARE MEDICAID,2164.00,,,,,,,558.5300,2164.0000,percent of total billed charges,"100% of $2,164.00 in Billed Charges for Rev 361 Proc 49083 = $2,164.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABD PARACENTESIS W IMG GUID,49083,CPT,361,RC,36100141,CDM,,,,both,,,2164.0000,324.6000,WELLCARE,WELLCARE MEDICARE,872.26,,,,,,,558.5300,2164.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GRAFT FILLER FOR RIA,272,RC,,,,,,,,both,,,4031.4200,604.7100,AETNA,AETNA,1721.42,,,,,,,1040.5100,4031.4200,percent of total billed charges,"42.7% of $4,031.42 in Billed Charges for Rev 272 = $1,721.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT FILLER FOR RIA,272,RC,,,,,,,,both,,,4031.4200,604.7100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2821.99,,,,,,,1040.5100,4031.4200,percent of total billed charges,"Rev 272 $4,031.42 in Billed Charges at 70% = $2,821.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT FILLER FOR RIA,272,RC,,,,,,,,both,,,4031.4200,604.7100,CIGNA HEALTHCARE,CIGNA HMO,1681.10,,,,,,,1040.5100,4031.4200,percent of total billed charges,"41.7% of $4,031.42 in Billed Charges for Rev 272 = $1,681.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT FILLER FOR RIA,272,RC,,,,,,,,both,,,4031.4200,604.7100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1870.58,,,,,,,1040.5100,4031.4200,percent of total billed charges,"46.4% of $4,031.42 in Billed Charges for Rev 272 = $1,870.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT FILLER FOR RIA,272,RC,,,,,,,,both,,,4031.4200,604.7100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1681.10,,,,,,,1040.5100,4031.4200,percent of total billed charges,"41.7% of $4,031.42 in Billed Charges for Rev 272 = $1,681.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT FILLER FOR RIA,272,RC,,,,,,,,both,,,4031.4200,604.7100,CIGNA HEALTHCARE,CIGNA PPO,1681.10,,,,,,,1040.5100,4031.4200,percent of total billed charges,"41.7% of $4,031.42 in Billed Charges for Rev 272 = $1,681.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT FILLER FOR RIA,272,RC,,,,,,,,both,,,4031.4200,604.7100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3628.28,,,,,,,1040.5100,4031.4200,percent of total billed charges,"90% of $4,031.42 in Billed Charges for Rev 272 = $3,628.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT FILLER FOR RIA,272,RC,,,,,,,,both,,,4031.4200,604.7100,MEDCOST,MEDCOST VHN,1918.55,,,,,,,1040.5100,4031.4200,percent of total billed charges,"47.59% of $4,031.42 in Billed Charges for Rev 272 = $1,918.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT FILLER FOR RIA,272,RC,,,,,,,,both,,,4031.4200,604.7100,SENTARA HEALTH,SENTARA HEALTH,1040.51,,,,,,,1040.5100,4031.4200,percent of total billed charges,"25.81% of $4,031.42 in Billed Charges for Rev 272 = $1,040.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT FILLER FOR RIA,272,RC,,,,,,,,both,,,4031.4200,604.7100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4031.42,,,,,,,1040.5100,4031.4200,percent of total billed charges,"100% of $4,031.42 in Billed Charges for Rev 272 = $4,031.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT FILLER FOR RIA,272,RC,,,,,,,,both,,,4031.4200,604.7100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2015.71,,,,,,,1040.5100,4031.4200,percent of total billed charges,"Rev 272 $4,031.42 in Billed Charges at 50% = $2,015.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT FILLER FOR RIA,272,RC,,,,,,,,both,,,4031.4200,604.7100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1302.15,,,,,,,1040.5100,4031.4200,other,"32.3% of $4,031.42 in Billed Charges for Rev 272 = $1,302.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GRAFT FILLER FOR RIA,272,RC,,,,,,,,both,,,4031.4200,604.7100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1237.65,,,,,,,1040.5100,4031.4200,other,"30.7% of $4,031.42 in Billed Charges for Rev 272 = $1,237.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GRAFT FILLER FOR RIA,272,RC,,,,,,,,both,,,4031.4200,604.7100,UNITED HEALTHCARE,UNITED HEALTHCARE,1302.15,,,,,,,1040.5100,4031.4200,percent of total billed charges,"32.3% of $4,031.42 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT FILLER FOR RIA,272,RC,,,,,,,,both,,,4031.4200,604.7100,WELLCARE,WELLCARE MEDICAID,4031.42,,,,,,,1040.5100,4031.4200,percent of total billed charges,"100% of $4,031.42 in Billed Charges for Rev 272 = $4,031.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT PASSING GUIDE PIN,278,RC,,,,,,,,both,,,967.7200,145.1600,AETNA,AETNA,464.51,,,,,,,249.7700,967.7200,percent of total billed charges,48% of $967.72 in Billed Charges for Rev 278 = $464.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRAFT PASSING GUIDE PIN,278,RC,,,,,,,,both,,,967.7200,145.1600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,483.86,,,,,,,249.7700,967.7200,percent of total billed charges,50% of $967.72 in Billed Charges for Rev 278 = $483.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRAFT PASSING GUIDE PIN,278,RC,,,,,,,,both,,,967.7200,145.1600,CIGNA HEALTHCARE,CIGNA HMO,403.54,,,,,,,249.7700,967.7200,percent of total billed charges,41.7% of $967.72 in Billed Charges for Rev 278 = $403.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRAFT PASSING GUIDE PIN,278,RC,,,,,,,,both,,,967.7200,145.1600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,387.09,,,,,,,249.7700,967.7200,percent of total billed charges,40% of $967.72 in Billed Charges for Rev 278 = $387.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRAFT PASSING GUIDE PIN,278,RC,,,,,,,,both,,,967.7200,145.1600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,403.54,,,,,,,249.7700,967.7200,percent of total billed charges,41.7% of $967.72 in Billed Charges for Rev 278 = $403.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRAFT PASSING GUIDE PIN,278,RC,,,,,,,,both,,,967.7200,145.1600,CIGNA HEALTHCARE,CIGNA PPO,403.54,,,,,,,249.7700,967.7200,percent of total billed charges,41.7% of $967.72 in Billed Charges for Rev 278 = $403.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRAFT PASSING GUIDE PIN,278,RC,,,,,,,,both,,,967.7200,145.1600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,870.95,,,,,,,249.7700,967.7200,percent of total billed charges,90% of $967.72 in Billed Charges for Rev 278 = $870.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRAFT PASSING GUIDE PIN,278,RC,,,,,,,,both,,,967.7200,145.1600,MEDCOST,MEDCOST VHN,460.54,,,,,,,249.7700,967.7200,percent of total billed charges,47.59% of $967.72 in Billed Charges for Rev 278 = $460.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRAFT PASSING GUIDE PIN,278,RC,,,,,,,,both,,,967.7200,145.1600,SENTARA HEALTH,SENTARA HEALTH,249.77,,,,,,,249.7700,967.7200,percent of total billed charges,25.81% of $967.72 in Billed Charges for Rev 278 = $249.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRAFT PASSING GUIDE PIN,278,RC,,,,,,,,both,,,967.7200,145.1600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",967.72,,,,,,,249.7700,967.7200,percent of total billed charges,100% of $967.72 in Billed Charges for Rev 278 = $967.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRAFT PASSING GUIDE PIN,278,RC,,,,,,,,both,,,967.7200,145.1600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,483.86,,,,,,,249.7700,967.7200,percent of total billed charges,Rev 278 $967.72 in Billed Charges at 50% = $483.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRAFT PASSING GUIDE PIN,278,RC,,,,,,,,both,,,967.7200,145.1600,WELLCARE,WELLCARE MEDICAID,967.72,,,,,,,249.7700,967.7200,percent of total billed charges,100% of $967.72 in Billed Charges for Rev 278 = $967.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRAFT PRESUTURE LINK PCL,278,RC,,,,,,,,both,,,23853.3000,3578.0000,AETNA,AETNA,11449.58,,,,,,,1693.5800,23853.3000,percent of total billed charges,"48% of $23,853.30 in Billed Charges for Rev 278 = $11,449.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT PRESUTURE LINK PCL,278,RC,,,,,,,,both,,,23853.3000,3578.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11926.65,,,,,,,1693.5800,23853.3000,percent of total billed charges,"50% of $23,853.30 in Billed Charges for Rev 278 = $11,926.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT PRESUTURE LINK PCL,278,RC,,,,,,,,both,,,23853.3000,3578.0000,CIGNA HEALTHCARE,CIGNA HMO,9946.83,,,,,,,1693.5800,23853.3000,percent of total billed charges,"41.7% of $23,853.30 in Billed Charges for Rev 278 = $9,946.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT PRESUTURE LINK PCL,278,RC,,,,,,,,both,,,23853.3000,3578.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,9541.32,,,,,,,1693.5800,23853.3000,percent of total billed charges,"40% of $23,853.30 in Billed Charges for Rev 278 = $9,541.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT PRESUTURE LINK PCL,278,RC,,,,,,,,both,,,23853.3000,3578.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9946.83,,,,,,,1693.5800,23853.3000,percent of total billed charges,"41.7% of $23,853.30 in Billed Charges for Rev 278 = $9,946.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT PRESUTURE LINK PCL,278,RC,,,,,,,,both,,,23853.3000,3578.0000,CIGNA HEALTHCARE,CIGNA PPO,9946.83,,,,,,,1693.5800,23853.3000,percent of total billed charges,"41.7% of $23,853.30 in Billed Charges for Rev 278 = $9,946.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT PRESUTURE LINK PCL,278,RC,,,,,,,,both,,,23853.3000,3578.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,21467.97,,,,,,,1693.5800,23853.3000,percent of total billed charges,"90% of $23,853.30 in Billed Charges for Rev 278 = $21,467.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT PRESUTURE LINK PCL,278,RC,,,,,,,,both,,,23853.3000,3578.0000,MEDCOST,MEDCOST VHN,11351.79,,,,,,,1693.5800,23853.3000,percent of total billed charges,"47.59% of $23,853.30 in Billed Charges for Rev 278 = $11,351.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT PRESUTURE LINK PCL,278,RC,,,,,,,,both,,,23853.3000,3578.0000,SENTARA HEALTH,SENTARA HEALTH,6156.54,,,,,,,1693.5800,23853.3000,percent of total billed charges,"25.81% of $23,853.30 in Billed Charges for Rev 278 = $6,156.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT PRESUTURE LINK PCL,278,RC,,,,,,,,both,,,23853.3000,3578.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",23853.30,,,,,,,1693.5800,23853.3000,percent of total billed charges,"100% of $23,853.30 in Billed Charges for Rev 278 = $23,853.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT PRESUTURE LINK PCL,278,RC,,,,,,,,both,,,23853.3000,3578.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11926.65,,,,,,,1693.5800,23853.3000,percent of total billed charges,"Rev 278 $23,853.30 in Billed Charges at 50% = $11,926.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT PRESUTURE LINK PCL,278,RC,,,,,,,,both,,,23853.3000,3578.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1789.00,,,,,,,1693.5800,23853.3000,percent of total billed charges,"7.5% of $23,853.30 in Billed Charges for Rev 278 = $1,789.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT PRESUTURE LINK PCL,278,RC,,,,,,,,both,,,23853.3000,3578.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1693.58,,,,,,,1693.5800,23853.3000,percent of total billed charges,"7.1% of $23,853.30 in Billed Charges for Rev 278 = $1,693.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT PRESUTURE LINK PCL,278,RC,,,,,,,,both,,,23853.3000,3578.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,1693.58,,,,,,,1693.5800,23853.3000,percent of total billed charges,"7.1% of $23,853.30 in Billed Charges for Rev 278 = $1,693.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT PRESUTURE LINK PCL,278,RC,,,,,,,,both,,,23853.3000,3578.0000,WELLCARE,WELLCARE MEDICAID,23853.30,,,,,,,1693.5800,23853.3000,percent of total billed charges,"100% of $23,853.30 in Billed Charges for Rev 278 = $23,853.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,AETNA,AETNA,250.22,,,,,,,23.5500,602.7100,percent of total billed charges,42.7% of $586.00 in Billed Charges for Rev 510 Proc 58301 = $250.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,312.61,,,,,,,23.5500,602.7100,fee schedule,"APG 00417 Proc 58301 at $836.60 (Base Rate) * 0.3593 (Relative Weight) = $300.59 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $300.59 at 104% = $312.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,276.47,,,,,,,23.5500,602.7100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,AETNA,AETNA HEALTHCARE MEDICARE,276.47,,,,,,,23.5500,602.7100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,276.47,,,,,,,23.5500,602.7100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,AMBETTER,AMBETTER,602.71,,,,,,,23.5500,602.7100,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,287.53,,,,,,,23.5500,602.7100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,BLUE CROSS,ANTHEM EXCHANGE,586.00,,,,,,,23.5500,602.7100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,309.61,,,,,,,23.5500,602.7100,fee schedule,"APG 00417 Proc 58301 at $836.60 (Base Rate) * 0.3593 (Relative Weight) = $300.59 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $300.59 at 103% = $309.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,BLUE CROSS,ANTHEM HMO,586.00,,,,,,,23.5500,602.7100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,284.77,,,,,,,23.5500,602.7100,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",586.00,,,,,,,23.5500,602.7100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,97.98,,,,,,,23.5500,602.7100,fee schedule,$97.98 from Fee Schedule BLDTM_23 for Rev 510 Proc 58301 * Qty 1 = $97.98 at 100% = $97.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,BLUE CROSS,BLUE CROSS MEDICARE,287.53,,,,,,,23.5500,602.7100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,BLUE CROSS,TENNCARE BLUE CARE,23.55,,,,,,,23.5500,602.7100,fee schedule,$20.30 from Fee Schedule TC_24 for Rev 510 Proc 58301 * Qty 1 = $20.30 at 116% = $23.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,BLUE CROSS,TENNCARE BLUE SELECT,23.55,,,,,,,23.5500,602.7100,fee schedule,$20.30 from Fee Schedule TC_24 for Rev 510 Proc 58301 * Qty 1 = $20.30 at 116% = $23.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,CIGNA HEALTHCARE,CIGNA HMO,244.36,,,,,,,23.5500,602.7100,percent of total billed charges,41.7% of $586.00 in Billed Charges for Rev 510 Proc 58301 = $244.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,271.90,,,,,,,23.5500,602.7100,percent of total billed charges,46.4% of $586.00 in Billed Charges for Rev 510 Proc 58301 = $271.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,290.30,,,,,,,23.5500,602.7100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,244.36,,,,,,,23.5500,602.7100,percent of total billed charges,41.7% of $586.00 in Billed Charges for Rev 510 Proc 58301 = $244.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,CIGNA HEALTHCARE,CIGNA PPO,244.36,,,,,,,23.5500,602.7100,percent of total billed charges,41.7% of $586.00 in Billed Charges for Rev 510 Proc 58301 = $244.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,290.30,,,,,,,23.5500,602.7100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,527.40,,,,,,,23.5500,602.7100,percent of total billed charges,90% of $586.00 in Billed Charges for Rev 510 Proc 58301 = $527.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,HUMANA,HUMANA MEDICARE,276.47,,,,,,,23.5500,602.7100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,276.47,,,,,,,23.5500,602.7100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,MEDCOST,MEDCOST VHN,278.88,,,,,,,23.5500,602.7100,percent of total billed charges,47.59% of $586.00 in Billed Charges for Rev 510 Proc 58301 = $278.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,315.62,,,,,,,23.5500,602.7100,fee schedule,"APG 00417 Proc 58301 at $836.60 (Base Rate) * 0.3593 (Relative Weight) = $300.59 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $300.59 at 100% = $300.59... $300.59 at 105% = $315.62 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,290.30,,,,,,,23.5500,602.7100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,290.30,,,,,,,23.5500,602.7100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,NHC ADVANTAGE,NHC ADVANTAGE,290.30,,,,,,,23.5500,602.7100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,309.91,,,,,,,23.5500,602.7100,fee schedule,"APG 00417 Proc 58301 at $836.60 (Base Rate) * 0.3593 (Relative Weight) = $300.59 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $300.59 at 100% = $300.59... $300.59 at 103.1% = $309.91 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,SENTARA HEALTH,SENTARA HEALTH,151.25,,,,,,,23.5500,602.7100,percent of total billed charges,25.81% of $586.00 in Billed Charges for Rev 510 Proc 58301 = $151.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,SENTARA HEALTH,SENTARA MEDICARE,276.47,,,,,,,23.5500,602.7100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",586.00,,,,,,,23.5500,602.7100,percent of total billed charges,100% of $586.00 in Billed Charges for Rev 510 Proc 58301 = $586.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,113.08,,,,,,,23.5500,602.7100,fee schedule,$226.16 from Fee Schedule TCUHC24 for Rev 510 Proc 58301 * Qty 1 = $226.16 at 50% = $113.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,189.28,,,,,,,23.5500,602.7100,other,32.3% of $586.00 in Billed Charges for Rev 510 Proc 58301 = $189.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,179.90,,,,,,,23.5500,602.7100,other,30.7% of $586.00 in Billed Charges for Rev 510 Proc 58301 = $179.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,189.28,,,,,,,23.5500,602.7100,percent of total billed charges,32.3% of $586.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,309.61,,,,,,,23.5500,602.7100,fee schedule,"APG 00417 Proc 58301 at $836.60 (Base Rate) * 0.3593 (Relative Weight) = $300.59 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $300.59 at 103% = $309.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,276.47,,,,,,,23.5500,602.7100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,276.47,,,,,,,23.5500,602.7100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,WELLCARE,WELLCARE MEDICAID,586.00,,,,,,,23.5500,602.7100,percent of total billed charges,100% of $586.00 in Billed Charges for Rev 510 Proc 58301 = $586.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL IUD,58301,CPT,510,RC,51000206,CDM,,,,both,,,586.0000,87.9000,WELLCARE,WELLCARE MEDICARE,293.06,,,,,,,23.5500,602.7100,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CATH HYSTEROSALPINGOGRAM.,58340,CPT,361,RC,36100175,CDM,,,,both,,,497.0000,74.5500,AETNA,AETNA,212.22,,,,,,,128.2800,500.0000,percent of total billed charges,42.7% of $497.00 in Billed Charges for Rev 361 Proc 58340 = $212.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ CATH HYSTEROSALPINGOGRAM.,58340,CPT,361,RC,36100175,CDM,,,,both,,,497.0000,74.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,495.24,,,,,,,128.2800,500.0000,fee schedule,APG 00278 Proc 58340 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 104% = $495.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CATH HYSTEROSALPINGOGRAM.,58340,CPT,361,RC,36100175,CDM,,,,both,,,497.0000,74.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,490.48,,,,,,,128.2800,500.0000,fee schedule,APG 00278 Proc 58340 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 103% = $490.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CATH HYSTEROSALPINGOGRAM.,58340,CPT,361,RC,36100175,CDM,,,,both,,,497.0000,74.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,497.00,,,,,,,128.2800,500.0000,case rate,"Rev 361 Proc 58340 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $497.00 in Billed Charges - $0.00 in ASG Allowed Amount = $497.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ CATH HYSTEROSALPINGOGRAM.,58340,CPT,361,RC,36100175,CDM,,,,both,,,497.0000,74.5500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,128.2800,500.0000,case rate,Rev 361 Proc 58340 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CATH HYSTEROSALPINGOGRAM.,58340,CPT,361,RC,36100175,CDM,,,,both,,,497.0000,74.5500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,128.2800,500.0000,case rate,Rev 361 Proc 58340 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CATH HYSTEROSALPINGOGRAM.,58340,CPT,361,RC,36100175,CDM,,,,both,,,497.0000,74.5500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,128.2800,500.0000,case rate,Rev 361 Proc 58340 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CATH HYSTEROSALPINGOGRAM.,58340,CPT,361,RC,36100175,CDM,,,,both,,,497.0000,74.5500,BLUE CROSS,TENNCARE BLUE CARE,497.00,,,,,,,128.2800,500.0000,case rate,"Rev 361 Proc 58340 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total (Service Line reduced to $497.00, claim capped at $497.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ CATH HYSTEROSALPINGOGRAM.,58340,CPT,361,RC,36100175,CDM,,,,both,,,497.0000,74.5500,BLUE CROSS,TENNCARE BLUE SELECT,497.00,,,,,,,128.2800,500.0000,case rate,"Rev 361 Proc 58340 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total (Service Line reduced to $497.00, claim capped at $497.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ CATH HYSTEROSALPINGOGRAM.,58340,CPT,361,RC,36100175,CDM,,,,both,,,497.0000,74.5500,CIGNA HEALTHCARE,CIGNA HMO,497.00,,,,,,,128.2800,500.0000,case rate,"Rev 361 Proc 58340 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $497.00 in Billed Charges - $0.00 in ASG Allowed Amount = $497.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ CATH HYSTEROSALPINGOGRAM.,58340,CPT,361,RC,36100175,CDM,,,,both,,,497.0000,74.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,497.00,,,,,,,128.2800,500.0000,case rate,"Rev 361 Proc 58340 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $497.00 in Billed Charges - $0.00 in ASG Allowed Amount = $497.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ CATH HYSTEROSALPINGOGRAM.,58340,CPT,361,RC,36100175,CDM,,,,both,,,497.0000,74.5500,CIGNA HEALTHCARE,CIGNA PPO,497.00,,,,,,,128.2800,500.0000,case rate,"Rev 361 Proc 58340 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $497.00 in Billed Charges - $0.00 in ASG Allowed Amount = $497.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ CATH HYSTEROSALPINGOGRAM.,58340,CPT,361,RC,36100175,CDM,,,,both,,,497.0000,74.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,447.30,,,,,,,128.2800,500.0000,percent of total billed charges,90% of $497.00 in Billed Charges for Rev 361 Proc 58340 = $447.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ CATH HYSTEROSALPINGOGRAM.,58340,CPT,361,RC,36100175,CDM,,,,both,,,497.0000,74.5500,MEDCOST,MEDCOST VHN,236.52,,,,,,,128.2800,500.0000,percent of total billed charges,47.59% of $497.00 in Billed Charges for Rev 361 Proc 58340 = $236.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ CATH HYSTEROSALPINGOGRAM.,58340,CPT,361,RC,36100175,CDM,,,,both,,,497.0000,74.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,500.00,,,,,,,128.2800,500.0000,fee schedule,APG 00278 Proc 58340 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 100% = $476.19... $476.19 at 105% = $500.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CATH HYSTEROSALPINGOGRAM.,58340,CPT,361,RC,36100175,CDM,,,,both,,,497.0000,74.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,490.95,,,,,,,128.2800,500.0000,fee schedule,APG 00278 Proc 58340 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 100% = $476.19... $476.19 at 103.1% = $490.95 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CATH HYSTEROSALPINGOGRAM.,58340,CPT,361,RC,36100175,CDM,,,,both,,,497.0000,74.5500,SENTARA HEALTH,SENTARA HEALTH,128.28,,,,,,,128.2800,500.0000,percent of total billed charges,25.81% of $497.00 in Billed Charges for Rev 361 Proc 58340 = $128.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ CATH HYSTEROSALPINGOGRAM.,58340,CPT,361,RC,36100175,CDM,,,,both,,,497.0000,74.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",497.00,,,,,,,128.2800,500.0000,percent of total billed charges,100% of $497.00 in Billed Charges for Rev 361 Proc 58340 = $497.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ CATH HYSTEROSALPINGOGRAM.,58340,CPT,361,RC,36100175,CDM,,,,both,,,497.0000,74.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,128.2800,500.0000,case rate,Rev 361 Proc 58340 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CATH HYSTEROSALPINGOGRAM.,58340,CPT,361,RC,36100175,CDM,,,,both,,,497.0000,74.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,128.2800,500.0000,case rate,Rev 361 Proc 58340 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CATH HYSTEROSALPINGOGRAM.,58340,CPT,361,RC,36100175,CDM,,,,both,,,497.0000,74.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,128.2800,500.0000,case rate,Rev 361 Proc 58340 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CATH HYSTEROSALPINGOGRAM.,58340,CPT,361,RC,36100175,CDM,,,,both,,,497.0000,74.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,497.00,,,,,,,128.2800,500.0000,case rate,"Rev 361 Proc 58340 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total (Service Line reduced to $497.00, claim capped at $497.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ CATH HYSTEROSALPINGOGRAM.,58340,CPT,361,RC,36100175,CDM,,,,both,,,497.0000,74.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,490.48,,,,,,,128.2800,500.0000,fee schedule,APG 00278 Proc 58340 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 103% = $490.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ CATH HYSTEROSALPINGOGRAM.,58340,CPT,361,RC,36100175,CDM,,,,both,,,497.0000,74.5500,WELLCARE,WELLCARE MEDICAID,497.00,,,,,,,128.2800,500.0000,percent of total billed charges,100% of $497.00 in Billed Charges for Rev 361 Proc 58340 = $497.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,AETNA,AETNA,4504.00,,,,,,,173.1800,10548.0000,percent of total billed charges,"42.7% of $10,548.00 in Billed Charges for Rev 510 Proc 59320 = $4,504.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2546.59,,,,,,,173.1800,10548.0000,fee schedule,"APG 00205 Proc 59320 at $836.60 (Base Rate) * 2.9269 (Relative Weight) = $2,448.64 (Total Line Payment) at 104% = $2,546.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2936.96,,,,,,,173.1800,10548.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,AETNA,AETNA HEALTHCARE MEDICARE,2936.96,,,,,,,173.1800,10548.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,2936.96,,,,,,,173.1800,10548.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,AMBETTER,AMBETTER,6402.58,,,,,,,173.1800,10548.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3054.44,,,,,,,173.1800,10548.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,BLUE CROSS,ANTHEM EXCHANGE,7230.96,,,,,,,173.1800,10548.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2522.10,,,,,,,173.1800,10548.0000,fee schedule,"APG 00205 Proc 59320 at $836.60 (Base Rate) * 2.9269 (Relative Weight) = $2,448.64 (Total Line Payment) at 103% = $2,522.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,BLUE CROSS,ANTHEM HMO,7682.46,,,,,,,173.1800,10548.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3025.07,,,,,,,173.1800,10548.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9037.70,,,,,,,173.1800,10548.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,173.18,,,,,,,173.1800,10548.0000,fee schedule,$173.18 from Fee Schedule BLDTM_23 for Rev 510 Proc 59320 * Qty 1 = $173.18 at 100% = $173.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,BLUE CROSS,BLUE CROSS MEDICARE,3054.44,,,,,,,173.1800,10548.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,CIGNA HEALTHCARE,CIGNA HMO,4398.52,,,,,,,173.1800,10548.0000,percent of total billed charges,"41.7% of $10,548.00 in Billed Charges for Rev 510 Proc 59320 = $4,398.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4894.27,,,,,,,173.1800,10548.0000,percent of total billed charges,"46.4% of $10,548.00 in Billed Charges for Rev 510 Proc 59320 = $4,894.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,3083.81,,,,,,,173.1800,10548.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4398.52,,,,,,,173.1800,10548.0000,percent of total billed charges,"41.7% of $10,548.00 in Billed Charges for Rev 510 Proc 59320 = $4,398.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,CIGNA HEALTHCARE,CIGNA PPO,4398.52,,,,,,,173.1800,10548.0000,percent of total billed charges,"41.7% of $10,548.00 in Billed Charges for Rev 510 Proc 59320 = $4,398.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3083.81,,,,,,,173.1800,10548.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9493.20,,,,,,,173.1800,10548.0000,percent of total billed charges,"90% of $10,548.00 in Billed Charges for Rev 510 Proc 59320 = $9,493.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,HUMANA,HUMANA MEDICARE,2936.96,,,,,,,173.1800,10548.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2936.96,,,,,,,173.1800,10548.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,MEDCOST,MEDCOST VHN,5019.79,,,,,,,173.1800,10548.0000,percent of total billed charges,"47.59% of $10,548.00 in Billed Charges for Rev 510 Proc 59320 = $5,019.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2571.07,,,,,,,173.1800,10548.0000,fee schedule,"APG 00205 Proc 59320 at $836.60 (Base Rate) * 2.9269 (Relative Weight) = $2,448.64 (Total Line Payment) at 100% = $2,448.64... $2,448.64 at 105% = $2,571.07 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3083.81,,,,,,,173.1800,10548.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3083.81,,,,,,,173.1800,10548.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,NHC ADVANTAGE,NHC ADVANTAGE,3083.81,,,,,,,173.1800,10548.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2524.55,,,,,,,173.1800,10548.0000,fee schedule,"APG 00205 Proc 59320 at $836.60 (Base Rate) * 2.9269 (Relative Weight) = $2,448.64 (Total Line Payment) at 100% = $2,448.64... $2,448.64 at 103.1% = $2,524.55 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,SENTARA HEALTH,SENTARA HEALTH,2722.44,,,,,,,173.1800,10548.0000,percent of total billed charges,"25.81% of $10,548.00 in Billed Charges for Rev 510 Proc 59320 = $2,722.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,SENTARA HEALTH,SENTARA MEDICARE,2936.96,,,,,,,173.1800,10548.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10548.00,,,,,,,173.1800,10548.0000,percent of total billed charges,"100% of $10,548.00 in Billed Charges for Rev 510 Proc 59320 = $10,548.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,923.10,,,,,,,173.1800,10548.0000,fee schedule,"$1,846.20 from Fee Schedule TCUHC24 for Rev 510 Proc 59320 * Qty 1 = $1,846.20 at 50% = $923.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3407.00,,,,,,,173.1800,10548.0000,other,"32.3% of $10,548.00 in Billed Charges for Rev 510 Proc 59320 = $3,407.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3238.24,,,,,,,173.1800,10548.0000,other,"30.7% of $10,548.00 in Billed Charges for Rev 510 Proc 59320 = $3,238.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,3407.00,,,,,,,173.1800,10548.0000,percent of total billed charges,"32.3% of $10,548.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2522.10,,,,,,,173.1800,10548.0000,fee schedule,"APG 00205 Proc 59320 at $836.60 (Base Rate) * 2.9269 (Relative Weight) = $2,448.64 (Total Line Payment) at 103% = $2,522.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2936.96,,,,,,,173.1800,10548.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2936.96,,,,,,,173.1800,10548.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,WELLCARE,WELLCARE MEDICAID,10548.00,,,,,,,173.1800,10548.0000,percent of total billed charges,"100% of $10,548.00 in Billed Charges for Rev 510 Proc 59320 = $10,548.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CERCLAGE CERVIX PREGNANCY CERVICAL,59320,CPT,510,RC,51000253,CDM,,,,both,,,10548.0000,1582.2000,WELLCARE,WELLCARE MEDICARE,3113.18,,,,,,,173.1800,10548.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,AETNA,AETNA,1323.27,,,,,,,109.0000,6402.5800,percent of total billed charges,"42.7% of $3,099.00 in Billed Charges for Rev 450 Proc 59409 = $1,323.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3432.66,,,,,,,109.0000,6402.5800,fee schedule,"APG 00195 Proc 59409 at $836.60 (Base Rate) * 3.9453 (Relative Weight) = $3,300.64 (Total Line Payment) at 104% = $3,432.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2936.96,,,,,,,109.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,AETNA,AETNA HEALTHCARE MEDICARE,2936.96,,,,,,,109.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,2936.96,,,,,,,109.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,AMBETTER,AMBETTER,6402.58,,,,,,,109.0000,6402.5800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3054.44,,,,,,,109.0000,6402.5800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,BLUE CROSS,ANTHEM EXCHANGE,3099.00,,,,,,,109.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3099.00,,,,,,,109.0000,6402.5800,fee schedule,"APG 00195 Proc 59409 at $836.60 (Base Rate) * 3.9453 (Relative Weight) = $3,300.64 (Total Line Payment) at 103% = $3,399.66 (Service Line reduced to $3,099.00, claim capped at $3,099.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,BLUE CROSS,ANTHEM HMO,3099.00,,,,,,,109.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3025.07,,,,,,,109.0000,6402.5800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3099.00,,,,,,,109.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,800.16,,,,,,,109.0000,6402.5800,fee schedule,$800.16 from Fee Schedule BLDTM_23 for Rev 450 Proc 59409 * Qty 1 = $800.16 at 100% = $800.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,BLUE CROSS,BLUE CROSS MEDICARE,3054.44,,,,,,,109.0000,6402.5800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,3083.81,,,,,,,109.0000,6402.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3083.81,,,,,,,109.0000,6402.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2789.10,,,,,,,109.0000,6402.5800,percent of total billed charges,"90% of $3,099.00 in Billed Charges for Rev 450 Proc 59409 = $2,789.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,HUMANA,HUMANA MEDICARE,2936.96,,,,,,,109.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2936.96,,,,,,,109.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,MEDCOST,MEDCOST VHN,1474.81,,,,,,,109.0000,6402.5800,percent of total billed charges,"47.59% of $3,099.00 in Billed Charges for Rev 450 Proc 59409 = $1,474.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3465.67,,,,,,,109.0000,6402.5800,fee schedule,"APG 00195 Proc 59409 at $836.60 (Base Rate) * 3.9453 (Relative Weight) = $3,300.64 (Total Line Payment) at 100% = $3,300.64... $3,300.64 at 105% = $3,465.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3083.81,,,,,,,109.0000,6402.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3083.81,,,,,,,109.0000,6402.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,NHC ADVANTAGE,NHC ADVANTAGE,3083.81,,,,,,,109.0000,6402.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3402.96,,,,,,,109.0000,6402.5800,fee schedule,"APG 00195 Proc 59409 at $836.60 (Base Rate) * 3.9453 (Relative Weight) = $3,300.64 (Total Line Payment) at 100% = $3,300.64... $3,300.64 at 103.1% = $3,402.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,SENTARA HEALTH,SENTARA HEALTH,799.85,,,,,,,109.0000,6402.5800,percent of total billed charges,"25.81% of $3,099.00 in Billed Charges for Rev 450 Proc 59409 = $799.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,SENTARA HEALTH,SENTARA MEDICARE,2936.96,,,,,,,109.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3099.00,,,,,,,109.0000,6402.5800,percent of total billed charges,"100% of $3,099.00 in Billed Charges for Rev 450 Proc 59409 = $3,099.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,6402.5800,case rate,Rev 450 Proc 59409 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,6402.5800,case rate,Rev 450 Proc 59409 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,6402.5800,case rate,Rev 450 Proc 59409 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,6402.5800,case rate,Rev 450 Proc 59409 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3399.66,,,,,,,109.0000,6402.5800,fee schedule,"APG 00195 Proc 59409 at $836.60 (Base Rate) * 3.9453 (Relative Weight) = $3,300.64 (Total Line Payment) at 103% = $3,399.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2936.96,,,,,,,109.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2936.96,,,,,,,109.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,WELLCARE,WELLCARE MEDICAID,3099.00,,,,,,,109.0000,6402.5800,percent of total billed charges,"100% of $3,099.00 in Billed Charges for Rev 450 Proc 59409 = $3,099.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VAGINAL DELIVERY,59409,CPT,450,RC,45000282,CDM,,,,both,,,3099.0000,464.8500,WELLCARE,WELLCARE MEDICARE,3113.18,,,,,,,109.0000,6402.5800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,AETNA,AETNA,7145.42,,,,,,,890.0000,22390.4700,percent of total billed charges,"42.7% of $16,734.00 in Billed Charges for Rev 361 Proc 0339T = $7,145.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,22177.24,,,,,,,890.0000,22390.4700,fee schedule,"APG 00122 Proc 0339T at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 104% = $22,177.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5163.81,,,,,,,890.0000,22390.4700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,AETNA,AETNA HEALTHCARE MEDICARE,5163.81,,,,,,,890.0000,22390.4700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,5163.81,,,,,,,890.0000,22390.4700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,AMBETTER,AMBETTER,11257.11,,,,,,,890.0000,22390.4700,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,5370.36,,,,,,,890.0000,22390.4700,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,BLUE CROSS,ANTHEM EXCHANGE,12713.57,,,,,,,890.0000,22390.4700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,16734.00,,,,,,,890.0000,22390.4700,fee schedule,"APG 00122 Proc 0339T at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99 (Service Line reduced to $16,734.00, claim capped at $16,734.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,BLUE CROSS,ANTHEM HMO,13507.41,,,,,,,890.0000,22390.4700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5318.72,,,,,,,890.0000,22390.4700,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",15890.21,,,,,,,890.0000,22390.4700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,890.0000,22390.4700,case rate,"Rev 361 Proc 0339T ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,BLUE CROSS,BLUE CROSS MEDICARE,5370.36,,,,,,,890.0000,22390.4700,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,890.0000,22390.4700,case rate,"Rev 361 Proc 0339T ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,890.0000,22390.4700,case rate,"Rev 361 Proc 0339T ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,BLUE CROSS,TENNCARE BLUE CARE,890.00,,,,,,,890.0000,22390.4700,case rate,Rev 361 Proc 0339T ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,BLUE CROSS,TENNCARE BLUE SELECT,890.00,,,,,,,890.0000,22390.4700,case rate,Rev 361 Proc 0339T ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,CIGNA HEALTHCARE,CIGNA HMO,8003.00,,,,,,,890.0000,22390.4700,case rate,"Rev 361 Proc 0339T ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6048.00,,,,,,,890.0000,22390.4700,case rate,"Rev 361 Proc 0339T ASG Rate of $6,048.00 at 100% of $6,048.00 = $6,048.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,5422.00,,,,,,,890.0000,22390.4700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8003.00,,,,,,,890.0000,22390.4700,case rate,"Rev 361 Proc 0339T ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,CIGNA HEALTHCARE,CIGNA PPO,8003.00,,,,,,,890.0000,22390.4700,case rate,"Rev 361 Proc 0339T ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,5422.00,,,,,,,890.0000,22390.4700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,15060.60,,,,,,,890.0000,22390.4700,percent of total billed charges,"90% of $16,734.00 in Billed Charges for Rev 361 Proc 0339T = $15,060.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,HUMANA,HUMANA MEDICARE,5163.81,,,,,,,890.0000,22390.4700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5163.81,,,,,,,890.0000,22390.4700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,MEDCOST,MEDCOST VHN,7963.71,,,,,,,890.0000,22390.4700,percent of total billed charges,"47.59% of $16,734.00 in Billed Charges for Rev 361 Proc 0339T = $7,963.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,22390.47,,,,,,,890.0000,22390.4700,fee schedule,"APG 00122 Proc 0339T at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 105% = $22,390.47 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,5422.00,,,,,,,890.0000,22390.4700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,5422.00,,,,,,,890.0000,22390.4700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,NHC ADVANTAGE,NHC ADVANTAGE,5422.00,,,,,,,890.0000,22390.4700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,21985.31,,,,,,,890.0000,22390.4700,fee schedule,"APG 00122 Proc 0339T at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 103.1% = $21,985.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,SENTARA HEALTH,SENTARA HEALTH,4319.05,,,,,,,890.0000,22390.4700,percent of total billed charges,"25.81% of $16,734.00 in Billed Charges for Rev 361 Proc 0339T = $4,319.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,SENTARA HEALTH,SENTARA MEDICARE,5163.81,,,,,,,890.0000,22390.4700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",16734.00,,,,,,,890.0000,22390.4700,percent of total billed charges,"100% of $16,734.00 in Billed Charges for Rev 361 Proc 0339T = $16,734.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,890.0000,22390.4700,case rate,"Rev 361 Proc 0339T ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,890.0000,22390.4700,case rate,"Rev 361 Proc 0339T ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,890.0000,22390.4700,case rate,"Rev 361 Proc 0339T ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,890.0000,22390.4700,case rate,"Rev 361 Proc 0339T ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,21963.99,,,,,,,890.0000,22390.4700,fee schedule,"APG 00122 Proc 0339T at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5163.81,,,,,,,890.0000,22390.4700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5163.81,,,,,,,890.0000,22390.4700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,WELLCARE,WELLCARE MEDICAID,16734.00,,,,,,,890.0000,22390.4700,percent of total billed charges,"100% of $16,734.00 in Billed Charges for Rev 361 Proc 0339T = $16,734.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH RENAL SYMPATH DENERVATION BILATERAL,0339T,CPT,361,RC,36100331,CDM,,,,both,,,16734.0000,2510.1000,WELLCARE,WELLCARE MEDICARE,5473.64,,,,,,,890.0000,22390.4700,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMVI/REPLAC W PROSTH VALVE PERCU APPR INCL TRANSSEPTAL PUNCT,0483T,CPT,360,RC,36000114,CDM,,,,both,,,30366.0000,4554.9000,AETNA,AETNA,12966.28,,,,,,,968.0000,30366.0000,percent of total billed charges,"42.7% of $30,366.00 in Billed Charges for Rev 360 Proc 0483T = $12,966.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVI/REPLAC W PROSTH VALVE PERCU APPR INCL TRANSSEPTAL PUNCT,0483T,CPT,360,RC,36000114,CDM,,,,both,,,30366.0000,4554.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,20883.80,,,,,,,968.0000,30366.0000,fee schedule,"APG 00121 Proc 0483T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 104% = $20,883.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVI/REPLAC W PROSTH VALVE PERCU APPR INCL TRANSSEPTAL PUNCT,0483T,CPT,360,RC,36000114,CDM,,,,both,,,30366.0000,4554.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,20682.99,,,,,,,968.0000,30366.0000,fee schedule,"APG 00121 Proc 0483T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVI/REPLAC W PROSTH VALVE PERCU APPR INCL TRANSSEPTAL PUNCT,0483T,CPT,360,RC,36000114,CDM,,,,both,,,30366.0000,4554.9000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,968.0000,30366.0000,case rate,"Rev 360 Proc 0483T ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVI/REPLAC W PROSTH VALVE PERCU APPR INCL TRANSSEPTAL PUNCT,0483T,CPT,360,RC,36000114,CDM,,,,both,,,30366.0000,4554.9000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,968.0000,30366.0000,case rate,"Rev 360 Proc 0483T ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVI/REPLAC W PROSTH VALVE PERCU APPR INCL TRANSSEPTAL PUNCT,0483T,CPT,360,RC,36000114,CDM,,,,both,,,30366.0000,4554.9000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,968.0000,30366.0000,case rate,"Rev 360 Proc 0483T ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVI/REPLAC W PROSTH VALVE PERCU APPR INCL TRANSSEPTAL PUNCT,0483T,CPT,360,RC,36000114,CDM,,,,both,,,30366.0000,4554.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,27329.40,,,,,,,968.0000,30366.0000,percent of total billed charges,"90% of $30,366.00 in Billed Charges for Rev 360 Proc 0483T = $27,329.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVI/REPLAC W PROSTH VALVE PERCU APPR INCL TRANSSEPTAL PUNCT,0483T,CPT,360,RC,36000114,CDM,,,,both,,,30366.0000,4554.9000,MEDCOST,MEDCOST VHN,14451.18,,,,,,,968.0000,30366.0000,percent of total billed charges,"47.59% of $30,366.00 in Billed Charges for Rev 360 Proc 0483T = $14,451.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVI/REPLAC W PROSTH VALVE PERCU APPR INCL TRANSSEPTAL PUNCT,0483T,CPT,360,RC,36000114,CDM,,,,both,,,30366.0000,4554.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,21084.61,,,,,,,968.0000,30366.0000,fee schedule,"APG 00121 Proc 0483T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 105% = $21,084.61 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVI/REPLAC W PROSTH VALVE PERCU APPR INCL TRANSSEPTAL PUNCT,0483T,CPT,360,RC,36000114,CDM,,,,both,,,30366.0000,4554.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,20703.08,,,,,,,968.0000,30366.0000,fee schedule,"APG 00121 Proc 0483T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 103.1% = $20,703.08 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVI/REPLAC W PROSTH VALVE PERCU APPR INCL TRANSSEPTAL PUNCT,0483T,CPT,360,RC,36000114,CDM,,,,both,,,30366.0000,4554.9000,SENTARA HEALTH,SENTARA HEALTH,7837.46,,,,,,,968.0000,30366.0000,percent of total billed charges,"25.81% of $30,366.00 in Billed Charges for Rev 360 Proc 0483T = $7,837.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVI/REPLAC W PROSTH VALVE PERCU APPR INCL TRANSSEPTAL PUNCT,0483T,CPT,360,RC,36000114,CDM,,,,both,,,30366.0000,4554.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",30366.00,,,,,,,968.0000,30366.0000,percent of total billed charges,"100% of $30,366.00 in Billed Charges for Rev 360 Proc 0483T = $30,366.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVI/REPLAC W PROSTH VALVE PERCU APPR INCL TRANSSEPTAL PUNCT,0483T,CPT,360,RC,36000114,CDM,,,,both,,,30366.0000,4554.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,968.0000,30366.0000,case rate,Rev 360 Proc 0483T ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMVI/REPLAC W PROSTH VALVE PERCU APPR INCL TRANSSEPTAL PUNCT,0483T,CPT,360,RC,36000114,CDM,,,,both,,,30366.0000,4554.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,968.0000,30366.0000,case rate,"Rev 360 Proc 0483T ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVI/REPLAC W PROSTH VALVE PERCU APPR INCL TRANSSEPTAL PUNCT,0483T,CPT,360,RC,36000114,CDM,,,,both,,,30366.0000,4554.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,968.0000,30366.0000,case rate,"Rev 360 Proc 0483T ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVI/REPLAC W PROSTH VALVE PERCU APPR INCL TRANSSEPTAL PUNCT,0483T,CPT,360,RC,36000114,CDM,,,,both,,,30366.0000,4554.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,968.0000,30366.0000,case rate,"Rev 360 Proc 0483T ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVI/REPLAC W PROSTH VALVE PERCU APPR INCL TRANSSEPTAL PUNCT,0483T,CPT,360,RC,36000114,CDM,,,,both,,,30366.0000,4554.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,20682.99,,,,,,,968.0000,30366.0000,fee schedule,"APG 00121 Proc 0483T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVI/REPLAC W PROSTH VALVE PERCU APPR INCL TRANSSEPTAL PUNCT,0483T,CPT,360,RC,36000114,CDM,,,,both,,,30366.0000,4554.9000,WELLCARE,WELLCARE MEDICAID,30366.00,,,,,,,968.0000,30366.0000,percent of total billed charges,"100% of $30,366.00 in Billed Charges for Rev 360 Proc 0483T = $30,366.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVI/REPLAC W PROSTH VALVE TRANSTH EXPOSURE,0484T,CPT,360,RC,36000115,CDM,,,,both,,,30366.0000,4554.9000,AETNA,AETNA,12966.28,,,,,,,968.0000,30366.0000,percent of total billed charges,"42.7% of $30,366.00 in Billed Charges for Rev 360 Proc 0484T = $12,966.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVI/REPLAC W PROSTH VALVE TRANSTH EXPOSURE,0484T,CPT,360,RC,36000115,CDM,,,,both,,,30366.0000,4554.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,20883.80,,,,,,,968.0000,30366.0000,fee schedule,"APG 00121 Proc 0484T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 104% = $20,883.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVI/REPLAC W PROSTH VALVE TRANSTH EXPOSURE,0484T,CPT,360,RC,36000115,CDM,,,,both,,,30366.0000,4554.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,20682.99,,,,,,,968.0000,30366.0000,fee schedule,"APG 00121 Proc 0484T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVI/REPLAC W PROSTH VALVE TRANSTH EXPOSURE,0484T,CPT,360,RC,36000115,CDM,,,,both,,,30366.0000,4554.9000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,968.0000,30366.0000,case rate,"Rev 360 Proc 0484T ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVI/REPLAC W PROSTH VALVE TRANSTH EXPOSURE,0484T,CPT,360,RC,36000115,CDM,,,,both,,,30366.0000,4554.9000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,968.0000,30366.0000,case rate,"Rev 360 Proc 0484T ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVI/REPLAC W PROSTH VALVE TRANSTH EXPOSURE,0484T,CPT,360,RC,36000115,CDM,,,,both,,,30366.0000,4554.9000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,968.0000,30366.0000,case rate,"Rev 360 Proc 0484T ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVI/REPLAC W PROSTH VALVE TRANSTH EXPOSURE,0484T,CPT,360,RC,36000115,CDM,,,,both,,,30366.0000,4554.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,27329.40,,,,,,,968.0000,30366.0000,percent of total billed charges,"90% of $30,366.00 in Billed Charges for Rev 360 Proc 0484T = $27,329.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVI/REPLAC W PROSTH VALVE TRANSTH EXPOSURE,0484T,CPT,360,RC,36000115,CDM,,,,both,,,30366.0000,4554.9000,MEDCOST,MEDCOST VHN,14451.18,,,,,,,968.0000,30366.0000,percent of total billed charges,"47.59% of $30,366.00 in Billed Charges for Rev 360 Proc 0484T = $14,451.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVI/REPLAC W PROSTH VALVE TRANSTH EXPOSURE,0484T,CPT,360,RC,36000115,CDM,,,,both,,,30366.0000,4554.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,21084.61,,,,,,,968.0000,30366.0000,fee schedule,"APG 00121 Proc 0484T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 105% = $21,084.61 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVI/REPLAC W PROSTH VALVE TRANSTH EXPOSURE,0484T,CPT,360,RC,36000115,CDM,,,,both,,,30366.0000,4554.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,20703.08,,,,,,,968.0000,30366.0000,fee schedule,"APG 00121 Proc 0484T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 103.1% = $20,703.08 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVI/REPLAC W PROSTH VALVE TRANSTH EXPOSURE,0484T,CPT,360,RC,36000115,CDM,,,,both,,,30366.0000,4554.9000,SENTARA HEALTH,SENTARA HEALTH,7837.46,,,,,,,968.0000,30366.0000,percent of total billed charges,"25.81% of $30,366.00 in Billed Charges for Rev 360 Proc 0484T = $7,837.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVI/REPLAC W PROSTH VALVE TRANSTH EXPOSURE,0484T,CPT,360,RC,36000115,CDM,,,,both,,,30366.0000,4554.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",30366.00,,,,,,,968.0000,30366.0000,percent of total billed charges,"100% of $30,366.00 in Billed Charges for Rev 360 Proc 0484T = $30,366.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVI/REPLAC W PROSTH VALVE TRANSTH EXPOSURE,0484T,CPT,360,RC,36000115,CDM,,,,both,,,30366.0000,4554.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,968.0000,30366.0000,case rate,Rev 360 Proc 0484T ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMVI/REPLAC W PROSTH VALVE TRANSTH EXPOSURE,0484T,CPT,360,RC,36000115,CDM,,,,both,,,30366.0000,4554.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,968.0000,30366.0000,case rate,"Rev 360 Proc 0484T ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVI/REPLAC W PROSTH VALVE TRANSTH EXPOSURE,0484T,CPT,360,RC,36000115,CDM,,,,both,,,30366.0000,4554.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,968.0000,30366.0000,case rate,"Rev 360 Proc 0484T ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVI/REPLAC W PROSTH VALVE TRANSTH EXPOSURE,0484T,CPT,360,RC,36000115,CDM,,,,both,,,30366.0000,4554.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,968.0000,30366.0000,case rate,"Rev 360 Proc 0484T ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVI/REPLAC W PROSTH VALVE TRANSTH EXPOSURE,0484T,CPT,360,RC,36000115,CDM,,,,both,,,30366.0000,4554.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,20682.99,,,,,,,968.0000,30366.0000,fee schedule,"APG 00121 Proc 0484T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVI/REPLAC W PROSTH VALVE TRANSTH EXPOSURE,0484T,CPT,360,RC,36000115,CDM,,,,both,,,30366.0000,4554.9000,WELLCARE,WELLCARE MEDICAID,30366.00,,,,,,,968.0000,30366.0000,percent of total billed charges,"100% of $30,366.00 in Billed Charges for Rev 360 Proc 0484T = $30,366.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TTVR PERCU APPR INITIAL PROSTHESIS,0569T,CPT,360,RC,36000119,CDM,,,,both,,,15085.0000,2262.7500,AETNA,AETNA,6441.30,,,,,,,968.0000,21084.6100,percent of total billed charges,"42.7% of $15,085.00 in Billed Charges for Rev 360 Proc 0569T = $6,441.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TTVR PERCU APPR INITIAL PROSTHESIS,0569T,CPT,360,RC,36000119,CDM,,,,both,,,15085.0000,2262.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,20883.80,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 0569T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 104% = $20,883.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR INITIAL PROSTHESIS,0569T,CPT,360,RC,36000119,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,ANTHEM EXCHANGE,15085.00,,,,,,,968.0000,21084.6100,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 360 Proc 0569T * Qty 1 = $12,718.06 at 199.87% = $25,419.59 (Service Line reduced to $15,085.00, claim capped at $15,085.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR INITIAL PROSTHESIS,0569T,CPT,360,RC,36000119,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15085.00,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 0569T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99 (Service Line reduced to $15,085.00, claim capped at $15,085.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR INITIAL PROSTHESIS,0569T,CPT,360,RC,36000119,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,ANTHEM HMO,15085.00,,,,,,,968.0000,21084.6100,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 360 Proc 0569T * Qty 1 = $12,718.06 at 212.35% = $27,006.80 (Service Line reduced to $15,085.00, claim capped at $15,085.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR INITIAL PROSTHESIS,0569T,CPT,360,RC,36000119,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",15085.00,,,,,,,968.0000,21084.6100,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 360 Proc 0569T * Qty 1 = $12,718.06 at 249.81% = $31,770.99 (Service Line reduced to $15,085.00, claim capped at $15,085.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR INITIAL PROSTHESIS,0569T,CPT,360,RC,36000119,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 0569T ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR INITIAL PROSTHESIS,0569T,CPT,360,RC,36000119,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 0569T ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR INITIAL PROSTHESIS,0569T,CPT,360,RC,36000119,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 0569T ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR INITIAL PROSTHESIS,0569T,CPT,360,RC,36000119,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,TENNCARE BLUE CARE,1584.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 0569T ASG Rate of $1,584.00 at 100% of $1,584.00 = $1,584.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR INITIAL PROSTHESIS,0569T,CPT,360,RC,36000119,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,TENNCARE BLUE SELECT,1584.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 0569T ASG Rate of $1,584.00 at 100% of $1,584.00 = $1,584.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR INITIAL PROSTHESIS,0569T,CPT,360,RC,36000119,CDM,,,,both,,,15085.0000,2262.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13576.50,,,,,,,968.0000,21084.6100,percent of total billed charges,"90% of $15,085.00 in Billed Charges for Rev 360 Proc 0569T = $13,576.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TTVR PERCU APPR INITIAL PROSTHESIS,0569T,CPT,360,RC,36000119,CDM,,,,both,,,15085.0000,2262.7500,MEDCOST,MEDCOST VHN,7178.95,,,,,,,968.0000,21084.6100,percent of total billed charges,"47.59% of $15,085.00 in Billed Charges for Rev 360 Proc 0569T = $7,178.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TTVR PERCU APPR INITIAL PROSTHESIS,0569T,CPT,360,RC,36000119,CDM,,,,both,,,15085.0000,2262.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,21084.61,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 0569T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 105% = $21,084.61 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR INITIAL PROSTHESIS,0569T,CPT,360,RC,36000119,CDM,,,,both,,,15085.0000,2262.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,20703.08,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 0569T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 103.1% = $20,703.08 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR INITIAL PROSTHESIS,0569T,CPT,360,RC,36000119,CDM,,,,both,,,15085.0000,2262.7500,SENTARA HEALTH,SENTARA HEALTH,3893.44,,,,,,,968.0000,21084.6100,percent of total billed charges,"25.81% of $15,085.00 in Billed Charges for Rev 360 Proc 0569T = $3,893.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TTVR PERCU APPR INITIAL PROSTHESIS,0569T,CPT,360,RC,36000119,CDM,,,,both,,,15085.0000,2262.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15085.00,,,,,,,968.0000,21084.6100,percent of total billed charges,"100% of $15,085.00 in Billed Charges for Rev 360 Proc 0569T = $15,085.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TTVR PERCU APPR INITIAL PROSTHESIS,0569T,CPT,360,RC,36000119,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,968.0000,21084.6100,case rate,Rev 360 Proc 0569T ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TTVR PERCU APPR INITIAL PROSTHESIS,0569T,CPT,360,RC,36000119,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 0569T ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR INITIAL PROSTHESIS,0569T,CPT,360,RC,36000119,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 0569T ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR INITIAL PROSTHESIS,0569T,CPT,360,RC,36000119,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 0569T ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR INITIAL PROSTHESIS,0569T,CPT,360,RC,36000119,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,20682.99,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 0569T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR INITIAL PROSTHESIS,0569T,CPT,360,RC,36000119,CDM,,,,both,,,15085.0000,2262.7500,WELLCARE,WELLCARE MEDICAID,15085.00,,,,,,,968.0000,21084.6100,percent of total billed charges,"100% of $15,085.00 in Billed Charges for Rev 360 Proc 0569T = $15,085.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TTVR PERCU APPR EA ADDL PROSTHESIS,0570T,CPT,360,RC,36000120,CDM,,,,both,,,15085.0000,2262.7500,AETNA,AETNA,6441.30,,,,,,,148.0000,21084.6100,percent of total billed charges,"42.7% of $15,085.00 in Billed Charges for Rev 360 Proc 0570T = $6,441.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TTVR PERCU APPR EA ADDL PROSTHESIS,0570T,CPT,360,RC,36000120,CDM,,,,both,,,15085.0000,2262.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,20883.80,,,,,,,148.0000,21084.6100,fee schedule,"APG 00121 Proc 0570T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 104% = $20,883.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR EA ADDL PROSTHESIS,0570T,CPT,360,RC,36000120,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,ANTHEM EXCHANGE,15085.00,,,,,,,148.0000,21084.6100,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 360 Proc 0570T * Qty 1 = $12,718.06 at 199.87% = $25,419.59 (Service Line reduced to $15,085.00, claim capped at $15,085.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR EA ADDL PROSTHESIS,0570T,CPT,360,RC,36000120,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15085.00,,,,,,,148.0000,21084.6100,fee schedule,"APG 00121 Proc 0570T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99 (Service Line reduced to $15,085.00, claim capped at $15,085.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR EA ADDL PROSTHESIS,0570T,CPT,360,RC,36000120,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,ANTHEM HMO,15085.00,,,,,,,148.0000,21084.6100,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 360 Proc 0570T * Qty 1 = $12,718.06 at 212.35% = $27,006.80 (Service Line reduced to $15,085.00, claim capped at $15,085.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR EA ADDL PROSTHESIS,0570T,CPT,360,RC,36000120,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",15085.00,,,,,,,148.0000,21084.6100,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 360 Proc 0570T * Qty 1 = $12,718.06 at 249.81% = $31,770.99 (Service Line reduced to $15,085.00, claim capped at $15,085.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR EA ADDL PROSTHESIS,0570T,CPT,360,RC,36000120,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,21084.6100,case rate,Rev 360 Proc 0570T ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TTVR PERCU APPR EA ADDL PROSTHESIS,0570T,CPT,360,RC,36000120,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,21084.6100,case rate,Rev 360 Proc 0570T ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TTVR PERCU APPR EA ADDL PROSTHESIS,0570T,CPT,360,RC,36000120,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,21084.6100,case rate,Rev 360 Proc 0570T ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TTVR PERCU APPR EA ADDL PROSTHESIS,0570T,CPT,360,RC,36000120,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,148.0000,21084.6100,case rate,Rev 360 Proc 0570T ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TTVR PERCU APPR EA ADDL PROSTHESIS,0570T,CPT,360,RC,36000120,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,148.0000,21084.6100,case rate,Rev 360 Proc 0570T ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TTVR PERCU APPR EA ADDL PROSTHESIS,0570T,CPT,360,RC,36000120,CDM,,,,both,,,15085.0000,2262.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13576.50,,,,,,,148.0000,21084.6100,percent of total billed charges,"90% of $15,085.00 in Billed Charges for Rev 360 Proc 0570T = $13,576.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TTVR PERCU APPR EA ADDL PROSTHESIS,0570T,CPT,360,RC,36000120,CDM,,,,both,,,15085.0000,2262.7500,MEDCOST,MEDCOST VHN,7178.95,,,,,,,148.0000,21084.6100,percent of total billed charges,"47.59% of $15,085.00 in Billed Charges for Rev 360 Proc 0570T = $7,178.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TTVR PERCU APPR EA ADDL PROSTHESIS,0570T,CPT,360,RC,36000120,CDM,,,,both,,,15085.0000,2262.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,21084.61,,,,,,,148.0000,21084.6100,fee schedule,"APG 00121 Proc 0570T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 105% = $21,084.61 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR EA ADDL PROSTHESIS,0570T,CPT,360,RC,36000120,CDM,,,,both,,,15085.0000,2262.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,20703.08,,,,,,,148.0000,21084.6100,fee schedule,"APG 00121 Proc 0570T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 103.1% = $20,703.08 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR EA ADDL PROSTHESIS,0570T,CPT,360,RC,36000120,CDM,,,,both,,,15085.0000,2262.7500,SENTARA HEALTH,SENTARA HEALTH,3893.44,,,,,,,148.0000,21084.6100,percent of total billed charges,"25.81% of $15,085.00 in Billed Charges for Rev 360 Proc 0570T = $3,893.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TTVR PERCU APPR EA ADDL PROSTHESIS,0570T,CPT,360,RC,36000120,CDM,,,,both,,,15085.0000,2262.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15085.00,,,,,,,148.0000,21084.6100,percent of total billed charges,"100% of $15,085.00 in Billed Charges for Rev 360 Proc 0570T = $15,085.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TTVR PERCU APPR EA ADDL PROSTHESIS,0570T,CPT,360,RC,36000120,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,148.0000,21084.6100,case rate,Rev 360 Proc 0570T ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TTVR PERCU APPR EA ADDL PROSTHESIS,0570T,CPT,360,RC,36000120,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,148.0000,21084.6100,case rate,"Rev 360 Proc 0570T ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR EA ADDL PROSTHESIS,0570T,CPT,360,RC,36000120,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,148.0000,21084.6100,case rate,"Rev 360 Proc 0570T ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR EA ADDL PROSTHESIS,0570T,CPT,360,RC,36000120,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,148.0000,21084.6100,case rate,"Rev 360 Proc 0570T ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR EA ADDL PROSTHESIS,0570T,CPT,360,RC,36000120,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,20682.99,,,,,,,148.0000,21084.6100,fee schedule,"APG 00121 Proc 0570T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVR PERCU APPR EA ADDL PROSTHESIS,0570T,CPT,360,RC,36000120,CDM,,,,both,,,15085.0000,2262.7500,WELLCARE,WELLCARE MEDICAID,15085.00,,,,,,,148.0000,21084.6100,percent of total billed charges,"100% of $15,085.00 in Billed Charges for Rev 360 Proc 0570T = $15,085.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,AETNA,AETNA,42351.57,,,,,,,12398.0000,99184.0000,percent of total billed charges,"42.7% of $99,184.00 in Billed Charges for Rev 481 Proc 0571T = $42,351.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,32079.69,,,,,,,12398.0000,99184.0000,fee schedule,"APG 00097 Proc 0571T at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 104% = $32,079.69. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,28478.32,,,,,,,12398.0000,99184.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,AETNA,AETNA HEALTHCARE MEDICARE,28478.32,,,,,,,12398.0000,99184.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,28478.32,,,,,,,12398.0000,99184.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,AMBETTER,AMBETTER,62082.73,,,,,,,12398.0000,99184.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,29617.45,,,,,,,12398.0000,99184.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,BLUE CROSS,ANTHEM EXCHANGE,70115.16,,,,,,,12398.0000,99184.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,31771.24,,,,,,,12398.0000,99184.0000,fee schedule,"APG 00097 Proc 0571T at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 103% = $31,771.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,BLUE CROSS,ANTHEM HMO,74493.19,,,,,,,12398.0000,99184.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,29332.66,,,,,,,12398.0000,99184.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",87634.30,,,,,,,12398.0000,99184.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,69428.80,,,,,,,12398.0000,99184.0000,percent of total billed charges,"Rev 481 Proc 0571T $99,184.00 in Billed Charges at 70% = $69,428.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,BLUE CROSS,BLUE CROSS E NETWORK,12398.00,,,,,,,12398.0000,99184.0000,case rate,"Rev 481 Proc 0571T ASG Rate of $12,398.00 at 100% of $12,398.00 = $12,398.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,BLUE CROSS,BLUE CROSS MEDICARE,29617.45,,,,,,,12398.0000,99184.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,BLUE CROSS,BLUE CROSS P NETWORK,12677.00,,,,,,,12398.0000,99184.0000,case rate,"Rev 481 Proc 0571T ASG Rate of $12,677.00 at 100% of $12,677.00 = $12,677.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,BLUE CROSS,BLUE CROSS S NETWORK,12677.00,,,,,,,12398.0000,99184.0000,case rate,"Rev 481 Proc 0571T ASG Rate of $12,677.00 at 100% of $12,677.00 = $12,677.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,CIGNA HEALTHCARE,CIGNA HMO,41359.73,,,,,,,12398.0000,99184.0000,percent of total billed charges,"41.7% of $99,184.00 in Billed Charges for Rev 481 Proc 0571T = $41,359.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,46021.38,,,,,,,12398.0000,99184.0000,percent of total billed charges,"46.4% of $99,184.00 in Billed Charges for Rev 481 Proc 0571T = $46,021.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,29902.23,,,,,,,12398.0000,99184.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,41359.73,,,,,,,12398.0000,99184.0000,percent of total billed charges,"41.7% of $99,184.00 in Billed Charges for Rev 481 Proc 0571T = $41,359.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,CIGNA HEALTHCARE,CIGNA PPO,41359.73,,,,,,,12398.0000,99184.0000,percent of total billed charges,"41.7% of $99,184.00 in Billed Charges for Rev 481 Proc 0571T = $41,359.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,29902.23,,,,,,,12398.0000,99184.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,89265.60,,,,,,,12398.0000,99184.0000,percent of total billed charges,"90% of $99,184.00 in Billed Charges for Rev 481 Proc 0571T = $89,265.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,HUMANA,HUMANA MEDICARE,28478.32,,,,,,,12398.0000,99184.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,28478.32,,,,,,,12398.0000,99184.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,MEDCOST,MEDCOST VHN,47201.67,,,,,,,12398.0000,99184.0000,percent of total billed charges,"47.59% of $99,184.00 in Billed Charges for Rev 481 Proc 0571T = $47,201.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,32388.15,,,,,,,12398.0000,99184.0000,fee schedule,"APG 00097 Proc 0571T at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 100% = $30,845.86... $30,845.86 at 105% = $32,388.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,29902.23,,,,,,,12398.0000,99184.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,29902.23,,,,,,,12398.0000,99184.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,NHC ADVANTAGE,NHC ADVANTAGE,29902.23,,,,,,,12398.0000,99184.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,31802.08,,,,,,,12398.0000,99184.0000,fee schedule,"APG 00097 Proc 0571T at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 100% = $30,845.86... $30,845.86 at 103.1% = $31,802.08 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,SENTARA HEALTH,SENTARA HEALTH,25599.39,,,,,,,12398.0000,99184.0000,percent of total billed charges,"25.81% of $99,184.00 in Billed Charges for Rev 481 Proc 0571T = $25,599.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,SENTARA HEALTH,SENTARA MEDICARE,28478.32,,,,,,,12398.0000,99184.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",99184.00,,,,,,,12398.0000,99184.0000,percent of total billed charges,"100% of $99,184.00 in Billed Charges for Rev 481 Proc 0571T = $99,184.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14690.00,,,,,,,12398.0000,99184.0000,case rate,"Rev 481 Proc 0571T ASG Rate of $14,690.00 at 100% of $14,690.00 = $14,690.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13326.00,,,,,,,12398.0000,99184.0000,case rate,"Rev 481 Proc 0571T ASG Rate of $13,326.00 at 100% of $13,326.00 = $13,326.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,12749.00,,,,,,,12398.0000,99184.0000,case rate,"Rev 481 Proc 0571T ASG Rate of $12,749.00 at 100% of $12,749.00 = $12,749.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,21642.00,,,,,,,12398.0000,99184.0000,case rate,"Rev 481 Proc 0571T ASG Rate of $21,642.00 at 100% of $21,642.00 = $21,642.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,31771.24,,,,,,,12398.0000,99184.0000,fee schedule,"APG 00097 Proc 0571T at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 103% = $31,771.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,28478.32,,,,,,,12398.0000,99184.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,28478.32,,,,,,,12398.0000,99184.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,WELLCARE,WELLCARE MEDICAID,99184.00,,,,,,,12398.0000,99184.0000,percent of total billed charges,"100% of $99,184.00 in Billed Charges for Rev 481 Proc 0571T = $99,184.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE,0571T,CPT,481,RC,48100230,CDM,,,,both,,,99184.0000,14877.6000,WELLCARE,WELLCARE MEDICARE,30187.01,,,,,,,12398.0000,99184.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,AETNA,AETNA,5055.25,,,,,,,1881.0000,11839.0000,percent of total billed charges,"42.7% of $11,839.00 in Billed Charges for Rev 481 Proc 0574T = $5,055.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2176.64,,,,,,,1881.0000,11839.0000,fee schedule,"APG 00074 Proc 0574T at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 104% = $2,176.64. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3390.45,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,AETNA,AETNA HEALTHCARE MEDICARE,3390.45,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,3390.45,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,AMBETTER,AMBETTER,7391.18,,,,,,,1881.0000,11839.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3526.07,,,,,,,1881.0000,11839.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,ANTHEM EXCHANGE,8347.47,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2155.71,,,,,,,1881.0000,11839.0000,fee schedule,"APG 00074 Proc 0574T at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,ANTHEM HMO,8868.69,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3492.16,,,,,,,1881.0000,11839.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",10433.19,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8287.30,,,,,,,1881.0000,11839.0000,percent of total billed charges,"Rev 481 Proc 0574T $11,839.00 in Billed Charges at 70% = $8,287.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,1881.0000,11839.0000,case rate,"Rev 481 Proc 0574T ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,BLUE CROSS MEDICARE,3526.07,,,,,,,1881.0000,11839.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,1881.0000,11839.0000,case rate,"Rev 481 Proc 0574T ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,1881.0000,11839.0000,case rate,"Rev 481 Proc 0574T ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,CIGNA HEALTHCARE,CIGNA HMO,4936.86,,,,,,,1881.0000,11839.0000,percent of total billed charges,"41.7% of $11,839.00 in Billed Charges for Rev 481 Proc 0574T = $4,936.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5493.30,,,,,,,1881.0000,11839.0000,percent of total billed charges,"46.4% of $11,839.00 in Billed Charges for Rev 481 Proc 0574T = $5,493.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,3559.97,,,,,,,1881.0000,11839.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4936.86,,,,,,,1881.0000,11839.0000,percent of total billed charges,"41.7% of $11,839.00 in Billed Charges for Rev 481 Proc 0574T = $4,936.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,CIGNA HEALTHCARE,CIGNA PPO,4936.86,,,,,,,1881.0000,11839.0000,percent of total billed charges,"41.7% of $11,839.00 in Billed Charges for Rev 481 Proc 0574T = $4,936.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3559.97,,,,,,,1881.0000,11839.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10655.10,,,,,,,1881.0000,11839.0000,percent of total billed charges,"90% of $11,839.00 in Billed Charges for Rev 481 Proc 0574T = $10,655.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,HUMANA,HUMANA MEDICARE,3390.45,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3390.45,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,MEDCOST,MEDCOST VHN,5634.18,,,,,,,1881.0000,11839.0000,percent of total billed charges,"47.59% of $11,839.00 in Billed Charges for Rev 481 Proc 0574T = $5,634.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2197.57,,,,,,,1881.0000,11839.0000,fee schedule,"APG 00074 Proc 0574T at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 105% = $2,197.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3559.97,,,,,,,1881.0000,11839.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3559.97,,,,,,,1881.0000,11839.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,NHC ADVANTAGE,NHC ADVANTAGE,3559.97,,,,,,,1881.0000,11839.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2157.80,,,,,,,1881.0000,11839.0000,fee schedule,"APG 00074 Proc 0574T at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 103.1% = $2,157.80 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,SENTARA HEALTH,SENTARA HEALTH,3055.65,,,,,,,1881.0000,11839.0000,percent of total billed charges,"25.81% of $11,839.00 in Billed Charges for Rev 481 Proc 0574T = $3,055.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,SENTARA HEALTH,SENTARA MEDICARE,3390.45,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11839.00,,,,,,,1881.0000,11839.0000,percent of total billed charges,"100% of $11,839.00 in Billed Charges for Rev 481 Proc 0574T = $11,839.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,1881.0000,11839.0000,case rate,"Rev 481 Proc 0574T ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,1881.0000,11839.0000,case rate,"Rev 481 Proc 0574T ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,1881.0000,11839.0000,case rate,"Rev 481 Proc 0574T ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,1881.0000,11839.0000,case rate,"Rev 481 Proc 0574T ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2155.71,,,,,,,1881.0000,11839.0000,fee schedule,"APG 00074 Proc 0574T at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3390.45,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3390.45,,,,,,,1881.0000,11839.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,WELLCARE,WELLCARE MEDICAID,11839.00,,,,,,,1881.0000,11839.0000,percent of total billed charges,"100% of $11,839.00 in Billed Charges for Rev 481 Proc 0574T = $11,839.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOS PREV IMPL SS IMPLTBL DFB PACING ELTRD,0574T,CPT,481,RC,48100233,CDM,,,,both,,,11839.0000,1775.8500,WELLCARE,WELLCARE MEDICARE,3593.87,,,,,,,1881.0000,11839.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,AETNA,AETNA,48.25,,,,,,,29.1700,113.0000,percent of total billed charges,42.7% of $113.00 in Billed Charges for Rev 481 Proc 0576T = $48.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,51.42,,,,,,,29.1700,113.0000,fee schedule,APG 00488 Proc 0576T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 104% = $51.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,33.86,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,AETNA,AETNA HEALTHCARE MEDICARE,33.86,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,33.86,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,AMBETTER,AMBETTER,73.82,,,,,,,29.1700,113.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,35.22,,,,,,,29.1700,113.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,ANTHEM EXCHANGE,83.37,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,50.93,,,,,,,29.1700,113.0000,fee schedule,APG 00488 Proc 0576T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 103% = $50.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,ANTHEM HMO,88.57,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,34.88,,,,,,,29.1700,113.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",104.20,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,79.10,,,,,,,29.1700,113.0000,percent of total billed charges,Rev 481 Proc 0576T $113.00 in Billed Charges at 70% = $79.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,BLUE CROSS MEDICARE,35.22,,,,,,,29.1700,113.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA HMO,47.12,,,,,,,29.1700,113.0000,percent of total billed charges,41.7% of $113.00 in Billed Charges for Rev 481 Proc 0576T = $47.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,52.43,,,,,,,29.1700,113.0000,percent of total billed charges,46.4% of $113.00 in Billed Charges for Rev 481 Proc 0576T = $52.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,35.55,,,,,,,29.1700,113.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,47.12,,,,,,,29.1700,113.0000,percent of total billed charges,41.7% of $113.00 in Billed Charges for Rev 481 Proc 0576T = $47.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA PPO,47.12,,,,,,,29.1700,113.0000,percent of total billed charges,41.7% of $113.00 in Billed Charges for Rev 481 Proc 0576T = $47.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,35.55,,,,,,,29.1700,113.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,101.70,,,,,,,29.1700,113.0000,percent of total billed charges,90% of $113.00 in Billed Charges for Rev 481 Proc 0576T = $101.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,HUMANA,HUMANA MEDICARE,33.86,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,33.86,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,MEDCOST,MEDCOST VHN,53.78,,,,,,,29.1700,113.0000,percent of total billed charges,47.59% of $113.00 in Billed Charges for Rev 481 Proc 0576T = $53.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,51.91,,,,,,,29.1700,113.0000,fee schedule,APG 00488 Proc 0576T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 100% = $49.44... $49.44 at 105% = $51.91 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,35.55,,,,,,,29.1700,113.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,35.55,,,,,,,29.1700,113.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,NHC ADVANTAGE,NHC ADVANTAGE,35.55,,,,,,,29.1700,113.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,50.97,,,,,,,29.1700,113.0000,fee schedule,APG 00488 Proc 0576T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 100% = $49.44... $49.44 at 103.1% = $50.97 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,SENTARA HEALTH,SENTARA HEALTH,29.17,,,,,,,29.1700,113.0000,percent of total billed charges,25.81% of $113.00 in Billed Charges for Rev 481 Proc 0576T = $29.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,SENTARA HEALTH,SENTARA MEDICARE,33.86,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",113.00,,,,,,,29.1700,113.0000,percent of total billed charges,100% of $113.00 in Billed Charges for Rev 481 Proc 0576T = $113.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,50.93,,,,,,,29.1700,113.0000,fee schedule,APG 00488 Proc 0576T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 103% = $50.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,33.86,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,33.86,,,,,,,29.1700,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,WELLCARE,WELLCARE MEDICAID,113.00,,,,,,,29.1700,113.0000,percent of total billed charges,100% of $113.00 in Billed Charges for Rev 481 Proc 0576T = $113.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON,0576T,CPT,481,RC,48100238,CDM,,,,both,,,113.0000,16.9500,WELLCARE,WELLCARE MEDICARE,35.89,,,,,,,29.1700,113.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,AETNA,AETNA,2457.81,,,,,,,12.0000,6402.5800,percent of total billed charges,"42.7% of $5,756.00 in Billed Charges for Rev 720 Proc 59412 = $2,457.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,846.66,,,,,,,12.0000,6402.5800,fee schedule,APG 00178 Proc 59412 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment) at 104% = $846.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2936.96,,,,,,,12.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,AETNA,AETNA HEALTHCARE MEDICARE,2936.96,,,,,,,12.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,2936.96,,,,,,,12.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,AMBETTER,AMBETTER,6402.58,,,,,,,12.0000,6402.5800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3054.44,,,,,,,12.0000,6402.5800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,BLUE CROSS,ANTHEM EXCHANGE,5756.00,,,,,,,12.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,838.52,,,,,,,12.0000,6402.5800,fee schedule,APG 00178 Proc 59412 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment) at 103% = $838.52. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,BLUE CROSS,ANTHEM HMO,5756.00,,,,,,,12.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3025.07,,,,,,,12.0000,6402.5800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5756.00,,,,,,,12.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,122.80,,,,,,,12.0000,6402.5800,fee schedule,$122.80 from Fee Schedule BLDTM_23 for Rev 720 Proc 59412 * Qty 1 = $122.80 at 100% = $122.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,BLUE CROSS,BLUE CROSS E NETWORK,46.00,,,,,,,12.0000,6402.5800,other,Rev 720 Proc 59412 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,BLUE CROSS,BLUE CROSS MEDICARE,3054.44,,,,,,,12.0000,6402.5800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,BLUE CROSS,BLUE CROSS P NETWORK,46.00,,,,,,,12.0000,6402.5800,other,Rev 720 Proc 59412 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,BLUE CROSS,BLUE CROSS S NETWORK,46.00,,,,,,,12.0000,6402.5800,other,Rev 720 Proc 59412 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,BLUE CROSS,TENNCARE BLUE CARE,12.00,,,,,,,12.0000,6402.5800,other,Rev 720 Proc 59412 Qty 1 * $12.00 = $12.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,BLUE CROSS,TENNCARE BLUE SELECT,12.00,,,,,,,12.0000,6402.5800,other,Rev 720 Proc 59412 Qty 1 * $12.00 = $12.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,CIGNA HEALTHCARE,CIGNA HMO,2400.25,,,,,,,12.0000,6402.5800,percent of total billed charges,"41.7% of $5,756.00 in Billed Charges for Rev 720 Proc 59412 = $2,400.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2670.78,,,,,,,12.0000,6402.5800,percent of total billed charges,"46.4% of $5,756.00 in Billed Charges for Rev 720 Proc 59412 = $2,670.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,3083.81,,,,,,,12.0000,6402.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2400.25,,,,,,,12.0000,6402.5800,percent of total billed charges,"41.7% of $5,756.00 in Billed Charges for Rev 720 Proc 59412 = $2,400.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,CIGNA HEALTHCARE,CIGNA PPO,2400.25,,,,,,,12.0000,6402.5800,percent of total billed charges,"41.7% of $5,756.00 in Billed Charges for Rev 720 Proc 59412 = $2,400.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3083.81,,,,,,,12.0000,6402.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5180.40,,,,,,,12.0000,6402.5800,percent of total billed charges,"90% of $5,756.00 in Billed Charges for Rev 720 Proc 59412 = $5,180.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,HUMANA,HUMANA MEDICARE,2936.96,,,,,,,12.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2936.96,,,,,,,12.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,MEDCOST,MEDCOST VHN,2739.28,,,,,,,12.0000,6402.5800,percent of total billed charges,"47.59% of $5,756.00 in Billed Charges for Rev 720 Proc 59412 = $2,739.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,854.81,,,,,,,12.0000,6402.5800,fee schedule,APG 00178 Proc 59412 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment) at 100% = $814.10... $814.10 at 105% = $854.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3083.81,,,,,,,12.0000,6402.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3083.81,,,,,,,12.0000,6402.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,NHC ADVANTAGE,NHC ADVANTAGE,3083.81,,,,,,,12.0000,6402.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,839.34,,,,,,,12.0000,6402.5800,fee schedule,APG 00178 Proc 59412 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment) at 100% = $814.10... $814.10 at 103.1% = $839.34 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,SENTARA HEALTH,SENTARA HEALTH,1485.62,,,,,,,12.0000,6402.5800,percent of total billed charges,"25.81% of $5,756.00 in Billed Charges for Rev 720 Proc 59412 = $1,485.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,SENTARA HEALTH,SENTARA MEDICARE,2936.96,,,,,,,12.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5756.00,,,,,,,12.0000,6402.5800,percent of total billed charges,"100% of $5,756.00 in Billed Charges for Rev 720 Proc 59412 = $5,756.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,923.10,,,,,,,12.0000,6402.5800,fee schedule,"$1,846.20 from Fee Schedule TCUHC24 for Rev 720 Proc 59412 * Qty 1 = $1,846.20 at 50% = $923.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,259.00,,,,,,,12.0000,6402.5800,other,Rev 720 Proc 59412 1 Visit at $259.00 per Visit = $259.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,247.00,,,,,,,12.0000,6402.5800,other,Rev 720 Proc 59412 1 Visit at $247.00 per Visit = $247.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,408.00,,,,,,,12.0000,6402.5800,other,Rev 720 Proc 59412 1 Visit at $408.00 per Visit = $408.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,838.52,,,,,,,12.0000,6402.5800,fee schedule,APG 00178 Proc 59412 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment) at 103% = $838.52. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2936.96,,,,,,,12.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2936.96,,,,,,,12.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,WELLCARE,WELLCARE MEDICAID,5756.00,,,,,,,12.0000,6402.5800,percent of total billed charges,"100% of $5,756.00 in Billed Charges for Rev 720 Proc 59412 = $5,756.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LD EXTERNAL CEPHALIC VERSION,59412,CPT,720,RC,72000001,CDM,,,,both,,,5756.0000,863.4000,WELLCARE,WELLCARE MEDICARE,3113.18,,,,,,,12.0000,6402.5800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,AETNA,AETNA,2457.81,,,,,,,12.0000,6402.5800,percent of total billed charges,"42.7% of $5,756.00 in Billed Charges for Rev 720 Proc 59414 = $2,457.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2546.59,,,,,,,12.0000,6402.5800,fee schedule,"APG 00205 Proc 59414 at $836.60 (Base Rate) * 2.9269 (Relative Weight) = $2,448.64 (Total Line Payment) at 104% = $2,546.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2936.96,,,,,,,12.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,AETNA,AETNA HEALTHCARE MEDICARE,2936.96,,,,,,,12.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,2936.96,,,,,,,12.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,AMBETTER,AMBETTER,6402.58,,,,,,,12.0000,6402.5800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3054.44,,,,,,,12.0000,6402.5800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,BLUE CROSS,ANTHEM EXCHANGE,5756.00,,,,,,,12.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2522.10,,,,,,,12.0000,6402.5800,fee schedule,"APG 00205 Proc 59414 at $836.60 (Base Rate) * 2.9269 (Relative Weight) = $2,448.64 (Total Line Payment) at 103% = $2,522.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,BLUE CROSS,ANTHEM HMO,5756.00,,,,,,,12.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3025.07,,,,,,,12.0000,6402.5800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5756.00,,,,,,,12.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,114.25,,,,,,,12.0000,6402.5800,fee schedule,$114.25 from Fee Schedule BLDTM_23 for Rev 720 Proc 59414 * Qty 1 = $114.25 at 100% = $114.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,BLUE CROSS,BLUE CROSS E NETWORK,46.00,,,,,,,12.0000,6402.5800,other,Rev 720 Proc 59414 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,BLUE CROSS,BLUE CROSS MEDICARE,3054.44,,,,,,,12.0000,6402.5800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,BLUE CROSS,BLUE CROSS P NETWORK,46.00,,,,,,,12.0000,6402.5800,other,Rev 720 Proc 59414 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,BLUE CROSS,BLUE CROSS S NETWORK,46.00,,,,,,,12.0000,6402.5800,other,Rev 720 Proc 59414 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,BLUE CROSS,TENNCARE BLUE CARE,12.00,,,,,,,12.0000,6402.5800,other,Rev 720 Proc 59414 Qty 1 * $12.00 = $12.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,BLUE CROSS,TENNCARE BLUE SELECT,12.00,,,,,,,12.0000,6402.5800,other,Rev 720 Proc 59414 Qty 1 * $12.00 = $12.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,CIGNA HEALTHCARE,CIGNA HMO,2400.25,,,,,,,12.0000,6402.5800,percent of total billed charges,"41.7% of $5,756.00 in Billed Charges for Rev 720 Proc 59414 = $2,400.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2670.78,,,,,,,12.0000,6402.5800,percent of total billed charges,"46.4% of $5,756.00 in Billed Charges for Rev 720 Proc 59414 = $2,670.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,3083.81,,,,,,,12.0000,6402.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2400.25,,,,,,,12.0000,6402.5800,percent of total billed charges,"41.7% of $5,756.00 in Billed Charges for Rev 720 Proc 59414 = $2,400.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,CIGNA HEALTHCARE,CIGNA PPO,2400.25,,,,,,,12.0000,6402.5800,percent of total billed charges,"41.7% of $5,756.00 in Billed Charges for Rev 720 Proc 59414 = $2,400.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3083.81,,,,,,,12.0000,6402.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5180.40,,,,,,,12.0000,6402.5800,percent of total billed charges,"90% of $5,756.00 in Billed Charges for Rev 720 Proc 59414 = $5,180.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,HUMANA,HUMANA MEDICARE,2936.96,,,,,,,12.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2936.96,,,,,,,12.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,MEDCOST,MEDCOST VHN,2739.28,,,,,,,12.0000,6402.5800,percent of total billed charges,"47.59% of $5,756.00 in Billed Charges for Rev 720 Proc 59414 = $2,739.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2571.07,,,,,,,12.0000,6402.5800,fee schedule,"APG 00205 Proc 59414 at $836.60 (Base Rate) * 2.9269 (Relative Weight) = $2,448.64 (Total Line Payment) at 100% = $2,448.64... $2,448.64 at 105% = $2,571.07 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3083.81,,,,,,,12.0000,6402.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3083.81,,,,,,,12.0000,6402.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,NHC ADVANTAGE,NHC ADVANTAGE,3083.81,,,,,,,12.0000,6402.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2524.55,,,,,,,12.0000,6402.5800,fee schedule,"APG 00205 Proc 59414 at $836.60 (Base Rate) * 2.9269 (Relative Weight) = $2,448.64 (Total Line Payment) at 100% = $2,448.64... $2,448.64 at 103.1% = $2,524.55 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,SENTARA HEALTH,SENTARA HEALTH,1485.62,,,,,,,12.0000,6402.5800,percent of total billed charges,"25.81% of $5,756.00 in Billed Charges for Rev 720 Proc 59414 = $1,485.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,SENTARA HEALTH,SENTARA MEDICARE,2936.96,,,,,,,12.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5756.00,,,,,,,12.0000,6402.5800,percent of total billed charges,"100% of $5,756.00 in Billed Charges for Rev 720 Proc 59414 = $5,756.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,923.10,,,,,,,12.0000,6402.5800,fee schedule,"$1,846.20 from Fee Schedule TCUHC24 for Rev 720 Proc 59414 * Qty 1 = $1,846.20 at 50% = $923.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,259.00,,,,,,,12.0000,6402.5800,other,Rev 720 Proc 59414 1 Visit at $259.00 per Visit = $259.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,247.00,,,,,,,12.0000,6402.5800,other,Rev 720 Proc 59414 1 Visit at $247.00 per Visit = $247.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,408.00,,,,,,,12.0000,6402.5800,other,Rev 720 Proc 59414 1 Visit at $408.00 per Visit = $408.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2522.10,,,,,,,12.0000,6402.5800,fee schedule,"APG 00205 Proc 59414 at $836.60 (Base Rate) * 2.9269 (Relative Weight) = $2,448.64 (Total Line Payment) at 103% = $2,522.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2936.96,,,,,,,12.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2936.96,,,,,,,12.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,WELLCARE,WELLCARE MEDICAID,5756.00,,,,,,,12.0000,6402.5800,percent of total billed charges,"100% of $5,756.00 in Billed Charges for Rev 720 Proc 59414 = $5,756.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DELIVERY OF PLACENTA ONLY,59414,CPT,720,RC,72000002,CDM,,,,both,,,5756.0000,863.4000,WELLCARE,WELLCARE MEDICARE,3113.18,,,,,,,12.0000,6402.5800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTEPARTUM CARE ONLY 4-6 VISITS,59425,CPT,521,RC,52100137,CDM,,,,both,,,1222.0000,183.3000,AETNA,AETNA,521.79,,,,,,,312.4500,1222.0000,percent of total billed charges,"42.7% of $1,222.00 in Billed Charges for Rev 521 Proc 59425 = $521.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANTEPARTUM CARE ONLY 4-6 VISITS,59425,CPT,521,RC,52100137,CDM,,,,both,,,1222.0000,183.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,315.49,,,,,,,312.4500,1222.0000,fee schedule,APG 00203 Proc 59425 at $836.60 (Base Rate) * 0.3626 (Relative Weight) = $303.35 (Total Line Payment) at 104% = $315.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTEPARTUM CARE ONLY 4-6 VISITS,59425,CPT,521,RC,52100137,CDM,,,,both,,,1222.0000,183.3000,BLUE CROSS,ANTHEM EXCHANGE,518.52,,,,,,,312.4500,1222.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTEPARTUM CARE ONLY 4-6 VISITS,59425,CPT,521,RC,52100137,CDM,,,,both,,,1222.0000,183.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,312.45,,,,,,,312.4500,1222.0000,fee schedule,APG 00203 Proc 59425 at $836.60 (Base Rate) * 0.3626 (Relative Weight) = $303.35 (Total Line Payment) at 103% = $312.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTEPARTUM CARE ONLY 4-6 VISITS,59425,CPT,521,RC,52100137,CDM,,,,both,,,1222.0000,183.3000,BLUE CROSS,ANTHEM HMO,518.52,,,,,,,312.4500,1222.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTEPARTUM CARE ONLY 4-6 VISITS,59425,CPT,521,RC,52100137,CDM,,,,both,,,1222.0000,183.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",518.52,,,,,,,312.4500,1222.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTEPARTUM CARE ONLY 4-6 VISITS,59425,CPT,521,RC,52100137,CDM,,,,both,,,1222.0000,183.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,332.42,,,,,,,312.4500,1222.0000,fee schedule,$332.42 from Fee Schedule BLDTM_23 for Rev 521 Proc 59425 * Qty 1 = $332.42 at 100% = $332.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTEPARTUM CARE ONLY 4-6 VISITS,59425,CPT,521,RC,52100137,CDM,,,,both,,,1222.0000,183.3000,CIGNA HEALTHCARE,CIGNA HMO,509.57,,,,,,,312.4500,1222.0000,percent of total billed charges,"41.7% of $1,222.00 in Billed Charges for Rev 521 Proc 59425 = $509.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANTEPARTUM CARE ONLY 4-6 VISITS,59425,CPT,521,RC,52100137,CDM,,,,both,,,1222.0000,183.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,567.01,,,,,,,312.4500,1222.0000,percent of total billed charges,"46.4% of $1,222.00 in Billed Charges for Rev 521 Proc 59425 = $567.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANTEPARTUM CARE ONLY 4-6 VISITS,59425,CPT,521,RC,52100137,CDM,,,,both,,,1222.0000,183.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,509.57,,,,,,,312.4500,1222.0000,percent of total billed charges,"41.7% of $1,222.00 in Billed Charges for Rev 521 Proc 59425 = $509.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANTEPARTUM CARE ONLY 4-6 VISITS,59425,CPT,521,RC,52100137,CDM,,,,both,,,1222.0000,183.3000,CIGNA HEALTHCARE,CIGNA PPO,509.57,,,,,,,312.4500,1222.0000,percent of total billed charges,"41.7% of $1,222.00 in Billed Charges for Rev 521 Proc 59425 = $509.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANTEPARTUM CARE ONLY 4-6 VISITS,59425,CPT,521,RC,52100137,CDM,,,,both,,,1222.0000,183.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1099.80,,,,,,,312.4500,1222.0000,percent of total billed charges,"90% of $1,222.00 in Billed Charges for Rev 521 Proc 59425 = $1,099.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANTEPARTUM CARE ONLY 4-6 VISITS,59425,CPT,521,RC,52100137,CDM,,,,both,,,1222.0000,183.3000,MEDCOST,MEDCOST VHN,581.55,,,,,,,312.4500,1222.0000,percent of total billed charges,"47.59% of $1,222.00 in Billed Charges for Rev 521 Proc 59425 = $581.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANTEPARTUM CARE ONLY 4-6 VISITS,59425,CPT,521,RC,52100137,CDM,,,,both,,,1222.0000,183.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,318.52,,,,,,,312.4500,1222.0000,fee schedule,APG 00203 Proc 59425 at $836.60 (Base Rate) * 0.3626 (Relative Weight) = $303.35 (Total Line Payment) at 100% = $303.35... $303.35 at 105% = $318.52 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTEPARTUM CARE ONLY 4-6 VISITS,59425,CPT,521,RC,52100137,CDM,,,,both,,,1222.0000,183.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,312.75,,,,,,,312.4500,1222.0000,fee schedule,APG 00203 Proc 59425 at $836.60 (Base Rate) * 0.3626 (Relative Weight) = $303.35 (Total Line Payment) at 100% = $303.35... $303.35 at 103.1% = $312.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTEPARTUM CARE ONLY 4-6 VISITS,59425,CPT,521,RC,52100137,CDM,,,,both,,,1222.0000,183.3000,SENTARA HEALTH,SENTARA HEALTH,315.40,,,,,,,312.4500,1222.0000,percent of total billed charges,"25.81% of $1,222.00 in Billed Charges for Rev 521 Proc 59425 = $315.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANTEPARTUM CARE ONLY 4-6 VISITS,59425,CPT,521,RC,52100137,CDM,,,,both,,,1222.0000,183.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1222.00,,,,,,,312.4500,1222.0000,percent of total billed charges,"100% of $1,222.00 in Billed Charges for Rev 521 Proc 59425 = $1,222.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANTEPARTUM CARE ONLY 4-6 VISITS,59425,CPT,521,RC,52100137,CDM,,,,both,,,1222.0000,183.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,312.45,,,,,,,312.4500,1222.0000,fee schedule,APG 00203 Proc 59425 at $836.60 (Base Rate) * 0.3626 (Relative Weight) = $303.35 (Total Line Payment) at 103% = $312.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTEPARTUM CARE ONLY 4-6 VISITS,59425,CPT,521,RC,52100137,CDM,,,,both,,,1222.0000,183.3000,WELLCARE,WELLCARE MEDICAID,1222.00,,,,,,,312.4500,1222.0000,percent of total billed charges,"100% of $1,222.00 in Billed Charges for Rev 521 Proc 59425 = $1,222.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,AETNA,AETNA,2376.26,,,,,,,109.0000,6402.5800,percent of total billed charges,"42.7% of $5,565.00 in Billed Charges for Rev 450 Proc 59812 = $2,376.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2571.21,,,,,,,109.0000,6402.5800,fee schedule,"APG 00194 Proc 59812 at $836.60 (Base Rate) * 2.9552 (Relative Weight) = $2,472.32 (Total Line Payment) at 104% = $2,571.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2936.96,,,,,,,109.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,AETNA,AETNA HEALTHCARE MEDICARE,2936.96,,,,,,,109.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,2936.96,,,,,,,109.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,AMBETTER,AMBETTER,6402.58,,,,,,,109.0000,6402.5800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3054.44,,,,,,,109.0000,6402.5800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,BLUE CROSS,ANTHEM EXCHANGE,5565.00,,,,,,,109.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2546.49,,,,,,,109.0000,6402.5800,fee schedule,"APG 00194 Proc 59812 at $836.60 (Base Rate) * 2.9552 (Relative Weight) = $2,472.32 (Total Line Payment) at 103% = $2,546.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,BLUE CROSS,ANTHEM HMO,5565.00,,,,,,,109.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3025.07,,,,,,,109.0000,6402.5800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5565.00,,,,,,,109.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,291.22,,,,,,,109.0000,6402.5800,fee schedule,$291.22 from Fee Schedule BLDTM_23 for Rev 450 Proc 59812 * Qty 1 = $291.22 at 100% = $291.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,BLUE CROSS,BLUE CROSS MEDICARE,3054.44,,,,,,,109.0000,6402.5800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,3083.81,,,,,,,109.0000,6402.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3083.81,,,,,,,109.0000,6402.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5008.50,,,,,,,109.0000,6402.5800,percent of total billed charges,"90% of $5,565.00 in Billed Charges for Rev 450 Proc 59812 = $5,008.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,HUMANA,HUMANA MEDICARE,2936.96,,,,,,,109.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2936.96,,,,,,,109.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,MEDCOST,MEDCOST VHN,2648.38,,,,,,,109.0000,6402.5800,percent of total billed charges,"47.59% of $5,565.00 in Billed Charges for Rev 450 Proc 59812 = $2,648.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2595.94,,,,,,,109.0000,6402.5800,fee schedule,"APG 00194 Proc 59812 at $836.60 (Base Rate) * 2.9552 (Relative Weight) = $2,472.32 (Total Line Payment) at 100% = $2,472.32... $2,472.32 at 105% = $2,595.94 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3083.81,,,,,,,109.0000,6402.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3083.81,,,,,,,109.0000,6402.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,NHC ADVANTAGE,NHC ADVANTAGE,3083.81,,,,,,,109.0000,6402.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2548.96,,,,,,,109.0000,6402.5800,fee schedule,"APG 00194 Proc 59812 at $836.60 (Base Rate) * 2.9552 (Relative Weight) = $2,472.32 (Total Line Payment) at 100% = $2,472.32... $2,472.32 at 103.1% = $2,548.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,SENTARA HEALTH,SENTARA HEALTH,1436.33,,,,,,,109.0000,6402.5800,percent of total billed charges,"25.81% of $5,565.00 in Billed Charges for Rev 450 Proc 59812 = $1,436.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,SENTARA HEALTH,SENTARA MEDICARE,2936.96,,,,,,,109.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5565.00,,,,,,,109.0000,6402.5800,percent of total billed charges,"100% of $5,565.00 in Billed Charges for Rev 450 Proc 59812 = $5,565.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,6402.5800,case rate,Rev 450 Proc 59812 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,6402.5800,case rate,Rev 450 Proc 59812 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,6402.5800,case rate,Rev 450 Proc 59812 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,6402.5800,case rate,Rev 450 Proc 59812 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2546.49,,,,,,,109.0000,6402.5800,fee schedule,"APG 00194 Proc 59812 at $836.60 (Base Rate) * 2.9552 (Relative Weight) = $2,472.32 (Total Line Payment) at 103% = $2,546.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2936.96,,,,,,,109.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2936.96,,,,,,,109.0000,6402.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,WELLCARE,WELLCARE MEDICAID,5565.00,,,,,,,109.0000,6402.5800,percent of total billed charges,"100% of $5,565.00 in Billed Charges for Rev 450 Proc 59812 = $5,565.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TREATMENT OF INCOMPLETE ABORTION,59812,CPT,450,RC,45000029,CDM,,,,both,,,5565.0000,834.7500,WELLCARE,WELLCARE MEDICARE,3113.18,,,,,,,109.0000,6402.5800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,AETNA,AETNA,479.95,,,,,,,175.0000,1400.5900,percent of total billed charges,"42.7% of $1,124.00 in Billed Charges for Rev 361 Proc 60300 = $479.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,175.0000,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,175.0000,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,175.0000,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,AMBETTER,AMBETTER,1400.59,,,,,,,175.0000,1400.5900,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,175.0000,1400.5900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,BLUE CROSS,ANTHEM EXCHANGE,1124.00,,,,,,,175.0000,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,BLUE CROSS,ANTHEM HMO,1124.00,,,,,,,175.0000,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,175.0000,1400.5900,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1124.00,,,,,,,175.0000,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,175.0000,1400.5900,case rate,Rev 361 Proc 60300 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,175.0000,1400.5900,case rate,Rev 361 Proc 60300 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,175.0000,1400.5900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,175.0000,1400.5900,case rate,Rev 361 Proc 60300 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,175.0000,1400.5900,case rate,Rev 361 Proc 60300 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,175.0000,1400.5900,case rate,Rev 361 Proc 60300 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,175.0000,1400.5900,case rate,Rev 361 Proc 60300 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,CIGNA HEALTHCARE,CIGNA HMO,228.00,,,,,,,175.0000,1400.5900,case rate,Rev 361 Proc 60300 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.00,,,,,,,175.0000,1400.5900,case rate,Rev 361 Proc 60300 ASG Rate of $175.00 at 100% of $175.00 = $175.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,175.0000,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.00,,,,,,,175.0000,1400.5900,case rate,Rev 361 Proc 60300 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,CIGNA HEALTHCARE,CIGNA PPO,228.00,,,,,,,175.0000,1400.5900,case rate,Rev 361 Proc 60300 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,175.0000,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1011.60,,,,,,,175.0000,1400.5900,percent of total billed charges,"90% of $1,124.00 in Billed Charges for Rev 361 Proc 60300 = $1,011.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,HUMANA,HUMANA MEDICARE,642.47,,,,,,,175.0000,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,175.0000,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,MEDCOST,MEDCOST VHN,534.91,,,,,,,175.0000,1400.5900,percent of total billed charges,"47.59% of $1,124.00 in Billed Charges for Rev 361 Proc 60300 = $534.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,175.0000,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,175.0000,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,175.0000,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,SENTARA HEALTH,SENTARA HEALTH,290.10,,,,,,,175.0000,1400.5900,percent of total billed charges,"25.81% of $1,124.00 in Billed Charges for Rev 361 Proc 60300 = $290.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,175.0000,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1124.00,,,,,,,175.0000,1400.5900,percent of total billed charges,"100% of $1,124.00 in Billed Charges for Rev 361 Proc 60300 = $1,124.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,175.0000,1400.5900,case rate,Rev 361 Proc 60300 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,175.0000,1400.5900,case rate,Rev 361 Proc 60300 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,175.0000,1400.5900,case rate,Rev 361 Proc 60300 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,175.0000,1400.5900,case rate,"Rev 361 Proc 60300 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,175.0000,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,175.0000,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,WELLCARE,WELLCARE MEDICAID,1124.00,,,,,,,175.0000,1400.5900,percent of total billed charges,"100% of $1,124.00 in Billed Charges for Rev 361 Proc 60300 = $1,124.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIR CYST THYROID,60300,CPT,361,RC,36100181,CDM,,,,both,,,1124.0000,168.6000,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,175.0000,1400.5900,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,AETNA,AETNA,1776.75,,,,,,,578.0000,5448.8200,percent of total billed charges,"42.7% of $4,161.00 in Billed Charges for Rev 361 Proc 60540 = $1,776.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,5396.92,,,,,,,578.0000,5448.8200,fee schedule,"APG 00108 Proc 60540 at $836.60 (Base Rate) * 6.2029 (Relative Weight) = $5,189.35 (Total Line Payment) at 104% = $5,396.92. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,BLUE CROSS,ANTHEM EXCHANGE,4161.00,,,,,,,578.0000,5448.8200,fee schedule,"$6,634.21 from Fee Schedule ANT_C_APC for Rev 361 Proc 60540 * Qty 1 = $6,634.21 at 199.87% = $13,259.80 (Service Line reduced to $4,161.00, claim capped at $4,161.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,4161.00,,,,,,,578.0000,5448.8200,fee schedule,"APG 00108 Proc 60540 at $836.60 (Base Rate) * 6.2029 (Relative Weight) = $5,189.35 (Total Line Payment) at 103% = $5,345.03 (Service Line reduced to $4,161.00, claim capped at $4,161.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,BLUE CROSS,ANTHEM HMO,4161.00,,,,,,,578.0000,5448.8200,fee schedule,"$6,634.21 from Fee Schedule ANT_C_APC for Rev 361 Proc 60540 * Qty 1 = $6,634.21 at 212.35% = $14,087.74 (Service Line reduced to $4,161.00, claim capped at $4,161.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4161.00,,,,,,,578.0000,5448.8200,fee schedule,"$6,634.21 from Fee Schedule ANT_C_APC for Rev 361 Proc 60540 * Qty 1 = $6,634.21 at 249.81% = $16,572.92 (Service Line reduced to $4,161.00, claim capped at $4,161.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1336.00,,,,,,,578.0000,5448.8200,case rate,"Rev 361 Proc 60540 ASG Rate of $1,336.00 at 100% of $1,336.00 = $1,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,578.0000,5448.8200,case rate,"Rev 361 Proc 60540 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,578.0000,5448.8200,case rate,"Rev 361 Proc 60540 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,578.0000,5448.8200,case rate,"Rev 361 Proc 60540 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,5448.8200,case rate,Rev 361 Proc 60540 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,5448.8200,case rate,Rev 361 Proc 60540 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,CIGNA HEALTHCARE,CIGNA HMO,4161.00,,,,,,,578.0000,5448.8200,case rate,"Rev 361 Proc 60540 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $4,161.00 in Billed Charges - $0.00 in ASG Allowed Amount = $4,161.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,578.0000,5448.8200,case rate,"Rev 361 Proc 60540 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4161.00,,,,,,,578.0000,5448.8200,case rate,"Rev 361 Proc 60540 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $4,161.00 in Billed Charges - $0.00 in ASG Allowed Amount = $4,161.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,CIGNA HEALTHCARE,CIGNA PPO,4161.00,,,,,,,578.0000,5448.8200,case rate,"Rev 361 Proc 60540 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $4,161.00 in Billed Charges - $0.00 in ASG Allowed Amount = $4,161.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3744.90,,,,,,,578.0000,5448.8200,percent of total billed charges,"90% of $4,161.00 in Billed Charges for Rev 361 Proc 60540 = $3,744.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,MEDCOST,MEDCOST VHN,1980.22,,,,,,,578.0000,5448.8200,percent of total billed charges,"47.59% of $4,161.00 in Billed Charges for Rev 361 Proc 60540 = $1,980.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,5448.82,,,,,,,578.0000,5448.8200,fee schedule,"APG 00108 Proc 60540 at $836.60 (Base Rate) * 6.2029 (Relative Weight) = $5,189.35 (Total Line Payment) at 100% = $5,189.35... $5,189.35 at 105% = $5,448.82 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,5350.22,,,,,,,578.0000,5448.8200,fee schedule,"APG 00108 Proc 60540 at $836.60 (Base Rate) * 6.2029 (Relative Weight) = $5,189.35 (Total Line Payment) at 100% = $5,189.35... $5,189.35 at 103.1% = $5,350.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,SENTARA HEALTH,SENTARA HEALTH,1073.95,,,,,,,578.0000,5448.8200,percent of total billed charges,"25.81% of $4,161.00 in Billed Charges for Rev 361 Proc 60540 = $1,073.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4161.00,,,,,,,578.0000,5448.8200,percent of total billed charges,"100% of $4,161.00 in Billed Charges for Rev 361 Proc 60540 = $4,161.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,578.0000,5448.8200,case rate,Rev 361 Proc 60540 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,578.0000,5448.8200,case rate,"Rev 361 Proc 60540 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,578.0000,5448.8200,case rate,"Rev 361 Proc 60540 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,578.0000,5448.8200,case rate,"Rev 361 Proc 60540 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,5345.03,,,,,,,578.0000,5448.8200,fee schedule,"APG 00108 Proc 60540 at $836.60 (Base Rate) * 6.2029 (Relative Weight) = $5,189.35 (Total Line Payment) at 103% = $5,345.03. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ADRENAL INPT,60540,CPT,361,RC,36100182,CDM,,,,both,,,4161.0000,624.1500,WELLCARE,WELLCARE MEDICAID,4161.00,,,,,,,578.0000,5448.8200,percent of total billed charges,"100% of $4,161.00 in Billed Charges for Rev 361 Proc 60540 = $4,161.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,AETNA,AETNA,2085.04,,,,,,,224.0000,4883.0000,percent of total billed charges,"42.7% of $4,883.00 in Billed Charges for Rev 320 Proc 60660 = $2,085.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,224.0000,4883.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,224.0000,4883.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,224.0000,4883.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,AMBETTER,AMBETTER,3266.63,,,,,,,224.0000,4883.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,224.0000,4883.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,BLUE CROSS,ANTHEM EXCHANGE,3689.28,,,,,,,224.0000,4883.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,BLUE CROSS,ANTHEM HMO,3919.64,,,,,,,224.0000,4883.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,224.0000,4883.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4611.09,,,,,,,224.0000,4883.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3418.10,,,,,,,224.0000,4883.0000,percent of total billed charges,"Rev 320 Proc 60660 $4,883.00 in Billed Charges at 70% = $3,418.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,224.0000,4883.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,CIGNA HEALTHCARE,CIGNA HMO,2036.21,,,,,,,224.0000,4883.0000,percent of total billed charges,"Rev 320 Proc 60660 $4,883.00 in Billed Charges at 41.7% = $2,036.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,224.0000,4883.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2036.21,,,,,,,224.0000,4883.0000,percent of total billed charges,"Rev 320 Proc 60660 $4,883.00 in Billed Charges at 41.7% = $2,036.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,CIGNA HEALTHCARE,CIGNA PPO,2036.21,,,,,,,224.0000,4883.0000,percent of total billed charges,"Rev 320 Proc 60660 $4,883.00 in Billed Charges at 41.7% = $2,036.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,224.0000,4883.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4394.70,,,,,,,224.0000,4883.0000,percent of total billed charges,"90% of $4,883.00 in Billed Charges for Rev 320 Proc 60660 = $4,394.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,224.0000,4883.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,224.0000,4883.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,MEDCOST,MEDCOST VHN,2323.82,,,,,,,224.0000,4883.0000,percent of total billed charges,"47.59% of $4,883.00 in Billed Charges for Rev 320 Proc 60660 = $2,323.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,224.0000,4883.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,224.0000,4883.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,224.0000,4883.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,SENTARA HEALTH,SENTARA HEALTH,1260.30,,,,,,,224.0000,4883.0000,percent of total billed charges,"25.81% of $4,883.00 in Billed Charges for Rev 320 Proc 60660 = $1,260.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,224.0000,4883.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4883.00,,,,,,,224.0000,4883.0000,percent of total billed charges,"100% of $4,883.00 in Billed Charges for Rev 320 Proc 60660 = $4,883.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,810.12,,,,,,,224.0000,4883.0000,fee schedule,"$1,620.24 from Fee Schedule TCUHC24 for Rev 320 Proc 60660 * Qty 1 = $1,620.24 at 50% = $810.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,224.0000,4883.0000,other,Rev 320 Proc 60660 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,224.0000,4883.0000,other,Rev 320 Proc 60660 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,224.0000,4883.0000,other,Rev 320 Proc 60660 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,224.0000,4883.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,224.0000,4883.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,WELLCARE,WELLCARE MEDICAID,4883.00,,,,,,,224.0000,4883.0000,percent of total billed charges,"100% of $4,883.00 in Billed Charges for Rev 320 Proc 60660 = $4,883.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLTJ 1/+THYROID NODULE 1 LOBE/ISTHMUS PERQ RF,60660,CPT,320,RC,32000329,CDM,,,,both,,,4883.0000,732.4500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,224.0000,4883.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYR NDUL ADDL LOBE PERQ RADIOFREQUENCY,60661,CPT,320,RC,32000330,CDM,,,,both,,,2441.0000,366.1500,AETNA,AETNA,1042.31,,,,,,,224.0000,2441.0000,percent of total billed charges,"42.7% of $2,441.00 in Billed Charges for Rev 320 Proc 60661 = $1,042.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLTJ 1/+THYR NDUL ADDL LOBE PERQ RADIOFREQUENCY,60661,CPT,320,RC,32000330,CDM,,,,both,,,2441.0000,366.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1708.70,,,,,,,224.0000,2441.0000,percent of total billed charges,"Rev 320 Proc 60661 $2,441.00 in Billed Charges at 70% = $1,708.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLTJ 1/+THYR NDUL ADDL LOBE PERQ RADIOFREQUENCY,60661,CPT,320,RC,32000330,CDM,,,,both,,,2441.0000,366.1500,CIGNA HEALTHCARE,CIGNA HMO,1017.90,,,,,,,224.0000,2441.0000,percent of total billed charges,"Rev 320 Proc 60661 $2,441.00 in Billed Charges at 41.7% = $1,017.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLTJ 1/+THYR NDUL ADDL LOBE PERQ RADIOFREQUENCY,60661,CPT,320,RC,32000330,CDM,,,,both,,,2441.0000,366.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1017.90,,,,,,,224.0000,2441.0000,percent of total billed charges,"Rev 320 Proc 60661 $2,441.00 in Billed Charges at 41.7% = $1,017.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLTJ 1/+THYR NDUL ADDL LOBE PERQ RADIOFREQUENCY,60661,CPT,320,RC,32000330,CDM,,,,both,,,2441.0000,366.1500,CIGNA HEALTHCARE,CIGNA PPO,1017.90,,,,,,,224.0000,2441.0000,percent of total billed charges,"Rev 320 Proc 60661 $2,441.00 in Billed Charges at 41.7% = $1,017.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLTJ 1/+THYR NDUL ADDL LOBE PERQ RADIOFREQUENCY,60661,CPT,320,RC,32000330,CDM,,,,both,,,2441.0000,366.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2196.90,,,,,,,224.0000,2441.0000,percent of total billed charges,"90% of $2,441.00 in Billed Charges for Rev 320 Proc 60661 = $2,196.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLTJ 1/+THYR NDUL ADDL LOBE PERQ RADIOFREQUENCY,60661,CPT,320,RC,32000330,CDM,,,,both,,,2441.0000,366.1500,MEDCOST,MEDCOST VHN,1161.67,,,,,,,224.0000,2441.0000,percent of total billed charges,"47.59% of $2,441.00 in Billed Charges for Rev 320 Proc 60661 = $1,161.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLTJ 1/+THYR NDUL ADDL LOBE PERQ RADIOFREQUENCY,60661,CPT,320,RC,32000330,CDM,,,,both,,,2441.0000,366.1500,SENTARA HEALTH,SENTARA HEALTH,630.02,,,,,,,224.0000,2441.0000,percent of total billed charges,"25.81% of $2,441.00 in Billed Charges for Rev 320 Proc 60661 = $630.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLTJ 1/+THYR NDUL ADDL LOBE PERQ RADIOFREQUENCY,60661,CPT,320,RC,32000330,CDM,,,,both,,,2441.0000,366.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2441.00,,,,,,,224.0000,2441.0000,percent of total billed charges,"100% of $2,441.00 in Billed Charges for Rev 320 Proc 60661 = $2,441.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLTJ 1/+THYR NDUL ADDL LOBE PERQ RADIOFREQUENCY,60661,CPT,320,RC,32000330,CDM,,,,both,,,2441.0000,366.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,224.0000,2441.0000,other,Rev 320 Proc 60661 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYR NDUL ADDL LOBE PERQ RADIOFREQUENCY,60661,CPT,320,RC,32000330,CDM,,,,both,,,2441.0000,366.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,224.0000,2441.0000,other,Rev 320 Proc 60661 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYR NDUL ADDL LOBE PERQ RADIOFREQUENCY,60661,CPT,320,RC,32000330,CDM,,,,both,,,2441.0000,366.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,224.0000,2441.0000,other,Rev 320 Proc 60661 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLTJ 1/+THYR NDUL ADDL LOBE PERQ RADIOFREQUENCY,60661,CPT,320,RC,32000330,CDM,,,,both,,,2441.0000,366.1500,WELLCARE,WELLCARE MEDICAID,2441.00,,,,,,,224.0000,2441.0000,percent of total billed charges,"100% of $2,441.00 in Billed Charges for Rev 320 Proc 60661 = $2,441.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,AETNA,AETNA,2509.48,,,,,,,1082.0000,11957.2000,percent of total billed charges,"42.7% of $5,877.00 in Billed Charges for Rev 361 Proc 60699 = $2,509.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,4750.20,,,,,,,1082.0000,11957.2000,fee schedule,"APG 00115 Proc 60699 at $836.60 (Base Rate) * 5.4596 (Relative Weight) = $4,567.50 (Total Line Payment) at 104% = $4,750.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5484.95,,,,,,,1082.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,AETNA,AETNA HEALTHCARE MEDICARE,5484.95,,,,,,,1082.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,5484.95,,,,,,,1082.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,AMBETTER,AMBETTER,11957.20,,,,,,,1082.0000,11957.2000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,5704.35,,,,,,,1082.0000,11957.2000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,BLUE CROSS,ANTHEM EXCHANGE,5877.00,,,,,,,1082.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,4704.53,,,,,,,1082.0000,11957.2000,fee schedule,"APG 00115 Proc 60699 at $836.60 (Base Rate) * 5.4596 (Relative Weight) = $4,567.50 (Total Line Payment) at 103% = $4,704.53. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,BLUE CROSS,ANTHEM HMO,5877.00,,,,,,,1082.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5649.50,,,,,,,1082.0000,11957.2000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5877.00,,,,,,,1082.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1082.00,,,,,,,1082.0000,11957.2000,case rate,"Rev 361 Proc 60699 ASG Rate of $1,082.00 at 100% of $1,082.00 = $1,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,BLUE CROSS,BLUE CROSS E NETWORK,5877.00,,,,,,,1082.0000,11957.2000,case rate,"Rev 361 Proc 60699 ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total (Service Line reduced to $5,877.00, claim capped at $5,877.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,BLUE CROSS,BLUE CROSS MEDICARE,5704.35,,,,,,,1082.0000,11957.2000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,BLUE CROSS,BLUE CROSS P NETWORK,5877.00,,,,,,,1082.0000,11957.2000,case rate,"Rev 361 Proc 60699 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total (Service Line reduced to $5,877.00, claim capped at $5,877.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,BLUE CROSS,BLUE CROSS S NETWORK,5877.00,,,,,,,1082.0000,11957.2000,case rate,"Rev 361 Proc 60699 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total (Service Line reduced to $5,877.00, claim capped at $5,877.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,1082.0000,11957.2000,case rate,"Rev 361 Proc 60699 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,1082.0000,11957.2000,case rate,"Rev 361 Proc 60699 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,5759.20,,,,,,,1082.0000,11957.2000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,1082.0000,11957.2000,case rate,"Rev 361 Proc 60699 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,1082.0000,11957.2000,case rate,"Rev 361 Proc 60699 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,5759.20,,,,,,,1082.0000,11957.2000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5289.30,,,,,,,1082.0000,11957.2000,percent of total billed charges,"90% of $5,877.00 in Billed Charges for Rev 361 Proc 60699 = $5,289.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,HUMANA,HUMANA MEDICARE,5484.95,,,,,,,1082.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5484.95,,,,,,,1082.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,MEDCOST,MEDCOST VHN,2796.86,,,,,,,1082.0000,11957.2000,percent of total billed charges,"47.59% of $5,877.00 in Billed Charges for Rev 361 Proc 60699 = $2,796.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,4795.88,,,,,,,1082.0000,11957.2000,fee schedule,"APG 00115 Proc 60699 at $836.60 (Base Rate) * 5.4596 (Relative Weight) = $4,567.50 (Total Line Payment) at 100% = $4,567.50... $4,567.50 at 105% = $4,795.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,5759.20,,,,,,,1082.0000,11957.2000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,5759.20,,,,,,,1082.0000,11957.2000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,NHC ADVANTAGE,NHC ADVANTAGE,5759.20,,,,,,,1082.0000,11957.2000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,4709.09,,,,,,,1082.0000,11957.2000,fee schedule,"APG 00115 Proc 60699 at $836.60 (Base Rate) * 5.4596 (Relative Weight) = $4,567.50 (Total Line Payment) at 100% = $4,567.50... $4,567.50 at 103.1% = $4,709.09 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,SENTARA HEALTH,SENTARA HEALTH,1516.85,,,,,,,1082.0000,11957.2000,percent of total billed charges,"25.81% of $5,877.00 in Billed Charges for Rev 361 Proc 60699 = $1,516.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,SENTARA HEALTH,SENTARA MEDICARE,5484.95,,,,,,,1082.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5877.00,,,,,,,1082.0000,11957.2000,percent of total billed charges,"100% of $5,877.00 in Billed Charges for Rev 361 Proc 60699 = $5,877.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,1082.0000,11957.2000,case rate,"Rev 361 Proc 60699 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5877.00,,,,,,,1082.0000,11957.2000,case rate,"Rev 361 Proc 60699 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total (Service Line reduced to $5,877.00, claim capped at $5,877.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,5877.00,,,,,,,1082.0000,11957.2000,case rate,"Rev 361 Proc 60699 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total (Service Line reduced to $5,877.00, claim capped at $5,877.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,5877.00,,,,,,,1082.0000,11957.2000,case rate,"Rev 361 Proc 60699 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total (Service Line reduced to $5,877.00, claim capped at $5,877.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,4704.53,,,,,,,1082.0000,11957.2000,fee schedule,"APG 00115 Proc 60699 at $836.60 (Base Rate) * 5.4596 (Relative Weight) = $4,567.50 (Total Line Payment) at 103% = $4,704.53. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5484.95,,,,,,,1082.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5484.95,,,,,,,1082.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,WELLCARE,WELLCARE MEDICAID,5877.00,,,,,,,1082.0000,11957.2000,percent of total billed charges,"100% of $5,877.00 in Billed Charges for Rev 361 Proc 60699 = $5,877.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC UNLISTED PROCEDURE ENDOCRINE,60699,CPT,361,RC,36100183,CDM,,,,both,,,5877.0000,881.5500,WELLCARE,WELLCARE MEDICARE,5814.05,,,,,,,1082.0000,11957.2000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,AETNA,AETNA,30343.90,,,,,,,12398.0000,71063.0000,percent of total billed charges,"42.7% of $71,063.00 in Billed Charges for Rev 481 Proc 0614T = $30,343.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,32079.69,,,,,,,12398.0000,71063.0000,fee schedule,"APG 00097 Proc 0614T at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 104% = $32,079.69. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,20181.03,,,,,,,12398.0000,71063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,AETNA,AETNA HEALTHCARE MEDICARE,20181.03,,,,,,,12398.0000,71063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,20181.03,,,,,,,12398.0000,71063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,AMBETTER,AMBETTER,43994.64,,,,,,,12398.0000,71063.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,20988.27,,,,,,,12398.0000,71063.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,BLUE CROSS,ANTHEM EXCHANGE,49686.78,,,,,,,12398.0000,71063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,31771.24,,,,,,,12398.0000,71063.0000,fee schedule,"APG 00097 Proc 0614T at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 103% = $31,771.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,BLUE CROSS,ANTHEM HMO,52789.25,,,,,,,12398.0000,71063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,20786.46,,,,,,,12398.0000,71063.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",62101.64,,,,,,,12398.0000,71063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,49744.10,,,,,,,12398.0000,71063.0000,percent of total billed charges,"Rev 481 Proc 0614T $71,063.00 in Billed Charges at 70% = $49,744.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,BLUE CROSS,BLUE CROSS E NETWORK,12398.00,,,,,,,12398.0000,71063.0000,case rate,"Rev 481 Proc 0614T ASG Rate of $12,398.00 at 100% of $12,398.00 = $12,398.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,BLUE CROSS,BLUE CROSS MEDICARE,20988.27,,,,,,,12398.0000,71063.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,BLUE CROSS,BLUE CROSS P NETWORK,12677.00,,,,,,,12398.0000,71063.0000,case rate,"Rev 481 Proc 0614T ASG Rate of $12,677.00 at 100% of $12,677.00 = $12,677.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,BLUE CROSS,BLUE CROSS S NETWORK,12677.00,,,,,,,12398.0000,71063.0000,case rate,"Rev 481 Proc 0614T ASG Rate of $12,677.00 at 100% of $12,677.00 = $12,677.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,CIGNA HEALTHCARE,CIGNA HMO,29633.27,,,,,,,12398.0000,71063.0000,percent of total billed charges,"41.7% of $71,063.00 in Billed Charges for Rev 481 Proc 0614T = $29,633.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,32973.23,,,,,,,12398.0000,71063.0000,percent of total billed charges,"46.4% of $71,063.00 in Billed Charges for Rev 481 Proc 0614T = $32,973.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,21190.08,,,,,,,12398.0000,71063.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,29633.27,,,,,,,12398.0000,71063.0000,percent of total billed charges,"41.7% of $71,063.00 in Billed Charges for Rev 481 Proc 0614T = $29,633.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,CIGNA HEALTHCARE,CIGNA PPO,29633.27,,,,,,,12398.0000,71063.0000,percent of total billed charges,"41.7% of $71,063.00 in Billed Charges for Rev 481 Proc 0614T = $29,633.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,21190.08,,,,,,,12398.0000,71063.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,63956.70,,,,,,,12398.0000,71063.0000,percent of total billed charges,"90% of $71,063.00 in Billed Charges for Rev 481 Proc 0614T = $63,956.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,HUMANA,HUMANA MEDICARE,20181.03,,,,,,,12398.0000,71063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,20181.03,,,,,,,12398.0000,71063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,MEDCOST,MEDCOST VHN,33818.88,,,,,,,12398.0000,71063.0000,percent of total billed charges,"47.59% of $71,063.00 in Billed Charges for Rev 481 Proc 0614T = $33,818.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,32388.15,,,,,,,12398.0000,71063.0000,fee schedule,"APG 00097 Proc 0614T at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 100% = $30,845.86... $30,845.86 at 105% = $32,388.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,21190.08,,,,,,,12398.0000,71063.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,21190.08,,,,,,,12398.0000,71063.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,NHC ADVANTAGE,NHC ADVANTAGE,21190.08,,,,,,,12398.0000,71063.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,31802.08,,,,,,,12398.0000,71063.0000,fee schedule,"APG 00097 Proc 0614T at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 100% = $30,845.86... $30,845.86 at 103.1% = $31,802.08 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,SENTARA HEALTH,SENTARA HEALTH,18341.36,,,,,,,12398.0000,71063.0000,percent of total billed charges,"25.81% of $71,063.00 in Billed Charges for Rev 481 Proc 0614T = $18,341.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,SENTARA HEALTH,SENTARA MEDICARE,20181.03,,,,,,,12398.0000,71063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",71063.00,,,,,,,12398.0000,71063.0000,percent of total billed charges,"100% of $71,063.00 in Billed Charges for Rev 481 Proc 0614T = $71,063.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14690.00,,,,,,,12398.0000,71063.0000,case rate,"Rev 481 Proc 0614T ASG Rate of $14,690.00 at 100% of $14,690.00 = $14,690.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13326.00,,,,,,,12398.0000,71063.0000,case rate,"Rev 481 Proc 0614T ASG Rate of $13,326.00 at 100% of $13,326.00 = $13,326.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,12749.00,,,,,,,12398.0000,71063.0000,case rate,"Rev 481 Proc 0614T ASG Rate of $12,749.00 at 100% of $12,749.00 = $12,749.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,21642.00,,,,,,,12398.0000,71063.0000,case rate,"Rev 481 Proc 0614T ASG Rate of $21,642.00 at 100% of $21,642.00 = $21,642.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,31771.24,,,,,,,12398.0000,71063.0000,fee schedule,"APG 00097 Proc 0614T at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 103% = $31,771.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,20181.03,,,,,,,12398.0000,71063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,20181.03,,,,,,,12398.0000,71063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,WELLCARE,WELLCARE MEDICAID,71063.00,,,,,,,12398.0000,71063.0000,percent of total billed charges,"100% of $71,063.00 in Billed Charges for Rev 481 Proc 0614T = $71,063.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL&RPLCMT SUBSTERNAL IMPLTBL DEFIBRILLATOR PG,0614T,CPT,481,RC,48100236,CDM,,,,both,,,71063.0000,10659.4500,WELLCARE,WELLCARE MEDICARE,21391.89,,,,,,,12398.0000,71063.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,AETNA,AETNA,6839.26,,,,,,,2853.0000,16017.0000,percent of total billed charges,"42.7% of $16,017.00 in Billed Charges for Rev 481 Proc 0644T = $6,839.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,12234.58,,,,,,,2853.0000,16017.0000,fee schedule,"APG 00099 Proc 0644T at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 104% = $12,234.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5163.81,,,,,,,2853.0000,16017.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,AETNA,AETNA HEALTHCARE MEDICARE,5163.81,,,,,,,2853.0000,16017.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,5163.81,,,,,,,2853.0000,16017.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,AMBETTER,AMBETTER,11257.11,,,,,,,2853.0000,16017.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,5370.36,,,,,,,2853.0000,16017.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,BLUE CROSS,ANTHEM EXCHANGE,12713.57,,,,,,,2853.0000,16017.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,12116.94,,,,,,,2853.0000,16017.0000,fee schedule,"APG 00099 Proc 0644T at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,BLUE CROSS,ANTHEM HMO,13507.41,,,,,,,2853.0000,16017.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5318.72,,,,,,,2853.0000,16017.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",15890.21,,,,,,,2853.0000,16017.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11211.90,,,,,,,2853.0000,16017.0000,percent of total billed charges,"Rev 481 Proc 0644T $16,017.00 in Billed Charges at 70% = $11,211.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,2853.0000,16017.0000,case rate,"Rev 481 Proc 0644T ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,BLUE CROSS,BLUE CROSS MEDICARE,5370.36,,,,,,,2853.0000,16017.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,2853.0000,16017.0000,case rate,"Rev 481 Proc 0644T ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,2853.0000,16017.0000,case rate,"Rev 481 Proc 0644T ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,CIGNA HEALTHCARE,CIGNA HMO,6679.09,,,,,,,2853.0000,16017.0000,percent of total billed charges,"41.7% of $16,017.00 in Billed Charges for Rev 481 Proc 0644T = $6,679.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7431.89,,,,,,,2853.0000,16017.0000,percent of total billed charges,"46.4% of $16,017.00 in Billed Charges for Rev 481 Proc 0644T = $7,431.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,5422.00,,,,,,,2853.0000,16017.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6679.09,,,,,,,2853.0000,16017.0000,percent of total billed charges,"41.7% of $16,017.00 in Billed Charges for Rev 481 Proc 0644T = $6,679.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,CIGNA HEALTHCARE,CIGNA PPO,6679.09,,,,,,,2853.0000,16017.0000,percent of total billed charges,"41.7% of $16,017.00 in Billed Charges for Rev 481 Proc 0644T = $6,679.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,5422.00,,,,,,,2853.0000,16017.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,14415.30,,,,,,,2853.0000,16017.0000,percent of total billed charges,"90% of $16,017.00 in Billed Charges for Rev 481 Proc 0644T = $14,415.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,HUMANA,HUMANA MEDICARE,5163.81,,,,,,,2853.0000,16017.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5163.81,,,,,,,2853.0000,16017.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,MEDCOST,MEDCOST VHN,7622.49,,,,,,,2853.0000,16017.0000,percent of total billed charges,"47.59% of $16,017.00 in Billed Charges for Rev 481 Proc 0644T = $7,622.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,12352.22,,,,,,,2853.0000,16017.0000,fee schedule,"APG 00099 Proc 0644T at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 105% = $12,352.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,5422.00,,,,,,,2853.0000,16017.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,5422.00,,,,,,,2853.0000,16017.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,NHC ADVANTAGE,NHC ADVANTAGE,5422.00,,,,,,,2853.0000,16017.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,12128.70,,,,,,,2853.0000,16017.0000,fee schedule,"APG 00099 Proc 0644T at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 103.1% = $12,128.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,SENTARA HEALTH,SENTARA HEALTH,4133.99,,,,,,,2853.0000,16017.0000,percent of total billed charges,"25.81% of $16,017.00 in Billed Charges for Rev 481 Proc 0644T = $4,133.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,SENTARA HEALTH,SENTARA MEDICARE,5163.81,,,,,,,2853.0000,16017.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",16017.00,,,,,,,2853.0000,16017.0000,percent of total billed charges,"100% of $16,017.00 in Billed Charges for Rev 481 Proc 0644T = $16,017.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,2853.0000,16017.0000,case rate,"Rev 481 Proc 0644T ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,2853.0000,16017.0000,case rate,"Rev 481 Proc 0644T ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,2853.0000,16017.0000,case rate,"Rev 481 Proc 0644T ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,2853.0000,16017.0000,case rate,"Rev 481 Proc 0644T ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,12116.94,,,,,,,2853.0000,16017.0000,fee schedule,"APG 00099 Proc 0644T at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5163.81,,,,,,,2853.0000,16017.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5163.81,,,,,,,2853.0000,16017.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,WELLCARE,WELLCARE MEDICAID,16017.00,,,,,,,2853.0000,16017.0000,percent of total billed charges,"100% of $16,017.00 in Billed Charges for Rev 481 Proc 0644T = $16,017.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL/DBULK ICAR MASS SUCTION DEVICE PERQ,0644T,CPT,481,RC,48100220,CDM,,,,both,,,16017.0000,2402.5500,WELLCARE,WELLCARE MEDICARE,5473.64,,,,,,,2853.0000,16017.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,AETNA,AETNA,10912.41,,,,,,,1571.0000,25556.0000,percent of total billed charges,"42.7% of $25,556.00 in Billed Charges for Rev 480 Proc 0646T = $10,912.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,20883.80,,,,,,,1571.0000,25556.0000,fee schedule,"APG 00121 Proc 0646T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 104% = $20,883.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,BLUE CROSS,ANTHEM EXCHANGE,25419.59,,,,,,,1571.0000,25556.0000,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 480 Proc 0646T * Qty 1 = $12,718.06 at 199.87% = $25,419.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,20682.99,,,,,,,1571.0000,25556.0000,fee schedule,"APG 00121 Proc 0646T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,BLUE CROSS,ANTHEM HMO,25556.00,,,,,,,1571.0000,25556.0000,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 480 Proc 0646T * Qty 1 = $12,718.06 at 212.35% = $27,006.80 (Service Line reduced to $25,556.00, claim capped at $25,556.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",25556.00,,,,,,,1571.0000,25556.0000,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 480 Proc 0646T * Qty 1 = $12,718.06 at 249.81% = $31,770.99 (Service Line reduced to $25,556.00, claim capped at $25,556.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,17889.20,,,,,,,1571.0000,25556.0000,percent of total billed charges,"Rev 480 Proc 0646T $25,556.00 in Billed Charges at 70% = $17,889.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,1571.0000,25556.0000,case rate,"Rev 480 Proc 0646T ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,1571.0000,25556.0000,case rate,"Rev 480 Proc 0646T ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,1571.0000,25556.0000,case rate,"Rev 480 Proc 0646T ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,CIGNA HEALTHCARE,CIGNA HMO,10656.85,,,,,,,1571.0000,25556.0000,percent of total billed charges,"41.7% of $25,556.00 in Billed Charges for Rev 480 Proc 0646T = $10,656.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11857.98,,,,,,,1571.0000,25556.0000,percent of total billed charges,"46.4% of $25,556.00 in Billed Charges for Rev 480 Proc 0646T = $11,857.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,10656.85,,,,,,,1571.0000,25556.0000,percent of total billed charges,"41.7% of $25,556.00 in Billed Charges for Rev 480 Proc 0646T = $10,656.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,CIGNA HEALTHCARE,CIGNA PPO,10656.85,,,,,,,1571.0000,25556.0000,percent of total billed charges,"41.7% of $25,556.00 in Billed Charges for Rev 480 Proc 0646T = $10,656.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,23000.40,,,,,,,1571.0000,25556.0000,percent of total billed charges,"90% of $25,556.00 in Billed Charges for Rev 480 Proc 0646T = $23,000.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,MEDCOST,MEDCOST VHN,12162.10,,,,,,,1571.0000,25556.0000,percent of total billed charges,"47.59% of $25,556.00 in Billed Charges for Rev 480 Proc 0646T = $12,162.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,21084.61,,,,,,,1571.0000,25556.0000,fee schedule,"APG 00121 Proc 0646T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 105% = $21,084.61 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,20703.08,,,,,,,1571.0000,25556.0000,fee schedule,"APG 00121 Proc 0646T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 103.1% = $20,703.08 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,SENTARA HEALTH,SENTARA HEALTH,6596.00,,,,,,,1571.0000,25556.0000,percent of total billed charges,"25.81% of $25,556.00 in Billed Charges for Rev 480 Proc 0646T = $6,596.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",25556.00,,,,,,,1571.0000,25556.0000,percent of total billed charges,"100% of $25,556.00 in Billed Charges for Rev 480 Proc 0646T = $25,556.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,12778.00,,,,,,,1571.0000,25556.0000,percent of total billed charges,"Rev 480 Proc 0646T $25,556.00 in Billed Charges at 50% = $12,778.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1642.00,,,,,,,1571.0000,25556.0000,other,"Rev 480 Proc 0646T 1 Visit at $1,642.00 per Visit = $1,642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1571.00,,,,,,,1571.0000,25556.0000,other,"Rev 480 Proc 0646T 1 Visit at $1,571.00 per Visit = $1,571.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,3097.00,,,,,,,1571.0000,25556.0000,other,"Rev 480 Proc 0646T 1 Visit at $3,097.00 per Visit = $3,097.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,20682.99,,,,,,,1571.0000,25556.0000,fee schedule,"APG 00121 Proc 0646T at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TTVI/RPLCMT PROSTC VLV PERQ W/R HRT CATH&ANGRPH,0646T,CPT,480,RC,48000092,CDM,,,,both,,,25556.0000,3833.4000,WELLCARE,WELLCARE MEDICAID,25556.00,,,,,,,1571.0000,25556.0000,percent of total billed charges,"100% of $25,556.00 in Billed Charges for Rev 480 Proc 0646T = $25,556.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,AETNA,AETNA,11458.12,,,,,,,1571.0000,38096.9000,percent of total billed charges,"42.7% of $26,834.00 in Billed Charges for Rev 480 Proc 0825T = $11,458.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11330.93,,,,,,,1571.0000,38096.9000,fee schedule,"APG 00086 Proc 0825T at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 104% = $11,330.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,17475.64,,,,,,,1571.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,AETNA,AETNA HEALTHCARE MEDICARE,17475.64,,,,,,,1571.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,17475.64,,,,,,,1571.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,AMBETTER,AMBETTER,38096.90,,,,,,,1571.0000,38096.9000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,18174.67,,,,,,,1571.0000,38096.9000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,ANTHEM EXCHANGE,26834.00,,,,,,,1571.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11221.98,,,,,,,1571.0000,38096.9000,fee schedule,"APG 00086 Proc 0825T at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,ANTHEM HMO,26834.00,,,,,,,1571.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,17999.91,,,,,,,1571.0000,38096.9000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",26834.00,,,,,,,1571.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,18783.80,,,,,,,1571.0000,38096.9000,percent of total billed charges,"Rev 480 Proc 0825T $26,834.00 in Billed Charges at 70% = $18,783.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,BLUE CROSS E NETWORK,11219.00,,,,,,,1571.0000,38096.9000,case rate,"Rev 480 Proc 0825T ASG Rate of $11,219.00 at 100% of $11,219.00 = $11,219.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,BLUE CROSS MEDICARE,18174.67,,,,,,,1571.0000,38096.9000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,BLUE CROSS P NETWORK,11472.00,,,,,,,1571.0000,38096.9000,case rate,"Rev 480 Proc 0825T ASG Rate of $11,472.00 at 100% of $11,472.00 = $11,472.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,BLUE CROSS S NETWORK,11472.00,,,,,,,1571.0000,38096.9000,case rate,"Rev 480 Proc 0825T ASG Rate of $11,472.00 at 100% of $11,472.00 = $11,472.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,CIGNA HEALTHCARE,CIGNA HMO,11189.78,,,,,,,1571.0000,38096.9000,percent of total billed charges,"41.7% of $26,834.00 in Billed Charges for Rev 480 Proc 0825T = $11,189.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12450.98,,,,,,,1571.0000,38096.9000,percent of total billed charges,"46.4% of $26,834.00 in Billed Charges for Rev 480 Proc 0825T = $12,450.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,18349.42,,,,,,,1571.0000,38096.9000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11189.78,,,,,,,1571.0000,38096.9000,percent of total billed charges,"41.7% of $26,834.00 in Billed Charges for Rev 480 Proc 0825T = $11,189.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,CIGNA HEALTHCARE,CIGNA PPO,11189.78,,,,,,,1571.0000,38096.9000,percent of total billed charges,"41.7% of $26,834.00 in Billed Charges for Rev 480 Proc 0825T = $11,189.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,18349.42,,,,,,,1571.0000,38096.9000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,24150.60,,,,,,,1571.0000,38096.9000,percent of total billed charges,"90% of $26,834.00 in Billed Charges for Rev 480 Proc 0825T = $24,150.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,HUMANA,HUMANA MEDICARE,17475.64,,,,,,,1571.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,17475.64,,,,,,,1571.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,MEDCOST,MEDCOST VHN,12770.30,,,,,,,1571.0000,38096.9000,percent of total billed charges,"47.59% of $26,834.00 in Billed Charges for Rev 480 Proc 0825T = $12,770.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11439.89,,,,,,,1571.0000,38096.9000,fee schedule,"APG 00086 Proc 0825T at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 105% = $11,439.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,18349.42,,,,,,,1571.0000,38096.9000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,18349.42,,,,,,,1571.0000,38096.9000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,NHC ADVANTAGE,NHC ADVANTAGE,18349.42,,,,,,,1571.0000,38096.9000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11232.88,,,,,,,1571.0000,38096.9000,fee schedule,"APG 00086 Proc 0825T at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 103.1% = $11,232.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,SENTARA HEALTH,SENTARA HEALTH,6925.86,,,,,,,1571.0000,38096.9000,percent of total billed charges,"25.81% of $26,834.00 in Billed Charges for Rev 480 Proc 0825T = $6,925.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,SENTARA HEALTH,SENTARA MEDICARE,17475.64,,,,,,,1571.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",26834.00,,,,,,,1571.0000,38096.9000,percent of total billed charges,"100% of $26,834.00 in Billed Charges for Rev 480 Proc 0825T = $26,834.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9282.68,,,,,,,1571.0000,38096.9000,fee schedule,"$18,565.35 from Fee Schedule TCUHC24 for Rev 480 Proc 0825T * Qty 1 = $18,565.35 at 50% = $9,282.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1642.00,,,,,,,1571.0000,38096.9000,other,"Rev 480 Proc 0825T 1 Visit at $1,642.00 per Visit = $1,642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1571.00,,,,,,,1571.0000,38096.9000,other,"Rev 480 Proc 0825T 1 Visit at $1,571.00 per Visit = $1,571.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,3097.00,,,,,,,1571.0000,38096.9000,other,"Rev 480 Proc 0825T 1 Visit at $3,097.00 per Visit = $3,097.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11221.98,,,,,,,1571.0000,38096.9000,fee schedule,"APG 00086 Proc 0825T at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,17475.64,,,,,,,1571.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,17475.64,,,,,,,1571.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,WELLCARE,WELLCARE MEDICAID,26834.00,,,,,,,1571.0000,38096.9000,percent of total billed charges,"100% of $26,834.00 in Billed Charges for Rev 480 Proc 0825T = $26,834.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TCAT RMVL&RPLCMT PERM 1CHMBR LDLS PM R ATRIAL,0825T,CPT,480,RC,48000084,CDM,,,,both,,,26834.0000,4025.1000,WELLCARE,WELLCARE MEDICARE,18524.18,,,,,,,1571.0000,38096.9000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,AETNA,AETNA,1462.90,,,,,,,17.9700,3426.0000,percent of total billed charges,"42.7% of $3,426.00 in Billed Charges for Rev 480 Proc 0826T = $1,462.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,51.42,,,,,,,17.9700,3426.0000,fee schedule,APG 00488 Proc 0826T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 104% = $51.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,33.86,,,,,,,17.9700,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,AETNA,AETNA HEALTHCARE MEDICARE,33.86,,,,,,,17.9700,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,33.86,,,,,,,17.9700,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,AMBETTER,AMBETTER,73.82,,,,,,,17.9700,3426.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,35.22,,,,,,,17.9700,3426.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,ANTHEM EXCHANGE,83.37,,,,,,,17.9700,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,50.93,,,,,,,17.9700,3426.0000,fee schedule,APG 00488 Proc 0826T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 103% = $50.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,ANTHEM HMO,88.57,,,,,,,17.9700,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,34.88,,,,,,,17.9700,3426.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",104.20,,,,,,,17.9700,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2398.20,,,,,,,17.9700,3426.0000,percent of total billed charges,"Rev 480 Proc 0826T $3,426.00 in Billed Charges at 70% = $2,398.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,17.9700,3426.0000,case rate,Rev 480 Proc 0826T ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,BLUE CROSS MEDICARE,35.22,,,,,,,17.9700,3426.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,17.9700,3426.0000,case rate,Rev 480 Proc 0826T ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,17.9700,3426.0000,case rate,Rev 480 Proc 0826T ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,CIGNA HEALTHCARE,CIGNA HMO,1428.64,,,,,,,17.9700,3426.0000,percent of total billed charges,"41.7% of $3,426.00 in Billed Charges for Rev 480 Proc 0826T = $1,428.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1589.66,,,,,,,17.9700,3426.0000,percent of total billed charges,"46.4% of $3,426.00 in Billed Charges for Rev 480 Proc 0826T = $1,589.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,35.55,,,,,,,17.9700,3426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1428.64,,,,,,,17.9700,3426.0000,percent of total billed charges,"41.7% of $3,426.00 in Billed Charges for Rev 480 Proc 0826T = $1,428.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,CIGNA HEALTHCARE,CIGNA PPO,1428.64,,,,,,,17.9700,3426.0000,percent of total billed charges,"41.7% of $3,426.00 in Billed Charges for Rev 480 Proc 0826T = $1,428.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,35.55,,,,,,,17.9700,3426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3083.40,,,,,,,17.9700,3426.0000,percent of total billed charges,"90% of $3,426.00 in Billed Charges for Rev 480 Proc 0826T = $3,083.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,HUMANA,HUMANA MEDICARE,33.86,,,,,,,17.9700,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,33.86,,,,,,,17.9700,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,MEDCOST,MEDCOST VHN,1630.43,,,,,,,17.9700,3426.0000,percent of total billed charges,"47.59% of $3,426.00 in Billed Charges for Rev 480 Proc 0826T = $1,630.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,51.91,,,,,,,17.9700,3426.0000,fee schedule,APG 00488 Proc 0826T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 100% = $49.44... $49.44 at 105% = $51.91 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,35.55,,,,,,,17.9700,3426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,35.55,,,,,,,17.9700,3426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,NHC ADVANTAGE,NHC ADVANTAGE,35.55,,,,,,,17.9700,3426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,50.97,,,,,,,17.9700,3426.0000,fee schedule,APG 00488 Proc 0826T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 100% = $49.44... $49.44 at 103.1% = $50.97 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,SENTARA HEALTH,SENTARA HEALTH,884.25,,,,,,,17.9700,3426.0000,percent of total billed charges,"25.81% of $3,426.00 in Billed Charges for Rev 480 Proc 0826T = $884.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,SENTARA HEALTH,SENTARA MEDICARE,33.86,,,,,,,17.9700,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3426.00,,,,,,,17.9700,3426.0000,percent of total billed charges,"100% of $3,426.00 in Billed Charges for Rev 480 Proc 0826T = $3,426.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,17.97,,,,,,,17.9700,3426.0000,fee schedule,$35.93 from Fee Schedule TCUHC24 for Rev 480 Proc 0826T * Qty 1 = $35.93 at 50% = $17.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1642.00,,,,,,,17.9700,3426.0000,other,"Rev 480 Proc 0826T 1 Visit at $1,642.00 per Visit = $1,642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1571.00,,,,,,,17.9700,3426.0000,other,"Rev 480 Proc 0826T 1 Visit at $1,571.00 per Visit = $1,571.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,3097.00,,,,,,,17.9700,3426.0000,other,"Rev 480 Proc 0826T 1 Visit at $3,097.00 per Visit = $3,097.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,50.93,,,,,,,17.9700,3426.0000,fee schedule,APG 00488 Proc 0826T at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 103% = $50.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,33.86,,,,,,,17.9700,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,33.86,,,,,,,17.9700,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,WELLCARE,WELLCARE MEDICAID,3426.00,,,,,,,17.9700,3426.0000,percent of total billed charges,"100% of $3,426.00 in Billed Charges for Rev 480 Proc 0826T = $3,426.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP,0826T,CPT,480,RC,48000085,CDM,,,,both,,,3426.0000,513.9000,WELLCARE,WELLCARE MEDICARE,35.89,,,,,,,17.9700,3426.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CAP FOR DRIVING 357.411,272,RC,,,,,,,,both,,,6156.1200,923.4200,AETNA,AETNA,2628.66,,,,,,,1588.8900,6156.1200,percent of total billed charges,"42.7% of $6,156.12 in Billed Charges for Rev 272 = $2,628.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAP FOR DRIVING 357.411,272,RC,,,,,,,,both,,,6156.1200,923.4200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4309.28,,,,,,,1588.8900,6156.1200,percent of total billed charges,"Rev 272 $6,156.12 in Billed Charges at 70% = $4,309.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAP FOR DRIVING 357.411,272,RC,,,,,,,,both,,,6156.1200,923.4200,CIGNA HEALTHCARE,CIGNA HMO,2567.10,,,,,,,1588.8900,6156.1200,percent of total billed charges,"41.7% of $6,156.12 in Billed Charges for Rev 272 = $2,567.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAP FOR DRIVING 357.411,272,RC,,,,,,,,both,,,6156.1200,923.4200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2856.44,,,,,,,1588.8900,6156.1200,percent of total billed charges,"46.4% of $6,156.12 in Billed Charges for Rev 272 = $2,856.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAP FOR DRIVING 357.411,272,RC,,,,,,,,both,,,6156.1200,923.4200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2567.10,,,,,,,1588.8900,6156.1200,percent of total billed charges,"41.7% of $6,156.12 in Billed Charges for Rev 272 = $2,567.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAP FOR DRIVING 357.411,272,RC,,,,,,,,both,,,6156.1200,923.4200,CIGNA HEALTHCARE,CIGNA PPO,2567.10,,,,,,,1588.8900,6156.1200,percent of total billed charges,"41.7% of $6,156.12 in Billed Charges for Rev 272 = $2,567.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAP FOR DRIVING 357.411,272,RC,,,,,,,,both,,,6156.1200,923.4200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5540.51,,,,,,,1588.8900,6156.1200,percent of total billed charges,"90% of $6,156.12 in Billed Charges for Rev 272 = $5,540.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAP FOR DRIVING 357.411,272,RC,,,,,,,,both,,,6156.1200,923.4200,MEDCOST,MEDCOST VHN,2929.70,,,,,,,1588.8900,6156.1200,percent of total billed charges,"47.59% of $6,156.12 in Billed Charges for Rev 272 = $2,929.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAP FOR DRIVING 357.411,272,RC,,,,,,,,both,,,6156.1200,923.4200,SENTARA HEALTH,SENTARA HEALTH,1588.89,,,,,,,1588.8900,6156.1200,percent of total billed charges,"25.81% of $6,156.12 in Billed Charges for Rev 272 = $1,588.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAP FOR DRIVING 357.411,272,RC,,,,,,,,both,,,6156.1200,923.4200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6156.12,,,,,,,1588.8900,6156.1200,percent of total billed charges,"100% of $6,156.12 in Billed Charges for Rev 272 = $6,156.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAP FOR DRIVING 357.411,272,RC,,,,,,,,both,,,6156.1200,923.4200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3078.06,,,,,,,1588.8900,6156.1200,percent of total billed charges,"Rev 272 $6,156.12 in Billed Charges at 50% = $3,078.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAP FOR DRIVING 357.411,272,RC,,,,,,,,both,,,6156.1200,923.4200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1988.43,,,,,,,1588.8900,6156.1200,other,"32.3% of $6,156.12 in Billed Charges for Rev 272 = $1,988.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CAP FOR DRIVING 357.411,272,RC,,,,,,,,both,,,6156.1200,923.4200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1889.93,,,,,,,1588.8900,6156.1200,other,"30.7% of $6,156.12 in Billed Charges for Rev 272 = $1,889.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CAP FOR DRIVING 357.411,272,RC,,,,,,,,both,,,6156.1200,923.4200,UNITED HEALTHCARE,UNITED HEALTHCARE,1988.43,,,,,,,1588.8900,6156.1200,percent of total billed charges,"32.3% of $6,156.12 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAP FOR DRIVING 357.411,272,RC,,,,,,,,both,,,6156.1200,923.4200,WELLCARE,WELLCARE MEDICAID,6156.12,,,,,,,1588.8900,6156.1200,percent of total billed charges,"100% of $6,156.12 in Billed Charges for Rev 272 = $6,156.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPSULE BRAVO CF DELIVERY DEVICE,272,RC,27200002,CDM,,,,,,both,,,3418.2800,512.7400,AETNA,AETNA,1459.61,,,,,,,882.2600,3418.2800,percent of total billed charges,"42.7% of $3,418.28 in Billed Charges for Rev 272 = $1,459.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPSULE BRAVO CF DELIVERY DEVICE,272,RC,27200002,CDM,,,,,,both,,,3418.2800,512.7400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2392.80,,,,,,,882.2600,3418.2800,percent of total billed charges,"Rev 272 $3,418.28 in Billed Charges at 70% = $2,392.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPSULE BRAVO CF DELIVERY DEVICE,272,RC,27200002,CDM,,,,,,both,,,3418.2800,512.7400,CIGNA HEALTHCARE,CIGNA HMO,1425.42,,,,,,,882.2600,3418.2800,percent of total billed charges,"41.7% of $3,418.28 in Billed Charges for Rev 272 = $1,425.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPSULE BRAVO CF DELIVERY DEVICE,272,RC,27200002,CDM,,,,,,both,,,3418.2800,512.7400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1586.08,,,,,,,882.2600,3418.2800,percent of total billed charges,"46.4% of $3,418.28 in Billed Charges for Rev 272 = $1,586.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPSULE BRAVO CF DELIVERY DEVICE,272,RC,27200002,CDM,,,,,,both,,,3418.2800,512.7400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1425.42,,,,,,,882.2600,3418.2800,percent of total billed charges,"41.7% of $3,418.28 in Billed Charges for Rev 272 = $1,425.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPSULE BRAVO CF DELIVERY DEVICE,272,RC,27200002,CDM,,,,,,both,,,3418.2800,512.7400,CIGNA HEALTHCARE,CIGNA PPO,1425.42,,,,,,,882.2600,3418.2800,percent of total billed charges,"41.7% of $3,418.28 in Billed Charges for Rev 272 = $1,425.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPSULE BRAVO CF DELIVERY DEVICE,272,RC,27200002,CDM,,,,,,both,,,3418.2800,512.7400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3076.45,,,,,,,882.2600,3418.2800,percent of total billed charges,"90% of $3,418.28 in Billed Charges for Rev 272 = $3,076.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPSULE BRAVO CF DELIVERY DEVICE,272,RC,27200002,CDM,,,,,,both,,,3418.2800,512.7400,MEDCOST,MEDCOST VHN,1626.76,,,,,,,882.2600,3418.2800,percent of total billed charges,"47.59% of $3,418.28 in Billed Charges for Rev 272 = $1,626.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPSULE BRAVO CF DELIVERY DEVICE,272,RC,27200002,CDM,,,,,,both,,,3418.2800,512.7400,SENTARA HEALTH,SENTARA HEALTH,882.26,,,,,,,882.2600,3418.2800,percent of total billed charges,"25.81% of $3,418.28 in Billed Charges for Rev 272 = $882.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPSULE BRAVO CF DELIVERY DEVICE,272,RC,27200002,CDM,,,,,,both,,,3418.2800,512.7400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3418.28,,,,,,,882.2600,3418.2800,percent of total billed charges,"100% of $3,418.28 in Billed Charges for Rev 272 = $3,418.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPSULE BRAVO CF DELIVERY DEVICE,272,RC,27200002,CDM,,,,,,both,,,3418.2800,512.7400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1709.14,,,,,,,882.2600,3418.2800,percent of total billed charges,"Rev 272 $3,418.28 in Billed Charges at 50% = $1,709.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPSULE BRAVO CF DELIVERY DEVICE,272,RC,27200002,CDM,,,,,,both,,,3418.2800,512.7400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1104.10,,,,,,,882.2600,3418.2800,other,"32.3% of $3,418.28 in Billed Charges for Rev 272 = $1,104.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CAPSULE BRAVO CF DELIVERY DEVICE,272,RC,27200002,CDM,,,,,,both,,,3418.2800,512.7400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1049.41,,,,,,,882.2600,3418.2800,other,"30.7% of $3,418.28 in Billed Charges for Rev 272 = $1,049.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CAPSULE BRAVO CF DELIVERY DEVICE,272,RC,27200002,CDM,,,,,,both,,,3418.2800,512.7400,UNITED HEALTHCARE,UNITED HEALTHCARE,1104.10,,,,,,,882.2600,3418.2800,percent of total billed charges,"32.3% of $3,418.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPSULE BRAVO CF DELIVERY DEVICE,272,RC,27200002,CDM,,,,,,both,,,3418.2800,512.7400,WELLCARE,WELLCARE MEDICAID,3418.28,,,,,,,882.2600,3418.2800,percent of total billed charges,"100% of $3,418.28 in Billed Charges for Rev 272 = $3,418.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARDIAC GRASPER PROBE DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2613.4900,392.0200,AETNA,AETNA,1115.96,,,,,,,674.5400,2613.4900,percent of total billed charges,"42.7% of $2,613.49 in Billed Charges for Rev 272 = $1,115.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARDIAC GRASPER PROBE DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2613.4900,392.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1829.44,,,,,,,674.5400,2613.4900,percent of total billed charges,"Rev 272 $2,613.49 in Billed Charges at 70% = $1,829.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARDIAC GRASPER PROBE DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2613.4900,392.0200,CIGNA HEALTHCARE,CIGNA HMO,1089.83,,,,,,,674.5400,2613.4900,percent of total billed charges,"41.7% of $2,613.49 in Billed Charges for Rev 272 = $1,089.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARDIAC GRASPER PROBE DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2613.4900,392.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1212.66,,,,,,,674.5400,2613.4900,percent of total billed charges,"46.4% of $2,613.49 in Billed Charges for Rev 272 = $1,212.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARDIAC GRASPER PROBE DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2613.4900,392.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1089.83,,,,,,,674.5400,2613.4900,percent of total billed charges,"41.7% of $2,613.49 in Billed Charges for Rev 272 = $1,089.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARDIAC GRASPER PROBE DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2613.4900,392.0200,CIGNA HEALTHCARE,CIGNA PPO,1089.83,,,,,,,674.5400,2613.4900,percent of total billed charges,"41.7% of $2,613.49 in Billed Charges for Rev 272 = $1,089.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARDIAC GRASPER PROBE DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2613.4900,392.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2352.14,,,,,,,674.5400,2613.4900,percent of total billed charges,"90% of $2,613.49 in Billed Charges for Rev 272 = $2,352.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARDIAC GRASPER PROBE DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2613.4900,392.0200,MEDCOST,MEDCOST VHN,1243.76,,,,,,,674.5400,2613.4900,percent of total billed charges,"47.59% of $2,613.49 in Billed Charges for Rev 272 = $1,243.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARDIAC GRASPER PROBE DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2613.4900,392.0200,SENTARA HEALTH,SENTARA HEALTH,674.54,,,,,,,674.5400,2613.4900,percent of total billed charges,"25.81% of $2,613.49 in Billed Charges for Rev 272 = $674.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARDIAC GRASPER PROBE DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2613.4900,392.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2613.49,,,,,,,674.5400,2613.4900,percent of total billed charges,"100% of $2,613.49 in Billed Charges for Rev 272 = $2,613.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARDIAC GRASPER PROBE DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2613.4900,392.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1306.75,,,,,,,674.5400,2613.4900,percent of total billed charges,"Rev 272 $2,613.49 in Billed Charges at 50% = $1,306.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARDIAC GRASPER PROBE DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2613.4900,392.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,844.16,,,,,,,674.5400,2613.4900,other,"32.3% of $2,613.49 in Billed Charges for Rev 272 = $844.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CARDIAC GRASPER PROBE DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2613.4900,392.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,802.34,,,,,,,674.5400,2613.4900,other,"30.7% of $2,613.49 in Billed Charges for Rev 272 = $802.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CARDIAC GRASPER PROBE DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2613.4900,392.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,844.16,,,,,,,674.5400,2613.4900,percent of total billed charges,"32.3% of $2,613.49 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARDIAC GRASPER PROBE DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2613.4900,392.0200,WELLCARE,WELLCARE MEDICAID,2613.49,,,,,,,674.5400,2613.4900,percent of total billed charges,"100% of $2,613.49 in Billed Charges for Rev 272 = $2,613.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,AETNA,AETNA,387.72,,,,,,,109.0000,908.0000,percent of total billed charges,42.7% of $908.00 in Billed Charges for Rev 450 Proc 12014 = $387.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,272.07,,,,,,,109.0000,908.0000,fee schedule,"APG 00016 Proc 12014 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 104% = $272.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,109.0000,908.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,109.0000,908.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,109.0000,908.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,AMBETTER,AMBETTER,396.83,,,,,,,109.0000,908.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,109.0000,908.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,109.0000,908.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,269.45,,,,,,,109.0000,908.0000,fee schedule,"APG 00016 Proc 12014 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,109.0000,908.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,109.0000,908.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",560.15,,,,,,,109.0000,908.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,150.40,,,,,,,109.0000,908.0000,fee schedule,$150.40 from Fee Schedule BLDTM_23 for Rev 450 Proc 12014 * Qty 1 = $150.40 at 100% = $150.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,109.0000,908.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,109.0000,908.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,109.0000,908.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,817.20,,,,,,,109.0000,908.0000,percent of total billed charges,90% of $908.00 in Billed Charges for Rev 450 Proc 12014 = $817.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,HUMANA,HUMANA MEDICARE,182.03,,,,,,,109.0000,908.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,109.0000,908.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,MEDCOST,MEDCOST VHN,432.12,,,,,,,109.0000,908.0000,percent of total billed charges,47.59% of $908.00 in Billed Charges for Rev 450 Proc 12014 = $432.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,274.68,,,,,,,109.0000,908.0000,fee schedule,"APG 00016 Proc 12014 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 105% = $274.68 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,109.0000,908.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,109.0000,908.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,109.0000,908.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,269.71,,,,,,,109.0000,908.0000,fee schedule,"APG 00016 Proc 12014 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 103.1% = $269.71 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,SENTARA HEALTH,SENTARA HEALTH,234.35,,,,,,,109.0000,908.0000,percent of total billed charges,25.81% of $908.00 in Billed Charges for Rev 450 Proc 12014 = $234.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,109.0000,908.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",908.00,,,,,,,109.0000,908.0000,percent of total billed charges,100% of $908.00 in Billed Charges for Rev 450 Proc 12014 = $908.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,908.0000,case rate,Rev 450 Proc 12014 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,908.0000,case rate,Rev 450 Proc 12014 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,908.0000,case rate,Rev 450 Proc 12014 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,908.0000,case rate,Rev 450 Proc 12014 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,269.45,,,,,,,109.0000,908.0000,fee schedule,"APG 00016 Proc 12014 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,109.0000,908.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,109.0000,908.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,WELLCARE,WELLCARE MEDICAID,908.00,,,,,,,109.0000,908.0000,percent of total billed charges,100% of $908.00 in Billed Charges for Rev 450 Proc 12014 = $908.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIM REP FACE MM 5.1-7.5,12014,CPT,450,RC,45000045,CDM,,,,both,,,908.0000,136.2000,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,109.0000,908.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,AETNA,AETNA,503.01,,,,,,,109.0000,1178.0000,percent of total billed charges,"42.7% of $1,178.00 in Billed Charges for Rev 450 Proc 12015 = $503.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,272.07,,,,,,,109.0000,1178.0000,fee schedule,"APG 00016 Proc 12015 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 104% = $272.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,109.0000,1178.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,109.0000,1178.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,109.0000,1178.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,AMBETTER,AMBETTER,396.83,,,,,,,109.0000,1178.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,109.0000,1178.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,109.0000,1178.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,269.45,,,,,,,109.0000,1178.0000,fee schedule,"APG 00016 Proc 12015 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,109.0000,1178.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,109.0000,1178.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",560.15,,,,,,,109.0000,1178.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,194.40,,,,,,,109.0000,1178.0000,fee schedule,$194.40 from Fee Schedule BLDTM_23 for Rev 450 Proc 12015 * Qty 1 = $194.40 at 100% = $194.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,109.0000,1178.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,109.0000,1178.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,109.0000,1178.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1060.20,,,,,,,109.0000,1178.0000,percent of total billed charges,"90% of $1,178.00 in Billed Charges for Rev 450 Proc 12015 = $1,060.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,HUMANA,HUMANA MEDICARE,182.03,,,,,,,109.0000,1178.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,109.0000,1178.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,MEDCOST,MEDCOST VHN,560.61,,,,,,,109.0000,1178.0000,percent of total billed charges,"47.59% of $1,178.00 in Billed Charges for Rev 450 Proc 12015 = $560.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,274.68,,,,,,,109.0000,1178.0000,fee schedule,"APG 00016 Proc 12015 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 105% = $274.68 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,109.0000,1178.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,109.0000,1178.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,109.0000,1178.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,269.71,,,,,,,109.0000,1178.0000,fee schedule,"APG 00016 Proc 12015 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 103.1% = $269.71 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,SENTARA HEALTH,SENTARA HEALTH,304.04,,,,,,,109.0000,1178.0000,percent of total billed charges,"25.81% of $1,178.00 in Billed Charges for Rev 450 Proc 12015 = $304.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,109.0000,1178.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1178.00,,,,,,,109.0000,1178.0000,percent of total billed charges,"100% of $1,178.00 in Billed Charges for Rev 450 Proc 12015 = $1,178.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1178.0000,case rate,Rev 450 Proc 12015 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1178.0000,case rate,Rev 450 Proc 12015 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1178.0000,case rate,Rev 450 Proc 12015 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1178.0000,case rate,Rev 450 Proc 12015 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,269.45,,,,,,,109.0000,1178.0000,fee schedule,"APG 00016 Proc 12015 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,109.0000,1178.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,109.0000,1178.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,WELLCARE,WELLCARE MEDICAID,1178.00,,,,,,,109.0000,1178.0000,percent of total billed charges,"100% of $1,178.00 in Billed Charges for Rev 450 Proc 12015 = $1,178.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIM REP FACE MM 7.6-12.5,12015,CPT,450,RC,45000046,CDM,,,,both,,,1178.0000,176.7000,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,109.0000,1178.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,AETNA,AETNA,705.40,,,,,,,109.0000,1652.0000,percent of total billed charges,"42.7% of $1,652.00 in Billed Charges for Rev 450 Proc 12016 = $705.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,272.07,,,,,,,109.0000,1652.0000,fee schedule,"APG 00016 Proc 12016 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 104% = $272.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,109.0000,1652.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,1652.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,109.0000,1652.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,AMBETTER,AMBETTER,804.03,,,,,,,109.0000,1652.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,109.0000,1652.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,109.0000,1652.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,269.45,,,,,,,109.0000,1652.0000,fee schedule,"APG 00016 Proc 12016 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,109.0000,1652.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,109.0000,1652.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1134.94,,,,,,,109.0000,1652.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,243.19,,,,,,,109.0000,1652.0000,fee schedule,$243.19 from Fee Schedule BLDTM_23 for Rev 450 Proc 12016 * Qty 1 = $243.19 at 100% = $243.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,109.0000,1652.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,109.0000,1652.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,109.0000,1652.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1486.80,,,,,,,109.0000,1652.0000,percent of total billed charges,"90% of $1,652.00 in Billed Charges for Rev 450 Proc 12016 = $1,486.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,HUMANA,HUMANA MEDICARE,368.82,,,,,,,109.0000,1652.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,109.0000,1652.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,MEDCOST,MEDCOST VHN,786.19,,,,,,,109.0000,1652.0000,percent of total billed charges,"47.59% of $1,652.00 in Billed Charges for Rev 450 Proc 12016 = $786.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,274.68,,,,,,,109.0000,1652.0000,fee schedule,"APG 00016 Proc 12016 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 105% = $274.68 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,109.0000,1652.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,109.0000,1652.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,109.0000,1652.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,269.71,,,,,,,109.0000,1652.0000,fee schedule,"APG 00016 Proc 12016 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 103.1% = $269.71 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,SENTARA HEALTH,SENTARA HEALTH,426.38,,,,,,,109.0000,1652.0000,percent of total billed charges,"25.81% of $1,652.00 in Billed Charges for Rev 450 Proc 12016 = $426.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,109.0000,1652.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1652.00,,,,,,,109.0000,1652.0000,percent of total billed charges,"100% of $1,652.00 in Billed Charges for Rev 450 Proc 12016 = $1,652.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1652.0000,case rate,Rev 450 Proc 12016 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1652.0000,case rate,Rev 450 Proc 12016 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1652.0000,case rate,Rev 450 Proc 12016 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1652.0000,case rate,Rev 450 Proc 12016 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,269.45,,,,,,,109.0000,1652.0000,fee schedule,"APG 00016 Proc 12016 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,1652.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,109.0000,1652.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,WELLCARE,WELLCARE MEDICAID,1652.00,,,,,,,109.0000,1652.0000,percent of total billed charges,"100% of $1,652.00 in Billed Charges for Rev 450 Proc 12016 = $1,652.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIM REP FACE MM 12.6-20,12016,CPT,450,RC,45000047,CDM,,,,both,,,1652.0000,247.8000,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,109.0000,1652.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CARTRIDGE NEEDLE INJECTOR II CAT01857,272,RC,,,,,,,,both,,,3246.6400,487.0000,AETNA,AETNA,1386.32,,,,,,,837.9600,3246.6400,percent of total billed charges,"42.7% of $3,246.64 in Billed Charges for Rev 272 = $1,386.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NEEDLE INJECTOR II CAT01857,272,RC,,,,,,,,both,,,3246.6400,487.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2272.65,,,,,,,837.9600,3246.6400,percent of total billed charges,"Rev 272 $3,246.64 in Billed Charges at 70% = $2,272.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NEEDLE INJECTOR II CAT01857,272,RC,,,,,,,,both,,,3246.6400,487.0000,CIGNA HEALTHCARE,CIGNA HMO,1353.85,,,,,,,837.9600,3246.6400,percent of total billed charges,"41.7% of $3,246.64 in Billed Charges for Rev 272 = $1,353.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NEEDLE INJECTOR II CAT01857,272,RC,,,,,,,,both,,,3246.6400,487.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1506.44,,,,,,,837.9600,3246.6400,percent of total billed charges,"46.4% of $3,246.64 in Billed Charges for Rev 272 = $1,506.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NEEDLE INJECTOR II CAT01857,272,RC,,,,,,,,both,,,3246.6400,487.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1353.85,,,,,,,837.9600,3246.6400,percent of total billed charges,"41.7% of $3,246.64 in Billed Charges for Rev 272 = $1,353.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NEEDLE INJECTOR II CAT01857,272,RC,,,,,,,,both,,,3246.6400,487.0000,CIGNA HEALTHCARE,CIGNA PPO,1353.85,,,,,,,837.9600,3246.6400,percent of total billed charges,"41.7% of $3,246.64 in Billed Charges for Rev 272 = $1,353.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NEEDLE INJECTOR II CAT01857,272,RC,,,,,,,,both,,,3246.6400,487.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2921.98,,,,,,,837.9600,3246.6400,percent of total billed charges,"90% of $3,246.64 in Billed Charges for Rev 272 = $2,921.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NEEDLE INJECTOR II CAT01857,272,RC,,,,,,,,both,,,3246.6400,487.0000,MEDCOST,MEDCOST VHN,1545.08,,,,,,,837.9600,3246.6400,percent of total billed charges,"47.59% of $3,246.64 in Billed Charges for Rev 272 = $1,545.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NEEDLE INJECTOR II CAT01857,272,RC,,,,,,,,both,,,3246.6400,487.0000,SENTARA HEALTH,SENTARA HEALTH,837.96,,,,,,,837.9600,3246.6400,percent of total billed charges,"25.81% of $3,246.64 in Billed Charges for Rev 272 = $837.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NEEDLE INJECTOR II CAT01857,272,RC,,,,,,,,both,,,3246.6400,487.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3246.64,,,,,,,837.9600,3246.6400,percent of total billed charges,"100% of $3,246.64 in Billed Charges for Rev 272 = $3,246.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NEEDLE INJECTOR II CAT01857,272,RC,,,,,,,,both,,,3246.6400,487.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1623.32,,,,,,,837.9600,3246.6400,percent of total billed charges,"Rev 272 $3,246.64 in Billed Charges at 50% = $1,623.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NEEDLE INJECTOR II CAT01857,272,RC,,,,,,,,both,,,3246.6400,487.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1048.66,,,,,,,837.9600,3246.6400,other,"32.3% of $3,246.64 in Billed Charges for Rev 272 = $1,048.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CARTRIDGE NEEDLE INJECTOR II CAT01857,272,RC,,,,,,,,both,,,3246.6400,487.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,996.72,,,,,,,837.9600,3246.6400,other,"30.7% of $3,246.64 in Billed Charges for Rev 272 = $996.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CARTRIDGE NEEDLE INJECTOR II CAT01857,272,RC,,,,,,,,both,,,3246.6400,487.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,1048.66,,,,,,,837.9600,3246.6400,percent of total billed charges,"32.3% of $3,246.64 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NEEDLE INJECTOR II CAT01857,272,RC,,,,,,,,both,,,3246.6400,487.0000,WELLCARE,WELLCARE MEDICAID,3246.64,,,,,,,837.9600,3246.6400,percent of total billed charges,"100% of $3,246.64 in Billed Charges for Rev 272 = $3,246.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NOVOSTITCH 2-0,272,RC,,,,,,,,both,,,5704.0500,855.6100,AETNA,AETNA,2435.63,,,,,,,1472.2200,5704.0500,percent of total billed charges,"42.7% of $5,704.05 in Billed Charges for Rev 272 = $2,435.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NOVOSTITCH 2-0,272,RC,,,,,,,,both,,,5704.0500,855.6100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3992.84,,,,,,,1472.2200,5704.0500,percent of total billed charges,"Rev 272 $5,704.05 in Billed Charges at 70% = $3,992.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NOVOSTITCH 2-0,272,RC,,,,,,,,both,,,5704.0500,855.6100,CIGNA HEALTHCARE,CIGNA HMO,2378.59,,,,,,,1472.2200,5704.0500,percent of total billed charges,"41.7% of $5,704.05 in Billed Charges for Rev 272 = $2,378.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NOVOSTITCH 2-0,272,RC,,,,,,,,both,,,5704.0500,855.6100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2646.68,,,,,,,1472.2200,5704.0500,percent of total billed charges,"46.4% of $5,704.05 in Billed Charges for Rev 272 = $2,646.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NOVOSTITCH 2-0,272,RC,,,,,,,,both,,,5704.0500,855.6100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2378.59,,,,,,,1472.2200,5704.0500,percent of total billed charges,"41.7% of $5,704.05 in Billed Charges for Rev 272 = $2,378.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NOVOSTITCH 2-0,272,RC,,,,,,,,both,,,5704.0500,855.6100,CIGNA HEALTHCARE,CIGNA PPO,2378.59,,,,,,,1472.2200,5704.0500,percent of total billed charges,"41.7% of $5,704.05 in Billed Charges for Rev 272 = $2,378.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NOVOSTITCH 2-0,272,RC,,,,,,,,both,,,5704.0500,855.6100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5133.65,,,,,,,1472.2200,5704.0500,percent of total billed charges,"90% of $5,704.05 in Billed Charges for Rev 272 = $5,133.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NOVOSTITCH 2-0,272,RC,,,,,,,,both,,,5704.0500,855.6100,MEDCOST,MEDCOST VHN,2714.56,,,,,,,1472.2200,5704.0500,percent of total billed charges,"47.59% of $5,704.05 in Billed Charges for Rev 272 = $2,714.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NOVOSTITCH 2-0,272,RC,,,,,,,,both,,,5704.0500,855.6100,SENTARA HEALTH,SENTARA HEALTH,1472.22,,,,,,,1472.2200,5704.0500,percent of total billed charges,"25.81% of $5,704.05 in Billed Charges for Rev 272 = $1,472.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NOVOSTITCH 2-0,272,RC,,,,,,,,both,,,5704.0500,855.6100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5704.05,,,,,,,1472.2200,5704.0500,percent of total billed charges,"100% of $5,704.05 in Billed Charges for Rev 272 = $5,704.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NOVOSTITCH 2-0,272,RC,,,,,,,,both,,,5704.0500,855.6100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2852.03,,,,,,,1472.2200,5704.0500,percent of total billed charges,"Rev 272 $5,704.05 in Billed Charges at 50% = $2,852.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NOVOSTITCH 2-0,272,RC,,,,,,,,both,,,5704.0500,855.6100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1842.41,,,,,,,1472.2200,5704.0500,other,"32.3% of $5,704.05 in Billed Charges for Rev 272 = $1,842.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CARTRIDGE NOVOSTITCH 2-0,272,RC,,,,,,,,both,,,5704.0500,855.6100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1751.14,,,,,,,1472.2200,5704.0500,other,"30.7% of $5,704.05 in Billed Charges for Rev 272 = $1,751.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CARTRIDGE NOVOSTITCH 2-0,272,RC,,,,,,,,both,,,5704.0500,855.6100,UNITED HEALTHCARE,UNITED HEALTHCARE,1842.41,,,,,,,1472.2200,5704.0500,percent of total billed charges,"32.3% of $5,704.05 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE NOVOSTITCH 2-0,272,RC,,,,,,,,both,,,5704.0500,855.6100,WELLCARE,WELLCARE MEDICAID,5704.05,,,,,,,1472.2200,5704.0500,percent of total billed charges,"100% of $5,704.05 in Billed Charges for Rev 272 = $5,704.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA,699.85,,,,,,,72.2000,1639.0000,percent of total billed charges,"42.7% of $1,639.00 in Billed Charges for Rev 450 Proc 12020 = $699.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,72.2000,1639.0000,fee schedule,"APG 00017 Proc 12020 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,670.54,,,,,,,72.2000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA HEALTHCARE MEDICARE,670.54,,,,,,,72.2000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,670.54,,,,,,,72.2000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,AMBETTER,AMBETTER,1461.78,,,,,,,72.2000,1639.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,697.36,,,,,,,72.2000,1639.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM EXCHANGE,1639.00,,,,,,,72.2000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,72.2000,1639.0000,fee schedule,"APG 00017 Proc 12020 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM HMO,1639.00,,,,,,,72.2000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,690.66,,,,,,,72.2000,1639.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1639.00,,,,,,,72.2000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,156.00,,,,,,,72.2000,1639.0000,fee schedule,$156.00 from Fee Schedule BLDTM_23 for Rev 450 Proc 12020 * Qty 1 = $156.00 at 100% = $156.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,BLUE CROSS MEDICARE,697.36,,,,,,,72.2000,1639.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,TENNCARE BLUE CARE,72.20,,,,,,,72.2000,1639.0000,fee schedule,$62.24 from Fee Schedule TC_24 for Rev 450 Proc 12020 * Qty 1 = $62.24 at 116% = $72.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,TENNCARE BLUE SELECT,72.20,,,,,,,72.2000,1639.0000,fee schedule,$62.24 from Fee Schedule TC_24 for Rev 450 Proc 12020 * Qty 1 = $62.24 at 116% = $72.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,704.07,,,,,,,72.2000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,704.07,,,,,,,72.2000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1475.10,,,,,,,72.2000,1639.0000,percent of total billed charges,"90% of $1,639.00 in Billed Charges for Rev 450 Proc 12020 = $1,475.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,HUMANA,HUMANA MEDICARE,670.54,,,,,,,72.2000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,670.54,,,,,,,72.2000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,MEDCOST,MEDCOST VHN,780.00,,,,,,,72.2000,1639.0000,percent of total billed charges,"47.59% of $1,639.00 in Billed Charges for Rev 450 Proc 12020 = $780.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,72.2000,1639.0000,fee schedule,"APG 00017 Proc 12020 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,704.07,,,,,,,72.2000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,704.07,,,,,,,72.2000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,NHC ADVANTAGE,NHC ADVANTAGE,704.07,,,,,,,72.2000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,72.2000,1639.0000,fee schedule,"APG 00017 Proc 12020 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,SENTARA HEALTH,SENTARA HEALTH,423.03,,,,,,,72.2000,1639.0000,percent of total billed charges,"25.81% of $1,639.00 in Billed Charges for Rev 450 Proc 12020 = $423.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,SENTARA HEALTH,SENTARA MEDICARE,670.54,,,,,,,72.2000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1639.00,,,,,,,72.2000,1639.0000,percent of total billed charges,"100% of $1,639.00 in Billed Charges for Rev 450 Proc 12020 = $1,639.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,72.2000,1639.0000,case rate,Rev 450 Proc 12020 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,72.2000,1639.0000,case rate,Rev 450 Proc 12020 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,72.2000,1639.0000,case rate,Rev 450 Proc 12020 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,72.2000,1639.0000,case rate,Rev 450 Proc 12020 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,72.2000,1639.0000,fee schedule,"APG 00017 Proc 12020 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,670.54,,,,,,,72.2000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,670.54,,,,,,,72.2000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,WELLCARE,WELLCARE MEDICAID,1639.00,,,,,,,72.2000,1639.0000,percent of total billed charges,"100% of $1,639.00 in Billed Charges for Rev 450 Proc 12020 = $1,639.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX SUP WOUND DEHIS SIM CLOSE,12020,CPT,450,RC,45000048,CDM,,,,both,,,1639.0000,245.8500,WELLCARE,WELLCARE MEDICARE,710.77,,,,,,,72.2000,1639.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,AETNA,AETNA,284.81,,,,,,,58.0700,804.0300,percent of total billed charges,42.7% of $667.00 in Billed Charges for Rev 450 Proc 12031 = $284.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,58.0700,804.0300,fee schedule,"APG 00017 Proc 12031 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,58.0700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,58.0700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,58.0700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,AMBETTER,AMBETTER,804.03,,,,,,,58.0700,804.0300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,58.0700,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,BLUE CROSS,ANTHEM EXCHANGE,667.00,,,,,,,58.0700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,58.0700,804.0300,fee schedule,"APG 00017 Proc 12031 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,BLUE CROSS,ANTHEM HMO,667.00,,,,,,,58.0700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,58.0700,804.0300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",667.00,,,,,,,58.0700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,116.37,,,,,,,58.0700,804.0300,fee schedule,$116.37 from Fee Schedule BLDTM_23 for Rev 450 Proc 12031 * Qty 1 = $116.37 at 100% = $116.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,58.0700,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,BLUE CROSS,TENNCARE BLUE CARE,58.07,,,,,,,58.0700,804.0300,fee schedule,$50.06 from Fee Schedule TC_24 for Rev 450 Proc 12031 * Qty 1 = $50.06 at 116% = $58.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,BLUE CROSS,TENNCARE BLUE SELECT,58.07,,,,,,,58.0700,804.0300,fee schedule,$50.06 from Fee Schedule TC_24 for Rev 450 Proc 12031 * Qty 1 = $50.06 at 116% = $58.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,58.0700,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,58.0700,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,600.30,,,,,,,58.0700,804.0300,percent of total billed charges,90% of $667.00 in Billed Charges for Rev 450 Proc 12031 = $600.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,58.0700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,58.0700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,MEDCOST,MEDCOST VHN,317.43,,,,,,,58.0700,804.0300,percent of total billed charges,47.59% of $667.00 in Billed Charges for Rev 450 Proc 12031 = $317.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,58.0700,804.0300,fee schedule,"APG 00017 Proc 12031 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,58.0700,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,58.0700,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,58.0700,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,58.0700,804.0300,fee schedule,"APG 00017 Proc 12031 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,SENTARA HEALTH,SENTARA HEALTH,172.15,,,,,,,58.0700,804.0300,percent of total billed charges,25.81% of $667.00 in Billed Charges for Rev 450 Proc 12031 = $172.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,58.0700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",667.00,,,,,,,58.0700,804.0300,percent of total billed charges,100% of $667.00 in Billed Charges for Rev 450 Proc 12031 = $667.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,58.0700,804.0300,case rate,Rev 450 Proc 12031 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,58.0700,804.0300,case rate,Rev 450 Proc 12031 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,58.0700,804.0300,case rate,Rev 450 Proc 12031 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,667.00,,,,,,,58.0700,804.0300,case rate,"Rev 450 Proc 12031 at Case Rate $847.00 (Service Line reduced to $667.00, claim capped at $667.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,58.0700,804.0300,fee schedule,"APG 00017 Proc 12031 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,58.0700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,58.0700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,WELLCARE,WELLCARE MEDICAID,667.00,,,,,,,58.0700,804.0300,percent of total billed charges,100% of $667.00 in Billed Charges for Rev 450 Proc 12031 = $667.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS SCLP TRUNK LESS 2.5,12031,CPT,450,RC,45000050,CDM,,,,both,,,667.0000,100.0500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,58.0700,804.0300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,AETNA,AETNA,367.65,,,,,,,109.0000,861.0000,percent of total billed charges,42.7% of $861.00 in Billed Charges for Rev 450 Proc 12032 = $367.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,109.0000,861.0000,fee schedule,"APG 00017 Proc 12032 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,109.0000,861.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,861.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,109.0000,861.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,AMBETTER,AMBETTER,804.03,,,,,,,109.0000,861.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,109.0000,861.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,BLUE CROSS,ANTHEM EXCHANGE,861.00,,,,,,,109.0000,861.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,109.0000,861.0000,fee schedule,"APG 00017 Proc 12032 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,BLUE CROSS,ANTHEM HMO,861.00,,,,,,,109.0000,861.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,109.0000,861.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",861.00,,,,,,,109.0000,861.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,145.89,,,,,,,109.0000,861.0000,fee schedule,$145.89 from Fee Schedule BLDTM_23 for Rev 450 Proc 12032 * Qty 1 = $145.89 at 100% = $145.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,109.0000,861.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,109.0000,861.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,109.0000,861.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,774.90,,,,,,,109.0000,861.0000,percent of total billed charges,90% of $861.00 in Billed Charges for Rev 450 Proc 12032 = $774.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,109.0000,861.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,109.0000,861.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,MEDCOST,MEDCOST VHN,409.75,,,,,,,109.0000,861.0000,percent of total billed charges,47.59% of $861.00 in Billed Charges for Rev 450 Proc 12032 = $409.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,109.0000,861.0000,fee schedule,"APG 00017 Proc 12032 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,109.0000,861.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,109.0000,861.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,109.0000,861.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,109.0000,861.0000,fee schedule,"APG 00017 Proc 12032 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,SENTARA HEALTH,SENTARA HEALTH,222.22,,,,,,,109.0000,861.0000,percent of total billed charges,25.81% of $861.00 in Billed Charges for Rev 450 Proc 12032 = $222.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,109.0000,861.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",861.00,,,,,,,109.0000,861.0000,percent of total billed charges,100% of $861.00 in Billed Charges for Rev 450 Proc 12032 = $861.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,861.0000,case rate,Rev 450 Proc 12032 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,861.0000,case rate,Rev 450 Proc 12032 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,861.0000,case rate,Rev 450 Proc 12032 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,861.0000,case rate,Rev 450 Proc 12032 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,109.0000,861.0000,fee schedule,"APG 00017 Proc 12032 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,861.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,109.0000,861.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,WELLCARE,WELLCARE MEDICAID,861.00,,,,,,,109.0000,861.0000,percent of total billed charges,100% of $861.00 in Billed Charges for Rev 450 Proc 12032 = $861.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTERMED SCLP TRUNK 2.6-7.5,12032,CPT,450,RC,45000051,CDM,,,,both,,,861.0000,129.1500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,109.0000,861.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,AETNA,AETNA,885.60,,,,,,,109.0000,2074.0000,percent of total billed charges,"42.7% of $2,074.00 in Billed Charges for Rev 450 Proc 12035 = $885.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,109.0000,2074.0000,fee schedule,"APG 00017 Proc 12035 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,109.0000,2074.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,2074.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,109.0000,2074.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,AMBETTER,AMBETTER,804.03,,,,,,,109.0000,2074.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,109.0000,2074.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,109.0000,2074.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,109.0000,2074.0000,fee schedule,"APG 00017 Proc 12035 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,109.0000,2074.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,109.0000,2074.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1134.94,,,,,,,109.0000,2074.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,211.63,,,,,,,109.0000,2074.0000,fee schedule,$211.63 from Fee Schedule BLDTM_23 for Rev 450 Proc 12035 * Qty 1 = $211.63 at 100% = $211.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,109.0000,2074.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,109.0000,2074.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,109.0000,2074.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1866.60,,,,,,,109.0000,2074.0000,percent of total billed charges,"90% of $2,074.00 in Billed Charges for Rev 450 Proc 12035 = $1,866.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,HUMANA,HUMANA MEDICARE,368.82,,,,,,,109.0000,2074.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,109.0000,2074.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,MEDCOST,MEDCOST VHN,987.02,,,,,,,109.0000,2074.0000,percent of total billed charges,"47.59% of $2,074.00 in Billed Charges for Rev 450 Proc 12035 = $987.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,109.0000,2074.0000,fee schedule,"APG 00017 Proc 12035 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,109.0000,2074.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,109.0000,2074.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,109.0000,2074.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,109.0000,2074.0000,fee schedule,"APG 00017 Proc 12035 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,SENTARA HEALTH,SENTARA HEALTH,535.30,,,,,,,109.0000,2074.0000,percent of total billed charges,"25.81% of $2,074.00 in Billed Charges for Rev 450 Proc 12035 = $535.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,109.0000,2074.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2074.00,,,,,,,109.0000,2074.0000,percent of total billed charges,"100% of $2,074.00 in Billed Charges for Rev 450 Proc 12035 = $2,074.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,2074.0000,case rate,Rev 450 Proc 12035 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,2074.0000,case rate,Rev 450 Proc 12035 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,2074.0000,case rate,Rev 450 Proc 12035 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,2074.0000,case rate,Rev 450 Proc 12035 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,109.0000,2074.0000,fee schedule,"APG 00017 Proc 12035 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,2074.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,109.0000,2074.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,WELLCARE,WELLCARE MEDICAID,2074.00,,,,,,,109.0000,2074.0000,percent of total billed charges,"100% of $2,074.00 in Billed Charges for Rev 450 Proc 12035 = $2,074.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTERMED SCLP TRUNK 12.6-20,12035,CPT,450,RC,45000053,CDM,,,,both,,,2074.0000,311.1000,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,109.0000,2074.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,AETNA,AETNA,918.05,,,,,,,109.0000,2150.0000,percent of total billed charges,"42.7% of $2,150.00 in Billed Charges for Rev 450 Proc 12036 = $918.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,109.0000,2150.0000,fee schedule,"APG 00017 Proc 12036 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,670.54,,,,,,,109.0000,2150.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,AETNA,AETNA HEALTHCARE MEDICARE,670.54,,,,,,,109.0000,2150.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,670.54,,,,,,,109.0000,2150.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,AMBETTER,AMBETTER,1461.78,,,,,,,109.0000,2150.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,697.36,,,,,,,109.0000,2150.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,BLUE CROSS,ANTHEM EXCHANGE,1650.91,,,,,,,109.0000,2150.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,109.0000,2150.0000,fee schedule,"APG 00017 Proc 12036 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,BLUE CROSS,ANTHEM HMO,1753.99,,,,,,,109.0000,2150.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,690.66,,,,,,,109.0000,2150.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2063.41,,,,,,,109.0000,2150.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,263.66,,,,,,,109.0000,2150.0000,fee schedule,$263.66 from Fee Schedule BLDTM_23 for Rev 450 Proc 12036 * Qty 1 = $263.66 at 100% = $263.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,BLUE CROSS,BLUE CROSS MEDICARE,697.36,,,,,,,109.0000,2150.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,704.07,,,,,,,109.0000,2150.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,704.07,,,,,,,109.0000,2150.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1935.00,,,,,,,109.0000,2150.0000,percent of total billed charges,"90% of $2,150.00 in Billed Charges for Rev 450 Proc 12036 = $1,935.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,HUMANA,HUMANA MEDICARE,670.54,,,,,,,109.0000,2150.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,670.54,,,,,,,109.0000,2150.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,MEDCOST,MEDCOST VHN,1023.19,,,,,,,109.0000,2150.0000,percent of total billed charges,"47.59% of $2,150.00 in Billed Charges for Rev 450 Proc 12036 = $1,023.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,109.0000,2150.0000,fee schedule,"APG 00017 Proc 12036 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,704.07,,,,,,,109.0000,2150.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,704.07,,,,,,,109.0000,2150.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,NHC ADVANTAGE,NHC ADVANTAGE,704.07,,,,,,,109.0000,2150.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,109.0000,2150.0000,fee schedule,"APG 00017 Proc 12036 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,SENTARA HEALTH,SENTARA HEALTH,554.92,,,,,,,109.0000,2150.0000,percent of total billed charges,"25.81% of $2,150.00 in Billed Charges for Rev 450 Proc 12036 = $554.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,SENTARA HEALTH,SENTARA MEDICARE,670.54,,,,,,,109.0000,2150.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2150.00,,,,,,,109.0000,2150.0000,percent of total billed charges,"100% of $2,150.00 in Billed Charges for Rev 450 Proc 12036 = $2,150.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,2150.0000,case rate,Rev 450 Proc 12036 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,2150.0000,case rate,Rev 450 Proc 12036 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,2150.0000,case rate,Rev 450 Proc 12036 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,2150.0000,case rate,Rev 450 Proc 12036 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,109.0000,2150.0000,fee schedule,"APG 00017 Proc 12036 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,670.54,,,,,,,109.0000,2150.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,670.54,,,,,,,109.0000,2150.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,WELLCARE,WELLCARE MEDICAID,2150.00,,,,,,,109.0000,2150.0000,percent of total billed charges,"100% of $2,150.00 in Billed Charges for Rev 450 Proc 12036 = $2,150.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTERMED SCLP TRUNK 20.1-30,12036,CPT,450,RC,45000054,CDM,,,,both,,,2150.0000,322.5000,WELLCARE,WELLCARE MEDICARE,710.77,,,,,,,109.0000,2150.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,AETNA,AETNA,388.57,,,,,,,109.0000,4080.8800,percent of total billed charges,42.7% of $910.00 in Billed Charges for Rev 450 Proc 12037 = $388.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,109.0000,4080.8800,fee schedule,"APG 00017 Proc 12037 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,910.00,,,,,,,109.0000,4080.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,AETNA,AETNA HEALTHCARE MEDICARE,910.00,,,,,,,109.0000,4080.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,910.00,,,,,,,109.0000,4080.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,AMBETTER,AMBETTER,4080.88,,,,,,,109.0000,4080.8800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,910.00,,,,,,,109.0000,4080.8800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,BLUE CROSS,ANTHEM EXCHANGE,910.00,,,,,,,109.0000,4080.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,109.0000,4080.8800,fee schedule,"APG 00017 Proc 12037 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,BLUE CROSS,ANTHEM HMO,910.00,,,,,,,109.0000,4080.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,910.00,,,,,,,109.0000,4080.8800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",910.00,,,,,,,109.0000,4080.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,314.56,,,,,,,109.0000,4080.8800,fee schedule,$314.56 from Fee Schedule BLDTM_23 for Rev 450 Proc 12037 * Qty 1 = $314.56 at 100% = $314.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,BLUE CROSS,BLUE CROSS MEDICARE,1946.84,,,,,,,109.0000,4080.8800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,910.00,,,,,,,109.0000,4080.8800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,910.00,,,,,,,109.0000,4080.8800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,819.00,,,,,,,109.0000,4080.8800,percent of total billed charges,90% of $910.00 in Billed Charges for Rev 450 Proc 12037 = $819.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,HUMANA,HUMANA MEDICARE,910.00,,,,,,,109.0000,4080.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,910.00,,,,,,,109.0000,4080.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,MEDCOST,MEDCOST VHN,433.07,,,,,,,109.0000,4080.8800,percent of total billed charges,47.59% of $910.00 in Billed Charges for Rev 450 Proc 12037 = $433.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,109.0000,4080.8800,fee schedule,"APG 00017 Proc 12037 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,910.00,,,,,,,109.0000,4080.8800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,910.00,,,,,,,109.0000,4080.8800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,NHC ADVANTAGE,NHC ADVANTAGE,910.00,,,,,,,109.0000,4080.8800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,109.0000,4080.8800,fee schedule,"APG 00017 Proc 12037 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,SENTARA HEALTH,SENTARA HEALTH,234.87,,,,,,,109.0000,4080.8800,percent of total billed charges,25.81% of $910.00 in Billed Charges for Rev 450 Proc 12037 = $234.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,SENTARA HEALTH,SENTARA MEDICARE,910.00,,,,,,,109.0000,4080.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",910.00,,,,,,,109.0000,4080.8800,percent of total billed charges,100% of $910.00 in Billed Charges for Rev 450 Proc 12037 = $910.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,4080.8800,case rate,Rev 450 Proc 12037 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,4080.8800,case rate,Rev 450 Proc 12037 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,4080.8800,case rate,Rev 450 Proc 12037 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,4080.8800,case rate,Rev 450 Proc 12037 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,109.0000,4080.8800,fee schedule,"APG 00017 Proc 12037 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,910.00,,,,,,,109.0000,4080.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,910.00,,,,,,,109.0000,4080.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,WELLCARE,WELLCARE MEDICAID,910.00,,,,,,,109.0000,4080.8800,percent of total billed charges,100% of $910.00 in Billed Charges for Rev 450 Proc 12037 = $910.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS WND EXCL H/F >30CM,12037,CPT,450,RC,45000309,CDM,,,,both,,,910.0000,136.5000,WELLCARE,WELLCARE MEDICARE,1984.28,,,,,,,109.0000,4080.8800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,AETNA,AETNA,318.97,,,,,,,61.2100,804.0300,percent of total billed charges,42.7% of $747.00 in Billed Charges for Rev 450 Proc 12041 = $318.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,61.2100,804.0300,fee schedule,"APG 00017 Proc 12041 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,61.2100,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,61.2100,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,61.2100,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,AMBETTER,AMBETTER,804.03,,,,,,,61.2100,804.0300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,61.2100,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,BLUE CROSS,ANTHEM EXCHANGE,747.00,,,,,,,61.2100,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,61.2100,804.0300,fee schedule,"APG 00017 Proc 12041 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,BLUE CROSS,ANTHEM HMO,747.00,,,,,,,61.2100,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,61.2100,804.0300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",747.00,,,,,,,61.2100,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,143.23,,,,,,,61.2100,804.0300,fee schedule,$143.23 from Fee Schedule BLDTM_23 for Rev 450 Proc 12041 * Qty 1 = $143.23 at 100% = $143.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,61.2100,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,BLUE CROSS,TENNCARE BLUE CARE,61.21,,,,,,,61.2100,804.0300,fee schedule,$52.77 from Fee Schedule TC_24 for Rev 450 Proc 12041 * Qty 1 = $52.77 at 116% = $61.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,BLUE CROSS,TENNCARE BLUE SELECT,61.21,,,,,,,61.2100,804.0300,fee schedule,$52.77 from Fee Schedule TC_24 for Rev 450 Proc 12041 * Qty 1 = $52.77 at 116% = $61.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,61.2100,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,61.2100,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,672.30,,,,,,,61.2100,804.0300,percent of total billed charges,90% of $747.00 in Billed Charges for Rev 450 Proc 12041 = $672.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,61.2100,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,61.2100,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,MEDCOST,MEDCOST VHN,355.50,,,,,,,61.2100,804.0300,percent of total billed charges,47.59% of $747.00 in Billed Charges for Rev 450 Proc 12041 = $355.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,61.2100,804.0300,fee schedule,"APG 00017 Proc 12041 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,61.2100,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,61.2100,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,61.2100,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,61.2100,804.0300,fee schedule,"APG 00017 Proc 12041 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,SENTARA HEALTH,SENTARA HEALTH,192.80,,,,,,,61.2100,804.0300,percent of total billed charges,25.81% of $747.00 in Billed Charges for Rev 450 Proc 12041 = $192.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,61.2100,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",747.00,,,,,,,61.2100,804.0300,percent of total billed charges,100% of $747.00 in Billed Charges for Rev 450 Proc 12041 = $747.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,61.2100,804.0300,case rate,Rev 450 Proc 12041 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,61.2100,804.0300,case rate,Rev 450 Proc 12041 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,61.2100,804.0300,case rate,Rev 450 Proc 12041 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,747.00,,,,,,,61.2100,804.0300,case rate,"Rev 450 Proc 12041 at Case Rate $847.00 (Service Line reduced to $747.00, claim capped at $747.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,61.2100,804.0300,fee schedule,"APG 00017 Proc 12041 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,61.2100,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,61.2100,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,WELLCARE,WELLCARE MEDICAID,747.00,,,,,,,61.2100,804.0300,percent of total billed charges,100% of $747.00 in Billed Charges for Rev 450 Proc 12041 = $747.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLS NECK FT GEN LESS 2.5,12041,CPT,450,RC,45000055,CDM,,,,both,,,747.0000,112.0500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,61.2100,804.0300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CASSETTE PHACO MICROSMOOTH BALANCED .09 45DEG  8065752918,272,RC,27200002,CDM,,,,,,both,,,4154.3100,623.1500,AETNA,AETNA,1773.89,,,,,,,1072.2300,4154.3100,percent of total billed charges,"42.7% of $4,154.31 in Billed Charges for Rev 272 = $1,773.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO MICROSMOOTH BALANCED .09 45DEG  8065752918,272,RC,27200002,CDM,,,,,,both,,,4154.3100,623.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2908.02,,,,,,,1072.2300,4154.3100,percent of total billed charges,"Rev 272 $4,154.31 in Billed Charges at 70% = $2,908.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO MICROSMOOTH BALANCED .09 45DEG  8065752918,272,RC,27200002,CDM,,,,,,both,,,4154.3100,623.1500,CIGNA HEALTHCARE,CIGNA HMO,1732.35,,,,,,,1072.2300,4154.3100,percent of total billed charges,"41.7% of $4,154.31 in Billed Charges for Rev 272 = $1,732.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO MICROSMOOTH BALANCED .09 45DEG  8065752918,272,RC,27200002,CDM,,,,,,both,,,4154.3100,623.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1927.60,,,,,,,1072.2300,4154.3100,percent of total billed charges,"46.4% of $4,154.31 in Billed Charges for Rev 272 = $1,927.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO MICROSMOOTH BALANCED .09 45DEG  8065752918,272,RC,27200002,CDM,,,,,,both,,,4154.3100,623.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1732.35,,,,,,,1072.2300,4154.3100,percent of total billed charges,"41.7% of $4,154.31 in Billed Charges for Rev 272 = $1,732.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO MICROSMOOTH BALANCED .09 45DEG  8065752918,272,RC,27200002,CDM,,,,,,both,,,4154.3100,623.1500,CIGNA HEALTHCARE,CIGNA PPO,1732.35,,,,,,,1072.2300,4154.3100,percent of total billed charges,"41.7% of $4,154.31 in Billed Charges for Rev 272 = $1,732.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO MICROSMOOTH BALANCED .09 45DEG  8065752918,272,RC,27200002,CDM,,,,,,both,,,4154.3100,623.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3738.88,,,,,,,1072.2300,4154.3100,percent of total billed charges,"90% of $4,154.31 in Billed Charges for Rev 272 = $3,738.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO MICROSMOOTH BALANCED .09 45DEG  8065752918,272,RC,27200002,CDM,,,,,,both,,,4154.3100,623.1500,MEDCOST,MEDCOST VHN,1977.04,,,,,,,1072.2300,4154.3100,percent of total billed charges,"47.59% of $4,154.31 in Billed Charges for Rev 272 = $1,977.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO MICROSMOOTH BALANCED .09 45DEG  8065752918,272,RC,27200002,CDM,,,,,,both,,,4154.3100,623.1500,SENTARA HEALTH,SENTARA HEALTH,1072.23,,,,,,,1072.2300,4154.3100,percent of total billed charges,"25.81% of $4,154.31 in Billed Charges for Rev 272 = $1,072.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO MICROSMOOTH BALANCED .09 45DEG  8065752918,272,RC,27200002,CDM,,,,,,both,,,4154.3100,623.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4154.31,,,,,,,1072.2300,4154.3100,percent of total billed charges,"100% of $4,154.31 in Billed Charges for Rev 272 = $4,154.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO MICROSMOOTH BALANCED .09 45DEG  8065752918,272,RC,27200002,CDM,,,,,,both,,,4154.3100,623.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2077.16,,,,,,,1072.2300,4154.3100,percent of total billed charges,"Rev 272 $4,154.31 in Billed Charges at 50% = $2,077.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO MICROSMOOTH BALANCED .09 45DEG  8065752918,272,RC,27200002,CDM,,,,,,both,,,4154.3100,623.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1341.84,,,,,,,1072.2300,4154.3100,other,"32.3% of $4,154.31 in Billed Charges for Rev 272 = $1,341.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CASSETTE PHACO MICROSMOOTH BALANCED .09 45DEG  8065752918,272,RC,27200002,CDM,,,,,,both,,,4154.3100,623.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1275.37,,,,,,,1072.2300,4154.3100,other,"30.7% of $4,154.31 in Billed Charges for Rev 272 = $1,275.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CASSETTE PHACO MICROSMOOTH BALANCED .09 45DEG  8065752918,272,RC,27200002,CDM,,,,,,both,,,4154.3100,623.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,1341.84,,,,,,,1072.2300,4154.3100,percent of total billed charges,"32.3% of $4,154.31 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO MICROSMOOTH BALANCED .09 45DEG  8065752918,272,RC,27200002,CDM,,,,,,both,,,4154.3100,623.1500,WELLCARE,WELLCARE MEDICAID,4154.31,,,,,,,1072.2300,4154.3100,percent of total billed charges,"100% of $4,154.31 in Billed Charges for Rev 272 = $4,154.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP SMALL COMBINATION 390.041,272,RC,27200002,CDM,,,,,,both,,,3050.8400,457.6300,AETNA,AETNA,1302.71,,,,,,,787.4200,3050.8400,percent of total billed charges,"42.7% of $3,050.84 in Billed Charges for Rev 272 = $1,302.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP SMALL COMBINATION 390.041,272,RC,27200002,CDM,,,,,,both,,,3050.8400,457.6300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2135.59,,,,,,,787.4200,3050.8400,percent of total billed charges,"Rev 272 $3,050.84 in Billed Charges at 70% = $2,135.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP SMALL COMBINATION 390.041,272,RC,27200002,CDM,,,,,,both,,,3050.8400,457.6300,CIGNA HEALTHCARE,CIGNA HMO,1272.20,,,,,,,787.4200,3050.8400,percent of total billed charges,"41.7% of $3,050.84 in Billed Charges for Rev 272 = $1,272.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP SMALL COMBINATION 390.041,272,RC,27200002,CDM,,,,,,both,,,3050.8400,457.6300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1415.59,,,,,,,787.4200,3050.8400,percent of total billed charges,"46.4% of $3,050.84 in Billed Charges for Rev 272 = $1,415.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP SMALL COMBINATION 390.041,272,RC,27200002,CDM,,,,,,both,,,3050.8400,457.6300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1272.20,,,,,,,787.4200,3050.8400,percent of total billed charges,"41.7% of $3,050.84 in Billed Charges for Rev 272 = $1,272.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP SMALL COMBINATION 390.041,272,RC,27200002,CDM,,,,,,both,,,3050.8400,457.6300,CIGNA HEALTHCARE,CIGNA PPO,1272.20,,,,,,,787.4200,3050.8400,percent of total billed charges,"41.7% of $3,050.84 in Billed Charges for Rev 272 = $1,272.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP SMALL COMBINATION 390.041,272,RC,27200002,CDM,,,,,,both,,,3050.8400,457.6300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2745.76,,,,,,,787.4200,3050.8400,percent of total billed charges,"90% of $3,050.84 in Billed Charges for Rev 272 = $2,745.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP SMALL COMBINATION 390.041,272,RC,27200002,CDM,,,,,,both,,,3050.8400,457.6300,MEDCOST,MEDCOST VHN,1451.89,,,,,,,787.4200,3050.8400,percent of total billed charges,"47.59% of $3,050.84 in Billed Charges for Rev 272 = $1,451.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP SMALL COMBINATION 390.041,272,RC,27200002,CDM,,,,,,both,,,3050.8400,457.6300,SENTARA HEALTH,SENTARA HEALTH,787.42,,,,,,,787.4200,3050.8400,percent of total billed charges,"25.81% of $3,050.84 in Billed Charges for Rev 272 = $787.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP SMALL COMBINATION 390.041,272,RC,27200002,CDM,,,,,,both,,,3050.8400,457.6300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3050.84,,,,,,,787.4200,3050.8400,percent of total billed charges,"100% of $3,050.84 in Billed Charges for Rev 272 = $3,050.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP SMALL COMBINATION 390.041,272,RC,27200002,CDM,,,,,,both,,,3050.8400,457.6300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1525.42,,,,,,,787.4200,3050.8400,percent of total billed charges,"Rev 272 $3,050.84 in Billed Charges at 50% = $1,525.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP SMALL COMBINATION 390.041,272,RC,27200002,CDM,,,,,,both,,,3050.8400,457.6300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,985.42,,,,,,,787.4200,3050.8400,other,"32.3% of $3,050.84 in Billed Charges for Rev 272 = $985.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP SMALL COMBINATION 390.041,272,RC,27200002,CDM,,,,,,both,,,3050.8400,457.6300,UNITED HEALTHCARE,UHC HERITAGE SELECT,936.61,,,,,,,787.4200,3050.8400,other,"30.7% of $3,050.84 in Billed Charges for Rev 272 = $936.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP SMALL COMBINATION 390.041,272,RC,27200002,CDM,,,,,,both,,,3050.8400,457.6300,UNITED HEALTHCARE,UNITED HEALTHCARE,985.42,,,,,,,787.4200,3050.8400,percent of total billed charges,"32.3% of $3,050.84 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP SMALL COMBINATION 390.041,272,RC,27200002,CDM,,,,,,both,,,3050.8400,457.6300,WELLCARE,WELLCARE MEDICAID,3050.84,,,,,,,787.4200,3050.8400,percent of total billed charges,"100% of $3,050.84 in Billed Charges for Rev 272 = $3,050.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER FILSHIE PESSARY 7MM DUAL INCISION SINGLE-USE AVM-951,272,RC,27200002,CDM,,,,,,both,,,3305.0300,495.7500,AETNA,AETNA,1411.25,,,,,,,853.0300,3305.0300,percent of total billed charges,"42.7% of $3,305.03 in Billed Charges for Rev 272 = $1,411.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER FILSHIE PESSARY 7MM DUAL INCISION SINGLE-USE AVM-951,272,RC,27200002,CDM,,,,,,both,,,3305.0300,495.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2313.52,,,,,,,853.0300,3305.0300,percent of total billed charges,"Rev 272 $3,305.03 in Billed Charges at 70% = $2,313.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER FILSHIE PESSARY 7MM DUAL INCISION SINGLE-USE AVM-951,272,RC,27200002,CDM,,,,,,both,,,3305.0300,495.7500,CIGNA HEALTHCARE,CIGNA HMO,1378.20,,,,,,,853.0300,3305.0300,percent of total billed charges,"41.7% of $3,305.03 in Billed Charges for Rev 272 = $1,378.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER FILSHIE PESSARY 7MM DUAL INCISION SINGLE-USE AVM-951,272,RC,27200002,CDM,,,,,,both,,,3305.0300,495.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1533.53,,,,,,,853.0300,3305.0300,percent of total billed charges,"46.4% of $3,305.03 in Billed Charges for Rev 272 = $1,533.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER FILSHIE PESSARY 7MM DUAL INCISION SINGLE-USE AVM-951,272,RC,27200002,CDM,,,,,,both,,,3305.0300,495.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1378.20,,,,,,,853.0300,3305.0300,percent of total billed charges,"41.7% of $3,305.03 in Billed Charges for Rev 272 = $1,378.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER FILSHIE PESSARY 7MM DUAL INCISION SINGLE-USE AVM-951,272,RC,27200002,CDM,,,,,,both,,,3305.0300,495.7500,CIGNA HEALTHCARE,CIGNA PPO,1378.20,,,,,,,853.0300,3305.0300,percent of total billed charges,"41.7% of $3,305.03 in Billed Charges for Rev 272 = $1,378.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER FILSHIE PESSARY 7MM DUAL INCISION SINGLE-USE AVM-951,272,RC,27200002,CDM,,,,,,both,,,3305.0300,495.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2974.53,,,,,,,853.0300,3305.0300,percent of total billed charges,"90% of $3,305.03 in Billed Charges for Rev 272 = $2,974.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER FILSHIE PESSARY 7MM DUAL INCISION SINGLE-USE AVM-951,272,RC,27200002,CDM,,,,,,both,,,3305.0300,495.7500,MEDCOST,MEDCOST VHN,1572.86,,,,,,,853.0300,3305.0300,percent of total billed charges,"47.59% of $3,305.03 in Billed Charges for Rev 272 = $1,572.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER FILSHIE PESSARY 7MM DUAL INCISION SINGLE-USE AVM-951,272,RC,27200002,CDM,,,,,,both,,,3305.0300,495.7500,SENTARA HEALTH,SENTARA HEALTH,853.03,,,,,,,853.0300,3305.0300,percent of total billed charges,"25.81% of $3,305.03 in Billed Charges for Rev 272 = $853.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER FILSHIE PESSARY 7MM DUAL INCISION SINGLE-USE AVM-951,272,RC,27200002,CDM,,,,,,both,,,3305.0300,495.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3305.03,,,,,,,853.0300,3305.0300,percent of total billed charges,"100% of $3,305.03 in Billed Charges for Rev 272 = $3,305.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER FILSHIE PESSARY 7MM DUAL INCISION SINGLE-USE AVM-951,272,RC,27200002,CDM,,,,,,both,,,3305.0300,495.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1652.52,,,,,,,853.0300,3305.0300,percent of total billed charges,"Rev 272 $3,305.03 in Billed Charges at 50% = $1,652.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER FILSHIE PESSARY 7MM DUAL INCISION SINGLE-USE AVM-951,272,RC,27200002,CDM,,,,,,both,,,3305.0300,495.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1067.52,,,,,,,853.0300,3305.0300,other,"32.3% of $3,305.03 in Billed Charges for Rev 272 = $1,067.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLIP APPLIER FILSHIE PESSARY 7MM DUAL INCISION SINGLE-USE AVM-951,272,RC,27200002,CDM,,,,,,both,,,3305.0300,495.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1014.64,,,,,,,853.0300,3305.0300,other,"30.7% of $3,305.03 in Billed Charges for Rev 272 = $1,014.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLIP APPLIER FILSHIE PESSARY 7MM DUAL INCISION SINGLE-USE AVM-951,272,RC,27200002,CDM,,,,,,both,,,3305.0300,495.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,1067.52,,,,,,,853.0300,3305.0300,percent of total billed charges,"32.3% of $3,305.03 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER FILSHIE PESSARY 7MM DUAL INCISION SINGLE-USE AVM-951,272,RC,27200002,CDM,,,,,,both,,,3305.0300,495.7500,WELLCARE,WELLCARE MEDICAID,3305.03,,,,,,,853.0300,3305.0300,percent of total billed charges,"100% of $3,305.03 in Billed Charges for Rev 272 = $3,305.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,AETNA,AETNA,429.56,,,,,,,109.0000,1006.0000,percent of total billed charges,"42.7% of $1,006.00 in Billed Charges for Rev 450 Proc 12042 = $429.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,109.0000,1006.0000,fee schedule,"APG 00017 Proc 12042 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,109.0000,1006.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,1006.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,109.0000,1006.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,AMBETTER,AMBETTER,804.03,,,,,,,109.0000,1006.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,109.0000,1006.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,109.0000,1006.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,109.0000,1006.0000,fee schedule,"APG 00017 Proc 12042 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,109.0000,1006.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,109.0000,1006.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1006.00,,,,,,,109.0000,1006.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,173.66,,,,,,,109.0000,1006.0000,fee schedule,$173.66 from Fee Schedule BLDTM_23 for Rev 450 Proc 12042 * Qty 1 = $173.66 at 100% = $173.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,109.0000,1006.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,109.0000,1006.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,109.0000,1006.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,905.40,,,,,,,109.0000,1006.0000,percent of total billed charges,"90% of $1,006.00 in Billed Charges for Rev 450 Proc 12042 = $905.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,HUMANA,HUMANA MEDICARE,368.82,,,,,,,109.0000,1006.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,109.0000,1006.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,MEDCOST,MEDCOST VHN,478.76,,,,,,,109.0000,1006.0000,percent of total billed charges,"47.59% of $1,006.00 in Billed Charges for Rev 450 Proc 12042 = $478.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,109.0000,1006.0000,fee schedule,"APG 00017 Proc 12042 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,109.0000,1006.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,109.0000,1006.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,109.0000,1006.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,109.0000,1006.0000,fee schedule,"APG 00017 Proc 12042 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,SENTARA HEALTH,SENTARA HEALTH,259.65,,,,,,,109.0000,1006.0000,percent of total billed charges,"25.81% of $1,006.00 in Billed Charges for Rev 450 Proc 12042 = $259.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,109.0000,1006.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1006.00,,,,,,,109.0000,1006.0000,percent of total billed charges,"100% of $1,006.00 in Billed Charges for Rev 450 Proc 12042 = $1,006.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1006.0000,case rate,Rev 450 Proc 12042 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1006.0000,case rate,Rev 450 Proc 12042 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1006.0000,case rate,Rev 450 Proc 12042 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1006.0000,case rate,Rev 450 Proc 12042 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,109.0000,1006.0000,fee schedule,"APG 00017 Proc 12042 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,1006.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,109.0000,1006.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,WELLCARE,WELLCARE MEDICAID,1006.00,,,,,,,109.0000,1006.0000,percent of total billed charges,"100% of $1,006.00 in Billed Charges for Rev 450 Proc 12042 = $1,006.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS NECK GEN 2.6-7.5,12042,CPT,450,RC,45000056,CDM,,,,both,,,1006.0000,150.9000,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,109.0000,1006.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,AETNA,AETNA,1139.24,,,,,,,47.0800,3459.2600,percent of total billed charges,"42.7% of $2,668.00 in Billed Charges for Rev 510 Proc 20670 = $1,139.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3426.31,,,,,,,47.0800,3459.2600,fee schedule,"APG 00054 Proc 20670 at $836.60 (Base Rate) * 3.938 (Relative Weight) = $3,294.53 (Total Line Payment) at 104% = $3,426.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,47.0800,3459.2600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,47.0800,3459.2600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,47.0800,3459.2600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,AMBETTER,AMBETTER,3266.63,,,,,,,47.0800,3459.2600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,47.0800,3459.2600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,BLUE CROSS,ANTHEM EXCHANGE,2668.00,,,,,,,47.0800,3459.2600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2668.00,,,,,,,47.0800,3459.2600,fee schedule,"APG 00054 Proc 20670 at $836.60 (Base Rate) * 3.938 (Relative Weight) = $3,294.53 (Total Line Payment) at 103% = $3,393.37 (Service Line reduced to $2,668.00, claim capped at $2,668.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,BLUE CROSS,ANTHEM HMO,2668.00,,,,,,,47.0800,3459.2600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,47.0800,3459.2600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2668.00,,,,,,,47.0800,3459.2600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,111.55,,,,,,,47.0800,3459.2600,fee schedule,$111.55 from Fee Schedule BLDTM_23 for Rev 510 Proc 20670 * Qty 1 = $111.55 at 100% = $111.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,47.0800,3459.2600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,BLUE CROSS,TENNCARE BLUE CARE,47.08,,,,,,,47.0800,3459.2600,fee schedule,$40.59 from Fee Schedule TC_24 for Rev 510 Proc 20670 * Qty 1 = $40.59 at 116% = $47.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,BLUE CROSS,TENNCARE BLUE SELECT,47.08,,,,,,,47.0800,3459.2600,fee schedule,$40.59 from Fee Schedule TC_24 for Rev 510 Proc 20670 * Qty 1 = $40.59 at 116% = $47.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,CIGNA HEALTHCARE,CIGNA HMO,1112.56,,,,,,,47.0800,3459.2600,percent of total billed charges,"41.7% of $2,668.00 in Billed Charges for Rev 510 Proc 20670 = $1,112.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1237.95,,,,,,,47.0800,3459.2600,percent of total billed charges,"46.4% of $2,668.00 in Billed Charges for Rev 510 Proc 20670 = $1,237.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,47.0800,3459.2600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1112.56,,,,,,,47.0800,3459.2600,percent of total billed charges,"41.7% of $2,668.00 in Billed Charges for Rev 510 Proc 20670 = $1,112.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,CIGNA HEALTHCARE,CIGNA PPO,1112.56,,,,,,,47.0800,3459.2600,percent of total billed charges,"41.7% of $2,668.00 in Billed Charges for Rev 510 Proc 20670 = $1,112.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,47.0800,3459.2600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2401.20,,,,,,,47.0800,3459.2600,percent of total billed charges,"90% of $2,668.00 in Billed Charges for Rev 510 Proc 20670 = $2,401.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,47.0800,3459.2600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,47.0800,3459.2600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,MEDCOST,MEDCOST VHN,1269.70,,,,,,,47.0800,3459.2600,percent of total billed charges,"47.59% of $2,668.00 in Billed Charges for Rev 510 Proc 20670 = $1,269.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3459.26,,,,,,,47.0800,3459.2600,fee schedule,"APG 00054 Proc 20670 at $836.60 (Base Rate) * 3.938 (Relative Weight) = $3,294.53 (Total Line Payment) at 100% = $3,294.53... $3,294.53 at 105% = $3,459.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,47.0800,3459.2600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,47.0800,3459.2600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,47.0800,3459.2600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3396.66,,,,,,,47.0800,3459.2600,fee schedule,"APG 00054 Proc 20670 at $836.60 (Base Rate) * 3.938 (Relative Weight) = $3,294.53 (Total Line Payment) at 100% = $3,294.53... $3,294.53 at 103.1% = $3,396.66 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,SENTARA HEALTH,SENTARA HEALTH,688.61,,,,,,,47.0800,3459.2600,percent of total billed charges,"25.81% of $2,668.00 in Billed Charges for Rev 510 Proc 20670 = $688.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,47.0800,3459.2600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2668.00,,,,,,,47.0800,3459.2600,percent of total billed charges,"100% of $2,668.00 in Billed Charges for Rev 510 Proc 20670 = $2,668.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,670.71,,,,,,,47.0800,3459.2600,fee schedule,"$1,341.41 from Fee Schedule TCUHC24 for Rev 510 Proc 20670 * Qty 1 = $1,341.41 at 50% = $670.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,861.76,,,,,,,47.0800,3459.2600,other,"32.3% of $2,668.00 in Billed Charges for Rev 510 Proc 20670 = $861.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,819.08,,,,,,,47.0800,3459.2600,other,"30.7% of $2,668.00 in Billed Charges for Rev 510 Proc 20670 = $819.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,861.76,,,,,,,47.0800,3459.2600,percent of total billed charges,"32.3% of $2,668.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3393.37,,,,,,,47.0800,3459.2600,fee schedule,"APG 00054 Proc 20670 at $836.60 (Base Rate) * 3.938 (Relative Weight) = $3,294.53 (Total Line Payment) at 103% = $3,393.37. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,47.0800,3459.2600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,47.0800,3459.2600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,WELLCARE,WELLCARE MEDICAID,2668.00,,,,,,,47.0800,3459.2600,percent of total billed charges,"100% of $2,668.00 in Billed Charges for Rev 510 Proc 20670 = $2,668.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL OF SUPERFICIAL IMPLANT,20670,CPT,510,RC,51000045,CDM,,,,both,,,2668.0000,400.2000,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,47.0800,3459.2600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,AETNA,AETNA,908.66,,,,,,,45.5200,2128.0000,percent of total billed charges,"42.7% of $2,128.00 in Billed Charges for Rev 450 Proc 20950 = $908.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,250.14,,,,,,,45.5200,2128.0000,fee schedule,"APG 02030 Proc 20950 at $836.60 (Base Rate) * 0.2875 (Relative Weight) = $240.52 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.52 at 104% = $250.14. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,45.5200,2128.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,45.5200,2128.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,45.5200,2128.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,AMBETTER,AMBETTER,1400.59,,,,,,,45.5200,2128.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,45.5200,2128.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,45.5200,2128.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.74,,,,,,,45.5200,2128.0000,fee schedule,"APG 02030 Proc 20950 at $836.60 (Base Rate) * 0.2875 (Relative Weight) = $240.52 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.52 at 103% = $247.74. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,45.5200,2128.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,45.5200,2128.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1977.02,,,,,,,45.5200,2128.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,84.58,,,,,,,45.5200,2128.0000,fee schedule,$84.58 from Fee Schedule BLDTM_23 for Rev 450 Proc 20950 * Qty 1 = $84.58 at 100% = $84.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,45.5200,2128.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,TENNCARE BLUE CARE,45.52,,,,,,,45.5200,2128.0000,fee schedule,$39.24 from Fee Schedule TC_24 for Rev 450 Proc 20950 * Qty 1 = $39.24 at 116% = $45.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,TENNCARE BLUE SELECT,45.52,,,,,,,45.5200,2128.0000,fee schedule,$39.24 from Fee Schedule TC_24 for Rev 450 Proc 20950 * Qty 1 = $39.24 at 116% = $45.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,45.5200,2128.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,45.5200,2128.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1915.20,,,,,,,45.5200,2128.0000,percent of total billed charges,"90% of $2,128.00 in Billed Charges for Rev 450 Proc 20950 = $1,915.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,HUMANA,HUMANA MEDICARE,642.47,,,,,,,45.5200,2128.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,45.5200,2128.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,MEDCOST,MEDCOST VHN,1012.72,,,,,,,45.5200,2128.0000,percent of total billed charges,"47.59% of $2,128.00 in Billed Charges for Rev 450 Proc 20950 = $1,012.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.55,,,,,,,45.5200,2128.0000,fee schedule,"APG 02030 Proc 20950 at $836.60 (Base Rate) * 0.2875 (Relative Weight) = $240.52 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.52 at 100% = $240.52... $240.52 at 105% = $252.55 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,45.5200,2128.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,45.5200,2128.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,45.5200,2128.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.98,,,,,,,45.5200,2128.0000,fee schedule,"APG 02030 Proc 20950 at $836.60 (Base Rate) * 0.2875 (Relative Weight) = $240.52 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.52 at 100% = $240.52... $240.52 at 103.1% = $247.98 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,SENTARA HEALTH,SENTARA HEALTH,549.24,,,,,,,45.5200,2128.0000,percent of total billed charges,"25.81% of $2,128.00 in Billed Charges for Rev 450 Proc 20950 = $549.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,45.5200,2128.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2128.00,,,,,,,45.5200,2128.0000,percent of total billed charges,"100% of $2,128.00 in Billed Charges for Rev 450 Proc 20950 = $2,128.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,45.5200,2128.0000,case rate,Rev 450 Proc 20950 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,45.5200,2128.0000,case rate,Rev 450 Proc 20950 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,45.5200,2128.0000,case rate,Rev 450 Proc 20950 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,45.5200,2128.0000,case rate,Rev 450 Proc 20950 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.74,,,,,,,45.5200,2128.0000,fee schedule,"APG 02030 Proc 20950 at $836.60 (Base Rate) * 0.2875 (Relative Weight) = $240.52 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.52 at 103% = $247.74. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,45.5200,2128.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,45.5200,2128.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,WELLCARE,WELLCARE MEDICAID,2128.00,,,,,,,45.5200,2128.0000,percent of total billed charges,"100% of $2,128.00 in Billed Charges for Rev 450 Proc 20950 = $2,128.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MNTR INTERSTITIAL FLD PRESSURE CMPRT SYND,20950,CPT,450,RC,45000360,CDM,,,,both,,,2128.0000,319.2000,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,45.5200,2128.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA,808.31,,,,,,,109.0000,6557.5100,percent of total billed charges,"42.7% of $1,893.00 in Billed Charges for Rev 450 Proc 21320 = $808.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,6557.5100,fee schedule,APG 00041 Proc 21320 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1893.00,,,,,,,109.0000,6557.5100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA HEALTHCARE MEDICARE,1893.00,,,,,,,109.0000,6557.5100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,1893.00,,,,,,,109.0000,6557.5100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,AMBETTER,AMBETTER,6557.51,,,,,,,109.0000,6557.5100,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1893.00,,,,,,,109.0000,6557.5100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM EXCHANGE,1893.00,,,,,,,109.0000,6557.5100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,6557.5100,fee schedule,APG 00041 Proc 21320 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM HMO,1893.00,,,,,,,109.0000,6557.5100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1893.00,,,,,,,109.0000,6557.5100,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1893.00,,,,,,,109.0000,6557.5100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,269.51,,,,,,,109.0000,6557.5100,fee schedule,$269.51 from Fee Schedule BLDTM_23 for Rev 450 Proc 21320 * Qty 1 = $269.51 at 100% = $269.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,BLUE CROSS MEDICARE,3128.35,,,,,,,109.0000,6557.5100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,1893.00,,,,,,,109.0000,6557.5100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1893.00,,,,,,,109.0000,6557.5100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1703.70,,,,,,,109.0000,6557.5100,percent of total billed charges,"90% of $1,893.00 in Billed Charges for Rev 450 Proc 21320 = $1,703.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,HUMANA,HUMANA MEDICARE,1893.00,,,,,,,109.0000,6557.5100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1893.00,,,,,,,109.0000,6557.5100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,MEDCOST,MEDCOST VHN,900.88,,,,,,,109.0000,6557.5100,percent of total billed charges,"47.59% of $1,893.00 in Billed Charges for Rev 450 Proc 21320 = $900.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,6557.5100,fee schedule,APG 00041 Proc 21320 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1893.00,,,,,,,109.0000,6557.5100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1893.00,,,,,,,109.0000,6557.5100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,NHC ADVANTAGE,NHC ADVANTAGE,1893.00,,,,,,,109.0000,6557.5100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,6557.5100,fee schedule,APG 00041 Proc 21320 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,SENTARA HEALTH,SENTARA HEALTH,488.58,,,,,,,109.0000,6557.5100,percent of total billed charges,"25.81% of $1,893.00 in Billed Charges for Rev 450 Proc 21320 = $488.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,SENTARA HEALTH,SENTARA MEDICARE,1893.00,,,,,,,109.0000,6557.5100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1893.00,,,,,,,109.0000,6557.5100,percent of total billed charges,"100% of $1,893.00 in Billed Charges for Rev 450 Proc 21320 = $1,893.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,6557.5100,case rate,Rev 450 Proc 21320 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,6557.5100,case rate,Rev 450 Proc 21320 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,6557.5100,case rate,Rev 450 Proc 21320 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,6557.5100,case rate,Rev 450 Proc 21320 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,6557.5100,fee schedule,APG 00041 Proc 21320 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1893.00,,,,,,,109.0000,6557.5100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1893.00,,,,,,,109.0000,6557.5100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,WELLCARE,WELLCARE MEDICAID,1893.00,,,,,,,109.0000,6557.5100,percent of total billed charges,"100% of $1,893.00 in Billed Charges for Rev 450 Proc 21320 = $1,893.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX NASL BONE FX W STAB,21320,CPT,450,RC,45000098,CDM,,,,both,,,1893.0000,283.9500,WELLCARE,WELLCARE MEDICARE,3188.51,,,,,,,109.0000,6557.5100,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,AETNA,AETNA,3498.84,,,,,,,109.0000,8194.0000,percent of total billed charges,"42.7% of $8,194.00 in Billed Charges for Rev 450 Proc 21337 = $3,498.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,8194.0000,fee schedule,APG 00041 Proc 21337 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3008.03,,,,,,,109.0000,8194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,AETNA,AETNA HEALTHCARE MEDICARE,3008.03,,,,,,,109.0000,8194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,3008.03,,,,,,,109.0000,8194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,AMBETTER,AMBETTER,6557.51,,,,,,,109.0000,8194.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3128.35,,,,,,,109.0000,8194.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,BLUE CROSS,ANTHEM EXCHANGE,7405.94,,,,,,,109.0000,8194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,8194.0000,fee schedule,APG 00041 Proc 21337 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,BLUE CROSS,ANTHEM HMO,7868.37,,,,,,,109.0000,8194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3098.27,,,,,,,109.0000,8194.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8194.00,,,,,,,109.0000,8194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,253.90,,,,,,,109.0000,8194.0000,fee schedule,$253.90 from Fee Schedule BLDTM_23 for Rev 450 Proc 21337 * Qty 1 = $253.90 at 100% = $253.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,BLUE CROSS,BLUE CROSS MEDICARE,3128.35,,,,,,,109.0000,8194.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,3158.43,,,,,,,109.0000,8194.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3158.43,,,,,,,109.0000,8194.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7374.60,,,,,,,109.0000,8194.0000,percent of total billed charges,"90% of $8,194.00 in Billed Charges for Rev 450 Proc 21337 = $7,374.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,HUMANA,HUMANA MEDICARE,3008.03,,,,,,,109.0000,8194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3008.03,,,,,,,109.0000,8194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,MEDCOST,MEDCOST VHN,3899.52,,,,,,,109.0000,8194.0000,percent of total billed charges,"47.59% of $8,194.00 in Billed Charges for Rev 450 Proc 21337 = $3,899.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,8194.0000,fee schedule,APG 00041 Proc 21337 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3158.43,,,,,,,109.0000,8194.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3158.43,,,,,,,109.0000,8194.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,NHC ADVANTAGE,NHC ADVANTAGE,3158.43,,,,,,,109.0000,8194.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,8194.0000,fee schedule,APG 00041 Proc 21337 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,SENTARA HEALTH,SENTARA HEALTH,2114.87,,,,,,,109.0000,8194.0000,percent of total billed charges,"25.81% of $8,194.00 in Billed Charges for Rev 450 Proc 21337 = $2,114.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,SENTARA HEALTH,SENTARA MEDICARE,3008.03,,,,,,,109.0000,8194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8194.00,,,,,,,109.0000,8194.0000,percent of total billed charges,"100% of $8,194.00 in Billed Charges for Rev 450 Proc 21337 = $8,194.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,8194.0000,case rate,Rev 450 Proc 21337 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,8194.0000,case rate,Rev 450 Proc 21337 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,8194.0000,case rate,Rev 450 Proc 21337 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,8194.0000,case rate,Rev 450 Proc 21337 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,8194.0000,fee schedule,APG 00041 Proc 21337 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3008.03,,,,,,,109.0000,8194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3008.03,,,,,,,109.0000,8194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,WELLCARE,WELLCARE MEDICAID,8194.00,,,,,,,109.0000,8194.0000,percent of total billed charges,"100% of $8,194.00 in Billed Charges for Rev 450 Proc 21337 = $8,194.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX NASAL SPTL FX W/WO STAB,21337,CPT,450,RC,45000361,CDM,,,,both,,,8194.0000,1229.1000,WELLCARE,WELLCARE MEDICARE,3188.51,,,,,,,109.0000,8194.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,AETNA,AETNA,763.48,,,,,,,109.0000,1788.0000,percent of total billed charges,"42.7% of $1,788.00 in Billed Charges for Rev 450 Proc 21400 = $763.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,1788.0000,fee schedule,"APG 00041 Proc 21400 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,489.32,,,,,,,109.0000,1788.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,AETNA,AETNA HEALTHCARE MEDICARE,489.32,,,,,,,109.0000,1788.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,489.32,,,,,,,109.0000,1788.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,AMBETTER,AMBETTER,1066.72,,,,,,,109.0000,1788.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,508.89,,,,,,,109.0000,1788.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,BLUE CROSS,ANTHEM EXCHANGE,1204.74,,,,,,,109.0000,1788.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,1788.0000,fee schedule,"APG 00041 Proc 21400 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,BLUE CROSS,ANTHEM HMO,1279.96,,,,,,,109.0000,1788.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,504.00,,,,,,,109.0000,1788.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1505.75,,,,,,,109.0000,1788.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,153.21,,,,,,,109.0000,1788.0000,fee schedule,$153.21 from Fee Schedule BLDTM_23 for Rev 450 Proc 21400 * Qty 1 = $153.21 at 100% = $153.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,BLUE CROSS,BLUE CROSS MEDICARE,508.89,,,,,,,109.0000,1788.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,513.78,,,,,,,109.0000,1788.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,513.78,,,,,,,109.0000,1788.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1609.20,,,,,,,109.0000,1788.0000,percent of total billed charges,"90% of $1,788.00 in Billed Charges for Rev 450 Proc 21400 = $1,609.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,HUMANA,HUMANA MEDICARE,489.32,,,,,,,109.0000,1788.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,489.32,,,,,,,109.0000,1788.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,MEDCOST,MEDCOST VHN,850.91,,,,,,,109.0000,1788.0000,percent of total billed charges,"47.59% of $1,788.00 in Billed Charges for Rev 450 Proc 21400 = $850.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,1788.0000,fee schedule,"APG 00041 Proc 21400 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,513.78,,,,,,,109.0000,1788.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,513.78,,,,,,,109.0000,1788.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,NHC ADVANTAGE,NHC ADVANTAGE,513.78,,,,,,,109.0000,1788.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,1788.0000,fee schedule,"APG 00041 Proc 21400 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,SENTARA HEALTH,SENTARA HEALTH,461.48,,,,,,,109.0000,1788.0000,percent of total billed charges,"25.81% of $1,788.00 in Billed Charges for Rev 450 Proc 21400 = $461.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,SENTARA HEALTH,SENTARA MEDICARE,489.32,,,,,,,109.0000,1788.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1788.00,,,,,,,109.0000,1788.0000,percent of total billed charges,"100% of $1,788.00 in Billed Charges for Rev 450 Proc 21400 = $1,788.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1788.0000,case rate,Rev 450 Proc 21400 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1788.0000,case rate,Rev 450 Proc 21400 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1788.0000,case rate,Rev 450 Proc 21400 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1788.0000,case rate,Rev 450 Proc 21400 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,1788.0000,fee schedule,"APG 00041 Proc 21400 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,489.32,,,,,,,109.0000,1788.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,489.32,,,,,,,109.0000,1788.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,WELLCARE,WELLCARE MEDICAID,1788.00,,,,,,,109.0000,1788.0000,percent of total billed charges,"100% of $1,788.00 in Billed Charges for Rev 450 Proc 21400 = $1,788.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX FX ORBIT EXCPT BLOWOUT W/O MANIP,21400,CPT,450,RC,45000362,CDM,,,,both,,,1788.0000,268.2000,WELLCARE,WELLCARE MEDICARE,518.68,,,,,,,109.0000,1788.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,5618.0900,842.7100,AETNA,AETNA,2398.92,,,,,,,1450.0300,5618.0900,percent of total billed charges,"42.7% of $5,618.09 in Billed Charges for Rev 272 = $2,398.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,5618.0900,842.7100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3932.66,,,,,,,1450.0300,5618.0900,percent of total billed charges,"Rev 272 $5,618.09 in Billed Charges at 70% = $3,932.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,5618.0900,842.7100,CIGNA HEALTHCARE,CIGNA HMO,2342.74,,,,,,,1450.0300,5618.0900,percent of total billed charges,"41.7% of $5,618.09 in Billed Charges for Rev 272 = $2,342.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,5618.0900,842.7100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2606.79,,,,,,,1450.0300,5618.0900,percent of total billed charges,"46.4% of $5,618.09 in Billed Charges for Rev 272 = $2,606.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,5618.0900,842.7100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2342.74,,,,,,,1450.0300,5618.0900,percent of total billed charges,"41.7% of $5,618.09 in Billed Charges for Rev 272 = $2,342.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,5618.0900,842.7100,CIGNA HEALTHCARE,CIGNA PPO,2342.74,,,,,,,1450.0300,5618.0900,percent of total billed charges,"41.7% of $5,618.09 in Billed Charges for Rev 272 = $2,342.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,5618.0900,842.7100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5056.28,,,,,,,1450.0300,5618.0900,percent of total billed charges,"90% of $5,618.09 in Billed Charges for Rev 272 = $5,056.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,5618.0900,842.7100,MEDCOST,MEDCOST VHN,2673.65,,,,,,,1450.0300,5618.0900,percent of total billed charges,"47.59% of $5,618.09 in Billed Charges for Rev 272 = $2,673.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,5618.0900,842.7100,SENTARA HEALTH,SENTARA HEALTH,1450.03,,,,,,,1450.0300,5618.0900,percent of total billed charges,"25.81% of $5,618.09 in Billed Charges for Rev 272 = $1,450.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,5618.0900,842.7100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5618.09,,,,,,,1450.0300,5618.0900,percent of total billed charges,"100% of $5,618.09 in Billed Charges for Rev 272 = $5,618.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,5618.0900,842.7100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2809.05,,,,,,,1450.0300,5618.0900,percent of total billed charges,"Rev 272 $5,618.09 in Billed Charges at 50% = $2,809.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,5618.0900,842.7100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1814.64,,,,,,,1450.0300,5618.0900,other,"32.3% of $5,618.09 in Billed Charges for Rev 272 = $1,814.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,5618.0900,842.7100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1724.75,,,,,,,1450.0300,5618.0900,other,"30.7% of $5,618.09 in Billed Charges for Rev 272 = $1,724.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,5618.0900,842.7100,UNITED HEALTHCARE,UNITED HEALTHCARE,1814.64,,,,,,,1450.0300,5618.0900,percent of total billed charges,"32.3% of $5,618.09 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,5618.0900,842.7100,WELLCARE,WELLCARE MEDICAID,5618.09,,,,,,,1450.0300,5618.0900,percent of total billed charges,"100% of $5,618.09 in Billed Charges for Rev 272 = $5,618.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP DISPOSABLE SCALP CLIP APPLIER,272,RC,27200002,CDM,,,,,,both,,,915.7600,137.3600,AETNA,AETNA,391.03,,,,,,,236.3600,915.7600,percent of total billed charges,42.7% of $915.76 in Billed Charges for Rev 272 = $391.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DISPOSABLE SCALP CLIP APPLIER,272,RC,27200002,CDM,,,,,,both,,,915.7600,137.3600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,641.03,,,,,,,236.3600,915.7600,percent of total billed charges,Rev 272 $915.76 in Billed Charges at 70% = $641.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DISPOSABLE SCALP CLIP APPLIER,272,RC,27200002,CDM,,,,,,both,,,915.7600,137.3600,CIGNA HEALTHCARE,CIGNA HMO,381.87,,,,,,,236.3600,915.7600,percent of total billed charges,41.7% of $915.76 in Billed Charges for Rev 272 = $381.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DISPOSABLE SCALP CLIP APPLIER,272,RC,27200002,CDM,,,,,,both,,,915.7600,137.3600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,424.91,,,,,,,236.3600,915.7600,percent of total billed charges,46.4% of $915.76 in Billed Charges for Rev 272 = $424.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DISPOSABLE SCALP CLIP APPLIER,272,RC,27200002,CDM,,,,,,both,,,915.7600,137.3600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,381.87,,,,,,,236.3600,915.7600,percent of total billed charges,41.7% of $915.76 in Billed Charges for Rev 272 = $381.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DISPOSABLE SCALP CLIP APPLIER,272,RC,27200002,CDM,,,,,,both,,,915.7600,137.3600,CIGNA HEALTHCARE,CIGNA PPO,381.87,,,,,,,236.3600,915.7600,percent of total billed charges,41.7% of $915.76 in Billed Charges for Rev 272 = $381.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DISPOSABLE SCALP CLIP APPLIER,272,RC,27200002,CDM,,,,,,both,,,915.7600,137.3600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,824.18,,,,,,,236.3600,915.7600,percent of total billed charges,90% of $915.76 in Billed Charges for Rev 272 = $824.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DISPOSABLE SCALP CLIP APPLIER,272,RC,27200002,CDM,,,,,,both,,,915.7600,137.3600,MEDCOST,MEDCOST VHN,435.81,,,,,,,236.3600,915.7600,percent of total billed charges,47.59% of $915.76 in Billed Charges for Rev 272 = $435.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DISPOSABLE SCALP CLIP APPLIER,272,RC,27200002,CDM,,,,,,both,,,915.7600,137.3600,SENTARA HEALTH,SENTARA HEALTH,236.36,,,,,,,236.3600,915.7600,percent of total billed charges,25.81% of $915.76 in Billed Charges for Rev 272 = $236.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DISPOSABLE SCALP CLIP APPLIER,272,RC,27200002,CDM,,,,,,both,,,915.7600,137.3600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",915.76,,,,,,,236.3600,915.7600,percent of total billed charges,100% of $915.76 in Billed Charges for Rev 272 = $915.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DISPOSABLE SCALP CLIP APPLIER,272,RC,27200002,CDM,,,,,,both,,,915.7600,137.3600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,457.88,,,,,,,236.3600,915.7600,percent of total billed charges,Rev 272 $915.76 in Billed Charges at 50% = $457.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DISPOSABLE SCALP CLIP APPLIER,272,RC,27200002,CDM,,,,,,both,,,915.7600,137.3600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,295.79,,,,,,,236.3600,915.7600,other,32.3% of $915.76 in Billed Charges for Rev 272 = $295.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CLIP DISPOSABLE SCALP CLIP APPLIER,272,RC,27200002,CDM,,,,,,both,,,915.7600,137.3600,UNITED HEALTHCARE,UHC HERITAGE SELECT,281.14,,,,,,,236.3600,915.7600,other,30.7% of $915.76 in Billed Charges for Rev 272 = $281.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CLIP DISPOSABLE SCALP CLIP APPLIER,272,RC,27200002,CDM,,,,,,both,,,915.7600,137.3600,UNITED HEALTHCARE,UNITED HEALTHCARE,295.79,,,,,,,236.3600,915.7600,percent of total billed charges,32.3% of $915.76 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DISPOSABLE SCALP CLIP APPLIER,272,RC,27200002,CDM,,,,,,both,,,915.7600,137.3600,WELLCARE,WELLCARE MEDICAID,915.76,,,,,,,236.3600,915.7600,percent of total billed charges,100% of $915.76 in Billed Charges for Rev 272 = $915.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,AETNA,AETNA,763.48,,,,,,,109.0000,1788.0000,percent of total billed charges,"42.7% of $1,788.00 in Billed Charges for Rev 450 Proc 21450 = $763.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,1788.0000,fee schedule,"APG 00041 Proc 21450 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,489.32,,,,,,,109.0000,1788.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,AETNA,AETNA HEALTHCARE MEDICARE,489.32,,,,,,,109.0000,1788.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,489.32,,,,,,,109.0000,1788.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,AMBETTER,AMBETTER,1066.72,,,,,,,109.0000,1788.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,508.89,,,,,,,109.0000,1788.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,BLUE CROSS,ANTHEM EXCHANGE,1204.74,,,,,,,109.0000,1788.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,1788.0000,fee schedule,"APG 00041 Proc 21450 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,BLUE CROSS,ANTHEM HMO,1279.96,,,,,,,109.0000,1788.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,504.00,,,,,,,109.0000,1788.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1505.75,,,,,,,109.0000,1788.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,260.03,,,,,,,109.0000,1788.0000,fee schedule,$260.03 from Fee Schedule BLDTM_23 for Rev 450 Proc 21450 * Qty 1 = $260.03 at 100% = $260.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,BLUE CROSS,BLUE CROSS MEDICARE,508.89,,,,,,,109.0000,1788.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,513.78,,,,,,,109.0000,1788.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,513.78,,,,,,,109.0000,1788.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1609.20,,,,,,,109.0000,1788.0000,percent of total billed charges,"90% of $1,788.00 in Billed Charges for Rev 450 Proc 21450 = $1,609.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,HUMANA,HUMANA MEDICARE,489.32,,,,,,,109.0000,1788.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,489.32,,,,,,,109.0000,1788.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,MEDCOST,MEDCOST VHN,850.91,,,,,,,109.0000,1788.0000,percent of total billed charges,"47.59% of $1,788.00 in Billed Charges for Rev 450 Proc 21450 = $850.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,1788.0000,fee schedule,"APG 00041 Proc 21450 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,513.78,,,,,,,109.0000,1788.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,513.78,,,,,,,109.0000,1788.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,NHC ADVANTAGE,NHC ADVANTAGE,513.78,,,,,,,109.0000,1788.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,1788.0000,fee schedule,"APG 00041 Proc 21450 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,SENTARA HEALTH,SENTARA HEALTH,461.48,,,,,,,109.0000,1788.0000,percent of total billed charges,"25.81% of $1,788.00 in Billed Charges for Rev 450 Proc 21450 = $461.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,SENTARA HEALTH,SENTARA MEDICARE,489.32,,,,,,,109.0000,1788.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1788.00,,,,,,,109.0000,1788.0000,percent of total billed charges,"100% of $1,788.00 in Billed Charges for Rev 450 Proc 21450 = $1,788.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1788.0000,case rate,Rev 450 Proc 21450 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1788.0000,case rate,Rev 450 Proc 21450 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1788.0000,case rate,Rev 450 Proc 21450 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1788.0000,case rate,Rev 450 Proc 21450 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,1788.0000,fee schedule,"APG 00041 Proc 21450 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,489.32,,,,,,,109.0000,1788.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,489.32,,,,,,,109.0000,1788.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,WELLCARE,WELLCARE MEDICAID,1788.00,,,,,,,109.0000,1788.0000,percent of total billed charges,"100% of $1,788.00 in Billed Charges for Rev 450 Proc 21450 = $1,788.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MANDIBULAR FX W/O MANIP,21450,CPT,450,RC,45000364,CDM,,,,both,,,1788.0000,268.2000,WELLCARE,WELLCARE MEDICARE,518.68,,,,,,,109.0000,1788.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA,584.99,,,,,,,31.3900,1370.0000,percent of total billed charges,"42.7% of $1,370.00 in Billed Charges for Rev 450 Proc 21480 = $584.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,265.28,,,,,,,31.3900,1370.0000,fee schedule,"APG 00249 Proc 21480 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 104% = $265.28. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,31.3900,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,31.3900,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,31.3900,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,AMBETTER,AMBETTER,487.87,,,,,,,31.3900,1370.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,31.3900,1370.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,31.3900,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,262.73,,,,,,,31.3900,1370.0000,fee schedule,"APG 00249 Proc 21480 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 103% = $262.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,31.3900,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,31.3900,1370.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,31.3900,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,69.98,,,,,,,31.3900,1370.0000,fee schedule,$69.98 from Fee Schedule BLDTM_23 for Rev 450 Proc 21480 * Qty 1 = $69.98 at 100% = $69.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,31.3900,1370.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,TENNCARE BLUE CARE,31.39,,,,,,,31.3900,1370.0000,fee schedule,$27.06 from Fee Schedule TC_24 for Rev 450 Proc 21480 * Qty 1 = $27.06 at 116% = $31.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,TENNCARE BLUE SELECT,31.39,,,,,,,31.3900,1370.0000,fee schedule,$27.06 from Fee Schedule TC_24 for Rev 450 Proc 21480 * Qty 1 = $27.06 at 116% = $31.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,31.3900,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,31.3900,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1233.00,,,,,,,31.3900,1370.0000,percent of total billed charges,"90% of $1,370.00 in Billed Charges for Rev 450 Proc 21480 = $1,233.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,31.3900,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,31.3900,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,MEDCOST,MEDCOST VHN,651.98,,,,,,,31.3900,1370.0000,percent of total billed charges,"47.59% of $1,370.00 in Billed Charges for Rev 450 Proc 21480 = $651.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,267.83,,,,,,,31.3900,1370.0000,fee schedule,"APG 00249 Proc 21480 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 100% = $255.08... $255.08 at 105% = $267.83 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,31.3900,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,31.3900,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,31.3900,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,262.99,,,,,,,31.3900,1370.0000,fee schedule,"APG 00249 Proc 21480 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 100% = $255.08... $255.08 at 103.1% = $262.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,SENTARA HEALTH,SENTARA HEALTH,353.60,,,,,,,31.3900,1370.0000,percent of total billed charges,"25.81% of $1,370.00 in Billed Charges for Rev 450 Proc 21480 = $353.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,31.3900,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1370.00,,,,,,,31.3900,1370.0000,percent of total billed charges,"100% of $1,370.00 in Billed Charges for Rev 450 Proc 21480 = $1,370.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,31.3900,1370.0000,case rate,Rev 450 Proc 21480 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,31.3900,1370.0000,case rate,Rev 450 Proc 21480 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,31.3900,1370.0000,case rate,Rev 450 Proc 21480 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,31.3900,1370.0000,case rate,Rev 450 Proc 21480 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,262.73,,,,,,,31.3900,1370.0000,fee schedule,"APG 00249 Proc 21480 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 103% = $262.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,31.3900,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,31.3900,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,WELLCARE,WELLCARE MEDICAID,1370.00,,,,,,,31.3900,1370.0000,percent of total billed charges,"100% of $1,370.00 in Billed Charges for Rev 450 Proc 21480 = $1,370.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TX TM DISLOC INIT SUBS,21480,CPT,450,RC,45000099,CDM,,,,both,,,1370.0000,205.5000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,31.3900,1370.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,AETNA,AETNA,3728.99,,,,,,,109.0000,8733.0000,percent of total billed charges,"42.7% of $8,733.00 in Billed Charges for Rev 450 Proc 21501 = $3,728.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3310.16,,,,,,,109.0000,8733.0000,fee schedule,"APG 00069 Proc 21501 at $836.60 (Base Rate) * 3.8045 (Relative Weight) = $3,182.84 (Total Line Payment) at 104% = $3,310.16. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,AETNA,AETNA HEALTHCARE MEDICARE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,AMBETTER,AMBETTER,5745.12,,,,,,,109.0000,8733.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2740.79,,,,,,,109.0000,8733.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,ANTHEM EXCHANGE,6488.44,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3278.33,,,,,,,109.0000,8733.0000,fee schedule,"APG 00069 Proc 21501 at $836.60 (Base Rate) * 3.8045 (Relative Weight) = $3,182.84 (Total Line Payment) at 103% = $3,278.33. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,ANTHEM HMO,6893.58,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2714.44,,,,,,,109.0000,8733.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8109.66,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,232.07,,,,,,,109.0000,8733.0000,fee schedule,$232.07 from Fee Schedule BLDTM_23 for Rev 450 Proc 21501 * Qty 1 = $232.07 at 100% = $232.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,BLUE CROSS MEDICARE,2740.79,,,,,,,109.0000,8733.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,2767.14,,,,,,,109.0000,8733.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,2767.14,,,,,,,109.0000,8733.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7859.70,,,,,,,109.0000,8733.0000,percent of total billed charges,"90% of $8,733.00 in Billed Charges for Rev 450 Proc 21501 = $7,859.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,HUMANA,HUMANA MEDICARE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,MEDCOST,MEDCOST VHN,4156.03,,,,,,,109.0000,8733.0000,percent of total billed charges,"47.59% of $8,733.00 in Billed Charges for Rev 450 Proc 21501 = $4,156.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3341.98,,,,,,,109.0000,8733.0000,fee schedule,"APG 00069 Proc 21501 at $836.60 (Base Rate) * 3.8045 (Relative Weight) = $3,182.84 (Total Line Payment) at 100% = $3,182.84... $3,182.84 at 105% = $3,341.98 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,2767.14,,,,,,,109.0000,8733.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,2767.14,,,,,,,109.0000,8733.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,NHC ADVANTAGE,NHC ADVANTAGE,2767.14,,,,,,,109.0000,8733.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3281.51,,,,,,,109.0000,8733.0000,fee schedule,"APG 00069 Proc 21501 at $836.60 (Base Rate) * 3.8045 (Relative Weight) = $3,182.84 (Total Line Payment) at 100% = $3,182.84... $3,182.84 at 103.1% = $3,281.51 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,SENTARA HEALTH,SENTARA HEALTH,2253.99,,,,,,,109.0000,8733.0000,percent of total billed charges,"25.81% of $8,733.00 in Billed Charges for Rev 450 Proc 21501 = $2,253.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,SENTARA HEALTH,SENTARA MEDICARE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8733.00,,,,,,,109.0000,8733.0000,percent of total billed charges,"100% of $8,733.00 in Billed Charges for Rev 450 Proc 21501 = $8,733.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,8733.0000,case rate,Rev 450 Proc 21501 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,8733.0000,case rate,Rev 450 Proc 21501 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,8733.0000,case rate,Rev 450 Proc 21501 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,8733.0000,case rate,Rev 450 Proc 21501 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3278.33,,,,,,,109.0000,8733.0000,fee schedule,"APG 00069 Proc 21501 at $836.60 (Base Rate) * 3.8045 (Relative Weight) = $3,182.84 (Total Line Payment) at 103% = $3,278.33. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,WELLCARE,WELLCARE MEDICAID,8733.00,,,,,,,109.0000,8733.0000,percent of total billed charges,"100% of $8,733.00 in Billed Charges for Rev 450 Proc 21501 = $8,733.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID DEEP ABSC/HEMATOMA SOFT TISSUE NECK/THORAX,21501,CPT,450,RC,45000367,CDM,,,,both,,,8733.0000,1309.9500,WELLCARE,WELLCARE MEDICARE,2793.50,,,,,,,109.0000,8733.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,AETNA,AETNA,3747.35,,,,,,,890.0000,8776.0000,percent of total billed charges,"42.7% of $8,776.00 in Billed Charges for Rev 361 Proc 22511 = $3,747.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,7174.98,,,,,,,890.0000,8776.0000,fee schedule,"APG 00028 Proc 22511 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 104% = $7,174.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2968.60,,,,,,,890.0000,8776.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,AETNA,AETNA HEALTHCARE MEDICARE,2968.60,,,,,,,890.0000,8776.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,2968.60,,,,,,,890.0000,8776.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,AMBETTER,AMBETTER,6471.55,,,,,,,890.0000,8776.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3087.35,,,,,,,890.0000,8776.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,BLUE CROSS,ANTHEM EXCHANGE,7308.87,,,,,,,890.0000,8776.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,7105.99,,,,,,,890.0000,8776.0000,fee schedule,"APG 00028 Proc 22511 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 103% = $7,105.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,BLUE CROSS,ANTHEM HMO,7765.24,,,,,,,890.0000,8776.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3057.66,,,,,,,890.0000,8776.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8776.00,,,,,,,890.0000,8776.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,890.0000,8776.0000,case rate,"Rev 361 Proc 22511 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,890.0000,8776.0000,case rate,"Rev 361 Proc 22511 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,BLUE CROSS,BLUE CROSS MEDICARE,3087.35,,,,,,,890.0000,8776.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,890.0000,8776.0000,case rate,"Rev 361 Proc 22511 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,890.0000,8776.0000,case rate,"Rev 361 Proc 22511 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,BLUE CROSS,TENNCARE BLUE CARE,890.00,,,,,,,890.0000,8776.0000,case rate,Rev 361 Proc 22511 ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,BLUE CROSS,TENNCARE BLUE SELECT,890.00,,,,,,,890.0000,8776.0000,case rate,Rev 361 Proc 22511 ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,CIGNA HEALTHCARE,CIGNA HMO,8003.00,,,,,,,890.0000,8776.0000,case rate,"Rev 361 Proc 22511 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6048.00,,,,,,,890.0000,8776.0000,case rate,"Rev 361 Proc 22511 ASG Rate of $6,048.00 at 100% of $6,048.00 = $6,048.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,3117.03,,,,,,,890.0000,8776.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8003.00,,,,,,,890.0000,8776.0000,case rate,"Rev 361 Proc 22511 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,CIGNA HEALTHCARE,CIGNA PPO,8003.00,,,,,,,890.0000,8776.0000,case rate,"Rev 361 Proc 22511 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3117.03,,,,,,,890.0000,8776.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7898.40,,,,,,,890.0000,8776.0000,percent of total billed charges,"90% of $8,776.00 in Billed Charges for Rev 361 Proc 22511 = $7,898.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,HUMANA,HUMANA MEDICARE,2968.60,,,,,,,890.0000,8776.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2968.60,,,,,,,890.0000,8776.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,MEDCOST,MEDCOST VHN,4176.50,,,,,,,890.0000,8776.0000,percent of total billed charges,"47.59% of $8,776.00 in Billed Charges for Rev 361 Proc 22511 = $4,176.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,7243.97,,,,,,,890.0000,8776.0000,fee schedule,"APG 00028 Proc 22511 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 100% = $6,899.02... $6,899.02 at 105% = $7,243.97 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3117.03,,,,,,,890.0000,8776.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3117.03,,,,,,,890.0000,8776.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,NHC ADVANTAGE,NHC ADVANTAGE,3117.03,,,,,,,890.0000,8776.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,7112.89,,,,,,,890.0000,8776.0000,fee schedule,"APG 00028 Proc 22511 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 100% = $6,899.02... $6,899.02 at 103.1% = $7,112.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,SENTARA HEALTH,SENTARA HEALTH,2265.09,,,,,,,890.0000,8776.0000,percent of total billed charges,"25.81% of $8,776.00 in Billed Charges for Rev 361 Proc 22511 = $2,265.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,SENTARA HEALTH,SENTARA MEDICARE,2968.60,,,,,,,890.0000,8776.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8776.00,,,,,,,890.0000,8776.0000,percent of total billed charges,"100% of $8,776.00 in Billed Charges for Rev 361 Proc 22511 = $8,776.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,890.0000,8776.0000,case rate,"Rev 361 Proc 22511 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,890.0000,8776.0000,case rate,"Rev 361 Proc 22511 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,890.0000,8776.0000,case rate,"Rev 361 Proc 22511 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,890.0000,8776.0000,case rate,"Rev 361 Proc 22511 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,7105.99,,,,,,,890.0000,8776.0000,fee schedule,"APG 00028 Proc 22511 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 103% = $7,105.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2968.60,,,,,,,890.0000,8776.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2968.60,,,,,,,890.0000,8776.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,WELLCARE,WELLCARE MEDICAID,8776.00,,,,,,,890.0000,8776.0000,percent of total billed charges,"100% of $8,776.00 in Billed Charges for Rev 361 Proc 22511 = $8,776.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERTEBROPLASTY 1 VERT BODY UNIL BIL LUMBOSACRAL,22511,CPT,361,RC,36100269,CDM,,,,both,,,8776.0000,1316.4000,WELLCARE,WELLCARE MEDICARE,3146.72,,,,,,,890.0000,8776.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,AETNA,AETNA,9833.81,,,,,,,890.0000,23030.0000,percent of total billed charges,"42.7% of $23,030.00 in Billed Charges for Rev 361 Proc 22513 = $9,833.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,7174.98,,,,,,,890.0000,23030.0000,fee schedule,"APG 00028 Proc 22513 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 104% = $7,174.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,6583.38,,,,,,,890.0000,23030.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,AETNA,AETNA HEALTHCARE MEDICARE,6583.38,,,,,,,890.0000,23030.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,6583.38,,,,,,,890.0000,23030.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,AMBETTER,AMBETTER,14351.76,,,,,,,890.0000,23030.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,6846.71,,,,,,,890.0000,23030.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,BLUE CROSS,ANTHEM EXCHANGE,16208.64,,,,,,,890.0000,23030.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,7105.99,,,,,,,890.0000,23030.0000,fee schedule,"APG 00028 Proc 22513 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 103% = $7,105.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,BLUE CROSS,ANTHEM HMO,17220.71,,,,,,,890.0000,23030.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,6780.88,,,,,,,890.0000,23030.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",20258.57,,,,,,,890.0000,23030.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,890.0000,23030.0000,case rate,"Rev 361 Proc 22513 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,890.0000,23030.0000,case rate,"Rev 361 Proc 22513 ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,BLUE CROSS,BLUE CROSS MEDICARE,6846.71,,,,,,,890.0000,23030.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,890.0000,23030.0000,case rate,"Rev 361 Proc 22513 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,890.0000,23030.0000,case rate,"Rev 361 Proc 22513 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,BLUE CROSS,TENNCARE BLUE CARE,890.00,,,,,,,890.0000,23030.0000,case rate,Rev 361 Proc 22513 ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,BLUE CROSS,TENNCARE BLUE SELECT,890.00,,,,,,,890.0000,23030.0000,case rate,Rev 361 Proc 22513 ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,890.0000,23030.0000,case rate,"Rev 361 Proc 22513 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,890.0000,23030.0000,case rate,"Rev 361 Proc 22513 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,6912.55,,,,,,,890.0000,23030.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,890.0000,23030.0000,case rate,"Rev 361 Proc 22513 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,890.0000,23030.0000,case rate,"Rev 361 Proc 22513 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,6912.55,,,,,,,890.0000,23030.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,20727.00,,,,,,,890.0000,23030.0000,percent of total billed charges,"90% of $23,030.00 in Billed Charges for Rev 361 Proc 22513 = $20,727.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,HUMANA,HUMANA MEDICARE,6583.38,,,,,,,890.0000,23030.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,6583.38,,,,,,,890.0000,23030.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,MEDCOST,MEDCOST VHN,10959.98,,,,,,,890.0000,23030.0000,percent of total billed charges,"47.59% of $23,030.00 in Billed Charges for Rev 361 Proc 22513 = $10,959.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,7243.97,,,,,,,890.0000,23030.0000,fee schedule,"APG 00028 Proc 22513 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 100% = $6,899.02... $6,899.02 at 105% = $7,243.97 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,6912.55,,,,,,,890.0000,23030.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,6912.55,,,,,,,890.0000,23030.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,NHC ADVANTAGE,NHC ADVANTAGE,6912.55,,,,,,,890.0000,23030.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,7112.89,,,,,,,890.0000,23030.0000,fee schedule,"APG 00028 Proc 22513 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 100% = $6,899.02... $6,899.02 at 103.1% = $7,112.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,SENTARA HEALTH,SENTARA HEALTH,5944.04,,,,,,,890.0000,23030.0000,percent of total billed charges,"25.81% of $23,030.00 in Billed Charges for Rev 361 Proc 22513 = $5,944.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,SENTARA HEALTH,SENTARA MEDICARE,6583.38,,,,,,,890.0000,23030.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",23030.00,,,,,,,890.0000,23030.0000,percent of total billed charges,"100% of $23,030.00 in Billed Charges for Rev 361 Proc 22513 = $23,030.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,890.0000,23030.0000,case rate,"Rev 361 Proc 22513 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,890.0000,23030.0000,case rate,"Rev 361 Proc 22513 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,890.0000,23030.0000,case rate,"Rev 361 Proc 22513 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,890.0000,23030.0000,case rate,"Rev 361 Proc 22513 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,7105.99,,,,,,,890.0000,23030.0000,fee schedule,"APG 00028 Proc 22513 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 103% = $7,105.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,6583.38,,,,,,,890.0000,23030.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,6583.38,,,,,,,890.0000,23030.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,WELLCARE,WELLCARE MEDICAID,23030.00,,,,,,,890.0000,23030.0000,percent of total billed charges,"100% of $23,030.00 in Billed Charges for Rev 361 Proc 22513 = $23,030.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERT AUGMENTATION 1 VERT BODY UNIL BIL THOR,22513,CPT,361,RC,36100271,CDM,,,,both,,,23030.0000,3454.5000,WELLCARE,WELLCARE MEDICARE,6978.38,,,,,,,890.0000,23030.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION EA ADDL THOR/LUMB,22515,CPT,361,RC,36100273,CDM,,,,both,,,1215.0000,182.2500,AETNA,AETNA,518.81,,,,,,,148.0000,7243.9700,percent of total billed charges,"42.7% of $1,215.00 in Billed Charges for Rev 361 Proc 22515 = $518.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERT AUGMENTATION EA ADDL THOR/LUMB,22515,CPT,361,RC,36100273,CDM,,,,both,,,1215.0000,182.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,7174.98,,,,,,,148.0000,7243.9700,fee schedule,"APG 00028 Proc 22515 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 104% = $7,174.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION EA ADDL THOR/LUMB,22515,CPT,361,RC,36100273,CDM,,,,both,,,1215.0000,182.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1215.00,,,,,,,148.0000,7243.9700,fee schedule,"APG 00028 Proc 22515 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 103% = $7,105.99 (Service Line reduced to $1,215.00, claim capped at $1,215.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION EA ADDL THOR/LUMB,22515,CPT,361,RC,36100273,CDM,,,,both,,,1215.0000,182.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1215.00,,,,,,,148.0000,7243.9700,case rate,"Rev 361 Proc 22515 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $1,215.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,215.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION EA ADDL THOR/LUMB,22515,CPT,361,RC,36100273,CDM,,,,both,,,1215.0000,182.2500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,7243.9700,case rate,Rev 361 Proc 22515 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION EA ADDL THOR/LUMB,22515,CPT,361,RC,36100273,CDM,,,,both,,,1215.0000,182.2500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,7243.9700,case rate,Rev 361 Proc 22515 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION EA ADDL THOR/LUMB,22515,CPT,361,RC,36100273,CDM,,,,both,,,1215.0000,182.2500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,7243.9700,case rate,Rev 361 Proc 22515 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION EA ADDL THOR/LUMB,22515,CPT,361,RC,36100273,CDM,,,,both,,,1215.0000,182.2500,CIGNA HEALTHCARE,CIGNA HMO,1215.00,,,,,,,148.0000,7243.9700,case rate,"Rev 361 Proc 22515 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,215.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,215.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION EA ADDL THOR/LUMB,22515,CPT,361,RC,36100273,CDM,,,,both,,,1215.0000,182.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1215.00,,,,,,,148.0000,7243.9700,case rate,"Rev 361 Proc 22515 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $1,215.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,215.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION EA ADDL THOR/LUMB,22515,CPT,361,RC,36100273,CDM,,,,both,,,1215.0000,182.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1215.00,,,,,,,148.0000,7243.9700,case rate,"Rev 361 Proc 22515 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,215.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,215.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION EA ADDL THOR/LUMB,22515,CPT,361,RC,36100273,CDM,,,,both,,,1215.0000,182.2500,CIGNA HEALTHCARE,CIGNA PPO,1215.00,,,,,,,148.0000,7243.9700,case rate,"Rev 361 Proc 22515 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,215.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,215.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION EA ADDL THOR/LUMB,22515,CPT,361,RC,36100273,CDM,,,,both,,,1215.0000,182.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1093.50,,,,,,,148.0000,7243.9700,percent of total billed charges,"90% of $1,215.00 in Billed Charges for Rev 361 Proc 22515 = $1,093.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERT AUGMENTATION EA ADDL THOR/LUMB,22515,CPT,361,RC,36100273,CDM,,,,both,,,1215.0000,182.2500,MEDCOST,MEDCOST VHN,578.22,,,,,,,148.0000,7243.9700,percent of total billed charges,"47.59% of $1,215.00 in Billed Charges for Rev 361 Proc 22515 = $578.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERT AUGMENTATION EA ADDL THOR/LUMB,22515,CPT,361,RC,36100273,CDM,,,,both,,,1215.0000,182.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,7243.97,,,,,,,148.0000,7243.9700,fee schedule,"APG 00028 Proc 22515 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 100% = $6,899.02... $6,899.02 at 105% = $7,243.97 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION EA ADDL THOR/LUMB,22515,CPT,361,RC,36100273,CDM,,,,both,,,1215.0000,182.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,7112.89,,,,,,,148.0000,7243.9700,fee schedule,"APG 00028 Proc 22515 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 100% = $6,899.02... $6,899.02 at 103.1% = $7,112.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION EA ADDL THOR/LUMB,22515,CPT,361,RC,36100273,CDM,,,,both,,,1215.0000,182.2500,SENTARA HEALTH,SENTARA HEALTH,313.59,,,,,,,148.0000,7243.9700,percent of total billed charges,"25.81% of $1,215.00 in Billed Charges for Rev 361 Proc 22515 = $313.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERT AUGMENTATION EA ADDL THOR/LUMB,22515,CPT,361,RC,36100273,CDM,,,,both,,,1215.0000,182.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1215.00,,,,,,,148.0000,7243.9700,percent of total billed charges,"100% of $1,215.00 in Billed Charges for Rev 361 Proc 22515 = $1,215.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU VERT AUGMENTATION EA ADDL THOR/LUMB,22515,CPT,361,RC,36100273,CDM,,,,both,,,1215.0000,182.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,148.0000,7243.9700,case rate,Rev 361 Proc 22515 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION EA ADDL THOR/LUMB,22515,CPT,361,RC,36100273,CDM,,,,both,,,1215.0000,182.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,148.0000,7243.9700,case rate,Rev 361 Proc 22515 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION EA ADDL THOR/LUMB,22515,CPT,361,RC,36100273,CDM,,,,both,,,1215.0000,182.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,148.0000,7243.9700,case rate,Rev 361 Proc 22515 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION EA ADDL THOR/LUMB,22515,CPT,361,RC,36100273,CDM,,,,both,,,1215.0000,182.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,148.0000,7243.9700,case rate,Rev 361 Proc 22515 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU VERT AUGMENTATION EA ADDL THOR/LUMB,22515,CPT,361,RC,36100273,CDM,,,,both,,,1215.0000,182.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,7105.99,,,,,,,148.0000,7243.9700,fee schedule,"APG 00028 Proc 22515 at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 103% = $7,105.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU VERT AUGMENTATION EA ADDL THOR/LUMB,22515,CPT,361,RC,36100273,CDM,,,,both,,,1215.0000,182.2500,WELLCARE,WELLCARE MEDICAID,1215.00,,,,,,,148.0000,7243.9700,percent of total billed charges,"100% of $1,215.00 in Billed Charges for Rev 361 Proc 22515 = $1,215.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,AETNA,AETNA,2034.66,,,,,,,775.0000,4765.0000,percent of total billed charges,"42.7% of $4,765.00 in Billed Charges for Rev 361 Proc 22902 = $2,034.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2612.63,,,,,,,775.0000,4765.0000,fee schedule,"APG 00051 Proc 22902 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 104% = $2,612.63. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,775.0000,4765.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,775.0000,4765.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,775.0000,4765.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,AMBETTER,AMBETTER,3266.63,,,,,,,775.0000,4765.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,775.0000,4765.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,BLUE CROSS,ANTHEM EXCHANGE,3689.28,,,,,,,775.0000,4765.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2587.51,,,,,,,775.0000,4765.0000,fee schedule,"APG 00051 Proc 22902 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,BLUE CROSS,ANTHEM HMO,3919.64,,,,,,,775.0000,4765.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,775.0000,4765.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4611.09,,,,,,,775.0000,4765.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,948.00,,,,,,,775.0000,4765.0000,case rate,Rev 361 Proc 22902 ASG Rate of $948.00 at 100% of $948.00 = $948.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,775.0000,4765.0000,case rate,"Rev 361 Proc 22902 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,775.0000,4765.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,775.0000,4765.0000,case rate,"Rev 361 Proc 22902 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,775.0000,4765.0000,case rate,"Rev 361 Proc 22902 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,4765.0000,case rate,Rev 361 Proc 22902 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,4765.0000,case rate,Rev 361 Proc 22902 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,CIGNA HEALTHCARE,CIGNA HMO,4765.00,,,,,,,775.0000,4765.0000,case rate,"Rev 361 Proc 22902 ASG Rate of $5,761.00 at 100% of $5,761.00 = $5,761.00 Total (Limited to $4,765.00 in Billed Charges - $0.00 in ASG Allowed Amount = $4,765.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4353.00,,,,,,,775.0000,4765.0000,case rate,"Rev 361 Proc 22902 ASG Rate of $4,353.00 at 100% of $4,353.00 = $4,353.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,775.0000,4765.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4765.00,,,,,,,775.0000,4765.0000,case rate,"Rev 361 Proc 22902 ASG Rate of $5,761.00 at 100% of $5,761.00 = $5,761.00 Total (Limited to $4,765.00 in Billed Charges - $0.00 in ASG Allowed Amount = $4,765.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,CIGNA HEALTHCARE,CIGNA PPO,4765.00,,,,,,,775.0000,4765.0000,case rate,"Rev 361 Proc 22902 ASG Rate of $5,761.00 at 100% of $5,761.00 = $5,761.00 Total (Limited to $4,765.00 in Billed Charges - $0.00 in ASG Allowed Amount = $4,765.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,775.0000,4765.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4288.50,,,,,,,775.0000,4765.0000,percent of total billed charges,"90% of $4,765.00 in Billed Charges for Rev 361 Proc 22902 = $4,288.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,775.0000,4765.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,775.0000,4765.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,MEDCOST,MEDCOST VHN,2267.66,,,,,,,775.0000,4765.0000,percent of total billed charges,"47.59% of $4,765.00 in Billed Charges for Rev 361 Proc 22902 = $2,267.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2637.75,,,,,,,775.0000,4765.0000,fee schedule,"APG 00051 Proc 22902 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 105% = $2,637.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,775.0000,4765.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,775.0000,4765.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,775.0000,4765.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2590.02,,,,,,,775.0000,4765.0000,fee schedule,"APG 00051 Proc 22902 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 103.1% = $2,590.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,SENTARA HEALTH,SENTARA HEALTH,1229.85,,,,,,,775.0000,4765.0000,percent of total billed charges,"25.81% of $4,765.00 in Billed Charges for Rev 361 Proc 22902 = $1,229.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,775.0000,4765.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4765.00,,,,,,,775.0000,4765.0000,percent of total billed charges,"100% of $4,765.00 in Billed Charges for Rev 361 Proc 22902 = $4,765.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,775.0000,4765.0000,case rate,Rev 361 Proc 22902 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,775.0000,4765.0000,case rate,"Rev 361 Proc 22902 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,775.0000,4765.0000,case rate,"Rev 361 Proc 22902 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,775.0000,4765.0000,case rate,"Rev 361 Proc 22902 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2587.51,,,,,,,775.0000,4765.0000,fee schedule,"APG 00051 Proc 22902 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,775.0000,4765.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,775.0000,4765.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,WELLCARE,WELLCARE MEDICAID,4765.00,,,,,,,775.0000,4765.0000,percent of total billed charges,"100% of $4,765.00 in Billed Charges for Rev 361 Proc 22902 = $4,765.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABD WALL SUPRA SOFT TISSUE,22902,CPT,361,RC,36100075,CDM,,,,both,,,4765.0000,714.7500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,775.0000,4765.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,AETNA,AETNA,3728.99,,,,,,,109.0000,8733.0000,percent of total billed charges,"42.7% of $8,733.00 in Billed Charges for Rev 450 Proc 23030 = $3,728.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2612.63,,,,,,,109.0000,8733.0000,fee schedule,"APG 00051 Proc 23030 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 104% = $2,612.63. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,AETNA,AETNA HEALTHCARE MEDICARE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,AMBETTER,AMBETTER,5745.12,,,,,,,109.0000,8733.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2740.79,,,,,,,109.0000,8733.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,ANTHEM EXCHANGE,6488.44,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2587.51,,,,,,,109.0000,8733.0000,fee schedule,"APG 00051 Proc 23030 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,ANTHEM HMO,6893.58,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2714.44,,,,,,,109.0000,8733.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8109.66,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,202.23,,,,,,,109.0000,8733.0000,fee schedule,$202.23 from Fee Schedule BLDTM_23 for Rev 450 Proc 23030 * Qty 1 = $202.23 at 100% = $202.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,BLUE CROSS MEDICARE,2740.79,,,,,,,109.0000,8733.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,2767.14,,,,,,,109.0000,8733.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,2767.14,,,,,,,109.0000,8733.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7859.70,,,,,,,109.0000,8733.0000,percent of total billed charges,"90% of $8,733.00 in Billed Charges for Rev 450 Proc 23030 = $7,859.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,HUMANA,HUMANA MEDICARE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,MEDCOST,MEDCOST VHN,4156.03,,,,,,,109.0000,8733.0000,percent of total billed charges,"47.59% of $8,733.00 in Billed Charges for Rev 450 Proc 23030 = $4,156.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2637.75,,,,,,,109.0000,8733.0000,fee schedule,"APG 00051 Proc 23030 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 105% = $2,637.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,2767.14,,,,,,,109.0000,8733.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,2767.14,,,,,,,109.0000,8733.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,NHC ADVANTAGE,NHC ADVANTAGE,2767.14,,,,,,,109.0000,8733.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2590.02,,,,,,,109.0000,8733.0000,fee schedule,"APG 00051 Proc 23030 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 103.1% = $2,590.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,SENTARA HEALTH,SENTARA HEALTH,2253.99,,,,,,,109.0000,8733.0000,percent of total billed charges,"25.81% of $8,733.00 in Billed Charges for Rev 450 Proc 23030 = $2,253.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,SENTARA HEALTH,SENTARA MEDICARE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8733.00,,,,,,,109.0000,8733.0000,percent of total billed charges,"100% of $8,733.00 in Billed Charges for Rev 450 Proc 23030 = $8,733.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,8733.0000,case rate,Rev 450 Proc 23030 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,8733.0000,case rate,Rev 450 Proc 23030 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,8733.0000,case rate,Rev 450 Proc 23030 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,8733.0000,case rate,Rev 450 Proc 23030 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2587.51,,,,,,,109.0000,8733.0000,fee schedule,"APG 00051 Proc 23030 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,WELLCARE,WELLCARE MEDICAID,8733.00,,,,,,,109.0000,8733.0000,percent of total billed charges,"100% of $8,733.00 in Billed Charges for Rev 450 Proc 23030 = $8,733.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID SHOULDER DEEP ABSC/HEMATOMA,23030,CPT,450,RC,45000369,CDM,,,,both,,,8733.0000,1309.9500,WELLCARE,WELLCARE MEDICARE,2793.50,,,,,,,109.0000,8733.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,AETNA,AETNA,908.66,,,,,,,84.0900,3266.6300,percent of total billed charges,"42.7% of $2,128.00 in Billed Charges for Rev 450 Proc 23330 = $908.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2612.63,,,,,,,84.0900,3266.6300,fee schedule,"APG 00051 Proc 23330 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 104% = $2,612.63. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,84.0900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,84.0900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,84.0900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,AMBETTER,AMBETTER,3266.63,,,,,,,84.0900,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,84.0900,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,ANTHEM EXCHANGE,2128.00,,,,,,,84.0900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2128.00,,,,,,,84.0900,3266.6300,fee schedule,"APG 00051 Proc 23330 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51 (Service Line reduced to $2,128.00, claim capped at $2,128.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,ANTHEM HMO,2128.00,,,,,,,84.0900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,84.0900,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2128.00,,,,,,,84.0900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,84.09,,,,,,,84.0900,3266.6300,fee schedule,$84.09 from Fee Schedule BLDTM_23 for Rev 450 Proc 23330 * Qty 1 = $84.09 at 100% = $84.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,84.0900,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,84.0900,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,84.0900,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1915.20,,,,,,,84.0900,3266.6300,percent of total billed charges,"90% of $2,128.00 in Billed Charges for Rev 450 Proc 23330 = $1,915.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,84.0900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,84.0900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,MEDCOST,MEDCOST VHN,1012.72,,,,,,,84.0900,3266.6300,percent of total billed charges,"47.59% of $2,128.00 in Billed Charges for Rev 450 Proc 23330 = $1,012.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2637.75,,,,,,,84.0900,3266.6300,fee schedule,"APG 00051 Proc 23330 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 105% = $2,637.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,84.0900,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,84.0900,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,84.0900,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2590.02,,,,,,,84.0900,3266.6300,fee schedule,"APG 00051 Proc 23330 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 103.1% = $2,590.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,SENTARA HEALTH,SENTARA HEALTH,549.24,,,,,,,84.0900,3266.6300,percent of total billed charges,"25.81% of $2,128.00 in Billed Charges for Rev 450 Proc 23330 = $549.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,84.0900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2128.00,,,,,,,84.0900,3266.6300,percent of total billed charges,"100% of $2,128.00 in Billed Charges for Rev 450 Proc 23330 = $2,128.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,84.0900,3266.6300,case rate,Rev 450 Proc 23330 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,84.0900,3266.6300,case rate,Rev 450 Proc 23330 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,84.0900,3266.6300,case rate,Rev 450 Proc 23330 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,84.0900,3266.6300,case rate,Rev 450 Proc 23330 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2587.51,,,,,,,84.0900,3266.6300,fee schedule,"APG 00051 Proc 23330 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,84.0900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,84.0900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,WELLCARE,WELLCARE MEDICAID,2128.00,,,,,,,84.0900,3266.6300,percent of total billed charges,"100% of $2,128.00 in Billed Charges for Rev 450 Proc 23330 = $2,128.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL FB SHOULDER SUBCU,23330,CPT,450,RC,45000370,CDM,,,,both,,,2128.0000,319.2000,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,84.0900,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DEVICE BIOVAS SUCTION,272,RC,27200002,CDM,,,,,,both,,,1164.3500,174.6500,AETNA,AETNA,497.18,,,,,,,300.5200,1164.3500,percent of total billed charges,"42.7% of $1,164.35 in Billed Charges for Rev 272 = $497.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE BIOVAS SUCTION,272,RC,27200002,CDM,,,,,,both,,,1164.3500,174.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,815.05,,,,,,,300.5200,1164.3500,percent of total billed charges,"Rev 272 $1,164.35 in Billed Charges at 70% = $815.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE BIOVAS SUCTION,272,RC,27200002,CDM,,,,,,both,,,1164.3500,174.6500,CIGNA HEALTHCARE,CIGNA HMO,485.53,,,,,,,300.5200,1164.3500,percent of total billed charges,"41.7% of $1,164.35 in Billed Charges for Rev 272 = $485.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE BIOVAS SUCTION,272,RC,27200002,CDM,,,,,,both,,,1164.3500,174.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,540.26,,,,,,,300.5200,1164.3500,percent of total billed charges,"46.4% of $1,164.35 in Billed Charges for Rev 272 = $540.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE BIOVAS SUCTION,272,RC,27200002,CDM,,,,,,both,,,1164.3500,174.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,485.53,,,,,,,300.5200,1164.3500,percent of total billed charges,"41.7% of $1,164.35 in Billed Charges for Rev 272 = $485.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE BIOVAS SUCTION,272,RC,27200002,CDM,,,,,,both,,,1164.3500,174.6500,CIGNA HEALTHCARE,CIGNA PPO,485.53,,,,,,,300.5200,1164.3500,percent of total billed charges,"41.7% of $1,164.35 in Billed Charges for Rev 272 = $485.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE BIOVAS SUCTION,272,RC,27200002,CDM,,,,,,both,,,1164.3500,174.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1047.92,,,,,,,300.5200,1164.3500,percent of total billed charges,"90% of $1,164.35 in Billed Charges for Rev 272 = $1,047.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE BIOVAS SUCTION,272,RC,27200002,CDM,,,,,,both,,,1164.3500,174.6500,MEDCOST,MEDCOST VHN,554.11,,,,,,,300.5200,1164.3500,percent of total billed charges,"47.59% of $1,164.35 in Billed Charges for Rev 272 = $554.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE BIOVAS SUCTION,272,RC,27200002,CDM,,,,,,both,,,1164.3500,174.6500,SENTARA HEALTH,SENTARA HEALTH,300.52,,,,,,,300.5200,1164.3500,percent of total billed charges,"25.81% of $1,164.35 in Billed Charges for Rev 272 = $300.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE BIOVAS SUCTION,272,RC,27200002,CDM,,,,,,both,,,1164.3500,174.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1164.35,,,,,,,300.5200,1164.3500,percent of total billed charges,"100% of $1,164.35 in Billed Charges for Rev 272 = $1,164.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE BIOVAS SUCTION,272,RC,27200002,CDM,,,,,,both,,,1164.3500,174.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,582.18,,,,,,,300.5200,1164.3500,percent of total billed charges,"Rev 272 $1,164.35 in Billed Charges at 50% = $582.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE BIOVAS SUCTION,272,RC,27200002,CDM,,,,,,both,,,1164.3500,174.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,376.09,,,,,,,300.5200,1164.3500,other,"32.3% of $1,164.35 in Billed Charges for Rev 272 = $376.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE BIOVAS SUCTION,272,RC,27200002,CDM,,,,,,both,,,1164.3500,174.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,357.46,,,,,,,300.5200,1164.3500,other,"30.7% of $1,164.35 in Billed Charges for Rev 272 = $357.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE BIOVAS SUCTION,272,RC,27200002,CDM,,,,,,both,,,1164.3500,174.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,376.09,,,,,,,300.5200,1164.3500,percent of total billed charges,"32.3% of $1,164.35 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE BIOVAS SUCTION,272,RC,27200002,CDM,,,,,,both,,,1164.3500,174.6500,WELLCARE,WELLCARE MEDICAID,1164.35,,,,,,,300.5200,1164.3500,percent of total billed charges,"100% of $1,164.35 in Billed Charges for Rev 272 = $1,164.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP FIXING ENDOSCOPIC HEMOSTATIC QUICKCLIP 2.8 MM X 230 CM STERILE,272,RC,27200002,CDM,,,,,,both,,,1496.3000,224.4500,AETNA,AETNA,638.92,,,,,,,386.2000,1496.3000,percent of total billed charges,"42.7% of $1,496.30 in Billed Charges for Rev 272 = $638.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP FIXING ENDOSCOPIC HEMOSTATIC QUICKCLIP 2.8 MM X 230 CM STERILE,272,RC,27200002,CDM,,,,,,both,,,1496.3000,224.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1047.41,,,,,,,386.2000,1496.3000,percent of total billed charges,"Rev 272 $1,496.30 in Billed Charges at 70% = $1,047.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP FIXING ENDOSCOPIC HEMOSTATIC QUICKCLIP 2.8 MM X 230 CM STERILE,272,RC,27200002,CDM,,,,,,both,,,1496.3000,224.4500,CIGNA HEALTHCARE,CIGNA HMO,623.96,,,,,,,386.2000,1496.3000,percent of total billed charges,"41.7% of $1,496.30 in Billed Charges for Rev 272 = $623.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP FIXING ENDOSCOPIC HEMOSTATIC QUICKCLIP 2.8 MM X 230 CM STERILE,272,RC,27200002,CDM,,,,,,both,,,1496.3000,224.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,694.28,,,,,,,386.2000,1496.3000,percent of total billed charges,"46.4% of $1,496.30 in Billed Charges for Rev 272 = $694.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP FIXING ENDOSCOPIC HEMOSTATIC QUICKCLIP 2.8 MM X 230 CM STERILE,272,RC,27200002,CDM,,,,,,both,,,1496.3000,224.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,623.96,,,,,,,386.2000,1496.3000,percent of total billed charges,"41.7% of $1,496.30 in Billed Charges for Rev 272 = $623.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP FIXING ENDOSCOPIC HEMOSTATIC QUICKCLIP 2.8 MM X 230 CM STERILE,272,RC,27200002,CDM,,,,,,both,,,1496.3000,224.4500,CIGNA HEALTHCARE,CIGNA PPO,623.96,,,,,,,386.2000,1496.3000,percent of total billed charges,"41.7% of $1,496.30 in Billed Charges for Rev 272 = $623.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP FIXING ENDOSCOPIC HEMOSTATIC QUICKCLIP 2.8 MM X 230 CM STERILE,272,RC,27200002,CDM,,,,,,both,,,1496.3000,224.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1346.67,,,,,,,386.2000,1496.3000,percent of total billed charges,"90% of $1,496.30 in Billed Charges for Rev 272 = $1,346.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP FIXING ENDOSCOPIC HEMOSTATIC QUICKCLIP 2.8 MM X 230 CM STERILE,272,RC,27200002,CDM,,,,,,both,,,1496.3000,224.4500,MEDCOST,MEDCOST VHN,712.09,,,,,,,386.2000,1496.3000,percent of total billed charges,"47.59% of $1,496.30 in Billed Charges for Rev 272 = $712.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP FIXING ENDOSCOPIC HEMOSTATIC QUICKCLIP 2.8 MM X 230 CM STERILE,272,RC,27200002,CDM,,,,,,both,,,1496.3000,224.4500,SENTARA HEALTH,SENTARA HEALTH,386.20,,,,,,,386.2000,1496.3000,percent of total billed charges,"25.81% of $1,496.30 in Billed Charges for Rev 272 = $386.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP FIXING ENDOSCOPIC HEMOSTATIC QUICKCLIP 2.8 MM X 230 CM STERILE,272,RC,27200002,CDM,,,,,,both,,,1496.3000,224.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1496.30,,,,,,,386.2000,1496.3000,percent of total billed charges,"100% of $1,496.30 in Billed Charges for Rev 272 = $1,496.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP FIXING ENDOSCOPIC HEMOSTATIC QUICKCLIP 2.8 MM X 230 CM STERILE,272,RC,27200002,CDM,,,,,,both,,,1496.3000,224.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,748.15,,,,,,,386.2000,1496.3000,percent of total billed charges,"Rev 272 $1,496.30 in Billed Charges at 50% = $748.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP FIXING ENDOSCOPIC HEMOSTATIC QUICKCLIP 2.8 MM X 230 CM STERILE,272,RC,27200002,CDM,,,,,,both,,,1496.3000,224.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,483.30,,,,,,,386.2000,1496.3000,other,"32.3% of $1,496.30 in Billed Charges for Rev 272 = $483.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE CLIP FIXING ENDOSCOPIC HEMOSTATIC QUICKCLIP 2.8 MM X 230 CM STERILE,272,RC,27200002,CDM,,,,,,both,,,1496.3000,224.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,459.36,,,,,,,386.2000,1496.3000,other,"30.7% of $1,496.30 in Billed Charges for Rev 272 = $459.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE CLIP FIXING ENDOSCOPIC HEMOSTATIC QUICKCLIP 2.8 MM X 230 CM STERILE,272,RC,27200002,CDM,,,,,,both,,,1496.3000,224.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,483.30,,,,,,,386.2000,1496.3000,percent of total billed charges,"32.3% of $1,496.30 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP FIXING ENDOSCOPIC HEMOSTATIC QUICKCLIP 2.8 MM X 230 CM STERILE,272,RC,27200002,CDM,,,,,,both,,,1496.3000,224.4500,WELLCARE,WELLCARE MEDICAID,1496.30,,,,,,,386.2000,1496.3000,percent of total billed charges,"100% of $1,496.30 in Billed Charges for Rev 272 = $1,496.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION,272,RC,27200002,CDM,,,,,,both,,,3296.4100,494.4600,AETNA,AETNA,1407.57,,,,,,,850.8000,3296.4100,percent of total billed charges,"42.7% of $3,296.41 in Billed Charges for Rev 272 = $1,407.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION,272,RC,27200002,CDM,,,,,,both,,,3296.4100,494.4600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2307.49,,,,,,,850.8000,3296.4100,percent of total billed charges,"Rev 272 $3,296.41 in Billed Charges at 70% = $2,307.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION,272,RC,27200002,CDM,,,,,,both,,,3296.4100,494.4600,CIGNA HEALTHCARE,CIGNA HMO,1374.60,,,,,,,850.8000,3296.4100,percent of total billed charges,"41.7% of $3,296.41 in Billed Charges for Rev 272 = $1,374.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION,272,RC,27200002,CDM,,,,,,both,,,3296.4100,494.4600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1529.53,,,,,,,850.8000,3296.4100,percent of total billed charges,"46.4% of $3,296.41 in Billed Charges for Rev 272 = $1,529.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION,272,RC,27200002,CDM,,,,,,both,,,3296.4100,494.4600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1374.60,,,,,,,850.8000,3296.4100,percent of total billed charges,"41.7% of $3,296.41 in Billed Charges for Rev 272 = $1,374.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION,272,RC,27200002,CDM,,,,,,both,,,3296.4100,494.4600,CIGNA HEALTHCARE,CIGNA PPO,1374.60,,,,,,,850.8000,3296.4100,percent of total billed charges,"41.7% of $3,296.41 in Billed Charges for Rev 272 = $1,374.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION,272,RC,27200002,CDM,,,,,,both,,,3296.4100,494.4600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2966.77,,,,,,,850.8000,3296.4100,percent of total billed charges,"90% of $3,296.41 in Billed Charges for Rev 272 = $2,966.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION,272,RC,27200002,CDM,,,,,,both,,,3296.4100,494.4600,MEDCOST,MEDCOST VHN,1568.76,,,,,,,850.8000,3296.4100,percent of total billed charges,"47.59% of $3,296.41 in Billed Charges for Rev 272 = $1,568.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION,272,RC,27200002,CDM,,,,,,both,,,3296.4100,494.4600,SENTARA HEALTH,SENTARA HEALTH,850.80,,,,,,,850.8000,3296.4100,percent of total billed charges,"25.81% of $3,296.41 in Billed Charges for Rev 272 = $850.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION,272,RC,27200002,CDM,,,,,,both,,,3296.4100,494.4600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3296.41,,,,,,,850.8000,3296.4100,percent of total billed charges,"100% of $3,296.41 in Billed Charges for Rev 272 = $3,296.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION,272,RC,27200002,CDM,,,,,,both,,,3296.4100,494.4600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1648.21,,,,,,,850.8000,3296.4100,percent of total billed charges,"Rev 272 $3,296.41 in Billed Charges at 50% = $1,648.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION,272,RC,27200002,CDM,,,,,,both,,,3296.4100,494.4600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1064.74,,,,,,,850.8000,3296.4100,other,"32.3% of $3,296.41 in Billed Charges for Rev 272 = $1,064.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE CLIP RESOLUTION,272,RC,27200002,CDM,,,,,,both,,,3296.4100,494.4600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1012.00,,,,,,,850.8000,3296.4100,other,"30.7% of $3,296.41 in Billed Charges for Rev 272 = $1,012.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE CLIP RESOLUTION,272,RC,27200002,CDM,,,,,,both,,,3296.4100,494.4600,UNITED HEALTHCARE,UNITED HEALTHCARE,1064.74,,,,,,,850.8000,3296.4100,percent of total billed charges,"32.3% of $3,296.41 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION,272,RC,27200002,CDM,,,,,,both,,,3296.4100,494.4600,WELLCARE,WELLCARE MEDICAID,3296.41,,,,,,,850.8000,3296.4100,percent of total billed charges,"100% of $3,296.41 in Billed Charges for Rev 272 = $3,296.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,AETNA,AETNA,1646.51,,,,,,,109.0000,3856.0000,percent of total billed charges,"42.7% of $3,856.00 in Billed Charges for Rev 450 Proc 23505 = $1,646.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,3856.0000,fee schedule,APG 00041 Proc 23505 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,3856.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,3856.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,3856.0000,fee schedule,APG 00041 Proc 23505 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,3856.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3856.00,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,226.05,,,,,,,109.0000,3856.0000,fee schedule,$226.05 from Fee Schedule BLDTM_23 for Rev 450 Proc 23505 * Qty 1 = $226.05 at 100% = $226.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,3856.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,3856.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,3856.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3470.40,,,,,,,109.0000,3856.0000,percent of total billed charges,"90% of $3,856.00 in Billed Charges for Rev 450 Proc 23505 = $3,470.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,MEDCOST,MEDCOST VHN,1835.07,,,,,,,109.0000,3856.0000,percent of total billed charges,"47.59% of $3,856.00 in Billed Charges for Rev 450 Proc 23505 = $1,835.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,3856.0000,fee schedule,APG 00041 Proc 23505 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,3856.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,3856.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,3856.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,3856.0000,fee schedule,APG 00041 Proc 23505 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,SENTARA HEALTH,SENTARA HEALTH,995.23,,,,,,,109.0000,3856.0000,percent of total billed charges,"25.81% of $3,856.00 in Billed Charges for Rev 450 Proc 23505 = $995.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3856.00,,,,,,,109.0000,3856.0000,percent of total billed charges,"100% of $3,856.00 in Billed Charges for Rev 450 Proc 23505 = $3,856.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3856.0000,case rate,Rev 450 Proc 23505 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3856.0000,case rate,Rev 450 Proc 23505 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3856.0000,case rate,Rev 450 Proc 23505 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3856.0000,case rate,Rev 450 Proc 23505 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,3856.0000,fee schedule,APG 00041 Proc 23505 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,WELLCARE,WELLCARE MEDICAID,3856.00,,,,,,,109.0000,3856.0000,percent of total billed charges,"100% of $3,856.00 in Billed Charges for Rev 450 Proc 23505 = $3,856.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CLAVICLE FX W MANI,23505,CPT,450,RC,45000103,CDM,,,,both,,,3856.0000,578.4000,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,3856.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,AETNA,AETNA,605.91,,,,,,,109.0000,3180.3800,percent of total billed charges,"42.7% of $1,419.00 in Billed Charges for Rev 450 Proc 23520 = $605.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 23520 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1419.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,AETNA,AETNA HEALTHCARE MEDICARE,1419.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,1419.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,3180.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1419.00,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,BLUE CROSS,ANTHEM EXCHANGE,1419.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 23520 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,BLUE CROSS,ANTHEM HMO,1419.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1419.00,,,,,,,109.0000,3180.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1419.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,126.99,,,,,,,109.0000,3180.3800,fee schedule,$126.99 from Fee Schedule BLDTM_23 for Rev 450 Proc 23520 * Qty 1 = $126.99 at 100% = $126.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,1419.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1419.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1277.10,,,,,,,109.0000,3180.3800,percent of total billed charges,"90% of $1,419.00 in Billed Charges for Rev 450 Proc 23520 = $1,277.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,HUMANA,HUMANA MEDICARE,1419.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1419.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,MEDCOST,MEDCOST VHN,675.30,,,,,,,109.0000,3180.3800,percent of total billed charges,"47.59% of $1,419.00 in Billed Charges for Rev 450 Proc 23520 = $675.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 23520 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1419.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1419.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,NHC ADVANTAGE,NHC ADVANTAGE,1419.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 23520 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,SENTARA HEALTH,SENTARA HEALTH,366.24,,,,,,,109.0000,3180.3800,percent of total billed charges,"25.81% of $1,419.00 in Billed Charges for Rev 450 Proc 23520 = $366.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,SENTARA HEALTH,SENTARA MEDICARE,1419.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1419.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,419.00 in Billed Charges for Rev 450 Proc 23520 = $1,419.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 23520 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 23520 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 23520 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 23520 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 23520 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1419.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1419.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,WELLCARE,WELLCARE MEDICAID,1419.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,419.00 in Billed Charges for Rev 450 Proc 23520 = $1,419.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STERNOCLAVIC DISLOC W/O MANIP,23520,CPT,450,RC,45000104,CDM,,,,both,,,1419.0000,212.8500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,3180.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA,603.35,,,,,,,109.0000,1413.0000,percent of total billed charges,"42.7% of $1,413.00 in Billed Charges for Rev 450 Proc 23545 = $603.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 23545 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,1413.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,1413.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 23545 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,1413.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,187.93,,,,,,,109.0000,1413.0000,fee schedule,$187.93 from Fee Schedule BLDTM_23 for Rev 450 Proc 23545 * Qty 1 = $187.93 at 100% = $187.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,1413.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1271.70,,,,,,,109.0000,1413.0000,percent of total billed charges,"90% of $1,413.00 in Billed Charges for Rev 450 Proc 23545 = $1,271.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,MEDCOST,MEDCOST VHN,672.45,,,,,,,109.0000,1413.0000,percent of total billed charges,"47.59% of $1,413.00 in Billed Charges for Rev 450 Proc 23545 = $672.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 23545 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 23545 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA HEALTH,364.70,,,,,,,109.0000,1413.0000,percent of total billed charges,"25.81% of $1,413.00 in Billed Charges for Rev 450 Proc 23545 = $364.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1413.00,,,,,,,109.0000,1413.0000,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 23545 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 23545 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 23545 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 23545 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 23545 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 23545 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICAID,1413.00,,,,,,,109.0000,1413.0000,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 23545 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX AC DISLOC W MANIPULAT,23545,CPT,450,RC,45000107,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,1413.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA,2059.42,,,,,,,109.0000,4823.0000,percent of total billed charges,"42.7% of $4,823.00 in Billed Charges for Rev 450 Proc 23575 = $2,059.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 23575 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,4823.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,4823.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 23575 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,4823.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4489.34,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,246.49,,,,,,,109.0000,4823.0000,fee schedule,$246.49 from Fee Schedule BLDTM_23 for Rev 450 Proc 23575 * Qty 1 = $246.49 at 100% = $246.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,4823.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4340.70,,,,,,,109.0000,4823.0000,percent of total billed charges,"90% of $4,823.00 in Billed Charges for Rev 450 Proc 23575 = $4,340.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,MEDCOST,MEDCOST VHN,2295.27,,,,,,,109.0000,4823.0000,percent of total billed charges,"47.59% of $4,823.00 in Billed Charges for Rev 450 Proc 23575 = $2,295.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 23575 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 23575 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,SENTARA HEALTH,SENTARA HEALTH,1244.82,,,,,,,109.0000,4823.0000,percent of total billed charges,"25.81% of $4,823.00 in Billed Charges for Rev 450 Proc 23575 = $1,244.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4823.00,,,,,,,109.0000,4823.0000,percent of total billed charges,"100% of $4,823.00 in Billed Charges for Rev 450 Proc 23575 = $4,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 23575 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 23575 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 23575 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 23575 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 23575 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,WELLCARE,WELLCARE MEDICAID,4823.00,,,,,,,109.0000,4823.0000,percent of total billed charges,"100% of $4,823.00 in Billed Charges for Rev 450 Proc 23575 = $4,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX SCAPULAR FX W MANIP W/WO SKELETAL TRCTN,23575,CPT,450,RC,45000372,CDM,,,,both,,,4823.0000,723.4500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,4823.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA,808.31,,,,,,,109.0000,3180.3800,percent of total billed charges,"42.7% of $1,893.00 in Billed Charges for Rev 450 Proc 27825 = $808.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27825 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,3180.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM EXCHANGE,1893.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27825 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM HMO,1893.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,3180.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1893.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,492.23,,,,,,,109.0000,3180.3800,fee schedule,$492.23 from Fee Schedule BLDTM_23 for Rev 450 Proc 27825 * Qty 1 = $492.23 at 100% = $492.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1703.70,,,,,,,109.0000,3180.3800,percent of total billed charges,"90% of $1,893.00 in Billed Charges for Rev 450 Proc 27825 = $1,703.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,MEDCOST,MEDCOST VHN,900.88,,,,,,,109.0000,3180.3800,percent of total billed charges,"47.59% of $1,893.00 in Billed Charges for Rev 450 Proc 27825 = $900.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27825 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27825 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,SENTARA HEALTH,SENTARA HEALTH,488.58,,,,,,,109.0000,3180.3800,percent of total billed charges,"25.81% of $1,893.00 in Billed Charges for Rev 450 Proc 27825 = $488.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1893.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,893.00 in Billed Charges for Rev 450 Proc 27825 = $1,893.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 27825 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 27825 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 27825 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 27825 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27825 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,WELLCARE,WELLCARE MEDICAID,1893.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,893.00 in Billed Charges for Rev 450 Proc 27825 = $1,893.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLS TX FX ARTIC DIST TIB W MAN,27825,CPT,450,RC,45000175,CDM,,,,both,,,1893.0000,283.9500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,3180.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA,603.35,,,,,,,109.0000,1413.0000,percent of total billed charges,"42.7% of $1,413.00 in Billed Charges for Rev 450 Proc 27830 = $603.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 27830 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,1413.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,1413.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 27830 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,1413.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,284.82,,,,,,,109.0000,1413.0000,fee schedule,$284.82 from Fee Schedule BLDTM_23 for Rev 450 Proc 27830 * Qty 1 = $284.82 at 100% = $284.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,1413.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1271.70,,,,,,,109.0000,1413.0000,percent of total billed charges,"90% of $1,413.00 in Billed Charges for Rev 450 Proc 27830 = $1,271.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,MEDCOST,MEDCOST VHN,672.45,,,,,,,109.0000,1413.0000,percent of total billed charges,"47.59% of $1,413.00 in Billed Charges for Rev 450 Proc 27830 = $672.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 27830 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 27830 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA HEALTH,364.70,,,,,,,109.0000,1413.0000,percent of total billed charges,"25.81% of $1,413.00 in Billed Charges for Rev 450 Proc 27830 = $364.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1413.00,,,,,,,109.0000,1413.0000,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 27830 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 27830 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 27830 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 27830 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 27830 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 27830 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICAID,1413.00,,,,,,,109.0000,1413.0000,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 27830 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD PRX TIB FIB JNT DIS WO A,27830,CPT,450,RC,45000176,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,1413.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA,603.35,,,,,,,109.0000,1413.0000,percent of total billed charges,"42.7% of $1,413.00 in Billed Charges for Rev 450 Proc 27840 = $603.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 27840 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,1413.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,1413.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 27840 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,1413.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,249.07,,,,,,,109.0000,1413.0000,fee schedule,$249.07 from Fee Schedule BLDTM_23 for Rev 450 Proc 27840 * Qty 1 = $249.07 at 100% = $249.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,1413.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1271.70,,,,,,,109.0000,1413.0000,percent of total billed charges,"90% of $1,413.00 in Billed Charges for Rev 450 Proc 27840 = $1,271.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,MEDCOST,MEDCOST VHN,672.45,,,,,,,109.0000,1413.0000,percent of total billed charges,"47.59% of $1,413.00 in Billed Charges for Rev 450 Proc 27840 = $672.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 27840 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 27840 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA HEALTH,364.70,,,,,,,109.0000,1413.0000,percent of total billed charges,"25.81% of $1,413.00 in Billed Charges for Rev 450 Proc 27840 = $364.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1413.00,,,,,,,109.0000,1413.0000,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 27840 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 27840 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 27840 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 27840 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 27840 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 27840 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICAID,1413.00,,,,,,,109.0000,1413.0000,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 27840 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX ANKLE DISLOC WO ANES,27840,CPT,450,RC,45000177,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,1413.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DEVICE ENDOSTITCH POLYSORB 3-0,272,RC,,,,,,,,both,,,748.9900,112.3500,AETNA,AETNA,319.82,,,,,,,193.3100,748.9900,percent of total billed charges,42.7% of $748.99 in Billed Charges for Rev 272 = $319.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE ENDOSTITCH POLYSORB 3-0,272,RC,,,,,,,,both,,,748.9900,112.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,524.29,,,,,,,193.3100,748.9900,percent of total billed charges,Rev 272 $748.99 in Billed Charges at 70% = $524.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE ENDOSTITCH POLYSORB 3-0,272,RC,,,,,,,,both,,,748.9900,112.3500,CIGNA HEALTHCARE,CIGNA HMO,312.33,,,,,,,193.3100,748.9900,percent of total billed charges,41.7% of $748.99 in Billed Charges for Rev 272 = $312.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE ENDOSTITCH POLYSORB 3-0,272,RC,,,,,,,,both,,,748.9900,112.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,347.53,,,,,,,193.3100,748.9900,percent of total billed charges,46.4% of $748.99 in Billed Charges for Rev 272 = $347.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE ENDOSTITCH POLYSORB 3-0,272,RC,,,,,,,,both,,,748.9900,112.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,312.33,,,,,,,193.3100,748.9900,percent of total billed charges,41.7% of $748.99 in Billed Charges for Rev 272 = $312.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE ENDOSTITCH POLYSORB 3-0,272,RC,,,,,,,,both,,,748.9900,112.3500,CIGNA HEALTHCARE,CIGNA PPO,312.33,,,,,,,193.3100,748.9900,percent of total billed charges,41.7% of $748.99 in Billed Charges for Rev 272 = $312.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE ENDOSTITCH POLYSORB 3-0,272,RC,,,,,,,,both,,,748.9900,112.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,674.09,,,,,,,193.3100,748.9900,percent of total billed charges,90% of $748.99 in Billed Charges for Rev 272 = $674.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE ENDOSTITCH POLYSORB 3-0,272,RC,,,,,,,,both,,,748.9900,112.3500,MEDCOST,MEDCOST VHN,356.44,,,,,,,193.3100,748.9900,percent of total billed charges,47.59% of $748.99 in Billed Charges for Rev 272 = $356.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE ENDOSTITCH POLYSORB 3-0,272,RC,,,,,,,,both,,,748.9900,112.3500,SENTARA HEALTH,SENTARA HEALTH,193.31,,,,,,,193.3100,748.9900,percent of total billed charges,25.81% of $748.99 in Billed Charges for Rev 272 = $193.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE ENDOSTITCH POLYSORB 3-0,272,RC,,,,,,,,both,,,748.9900,112.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",748.99,,,,,,,193.3100,748.9900,percent of total billed charges,100% of $748.99 in Billed Charges for Rev 272 = $748.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE ENDOSTITCH POLYSORB 3-0,272,RC,,,,,,,,both,,,748.9900,112.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,374.50,,,,,,,193.3100,748.9900,percent of total billed charges,Rev 272 $748.99 in Billed Charges at 50% = $374.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE ENDOSTITCH POLYSORB 3-0,272,RC,,,,,,,,both,,,748.9900,112.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,241.92,,,,,,,193.3100,748.9900,other,32.3% of $748.99 in Billed Charges for Rev 272 = $241.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DEVICE ENDOSTITCH POLYSORB 3-0,272,RC,,,,,,,,both,,,748.9900,112.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,229.94,,,,,,,193.3100,748.9900,other,30.7% of $748.99 in Billed Charges for Rev 272 = $229.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DEVICE ENDOSTITCH POLYSORB 3-0,272,RC,,,,,,,,both,,,748.9900,112.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,241.92,,,,,,,193.3100,748.9900,percent of total billed charges,32.3% of $748.99 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE ENDOSTITCH POLYSORB 3-0,272,RC,,,,,,,,both,,,748.9900,112.3500,WELLCARE,WELLCARE MEDICAID,748.99,,,,,,,193.3100,748.9900,percent of total billed charges,100% of $748.99 in Billed Charges for Rev 272 = $748.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE GRAFT SPREADER,272,RC,27200002,CDM,,,,,,both,,,4625.4700,693.8200,AETNA,AETNA,1975.08,,,,,,,1193.8300,4625.4700,percent of total billed charges,"42.7% of $4,625.47 in Billed Charges for Rev 272 = $1,975.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRAFT SPREADER,272,RC,27200002,CDM,,,,,,both,,,4625.4700,693.8200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3237.83,,,,,,,1193.8300,4625.4700,percent of total billed charges,"Rev 272 $4,625.47 in Billed Charges at 70% = $3,237.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRAFT SPREADER,272,RC,27200002,CDM,,,,,,both,,,4625.4700,693.8200,CIGNA HEALTHCARE,CIGNA HMO,1928.82,,,,,,,1193.8300,4625.4700,percent of total billed charges,"41.7% of $4,625.47 in Billed Charges for Rev 272 = $1,928.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRAFT SPREADER,272,RC,27200002,CDM,,,,,,both,,,4625.4700,693.8200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2146.22,,,,,,,1193.8300,4625.4700,percent of total billed charges,"46.4% of $4,625.47 in Billed Charges for Rev 272 = $2,146.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRAFT SPREADER,272,RC,27200002,CDM,,,,,,both,,,4625.4700,693.8200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1928.82,,,,,,,1193.8300,4625.4700,percent of total billed charges,"41.7% of $4,625.47 in Billed Charges for Rev 272 = $1,928.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRAFT SPREADER,272,RC,27200002,CDM,,,,,,both,,,4625.4700,693.8200,CIGNA HEALTHCARE,CIGNA PPO,1928.82,,,,,,,1193.8300,4625.4700,percent of total billed charges,"41.7% of $4,625.47 in Billed Charges for Rev 272 = $1,928.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRAFT SPREADER,272,RC,27200002,CDM,,,,,,both,,,4625.4700,693.8200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4162.92,,,,,,,1193.8300,4625.4700,percent of total billed charges,"90% of $4,625.47 in Billed Charges for Rev 272 = $4,162.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRAFT SPREADER,272,RC,27200002,CDM,,,,,,both,,,4625.4700,693.8200,MEDCOST,MEDCOST VHN,2201.26,,,,,,,1193.8300,4625.4700,percent of total billed charges,"47.59% of $4,625.47 in Billed Charges for Rev 272 = $2,201.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRAFT SPREADER,272,RC,27200002,CDM,,,,,,both,,,4625.4700,693.8200,SENTARA HEALTH,SENTARA HEALTH,1193.83,,,,,,,1193.8300,4625.4700,percent of total billed charges,"25.81% of $4,625.47 in Billed Charges for Rev 272 = $1,193.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRAFT SPREADER,272,RC,27200002,CDM,,,,,,both,,,4625.4700,693.8200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4625.47,,,,,,,1193.8300,4625.4700,percent of total billed charges,"100% of $4,625.47 in Billed Charges for Rev 272 = $4,625.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRAFT SPREADER,272,RC,27200002,CDM,,,,,,both,,,4625.4700,693.8200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2312.74,,,,,,,1193.8300,4625.4700,percent of total billed charges,"Rev 272 $4,625.47 in Billed Charges at 50% = $2,312.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRAFT SPREADER,272,RC,27200002,CDM,,,,,,both,,,4625.4700,693.8200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1494.03,,,,,,,1193.8300,4625.4700,other,"32.3% of $4,625.47 in Billed Charges for Rev 272 = $1,494.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE GRAFT SPREADER,272,RC,27200002,CDM,,,,,,both,,,4625.4700,693.8200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1420.02,,,,,,,1193.8300,4625.4700,other,"30.7% of $4,625.47 in Billed Charges for Rev 272 = $1,420.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE GRAFT SPREADER,272,RC,27200002,CDM,,,,,,both,,,4625.4700,693.8200,UNITED HEALTHCARE,UNITED HEALTHCARE,1494.03,,,,,,,1193.8300,4625.4700,percent of total billed charges,"32.3% of $4,625.47 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRAFT SPREADER,272,RC,27200002,CDM,,,,,,both,,,4625.4700,693.8200,WELLCARE,WELLCARE MEDICAID,4625.47,,,,,,,1193.8300,4625.4700,percent of total billed charges,"100% of $4,625.47 in Billed Charges for Rev 272 = $4,625.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRASPING RAPTOR 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1121.6200,168.2400,AETNA,AETNA,478.93,,,,,,,289.4900,1121.6200,percent of total billed charges,"42.7% of $1,121.62 in Billed Charges for Rev 272 = $478.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRASPING RAPTOR 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1121.6200,168.2400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,785.13,,,,,,,289.4900,1121.6200,percent of total billed charges,"Rev 272 $1,121.62 in Billed Charges at 70% = $785.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRASPING RAPTOR 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1121.6200,168.2400,CIGNA HEALTHCARE,CIGNA HMO,467.72,,,,,,,289.4900,1121.6200,percent of total billed charges,"41.7% of $1,121.62 in Billed Charges for Rev 272 = $467.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRASPING RAPTOR 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1121.6200,168.2400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,520.43,,,,,,,289.4900,1121.6200,percent of total billed charges,"46.4% of $1,121.62 in Billed Charges for Rev 272 = $520.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRASPING RAPTOR 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1121.6200,168.2400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,467.72,,,,,,,289.4900,1121.6200,percent of total billed charges,"41.7% of $1,121.62 in Billed Charges for Rev 272 = $467.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRASPING RAPTOR 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1121.6200,168.2400,CIGNA HEALTHCARE,CIGNA PPO,467.72,,,,,,,289.4900,1121.6200,percent of total billed charges,"41.7% of $1,121.62 in Billed Charges for Rev 272 = $467.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRASPING RAPTOR 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1121.6200,168.2400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1009.46,,,,,,,289.4900,1121.6200,percent of total billed charges,"90% of $1,121.62 in Billed Charges for Rev 272 = $1,009.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRASPING RAPTOR 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1121.6200,168.2400,MEDCOST,MEDCOST VHN,533.78,,,,,,,289.4900,1121.6200,percent of total billed charges,"47.59% of $1,121.62 in Billed Charges for Rev 272 = $533.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRASPING RAPTOR 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1121.6200,168.2400,SENTARA HEALTH,SENTARA HEALTH,289.49,,,,,,,289.4900,1121.6200,percent of total billed charges,"25.81% of $1,121.62 in Billed Charges for Rev 272 = $289.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRASPING RAPTOR 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1121.6200,168.2400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1121.62,,,,,,,289.4900,1121.6200,percent of total billed charges,"100% of $1,121.62 in Billed Charges for Rev 272 = $1,121.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRASPING RAPTOR 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1121.6200,168.2400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,560.81,,,,,,,289.4900,1121.6200,percent of total billed charges,"Rev 272 $1,121.62 in Billed Charges at 50% = $560.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRASPING RAPTOR 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1121.6200,168.2400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,362.28,,,,,,,289.4900,1121.6200,other,"32.3% of $1,121.62 in Billed Charges for Rev 272 = $362.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE GRASPING RAPTOR 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1121.6200,168.2400,UNITED HEALTHCARE,UHC HERITAGE SELECT,344.34,,,,,,,289.4900,1121.6200,other,"30.7% of $1,121.62 in Billed Charges for Rev 272 = $344.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE GRASPING RAPTOR 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1121.6200,168.2400,UNITED HEALTHCARE,UNITED HEALTHCARE,362.28,,,,,,,289.4900,1121.6200,percent of total billed charges,"32.3% of $1,121.62 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GRASPING RAPTOR 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1121.6200,168.2400,WELLCARE,WELLCARE MEDICAID,1121.62,,,,,,,289.4900,1121.6200,percent of total billed charges,"100% of $1,121.62 in Billed Charges for Rev 272 = $1,121.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GYN POSITIONING COLPASSIST VAGINAL,272,RC,,,,,,,,both,,,3477.6000,521.6400,AETNA,AETNA,1484.94,,,,,,,897.5700,3477.6000,percent of total billed charges,"42.7% of $3,477.60 in Billed Charges for Rev 272 = $1,484.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GYN POSITIONING COLPASSIST VAGINAL,272,RC,,,,,,,,both,,,3477.6000,521.6400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2434.32,,,,,,,897.5700,3477.6000,percent of total billed charges,"Rev 272 $3,477.60 in Billed Charges at 70% = $2,434.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GYN POSITIONING COLPASSIST VAGINAL,272,RC,,,,,,,,both,,,3477.6000,521.6400,CIGNA HEALTHCARE,CIGNA HMO,1450.16,,,,,,,897.5700,3477.6000,percent of total billed charges,"41.7% of $3,477.60 in Billed Charges for Rev 272 = $1,450.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GYN POSITIONING COLPASSIST VAGINAL,272,RC,,,,,,,,both,,,3477.6000,521.6400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1613.61,,,,,,,897.5700,3477.6000,percent of total billed charges,"46.4% of $3,477.60 in Billed Charges for Rev 272 = $1,613.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GYN POSITIONING COLPASSIST VAGINAL,272,RC,,,,,,,,both,,,3477.6000,521.6400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1450.16,,,,,,,897.5700,3477.6000,percent of total billed charges,"41.7% of $3,477.60 in Billed Charges for Rev 272 = $1,450.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GYN POSITIONING COLPASSIST VAGINAL,272,RC,,,,,,,,both,,,3477.6000,521.6400,CIGNA HEALTHCARE,CIGNA PPO,1450.16,,,,,,,897.5700,3477.6000,percent of total billed charges,"41.7% of $3,477.60 in Billed Charges for Rev 272 = $1,450.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GYN POSITIONING COLPASSIST VAGINAL,272,RC,,,,,,,,both,,,3477.6000,521.6400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3129.84,,,,,,,897.5700,3477.6000,percent of total billed charges,"90% of $3,477.60 in Billed Charges for Rev 272 = $3,129.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GYN POSITIONING COLPASSIST VAGINAL,272,RC,,,,,,,,both,,,3477.6000,521.6400,MEDCOST,MEDCOST VHN,1654.99,,,,,,,897.5700,3477.6000,percent of total billed charges,"47.59% of $3,477.60 in Billed Charges for Rev 272 = $1,654.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GYN POSITIONING COLPASSIST VAGINAL,272,RC,,,,,,,,both,,,3477.6000,521.6400,SENTARA HEALTH,SENTARA HEALTH,897.57,,,,,,,897.5700,3477.6000,percent of total billed charges,"25.81% of $3,477.60 in Billed Charges for Rev 272 = $897.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GYN POSITIONING COLPASSIST VAGINAL,272,RC,,,,,,,,both,,,3477.6000,521.6400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3477.60,,,,,,,897.5700,3477.6000,percent of total billed charges,"100% of $3,477.60 in Billed Charges for Rev 272 = $3,477.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GYN POSITIONING COLPASSIST VAGINAL,272,RC,,,,,,,,both,,,3477.6000,521.6400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1738.80,,,,,,,897.5700,3477.6000,percent of total billed charges,"Rev 272 $3,477.60 in Billed Charges at 50% = $1,738.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GYN POSITIONING COLPASSIST VAGINAL,272,RC,,,,,,,,both,,,3477.6000,521.6400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1123.26,,,,,,,897.5700,3477.6000,other,"32.3% of $3,477.60 in Billed Charges for Rev 272 = $1,123.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE GYN POSITIONING COLPASSIST VAGINAL,272,RC,,,,,,,,both,,,3477.6000,521.6400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1067.62,,,,,,,897.5700,3477.6000,other,"30.7% of $3,477.60 in Billed Charges for Rev 272 = $1,067.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE GYN POSITIONING COLPASSIST VAGINAL,272,RC,,,,,,,,both,,,3477.6000,521.6400,UNITED HEALTHCARE,UNITED HEALTHCARE,1123.26,,,,,,,897.5700,3477.6000,percent of total billed charges,"32.3% of $3,477.60 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GYN POSITIONING COLPASSIST VAGINAL,272,RC,,,,,,,,both,,,3477.6000,521.6400,WELLCARE,WELLCARE MEDICAID,3477.60,,,,,,,897.5700,3477.6000,percent of total billed charges,"100% of $3,477.60 in Billed Charges for Rev 272 = $3,477.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,AETNA,AETNA,1893.75,,,,,,,285.0600,4435.0000,percent of total billed charges,"42.7% of $4,435.00 in Billed Charges for Rev 521 Proc 28080 = $1,893.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3128.66,,,,,,,285.0600,4435.0000,fee schedule,"APG 00035 Proc 28080 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 104% = $3,128.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,285.0600,4435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,285.0600,4435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,285.0600,4435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,AMBETTER,AMBETTER,3180.38,,,,,,,285.0600,4435.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,285.0600,4435.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,285.0600,4435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3098.58,,,,,,,285.0600,4435.0000,fee schedule,"APG 00035 Proc 28080 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 103% = $3,098.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,285.0600,4435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,285.0600,4435.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4435.00,,,,,,,285.0600,4435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,285.06,,,,,,,285.0600,4435.0000,fee schedule,$285.06 from Fee Schedule BLDTM_23 for Rev 521 Proc 28080 * Qty 1 = $285.06 at 100% = $285.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,285.0600,4435.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,CIGNA HEALTHCARE,CIGNA HMO,1849.40,,,,,,,285.0600,4435.0000,percent of total billed charges,"41.7% of $4,435.00 in Billed Charges for Rev 521 Proc 28080 = $1,849.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2057.84,,,,,,,285.0600,4435.0000,percent of total billed charges,"46.4% of $4,435.00 in Billed Charges for Rev 521 Proc 28080 = $2,057.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,285.0600,4435.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1849.40,,,,,,,285.0600,4435.0000,percent of total billed charges,"41.7% of $4,435.00 in Billed Charges for Rev 521 Proc 28080 = $1,849.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,CIGNA HEALTHCARE,CIGNA PPO,1849.40,,,,,,,285.0600,4435.0000,percent of total billed charges,"41.7% of $4,435.00 in Billed Charges for Rev 521 Proc 28080 = $1,849.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,285.0600,4435.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3991.50,,,,,,,285.0600,4435.0000,percent of total billed charges,"90% of $4,435.00 in Billed Charges for Rev 521 Proc 28080 = $3,991.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,285.0600,4435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,285.0600,4435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,MEDCOST,MEDCOST VHN,2110.62,,,,,,,285.0600,4435.0000,percent of total billed charges,"47.59% of $4,435.00 in Billed Charges for Rev 521 Proc 28080 = $2,110.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3158.75,,,,,,,285.0600,4435.0000,fee schedule,"APG 00035 Proc 28080 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 100% = $3,008.33... $3,008.33 at 105% = $3,158.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,285.0600,4435.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,285.0600,4435.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,285.0600,4435.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3101.59,,,,,,,285.0600,4435.0000,fee schedule,"APG 00035 Proc 28080 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 100% = $3,008.33... $3,008.33 at 103.1% = $3,101.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,SENTARA HEALTH,SENTARA HEALTH,1144.67,,,,,,,285.0600,4435.0000,percent of total billed charges,"25.81% of $4,435.00 in Billed Charges for Rev 521 Proc 28080 = $1,144.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,285.0600,4435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4435.00,,,,,,,285.0600,4435.0000,percent of total billed charges,"100% of $4,435.00 in Billed Charges for Rev 521 Proc 28080 = $4,435.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,871.76,,,,,,,285.0600,4435.0000,fee schedule,"$1,743.52 from Fee Schedule TCUHC24 for Rev 521 Proc 28080 * Qty 1 = $1,743.52 at 50% = $871.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3098.58,,,,,,,285.0600,4435.0000,fee schedule,"APG 00035 Proc 28080 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 103% = $3,098.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,285.0600,4435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,285.0600,4435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,WELLCARE,WELLCARE MEDICAID,4435.00,,,,,,,285.0600,4435.0000,percent of total billed charges,"100% of $4,435.00 in Billed Charges for Rev 521 Proc 28080 = $4,435.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MORTON NEUROMA SNGL EA,28080,CPT,521,RC,52100093,CDM,,,,both,,,4435.0000,665.2500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,285.0600,4435.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,AETNA,AETNA,877.91,,,,,,,47.0800,2056.0000,percent of total billed charges,"42.7% of $2,056.00 in Billed Charges for Rev 450 Proc 28190 = $877.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,47.0800,2056.0000,fee schedule,"APG 00009 Proc 28190 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,47.0800,2056.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,47.0800,2056.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,47.0800,2056.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,AMBETTER,AMBETTER,1400.59,,,,,,,47.0800,2056.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,47.0800,2056.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,47.0800,2056.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,47.0800,2056.0000,fee schedule,"APG 00009 Proc 28190 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,47.0800,2056.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,47.0800,2056.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1977.02,,,,,,,47.0800,2056.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,95.83,,,,,,,47.0800,2056.0000,fee schedule,$95.83 from Fee Schedule BLDTM_23 for Rev 450 Proc 28190 * Qty 1 = $95.83 at 100% = $95.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,47.0800,2056.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,BLUE CROSS,TENNCARE BLUE CARE,47.08,,,,,,,47.0800,2056.0000,fee schedule,$40.59 from Fee Schedule TC_24 for Rev 450 Proc 28190 * Qty 1 = $40.59 at 116% = $47.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,BLUE CROSS,TENNCARE BLUE SELECT,47.08,,,,,,,47.0800,2056.0000,fee schedule,$40.59 from Fee Schedule TC_24 for Rev 450 Proc 28190 * Qty 1 = $40.59 at 116% = $47.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,47.0800,2056.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,47.0800,2056.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1850.40,,,,,,,47.0800,2056.0000,percent of total billed charges,"90% of $2,056.00 in Billed Charges for Rev 450 Proc 28190 = $1,850.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,HUMANA,HUMANA MEDICARE,642.47,,,,,,,47.0800,2056.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,47.0800,2056.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,MEDCOST,MEDCOST VHN,978.45,,,,,,,47.0800,2056.0000,percent of total billed charges,"47.59% of $2,056.00 in Billed Charges for Rev 450 Proc 28190 = $978.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,47.0800,2056.0000,fee schedule,"APG 00009 Proc 28190 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,47.0800,2056.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,47.0800,2056.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,47.0800,2056.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,47.0800,2056.0000,fee schedule,"APG 00009 Proc 28190 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,SENTARA HEALTH,SENTARA HEALTH,530.65,,,,,,,47.0800,2056.0000,percent of total billed charges,"25.81% of $2,056.00 in Billed Charges for Rev 450 Proc 28190 = $530.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,47.0800,2056.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2056.00,,,,,,,47.0800,2056.0000,percent of total billed charges,"100% of $2,056.00 in Billed Charges for Rev 450 Proc 28190 = $2,056.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,47.0800,2056.0000,case rate,Rev 450 Proc 28190 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,47.0800,2056.0000,case rate,Rev 450 Proc 28190 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,47.0800,2056.0000,case rate,Rev 450 Proc 28190 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,47.0800,2056.0000,case rate,Rev 450 Proc 28190 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,47.0800,2056.0000,fee schedule,"APG 00009 Proc 28190 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,47.0800,2056.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,47.0800,2056.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,WELLCARE,WELLCARE MEDICAID,2056.00,,,,,,,47.0800,2056.0000,percent of total billed charges,"100% of $2,056.00 in Billed Charges for Rev 450 Proc 28190 = $2,056.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FOREIGN BODY FOOT SUBQ,28190,CPT,450,RC,45000178,CDM,,,,both,,,2056.0000,308.4000,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,47.0800,2056.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA,808.31,,,,,,,109.0000,1893.0000,percent of total billed charges,"42.7% of $1,893.00 in Billed Charges for Rev 450 Proc 28405 = $808.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,1893.0000,fee schedule,"APG 00041 Proc 28405 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,1893.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1893.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,1893.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,1893.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,1893.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,1893.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,1893.0000,fee schedule,"APG 00041 Proc 28405 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,1893.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,1893.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,1893.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,264.75,,,,,,,109.0000,1893.0000,fee schedule,$264.75 from Fee Schedule BLDTM_23 for Rev 450 Proc 28405 * Qty 1 = $264.75 at 100% = $264.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,1893.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,1893.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,1893.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1703.70,,,,,,,109.0000,1893.0000,percent of total billed charges,"90% of $1,893.00 in Billed Charges for Rev 450 Proc 28405 = $1,703.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,1893.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,1893.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,MEDCOST,MEDCOST VHN,900.88,,,,,,,109.0000,1893.0000,percent of total billed charges,"47.59% of $1,893.00 in Billed Charges for Rev 450 Proc 28405 = $900.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,1893.0000,fee schedule,"APG 00041 Proc 28405 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,1893.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,1893.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,1893.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,1893.0000,fee schedule,"APG 00041 Proc 28405 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,SENTARA HEALTH,SENTARA HEALTH,488.58,,,,,,,109.0000,1893.0000,percent of total billed charges,"25.81% of $1,893.00 in Billed Charges for Rev 450 Proc 28405 = $488.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,1893.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1893.00,,,,,,,109.0000,1893.0000,percent of total billed charges,"100% of $1,893.00 in Billed Charges for Rev 450 Proc 28405 = $1,893.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1893.0000,case rate,Rev 450 Proc 28405 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1893.0000,case rate,Rev 450 Proc 28405 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1893.0000,case rate,Rev 450 Proc 28405 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1893.0000,case rate,Rev 450 Proc 28405 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,1893.0000,fee schedule,"APG 00041 Proc 28405 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1893.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,1893.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,WELLCARE,WELLCARE MEDICAID,1893.00,,,,,,,109.0000,1893.0000,percent of total billed charges,"100% of $1,893.00 in Billed Charges for Rev 450 Proc 28405 = $1,893.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CALCANEAL FX W MANIP,28405,CPT,450,RC,45000180,CDM,,,,both,,,1893.0000,283.9500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,1893.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA,808.31,,,,,,,109.0000,3180.3800,percent of total billed charges,"42.7% of $1,893.00 in Billed Charges for Rev 450 Proc 28435 = $808.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 28435 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,3180.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM EXCHANGE,1893.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 28435 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM HMO,1893.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,3180.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1893.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,207.88,,,,,,,109.0000,3180.3800,fee schedule,$207.88 from Fee Schedule BLDTM_23 for Rev 450 Proc 28435 * Qty 1 = $207.88 at 100% = $207.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1703.70,,,,,,,109.0000,3180.3800,percent of total billed charges,"90% of $1,893.00 in Billed Charges for Rev 450 Proc 28435 = $1,703.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,MEDCOST,MEDCOST VHN,900.88,,,,,,,109.0000,3180.3800,percent of total billed charges,"47.59% of $1,893.00 in Billed Charges for Rev 450 Proc 28435 = $900.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 28435 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 28435 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,SENTARA HEALTH,SENTARA HEALTH,488.58,,,,,,,109.0000,3180.3800,percent of total billed charges,"25.81% of $1,893.00 in Billed Charges for Rev 450 Proc 28435 = $488.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1893.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,893.00 in Billed Charges for Rev 450 Proc 28435 = $1,893.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 28435 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 28435 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 28435 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 28435 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 28435 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,WELLCARE,WELLCARE MEDICAID,1893.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,893.00 in Billed Charges for Rev 450 Proc 28435 = $1,893.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX TALUS FX W MANIP,28435,CPT,450,RC,45000092,CDM,,,,both,,,1893.0000,283.9500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,3180.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DEVICE INCISOR TRUCLEAR 5MM,272,RC,27200002,CDM,,,,,,both,,,6919.4300,1037.9100,AETNA,AETNA,2954.60,,,,,,,1785.9000,6919.4300,percent of total billed charges,"42.7% of $6,919.43 in Billed Charges for Rev 272 = $2,954.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE INCISOR TRUCLEAR 5MM,272,RC,27200002,CDM,,,,,,both,,,6919.4300,1037.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4843.60,,,,,,,1785.9000,6919.4300,percent of total billed charges,"Rev 272 $6,919.43 in Billed Charges at 70% = $4,843.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE INCISOR TRUCLEAR 5MM,272,RC,27200002,CDM,,,,,,both,,,6919.4300,1037.9100,CIGNA HEALTHCARE,CIGNA HMO,2885.40,,,,,,,1785.9000,6919.4300,percent of total billed charges,"41.7% of $6,919.43 in Billed Charges for Rev 272 = $2,885.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE INCISOR TRUCLEAR 5MM,272,RC,27200002,CDM,,,,,,both,,,6919.4300,1037.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3210.62,,,,,,,1785.9000,6919.4300,percent of total billed charges,"46.4% of $6,919.43 in Billed Charges for Rev 272 = $3,210.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE INCISOR TRUCLEAR 5MM,272,RC,27200002,CDM,,,,,,both,,,6919.4300,1037.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2885.40,,,,,,,1785.9000,6919.4300,percent of total billed charges,"41.7% of $6,919.43 in Billed Charges for Rev 272 = $2,885.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE INCISOR TRUCLEAR 5MM,272,RC,27200002,CDM,,,,,,both,,,6919.4300,1037.9100,CIGNA HEALTHCARE,CIGNA PPO,2885.40,,,,,,,1785.9000,6919.4300,percent of total billed charges,"41.7% of $6,919.43 in Billed Charges for Rev 272 = $2,885.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE INCISOR TRUCLEAR 5MM,272,RC,27200002,CDM,,,,,,both,,,6919.4300,1037.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6227.49,,,,,,,1785.9000,6919.4300,percent of total billed charges,"90% of $6,919.43 in Billed Charges for Rev 272 = $6,227.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE INCISOR TRUCLEAR 5MM,272,RC,27200002,CDM,,,,,,both,,,6919.4300,1037.9100,MEDCOST,MEDCOST VHN,3292.96,,,,,,,1785.9000,6919.4300,percent of total billed charges,"47.59% of $6,919.43 in Billed Charges for Rev 272 = $3,292.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE INCISOR TRUCLEAR 5MM,272,RC,27200002,CDM,,,,,,both,,,6919.4300,1037.9100,SENTARA HEALTH,SENTARA HEALTH,1785.90,,,,,,,1785.9000,6919.4300,percent of total billed charges,"25.81% of $6,919.43 in Billed Charges for Rev 272 = $1,785.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE INCISOR TRUCLEAR 5MM,272,RC,27200002,CDM,,,,,,both,,,6919.4300,1037.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6919.43,,,,,,,1785.9000,6919.4300,percent of total billed charges,"100% of $6,919.43 in Billed Charges for Rev 272 = $6,919.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE INCISOR TRUCLEAR 5MM,272,RC,27200002,CDM,,,,,,both,,,6919.4300,1037.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3459.72,,,,,,,1785.9000,6919.4300,percent of total billed charges,"Rev 272 $6,919.43 in Billed Charges at 50% = $3,459.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE INCISOR TRUCLEAR 5MM,272,RC,27200002,CDM,,,,,,both,,,6919.4300,1037.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2234.98,,,,,,,1785.9000,6919.4300,other,"32.3% of $6,919.43 in Billed Charges for Rev 272 = $2,234.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE INCISOR TRUCLEAR 5MM,272,RC,27200002,CDM,,,,,,both,,,6919.4300,1037.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,2124.27,,,,,,,1785.9000,6919.4300,other,"30.7% of $6,919.43 in Billed Charges for Rev 272 = $2,124.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE INCISOR TRUCLEAR 5MM,272,RC,27200002,CDM,,,,,,both,,,6919.4300,1037.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,2234.98,,,,,,,1785.9000,6919.4300,percent of total billed charges,"32.3% of $6,919.43 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE INCISOR TRUCLEAR 5MM,272,RC,27200002,CDM,,,,,,both,,,6919.4300,1037.9100,WELLCARE,WELLCARE MEDICAID,6919.43,,,,,,,1785.9000,6919.4300,percent of total billed charges,"100% of $6,919.43 in Billed Charges for Rev 272 = $6,919.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE LEVEL ONE STERILE FORMING FOR ORBITAL IMPS,272,RC,,,,,,,,both,,,5519.6500,827.9500,AETNA,AETNA,2356.89,,,,,,,1424.6200,5519.6500,percent of total billed charges,"42.7% of $5,519.65 in Billed Charges for Rev 272 = $2,356.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE LEVEL ONE STERILE FORMING FOR ORBITAL IMPS,272,RC,,,,,,,,both,,,5519.6500,827.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3863.76,,,,,,,1424.6200,5519.6500,percent of total billed charges,"Rev 272 $5,519.65 in Billed Charges at 70% = $3,863.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE LEVEL ONE STERILE FORMING FOR ORBITAL IMPS,272,RC,,,,,,,,both,,,5519.6500,827.9500,CIGNA HEALTHCARE,CIGNA HMO,2301.69,,,,,,,1424.6200,5519.6500,percent of total billed charges,"41.7% of $5,519.65 in Billed Charges for Rev 272 = $2,301.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE LEVEL ONE STERILE FORMING FOR ORBITAL IMPS,272,RC,,,,,,,,both,,,5519.6500,827.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2561.12,,,,,,,1424.6200,5519.6500,percent of total billed charges,"46.4% of $5,519.65 in Billed Charges for Rev 272 = $2,561.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE LEVEL ONE STERILE FORMING FOR ORBITAL IMPS,272,RC,,,,,,,,both,,,5519.6500,827.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2301.69,,,,,,,1424.6200,5519.6500,percent of total billed charges,"41.7% of $5,519.65 in Billed Charges for Rev 272 = $2,301.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE LEVEL ONE STERILE FORMING FOR ORBITAL IMPS,272,RC,,,,,,,,both,,,5519.6500,827.9500,CIGNA HEALTHCARE,CIGNA PPO,2301.69,,,,,,,1424.6200,5519.6500,percent of total billed charges,"41.7% of $5,519.65 in Billed Charges for Rev 272 = $2,301.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE LEVEL ONE STERILE FORMING FOR ORBITAL IMPS,272,RC,,,,,,,,both,,,5519.6500,827.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4967.69,,,,,,,1424.6200,5519.6500,percent of total billed charges,"90% of $5,519.65 in Billed Charges for Rev 272 = $4,967.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE LEVEL ONE STERILE FORMING FOR ORBITAL IMPS,272,RC,,,,,,,,both,,,5519.6500,827.9500,MEDCOST,MEDCOST VHN,2626.80,,,,,,,1424.6200,5519.6500,percent of total billed charges,"47.59% of $5,519.65 in Billed Charges for Rev 272 = $2,626.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE LEVEL ONE STERILE FORMING FOR ORBITAL IMPS,272,RC,,,,,,,,both,,,5519.6500,827.9500,SENTARA HEALTH,SENTARA HEALTH,1424.62,,,,,,,1424.6200,5519.6500,percent of total billed charges,"25.81% of $5,519.65 in Billed Charges for Rev 272 = $1,424.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE LEVEL ONE STERILE FORMING FOR ORBITAL IMPS,272,RC,,,,,,,,both,,,5519.6500,827.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5519.65,,,,,,,1424.6200,5519.6500,percent of total billed charges,"100% of $5,519.65 in Billed Charges for Rev 272 = $5,519.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE LEVEL ONE STERILE FORMING FOR ORBITAL IMPS,272,RC,,,,,,,,both,,,5519.6500,827.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2759.83,,,,,,,1424.6200,5519.6500,percent of total billed charges,"Rev 272 $5,519.65 in Billed Charges at 50% = $2,759.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE LEVEL ONE STERILE FORMING FOR ORBITAL IMPS,272,RC,,,,,,,,both,,,5519.6500,827.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1782.85,,,,,,,1424.6200,5519.6500,other,"32.3% of $5,519.65 in Billed Charges for Rev 272 = $1,782.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE LEVEL ONE STERILE FORMING FOR ORBITAL IMPS,272,RC,,,,,,,,both,,,5519.6500,827.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1694.53,,,,,,,1424.6200,5519.6500,other,"30.7% of $5,519.65 in Billed Charges for Rev 272 = $1,694.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE LEVEL ONE STERILE FORMING FOR ORBITAL IMPS,272,RC,,,,,,,,both,,,5519.6500,827.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,1782.85,,,,,,,1424.6200,5519.6500,percent of total billed charges,"32.3% of $5,519.65 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE LEVEL ONE STERILE FORMING FOR ORBITAL IMPS,272,RC,,,,,,,,both,,,5519.6500,827.9500,WELLCARE,WELLCARE MEDICAID,5519.65,,,,,,,1424.6200,5519.6500,percent of total billed charges,"100% of $5,519.65 in Billed Charges for Rev 272 = $5,519.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MEASURING DEPTH FOR LOCKING SCREWS 18-110MM,272,RC,,,,,,,,both,,,7949.4800,1192.4200,AETNA,AETNA,3394.43,,,,,,,2051.7600,7949.4800,percent of total billed charges,"42.7% of $7,949.48 in Billed Charges for Rev 272 = $3,394.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MEASURING DEPTH FOR LOCKING SCREWS 18-110MM,272,RC,,,,,,,,both,,,7949.4800,1192.4200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5564.64,,,,,,,2051.7600,7949.4800,percent of total billed charges,"Rev 272 $7,949.48 in Billed Charges at 70% = $5,564.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MEASURING DEPTH FOR LOCKING SCREWS 18-110MM,272,RC,,,,,,,,both,,,7949.4800,1192.4200,CIGNA HEALTHCARE,CIGNA HMO,3314.93,,,,,,,2051.7600,7949.4800,percent of total billed charges,"41.7% of $7,949.48 in Billed Charges for Rev 272 = $3,314.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MEASURING DEPTH FOR LOCKING SCREWS 18-110MM,272,RC,,,,,,,,both,,,7949.4800,1192.4200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3688.56,,,,,,,2051.7600,7949.4800,percent of total billed charges,"46.4% of $7,949.48 in Billed Charges for Rev 272 = $3,688.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MEASURING DEPTH FOR LOCKING SCREWS 18-110MM,272,RC,,,,,,,,both,,,7949.4800,1192.4200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3314.93,,,,,,,2051.7600,7949.4800,percent of total billed charges,"41.7% of $7,949.48 in Billed Charges for Rev 272 = $3,314.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MEASURING DEPTH FOR LOCKING SCREWS 18-110MM,272,RC,,,,,,,,both,,,7949.4800,1192.4200,CIGNA HEALTHCARE,CIGNA PPO,3314.93,,,,,,,2051.7600,7949.4800,percent of total billed charges,"41.7% of $7,949.48 in Billed Charges for Rev 272 = $3,314.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MEASURING DEPTH FOR LOCKING SCREWS 18-110MM,272,RC,,,,,,,,both,,,7949.4800,1192.4200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7154.53,,,,,,,2051.7600,7949.4800,percent of total billed charges,"90% of $7,949.48 in Billed Charges for Rev 272 = $7,154.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MEASURING DEPTH FOR LOCKING SCREWS 18-110MM,272,RC,,,,,,,,both,,,7949.4800,1192.4200,MEDCOST,MEDCOST VHN,3783.16,,,,,,,2051.7600,7949.4800,percent of total billed charges,"47.59% of $7,949.48 in Billed Charges for Rev 272 = $3,783.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MEASURING DEPTH FOR LOCKING SCREWS 18-110MM,272,RC,,,,,,,,both,,,7949.4800,1192.4200,SENTARA HEALTH,SENTARA HEALTH,2051.76,,,,,,,2051.7600,7949.4800,percent of total billed charges,"25.81% of $7,949.48 in Billed Charges for Rev 272 = $2,051.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MEASURING DEPTH FOR LOCKING SCREWS 18-110MM,272,RC,,,,,,,,both,,,7949.4800,1192.4200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7949.48,,,,,,,2051.7600,7949.4800,percent of total billed charges,"100% of $7,949.48 in Billed Charges for Rev 272 = $7,949.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MEASURING DEPTH FOR LOCKING SCREWS 18-110MM,272,RC,,,,,,,,both,,,7949.4800,1192.4200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3974.74,,,,,,,2051.7600,7949.4800,percent of total billed charges,"Rev 272 $7,949.48 in Billed Charges at 50% = $3,974.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MEASURING DEPTH FOR LOCKING SCREWS 18-110MM,272,RC,,,,,,,,both,,,7949.4800,1192.4200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2567.68,,,,,,,2051.7600,7949.4800,other,"32.3% of $7,949.48 in Billed Charges for Rev 272 = $2,567.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE MEASURING DEPTH FOR LOCKING SCREWS 18-110MM,272,RC,,,,,,,,both,,,7949.4800,1192.4200,UNITED HEALTHCARE,UHC HERITAGE SELECT,2440.49,,,,,,,2051.7600,7949.4800,other,"30.7% of $7,949.48 in Billed Charges for Rev 272 = $2,440.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE MEASURING DEPTH FOR LOCKING SCREWS 18-110MM,272,RC,,,,,,,,both,,,7949.4800,1192.4200,UNITED HEALTHCARE,UNITED HEALTHCARE,2567.68,,,,,,,2051.7600,7949.4800,percent of total billed charges,"32.3% of $7,949.48 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MEASURING DEPTH FOR LOCKING SCREWS 18-110MM,272,RC,,,,,,,,both,,,7949.4800,1192.4200,WELLCARE,WELLCARE MEDICAID,7949.48,,,,,,,2051.7600,7949.4800,percent of total billed charges,"100% of $7,949.48 in Billed Charges for Rev 272 = $7,949.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NITINOL RETRIEVAL 10MM,272,RC,27200002,CDM,,,,,,both,,,3219.7800,482.9700,AETNA,AETNA,1374.85,,,,,,,831.0300,3219.7800,percent of total billed charges,"42.7% of $3,219.78 in Billed Charges for Rev 272 = $1,374.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NITINOL RETRIEVAL 10MM,272,RC,27200002,CDM,,,,,,both,,,3219.7800,482.9700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2253.85,,,,,,,831.0300,3219.7800,percent of total billed charges,"Rev 272 $3,219.78 in Billed Charges at 70% = $2,253.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NITINOL RETRIEVAL 10MM,272,RC,27200002,CDM,,,,,,both,,,3219.7800,482.9700,CIGNA HEALTHCARE,CIGNA HMO,1342.65,,,,,,,831.0300,3219.7800,percent of total billed charges,"41.7% of $3,219.78 in Billed Charges for Rev 272 = $1,342.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NITINOL RETRIEVAL 10MM,272,RC,27200002,CDM,,,,,,both,,,3219.7800,482.9700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1493.98,,,,,,,831.0300,3219.7800,percent of total billed charges,"46.4% of $3,219.78 in Billed Charges for Rev 272 = $1,493.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NITINOL RETRIEVAL 10MM,272,RC,27200002,CDM,,,,,,both,,,3219.7800,482.9700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1342.65,,,,,,,831.0300,3219.7800,percent of total billed charges,"41.7% of $3,219.78 in Billed Charges for Rev 272 = $1,342.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NITINOL RETRIEVAL 10MM,272,RC,27200002,CDM,,,,,,both,,,3219.7800,482.9700,CIGNA HEALTHCARE,CIGNA PPO,1342.65,,,,,,,831.0300,3219.7800,percent of total billed charges,"41.7% of $3,219.78 in Billed Charges for Rev 272 = $1,342.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NITINOL RETRIEVAL 10MM,272,RC,27200002,CDM,,,,,,both,,,3219.7800,482.9700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2897.80,,,,,,,831.0300,3219.7800,percent of total billed charges,"90% of $3,219.78 in Billed Charges for Rev 272 = $2,897.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NITINOL RETRIEVAL 10MM,272,RC,27200002,CDM,,,,,,both,,,3219.7800,482.9700,MEDCOST,MEDCOST VHN,1532.29,,,,,,,831.0300,3219.7800,percent of total billed charges,"47.59% of $3,219.78 in Billed Charges for Rev 272 = $1,532.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NITINOL RETRIEVAL 10MM,272,RC,27200002,CDM,,,,,,both,,,3219.7800,482.9700,SENTARA HEALTH,SENTARA HEALTH,831.03,,,,,,,831.0300,3219.7800,percent of total billed charges,"25.81% of $3,219.78 in Billed Charges for Rev 272 = $831.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NITINOL RETRIEVAL 10MM,272,RC,27200002,CDM,,,,,,both,,,3219.7800,482.9700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3219.78,,,,,,,831.0300,3219.7800,percent of total billed charges,"100% of $3,219.78 in Billed Charges for Rev 272 = $3,219.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NITINOL RETRIEVAL 10MM,272,RC,27200002,CDM,,,,,,both,,,3219.7800,482.9700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1609.89,,,,,,,831.0300,3219.7800,percent of total billed charges,"Rev 272 $3,219.78 in Billed Charges at 50% = $1,609.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NITINOL RETRIEVAL 10MM,272,RC,27200002,CDM,,,,,,both,,,3219.7800,482.9700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1039.99,,,,,,,831.0300,3219.7800,other,"32.3% of $3,219.78 in Billed Charges for Rev 272 = $1,039.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE NITINOL RETRIEVAL 10MM,272,RC,27200002,CDM,,,,,,both,,,3219.7800,482.9700,UNITED HEALTHCARE,UHC HERITAGE SELECT,988.47,,,,,,,831.0300,3219.7800,other,"30.7% of $3,219.78 in Billed Charges for Rev 272 = $988.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE NITINOL RETRIEVAL 10MM,272,RC,27200002,CDM,,,,,,both,,,3219.7800,482.9700,UNITED HEALTHCARE,UNITED HEALTHCARE,1039.99,,,,,,,831.0300,3219.7800,percent of total billed charges,"32.3% of $3,219.78 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NITINOL RETRIEVAL 10MM,272,RC,27200002,CDM,,,,,,both,,,3219.7800,482.9700,WELLCARE,WELLCARE MEDICAID,3219.78,,,,,,,831.0300,3219.7800,percent of total billed charges,"100% of $3,219.78 in Billed Charges for Rev 272 = $3,219.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL ACCESS 10G STERILE,272,RC,,,,,,,,both,,,1443.6400,216.5500,AETNA,AETNA,616.43,,,,,,,372.6000,1443.6400,percent of total billed charges,"42.7% of $1,443.64 in Billed Charges for Rev 272 = $616.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL ACCESS 10G STERILE,272,RC,,,,,,,,both,,,1443.6400,216.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1010.55,,,,,,,372.6000,1443.6400,percent of total billed charges,"Rev 272 $1,443.64 in Billed Charges at 70% = $1,010.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL ACCESS 10G STERILE,272,RC,,,,,,,,both,,,1443.6400,216.5500,CIGNA HEALTHCARE,CIGNA HMO,602.00,,,,,,,372.6000,1443.6400,percent of total billed charges,"41.7% of $1,443.64 in Billed Charges for Rev 272 = $602.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL ACCESS 10G STERILE,272,RC,,,,,,,,both,,,1443.6400,216.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,669.85,,,,,,,372.6000,1443.6400,percent of total billed charges,"46.4% of $1,443.64 in Billed Charges for Rev 272 = $669.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL ACCESS 10G STERILE,272,RC,,,,,,,,both,,,1443.6400,216.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,602.00,,,,,,,372.6000,1443.6400,percent of total billed charges,"41.7% of $1,443.64 in Billed Charges for Rev 272 = $602.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL ACCESS 10G STERILE,272,RC,,,,,,,,both,,,1443.6400,216.5500,CIGNA HEALTHCARE,CIGNA PPO,602.00,,,,,,,372.6000,1443.6400,percent of total billed charges,"41.7% of $1,443.64 in Billed Charges for Rev 272 = $602.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL ACCESS 10G STERILE,272,RC,,,,,,,,both,,,1443.6400,216.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1299.28,,,,,,,372.6000,1443.6400,percent of total billed charges,"90% of $1,443.64 in Billed Charges for Rev 272 = $1,299.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL ACCESS 10G STERILE,272,RC,,,,,,,,both,,,1443.6400,216.5500,MEDCOST,MEDCOST VHN,687.03,,,,,,,372.6000,1443.6400,percent of total billed charges,"47.59% of $1,443.64 in Billed Charges for Rev 272 = $687.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL ACCESS 10G STERILE,272,RC,,,,,,,,both,,,1443.6400,216.5500,SENTARA HEALTH,SENTARA HEALTH,372.60,,,,,,,372.6000,1443.6400,percent of total billed charges,"25.81% of $1,443.64 in Billed Charges for Rev 272 = $372.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL ACCESS 10G STERILE,272,RC,,,,,,,,both,,,1443.6400,216.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1443.64,,,,,,,372.6000,1443.6400,percent of total billed charges,"100% of $1,443.64 in Billed Charges for Rev 272 = $1,443.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL ACCESS 10G STERILE,272,RC,,,,,,,,both,,,1443.6400,216.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,721.82,,,,,,,372.6000,1443.6400,percent of total billed charges,"Rev 272 $1,443.64 in Billed Charges at 50% = $721.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL ACCESS 10G STERILE,272,RC,,,,,,,,both,,,1443.6400,216.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,466.30,,,,,,,372.6000,1443.6400,other,"32.3% of $1,443.64 in Billed Charges for Rev 272 = $466.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL ACCESS 10G STERILE,272,RC,,,,,,,,both,,,1443.6400,216.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,443.20,,,,,,,372.6000,1443.6400,other,"30.7% of $1,443.64 in Billed Charges for Rev 272 = $443.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL ACCESS 10G STERILE,272,RC,,,,,,,,both,,,1443.6400,216.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,466.30,,,,,,,372.6000,1443.6400,percent of total billed charges,"32.3% of $1,443.64 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL ACCESS 10G STERILE,272,RC,,,,,,,,both,,,1443.6400,216.5500,WELLCARE,WELLCARE MEDICAID,1443.64,,,,,,,372.6000,1443.6400,percent of total billed charges,"100% of $1,443.64 in Billed Charges for Rev 272 = $1,443.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,AETNA,AETNA,189.59,,,,,,,109.0000,703.3600,percent of total billed charges,42.7% of $444.00 in Billed Charges for Rev 450 Proc 28470 = $189.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,703.3600,fee schedule,"APG 00041 Proc 28470 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,703.3600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,BLUE CROSS,ANTHEM EXCHANGE,444.00,,,,,,,109.0000,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,444.00,,,,,,,109.0000,703.3600,fee schedule,"APG 00041 Proc 28470 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96 (Service Line reduced to $444.00, claim capped at $444.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,BLUE CROSS,ANTHEM HMO,444.00,,,,,,,109.0000,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,703.3600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",444.00,,,,,,,109.0000,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,159.44,,,,,,,109.0000,703.3600,fee schedule,$159.44 from Fee Schedule BLDTM_23 for Rev 450 Proc 28470 * Qty 1 = $159.44 at 100% = $159.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,399.60,,,,,,,109.0000,703.3600,percent of total billed charges,90% of $444.00 in Billed Charges for Rev 450 Proc 28470 = $399.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,MEDCOST,MEDCOST VHN,211.30,,,,,,,109.0000,703.3600,percent of total billed charges,47.59% of $444.00 in Billed Charges for Rev 450 Proc 28470 = $211.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,703.3600,fee schedule,"APG 00041 Proc 28470 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,703.3600,fee schedule,"APG 00041 Proc 28470 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,SENTARA HEALTH,SENTARA HEALTH,114.60,,,,,,,109.0000,703.3600,percent of total billed charges,25.81% of $444.00 in Billed Charges for Rev 450 Proc 28470 = $114.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",444.00,,,,,,,109.0000,703.3600,percent of total billed charges,100% of $444.00 in Billed Charges for Rev 450 Proc 28470 = $444.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,703.3600,case rate,Rev 450 Proc 28470 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,444.00,,,,,,,109.0000,703.3600,case rate,"Rev 450 Proc 28470 at Case Rate $491.00 (Service Line reduced to $444.00, claim capped at $444.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,444.00,,,,,,,109.0000,703.3600,case rate,"Rev 450 Proc 28470 at Case Rate $471.00 (Service Line reduced to $444.00, claim capped at $444.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,444.00,,,,,,,109.0000,703.3600,case rate,"Rev 450 Proc 28470 at Case Rate $847.00 (Service Line reduced to $444.00, claim capped at $444.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,703.3600,fee schedule,"APG 00041 Proc 28470 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,WELLCARE,WELLCARE MEDICAID,444.00,,,,,,,109.0000,703.3600,percent of total billed charges,100% of $444.00 in Billed Charges for Rev 450 Proc 28470 = $444.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TX METATARSAL FX WO MANIP,28470,CPT,450,RC,45000183,CDM,,,,both,,,444.0000,66.6000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,703.3600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,AETNA,AETNA,316.83,,,,,,,109.0000,742.0000,percent of total billed charges,42.7% of $742.00 in Billed Charges for Rev 450 Proc 28475 = $316.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,742.0000,fee schedule,"APG 00041 Proc 28475 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,742.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,742.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,742.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,742.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,742.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,742.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,742.0000,fee schedule,"APG 00041 Proc 28475 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,742.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,742.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,742.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,170.73,,,,,,,109.0000,742.0000,fee schedule,$170.73 from Fee Schedule BLDTM_23 for Rev 450 Proc 28475 * Qty 1 = $170.73 at 100% = $170.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,742.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,742.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,742.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,667.80,,,,,,,109.0000,742.0000,percent of total billed charges,90% of $742.00 in Billed Charges for Rev 450 Proc 28475 = $667.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,742.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,742.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,MEDCOST,MEDCOST VHN,353.12,,,,,,,109.0000,742.0000,percent of total billed charges,47.59% of $742.00 in Billed Charges for Rev 450 Proc 28475 = $353.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,742.0000,fee schedule,"APG 00041 Proc 28475 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,742.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,742.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,742.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,742.0000,fee schedule,"APG 00041 Proc 28475 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,SENTARA HEALTH,SENTARA HEALTH,191.51,,,,,,,109.0000,742.0000,percent of total billed charges,25.81% of $742.00 in Billed Charges for Rev 450 Proc 28475 = $191.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,742.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",742.00,,,,,,,109.0000,742.0000,percent of total billed charges,100% of $742.00 in Billed Charges for Rev 450 Proc 28475 = $742.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,742.0000,case rate,Rev 450 Proc 28475 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,742.0000,case rate,Rev 450 Proc 28475 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,742.0000,case rate,Rev 450 Proc 28475 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,742.00,,,,,,,109.0000,742.0000,case rate,"Rev 450 Proc 28475 at Case Rate $847.00 (Service Line reduced to $742.00, claim capped at $742.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,742.0000,fee schedule,"APG 00041 Proc 28475 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,742.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,742.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,WELLCARE,WELLCARE MEDICAID,742.00,,,,,,,109.0000,742.0000,percent of total billed charges,100% of $742.00 in Billed Charges for Rev 450 Proc 28475 = $742.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX METATARSAL FX W MAN EA,28475,CPT,450,RC,45000184,CDM,,,,both,,,742.0000,111.3000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,742.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,AETNA,AETNA,227.16,,,,,,,83.5200,703.3600,percent of total billed charges,42.7% of $532.00 in Billed Charges for Rev 450 Proc 28495 = $227.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,83.5200,703.3600,fee schedule,"APG 00041 Proc 28495 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,83.5200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,83.5200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,83.5200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,AMBETTER,AMBETTER,487.87,,,,,,,83.5200,703.3600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,83.5200,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,BLUE CROSS,ANTHEM EXCHANGE,532.00,,,,,,,83.5200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,532.00,,,,,,,83.5200,703.3600,fee schedule,"APG 00041 Proc 28495 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96 (Service Line reduced to $532.00, claim capped at $532.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,BLUE CROSS,ANTHEM HMO,532.00,,,,,,,83.5200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,83.5200,703.3600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",532.00,,,,,,,83.5200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,83.52,,,,,,,83.5200,703.3600,fee schedule,$83.52 from Fee Schedule BLDTM_23 for Rev 450 Proc 28495 * Qty 1 = $83.52 at 100% = $83.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,83.5200,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,83.5200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,83.5200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,478.80,,,,,,,83.5200,703.3600,percent of total billed charges,90% of $532.00 in Billed Charges for Rev 450 Proc 28495 = $478.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,83.5200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,83.5200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,MEDCOST,MEDCOST VHN,253.18,,,,,,,83.5200,703.3600,percent of total billed charges,47.59% of $532.00 in Billed Charges for Rev 450 Proc 28495 = $253.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,83.5200,703.3600,fee schedule,"APG 00041 Proc 28495 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,83.5200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,83.5200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,83.5200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,83.5200,703.3600,fee schedule,"APG 00041 Proc 28495 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,SENTARA HEALTH,SENTARA HEALTH,137.31,,,,,,,83.5200,703.3600,percent of total billed charges,25.81% of $532.00 in Billed Charges for Rev 450 Proc 28495 = $137.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,83.5200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",532.00,,,,,,,83.5200,703.3600,percent of total billed charges,100% of $532.00 in Billed Charges for Rev 450 Proc 28495 = $532.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,83.5200,703.3600,case rate,Rev 450 Proc 28495 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,83.5200,703.3600,case rate,Rev 450 Proc 28495 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,83.5200,703.3600,case rate,Rev 450 Proc 28495 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,532.00,,,,,,,83.5200,703.3600,case rate,"Rev 450 Proc 28495 at Case Rate $847.00 (Service Line reduced to $532.00, claim capped at $532.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,83.5200,703.3600,fee schedule,"APG 00041 Proc 28495 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,83.5200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,83.5200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,WELLCARE,WELLCARE MEDICAID,532.00,,,,,,,83.5200,703.3600,percent of total billed charges,100% of $532.00 in Billed Charges for Rev 450 Proc 28495 = $532.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GREAT TOE FX W MANIP,28495,CPT,450,RC,45000186,CDM,,,,both,,,532.0000,79.8000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,83.5200,703.3600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA,180.19,,,,,,,61.5100,703.3600,percent of total billed charges,42.7% of $422.00 in Billed Charges for Rev 450 Proc 28510 = $180.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,61.5100,703.3600,fee schedule,"APG 00041 Proc 28510 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,61.5100,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,61.5100,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,61.5100,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,AMBETTER,AMBETTER,487.87,,,,,,,61.5100,703.3600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,61.5100,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM EXCHANGE,422.00,,,,,,,61.5100,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,422.00,,,,,,,61.5100,703.3600,fee schedule,"APG 00041 Proc 28510 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HMO,422.00,,,,,,,61.5100,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,61.5100,703.3600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",422.00,,,,,,,61.5100,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,61.51,,,,,,,61.5100,703.3600,fee schedule,$61.51 from Fee Schedule BLDTM_23 for Rev 450 Proc 28510 * Qty 1 = $61.51 at 100% = $61.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,61.5100,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,61.5100,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,61.5100,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,379.80,,,,,,,61.5100,703.3600,percent of total billed charges,90% of $422.00 in Billed Charges for Rev 450 Proc 28510 = $379.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,61.5100,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,61.5100,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,MEDCOST,MEDCOST VHN,200.83,,,,,,,61.5100,703.3600,percent of total billed charges,47.59% of $422.00 in Billed Charges for Rev 450 Proc 28510 = $200.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,61.5100,703.3600,fee schedule,"APG 00041 Proc 28510 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,61.5100,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,61.5100,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,61.5100,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,61.5100,703.3600,fee schedule,"APG 00041 Proc 28510 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA HEALTH,108.92,,,,,,,61.5100,703.3600,percent of total billed charges,25.81% of $422.00 in Billed Charges for Rev 450 Proc 28510 = $108.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,61.5100,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",422.00,,,,,,,61.5100,703.3600,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 28510 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,61.5100,703.3600,case rate,Rev 450 Proc 28510 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,422.00,,,,,,,61.5100,703.3600,case rate,"Rev 450 Proc 28510 at Case Rate $491.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,422.00,,,,,,,61.5100,703.3600,case rate,"Rev 450 Proc 28510 at Case Rate $471.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,422.00,,,,,,,61.5100,703.3600,case rate,"Rev 450 Proc 28510 at Case Rate $847.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,61.5100,703.3600,fee schedule,"APG 00041 Proc 28510 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,61.5100,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,61.5100,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICAID,422.00,,,,,,,61.5100,703.3600,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 28510 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHAL FRACT O/T GRT TOE W/O MAN,28510,CPT,450,RC,45000187,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,61.5100,703.3600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,AETNA,AETNA,248.51,,,,,,,78.4400,703.3600,percent of total billed charges,42.7% of $582.00 in Billed Charges for Rev 450 Proc 28515 = $248.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,78.4400,703.3600,fee schedule,"APG 00041 Proc 28515 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,78.4400,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,78.4400,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,78.4400,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,AMBETTER,AMBETTER,487.87,,,,,,,78.4400,703.3600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,78.4400,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,78.4400,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,582.00,,,,,,,78.4400,703.3600,fee schedule,"APG 00041 Proc 28515 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96 (Service Line reduced to $582.00, claim capped at $582.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,BLUE CROSS,ANTHEM HMO,582.00,,,,,,,78.4400,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,78.4400,703.3600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",582.00,,,,,,,78.4400,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,78.44,,,,,,,78.4400,703.3600,fee schedule,$78.44 from Fee Schedule BLDTM_23 for Rev 450 Proc 28515 * Qty 1 = $78.44 at 100% = $78.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,78.4400,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,78.4400,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,78.4400,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,523.80,,,,,,,78.4400,703.3600,percent of total billed charges,90% of $582.00 in Billed Charges for Rev 450 Proc 28515 = $523.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,78.4400,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,78.4400,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,MEDCOST,MEDCOST VHN,276.97,,,,,,,78.4400,703.3600,percent of total billed charges,47.59% of $582.00 in Billed Charges for Rev 450 Proc 28515 = $276.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,78.4400,703.3600,fee schedule,"APG 00041 Proc 28515 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,78.4400,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,78.4400,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,78.4400,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,78.4400,703.3600,fee schedule,"APG 00041 Proc 28515 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,SENTARA HEALTH,SENTARA HEALTH,150.21,,,,,,,78.4400,703.3600,percent of total billed charges,25.81% of $582.00 in Billed Charges for Rev 450 Proc 28515 = $150.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,78.4400,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",582.00,,,,,,,78.4400,703.3600,percent of total billed charges,100% of $582.00 in Billed Charges for Rev 450 Proc 28515 = $582.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,78.4400,703.3600,case rate,Rev 450 Proc 28515 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,78.4400,703.3600,case rate,Rev 450 Proc 28515 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,78.4400,703.3600,case rate,Rev 450 Proc 28515 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,582.00,,,,,,,78.4400,703.3600,case rate,"Rev 450 Proc 28515 at Case Rate $847.00 (Service Line reduced to $582.00, claim capped at $582.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,78.4400,703.3600,fee schedule,"APG 00041 Proc 28515 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,78.4400,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,78.4400,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,WELLCARE,WELLCARE MEDICAID,582.00,,,,,,,78.4400,703.3600,percent of total billed charges,100% of $582.00 in Billed Charges for Rev 450 Proc 28515 = $582.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX FX PHAL EX GT TOE W MA,28515,CPT,450,RC,45000188,CDM,,,,both,,,582.0000,87.3000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,78.4400,703.3600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ PHRENIC NRV STIMULATOR TRANSVNS SENSING LD,33277,CPT,481,RC,48100223,CDM,,,,both,,,35553.0000,5332.9500,AETNA,AETNA,15181.13,,,,,,,148.0000,35553.0000,percent of total billed charges,"42.7% of $35,553.00 in Billed Charges for Rev 481 Proc 33277 = $15,181.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ PHRENIC NRV STIMULATOR TRANSVNS SENSING LD,33277,CPT,481,RC,48100223,CDM,,,,both,,,35553.0000,5332.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,4567.49,,,,,,,148.0000,35553.0000,fee schedule,"APG 00276 Proc 33277 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 104% = $4,567.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ PHRENIC NRV STIMULATOR TRANSVNS SENSING LD,33277,CPT,481,RC,48100223,CDM,,,,both,,,35553.0000,5332.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,4523.57,,,,,,,148.0000,35553.0000,fee schedule,"APG 00276 Proc 33277 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 103% = $4,523.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ PHRENIC NRV STIMULATOR TRANSVNS SENSING LD,33277,CPT,481,RC,48100223,CDM,,,,both,,,35553.0000,5332.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,24887.10,,,,,,,148.0000,35553.0000,percent of total billed charges,"Rev 481 Proc 33277 $35,553.00 in Billed Charges at 70% = $24,887.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ PHRENIC NRV STIMULATOR TRANSVNS SENSING LD,33277,CPT,481,RC,48100223,CDM,,,,both,,,35553.0000,5332.9500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,35553.0000,case rate,Rev 481 Proc 33277 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ PHRENIC NRV STIMULATOR TRANSVNS SENSING LD,33277,CPT,481,RC,48100223,CDM,,,,both,,,35553.0000,5332.9500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,35553.0000,case rate,Rev 481 Proc 33277 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ PHRENIC NRV STIMULATOR TRANSVNS SENSING LD,33277,CPT,481,RC,48100223,CDM,,,,both,,,35553.0000,5332.9500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,35553.0000,case rate,Rev 481 Proc 33277 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ PHRENIC NRV STIMULATOR TRANSVNS SENSING LD,33277,CPT,481,RC,48100223,CDM,,,,both,,,35553.0000,5332.9500,CIGNA HEALTHCARE,CIGNA HMO,14825.60,,,,,,,148.0000,35553.0000,percent of total billed charges,"41.7% of $35,553.00 in Billed Charges for Rev 481 Proc 33277 = $14,825.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ PHRENIC NRV STIMULATOR TRANSVNS SENSING LD,33277,CPT,481,RC,48100223,CDM,,,,both,,,35553.0000,5332.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,16496.59,,,,,,,148.0000,35553.0000,percent of total billed charges,"46.4% of $35,553.00 in Billed Charges for Rev 481 Proc 33277 = $16,496.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ PHRENIC NRV STIMULATOR TRANSVNS SENSING LD,33277,CPT,481,RC,48100223,CDM,,,,both,,,35553.0000,5332.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,14825.60,,,,,,,148.0000,35553.0000,percent of total billed charges,"41.7% of $35,553.00 in Billed Charges for Rev 481 Proc 33277 = $14,825.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ PHRENIC NRV STIMULATOR TRANSVNS SENSING LD,33277,CPT,481,RC,48100223,CDM,,,,both,,,35553.0000,5332.9500,CIGNA HEALTHCARE,CIGNA PPO,14825.60,,,,,,,148.0000,35553.0000,percent of total billed charges,"41.7% of $35,553.00 in Billed Charges for Rev 481 Proc 33277 = $14,825.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ PHRENIC NRV STIMULATOR TRANSVNS SENSING LD,33277,CPT,481,RC,48100223,CDM,,,,both,,,35553.0000,5332.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,31997.70,,,,,,,148.0000,35553.0000,percent of total billed charges,"90% of $35,553.00 in Billed Charges for Rev 481 Proc 33277 = $31,997.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ PHRENIC NRV STIMULATOR TRANSVNS SENSING LD,33277,CPT,481,RC,48100223,CDM,,,,both,,,35553.0000,5332.9500,MEDCOST,MEDCOST VHN,16919.67,,,,,,,148.0000,35553.0000,percent of total billed charges,"47.59% of $35,553.00 in Billed Charges for Rev 481 Proc 33277 = $16,919.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ PHRENIC NRV STIMULATOR TRANSVNS SENSING LD,33277,CPT,481,RC,48100223,CDM,,,,both,,,35553.0000,5332.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,4611.41,,,,,,,148.0000,35553.0000,fee schedule,"APG 00276 Proc 33277 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 100% = $4,391.82... $4,391.82 at 105% = $4,611.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ PHRENIC NRV STIMULATOR TRANSVNS SENSING LD,33277,CPT,481,RC,48100223,CDM,,,,both,,,35553.0000,5332.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,4527.97,,,,,,,148.0000,35553.0000,fee schedule,"APG 00276 Proc 33277 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 100% = $4,391.82... $4,391.82 at 103.1% = $4,527.97 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ PHRENIC NRV STIMULATOR TRANSVNS SENSING LD,33277,CPT,481,RC,48100223,CDM,,,,both,,,35553.0000,5332.9500,SENTARA HEALTH,SENTARA HEALTH,9176.23,,,,,,,148.0000,35553.0000,percent of total billed charges,"25.81% of $35,553.00 in Billed Charges for Rev 481 Proc 33277 = $9,176.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ PHRENIC NRV STIMULATOR TRANSVNS SENSING LD,33277,CPT,481,RC,48100223,CDM,,,,both,,,35553.0000,5332.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",35553.00,,,,,,,148.0000,35553.0000,percent of total billed charges,"100% of $35,553.00 in Billed Charges for Rev 481 Proc 33277 = $35,553.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSJ PHRENIC NRV STIMULATOR TRANSVNS SENSING LD,33277,CPT,481,RC,48100223,CDM,,,,both,,,35553.0000,5332.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,148.0000,35553.0000,case rate,Rev 481 Proc 33277 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ PHRENIC NRV STIMULATOR TRANSVNS SENSING LD,33277,CPT,481,RC,48100223,CDM,,,,both,,,35553.0000,5332.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,148.0000,35553.0000,case rate,Rev 481 Proc 33277 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ PHRENIC NRV STIMULATOR TRANSVNS SENSING LD,33277,CPT,481,RC,48100223,CDM,,,,both,,,35553.0000,5332.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,148.0000,35553.0000,case rate,Rev 481 Proc 33277 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ PHRENIC NRV STIMULATOR TRANSVNS SENSING LD,33277,CPT,481,RC,48100223,CDM,,,,both,,,35553.0000,5332.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,148.0000,35553.0000,case rate,Rev 481 Proc 33277 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSJ PHRENIC NRV STIMULATOR TRANSVNS SENSING LD,33277,CPT,481,RC,48100223,CDM,,,,both,,,35553.0000,5332.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,4523.57,,,,,,,148.0000,35553.0000,fee schedule,"APG 00276 Proc 33277 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 103% = $4,523.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSJ PHRENIC NRV STIMULATOR TRANSVNS SENSING LD,33277,CPT,481,RC,48100223,CDM,,,,both,,,35553.0000,5332.9500,WELLCARE,WELLCARE MEDICAID,35553.00,,,,,,,148.0000,35553.0000,percent of total billed charges,"100% of $35,553.00 in Billed Charges for Rev 481 Proc 33277 = $35,553.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,AETNA,AETNA,4425.43,,,,,,,1881.0000,10364.0000,percent of total billed charges,"42.7% of $10,364.00 in Billed Charges for Rev 481 Proc 33278 = $4,425.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,4567.49,,,,,,,1881.0000,10364.0000,fee schedule,"APG 00276 Proc 33278 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 104% = $4,567.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,AETNA,AETNA HEALTHCARE MEDICARE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,AMBETTER,AMBETTER,6914.80,,,,,,,1881.0000,10364.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3298.81,,,,,,,1881.0000,10364.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,ANTHEM EXCHANGE,7809.46,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,4523.57,,,,,,,1881.0000,10364.0000,fee schedule,"APG 00276 Proc 33278 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 103% = $4,523.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,ANTHEM HMO,8297.09,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3267.09,,,,,,,1881.0000,10364.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9760.75,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7254.80,,,,,,,1881.0000,10364.0000,percent of total billed charges,"Rev 481 Proc 33278 $10,364.00 in Billed Charges at 70% = $7,254.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33278 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,BLUE CROSS MEDICARE,3298.81,,,,,,,1881.0000,10364.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33278 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33278 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,CIGNA HEALTHCARE,CIGNA HMO,4321.79,,,,,,,1881.0000,10364.0000,percent of total billed charges,"41.7% of $10,364.00 in Billed Charges for Rev 481 Proc 33278 = $4,321.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4808.90,,,,,,,1881.0000,10364.0000,percent of total billed charges,"46.4% of $10,364.00 in Billed Charges for Rev 481 Proc 33278 = $4,808.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,3330.52,,,,,,,1881.0000,10364.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4321.79,,,,,,,1881.0000,10364.0000,percent of total billed charges,"41.7% of $10,364.00 in Billed Charges for Rev 481 Proc 33278 = $4,321.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,CIGNA HEALTHCARE,CIGNA PPO,4321.79,,,,,,,1881.0000,10364.0000,percent of total billed charges,"41.7% of $10,364.00 in Billed Charges for Rev 481 Proc 33278 = $4,321.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3330.52,,,,,,,1881.0000,10364.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9327.60,,,,,,,1881.0000,10364.0000,percent of total billed charges,"90% of $10,364.00 in Billed Charges for Rev 481 Proc 33278 = $9,327.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,HUMANA,HUMANA MEDICARE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,MEDCOST,MEDCOST VHN,4932.23,,,,,,,1881.0000,10364.0000,percent of total billed charges,"47.59% of $10,364.00 in Billed Charges for Rev 481 Proc 33278 = $4,932.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,4611.41,,,,,,,1881.0000,10364.0000,fee schedule,"APG 00276 Proc 33278 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 100% = $4,391.82... $4,391.82 at 105% = $4,611.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3330.52,,,,,,,1881.0000,10364.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3330.52,,,,,,,1881.0000,10364.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,NHC ADVANTAGE,NHC ADVANTAGE,3330.52,,,,,,,1881.0000,10364.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,4527.97,,,,,,,1881.0000,10364.0000,fee schedule,"APG 00276 Proc 33278 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 100% = $4,391.82... $4,391.82 at 103.1% = $4,527.97 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,SENTARA HEALTH,SENTARA HEALTH,2674.95,,,,,,,1881.0000,10364.0000,percent of total billed charges,"25.81% of $10,364.00 in Billed Charges for Rev 481 Proc 33278 = $2,674.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,SENTARA HEALTH,SENTARA MEDICARE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10364.00,,,,,,,1881.0000,10364.0000,percent of total billed charges,"100% of $10,364.00 in Billed Charges for Rev 481 Proc 33278 = $10,364.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33278 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33278 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33278 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33278 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,4523.57,,,,,,,1881.0000,10364.0000,fee schedule,"APG 00276 Proc 33278 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 103% = $4,523.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,WELLCARE,WELLCARE MEDICAID,10364.00,,,,,,,1881.0000,10364.0000,percent of total billed charges,"100% of $10,364.00 in Billed Charges for Rev 481 Proc 33278 = $10,364.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL PHRENIC NERVE STIMULATOR SYSTEM,33278,CPT,481,RC,48100224,CDM,,,,both,,,10364.0000,1554.6000,WELLCARE,WELLCARE MEDICARE,3362.24,,,,,,,1881.0000,10364.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,AETNA,AETNA,4425.43,,,,,,,1881.0000,10364.0000,percent of total billed charges,"42.7% of $10,364.00 in Billed Charges for Rev 481 Proc 33279 = $4,425.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,4567.49,,,,,,,1881.0000,10364.0000,fee schedule,"APG 00276 Proc 33279 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 104% = $4,567.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,AETNA,AETNA HEALTHCARE MEDICARE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,AMBETTER,AMBETTER,6914.80,,,,,,,1881.0000,10364.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3298.81,,,,,,,1881.0000,10364.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,ANTHEM EXCHANGE,7809.46,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,4523.57,,,,,,,1881.0000,10364.0000,fee schedule,"APG 00276 Proc 33279 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 103% = $4,523.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,ANTHEM HMO,8297.09,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3267.09,,,,,,,1881.0000,10364.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9760.75,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7254.80,,,,,,,1881.0000,10364.0000,percent of total billed charges,"Rev 481 Proc 33279 $10,364.00 in Billed Charges at 70% = $7,254.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33279 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,BLUE CROSS MEDICARE,3298.81,,,,,,,1881.0000,10364.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33279 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33279 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,CIGNA HEALTHCARE,CIGNA HMO,4321.79,,,,,,,1881.0000,10364.0000,percent of total billed charges,"41.7% of $10,364.00 in Billed Charges for Rev 481 Proc 33279 = $4,321.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4808.90,,,,,,,1881.0000,10364.0000,percent of total billed charges,"46.4% of $10,364.00 in Billed Charges for Rev 481 Proc 33279 = $4,808.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,3330.52,,,,,,,1881.0000,10364.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4321.79,,,,,,,1881.0000,10364.0000,percent of total billed charges,"41.7% of $10,364.00 in Billed Charges for Rev 481 Proc 33279 = $4,321.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,CIGNA HEALTHCARE,CIGNA PPO,4321.79,,,,,,,1881.0000,10364.0000,percent of total billed charges,"41.7% of $10,364.00 in Billed Charges for Rev 481 Proc 33279 = $4,321.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3330.52,,,,,,,1881.0000,10364.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9327.60,,,,,,,1881.0000,10364.0000,percent of total billed charges,"90% of $10,364.00 in Billed Charges for Rev 481 Proc 33279 = $9,327.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,HUMANA,HUMANA MEDICARE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,MEDCOST,MEDCOST VHN,4932.23,,,,,,,1881.0000,10364.0000,percent of total billed charges,"47.59% of $10,364.00 in Billed Charges for Rev 481 Proc 33279 = $4,932.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,4611.41,,,,,,,1881.0000,10364.0000,fee schedule,"APG 00276 Proc 33279 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 100% = $4,391.82... $4,391.82 at 105% = $4,611.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3330.52,,,,,,,1881.0000,10364.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3330.52,,,,,,,1881.0000,10364.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,NHC ADVANTAGE,NHC ADVANTAGE,3330.52,,,,,,,1881.0000,10364.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,4527.97,,,,,,,1881.0000,10364.0000,fee schedule,"APG 00276 Proc 33279 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 100% = $4,391.82... $4,391.82 at 103.1% = $4,527.97 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,SENTARA HEALTH,SENTARA HEALTH,2674.95,,,,,,,1881.0000,10364.0000,percent of total billed charges,"25.81% of $10,364.00 in Billed Charges for Rev 481 Proc 33279 = $2,674.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,SENTARA HEALTH,SENTARA MEDICARE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10364.00,,,,,,,1881.0000,10364.0000,percent of total billed charges,"100% of $10,364.00 in Billed Charges for Rev 481 Proc 33279 = $10,364.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33279 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33279 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33279 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33279 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,4523.57,,,,,,,1881.0000,10364.0000,fee schedule,"APG 00276 Proc 33279 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 103% = $4,523.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,WELLCARE,WELLCARE MEDICAID,10364.00,,,,,,,1881.0000,10364.0000,percent of total billed charges,"100% of $10,364.00 in Billed Charges for Rev 481 Proc 33279 = $10,364.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD,33279,CPT,481,RC,48100225,CDM,,,,both,,,10364.0000,1554.6000,WELLCARE,WELLCARE MEDICARE,3362.24,,,,,,,1881.0000,10364.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRILL AO 4.2 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1209.8800,181.4800,AETNA,AETNA,516.62,,,,,,,312.2700,1209.8800,percent of total billed charges,"42.7% of $1,209.88 in Billed Charges for Rev 272 = $516.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL AO 4.2 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1209.8800,181.4800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,846.92,,,,,,,312.2700,1209.8800,percent of total billed charges,"Rev 272 $1,209.88 in Billed Charges at 70% = $846.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL AO 4.2 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1209.8800,181.4800,CIGNA HEALTHCARE,CIGNA HMO,504.52,,,,,,,312.2700,1209.8800,percent of total billed charges,"41.7% of $1,209.88 in Billed Charges for Rev 272 = $504.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL AO 4.2 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1209.8800,181.4800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,561.38,,,,,,,312.2700,1209.8800,percent of total billed charges,"46.4% of $1,209.88 in Billed Charges for Rev 272 = $561.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL AO 4.2 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1209.8800,181.4800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,504.52,,,,,,,312.2700,1209.8800,percent of total billed charges,"41.7% of $1,209.88 in Billed Charges for Rev 272 = $504.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL AO 4.2 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1209.8800,181.4800,CIGNA HEALTHCARE,CIGNA PPO,504.52,,,,,,,312.2700,1209.8800,percent of total billed charges,"41.7% of $1,209.88 in Billed Charges for Rev 272 = $504.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL AO 4.2 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1209.8800,181.4800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1088.89,,,,,,,312.2700,1209.8800,percent of total billed charges,"90% of $1,209.88 in Billed Charges for Rev 272 = $1,088.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL AO 4.2 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1209.8800,181.4800,MEDCOST,MEDCOST VHN,575.78,,,,,,,312.2700,1209.8800,percent of total billed charges,"47.59% of $1,209.88 in Billed Charges for Rev 272 = $575.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL AO 4.2 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1209.8800,181.4800,SENTARA HEALTH,SENTARA HEALTH,312.27,,,,,,,312.2700,1209.8800,percent of total billed charges,"25.81% of $1,209.88 in Billed Charges for Rev 272 = $312.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL AO 4.2 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1209.8800,181.4800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1209.88,,,,,,,312.2700,1209.8800,percent of total billed charges,"100% of $1,209.88 in Billed Charges for Rev 272 = $1,209.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL AO 4.2 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1209.8800,181.4800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,604.94,,,,,,,312.2700,1209.8800,percent of total billed charges,"Rev 272 $1,209.88 in Billed Charges at 50% = $604.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL AO 4.2 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1209.8800,181.4800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,390.79,,,,,,,312.2700,1209.8800,other,"32.3% of $1,209.88 in Billed Charges for Rev 272 = $390.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL AO 4.2 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1209.8800,181.4800,UNITED HEALTHCARE,UHC HERITAGE SELECT,371.43,,,,,,,312.2700,1209.8800,other,"30.7% of $1,209.88 in Billed Charges for Rev 272 = $371.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL AO 4.2 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1209.8800,181.4800,UNITED HEALTHCARE,UNITED HEALTHCARE,390.79,,,,,,,312.2700,1209.8800,percent of total billed charges,"32.3% of $1,209.88 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL AO 4.2 X 180MM,272,RC,27200002,CDM,,,,,,both,,,1209.8800,181.4800,WELLCARE,WELLCARE MEDICAID,1209.88,,,,,,,312.2700,1209.8800,percent of total billed charges,"100% of $1,209.88 in Billed Charges for Rev 272 = $1,209.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,858.7200,128.8100,AETNA,AETNA,366.67,,,,,,,221.6400,858.7200,percent of total billed charges,42.7% of $858.72 in Billed Charges for Rev 272 = $366.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,858.7200,128.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,601.10,,,,,,,221.6400,858.7200,percent of total billed charges,Rev 272 $858.72 in Billed Charges at 70% = $601.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,858.7200,128.8100,CIGNA HEALTHCARE,CIGNA HMO,358.09,,,,,,,221.6400,858.7200,percent of total billed charges,41.7% of $858.72 in Billed Charges for Rev 272 = $358.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,858.7200,128.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,398.45,,,,,,,221.6400,858.7200,percent of total billed charges,46.4% of $858.72 in Billed Charges for Rev 272 = $398.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,858.7200,128.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,358.09,,,,,,,221.6400,858.7200,percent of total billed charges,41.7% of $858.72 in Billed Charges for Rev 272 = $358.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,858.7200,128.8100,CIGNA HEALTHCARE,CIGNA PPO,358.09,,,,,,,221.6400,858.7200,percent of total billed charges,41.7% of $858.72 in Billed Charges for Rev 272 = $358.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,858.7200,128.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,772.85,,,,,,,221.6400,858.7200,percent of total billed charges,90% of $858.72 in Billed Charges for Rev 272 = $772.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,858.7200,128.8100,MEDCOST,MEDCOST VHN,408.66,,,,,,,221.6400,858.7200,percent of total billed charges,47.59% of $858.72 in Billed Charges for Rev 272 = $408.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,858.7200,128.8100,SENTARA HEALTH,SENTARA HEALTH,221.64,,,,,,,221.6400,858.7200,percent of total billed charges,25.81% of $858.72 in Billed Charges for Rev 272 = $221.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,858.7200,128.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",858.72,,,,,,,221.6400,858.7200,percent of total billed charges,100% of $858.72 in Billed Charges for Rev 272 = $858.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,858.7200,128.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,429.36,,,,,,,221.6400,858.7200,percent of total billed charges,Rev 272 $858.72 in Billed Charges at 50% = $429.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,858.7200,128.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,277.37,,,,,,,221.6400,858.7200,other,32.3% of $858.72 in Billed Charges for Rev 272 = $277.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,858.7200,128.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,263.63,,,,,,,221.6400,858.7200,other,30.7% of $858.72 in Billed Charges for Rev 272 = $263.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,858.7200,128.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,277.37,,,,,,,221.6400,858.7200,percent of total billed charges,32.3% of $858.72 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,858.7200,128.8100,WELLCARE,WELLCARE MEDICAID,858.72,,,,,,,221.6400,858.7200,percent of total billed charges,100% of $858.72 in Billed Charges for Rev 272 = $858.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,,,,,,,,both,,,966.0600,144.9100,AETNA,AETNA,412.51,,,,,,,249.3400,966.0600,percent of total billed charges,42.7% of $966.06 in Billed Charges for Rev 272 = $412.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,,,,,,,,both,,,966.0600,144.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,676.24,,,,,,,249.3400,966.0600,percent of total billed charges,Rev 272 $966.06 in Billed Charges at 70% = $676.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,,,,,,,,both,,,966.0600,144.9100,CIGNA HEALTHCARE,CIGNA HMO,402.85,,,,,,,249.3400,966.0600,percent of total billed charges,41.7% of $966.06 in Billed Charges for Rev 272 = $402.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,,,,,,,,both,,,966.0600,144.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,448.25,,,,,,,249.3400,966.0600,percent of total billed charges,46.4% of $966.06 in Billed Charges for Rev 272 = $448.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,,,,,,,,both,,,966.0600,144.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,402.85,,,,,,,249.3400,966.0600,percent of total billed charges,41.7% of $966.06 in Billed Charges for Rev 272 = $402.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,,,,,,,,both,,,966.0600,144.9100,CIGNA HEALTHCARE,CIGNA PPO,402.85,,,,,,,249.3400,966.0600,percent of total billed charges,41.7% of $966.06 in Billed Charges for Rev 272 = $402.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,,,,,,,,both,,,966.0600,144.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,869.45,,,,,,,249.3400,966.0600,percent of total billed charges,90% of $966.06 in Billed Charges for Rev 272 = $869.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,,,,,,,,both,,,966.0600,144.9100,MEDCOST,MEDCOST VHN,459.75,,,,,,,249.3400,966.0600,percent of total billed charges,47.59% of $966.06 in Billed Charges for Rev 272 = $459.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,,,,,,,,both,,,966.0600,144.9100,SENTARA HEALTH,SENTARA HEALTH,249.34,,,,,,,249.3400,966.0600,percent of total billed charges,25.81% of $966.06 in Billed Charges for Rev 272 = $249.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,,,,,,,,both,,,966.0600,144.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",966.06,,,,,,,249.3400,966.0600,percent of total billed charges,100% of $966.06 in Billed Charges for Rev 272 = $966.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,,,,,,,,both,,,966.0600,144.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,483.03,,,,,,,249.3400,966.0600,percent of total billed charges,Rev 272 $966.06 in Billed Charges at 50% = $483.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,,,,,,,,both,,,966.0600,144.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,312.04,,,,,,,249.3400,966.0600,other,32.3% of $966.06 in Billed Charges for Rev 272 = $312.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRILL BIT,272,RC,,,,,,,,both,,,966.0600,144.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,296.58,,,,,,,249.3400,966.0600,other,30.7% of $966.06 in Billed Charges for Rev 272 = $296.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRILL BIT,272,RC,,,,,,,,both,,,966.0600,144.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,312.04,,,,,,,249.3400,966.0600,percent of total billed charges,32.3% of $966.06 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT,272,RC,,,,,,,,both,,,966.0600,144.9100,WELLCARE,WELLCARE MEDICAID,966.06,,,,,,,249.3400,966.0600,percent of total billed charges,100% of $966.06 in Billed Charges for Rev 272 = $966.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,AETNA,AETNA,4425.43,,,,,,,1881.0000,10364.0000,percent of total billed charges,"42.7% of $10,364.00 in Billed Charges for Rev 481 Proc 33280 = $4,425.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,4567.49,,,,,,,1881.0000,10364.0000,fee schedule,"APG 00276 Proc 33280 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 104% = $4,567.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,AETNA,AETNA HEALTHCARE MEDICARE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,AMBETTER,AMBETTER,6914.80,,,,,,,1881.0000,10364.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3298.81,,,,,,,1881.0000,10364.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,ANTHEM EXCHANGE,7809.46,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,4523.57,,,,,,,1881.0000,10364.0000,fee schedule,"APG 00276 Proc 33280 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 103% = $4,523.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,ANTHEM HMO,8297.09,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3267.09,,,,,,,1881.0000,10364.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9760.75,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7254.80,,,,,,,1881.0000,10364.0000,percent of total billed charges,"Rev 481 Proc 33280 $10,364.00 in Billed Charges at 70% = $7,254.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33280 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,BLUE CROSS MEDICARE,3298.81,,,,,,,1881.0000,10364.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33280 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33280 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,CIGNA HEALTHCARE,CIGNA HMO,4321.79,,,,,,,1881.0000,10364.0000,percent of total billed charges,"41.7% of $10,364.00 in Billed Charges for Rev 481 Proc 33280 = $4,321.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4808.90,,,,,,,1881.0000,10364.0000,percent of total billed charges,"46.4% of $10,364.00 in Billed Charges for Rev 481 Proc 33280 = $4,808.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,3330.52,,,,,,,1881.0000,10364.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4321.79,,,,,,,1881.0000,10364.0000,percent of total billed charges,"41.7% of $10,364.00 in Billed Charges for Rev 481 Proc 33280 = $4,321.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,CIGNA HEALTHCARE,CIGNA PPO,4321.79,,,,,,,1881.0000,10364.0000,percent of total billed charges,"41.7% of $10,364.00 in Billed Charges for Rev 481 Proc 33280 = $4,321.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3330.52,,,,,,,1881.0000,10364.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9327.60,,,,,,,1881.0000,10364.0000,percent of total billed charges,"90% of $10,364.00 in Billed Charges for Rev 481 Proc 33280 = $9,327.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,HUMANA,HUMANA MEDICARE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,MEDCOST,MEDCOST VHN,4932.23,,,,,,,1881.0000,10364.0000,percent of total billed charges,"47.59% of $10,364.00 in Billed Charges for Rev 481 Proc 33280 = $4,932.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,4611.41,,,,,,,1881.0000,10364.0000,fee schedule,"APG 00276 Proc 33280 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 100% = $4,391.82... $4,391.82 at 105% = $4,611.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3330.52,,,,,,,1881.0000,10364.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3330.52,,,,,,,1881.0000,10364.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,NHC ADVANTAGE,NHC ADVANTAGE,3330.52,,,,,,,1881.0000,10364.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,4527.97,,,,,,,1881.0000,10364.0000,fee schedule,"APG 00276 Proc 33280 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 100% = $4,391.82... $4,391.82 at 103.1% = $4,527.97 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,SENTARA HEALTH,SENTARA HEALTH,2674.95,,,,,,,1881.0000,10364.0000,percent of total billed charges,"25.81% of $10,364.00 in Billed Charges for Rev 481 Proc 33280 = $2,674.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,SENTARA HEALTH,SENTARA MEDICARE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10364.00,,,,,,,1881.0000,10364.0000,percent of total billed charges,"100% of $10,364.00 in Billed Charges for Rev 481 Proc 33280 = $10,364.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33280 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33280 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33280 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33280 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,4523.57,,,,,,,1881.0000,10364.0000,fee schedule,"APG 00276 Proc 33280 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 103% = $4,523.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,WELLCARE,WELLCARE MEDICAID,10364.00,,,,,,,1881.0000,10364.0000,percent of total billed charges,"100% of $10,364.00 in Billed Charges for Rev 481 Proc 33280 = $10,364.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY,33280,CPT,481,RC,48100226,CDM,,,,both,,,10364.0000,1554.6000,WELLCARE,WELLCARE MEDICARE,3362.24,,,,,,,1881.0000,10364.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,AETNA,AETNA,4425.43,,,,,,,1881.0000,10364.0000,percent of total billed charges,"42.7% of $10,364.00 in Billed Charges for Rev 481 Proc 33281 = $4,425.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,4567.49,,,,,,,1881.0000,10364.0000,fee schedule,"APG 00276 Proc 33281 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 104% = $4,567.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,AETNA,AETNA HEALTHCARE MEDICARE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,AMBETTER,AMBETTER,6914.80,,,,,,,1881.0000,10364.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3298.81,,,,,,,1881.0000,10364.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,ANTHEM EXCHANGE,7809.46,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,4523.57,,,,,,,1881.0000,10364.0000,fee schedule,"APG 00276 Proc 33281 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 103% = $4,523.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,ANTHEM HMO,8297.09,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3267.09,,,,,,,1881.0000,10364.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9760.75,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7254.80,,,,,,,1881.0000,10364.0000,percent of total billed charges,"Rev 481 Proc 33281 $10,364.00 in Billed Charges at 70% = $7,254.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33281 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,BLUE CROSS MEDICARE,3298.81,,,,,,,1881.0000,10364.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33281 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33281 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,CIGNA HEALTHCARE,CIGNA HMO,4321.79,,,,,,,1881.0000,10364.0000,percent of total billed charges,"41.7% of $10,364.00 in Billed Charges for Rev 481 Proc 33281 = $4,321.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4808.90,,,,,,,1881.0000,10364.0000,percent of total billed charges,"46.4% of $10,364.00 in Billed Charges for Rev 481 Proc 33281 = $4,808.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,3330.52,,,,,,,1881.0000,10364.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4321.79,,,,,,,1881.0000,10364.0000,percent of total billed charges,"41.7% of $10,364.00 in Billed Charges for Rev 481 Proc 33281 = $4,321.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,CIGNA HEALTHCARE,CIGNA PPO,4321.79,,,,,,,1881.0000,10364.0000,percent of total billed charges,"41.7% of $10,364.00 in Billed Charges for Rev 481 Proc 33281 = $4,321.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3330.52,,,,,,,1881.0000,10364.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9327.60,,,,,,,1881.0000,10364.0000,percent of total billed charges,"90% of $10,364.00 in Billed Charges for Rev 481 Proc 33281 = $9,327.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,HUMANA,HUMANA MEDICARE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,MEDCOST,MEDCOST VHN,4932.23,,,,,,,1881.0000,10364.0000,percent of total billed charges,"47.59% of $10,364.00 in Billed Charges for Rev 481 Proc 33281 = $4,932.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,4611.41,,,,,,,1881.0000,10364.0000,fee schedule,"APG 00276 Proc 33281 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 100% = $4,391.82... $4,391.82 at 105% = $4,611.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3330.52,,,,,,,1881.0000,10364.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3330.52,,,,,,,1881.0000,10364.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,NHC ADVANTAGE,NHC ADVANTAGE,3330.52,,,,,,,1881.0000,10364.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,4527.97,,,,,,,1881.0000,10364.0000,fee schedule,"APG 00276 Proc 33281 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 100% = $4,391.82... $4,391.82 at 103.1% = $4,527.97 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,SENTARA HEALTH,SENTARA HEALTH,2674.95,,,,,,,1881.0000,10364.0000,percent of total billed charges,"25.81% of $10,364.00 in Billed Charges for Rev 481 Proc 33281 = $2,674.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,SENTARA HEALTH,SENTARA MEDICARE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10364.00,,,,,,,1881.0000,10364.0000,percent of total billed charges,"100% of $10,364.00 in Billed Charges for Rev 481 Proc 33281 = $10,364.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33281 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33281 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33281 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,1881.0000,10364.0000,case rate,"Rev 481 Proc 33281 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,4523.57,,,,,,,1881.0000,10364.0000,fee schedule,"APG 00276 Proc 33281 at $836.60 (Base Rate) * 5.2496 (Relative Weight) = $4,391.82 (Total Line Payment) at 103% = $4,523.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3171.93,,,,,,,1881.0000,10364.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,WELLCARE,WELLCARE MEDICAID,10364.00,,,,,,,1881.0000,10364.0000,percent of total billed charges,"100% of $10,364.00 in Billed Charges for Rev 481 Proc 33281 = $10,364.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD,33281,CPT,481,RC,48100227,CDM,,,,both,,,10364.0000,1554.6000,WELLCARE,WELLCARE MEDICARE,3362.24,,,,,,,1881.0000,10364.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,AETNA,AETNA,11999.13,,,,,,,1571.0000,28101.0000,percent of total billed charges,"42.7% of $28,101.00 in Billed Charges for Rev 480 Proc 33285 = $11,999.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11330.93,,,,,,,1571.0000,28101.0000,fee schedule,"APG 00086 Proc 33285 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 104% = $11,330.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,7508.05,,,,,,,1571.0000,28101.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,AETNA,AETNA HEALTHCARE MEDICARE,7508.05,,,,,,,1571.0000,28101.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,7508.05,,,,,,,1571.0000,28101.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,AMBETTER,AMBETTER,16367.55,,,,,,,1571.0000,28101.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,7808.37,,,,,,,1571.0000,28101.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,BLUE CROSS,ANTHEM EXCHANGE,18485.22,,,,,,,1571.0000,28101.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11221.98,,,,,,,1571.0000,28101.0000,fee schedule,"APG 00086 Proc 33285 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,BLUE CROSS,ANTHEM HMO,19639.44,,,,,,,1571.0000,28101.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,7733.29,,,,,,,1571.0000,28101.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",23103.98,,,,,,,1571.0000,28101.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,19670.70,,,,,,,1571.0000,28101.0000,percent of total billed charges,"Rev 480 Proc 33285 $28,101.00 in Billed Charges at 70% = $19,670.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,1571.0000,28101.0000,case rate,"Rev 480 Proc 33285 ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,BLUE CROSS,BLUE CROSS MEDICARE,7808.37,,,,,,,1571.0000,28101.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,1571.0000,28101.0000,case rate,"Rev 480 Proc 33285 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,1571.0000,28101.0000,case rate,"Rev 480 Proc 33285 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,CIGNA HEALTHCARE,CIGNA HMO,11718.12,,,,,,,1571.0000,28101.0000,percent of total billed charges,"41.7% of $28,101.00 in Billed Charges for Rev 480 Proc 33285 = $11,718.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,13038.86,,,,,,,1571.0000,28101.0000,percent of total billed charges,"46.4% of $28,101.00 in Billed Charges for Rev 480 Proc 33285 = $13,038.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,7883.45,,,,,,,1571.0000,28101.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11718.12,,,,,,,1571.0000,28101.0000,percent of total billed charges,"41.7% of $28,101.00 in Billed Charges for Rev 480 Proc 33285 = $11,718.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,CIGNA HEALTHCARE,CIGNA PPO,11718.12,,,,,,,1571.0000,28101.0000,percent of total billed charges,"41.7% of $28,101.00 in Billed Charges for Rev 480 Proc 33285 = $11,718.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,7883.45,,,,,,,1571.0000,28101.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,25290.90,,,,,,,1571.0000,28101.0000,percent of total billed charges,"90% of $28,101.00 in Billed Charges for Rev 480 Proc 33285 = $25,290.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,HUMANA,HUMANA MEDICARE,7508.05,,,,,,,1571.0000,28101.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,7508.05,,,,,,,1571.0000,28101.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,MEDCOST,MEDCOST VHN,13373.27,,,,,,,1571.0000,28101.0000,percent of total billed charges,"47.59% of $28,101.00 in Billed Charges for Rev 480 Proc 33285 = $13,373.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11439.89,,,,,,,1571.0000,28101.0000,fee schedule,"APG 00086 Proc 33285 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 105% = $11,439.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,7883.45,,,,,,,1571.0000,28101.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,7883.45,,,,,,,1571.0000,28101.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,NHC ADVANTAGE,NHC ADVANTAGE,7883.45,,,,,,,1571.0000,28101.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11232.88,,,,,,,1571.0000,28101.0000,fee schedule,"APG 00086 Proc 33285 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 103.1% = $11,232.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,SENTARA HEALTH,SENTARA HEALTH,7252.87,,,,,,,1571.0000,28101.0000,percent of total billed charges,"25.81% of $28,101.00 in Billed Charges for Rev 480 Proc 33285 = $7,252.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,SENTARA HEALTH,SENTARA MEDICARE,7508.05,,,,,,,1571.0000,28101.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",28101.00,,,,,,,1571.0000,28101.0000,percent of total billed charges,"100% of $28,101.00 in Billed Charges for Rev 480 Proc 33285 = $28,101.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3702.06,,,,,,,1571.0000,28101.0000,fee schedule,"$7,404.11 from Fee Schedule TCUHC24 for Rev 480 Proc 33285 * Qty 1 = $7,404.11 at 50% = $3,702.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1642.00,,,,,,,1571.0000,28101.0000,other,"Rev 480 Proc 33285 1 Visit at $1,642.00 per Visit = $1,642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1571.00,,,,,,,1571.0000,28101.0000,other,"Rev 480 Proc 33285 1 Visit at $1,571.00 per Visit = $1,571.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,3097.00,,,,,,,1571.0000,28101.0000,other,"Rev 480 Proc 33285 1 Visit at $3,097.00 per Visit = $3,097.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11221.98,,,,,,,1571.0000,28101.0000,fee schedule,"APG 00086 Proc 33285 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,7508.05,,,,,,,1571.0000,28101.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,7508.05,,,,,,,1571.0000,28101.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,WELLCARE,WELLCARE MEDICAID,28101.00,,,,,,,1571.0000,28101.0000,percent of total billed charges,"100% of $28,101.00 in Billed Charges for Rev 480 Proc 33285 = $28,101.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT SUBQ CARDIAC RHYTHM MONITOR W PRGRMG,33285,CPT,480,RC,48000077,CDM,,,,both,,,28101.0000,4215.1500,WELLCARE,WELLCARE MEDICARE,7958.53,,,,,,,1571.0000,28101.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,AETNA,AETNA,1462.90,,,,,,,289.6700,3426.0000,percent of total billed charges,"42.7% of $3,426.00 in Billed Charges for Rev 480 Proc 33286 = $1,462.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2176.64,,,,,,,289.6700,3426.0000,fee schedule,"APG 00074 Proc 33286 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 104% = $2,176.64. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,289.6700,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,289.6700,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,289.6700,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,AMBETTER,AMBETTER,1400.59,,,,,,,289.6700,3426.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,289.6700,3426.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,289.6700,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2155.71,,,,,,,289.6700,3426.0000,fee schedule,"APG 00074 Proc 33286 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,289.6700,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,289.6700,3426.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1977.02,,,,,,,289.6700,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2398.20,,,,,,,289.6700,3426.0000,percent of total billed charges,"Rev 480 Proc 33286 $3,426.00 in Billed Charges at 70% = $2,398.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,289.6700,3426.0000,case rate,Rev 480 Proc 33286 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,289.6700,3426.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,289.6700,3426.0000,case rate,Rev 480 Proc 33286 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,289.6700,3426.0000,case rate,Rev 480 Proc 33286 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,CIGNA HEALTHCARE,CIGNA HMO,1428.64,,,,,,,289.6700,3426.0000,percent of total billed charges,"41.7% of $3,426.00 in Billed Charges for Rev 480 Proc 33286 = $1,428.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1589.66,,,,,,,289.6700,3426.0000,percent of total billed charges,"46.4% of $3,426.00 in Billed Charges for Rev 480 Proc 33286 = $1,589.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,289.6700,3426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1428.64,,,,,,,289.6700,3426.0000,percent of total billed charges,"41.7% of $3,426.00 in Billed Charges for Rev 480 Proc 33286 = $1,428.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,CIGNA HEALTHCARE,CIGNA PPO,1428.64,,,,,,,289.6700,3426.0000,percent of total billed charges,"41.7% of $3,426.00 in Billed Charges for Rev 480 Proc 33286 = $1,428.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,289.6700,3426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3083.40,,,,,,,289.6700,3426.0000,percent of total billed charges,"90% of $3,426.00 in Billed Charges for Rev 480 Proc 33286 = $3,083.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,HUMANA,HUMANA MEDICARE,642.47,,,,,,,289.6700,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,289.6700,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,MEDCOST,MEDCOST VHN,1630.43,,,,,,,289.6700,3426.0000,percent of total billed charges,"47.59% of $3,426.00 in Billed Charges for Rev 480 Proc 33286 = $1,630.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2197.57,,,,,,,289.6700,3426.0000,fee schedule,"APG 00074 Proc 33286 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 105% = $2,197.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,289.6700,3426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,289.6700,3426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,289.6700,3426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2157.80,,,,,,,289.6700,3426.0000,fee schedule,"APG 00074 Proc 33286 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 103.1% = $2,157.80 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,SENTARA HEALTH,SENTARA HEALTH,884.25,,,,,,,289.6700,3426.0000,percent of total billed charges,"25.81% of $3,426.00 in Billed Charges for Rev 480 Proc 33286 = $884.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,289.6700,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3426.00,,,,,,,289.6700,3426.0000,percent of total billed charges,"100% of $3,426.00 in Billed Charges for Rev 480 Proc 33286 = $3,426.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,289.67,,,,,,,289.6700,3426.0000,fee schedule,$579.34 from Fee Schedule TCUHC24 for Rev 480 Proc 33286 * Qty 1 = $579.34 at 50% = $289.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1642.00,,,,,,,289.6700,3426.0000,other,"Rev 480 Proc 33286 1 Visit at $1,642.00 per Visit = $1,642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1571.00,,,,,,,289.6700,3426.0000,other,"Rev 480 Proc 33286 1 Visit at $1,571.00 per Visit = $1,571.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,3097.00,,,,,,,289.6700,3426.0000,other,"Rev 480 Proc 33286 1 Visit at $3,097.00 per Visit = $3,097.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2155.71,,,,,,,289.6700,3426.0000,fee schedule,"APG 00074 Proc 33286 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,289.6700,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,289.6700,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,WELLCARE,WELLCARE MEDICAID,3426.00,,,,,,,289.6700,3426.0000,percent of total billed charges,"100% of $3,426.00 in Billed Charges for Rev 480 Proc 33286 = $3,426.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SUBQ CARDIAC RHYTHM MONITOR,33286,CPT,480,RC,48000078,CDM,,,,both,,,3426.0000,513.9000,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,289.6700,3426.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,AETNA,AETNA,47551.15,,,,,,,7778.0000,111361.0000,percent of total billed charges,"42.7% of $111,361.00 in Billed Charges for Rev 481 Proc 33289 = $47,551.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,32079.69,,,,,,,7778.0000,111361.0000,fee schedule,"APG 00097 Proc 33289 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 104% = $32,079.69. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,26023.67,,,,,,,7778.0000,111361.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,AETNA,AETNA HEALTHCARE MEDICARE,26023.67,,,,,,,7778.0000,111361.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,26023.67,,,,,,,7778.0000,111361.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,AMBETTER,AMBETTER,56731.61,,,,,,,7778.0000,111361.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,27064.62,,,,,,,7778.0000,111361.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,BLUE CROSS,ANTHEM EXCHANGE,64071.71,,,,,,,7778.0000,111361.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,31771.24,,,,,,,7778.0000,111361.0000,fee schedule,"APG 00097 Proc 33289 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 103% = $31,771.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,BLUE CROSS,ANTHEM HMO,68072.38,,,,,,,7778.0000,111361.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,26804.38,,,,,,,7778.0000,111361.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",80080.82,,,,,,,7778.0000,111361.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,77952.70,,,,,,,7778.0000,111361.0000,percent of total billed charges,"Rev 481 Proc 33289 $111,361.00 in Billed Charges at 70% = $77,952.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,BLUE CROSS,BLUE CROSS E NETWORK,12774.00,,,,,,,7778.0000,111361.0000,case rate,"Rev 481 Proc 33289 ASG Rate of $12,774.00 at 100% of $12,774.00 = $12,774.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,BLUE CROSS,BLUE CROSS MEDICARE,27064.62,,,,,,,7778.0000,111361.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,BLUE CROSS,BLUE CROSS P NETWORK,12197.00,,,,,,,7778.0000,111361.0000,case rate,"Rev 481 Proc 33289 ASG Rate of $12,197.00 at 100% of $12,197.00 = $12,197.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,BLUE CROSS,BLUE CROSS S NETWORK,12197.00,,,,,,,7778.0000,111361.0000,case rate,"Rev 481 Proc 33289 ASG Rate of $12,197.00 at 100% of $12,197.00 = $12,197.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,CIGNA HEALTHCARE,CIGNA HMO,10289.00,,,,,,,7778.0000,111361.0000,other,"Rev 481 Proc 33289 1 Visit at $10,289.00 per Visit = $10,289.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7778.00,,,,,,,7778.0000,111361.0000,other,"Rev 481 Proc 33289 1 Visit at $7,778.00 per Visit = $7,778.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,27324.86,,,,,,,7778.0000,111361.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,10289.00,,,,,,,7778.0000,111361.0000,other,"Rev 481 Proc 33289 1 Visit at $10,289.00 per Visit = $10,289.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,CIGNA HEALTHCARE,CIGNA PPO,10289.00,,,,,,,7778.0000,111361.0000,other,"Rev 481 Proc 33289 1 Visit at $10,289.00 per Visit = $10,289.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,27324.86,,,,,,,7778.0000,111361.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,100224.90,,,,,,,7778.0000,111361.0000,percent of total billed charges,"90% of $111,361.00 in Billed Charges for Rev 481 Proc 33289 = $100,224.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,HUMANA,HUMANA MEDICARE,26023.67,,,,,,,7778.0000,111361.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,26023.67,,,,,,,7778.0000,111361.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,MEDCOST,MEDCOST VHN,52996.70,,,,,,,7778.0000,111361.0000,percent of total billed charges,"47.59% of $111,361.00 in Billed Charges for Rev 481 Proc 33289 = $52,996.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,32388.15,,,,,,,7778.0000,111361.0000,fee schedule,"APG 00097 Proc 33289 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 100% = $30,845.86... $30,845.86 at 105% = $32,388.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,27324.86,,,,,,,7778.0000,111361.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,27324.86,,,,,,,7778.0000,111361.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,NHC ADVANTAGE,NHC ADVANTAGE,27324.86,,,,,,,7778.0000,111361.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,31802.08,,,,,,,7778.0000,111361.0000,fee schedule,"APG 00097 Proc 33289 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 100% = $30,845.86... $30,845.86 at 103.1% = $31,802.08 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,SENTARA HEALTH,SENTARA HEALTH,28742.27,,,,,,,7778.0000,111361.0000,percent of total billed charges,"25.81% of $111,361.00 in Billed Charges for Rev 481 Proc 33289 = $28,742.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,SENTARA HEALTH,SENTARA MEDICARE,26023.67,,,,,,,7778.0000,111361.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",111361.00,,,,,,,7778.0000,111361.0000,percent of total billed charges,"100% of $111,361.00 in Billed Charges for Rev 481 Proc 33289 = $111,361.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14690.00,,,,,,,7778.0000,111361.0000,case rate,"Rev 481 Proc 33289 ASG Rate of $14,690.00 at 100% of $14,690.00 = $14,690.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13326.00,,,,,,,7778.0000,111361.0000,case rate,"Rev 481 Proc 33289 ASG Rate of $13,326.00 at 100% of $13,326.00 = $13,326.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,12749.00,,,,,,,7778.0000,111361.0000,case rate,"Rev 481 Proc 33289 ASG Rate of $12,749.00 at 100% of $12,749.00 = $12,749.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,21642.00,,,,,,,7778.0000,111361.0000,case rate,"Rev 481 Proc 33289 ASG Rate of $21,642.00 at 100% of $21,642.00 = $21,642.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,31771.24,,,,,,,7778.0000,111361.0000,fee schedule,"APG 00097 Proc 33289 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 103% = $31,771.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,26023.67,,,,,,,7778.0000,111361.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,26023.67,,,,,,,7778.0000,111361.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,WELLCARE,WELLCARE MEDICAID,111361.00,,,,,,,7778.0000,111361.0000,percent of total billed charges,"100% of $111,361.00 in Billed Charges for Rev 481 Proc 33289 = $111,361.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH IMPL WRLS PA PRS SNR L-T HEMDYN MNTR,33289,CPT,481,RC,48100173,CDM,,,,both,,,111361.0000,16704.1500,WELLCARE,WELLCARE MEDICARE,27585.10,,,,,,,7778.0000,111361.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAVR OPEN FEM ART APPROACH,33362,CPT,360,RC,48100164,CDM,,,,both,,,15085.0000,2262.7500,AETNA,AETNA,6441.30,,,,,,,968.0000,21084.6100,percent of total billed charges,"42.7% of $15,085.00 in Billed Charges for Rev 360 Proc 33362 = $6,441.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR OPEN FEM ART APPROACH,33362,CPT,360,RC,48100164,CDM,,,,both,,,15085.0000,2262.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,20883.80,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33362 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 104% = $20,883.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN FEM ART APPROACH,33362,CPT,360,RC,48100164,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15085.00,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33362 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99 (Service Line reduced to $15,085.00, claim capped at $15,085.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN FEM ART APPROACH,33362,CPT,360,RC,48100164,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33362 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN FEM ART APPROACH,33362,CPT,360,RC,48100164,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS E NETWORK,9347.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33362 ASG Rate of $9,347.00 at 100% of $9,347.00 = $9,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN FEM ART APPROACH,33362,CPT,360,RC,48100164,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS P NETWORK,9558.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33362 ASG Rate of $9,558.00 at 100% of $9,558.00 = $9,558.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN FEM ART APPROACH,33362,CPT,360,RC,48100164,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS S NETWORK,9558.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33362 ASG Rate of $9,558.00 at 100% of $9,558.00 = $9,558.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN FEM ART APPROACH,33362,CPT,360,RC,48100164,CDM,,,,both,,,15085.0000,2262.7500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33362 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN FEM ART APPROACH,33362,CPT,360,RC,48100164,CDM,,,,both,,,15085.0000,2262.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33362 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN FEM ART APPROACH,33362,CPT,360,RC,48100164,CDM,,,,both,,,15085.0000,2262.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33362 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN FEM ART APPROACH,33362,CPT,360,RC,48100164,CDM,,,,both,,,15085.0000,2262.7500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33362 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN FEM ART APPROACH,33362,CPT,360,RC,48100164,CDM,,,,both,,,15085.0000,2262.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13576.50,,,,,,,968.0000,21084.6100,percent of total billed charges,"90% of $15,085.00 in Billed Charges for Rev 360 Proc 33362 = $13,576.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR OPEN FEM ART APPROACH,33362,CPT,360,RC,48100164,CDM,,,,both,,,15085.0000,2262.7500,MEDCOST,MEDCOST VHN,7178.95,,,,,,,968.0000,21084.6100,percent of total billed charges,"47.59% of $15,085.00 in Billed Charges for Rev 360 Proc 33362 = $7,178.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR OPEN FEM ART APPROACH,33362,CPT,360,RC,48100164,CDM,,,,both,,,15085.0000,2262.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,21084.61,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33362 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 105% = $21,084.61 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN FEM ART APPROACH,33362,CPT,360,RC,48100164,CDM,,,,both,,,15085.0000,2262.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,20703.08,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33362 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 103.1% = $20,703.08 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN FEM ART APPROACH,33362,CPT,360,RC,48100164,CDM,,,,both,,,15085.0000,2262.7500,SENTARA HEALTH,SENTARA HEALTH,3893.44,,,,,,,968.0000,21084.6100,percent of total billed charges,"25.81% of $15,085.00 in Billed Charges for Rev 360 Proc 33362 = $3,893.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR OPEN FEM ART APPROACH,33362,CPT,360,RC,48100164,CDM,,,,both,,,15085.0000,2262.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15085.00,,,,,,,968.0000,21084.6100,percent of total billed charges,"100% of $15,085.00 in Billed Charges for Rev 360 Proc 33362 = $15,085.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR OPEN FEM ART APPROACH,33362,CPT,360,RC,48100164,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,968.0000,21084.6100,case rate,Rev 360 Proc 33362 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAVR OPEN FEM ART APPROACH,33362,CPT,360,RC,48100164,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33362 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN FEM ART APPROACH,33362,CPT,360,RC,48100164,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33362 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN FEM ART APPROACH,33362,CPT,360,RC,48100164,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33362 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN FEM ART APPROACH,33362,CPT,360,RC,48100164,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,20682.99,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33362 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN FEM ART APPROACH,33362,CPT,360,RC,48100164,CDM,,,,both,,,15085.0000,2262.7500,WELLCARE,WELLCARE MEDICAID,15085.00,,,,,,,968.0000,21084.6100,percent of total billed charges,"100% of $15,085.00 in Billed Charges for Rev 360 Proc 33362 = $15,085.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR OPEN AXILLARY ART APPROACH,33363,CPT,360,RC,36000117,CDM,,,,both,,,2760.0000,414.0000,AETNA,AETNA,1178.52,,,,,,,712.3600,21084.6100,percent of total billed charges,"42.7% of $2,760.00 in Billed Charges for Rev 360 Proc 33363 = $1,178.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR OPEN AXILLARY ART APPROACH,33363,CPT,360,RC,36000117,CDM,,,,both,,,2760.0000,414.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,20883.80,,,,,,,712.3600,21084.6100,fee schedule,"APG 00121 Proc 33363 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 104% = $20,883.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN AXILLARY ART APPROACH,33363,CPT,360,RC,36000117,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2760.00,,,,,,,712.3600,21084.6100,fee schedule,"APG 00121 Proc 33363 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99 (Service Line reduced to $2,760.00, claim capped at $2,760.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN AXILLARY ART APPROACH,33363,CPT,360,RC,36000117,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,712.3600,21084.6100,case rate,"Rev 360 Proc 33363 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN AXILLARY ART APPROACH,33363,CPT,360,RC,36000117,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,BLUE CROSS E NETWORK,2760.00,,,,,,,712.3600,21084.6100,case rate,"Rev 360 Proc 33363 ASG Rate of $9,347.00 at 100% of $9,347.00 = $9,347.00 Total (Service Line reduced to $2,760.00, claim capped at $2,760.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN AXILLARY ART APPROACH,33363,CPT,360,RC,36000117,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,BLUE CROSS P NETWORK,2760.00,,,,,,,712.3600,21084.6100,case rate,"Rev 360 Proc 33363 ASG Rate of $9,558.00 at 100% of $9,558.00 = $9,558.00 Total (Service Line reduced to $2,760.00, claim capped at $2,760.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN AXILLARY ART APPROACH,33363,CPT,360,RC,36000117,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,BLUE CROSS S NETWORK,2760.00,,,,,,,712.3600,21084.6100,case rate,"Rev 360 Proc 33363 ASG Rate of $9,558.00 at 100% of $9,558.00 = $9,558.00 Total (Service Line reduced to $2,760.00, claim capped at $2,760.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN AXILLARY ART APPROACH,33363,CPT,360,RC,36000117,CDM,,,,both,,,2760.0000,414.0000,CIGNA HEALTHCARE,CIGNA HMO,2760.00,,,,,,,712.3600,21084.6100,case rate,"Rev 360 Proc 33363 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,760.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,760.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN AXILLARY ART APPROACH,33363,CPT,360,RC,36000117,CDM,,,,both,,,2760.0000,414.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2760.00,,,,,,,712.3600,21084.6100,case rate,"Rev 360 Proc 33363 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $2,760.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,760.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN AXILLARY ART APPROACH,33363,CPT,360,RC,36000117,CDM,,,,both,,,2760.0000,414.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2760.00,,,,,,,712.3600,21084.6100,case rate,"Rev 360 Proc 33363 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,760.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,760.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN AXILLARY ART APPROACH,33363,CPT,360,RC,36000117,CDM,,,,both,,,2760.0000,414.0000,CIGNA HEALTHCARE,CIGNA PPO,2760.00,,,,,,,712.3600,21084.6100,case rate,"Rev 360 Proc 33363 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,760.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,760.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN AXILLARY ART APPROACH,33363,CPT,360,RC,36000117,CDM,,,,both,,,2760.0000,414.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2484.00,,,,,,,712.3600,21084.6100,percent of total billed charges,"90% of $2,760.00 in Billed Charges for Rev 360 Proc 33363 = $2,484.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR OPEN AXILLARY ART APPROACH,33363,CPT,360,RC,36000117,CDM,,,,both,,,2760.0000,414.0000,MEDCOST,MEDCOST VHN,1313.48,,,,,,,712.3600,21084.6100,percent of total billed charges,"47.59% of $2,760.00 in Billed Charges for Rev 360 Proc 33363 = $1,313.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR OPEN AXILLARY ART APPROACH,33363,CPT,360,RC,36000117,CDM,,,,both,,,2760.0000,414.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,21084.61,,,,,,,712.3600,21084.6100,fee schedule,"APG 00121 Proc 33363 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 105% = $21,084.61 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN AXILLARY ART APPROACH,33363,CPT,360,RC,36000117,CDM,,,,both,,,2760.0000,414.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,20703.08,,,,,,,712.3600,21084.6100,fee schedule,"APG 00121 Proc 33363 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 103.1% = $20,703.08 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN AXILLARY ART APPROACH,33363,CPT,360,RC,36000117,CDM,,,,both,,,2760.0000,414.0000,SENTARA HEALTH,SENTARA HEALTH,712.36,,,,,,,712.3600,21084.6100,percent of total billed charges,"25.81% of $2,760.00 in Billed Charges for Rev 360 Proc 33363 = $712.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR OPEN AXILLARY ART APPROACH,33363,CPT,360,RC,36000117,CDM,,,,both,,,2760.0000,414.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2760.00,,,,,,,712.3600,21084.6100,percent of total billed charges,"100% of $2,760.00 in Billed Charges for Rev 360 Proc 33363 = $2,760.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR OPEN AXILLARY ART APPROACH,33363,CPT,360,RC,36000117,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,712.3600,21084.6100,case rate,Rev 360 Proc 33363 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAVR OPEN AXILLARY ART APPROACH,33363,CPT,360,RC,36000117,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,712.3600,21084.6100,case rate,"Rev 360 Proc 33363 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN AXILLARY ART APPROACH,33363,CPT,360,RC,36000117,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,712.3600,21084.6100,case rate,"Rev 360 Proc 33363 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN AXILLARY ART APPROACH,33363,CPT,360,RC,36000117,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,712.3600,21084.6100,case rate,"Rev 360 Proc 33363 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN AXILLARY ART APPROACH,33363,CPT,360,RC,36000117,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,20682.99,,,,,,,712.3600,21084.6100,fee schedule,"APG 00121 Proc 33363 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR OPEN AXILLARY ART APPROACH,33363,CPT,360,RC,36000117,CDM,,,,both,,,2760.0000,414.0000,WELLCARE,WELLCARE MEDICAID,2760.00,,,,,,,712.3600,21084.6100,percent of total billed charges,"100% of $2,760.00 in Billed Charges for Rev 360 Proc 33363 = $2,760.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR TRANSAORTIC APPROACH,33365,CPT,360,RC,48100035,CDM,,,,both,,,2760.0000,414.0000,AETNA,AETNA,1178.52,,,,,,,712.3600,21084.6100,percent of total billed charges,"42.7% of $2,760.00 in Billed Charges for Rev 360 Proc 33365 = $1,178.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR TRANSAORTIC APPROACH,33365,CPT,360,RC,48100035,CDM,,,,both,,,2760.0000,414.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,20883.80,,,,,,,712.3600,21084.6100,fee schedule,"APG 00121 Proc 33365 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 104% = $20,883.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAORTIC APPROACH,33365,CPT,360,RC,48100035,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2760.00,,,,,,,712.3600,21084.6100,fee schedule,"APG 00121 Proc 33365 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99 (Service Line reduced to $2,760.00, claim capped at $2,760.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAORTIC APPROACH,33365,CPT,360,RC,48100035,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,712.3600,21084.6100,case rate,"Rev 360 Proc 33365 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAORTIC APPROACH,33365,CPT,360,RC,48100035,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,BLUE CROSS E NETWORK,2760.00,,,,,,,712.3600,21084.6100,case rate,"Rev 360 Proc 33365 ASG Rate of $9,347.00 at 100% of $9,347.00 = $9,347.00 Total (Service Line reduced to $2,760.00, claim capped at $2,760.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAORTIC APPROACH,33365,CPT,360,RC,48100035,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,BLUE CROSS P NETWORK,2760.00,,,,,,,712.3600,21084.6100,case rate,"Rev 360 Proc 33365 ASG Rate of $9,558.00 at 100% of $9,558.00 = $9,558.00 Total (Service Line reduced to $2,760.00, claim capped at $2,760.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAORTIC APPROACH,33365,CPT,360,RC,48100035,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,BLUE CROSS S NETWORK,2760.00,,,,,,,712.3600,21084.6100,case rate,"Rev 360 Proc 33365 ASG Rate of $9,558.00 at 100% of $9,558.00 = $9,558.00 Total (Service Line reduced to $2,760.00, claim capped at $2,760.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAORTIC APPROACH,33365,CPT,360,RC,48100035,CDM,,,,both,,,2760.0000,414.0000,CIGNA HEALTHCARE,CIGNA HMO,2760.00,,,,,,,712.3600,21084.6100,case rate,"Rev 360 Proc 33365 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,760.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,760.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAORTIC APPROACH,33365,CPT,360,RC,48100035,CDM,,,,both,,,2760.0000,414.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2760.00,,,,,,,712.3600,21084.6100,case rate,"Rev 360 Proc 33365 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $2,760.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,760.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAORTIC APPROACH,33365,CPT,360,RC,48100035,CDM,,,,both,,,2760.0000,414.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2760.00,,,,,,,712.3600,21084.6100,case rate,"Rev 360 Proc 33365 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,760.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,760.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAORTIC APPROACH,33365,CPT,360,RC,48100035,CDM,,,,both,,,2760.0000,414.0000,CIGNA HEALTHCARE,CIGNA PPO,2760.00,,,,,,,712.3600,21084.6100,case rate,"Rev 360 Proc 33365 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,760.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,760.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAORTIC APPROACH,33365,CPT,360,RC,48100035,CDM,,,,both,,,2760.0000,414.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2484.00,,,,,,,712.3600,21084.6100,percent of total billed charges,"90% of $2,760.00 in Billed Charges for Rev 360 Proc 33365 = $2,484.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR TRANSAORTIC APPROACH,33365,CPT,360,RC,48100035,CDM,,,,both,,,2760.0000,414.0000,MEDCOST,MEDCOST VHN,1313.48,,,,,,,712.3600,21084.6100,percent of total billed charges,"47.59% of $2,760.00 in Billed Charges for Rev 360 Proc 33365 = $1,313.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR TRANSAORTIC APPROACH,33365,CPT,360,RC,48100035,CDM,,,,both,,,2760.0000,414.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,21084.61,,,,,,,712.3600,21084.6100,fee schedule,"APG 00121 Proc 33365 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 105% = $21,084.61 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAORTIC APPROACH,33365,CPT,360,RC,48100035,CDM,,,,both,,,2760.0000,414.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,20703.08,,,,,,,712.3600,21084.6100,fee schedule,"APG 00121 Proc 33365 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 103.1% = $20,703.08 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAORTIC APPROACH,33365,CPT,360,RC,48100035,CDM,,,,both,,,2760.0000,414.0000,SENTARA HEALTH,SENTARA HEALTH,712.36,,,,,,,712.3600,21084.6100,percent of total billed charges,"25.81% of $2,760.00 in Billed Charges for Rev 360 Proc 33365 = $712.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR TRANSAORTIC APPROACH,33365,CPT,360,RC,48100035,CDM,,,,both,,,2760.0000,414.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2760.00,,,,,,,712.3600,21084.6100,percent of total billed charges,"100% of $2,760.00 in Billed Charges for Rev 360 Proc 33365 = $2,760.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR TRANSAORTIC APPROACH,33365,CPT,360,RC,48100035,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,712.3600,21084.6100,case rate,Rev 360 Proc 33365 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAVR TRANSAORTIC APPROACH,33365,CPT,360,RC,48100035,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,712.3600,21084.6100,case rate,"Rev 360 Proc 33365 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAORTIC APPROACH,33365,CPT,360,RC,48100035,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,712.3600,21084.6100,case rate,"Rev 360 Proc 33365 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAORTIC APPROACH,33365,CPT,360,RC,48100035,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,712.3600,21084.6100,case rate,"Rev 360 Proc 33365 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAORTIC APPROACH,33365,CPT,360,RC,48100035,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,20682.99,,,,,,,712.3600,21084.6100,fee schedule,"APG 00121 Proc 33365 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAORTIC APPROACH,33365,CPT,360,RC,48100035,CDM,,,,both,,,2760.0000,414.0000,WELLCARE,WELLCARE MEDICAID,2760.00,,,,,,,712.3600,21084.6100,percent of total billed charges,"100% of $2,760.00 in Billed Charges for Rev 360 Proc 33365 = $2,760.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR TRANSAPICAL APPROACH,33366,CPT,360,RC,48100138,CDM,,,,both,,,15085.0000,2262.7500,AETNA,AETNA,6441.30,,,,,,,968.0000,21084.6100,percent of total billed charges,"42.7% of $15,085.00 in Billed Charges for Rev 360 Proc 33366 = $6,441.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR TRANSAPICAL APPROACH,33366,CPT,360,RC,48100138,CDM,,,,both,,,15085.0000,2262.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,20883.80,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33366 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 104% = $20,883.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAPICAL APPROACH,33366,CPT,360,RC,48100138,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15085.00,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33366 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99 (Service Line reduced to $15,085.00, claim capped at $15,085.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAPICAL APPROACH,33366,CPT,360,RC,48100138,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33366 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAPICAL APPROACH,33366,CPT,360,RC,48100138,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS E NETWORK,9347.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33366 ASG Rate of $9,347.00 at 100% of $9,347.00 = $9,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAPICAL APPROACH,33366,CPT,360,RC,48100138,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS P NETWORK,9558.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33366 ASG Rate of $9,558.00 at 100% of $9,558.00 = $9,558.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAPICAL APPROACH,33366,CPT,360,RC,48100138,CDM,,,,both,,,15085.0000,2262.7500,BLUE CROSS,BLUE CROSS S NETWORK,9558.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33366 ASG Rate of $9,558.00 at 100% of $9,558.00 = $9,558.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAPICAL APPROACH,33366,CPT,360,RC,48100138,CDM,,,,both,,,15085.0000,2262.7500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33366 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAPICAL APPROACH,33366,CPT,360,RC,48100138,CDM,,,,both,,,15085.0000,2262.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33366 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAPICAL APPROACH,33366,CPT,360,RC,48100138,CDM,,,,both,,,15085.0000,2262.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33366 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAPICAL APPROACH,33366,CPT,360,RC,48100138,CDM,,,,both,,,15085.0000,2262.7500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33366 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAPICAL APPROACH,33366,CPT,360,RC,48100138,CDM,,,,both,,,15085.0000,2262.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13576.50,,,,,,,968.0000,21084.6100,percent of total billed charges,"90% of $15,085.00 in Billed Charges for Rev 360 Proc 33366 = $13,576.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR TRANSAPICAL APPROACH,33366,CPT,360,RC,48100138,CDM,,,,both,,,15085.0000,2262.7500,MEDCOST,MEDCOST VHN,7178.95,,,,,,,968.0000,21084.6100,percent of total billed charges,"47.59% of $15,085.00 in Billed Charges for Rev 360 Proc 33366 = $7,178.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR TRANSAPICAL APPROACH,33366,CPT,360,RC,48100138,CDM,,,,both,,,15085.0000,2262.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,21084.61,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33366 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 105% = $21,084.61 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAPICAL APPROACH,33366,CPT,360,RC,48100138,CDM,,,,both,,,15085.0000,2262.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,20703.08,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33366 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 103.1% = $20,703.08 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAPICAL APPROACH,33366,CPT,360,RC,48100138,CDM,,,,both,,,15085.0000,2262.7500,SENTARA HEALTH,SENTARA HEALTH,3893.44,,,,,,,968.0000,21084.6100,percent of total billed charges,"25.81% of $15,085.00 in Billed Charges for Rev 360 Proc 33366 = $3,893.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR TRANSAPICAL APPROACH,33366,CPT,360,RC,48100138,CDM,,,,both,,,15085.0000,2262.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15085.00,,,,,,,968.0000,21084.6100,percent of total billed charges,"100% of $15,085.00 in Billed Charges for Rev 360 Proc 33366 = $15,085.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TAVR TRANSAPICAL APPROACH,33366,CPT,360,RC,48100138,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,968.0000,21084.6100,case rate,Rev 360 Proc 33366 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAVR TRANSAPICAL APPROACH,33366,CPT,360,RC,48100138,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33366 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAPICAL APPROACH,33366,CPT,360,RC,48100138,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33366 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAPICAL APPROACH,33366,CPT,360,RC,48100138,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,968.0000,21084.6100,case rate,"Rev 360 Proc 33366 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAPICAL APPROACH,33366,CPT,360,RC,48100138,CDM,,,,both,,,15085.0000,2262.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,20682.99,,,,,,,968.0000,21084.6100,fee schedule,"APG 00121 Proc 33366 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TAVR TRANSAPICAL APPROACH,33366,CPT,360,RC,48100138,CDM,,,,both,,,15085.0000,2262.7500,WELLCARE,WELLCARE MEDICAID,15085.00,,,,,,,968.0000,21084.6100,percent of total billed charges,"100% of $15,085.00 in Billed Charges for Rev 360 Proc 33366 = $15,085.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVR PERQ APPROACH ADDL PROSTHESIS,33419,CPT,481,RC,48100154,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA,5175.67,,,,,,,148.0000,21084.6100,percent of total billed charges,"42.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33419 = $5,175.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVR PERQ APPROACH ADDL PROSTHESIS,33419,CPT,481,RC,48100154,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,20883.80,,,,,,,148.0000,21084.6100,fee schedule,"APG 00121 Proc 33419 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 104% = $20,883.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVR PERQ APPROACH ADDL PROSTHESIS,33419,CPT,481,RC,48100154,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,12121.00,,,,,,,148.0000,21084.6100,fee schedule,"APG 00121 Proc 33419 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99 (Service Line reduced to $12,121.00, claim capped at $12,121.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVR PERQ APPROACH ADDL PROSTHESIS,33419,CPT,481,RC,48100154,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8484.70,,,,,,,148.0000,21084.6100,percent of total billed charges,"Rev 481 Proc 33419 $12,121.00 in Billed Charges at 70% = $8,484.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVR PERQ APPROACH ADDL PROSTHESIS,33419,CPT,481,RC,48100154,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,21084.6100,case rate,Rev 481 Proc 33419 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMVR PERQ APPROACH ADDL PROSTHESIS,33419,CPT,481,RC,48100154,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,21084.6100,case rate,Rev 481 Proc 33419 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMVR PERQ APPROACH ADDL PROSTHESIS,33419,CPT,481,RC,48100154,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,21084.6100,case rate,Rev 481 Proc 33419 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMVR PERQ APPROACH ADDL PROSTHESIS,33419,CPT,481,RC,48100154,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA HMO,5054.46,,,,,,,148.0000,21084.6100,percent of total billed charges,"41.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33419 = $5,054.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVR PERQ APPROACH ADDL PROSTHESIS,33419,CPT,481,RC,48100154,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5624.14,,,,,,,148.0000,21084.6100,percent of total billed charges,"46.4% of $12,121.00 in Billed Charges for Rev 481 Proc 33419 = $5,624.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVR PERQ APPROACH ADDL PROSTHESIS,33419,CPT,481,RC,48100154,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5054.46,,,,,,,148.0000,21084.6100,percent of total billed charges,"41.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33419 = $5,054.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVR PERQ APPROACH ADDL PROSTHESIS,33419,CPT,481,RC,48100154,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA PPO,5054.46,,,,,,,148.0000,21084.6100,percent of total billed charges,"41.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33419 = $5,054.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVR PERQ APPROACH ADDL PROSTHESIS,33419,CPT,481,RC,48100154,CDM,,,,both,,,12121.0000,1818.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10908.90,,,,,,,148.0000,21084.6100,percent of total billed charges,"90% of $12,121.00 in Billed Charges for Rev 481 Proc 33419 = $10,908.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVR PERQ APPROACH ADDL PROSTHESIS,33419,CPT,481,RC,48100154,CDM,,,,both,,,12121.0000,1818.1500,MEDCOST,MEDCOST VHN,5768.38,,,,,,,148.0000,21084.6100,percent of total billed charges,"47.59% of $12,121.00 in Billed Charges for Rev 481 Proc 33419 = $5,768.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVR PERQ APPROACH ADDL PROSTHESIS,33419,CPT,481,RC,48100154,CDM,,,,both,,,12121.0000,1818.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,21084.61,,,,,,,148.0000,21084.6100,fee schedule,"APG 00121 Proc 33419 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 105% = $21,084.61 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVR PERQ APPROACH ADDL PROSTHESIS,33419,CPT,481,RC,48100154,CDM,,,,both,,,12121.0000,1818.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,20703.08,,,,,,,148.0000,21084.6100,fee schedule,"APG 00121 Proc 33419 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 100% = $20,080.58... $20,080.58 at 103.1% = $20,703.08 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVR PERQ APPROACH ADDL PROSTHESIS,33419,CPT,481,RC,48100154,CDM,,,,both,,,12121.0000,1818.1500,SENTARA HEALTH,SENTARA HEALTH,3128.43,,,,,,,148.0000,21084.6100,percent of total billed charges,"25.81% of $12,121.00 in Billed Charges for Rev 481 Proc 33419 = $3,128.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVR PERQ APPROACH ADDL PROSTHESIS,33419,CPT,481,RC,48100154,CDM,,,,both,,,12121.0000,1818.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12121.00,,,,,,,148.0000,21084.6100,percent of total billed charges,"100% of $12,121.00 in Billed Charges for Rev 481 Proc 33419 = $12,121.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMVR PERQ APPROACH ADDL PROSTHESIS,33419,CPT,481,RC,48100154,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,148.0000,21084.6100,case rate,Rev 481 Proc 33419 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMVR PERQ APPROACH ADDL PROSTHESIS,33419,CPT,481,RC,48100154,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,148.0000,21084.6100,case rate,Rev 481 Proc 33419 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMVR PERQ APPROACH ADDL PROSTHESIS,33419,CPT,481,RC,48100154,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,148.0000,21084.6100,case rate,Rev 481 Proc 33419 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMVR PERQ APPROACH ADDL PROSTHESIS,33419,CPT,481,RC,48100154,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,148.0000,21084.6100,case rate,Rev 481 Proc 33419 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMVR PERQ APPROACH ADDL PROSTHESIS,33419,CPT,481,RC,48100154,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,20682.99,,,,,,,148.0000,21084.6100,fee schedule,"APG 00121 Proc 33419 at $836.60 (Base Rate) * 24.0026 (Relative Weight) = $20,080.58 (Total Line Payment) at 103% = $20,682.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TMVR PERQ APPROACH ADDL PROSTHESIS,33419,CPT,481,RC,48100154,CDM,,,,both,,,12121.0000,1818.1500,WELLCARE,WELLCARE MEDICAID,12121.00,,,,,,,148.0000,21084.6100,percent of total billed charges,"100% of $12,121.00 in Billed Charges for Rev 481 Proc 33419 = $12,121.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDO RPR DESCEND THOR AORTA,33880,CPT,361,RC,36100012,CDM,,,,both,,,6653.0000,997.9500,AETNA,AETNA,2840.83,,,,,,,968.0000,22390.4700,percent of total billed charges,"42.7% of $6,653.00 in Billed Charges for Rev 361 Proc 33880 = $2,840.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDO RPR DESCEND THOR AORTA,33880,CPT,361,RC,36100012,CDM,,,,both,,,6653.0000,997.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,22177.24,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 33880 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 104% = $22,177.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDO RPR DESCEND THOR AORTA,33880,CPT,361,RC,36100012,CDM,,,,both,,,6653.0000,997.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,6653.00,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 33880 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99 (Service Line reduced to $6,653.00, claim capped at $6,653.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDO RPR DESCEND THOR AORTA,33880,CPT,361,RC,36100012,CDM,,,,both,,,6653.0000,997.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 33880 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDO RPR DESCEND THOR AORTA,33880,CPT,361,RC,36100012,CDM,,,,both,,,6653.0000,997.9500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 33880 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDO RPR DESCEND THOR AORTA,33880,CPT,361,RC,36100012,CDM,,,,both,,,6653.0000,997.9500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 33880 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDO RPR DESCEND THOR AORTA,33880,CPT,361,RC,36100012,CDM,,,,both,,,6653.0000,997.9500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 33880 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDO RPR DESCEND THOR AORTA,33880,CPT,361,RC,36100012,CDM,,,,both,,,6653.0000,997.9500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 33880 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDO RPR DESCEND THOR AORTA,33880,CPT,361,RC,36100012,CDM,,,,both,,,6653.0000,997.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 33880 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDO RPR DESCEND THOR AORTA,33880,CPT,361,RC,36100012,CDM,,,,both,,,6653.0000,997.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 33880 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDO RPR DESCEND THOR AORTA,33880,CPT,361,RC,36100012,CDM,,,,both,,,6653.0000,997.9500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 33880 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDO RPR DESCEND THOR AORTA,33880,CPT,361,RC,36100012,CDM,,,,both,,,6653.0000,997.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5987.70,,,,,,,968.0000,22390.4700,percent of total billed charges,"90% of $6,653.00 in Billed Charges for Rev 361 Proc 33880 = $5,987.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDO RPR DESCEND THOR AORTA,33880,CPT,361,RC,36100012,CDM,,,,both,,,6653.0000,997.9500,MEDCOST,MEDCOST VHN,3166.16,,,,,,,968.0000,22390.4700,percent of total billed charges,"47.59% of $6,653.00 in Billed Charges for Rev 361 Proc 33880 = $3,166.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDO RPR DESCEND THOR AORTA,33880,CPT,361,RC,36100012,CDM,,,,both,,,6653.0000,997.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,22390.47,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 33880 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 105% = $22,390.47 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDO RPR DESCEND THOR AORTA,33880,CPT,361,RC,36100012,CDM,,,,both,,,6653.0000,997.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,21985.31,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 33880 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 103.1% = $21,985.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDO RPR DESCEND THOR AORTA,33880,CPT,361,RC,36100012,CDM,,,,both,,,6653.0000,997.9500,SENTARA HEALTH,SENTARA HEALTH,1717.14,,,,,,,968.0000,22390.4700,percent of total billed charges,"25.81% of $6,653.00 in Billed Charges for Rev 361 Proc 33880 = $1,717.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDO RPR DESCEND THOR AORTA,33880,CPT,361,RC,36100012,CDM,,,,both,,,6653.0000,997.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6653.00,,,,,,,968.0000,22390.4700,percent of total billed charges,"100% of $6,653.00 in Billed Charges for Rev 361 Proc 33880 = $6,653.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDO RPR DESCEND THOR AORTA,33880,CPT,361,RC,36100012,CDM,,,,both,,,6653.0000,997.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,968.0000,22390.4700,case rate,Rev 361 Proc 33880 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDO RPR DESCEND THOR AORTA,33880,CPT,361,RC,36100012,CDM,,,,both,,,6653.0000,997.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 33880 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDO RPR DESCEND THOR AORTA,33880,CPT,361,RC,36100012,CDM,,,,both,,,6653.0000,997.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 33880 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDO RPR DESCEND THOR AORTA,33880,CPT,361,RC,36100012,CDM,,,,both,,,6653.0000,997.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 33880 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDO RPR DESCEND THOR AORTA,33880,CPT,361,RC,36100012,CDM,,,,both,,,6653.0000,997.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,21963.99,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 33880 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDO RPR DESCEND THOR AORTA,33880,CPT,361,RC,36100012,CDM,,,,both,,,6653.0000,997.9500,WELLCARE,WELLCARE MEDICAID,6653.00,,,,,,,968.0000,22390.4700,percent of total billed charges,"100% of $6,653.00 in Billed Charges for Rev 361 Proc 33880 = $6,653.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,33948,CPT,360,RC,36000239,CDM,,,,both,,,2756.0000,413.4000,AETNA,AETNA,1176.81,,,,,,,711.3200,11503.0400,percent of total billed charges,"42.7% of $2,756.00 in Billed Charges for Rev 360 Proc 33948 = $1,176.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,33948,CPT,360,RC,36000239,CDM,,,,both,,,2756.0000,413.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11393.49,,,,,,,711.3200,11503.0400,fee schedule,"APG 03070 Proc 33948 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 104% = $11,393.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,33948,CPT,360,RC,36000239,CDM,,,,both,,,2756.0000,413.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2756.00,,,,,,,711.3200,11503.0400,fee schedule,"APG 03070 Proc 33948 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94 (Service Line reduced to $2,756.00, claim capped at $2,756.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,33948,CPT,360,RC,36000239,CDM,,,,both,,,2756.0000,413.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,711.3200,11503.0400,case rate,"Rev 360 Proc 33948 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,33948,CPT,360,RC,36000239,CDM,,,,both,,,2756.0000,413.4000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,711.3200,11503.0400,case rate,"Rev 360 Proc 33948 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,33948,CPT,360,RC,36000239,CDM,,,,both,,,2756.0000,413.4000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,711.3200,11503.0400,case rate,"Rev 360 Proc 33948 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,33948,CPT,360,RC,36000239,CDM,,,,both,,,2756.0000,413.4000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,711.3200,11503.0400,case rate,"Rev 360 Proc 33948 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,33948,CPT,360,RC,36000239,CDM,,,,both,,,2756.0000,413.4000,CIGNA HEALTHCARE,CIGNA HMO,2756.00,,,,,,,711.3200,11503.0400,case rate,"Rev 360 Proc 33948 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,756.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,756.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,33948,CPT,360,RC,36000239,CDM,,,,both,,,2756.0000,413.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2756.00,,,,,,,711.3200,11503.0400,case rate,"Rev 360 Proc 33948 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $2,756.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,756.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,33948,CPT,360,RC,36000239,CDM,,,,both,,,2756.0000,413.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2756.00,,,,,,,711.3200,11503.0400,case rate,"Rev 360 Proc 33948 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,756.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,756.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,33948,CPT,360,RC,36000239,CDM,,,,both,,,2756.0000,413.4000,CIGNA HEALTHCARE,CIGNA PPO,2756.00,,,,,,,711.3200,11503.0400,case rate,"Rev 360 Proc 33948 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,756.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,756.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,33948,CPT,360,RC,36000239,CDM,,,,both,,,2756.0000,413.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2480.40,,,,,,,711.3200,11503.0400,percent of total billed charges,"90% of $2,756.00 in Billed Charges for Rev 360 Proc 33948 = $2,480.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,33948,CPT,360,RC,36000239,CDM,,,,both,,,2756.0000,413.4000,MEDCOST,MEDCOST VHN,1311.58,,,,,,,711.3200,11503.0400,percent of total billed charges,"47.59% of $2,756.00 in Billed Charges for Rev 360 Proc 33948 = $1,311.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,33948,CPT,360,RC,36000239,CDM,,,,both,,,2756.0000,413.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11503.04,,,,,,,711.3200,11503.0400,fee schedule,"APG 03070 Proc 33948 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 105% = $11,503.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,33948,CPT,360,RC,36000239,CDM,,,,both,,,2756.0000,413.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11294.89,,,,,,,711.3200,11503.0400,fee schedule,"APG 03070 Proc 33948 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 103.1% = $11,294.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,33948,CPT,360,RC,36000239,CDM,,,,both,,,2756.0000,413.4000,SENTARA HEALTH,SENTARA HEALTH,711.32,,,,,,,711.3200,11503.0400,percent of total billed charges,"25.81% of $2,756.00 in Billed Charges for Rev 360 Proc 33948 = $711.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,33948,CPT,360,RC,36000239,CDM,,,,both,,,2756.0000,413.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2756.00,,,,,,,711.3200,11503.0400,percent of total billed charges,"100% of $2,756.00 in Billed Charges for Rev 360 Proc 33948 = $2,756.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,33948,CPT,360,RC,36000239,CDM,,,,both,,,2756.0000,413.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,711.3200,11503.0400,case rate,Rev 360 Proc 33948 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,33948,CPT,360,RC,36000239,CDM,,,,both,,,2756.0000,413.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,711.3200,11503.0400,case rate,"Rev 360 Proc 33948 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,33948,CPT,360,RC,36000239,CDM,,,,both,,,2756.0000,413.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,711.3200,11503.0400,case rate,"Rev 360 Proc 33948 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,33948,CPT,360,RC,36000239,CDM,,,,both,,,2756.0000,413.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,711.3200,11503.0400,case rate,"Rev 360 Proc 33948 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,33948,CPT,360,RC,36000239,CDM,,,,both,,,2756.0000,413.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11283.94,,,,,,,711.3200,11503.0400,fee schedule,"APG 03070 Proc 33948 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS,33948,CPT,360,RC,36000239,CDM,,,,both,,,2756.0000,413.4000,WELLCARE,WELLCARE MEDICAID,2756.00,,,,,,,711.3200,11503.0400,percent of total billed charges,"100% of $2,756.00 in Billed Charges for Rev 360 Proc 33948 = $2,756.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL,33949,CPT,360,RC,36000240,CDM,,,,both,,,2756.0000,413.4000,AETNA,AETNA,1176.81,,,,,,,711.3200,11503.0400,percent of total billed charges,"42.7% of $2,756.00 in Billed Charges for Rev 360 Proc 33949 = $1,176.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL,33949,CPT,360,RC,36000240,CDM,,,,both,,,2756.0000,413.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11393.49,,,,,,,711.3200,11503.0400,fee schedule,"APG 03070 Proc 33949 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 104% = $11,393.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL,33949,CPT,360,RC,36000240,CDM,,,,both,,,2756.0000,413.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2756.00,,,,,,,711.3200,11503.0400,fee schedule,"APG 03070 Proc 33949 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94 (Service Line reduced to $2,756.00, claim capped at $2,756.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL,33949,CPT,360,RC,36000240,CDM,,,,both,,,2756.0000,413.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,711.3200,11503.0400,case rate,"Rev 360 Proc 33949 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL,33949,CPT,360,RC,36000240,CDM,,,,both,,,2756.0000,413.4000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,711.3200,11503.0400,case rate,"Rev 360 Proc 33949 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL,33949,CPT,360,RC,36000240,CDM,,,,both,,,2756.0000,413.4000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,711.3200,11503.0400,case rate,"Rev 360 Proc 33949 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL,33949,CPT,360,RC,36000240,CDM,,,,both,,,2756.0000,413.4000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,711.3200,11503.0400,case rate,"Rev 360 Proc 33949 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL,33949,CPT,360,RC,36000240,CDM,,,,both,,,2756.0000,413.4000,CIGNA HEALTHCARE,CIGNA HMO,2756.00,,,,,,,711.3200,11503.0400,case rate,"Rev 360 Proc 33949 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,756.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,756.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL,33949,CPT,360,RC,36000240,CDM,,,,both,,,2756.0000,413.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2756.00,,,,,,,711.3200,11503.0400,case rate,"Rev 360 Proc 33949 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $2,756.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,756.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL,33949,CPT,360,RC,36000240,CDM,,,,both,,,2756.0000,413.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2756.00,,,,,,,711.3200,11503.0400,case rate,"Rev 360 Proc 33949 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,756.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,756.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL,33949,CPT,360,RC,36000240,CDM,,,,both,,,2756.0000,413.4000,CIGNA HEALTHCARE,CIGNA PPO,2756.00,,,,,,,711.3200,11503.0400,case rate,"Rev 360 Proc 33949 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,756.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,756.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL,33949,CPT,360,RC,36000240,CDM,,,,both,,,2756.0000,413.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2480.40,,,,,,,711.3200,11503.0400,percent of total billed charges,"90% of $2,756.00 in Billed Charges for Rev 360 Proc 33949 = $2,480.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL,33949,CPT,360,RC,36000240,CDM,,,,both,,,2756.0000,413.4000,MEDCOST,MEDCOST VHN,1311.58,,,,,,,711.3200,11503.0400,percent of total billed charges,"47.59% of $2,756.00 in Billed Charges for Rev 360 Proc 33949 = $1,311.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL,33949,CPT,360,RC,36000240,CDM,,,,both,,,2756.0000,413.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11503.04,,,,,,,711.3200,11503.0400,fee schedule,"APG 03070 Proc 33949 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 105% = $11,503.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL,33949,CPT,360,RC,36000240,CDM,,,,both,,,2756.0000,413.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11294.89,,,,,,,711.3200,11503.0400,fee schedule,"APG 03070 Proc 33949 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 103.1% = $11,294.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL,33949,CPT,360,RC,36000240,CDM,,,,both,,,2756.0000,413.4000,SENTARA HEALTH,SENTARA HEALTH,711.32,,,,,,,711.3200,11503.0400,percent of total billed charges,"25.81% of $2,756.00 in Billed Charges for Rev 360 Proc 33949 = $711.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL,33949,CPT,360,RC,36000240,CDM,,,,both,,,2756.0000,413.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2756.00,,,,,,,711.3200,11503.0400,percent of total billed charges,"100% of $2,756.00 in Billed Charges for Rev 360 Proc 33949 = $2,756.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL,33949,CPT,360,RC,36000240,CDM,,,,both,,,2756.0000,413.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,711.3200,11503.0400,case rate,Rev 360 Proc 33949 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL,33949,CPT,360,RC,36000240,CDM,,,,both,,,2756.0000,413.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,711.3200,11503.0400,case rate,"Rev 360 Proc 33949 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL,33949,CPT,360,RC,36000240,CDM,,,,both,,,2756.0000,413.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,711.3200,11503.0400,case rate,"Rev 360 Proc 33949 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL,33949,CPT,360,RC,36000240,CDM,,,,both,,,2756.0000,413.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,711.3200,11503.0400,case rate,"Rev 360 Proc 33949 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL,33949,CPT,360,RC,36000240,CDM,,,,both,,,2756.0000,413.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11283.94,,,,,,,711.3200,11503.0400,fee schedule,"APG 03070 Proc 33949 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL,33949,CPT,360,RC,36000240,CDM,,,,both,,,2756.0000,413.4000,WELLCARE,WELLCARE MEDICAID,2756.00,,,,,,,711.3200,11503.0400,percent of total billed charges,"100% of $2,756.00 in Billed Charges for Rev 360 Proc 33949 = $2,756.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ,33951,CPT,360,RC,36000241,CDM,,,,both,,,3087.0000,463.0500,AETNA,AETNA,1318.15,,,,,,,796.7500,11503.0400,percent of total billed charges,"42.7% of $3,087.00 in Billed Charges for Rev 360 Proc 33951 = $1,318.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ,33951,CPT,360,RC,36000241,CDM,,,,both,,,3087.0000,463.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11393.49,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33951 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 104% = $11,393.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ,33951,CPT,360,RC,36000241,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3087.00,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33951 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94 (Service Line reduced to $3,087.00, claim capped at $3,087.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ,33951,CPT,360,RC,36000241,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33951 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ,33951,CPT,360,RC,36000241,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33951 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ,33951,CPT,360,RC,36000241,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33951 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ,33951,CPT,360,RC,36000241,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33951 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ,33951,CPT,360,RC,36000241,CDM,,,,both,,,3087.0000,463.0500,CIGNA HEALTHCARE,CIGNA HMO,3087.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33951 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $3,087.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,087.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ,33951,CPT,360,RC,36000241,CDM,,,,both,,,3087.0000,463.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3087.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33951 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $3,087.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,087.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ,33951,CPT,360,RC,36000241,CDM,,,,both,,,3087.0000,463.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3087.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33951 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $3,087.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,087.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ,33951,CPT,360,RC,36000241,CDM,,,,both,,,3087.0000,463.0500,CIGNA HEALTHCARE,CIGNA PPO,3087.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33951 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $3,087.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,087.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ,33951,CPT,360,RC,36000241,CDM,,,,both,,,3087.0000,463.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2778.30,,,,,,,796.7500,11503.0400,percent of total billed charges,"90% of $3,087.00 in Billed Charges for Rev 360 Proc 33951 = $2,778.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ,33951,CPT,360,RC,36000241,CDM,,,,both,,,3087.0000,463.0500,MEDCOST,MEDCOST VHN,1469.10,,,,,,,796.7500,11503.0400,percent of total billed charges,"47.59% of $3,087.00 in Billed Charges for Rev 360 Proc 33951 = $1,469.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ,33951,CPT,360,RC,36000241,CDM,,,,both,,,3087.0000,463.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11503.04,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33951 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 105% = $11,503.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ,33951,CPT,360,RC,36000241,CDM,,,,both,,,3087.0000,463.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11294.89,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33951 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 103.1% = $11,294.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ,33951,CPT,360,RC,36000241,CDM,,,,both,,,3087.0000,463.0500,SENTARA HEALTH,SENTARA HEALTH,796.75,,,,,,,796.7500,11503.0400,percent of total billed charges,"25.81% of $3,087.00 in Billed Charges for Rev 360 Proc 33951 = $796.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ,33951,CPT,360,RC,36000241,CDM,,,,both,,,3087.0000,463.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3087.00,,,,,,,796.7500,11503.0400,percent of total billed charges,"100% of $3,087.00 in Billed Charges for Rev 360 Proc 33951 = $3,087.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ,33951,CPT,360,RC,36000241,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,796.7500,11503.0400,case rate,Rev 360 Proc 33951 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ,33951,CPT,360,RC,36000241,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33951 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ,33951,CPT,360,RC,36000241,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33951 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ,33951,CPT,360,RC,36000241,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33951 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ,33951,CPT,360,RC,36000241,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11283.94,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33951 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ,33951,CPT,360,RC,36000241,CDM,,,,both,,,3087.0000,463.0500,WELLCARE,WELLCARE MEDICAID,3087.00,,,,,,,796.7500,11503.0400,percent of total billed charges,"100% of $3,087.00 in Billed Charges for Rev 360 Proc 33951 = $3,087.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,AETNA,AETNA,699.43,,,,,,,422.7700,1638.0000,percent of total billed charges,"42.7% of $1,638.00 in Billed Charges for Rev 361 Proc 36589 = $699.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1057.13,,,,,,,422.7700,1638.0000,fee schedule,"APG 00076 Proc 36589 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,016.47 at 104% = $1,057.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,569.14,,,,,,,422.7700,1638.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,AETNA,AETNA HEALTHCARE MEDICARE,569.14,,,,,,,422.7700,1638.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,569.14,,,,,,,422.7700,1638.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,AMBETTER,AMBETTER,1240.72,,,,,,,422.7700,1638.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,591.90,,,,,,,422.7700,1638.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,BLUE CROSS,ANTHEM EXCHANGE,1401.25,,,,,,,422.7700,1638.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1046.96,,,,,,,422.7700,1638.0000,fee schedule,"APG 00076 Proc 36589 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,016.47 at 103% = $1,046.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,BLUE CROSS,ANTHEM HMO,1488.74,,,,,,,422.7700,1638.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,586.21,,,,,,,422.7700,1638.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1638.00,,,,,,,422.7700,1638.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,422.7700,1638.0000,case rate,Rev 361 Proc 36589 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,422.7700,1638.0000,case rate,Rev 361 Proc 36589 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,BLUE CROSS,BLUE CROSS MEDICARE,591.90,,,,,,,422.7700,1638.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,422.7700,1638.0000,case rate,Rev 361 Proc 36589 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,422.7700,1638.0000,case rate,Rev 361 Proc 36589 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,422.7700,1638.0000,case rate,Rev 361 Proc 36589 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,422.7700,1638.0000,case rate,Rev 361 Proc 36589 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,CIGNA HEALTHCARE,CIGNA HMO,1638.00,,,,,,,422.7700,1638.0000,case rate,"Rev 361 Proc 36589 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,638.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,638.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,422.7700,1638.0000,case rate,"Rev 361 Proc 36589 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,597.59,,,,,,,422.7700,1638.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1638.00,,,,,,,422.7700,1638.0000,case rate,"Rev 361 Proc 36589 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,638.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,638.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,CIGNA HEALTHCARE,CIGNA PPO,1638.00,,,,,,,422.7700,1638.0000,case rate,"Rev 361 Proc 36589 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,638.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,638.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,597.59,,,,,,,422.7700,1638.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1474.20,,,,,,,422.7700,1638.0000,percent of total billed charges,"90% of $1,638.00 in Billed Charges for Rev 361 Proc 36589 = $1,474.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,HUMANA,HUMANA MEDICARE,569.14,,,,,,,422.7700,1638.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,569.14,,,,,,,422.7700,1638.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,MEDCOST,MEDCOST VHN,779.52,,,,,,,422.7700,1638.0000,percent of total billed charges,"47.59% of $1,638.00 in Billed Charges for Rev 361 Proc 36589 = $779.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1067.29,,,,,,,422.7700,1638.0000,fee schedule,"APG 00076 Proc 36589 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,016.47 at 100% = $1,016.47... $1,016.47 at 105% = $1,067.29 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,597.59,,,,,,,422.7700,1638.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,597.59,,,,,,,422.7700,1638.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,NHC ADVANTAGE,NHC ADVANTAGE,597.59,,,,,,,422.7700,1638.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1047.98,,,,,,,422.7700,1638.0000,fee schedule,"APG 00076 Proc 36589 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,016.47 at 100% = $1,016.47... $1,016.47 at 103.1% = $1,047.98 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,SENTARA HEALTH,SENTARA HEALTH,422.77,,,,,,,422.7700,1638.0000,percent of total billed charges,"25.81% of $1,638.00 in Billed Charges for Rev 361 Proc 36589 = $422.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,SENTARA HEALTH,SENTARA MEDICARE,569.14,,,,,,,422.7700,1638.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1638.00,,,,,,,422.7700,1638.0000,percent of total billed charges,"100% of $1,638.00 in Billed Charges for Rev 361 Proc 36589 = $1,638.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,422.7700,1638.0000,case rate,Rev 361 Proc 36589 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,422.7700,1638.0000,case rate,Rev 361 Proc 36589 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,422.7700,1638.0000,case rate,Rev 361 Proc 36589 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,422.7700,1638.0000,case rate,"Rev 361 Proc 36589 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1046.96,,,,,,,422.7700,1638.0000,fee schedule,"APG 00076 Proc 36589 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,016.47 at 103% = $1,046.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,569.14,,,,,,,422.7700,1638.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,569.14,,,,,,,422.7700,1638.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,WELLCARE,WELLCARE MEDICAID,1638.00,,,,,,,422.7700,1638.0000,percent of total billed charges,"100% of $1,638.00 in Billed Charges for Rev 361 Proc 36589 = $1,638.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL OF CVC W/O PORT PUMP,36589,CPT,361,RC,36100097,CDM,,,,both,,,1638.0000,245.7000,WELLCARE,WELLCARE MEDICARE,603.28,,,,,,,422.7700,1638.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRILL STOP 7.5,272,RC,,,,,,,,both,,,1960.1200,294.0200,AETNA,AETNA,836.97,,,,,,,505.9100,1960.1200,percent of total billed charges,"42.7% of $1,960.12 in Billed Charges for Rev 272 = $836.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL STOP 7.5,272,RC,,,,,,,,both,,,1960.1200,294.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1372.08,,,,,,,505.9100,1960.1200,percent of total billed charges,"Rev 272 $1,960.12 in Billed Charges at 70% = $1,372.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL STOP 7.5,272,RC,,,,,,,,both,,,1960.1200,294.0200,CIGNA HEALTHCARE,CIGNA HMO,817.37,,,,,,,505.9100,1960.1200,percent of total billed charges,"41.7% of $1,960.12 in Billed Charges for Rev 272 = $817.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL STOP 7.5,272,RC,,,,,,,,both,,,1960.1200,294.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,909.50,,,,,,,505.9100,1960.1200,percent of total billed charges,"46.4% of $1,960.12 in Billed Charges for Rev 272 = $909.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL STOP 7.5,272,RC,,,,,,,,both,,,1960.1200,294.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,817.37,,,,,,,505.9100,1960.1200,percent of total billed charges,"41.7% of $1,960.12 in Billed Charges for Rev 272 = $817.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL STOP 7.5,272,RC,,,,,,,,both,,,1960.1200,294.0200,CIGNA HEALTHCARE,CIGNA PPO,817.37,,,,,,,505.9100,1960.1200,percent of total billed charges,"41.7% of $1,960.12 in Billed Charges for Rev 272 = $817.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL STOP 7.5,272,RC,,,,,,,,both,,,1960.1200,294.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1764.11,,,,,,,505.9100,1960.1200,percent of total billed charges,"90% of $1,960.12 in Billed Charges for Rev 272 = $1,764.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL STOP 7.5,272,RC,,,,,,,,both,,,1960.1200,294.0200,MEDCOST,MEDCOST VHN,932.82,,,,,,,505.9100,1960.1200,percent of total billed charges,"47.59% of $1,960.12 in Billed Charges for Rev 272 = $932.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL STOP 7.5,272,RC,,,,,,,,both,,,1960.1200,294.0200,SENTARA HEALTH,SENTARA HEALTH,505.91,,,,,,,505.9100,1960.1200,percent of total billed charges,"25.81% of $1,960.12 in Billed Charges for Rev 272 = $505.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL STOP 7.5,272,RC,,,,,,,,both,,,1960.1200,294.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1960.12,,,,,,,505.9100,1960.1200,percent of total billed charges,"100% of $1,960.12 in Billed Charges for Rev 272 = $1,960.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL STOP 7.5,272,RC,,,,,,,,both,,,1960.1200,294.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,980.06,,,,,,,505.9100,1960.1200,percent of total billed charges,"Rev 272 $1,960.12 in Billed Charges at 50% = $980.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL STOP 7.5,272,RC,,,,,,,,both,,,1960.1200,294.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,633.12,,,,,,,505.9100,1960.1200,other,"32.3% of $1,960.12 in Billed Charges for Rev 272 = $633.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL STOP 7.5,272,RC,,,,,,,,both,,,1960.1200,294.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,601.76,,,,,,,505.9100,1960.1200,other,"30.7% of $1,960.12 in Billed Charges for Rev 272 = $601.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL STOP 7.5,272,RC,,,,,,,,both,,,1960.1200,294.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,633.12,,,,,,,505.9100,1960.1200,percent of total billed charges,"32.3% of $1,960.12 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL STOP 7.5,272,RC,,,,,,,,both,,,1960.1200,294.0200,WELLCARE,WELLCARE MEDICAID,1960.12,,,,,,,505.9100,1960.1200,percent of total billed charges,"100% of $1,960.12 in Billed Charges for Rev 272 = $1,960.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL STRAIGHT SHAFT 35MM  71355371,272,RC,,,,,,,,both,,,898.3900,134.7600,AETNA,AETNA,383.61,,,,,,,231.8700,898.3900,percent of total billed charges,42.7% of $898.39 in Billed Charges for Rev 272 = $383.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL STRAIGHT SHAFT 35MM  71355371,272,RC,,,,,,,,both,,,898.3900,134.7600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,628.87,,,,,,,231.8700,898.3900,percent of total billed charges,Rev 272 $898.39 in Billed Charges at 70% = $628.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL STRAIGHT SHAFT 35MM  71355371,272,RC,,,,,,,,both,,,898.3900,134.7600,CIGNA HEALTHCARE,CIGNA HMO,374.63,,,,,,,231.8700,898.3900,percent of total billed charges,41.7% of $898.39 in Billed Charges for Rev 272 = $374.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL STRAIGHT SHAFT 35MM  71355371,272,RC,,,,,,,,both,,,898.3900,134.7600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,416.85,,,,,,,231.8700,898.3900,percent of total billed charges,46.4% of $898.39 in Billed Charges for Rev 272 = $416.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL STRAIGHT SHAFT 35MM  71355371,272,RC,,,,,,,,both,,,898.3900,134.7600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,374.63,,,,,,,231.8700,898.3900,percent of total billed charges,41.7% of $898.39 in Billed Charges for Rev 272 = $374.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL STRAIGHT SHAFT 35MM  71355371,272,RC,,,,,,,,both,,,898.3900,134.7600,CIGNA HEALTHCARE,CIGNA PPO,374.63,,,,,,,231.8700,898.3900,percent of total billed charges,41.7% of $898.39 in Billed Charges for Rev 272 = $374.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL STRAIGHT SHAFT 35MM  71355371,272,RC,,,,,,,,both,,,898.3900,134.7600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,808.55,,,,,,,231.8700,898.3900,percent of total billed charges,90% of $898.39 in Billed Charges for Rev 272 = $808.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL STRAIGHT SHAFT 35MM  71355371,272,RC,,,,,,,,both,,,898.3900,134.7600,MEDCOST,MEDCOST VHN,427.54,,,,,,,231.8700,898.3900,percent of total billed charges,47.59% of $898.39 in Billed Charges for Rev 272 = $427.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL STRAIGHT SHAFT 35MM  71355371,272,RC,,,,,,,,both,,,898.3900,134.7600,SENTARA HEALTH,SENTARA HEALTH,231.87,,,,,,,231.8700,898.3900,percent of total billed charges,25.81% of $898.39 in Billed Charges for Rev 272 = $231.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL STRAIGHT SHAFT 35MM  71355371,272,RC,,,,,,,,both,,,898.3900,134.7600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",898.39,,,,,,,231.8700,898.3900,percent of total billed charges,100% of $898.39 in Billed Charges for Rev 272 = $898.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL STRAIGHT SHAFT 35MM  71355371,272,RC,,,,,,,,both,,,898.3900,134.7600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,449.20,,,,,,,231.8700,898.3900,percent of total billed charges,Rev 272 $898.39 in Billed Charges at 50% = $449.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL STRAIGHT SHAFT 35MM  71355371,272,RC,,,,,,,,both,,,898.3900,134.7600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,290.18,,,,,,,231.8700,898.3900,other,32.3% of $898.39 in Billed Charges for Rev 272 = $290.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRILL STRAIGHT SHAFT 35MM  71355371,272,RC,,,,,,,,both,,,898.3900,134.7600,UNITED HEALTHCARE,UHC HERITAGE SELECT,275.81,,,,,,,231.8700,898.3900,other,30.7% of $898.39 in Billed Charges for Rev 272 = $275.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRILL STRAIGHT SHAFT 35MM  71355371,272,RC,,,,,,,,both,,,898.3900,134.7600,UNITED HEALTHCARE,UNITED HEALTHCARE,290.18,,,,,,,231.8700,898.3900,percent of total billed charges,32.3% of $898.39 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL STRAIGHT SHAFT 35MM  71355371,272,RC,,,,,,,,both,,,898.3900,134.7600,WELLCARE,WELLCARE MEDICAID,898.39,,,,,,,231.8700,898.3900,percent of total billed charges,100% of $898.39 in Billed Charges for Rev 272 = $898.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,AETNA,AETNA,96.50,,,,,,,18.4200,263.1500,percent of total billed charges,42.7% of $226.00 in Billed Charges for Rev 300 Proc 36591 = $96.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,102.23,,,,,,,18.4200,263.1500,fee schedule,APG 00494 Proc 36591 at $836.60 (Base Rate) * 0.1175 (Relative Weight) = $98.30 (Total Line Payment) at 104% = $102.23. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,120.71,,,,,,,18.4200,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,AETNA,AETNA HEALTHCARE MEDICARE,120.71,,,,,,,18.4200,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,120.71,,,,,,,18.4200,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,AMBETTER,AMBETTER,263.15,,,,,,,18.4200,263.1500,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,125.54,,,,,,,18.4200,263.1500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,ANTHEM EXCHANGE,226.00,,,,,,,18.4200,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,101.25,,,,,,,18.4200,263.1500,fee schedule,APG 00494 Proc 36591 at $836.60 (Base Rate) * 0.1175 (Relative Weight) = $98.30 (Total Line Payment) at 103% = $101.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,ANTHEM HMO,226.00,,,,,,,18.4200,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,124.33,,,,,,,18.4200,263.1500,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",226.00,,,,,,,18.4200,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,18.42,,,,,,,18.4200,263.1500,fee schedule,$18.42 from Fee Schedule BLDTM_23 for Rev 300 Proc 36591 * Qty 1 = $18.42 at 100% = $18.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,BLUE CROSS MEDICARE,125.54,,,,,,,18.4200,263.1500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,CIGNA HEALTHCARE,CIGNA HMO,94.24,,,,,,,18.4200,263.1500,percent of total billed charges,Rev 300 Proc 36591 $226.00 in Billed Charges at 41.7% = $94.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,96.73,,,,,,,18.4200,263.1500,percent of total billed charges,Rev 300 Proc 36591 $226.00 in Billed Charges at 42.8% = $96.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,126.75,,,,,,,18.4200,263.1500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,94.24,,,,,,,18.4200,263.1500,percent of total billed charges,Rev 300 Proc 36591 $226.00 in Billed Charges at 41.7% = $94.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,CIGNA HEALTHCARE,CIGNA PPO,94.24,,,,,,,18.4200,263.1500,percent of total billed charges,Rev 300 Proc 36591 $226.00 in Billed Charges at 41.7% = $94.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,126.75,,,,,,,18.4200,263.1500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,203.40,,,,,,,18.4200,263.1500,percent of total billed charges,90% of $226.00 in Billed Charges for Rev 300 Proc 36591 = $203.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,HUMANA,HUMANA MEDICARE,120.71,,,,,,,18.4200,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,120.71,,,,,,,18.4200,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,MEDCOST,MEDCOST VHN,107.55,,,,,,,18.4200,263.1500,percent of total billed charges,47.59% of $226.00 in Billed Charges for Rev 300 Proc 36591 = $107.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,103.22,,,,,,,18.4200,263.1500,fee schedule,APG 00494 Proc 36591 at $836.60 (Base Rate) * 0.1175 (Relative Weight) = $98.30 (Total Line Payment) at 100% = $98.30... $98.30 at 105% = $103.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,126.75,,,,,,,18.4200,263.1500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,126.75,,,,,,,18.4200,263.1500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,NHC ADVANTAGE,NHC ADVANTAGE,126.75,,,,,,,18.4200,263.1500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,101.35,,,,,,,18.4200,263.1500,fee schedule,APG 00494 Proc 36591 at $836.60 (Base Rate) * 0.1175 (Relative Weight) = $98.30 (Total Line Payment) at 100% = $98.30... $98.30 at 103.1% = $101.35 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,SENTARA HEALTH,SENTARA HEALTH,58.33,,,,,,,18.4200,263.1500,percent of total billed charges,25.81% of $226.00 in Billed Charges for Rev 300 Proc 36591 = $58.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,SENTARA HEALTH,SENTARA MEDICARE,120.71,,,,,,,18.4200,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",226.00,,,,,,,18.4200,263.1500,percent of total billed charges,100% of $226.00 in Billed Charges for Rev 300 Proc 36591 = $226.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,39.41,,,,,,,18.4200,263.1500,fee schedule,$78.82 from Fee Schedule TCUHC24 for Rev 300 Proc 36591 * Qty 1 = $78.82 at 50% = $39.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,101.25,,,,,,,18.4200,263.1500,fee schedule,APG 00494 Proc 36591 at $836.60 (Base Rate) * 0.1175 (Relative Weight) = $98.30 (Total Line Payment) at 103% = $101.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,120.71,,,,,,,18.4200,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,120.71,,,,,,,18.4200,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,WELLCARE,WELLCARE MEDICAID,226.00,,,,,,,18.4200,263.1500,percent of total billed charges,100% of $226.00 in Billed Charges for Rev 300 Proc 36591 = $226.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD DRAW IMPLANTED PORT,36591,CPT,300,RC,30000003,CDM,,,,both,,,226.0000,33.9000,WELLCARE,WELLCARE MEDICARE,127.95,,,,,,,18.4200,263.1500,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,AETNA,AETNA,72.59,,,,,,,43.8800,263.1500,percent of total billed charges,42.7% of $170.00 in Billed Charges for Rev 361 Proc 36592 = $72.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,102.23,,,,,,,43.8800,263.1500,fee schedule,APG 00494 Proc 36592 at $836.60 (Base Rate) * 0.1175 (Relative Weight) = $98.30 (Total Line Payment) at 104% = $102.23. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,120.71,,,,,,,43.8800,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,AETNA,AETNA HEALTHCARE MEDICARE,120.71,,,,,,,43.8800,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,120.71,,,,,,,43.8800,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,AMBETTER,AMBETTER,263.15,,,,,,,43.8800,263.1500,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,125.54,,,,,,,43.8800,263.1500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,BLUE CROSS,ANTHEM EXCHANGE,170.00,,,,,,,43.8800,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,101.25,,,,,,,43.8800,263.1500,fee schedule,APG 00494 Proc 36592 at $836.60 (Base Rate) * 0.1175 (Relative Weight) = $98.30 (Total Line Payment) at 103% = $101.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,BLUE CROSS,ANTHEM HMO,170.00,,,,,,,43.8800,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,124.33,,,,,,,43.8800,263.1500,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",170.00,,,,,,,43.8800,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,170.00,,,,,,,43.8800,263.1500,case rate,"Rev 361 Proc 36592 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $170.00 in Billed Charges - $0.00 in ASG Allowed Amount = $170.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,BLUE CROSS,BLUE CROSS E NETWORK,170.00,,,,,,,43.8800,263.1500,case rate,"Rev 361 Proc 36592 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total (Service Line reduced to $170.00, claim capped at $170.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,BLUE CROSS,BLUE CROSS MEDICARE,125.54,,,,,,,43.8800,263.1500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,BLUE CROSS,BLUE CROSS P NETWORK,170.00,,,,,,,43.8800,263.1500,case rate,"Rev 361 Proc 36592 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total (Service Line reduced to $170.00, claim capped at $170.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,BLUE CROSS,BLUE CROSS S NETWORK,170.00,,,,,,,43.8800,263.1500,case rate,"Rev 361 Proc 36592 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total (Service Line reduced to $170.00, claim capped at $170.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,CIGNA HEALTHCARE,CIGNA HMO,170.00,,,,,,,43.8800,263.1500,case rate,Rev 361 Proc 36592 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total (Limited to $170.00 in Billed Charges - $0.00 in ASG Allowed Amount = $170.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,170.00,,,,,,,43.8800,263.1500,case rate,Rev 361 Proc 36592 ASG Rate of $175.00 at 100% of $175.00 = $175.00 Total (Limited to $170.00 in Billed Charges - $0.00 in ASG Allowed Amount = $170.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,126.75,,,,,,,43.8800,263.1500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,170.00,,,,,,,43.8800,263.1500,case rate,Rev 361 Proc 36592 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total (Limited to $170.00 in Billed Charges - $0.00 in ASG Allowed Amount = $170.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,CIGNA HEALTHCARE,CIGNA PPO,170.00,,,,,,,43.8800,263.1500,case rate,Rev 361 Proc 36592 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total (Limited to $170.00 in Billed Charges - $0.00 in ASG Allowed Amount = $170.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,126.75,,,,,,,43.8800,263.1500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,153.00,,,,,,,43.8800,263.1500,percent of total billed charges,90% of $170.00 in Billed Charges for Rev 361 Proc 36592 = $153.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,HUMANA,HUMANA MEDICARE,120.71,,,,,,,43.8800,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,120.71,,,,,,,43.8800,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,MEDCOST,MEDCOST VHN,80.90,,,,,,,43.8800,263.1500,percent of total billed charges,47.59% of $170.00 in Billed Charges for Rev 361 Proc 36592 = $80.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,103.22,,,,,,,43.8800,263.1500,fee schedule,APG 00494 Proc 36592 at $836.60 (Base Rate) * 0.1175 (Relative Weight) = $98.30 (Total Line Payment) at 100% = $98.30... $98.30 at 105% = $103.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,126.75,,,,,,,43.8800,263.1500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,126.75,,,,,,,43.8800,263.1500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,NHC ADVANTAGE,NHC ADVANTAGE,126.75,,,,,,,43.8800,263.1500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,101.35,,,,,,,43.8800,263.1500,fee schedule,APG 00494 Proc 36592 at $836.60 (Base Rate) * 0.1175 (Relative Weight) = $98.30 (Total Line Payment) at 100% = $98.30... $98.30 at 103.1% = $101.35 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,SENTARA HEALTH,SENTARA HEALTH,43.88,,,,,,,43.8800,263.1500,percent of total billed charges,25.81% of $170.00 in Billed Charges for Rev 361 Proc 36592 = $43.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,SENTARA HEALTH,SENTARA MEDICARE,120.71,,,,,,,43.8800,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",170.00,,,,,,,43.8800,263.1500,percent of total billed charges,100% of $170.00 in Billed Charges for Rev 361 Proc 36592 = $170.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,170.00,,,,,,,43.8800,263.1500,case rate,Rev 361 Proc 36592 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total (Limited to $170.00 in Billed Charges - $0.00 in ASG Allowed Amount = $170.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,170.00,,,,,,,43.8800,263.1500,case rate,"Rev 361 Proc 36592 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total (Service Line reduced to $170.00, claim capped at $170.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,170.00,,,,,,,43.8800,263.1500,case rate,"Rev 361 Proc 36592 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total (Service Line reduced to $170.00, claim capped at $170.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,170.00,,,,,,,43.8800,263.1500,case rate,"Rev 361 Proc 36592 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total (Service Line reduced to $170.00, claim capped at $170.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,101.25,,,,,,,43.8800,263.1500,fee schedule,APG 00494 Proc 36592 at $836.60 (Base Rate) * 0.1175 (Relative Weight) = $98.30 (Total Line Payment) at 103% = $101.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,120.71,,,,,,,43.8800,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,120.71,,,,,,,43.8800,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,WELLCARE,WELLCARE MEDICAID,170.00,,,,,,,43.8800,263.1500,percent of total billed charges,100% of $170.00 in Billed Charges for Rev 361 Proc 36592 = $170.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD DRAW CENTRAL/PERIPH CATH,36592,CPT,361,RC,36100091,CDM,,,,both,,,170.0000,25.5000,WELLCARE,WELLCARE MEDICARE,127.95,,,,,,,43.8800,263.1500,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,AETNA,AETNA,745.12,,,,,,,173.0000,1745.0000,percent of total billed charges,"42.7% of $1,745.00 in Billed Charges for Rev 361 Proc 36593 = $745.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,406.06,,,,,,,173.0000,1745.0000,fee schedule,"APG 00111 Proc 36593 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $390.44 at 104% = $406.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,299.68,,,,,,,173.0000,1745.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,AETNA,AETNA HEALTHCARE MEDICARE,299.68,,,,,,,173.0000,1745.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,299.68,,,,,,,173.0000,1745.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,AMBETTER,AMBETTER,653.30,,,,,,,173.0000,1745.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,311.67,,,,,,,173.0000,1745.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,BLUE CROSS,ANTHEM EXCHANGE,737.82,,,,,,,173.0000,1745.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,402.15,,,,,,,173.0000,1745.0000,fee schedule,"APG 00111 Proc 36593 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $390.44 at 103% = $402.15. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,BLUE CROSS,ANTHEM HMO,783.89,,,,,,,173.0000,1745.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,308.67,,,,,,,173.0000,1745.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",922.17,,,,,,,173.0000,1745.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,173.0000,1745.0000,case rate,"Rev 361 Proc 36593 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,173.0000,1745.0000,case rate,Rev 361 Proc 36593 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,BLUE CROSS,BLUE CROSS MEDICARE,311.67,,,,,,,173.0000,1745.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,173.0000,1745.0000,case rate,Rev 361 Proc 36593 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,173.0000,1745.0000,case rate,Rev 361 Proc 36593 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,CIGNA HEALTHCARE,CIGNA HMO,228.00,,,,,,,173.0000,1745.0000,case rate,Rev 361 Proc 36593 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.00,,,,,,,173.0000,1745.0000,case rate,Rev 361 Proc 36593 ASG Rate of $175.00 at 100% of $175.00 = $175.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,314.66,,,,,,,173.0000,1745.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.00,,,,,,,173.0000,1745.0000,case rate,Rev 361 Proc 36593 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,CIGNA HEALTHCARE,CIGNA PPO,228.00,,,,,,,173.0000,1745.0000,case rate,Rev 361 Proc 36593 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,314.66,,,,,,,173.0000,1745.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1570.50,,,,,,,173.0000,1745.0000,percent of total billed charges,"90% of $1,745.00 in Billed Charges for Rev 361 Proc 36593 = $1,570.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,HUMANA,HUMANA MEDICARE,299.68,,,,,,,173.0000,1745.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,299.68,,,,,,,173.0000,1745.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,MEDCOST,MEDCOST VHN,830.45,,,,,,,173.0000,1745.0000,percent of total billed charges,"47.59% of $1,745.00 in Billed Charges for Rev 361 Proc 36593 = $830.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,409.96,,,,,,,173.0000,1745.0000,fee schedule,"APG 00111 Proc 36593 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $390.44 at 100% = $390.44... $390.44 at 105% = $409.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,314.66,,,,,,,173.0000,1745.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,314.66,,,,,,,173.0000,1745.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,NHC ADVANTAGE,NHC ADVANTAGE,314.66,,,,,,,173.0000,1745.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,402.54,,,,,,,173.0000,1745.0000,fee schedule,"APG 00111 Proc 36593 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $390.44 at 100% = $390.44... $390.44 at 103.1% = $402.54 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,SENTARA HEALTH,SENTARA HEALTH,450.38,,,,,,,173.0000,1745.0000,percent of total billed charges,"25.81% of $1,745.00 in Billed Charges for Rev 361 Proc 36593 = $450.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,SENTARA HEALTH,SENTARA MEDICARE,299.68,,,,,,,173.0000,1745.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1745.00,,,,,,,173.0000,1745.0000,percent of total billed charges,"100% of $1,745.00 in Billed Charges for Rev 361 Proc 36593 = $1,745.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,173.0000,1745.0000,case rate,Rev 361 Proc 36593 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,173.0000,1745.0000,case rate,Rev 361 Proc 36593 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,173.0000,1745.0000,case rate,Rev 361 Proc 36593 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,173.0000,1745.0000,case rate,Rev 361 Proc 36593 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,402.15,,,,,,,173.0000,1745.0000,fee schedule,"APG 00111 Proc 36593 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $390.44 at 103% = $402.15. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,299.68,,,,,,,173.0000,1745.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,299.68,,,,,,,173.0000,1745.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,WELLCARE,WELLCARE MEDICAID,1745.00,,,,,,,173.0000,1745.0000,percent of total billed charges,"100% of $1,745.00 in Billed Charges for Rev 361 Proc 36593 = $1,745.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DECLOT IMPLANT CATH W THROMBOL,36593,CPT,361,RC,36100098,CDM,,,,both,,,1745.0000,261.7500,WELLCARE,WELLCARE MEDICARE,317.66,,,,,,,173.0000,1745.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,AETNA,AETNA,1312.17,,,,,,,578.0000,3113.4500,percent of total billed charges,"42.7% of $3,073.00 in Billed Charges for Rev 361 Proc 36596 = $1,312.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1057.13,,,,,,,578.0000,3113.4500,fee schedule,"APG 00076 Proc 36596 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment) at 104% = $1,057.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1428.19,,,,,,,578.0000,3113.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,AETNA,AETNA HEALTHCARE MEDICARE,1428.19,,,,,,,578.0000,3113.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,1428.19,,,,,,,578.0000,3113.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,AMBETTER,AMBETTER,3113.45,,,,,,,578.0000,3113.4500,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1485.32,,,,,,,578.0000,3113.4500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,BLUE CROSS,ANTHEM EXCHANGE,3073.00,,,,,,,578.0000,3113.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1046.96,,,,,,,578.0000,3113.4500,fee schedule,"APG 00076 Proc 36596 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment) at 103% = $1,046.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,BLUE CROSS,ANTHEM HMO,3073.00,,,,,,,578.0000,3113.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1471.04,,,,,,,578.0000,3113.4500,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3073.00,,,,,,,578.0000,3113.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,578.0000,3113.4500,case rate,Rev 361 Proc 36596 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,578.0000,3113.4500,case rate,"Rev 361 Proc 36596 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,BLUE CROSS,BLUE CROSS MEDICARE,1485.32,,,,,,,578.0000,3113.4500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,578.0000,3113.4500,case rate,"Rev 361 Proc 36596 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,578.0000,3113.4500,case rate,"Rev 361 Proc 36596 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,3113.4500,case rate,Rev 361 Proc 36596 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,3113.4500,case rate,Rev 361 Proc 36596 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,578.0000,3113.4500,case rate,"Rev 361 Proc 36596 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,578.0000,3113.4500,case rate,"Rev 361 Proc 36596 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,1499.60,,,,,,,578.0000,3113.4500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,578.0000,3113.4500,case rate,"Rev 361 Proc 36596 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,578.0000,3113.4500,case rate,"Rev 361 Proc 36596 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1499.60,,,,,,,578.0000,3113.4500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2765.70,,,,,,,578.0000,3113.4500,percent of total billed charges,"90% of $3,073.00 in Billed Charges for Rev 361 Proc 36596 = $2,765.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,HUMANA,HUMANA MEDICARE,1428.19,,,,,,,578.0000,3113.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1428.19,,,,,,,578.0000,3113.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,MEDCOST,MEDCOST VHN,1462.44,,,,,,,578.0000,3113.4500,percent of total billed charges,"47.59% of $3,073.00 in Billed Charges for Rev 361 Proc 36596 = $1,462.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1067.29,,,,,,,578.0000,3113.4500,fee schedule,"APG 00076 Proc 36596 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment) at 100% = $1,016.47... $1,016.47 at 105% = $1,067.29 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1499.60,,,,,,,578.0000,3113.4500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1499.60,,,,,,,578.0000,3113.4500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,NHC ADVANTAGE,NHC ADVANTAGE,1499.60,,,,,,,578.0000,3113.4500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1047.98,,,,,,,578.0000,3113.4500,fee schedule,"APG 00076 Proc 36596 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment) at 100% = $1,016.47... $1,016.47 at 103.1% = $1,047.98 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,SENTARA HEALTH,SENTARA HEALTH,793.14,,,,,,,578.0000,3113.4500,percent of total billed charges,"25.81% of $3,073.00 in Billed Charges for Rev 361 Proc 36596 = $793.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,SENTARA HEALTH,SENTARA MEDICARE,1428.19,,,,,,,578.0000,3113.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3073.00,,,,,,,578.0000,3113.4500,percent of total billed charges,"100% of $3,073.00 in Billed Charges for Rev 361 Proc 36596 = $3,073.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,578.0000,3113.4500,case rate,Rev 361 Proc 36596 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,578.0000,3113.4500,case rate,Rev 361 Proc 36596 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,578.0000,3113.4500,case rate,Rev 361 Proc 36596 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,578.0000,3113.4500,case rate,"Rev 361 Proc 36596 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1046.96,,,,,,,578.0000,3113.4500,fee schedule,"APG 00076 Proc 36596 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment) at 103% = $1,046.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1428.19,,,,,,,578.0000,3113.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1428.19,,,,,,,578.0000,3113.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,WELLCARE,WELLCARE MEDICAID,3073.00,,,,,,,578.0000,3113.4500,percent of total billed charges,"100% of $3,073.00 in Billed Charges for Rev 361 Proc 36596 = $3,073.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IR REMOVAL INTRACATH OBSTR MATERIAL,36596,CPT,361,RC,36100282,CDM,,,,both,,,3073.0000,460.9500,WELLCARE,WELLCARE MEDICARE,1513.88,,,,,,,578.0000,3113.4500,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,AETNA,AETNA,1527.38,,,,,,,578.0000,3577.0000,percent of total billed charges,"42.7% of $3,577.00 in Billed Charges for Rev 361 Proc 36597 = $1,527.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1057.13,,,,,,,578.0000,3577.0000,fee schedule,"APG 00076 Proc 36597 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment) at 104% = $1,057.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1428.19,,,,,,,578.0000,3577.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,AETNA,AETNA HEALTHCARE MEDICARE,1428.19,,,,,,,578.0000,3577.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,1428.19,,,,,,,578.0000,3577.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,AMBETTER,AMBETTER,3113.45,,,,,,,578.0000,3577.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1485.32,,,,,,,578.0000,3577.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,BLUE CROSS,ANTHEM EXCHANGE,3516.27,,,,,,,578.0000,3577.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1046.96,,,,,,,578.0000,3577.0000,fee schedule,"APG 00076 Proc 36597 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment) at 103% = $1,046.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,BLUE CROSS,ANTHEM HMO,3577.00,,,,,,,578.0000,3577.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1471.04,,,,,,,578.0000,3577.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3577.00,,,,,,,578.0000,3577.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1336.00,,,,,,,578.0000,3577.0000,case rate,"Rev 361 Proc 36597 ASG Rate of $1,336.00 at 100% of $1,336.00 = $1,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,578.0000,3577.0000,case rate,"Rev 361 Proc 36597 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,BLUE CROSS,BLUE CROSS MEDICARE,1485.32,,,,,,,578.0000,3577.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,578.0000,3577.0000,case rate,"Rev 361 Proc 36597 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,578.0000,3577.0000,case rate,"Rev 361 Proc 36597 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,3577.0000,case rate,Rev 361 Proc 36597 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,3577.0000,case rate,Rev 361 Proc 36597 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,578.0000,3577.0000,case rate,"Rev 361 Proc 36597 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,578.0000,3577.0000,case rate,"Rev 361 Proc 36597 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,1499.60,,,,,,,578.0000,3577.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,578.0000,3577.0000,case rate,"Rev 361 Proc 36597 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,578.0000,3577.0000,case rate,"Rev 361 Proc 36597 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1499.60,,,,,,,578.0000,3577.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3219.30,,,,,,,578.0000,3577.0000,percent of total billed charges,"90% of $3,577.00 in Billed Charges for Rev 361 Proc 36597 = $3,219.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,HUMANA,HUMANA MEDICARE,1428.19,,,,,,,578.0000,3577.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1428.19,,,,,,,578.0000,3577.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,MEDCOST,MEDCOST VHN,1702.29,,,,,,,578.0000,3577.0000,percent of total billed charges,"47.59% of $3,577.00 in Billed Charges for Rev 361 Proc 36597 = $1,702.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1067.29,,,,,,,578.0000,3577.0000,fee schedule,"APG 00076 Proc 36597 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment) at 100% = $1,016.47... $1,016.47 at 105% = $1,067.29 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1499.60,,,,,,,578.0000,3577.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1499.60,,,,,,,578.0000,3577.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,NHC ADVANTAGE,NHC ADVANTAGE,1499.60,,,,,,,578.0000,3577.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1047.98,,,,,,,578.0000,3577.0000,fee schedule,"APG 00076 Proc 36597 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment) at 100% = $1,016.47... $1,016.47 at 103.1% = $1,047.98 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,SENTARA HEALTH,SENTARA HEALTH,923.22,,,,,,,578.0000,3577.0000,percent of total billed charges,"25.81% of $3,577.00 in Billed Charges for Rev 361 Proc 36597 = $923.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,SENTARA HEALTH,SENTARA MEDICARE,1428.19,,,,,,,578.0000,3577.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3577.00,,,,,,,578.0000,3577.0000,percent of total billed charges,"100% of $3,577.00 in Billed Charges for Rev 361 Proc 36597 = $3,577.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,578.0000,3577.0000,case rate,Rev 361 Proc 36597 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,578.0000,3577.0000,case rate,Rev 361 Proc 36597 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,578.0000,3577.0000,case rate,Rev 361 Proc 36597 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,578.0000,3577.0000,case rate,"Rev 361 Proc 36597 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1046.96,,,,,,,578.0000,3577.0000,fee schedule,"APG 00076 Proc 36597 at $836.60 (Base Rate) * 1.215 (Relative Weight) = $1,016.47 (Total Line Payment) at 103% = $1,046.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1428.19,,,,,,,578.0000,3577.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1428.19,,,,,,,578.0000,3577.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,WELLCARE,WELLCARE MEDICAID,3577.00,,,,,,,578.0000,3577.0000,percent of total billed charges,"100% of $3,577.00 in Billed Charges for Rev 361 Proc 36597 = $3,577.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION PREV CVC W FLUORO,36597,CPT,361,RC,36100101,CDM,,,,both,,,3577.0000,536.5500,WELLCARE,WELLCARE MEDICARE,1513.88,,,,,,,578.0000,3577.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,AETNA,AETNA,53.38,,,,,,,22.2800,263.1500,percent of total billed charges,42.7% of $125.00 in Billed Charges for Rev 300 Proc 36600 = $53.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,102.23,,,,,,,22.2800,263.1500,fee schedule,APG 00494 Proc 36600 at $836.60 (Base Rate) * 0.1175 (Relative Weight) = $98.30 (Total Line Payment) at 104% = $102.23. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,120.71,,,,,,,22.2800,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,AETNA,AETNA HEALTHCARE MEDICARE,120.71,,,,,,,22.2800,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,120.71,,,,,,,22.2800,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,AMBETTER,AMBETTER,263.15,,,,,,,22.2800,263.1500,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,125.00,,,,,,,22.2800,263.1500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,BLUE CROSS,ANTHEM EXCHANGE,125.00,,,,,,,22.2800,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,101.25,,,,,,,22.2800,263.1500,fee schedule,APG 00494 Proc 36600 at $836.60 (Base Rate) * 0.1175 (Relative Weight) = $98.30 (Total Line Payment) at 103% = $101.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,BLUE CROSS,ANTHEM HMO,125.00,,,,,,,22.2800,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,124.33,,,,,,,22.2800,263.1500,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",125.00,,,,,,,22.2800,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,27.79,,,,,,,22.2800,263.1500,fee schedule,$27.79 from Fee Schedule BLDTM_23 for Rev 300 Proc 36600 * Qty 1 = $27.79 at 100% = $27.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,BLUE CROSS,BLUE CROSS MEDICARE,125.54,,,,,,,22.2800,263.1500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,BLUE CROSS,TENNCARE BLUE CARE,22.28,,,,,,,22.2800,263.1500,fee schedule,$19.21 from Fee Schedule TC_24 for Rev 300 Proc 36600 * Qty 1 = $19.21 at 116% = $22.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,BLUE CROSS,TENNCARE BLUE SELECT,22.28,,,,,,,22.2800,263.1500,fee schedule,$19.21 from Fee Schedule TC_24 for Rev 300 Proc 36600 * Qty 1 = $19.21 at 116% = $22.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,CIGNA HEALTHCARE,CIGNA HMO,52.13,,,,,,,22.2800,263.1500,percent of total billed charges,Rev 300 Proc 36600 $125.00 in Billed Charges at 41.7% = $52.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,53.50,,,,,,,22.2800,263.1500,percent of total billed charges,Rev 300 Proc 36600 $125.00 in Billed Charges at 42.8% = $53.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,125.00,,,,,,,22.2800,263.1500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,52.13,,,,,,,22.2800,263.1500,percent of total billed charges,Rev 300 Proc 36600 $125.00 in Billed Charges at 41.7% = $52.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,CIGNA HEALTHCARE,CIGNA PPO,52.13,,,,,,,22.2800,263.1500,percent of total billed charges,Rev 300 Proc 36600 $125.00 in Billed Charges at 41.7% = $52.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,125.00,,,,,,,22.2800,263.1500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,112.50,,,,,,,22.2800,263.1500,percent of total billed charges,90% of $125.00 in Billed Charges for Rev 300 Proc 36600 = $112.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,HUMANA,HUMANA MEDICARE,120.71,,,,,,,22.2800,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,120.71,,,,,,,22.2800,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,MEDCOST,MEDCOST VHN,59.49,,,,,,,22.2800,263.1500,percent of total billed charges,47.59% of $125.00 in Billed Charges for Rev 300 Proc 36600 = $59.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,103.22,,,,,,,22.2800,263.1500,fee schedule,APG 00494 Proc 36600 at $836.60 (Base Rate) * 0.1175 (Relative Weight) = $98.30 (Total Line Payment) at 100% = $98.30... $98.30 at 105% = $103.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,125.00,,,,,,,22.2800,263.1500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,125.00,,,,,,,22.2800,263.1500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,NHC ADVANTAGE,NHC ADVANTAGE,125.00,,,,,,,22.2800,263.1500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,101.35,,,,,,,22.2800,263.1500,fee schedule,APG 00494 Proc 36600 at $836.60 (Base Rate) * 0.1175 (Relative Weight) = $98.30 (Total Line Payment) at 100% = $98.30... $98.30 at 103.1% = $101.35 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,SENTARA HEALTH,SENTARA HEALTH,32.26,,,,,,,22.2800,263.1500,percent of total billed charges,25.81% of $125.00 in Billed Charges for Rev 300 Proc 36600 = $32.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,SENTARA HEALTH,SENTARA MEDICARE,120.71,,,,,,,22.2800,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",125.00,,,,,,,22.2800,263.1500,percent of total billed charges,100% of $125.00 in Billed Charges for Rev 300 Proc 36600 = $125.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,65.88,,,,,,,22.2800,263.1500,fee schedule,$131.75 from Fee Schedule TCUHC24 for Rev 300 Proc 36600 * Qty 1 = $131.75 at 50% = $65.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,101.25,,,,,,,22.2800,263.1500,fee schedule,APG 00494 Proc 36600 at $836.60 (Base Rate) * 0.1175 (Relative Weight) = $98.30 (Total Line Payment) at 103% = $101.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,120.71,,,,,,,22.2800,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,120.71,,,,,,,22.2800,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,WELLCARE,WELLCARE MEDICAID,125.00,,,,,,,22.2800,263.1500,percent of total billed charges,100% of $125.00 in Billed Charges for Rev 300 Proc 36600 = $125.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTERIAL PUNCTURE ONLY,36600,CPT,300,RC,30000004,CDM,,,,both,,,125.0000,18.7500,WELLCARE,WELLCARE MEDICARE,127.95,,,,,,,22.2800,263.1500,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,AETNA,AETNA,90.10,,,,,,,54.4600,211.0000,percent of total billed charges,42.7% of $211.00 in Billed Charges for Rev 360 Proc 36660 = $90.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,102.23,,,,,,,54.4600,211.0000,fee schedule,APG 00494 Proc 36660 at $836.60 (Base Rate) * 0.1175 (Relative Weight) = $98.30 (Total Line Payment) at 104% = $102.23. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,BLUE CROSS,ANTHEM EXCHANGE,211.00,,,,,,,54.4600,211.0000,fee schedule,"$693.36 from Fee Schedule ANT_C_APC for Rev 360 Proc 36660 * Qty 1 = $693.36 at 199.87% = $1,385.82 (Service Line reduced to $211.00, claim capped at $211.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,101.25,,,,,,,54.4600,211.0000,fee schedule,APG 00494 Proc 36660 at $836.60 (Base Rate) * 0.1175 (Relative Weight) = $98.30 (Total Line Payment) at 103% = $101.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,BLUE CROSS,ANTHEM HMO,211.00,,,,,,,54.4600,211.0000,fee schedule,"$693.36 from Fee Schedule ANT_C_APC for Rev 360 Proc 36660 * Qty 1 = $693.36 at 212.35% = $1,472.35 (Service Line reduced to $211.00, claim capped at $211.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",211.00,,,,,,,54.4600,211.0000,fee schedule,"$693.36 from Fee Schedule ANT_C_APC for Rev 360 Proc 36660 * Qty 1 = $693.36 at 249.81% = $1,732.08 (Service Line reduced to $211.00, claim capped at $211.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,211.00,,,,,,,54.4600,211.0000,case rate,Rev 360 Proc 36660 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total (Limited to $211.00 in Billed Charges - $0.00 in ASG Allowed Amount = $211.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,BLUE CROSS,BLUE CROSS E NETWORK,211.00,,,,,,,54.4600,211.0000,case rate,"Rev 360 Proc 36660 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total (Service Line reduced to $211.00, claim capped at $211.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,BLUE CROSS,BLUE CROSS P NETWORK,211.00,,,,,,,54.4600,211.0000,case rate,"Rev 360 Proc 36660 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total (Service Line reduced to $211.00, claim capped at $211.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,BLUE CROSS,BLUE CROSS S NETWORK,211.00,,,,,,,54.4600,211.0000,case rate,"Rev 360 Proc 36660 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total (Service Line reduced to $211.00, claim capped at $211.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,BLUE CROSS,TENNCARE BLUE CARE,211.00,,,,,,,54.4600,211.0000,case rate,"Rev 360 Proc 36660 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total (Service Line reduced to $211.00, claim capped at $211.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,BLUE CROSS,TENNCARE BLUE SELECT,211.00,,,,,,,54.4600,211.0000,case rate,"Rev 360 Proc 36660 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total (Service Line reduced to $211.00, claim capped at $211.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,CIGNA HEALTHCARE,CIGNA HMO,211.00,,,,,,,54.4600,211.0000,case rate,"Rev 360 Proc 36660 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $211.00 in Billed Charges - $0.00 in ASG Allowed Amount = $211.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,211.00,,,,,,,54.4600,211.0000,case rate,"Rev 360 Proc 36660 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $211.00 in Billed Charges - $0.00 in ASG Allowed Amount = $211.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,211.00,,,,,,,54.4600,211.0000,case rate,"Rev 360 Proc 36660 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $211.00 in Billed Charges - $0.00 in ASG Allowed Amount = $211.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,CIGNA HEALTHCARE,CIGNA PPO,211.00,,,,,,,54.4600,211.0000,case rate,"Rev 360 Proc 36660 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $211.00 in Billed Charges - $0.00 in ASG Allowed Amount = $211.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,189.90,,,,,,,54.4600,211.0000,percent of total billed charges,90% of $211.00 in Billed Charges for Rev 360 Proc 36660 = $189.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,MEDCOST,MEDCOST VHN,100.41,,,,,,,54.4600,211.0000,percent of total billed charges,47.59% of $211.00 in Billed Charges for Rev 360 Proc 36660 = $100.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,103.22,,,,,,,54.4600,211.0000,fee schedule,APG 00494 Proc 36660 at $836.60 (Base Rate) * 0.1175 (Relative Weight) = $98.30 (Total Line Payment) at 100% = $98.30... $98.30 at 105% = $103.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,101.35,,,,,,,54.4600,211.0000,fee schedule,APG 00494 Proc 36660 at $836.60 (Base Rate) * 0.1175 (Relative Weight) = $98.30 (Total Line Payment) at 100% = $98.30... $98.30 at 103.1% = $101.35 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,SENTARA HEALTH,SENTARA HEALTH,54.46,,,,,,,54.4600,211.0000,percent of total billed charges,25.81% of $211.00 in Billed Charges for Rev 360 Proc 36660 = $54.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",211.00,,,,,,,54.4600,211.0000,percent of total billed charges,100% of $211.00 in Billed Charges for Rev 360 Proc 36660 = $211.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,211.00,,,,,,,54.4600,211.0000,case rate,Rev 360 Proc 36660 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total (Limited to $211.00 in Billed Charges - $0.00 in ASG Allowed Amount = $211.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,211.00,,,,,,,54.4600,211.0000,case rate,"Rev 360 Proc 36660 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total (Service Line reduced to $211.00, claim capped at $211.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,211.00,,,,,,,54.4600,211.0000,case rate,"Rev 360 Proc 36660 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total (Service Line reduced to $211.00, claim capped at $211.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,211.00,,,,,,,54.4600,211.0000,case rate,"Rev 360 Proc 36660 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total (Service Line reduced to $211.00, claim capped at $211.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,101.25,,,,,,,54.4600,211.0000,fee schedule,APG 00494 Proc 36660 at $836.60 (Base Rate) * 0.1175 (Relative Weight) = $98.30 (Total Line Payment) at 103% = $101.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UMBILICAL ARTERY CATH NEWBORN DX/TX,36660,CPT,360,RC,36000110,CDM,,,,both,,,211.0000,31.6500,WELLCARE,WELLCARE MEDICAID,211.00,,,,,,,54.4600,211.0000,percent of total billed charges,100% of $211.00 in Billed Charges for Rev 360 Proc 36660 = $211.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL TWIST 4.0 110245,272,RC,,,,,,,,both,,,3361.4500,504.2200,AETNA,AETNA,1435.34,,,,,,,867.5900,3361.4500,percent of total billed charges,"42.7% of $3,361.45 in Billed Charges for Rev 272 = $1,435.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL TWIST 4.0 110245,272,RC,,,,,,,,both,,,3361.4500,504.2200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2353.02,,,,,,,867.5900,3361.4500,percent of total billed charges,"Rev 272 $3,361.45 in Billed Charges at 70% = $2,353.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL TWIST 4.0 110245,272,RC,,,,,,,,both,,,3361.4500,504.2200,CIGNA HEALTHCARE,CIGNA HMO,1401.72,,,,,,,867.5900,3361.4500,percent of total billed charges,"41.7% of $3,361.45 in Billed Charges for Rev 272 = $1,401.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL TWIST 4.0 110245,272,RC,,,,,,,,both,,,3361.4500,504.2200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1559.71,,,,,,,867.5900,3361.4500,percent of total billed charges,"46.4% of $3,361.45 in Billed Charges for Rev 272 = $1,559.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL TWIST 4.0 110245,272,RC,,,,,,,,both,,,3361.4500,504.2200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1401.72,,,,,,,867.5900,3361.4500,percent of total billed charges,"41.7% of $3,361.45 in Billed Charges for Rev 272 = $1,401.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL TWIST 4.0 110245,272,RC,,,,,,,,both,,,3361.4500,504.2200,CIGNA HEALTHCARE,CIGNA PPO,1401.72,,,,,,,867.5900,3361.4500,percent of total billed charges,"41.7% of $3,361.45 in Billed Charges for Rev 272 = $1,401.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL TWIST 4.0 110245,272,RC,,,,,,,,both,,,3361.4500,504.2200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3025.31,,,,,,,867.5900,3361.4500,percent of total billed charges,"90% of $3,361.45 in Billed Charges for Rev 272 = $3,025.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL TWIST 4.0 110245,272,RC,,,,,,,,both,,,3361.4500,504.2200,MEDCOST,MEDCOST VHN,1599.71,,,,,,,867.5900,3361.4500,percent of total billed charges,"47.59% of $3,361.45 in Billed Charges for Rev 272 = $1,599.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL TWIST 4.0 110245,272,RC,,,,,,,,both,,,3361.4500,504.2200,SENTARA HEALTH,SENTARA HEALTH,867.59,,,,,,,867.5900,3361.4500,percent of total billed charges,"25.81% of $3,361.45 in Billed Charges for Rev 272 = $867.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL TWIST 4.0 110245,272,RC,,,,,,,,both,,,3361.4500,504.2200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3361.45,,,,,,,867.5900,3361.4500,percent of total billed charges,"100% of $3,361.45 in Billed Charges for Rev 272 = $3,361.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL TWIST 4.0 110245,272,RC,,,,,,,,both,,,3361.4500,504.2200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1680.73,,,,,,,867.5900,3361.4500,percent of total billed charges,"Rev 272 $3,361.45 in Billed Charges at 50% = $1,680.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL TWIST 4.0 110245,272,RC,,,,,,,,both,,,3361.4500,504.2200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1085.75,,,,,,,867.5900,3361.4500,other,"32.3% of $3,361.45 in Billed Charges for Rev 272 = $1,085.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL TWIST 4.0 110245,272,RC,,,,,,,,both,,,3361.4500,504.2200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1031.97,,,,,,,867.5900,3361.4500,other,"30.7% of $3,361.45 in Billed Charges for Rev 272 = $1,031.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL TWIST 4.0 110245,272,RC,,,,,,,,both,,,3361.4500,504.2200,UNITED HEALTHCARE,UNITED HEALTHCARE,1085.75,,,,,,,867.5900,3361.4500,percent of total billed charges,"32.3% of $3,361.45 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL TWIST 4.0 110245,272,RC,,,,,,,,both,,,3361.4500,504.2200,WELLCARE,WELLCARE MEDICAID,3361.45,,,,,,,867.5900,3361.4500,percent of total billed charges,"100% of $3,361.45 in Billed Charges for Rev 272 = $3,361.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL WIDENING CERVICAL 4MM BAHA,272,RC,27200002,CDM,,,,,,both,,,1936.7800,290.5200,AETNA,AETNA,827.01,,,,,,,499.8800,1936.7800,percent of total billed charges,"42.7% of $1,936.78 in Billed Charges for Rev 272 = $827.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL WIDENING CERVICAL 4MM BAHA,272,RC,27200002,CDM,,,,,,both,,,1936.7800,290.5200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1355.75,,,,,,,499.8800,1936.7800,percent of total billed charges,"Rev 272 $1,936.78 in Billed Charges at 70% = $1,355.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL WIDENING CERVICAL 4MM BAHA,272,RC,27200002,CDM,,,,,,both,,,1936.7800,290.5200,CIGNA HEALTHCARE,CIGNA HMO,807.64,,,,,,,499.8800,1936.7800,percent of total billed charges,"41.7% of $1,936.78 in Billed Charges for Rev 272 = $807.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL WIDENING CERVICAL 4MM BAHA,272,RC,27200002,CDM,,,,,,both,,,1936.7800,290.5200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,898.67,,,,,,,499.8800,1936.7800,percent of total billed charges,"46.4% of $1,936.78 in Billed Charges for Rev 272 = $898.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL WIDENING CERVICAL 4MM BAHA,272,RC,27200002,CDM,,,,,,both,,,1936.7800,290.5200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,807.64,,,,,,,499.8800,1936.7800,percent of total billed charges,"41.7% of $1,936.78 in Billed Charges for Rev 272 = $807.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL WIDENING CERVICAL 4MM BAHA,272,RC,27200002,CDM,,,,,,both,,,1936.7800,290.5200,CIGNA HEALTHCARE,CIGNA PPO,807.64,,,,,,,499.8800,1936.7800,percent of total billed charges,"41.7% of $1,936.78 in Billed Charges for Rev 272 = $807.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL WIDENING CERVICAL 4MM BAHA,272,RC,27200002,CDM,,,,,,both,,,1936.7800,290.5200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1743.10,,,,,,,499.8800,1936.7800,percent of total billed charges,"90% of $1,936.78 in Billed Charges for Rev 272 = $1,743.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL WIDENING CERVICAL 4MM BAHA,272,RC,27200002,CDM,,,,,,both,,,1936.7800,290.5200,MEDCOST,MEDCOST VHN,921.71,,,,,,,499.8800,1936.7800,percent of total billed charges,"47.59% of $1,936.78 in Billed Charges for Rev 272 = $921.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL WIDENING CERVICAL 4MM BAHA,272,RC,27200002,CDM,,,,,,both,,,1936.7800,290.5200,SENTARA HEALTH,SENTARA HEALTH,499.88,,,,,,,499.8800,1936.7800,percent of total billed charges,"25.81% of $1,936.78 in Billed Charges for Rev 272 = $499.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL WIDENING CERVICAL 4MM BAHA,272,RC,27200002,CDM,,,,,,both,,,1936.7800,290.5200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1936.78,,,,,,,499.8800,1936.7800,percent of total billed charges,"100% of $1,936.78 in Billed Charges for Rev 272 = $1,936.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL WIDENING CERVICAL 4MM BAHA,272,RC,27200002,CDM,,,,,,both,,,1936.7800,290.5200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.39,,,,,,,499.8800,1936.7800,percent of total billed charges,"Rev 272 $1,936.78 in Billed Charges at 50% = $968.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL WIDENING CERVICAL 4MM BAHA,272,RC,27200002,CDM,,,,,,both,,,1936.7800,290.5200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,625.58,,,,,,,499.8800,1936.7800,other,"32.3% of $1,936.78 in Billed Charges for Rev 272 = $625.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL WIDENING CERVICAL 4MM BAHA,272,RC,27200002,CDM,,,,,,both,,,1936.7800,290.5200,UNITED HEALTHCARE,UHC HERITAGE SELECT,594.59,,,,,,,499.8800,1936.7800,other,"30.7% of $1,936.78 in Billed Charges for Rev 272 = $594.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL WIDENING CERVICAL 4MM BAHA,272,RC,27200002,CDM,,,,,,both,,,1936.7800,290.5200,UNITED HEALTHCARE,UNITED HEALTHCARE,625.58,,,,,,,499.8800,1936.7800,percent of total billed charges,"32.3% of $1,936.78 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL WIDENING CERVICAL 4MM BAHA,272,RC,27200002,CDM,,,,,,both,,,1936.7800,290.5200,WELLCARE,WELLCARE MEDICAID,1936.78,,,,,,,499.8800,1936.7800,percent of total billed charges,"100% of $1,936.78 in Billed Charges for Rev 272 = $1,936.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,AETNA,AETNA,9657.89,,,,,,,578.0000,36257.3800,percent of total billed charges,"42.7% of $22,618.00 in Billed Charges for Rev 361 Proc 36837 = $9,657.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,5150.08,,,,,,,578.0000,36257.3800,fee schedule,"APG 00059 Proc 36837 at $836.60 (Base Rate) * 5.9192 (Relative Weight) = $4,952.00 (Total Line Payment) at 104% = $5,150.08. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,16631.83,,,,,,,578.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,AETNA,AETNA HEALTHCARE MEDICARE,16631.83,,,,,,,578.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,16631.83,,,,,,,578.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,AMBETTER,AMBETTER,36257.38,,,,,,,578.0000,36257.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,17297.10,,,,,,,578.0000,36257.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,BLUE CROSS,ANTHEM EXCHANGE,22618.00,,,,,,,578.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,5100.56,,,,,,,578.0000,36257.3800,fee schedule,"APG 00059 Proc 36837 at $836.60 (Base Rate) * 5.9192 (Relative Weight) = $4,952.00 (Total Line Payment) at 103% = $5,100.56. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,BLUE CROSS,ANTHEM HMO,22618.00,,,,,,,578.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,17130.78,,,,,,,578.0000,36257.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",22618.00,,,,,,,578.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,578.0000,36257.3800,case rate,"Rev 361 Proc 36837 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,BLUE CROSS,BLUE CROSS MEDICARE,17297.10,,,,,,,578.0000,36257.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,36257.3800,case rate,Rev 361 Proc 36837 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,36257.3800,case rate,Rev 361 Proc 36837 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,578.0000,36257.3800,case rate,"Rev 361 Proc 36837 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,578.0000,36257.3800,case rate,"Rev 361 Proc 36837 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,17463.42,,,,,,,578.0000,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,578.0000,36257.3800,case rate,"Rev 361 Proc 36837 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,578.0000,36257.3800,case rate,"Rev 361 Proc 36837 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,17463.42,,,,,,,578.0000,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,20356.20,,,,,,,578.0000,36257.3800,percent of total billed charges,"90% of $22,618.00 in Billed Charges for Rev 361 Proc 36837 = $20,356.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,HUMANA,HUMANA MEDICARE,16631.83,,,,,,,578.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,16631.83,,,,,,,578.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,MEDCOST,MEDCOST VHN,10763.91,,,,,,,578.0000,36257.3800,percent of total billed charges,"47.59% of $22,618.00 in Billed Charges for Rev 361 Proc 36837 = $10,763.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,5199.60,,,,,,,578.0000,36257.3800,fee schedule,"APG 00059 Proc 36837 at $836.60 (Base Rate) * 5.9192 (Relative Weight) = $4,952.00 (Total Line Payment) at 100% = $4,952.00... $4,952.00 at 105% = $5,199.60 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,17463.42,,,,,,,578.0000,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,17463.42,,,,,,,578.0000,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,NHC ADVANTAGE,NHC ADVANTAGE,17463.42,,,,,,,578.0000,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,5105.51,,,,,,,578.0000,36257.3800,fee schedule,"APG 00059 Proc 36837 at $836.60 (Base Rate) * 5.9192 (Relative Weight) = $4,952.00 (Total Line Payment) at 100% = $4,952.00... $4,952.00 at 103.1% = $5,105.51 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,SENTARA HEALTH,SENTARA HEALTH,5837.71,,,,,,,578.0000,36257.3800,percent of total billed charges,"25.81% of $22,618.00 in Billed Charges for Rev 361 Proc 36837 = $5,837.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,SENTARA HEALTH,SENTARA MEDICARE,16631.83,,,,,,,578.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",22618.00,,,,,,,578.0000,36257.3800,percent of total billed charges,"100% of $22,618.00 in Billed Charges for Rev 361 Proc 36837 = $22,618.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,578.0000,36257.3800,case rate,"Rev 361 Proc 36837 ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,578.0000,36257.3800,case rate,"Rev 361 Proc 36837 ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,578.0000,36257.3800,case rate,"Rev 361 Proc 36837 ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,20054.00,,,,,,,578.0000,36257.3800,case rate,"Rev 361 Proc 36837 ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,5100.56,,,,,,,578.0000,36257.3800,fee schedule,"APG 00059 Proc 36837 at $836.60 (Base Rate) * 5.9192 (Relative Weight) = $4,952.00 (Total Line Payment) at 103% = $5,100.56. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,16631.83,,,,,,,578.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,16631.83,,,,,,,578.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,WELLCARE,WELLCARE MEDICAID,22618.00,,,,,,,578.0000,36257.3800,percent of total billed charges,"100% of $22,618.00 in Billed Charges for Rev 361 Proc 36837 = $22,618.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES,36837,CPT,361,RC,36100533,CDM,,,,both,,,22618.0000,3392.7000,WELLCARE,WELLCARE MEDICARE,17629.74,,,,,,,578.0000,36257.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,AETNA,AETNA,15236.21,,,,,,,775.0000,35682.0000,percent of total billed charges,"42.7% of $35,682.00 in Billed Charges for Rev 361 Proc 36903 = $15,236.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15721.62,,,,,,,775.0000,35682.0000,fee schedule,"APG 00085 Proc 36903 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 104% = $15,721.62. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,10473.75,,,,,,,775.0000,35682.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,AETNA,AETNA HEALTHCARE MEDICARE,10473.75,,,,,,,775.0000,35682.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,10473.75,,,,,,,775.0000,35682.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,AMBETTER,AMBETTER,22832.77,,,,,,,775.0000,35682.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,10892.70,,,,,,,775.0000,35682.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,BLUE CROSS,ANTHEM EXCHANGE,25786.93,,,,,,,775.0000,35682.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15570.45,,,,,,,775.0000,35682.0000,fee schedule,"APG 00085 Proc 36903 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,BLUE CROSS,ANTHEM HMO,27397.08,,,,,,,775.0000,35682.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,10787.96,,,,,,,775.0000,35682.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",32230.11,,,,,,,775.0000,35682.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,775.0000,35682.0000,case rate,"Rev 361 Proc 36903 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,BLUE CROSS,BLUE CROSS E NETWORK,8571.00,,,,,,,775.0000,35682.0000,case rate,"Rev 361 Proc 36903 ASG Rate of $8,571.00 at 100% of $8,571.00 = $8,571.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,BLUE CROSS,BLUE CROSS MEDICARE,10892.70,,,,,,,775.0000,35682.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,BLUE CROSS,BLUE CROSS P NETWORK,8764.00,,,,,,,775.0000,35682.0000,case rate,"Rev 361 Proc 36903 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,BLUE CROSS,BLUE CROSS S NETWORK,8764.00,,,,,,,775.0000,35682.0000,case rate,"Rev 361 Proc 36903 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,35682.0000,case rate,Rev 361 Proc 36903 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,35682.0000,case rate,Rev 361 Proc 36903 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,775.0000,35682.0000,case rate,"Rev 361 Proc 36903 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,775.0000,35682.0000,case rate,"Rev 361 Proc 36903 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,10997.44,,,,,,,775.0000,35682.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,775.0000,35682.0000,case rate,"Rev 361 Proc 36903 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,775.0000,35682.0000,case rate,"Rev 361 Proc 36903 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,10997.44,,,,,,,775.0000,35682.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,32113.80,,,,,,,775.0000,35682.0000,percent of total billed charges,"90% of $35,682.00 in Billed Charges for Rev 361 Proc 36903 = $32,113.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,HUMANA,HUMANA MEDICARE,10473.75,,,,,,,775.0000,35682.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,10473.75,,,,,,,775.0000,35682.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,MEDCOST,MEDCOST VHN,16981.06,,,,,,,775.0000,35682.0000,percent of total billed charges,"47.59% of $35,682.00 in Billed Charges for Rev 361 Proc 36903 = $16,981.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15872.79,,,,,,,775.0000,35682.0000,fee schedule,"APG 00085 Proc 36903 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 105% = $15,872.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,10997.44,,,,,,,775.0000,35682.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,10997.44,,,,,,,775.0000,35682.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,NHC ADVANTAGE,NHC ADVANTAGE,10997.44,,,,,,,775.0000,35682.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15585.57,,,,,,,775.0000,35682.0000,fee schedule,"APG 00085 Proc 36903 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 103.1% = $15,585.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,SENTARA HEALTH,SENTARA HEALTH,9209.52,,,,,,,775.0000,35682.0000,percent of total billed charges,"25.81% of $35,682.00 in Billed Charges for Rev 361 Proc 36903 = $9,209.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,SENTARA HEALTH,SENTARA MEDICARE,10473.75,,,,,,,775.0000,35682.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",35682.00,,,,,,,775.0000,35682.0000,percent of total billed charges,"100% of $35,682.00 in Billed Charges for Rev 361 Proc 36903 = $35,682.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,775.0000,35682.0000,case rate,"Rev 361 Proc 36903 ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,775.0000,35682.0000,case rate,"Rev 361 Proc 36903 ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,775.0000,35682.0000,case rate,"Rev 361 Proc 36903 ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,20054.00,,,,,,,775.0000,35682.0000,case rate,"Rev 361 Proc 36903 ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15570.45,,,,,,,775.0000,35682.0000,fee schedule,"APG 00085 Proc 36903 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,10473.75,,,,,,,775.0000,35682.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,10473.75,,,,,,,775.0000,35682.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,WELLCARE,WELLCARE MEDICAID,35682.00,,,,,,,775.0000,35682.0000,percent of total billed charges,"100% of $35,682.00 in Billed Charges for Rev 361 Proc 36903 = $35,682.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRO NDL/CATH DLYSS CRCT W DX ANGIO W TRANSCATH PLCMT INTRVS STENT,36903,CPT,361,RC,36100338,CDM,,,,both,,,35682.0000,5352.3000,WELLCARE,WELLCARE MEDICARE,11102.17,,,,,,,775.0000,35682.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,AETNA,AETNA,1920.65,,,,,,,43.9400,4498.0000,percent of total billed charges,"42.7% of $4,498.00 in Billed Charges for Rev 450 Proc 46320 = $1,920.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2106.69,,,,,,,43.9400,4498.0000,fee schedule,"APG 00141 Proc 46320 at $836.60 (Base Rate) * 2.4213 (Relative Weight) = $2,025.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,025.66 at 104% = $2,106.69. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1085.68,,,,,,,43.9400,4498.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,AETNA,AETNA HEALTHCARE MEDICARE,1085.68,,,,,,,43.9400,4498.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,1085.68,,,,,,,43.9400,4498.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,AMBETTER,AMBETTER,2366.79,,,,,,,43.9400,4498.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1129.11,,,,,,,43.9400,4498.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,BLUE CROSS,ANTHEM EXCHANGE,2673.00,,,,,,,43.9400,4498.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2086.43,,,,,,,43.9400,4498.0000,fee schedule,"APG 00141 Proc 46320 at $836.60 (Base Rate) * 2.4213 (Relative Weight) = $2,025.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,025.66 at 103% = $2,086.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,BLUE CROSS,ANTHEM HMO,2839.91,,,,,,,43.9400,4498.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1118.25,,,,,,,43.9400,4498.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3340.88,,,,,,,43.9400,4498.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,101.78,,,,,,,43.9400,4498.0000,fee schedule,$101.78 from Fee Schedule BLDTM_23 for Rev 450 Proc 46320 * Qty 1 = $101.78 at 100% = $101.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,BLUE CROSS,BLUE CROSS MEDICARE,1129.11,,,,,,,43.9400,4498.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,BLUE CROSS,TENNCARE BLUE CARE,43.94,,,,,,,43.9400,4498.0000,fee schedule,$37.88 from Fee Schedule TC_24 for Rev 450 Proc 46320 * Qty 1 = $37.88 at 116% = $43.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,BLUE CROSS,TENNCARE BLUE SELECT,43.94,,,,,,,43.9400,4498.0000,fee schedule,$37.88 from Fee Schedule TC_24 for Rev 450 Proc 46320 * Qty 1 = $37.88 at 116% = $43.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,1139.97,,,,,,,43.9400,4498.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1139.97,,,,,,,43.9400,4498.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4048.20,,,,,,,43.9400,4498.0000,percent of total billed charges,"90% of $4,498.00 in Billed Charges for Rev 450 Proc 46320 = $4,048.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,HUMANA,HUMANA MEDICARE,1085.68,,,,,,,43.9400,4498.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1085.68,,,,,,,43.9400,4498.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,MEDCOST,MEDCOST VHN,2140.60,,,,,,,43.9400,4498.0000,percent of total billed charges,"47.59% of $4,498.00 in Billed Charges for Rev 450 Proc 46320 = $2,140.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2126.94,,,,,,,43.9400,4498.0000,fee schedule,"APG 00141 Proc 46320 at $836.60 (Base Rate) * 2.4213 (Relative Weight) = $2,025.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,025.66 at 100% = $2,025.66... $2,025.66 at 105% = $2,126.94 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1139.97,,,,,,,43.9400,4498.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1139.97,,,,,,,43.9400,4498.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,NHC ADVANTAGE,NHC ADVANTAGE,1139.97,,,,,,,43.9400,4498.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2088.46,,,,,,,43.9400,4498.0000,fee schedule,"APG 00141 Proc 46320 at $836.60 (Base Rate) * 2.4213 (Relative Weight) = $2,025.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,025.66 at 100% = $2,025.66... $2,025.66 at 103.1% = $2,088.46 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,SENTARA HEALTH,SENTARA HEALTH,1160.93,,,,,,,43.9400,4498.0000,percent of total billed charges,"25.81% of $4,498.00 in Billed Charges for Rev 450 Proc 46320 = $1,160.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,SENTARA HEALTH,SENTARA MEDICARE,1085.68,,,,,,,43.9400,4498.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4498.00,,,,,,,43.9400,4498.0000,percent of total billed charges,"100% of $4,498.00 in Billed Charges for Rev 450 Proc 46320 = $4,498.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,43.9400,4498.0000,case rate,Rev 450 Proc 46320 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,43.9400,4498.0000,case rate,Rev 450 Proc 46320 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,43.9400,4498.0000,case rate,Rev 450 Proc 46320 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,43.9400,4498.0000,case rate,Rev 450 Proc 46320 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2086.43,,,,,,,43.9400,4498.0000,fee schedule,"APG 00141 Proc 46320 at $836.60 (Base Rate) * 2.4213 (Relative Weight) = $2,025.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,025.66 at 103% = $2,086.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1085.68,,,,,,,43.9400,4498.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1085.68,,,,,,,43.9400,4498.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,WELLCARE,WELLCARE MEDICAID,4498.00,,,,,,,43.9400,4498.0000,percent of total billed charges,"100% of $4,498.00 in Billed Charges for Rev 450 Proc 46320 = $4,498.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCIS EXTERN THROMB HEMORRHOID,46320,CPT,450,RC,45000262,CDM,,,,both,,,4498.0000,674.7000,WELLCARE,WELLCARE MEDICARE,1150.82,,,,,,,43.9400,4498.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,AETNA,AETNA,393.69,,,,,,,15.6900,922.0000,percent of total billed charges,42.7% of $922.00 in Billed Charges for Rev 450 Proc 46600 = $393.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,513.77,,,,,,,15.6900,922.0000,fee schedule,APG 00130 Proc 46600 at $836.60 (Base Rate) * 0.5905 (Relative Weight) = $494.01 (Total Line Payment) at 104% = $513.77. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,120.71,,,,,,,15.6900,922.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,AETNA,AETNA HEALTHCARE MEDICARE,120.71,,,,,,,15.6900,922.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,120.71,,,,,,,15.6900,922.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,AMBETTER,AMBETTER,263.15,,,,,,,15.6900,922.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,125.54,,,,,,,15.6900,922.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,BLUE CROSS,ANTHEM EXCHANGE,297.21,,,,,,,15.6900,922.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,508.83,,,,,,,15.6900,922.0000,fee schedule,APG 00130 Proc 46600 at $836.60 (Base Rate) * 0.5905 (Relative Weight) = $494.01 (Total Line Payment) at 103% = $508.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,BLUE CROSS,ANTHEM HMO,315.76,,,,,,,15.6900,922.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,124.33,,,,,,,15.6900,922.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",371.47,,,,,,,15.6900,922.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,31.22,,,,,,,15.6900,922.0000,fee schedule,$31.22 from Fee Schedule BLDTM_23 for Rev 450 Proc 46600 * Qty 1 = $31.22 at 100% = $31.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,BLUE CROSS,BLUE CROSS MEDICARE,125.54,,,,,,,15.6900,922.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,BLUE CROSS,TENNCARE BLUE CARE,15.69,,,,,,,15.6900,922.0000,fee schedule,$13.53 from Fee Schedule TC_24 for Rev 450 Proc 46600 * Qty 1 = $13.53 at 116% = $15.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,BLUE CROSS,TENNCARE BLUE SELECT,15.69,,,,,,,15.6900,922.0000,fee schedule,$13.53 from Fee Schedule TC_24 for Rev 450 Proc 46600 * Qty 1 = $13.53 at 116% = $15.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,126.75,,,,,,,15.6900,922.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,126.75,,,,,,,15.6900,922.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,829.80,,,,,,,15.6900,922.0000,percent of total billed charges,90% of $922.00 in Billed Charges for Rev 450 Proc 46600 = $829.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,HUMANA,HUMANA MEDICARE,120.71,,,,,,,15.6900,922.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,120.71,,,,,,,15.6900,922.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,MEDCOST,MEDCOST VHN,438.78,,,,,,,15.6900,922.0000,percent of total billed charges,47.59% of $922.00 in Billed Charges for Rev 450 Proc 46600 = $438.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,518.71,,,,,,,15.6900,922.0000,fee schedule,APG 00130 Proc 46600 at $836.60 (Base Rate) * 0.5905 (Relative Weight) = $494.01 (Total Line Payment) at 100% = $494.01... $494.01 at 105% = $518.71 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,126.75,,,,,,,15.6900,922.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,126.75,,,,,,,15.6900,922.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,NHC ADVANTAGE,NHC ADVANTAGE,126.75,,,,,,,15.6900,922.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,509.32,,,,,,,15.6900,922.0000,fee schedule,APG 00130 Proc 46600 at $836.60 (Base Rate) * 0.5905 (Relative Weight) = $494.01 (Total Line Payment) at 100% = $494.01... $494.01 at 103.1% = $509.32 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,SENTARA HEALTH,SENTARA HEALTH,237.97,,,,,,,15.6900,922.0000,percent of total billed charges,25.81% of $922.00 in Billed Charges for Rev 450 Proc 46600 = $237.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,SENTARA HEALTH,SENTARA MEDICARE,120.71,,,,,,,15.6900,922.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",922.00,,,,,,,15.6900,922.0000,percent of total billed charges,100% of $922.00 in Billed Charges for Rev 450 Proc 46600 = $922.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,15.6900,922.0000,case rate,Rev 450 Proc 46600 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,15.6900,922.0000,case rate,Rev 450 Proc 46600 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,15.6900,922.0000,case rate,Rev 450 Proc 46600 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,15.6900,922.0000,case rate,Rev 450 Proc 46600 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,508.83,,,,,,,15.6900,922.0000,fee schedule,APG 00130 Proc 46600 at $836.60 (Base Rate) * 0.5905 (Relative Weight) = $494.01 (Total Line Payment) at 103% = $508.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,120.71,,,,,,,15.6900,922.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,120.71,,,,,,,15.6900,922.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,WELLCARE,WELLCARE MEDICAID,922.00,,,,,,,15.6900,922.0000,percent of total billed charges,100% of $922.00 in Billed Charges for Rev 450 Proc 46600 = $922.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANOSCOPY DIAGNOSTIC,46600,CPT,450,RC,45000263,CDM,,,,both,,,922.0000,138.3000,WELLCARE,WELLCARE MEDICARE,127.95,,,,,,,15.6900,922.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,AETNA,AETNA,1101.66,,,,,,,109.0000,2580.0000,percent of total billed charges,"42.7% of $2,580.00 in Billed Charges for Rev 450 Proc 46930 = $1,101.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2106.69,,,,,,,109.0000,2580.0000,fee schedule,"APG 00141 Proc 46930 at $836.60 (Base Rate) * 2.4213 (Relative Weight) = $2,025.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,025.66 at 104% = $2,106.69. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1085.68,,,,,,,109.0000,2580.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,AETNA,AETNA HEALTHCARE MEDICARE,1085.68,,,,,,,109.0000,2580.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,ALLCARE MEDICARE,ALLCARE MEDICARE,1085.68,,,,,,,109.0000,2580.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,AMBETTER,AMBETTER,2366.79,,,,,,,109.0000,2580.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1129.11,,,,,,,109.0000,2580.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,BLUE CROSS,ANTHEM EXCHANGE,2580.00,,,,,,,109.0000,2580.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2086.43,,,,,,,109.0000,2580.0000,fee schedule,"APG 00141 Proc 46930 at $836.60 (Base Rate) * 2.4213 (Relative Weight) = $2,025.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,025.66 at 103% = $2,086.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,BLUE CROSS,ANTHEM HMO,2580.00,,,,,,,109.0000,2580.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1118.25,,,,,,,109.0000,2580.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2580.00,,,,,,,109.0000,2580.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,173.28,,,,,,,109.0000,2580.0000,fee schedule,$173.28 from Fee Schedule BLDTM_23 for Rev 450 Proc 46930 * Qty 1 = $173.28 at 100% = $173.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,BLUE CROSS,BLUE CROSS MEDICARE,1129.11,,,,,,,109.0000,2580.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,CIGNA HEALTHCARE,CIGNA MEDICARE,1139.97,,,,,,,109.0000,2580.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1139.97,,,,,,,109.0000,2580.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2322.00,,,,,,,109.0000,2580.0000,percent of total billed charges,"90% of $2,580.00 in Billed Charges for Rev 450 Proc 46930 = $2,322.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,HUMANA,HUMANA MEDICARE,1085.68,,,,,,,109.0000,2580.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1085.68,,,,,,,109.0000,2580.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,MEDCOST,MEDCOST VHN,1227.82,,,,,,,109.0000,2580.0000,percent of total billed charges,"47.59% of $2,580.00 in Billed Charges for Rev 450 Proc 46930 = $1,227.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2126.94,,,,,,,109.0000,2580.0000,fee schedule,"APG 00141 Proc 46930 at $836.60 (Base Rate) * 2.4213 (Relative Weight) = $2,025.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,025.66 at 100% = $2,025.66... $2,025.66 at 105% = $2,126.94 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1139.97,,,,,,,109.0000,2580.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1139.97,,,,,,,109.0000,2580.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,NHC ADVANTAGE,NHC ADVANTAGE,1139.97,,,,,,,109.0000,2580.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2088.46,,,,,,,109.0000,2580.0000,fee schedule,"APG 00141 Proc 46930 at $836.60 (Base Rate) * 2.4213 (Relative Weight) = $2,025.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,025.66 at 100% = $2,025.66... $2,025.66 at 103.1% = $2,088.46 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,SENTARA HEALTH,SENTARA HEALTH,665.90,,,,,,,109.0000,2580.0000,percent of total billed charges,"25.81% of $2,580.00 in Billed Charges for Rev 450 Proc 46930 = $665.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,SENTARA HEALTH,SENTARA MEDICARE,1085.68,,,,,,,109.0000,2580.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2580.00,,,,,,,109.0000,2580.0000,percent of total billed charges,"100% of $2,580.00 in Billed Charges for Rev 450 Proc 46930 = $2,580.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,2580.0000,case rate,Rev 450 Proc 46930 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,2580.0000,case rate,Rev 450 Proc 46930 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,2580.0000,case rate,Rev 450 Proc 46930 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,2580.0000,case rate,Rev 450 Proc 46930 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2086.43,,,,,,,109.0000,2580.0000,fee schedule,"APG 00141 Proc 46930 at $836.60 (Base Rate) * 2.4213 (Relative Weight) = $2,025.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,025.66 at 103% = $2,086.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1085.68,,,,,,,109.0000,2580.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1085.68,,,,,,,109.0000,2580.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,WELLCARE,WELLCARE MEDICAID,2580.00,,,,,,,109.0000,2580.0000,percent of total billed charges,"100% of $2,580.00 in Billed Charges for Rev 450 Proc 46930 = $2,580.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT HEMORRHOIDS EXTERNAL,46930,CPT,450,RC,45000264,CDM,,,,both,,,2580.0000,387.0000,WELLCARE,WELLCARE MEDICARE,1150.82,,,,,,,109.0000,2580.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRIVE HEX 3.5,272,RC,,,,,,,,both,,,2748.3200,412.2500,AETNA,AETNA,1173.53,,,,,,,709.3400,2748.3200,percent of total billed charges,"42.7% of $2,748.32 in Billed Charges for Rev 272 = $1,173.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVE HEX 3.5,272,RC,,,,,,,,both,,,2748.3200,412.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1923.82,,,,,,,709.3400,2748.3200,percent of total billed charges,"Rev 272 $2,748.32 in Billed Charges at 70% = $1,923.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVE HEX 3.5,272,RC,,,,,,,,both,,,2748.3200,412.2500,CIGNA HEALTHCARE,CIGNA HMO,1146.05,,,,,,,709.3400,2748.3200,percent of total billed charges,"41.7% of $2,748.32 in Billed Charges for Rev 272 = $1,146.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVE HEX 3.5,272,RC,,,,,,,,both,,,2748.3200,412.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1275.22,,,,,,,709.3400,2748.3200,percent of total billed charges,"46.4% of $2,748.32 in Billed Charges for Rev 272 = $1,275.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVE HEX 3.5,272,RC,,,,,,,,both,,,2748.3200,412.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1146.05,,,,,,,709.3400,2748.3200,percent of total billed charges,"41.7% of $2,748.32 in Billed Charges for Rev 272 = $1,146.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVE HEX 3.5,272,RC,,,,,,,,both,,,2748.3200,412.2500,CIGNA HEALTHCARE,CIGNA PPO,1146.05,,,,,,,709.3400,2748.3200,percent of total billed charges,"41.7% of $2,748.32 in Billed Charges for Rev 272 = $1,146.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVE HEX 3.5,272,RC,,,,,,,,both,,,2748.3200,412.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2473.49,,,,,,,709.3400,2748.3200,percent of total billed charges,"90% of $2,748.32 in Billed Charges for Rev 272 = $2,473.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVE HEX 3.5,272,RC,,,,,,,,both,,,2748.3200,412.2500,MEDCOST,MEDCOST VHN,1307.93,,,,,,,709.3400,2748.3200,percent of total billed charges,"47.59% of $2,748.32 in Billed Charges for Rev 272 = $1,307.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVE HEX 3.5,272,RC,,,,,,,,both,,,2748.3200,412.2500,SENTARA HEALTH,SENTARA HEALTH,709.34,,,,,,,709.3400,2748.3200,percent of total billed charges,"25.81% of $2,748.32 in Billed Charges for Rev 272 = $709.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVE HEX 3.5,272,RC,,,,,,,,both,,,2748.3200,412.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2748.32,,,,,,,709.3400,2748.3200,percent of total billed charges,"100% of $2,748.32 in Billed Charges for Rev 272 = $2,748.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVE HEX 3.5,272,RC,,,,,,,,both,,,2748.3200,412.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1374.16,,,,,,,709.3400,2748.3200,percent of total billed charges,"Rev 272 $2,748.32 in Billed Charges at 50% = $1,374.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVE HEX 3.5,272,RC,,,,,,,,both,,,2748.3200,412.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,887.71,,,,,,,709.3400,2748.3200,other,"32.3% of $2,748.32 in Billed Charges for Rev 272 = $887.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRIVE HEX 3.5,272,RC,,,,,,,,both,,,2748.3200,412.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,843.73,,,,,,,709.3400,2748.3200,other,"30.7% of $2,748.32 in Billed Charges for Rev 272 = $843.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRIVE HEX 3.5,272,RC,,,,,,,,both,,,2748.3200,412.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,887.71,,,,,,,709.3400,2748.3200,percent of total billed charges,"32.3% of $2,748.32 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVE HEX 3.5,272,RC,,,,,,,,both,,,2748.3200,412.2500,WELLCARE,WELLCARE MEDICAID,2748.32,,,,,,,709.3400,2748.3200,percent of total billed charges,"100% of $2,748.32 in Billed Charges for Rev 272 = $2,748.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENSITE PRECISION PATCH,272,RC,27200002,CDM,,,,,,both,,,11491.0700,1723.6600,AETNA,AETNA,4906.69,,,,,,,2965.8500,11491.0700,percent of total billed charges,"42.7% of $11,491.07 in Billed Charges for Rev 272 = $4,906.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENSITE PRECISION PATCH,272,RC,27200002,CDM,,,,,,both,,,11491.0700,1723.6600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8043.75,,,,,,,2965.8500,11491.0700,percent of total billed charges,"Rev 272 $11,491.07 in Billed Charges at 70% = $8,043.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENSITE PRECISION PATCH,272,RC,27200002,CDM,,,,,,both,,,11491.0700,1723.6600,CIGNA HEALTHCARE,CIGNA HMO,4791.78,,,,,,,2965.8500,11491.0700,percent of total billed charges,"41.7% of $11,491.07 in Billed Charges for Rev 272 = $4,791.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENSITE PRECISION PATCH,272,RC,27200002,CDM,,,,,,both,,,11491.0700,1723.6600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5331.86,,,,,,,2965.8500,11491.0700,percent of total billed charges,"46.4% of $11,491.07 in Billed Charges for Rev 272 = $5,331.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENSITE PRECISION PATCH,272,RC,27200002,CDM,,,,,,both,,,11491.0700,1723.6600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4791.78,,,,,,,2965.8500,11491.0700,percent of total billed charges,"41.7% of $11,491.07 in Billed Charges for Rev 272 = $4,791.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENSITE PRECISION PATCH,272,RC,27200002,CDM,,,,,,both,,,11491.0700,1723.6600,CIGNA HEALTHCARE,CIGNA PPO,4791.78,,,,,,,2965.8500,11491.0700,percent of total billed charges,"41.7% of $11,491.07 in Billed Charges for Rev 272 = $4,791.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENSITE PRECISION PATCH,272,RC,27200002,CDM,,,,,,both,,,11491.0700,1723.6600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10341.96,,,,,,,2965.8500,11491.0700,percent of total billed charges,"90% of $11,491.07 in Billed Charges for Rev 272 = $10,341.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENSITE PRECISION PATCH,272,RC,27200002,CDM,,,,,,both,,,11491.0700,1723.6600,MEDCOST,MEDCOST VHN,5468.60,,,,,,,2965.8500,11491.0700,percent of total billed charges,"47.59% of $11,491.07 in Billed Charges for Rev 272 = $5,468.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENSITE PRECISION PATCH,272,RC,27200002,CDM,,,,,,both,,,11491.0700,1723.6600,SENTARA HEALTH,SENTARA HEALTH,2965.85,,,,,,,2965.8500,11491.0700,percent of total billed charges,"25.81% of $11,491.07 in Billed Charges for Rev 272 = $2,965.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENSITE PRECISION PATCH,272,RC,27200002,CDM,,,,,,both,,,11491.0700,1723.6600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11491.07,,,,,,,2965.8500,11491.0700,percent of total billed charges,"100% of $11,491.07 in Billed Charges for Rev 272 = $11,491.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENSITE PRECISION PATCH,272,RC,27200002,CDM,,,,,,both,,,11491.0700,1723.6600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5745.54,,,,,,,2965.8500,11491.0700,percent of total billed charges,"Rev 272 $11,491.07 in Billed Charges at 50% = $5,745.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENSITE PRECISION PATCH,272,RC,27200002,CDM,,,,,,both,,,11491.0700,1723.6600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3711.62,,,,,,,2965.8500,11491.0700,other,"32.3% of $11,491.07 in Billed Charges for Rev 272 = $3,711.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENSITE PRECISION PATCH,272,RC,27200002,CDM,,,,,,both,,,11491.0700,1723.6600,UNITED HEALTHCARE,UHC HERITAGE SELECT,3527.76,,,,,,,2965.8500,11491.0700,other,"30.7% of $11,491.07 in Billed Charges for Rev 272 = $3,527.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENSITE PRECISION PATCH,272,RC,27200002,CDM,,,,,,both,,,11491.0700,1723.6600,UNITED HEALTHCARE,UNITED HEALTHCARE,3711.62,,,,,,,2965.8500,11491.0700,percent of total billed charges,"32.3% of $11,491.07 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENSITE PRECISION PATCH,272,RC,27200002,CDM,,,,,,both,,,11491.0700,1723.6600,WELLCARE,WELLCARE MEDICAID,11491.07,,,,,,,2965.8500,11491.0700,percent of total billed charges,"100% of $11,491.07 in Billed Charges for Rev 272 = $11,491.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,AETNA,AETNA,5098.81,,,,,,,775.0000,11957.2000,percent of total billed charges,"42.7% of $11,941.00 in Billed Charges for Rev 361 Proc 47382 = $5,098.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,8150.06,,,,,,,775.0000,11957.2000,fee schedule,"APG 00152 Proc 47382 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 104% = $8,150.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5484.95,,,,,,,775.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,AETNA,AETNA HEALTHCARE MEDICARE,5484.95,,,,,,,775.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,5484.95,,,,,,,775.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,AMBETTER,AMBETTER,11957.20,,,,,,,775.0000,11957.2000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,5704.35,,,,,,,775.0000,11957.2000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,BLUE CROSS,ANTHEM EXCHANGE,11941.00,,,,,,,775.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,8071.70,,,,,,,775.0000,11957.2000,fee schedule,"APG 00152 Proc 47382 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 103% = $8,071.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,BLUE CROSS,ANTHEM HMO,11941.00,,,,,,,775.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5649.50,,,,,,,775.0000,11957.2000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",11941.00,,,,,,,775.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,775.0000,11957.2000,case rate,"Rev 361 Proc 47382 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,775.0000,11957.2000,case rate,"Rev 361 Proc 47382 ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,BLUE CROSS,BLUE CROSS MEDICARE,5704.35,,,,,,,775.0000,11957.2000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,775.0000,11957.2000,case rate,"Rev 361 Proc 47382 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,775.0000,11957.2000,case rate,"Rev 361 Proc 47382 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,11957.2000,case rate,Rev 361 Proc 47382 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,11957.2000,case rate,Rev 361 Proc 47382 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,775.0000,11957.2000,case rate,"Rev 361 Proc 47382 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,775.0000,11957.2000,case rate,"Rev 361 Proc 47382 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,5759.20,,,,,,,775.0000,11957.2000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,775.0000,11957.2000,case rate,"Rev 361 Proc 47382 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,775.0000,11957.2000,case rate,"Rev 361 Proc 47382 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,5759.20,,,,,,,775.0000,11957.2000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10746.90,,,,,,,775.0000,11957.2000,percent of total billed charges,"90% of $11,941.00 in Billed Charges for Rev 361 Proc 47382 = $10,746.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,HUMANA,HUMANA MEDICARE,5484.95,,,,,,,775.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5484.95,,,,,,,775.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,MEDCOST,MEDCOST VHN,5682.72,,,,,,,775.0000,11957.2000,percent of total billed charges,"47.59% of $11,941.00 in Billed Charges for Rev 361 Proc 47382 = $5,682.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,8228.43,,,,,,,775.0000,11957.2000,fee schedule,"APG 00152 Proc 47382 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 100% = $7,836.60... $7,836.60 at 105% = $8,228.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,5759.20,,,,,,,775.0000,11957.2000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,5759.20,,,,,,,775.0000,11957.2000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,NHC ADVANTAGE,NHC ADVANTAGE,5759.20,,,,,,,775.0000,11957.2000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,8079.53,,,,,,,775.0000,11957.2000,fee schedule,"APG 00152 Proc 47382 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 100% = $7,836.60... $7,836.60 at 103.1% = $8,079.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,SENTARA HEALTH,SENTARA HEALTH,3081.97,,,,,,,775.0000,11957.2000,percent of total billed charges,"25.81% of $11,941.00 in Billed Charges for Rev 361 Proc 47382 = $3,081.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,SENTARA HEALTH,SENTARA MEDICARE,5484.95,,,,,,,775.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11941.00,,,,,,,775.0000,11957.2000,percent of total billed charges,"100% of $11,941.00 in Billed Charges for Rev 361 Proc 47382 = $11,941.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,775.0000,11957.2000,case rate,"Rev 361 Proc 47382 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,775.0000,11957.2000,case rate,"Rev 361 Proc 47382 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,775.0000,11957.2000,case rate,"Rev 361 Proc 47382 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,775.0000,11957.2000,case rate,"Rev 361 Proc 47382 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,8071.70,,,,,,,775.0000,11957.2000,fee schedule,"APG 00152 Proc 47382 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 103% = $8,071.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5484.95,,,,,,,775.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5484.95,,,,,,,775.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,WELLCARE,WELLCARE MEDICAID,11941.00,,,,,,,775.0000,11957.2000,percent of total billed charges,"100% of $11,941.00 in Billed Charges for Rev 361 Proc 47382 = $11,941.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ABLATION 1+ LIVER TUMOR(S) PERCUT RF,47382,CPT,361,RC,36100288,CDM,,,,both,,,11941.0000,1791.1500,WELLCARE,WELLCARE MEDICARE,5814.05,,,,,,,775.0000,11957.2000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,AETNA,AETNA,2924.10,,,,,,,578.0000,7081.5200,percent of total billed charges,"42.7% of $6,848.00 in Billed Charges for Rev 361 Proc 47490 = $2,924.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3288.49,,,,,,,578.0000,7081.5200,fee schedule,"APG 00151 Proc 47490 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 104% = $3,288.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3248.41,,,,,,,578.0000,7081.5200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,AETNA,AETNA HEALTHCARE MEDICARE,3248.41,,,,,,,578.0000,7081.5200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,3248.41,,,,,,,578.0000,7081.5200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,AMBETTER,AMBETTER,7081.52,,,,,,,578.0000,7081.5200,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3378.34,,,,,,,578.0000,7081.5200,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,BLUE CROSS,ANTHEM EXCHANGE,6848.00,,,,,,,578.0000,7081.5200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3256.87,,,,,,,578.0000,7081.5200,fee schedule,"APG 00151 Proc 47490 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 103% = $3,256.87. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,BLUE CROSS,ANTHEM HMO,6848.00,,,,,,,578.0000,7081.5200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3345.86,,,,,,,578.0000,7081.5200,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",6848.00,,,,,,,578.0000,7081.5200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,948.00,,,,,,,578.0000,7081.5200,case rate,Rev 361 Proc 47490 ASG Rate of $948.00 at 100% of $948.00 = $948.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,578.0000,7081.5200,case rate,"Rev 361 Proc 47490 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,BLUE CROSS,BLUE CROSS MEDICARE,3378.34,,,,,,,578.0000,7081.5200,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,578.0000,7081.5200,case rate,"Rev 361 Proc 47490 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,578.0000,7081.5200,case rate,"Rev 361 Proc 47490 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,7081.5200,case rate,Rev 361 Proc 47490 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,7081.5200,case rate,Rev 361 Proc 47490 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,578.0000,7081.5200,case rate,"Rev 361 Proc 47490 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,578.0000,7081.5200,case rate,"Rev 361 Proc 47490 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,3410.83,,,,,,,578.0000,7081.5200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,578.0000,7081.5200,case rate,"Rev 361 Proc 47490 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,578.0000,7081.5200,case rate,"Rev 361 Proc 47490 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3410.83,,,,,,,578.0000,7081.5200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6163.20,,,,,,,578.0000,7081.5200,percent of total billed charges,"90% of $6,848.00 in Billed Charges for Rev 361 Proc 47490 = $6,163.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,HUMANA,HUMANA MEDICARE,3248.41,,,,,,,578.0000,7081.5200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3248.41,,,,,,,578.0000,7081.5200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,MEDCOST,MEDCOST VHN,3258.96,,,,,,,578.0000,7081.5200,percent of total billed charges,"47.59% of $6,848.00 in Billed Charges for Rev 361 Proc 47490 = $3,258.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3320.11,,,,,,,578.0000,7081.5200,fee schedule,"APG 00151 Proc 47490 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 100% = $3,162.01... $3,162.01 at 105% = $3,320.11 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3410.83,,,,,,,578.0000,7081.5200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3410.83,,,,,,,578.0000,7081.5200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,NHC ADVANTAGE,NHC ADVANTAGE,3410.83,,,,,,,578.0000,7081.5200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3260.03,,,,,,,578.0000,7081.5200,fee schedule,"APG 00151 Proc 47490 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 100% = $3,162.01... $3,162.01 at 103.1% = $3,260.03 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,SENTARA HEALTH,SENTARA HEALTH,1767.47,,,,,,,578.0000,7081.5200,percent of total billed charges,"25.81% of $6,848.00 in Billed Charges for Rev 361 Proc 47490 = $1,767.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,SENTARA HEALTH,SENTARA MEDICARE,3248.41,,,,,,,578.0000,7081.5200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6848.00,,,,,,,578.0000,7081.5200,percent of total billed charges,"100% of $6,848.00 in Billed Charges for Rev 361 Proc 47490 = $6,848.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,578.0000,7081.5200,case rate,"Rev 361 Proc 47490 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,578.0000,7081.5200,case rate,"Rev 361 Proc 47490 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,578.0000,7081.5200,case rate,"Rev 361 Proc 47490 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,578.0000,7081.5200,case rate,"Rev 361 Proc 47490 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3256.87,,,,,,,578.0000,7081.5200,fee schedule,"APG 00151 Proc 47490 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 103% = $3,256.87. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3248.41,,,,,,,578.0000,7081.5200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3248.41,,,,,,,578.0000,7081.5200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,WELLCARE,WELLCARE MEDICAID,6848.00,,,,,,,578.0000,7081.5200,percent of total billed charges,"100% of $6,848.00 in Billed Charges for Rev 361 Proc 47490 = $6,848.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHOLECYSTOSTOMY PERCU COMPLETE PROC,47490,CPT,361,RC,36100094,CDM,,,,both,,,6848.0000,1027.2000,WELLCARE,WELLCARE MEDICARE,3443.31,,,,,,,578.0000,7081.5200,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,AETNA,AETNA,3565.45,,,,,,,775.0000,8350.0000,percent of total billed charges,"42.7% of $8,350.00 in Billed Charges for Rev 361 Proc 47533 = $3,565.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3288.49,,,,,,,775.0000,8350.0000,fee schedule,"APG 00151 Proc 47533 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 104% = $3,288.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3248.41,,,,,,,775.0000,8350.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,AETNA,AETNA HEALTHCARE MEDICARE,3248.41,,,,,,,775.0000,8350.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,3248.41,,,,,,,775.0000,8350.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,AMBETTER,AMBETTER,7081.52,,,,,,,775.0000,8350.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3378.34,,,,,,,775.0000,8350.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,BLUE CROSS,ANTHEM EXCHANGE,7997.76,,,,,,,775.0000,8350.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3256.87,,,,,,,775.0000,8350.0000,fee schedule,"APG 00151 Proc 47533 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 103% = $3,256.87. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,BLUE CROSS,ANTHEM HMO,8350.00,,,,,,,775.0000,8350.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3345.86,,,,,,,775.0000,8350.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8350.00,,,,,,,775.0000,8350.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,775.0000,8350.0000,case rate,"Rev 361 Proc 47533 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,775.0000,8350.0000,case rate,"Rev 361 Proc 47533 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,BLUE CROSS,BLUE CROSS MEDICARE,3378.34,,,,,,,775.0000,8350.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,775.0000,8350.0000,case rate,"Rev 361 Proc 47533 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,775.0000,8350.0000,case rate,"Rev 361 Proc 47533 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,8350.0000,case rate,Rev 361 Proc 47533 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,8350.0000,case rate,Rev 361 Proc 47533 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,CIGNA HEALTHCARE,CIGNA HMO,8003.00,,,,,,,775.0000,8350.0000,case rate,"Rev 361 Proc 47533 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6048.00,,,,,,,775.0000,8350.0000,case rate,"Rev 361 Proc 47533 ASG Rate of $6,048.00 at 100% of $6,048.00 = $6,048.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,3410.83,,,,,,,775.0000,8350.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8003.00,,,,,,,775.0000,8350.0000,case rate,"Rev 361 Proc 47533 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,CIGNA HEALTHCARE,CIGNA PPO,8003.00,,,,,,,775.0000,8350.0000,case rate,"Rev 361 Proc 47533 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3410.83,,,,,,,775.0000,8350.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7515.00,,,,,,,775.0000,8350.0000,percent of total billed charges,"90% of $8,350.00 in Billed Charges for Rev 361 Proc 47533 = $7,515.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,HUMANA,HUMANA MEDICARE,3248.41,,,,,,,775.0000,8350.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3248.41,,,,,,,775.0000,8350.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,MEDCOST,MEDCOST VHN,3973.77,,,,,,,775.0000,8350.0000,percent of total billed charges,"47.59% of $8,350.00 in Billed Charges for Rev 361 Proc 47533 = $3,973.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3320.11,,,,,,,775.0000,8350.0000,fee schedule,"APG 00151 Proc 47533 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 100% = $3,162.01... $3,162.01 at 105% = $3,320.11 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3410.83,,,,,,,775.0000,8350.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3410.83,,,,,,,775.0000,8350.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,NHC ADVANTAGE,NHC ADVANTAGE,3410.83,,,,,,,775.0000,8350.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3260.03,,,,,,,775.0000,8350.0000,fee schedule,"APG 00151 Proc 47533 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 100% = $3,162.01... $3,162.01 at 103.1% = $3,260.03 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,SENTARA HEALTH,SENTARA HEALTH,2155.14,,,,,,,775.0000,8350.0000,percent of total billed charges,"25.81% of $8,350.00 in Billed Charges for Rev 361 Proc 47533 = $2,155.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,SENTARA HEALTH,SENTARA MEDICARE,3248.41,,,,,,,775.0000,8350.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8350.00,,,,,,,775.0000,8350.0000,percent of total billed charges,"100% of $8,350.00 in Billed Charges for Rev 361 Proc 47533 = $8,350.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,775.0000,8350.0000,case rate,"Rev 361 Proc 47533 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,775.0000,8350.0000,case rate,"Rev 361 Proc 47533 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,775.0000,8350.0000,case rate,"Rev 361 Proc 47533 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,775.0000,8350.0000,case rate,"Rev 361 Proc 47533 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3256.87,,,,,,,775.0000,8350.0000,fee schedule,"APG 00151 Proc 47533 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 103% = $3,256.87. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3248.41,,,,,,,775.0000,8350.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3248.41,,,,,,,775.0000,8350.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,WELLCARE,WELLCARE MEDICAID,8350.00,,,,,,,775.0000,8350.0000,percent of total billed charges,"100% of $8,350.00 in Billed Charges for Rev 361 Proc 47533 = $8,350.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I EXTERNAL,47533,CPT,361,RC,36100302,CDM,,,,both,,,8350.0000,1252.5000,WELLCARE,WELLCARE MEDICARE,3443.31,,,,,,,775.0000,8350.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,AETNA,AETNA,5191.04,,,,,,,775.0000,12157.0000,percent of total billed charges,"42.7% of $12,157.00 in Billed Charges for Rev 361 Proc 47534 = $5,191.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3288.49,,,,,,,775.0000,12157.0000,fee schedule,"APG 00151 Proc 47534 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 104% = $3,288.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3248.41,,,,,,,775.0000,12157.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,AETNA,AETNA HEALTHCARE MEDICARE,3248.41,,,,,,,775.0000,12157.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,3248.41,,,,,,,775.0000,12157.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,AMBETTER,AMBETTER,7081.52,,,,,,,775.0000,12157.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3378.34,,,,,,,775.0000,12157.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,BLUE CROSS,ANTHEM EXCHANGE,7997.76,,,,,,,775.0000,12157.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3256.87,,,,,,,775.0000,12157.0000,fee schedule,"APG 00151 Proc 47534 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 103% = $3,256.87. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,BLUE CROSS,ANTHEM HMO,8497.14,,,,,,,775.0000,12157.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3345.86,,,,,,,775.0000,12157.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9996.10,,,,,,,775.0000,12157.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,775.0000,12157.0000,case rate,"Rev 361 Proc 47534 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,775.0000,12157.0000,case rate,"Rev 361 Proc 47534 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,BLUE CROSS,BLUE CROSS MEDICARE,3378.34,,,,,,,775.0000,12157.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,775.0000,12157.0000,case rate,"Rev 361 Proc 47534 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,775.0000,12157.0000,case rate,"Rev 361 Proc 47534 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,12157.0000,case rate,Rev 361 Proc 47534 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,12157.0000,case rate,Rev 361 Proc 47534 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,CIGNA HEALTHCARE,CIGNA HMO,8003.00,,,,,,,775.0000,12157.0000,case rate,"Rev 361 Proc 47534 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6048.00,,,,,,,775.0000,12157.0000,case rate,"Rev 361 Proc 47534 ASG Rate of $6,048.00 at 100% of $6,048.00 = $6,048.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,3410.83,,,,,,,775.0000,12157.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8003.00,,,,,,,775.0000,12157.0000,case rate,"Rev 361 Proc 47534 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,CIGNA HEALTHCARE,CIGNA PPO,8003.00,,,,,,,775.0000,12157.0000,case rate,"Rev 361 Proc 47534 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3410.83,,,,,,,775.0000,12157.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10941.30,,,,,,,775.0000,12157.0000,percent of total billed charges,"90% of $12,157.00 in Billed Charges for Rev 361 Proc 47534 = $10,941.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,HUMANA,HUMANA MEDICARE,3248.41,,,,,,,775.0000,12157.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3248.41,,,,,,,775.0000,12157.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,MEDCOST,MEDCOST VHN,5785.52,,,,,,,775.0000,12157.0000,percent of total billed charges,"47.59% of $12,157.00 in Billed Charges for Rev 361 Proc 47534 = $5,785.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3320.11,,,,,,,775.0000,12157.0000,fee schedule,"APG 00151 Proc 47534 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 100% = $3,162.01... $3,162.01 at 105% = $3,320.11 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3410.83,,,,,,,775.0000,12157.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3410.83,,,,,,,775.0000,12157.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,NHC ADVANTAGE,NHC ADVANTAGE,3410.83,,,,,,,775.0000,12157.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3260.03,,,,,,,775.0000,12157.0000,fee schedule,"APG 00151 Proc 47534 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 100% = $3,162.01... $3,162.01 at 103.1% = $3,260.03 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,SENTARA HEALTH,SENTARA HEALTH,3137.72,,,,,,,775.0000,12157.0000,percent of total billed charges,"25.81% of $12,157.00 in Billed Charges for Rev 361 Proc 47534 = $3,137.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,SENTARA HEALTH,SENTARA MEDICARE,3248.41,,,,,,,775.0000,12157.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12157.00,,,,,,,775.0000,12157.0000,percent of total billed charges,"100% of $12,157.00 in Billed Charges for Rev 361 Proc 47534 = $12,157.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,775.0000,12157.0000,case rate,"Rev 361 Proc 47534 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,775.0000,12157.0000,case rate,"Rev 361 Proc 47534 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,775.0000,12157.0000,case rate,"Rev 361 Proc 47534 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,775.0000,12157.0000,case rate,"Rev 361 Proc 47534 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3256.87,,,,,,,775.0000,12157.0000,fee schedule,"APG 00151 Proc 47534 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 103% = $3,256.87. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3248.41,,,,,,,775.0000,12157.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3248.41,,,,,,,775.0000,12157.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,WELLCARE,WELLCARE MEDICAID,12157.00,,,,,,,775.0000,12157.0000,percent of total billed charges,"100% of $12,157.00 in Billed Charges for Rev 361 Proc 47534 = $12,157.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE BILIARY DRAINAGE CATH PERCU INCL IMG RAD S&I INT-EXT,47534,CPT,361,RC,36100303,CDM,,,,both,,,12157.0000,1823.5500,WELLCARE,WELLCARE MEDICARE,3443.31,,,,,,,775.0000,12157.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,AETNA,AETNA,3147.84,,,,,,,775.0000,7372.0000,percent of total billed charges,"42.7% of $7,372.00 in Billed Charges for Rev 361 Proc 47536 = $3,147.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3288.49,,,,,,,775.0000,7372.0000,fee schedule,"APG 00151 Proc 47536 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 104% = $3,288.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3248.41,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,AETNA,AETNA HEALTHCARE MEDICARE,3248.41,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,3248.41,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,AMBETTER,AMBETTER,7081.52,,,,,,,775.0000,7372.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3378.34,,,,,,,775.0000,7372.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,ANTHEM EXCHANGE,7372.00,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3256.87,,,,,,,775.0000,7372.0000,fee schedule,"APG 00151 Proc 47536 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 103% = $3,256.87. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,ANTHEM HMO,7372.00,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3345.86,,,,,,,775.0000,7372.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",7372.00,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 47536 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 47536 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,BLUE CROSS MEDICARE,3378.34,,,,,,,775.0000,7372.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 47536 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 47536 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,7372.0000,case rate,Rev 361 Proc 47536 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,7372.0000,case rate,Rev 361 Proc 47536 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,CIGNA HEALTHCARE,CIGNA HMO,7372.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 47536 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total (Limited to $7,372.00 in Billed Charges - $0.00 in ASG Allowed Amount = $7,372.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6048.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 47536 ASG Rate of $6,048.00 at 100% of $6,048.00 = $6,048.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,3410.83,,,,,,,775.0000,7372.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7372.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 47536 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total (Limited to $7,372.00 in Billed Charges - $0.00 in ASG Allowed Amount = $7,372.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,CIGNA HEALTHCARE,CIGNA PPO,7372.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 47536 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total (Limited to $7,372.00 in Billed Charges - $0.00 in ASG Allowed Amount = $7,372.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3410.83,,,,,,,775.0000,7372.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6634.80,,,,,,,775.0000,7372.0000,percent of total billed charges,"90% of $7,372.00 in Billed Charges for Rev 361 Proc 47536 = $6,634.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,HUMANA,HUMANA MEDICARE,3248.41,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3248.41,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,MEDCOST,MEDCOST VHN,3508.33,,,,,,,775.0000,7372.0000,percent of total billed charges,"47.59% of $7,372.00 in Billed Charges for Rev 361 Proc 47536 = $3,508.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3320.11,,,,,,,775.0000,7372.0000,fee schedule,"APG 00151 Proc 47536 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 100% = $3,162.01... $3,162.01 at 105% = $3,320.11 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3410.83,,,,,,,775.0000,7372.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3410.83,,,,,,,775.0000,7372.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,NHC ADVANTAGE,NHC ADVANTAGE,3410.83,,,,,,,775.0000,7372.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3260.03,,,,,,,775.0000,7372.0000,fee schedule,"APG 00151 Proc 47536 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 100% = $3,162.01... $3,162.01 at 103.1% = $3,260.03 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,SENTARA HEALTH,SENTARA HEALTH,1902.71,,,,,,,775.0000,7372.0000,percent of total billed charges,"25.81% of $7,372.00 in Billed Charges for Rev 361 Proc 47536 = $1,902.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,SENTARA HEALTH,SENTARA MEDICARE,3248.41,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7372.00,,,,,,,775.0000,7372.0000,percent of total billed charges,"100% of $7,372.00 in Billed Charges for Rev 361 Proc 47536 = $7,372.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 47536 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 47536 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 47536 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 47536 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3256.87,,,,,,,775.0000,7372.0000,fee schedule,"APG 00151 Proc 47536 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 103% = $3,256.87. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3248.41,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3248.41,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,WELLCARE,WELLCARE MEDICAID,7372.00,,,,,,,775.0000,7372.0000,percent of total billed charges,"100% of $7,372.00 in Billed Charges for Rev 361 Proc 47536 = $7,372.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCHANGE BILIARY DRAIN CATH PERCU INCL IMG RAD S&I,47536,CPT,361,RC,36100305,CDM,,,,both,,,7372.0000,1105.8000,WELLCARE,WELLCARE MEDICARE,3443.31,,,,,,,775.0000,7372.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,AETNA,AETNA,6186.38,,,,,,,775.0000,14488.0000,percent of total billed charges,"42.7% of $14,488.00 in Billed Charges for Rev 361 Proc 47539 = $6,186.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3288.49,,,,,,,775.0000,14488.0000,fee schedule,"APG 00151 Proc 47539 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 104% = $3,288.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5484.95,,,,,,,775.0000,14488.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,AETNA,AETNA HEALTHCARE MEDICARE,5484.95,,,,,,,775.0000,14488.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,5484.95,,,,,,,775.0000,14488.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,AMBETTER,AMBETTER,11957.20,,,,,,,775.0000,14488.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,5704.35,,,,,,,775.0000,14488.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,BLUE CROSS,ANTHEM EXCHANGE,13504.26,,,,,,,775.0000,14488.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3256.87,,,,,,,775.0000,14488.0000,fee schedule,"APG 00151 Proc 47539 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 103% = $3,256.87. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,BLUE CROSS,ANTHEM HMO,14347.47,,,,,,,775.0000,14488.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5649.50,,,,,,,775.0000,14488.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",14488.00,,,,,,,775.0000,14488.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,775.0000,14488.0000,case rate,"Rev 361 Proc 47539 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,775.0000,14488.0000,case rate,"Rev 361 Proc 47539 ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,BLUE CROSS,BLUE CROSS MEDICARE,5704.35,,,,,,,775.0000,14488.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,775.0000,14488.0000,case rate,"Rev 361 Proc 47539 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,775.0000,14488.0000,case rate,"Rev 361 Proc 47539 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,14488.0000,case rate,Rev 361 Proc 47539 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,14488.0000,case rate,Rev 361 Proc 47539 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,CIGNA HEALTHCARE,CIGNA HMO,8003.00,,,,,,,775.0000,14488.0000,case rate,"Rev 361 Proc 47539 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6048.00,,,,,,,775.0000,14488.0000,case rate,"Rev 361 Proc 47539 ASG Rate of $6,048.00 at 100% of $6,048.00 = $6,048.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,5759.20,,,,,,,775.0000,14488.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8003.00,,,,,,,775.0000,14488.0000,case rate,"Rev 361 Proc 47539 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,CIGNA HEALTHCARE,CIGNA PPO,8003.00,,,,,,,775.0000,14488.0000,case rate,"Rev 361 Proc 47539 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,5759.20,,,,,,,775.0000,14488.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13039.20,,,,,,,775.0000,14488.0000,percent of total billed charges,"90% of $14,488.00 in Billed Charges for Rev 361 Proc 47539 = $13,039.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,HUMANA,HUMANA MEDICARE,5484.95,,,,,,,775.0000,14488.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5484.95,,,,,,,775.0000,14488.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,MEDCOST,MEDCOST VHN,6894.84,,,,,,,775.0000,14488.0000,percent of total billed charges,"47.59% of $14,488.00 in Billed Charges for Rev 361 Proc 47539 = $6,894.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3320.11,,,,,,,775.0000,14488.0000,fee schedule,"APG 00151 Proc 47539 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 100% = $3,162.01... $3,162.01 at 105% = $3,320.11 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,5759.20,,,,,,,775.0000,14488.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,5759.20,,,,,,,775.0000,14488.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,NHC ADVANTAGE,NHC ADVANTAGE,5759.20,,,,,,,775.0000,14488.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3260.03,,,,,,,775.0000,14488.0000,fee schedule,"APG 00151 Proc 47539 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 100% = $3,162.01... $3,162.01 at 103.1% = $3,260.03 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,SENTARA HEALTH,SENTARA HEALTH,3739.35,,,,,,,775.0000,14488.0000,percent of total billed charges,"25.81% of $14,488.00 in Billed Charges for Rev 361 Proc 47539 = $3,739.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,SENTARA HEALTH,SENTARA MEDICARE,5484.95,,,,,,,775.0000,14488.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",14488.00,,,,,,,775.0000,14488.0000,percent of total billed charges,"100% of $14,488.00 in Billed Charges for Rev 361 Proc 47539 = $14,488.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,775.0000,14488.0000,case rate,"Rev 361 Proc 47539 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,775.0000,14488.0000,case rate,"Rev 361 Proc 47539 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,775.0000,14488.0000,case rate,"Rev 361 Proc 47539 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,775.0000,14488.0000,case rate,"Rev 361 Proc 47539 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3256.87,,,,,,,775.0000,14488.0000,fee schedule,"APG 00151 Proc 47539 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment) at 103% = $3,256.87. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5484.95,,,,,,,775.0000,14488.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5484.95,,,,,,,775.0000,14488.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,WELLCARE,WELLCARE MEDICAID,14488.00,,,,,,,775.0000,14488.0000,percent of total billed charges,"100% of $14,488.00 in Billed Charges for Rev 361 Proc 47539 = $14,488.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE STNT BILE DCT PERC INCL IMG NEW ACC WO BIL DRAIN CATH,47539,CPT,361,RC,36100308,CDM,,,,both,,,14488.0000,2173.2000,WELLCARE,WELLCARE MEDICARE,5814.05,,,,,,,775.0000,14488.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,AETNA,AETNA,6186.38,,,,,,,775.0000,14488.0000,percent of total billed charges,"42.7% of $14,488.00 in Billed Charges for Rev 361 Proc 47540 = $6,186.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,8150.06,,,,,,,775.0000,14488.0000,fee schedule,"APG 00152 Proc 47540 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 104% = $8,150.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5484.95,,,,,,,775.0000,14488.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,AETNA,AETNA HEALTHCARE MEDICARE,5484.95,,,,,,,775.0000,14488.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,5484.95,,,,,,,775.0000,14488.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,AMBETTER,AMBETTER,11957.20,,,,,,,775.0000,14488.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,5704.35,,,,,,,775.0000,14488.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,BLUE CROSS,ANTHEM EXCHANGE,13504.26,,,,,,,775.0000,14488.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,8071.70,,,,,,,775.0000,14488.0000,fee schedule,"APG 00152 Proc 47540 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 103% = $8,071.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,BLUE CROSS,ANTHEM HMO,14347.47,,,,,,,775.0000,14488.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5649.50,,,,,,,775.0000,14488.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",14488.00,,,,,,,775.0000,14488.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,775.0000,14488.0000,case rate,"Rev 361 Proc 47540 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,775.0000,14488.0000,case rate,"Rev 361 Proc 47540 ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,BLUE CROSS,BLUE CROSS MEDICARE,5704.35,,,,,,,775.0000,14488.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,775.0000,14488.0000,case rate,"Rev 361 Proc 47540 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,775.0000,14488.0000,case rate,"Rev 361 Proc 47540 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,14488.0000,case rate,Rev 361 Proc 47540 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,14488.0000,case rate,Rev 361 Proc 47540 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,CIGNA HEALTHCARE,CIGNA HMO,8003.00,,,,,,,775.0000,14488.0000,case rate,"Rev 361 Proc 47540 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6048.00,,,,,,,775.0000,14488.0000,case rate,"Rev 361 Proc 47540 ASG Rate of $6,048.00 at 100% of $6,048.00 = $6,048.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,5759.20,,,,,,,775.0000,14488.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8003.00,,,,,,,775.0000,14488.0000,case rate,"Rev 361 Proc 47540 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,CIGNA HEALTHCARE,CIGNA PPO,8003.00,,,,,,,775.0000,14488.0000,case rate,"Rev 361 Proc 47540 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,5759.20,,,,,,,775.0000,14488.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13039.20,,,,,,,775.0000,14488.0000,percent of total billed charges,"90% of $14,488.00 in Billed Charges for Rev 361 Proc 47540 = $13,039.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,HUMANA,HUMANA MEDICARE,5484.95,,,,,,,775.0000,14488.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5484.95,,,,,,,775.0000,14488.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,MEDCOST,MEDCOST VHN,6894.84,,,,,,,775.0000,14488.0000,percent of total billed charges,"47.59% of $14,488.00 in Billed Charges for Rev 361 Proc 47540 = $6,894.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,8228.43,,,,,,,775.0000,14488.0000,fee schedule,"APG 00152 Proc 47540 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 100% = $7,836.60... $7,836.60 at 105% = $8,228.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,5759.20,,,,,,,775.0000,14488.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,5759.20,,,,,,,775.0000,14488.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,NHC ADVANTAGE,NHC ADVANTAGE,5759.20,,,,,,,775.0000,14488.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,8079.53,,,,,,,775.0000,14488.0000,fee schedule,"APG 00152 Proc 47540 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 100% = $7,836.60... $7,836.60 at 103.1% = $8,079.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,SENTARA HEALTH,SENTARA HEALTH,3739.35,,,,,,,775.0000,14488.0000,percent of total billed charges,"25.81% of $14,488.00 in Billed Charges for Rev 361 Proc 47540 = $3,739.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,SENTARA HEALTH,SENTARA MEDICARE,5484.95,,,,,,,775.0000,14488.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",14488.00,,,,,,,775.0000,14488.0000,percent of total billed charges,"100% of $14,488.00 in Billed Charges for Rev 361 Proc 47540 = $14,488.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,775.0000,14488.0000,case rate,"Rev 361 Proc 47540 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,775.0000,14488.0000,case rate,"Rev 361 Proc 47540 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,775.0000,14488.0000,case rate,"Rev 361 Proc 47540 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,775.0000,14488.0000,case rate,"Rev 361 Proc 47540 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,8071.70,,,,,,,775.0000,14488.0000,fee schedule,"APG 00152 Proc 47540 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 103% = $8,071.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5484.95,,,,,,,775.0000,14488.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5484.95,,,,,,,775.0000,14488.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,WELLCARE,WELLCARE MEDICAID,14488.00,,,,,,,775.0000,14488.0000,percent of total billed charges,"100% of $14,488.00 in Billed Charges for Rev 361 Proc 47540 = $14,488.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE STNT BILE DUCT PERCU INCL IMG NEW ACC W BIL DRN CATH,47540,CPT,361,RC,36100309,CDM,,,,both,,,14488.0000,2173.2000,WELLCARE,WELLCARE MEDICARE,5814.05,,,,,,,775.0000,14488.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
EXPANDER KYPHON,272,RC,27200002,CDM,,,,,,both,,,25285.1200,3792.7700,AETNA,AETNA,10796.75,,,,,,,6526.0900,25285.1200,percent of total billed charges,"42.7% of $25,285.12 in Billed Charges for Rev 272 = $10,796.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXPANDER KYPHON,272,RC,27200002,CDM,,,,,,both,,,25285.1200,3792.7700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,17699.58,,,,,,,6526.0900,25285.1200,percent of total billed charges,"Rev 272 $25,285.12 in Billed Charges at 70% = $17,699.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXPANDER KYPHON,272,RC,27200002,CDM,,,,,,both,,,25285.1200,3792.7700,CIGNA HEALTHCARE,CIGNA HMO,10543.90,,,,,,,6526.0900,25285.1200,percent of total billed charges,"41.7% of $25,285.12 in Billed Charges for Rev 272 = $10,543.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXPANDER KYPHON,272,RC,27200002,CDM,,,,,,both,,,25285.1200,3792.7700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11732.30,,,,,,,6526.0900,25285.1200,percent of total billed charges,"46.4% of $25,285.12 in Billed Charges for Rev 272 = $11,732.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXPANDER KYPHON,272,RC,27200002,CDM,,,,,,both,,,25285.1200,3792.7700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,10543.90,,,,,,,6526.0900,25285.1200,percent of total billed charges,"41.7% of $25,285.12 in Billed Charges for Rev 272 = $10,543.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXPANDER KYPHON,272,RC,27200002,CDM,,,,,,both,,,25285.1200,3792.7700,CIGNA HEALTHCARE,CIGNA PPO,10543.90,,,,,,,6526.0900,25285.1200,percent of total billed charges,"41.7% of $25,285.12 in Billed Charges for Rev 272 = $10,543.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXPANDER KYPHON,272,RC,27200002,CDM,,,,,,both,,,25285.1200,3792.7700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,22756.61,,,,,,,6526.0900,25285.1200,percent of total billed charges,"90% of $25,285.12 in Billed Charges for Rev 272 = $22,756.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXPANDER KYPHON,272,RC,27200002,CDM,,,,,,both,,,25285.1200,3792.7700,MEDCOST,MEDCOST VHN,12033.19,,,,,,,6526.0900,25285.1200,percent of total billed charges,"47.59% of $25,285.12 in Billed Charges for Rev 272 = $12,033.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXPANDER KYPHON,272,RC,27200002,CDM,,,,,,both,,,25285.1200,3792.7700,SENTARA HEALTH,SENTARA HEALTH,6526.09,,,,,,,6526.0900,25285.1200,percent of total billed charges,"25.81% of $25,285.12 in Billed Charges for Rev 272 = $6,526.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXPANDER KYPHON,272,RC,27200002,CDM,,,,,,both,,,25285.1200,3792.7700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",25285.12,,,,,,,6526.0900,25285.1200,percent of total billed charges,"100% of $25,285.12 in Billed Charges for Rev 272 = $25,285.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXPANDER KYPHON,272,RC,27200002,CDM,,,,,,both,,,25285.1200,3792.7700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,12642.56,,,,,,,6526.0900,25285.1200,percent of total billed charges,"Rev 272 $25,285.12 in Billed Charges at 50% = $12,642.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXPANDER KYPHON,272,RC,27200002,CDM,,,,,,both,,,25285.1200,3792.7700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,8167.09,,,,,,,6526.0900,25285.1200,other,"32.3% of $25,285.12 in Billed Charges for Rev 272 = $8,167.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
EXPANDER KYPHON,272,RC,27200002,CDM,,,,,,both,,,25285.1200,3792.7700,UNITED HEALTHCARE,UHC HERITAGE SELECT,7762.53,,,,,,,6526.0900,25285.1200,other,"30.7% of $25,285.12 in Billed Charges for Rev 272 = $7,762.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
EXPANDER KYPHON,272,RC,27200002,CDM,,,,,,both,,,25285.1200,3792.7700,UNITED HEALTHCARE,UNITED HEALTHCARE,8167.09,,,,,,,6526.0900,25285.1200,percent of total billed charges,"32.3% of $25,285.12 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXPANDER KYPHON,272,RC,27200002,CDM,,,,,,both,,,25285.1200,3792.7700,WELLCARE,WELLCARE MEDICAID,25285.12,,,,,,,6526.0900,25285.1200,percent of total billed charges,"100% of $25,285.12 in Billed Charges for Rev 272 = $25,285.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT,47543,CPT,361,RC,36100536,CDM,,,,both,,,5607.0000,841.0500,AETNA,AETNA,2394.19,,,,,,,148.0000,8228.4300,percent of total billed charges,"42.7% of $5,607.00 in Billed Charges for Rev 361 Proc 47543 = $2,394.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT,47543,CPT,361,RC,36100536,CDM,,,,both,,,5607.0000,841.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,8150.06,,,,,,,148.0000,8228.4300,fee schedule,"APG 00152 Proc 47543 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 104% = $8,150.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT,47543,CPT,361,RC,36100536,CDM,,,,both,,,5607.0000,841.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,5607.00,,,,,,,148.0000,8228.4300,fee schedule,"APG 00152 Proc 47543 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 103% = $8,071.70 (Service Line reduced to $5,607.00, claim capped at $5,607.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT,47543,CPT,361,RC,36100536,CDM,,,,both,,,5607.0000,841.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,148.0000,8228.4300,case rate,"Rev 361 Proc 47543 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT,47543,CPT,361,RC,36100536,CDM,,,,both,,,5607.0000,841.0500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47543 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT,47543,CPT,361,RC,36100536,CDM,,,,both,,,5607.0000,841.0500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47543 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT,47543,CPT,361,RC,36100536,CDM,,,,both,,,5607.0000,841.0500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47543 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT,47543,CPT,361,RC,36100536,CDM,,,,both,,,5607.0000,841.0500,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47543 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT,47543,CPT,361,RC,36100536,CDM,,,,both,,,5607.0000,841.0500,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47543 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT,47543,CPT,361,RC,36100536,CDM,,,,both,,,5607.0000,841.0500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,148.0000,8228.4300,case rate,"Rev 361 Proc 47543 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT,47543,CPT,361,RC,36100536,CDM,,,,both,,,5607.0000,841.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,148.0000,8228.4300,case rate,"Rev 361 Proc 47543 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT,47543,CPT,361,RC,36100536,CDM,,,,both,,,5607.0000,841.0500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,148.0000,8228.4300,case rate,"Rev 361 Proc 47543 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT,47543,CPT,361,RC,36100536,CDM,,,,both,,,5607.0000,841.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5046.30,,,,,,,148.0000,8228.4300,percent of total billed charges,"90% of $5,607.00 in Billed Charges for Rev 361 Proc 47543 = $5,046.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT,47543,CPT,361,RC,36100536,CDM,,,,both,,,5607.0000,841.0500,MEDCOST,MEDCOST VHN,2668.37,,,,,,,148.0000,8228.4300,percent of total billed charges,"47.59% of $5,607.00 in Billed Charges for Rev 361 Proc 47543 = $2,668.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT,47543,CPT,361,RC,36100536,CDM,,,,both,,,5607.0000,841.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,8228.43,,,,,,,148.0000,8228.4300,fee schedule,"APG 00152 Proc 47543 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 100% = $7,836.60... $7,836.60 at 105% = $8,228.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT,47543,CPT,361,RC,36100536,CDM,,,,both,,,5607.0000,841.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,8079.53,,,,,,,148.0000,8228.4300,fee schedule,"APG 00152 Proc 47543 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 100% = $7,836.60... $7,836.60 at 103.1% = $8,079.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT,47543,CPT,361,RC,36100536,CDM,,,,both,,,5607.0000,841.0500,SENTARA HEALTH,SENTARA HEALTH,1447.17,,,,,,,148.0000,8228.4300,percent of total billed charges,"25.81% of $5,607.00 in Billed Charges for Rev 361 Proc 47543 = $1,447.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT,47543,CPT,361,RC,36100536,CDM,,,,both,,,5607.0000,841.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5607.00,,,,,,,148.0000,8228.4300,percent of total billed charges,"100% of $5,607.00 in Billed Charges for Rev 361 Proc 47543 = $5,607.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT,47543,CPT,361,RC,36100536,CDM,,,,both,,,5607.0000,841.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47543 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT,47543,CPT,361,RC,36100536,CDM,,,,both,,,5607.0000,841.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47543 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT,47543,CPT,361,RC,36100536,CDM,,,,both,,,5607.0000,841.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47543 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT,47543,CPT,361,RC,36100536,CDM,,,,both,,,5607.0000,841.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47543 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT,47543,CPT,361,RC,36100536,CDM,,,,both,,,5607.0000,841.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,8071.70,,,,,,,148.0000,8228.4300,fee schedule,"APG 00152 Proc 47543 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 103% = $8,071.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT,47543,CPT,361,RC,36100536,CDM,,,,both,,,5607.0000,841.0500,WELLCARE,WELLCARE MEDICAID,5607.00,,,,,,,148.0000,8228.4300,percent of total billed charges,"100% of $5,607.00 in Billed Charges for Rev 361 Proc 47543 = $5,607.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HB REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,47544,CPT,361,RC,36100539,CDM,,,,both,,,5607.0000,841.0500,AETNA,AETNA,2394.19,,,,,,,148.0000,8228.4300,percent of total billed charges,"42.7% of $5,607.00 in Billed Charges for Rev 361 Proc 47544 = $2,394.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HB REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,47544,CPT,361,RC,36100539,CDM,,,,both,,,5607.0000,841.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,8150.06,,,,,,,148.0000,8228.4300,fee schedule,"APG 00152 Proc 47544 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 104% = $8,150.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HB REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,47544,CPT,361,RC,36100539,CDM,,,,both,,,5607.0000,841.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,5607.00,,,,,,,148.0000,8228.4300,fee schedule,"APG 00152 Proc 47544 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 103% = $8,071.70 (Service Line reduced to $5,607.00, claim capped at $5,607.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HB REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,47544,CPT,361,RC,36100539,CDM,,,,both,,,5607.0000,841.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,148.0000,8228.4300,case rate,"Rev 361 Proc 47544 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HB REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,47544,CPT,361,RC,36100539,CDM,,,,both,,,5607.0000,841.0500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47544 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HB REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,47544,CPT,361,RC,36100539,CDM,,,,both,,,5607.0000,841.0500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47544 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HB REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,47544,CPT,361,RC,36100539,CDM,,,,both,,,5607.0000,841.0500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47544 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HB REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,47544,CPT,361,RC,36100539,CDM,,,,both,,,5607.0000,841.0500,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47544 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HB REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,47544,CPT,361,RC,36100539,CDM,,,,both,,,5607.0000,841.0500,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47544 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HB REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,47544,CPT,361,RC,36100539,CDM,,,,both,,,5607.0000,841.0500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,148.0000,8228.4300,case rate,"Rev 361 Proc 47544 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HB REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,47544,CPT,361,RC,36100539,CDM,,,,both,,,5607.0000,841.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,148.0000,8228.4300,case rate,"Rev 361 Proc 47544 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HB REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,47544,CPT,361,RC,36100539,CDM,,,,both,,,5607.0000,841.0500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,148.0000,8228.4300,case rate,"Rev 361 Proc 47544 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HB REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,47544,CPT,361,RC,36100539,CDM,,,,both,,,5607.0000,841.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5046.30,,,,,,,148.0000,8228.4300,percent of total billed charges,"90% of $5,607.00 in Billed Charges for Rev 361 Proc 47544 = $5,046.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HB REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,47544,CPT,361,RC,36100539,CDM,,,,both,,,5607.0000,841.0500,MEDCOST,MEDCOST VHN,2668.37,,,,,,,148.0000,8228.4300,percent of total billed charges,"47.59% of $5,607.00 in Billed Charges for Rev 361 Proc 47544 = $2,668.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HB REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,47544,CPT,361,RC,36100539,CDM,,,,both,,,5607.0000,841.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,8228.43,,,,,,,148.0000,8228.4300,fee schedule,"APG 00152 Proc 47544 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 100% = $7,836.60... $7,836.60 at 105% = $8,228.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HB REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,47544,CPT,361,RC,36100539,CDM,,,,both,,,5607.0000,841.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,8079.53,,,,,,,148.0000,8228.4300,fee schedule,"APG 00152 Proc 47544 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 100% = $7,836.60... $7,836.60 at 103.1% = $8,079.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HB REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,47544,CPT,361,RC,36100539,CDM,,,,both,,,5607.0000,841.0500,SENTARA HEALTH,SENTARA HEALTH,1447.17,,,,,,,148.0000,8228.4300,percent of total billed charges,"25.81% of $5,607.00 in Billed Charges for Rev 361 Proc 47544 = $1,447.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HB REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,47544,CPT,361,RC,36100539,CDM,,,,both,,,5607.0000,841.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5607.00,,,,,,,148.0000,8228.4300,percent of total billed charges,"100% of $5,607.00 in Billed Charges for Rev 361 Proc 47544 = $5,607.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HB REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,47544,CPT,361,RC,36100539,CDM,,,,both,,,5607.0000,841.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47544 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HB REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,47544,CPT,361,RC,36100539,CDM,,,,both,,,5607.0000,841.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47544 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HB REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,47544,CPT,361,RC,36100539,CDM,,,,both,,,5607.0000,841.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47544 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HB REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,47544,CPT,361,RC,36100539,CDM,,,,both,,,5607.0000,841.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,148.0000,8228.4300,case rate,Rev 361 Proc 47544 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HB REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,47544,CPT,361,RC,36100539,CDM,,,,both,,,5607.0000,841.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,8071.70,,,,,,,148.0000,8228.4300,fee schedule,"APG 00152 Proc 47544 at $836.60 (Base Rate) * 9.3672 (Relative Weight) = $7,836.60 (Total Line Payment) at 103% = $8,071.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HB REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I,47544,CPT,361,RC,36100539,CDM,,,,both,,,5607.0000,841.0500,WELLCARE,WELLCARE MEDICAID,5607.00,,,,,,,148.0000,8228.4300,percent of total billed charges,"100% of $5,607.00 in Billed Charges for Rev 361 Proc 47544 = $5,607.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,AETNA,AETNA,1075.61,,,,,,,650.1500,3320.1100,percent of total billed charges,"42.7% of $2,519.00 in Billed Charges for Rev 361 Proc 47999 = $1,075.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3288.49,,,,,,,650.1500,3320.1100,fee schedule,"APG 00151 Proc 47999 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $3,162.01 at 104% = $3,288.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,822.88,,,,,,,650.1500,3320.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,AETNA,AETNA HEALTHCARE MEDICARE,822.88,,,,,,,650.1500,3320.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,822.88,,,,,,,650.1500,3320.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,AMBETTER,AMBETTER,1793.89,,,,,,,650.1500,3320.1100,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,855.80,,,,,,,650.1500,3320.1100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,BLUE CROSS,ANTHEM EXCHANGE,2025.98,,,,,,,650.1500,3320.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2519.00,,,,,,,650.1500,3320.1100,fee schedule,"APG 00151 Proc 47999 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $3,162.01 at 103% = $3,256.87 (Service Line reduced to $2,519.00, claim capped at $2,519.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,BLUE CROSS,ANTHEM HMO,2152.49,,,,,,,650.1500,3320.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,847.57,,,,,,,650.1500,3320.1100,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2519.00,,,,,,,650.1500,3320.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1082.00,,,,,,,650.1500,3320.1100,case rate,"Rev 361 Proc 47999 ASG Rate of $1,082.00 at 100% of $1,082.00 = $1,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,650.1500,3320.1100,case rate,Rev 361 Proc 47999 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,BLUE CROSS,BLUE CROSS MEDICARE,855.80,,,,,,,650.1500,3320.1100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,650.1500,3320.1100,case rate,Rev 361 Proc 47999 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,650.1500,3320.1100,case rate,Rev 361 Proc 47999 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,CIGNA HEALTHCARE,CIGNA HMO,2519.00,,,,,,,650.1500,3320.1100,case rate,"Rev 361 Proc 47999 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,519.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,519.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2519.00,,,,,,,650.1500,3320.1100,case rate,"Rev 361 Proc 47999 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $2,519.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,519.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,864.03,,,,,,,650.1500,3320.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2519.00,,,,,,,650.1500,3320.1100,case rate,"Rev 361 Proc 47999 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,519.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,519.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,CIGNA HEALTHCARE,CIGNA PPO,2519.00,,,,,,,650.1500,3320.1100,case rate,"Rev 361 Proc 47999 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,519.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,519.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,864.03,,,,,,,650.1500,3320.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2267.10,,,,,,,650.1500,3320.1100,percent of total billed charges,"90% of $2,519.00 in Billed Charges for Rev 361 Proc 47999 = $2,267.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,HUMANA,HUMANA MEDICARE,822.88,,,,,,,650.1500,3320.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,822.88,,,,,,,650.1500,3320.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,MEDCOST,MEDCOST VHN,1198.79,,,,,,,650.1500,3320.1100,percent of total billed charges,"47.59% of $2,519.00 in Billed Charges for Rev 361 Proc 47999 = $1,198.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3320.11,,,,,,,650.1500,3320.1100,fee schedule,"APG 00151 Proc 47999 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $3,162.01 at 100% = $3,162.01... $3,162.01 at 105% = $3,320.11 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,864.03,,,,,,,650.1500,3320.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,864.03,,,,,,,650.1500,3320.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,NHC ADVANTAGE,NHC ADVANTAGE,864.03,,,,,,,650.1500,3320.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3260.03,,,,,,,650.1500,3320.1100,fee schedule,"APG 00151 Proc 47999 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $3,162.01 at 100% = $3,162.01... $3,162.01 at 103.1% = $3,260.03 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,SENTARA HEALTH,SENTARA HEALTH,650.15,,,,,,,650.1500,3320.1100,percent of total billed charges,"25.81% of $2,519.00 in Billed Charges for Rev 361 Proc 47999 = $650.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,SENTARA HEALTH,SENTARA MEDICARE,822.88,,,,,,,650.1500,3320.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2519.00,,,,,,,650.1500,3320.1100,percent of total billed charges,"100% of $2,519.00 in Billed Charges for Rev 361 Proc 47999 = $2,519.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,650.1500,3320.1100,case rate,Rev 361 Proc 47999 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,650.1500,3320.1100,case rate,"Rev 361 Proc 47999 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,650.1500,3320.1100,case rate,"Rev 361 Proc 47999 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,650.1500,3320.1100,case rate,"Rev 361 Proc 47999 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3256.87,,,,,,,650.1500,3320.1100,fee schedule,"APG 00151 Proc 47999 at $836.60 (Base Rate) * 3.7796 (Relative Weight) = $3,162.01 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $3,162.01 at 103% = $3,256.87. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,822.88,,,,,,,650.1500,3320.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,822.88,,,,,,,650.1500,3320.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,WELLCARE,WELLCARE MEDICAID,2519.00,,,,,,,650.1500,3320.1100,percent of total billed charges,"100% of $2,519.00 in Billed Charges for Rev 361 Proc 47999 = $2,519.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC UNLISTED PROC BILIARY TRACT,47999,CPT,361,RC,36100444,CDM,,,,both,,,2519.0000,377.8500,WELLCARE,WELLCARE MEDICARE,872.26,,,,,,,650.1500,3320.1100,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,AETNA,AETNA,105.90,,,,,,,26.6800,756.0600,percent of total billed charges,42.7% of $248.00 in Billed Charges for Rev 521 Proc 58100 = $105.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,748.86,,,,,,,26.6800,756.0600,fee schedule,"APG 00209 Proc 58100 at $836.60 (Base Rate) * 0.8607 (Relative Weight) = $720.06 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $720.06 at 104% = $748.86. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,183.42,,,,,,,26.6800,756.0600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,AETNA,AETNA HEALTHCARE MEDICARE,183.42,,,,,,,26.6800,756.0600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,183.42,,,,,,,26.6800,756.0600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,AMBETTER,AMBETTER,399.87,,,,,,,26.6800,756.0600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,190.76,,,,,,,26.6800,756.0600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,ANTHEM EXCHANGE,248.00,,,,,,,26.6800,756.0600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,248.00,,,,,,,26.6800,756.0600,fee schedule,"APG 00209 Proc 58100 at $836.60 (Base Rate) * 0.8607 (Relative Weight) = $720.06 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $720.06 at 103% = $741.66 (Service Line reduced to $248.00, claim capped at $248.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,ANTHEM HMO,248.00,,,,,,,26.6800,756.0600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,188.93,,,,,,,26.6800,756.0600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",248.00,,,,,,,26.6800,756.0600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,77.66,,,,,,,26.6800,756.0600,fee schedule,$77.66 from Fee Schedule BLDTM_23 for Rev 521 Proc 58100 * Qty 1 = $77.66 at 100% = $77.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,BLUE CROSS MEDICARE,190.76,,,,,,,26.6800,756.0600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,TENNCARE BLUE CARE,26.68,,,,,,,26.6800,756.0600,fee schedule,$23.00 from Fee Schedule TC_24 for Rev 521 Proc 58100 * Qty 1 = $23.00 at 116% = $26.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,TENNCARE BLUE SELECT,26.68,,,,,,,26.6800,756.0600,fee schedule,$23.00 from Fee Schedule TC_24 for Rev 521 Proc 58100 * Qty 1 = $23.00 at 116% = $26.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,CIGNA HEALTHCARE,CIGNA HMO,103.42,,,,,,,26.6800,756.0600,percent of total billed charges,41.7% of $248.00 in Billed Charges for Rev 521 Proc 58100 = $103.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,115.07,,,,,,,26.6800,756.0600,percent of total billed charges,46.4% of $248.00 in Billed Charges for Rev 521 Proc 58100 = $115.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,192.60,,,,,,,26.6800,756.0600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,103.42,,,,,,,26.6800,756.0600,percent of total billed charges,41.7% of $248.00 in Billed Charges for Rev 521 Proc 58100 = $103.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,CIGNA HEALTHCARE,CIGNA PPO,103.42,,,,,,,26.6800,756.0600,percent of total billed charges,41.7% of $248.00 in Billed Charges for Rev 521 Proc 58100 = $103.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,192.60,,,,,,,26.6800,756.0600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,223.20,,,,,,,26.6800,756.0600,percent of total billed charges,90% of $248.00 in Billed Charges for Rev 521 Proc 58100 = $223.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,HUMANA,HUMANA MEDICARE,183.42,,,,,,,26.6800,756.0600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,183.42,,,,,,,26.6800,756.0600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,MEDCOST,MEDCOST VHN,118.02,,,,,,,26.6800,756.0600,percent of total billed charges,47.59% of $248.00 in Billed Charges for Rev 521 Proc 58100 = $118.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,756.06,,,,,,,26.6800,756.0600,fee schedule,"APG 00209 Proc 58100 at $836.60 (Base Rate) * 0.8607 (Relative Weight) = $720.06 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $720.06 at 100% = $720.06... $720.06 at 105% = $756.06 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,192.60,,,,,,,26.6800,756.0600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,192.60,,,,,,,26.6800,756.0600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,NHC ADVANTAGE,NHC ADVANTAGE,192.60,,,,,,,26.6800,756.0600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,742.38,,,,,,,26.6800,756.0600,fee schedule,"APG 00209 Proc 58100 at $836.60 (Base Rate) * 0.8607 (Relative Weight) = $720.06 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $720.06 at 100% = $720.06... $720.06 at 103.1% = $742.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,SENTARA HEALTH,SENTARA HEALTH,64.01,,,,,,,26.6800,756.0600,percent of total billed charges,25.81% of $248.00 in Billed Charges for Rev 521 Proc 58100 = $64.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,SENTARA HEALTH,SENTARA MEDICARE,183.42,,,,,,,26.6800,756.0600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",248.00,,,,,,,26.6800,756.0600,percent of total billed charges,100% of $248.00 in Billed Charges for Rev 521 Proc 58100 = $248.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,113.08,,,,,,,26.6800,756.0600,fee schedule,$226.16 from Fee Schedule TCUHC24 for Rev 521 Proc 58100 * Qty 1 = $226.16 at 50% = $113.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,741.66,,,,,,,26.6800,756.0600,fee schedule,"APG 00209 Proc 58100 at $836.60 (Base Rate) * 0.8607 (Relative Weight) = $720.06 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $720.06 at 103% = $741.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,183.42,,,,,,,26.6800,756.0600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,183.42,,,,,,,26.6800,756.0600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,WELLCARE,WELLCARE MEDICAID,248.00,,,,,,,26.6800,756.0600,percent of total billed charges,100% of $248.00 in Billed Charges for Rev 521 Proc 58100 = $248.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENDOMETRIAL BX WOW ENDOCRV BX WO CRV DIL ANY METH,58100,CPT,521,RC,52100136,CDM,,,,both,,,248.0000,37.2000,WELLCARE,WELLCARE MEDICARE,194.43,,,,,,,26.6800,756.0600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,AETNA,AETNA,3620.53,,,,,,,109.0000,8479.0000,percent of total billed charges,"42.7% of $8,479.00 in Billed Charges for Rev 450 Proc 58120 = $3,620.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3395.34,,,,,,,109.0000,8479.0000,fee schedule,"APG 00207 Proc 58120 at $836.60 (Base Rate) * 3.9024 (Relative Weight) = $3,264.75 (Total Line Payment) at 104% = $3,395.34. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2936.96,,,,,,,109.0000,8479.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,AETNA,AETNA HEALTHCARE MEDICARE,2936.96,,,,,,,109.0000,8479.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,2936.96,,,,,,,109.0000,8479.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,AMBETTER,AMBETTER,6402.58,,,,,,,109.0000,8479.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3054.44,,,,,,,109.0000,8479.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,BLUE CROSS,ANTHEM EXCHANGE,7230.96,,,,,,,109.0000,8479.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3362.69,,,,,,,109.0000,8479.0000,fee schedule,"APG 00207 Proc 58120 at $836.60 (Base Rate) * 3.9024 (Relative Weight) = $3,264.75 (Total Line Payment) at 103% = $3,362.69. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,BLUE CROSS,ANTHEM HMO,7682.46,,,,,,,109.0000,8479.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3025.07,,,,,,,109.0000,8479.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8479.00,,,,,,,109.0000,8479.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,318.22,,,,,,,109.0000,8479.0000,fee schedule,$318.22 from Fee Schedule BLDTM_23 for Rev 450 Proc 58120 * Qty 1 = $318.22 at 100% = $318.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,BLUE CROSS,BLUE CROSS MEDICARE,3054.44,,,,,,,109.0000,8479.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,3083.81,,,,,,,109.0000,8479.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3083.81,,,,,,,109.0000,8479.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7631.10,,,,,,,109.0000,8479.0000,percent of total billed charges,"90% of $8,479.00 in Billed Charges for Rev 450 Proc 58120 = $7,631.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,HUMANA,HUMANA MEDICARE,2936.96,,,,,,,109.0000,8479.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2936.96,,,,,,,109.0000,8479.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,MEDCOST,MEDCOST VHN,4035.16,,,,,,,109.0000,8479.0000,percent of total billed charges,"47.59% of $8,479.00 in Billed Charges for Rev 450 Proc 58120 = $4,035.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3427.99,,,,,,,109.0000,8479.0000,fee schedule,"APG 00207 Proc 58120 at $836.60 (Base Rate) * 3.9024 (Relative Weight) = $3,264.75 (Total Line Payment) at 100% = $3,264.75... $3,264.75 at 105% = $3,427.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3083.81,,,,,,,109.0000,8479.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3083.81,,,,,,,109.0000,8479.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,NHC ADVANTAGE,NHC ADVANTAGE,3083.81,,,,,,,109.0000,8479.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3365.96,,,,,,,109.0000,8479.0000,fee schedule,"APG 00207 Proc 58120 at $836.60 (Base Rate) * 3.9024 (Relative Weight) = $3,264.75 (Total Line Payment) at 100% = $3,264.75... $3,264.75 at 103.1% = $3,365.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,SENTARA HEALTH,SENTARA HEALTH,2188.43,,,,,,,109.0000,8479.0000,percent of total billed charges,"25.81% of $8,479.00 in Billed Charges for Rev 450 Proc 58120 = $2,188.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,SENTARA HEALTH,SENTARA MEDICARE,2936.96,,,,,,,109.0000,8479.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8479.00,,,,,,,109.0000,8479.0000,percent of total billed charges,"100% of $8,479.00 in Billed Charges for Rev 450 Proc 58120 = $8,479.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,8479.0000,case rate,Rev 450 Proc 58120 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,8479.0000,case rate,Rev 450 Proc 58120 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,8479.0000,case rate,Rev 450 Proc 58120 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,8479.0000,case rate,Rev 450 Proc 58120 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3362.69,,,,,,,109.0000,8479.0000,fee schedule,"APG 00207 Proc 58120 at $836.60 (Base Rate) * 3.9024 (Relative Weight) = $3,264.75 (Total Line Payment) at 103% = $3,362.69. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2936.96,,,,,,,109.0000,8479.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2936.96,,,,,,,109.0000,8479.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,WELLCARE,WELLCARE MEDICAID,8479.00,,,,,,,109.0000,8479.0000,percent of total billed charges,"100% of $8,479.00 in Billed Charges for Rev 450 Proc 58120 = $8,479.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DILATION & CURETTAGE DX&/THER NONOBSTETRIC,58120,CPT,450,RC,45000408,CDM,,,,both,,,8479.0000,1271.8500,WELLCARE,WELLCARE MEDICARE,3113.18,,,,,,,109.0000,8479.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT IUD,58300,CPT,510,RC,51000208,CDM,,,,both,,,1491.0000,223.6500,AETNA,AETNA,636.66,,,,,,,26.1000,1491.0000,percent of total billed charges,"42.7% of $1,491.00 in Billed Charges for Rev 510 Proc 58300 = $636.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT IUD,58300,CPT,510,RC,51000208,CDM,,,,both,,,1491.0000,223.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,312.61,,,,,,,26.1000,1491.0000,fee schedule,APG 00417 Proc 58300 at $836.60 (Base Rate) * 0.3593 (Relative Weight) = $300.59 (Total Line Payment) at 104% = $312.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT IUD,58300,CPT,510,RC,51000208,CDM,,,,both,,,1491.0000,223.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,309.61,,,,,,,26.1000,1491.0000,fee schedule,APG 00417 Proc 58300 at $836.60 (Base Rate) * 0.3593 (Relative Weight) = $300.59 (Total Line Payment) at 103% = $309.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT IUD,58300,CPT,510,RC,51000208,CDM,,,,both,,,1491.0000,223.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,95.32,,,,,,,26.1000,1491.0000,fee schedule,$95.32 from Fee Schedule BLDTM_23 for Rev 510 Proc 58300 * Qty 1 = $95.32 at 100% = $95.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT IUD,58300,CPT,510,RC,51000208,CDM,,,,both,,,1491.0000,223.6500,BLUE CROSS,TENNCARE BLUE CARE,34.53,,,,,,,26.1000,1491.0000,fee schedule,$29.77 from Fee Schedule TC_24 for Rev 510 Proc 58300 * Qty 1 = $29.77 at 116% = $34.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT IUD,58300,CPT,510,RC,51000208,CDM,,,,both,,,1491.0000,223.6500,BLUE CROSS,TENNCARE BLUE SELECT,34.53,,,,,,,26.1000,1491.0000,fee schedule,$29.77 from Fee Schedule TC_24 for Rev 510 Proc 58300 * Qty 1 = $29.77 at 116% = $34.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT IUD,58300,CPT,510,RC,51000208,CDM,,,,both,,,1491.0000,223.6500,CIGNA HEALTHCARE,CIGNA HMO,621.75,,,,,,,26.1000,1491.0000,percent of total billed charges,"41.7% of $1,491.00 in Billed Charges for Rev 510 Proc 58300 = $621.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT IUD,58300,CPT,510,RC,51000208,CDM,,,,both,,,1491.0000,223.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,691.82,,,,,,,26.1000,1491.0000,percent of total billed charges,"46.4% of $1,491.00 in Billed Charges for Rev 510 Proc 58300 = $691.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT IUD,58300,CPT,510,RC,51000208,CDM,,,,both,,,1491.0000,223.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,621.75,,,,,,,26.1000,1491.0000,percent of total billed charges,"41.7% of $1,491.00 in Billed Charges for Rev 510 Proc 58300 = $621.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT IUD,58300,CPT,510,RC,51000208,CDM,,,,both,,,1491.0000,223.6500,CIGNA HEALTHCARE,CIGNA PPO,621.75,,,,,,,26.1000,1491.0000,percent of total billed charges,"41.7% of $1,491.00 in Billed Charges for Rev 510 Proc 58300 = $621.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT IUD,58300,CPT,510,RC,51000208,CDM,,,,both,,,1491.0000,223.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1341.90,,,,,,,26.1000,1491.0000,percent of total billed charges,"90% of $1,491.00 in Billed Charges for Rev 510 Proc 58300 = $1,341.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT IUD,58300,CPT,510,RC,51000208,CDM,,,,both,,,1491.0000,223.6500,MEDCOST,MEDCOST VHN,709.57,,,,,,,26.1000,1491.0000,percent of total billed charges,"47.59% of $1,491.00 in Billed Charges for Rev 510 Proc 58300 = $709.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT IUD,58300,CPT,510,RC,51000208,CDM,,,,both,,,1491.0000,223.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,315.62,,,,,,,26.1000,1491.0000,fee schedule,APG 00417 Proc 58300 at $836.60 (Base Rate) * 0.3593 (Relative Weight) = $300.59 (Total Line Payment) at 100% = $300.59... $300.59 at 105% = $315.62 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT IUD,58300,CPT,510,RC,51000208,CDM,,,,both,,,1491.0000,223.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,309.91,,,,,,,26.1000,1491.0000,fee schedule,APG 00417 Proc 58300 at $836.60 (Base Rate) * 0.3593 (Relative Weight) = $300.59 (Total Line Payment) at 100% = $300.59... $300.59 at 103.1% = $309.91 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT IUD,58300,CPT,510,RC,51000208,CDM,,,,both,,,1491.0000,223.6500,SENTARA HEALTH,SENTARA HEALTH,384.83,,,,,,,26.1000,1491.0000,percent of total billed charges,"25.81% of $1,491.00 in Billed Charges for Rev 510 Proc 58300 = $384.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT IUD,58300,CPT,510,RC,51000208,CDM,,,,both,,,1491.0000,223.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1491.00,,,,,,,26.1000,1491.0000,percent of total billed charges,"100% of $1,491.00 in Billed Charges for Rev 510 Proc 58300 = $1,491.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT IUD,58300,CPT,510,RC,51000208,CDM,,,,both,,,1491.0000,223.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,26.10,,,,,,,26.1000,1491.0000,fee schedule,$52.20 from Fee Schedule TCUHC24 for Rev 510 Proc 58300 * Qty 1 = $52.20 at 50% = $26.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT IUD,58300,CPT,510,RC,51000208,CDM,,,,both,,,1491.0000,223.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,481.59,,,,,,,26.1000,1491.0000,other,"32.3% of $1,491.00 in Billed Charges for Rev 510 Proc 58300 = $481.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT IUD,58300,CPT,510,RC,51000208,CDM,,,,both,,,1491.0000,223.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,457.74,,,,,,,26.1000,1491.0000,other,"30.7% of $1,491.00 in Billed Charges for Rev 510 Proc 58300 = $457.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT IUD,58300,CPT,510,RC,51000208,CDM,,,,both,,,1491.0000,223.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,481.59,,,,,,,26.1000,1491.0000,percent of total billed charges,"32.3% of $1,491.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT IUD,58300,CPT,510,RC,51000208,CDM,,,,both,,,1491.0000,223.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,309.61,,,,,,,26.1000,1491.0000,fee schedule,APG 00417 Proc 58300 at $836.60 (Base Rate) * 0.3593 (Relative Weight) = $300.59 (Total Line Payment) at 103% = $309.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT IUD,58300,CPT,510,RC,51000208,CDM,,,,both,,,1491.0000,223.6500,WELLCARE,WELLCARE MEDICAID,1491.00,,,,,,,26.1000,1491.0000,percent of total billed charges,"100% of $1,491.00 in Billed Charges for Rev 510 Proc 58300 = $1,491.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2370.1900,355.5300,AETNA,AETNA,1012.07,,,,,,,611.7500,2370.1900,percent of total billed charges,"42.7% of $2,370.19 in Billed Charges for Rev 272 = $1,012.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2370.1900,355.5300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1659.13,,,,,,,611.7500,2370.1900,percent of total billed charges,"Rev 272 $2,370.19 in Billed Charges at 70% = $1,659.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2370.1900,355.5300,CIGNA HEALTHCARE,CIGNA HMO,988.37,,,,,,,611.7500,2370.1900,percent of total billed charges,"41.7% of $2,370.19 in Billed Charges for Rev 272 = $988.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2370.1900,355.5300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1099.77,,,,,,,611.7500,2370.1900,percent of total billed charges,"46.4% of $2,370.19 in Billed Charges for Rev 272 = $1,099.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2370.1900,355.5300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,988.37,,,,,,,611.7500,2370.1900,percent of total billed charges,"41.7% of $2,370.19 in Billed Charges for Rev 272 = $988.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2370.1900,355.5300,CIGNA HEALTHCARE,CIGNA PPO,988.37,,,,,,,611.7500,2370.1900,percent of total billed charges,"41.7% of $2,370.19 in Billed Charges for Rev 272 = $988.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2370.1900,355.5300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2133.17,,,,,,,611.7500,2370.1900,percent of total billed charges,"90% of $2,370.19 in Billed Charges for Rev 272 = $2,133.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2370.1900,355.5300,MEDCOST,MEDCOST VHN,1127.97,,,,,,,611.7500,2370.1900,percent of total billed charges,"47.59% of $2,370.19 in Billed Charges for Rev 272 = $1,127.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2370.1900,355.5300,SENTARA HEALTH,SENTARA HEALTH,611.75,,,,,,,611.7500,2370.1900,percent of total billed charges,"25.81% of $2,370.19 in Billed Charges for Rev 272 = $611.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2370.1900,355.5300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2370.19,,,,,,,611.7500,2370.1900,percent of total billed charges,"100% of $2,370.19 in Billed Charges for Rev 272 = $2,370.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2370.1900,355.5300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1185.10,,,,,,,611.7500,2370.1900,percent of total billed charges,"Rev 272 $2,370.19 in Billed Charges at 50% = $1,185.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2370.1900,355.5300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,765.57,,,,,,,611.7500,2370.1900,other,"32.3% of $2,370.19 in Billed Charges for Rev 272 = $765.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2370.1900,355.5300,UNITED HEALTHCARE,UHC HERITAGE SELECT,727.65,,,,,,,611.7500,2370.1900,other,"30.7% of $2,370.19 in Billed Charges for Rev 272 = $727.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2370.1900,355.5300,UNITED HEALTHCARE,UNITED HEALTHCARE,765.57,,,,,,,611.7500,2370.1900,percent of total billed charges,"32.3% of $2,370.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2370.1900,355.5300,WELLCARE,WELLCARE MEDICAID,2370.19,,,,,,,611.7500,2370.1900,percent of total billed charges,"100% of $2,370.19 in Billed Charges for Rev 272 = $2,370.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2662.9600,399.4400,AETNA,AETNA,1137.08,,,,,,,687.3100,2662.9600,percent of total billed charges,"42.7% of $2,662.96 in Billed Charges for Rev 272 = $1,137.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2662.9600,399.4400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1864.07,,,,,,,687.3100,2662.9600,percent of total billed charges,"Rev 272 $2,662.96 in Billed Charges at 70% = $1,864.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2662.9600,399.4400,CIGNA HEALTHCARE,CIGNA HMO,1110.45,,,,,,,687.3100,2662.9600,percent of total billed charges,"41.7% of $2,662.96 in Billed Charges for Rev 272 = $1,110.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2662.9600,399.4400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1235.61,,,,,,,687.3100,2662.9600,percent of total billed charges,"46.4% of $2,662.96 in Billed Charges for Rev 272 = $1,235.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2662.9600,399.4400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1110.45,,,,,,,687.3100,2662.9600,percent of total billed charges,"41.7% of $2,662.96 in Billed Charges for Rev 272 = $1,110.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2662.9600,399.4400,CIGNA HEALTHCARE,CIGNA PPO,1110.45,,,,,,,687.3100,2662.9600,percent of total billed charges,"41.7% of $2,662.96 in Billed Charges for Rev 272 = $1,110.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2662.9600,399.4400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2396.66,,,,,,,687.3100,2662.9600,percent of total billed charges,"90% of $2,662.96 in Billed Charges for Rev 272 = $2,396.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2662.9600,399.4400,MEDCOST,MEDCOST VHN,1267.30,,,,,,,687.3100,2662.9600,percent of total billed charges,"47.59% of $2,662.96 in Billed Charges for Rev 272 = $1,267.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2662.9600,399.4400,SENTARA HEALTH,SENTARA HEALTH,687.31,,,,,,,687.3100,2662.9600,percent of total billed charges,"25.81% of $2,662.96 in Billed Charges for Rev 272 = $687.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2662.9600,399.4400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2662.96,,,,,,,687.3100,2662.9600,percent of total billed charges,"100% of $2,662.96 in Billed Charges for Rev 272 = $2,662.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2662.9600,399.4400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1331.48,,,,,,,687.3100,2662.9600,percent of total billed charges,"Rev 272 $2,662.96 in Billed Charges at 50% = $1,331.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2662.9600,399.4400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,860.14,,,,,,,687.3100,2662.9600,other,"32.3% of $2,662.96 in Billed Charges for Rev 272 = $860.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2662.9600,399.4400,UNITED HEALTHCARE,UHC HERITAGE SELECT,817.53,,,,,,,687.3100,2662.9600,other,"30.7% of $2,662.96 in Billed Charges for Rev 272 = $817.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2662.9600,399.4400,UNITED HEALTHCARE,UNITED HEALTHCARE,860.14,,,,,,,687.3100,2662.9600,percent of total billed charges,"32.3% of $2,662.96 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR DISP,272,RC,27200002,CDM,,,,,,both,,,2662.9600,399.4400,WELLCARE,WELLCARE MEDICAID,2662.96,,,,,,,687.3100,2662.9600,percent of total billed charges,"100% of $2,662.96 in Billed Charges for Rev 272 = $2,662.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR SCREW STEM,272,RC,,,,,,,,both,,,13482.3000,2022.3500,AETNA,AETNA,5756.94,,,,,,,3479.7800,13482.3000,percent of total billed charges,"42.7% of $13,482.30 in Billed Charges for Rev 272 = $5,756.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR SCREW STEM,272,RC,,,,,,,,both,,,13482.3000,2022.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9437.61,,,,,,,3479.7800,13482.3000,percent of total billed charges,"Rev 272 $13,482.30 in Billed Charges at 70% = $9,437.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR SCREW STEM,272,RC,,,,,,,,both,,,13482.3000,2022.3500,CIGNA HEALTHCARE,CIGNA HMO,5622.12,,,,,,,3479.7800,13482.3000,percent of total billed charges,"41.7% of $13,482.30 in Billed Charges for Rev 272 = $5,622.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR SCREW STEM,272,RC,,,,,,,,both,,,13482.3000,2022.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6255.79,,,,,,,3479.7800,13482.3000,percent of total billed charges,"46.4% of $13,482.30 in Billed Charges for Rev 272 = $6,255.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR SCREW STEM,272,RC,,,,,,,,both,,,13482.3000,2022.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5622.12,,,,,,,3479.7800,13482.3000,percent of total billed charges,"41.7% of $13,482.30 in Billed Charges for Rev 272 = $5,622.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR SCREW STEM,272,RC,,,,,,,,both,,,13482.3000,2022.3500,CIGNA HEALTHCARE,CIGNA PPO,5622.12,,,,,,,3479.7800,13482.3000,percent of total billed charges,"41.7% of $13,482.30 in Billed Charges for Rev 272 = $5,622.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR SCREW STEM,272,RC,,,,,,,,both,,,13482.3000,2022.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12134.07,,,,,,,3479.7800,13482.3000,percent of total billed charges,"90% of $13,482.30 in Billed Charges for Rev 272 = $12,134.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR SCREW STEM,272,RC,,,,,,,,both,,,13482.3000,2022.3500,MEDCOST,MEDCOST VHN,6416.23,,,,,,,3479.7800,13482.3000,percent of total billed charges,"47.59% of $13,482.30 in Billed Charges for Rev 272 = $6,416.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR SCREW STEM,272,RC,,,,,,,,both,,,13482.3000,2022.3500,SENTARA HEALTH,SENTARA HEALTH,3479.78,,,,,,,3479.7800,13482.3000,percent of total billed charges,"25.81% of $13,482.30 in Billed Charges for Rev 272 = $3,479.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR SCREW STEM,272,RC,,,,,,,,both,,,13482.3000,2022.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13482.30,,,,,,,3479.7800,13482.3000,percent of total billed charges,"100% of $13,482.30 in Billed Charges for Rev 272 = $13,482.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR SCREW STEM,272,RC,,,,,,,,both,,,13482.3000,2022.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6741.15,,,,,,,3479.7800,13482.3000,percent of total billed charges,"Rev 272 $13,482.30 in Billed Charges at 50% = $6,741.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR SCREW STEM,272,RC,,,,,,,,both,,,13482.3000,2022.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4354.78,,,,,,,3479.7800,13482.3000,other,"32.3% of $13,482.30 in Billed Charges for Rev 272 = $4,354.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
EXTRACTOR SCREW STEM,272,RC,,,,,,,,both,,,13482.3000,2022.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,4139.07,,,,,,,3479.7800,13482.3000,other,"30.7% of $13,482.30 in Billed Charges for Rev 272 = $4,139.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
EXTRACTOR SCREW STEM,272,RC,,,,,,,,both,,,13482.3000,2022.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,4354.78,,,,,,,3479.7800,13482.3000,percent of total billed charges,"32.3% of $13,482.30 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR SCREW STEM,272,RC,,,,,,,,both,,,13482.3000,2022.3500,WELLCARE,WELLCARE MEDICAID,13482.30,,,,,,,3479.7800,13482.3000,percent of total billed charges,"100% of $13,482.30 in Billed Charges for Rev 272 = $13,482.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE N-COMPASS NITINOL,272,RC,,,,,,,,both,,,3474.2900,521.1400,AETNA,AETNA,1483.52,,,,,,,896.7100,3474.2900,percent of total billed charges,"42.7% of $3,474.29 in Billed Charges for Rev 272 = $1,483.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE N-COMPASS NITINOL,272,RC,,,,,,,,both,,,3474.2900,521.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2432.00,,,,,,,896.7100,3474.2900,percent of total billed charges,"Rev 272 $3,474.29 in Billed Charges at 70% = $2,432.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE N-COMPASS NITINOL,272,RC,,,,,,,,both,,,3474.2900,521.1400,CIGNA HEALTHCARE,CIGNA HMO,1448.78,,,,,,,896.7100,3474.2900,percent of total billed charges,"41.7% of $3,474.29 in Billed Charges for Rev 272 = $1,448.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE N-COMPASS NITINOL,272,RC,,,,,,,,both,,,3474.2900,521.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1612.07,,,,,,,896.7100,3474.2900,percent of total billed charges,"46.4% of $3,474.29 in Billed Charges for Rev 272 = $1,612.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE N-COMPASS NITINOL,272,RC,,,,,,,,both,,,3474.2900,521.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1448.78,,,,,,,896.7100,3474.2900,percent of total billed charges,"41.7% of $3,474.29 in Billed Charges for Rev 272 = $1,448.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE N-COMPASS NITINOL,272,RC,,,,,,,,both,,,3474.2900,521.1400,CIGNA HEALTHCARE,CIGNA PPO,1448.78,,,,,,,896.7100,3474.2900,percent of total billed charges,"41.7% of $3,474.29 in Billed Charges for Rev 272 = $1,448.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE N-COMPASS NITINOL,272,RC,,,,,,,,both,,,3474.2900,521.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3126.86,,,,,,,896.7100,3474.2900,percent of total billed charges,"90% of $3,474.29 in Billed Charges for Rev 272 = $3,126.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE N-COMPASS NITINOL,272,RC,,,,,,,,both,,,3474.2900,521.1400,MEDCOST,MEDCOST VHN,1653.41,,,,,,,896.7100,3474.2900,percent of total billed charges,"47.59% of $3,474.29 in Billed Charges for Rev 272 = $1,653.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE N-COMPASS NITINOL,272,RC,,,,,,,,both,,,3474.2900,521.1400,SENTARA HEALTH,SENTARA HEALTH,896.71,,,,,,,896.7100,3474.2900,percent of total billed charges,"25.81% of $3,474.29 in Billed Charges for Rev 272 = $896.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE N-COMPASS NITINOL,272,RC,,,,,,,,both,,,3474.2900,521.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3474.29,,,,,,,896.7100,3474.2900,percent of total billed charges,"100% of $3,474.29 in Billed Charges for Rev 272 = $3,474.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE N-COMPASS NITINOL,272,RC,,,,,,,,both,,,3474.2900,521.1400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1737.15,,,,,,,896.7100,3474.2900,percent of total billed charges,"Rev 272 $3,474.29 in Billed Charges at 50% = $1,737.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE N-COMPASS NITINOL,272,RC,,,,,,,,both,,,3474.2900,521.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1122.20,,,,,,,896.7100,3474.2900,other,"32.3% of $3,474.29 in Billed Charges for Rev 272 = $1,122.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
EXTRACTOR STONE N-COMPASS NITINOL,272,RC,,,,,,,,both,,,3474.2900,521.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1066.61,,,,,,,896.7100,3474.2900,other,"30.7% of $3,474.29 in Billed Charges for Rev 272 = $1,066.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
EXTRACTOR STONE N-COMPASS NITINOL,272,RC,,,,,,,,both,,,3474.2900,521.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,1122.20,,,,,,,896.7100,3474.2900,percent of total billed charges,"32.3% of $3,474.29 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE N-COMPASS NITINOL,272,RC,,,,,,,,both,,,3474.2900,521.1400,WELLCARE,WELLCARE MEDICAID,3474.29,,,,,,,896.7100,3474.2900,percent of total billed charges,"100% of $3,474.29 in Billed Charges for Rev 272 = $3,474.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NITINOL NCOMPASS 1.7 X 115 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3302.0200,495.3000,AETNA,AETNA,1409.96,,,,,,,852.2500,3302.0200,percent of total billed charges,"42.7% of $3,302.02 in Billed Charges for Rev 272 = $1,409.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NITINOL NCOMPASS 1.7 X 115 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3302.0200,495.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2311.41,,,,,,,852.2500,3302.0200,percent of total billed charges,"Rev 272 $3,302.02 in Billed Charges at 70% = $2,311.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NITINOL NCOMPASS 1.7 X 115 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3302.0200,495.3000,CIGNA HEALTHCARE,CIGNA HMO,1376.94,,,,,,,852.2500,3302.0200,percent of total billed charges,"41.7% of $3,302.02 in Billed Charges for Rev 272 = $1,376.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NITINOL NCOMPASS 1.7 X 115 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3302.0200,495.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1532.14,,,,,,,852.2500,3302.0200,percent of total billed charges,"46.4% of $3,302.02 in Billed Charges for Rev 272 = $1,532.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NITINOL NCOMPASS 1.7 X 115 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3302.0200,495.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1376.94,,,,,,,852.2500,3302.0200,percent of total billed charges,"41.7% of $3,302.02 in Billed Charges for Rev 272 = $1,376.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NITINOL NCOMPASS 1.7 X 115 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3302.0200,495.3000,CIGNA HEALTHCARE,CIGNA PPO,1376.94,,,,,,,852.2500,3302.0200,percent of total billed charges,"41.7% of $3,302.02 in Billed Charges for Rev 272 = $1,376.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NITINOL NCOMPASS 1.7 X 115 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3302.0200,495.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2971.82,,,,,,,852.2500,3302.0200,percent of total billed charges,"90% of $3,302.02 in Billed Charges for Rev 272 = $2,971.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NITINOL NCOMPASS 1.7 X 115 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3302.0200,495.3000,MEDCOST,MEDCOST VHN,1571.43,,,,,,,852.2500,3302.0200,percent of total billed charges,"47.59% of $3,302.02 in Billed Charges for Rev 272 = $1,571.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NITINOL NCOMPASS 1.7 X 115 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3302.0200,495.3000,SENTARA HEALTH,SENTARA HEALTH,852.25,,,,,,,852.2500,3302.0200,percent of total billed charges,"25.81% of $3,302.02 in Billed Charges for Rev 272 = $852.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NITINOL NCOMPASS 1.7 X 115 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3302.0200,495.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3302.02,,,,,,,852.2500,3302.0200,percent of total billed charges,"100% of $3,302.02 in Billed Charges for Rev 272 = $3,302.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NITINOL NCOMPASS 1.7 X 115 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3302.0200,495.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1651.01,,,,,,,852.2500,3302.0200,percent of total billed charges,"Rev 272 $3,302.02 in Billed Charges at 50% = $1,651.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NITINOL NCOMPASS 1.7 X 115 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3302.0200,495.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1066.55,,,,,,,852.2500,3302.0200,other,"32.3% of $3,302.02 in Billed Charges for Rev 272 = $1,066.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
EXTRACTOR STONE NITINOL NCOMPASS 1.7 X 115 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3302.0200,495.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1013.72,,,,,,,852.2500,3302.0200,other,"30.7% of $3,302.02 in Billed Charges for Rev 272 = $1,013.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
EXTRACTOR STONE NITINOL NCOMPASS 1.7 X 115 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3302.0200,495.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,1066.55,,,,,,,852.2500,3302.0200,percent of total billed charges,"32.3% of $3,302.02 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NITINOL NCOMPASS 1.7 X 115 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3302.0200,495.3000,WELLCARE,WELLCARE MEDICAID,3302.02,,,,,,,852.2500,3302.0200,percent of total billed charges,"100% of $3,302.02 in Billed Charges for Rev 272 = $3,302.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,AETNA,AETNA,575.60,,,,,,,347.9200,1821.7100,percent of total billed charges,"42.7% of $1,348.00 in Billed Charges for Rev 361 Proc 59000 = $575.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,846.66,,,,,,,347.9200,1821.7100,fee schedule,"APG 00178 Proc 59000 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $814.10 at 104% = $846.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,835.65,,,,,,,347.9200,1821.7100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,AETNA,AETNA HEALTHCARE MEDICARE,835.65,,,,,,,347.9200,1821.7100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,835.65,,,,,,,347.9200,1821.7100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,AMBETTER,AMBETTER,1821.71,,,,,,,347.9200,1821.7100,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,869.07,,,,,,,347.9200,1821.7100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,BLUE CROSS,ANTHEM EXCHANGE,1348.00,,,,,,,347.9200,1821.7100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,838.52,,,,,,,347.9200,1821.7100,fee schedule,"APG 00178 Proc 59000 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $814.10 at 103% = $838.52. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,BLUE CROSS,ANTHEM HMO,1348.00,,,,,,,347.9200,1821.7100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,860.71,,,,,,,347.9200,1821.7100,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1348.00,,,,,,,347.9200,1821.7100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,347.9200,1821.7100,case rate,Rev 361 Proc 59000 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,347.9200,1821.7100,case rate,Rev 361 Proc 59000 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,BLUE CROSS,BLUE CROSS MEDICARE,869.07,,,,,,,347.9200,1821.7100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,347.9200,1821.7100,case rate,Rev 361 Proc 59000 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,347.9200,1821.7100,case rate,Rev 361 Proc 59000 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,347.9200,1821.7100,case rate,Rev 361 Proc 59000 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,347.9200,1821.7100,case rate,Rev 361 Proc 59000 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,CIGNA HEALTHCARE,CIGNA HMO,1348.00,,,,,,,347.9200,1821.7100,other,"Rev 361 Proc 59000 1 Visit at $1,932.00 per Visit = $1,932.00 (Limited to $1,348.00 in Billed Charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1348.00,,,,,,,347.9200,1821.7100,other,"Rev 361 Proc 59000 1 Visit at $1,461.00 per Visit = $1,461.00 (Limited to $1,348.00 in Billed Charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,877.43,,,,,,,347.9200,1821.7100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1348.00,,,,,,,347.9200,1821.7100,other,"Rev 361 Proc 59000 1 Visit at $1,932.00 per Visit = $1,932.00 (Limited to $1,348.00 in Billed Charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,CIGNA HEALTHCARE,CIGNA PPO,1348.00,,,,,,,347.9200,1821.7100,other,"Rev 361 Proc 59000 1 Visit at $1,932.00 per Visit = $1,932.00 (Limited to $1,348.00 in Billed Charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,877.43,,,,,,,347.9200,1821.7100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1213.20,,,,,,,347.9200,1821.7100,percent of total billed charges,"90% of $1,348.00 in Billed Charges for Rev 361 Proc 59000 = $1,213.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,HUMANA,HUMANA MEDICARE,835.65,,,,,,,347.9200,1821.7100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,835.65,,,,,,,347.9200,1821.7100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,MEDCOST,MEDCOST VHN,641.51,,,,,,,347.9200,1821.7100,percent of total billed charges,"47.59% of $1,348.00 in Billed Charges for Rev 361 Proc 59000 = $641.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,854.81,,,,,,,347.9200,1821.7100,fee schedule,"APG 00178 Proc 59000 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $814.10 at 100% = $814.10... $814.10 at 105% = $854.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,877.43,,,,,,,347.9200,1821.7100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,877.43,,,,,,,347.9200,1821.7100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,NHC ADVANTAGE,NHC ADVANTAGE,877.43,,,,,,,347.9200,1821.7100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,839.34,,,,,,,347.9200,1821.7100,fee schedule,"APG 00178 Proc 59000 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $814.10 at 100% = $814.10... $814.10 at 103.1% = $839.34 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,SENTARA HEALTH,SENTARA HEALTH,347.92,,,,,,,347.9200,1821.7100,percent of total billed charges,"25.81% of $1,348.00 in Billed Charges for Rev 361 Proc 59000 = $347.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,SENTARA HEALTH,SENTARA MEDICARE,835.65,,,,,,,347.9200,1821.7100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1348.00,,,,,,,347.9200,1821.7100,percent of total billed charges,"100% of $1,348.00 in Billed Charges for Rev 361 Proc 59000 = $1,348.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,347.9200,1821.7100,case rate,Rev 361 Proc 59000 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,347.9200,1821.7100,case rate,Rev 361 Proc 59000 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,347.9200,1821.7100,case rate,Rev 361 Proc 59000 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,347.9200,1821.7100,case rate,"Rev 361 Proc 59000 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,838.52,,,,,,,347.9200,1821.7100,fee schedule,"APG 00178 Proc 59000 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $814.10 at 103% = $838.52. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,835.65,,,,,,,347.9200,1821.7100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,835.65,,,,,,,347.9200,1821.7100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,WELLCARE,WELLCARE MEDICAID,1348.00,,,,,,,347.9200,1821.7100,percent of total billed charges,"100% of $1,348.00 in Billed Charges for Rev 361 Proc 59000 = $1,348.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMNIOCENTESIS DX,59000,CPT,361,RC,36100177,CDM,,,,both,,,1348.0000,202.2000,WELLCARE,WELLCARE MEDICARE,885.78,,,,,,,347.9200,1821.7100,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,AETNA,AETNA,407.36,,,,,,,173.0000,954.0000,percent of total billed charges,42.7% of $954.00 in Billed Charges for Rev 361 Proc 59001 = $407.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,846.66,,,,,,,173.0000,954.0000,fee schedule,"APG 00178 Proc 59001 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $814.10 at 104% = $846.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,276.47,,,,,,,173.0000,954.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,AETNA,AETNA HEALTHCARE MEDICARE,276.47,,,,,,,173.0000,954.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,276.47,,,,,,,173.0000,954.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,AMBETTER,AMBETTER,602.71,,,,,,,173.0000,954.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,287.53,,,,,,,173.0000,954.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,BLUE CROSS,ANTHEM EXCHANGE,680.70,,,,,,,173.0000,954.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,838.52,,,,,,,173.0000,954.0000,fee schedule,"APG 00178 Proc 59001 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $814.10 at 103% = $838.52. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,BLUE CROSS,ANTHEM HMO,723.20,,,,,,,173.0000,954.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,284.77,,,,,,,173.0000,954.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",850.78,,,,,,,173.0000,954.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,954.00,,,,,,,173.0000,954.0000,case rate,"Rev 361 Proc 59001 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $954.00 in Billed Charges - $0.00 in ASG Allowed Amount = $954.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,173.0000,954.0000,case rate,Rev 361 Proc 59001 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,BLUE CROSS,BLUE CROSS MEDICARE,287.53,,,,,,,173.0000,954.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,173.0000,954.0000,case rate,Rev 361 Proc 59001 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,173.0000,954.0000,case rate,Rev 361 Proc 59001 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,173.0000,954.0000,case rate,Rev 361 Proc 59001 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,173.0000,954.0000,case rate,Rev 361 Proc 59001 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,CIGNA HEALTHCARE,CIGNA HMO,954.00,,,,,,,173.0000,954.0000,other,"Rev 361 Proc 59001 1 Visit at $1,932.00 per Visit = $1,932.00 (Limited to $954.00 in Billed Charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,954.00,,,,,,,173.0000,954.0000,other,"Rev 361 Proc 59001 1 Visit at $1,461.00 per Visit = $1,461.00 (Limited to $954.00 in Billed Charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,290.30,,,,,,,173.0000,954.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,954.00,,,,,,,173.0000,954.0000,other,"Rev 361 Proc 59001 1 Visit at $1,932.00 per Visit = $1,932.00 (Limited to $954.00 in Billed Charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,CIGNA HEALTHCARE,CIGNA PPO,954.00,,,,,,,173.0000,954.0000,other,"Rev 361 Proc 59001 1 Visit at $1,932.00 per Visit = $1,932.00 (Limited to $954.00 in Billed Charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,290.30,,,,,,,173.0000,954.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,858.60,,,,,,,173.0000,954.0000,percent of total billed charges,90% of $954.00 in Billed Charges for Rev 361 Proc 59001 = $858.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,HUMANA,HUMANA MEDICARE,276.47,,,,,,,173.0000,954.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,276.47,,,,,,,173.0000,954.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,MEDCOST,MEDCOST VHN,454.01,,,,,,,173.0000,954.0000,percent of total billed charges,47.59% of $954.00 in Billed Charges for Rev 361 Proc 59001 = $454.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,854.81,,,,,,,173.0000,954.0000,fee schedule,"APG 00178 Proc 59001 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $814.10 at 100% = $814.10... $814.10 at 105% = $854.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,290.30,,,,,,,173.0000,954.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,290.30,,,,,,,173.0000,954.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,NHC ADVANTAGE,NHC ADVANTAGE,290.30,,,,,,,173.0000,954.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,839.34,,,,,,,173.0000,954.0000,fee schedule,"APG 00178 Proc 59001 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $814.10 at 100% = $814.10... $814.10 at 103.1% = $839.34 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,SENTARA HEALTH,SENTARA HEALTH,246.23,,,,,,,173.0000,954.0000,percent of total billed charges,25.81% of $954.00 in Billed Charges for Rev 361 Proc 59001 = $246.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,SENTARA HEALTH,SENTARA MEDICARE,276.47,,,,,,,173.0000,954.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",954.00,,,,,,,173.0000,954.0000,percent of total billed charges,100% of $954.00 in Billed Charges for Rev 361 Proc 59001 = $954.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,173.0000,954.0000,case rate,Rev 361 Proc 59001 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,173.0000,954.0000,case rate,Rev 361 Proc 59001 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,173.0000,954.0000,case rate,Rev 361 Proc 59001 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,173.0000,954.0000,case rate,Rev 361 Proc 59001 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,838.52,,,,,,,173.0000,954.0000,fee schedule,"APG 00178 Proc 59001 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $814.10 at 103% = $838.52. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,276.47,,,,,,,173.0000,954.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,276.47,,,,,,,173.0000,954.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,WELLCARE,WELLCARE MEDICAID,954.00,,,,,,,173.0000,954.0000,percent of total billed charges,100% of $954.00 in Billed Charges for Rev 361 Proc 59001 = $954.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AMNIOCENTESIS THER AMNIOTIC FLUID RDCTN INCL US GUID,59001,CPT,361,RC,36100433,CDM,,,,both,,,954.0000,143.1000,WELLCARE,WELLCARE MEDICARE,293.06,,,,,,,173.0000,954.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,AETNA,AETNA,612.75,,,,,,,11.4200,1435.0000,percent of total billed charges,"42.7% of $1,435.00 in Billed Charges for Rev 920 Proc 59020 = $612.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,282.86,,,,,,,11.4200,1435.0000,fee schedule,"APG 00191 Proc 59020 at $836.60 (Base Rate) * 0.3251 (Relative Weight) = $271.98 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $271.98 at 104% = $282.86. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,183.42,,,,,,,11.4200,1435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,AETNA,AETNA HEALTHCARE MEDICARE,183.42,,,,,,,11.4200,1435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,183.42,,,,,,,11.4200,1435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,AMBETTER,AMBETTER,399.87,,,,,,,11.4200,1435.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,190.76,,,,,,,11.4200,1435.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,BLUE CROSS,ANTHEM EXCHANGE,451.61,,,,,,,11.4200,1435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,280.14,,,,,,,11.4200,1435.0000,fee schedule,"APG 00191 Proc 59020 at $836.60 (Base Rate) * 0.3251 (Relative Weight) = $271.98 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $271.98 at 103% = $280.14. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,BLUE CROSS,ANTHEM HMO,479.80,,,,,,,11.4200,1435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,188.93,,,,,,,11.4200,1435.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",564.45,,,,,,,11.4200,1435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11.42,,,,,,,11.4200,1435.0000,fee schedule,$11.42 from Fee Schedule BLDTM_23 for Rev 920 Proc 59020 * Qty 1 = $11.42 at 100% = $11.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,BLUE CROSS,BLUE CROSS MEDICARE,190.76,,,,,,,11.4200,1435.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,BLUE CROSS,TENNCARE BLUE CARE,20.39,,,,,,,11.4200,1435.0000,fee schedule,$17.58 from Fee Schedule TC_24 for Rev 920 Proc 59020 * Qty 1 = $17.58 at 116% = $20.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,BLUE CROSS,TENNCARE BLUE SELECT,20.39,,,,,,,11.4200,1435.0000,fee schedule,$17.58 from Fee Schedule TC_24 for Rev 920 Proc 59020 * Qty 1 = $17.58 at 116% = $20.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,CIGNA HEALTHCARE,CIGNA HMO,598.40,,,,,,,11.4200,1435.0000,percent of total billed charges,"41.7% of $1,435.00 in Billed Charges for Rev 920 Proc 59020 = $598.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,665.84,,,,,,,11.4200,1435.0000,percent of total billed charges,"46.4% of $1,435.00 in Billed Charges for Rev 920 Proc 59020 = $665.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,192.60,,,,,,,11.4200,1435.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,598.40,,,,,,,11.4200,1435.0000,percent of total billed charges,"41.7% of $1,435.00 in Billed Charges for Rev 920 Proc 59020 = $598.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,CIGNA HEALTHCARE,CIGNA PPO,598.40,,,,,,,11.4200,1435.0000,percent of total billed charges,"41.7% of $1,435.00 in Billed Charges for Rev 920 Proc 59020 = $598.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,192.60,,,,,,,11.4200,1435.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1291.50,,,,,,,11.4200,1435.0000,percent of total billed charges,"90% of $1,435.00 in Billed Charges for Rev 920 Proc 59020 = $1,291.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,HUMANA,HUMANA MEDICARE,183.42,,,,,,,11.4200,1435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,183.42,,,,,,,11.4200,1435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,MEDCOST,MEDCOST VHN,682.92,,,,,,,11.4200,1435.0000,percent of total billed charges,"47.59% of $1,435.00 in Billed Charges for Rev 920 Proc 59020 = $682.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,285.58,,,,,,,11.4200,1435.0000,fee schedule,"APG 00191 Proc 59020 at $836.60 (Base Rate) * 0.3251 (Relative Weight) = $271.98 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $271.98 at 100% = $271.98... $271.98 at 105% = $285.58 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,192.60,,,,,,,11.4200,1435.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,192.60,,,,,,,11.4200,1435.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,NHC ADVANTAGE,NHC ADVANTAGE,192.60,,,,,,,11.4200,1435.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,280.41,,,,,,,11.4200,1435.0000,fee schedule,"APG 00191 Proc 59020 at $836.60 (Base Rate) * 0.3251 (Relative Weight) = $271.98 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $271.98 at 100% = $271.98... $271.98 at 103.1% = $280.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,SENTARA HEALTH,SENTARA HEALTH,370.37,,,,,,,11.4200,1435.0000,percent of total billed charges,"25.81% of $1,435.00 in Billed Charges for Rev 920 Proc 59020 = $370.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,SENTARA HEALTH,SENTARA MEDICARE,183.42,,,,,,,11.4200,1435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1435.00,,,,,,,11.4200,1435.0000,percent of total billed charges,"100% of $1,435.00 in Billed Charges for Rev 920 Proc 59020 = $1,435.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,65.49,,,,,,,11.4200,1435.0000,fee schedule,$130.98 from Fee Schedule TCUHC24 for Rev 920 Proc 59020 * Qty 1 = $130.98 at 50% = $65.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,423.00,,,,,,,11.4200,1435.0000,other,Rev 920 Proc 59020 1 Visit at $423.00 per Visit = $423.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,405.00,,,,,,,11.4200,1435.0000,other,Rev 920 Proc 59020 1 Visit at $405.00 per Visit = $405.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,667.00,,,,,,,11.4200,1435.0000,other,Rev 920 Proc 59020 1 Visit at $667.00 per Visit = $667.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,280.14,,,,,,,11.4200,1435.0000,fee schedule,"APG 00191 Proc 59020 at $836.60 (Base Rate) * 0.3251 (Relative Weight) = $271.98 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $271.98 at 103% = $280.14. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,183.42,,,,,,,11.4200,1435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,183.42,,,,,,,11.4200,1435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,WELLCARE,WELLCARE MEDICAID,1435.00,,,,,,,11.4200,1435.0000,percent of total billed charges,"100% of $1,435.00 in Billed Charges for Rev 920 Proc 59020 = $1,435.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OXYTOCIN CHALLENGE TEST,59020,CPT,920,RC,92000002,CDM,,,,both,,,1435.0000,215.2500,WELLCARE,WELLCARE MEDICARE,194.43,,,,,,,11.4200,1435.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,AETNA,AETNA,105.90,,,,,,,8.3500,399.8700,percent of total billed charges,42.7% of $248.00 in Billed Charges for Rev 920 Proc 59025 = $105.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,282.86,,,,,,,8.3500,399.8700,fee schedule,"APG 00191 Proc 59025 at $836.60 (Base Rate) * 0.3251 (Relative Weight) = $271.98 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $271.98 at 104% = $282.86. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,183.42,,,,,,,8.3500,399.8700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,AETNA,AETNA HEALTHCARE MEDICARE,183.42,,,,,,,8.3500,399.8700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,183.42,,,,,,,8.3500,399.8700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,AMBETTER,AMBETTER,399.87,,,,,,,8.3500,399.8700,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,190.76,,,,,,,8.3500,399.8700,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,ANTHEM EXCHANGE,248.00,,,,,,,8.3500,399.8700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,248.00,,,,,,,8.3500,399.8700,fee schedule,"APG 00191 Proc 59025 at $836.60 (Base Rate) * 0.3251 (Relative Weight) = $271.98 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $271.98 at 103% = $280.14 (Service Line reduced to $248.00, claim capped at $248.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,ANTHEM HMO,248.00,,,,,,,8.3500,399.8700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,188.93,,,,,,,8.3500,399.8700,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",248.00,,,,,,,8.3500,399.8700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9.78,,,,,,,8.3500,399.8700,fee schedule,$9.78 from Fee Schedule BLDTM_23 for Rev 920 Proc 59025 * Qty 1 = $9.78 at 100% = $9.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,BLUE CROSS MEDICARE,190.76,,,,,,,8.3500,399.8700,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,TENNCARE BLUE CARE,8.35,,,,,,,8.3500,399.8700,fee schedule,$7.20 from Fee Schedule TC_24 for Rev 920 Proc 59025 * Qty 1 = $7.20 at 116% = $8.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,TENNCARE BLUE SELECT,8.35,,,,,,,8.3500,399.8700,fee schedule,$7.20 from Fee Schedule TC_24 for Rev 920 Proc 59025 * Qty 1 = $7.20 at 116% = $8.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,CIGNA HEALTHCARE,CIGNA HMO,248.00,,,,,,,8.3500,399.8700,other,"Rev 920 Proc 59025 1 Visit at $1,896.00 per Visit = $1,896.00 (Limited to $248.00 in Billed Charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,248.00,,,,,,,8.3500,399.8700,other,"Rev 920 Proc 59025 1 Visit at $1,461.00 per Visit = $1,461.00 (Limited to $248.00 in Billed Charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,192.60,,,,,,,8.3500,399.8700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,248.00,,,,,,,8.3500,399.8700,other,"Rev 920 Proc 59025 1 Visit at $1,896.00 per Visit = $1,896.00 (Limited to $248.00 in Billed Charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,CIGNA HEALTHCARE,CIGNA PPO,248.00,,,,,,,8.3500,399.8700,other,"Rev 920 Proc 59025 1 Visit at $1,896.00 per Visit = $1,896.00 (Limited to $248.00 in Billed Charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,192.60,,,,,,,8.3500,399.8700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,223.20,,,,,,,8.3500,399.8700,percent of total billed charges,90% of $248.00 in Billed Charges for Rev 920 Proc 59025 = $223.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,HUMANA,HUMANA MEDICARE,183.42,,,,,,,8.3500,399.8700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,183.42,,,,,,,8.3500,399.8700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,MEDCOST,MEDCOST VHN,118.02,,,,,,,8.3500,399.8700,percent of total billed charges,47.59% of $248.00 in Billed Charges for Rev 920 Proc 59025 = $118.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,285.58,,,,,,,8.3500,399.8700,fee schedule,"APG 00191 Proc 59025 at $836.60 (Base Rate) * 0.3251 (Relative Weight) = $271.98 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $271.98 at 100% = $271.98... $271.98 at 105% = $285.58 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,192.60,,,,,,,8.3500,399.8700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,192.60,,,,,,,8.3500,399.8700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,NHC ADVANTAGE,NHC ADVANTAGE,192.60,,,,,,,8.3500,399.8700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,280.41,,,,,,,8.3500,399.8700,fee schedule,"APG 00191 Proc 59025 at $836.60 (Base Rate) * 0.3251 (Relative Weight) = $271.98 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $271.98 at 100% = $271.98... $271.98 at 103.1% = $280.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,SENTARA HEALTH,SENTARA HEALTH,64.01,,,,,,,8.3500,399.8700,percent of total billed charges,25.81% of $248.00 in Billed Charges for Rev 920 Proc 59025 = $64.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,SENTARA HEALTH,SENTARA MEDICARE,183.42,,,,,,,8.3500,399.8700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",248.00,,,,,,,8.3500,399.8700,percent of total billed charges,100% of $248.00 in Billed Charges for Rev 920 Proc 59025 = $248.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,65.49,,,,,,,8.3500,399.8700,fee schedule,$130.98 from Fee Schedule TCUHC24 for Rev 920 Proc 59025 * Qty 1 = $130.98 at 50% = $65.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,248.00,,,,,,,8.3500,399.8700,other,"Rev 920 Proc 59025 1 Visit at $423.00 per Visit = $423.00 (Service Line reduced to $248.00, claim capped at $248.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,248.00,,,,,,,8.3500,399.8700,other,"Rev 920 Proc 59025 1 Visit at $405.00 per Visit = $405.00 (Service Line reduced to $248.00, claim capped at $248.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,248.00,,,,,,,8.3500,399.8700,other,"Rev 920 Proc 59025 1 Visit at $667.00 per Visit = $667.00 (Service Line reduced to $248.00, claim capped at $248.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,280.14,,,,,,,8.3500,399.8700,fee schedule,"APG 00191 Proc 59025 at $836.60 (Base Rate) * 0.3251 (Relative Weight) = $271.98 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $271.98 at 103% = $280.14. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,183.42,,,,,,,8.3500,399.8700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,183.42,,,,,,,8.3500,399.8700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,WELLCARE,WELLCARE MEDICAID,248.00,,,,,,,8.3500,399.8700,percent of total billed charges,100% of $248.00 in Billed Charges for Rev 920 Proc 59025 = $248.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NON STRESS TEST,59025,CPT,920,RC,92000003,CDM,,,,both,,,248.0000,37.2000,WELLCARE,WELLCARE MEDICARE,194.43,,,,,,,8.3500,399.8700,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,AETNA,AETNA,557.24,,,,,,,243.6300,1305.0000,percent of total billed charges,"42.7% of $1,305.00 in Billed Charges for Rev 920 Proc 59070 = $557.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,846.66,,,,,,,243.6300,1305.0000,fee schedule,"APG 00178 Proc 59070 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $814.10 at 104% = $846.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,276.47,,,,,,,243.6300,1305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,AETNA,AETNA HEALTHCARE MEDICARE,276.47,,,,,,,243.6300,1305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,276.47,,,,,,,243.6300,1305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,AMBETTER,AMBETTER,602.71,,,,,,,243.6300,1305.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,287.53,,,,,,,243.6300,1305.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,BLUE CROSS,ANTHEM EXCHANGE,680.70,,,,,,,243.6300,1305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,838.52,,,,,,,243.6300,1305.0000,fee schedule,"APG 00178 Proc 59070 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $814.10 at 103% = $838.52. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,BLUE CROSS,ANTHEM HMO,723.20,,,,,,,243.6300,1305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,284.77,,,,,,,243.6300,1305.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",850.78,,,,,,,243.6300,1305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,403.02,,,,,,,243.6300,1305.0000,fee schedule,$403.02 from Fee Schedule BLDTM_23 for Rev 920 Proc 59070 * Qty 1 = $403.02 at 100% = $403.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,BLUE CROSS,BLUE CROSS MEDICARE,287.53,,,,,,,243.6300,1305.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,CIGNA HEALTHCARE,CIGNA HMO,544.19,,,,,,,243.6300,1305.0000,percent of total billed charges,"41.7% of $1,305.00 in Billed Charges for Rev 920 Proc 59070 = $544.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,605.52,,,,,,,243.6300,1305.0000,percent of total billed charges,"46.4% of $1,305.00 in Billed Charges for Rev 920 Proc 59070 = $605.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,290.30,,,,,,,243.6300,1305.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,544.19,,,,,,,243.6300,1305.0000,percent of total billed charges,"41.7% of $1,305.00 in Billed Charges for Rev 920 Proc 59070 = $544.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,CIGNA HEALTHCARE,CIGNA PPO,544.19,,,,,,,243.6300,1305.0000,percent of total billed charges,"41.7% of $1,305.00 in Billed Charges for Rev 920 Proc 59070 = $544.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,290.30,,,,,,,243.6300,1305.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1174.50,,,,,,,243.6300,1305.0000,percent of total billed charges,"90% of $1,305.00 in Billed Charges for Rev 920 Proc 59070 = $1,174.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,HUMANA,HUMANA MEDICARE,276.47,,,,,,,243.6300,1305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,276.47,,,,,,,243.6300,1305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,MEDCOST,MEDCOST VHN,621.05,,,,,,,243.6300,1305.0000,percent of total billed charges,"47.59% of $1,305.00 in Billed Charges for Rev 920 Proc 59070 = $621.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,854.81,,,,,,,243.6300,1305.0000,fee schedule,"APG 00178 Proc 59070 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $814.10 at 100% = $814.10... $814.10 at 105% = $854.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,290.30,,,,,,,243.6300,1305.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,290.30,,,,,,,243.6300,1305.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,NHC ADVANTAGE,NHC ADVANTAGE,290.30,,,,,,,243.6300,1305.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,839.34,,,,,,,243.6300,1305.0000,fee schedule,"APG 00178 Proc 59070 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $814.10 at 100% = $814.10... $814.10 at 103.1% = $839.34 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,SENTARA HEALTH,SENTARA HEALTH,336.82,,,,,,,243.6300,1305.0000,percent of total billed charges,"25.81% of $1,305.00 in Billed Charges for Rev 920 Proc 59070 = $336.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,SENTARA HEALTH,SENTARA MEDICARE,276.47,,,,,,,243.6300,1305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1305.00,,,,,,,243.6300,1305.0000,percent of total billed charges,"100% of $1,305.00 in Billed Charges for Rev 920 Proc 59070 = $1,305.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,243.63,,,,,,,243.6300,1305.0000,fee schedule,$487.25 from Fee Schedule TCUHC24 for Rev 920 Proc 59070 * Qty 1 = $487.25 at 50% = $243.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,423.00,,,,,,,243.6300,1305.0000,other,Rev 920 Proc 59070 1 Visit at $423.00 per Visit = $423.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,405.00,,,,,,,243.6300,1305.0000,other,Rev 920 Proc 59070 1 Visit at $405.00 per Visit = $405.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,667.00,,,,,,,243.6300,1305.0000,other,Rev 920 Proc 59070 1 Visit at $667.00 per Visit = $667.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,838.52,,,,,,,243.6300,1305.0000,fee schedule,"APG 00178 Proc 59070 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $814.10 at 103% = $838.52. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,276.47,,,,,,,243.6300,1305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,276.47,,,,,,,243.6300,1305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,WELLCARE,WELLCARE MEDICAID,1305.00,,,,,,,243.6300,1305.0000,percent of total billed charges,"100% of $1,305.00 in Billed Charges for Rev 920 Proc 59070 = $1,305.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMNIOINFUSION,59070,CPT,920,RC,92000004,CDM,,,,both,,,1305.0000,195.7500,WELLCARE,WELLCARE MEDICARE,293.06,,,,,,,243.6300,1305.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,AETNA,AETNA,887.31,,,,,,,173.0000,2078.0000,percent of total billed charges,"42.7% of $2,078.00 in Billed Charges for Rev 361 Proc 59200 = $887.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,846.66,,,,,,,173.0000,2078.0000,fee schedule,"APG 00178 Proc 59200 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $814.10 at 104% = $846.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,276.47,,,,,,,173.0000,2078.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,AETNA,AETNA HEALTHCARE MEDICARE,276.47,,,,,,,173.0000,2078.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,276.47,,,,,,,173.0000,2078.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,AMBETTER,AMBETTER,602.71,,,,,,,173.0000,2078.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,287.53,,,,,,,173.0000,2078.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,BLUE CROSS,ANTHEM EXCHANGE,680.70,,,,,,,173.0000,2078.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,838.52,,,,,,,173.0000,2078.0000,fee schedule,"APG 00178 Proc 59200 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $814.10 at 103% = $838.52. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,BLUE CROSS,ANTHEM HMO,723.20,,,,,,,173.0000,2078.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,284.77,,,,,,,173.0000,2078.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",850.78,,,,,,,173.0000,2078.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,173.0000,2078.0000,case rate,"Rev 361 Proc 59200 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,173.0000,2078.0000,case rate,Rev 361 Proc 59200 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,BLUE CROSS,BLUE CROSS MEDICARE,287.53,,,,,,,173.0000,2078.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,173.0000,2078.0000,case rate,Rev 361 Proc 59200 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,173.0000,2078.0000,case rate,Rev 361 Proc 59200 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,173.0000,2078.0000,case rate,Rev 361 Proc 59200 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,173.0000,2078.0000,case rate,Rev 361 Proc 59200 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,173.0000,2078.0000,case rate,"Rev 361 Proc 59200 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,173.0000,2078.0000,case rate,"Rev 361 Proc 59200 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,290.30,,,,,,,173.0000,2078.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,173.0000,2078.0000,case rate,"Rev 361 Proc 59200 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,173.0000,2078.0000,case rate,"Rev 361 Proc 59200 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,290.30,,,,,,,173.0000,2078.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1870.20,,,,,,,173.0000,2078.0000,percent of total billed charges,"90% of $2,078.00 in Billed Charges for Rev 361 Proc 59200 = $1,870.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,HUMANA,HUMANA MEDICARE,276.47,,,,,,,173.0000,2078.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,276.47,,,,,,,173.0000,2078.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,MEDCOST,MEDCOST VHN,988.92,,,,,,,173.0000,2078.0000,percent of total billed charges,"47.59% of $2,078.00 in Billed Charges for Rev 361 Proc 59200 = $988.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,854.81,,,,,,,173.0000,2078.0000,fee schedule,"APG 00178 Proc 59200 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $814.10 at 100% = $814.10... $814.10 at 105% = $854.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,290.30,,,,,,,173.0000,2078.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,290.30,,,,,,,173.0000,2078.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,NHC ADVANTAGE,NHC ADVANTAGE,290.30,,,,,,,173.0000,2078.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,839.34,,,,,,,173.0000,2078.0000,fee schedule,"APG 00178 Proc 59200 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $814.10 at 100% = $814.10... $814.10 at 103.1% = $839.34 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,SENTARA HEALTH,SENTARA HEALTH,536.33,,,,,,,173.0000,2078.0000,percent of total billed charges,"25.81% of $2,078.00 in Billed Charges for Rev 361 Proc 59200 = $536.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,SENTARA HEALTH,SENTARA MEDICARE,276.47,,,,,,,173.0000,2078.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2078.00,,,,,,,173.0000,2078.0000,percent of total billed charges,"100% of $2,078.00 in Billed Charges for Rev 361 Proc 59200 = $2,078.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,173.0000,2078.0000,case rate,Rev 361 Proc 59200 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,173.0000,2078.0000,case rate,Rev 361 Proc 59200 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,173.0000,2078.0000,case rate,Rev 361 Proc 59200 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,173.0000,2078.0000,case rate,Rev 361 Proc 59200 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,838.52,,,,,,,173.0000,2078.0000,fee schedule,"APG 00178 Proc 59200 at $836.60 (Base Rate) * 0.9731 (Relative Weight) = $814.10 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $814.10 at 103% = $838.52. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,276.47,,,,,,,173.0000,2078.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,276.47,,,,,,,173.0000,2078.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,WELLCARE,WELLCARE MEDICAID,2078.00,,,,,,,173.0000,2078.0000,percent of total billed charges,"100% of $2,078.00 in Billed Charges for Rev 361 Proc 59200 = $2,078.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT CERV DILATOR,59200,CPT,361,RC,36100179,CDM,,,,both,,,2078.0000,311.7000,WELLCARE,WELLCARE MEDICARE,293.06,,,,,,,173.0000,2078.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
FORCEP MALIS BIPOLAR CORD 23CM 1.0TIP,272,RC,27200002,CDM,,,,,,both,,,3935.1900,590.2800,AETNA,AETNA,1680.33,,,,,,,1015.6700,3935.1900,percent of total billed charges,"42.7% of $3,935.19 in Billed Charges for Rev 272 = $1,680.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MALIS BIPOLAR CORD 23CM 1.0TIP,272,RC,27200002,CDM,,,,,,both,,,3935.1900,590.2800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2754.63,,,,,,,1015.6700,3935.1900,percent of total billed charges,"Rev 272 $3,935.19 in Billed Charges at 70% = $2,754.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MALIS BIPOLAR CORD 23CM 1.0TIP,272,RC,27200002,CDM,,,,,,both,,,3935.1900,590.2800,CIGNA HEALTHCARE,CIGNA HMO,1640.97,,,,,,,1015.6700,3935.1900,percent of total billed charges,"41.7% of $3,935.19 in Billed Charges for Rev 272 = $1,640.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MALIS BIPOLAR CORD 23CM 1.0TIP,272,RC,27200002,CDM,,,,,,both,,,3935.1900,590.2800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1825.93,,,,,,,1015.6700,3935.1900,percent of total billed charges,"46.4% of $3,935.19 in Billed Charges for Rev 272 = $1,825.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MALIS BIPOLAR CORD 23CM 1.0TIP,272,RC,27200002,CDM,,,,,,both,,,3935.1900,590.2800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1640.97,,,,,,,1015.6700,3935.1900,percent of total billed charges,"41.7% of $3,935.19 in Billed Charges for Rev 272 = $1,640.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MALIS BIPOLAR CORD 23CM 1.0TIP,272,RC,27200002,CDM,,,,,,both,,,3935.1900,590.2800,CIGNA HEALTHCARE,CIGNA PPO,1640.97,,,,,,,1015.6700,3935.1900,percent of total billed charges,"41.7% of $3,935.19 in Billed Charges for Rev 272 = $1,640.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MALIS BIPOLAR CORD 23CM 1.0TIP,272,RC,27200002,CDM,,,,,,both,,,3935.1900,590.2800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3541.67,,,,,,,1015.6700,3935.1900,percent of total billed charges,"90% of $3,935.19 in Billed Charges for Rev 272 = $3,541.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MALIS BIPOLAR CORD 23CM 1.0TIP,272,RC,27200002,CDM,,,,,,both,,,3935.1900,590.2800,MEDCOST,MEDCOST VHN,1872.76,,,,,,,1015.6700,3935.1900,percent of total billed charges,"47.59% of $3,935.19 in Billed Charges for Rev 272 = $1,872.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MALIS BIPOLAR CORD 23CM 1.0TIP,272,RC,27200002,CDM,,,,,,both,,,3935.1900,590.2800,SENTARA HEALTH,SENTARA HEALTH,1015.67,,,,,,,1015.6700,3935.1900,percent of total billed charges,"25.81% of $3,935.19 in Billed Charges for Rev 272 = $1,015.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MALIS BIPOLAR CORD 23CM 1.0TIP,272,RC,27200002,CDM,,,,,,both,,,3935.1900,590.2800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3935.19,,,,,,,1015.6700,3935.1900,percent of total billed charges,"100% of $3,935.19 in Billed Charges for Rev 272 = $3,935.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MALIS BIPOLAR CORD 23CM 1.0TIP,272,RC,27200002,CDM,,,,,,both,,,3935.1900,590.2800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1967.60,,,,,,,1015.6700,3935.1900,percent of total billed charges,"Rev 272 $3,935.19 in Billed Charges at 50% = $1,967.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MALIS BIPOLAR CORD 23CM 1.0TIP,272,RC,27200002,CDM,,,,,,both,,,3935.1900,590.2800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1271.07,,,,,,,1015.6700,3935.1900,other,"32.3% of $3,935.19 in Billed Charges for Rev 272 = $1,271.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP MALIS BIPOLAR CORD 23CM 1.0TIP,272,RC,27200002,CDM,,,,,,both,,,3935.1900,590.2800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1208.10,,,,,,,1015.6700,3935.1900,other,"30.7% of $3,935.19 in Billed Charges for Rev 272 = $1,208.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP MALIS BIPOLAR CORD 23CM 1.0TIP,272,RC,27200002,CDM,,,,,,both,,,3935.1900,590.2800,UNITED HEALTHCARE,UNITED HEALTHCARE,1271.07,,,,,,,1015.6700,3935.1900,percent of total billed charges,"32.3% of $3,935.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MALIS BIPOLAR CORD 23CM 1.0TIP,272,RC,27200002,CDM,,,,,,both,,,3935.1900,590.2800,WELLCARE,WELLCARE MEDICAID,3935.19,,,,,,,1015.6700,3935.1900,percent of total billed charges,"100% of $3,935.19 in Billed Charges for Rev 272 = $3,935.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1053.8800,158.0800,AETNA,AETNA,450.01,,,,,,,272.0100,1053.8800,percent of total billed charges,"42.7% of $1,053.88 in Billed Charges for Rev 272 = $450.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1053.8800,158.0800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,737.72,,,,,,,272.0100,1053.8800,percent of total billed charges,"Rev 272 $1,053.88 in Billed Charges at 70% = $737.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1053.8800,158.0800,CIGNA HEALTHCARE,CIGNA HMO,439.47,,,,,,,272.0100,1053.8800,percent of total billed charges,"41.7% of $1,053.88 in Billed Charges for Rev 272 = $439.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1053.8800,158.0800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,489.00,,,,,,,272.0100,1053.8800,percent of total billed charges,"46.4% of $1,053.88 in Billed Charges for Rev 272 = $489.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1053.8800,158.0800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,439.47,,,,,,,272.0100,1053.8800,percent of total billed charges,"41.7% of $1,053.88 in Billed Charges for Rev 272 = $439.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1053.8800,158.0800,CIGNA HEALTHCARE,CIGNA PPO,439.47,,,,,,,272.0100,1053.8800,percent of total billed charges,"41.7% of $1,053.88 in Billed Charges for Rev 272 = $439.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1053.8800,158.0800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,948.49,,,,,,,272.0100,1053.8800,percent of total billed charges,"90% of $1,053.88 in Billed Charges for Rev 272 = $948.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1053.8800,158.0800,MEDCOST,MEDCOST VHN,501.54,,,,,,,272.0100,1053.8800,percent of total billed charges,"47.59% of $1,053.88 in Billed Charges for Rev 272 = $501.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1053.8800,158.0800,SENTARA HEALTH,SENTARA HEALTH,272.01,,,,,,,272.0100,1053.8800,percent of total billed charges,"25.81% of $1,053.88 in Billed Charges for Rev 272 = $272.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1053.8800,158.0800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1053.88,,,,,,,272.0100,1053.8800,percent of total billed charges,"100% of $1,053.88 in Billed Charges for Rev 272 = $1,053.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1053.8800,158.0800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,526.94,,,,,,,272.0100,1053.8800,percent of total billed charges,"Rev 272 $1,053.88 in Billed Charges at 50% = $526.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1053.8800,158.0800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,340.40,,,,,,,272.0100,1053.8800,other,"32.3% of $1,053.88 in Billed Charges for Rev 272 = $340.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1053.8800,158.0800,UNITED HEALTHCARE,UHC HERITAGE SELECT,323.54,,,,,,,272.0100,1053.8800,other,"30.7% of $1,053.88 in Billed Charges for Rev 272 = $323.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1053.8800,158.0800,UNITED HEALTHCARE,UNITED HEALTHCARE,340.40,,,,,,,272.0100,1053.8800,percent of total billed charges,"32.3% of $1,053.88 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1053.8800,158.0800,WELLCARE,WELLCARE MEDICAID,1053.88,,,,,,,272.0100,1053.8800,percent of total billed charges,"100% of $1,053.88 in Billed Charges for Rev 272 = $1,053.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1085.4900,162.8200,AETNA,AETNA,463.50,,,,,,,280.1700,1085.4900,percent of total billed charges,"42.7% of $1,085.49 in Billed Charges for Rev 272 = $463.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1085.4900,162.8200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,759.84,,,,,,,280.1700,1085.4900,percent of total billed charges,"Rev 272 $1,085.49 in Billed Charges at 70% = $759.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1085.4900,162.8200,CIGNA HEALTHCARE,CIGNA HMO,452.65,,,,,,,280.1700,1085.4900,percent of total billed charges,"41.7% of $1,085.49 in Billed Charges for Rev 272 = $452.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1085.4900,162.8200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,503.67,,,,,,,280.1700,1085.4900,percent of total billed charges,"46.4% of $1,085.49 in Billed Charges for Rev 272 = $503.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1085.4900,162.8200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,452.65,,,,,,,280.1700,1085.4900,percent of total billed charges,"41.7% of $1,085.49 in Billed Charges for Rev 272 = $452.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1085.4900,162.8200,CIGNA HEALTHCARE,CIGNA PPO,452.65,,,,,,,280.1700,1085.4900,percent of total billed charges,"41.7% of $1,085.49 in Billed Charges for Rev 272 = $452.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1085.4900,162.8200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,976.94,,,,,,,280.1700,1085.4900,percent of total billed charges,"90% of $1,085.49 in Billed Charges for Rev 272 = $976.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1085.4900,162.8200,MEDCOST,MEDCOST VHN,516.58,,,,,,,280.1700,1085.4900,percent of total billed charges,"47.59% of $1,085.49 in Billed Charges for Rev 272 = $516.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1085.4900,162.8200,SENTARA HEALTH,SENTARA HEALTH,280.17,,,,,,,280.1700,1085.4900,percent of total billed charges,"25.81% of $1,085.49 in Billed Charges for Rev 272 = $280.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1085.4900,162.8200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1085.49,,,,,,,280.1700,1085.4900,percent of total billed charges,"100% of $1,085.49 in Billed Charges for Rev 272 = $1,085.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1085.4900,162.8200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,542.75,,,,,,,280.1700,1085.4900,percent of total billed charges,"Rev 272 $1,085.49 in Billed Charges at 50% = $542.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1085.4900,162.8200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,350.61,,,,,,,280.1700,1085.4900,other,"32.3% of $1,085.49 in Billed Charges for Rev 272 = $350.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1085.4900,162.8200,UNITED HEALTHCARE,UHC HERITAGE SELECT,333.25,,,,,,,280.1700,1085.4900,other,"30.7% of $1,085.49 in Billed Charges for Rev 272 = $333.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1085.4900,162.8200,UNITED HEALTHCARE,UNITED HEALTHCARE,350.61,,,,,,,280.1700,1085.4900,percent of total billed charges,"32.3% of $1,085.49 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP PED FOREIGN RETREIVAL,272,RC,27200002,CDM,,,,,,both,,,1085.4900,162.8200,WELLCARE,WELLCARE MEDICAID,1085.49,,,,,,,280.1700,1085.4900,percent of total billed charges,"100% of $1,085.49 in Billed Charges for Rev 272 = $1,085.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP REDUCTION WITH SERRATED JAW RATCHET 144 MM,272,RC,,,,,,,,both,,,7359.2600,1103.8900,AETNA,AETNA,3142.40,,,,,,,1899.4300,7359.2600,percent of total billed charges,"42.7% of $7,359.26 in Billed Charges for Rev 272 = $3,142.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP REDUCTION WITH SERRATED JAW RATCHET 144 MM,272,RC,,,,,,,,both,,,7359.2600,1103.8900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5151.48,,,,,,,1899.4300,7359.2600,percent of total billed charges,"Rev 272 $7,359.26 in Billed Charges at 70% = $5,151.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP REDUCTION WITH SERRATED JAW RATCHET 144 MM,272,RC,,,,,,,,both,,,7359.2600,1103.8900,CIGNA HEALTHCARE,CIGNA HMO,3068.81,,,,,,,1899.4300,7359.2600,percent of total billed charges,"41.7% of $7,359.26 in Billed Charges for Rev 272 = $3,068.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP REDUCTION WITH SERRATED JAW RATCHET 144 MM,272,RC,,,,,,,,both,,,7359.2600,1103.8900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3414.70,,,,,,,1899.4300,7359.2600,percent of total billed charges,"46.4% of $7,359.26 in Billed Charges for Rev 272 = $3,414.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP REDUCTION WITH SERRATED JAW RATCHET 144 MM,272,RC,,,,,,,,both,,,7359.2600,1103.8900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3068.81,,,,,,,1899.4300,7359.2600,percent of total billed charges,"41.7% of $7,359.26 in Billed Charges for Rev 272 = $3,068.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP REDUCTION WITH SERRATED JAW RATCHET 144 MM,272,RC,,,,,,,,both,,,7359.2600,1103.8900,CIGNA HEALTHCARE,CIGNA PPO,3068.81,,,,,,,1899.4300,7359.2600,percent of total billed charges,"41.7% of $7,359.26 in Billed Charges for Rev 272 = $3,068.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP REDUCTION WITH SERRATED JAW RATCHET 144 MM,272,RC,,,,,,,,both,,,7359.2600,1103.8900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6623.33,,,,,,,1899.4300,7359.2600,percent of total billed charges,"90% of $7,359.26 in Billed Charges for Rev 272 = $6,623.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP REDUCTION WITH SERRATED JAW RATCHET 144 MM,272,RC,,,,,,,,both,,,7359.2600,1103.8900,MEDCOST,MEDCOST VHN,3502.27,,,,,,,1899.4300,7359.2600,percent of total billed charges,"47.59% of $7,359.26 in Billed Charges for Rev 272 = $3,502.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP REDUCTION WITH SERRATED JAW RATCHET 144 MM,272,RC,,,,,,,,both,,,7359.2600,1103.8900,SENTARA HEALTH,SENTARA HEALTH,1899.43,,,,,,,1899.4300,7359.2600,percent of total billed charges,"25.81% of $7,359.26 in Billed Charges for Rev 272 = $1,899.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP REDUCTION WITH SERRATED JAW RATCHET 144 MM,272,RC,,,,,,,,both,,,7359.2600,1103.8900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7359.26,,,,,,,1899.4300,7359.2600,percent of total billed charges,"100% of $7,359.26 in Billed Charges for Rev 272 = $7,359.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP REDUCTION WITH SERRATED JAW RATCHET 144 MM,272,RC,,,,,,,,both,,,7359.2600,1103.8900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3679.63,,,,,,,1899.4300,7359.2600,percent of total billed charges,"Rev 272 $7,359.26 in Billed Charges at 50% = $3,679.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP REDUCTION WITH SERRATED JAW RATCHET 144 MM,272,RC,,,,,,,,both,,,7359.2600,1103.8900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2377.04,,,,,,,1899.4300,7359.2600,other,"32.3% of $7,359.26 in Billed Charges for Rev 272 = $2,377.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP REDUCTION WITH SERRATED JAW RATCHET 144 MM,272,RC,,,,,,,,both,,,7359.2600,1103.8900,UNITED HEALTHCARE,UHC HERITAGE SELECT,2259.29,,,,,,,1899.4300,7359.2600,other,"30.7% of $7,359.26 in Billed Charges for Rev 272 = $2,259.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP REDUCTION WITH SERRATED JAW RATCHET 144 MM,272,RC,,,,,,,,both,,,7359.2600,1103.8900,UNITED HEALTHCARE,UNITED HEALTHCARE,2377.04,,,,,,,1899.4300,7359.2600,percent of total billed charges,"32.3% of $7,359.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP REDUCTION WITH SERRATED JAW RATCHET 144 MM,272,RC,,,,,,,,both,,,7359.2600,1103.8900,WELLCARE,WELLCARE MEDICAID,7359.26,,,,,,,1899.4300,7359.2600,percent of total billed charges,"100% of $7,359.26 in Billed Charges for Rev 272 = $7,359.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SPYBITE MAX,272,RC,27200002,CDM,,,,,,both,,,10022.5300,1503.3800,AETNA,AETNA,4279.62,,,,,,,2586.8200,10022.5300,percent of total billed charges,"42.7% of $10,022.53 in Billed Charges for Rev 272 = $4,279.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SPYBITE MAX,272,RC,27200002,CDM,,,,,,both,,,10022.5300,1503.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7015.77,,,,,,,2586.8200,10022.5300,percent of total billed charges,"Rev 272 $10,022.53 in Billed Charges at 70% = $7,015.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SPYBITE MAX,272,RC,27200002,CDM,,,,,,both,,,10022.5300,1503.3800,CIGNA HEALTHCARE,CIGNA HMO,4179.40,,,,,,,2586.8200,10022.5300,percent of total billed charges,"41.7% of $10,022.53 in Billed Charges for Rev 272 = $4,179.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SPYBITE MAX,272,RC,27200002,CDM,,,,,,both,,,10022.5300,1503.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4650.45,,,,,,,2586.8200,10022.5300,percent of total billed charges,"46.4% of $10,022.53 in Billed Charges for Rev 272 = $4,650.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SPYBITE MAX,272,RC,27200002,CDM,,,,,,both,,,10022.5300,1503.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4179.40,,,,,,,2586.8200,10022.5300,percent of total billed charges,"41.7% of $10,022.53 in Billed Charges for Rev 272 = $4,179.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SPYBITE MAX,272,RC,27200002,CDM,,,,,,both,,,10022.5300,1503.3800,CIGNA HEALTHCARE,CIGNA PPO,4179.40,,,,,,,2586.8200,10022.5300,percent of total billed charges,"41.7% of $10,022.53 in Billed Charges for Rev 272 = $4,179.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SPYBITE MAX,272,RC,27200002,CDM,,,,,,both,,,10022.5300,1503.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9020.28,,,,,,,2586.8200,10022.5300,percent of total billed charges,"90% of $10,022.53 in Billed Charges for Rev 272 = $9,020.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SPYBITE MAX,272,RC,27200002,CDM,,,,,,both,,,10022.5300,1503.3800,MEDCOST,MEDCOST VHN,4769.72,,,,,,,2586.8200,10022.5300,percent of total billed charges,"47.59% of $10,022.53 in Billed Charges for Rev 272 = $4,769.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SPYBITE MAX,272,RC,27200002,CDM,,,,,,both,,,10022.5300,1503.3800,SENTARA HEALTH,SENTARA HEALTH,2586.82,,,,,,,2586.8200,10022.5300,percent of total billed charges,"25.81% of $10,022.53 in Billed Charges for Rev 272 = $2,586.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SPYBITE MAX,272,RC,27200002,CDM,,,,,,both,,,10022.5300,1503.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10022.53,,,,,,,2586.8200,10022.5300,percent of total billed charges,"100% of $10,022.53 in Billed Charges for Rev 272 = $10,022.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SPYBITE MAX,272,RC,27200002,CDM,,,,,,both,,,10022.5300,1503.3800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5011.27,,,,,,,2586.8200,10022.5300,percent of total billed charges,"Rev 272 $10,022.53 in Billed Charges at 50% = $5,011.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SPYBITE MAX,272,RC,27200002,CDM,,,,,,both,,,10022.5300,1503.3800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3237.28,,,,,,,2586.8200,10022.5300,other,"32.3% of $10,022.53 in Billed Charges for Rev 272 = $3,237.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP SPYBITE MAX,272,RC,27200002,CDM,,,,,,both,,,10022.5300,1503.3800,UNITED HEALTHCARE,UHC HERITAGE SELECT,3076.92,,,,,,,2586.8200,10022.5300,other,"30.7% of $10,022.53 in Billed Charges for Rev 272 = $3,076.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP SPYBITE MAX,272,RC,27200002,CDM,,,,,,both,,,10022.5300,1503.3800,UNITED HEALTHCARE,UNITED HEALTHCARE,3237.28,,,,,,,2586.8200,10022.5300,percent of total billed charges,"32.3% of $10,022.53 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SPYBITE MAX,272,RC,27200002,CDM,,,,,,both,,,10022.5300,1503.3800,WELLCARE,WELLCARE MEDICAID,10022.53,,,,,,,2586.8200,10022.5300,percent of total billed charges,"100% of $10,022.53 in Billed Charges for Rev 272 = $10,022.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANTEPARTUM CARE ONLY 7 OR MORE VISITS,59426,CPT,521,RC,52100138,CDM,,,,both,,,2163.0000,324.4500,AETNA,AETNA,923.60,,,,,,,312.4500,2163.0000,percent of total billed charges,"42.7% of $2,163.00 in Billed Charges for Rev 521 Proc 59426 = $923.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANTEPARTUM CARE ONLY 7 OR MORE VISITS,59426,CPT,521,RC,52100138,CDM,,,,both,,,2163.0000,324.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,315.49,,,,,,,312.4500,2163.0000,fee schedule,APG 00203 Proc 59426 at $836.60 (Base Rate) * 0.3626 (Relative Weight) = $303.35 (Total Line Payment) at 104% = $315.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTEPARTUM CARE ONLY 7 OR MORE VISITS,59426,CPT,521,RC,52100138,CDM,,,,both,,,2163.0000,324.4500,BLUE CROSS,ANTHEM EXCHANGE,951.94,,,,,,,312.4500,2163.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTEPARTUM CARE ONLY 7 OR MORE VISITS,59426,CPT,521,RC,52100138,CDM,,,,both,,,2163.0000,324.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,312.45,,,,,,,312.4500,2163.0000,fee schedule,APG 00203 Proc 59426 at $836.60 (Base Rate) * 0.3626 (Relative Weight) = $303.35 (Total Line Payment) at 103% = $312.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTEPARTUM CARE ONLY 7 OR MORE VISITS,59426,CPT,521,RC,52100138,CDM,,,,both,,,2163.0000,324.4500,BLUE CROSS,ANTHEM HMO,951.94,,,,,,,312.4500,2163.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTEPARTUM CARE ONLY 7 OR MORE VISITS,59426,CPT,521,RC,52100138,CDM,,,,both,,,2163.0000,324.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",951.94,,,,,,,312.4500,2163.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTEPARTUM CARE ONLY 7 OR MORE VISITS,59426,CPT,521,RC,52100138,CDM,,,,both,,,2163.0000,324.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,570.58,,,,,,,312.4500,2163.0000,fee schedule,$570.58 from Fee Schedule BLDTM_23 for Rev 521 Proc 59426 * Qty 1 = $570.58 at 100% = $570.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTEPARTUM CARE ONLY 7 OR MORE VISITS,59426,CPT,521,RC,52100138,CDM,,,,both,,,2163.0000,324.4500,CIGNA HEALTHCARE,CIGNA HMO,901.97,,,,,,,312.4500,2163.0000,percent of total billed charges,"41.7% of $2,163.00 in Billed Charges for Rev 521 Proc 59426 = $901.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANTEPARTUM CARE ONLY 7 OR MORE VISITS,59426,CPT,521,RC,52100138,CDM,,,,both,,,2163.0000,324.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1003.63,,,,,,,312.4500,2163.0000,percent of total billed charges,"46.4% of $2,163.00 in Billed Charges for Rev 521 Proc 59426 = $1,003.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANTEPARTUM CARE ONLY 7 OR MORE VISITS,59426,CPT,521,RC,52100138,CDM,,,,both,,,2163.0000,324.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,901.97,,,,,,,312.4500,2163.0000,percent of total billed charges,"41.7% of $2,163.00 in Billed Charges for Rev 521 Proc 59426 = $901.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANTEPARTUM CARE ONLY 7 OR MORE VISITS,59426,CPT,521,RC,52100138,CDM,,,,both,,,2163.0000,324.4500,CIGNA HEALTHCARE,CIGNA PPO,901.97,,,,,,,312.4500,2163.0000,percent of total billed charges,"41.7% of $2,163.00 in Billed Charges for Rev 521 Proc 59426 = $901.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANTEPARTUM CARE ONLY 7 OR MORE VISITS,59426,CPT,521,RC,52100138,CDM,,,,both,,,2163.0000,324.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1946.70,,,,,,,312.4500,2163.0000,percent of total billed charges,"90% of $2,163.00 in Billed Charges for Rev 521 Proc 59426 = $1,946.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANTEPARTUM CARE ONLY 7 OR MORE VISITS,59426,CPT,521,RC,52100138,CDM,,,,both,,,2163.0000,324.4500,MEDCOST,MEDCOST VHN,1029.37,,,,,,,312.4500,2163.0000,percent of total billed charges,"47.59% of $2,163.00 in Billed Charges for Rev 521 Proc 59426 = $1,029.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANTEPARTUM CARE ONLY 7 OR MORE VISITS,59426,CPT,521,RC,52100138,CDM,,,,both,,,2163.0000,324.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,318.52,,,,,,,312.4500,2163.0000,fee schedule,APG 00203 Proc 59426 at $836.60 (Base Rate) * 0.3626 (Relative Weight) = $303.35 (Total Line Payment) at 100% = $303.35... $303.35 at 105% = $318.52 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTEPARTUM CARE ONLY 7 OR MORE VISITS,59426,CPT,521,RC,52100138,CDM,,,,both,,,2163.0000,324.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,312.75,,,,,,,312.4500,2163.0000,fee schedule,APG 00203 Proc 59426 at $836.60 (Base Rate) * 0.3626 (Relative Weight) = $303.35 (Total Line Payment) at 100% = $303.35... $303.35 at 103.1% = $312.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTEPARTUM CARE ONLY 7 OR MORE VISITS,59426,CPT,521,RC,52100138,CDM,,,,both,,,2163.0000,324.4500,SENTARA HEALTH,SENTARA HEALTH,558.27,,,,,,,312.4500,2163.0000,percent of total billed charges,"25.81% of $2,163.00 in Billed Charges for Rev 521 Proc 59426 = $558.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANTEPARTUM CARE ONLY 7 OR MORE VISITS,59426,CPT,521,RC,52100138,CDM,,,,both,,,2163.0000,324.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2163.00,,,,,,,312.4500,2163.0000,percent of total billed charges,"100% of $2,163.00 in Billed Charges for Rev 521 Proc 59426 = $2,163.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANTEPARTUM CARE ONLY 7 OR MORE VISITS,59426,CPT,521,RC,52100138,CDM,,,,both,,,2163.0000,324.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,312.45,,,,,,,312.4500,2163.0000,fee schedule,APG 00203 Proc 59426 at $836.60 (Base Rate) * 0.3626 (Relative Weight) = $303.35 (Total Line Payment) at 103% = $312.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTEPARTUM CARE ONLY 7 OR MORE VISITS,59426,CPT,521,RC,52100138,CDM,,,,both,,,2163.0000,324.4500,WELLCARE,WELLCARE MEDICAID,2163.00,,,,,,,312.4500,2163.0000,percent of total billed charges,"100% of $2,163.00 in Billed Charges for Rev 521 Proc 59426 = $2,163.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC POSTPARTUM CARE ONLY,59430,CPT,521,RC,52100139,CDM,,,,both,,,480.0000,72.0000,AETNA,AETNA,204.96,,,,,,,108.1700,480.0000,percent of total billed charges,42.7% of $480.00 in Billed Charges for Rev 521 Proc 59430 = $204.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POSTPARTUM CARE ONLY,59430,CPT,521,RC,52100139,CDM,,,,both,,,480.0000,72.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,315.49,,,,,,,108.1700,480.0000,fee schedule,APG 00203 Proc 59430 at $836.60 (Base Rate) * 0.3626 (Relative Weight) = $303.35 (Total Line Payment) at 104% = $315.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTPARTUM CARE ONLY,59430,CPT,521,RC,52100139,CDM,,,,both,,,480.0000,72.0000,BLUE CROSS,ANTHEM EXCHANGE,235.78,,,,,,,108.1700,480.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTPARTUM CARE ONLY,59430,CPT,521,RC,52100139,CDM,,,,both,,,480.0000,72.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,312.45,,,,,,,108.1700,480.0000,fee schedule,APG 00203 Proc 59430 at $836.60 (Base Rate) * 0.3626 (Relative Weight) = $303.35 (Total Line Payment) at 103% = $312.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTPARTUM CARE ONLY,59430,CPT,521,RC,52100139,CDM,,,,both,,,480.0000,72.0000,BLUE CROSS,ANTHEM HMO,235.78,,,,,,,108.1700,480.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTPARTUM CARE ONLY,59430,CPT,521,RC,52100139,CDM,,,,both,,,480.0000,72.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",235.78,,,,,,,108.1700,480.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTPARTUM CARE ONLY,59430,CPT,521,RC,52100139,CDM,,,,both,,,480.0000,72.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,108.17,,,,,,,108.1700,480.0000,fee schedule,$108.17 from Fee Schedule BLDTM_23 for Rev 521 Proc 59430 * Qty 1 = $108.17 at 100% = $108.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTPARTUM CARE ONLY,59430,CPT,521,RC,52100139,CDM,,,,both,,,480.0000,72.0000,CIGNA HEALTHCARE,CIGNA HMO,200.16,,,,,,,108.1700,480.0000,percent of total billed charges,41.7% of $480.00 in Billed Charges for Rev 521 Proc 59430 = $200.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POSTPARTUM CARE ONLY,59430,CPT,521,RC,52100139,CDM,,,,both,,,480.0000,72.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,222.72,,,,,,,108.1700,480.0000,percent of total billed charges,46.4% of $480.00 in Billed Charges for Rev 521 Proc 59430 = $222.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POSTPARTUM CARE ONLY,59430,CPT,521,RC,52100139,CDM,,,,both,,,480.0000,72.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,200.16,,,,,,,108.1700,480.0000,percent of total billed charges,41.7% of $480.00 in Billed Charges for Rev 521 Proc 59430 = $200.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POSTPARTUM CARE ONLY,59430,CPT,521,RC,52100139,CDM,,,,both,,,480.0000,72.0000,CIGNA HEALTHCARE,CIGNA PPO,200.16,,,,,,,108.1700,480.0000,percent of total billed charges,41.7% of $480.00 in Billed Charges for Rev 521 Proc 59430 = $200.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POSTPARTUM CARE ONLY,59430,CPT,521,RC,52100139,CDM,,,,both,,,480.0000,72.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,432.00,,,,,,,108.1700,480.0000,percent of total billed charges,90% of $480.00 in Billed Charges for Rev 521 Proc 59430 = $432.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POSTPARTUM CARE ONLY,59430,CPT,521,RC,52100139,CDM,,,,both,,,480.0000,72.0000,MEDCOST,MEDCOST VHN,228.43,,,,,,,108.1700,480.0000,percent of total billed charges,47.59% of $480.00 in Billed Charges for Rev 521 Proc 59430 = $228.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POSTPARTUM CARE ONLY,59430,CPT,521,RC,52100139,CDM,,,,both,,,480.0000,72.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,318.52,,,,,,,108.1700,480.0000,fee schedule,APG 00203 Proc 59430 at $836.60 (Base Rate) * 0.3626 (Relative Weight) = $303.35 (Total Line Payment) at 100% = $303.35... $303.35 at 105% = $318.52 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTPARTUM CARE ONLY,59430,CPT,521,RC,52100139,CDM,,,,both,,,480.0000,72.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,312.75,,,,,,,108.1700,480.0000,fee schedule,APG 00203 Proc 59430 at $836.60 (Base Rate) * 0.3626 (Relative Weight) = $303.35 (Total Line Payment) at 100% = $303.35... $303.35 at 103.1% = $312.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTPARTUM CARE ONLY,59430,CPT,521,RC,52100139,CDM,,,,both,,,480.0000,72.0000,SENTARA HEALTH,SENTARA HEALTH,123.89,,,,,,,108.1700,480.0000,percent of total billed charges,25.81% of $480.00 in Billed Charges for Rev 521 Proc 59430 = $123.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POSTPARTUM CARE ONLY,59430,CPT,521,RC,52100139,CDM,,,,both,,,480.0000,72.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",480.00,,,,,,,108.1700,480.0000,percent of total billed charges,100% of $480.00 in Billed Charges for Rev 521 Proc 59430 = $480.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POSTPARTUM CARE ONLY,59430,CPT,521,RC,52100139,CDM,,,,both,,,480.0000,72.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,312.45,,,,,,,108.1700,480.0000,fee schedule,APG 00203 Proc 59430 at $836.60 (Base Rate) * 0.3626 (Relative Weight) = $303.35 (Total Line Payment) at 103% = $312.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTPARTUM CARE ONLY,59430,CPT,521,RC,52100139,CDM,,,,both,,,480.0000,72.0000,WELLCARE,WELLCARE MEDICAID,480.00,,,,,,,108.1700,480.0000,percent of total billed charges,100% of $480.00 in Billed Charges for Rev 521 Proc 59430 = $480.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CESAREAN DELIVERY ONLY,59514,CPT,450,RC,45000323,CDM,,,,both,,,5262.0000,789.3000,AETNA,AETNA,2246.87,,,,,,,109.0000,5262.0000,percent of total billed charges,"42.7% of $5,262.00 in Billed Charges for Rev 450 Proc 59514 = $2,246.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CESAREAN DELIVERY ONLY,59514,CPT,450,RC,45000323,CDM,,,,both,,,5262.0000,789.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3796.09,,,,,,,109.0000,5262.0000,fee schedule,"APG 00202 Proc 59514 at $836.60 (Base Rate) * 4.363 (Relative Weight) = $3,650.09 (Total Line Payment) at 104% = $3,796.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CESAREAN DELIVERY ONLY,59514,CPT,450,RC,45000323,CDM,,,,both,,,5262.0000,789.3000,BLUE CROSS,ANTHEM EXCHANGE,5262.00,,,,,,,109.0000,5262.0000,fee schedule,"$3,565.73 from Fee Schedule ANT_C_APC for Rev 450 Proc 59514 * Qty 1 = $3,565.73 at 199.87% = $7,126.82 (Service Line reduced to $5,262.00, claim capped at $5,262.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CESAREAN DELIVERY ONLY,59514,CPT,450,RC,45000323,CDM,,,,both,,,5262.0000,789.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3759.59,,,,,,,109.0000,5262.0000,fee schedule,"APG 00202 Proc 59514 at $836.60 (Base Rate) * 4.363 (Relative Weight) = $3,650.09 (Total Line Payment) at 103% = $3,759.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CESAREAN DELIVERY ONLY,59514,CPT,450,RC,45000323,CDM,,,,both,,,5262.0000,789.3000,BLUE CROSS,ANTHEM HMO,5262.00,,,,,,,109.0000,5262.0000,fee schedule,"$3,565.73 from Fee Schedule ANT_C_APC for Rev 450 Proc 59514 * Qty 1 = $3,565.73 at 212.35% = $7,571.83 (Service Line reduced to $5,262.00, claim capped at $5,262.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CESAREAN DELIVERY ONLY,59514,CPT,450,RC,45000323,CDM,,,,both,,,5262.0000,789.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5262.00,,,,,,,109.0000,5262.0000,fee schedule,"$3,565.73 from Fee Schedule ANT_C_APC for Rev 450 Proc 59514 * Qty 1 = $3,565.73 at 249.81% = $8,907.55 (Service Line reduced to $5,262.00, claim capped at $5,262.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CESAREAN DELIVERY ONLY,59514,CPT,450,RC,45000323,CDM,,,,both,,,5262.0000,789.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1073.35,,,,,,,109.0000,5262.0000,fee schedule,"$1,073.35 from Fee Schedule BLDTM_23 for Rev 450 Proc 59514 * Qty 1 = $1,073.35 at 100% = $1,073.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CESAREAN DELIVERY ONLY,59514,CPT,450,RC,45000323,CDM,,,,both,,,5262.0000,789.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4735.80,,,,,,,109.0000,5262.0000,percent of total billed charges,"90% of $5,262.00 in Billed Charges for Rev 450 Proc 59514 = $4,735.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CESAREAN DELIVERY ONLY,59514,CPT,450,RC,45000323,CDM,,,,both,,,5262.0000,789.3000,MEDCOST,MEDCOST VHN,2504.19,,,,,,,109.0000,5262.0000,percent of total billed charges,"47.59% of $5,262.00 in Billed Charges for Rev 450 Proc 59514 = $2,504.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CESAREAN DELIVERY ONLY,59514,CPT,450,RC,45000323,CDM,,,,both,,,5262.0000,789.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3832.59,,,,,,,109.0000,5262.0000,fee schedule,"APG 00202 Proc 59514 at $836.60 (Base Rate) * 4.363 (Relative Weight) = $3,650.09 (Total Line Payment) at 100% = $3,650.09... $3,650.09 at 105% = $3,832.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CESAREAN DELIVERY ONLY,59514,CPT,450,RC,45000323,CDM,,,,both,,,5262.0000,789.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3763.24,,,,,,,109.0000,5262.0000,fee schedule,"APG 00202 Proc 59514 at $836.60 (Base Rate) * 4.363 (Relative Weight) = $3,650.09 (Total Line Payment) at 100% = $3,650.09... $3,650.09 at 103.1% = $3,763.24 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CESAREAN DELIVERY ONLY,59514,CPT,450,RC,45000323,CDM,,,,both,,,5262.0000,789.3000,SENTARA HEALTH,SENTARA HEALTH,1358.12,,,,,,,109.0000,5262.0000,percent of total billed charges,"25.81% of $5,262.00 in Billed Charges for Rev 450 Proc 59514 = $1,358.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CESAREAN DELIVERY ONLY,59514,CPT,450,RC,45000323,CDM,,,,both,,,5262.0000,789.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5262.00,,,,,,,109.0000,5262.0000,percent of total billed charges,"100% of $5,262.00 in Billed Charges for Rev 450 Proc 59514 = $5,262.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CESAREAN DELIVERY ONLY,59514,CPT,450,RC,45000323,CDM,,,,both,,,5262.0000,789.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,5262.0000,case rate,Rev 450 Proc 59514 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CESAREAN DELIVERY ONLY,59514,CPT,450,RC,45000323,CDM,,,,both,,,5262.0000,789.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,5262.0000,case rate,Rev 450 Proc 59514 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CESAREAN DELIVERY ONLY,59514,CPT,450,RC,45000323,CDM,,,,both,,,5262.0000,789.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,5262.0000,case rate,Rev 450 Proc 59514 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CESAREAN DELIVERY ONLY,59514,CPT,450,RC,45000323,CDM,,,,both,,,5262.0000,789.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,5262.0000,case rate,Rev 450 Proc 59514 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CESAREAN DELIVERY ONLY,59514,CPT,450,RC,45000323,CDM,,,,both,,,5262.0000,789.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3759.59,,,,,,,109.0000,5262.0000,fee schedule,"APG 00202 Proc 59514 at $836.60 (Base Rate) * 4.363 (Relative Weight) = $3,650.09 (Total Line Payment) at 103% = $3,759.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CESAREAN DELIVERY ONLY,59514,CPT,450,RC,45000323,CDM,,,,both,,,5262.0000,789.3000,WELLCARE,WELLCARE MEDICAID,5262.00,,,,,,,109.0000,5262.0000,percent of total billed charges,"100% of $5,262.00 in Billed Charges for Rev 450 Proc 59514 = $5,262.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,AETNA,AETNA,1820.73,,,,,,,578.0000,4264.0000,percent of total billed charges,"42.7% of $4,264.00 in Billed Charges for Rev 361 Proc 60100 = $1,820.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,578.0000,4264.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,578.0000,4264.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,578.0000,4264.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,AMBETTER,AMBETTER,1400.59,,,,,,,578.0000,4264.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,578.0000,4264.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,578.0000,4264.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,578.0000,4264.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,578.0000,4264.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1977.02,,,,,,,578.0000,4264.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,578.0000,4264.0000,case rate,Rev 361 Proc 60100 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,578.0000,4264.0000,case rate,Rev 361 Proc 60100 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,578.0000,4264.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,578.0000,4264.0000,case rate,Rev 361 Proc 60100 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,578.0000,4264.0000,case rate,Rev 361 Proc 60100 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,4264.0000,case rate,Rev 361 Proc 60100 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,4264.0000,case rate,Rev 361 Proc 60100 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,578.0000,4264.0000,case rate,"Rev 361 Proc 60100 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,578.0000,4264.0000,case rate,"Rev 361 Proc 60100 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,578.0000,4264.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,578.0000,4264.0000,case rate,"Rev 361 Proc 60100 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,578.0000,4264.0000,case rate,"Rev 361 Proc 60100 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,578.0000,4264.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3837.60,,,,,,,578.0000,4264.0000,percent of total billed charges,"90% of $4,264.00 in Billed Charges for Rev 361 Proc 60100 = $3,837.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,HUMANA,HUMANA MEDICARE,642.47,,,,,,,578.0000,4264.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,578.0000,4264.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,MEDCOST,MEDCOST VHN,2029.24,,,,,,,578.0000,4264.0000,percent of total billed charges,"47.59% of $4,264.00 in Billed Charges for Rev 361 Proc 60100 = $2,029.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,578.0000,4264.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,578.0000,4264.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,578.0000,4264.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,SENTARA HEALTH,SENTARA HEALTH,1100.54,,,,,,,578.0000,4264.0000,percent of total billed charges,"25.81% of $4,264.00 in Billed Charges for Rev 361 Proc 60100 = $1,100.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,578.0000,4264.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4264.00,,,,,,,578.0000,4264.0000,percent of total billed charges,"100% of $4,264.00 in Billed Charges for Rev 361 Proc 60100 = $4,264.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,578.0000,4264.0000,case rate,Rev 361 Proc 60100 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,578.0000,4264.0000,case rate,Rev 361 Proc 60100 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,578.0000,4264.0000,case rate,Rev 361 Proc 60100 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,578.0000,4264.0000,case rate,"Rev 361 Proc 60100 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,578.0000,4264.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,578.0000,4264.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,WELLCARE,WELLCARE MEDICAID,4264.00,,,,,,,578.0000,4264.0000,percent of total billed charges,"100% of $4,264.00 in Billed Charges for Rev 361 Proc 60100 = $4,264.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX THYROID,60100,CPT,361,RC,36100180,CDM,,,,both,,,4264.0000,639.6000,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,578.0000,4264.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,AETNA,AETNA,1094.40,,,,,,,109.0000,2563.0000,percent of total billed charges,"42.7% of $2,563.00 in Billed Charges for Rev 450 Proc 61020 = $1,094.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2101.29,,,,,,,109.0000,2563.0000,fee schedule,"APG 00220 Proc 61020 at $836.60 (Base Rate) * 2.4151 (Relative Weight) = $2,020.47 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,020.47 at 104% = $2,101.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,802.46,,,,,,,109.0000,2563.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,AETNA,AETNA HEALTHCARE MEDICARE,802.46,,,,,,,109.0000,2563.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,802.46,,,,,,,109.0000,2563.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,AMBETTER,AMBETTER,1749.36,,,,,,,109.0000,2563.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,834.56,,,,,,,109.0000,2563.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,BLUE CROSS,ANTHEM EXCHANGE,1975.70,,,,,,,109.0000,2563.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2081.09,,,,,,,109.0000,2563.0000,fee schedule,"APG 00220 Proc 61020 at $836.60 (Base Rate) * 2.4151 (Relative Weight) = $2,020.47 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,020.47 at 103% = $2,081.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,BLUE CROSS,ANTHEM HMO,2099.06,,,,,,,109.0000,2563.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,826.53,,,,,,,109.0000,2563.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2469.35,,,,,,,109.0000,2563.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,169.55,,,,,,,109.0000,2563.0000,fee schedule,$169.55 from Fee Schedule BLDTM_23 for Rev 450 Proc 61020 * Qty 1 = $169.55 at 100% = $169.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,BLUE CROSS,BLUE CROSS MEDICARE,834.56,,,,,,,109.0000,2563.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,842.58,,,,,,,109.0000,2563.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,842.58,,,,,,,109.0000,2563.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2306.70,,,,,,,109.0000,2563.0000,percent of total billed charges,"90% of $2,563.00 in Billed Charges for Rev 450 Proc 61020 = $2,306.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,HUMANA,HUMANA MEDICARE,802.46,,,,,,,109.0000,2563.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,802.46,,,,,,,109.0000,2563.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,MEDCOST,MEDCOST VHN,1219.73,,,,,,,109.0000,2563.0000,percent of total billed charges,"47.59% of $2,563.00 in Billed Charges for Rev 450 Proc 61020 = $1,219.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2121.49,,,,,,,109.0000,2563.0000,fee schedule,"APG 00220 Proc 61020 at $836.60 (Base Rate) * 2.4151 (Relative Weight) = $2,020.47 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,020.47 at 100% = $2,020.47... $2,020.47 at 105% = $2,121.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,842.58,,,,,,,109.0000,2563.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,842.58,,,,,,,109.0000,2563.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,NHC ADVANTAGE,NHC ADVANTAGE,842.58,,,,,,,109.0000,2563.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2083.10,,,,,,,109.0000,2563.0000,fee schedule,"APG 00220 Proc 61020 at $836.60 (Base Rate) * 2.4151 (Relative Weight) = $2,020.47 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,020.47 at 100% = $2,020.47... $2,020.47 at 103.1% = $2,083.10 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,SENTARA HEALTH,SENTARA HEALTH,661.51,,,,,,,109.0000,2563.0000,percent of total billed charges,"25.81% of $2,563.00 in Billed Charges for Rev 450 Proc 61020 = $661.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,SENTARA HEALTH,SENTARA MEDICARE,802.46,,,,,,,109.0000,2563.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2563.00,,,,,,,109.0000,2563.0000,percent of total billed charges,"100% of $2,563.00 in Billed Charges for Rev 450 Proc 61020 = $2,563.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,2563.0000,case rate,Rev 450 Proc 61020 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,2563.0000,case rate,Rev 450 Proc 61020 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,2563.0000,case rate,Rev 450 Proc 61020 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,2563.0000,case rate,Rev 450 Proc 61020 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2081.09,,,,,,,109.0000,2563.0000,fee schedule,"APG 00220 Proc 61020 at $836.60 (Base Rate) * 2.4151 (Relative Weight) = $2,020.47 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,020.47 at 103% = $2,081.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,802.46,,,,,,,109.0000,2563.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,802.46,,,,,,,109.0000,2563.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,WELLCARE,WELLCARE MEDICAID,2563.00,,,,,,,109.0000,2563.0000,percent of total billed charges,"100% of $2,563.00 in Billed Charges for Rev 450 Proc 61020 = $2,563.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENTRICULAR PUNCTURE THRU PREV VENT CATH WO INJECTION,61020,CPT,450,RC,45000325,CDM,,,,both,,,2563.0000,384.4500,WELLCARE,WELLCARE MEDICARE,850.61,,,,,,,109.0000,2563.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
FORCEPS BIPOLAR STERILE,272,RC,27200002,CDM,,,,,,both,,,6746.3400,1011.9500,AETNA,AETNA,2880.69,,,,,,,1741.2300,6746.3400,percent of total billed charges,"42.7% of $6,746.34 in Billed Charges for Rev 272 = $2,880.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STERILE,272,RC,27200002,CDM,,,,,,both,,,6746.3400,1011.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4722.44,,,,,,,1741.2300,6746.3400,percent of total billed charges,"Rev 272 $6,746.34 in Billed Charges at 70% = $4,722.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STERILE,272,RC,27200002,CDM,,,,,,both,,,6746.3400,1011.9500,CIGNA HEALTHCARE,CIGNA HMO,2813.22,,,,,,,1741.2300,6746.3400,percent of total billed charges,"41.7% of $6,746.34 in Billed Charges for Rev 272 = $2,813.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STERILE,272,RC,27200002,CDM,,,,,,both,,,6746.3400,1011.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3130.30,,,,,,,1741.2300,6746.3400,percent of total billed charges,"46.4% of $6,746.34 in Billed Charges for Rev 272 = $3,130.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STERILE,272,RC,27200002,CDM,,,,,,both,,,6746.3400,1011.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2813.22,,,,,,,1741.2300,6746.3400,percent of total billed charges,"41.7% of $6,746.34 in Billed Charges for Rev 272 = $2,813.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STERILE,272,RC,27200002,CDM,,,,,,both,,,6746.3400,1011.9500,CIGNA HEALTHCARE,CIGNA PPO,2813.22,,,,,,,1741.2300,6746.3400,percent of total billed charges,"41.7% of $6,746.34 in Billed Charges for Rev 272 = $2,813.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STERILE,272,RC,27200002,CDM,,,,,,both,,,6746.3400,1011.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6071.71,,,,,,,1741.2300,6746.3400,percent of total billed charges,"90% of $6,746.34 in Billed Charges for Rev 272 = $6,071.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STERILE,272,RC,27200002,CDM,,,,,,both,,,6746.3400,1011.9500,MEDCOST,MEDCOST VHN,3210.58,,,,,,,1741.2300,6746.3400,percent of total billed charges,"47.59% of $6,746.34 in Billed Charges for Rev 272 = $3,210.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STERILE,272,RC,27200002,CDM,,,,,,both,,,6746.3400,1011.9500,SENTARA HEALTH,SENTARA HEALTH,1741.23,,,,,,,1741.2300,6746.3400,percent of total billed charges,"25.81% of $6,746.34 in Billed Charges for Rev 272 = $1,741.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STERILE,272,RC,27200002,CDM,,,,,,both,,,6746.3400,1011.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6746.34,,,,,,,1741.2300,6746.3400,percent of total billed charges,"100% of $6,746.34 in Billed Charges for Rev 272 = $6,746.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STERILE,272,RC,27200002,CDM,,,,,,both,,,6746.3400,1011.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3373.17,,,,,,,1741.2300,6746.3400,percent of total billed charges,"Rev 272 $6,746.34 in Billed Charges at 50% = $3,373.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STERILE,272,RC,27200002,CDM,,,,,,both,,,6746.3400,1011.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2179.07,,,,,,,1741.2300,6746.3400,other,"32.3% of $6,746.34 in Billed Charges for Rev 272 = $2,179.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEPS BIPOLAR STERILE,272,RC,27200002,CDM,,,,,,both,,,6746.3400,1011.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2071.13,,,,,,,1741.2300,6746.3400,other,"30.7% of $6,746.34 in Billed Charges for Rev 272 = $2,071.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEPS BIPOLAR STERILE,272,RC,27200002,CDM,,,,,,both,,,6746.3400,1011.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,2179.07,,,,,,,1741.2300,6746.3400,percent of total billed charges,"32.3% of $6,746.34 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STERILE,272,RC,27200002,CDM,,,,,,both,,,6746.3400,1011.9500,WELLCARE,WELLCARE MEDICAID,6746.34,,,,,,,1741.2300,6746.3400,percent of total billed charges,"100% of $6,746.34 in Billed Charges for Rev 272 = $6,746.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BX. RADIAL JAW   COLD,272,RC,27200002,CDM,,,,,,both,,,952.7000,142.9100,AETNA,AETNA,406.80,,,,,,,245.8900,952.7000,percent of total billed charges,42.7% of $952.70 in Billed Charges for Rev 272 = $406.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEPS BX. RADIAL JAW   COLD,272,RC,27200002,CDM,,,,,,both,,,952.7000,142.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,666.89,,,,,,,245.8900,952.7000,percent of total billed charges,Rev 272 $952.70 in Billed Charges at 70% = $666.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEPS BX. RADIAL JAW   COLD,272,RC,27200002,CDM,,,,,,both,,,952.7000,142.9100,CIGNA HEALTHCARE,CIGNA HMO,397.28,,,,,,,245.8900,952.7000,percent of total billed charges,41.7% of $952.70 in Billed Charges for Rev 272 = $397.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEPS BX. RADIAL JAW   COLD,272,RC,27200002,CDM,,,,,,both,,,952.7000,142.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,442.05,,,,,,,245.8900,952.7000,percent of total billed charges,46.4% of $952.70 in Billed Charges for Rev 272 = $442.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEPS BX. RADIAL JAW   COLD,272,RC,27200002,CDM,,,,,,both,,,952.7000,142.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,397.28,,,,,,,245.8900,952.7000,percent of total billed charges,41.7% of $952.70 in Billed Charges for Rev 272 = $397.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEPS BX. RADIAL JAW   COLD,272,RC,27200002,CDM,,,,,,both,,,952.7000,142.9100,CIGNA HEALTHCARE,CIGNA PPO,397.28,,,,,,,245.8900,952.7000,percent of total billed charges,41.7% of $952.70 in Billed Charges for Rev 272 = $397.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEPS BX. RADIAL JAW   COLD,272,RC,27200002,CDM,,,,,,both,,,952.7000,142.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,857.43,,,,,,,245.8900,952.7000,percent of total billed charges,90% of $952.70 in Billed Charges for Rev 272 = $857.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEPS BX. RADIAL JAW   COLD,272,RC,27200002,CDM,,,,,,both,,,952.7000,142.9100,MEDCOST,MEDCOST VHN,453.39,,,,,,,245.8900,952.7000,percent of total billed charges,47.59% of $952.70 in Billed Charges for Rev 272 = $453.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEPS BX. RADIAL JAW   COLD,272,RC,27200002,CDM,,,,,,both,,,952.7000,142.9100,SENTARA HEALTH,SENTARA HEALTH,245.89,,,,,,,245.8900,952.7000,percent of total billed charges,25.81% of $952.70 in Billed Charges for Rev 272 = $245.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEPS BX. RADIAL JAW   COLD,272,RC,27200002,CDM,,,,,,both,,,952.7000,142.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",952.70,,,,,,,245.8900,952.7000,percent of total billed charges,100% of $952.70 in Billed Charges for Rev 272 = $952.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEPS BX. RADIAL JAW   COLD,272,RC,27200002,CDM,,,,,,both,,,952.7000,142.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,476.35,,,,,,,245.8900,952.7000,percent of total billed charges,Rev 272 $952.70 in Billed Charges at 50% = $476.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEPS BX. RADIAL JAW   COLD,272,RC,27200002,CDM,,,,,,both,,,952.7000,142.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,307.72,,,,,,,245.8900,952.7000,other,32.3% of $952.70 in Billed Charges for Rev 272 = $307.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
FORCEPS BX. RADIAL JAW   COLD,272,RC,27200002,CDM,,,,,,both,,,952.7000,142.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,292.48,,,,,,,245.8900,952.7000,other,30.7% of $952.70 in Billed Charges for Rev 272 = $292.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
FORCEPS BX. RADIAL JAW   COLD,272,RC,27200002,CDM,,,,,,both,,,952.7000,142.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,307.72,,,,,,,245.8900,952.7000,percent of total billed charges,32.3% of $952.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEPS BX. RADIAL JAW   COLD,272,RC,27200002,CDM,,,,,,both,,,952.7000,142.9100,WELLCARE,WELLCARE MEDICAID,952.70,,,,,,,245.8900,952.7000,percent of total billed charges,100% of $952.70 in Billed Charges for Rev 272 = $952.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA VACURETTE SIZE 9 21413,270,RC,,,,,,,,both,,,3649.5500,547.4300,AETNA,AETNA,1558.36,,,,,,,941.9500,3649.5500,percent of total billed charges,"42.7% of $3,649.55 in Billed Charges for Rev 270 = $1,558.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VACURETTE SIZE 9 21413,270,RC,,,,,,,,both,,,3649.5500,547.4300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2554.69,,,,,,,941.9500,3649.5500,percent of total billed charges,"Rev 270 $3,649.55 in Billed Charges at 70% = $2,554.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VACURETTE SIZE 9 21413,270,RC,,,,,,,,both,,,3649.5500,547.4300,CIGNA HEALTHCARE,CIGNA HMO,1521.86,,,,,,,941.9500,3649.5500,percent of total billed charges,"41.7% of $3,649.55 in Billed Charges for Rev 270 = $1,521.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VACURETTE SIZE 9 21413,270,RC,,,,,,,,both,,,3649.5500,547.4300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1693.39,,,,,,,941.9500,3649.5500,percent of total billed charges,"46.4% of $3,649.55 in Billed Charges for Rev 270 = $1,693.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VACURETTE SIZE 9 21413,270,RC,,,,,,,,both,,,3649.5500,547.4300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1521.86,,,,,,,941.9500,3649.5500,percent of total billed charges,"41.7% of $3,649.55 in Billed Charges for Rev 270 = $1,521.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VACURETTE SIZE 9 21413,270,RC,,,,,,,,both,,,3649.5500,547.4300,CIGNA HEALTHCARE,CIGNA PPO,1521.86,,,,,,,941.9500,3649.5500,percent of total billed charges,"41.7% of $3,649.55 in Billed Charges for Rev 270 = $1,521.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VACURETTE SIZE 9 21413,270,RC,,,,,,,,both,,,3649.5500,547.4300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3284.60,,,,,,,941.9500,3649.5500,percent of total billed charges,"90% of $3,649.55 in Billed Charges for Rev 270 = $3,284.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VACURETTE SIZE 9 21413,270,RC,,,,,,,,both,,,3649.5500,547.4300,MEDCOST,MEDCOST VHN,1736.82,,,,,,,941.9500,3649.5500,percent of total billed charges,"47.59% of $3,649.55 in Billed Charges for Rev 270 = $1,736.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VACURETTE SIZE 9 21413,270,RC,,,,,,,,both,,,3649.5500,547.4300,SENTARA HEALTH,SENTARA HEALTH,941.95,,,,,,,941.9500,3649.5500,percent of total billed charges,"25.81% of $3,649.55 in Billed Charges for Rev 270 = $941.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VACURETTE SIZE 9 21413,270,RC,,,,,,,,both,,,3649.5500,547.4300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3649.55,,,,,,,941.9500,3649.5500,percent of total billed charges,"100% of $3,649.55 in Billed Charges for Rev 270 = $3,649.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VACURETTE SIZE 9 21413,270,RC,,,,,,,,both,,,3649.5500,547.4300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1824.78,,,,,,,941.9500,3649.5500,percent of total billed charges,"Rev 270 $3,649.55 in Billed Charges at 50% = $1,824.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VACURETTE SIZE 9 21413,270,RC,,,,,,,,both,,,3649.5500,547.4300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1178.80,,,,,,,941.9500,3649.5500,other,"32.3% of $3,649.55 in Billed Charges for Rev 270 = $1,178.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA VACURETTE SIZE 9 21413,270,RC,,,,,,,,both,,,3649.5500,547.4300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1120.41,,,,,,,941.9500,3649.5500,other,"30.7% of $3,649.55 in Billed Charges for Rev 270 = $1,120.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA VACURETTE SIZE 9 21413,270,RC,,,,,,,,both,,,3649.5500,547.4300,UNITED HEALTHCARE,UNITED HEALTHCARE,1178.80,,,,,,,941.9500,3649.5500,percent of total billed charges,"32.3% of $3,649.55 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VACURETTE SIZE 9 21413,270,RC,,,,,,,,both,,,3649.5500,547.4300,WELLCARE,WELLCARE MEDICAID,3649.55,,,,,,,941.9500,3649.5500,percent of total billed charges,"100% of $3,649.55 in Billed Charges for Rev 270 = $3,649.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VENUS 27F X 30IN,272,RC,27200002,CDM,,,,,,both,,,4312.2600,646.8400,AETNA,AETNA,1841.34,,,,,,,1112.9900,4312.2600,percent of total billed charges,"42.7% of $4,312.26 in Billed Charges for Rev 272 = $1,841.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VENUS 27F X 30IN,272,RC,27200002,CDM,,,,,,both,,,4312.2600,646.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3018.58,,,,,,,1112.9900,4312.2600,percent of total billed charges,"Rev 272 $4,312.26 in Billed Charges at 70% = $3,018.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VENUS 27F X 30IN,272,RC,27200002,CDM,,,,,,both,,,4312.2600,646.8400,CIGNA HEALTHCARE,CIGNA HMO,1798.21,,,,,,,1112.9900,4312.2600,percent of total billed charges,"41.7% of $4,312.26 in Billed Charges for Rev 272 = $1,798.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VENUS 27F X 30IN,272,RC,27200002,CDM,,,,,,both,,,4312.2600,646.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2000.89,,,,,,,1112.9900,4312.2600,percent of total billed charges,"46.4% of $4,312.26 in Billed Charges for Rev 272 = $2,000.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VENUS 27F X 30IN,272,RC,27200002,CDM,,,,,,both,,,4312.2600,646.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1798.21,,,,,,,1112.9900,4312.2600,percent of total billed charges,"41.7% of $4,312.26 in Billed Charges for Rev 272 = $1,798.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VENUS 27F X 30IN,272,RC,27200002,CDM,,,,,,both,,,4312.2600,646.8400,CIGNA HEALTHCARE,CIGNA PPO,1798.21,,,,,,,1112.9900,4312.2600,percent of total billed charges,"41.7% of $4,312.26 in Billed Charges for Rev 272 = $1,798.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VENUS 27F X 30IN,272,RC,27200002,CDM,,,,,,both,,,4312.2600,646.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3881.03,,,,,,,1112.9900,4312.2600,percent of total billed charges,"90% of $4,312.26 in Billed Charges for Rev 272 = $3,881.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VENUS 27F X 30IN,272,RC,27200002,CDM,,,,,,both,,,4312.2600,646.8400,MEDCOST,MEDCOST VHN,2052.20,,,,,,,1112.9900,4312.2600,percent of total billed charges,"47.59% of $4,312.26 in Billed Charges for Rev 272 = $2,052.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VENUS 27F X 30IN,272,RC,27200002,CDM,,,,,,both,,,4312.2600,646.8400,SENTARA HEALTH,SENTARA HEALTH,1112.99,,,,,,,1112.9900,4312.2600,percent of total billed charges,"25.81% of $4,312.26 in Billed Charges for Rev 272 = $1,112.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VENUS 27F X 30IN,272,RC,27200002,CDM,,,,,,both,,,4312.2600,646.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4312.26,,,,,,,1112.9900,4312.2600,percent of total billed charges,"100% of $4,312.26 in Billed Charges for Rev 272 = $4,312.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VENUS 27F X 30IN,272,RC,27200002,CDM,,,,,,both,,,4312.2600,646.8400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2156.13,,,,,,,1112.9900,4312.2600,percent of total billed charges,"Rev 272 $4,312.26 in Billed Charges at 50% = $2,156.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VENUS 27F X 30IN,272,RC,27200002,CDM,,,,,,both,,,4312.2600,646.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1392.86,,,,,,,1112.9900,4312.2600,other,"32.3% of $4,312.26 in Billed Charges for Rev 272 = $1,392.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA VENUS 27F X 30IN,272,RC,27200002,CDM,,,,,,both,,,4312.2600,646.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1323.86,,,,,,,1112.9900,4312.2600,other,"30.7% of $4,312.26 in Billed Charges for Rev 272 = $1,323.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA VENUS 27F X 30IN,272,RC,27200002,CDM,,,,,,both,,,4312.2600,646.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,1392.86,,,,,,,1112.9900,4312.2600,percent of total billed charges,"32.3% of $4,312.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA VENUS 27F X 30IN,272,RC,27200002,CDM,,,,,,both,,,4312.2600,646.8400,WELLCARE,WELLCARE MEDICAID,4312.26,,,,,,,1112.9900,4312.2600,percent of total billed charges,"100% of $4,312.26 in Billed Charges for Rev 272 = $4,312.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE DBM INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,21810.2100,3271.5300,AETNA,AETNA,9312.96,,,,,,,5629.2200,21810.2100,percent of total billed charges,"42.7% of $21,810.21 in Billed Charges for Rev 272 = $9,312.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE DBM INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,21810.2100,3271.5300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,15267.15,,,,,,,5629.2200,21810.2100,percent of total billed charges,"Rev 272 $21,810.21 in Billed Charges at 70% = $15,267.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE DBM INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,21810.2100,3271.5300,CIGNA HEALTHCARE,CIGNA HMO,9094.86,,,,,,,5629.2200,21810.2100,percent of total billed charges,"41.7% of $21,810.21 in Billed Charges for Rev 272 = $9,094.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE DBM INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,21810.2100,3271.5300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10119.94,,,,,,,5629.2200,21810.2100,percent of total billed charges,"46.4% of $21,810.21 in Billed Charges for Rev 272 = $10,119.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE DBM INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,21810.2100,3271.5300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9094.86,,,,,,,5629.2200,21810.2100,percent of total billed charges,"41.7% of $21,810.21 in Billed Charges for Rev 272 = $9,094.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE DBM INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,21810.2100,3271.5300,CIGNA HEALTHCARE,CIGNA PPO,9094.86,,,,,,,5629.2200,21810.2100,percent of total billed charges,"41.7% of $21,810.21 in Billed Charges for Rev 272 = $9,094.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE DBM INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,21810.2100,3271.5300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,19629.19,,,,,,,5629.2200,21810.2100,percent of total billed charges,"90% of $21,810.21 in Billed Charges for Rev 272 = $19,629.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE DBM INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,21810.2100,3271.5300,MEDCOST,MEDCOST VHN,10379.48,,,,,,,5629.2200,21810.2100,percent of total billed charges,"47.59% of $21,810.21 in Billed Charges for Rev 272 = $10,379.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE DBM INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,21810.2100,3271.5300,SENTARA HEALTH,SENTARA HEALTH,5629.22,,,,,,,5629.2200,21810.2100,percent of total billed charges,"25.81% of $21,810.21 in Billed Charges for Rev 272 = $5,629.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE DBM INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,21810.2100,3271.5300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",21810.21,,,,,,,5629.2200,21810.2100,percent of total billed charges,"100% of $21,810.21 in Billed Charges for Rev 272 = $21,810.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE DBM INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,21810.2100,3271.5300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,10905.11,,,,,,,5629.2200,21810.2100,percent of total billed charges,"Rev 272 $21,810.21 in Billed Charges at 50% = $10,905.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE DBM INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,21810.2100,3271.5300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7044.70,,,,,,,5629.2200,21810.2100,other,"32.3% of $21,810.21 in Billed Charges for Rev 272 = $7,044.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CARTRIDGE DBM INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,21810.2100,3271.5300,UNITED HEALTHCARE,UHC HERITAGE SELECT,6695.73,,,,,,,5629.2200,21810.2100,other,"30.7% of $21,810.21 in Billed Charges for Rev 272 = $6,695.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CARTRIDGE DBM INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,21810.2100,3271.5300,UNITED HEALTHCARE,UNITED HEALTHCARE,7044.70,,,,,,,5629.2200,21810.2100,percent of total billed charges,"32.3% of $21,810.21 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE DBM INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,21810.2100,3271.5300,WELLCARE,WELLCARE MEDICAID,21810.21,,,,,,,5629.2200,21810.2100,percent of total billed charges,"100% of $21,810.21 in Billed Charges for Rev 272 = $21,810.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE GIA 80MM MED/THICK,272,RC,,,,,,,,both,,,4329.2100,649.3800,AETNA,AETNA,1848.57,,,,,,,1117.3700,4329.2100,percent of total billed charges,"42.7% of $4,329.21 in Billed Charges for Rev 272 = $1,848.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE GIA 80MM MED/THICK,272,RC,,,,,,,,both,,,4329.2100,649.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3030.45,,,,,,,1117.3700,4329.2100,percent of total billed charges,"Rev 272 $4,329.21 in Billed Charges at 70% = $3,030.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE GIA 80MM MED/THICK,272,RC,,,,,,,,both,,,4329.2100,649.3800,CIGNA HEALTHCARE,CIGNA HMO,1805.28,,,,,,,1117.3700,4329.2100,percent of total billed charges,"41.7% of $4,329.21 in Billed Charges for Rev 272 = $1,805.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE GIA 80MM MED/THICK,272,RC,,,,,,,,both,,,4329.2100,649.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2008.75,,,,,,,1117.3700,4329.2100,percent of total billed charges,"46.4% of $4,329.21 in Billed Charges for Rev 272 = $2,008.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE GIA 80MM MED/THICK,272,RC,,,,,,,,both,,,4329.2100,649.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1805.28,,,,,,,1117.3700,4329.2100,percent of total billed charges,"41.7% of $4,329.21 in Billed Charges for Rev 272 = $1,805.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE GIA 80MM MED/THICK,272,RC,,,,,,,,both,,,4329.2100,649.3800,CIGNA HEALTHCARE,CIGNA PPO,1805.28,,,,,,,1117.3700,4329.2100,percent of total billed charges,"41.7% of $4,329.21 in Billed Charges for Rev 272 = $1,805.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE GIA 80MM MED/THICK,272,RC,,,,,,,,both,,,4329.2100,649.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3896.29,,,,,,,1117.3700,4329.2100,percent of total billed charges,"90% of $4,329.21 in Billed Charges for Rev 272 = $3,896.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE GIA 80MM MED/THICK,272,RC,,,,,,,,both,,,4329.2100,649.3800,MEDCOST,MEDCOST VHN,2060.27,,,,,,,1117.3700,4329.2100,percent of total billed charges,"47.59% of $4,329.21 in Billed Charges for Rev 272 = $2,060.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE GIA 80MM MED/THICK,272,RC,,,,,,,,both,,,4329.2100,649.3800,SENTARA HEALTH,SENTARA HEALTH,1117.37,,,,,,,1117.3700,4329.2100,percent of total billed charges,"25.81% of $4,329.21 in Billed Charges for Rev 272 = $1,117.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE GIA 80MM MED/THICK,272,RC,,,,,,,,both,,,4329.2100,649.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4329.21,,,,,,,1117.3700,4329.2100,percent of total billed charges,"100% of $4,329.21 in Billed Charges for Rev 272 = $4,329.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE GIA 80MM MED/THICK,272,RC,,,,,,,,both,,,4329.2100,649.3800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2164.61,,,,,,,1117.3700,4329.2100,percent of total billed charges,"Rev 272 $4,329.21 in Billed Charges at 50% = $2,164.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE GIA 80MM MED/THICK,272,RC,,,,,,,,both,,,4329.2100,649.3800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1398.33,,,,,,,1117.3700,4329.2100,other,"32.3% of $4,329.21 in Billed Charges for Rev 272 = $1,398.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CARTRIDGE GIA 80MM MED/THICK,272,RC,,,,,,,,both,,,4329.2100,649.3800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1329.07,,,,,,,1117.3700,4329.2100,other,"30.7% of $4,329.21 in Billed Charges for Rev 272 = $1,329.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CARTRIDGE GIA 80MM MED/THICK,272,RC,,,,,,,,both,,,4329.2100,649.3800,UNITED HEALTHCARE,UNITED HEALTHCARE,1398.33,,,,,,,1117.3700,4329.2100,percent of total billed charges,"32.3% of $4,329.21 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE GIA 80MM MED/THICK,272,RC,,,,,,,,both,,,4329.2100,649.3800,WELLCARE,WELLCARE MEDICAID,4329.21,,,,,,,1117.3700,4329.2100,percent of total billed charges,"100% of $4,329.21 in Billed Charges for Rev 272 = $4,329.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ULTRASOUND TRANSDUCER 1.6MM DIA PIECEX18 PUNCTURE ATTACHMENT,272,RC,27200002,CDM,,,,,,both,,,150.3700,22.5600,AETNA,AETNA,64.21,,,,,,,38.8100,150.3700,percent of total billed charges,42.7% of $150.37 in Billed Charges for Rev 272 = $64.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE ULTRASOUND TRANSDUCER 1.6MM DIA PIECEX18 PUNCTURE ATTACHMENT,272,RC,27200002,CDM,,,,,,both,,,150.3700,22.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,105.26,,,,,,,38.8100,150.3700,percent of total billed charges,Rev 272 $150.37 in Billed Charges at 70% = $105.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE ULTRASOUND TRANSDUCER 1.6MM DIA PIECEX18 PUNCTURE ATTACHMENT,272,RC,27200002,CDM,,,,,,both,,,150.3700,22.5600,CIGNA HEALTHCARE,CIGNA HMO,62.70,,,,,,,38.8100,150.3700,percent of total billed charges,41.7% of $150.37 in Billed Charges for Rev 272 = $62.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE ULTRASOUND TRANSDUCER 1.6MM DIA PIECEX18 PUNCTURE ATTACHMENT,272,RC,27200002,CDM,,,,,,both,,,150.3700,22.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,69.77,,,,,,,38.8100,150.3700,percent of total billed charges,46.4% of $150.37 in Billed Charges for Rev 272 = $69.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE ULTRASOUND TRANSDUCER 1.6MM DIA PIECEX18 PUNCTURE ATTACHMENT,272,RC,27200002,CDM,,,,,,both,,,150.3700,22.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,62.70,,,,,,,38.8100,150.3700,percent of total billed charges,41.7% of $150.37 in Billed Charges for Rev 272 = $62.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE ULTRASOUND TRANSDUCER 1.6MM DIA PIECEX18 PUNCTURE ATTACHMENT,272,RC,27200002,CDM,,,,,,both,,,150.3700,22.5600,CIGNA HEALTHCARE,CIGNA PPO,62.70,,,,,,,38.8100,150.3700,percent of total billed charges,41.7% of $150.37 in Billed Charges for Rev 272 = $62.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE ULTRASOUND TRANSDUCER 1.6MM DIA PIECEX18 PUNCTURE ATTACHMENT,272,RC,27200002,CDM,,,,,,both,,,150.3700,22.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,135.33,,,,,,,38.8100,150.3700,percent of total billed charges,90% of $150.37 in Billed Charges for Rev 272 = $135.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE ULTRASOUND TRANSDUCER 1.6MM DIA PIECEX18 PUNCTURE ATTACHMENT,272,RC,27200002,CDM,,,,,,both,,,150.3700,22.5600,MEDCOST,MEDCOST VHN,71.56,,,,,,,38.8100,150.3700,percent of total billed charges,47.59% of $150.37 in Billed Charges for Rev 272 = $71.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE ULTRASOUND TRANSDUCER 1.6MM DIA PIECEX18 PUNCTURE ATTACHMENT,272,RC,27200002,CDM,,,,,,both,,,150.3700,22.5600,SENTARA HEALTH,SENTARA HEALTH,38.81,,,,,,,38.8100,150.3700,percent of total billed charges,25.81% of $150.37 in Billed Charges for Rev 272 = $38.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE ULTRASOUND TRANSDUCER 1.6MM DIA PIECEX18 PUNCTURE ATTACHMENT,272,RC,27200002,CDM,,,,,,both,,,150.3700,22.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",150.37,,,,,,,38.8100,150.3700,percent of total billed charges,100% of $150.37 in Billed Charges for Rev 272 = $150.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE ULTRASOUND TRANSDUCER 1.6MM DIA PIECEX18 PUNCTURE ATTACHMENT,272,RC,27200002,CDM,,,,,,both,,,150.3700,22.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,75.19,,,,,,,38.8100,150.3700,percent of total billed charges,Rev 272 $150.37 in Billed Charges at 50% = $75.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE ULTRASOUND TRANSDUCER 1.6MM DIA PIECEX18 PUNCTURE ATTACHMENT,272,RC,27200002,CDM,,,,,,both,,,150.3700,22.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,48.57,,,,,,,38.8100,150.3700,other,32.3% of $150.37 in Billed Charges for Rev 272 = $48.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GUIDE ULTRASOUND TRANSDUCER 1.6MM DIA PIECEX18 PUNCTURE ATTACHMENT,272,RC,27200002,CDM,,,,,,both,,,150.3700,22.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,46.16,,,,,,,38.8100,150.3700,other,30.7% of $150.37 in Billed Charges for Rev 272 = $46.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GUIDE ULTRASOUND TRANSDUCER 1.6MM DIA PIECEX18 PUNCTURE ATTACHMENT,272,RC,27200002,CDM,,,,,,both,,,150.3700,22.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,48.57,,,,,,,38.8100,150.3700,percent of total billed charges,32.3% of $150.37 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE ULTRASOUND TRANSDUCER 1.6MM DIA PIECEX18 PUNCTURE ATTACHMENT,272,RC,27200002,CDM,,,,,,both,,,150.3700,22.5600,WELLCARE,WELLCARE MEDICAID,150.37,,,,,,,38.8100,150.3700,percent of total billed charges,100% of $150.37 in Billed Charges for Rev 272 = $150.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CARTRIDGE INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,7000.4300,1050.0600,AETNA,AETNA,2989.18,,,,,,,1806.8100,7000.4300,percent of total billed charges,"42.7% of $7,000.43 in Billed Charges for Rev 272 = $2,989.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,7000.4300,1050.0600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4900.30,,,,,,,1806.8100,7000.4300,percent of total billed charges,"Rev 272 $7,000.43 in Billed Charges at 70% = $4,900.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,7000.4300,1050.0600,CIGNA HEALTHCARE,CIGNA HMO,2919.18,,,,,,,1806.8100,7000.4300,percent of total billed charges,"41.7% of $7,000.43 in Billed Charges for Rev 272 = $2,919.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,7000.4300,1050.0600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3248.20,,,,,,,1806.8100,7000.4300,percent of total billed charges,"46.4% of $7,000.43 in Billed Charges for Rev 272 = $3,248.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,7000.4300,1050.0600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2919.18,,,,,,,1806.8100,7000.4300,percent of total billed charges,"41.7% of $7,000.43 in Billed Charges for Rev 272 = $2,919.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,7000.4300,1050.0600,CIGNA HEALTHCARE,CIGNA PPO,2919.18,,,,,,,1806.8100,7000.4300,percent of total billed charges,"41.7% of $7,000.43 in Billed Charges for Rev 272 = $2,919.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,7000.4300,1050.0600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6300.39,,,,,,,1806.8100,7000.4300,percent of total billed charges,"90% of $7,000.43 in Billed Charges for Rev 272 = $6,300.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,7000.4300,1050.0600,MEDCOST,MEDCOST VHN,3331.50,,,,,,,1806.8100,7000.4300,percent of total billed charges,"47.59% of $7,000.43 in Billed Charges for Rev 272 = $3,331.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,7000.4300,1050.0600,SENTARA HEALTH,SENTARA HEALTH,1806.81,,,,,,,1806.8100,7000.4300,percent of total billed charges,"25.81% of $7,000.43 in Billed Charges for Rev 272 = $1,806.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,7000.4300,1050.0600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7000.43,,,,,,,1806.8100,7000.4300,percent of total billed charges,"100% of $7,000.43 in Billed Charges for Rev 272 = $7,000.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,7000.4300,1050.0600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3500.22,,,,,,,1806.8100,7000.4300,percent of total billed charges,"Rev 272 $7,000.43 in Billed Charges at 50% = $3,500.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,7000.4300,1050.0600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2261.14,,,,,,,1806.8100,7000.4300,other,"32.3% of $7,000.43 in Billed Charges for Rev 272 = $2,261.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CARTRIDGE INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,7000.4300,1050.0600,UNITED HEALTHCARE,UHC HERITAGE SELECT,2149.13,,,,,,,1806.8100,7000.4300,other,"30.7% of $7,000.43 in Billed Charges for Rev 272 = $2,149.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CARTRIDGE INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,7000.4300,1050.0600,UNITED HEALTHCARE,UNITED HEALTHCARE,2261.14,,,,,,,1806.8100,7000.4300,percent of total billed charges,"32.3% of $7,000.43 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CARTRIDGE INSTAFILL 5CC,272,RC,27200002,CDM,,,,,,both,,,7000.4300,1050.0600,WELLCARE,WELLCARE MEDICAID,7000.43,,,,,,,1806.8100,7000.4300,percent of total billed charges,"100% of $7,000.43 in Billed Charges for Rev 272 = $7,000.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO CENTUR ACT .09,272,RC,27200002,CDM,,,,,,both,,,1085.8400,162.8800,AETNA,AETNA,463.65,,,,,,,280.2600,1085.8400,percent of total billed charges,"42.7% of $1,085.84 in Billed Charges for Rev 272 = $463.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO CENTUR ACT .09,272,RC,27200002,CDM,,,,,,both,,,1085.8400,162.8800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,760.09,,,,,,,280.2600,1085.8400,percent of total billed charges,"Rev 272 $1,085.84 in Billed Charges at 70% = $760.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO CENTUR ACT .09,272,RC,27200002,CDM,,,,,,both,,,1085.8400,162.8800,CIGNA HEALTHCARE,CIGNA HMO,452.80,,,,,,,280.2600,1085.8400,percent of total billed charges,"41.7% of $1,085.84 in Billed Charges for Rev 272 = $452.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO CENTUR ACT .09,272,RC,27200002,CDM,,,,,,both,,,1085.8400,162.8800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,503.83,,,,,,,280.2600,1085.8400,percent of total billed charges,"46.4% of $1,085.84 in Billed Charges for Rev 272 = $503.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO CENTUR ACT .09,272,RC,27200002,CDM,,,,,,both,,,1085.8400,162.8800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,452.80,,,,,,,280.2600,1085.8400,percent of total billed charges,"41.7% of $1,085.84 in Billed Charges for Rev 272 = $452.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO CENTUR ACT .09,272,RC,27200002,CDM,,,,,,both,,,1085.8400,162.8800,CIGNA HEALTHCARE,CIGNA PPO,452.80,,,,,,,280.2600,1085.8400,percent of total billed charges,"41.7% of $1,085.84 in Billed Charges for Rev 272 = $452.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO CENTUR ACT .09,272,RC,27200002,CDM,,,,,,both,,,1085.8400,162.8800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,977.26,,,,,,,280.2600,1085.8400,percent of total billed charges,"90% of $1,085.84 in Billed Charges for Rev 272 = $977.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO CENTUR ACT .09,272,RC,27200002,CDM,,,,,,both,,,1085.8400,162.8800,MEDCOST,MEDCOST VHN,516.75,,,,,,,280.2600,1085.8400,percent of total billed charges,"47.59% of $1,085.84 in Billed Charges for Rev 272 = $516.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO CENTUR ACT .09,272,RC,27200002,CDM,,,,,,both,,,1085.8400,162.8800,SENTARA HEALTH,SENTARA HEALTH,280.26,,,,,,,280.2600,1085.8400,percent of total billed charges,"25.81% of $1,085.84 in Billed Charges for Rev 272 = $280.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO CENTUR ACT .09,272,RC,27200002,CDM,,,,,,both,,,1085.8400,162.8800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1085.84,,,,,,,280.2600,1085.8400,percent of total billed charges,"100% of $1,085.84 in Billed Charges for Rev 272 = $1,085.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO CENTUR ACT .09,272,RC,27200002,CDM,,,,,,both,,,1085.8400,162.8800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,542.92,,,,,,,280.2600,1085.8400,percent of total billed charges,"Rev 272 $1,085.84 in Billed Charges at 50% = $542.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO CENTUR ACT .09,272,RC,27200002,CDM,,,,,,both,,,1085.8400,162.8800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,350.73,,,,,,,280.2600,1085.8400,other,"32.3% of $1,085.84 in Billed Charges for Rev 272 = $350.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CASSETTE PHACO CENTUR ACT .09,272,RC,27200002,CDM,,,,,,both,,,1085.8400,162.8800,UNITED HEALTHCARE,UHC HERITAGE SELECT,333.35,,,,,,,280.2600,1085.8400,other,"30.7% of $1,085.84 in Billed Charges for Rev 272 = $333.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CASSETTE PHACO CENTUR ACT .09,272,RC,27200002,CDM,,,,,,both,,,1085.8400,162.8800,UNITED HEALTHCARE,UNITED HEALTHCARE,350.73,,,,,,,280.2600,1085.8400,percent of total billed charges,"32.3% of $1,085.84 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE PHACO CENTUR ACT .09,272,RC,27200002,CDM,,,,,,both,,,1085.8400,162.8800,WELLCARE,WELLCARE MEDICAID,1085.84,,,,,,,280.2600,1085.8400,percent of total billed charges,"100% of $1,085.84 in Billed Charges for Rev 272 = $1,085.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE ULTRASOUND 8065751723,272,RC,,,,,,,,both,,,3438.9200,515.8400,AETNA,AETNA,1468.42,,,,,,,887.5900,3438.9200,percent of total billed charges,"42.7% of $3,438.92 in Billed Charges for Rev 272 = $1,468.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE ULTRASOUND 8065751723,272,RC,,,,,,,,both,,,3438.9200,515.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2407.24,,,,,,,887.5900,3438.9200,percent of total billed charges,"Rev 272 $3,438.92 in Billed Charges at 70% = $2,407.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE ULTRASOUND 8065751723,272,RC,,,,,,,,both,,,3438.9200,515.8400,CIGNA HEALTHCARE,CIGNA HMO,1434.03,,,,,,,887.5900,3438.9200,percent of total billed charges,"41.7% of $3,438.92 in Billed Charges for Rev 272 = $1,434.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE ULTRASOUND 8065751723,272,RC,,,,,,,,both,,,3438.9200,515.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1595.66,,,,,,,887.5900,3438.9200,percent of total billed charges,"46.4% of $3,438.92 in Billed Charges for Rev 272 = $1,595.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE ULTRASOUND 8065751723,272,RC,,,,,,,,both,,,3438.9200,515.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1434.03,,,,,,,887.5900,3438.9200,percent of total billed charges,"41.7% of $3,438.92 in Billed Charges for Rev 272 = $1,434.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE ULTRASOUND 8065751723,272,RC,,,,,,,,both,,,3438.9200,515.8400,CIGNA HEALTHCARE,CIGNA PPO,1434.03,,,,,,,887.5900,3438.9200,percent of total billed charges,"41.7% of $3,438.92 in Billed Charges for Rev 272 = $1,434.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE ULTRASOUND 8065751723,272,RC,,,,,,,,both,,,3438.9200,515.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3095.03,,,,,,,887.5900,3438.9200,percent of total billed charges,"90% of $3,438.92 in Billed Charges for Rev 272 = $3,095.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE ULTRASOUND 8065751723,272,RC,,,,,,,,both,,,3438.9200,515.8400,MEDCOST,MEDCOST VHN,1636.58,,,,,,,887.5900,3438.9200,percent of total billed charges,"47.59% of $3,438.92 in Billed Charges for Rev 272 = $1,636.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE ULTRASOUND 8065751723,272,RC,,,,,,,,both,,,3438.9200,515.8400,SENTARA HEALTH,SENTARA HEALTH,887.59,,,,,,,887.5900,3438.9200,percent of total billed charges,"25.81% of $3,438.92 in Billed Charges for Rev 272 = $887.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE ULTRASOUND 8065751723,272,RC,,,,,,,,both,,,3438.9200,515.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3438.92,,,,,,,887.5900,3438.9200,percent of total billed charges,"100% of $3,438.92 in Billed Charges for Rev 272 = $3,438.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE ULTRASOUND 8065751723,272,RC,,,,,,,,both,,,3438.9200,515.8400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1719.46,,,,,,,887.5900,3438.9200,percent of total billed charges,"Rev 272 $3,438.92 in Billed Charges at 50% = $1,719.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE ULTRASOUND 8065751723,272,RC,,,,,,,,both,,,3438.9200,515.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1110.77,,,,,,,887.5900,3438.9200,other,"32.3% of $3,438.92 in Billed Charges for Rev 272 = $1,110.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CASSETTE ULTRASOUND 8065751723,272,RC,,,,,,,,both,,,3438.9200,515.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.75,,,,,,,887.5900,3438.9200,other,"30.7% of $3,438.92 in Billed Charges for Rev 272 = $1,055.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CASSETTE ULTRASOUND 8065751723,272,RC,,,,,,,,both,,,3438.9200,515.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,1110.77,,,,,,,887.5900,3438.9200,percent of total billed charges,"32.3% of $3,438.92 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CASSETTE ULTRASOUND 8065751723,272,RC,,,,,,,,both,,,3438.9200,515.8400,WELLCARE,WELLCARE MEDICAID,3438.92,,,,,,,887.5900,3438.9200,percent of total billed charges,"100% of $3,438.92 in Billed Charges for Rev 272 = $3,438.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDEWIRE RETRIEVE,272,RC,27200002,CDM,,,,,,both,,,964.5000,144.6800,AETNA,AETNA,411.84,,,,,,,248.9400,964.5000,percent of total billed charges,42.7% of $964.50 in Billed Charges for Rev 272 = $411.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDEWIRE RETRIEVE,272,RC,27200002,CDM,,,,,,both,,,964.5000,144.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,675.15,,,,,,,248.9400,964.5000,percent of total billed charges,Rev 272 $964.50 in Billed Charges at 70% = $675.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDEWIRE RETRIEVE,272,RC,27200002,CDM,,,,,,both,,,964.5000,144.6800,CIGNA HEALTHCARE,CIGNA HMO,402.20,,,,,,,248.9400,964.5000,percent of total billed charges,41.7% of $964.50 in Billed Charges for Rev 272 = $402.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDEWIRE RETRIEVE,272,RC,27200002,CDM,,,,,,both,,,964.5000,144.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,447.53,,,,,,,248.9400,964.5000,percent of total billed charges,46.4% of $964.50 in Billed Charges for Rev 272 = $447.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDEWIRE RETRIEVE,272,RC,27200002,CDM,,,,,,both,,,964.5000,144.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,402.20,,,,,,,248.9400,964.5000,percent of total billed charges,41.7% of $964.50 in Billed Charges for Rev 272 = $402.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDEWIRE RETRIEVE,272,RC,27200002,CDM,,,,,,both,,,964.5000,144.6800,CIGNA HEALTHCARE,CIGNA PPO,402.20,,,,,,,248.9400,964.5000,percent of total billed charges,41.7% of $964.50 in Billed Charges for Rev 272 = $402.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDEWIRE RETRIEVE,272,RC,27200002,CDM,,,,,,both,,,964.5000,144.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,868.05,,,,,,,248.9400,964.5000,percent of total billed charges,90% of $964.50 in Billed Charges for Rev 272 = $868.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDEWIRE RETRIEVE,272,RC,27200002,CDM,,,,,,both,,,964.5000,144.6800,MEDCOST,MEDCOST VHN,459.01,,,,,,,248.9400,964.5000,percent of total billed charges,47.59% of $964.50 in Billed Charges for Rev 272 = $459.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDEWIRE RETRIEVE,272,RC,27200002,CDM,,,,,,both,,,964.5000,144.6800,SENTARA HEALTH,SENTARA HEALTH,248.94,,,,,,,248.9400,964.5000,percent of total billed charges,25.81% of $964.50 in Billed Charges for Rev 272 = $248.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDEWIRE RETRIEVE,272,RC,27200002,CDM,,,,,,both,,,964.5000,144.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",964.50,,,,,,,248.9400,964.5000,percent of total billed charges,100% of $964.50 in Billed Charges for Rev 272 = $964.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDEWIRE RETRIEVE,272,RC,27200002,CDM,,,,,,both,,,964.5000,144.6800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,482.25,,,,,,,248.9400,964.5000,percent of total billed charges,Rev 272 $964.50 in Billed Charges at 50% = $482.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDEWIRE RETRIEVE,272,RC,27200002,CDM,,,,,,both,,,964.5000,144.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,311.53,,,,,,,248.9400,964.5000,other,32.3% of $964.50 in Billed Charges for Rev 272 = $311.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GUIDEWIRE RETRIEVE,272,RC,27200002,CDM,,,,,,both,,,964.5000,144.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,296.10,,,,,,,248.9400,964.5000,other,30.7% of $964.50 in Billed Charges for Rev 272 = $296.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GUIDEWIRE RETRIEVE,272,RC,27200002,CDM,,,,,,both,,,964.5000,144.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,311.53,,,,,,,248.9400,964.5000,percent of total billed charges,32.3% of $964.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDEWIRE RETRIEVE,272,RC,27200002,CDM,,,,,,both,,,964.5000,144.6800,WELLCARE,WELLCARE MEDICAID,964.50,,,,,,,248.9400,964.5000,percent of total billed charges,100% of $964.50 in Billed Charges for Rev 272 = $964.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HAND DRILL 11G,272,RC,27200002,CDM,,,,,,both,,,3551.8100,532.7700,AETNA,AETNA,1516.62,,,,,,,916.7200,3551.8100,percent of total billed charges,"42.7% of $3,551.81 in Billed Charges for Rev 272 = $1,516.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HAND DRILL 11G,272,RC,27200002,CDM,,,,,,both,,,3551.8100,532.7700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2486.27,,,,,,,916.7200,3551.8100,percent of total billed charges,"Rev 272 $3,551.81 in Billed Charges at 70% = $2,486.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HAND DRILL 11G,272,RC,27200002,CDM,,,,,,both,,,3551.8100,532.7700,CIGNA HEALTHCARE,CIGNA HMO,1481.10,,,,,,,916.7200,3551.8100,percent of total billed charges,"41.7% of $3,551.81 in Billed Charges for Rev 272 = $1,481.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HAND DRILL 11G,272,RC,27200002,CDM,,,,,,both,,,3551.8100,532.7700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1648.04,,,,,,,916.7200,3551.8100,percent of total billed charges,"46.4% of $3,551.81 in Billed Charges for Rev 272 = $1,648.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HAND DRILL 11G,272,RC,27200002,CDM,,,,,,both,,,3551.8100,532.7700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1481.10,,,,,,,916.7200,3551.8100,percent of total billed charges,"41.7% of $3,551.81 in Billed Charges for Rev 272 = $1,481.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HAND DRILL 11G,272,RC,27200002,CDM,,,,,,both,,,3551.8100,532.7700,CIGNA HEALTHCARE,CIGNA PPO,1481.10,,,,,,,916.7200,3551.8100,percent of total billed charges,"41.7% of $3,551.81 in Billed Charges for Rev 272 = $1,481.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HAND DRILL 11G,272,RC,27200002,CDM,,,,,,both,,,3551.8100,532.7700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3196.63,,,,,,,916.7200,3551.8100,percent of total billed charges,"90% of $3,551.81 in Billed Charges for Rev 272 = $3,196.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HAND DRILL 11G,272,RC,27200002,CDM,,,,,,both,,,3551.8100,532.7700,MEDCOST,MEDCOST VHN,1690.31,,,,,,,916.7200,3551.8100,percent of total billed charges,"47.59% of $3,551.81 in Billed Charges for Rev 272 = $1,690.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HAND DRILL 11G,272,RC,27200002,CDM,,,,,,both,,,3551.8100,532.7700,SENTARA HEALTH,SENTARA HEALTH,916.72,,,,,,,916.7200,3551.8100,percent of total billed charges,"25.81% of $3,551.81 in Billed Charges for Rev 272 = $916.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HAND DRILL 11G,272,RC,27200002,CDM,,,,,,both,,,3551.8100,532.7700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3551.81,,,,,,,916.7200,3551.8100,percent of total billed charges,"100% of $3,551.81 in Billed Charges for Rev 272 = $3,551.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HAND DRILL 11G,272,RC,27200002,CDM,,,,,,both,,,3551.8100,532.7700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1775.91,,,,,,,916.7200,3551.8100,percent of total billed charges,"Rev 272 $3,551.81 in Billed Charges at 50% = $1,775.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HAND DRILL 11G,272,RC,27200002,CDM,,,,,,both,,,3551.8100,532.7700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1147.23,,,,,,,916.7200,3551.8100,other,"32.3% of $3,551.81 in Billed Charges for Rev 272 = $1,147.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HAND DRILL 11G,272,RC,27200002,CDM,,,,,,both,,,3551.8100,532.7700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1090.41,,,,,,,916.7200,3551.8100,other,"30.7% of $3,551.81 in Billed Charges for Rev 272 = $1,090.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HAND DRILL 11G,272,RC,27200002,CDM,,,,,,both,,,3551.8100,532.7700,UNITED HEALTHCARE,UNITED HEALTHCARE,1147.23,,,,,,,916.7200,3551.8100,percent of total billed charges,"32.3% of $3,551.81 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HAND DRILL 11G,272,RC,27200002,CDM,,,,,,both,,,3551.8100,532.7700,WELLCARE,WELLCARE MEDICAID,3551.81,,,,,,,916.7200,3551.8100,percent of total billed charges,"100% of $3,551.81 in Billed Charges for Rev 272 = $3,551.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DOPPLER INTRAOPERATIVE D900-P-USA,272,RC,,,,,,,,both,,,4673.4800,701.0200,AETNA,AETNA,1995.58,,,,,,,1206.2300,4673.4800,percent of total billed charges,"42.7% of $4,673.48 in Billed Charges for Rev 272 = $1,995.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DOPPLER INTRAOPERATIVE D900-P-USA,272,RC,,,,,,,,both,,,4673.4800,701.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3271.44,,,,,,,1206.2300,4673.4800,percent of total billed charges,"Rev 272 $4,673.48 in Billed Charges at 70% = $3,271.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DOPPLER INTRAOPERATIVE D900-P-USA,272,RC,,,,,,,,both,,,4673.4800,701.0200,CIGNA HEALTHCARE,CIGNA HMO,1948.84,,,,,,,1206.2300,4673.4800,percent of total billed charges,"41.7% of $4,673.48 in Billed Charges for Rev 272 = $1,948.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DOPPLER INTRAOPERATIVE D900-P-USA,272,RC,,,,,,,,both,,,4673.4800,701.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2168.49,,,,,,,1206.2300,4673.4800,percent of total billed charges,"46.4% of $4,673.48 in Billed Charges for Rev 272 = $2,168.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DOPPLER INTRAOPERATIVE D900-P-USA,272,RC,,,,,,,,both,,,4673.4800,701.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1948.84,,,,,,,1206.2300,4673.4800,percent of total billed charges,"41.7% of $4,673.48 in Billed Charges for Rev 272 = $1,948.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DOPPLER INTRAOPERATIVE D900-P-USA,272,RC,,,,,,,,both,,,4673.4800,701.0200,CIGNA HEALTHCARE,CIGNA PPO,1948.84,,,,,,,1206.2300,4673.4800,percent of total billed charges,"41.7% of $4,673.48 in Billed Charges for Rev 272 = $1,948.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DOPPLER INTRAOPERATIVE D900-P-USA,272,RC,,,,,,,,both,,,4673.4800,701.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4206.13,,,,,,,1206.2300,4673.4800,percent of total billed charges,"90% of $4,673.48 in Billed Charges for Rev 272 = $4,206.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DOPPLER INTRAOPERATIVE D900-P-USA,272,RC,,,,,,,,both,,,4673.4800,701.0200,MEDCOST,MEDCOST VHN,2224.11,,,,,,,1206.2300,4673.4800,percent of total billed charges,"47.59% of $4,673.48 in Billed Charges for Rev 272 = $2,224.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DOPPLER INTRAOPERATIVE D900-P-USA,272,RC,,,,,,,,both,,,4673.4800,701.0200,SENTARA HEALTH,SENTARA HEALTH,1206.23,,,,,,,1206.2300,4673.4800,percent of total billed charges,"25.81% of $4,673.48 in Billed Charges for Rev 272 = $1,206.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DOPPLER INTRAOPERATIVE D900-P-USA,272,RC,,,,,,,,both,,,4673.4800,701.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4673.48,,,,,,,1206.2300,4673.4800,percent of total billed charges,"100% of $4,673.48 in Billed Charges for Rev 272 = $4,673.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DOPPLER INTRAOPERATIVE D900-P-USA,272,RC,,,,,,,,both,,,4673.4800,701.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2336.74,,,,,,,1206.2300,4673.4800,percent of total billed charges,"Rev 272 $4,673.48 in Billed Charges at 50% = $2,336.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DOPPLER INTRAOPERATIVE D900-P-USA,272,RC,,,,,,,,both,,,4673.4800,701.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1509.53,,,,,,,1206.2300,4673.4800,other,"32.3% of $4,673.48 in Billed Charges for Rev 272 = $1,509.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HANDLE DOPPLER INTRAOPERATIVE D900-P-USA,272,RC,,,,,,,,both,,,4673.4800,701.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1434.76,,,,,,,1206.2300,4673.4800,other,"30.7% of $4,673.48 in Billed Charges for Rev 272 = $1,434.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HANDLE DOPPLER INTRAOPERATIVE D900-P-USA,272,RC,,,,,,,,both,,,4673.4800,701.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,1509.53,,,,,,,1206.2300,4673.4800,percent of total billed charges,"32.3% of $4,673.48 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DOPPLER INTRAOPERATIVE D900-P-USA,272,RC,,,,,,,,both,,,4673.4800,701.0200,WELLCARE,WELLCARE MEDICAID,4673.48,,,,,,,1206.2300,4673.4800,percent of total billed charges,"100% of $4,673.48 in Billed Charges for Rev 272 = $4,673.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE SHARPSHOOTER 4700,272,RC,,,,,,,,both,,,4664.0500,699.6100,AETNA,AETNA,1991.55,,,,,,,1203.7900,4664.0500,percent of total billed charges,"42.7% of $4,664.05 in Billed Charges for Rev 272 = $1,991.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE SHARPSHOOTER 4700,272,RC,,,,,,,,both,,,4664.0500,699.6100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3264.84,,,,,,,1203.7900,4664.0500,percent of total billed charges,"Rev 272 $4,664.05 in Billed Charges at 70% = $3,264.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE SHARPSHOOTER 4700,272,RC,,,,,,,,both,,,4664.0500,699.6100,CIGNA HEALTHCARE,CIGNA HMO,1944.91,,,,,,,1203.7900,4664.0500,percent of total billed charges,"41.7% of $4,664.05 in Billed Charges for Rev 272 = $1,944.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE SHARPSHOOTER 4700,272,RC,,,,,,,,both,,,4664.0500,699.6100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2164.12,,,,,,,1203.7900,4664.0500,percent of total billed charges,"46.4% of $4,664.05 in Billed Charges for Rev 272 = $2,164.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE SHARPSHOOTER 4700,272,RC,,,,,,,,both,,,4664.0500,699.6100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1944.91,,,,,,,1203.7900,4664.0500,percent of total billed charges,"41.7% of $4,664.05 in Billed Charges for Rev 272 = $1,944.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE SHARPSHOOTER 4700,272,RC,,,,,,,,both,,,4664.0500,699.6100,CIGNA HEALTHCARE,CIGNA PPO,1944.91,,,,,,,1203.7900,4664.0500,percent of total billed charges,"41.7% of $4,664.05 in Billed Charges for Rev 272 = $1,944.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE SHARPSHOOTER 4700,272,RC,,,,,,,,both,,,4664.0500,699.6100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4197.65,,,,,,,1203.7900,4664.0500,percent of total billed charges,"90% of $4,664.05 in Billed Charges for Rev 272 = $4,197.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE SHARPSHOOTER 4700,272,RC,,,,,,,,both,,,4664.0500,699.6100,MEDCOST,MEDCOST VHN,2219.62,,,,,,,1203.7900,4664.0500,percent of total billed charges,"47.59% of $4,664.05 in Billed Charges for Rev 272 = $2,219.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE SHARPSHOOTER 4700,272,RC,,,,,,,,both,,,4664.0500,699.6100,SENTARA HEALTH,SENTARA HEALTH,1203.79,,,,,,,1203.7900,4664.0500,percent of total billed charges,"25.81% of $4,664.05 in Billed Charges for Rev 272 = $1,203.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE SHARPSHOOTER 4700,272,RC,,,,,,,,both,,,4664.0500,699.6100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4664.05,,,,,,,1203.7900,4664.0500,percent of total billed charges,"100% of $4,664.05 in Billed Charges for Rev 272 = $4,664.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE SHARPSHOOTER 4700,272,RC,,,,,,,,both,,,4664.0500,699.6100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2332.03,,,,,,,1203.7900,4664.0500,percent of total billed charges,"Rev 272 $4,664.05 in Billed Charges at 50% = $2,332.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE SHARPSHOOTER 4700,272,RC,,,,,,,,both,,,4664.0500,699.6100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1506.49,,,,,,,1203.7900,4664.0500,other,"32.3% of $4,664.05 in Billed Charges for Rev 272 = $1,506.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HANDLE SHARPSHOOTER 4700,272,RC,,,,,,,,both,,,4664.0500,699.6100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1431.86,,,,,,,1203.7900,4664.0500,other,"30.7% of $4,664.05 in Billed Charges for Rev 272 = $1,431.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HANDLE SHARPSHOOTER 4700,272,RC,,,,,,,,both,,,4664.0500,699.6100,UNITED HEALTHCARE,UNITED HEALTHCARE,1506.49,,,,,,,1203.7900,4664.0500,percent of total billed charges,"32.3% of $4,664.05 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE SHARPSHOOTER 4700,272,RC,,,,,,,,both,,,4664.0500,699.6100,WELLCARE,WELLCARE MEDICAID,4664.05,,,,,,,1203.7900,4664.0500,percent of total billed charges,"100% of $4,664.05 in Billed Charges for Rev 272 = $4,664.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,,,,,,,,both,,,10652.8800,1597.9300,AETNA,AETNA,4548.78,,,,,,,2749.5100,10652.8800,percent of total billed charges,"42.7% of $10,652.88 in Billed Charges for Rev 272 = $4,548.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,,,,,,,,both,,,10652.8800,1597.9300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7457.02,,,,,,,2749.5100,10652.8800,percent of total billed charges,"Rev 272 $10,652.88 in Billed Charges at 70% = $7,457.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,,,,,,,,both,,,10652.8800,1597.9300,CIGNA HEALTHCARE,CIGNA HMO,4442.25,,,,,,,2749.5100,10652.8800,percent of total billed charges,"41.7% of $10,652.88 in Billed Charges for Rev 272 = $4,442.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,,,,,,,,both,,,10652.8800,1597.9300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4942.94,,,,,,,2749.5100,10652.8800,percent of total billed charges,"46.4% of $10,652.88 in Billed Charges for Rev 272 = $4,942.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,,,,,,,,both,,,10652.8800,1597.9300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4442.25,,,,,,,2749.5100,10652.8800,percent of total billed charges,"41.7% of $10,652.88 in Billed Charges for Rev 272 = $4,442.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,,,,,,,,both,,,10652.8800,1597.9300,CIGNA HEALTHCARE,CIGNA PPO,4442.25,,,,,,,2749.5100,10652.8800,percent of total billed charges,"41.7% of $10,652.88 in Billed Charges for Rev 272 = $4,442.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,,,,,,,,both,,,10652.8800,1597.9300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9587.59,,,,,,,2749.5100,10652.8800,percent of total billed charges,"90% of $10,652.88 in Billed Charges for Rev 272 = $9,587.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,,,,,,,,both,,,10652.8800,1597.9300,MEDCOST,MEDCOST VHN,5069.71,,,,,,,2749.5100,10652.8800,percent of total billed charges,"47.59% of $10,652.88 in Billed Charges for Rev 272 = $5,069.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,,,,,,,,both,,,10652.8800,1597.9300,SENTARA HEALTH,SENTARA HEALTH,2749.51,,,,,,,2749.5100,10652.8800,percent of total billed charges,"25.81% of $10,652.88 in Billed Charges for Rev 272 = $2,749.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,,,,,,,,both,,,10652.8800,1597.9300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10652.88,,,,,,,2749.5100,10652.8800,percent of total billed charges,"100% of $10,652.88 in Billed Charges for Rev 272 = $10,652.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,,,,,,,,both,,,10652.8800,1597.9300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5326.44,,,,,,,2749.5100,10652.8800,percent of total billed charges,"Rev 272 $10,652.88 in Billed Charges at 50% = $5,326.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,,,,,,,,both,,,10652.8800,1597.9300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3440.88,,,,,,,2749.5100,10652.8800,other,"32.3% of $10,652.88 in Billed Charges for Rev 272 = $3,440.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAW MICRO 12CM SONOPET,272,RC,,,,,,,,both,,,10652.8800,1597.9300,UNITED HEALTHCARE,UHC HERITAGE SELECT,3270.43,,,,,,,2749.5100,10652.8800,other,"30.7% of $10,652.88 in Billed Charges for Rev 272 = $3,270.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAW MICRO 12CM SONOPET,272,RC,,,,,,,,both,,,10652.8800,1597.9300,UNITED HEALTHCARE,UNITED HEALTHCARE,3440.88,,,,,,,2749.5100,10652.8800,percent of total billed charges,"32.3% of $10,652.88 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,,,,,,,,both,,,10652.8800,1597.9300,WELLCARE,WELLCARE MEDICAID,10652.88,,,,,,,2749.5100,10652.8800,percent of total billed charges,"100% of $10,652.88 in Billed Charges for Rev 272 = $10,652.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,27200002,CDM,,,,,,both,,,10652.9100,1597.9400,AETNA,AETNA,4548.79,,,,,,,2749.5200,10652.9100,percent of total billed charges,"42.7% of $10,652.91 in Billed Charges for Rev 272 = $4,548.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,27200002,CDM,,,,,,both,,,10652.9100,1597.9400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7457.04,,,,,,,2749.5200,10652.9100,percent of total billed charges,"Rev 272 $10,652.91 in Billed Charges at 70% = $7,457.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,27200002,CDM,,,,,,both,,,10652.9100,1597.9400,CIGNA HEALTHCARE,CIGNA HMO,4442.26,,,,,,,2749.5200,10652.9100,percent of total billed charges,"41.7% of $10,652.91 in Billed Charges for Rev 272 = $4,442.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,27200002,CDM,,,,,,both,,,10652.9100,1597.9400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4942.95,,,,,,,2749.5200,10652.9100,percent of total billed charges,"46.4% of $10,652.91 in Billed Charges for Rev 272 = $4,942.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,27200002,CDM,,,,,,both,,,10652.9100,1597.9400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4442.26,,,,,,,2749.5200,10652.9100,percent of total billed charges,"41.7% of $10,652.91 in Billed Charges for Rev 272 = $4,442.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,27200002,CDM,,,,,,both,,,10652.9100,1597.9400,CIGNA HEALTHCARE,CIGNA PPO,4442.26,,,,,,,2749.5200,10652.9100,percent of total billed charges,"41.7% of $10,652.91 in Billed Charges for Rev 272 = $4,442.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,27200002,CDM,,,,,,both,,,10652.9100,1597.9400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9587.62,,,,,,,2749.5200,10652.9100,percent of total billed charges,"90% of $10,652.91 in Billed Charges for Rev 272 = $9,587.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,27200002,CDM,,,,,,both,,,10652.9100,1597.9400,MEDCOST,MEDCOST VHN,5069.72,,,,,,,2749.5200,10652.9100,percent of total billed charges,"47.59% of $10,652.91 in Billed Charges for Rev 272 = $5,069.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,27200002,CDM,,,,,,both,,,10652.9100,1597.9400,SENTARA HEALTH,SENTARA HEALTH,2749.52,,,,,,,2749.5200,10652.9100,percent of total billed charges,"25.81% of $10,652.91 in Billed Charges for Rev 272 = $2,749.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,27200002,CDM,,,,,,both,,,10652.9100,1597.9400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10652.91,,,,,,,2749.5200,10652.9100,percent of total billed charges,"100% of $10,652.91 in Billed Charges for Rev 272 = $10,652.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,27200002,CDM,,,,,,both,,,10652.9100,1597.9400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5326.46,,,,,,,2749.5200,10652.9100,percent of total billed charges,"Rev 272 $10,652.91 in Billed Charges at 50% = $5,326.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,27200002,CDM,,,,,,both,,,10652.9100,1597.9400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3440.89,,,,,,,2749.5200,10652.9100,other,"32.3% of $10,652.91 in Billed Charges for Rev 272 = $3,440.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAW MICRO 12CM SONOPET,272,RC,27200002,CDM,,,,,,both,,,10652.9100,1597.9400,UNITED HEALTHCARE,UHC HERITAGE SELECT,3270.44,,,,,,,2749.5200,10652.9100,other,"30.7% of $10,652.91 in Billed Charges for Rev 272 = $3,270.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAW MICRO 12CM SONOPET,272,RC,27200002,CDM,,,,,,both,,,10652.9100,1597.9400,UNITED HEALTHCARE,UNITED HEALTHCARE,3440.89,,,,,,,2749.5200,10652.9100,percent of total billed charges,"32.3% of $10,652.91 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAW MICRO 12CM SONOPET,272,RC,27200002,CDM,,,,,,both,,,10652.9100,1597.9400,WELLCARE,WELLCARE MEDICAID,10652.91,,,,,,,2749.5200,10652.9100,percent of total billed charges,"100% of $10,652.91 in Billed Charges for Rev 272 = $10,652.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER 11 IN,272,RC,27200002,CDM,,,,,,both,,,445.7500,66.8600,AETNA,AETNA,190.34,,,,,,,115.0500,445.7500,percent of total billed charges,42.7% of $445.75 in Billed Charges for Rev 272 = $190.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP APPLIER 11 IN,272,RC,27200002,CDM,,,,,,both,,,445.7500,66.8600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,312.03,,,,,,,115.0500,445.7500,percent of total billed charges,Rev 272 $445.75 in Billed Charges at 70% = $312.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP APPLIER 11 IN,272,RC,27200002,CDM,,,,,,both,,,445.7500,66.8600,CIGNA HEALTHCARE,CIGNA HMO,185.88,,,,,,,115.0500,445.7500,percent of total billed charges,41.7% of $445.75 in Billed Charges for Rev 272 = $185.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP APPLIER 11 IN,272,RC,27200002,CDM,,,,,,both,,,445.7500,66.8600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,206.83,,,,,,,115.0500,445.7500,percent of total billed charges,46.4% of $445.75 in Billed Charges for Rev 272 = $206.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP APPLIER 11 IN,272,RC,27200002,CDM,,,,,,both,,,445.7500,66.8600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,185.88,,,,,,,115.0500,445.7500,percent of total billed charges,41.7% of $445.75 in Billed Charges for Rev 272 = $185.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP APPLIER 11 IN,272,RC,27200002,CDM,,,,,,both,,,445.7500,66.8600,CIGNA HEALTHCARE,CIGNA PPO,185.88,,,,,,,115.0500,445.7500,percent of total billed charges,41.7% of $445.75 in Billed Charges for Rev 272 = $185.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP APPLIER 11 IN,272,RC,27200002,CDM,,,,,,both,,,445.7500,66.8600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,401.18,,,,,,,115.0500,445.7500,percent of total billed charges,90% of $445.75 in Billed Charges for Rev 272 = $401.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP APPLIER 11 IN,272,RC,27200002,CDM,,,,,,both,,,445.7500,66.8600,MEDCOST,MEDCOST VHN,212.13,,,,,,,115.0500,445.7500,percent of total billed charges,47.59% of $445.75 in Billed Charges for Rev 272 = $212.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP APPLIER 11 IN,272,RC,27200002,CDM,,,,,,both,,,445.7500,66.8600,SENTARA HEALTH,SENTARA HEALTH,115.05,,,,,,,115.0500,445.7500,percent of total billed charges,25.81% of $445.75 in Billed Charges for Rev 272 = $115.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP APPLIER 11 IN,272,RC,27200002,CDM,,,,,,both,,,445.7500,66.8600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",445.75,,,,,,,115.0500,445.7500,percent of total billed charges,100% of $445.75 in Billed Charges for Rev 272 = $445.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP APPLIER 11 IN,272,RC,27200002,CDM,,,,,,both,,,445.7500,66.8600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,222.88,,,,,,,115.0500,445.7500,percent of total billed charges,Rev 272 $445.75 in Billed Charges at 50% = $222.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP APPLIER 11 IN,272,RC,27200002,CDM,,,,,,both,,,445.7500,66.8600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,143.98,,,,,,,115.0500,445.7500,other,32.3% of $445.75 in Billed Charges for Rev 272 = $143.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CLIP APPLIER 11 IN,272,RC,27200002,CDM,,,,,,both,,,445.7500,66.8600,UNITED HEALTHCARE,UHC HERITAGE SELECT,136.85,,,,,,,115.0500,445.7500,other,30.7% of $445.75 in Billed Charges for Rev 272 = $136.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CLIP APPLIER 11 IN,272,RC,27200002,CDM,,,,,,both,,,445.7500,66.8600,UNITED HEALTHCARE,UNITED HEALTHCARE,143.98,,,,,,,115.0500,445.7500,percent of total billed charges,32.3% of $445.75 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP APPLIER 11 IN,272,RC,27200002,CDM,,,,,,both,,,445.7500,66.8600,WELLCARE,WELLCARE MEDICAID,445.75,,,,,,,115.0500,445.7500,percent of total billed charges,100% of $445.75 in Billed Charges for Rev 272 = $445.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,4261.1300,639.1700,AETNA,AETNA,1819.50,,,,,,,1099.8000,4261.1300,percent of total billed charges,"42.7% of $4,261.13 in Billed Charges for Rev 272 = $1,819.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,4261.1300,639.1700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2982.79,,,,,,,1099.8000,4261.1300,percent of total billed charges,"Rev 272 $4,261.13 in Billed Charges at 70% = $2,982.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,4261.1300,639.1700,CIGNA HEALTHCARE,CIGNA HMO,1776.89,,,,,,,1099.8000,4261.1300,percent of total billed charges,"41.7% of $4,261.13 in Billed Charges for Rev 272 = $1,776.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,4261.1300,639.1700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1977.16,,,,,,,1099.8000,4261.1300,percent of total billed charges,"46.4% of $4,261.13 in Billed Charges for Rev 272 = $1,977.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,4261.1300,639.1700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1776.89,,,,,,,1099.8000,4261.1300,percent of total billed charges,"41.7% of $4,261.13 in Billed Charges for Rev 272 = $1,776.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,4261.1300,639.1700,CIGNA HEALTHCARE,CIGNA PPO,1776.89,,,,,,,1099.8000,4261.1300,percent of total billed charges,"41.7% of $4,261.13 in Billed Charges for Rev 272 = $1,776.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,4261.1300,639.1700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3835.02,,,,,,,1099.8000,4261.1300,percent of total billed charges,"90% of $4,261.13 in Billed Charges for Rev 272 = $3,835.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,4261.1300,639.1700,MEDCOST,MEDCOST VHN,2027.87,,,,,,,1099.8000,4261.1300,percent of total billed charges,"47.59% of $4,261.13 in Billed Charges for Rev 272 = $2,027.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,4261.1300,639.1700,SENTARA HEALTH,SENTARA HEALTH,1099.80,,,,,,,1099.8000,4261.1300,percent of total billed charges,"25.81% of $4,261.13 in Billed Charges for Rev 272 = $1,099.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,4261.1300,639.1700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4261.13,,,,,,,1099.8000,4261.1300,percent of total billed charges,"100% of $4,261.13 in Billed Charges for Rev 272 = $4,261.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,4261.1300,639.1700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2130.57,,,,,,,1099.8000,4261.1300,percent of total billed charges,"Rev 272 $4,261.13 in Billed Charges at 50% = $2,130.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,4261.1300,639.1700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1376.35,,,,,,,1099.8000,4261.1300,other,"32.3% of $4,261.13 in Billed Charges for Rev 272 = $1,376.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,4261.1300,639.1700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1308.17,,,,,,,1099.8000,4261.1300,other,"30.7% of $4,261.13 in Billed Charges for Rev 272 = $1,308.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,4261.1300,639.1700,UNITED HEALTHCARE,UNITED HEALTHCARE,1376.35,,,,,,,1099.8000,4261.1300,percent of total billed charges,"32.3% of $4,261.13 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP APPLIER III 5MM SURPASS SEE LN 148127,272,RC,27200002,CDM,,,,,,both,,,4261.1300,639.1700,WELLCARE,WELLCARE MEDICAID,4261.13,,,,,,,1099.8000,4261.1300,percent of total billed charges,"100% of $4,261.13 in Billed Charges for Rev 272 = $4,261.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE WITH MINI QUICK COUPLING 311.01,272,RC,,,,,,,,both,,,3400.4400,510.0700,AETNA,AETNA,1451.99,,,,,,,877.6500,3400.4400,percent of total billed charges,"42.7% of $3,400.44 in Billed Charges for Rev 272 = $1,451.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE WITH MINI QUICK COUPLING 311.01,272,RC,,,,,,,,both,,,3400.4400,510.0700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2380.31,,,,,,,877.6500,3400.4400,percent of total billed charges,"Rev 272 $3,400.44 in Billed Charges at 70% = $2,380.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE WITH MINI QUICK COUPLING 311.01,272,RC,,,,,,,,both,,,3400.4400,510.0700,CIGNA HEALTHCARE,CIGNA HMO,1417.98,,,,,,,877.6500,3400.4400,percent of total billed charges,"41.7% of $3,400.44 in Billed Charges for Rev 272 = $1,417.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE WITH MINI QUICK COUPLING 311.01,272,RC,,,,,,,,both,,,3400.4400,510.0700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1577.80,,,,,,,877.6500,3400.4400,percent of total billed charges,"46.4% of $3,400.44 in Billed Charges for Rev 272 = $1,577.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE WITH MINI QUICK COUPLING 311.01,272,RC,,,,,,,,both,,,3400.4400,510.0700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1417.98,,,,,,,877.6500,3400.4400,percent of total billed charges,"41.7% of $3,400.44 in Billed Charges for Rev 272 = $1,417.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE WITH MINI QUICK COUPLING 311.01,272,RC,,,,,,,,both,,,3400.4400,510.0700,CIGNA HEALTHCARE,CIGNA PPO,1417.98,,,,,,,877.6500,3400.4400,percent of total billed charges,"41.7% of $3,400.44 in Billed Charges for Rev 272 = $1,417.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE WITH MINI QUICK COUPLING 311.01,272,RC,,,,,,,,both,,,3400.4400,510.0700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3060.40,,,,,,,877.6500,3400.4400,percent of total billed charges,"90% of $3,400.44 in Billed Charges for Rev 272 = $3,060.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE WITH MINI QUICK COUPLING 311.01,272,RC,,,,,,,,both,,,3400.4400,510.0700,MEDCOST,MEDCOST VHN,1618.27,,,,,,,877.6500,3400.4400,percent of total billed charges,"47.59% of $3,400.44 in Billed Charges for Rev 272 = $1,618.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE WITH MINI QUICK COUPLING 311.01,272,RC,,,,,,,,both,,,3400.4400,510.0700,SENTARA HEALTH,SENTARA HEALTH,877.65,,,,,,,877.6500,3400.4400,percent of total billed charges,"25.81% of $3,400.44 in Billed Charges for Rev 272 = $877.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE WITH MINI QUICK COUPLING 311.01,272,RC,,,,,,,,both,,,3400.4400,510.0700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3400.44,,,,,,,877.6500,3400.4400,percent of total billed charges,"100% of $3,400.44 in Billed Charges for Rev 272 = $3,400.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE WITH MINI QUICK COUPLING 311.01,272,RC,,,,,,,,both,,,3400.4400,510.0700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1700.22,,,,,,,877.6500,3400.4400,percent of total billed charges,"Rev 272 $3,400.44 in Billed Charges at 50% = $1,700.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE WITH MINI QUICK COUPLING 311.01,272,RC,,,,,,,,both,,,3400.4400,510.0700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1098.34,,,,,,,877.6500,3400.4400,other,"32.3% of $3,400.44 in Billed Charges for Rev 272 = $1,098.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HANDLE WITH MINI QUICK COUPLING 311.01,272,RC,,,,,,,,both,,,3400.4400,510.0700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1043.94,,,,,,,877.6500,3400.4400,other,"30.7% of $3,400.44 in Billed Charges for Rev 272 = $1,043.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HANDLE WITH MINI QUICK COUPLING 311.01,272,RC,,,,,,,,both,,,3400.4400,510.0700,UNITED HEALTHCARE,UNITED HEALTHCARE,1098.34,,,,,,,877.6500,3400.4400,percent of total billed charges,"32.3% of $3,400.44 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE WITH MINI QUICK COUPLING 311.01,272,RC,,,,,,,,both,,,3400.4400,510.0700,WELLCARE,WELLCARE MEDICAID,3400.44,,,,,,,877.6500,3400.4400,percent of total billed charges,"100% of $3,400.44 in Billed Charges for Rev 272 = $3,400.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY FEM-FLEX II 16FR,272,RC,27200002,CDM,,,,,,both,,,3179.3300,476.9000,AETNA,AETNA,1357.57,,,,,,,820.5900,3179.3300,percent of total billed charges,"42.7% of $3,179.33 in Billed Charges for Rev 272 = $1,357.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY FEM-FLEX II 16FR,272,RC,27200002,CDM,,,,,,both,,,3179.3300,476.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2225.53,,,,,,,820.5900,3179.3300,percent of total billed charges,"Rev 272 $3,179.33 in Billed Charges at 70% = $2,225.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY FEM-FLEX II 16FR,272,RC,27200002,CDM,,,,,,both,,,3179.3300,476.9000,CIGNA HEALTHCARE,CIGNA HMO,1325.78,,,,,,,820.5900,3179.3300,percent of total billed charges,"41.7% of $3,179.33 in Billed Charges for Rev 272 = $1,325.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY FEM-FLEX II 16FR,272,RC,27200002,CDM,,,,,,both,,,3179.3300,476.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1475.21,,,,,,,820.5900,3179.3300,percent of total billed charges,"46.4% of $3,179.33 in Billed Charges for Rev 272 = $1,475.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY FEM-FLEX II 16FR,272,RC,27200002,CDM,,,,,,both,,,3179.3300,476.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1325.78,,,,,,,820.5900,3179.3300,percent of total billed charges,"41.7% of $3,179.33 in Billed Charges for Rev 272 = $1,325.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY FEM-FLEX II 16FR,272,RC,27200002,CDM,,,,,,both,,,3179.3300,476.9000,CIGNA HEALTHCARE,CIGNA PPO,1325.78,,,,,,,820.5900,3179.3300,percent of total billed charges,"41.7% of $3,179.33 in Billed Charges for Rev 272 = $1,325.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY FEM-FLEX II 16FR,272,RC,27200002,CDM,,,,,,both,,,3179.3300,476.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2861.40,,,,,,,820.5900,3179.3300,percent of total billed charges,"90% of $3,179.33 in Billed Charges for Rev 272 = $2,861.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY FEM-FLEX II 16FR,272,RC,27200002,CDM,,,,,,both,,,3179.3300,476.9000,MEDCOST,MEDCOST VHN,1513.04,,,,,,,820.5900,3179.3300,percent of total billed charges,"47.59% of $3,179.33 in Billed Charges for Rev 272 = $1,513.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY FEM-FLEX II 16FR,272,RC,27200002,CDM,,,,,,both,,,3179.3300,476.9000,SENTARA HEALTH,SENTARA HEALTH,820.59,,,,,,,820.5900,3179.3300,percent of total billed charges,"25.81% of $3,179.33 in Billed Charges for Rev 272 = $820.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY FEM-FLEX II 16FR,272,RC,27200002,CDM,,,,,,both,,,3179.3300,476.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3179.33,,,,,,,820.5900,3179.3300,percent of total billed charges,"100% of $3,179.33 in Billed Charges for Rev 272 = $3,179.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY FEM-FLEX II 16FR,272,RC,27200002,CDM,,,,,,both,,,3179.3300,476.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1589.67,,,,,,,820.5900,3179.3300,percent of total billed charges,"Rev 272 $3,179.33 in Billed Charges at 50% = $1,589.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY FEM-FLEX II 16FR,272,RC,27200002,CDM,,,,,,both,,,3179.3300,476.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1026.92,,,,,,,820.5900,3179.3300,other,"32.3% of $3,179.33 in Billed Charges for Rev 272 = $1,026.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA FEMORAL ARTERY FEM-FLEX II 16FR,272,RC,27200002,CDM,,,,,,both,,,3179.3300,476.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,976.05,,,,,,,820.5900,3179.3300,other,"30.7% of $3,179.33 in Billed Charges for Rev 272 = $976.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA FEMORAL ARTERY FEM-FLEX II 16FR,272,RC,27200002,CDM,,,,,,both,,,3179.3300,476.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,1026.92,,,,,,,820.5900,3179.3300,percent of total billed charges,"32.3% of $3,179.33 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY FEM-FLEX II 16FR,272,RC,27200002,CDM,,,,,,both,,,3179.3300,476.9000,WELLCARE,WELLCARE MEDICAID,3179.33,,,,,,,820.5900,3179.3300,percent of total billed charges,"100% of $3,179.33 in Billed Charges for Rev 272 = $3,179.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA GAUGE ACCESS 11,272,RC,27200002,CDM,,,,,,both,,,592.0800,88.8100,AETNA,AETNA,252.82,,,,,,,152.8200,592.0800,percent of total billed charges,42.7% of $592.08 in Billed Charges for Rev 272 = $252.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA GAUGE ACCESS 11,272,RC,27200002,CDM,,,,,,both,,,592.0800,88.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,414.46,,,,,,,152.8200,592.0800,percent of total billed charges,Rev 272 $592.08 in Billed Charges at 70% = $414.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA GAUGE ACCESS 11,272,RC,27200002,CDM,,,,,,both,,,592.0800,88.8100,CIGNA HEALTHCARE,CIGNA HMO,246.90,,,,,,,152.8200,592.0800,percent of total billed charges,41.7% of $592.08 in Billed Charges for Rev 272 = $246.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA GAUGE ACCESS 11,272,RC,27200002,CDM,,,,,,both,,,592.0800,88.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,274.73,,,,,,,152.8200,592.0800,percent of total billed charges,46.4% of $592.08 in Billed Charges for Rev 272 = $274.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA GAUGE ACCESS 11,272,RC,27200002,CDM,,,,,,both,,,592.0800,88.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,246.90,,,,,,,152.8200,592.0800,percent of total billed charges,41.7% of $592.08 in Billed Charges for Rev 272 = $246.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA GAUGE ACCESS 11,272,RC,27200002,CDM,,,,,,both,,,592.0800,88.8100,CIGNA HEALTHCARE,CIGNA PPO,246.90,,,,,,,152.8200,592.0800,percent of total billed charges,41.7% of $592.08 in Billed Charges for Rev 272 = $246.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA GAUGE ACCESS 11,272,RC,27200002,CDM,,,,,,both,,,592.0800,88.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,532.87,,,,,,,152.8200,592.0800,percent of total billed charges,90% of $592.08 in Billed Charges for Rev 272 = $532.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA GAUGE ACCESS 11,272,RC,27200002,CDM,,,,,,both,,,592.0800,88.8100,MEDCOST,MEDCOST VHN,281.77,,,,,,,152.8200,592.0800,percent of total billed charges,47.59% of $592.08 in Billed Charges for Rev 272 = $281.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA GAUGE ACCESS 11,272,RC,27200002,CDM,,,,,,both,,,592.0800,88.8100,SENTARA HEALTH,SENTARA HEALTH,152.82,,,,,,,152.8200,592.0800,percent of total billed charges,25.81% of $592.08 in Billed Charges for Rev 272 = $152.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA GAUGE ACCESS 11,272,RC,27200002,CDM,,,,,,both,,,592.0800,88.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",592.08,,,,,,,152.8200,592.0800,percent of total billed charges,100% of $592.08 in Billed Charges for Rev 272 = $592.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA GAUGE ACCESS 11,272,RC,27200002,CDM,,,,,,both,,,592.0800,88.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,296.04,,,,,,,152.8200,592.0800,percent of total billed charges,Rev 272 $592.08 in Billed Charges at 50% = $296.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA GAUGE ACCESS 11,272,RC,27200002,CDM,,,,,,both,,,592.0800,88.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,191.24,,,,,,,152.8200,592.0800,other,32.3% of $592.08 in Billed Charges for Rev 272 = $191.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CANNULA GAUGE ACCESS 11,272,RC,27200002,CDM,,,,,,both,,,592.0800,88.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,181.77,,,,,,,152.8200,592.0800,other,30.7% of $592.08 in Billed Charges for Rev 272 = $181.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CANNULA GAUGE ACCESS 11,272,RC,27200002,CDM,,,,,,both,,,592.0800,88.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,191.24,,,,,,,152.8200,592.0800,percent of total billed charges,32.3% of $592.08 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA GAUGE ACCESS 11,272,RC,27200002,CDM,,,,,,both,,,592.0800,88.8100,WELLCARE,WELLCARE MEDICAID,592.08,,,,,,,152.8200,592.0800,percent of total billed charges,100% of $592.08 in Billed Charges for Rev 272 = $592.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DURACLIP HEMOCLIP 235CM 16MM,272,RC,27200002,CDM,,,,,,both,,,1639.6600,245.9500,AETNA,AETNA,700.13,,,,,,,423.2000,1639.6600,percent of total billed charges,"42.7% of $1,639.66 in Billed Charges for Rev 272 = $700.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP DURACLIP HEMOCLIP 235CM 16MM,272,RC,27200002,CDM,,,,,,both,,,1639.6600,245.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1147.76,,,,,,,423.2000,1639.6600,percent of total billed charges,"Rev 272 $1,639.66 in Billed Charges at 70% = $1,147.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP DURACLIP HEMOCLIP 235CM 16MM,272,RC,27200002,CDM,,,,,,both,,,1639.6600,245.9500,CIGNA HEALTHCARE,CIGNA HMO,683.74,,,,,,,423.2000,1639.6600,percent of total billed charges,"41.7% of $1,639.66 in Billed Charges for Rev 272 = $683.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP DURACLIP HEMOCLIP 235CM 16MM,272,RC,27200002,CDM,,,,,,both,,,1639.6600,245.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,760.80,,,,,,,423.2000,1639.6600,percent of total billed charges,"46.4% of $1,639.66 in Billed Charges for Rev 272 = $760.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP DURACLIP HEMOCLIP 235CM 16MM,272,RC,27200002,CDM,,,,,,both,,,1639.6600,245.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,683.74,,,,,,,423.2000,1639.6600,percent of total billed charges,"41.7% of $1,639.66 in Billed Charges for Rev 272 = $683.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP DURACLIP HEMOCLIP 235CM 16MM,272,RC,27200002,CDM,,,,,,both,,,1639.6600,245.9500,CIGNA HEALTHCARE,CIGNA PPO,683.74,,,,,,,423.2000,1639.6600,percent of total billed charges,"41.7% of $1,639.66 in Billed Charges for Rev 272 = $683.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP DURACLIP HEMOCLIP 235CM 16MM,272,RC,27200002,CDM,,,,,,both,,,1639.6600,245.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1475.69,,,,,,,423.2000,1639.6600,percent of total billed charges,"90% of $1,639.66 in Billed Charges for Rev 272 = $1,475.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP DURACLIP HEMOCLIP 235CM 16MM,272,RC,27200002,CDM,,,,,,both,,,1639.6600,245.9500,MEDCOST,MEDCOST VHN,780.31,,,,,,,423.2000,1639.6600,percent of total billed charges,"47.59% of $1,639.66 in Billed Charges for Rev 272 = $780.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP DURACLIP HEMOCLIP 235CM 16MM,272,RC,27200002,CDM,,,,,,both,,,1639.6600,245.9500,SENTARA HEALTH,SENTARA HEALTH,423.20,,,,,,,423.2000,1639.6600,percent of total billed charges,"25.81% of $1,639.66 in Billed Charges for Rev 272 = $423.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP DURACLIP HEMOCLIP 235CM 16MM,272,RC,27200002,CDM,,,,,,both,,,1639.6600,245.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1639.66,,,,,,,423.2000,1639.6600,percent of total billed charges,"100% of $1,639.66 in Billed Charges for Rev 272 = $1,639.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP DURACLIP HEMOCLIP 235CM 16MM,272,RC,27200002,CDM,,,,,,both,,,1639.6600,245.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,819.83,,,,,,,423.2000,1639.6600,percent of total billed charges,"Rev 272 $1,639.66 in Billed Charges at 50% = $819.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP DURACLIP HEMOCLIP 235CM 16MM,272,RC,27200002,CDM,,,,,,both,,,1639.6600,245.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,529.61,,,,,,,423.2000,1639.6600,other,"32.3% of $1,639.66 in Billed Charges for Rev 272 = $529.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLIP DURACLIP HEMOCLIP 235CM 16MM,272,RC,27200002,CDM,,,,,,both,,,1639.6600,245.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,503.38,,,,,,,423.2000,1639.6600,other,"30.7% of $1,639.66 in Billed Charges for Rev 272 = $503.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLIP DURACLIP HEMOCLIP 235CM 16MM,272,RC,27200002,CDM,,,,,,both,,,1639.6600,245.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,529.61,,,,,,,423.2000,1639.6600,percent of total billed charges,"32.3% of $1,639.66 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP DURACLIP HEMOCLIP 235CM 16MM,272,RC,27200002,CDM,,,,,,both,,,1639.6600,245.9500,WELLCARE,WELLCARE MEDICAID,1639.66,,,,,,,423.2000,1639.6600,percent of total billed charges,"100% of $1,639.66 in Billed Charges for Rev 272 = $1,639.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP DYNAMIZATION 390.006,272,RC,,,,,,,,both,,,921.6700,138.2500,AETNA,AETNA,393.55,,,,,,,237.8800,921.6700,percent of total billed charges,42.7% of $921.67 in Billed Charges for Rev 272 = $393.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DYNAMIZATION 390.006,272,RC,,,,,,,,both,,,921.6700,138.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,645.17,,,,,,,237.8800,921.6700,percent of total billed charges,Rev 272 $921.67 in Billed Charges at 70% = $645.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DYNAMIZATION 390.006,272,RC,,,,,,,,both,,,921.6700,138.2500,CIGNA HEALTHCARE,CIGNA HMO,384.34,,,,,,,237.8800,921.6700,percent of total billed charges,41.7% of $921.67 in Billed Charges for Rev 272 = $384.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DYNAMIZATION 390.006,272,RC,,,,,,,,both,,,921.6700,138.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,427.65,,,,,,,237.8800,921.6700,percent of total billed charges,46.4% of $921.67 in Billed Charges for Rev 272 = $427.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DYNAMIZATION 390.006,272,RC,,,,,,,,both,,,921.6700,138.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,384.34,,,,,,,237.8800,921.6700,percent of total billed charges,41.7% of $921.67 in Billed Charges for Rev 272 = $384.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DYNAMIZATION 390.006,272,RC,,,,,,,,both,,,921.6700,138.2500,CIGNA HEALTHCARE,CIGNA PPO,384.34,,,,,,,237.8800,921.6700,percent of total billed charges,41.7% of $921.67 in Billed Charges for Rev 272 = $384.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DYNAMIZATION 390.006,272,RC,,,,,,,,both,,,921.6700,138.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,829.50,,,,,,,237.8800,921.6700,percent of total billed charges,90% of $921.67 in Billed Charges for Rev 272 = $829.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DYNAMIZATION 390.006,272,RC,,,,,,,,both,,,921.6700,138.2500,MEDCOST,MEDCOST VHN,438.62,,,,,,,237.8800,921.6700,percent of total billed charges,47.59% of $921.67 in Billed Charges for Rev 272 = $438.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DYNAMIZATION 390.006,272,RC,,,,,,,,both,,,921.6700,138.2500,SENTARA HEALTH,SENTARA HEALTH,237.88,,,,,,,237.8800,921.6700,percent of total billed charges,25.81% of $921.67 in Billed Charges for Rev 272 = $237.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DYNAMIZATION 390.006,272,RC,,,,,,,,both,,,921.6700,138.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",921.67,,,,,,,237.8800,921.6700,percent of total billed charges,100% of $921.67 in Billed Charges for Rev 272 = $921.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DYNAMIZATION 390.006,272,RC,,,,,,,,both,,,921.6700,138.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,460.84,,,,,,,237.8800,921.6700,percent of total billed charges,Rev 272 $921.67 in Billed Charges at 50% = $460.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DYNAMIZATION 390.006,272,RC,,,,,,,,both,,,921.6700,138.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,297.70,,,,,,,237.8800,921.6700,other,32.3% of $921.67 in Billed Charges for Rev 272 = $297.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CLIP DYNAMIZATION 390.006,272,RC,,,,,,,,both,,,921.6700,138.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,282.95,,,,,,,237.8800,921.6700,other,30.7% of $921.67 in Billed Charges for Rev 272 = $282.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CLIP DYNAMIZATION 390.006,272,RC,,,,,,,,both,,,921.6700,138.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,297.70,,,,,,,237.8800,921.6700,percent of total billed charges,32.3% of $921.67 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP DYNAMIZATION 390.006,272,RC,,,,,,,,both,,,921.6700,138.2500,WELLCARE,WELLCARE MEDICAID,921.67,,,,,,,237.8800,921.6700,percent of total billed charges,100% of $921.67 in Billed Charges for Rev 272 = $921.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLIP HEMOSTASIS RETENTIA 180CM 12MM OPENING,272,RC,,,,,,,,both,,,1192.6700,178.9000,AETNA,AETNA,509.27,,,,,,,307.8300,1192.6700,percent of total billed charges,"42.7% of $1,192.67 in Billed Charges for Rev 272 = $509.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP HEMOSTASIS RETENTIA 180CM 12MM OPENING,272,RC,,,,,,,,both,,,1192.6700,178.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,834.87,,,,,,,307.8300,1192.6700,percent of total billed charges,"Rev 272 $1,192.67 in Billed Charges at 70% = $834.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP HEMOSTASIS RETENTIA 180CM 12MM OPENING,272,RC,,,,,,,,both,,,1192.6700,178.9000,CIGNA HEALTHCARE,CIGNA HMO,497.34,,,,,,,307.8300,1192.6700,percent of total billed charges,"41.7% of $1,192.67 in Billed Charges for Rev 272 = $497.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP HEMOSTASIS RETENTIA 180CM 12MM OPENING,272,RC,,,,,,,,both,,,1192.6700,178.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,553.40,,,,,,,307.8300,1192.6700,percent of total billed charges,"46.4% of $1,192.67 in Billed Charges for Rev 272 = $553.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP HEMOSTASIS RETENTIA 180CM 12MM OPENING,272,RC,,,,,,,,both,,,1192.6700,178.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,497.34,,,,,,,307.8300,1192.6700,percent of total billed charges,"41.7% of $1,192.67 in Billed Charges for Rev 272 = $497.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP HEMOSTASIS RETENTIA 180CM 12MM OPENING,272,RC,,,,,,,,both,,,1192.6700,178.9000,CIGNA HEALTHCARE,CIGNA PPO,497.34,,,,,,,307.8300,1192.6700,percent of total billed charges,"41.7% of $1,192.67 in Billed Charges for Rev 272 = $497.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP HEMOSTASIS RETENTIA 180CM 12MM OPENING,272,RC,,,,,,,,both,,,1192.6700,178.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1073.40,,,,,,,307.8300,1192.6700,percent of total billed charges,"90% of $1,192.67 in Billed Charges for Rev 272 = $1,073.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP HEMOSTASIS RETENTIA 180CM 12MM OPENING,272,RC,,,,,,,,both,,,1192.6700,178.9000,MEDCOST,MEDCOST VHN,567.59,,,,,,,307.8300,1192.6700,percent of total billed charges,"47.59% of $1,192.67 in Billed Charges for Rev 272 = $567.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP HEMOSTASIS RETENTIA 180CM 12MM OPENING,272,RC,,,,,,,,both,,,1192.6700,178.9000,SENTARA HEALTH,SENTARA HEALTH,307.83,,,,,,,307.8300,1192.6700,percent of total billed charges,"25.81% of $1,192.67 in Billed Charges for Rev 272 = $307.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP HEMOSTASIS RETENTIA 180CM 12MM OPENING,272,RC,,,,,,,,both,,,1192.6700,178.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1192.67,,,,,,,307.8300,1192.6700,percent of total billed charges,"100% of $1,192.67 in Billed Charges for Rev 272 = $1,192.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP HEMOSTASIS RETENTIA 180CM 12MM OPENING,272,RC,,,,,,,,both,,,1192.6700,178.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,596.34,,,,,,,307.8300,1192.6700,percent of total billed charges,"Rev 272 $1,192.67 in Billed Charges at 50% = $596.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP HEMOSTASIS RETENTIA 180CM 12MM OPENING,272,RC,,,,,,,,both,,,1192.6700,178.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,385.23,,,,,,,307.8300,1192.6700,other,"32.3% of $1,192.67 in Billed Charges for Rev 272 = $385.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLIP HEMOSTASIS RETENTIA 180CM 12MM OPENING,272,RC,,,,,,,,both,,,1192.6700,178.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,366.15,,,,,,,307.8300,1192.6700,other,"30.7% of $1,192.67 in Billed Charges for Rev 272 = $366.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLIP HEMOSTASIS RETENTIA 180CM 12MM OPENING,272,RC,,,,,,,,both,,,1192.6700,178.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,385.23,,,,,,,307.8300,1192.6700,percent of total billed charges,"32.3% of $1,192.67 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLIP HEMOSTASIS RETENTIA 180CM 12MM OPENING,272,RC,,,,,,,,both,,,1192.6700,178.9000,WELLCARE,WELLCARE MEDICAID,1192.67,,,,,,,307.8300,1192.6700,percent of total billed charges,"100% of $1,192.67 in Billed Charges for Rev 272 = $1,192.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA HIP CLEAR TRAC 8.5 X 90MM,272,RC,,,,,,,,both,,,1970.5900,295.5900,AETNA,AETNA,841.44,,,,,,,508.6100,1970.5900,percent of total billed charges,"42.7% of $1,970.59 in Billed Charges for Rev 272 = $841.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA HIP CLEAR TRAC 8.5 X 90MM,272,RC,,,,,,,,both,,,1970.5900,295.5900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1379.41,,,,,,,508.6100,1970.5900,percent of total billed charges,"Rev 272 $1,970.59 in Billed Charges at 70% = $1,379.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA HIP CLEAR TRAC 8.5 X 90MM,272,RC,,,,,,,,both,,,1970.5900,295.5900,CIGNA HEALTHCARE,CIGNA HMO,821.74,,,,,,,508.6100,1970.5900,percent of total billed charges,"41.7% of $1,970.59 in Billed Charges for Rev 272 = $821.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA HIP CLEAR TRAC 8.5 X 90MM,272,RC,,,,,,,,both,,,1970.5900,295.5900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,914.35,,,,,,,508.6100,1970.5900,percent of total billed charges,"46.4% of $1,970.59 in Billed Charges for Rev 272 = $914.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA HIP CLEAR TRAC 8.5 X 90MM,272,RC,,,,,,,,both,,,1970.5900,295.5900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,821.74,,,,,,,508.6100,1970.5900,percent of total billed charges,"41.7% of $1,970.59 in Billed Charges for Rev 272 = $821.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA HIP CLEAR TRAC 8.5 X 90MM,272,RC,,,,,,,,both,,,1970.5900,295.5900,CIGNA HEALTHCARE,CIGNA PPO,821.74,,,,,,,508.6100,1970.5900,percent of total billed charges,"41.7% of $1,970.59 in Billed Charges for Rev 272 = $821.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA HIP CLEAR TRAC 8.5 X 90MM,272,RC,,,,,,,,both,,,1970.5900,295.5900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1773.53,,,,,,,508.6100,1970.5900,percent of total billed charges,"90% of $1,970.59 in Billed Charges for Rev 272 = $1,773.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA HIP CLEAR TRAC 8.5 X 90MM,272,RC,,,,,,,,both,,,1970.5900,295.5900,MEDCOST,MEDCOST VHN,937.80,,,,,,,508.6100,1970.5900,percent of total billed charges,"47.59% of $1,970.59 in Billed Charges for Rev 272 = $937.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA HIP CLEAR TRAC 8.5 X 90MM,272,RC,,,,,,,,both,,,1970.5900,295.5900,SENTARA HEALTH,SENTARA HEALTH,508.61,,,,,,,508.6100,1970.5900,percent of total billed charges,"25.81% of $1,970.59 in Billed Charges for Rev 272 = $508.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA HIP CLEAR TRAC 8.5 X 90MM,272,RC,,,,,,,,both,,,1970.5900,295.5900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1970.59,,,,,,,508.6100,1970.5900,percent of total billed charges,"100% of $1,970.59 in Billed Charges for Rev 272 = $1,970.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA HIP CLEAR TRAC 8.5 X 90MM,272,RC,,,,,,,,both,,,1970.5900,295.5900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,985.30,,,,,,,508.6100,1970.5900,percent of total billed charges,"Rev 272 $1,970.59 in Billed Charges at 50% = $985.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA HIP CLEAR TRAC 8.5 X 90MM,272,RC,,,,,,,,both,,,1970.5900,295.5900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,636.50,,,,,,,508.6100,1970.5900,other,"32.3% of $1,970.59 in Billed Charges for Rev 272 = $636.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA HIP CLEAR TRAC 8.5 X 90MM,272,RC,,,,,,,,both,,,1970.5900,295.5900,UNITED HEALTHCARE,UHC HERITAGE SELECT,604.97,,,,,,,508.6100,1970.5900,other,"30.7% of $1,970.59 in Billed Charges for Rev 272 = $604.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA HIP CLEAR TRAC 8.5 X 90MM,272,RC,,,,,,,,both,,,1970.5900,295.5900,UNITED HEALTHCARE,UNITED HEALTHCARE,636.50,,,,,,,508.6100,1970.5900,percent of total billed charges,"32.3% of $1,970.59 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA HIP CLEAR TRAC 8.5 X 90MM,272,RC,,,,,,,,both,,,1970.5900,295.5900,WELLCARE,WELLCARE MEDICAID,1970.59,,,,,,,508.6100,1970.5900,percent of total billed charges,"100% of $1,970.59 in Billed Charges for Rev 272 = $1,970.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA HYDRODISSECTION 25G,272,RC,27200002,CDM,,,,,,both,,,549.6600,82.4500,AETNA,AETNA,234.70,,,,,,,141.8700,549.6600,percent of total billed charges,42.7% of $549.66 in Billed Charges for Rev 272 = $234.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA HYDRODISSECTION 25G,272,RC,27200002,CDM,,,,,,both,,,549.6600,82.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,384.76,,,,,,,141.8700,549.6600,percent of total billed charges,Rev 272 $549.66 in Billed Charges at 70% = $384.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA HYDRODISSECTION 25G,272,RC,27200002,CDM,,,,,,both,,,549.6600,82.4500,CIGNA HEALTHCARE,CIGNA HMO,229.21,,,,,,,141.8700,549.6600,percent of total billed charges,41.7% of $549.66 in Billed Charges for Rev 272 = $229.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA HYDRODISSECTION 25G,272,RC,27200002,CDM,,,,,,both,,,549.6600,82.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,255.04,,,,,,,141.8700,549.6600,percent of total billed charges,46.4% of $549.66 in Billed Charges for Rev 272 = $255.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA HYDRODISSECTION 25G,272,RC,27200002,CDM,,,,,,both,,,549.6600,82.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,229.21,,,,,,,141.8700,549.6600,percent of total billed charges,41.7% of $549.66 in Billed Charges for Rev 272 = $229.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA HYDRODISSECTION 25G,272,RC,27200002,CDM,,,,,,both,,,549.6600,82.4500,CIGNA HEALTHCARE,CIGNA PPO,229.21,,,,,,,141.8700,549.6600,percent of total billed charges,41.7% of $549.66 in Billed Charges for Rev 272 = $229.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA HYDRODISSECTION 25G,272,RC,27200002,CDM,,,,,,both,,,549.6600,82.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,494.69,,,,,,,141.8700,549.6600,percent of total billed charges,90% of $549.66 in Billed Charges for Rev 272 = $494.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA HYDRODISSECTION 25G,272,RC,27200002,CDM,,,,,,both,,,549.6600,82.4500,MEDCOST,MEDCOST VHN,261.58,,,,,,,141.8700,549.6600,percent of total billed charges,47.59% of $549.66 in Billed Charges for Rev 272 = $261.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA HYDRODISSECTION 25G,272,RC,27200002,CDM,,,,,,both,,,549.6600,82.4500,SENTARA HEALTH,SENTARA HEALTH,141.87,,,,,,,141.8700,549.6600,percent of total billed charges,25.81% of $549.66 in Billed Charges for Rev 272 = $141.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA HYDRODISSECTION 25G,272,RC,27200002,CDM,,,,,,both,,,549.6600,82.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",549.66,,,,,,,141.8700,549.6600,percent of total billed charges,100% of $549.66 in Billed Charges for Rev 272 = $549.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA HYDRODISSECTION 25G,272,RC,27200002,CDM,,,,,,both,,,549.6600,82.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,274.83,,,,,,,141.8700,549.6600,percent of total billed charges,Rev 272 $549.66 in Billed Charges at 50% = $274.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA HYDRODISSECTION 25G,272,RC,27200002,CDM,,,,,,both,,,549.6600,82.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,177.54,,,,,,,141.8700,549.6600,other,32.3% of $549.66 in Billed Charges for Rev 272 = $177.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CANNULA HYDRODISSECTION 25G,272,RC,27200002,CDM,,,,,,both,,,549.6600,82.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,168.75,,,,,,,141.8700,549.6600,other,30.7% of $549.66 in Billed Charges for Rev 272 = $168.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CANNULA HYDRODISSECTION 25G,272,RC,27200002,CDM,,,,,,both,,,549.6600,82.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,177.54,,,,,,,141.8700,549.6600,percent of total billed charges,32.3% of $549.66 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA HYDRODISSECTION 25G,272,RC,27200002,CDM,,,,,,both,,,549.6600,82.4500,WELLCARE,WELLCARE MEDICAID,549.66,,,,,,,141.8700,549.6600,percent of total billed charges,100% of $549.66 in Billed Charges for Rev 272 = $549.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA PIVOT TRANSPORT 8MM CAT00223,272,RC,27200002,CDM,,,,,,both,,,990.5300,148.5800,AETNA,AETNA,422.96,,,,,,,255.6600,990.5300,percent of total billed charges,42.7% of $990.53 in Billed Charges for Rev 272 = $422.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA PIVOT TRANSPORT 8MM CAT00223,272,RC,27200002,CDM,,,,,,both,,,990.5300,148.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,693.37,,,,,,,255.6600,990.5300,percent of total billed charges,Rev 272 $990.53 in Billed Charges at 70% = $693.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA PIVOT TRANSPORT 8MM CAT00223,272,RC,27200002,CDM,,,,,,both,,,990.5300,148.5800,CIGNA HEALTHCARE,CIGNA HMO,413.05,,,,,,,255.6600,990.5300,percent of total billed charges,41.7% of $990.53 in Billed Charges for Rev 272 = $413.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA PIVOT TRANSPORT 8MM CAT00223,272,RC,27200002,CDM,,,,,,both,,,990.5300,148.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,459.61,,,,,,,255.6600,990.5300,percent of total billed charges,46.4% of $990.53 in Billed Charges for Rev 272 = $459.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA PIVOT TRANSPORT 8MM CAT00223,272,RC,27200002,CDM,,,,,,both,,,990.5300,148.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,413.05,,,,,,,255.6600,990.5300,percent of total billed charges,41.7% of $990.53 in Billed Charges for Rev 272 = $413.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA PIVOT TRANSPORT 8MM CAT00223,272,RC,27200002,CDM,,,,,,both,,,990.5300,148.5800,CIGNA HEALTHCARE,CIGNA PPO,413.05,,,,,,,255.6600,990.5300,percent of total billed charges,41.7% of $990.53 in Billed Charges for Rev 272 = $413.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA PIVOT TRANSPORT 8MM CAT00223,272,RC,27200002,CDM,,,,,,both,,,990.5300,148.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,891.48,,,,,,,255.6600,990.5300,percent of total billed charges,90% of $990.53 in Billed Charges for Rev 272 = $891.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA PIVOT TRANSPORT 8MM CAT00223,272,RC,27200002,CDM,,,,,,both,,,990.5300,148.5800,MEDCOST,MEDCOST VHN,471.39,,,,,,,255.6600,990.5300,percent of total billed charges,47.59% of $990.53 in Billed Charges for Rev 272 = $471.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA PIVOT TRANSPORT 8MM CAT00223,272,RC,27200002,CDM,,,,,,both,,,990.5300,148.5800,SENTARA HEALTH,SENTARA HEALTH,255.66,,,,,,,255.6600,990.5300,percent of total billed charges,25.81% of $990.53 in Billed Charges for Rev 272 = $255.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA PIVOT TRANSPORT 8MM CAT00223,272,RC,27200002,CDM,,,,,,both,,,990.5300,148.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",990.53,,,,,,,255.6600,990.5300,percent of total billed charges,100% of $990.53 in Billed Charges for Rev 272 = $990.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA PIVOT TRANSPORT 8MM CAT00223,272,RC,27200002,CDM,,,,,,both,,,990.5300,148.5800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,495.27,,,,,,,255.6600,990.5300,percent of total billed charges,Rev 272 $990.53 in Billed Charges at 50% = $495.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA PIVOT TRANSPORT 8MM CAT00223,272,RC,27200002,CDM,,,,,,both,,,990.5300,148.5800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,319.94,,,,,,,255.6600,990.5300,other,32.3% of $990.53 in Billed Charges for Rev 272 = $319.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CANNULA PIVOT TRANSPORT 8MM CAT00223,272,RC,27200002,CDM,,,,,,both,,,990.5300,148.5800,UNITED HEALTHCARE,UHC HERITAGE SELECT,304.09,,,,,,,255.6600,990.5300,other,30.7% of $990.53 in Billed Charges for Rev 272 = $304.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CANNULA PIVOT TRANSPORT 8MM CAT00223,272,RC,27200002,CDM,,,,,,both,,,990.5300,148.5800,UNITED HEALTHCARE,UNITED HEALTHCARE,319.94,,,,,,,255.6600,990.5300,percent of total billed charges,32.3% of $990.53 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA PIVOT TRANSPORT 8MM CAT00223,272,RC,27200002,CDM,,,,,,both,,,990.5300,148.5800,WELLCARE,WELLCARE MEDICAID,990.53,,,,,,,255.6600,990.5300,percent of total billed charges,100% of $990.53 in Billed Charges for Rev 272 = $990.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE BONE FILLER SZ 3,272,RC,27200002,CDM,,,,,,both,,,766.9400,115.0400,AETNA,AETNA,327.48,,,,,,,197.9500,766.9400,percent of total billed charges,42.7% of $766.94 in Billed Charges for Rev 272 = $327.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE BONE FILLER SZ 3,272,RC,27200002,CDM,,,,,,both,,,766.9400,115.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,536.86,,,,,,,197.9500,766.9400,percent of total billed charges,Rev 272 $766.94 in Billed Charges at 70% = $536.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE BONE FILLER SZ 3,272,RC,27200002,CDM,,,,,,both,,,766.9400,115.0400,CIGNA HEALTHCARE,CIGNA HMO,319.81,,,,,,,197.9500,766.9400,percent of total billed charges,41.7% of $766.94 in Billed Charges for Rev 272 = $319.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE BONE FILLER SZ 3,272,RC,27200002,CDM,,,,,,both,,,766.9400,115.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,355.86,,,,,,,197.9500,766.9400,percent of total billed charges,46.4% of $766.94 in Billed Charges for Rev 272 = $355.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE BONE FILLER SZ 3,272,RC,27200002,CDM,,,,,,both,,,766.9400,115.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,319.81,,,,,,,197.9500,766.9400,percent of total billed charges,41.7% of $766.94 in Billed Charges for Rev 272 = $319.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE BONE FILLER SZ 3,272,RC,27200002,CDM,,,,,,both,,,766.9400,115.0400,CIGNA HEALTHCARE,CIGNA PPO,319.81,,,,,,,197.9500,766.9400,percent of total billed charges,41.7% of $766.94 in Billed Charges for Rev 272 = $319.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE BONE FILLER SZ 3,272,RC,27200002,CDM,,,,,,both,,,766.9400,115.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,690.25,,,,,,,197.9500,766.9400,percent of total billed charges,90% of $766.94 in Billed Charges for Rev 272 = $690.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE BONE FILLER SZ 3,272,RC,27200002,CDM,,,,,,both,,,766.9400,115.0400,MEDCOST,MEDCOST VHN,364.99,,,,,,,197.9500,766.9400,percent of total billed charges,47.59% of $766.94 in Billed Charges for Rev 272 = $364.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE BONE FILLER SZ 3,272,RC,27200002,CDM,,,,,,both,,,766.9400,115.0400,SENTARA HEALTH,SENTARA HEALTH,197.95,,,,,,,197.9500,766.9400,percent of total billed charges,25.81% of $766.94 in Billed Charges for Rev 272 = $197.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE BONE FILLER SZ 3,272,RC,27200002,CDM,,,,,,both,,,766.9400,115.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",766.94,,,,,,,197.9500,766.9400,percent of total billed charges,100% of $766.94 in Billed Charges for Rev 272 = $766.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE BONE FILLER SZ 3,272,RC,27200002,CDM,,,,,,both,,,766.9400,115.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,383.47,,,,,,,197.9500,766.9400,percent of total billed charges,Rev 272 $766.94 in Billed Charges at 50% = $383.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE BONE FILLER SZ 3,272,RC,27200002,CDM,,,,,,both,,,766.9400,115.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,247.72,,,,,,,197.9500,766.9400,other,32.3% of $766.94 in Billed Charges for Rev 272 = $247.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DEVICE BONE FILLER SZ 3,272,RC,27200002,CDM,,,,,,both,,,766.9400,115.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,235.45,,,,,,,197.9500,766.9400,other,30.7% of $766.94 in Billed Charges for Rev 272 = $235.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DEVICE BONE FILLER SZ 3,272,RC,27200002,CDM,,,,,,both,,,766.9400,115.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,247.72,,,,,,,197.9500,766.9400,percent of total billed charges,32.3% of $766.94 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE BONE FILLER SZ 3,272,RC,27200002,CDM,,,,,,both,,,766.9400,115.0400,WELLCARE,WELLCARE MEDICAID,766.94,,,,,,,197.9500,766.9400,percent of total billed charges,100% of $766.94 in Billed Charges for Rev 272 = $766.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE CLIP RESOLUTION 360 235CM M00521232,272,RC,27200002,CDM,,,,,,both,,,3577.2300,536.5800,AETNA,AETNA,1527.48,,,,,,,923.2800,3577.2300,percent of total billed charges,"42.7% of $3,577.23 in Billed Charges for Rev 272 = $1,527.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION 360 235CM M00521232,272,RC,27200002,CDM,,,,,,both,,,3577.2300,536.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2504.06,,,,,,,923.2800,3577.2300,percent of total billed charges,"Rev 272 $3,577.23 in Billed Charges at 70% = $2,504.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION 360 235CM M00521232,272,RC,27200002,CDM,,,,,,both,,,3577.2300,536.5800,CIGNA HEALTHCARE,CIGNA HMO,1491.70,,,,,,,923.2800,3577.2300,percent of total billed charges,"41.7% of $3,577.23 in Billed Charges for Rev 272 = $1,491.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION 360 235CM M00521232,272,RC,27200002,CDM,,,,,,both,,,3577.2300,536.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1659.83,,,,,,,923.2800,3577.2300,percent of total billed charges,"46.4% of $3,577.23 in Billed Charges for Rev 272 = $1,659.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION 360 235CM M00521232,272,RC,27200002,CDM,,,,,,both,,,3577.2300,536.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1491.70,,,,,,,923.2800,3577.2300,percent of total billed charges,"41.7% of $3,577.23 in Billed Charges for Rev 272 = $1,491.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION 360 235CM M00521232,272,RC,27200002,CDM,,,,,,both,,,3577.2300,536.5800,CIGNA HEALTHCARE,CIGNA PPO,1491.70,,,,,,,923.2800,3577.2300,percent of total billed charges,"41.7% of $3,577.23 in Billed Charges for Rev 272 = $1,491.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION 360 235CM M00521232,272,RC,27200002,CDM,,,,,,both,,,3577.2300,536.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3219.51,,,,,,,923.2800,3577.2300,percent of total billed charges,"90% of $3,577.23 in Billed Charges for Rev 272 = $3,219.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION 360 235CM M00521232,272,RC,27200002,CDM,,,,,,both,,,3577.2300,536.5800,MEDCOST,MEDCOST VHN,1702.40,,,,,,,923.2800,3577.2300,percent of total billed charges,"47.59% of $3,577.23 in Billed Charges for Rev 272 = $1,702.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION 360 235CM M00521232,272,RC,27200002,CDM,,,,,,both,,,3577.2300,536.5800,SENTARA HEALTH,SENTARA HEALTH,923.28,,,,,,,923.2800,3577.2300,percent of total billed charges,"25.81% of $3,577.23 in Billed Charges for Rev 272 = $923.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION 360 235CM M00521232,272,RC,27200002,CDM,,,,,,both,,,3577.2300,536.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3577.23,,,,,,,923.2800,3577.2300,percent of total billed charges,"100% of $3,577.23 in Billed Charges for Rev 272 = $3,577.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION 360 235CM M00521232,272,RC,27200002,CDM,,,,,,both,,,3577.2300,536.5800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1788.62,,,,,,,923.2800,3577.2300,percent of total billed charges,"Rev 272 $3,577.23 in Billed Charges at 50% = $1,788.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION 360 235CM M00521232,272,RC,27200002,CDM,,,,,,both,,,3577.2300,536.5800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1155.45,,,,,,,923.2800,3577.2300,other,"32.3% of $3,577.23 in Billed Charges for Rev 272 = $1,155.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE CLIP RESOLUTION 360 235CM M00521232,272,RC,27200002,CDM,,,,,,both,,,3577.2300,536.5800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1098.21,,,,,,,923.2800,3577.2300,other,"30.7% of $3,577.23 in Billed Charges for Rev 272 = $1,098.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE CLIP RESOLUTION 360 235CM M00521232,272,RC,27200002,CDM,,,,,,both,,,3577.2300,536.5800,UNITED HEALTHCARE,UNITED HEALTHCARE,1155.45,,,,,,,923.2800,3577.2300,percent of total billed charges,"32.3% of $3,577.23 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLIP RESOLUTION 360 235CM M00521232,272,RC,27200002,CDM,,,,,,both,,,3577.2300,536.5800,WELLCARE,WELLCARE MEDICAID,3577.23,,,,,,,923.2800,3577.2300,percent of total billed charges,"100% of $3,577.23 in Billed Charges for Rev 272 = $3,577.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA SCOTT DISP. 8FR. 10CM,272,RC,27200002,CDM,,,,,,both,,,946.0600,141.9100,AETNA,AETNA,403.97,,,,,,,244.1800,946.0600,percent of total billed charges,42.7% of $946.06 in Billed Charges for Rev 272 = $403.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA SCOTT DISP. 8FR. 10CM,272,RC,27200002,CDM,,,,,,both,,,946.0600,141.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,662.24,,,,,,,244.1800,946.0600,percent of total billed charges,Rev 272 $946.06 in Billed Charges at 70% = $662.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA SCOTT DISP. 8FR. 10CM,272,RC,27200002,CDM,,,,,,both,,,946.0600,141.9100,CIGNA HEALTHCARE,CIGNA HMO,394.51,,,,,,,244.1800,946.0600,percent of total billed charges,41.7% of $946.06 in Billed Charges for Rev 272 = $394.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA SCOTT DISP. 8FR. 10CM,272,RC,27200002,CDM,,,,,,both,,,946.0600,141.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,438.97,,,,,,,244.1800,946.0600,percent of total billed charges,46.4% of $946.06 in Billed Charges for Rev 272 = $438.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA SCOTT DISP. 8FR. 10CM,272,RC,27200002,CDM,,,,,,both,,,946.0600,141.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,394.51,,,,,,,244.1800,946.0600,percent of total billed charges,41.7% of $946.06 in Billed Charges for Rev 272 = $394.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA SCOTT DISP. 8FR. 10CM,272,RC,27200002,CDM,,,,,,both,,,946.0600,141.9100,CIGNA HEALTHCARE,CIGNA PPO,394.51,,,,,,,244.1800,946.0600,percent of total billed charges,41.7% of $946.06 in Billed Charges for Rev 272 = $394.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA SCOTT DISP. 8FR. 10CM,272,RC,27200002,CDM,,,,,,both,,,946.0600,141.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,851.45,,,,,,,244.1800,946.0600,percent of total billed charges,90% of $946.06 in Billed Charges for Rev 272 = $851.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA SCOTT DISP. 8FR. 10CM,272,RC,27200002,CDM,,,,,,both,,,946.0600,141.9100,MEDCOST,MEDCOST VHN,450.23,,,,,,,244.1800,946.0600,percent of total billed charges,47.59% of $946.06 in Billed Charges for Rev 272 = $450.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA SCOTT DISP. 8FR. 10CM,272,RC,27200002,CDM,,,,,,both,,,946.0600,141.9100,SENTARA HEALTH,SENTARA HEALTH,244.18,,,,,,,244.1800,946.0600,percent of total billed charges,25.81% of $946.06 in Billed Charges for Rev 272 = $244.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA SCOTT DISP. 8FR. 10CM,272,RC,27200002,CDM,,,,,,both,,,946.0600,141.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",946.06,,,,,,,244.1800,946.0600,percent of total billed charges,100% of $946.06 in Billed Charges for Rev 272 = $946.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA SCOTT DISP. 8FR. 10CM,272,RC,27200002,CDM,,,,,,both,,,946.0600,141.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,473.03,,,,,,,244.1800,946.0600,percent of total billed charges,Rev 272 $946.06 in Billed Charges at 50% = $473.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA SCOTT DISP. 8FR. 10CM,272,RC,27200002,CDM,,,,,,both,,,946.0600,141.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,305.58,,,,,,,244.1800,946.0600,other,32.3% of $946.06 in Billed Charges for Rev 272 = $305.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CANNULA SCOTT DISP. 8FR. 10CM,272,RC,27200002,CDM,,,,,,both,,,946.0600,141.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,290.44,,,,,,,244.1800,946.0600,other,30.7% of $946.06 in Billed Charges for Rev 272 = $290.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CANNULA SCOTT DISP. 8FR. 10CM,272,RC,27200002,CDM,,,,,,both,,,946.0600,141.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,305.58,,,,,,,244.1800,946.0600,percent of total billed charges,32.3% of $946.06 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA SCOTT DISP. 8FR. 10CM,272,RC,27200002,CDM,,,,,,both,,,946.0600,141.9100,WELLCARE,WELLCARE MEDICAID,946.06,,,,,,,244.1800,946.0600,percent of total billed charges,100% of $946.06 in Billed Charges for Rev 272 = $946.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA STRAIGHT KNOT FAST FIX,272,RC,,,,,,,,both,,,1375.1900,206.2800,AETNA,AETNA,587.21,,,,,,,354.9400,1375.1900,percent of total billed charges,"42.7% of $1,375.19 in Billed Charges for Rev 272 = $587.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA STRAIGHT KNOT FAST FIX,272,RC,,,,,,,,both,,,1375.1900,206.2800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,962.63,,,,,,,354.9400,1375.1900,percent of total billed charges,"Rev 272 $1,375.19 in Billed Charges at 70% = $962.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA STRAIGHT KNOT FAST FIX,272,RC,,,,,,,,both,,,1375.1900,206.2800,CIGNA HEALTHCARE,CIGNA HMO,573.45,,,,,,,354.9400,1375.1900,percent of total billed charges,"41.7% of $1,375.19 in Billed Charges for Rev 272 = $573.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA STRAIGHT KNOT FAST FIX,272,RC,,,,,,,,both,,,1375.1900,206.2800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,638.09,,,,,,,354.9400,1375.1900,percent of total billed charges,"46.4% of $1,375.19 in Billed Charges for Rev 272 = $638.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA STRAIGHT KNOT FAST FIX,272,RC,,,,,,,,both,,,1375.1900,206.2800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,573.45,,,,,,,354.9400,1375.1900,percent of total billed charges,"41.7% of $1,375.19 in Billed Charges for Rev 272 = $573.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA STRAIGHT KNOT FAST FIX,272,RC,,,,,,,,both,,,1375.1900,206.2800,CIGNA HEALTHCARE,CIGNA PPO,573.45,,,,,,,354.9400,1375.1900,percent of total billed charges,"41.7% of $1,375.19 in Billed Charges for Rev 272 = $573.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA STRAIGHT KNOT FAST FIX,272,RC,,,,,,,,both,,,1375.1900,206.2800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1237.67,,,,,,,354.9400,1375.1900,percent of total billed charges,"90% of $1,375.19 in Billed Charges for Rev 272 = $1,237.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA STRAIGHT KNOT FAST FIX,272,RC,,,,,,,,both,,,1375.1900,206.2800,MEDCOST,MEDCOST VHN,654.45,,,,,,,354.9400,1375.1900,percent of total billed charges,"47.59% of $1,375.19 in Billed Charges for Rev 272 = $654.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA STRAIGHT KNOT FAST FIX,272,RC,,,,,,,,both,,,1375.1900,206.2800,SENTARA HEALTH,SENTARA HEALTH,354.94,,,,,,,354.9400,1375.1900,percent of total billed charges,"25.81% of $1,375.19 in Billed Charges for Rev 272 = $354.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA STRAIGHT KNOT FAST FIX,272,RC,,,,,,,,both,,,1375.1900,206.2800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1375.19,,,,,,,354.9400,1375.1900,percent of total billed charges,"100% of $1,375.19 in Billed Charges for Rev 272 = $1,375.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA STRAIGHT KNOT FAST FIX,272,RC,,,,,,,,both,,,1375.1900,206.2800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,687.60,,,,,,,354.9400,1375.1900,percent of total billed charges,"Rev 272 $1,375.19 in Billed Charges at 50% = $687.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA STRAIGHT KNOT FAST FIX,272,RC,,,,,,,,both,,,1375.1900,206.2800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,444.19,,,,,,,354.9400,1375.1900,other,"32.3% of $1,375.19 in Billed Charges for Rev 272 = $444.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA STRAIGHT KNOT FAST FIX,272,RC,,,,,,,,both,,,1375.1900,206.2800,UNITED HEALTHCARE,UHC HERITAGE SELECT,422.18,,,,,,,354.9400,1375.1900,other,"30.7% of $1,375.19 in Billed Charges for Rev 272 = $422.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA STRAIGHT KNOT FAST FIX,272,RC,,,,,,,,both,,,1375.1900,206.2800,UNITED HEALTHCARE,UNITED HEALTHCARE,444.19,,,,,,,354.9400,1375.1900,percent of total billed charges,"32.3% of $1,375.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA STRAIGHT KNOT FAST FIX,272,RC,,,,,,,,both,,,1375.1900,206.2800,WELLCARE,WELLCARE MEDICAID,1375.19,,,,,,,354.9400,1375.1900,percent of total billed charges,"100% of $1,375.19 in Billed Charges for Rev 272 = $1,375.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHLORAPREP TEAL TINT 10.5ML,270,RC,,,,,,,,both,,,34.7800,5.2200,AETNA,AETNA,14.85,,,,,,,8.9800,34.7800,percent of total billed charges,42.7% of $34.78 in Billed Charges for Rev 270 = $14.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CHLORAPREP TEAL TINT 10.5ML,270,RC,,,,,,,,both,,,34.7800,5.2200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,24.35,,,,,,,8.9800,34.7800,percent of total billed charges,Rev 270 $34.78 in Billed Charges at 70% = $24.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CHLORAPREP TEAL TINT 10.5ML,270,RC,,,,,,,,both,,,34.7800,5.2200,CIGNA HEALTHCARE,CIGNA HMO,14.50,,,,,,,8.9800,34.7800,percent of total billed charges,41.7% of $34.78 in Billed Charges for Rev 270 = $14.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CHLORAPREP TEAL TINT 10.5ML,270,RC,,,,,,,,both,,,34.7800,5.2200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,16.14,,,,,,,8.9800,34.7800,percent of total billed charges,46.4% of $34.78 in Billed Charges for Rev 270 = $16.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CHLORAPREP TEAL TINT 10.5ML,270,RC,,,,,,,,both,,,34.7800,5.2200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,14.50,,,,,,,8.9800,34.7800,percent of total billed charges,41.7% of $34.78 in Billed Charges for Rev 270 = $14.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CHLORAPREP TEAL TINT 10.5ML,270,RC,,,,,,,,both,,,34.7800,5.2200,CIGNA HEALTHCARE,CIGNA PPO,14.50,,,,,,,8.9800,34.7800,percent of total billed charges,41.7% of $34.78 in Billed Charges for Rev 270 = $14.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CHLORAPREP TEAL TINT 10.5ML,270,RC,,,,,,,,both,,,34.7800,5.2200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,31.30,,,,,,,8.9800,34.7800,percent of total billed charges,90% of $34.78 in Billed Charges for Rev 270 = $31.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CHLORAPREP TEAL TINT 10.5ML,270,RC,,,,,,,,both,,,34.7800,5.2200,MEDCOST,MEDCOST VHN,16.55,,,,,,,8.9800,34.7800,percent of total billed charges,47.59% of $34.78 in Billed Charges for Rev 270 = $16.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CHLORAPREP TEAL TINT 10.5ML,270,RC,,,,,,,,both,,,34.7800,5.2200,SENTARA HEALTH,SENTARA HEALTH,8.98,,,,,,,8.9800,34.7800,percent of total billed charges,25.81% of $34.78 in Billed Charges for Rev 270 = $8.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CHLORAPREP TEAL TINT 10.5ML,270,RC,,,,,,,,both,,,34.7800,5.2200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",34.78,,,,,,,8.9800,34.7800,percent of total billed charges,100% of $34.78 in Billed Charges for Rev 270 = $34.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CHLORAPREP TEAL TINT 10.5ML,270,RC,,,,,,,,both,,,34.7800,5.2200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,17.39,,,,,,,8.9800,34.7800,percent of total billed charges,Rev 270 $34.78 in Billed Charges at 50% = $17.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CHLORAPREP TEAL TINT 10.5ML,270,RC,,,,,,,,both,,,34.7800,5.2200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,11.23,,,,,,,8.9800,34.7800,other,32.3% of $34.78 in Billed Charges for Rev 270 = $11.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CHLORAPREP TEAL TINT 10.5ML,270,RC,,,,,,,,both,,,34.7800,5.2200,UNITED HEALTHCARE,UHC HERITAGE SELECT,10.68,,,,,,,8.9800,34.7800,other,30.7% of $34.78 in Billed Charges for Rev 270 = $10.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CHLORAPREP TEAL TINT 10.5ML,270,RC,,,,,,,,both,,,34.7800,5.2200,UNITED HEALTHCARE,UNITED HEALTHCARE,11.23,,,,,,,8.9800,34.7800,percent of total billed charges,32.3% of $34.78 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CHLORAPREP TEAL TINT 10.5ML,270,RC,,,,,,,,both,,,34.7800,5.2200,WELLCARE,WELLCARE MEDICAID,34.78,,,,,,,8.9800,34.7800,percent of total billed charges,100% of $34.78 in Billed Charges for Rev 270 = $34.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CHOLANGIOGRAPHY SET ARROW LAP,272,RC,27200002,CDM,,,,,,both,,,1232.0700,184.8100,AETNA,AETNA,526.09,,,,,,,318.0000,1232.0700,percent of total billed charges,"42.7% of $1,232.07 in Billed Charges for Rev 272 = $526.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHOLANGIOGRAPHY SET ARROW LAP,272,RC,27200002,CDM,,,,,,both,,,1232.0700,184.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,862.45,,,,,,,318.0000,1232.0700,percent of total billed charges,"Rev 272 $1,232.07 in Billed Charges at 70% = $862.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHOLANGIOGRAPHY SET ARROW LAP,272,RC,27200002,CDM,,,,,,both,,,1232.0700,184.8100,CIGNA HEALTHCARE,CIGNA HMO,513.77,,,,,,,318.0000,1232.0700,percent of total billed charges,"41.7% of $1,232.07 in Billed Charges for Rev 272 = $513.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHOLANGIOGRAPHY SET ARROW LAP,272,RC,27200002,CDM,,,,,,both,,,1232.0700,184.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,571.68,,,,,,,318.0000,1232.0700,percent of total billed charges,"46.4% of $1,232.07 in Billed Charges for Rev 272 = $571.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHOLANGIOGRAPHY SET ARROW LAP,272,RC,27200002,CDM,,,,,,both,,,1232.0700,184.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,513.77,,,,,,,318.0000,1232.0700,percent of total billed charges,"41.7% of $1,232.07 in Billed Charges for Rev 272 = $513.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHOLANGIOGRAPHY SET ARROW LAP,272,RC,27200002,CDM,,,,,,both,,,1232.0700,184.8100,CIGNA HEALTHCARE,CIGNA PPO,513.77,,,,,,,318.0000,1232.0700,percent of total billed charges,"41.7% of $1,232.07 in Billed Charges for Rev 272 = $513.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHOLANGIOGRAPHY SET ARROW LAP,272,RC,27200002,CDM,,,,,,both,,,1232.0700,184.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1108.86,,,,,,,318.0000,1232.0700,percent of total billed charges,"90% of $1,232.07 in Billed Charges for Rev 272 = $1,108.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHOLANGIOGRAPHY SET ARROW LAP,272,RC,27200002,CDM,,,,,,both,,,1232.0700,184.8100,MEDCOST,MEDCOST VHN,586.34,,,,,,,318.0000,1232.0700,percent of total billed charges,"47.59% of $1,232.07 in Billed Charges for Rev 272 = $586.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHOLANGIOGRAPHY SET ARROW LAP,272,RC,27200002,CDM,,,,,,both,,,1232.0700,184.8100,SENTARA HEALTH,SENTARA HEALTH,318.00,,,,,,,318.0000,1232.0700,percent of total billed charges,"25.81% of $1,232.07 in Billed Charges for Rev 272 = $318.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHOLANGIOGRAPHY SET ARROW LAP,272,RC,27200002,CDM,,,,,,both,,,1232.0700,184.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1232.07,,,,,,,318.0000,1232.0700,percent of total billed charges,"100% of $1,232.07 in Billed Charges for Rev 272 = $1,232.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHOLANGIOGRAPHY SET ARROW LAP,272,RC,27200002,CDM,,,,,,both,,,1232.0700,184.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,616.04,,,,,,,318.0000,1232.0700,percent of total billed charges,"Rev 272 $1,232.07 in Billed Charges at 50% = $616.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHOLANGIOGRAPHY SET ARROW LAP,272,RC,27200002,CDM,,,,,,both,,,1232.0700,184.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,397.96,,,,,,,318.0000,1232.0700,other,"32.3% of $1,232.07 in Billed Charges for Rev 272 = $397.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CHOLANGIOGRAPHY SET ARROW LAP,272,RC,27200002,CDM,,,,,,both,,,1232.0700,184.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,378.25,,,,,,,318.0000,1232.0700,other,"30.7% of $1,232.07 in Billed Charges for Rev 272 = $378.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CHOLANGIOGRAPHY SET ARROW LAP,272,RC,27200002,CDM,,,,,,both,,,1232.0700,184.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,397.96,,,,,,,318.0000,1232.0700,percent of total billed charges,"32.3% of $1,232.07 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHOLANGIOGRAPHY SET ARROW LAP,272,RC,27200002,CDM,,,,,,both,,,1232.0700,184.8100,WELLCARE,WELLCARE MEDICAID,1232.07,,,,,,,318.0000,1232.0700,percent of total billed charges,"100% of $1,232.07 in Billed Charges for Rev 272 = $1,232.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLOSURE MYNX CONTROL 6/7FR,272,RC,27200002,CDM,,,,,,both,,,2437.1900,365.5800,AETNA,AETNA,1040.68,,,,,,,629.0400,2437.1900,percent of total billed charges,"42.7% of $2,437.19 in Billed Charges for Rev 272 = $1,040.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLOSURE MYNX CONTROL 6/7FR,272,RC,27200002,CDM,,,,,,both,,,2437.1900,365.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1706.03,,,,,,,629.0400,2437.1900,percent of total billed charges,"Rev 272 $2,437.19 in Billed Charges at 70% = $1,706.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLOSURE MYNX CONTROL 6/7FR,272,RC,27200002,CDM,,,,,,both,,,2437.1900,365.5800,CIGNA HEALTHCARE,CIGNA HMO,1016.31,,,,,,,629.0400,2437.1900,percent of total billed charges,"41.7% of $2,437.19 in Billed Charges for Rev 272 = $1,016.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLOSURE MYNX CONTROL 6/7FR,272,RC,27200002,CDM,,,,,,both,,,2437.1900,365.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1130.86,,,,,,,629.0400,2437.1900,percent of total billed charges,"46.4% of $2,437.19 in Billed Charges for Rev 272 = $1,130.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLOSURE MYNX CONTROL 6/7FR,272,RC,27200002,CDM,,,,,,both,,,2437.1900,365.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1016.31,,,,,,,629.0400,2437.1900,percent of total billed charges,"41.7% of $2,437.19 in Billed Charges for Rev 272 = $1,016.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLOSURE MYNX CONTROL 6/7FR,272,RC,27200002,CDM,,,,,,both,,,2437.1900,365.5800,CIGNA HEALTHCARE,CIGNA PPO,1016.31,,,,,,,629.0400,2437.1900,percent of total billed charges,"41.7% of $2,437.19 in Billed Charges for Rev 272 = $1,016.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLOSURE MYNX CONTROL 6/7FR,272,RC,27200002,CDM,,,,,,both,,,2437.1900,365.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2193.47,,,,,,,629.0400,2437.1900,percent of total billed charges,"90% of $2,437.19 in Billed Charges for Rev 272 = $2,193.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLOSURE MYNX CONTROL 6/7FR,272,RC,27200002,CDM,,,,,,both,,,2437.1900,365.5800,MEDCOST,MEDCOST VHN,1159.86,,,,,,,629.0400,2437.1900,percent of total billed charges,"47.59% of $2,437.19 in Billed Charges for Rev 272 = $1,159.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLOSURE MYNX CONTROL 6/7FR,272,RC,27200002,CDM,,,,,,both,,,2437.1900,365.5800,SENTARA HEALTH,SENTARA HEALTH,629.04,,,,,,,629.0400,2437.1900,percent of total billed charges,"25.81% of $2,437.19 in Billed Charges for Rev 272 = $629.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLOSURE MYNX CONTROL 6/7FR,272,RC,27200002,CDM,,,,,,both,,,2437.1900,365.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2437.19,,,,,,,629.0400,2437.1900,percent of total billed charges,"100% of $2,437.19 in Billed Charges for Rev 272 = $2,437.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLOSURE MYNX CONTROL 6/7FR,272,RC,27200002,CDM,,,,,,both,,,2437.1900,365.5800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1218.60,,,,,,,629.0400,2437.1900,percent of total billed charges,"Rev 272 $2,437.19 in Billed Charges at 50% = $1,218.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLOSURE MYNX CONTROL 6/7FR,272,RC,27200002,CDM,,,,,,both,,,2437.1900,365.5800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,787.21,,,,,,,629.0400,2437.1900,other,"32.3% of $2,437.19 in Billed Charges for Rev 272 = $787.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE CLOSURE MYNX CONTROL 6/7FR,272,RC,27200002,CDM,,,,,,both,,,2437.1900,365.5800,UNITED HEALTHCARE,UHC HERITAGE SELECT,748.22,,,,,,,629.0400,2437.1900,other,"30.7% of $2,437.19 in Billed Charges for Rev 272 = $748.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE CLOSURE MYNX CONTROL 6/7FR,272,RC,27200002,CDM,,,,,,both,,,2437.1900,365.5800,UNITED HEALTHCARE,UNITED HEALTHCARE,787.21,,,,,,,629.0400,2437.1900,percent of total billed charges,"32.3% of $2,437.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE CLOSURE MYNX CONTROL 6/7FR,272,RC,27200002,CDM,,,,,,both,,,2437.1900,365.5800,WELLCARE,WELLCARE MEDICAID,2437.19,,,,,,,629.0400,2437.1900,percent of total billed charges,"100% of $2,437.19 in Billed Charges for Rev 272 = $2,437.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE COR-KNOT COMBO KIT,272,RC,27200002,CDM,,,,,,both,,,7933.8200,1190.0700,AETNA,AETNA,3387.74,,,,,,,2047.7200,7933.8200,percent of total billed charges,"42.7% of $7,933.82 in Billed Charges for Rev 272 = $3,387.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE COR-KNOT COMBO KIT,272,RC,27200002,CDM,,,,,,both,,,7933.8200,1190.0700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5553.67,,,,,,,2047.7200,7933.8200,percent of total billed charges,"Rev 272 $7,933.82 in Billed Charges at 70% = $5,553.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE COR-KNOT COMBO KIT,272,RC,27200002,CDM,,,,,,both,,,7933.8200,1190.0700,CIGNA HEALTHCARE,CIGNA HMO,3308.40,,,,,,,2047.7200,7933.8200,percent of total billed charges,"41.7% of $7,933.82 in Billed Charges for Rev 272 = $3,308.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE COR-KNOT COMBO KIT,272,RC,27200002,CDM,,,,,,both,,,7933.8200,1190.0700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3681.29,,,,,,,2047.7200,7933.8200,percent of total billed charges,"46.4% of $7,933.82 in Billed Charges for Rev 272 = $3,681.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE COR-KNOT COMBO KIT,272,RC,27200002,CDM,,,,,,both,,,7933.8200,1190.0700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3308.40,,,,,,,2047.7200,7933.8200,percent of total billed charges,"41.7% of $7,933.82 in Billed Charges for Rev 272 = $3,308.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE COR-KNOT COMBO KIT,272,RC,27200002,CDM,,,,,,both,,,7933.8200,1190.0700,CIGNA HEALTHCARE,CIGNA PPO,3308.40,,,,,,,2047.7200,7933.8200,percent of total billed charges,"41.7% of $7,933.82 in Billed Charges for Rev 272 = $3,308.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE COR-KNOT COMBO KIT,272,RC,27200002,CDM,,,,,,both,,,7933.8200,1190.0700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7140.44,,,,,,,2047.7200,7933.8200,percent of total billed charges,"90% of $7,933.82 in Billed Charges for Rev 272 = $7,140.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE COR-KNOT COMBO KIT,272,RC,27200002,CDM,,,,,,both,,,7933.8200,1190.0700,MEDCOST,MEDCOST VHN,3775.70,,,,,,,2047.7200,7933.8200,percent of total billed charges,"47.59% of $7,933.82 in Billed Charges for Rev 272 = $3,775.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE COR-KNOT COMBO KIT,272,RC,27200002,CDM,,,,,,both,,,7933.8200,1190.0700,SENTARA HEALTH,SENTARA HEALTH,2047.72,,,,,,,2047.7200,7933.8200,percent of total billed charges,"25.81% of $7,933.82 in Billed Charges for Rev 272 = $2,047.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE COR-KNOT COMBO KIT,272,RC,27200002,CDM,,,,,,both,,,7933.8200,1190.0700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7933.82,,,,,,,2047.7200,7933.8200,percent of total billed charges,"100% of $7,933.82 in Billed Charges for Rev 272 = $7,933.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE COR-KNOT COMBO KIT,272,RC,27200002,CDM,,,,,,both,,,7933.8200,1190.0700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3966.91,,,,,,,2047.7200,7933.8200,percent of total billed charges,"Rev 272 $7,933.82 in Billed Charges at 50% = $3,966.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE COR-KNOT COMBO KIT,272,RC,27200002,CDM,,,,,,both,,,7933.8200,1190.0700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2562.62,,,,,,,2047.7200,7933.8200,other,"32.3% of $7,933.82 in Billed Charges for Rev 272 = $2,562.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE COR-KNOT COMBO KIT,272,RC,27200002,CDM,,,,,,both,,,7933.8200,1190.0700,UNITED HEALTHCARE,UHC HERITAGE SELECT,2435.68,,,,,,,2047.7200,7933.8200,other,"30.7% of $7,933.82 in Billed Charges for Rev 272 = $2,435.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE COR-KNOT COMBO KIT,272,RC,27200002,CDM,,,,,,both,,,7933.8200,1190.0700,UNITED HEALTHCARE,UNITED HEALTHCARE,2562.62,,,,,,,2047.7200,7933.8200,percent of total billed charges,"32.3% of $7,933.82 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE COR-KNOT COMBO KIT,272,RC,27200002,CDM,,,,,,both,,,7933.8200,1190.0700,WELLCARE,WELLCARE MEDICAID,7933.82,,,,,,,2047.7200,7933.8200,percent of total billed charges,"100% of $7,933.82 in Billed Charges for Rev 272 = $7,933.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GASPING TALON,272,RC,27200002,CDM,,,,,,both,,,1369.9500,205.4900,AETNA,AETNA,584.97,,,,,,,353.5800,1369.9500,percent of total billed charges,"42.7% of $1,369.95 in Billed Charges for Rev 272 = $584.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GASPING TALON,272,RC,27200002,CDM,,,,,,both,,,1369.9500,205.4900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,958.97,,,,,,,353.5800,1369.9500,percent of total billed charges,"Rev 272 $1,369.95 in Billed Charges at 70% = $958.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GASPING TALON,272,RC,27200002,CDM,,,,,,both,,,1369.9500,205.4900,CIGNA HEALTHCARE,CIGNA HMO,571.27,,,,,,,353.5800,1369.9500,percent of total billed charges,"41.7% of $1,369.95 in Billed Charges for Rev 272 = $571.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GASPING TALON,272,RC,27200002,CDM,,,,,,both,,,1369.9500,205.4900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,635.66,,,,,,,353.5800,1369.9500,percent of total billed charges,"46.4% of $1,369.95 in Billed Charges for Rev 272 = $635.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GASPING TALON,272,RC,27200002,CDM,,,,,,both,,,1369.9500,205.4900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,571.27,,,,,,,353.5800,1369.9500,percent of total billed charges,"41.7% of $1,369.95 in Billed Charges for Rev 272 = $571.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GASPING TALON,272,RC,27200002,CDM,,,,,,both,,,1369.9500,205.4900,CIGNA HEALTHCARE,CIGNA PPO,571.27,,,,,,,353.5800,1369.9500,percent of total billed charges,"41.7% of $1,369.95 in Billed Charges for Rev 272 = $571.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GASPING TALON,272,RC,27200002,CDM,,,,,,both,,,1369.9500,205.4900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1232.96,,,,,,,353.5800,1369.9500,percent of total billed charges,"90% of $1,369.95 in Billed Charges for Rev 272 = $1,232.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GASPING TALON,272,RC,27200002,CDM,,,,,,both,,,1369.9500,205.4900,MEDCOST,MEDCOST VHN,651.96,,,,,,,353.5800,1369.9500,percent of total billed charges,"47.59% of $1,369.95 in Billed Charges for Rev 272 = $651.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GASPING TALON,272,RC,27200002,CDM,,,,,,both,,,1369.9500,205.4900,SENTARA HEALTH,SENTARA HEALTH,353.58,,,,,,,353.5800,1369.9500,percent of total billed charges,"25.81% of $1,369.95 in Billed Charges for Rev 272 = $353.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GASPING TALON,272,RC,27200002,CDM,,,,,,both,,,1369.9500,205.4900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1369.95,,,,,,,353.5800,1369.9500,percent of total billed charges,"100% of $1,369.95 in Billed Charges for Rev 272 = $1,369.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GASPING TALON,272,RC,27200002,CDM,,,,,,both,,,1369.9500,205.4900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,684.98,,,,,,,353.5800,1369.9500,percent of total billed charges,"Rev 272 $1,369.95 in Billed Charges at 50% = $684.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GASPING TALON,272,RC,27200002,CDM,,,,,,both,,,1369.9500,205.4900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,442.49,,,,,,,353.5800,1369.9500,other,"32.3% of $1,369.95 in Billed Charges for Rev 272 = $442.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE GASPING TALON,272,RC,27200002,CDM,,,,,,both,,,1369.9500,205.4900,UNITED HEALTHCARE,UHC HERITAGE SELECT,420.57,,,,,,,353.5800,1369.9500,other,"30.7% of $1,369.95 in Billed Charges for Rev 272 = $420.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE GASPING TALON,272,RC,27200002,CDM,,,,,,both,,,1369.9500,205.4900,UNITED HEALTHCARE,UNITED HEALTHCARE,442.49,,,,,,,353.5800,1369.9500,percent of total billed charges,"32.3% of $1,369.95 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE GASPING TALON,272,RC,27200002,CDM,,,,,,both,,,1369.9500,205.4900,WELLCARE,WELLCARE MEDICAID,1369.95,,,,,,,353.5800,1369.9500,percent of total billed charges,"100% of $1,369.95 in Billed Charges for Rev 272 = $1,369.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHUCK UNIVERSAL WITH T-HANDLE,272,RC,,,,,,,,both,,,9670.0200,1450.5000,AETNA,AETNA,4129.10,,,,,,,2495.8300,9670.0200,percent of total billed charges,"42.7% of $9,670.02 in Billed Charges for Rev 272 = $4,129.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHUCK UNIVERSAL WITH T-HANDLE,272,RC,,,,,,,,both,,,9670.0200,1450.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6769.01,,,,,,,2495.8300,9670.0200,percent of total billed charges,"Rev 272 $9,670.02 in Billed Charges at 70% = $6,769.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHUCK UNIVERSAL WITH T-HANDLE,272,RC,,,,,,,,both,,,9670.0200,1450.5000,CIGNA HEALTHCARE,CIGNA HMO,4032.40,,,,,,,2495.8300,9670.0200,percent of total billed charges,"41.7% of $9,670.02 in Billed Charges for Rev 272 = $4,032.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHUCK UNIVERSAL WITH T-HANDLE,272,RC,,,,,,,,both,,,9670.0200,1450.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4486.89,,,,,,,2495.8300,9670.0200,percent of total billed charges,"46.4% of $9,670.02 in Billed Charges for Rev 272 = $4,486.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHUCK UNIVERSAL WITH T-HANDLE,272,RC,,,,,,,,both,,,9670.0200,1450.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4032.40,,,,,,,2495.8300,9670.0200,percent of total billed charges,"41.7% of $9,670.02 in Billed Charges for Rev 272 = $4,032.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHUCK UNIVERSAL WITH T-HANDLE,272,RC,,,,,,,,both,,,9670.0200,1450.5000,CIGNA HEALTHCARE,CIGNA PPO,4032.40,,,,,,,2495.8300,9670.0200,percent of total billed charges,"41.7% of $9,670.02 in Billed Charges for Rev 272 = $4,032.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHUCK UNIVERSAL WITH T-HANDLE,272,RC,,,,,,,,both,,,9670.0200,1450.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8703.02,,,,,,,2495.8300,9670.0200,percent of total billed charges,"90% of $9,670.02 in Billed Charges for Rev 272 = $8,703.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHUCK UNIVERSAL WITH T-HANDLE,272,RC,,,,,,,,both,,,9670.0200,1450.5000,MEDCOST,MEDCOST VHN,4601.96,,,,,,,2495.8300,9670.0200,percent of total billed charges,"47.59% of $9,670.02 in Billed Charges for Rev 272 = $4,601.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHUCK UNIVERSAL WITH T-HANDLE,272,RC,,,,,,,,both,,,9670.0200,1450.5000,SENTARA HEALTH,SENTARA HEALTH,2495.83,,,,,,,2495.8300,9670.0200,percent of total billed charges,"25.81% of $9,670.02 in Billed Charges for Rev 272 = $2,495.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHUCK UNIVERSAL WITH T-HANDLE,272,RC,,,,,,,,both,,,9670.0200,1450.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9670.02,,,,,,,2495.8300,9670.0200,percent of total billed charges,"100% of $9,670.02 in Billed Charges for Rev 272 = $9,670.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHUCK UNIVERSAL WITH T-HANDLE,272,RC,,,,,,,,both,,,9670.0200,1450.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4835.01,,,,,,,2495.8300,9670.0200,percent of total billed charges,"Rev 272 $9,670.02 in Billed Charges at 50% = $4,835.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHUCK UNIVERSAL WITH T-HANDLE,272,RC,,,,,,,,both,,,9670.0200,1450.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3123.42,,,,,,,2495.8300,9670.0200,other,"32.3% of $9,670.02 in Billed Charges for Rev 272 = $3,123.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CHUCK UNIVERSAL WITH T-HANDLE,272,RC,,,,,,,,both,,,9670.0200,1450.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2968.70,,,,,,,2495.8300,9670.0200,other,"30.7% of $9,670.02 in Billed Charges for Rev 272 = $2,968.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CHUCK UNIVERSAL WITH T-HANDLE,272,RC,,,,,,,,both,,,9670.0200,1450.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,3123.42,,,,,,,2495.8300,9670.0200,percent of total billed charges,"32.3% of $9,670.02 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHUCK UNIVERSAL WITH T-HANDLE,272,RC,,,,,,,,both,,,9670.0200,1450.5000,WELLCARE,WELLCARE MEDICAID,9670.02,,,,,,,2495.8300,9670.0200,percent of total billed charges,"100% of $9,670.02 in Billed Charges for Rev 272 = $9,670.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CI PACK SHOULDER ARTHRO,272,RC,,,,,,,,both,,,720.2700,108.0400,AETNA,AETNA,307.56,,,,,,,185.9000,720.2700,percent of total billed charges,42.7% of $720.27 in Billed Charges for Rev 272 = $307.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CI PACK SHOULDER ARTHRO,272,RC,,,,,,,,both,,,720.2700,108.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,504.19,,,,,,,185.9000,720.2700,percent of total billed charges,Rev 272 $720.27 in Billed Charges at 70% = $504.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CI PACK SHOULDER ARTHRO,272,RC,,,,,,,,both,,,720.2700,108.0400,CIGNA HEALTHCARE,CIGNA HMO,300.35,,,,,,,185.9000,720.2700,percent of total billed charges,41.7% of $720.27 in Billed Charges for Rev 272 = $300.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CI PACK SHOULDER ARTHRO,272,RC,,,,,,,,both,,,720.2700,108.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,334.21,,,,,,,185.9000,720.2700,percent of total billed charges,46.4% of $720.27 in Billed Charges for Rev 272 = $334.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CI PACK SHOULDER ARTHRO,272,RC,,,,,,,,both,,,720.2700,108.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,300.35,,,,,,,185.9000,720.2700,percent of total billed charges,41.7% of $720.27 in Billed Charges for Rev 272 = $300.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CI PACK SHOULDER ARTHRO,272,RC,,,,,,,,both,,,720.2700,108.0400,CIGNA HEALTHCARE,CIGNA PPO,300.35,,,,,,,185.9000,720.2700,percent of total billed charges,41.7% of $720.27 in Billed Charges for Rev 272 = $300.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CI PACK SHOULDER ARTHRO,272,RC,,,,,,,,both,,,720.2700,108.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,648.24,,,,,,,185.9000,720.2700,percent of total billed charges,90% of $720.27 in Billed Charges for Rev 272 = $648.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CI PACK SHOULDER ARTHRO,272,RC,,,,,,,,both,,,720.2700,108.0400,MEDCOST,MEDCOST VHN,342.78,,,,,,,185.9000,720.2700,percent of total billed charges,47.59% of $720.27 in Billed Charges for Rev 272 = $342.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CI PACK SHOULDER ARTHRO,272,RC,,,,,,,,both,,,720.2700,108.0400,SENTARA HEALTH,SENTARA HEALTH,185.90,,,,,,,185.9000,720.2700,percent of total billed charges,25.81% of $720.27 in Billed Charges for Rev 272 = $185.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CI PACK SHOULDER ARTHRO,272,RC,,,,,,,,both,,,720.2700,108.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",720.27,,,,,,,185.9000,720.2700,percent of total billed charges,100% of $720.27 in Billed Charges for Rev 272 = $720.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CI PACK SHOULDER ARTHRO,272,RC,,,,,,,,both,,,720.2700,108.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,360.14,,,,,,,185.9000,720.2700,percent of total billed charges,Rev 272 $720.27 in Billed Charges at 50% = $360.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CI PACK SHOULDER ARTHRO,272,RC,,,,,,,,both,,,720.2700,108.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,232.65,,,,,,,185.9000,720.2700,other,32.3% of $720.27 in Billed Charges for Rev 272 = $232.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CI PACK SHOULDER ARTHRO,272,RC,,,,,,,,both,,,720.2700,108.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,221.12,,,,,,,185.9000,720.2700,other,30.7% of $720.27 in Billed Charges for Rev 272 = $221.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CI PACK SHOULDER ARTHRO,272,RC,,,,,,,,both,,,720.2700,108.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,232.65,,,,,,,185.9000,720.2700,percent of total billed charges,32.3% of $720.27 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CI PACK SHOULDER ARTHRO,272,RC,,,,,,,,both,,,720.2700,108.0400,WELLCARE,WELLCARE MEDICAID,720.27,,,,,,,185.9000,720.2700,percent of total billed charges,100% of $720.27 in Billed Charges for Rev 272 = $720.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CLAMP 8.0MM/11.0MM COMB MR SAF,272,RC,27200002,CDM,,,,,,both,,,5461.5800,819.2400,AETNA,AETNA,2332.09,,,,,,,1409.6300,5461.5800,percent of total billed charges,"42.7% of $5,461.58 in Billed Charges for Rev 272 = $2,332.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP 8.0MM/11.0MM COMB MR SAF,272,RC,27200002,CDM,,,,,,both,,,5461.5800,819.2400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3823.11,,,,,,,1409.6300,5461.5800,percent of total billed charges,"Rev 272 $5,461.58 in Billed Charges at 70% = $3,823.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP 8.0MM/11.0MM COMB MR SAF,272,RC,27200002,CDM,,,,,,both,,,5461.5800,819.2400,CIGNA HEALTHCARE,CIGNA HMO,2277.48,,,,,,,1409.6300,5461.5800,percent of total billed charges,"41.7% of $5,461.58 in Billed Charges for Rev 272 = $2,277.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP 8.0MM/11.0MM COMB MR SAF,272,RC,27200002,CDM,,,,,,both,,,5461.5800,819.2400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2534.17,,,,,,,1409.6300,5461.5800,percent of total billed charges,"46.4% of $5,461.58 in Billed Charges for Rev 272 = $2,534.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP 8.0MM/11.0MM COMB MR SAF,272,RC,27200002,CDM,,,,,,both,,,5461.5800,819.2400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2277.48,,,,,,,1409.6300,5461.5800,percent of total billed charges,"41.7% of $5,461.58 in Billed Charges for Rev 272 = $2,277.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP 8.0MM/11.0MM COMB MR SAF,272,RC,27200002,CDM,,,,,,both,,,5461.5800,819.2400,CIGNA HEALTHCARE,CIGNA PPO,2277.48,,,,,,,1409.6300,5461.5800,percent of total billed charges,"41.7% of $5,461.58 in Billed Charges for Rev 272 = $2,277.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP 8.0MM/11.0MM COMB MR SAF,272,RC,27200002,CDM,,,,,,both,,,5461.5800,819.2400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4915.42,,,,,,,1409.6300,5461.5800,percent of total billed charges,"90% of $5,461.58 in Billed Charges for Rev 272 = $4,915.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP 8.0MM/11.0MM COMB MR SAF,272,RC,27200002,CDM,,,,,,both,,,5461.5800,819.2400,MEDCOST,MEDCOST VHN,2599.17,,,,,,,1409.6300,5461.5800,percent of total billed charges,"47.59% of $5,461.58 in Billed Charges for Rev 272 = $2,599.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP 8.0MM/11.0MM COMB MR SAF,272,RC,27200002,CDM,,,,,,both,,,5461.5800,819.2400,SENTARA HEALTH,SENTARA HEALTH,1409.63,,,,,,,1409.6300,5461.5800,percent of total billed charges,"25.81% of $5,461.58 in Billed Charges for Rev 272 = $1,409.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP 8.0MM/11.0MM COMB MR SAF,272,RC,27200002,CDM,,,,,,both,,,5461.5800,819.2400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5461.58,,,,,,,1409.6300,5461.5800,percent of total billed charges,"100% of $5,461.58 in Billed Charges for Rev 272 = $5,461.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP 8.0MM/11.0MM COMB MR SAF,272,RC,27200002,CDM,,,,,,both,,,5461.5800,819.2400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2730.79,,,,,,,1409.6300,5461.5800,percent of total billed charges,"Rev 272 $5,461.58 in Billed Charges at 50% = $2,730.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP 8.0MM/11.0MM COMB MR SAF,272,RC,27200002,CDM,,,,,,both,,,5461.5800,819.2400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1764.09,,,,,,,1409.6300,5461.5800,other,"32.3% of $5,461.58 in Billed Charges for Rev 272 = $1,764.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP 8.0MM/11.0MM COMB MR SAF,272,RC,27200002,CDM,,,,,,both,,,5461.5800,819.2400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1676.71,,,,,,,1409.6300,5461.5800,other,"30.7% of $5,461.58 in Billed Charges for Rev 272 = $1,676.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP 8.0MM/11.0MM COMB MR SAF,272,RC,27200002,CDM,,,,,,both,,,5461.5800,819.2400,UNITED HEALTHCARE,UNITED HEALTHCARE,1764.09,,,,,,,1409.6300,5461.5800,percent of total billed charges,"32.3% of $5,461.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP 8.0MM/11.0MM COMB MR SAF,272,RC,27200002,CDM,,,,,,both,,,5461.5800,819.2400,WELLCARE,WELLCARE MEDICAID,5461.58,,,,,,,1409.6300,5461.5800,percent of total billed charges,"100% of $5,461.58 in Billed Charges for Rev 272 = $5,461.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP BAR TO BAR,272,RC,,,,,,,,both,,,8462.7400,1269.4100,AETNA,AETNA,3613.59,,,,,,,2184.2300,8462.7400,percent of total billed charges,"42.7% of $8,462.74 in Billed Charges for Rev 272 = $3,613.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP BAR TO BAR,272,RC,,,,,,,,both,,,8462.7400,1269.4100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5923.92,,,,,,,2184.2300,8462.7400,percent of total billed charges,"Rev 272 $8,462.74 in Billed Charges at 70% = $5,923.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP BAR TO BAR,272,RC,,,,,,,,both,,,8462.7400,1269.4100,CIGNA HEALTHCARE,CIGNA HMO,3528.96,,,,,,,2184.2300,8462.7400,percent of total billed charges,"41.7% of $8,462.74 in Billed Charges for Rev 272 = $3,528.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP BAR TO BAR,272,RC,,,,,,,,both,,,8462.7400,1269.4100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3926.71,,,,,,,2184.2300,8462.7400,percent of total billed charges,"46.4% of $8,462.74 in Billed Charges for Rev 272 = $3,926.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP BAR TO BAR,272,RC,,,,,,,,both,,,8462.7400,1269.4100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3528.96,,,,,,,2184.2300,8462.7400,percent of total billed charges,"41.7% of $8,462.74 in Billed Charges for Rev 272 = $3,528.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP BAR TO BAR,272,RC,,,,,,,,both,,,8462.7400,1269.4100,CIGNA HEALTHCARE,CIGNA PPO,3528.96,,,,,,,2184.2300,8462.7400,percent of total billed charges,"41.7% of $8,462.74 in Billed Charges for Rev 272 = $3,528.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP BAR TO BAR,272,RC,,,,,,,,both,,,8462.7400,1269.4100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7616.47,,,,,,,2184.2300,8462.7400,percent of total billed charges,"90% of $8,462.74 in Billed Charges for Rev 272 = $7,616.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP BAR TO BAR,272,RC,,,,,,,,both,,,8462.7400,1269.4100,MEDCOST,MEDCOST VHN,4027.42,,,,,,,2184.2300,8462.7400,percent of total billed charges,"47.59% of $8,462.74 in Billed Charges for Rev 272 = $4,027.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP BAR TO BAR,272,RC,,,,,,,,both,,,8462.7400,1269.4100,SENTARA HEALTH,SENTARA HEALTH,2184.23,,,,,,,2184.2300,8462.7400,percent of total billed charges,"25.81% of $8,462.74 in Billed Charges for Rev 272 = $2,184.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP BAR TO BAR,272,RC,,,,,,,,both,,,8462.7400,1269.4100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8462.74,,,,,,,2184.2300,8462.7400,percent of total billed charges,"100% of $8,462.74 in Billed Charges for Rev 272 = $8,462.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP BAR TO BAR,272,RC,,,,,,,,both,,,8462.7400,1269.4100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4231.37,,,,,,,2184.2300,8462.7400,percent of total billed charges,"Rev 272 $8,462.74 in Billed Charges at 50% = $4,231.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP BAR TO BAR,272,RC,,,,,,,,both,,,8462.7400,1269.4100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2733.47,,,,,,,2184.2300,8462.7400,other,"32.3% of $8,462.74 in Billed Charges for Rev 272 = $2,733.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP BAR TO BAR,272,RC,,,,,,,,both,,,8462.7400,1269.4100,UNITED HEALTHCARE,UHC HERITAGE SELECT,2598.06,,,,,,,2184.2300,8462.7400,other,"30.7% of $8,462.74 in Billed Charges for Rev 272 = $2,598.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP BAR TO BAR,272,RC,,,,,,,,both,,,8462.7400,1269.4100,UNITED HEALTHCARE,UNITED HEALTHCARE,2733.47,,,,,,,2184.2300,8462.7400,percent of total billed charges,"32.3% of $8,462.74 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP BAR TO BAR,272,RC,,,,,,,,both,,,8462.7400,1269.4100,WELLCARE,WELLCARE MEDICAID,8462.74,,,,,,,2184.2300,8462.7400,percent of total billed charges,"100% of $8,462.74 in Billed Charges for Rev 272 = $8,462.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP EXTERNAL FIXATION LAMP SYMMETRICAL FOR 4MM PIN,272,RC,27200002,CDM,,,,,,both,,,4546.4400,681.9700,AETNA,AETNA,1941.33,,,,,,,1173.4400,4546.4400,percent of total billed charges,"42.7% of $4,546.44 in Billed Charges for Rev 272 = $1,941.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP EXTERNAL FIXATION LAMP SYMMETRICAL FOR 4MM PIN,272,RC,27200002,CDM,,,,,,both,,,4546.4400,681.9700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3182.51,,,,,,,1173.4400,4546.4400,percent of total billed charges,"Rev 272 $4,546.44 in Billed Charges at 70% = $3,182.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP EXTERNAL FIXATION LAMP SYMMETRICAL FOR 4MM PIN,272,RC,27200002,CDM,,,,,,both,,,4546.4400,681.9700,CIGNA HEALTHCARE,CIGNA HMO,1895.87,,,,,,,1173.4400,4546.4400,percent of total billed charges,"41.7% of $4,546.44 in Billed Charges for Rev 272 = $1,895.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP EXTERNAL FIXATION LAMP SYMMETRICAL FOR 4MM PIN,272,RC,27200002,CDM,,,,,,both,,,4546.4400,681.9700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2109.55,,,,,,,1173.4400,4546.4400,percent of total billed charges,"46.4% of $4,546.44 in Billed Charges for Rev 272 = $2,109.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP EXTERNAL FIXATION LAMP SYMMETRICAL FOR 4MM PIN,272,RC,27200002,CDM,,,,,,both,,,4546.4400,681.9700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1895.87,,,,,,,1173.4400,4546.4400,percent of total billed charges,"41.7% of $4,546.44 in Billed Charges for Rev 272 = $1,895.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP EXTERNAL FIXATION LAMP SYMMETRICAL FOR 4MM PIN,272,RC,27200002,CDM,,,,,,both,,,4546.4400,681.9700,CIGNA HEALTHCARE,CIGNA PPO,1895.87,,,,,,,1173.4400,4546.4400,percent of total billed charges,"41.7% of $4,546.44 in Billed Charges for Rev 272 = $1,895.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP EXTERNAL FIXATION LAMP SYMMETRICAL FOR 4MM PIN,272,RC,27200002,CDM,,,,,,both,,,4546.4400,681.9700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4091.80,,,,,,,1173.4400,4546.4400,percent of total billed charges,"90% of $4,546.44 in Billed Charges for Rev 272 = $4,091.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP EXTERNAL FIXATION LAMP SYMMETRICAL FOR 4MM PIN,272,RC,27200002,CDM,,,,,,both,,,4546.4400,681.9700,MEDCOST,MEDCOST VHN,2163.65,,,,,,,1173.4400,4546.4400,percent of total billed charges,"47.59% of $4,546.44 in Billed Charges for Rev 272 = $2,163.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP EXTERNAL FIXATION LAMP SYMMETRICAL FOR 4MM PIN,272,RC,27200002,CDM,,,,,,both,,,4546.4400,681.9700,SENTARA HEALTH,SENTARA HEALTH,1173.44,,,,,,,1173.4400,4546.4400,percent of total billed charges,"25.81% of $4,546.44 in Billed Charges for Rev 272 = $1,173.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP EXTERNAL FIXATION LAMP SYMMETRICAL FOR 4MM PIN,272,RC,27200002,CDM,,,,,,both,,,4546.4400,681.9700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4546.44,,,,,,,1173.4400,4546.4400,percent of total billed charges,"100% of $4,546.44 in Billed Charges for Rev 272 = $4,546.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP EXTERNAL FIXATION LAMP SYMMETRICAL FOR 4MM PIN,272,RC,27200002,CDM,,,,,,both,,,4546.4400,681.9700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2273.22,,,,,,,1173.4400,4546.4400,percent of total billed charges,"Rev 272 $4,546.44 in Billed Charges at 50% = $2,273.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP EXTERNAL FIXATION LAMP SYMMETRICAL FOR 4MM PIN,272,RC,27200002,CDM,,,,,,both,,,4546.4400,681.9700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1468.50,,,,,,,1173.4400,4546.4400,other,"32.3% of $4,546.44 in Billed Charges for Rev 272 = $1,468.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP EXTERNAL FIXATION LAMP SYMMETRICAL FOR 4MM PIN,272,RC,27200002,CDM,,,,,,both,,,4546.4400,681.9700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1395.76,,,,,,,1173.4400,4546.4400,other,"30.7% of $4,546.44 in Billed Charges for Rev 272 = $1,395.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP EXTERNAL FIXATION LAMP SYMMETRICAL FOR 4MM PIN,272,RC,27200002,CDM,,,,,,both,,,4546.4400,681.9700,UNITED HEALTHCARE,UNITED HEALTHCARE,1468.50,,,,,,,1173.4400,4546.4400,percent of total billed charges,"32.3% of $4,546.44 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP EXTERNAL FIXATION LAMP SYMMETRICAL FOR 4MM PIN,272,RC,27200002,CDM,,,,,,both,,,4546.4400,681.9700,WELLCARE,WELLCARE MEDICAID,4546.44,,,,,,,1173.4400,4546.4400,percent of total billed charges,"100% of $4,546.44 in Billed Charges for Rev 272 = $4,546.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP FIXATION ADJUSTABLE DIST RADIUS 4.0 390.051,272,RC,27200002,CDM,,,,,,both,,,6864.3600,1029.6500,AETNA,AETNA,2931.08,,,,,,,1771.6900,6864.3600,percent of total billed charges,"42.7% of $6,864.36 in Billed Charges for Rev 272 = $2,931.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP FIXATION ADJUSTABLE DIST RADIUS 4.0 390.051,272,RC,27200002,CDM,,,,,,both,,,6864.3600,1029.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4805.05,,,,,,,1771.6900,6864.3600,percent of total billed charges,"Rev 272 $6,864.36 in Billed Charges at 70% = $4,805.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP FIXATION ADJUSTABLE DIST RADIUS 4.0 390.051,272,RC,27200002,CDM,,,,,,both,,,6864.3600,1029.6500,CIGNA HEALTHCARE,CIGNA HMO,2862.44,,,,,,,1771.6900,6864.3600,percent of total billed charges,"41.7% of $6,864.36 in Billed Charges for Rev 272 = $2,862.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP FIXATION ADJUSTABLE DIST RADIUS 4.0 390.051,272,RC,27200002,CDM,,,,,,both,,,6864.3600,1029.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3185.06,,,,,,,1771.6900,6864.3600,percent of total billed charges,"46.4% of $6,864.36 in Billed Charges for Rev 272 = $3,185.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP FIXATION ADJUSTABLE DIST RADIUS 4.0 390.051,272,RC,27200002,CDM,,,,,,both,,,6864.3600,1029.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2862.44,,,,,,,1771.6900,6864.3600,percent of total billed charges,"41.7% of $6,864.36 in Billed Charges for Rev 272 = $2,862.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP FIXATION ADJUSTABLE DIST RADIUS 4.0 390.051,272,RC,27200002,CDM,,,,,,both,,,6864.3600,1029.6500,CIGNA HEALTHCARE,CIGNA PPO,2862.44,,,,,,,1771.6900,6864.3600,percent of total billed charges,"41.7% of $6,864.36 in Billed Charges for Rev 272 = $2,862.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP FIXATION ADJUSTABLE DIST RADIUS 4.0 390.051,272,RC,27200002,CDM,,,,,,both,,,6864.3600,1029.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6177.92,,,,,,,1771.6900,6864.3600,percent of total billed charges,"90% of $6,864.36 in Billed Charges for Rev 272 = $6,177.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP FIXATION ADJUSTABLE DIST RADIUS 4.0 390.051,272,RC,27200002,CDM,,,,,,both,,,6864.3600,1029.6500,MEDCOST,MEDCOST VHN,3266.75,,,,,,,1771.6900,6864.3600,percent of total billed charges,"47.59% of $6,864.36 in Billed Charges for Rev 272 = $3,266.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP FIXATION ADJUSTABLE DIST RADIUS 4.0 390.051,272,RC,27200002,CDM,,,,,,both,,,6864.3600,1029.6500,SENTARA HEALTH,SENTARA HEALTH,1771.69,,,,,,,1771.6900,6864.3600,percent of total billed charges,"25.81% of $6,864.36 in Billed Charges for Rev 272 = $1,771.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP FIXATION ADJUSTABLE DIST RADIUS 4.0 390.051,272,RC,27200002,CDM,,,,,,both,,,6864.3600,1029.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6864.36,,,,,,,1771.6900,6864.3600,percent of total billed charges,"100% of $6,864.36 in Billed Charges for Rev 272 = $6,864.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP FIXATION ADJUSTABLE DIST RADIUS 4.0 390.051,272,RC,27200002,CDM,,,,,,both,,,6864.3600,1029.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3432.18,,,,,,,1771.6900,6864.3600,percent of total billed charges,"Rev 272 $6,864.36 in Billed Charges at 50% = $3,432.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP FIXATION ADJUSTABLE DIST RADIUS 4.0 390.051,272,RC,27200002,CDM,,,,,,both,,,6864.3600,1029.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2217.19,,,,,,,1771.6900,6864.3600,other,"32.3% of $6,864.36 in Billed Charges for Rev 272 = $2,217.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP FIXATION ADJUSTABLE DIST RADIUS 4.0 390.051,272,RC,27200002,CDM,,,,,,both,,,6864.3600,1029.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2107.36,,,,,,,1771.6900,6864.3600,other,"30.7% of $6,864.36 in Billed Charges for Rev 272 = $2,107.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP FIXATION ADJUSTABLE DIST RADIUS 4.0 390.051,272,RC,27200002,CDM,,,,,,both,,,6864.3600,1029.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,2217.19,,,,,,,1771.6900,6864.3600,percent of total billed charges,"32.3% of $6,864.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP FIXATION ADJUSTABLE DIST RADIUS 4.0 390.051,272,RC,27200002,CDM,,,,,,both,,,6864.3600,1029.6500,WELLCARE,WELLCARE MEDICAID,6864.36,,,,,,,1771.6900,6864.3600,percent of total billed charges,"100% of $6,864.36 in Billed Charges for Rev 272 = $6,864.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MYOSURE TISSUE REMOVING SYS W/LESS THAN 1MM DISTAL,272,RC,27200002,CDM,,,,,,both,,,11978.5100,1796.7800,AETNA,AETNA,5114.82,,,,,,,3091.6500,11978.5100,percent of total billed charges,"42.7% of $11,978.51 in Billed Charges for Rev 272 = $5,114.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MYOSURE TISSUE REMOVING SYS W/LESS THAN 1MM DISTAL,272,RC,27200002,CDM,,,,,,both,,,11978.5100,1796.7800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8384.96,,,,,,,3091.6500,11978.5100,percent of total billed charges,"Rev 272 $11,978.51 in Billed Charges at 70% = $8,384.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MYOSURE TISSUE REMOVING SYS W/LESS THAN 1MM DISTAL,272,RC,27200002,CDM,,,,,,both,,,11978.5100,1796.7800,CIGNA HEALTHCARE,CIGNA HMO,4995.04,,,,,,,3091.6500,11978.5100,percent of total billed charges,"41.7% of $11,978.51 in Billed Charges for Rev 272 = $4,995.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MYOSURE TISSUE REMOVING SYS W/LESS THAN 1MM DISTAL,272,RC,27200002,CDM,,,,,,both,,,11978.5100,1796.7800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5558.03,,,,,,,3091.6500,11978.5100,percent of total billed charges,"46.4% of $11,978.51 in Billed Charges for Rev 272 = $5,558.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MYOSURE TISSUE REMOVING SYS W/LESS THAN 1MM DISTAL,272,RC,27200002,CDM,,,,,,both,,,11978.5100,1796.7800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4995.04,,,,,,,3091.6500,11978.5100,percent of total billed charges,"41.7% of $11,978.51 in Billed Charges for Rev 272 = $4,995.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MYOSURE TISSUE REMOVING SYS W/LESS THAN 1MM DISTAL,272,RC,27200002,CDM,,,,,,both,,,11978.5100,1796.7800,CIGNA HEALTHCARE,CIGNA PPO,4995.04,,,,,,,3091.6500,11978.5100,percent of total billed charges,"41.7% of $11,978.51 in Billed Charges for Rev 272 = $4,995.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MYOSURE TISSUE REMOVING SYS W/LESS THAN 1MM DISTAL,272,RC,27200002,CDM,,,,,,both,,,11978.5100,1796.7800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10780.66,,,,,,,3091.6500,11978.5100,percent of total billed charges,"90% of $11,978.51 in Billed Charges for Rev 272 = $10,780.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MYOSURE TISSUE REMOVING SYS W/LESS THAN 1MM DISTAL,272,RC,27200002,CDM,,,,,,both,,,11978.5100,1796.7800,MEDCOST,MEDCOST VHN,5700.57,,,,,,,3091.6500,11978.5100,percent of total billed charges,"47.59% of $11,978.51 in Billed Charges for Rev 272 = $5,700.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MYOSURE TISSUE REMOVING SYS W/LESS THAN 1MM DISTAL,272,RC,27200002,CDM,,,,,,both,,,11978.5100,1796.7800,SENTARA HEALTH,SENTARA HEALTH,3091.65,,,,,,,3091.6500,11978.5100,percent of total billed charges,"25.81% of $11,978.51 in Billed Charges for Rev 272 = $3,091.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MYOSURE TISSUE REMOVING SYS W/LESS THAN 1MM DISTAL,272,RC,27200002,CDM,,,,,,both,,,11978.5100,1796.7800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11978.51,,,,,,,3091.6500,11978.5100,percent of total billed charges,"100% of $11,978.51 in Billed Charges for Rev 272 = $11,978.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MYOSURE TISSUE REMOVING SYS W/LESS THAN 1MM DISTAL,272,RC,27200002,CDM,,,,,,both,,,11978.5100,1796.7800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5989.26,,,,,,,3091.6500,11978.5100,percent of total billed charges,"Rev 272 $11,978.51 in Billed Charges at 50% = $5,989.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MYOSURE TISSUE REMOVING SYS W/LESS THAN 1MM DISTAL,272,RC,27200002,CDM,,,,,,both,,,11978.5100,1796.7800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3869.06,,,,,,,3091.6500,11978.5100,other,"32.3% of $11,978.51 in Billed Charges for Rev 272 = $3,869.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE MYOSURE TISSUE REMOVING SYS W/LESS THAN 1MM DISTAL,272,RC,27200002,CDM,,,,,,both,,,11978.5100,1796.7800,UNITED HEALTHCARE,UHC HERITAGE SELECT,3677.40,,,,,,,3091.6500,11978.5100,other,"30.7% of $11,978.51 in Billed Charges for Rev 272 = $3,677.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE MYOSURE TISSUE REMOVING SYS W/LESS THAN 1MM DISTAL,272,RC,27200002,CDM,,,,,,both,,,11978.5100,1796.7800,UNITED HEALTHCARE,UNITED HEALTHCARE,3869.06,,,,,,,3091.6500,11978.5100,percent of total billed charges,"32.3% of $11,978.51 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE MYOSURE TISSUE REMOVING SYS W/LESS THAN 1MM DISTAL,272,RC,27200002,CDM,,,,,,both,,,11978.5100,1796.7800,WELLCARE,WELLCARE MEDICAID,11978.51,,,,,,,3091.6500,11978.5100,percent of total billed charges,"100% of $11,978.51 in Billed Charges for Rev 272 = $11,978.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NOVASURE V5 AMBLATION,272,RC,27200002,CDM,,,,,,both,,,12835.8400,1925.3800,AETNA,AETNA,5480.90,,,,,,,3312.9300,12835.8400,percent of total billed charges,"42.7% of $12,835.84 in Billed Charges for Rev 272 = $5,480.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NOVASURE V5 AMBLATION,272,RC,27200002,CDM,,,,,,both,,,12835.8400,1925.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8985.09,,,,,,,3312.9300,12835.8400,percent of total billed charges,"Rev 272 $12,835.84 in Billed Charges at 70% = $8,985.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NOVASURE V5 AMBLATION,272,RC,27200002,CDM,,,,,,both,,,12835.8400,1925.3800,CIGNA HEALTHCARE,CIGNA HMO,5352.55,,,,,,,3312.9300,12835.8400,percent of total billed charges,"41.7% of $12,835.84 in Billed Charges for Rev 272 = $5,352.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NOVASURE V5 AMBLATION,272,RC,27200002,CDM,,,,,,both,,,12835.8400,1925.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5955.83,,,,,,,3312.9300,12835.8400,percent of total billed charges,"46.4% of $12,835.84 in Billed Charges for Rev 272 = $5,955.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NOVASURE V5 AMBLATION,272,RC,27200002,CDM,,,,,,both,,,12835.8400,1925.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5352.55,,,,,,,3312.9300,12835.8400,percent of total billed charges,"41.7% of $12,835.84 in Billed Charges for Rev 272 = $5,352.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NOVASURE V5 AMBLATION,272,RC,27200002,CDM,,,,,,both,,,12835.8400,1925.3800,CIGNA HEALTHCARE,CIGNA PPO,5352.55,,,,,,,3312.9300,12835.8400,percent of total billed charges,"41.7% of $12,835.84 in Billed Charges for Rev 272 = $5,352.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NOVASURE V5 AMBLATION,272,RC,27200002,CDM,,,,,,both,,,12835.8400,1925.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11552.26,,,,,,,3312.9300,12835.8400,percent of total billed charges,"90% of $12,835.84 in Billed Charges for Rev 272 = $11,552.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NOVASURE V5 AMBLATION,272,RC,27200002,CDM,,,,,,both,,,12835.8400,1925.3800,MEDCOST,MEDCOST VHN,6108.58,,,,,,,3312.9300,12835.8400,percent of total billed charges,"47.59% of $12,835.84 in Billed Charges for Rev 272 = $6,108.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NOVASURE V5 AMBLATION,272,RC,27200002,CDM,,,,,,both,,,12835.8400,1925.3800,SENTARA HEALTH,SENTARA HEALTH,3312.93,,,,,,,3312.9300,12835.8400,percent of total billed charges,"25.81% of $12,835.84 in Billed Charges for Rev 272 = $3,312.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NOVASURE V5 AMBLATION,272,RC,27200002,CDM,,,,,,both,,,12835.8400,1925.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12835.84,,,,,,,3312.9300,12835.8400,percent of total billed charges,"100% of $12,835.84 in Billed Charges for Rev 272 = $12,835.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NOVASURE V5 AMBLATION,272,RC,27200002,CDM,,,,,,both,,,12835.8400,1925.3800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6417.92,,,,,,,3312.9300,12835.8400,percent of total billed charges,"Rev 272 $12,835.84 in Billed Charges at 50% = $6,417.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NOVASURE V5 AMBLATION,272,RC,27200002,CDM,,,,,,both,,,12835.8400,1925.3800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4145.98,,,,,,,3312.9300,12835.8400,other,"32.3% of $12,835.84 in Billed Charges for Rev 272 = $4,145.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE NOVASURE V5 AMBLATION,272,RC,27200002,CDM,,,,,,both,,,12835.8400,1925.3800,UNITED HEALTHCARE,UHC HERITAGE SELECT,3940.60,,,,,,,3312.9300,12835.8400,other,"30.7% of $12,835.84 in Billed Charges for Rev 272 = $3,940.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE NOVASURE V5 AMBLATION,272,RC,27200002,CDM,,,,,,both,,,12835.8400,1925.3800,UNITED HEALTHCARE,UNITED HEALTHCARE,4145.98,,,,,,,3312.9300,12835.8400,percent of total billed charges,"32.3% of $12,835.84 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NOVASURE V5 AMBLATION,272,RC,27200002,CDM,,,,,,both,,,12835.8400,1925.3800,WELLCARE,WELLCARE MEDICAID,12835.84,,,,,,,3312.9300,12835.8400,percent of total billed charges,"100% of $12,835.84 in Billed Charges for Rev 272 = $12,835.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NSTRAP STONE ENTRAP,272,RC,27200002,CDM,,,,,,both,,,3165.4400,474.8200,AETNA,AETNA,1351.64,,,,,,,817.0000,3165.4400,percent of total billed charges,"42.7% of $3,165.44 in Billed Charges for Rev 272 = $1,351.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NSTRAP STONE ENTRAP,272,RC,27200002,CDM,,,,,,both,,,3165.4400,474.8200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2215.81,,,,,,,817.0000,3165.4400,percent of total billed charges,"Rev 272 $3,165.44 in Billed Charges at 70% = $2,215.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NSTRAP STONE ENTRAP,272,RC,27200002,CDM,,,,,,both,,,3165.4400,474.8200,CIGNA HEALTHCARE,CIGNA HMO,1319.99,,,,,,,817.0000,3165.4400,percent of total billed charges,"41.7% of $3,165.44 in Billed Charges for Rev 272 = $1,319.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NSTRAP STONE ENTRAP,272,RC,27200002,CDM,,,,,,both,,,3165.4400,474.8200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1468.76,,,,,,,817.0000,3165.4400,percent of total billed charges,"46.4% of $3,165.44 in Billed Charges for Rev 272 = $1,468.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NSTRAP STONE ENTRAP,272,RC,27200002,CDM,,,,,,both,,,3165.4400,474.8200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1319.99,,,,,,,817.0000,3165.4400,percent of total billed charges,"41.7% of $3,165.44 in Billed Charges for Rev 272 = $1,319.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NSTRAP STONE ENTRAP,272,RC,27200002,CDM,,,,,,both,,,3165.4400,474.8200,CIGNA HEALTHCARE,CIGNA PPO,1319.99,,,,,,,817.0000,3165.4400,percent of total billed charges,"41.7% of $3,165.44 in Billed Charges for Rev 272 = $1,319.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NSTRAP STONE ENTRAP,272,RC,27200002,CDM,,,,,,both,,,3165.4400,474.8200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2848.90,,,,,,,817.0000,3165.4400,percent of total billed charges,"90% of $3,165.44 in Billed Charges for Rev 272 = $2,848.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NSTRAP STONE ENTRAP,272,RC,27200002,CDM,,,,,,both,,,3165.4400,474.8200,MEDCOST,MEDCOST VHN,1506.43,,,,,,,817.0000,3165.4400,percent of total billed charges,"47.59% of $3,165.44 in Billed Charges for Rev 272 = $1,506.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NSTRAP STONE ENTRAP,272,RC,27200002,CDM,,,,,,both,,,3165.4400,474.8200,SENTARA HEALTH,SENTARA HEALTH,817.00,,,,,,,817.0000,3165.4400,percent of total billed charges,"25.81% of $3,165.44 in Billed Charges for Rev 272 = $817.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NSTRAP STONE ENTRAP,272,RC,27200002,CDM,,,,,,both,,,3165.4400,474.8200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3165.44,,,,,,,817.0000,3165.4400,percent of total billed charges,"100% of $3,165.44 in Billed Charges for Rev 272 = $3,165.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NSTRAP STONE ENTRAP,272,RC,27200002,CDM,,,,,,both,,,3165.4400,474.8200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1582.72,,,,,,,817.0000,3165.4400,percent of total billed charges,"Rev 272 $3,165.44 in Billed Charges at 50% = $1,582.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NSTRAP STONE ENTRAP,272,RC,27200002,CDM,,,,,,both,,,3165.4400,474.8200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1022.44,,,,,,,817.0000,3165.4400,other,"32.3% of $3,165.44 in Billed Charges for Rev 272 = $1,022.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE NSTRAP STONE ENTRAP,272,RC,27200002,CDM,,,,,,both,,,3165.4400,474.8200,UNITED HEALTHCARE,UHC HERITAGE SELECT,971.79,,,,,,,817.0000,3165.4400,other,"30.7% of $3,165.44 in Billed Charges for Rev 272 = $971.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE NSTRAP STONE ENTRAP,272,RC,27200002,CDM,,,,,,both,,,3165.4400,474.8200,UNITED HEALTHCARE,UNITED HEALTHCARE,1022.44,,,,,,,817.0000,3165.4400,percent of total billed charges,"32.3% of $3,165.44 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE NSTRAP STONE ENTRAP,272,RC,27200002,CDM,,,,,,both,,,3165.4400,474.8200,WELLCARE,WELLCARE MEDICAID,3165.44,,,,,,,817.0000,3165.4400,percent of total billed charges,"100% of $3,165.44 in Billed Charges for Rev 272 = $3,165.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN 4 POS -MR,272,RC,27200002,CDM,,,,,,both,,,5747.5000,862.1300,AETNA,AETNA,2454.18,,,,,,,1483.4300,5747.5000,percent of total billed charges,"42.7% of $5,747.50 in Billed Charges for Rev 272 = $2,454.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN 4 POS -MR,272,RC,27200002,CDM,,,,,,both,,,5747.5000,862.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4023.25,,,,,,,1483.4300,5747.5000,percent of total billed charges,"Rev 272 $5,747.50 in Billed Charges at 70% = $4,023.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN 4 POS -MR,272,RC,27200002,CDM,,,,,,both,,,5747.5000,862.1300,CIGNA HEALTHCARE,CIGNA HMO,2396.71,,,,,,,1483.4300,5747.5000,percent of total billed charges,"41.7% of $5,747.50 in Billed Charges for Rev 272 = $2,396.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN 4 POS -MR,272,RC,27200002,CDM,,,,,,both,,,5747.5000,862.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2666.84,,,,,,,1483.4300,5747.5000,percent of total billed charges,"46.4% of $5,747.50 in Billed Charges for Rev 272 = $2,666.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN 4 POS -MR,272,RC,27200002,CDM,,,,,,both,,,5747.5000,862.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2396.71,,,,,,,1483.4300,5747.5000,percent of total billed charges,"41.7% of $5,747.50 in Billed Charges for Rev 272 = $2,396.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN 4 POS -MR,272,RC,27200002,CDM,,,,,,both,,,5747.5000,862.1300,CIGNA HEALTHCARE,CIGNA PPO,2396.71,,,,,,,1483.4300,5747.5000,percent of total billed charges,"41.7% of $5,747.50 in Billed Charges for Rev 272 = $2,396.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN 4 POS -MR,272,RC,27200002,CDM,,,,,,both,,,5747.5000,862.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5172.75,,,,,,,1483.4300,5747.5000,percent of total billed charges,"90% of $5,747.50 in Billed Charges for Rev 272 = $5,172.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN 4 POS -MR,272,RC,27200002,CDM,,,,,,both,,,5747.5000,862.1300,MEDCOST,MEDCOST VHN,2735.24,,,,,,,1483.4300,5747.5000,percent of total billed charges,"47.59% of $5,747.50 in Billed Charges for Rev 272 = $2,735.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN 4 POS -MR,272,RC,27200002,CDM,,,,,,both,,,5747.5000,862.1300,SENTARA HEALTH,SENTARA HEALTH,1483.43,,,,,,,1483.4300,5747.5000,percent of total billed charges,"25.81% of $5,747.50 in Billed Charges for Rev 272 = $1,483.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN 4 POS -MR,272,RC,27200002,CDM,,,,,,both,,,5747.5000,862.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5747.50,,,,,,,1483.4300,5747.5000,percent of total billed charges,"100% of $5,747.50 in Billed Charges for Rev 272 = $5,747.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN 4 POS -MR,272,RC,27200002,CDM,,,,,,both,,,5747.5000,862.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2873.75,,,,,,,1483.4300,5747.5000,percent of total billed charges,"Rev 272 $5,747.50 in Billed Charges at 50% = $2,873.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN 4 POS -MR,272,RC,27200002,CDM,,,,,,both,,,5747.5000,862.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1856.44,,,,,,,1483.4300,5747.5000,other,"32.3% of $5,747.50 in Billed Charges for Rev 272 = $1,856.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP MED MULTI-PIN 4 POS -MR,272,RC,27200002,CDM,,,,,,both,,,5747.5000,862.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1764.48,,,,,,,1483.4300,5747.5000,other,"30.7% of $5,747.50 in Billed Charges for Rev 272 = $1,764.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP MED MULTI-PIN 4 POS -MR,272,RC,27200002,CDM,,,,,,both,,,5747.5000,862.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,1856.44,,,,,,,1483.4300,5747.5000,percent of total billed charges,"32.3% of $5,747.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN 4 POS -MR,272,RC,27200002,CDM,,,,,,both,,,5747.5000,862.1300,WELLCARE,WELLCARE MEDICAID,5747.50,,,,,,,1483.4300,5747.5000,percent of total billed charges,"100% of $5,747.50 in Billed Charges for Rev 272 = $5,747.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MEDIUM COMBINATION MR SA,272,RC,27200002,CDM,,,,,,both,,,4748.7800,712.3200,AETNA,AETNA,2027.73,,,,,,,1225.6600,4748.7800,percent of total billed charges,"42.7% of $4,748.78 in Billed Charges for Rev 272 = $2,027.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MEDIUM COMBINATION MR SA,272,RC,27200002,CDM,,,,,,both,,,4748.7800,712.3200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3324.15,,,,,,,1225.6600,4748.7800,percent of total billed charges,"Rev 272 $4,748.78 in Billed Charges at 70% = $3,324.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MEDIUM COMBINATION MR SA,272,RC,27200002,CDM,,,,,,both,,,4748.7800,712.3200,CIGNA HEALTHCARE,CIGNA HMO,1980.24,,,,,,,1225.6600,4748.7800,percent of total billed charges,"41.7% of $4,748.78 in Billed Charges for Rev 272 = $1,980.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MEDIUM COMBINATION MR SA,272,RC,27200002,CDM,,,,,,both,,,4748.7800,712.3200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2203.43,,,,,,,1225.6600,4748.7800,percent of total billed charges,"46.4% of $4,748.78 in Billed Charges for Rev 272 = $2,203.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MEDIUM COMBINATION MR SA,272,RC,27200002,CDM,,,,,,both,,,4748.7800,712.3200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1980.24,,,,,,,1225.6600,4748.7800,percent of total billed charges,"41.7% of $4,748.78 in Billed Charges for Rev 272 = $1,980.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MEDIUM COMBINATION MR SA,272,RC,27200002,CDM,,,,,,both,,,4748.7800,712.3200,CIGNA HEALTHCARE,CIGNA PPO,1980.24,,,,,,,1225.6600,4748.7800,percent of total billed charges,"41.7% of $4,748.78 in Billed Charges for Rev 272 = $1,980.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MEDIUM COMBINATION MR SA,272,RC,27200002,CDM,,,,,,both,,,4748.7800,712.3200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4273.90,,,,,,,1225.6600,4748.7800,percent of total billed charges,"90% of $4,748.78 in Billed Charges for Rev 272 = $4,273.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MEDIUM COMBINATION MR SA,272,RC,27200002,CDM,,,,,,both,,,4748.7800,712.3200,MEDCOST,MEDCOST VHN,2259.94,,,,,,,1225.6600,4748.7800,percent of total billed charges,"47.59% of $4,748.78 in Billed Charges for Rev 272 = $2,259.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MEDIUM COMBINATION MR SA,272,RC,27200002,CDM,,,,,,both,,,4748.7800,712.3200,SENTARA HEALTH,SENTARA HEALTH,1225.66,,,,,,,1225.6600,4748.7800,percent of total billed charges,"25.81% of $4,748.78 in Billed Charges for Rev 272 = $1,225.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MEDIUM COMBINATION MR SA,272,RC,27200002,CDM,,,,,,both,,,4748.7800,712.3200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4748.78,,,,,,,1225.6600,4748.7800,percent of total billed charges,"100% of $4,748.78 in Billed Charges for Rev 272 = $4,748.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MEDIUM COMBINATION MR SA,272,RC,27200002,CDM,,,,,,both,,,4748.7800,712.3200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2374.39,,,,,,,1225.6600,4748.7800,percent of total billed charges,"Rev 272 $4,748.78 in Billed Charges at 50% = $2,374.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MEDIUM COMBINATION MR SA,272,RC,27200002,CDM,,,,,,both,,,4748.7800,712.3200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1533.86,,,,,,,1225.6600,4748.7800,other,"32.3% of $4,748.78 in Billed Charges for Rev 272 = $1,533.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP MEDIUM COMBINATION MR SA,272,RC,27200002,CDM,,,,,,both,,,4748.7800,712.3200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1457.88,,,,,,,1225.6600,4748.7800,other,"30.7% of $4,748.78 in Billed Charges for Rev 272 = $1,457.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP MEDIUM COMBINATION MR SA,272,RC,27200002,CDM,,,,,,both,,,4748.7800,712.3200,UNITED HEALTHCARE,UNITED HEALTHCARE,1533.86,,,,,,,1225.6600,4748.7800,percent of total billed charges,"32.3% of $4,748.78 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MEDIUM COMBINATION MR SA,272,RC,27200002,CDM,,,,,,both,,,4748.7800,712.3200,WELLCARE,WELLCARE MEDICAID,4748.78,,,,,,,1225.6600,4748.7800,percent of total billed charges,"100% of $4,748.78 in Billed Charges for Rev 272 = $4,748.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP PIN MED 4 POSITION,272,RC,,,,,,,,both,,,3818.0800,572.7100,AETNA,AETNA,1630.32,,,,,,,985.4500,3818.0800,percent of total billed charges,"42.7% of $3,818.08 in Billed Charges for Rev 272 = $1,630.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP PIN MED 4 POSITION,272,RC,,,,,,,,both,,,3818.0800,572.7100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2672.66,,,,,,,985.4500,3818.0800,percent of total billed charges,"Rev 272 $3,818.08 in Billed Charges at 70% = $2,672.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP PIN MED 4 POSITION,272,RC,,,,,,,,both,,,3818.0800,572.7100,CIGNA HEALTHCARE,CIGNA HMO,1592.14,,,,,,,985.4500,3818.0800,percent of total billed charges,"41.7% of $3,818.08 in Billed Charges for Rev 272 = $1,592.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP PIN MED 4 POSITION,272,RC,,,,,,,,both,,,3818.0800,572.7100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1771.59,,,,,,,985.4500,3818.0800,percent of total billed charges,"46.4% of $3,818.08 in Billed Charges for Rev 272 = $1,771.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP PIN MED 4 POSITION,272,RC,,,,,,,,both,,,3818.0800,572.7100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1592.14,,,,,,,985.4500,3818.0800,percent of total billed charges,"41.7% of $3,818.08 in Billed Charges for Rev 272 = $1,592.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP PIN MED 4 POSITION,272,RC,,,,,,,,both,,,3818.0800,572.7100,CIGNA HEALTHCARE,CIGNA PPO,1592.14,,,,,,,985.4500,3818.0800,percent of total billed charges,"41.7% of $3,818.08 in Billed Charges for Rev 272 = $1,592.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP PIN MED 4 POSITION,272,RC,,,,,,,,both,,,3818.0800,572.7100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3436.27,,,,,,,985.4500,3818.0800,percent of total billed charges,"90% of $3,818.08 in Billed Charges for Rev 272 = $3,436.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP PIN MED 4 POSITION,272,RC,,,,,,,,both,,,3818.0800,572.7100,MEDCOST,MEDCOST VHN,1817.02,,,,,,,985.4500,3818.0800,percent of total billed charges,"47.59% of $3,818.08 in Billed Charges for Rev 272 = $1,817.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP PIN MED 4 POSITION,272,RC,,,,,,,,both,,,3818.0800,572.7100,SENTARA HEALTH,SENTARA HEALTH,985.45,,,,,,,985.4500,3818.0800,percent of total billed charges,"25.81% of $3,818.08 in Billed Charges for Rev 272 = $985.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP PIN MED 4 POSITION,272,RC,,,,,,,,both,,,3818.0800,572.7100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3818.08,,,,,,,985.4500,3818.0800,percent of total billed charges,"100% of $3,818.08 in Billed Charges for Rev 272 = $3,818.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP PIN MED 4 POSITION,272,RC,,,,,,,,both,,,3818.0800,572.7100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1909.04,,,,,,,985.4500,3818.0800,percent of total billed charges,"Rev 272 $3,818.08 in Billed Charges at 50% = $1,909.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP PIN MED 4 POSITION,272,RC,,,,,,,,both,,,3818.0800,572.7100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1233.24,,,,,,,985.4500,3818.0800,other,"32.3% of $3,818.08 in Billed Charges for Rev 272 = $1,233.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP PIN MED 4 POSITION,272,RC,,,,,,,,both,,,3818.0800,572.7100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1172.15,,,,,,,985.4500,3818.0800,other,"30.7% of $3,818.08 in Billed Charges for Rev 272 = $1,172.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP PIN MED 4 POSITION,272,RC,,,,,,,,both,,,3818.0800,572.7100,UNITED HEALTHCARE,UNITED HEALTHCARE,1233.24,,,,,,,985.4500,3818.0800,percent of total billed charges,"32.3% of $3,818.08 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP PIN MED 4 POSITION,272,RC,,,,,,,,both,,,3818.0800,572.7100,WELLCARE,WELLCARE MEDICAID,3818.08,,,,,,,985.4500,3818.0800,percent of total billed charges,"100% of $3,818.08 in Billed Charges for Rev 272 = $3,818.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL B 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,9359.5200,1403.9300,AETNA,AETNA,3996.52,,,,,,,2415.6900,9359.5200,percent of total billed charges,"42.7% of $9,359.52 in Billed Charges for Rev 272 = $3,996.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL B 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,9359.5200,1403.9300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6551.66,,,,,,,2415.6900,9359.5200,percent of total billed charges,"Rev 272 $9,359.52 in Billed Charges at 70% = $6,551.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL B 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,9359.5200,1403.9300,CIGNA HEALTHCARE,CIGNA HMO,3902.92,,,,,,,2415.6900,9359.5200,percent of total billed charges,"41.7% of $9,359.52 in Billed Charges for Rev 272 = $3,902.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL B 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,9359.5200,1403.9300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4342.82,,,,,,,2415.6900,9359.5200,percent of total billed charges,"46.4% of $9,359.52 in Billed Charges for Rev 272 = $4,342.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL B 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,9359.5200,1403.9300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3902.92,,,,,,,2415.6900,9359.5200,percent of total billed charges,"41.7% of $9,359.52 in Billed Charges for Rev 272 = $3,902.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL B 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,9359.5200,1403.9300,CIGNA HEALTHCARE,CIGNA PPO,3902.92,,,,,,,2415.6900,9359.5200,percent of total billed charges,"41.7% of $9,359.52 in Billed Charges for Rev 272 = $3,902.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL B 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,9359.5200,1403.9300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8423.57,,,,,,,2415.6900,9359.5200,percent of total billed charges,"90% of $9,359.52 in Billed Charges for Rev 272 = $8,423.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL B 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,9359.5200,1403.9300,MEDCOST,MEDCOST VHN,4454.20,,,,,,,2415.6900,9359.5200,percent of total billed charges,"47.59% of $9,359.52 in Billed Charges for Rev 272 = $4,454.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL B 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,9359.5200,1403.9300,SENTARA HEALTH,SENTARA HEALTH,2415.69,,,,,,,2415.6900,9359.5200,percent of total billed charges,"25.81% of $9,359.52 in Billed Charges for Rev 272 = $2,415.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL B 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,9359.5200,1403.9300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9359.52,,,,,,,2415.6900,9359.5200,percent of total billed charges,"100% of $9,359.52 in Billed Charges for Rev 272 = $9,359.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL B 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,9359.5200,1403.9300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4679.76,,,,,,,2415.6900,9359.5200,percent of total billed charges,"Rev 272 $9,359.52 in Billed Charges at 50% = $4,679.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL B 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,9359.5200,1403.9300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3023.13,,,,,,,2415.6900,9359.5200,other,"32.3% of $9,359.52 in Billed Charges for Rev 272 = $3,023.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL B 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,9359.5200,1403.9300,UNITED HEALTHCARE,UHC HERITAGE SELECT,2873.37,,,,,,,2415.6900,9359.5200,other,"30.7% of $9,359.52 in Billed Charges for Rev 272 = $2,873.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL B 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,9359.5200,1403.9300,UNITED HEALTHCARE,UNITED HEALTHCARE,3023.13,,,,,,,2415.6900,9359.5200,percent of total billed charges,"32.3% of $9,359.52 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL B 16MM CANNULATED HOLLOW,272,RC,27200002,CDM,,,,,,both,,,9359.5200,1403.9300,WELLCARE,WELLCARE MEDICAID,9359.52,,,,,,,2415.6900,9359.5200,percent of total billed charges,"100% of $9,359.52 in Billed Charges for Rev 272 = $9,359.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,1490.3100,223.5500,AETNA,AETNA,636.36,,,,,,,384.6500,1490.3100,percent of total billed charges,"42.7% of $1,490.31 in Billed Charges for Rev 272 = $636.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,1490.3100,223.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1043.22,,,,,,,384.6500,1490.3100,percent of total billed charges,"Rev 272 $1,490.31 in Billed Charges at 70% = $1,043.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,1490.3100,223.5500,CIGNA HEALTHCARE,CIGNA HMO,621.46,,,,,,,384.6500,1490.3100,percent of total billed charges,"41.7% of $1,490.31 in Billed Charges for Rev 272 = $621.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,1490.3100,223.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,691.50,,,,,,,384.6500,1490.3100,percent of total billed charges,"46.4% of $1,490.31 in Billed Charges for Rev 272 = $691.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,1490.3100,223.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,621.46,,,,,,,384.6500,1490.3100,percent of total billed charges,"41.7% of $1,490.31 in Billed Charges for Rev 272 = $621.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,1490.3100,223.5500,CIGNA HEALTHCARE,CIGNA PPO,621.46,,,,,,,384.6500,1490.3100,percent of total billed charges,"41.7% of $1,490.31 in Billed Charges for Rev 272 = $621.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,1490.3100,223.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1341.28,,,,,,,384.6500,1490.3100,percent of total billed charges,"90% of $1,490.31 in Billed Charges for Rev 272 = $1,341.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,1490.3100,223.5500,MEDCOST,MEDCOST VHN,709.24,,,,,,,384.6500,1490.3100,percent of total billed charges,"47.59% of $1,490.31 in Billed Charges for Rev 272 = $709.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,1490.3100,223.5500,SENTARA HEALTH,SENTARA HEALTH,384.65,,,,,,,384.6500,1490.3100,percent of total billed charges,"25.81% of $1,490.31 in Billed Charges for Rev 272 = $384.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,1490.3100,223.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1490.31,,,,,,,384.6500,1490.3100,percent of total billed charges,"100% of $1,490.31 in Billed Charges for Rev 272 = $1,490.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,1490.3100,223.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,745.16,,,,,,,384.6500,1490.3100,percent of total billed charges,"Rev 272 $1,490.31 in Billed Charges at 50% = $745.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,1490.3100,223.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,481.37,,,,,,,384.6500,1490.3100,other,"32.3% of $1,490.31 in Billed Charges for Rev 272 = $481.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,1490.3100,223.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,457.53,,,,,,,384.6500,1490.3100,other,"30.7% of $1,490.31 in Billed Charges for Rev 272 = $457.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,1490.3100,223.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,481.37,,,,,,,384.6500,1490.3100,percent of total billed charges,"32.3% of $1,490.31 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,27200002,CDM,,,,,,both,,,1490.3100,223.5500,WELLCARE,WELLCARE MEDICAID,1490.31,,,,,,,384.6500,1490.3100,percent of total billed charges,"100% of $1,490.31 in Billed Charges for Rev 272 = $1,490.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,,,,,,,,both,,,1592.9900,238.9500,AETNA,AETNA,680.21,,,,,,,411.1500,1592.9900,percent of total billed charges,"42.7% of $1,592.99 in Billed Charges for Rev 272 = $680.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,,,,,,,,both,,,1592.9900,238.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1115.09,,,,,,,411.1500,1592.9900,percent of total billed charges,"Rev 272 $1,592.99 in Billed Charges at 70% = $1,115.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,,,,,,,,both,,,1592.9900,238.9500,CIGNA HEALTHCARE,CIGNA HMO,664.28,,,,,,,411.1500,1592.9900,percent of total billed charges,"41.7% of $1,592.99 in Billed Charges for Rev 272 = $664.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,,,,,,,,both,,,1592.9900,238.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,739.15,,,,,,,411.1500,1592.9900,percent of total billed charges,"46.4% of $1,592.99 in Billed Charges for Rev 272 = $739.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,,,,,,,,both,,,1592.9900,238.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,664.28,,,,,,,411.1500,1592.9900,percent of total billed charges,"41.7% of $1,592.99 in Billed Charges for Rev 272 = $664.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,,,,,,,,both,,,1592.9900,238.9500,CIGNA HEALTHCARE,CIGNA PPO,664.28,,,,,,,411.1500,1592.9900,percent of total billed charges,"41.7% of $1,592.99 in Billed Charges for Rev 272 = $664.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,,,,,,,,both,,,1592.9900,238.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1433.69,,,,,,,411.1500,1592.9900,percent of total billed charges,"90% of $1,592.99 in Billed Charges for Rev 272 = $1,433.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,,,,,,,,both,,,1592.9900,238.9500,MEDCOST,MEDCOST VHN,758.10,,,,,,,411.1500,1592.9900,percent of total billed charges,"47.59% of $1,592.99 in Billed Charges for Rev 272 = $758.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,,,,,,,,both,,,1592.9900,238.9500,SENTARA HEALTH,SENTARA HEALTH,411.15,,,,,,,411.1500,1592.9900,percent of total billed charges,"25.81% of $1,592.99 in Billed Charges for Rev 272 = $411.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,,,,,,,,both,,,1592.9900,238.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1592.99,,,,,,,411.1500,1592.9900,percent of total billed charges,"100% of $1,592.99 in Billed Charges for Rev 272 = $1,592.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,,,,,,,,both,,,1592.9900,238.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,796.50,,,,,,,411.1500,1592.9900,percent of total billed charges,"Rev 272 $1,592.99 in Billed Charges at 50% = $796.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,,,,,,,,both,,,1592.9900,238.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,514.54,,,,,,,411.1500,1592.9900,other,"32.3% of $1,592.99 in Billed Charges for Rev 272 = $514.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT,272,RC,,,,,,,,both,,,1592.9900,238.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,489.05,,,,,,,411.1500,1592.9900,other,"30.7% of $1,592.99 in Billed Charges for Rev 272 = $489.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT,272,RC,,,,,,,,both,,,1592.9900,238.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,514.54,,,,,,,411.1500,1592.9900,percent of total billed charges,"32.3% of $1,592.99 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT,272,RC,,,,,,,,both,,,1592.9900,238.9500,WELLCARE,WELLCARE MEDICAID,1592.99,,,,,,,411.1500,1592.9900,percent of total billed charges,"100% of $1,592.99 in Billed Charges for Rev 272 = $1,592.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR SAFETY LOC 100MM TLC10,272,RC,27200002,CDM,,,,,,both,,,1628.4200,244.2600,AETNA,AETNA,695.34,,,,,,,420.3000,1628.4200,percent of total billed charges,"42.7% of $1,628.42 in Billed Charges for Rev 272 = $695.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR SAFETY LOC 100MM TLC10,272,RC,27200002,CDM,,,,,,both,,,1628.4200,244.2600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1139.89,,,,,,,420.3000,1628.4200,percent of total billed charges,"Rev 272 $1,628.42 in Billed Charges at 70% = $1,139.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR SAFETY LOC 100MM TLC10,272,RC,27200002,CDM,,,,,,both,,,1628.4200,244.2600,CIGNA HEALTHCARE,CIGNA HMO,679.05,,,,,,,420.3000,1628.4200,percent of total billed charges,"41.7% of $1,628.42 in Billed Charges for Rev 272 = $679.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR SAFETY LOC 100MM TLC10,272,RC,27200002,CDM,,,,,,both,,,1628.4200,244.2600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,755.59,,,,,,,420.3000,1628.4200,percent of total billed charges,"46.4% of $1,628.42 in Billed Charges for Rev 272 = $755.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR SAFETY LOC 100MM TLC10,272,RC,27200002,CDM,,,,,,both,,,1628.4200,244.2600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,679.05,,,,,,,420.3000,1628.4200,percent of total billed charges,"41.7% of $1,628.42 in Billed Charges for Rev 272 = $679.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR SAFETY LOC 100MM TLC10,272,RC,27200002,CDM,,,,,,both,,,1628.4200,244.2600,CIGNA HEALTHCARE,CIGNA PPO,679.05,,,,,,,420.3000,1628.4200,percent of total billed charges,"41.7% of $1,628.42 in Billed Charges for Rev 272 = $679.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR SAFETY LOC 100MM TLC10,272,RC,27200002,CDM,,,,,,both,,,1628.4200,244.2600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1465.58,,,,,,,420.3000,1628.4200,percent of total billed charges,"90% of $1,628.42 in Billed Charges for Rev 272 = $1,465.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR SAFETY LOC 100MM TLC10,272,RC,27200002,CDM,,,,,,both,,,1628.4200,244.2600,MEDCOST,MEDCOST VHN,774.97,,,,,,,420.3000,1628.4200,percent of total billed charges,"47.59% of $1,628.42 in Billed Charges for Rev 272 = $774.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR SAFETY LOC 100MM TLC10,272,RC,27200002,CDM,,,,,,both,,,1628.4200,244.2600,SENTARA HEALTH,SENTARA HEALTH,420.30,,,,,,,420.3000,1628.4200,percent of total billed charges,"25.81% of $1,628.42 in Billed Charges for Rev 272 = $420.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR SAFETY LOC 100MM TLC10,272,RC,27200002,CDM,,,,,,both,,,1628.4200,244.2600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1628.42,,,,,,,420.3000,1628.4200,percent of total billed charges,"100% of $1,628.42 in Billed Charges for Rev 272 = $1,628.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR SAFETY LOC 100MM TLC10,272,RC,27200002,CDM,,,,,,both,,,1628.4200,244.2600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,814.21,,,,,,,420.3000,1628.4200,percent of total billed charges,"Rev 272 $1,628.42 in Billed Charges at 50% = $814.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR SAFETY LOC 100MM TLC10,272,RC,27200002,CDM,,,,,,both,,,1628.4200,244.2600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,525.98,,,,,,,420.3000,1628.4200,other,"32.3% of $1,628.42 in Billed Charges for Rev 272 = $525.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTER PROXIMATE LINEAR SAFETY LOC 100MM TLC10,272,RC,27200002,CDM,,,,,,both,,,1628.4200,244.2600,UNITED HEALTHCARE,UHC HERITAGE SELECT,499.92,,,,,,,420.3000,1628.4200,other,"30.7% of $1,628.42 in Billed Charges for Rev 272 = $499.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTER PROXIMATE LINEAR SAFETY LOC 100MM TLC10,272,RC,27200002,CDM,,,,,,both,,,1628.4200,244.2600,UNITED HEALTHCARE,UNITED HEALTHCARE,525.98,,,,,,,420.3000,1628.4200,percent of total billed charges,"32.3% of $1,628.42 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR SAFETY LOC 100MM TLC10,272,RC,27200002,CDM,,,,,,both,,,1628.4200,244.2600,WELLCARE,WELLCARE MEDICAID,1628.42,,,,,,,420.3000,1628.4200,percent of total billed charges,"100% of $1,628.42 in Billed Charges for Rev 272 = $1,628.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 3.0MM,272,RC,,,,,,,,both,,,2056.3600,308.4500,AETNA,AETNA,878.07,,,,,,,530.7500,2056.3600,percent of total billed charges,"42.7% of $2,056.36 in Billed Charges for Rev 272 = $878.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 3.0MM,272,RC,,,,,,,,both,,,2056.3600,308.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1439.45,,,,,,,530.7500,2056.3600,percent of total billed charges,"Rev 272 $2,056.36 in Billed Charges at 70% = $1,439.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 3.0MM,272,RC,,,,,,,,both,,,2056.3600,308.4500,CIGNA HEALTHCARE,CIGNA HMO,857.50,,,,,,,530.7500,2056.3600,percent of total billed charges,"41.7% of $2,056.36 in Billed Charges for Rev 272 = $857.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 3.0MM,272,RC,,,,,,,,both,,,2056.3600,308.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,954.15,,,,,,,530.7500,2056.3600,percent of total billed charges,"46.4% of $2,056.36 in Billed Charges for Rev 272 = $954.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 3.0MM,272,RC,,,,,,,,both,,,2056.3600,308.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,857.50,,,,,,,530.7500,2056.3600,percent of total billed charges,"41.7% of $2,056.36 in Billed Charges for Rev 272 = $857.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 3.0MM,272,RC,,,,,,,,both,,,2056.3600,308.4500,CIGNA HEALTHCARE,CIGNA PPO,857.50,,,,,,,530.7500,2056.3600,percent of total billed charges,"41.7% of $2,056.36 in Billed Charges for Rev 272 = $857.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 3.0MM,272,RC,,,,,,,,both,,,2056.3600,308.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1850.72,,,,,,,530.7500,2056.3600,percent of total billed charges,"90% of $2,056.36 in Billed Charges for Rev 272 = $1,850.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 3.0MM,272,RC,,,,,,,,both,,,2056.3600,308.4500,MEDCOST,MEDCOST VHN,978.62,,,,,,,530.7500,2056.3600,percent of total billed charges,"47.59% of $2,056.36 in Billed Charges for Rev 272 = $978.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 3.0MM,272,RC,,,,,,,,both,,,2056.3600,308.4500,SENTARA HEALTH,SENTARA HEALTH,530.75,,,,,,,530.7500,2056.3600,percent of total billed charges,"25.81% of $2,056.36 in Billed Charges for Rev 272 = $530.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 3.0MM,272,RC,,,,,,,,both,,,2056.3600,308.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2056.36,,,,,,,530.7500,2056.3600,percent of total billed charges,"100% of $2,056.36 in Billed Charges for Rev 272 = $2,056.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 3.0MM,272,RC,,,,,,,,both,,,2056.3600,308.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1028.18,,,,,,,530.7500,2056.3600,percent of total billed charges,"Rev 272 $2,056.36 in Billed Charges at 50% = $1,028.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 3.0MM,272,RC,,,,,,,,both,,,2056.3600,308.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,664.20,,,,,,,530.7500,2056.3600,other,"32.3% of $2,056.36 in Billed Charges for Rev 272 = $664.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTER RND 3.0MM,272,RC,,,,,,,,both,,,2056.3600,308.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,631.30,,,,,,,530.7500,2056.3600,other,"30.7% of $2,056.36 in Billed Charges for Rev 272 = $631.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTER RND 3.0MM,272,RC,,,,,,,,both,,,2056.3600,308.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,664.20,,,,,,,530.7500,2056.3600,percent of total billed charges,"32.3% of $2,056.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 3.0MM,272,RC,,,,,,,,both,,,2056.3600,308.4500,WELLCARE,WELLCARE MEDICAID,2056.36,,,,,,,530.7500,2056.3600,percent of total billed charges,"100% of $2,056.36 in Billed Charges for Rev 272 = $2,056.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE AIR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,2196.6800,329.5000,AETNA,AETNA,937.98,,,,,,,566.9600,2196.6800,percent of total billed charges,"42.7% of $2,196.68 in Billed Charges for Rev 272 = $937.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE AIR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,2196.6800,329.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1537.68,,,,,,,566.9600,2196.6800,percent of total billed charges,"Rev 272 $2,196.68 in Billed Charges at 70% = $1,537.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE AIR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,2196.6800,329.5000,CIGNA HEALTHCARE,CIGNA HMO,916.02,,,,,,,566.9600,2196.6800,percent of total billed charges,"41.7% of $2,196.68 in Billed Charges for Rev 272 = $916.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE AIR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,2196.6800,329.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1019.26,,,,,,,566.9600,2196.6800,percent of total billed charges,"46.4% of $2,196.68 in Billed Charges for Rev 272 = $1,019.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE AIR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,2196.6800,329.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,916.02,,,,,,,566.9600,2196.6800,percent of total billed charges,"41.7% of $2,196.68 in Billed Charges for Rev 272 = $916.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE AIR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,2196.6800,329.5000,CIGNA HEALTHCARE,CIGNA PPO,916.02,,,,,,,566.9600,2196.6800,percent of total billed charges,"41.7% of $2,196.68 in Billed Charges for Rev 272 = $916.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE AIR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,2196.6800,329.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1977.01,,,,,,,566.9600,2196.6800,percent of total billed charges,"90% of $2,196.68 in Billed Charges for Rev 272 = $1,977.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE AIR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,2196.6800,329.5000,MEDCOST,MEDCOST VHN,1045.40,,,,,,,566.9600,2196.6800,percent of total billed charges,"47.59% of $2,196.68 in Billed Charges for Rev 272 = $1,045.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE AIR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,2196.6800,329.5000,SENTARA HEALTH,SENTARA HEALTH,566.96,,,,,,,566.9600,2196.6800,percent of total billed charges,"25.81% of $2,196.68 in Billed Charges for Rev 272 = $566.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE AIR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,2196.6800,329.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2196.68,,,,,,,566.9600,2196.6800,percent of total billed charges,"100% of $2,196.68 in Billed Charges for Rev 272 = $2,196.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE AIR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,2196.6800,329.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1098.34,,,,,,,566.9600,2196.6800,percent of total billed charges,"Rev 272 $2,196.68 in Billed Charges at 50% = $1,098.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE AIR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,2196.6800,329.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,709.53,,,,,,,566.9600,2196.6800,other,"32.3% of $2,196.68 in Billed Charges for Rev 272 = $709.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTER SUTURE AIR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,2196.6800,329.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,674.38,,,,,,,566.9600,2196.6800,other,"30.7% of $2,196.68 in Billed Charges for Rev 272 = $674.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTER SUTURE AIR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,2196.6800,329.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,709.53,,,,,,,566.9600,2196.6800,percent of total billed charges,"32.3% of $2,196.68 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE AIR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,2196.6800,329.5000,WELLCARE,WELLCARE MEDICAID,2196.68,,,,,,,566.9600,2196.6800,percent of total billed charges,"100% of $2,196.68 in Billed Charges for Rev 272 = $2,196.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL LP,272,RC,27200002,CDM,,,,,,both,,,130436.0700,19565.4100,AETNA,AETNA,55696.20,,,,,,,33665.5500,130436.0700,percent of total billed charges,"42.7% of $130,436.07 in Billed Charges for Rev 272 = $55,696.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL LP,272,RC,27200002,CDM,,,,,,both,,,130436.0700,19565.4100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,91305.25,,,,,,,33665.5500,130436.0700,percent of total billed charges,"Rev 272 $130,436.07 in Billed Charges at 70% = $91,305.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL LP,272,RC,27200002,CDM,,,,,,both,,,130436.0700,19565.4100,CIGNA HEALTHCARE,CIGNA HMO,54391.84,,,,,,,33665.5500,130436.0700,percent of total billed charges,"41.7% of $130,436.07 in Billed Charges for Rev 272 = $54,391.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL LP,272,RC,27200002,CDM,,,,,,both,,,130436.0700,19565.4100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,60522.34,,,,,,,33665.5500,130436.0700,percent of total billed charges,"46.4% of $130,436.07 in Billed Charges for Rev 272 = $60,522.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL LP,272,RC,27200002,CDM,,,,,,both,,,130436.0700,19565.4100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,54391.84,,,,,,,33665.5500,130436.0700,percent of total billed charges,"41.7% of $130,436.07 in Billed Charges for Rev 272 = $54,391.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL LP,272,RC,27200002,CDM,,,,,,both,,,130436.0700,19565.4100,CIGNA HEALTHCARE,CIGNA PPO,54391.84,,,,,,,33665.5500,130436.0700,percent of total billed charges,"41.7% of $130,436.07 in Billed Charges for Rev 272 = $54,391.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL LP,272,RC,27200002,CDM,,,,,,both,,,130436.0700,19565.4100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,117392.46,,,,,,,33665.5500,130436.0700,percent of total billed charges,"90% of $130,436.07 in Billed Charges for Rev 272 = $117,392.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL LP,272,RC,27200002,CDM,,,,,,both,,,130436.0700,19565.4100,MEDCOST,MEDCOST VHN,62074.53,,,,,,,33665.5500,130436.0700,percent of total billed charges,"47.59% of $130,436.07 in Billed Charges for Rev 272 = $62,074.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL LP,272,RC,27200002,CDM,,,,,,both,,,130436.0700,19565.4100,SENTARA HEALTH,SENTARA HEALTH,33665.55,,,,,,,33665.5500,130436.0700,percent of total billed charges,"25.81% of $130,436.07 in Billed Charges for Rev 272 = $33,665.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL LP,272,RC,27200002,CDM,,,,,,both,,,130436.0700,19565.4100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",130436.07,,,,,,,33665.5500,130436.0700,percent of total billed charges,"100% of $130,436.07 in Billed Charges for Rev 272 = $130,436.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL LP,272,RC,27200002,CDM,,,,,,both,,,130436.0700,19565.4100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,65218.04,,,,,,,33665.5500,130436.0700,percent of total billed charges,"Rev 272 $130,436.07 in Billed Charges at 50% = $65,218.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL LP,272,RC,27200002,CDM,,,,,,both,,,130436.0700,19565.4100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,42130.85,,,,,,,33665.5500,130436.0700,other,"32.3% of $130,436.07 in Billed Charges for Rev 272 = $42,130.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTING GUIDE IPS CRANIAL LP,272,RC,27200002,CDM,,,,,,both,,,130436.0700,19565.4100,UNITED HEALTHCARE,UHC HERITAGE SELECT,40043.87,,,,,,,33665.5500,130436.0700,other,"30.7% of $130,436.07 in Billed Charges for Rev 272 = $40,043.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTING GUIDE IPS CRANIAL LP,272,RC,27200002,CDM,,,,,,both,,,130436.0700,19565.4100,UNITED HEALTHCARE,UNITED HEALTHCARE,42130.85,,,,,,,33665.5500,130436.0700,percent of total billed charges,"32.3% of $130,436.07 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL LP,272,RC,27200002,CDM,,,,,,both,,,130436.0700,19565.4100,WELLCARE,WELLCARE MEDICAID,130436.07,,,,,,,33665.5500,130436.0700,percent of total billed charges,"100% of $130,436.07 in Billed Charges for Rev 272 = $130,436.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM,272,RC,27200002,CDM,,,,,,both,,,2035.0000,305.2500,AETNA,AETNA,868.95,,,,,,,525.2300,2035.0000,percent of total billed charges,"42.7% of $2,035.00 in Billed Charges for Rev 272 = $868.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM,272,RC,27200002,CDM,,,,,,both,,,2035.0000,305.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1424.50,,,,,,,525.2300,2035.0000,percent of total billed charges,"Rev 272 $2,035.00 in Billed Charges at 70% = $1,424.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM,272,RC,27200002,CDM,,,,,,both,,,2035.0000,305.2500,CIGNA HEALTHCARE,CIGNA HMO,848.60,,,,,,,525.2300,2035.0000,percent of total billed charges,"41.7% of $2,035.00 in Billed Charges for Rev 272 = $848.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM,272,RC,27200002,CDM,,,,,,both,,,2035.0000,305.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,944.24,,,,,,,525.2300,2035.0000,percent of total billed charges,"46.4% of $2,035.00 in Billed Charges for Rev 272 = $944.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM,272,RC,27200002,CDM,,,,,,both,,,2035.0000,305.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,848.60,,,,,,,525.2300,2035.0000,percent of total billed charges,"41.7% of $2,035.00 in Billed Charges for Rev 272 = $848.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM,272,RC,27200002,CDM,,,,,,both,,,2035.0000,305.2500,CIGNA HEALTHCARE,CIGNA PPO,848.60,,,,,,,525.2300,2035.0000,percent of total billed charges,"41.7% of $2,035.00 in Billed Charges for Rev 272 = $848.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM,272,RC,27200002,CDM,,,,,,both,,,2035.0000,305.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1831.50,,,,,,,525.2300,2035.0000,percent of total billed charges,"90% of $2,035.00 in Billed Charges for Rev 272 = $1,831.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM,272,RC,27200002,CDM,,,,,,both,,,2035.0000,305.2500,MEDCOST,MEDCOST VHN,968.46,,,,,,,525.2300,2035.0000,percent of total billed charges,"47.59% of $2,035.00 in Billed Charges for Rev 272 = $968.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM,272,RC,27200002,CDM,,,,,,both,,,2035.0000,305.2500,SENTARA HEALTH,SENTARA HEALTH,525.23,,,,,,,525.2300,2035.0000,percent of total billed charges,"25.81% of $2,035.00 in Billed Charges for Rev 272 = $525.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM,272,RC,27200002,CDM,,,,,,both,,,2035.0000,305.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2035.00,,,,,,,525.2300,2035.0000,percent of total billed charges,"100% of $2,035.00 in Billed Charges for Rev 272 = $2,035.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM,272,RC,27200002,CDM,,,,,,both,,,2035.0000,305.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1017.50,,,,,,,525.2300,2035.0000,percent of total billed charges,"Rev 272 $2,035.00 in Billed Charges at 50% = $1,017.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM,272,RC,27200002,CDM,,,,,,both,,,2035.0000,305.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,657.31,,,,,,,525.2300,2035.0000,other,"32.3% of $2,035.00 in Billed Charges for Rev 272 = $657.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 1.5MM,272,RC,27200002,CDM,,,,,,both,,,2035.0000,305.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,624.75,,,,,,,525.2300,2035.0000,other,"30.7% of $2,035.00 in Billed Charges for Rev 272 = $624.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 1.5MM,272,RC,27200002,CDM,,,,,,both,,,2035.0000,305.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,657.31,,,,,,,525.2300,2035.0000,percent of total billed charges,"32.3% of $2,035.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM,272,RC,27200002,CDM,,,,,,both,,,2035.0000,305.2500,WELLCARE,WELLCARE MEDICAID,2035.00,,,,,,,525.2300,2035.0000,percent of total billed charges,"100% of $2,035.00 in Billed Charges for Rev 272 = $2,035.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM 03.503.506,272,RC,,,,,,,,both,,,1939.6900,290.9500,AETNA,AETNA,828.25,,,,,,,500.6300,1939.6900,percent of total billed charges,"42.7% of $1,939.69 in Billed Charges for Rev 272 = $828.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM 03.503.506,272,RC,,,,,,,,both,,,1939.6900,290.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1357.78,,,,,,,500.6300,1939.6900,percent of total billed charges,"Rev 272 $1,939.69 in Billed Charges at 70% = $1,357.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM 03.503.506,272,RC,,,,,,,,both,,,1939.6900,290.9500,CIGNA HEALTHCARE,CIGNA HMO,808.85,,,,,,,500.6300,1939.6900,percent of total billed charges,"41.7% of $1,939.69 in Billed Charges for Rev 272 = $808.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM 03.503.506,272,RC,,,,,,,,both,,,1939.6900,290.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,900.02,,,,,,,500.6300,1939.6900,percent of total billed charges,"46.4% of $1,939.69 in Billed Charges for Rev 272 = $900.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM 03.503.506,272,RC,,,,,,,,both,,,1939.6900,290.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,808.85,,,,,,,500.6300,1939.6900,percent of total billed charges,"41.7% of $1,939.69 in Billed Charges for Rev 272 = $808.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM 03.503.506,272,RC,,,,,,,,both,,,1939.6900,290.9500,CIGNA HEALTHCARE,CIGNA PPO,808.85,,,,,,,500.6300,1939.6900,percent of total billed charges,"41.7% of $1,939.69 in Billed Charges for Rev 272 = $808.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM 03.503.506,272,RC,,,,,,,,both,,,1939.6900,290.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1745.72,,,,,,,500.6300,1939.6900,percent of total billed charges,"90% of $1,939.69 in Billed Charges for Rev 272 = $1,745.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM 03.503.506,272,RC,,,,,,,,both,,,1939.6900,290.9500,MEDCOST,MEDCOST VHN,923.10,,,,,,,500.6300,1939.6900,percent of total billed charges,"47.59% of $1,939.69 in Billed Charges for Rev 272 = $923.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM 03.503.506,272,RC,,,,,,,,both,,,1939.6900,290.9500,SENTARA HEALTH,SENTARA HEALTH,500.63,,,,,,,500.6300,1939.6900,percent of total billed charges,"25.81% of $1,939.69 in Billed Charges for Rev 272 = $500.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM 03.503.506,272,RC,,,,,,,,both,,,1939.6900,290.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1939.69,,,,,,,500.6300,1939.6900,percent of total billed charges,"100% of $1,939.69 in Billed Charges for Rev 272 = $1,939.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM 03.503.506,272,RC,,,,,,,,both,,,1939.6900,290.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,969.85,,,,,,,500.6300,1939.6900,percent of total billed charges,"Rev 272 $1,939.69 in Billed Charges at 50% = $969.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM 03.503.506,272,RC,,,,,,,,both,,,1939.6900,290.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,626.52,,,,,,,500.6300,1939.6900,other,"32.3% of $1,939.69 in Billed Charges for Rev 272 = $626.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 1.5MM 03.503.506,272,RC,,,,,,,,both,,,1939.6900,290.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,595.48,,,,,,,500.6300,1939.6900,other,"30.7% of $1,939.69 in Billed Charges for Rev 272 = $595.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 1.5MM 03.503.506,272,RC,,,,,,,,both,,,1939.6900,290.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,626.52,,,,,,,500.6300,1939.6900,percent of total billed charges,"32.3% of $1,939.69 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 1.5MM 03.503.506,272,RC,,,,,,,,both,,,1939.6900,290.9500,WELLCARE,WELLCARE MEDICAID,1939.69,,,,,,,500.6300,1939.6900,percent of total billed charges,"100% of $1,939.69 in Billed Charges for Rev 272 = $1,939.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 12MM 62-0032,272,RC,,,,,,,,both,,,1037.1000,155.5700,AETNA,AETNA,442.84,,,,,,,267.6800,1037.1000,percent of total billed charges,"42.7% of $1,037.10 in Billed Charges for Rev 272 = $442.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 12MM 62-0032,272,RC,,,,,,,,both,,,1037.1000,155.5700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,725.97,,,,,,,267.6800,1037.1000,percent of total billed charges,"Rev 272 $1,037.10 in Billed Charges at 70% = $725.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 12MM 62-0032,272,RC,,,,,,,,both,,,1037.1000,155.5700,CIGNA HEALTHCARE,CIGNA HMO,432.47,,,,,,,267.6800,1037.1000,percent of total billed charges,"41.7% of $1,037.10 in Billed Charges for Rev 272 = $432.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 12MM 62-0032,272,RC,,,,,,,,both,,,1037.1000,155.5700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,481.21,,,,,,,267.6800,1037.1000,percent of total billed charges,"46.4% of $1,037.10 in Billed Charges for Rev 272 = $481.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 12MM 62-0032,272,RC,,,,,,,,both,,,1037.1000,155.5700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,432.47,,,,,,,267.6800,1037.1000,percent of total billed charges,"41.7% of $1,037.10 in Billed Charges for Rev 272 = $432.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 12MM 62-0032,272,RC,,,,,,,,both,,,1037.1000,155.5700,CIGNA HEALTHCARE,CIGNA PPO,432.47,,,,,,,267.6800,1037.1000,percent of total billed charges,"41.7% of $1,037.10 in Billed Charges for Rev 272 = $432.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 12MM 62-0032,272,RC,,,,,,,,both,,,1037.1000,155.5700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,933.39,,,,,,,267.6800,1037.1000,percent of total billed charges,"90% of $1,037.10 in Billed Charges for Rev 272 = $933.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 12MM 62-0032,272,RC,,,,,,,,both,,,1037.1000,155.5700,MEDCOST,MEDCOST VHN,493.56,,,,,,,267.6800,1037.1000,percent of total billed charges,"47.59% of $1,037.10 in Billed Charges for Rev 272 = $493.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 12MM 62-0032,272,RC,,,,,,,,both,,,1037.1000,155.5700,SENTARA HEALTH,SENTARA HEALTH,267.68,,,,,,,267.6800,1037.1000,percent of total billed charges,"25.81% of $1,037.10 in Billed Charges for Rev 272 = $267.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 12MM 62-0032,272,RC,,,,,,,,both,,,1037.1000,155.5700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1037.10,,,,,,,267.6800,1037.1000,percent of total billed charges,"100% of $1,037.10 in Billed Charges for Rev 272 = $1,037.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 12MM 62-0032,272,RC,,,,,,,,both,,,1037.1000,155.5700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,518.55,,,,,,,267.6800,1037.1000,percent of total billed charges,"Rev 272 $1,037.10 in Billed Charges at 50% = $518.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 12MM 62-0032,272,RC,,,,,,,,both,,,1037.1000,155.5700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,334.98,,,,,,,267.6800,1037.1000,other,"32.3% of $1,037.10 in Billed Charges for Rev 272 = $334.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 12MM 62-0032,272,RC,,,,,,,,both,,,1037.1000,155.5700,UNITED HEALTHCARE,UHC HERITAGE SELECT,318.39,,,,,,,267.6800,1037.1000,other,"30.7% of $1,037.10 in Billed Charges for Rev 272 = $318.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 12MM 62-0032,272,RC,,,,,,,,both,,,1037.1000,155.5700,UNITED HEALTHCARE,UNITED HEALTHCARE,334.98,,,,,,,267.6800,1037.1000,percent of total billed charges,"32.3% of $1,037.10 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 12MM 62-0032,272,RC,,,,,,,,both,,,1037.1000,155.5700,WELLCARE,WELLCARE MEDICAID,1037.10,,,,,,,267.6800,1037.1000,percent of total billed charges,"100% of $1,037.10 in Billed Charges for Rev 272 = $1,037.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1523.5000,228.5300,AETNA,AETNA,650.53,,,,,,,393.2200,1523.5000,percent of total billed charges,"42.7% of $1,523.50 in Billed Charges for Rev 272 = $650.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1523.5000,228.5300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1066.45,,,,,,,393.2200,1523.5000,percent of total billed charges,"Rev 272 $1,523.50 in Billed Charges at 70% = $1,066.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1523.5000,228.5300,CIGNA HEALTHCARE,CIGNA HMO,635.30,,,,,,,393.2200,1523.5000,percent of total billed charges,"41.7% of $1,523.50 in Billed Charges for Rev 272 = $635.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1523.5000,228.5300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,706.90,,,,,,,393.2200,1523.5000,percent of total billed charges,"46.4% of $1,523.50 in Billed Charges for Rev 272 = $706.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1523.5000,228.5300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,635.30,,,,,,,393.2200,1523.5000,percent of total billed charges,"41.7% of $1,523.50 in Billed Charges for Rev 272 = $635.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1523.5000,228.5300,CIGNA HEALTHCARE,CIGNA PPO,635.30,,,,,,,393.2200,1523.5000,percent of total billed charges,"41.7% of $1,523.50 in Billed Charges for Rev 272 = $635.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1523.5000,228.5300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1371.15,,,,,,,393.2200,1523.5000,percent of total billed charges,"90% of $1,523.50 in Billed Charges for Rev 272 = $1,371.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1523.5000,228.5300,MEDCOST,MEDCOST VHN,725.03,,,,,,,393.2200,1523.5000,percent of total billed charges,"47.59% of $1,523.50 in Billed Charges for Rev 272 = $725.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1523.5000,228.5300,SENTARA HEALTH,SENTARA HEALTH,393.22,,,,,,,393.2200,1523.5000,percent of total billed charges,"25.81% of $1,523.50 in Billed Charges for Rev 272 = $393.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1523.5000,228.5300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1523.50,,,,,,,393.2200,1523.5000,percent of total billed charges,"100% of $1,523.50 in Billed Charges for Rev 272 = $1,523.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1523.5000,228.5300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,761.75,,,,,,,393.2200,1523.5000,percent of total billed charges,"Rev 272 $1,523.50 in Billed Charges at 50% = $761.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1523.5000,228.5300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,492.09,,,,,,,393.2200,1523.5000,other,"32.3% of $1,523.50 in Billed Charges for Rev 272 = $492.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1523.5000,228.5300,UNITED HEALTHCARE,UHC HERITAGE SELECT,467.71,,,,,,,393.2200,1523.5000,other,"30.7% of $1,523.50 in Billed Charges for Rev 272 = $467.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1523.5000,228.5300,UNITED HEALTHCARE,UNITED HEALTHCARE,492.09,,,,,,,393.2200,1523.5000,percent of total billed charges,"32.3% of $1,523.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1523.5000,228.5300,WELLCARE,WELLCARE MEDICAID,1523.50,,,,,,,393.2200,1523.5000,percent of total billed charges,"100% of $1,523.50 in Billed Charges for Rev 272 = $1,523.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE AXIUS EXPOSE 5,272,RC,27200002,CDM,,,,,,both,,,8509.0900,1276.3600,AETNA,AETNA,3633.38,,,,,,,2196.2000,8509.0900,percent of total billed charges,"42.7% of $8,509.09 in Billed Charges for Rev 272 = $3,633.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE AXIUS EXPOSE 5,272,RC,27200002,CDM,,,,,,both,,,8509.0900,1276.3600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5956.36,,,,,,,2196.2000,8509.0900,percent of total billed charges,"Rev 272 $8,509.09 in Billed Charges at 70% = $5,956.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE AXIUS EXPOSE 5,272,RC,27200002,CDM,,,,,,both,,,8509.0900,1276.3600,CIGNA HEALTHCARE,CIGNA HMO,3548.29,,,,,,,2196.2000,8509.0900,percent of total billed charges,"41.7% of $8,509.09 in Billed Charges for Rev 272 = $3,548.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE AXIUS EXPOSE 5,272,RC,27200002,CDM,,,,,,both,,,8509.0900,1276.3600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3948.22,,,,,,,2196.2000,8509.0900,percent of total billed charges,"46.4% of $8,509.09 in Billed Charges for Rev 272 = $3,948.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE AXIUS EXPOSE 5,272,RC,27200002,CDM,,,,,,both,,,8509.0900,1276.3600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3548.29,,,,,,,2196.2000,8509.0900,percent of total billed charges,"41.7% of $8,509.09 in Billed Charges for Rev 272 = $3,548.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE AXIUS EXPOSE 5,272,RC,27200002,CDM,,,,,,both,,,8509.0900,1276.3600,CIGNA HEALTHCARE,CIGNA PPO,3548.29,,,,,,,2196.2000,8509.0900,percent of total billed charges,"41.7% of $8,509.09 in Billed Charges for Rev 272 = $3,548.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE AXIUS EXPOSE 5,272,RC,27200002,CDM,,,,,,both,,,8509.0900,1276.3600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7658.18,,,,,,,2196.2000,8509.0900,percent of total billed charges,"90% of $8,509.09 in Billed Charges for Rev 272 = $7,658.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE AXIUS EXPOSE 5,272,RC,27200002,CDM,,,,,,both,,,8509.0900,1276.3600,MEDCOST,MEDCOST VHN,4049.48,,,,,,,2196.2000,8509.0900,percent of total billed charges,"47.59% of $8,509.09 in Billed Charges for Rev 272 = $4,049.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE AXIUS EXPOSE 5,272,RC,27200002,CDM,,,,,,both,,,8509.0900,1276.3600,SENTARA HEALTH,SENTARA HEALTH,2196.20,,,,,,,2196.2000,8509.0900,percent of total billed charges,"25.81% of $8,509.09 in Billed Charges for Rev 272 = $2,196.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE AXIUS EXPOSE 5,272,RC,27200002,CDM,,,,,,both,,,8509.0900,1276.3600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8509.09,,,,,,,2196.2000,8509.0900,percent of total billed charges,"100% of $8,509.09 in Billed Charges for Rev 272 = $8,509.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE AXIUS EXPOSE 5,272,RC,27200002,CDM,,,,,,both,,,8509.0900,1276.3600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4254.55,,,,,,,2196.2000,8509.0900,percent of total billed charges,"Rev 272 $8,509.09 in Billed Charges at 50% = $4,254.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE AXIUS EXPOSE 5,272,RC,27200002,CDM,,,,,,both,,,8509.0900,1276.3600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2748.44,,,,,,,2196.2000,8509.0900,other,"32.3% of $8,509.09 in Billed Charges for Rev 272 = $2,748.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE AXIUS EXPOSE 5,272,RC,27200002,CDM,,,,,,both,,,8509.0900,1276.3600,UNITED HEALTHCARE,UHC HERITAGE SELECT,2612.29,,,,,,,2196.2000,8509.0900,other,"30.7% of $8,509.09 in Billed Charges for Rev 272 = $2,612.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE AXIUS EXPOSE 5,272,RC,27200002,CDM,,,,,,both,,,8509.0900,1276.3600,UNITED HEALTHCARE,UNITED HEALTHCARE,2748.44,,,,,,,2196.2000,8509.0900,percent of total billed charges,"32.3% of $8,509.09 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE AXIUS EXPOSE 5,272,RC,27200002,CDM,,,,,,both,,,8509.0900,1276.3600,WELLCARE,WELLCARE MEDICAID,8509.09,,,,,,,2196.2000,8509.0900,percent of total billed charges,"100% of $8,509.09 in Billed Charges for Rev 272 = $8,509.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 14MM CANN FLEXIBLE,272,RC,,,,,,,,both,,,7659.7100,1148.9600,AETNA,AETNA,3270.70,,,,,,,1976.9700,7659.7100,percent of total billed charges,"42.7% of $7,659.71 in Billed Charges for Rev 272 = $3,270.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 14MM CANN FLEXIBLE,272,RC,,,,,,,,both,,,7659.7100,1148.9600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5361.80,,,,,,,1976.9700,7659.7100,percent of total billed charges,"Rev 272 $7,659.71 in Billed Charges at 70% = $5,361.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 14MM CANN FLEXIBLE,272,RC,,,,,,,,both,,,7659.7100,1148.9600,CIGNA HEALTHCARE,CIGNA HMO,3194.10,,,,,,,1976.9700,7659.7100,percent of total billed charges,"41.7% of $7,659.71 in Billed Charges for Rev 272 = $3,194.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 14MM CANN FLEXIBLE,272,RC,,,,,,,,both,,,7659.7100,1148.9600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3554.11,,,,,,,1976.9700,7659.7100,percent of total billed charges,"46.4% of $7,659.71 in Billed Charges for Rev 272 = $3,554.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 14MM CANN FLEXIBLE,272,RC,,,,,,,,both,,,7659.7100,1148.9600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3194.10,,,,,,,1976.9700,7659.7100,percent of total billed charges,"41.7% of $7,659.71 in Billed Charges for Rev 272 = $3,194.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 14MM CANN FLEXIBLE,272,RC,,,,,,,,both,,,7659.7100,1148.9600,CIGNA HEALTHCARE,CIGNA PPO,3194.10,,,,,,,1976.9700,7659.7100,percent of total billed charges,"41.7% of $7,659.71 in Billed Charges for Rev 272 = $3,194.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 14MM CANN FLEXIBLE,272,RC,,,,,,,,both,,,7659.7100,1148.9600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6893.74,,,,,,,1976.9700,7659.7100,percent of total billed charges,"90% of $7,659.71 in Billed Charges for Rev 272 = $6,893.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 14MM CANN FLEXIBLE,272,RC,,,,,,,,both,,,7659.7100,1148.9600,MEDCOST,MEDCOST VHN,3645.26,,,,,,,1976.9700,7659.7100,percent of total billed charges,"47.59% of $7,659.71 in Billed Charges for Rev 272 = $3,645.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 14MM CANN FLEXIBLE,272,RC,,,,,,,,both,,,7659.7100,1148.9600,SENTARA HEALTH,SENTARA HEALTH,1976.97,,,,,,,1976.9700,7659.7100,percent of total billed charges,"25.81% of $7,659.71 in Billed Charges for Rev 272 = $1,976.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 14MM CANN FLEXIBLE,272,RC,,,,,,,,both,,,7659.7100,1148.9600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7659.71,,,,,,,1976.9700,7659.7100,percent of total billed charges,"100% of $7,659.71 in Billed Charges for Rev 272 = $7,659.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 14MM CANN FLEXIBLE,272,RC,,,,,,,,both,,,7659.7100,1148.9600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3829.86,,,,,,,1976.9700,7659.7100,percent of total billed charges,"Rev 272 $7,659.71 in Billed Charges at 50% = $3,829.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 14MM CANN FLEXIBLE,272,RC,,,,,,,,both,,,7659.7100,1148.9600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2474.09,,,,,,,1976.9700,7659.7100,other,"32.3% of $7,659.71 in Billed Charges for Rev 272 = $2,474.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 14MM CANN FLEXIBLE,272,RC,,,,,,,,both,,,7659.7100,1148.9600,UNITED HEALTHCARE,UHC HERITAGE SELECT,2351.53,,,,,,,1976.9700,7659.7100,other,"30.7% of $7,659.71 in Billed Charges for Rev 272 = $2,351.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT 14MM CANN FLEXIBLE,272,RC,,,,,,,,both,,,7659.7100,1148.9600,UNITED HEALTHCARE,UNITED HEALTHCARE,2474.09,,,,,,,1976.9700,7659.7100,percent of total billed charges,"32.3% of $7,659.71 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT 14MM CANN FLEXIBLE,272,RC,,,,,,,,both,,,7659.7100,1148.9600,WELLCARE,WELLCARE MEDICAID,7659.71,,,,,,,1976.9700,7659.7100,percent of total billed charges,"100% of $7,659.71 in Billed Charges for Rev 272 = $7,659.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SURG HAND 4.3MM VALOR NAIL,272,RC,27200002,CDM,,,,,,both,,,2374.9600,356.2400,AETNA,AETNA,1014.11,,,,,,,612.9800,2374.9600,percent of total billed charges,"42.7% of $2,374.96 in Billed Charges for Rev 272 = $1,014.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SURG HAND 4.3MM VALOR NAIL,272,RC,27200002,CDM,,,,,,both,,,2374.9600,356.2400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1662.47,,,,,,,612.9800,2374.9600,percent of total billed charges,"Rev 272 $2,374.96 in Billed Charges at 70% = $1,662.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SURG HAND 4.3MM VALOR NAIL,272,RC,27200002,CDM,,,,,,both,,,2374.9600,356.2400,CIGNA HEALTHCARE,CIGNA HMO,990.36,,,,,,,612.9800,2374.9600,percent of total billed charges,"41.7% of $2,374.96 in Billed Charges for Rev 272 = $990.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SURG HAND 4.3MM VALOR NAIL,272,RC,27200002,CDM,,,,,,both,,,2374.9600,356.2400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1101.98,,,,,,,612.9800,2374.9600,percent of total billed charges,"46.4% of $2,374.96 in Billed Charges for Rev 272 = $1,101.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SURG HAND 4.3MM VALOR NAIL,272,RC,27200002,CDM,,,,,,both,,,2374.9600,356.2400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,990.36,,,,,,,612.9800,2374.9600,percent of total billed charges,"41.7% of $2,374.96 in Billed Charges for Rev 272 = $990.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SURG HAND 4.3MM VALOR NAIL,272,RC,27200002,CDM,,,,,,both,,,2374.9600,356.2400,CIGNA HEALTHCARE,CIGNA PPO,990.36,,,,,,,612.9800,2374.9600,percent of total billed charges,"41.7% of $2,374.96 in Billed Charges for Rev 272 = $990.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SURG HAND 4.3MM VALOR NAIL,272,RC,27200002,CDM,,,,,,both,,,2374.9600,356.2400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2137.46,,,,,,,612.9800,2374.9600,percent of total billed charges,"90% of $2,374.96 in Billed Charges for Rev 272 = $2,137.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SURG HAND 4.3MM VALOR NAIL,272,RC,27200002,CDM,,,,,,both,,,2374.9600,356.2400,MEDCOST,MEDCOST VHN,1130.24,,,,,,,612.9800,2374.9600,percent of total billed charges,"47.59% of $2,374.96 in Billed Charges for Rev 272 = $1,130.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SURG HAND 4.3MM VALOR NAIL,272,RC,27200002,CDM,,,,,,both,,,2374.9600,356.2400,SENTARA HEALTH,SENTARA HEALTH,612.98,,,,,,,612.9800,2374.9600,percent of total billed charges,"25.81% of $2,374.96 in Billed Charges for Rev 272 = $612.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SURG HAND 4.3MM VALOR NAIL,272,RC,27200002,CDM,,,,,,both,,,2374.9600,356.2400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2374.96,,,,,,,612.9800,2374.9600,percent of total billed charges,"100% of $2,374.96 in Billed Charges for Rev 272 = $2,374.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SURG HAND 4.3MM VALOR NAIL,272,RC,27200002,CDM,,,,,,both,,,2374.9600,356.2400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1187.48,,,,,,,612.9800,2374.9600,percent of total billed charges,"Rev 272 $2,374.96 in Billed Charges at 50% = $1,187.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SURG HAND 4.3MM VALOR NAIL,272,RC,27200002,CDM,,,,,,both,,,2374.9600,356.2400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,767.11,,,,,,,612.9800,2374.9600,other,"32.3% of $2,374.96 in Billed Charges for Rev 272 = $767.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL SURG HAND 4.3MM VALOR NAIL,272,RC,27200002,CDM,,,,,,both,,,2374.9600,356.2400,UNITED HEALTHCARE,UHC HERITAGE SELECT,729.11,,,,,,,612.9800,2374.9600,other,"30.7% of $2,374.96 in Billed Charges for Rev 272 = $729.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL SURG HAND 4.3MM VALOR NAIL,272,RC,27200002,CDM,,,,,,both,,,2374.9600,356.2400,UNITED HEALTHCARE,UNITED HEALTHCARE,767.11,,,,,,,612.9800,2374.9600,percent of total billed charges,"32.3% of $2,374.96 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SURG HAND 4.3MM VALOR NAIL,272,RC,27200002,CDM,,,,,,both,,,2374.9600,356.2400,WELLCARE,WELLCARE MEDICAID,2374.96,,,,,,,612.9800,2374.9600,percent of total billed charges,"100% of $2,374.96 in Billed Charges for Rev 272 = $2,374.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL T2 1806-3545S 1806-3545S,272,RC,,,,,,,,both,,,886.7200,133.0100,AETNA,AETNA,378.63,,,,,,,228.8600,886.7200,percent of total billed charges,42.7% of $886.72 in Billed Charges for Rev 272 = $378.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL T2 1806-3545S 1806-3545S,272,RC,,,,,,,,both,,,886.7200,133.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,620.70,,,,,,,228.8600,886.7200,percent of total billed charges,Rev 272 $886.72 in Billed Charges at 70% = $620.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL T2 1806-3545S 1806-3545S,272,RC,,,,,,,,both,,,886.7200,133.0100,CIGNA HEALTHCARE,CIGNA HMO,369.76,,,,,,,228.8600,886.7200,percent of total billed charges,41.7% of $886.72 in Billed Charges for Rev 272 = $369.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL T2 1806-3545S 1806-3545S,272,RC,,,,,,,,both,,,886.7200,133.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,411.44,,,,,,,228.8600,886.7200,percent of total billed charges,46.4% of $886.72 in Billed Charges for Rev 272 = $411.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL T2 1806-3545S 1806-3545S,272,RC,,,,,,,,both,,,886.7200,133.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,369.76,,,,,,,228.8600,886.7200,percent of total billed charges,41.7% of $886.72 in Billed Charges for Rev 272 = $369.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL T2 1806-3545S 1806-3545S,272,RC,,,,,,,,both,,,886.7200,133.0100,CIGNA HEALTHCARE,CIGNA PPO,369.76,,,,,,,228.8600,886.7200,percent of total billed charges,41.7% of $886.72 in Billed Charges for Rev 272 = $369.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL T2 1806-3545S 1806-3545S,272,RC,,,,,,,,both,,,886.7200,133.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,798.05,,,,,,,228.8600,886.7200,percent of total billed charges,90% of $886.72 in Billed Charges for Rev 272 = $798.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL T2 1806-3545S 1806-3545S,272,RC,,,,,,,,both,,,886.7200,133.0100,MEDCOST,MEDCOST VHN,421.99,,,,,,,228.8600,886.7200,percent of total billed charges,47.59% of $886.72 in Billed Charges for Rev 272 = $421.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL T2 1806-3545S 1806-3545S,272,RC,,,,,,,,both,,,886.7200,133.0100,SENTARA HEALTH,SENTARA HEALTH,228.86,,,,,,,228.8600,886.7200,percent of total billed charges,25.81% of $886.72 in Billed Charges for Rev 272 = $228.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL T2 1806-3545S 1806-3545S,272,RC,,,,,,,,both,,,886.7200,133.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",886.72,,,,,,,228.8600,886.7200,percent of total billed charges,100% of $886.72 in Billed Charges for Rev 272 = $886.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL T2 1806-3545S 1806-3545S,272,RC,,,,,,,,both,,,886.7200,133.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,443.36,,,,,,,228.8600,886.7200,percent of total billed charges,Rev 272 $886.72 in Billed Charges at 50% = $443.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL T2 1806-3545S 1806-3545S,272,RC,,,,,,,,both,,,886.7200,133.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,286.41,,,,,,,228.8600,886.7200,other,32.3% of $886.72 in Billed Charges for Rev 272 = $286.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRILL T2 1806-3545S 1806-3545S,272,RC,,,,,,,,both,,,886.7200,133.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,272.22,,,,,,,228.8600,886.7200,other,30.7% of $886.72 in Billed Charges for Rev 272 = $272.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRILL T2 1806-3545S 1806-3545S,272,RC,,,,,,,,both,,,886.7200,133.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,286.41,,,,,,,228.8600,886.7200,percent of total billed charges,32.3% of $886.72 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL T2 1806-3545S 1806-3545S,272,RC,,,,,,,,both,,,886.7200,133.0100,WELLCARE,WELLCARE MEDICAID,886.72,,,,,,,228.8600,886.7200,percent of total billed charges,100% of $886.72 in Billed Charges for Rev 272 = $886.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DEVICE BIOPSY ULTRASOUND GUIDE,272,RC,27200002,CDM,,,,,,both,,,2464.6700,369.7000,AETNA,AETNA,1052.41,,,,,,,636.1300,2464.6700,percent of total billed charges,"42.7% of $2,464.67 in Billed Charges for Rev 272 = $1,052.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE BIOPSY ULTRASOUND GUIDE,272,RC,27200002,CDM,,,,,,both,,,2464.6700,369.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1725.27,,,,,,,636.1300,2464.6700,percent of total billed charges,"Rev 272 $2,464.67 in Billed Charges at 70% = $1,725.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE BIOPSY ULTRASOUND GUIDE,272,RC,27200002,CDM,,,,,,both,,,2464.6700,369.7000,CIGNA HEALTHCARE,CIGNA HMO,1027.77,,,,,,,636.1300,2464.6700,percent of total billed charges,"41.7% of $2,464.67 in Billed Charges for Rev 272 = $1,027.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE BIOPSY ULTRASOUND GUIDE,272,RC,27200002,CDM,,,,,,both,,,2464.6700,369.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1143.61,,,,,,,636.1300,2464.6700,percent of total billed charges,"46.4% of $2,464.67 in Billed Charges for Rev 272 = $1,143.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE BIOPSY ULTRASOUND GUIDE,272,RC,27200002,CDM,,,,,,both,,,2464.6700,369.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1027.77,,,,,,,636.1300,2464.6700,percent of total billed charges,"41.7% of $2,464.67 in Billed Charges for Rev 272 = $1,027.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE BIOPSY ULTRASOUND GUIDE,272,RC,27200002,CDM,,,,,,both,,,2464.6700,369.7000,CIGNA HEALTHCARE,CIGNA PPO,1027.77,,,,,,,636.1300,2464.6700,percent of total billed charges,"41.7% of $2,464.67 in Billed Charges for Rev 272 = $1,027.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE BIOPSY ULTRASOUND GUIDE,272,RC,27200002,CDM,,,,,,both,,,2464.6700,369.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2218.20,,,,,,,636.1300,2464.6700,percent of total billed charges,"90% of $2,464.67 in Billed Charges for Rev 272 = $2,218.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE BIOPSY ULTRASOUND GUIDE,272,RC,27200002,CDM,,,,,,both,,,2464.6700,369.7000,MEDCOST,MEDCOST VHN,1172.94,,,,,,,636.1300,2464.6700,percent of total billed charges,"47.59% of $2,464.67 in Billed Charges for Rev 272 = $1,172.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE BIOPSY ULTRASOUND GUIDE,272,RC,27200002,CDM,,,,,,both,,,2464.6700,369.7000,SENTARA HEALTH,SENTARA HEALTH,636.13,,,,,,,636.1300,2464.6700,percent of total billed charges,"25.81% of $2,464.67 in Billed Charges for Rev 272 = $636.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE BIOPSY ULTRASOUND GUIDE,272,RC,27200002,CDM,,,,,,both,,,2464.6700,369.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2464.67,,,,,,,636.1300,2464.6700,percent of total billed charges,"100% of $2,464.67 in Billed Charges for Rev 272 = $2,464.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE BIOPSY ULTRASOUND GUIDE,272,RC,27200002,CDM,,,,,,both,,,2464.6700,369.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1232.34,,,,,,,636.1300,2464.6700,percent of total billed charges,"Rev 272 $2,464.67 in Billed Charges at 50% = $1,232.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE BIOPSY ULTRASOUND GUIDE,272,RC,27200002,CDM,,,,,,both,,,2464.6700,369.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,796.09,,,,,,,636.1300,2464.6700,other,"32.3% of $2,464.67 in Billed Charges for Rev 272 = $796.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE BIOPSY ULTRASOUND GUIDE,272,RC,27200002,CDM,,,,,,both,,,2464.6700,369.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,756.65,,,,,,,636.1300,2464.6700,other,"30.7% of $2,464.67 in Billed Charges for Rev 272 = $756.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DEVICE BIOPSY ULTRASOUND GUIDE,272,RC,27200002,CDM,,,,,,both,,,2464.6700,369.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,796.09,,,,,,,636.1300,2464.6700,percent of total billed charges,"32.3% of $2,464.67 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DEVICE BIOPSY ULTRASOUND GUIDE,272,RC,27200002,CDM,,,,,,both,,,2464.6700,369.7000,WELLCARE,WELLCARE MEDICAID,2464.67,,,,,,,636.1300,2464.6700,percent of total billed charges,"100% of $2,464.67 in Billed Charges for Rev 272 = $2,464.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING V.A.C GRANUFOAM X-LARGE,272,RC,27200002,CDM,,,,,,both,,,5082.4100,762.3600,AETNA,AETNA,2170.19,,,,,,,1311.7700,5082.4100,percent of total billed charges,"42.7% of $5,082.41 in Billed Charges for Rev 272 = $2,170.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING V.A.C GRANUFOAM X-LARGE,272,RC,27200002,CDM,,,,,,both,,,5082.4100,762.3600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3557.69,,,,,,,1311.7700,5082.4100,percent of total billed charges,"Rev 272 $5,082.41 in Billed Charges at 70% = $3,557.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING V.A.C GRANUFOAM X-LARGE,272,RC,27200002,CDM,,,,,,both,,,5082.4100,762.3600,CIGNA HEALTHCARE,CIGNA HMO,2119.37,,,,,,,1311.7700,5082.4100,percent of total billed charges,"41.7% of $5,082.41 in Billed Charges for Rev 272 = $2,119.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING V.A.C GRANUFOAM X-LARGE,272,RC,27200002,CDM,,,,,,both,,,5082.4100,762.3600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2358.24,,,,,,,1311.7700,5082.4100,percent of total billed charges,"46.4% of $5,082.41 in Billed Charges for Rev 272 = $2,358.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING V.A.C GRANUFOAM X-LARGE,272,RC,27200002,CDM,,,,,,both,,,5082.4100,762.3600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2119.37,,,,,,,1311.7700,5082.4100,percent of total billed charges,"41.7% of $5,082.41 in Billed Charges for Rev 272 = $2,119.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING V.A.C GRANUFOAM X-LARGE,272,RC,27200002,CDM,,,,,,both,,,5082.4100,762.3600,CIGNA HEALTHCARE,CIGNA PPO,2119.37,,,,,,,1311.7700,5082.4100,percent of total billed charges,"41.7% of $5,082.41 in Billed Charges for Rev 272 = $2,119.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING V.A.C GRANUFOAM X-LARGE,272,RC,27200002,CDM,,,,,,both,,,5082.4100,762.3600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4574.17,,,,,,,1311.7700,5082.4100,percent of total billed charges,"90% of $5,082.41 in Billed Charges for Rev 272 = $4,574.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING V.A.C GRANUFOAM X-LARGE,272,RC,27200002,CDM,,,,,,both,,,5082.4100,762.3600,MEDCOST,MEDCOST VHN,2418.72,,,,,,,1311.7700,5082.4100,percent of total billed charges,"47.59% of $5,082.41 in Billed Charges for Rev 272 = $2,418.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING V.A.C GRANUFOAM X-LARGE,272,RC,27200002,CDM,,,,,,both,,,5082.4100,762.3600,SENTARA HEALTH,SENTARA HEALTH,1311.77,,,,,,,1311.7700,5082.4100,percent of total billed charges,"25.81% of $5,082.41 in Billed Charges for Rev 272 = $1,311.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING V.A.C GRANUFOAM X-LARGE,272,RC,27200002,CDM,,,,,,both,,,5082.4100,762.3600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5082.41,,,,,,,1311.7700,5082.4100,percent of total billed charges,"100% of $5,082.41 in Billed Charges for Rev 272 = $5,082.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING V.A.C GRANUFOAM X-LARGE,272,RC,27200002,CDM,,,,,,both,,,5082.4100,762.3600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2541.21,,,,,,,1311.7700,5082.4100,percent of total billed charges,"Rev 272 $5,082.41 in Billed Charges at 50% = $2,541.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING V.A.C GRANUFOAM X-LARGE,272,RC,27200002,CDM,,,,,,both,,,5082.4100,762.3600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1641.62,,,,,,,1311.7700,5082.4100,other,"32.3% of $5,082.41 in Billed Charges for Rev 272 = $1,641.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING V.A.C GRANUFOAM X-LARGE,272,RC,27200002,CDM,,,,,,both,,,5082.4100,762.3600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1560.30,,,,,,,1311.7700,5082.4100,other,"30.7% of $5,082.41 in Billed Charges for Rev 272 = $1,560.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING V.A.C GRANUFOAM X-LARGE,272,RC,27200002,CDM,,,,,,both,,,5082.4100,762.3600,UNITED HEALTHCARE,UNITED HEALTHCARE,1641.62,,,,,,,1311.7700,5082.4100,percent of total billed charges,"32.3% of $5,082.41 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING V.A.C GRANUFOAM X-LARGE,272,RC,27200002,CDM,,,,,,both,,,5082.4100,762.3600,WELLCARE,WELLCARE MEDICAID,5082.41,,,,,,,1311.7700,5082.4100,percent of total billed charges,"100% of $5,082.41 in Billed Charges for Rev 272 = $5,082.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING V.A.C. SIMPLACE EX SMALL,272,RC,,,,,,,,both,,,377.0500,56.5600,AETNA,AETNA,161.00,,,,,,,97.3200,377.0500,percent of total billed charges,42.7% of $377.05 in Billed Charges for Rev 272 = $161.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING V.A.C. SIMPLACE EX SMALL,272,RC,,,,,,,,both,,,377.0500,56.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,263.94,,,,,,,97.3200,377.0500,percent of total billed charges,Rev 272 $377.05 in Billed Charges at 70% = $263.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING V.A.C. SIMPLACE EX SMALL,272,RC,,,,,,,,both,,,377.0500,56.5600,CIGNA HEALTHCARE,CIGNA HMO,157.23,,,,,,,97.3200,377.0500,percent of total billed charges,41.7% of $377.05 in Billed Charges for Rev 272 = $157.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING V.A.C. SIMPLACE EX SMALL,272,RC,,,,,,,,both,,,377.0500,56.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,174.95,,,,,,,97.3200,377.0500,percent of total billed charges,46.4% of $377.05 in Billed Charges for Rev 272 = $174.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING V.A.C. SIMPLACE EX SMALL,272,RC,,,,,,,,both,,,377.0500,56.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,157.23,,,,,,,97.3200,377.0500,percent of total billed charges,41.7% of $377.05 in Billed Charges for Rev 272 = $157.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING V.A.C. SIMPLACE EX SMALL,272,RC,,,,,,,,both,,,377.0500,56.5600,CIGNA HEALTHCARE,CIGNA PPO,157.23,,,,,,,97.3200,377.0500,percent of total billed charges,41.7% of $377.05 in Billed Charges for Rev 272 = $157.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING V.A.C. SIMPLACE EX SMALL,272,RC,,,,,,,,both,,,377.0500,56.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,339.35,,,,,,,97.3200,377.0500,percent of total billed charges,90% of $377.05 in Billed Charges for Rev 272 = $339.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING V.A.C. SIMPLACE EX SMALL,272,RC,,,,,,,,both,,,377.0500,56.5600,MEDCOST,MEDCOST VHN,179.44,,,,,,,97.3200,377.0500,percent of total billed charges,47.59% of $377.05 in Billed Charges for Rev 272 = $179.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING V.A.C. SIMPLACE EX SMALL,272,RC,,,,,,,,both,,,377.0500,56.5600,SENTARA HEALTH,SENTARA HEALTH,97.32,,,,,,,97.3200,377.0500,percent of total billed charges,25.81% of $377.05 in Billed Charges for Rev 272 = $97.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING V.A.C. SIMPLACE EX SMALL,272,RC,,,,,,,,both,,,377.0500,56.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",377.05,,,,,,,97.3200,377.0500,percent of total billed charges,100% of $377.05 in Billed Charges for Rev 272 = $377.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING V.A.C. SIMPLACE EX SMALL,272,RC,,,,,,,,both,,,377.0500,56.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,188.53,,,,,,,97.3200,377.0500,percent of total billed charges,Rev 272 $377.05 in Billed Charges at 50% = $188.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING V.A.C. SIMPLACE EX SMALL,272,RC,,,,,,,,both,,,377.0500,56.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,121.79,,,,,,,97.3200,377.0500,other,32.3% of $377.05 in Billed Charges for Rev 272 = $121.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING V.A.C. SIMPLACE EX SMALL,272,RC,,,,,,,,both,,,377.0500,56.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,115.75,,,,,,,97.3200,377.0500,other,30.7% of $377.05 in Billed Charges for Rev 272 = $115.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING V.A.C. SIMPLACE EX SMALL,272,RC,,,,,,,,both,,,377.0500,56.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,121.79,,,,,,,97.3200,377.0500,percent of total billed charges,32.3% of $377.05 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING V.A.C. SIMPLACE EX SMALL,272,RC,,,,,,,,both,,,377.0500,56.5600,WELLCARE,WELLCARE MEDICAID,377.05,,,,,,,97.3200,377.0500,percent of total billed charges,100% of $377.05 in Billed Charges for Rev 272 = $377.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL TWIST ANGULUS II 7MM STOP 1.5 X 15MM,272,RC,27200002,CDM,,,,,,both,,,1754.2500,263.1400,AETNA,AETNA,749.06,,,,,,,452.7700,1754.2500,percent of total billed charges,"42.7% of $1,754.25 in Billed Charges for Rev 272 = $749.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL TWIST ANGULUS II 7MM STOP 1.5 X 15MM,272,RC,27200002,CDM,,,,,,both,,,1754.2500,263.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1227.98,,,,,,,452.7700,1754.2500,percent of total billed charges,"Rev 272 $1,754.25 in Billed Charges at 70% = $1,227.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL TWIST ANGULUS II 7MM STOP 1.5 X 15MM,272,RC,27200002,CDM,,,,,,both,,,1754.2500,263.1400,CIGNA HEALTHCARE,CIGNA HMO,731.52,,,,,,,452.7700,1754.2500,percent of total billed charges,"41.7% of $1,754.25 in Billed Charges for Rev 272 = $731.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL TWIST ANGULUS II 7MM STOP 1.5 X 15MM,272,RC,27200002,CDM,,,,,,both,,,1754.2500,263.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,813.97,,,,,,,452.7700,1754.2500,percent of total billed charges,"46.4% of $1,754.25 in Billed Charges for Rev 272 = $813.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL TWIST ANGULUS II 7MM STOP 1.5 X 15MM,272,RC,27200002,CDM,,,,,,both,,,1754.2500,263.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,731.52,,,,,,,452.7700,1754.2500,percent of total billed charges,"41.7% of $1,754.25 in Billed Charges for Rev 272 = $731.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL TWIST ANGULUS II 7MM STOP 1.5 X 15MM,272,RC,27200002,CDM,,,,,,both,,,1754.2500,263.1400,CIGNA HEALTHCARE,CIGNA PPO,731.52,,,,,,,452.7700,1754.2500,percent of total billed charges,"41.7% of $1,754.25 in Billed Charges for Rev 272 = $731.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL TWIST ANGULUS II 7MM STOP 1.5 X 15MM,272,RC,27200002,CDM,,,,,,both,,,1754.2500,263.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1578.83,,,,,,,452.7700,1754.2500,percent of total billed charges,"90% of $1,754.25 in Billed Charges for Rev 272 = $1,578.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL TWIST ANGULUS II 7MM STOP 1.5 X 15MM,272,RC,27200002,CDM,,,,,,both,,,1754.2500,263.1400,MEDCOST,MEDCOST VHN,834.85,,,,,,,452.7700,1754.2500,percent of total billed charges,"47.59% of $1,754.25 in Billed Charges for Rev 272 = $834.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL TWIST ANGULUS II 7MM STOP 1.5 X 15MM,272,RC,27200002,CDM,,,,,,both,,,1754.2500,263.1400,SENTARA HEALTH,SENTARA HEALTH,452.77,,,,,,,452.7700,1754.2500,percent of total billed charges,"25.81% of $1,754.25 in Billed Charges for Rev 272 = $452.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL TWIST ANGULUS II 7MM STOP 1.5 X 15MM,272,RC,27200002,CDM,,,,,,both,,,1754.2500,263.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1754.25,,,,,,,452.7700,1754.2500,percent of total billed charges,"100% of $1,754.25 in Billed Charges for Rev 272 = $1,754.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL TWIST ANGULUS II 7MM STOP 1.5 X 15MM,272,RC,27200002,CDM,,,,,,both,,,1754.2500,263.1400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,877.13,,,,,,,452.7700,1754.2500,percent of total billed charges,"Rev 272 $1,754.25 in Billed Charges at 50% = $877.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL TWIST ANGULUS II 7MM STOP 1.5 X 15MM,272,RC,27200002,CDM,,,,,,both,,,1754.2500,263.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,566.62,,,,,,,452.7700,1754.2500,other,"32.3% of $1,754.25 in Billed Charges for Rev 272 = $566.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL TWIST ANGULUS II 7MM STOP 1.5 X 15MM,272,RC,27200002,CDM,,,,,,both,,,1754.2500,263.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,538.55,,,,,,,452.7700,1754.2500,other,"30.7% of $1,754.25 in Billed Charges for Rev 272 = $538.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL TWIST ANGULUS II 7MM STOP 1.5 X 15MM,272,RC,27200002,CDM,,,,,,both,,,1754.2500,263.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,566.62,,,,,,,452.7700,1754.2500,percent of total billed charges,"32.3% of $1,754.25 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL TWIST ANGULUS II 7MM STOP 1.5 X 15MM,272,RC,27200002,CDM,,,,,,both,,,1754.2500,263.1400,WELLCARE,WELLCARE MEDICAID,1754.25,,,,,,,452.7700,1754.2500,percent of total billed charges,"100% of $1,754.25 in Billed Charges for Rev 272 = $1,754.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILLING TEMPLATE,272,RC,,,,,,,,both,,,2985.4000,447.8100,AETNA,AETNA,1274.77,,,,,,,770.5300,2985.4000,percent of total billed charges,"42.7% of $2,985.40 in Billed Charges for Rev 272 = $1,274.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILLING TEMPLATE,272,RC,,,,,,,,both,,,2985.4000,447.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2089.78,,,,,,,770.5300,2985.4000,percent of total billed charges,"Rev 272 $2,985.40 in Billed Charges at 70% = $2,089.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILLING TEMPLATE,272,RC,,,,,,,,both,,,2985.4000,447.8100,CIGNA HEALTHCARE,CIGNA HMO,1244.91,,,,,,,770.5300,2985.4000,percent of total billed charges,"41.7% of $2,985.40 in Billed Charges for Rev 272 = $1,244.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILLING TEMPLATE,272,RC,,,,,,,,both,,,2985.4000,447.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1385.23,,,,,,,770.5300,2985.4000,percent of total billed charges,"46.4% of $2,985.40 in Billed Charges for Rev 272 = $1,385.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILLING TEMPLATE,272,RC,,,,,,,,both,,,2985.4000,447.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1244.91,,,,,,,770.5300,2985.4000,percent of total billed charges,"41.7% of $2,985.40 in Billed Charges for Rev 272 = $1,244.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILLING TEMPLATE,272,RC,,,,,,,,both,,,2985.4000,447.8100,CIGNA HEALTHCARE,CIGNA PPO,1244.91,,,,,,,770.5300,2985.4000,percent of total billed charges,"41.7% of $2,985.40 in Billed Charges for Rev 272 = $1,244.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILLING TEMPLATE,272,RC,,,,,,,,both,,,2985.4000,447.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2686.86,,,,,,,770.5300,2985.4000,percent of total billed charges,"90% of $2,985.40 in Billed Charges for Rev 272 = $2,686.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILLING TEMPLATE,272,RC,,,,,,,,both,,,2985.4000,447.8100,MEDCOST,MEDCOST VHN,1420.75,,,,,,,770.5300,2985.4000,percent of total billed charges,"47.59% of $2,985.40 in Billed Charges for Rev 272 = $1,420.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILLING TEMPLATE,272,RC,,,,,,,,both,,,2985.4000,447.8100,SENTARA HEALTH,SENTARA HEALTH,770.53,,,,,,,770.5300,2985.4000,percent of total billed charges,"25.81% of $2,985.40 in Billed Charges for Rev 272 = $770.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILLING TEMPLATE,272,RC,,,,,,,,both,,,2985.4000,447.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2985.40,,,,,,,770.5300,2985.4000,percent of total billed charges,"100% of $2,985.40 in Billed Charges for Rev 272 = $2,985.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILLING TEMPLATE,272,RC,,,,,,,,both,,,2985.4000,447.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1492.70,,,,,,,770.5300,2985.4000,percent of total billed charges,"Rev 272 $2,985.40 in Billed Charges at 50% = $1,492.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILLING TEMPLATE,272,RC,,,,,,,,both,,,2985.4000,447.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,964.28,,,,,,,770.5300,2985.4000,other,"32.3% of $2,985.40 in Billed Charges for Rev 272 = $964.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILLING TEMPLATE,272,RC,,,,,,,,both,,,2985.4000,447.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,916.52,,,,,,,770.5300,2985.4000,other,"30.7% of $2,985.40 in Billed Charges for Rev 272 = $916.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILLING TEMPLATE,272,RC,,,,,,,,both,,,2985.4000,447.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,964.28,,,,,,,770.5300,2985.4000,percent of total billed charges,"32.3% of $2,985.40 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILLING TEMPLATE,272,RC,,,,,,,,both,,,2985.4000,447.8100,WELLCARE,WELLCARE MEDICAID,2985.40,,,,,,,770.5300,2985.4000,percent of total billed charges,"100% of $2,985.40 in Billed Charges for Rev 272 = $2,985.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 1000MG,636,RC,63600017,CDM,,,,,,both,,,26.4500,3.9700,AETNA,AETNA,11.29,,,,,,,6.8300,26.4500,percent of total billed charges,42.7% of $26.45 in Billed Charges for Rev 636 = $11.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MICROMATRIX 1000MG,636,RC,63600017,CDM,,,,,,both,,,26.4500,3.9700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,18.52,,,,,,,6.8300,26.4500,percent of total billed charges,Rev 636 $26.45 in Billed Charges at 70% = $18.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MICROMATRIX 1000MG,636,RC,63600017,CDM,,,,,,both,,,26.4500,3.9700,CIGNA HEALTHCARE,CIGNA HMO,11.03,,,,,,,6.8300,26.4500,percent of total billed charges,41.7% of $26.45 in Billed Charges for Rev 636 = $11.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MICROMATRIX 1000MG,636,RC,63600017,CDM,,,,,,both,,,26.4500,3.9700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,19.34,,,,,,,6.8300,26.4500,percent of total billed charges,Rev 636 $26.45 in Billed Charges at 73.1% = $19.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MICROMATRIX 1000MG,636,RC,63600017,CDM,,,,,,both,,,26.4500,3.9700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11.03,,,,,,,6.8300,26.4500,percent of total billed charges,41.7% of $26.45 in Billed Charges for Rev 636 = $11.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MICROMATRIX 1000MG,636,RC,63600017,CDM,,,,,,both,,,26.4500,3.9700,CIGNA HEALTHCARE,CIGNA PPO,11.03,,,,,,,6.8300,26.4500,percent of total billed charges,41.7% of $26.45 in Billed Charges for Rev 636 = $11.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MICROMATRIX 1000MG,636,RC,63600017,CDM,,,,,,both,,,26.4500,3.9700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,23.81,,,,,,,6.8300,26.4500,percent of total billed charges,90% of $26.45 in Billed Charges for Rev 636 = $23.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MICROMATRIX 1000MG,636,RC,63600017,CDM,,,,,,both,,,26.4500,3.9700,MEDCOST,MEDCOST VHN,12.59,,,,,,,6.8300,26.4500,percent of total billed charges,47.59% of $26.45 in Billed Charges for Rev 636 = $12.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MICROMATRIX 1000MG,636,RC,63600017,CDM,,,,,,both,,,26.4500,3.9700,SENTARA HEALTH,SENTARA HEALTH,6.83,,,,,,,6.8300,26.4500,percent of total billed charges,25.81% of $26.45 in Billed Charges for Rev 636 = $6.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MICROMATRIX 1000MG,636,RC,63600017,CDM,,,,,,both,,,26.4500,3.9700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",26.45,,,,,,,6.8300,26.4500,percent of total billed charges,100% of $26.45 in Billed Charges for Rev 636 = $26.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MICROMATRIX 1000MG,636,RC,63600017,CDM,,,,,,both,,,26.4500,3.9700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,13.23,,,,,,,6.8300,26.4500,percent of total billed charges,Rev 636 $26.45 in Billed Charges at 50% = $13.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MICROMATRIX 1000MG,636,RC,63600017,CDM,,,,,,both,,,26.4500,3.9700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13.23,,,,,,,6.8300,26.4500,percent of total billed charges,Rev 636 $26.45 in Billed Charges at 50% = $13.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MICROMATRIX 1000MG,636,RC,63600017,CDM,,,,,,both,,,26.4500,3.9700,UNITED HEALTHCARE,UHC HERITAGE SELECT,13.23,,,,,,,6.8300,26.4500,percent of total billed charges,Rev 636 $26.45 in Billed Charges at 50% = $13.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MICROMATRIX 1000MG,636,RC,63600017,CDM,,,,,,both,,,26.4500,3.9700,UNITED HEALTHCARE,UNITED HEALTHCARE,13.23,,,,,,,6.8300,26.4500,percent of total billed charges,Rev 636 $26.45 in Billed Charges at 50% = $13.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MICROMATRIX 1000MG,636,RC,63600017,CDM,,,,,,both,,,26.4500,3.9700,WELLCARE,WELLCARE MEDICAID,26.45,,,,,,,6.8300,26.4500,percent of total billed charges,100% of $26.45 in Billed Charges for Rev 636 = $26.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND VAC ULTRA VERAFLO LARGE,272,RC,27200002,CDM,,,,,,both,,,2149.4100,322.4100,AETNA,AETNA,917.80,,,,,,,554.7600,2149.4100,percent of total billed charges,"42.7% of $2,149.41 in Billed Charges for Rev 272 = $917.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND VAC ULTRA VERAFLO LARGE,272,RC,27200002,CDM,,,,,,both,,,2149.4100,322.4100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1504.59,,,,,,,554.7600,2149.4100,percent of total billed charges,"Rev 272 $2,149.41 in Billed Charges at 70% = $1,504.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND VAC ULTRA VERAFLO LARGE,272,RC,27200002,CDM,,,,,,both,,,2149.4100,322.4100,CIGNA HEALTHCARE,CIGNA HMO,896.30,,,,,,,554.7600,2149.4100,percent of total billed charges,"41.7% of $2,149.41 in Billed Charges for Rev 272 = $896.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND VAC ULTRA VERAFLO LARGE,272,RC,27200002,CDM,,,,,,both,,,2149.4100,322.4100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,997.33,,,,,,,554.7600,2149.4100,percent of total billed charges,"46.4% of $2,149.41 in Billed Charges for Rev 272 = $997.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND VAC ULTRA VERAFLO LARGE,272,RC,27200002,CDM,,,,,,both,,,2149.4100,322.4100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,896.30,,,,,,,554.7600,2149.4100,percent of total billed charges,"41.7% of $2,149.41 in Billed Charges for Rev 272 = $896.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND VAC ULTRA VERAFLO LARGE,272,RC,27200002,CDM,,,,,,both,,,2149.4100,322.4100,CIGNA HEALTHCARE,CIGNA PPO,896.30,,,,,,,554.7600,2149.4100,percent of total billed charges,"41.7% of $2,149.41 in Billed Charges for Rev 272 = $896.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND VAC ULTRA VERAFLO LARGE,272,RC,27200002,CDM,,,,,,both,,,2149.4100,322.4100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1934.47,,,,,,,554.7600,2149.4100,percent of total billed charges,"90% of $2,149.41 in Billed Charges for Rev 272 = $1,934.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND VAC ULTRA VERAFLO LARGE,272,RC,27200002,CDM,,,,,,both,,,2149.4100,322.4100,MEDCOST,MEDCOST VHN,1022.90,,,,,,,554.7600,2149.4100,percent of total billed charges,"47.59% of $2,149.41 in Billed Charges for Rev 272 = $1,022.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND VAC ULTRA VERAFLO LARGE,272,RC,27200002,CDM,,,,,,both,,,2149.4100,322.4100,SENTARA HEALTH,SENTARA HEALTH,554.76,,,,,,,554.7600,2149.4100,percent of total billed charges,"25.81% of $2,149.41 in Billed Charges for Rev 272 = $554.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND VAC ULTRA VERAFLO LARGE,272,RC,27200002,CDM,,,,,,both,,,2149.4100,322.4100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2149.41,,,,,,,554.7600,2149.4100,percent of total billed charges,"100% of $2,149.41 in Billed Charges for Rev 272 = $2,149.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND VAC ULTRA VERAFLO LARGE,272,RC,27200002,CDM,,,,,,both,,,2149.4100,322.4100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1074.71,,,,,,,554.7600,2149.4100,percent of total billed charges,"Rev 272 $2,149.41 in Billed Charges at 50% = $1,074.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND VAC ULTRA VERAFLO LARGE,272,RC,27200002,CDM,,,,,,both,,,2149.4100,322.4100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,694.26,,,,,,,554.7600,2149.4100,other,"32.3% of $2,149.41 in Billed Charges for Rev 272 = $694.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING WOUND VAC ULTRA VERAFLO LARGE,272,RC,27200002,CDM,,,,,,both,,,2149.4100,322.4100,UNITED HEALTHCARE,UHC HERITAGE SELECT,659.87,,,,,,,554.7600,2149.4100,other,"30.7% of $2,149.41 in Billed Charges for Rev 272 = $659.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING WOUND VAC ULTRA VERAFLO LARGE,272,RC,27200002,CDM,,,,,,both,,,2149.4100,322.4100,UNITED HEALTHCARE,UNITED HEALTHCARE,694.26,,,,,,,554.7600,2149.4100,percent of total billed charges,"32.3% of $2,149.41 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND VAC ULTRA VERAFLO LARGE,272,RC,27200002,CDM,,,,,,both,,,2149.4100,322.4100,WELLCARE,WELLCARE MEDICAID,2149.41,,,,,,,554.7600,2149.4100,percent of total billed charges,"100% of $2,149.41 in Billed Charges for Rev 272 = $2,149.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1544.8600,231.7300,AETNA,AETNA,659.66,,,,,,,398.7300,1544.8600,percent of total billed charges,"42.7% of $1,544.86 in Billed Charges for Rev 272 = $659.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1544.8600,231.7300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1081.40,,,,,,,398.7300,1544.8600,percent of total billed charges,"Rev 272 $1,544.86 in Billed Charges at 70% = $1,081.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1544.8600,231.7300,CIGNA HEALTHCARE,CIGNA HMO,644.21,,,,,,,398.7300,1544.8600,percent of total billed charges,"41.7% of $1,544.86 in Billed Charges for Rev 272 = $644.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1544.8600,231.7300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,716.82,,,,,,,398.7300,1544.8600,percent of total billed charges,"46.4% of $1,544.86 in Billed Charges for Rev 272 = $716.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1544.8600,231.7300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,644.21,,,,,,,398.7300,1544.8600,percent of total billed charges,"41.7% of $1,544.86 in Billed Charges for Rev 272 = $644.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1544.8600,231.7300,CIGNA HEALTHCARE,CIGNA PPO,644.21,,,,,,,398.7300,1544.8600,percent of total billed charges,"41.7% of $1,544.86 in Billed Charges for Rev 272 = $644.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1544.8600,231.7300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1390.37,,,,,,,398.7300,1544.8600,percent of total billed charges,"90% of $1,544.86 in Billed Charges for Rev 272 = $1,390.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1544.8600,231.7300,MEDCOST,MEDCOST VHN,735.20,,,,,,,398.7300,1544.8600,percent of total billed charges,"47.59% of $1,544.86 in Billed Charges for Rev 272 = $735.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1544.8600,231.7300,SENTARA HEALTH,SENTARA HEALTH,398.73,,,,,,,398.7300,1544.8600,percent of total billed charges,"25.81% of $1,544.86 in Billed Charges for Rev 272 = $398.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1544.8600,231.7300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1544.86,,,,,,,398.7300,1544.8600,percent of total billed charges,"100% of $1,544.86 in Billed Charges for Rev 272 = $1,544.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1544.8600,231.7300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.43,,,,,,,398.7300,1544.8600,percent of total billed charges,"Rev 272 $1,544.86 in Billed Charges at 50% = $772.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1544.8600,231.7300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,498.99,,,,,,,398.7300,1544.8600,other,"32.3% of $1,544.86 in Billed Charges for Rev 272 = $498.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1544.8600,231.7300,UNITED HEALTHCARE,UHC HERITAGE SELECT,474.27,,,,,,,398.7300,1544.8600,other,"30.7% of $1,544.86 in Billed Charges for Rev 272 = $474.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1544.8600,231.7300,UNITED HEALTHCARE,UNITED HEALTHCARE,498.99,,,,,,,398.7300,1544.8600,percent of total billed charges,"32.3% of $1,544.86 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1544.8600,231.7300,WELLCARE,WELLCARE MEDICAID,1544.86,,,,,,,398.7300,1544.8600,percent of total billed charges,"100% of $1,544.86 in Billed Charges for Rev 272 = $1,544.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEX 3.5,272,RC,,,,,,,,both,,,3749.1200,562.3700,AETNA,AETNA,1600.87,,,,,,,967.6500,3749.1200,percent of total billed charges,"42.7% of $3,749.12 in Billed Charges for Rev 272 = $1,600.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEX 3.5,272,RC,,,,,,,,both,,,3749.1200,562.3700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2624.38,,,,,,,967.6500,3749.1200,percent of total billed charges,"Rev 272 $3,749.12 in Billed Charges at 70% = $2,624.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEX 3.5,272,RC,,,,,,,,both,,,3749.1200,562.3700,CIGNA HEALTHCARE,CIGNA HMO,1563.38,,,,,,,967.6500,3749.1200,percent of total billed charges,"41.7% of $3,749.12 in Billed Charges for Rev 272 = $1,563.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEX 3.5,272,RC,,,,,,,,both,,,3749.1200,562.3700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1739.59,,,,,,,967.6500,3749.1200,percent of total billed charges,"46.4% of $3,749.12 in Billed Charges for Rev 272 = $1,739.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEX 3.5,272,RC,,,,,,,,both,,,3749.1200,562.3700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1563.38,,,,,,,967.6500,3749.1200,percent of total billed charges,"41.7% of $3,749.12 in Billed Charges for Rev 272 = $1,563.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEX 3.5,272,RC,,,,,,,,both,,,3749.1200,562.3700,CIGNA HEALTHCARE,CIGNA PPO,1563.38,,,,,,,967.6500,3749.1200,percent of total billed charges,"41.7% of $3,749.12 in Billed Charges for Rev 272 = $1,563.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEX 3.5,272,RC,,,,,,,,both,,,3749.1200,562.3700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3374.21,,,,,,,967.6500,3749.1200,percent of total billed charges,"90% of $3,749.12 in Billed Charges for Rev 272 = $3,374.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEX 3.5,272,RC,,,,,,,,both,,,3749.1200,562.3700,MEDCOST,MEDCOST VHN,1784.21,,,,,,,967.6500,3749.1200,percent of total billed charges,"47.59% of $3,749.12 in Billed Charges for Rev 272 = $1,784.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEX 3.5,272,RC,,,,,,,,both,,,3749.1200,562.3700,SENTARA HEALTH,SENTARA HEALTH,967.65,,,,,,,967.6500,3749.1200,percent of total billed charges,"25.81% of $3,749.12 in Billed Charges for Rev 272 = $967.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEX 3.5,272,RC,,,,,,,,both,,,3749.1200,562.3700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3749.12,,,,,,,967.6500,3749.1200,percent of total billed charges,"100% of $3,749.12 in Billed Charges for Rev 272 = $3,749.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEX 3.5,272,RC,,,,,,,,both,,,3749.1200,562.3700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1874.56,,,,,,,967.6500,3749.1200,percent of total billed charges,"Rev 272 $3,749.12 in Billed Charges at 50% = $1,874.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEX 3.5,272,RC,,,,,,,,both,,,3749.1200,562.3700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1210.97,,,,,,,967.6500,3749.1200,other,"32.3% of $3,749.12 in Billed Charges for Rev 272 = $1,210.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRIVER HEX 3.5,272,RC,,,,,,,,both,,,3749.1200,562.3700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1150.98,,,,,,,967.6500,3749.1200,other,"30.7% of $3,749.12 in Billed Charges for Rev 272 = $1,150.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRIVER HEX 3.5,272,RC,,,,,,,,both,,,3749.1200,562.3700,UNITED HEALTHCARE,UNITED HEALTHCARE,1210.97,,,,,,,967.6500,3749.1200,percent of total billed charges,"32.3% of $3,749.12 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEX 3.5,272,RC,,,,,,,,both,,,3749.1200,562.3700,WELLCARE,WELLCARE MEDICAID,3749.12,,,,,,,967.6500,3749.1200,percent of total billed charges,"100% of $3,749.12 in Billed Charges for Rev 272 = $3,749.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEXALOB T15 SILVER,272,RC,,,,,,,,both,,,2188.2800,328.2400,AETNA,AETNA,934.40,,,,,,,564.8000,2188.2800,percent of total billed charges,"42.7% of $2,188.28 in Billed Charges for Rev 272 = $934.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEXALOB T15 SILVER,272,RC,,,,,,,,both,,,2188.2800,328.2400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1531.80,,,,,,,564.8000,2188.2800,percent of total billed charges,"Rev 272 $2,188.28 in Billed Charges at 70% = $1,531.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEXALOB T15 SILVER,272,RC,,,,,,,,both,,,2188.2800,328.2400,CIGNA HEALTHCARE,CIGNA HMO,912.51,,,,,,,564.8000,2188.2800,percent of total billed charges,"41.7% of $2,188.28 in Billed Charges for Rev 272 = $912.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEXALOB T15 SILVER,272,RC,,,,,,,,both,,,2188.2800,328.2400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1015.36,,,,,,,564.8000,2188.2800,percent of total billed charges,"46.4% of $2,188.28 in Billed Charges for Rev 272 = $1,015.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEXALOB T15 SILVER,272,RC,,,,,,,,both,,,2188.2800,328.2400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,912.51,,,,,,,564.8000,2188.2800,percent of total billed charges,"41.7% of $2,188.28 in Billed Charges for Rev 272 = $912.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEXALOB T15 SILVER,272,RC,,,,,,,,both,,,2188.2800,328.2400,CIGNA HEALTHCARE,CIGNA PPO,912.51,,,,,,,564.8000,2188.2800,percent of total billed charges,"41.7% of $2,188.28 in Billed Charges for Rev 272 = $912.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEXALOB T15 SILVER,272,RC,,,,,,,,both,,,2188.2800,328.2400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1969.45,,,,,,,564.8000,2188.2800,percent of total billed charges,"90% of $2,188.28 in Billed Charges for Rev 272 = $1,969.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEXALOB T15 SILVER,272,RC,,,,,,,,both,,,2188.2800,328.2400,MEDCOST,MEDCOST VHN,1041.40,,,,,,,564.8000,2188.2800,percent of total billed charges,"47.59% of $2,188.28 in Billed Charges for Rev 272 = $1,041.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEXALOB T15 SILVER,272,RC,,,,,,,,both,,,2188.2800,328.2400,SENTARA HEALTH,SENTARA HEALTH,564.80,,,,,,,564.8000,2188.2800,percent of total billed charges,"25.81% of $2,188.28 in Billed Charges for Rev 272 = $564.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEXALOB T15 SILVER,272,RC,,,,,,,,both,,,2188.2800,328.2400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2188.28,,,,,,,564.8000,2188.2800,percent of total billed charges,"100% of $2,188.28 in Billed Charges for Rev 272 = $2,188.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEXALOB T15 SILVER,272,RC,,,,,,,,both,,,2188.2800,328.2400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1094.14,,,,,,,564.8000,2188.2800,percent of total billed charges,"Rev 272 $2,188.28 in Billed Charges at 50% = $1,094.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEXALOB T15 SILVER,272,RC,,,,,,,,both,,,2188.2800,328.2400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,706.81,,,,,,,564.8000,2188.2800,other,"32.3% of $2,188.28 in Billed Charges for Rev 272 = $706.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRIVER HEXALOB T15 SILVER,272,RC,,,,,,,,both,,,2188.2800,328.2400,UNITED HEALTHCARE,UHC HERITAGE SELECT,671.80,,,,,,,564.8000,2188.2800,other,"30.7% of $2,188.28 in Billed Charges for Rev 272 = $671.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRIVER HEXALOB T15 SILVER,272,RC,,,,,,,,both,,,2188.2800,328.2400,UNITED HEALTHCARE,UNITED HEALTHCARE,706.81,,,,,,,564.8000,2188.2800,percent of total billed charges,"32.3% of $2,188.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRIVER HEXALOB T15 SILVER,272,RC,,,,,,,,both,,,2188.2800,328.2400,WELLCARE,WELLCARE MEDICAID,2188.28,,,,,,,564.8000,2188.2800,percent of total billed charges,"100% of $2,188.28 in Billed Charges for Rev 272 = $2,188.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOSCOPIC PLANTAR FACIOTOMY DISPOSABLE,272,RC,,,,,,,,both,,,7985.6700,1197.8500,AETNA,AETNA,3409.88,,,,,,,2061.1000,7985.6700,percent of total billed charges,"42.7% of $7,985.67 in Billed Charges for Rev 272 = $3,409.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOSCOPIC PLANTAR FACIOTOMY DISPOSABLE,272,RC,,,,,,,,both,,,7985.6700,1197.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5589.97,,,,,,,2061.1000,7985.6700,percent of total billed charges,"Rev 272 $7,985.67 in Billed Charges at 70% = $5,589.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOSCOPIC PLANTAR FACIOTOMY DISPOSABLE,272,RC,,,,,,,,both,,,7985.6700,1197.8500,CIGNA HEALTHCARE,CIGNA HMO,3330.02,,,,,,,2061.1000,7985.6700,percent of total billed charges,"41.7% of $7,985.67 in Billed Charges for Rev 272 = $3,330.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOSCOPIC PLANTAR FACIOTOMY DISPOSABLE,272,RC,,,,,,,,both,,,7985.6700,1197.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3705.35,,,,,,,2061.1000,7985.6700,percent of total billed charges,"46.4% of $7,985.67 in Billed Charges for Rev 272 = $3,705.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOSCOPIC PLANTAR FACIOTOMY DISPOSABLE,272,RC,,,,,,,,both,,,7985.6700,1197.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3330.02,,,,,,,2061.1000,7985.6700,percent of total billed charges,"41.7% of $7,985.67 in Billed Charges for Rev 272 = $3,330.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOSCOPIC PLANTAR FACIOTOMY DISPOSABLE,272,RC,,,,,,,,both,,,7985.6700,1197.8500,CIGNA HEALTHCARE,CIGNA PPO,3330.02,,,,,,,2061.1000,7985.6700,percent of total billed charges,"41.7% of $7,985.67 in Billed Charges for Rev 272 = $3,330.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOSCOPIC PLANTAR FACIOTOMY DISPOSABLE,272,RC,,,,,,,,both,,,7985.6700,1197.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7187.10,,,,,,,2061.1000,7985.6700,percent of total billed charges,"90% of $7,985.67 in Billed Charges for Rev 272 = $7,187.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOSCOPIC PLANTAR FACIOTOMY DISPOSABLE,272,RC,,,,,,,,both,,,7985.6700,1197.8500,MEDCOST,MEDCOST VHN,3800.38,,,,,,,2061.1000,7985.6700,percent of total billed charges,"47.59% of $7,985.67 in Billed Charges for Rev 272 = $3,800.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOSCOPIC PLANTAR FACIOTOMY DISPOSABLE,272,RC,,,,,,,,both,,,7985.6700,1197.8500,SENTARA HEALTH,SENTARA HEALTH,2061.10,,,,,,,2061.1000,7985.6700,percent of total billed charges,"25.81% of $7,985.67 in Billed Charges for Rev 272 = $2,061.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOSCOPIC PLANTAR FACIOTOMY DISPOSABLE,272,RC,,,,,,,,both,,,7985.6700,1197.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7985.67,,,,,,,2061.1000,7985.6700,percent of total billed charges,"100% of $7,985.67 in Billed Charges for Rev 272 = $7,985.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOSCOPIC PLANTAR FACIOTOMY DISPOSABLE,272,RC,,,,,,,,both,,,7985.6700,1197.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3992.84,,,,,,,2061.1000,7985.6700,percent of total billed charges,"Rev 272 $7,985.67 in Billed Charges at 50% = $3,992.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOSCOPIC PLANTAR FACIOTOMY DISPOSABLE,272,RC,,,,,,,,both,,,7985.6700,1197.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2579.37,,,,,,,2061.1000,7985.6700,other,"32.3% of $7,985.67 in Billed Charges for Rev 272 = $2,579.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENDOSCOPIC PLANTAR FACIOTOMY DISPOSABLE,272,RC,,,,,,,,both,,,7985.6700,1197.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2451.60,,,,,,,2061.1000,7985.6700,other,"30.7% of $7,985.67 in Billed Charges for Rev 272 = $2,451.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENDOSCOPIC PLANTAR FACIOTOMY DISPOSABLE,272,RC,,,,,,,,both,,,7985.6700,1197.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,2579.37,,,,,,,2061.1000,7985.6700,percent of total billed charges,"32.3% of $7,985.67 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOSCOPIC PLANTAR FACIOTOMY DISPOSABLE,272,RC,,,,,,,,both,,,7985.6700,1197.8500,WELLCARE,WELLCARE MEDICAID,7985.67,,,,,,,2061.1000,7985.6700,percent of total billed charges,"100% of $7,985.67 in Billed Charges for Rev 272 = $7,985.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1800.5100,270.0800,AETNA,AETNA,768.82,,,,,,,464.7100,1800.5100,percent of total billed charges,"42.7% of $1,800.51 in Billed Charges for Rev 272 = $768.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1800.5100,270.0800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1260.36,,,,,,,464.7100,1800.5100,percent of total billed charges,"Rev 272 $1,800.51 in Billed Charges at 70% = $1,260.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1800.5100,270.0800,CIGNA HEALTHCARE,CIGNA HMO,750.81,,,,,,,464.7100,1800.5100,percent of total billed charges,"41.7% of $1,800.51 in Billed Charges for Rev 272 = $750.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1800.5100,270.0800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,835.44,,,,,,,464.7100,1800.5100,percent of total billed charges,"46.4% of $1,800.51 in Billed Charges for Rev 272 = $835.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1800.5100,270.0800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,750.81,,,,,,,464.7100,1800.5100,percent of total billed charges,"41.7% of $1,800.51 in Billed Charges for Rev 272 = $750.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1800.5100,270.0800,CIGNA HEALTHCARE,CIGNA PPO,750.81,,,,,,,464.7100,1800.5100,percent of total billed charges,"41.7% of $1,800.51 in Billed Charges for Rev 272 = $750.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1800.5100,270.0800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1620.46,,,,,,,464.7100,1800.5100,percent of total billed charges,"90% of $1,800.51 in Billed Charges for Rev 272 = $1,620.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1800.5100,270.0800,MEDCOST,MEDCOST VHN,856.86,,,,,,,464.7100,1800.5100,percent of total billed charges,"47.59% of $1,800.51 in Billed Charges for Rev 272 = $856.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1800.5100,270.0800,SENTARA HEALTH,SENTARA HEALTH,464.71,,,,,,,464.7100,1800.5100,percent of total billed charges,"25.81% of $1,800.51 in Billed Charges for Rev 272 = $464.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1800.5100,270.0800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1800.51,,,,,,,464.7100,1800.5100,percent of total billed charges,"100% of $1,800.51 in Billed Charges for Rev 272 = $1,800.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1800.5100,270.0800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,900.26,,,,,,,464.7100,1800.5100,percent of total billed charges,"Rev 272 $1,800.51 in Billed Charges at 50% = $900.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1800.5100,270.0800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,581.56,,,,,,,464.7100,1800.5100,other,"32.3% of $1,800.51 in Billed Charges for Rev 272 = $581.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1800.5100,270.0800,UNITED HEALTHCARE,UHC HERITAGE SELECT,552.76,,,,,,,464.7100,1800.5100,other,"30.7% of $1,800.51 in Billed Charges for Rev 272 = $552.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1800.5100,270.0800,UNITED HEALTHCARE,UNITED HEALTHCARE,581.56,,,,,,,464.7100,1800.5100,percent of total billed charges,"32.3% of $1,800.51 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL  PILOT SHORT 4  0MM,272,RC,,,,,,,,both,,,1800.5100,270.0800,WELLCARE,WELLCARE MEDICAID,1800.51,,,,,,,464.7100,1800.5100,percent of total billed charges,"100% of $1,800.51 in Billed Charges for Rev 272 = $1,800.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL 700356,272,RC,,,,,,,,both,,,1142.8800,171.4300,AETNA,AETNA,488.01,,,,,,,294.9800,1142.8800,percent of total billed charges,"42.7% of $1,142.88 in Billed Charges for Rev 272 = $488.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL 700356,272,RC,,,,,,,,both,,,1142.8800,171.4300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,800.02,,,,,,,294.9800,1142.8800,percent of total billed charges,"Rev 272 $1,142.88 in Billed Charges at 70% = $800.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL 700356,272,RC,,,,,,,,both,,,1142.8800,171.4300,CIGNA HEALTHCARE,CIGNA HMO,476.58,,,,,,,294.9800,1142.8800,percent of total billed charges,"41.7% of $1,142.88 in Billed Charges for Rev 272 = $476.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL 700356,272,RC,,,,,,,,both,,,1142.8800,171.4300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,530.30,,,,,,,294.9800,1142.8800,percent of total billed charges,"46.4% of $1,142.88 in Billed Charges for Rev 272 = $530.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL 700356,272,RC,,,,,,,,both,,,1142.8800,171.4300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,476.58,,,,,,,294.9800,1142.8800,percent of total billed charges,"41.7% of $1,142.88 in Billed Charges for Rev 272 = $476.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL 700356,272,RC,,,,,,,,both,,,1142.8800,171.4300,CIGNA HEALTHCARE,CIGNA PPO,476.58,,,,,,,294.9800,1142.8800,percent of total billed charges,"41.7% of $1,142.88 in Billed Charges for Rev 272 = $476.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL 700356,272,RC,,,,,,,,both,,,1142.8800,171.4300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1028.59,,,,,,,294.9800,1142.8800,percent of total billed charges,"90% of $1,142.88 in Billed Charges for Rev 272 = $1,028.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL 700356,272,RC,,,,,,,,both,,,1142.8800,171.4300,MEDCOST,MEDCOST VHN,543.90,,,,,,,294.9800,1142.8800,percent of total billed charges,"47.59% of $1,142.88 in Billed Charges for Rev 272 = $543.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL 700356,272,RC,,,,,,,,both,,,1142.8800,171.4300,SENTARA HEALTH,SENTARA HEALTH,294.98,,,,,,,294.9800,1142.8800,percent of total billed charges,"25.81% of $1,142.88 in Billed Charges for Rev 272 = $294.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL 700356,272,RC,,,,,,,,both,,,1142.8800,171.4300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1142.88,,,,,,,294.9800,1142.8800,percent of total billed charges,"100% of $1,142.88 in Billed Charges for Rev 272 = $1,142.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL 700356,272,RC,,,,,,,,both,,,1142.8800,171.4300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,571.44,,,,,,,294.9800,1142.8800,percent of total billed charges,"Rev 272 $1,142.88 in Billed Charges at 50% = $571.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL 700356,272,RC,,,,,,,,both,,,1142.8800,171.4300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,369.15,,,,,,,294.9800,1142.8800,other,"32.3% of $1,142.88 in Billed Charges for Rev 272 = $369.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL 700356,272,RC,,,,,,,,both,,,1142.8800,171.4300,UNITED HEALTHCARE,UHC HERITAGE SELECT,350.86,,,,,,,294.9800,1142.8800,other,"30.7% of $1,142.88 in Billed Charges for Rev 272 = $350.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL 700356,272,RC,,,,,,,,both,,,1142.8800,171.4300,UNITED HEALTHCARE,UNITED HEALTHCARE,369.15,,,,,,,294.9800,1142.8800,percent of total billed charges,"32.3% of $1,142.88 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL 700356,272,RC,,,,,,,,both,,,1142.8800,171.4300,WELLCARE,WELLCARE MEDICAID,1142.88,,,,,,,294.9800,1142.8800,percent of total billed charges,"100% of $1,142.88 in Billed Charges for Rev 272 = $1,142.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CINCHLOCK CAT02463,272,RC,,,,,,,,both,,,2080.0100,312.0000,AETNA,AETNA,888.16,,,,,,,536.8500,2080.0100,percent of total billed charges,"42.7% of $2,080.01 in Billed Charges for Rev 272 = $888.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CINCHLOCK CAT02463,272,RC,,,,,,,,both,,,2080.0100,312.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1456.01,,,,,,,536.8500,2080.0100,percent of total billed charges,"Rev 272 $2,080.01 in Billed Charges at 70% = $1,456.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CINCHLOCK CAT02463,272,RC,,,,,,,,both,,,2080.0100,312.0000,CIGNA HEALTHCARE,CIGNA HMO,867.36,,,,,,,536.8500,2080.0100,percent of total billed charges,"41.7% of $2,080.01 in Billed Charges for Rev 272 = $867.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CINCHLOCK CAT02463,272,RC,,,,,,,,both,,,2080.0100,312.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,965.12,,,,,,,536.8500,2080.0100,percent of total billed charges,"46.4% of $2,080.01 in Billed Charges for Rev 272 = $965.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CINCHLOCK CAT02463,272,RC,,,,,,,,both,,,2080.0100,312.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,867.36,,,,,,,536.8500,2080.0100,percent of total billed charges,"41.7% of $2,080.01 in Billed Charges for Rev 272 = $867.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CINCHLOCK CAT02463,272,RC,,,,,,,,both,,,2080.0100,312.0000,CIGNA HEALTHCARE,CIGNA PPO,867.36,,,,,,,536.8500,2080.0100,percent of total billed charges,"41.7% of $2,080.01 in Billed Charges for Rev 272 = $867.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CINCHLOCK CAT02463,272,RC,,,,,,,,both,,,2080.0100,312.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1872.01,,,,,,,536.8500,2080.0100,percent of total billed charges,"90% of $2,080.01 in Billed Charges for Rev 272 = $1,872.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CINCHLOCK CAT02463,272,RC,,,,,,,,both,,,2080.0100,312.0000,MEDCOST,MEDCOST VHN,989.88,,,,,,,536.8500,2080.0100,percent of total billed charges,"47.59% of $2,080.01 in Billed Charges for Rev 272 = $989.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CINCHLOCK CAT02463,272,RC,,,,,,,,both,,,2080.0100,312.0000,SENTARA HEALTH,SENTARA HEALTH,536.85,,,,,,,536.8500,2080.0100,percent of total billed charges,"25.81% of $2,080.01 in Billed Charges for Rev 272 = $536.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CINCHLOCK CAT02463,272,RC,,,,,,,,both,,,2080.0100,312.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2080.01,,,,,,,536.8500,2080.0100,percent of total billed charges,"100% of $2,080.01 in Billed Charges for Rev 272 = $2,080.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CINCHLOCK CAT02463,272,RC,,,,,,,,both,,,2080.0100,312.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1040.01,,,,,,,536.8500,2080.0100,percent of total billed charges,"Rev 272 $2,080.01 in Billed Charges at 50% = $1,040.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CINCHLOCK CAT02463,272,RC,,,,,,,,both,,,2080.0100,312.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,671.84,,,,,,,536.8500,2080.0100,other,"32.3% of $2,080.01 in Billed Charges for Rev 272 = $671.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL CINCHLOCK CAT02463,272,RC,,,,,,,,both,,,2080.0100,312.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,638.56,,,,,,,536.8500,2080.0100,other,"30.7% of $2,080.01 in Billed Charges for Rev 272 = $638.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL CINCHLOCK CAT02463,272,RC,,,,,,,,both,,,2080.0100,312.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,671.84,,,,,,,536.8500,2080.0100,percent of total billed charges,"32.3% of $2,080.01 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CINCHLOCK CAT02463,272,RC,,,,,,,,both,,,2080.0100,312.0000,WELLCARE,WELLCARE MEDICAID,2080.01,,,,,,,536.8500,2080.0100,percent of total billed charges,"100% of $2,080.01 in Billed Charges for Rev 272 = $2,080.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENGINE CANNISTER PENUMBRA,272,RC,27200002,CDM,,,,,,both,,,3733.5600,560.0300,AETNA,AETNA,1594.23,,,,,,,963.6300,3733.5600,percent of total billed charges,"42.7% of $3,733.56 in Billed Charges for Rev 272 = $1,594.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENGINE CANNISTER PENUMBRA,272,RC,27200002,CDM,,,,,,both,,,3733.5600,560.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2613.49,,,,,,,963.6300,3733.5600,percent of total billed charges,"Rev 272 $3,733.56 in Billed Charges at 70% = $2,613.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENGINE CANNISTER PENUMBRA,272,RC,27200002,CDM,,,,,,both,,,3733.5600,560.0300,CIGNA HEALTHCARE,CIGNA HMO,1556.89,,,,,,,963.6300,3733.5600,percent of total billed charges,"41.7% of $3,733.56 in Billed Charges for Rev 272 = $1,556.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENGINE CANNISTER PENUMBRA,272,RC,27200002,CDM,,,,,,both,,,3733.5600,560.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1732.37,,,,,,,963.6300,3733.5600,percent of total billed charges,"46.4% of $3,733.56 in Billed Charges for Rev 272 = $1,732.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENGINE CANNISTER PENUMBRA,272,RC,27200002,CDM,,,,,,both,,,3733.5600,560.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1556.89,,,,,,,963.6300,3733.5600,percent of total billed charges,"41.7% of $3,733.56 in Billed Charges for Rev 272 = $1,556.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENGINE CANNISTER PENUMBRA,272,RC,27200002,CDM,,,,,,both,,,3733.5600,560.0300,CIGNA HEALTHCARE,CIGNA PPO,1556.89,,,,,,,963.6300,3733.5600,percent of total billed charges,"41.7% of $3,733.56 in Billed Charges for Rev 272 = $1,556.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENGINE CANNISTER PENUMBRA,272,RC,27200002,CDM,,,,,,both,,,3733.5600,560.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3360.20,,,,,,,963.6300,3733.5600,percent of total billed charges,"90% of $3,733.56 in Billed Charges for Rev 272 = $3,360.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENGINE CANNISTER PENUMBRA,272,RC,27200002,CDM,,,,,,both,,,3733.5600,560.0300,MEDCOST,MEDCOST VHN,1776.80,,,,,,,963.6300,3733.5600,percent of total billed charges,"47.59% of $3,733.56 in Billed Charges for Rev 272 = $1,776.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENGINE CANNISTER PENUMBRA,272,RC,27200002,CDM,,,,,,both,,,3733.5600,560.0300,SENTARA HEALTH,SENTARA HEALTH,963.63,,,,,,,963.6300,3733.5600,percent of total billed charges,"25.81% of $3,733.56 in Billed Charges for Rev 272 = $963.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENGINE CANNISTER PENUMBRA,272,RC,27200002,CDM,,,,,,both,,,3733.5600,560.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3733.56,,,,,,,963.6300,3733.5600,percent of total billed charges,"100% of $3,733.56 in Billed Charges for Rev 272 = $3,733.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENGINE CANNISTER PENUMBRA,272,RC,27200002,CDM,,,,,,both,,,3733.5600,560.0300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1866.78,,,,,,,963.6300,3733.5600,percent of total billed charges,"Rev 272 $3,733.56 in Billed Charges at 50% = $1,866.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENGINE CANNISTER PENUMBRA,272,RC,27200002,CDM,,,,,,both,,,3733.5600,560.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1205.94,,,,,,,963.6300,3733.5600,other,"32.3% of $3,733.56 in Billed Charges for Rev 272 = $1,205.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENGINE CANNISTER PENUMBRA,272,RC,27200002,CDM,,,,,,both,,,3733.5600,560.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1146.20,,,,,,,963.6300,3733.5600,other,"30.7% of $3,733.56 in Billed Charges for Rev 272 = $1,146.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENGINE CANNISTER PENUMBRA,272,RC,27200002,CDM,,,,,,both,,,3733.5600,560.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,1205.94,,,,,,,963.6300,3733.5600,percent of total billed charges,"32.3% of $3,733.56 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENGINE CANNISTER PENUMBRA,272,RC,27200002,CDM,,,,,,both,,,3733.5600,560.0300,WELLCARE,WELLCARE MEDICAID,3733.56,,,,,,,963.6300,3733.5600,percent of total billed charges,"100% of $3,733.56 in Billed Charges for Rev 272 = $3,733.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTENDED APPLICATOR TIP,272,RC,27200002,CDM,,,,,,both,,,1781.7400,267.2600,AETNA,AETNA,760.80,,,,,,,459.8700,1781.7400,percent of total billed charges,"42.7% of $1,781.74 in Billed Charges for Rev 272 = $760.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTENDED APPLICATOR TIP,272,RC,27200002,CDM,,,,,,both,,,1781.7400,267.2600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1247.22,,,,,,,459.8700,1781.7400,percent of total billed charges,"Rev 272 $1,781.74 in Billed Charges at 70% = $1,247.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTENDED APPLICATOR TIP,272,RC,27200002,CDM,,,,,,both,,,1781.7400,267.2600,CIGNA HEALTHCARE,CIGNA HMO,742.99,,,,,,,459.8700,1781.7400,percent of total billed charges,"41.7% of $1,781.74 in Billed Charges for Rev 272 = $742.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTENDED APPLICATOR TIP,272,RC,27200002,CDM,,,,,,both,,,1781.7400,267.2600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,826.73,,,,,,,459.8700,1781.7400,percent of total billed charges,"46.4% of $1,781.74 in Billed Charges for Rev 272 = $826.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTENDED APPLICATOR TIP,272,RC,27200002,CDM,,,,,,both,,,1781.7400,267.2600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,742.99,,,,,,,459.8700,1781.7400,percent of total billed charges,"41.7% of $1,781.74 in Billed Charges for Rev 272 = $742.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTENDED APPLICATOR TIP,272,RC,27200002,CDM,,,,,,both,,,1781.7400,267.2600,CIGNA HEALTHCARE,CIGNA PPO,742.99,,,,,,,459.8700,1781.7400,percent of total billed charges,"41.7% of $1,781.74 in Billed Charges for Rev 272 = $742.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTENDED APPLICATOR TIP,272,RC,27200002,CDM,,,,,,both,,,1781.7400,267.2600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1603.57,,,,,,,459.8700,1781.7400,percent of total billed charges,"90% of $1,781.74 in Billed Charges for Rev 272 = $1,603.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTENDED APPLICATOR TIP,272,RC,27200002,CDM,,,,,,both,,,1781.7400,267.2600,MEDCOST,MEDCOST VHN,847.93,,,,,,,459.8700,1781.7400,percent of total billed charges,"47.59% of $1,781.74 in Billed Charges for Rev 272 = $847.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTENDED APPLICATOR TIP,272,RC,27200002,CDM,,,,,,both,,,1781.7400,267.2600,SENTARA HEALTH,SENTARA HEALTH,459.87,,,,,,,459.8700,1781.7400,percent of total billed charges,"25.81% of $1,781.74 in Billed Charges for Rev 272 = $459.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTENDED APPLICATOR TIP,272,RC,27200002,CDM,,,,,,both,,,1781.7400,267.2600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1781.74,,,,,,,459.8700,1781.7400,percent of total billed charges,"100% of $1,781.74 in Billed Charges for Rev 272 = $1,781.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTENDED APPLICATOR TIP,272,RC,27200002,CDM,,,,,,both,,,1781.7400,267.2600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,890.87,,,,,,,459.8700,1781.7400,percent of total billed charges,"Rev 272 $1,781.74 in Billed Charges at 50% = $890.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTENDED APPLICATOR TIP,272,RC,27200002,CDM,,,,,,both,,,1781.7400,267.2600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,575.50,,,,,,,459.8700,1781.7400,other,"32.3% of $1,781.74 in Billed Charges for Rev 272 = $575.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
EXTENDED APPLICATOR TIP,272,RC,27200002,CDM,,,,,,both,,,1781.7400,267.2600,UNITED HEALTHCARE,UHC HERITAGE SELECT,546.99,,,,,,,459.8700,1781.7400,other,"30.7% of $1,781.74 in Billed Charges for Rev 272 = $546.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
EXTENDED APPLICATOR TIP,272,RC,27200002,CDM,,,,,,both,,,1781.7400,267.2600,UNITED HEALTHCARE,UNITED HEALTHCARE,575.50,,,,,,,459.8700,1781.7400,percent of total billed charges,"32.3% of $1,781.74 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTENDED APPLICATOR TIP,272,RC,27200002,CDM,,,,,,both,,,1781.7400,267.2600,WELLCARE,WELLCARE MEDICAID,1781.74,,,,,,,459.8700,1781.7400,percent of total billed charges,"100% of $1,781.74 in Billed Charges for Rev 272 = $1,781.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BALLOON 15-18,272,RC,27200002,CDM,,,,,,both,,,3319.9600,497.9900,AETNA,AETNA,1417.62,,,,,,,856.8800,3319.9600,percent of total billed charges,"42.7% of $3,319.96 in Billed Charges for Rev 272 = $1,417.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BALLOON 15-18,272,RC,27200002,CDM,,,,,,both,,,3319.9600,497.9900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2323.97,,,,,,,856.8800,3319.9600,percent of total billed charges,"Rev 272 $3,319.96 in Billed Charges at 70% = $2,323.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BALLOON 15-18,272,RC,27200002,CDM,,,,,,both,,,3319.9600,497.9900,CIGNA HEALTHCARE,CIGNA HMO,1384.42,,,,,,,856.8800,3319.9600,percent of total billed charges,"41.7% of $3,319.96 in Billed Charges for Rev 272 = $1,384.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BALLOON 15-18,272,RC,27200002,CDM,,,,,,both,,,3319.9600,497.9900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1540.46,,,,,,,856.8800,3319.9600,percent of total billed charges,"46.4% of $3,319.96 in Billed Charges for Rev 272 = $1,540.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BALLOON 15-18,272,RC,27200002,CDM,,,,,,both,,,3319.9600,497.9900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1384.42,,,,,,,856.8800,3319.9600,percent of total billed charges,"41.7% of $3,319.96 in Billed Charges for Rev 272 = $1,384.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BALLOON 15-18,272,RC,27200002,CDM,,,,,,both,,,3319.9600,497.9900,CIGNA HEALTHCARE,CIGNA PPO,1384.42,,,,,,,856.8800,3319.9600,percent of total billed charges,"41.7% of $3,319.96 in Billed Charges for Rev 272 = $1,384.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BALLOON 15-18,272,RC,27200002,CDM,,,,,,both,,,3319.9600,497.9900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2987.96,,,,,,,856.8800,3319.9600,percent of total billed charges,"90% of $3,319.96 in Billed Charges for Rev 272 = $2,987.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BALLOON 15-18,272,RC,27200002,CDM,,,,,,both,,,3319.9600,497.9900,MEDCOST,MEDCOST VHN,1579.97,,,,,,,856.8800,3319.9600,percent of total billed charges,"47.59% of $3,319.96 in Billed Charges for Rev 272 = $1,579.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BALLOON 15-18,272,RC,27200002,CDM,,,,,,both,,,3319.9600,497.9900,SENTARA HEALTH,SENTARA HEALTH,856.88,,,,,,,856.8800,3319.9600,percent of total billed charges,"25.81% of $3,319.96 in Billed Charges for Rev 272 = $856.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BALLOON 15-18,272,RC,27200002,CDM,,,,,,both,,,3319.9600,497.9900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3319.96,,,,,,,856.8800,3319.9600,percent of total billed charges,"100% of $3,319.96 in Billed Charges for Rev 272 = $3,319.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BALLOON 15-18,272,RC,27200002,CDM,,,,,,both,,,3319.9600,497.9900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1659.98,,,,,,,856.8800,3319.9600,percent of total billed charges,"Rev 272 $3,319.96 in Billed Charges at 50% = $1,659.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BALLOON 15-18,272,RC,27200002,CDM,,,,,,both,,,3319.9600,497.9900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1072.35,,,,,,,856.8800,3319.9600,other,"32.3% of $3,319.96 in Billed Charges for Rev 272 = $1,072.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
EXTRACTOR BALLOON 15-18,272,RC,27200002,CDM,,,,,,both,,,3319.9600,497.9900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1019.23,,,,,,,856.8800,3319.9600,other,"30.7% of $3,319.96 in Billed Charges for Rev 272 = $1,019.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
EXTRACTOR BALLOON 15-18,272,RC,27200002,CDM,,,,,,both,,,3319.9600,497.9900,UNITED HEALTHCARE,UNITED HEALTHCARE,1072.35,,,,,,,856.8800,3319.9600,percent of total billed charges,"32.3% of $3,319.96 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BALLOON 15-18,272,RC,27200002,CDM,,,,,,both,,,3319.9600,497.9900,WELLCARE,WELLCARE MEDICAID,3319.96,,,,,,,856.8800,3319.9600,percent of total billed charges,"100% of $3,319.96 in Billed Charges for Rev 272 = $3,319.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PACK RAPPAC 1.2,272,RC,,,,,,,,both,,,2567.0300,385.0500,AETNA,AETNA,1096.12,,,,,,,662.5500,2567.0300,percent of total billed charges,"42.7% of $2,567.03 in Billed Charges for Rev 272 = $1,096.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PACK RAPPAC 1.2,272,RC,,,,,,,,both,,,2567.0300,385.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1796.92,,,,,,,662.5500,2567.0300,percent of total billed charges,"Rev 272 $2,567.03 in Billed Charges at 70% = $1,796.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PACK RAPPAC 1.2,272,RC,,,,,,,,both,,,2567.0300,385.0500,CIGNA HEALTHCARE,CIGNA HMO,1070.45,,,,,,,662.5500,2567.0300,percent of total billed charges,"41.7% of $2,567.03 in Billed Charges for Rev 272 = $1,070.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PACK RAPPAC 1.2,272,RC,,,,,,,,both,,,2567.0300,385.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1191.10,,,,,,,662.5500,2567.0300,percent of total billed charges,"46.4% of $2,567.03 in Billed Charges for Rev 272 = $1,191.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PACK RAPPAC 1.2,272,RC,,,,,,,,both,,,2567.0300,385.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1070.45,,,,,,,662.5500,2567.0300,percent of total billed charges,"41.7% of $2,567.03 in Billed Charges for Rev 272 = $1,070.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PACK RAPPAC 1.2,272,RC,,,,,,,,both,,,2567.0300,385.0500,CIGNA HEALTHCARE,CIGNA PPO,1070.45,,,,,,,662.5500,2567.0300,percent of total billed charges,"41.7% of $2,567.03 in Billed Charges for Rev 272 = $1,070.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PACK RAPPAC 1.2,272,RC,,,,,,,,both,,,2567.0300,385.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2310.33,,,,,,,662.5500,2567.0300,percent of total billed charges,"90% of $2,567.03 in Billed Charges for Rev 272 = $2,310.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PACK RAPPAC 1.2,272,RC,,,,,,,,both,,,2567.0300,385.0500,MEDCOST,MEDCOST VHN,1221.65,,,,,,,662.5500,2567.0300,percent of total billed charges,"47.59% of $2,567.03 in Billed Charges for Rev 272 = $1,221.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PACK RAPPAC 1.2,272,RC,,,,,,,,both,,,2567.0300,385.0500,SENTARA HEALTH,SENTARA HEALTH,662.55,,,,,,,662.5500,2567.0300,percent of total billed charges,"25.81% of $2,567.03 in Billed Charges for Rev 272 = $662.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PACK RAPPAC 1.2,272,RC,,,,,,,,both,,,2567.0300,385.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2567.03,,,,,,,662.5500,2567.0300,percent of total billed charges,"100% of $2,567.03 in Billed Charges for Rev 272 = $2,567.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PACK RAPPAC 1.2,272,RC,,,,,,,,both,,,2567.0300,385.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1283.52,,,,,,,662.5500,2567.0300,percent of total billed charges,"Rev 272 $2,567.03 in Billed Charges at 50% = $1,283.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PACK RAPPAC 1.2,272,RC,,,,,,,,both,,,2567.0300,385.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,829.15,,,,,,,662.5500,2567.0300,other,"32.3% of $2,567.03 in Billed Charges for Rev 272 = $829.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL PACK RAPPAC 1.2,272,RC,,,,,,,,both,,,2567.0300,385.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,788.08,,,,,,,662.5500,2567.0300,other,"30.7% of $2,567.03 in Billed Charges for Rev 272 = $788.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL PACK RAPPAC 1.2,272,RC,,,,,,,,both,,,2567.0300,385.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,829.15,,,,,,,662.5500,2567.0300,percent of total billed charges,"32.3% of $2,567.03 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PACK RAPPAC 1.2,272,RC,,,,,,,,both,,,2567.0300,385.0500,WELLCARE,WELLCARE MEDICAID,2567.03,,,,,,,662.5500,2567.0300,percent of total billed charges,"100% of $2,567.03 in Billed Charges for Rev 272 = $2,567.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2124.1900,318.6300,AETNA,AETNA,907.03,,,,,,,548.2500,2124.1900,percent of total billed charges,"42.7% of $2,124.19 in Billed Charges for Rev 272 = $907.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2124.1900,318.6300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1486.93,,,,,,,548.2500,2124.1900,percent of total billed charges,"Rev 272 $2,124.19 in Billed Charges at 70% = $1,486.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2124.1900,318.6300,CIGNA HEALTHCARE,CIGNA HMO,885.79,,,,,,,548.2500,2124.1900,percent of total billed charges,"41.7% of $2,124.19 in Billed Charges for Rev 272 = $885.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2124.1900,318.6300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,985.62,,,,,,,548.2500,2124.1900,percent of total billed charges,"46.4% of $2,124.19 in Billed Charges for Rev 272 = $985.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2124.1900,318.6300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,885.79,,,,,,,548.2500,2124.1900,percent of total billed charges,"41.7% of $2,124.19 in Billed Charges for Rev 272 = $885.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2124.1900,318.6300,CIGNA HEALTHCARE,CIGNA PPO,885.79,,,,,,,548.2500,2124.1900,percent of total billed charges,"41.7% of $2,124.19 in Billed Charges for Rev 272 = $885.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2124.1900,318.6300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1911.77,,,,,,,548.2500,2124.1900,percent of total billed charges,"90% of $2,124.19 in Billed Charges for Rev 272 = $1,911.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2124.1900,318.6300,MEDCOST,MEDCOST VHN,1010.90,,,,,,,548.2500,2124.1900,percent of total billed charges,"47.59% of $2,124.19 in Billed Charges for Rev 272 = $1,010.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2124.1900,318.6300,SENTARA HEALTH,SENTARA HEALTH,548.25,,,,,,,548.2500,2124.1900,percent of total billed charges,"25.81% of $2,124.19 in Billed Charges for Rev 272 = $548.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2124.1900,318.6300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2124.19,,,,,,,548.2500,2124.1900,percent of total billed charges,"100% of $2,124.19 in Billed Charges for Rev 272 = $2,124.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2124.1900,318.6300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1062.10,,,,,,,548.2500,2124.1900,percent of total billed charges,"Rev 272 $2,124.19 in Billed Charges at 50% = $1,062.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2124.1900,318.6300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,686.11,,,,,,,548.2500,2124.1900,other,"32.3% of $2,124.19 in Billed Charges for Rev 272 = $686.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2124.1900,318.6300,UNITED HEALTHCARE,UHC HERITAGE SELECT,652.13,,,,,,,548.2500,2124.1900,other,"30.7% of $2,124.19 in Billed Charges for Rev 272 = $652.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2124.1900,318.6300,UNITED HEALTHCARE,UNITED HEALTHCARE,686.11,,,,,,,548.2500,2124.1900,percent of total billed charges,"32.3% of $2,124.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2124.1900,318.6300,WELLCARE,WELLCARE MEDICAID,2124.19,,,,,,,548.2500,2124.1900,percent of total billed charges,"100% of $2,124.19 in Billed Charges for Rev 272 = $2,124.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2488.7300,373.3100,AETNA,AETNA,1062.69,,,,,,,642.3400,2488.7300,percent of total billed charges,"42.7% of $2,488.73 in Billed Charges for Rev 272 = $1,062.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2488.7300,373.3100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1742.11,,,,,,,642.3400,2488.7300,percent of total billed charges,"Rev 272 $2,488.73 in Billed Charges at 70% = $1,742.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2488.7300,373.3100,CIGNA HEALTHCARE,CIGNA HMO,1037.80,,,,,,,642.3400,2488.7300,percent of total billed charges,"41.7% of $2,488.73 in Billed Charges for Rev 272 = $1,037.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2488.7300,373.3100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1154.77,,,,,,,642.3400,2488.7300,percent of total billed charges,"46.4% of $2,488.73 in Billed Charges for Rev 272 = $1,154.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2488.7300,373.3100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1037.80,,,,,,,642.3400,2488.7300,percent of total billed charges,"41.7% of $2,488.73 in Billed Charges for Rev 272 = $1,037.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2488.7300,373.3100,CIGNA HEALTHCARE,CIGNA PPO,1037.80,,,,,,,642.3400,2488.7300,percent of total billed charges,"41.7% of $2,488.73 in Billed Charges for Rev 272 = $1,037.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2488.7300,373.3100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2239.86,,,,,,,642.3400,2488.7300,percent of total billed charges,"90% of $2,488.73 in Billed Charges for Rev 272 = $2,239.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2488.7300,373.3100,MEDCOST,MEDCOST VHN,1184.39,,,,,,,642.3400,2488.7300,percent of total billed charges,"47.59% of $2,488.73 in Billed Charges for Rev 272 = $1,184.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2488.7300,373.3100,SENTARA HEALTH,SENTARA HEALTH,642.34,,,,,,,642.3400,2488.7300,percent of total billed charges,"25.81% of $2,488.73 in Billed Charges for Rev 272 = $642.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2488.7300,373.3100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2488.73,,,,,,,642.3400,2488.7300,percent of total billed charges,"100% of $2,488.73 in Billed Charges for Rev 272 = $2,488.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2488.7300,373.3100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1244.37,,,,,,,642.3400,2488.7300,percent of total billed charges,"Rev 272 $2,488.73 in Billed Charges at 50% = $1,244.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2488.7300,373.3100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,803.86,,,,,,,642.3400,2488.7300,other,"32.3% of $2,488.73 in Billed Charges for Rev 272 = $803.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2488.7300,373.3100,UNITED HEALTHCARE,UHC HERITAGE SELECT,764.04,,,,,,,642.3400,2488.7300,other,"30.7% of $2,488.73 in Billed Charges for Rev 272 = $764.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2488.7300,373.3100,UNITED HEALTHCARE,UNITED HEALTHCARE,803.86,,,,,,,642.3400,2488.7300,percent of total billed charges,"32.3% of $2,488.73 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PILOT 4.0MM MLONG AO,272,RC,,,,,,,,both,,,2488.7300,373.3100,WELLCARE,WELLCARE MEDICAID,2488.73,,,,,,,642.3400,2488.7300,percent of total billed charges,"100% of $2,488.73 in Billed Charges for Rev 272 = $2,488.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PIN BUTTON 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1687.8800,253.1800,AETNA,AETNA,720.72,,,,,,,435.6400,1687.8800,percent of total billed charges,"42.7% of $1,687.88 in Billed Charges for Rev 272 = $720.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PIN BUTTON 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1687.8800,253.1800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1181.52,,,,,,,435.6400,1687.8800,percent of total billed charges,"Rev 272 $1,687.88 in Billed Charges at 70% = $1,181.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PIN BUTTON 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1687.8800,253.1800,CIGNA HEALTHCARE,CIGNA HMO,703.85,,,,,,,435.6400,1687.8800,percent of total billed charges,"41.7% of $1,687.88 in Billed Charges for Rev 272 = $703.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PIN BUTTON 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1687.8800,253.1800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,783.18,,,,,,,435.6400,1687.8800,percent of total billed charges,"46.4% of $1,687.88 in Billed Charges for Rev 272 = $783.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PIN BUTTON 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1687.8800,253.1800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,703.85,,,,,,,435.6400,1687.8800,percent of total billed charges,"41.7% of $1,687.88 in Billed Charges for Rev 272 = $703.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PIN BUTTON 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1687.8800,253.1800,CIGNA HEALTHCARE,CIGNA PPO,703.85,,,,,,,435.6400,1687.8800,percent of total billed charges,"41.7% of $1,687.88 in Billed Charges for Rev 272 = $703.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PIN BUTTON 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1687.8800,253.1800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1519.09,,,,,,,435.6400,1687.8800,percent of total billed charges,"90% of $1,687.88 in Billed Charges for Rev 272 = $1,519.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PIN BUTTON 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1687.8800,253.1800,MEDCOST,MEDCOST VHN,803.26,,,,,,,435.6400,1687.8800,percent of total billed charges,"47.59% of $1,687.88 in Billed Charges for Rev 272 = $803.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PIN BUTTON 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1687.8800,253.1800,SENTARA HEALTH,SENTARA HEALTH,435.64,,,,,,,435.6400,1687.8800,percent of total billed charges,"25.81% of $1,687.88 in Billed Charges for Rev 272 = $435.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PIN BUTTON 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1687.8800,253.1800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1687.88,,,,,,,435.6400,1687.8800,percent of total billed charges,"100% of $1,687.88 in Billed Charges for Rev 272 = $1,687.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PIN BUTTON 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1687.8800,253.1800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,843.94,,,,,,,435.6400,1687.8800,percent of total billed charges,"Rev 272 $1,687.88 in Billed Charges at 50% = $843.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PIN BUTTON 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1687.8800,253.1800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,545.19,,,,,,,435.6400,1687.8800,other,"32.3% of $1,687.88 in Billed Charges for Rev 272 = $545.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL PIN BUTTON 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1687.8800,253.1800,UNITED HEALTHCARE,UHC HERITAGE SELECT,518.18,,,,,,,435.6400,1687.8800,other,"30.7% of $1,687.88 in Billed Charges for Rev 272 = $518.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL PIN BUTTON 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1687.8800,253.1800,UNITED HEALTHCARE,UNITED HEALTHCARE,545.19,,,,,,,435.6400,1687.8800,percent of total billed charges,"32.3% of $1,687.88 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL PIN BUTTON 3.7MM,272,RC,27200002,CDM,,,,,,both,,,1687.8800,253.1800,WELLCARE,WELLCARE MEDICAID,1687.88,,,,,,,435.6400,1687.8800,percent of total billed charges,"100% of $1,687.88 in Billed Charges for Rev 272 = $1,687.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BROKEN SCREW 5MMX6IN,272,RC,,,,,,,,both,,,3785.4200,567.8100,AETNA,AETNA,1616.37,,,,,,,977.0200,3785.4200,percent of total billed charges,"42.7% of $3,785.42 in Billed Charges for Rev 272 = $1,616.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BROKEN SCREW 5MMX6IN,272,RC,,,,,,,,both,,,3785.4200,567.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2649.79,,,,,,,977.0200,3785.4200,percent of total billed charges,"Rev 272 $3,785.42 in Billed Charges at 70% = $2,649.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BROKEN SCREW 5MMX6IN,272,RC,,,,,,,,both,,,3785.4200,567.8100,CIGNA HEALTHCARE,CIGNA HMO,1578.52,,,,,,,977.0200,3785.4200,percent of total billed charges,"41.7% of $3,785.42 in Billed Charges for Rev 272 = $1,578.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BROKEN SCREW 5MMX6IN,272,RC,,,,,,,,both,,,3785.4200,567.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1756.43,,,,,,,977.0200,3785.4200,percent of total billed charges,"46.4% of $3,785.42 in Billed Charges for Rev 272 = $1,756.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BROKEN SCREW 5MMX6IN,272,RC,,,,,,,,both,,,3785.4200,567.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1578.52,,,,,,,977.0200,3785.4200,percent of total billed charges,"41.7% of $3,785.42 in Billed Charges for Rev 272 = $1,578.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BROKEN SCREW 5MMX6IN,272,RC,,,,,,,,both,,,3785.4200,567.8100,CIGNA HEALTHCARE,CIGNA PPO,1578.52,,,,,,,977.0200,3785.4200,percent of total billed charges,"41.7% of $3,785.42 in Billed Charges for Rev 272 = $1,578.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BROKEN SCREW 5MMX6IN,272,RC,,,,,,,,both,,,3785.4200,567.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3406.88,,,,,,,977.0200,3785.4200,percent of total billed charges,"90% of $3,785.42 in Billed Charges for Rev 272 = $3,406.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BROKEN SCREW 5MMX6IN,272,RC,,,,,,,,both,,,3785.4200,567.8100,MEDCOST,MEDCOST VHN,1801.48,,,,,,,977.0200,3785.4200,percent of total billed charges,"47.59% of $3,785.42 in Billed Charges for Rev 272 = $1,801.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BROKEN SCREW 5MMX6IN,272,RC,,,,,,,,both,,,3785.4200,567.8100,SENTARA HEALTH,SENTARA HEALTH,977.02,,,,,,,977.0200,3785.4200,percent of total billed charges,"25.81% of $3,785.42 in Billed Charges for Rev 272 = $977.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BROKEN SCREW 5MMX6IN,272,RC,,,,,,,,both,,,3785.4200,567.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3785.42,,,,,,,977.0200,3785.4200,percent of total billed charges,"100% of $3,785.42 in Billed Charges for Rev 272 = $3,785.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BROKEN SCREW 5MMX6IN,272,RC,,,,,,,,both,,,3785.4200,567.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1892.71,,,,,,,977.0200,3785.4200,percent of total billed charges,"Rev 272 $3,785.42 in Billed Charges at 50% = $1,892.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BROKEN SCREW 5MMX6IN,272,RC,,,,,,,,both,,,3785.4200,567.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1222.69,,,,,,,977.0200,3785.4200,other,"32.3% of $3,785.42 in Billed Charges for Rev 272 = $1,222.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
EXTRACTOR BROKEN SCREW 5MMX6IN,272,RC,,,,,,,,both,,,3785.4200,567.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1162.12,,,,,,,977.0200,3785.4200,other,"30.7% of $3,785.42 in Billed Charges for Rev 272 = $1,162.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
EXTRACTOR BROKEN SCREW 5MMX6IN,272,RC,,,,,,,,both,,,3785.4200,567.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,1222.69,,,,,,,977.0200,3785.4200,percent of total billed charges,"32.3% of $3,785.42 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR BROKEN SCREW 5MMX6IN,272,RC,,,,,,,,both,,,3785.4200,567.8100,WELLCARE,WELLCARE MEDICAID,3785.42,,,,,,,977.0200,3785.4200,percent of total billed charges,"100% of $3,785.42 in Billed Charges for Rev 272 = $3,785.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,3314.2600,497.1400,AETNA,AETNA,1415.19,,,,,,,855.4100,3314.2600,percent of total billed charges,"42.7% of $3,314.26 in Billed Charges for Rev 272 = $1,415.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,3314.2600,497.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2319.98,,,,,,,855.4100,3314.2600,percent of total billed charges,"Rev 272 $3,314.26 in Billed Charges at 70% = $2,319.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,3314.2600,497.1400,CIGNA HEALTHCARE,CIGNA HMO,1382.05,,,,,,,855.4100,3314.2600,percent of total billed charges,"41.7% of $3,314.26 in Billed Charges for Rev 272 = $1,382.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,3314.2600,497.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1537.82,,,,,,,855.4100,3314.2600,percent of total billed charges,"46.4% of $3,314.26 in Billed Charges for Rev 272 = $1,537.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,3314.2600,497.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1382.05,,,,,,,855.4100,3314.2600,percent of total billed charges,"41.7% of $3,314.26 in Billed Charges for Rev 272 = $1,382.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,3314.2600,497.1400,CIGNA HEALTHCARE,CIGNA PPO,1382.05,,,,,,,855.4100,3314.2600,percent of total billed charges,"41.7% of $3,314.26 in Billed Charges for Rev 272 = $1,382.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,3314.2600,497.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2982.83,,,,,,,855.4100,3314.2600,percent of total billed charges,"90% of $3,314.26 in Billed Charges for Rev 272 = $2,982.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,3314.2600,497.1400,MEDCOST,MEDCOST VHN,1577.26,,,,,,,855.4100,3314.2600,percent of total billed charges,"47.59% of $3,314.26 in Billed Charges for Rev 272 = $1,577.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,3314.2600,497.1400,SENTARA HEALTH,SENTARA HEALTH,855.41,,,,,,,855.4100,3314.2600,percent of total billed charges,"25.81% of $3,314.26 in Billed Charges for Rev 272 = $855.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,3314.2600,497.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3314.26,,,,,,,855.4100,3314.2600,percent of total billed charges,"100% of $3,314.26 in Billed Charges for Rev 272 = $3,314.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,3314.2600,497.1400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1657.13,,,,,,,855.4100,3314.2600,percent of total billed charges,"Rev 272 $3,314.26 in Billed Charges at 50% = $1,657.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,3314.2600,497.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1070.51,,,,,,,855.4100,3314.2600,other,"32.3% of $3,314.26 in Billed Charges for Rev 272 = $1,070.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,3314.2600,497.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1017.48,,,,,,,855.4100,3314.2600,other,"30.7% of $3,314.26 in Billed Charges for Rev 272 = $1,017.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,3314.2600,497.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,1070.51,,,,,,,855.4100,3314.2600,percent of total billed charges,"32.3% of $3,314.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,3314.2600,497.1400,WELLCARE,WELLCARE MEDICAID,3314.26,,,,,,,855.4100,3314.2600,percent of total billed charges,"100% of $3,314.26 in Billed Charges for Rev 272 = $3,314.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,4369.7100,655.4600,AETNA,AETNA,1865.87,,,,,,,1127.8200,4369.7100,percent of total billed charges,"42.7% of $4,369.71 in Billed Charges for Rev 272 = $1,865.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,4369.7100,655.4600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3058.80,,,,,,,1127.8200,4369.7100,percent of total billed charges,"Rev 272 $4,369.71 in Billed Charges at 70% = $3,058.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,4369.7100,655.4600,CIGNA HEALTHCARE,CIGNA HMO,1822.17,,,,,,,1127.8200,4369.7100,percent of total billed charges,"41.7% of $4,369.71 in Billed Charges for Rev 272 = $1,822.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,4369.7100,655.4600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2027.55,,,,,,,1127.8200,4369.7100,percent of total billed charges,"46.4% of $4,369.71 in Billed Charges for Rev 272 = $2,027.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,4369.7100,655.4600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1822.17,,,,,,,1127.8200,4369.7100,percent of total billed charges,"41.7% of $4,369.71 in Billed Charges for Rev 272 = $1,822.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,4369.7100,655.4600,CIGNA HEALTHCARE,CIGNA PPO,1822.17,,,,,,,1127.8200,4369.7100,percent of total billed charges,"41.7% of $4,369.71 in Billed Charges for Rev 272 = $1,822.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,4369.7100,655.4600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3932.74,,,,,,,1127.8200,4369.7100,percent of total billed charges,"90% of $4,369.71 in Billed Charges for Rev 272 = $3,932.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,4369.7100,655.4600,MEDCOST,MEDCOST VHN,2079.55,,,,,,,1127.8200,4369.7100,percent of total billed charges,"47.59% of $4,369.71 in Billed Charges for Rev 272 = $2,079.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,4369.7100,655.4600,SENTARA HEALTH,SENTARA HEALTH,1127.82,,,,,,,1127.8200,4369.7100,percent of total billed charges,"25.81% of $4,369.71 in Billed Charges for Rev 272 = $1,127.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,4369.7100,655.4600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4369.71,,,,,,,1127.8200,4369.7100,percent of total billed charges,"100% of $4,369.71 in Billed Charges for Rev 272 = $4,369.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,4369.7100,655.4600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2184.86,,,,,,,1127.8200,4369.7100,percent of total billed charges,"Rev 272 $4,369.71 in Billed Charges at 50% = $2,184.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,4369.7100,655.4600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1411.42,,,,,,,1127.8200,4369.7100,other,"32.3% of $4,369.71 in Billed Charges for Rev 272 = $1,411.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,4369.7100,655.4600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1341.50,,,,,,,1127.8200,4369.7100,other,"30.7% of $4,369.71 in Billed Charges for Rev 272 = $1,341.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,4369.7100,655.4600,UNITED HEALTHCARE,UNITED HEALTHCARE,1411.42,,,,,,,1127.8200,4369.7100,percent of total billed charges,"32.3% of $4,369.71 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO RETRACTOR,272,RC,27200002,CDM,,,,,,both,,,4369.7100,655.4600,WELLCARE,WELLCARE MEDICAID,4369.71,,,,,,,1127.8200,4369.7100,percent of total billed charges,"100% of $4,369.71 in Billed Charges for Rev 272 = $4,369.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STCH SURGIDAC GRN 173026,272,RC,27200002,CDM,,,,,,both,,,720.3500,108.0500,AETNA,AETNA,307.59,,,,,,,185.9200,720.3500,percent of total billed charges,42.7% of $720.35 in Billed Charges for Rev 272 = $307.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO STCH SURGIDAC GRN 173026,272,RC,27200002,CDM,,,,,,both,,,720.3500,108.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,504.25,,,,,,,185.9200,720.3500,percent of total billed charges,Rev 272 $720.35 in Billed Charges at 70% = $504.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO STCH SURGIDAC GRN 173026,272,RC,27200002,CDM,,,,,,both,,,720.3500,108.0500,CIGNA HEALTHCARE,CIGNA HMO,300.39,,,,,,,185.9200,720.3500,percent of total billed charges,41.7% of $720.35 in Billed Charges for Rev 272 = $300.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO STCH SURGIDAC GRN 173026,272,RC,27200002,CDM,,,,,,both,,,720.3500,108.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,334.24,,,,,,,185.9200,720.3500,percent of total billed charges,46.4% of $720.35 in Billed Charges for Rev 272 = $334.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO STCH SURGIDAC GRN 173026,272,RC,27200002,CDM,,,,,,both,,,720.3500,108.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,300.39,,,,,,,185.9200,720.3500,percent of total billed charges,41.7% of $720.35 in Billed Charges for Rev 272 = $300.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO STCH SURGIDAC GRN 173026,272,RC,27200002,CDM,,,,,,both,,,720.3500,108.0500,CIGNA HEALTHCARE,CIGNA PPO,300.39,,,,,,,185.9200,720.3500,percent of total billed charges,41.7% of $720.35 in Billed Charges for Rev 272 = $300.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO STCH SURGIDAC GRN 173026,272,RC,27200002,CDM,,,,,,both,,,720.3500,108.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,648.32,,,,,,,185.9200,720.3500,percent of total billed charges,90% of $720.35 in Billed Charges for Rev 272 = $648.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO STCH SURGIDAC GRN 173026,272,RC,27200002,CDM,,,,,,both,,,720.3500,108.0500,MEDCOST,MEDCOST VHN,342.81,,,,,,,185.9200,720.3500,percent of total billed charges,47.59% of $720.35 in Billed Charges for Rev 272 = $342.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO STCH SURGIDAC GRN 173026,272,RC,27200002,CDM,,,,,,both,,,720.3500,108.0500,SENTARA HEALTH,SENTARA HEALTH,185.92,,,,,,,185.9200,720.3500,percent of total billed charges,25.81% of $720.35 in Billed Charges for Rev 272 = $185.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO STCH SURGIDAC GRN 173026,272,RC,27200002,CDM,,,,,,both,,,720.3500,108.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",720.35,,,,,,,185.9200,720.3500,percent of total billed charges,100% of $720.35 in Billed Charges for Rev 272 = $720.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO STCH SURGIDAC GRN 173026,272,RC,27200002,CDM,,,,,,both,,,720.3500,108.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,360.18,,,,,,,185.9200,720.3500,percent of total billed charges,Rev 272 $720.35 in Billed Charges at 50% = $360.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO STCH SURGIDAC GRN 173026,272,RC,27200002,CDM,,,,,,both,,,720.3500,108.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,232.67,,,,,,,185.9200,720.3500,other,32.3% of $720.35 in Billed Charges for Rev 272 = $232.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ENDO STCH SURGIDAC GRN 173026,272,RC,27200002,CDM,,,,,,both,,,720.3500,108.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,221.15,,,,,,,185.9200,720.3500,other,30.7% of $720.35 in Billed Charges for Rev 272 = $221.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ENDO STCH SURGIDAC GRN 173026,272,RC,27200002,CDM,,,,,,both,,,720.3500,108.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,232.67,,,,,,,185.9200,720.3500,percent of total billed charges,32.3% of $720.35 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO STCH SURGIDAC GRN 173026,272,RC,27200002,CDM,,,,,,both,,,720.3500,108.0500,WELLCARE,WELLCARE MEDICAID,720.35,,,,,,,185.9200,720.3500,percent of total billed charges,100% of $720.35 in Billed Charges for Rev 272 = $720.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,3713.9600,557.0900,AETNA,AETNA,1585.86,,,,,,,958.5700,3713.9600,percent of total billed charges,"42.7% of $3,713.96 in Billed Charges for Rev 272 = $1,585.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,3713.9600,557.0900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2599.77,,,,,,,958.5700,3713.9600,percent of total billed charges,"Rev 272 $3,713.96 in Billed Charges at 70% = $2,599.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,3713.9600,557.0900,CIGNA HEALTHCARE,CIGNA HMO,1548.72,,,,,,,958.5700,3713.9600,percent of total billed charges,"41.7% of $3,713.96 in Billed Charges for Rev 272 = $1,548.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,3713.9600,557.0900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1723.28,,,,,,,958.5700,3713.9600,percent of total billed charges,"46.4% of $3,713.96 in Billed Charges for Rev 272 = $1,723.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,3713.9600,557.0900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1548.72,,,,,,,958.5700,3713.9600,percent of total billed charges,"41.7% of $3,713.96 in Billed Charges for Rev 272 = $1,548.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,3713.9600,557.0900,CIGNA HEALTHCARE,CIGNA PPO,1548.72,,,,,,,958.5700,3713.9600,percent of total billed charges,"41.7% of $3,713.96 in Billed Charges for Rev 272 = $1,548.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,3713.9600,557.0900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3342.56,,,,,,,958.5700,3713.9600,percent of total billed charges,"90% of $3,713.96 in Billed Charges for Rev 272 = $3,342.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,3713.9600,557.0900,MEDCOST,MEDCOST VHN,1767.47,,,,,,,958.5700,3713.9600,percent of total billed charges,"47.59% of $3,713.96 in Billed Charges for Rev 272 = $1,767.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,3713.9600,557.0900,SENTARA HEALTH,SENTARA HEALTH,958.57,,,,,,,958.5700,3713.9600,percent of total billed charges,"25.81% of $3,713.96 in Billed Charges for Rev 272 = $958.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,3713.9600,557.0900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3713.96,,,,,,,958.5700,3713.9600,percent of total billed charges,"100% of $3,713.96 in Billed Charges for Rev 272 = $3,713.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,3713.9600,557.0900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1856.98,,,,,,,958.5700,3713.9600,percent of total billed charges,"Rev 272 $3,713.96 in Billed Charges at 50% = $1,856.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,3713.9600,557.0900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1199.61,,,,,,,958.5700,3713.9600,other,"32.3% of $3,713.96 in Billed Charges for Rev 272 = $1,199.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,3713.9600,557.0900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1140.19,,,,,,,958.5700,3713.9600,other,"30.7% of $3,713.96 in Billed Charges for Rev 272 = $1,140.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,3713.9600,557.0900,UNITED HEALTHCARE,UNITED HEALTHCARE,1199.61,,,,,,,958.5700,3713.9600,percent of total billed charges,"32.3% of $3,713.96 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,3713.9600,557.0900,WELLCARE,WELLCARE MEDICAID,3713.96,,,,,,,958.5700,3713.9600,percent of total billed charges,"100% of $3,713.96 in Billed Charges for Rev 272 = $3,713.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,4804.6900,720.7000,AETNA,AETNA,2051.60,,,,,,,1240.0900,4804.6900,percent of total billed charges,"42.7% of $4,804.69 in Billed Charges for Rev 272 = $2,051.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,4804.6900,720.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3363.28,,,,,,,1240.0900,4804.6900,percent of total billed charges,"Rev 272 $4,804.69 in Billed Charges at 70% = $3,363.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,4804.6900,720.7000,CIGNA HEALTHCARE,CIGNA HMO,2003.56,,,,,,,1240.0900,4804.6900,percent of total billed charges,"41.7% of $4,804.69 in Billed Charges for Rev 272 = $2,003.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,4804.6900,720.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2229.38,,,,,,,1240.0900,4804.6900,percent of total billed charges,"46.4% of $4,804.69 in Billed Charges for Rev 272 = $2,229.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,4804.6900,720.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2003.56,,,,,,,1240.0900,4804.6900,percent of total billed charges,"41.7% of $4,804.69 in Billed Charges for Rev 272 = $2,003.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,4804.6900,720.7000,CIGNA HEALTHCARE,CIGNA PPO,2003.56,,,,,,,1240.0900,4804.6900,percent of total billed charges,"41.7% of $4,804.69 in Billed Charges for Rev 272 = $2,003.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,4804.6900,720.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4324.22,,,,,,,1240.0900,4804.6900,percent of total billed charges,"90% of $4,804.69 in Billed Charges for Rev 272 = $4,324.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,4804.6900,720.7000,MEDCOST,MEDCOST VHN,2286.55,,,,,,,1240.0900,4804.6900,percent of total billed charges,"47.59% of $4,804.69 in Billed Charges for Rev 272 = $2,286.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,4804.6900,720.7000,SENTARA HEALTH,SENTARA HEALTH,1240.09,,,,,,,1240.0900,4804.6900,percent of total billed charges,"25.81% of $4,804.69 in Billed Charges for Rev 272 = $1,240.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,4804.6900,720.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4804.69,,,,,,,1240.0900,4804.6900,percent of total billed charges,"100% of $4,804.69 in Billed Charges for Rev 272 = $4,804.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,4804.6900,720.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2402.35,,,,,,,1240.0900,4804.6900,percent of total billed charges,"Rev 272 $4,804.69 in Billed Charges at 50% = $2,402.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,4804.6900,720.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1551.91,,,,,,,1240.0900,4804.6900,other,"32.3% of $4,804.69 in Billed Charges for Rev 272 = $1,551.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,4804.6900,720.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1475.04,,,,,,,1240.0900,4804.6900,other,"30.7% of $4,804.69 in Billed Charges for Rev 272 = $1,475.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,4804.6900,720.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,1551.91,,,,,,,1240.0900,4804.6900,percent of total billed charges,"32.3% of $4,804.69 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO STITCH 10MM 173016,272,RC,27200002,CDM,,,,,,both,,,4804.6900,720.7000,WELLCARE,WELLCARE MEDICAID,4804.69,,,,,,,1240.0900,4804.6900,percent of total billed charges,"100% of $4,804.69 in Billed Charges for Rev 272 = $4,804.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NGAGE NITINOL,272,RC,27200002,CDM,,,,,,both,,,3599.6700,539.9500,AETNA,AETNA,1537.06,,,,,,,929.0700,3599.6700,percent of total billed charges,"42.7% of $3,599.67 in Billed Charges for Rev 272 = $1,537.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NGAGE NITINOL,272,RC,27200002,CDM,,,,,,both,,,3599.6700,539.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2519.77,,,,,,,929.0700,3599.6700,percent of total billed charges,"Rev 272 $3,599.67 in Billed Charges at 70% = $2,519.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NGAGE NITINOL,272,RC,27200002,CDM,,,,,,both,,,3599.6700,539.9500,CIGNA HEALTHCARE,CIGNA HMO,1501.06,,,,,,,929.0700,3599.6700,percent of total billed charges,"41.7% of $3,599.67 in Billed Charges for Rev 272 = $1,501.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NGAGE NITINOL,272,RC,27200002,CDM,,,,,,both,,,3599.6700,539.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1670.25,,,,,,,929.0700,3599.6700,percent of total billed charges,"46.4% of $3,599.67 in Billed Charges for Rev 272 = $1,670.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NGAGE NITINOL,272,RC,27200002,CDM,,,,,,both,,,3599.6700,539.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1501.06,,,,,,,929.0700,3599.6700,percent of total billed charges,"41.7% of $3,599.67 in Billed Charges for Rev 272 = $1,501.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NGAGE NITINOL,272,RC,27200002,CDM,,,,,,both,,,3599.6700,539.9500,CIGNA HEALTHCARE,CIGNA PPO,1501.06,,,,,,,929.0700,3599.6700,percent of total billed charges,"41.7% of $3,599.67 in Billed Charges for Rev 272 = $1,501.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NGAGE NITINOL,272,RC,27200002,CDM,,,,,,both,,,3599.6700,539.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3239.70,,,,,,,929.0700,3599.6700,percent of total billed charges,"90% of $3,599.67 in Billed Charges for Rev 272 = $3,239.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NGAGE NITINOL,272,RC,27200002,CDM,,,,,,both,,,3599.6700,539.9500,MEDCOST,MEDCOST VHN,1713.08,,,,,,,929.0700,3599.6700,percent of total billed charges,"47.59% of $3,599.67 in Billed Charges for Rev 272 = $1,713.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NGAGE NITINOL,272,RC,27200002,CDM,,,,,,both,,,3599.6700,539.9500,SENTARA HEALTH,SENTARA HEALTH,929.07,,,,,,,929.0700,3599.6700,percent of total billed charges,"25.81% of $3,599.67 in Billed Charges for Rev 272 = $929.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NGAGE NITINOL,272,RC,27200002,CDM,,,,,,both,,,3599.6700,539.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3599.67,,,,,,,929.0700,3599.6700,percent of total billed charges,"100% of $3,599.67 in Billed Charges for Rev 272 = $3,599.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NGAGE NITINOL,272,RC,27200002,CDM,,,,,,both,,,3599.6700,539.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1799.84,,,,,,,929.0700,3599.6700,percent of total billed charges,"Rev 272 $3,599.67 in Billed Charges at 50% = $1,799.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NGAGE NITINOL,272,RC,27200002,CDM,,,,,,both,,,3599.6700,539.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1162.69,,,,,,,929.0700,3599.6700,other,"32.3% of $3,599.67 in Billed Charges for Rev 272 = $1,162.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
EXTRACTOR STONE NGAGE NITINOL,272,RC,27200002,CDM,,,,,,both,,,3599.6700,539.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1105.10,,,,,,,929.0700,3599.6700,other,"30.7% of $3,599.67 in Billed Charges for Rev 272 = $1,105.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
EXTRACTOR STONE NGAGE NITINOL,272,RC,27200002,CDM,,,,,,both,,,3599.6700,539.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,1162.69,,,,,,,929.0700,3599.6700,percent of total billed charges,"32.3% of $3,599.67 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
EXTRACTOR STONE NGAGE NITINOL,272,RC,27200002,CDM,,,,,,both,,,3599.6700,539.9500,WELLCARE,WELLCARE MEDICAID,3599.67,,,,,,,929.0700,3599.6700,percent of total billed charges,"100% of $3,599.67 in Billed Charges for Rev 272 = $3,599.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MACRO BIPOLAR CALIPER,272,RC,,,,,,,,both,,,401.6100,60.2400,AETNA,AETNA,171.49,,,,,,,103.6600,401.6100,percent of total billed charges,42.7% of $401.61 in Billed Charges for Rev 272 = $171.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP MACRO BIPOLAR CALIPER,272,RC,,,,,,,,both,,,401.6100,60.2400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,281.13,,,,,,,103.6600,401.6100,percent of total billed charges,Rev 272 $401.61 in Billed Charges at 70% = $281.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP MACRO BIPOLAR CALIPER,272,RC,,,,,,,,both,,,401.6100,60.2400,CIGNA HEALTHCARE,CIGNA HMO,167.47,,,,,,,103.6600,401.6100,percent of total billed charges,41.7% of $401.61 in Billed Charges for Rev 272 = $167.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP MACRO BIPOLAR CALIPER,272,RC,,,,,,,,both,,,401.6100,60.2400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,186.35,,,,,,,103.6600,401.6100,percent of total billed charges,46.4% of $401.61 in Billed Charges for Rev 272 = $186.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP MACRO BIPOLAR CALIPER,272,RC,,,,,,,,both,,,401.6100,60.2400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,167.47,,,,,,,103.6600,401.6100,percent of total billed charges,41.7% of $401.61 in Billed Charges for Rev 272 = $167.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP MACRO BIPOLAR CALIPER,272,RC,,,,,,,,both,,,401.6100,60.2400,CIGNA HEALTHCARE,CIGNA PPO,167.47,,,,,,,103.6600,401.6100,percent of total billed charges,41.7% of $401.61 in Billed Charges for Rev 272 = $167.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP MACRO BIPOLAR CALIPER,272,RC,,,,,,,,both,,,401.6100,60.2400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,361.45,,,,,,,103.6600,401.6100,percent of total billed charges,90% of $401.61 in Billed Charges for Rev 272 = $361.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP MACRO BIPOLAR CALIPER,272,RC,,,,,,,,both,,,401.6100,60.2400,MEDCOST,MEDCOST VHN,191.13,,,,,,,103.6600,401.6100,percent of total billed charges,47.59% of $401.61 in Billed Charges for Rev 272 = $191.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP MACRO BIPOLAR CALIPER,272,RC,,,,,,,,both,,,401.6100,60.2400,SENTARA HEALTH,SENTARA HEALTH,103.66,,,,,,,103.6600,401.6100,percent of total billed charges,25.81% of $401.61 in Billed Charges for Rev 272 = $103.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP MACRO BIPOLAR CALIPER,272,RC,,,,,,,,both,,,401.6100,60.2400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",401.61,,,,,,,103.6600,401.6100,percent of total billed charges,100% of $401.61 in Billed Charges for Rev 272 = $401.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP MACRO BIPOLAR CALIPER,272,RC,,,,,,,,both,,,401.6100,60.2400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,200.81,,,,,,,103.6600,401.6100,percent of total billed charges,Rev 272 $401.61 in Billed Charges at 50% = $200.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP MACRO BIPOLAR CALIPER,272,RC,,,,,,,,both,,,401.6100,60.2400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,129.72,,,,,,,103.6600,401.6100,other,32.3% of $401.61 in Billed Charges for Rev 272 = $129.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
FORCEP MACRO BIPOLAR CALIPER,272,RC,,,,,,,,both,,,401.6100,60.2400,UNITED HEALTHCARE,UHC HERITAGE SELECT,123.29,,,,,,,103.6600,401.6100,other,30.7% of $401.61 in Billed Charges for Rev 272 = $123.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
FORCEP MACRO BIPOLAR CALIPER,272,RC,,,,,,,,both,,,401.6100,60.2400,UNITED HEALTHCARE,UNITED HEALTHCARE,129.72,,,,,,,103.6600,401.6100,percent of total billed charges,32.3% of $401.61 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP MACRO BIPOLAR CALIPER,272,RC,,,,,,,,both,,,401.6100,60.2400,WELLCARE,WELLCARE MEDICAID,401.61,,,,,,,103.6600,401.6100,percent of total billed charges,100% of $401.61 in Billed Charges for Rev 272 = $401.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP MALIS IRR BIOPLAR 23CM 0.5MM,272,RC,27200002,CDM,,,,,,both,,,4525.7000,678.8600,AETNA,AETNA,1932.47,,,,,,,1168.0800,4525.7000,percent of total billed charges,"42.7% of $4,525.70 in Billed Charges for Rev 272 = $1,932.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MALIS IRR BIOPLAR 23CM 0.5MM,272,RC,27200002,CDM,,,,,,both,,,4525.7000,678.8600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3167.99,,,,,,,1168.0800,4525.7000,percent of total billed charges,"Rev 272 $4,525.70 in Billed Charges at 70% = $3,167.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MALIS IRR BIOPLAR 23CM 0.5MM,272,RC,27200002,CDM,,,,,,both,,,4525.7000,678.8600,CIGNA HEALTHCARE,CIGNA HMO,1887.22,,,,,,,1168.0800,4525.7000,percent of total billed charges,"41.7% of $4,525.70 in Billed Charges for Rev 272 = $1,887.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MALIS IRR BIOPLAR 23CM 0.5MM,272,RC,27200002,CDM,,,,,,both,,,4525.7000,678.8600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2099.92,,,,,,,1168.0800,4525.7000,percent of total billed charges,"46.4% of $4,525.70 in Billed Charges for Rev 272 = $2,099.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MALIS IRR BIOPLAR 23CM 0.5MM,272,RC,27200002,CDM,,,,,,both,,,4525.7000,678.8600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1887.22,,,,,,,1168.0800,4525.7000,percent of total billed charges,"41.7% of $4,525.70 in Billed Charges for Rev 272 = $1,887.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MALIS IRR BIOPLAR 23CM 0.5MM,272,RC,27200002,CDM,,,,,,both,,,4525.7000,678.8600,CIGNA HEALTHCARE,CIGNA PPO,1887.22,,,,,,,1168.0800,4525.7000,percent of total billed charges,"41.7% of $4,525.70 in Billed Charges for Rev 272 = $1,887.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MALIS IRR BIOPLAR 23CM 0.5MM,272,RC,27200002,CDM,,,,,,both,,,4525.7000,678.8600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4073.13,,,,,,,1168.0800,4525.7000,percent of total billed charges,"90% of $4,525.70 in Billed Charges for Rev 272 = $4,073.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MALIS IRR BIOPLAR 23CM 0.5MM,272,RC,27200002,CDM,,,,,,both,,,4525.7000,678.8600,MEDCOST,MEDCOST VHN,2153.78,,,,,,,1168.0800,4525.7000,percent of total billed charges,"47.59% of $4,525.70 in Billed Charges for Rev 272 = $2,153.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MALIS IRR BIOPLAR 23CM 0.5MM,272,RC,27200002,CDM,,,,,,both,,,4525.7000,678.8600,SENTARA HEALTH,SENTARA HEALTH,1168.08,,,,,,,1168.0800,4525.7000,percent of total billed charges,"25.81% of $4,525.70 in Billed Charges for Rev 272 = $1,168.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MALIS IRR BIOPLAR 23CM 0.5MM,272,RC,27200002,CDM,,,,,,both,,,4525.7000,678.8600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4525.70,,,,,,,1168.0800,4525.7000,percent of total billed charges,"100% of $4,525.70 in Billed Charges for Rev 272 = $4,525.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MALIS IRR BIOPLAR 23CM 0.5MM,272,RC,27200002,CDM,,,,,,both,,,4525.7000,678.8600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2262.85,,,,,,,1168.0800,4525.7000,percent of total billed charges,"Rev 272 $4,525.70 in Billed Charges at 50% = $2,262.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MALIS IRR BIOPLAR 23CM 0.5MM,272,RC,27200002,CDM,,,,,,both,,,4525.7000,678.8600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1461.80,,,,,,,1168.0800,4525.7000,other,"32.3% of $4,525.70 in Billed Charges for Rev 272 = $1,461.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP MALIS IRR BIOPLAR 23CM 0.5MM,272,RC,27200002,CDM,,,,,,both,,,4525.7000,678.8600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1389.39,,,,,,,1168.0800,4525.7000,other,"30.7% of $4,525.70 in Billed Charges for Rev 272 = $1,389.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP MALIS IRR BIOPLAR 23CM 0.5MM,272,RC,27200002,CDM,,,,,,both,,,4525.7000,678.8600,UNITED HEALTHCARE,UNITED HEALTHCARE,1461.80,,,,,,,1168.0800,4525.7000,percent of total billed charges,"32.3% of $4,525.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP MALIS IRR BIOPLAR 23CM 0.5MM,272,RC,27200002,CDM,,,,,,both,,,4525.7000,678.8600,WELLCARE,WELLCARE MEDICAID,4525.70,,,,,,,1168.0800,4525.7000,percent of total billed charges,"100% of $4,525.70 in Billed Charges for Rev 272 = $4,525.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO SYSTEM SET OTSC ANCHOR 165CM,272,RC,,,,,,,,both,,,5486.2600,822.9400,AETNA,AETNA,2342.63,,,,,,,1416.0000,5486.2600,percent of total billed charges,"42.7% of $5,486.26 in Billed Charges for Rev 272 = $2,342.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO SYSTEM SET OTSC ANCHOR 165CM,272,RC,,,,,,,,both,,,5486.2600,822.9400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3840.38,,,,,,,1416.0000,5486.2600,percent of total billed charges,"Rev 272 $5,486.26 in Billed Charges at 70% = $3,840.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO SYSTEM SET OTSC ANCHOR 165CM,272,RC,,,,,,,,both,,,5486.2600,822.9400,CIGNA HEALTHCARE,CIGNA HMO,2287.77,,,,,,,1416.0000,5486.2600,percent of total billed charges,"41.7% of $5,486.26 in Billed Charges for Rev 272 = $2,287.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO SYSTEM SET OTSC ANCHOR 165CM,272,RC,,,,,,,,both,,,5486.2600,822.9400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2545.62,,,,,,,1416.0000,5486.2600,percent of total billed charges,"46.4% of $5,486.26 in Billed Charges for Rev 272 = $2,545.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO SYSTEM SET OTSC ANCHOR 165CM,272,RC,,,,,,,,both,,,5486.2600,822.9400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2287.77,,,,,,,1416.0000,5486.2600,percent of total billed charges,"41.7% of $5,486.26 in Billed Charges for Rev 272 = $2,287.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO SYSTEM SET OTSC ANCHOR 165CM,272,RC,,,,,,,,both,,,5486.2600,822.9400,CIGNA HEALTHCARE,CIGNA PPO,2287.77,,,,,,,1416.0000,5486.2600,percent of total billed charges,"41.7% of $5,486.26 in Billed Charges for Rev 272 = $2,287.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO SYSTEM SET OTSC ANCHOR 165CM,272,RC,,,,,,,,both,,,5486.2600,822.9400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4937.63,,,,,,,1416.0000,5486.2600,percent of total billed charges,"90% of $5,486.26 in Billed Charges for Rev 272 = $4,937.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO SYSTEM SET OTSC ANCHOR 165CM,272,RC,,,,,,,,both,,,5486.2600,822.9400,MEDCOST,MEDCOST VHN,2610.91,,,,,,,1416.0000,5486.2600,percent of total billed charges,"47.59% of $5,486.26 in Billed Charges for Rev 272 = $2,610.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO SYSTEM SET OTSC ANCHOR 165CM,272,RC,,,,,,,,both,,,5486.2600,822.9400,SENTARA HEALTH,SENTARA HEALTH,1416.00,,,,,,,1416.0000,5486.2600,percent of total billed charges,"25.81% of $5,486.26 in Billed Charges for Rev 272 = $1,416.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO SYSTEM SET OTSC ANCHOR 165CM,272,RC,,,,,,,,both,,,5486.2600,822.9400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5486.26,,,,,,,1416.0000,5486.2600,percent of total billed charges,"100% of $5,486.26 in Billed Charges for Rev 272 = $5,486.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO SYSTEM SET OTSC ANCHOR 165CM,272,RC,,,,,,,,both,,,5486.2600,822.9400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2743.13,,,,,,,1416.0000,5486.2600,percent of total billed charges,"Rev 272 $5,486.26 in Billed Charges at 50% = $2,743.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO SYSTEM SET OTSC ANCHOR 165CM,272,RC,,,,,,,,both,,,5486.2600,822.9400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1772.06,,,,,,,1416.0000,5486.2600,other,"32.3% of $5,486.26 in Billed Charges for Rev 272 = $1,772.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENDO SYSTEM SET OTSC ANCHOR 165CM,272,RC,,,,,,,,both,,,5486.2600,822.9400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1684.28,,,,,,,1416.0000,5486.2600,other,"30.7% of $5,486.26 in Billed Charges for Rev 272 = $1,684.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENDO SYSTEM SET OTSC ANCHOR 165CM,272,RC,,,,,,,,both,,,5486.2600,822.9400,UNITED HEALTHCARE,UNITED HEALTHCARE,1772.06,,,,,,,1416.0000,5486.2600,percent of total billed charges,"32.3% of $5,486.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO SYSTEM SET OTSC ANCHOR 165CM,272,RC,,,,,,,,both,,,5486.2600,822.9400,WELLCARE,WELLCARE MEDICAID,5486.26,,,,,,,1416.0000,5486.2600,percent of total billed charges,"100% of $5,486.26 in Billed Charges for Rev 272 = $5,486.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOPROSTHESIS GORE TAG THORACIC CONFORMABLE 26 X 26 X 10,278,RC,,,,,,,,both,,,156809.5200,23521.4300,AETNA,AETNA,75268.57,,,,,,,11133.4800,156809.5200,percent of total billed charges,"48% of $156,809.52 in Billed Charges for Rev 278 = $75,268.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOPROSTHESIS GORE TAG THORACIC CONFORMABLE 26 X 26 X 10,278,RC,,,,,,,,both,,,156809.5200,23521.4300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,78404.76,,,,,,,11133.4800,156809.5200,percent of total billed charges,"50% of $156,809.52 in Billed Charges for Rev 278 = $78,404.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOPROSTHESIS GORE TAG THORACIC CONFORMABLE 26 X 26 X 10,278,RC,,,,,,,,both,,,156809.5200,23521.4300,CIGNA HEALTHCARE,CIGNA HMO,65389.57,,,,,,,11133.4800,156809.5200,percent of total billed charges,"41.7% of $156,809.52 in Billed Charges for Rev 278 = $65,389.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOPROSTHESIS GORE TAG THORACIC CONFORMABLE 26 X 26 X 10,278,RC,,,,,,,,both,,,156809.5200,23521.4300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,62723.81,,,,,,,11133.4800,156809.5200,percent of total billed charges,"40% of $156,809.52 in Billed Charges for Rev 278 = $62,723.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOPROSTHESIS GORE TAG THORACIC CONFORMABLE 26 X 26 X 10,278,RC,,,,,,,,both,,,156809.5200,23521.4300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,65389.57,,,,,,,11133.4800,156809.5200,percent of total billed charges,"41.7% of $156,809.52 in Billed Charges for Rev 278 = $65,389.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOPROSTHESIS GORE TAG THORACIC CONFORMABLE 26 X 26 X 10,278,RC,,,,,,,,both,,,156809.5200,23521.4300,CIGNA HEALTHCARE,CIGNA PPO,65389.57,,,,,,,11133.4800,156809.5200,percent of total billed charges,"41.7% of $156,809.52 in Billed Charges for Rev 278 = $65,389.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOPROSTHESIS GORE TAG THORACIC CONFORMABLE 26 X 26 X 10,278,RC,,,,,,,,both,,,156809.5200,23521.4300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,141128.57,,,,,,,11133.4800,156809.5200,percent of total billed charges,"90% of $156,809.52 in Billed Charges for Rev 278 = $141,128.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOPROSTHESIS GORE TAG THORACIC CONFORMABLE 26 X 26 X 10,278,RC,,,,,,,,both,,,156809.5200,23521.4300,MEDCOST,MEDCOST VHN,74625.65,,,,,,,11133.4800,156809.5200,percent of total billed charges,"47.59% of $156,809.52 in Billed Charges for Rev 278 = $74,625.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOPROSTHESIS GORE TAG THORACIC CONFORMABLE 26 X 26 X 10,278,RC,,,,,,,,both,,,156809.5200,23521.4300,SENTARA HEALTH,SENTARA HEALTH,40472.54,,,,,,,11133.4800,156809.5200,percent of total billed charges,"25.81% of $156,809.52 in Billed Charges for Rev 278 = $40,472.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOPROSTHESIS GORE TAG THORACIC CONFORMABLE 26 X 26 X 10,278,RC,,,,,,,,both,,,156809.5200,23521.4300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",156809.52,,,,,,,11133.4800,156809.5200,percent of total billed charges,"100% of $156,809.52 in Billed Charges for Rev 278 = $156,809.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOPROSTHESIS GORE TAG THORACIC CONFORMABLE 26 X 26 X 10,278,RC,,,,,,,,both,,,156809.5200,23521.4300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,78404.76,,,,,,,11133.4800,156809.5200,percent of total billed charges,"Rev 278 $156,809.52 in Billed Charges at 50% = $78,404.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOPROSTHESIS GORE TAG THORACIC CONFORMABLE 26 X 26 X 10,278,RC,,,,,,,,both,,,156809.5200,23521.4300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,11760.71,,,,,,,11133.4800,156809.5200,percent of total billed charges,"7.5% of $156,809.52 in Billed Charges for Rev 278 = $11,760.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOPROSTHESIS GORE TAG THORACIC CONFORMABLE 26 X 26 X 10,278,RC,,,,,,,,both,,,156809.5200,23521.4300,UNITED HEALTHCARE,UHC HERITAGE SELECT,11133.48,,,,,,,11133.4800,156809.5200,percent of total billed charges,"7.1% of $156,809.52 in Billed Charges for Rev 278 = $11,133.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOPROSTHESIS GORE TAG THORACIC CONFORMABLE 26 X 26 X 10,278,RC,,,,,,,,both,,,156809.5200,23521.4300,UNITED HEALTHCARE,UNITED HEALTHCARE,11133.48,,,,,,,11133.4800,156809.5200,percent of total billed charges,"7.1% of $156,809.52 in Billed Charges for Rev 278 = $11,133.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOPROSTHESIS GORE TAG THORACIC CONFORMABLE 26 X 26 X 10,278,RC,,,,,,,,both,,,156809.5200,23521.4300,WELLCARE,WELLCARE MEDICAID,156809.52,,,,,,,11133.4800,156809.5200,percent of total billed charges,"100% of $156,809.52 in Billed Charges for Rev 278 = $156,809.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SURLOK 3 PRONG 16MM 120 2.4FR,272,RC,27200002,CDM,,,,,,both,,,1474.1300,221.1200,AETNA,AETNA,629.45,,,,,,,380.4700,1474.1300,percent of total billed charges,"42.7% of $1,474.13 in Billed Charges for Rev 272 = $629.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SURLOK 3 PRONG 16MM 120 2.4FR,272,RC,27200002,CDM,,,,,,both,,,1474.1300,221.1200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1031.89,,,,,,,380.4700,1474.1300,percent of total billed charges,"Rev 272 $1,474.13 in Billed Charges at 70% = $1,031.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SURLOK 3 PRONG 16MM 120 2.4FR,272,RC,27200002,CDM,,,,,,both,,,1474.1300,221.1200,CIGNA HEALTHCARE,CIGNA HMO,614.71,,,,,,,380.4700,1474.1300,percent of total billed charges,"41.7% of $1,474.13 in Billed Charges for Rev 272 = $614.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SURLOK 3 PRONG 16MM 120 2.4FR,272,RC,27200002,CDM,,,,,,both,,,1474.1300,221.1200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,684.00,,,,,,,380.4700,1474.1300,percent of total billed charges,"46.4% of $1,474.13 in Billed Charges for Rev 272 = $684.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SURLOK 3 PRONG 16MM 120 2.4FR,272,RC,27200002,CDM,,,,,,both,,,1474.1300,221.1200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,614.71,,,,,,,380.4700,1474.1300,percent of total billed charges,"41.7% of $1,474.13 in Billed Charges for Rev 272 = $614.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SURLOK 3 PRONG 16MM 120 2.4FR,272,RC,27200002,CDM,,,,,,both,,,1474.1300,221.1200,CIGNA HEALTHCARE,CIGNA PPO,614.71,,,,,,,380.4700,1474.1300,percent of total billed charges,"41.7% of $1,474.13 in Billed Charges for Rev 272 = $614.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SURLOK 3 PRONG 16MM 120 2.4FR,272,RC,27200002,CDM,,,,,,both,,,1474.1300,221.1200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1326.72,,,,,,,380.4700,1474.1300,percent of total billed charges,"90% of $1,474.13 in Billed Charges for Rev 272 = $1,326.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SURLOK 3 PRONG 16MM 120 2.4FR,272,RC,27200002,CDM,,,,,,both,,,1474.1300,221.1200,MEDCOST,MEDCOST VHN,701.54,,,,,,,380.4700,1474.1300,percent of total billed charges,"47.59% of $1,474.13 in Billed Charges for Rev 272 = $701.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SURLOK 3 PRONG 16MM 120 2.4FR,272,RC,27200002,CDM,,,,,,both,,,1474.1300,221.1200,SENTARA HEALTH,SENTARA HEALTH,380.47,,,,,,,380.4700,1474.1300,percent of total billed charges,"25.81% of $1,474.13 in Billed Charges for Rev 272 = $380.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SURLOK 3 PRONG 16MM 120 2.4FR,272,RC,27200002,CDM,,,,,,both,,,1474.1300,221.1200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1474.13,,,,,,,380.4700,1474.1300,percent of total billed charges,"100% of $1,474.13 in Billed Charges for Rev 272 = $1,474.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SURLOK 3 PRONG 16MM 120 2.4FR,272,RC,27200002,CDM,,,,,,both,,,1474.1300,221.1200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,737.07,,,,,,,380.4700,1474.1300,percent of total billed charges,"Rev 272 $1,474.13 in Billed Charges at 50% = $737.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SURLOK 3 PRONG 16MM 120 2.4FR,272,RC,27200002,CDM,,,,,,both,,,1474.1300,221.1200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,476.14,,,,,,,380.4700,1474.1300,other,"32.3% of $1,474.13 in Billed Charges for Rev 272 = $476.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP SURLOK 3 PRONG 16MM 120 2.4FR,272,RC,27200002,CDM,,,,,,both,,,1474.1300,221.1200,UNITED HEALTHCARE,UHC HERITAGE SELECT,452.56,,,,,,,380.4700,1474.1300,other,"30.7% of $1,474.13 in Billed Charges for Rev 272 = $452.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP SURLOK 3 PRONG 16MM 120 2.4FR,272,RC,27200002,CDM,,,,,,both,,,1474.1300,221.1200,UNITED HEALTHCARE,UNITED HEALTHCARE,476.14,,,,,,,380.4700,1474.1300,percent of total billed charges,"32.3% of $1,474.13 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SURLOK 3 PRONG 16MM 120 2.4FR,272,RC,27200002,CDM,,,,,,both,,,1474.1300,221.1200,WELLCARE,WELLCARE MEDICAID,1474.13,,,,,,,380.4700,1474.1300,percent of total billed charges,"100% of $1,474.13 in Billed Charges for Rev 272 = $1,474.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SUTURE .12,272,RC,,,,,,,,both,,,2882.5200,432.3800,AETNA,AETNA,1230.84,,,,,,,743.9800,2882.5200,percent of total billed charges,"42.7% of $2,882.52 in Billed Charges for Rev 272 = $1,230.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SUTURE .12,272,RC,,,,,,,,both,,,2882.5200,432.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2017.76,,,,,,,743.9800,2882.5200,percent of total billed charges,"Rev 272 $2,882.52 in Billed Charges at 70% = $2,017.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SUTURE .12,272,RC,,,,,,,,both,,,2882.5200,432.3800,CIGNA HEALTHCARE,CIGNA HMO,1202.01,,,,,,,743.9800,2882.5200,percent of total billed charges,"41.7% of $2,882.52 in Billed Charges for Rev 272 = $1,202.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SUTURE .12,272,RC,,,,,,,,both,,,2882.5200,432.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1337.49,,,,,,,743.9800,2882.5200,percent of total billed charges,"46.4% of $2,882.52 in Billed Charges for Rev 272 = $1,337.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SUTURE .12,272,RC,,,,,,,,both,,,2882.5200,432.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1202.01,,,,,,,743.9800,2882.5200,percent of total billed charges,"41.7% of $2,882.52 in Billed Charges for Rev 272 = $1,202.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SUTURE .12,272,RC,,,,,,,,both,,,2882.5200,432.3800,CIGNA HEALTHCARE,CIGNA PPO,1202.01,,,,,,,743.9800,2882.5200,percent of total billed charges,"41.7% of $2,882.52 in Billed Charges for Rev 272 = $1,202.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SUTURE .12,272,RC,,,,,,,,both,,,2882.5200,432.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2594.27,,,,,,,743.9800,2882.5200,percent of total billed charges,"90% of $2,882.52 in Billed Charges for Rev 272 = $2,594.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SUTURE .12,272,RC,,,,,,,,both,,,2882.5200,432.3800,MEDCOST,MEDCOST VHN,1371.79,,,,,,,743.9800,2882.5200,percent of total billed charges,"47.59% of $2,882.52 in Billed Charges for Rev 272 = $1,371.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SUTURE .12,272,RC,,,,,,,,both,,,2882.5200,432.3800,SENTARA HEALTH,SENTARA HEALTH,743.98,,,,,,,743.9800,2882.5200,percent of total billed charges,"25.81% of $2,882.52 in Billed Charges for Rev 272 = $743.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SUTURE .12,272,RC,,,,,,,,both,,,2882.5200,432.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2882.52,,,,,,,743.9800,2882.5200,percent of total billed charges,"100% of $2,882.52 in Billed Charges for Rev 272 = $2,882.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SUTURE .12,272,RC,,,,,,,,both,,,2882.5200,432.3800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1441.26,,,,,,,743.9800,2882.5200,percent of total billed charges,"Rev 272 $2,882.52 in Billed Charges at 50% = $1,441.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SUTURE .12,272,RC,,,,,,,,both,,,2882.5200,432.3800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,931.05,,,,,,,743.9800,2882.5200,other,"32.3% of $2,882.52 in Billed Charges for Rev 272 = $931.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP SUTURE .12,272,RC,,,,,,,,both,,,2882.5200,432.3800,UNITED HEALTHCARE,UHC HERITAGE SELECT,884.93,,,,,,,743.9800,2882.5200,other,"30.7% of $2,882.52 in Billed Charges for Rev 272 = $884.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP SUTURE .12,272,RC,,,,,,,,both,,,2882.5200,432.3800,UNITED HEALTHCARE,UNITED HEALTHCARE,931.05,,,,,,,743.9800,2882.5200,percent of total billed charges,"32.3% of $2,882.52 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP SUTURE .12,272,RC,,,,,,,,both,,,2882.5200,432.3800,WELLCARE,WELLCARE MEDICAID,2882.52,,,,,,,743.9800,2882.5200,percent of total billed charges,"100% of $2,882.52 in Billed Charges for Rev 272 = $2,882.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY PREMARKED,272,RC,27200002,CDM,,,,,,both,,,1364.8200,204.7200,AETNA,AETNA,582.78,,,,,,,352.2600,1364.8200,percent of total billed charges,"42.7% of $1,364.82 in Billed Charges for Rev 272 = $582.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY PREMARKED,272,RC,27200002,CDM,,,,,,both,,,1364.8200,204.7200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,955.37,,,,,,,352.2600,1364.8200,percent of total billed charges,"Rev 272 $1,364.82 in Billed Charges at 70% = $955.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY PREMARKED,272,RC,27200002,CDM,,,,,,both,,,1364.8200,204.7200,CIGNA HEALTHCARE,CIGNA HMO,569.13,,,,,,,352.2600,1364.8200,percent of total billed charges,"41.7% of $1,364.82 in Billed Charges for Rev 272 = $569.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY PREMARKED,272,RC,27200002,CDM,,,,,,both,,,1364.8200,204.7200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,633.28,,,,,,,352.2600,1364.8200,percent of total billed charges,"46.4% of $1,364.82 in Billed Charges for Rev 272 = $633.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY PREMARKED,272,RC,27200002,CDM,,,,,,both,,,1364.8200,204.7200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,569.13,,,,,,,352.2600,1364.8200,percent of total billed charges,"41.7% of $1,364.82 in Billed Charges for Rev 272 = $569.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY PREMARKED,272,RC,27200002,CDM,,,,,,both,,,1364.8200,204.7200,CIGNA HEALTHCARE,CIGNA PPO,569.13,,,,,,,352.2600,1364.8200,percent of total billed charges,"41.7% of $1,364.82 in Billed Charges for Rev 272 = $569.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY PREMARKED,272,RC,27200002,CDM,,,,,,both,,,1364.8200,204.7200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1228.34,,,,,,,352.2600,1364.8200,percent of total billed charges,"90% of $1,364.82 in Billed Charges for Rev 272 = $1,228.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY PREMARKED,272,RC,27200002,CDM,,,,,,both,,,1364.8200,204.7200,MEDCOST,MEDCOST VHN,649.52,,,,,,,352.2600,1364.8200,percent of total billed charges,"47.59% of $1,364.82 in Billed Charges for Rev 272 = $649.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY PREMARKED,272,RC,27200002,CDM,,,,,,both,,,1364.8200,204.7200,SENTARA HEALTH,SENTARA HEALTH,352.26,,,,,,,352.2600,1364.8200,percent of total billed charges,"25.81% of $1,364.82 in Billed Charges for Rev 272 = $352.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY PREMARKED,272,RC,27200002,CDM,,,,,,both,,,1364.8200,204.7200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1364.82,,,,,,,352.2600,1364.8200,percent of total billed charges,"100% of $1,364.82 in Billed Charges for Rev 272 = $1,364.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY PREMARKED,272,RC,27200002,CDM,,,,,,both,,,1364.8200,204.7200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,682.41,,,,,,,352.2600,1364.8200,percent of total billed charges,"Rev 272 $1,364.82 in Billed Charges at 50% = $682.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY PREMARKED,272,RC,27200002,CDM,,,,,,both,,,1364.8200,204.7200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,440.84,,,,,,,352.2600,1364.8200,other,"32.3% of $1,364.82 in Billed Charges for Rev 272 = $440.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEPS BIOPSY PREMARKED,272,RC,27200002,CDM,,,,,,both,,,1364.8200,204.7200,UNITED HEALTHCARE,UHC HERITAGE SELECT,419.00,,,,,,,352.2600,1364.8200,other,"30.7% of $1,364.82 in Billed Charges for Rev 272 = $419.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEPS BIOPSY PREMARKED,272,RC,27200002,CDM,,,,,,both,,,1364.8200,204.7200,UNITED HEALTHCARE,UNITED HEALTHCARE,440.84,,,,,,,352.2600,1364.8200,percent of total billed charges,"32.3% of $1,364.82 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY PREMARKED,272,RC,27200002,CDM,,,,,,both,,,1364.8200,204.7200,WELLCARE,WELLCARE MEDICAID,1364.82,,,,,,,352.2600,1364.8200,percent of total billed charges,"100% of $1,364.82 in Billed Charges for Rev 272 = $1,364.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY RADIAL JAW 4,272,RC,27200002,CDM,,,,,,both,,,1196.4200,179.4600,AETNA,AETNA,510.87,,,,,,,308.8000,1196.4200,percent of total billed charges,"42.7% of $1,196.42 in Billed Charges for Rev 272 = $510.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY RADIAL JAW 4,272,RC,27200002,CDM,,,,,,both,,,1196.4200,179.4600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,837.49,,,,,,,308.8000,1196.4200,percent of total billed charges,"Rev 272 $1,196.42 in Billed Charges at 70% = $837.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY RADIAL JAW 4,272,RC,27200002,CDM,,,,,,both,,,1196.4200,179.4600,CIGNA HEALTHCARE,CIGNA HMO,498.91,,,,,,,308.8000,1196.4200,percent of total billed charges,"41.7% of $1,196.42 in Billed Charges for Rev 272 = $498.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY RADIAL JAW 4,272,RC,27200002,CDM,,,,,,both,,,1196.4200,179.4600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,555.14,,,,,,,308.8000,1196.4200,percent of total billed charges,"46.4% of $1,196.42 in Billed Charges for Rev 272 = $555.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY RADIAL JAW 4,272,RC,27200002,CDM,,,,,,both,,,1196.4200,179.4600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,498.91,,,,,,,308.8000,1196.4200,percent of total billed charges,"41.7% of $1,196.42 in Billed Charges for Rev 272 = $498.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY RADIAL JAW 4,272,RC,27200002,CDM,,,,,,both,,,1196.4200,179.4600,CIGNA HEALTHCARE,CIGNA PPO,498.91,,,,,,,308.8000,1196.4200,percent of total billed charges,"41.7% of $1,196.42 in Billed Charges for Rev 272 = $498.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY RADIAL JAW 4,272,RC,27200002,CDM,,,,,,both,,,1196.4200,179.4600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1076.78,,,,,,,308.8000,1196.4200,percent of total billed charges,"90% of $1,196.42 in Billed Charges for Rev 272 = $1,076.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY RADIAL JAW 4,272,RC,27200002,CDM,,,,,,both,,,1196.4200,179.4600,MEDCOST,MEDCOST VHN,569.38,,,,,,,308.8000,1196.4200,percent of total billed charges,"47.59% of $1,196.42 in Billed Charges for Rev 272 = $569.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY RADIAL JAW 4,272,RC,27200002,CDM,,,,,,both,,,1196.4200,179.4600,SENTARA HEALTH,SENTARA HEALTH,308.80,,,,,,,308.8000,1196.4200,percent of total billed charges,"25.81% of $1,196.42 in Billed Charges for Rev 272 = $308.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY RADIAL JAW 4,272,RC,27200002,CDM,,,,,,both,,,1196.4200,179.4600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1196.42,,,,,,,308.8000,1196.4200,percent of total billed charges,"100% of $1,196.42 in Billed Charges for Rev 272 = $1,196.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY RADIAL JAW 4,272,RC,27200002,CDM,,,,,,both,,,1196.4200,179.4600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,598.21,,,,,,,308.8000,1196.4200,percent of total billed charges,"Rev 272 $1,196.42 in Billed Charges at 50% = $598.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY RADIAL JAW 4,272,RC,27200002,CDM,,,,,,both,,,1196.4200,179.4600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,386.44,,,,,,,308.8000,1196.4200,other,"32.3% of $1,196.42 in Billed Charges for Rev 272 = $386.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEPS BIOPSY RADIAL JAW 4,272,RC,27200002,CDM,,,,,,both,,,1196.4200,179.4600,UNITED HEALTHCARE,UHC HERITAGE SELECT,367.30,,,,,,,308.8000,1196.4200,other,"30.7% of $1,196.42 in Billed Charges for Rev 272 = $367.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEPS BIOPSY RADIAL JAW 4,272,RC,27200002,CDM,,,,,,both,,,1196.4200,179.4600,UNITED HEALTHCARE,UNITED HEALTHCARE,386.44,,,,,,,308.8000,1196.4200,percent of total billed charges,"32.3% of $1,196.42 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIOPSY RADIAL JAW 4,272,RC,27200002,CDM,,,,,,both,,,1196.4200,179.4600,WELLCARE,WELLCARE MEDICAID,1196.42,,,,,,,308.8000,1196.4200,percent of total billed charges,"100% of $1,196.42 in Billed Charges for Rev 272 = $1,196.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIGOPSY BACKLOADING BIOPSY,272,RC,,,,,,,,both,,,5476.5100,821.4800,AETNA,AETNA,2338.47,,,,,,,1413.4900,5476.5100,percent of total billed charges,"42.7% of $5,476.51 in Billed Charges for Rev 272 = $2,338.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIGOPSY BACKLOADING BIOPSY,272,RC,,,,,,,,both,,,5476.5100,821.4800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3833.56,,,,,,,1413.4900,5476.5100,percent of total billed charges,"Rev 272 $5,476.51 in Billed Charges at 70% = $3,833.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIGOPSY BACKLOADING BIOPSY,272,RC,,,,,,,,both,,,5476.5100,821.4800,CIGNA HEALTHCARE,CIGNA HMO,2283.70,,,,,,,1413.4900,5476.5100,percent of total billed charges,"41.7% of $5,476.51 in Billed Charges for Rev 272 = $2,283.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIGOPSY BACKLOADING BIOPSY,272,RC,,,,,,,,both,,,5476.5100,821.4800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2541.10,,,,,,,1413.4900,5476.5100,percent of total billed charges,"46.4% of $5,476.51 in Billed Charges for Rev 272 = $2,541.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIGOPSY BACKLOADING BIOPSY,272,RC,,,,,,,,both,,,5476.5100,821.4800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2283.70,,,,,,,1413.4900,5476.5100,percent of total billed charges,"41.7% of $5,476.51 in Billed Charges for Rev 272 = $2,283.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIGOPSY BACKLOADING BIOPSY,272,RC,,,,,,,,both,,,5476.5100,821.4800,CIGNA HEALTHCARE,CIGNA PPO,2283.70,,,,,,,1413.4900,5476.5100,percent of total billed charges,"41.7% of $5,476.51 in Billed Charges for Rev 272 = $2,283.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIGOPSY BACKLOADING BIOPSY,272,RC,,,,,,,,both,,,5476.5100,821.4800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4928.86,,,,,,,1413.4900,5476.5100,percent of total billed charges,"90% of $5,476.51 in Billed Charges for Rev 272 = $4,928.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIGOPSY BACKLOADING BIOPSY,272,RC,,,,,,,,both,,,5476.5100,821.4800,MEDCOST,MEDCOST VHN,2606.27,,,,,,,1413.4900,5476.5100,percent of total billed charges,"47.59% of $5,476.51 in Billed Charges for Rev 272 = $2,606.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIGOPSY BACKLOADING BIOPSY,272,RC,,,,,,,,both,,,5476.5100,821.4800,SENTARA HEALTH,SENTARA HEALTH,1413.49,,,,,,,1413.4900,5476.5100,percent of total billed charges,"25.81% of $5,476.51 in Billed Charges for Rev 272 = $1,413.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIGOPSY BACKLOADING BIOPSY,272,RC,,,,,,,,both,,,5476.5100,821.4800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5476.51,,,,,,,1413.4900,5476.5100,percent of total billed charges,"100% of $5,476.51 in Billed Charges for Rev 272 = $5,476.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIGOPSY BACKLOADING BIOPSY,272,RC,,,,,,,,both,,,5476.5100,821.4800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2738.26,,,,,,,1413.4900,5476.5100,percent of total billed charges,"Rev 272 $5,476.51 in Billed Charges at 50% = $2,738.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIGOPSY BACKLOADING BIOPSY,272,RC,,,,,,,,both,,,5476.5100,821.4800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1768.91,,,,,,,1413.4900,5476.5100,other,"32.3% of $5,476.51 in Billed Charges for Rev 272 = $1,768.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP BIGOPSY BACKLOADING BIOPSY,272,RC,,,,,,,,both,,,5476.5100,821.4800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1681.29,,,,,,,1413.4900,5476.5100,other,"30.7% of $5,476.51 in Billed Charges for Rev 272 = $1,681.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP BIGOPSY BACKLOADING BIOPSY,272,RC,,,,,,,,both,,,5476.5100,821.4800,UNITED HEALTHCARE,UNITED HEALTHCARE,1768.91,,,,,,,1413.4900,5476.5100,percent of total billed charges,"32.3% of $5,476.51 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIGOPSY BACKLOADING BIOPSY,272,RC,,,,,,,,both,,,5476.5100,821.4800,WELLCARE,WELLCARE MEDICAID,5476.51,,,,,,,1413.4900,5476.5100,percent of total billed charges,"100% of $5,476.51 in Billed Charges for Rev 272 = $5,476.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4635.0100,695.2500,AETNA,AETNA,1979.15,,,,,,,1196.3000,4635.0100,percent of total billed charges,"42.7% of $4,635.01 in Billed Charges for Rev 272 = $1,979.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4635.0100,695.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3244.51,,,,,,,1196.3000,4635.0100,percent of total billed charges,"Rev 272 $4,635.01 in Billed Charges at 70% = $3,244.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4635.0100,695.2500,CIGNA HEALTHCARE,CIGNA HMO,1932.80,,,,,,,1196.3000,4635.0100,percent of total billed charges,"41.7% of $4,635.01 in Billed Charges for Rev 272 = $1,932.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4635.0100,695.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2150.64,,,,,,,1196.3000,4635.0100,percent of total billed charges,"46.4% of $4,635.01 in Billed Charges for Rev 272 = $2,150.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4635.0100,695.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.80,,,,,,,1196.3000,4635.0100,percent of total billed charges,"41.7% of $4,635.01 in Billed Charges for Rev 272 = $1,932.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4635.0100,695.2500,CIGNA HEALTHCARE,CIGNA PPO,1932.80,,,,,,,1196.3000,4635.0100,percent of total billed charges,"41.7% of $4,635.01 in Billed Charges for Rev 272 = $1,932.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4635.0100,695.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4171.51,,,,,,,1196.3000,4635.0100,percent of total billed charges,"90% of $4,635.01 in Billed Charges for Rev 272 = $4,171.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4635.0100,695.2500,MEDCOST,MEDCOST VHN,2205.80,,,,,,,1196.3000,4635.0100,percent of total billed charges,"47.59% of $4,635.01 in Billed Charges for Rev 272 = $2,205.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4635.0100,695.2500,SENTARA HEALTH,SENTARA HEALTH,1196.30,,,,,,,1196.3000,4635.0100,percent of total billed charges,"25.81% of $4,635.01 in Billed Charges for Rev 272 = $1,196.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4635.0100,695.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4635.01,,,,,,,1196.3000,4635.0100,percent of total billed charges,"100% of $4,635.01 in Billed Charges for Rev 272 = $4,635.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4635.0100,695.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2317.51,,,,,,,1196.3000,4635.0100,percent of total billed charges,"Rev 272 $4,635.01 in Billed Charges at 50% = $2,317.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4635.0100,695.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1497.11,,,,,,,1196.3000,4635.0100,other,"32.3% of $4,635.01 in Billed Charges for Rev 272 = $1,497.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4635.0100,695.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1422.95,,,,,,,1196.3000,4635.0100,other,"30.7% of $4,635.01 in Billed Charges for Rev 272 = $1,422.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4635.0100,695.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1497.11,,,,,,,1196.3000,4635.0100,percent of total billed charges,"32.3% of $4,635.01 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4635.0100,695.2500,WELLCARE,WELLCARE MEDICAID,4635.01,,,,,,,1196.3000,4635.0100,percent of total billed charges,"100% of $4,635.01 in Billed Charges for Rev 272 = $4,635.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4905.6900,735.8500,AETNA,AETNA,2094.73,,,,,,,1266.1600,4905.6900,percent of total billed charges,"42.7% of $4,905.69 in Billed Charges for Rev 272 = $2,094.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4905.6900,735.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3433.98,,,,,,,1266.1600,4905.6900,percent of total billed charges,"Rev 272 $4,905.69 in Billed Charges at 70% = $3,433.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4905.6900,735.8500,CIGNA HEALTHCARE,CIGNA HMO,2045.67,,,,,,,1266.1600,4905.6900,percent of total billed charges,"41.7% of $4,905.69 in Billed Charges for Rev 272 = $2,045.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4905.6900,735.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2276.24,,,,,,,1266.1600,4905.6900,percent of total billed charges,"46.4% of $4,905.69 in Billed Charges for Rev 272 = $2,276.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4905.6900,735.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2045.67,,,,,,,1266.1600,4905.6900,percent of total billed charges,"41.7% of $4,905.69 in Billed Charges for Rev 272 = $2,045.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4905.6900,735.8500,CIGNA HEALTHCARE,CIGNA PPO,2045.67,,,,,,,1266.1600,4905.6900,percent of total billed charges,"41.7% of $4,905.69 in Billed Charges for Rev 272 = $2,045.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4905.6900,735.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4415.12,,,,,,,1266.1600,4905.6900,percent of total billed charges,"90% of $4,905.69 in Billed Charges for Rev 272 = $4,415.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4905.6900,735.8500,MEDCOST,MEDCOST VHN,2334.62,,,,,,,1266.1600,4905.6900,percent of total billed charges,"47.59% of $4,905.69 in Billed Charges for Rev 272 = $2,334.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4905.6900,735.8500,SENTARA HEALTH,SENTARA HEALTH,1266.16,,,,,,,1266.1600,4905.6900,percent of total billed charges,"25.81% of $4,905.69 in Billed Charges for Rev 272 = $1,266.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4905.6900,735.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4905.69,,,,,,,1266.1600,4905.6900,percent of total billed charges,"100% of $4,905.69 in Billed Charges for Rev 272 = $4,905.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4905.6900,735.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2452.85,,,,,,,1266.1600,4905.6900,percent of total billed charges,"Rev 272 $4,905.69 in Billed Charges at 50% = $2,452.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4905.6900,735.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1584.54,,,,,,,1266.1600,4905.6900,other,"32.3% of $4,905.69 in Billed Charges for Rev 272 = $1,584.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4905.6900,735.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1506.05,,,,,,,1266.1600,4905.6900,other,"30.7% of $4,905.69 in Billed Charges for Rev 272 = $1,506.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4905.6900,735.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,1584.54,,,,,,,1266.1600,4905.6900,percent of total billed charges,"32.3% of $4,905.69 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,4905.6900,735.8500,WELLCARE,WELLCARE MEDICAID,4905.69,,,,,,,1266.1600,4905.6900,percent of total billed charges,"100% of $4,905.69 in Billed Charges for Rev 272 = $4,905.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,6667.2000,1000.0800,AETNA,AETNA,2846.89,,,,,,,1720.8000,6667.2000,percent of total billed charges,"42.7% of $6,667.20 in Billed Charges for Rev 272 = $2,846.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,6667.2000,1000.0800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4667.04,,,,,,,1720.8000,6667.2000,percent of total billed charges,"Rev 272 $6,667.20 in Billed Charges at 70% = $4,667.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,6667.2000,1000.0800,CIGNA HEALTHCARE,CIGNA HMO,2780.22,,,,,,,1720.8000,6667.2000,percent of total billed charges,"41.7% of $6,667.20 in Billed Charges for Rev 272 = $2,780.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,6667.2000,1000.0800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3093.58,,,,,,,1720.8000,6667.2000,percent of total billed charges,"46.4% of $6,667.20 in Billed Charges for Rev 272 = $3,093.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,6667.2000,1000.0800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2780.22,,,,,,,1720.8000,6667.2000,percent of total billed charges,"41.7% of $6,667.20 in Billed Charges for Rev 272 = $2,780.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,6667.2000,1000.0800,CIGNA HEALTHCARE,CIGNA PPO,2780.22,,,,,,,1720.8000,6667.2000,percent of total billed charges,"41.7% of $6,667.20 in Billed Charges for Rev 272 = $2,780.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,6667.2000,1000.0800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6000.48,,,,,,,1720.8000,6667.2000,percent of total billed charges,"90% of $6,667.20 in Billed Charges for Rev 272 = $6,000.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,6667.2000,1000.0800,MEDCOST,MEDCOST VHN,3172.92,,,,,,,1720.8000,6667.2000,percent of total billed charges,"47.59% of $6,667.20 in Billed Charges for Rev 272 = $3,172.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,6667.2000,1000.0800,SENTARA HEALTH,SENTARA HEALTH,1720.80,,,,,,,1720.8000,6667.2000,percent of total billed charges,"25.81% of $6,667.20 in Billed Charges for Rev 272 = $1,720.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,6667.2000,1000.0800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6667.20,,,,,,,1720.8000,6667.2000,percent of total billed charges,"100% of $6,667.20 in Billed Charges for Rev 272 = $6,667.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,6667.2000,1000.0800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3333.60,,,,,,,1720.8000,6667.2000,percent of total billed charges,"Rev 272 $6,667.20 in Billed Charges at 50% = $3,333.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,6667.2000,1000.0800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2153.51,,,,,,,1720.8000,6667.2000,other,"32.3% of $6,667.20 in Billed Charges for Rev 272 = $2,153.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,6667.2000,1000.0800,UNITED HEALTHCARE,UHC HERITAGE SELECT,2046.83,,,,,,,1720.8000,6667.2000,other,"30.7% of $6,667.20 in Billed Charges for Rev 272 = $2,046.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,6667.2000,1000.0800,UNITED HEALTHCARE,UNITED HEALTHCARE,2153.51,,,,,,,1720.8000,6667.2000,percent of total billed charges,"32.3% of $6,667.20 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY PIRANNA URETEROSCOPIC 1.0CM JAW 3FR X 115CM,272,RC,27200002,CDM,,,,,,both,,,6667.2000,1000.0800,WELLCARE,WELLCARE MEDICAID,6667.20,,,,,,,1720.8000,6667.2000,percent of total billed charges,"100% of $6,667.20 in Billed Charges for Rev 272 = $6,667.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STRT BAYONETD,272,RC,27200002,CDM,,,,,,both,,,8950.1700,1342.5300,AETNA,AETNA,3821.72,,,,,,,2310.0400,8950.1700,percent of total billed charges,"42.7% of $8,950.17 in Billed Charges for Rev 272 = $3,821.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STRT BAYONETD,272,RC,27200002,CDM,,,,,,both,,,8950.1700,1342.5300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6265.12,,,,,,,2310.0400,8950.1700,percent of total billed charges,"Rev 272 $8,950.17 in Billed Charges at 70% = $6,265.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STRT BAYONETD,272,RC,27200002,CDM,,,,,,both,,,8950.1700,1342.5300,CIGNA HEALTHCARE,CIGNA HMO,3732.22,,,,,,,2310.0400,8950.1700,percent of total billed charges,"41.7% of $8,950.17 in Billed Charges for Rev 272 = $3,732.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STRT BAYONETD,272,RC,27200002,CDM,,,,,,both,,,8950.1700,1342.5300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4152.88,,,,,,,2310.0400,8950.1700,percent of total billed charges,"46.4% of $8,950.17 in Billed Charges for Rev 272 = $4,152.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STRT BAYONETD,272,RC,27200002,CDM,,,,,,both,,,8950.1700,1342.5300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3732.22,,,,,,,2310.0400,8950.1700,percent of total billed charges,"41.7% of $8,950.17 in Billed Charges for Rev 272 = $3,732.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STRT BAYONETD,272,RC,27200002,CDM,,,,,,both,,,8950.1700,1342.5300,CIGNA HEALTHCARE,CIGNA PPO,3732.22,,,,,,,2310.0400,8950.1700,percent of total billed charges,"41.7% of $8,950.17 in Billed Charges for Rev 272 = $3,732.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STRT BAYONETD,272,RC,27200002,CDM,,,,,,both,,,8950.1700,1342.5300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8055.15,,,,,,,2310.0400,8950.1700,percent of total billed charges,"90% of $8,950.17 in Billed Charges for Rev 272 = $8,055.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STRT BAYONETD,272,RC,27200002,CDM,,,,,,both,,,8950.1700,1342.5300,MEDCOST,MEDCOST VHN,4259.39,,,,,,,2310.0400,8950.1700,percent of total billed charges,"47.59% of $8,950.17 in Billed Charges for Rev 272 = $4,259.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STRT BAYONETD,272,RC,27200002,CDM,,,,,,both,,,8950.1700,1342.5300,SENTARA HEALTH,SENTARA HEALTH,2310.04,,,,,,,2310.0400,8950.1700,percent of total billed charges,"25.81% of $8,950.17 in Billed Charges for Rev 272 = $2,310.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STRT BAYONETD,272,RC,27200002,CDM,,,,,,both,,,8950.1700,1342.5300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8950.17,,,,,,,2310.0400,8950.1700,percent of total billed charges,"100% of $8,950.17 in Billed Charges for Rev 272 = $8,950.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STRT BAYONETD,272,RC,27200002,CDM,,,,,,both,,,8950.1700,1342.5300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4475.09,,,,,,,2310.0400,8950.1700,percent of total billed charges,"Rev 272 $8,950.17 in Billed Charges at 50% = $4,475.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STRT BAYONETD,272,RC,27200002,CDM,,,,,,both,,,8950.1700,1342.5300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2890.90,,,,,,,2310.0400,8950.1700,other,"32.3% of $8,950.17 in Billed Charges for Rev 272 = $2,890.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEPS BIPOLAR STRT BAYONETD,272,RC,27200002,CDM,,,,,,both,,,8950.1700,1342.5300,UNITED HEALTHCARE,UHC HERITAGE SELECT,2747.70,,,,,,,2310.0400,8950.1700,other,"30.7% of $8,950.17 in Billed Charges for Rev 272 = $2,747.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEPS BIPOLAR STRT BAYONETD,272,RC,27200002,CDM,,,,,,both,,,8950.1700,1342.5300,UNITED HEALTHCARE,UNITED HEALTHCARE,2890.90,,,,,,,2310.0400,8950.1700,percent of total billed charges,"32.3% of $8,950.17 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEPS BIPOLAR STRT BAYONETD,272,RC,27200002,CDM,,,,,,both,,,8950.1700,1342.5300,WELLCARE,WELLCARE MEDICAID,8950.17,,,,,,,2310.0400,8950.1700,percent of total billed charges,"100% of $8,950.17 in Billed Charges for Rev 272 = $8,950.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE STEALTH TRAJ NAV,272,RC,27200002,CDM,,,,,,both,,,17267.7200,2590.1600,AETNA,AETNA,7373.32,,,,,,,4456.8000,17267.7200,percent of total billed charges,"42.7% of $17,267.72 in Billed Charges for Rev 272 = $7,373.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE STEALTH TRAJ NAV,272,RC,27200002,CDM,,,,,,both,,,17267.7200,2590.1600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,12087.40,,,,,,,4456.8000,17267.7200,percent of total billed charges,"Rev 272 $17,267.72 in Billed Charges at 70% = $12,087.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE STEALTH TRAJ NAV,272,RC,27200002,CDM,,,,,,both,,,17267.7200,2590.1600,CIGNA HEALTHCARE,CIGNA HMO,7200.64,,,,,,,4456.8000,17267.7200,percent of total billed charges,"41.7% of $17,267.72 in Billed Charges for Rev 272 = $7,200.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE STEALTH TRAJ NAV,272,RC,27200002,CDM,,,,,,both,,,17267.7200,2590.1600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8012.22,,,,,,,4456.8000,17267.7200,percent of total billed charges,"46.4% of $17,267.72 in Billed Charges for Rev 272 = $8,012.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE STEALTH TRAJ NAV,272,RC,27200002,CDM,,,,,,both,,,17267.7200,2590.1600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7200.64,,,,,,,4456.8000,17267.7200,percent of total billed charges,"41.7% of $17,267.72 in Billed Charges for Rev 272 = $7,200.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE STEALTH TRAJ NAV,272,RC,27200002,CDM,,,,,,both,,,17267.7200,2590.1600,CIGNA HEALTHCARE,CIGNA PPO,7200.64,,,,,,,4456.8000,17267.7200,percent of total billed charges,"41.7% of $17,267.72 in Billed Charges for Rev 272 = $7,200.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE STEALTH TRAJ NAV,272,RC,27200002,CDM,,,,,,both,,,17267.7200,2590.1600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,15540.95,,,,,,,4456.8000,17267.7200,percent of total billed charges,"90% of $17,267.72 in Billed Charges for Rev 272 = $15,540.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE STEALTH TRAJ NAV,272,RC,27200002,CDM,,,,,,both,,,17267.7200,2590.1600,MEDCOST,MEDCOST VHN,8217.71,,,,,,,4456.8000,17267.7200,percent of total billed charges,"47.59% of $17,267.72 in Billed Charges for Rev 272 = $8,217.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE STEALTH TRAJ NAV,272,RC,27200002,CDM,,,,,,both,,,17267.7200,2590.1600,SENTARA HEALTH,SENTARA HEALTH,4456.80,,,,,,,4456.8000,17267.7200,percent of total billed charges,"25.81% of $17,267.72 in Billed Charges for Rev 272 = $4,456.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE STEALTH TRAJ NAV,272,RC,27200002,CDM,,,,,,both,,,17267.7200,2590.1600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",17267.72,,,,,,,4456.8000,17267.7200,percent of total billed charges,"100% of $17,267.72 in Billed Charges for Rev 272 = $17,267.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE STEALTH TRAJ NAV,272,RC,27200002,CDM,,,,,,both,,,17267.7200,2590.1600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8633.86,,,,,,,4456.8000,17267.7200,percent of total billed charges,"Rev 272 $17,267.72 in Billed Charges at 50% = $8,633.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE STEALTH TRAJ NAV,272,RC,27200002,CDM,,,,,,both,,,17267.7200,2590.1600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5577.47,,,,,,,4456.8000,17267.7200,other,"32.3% of $17,267.72 in Billed Charges for Rev 272 = $5,577.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE STEALTH TRAJ NAV,272,RC,27200002,CDM,,,,,,both,,,17267.7200,2590.1600,UNITED HEALTHCARE,UHC HERITAGE SELECT,5301.19,,,,,,,4456.8000,17267.7200,other,"30.7% of $17,267.72 in Billed Charges for Rev 272 = $5,301.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE STEALTH TRAJ NAV,272,RC,27200002,CDM,,,,,,both,,,17267.7200,2590.1600,UNITED HEALTHCARE,UNITED HEALTHCARE,5577.47,,,,,,,4456.8000,17267.7200,percent of total billed charges,"32.3% of $17,267.72 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE STEALTH TRAJ NAV,272,RC,27200002,CDM,,,,,,both,,,17267.7200,2590.1600,WELLCARE,WELLCARE MEDICAID,17267.72,,,,,,,4456.8000,17267.7200,percent of total billed charges,"100% of $17,267.72 in Billed Charges for Rev 272 = $17,267.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE THR DRILL 3.2MM 312.445,272,RC,,,,,,,,both,,,2179.1500,326.8700,AETNA,AETNA,930.50,,,,,,,562.4400,2179.1500,percent of total billed charges,"42.7% of $2,179.15 in Billed Charges for Rev 272 = $930.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE THR DRILL 3.2MM 312.445,272,RC,,,,,,,,both,,,2179.1500,326.8700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1525.41,,,,,,,562.4400,2179.1500,percent of total billed charges,"Rev 272 $2,179.15 in Billed Charges at 70% = $1,525.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE THR DRILL 3.2MM 312.445,272,RC,,,,,,,,both,,,2179.1500,326.8700,CIGNA HEALTHCARE,CIGNA HMO,908.71,,,,,,,562.4400,2179.1500,percent of total billed charges,"41.7% of $2,179.15 in Billed Charges for Rev 272 = $908.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE THR DRILL 3.2MM 312.445,272,RC,,,,,,,,both,,,2179.1500,326.8700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1011.13,,,,,,,562.4400,2179.1500,percent of total billed charges,"46.4% of $2,179.15 in Billed Charges for Rev 272 = $1,011.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE THR DRILL 3.2MM 312.445,272,RC,,,,,,,,both,,,2179.1500,326.8700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,908.71,,,,,,,562.4400,2179.1500,percent of total billed charges,"41.7% of $2,179.15 in Billed Charges for Rev 272 = $908.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE THR DRILL 3.2MM 312.445,272,RC,,,,,,,,both,,,2179.1500,326.8700,CIGNA HEALTHCARE,CIGNA PPO,908.71,,,,,,,562.4400,2179.1500,percent of total billed charges,"41.7% of $2,179.15 in Billed Charges for Rev 272 = $908.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE THR DRILL 3.2MM 312.445,272,RC,,,,,,,,both,,,2179.1500,326.8700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1961.24,,,,,,,562.4400,2179.1500,percent of total billed charges,"90% of $2,179.15 in Billed Charges for Rev 272 = $1,961.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE THR DRILL 3.2MM 312.445,272,RC,,,,,,,,both,,,2179.1500,326.8700,MEDCOST,MEDCOST VHN,1037.06,,,,,,,562.4400,2179.1500,percent of total billed charges,"47.59% of $2,179.15 in Billed Charges for Rev 272 = $1,037.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE THR DRILL 3.2MM 312.445,272,RC,,,,,,,,both,,,2179.1500,326.8700,SENTARA HEALTH,SENTARA HEALTH,562.44,,,,,,,562.4400,2179.1500,percent of total billed charges,"25.81% of $2,179.15 in Billed Charges for Rev 272 = $562.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE THR DRILL 3.2MM 312.445,272,RC,,,,,,,,both,,,2179.1500,326.8700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2179.15,,,,,,,562.4400,2179.1500,percent of total billed charges,"100% of $2,179.15 in Billed Charges for Rev 272 = $2,179.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE THR DRILL 3.2MM 312.445,272,RC,,,,,,,,both,,,2179.1500,326.8700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1089.58,,,,,,,562.4400,2179.1500,percent of total billed charges,"Rev 272 $2,179.15 in Billed Charges at 50% = $1,089.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE THR DRILL 3.2MM 312.445,272,RC,,,,,,,,both,,,2179.1500,326.8700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,703.87,,,,,,,562.4400,2179.1500,other,"32.3% of $2,179.15 in Billed Charges for Rev 272 = $703.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE THR DRILL 3.2MM 312.445,272,RC,,,,,,,,both,,,2179.1500,326.8700,UNITED HEALTHCARE,UHC HERITAGE SELECT,669.00,,,,,,,562.4400,2179.1500,other,"30.7% of $2,179.15 in Billed Charges for Rev 272 = $669.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE THR DRILL 3.2MM 312.445,272,RC,,,,,,,,both,,,2179.1500,326.8700,UNITED HEALTHCARE,UNITED HEALTHCARE,703.87,,,,,,,562.4400,2179.1500,percent of total billed charges,"32.3% of $2,179.15 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE THR DRILL 3.2MM 312.445,272,RC,,,,,,,,both,,,2179.1500,326.8700,WELLCARE,WELLCARE MEDICAID,2179.15,,,,,,,562.4400,2179.1500,percent of total billed charges,"100% of $2,179.15 in Billed Charges for Rev 272 = $2,179.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY SUPERTRAX,272,RC,27200002,CDM,,,,,,both,,,1240.3700,186.0600,AETNA,AETNA,529.64,,,,,,,320.1400,1240.3700,percent of total billed charges,"42.7% of $1,240.37 in Billed Charges for Rev 272 = $529.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY SUPERTRAX,272,RC,27200002,CDM,,,,,,both,,,1240.3700,186.0600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,868.26,,,,,,,320.1400,1240.3700,percent of total billed charges,"Rev 272 $1,240.37 in Billed Charges at 70% = $868.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY SUPERTRAX,272,RC,27200002,CDM,,,,,,both,,,1240.3700,186.0600,CIGNA HEALTHCARE,CIGNA HMO,517.23,,,,,,,320.1400,1240.3700,percent of total billed charges,"41.7% of $1,240.37 in Billed Charges for Rev 272 = $517.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY SUPERTRAX,272,RC,27200002,CDM,,,,,,both,,,1240.3700,186.0600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,575.53,,,,,,,320.1400,1240.3700,percent of total billed charges,"46.4% of $1,240.37 in Billed Charges for Rev 272 = $575.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY SUPERTRAX,272,RC,27200002,CDM,,,,,,both,,,1240.3700,186.0600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,517.23,,,,,,,320.1400,1240.3700,percent of total billed charges,"41.7% of $1,240.37 in Billed Charges for Rev 272 = $517.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY SUPERTRAX,272,RC,27200002,CDM,,,,,,both,,,1240.3700,186.0600,CIGNA HEALTHCARE,CIGNA PPO,517.23,,,,,,,320.1400,1240.3700,percent of total billed charges,"41.7% of $1,240.37 in Billed Charges for Rev 272 = $517.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY SUPERTRAX,272,RC,27200002,CDM,,,,,,both,,,1240.3700,186.0600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1116.33,,,,,,,320.1400,1240.3700,percent of total billed charges,"90% of $1,240.37 in Billed Charges for Rev 272 = $1,116.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY SUPERTRAX,272,RC,27200002,CDM,,,,,,both,,,1240.3700,186.0600,MEDCOST,MEDCOST VHN,590.29,,,,,,,320.1400,1240.3700,percent of total billed charges,"47.59% of $1,240.37 in Billed Charges for Rev 272 = $590.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY SUPERTRAX,272,RC,27200002,CDM,,,,,,both,,,1240.3700,186.0600,SENTARA HEALTH,SENTARA HEALTH,320.14,,,,,,,320.1400,1240.3700,percent of total billed charges,"25.81% of $1,240.37 in Billed Charges for Rev 272 = $320.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY SUPERTRAX,272,RC,27200002,CDM,,,,,,both,,,1240.3700,186.0600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1240.37,,,,,,,320.1400,1240.3700,percent of total billed charges,"100% of $1,240.37 in Billed Charges for Rev 272 = $1,240.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY SUPERTRAX,272,RC,27200002,CDM,,,,,,both,,,1240.3700,186.0600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,620.19,,,,,,,320.1400,1240.3700,percent of total billed charges,"Rev 272 $1,240.37 in Billed Charges at 50% = $620.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY SUPERTRAX,272,RC,27200002,CDM,,,,,,both,,,1240.3700,186.0600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,400.64,,,,,,,320.1400,1240.3700,other,"32.3% of $1,240.37 in Billed Charges for Rev 272 = $400.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP BIOPSY SUPERTRAX,272,RC,27200002,CDM,,,,,,both,,,1240.3700,186.0600,UNITED HEALTHCARE,UHC HERITAGE SELECT,380.79,,,,,,,320.1400,1240.3700,other,"30.7% of $1,240.37 in Billed Charges for Rev 272 = $380.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP BIOPSY SUPERTRAX,272,RC,27200002,CDM,,,,,,both,,,1240.3700,186.0600,UNITED HEALTHCARE,UNITED HEALTHCARE,400.64,,,,,,,320.1400,1240.3700,percent of total billed charges,"32.3% of $1,240.37 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY SUPERTRAX,272,RC,27200002,CDM,,,,,,both,,,1240.3700,186.0600,WELLCARE,WELLCARE MEDICAID,1240.37,,,,,,,320.1400,1240.3700,percent of total billed charges,"100% of $1,240.37 in Billed Charges for Rev 272 = $1,240.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPOLAR FENESTRATED 14 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2177.9100,326.6900,AETNA,AETNA,929.97,,,,,,,562.1200,2177.9100,percent of total billed charges,"42.7% of $2,177.91 in Billed Charges for Rev 272 = $929.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPOLAR FENESTRATED 14 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2177.9100,326.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1524.54,,,,,,,562.1200,2177.9100,percent of total billed charges,"Rev 272 $2,177.91 in Billed Charges at 70% = $1,524.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPOLAR FENESTRATED 14 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2177.9100,326.6900,CIGNA HEALTHCARE,CIGNA HMO,908.19,,,,,,,562.1200,2177.9100,percent of total billed charges,"41.7% of $2,177.91 in Billed Charges for Rev 272 = $908.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPOLAR FENESTRATED 14 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2177.9100,326.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1010.55,,,,,,,562.1200,2177.9100,percent of total billed charges,"46.4% of $2,177.91 in Billed Charges for Rev 272 = $1,010.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPOLAR FENESTRATED 14 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2177.9100,326.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,908.19,,,,,,,562.1200,2177.9100,percent of total billed charges,"41.7% of $2,177.91 in Billed Charges for Rev 272 = $908.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPOLAR FENESTRATED 14 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2177.9100,326.6900,CIGNA HEALTHCARE,CIGNA PPO,908.19,,,,,,,562.1200,2177.9100,percent of total billed charges,"41.7% of $2,177.91 in Billed Charges for Rev 272 = $908.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPOLAR FENESTRATED 14 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2177.9100,326.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1960.12,,,,,,,562.1200,2177.9100,percent of total billed charges,"90% of $2,177.91 in Billed Charges for Rev 272 = $1,960.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPOLAR FENESTRATED 14 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2177.9100,326.6900,MEDCOST,MEDCOST VHN,1036.47,,,,,,,562.1200,2177.9100,percent of total billed charges,"47.59% of $2,177.91 in Billed Charges for Rev 272 = $1,036.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPOLAR FENESTRATED 14 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2177.9100,326.6900,SENTARA HEALTH,SENTARA HEALTH,562.12,,,,,,,562.1200,2177.9100,percent of total billed charges,"25.81% of $2,177.91 in Billed Charges for Rev 272 = $562.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPOLAR FENESTRATED 14 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2177.9100,326.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2177.91,,,,,,,562.1200,2177.9100,percent of total billed charges,"100% of $2,177.91 in Billed Charges for Rev 272 = $2,177.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPOLAR FENESTRATED 14 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2177.9100,326.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1088.96,,,,,,,562.1200,2177.9100,percent of total billed charges,"Rev 272 $2,177.91 in Billed Charges at 50% = $1,088.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPOLAR FENESTRATED 14 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2177.9100,326.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,703.46,,,,,,,562.1200,2177.9100,other,"32.3% of $2,177.91 in Billed Charges for Rev 272 = $703.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP BIPOLAR FENESTRATED 14 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2177.9100,326.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,668.62,,,,,,,562.1200,2177.9100,other,"30.7% of $2,177.91 in Billed Charges for Rev 272 = $668.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP BIPOLAR FENESTRATED 14 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2177.9100,326.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,703.46,,,,,,,562.1200,2177.9100,percent of total billed charges,"32.3% of $2,177.91 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPOLAR FENESTRATED 14 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2177.9100,326.6900,WELLCARE,WELLCARE MEDICAID,2177.91,,,,,,,562.1200,2177.9100,percent of total billed charges,"100% of $2,177.91 in Billed Charges for Rev 272 = $2,177.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP CUP BIOPSY,272,RC,,,,,,,,both,,,4710.6100,706.5900,AETNA,AETNA,2011.43,,,,,,,1215.8100,4710.6100,percent of total billed charges,"42.7% of $4,710.61 in Billed Charges for Rev 272 = $2,011.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP CUP BIOPSY,272,RC,,,,,,,,both,,,4710.6100,706.5900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3297.43,,,,,,,1215.8100,4710.6100,percent of total billed charges,"Rev 272 $4,710.61 in Billed Charges at 70% = $3,297.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP CUP BIOPSY,272,RC,,,,,,,,both,,,4710.6100,706.5900,CIGNA HEALTHCARE,CIGNA HMO,1964.32,,,,,,,1215.8100,4710.6100,percent of total billed charges,"41.7% of $4,710.61 in Billed Charges for Rev 272 = $1,964.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP CUP BIOPSY,272,RC,,,,,,,,both,,,4710.6100,706.5900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2185.72,,,,,,,1215.8100,4710.6100,percent of total billed charges,"46.4% of $4,710.61 in Billed Charges for Rev 272 = $2,185.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP CUP BIOPSY,272,RC,,,,,,,,both,,,4710.6100,706.5900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1964.32,,,,,,,1215.8100,4710.6100,percent of total billed charges,"41.7% of $4,710.61 in Billed Charges for Rev 272 = $1,964.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP CUP BIOPSY,272,RC,,,,,,,,both,,,4710.6100,706.5900,CIGNA HEALTHCARE,CIGNA PPO,1964.32,,,,,,,1215.8100,4710.6100,percent of total billed charges,"41.7% of $4,710.61 in Billed Charges for Rev 272 = $1,964.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP CUP BIOPSY,272,RC,,,,,,,,both,,,4710.6100,706.5900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4239.55,,,,,,,1215.8100,4710.6100,percent of total billed charges,"90% of $4,710.61 in Billed Charges for Rev 272 = $4,239.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP CUP BIOPSY,272,RC,,,,,,,,both,,,4710.6100,706.5900,MEDCOST,MEDCOST VHN,2241.78,,,,,,,1215.8100,4710.6100,percent of total billed charges,"47.59% of $4,710.61 in Billed Charges for Rev 272 = $2,241.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP CUP BIOPSY,272,RC,,,,,,,,both,,,4710.6100,706.5900,SENTARA HEALTH,SENTARA HEALTH,1215.81,,,,,,,1215.8100,4710.6100,percent of total billed charges,"25.81% of $4,710.61 in Billed Charges for Rev 272 = $1,215.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP CUP BIOPSY,272,RC,,,,,,,,both,,,4710.6100,706.5900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4710.61,,,,,,,1215.8100,4710.6100,percent of total billed charges,"100% of $4,710.61 in Billed Charges for Rev 272 = $4,710.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP CUP BIOPSY,272,RC,,,,,,,,both,,,4710.6100,706.5900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2355.31,,,,,,,1215.8100,4710.6100,percent of total billed charges,"Rev 272 $4,710.61 in Billed Charges at 50% = $2,355.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP CUP BIOPSY,272,RC,,,,,,,,both,,,4710.6100,706.5900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1521.53,,,,,,,1215.8100,4710.6100,other,"32.3% of $4,710.61 in Billed Charges for Rev 272 = $1,521.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP CUP BIOPSY,272,RC,,,,,,,,both,,,4710.6100,706.5900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1446.16,,,,,,,1215.8100,4710.6100,other,"30.7% of $4,710.61 in Billed Charges for Rev 272 = $1,446.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP CUP BIOPSY,272,RC,,,,,,,,both,,,4710.6100,706.5900,UNITED HEALTHCARE,UNITED HEALTHCARE,1521.53,,,,,,,1215.8100,4710.6100,percent of total billed charges,"32.3% of $4,710.61 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP CUP BIOPSY,272,RC,,,,,,,,both,,,4710.6100,706.5900,WELLCARE,WELLCARE MEDICAID,4710.61,,,,,,,1215.8100,4710.6100,percent of total billed charges,"100% of $4,710.61 in Billed Charges for Rev 272 = $4,710.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE TRUMATCH TITANIUM 3D PRINTED,272,RC,27200002,CDM,,,,,,both,,,34102.8600,5115.4300,AETNA,AETNA,14561.92,,,,,,,8801.9500,34102.8600,percent of total billed charges,"42.7% of $34,102.86 in Billed Charges for Rev 272 = $14,561.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE TRUMATCH TITANIUM 3D PRINTED,272,RC,27200002,CDM,,,,,,both,,,34102.8600,5115.4300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,23872.00,,,,,,,8801.9500,34102.8600,percent of total billed charges,"Rev 272 $34,102.86 in Billed Charges at 70% = $23,872.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE TRUMATCH TITANIUM 3D PRINTED,272,RC,27200002,CDM,,,,,,both,,,34102.8600,5115.4300,CIGNA HEALTHCARE,CIGNA HMO,14220.89,,,,,,,8801.9500,34102.8600,percent of total billed charges,"41.7% of $34,102.86 in Billed Charges for Rev 272 = $14,220.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE TRUMATCH TITANIUM 3D PRINTED,272,RC,27200002,CDM,,,,,,both,,,34102.8600,5115.4300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,15823.73,,,,,,,8801.9500,34102.8600,percent of total billed charges,"46.4% of $34,102.86 in Billed Charges for Rev 272 = $15,823.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE TRUMATCH TITANIUM 3D PRINTED,272,RC,27200002,CDM,,,,,,both,,,34102.8600,5115.4300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,14220.89,,,,,,,8801.9500,34102.8600,percent of total billed charges,"41.7% of $34,102.86 in Billed Charges for Rev 272 = $14,220.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE TRUMATCH TITANIUM 3D PRINTED,272,RC,27200002,CDM,,,,,,both,,,34102.8600,5115.4300,CIGNA HEALTHCARE,CIGNA PPO,14220.89,,,,,,,8801.9500,34102.8600,percent of total billed charges,"41.7% of $34,102.86 in Billed Charges for Rev 272 = $14,220.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE TRUMATCH TITANIUM 3D PRINTED,272,RC,27200002,CDM,,,,,,both,,,34102.8600,5115.4300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,30692.57,,,,,,,8801.9500,34102.8600,percent of total billed charges,"90% of $34,102.86 in Billed Charges for Rev 272 = $30,692.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE TRUMATCH TITANIUM 3D PRINTED,272,RC,27200002,CDM,,,,,,both,,,34102.8600,5115.4300,MEDCOST,MEDCOST VHN,16229.55,,,,,,,8801.9500,34102.8600,percent of total billed charges,"47.59% of $34,102.86 in Billed Charges for Rev 272 = $16,229.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE TRUMATCH TITANIUM 3D PRINTED,272,RC,27200002,CDM,,,,,,both,,,34102.8600,5115.4300,SENTARA HEALTH,SENTARA HEALTH,8801.95,,,,,,,8801.9500,34102.8600,percent of total billed charges,"25.81% of $34,102.86 in Billed Charges for Rev 272 = $8,801.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE TRUMATCH TITANIUM 3D PRINTED,272,RC,27200002,CDM,,,,,,both,,,34102.8600,5115.4300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",34102.86,,,,,,,8801.9500,34102.8600,percent of total billed charges,"100% of $34,102.86 in Billed Charges for Rev 272 = $34,102.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE TRUMATCH TITANIUM 3D PRINTED,272,RC,27200002,CDM,,,,,,both,,,34102.8600,5115.4300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,17051.43,,,,,,,8801.9500,34102.8600,percent of total billed charges,"Rev 272 $34,102.86 in Billed Charges at 50% = $17,051.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE TRUMATCH TITANIUM 3D PRINTED,272,RC,27200002,CDM,,,,,,both,,,34102.8600,5115.4300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,11015.22,,,,,,,8801.9500,34102.8600,other,"32.3% of $34,102.86 in Billed Charges for Rev 272 = $11,015.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE TRUMATCH TITANIUM 3D PRINTED,272,RC,27200002,CDM,,,,,,both,,,34102.8600,5115.4300,UNITED HEALTHCARE,UHC HERITAGE SELECT,10469.58,,,,,,,8801.9500,34102.8600,other,"30.7% of $34,102.86 in Billed Charges for Rev 272 = $10,469.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE TRUMATCH TITANIUM 3D PRINTED,272,RC,27200002,CDM,,,,,,both,,,34102.8600,5115.4300,UNITED HEALTHCARE,UNITED HEALTHCARE,11015.22,,,,,,,8801.9500,34102.8600,percent of total billed charges,"32.3% of $34,102.86 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE TRUMATCH TITANIUM 3D PRINTED,272,RC,27200002,CDM,,,,,,both,,,34102.8600,5115.4300,WELLCARE,WELLCARE MEDICAID,34102.86,,,,,,,8801.9500,34102.8600,percent of total billed charges,"100% of $34,102.86 in Billed Charges for Rev 272 = $34,102.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDEWIRE W/TROCAR TIP 1.1MM,272,RC,27200002,CDM,,,,,,both,,,248.9000,37.3400,AETNA,AETNA,106.28,,,,,,,64.2400,248.9000,percent of total billed charges,42.7% of $248.90 in Billed Charges for Rev 272 = $106.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDEWIRE W/TROCAR TIP 1.1MM,272,RC,27200002,CDM,,,,,,both,,,248.9000,37.3400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,174.23,,,,,,,64.2400,248.9000,percent of total billed charges,Rev 272 $248.90 in Billed Charges at 70% = $174.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDEWIRE W/TROCAR TIP 1.1MM,272,RC,27200002,CDM,,,,,,both,,,248.9000,37.3400,CIGNA HEALTHCARE,CIGNA HMO,103.79,,,,,,,64.2400,248.9000,percent of total billed charges,41.7% of $248.90 in Billed Charges for Rev 272 = $103.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDEWIRE W/TROCAR TIP 1.1MM,272,RC,27200002,CDM,,,,,,both,,,248.9000,37.3400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,115.49,,,,,,,64.2400,248.9000,percent of total billed charges,46.4% of $248.90 in Billed Charges for Rev 272 = $115.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDEWIRE W/TROCAR TIP 1.1MM,272,RC,27200002,CDM,,,,,,both,,,248.9000,37.3400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,103.79,,,,,,,64.2400,248.9000,percent of total billed charges,41.7% of $248.90 in Billed Charges for Rev 272 = $103.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDEWIRE W/TROCAR TIP 1.1MM,272,RC,27200002,CDM,,,,,,both,,,248.9000,37.3400,CIGNA HEALTHCARE,CIGNA PPO,103.79,,,,,,,64.2400,248.9000,percent of total billed charges,41.7% of $248.90 in Billed Charges for Rev 272 = $103.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDEWIRE W/TROCAR TIP 1.1MM,272,RC,27200002,CDM,,,,,,both,,,248.9000,37.3400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,224.01,,,,,,,64.2400,248.9000,percent of total billed charges,90% of $248.90 in Billed Charges for Rev 272 = $224.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDEWIRE W/TROCAR TIP 1.1MM,272,RC,27200002,CDM,,,,,,both,,,248.9000,37.3400,MEDCOST,MEDCOST VHN,118.45,,,,,,,64.2400,248.9000,percent of total billed charges,47.59% of $248.90 in Billed Charges for Rev 272 = $118.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDEWIRE W/TROCAR TIP 1.1MM,272,RC,27200002,CDM,,,,,,both,,,248.9000,37.3400,SENTARA HEALTH,SENTARA HEALTH,64.24,,,,,,,64.2400,248.9000,percent of total billed charges,25.81% of $248.90 in Billed Charges for Rev 272 = $64.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDEWIRE W/TROCAR TIP 1.1MM,272,RC,27200002,CDM,,,,,,both,,,248.9000,37.3400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",248.90,,,,,,,64.2400,248.9000,percent of total billed charges,100% of $248.90 in Billed Charges for Rev 272 = $248.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDEWIRE W/TROCAR TIP 1.1MM,272,RC,27200002,CDM,,,,,,both,,,248.9000,37.3400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,124.45,,,,,,,64.2400,248.9000,percent of total billed charges,Rev 272 $248.90 in Billed Charges at 50% = $124.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDEWIRE W/TROCAR TIP 1.1MM,272,RC,27200002,CDM,,,,,,both,,,248.9000,37.3400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,80.39,,,,,,,64.2400,248.9000,other,32.3% of $248.90 in Billed Charges for Rev 272 = $80.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GUIDEWIRE W/TROCAR TIP 1.1MM,272,RC,27200002,CDM,,,,,,both,,,248.9000,37.3400,UNITED HEALTHCARE,UHC HERITAGE SELECT,76.41,,,,,,,64.2400,248.9000,other,30.7% of $248.90 in Billed Charges for Rev 272 = $76.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GUIDEWIRE W/TROCAR TIP 1.1MM,272,RC,27200002,CDM,,,,,,both,,,248.9000,37.3400,UNITED HEALTHCARE,UNITED HEALTHCARE,80.39,,,,,,,64.2400,248.9000,percent of total billed charges,32.3% of $248.90 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDEWIRE W/TROCAR TIP 1.1MM,272,RC,27200002,CDM,,,,,,both,,,248.9000,37.3400,WELLCARE,WELLCARE MEDICAID,248.90,,,,,,,64.2400,248.9000,percent of total billed charges,100% of $248.90 in Billed Charges for Rev 272 = $248.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP ELECTROSURGICAL HEM,272,RC,,,,,,,,both,,,1886.3800,282.9600,AETNA,AETNA,805.48,,,,,,,486.8700,1886.3800,percent of total billed charges,"42.7% of $1,886.38 in Billed Charges for Rev 272 = $805.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ELECTROSURGICAL HEM,272,RC,,,,,,,,both,,,1886.3800,282.9600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1320.47,,,,,,,486.8700,1886.3800,percent of total billed charges,"Rev 272 $1,886.38 in Billed Charges at 70% = $1,320.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ELECTROSURGICAL HEM,272,RC,,,,,,,,both,,,1886.3800,282.9600,CIGNA HEALTHCARE,CIGNA HMO,786.62,,,,,,,486.8700,1886.3800,percent of total billed charges,"41.7% of $1,886.38 in Billed Charges for Rev 272 = $786.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ELECTROSURGICAL HEM,272,RC,,,,,,,,both,,,1886.3800,282.9600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,875.28,,,,,,,486.8700,1886.3800,percent of total billed charges,"46.4% of $1,886.38 in Billed Charges for Rev 272 = $875.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ELECTROSURGICAL HEM,272,RC,,,,,,,,both,,,1886.3800,282.9600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,786.62,,,,,,,486.8700,1886.3800,percent of total billed charges,"41.7% of $1,886.38 in Billed Charges for Rev 272 = $786.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ELECTROSURGICAL HEM,272,RC,,,,,,,,both,,,1886.3800,282.9600,CIGNA HEALTHCARE,CIGNA PPO,786.62,,,,,,,486.8700,1886.3800,percent of total billed charges,"41.7% of $1,886.38 in Billed Charges for Rev 272 = $786.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ELECTROSURGICAL HEM,272,RC,,,,,,,,both,,,1886.3800,282.9600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1697.74,,,,,,,486.8700,1886.3800,percent of total billed charges,"90% of $1,886.38 in Billed Charges for Rev 272 = $1,697.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ELECTROSURGICAL HEM,272,RC,,,,,,,,both,,,1886.3800,282.9600,MEDCOST,MEDCOST VHN,897.73,,,,,,,486.8700,1886.3800,percent of total billed charges,"47.59% of $1,886.38 in Billed Charges for Rev 272 = $897.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ELECTROSURGICAL HEM,272,RC,,,,,,,,both,,,1886.3800,282.9600,SENTARA HEALTH,SENTARA HEALTH,486.87,,,,,,,486.8700,1886.3800,percent of total billed charges,"25.81% of $1,886.38 in Billed Charges for Rev 272 = $486.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ELECTROSURGICAL HEM,272,RC,,,,,,,,both,,,1886.3800,282.9600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1886.38,,,,,,,486.8700,1886.3800,percent of total billed charges,"100% of $1,886.38 in Billed Charges for Rev 272 = $1,886.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ELECTROSURGICAL HEM,272,RC,,,,,,,,both,,,1886.3800,282.9600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,943.19,,,,,,,486.8700,1886.3800,percent of total billed charges,"Rev 272 $1,886.38 in Billed Charges at 50% = $943.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ELECTROSURGICAL HEM,272,RC,,,,,,,,both,,,1886.3800,282.9600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,609.30,,,,,,,486.8700,1886.3800,other,"32.3% of $1,886.38 in Billed Charges for Rev 272 = $609.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP ELECTROSURGICAL HEM,272,RC,,,,,,,,both,,,1886.3800,282.9600,UNITED HEALTHCARE,UHC HERITAGE SELECT,579.12,,,,,,,486.8700,1886.3800,other,"30.7% of $1,886.38 in Billed Charges for Rev 272 = $579.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP ELECTROSURGICAL HEM,272,RC,,,,,,,,both,,,1886.3800,282.9600,UNITED HEALTHCARE,UNITED HEALTHCARE,609.30,,,,,,,486.8700,1886.3800,percent of total billed charges,"32.3% of $1,886.38 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ELECTROSURGICAL HEM,272,RC,,,,,,,,both,,,1886.3800,282.9600,WELLCARE,WELLCARE MEDICAID,1886.38,,,,,,,486.8700,1886.3800,percent of total billed charges,"100% of $1,886.38 in Billed Charges for Rev 272 = $1,886.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP FLEXCYSTO GRASP,272,RC,27200002,CDM,,,,,,both,,,686.3500,102.9500,AETNA,AETNA,293.07,,,,,,,177.1500,686.3500,percent of total billed charges,42.7% of $686.35 in Billed Charges for Rev 272 = $293.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP FLEXCYSTO GRASP,272,RC,27200002,CDM,,,,,,both,,,686.3500,102.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,480.45,,,,,,,177.1500,686.3500,percent of total billed charges,Rev 272 $686.35 in Billed Charges at 70% = $480.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP FLEXCYSTO GRASP,272,RC,27200002,CDM,,,,,,both,,,686.3500,102.9500,CIGNA HEALTHCARE,CIGNA HMO,286.21,,,,,,,177.1500,686.3500,percent of total billed charges,41.7% of $686.35 in Billed Charges for Rev 272 = $286.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP FLEXCYSTO GRASP,272,RC,27200002,CDM,,,,,,both,,,686.3500,102.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,318.47,,,,,,,177.1500,686.3500,percent of total billed charges,46.4% of $686.35 in Billed Charges for Rev 272 = $318.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP FLEXCYSTO GRASP,272,RC,27200002,CDM,,,,,,both,,,686.3500,102.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,286.21,,,,,,,177.1500,686.3500,percent of total billed charges,41.7% of $686.35 in Billed Charges for Rev 272 = $286.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP FLEXCYSTO GRASP,272,RC,27200002,CDM,,,,,,both,,,686.3500,102.9500,CIGNA HEALTHCARE,CIGNA PPO,286.21,,,,,,,177.1500,686.3500,percent of total billed charges,41.7% of $686.35 in Billed Charges for Rev 272 = $286.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP FLEXCYSTO GRASP,272,RC,27200002,CDM,,,,,,both,,,686.3500,102.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,617.72,,,,,,,177.1500,686.3500,percent of total billed charges,90% of $686.35 in Billed Charges for Rev 272 = $617.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP FLEXCYSTO GRASP,272,RC,27200002,CDM,,,,,,both,,,686.3500,102.9500,MEDCOST,MEDCOST VHN,326.63,,,,,,,177.1500,686.3500,percent of total billed charges,47.59% of $686.35 in Billed Charges for Rev 272 = $326.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP FLEXCYSTO GRASP,272,RC,27200002,CDM,,,,,,both,,,686.3500,102.9500,SENTARA HEALTH,SENTARA HEALTH,177.15,,,,,,,177.1500,686.3500,percent of total billed charges,25.81% of $686.35 in Billed Charges for Rev 272 = $177.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP FLEXCYSTO GRASP,272,RC,27200002,CDM,,,,,,both,,,686.3500,102.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",686.35,,,,,,,177.1500,686.3500,percent of total billed charges,100% of $686.35 in Billed Charges for Rev 272 = $686.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP FLEXCYSTO GRASP,272,RC,27200002,CDM,,,,,,both,,,686.3500,102.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,343.18,,,,,,,177.1500,686.3500,percent of total billed charges,Rev 272 $686.35 in Billed Charges at 50% = $343.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP FLEXCYSTO GRASP,272,RC,27200002,CDM,,,,,,both,,,686.3500,102.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,221.69,,,,,,,177.1500,686.3500,other,32.3% of $686.35 in Billed Charges for Rev 272 = $221.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
FORCEP FLEXCYSTO GRASP,272,RC,27200002,CDM,,,,,,both,,,686.3500,102.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,210.71,,,,,,,177.1500,686.3500,other,30.7% of $686.35 in Billed Charges for Rev 272 = $210.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
FORCEP FLEXCYSTO GRASP,272,RC,27200002,CDM,,,,,,both,,,686.3500,102.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,221.69,,,,,,,177.1500,686.3500,percent of total billed charges,32.3% of $686.35 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP FLEXCYSTO GRASP,272,RC,27200002,CDM,,,,,,both,,,686.3500,102.9500,WELLCARE,WELLCARE MEDICAID,686.35,,,,,,,177.1500,686.3500,percent of total billed charges,100% of $686.35 in Billed Charges for Rev 272 = $686.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP GRASPER 3 PRONG1.8X240,272,RC,27200002,CDM,,,,,,both,,,694.6300,104.1900,AETNA,AETNA,296.61,,,,,,,179.2800,694.6300,percent of total billed charges,42.7% of $694.63 in Billed Charges for Rev 272 = $296.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP GRASPER 3 PRONG1.8X240,272,RC,27200002,CDM,,,,,,both,,,694.6300,104.1900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,486.24,,,,,,,179.2800,694.6300,percent of total billed charges,Rev 272 $694.63 in Billed Charges at 70% = $486.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP GRASPER 3 PRONG1.8X240,272,RC,27200002,CDM,,,,,,both,,,694.6300,104.1900,CIGNA HEALTHCARE,CIGNA HMO,289.66,,,,,,,179.2800,694.6300,percent of total billed charges,41.7% of $694.63 in Billed Charges for Rev 272 = $289.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP GRASPER 3 PRONG1.8X240,272,RC,27200002,CDM,,,,,,both,,,694.6300,104.1900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,322.31,,,,,,,179.2800,694.6300,percent of total billed charges,46.4% of $694.63 in Billed Charges for Rev 272 = $322.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP GRASPER 3 PRONG1.8X240,272,RC,27200002,CDM,,,,,,both,,,694.6300,104.1900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,289.66,,,,,,,179.2800,694.6300,percent of total billed charges,41.7% of $694.63 in Billed Charges for Rev 272 = $289.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP GRASPER 3 PRONG1.8X240,272,RC,27200002,CDM,,,,,,both,,,694.6300,104.1900,CIGNA HEALTHCARE,CIGNA PPO,289.66,,,,,,,179.2800,694.6300,percent of total billed charges,41.7% of $694.63 in Billed Charges for Rev 272 = $289.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP GRASPER 3 PRONG1.8X240,272,RC,27200002,CDM,,,,,,both,,,694.6300,104.1900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,625.17,,,,,,,179.2800,694.6300,percent of total billed charges,90% of $694.63 in Billed Charges for Rev 272 = $625.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP GRASPER 3 PRONG1.8X240,272,RC,27200002,CDM,,,,,,both,,,694.6300,104.1900,MEDCOST,MEDCOST VHN,330.57,,,,,,,179.2800,694.6300,percent of total billed charges,47.59% of $694.63 in Billed Charges for Rev 272 = $330.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP GRASPER 3 PRONG1.8X240,272,RC,27200002,CDM,,,,,,both,,,694.6300,104.1900,SENTARA HEALTH,SENTARA HEALTH,179.28,,,,,,,179.2800,694.6300,percent of total billed charges,25.81% of $694.63 in Billed Charges for Rev 272 = $179.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP GRASPER 3 PRONG1.8X240,272,RC,27200002,CDM,,,,,,both,,,694.6300,104.1900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",694.63,,,,,,,179.2800,694.6300,percent of total billed charges,100% of $694.63 in Billed Charges for Rev 272 = $694.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP GRASPER 3 PRONG1.8X240,272,RC,27200002,CDM,,,,,,both,,,694.6300,104.1900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,347.32,,,,,,,179.2800,694.6300,percent of total billed charges,Rev 272 $694.63 in Billed Charges at 50% = $347.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP GRASPER 3 PRONG1.8X240,272,RC,27200002,CDM,,,,,,both,,,694.6300,104.1900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,224.37,,,,,,,179.2800,694.6300,other,32.3% of $694.63 in Billed Charges for Rev 272 = $224.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
FORCEP GRASPER 3 PRONG1.8X240,272,RC,27200002,CDM,,,,,,both,,,694.6300,104.1900,UNITED HEALTHCARE,UHC HERITAGE SELECT,213.25,,,,,,,179.2800,694.6300,other,30.7% of $694.63 in Billed Charges for Rev 272 = $213.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
FORCEP GRASPER 3 PRONG1.8X240,272,RC,27200002,CDM,,,,,,both,,,694.6300,104.1900,UNITED HEALTHCARE,UNITED HEALTHCARE,224.37,,,,,,,179.2800,694.6300,percent of total billed charges,32.3% of $694.63 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP GRASPER 3 PRONG1.8X240,272,RC,27200002,CDM,,,,,,both,,,694.6300,104.1900,WELLCARE,WELLCARE MEDICAID,694.63,,,,,,,179.2800,694.6300,percent of total billed charges,100% of $694.63 in Billed Charges for Rev 272 = $694.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP LYONS DISSECTING W/CORD 942005PK,272,RC,27200002,CDM,,,,,,both,,,3526.1400,528.9200,AETNA,AETNA,1505.66,,,,,,,910.1000,3526.1400,percent of total billed charges,"42.7% of $3,526.14 in Billed Charges for Rev 272 = $1,505.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LYONS DISSECTING W/CORD 942005PK,272,RC,27200002,CDM,,,,,,both,,,3526.1400,528.9200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2468.30,,,,,,,910.1000,3526.1400,percent of total billed charges,"Rev 272 $3,526.14 in Billed Charges at 70% = $2,468.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LYONS DISSECTING W/CORD 942005PK,272,RC,27200002,CDM,,,,,,both,,,3526.1400,528.9200,CIGNA HEALTHCARE,CIGNA HMO,1470.40,,,,,,,910.1000,3526.1400,percent of total billed charges,"41.7% of $3,526.14 in Billed Charges for Rev 272 = $1,470.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LYONS DISSECTING W/CORD 942005PK,272,RC,27200002,CDM,,,,,,both,,,3526.1400,528.9200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1636.13,,,,,,,910.1000,3526.1400,percent of total billed charges,"46.4% of $3,526.14 in Billed Charges for Rev 272 = $1,636.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LYONS DISSECTING W/CORD 942005PK,272,RC,27200002,CDM,,,,,,both,,,3526.1400,528.9200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1470.40,,,,,,,910.1000,3526.1400,percent of total billed charges,"41.7% of $3,526.14 in Billed Charges for Rev 272 = $1,470.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LYONS DISSECTING W/CORD 942005PK,272,RC,27200002,CDM,,,,,,both,,,3526.1400,528.9200,CIGNA HEALTHCARE,CIGNA PPO,1470.40,,,,,,,910.1000,3526.1400,percent of total billed charges,"41.7% of $3,526.14 in Billed Charges for Rev 272 = $1,470.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LYONS DISSECTING W/CORD 942005PK,272,RC,27200002,CDM,,,,,,both,,,3526.1400,528.9200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3173.53,,,,,,,910.1000,3526.1400,percent of total billed charges,"90% of $3,526.14 in Billed Charges for Rev 272 = $3,173.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LYONS DISSECTING W/CORD 942005PK,272,RC,27200002,CDM,,,,,,both,,,3526.1400,528.9200,MEDCOST,MEDCOST VHN,1678.09,,,,,,,910.1000,3526.1400,percent of total billed charges,"47.59% of $3,526.14 in Billed Charges for Rev 272 = $1,678.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LYONS DISSECTING W/CORD 942005PK,272,RC,27200002,CDM,,,,,,both,,,3526.1400,528.9200,SENTARA HEALTH,SENTARA HEALTH,910.10,,,,,,,910.1000,3526.1400,percent of total billed charges,"25.81% of $3,526.14 in Billed Charges for Rev 272 = $910.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LYONS DISSECTING W/CORD 942005PK,272,RC,27200002,CDM,,,,,,both,,,3526.1400,528.9200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3526.14,,,,,,,910.1000,3526.1400,percent of total billed charges,"100% of $3,526.14 in Billed Charges for Rev 272 = $3,526.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LYONS DISSECTING W/CORD 942005PK,272,RC,27200002,CDM,,,,,,both,,,3526.1400,528.9200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1763.07,,,,,,,910.1000,3526.1400,percent of total billed charges,"Rev 272 $3,526.14 in Billed Charges at 50% = $1,763.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LYONS DISSECTING W/CORD 942005PK,272,RC,27200002,CDM,,,,,,both,,,3526.1400,528.9200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1138.94,,,,,,,910.1000,3526.1400,other,"32.3% of $3,526.14 in Billed Charges for Rev 272 = $1,138.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP LYONS DISSECTING W/CORD 942005PK,272,RC,27200002,CDM,,,,,,both,,,3526.1400,528.9200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1082.53,,,,,,,910.1000,3526.1400,other,"30.7% of $3,526.14 in Billed Charges for Rev 272 = $1,082.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP LYONS DISSECTING W/CORD 942005PK,272,RC,27200002,CDM,,,,,,both,,,3526.1400,528.9200,UNITED HEALTHCARE,UNITED HEALTHCARE,1138.94,,,,,,,910.1000,3526.1400,percent of total billed charges,"32.3% of $3,526.14 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LYONS DISSECTING W/CORD 942005PK,272,RC,27200002,CDM,,,,,,both,,,3526.1400,528.9200,WELLCARE,WELLCARE MEDICAID,3526.14,,,,,,,910.1000,3526.1400,percent of total billed charges,"100% of $3,526.14 in Billed Charges for Rev 272 = $3,526.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IBALANCE UKA DISPOSABLE TIBIAL CUTTING LEFT,272,RC,,,,,,,,both,,,7218.2200,1082.7300,AETNA,AETNA,3082.18,,,,,,,1863.0200,7218.2200,percent of total billed charges,"42.7% of $7,218.22 in Billed Charges for Rev 272 = $3,082.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IBALANCE UKA DISPOSABLE TIBIAL CUTTING LEFT,272,RC,,,,,,,,both,,,7218.2200,1082.7300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5052.75,,,,,,,1863.0200,7218.2200,percent of total billed charges,"Rev 272 $7,218.22 in Billed Charges at 70% = $5,052.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IBALANCE UKA DISPOSABLE TIBIAL CUTTING LEFT,272,RC,,,,,,,,both,,,7218.2200,1082.7300,CIGNA HEALTHCARE,CIGNA HMO,3010.00,,,,,,,1863.0200,7218.2200,percent of total billed charges,"41.7% of $7,218.22 in Billed Charges for Rev 272 = $3,010.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IBALANCE UKA DISPOSABLE TIBIAL CUTTING LEFT,272,RC,,,,,,,,both,,,7218.2200,1082.7300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3349.25,,,,,,,1863.0200,7218.2200,percent of total billed charges,"46.4% of $7,218.22 in Billed Charges for Rev 272 = $3,349.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IBALANCE UKA DISPOSABLE TIBIAL CUTTING LEFT,272,RC,,,,,,,,both,,,7218.2200,1082.7300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3010.00,,,,,,,1863.0200,7218.2200,percent of total billed charges,"41.7% of $7,218.22 in Billed Charges for Rev 272 = $3,010.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IBALANCE UKA DISPOSABLE TIBIAL CUTTING LEFT,272,RC,,,,,,,,both,,,7218.2200,1082.7300,CIGNA HEALTHCARE,CIGNA PPO,3010.00,,,,,,,1863.0200,7218.2200,percent of total billed charges,"41.7% of $7,218.22 in Billed Charges for Rev 272 = $3,010.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IBALANCE UKA DISPOSABLE TIBIAL CUTTING LEFT,272,RC,,,,,,,,both,,,7218.2200,1082.7300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6496.40,,,,,,,1863.0200,7218.2200,percent of total billed charges,"90% of $7,218.22 in Billed Charges for Rev 272 = $6,496.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IBALANCE UKA DISPOSABLE TIBIAL CUTTING LEFT,272,RC,,,,,,,,both,,,7218.2200,1082.7300,MEDCOST,MEDCOST VHN,3435.15,,,,,,,1863.0200,7218.2200,percent of total billed charges,"47.59% of $7,218.22 in Billed Charges for Rev 272 = $3,435.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IBALANCE UKA DISPOSABLE TIBIAL CUTTING LEFT,272,RC,,,,,,,,both,,,7218.2200,1082.7300,SENTARA HEALTH,SENTARA HEALTH,1863.02,,,,,,,1863.0200,7218.2200,percent of total billed charges,"25.81% of $7,218.22 in Billed Charges for Rev 272 = $1,863.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IBALANCE UKA DISPOSABLE TIBIAL CUTTING LEFT,272,RC,,,,,,,,both,,,7218.2200,1082.7300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7218.22,,,,,,,1863.0200,7218.2200,percent of total billed charges,"100% of $7,218.22 in Billed Charges for Rev 272 = $7,218.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IBALANCE UKA DISPOSABLE TIBIAL CUTTING LEFT,272,RC,,,,,,,,both,,,7218.2200,1082.7300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3609.11,,,,,,,1863.0200,7218.2200,percent of total billed charges,"Rev 272 $7,218.22 in Billed Charges at 50% = $3,609.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IBALANCE UKA DISPOSABLE TIBIAL CUTTING LEFT,272,RC,,,,,,,,both,,,7218.2200,1082.7300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2331.49,,,,,,,1863.0200,7218.2200,other,"32.3% of $7,218.22 in Billed Charges for Rev 272 = $2,331.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE IBALANCE UKA DISPOSABLE TIBIAL CUTTING LEFT,272,RC,,,,,,,,both,,,7218.2200,1082.7300,UNITED HEALTHCARE,UHC HERITAGE SELECT,2215.99,,,,,,,1863.0200,7218.2200,other,"30.7% of $7,218.22 in Billed Charges for Rev 272 = $2,215.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE IBALANCE UKA DISPOSABLE TIBIAL CUTTING LEFT,272,RC,,,,,,,,both,,,7218.2200,1082.7300,UNITED HEALTHCARE,UNITED HEALTHCARE,2331.49,,,,,,,1863.0200,7218.2200,percent of total billed charges,"32.3% of $7,218.22 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IBALANCE UKA DISPOSABLE TIBIAL CUTTING LEFT,272,RC,,,,,,,,both,,,7218.2200,1082.7300,WELLCARE,WELLCARE MEDICAID,7218.22,,,,,,,1863.0200,7218.2200,percent of total billed charges,"100% of $7,218.22 in Billed Charges for Rev 272 = $7,218.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DRILL 6-POSITION,272,RC,,,,,,,,both,,,4067.7100,610.1600,AETNA,AETNA,1736.91,,,,,,,1049.8800,4067.7100,percent of total billed charges,"42.7% of $4,067.71 in Billed Charges for Rev 272 = $1,736.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DRILL 6-POSITION,272,RC,,,,,,,,both,,,4067.7100,610.1600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2847.40,,,,,,,1049.8800,4067.7100,percent of total billed charges,"Rev 272 $4,067.71 in Billed Charges at 70% = $2,847.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DRILL 6-POSITION,272,RC,,,,,,,,both,,,4067.7100,610.1600,CIGNA HEALTHCARE,CIGNA HMO,1696.24,,,,,,,1049.8800,4067.7100,percent of total billed charges,"41.7% of $4,067.71 in Billed Charges for Rev 272 = $1,696.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DRILL 6-POSITION,272,RC,,,,,,,,both,,,4067.7100,610.1600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1887.42,,,,,,,1049.8800,4067.7100,percent of total billed charges,"46.4% of $4,067.71 in Billed Charges for Rev 272 = $1,887.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DRILL 6-POSITION,272,RC,,,,,,,,both,,,4067.7100,610.1600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1696.24,,,,,,,1049.8800,4067.7100,percent of total billed charges,"41.7% of $4,067.71 in Billed Charges for Rev 272 = $1,696.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DRILL 6-POSITION,272,RC,,,,,,,,both,,,4067.7100,610.1600,CIGNA HEALTHCARE,CIGNA PPO,1696.24,,,,,,,1049.8800,4067.7100,percent of total billed charges,"41.7% of $4,067.71 in Billed Charges for Rev 272 = $1,696.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DRILL 6-POSITION,272,RC,,,,,,,,both,,,4067.7100,610.1600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3660.94,,,,,,,1049.8800,4067.7100,percent of total billed charges,"90% of $4,067.71 in Billed Charges for Rev 272 = $3,660.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DRILL 6-POSITION,272,RC,,,,,,,,both,,,4067.7100,610.1600,MEDCOST,MEDCOST VHN,1935.82,,,,,,,1049.8800,4067.7100,percent of total billed charges,"47.59% of $4,067.71 in Billed Charges for Rev 272 = $1,935.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DRILL 6-POSITION,272,RC,,,,,,,,both,,,4067.7100,610.1600,SENTARA HEALTH,SENTARA HEALTH,1049.88,,,,,,,1049.8800,4067.7100,percent of total billed charges,"25.81% of $4,067.71 in Billed Charges for Rev 272 = $1,049.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DRILL 6-POSITION,272,RC,,,,,,,,both,,,4067.7100,610.1600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4067.71,,,,,,,1049.8800,4067.7100,percent of total billed charges,"100% of $4,067.71 in Billed Charges for Rev 272 = $4,067.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DRILL 6-POSITION,272,RC,,,,,,,,both,,,4067.7100,610.1600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2033.86,,,,,,,1049.8800,4067.7100,percent of total billed charges,"Rev 272 $4,067.71 in Billed Charges at 50% = $2,033.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DRILL 6-POSITION,272,RC,,,,,,,,both,,,4067.7100,610.1600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1313.87,,,,,,,1049.8800,4067.7100,other,"32.3% of $4,067.71 in Billed Charges for Rev 272 = $1,313.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HANDLE DRILL 6-POSITION,272,RC,,,,,,,,both,,,4067.7100,610.1600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1248.79,,,,,,,1049.8800,4067.7100,other,"30.7% of $4,067.71 in Billed Charges for Rev 272 = $1,248.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HANDLE DRILL 6-POSITION,272,RC,,,,,,,,both,,,4067.7100,610.1600,UNITED HEALTHCARE,UNITED HEALTHCARE,1313.87,,,,,,,1049.8800,4067.7100,percent of total billed charges,"32.3% of $4,067.71 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE DRILL 6-POSITION,272,RC,,,,,,,,both,,,4067.7100,610.1600,WELLCARE,WELLCARE MEDICAID,4067.71,,,,,,,1049.8800,4067.7100,percent of total billed charges,"100% of $4,067.71 in Billed Charges for Rev 272 = $4,067.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ENDO GIA ULTRA 12MM XL SURPASS SEE LN 67225,272,RC,27200002,CDM,,,,,,both,,,6225.4100,933.8100,AETNA,AETNA,2658.25,,,,,,,1606.7800,6225.4100,percent of total billed charges,"42.7% of $6,225.41 in Billed Charges for Rev 272 = $2,658.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ENDO GIA ULTRA 12MM XL SURPASS SEE LN 67225,272,RC,27200002,CDM,,,,,,both,,,6225.4100,933.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4357.79,,,,,,,1606.7800,6225.4100,percent of total billed charges,"Rev 272 $6,225.41 in Billed Charges at 70% = $4,357.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ENDO GIA ULTRA 12MM XL SURPASS SEE LN 67225,272,RC,27200002,CDM,,,,,,both,,,6225.4100,933.8100,CIGNA HEALTHCARE,CIGNA HMO,2596.00,,,,,,,1606.7800,6225.4100,percent of total billed charges,"41.7% of $6,225.41 in Billed Charges for Rev 272 = $2,596.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ENDO GIA ULTRA 12MM XL SURPASS SEE LN 67225,272,RC,27200002,CDM,,,,,,both,,,6225.4100,933.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2888.59,,,,,,,1606.7800,6225.4100,percent of total billed charges,"46.4% of $6,225.41 in Billed Charges for Rev 272 = $2,888.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ENDO GIA ULTRA 12MM XL SURPASS SEE LN 67225,272,RC,27200002,CDM,,,,,,both,,,6225.4100,933.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2596.00,,,,,,,1606.7800,6225.4100,percent of total billed charges,"41.7% of $6,225.41 in Billed Charges for Rev 272 = $2,596.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ENDO GIA ULTRA 12MM XL SURPASS SEE LN 67225,272,RC,27200002,CDM,,,,,,both,,,6225.4100,933.8100,CIGNA HEALTHCARE,CIGNA PPO,2596.00,,,,,,,1606.7800,6225.4100,percent of total billed charges,"41.7% of $6,225.41 in Billed Charges for Rev 272 = $2,596.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ENDO GIA ULTRA 12MM XL SURPASS SEE LN 67225,272,RC,27200002,CDM,,,,,,both,,,6225.4100,933.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5602.87,,,,,,,1606.7800,6225.4100,percent of total billed charges,"90% of $6,225.41 in Billed Charges for Rev 272 = $5,602.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ENDO GIA ULTRA 12MM XL SURPASS SEE LN 67225,272,RC,27200002,CDM,,,,,,both,,,6225.4100,933.8100,MEDCOST,MEDCOST VHN,2962.67,,,,,,,1606.7800,6225.4100,percent of total billed charges,"47.59% of $6,225.41 in Billed Charges for Rev 272 = $2,962.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ENDO GIA ULTRA 12MM XL SURPASS SEE LN 67225,272,RC,27200002,CDM,,,,,,both,,,6225.4100,933.8100,SENTARA HEALTH,SENTARA HEALTH,1606.78,,,,,,,1606.7800,6225.4100,percent of total billed charges,"25.81% of $6,225.41 in Billed Charges for Rev 272 = $1,606.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ENDO GIA ULTRA 12MM XL SURPASS SEE LN 67225,272,RC,27200002,CDM,,,,,,both,,,6225.4100,933.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6225.41,,,,,,,1606.7800,6225.4100,percent of total billed charges,"100% of $6,225.41 in Billed Charges for Rev 272 = $6,225.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ENDO GIA ULTRA 12MM XL SURPASS SEE LN 67225,272,RC,27200002,CDM,,,,,,both,,,6225.4100,933.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3112.71,,,,,,,1606.7800,6225.4100,percent of total billed charges,"Rev 272 $6,225.41 in Billed Charges at 50% = $3,112.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ENDO GIA ULTRA 12MM XL SURPASS SEE LN 67225,272,RC,27200002,CDM,,,,,,both,,,6225.4100,933.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2010.81,,,,,,,1606.7800,6225.4100,other,"32.3% of $6,225.41 in Billed Charges for Rev 272 = $2,010.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HANDLE ENDO GIA ULTRA 12MM XL SURPASS SEE LN 67225,272,RC,27200002,CDM,,,,,,both,,,6225.4100,933.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1911.20,,,,,,,1606.7800,6225.4100,other,"30.7% of $6,225.41 in Billed Charges for Rev 272 = $1,911.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HANDLE ENDO GIA ULTRA 12MM XL SURPASS SEE LN 67225,272,RC,27200002,CDM,,,,,,both,,,6225.4100,933.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,2010.81,,,,,,,1606.7800,6225.4100,percent of total billed charges,"32.3% of $6,225.41 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ENDO GIA ULTRA 12MM XL SURPASS SEE LN 67225,272,RC,27200002,CDM,,,,,,both,,,6225.4100,933.8100,WELLCARE,WELLCARE MEDICAID,6225.41,,,,,,,1606.7800,6225.4100,percent of total billed charges,"100% of $6,225.41 in Billed Charges for Rev 272 = $6,225.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE SIZER,272,RC,27200002,CDM,,,,,,both,,,622.2600,93.3400,AETNA,AETNA,265.71,,,,,,,160.6100,622.2600,percent of total billed charges,42.7% of $622.26 in Billed Charges for Rev 272 = $265.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HANDLE SIZER,272,RC,27200002,CDM,,,,,,both,,,622.2600,93.3400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,435.58,,,,,,,160.6100,622.2600,percent of total billed charges,Rev 272 $622.26 in Billed Charges at 70% = $435.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HANDLE SIZER,272,RC,27200002,CDM,,,,,,both,,,622.2600,93.3400,CIGNA HEALTHCARE,CIGNA HMO,259.48,,,,,,,160.6100,622.2600,percent of total billed charges,41.7% of $622.26 in Billed Charges for Rev 272 = $259.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HANDLE SIZER,272,RC,27200002,CDM,,,,,,both,,,622.2600,93.3400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,288.73,,,,,,,160.6100,622.2600,percent of total billed charges,46.4% of $622.26 in Billed Charges for Rev 272 = $288.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HANDLE SIZER,272,RC,27200002,CDM,,,,,,both,,,622.2600,93.3400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,259.48,,,,,,,160.6100,622.2600,percent of total billed charges,41.7% of $622.26 in Billed Charges for Rev 272 = $259.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HANDLE SIZER,272,RC,27200002,CDM,,,,,,both,,,622.2600,93.3400,CIGNA HEALTHCARE,CIGNA PPO,259.48,,,,,,,160.6100,622.2600,percent of total billed charges,41.7% of $622.26 in Billed Charges for Rev 272 = $259.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HANDLE SIZER,272,RC,27200002,CDM,,,,,,both,,,622.2600,93.3400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,560.03,,,,,,,160.6100,622.2600,percent of total billed charges,90% of $622.26 in Billed Charges for Rev 272 = $560.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HANDLE SIZER,272,RC,27200002,CDM,,,,,,both,,,622.2600,93.3400,MEDCOST,MEDCOST VHN,296.13,,,,,,,160.6100,622.2600,percent of total billed charges,47.59% of $622.26 in Billed Charges for Rev 272 = $296.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HANDLE SIZER,272,RC,27200002,CDM,,,,,,both,,,622.2600,93.3400,SENTARA HEALTH,SENTARA HEALTH,160.61,,,,,,,160.6100,622.2600,percent of total billed charges,25.81% of $622.26 in Billed Charges for Rev 272 = $160.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HANDLE SIZER,272,RC,27200002,CDM,,,,,,both,,,622.2600,93.3400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",622.26,,,,,,,160.6100,622.2600,percent of total billed charges,100% of $622.26 in Billed Charges for Rev 272 = $622.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HANDLE SIZER,272,RC,27200002,CDM,,,,,,both,,,622.2600,93.3400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,311.13,,,,,,,160.6100,622.2600,percent of total billed charges,Rev 272 $622.26 in Billed Charges at 50% = $311.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HANDLE SIZER,272,RC,27200002,CDM,,,,,,both,,,622.2600,93.3400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,200.99,,,,,,,160.6100,622.2600,other,32.3% of $622.26 in Billed Charges for Rev 272 = $200.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HANDLE SIZER,272,RC,27200002,CDM,,,,,,both,,,622.2600,93.3400,UNITED HEALTHCARE,UHC HERITAGE SELECT,191.03,,,,,,,160.6100,622.2600,other,30.7% of $622.26 in Billed Charges for Rev 272 = $191.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HANDLE SIZER,272,RC,27200002,CDM,,,,,,both,,,622.2600,93.3400,UNITED HEALTHCARE,UNITED HEALTHCARE,200.99,,,,,,,160.6100,622.2600,percent of total billed charges,32.3% of $622.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HANDLE SIZER,272,RC,27200002,CDM,,,,,,both,,,622.2600,93.3400,WELLCARE,WELLCARE MEDICAID,622.26,,,,,,,160.6100,622.2600,percent of total billed charges,100% of $622.26 in Billed Charges for Rev 272 = $622.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HANDLE ZONE NAVIGATOR SYSTEM,272,RC,27200002,CDM,,,,,,both,,,3090.5600,463.5800,AETNA,AETNA,1319.67,,,,,,,797.6700,3090.5600,percent of total billed charges,"42.7% of $3,090.56 in Billed Charges for Rev 272 = $1,319.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ZONE NAVIGATOR SYSTEM,272,RC,27200002,CDM,,,,,,both,,,3090.5600,463.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2163.39,,,,,,,797.6700,3090.5600,percent of total billed charges,"Rev 272 $3,090.56 in Billed Charges at 70% = $2,163.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ZONE NAVIGATOR SYSTEM,272,RC,27200002,CDM,,,,,,both,,,3090.5600,463.5800,CIGNA HEALTHCARE,CIGNA HMO,1288.76,,,,,,,797.6700,3090.5600,percent of total billed charges,"41.7% of $3,090.56 in Billed Charges for Rev 272 = $1,288.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ZONE NAVIGATOR SYSTEM,272,RC,27200002,CDM,,,,,,both,,,3090.5600,463.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1434.02,,,,,,,797.6700,3090.5600,percent of total billed charges,"46.4% of $3,090.56 in Billed Charges for Rev 272 = $1,434.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ZONE NAVIGATOR SYSTEM,272,RC,27200002,CDM,,,,,,both,,,3090.5600,463.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1288.76,,,,,,,797.6700,3090.5600,percent of total billed charges,"41.7% of $3,090.56 in Billed Charges for Rev 272 = $1,288.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ZONE NAVIGATOR SYSTEM,272,RC,27200002,CDM,,,,,,both,,,3090.5600,463.5800,CIGNA HEALTHCARE,CIGNA PPO,1288.76,,,,,,,797.6700,3090.5600,percent of total billed charges,"41.7% of $3,090.56 in Billed Charges for Rev 272 = $1,288.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ZONE NAVIGATOR SYSTEM,272,RC,27200002,CDM,,,,,,both,,,3090.5600,463.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2781.50,,,,,,,797.6700,3090.5600,percent of total billed charges,"90% of $3,090.56 in Billed Charges for Rev 272 = $2,781.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ZONE NAVIGATOR SYSTEM,272,RC,27200002,CDM,,,,,,both,,,3090.5600,463.5800,MEDCOST,MEDCOST VHN,1470.80,,,,,,,797.6700,3090.5600,percent of total billed charges,"47.59% of $3,090.56 in Billed Charges for Rev 272 = $1,470.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ZONE NAVIGATOR SYSTEM,272,RC,27200002,CDM,,,,,,both,,,3090.5600,463.5800,SENTARA HEALTH,SENTARA HEALTH,797.67,,,,,,,797.6700,3090.5600,percent of total billed charges,"25.81% of $3,090.56 in Billed Charges for Rev 272 = $797.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ZONE NAVIGATOR SYSTEM,272,RC,27200002,CDM,,,,,,both,,,3090.5600,463.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3090.56,,,,,,,797.6700,3090.5600,percent of total billed charges,"100% of $3,090.56 in Billed Charges for Rev 272 = $3,090.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ZONE NAVIGATOR SYSTEM,272,RC,27200002,CDM,,,,,,both,,,3090.5600,463.5800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1545.28,,,,,,,797.6700,3090.5600,percent of total billed charges,"Rev 272 $3,090.56 in Billed Charges at 50% = $1,545.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ZONE NAVIGATOR SYSTEM,272,RC,27200002,CDM,,,,,,both,,,3090.5600,463.5800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,998.25,,,,,,,797.6700,3090.5600,other,"32.3% of $3,090.56 in Billed Charges for Rev 272 = $998.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HANDLE ZONE NAVIGATOR SYSTEM,272,RC,27200002,CDM,,,,,,both,,,3090.5600,463.5800,UNITED HEALTHCARE,UHC HERITAGE SELECT,948.80,,,,,,,797.6700,3090.5600,other,"30.7% of $3,090.56 in Billed Charges for Rev 272 = $948.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HANDLE ZONE NAVIGATOR SYSTEM,272,RC,27200002,CDM,,,,,,both,,,3090.5600,463.5800,UNITED HEALTHCARE,UNITED HEALTHCARE,998.25,,,,,,,797.6700,3090.5600,percent of total billed charges,"32.3% of $3,090.56 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HANDLE ZONE NAVIGATOR SYSTEM,272,RC,27200002,CDM,,,,,,both,,,3090.5600,463.5800,WELLCARE,WELLCARE MEDICAID,3090.56,,,,,,,797.6700,3090.5600,percent of total billed charges,"100% of $3,090.56 in Billed Charges for Rev 272 = $3,090.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING RECON IPS,272,RC,27200002,CDM,,,,,,both,,,21478.3400,3221.7500,AETNA,AETNA,9171.25,,,,,,,5543.5600,21478.3400,percent of total billed charges,"42.7% of $21,478.34 in Billed Charges for Rev 272 = $9,171.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING RECON IPS,272,RC,27200002,CDM,,,,,,both,,,21478.3400,3221.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,15034.84,,,,,,,5543.5600,21478.3400,percent of total billed charges,"Rev 272 $21,478.34 in Billed Charges at 70% = $15,034.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING RECON IPS,272,RC,27200002,CDM,,,,,,both,,,21478.3400,3221.7500,CIGNA HEALTHCARE,CIGNA HMO,8956.47,,,,,,,5543.5600,21478.3400,percent of total billed charges,"41.7% of $21,478.34 in Billed Charges for Rev 272 = $8,956.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING RECON IPS,272,RC,27200002,CDM,,,,,,both,,,21478.3400,3221.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,9965.95,,,,,,,5543.5600,21478.3400,percent of total billed charges,"46.4% of $21,478.34 in Billed Charges for Rev 272 = $9,965.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING RECON IPS,272,RC,27200002,CDM,,,,,,both,,,21478.3400,3221.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8956.47,,,,,,,5543.5600,21478.3400,percent of total billed charges,"41.7% of $21,478.34 in Billed Charges for Rev 272 = $8,956.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING RECON IPS,272,RC,27200002,CDM,,,,,,both,,,21478.3400,3221.7500,CIGNA HEALTHCARE,CIGNA PPO,8956.47,,,,,,,5543.5600,21478.3400,percent of total billed charges,"41.7% of $21,478.34 in Billed Charges for Rev 272 = $8,956.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING RECON IPS,272,RC,27200002,CDM,,,,,,both,,,21478.3400,3221.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,19330.51,,,,,,,5543.5600,21478.3400,percent of total billed charges,"90% of $21,478.34 in Billed Charges for Rev 272 = $19,330.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING RECON IPS,272,RC,27200002,CDM,,,,,,both,,,21478.3400,3221.7500,MEDCOST,MEDCOST VHN,10221.54,,,,,,,5543.5600,21478.3400,percent of total billed charges,"47.59% of $21,478.34 in Billed Charges for Rev 272 = $10,221.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING RECON IPS,272,RC,27200002,CDM,,,,,,both,,,21478.3400,3221.7500,SENTARA HEALTH,SENTARA HEALTH,5543.56,,,,,,,5543.5600,21478.3400,percent of total billed charges,"25.81% of $21,478.34 in Billed Charges for Rev 272 = $5,543.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING RECON IPS,272,RC,27200002,CDM,,,,,,both,,,21478.3400,3221.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",21478.34,,,,,,,5543.5600,21478.3400,percent of total billed charges,"100% of $21,478.34 in Billed Charges for Rev 272 = $21,478.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING RECON IPS,272,RC,27200002,CDM,,,,,,both,,,21478.3400,3221.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,10739.17,,,,,,,5543.5600,21478.3400,percent of total billed charges,"Rev 272 $21,478.34 in Billed Charges at 50% = $10,739.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING RECON IPS,272,RC,27200002,CDM,,,,,,both,,,21478.3400,3221.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,6937.50,,,,,,,5543.5600,21478.3400,other,"32.3% of $21,478.34 in Billed Charges for Rev 272 = $6,937.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE MARKING RECON IPS,272,RC,27200002,CDM,,,,,,both,,,21478.3400,3221.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,6593.85,,,,,,,5543.5600,21478.3400,other,"30.7% of $21,478.34 in Billed Charges for Rev 272 = $6,593.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE MARKING RECON IPS,272,RC,27200002,CDM,,,,,,both,,,21478.3400,3221.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,6937.50,,,,,,,5543.5600,21478.3400,percent of total billed charges,"32.3% of $21,478.34 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING RECON IPS,272,RC,27200002,CDM,,,,,,both,,,21478.3400,3221.7500,WELLCARE,WELLCARE MEDICAID,21478.34,,,,,,,5543.5600,21478.3400,percent of total billed charges,"100% of $21,478.34 in Billed Charges for Rev 272 = $21,478.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING WITH PLANNING CRANIAL PRIMARY,272,RC,27200002,CDM,,,,,,both,,,62920.8600,9438.1300,AETNA,AETNA,26867.21,,,,,,,16239.8700,62920.8600,percent of total billed charges,"42.7% of $62,920.86 in Billed Charges for Rev 272 = $26,867.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING WITH PLANNING CRANIAL PRIMARY,272,RC,27200002,CDM,,,,,,both,,,62920.8600,9438.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,44044.60,,,,,,,16239.8700,62920.8600,percent of total billed charges,"Rev 272 $62,920.86 in Billed Charges at 70% = $44,044.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING WITH PLANNING CRANIAL PRIMARY,272,RC,27200002,CDM,,,,,,both,,,62920.8600,9438.1300,CIGNA HEALTHCARE,CIGNA HMO,26238.00,,,,,,,16239.8700,62920.8600,percent of total billed charges,"41.7% of $62,920.86 in Billed Charges for Rev 272 = $26,238.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING WITH PLANNING CRANIAL PRIMARY,272,RC,27200002,CDM,,,,,,both,,,62920.8600,9438.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,29195.28,,,,,,,16239.8700,62920.8600,percent of total billed charges,"46.4% of $62,920.86 in Billed Charges for Rev 272 = $29,195.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING WITH PLANNING CRANIAL PRIMARY,272,RC,27200002,CDM,,,,,,both,,,62920.8600,9438.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,26238.00,,,,,,,16239.8700,62920.8600,percent of total billed charges,"41.7% of $62,920.86 in Billed Charges for Rev 272 = $26,238.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING WITH PLANNING CRANIAL PRIMARY,272,RC,27200002,CDM,,,,,,both,,,62920.8600,9438.1300,CIGNA HEALTHCARE,CIGNA PPO,26238.00,,,,,,,16239.8700,62920.8600,percent of total billed charges,"41.7% of $62,920.86 in Billed Charges for Rev 272 = $26,238.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING WITH PLANNING CRANIAL PRIMARY,272,RC,27200002,CDM,,,,,,both,,,62920.8600,9438.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,56628.77,,,,,,,16239.8700,62920.8600,percent of total billed charges,"90% of $62,920.86 in Billed Charges for Rev 272 = $56,628.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING WITH PLANNING CRANIAL PRIMARY,272,RC,27200002,CDM,,,,,,both,,,62920.8600,9438.1300,MEDCOST,MEDCOST VHN,29944.04,,,,,,,16239.8700,62920.8600,percent of total billed charges,"47.59% of $62,920.86 in Billed Charges for Rev 272 = $29,944.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING WITH PLANNING CRANIAL PRIMARY,272,RC,27200002,CDM,,,,,,both,,,62920.8600,9438.1300,SENTARA HEALTH,SENTARA HEALTH,16239.87,,,,,,,16239.8700,62920.8600,percent of total billed charges,"25.81% of $62,920.86 in Billed Charges for Rev 272 = $16,239.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING WITH PLANNING CRANIAL PRIMARY,272,RC,27200002,CDM,,,,,,both,,,62920.8600,9438.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",62920.86,,,,,,,16239.8700,62920.8600,percent of total billed charges,"100% of $62,920.86 in Billed Charges for Rev 272 = $62,920.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING WITH PLANNING CRANIAL PRIMARY,272,RC,27200002,CDM,,,,,,both,,,62920.8600,9438.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,31460.43,,,,,,,16239.8700,62920.8600,percent of total billed charges,"Rev 272 $62,920.86 in Billed Charges at 50% = $31,460.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING WITH PLANNING CRANIAL PRIMARY,272,RC,27200002,CDM,,,,,,both,,,62920.8600,9438.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,20323.44,,,,,,,16239.8700,62920.8600,other,"32.3% of $62,920.86 in Billed Charges for Rev 272 = $20,323.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE MARKING WITH PLANNING CRANIAL PRIMARY,272,RC,27200002,CDM,,,,,,both,,,62920.8600,9438.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,19316.70,,,,,,,16239.8700,62920.8600,other,"30.7% of $62,920.86 in Billed Charges for Rev 272 = $19,316.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE MARKING WITH PLANNING CRANIAL PRIMARY,272,RC,27200002,CDM,,,,,,both,,,62920.8600,9438.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,20323.44,,,,,,,16239.8700,62920.8600,percent of total billed charges,"32.3% of $62,920.86 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE MARKING WITH PLANNING CRANIAL PRIMARY,272,RC,27200002,CDM,,,,,,both,,,62920.8600,9438.1300,WELLCARE,WELLCARE MEDICAID,62920.86,,,,,,,16239.8700,62920.8600,percent of total billed charges,"100% of $62,920.86 in Billed Charges for Rev 272 = $62,920.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN,272,RC,27200002,CDM,,,,,,both,,,504.0300,75.6000,AETNA,AETNA,215.22,,,,,,,130.0900,504.0300,percent of total billed charges,42.7% of $504.03 in Billed Charges for Rev 272 = $215.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN,272,RC,27200002,CDM,,,,,,both,,,504.0300,75.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,352.82,,,,,,,130.0900,504.0300,percent of total billed charges,Rev 272 $504.03 in Billed Charges at 70% = $352.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN,272,RC,27200002,CDM,,,,,,both,,,504.0300,75.6000,CIGNA HEALTHCARE,CIGNA HMO,210.18,,,,,,,130.0900,504.0300,percent of total billed charges,41.7% of $504.03 in Billed Charges for Rev 272 = $210.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN,272,RC,27200002,CDM,,,,,,both,,,504.0300,75.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,233.87,,,,,,,130.0900,504.0300,percent of total billed charges,46.4% of $504.03 in Billed Charges for Rev 272 = $233.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN,272,RC,27200002,CDM,,,,,,both,,,504.0300,75.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,210.18,,,,,,,130.0900,504.0300,percent of total billed charges,41.7% of $504.03 in Billed Charges for Rev 272 = $210.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN,272,RC,27200002,CDM,,,,,,both,,,504.0300,75.6000,CIGNA HEALTHCARE,CIGNA PPO,210.18,,,,,,,130.0900,504.0300,percent of total billed charges,41.7% of $504.03 in Billed Charges for Rev 272 = $210.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN,272,RC,27200002,CDM,,,,,,both,,,504.0300,75.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,453.63,,,,,,,130.0900,504.0300,percent of total billed charges,90% of $504.03 in Billed Charges for Rev 272 = $453.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN,272,RC,27200002,CDM,,,,,,both,,,504.0300,75.6000,MEDCOST,MEDCOST VHN,239.87,,,,,,,130.0900,504.0300,percent of total billed charges,47.59% of $504.03 in Billed Charges for Rev 272 = $239.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN,272,RC,27200002,CDM,,,,,,both,,,504.0300,75.6000,SENTARA HEALTH,SENTARA HEALTH,130.09,,,,,,,130.0900,504.0300,percent of total billed charges,25.81% of $504.03 in Billed Charges for Rev 272 = $130.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN,272,RC,27200002,CDM,,,,,,both,,,504.0300,75.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",504.03,,,,,,,130.0900,504.0300,percent of total billed charges,100% of $504.03 in Billed Charges for Rev 272 = $504.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN,272,RC,27200002,CDM,,,,,,both,,,504.0300,75.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,252.02,,,,,,,130.0900,504.0300,percent of total billed charges,Rev 272 $504.03 in Billed Charges at 50% = $252.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN,272,RC,27200002,CDM,,,,,,both,,,504.0300,75.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,162.80,,,,,,,130.0900,504.0300,other,32.3% of $504.03 in Billed Charges for Rev 272 = $162.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GUIDE PIN,272,RC,27200002,CDM,,,,,,both,,,504.0300,75.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,154.74,,,,,,,130.0900,504.0300,other,30.7% of $504.03 in Billed Charges for Rev 272 = $154.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GUIDE PIN,272,RC,27200002,CDM,,,,,,both,,,504.0300,75.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,162.80,,,,,,,130.0900,504.0300,percent of total billed charges,32.3% of $504.03 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN,272,RC,27200002,CDM,,,,,,both,,,504.0300,75.6000,WELLCARE,WELLCARE MEDICAID,504.03,,,,,,,130.0900,504.0300,percent of total billed charges,100% of $504.03 in Billed Charges for Rev 272 = $504.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 1.25MM,272,RC,,,,,,,,both,,,220.2800,33.0400,AETNA,AETNA,94.06,,,,,,,56.8500,220.2800,percent of total billed charges,42.7% of $220.28 in Billed Charges for Rev 272 = $94.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 1.25MM,272,RC,,,,,,,,both,,,220.2800,33.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,154.20,,,,,,,56.8500,220.2800,percent of total billed charges,Rev 272 $220.28 in Billed Charges at 70% = $154.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 1.25MM,272,RC,,,,,,,,both,,,220.2800,33.0400,CIGNA HEALTHCARE,CIGNA HMO,91.86,,,,,,,56.8500,220.2800,percent of total billed charges,41.7% of $220.28 in Billed Charges for Rev 272 = $91.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 1.25MM,272,RC,,,,,,,,both,,,220.2800,33.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,102.21,,,,,,,56.8500,220.2800,percent of total billed charges,46.4% of $220.28 in Billed Charges for Rev 272 = $102.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 1.25MM,272,RC,,,,,,,,both,,,220.2800,33.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,91.86,,,,,,,56.8500,220.2800,percent of total billed charges,41.7% of $220.28 in Billed Charges for Rev 272 = $91.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 1.25MM,272,RC,,,,,,,,both,,,220.2800,33.0400,CIGNA HEALTHCARE,CIGNA PPO,91.86,,,,,,,56.8500,220.2800,percent of total billed charges,41.7% of $220.28 in Billed Charges for Rev 272 = $91.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 1.25MM,272,RC,,,,,,,,both,,,220.2800,33.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,198.25,,,,,,,56.8500,220.2800,percent of total billed charges,90% of $220.28 in Billed Charges for Rev 272 = $198.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 1.25MM,272,RC,,,,,,,,both,,,220.2800,33.0400,MEDCOST,MEDCOST VHN,104.83,,,,,,,56.8500,220.2800,percent of total billed charges,47.59% of $220.28 in Billed Charges for Rev 272 = $104.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 1.25MM,272,RC,,,,,,,,both,,,220.2800,33.0400,SENTARA HEALTH,SENTARA HEALTH,56.85,,,,,,,56.8500,220.2800,percent of total billed charges,25.81% of $220.28 in Billed Charges for Rev 272 = $56.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 1.25MM,272,RC,,,,,,,,both,,,220.2800,33.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",220.28,,,,,,,56.8500,220.2800,percent of total billed charges,100% of $220.28 in Billed Charges for Rev 272 = $220.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 1.25MM,272,RC,,,,,,,,both,,,220.2800,33.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,110.14,,,,,,,56.8500,220.2800,percent of total billed charges,Rev 272 $220.28 in Billed Charges at 50% = $110.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 1.25MM,272,RC,,,,,,,,both,,,220.2800,33.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,71.15,,,,,,,56.8500,220.2800,other,32.3% of $220.28 in Billed Charges for Rev 272 = $71.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GUIDE PIN 1.25MM,272,RC,,,,,,,,both,,,220.2800,33.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,67.63,,,,,,,56.8500,220.2800,other,30.7% of $220.28 in Billed Charges for Rev 272 = $67.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GUIDE PIN 1.25MM,272,RC,,,,,,,,both,,,220.2800,33.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,71.15,,,,,,,56.8500,220.2800,percent of total billed charges,32.3% of $220.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 1.25MM,272,RC,,,,,,,,both,,,220.2800,33.0400,WELLCARE,WELLCARE MEDICAID,220.28,,,,,,,56.8500,220.2800,percent of total billed charges,100% of $220.28 in Billed Charges for Rev 272 = $220.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA FEMORAL VENOUS 18FR (CVOR),272,RC,,,,,,,,both,,,3159.7300,473.9600,AETNA,AETNA,1349.20,,,,,,,815.5300,3159.7300,percent of total billed charges,"42.7% of $3,159.73 in Billed Charges for Rev 272 = $1,349.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 18FR (CVOR),272,RC,,,,,,,,both,,,3159.7300,473.9600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2211.81,,,,,,,815.5300,3159.7300,percent of total billed charges,"Rev 272 $3,159.73 in Billed Charges at 70% = $2,211.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 18FR (CVOR),272,RC,,,,,,,,both,,,3159.7300,473.9600,CIGNA HEALTHCARE,CIGNA HMO,1317.61,,,,,,,815.5300,3159.7300,percent of total billed charges,"41.7% of $3,159.73 in Billed Charges for Rev 272 = $1,317.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 18FR (CVOR),272,RC,,,,,,,,both,,,3159.7300,473.9600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1466.11,,,,,,,815.5300,3159.7300,percent of total billed charges,"46.4% of $3,159.73 in Billed Charges for Rev 272 = $1,466.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 18FR (CVOR),272,RC,,,,,,,,both,,,3159.7300,473.9600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1317.61,,,,,,,815.5300,3159.7300,percent of total billed charges,"41.7% of $3,159.73 in Billed Charges for Rev 272 = $1,317.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 18FR (CVOR),272,RC,,,,,,,,both,,,3159.7300,473.9600,CIGNA HEALTHCARE,CIGNA PPO,1317.61,,,,,,,815.5300,3159.7300,percent of total billed charges,"41.7% of $3,159.73 in Billed Charges for Rev 272 = $1,317.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 18FR (CVOR),272,RC,,,,,,,,both,,,3159.7300,473.9600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2843.76,,,,,,,815.5300,3159.7300,percent of total billed charges,"90% of $3,159.73 in Billed Charges for Rev 272 = $2,843.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 18FR (CVOR),272,RC,,,,,,,,both,,,3159.7300,473.9600,MEDCOST,MEDCOST VHN,1503.72,,,,,,,815.5300,3159.7300,percent of total billed charges,"47.59% of $3,159.73 in Billed Charges for Rev 272 = $1,503.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 18FR (CVOR),272,RC,,,,,,,,both,,,3159.7300,473.9600,SENTARA HEALTH,SENTARA HEALTH,815.53,,,,,,,815.5300,3159.7300,percent of total billed charges,"25.81% of $3,159.73 in Billed Charges for Rev 272 = $815.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 18FR (CVOR),272,RC,,,,,,,,both,,,3159.7300,473.9600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3159.73,,,,,,,815.5300,3159.7300,percent of total billed charges,"100% of $3,159.73 in Billed Charges for Rev 272 = $3,159.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 18FR (CVOR),272,RC,,,,,,,,both,,,3159.7300,473.9600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1579.87,,,,,,,815.5300,3159.7300,percent of total billed charges,"Rev 272 $3,159.73 in Billed Charges at 50% = $1,579.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 18FR (CVOR),272,RC,,,,,,,,both,,,3159.7300,473.9600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1020.59,,,,,,,815.5300,3159.7300,other,"32.3% of $3,159.73 in Billed Charges for Rev 272 = $1,020.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA FEMORAL VENOUS 18FR (CVOR),272,RC,,,,,,,,both,,,3159.7300,473.9600,UNITED HEALTHCARE,UHC HERITAGE SELECT,970.04,,,,,,,815.5300,3159.7300,other,"30.7% of $3,159.73 in Billed Charges for Rev 272 = $970.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA FEMORAL VENOUS 18FR (CVOR),272,RC,,,,,,,,both,,,3159.7300,473.9600,UNITED HEALTHCARE,UNITED HEALTHCARE,1020.59,,,,,,,815.5300,3159.7300,percent of total billed charges,"32.3% of $3,159.73 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 18FR (CVOR),272,RC,,,,,,,,both,,,3159.7300,473.9600,WELLCARE,WELLCARE MEDICAID,3159.73,,,,,,,815.5300,3159.7300,percent of total billed charges,"100% of $3,159.73 in Billed Charges for Rev 272 = $3,159.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 25FR,272,RC,,,,,,,,both,,,3696.2200,554.4300,AETNA,AETNA,1578.29,,,,,,,953.9900,3696.2200,percent of total billed charges,"42.7% of $3,696.22 in Billed Charges for Rev 272 = $1,578.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 25FR,272,RC,,,,,,,,both,,,3696.2200,554.4300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2587.35,,,,,,,953.9900,3696.2200,percent of total billed charges,"Rev 272 $3,696.22 in Billed Charges at 70% = $2,587.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 25FR,272,RC,,,,,,,,both,,,3696.2200,554.4300,CIGNA HEALTHCARE,CIGNA HMO,1541.32,,,,,,,953.9900,3696.2200,percent of total billed charges,"41.7% of $3,696.22 in Billed Charges for Rev 272 = $1,541.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 25FR,272,RC,,,,,,,,both,,,3696.2200,554.4300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1715.05,,,,,,,953.9900,3696.2200,percent of total billed charges,"46.4% of $3,696.22 in Billed Charges for Rev 272 = $1,715.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 25FR,272,RC,,,,,,,,both,,,3696.2200,554.4300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1541.32,,,,,,,953.9900,3696.2200,percent of total billed charges,"41.7% of $3,696.22 in Billed Charges for Rev 272 = $1,541.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 25FR,272,RC,,,,,,,,both,,,3696.2200,554.4300,CIGNA HEALTHCARE,CIGNA PPO,1541.32,,,,,,,953.9900,3696.2200,percent of total billed charges,"41.7% of $3,696.22 in Billed Charges for Rev 272 = $1,541.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 25FR,272,RC,,,,,,,,both,,,3696.2200,554.4300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3326.60,,,,,,,953.9900,3696.2200,percent of total billed charges,"90% of $3,696.22 in Billed Charges for Rev 272 = $3,326.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 25FR,272,RC,,,,,,,,both,,,3696.2200,554.4300,MEDCOST,MEDCOST VHN,1759.03,,,,,,,953.9900,3696.2200,percent of total billed charges,"47.59% of $3,696.22 in Billed Charges for Rev 272 = $1,759.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 25FR,272,RC,,,,,,,,both,,,3696.2200,554.4300,SENTARA HEALTH,SENTARA HEALTH,953.99,,,,,,,953.9900,3696.2200,percent of total billed charges,"25.81% of $3,696.22 in Billed Charges for Rev 272 = $953.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 25FR,272,RC,,,,,,,,both,,,3696.2200,554.4300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3696.22,,,,,,,953.9900,3696.2200,percent of total billed charges,"100% of $3,696.22 in Billed Charges for Rev 272 = $3,696.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 25FR,272,RC,,,,,,,,both,,,3696.2200,554.4300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1848.11,,,,,,,953.9900,3696.2200,percent of total billed charges,"Rev 272 $3,696.22 in Billed Charges at 50% = $1,848.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 25FR,272,RC,,,,,,,,both,,,3696.2200,554.4300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1193.88,,,,,,,953.9900,3696.2200,other,"32.3% of $3,696.22 in Billed Charges for Rev 272 = $1,193.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA FEMORAL VENOUS 25FR,272,RC,,,,,,,,both,,,3696.2200,554.4300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1134.74,,,,,,,953.9900,3696.2200,other,"30.7% of $3,696.22 in Billed Charges for Rev 272 = $1,134.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA FEMORAL VENOUS 25FR,272,RC,,,,,,,,both,,,3696.2200,554.4300,UNITED HEALTHCARE,UNITED HEALTHCARE,1193.88,,,,,,,953.9900,3696.2200,percent of total billed charges,"32.3% of $3,696.22 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL VENOUS 25FR,272,RC,,,,,,,,both,,,3696.2200,554.4300,WELLCARE,WELLCARE MEDICAID,3696.22,,,,,,,953.9900,3696.2200,percent of total billed charges,"100% of $3,696.22 in Billed Charges for Rev 272 = $3,696.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II OBTURATOR,272,RC,,,,,,,,both,,,3969.6000,595.4400,AETNA,AETNA,1695.02,,,,,,,1024.5500,3969.6000,percent of total billed charges,"42.7% of $3,969.60 in Billed Charges for Rev 272 = $1,695.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II OBTURATOR,272,RC,,,,,,,,both,,,3969.6000,595.4400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2778.72,,,,,,,1024.5500,3969.6000,percent of total billed charges,"Rev 272 $3,969.60 in Billed Charges at 70% = $2,778.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II OBTURATOR,272,RC,,,,,,,,both,,,3969.6000,595.4400,CIGNA HEALTHCARE,CIGNA HMO,1655.32,,,,,,,1024.5500,3969.6000,percent of total billed charges,"41.7% of $3,969.60 in Billed Charges for Rev 272 = $1,655.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II OBTURATOR,272,RC,,,,,,,,both,,,3969.6000,595.4400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1841.89,,,,,,,1024.5500,3969.6000,percent of total billed charges,"46.4% of $3,969.60 in Billed Charges for Rev 272 = $1,841.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II OBTURATOR,272,RC,,,,,,,,both,,,3969.6000,595.4400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1655.32,,,,,,,1024.5500,3969.6000,percent of total billed charges,"41.7% of $3,969.60 in Billed Charges for Rev 272 = $1,655.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II OBTURATOR,272,RC,,,,,,,,both,,,3969.6000,595.4400,CIGNA HEALTHCARE,CIGNA PPO,1655.32,,,,,,,1024.5500,3969.6000,percent of total billed charges,"41.7% of $3,969.60 in Billed Charges for Rev 272 = $1,655.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II OBTURATOR,272,RC,,,,,,,,both,,,3969.6000,595.4400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3572.64,,,,,,,1024.5500,3969.6000,percent of total billed charges,"90% of $3,969.60 in Billed Charges for Rev 272 = $3,572.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II OBTURATOR,272,RC,,,,,,,,both,,,3969.6000,595.4400,MEDCOST,MEDCOST VHN,1889.13,,,,,,,1024.5500,3969.6000,percent of total billed charges,"47.59% of $3,969.60 in Billed Charges for Rev 272 = $1,889.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II OBTURATOR,272,RC,,,,,,,,both,,,3969.6000,595.4400,SENTARA HEALTH,SENTARA HEALTH,1024.55,,,,,,,1024.5500,3969.6000,percent of total billed charges,"25.81% of $3,969.60 in Billed Charges for Rev 272 = $1,024.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II OBTURATOR,272,RC,,,,,,,,both,,,3969.6000,595.4400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3969.60,,,,,,,1024.5500,3969.6000,percent of total billed charges,"100% of $3,969.60 in Billed Charges for Rev 272 = $3,969.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II OBTURATOR,272,RC,,,,,,,,both,,,3969.6000,595.4400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1984.80,,,,,,,1024.5500,3969.6000,percent of total billed charges,"Rev 272 $3,969.60 in Billed Charges at 50% = $1,984.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II OBTURATOR,272,RC,,,,,,,,both,,,3969.6000,595.4400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1282.18,,,,,,,1024.5500,3969.6000,other,"32.3% of $3,969.60 in Billed Charges for Rev 272 = $1,282.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA FLOWPORT II OBTURATOR,272,RC,,,,,,,,both,,,3969.6000,595.4400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1218.67,,,,,,,1024.5500,3969.6000,other,"30.7% of $3,969.60 in Billed Charges for Rev 272 = $1,218.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA FLOWPORT II OBTURATOR,272,RC,,,,,,,,both,,,3969.6000,595.4400,UNITED HEALTHCARE,UNITED HEALTHCARE,1282.18,,,,,,,1024.5500,3969.6000,percent of total billed charges,"32.3% of $3,969.60 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II OBTURATOR,272,RC,,,,,,,,both,,,3969.6000,595.4400,WELLCARE,WELLCARE MEDICAID,3969.60,,,,,,,1024.5500,3969.6000,percent of total billed charges,"100% of $3,969.60 in Billed Charges for Rev 272 = $3,969.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II WITH OBTURATOR CAT01548,272,RC,,,,,,,,both,,,4347.1100,652.0700,AETNA,AETNA,1856.22,,,,,,,1121.9900,4347.1100,percent of total billed charges,"42.7% of $4,347.11 in Billed Charges for Rev 272 = $1,856.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II WITH OBTURATOR CAT01548,272,RC,,,,,,,,both,,,4347.1100,652.0700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3042.98,,,,,,,1121.9900,4347.1100,percent of total billed charges,"Rev 272 $4,347.11 in Billed Charges at 70% = $3,042.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II WITH OBTURATOR CAT01548,272,RC,,,,,,,,both,,,4347.1100,652.0700,CIGNA HEALTHCARE,CIGNA HMO,1812.74,,,,,,,1121.9900,4347.1100,percent of total billed charges,"41.7% of $4,347.11 in Billed Charges for Rev 272 = $1,812.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II WITH OBTURATOR CAT01548,272,RC,,,,,,,,both,,,4347.1100,652.0700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2017.06,,,,,,,1121.9900,4347.1100,percent of total billed charges,"46.4% of $4,347.11 in Billed Charges for Rev 272 = $2,017.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II WITH OBTURATOR CAT01548,272,RC,,,,,,,,both,,,4347.1100,652.0700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1812.74,,,,,,,1121.9900,4347.1100,percent of total billed charges,"41.7% of $4,347.11 in Billed Charges for Rev 272 = $1,812.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II WITH OBTURATOR CAT01548,272,RC,,,,,,,,both,,,4347.1100,652.0700,CIGNA HEALTHCARE,CIGNA PPO,1812.74,,,,,,,1121.9900,4347.1100,percent of total billed charges,"41.7% of $4,347.11 in Billed Charges for Rev 272 = $1,812.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II WITH OBTURATOR CAT01548,272,RC,,,,,,,,both,,,4347.1100,652.0700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3912.40,,,,,,,1121.9900,4347.1100,percent of total billed charges,"90% of $4,347.11 in Billed Charges for Rev 272 = $3,912.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II WITH OBTURATOR CAT01548,272,RC,,,,,,,,both,,,4347.1100,652.0700,MEDCOST,MEDCOST VHN,2068.79,,,,,,,1121.9900,4347.1100,percent of total billed charges,"47.59% of $4,347.11 in Billed Charges for Rev 272 = $2,068.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II WITH OBTURATOR CAT01548,272,RC,,,,,,,,both,,,4347.1100,652.0700,SENTARA HEALTH,SENTARA HEALTH,1121.99,,,,,,,1121.9900,4347.1100,percent of total billed charges,"25.81% of $4,347.11 in Billed Charges for Rev 272 = $1,121.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II WITH OBTURATOR CAT01548,272,RC,,,,,,,,both,,,4347.1100,652.0700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4347.11,,,,,,,1121.9900,4347.1100,percent of total billed charges,"100% of $4,347.11 in Billed Charges for Rev 272 = $4,347.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II WITH OBTURATOR CAT01548,272,RC,,,,,,,,both,,,4347.1100,652.0700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2173.56,,,,,,,1121.9900,4347.1100,percent of total billed charges,"Rev 272 $4,347.11 in Billed Charges at 50% = $2,173.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II WITH OBTURATOR CAT01548,272,RC,,,,,,,,both,,,4347.1100,652.0700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1404.12,,,,,,,1121.9900,4347.1100,other,"32.3% of $4,347.11 in Billed Charges for Rev 272 = $1,404.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA FLOWPORT II WITH OBTURATOR CAT01548,272,RC,,,,,,,,both,,,4347.1100,652.0700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1334.56,,,,,,,1121.9900,4347.1100,other,"30.7% of $4,347.11 in Billed Charges for Rev 272 = $1,334.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA FLOWPORT II WITH OBTURATOR CAT01548,272,RC,,,,,,,,both,,,4347.1100,652.0700,UNITED HEALTHCARE,UNITED HEALTHCARE,1404.12,,,,,,,1121.9900,4347.1100,percent of total billed charges,"32.3% of $4,347.11 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FLOWPORT II WITH OBTURATOR CAT01548,272,RC,,,,,,,,both,,,4347.1100,652.0700,WELLCARE,WELLCARE MEDICAID,4347.11,,,,,,,1121.9900,4347.1100,percent of total billed charges,"100% of $4,347.11 in Billed Charges for Rev 272 = $4,347.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 2.4MM,272,RC,27200002,CDM,,,,,,both,,,554.8500,83.2300,AETNA,AETNA,236.92,,,,,,,143.2100,554.8500,percent of total billed charges,42.7% of $554.85 in Billed Charges for Rev 272 = $236.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 2.4MM,272,RC,27200002,CDM,,,,,,both,,,554.8500,83.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,388.40,,,,,,,143.2100,554.8500,percent of total billed charges,Rev 272 $554.85 in Billed Charges at 70% = $388.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 2.4MM,272,RC,27200002,CDM,,,,,,both,,,554.8500,83.2300,CIGNA HEALTHCARE,CIGNA HMO,231.37,,,,,,,143.2100,554.8500,percent of total billed charges,41.7% of $554.85 in Billed Charges for Rev 272 = $231.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 2.4MM,272,RC,27200002,CDM,,,,,,both,,,554.8500,83.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,257.45,,,,,,,143.2100,554.8500,percent of total billed charges,46.4% of $554.85 in Billed Charges for Rev 272 = $257.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 2.4MM,272,RC,27200002,CDM,,,,,,both,,,554.8500,83.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,231.37,,,,,,,143.2100,554.8500,percent of total billed charges,41.7% of $554.85 in Billed Charges for Rev 272 = $231.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 2.4MM,272,RC,27200002,CDM,,,,,,both,,,554.8500,83.2300,CIGNA HEALTHCARE,CIGNA PPO,231.37,,,,,,,143.2100,554.8500,percent of total billed charges,41.7% of $554.85 in Billed Charges for Rev 272 = $231.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 2.4MM,272,RC,27200002,CDM,,,,,,both,,,554.8500,83.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,499.37,,,,,,,143.2100,554.8500,percent of total billed charges,90% of $554.85 in Billed Charges for Rev 272 = $499.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 2.4MM,272,RC,27200002,CDM,,,,,,both,,,554.8500,83.2300,MEDCOST,MEDCOST VHN,264.05,,,,,,,143.2100,554.8500,percent of total billed charges,47.59% of $554.85 in Billed Charges for Rev 272 = $264.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 2.4MM,272,RC,27200002,CDM,,,,,,both,,,554.8500,83.2300,SENTARA HEALTH,SENTARA HEALTH,143.21,,,,,,,143.2100,554.8500,percent of total billed charges,25.81% of $554.85 in Billed Charges for Rev 272 = $143.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 2.4MM,272,RC,27200002,CDM,,,,,,both,,,554.8500,83.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",554.85,,,,,,,143.2100,554.8500,percent of total billed charges,100% of $554.85 in Billed Charges for Rev 272 = $554.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 2.4MM,272,RC,27200002,CDM,,,,,,both,,,554.8500,83.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,277.43,,,,,,,143.2100,554.8500,percent of total billed charges,Rev 272 $554.85 in Billed Charges at 50% = $277.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 2.4MM,272,RC,27200002,CDM,,,,,,both,,,554.8500,83.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,179.22,,,,,,,143.2100,554.8500,other,32.3% of $554.85 in Billed Charges for Rev 272 = $179.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GUIDE PIN 2.4MM,272,RC,27200002,CDM,,,,,,both,,,554.8500,83.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,170.34,,,,,,,143.2100,554.8500,other,30.7% of $554.85 in Billed Charges for Rev 272 = $170.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GUIDE PIN 2.4MM,272,RC,27200002,CDM,,,,,,both,,,554.8500,83.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,179.22,,,,,,,143.2100,554.8500,percent of total billed charges,32.3% of $554.85 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN 2.4MM,272,RC,27200002,CDM,,,,,,both,,,554.8500,83.2300,WELLCARE,WELLCARE MEDICAID,554.85,,,,,,,143.2100,554.8500,percent of total billed charges,100% of $554.85 in Billed Charges for Rev 272 = $554.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN REVERSE 2.5MM,272,RC,,,,,,,,both,,,1540.0900,231.0100,AETNA,AETNA,657.62,,,,,,,397.5000,1540.0900,percent of total billed charges,"42.7% of $1,540.09 in Billed Charges for Rev 272 = $657.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN REVERSE 2.5MM,272,RC,,,,,,,,both,,,1540.0900,231.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1078.06,,,,,,,397.5000,1540.0900,percent of total billed charges,"Rev 272 $1,540.09 in Billed Charges at 70% = $1,078.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN REVERSE 2.5MM,272,RC,,,,,,,,both,,,1540.0900,231.0100,CIGNA HEALTHCARE,CIGNA HMO,642.22,,,,,,,397.5000,1540.0900,percent of total billed charges,"41.7% of $1,540.09 in Billed Charges for Rev 272 = $642.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN REVERSE 2.5MM,272,RC,,,,,,,,both,,,1540.0900,231.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,714.60,,,,,,,397.5000,1540.0900,percent of total billed charges,"46.4% of $1,540.09 in Billed Charges for Rev 272 = $714.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN REVERSE 2.5MM,272,RC,,,,,,,,both,,,1540.0900,231.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,642.22,,,,,,,397.5000,1540.0900,percent of total billed charges,"41.7% of $1,540.09 in Billed Charges for Rev 272 = $642.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN REVERSE 2.5MM,272,RC,,,,,,,,both,,,1540.0900,231.0100,CIGNA HEALTHCARE,CIGNA PPO,642.22,,,,,,,397.5000,1540.0900,percent of total billed charges,"41.7% of $1,540.09 in Billed Charges for Rev 272 = $642.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN REVERSE 2.5MM,272,RC,,,,,,,,both,,,1540.0900,231.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1386.08,,,,,,,397.5000,1540.0900,percent of total billed charges,"90% of $1,540.09 in Billed Charges for Rev 272 = $1,386.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN REVERSE 2.5MM,272,RC,,,,,,,,both,,,1540.0900,231.0100,MEDCOST,MEDCOST VHN,732.93,,,,,,,397.5000,1540.0900,percent of total billed charges,"47.59% of $1,540.09 in Billed Charges for Rev 272 = $732.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN REVERSE 2.5MM,272,RC,,,,,,,,both,,,1540.0900,231.0100,SENTARA HEALTH,SENTARA HEALTH,397.50,,,,,,,397.5000,1540.0900,percent of total billed charges,"25.81% of $1,540.09 in Billed Charges for Rev 272 = $397.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN REVERSE 2.5MM,272,RC,,,,,,,,both,,,1540.0900,231.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1540.09,,,,,,,397.5000,1540.0900,percent of total billed charges,"100% of $1,540.09 in Billed Charges for Rev 272 = $1,540.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN REVERSE 2.5MM,272,RC,,,,,,,,both,,,1540.0900,231.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,770.05,,,,,,,397.5000,1540.0900,percent of total billed charges,"Rev 272 $1,540.09 in Billed Charges at 50% = $770.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN REVERSE 2.5MM,272,RC,,,,,,,,both,,,1540.0900,231.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,497.45,,,,,,,397.5000,1540.0900,other,"32.3% of $1,540.09 in Billed Charges for Rev 272 = $497.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE PIN REVERSE 2.5MM,272,RC,,,,,,,,both,,,1540.0900,231.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,472.81,,,,,,,397.5000,1540.0900,other,"30.7% of $1,540.09 in Billed Charges for Rev 272 = $472.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE PIN REVERSE 2.5MM,272,RC,,,,,,,,both,,,1540.0900,231.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,497.45,,,,,,,397.5000,1540.0900,percent of total billed charges,"32.3% of $1,540.09 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN REVERSE 2.5MM,272,RC,,,,,,,,both,,,1540.0900,231.0100,WELLCARE,WELLCARE MEDICAID,1540.09,,,,,,,397.5000,1540.0900,percent of total billed charges,"100% of $1,540.09 in Billed Charges for Rev 272 = $1,540.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,1956.4900,293.4700,AETNA,AETNA,835.42,,,,,,,504.9700,1956.4900,percent of total billed charges,"42.7% of $1,956.49 in Billed Charges for Rev 272 = $835.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,1956.4900,293.4700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1369.54,,,,,,,504.9700,1956.4900,percent of total billed charges,"Rev 272 $1,956.49 in Billed Charges at 70% = $1,369.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,1956.4900,293.4700,CIGNA HEALTHCARE,CIGNA HMO,815.86,,,,,,,504.9700,1956.4900,percent of total billed charges,"41.7% of $1,956.49 in Billed Charges for Rev 272 = $815.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,1956.4900,293.4700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,907.81,,,,,,,504.9700,1956.4900,percent of total billed charges,"46.4% of $1,956.49 in Billed Charges for Rev 272 = $907.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,1956.4900,293.4700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,815.86,,,,,,,504.9700,1956.4900,percent of total billed charges,"41.7% of $1,956.49 in Billed Charges for Rev 272 = $815.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,1956.4900,293.4700,CIGNA HEALTHCARE,CIGNA PPO,815.86,,,,,,,504.9700,1956.4900,percent of total billed charges,"41.7% of $1,956.49 in Billed Charges for Rev 272 = $815.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,1956.4900,293.4700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1760.84,,,,,,,504.9700,1956.4900,percent of total billed charges,"90% of $1,956.49 in Billed Charges for Rev 272 = $1,760.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,1956.4900,293.4700,MEDCOST,MEDCOST VHN,931.09,,,,,,,504.9700,1956.4900,percent of total billed charges,"47.59% of $1,956.49 in Billed Charges for Rev 272 = $931.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,1956.4900,293.4700,SENTARA HEALTH,SENTARA HEALTH,504.97,,,,,,,504.9700,1956.4900,percent of total billed charges,"25.81% of $1,956.49 in Billed Charges for Rev 272 = $504.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,1956.4900,293.4700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1956.49,,,,,,,504.9700,1956.4900,percent of total billed charges,"100% of $1,956.49 in Billed Charges for Rev 272 = $1,956.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,1956.4900,293.4700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,978.25,,,,,,,504.9700,1956.4900,percent of total billed charges,"Rev 272 $1,956.49 in Billed Charges at 50% = $978.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,1956.4900,293.4700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,631.95,,,,,,,504.9700,1956.4900,other,"32.3% of $1,956.49 in Billed Charges for Rev 272 = $631.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,1956.4900,293.4700,UNITED HEALTHCARE,UHC HERITAGE SELECT,600.64,,,,,,,504.9700,1956.4900,other,"30.7% of $1,956.49 in Billed Charges for Rev 272 = $600.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,1956.4900,293.4700,UNITED HEALTHCARE,UNITED HEALTHCARE,631.95,,,,,,,504.9700,1956.4900,percent of total billed charges,"32.3% of $1,956.49 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,1956.4900,293.4700,WELLCARE,WELLCARE MEDICAID,1956.49,,,,,,,504.9700,1956.4900,percent of total billed charges,"100% of $1,956.49 in Billed Charges for Rev 272 = $1,956.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA IRRIGATION ANTERIOR CHAMBER 27G,272,RC,,,,,,,,both,,,78.0900,11.7100,AETNA,AETNA,33.34,,,,,,,20.1600,78.0900,percent of total billed charges,42.7% of $78.09 in Billed Charges for Rev 272 = $33.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA IRRIGATION ANTERIOR CHAMBER 27G,272,RC,,,,,,,,both,,,78.0900,11.7100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,54.66,,,,,,,20.1600,78.0900,percent of total billed charges,Rev 272 $78.09 in Billed Charges at 70% = $54.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA IRRIGATION ANTERIOR CHAMBER 27G,272,RC,,,,,,,,both,,,78.0900,11.7100,CIGNA HEALTHCARE,CIGNA HMO,32.56,,,,,,,20.1600,78.0900,percent of total billed charges,41.7% of $78.09 in Billed Charges for Rev 272 = $32.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA IRRIGATION ANTERIOR CHAMBER 27G,272,RC,,,,,,,,both,,,78.0900,11.7100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,36.23,,,,,,,20.1600,78.0900,percent of total billed charges,46.4% of $78.09 in Billed Charges for Rev 272 = $36.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA IRRIGATION ANTERIOR CHAMBER 27G,272,RC,,,,,,,,both,,,78.0900,11.7100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,32.56,,,,,,,20.1600,78.0900,percent of total billed charges,41.7% of $78.09 in Billed Charges for Rev 272 = $32.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA IRRIGATION ANTERIOR CHAMBER 27G,272,RC,,,,,,,,both,,,78.0900,11.7100,CIGNA HEALTHCARE,CIGNA PPO,32.56,,,,,,,20.1600,78.0900,percent of total billed charges,41.7% of $78.09 in Billed Charges for Rev 272 = $32.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA IRRIGATION ANTERIOR CHAMBER 27G,272,RC,,,,,,,,both,,,78.0900,11.7100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,70.28,,,,,,,20.1600,78.0900,percent of total billed charges,90% of $78.09 in Billed Charges for Rev 272 = $70.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA IRRIGATION ANTERIOR CHAMBER 27G,272,RC,,,,,,,,both,,,78.0900,11.7100,MEDCOST,MEDCOST VHN,37.16,,,,,,,20.1600,78.0900,percent of total billed charges,47.59% of $78.09 in Billed Charges for Rev 272 = $37.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA IRRIGATION ANTERIOR CHAMBER 27G,272,RC,,,,,,,,both,,,78.0900,11.7100,SENTARA HEALTH,SENTARA HEALTH,20.16,,,,,,,20.1600,78.0900,percent of total billed charges,25.81% of $78.09 in Billed Charges for Rev 272 = $20.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA IRRIGATION ANTERIOR CHAMBER 27G,272,RC,,,,,,,,both,,,78.0900,11.7100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",78.09,,,,,,,20.1600,78.0900,percent of total billed charges,100% of $78.09 in Billed Charges for Rev 272 = $78.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA IRRIGATION ANTERIOR CHAMBER 27G,272,RC,,,,,,,,both,,,78.0900,11.7100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,39.05,,,,,,,20.1600,78.0900,percent of total billed charges,Rev 272 $78.09 in Billed Charges at 50% = $39.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA IRRIGATION ANTERIOR CHAMBER 27G,272,RC,,,,,,,,both,,,78.0900,11.7100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,25.22,,,,,,,20.1600,78.0900,other,32.3% of $78.09 in Billed Charges for Rev 272 = $25.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CANNULA IRRIGATION ANTERIOR CHAMBER 27G,272,RC,,,,,,,,both,,,78.0900,11.7100,UNITED HEALTHCARE,UHC HERITAGE SELECT,23.97,,,,,,,20.1600,78.0900,other,30.7% of $78.09 in Billed Charges for Rev 272 = $23.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CANNULA IRRIGATION ANTERIOR CHAMBER 27G,272,RC,,,,,,,,both,,,78.0900,11.7100,UNITED HEALTHCARE,UNITED HEALTHCARE,25.22,,,,,,,20.1600,78.0900,percent of total billed charges,32.3% of $78.09 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA IRRIGATION ANTERIOR CHAMBER 27G,272,RC,,,,,,,,both,,,78.0900,11.7100,WELLCARE,WELLCARE MEDICAID,78.09,,,,,,,20.1600,78.0900,percent of total billed charges,100% of $78.09 in Billed Charges for Rev 272 = $78.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA RETROGRADE 94915,272,RC,27200002,CDM,,,,,,both,,,823.2500,123.4900,AETNA,AETNA,351.53,,,,,,,212.4800,823.2500,percent of total billed charges,42.7% of $823.25 in Billed Charges for Rev 272 = $351.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA RETROGRADE 94915,272,RC,27200002,CDM,,,,,,both,,,823.2500,123.4900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,576.28,,,,,,,212.4800,823.2500,percent of total billed charges,Rev 272 $823.25 in Billed Charges at 70% = $576.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA RETROGRADE 94915,272,RC,27200002,CDM,,,,,,both,,,823.2500,123.4900,CIGNA HEALTHCARE,CIGNA HMO,343.30,,,,,,,212.4800,823.2500,percent of total billed charges,41.7% of $823.25 in Billed Charges for Rev 272 = $343.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA RETROGRADE 94915,272,RC,27200002,CDM,,,,,,both,,,823.2500,123.4900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,381.99,,,,,,,212.4800,823.2500,percent of total billed charges,46.4% of $823.25 in Billed Charges for Rev 272 = $381.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA RETROGRADE 94915,272,RC,27200002,CDM,,,,,,both,,,823.2500,123.4900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,343.30,,,,,,,212.4800,823.2500,percent of total billed charges,41.7% of $823.25 in Billed Charges for Rev 272 = $343.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA RETROGRADE 94915,272,RC,27200002,CDM,,,,,,both,,,823.2500,123.4900,CIGNA HEALTHCARE,CIGNA PPO,343.30,,,,,,,212.4800,823.2500,percent of total billed charges,41.7% of $823.25 in Billed Charges for Rev 272 = $343.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA RETROGRADE 94915,272,RC,27200002,CDM,,,,,,both,,,823.2500,123.4900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,740.93,,,,,,,212.4800,823.2500,percent of total billed charges,90% of $823.25 in Billed Charges for Rev 272 = $740.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA RETROGRADE 94915,272,RC,27200002,CDM,,,,,,both,,,823.2500,123.4900,MEDCOST,MEDCOST VHN,391.78,,,,,,,212.4800,823.2500,percent of total billed charges,47.59% of $823.25 in Billed Charges for Rev 272 = $391.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA RETROGRADE 94915,272,RC,27200002,CDM,,,,,,both,,,823.2500,123.4900,SENTARA HEALTH,SENTARA HEALTH,212.48,,,,,,,212.4800,823.2500,percent of total billed charges,25.81% of $823.25 in Billed Charges for Rev 272 = $212.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA RETROGRADE 94915,272,RC,27200002,CDM,,,,,,both,,,823.2500,123.4900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",823.25,,,,,,,212.4800,823.2500,percent of total billed charges,100% of $823.25 in Billed Charges for Rev 272 = $823.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA RETROGRADE 94915,272,RC,27200002,CDM,,,,,,both,,,823.2500,123.4900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,411.63,,,,,,,212.4800,823.2500,percent of total billed charges,Rev 272 $823.25 in Billed Charges at 50% = $411.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA RETROGRADE 94915,272,RC,27200002,CDM,,,,,,both,,,823.2500,123.4900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,265.91,,,,,,,212.4800,823.2500,other,32.3% of $823.25 in Billed Charges for Rev 272 = $265.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CANNULA RETROGRADE 94915,272,RC,27200002,CDM,,,,,,both,,,823.2500,123.4900,UNITED HEALTHCARE,UHC HERITAGE SELECT,252.74,,,,,,,212.4800,823.2500,other,30.7% of $823.25 in Billed Charges for Rev 272 = $252.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CANNULA RETROGRADE 94915,272,RC,27200002,CDM,,,,,,both,,,823.2500,123.4900,UNITED HEALTHCARE,UNITED HEALTHCARE,265.91,,,,,,,212.4800,823.2500,percent of total billed charges,32.3% of $823.25 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA RETROGRADE 94915,272,RC,27200002,CDM,,,,,,both,,,823.2500,123.4900,WELLCARE,WELLCARE MEDICAID,823.25,,,,,,,212.4800,823.2500,percent of total billed charges,100% of $823.25 in Billed Charges for Rev 272 = $823.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNUAL ARTERIAL DILATOR TIP 24FR,272,RC,27200002,CDM,,,,,,both,,,522.0800,78.3100,AETNA,AETNA,222.93,,,,,,,134.7500,522.0800,percent of total billed charges,42.7% of $522.08 in Billed Charges for Rev 272 = $222.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNUAL ARTERIAL DILATOR TIP 24FR,272,RC,27200002,CDM,,,,,,both,,,522.0800,78.3100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,365.46,,,,,,,134.7500,522.0800,percent of total billed charges,Rev 272 $522.08 in Billed Charges at 70% = $365.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNUAL ARTERIAL DILATOR TIP 24FR,272,RC,27200002,CDM,,,,,,both,,,522.0800,78.3100,CIGNA HEALTHCARE,CIGNA HMO,217.71,,,,,,,134.7500,522.0800,percent of total billed charges,41.7% of $522.08 in Billed Charges for Rev 272 = $217.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNUAL ARTERIAL DILATOR TIP 24FR,272,RC,27200002,CDM,,,,,,both,,,522.0800,78.3100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,242.25,,,,,,,134.7500,522.0800,percent of total billed charges,46.4% of $522.08 in Billed Charges for Rev 272 = $242.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNUAL ARTERIAL DILATOR TIP 24FR,272,RC,27200002,CDM,,,,,,both,,,522.0800,78.3100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,217.71,,,,,,,134.7500,522.0800,percent of total billed charges,41.7% of $522.08 in Billed Charges for Rev 272 = $217.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNUAL ARTERIAL DILATOR TIP 24FR,272,RC,27200002,CDM,,,,,,both,,,522.0800,78.3100,CIGNA HEALTHCARE,CIGNA PPO,217.71,,,,,,,134.7500,522.0800,percent of total billed charges,41.7% of $522.08 in Billed Charges for Rev 272 = $217.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNUAL ARTERIAL DILATOR TIP 24FR,272,RC,27200002,CDM,,,,,,both,,,522.0800,78.3100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,469.87,,,,,,,134.7500,522.0800,percent of total billed charges,90% of $522.08 in Billed Charges for Rev 272 = $469.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNUAL ARTERIAL DILATOR TIP 24FR,272,RC,27200002,CDM,,,,,,both,,,522.0800,78.3100,MEDCOST,MEDCOST VHN,248.46,,,,,,,134.7500,522.0800,percent of total billed charges,47.59% of $522.08 in Billed Charges for Rev 272 = $248.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNUAL ARTERIAL DILATOR TIP 24FR,272,RC,27200002,CDM,,,,,,both,,,522.0800,78.3100,SENTARA HEALTH,SENTARA HEALTH,134.75,,,,,,,134.7500,522.0800,percent of total billed charges,25.81% of $522.08 in Billed Charges for Rev 272 = $134.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNUAL ARTERIAL DILATOR TIP 24FR,272,RC,27200002,CDM,,,,,,both,,,522.0800,78.3100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",522.08,,,,,,,134.7500,522.0800,percent of total billed charges,100% of $522.08 in Billed Charges for Rev 272 = $522.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNUAL ARTERIAL DILATOR TIP 24FR,272,RC,27200002,CDM,,,,,,both,,,522.0800,78.3100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,261.04,,,,,,,134.7500,522.0800,percent of total billed charges,Rev 272 $522.08 in Billed Charges at 50% = $261.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNUAL ARTERIAL DILATOR TIP 24FR,272,RC,27200002,CDM,,,,,,both,,,522.0800,78.3100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,168.63,,,,,,,134.7500,522.0800,other,32.3% of $522.08 in Billed Charges for Rev 272 = $168.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CANNUAL ARTERIAL DILATOR TIP 24FR,272,RC,27200002,CDM,,,,,,both,,,522.0800,78.3100,UNITED HEALTHCARE,UHC HERITAGE SELECT,160.28,,,,,,,134.7500,522.0800,other,30.7% of $522.08 in Billed Charges for Rev 272 = $160.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CANNUAL ARTERIAL DILATOR TIP 24FR,272,RC,27200002,CDM,,,,,,both,,,522.0800,78.3100,UNITED HEALTHCARE,UNITED HEALTHCARE,168.63,,,,,,,134.7500,522.0800,percent of total billed charges,32.3% of $522.08 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNUAL ARTERIAL DILATOR TIP 24FR,272,RC,27200002,CDM,,,,,,both,,,522.0800,78.3100,WELLCARE,WELLCARE MEDICAID,522.08,,,,,,,134.7500,522.0800,percent of total billed charges,100% of $522.08 in Billed Charges for Rev 272 = $522.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA 10X30MM,272,RC,27200002,CDM,,,,,,both,,,572.3500,85.8500,AETNA,AETNA,244.39,,,,,,,147.7200,572.3500,percent of total billed charges,42.7% of $572.35 in Billed Charges for Rev 272 = $244.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA 10X30MM,272,RC,27200002,CDM,,,,,,both,,,572.3500,85.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,400.65,,,,,,,147.7200,572.3500,percent of total billed charges,Rev 272 $572.35 in Billed Charges at 70% = $400.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA 10X30MM,272,RC,27200002,CDM,,,,,,both,,,572.3500,85.8500,CIGNA HEALTHCARE,CIGNA HMO,238.67,,,,,,,147.7200,572.3500,percent of total billed charges,41.7% of $572.35 in Billed Charges for Rev 272 = $238.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA 10X30MM,272,RC,27200002,CDM,,,,,,both,,,572.3500,85.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,265.57,,,,,,,147.7200,572.3500,percent of total billed charges,46.4% of $572.35 in Billed Charges for Rev 272 = $265.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA 10X30MM,272,RC,27200002,CDM,,,,,,both,,,572.3500,85.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,238.67,,,,,,,147.7200,572.3500,percent of total billed charges,41.7% of $572.35 in Billed Charges for Rev 272 = $238.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA 10X30MM,272,RC,27200002,CDM,,,,,,both,,,572.3500,85.8500,CIGNA HEALTHCARE,CIGNA PPO,238.67,,,,,,,147.7200,572.3500,percent of total billed charges,41.7% of $572.35 in Billed Charges for Rev 272 = $238.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA 10X30MM,272,RC,27200002,CDM,,,,,,both,,,572.3500,85.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,515.12,,,,,,,147.7200,572.3500,percent of total billed charges,90% of $572.35 in Billed Charges for Rev 272 = $515.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA 10X30MM,272,RC,27200002,CDM,,,,,,both,,,572.3500,85.8500,MEDCOST,MEDCOST VHN,272.38,,,,,,,147.7200,572.3500,percent of total billed charges,47.59% of $572.35 in Billed Charges for Rev 272 = $272.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA 10X30MM,272,RC,27200002,CDM,,,,,,both,,,572.3500,85.8500,SENTARA HEALTH,SENTARA HEALTH,147.72,,,,,,,147.7200,572.3500,percent of total billed charges,25.81% of $572.35 in Billed Charges for Rev 272 = $147.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA 10X30MM,272,RC,27200002,CDM,,,,,,both,,,572.3500,85.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",572.35,,,,,,,147.7200,572.3500,percent of total billed charges,100% of $572.35 in Billed Charges for Rev 272 = $572.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA 10X30MM,272,RC,27200002,CDM,,,,,,both,,,572.3500,85.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,286.18,,,,,,,147.7200,572.3500,percent of total billed charges,Rev 272 $572.35 in Billed Charges at 50% = $286.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA 10X30MM,272,RC,27200002,CDM,,,,,,both,,,572.3500,85.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,184.87,,,,,,,147.7200,572.3500,other,32.3% of $572.35 in Billed Charges for Rev 272 = $184.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CANNULA 10X30MM,272,RC,27200002,CDM,,,,,,both,,,572.3500,85.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,175.71,,,,,,,147.7200,572.3500,other,30.7% of $572.35 in Billed Charges for Rev 272 = $175.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CANNULA 10X30MM,272,RC,27200002,CDM,,,,,,both,,,572.3500,85.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,184.87,,,,,,,147.7200,572.3500,percent of total billed charges,32.3% of $572.35 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA 10X30MM,272,RC,27200002,CDM,,,,,,both,,,572.3500,85.8500,WELLCARE,WELLCARE MEDICAID,572.35,,,,,,,147.7200,572.3500,percent of total billed charges,100% of $572.35 in Billed Charges for Rev 272 = $572.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,5056.9000,758.5400,AETNA,AETNA,2159.30,,,,,,,1305.1900,5056.9000,percent of total billed charges,"42.7% of $5,056.90 in Billed Charges for Rev 272 = $2,159.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,5056.9000,758.5400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3539.83,,,,,,,1305.1900,5056.9000,percent of total billed charges,"Rev 272 $5,056.90 in Billed Charges at 70% = $3,539.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,5056.9000,758.5400,CIGNA HEALTHCARE,CIGNA HMO,2108.73,,,,,,,1305.1900,5056.9000,percent of total billed charges,"41.7% of $5,056.90 in Billed Charges for Rev 272 = $2,108.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,5056.9000,758.5400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2346.40,,,,,,,1305.1900,5056.9000,percent of total billed charges,"46.4% of $5,056.90 in Billed Charges for Rev 272 = $2,346.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,5056.9000,758.5400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2108.73,,,,,,,1305.1900,5056.9000,percent of total billed charges,"41.7% of $5,056.90 in Billed Charges for Rev 272 = $2,108.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,5056.9000,758.5400,CIGNA HEALTHCARE,CIGNA PPO,2108.73,,,,,,,1305.1900,5056.9000,percent of total billed charges,"41.7% of $5,056.90 in Billed Charges for Rev 272 = $2,108.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,5056.9000,758.5400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4551.21,,,,,,,1305.1900,5056.9000,percent of total billed charges,"90% of $5,056.90 in Billed Charges for Rev 272 = $4,551.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,5056.9000,758.5400,MEDCOST,MEDCOST VHN,2406.58,,,,,,,1305.1900,5056.9000,percent of total billed charges,"47.59% of $5,056.90 in Billed Charges for Rev 272 = $2,406.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,5056.9000,758.5400,SENTARA HEALTH,SENTARA HEALTH,1305.19,,,,,,,1305.1900,5056.9000,percent of total billed charges,"25.81% of $5,056.90 in Billed Charges for Rev 272 = $1,305.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,5056.9000,758.5400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5056.90,,,,,,,1305.1900,5056.9000,percent of total billed charges,"100% of $5,056.90 in Billed Charges for Rev 272 = $5,056.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,5056.9000,758.5400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2528.45,,,,,,,1305.1900,5056.9000,percent of total billed charges,"Rev 272 $5,056.90 in Billed Charges at 50% = $2,528.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,5056.9000,758.5400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1633.38,,,,,,,1305.1900,5056.9000,other,"32.3% of $5,056.90 in Billed Charges for Rev 272 = $1,633.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,5056.9000,758.5400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1552.47,,,,,,,1305.1900,5056.9000,other,"30.7% of $5,056.90 in Billed Charges for Rev 272 = $1,552.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,5056.9000,758.5400,UNITED HEALTHCARE,UNITED HEALTHCARE,1633.38,,,,,,,1305.1900,5056.9000,percent of total billed charges,"32.3% of $5,056.90 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,5056.9000,758.5400,WELLCARE,WELLCARE MEDICAID,5056.90,,,,,,,1305.1900,5056.9000,percent of total billed charges,"100% of $5,056.90 in Billed Charges for Rev 272 = $5,056.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 11GA X 120MM SIDE,272,RC,27200002,CDM,,,,,,both,,,4785.5900,717.8400,AETNA,AETNA,2043.45,,,,,,,1235.1600,4785.5900,percent of total billed charges,"42.7% of $4,785.59 in Billed Charges for Rev 272 = $2,043.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 11GA X 120MM SIDE,272,RC,27200002,CDM,,,,,,both,,,4785.5900,717.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3349.91,,,,,,,1235.1600,4785.5900,percent of total billed charges,"Rev 272 $4,785.59 in Billed Charges at 70% = $3,349.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 11GA X 120MM SIDE,272,RC,27200002,CDM,,,,,,both,,,4785.5900,717.8400,CIGNA HEALTHCARE,CIGNA HMO,1995.59,,,,,,,1235.1600,4785.5900,percent of total billed charges,"41.7% of $4,785.59 in Billed Charges for Rev 272 = $1,995.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 11GA X 120MM SIDE,272,RC,27200002,CDM,,,,,,both,,,4785.5900,717.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2220.51,,,,,,,1235.1600,4785.5900,percent of total billed charges,"46.4% of $4,785.59 in Billed Charges for Rev 272 = $2,220.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 11GA X 120MM SIDE,272,RC,27200002,CDM,,,,,,both,,,4785.5900,717.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1995.59,,,,,,,1235.1600,4785.5900,percent of total billed charges,"41.7% of $4,785.59 in Billed Charges for Rev 272 = $1,995.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 11GA X 120MM SIDE,272,RC,27200002,CDM,,,,,,both,,,4785.5900,717.8400,CIGNA HEALTHCARE,CIGNA PPO,1995.59,,,,,,,1235.1600,4785.5900,percent of total billed charges,"41.7% of $4,785.59 in Billed Charges for Rev 272 = $1,995.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 11GA X 120MM SIDE,272,RC,27200002,CDM,,,,,,both,,,4785.5900,717.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4307.03,,,,,,,1235.1600,4785.5900,percent of total billed charges,"90% of $4,785.59 in Billed Charges for Rev 272 = $4,307.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 11GA X 120MM SIDE,272,RC,27200002,CDM,,,,,,both,,,4785.5900,717.8400,MEDCOST,MEDCOST VHN,2277.46,,,,,,,1235.1600,4785.5900,percent of total billed charges,"47.59% of $4,785.59 in Billed Charges for Rev 272 = $2,277.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 11GA X 120MM SIDE,272,RC,27200002,CDM,,,,,,both,,,4785.5900,717.8400,SENTARA HEALTH,SENTARA HEALTH,1235.16,,,,,,,1235.1600,4785.5900,percent of total billed charges,"25.81% of $4,785.59 in Billed Charges for Rev 272 = $1,235.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 11GA X 120MM SIDE,272,RC,27200002,CDM,,,,,,both,,,4785.5900,717.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4785.59,,,,,,,1235.1600,4785.5900,percent of total billed charges,"100% of $4,785.59 in Billed Charges for Rev 272 = $4,785.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 11GA X 120MM SIDE,272,RC,27200002,CDM,,,,,,both,,,4785.5900,717.8400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2392.80,,,,,,,1235.1600,4785.5900,percent of total billed charges,"Rev 272 $4,785.59 in Billed Charges at 50% = $2,392.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 11GA X 120MM SIDE,272,RC,27200002,CDM,,,,,,both,,,4785.5900,717.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1545.75,,,,,,,1235.1600,4785.5900,other,"32.3% of $4,785.59 in Billed Charges for Rev 272 = $1,545.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA ACCUPORT 11GA X 120MM SIDE,272,RC,27200002,CDM,,,,,,both,,,4785.5900,717.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1469.18,,,,,,,1235.1600,4785.5900,other,"30.7% of $4,785.59 in Billed Charges for Rev 272 = $1,469.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA ACCUPORT 11GA X 120MM SIDE,272,RC,27200002,CDM,,,,,,both,,,4785.5900,717.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,1545.75,,,,,,,1235.1600,4785.5900,percent of total billed charges,"32.3% of $4,785.59 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 11GA X 120MM SIDE,272,RC,27200002,CDM,,,,,,both,,,4785.5900,717.8400,WELLCARE,WELLCARE MEDICAID,4785.59,,,,,,,1235.1600,4785.5900,percent of total billed charges,"100% of $4,785.59 in Billed Charges for Rev 272 = $4,785.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 8GA X 200MM,272,RC,,,,,,,,both,,,5289.2100,793.3800,AETNA,AETNA,2258.49,,,,,,,1365.1500,5289.2100,percent of total billed charges,"42.7% of $5,289.21 in Billed Charges for Rev 272 = $2,258.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 8GA X 200MM,272,RC,,,,,,,,both,,,5289.2100,793.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3702.45,,,,,,,1365.1500,5289.2100,percent of total billed charges,"Rev 272 $5,289.21 in Billed Charges at 70% = $3,702.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 8GA X 200MM,272,RC,,,,,,,,both,,,5289.2100,793.3800,CIGNA HEALTHCARE,CIGNA HMO,2205.60,,,,,,,1365.1500,5289.2100,percent of total billed charges,"41.7% of $5,289.21 in Billed Charges for Rev 272 = $2,205.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 8GA X 200MM,272,RC,,,,,,,,both,,,5289.2100,793.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2454.19,,,,,,,1365.1500,5289.2100,percent of total billed charges,"46.4% of $5,289.21 in Billed Charges for Rev 272 = $2,454.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 8GA X 200MM,272,RC,,,,,,,,both,,,5289.2100,793.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2205.60,,,,,,,1365.1500,5289.2100,percent of total billed charges,"41.7% of $5,289.21 in Billed Charges for Rev 272 = $2,205.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 8GA X 200MM,272,RC,,,,,,,,both,,,5289.2100,793.3800,CIGNA HEALTHCARE,CIGNA PPO,2205.60,,,,,,,1365.1500,5289.2100,percent of total billed charges,"41.7% of $5,289.21 in Billed Charges for Rev 272 = $2,205.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 8GA X 200MM,272,RC,,,,,,,,both,,,5289.2100,793.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4760.29,,,,,,,1365.1500,5289.2100,percent of total billed charges,"90% of $5,289.21 in Billed Charges for Rev 272 = $4,760.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 8GA X 200MM,272,RC,,,,,,,,both,,,5289.2100,793.3800,MEDCOST,MEDCOST VHN,2517.14,,,,,,,1365.1500,5289.2100,percent of total billed charges,"47.59% of $5,289.21 in Billed Charges for Rev 272 = $2,517.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 8GA X 200MM,272,RC,,,,,,,,both,,,5289.2100,793.3800,SENTARA HEALTH,SENTARA HEALTH,1365.15,,,,,,,1365.1500,5289.2100,percent of total billed charges,"25.81% of $5,289.21 in Billed Charges for Rev 272 = $1,365.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 8GA X 200MM,272,RC,,,,,,,,both,,,5289.2100,793.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5289.21,,,,,,,1365.1500,5289.2100,percent of total billed charges,"100% of $5,289.21 in Billed Charges for Rev 272 = $5,289.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 8GA X 200MM,272,RC,,,,,,,,both,,,5289.2100,793.3800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2644.61,,,,,,,1365.1500,5289.2100,percent of total billed charges,"Rev 272 $5,289.21 in Billed Charges at 50% = $2,644.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 8GA X 200MM,272,RC,,,,,,,,both,,,5289.2100,793.3800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1708.41,,,,,,,1365.1500,5289.2100,other,"32.3% of $5,289.21 in Billed Charges for Rev 272 = $1,708.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA ACCUPORT 8GA X 200MM,272,RC,,,,,,,,both,,,5289.2100,793.3800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1623.79,,,,,,,1365.1500,5289.2100,other,"30.7% of $5,289.21 in Billed Charges for Rev 272 = $1,623.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA ACCUPORT 8GA X 200MM,272,RC,,,,,,,,both,,,5289.2100,793.3800,UNITED HEALTHCARE,UNITED HEALTHCARE,1708.41,,,,,,,1365.1500,5289.2100,percent of total billed charges,"32.3% of $5,289.21 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ACCUPORT 8GA X 200MM,272,RC,,,,,,,,both,,,5289.2100,793.3800,WELLCARE,WELLCARE MEDICAID,5289.21,,,,,,,1365.1500,5289.2100,percent of total billed charges,"100% of $5,289.21 in Billed Charges for Rev 272 = $5,289.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA SPINE FENESTRATED SCREW OPEN  16GX160MM,272,RC,,,,,,,,both,,,3811.3400,571.7000,AETNA,AETNA,1627.44,,,,,,,983.7100,3811.3400,percent of total billed charges,"42.7% of $3,811.34 in Billed Charges for Rev 272 = $1,627.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA SPINE FENESTRATED SCREW OPEN  16GX160MM,272,RC,,,,,,,,both,,,3811.3400,571.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2667.94,,,,,,,983.7100,3811.3400,percent of total billed charges,"Rev 272 $3,811.34 in Billed Charges at 70% = $2,667.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA SPINE FENESTRATED SCREW OPEN  16GX160MM,272,RC,,,,,,,,both,,,3811.3400,571.7000,CIGNA HEALTHCARE,CIGNA HMO,1589.33,,,,,,,983.7100,3811.3400,percent of total billed charges,"41.7% of $3,811.34 in Billed Charges for Rev 272 = $1,589.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA SPINE FENESTRATED SCREW OPEN  16GX160MM,272,RC,,,,,,,,both,,,3811.3400,571.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1768.46,,,,,,,983.7100,3811.3400,percent of total billed charges,"46.4% of $3,811.34 in Billed Charges for Rev 272 = $1,768.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA SPINE FENESTRATED SCREW OPEN  16GX160MM,272,RC,,,,,,,,both,,,3811.3400,571.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1589.33,,,,,,,983.7100,3811.3400,percent of total billed charges,"41.7% of $3,811.34 in Billed Charges for Rev 272 = $1,589.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA SPINE FENESTRATED SCREW OPEN  16GX160MM,272,RC,,,,,,,,both,,,3811.3400,571.7000,CIGNA HEALTHCARE,CIGNA PPO,1589.33,,,,,,,983.7100,3811.3400,percent of total billed charges,"41.7% of $3,811.34 in Billed Charges for Rev 272 = $1,589.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA SPINE FENESTRATED SCREW OPEN  16GX160MM,272,RC,,,,,,,,both,,,3811.3400,571.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3430.21,,,,,,,983.7100,3811.3400,percent of total billed charges,"90% of $3,811.34 in Billed Charges for Rev 272 = $3,430.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA SPINE FENESTRATED SCREW OPEN  16GX160MM,272,RC,,,,,,,,both,,,3811.3400,571.7000,MEDCOST,MEDCOST VHN,1813.82,,,,,,,983.7100,3811.3400,percent of total billed charges,"47.59% of $3,811.34 in Billed Charges for Rev 272 = $1,813.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA SPINE FENESTRATED SCREW OPEN  16GX160MM,272,RC,,,,,,,,both,,,3811.3400,571.7000,SENTARA HEALTH,SENTARA HEALTH,983.71,,,,,,,983.7100,3811.3400,percent of total billed charges,"25.81% of $3,811.34 in Billed Charges for Rev 272 = $983.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA SPINE FENESTRATED SCREW OPEN  16GX160MM,272,RC,,,,,,,,both,,,3811.3400,571.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3811.34,,,,,,,983.7100,3811.3400,percent of total billed charges,"100% of $3,811.34 in Billed Charges for Rev 272 = $3,811.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA SPINE FENESTRATED SCREW OPEN  16GX160MM,272,RC,,,,,,,,both,,,3811.3400,571.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1905.67,,,,,,,983.7100,3811.3400,percent of total billed charges,"Rev 272 $3,811.34 in Billed Charges at 50% = $1,905.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA SPINE FENESTRATED SCREW OPEN  16GX160MM,272,RC,,,,,,,,both,,,3811.3400,571.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1231.06,,,,,,,983.7100,3811.3400,other,"32.3% of $3,811.34 in Billed Charges for Rev 272 = $1,231.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA SPINE FENESTRATED SCREW OPEN  16GX160MM,272,RC,,,,,,,,both,,,3811.3400,571.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1170.08,,,,,,,983.7100,3811.3400,other,"30.7% of $3,811.34 in Billed Charges for Rev 272 = $1,170.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA SPINE FENESTRATED SCREW OPEN  16GX160MM,272,RC,,,,,,,,both,,,3811.3400,571.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,1231.06,,,,,,,983.7100,3811.3400,percent of total billed charges,"32.3% of $3,811.34 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA SPINE FENESTRATED SCREW OPEN  16GX160MM,272,RC,,,,,,,,both,,,3811.3400,571.7000,WELLCARE,WELLCARE MEDICAID,3811.34,,,,,,,983.7100,3811.3400,percent of total billed charges,"100% of $3,811.34 in Billed Charges for Rev 272 = $3,811.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,,,,,,,,both,,,15815.7800,2372.3700,AETNA,AETNA,6753.34,,,,,,,4082.0500,15815.7800,percent of total billed charges,"42.7% of $15,815.78 in Billed Charges for Rev 272 = $6,753.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,,,,,,,,both,,,15815.7800,2372.3700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11071.05,,,,,,,4082.0500,15815.7800,percent of total billed charges,"Rev 272 $15,815.78 in Billed Charges at 70% = $11,071.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,,,,,,,,both,,,15815.7800,2372.3700,CIGNA HEALTHCARE,CIGNA HMO,6595.18,,,,,,,4082.0500,15815.7800,percent of total billed charges,"41.7% of $15,815.78 in Billed Charges for Rev 272 = $6,595.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,,,,,,,,both,,,15815.7800,2372.3700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7338.52,,,,,,,4082.0500,15815.7800,percent of total billed charges,"46.4% of $15,815.78 in Billed Charges for Rev 272 = $7,338.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,,,,,,,,both,,,15815.7800,2372.3700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6595.18,,,,,,,4082.0500,15815.7800,percent of total billed charges,"41.7% of $15,815.78 in Billed Charges for Rev 272 = $6,595.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,,,,,,,,both,,,15815.7800,2372.3700,CIGNA HEALTHCARE,CIGNA PPO,6595.18,,,,,,,4082.0500,15815.7800,percent of total billed charges,"41.7% of $15,815.78 in Billed Charges for Rev 272 = $6,595.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,,,,,,,,both,,,15815.7800,2372.3700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,14234.20,,,,,,,4082.0500,15815.7800,percent of total billed charges,"90% of $15,815.78 in Billed Charges for Rev 272 = $14,234.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,,,,,,,,both,,,15815.7800,2372.3700,MEDCOST,MEDCOST VHN,7526.73,,,,,,,4082.0500,15815.7800,percent of total billed charges,"47.59% of $15,815.78 in Billed Charges for Rev 272 = $7,526.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,,,,,,,,both,,,15815.7800,2372.3700,SENTARA HEALTH,SENTARA HEALTH,4082.05,,,,,,,4082.0500,15815.7800,percent of total billed charges,"25.81% of $15,815.78 in Billed Charges for Rev 272 = $4,082.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,,,,,,,,both,,,15815.7800,2372.3700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15815.78,,,,,,,4082.0500,15815.7800,percent of total billed charges,"100% of $15,815.78 in Billed Charges for Rev 272 = $15,815.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,,,,,,,,both,,,15815.7800,2372.3700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7907.89,,,,,,,4082.0500,15815.7800,percent of total billed charges,"Rev 272 $15,815.78 in Billed Charges at 50% = $7,907.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,,,,,,,,both,,,15815.7800,2372.3700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5108.50,,,,,,,4082.0500,15815.7800,other,"32.3% of $15,815.78 in Billed Charges for Rev 272 = $5,108.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CHARGING SYSTEM,272,RC,,,,,,,,both,,,15815.7800,2372.3700,UNITED HEALTHCARE,UHC HERITAGE SELECT,4855.44,,,,,,,4082.0500,15815.7800,other,"30.7% of $15,815.78 in Billed Charges for Rev 272 = $4,855.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CHARGING SYSTEM,272,RC,,,,,,,,both,,,15815.7800,2372.3700,UNITED HEALTHCARE,UNITED HEALTHCARE,5108.50,,,,,,,4082.0500,15815.7800,percent of total billed charges,"32.3% of $15,815.78 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,,,,,,,,both,,,15815.7800,2372.3700,WELLCARE,WELLCARE MEDICAID,15815.78,,,,,,,4082.0500,15815.7800,percent of total billed charges,"100% of $15,815.78 in Billed Charges for Rev 272 = $15,815.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ANKLE TRANSLATING,272,RC,,,,,,,,both,,,40331.6800,6049.7500,AETNA,AETNA,17221.63,,,,,,,10409.6100,40331.6800,percent of total billed charges,"42.7% of $40,331.68 in Billed Charges for Rev 272 = $17,221.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ANKLE TRANSLATING,272,RC,,,,,,,,both,,,40331.6800,6049.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,28232.18,,,,,,,10409.6100,40331.6800,percent of total billed charges,"Rev 272 $40,331.68 in Billed Charges at 70% = $28,232.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ANKLE TRANSLATING,272,RC,,,,,,,,both,,,40331.6800,6049.7500,CIGNA HEALTHCARE,CIGNA HMO,16818.31,,,,,,,10409.6100,40331.6800,percent of total billed charges,"41.7% of $40,331.68 in Billed Charges for Rev 272 = $16,818.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ANKLE TRANSLATING,272,RC,,,,,,,,both,,,40331.6800,6049.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,18713.90,,,,,,,10409.6100,40331.6800,percent of total billed charges,"46.4% of $40,331.68 in Billed Charges for Rev 272 = $18,713.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ANKLE TRANSLATING,272,RC,,,,,,,,both,,,40331.6800,6049.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,16818.31,,,,,,,10409.6100,40331.6800,percent of total billed charges,"41.7% of $40,331.68 in Billed Charges for Rev 272 = $16,818.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ANKLE TRANSLATING,272,RC,,,,,,,,both,,,40331.6800,6049.7500,CIGNA HEALTHCARE,CIGNA PPO,16818.31,,,,,,,10409.6100,40331.6800,percent of total billed charges,"41.7% of $40,331.68 in Billed Charges for Rev 272 = $16,818.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ANKLE TRANSLATING,272,RC,,,,,,,,both,,,40331.6800,6049.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,36298.51,,,,,,,10409.6100,40331.6800,percent of total billed charges,"90% of $40,331.68 in Billed Charges for Rev 272 = $36,298.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ANKLE TRANSLATING,272,RC,,,,,,,,both,,,40331.6800,6049.7500,MEDCOST,MEDCOST VHN,19193.85,,,,,,,10409.6100,40331.6800,percent of total billed charges,"47.59% of $40,331.68 in Billed Charges for Rev 272 = $19,193.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ANKLE TRANSLATING,272,RC,,,,,,,,both,,,40331.6800,6049.7500,SENTARA HEALTH,SENTARA HEALTH,10409.61,,,,,,,10409.6100,40331.6800,percent of total billed charges,"25.81% of $40,331.68 in Billed Charges for Rev 272 = $10,409.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ANKLE TRANSLATING,272,RC,,,,,,,,both,,,40331.6800,6049.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",40331.68,,,,,,,10409.6100,40331.6800,percent of total billed charges,"100% of $40,331.68 in Billed Charges for Rev 272 = $40,331.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ANKLE TRANSLATING,272,RC,,,,,,,,both,,,40331.6800,6049.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,20165.84,,,,,,,10409.6100,40331.6800,percent of total billed charges,"Rev 272 $40,331.68 in Billed Charges at 50% = $20,165.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ANKLE TRANSLATING,272,RC,,,,,,,,both,,,40331.6800,6049.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13027.13,,,,,,,10409.6100,40331.6800,other,"32.3% of $40,331.68 in Billed Charges for Rev 272 = $13,027.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP ANKLE TRANSLATING,272,RC,,,,,,,,both,,,40331.6800,6049.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,12381.83,,,,,,,10409.6100,40331.6800,other,"30.7% of $40,331.68 in Billed Charges for Rev 272 = $12,381.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP ANKLE TRANSLATING,272,RC,,,,,,,,both,,,40331.6800,6049.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,13027.13,,,,,,,10409.6100,40331.6800,percent of total billed charges,"32.3% of $40,331.68 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ANKLE TRANSLATING,272,RC,,,,,,,,both,,,40331.6800,6049.7500,WELLCARE,WELLCARE MEDICAID,40331.68,,,,,,,10409.6100,40331.6800,percent of total billed charges,"100% of $40,331.68 in Billed Charges for Rev 272 = $40,331.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP CRANIAL FLAP TUBE TITANIUM 18MM,272,RC,,,,,,,,both,,,4157.5300,623.6300,AETNA,AETNA,1775.27,,,,,,,1073.0600,4157.5300,percent of total billed charges,"42.7% of $4,157.53 in Billed Charges for Rev 272 = $1,775.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP CRANIAL FLAP TUBE TITANIUM 18MM,272,RC,,,,,,,,both,,,4157.5300,623.6300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2910.27,,,,,,,1073.0600,4157.5300,percent of total billed charges,"Rev 272 $4,157.53 in Billed Charges at 70% = $2,910.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP CRANIAL FLAP TUBE TITANIUM 18MM,272,RC,,,,,,,,both,,,4157.5300,623.6300,CIGNA HEALTHCARE,CIGNA HMO,1733.69,,,,,,,1073.0600,4157.5300,percent of total billed charges,"41.7% of $4,157.53 in Billed Charges for Rev 272 = $1,733.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP CRANIAL FLAP TUBE TITANIUM 18MM,272,RC,,,,,,,,both,,,4157.5300,623.6300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1929.09,,,,,,,1073.0600,4157.5300,percent of total billed charges,"46.4% of $4,157.53 in Billed Charges for Rev 272 = $1,929.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP CRANIAL FLAP TUBE TITANIUM 18MM,272,RC,,,,,,,,both,,,4157.5300,623.6300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1733.69,,,,,,,1073.0600,4157.5300,percent of total billed charges,"41.7% of $4,157.53 in Billed Charges for Rev 272 = $1,733.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP CRANIAL FLAP TUBE TITANIUM 18MM,272,RC,,,,,,,,both,,,4157.5300,623.6300,CIGNA HEALTHCARE,CIGNA PPO,1733.69,,,,,,,1073.0600,4157.5300,percent of total billed charges,"41.7% of $4,157.53 in Billed Charges for Rev 272 = $1,733.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP CRANIAL FLAP TUBE TITANIUM 18MM,272,RC,,,,,,,,both,,,4157.5300,623.6300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3741.78,,,,,,,1073.0600,4157.5300,percent of total billed charges,"90% of $4,157.53 in Billed Charges for Rev 272 = $3,741.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP CRANIAL FLAP TUBE TITANIUM 18MM,272,RC,,,,,,,,both,,,4157.5300,623.6300,MEDCOST,MEDCOST VHN,1978.57,,,,,,,1073.0600,4157.5300,percent of total billed charges,"47.59% of $4,157.53 in Billed Charges for Rev 272 = $1,978.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP CRANIAL FLAP TUBE TITANIUM 18MM,272,RC,,,,,,,,both,,,4157.5300,623.6300,SENTARA HEALTH,SENTARA HEALTH,1073.06,,,,,,,1073.0600,4157.5300,percent of total billed charges,"25.81% of $4,157.53 in Billed Charges for Rev 272 = $1,073.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP CRANIAL FLAP TUBE TITANIUM 18MM,272,RC,,,,,,,,both,,,4157.5300,623.6300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4157.53,,,,,,,1073.0600,4157.5300,percent of total billed charges,"100% of $4,157.53 in Billed Charges for Rev 272 = $4,157.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP CRANIAL FLAP TUBE TITANIUM 18MM,272,RC,,,,,,,,both,,,4157.5300,623.6300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2078.77,,,,,,,1073.0600,4157.5300,percent of total billed charges,"Rev 272 $4,157.53 in Billed Charges at 50% = $2,078.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP CRANIAL FLAP TUBE TITANIUM 18MM,272,RC,,,,,,,,both,,,4157.5300,623.6300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1342.88,,,,,,,1073.0600,4157.5300,other,"32.3% of $4,157.53 in Billed Charges for Rev 272 = $1,342.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP CRANIAL FLAP TUBE TITANIUM 18MM,272,RC,,,,,,,,both,,,4157.5300,623.6300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1276.36,,,,,,,1073.0600,4157.5300,other,"30.7% of $4,157.53 in Billed Charges for Rev 272 = $1,276.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP CRANIAL FLAP TUBE TITANIUM 18MM,272,RC,,,,,,,,both,,,4157.5300,623.6300,UNITED HEALTHCARE,UNITED HEALTHCARE,1342.88,,,,,,,1073.0600,4157.5300,percent of total billed charges,"32.3% of $4,157.53 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP CRANIAL FLAP TUBE TITANIUM 18MM,272,RC,,,,,,,,both,,,4157.5300,623.6300,WELLCARE,WELLCARE MEDICAID,4157.53,,,,,,,1073.0600,4157.5300,percent of total billed charges,"100% of $4,157.53 in Billed Charges for Rev 272 = $4,157.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ISOLATOR STANDARD ENCOMPASS,272,RC,27200002,CDM,,,,,,both,,,56003.4000,8400.5100,AETNA,AETNA,23913.45,,,,,,,14454.4800,56003.4000,percent of total billed charges,"42.7% of $56,003.40 in Billed Charges for Rev 272 = $23,913.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ISOLATOR STANDARD ENCOMPASS,272,RC,27200002,CDM,,,,,,both,,,56003.4000,8400.5100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,39202.38,,,,,,,14454.4800,56003.4000,percent of total billed charges,"Rev 272 $56,003.40 in Billed Charges at 70% = $39,202.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ISOLATOR STANDARD ENCOMPASS,272,RC,27200002,CDM,,,,,,both,,,56003.4000,8400.5100,CIGNA HEALTHCARE,CIGNA HMO,23353.42,,,,,,,14454.4800,56003.4000,percent of total billed charges,"41.7% of $56,003.40 in Billed Charges for Rev 272 = $23,353.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ISOLATOR STANDARD ENCOMPASS,272,RC,27200002,CDM,,,,,,both,,,56003.4000,8400.5100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,25985.58,,,,,,,14454.4800,56003.4000,percent of total billed charges,"46.4% of $56,003.40 in Billed Charges for Rev 272 = $25,985.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ISOLATOR STANDARD ENCOMPASS,272,RC,27200002,CDM,,,,,,both,,,56003.4000,8400.5100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,23353.42,,,,,,,14454.4800,56003.4000,percent of total billed charges,"41.7% of $56,003.40 in Billed Charges for Rev 272 = $23,353.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ISOLATOR STANDARD ENCOMPASS,272,RC,27200002,CDM,,,,,,both,,,56003.4000,8400.5100,CIGNA HEALTHCARE,CIGNA PPO,23353.42,,,,,,,14454.4800,56003.4000,percent of total billed charges,"41.7% of $56,003.40 in Billed Charges for Rev 272 = $23,353.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ISOLATOR STANDARD ENCOMPASS,272,RC,27200002,CDM,,,,,,both,,,56003.4000,8400.5100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,50403.06,,,,,,,14454.4800,56003.4000,percent of total billed charges,"90% of $56,003.40 in Billed Charges for Rev 272 = $50,403.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ISOLATOR STANDARD ENCOMPASS,272,RC,27200002,CDM,,,,,,both,,,56003.4000,8400.5100,MEDCOST,MEDCOST VHN,26652.02,,,,,,,14454.4800,56003.4000,percent of total billed charges,"47.59% of $56,003.40 in Billed Charges for Rev 272 = $26,652.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ISOLATOR STANDARD ENCOMPASS,272,RC,27200002,CDM,,,,,,both,,,56003.4000,8400.5100,SENTARA HEALTH,SENTARA HEALTH,14454.48,,,,,,,14454.4800,56003.4000,percent of total billed charges,"25.81% of $56,003.40 in Billed Charges for Rev 272 = $14,454.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ISOLATOR STANDARD ENCOMPASS,272,RC,27200002,CDM,,,,,,both,,,56003.4000,8400.5100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",56003.40,,,,,,,14454.4800,56003.4000,percent of total billed charges,"100% of $56,003.40 in Billed Charges for Rev 272 = $56,003.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ISOLATOR STANDARD ENCOMPASS,272,RC,27200002,CDM,,,,,,both,,,56003.4000,8400.5100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,28001.70,,,,,,,14454.4800,56003.4000,percent of total billed charges,"Rev 272 $56,003.40 in Billed Charges at 50% = $28,001.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ISOLATOR STANDARD ENCOMPASS,272,RC,27200002,CDM,,,,,,both,,,56003.4000,8400.5100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,18089.10,,,,,,,14454.4800,56003.4000,other,"32.3% of $56,003.40 in Billed Charges for Rev 272 = $18,089.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP ISOLATOR STANDARD ENCOMPASS,272,RC,27200002,CDM,,,,,,both,,,56003.4000,8400.5100,UNITED HEALTHCARE,UHC HERITAGE SELECT,17193.04,,,,,,,14454.4800,56003.4000,other,"30.7% of $56,003.40 in Billed Charges for Rev 272 = $17,193.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP ISOLATOR STANDARD ENCOMPASS,272,RC,27200002,CDM,,,,,,both,,,56003.4000,8400.5100,UNITED HEALTHCARE,UNITED HEALTHCARE,18089.10,,,,,,,14454.4800,56003.4000,percent of total billed charges,"32.3% of $56,003.40 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP ISOLATOR STANDARD ENCOMPASS,272,RC,27200002,CDM,,,,,,both,,,56003.4000,8400.5100,WELLCARE,WELLCARE MEDICAID,56003.40,,,,,,,14454.4800,56003.4000,percent of total billed charges,"100% of $56,003.40 in Billed Charges for Rev 272 = $56,003.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN  6 POS-MR,272,RC,27200002,CDM,,,,,,both,,,6255.9900,938.4000,AETNA,AETNA,2671.31,,,,,,,1614.6700,6255.9900,percent of total billed charges,"42.7% of $6,255.99 in Billed Charges for Rev 272 = $2,671.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN  6 POS-MR,272,RC,27200002,CDM,,,,,,both,,,6255.9900,938.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4379.19,,,,,,,1614.6700,6255.9900,percent of total billed charges,"Rev 272 $6,255.99 in Billed Charges at 70% = $4,379.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN  6 POS-MR,272,RC,27200002,CDM,,,,,,both,,,6255.9900,938.4000,CIGNA HEALTHCARE,CIGNA HMO,2608.75,,,,,,,1614.6700,6255.9900,percent of total billed charges,"41.7% of $6,255.99 in Billed Charges for Rev 272 = $2,608.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN  6 POS-MR,272,RC,27200002,CDM,,,,,,both,,,6255.9900,938.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2902.78,,,,,,,1614.6700,6255.9900,percent of total billed charges,"46.4% of $6,255.99 in Billed Charges for Rev 272 = $2,902.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN  6 POS-MR,272,RC,27200002,CDM,,,,,,both,,,6255.9900,938.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2608.75,,,,,,,1614.6700,6255.9900,percent of total billed charges,"41.7% of $6,255.99 in Billed Charges for Rev 272 = $2,608.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN  6 POS-MR,272,RC,27200002,CDM,,,,,,both,,,6255.9900,938.4000,CIGNA HEALTHCARE,CIGNA PPO,2608.75,,,,,,,1614.6700,6255.9900,percent of total billed charges,"41.7% of $6,255.99 in Billed Charges for Rev 272 = $2,608.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN  6 POS-MR,272,RC,27200002,CDM,,,,,,both,,,6255.9900,938.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5630.39,,,,,,,1614.6700,6255.9900,percent of total billed charges,"90% of $6,255.99 in Billed Charges for Rev 272 = $5,630.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN  6 POS-MR,272,RC,27200002,CDM,,,,,,both,,,6255.9900,938.4000,MEDCOST,MEDCOST VHN,2977.23,,,,,,,1614.6700,6255.9900,percent of total billed charges,"47.59% of $6,255.99 in Billed Charges for Rev 272 = $2,977.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN  6 POS-MR,272,RC,27200002,CDM,,,,,,both,,,6255.9900,938.4000,SENTARA HEALTH,SENTARA HEALTH,1614.67,,,,,,,1614.6700,6255.9900,percent of total billed charges,"25.81% of $6,255.99 in Billed Charges for Rev 272 = $1,614.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN  6 POS-MR,272,RC,27200002,CDM,,,,,,both,,,6255.9900,938.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6255.99,,,,,,,1614.6700,6255.9900,percent of total billed charges,"100% of $6,255.99 in Billed Charges for Rev 272 = $6,255.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN  6 POS-MR,272,RC,27200002,CDM,,,,,,both,,,6255.9900,938.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3128.00,,,,,,,1614.6700,6255.9900,percent of total billed charges,"Rev 272 $6,255.99 in Billed Charges at 50% = $3,128.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN  6 POS-MR,272,RC,27200002,CDM,,,,,,both,,,6255.9900,938.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2020.68,,,,,,,1614.6700,6255.9900,other,"32.3% of $6,255.99 in Billed Charges for Rev 272 = $2,020.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP MED MULTI-PIN  6 POS-MR,272,RC,27200002,CDM,,,,,,both,,,6255.9900,938.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1920.59,,,,,,,1614.6700,6255.9900,other,"30.7% of $6,255.99 in Billed Charges for Rev 272 = $1,920.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP MED MULTI-PIN  6 POS-MR,272,RC,27200002,CDM,,,,,,both,,,6255.9900,938.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,2020.68,,,,,,,1614.6700,6255.9900,percent of total billed charges,"32.3% of $6,255.99 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP MED MULTI-PIN  6 POS-MR,272,RC,27200002,CDM,,,,,,both,,,6255.9900,938.4000,WELLCARE,WELLCARE MEDICAID,6255.99,,,,,,,1614.6700,6255.9900,percent of total billed charges,"100% of $6,255.99 in Billed Charges for Rev 272 = $6,255.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP RX STD .035,272,RC,27200002,CDM,,,,,,both,,,1347.5000,202.1300,AETNA,AETNA,575.38,,,,,,,347.7900,1347.5000,percent of total billed charges,"42.7% of $1,347.50 in Billed Charges for Rev 272 = $575.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP RX STD .035,272,RC,27200002,CDM,,,,,,both,,,1347.5000,202.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,943.25,,,,,,,347.7900,1347.5000,percent of total billed charges,"Rev 272 $1,347.50 in Billed Charges at 70% = $943.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP RX STD .035,272,RC,27200002,CDM,,,,,,both,,,1347.5000,202.1300,CIGNA HEALTHCARE,CIGNA HMO,561.91,,,,,,,347.7900,1347.5000,percent of total billed charges,"41.7% of $1,347.50 in Billed Charges for Rev 272 = $561.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP RX STD .035,272,RC,27200002,CDM,,,,,,both,,,1347.5000,202.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,625.24,,,,,,,347.7900,1347.5000,percent of total billed charges,"46.4% of $1,347.50 in Billed Charges for Rev 272 = $625.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP RX STD .035,272,RC,27200002,CDM,,,,,,both,,,1347.5000,202.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,561.91,,,,,,,347.7900,1347.5000,percent of total billed charges,"41.7% of $1,347.50 in Billed Charges for Rev 272 = $561.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP RX STD .035,272,RC,27200002,CDM,,,,,,both,,,1347.5000,202.1300,CIGNA HEALTHCARE,CIGNA PPO,561.91,,,,,,,347.7900,1347.5000,percent of total billed charges,"41.7% of $1,347.50 in Billed Charges for Rev 272 = $561.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP RX STD .035,272,RC,27200002,CDM,,,,,,both,,,1347.5000,202.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1212.75,,,,,,,347.7900,1347.5000,percent of total billed charges,"90% of $1,347.50 in Billed Charges for Rev 272 = $1,212.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP RX STD .035,272,RC,27200002,CDM,,,,,,both,,,1347.5000,202.1300,MEDCOST,MEDCOST VHN,641.28,,,,,,,347.7900,1347.5000,percent of total billed charges,"47.59% of $1,347.50 in Billed Charges for Rev 272 = $641.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP RX STD .035,272,RC,27200002,CDM,,,,,,both,,,1347.5000,202.1300,SENTARA HEALTH,SENTARA HEALTH,347.79,,,,,,,347.7900,1347.5000,percent of total billed charges,"25.81% of $1,347.50 in Billed Charges for Rev 272 = $347.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP RX STD .035,272,RC,27200002,CDM,,,,,,both,,,1347.5000,202.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1347.50,,,,,,,347.7900,1347.5000,percent of total billed charges,"100% of $1,347.50 in Billed Charges for Rev 272 = $1,347.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP RX STD .035,272,RC,27200002,CDM,,,,,,both,,,1347.5000,202.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,673.75,,,,,,,347.7900,1347.5000,percent of total billed charges,"Rev 272 $1,347.50 in Billed Charges at 50% = $673.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP RX STD .035,272,RC,27200002,CDM,,,,,,both,,,1347.5000,202.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.24,,,,,,,347.7900,1347.5000,other,"32.3% of $1,347.50 in Billed Charges for Rev 272 = $435.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA ERCP RX STD .035,272,RC,27200002,CDM,,,,,,both,,,1347.5000,202.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,413.68,,,,,,,347.7900,1347.5000,other,"30.7% of $1,347.50 in Billed Charges for Rev 272 = $413.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA ERCP RX STD .035,272,RC,27200002,CDM,,,,,,both,,,1347.5000,202.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,435.24,,,,,,,347.7900,1347.5000,percent of total billed charges,"32.3% of $1,347.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP RX STD .035,272,RC,27200002,CDM,,,,,,both,,,1347.5000,202.1300,WELLCARE,WELLCARE MEDICAID,1347.50,,,,,,,347.7900,1347.5000,percent of total billed charges,"100% of $1,347.50 in Billed Charges for Rev 272 = $1,347.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER ION FULLY ARTICULATING,272,RC,27200002,CDM,,,,,,both,,,10111.7300,1516.7600,AETNA,AETNA,4317.71,,,,,,,2609.8400,10111.7300,percent of total billed charges,"42.7% of $10,111.73 in Billed Charges for Rev 272 = $4,317.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER ION FULLY ARTICULATING,272,RC,27200002,CDM,,,,,,both,,,10111.7300,1516.7600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7078.21,,,,,,,2609.8400,10111.7300,percent of total billed charges,"Rev 272 $10,111.73 in Billed Charges at 70% = $7,078.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER ION FULLY ARTICULATING,272,RC,27200002,CDM,,,,,,both,,,10111.7300,1516.7600,CIGNA HEALTHCARE,CIGNA HMO,4216.59,,,,,,,2609.8400,10111.7300,percent of total billed charges,"41.7% of $10,111.73 in Billed Charges for Rev 272 = $4,216.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER ION FULLY ARTICULATING,272,RC,27200002,CDM,,,,,,both,,,10111.7300,1516.7600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4691.84,,,,,,,2609.8400,10111.7300,percent of total billed charges,"46.4% of $10,111.73 in Billed Charges for Rev 272 = $4,691.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER ION FULLY ARTICULATING,272,RC,27200002,CDM,,,,,,both,,,10111.7300,1516.7600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4216.59,,,,,,,2609.8400,10111.7300,percent of total billed charges,"41.7% of $10,111.73 in Billed Charges for Rev 272 = $4,216.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER ION FULLY ARTICULATING,272,RC,27200002,CDM,,,,,,both,,,10111.7300,1516.7600,CIGNA HEALTHCARE,CIGNA PPO,4216.59,,,,,,,2609.8400,10111.7300,percent of total billed charges,"41.7% of $10,111.73 in Billed Charges for Rev 272 = $4,216.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER ION FULLY ARTICULATING,272,RC,27200002,CDM,,,,,,both,,,10111.7300,1516.7600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9100.56,,,,,,,2609.8400,10111.7300,percent of total billed charges,"90% of $10,111.73 in Billed Charges for Rev 272 = $9,100.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER ION FULLY ARTICULATING,272,RC,27200002,CDM,,,,,,both,,,10111.7300,1516.7600,MEDCOST,MEDCOST VHN,4812.17,,,,,,,2609.8400,10111.7300,percent of total billed charges,"47.59% of $10,111.73 in Billed Charges for Rev 272 = $4,812.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER ION FULLY ARTICULATING,272,RC,27200002,CDM,,,,,,both,,,10111.7300,1516.7600,SENTARA HEALTH,SENTARA HEALTH,2609.84,,,,,,,2609.8400,10111.7300,percent of total billed charges,"25.81% of $10,111.73 in Billed Charges for Rev 272 = $2,609.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER ION FULLY ARTICULATING,272,RC,27200002,CDM,,,,,,both,,,10111.7300,1516.7600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10111.73,,,,,,,2609.8400,10111.7300,percent of total billed charges,"100% of $10,111.73 in Billed Charges for Rev 272 = $10,111.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER ION FULLY ARTICULATING,272,RC,27200002,CDM,,,,,,both,,,10111.7300,1516.7600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5055.87,,,,,,,2609.8400,10111.7300,percent of total billed charges,"Rev 272 $10,111.73 in Billed Charges at 50% = $5,055.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER ION FULLY ARTICULATING,272,RC,27200002,CDM,,,,,,both,,,10111.7300,1516.7600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3266.09,,,,,,,2609.8400,10111.7300,other,"32.3% of $10,111.73 in Billed Charges for Rev 272 = $3,266.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATHETER ION FULLY ARTICULATING,272,RC,27200002,CDM,,,,,,both,,,10111.7300,1516.7600,UNITED HEALTHCARE,UHC HERITAGE SELECT,3104.30,,,,,,,2609.8400,10111.7300,other,"30.7% of $10,111.73 in Billed Charges for Rev 272 = $3,104.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATHETER ION FULLY ARTICULATING,272,RC,27200002,CDM,,,,,,both,,,10111.7300,1516.7600,UNITED HEALTHCARE,UNITED HEALTHCARE,3266.09,,,,,,,2609.8400,10111.7300,percent of total billed charges,"32.3% of $10,111.73 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER ION FULLY ARTICULATING,272,RC,27200002,CDM,,,,,,both,,,10111.7300,1516.7600,WELLCARE,WELLCARE MEDICAID,10111.73,,,,,,,2609.8400,10111.7300,percent of total billed charges,"100% of $10,111.73 in Billed Charges for Rev 272 = $10,111.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP RF ABLATION ATRICURE,272,RC,27200002,CDM,,,,,,both,,,32108.6200,4816.2900,AETNA,AETNA,13710.38,,,,,,,8287.2300,32108.6200,percent of total billed charges,"42.7% of $32,108.62 in Billed Charges for Rev 272 = $13,710.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP RF ABLATION ATRICURE,272,RC,27200002,CDM,,,,,,both,,,32108.6200,4816.2900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,22476.03,,,,,,,8287.2300,32108.6200,percent of total billed charges,"Rev 272 $32,108.62 in Billed Charges at 70% = $22,476.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP RF ABLATION ATRICURE,272,RC,27200002,CDM,,,,,,both,,,32108.6200,4816.2900,CIGNA HEALTHCARE,CIGNA HMO,13389.29,,,,,,,8287.2300,32108.6200,percent of total billed charges,"41.7% of $32,108.62 in Billed Charges for Rev 272 = $13,389.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP RF ABLATION ATRICURE,272,RC,27200002,CDM,,,,,,both,,,32108.6200,4816.2900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,14898.40,,,,,,,8287.2300,32108.6200,percent of total billed charges,"46.4% of $32,108.62 in Billed Charges for Rev 272 = $14,898.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP RF ABLATION ATRICURE,272,RC,27200002,CDM,,,,,,both,,,32108.6200,4816.2900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,13389.29,,,,,,,8287.2300,32108.6200,percent of total billed charges,"41.7% of $32,108.62 in Billed Charges for Rev 272 = $13,389.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP RF ABLATION ATRICURE,272,RC,27200002,CDM,,,,,,both,,,32108.6200,4816.2900,CIGNA HEALTHCARE,CIGNA PPO,13389.29,,,,,,,8287.2300,32108.6200,percent of total billed charges,"41.7% of $32,108.62 in Billed Charges for Rev 272 = $13,389.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP RF ABLATION ATRICURE,272,RC,27200002,CDM,,,,,,both,,,32108.6200,4816.2900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,28897.76,,,,,,,8287.2300,32108.6200,percent of total billed charges,"90% of $32,108.62 in Billed Charges for Rev 272 = $28,897.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP RF ABLATION ATRICURE,272,RC,27200002,CDM,,,,,,both,,,32108.6200,4816.2900,MEDCOST,MEDCOST VHN,15280.49,,,,,,,8287.2300,32108.6200,percent of total billed charges,"47.59% of $32,108.62 in Billed Charges for Rev 272 = $15,280.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP RF ABLATION ATRICURE,272,RC,27200002,CDM,,,,,,both,,,32108.6200,4816.2900,SENTARA HEALTH,SENTARA HEALTH,8287.23,,,,,,,8287.2300,32108.6200,percent of total billed charges,"25.81% of $32,108.62 in Billed Charges for Rev 272 = $8,287.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP RF ABLATION ATRICURE,272,RC,27200002,CDM,,,,,,both,,,32108.6200,4816.2900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",32108.62,,,,,,,8287.2300,32108.6200,percent of total billed charges,"100% of $32,108.62 in Billed Charges for Rev 272 = $32,108.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP RF ABLATION ATRICURE,272,RC,27200002,CDM,,,,,,both,,,32108.6200,4816.2900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,16054.31,,,,,,,8287.2300,32108.6200,percent of total billed charges,"Rev 272 $32,108.62 in Billed Charges at 50% = $16,054.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP RF ABLATION ATRICURE,272,RC,27200002,CDM,,,,,,both,,,32108.6200,4816.2900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,10371.08,,,,,,,8287.2300,32108.6200,other,"32.3% of $32,108.62 in Billed Charges for Rev 272 = $10,371.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP RF ABLATION ATRICURE,272,RC,27200002,CDM,,,,,,both,,,32108.6200,4816.2900,UNITED HEALTHCARE,UHC HERITAGE SELECT,9857.35,,,,,,,8287.2300,32108.6200,other,"30.7% of $32,108.62 in Billed Charges for Rev 272 = $9,857.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CLAMP RF ABLATION ATRICURE,272,RC,27200002,CDM,,,,,,both,,,32108.6200,4816.2900,UNITED HEALTHCARE,UNITED HEALTHCARE,10371.08,,,,,,,8287.2300,32108.6200,percent of total billed charges,"32.3% of $32,108.62 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CLAMP RF ABLATION ATRICURE,272,RC,27200002,CDM,,,,,,both,,,32108.6200,4816.2900,WELLCARE,WELLCARE MEDICAID,32108.62,,,,,,,8287.2300,32108.6200,percent of total billed charges,"100% of $32,108.62 in Billed Charges for Rev 272 = $32,108.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,1739.1500,260.8700,AETNA,AETNA,742.62,,,,,,,448.8700,1739.1500,percent of total billed charges,"42.7% of $1,739.15 in Billed Charges for Rev 272 = $742.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,1739.1500,260.8700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1217.41,,,,,,,448.8700,1739.1500,percent of total billed charges,"Rev 272 $1,739.15 in Billed Charges at 70% = $1,217.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,1739.1500,260.8700,CIGNA HEALTHCARE,CIGNA HMO,725.23,,,,,,,448.8700,1739.1500,percent of total billed charges,"41.7% of $1,739.15 in Billed Charges for Rev 272 = $725.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,1739.1500,260.8700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,806.97,,,,,,,448.8700,1739.1500,percent of total billed charges,"46.4% of $1,739.15 in Billed Charges for Rev 272 = $806.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,1739.1500,260.8700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,725.23,,,,,,,448.8700,1739.1500,percent of total billed charges,"41.7% of $1,739.15 in Billed Charges for Rev 272 = $725.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,1739.1500,260.8700,CIGNA HEALTHCARE,CIGNA PPO,725.23,,,,,,,448.8700,1739.1500,percent of total billed charges,"41.7% of $1,739.15 in Billed Charges for Rev 272 = $725.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,1739.1500,260.8700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1565.24,,,,,,,448.8700,1739.1500,percent of total billed charges,"90% of $1,739.15 in Billed Charges for Rev 272 = $1,565.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,1739.1500,260.8700,MEDCOST,MEDCOST VHN,827.66,,,,,,,448.8700,1739.1500,percent of total billed charges,"47.59% of $1,739.15 in Billed Charges for Rev 272 = $827.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,1739.1500,260.8700,SENTARA HEALTH,SENTARA HEALTH,448.87,,,,,,,448.8700,1739.1500,percent of total billed charges,"25.81% of $1,739.15 in Billed Charges for Rev 272 = $448.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,1739.1500,260.8700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1739.15,,,,,,,448.8700,1739.1500,percent of total billed charges,"100% of $1,739.15 in Billed Charges for Rev 272 = $1,739.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,1739.1500,260.8700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,869.58,,,,,,,448.8700,1739.1500,percent of total billed charges,"Rev 272 $1,739.15 in Billed Charges at 50% = $869.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,1739.1500,260.8700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,561.75,,,,,,,448.8700,1739.1500,other,"32.3% of $1,739.15 in Billed Charges for Rev 272 = $561.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,1739.1500,260.8700,UNITED HEALTHCARE,UHC HERITAGE SELECT,533.92,,,,,,,448.8700,1739.1500,other,"30.7% of $1,739.15 in Billed Charges for Rev 272 = $533.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,1739.1500,260.8700,UNITED HEALTHCARE,UNITED HEALTHCARE,561.75,,,,,,,448.8700,1739.1500,percent of total billed charges,"32.3% of $1,739.15 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,1739.1500,260.8700,WELLCARE,WELLCARE MEDICAID,1739.15,,,,,,,448.8700,1739.1500,percent of total billed charges,"100% of $1,739.15 in Billed Charges for Rev 272 = $1,739.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,2123.3600,318.5000,AETNA,AETNA,906.67,,,,,,,548.0400,2123.3600,percent of total billed charges,"42.7% of $2,123.36 in Billed Charges for Rev 272 = $906.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,2123.3600,318.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1486.35,,,,,,,548.0400,2123.3600,percent of total billed charges,"Rev 272 $2,123.36 in Billed Charges at 70% = $1,486.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,2123.3600,318.5000,CIGNA HEALTHCARE,CIGNA HMO,885.44,,,,,,,548.0400,2123.3600,percent of total billed charges,"41.7% of $2,123.36 in Billed Charges for Rev 272 = $885.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,2123.3600,318.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,985.24,,,,,,,548.0400,2123.3600,percent of total billed charges,"46.4% of $2,123.36 in Billed Charges for Rev 272 = $985.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,2123.3600,318.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,885.44,,,,,,,548.0400,2123.3600,percent of total billed charges,"41.7% of $2,123.36 in Billed Charges for Rev 272 = $885.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,2123.3600,318.5000,CIGNA HEALTHCARE,CIGNA PPO,885.44,,,,,,,548.0400,2123.3600,percent of total billed charges,"41.7% of $2,123.36 in Billed Charges for Rev 272 = $885.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,2123.3600,318.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1911.02,,,,,,,548.0400,2123.3600,percent of total billed charges,"90% of $2,123.36 in Billed Charges for Rev 272 = $1,911.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,2123.3600,318.5000,MEDCOST,MEDCOST VHN,1010.51,,,,,,,548.0400,2123.3600,percent of total billed charges,"47.59% of $2,123.36 in Billed Charges for Rev 272 = $1,010.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,2123.3600,318.5000,SENTARA HEALTH,SENTARA HEALTH,548.04,,,,,,,548.0400,2123.3600,percent of total billed charges,"25.81% of $2,123.36 in Billed Charges for Rev 272 = $548.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,2123.3600,318.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2123.36,,,,,,,548.0400,2123.3600,percent of total billed charges,"100% of $2,123.36 in Billed Charges for Rev 272 = $2,123.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,2123.3600,318.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1061.68,,,,,,,548.0400,2123.3600,percent of total billed charges,"Rev 272 $2,123.36 in Billed Charges at 50% = $1,061.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,2123.3600,318.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,685.85,,,,,,,548.0400,2123.3600,other,"32.3% of $2,123.36 in Billed Charges for Rev 272 = $685.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,2123.3600,318.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,651.87,,,,,,,548.0400,2123.3600,other,"30.7% of $2,123.36 in Billed Charges for Rev 272 = $651.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,2123.3600,318.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,685.85,,,,,,,548.0400,2123.3600,percent of total billed charges,"32.3% of $2,123.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER PROXIMATE LINEAR TCT10,272,RC,27200002,CDM,,,,,,both,,,2123.3600,318.5000,WELLCARE,WELLCARE MEDICAID,2123.36,,,,,,,548.0400,2123.3600,percent of total billed charges,"100% of $2,123.36 in Billed Charges for Rev 272 = $2,123.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER QUINTON TITANIUM EXTENDER ADULT,272,RC,27200002,CDM,,,,,,both,,,869.7100,130.4600,AETNA,AETNA,371.37,,,,,,,224.4700,869.7100,percent of total billed charges,42.7% of $869.71 in Billed Charges for Rev 272 = $371.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER QUINTON TITANIUM EXTENDER ADULT,272,RC,27200002,CDM,,,,,,both,,,869.7100,130.4600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,608.80,,,,,,,224.4700,869.7100,percent of total billed charges,Rev 272 $869.71 in Billed Charges at 70% = $608.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER QUINTON TITANIUM EXTENDER ADULT,272,RC,27200002,CDM,,,,,,both,,,869.7100,130.4600,CIGNA HEALTHCARE,CIGNA HMO,362.67,,,,,,,224.4700,869.7100,percent of total billed charges,41.7% of $869.71 in Billed Charges for Rev 272 = $362.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER QUINTON TITANIUM EXTENDER ADULT,272,RC,27200002,CDM,,,,,,both,,,869.7100,130.4600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,403.55,,,,,,,224.4700,869.7100,percent of total billed charges,46.4% of $869.71 in Billed Charges for Rev 272 = $403.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER QUINTON TITANIUM EXTENDER ADULT,272,RC,27200002,CDM,,,,,,both,,,869.7100,130.4600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,362.67,,,,,,,224.4700,869.7100,percent of total billed charges,41.7% of $869.71 in Billed Charges for Rev 272 = $362.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER QUINTON TITANIUM EXTENDER ADULT,272,RC,27200002,CDM,,,,,,both,,,869.7100,130.4600,CIGNA HEALTHCARE,CIGNA PPO,362.67,,,,,,,224.4700,869.7100,percent of total billed charges,41.7% of $869.71 in Billed Charges for Rev 272 = $362.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER QUINTON TITANIUM EXTENDER ADULT,272,RC,27200002,CDM,,,,,,both,,,869.7100,130.4600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,782.74,,,,,,,224.4700,869.7100,percent of total billed charges,90% of $869.71 in Billed Charges for Rev 272 = $782.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER QUINTON TITANIUM EXTENDER ADULT,272,RC,27200002,CDM,,,,,,both,,,869.7100,130.4600,MEDCOST,MEDCOST VHN,413.90,,,,,,,224.4700,869.7100,percent of total billed charges,47.59% of $869.71 in Billed Charges for Rev 272 = $413.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER QUINTON TITANIUM EXTENDER ADULT,272,RC,27200002,CDM,,,,,,both,,,869.7100,130.4600,SENTARA HEALTH,SENTARA HEALTH,224.47,,,,,,,224.4700,869.7100,percent of total billed charges,25.81% of $869.71 in Billed Charges for Rev 272 = $224.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER QUINTON TITANIUM EXTENDER ADULT,272,RC,27200002,CDM,,,,,,both,,,869.7100,130.4600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",869.71,,,,,,,224.4700,869.7100,percent of total billed charges,100% of $869.71 in Billed Charges for Rev 272 = $869.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER QUINTON TITANIUM EXTENDER ADULT,272,RC,27200002,CDM,,,,,,both,,,869.7100,130.4600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,434.86,,,,,,,224.4700,869.7100,percent of total billed charges,Rev 272 $869.71 in Billed Charges at 50% = $434.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER QUINTON TITANIUM EXTENDER ADULT,272,RC,27200002,CDM,,,,,,both,,,869.7100,130.4600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,280.92,,,,,,,224.4700,869.7100,other,32.3% of $869.71 in Billed Charges for Rev 272 = $280.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATHETER QUINTON TITANIUM EXTENDER ADULT,272,RC,27200002,CDM,,,,,,both,,,869.7100,130.4600,UNITED HEALTHCARE,UHC HERITAGE SELECT,267.00,,,,,,,224.4700,869.7100,other,30.7% of $869.71 in Billed Charges for Rev 272 = $267.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATHETER QUINTON TITANIUM EXTENDER ADULT,272,RC,27200002,CDM,,,,,,both,,,869.7100,130.4600,UNITED HEALTHCARE,UNITED HEALTHCARE,280.92,,,,,,,224.4700,869.7100,percent of total billed charges,32.3% of $869.71 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER QUINTON TITANIUM EXTENDER ADULT,272,RC,27200002,CDM,,,,,,both,,,869.7100,130.4600,WELLCARE,WELLCARE MEDICAID,869.71,,,,,,,224.4700,869.7100,percent of total billed charges,100% of $869.71 in Billed Charges for Rev 272 = $869.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUTTER RND 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2318.7500,347.8100,AETNA,AETNA,990.11,,,,,,,598.4700,2318.7500,percent of total billed charges,"42.7% of $2,318.75 in Billed Charges for Rev 272 = $990.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2318.7500,347.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1623.13,,,,,,,598.4700,2318.7500,percent of total billed charges,"Rev 272 $2,318.75 in Billed Charges at 70% = $1,623.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2318.7500,347.8100,CIGNA HEALTHCARE,CIGNA HMO,966.92,,,,,,,598.4700,2318.7500,percent of total billed charges,"41.7% of $2,318.75 in Billed Charges for Rev 272 = $966.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2318.7500,347.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1075.90,,,,,,,598.4700,2318.7500,percent of total billed charges,"46.4% of $2,318.75 in Billed Charges for Rev 272 = $1,075.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2318.7500,347.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,966.92,,,,,,,598.4700,2318.7500,percent of total billed charges,"41.7% of $2,318.75 in Billed Charges for Rev 272 = $966.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2318.7500,347.8100,CIGNA HEALTHCARE,CIGNA PPO,966.92,,,,,,,598.4700,2318.7500,percent of total billed charges,"41.7% of $2,318.75 in Billed Charges for Rev 272 = $966.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2318.7500,347.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2086.88,,,,,,,598.4700,2318.7500,percent of total billed charges,"90% of $2,318.75 in Billed Charges for Rev 272 = $2,086.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2318.7500,347.8100,MEDCOST,MEDCOST VHN,1103.49,,,,,,,598.4700,2318.7500,percent of total billed charges,"47.59% of $2,318.75 in Billed Charges for Rev 272 = $1,103.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2318.7500,347.8100,SENTARA HEALTH,SENTARA HEALTH,598.47,,,,,,,598.4700,2318.7500,percent of total billed charges,"25.81% of $2,318.75 in Billed Charges for Rev 272 = $598.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2318.7500,347.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2318.75,,,,,,,598.4700,2318.7500,percent of total billed charges,"100% of $2,318.75 in Billed Charges for Rev 272 = $2,318.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2318.7500,347.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1159.38,,,,,,,598.4700,2318.7500,percent of total billed charges,"Rev 272 $2,318.75 in Billed Charges at 50% = $1,159.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2318.7500,347.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,748.96,,,,,,,598.4700,2318.7500,other,"32.3% of $2,318.75 in Billed Charges for Rev 272 = $748.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTER RND 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2318.7500,347.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,711.86,,,,,,,598.4700,2318.7500,other,"30.7% of $2,318.75 in Billed Charges for Rev 272 = $711.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTER RND 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2318.7500,347.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,748.96,,,,,,,598.4700,2318.7500,percent of total billed charges,"32.3% of $2,318.75 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER RND 4.0MM,272,RC,27200002,CDM,,,,,,both,,,2318.7500,347.8100,WELLCARE,WELLCARE MEDICAID,2318.75,,,,,,,598.4700,2318.7500,percent of total billed charges,"100% of $2,318.75 in Billed Charges for Rev 272 = $2,318.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE KNOT PUSHER AR-5845,272,RC,27200002,CDM,,,,,,both,,,2717.2000,407.5800,AETNA,AETNA,1160.24,,,,,,,701.3100,2717.2000,percent of total billed charges,"42.7% of $2,717.20 in Billed Charges for Rev 272 = $1,160.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE KNOT PUSHER AR-5845,272,RC,27200002,CDM,,,,,,both,,,2717.2000,407.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1902.04,,,,,,,701.3100,2717.2000,percent of total billed charges,"Rev 272 $2,717.20 in Billed Charges at 70% = $1,902.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE KNOT PUSHER AR-5845,272,RC,27200002,CDM,,,,,,both,,,2717.2000,407.5800,CIGNA HEALTHCARE,CIGNA HMO,1133.07,,,,,,,701.3100,2717.2000,percent of total billed charges,"41.7% of $2,717.20 in Billed Charges for Rev 272 = $1,133.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE KNOT PUSHER AR-5845,272,RC,27200002,CDM,,,,,,both,,,2717.2000,407.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1260.78,,,,,,,701.3100,2717.2000,percent of total billed charges,"46.4% of $2,717.20 in Billed Charges for Rev 272 = $1,260.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE KNOT PUSHER AR-5845,272,RC,27200002,CDM,,,,,,both,,,2717.2000,407.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1133.07,,,,,,,701.3100,2717.2000,percent of total billed charges,"41.7% of $2,717.20 in Billed Charges for Rev 272 = $1,133.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE KNOT PUSHER AR-5845,272,RC,27200002,CDM,,,,,,both,,,2717.2000,407.5800,CIGNA HEALTHCARE,CIGNA PPO,1133.07,,,,,,,701.3100,2717.2000,percent of total billed charges,"41.7% of $2,717.20 in Billed Charges for Rev 272 = $1,133.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE KNOT PUSHER AR-5845,272,RC,27200002,CDM,,,,,,both,,,2717.2000,407.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2445.48,,,,,,,701.3100,2717.2000,percent of total billed charges,"90% of $2,717.20 in Billed Charges for Rev 272 = $2,445.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE KNOT PUSHER AR-5845,272,RC,27200002,CDM,,,,,,both,,,2717.2000,407.5800,MEDCOST,MEDCOST VHN,1293.12,,,,,,,701.3100,2717.2000,percent of total billed charges,"47.59% of $2,717.20 in Billed Charges for Rev 272 = $1,293.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE KNOT PUSHER AR-5845,272,RC,27200002,CDM,,,,,,both,,,2717.2000,407.5800,SENTARA HEALTH,SENTARA HEALTH,701.31,,,,,,,701.3100,2717.2000,percent of total billed charges,"25.81% of $2,717.20 in Billed Charges for Rev 272 = $701.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE KNOT PUSHER AR-5845,272,RC,27200002,CDM,,,,,,both,,,2717.2000,407.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2717.20,,,,,,,701.3100,2717.2000,percent of total billed charges,"100% of $2,717.20 in Billed Charges for Rev 272 = $2,717.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE KNOT PUSHER AR-5845,272,RC,27200002,CDM,,,,,,both,,,2717.2000,407.5800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1358.60,,,,,,,701.3100,2717.2000,percent of total billed charges,"Rev 272 $2,717.20 in Billed Charges at 50% = $1,358.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE KNOT PUSHER AR-5845,272,RC,27200002,CDM,,,,,,both,,,2717.2000,407.5800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,877.66,,,,,,,701.3100,2717.2000,other,"32.3% of $2,717.20 in Billed Charges for Rev 272 = $877.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTER SUTURE KNOT PUSHER AR-5845,272,RC,27200002,CDM,,,,,,both,,,2717.2000,407.5800,UNITED HEALTHCARE,UHC HERITAGE SELECT,834.18,,,,,,,701.3100,2717.2000,other,"30.7% of $2,717.20 in Billed Charges for Rev 272 = $834.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTER SUTURE KNOT PUSHER AR-5845,272,RC,27200002,CDM,,,,,,both,,,2717.2000,407.5800,UNITED HEALTHCARE,UNITED HEALTHCARE,877.66,,,,,,,701.3100,2717.2000,percent of total billed charges,"32.3% of $2,717.20 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER SUTURE KNOT PUSHER AR-5845,272,RC,27200002,CDM,,,,,,both,,,2717.2000,407.5800,WELLCARE,WELLCARE MEDICAID,2717.20,,,,,,,701.3100,2717.2000,percent of total billed charges,"100% of $2,717.20 in Billed Charges for Rev 272 = $2,717.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,21986.5200,3297.9800,AETNA,AETNA,9388.24,,,,,,,5674.7200,21986.5200,percent of total billed charges,"42.7% of $21,986.52 in Billed Charges for Rev 272 = $9,388.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,21986.5200,3297.9800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,15390.56,,,,,,,5674.7200,21986.5200,percent of total billed charges,"Rev 272 $21,986.52 in Billed Charges at 70% = $15,390.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,21986.5200,3297.9800,CIGNA HEALTHCARE,CIGNA HMO,9168.38,,,,,,,5674.7200,21986.5200,percent of total billed charges,"41.7% of $21,986.52 in Billed Charges for Rev 272 = $9,168.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,21986.5200,3297.9800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10201.75,,,,,,,5674.7200,21986.5200,percent of total billed charges,"46.4% of $21,986.52 in Billed Charges for Rev 272 = $10,201.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,21986.5200,3297.9800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9168.38,,,,,,,5674.7200,21986.5200,percent of total billed charges,"41.7% of $21,986.52 in Billed Charges for Rev 272 = $9,168.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,21986.5200,3297.9800,CIGNA HEALTHCARE,CIGNA PPO,9168.38,,,,,,,5674.7200,21986.5200,percent of total billed charges,"41.7% of $21,986.52 in Billed Charges for Rev 272 = $9,168.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,21986.5200,3297.9800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,19787.87,,,,,,,5674.7200,21986.5200,percent of total billed charges,"90% of $21,986.52 in Billed Charges for Rev 272 = $19,787.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,21986.5200,3297.9800,MEDCOST,MEDCOST VHN,10463.38,,,,,,,5674.7200,21986.5200,percent of total billed charges,"47.59% of $21,986.52 in Billed Charges for Rev 272 = $10,463.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,21986.5200,3297.9800,SENTARA HEALTH,SENTARA HEALTH,5674.72,,,,,,,5674.7200,21986.5200,percent of total billed charges,"25.81% of $21,986.52 in Billed Charges for Rev 272 = $5,674.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,21986.5200,3297.9800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",21986.52,,,,,,,5674.7200,21986.5200,percent of total billed charges,"100% of $21,986.52 in Billed Charges for Rev 272 = $21,986.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,21986.5200,3297.9800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,10993.26,,,,,,,5674.7200,21986.5200,percent of total billed charges,"Rev 272 $21,986.52 in Billed Charges at 50% = $10,993.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,21986.5200,3297.9800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7101.65,,,,,,,5674.7200,21986.5200,other,"32.3% of $21,986.52 in Billed Charges for Rev 272 = $7,101.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,21986.5200,3297.9800,UNITED HEALTHCARE,UHC HERITAGE SELECT,6749.86,,,,,,,5674.7200,21986.5200,other,"30.7% of $21,986.52 in Billed Charges for Rev 272 = $6,749.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,21986.5200,3297.9800,UNITED HEALTHCARE,UNITED HEALTHCARE,7101.65,,,,,,,5674.7200,21986.5200,percent of total billed charges,"32.3% of $21,986.52 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,21986.5200,3297.9800,WELLCARE,WELLCARE MEDICAID,21986.52,,,,,,,5674.7200,21986.5200,percent of total billed charges,"100% of $21,986.52 in Billed Charges for Rev 272 = $21,986.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELINEATOR ADVINCULA 2.5CM ULTEM PLASTIC CUP,272,RC,27200002,CDM,,,,,,both,,,3369.3700,505.4100,AETNA,AETNA,1438.72,,,,,,,869.6300,3369.3700,percent of total billed charges,"42.7% of $3,369.37 in Billed Charges for Rev 272 = $1,438.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELINEATOR ADVINCULA 2.5CM ULTEM PLASTIC CUP,272,RC,27200002,CDM,,,,,,both,,,3369.3700,505.4100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2358.56,,,,,,,869.6300,3369.3700,percent of total billed charges,"Rev 272 $3,369.37 in Billed Charges at 70% = $2,358.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELINEATOR ADVINCULA 2.5CM ULTEM PLASTIC CUP,272,RC,27200002,CDM,,,,,,both,,,3369.3700,505.4100,CIGNA HEALTHCARE,CIGNA HMO,1405.03,,,,,,,869.6300,3369.3700,percent of total billed charges,"41.7% of $3,369.37 in Billed Charges for Rev 272 = $1,405.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELINEATOR ADVINCULA 2.5CM ULTEM PLASTIC CUP,272,RC,27200002,CDM,,,,,,both,,,3369.3700,505.4100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1563.39,,,,,,,869.6300,3369.3700,percent of total billed charges,"46.4% of $3,369.37 in Billed Charges for Rev 272 = $1,563.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELINEATOR ADVINCULA 2.5CM ULTEM PLASTIC CUP,272,RC,27200002,CDM,,,,,,both,,,3369.3700,505.4100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1405.03,,,,,,,869.6300,3369.3700,percent of total billed charges,"41.7% of $3,369.37 in Billed Charges for Rev 272 = $1,405.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELINEATOR ADVINCULA 2.5CM ULTEM PLASTIC CUP,272,RC,27200002,CDM,,,,,,both,,,3369.3700,505.4100,CIGNA HEALTHCARE,CIGNA PPO,1405.03,,,,,,,869.6300,3369.3700,percent of total billed charges,"41.7% of $3,369.37 in Billed Charges for Rev 272 = $1,405.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELINEATOR ADVINCULA 2.5CM ULTEM PLASTIC CUP,272,RC,27200002,CDM,,,,,,both,,,3369.3700,505.4100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3032.43,,,,,,,869.6300,3369.3700,percent of total billed charges,"90% of $3,369.37 in Billed Charges for Rev 272 = $3,032.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELINEATOR ADVINCULA 2.5CM ULTEM PLASTIC CUP,272,RC,27200002,CDM,,,,,,both,,,3369.3700,505.4100,MEDCOST,MEDCOST VHN,1603.48,,,,,,,869.6300,3369.3700,percent of total billed charges,"47.59% of $3,369.37 in Billed Charges for Rev 272 = $1,603.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELINEATOR ADVINCULA 2.5CM ULTEM PLASTIC CUP,272,RC,27200002,CDM,,,,,,both,,,3369.3700,505.4100,SENTARA HEALTH,SENTARA HEALTH,869.63,,,,,,,869.6300,3369.3700,percent of total billed charges,"25.81% of $3,369.37 in Billed Charges for Rev 272 = $869.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELINEATOR ADVINCULA 2.5CM ULTEM PLASTIC CUP,272,RC,27200002,CDM,,,,,,both,,,3369.3700,505.4100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3369.37,,,,,,,869.6300,3369.3700,percent of total billed charges,"100% of $3,369.37 in Billed Charges for Rev 272 = $3,369.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELINEATOR ADVINCULA 2.5CM ULTEM PLASTIC CUP,272,RC,27200002,CDM,,,,,,both,,,3369.3700,505.4100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1684.69,,,,,,,869.6300,3369.3700,percent of total billed charges,"Rev 272 $3,369.37 in Billed Charges at 50% = $1,684.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELINEATOR ADVINCULA 2.5CM ULTEM PLASTIC CUP,272,RC,27200002,CDM,,,,,,both,,,3369.3700,505.4100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1088.31,,,,,,,869.6300,3369.3700,other,"32.3% of $3,369.37 in Billed Charges for Rev 272 = $1,088.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DELINEATOR ADVINCULA 2.5CM ULTEM PLASTIC CUP,272,RC,27200002,CDM,,,,,,both,,,3369.3700,505.4100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1034.40,,,,,,,869.6300,3369.3700,other,"30.7% of $3,369.37 in Billed Charges for Rev 272 = $1,034.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DELINEATOR ADVINCULA 2.5CM ULTEM PLASTIC CUP,272,RC,27200002,CDM,,,,,,both,,,3369.3700,505.4100,UNITED HEALTHCARE,UNITED HEALTHCARE,1088.31,,,,,,,869.6300,3369.3700,percent of total billed charges,"32.3% of $3,369.37 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELINEATOR ADVINCULA 2.5CM ULTEM PLASTIC CUP,272,RC,27200002,CDM,,,,,,both,,,3369.3700,505.4100,WELLCARE,WELLCARE MEDICAID,3369.37,,,,,,,869.6300,3369.3700,percent of total billed charges,"100% of $3,369.37 in Billed Charges for Rev 272 = $3,369.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT DELIVERY GUN,272,RC,27200002,CDM,,,,,,both,,,3786.9700,568.0500,AETNA,AETNA,1617.04,,,,,,,977.4200,3786.9700,percent of total billed charges,"42.7% of $3,786.97 in Billed Charges for Rev 272 = $1,617.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT DELIVERY GUN,272,RC,27200002,CDM,,,,,,both,,,3786.9700,568.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2650.88,,,,,,,977.4200,3786.9700,percent of total billed charges,"Rev 272 $3,786.97 in Billed Charges at 70% = $2,650.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT DELIVERY GUN,272,RC,27200002,CDM,,,,,,both,,,3786.9700,568.0500,CIGNA HEALTHCARE,CIGNA HMO,1579.17,,,,,,,977.4200,3786.9700,percent of total billed charges,"41.7% of $3,786.97 in Billed Charges for Rev 272 = $1,579.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT DELIVERY GUN,272,RC,27200002,CDM,,,,,,both,,,3786.9700,568.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1757.15,,,,,,,977.4200,3786.9700,percent of total billed charges,"46.4% of $3,786.97 in Billed Charges for Rev 272 = $1,757.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT DELIVERY GUN,272,RC,27200002,CDM,,,,,,both,,,3786.9700,568.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1579.17,,,,,,,977.4200,3786.9700,percent of total billed charges,"41.7% of $3,786.97 in Billed Charges for Rev 272 = $1,579.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT DELIVERY GUN,272,RC,27200002,CDM,,,,,,both,,,3786.9700,568.0500,CIGNA HEALTHCARE,CIGNA PPO,1579.17,,,,,,,977.4200,3786.9700,percent of total billed charges,"41.7% of $3,786.97 in Billed Charges for Rev 272 = $1,579.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT DELIVERY GUN,272,RC,27200002,CDM,,,,,,both,,,3786.9700,568.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3408.27,,,,,,,977.4200,3786.9700,percent of total billed charges,"90% of $3,786.97 in Billed Charges for Rev 272 = $3,408.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT DELIVERY GUN,272,RC,27200002,CDM,,,,,,both,,,3786.9700,568.0500,MEDCOST,MEDCOST VHN,1802.22,,,,,,,977.4200,3786.9700,percent of total billed charges,"47.59% of $3,786.97 in Billed Charges for Rev 272 = $1,802.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT DELIVERY GUN,272,RC,27200002,CDM,,,,,,both,,,3786.9700,568.0500,SENTARA HEALTH,SENTARA HEALTH,977.42,,,,,,,977.4200,3786.9700,percent of total billed charges,"25.81% of $3,786.97 in Billed Charges for Rev 272 = $977.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT DELIVERY GUN,272,RC,27200002,CDM,,,,,,both,,,3786.9700,568.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3786.97,,,,,,,977.4200,3786.9700,percent of total billed charges,"100% of $3,786.97 in Billed Charges for Rev 272 = $3,786.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT DELIVERY GUN,272,RC,27200002,CDM,,,,,,both,,,3786.9700,568.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1893.49,,,,,,,977.4200,3786.9700,percent of total billed charges,"Rev 272 $3,786.97 in Billed Charges at 50% = $1,893.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT DELIVERY GUN,272,RC,27200002,CDM,,,,,,both,,,3786.9700,568.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1223.19,,,,,,,977.4200,3786.9700,other,"32.3% of $3,786.97 in Billed Charges for Rev 272 = $1,223.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CEMENT DELIVERY GUN,272,RC,27200002,CDM,,,,,,both,,,3786.9700,568.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1162.60,,,,,,,977.4200,3786.9700,other,"30.7% of $3,786.97 in Billed Charges for Rev 272 = $1,162.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CEMENT DELIVERY GUN,272,RC,27200002,CDM,,,,,,both,,,3786.9700,568.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,1223.19,,,,,,,977.4200,3786.9700,percent of total billed charges,"32.3% of $3,786.97 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT DELIVERY GUN,272,RC,27200002,CDM,,,,,,both,,,3786.9700,568.0500,WELLCARE,WELLCARE MEDICAID,3786.97,,,,,,,977.4200,3786.9700,percent of total billed charges,"100% of $3,786.97 in Billed Charges for Rev 272 = $3,786.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT OTOLOOGIC PROCEM,272,RC,,,,,,,,both,,,4770.6600,715.6000,AETNA,AETNA,2037.07,,,,,,,1231.3100,4770.6600,percent of total billed charges,"42.7% of $4,770.66 in Billed Charges for Rev 272 = $2,037.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT OTOLOOGIC PROCEM,272,RC,,,,,,,,both,,,4770.6600,715.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3339.46,,,,,,,1231.3100,4770.6600,percent of total billed charges,"Rev 272 $4,770.66 in Billed Charges at 70% = $3,339.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT OTOLOOGIC PROCEM,272,RC,,,,,,,,both,,,4770.6600,715.6000,CIGNA HEALTHCARE,CIGNA HMO,1989.37,,,,,,,1231.3100,4770.6600,percent of total billed charges,"41.7% of $4,770.66 in Billed Charges for Rev 272 = $1,989.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT OTOLOOGIC PROCEM,272,RC,,,,,,,,both,,,4770.6600,715.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2213.59,,,,,,,1231.3100,4770.6600,percent of total billed charges,"46.4% of $4,770.66 in Billed Charges for Rev 272 = $2,213.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT OTOLOOGIC PROCEM,272,RC,,,,,,,,both,,,4770.6600,715.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1989.37,,,,,,,1231.3100,4770.6600,percent of total billed charges,"41.7% of $4,770.66 in Billed Charges for Rev 272 = $1,989.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT OTOLOOGIC PROCEM,272,RC,,,,,,,,both,,,4770.6600,715.6000,CIGNA HEALTHCARE,CIGNA PPO,1989.37,,,,,,,1231.3100,4770.6600,percent of total billed charges,"41.7% of $4,770.66 in Billed Charges for Rev 272 = $1,989.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT OTOLOOGIC PROCEM,272,RC,,,,,,,,both,,,4770.6600,715.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4293.59,,,,,,,1231.3100,4770.6600,percent of total billed charges,"90% of $4,770.66 in Billed Charges for Rev 272 = $4,293.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT OTOLOOGIC PROCEM,272,RC,,,,,,,,both,,,4770.6600,715.6000,MEDCOST,MEDCOST VHN,2270.36,,,,,,,1231.3100,4770.6600,percent of total billed charges,"47.59% of $4,770.66 in Billed Charges for Rev 272 = $2,270.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT OTOLOOGIC PROCEM,272,RC,,,,,,,,both,,,4770.6600,715.6000,SENTARA HEALTH,SENTARA HEALTH,1231.31,,,,,,,1231.3100,4770.6600,percent of total billed charges,"25.81% of $4,770.66 in Billed Charges for Rev 272 = $1,231.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT OTOLOOGIC PROCEM,272,RC,,,,,,,,both,,,4770.6600,715.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4770.66,,,,,,,1231.3100,4770.6600,percent of total billed charges,"100% of $4,770.66 in Billed Charges for Rev 272 = $4,770.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT OTOLOOGIC PROCEM,272,RC,,,,,,,,both,,,4770.6600,715.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2385.33,,,,,,,1231.3100,4770.6600,percent of total billed charges,"Rev 272 $4,770.66 in Billed Charges at 50% = $2,385.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT OTOLOOGIC PROCEM,272,RC,,,,,,,,both,,,4770.6600,715.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1540.92,,,,,,,1231.3100,4770.6600,other,"32.3% of $4,770.66 in Billed Charges for Rev 272 = $1,540.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CEMENT OTOLOOGIC PROCEM,272,RC,,,,,,,,both,,,4770.6600,715.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1464.59,,,,,,,1231.3100,4770.6600,other,"30.7% of $4,770.66 in Billed Charges for Rev 272 = $1,464.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CEMENT OTOLOOGIC PROCEM,272,RC,,,,,,,,both,,,4770.6600,715.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,1540.92,,,,,,,1231.3100,4770.6600,percent of total billed charges,"32.3% of $4,770.66 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT OTOLOOGIC PROCEM,272,RC,,,,,,,,both,,,4770.6600,715.6000,WELLCARE,WELLCARE MEDICAID,4770.66,,,,,,,1231.3100,4770.6600,percent of total billed charges,"100% of $4,770.66 in Billed Charges for Rev 272 = $4,770.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,27200002,CDM,,,,,,both,,,8763.5000,1314.5300,AETNA,AETNA,3742.01,,,,,,,2261.8600,8763.5000,percent of total billed charges,"42.7% of $8,763.50 in Billed Charges for Rev 272 = $3,742.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,27200002,CDM,,,,,,both,,,8763.5000,1314.5300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6134.45,,,,,,,2261.8600,8763.5000,percent of total billed charges,"Rev 272 $8,763.50 in Billed Charges at 70% = $6,134.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,27200002,CDM,,,,,,both,,,8763.5000,1314.5300,CIGNA HEALTHCARE,CIGNA HMO,3654.38,,,,,,,2261.8600,8763.5000,percent of total billed charges,"41.7% of $8,763.50 in Billed Charges for Rev 272 = $3,654.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,27200002,CDM,,,,,,both,,,8763.5000,1314.5300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4066.26,,,,,,,2261.8600,8763.5000,percent of total billed charges,"46.4% of $8,763.50 in Billed Charges for Rev 272 = $4,066.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,27200002,CDM,,,,,,both,,,8763.5000,1314.5300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3654.38,,,,,,,2261.8600,8763.5000,percent of total billed charges,"41.7% of $8,763.50 in Billed Charges for Rev 272 = $3,654.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,27200002,CDM,,,,,,both,,,8763.5000,1314.5300,CIGNA HEALTHCARE,CIGNA PPO,3654.38,,,,,,,2261.8600,8763.5000,percent of total billed charges,"41.7% of $8,763.50 in Billed Charges for Rev 272 = $3,654.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,27200002,CDM,,,,,,both,,,8763.5000,1314.5300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7887.15,,,,,,,2261.8600,8763.5000,percent of total billed charges,"90% of $8,763.50 in Billed Charges for Rev 272 = $7,887.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,27200002,CDM,,,,,,both,,,8763.5000,1314.5300,MEDCOST,MEDCOST VHN,4170.55,,,,,,,2261.8600,8763.5000,percent of total billed charges,"47.59% of $8,763.50 in Billed Charges for Rev 272 = $4,170.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,27200002,CDM,,,,,,both,,,8763.5000,1314.5300,SENTARA HEALTH,SENTARA HEALTH,2261.86,,,,,,,2261.8600,8763.5000,percent of total billed charges,"25.81% of $8,763.50 in Billed Charges for Rev 272 = $2,261.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,27200002,CDM,,,,,,both,,,8763.5000,1314.5300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8763.50,,,,,,,2261.8600,8763.5000,percent of total billed charges,"100% of $8,763.50 in Billed Charges for Rev 272 = $8,763.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,27200002,CDM,,,,,,both,,,8763.5000,1314.5300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4381.75,,,,,,,2261.8600,8763.5000,percent of total billed charges,"Rev 272 $8,763.50 in Billed Charges at 50% = $4,381.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,27200002,CDM,,,,,,both,,,8763.5000,1314.5300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2830.61,,,,,,,2261.8600,8763.5000,other,"32.3% of $8,763.50 in Billed Charges for Rev 272 = $2,830.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CHARGING SYSTEM,272,RC,27200002,CDM,,,,,,both,,,8763.5000,1314.5300,UNITED HEALTHCARE,UHC HERITAGE SELECT,2690.39,,,,,,,2261.8600,8763.5000,other,"30.7% of $8,763.50 in Billed Charges for Rev 272 = $2,690.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CHARGING SYSTEM,272,RC,27200002,CDM,,,,,,both,,,8763.5000,1314.5300,UNITED HEALTHCARE,UNITED HEALTHCARE,2830.61,,,,,,,2261.8600,8763.5000,percent of total billed charges,"32.3% of $8,763.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CHARGING SYSTEM,272,RC,27200002,CDM,,,,,,both,,,8763.5000,1314.5300,WELLCARE,WELLCARE MEDICAID,8763.50,,,,,,,2261.8600,8763.5000,percent of total billed charges,"100% of $8,763.50 in Billed Charges for Rev 272 = $8,763.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE LARGE,272,RC,,,,,,,,both,,,4241.7400,636.2600,AETNA,AETNA,1811.22,,,,,,,1094.7900,4241.7400,percent of total billed charges,"42.7% of $4,241.74 in Billed Charges for Rev 272 = $1,811.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE LARGE,272,RC,,,,,,,,both,,,4241.7400,636.2600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2969.22,,,,,,,1094.7900,4241.7400,percent of total billed charges,"Rev 272 $4,241.74 in Billed Charges at 70% = $2,969.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE LARGE,272,RC,,,,,,,,both,,,4241.7400,636.2600,CIGNA HEALTHCARE,CIGNA HMO,1768.81,,,,,,,1094.7900,4241.7400,percent of total billed charges,"41.7% of $4,241.74 in Billed Charges for Rev 272 = $1,768.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE LARGE,272,RC,,,,,,,,both,,,4241.7400,636.2600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1968.17,,,,,,,1094.7900,4241.7400,percent of total billed charges,"46.4% of $4,241.74 in Billed Charges for Rev 272 = $1,968.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE LARGE,272,RC,,,,,,,,both,,,4241.7400,636.2600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1768.81,,,,,,,1094.7900,4241.7400,percent of total billed charges,"41.7% of $4,241.74 in Billed Charges for Rev 272 = $1,768.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE LARGE,272,RC,,,,,,,,both,,,4241.7400,636.2600,CIGNA HEALTHCARE,CIGNA PPO,1768.81,,,,,,,1094.7900,4241.7400,percent of total billed charges,"41.7% of $4,241.74 in Billed Charges for Rev 272 = $1,768.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE LARGE,272,RC,,,,,,,,both,,,4241.7400,636.2600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3817.57,,,,,,,1094.7900,4241.7400,percent of total billed charges,"90% of $4,241.74 in Billed Charges for Rev 272 = $3,817.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE LARGE,272,RC,,,,,,,,both,,,4241.7400,636.2600,MEDCOST,MEDCOST VHN,2018.64,,,,,,,1094.7900,4241.7400,percent of total billed charges,"47.59% of $4,241.74 in Billed Charges for Rev 272 = $2,018.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE LARGE,272,RC,,,,,,,,both,,,4241.7400,636.2600,SENTARA HEALTH,SENTARA HEALTH,1094.79,,,,,,,1094.7900,4241.7400,percent of total billed charges,"25.81% of $4,241.74 in Billed Charges for Rev 272 = $1,094.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE LARGE,272,RC,,,,,,,,both,,,4241.7400,636.2600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4241.74,,,,,,,1094.7900,4241.7400,percent of total billed charges,"100% of $4,241.74 in Billed Charges for Rev 272 = $4,241.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE LARGE,272,RC,,,,,,,,both,,,4241.7400,636.2600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2120.87,,,,,,,1094.7900,4241.7400,percent of total billed charges,"Rev 272 $4,241.74 in Billed Charges at 50% = $2,120.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE LARGE,272,RC,,,,,,,,both,,,4241.7400,636.2600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1370.08,,,,,,,1094.7900,4241.7400,other,"32.3% of $4,241.74 in Billed Charges for Rev 272 = $1,370.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DELIVERY SYSTEM BIOCARTILAGE LARGE,272,RC,,,,,,,,both,,,4241.7400,636.2600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1302.21,,,,,,,1094.7900,4241.7400,other,"30.7% of $4,241.74 in Billed Charges for Rev 272 = $1,302.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DELIVERY SYSTEM BIOCARTILAGE LARGE,272,RC,,,,,,,,both,,,4241.7400,636.2600,UNITED HEALTHCARE,UNITED HEALTHCARE,1370.08,,,,,,,1094.7900,4241.7400,percent of total billed charges,"32.3% of $4,241.74 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE LARGE,272,RC,,,,,,,,both,,,4241.7400,636.2600,WELLCARE,WELLCARE MEDICAID,4241.74,,,,,,,1094.7900,4241.7400,percent of total billed charges,"100% of $4,241.74 in Billed Charges for Rev 272 = $4,241.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE SMALL,272,RC,27200002,CDM,,,,,,both,,,3181.3000,477.2000,AETNA,AETNA,1358.42,,,,,,,821.0900,3181.3000,percent of total billed charges,"42.7% of $3,181.30 in Billed Charges for Rev 272 = $1,358.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE SMALL,272,RC,27200002,CDM,,,,,,both,,,3181.3000,477.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2226.91,,,,,,,821.0900,3181.3000,percent of total billed charges,"Rev 272 $3,181.30 in Billed Charges at 70% = $2,226.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE SMALL,272,RC,27200002,CDM,,,,,,both,,,3181.3000,477.2000,CIGNA HEALTHCARE,CIGNA HMO,1326.60,,,,,,,821.0900,3181.3000,percent of total billed charges,"41.7% of $3,181.30 in Billed Charges for Rev 272 = $1,326.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE SMALL,272,RC,27200002,CDM,,,,,,both,,,3181.3000,477.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1476.12,,,,,,,821.0900,3181.3000,percent of total billed charges,"46.4% of $3,181.30 in Billed Charges for Rev 272 = $1,476.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE SMALL,272,RC,27200002,CDM,,,,,,both,,,3181.3000,477.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1326.60,,,,,,,821.0900,3181.3000,percent of total billed charges,"41.7% of $3,181.30 in Billed Charges for Rev 272 = $1,326.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE SMALL,272,RC,27200002,CDM,,,,,,both,,,3181.3000,477.2000,CIGNA HEALTHCARE,CIGNA PPO,1326.60,,,,,,,821.0900,3181.3000,percent of total billed charges,"41.7% of $3,181.30 in Billed Charges for Rev 272 = $1,326.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE SMALL,272,RC,27200002,CDM,,,,,,both,,,3181.3000,477.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2863.17,,,,,,,821.0900,3181.3000,percent of total billed charges,"90% of $3,181.30 in Billed Charges for Rev 272 = $2,863.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE SMALL,272,RC,27200002,CDM,,,,,,both,,,3181.3000,477.2000,MEDCOST,MEDCOST VHN,1513.98,,,,,,,821.0900,3181.3000,percent of total billed charges,"47.59% of $3,181.30 in Billed Charges for Rev 272 = $1,513.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE SMALL,272,RC,27200002,CDM,,,,,,both,,,3181.3000,477.2000,SENTARA HEALTH,SENTARA HEALTH,821.09,,,,,,,821.0900,3181.3000,percent of total billed charges,"25.81% of $3,181.30 in Billed Charges for Rev 272 = $821.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE SMALL,272,RC,27200002,CDM,,,,,,both,,,3181.3000,477.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3181.30,,,,,,,821.0900,3181.3000,percent of total billed charges,"100% of $3,181.30 in Billed Charges for Rev 272 = $3,181.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE SMALL,272,RC,27200002,CDM,,,,,,both,,,3181.3000,477.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1590.65,,,,,,,821.0900,3181.3000,percent of total billed charges,"Rev 272 $3,181.30 in Billed Charges at 50% = $1,590.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE SMALL,272,RC,27200002,CDM,,,,,,both,,,3181.3000,477.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1027.56,,,,,,,821.0900,3181.3000,other,"32.3% of $3,181.30 in Billed Charges for Rev 272 = $1,027.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DELIVERY SYSTEM BIOCARTILAGE SMALL,272,RC,27200002,CDM,,,,,,both,,,3181.3000,477.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,976.66,,,,,,,821.0900,3181.3000,other,"30.7% of $3,181.30 in Billed Charges for Rev 272 = $976.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DELIVERY SYSTEM BIOCARTILAGE SMALL,272,RC,27200002,CDM,,,,,,both,,,3181.3000,477.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,1027.56,,,,,,,821.0900,3181.3000,percent of total billed charges,"32.3% of $3,181.30 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM BIOCARTILAGE SMALL,272,RC,27200002,CDM,,,,,,both,,,3181.3000,477.2000,WELLCARE,WELLCARE MEDICAID,3181.30,,,,,,,821.0900,3181.3000,percent of total billed charges,"100% of $3,181.30 in Billed Charges for Rev 272 = $3,181.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DELIVERY SYSTEM INJECTATE-COLD CO-SET 93600,272,RC,,,,,,,,both,,,648.0800,97.2100,AETNA,AETNA,276.73,,,,,,,167.2700,648.0800,percent of total billed charges,42.7% of $648.08 in Billed Charges for Rev 272 = $276.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DELIVERY SYSTEM INJECTATE-COLD CO-SET 93600,272,RC,,,,,,,,both,,,648.0800,97.2100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,453.66,,,,,,,167.2700,648.0800,percent of total billed charges,Rev 272 $648.08 in Billed Charges at 70% = $453.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DELIVERY SYSTEM INJECTATE-COLD CO-SET 93600,272,RC,,,,,,,,both,,,648.0800,97.2100,CIGNA HEALTHCARE,CIGNA HMO,270.25,,,,,,,167.2700,648.0800,percent of total billed charges,41.7% of $648.08 in Billed Charges for Rev 272 = $270.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DELIVERY SYSTEM INJECTATE-COLD CO-SET 93600,272,RC,,,,,,,,both,,,648.0800,97.2100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,300.71,,,,,,,167.2700,648.0800,percent of total billed charges,46.4% of $648.08 in Billed Charges for Rev 272 = $300.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DELIVERY SYSTEM INJECTATE-COLD CO-SET 93600,272,RC,,,,,,,,both,,,648.0800,97.2100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,270.25,,,,,,,167.2700,648.0800,percent of total billed charges,41.7% of $648.08 in Billed Charges for Rev 272 = $270.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DELIVERY SYSTEM INJECTATE-COLD CO-SET 93600,272,RC,,,,,,,,both,,,648.0800,97.2100,CIGNA HEALTHCARE,CIGNA PPO,270.25,,,,,,,167.2700,648.0800,percent of total billed charges,41.7% of $648.08 in Billed Charges for Rev 272 = $270.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DELIVERY SYSTEM INJECTATE-COLD CO-SET 93600,272,RC,,,,,,,,both,,,648.0800,97.2100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,583.27,,,,,,,167.2700,648.0800,percent of total billed charges,90% of $648.08 in Billed Charges for Rev 272 = $583.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DELIVERY SYSTEM INJECTATE-COLD CO-SET 93600,272,RC,,,,,,,,both,,,648.0800,97.2100,MEDCOST,MEDCOST VHN,308.42,,,,,,,167.2700,648.0800,percent of total billed charges,47.59% of $648.08 in Billed Charges for Rev 272 = $308.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DELIVERY SYSTEM INJECTATE-COLD CO-SET 93600,272,RC,,,,,,,,both,,,648.0800,97.2100,SENTARA HEALTH,SENTARA HEALTH,167.27,,,,,,,167.2700,648.0800,percent of total billed charges,25.81% of $648.08 in Billed Charges for Rev 272 = $167.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DELIVERY SYSTEM INJECTATE-COLD CO-SET 93600,272,RC,,,,,,,,both,,,648.0800,97.2100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",648.08,,,,,,,167.2700,648.0800,percent of total billed charges,100% of $648.08 in Billed Charges for Rev 272 = $648.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DELIVERY SYSTEM INJECTATE-COLD CO-SET 93600,272,RC,,,,,,,,both,,,648.0800,97.2100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,324.04,,,,,,,167.2700,648.0800,percent of total billed charges,Rev 272 $648.08 in Billed Charges at 50% = $324.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DELIVERY SYSTEM INJECTATE-COLD CO-SET 93600,272,RC,,,,,,,,both,,,648.0800,97.2100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,209.33,,,,,,,167.2700,648.0800,other,32.3% of $648.08 in Billed Charges for Rev 272 = $209.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DELIVERY SYSTEM INJECTATE-COLD CO-SET 93600,272,RC,,,,,,,,both,,,648.0800,97.2100,UNITED HEALTHCARE,UHC HERITAGE SELECT,198.96,,,,,,,167.2700,648.0800,other,30.7% of $648.08 in Billed Charges for Rev 272 = $198.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DELIVERY SYSTEM INJECTATE-COLD CO-SET 93600,272,RC,,,,,,,,both,,,648.0800,97.2100,UNITED HEALTHCARE,UNITED HEALTHCARE,209.33,,,,,,,167.2700,648.0800,percent of total billed charges,32.3% of $648.08 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DELIVERY SYSTEM INJECTATE-COLD CO-SET 93600,272,RC,,,,,,,,both,,,648.0800,97.2100,WELLCARE,WELLCARE MEDICAID,648.08,,,,,,,167.2700,648.0800,percent of total billed charges,100% of $648.08 in Billed Charges for Rev 272 = $648.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1494.3600,224.1500,AETNA,AETNA,638.09,,,,,,,385.6900,1494.3600,percent of total billed charges,"42.7% of $1,494.36 in Billed Charges for Rev 272 = $638.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1494.3600,224.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1046.05,,,,,,,385.6900,1494.3600,percent of total billed charges,"Rev 272 $1,494.36 in Billed Charges at 70% = $1,046.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1494.3600,224.1500,CIGNA HEALTHCARE,CIGNA HMO,623.15,,,,,,,385.6900,1494.3600,percent of total billed charges,"41.7% of $1,494.36 in Billed Charges for Rev 272 = $623.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1494.3600,224.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,693.38,,,,,,,385.6900,1494.3600,percent of total billed charges,"46.4% of $1,494.36 in Billed Charges for Rev 272 = $693.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1494.3600,224.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,623.15,,,,,,,385.6900,1494.3600,percent of total billed charges,"41.7% of $1,494.36 in Billed Charges for Rev 272 = $623.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1494.3600,224.1500,CIGNA HEALTHCARE,CIGNA PPO,623.15,,,,,,,385.6900,1494.3600,percent of total billed charges,"41.7% of $1,494.36 in Billed Charges for Rev 272 = $623.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1494.3600,224.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1344.92,,,,,,,385.6900,1494.3600,percent of total billed charges,"90% of $1,494.36 in Billed Charges for Rev 272 = $1,344.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1494.3600,224.1500,MEDCOST,MEDCOST VHN,711.17,,,,,,,385.6900,1494.3600,percent of total billed charges,"47.59% of $1,494.36 in Billed Charges for Rev 272 = $711.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1494.3600,224.1500,SENTARA HEALTH,SENTARA HEALTH,385.69,,,,,,,385.6900,1494.3600,percent of total billed charges,"25.81% of $1,494.36 in Billed Charges for Rev 272 = $385.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1494.3600,224.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1494.36,,,,,,,385.6900,1494.3600,percent of total billed charges,"100% of $1,494.36 in Billed Charges for Rev 272 = $1,494.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1494.3600,224.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,747.18,,,,,,,385.6900,1494.3600,percent of total billed charges,"Rev 272 $1,494.36 in Billed Charges at 50% = $747.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1494.3600,224.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,482.68,,,,,,,385.6900,1494.3600,other,"32.3% of $1,494.36 in Billed Charges for Rev 272 = $482.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1494.3600,224.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,458.77,,,,,,,385.6900,1494.3600,other,"30.7% of $1,494.36 in Billed Charges for Rev 272 = $458.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1494.3600,224.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,482.68,,,,,,,385.6900,1494.3600,percent of total billed charges,"32.3% of $1,494.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DERMABOND PRINEO SKIN CLOS,272,RC,27200002,CDM,,,,,,both,,,1494.3600,224.1500,WELLCARE,WELLCARE MEDICAID,1494.36,,,,,,,385.6900,1494.3600,percent of total billed charges,"100% of $1,494.36 in Billed Charges for Rev 272 = $1,494.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SURGICEL FIBRILLAR 2 X 4 1962,272,RC,27200002,CDM,,,,,,both,,,854.3300,128.1500,AETNA,AETNA,364.80,,,,,,,220.5000,854.3300,percent of total billed charges,42.7% of $854.33 in Billed Charges for Rev 272 = $364.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING SURGICEL FIBRILLAR 2 X 4 1962,272,RC,27200002,CDM,,,,,,both,,,854.3300,128.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,598.03,,,,,,,220.5000,854.3300,percent of total billed charges,Rev 272 $854.33 in Billed Charges at 70% = $598.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING SURGICEL FIBRILLAR 2 X 4 1962,272,RC,27200002,CDM,,,,,,both,,,854.3300,128.1500,CIGNA HEALTHCARE,CIGNA HMO,356.26,,,,,,,220.5000,854.3300,percent of total billed charges,41.7% of $854.33 in Billed Charges for Rev 272 = $356.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING SURGICEL FIBRILLAR 2 X 4 1962,272,RC,27200002,CDM,,,,,,both,,,854.3300,128.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,396.41,,,,,,,220.5000,854.3300,percent of total billed charges,46.4% of $854.33 in Billed Charges for Rev 272 = $396.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING SURGICEL FIBRILLAR 2 X 4 1962,272,RC,27200002,CDM,,,,,,both,,,854.3300,128.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,356.26,,,,,,,220.5000,854.3300,percent of total billed charges,41.7% of $854.33 in Billed Charges for Rev 272 = $356.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING SURGICEL FIBRILLAR 2 X 4 1962,272,RC,27200002,CDM,,,,,,both,,,854.3300,128.1500,CIGNA HEALTHCARE,CIGNA PPO,356.26,,,,,,,220.5000,854.3300,percent of total billed charges,41.7% of $854.33 in Billed Charges for Rev 272 = $356.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING SURGICEL FIBRILLAR 2 X 4 1962,272,RC,27200002,CDM,,,,,,both,,,854.3300,128.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,768.90,,,,,,,220.5000,854.3300,percent of total billed charges,90% of $854.33 in Billed Charges for Rev 272 = $768.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING SURGICEL FIBRILLAR 2 X 4 1962,272,RC,27200002,CDM,,,,,,both,,,854.3300,128.1500,MEDCOST,MEDCOST VHN,406.58,,,,,,,220.5000,854.3300,percent of total billed charges,47.59% of $854.33 in Billed Charges for Rev 272 = $406.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING SURGICEL FIBRILLAR 2 X 4 1962,272,RC,27200002,CDM,,,,,,both,,,854.3300,128.1500,SENTARA HEALTH,SENTARA HEALTH,220.50,,,,,,,220.5000,854.3300,percent of total billed charges,25.81% of $854.33 in Billed Charges for Rev 272 = $220.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING SURGICEL FIBRILLAR 2 X 4 1962,272,RC,27200002,CDM,,,,,,both,,,854.3300,128.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",854.33,,,,,,,220.5000,854.3300,percent of total billed charges,100% of $854.33 in Billed Charges for Rev 272 = $854.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING SURGICEL FIBRILLAR 2 X 4 1962,272,RC,27200002,CDM,,,,,,both,,,854.3300,128.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,427.17,,,,,,,220.5000,854.3300,percent of total billed charges,Rev 272 $854.33 in Billed Charges at 50% = $427.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING SURGICEL FIBRILLAR 2 X 4 1962,272,RC,27200002,CDM,,,,,,both,,,854.3300,128.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,275.95,,,,,,,220.5000,854.3300,other,32.3% of $854.33 in Billed Charges for Rev 272 = $275.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SURGICEL FIBRILLAR 2 X 4 1962,272,RC,27200002,CDM,,,,,,both,,,854.3300,128.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,262.28,,,,,,,220.5000,854.3300,other,30.7% of $854.33 in Billed Charges for Rev 272 = $262.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SURGICEL FIBRILLAR 2 X 4 1962,272,RC,27200002,CDM,,,,,,both,,,854.3300,128.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,275.95,,,,,,,220.5000,854.3300,percent of total billed charges,32.3% of $854.33 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING SURGICEL FIBRILLAR 2 X 4 1962,272,RC,27200002,CDM,,,,,,both,,,854.3300,128.1500,WELLCARE,WELLCARE MEDICAID,854.33,,,,,,,220.5000,854.3300,percent of total billed charges,100% of $854.33 in Billed Charges for Rev 272 = $854.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUTTER FLIPCUTTER II 9.5MM AR-1204AF-95,272,RC,,,,,,,,both,,,4013.5800,602.0400,AETNA,AETNA,1713.80,,,,,,,1035.9100,4013.5800,percent of total billed charges,"42.7% of $4,013.58 in Billed Charges for Rev 272 = $1,713.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER FLIPCUTTER II 9.5MM AR-1204AF-95,272,RC,,,,,,,,both,,,4013.5800,602.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2809.51,,,,,,,1035.9100,4013.5800,percent of total billed charges,"Rev 272 $4,013.58 in Billed Charges at 70% = $2,809.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER FLIPCUTTER II 9.5MM AR-1204AF-95,272,RC,,,,,,,,both,,,4013.5800,602.0400,CIGNA HEALTHCARE,CIGNA HMO,1673.66,,,,,,,1035.9100,4013.5800,percent of total billed charges,"41.7% of $4,013.58 in Billed Charges for Rev 272 = $1,673.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER FLIPCUTTER II 9.5MM AR-1204AF-95,272,RC,,,,,,,,both,,,4013.5800,602.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1862.30,,,,,,,1035.9100,4013.5800,percent of total billed charges,"46.4% of $4,013.58 in Billed Charges for Rev 272 = $1,862.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER FLIPCUTTER II 9.5MM AR-1204AF-95,272,RC,,,,,,,,both,,,4013.5800,602.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1673.66,,,,,,,1035.9100,4013.5800,percent of total billed charges,"41.7% of $4,013.58 in Billed Charges for Rev 272 = $1,673.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER FLIPCUTTER II 9.5MM AR-1204AF-95,272,RC,,,,,,,,both,,,4013.5800,602.0400,CIGNA HEALTHCARE,CIGNA PPO,1673.66,,,,,,,1035.9100,4013.5800,percent of total billed charges,"41.7% of $4,013.58 in Billed Charges for Rev 272 = $1,673.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER FLIPCUTTER II 9.5MM AR-1204AF-95,272,RC,,,,,,,,both,,,4013.5800,602.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3612.22,,,,,,,1035.9100,4013.5800,percent of total billed charges,"90% of $4,013.58 in Billed Charges for Rev 272 = $3,612.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER FLIPCUTTER II 9.5MM AR-1204AF-95,272,RC,,,,,,,,both,,,4013.5800,602.0400,MEDCOST,MEDCOST VHN,1910.06,,,,,,,1035.9100,4013.5800,percent of total billed charges,"47.59% of $4,013.58 in Billed Charges for Rev 272 = $1,910.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER FLIPCUTTER II 9.5MM AR-1204AF-95,272,RC,,,,,,,,both,,,4013.5800,602.0400,SENTARA HEALTH,SENTARA HEALTH,1035.91,,,,,,,1035.9100,4013.5800,percent of total billed charges,"25.81% of $4,013.58 in Billed Charges for Rev 272 = $1,035.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER FLIPCUTTER II 9.5MM AR-1204AF-95,272,RC,,,,,,,,both,,,4013.5800,602.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4013.58,,,,,,,1035.9100,4013.5800,percent of total billed charges,"100% of $4,013.58 in Billed Charges for Rev 272 = $4,013.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER FLIPCUTTER II 9.5MM AR-1204AF-95,272,RC,,,,,,,,both,,,4013.5800,602.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2006.79,,,,,,,1035.9100,4013.5800,percent of total billed charges,"Rev 272 $4,013.58 in Billed Charges at 50% = $2,006.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER FLIPCUTTER II 9.5MM AR-1204AF-95,272,RC,,,,,,,,both,,,4013.5800,602.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1296.39,,,,,,,1035.9100,4013.5800,other,"32.3% of $4,013.58 in Billed Charges for Rev 272 = $1,296.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTER FLIPCUTTER II 9.5MM AR-1204AF-95,272,RC,,,,,,,,both,,,4013.5800,602.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1232.17,,,,,,,1035.9100,4013.5800,other,"30.7% of $4,013.58 in Billed Charges for Rev 272 = $1,232.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTER FLIPCUTTER II 9.5MM AR-1204AF-95,272,RC,,,,,,,,both,,,4013.5800,602.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,1296.39,,,,,,,1035.9100,4013.5800,percent of total billed charges,"32.3% of $4,013.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER FLIPCUTTER II 9.5MM AR-1204AF-95,272,RC,,,,,,,,both,,,4013.5800,602.0400,WELLCARE,WELLCARE MEDICAID,4013.58,,,,,,,1035.9100,4013.5800,percent of total billed charges,"100% of $4,013.58 in Billed Charges for Rev 272 = $4,013.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR ECHELON FLEX 45 ARTICULATING EC45A,272,RC,27200002,CDM,,,,,,both,,,2839.1000,425.8700,AETNA,AETNA,1212.30,,,,,,,732.7700,2839.1000,percent of total billed charges,"42.7% of $2,839.10 in Billed Charges for Rev 272 = $1,212.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR ECHELON FLEX 45 ARTICULATING EC45A,272,RC,27200002,CDM,,,,,,both,,,2839.1000,425.8700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1987.37,,,,,,,732.7700,2839.1000,percent of total billed charges,"Rev 272 $2,839.10 in Billed Charges at 70% = $1,987.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR ECHELON FLEX 45 ARTICULATING EC45A,272,RC,27200002,CDM,,,,,,both,,,2839.1000,425.8700,CIGNA HEALTHCARE,CIGNA HMO,1183.90,,,,,,,732.7700,2839.1000,percent of total billed charges,"41.7% of $2,839.10 in Billed Charges for Rev 272 = $1,183.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR ECHELON FLEX 45 ARTICULATING EC45A,272,RC,27200002,CDM,,,,,,both,,,2839.1000,425.8700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1317.34,,,,,,,732.7700,2839.1000,percent of total billed charges,"46.4% of $2,839.10 in Billed Charges for Rev 272 = $1,317.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR ECHELON FLEX 45 ARTICULATING EC45A,272,RC,27200002,CDM,,,,,,both,,,2839.1000,425.8700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1183.90,,,,,,,732.7700,2839.1000,percent of total billed charges,"41.7% of $2,839.10 in Billed Charges for Rev 272 = $1,183.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR ECHELON FLEX 45 ARTICULATING EC45A,272,RC,27200002,CDM,,,,,,both,,,2839.1000,425.8700,CIGNA HEALTHCARE,CIGNA PPO,1183.90,,,,,,,732.7700,2839.1000,percent of total billed charges,"41.7% of $2,839.10 in Billed Charges for Rev 272 = $1,183.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR ECHELON FLEX 45 ARTICULATING EC45A,272,RC,27200002,CDM,,,,,,both,,,2839.1000,425.8700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2555.19,,,,,,,732.7700,2839.1000,percent of total billed charges,"90% of $2,839.10 in Billed Charges for Rev 272 = $2,555.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR ECHELON FLEX 45 ARTICULATING EC45A,272,RC,27200002,CDM,,,,,,both,,,2839.1000,425.8700,MEDCOST,MEDCOST VHN,1351.13,,,,,,,732.7700,2839.1000,percent of total billed charges,"47.59% of $2,839.10 in Billed Charges for Rev 272 = $1,351.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR ECHELON FLEX 45 ARTICULATING EC45A,272,RC,27200002,CDM,,,,,,both,,,2839.1000,425.8700,SENTARA HEALTH,SENTARA HEALTH,732.77,,,,,,,732.7700,2839.1000,percent of total billed charges,"25.81% of $2,839.10 in Billed Charges for Rev 272 = $732.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR ECHELON FLEX 45 ARTICULATING EC45A,272,RC,27200002,CDM,,,,,,both,,,2839.1000,425.8700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2839.10,,,,,,,732.7700,2839.1000,percent of total billed charges,"100% of $2,839.10 in Billed Charges for Rev 272 = $2,839.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR ECHELON FLEX 45 ARTICULATING EC45A,272,RC,27200002,CDM,,,,,,both,,,2839.1000,425.8700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1419.55,,,,,,,732.7700,2839.1000,percent of total billed charges,"Rev 272 $2,839.10 in Billed Charges at 50% = $1,419.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR ECHELON FLEX 45 ARTICULATING EC45A,272,RC,27200002,CDM,,,,,,both,,,2839.1000,425.8700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,917.03,,,,,,,732.7700,2839.1000,other,"32.3% of $2,839.10 in Billed Charges for Rev 272 = $917.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTER LINEAR ECHELON FLEX 45 ARTICULATING EC45A,272,RC,27200002,CDM,,,,,,both,,,2839.1000,425.8700,UNITED HEALTHCARE,UHC HERITAGE SELECT,871.60,,,,,,,732.7700,2839.1000,other,"30.7% of $2,839.10 in Billed Charges for Rev 272 = $871.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTER LINEAR ECHELON FLEX 45 ARTICULATING EC45A,272,RC,27200002,CDM,,,,,,both,,,2839.1000,425.8700,UNITED HEALTHCARE,UNITED HEALTHCARE,917.03,,,,,,,732.7700,2839.1000,percent of total billed charges,"32.3% of $2,839.10 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR ECHELON FLEX 45 ARTICULATING EC45A,272,RC,27200002,CDM,,,,,,both,,,2839.1000,425.8700,WELLCARE,WELLCARE MEDICAID,2839.10,,,,,,,732.7700,2839.1000,percent of total billed charges,"100% of $2,839.10 in Billed Charges for Rev 272 = $2,839.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VAC SILVER MED.,272,RC,27200002,CDM,,,,,,both,,,571.3800,85.7100,AETNA,AETNA,243.98,,,,,,,147.4700,571.3800,percent of total billed charges,42.7% of $571.38 in Billed Charges for Rev 272 = $243.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING VAC SILVER MED.,272,RC,27200002,CDM,,,,,,both,,,571.3800,85.7100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,399.97,,,,,,,147.4700,571.3800,percent of total billed charges,Rev 272 $571.38 in Billed Charges at 70% = $399.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING VAC SILVER MED.,272,RC,27200002,CDM,,,,,,both,,,571.3800,85.7100,CIGNA HEALTHCARE,CIGNA HMO,238.27,,,,,,,147.4700,571.3800,percent of total billed charges,41.7% of $571.38 in Billed Charges for Rev 272 = $238.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING VAC SILVER MED.,272,RC,27200002,CDM,,,,,,both,,,571.3800,85.7100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,265.12,,,,,,,147.4700,571.3800,percent of total billed charges,46.4% of $571.38 in Billed Charges for Rev 272 = $265.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING VAC SILVER MED.,272,RC,27200002,CDM,,,,,,both,,,571.3800,85.7100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,238.27,,,,,,,147.4700,571.3800,percent of total billed charges,41.7% of $571.38 in Billed Charges for Rev 272 = $238.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING VAC SILVER MED.,272,RC,27200002,CDM,,,,,,both,,,571.3800,85.7100,CIGNA HEALTHCARE,CIGNA PPO,238.27,,,,,,,147.4700,571.3800,percent of total billed charges,41.7% of $571.38 in Billed Charges for Rev 272 = $238.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING VAC SILVER MED.,272,RC,27200002,CDM,,,,,,both,,,571.3800,85.7100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,514.24,,,,,,,147.4700,571.3800,percent of total billed charges,90% of $571.38 in Billed Charges for Rev 272 = $514.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING VAC SILVER MED.,272,RC,27200002,CDM,,,,,,both,,,571.3800,85.7100,MEDCOST,MEDCOST VHN,271.92,,,,,,,147.4700,571.3800,percent of total billed charges,47.59% of $571.38 in Billed Charges for Rev 272 = $271.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING VAC SILVER MED.,272,RC,27200002,CDM,,,,,,both,,,571.3800,85.7100,SENTARA HEALTH,SENTARA HEALTH,147.47,,,,,,,147.4700,571.3800,percent of total billed charges,25.81% of $571.38 in Billed Charges for Rev 272 = $147.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING VAC SILVER MED.,272,RC,27200002,CDM,,,,,,both,,,571.3800,85.7100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",571.38,,,,,,,147.4700,571.3800,percent of total billed charges,100% of $571.38 in Billed Charges for Rev 272 = $571.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING VAC SILVER MED.,272,RC,27200002,CDM,,,,,,both,,,571.3800,85.7100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,285.69,,,,,,,147.4700,571.3800,percent of total billed charges,Rev 272 $571.38 in Billed Charges at 50% = $285.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING VAC SILVER MED.,272,RC,27200002,CDM,,,,,,both,,,571.3800,85.7100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,184.56,,,,,,,147.4700,571.3800,other,32.3% of $571.38 in Billed Charges for Rev 272 = $184.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING VAC SILVER MED.,272,RC,27200002,CDM,,,,,,both,,,571.3800,85.7100,UNITED HEALTHCARE,UHC HERITAGE SELECT,175.41,,,,,,,147.4700,571.3800,other,30.7% of $571.38 in Billed Charges for Rev 272 = $175.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING VAC SILVER MED.,272,RC,27200002,CDM,,,,,,both,,,571.3800,85.7100,UNITED HEALTHCARE,UNITED HEALTHCARE,184.56,,,,,,,147.4700,571.3800,percent of total billed charges,32.3% of $571.38 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING VAC SILVER MED.,272,RC,27200002,CDM,,,,,,both,,,571.3800,85.7100,WELLCARE,WELLCARE MEDICAID,571.38,,,,,,,147.4700,571.3800,percent of total billed charges,100% of $571.38 in Billed Charges for Rev 272 = $571.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING VERAFLO CLEANSE CHOICE ULTVCC05LG,272,RC,,,,,,,,both,,,2579.2900,386.8900,AETNA,AETNA,1101.36,,,,,,,665.7100,2579.2900,percent of total billed charges,"42.7% of $2,579.29 in Billed Charges for Rev 272 = $1,101.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO CLEANSE CHOICE ULTVCC05LG,272,RC,,,,,,,,both,,,2579.2900,386.8900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1805.50,,,,,,,665.7100,2579.2900,percent of total billed charges,"Rev 272 $2,579.29 in Billed Charges at 70% = $1,805.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO CLEANSE CHOICE ULTVCC05LG,272,RC,,,,,,,,both,,,2579.2900,386.8900,CIGNA HEALTHCARE,CIGNA HMO,1075.56,,,,,,,665.7100,2579.2900,percent of total billed charges,"41.7% of $2,579.29 in Billed Charges for Rev 272 = $1,075.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO CLEANSE CHOICE ULTVCC05LG,272,RC,,,,,,,,both,,,2579.2900,386.8900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1196.79,,,,,,,665.7100,2579.2900,percent of total billed charges,"46.4% of $2,579.29 in Billed Charges for Rev 272 = $1,196.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO CLEANSE CHOICE ULTVCC05LG,272,RC,,,,,,,,both,,,2579.2900,386.8900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1075.56,,,,,,,665.7100,2579.2900,percent of total billed charges,"41.7% of $2,579.29 in Billed Charges for Rev 272 = $1,075.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO CLEANSE CHOICE ULTVCC05LG,272,RC,,,,,,,,both,,,2579.2900,386.8900,CIGNA HEALTHCARE,CIGNA PPO,1075.56,,,,,,,665.7100,2579.2900,percent of total billed charges,"41.7% of $2,579.29 in Billed Charges for Rev 272 = $1,075.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO CLEANSE CHOICE ULTVCC05LG,272,RC,,,,,,,,both,,,2579.2900,386.8900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2321.36,,,,,,,665.7100,2579.2900,percent of total billed charges,"90% of $2,579.29 in Billed Charges for Rev 272 = $2,321.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO CLEANSE CHOICE ULTVCC05LG,272,RC,,,,,,,,both,,,2579.2900,386.8900,MEDCOST,MEDCOST VHN,1227.48,,,,,,,665.7100,2579.2900,percent of total billed charges,"47.59% of $2,579.29 in Billed Charges for Rev 272 = $1,227.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO CLEANSE CHOICE ULTVCC05LG,272,RC,,,,,,,,both,,,2579.2900,386.8900,SENTARA HEALTH,SENTARA HEALTH,665.71,,,,,,,665.7100,2579.2900,percent of total billed charges,"25.81% of $2,579.29 in Billed Charges for Rev 272 = $665.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO CLEANSE CHOICE ULTVCC05LG,272,RC,,,,,,,,both,,,2579.2900,386.8900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2579.29,,,,,,,665.7100,2579.2900,percent of total billed charges,"100% of $2,579.29 in Billed Charges for Rev 272 = $2,579.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO CLEANSE CHOICE ULTVCC05LG,272,RC,,,,,,,,both,,,2579.2900,386.8900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1289.65,,,,,,,665.7100,2579.2900,percent of total billed charges,"Rev 272 $2,579.29 in Billed Charges at 50% = $1,289.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO CLEANSE CHOICE ULTVCC05LG,272,RC,,,,,,,,both,,,2579.2900,386.8900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,833.11,,,,,,,665.7100,2579.2900,other,"32.3% of $2,579.29 in Billed Charges for Rev 272 = $833.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING VERAFLO CLEANSE CHOICE ULTVCC05LG,272,RC,,,,,,,,both,,,2579.2900,386.8900,UNITED HEALTHCARE,UHC HERITAGE SELECT,791.84,,,,,,,665.7100,2579.2900,other,"30.7% of $2,579.29 in Billed Charges for Rev 272 = $791.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING VERAFLO CLEANSE CHOICE ULTVCC05LG,272,RC,,,,,,,,both,,,2579.2900,386.8900,UNITED HEALTHCARE,UNITED HEALTHCARE,833.11,,,,,,,665.7100,2579.2900,percent of total billed charges,"32.3% of $2,579.29 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO CLEANSE CHOICE ULTVCC05LG,272,RC,,,,,,,,both,,,2579.2900,386.8900,WELLCARE,WELLCARE MEDICAID,2579.29,,,,,,,665.7100,2579.2900,percent of total billed charges,"100% of $2,579.29 in Billed Charges for Rev 272 = $2,579.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO MED,272,RC,27200002,CDM,,,,,,both,,,1133.0300,169.9500,AETNA,AETNA,483.80,,,,,,,292.4400,1133.0300,percent of total billed charges,"42.7% of $1,133.03 in Billed Charges for Rev 272 = $483.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO MED,272,RC,27200002,CDM,,,,,,both,,,1133.0300,169.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,793.12,,,,,,,292.4400,1133.0300,percent of total billed charges,"Rev 272 $1,133.03 in Billed Charges at 70% = $793.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO MED,272,RC,27200002,CDM,,,,,,both,,,1133.0300,169.9500,CIGNA HEALTHCARE,CIGNA HMO,472.47,,,,,,,292.4400,1133.0300,percent of total billed charges,"41.7% of $1,133.03 in Billed Charges for Rev 272 = $472.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO MED,272,RC,27200002,CDM,,,,,,both,,,1133.0300,169.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,525.73,,,,,,,292.4400,1133.0300,percent of total billed charges,"46.4% of $1,133.03 in Billed Charges for Rev 272 = $525.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO MED,272,RC,27200002,CDM,,,,,,both,,,1133.0300,169.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,472.47,,,,,,,292.4400,1133.0300,percent of total billed charges,"41.7% of $1,133.03 in Billed Charges for Rev 272 = $472.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO MED,272,RC,27200002,CDM,,,,,,both,,,1133.0300,169.9500,CIGNA HEALTHCARE,CIGNA PPO,472.47,,,,,,,292.4400,1133.0300,percent of total billed charges,"41.7% of $1,133.03 in Billed Charges for Rev 272 = $472.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO MED,272,RC,27200002,CDM,,,,,,both,,,1133.0300,169.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1019.73,,,,,,,292.4400,1133.0300,percent of total billed charges,"90% of $1,133.03 in Billed Charges for Rev 272 = $1,019.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO MED,272,RC,27200002,CDM,,,,,,both,,,1133.0300,169.9500,MEDCOST,MEDCOST VHN,539.21,,,,,,,292.4400,1133.0300,percent of total billed charges,"47.59% of $1,133.03 in Billed Charges for Rev 272 = $539.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO MED,272,RC,27200002,CDM,,,,,,both,,,1133.0300,169.9500,SENTARA HEALTH,SENTARA HEALTH,292.44,,,,,,,292.4400,1133.0300,percent of total billed charges,"25.81% of $1,133.03 in Billed Charges for Rev 272 = $292.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO MED,272,RC,27200002,CDM,,,,,,both,,,1133.0300,169.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1133.03,,,,,,,292.4400,1133.0300,percent of total billed charges,"100% of $1,133.03 in Billed Charges for Rev 272 = $1,133.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO MED,272,RC,27200002,CDM,,,,,,both,,,1133.0300,169.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,566.52,,,,,,,292.4400,1133.0300,percent of total billed charges,"Rev 272 $1,133.03 in Billed Charges at 50% = $566.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO MED,272,RC,27200002,CDM,,,,,,both,,,1133.0300,169.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,365.97,,,,,,,292.4400,1133.0300,other,"32.3% of $1,133.03 in Billed Charges for Rev 272 = $365.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING VERAFLO MED,272,RC,27200002,CDM,,,,,,both,,,1133.0300,169.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,347.84,,,,,,,292.4400,1133.0300,other,"30.7% of $1,133.03 in Billed Charges for Rev 272 = $347.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING VERAFLO MED,272,RC,27200002,CDM,,,,,,both,,,1133.0300,169.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,365.97,,,,,,,292.4400,1133.0300,percent of total billed charges,"32.3% of $1,133.03 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING VERAFLO MED,272,RC,27200002,CDM,,,,,,both,,,1133.0300,169.9500,WELLCARE,WELLCARE MEDICAID,1133.03,,,,,,,292.4400,1133.0300,percent of total billed charges,"100% of $1,133.03 in Billed Charges for Rev 272 = $1,133.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WITTMANN VELCRO PATCH 20 X 40,272,RC,,,,,,,,both,,,77782.5000,11667.3800,AETNA,AETNA,33213.13,,,,,,,20075.6600,77782.5000,percent of total billed charges,"42.7% of $77,782.50 in Billed Charges for Rev 272 = $33,213.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WITTMANN VELCRO PATCH 20 X 40,272,RC,,,,,,,,both,,,77782.5000,11667.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,54447.75,,,,,,,20075.6600,77782.5000,percent of total billed charges,"Rev 272 $77,782.50 in Billed Charges at 70% = $54,447.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WITTMANN VELCRO PATCH 20 X 40,272,RC,,,,,,,,both,,,77782.5000,11667.3800,CIGNA HEALTHCARE,CIGNA HMO,32435.30,,,,,,,20075.6600,77782.5000,percent of total billed charges,"41.7% of $77,782.50 in Billed Charges for Rev 272 = $32,435.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WITTMANN VELCRO PATCH 20 X 40,272,RC,,,,,,,,both,,,77782.5000,11667.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,36091.08,,,,,,,20075.6600,77782.5000,percent of total billed charges,"46.4% of $77,782.50 in Billed Charges for Rev 272 = $36,091.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WITTMANN VELCRO PATCH 20 X 40,272,RC,,,,,,,,both,,,77782.5000,11667.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,32435.30,,,,,,,20075.6600,77782.5000,percent of total billed charges,"41.7% of $77,782.50 in Billed Charges for Rev 272 = $32,435.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WITTMANN VELCRO PATCH 20 X 40,272,RC,,,,,,,,both,,,77782.5000,11667.3800,CIGNA HEALTHCARE,CIGNA PPO,32435.30,,,,,,,20075.6600,77782.5000,percent of total billed charges,"41.7% of $77,782.50 in Billed Charges for Rev 272 = $32,435.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WITTMANN VELCRO PATCH 20 X 40,272,RC,,,,,,,,both,,,77782.5000,11667.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,70004.25,,,,,,,20075.6600,77782.5000,percent of total billed charges,"90% of $77,782.50 in Billed Charges for Rev 272 = $70,004.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WITTMANN VELCRO PATCH 20 X 40,272,RC,,,,,,,,both,,,77782.5000,11667.3800,MEDCOST,MEDCOST VHN,37016.69,,,,,,,20075.6600,77782.5000,percent of total billed charges,"47.59% of $77,782.50 in Billed Charges for Rev 272 = $37,016.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WITTMANN VELCRO PATCH 20 X 40,272,RC,,,,,,,,both,,,77782.5000,11667.3800,SENTARA HEALTH,SENTARA HEALTH,20075.66,,,,,,,20075.6600,77782.5000,percent of total billed charges,"25.81% of $77,782.50 in Billed Charges for Rev 272 = $20,075.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WITTMANN VELCRO PATCH 20 X 40,272,RC,,,,,,,,both,,,77782.5000,11667.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",77782.50,,,,,,,20075.6600,77782.5000,percent of total billed charges,"100% of $77,782.50 in Billed Charges for Rev 272 = $77,782.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WITTMANN VELCRO PATCH 20 X 40,272,RC,,,,,,,,both,,,77782.5000,11667.3800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,38891.25,,,,,,,20075.6600,77782.5000,percent of total billed charges,"Rev 272 $77,782.50 in Billed Charges at 50% = $38,891.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WITTMANN VELCRO PATCH 20 X 40,272,RC,,,,,,,,both,,,77782.5000,11667.3800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,25123.75,,,,,,,20075.6600,77782.5000,other,"32.3% of $77,782.50 in Billed Charges for Rev 272 = $25,123.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING WITTMANN VELCRO PATCH 20 X 40,272,RC,,,,,,,,both,,,77782.5000,11667.3800,UNITED HEALTHCARE,UHC HERITAGE SELECT,23879.23,,,,,,,20075.6600,77782.5000,other,"30.7% of $77,782.50 in Billed Charges for Rev 272 = $23,879.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING WITTMANN VELCRO PATCH 20 X 40,272,RC,,,,,,,,both,,,77782.5000,11667.3800,UNITED HEALTHCARE,UNITED HEALTHCARE,25123.75,,,,,,,20075.6600,77782.5000,percent of total billed charges,"32.3% of $77,782.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WITTMANN VELCRO PATCH 20 X 40,272,RC,,,,,,,,both,,,77782.5000,11667.3800,WELLCARE,WELLCARE MEDICAID,77782.50,,,,,,,20075.6600,77782.5000,percent of total billed charges,"100% of $77,782.50 in Billed Charges for Rev 272 = $77,782.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.0000,4.2000,AETNA,AETNA,11.96,,,,,,,7.2300,28.0000,percent of total billed charges,42.7% of $28.00 in Billed Charges for Rev 636 = $11.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.0000,4.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,19.60,,,,,,,7.2300,28.0000,percent of total billed charges,Rev 636 $28.00 in Billed Charges at 70% = $19.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.0000,4.2000,CIGNA HEALTHCARE,CIGNA HMO,11.68,,,,,,,7.2300,28.0000,percent of total billed charges,41.7% of $28.00 in Billed Charges for Rev 636 = $11.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.0000,4.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,20.47,,,,,,,7.2300,28.0000,percent of total billed charges,Rev 636 $28.00 in Billed Charges at 73.1% = $20.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.0000,4.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11.68,,,,,,,7.2300,28.0000,percent of total billed charges,41.7% of $28.00 in Billed Charges for Rev 636 = $11.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.0000,4.2000,CIGNA HEALTHCARE,CIGNA PPO,11.68,,,,,,,7.2300,28.0000,percent of total billed charges,41.7% of $28.00 in Billed Charges for Rev 636 = $11.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.0000,4.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,25.20,,,,,,,7.2300,28.0000,percent of total billed charges,90% of $28.00 in Billed Charges for Rev 636 = $25.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.0000,4.2000,MEDCOST,MEDCOST VHN,13.33,,,,,,,7.2300,28.0000,percent of total billed charges,47.59% of $28.00 in Billed Charges for Rev 636 = $13.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.0000,4.2000,SENTARA HEALTH,SENTARA HEALTH,7.23,,,,,,,7.2300,28.0000,percent of total billed charges,25.81% of $28.00 in Billed Charges for Rev 636 = $7.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.0000,4.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",28.00,,,,,,,7.2300,28.0000,percent of total billed charges,100% of $28.00 in Billed Charges for Rev 636 = $28.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.0000,4.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14.00,,,,,,,7.2300,28.0000,percent of total billed charges,Rev 636 $28.00 in Billed Charges at 50% = $14.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.0000,4.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,14.00,,,,,,,7.2300,28.0000,percent of total billed charges,Rev 636 $28.00 in Billed Charges at 50% = $14.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.0000,4.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,14.00,,,,,,,7.2300,28.0000,percent of total billed charges,Rev 636 $28.00 in Billed Charges at 50% = $14.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.0000,4.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,14.00,,,,,,,7.2300,28.0000,percent of total billed charges,Rev 636 $28.00 in Billed Charges at 50% = $14.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.0000,4.2000,WELLCARE,WELLCARE MEDICAID,28.00,,,,,,,7.2300,28.0000,percent of total billed charges,100% of $28.00 in Billed Charges for Rev 636 = $28.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.8900,4.3300,AETNA,AETNA,12.34,,,,,,,7.4600,28.8900,percent of total billed charges,42.7% of $28.89 in Billed Charges for Rev 636 = $12.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.8900,4.3300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,20.22,,,,,,,7.4600,28.8900,percent of total billed charges,Rev 636 $28.89 in Billed Charges at 70% = $20.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.8900,4.3300,CIGNA HEALTHCARE,CIGNA HMO,12.05,,,,,,,7.4600,28.8900,percent of total billed charges,41.7% of $28.89 in Billed Charges for Rev 636 = $12.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.8900,4.3300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,21.12,,,,,,,7.4600,28.8900,percent of total billed charges,Rev 636 $28.89 in Billed Charges at 73.1% = $21.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.8900,4.3300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,12.05,,,,,,,7.4600,28.8900,percent of total billed charges,41.7% of $28.89 in Billed Charges for Rev 636 = $12.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.8900,4.3300,CIGNA HEALTHCARE,CIGNA PPO,12.05,,,,,,,7.4600,28.8900,percent of total billed charges,41.7% of $28.89 in Billed Charges for Rev 636 = $12.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.8900,4.3300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,26.00,,,,,,,7.4600,28.8900,percent of total billed charges,90% of $28.89 in Billed Charges for Rev 636 = $26.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.8900,4.3300,MEDCOST,MEDCOST VHN,13.75,,,,,,,7.4600,28.8900,percent of total billed charges,47.59% of $28.89 in Billed Charges for Rev 636 = $13.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.8900,4.3300,SENTARA HEALTH,SENTARA HEALTH,7.46,,,,,,,7.4600,28.8900,percent of total billed charges,25.81% of $28.89 in Billed Charges for Rev 636 = $7.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.8900,4.3300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",28.89,,,,,,,7.4600,28.8900,percent of total billed charges,100% of $28.89 in Billed Charges for Rev 636 = $28.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.8900,4.3300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14.45,,,,,,,7.4600,28.8900,percent of total billed charges,Rev 636 $28.89 in Billed Charges at 50% = $14.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.8900,4.3300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,14.45,,,,,,,7.4600,28.8900,percent of total billed charges,Rev 636 $28.89 in Billed Charges at 50% = $14.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.8900,4.3300,UNITED HEALTHCARE,UHC HERITAGE SELECT,14.45,,,,,,,7.4600,28.8900,percent of total billed charges,Rev 636 $28.89 in Billed Charges at 50% = $14.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.8900,4.3300,UNITED HEALTHCARE,UNITED HEALTHCARE,14.45,,,,,,,7.4600,28.8900,percent of total billed charges,Rev 636 $28.89 in Billed Charges at 50% = $14.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MATRISTEM MICROMATRIX 500MG,636,RC,63600017,CDM,,,,,,both,,,28.8900,4.3300,WELLCARE,WELLCARE MEDICAID,28.89,,,,,,,7.4600,28.8900,percent of total billed charges,100% of $28.89 in Billed Charges for Rev 636 = $28.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND MICROMATRIX 100MG,636,RC,,,,,,,,both,,,3182.3400,477.3500,AETNA,AETNA,1358.86,,,,,,,821.3600,3182.3400,percent of total billed charges,"42.7% of $3,182.34 in Billed Charges for Rev 636 = $1,358.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 100MG,636,RC,,,,,,,,both,,,3182.3400,477.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2227.64,,,,,,,821.3600,3182.3400,percent of total billed charges,"Rev 636 $3,182.34 in Billed Charges at 70% = $2,227.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 100MG,636,RC,,,,,,,,both,,,3182.3400,477.3500,CIGNA HEALTHCARE,CIGNA HMO,1327.04,,,,,,,821.3600,3182.3400,percent of total billed charges,"41.7% of $3,182.34 in Billed Charges for Rev 636 = $1,327.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 100MG,636,RC,,,,,,,,both,,,3182.3400,477.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2326.29,,,,,,,821.3600,3182.3400,percent of total billed charges,"Rev 636 $3,182.34 in Billed Charges at 73.1% = $2,326.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 100MG,636,RC,,,,,,,,both,,,3182.3400,477.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1327.04,,,,,,,821.3600,3182.3400,percent of total billed charges,"41.7% of $3,182.34 in Billed Charges for Rev 636 = $1,327.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 100MG,636,RC,,,,,,,,both,,,3182.3400,477.3500,CIGNA HEALTHCARE,CIGNA PPO,1327.04,,,,,,,821.3600,3182.3400,percent of total billed charges,"41.7% of $3,182.34 in Billed Charges for Rev 636 = $1,327.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 100MG,636,RC,,,,,,,,both,,,3182.3400,477.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2864.11,,,,,,,821.3600,3182.3400,percent of total billed charges,"90% of $3,182.34 in Billed Charges for Rev 636 = $2,864.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 100MG,636,RC,,,,,,,,both,,,3182.3400,477.3500,MEDCOST,MEDCOST VHN,1514.48,,,,,,,821.3600,3182.3400,percent of total billed charges,"47.59% of $3,182.34 in Billed Charges for Rev 636 = $1,514.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 100MG,636,RC,,,,,,,,both,,,3182.3400,477.3500,SENTARA HEALTH,SENTARA HEALTH,821.36,,,,,,,821.3600,3182.3400,percent of total billed charges,"25.81% of $3,182.34 in Billed Charges for Rev 636 = $821.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 100MG,636,RC,,,,,,,,both,,,3182.3400,477.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3182.34,,,,,,,821.3600,3182.3400,percent of total billed charges,"100% of $3,182.34 in Billed Charges for Rev 636 = $3,182.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 100MG,636,RC,,,,,,,,both,,,3182.3400,477.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1591.17,,,,,,,821.3600,3182.3400,percent of total billed charges,"Rev 636 $3,182.34 in Billed Charges at 50% = $1,591.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 100MG,636,RC,,,,,,,,both,,,3182.3400,477.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1591.17,,,,,,,821.3600,3182.3400,percent of total billed charges,"Rev 636 $3,182.34 in Billed Charges at 50% = $1,591.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 100MG,636,RC,,,,,,,,both,,,3182.3400,477.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1591.17,,,,,,,821.3600,3182.3400,percent of total billed charges,"Rev 636 $3,182.34 in Billed Charges at 50% = $1,591.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 100MG,636,RC,,,,,,,,both,,,3182.3400,477.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,1591.17,,,,,,,821.3600,3182.3400,percent of total billed charges,"Rev 636 $3,182.34 in Billed Charges at 50% = $1,591.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 100MG,636,RC,,,,,,,,both,,,3182.3400,477.3500,WELLCARE,WELLCARE MEDICAID,3182.34,,,,,,,821.3600,3182.3400,percent of total billed charges,"100% of $3,182.34 in Billed Charges for Rev 636 = $3,182.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 200MG,636,RC,63600017,CDM,,,,,,both,,,6364.6800,954.7000,AETNA,AETNA,2717.72,,,,,,,1642.7200,6364.6800,percent of total billed charges,"42.7% of $6,364.68 in Billed Charges for Rev 636 = $2,717.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 200MG,636,RC,63600017,CDM,,,,,,both,,,6364.6800,954.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4455.28,,,,,,,1642.7200,6364.6800,percent of total billed charges,"Rev 636 $6,364.68 in Billed Charges at 70% = $4,455.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 200MG,636,RC,63600017,CDM,,,,,,both,,,6364.6800,954.7000,CIGNA HEALTHCARE,CIGNA HMO,2654.07,,,,,,,1642.7200,6364.6800,percent of total billed charges,"41.7% of $6,364.68 in Billed Charges for Rev 636 = $2,654.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 200MG,636,RC,63600017,CDM,,,,,,both,,,6364.6800,954.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4652.58,,,,,,,1642.7200,6364.6800,percent of total billed charges,"Rev 636 $6,364.68 in Billed Charges at 73.1% = $4,652.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 200MG,636,RC,63600017,CDM,,,,,,both,,,6364.6800,954.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2654.07,,,,,,,1642.7200,6364.6800,percent of total billed charges,"41.7% of $6,364.68 in Billed Charges for Rev 636 = $2,654.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 200MG,636,RC,63600017,CDM,,,,,,both,,,6364.6800,954.7000,CIGNA HEALTHCARE,CIGNA PPO,2654.07,,,,,,,1642.7200,6364.6800,percent of total billed charges,"41.7% of $6,364.68 in Billed Charges for Rev 636 = $2,654.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 200MG,636,RC,63600017,CDM,,,,,,both,,,6364.6800,954.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5728.21,,,,,,,1642.7200,6364.6800,percent of total billed charges,"90% of $6,364.68 in Billed Charges for Rev 636 = $5,728.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 200MG,636,RC,63600017,CDM,,,,,,both,,,6364.6800,954.7000,MEDCOST,MEDCOST VHN,3028.95,,,,,,,1642.7200,6364.6800,percent of total billed charges,"47.59% of $6,364.68 in Billed Charges for Rev 636 = $3,028.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 200MG,636,RC,63600017,CDM,,,,,,both,,,6364.6800,954.7000,SENTARA HEALTH,SENTARA HEALTH,1642.72,,,,,,,1642.7200,6364.6800,percent of total billed charges,"25.81% of $6,364.68 in Billed Charges for Rev 636 = $1,642.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 200MG,636,RC,63600017,CDM,,,,,,both,,,6364.6800,954.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6364.68,,,,,,,1642.7200,6364.6800,percent of total billed charges,"100% of $6,364.68 in Billed Charges for Rev 636 = $6,364.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 200MG,636,RC,63600017,CDM,,,,,,both,,,6364.6800,954.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3182.34,,,,,,,1642.7200,6364.6800,percent of total billed charges,"Rev 636 $6,364.68 in Billed Charges at 50% = $3,182.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 200MG,636,RC,63600017,CDM,,,,,,both,,,6364.6800,954.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3182.34,,,,,,,1642.7200,6364.6800,percent of total billed charges,"Rev 636 $6,364.68 in Billed Charges at 50% = $3,182.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 200MG,636,RC,63600017,CDM,,,,,,both,,,6364.6800,954.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3182.34,,,,,,,1642.7200,6364.6800,percent of total billed charges,"Rev 636 $6,364.68 in Billed Charges at 50% = $3,182.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 200MG,636,RC,63600017,CDM,,,,,,both,,,6364.6800,954.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,3182.34,,,,,,,1642.7200,6364.6800,percent of total billed charges,"Rev 636 $6,364.68 in Billed Charges at 50% = $3,182.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND MICROMATRIX 200MG,636,RC,63600017,CDM,,,,,,both,,,6364.6800,954.7000,WELLCARE,WELLCARE MEDICAID,6364.68,,,,,,,1642.7200,6364.6800,percent of total billed charges,"100% of $6,364.68 in Billed Charges for Rev 636 = $6,364.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASAL HEMOPORE 3.15,272,RC,27200002,CDM,,,,,,both,,,2708.7400,406.3100,AETNA,AETNA,1156.63,,,,,,,699.1300,2708.7400,percent of total billed charges,"42.7% of $2,708.74 in Billed Charges for Rev 272 = $1,156.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASAL HEMOPORE 3.15,272,RC,27200002,CDM,,,,,,both,,,2708.7400,406.3100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1896.12,,,,,,,699.1300,2708.7400,percent of total billed charges,"Rev 272 $2,708.74 in Billed Charges at 70% = $1,896.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASAL HEMOPORE 3.15,272,RC,27200002,CDM,,,,,,both,,,2708.7400,406.3100,CIGNA HEALTHCARE,CIGNA HMO,1129.54,,,,,,,699.1300,2708.7400,percent of total billed charges,"41.7% of $2,708.74 in Billed Charges for Rev 272 = $1,129.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASAL HEMOPORE 3.15,272,RC,27200002,CDM,,,,,,both,,,2708.7400,406.3100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1256.86,,,,,,,699.1300,2708.7400,percent of total billed charges,"46.4% of $2,708.74 in Billed Charges for Rev 272 = $1,256.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASAL HEMOPORE 3.15,272,RC,27200002,CDM,,,,,,both,,,2708.7400,406.3100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1129.54,,,,,,,699.1300,2708.7400,percent of total billed charges,"41.7% of $2,708.74 in Billed Charges for Rev 272 = $1,129.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASAL HEMOPORE 3.15,272,RC,27200002,CDM,,,,,,both,,,2708.7400,406.3100,CIGNA HEALTHCARE,CIGNA PPO,1129.54,,,,,,,699.1300,2708.7400,percent of total billed charges,"41.7% of $2,708.74 in Billed Charges for Rev 272 = $1,129.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASAL HEMOPORE 3.15,272,RC,27200002,CDM,,,,,,both,,,2708.7400,406.3100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2437.87,,,,,,,699.1300,2708.7400,percent of total billed charges,"90% of $2,708.74 in Billed Charges for Rev 272 = $2,437.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASAL HEMOPORE 3.15,272,RC,27200002,CDM,,,,,,both,,,2708.7400,406.3100,MEDCOST,MEDCOST VHN,1289.09,,,,,,,699.1300,2708.7400,percent of total billed charges,"47.59% of $2,708.74 in Billed Charges for Rev 272 = $1,289.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASAL HEMOPORE 3.15,272,RC,27200002,CDM,,,,,,both,,,2708.7400,406.3100,SENTARA HEALTH,SENTARA HEALTH,699.13,,,,,,,699.1300,2708.7400,percent of total billed charges,"25.81% of $2,708.74 in Billed Charges for Rev 272 = $699.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASAL HEMOPORE 3.15,272,RC,27200002,CDM,,,,,,both,,,2708.7400,406.3100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2708.74,,,,,,,699.1300,2708.7400,percent of total billed charges,"100% of $2,708.74 in Billed Charges for Rev 272 = $2,708.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASAL HEMOPORE 3.15,272,RC,27200002,CDM,,,,,,both,,,2708.7400,406.3100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1354.37,,,,,,,699.1300,2708.7400,percent of total billed charges,"Rev 272 $2,708.74 in Billed Charges at 50% = $1,354.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASAL HEMOPORE 3.15,272,RC,27200002,CDM,,,,,,both,,,2708.7400,406.3100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,874.92,,,,,,,699.1300,2708.7400,other,"32.3% of $2,708.74 in Billed Charges for Rev 272 = $874.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING NASAL HEMOPORE 3.15,272,RC,27200002,CDM,,,,,,both,,,2708.7400,406.3100,UNITED HEALTHCARE,UHC HERITAGE SELECT,831.58,,,,,,,699.1300,2708.7400,other,"30.7% of $2,708.74 in Billed Charges for Rev 272 = $831.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING NASAL HEMOPORE 3.15,272,RC,27200002,CDM,,,,,,both,,,2708.7400,406.3100,UNITED HEALTHCARE,UNITED HEALTHCARE,874.92,,,,,,,699.1300,2708.7400,percent of total billed charges,"32.3% of $2,708.74 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASAL HEMOPORE 3.15,272,RC,27200002,CDM,,,,,,both,,,2708.7400,406.3100,WELLCARE,WELLCARE MEDICAID,2708.74,,,,,,,699.1300,2708.7400,percent of total billed charges,"100% of $2,708.74 in Billed Charges for Rev 272 = $2,708.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 4CM,272,RC,27200002,CDM,,,,,,both,,,1347.9200,202.1900,AETNA,AETNA,575.56,,,,,,,347.9000,1347.9200,percent of total billed charges,"42.7% of $1,347.92 in Billed Charges for Rev 272 = $575.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 4CM,272,RC,27200002,CDM,,,,,,both,,,1347.9200,202.1900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,943.54,,,,,,,347.9000,1347.9200,percent of total billed charges,"Rev 272 $1,347.92 in Billed Charges at 70% = $943.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 4CM,272,RC,27200002,CDM,,,,,,both,,,1347.9200,202.1900,CIGNA HEALTHCARE,CIGNA HMO,562.08,,,,,,,347.9000,1347.9200,percent of total billed charges,"41.7% of $1,347.92 in Billed Charges for Rev 272 = $562.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 4CM,272,RC,27200002,CDM,,,,,,both,,,1347.9200,202.1900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,625.43,,,,,,,347.9000,1347.9200,percent of total billed charges,"46.4% of $1,347.92 in Billed Charges for Rev 272 = $625.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 4CM,272,RC,27200002,CDM,,,,,,both,,,1347.9200,202.1900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,562.08,,,,,,,347.9000,1347.9200,percent of total billed charges,"41.7% of $1,347.92 in Billed Charges for Rev 272 = $562.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 4CM,272,RC,27200002,CDM,,,,,,both,,,1347.9200,202.1900,CIGNA HEALTHCARE,CIGNA PPO,562.08,,,,,,,347.9000,1347.9200,percent of total billed charges,"41.7% of $1,347.92 in Billed Charges for Rev 272 = $562.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 4CM,272,RC,27200002,CDM,,,,,,both,,,1347.9200,202.1900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1213.13,,,,,,,347.9000,1347.9200,percent of total billed charges,"90% of $1,347.92 in Billed Charges for Rev 272 = $1,213.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 4CM,272,RC,27200002,CDM,,,,,,both,,,1347.9200,202.1900,MEDCOST,MEDCOST VHN,641.48,,,,,,,347.9000,1347.9200,percent of total billed charges,"47.59% of $1,347.92 in Billed Charges for Rev 272 = $641.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 4CM,272,RC,27200002,CDM,,,,,,both,,,1347.9200,202.1900,SENTARA HEALTH,SENTARA HEALTH,347.90,,,,,,,347.9000,1347.9200,percent of total billed charges,"25.81% of $1,347.92 in Billed Charges for Rev 272 = $347.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 4CM,272,RC,27200002,CDM,,,,,,both,,,1347.9200,202.1900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1347.92,,,,,,,347.9000,1347.9200,percent of total billed charges,"100% of $1,347.92 in Billed Charges for Rev 272 = $1,347.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 4CM,272,RC,27200002,CDM,,,,,,both,,,1347.9200,202.1900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,673.96,,,,,,,347.9000,1347.9200,percent of total billed charges,"Rev 272 $1,347.92 in Billed Charges at 50% = $673.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 4CM,272,RC,27200002,CDM,,,,,,both,,,1347.9200,202.1900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.38,,,,,,,347.9000,1347.9200,other,"32.3% of $1,347.92 in Billed Charges for Rev 272 = $435.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING NASOPORE 4CM,272,RC,27200002,CDM,,,,,,both,,,1347.9200,202.1900,UNITED HEALTHCARE,UHC HERITAGE SELECT,413.81,,,,,,,347.9000,1347.9200,other,"30.7% of $1,347.92 in Billed Charges for Rev 272 = $413.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING NASOPORE 4CM,272,RC,27200002,CDM,,,,,,both,,,1347.9200,202.1900,UNITED HEALTHCARE,UNITED HEALTHCARE,435.38,,,,,,,347.9000,1347.9200,percent of total billed charges,"32.3% of $1,347.92 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 4CM,272,RC,27200002,CDM,,,,,,both,,,1347.9200,202.1900,WELLCARE,WELLCARE MEDICAID,1347.92,,,,,,,347.9000,1347.9200,percent of total billed charges,"100% of $1,347.92 in Billed Charges for Rev 272 = $1,347.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM STD,272,RC,27200002,CDM,,,,,,both,,,1955.6700,293.3500,AETNA,AETNA,835.07,,,,,,,504.7600,1955.6700,percent of total billed charges,"42.7% of $1,955.67 in Billed Charges for Rev 272 = $835.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM STD,272,RC,27200002,CDM,,,,,,both,,,1955.6700,293.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1368.97,,,,,,,504.7600,1955.6700,percent of total billed charges,"Rev 272 $1,955.67 in Billed Charges at 70% = $1,368.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM STD,272,RC,27200002,CDM,,,,,,both,,,1955.6700,293.3500,CIGNA HEALTHCARE,CIGNA HMO,815.51,,,,,,,504.7600,1955.6700,percent of total billed charges,"41.7% of $1,955.67 in Billed Charges for Rev 272 = $815.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM STD,272,RC,27200002,CDM,,,,,,both,,,1955.6700,293.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,907.43,,,,,,,504.7600,1955.6700,percent of total billed charges,"46.4% of $1,955.67 in Billed Charges for Rev 272 = $907.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM STD,272,RC,27200002,CDM,,,,,,both,,,1955.6700,293.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,815.51,,,,,,,504.7600,1955.6700,percent of total billed charges,"41.7% of $1,955.67 in Billed Charges for Rev 272 = $815.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM STD,272,RC,27200002,CDM,,,,,,both,,,1955.6700,293.3500,CIGNA HEALTHCARE,CIGNA PPO,815.51,,,,,,,504.7600,1955.6700,percent of total billed charges,"41.7% of $1,955.67 in Billed Charges for Rev 272 = $815.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM STD,272,RC,27200002,CDM,,,,,,both,,,1955.6700,293.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1760.10,,,,,,,504.7600,1955.6700,percent of total billed charges,"90% of $1,955.67 in Billed Charges for Rev 272 = $1,760.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM STD,272,RC,27200002,CDM,,,,,,both,,,1955.6700,293.3500,MEDCOST,MEDCOST VHN,930.70,,,,,,,504.7600,1955.6700,percent of total billed charges,"47.59% of $1,955.67 in Billed Charges for Rev 272 = $930.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM STD,272,RC,27200002,CDM,,,,,,both,,,1955.6700,293.3500,SENTARA HEALTH,SENTARA HEALTH,504.76,,,,,,,504.7600,1955.6700,percent of total billed charges,"25.81% of $1,955.67 in Billed Charges for Rev 272 = $504.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM STD,272,RC,27200002,CDM,,,,,,both,,,1955.6700,293.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1955.67,,,,,,,504.7600,1955.6700,percent of total billed charges,"100% of $1,955.67 in Billed Charges for Rev 272 = $1,955.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM STD,272,RC,27200002,CDM,,,,,,both,,,1955.6700,293.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,977.84,,,,,,,504.7600,1955.6700,percent of total billed charges,"Rev 272 $1,955.67 in Billed Charges at 50% = $977.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM STD,272,RC,27200002,CDM,,,,,,both,,,1955.6700,293.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,631.68,,,,,,,504.7600,1955.6700,other,"32.3% of $1,955.67 in Billed Charges for Rev 272 = $631.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING NASOPORE 8CM STD,272,RC,27200002,CDM,,,,,,both,,,1955.6700,293.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,600.39,,,,,,,504.7600,1955.6700,other,"30.7% of $1,955.67 in Billed Charges for Rev 272 = $600.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING NASOPORE 8CM STD,272,RC,27200002,CDM,,,,,,both,,,1955.6700,293.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,631.68,,,,,,,504.7600,1955.6700,percent of total billed charges,"32.3% of $1,955.67 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM STD,272,RC,27200002,CDM,,,,,,both,,,1955.6700,293.3500,WELLCARE,WELLCARE MEDICAID,1955.67,,,,,,,504.7600,1955.6700,percent of total billed charges,"100% of $1,955.67 in Billed Charges for Rev 272 = $1,955.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL E CANN DISTAL CUTTING 2.7 X 70MM,272,RC,27200002,CDM,,,,,,both,,,4521.7600,678.2600,AETNA,AETNA,1930.79,,,,,,,1167.0700,4521.7600,percent of total billed charges,"42.7% of $4,521.76 in Billed Charges for Rev 272 = $1,930.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL E CANN DISTAL CUTTING 2.7 X 70MM,272,RC,27200002,CDM,,,,,,both,,,4521.7600,678.2600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3165.23,,,,,,,1167.0700,4521.7600,percent of total billed charges,"Rev 272 $4,521.76 in Billed Charges at 70% = $3,165.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL E CANN DISTAL CUTTING 2.7 X 70MM,272,RC,27200002,CDM,,,,,,both,,,4521.7600,678.2600,CIGNA HEALTHCARE,CIGNA HMO,1885.57,,,,,,,1167.0700,4521.7600,percent of total billed charges,"41.7% of $4,521.76 in Billed Charges for Rev 272 = $1,885.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL E CANN DISTAL CUTTING 2.7 X 70MM,272,RC,27200002,CDM,,,,,,both,,,4521.7600,678.2600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2098.10,,,,,,,1167.0700,4521.7600,percent of total billed charges,"46.4% of $4,521.76 in Billed Charges for Rev 272 = $2,098.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL E CANN DISTAL CUTTING 2.7 X 70MM,272,RC,27200002,CDM,,,,,,both,,,4521.7600,678.2600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1885.57,,,,,,,1167.0700,4521.7600,percent of total billed charges,"41.7% of $4,521.76 in Billed Charges for Rev 272 = $1,885.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL E CANN DISTAL CUTTING 2.7 X 70MM,272,RC,27200002,CDM,,,,,,both,,,4521.7600,678.2600,CIGNA HEALTHCARE,CIGNA PPO,1885.57,,,,,,,1167.0700,4521.7600,percent of total billed charges,"41.7% of $4,521.76 in Billed Charges for Rev 272 = $1,885.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL E CANN DISTAL CUTTING 2.7 X 70MM,272,RC,27200002,CDM,,,,,,both,,,4521.7600,678.2600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4069.58,,,,,,,1167.0700,4521.7600,percent of total billed charges,"90% of $4,521.76 in Billed Charges for Rev 272 = $4,069.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL E CANN DISTAL CUTTING 2.7 X 70MM,272,RC,27200002,CDM,,,,,,both,,,4521.7600,678.2600,MEDCOST,MEDCOST VHN,2151.91,,,,,,,1167.0700,4521.7600,percent of total billed charges,"47.59% of $4,521.76 in Billed Charges for Rev 272 = $2,151.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL E CANN DISTAL CUTTING 2.7 X 70MM,272,RC,27200002,CDM,,,,,,both,,,4521.7600,678.2600,SENTARA HEALTH,SENTARA HEALTH,1167.07,,,,,,,1167.0700,4521.7600,percent of total billed charges,"25.81% of $4,521.76 in Billed Charges for Rev 272 = $1,167.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL E CANN DISTAL CUTTING 2.7 X 70MM,272,RC,27200002,CDM,,,,,,both,,,4521.7600,678.2600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4521.76,,,,,,,1167.0700,4521.7600,percent of total billed charges,"100% of $4,521.76 in Billed Charges for Rev 272 = $4,521.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL E CANN DISTAL CUTTING 2.7 X 70MM,272,RC,27200002,CDM,,,,,,both,,,4521.7600,678.2600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2260.88,,,,,,,1167.0700,4521.7600,percent of total billed charges,"Rev 272 $4,521.76 in Billed Charges at 50% = $2,260.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL E CANN DISTAL CUTTING 2.7 X 70MM,272,RC,27200002,CDM,,,,,,both,,,4521.7600,678.2600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1460.53,,,,,,,1167.0700,4521.7600,other,"32.3% of $4,521.76 in Billed Charges for Rev 272 = $1,460.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL E CANN DISTAL CUTTING 2.7 X 70MM,272,RC,27200002,CDM,,,,,,both,,,4521.7600,678.2600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1388.18,,,,,,,1167.0700,4521.7600,other,"30.7% of $4,521.76 in Billed Charges for Rev 272 = $1,388.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL E CANN DISTAL CUTTING 2.7 X 70MM,272,RC,27200002,CDM,,,,,,both,,,4521.7600,678.2600,UNITED HEALTHCARE,UNITED HEALTHCARE,1460.53,,,,,,,1167.0700,4521.7600,percent of total billed charges,"32.3% of $4,521.76 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL E CANN DISTAL CUTTING 2.7 X 70MM,272,RC,27200002,CDM,,,,,,both,,,4521.7600,678.2600,WELLCARE,WELLCARE MEDICAID,4521.76,,,,,,,1167.0700,4521.7600,percent of total billed charges,"100% of $4,521.76 in Billed Charges for Rev 272 = $4,521.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL MINI DRILL AT3,272,RC,27200002,CDM,,,,,,both,,,7321.9300,1098.2900,AETNA,AETNA,3126.46,,,,,,,1889.7900,7321.9300,percent of total billed charges,"42.7% of $7,321.93 in Billed Charges for Rev 272 = $3,126.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL MINI DRILL AT3,272,RC,27200002,CDM,,,,,,both,,,7321.9300,1098.2900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5125.35,,,,,,,1889.7900,7321.9300,percent of total billed charges,"Rev 272 $7,321.93 in Billed Charges at 70% = $5,125.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL MINI DRILL AT3,272,RC,27200002,CDM,,,,,,both,,,7321.9300,1098.2900,CIGNA HEALTHCARE,CIGNA HMO,3053.24,,,,,,,1889.7900,7321.9300,percent of total billed charges,"41.7% of $7,321.93 in Billed Charges for Rev 272 = $3,053.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL MINI DRILL AT3,272,RC,27200002,CDM,,,,,,both,,,7321.9300,1098.2900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3397.38,,,,,,,1889.7900,7321.9300,percent of total billed charges,"46.4% of $7,321.93 in Billed Charges for Rev 272 = $3,397.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL MINI DRILL AT3,272,RC,27200002,CDM,,,,,,both,,,7321.9300,1098.2900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3053.24,,,,,,,1889.7900,7321.9300,percent of total billed charges,"41.7% of $7,321.93 in Billed Charges for Rev 272 = $3,053.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL MINI DRILL AT3,272,RC,27200002,CDM,,,,,,both,,,7321.9300,1098.2900,CIGNA HEALTHCARE,CIGNA PPO,3053.24,,,,,,,1889.7900,7321.9300,percent of total billed charges,"41.7% of $7,321.93 in Billed Charges for Rev 272 = $3,053.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL MINI DRILL AT3,272,RC,27200002,CDM,,,,,,both,,,7321.9300,1098.2900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6589.74,,,,,,,1889.7900,7321.9300,percent of total billed charges,"90% of $7,321.93 in Billed Charges for Rev 272 = $6,589.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL MINI DRILL AT3,272,RC,27200002,CDM,,,,,,both,,,7321.9300,1098.2900,MEDCOST,MEDCOST VHN,3484.51,,,,,,,1889.7900,7321.9300,percent of total billed charges,"47.59% of $7,321.93 in Billed Charges for Rev 272 = $3,484.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL MINI DRILL AT3,272,RC,27200002,CDM,,,,,,both,,,7321.9300,1098.2900,SENTARA HEALTH,SENTARA HEALTH,1889.79,,,,,,,1889.7900,7321.9300,percent of total billed charges,"25.81% of $7,321.93 in Billed Charges for Rev 272 = $1,889.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL MINI DRILL AT3,272,RC,27200002,CDM,,,,,,both,,,7321.9300,1098.2900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7321.93,,,,,,,1889.7900,7321.9300,percent of total billed charges,"100% of $7,321.93 in Billed Charges for Rev 272 = $7,321.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL MINI DRILL AT3,272,RC,27200002,CDM,,,,,,both,,,7321.9300,1098.2900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3660.97,,,,,,,1889.7900,7321.9300,percent of total billed charges,"Rev 272 $7,321.93 in Billed Charges at 50% = $3,660.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL MINI DRILL AT3,272,RC,27200002,CDM,,,,,,both,,,7321.9300,1098.2900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2364.98,,,,,,,1889.7900,7321.9300,other,"32.3% of $7,321.93 in Billed Charges for Rev 272 = $2,364.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL MINI DRILL AT3,272,RC,27200002,CDM,,,,,,both,,,7321.9300,1098.2900,UNITED HEALTHCARE,UHC HERITAGE SELECT,2247.83,,,,,,,1889.7900,7321.9300,other,"30.7% of $7,321.93 in Billed Charges for Rev 272 = $2,247.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL MINI DRILL AT3,272,RC,27200002,CDM,,,,,,both,,,7321.9300,1098.2900,UNITED HEALTHCARE,UNITED HEALTHCARE,2364.98,,,,,,,1889.7900,7321.9300,percent of total billed charges,"32.3% of $7,321.93 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL MINI DRILL AT3,272,RC,27200002,CDM,,,,,,both,,,7321.9300,1098.2900,WELLCARE,WELLCARE MEDICAID,7321.93,,,,,,,1889.7900,7321.9300,percent of total billed charges,"100% of $7,321.93 in Billed Charges for Rev 272 = $7,321.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NEGATIVE PRESSURE PICO INCISION MANAGEMENT THERAPY 4 X 12 IN 66022003,272,RC,27200002,CDM,,,,,,both,,,2727.8800,409.1800,AETNA,AETNA,1164.80,,,,,,,704.0700,2727.8800,percent of total billed charges,"42.7% of $2,727.88 in Billed Charges for Rev 272 = $1,164.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NEGATIVE PRESSURE PICO INCISION MANAGEMENT THERAPY 4 X 12 IN 66022003,272,RC,27200002,CDM,,,,,,both,,,2727.8800,409.1800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1909.52,,,,,,,704.0700,2727.8800,percent of total billed charges,"Rev 272 $2,727.88 in Billed Charges at 70% = $1,909.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NEGATIVE PRESSURE PICO INCISION MANAGEMENT THERAPY 4 X 12 IN 66022003,272,RC,27200002,CDM,,,,,,both,,,2727.8800,409.1800,CIGNA HEALTHCARE,CIGNA HMO,1137.53,,,,,,,704.0700,2727.8800,percent of total billed charges,"41.7% of $2,727.88 in Billed Charges for Rev 272 = $1,137.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NEGATIVE PRESSURE PICO INCISION MANAGEMENT THERAPY 4 X 12 IN 66022003,272,RC,27200002,CDM,,,,,,both,,,2727.8800,409.1800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1265.74,,,,,,,704.0700,2727.8800,percent of total billed charges,"46.4% of $2,727.88 in Billed Charges for Rev 272 = $1,265.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NEGATIVE PRESSURE PICO INCISION MANAGEMENT THERAPY 4 X 12 IN 66022003,272,RC,27200002,CDM,,,,,,both,,,2727.8800,409.1800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1137.53,,,,,,,704.0700,2727.8800,percent of total billed charges,"41.7% of $2,727.88 in Billed Charges for Rev 272 = $1,137.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NEGATIVE PRESSURE PICO INCISION MANAGEMENT THERAPY 4 X 12 IN 66022003,272,RC,27200002,CDM,,,,,,both,,,2727.8800,409.1800,CIGNA HEALTHCARE,CIGNA PPO,1137.53,,,,,,,704.0700,2727.8800,percent of total billed charges,"41.7% of $2,727.88 in Billed Charges for Rev 272 = $1,137.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NEGATIVE PRESSURE PICO INCISION MANAGEMENT THERAPY 4 X 12 IN 66022003,272,RC,27200002,CDM,,,,,,both,,,2727.8800,409.1800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2455.09,,,,,,,704.0700,2727.8800,percent of total billed charges,"90% of $2,727.88 in Billed Charges for Rev 272 = $2,455.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NEGATIVE PRESSURE PICO INCISION MANAGEMENT THERAPY 4 X 12 IN 66022003,272,RC,27200002,CDM,,,,,,both,,,2727.8800,409.1800,MEDCOST,MEDCOST VHN,1298.20,,,,,,,704.0700,2727.8800,percent of total billed charges,"47.59% of $2,727.88 in Billed Charges for Rev 272 = $1,298.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NEGATIVE PRESSURE PICO INCISION MANAGEMENT THERAPY 4 X 12 IN 66022003,272,RC,27200002,CDM,,,,,,both,,,2727.8800,409.1800,SENTARA HEALTH,SENTARA HEALTH,704.07,,,,,,,704.0700,2727.8800,percent of total billed charges,"25.81% of $2,727.88 in Billed Charges for Rev 272 = $704.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NEGATIVE PRESSURE PICO INCISION MANAGEMENT THERAPY 4 X 12 IN 66022003,272,RC,27200002,CDM,,,,,,both,,,2727.8800,409.1800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2727.88,,,,,,,704.0700,2727.8800,percent of total billed charges,"100% of $2,727.88 in Billed Charges for Rev 272 = $2,727.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NEGATIVE PRESSURE PICO INCISION MANAGEMENT THERAPY 4 X 12 IN 66022003,272,RC,27200002,CDM,,,,,,both,,,2727.8800,409.1800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1363.94,,,,,,,704.0700,2727.8800,percent of total billed charges,"Rev 272 $2,727.88 in Billed Charges at 50% = $1,363.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NEGATIVE PRESSURE PICO INCISION MANAGEMENT THERAPY 4 X 12 IN 66022003,272,RC,27200002,CDM,,,,,,both,,,2727.8800,409.1800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,881.11,,,,,,,704.0700,2727.8800,other,"32.3% of $2,727.88 in Billed Charges for Rev 272 = $881.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING NEGATIVE PRESSURE PICO INCISION MANAGEMENT THERAPY 4 X 12 IN 66022003,272,RC,27200002,CDM,,,,,,both,,,2727.8800,409.1800,UNITED HEALTHCARE,UHC HERITAGE SELECT,837.46,,,,,,,704.0700,2727.8800,other,"30.7% of $2,727.88 in Billed Charges for Rev 272 = $837.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING NEGATIVE PRESSURE PICO INCISION MANAGEMENT THERAPY 4 X 12 IN 66022003,272,RC,27200002,CDM,,,,,,both,,,2727.8800,409.1800,UNITED HEALTHCARE,UNITED HEALTHCARE,881.11,,,,,,,704.0700,2727.8800,percent of total billed charges,"32.3% of $2,727.88 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NEGATIVE PRESSURE PICO INCISION MANAGEMENT THERAPY 4 X 12 IN 66022003,272,RC,27200002,CDM,,,,,,both,,,2727.8800,409.1800,WELLCARE,WELLCARE MEDICAID,2727.88,,,,,,,704.0700,2727.8800,percent of total billed charges,"100% of $2,727.88 in Billed Charges for Rev 272 = $2,727.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NPWT PICO 4 X 8,272,RC,27200002,CDM,,,,,,both,,,2728.2000,409.2300,AETNA,AETNA,1164.94,,,,,,,704.1500,2728.2000,percent of total billed charges,"42.7% of $2,728.20 in Billed Charges for Rev 272 = $1,164.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NPWT PICO 4 X 8,272,RC,27200002,CDM,,,,,,both,,,2728.2000,409.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1909.74,,,,,,,704.1500,2728.2000,percent of total billed charges,"Rev 272 $2,728.20 in Billed Charges at 70% = $1,909.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NPWT PICO 4 X 8,272,RC,27200002,CDM,,,,,,both,,,2728.2000,409.2300,CIGNA HEALTHCARE,CIGNA HMO,1137.66,,,,,,,704.1500,2728.2000,percent of total billed charges,"41.7% of $2,728.20 in Billed Charges for Rev 272 = $1,137.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NPWT PICO 4 X 8,272,RC,27200002,CDM,,,,,,both,,,2728.2000,409.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1265.88,,,,,,,704.1500,2728.2000,percent of total billed charges,"46.4% of $2,728.20 in Billed Charges for Rev 272 = $1,265.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NPWT PICO 4 X 8,272,RC,27200002,CDM,,,,,,both,,,2728.2000,409.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1137.66,,,,,,,704.1500,2728.2000,percent of total billed charges,"41.7% of $2,728.20 in Billed Charges for Rev 272 = $1,137.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NPWT PICO 4 X 8,272,RC,27200002,CDM,,,,,,both,,,2728.2000,409.2300,CIGNA HEALTHCARE,CIGNA PPO,1137.66,,,,,,,704.1500,2728.2000,percent of total billed charges,"41.7% of $2,728.20 in Billed Charges for Rev 272 = $1,137.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NPWT PICO 4 X 8,272,RC,27200002,CDM,,,,,,both,,,2728.2000,409.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2455.38,,,,,,,704.1500,2728.2000,percent of total billed charges,"90% of $2,728.20 in Billed Charges for Rev 272 = $2,455.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NPWT PICO 4 X 8,272,RC,27200002,CDM,,,,,,both,,,2728.2000,409.2300,MEDCOST,MEDCOST VHN,1298.35,,,,,,,704.1500,2728.2000,percent of total billed charges,"47.59% of $2,728.20 in Billed Charges for Rev 272 = $1,298.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NPWT PICO 4 X 8,272,RC,27200002,CDM,,,,,,both,,,2728.2000,409.2300,SENTARA HEALTH,SENTARA HEALTH,704.15,,,,,,,704.1500,2728.2000,percent of total billed charges,"25.81% of $2,728.20 in Billed Charges for Rev 272 = $704.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NPWT PICO 4 X 8,272,RC,27200002,CDM,,,,,,both,,,2728.2000,409.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2728.20,,,,,,,704.1500,2728.2000,percent of total billed charges,"100% of $2,728.20 in Billed Charges for Rev 272 = $2,728.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NPWT PICO 4 X 8,272,RC,27200002,CDM,,,,,,both,,,2728.2000,409.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1364.10,,,,,,,704.1500,2728.2000,percent of total billed charges,"Rev 272 $2,728.20 in Billed Charges at 50% = $1,364.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NPWT PICO 4 X 8,272,RC,27200002,CDM,,,,,,both,,,2728.2000,409.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,881.21,,,,,,,704.1500,2728.2000,other,"32.3% of $2,728.20 in Billed Charges for Rev 272 = $881.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING NPWT PICO 4 X 8,272,RC,27200002,CDM,,,,,,both,,,2728.2000,409.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,837.56,,,,,,,704.1500,2728.2000,other,"30.7% of $2,728.20 in Billed Charges for Rev 272 = $837.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING NPWT PICO 4 X 8,272,RC,27200002,CDM,,,,,,both,,,2728.2000,409.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,881.21,,,,,,,704.1500,2728.2000,percent of total billed charges,"32.3% of $2,728.20 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NPWT PICO 4 X 8,272,RC,27200002,CDM,,,,,,both,,,2728.2000,409.2300,WELLCARE,WELLCARE MEDICAID,2728.20,,,,,,,704.1500,2728.2000,percent of total billed charges,"100% of $2,728.20 in Billed Charges for Rev 272 = $2,728.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SHORT 2.0,272,RC,,,,,,,,both,,,1041.8700,156.2800,AETNA,AETNA,444.88,,,,,,,268.9100,1041.8700,percent of total billed charges,"42.7% of $1,041.87 in Billed Charges for Rev 272 = $444.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SHORT 2.0,272,RC,,,,,,,,both,,,1041.8700,156.2800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,729.31,,,,,,,268.9100,1041.8700,percent of total billed charges,"Rev 272 $1,041.87 in Billed Charges at 70% = $729.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SHORT 2.0,272,RC,,,,,,,,both,,,1041.8700,156.2800,CIGNA HEALTHCARE,CIGNA HMO,434.46,,,,,,,268.9100,1041.8700,percent of total billed charges,"41.7% of $1,041.87 in Billed Charges for Rev 272 = $434.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SHORT 2.0,272,RC,,,,,,,,both,,,1041.8700,156.2800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,483.43,,,,,,,268.9100,1041.8700,percent of total billed charges,"46.4% of $1,041.87 in Billed Charges for Rev 272 = $483.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SHORT 2.0,272,RC,,,,,,,,both,,,1041.8700,156.2800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,434.46,,,,,,,268.9100,1041.8700,percent of total billed charges,"41.7% of $1,041.87 in Billed Charges for Rev 272 = $434.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SHORT 2.0,272,RC,,,,,,,,both,,,1041.8700,156.2800,CIGNA HEALTHCARE,CIGNA PPO,434.46,,,,,,,268.9100,1041.8700,percent of total billed charges,"41.7% of $1,041.87 in Billed Charges for Rev 272 = $434.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SHORT 2.0,272,RC,,,,,,,,both,,,1041.8700,156.2800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,937.68,,,,,,,268.9100,1041.8700,percent of total billed charges,"90% of $1,041.87 in Billed Charges for Rev 272 = $937.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SHORT 2.0,272,RC,,,,,,,,both,,,1041.8700,156.2800,MEDCOST,MEDCOST VHN,495.83,,,,,,,268.9100,1041.8700,percent of total billed charges,"47.59% of $1,041.87 in Billed Charges for Rev 272 = $495.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SHORT 2.0,272,RC,,,,,,,,both,,,1041.8700,156.2800,SENTARA HEALTH,SENTARA HEALTH,268.91,,,,,,,268.9100,1041.8700,percent of total billed charges,"25.81% of $1,041.87 in Billed Charges for Rev 272 = $268.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SHORT 2.0,272,RC,,,,,,,,both,,,1041.8700,156.2800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1041.87,,,,,,,268.9100,1041.8700,percent of total billed charges,"100% of $1,041.87 in Billed Charges for Rev 272 = $1,041.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SHORT 2.0,272,RC,,,,,,,,both,,,1041.8700,156.2800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,520.94,,,,,,,268.9100,1041.8700,percent of total billed charges,"Rev 272 $1,041.87 in Billed Charges at 50% = $520.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SHORT 2.0,272,RC,,,,,,,,both,,,1041.8700,156.2800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,336.52,,,,,,,268.9100,1041.8700,other,"32.3% of $1,041.87 in Billed Charges for Rev 272 = $336.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL SHORT 2.0,272,RC,,,,,,,,both,,,1041.8700,156.2800,UNITED HEALTHCARE,UHC HERITAGE SELECT,319.85,,,,,,,268.9100,1041.8700,other,"30.7% of $1,041.87 in Billed Charges for Rev 272 = $319.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL SHORT 2.0,272,RC,,,,,,,,both,,,1041.8700,156.2800,UNITED HEALTHCARE,UNITED HEALTHCARE,336.52,,,,,,,268.9100,1041.8700,percent of total billed charges,"32.3% of $1,041.87 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL SHORT 2.0,272,RC,,,,,,,,both,,,1041.8700,156.2800,WELLCARE,WELLCARE MEDICAID,1041.87,,,,,,,268.9100,1041.8700,percent of total billed charges,"100% of $1,041.87 in Billed Charges for Rev 272 = $1,041.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLOSE,272,RC,,,,,,,,both,,,812.4600,121.8700,AETNA,AETNA,346.92,,,,,,,209.7000,812.4600,percent of total billed charges,42.7% of $812.46 in Billed Charges for Rev 272 = $346.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO CLOSE,272,RC,,,,,,,,both,,,812.4600,121.8700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,568.72,,,,,,,209.7000,812.4600,percent of total billed charges,Rev 272 $812.46 in Billed Charges at 70% = $568.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO CLOSE,272,RC,,,,,,,,both,,,812.4600,121.8700,CIGNA HEALTHCARE,CIGNA HMO,338.80,,,,,,,209.7000,812.4600,percent of total billed charges,41.7% of $812.46 in Billed Charges for Rev 272 = $338.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO CLOSE,272,RC,,,,,,,,both,,,812.4600,121.8700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,376.98,,,,,,,209.7000,812.4600,percent of total billed charges,46.4% of $812.46 in Billed Charges for Rev 272 = $376.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO CLOSE,272,RC,,,,,,,,both,,,812.4600,121.8700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,338.80,,,,,,,209.7000,812.4600,percent of total billed charges,41.7% of $812.46 in Billed Charges for Rev 272 = $338.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO CLOSE,272,RC,,,,,,,,both,,,812.4600,121.8700,CIGNA HEALTHCARE,CIGNA PPO,338.80,,,,,,,209.7000,812.4600,percent of total billed charges,41.7% of $812.46 in Billed Charges for Rev 272 = $338.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO CLOSE,272,RC,,,,,,,,both,,,812.4600,121.8700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,731.21,,,,,,,209.7000,812.4600,percent of total billed charges,90% of $812.46 in Billed Charges for Rev 272 = $731.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO CLOSE,272,RC,,,,,,,,both,,,812.4600,121.8700,MEDCOST,MEDCOST VHN,386.65,,,,,,,209.7000,812.4600,percent of total billed charges,47.59% of $812.46 in Billed Charges for Rev 272 = $386.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO CLOSE,272,RC,,,,,,,,both,,,812.4600,121.8700,SENTARA HEALTH,SENTARA HEALTH,209.70,,,,,,,209.7000,812.4600,percent of total billed charges,25.81% of $812.46 in Billed Charges for Rev 272 = $209.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO CLOSE,272,RC,,,,,,,,both,,,812.4600,121.8700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",812.46,,,,,,,209.7000,812.4600,percent of total billed charges,100% of $812.46 in Billed Charges for Rev 272 = $812.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO CLOSE,272,RC,,,,,,,,both,,,812.4600,121.8700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,406.23,,,,,,,209.7000,812.4600,percent of total billed charges,Rev 272 $812.46 in Billed Charges at 50% = $406.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO CLOSE,272,RC,,,,,,,,both,,,812.4600,121.8700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,262.42,,,,,,,209.7000,812.4600,other,32.3% of $812.46 in Billed Charges for Rev 272 = $262.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ENDO CLOSE,272,RC,,,,,,,,both,,,812.4600,121.8700,UNITED HEALTHCARE,UHC HERITAGE SELECT,249.43,,,,,,,209.7000,812.4600,other,30.7% of $812.46 in Billed Charges for Rev 272 = $249.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ENDO CLOSE,272,RC,,,,,,,,both,,,812.4600,121.8700,UNITED HEALTHCARE,UNITED HEALTHCARE,262.42,,,,,,,209.7000,812.4600,percent of total billed charges,32.3% of $812.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO CLOSE,272,RC,,,,,,,,both,,,812.4600,121.8700,WELLCARE,WELLCARE MEDICAID,812.46,,,,,,,209.7000,812.4600,percent of total billed charges,100% of $812.46 in Billed Charges for Rev 272 = $812.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ENDO CLOSE,272,RC,,,,,,,,both,,,9372.5800,1405.8900,AETNA,AETNA,4002.09,,,,,,,2419.0600,9372.5800,percent of total billed charges,"42.7% of $9,372.58 in Billed Charges for Rev 272 = $4,002.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLOSE,272,RC,,,,,,,,both,,,9372.5800,1405.8900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6560.81,,,,,,,2419.0600,9372.5800,percent of total billed charges,"Rev 272 $9,372.58 in Billed Charges at 70% = $6,560.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLOSE,272,RC,,,,,,,,both,,,9372.5800,1405.8900,CIGNA HEALTHCARE,CIGNA HMO,3908.37,,,,,,,2419.0600,9372.5800,percent of total billed charges,"41.7% of $9,372.58 in Billed Charges for Rev 272 = $3,908.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLOSE,272,RC,,,,,,,,both,,,9372.5800,1405.8900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4348.88,,,,,,,2419.0600,9372.5800,percent of total billed charges,"46.4% of $9,372.58 in Billed Charges for Rev 272 = $4,348.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLOSE,272,RC,,,,,,,,both,,,9372.5800,1405.8900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3908.37,,,,,,,2419.0600,9372.5800,percent of total billed charges,"41.7% of $9,372.58 in Billed Charges for Rev 272 = $3,908.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLOSE,272,RC,,,,,,,,both,,,9372.5800,1405.8900,CIGNA HEALTHCARE,CIGNA PPO,3908.37,,,,,,,2419.0600,9372.5800,percent of total billed charges,"41.7% of $9,372.58 in Billed Charges for Rev 272 = $3,908.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLOSE,272,RC,,,,,,,,both,,,9372.5800,1405.8900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8435.32,,,,,,,2419.0600,9372.5800,percent of total billed charges,"90% of $9,372.58 in Billed Charges for Rev 272 = $8,435.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLOSE,272,RC,,,,,,,,both,,,9372.5800,1405.8900,MEDCOST,MEDCOST VHN,4460.41,,,,,,,2419.0600,9372.5800,percent of total billed charges,"47.59% of $9,372.58 in Billed Charges for Rev 272 = $4,460.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLOSE,272,RC,,,,,,,,both,,,9372.5800,1405.8900,SENTARA HEALTH,SENTARA HEALTH,2419.06,,,,,,,2419.0600,9372.5800,percent of total billed charges,"25.81% of $9,372.58 in Billed Charges for Rev 272 = $2,419.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLOSE,272,RC,,,,,,,,both,,,9372.5800,1405.8900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9372.58,,,,,,,2419.0600,9372.5800,percent of total billed charges,"100% of $9,372.58 in Billed Charges for Rev 272 = $9,372.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLOSE,272,RC,,,,,,,,both,,,9372.5800,1405.8900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4686.29,,,,,,,2419.0600,9372.5800,percent of total billed charges,"Rev 272 $9,372.58 in Billed Charges at 50% = $4,686.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLOSE,272,RC,,,,,,,,both,,,9372.5800,1405.8900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3027.34,,,,,,,2419.0600,9372.5800,other,"32.3% of $9,372.58 in Billed Charges for Rev 272 = $3,027.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENDO CLOSE,272,RC,,,,,,,,both,,,9372.5800,1405.8900,UNITED HEALTHCARE,UHC HERITAGE SELECT,2877.38,,,,,,,2419.0600,9372.5800,other,"30.7% of $9,372.58 in Billed Charges for Rev 272 = $2,877.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENDO CLOSE,272,RC,,,,,,,,both,,,9372.5800,1405.8900,UNITED HEALTHCARE,UNITED HEALTHCARE,3027.34,,,,,,,2419.0600,9372.5800,percent of total billed charges,"32.3% of $9,372.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLOSE,272,RC,,,,,,,,both,,,9372.5800,1405.8900,WELLCARE,WELLCARE MEDICAID,9372.58,,,,,,,2419.0600,9372.5800,percent of total billed charges,"100% of $9,372.58 in Billed Charges for Rev 272 = $9,372.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,875.9300,131.3900,AETNA,AETNA,374.02,,,,,,,226.0800,875.9300,percent of total billed charges,42.7% of $875.93 in Billed Charges for Rev 272 = $374.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,875.9300,131.3900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,613.15,,,,,,,226.0800,875.9300,percent of total billed charges,Rev 272 $875.93 in Billed Charges at 70% = $613.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,875.9300,131.3900,CIGNA HEALTHCARE,CIGNA HMO,365.26,,,,,,,226.0800,875.9300,percent of total billed charges,41.7% of $875.93 in Billed Charges for Rev 272 = $365.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,875.9300,131.3900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,406.43,,,,,,,226.0800,875.9300,percent of total billed charges,46.4% of $875.93 in Billed Charges for Rev 272 = $406.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,875.9300,131.3900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,365.26,,,,,,,226.0800,875.9300,percent of total billed charges,41.7% of $875.93 in Billed Charges for Rev 272 = $365.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,875.9300,131.3900,CIGNA HEALTHCARE,CIGNA PPO,365.26,,,,,,,226.0800,875.9300,percent of total billed charges,41.7% of $875.93 in Billed Charges for Rev 272 = $365.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,875.9300,131.3900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,788.34,,,,,,,226.0800,875.9300,percent of total billed charges,90% of $875.93 in Billed Charges for Rev 272 = $788.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,875.9300,131.3900,MEDCOST,MEDCOST VHN,416.86,,,,,,,226.0800,875.9300,percent of total billed charges,47.59% of $875.93 in Billed Charges for Rev 272 = $416.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,875.9300,131.3900,SENTARA HEALTH,SENTARA HEALTH,226.08,,,,,,,226.0800,875.9300,percent of total billed charges,25.81% of $875.93 in Billed Charges for Rev 272 = $226.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,875.9300,131.3900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",875.93,,,,,,,226.0800,875.9300,percent of total billed charges,100% of $875.93 in Billed Charges for Rev 272 = $875.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,875.9300,131.3900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,437.97,,,,,,,226.0800,875.9300,percent of total billed charges,Rev 272 $875.93 in Billed Charges at 50% = $437.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,875.9300,131.3900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,282.93,,,,,,,226.0800,875.9300,other,32.3% of $875.93 in Billed Charges for Rev 272 = $282.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,875.9300,131.3900,UNITED HEALTHCARE,UHC HERITAGE SELECT,268.91,,,,,,,226.0800,875.9300,other,30.7% of $875.93 in Billed Charges for Rev 272 = $268.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,875.9300,131.3900,UNITED HEALTHCARE,UNITED HEALTHCARE,282.93,,,,,,,226.0800,875.9300,percent of total billed charges,32.3% of $875.93 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,875.9300,131.3900,WELLCARE,WELLCARE MEDICAID,875.93,,,,,,,226.0800,875.9300,percent of total billed charges,100% of $875.93 in Billed Charges for Rev 272 = $875.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,1391.1700,208.6800,AETNA,AETNA,594.03,,,,,,,359.0600,1391.1700,percent of total billed charges,"42.7% of $1,391.17 in Billed Charges for Rev 272 = $594.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,1391.1700,208.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,973.82,,,,,,,359.0600,1391.1700,percent of total billed charges,"Rev 272 $1,391.17 in Billed Charges at 70% = $973.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,1391.1700,208.6800,CIGNA HEALTHCARE,CIGNA HMO,580.12,,,,,,,359.0600,1391.1700,percent of total billed charges,"41.7% of $1,391.17 in Billed Charges for Rev 272 = $580.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,1391.1700,208.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,645.50,,,,,,,359.0600,1391.1700,percent of total billed charges,"46.4% of $1,391.17 in Billed Charges for Rev 272 = $645.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,1391.1700,208.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,580.12,,,,,,,359.0600,1391.1700,percent of total billed charges,"41.7% of $1,391.17 in Billed Charges for Rev 272 = $580.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,1391.1700,208.6800,CIGNA HEALTHCARE,CIGNA PPO,580.12,,,,,,,359.0600,1391.1700,percent of total billed charges,"41.7% of $1,391.17 in Billed Charges for Rev 272 = $580.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,1391.1700,208.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1252.05,,,,,,,359.0600,1391.1700,percent of total billed charges,"90% of $1,391.17 in Billed Charges for Rev 272 = $1,252.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,1391.1700,208.6800,MEDCOST,MEDCOST VHN,662.06,,,,,,,359.0600,1391.1700,percent of total billed charges,"47.59% of $1,391.17 in Billed Charges for Rev 272 = $662.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,1391.1700,208.6800,SENTARA HEALTH,SENTARA HEALTH,359.06,,,,,,,359.0600,1391.1700,percent of total billed charges,"25.81% of $1,391.17 in Billed Charges for Rev 272 = $359.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,1391.1700,208.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1391.17,,,,,,,359.0600,1391.1700,percent of total billed charges,"100% of $1,391.17 in Billed Charges for Rev 272 = $1,391.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,1391.1700,208.6800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,695.59,,,,,,,359.0600,1391.1700,percent of total billed charges,"Rev 272 $1,391.17 in Billed Charges at 50% = $695.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,1391.1700,208.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,449.35,,,,,,,359.0600,1391.1700,other,"32.3% of $1,391.17 in Billed Charges for Rev 272 = $449.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,1391.1700,208.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,427.09,,,,,,,359.0600,1391.1700,other,"30.7% of $1,391.17 in Billed Charges for Rev 272 = $427.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,1391.1700,208.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,449.35,,,,,,,359.0600,1391.1700,percent of total billed charges,"32.3% of $1,391.17 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 2.7 7117-3503,272,RC,,,,,,,,both,,,1391.1700,208.6800,WELLCARE,WELLCARE MEDICAID,1391.17,,,,,,,359.0600,1391.1700,percent of total billed charges,"100% of $1,391.17 in Billed Charges for Rev 272 = $1,391.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT PERIPHERAL SCREW 3.2MM,272,RC,27200002,CDM,,,,,,both,,,1441.5700,216.2400,AETNA,AETNA,615.55,,,,,,,372.0700,1441.5700,percent of total billed charges,"42.7% of $1,441.57 in Billed Charges for Rev 272 = $615.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT PERIPHERAL SCREW 3.2MM,272,RC,27200002,CDM,,,,,,both,,,1441.5700,216.2400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1009.10,,,,,,,372.0700,1441.5700,percent of total billed charges,"Rev 272 $1,441.57 in Billed Charges at 70% = $1,009.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT PERIPHERAL SCREW 3.2MM,272,RC,27200002,CDM,,,,,,both,,,1441.5700,216.2400,CIGNA HEALTHCARE,CIGNA HMO,601.13,,,,,,,372.0700,1441.5700,percent of total billed charges,"41.7% of $1,441.57 in Billed Charges for Rev 272 = $601.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT PERIPHERAL SCREW 3.2MM,272,RC,27200002,CDM,,,,,,both,,,1441.5700,216.2400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,668.89,,,,,,,372.0700,1441.5700,percent of total billed charges,"46.4% of $1,441.57 in Billed Charges for Rev 272 = $668.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT PERIPHERAL SCREW 3.2MM,272,RC,27200002,CDM,,,,,,both,,,1441.5700,216.2400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,601.13,,,,,,,372.0700,1441.5700,percent of total billed charges,"41.7% of $1,441.57 in Billed Charges for Rev 272 = $601.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT PERIPHERAL SCREW 3.2MM,272,RC,27200002,CDM,,,,,,both,,,1441.5700,216.2400,CIGNA HEALTHCARE,CIGNA PPO,601.13,,,,,,,372.0700,1441.5700,percent of total billed charges,"41.7% of $1,441.57 in Billed Charges for Rev 272 = $601.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT PERIPHERAL SCREW 3.2MM,272,RC,27200002,CDM,,,,,,both,,,1441.5700,216.2400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1297.41,,,,,,,372.0700,1441.5700,percent of total billed charges,"90% of $1,441.57 in Billed Charges for Rev 272 = $1,297.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT PERIPHERAL SCREW 3.2MM,272,RC,27200002,CDM,,,,,,both,,,1441.5700,216.2400,MEDCOST,MEDCOST VHN,686.04,,,,,,,372.0700,1441.5700,percent of total billed charges,"47.59% of $1,441.57 in Billed Charges for Rev 272 = $686.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT PERIPHERAL SCREW 3.2MM,272,RC,27200002,CDM,,,,,,both,,,1441.5700,216.2400,SENTARA HEALTH,SENTARA HEALTH,372.07,,,,,,,372.0700,1441.5700,percent of total billed charges,"25.81% of $1,441.57 in Billed Charges for Rev 272 = $372.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT PERIPHERAL SCREW 3.2MM,272,RC,27200002,CDM,,,,,,both,,,1441.5700,216.2400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1441.57,,,,,,,372.0700,1441.5700,percent of total billed charges,"100% of $1,441.57 in Billed Charges for Rev 272 = $1,441.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT PERIPHERAL SCREW 3.2MM,272,RC,27200002,CDM,,,,,,both,,,1441.5700,216.2400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,720.79,,,,,,,372.0700,1441.5700,percent of total billed charges,"Rev 272 $1,441.57 in Billed Charges at 50% = $720.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT PERIPHERAL SCREW 3.2MM,272,RC,27200002,CDM,,,,,,both,,,1441.5700,216.2400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,465.63,,,,,,,372.0700,1441.5700,other,"32.3% of $1,441.57 in Billed Charges for Rev 272 = $465.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT PERIPHERAL SCREW 3.2MM,272,RC,27200002,CDM,,,,,,both,,,1441.5700,216.2400,UNITED HEALTHCARE,UHC HERITAGE SELECT,442.56,,,,,,,372.0700,1441.5700,other,"30.7% of $1,441.57 in Billed Charges for Rev 272 = $442.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT PERIPHERAL SCREW 3.2MM,272,RC,27200002,CDM,,,,,,both,,,1441.5700,216.2400,UNITED HEALTHCARE,UNITED HEALTHCARE,465.63,,,,,,,372.0700,1441.5700,percent of total billed charges,"32.3% of $1,441.57 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT PERIPHERAL SCREW 3.2MM,272,RC,27200002,CDM,,,,,,both,,,1441.5700,216.2400,WELLCARE,WELLCARE MEDICAID,1441.57,,,,,,,372.0700,1441.5700,percent of total billed charges,"100% of $1,441.57 in Billed Charges for Rev 272 = $1,441.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT SS  2.4 7756010,272,RC,,,,,,,,both,,,1368.9700,205.3500,AETNA,AETNA,584.55,,,,,,,353.3300,1368.9700,percent of total billed charges,"42.7% of $1,368.97 in Billed Charges for Rev 272 = $584.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT SS  2.4 7756010,272,RC,,,,,,,,both,,,1368.9700,205.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,958.28,,,,,,,353.3300,1368.9700,percent of total billed charges,"Rev 272 $1,368.97 in Billed Charges at 70% = $958.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT SS  2.4 7756010,272,RC,,,,,,,,both,,,1368.9700,205.3500,CIGNA HEALTHCARE,CIGNA HMO,570.86,,,,,,,353.3300,1368.9700,percent of total billed charges,"41.7% of $1,368.97 in Billed Charges for Rev 272 = $570.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT SS  2.4 7756010,272,RC,,,,,,,,both,,,1368.9700,205.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,635.20,,,,,,,353.3300,1368.9700,percent of total billed charges,"46.4% of $1,368.97 in Billed Charges for Rev 272 = $635.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT SS  2.4 7756010,272,RC,,,,,,,,both,,,1368.9700,205.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,570.86,,,,,,,353.3300,1368.9700,percent of total billed charges,"41.7% of $1,368.97 in Billed Charges for Rev 272 = $570.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT SS  2.4 7756010,272,RC,,,,,,,,both,,,1368.9700,205.3500,CIGNA HEALTHCARE,CIGNA PPO,570.86,,,,,,,353.3300,1368.9700,percent of total billed charges,"41.7% of $1,368.97 in Billed Charges for Rev 272 = $570.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT SS  2.4 7756010,272,RC,,,,,,,,both,,,1368.9700,205.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1232.07,,,,,,,353.3300,1368.9700,percent of total billed charges,"90% of $1,368.97 in Billed Charges for Rev 272 = $1,232.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT SS  2.4 7756010,272,RC,,,,,,,,both,,,1368.9700,205.3500,MEDCOST,MEDCOST VHN,651.49,,,,,,,353.3300,1368.9700,percent of total billed charges,"47.59% of $1,368.97 in Billed Charges for Rev 272 = $651.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT SS  2.4 7756010,272,RC,,,,,,,,both,,,1368.9700,205.3500,SENTARA HEALTH,SENTARA HEALTH,353.33,,,,,,,353.3300,1368.9700,percent of total billed charges,"25.81% of $1,368.97 in Billed Charges for Rev 272 = $353.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT SS  2.4 7756010,272,RC,,,,,,,,both,,,1368.9700,205.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1368.97,,,,,,,353.3300,1368.9700,percent of total billed charges,"100% of $1,368.97 in Billed Charges for Rev 272 = $1,368.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT SS  2.4 7756010,272,RC,,,,,,,,both,,,1368.9700,205.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,684.49,,,,,,,353.3300,1368.9700,percent of total billed charges,"Rev 272 $1,368.97 in Billed Charges at 50% = $684.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT SS  2.4 7756010,272,RC,,,,,,,,both,,,1368.9700,205.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,442.18,,,,,,,353.3300,1368.9700,other,"32.3% of $1,368.97 in Billed Charges for Rev 272 = $442.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT SS  2.4 7756010,272,RC,,,,,,,,both,,,1368.9700,205.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,420.27,,,,,,,353.3300,1368.9700,other,"30.7% of $1,368.97 in Billed Charges for Rev 272 = $420.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT SS  2.4 7756010,272,RC,,,,,,,,both,,,1368.9700,205.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,442.18,,,,,,,353.3300,1368.9700,percent of total billed charges,"32.3% of $1,368.97 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT SS  2.4 7756010,272,RC,,,,,,,,both,,,1368.9700,205.3500,WELLCARE,WELLCARE MEDICAID,1368.97,,,,,,,353.3300,1368.9700,percent of total billed charges,"100% of $1,368.97 in Billed Charges for Rev 272 = $1,368.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOCLOT PHS 3G,272,RC,27200002,CDM,,,,,,both,,,12445.2000,1866.7800,AETNA,AETNA,5314.10,,,,,,,3212.1100,12445.2000,percent of total billed charges,"42.7% of $12,445.20 in Billed Charges for Rev 272 = $5,314.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOCLOT PHS 3G,272,RC,27200002,CDM,,,,,,both,,,12445.2000,1866.7800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8711.64,,,,,,,3212.1100,12445.2000,percent of total billed charges,"Rev 272 $12,445.20 in Billed Charges at 70% = $8,711.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOCLOT PHS 3G,272,RC,27200002,CDM,,,,,,both,,,12445.2000,1866.7800,CIGNA HEALTHCARE,CIGNA HMO,5189.65,,,,,,,3212.1100,12445.2000,percent of total billed charges,"41.7% of $12,445.20 in Billed Charges for Rev 272 = $5,189.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOCLOT PHS 3G,272,RC,27200002,CDM,,,,,,both,,,12445.2000,1866.7800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5774.57,,,,,,,3212.1100,12445.2000,percent of total billed charges,"46.4% of $12,445.20 in Billed Charges for Rev 272 = $5,774.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOCLOT PHS 3G,272,RC,27200002,CDM,,,,,,both,,,12445.2000,1866.7800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5189.65,,,,,,,3212.1100,12445.2000,percent of total billed charges,"41.7% of $12,445.20 in Billed Charges for Rev 272 = $5,189.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOCLOT PHS 3G,272,RC,27200002,CDM,,,,,,both,,,12445.2000,1866.7800,CIGNA HEALTHCARE,CIGNA PPO,5189.65,,,,,,,3212.1100,12445.2000,percent of total billed charges,"41.7% of $12,445.20 in Billed Charges for Rev 272 = $5,189.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOCLOT PHS 3G,272,RC,27200002,CDM,,,,,,both,,,12445.2000,1866.7800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11200.68,,,,,,,3212.1100,12445.2000,percent of total billed charges,"90% of $12,445.20 in Billed Charges for Rev 272 = $11,200.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOCLOT PHS 3G,272,RC,27200002,CDM,,,,,,both,,,12445.2000,1866.7800,MEDCOST,MEDCOST VHN,5922.67,,,,,,,3212.1100,12445.2000,percent of total billed charges,"47.59% of $12,445.20 in Billed Charges for Rev 272 = $5,922.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOCLOT PHS 3G,272,RC,27200002,CDM,,,,,,both,,,12445.2000,1866.7800,SENTARA HEALTH,SENTARA HEALTH,3212.11,,,,,,,3212.1100,12445.2000,percent of total billed charges,"25.81% of $12,445.20 in Billed Charges for Rev 272 = $3,212.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOCLOT PHS 3G,272,RC,27200002,CDM,,,,,,both,,,12445.2000,1866.7800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12445.20,,,,,,,3212.1100,12445.2000,percent of total billed charges,"100% of $12,445.20 in Billed Charges for Rev 272 = $12,445.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOCLOT PHS 3G,272,RC,27200002,CDM,,,,,,both,,,12445.2000,1866.7800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6222.60,,,,,,,3212.1100,12445.2000,percent of total billed charges,"Rev 272 $12,445.20 in Billed Charges at 50% = $6,222.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOCLOT PHS 3G,272,RC,27200002,CDM,,,,,,both,,,12445.2000,1866.7800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4019.80,,,,,,,3212.1100,12445.2000,other,"32.3% of $12,445.20 in Billed Charges for Rev 272 = $4,019.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENDOCLOT PHS 3G,272,RC,27200002,CDM,,,,,,both,,,12445.2000,1866.7800,UNITED HEALTHCARE,UHC HERITAGE SELECT,3820.68,,,,,,,3212.1100,12445.2000,other,"30.7% of $12,445.20 in Billed Charges for Rev 272 = $3,820.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENDOCLOT PHS 3G,272,RC,27200002,CDM,,,,,,both,,,12445.2000,1866.7800,UNITED HEALTHCARE,UNITED HEALTHCARE,4019.80,,,,,,,3212.1100,12445.2000,percent of total billed charges,"32.3% of $12,445.20 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDOCLOT PHS 3G,272,RC,27200002,CDM,,,,,,both,,,12445.2000,1866.7800,WELLCARE,WELLCARE MEDICAID,12445.20,,,,,,,3212.1100,12445.2000,percent of total billed charges,"100% of $12,445.20 in Billed Charges for Rev 272 = $12,445.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PRESS PAIRED EMG 8227304,272,RC,27200002,CDM,,,,,,both,,,1523.2900,228.4900,AETNA,AETNA,650.44,,,,,,,393.1600,1523.2900,percent of total billed charges,"42.7% of $1,523.29 in Billed Charges for Rev 272 = $650.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PRESS PAIRED EMG 8227304,272,RC,27200002,CDM,,,,,,both,,,1523.2900,228.4900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1066.30,,,,,,,393.1600,1523.2900,percent of total billed charges,"Rev 272 $1,523.29 in Billed Charges at 70% = $1,066.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PRESS PAIRED EMG 8227304,272,RC,27200002,CDM,,,,,,both,,,1523.2900,228.4900,CIGNA HEALTHCARE,CIGNA HMO,635.21,,,,,,,393.1600,1523.2900,percent of total billed charges,"41.7% of $1,523.29 in Billed Charges for Rev 272 = $635.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PRESS PAIRED EMG 8227304,272,RC,27200002,CDM,,,,,,both,,,1523.2900,228.4900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,706.81,,,,,,,393.1600,1523.2900,percent of total billed charges,"46.4% of $1,523.29 in Billed Charges for Rev 272 = $706.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PRESS PAIRED EMG 8227304,272,RC,27200002,CDM,,,,,,both,,,1523.2900,228.4900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,635.21,,,,,,,393.1600,1523.2900,percent of total billed charges,"41.7% of $1,523.29 in Billed Charges for Rev 272 = $635.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PRESS PAIRED EMG 8227304,272,RC,27200002,CDM,,,,,,both,,,1523.2900,228.4900,CIGNA HEALTHCARE,CIGNA PPO,635.21,,,,,,,393.1600,1523.2900,percent of total billed charges,"41.7% of $1,523.29 in Billed Charges for Rev 272 = $635.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PRESS PAIRED EMG 8227304,272,RC,27200002,CDM,,,,,,both,,,1523.2900,228.4900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1370.96,,,,,,,393.1600,1523.2900,percent of total billed charges,"90% of $1,523.29 in Billed Charges for Rev 272 = $1,370.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PRESS PAIRED EMG 8227304,272,RC,27200002,CDM,,,,,,both,,,1523.2900,228.4900,MEDCOST,MEDCOST VHN,724.93,,,,,,,393.1600,1523.2900,percent of total billed charges,"47.59% of $1,523.29 in Billed Charges for Rev 272 = $724.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PRESS PAIRED EMG 8227304,272,RC,27200002,CDM,,,,,,both,,,1523.2900,228.4900,SENTARA HEALTH,SENTARA HEALTH,393.16,,,,,,,393.1600,1523.2900,percent of total billed charges,"25.81% of $1,523.29 in Billed Charges for Rev 272 = $393.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PRESS PAIRED EMG 8227304,272,RC,27200002,CDM,,,,,,both,,,1523.2900,228.4900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1523.29,,,,,,,393.1600,1523.2900,percent of total billed charges,"100% of $1,523.29 in Billed Charges for Rev 272 = $1,523.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PRESS PAIRED EMG 8227304,272,RC,27200002,CDM,,,,,,both,,,1523.2900,228.4900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,761.65,,,,,,,393.1600,1523.2900,percent of total billed charges,"Rev 272 $1,523.29 in Billed Charges at 50% = $761.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PRESS PAIRED EMG 8227304,272,RC,27200002,CDM,,,,,,both,,,1523.2900,228.4900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,492.02,,,,,,,393.1600,1523.2900,other,"32.3% of $1,523.29 in Billed Charges for Rev 272 = $492.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE PRESS PAIRED EMG 8227304,272,RC,27200002,CDM,,,,,,both,,,1523.2900,228.4900,UNITED HEALTHCARE,UHC HERITAGE SELECT,467.65,,,,,,,393.1600,1523.2900,other,"30.7% of $1,523.29 in Billed Charges for Rev 272 = $467.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE PRESS PAIRED EMG 8227304,272,RC,27200002,CDM,,,,,,both,,,1523.2900,228.4900,UNITED HEALTHCARE,UNITED HEALTHCARE,492.02,,,,,,,393.1600,1523.2900,percent of total billed charges,"32.3% of $1,523.29 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE PRESS PAIRED EMG 8227304,272,RC,27200002,CDM,,,,,,both,,,1523.2900,228.4900,WELLCARE,WELLCARE MEDICAID,1523.29,,,,,,,393.1600,1523.2900,percent of total billed charges,"100% of $1,523.29 in Billed Charges for Rev 272 = $1,523.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLER BALL 26FR,272,RC,27200002,CDM,,,,,,both,,,1011.5200,151.7300,AETNA,AETNA,431.92,,,,,,,261.0700,1011.5200,percent of total billed charges,"42.7% of $1,011.52 in Billed Charges for Rev 272 = $431.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLER BALL 26FR,272,RC,27200002,CDM,,,,,,both,,,1011.5200,151.7300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,708.06,,,,,,,261.0700,1011.5200,percent of total billed charges,"Rev 272 $1,011.52 in Billed Charges at 70% = $708.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLER BALL 26FR,272,RC,27200002,CDM,,,,,,both,,,1011.5200,151.7300,CIGNA HEALTHCARE,CIGNA HMO,421.80,,,,,,,261.0700,1011.5200,percent of total billed charges,"41.7% of $1,011.52 in Billed Charges for Rev 272 = $421.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLER BALL 26FR,272,RC,27200002,CDM,,,,,,both,,,1011.5200,151.7300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,469.35,,,,,,,261.0700,1011.5200,percent of total billed charges,"46.4% of $1,011.52 in Billed Charges for Rev 272 = $469.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLER BALL 26FR,272,RC,27200002,CDM,,,,,,both,,,1011.5200,151.7300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,421.80,,,,,,,261.0700,1011.5200,percent of total billed charges,"41.7% of $1,011.52 in Billed Charges for Rev 272 = $421.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLER BALL 26FR,272,RC,27200002,CDM,,,,,,both,,,1011.5200,151.7300,CIGNA HEALTHCARE,CIGNA PPO,421.80,,,,,,,261.0700,1011.5200,percent of total billed charges,"41.7% of $1,011.52 in Billed Charges for Rev 272 = $421.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLER BALL 26FR,272,RC,27200002,CDM,,,,,,both,,,1011.5200,151.7300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,910.37,,,,,,,261.0700,1011.5200,percent of total billed charges,"90% of $1,011.52 in Billed Charges for Rev 272 = $910.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLER BALL 26FR,272,RC,27200002,CDM,,,,,,both,,,1011.5200,151.7300,MEDCOST,MEDCOST VHN,481.38,,,,,,,261.0700,1011.5200,percent of total billed charges,"47.59% of $1,011.52 in Billed Charges for Rev 272 = $481.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLER BALL 26FR,272,RC,27200002,CDM,,,,,,both,,,1011.5200,151.7300,SENTARA HEALTH,SENTARA HEALTH,261.07,,,,,,,261.0700,1011.5200,percent of total billed charges,"25.81% of $1,011.52 in Billed Charges for Rev 272 = $261.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLER BALL 26FR,272,RC,27200002,CDM,,,,,,both,,,1011.5200,151.7300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1011.52,,,,,,,261.0700,1011.5200,percent of total billed charges,"100% of $1,011.52 in Billed Charges for Rev 272 = $1,011.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLER BALL 26FR,272,RC,27200002,CDM,,,,,,both,,,1011.5200,151.7300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,505.76,,,,,,,261.0700,1011.5200,percent of total billed charges,"Rev 272 $1,011.52 in Billed Charges at 50% = $505.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLER BALL 26FR,272,RC,27200002,CDM,,,,,,both,,,1011.5200,151.7300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,326.72,,,,,,,261.0700,1011.5200,other,"32.3% of $1,011.52 in Billed Charges for Rev 272 = $326.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE ROLLER BALL 26FR,272,RC,27200002,CDM,,,,,,both,,,1011.5200,151.7300,UNITED HEALTHCARE,UHC HERITAGE SELECT,310.54,,,,,,,261.0700,1011.5200,other,"30.7% of $1,011.52 in Billed Charges for Rev 272 = $310.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE ROLLER BALL 26FR,272,RC,27200002,CDM,,,,,,both,,,1011.5200,151.7300,UNITED HEALTHCARE,UNITED HEALTHCARE,326.72,,,,,,,261.0700,1011.5200,percent of total billed charges,"32.3% of $1,011.52 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLER BALL 26FR,272,RC,27200002,CDM,,,,,,both,,,1011.5200,151.7300,WELLCARE,WELLCARE MEDICAID,1011.52,,,,,,,261.0700,1011.5200,percent of total billed charges,"100% of $1,011.52 in Billed Charges for Rev 272 = $1,011.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ALLIG TOOTH RETRIEVAL,272,RC,,,,,,,,both,,,3979.6600,596.9500,AETNA,AETNA,1699.31,,,,,,,1027.1500,3979.6600,percent of total billed charges,"42.7% of $3,979.66 in Billed Charges for Rev 272 = $1,699.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ALLIG TOOTH RETRIEVAL,272,RC,,,,,,,,both,,,3979.6600,596.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2785.76,,,,,,,1027.1500,3979.6600,percent of total billed charges,"Rev 272 $3,979.66 in Billed Charges at 70% = $2,785.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ALLIG TOOTH RETRIEVAL,272,RC,,,,,,,,both,,,3979.6600,596.9500,CIGNA HEALTHCARE,CIGNA HMO,1659.52,,,,,,,1027.1500,3979.6600,percent of total billed charges,"41.7% of $3,979.66 in Billed Charges for Rev 272 = $1,659.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ALLIG TOOTH RETRIEVAL,272,RC,,,,,,,,both,,,3979.6600,596.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1846.56,,,,,,,1027.1500,3979.6600,percent of total billed charges,"46.4% of $3,979.66 in Billed Charges for Rev 272 = $1,846.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ALLIG TOOTH RETRIEVAL,272,RC,,,,,,,,both,,,3979.6600,596.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1659.52,,,,,,,1027.1500,3979.6600,percent of total billed charges,"41.7% of $3,979.66 in Billed Charges for Rev 272 = $1,659.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ALLIG TOOTH RETRIEVAL,272,RC,,,,,,,,both,,,3979.6600,596.9500,CIGNA HEALTHCARE,CIGNA PPO,1659.52,,,,,,,1027.1500,3979.6600,percent of total billed charges,"41.7% of $3,979.66 in Billed Charges for Rev 272 = $1,659.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ALLIG TOOTH RETRIEVAL,272,RC,,,,,,,,both,,,3979.6600,596.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3581.69,,,,,,,1027.1500,3979.6600,percent of total billed charges,"90% of $3,979.66 in Billed Charges for Rev 272 = $3,581.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ALLIG TOOTH RETRIEVAL,272,RC,,,,,,,,both,,,3979.6600,596.9500,MEDCOST,MEDCOST VHN,1893.92,,,,,,,1027.1500,3979.6600,percent of total billed charges,"47.59% of $3,979.66 in Billed Charges for Rev 272 = $1,893.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ALLIG TOOTH RETRIEVAL,272,RC,,,,,,,,both,,,3979.6600,596.9500,SENTARA HEALTH,SENTARA HEALTH,1027.15,,,,,,,1027.1500,3979.6600,percent of total billed charges,"25.81% of $3,979.66 in Billed Charges for Rev 272 = $1,027.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ALLIG TOOTH RETRIEVAL,272,RC,,,,,,,,both,,,3979.6600,596.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3979.66,,,,,,,1027.1500,3979.6600,percent of total billed charges,"100% of $3,979.66 in Billed Charges for Rev 272 = $3,979.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ALLIG TOOTH RETRIEVAL,272,RC,,,,,,,,both,,,3979.6600,596.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1989.83,,,,,,,1027.1500,3979.6600,percent of total billed charges,"Rev 272 $3,979.66 in Billed Charges at 50% = $1,989.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ALLIG TOOTH RETRIEVAL,272,RC,,,,,,,,both,,,3979.6600,596.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1285.43,,,,,,,1027.1500,3979.6600,other,"32.3% of $3,979.66 in Billed Charges for Rev 272 = $1,285.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP ALLIG TOOTH RETRIEVAL,272,RC,,,,,,,,both,,,3979.6600,596.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1221.76,,,,,,,1027.1500,3979.6600,other,"30.7% of $3,979.66 in Billed Charges for Rev 272 = $1,221.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP ALLIG TOOTH RETRIEVAL,272,RC,,,,,,,,both,,,3979.6600,596.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,1285.43,,,,,,,1027.1500,3979.6600,percent of total billed charges,"32.3% of $3,979.66 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP ALLIG TOOTH RETRIEVAL,272,RC,,,,,,,,both,,,3979.6600,596.9500,WELLCARE,WELLCARE MEDICAID,3979.66,,,,,,,1027.1500,3979.6600,percent of total billed charges,"100% of $3,979.66 in Billed Charges for Rev 272 = $3,979.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY RADIAL EDGE SMOOTH CUP,272,RC,27200002,CDM,,,,,,both,,,1208.3900,181.2600,AETNA,AETNA,515.98,,,,,,,311.8900,1208.3900,percent of total billed charges,"42.7% of $1,208.39 in Billed Charges for Rev 272 = $515.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY RADIAL EDGE SMOOTH CUP,272,RC,27200002,CDM,,,,,,both,,,1208.3900,181.2600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,845.87,,,,,,,311.8900,1208.3900,percent of total billed charges,"Rev 272 $1,208.39 in Billed Charges at 70% = $845.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY RADIAL EDGE SMOOTH CUP,272,RC,27200002,CDM,,,,,,both,,,1208.3900,181.2600,CIGNA HEALTHCARE,CIGNA HMO,503.90,,,,,,,311.8900,1208.3900,percent of total billed charges,"41.7% of $1,208.39 in Billed Charges for Rev 272 = $503.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY RADIAL EDGE SMOOTH CUP,272,RC,27200002,CDM,,,,,,both,,,1208.3900,181.2600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,560.69,,,,,,,311.8900,1208.3900,percent of total billed charges,"46.4% of $1,208.39 in Billed Charges for Rev 272 = $560.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY RADIAL EDGE SMOOTH CUP,272,RC,27200002,CDM,,,,,,both,,,1208.3900,181.2600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,503.90,,,,,,,311.8900,1208.3900,percent of total billed charges,"41.7% of $1,208.39 in Billed Charges for Rev 272 = $503.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY RADIAL EDGE SMOOTH CUP,272,RC,27200002,CDM,,,,,,both,,,1208.3900,181.2600,CIGNA HEALTHCARE,CIGNA PPO,503.90,,,,,,,311.8900,1208.3900,percent of total billed charges,"41.7% of $1,208.39 in Billed Charges for Rev 272 = $503.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY RADIAL EDGE SMOOTH CUP,272,RC,27200002,CDM,,,,,,both,,,1208.3900,181.2600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1087.55,,,,,,,311.8900,1208.3900,percent of total billed charges,"90% of $1,208.39 in Billed Charges for Rev 272 = $1,087.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY RADIAL EDGE SMOOTH CUP,272,RC,27200002,CDM,,,,,,both,,,1208.3900,181.2600,MEDCOST,MEDCOST VHN,575.07,,,,,,,311.8900,1208.3900,percent of total billed charges,"47.59% of $1,208.39 in Billed Charges for Rev 272 = $575.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY RADIAL EDGE SMOOTH CUP,272,RC,27200002,CDM,,,,,,both,,,1208.3900,181.2600,SENTARA HEALTH,SENTARA HEALTH,311.89,,,,,,,311.8900,1208.3900,percent of total billed charges,"25.81% of $1,208.39 in Billed Charges for Rev 272 = $311.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY RADIAL EDGE SMOOTH CUP,272,RC,27200002,CDM,,,,,,both,,,1208.3900,181.2600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1208.39,,,,,,,311.8900,1208.3900,percent of total billed charges,"100% of $1,208.39 in Billed Charges for Rev 272 = $1,208.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY RADIAL EDGE SMOOTH CUP,272,RC,27200002,CDM,,,,,,both,,,1208.3900,181.2600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,604.20,,,,,,,311.8900,1208.3900,percent of total billed charges,"Rev 272 $1,208.39 in Billed Charges at 50% = $604.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY RADIAL EDGE SMOOTH CUP,272,RC,27200002,CDM,,,,,,both,,,1208.3900,181.2600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,390.31,,,,,,,311.8900,1208.3900,other,"32.3% of $1,208.39 in Billed Charges for Rev 272 = $390.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP BIOPSY RADIAL EDGE SMOOTH CUP,272,RC,27200002,CDM,,,,,,both,,,1208.3900,181.2600,UNITED HEALTHCARE,UHC HERITAGE SELECT,370.98,,,,,,,311.8900,1208.3900,other,"30.7% of $1,208.39 in Billed Charges for Rev 272 = $370.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP BIOPSY RADIAL EDGE SMOOTH CUP,272,RC,27200002,CDM,,,,,,both,,,1208.3900,181.2600,UNITED HEALTHCARE,UNITED HEALTHCARE,390.31,,,,,,,311.8900,1208.3900,percent of total billed charges,"32.3% of $1,208.39 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIOPSY RADIAL EDGE SMOOTH CUP,272,RC,27200002,CDM,,,,,,both,,,1208.3900,181.2600,WELLCARE,WELLCARE MEDICAID,1208.39,,,,,,,311.8900,1208.3900,percent of total billed charges,"100% of $1,208.39 in Billed Charges for Rev 272 = $1,208.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPLOAR MARYLAND SINGLE-SITE 5MM DAVINCI,272,RC,,,,,,,,both,,,6430.0200,964.5000,AETNA,AETNA,2745.62,,,,,,,1659.5900,6430.0200,percent of total billed charges,"42.7% of $6,430.02 in Billed Charges for Rev 272 = $2,745.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPLOAR MARYLAND SINGLE-SITE 5MM DAVINCI,272,RC,,,,,,,,both,,,6430.0200,964.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4501.01,,,,,,,1659.5900,6430.0200,percent of total billed charges,"Rev 272 $6,430.02 in Billed Charges at 70% = $4,501.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPLOAR MARYLAND SINGLE-SITE 5MM DAVINCI,272,RC,,,,,,,,both,,,6430.0200,964.5000,CIGNA HEALTHCARE,CIGNA HMO,2681.32,,,,,,,1659.5900,6430.0200,percent of total billed charges,"41.7% of $6,430.02 in Billed Charges for Rev 272 = $2,681.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPLOAR MARYLAND SINGLE-SITE 5MM DAVINCI,272,RC,,,,,,,,both,,,6430.0200,964.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2983.53,,,,,,,1659.5900,6430.0200,percent of total billed charges,"46.4% of $6,430.02 in Billed Charges for Rev 272 = $2,983.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPLOAR MARYLAND SINGLE-SITE 5MM DAVINCI,272,RC,,,,,,,,both,,,6430.0200,964.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2681.32,,,,,,,1659.5900,6430.0200,percent of total billed charges,"41.7% of $6,430.02 in Billed Charges for Rev 272 = $2,681.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPLOAR MARYLAND SINGLE-SITE 5MM DAVINCI,272,RC,,,,,,,,both,,,6430.0200,964.5000,CIGNA HEALTHCARE,CIGNA PPO,2681.32,,,,,,,1659.5900,6430.0200,percent of total billed charges,"41.7% of $6,430.02 in Billed Charges for Rev 272 = $2,681.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPLOAR MARYLAND SINGLE-SITE 5MM DAVINCI,272,RC,,,,,,,,both,,,6430.0200,964.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5787.02,,,,,,,1659.5900,6430.0200,percent of total billed charges,"90% of $6,430.02 in Billed Charges for Rev 272 = $5,787.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPLOAR MARYLAND SINGLE-SITE 5MM DAVINCI,272,RC,,,,,,,,both,,,6430.0200,964.5000,MEDCOST,MEDCOST VHN,3060.05,,,,,,,1659.5900,6430.0200,percent of total billed charges,"47.59% of $6,430.02 in Billed Charges for Rev 272 = $3,060.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPLOAR MARYLAND SINGLE-SITE 5MM DAVINCI,272,RC,,,,,,,,both,,,6430.0200,964.5000,SENTARA HEALTH,SENTARA HEALTH,1659.59,,,,,,,1659.5900,6430.0200,percent of total billed charges,"25.81% of $6,430.02 in Billed Charges for Rev 272 = $1,659.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPLOAR MARYLAND SINGLE-SITE 5MM DAVINCI,272,RC,,,,,,,,both,,,6430.0200,964.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6430.02,,,,,,,1659.5900,6430.0200,percent of total billed charges,"100% of $6,430.02 in Billed Charges for Rev 272 = $6,430.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPLOAR MARYLAND SINGLE-SITE 5MM DAVINCI,272,RC,,,,,,,,both,,,6430.0200,964.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3215.01,,,,,,,1659.5900,6430.0200,percent of total billed charges,"Rev 272 $6,430.02 in Billed Charges at 50% = $3,215.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPLOAR MARYLAND SINGLE-SITE 5MM DAVINCI,272,RC,,,,,,,,both,,,6430.0200,964.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2076.90,,,,,,,1659.5900,6430.0200,other,"32.3% of $6,430.02 in Billed Charges for Rev 272 = $2,076.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP BIPLOAR MARYLAND SINGLE-SITE 5MM DAVINCI,272,RC,,,,,,,,both,,,6430.0200,964.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1974.02,,,,,,,1659.5900,6430.0200,other,"30.7% of $6,430.02 in Billed Charges for Rev 272 = $1,974.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP BIPLOAR MARYLAND SINGLE-SITE 5MM DAVINCI,272,RC,,,,,,,,both,,,6430.0200,964.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,2076.90,,,,,,,1659.5900,6430.0200,percent of total billed charges,"32.3% of $6,430.02 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP BIPLOAR MARYLAND SINGLE-SITE 5MM DAVINCI,272,RC,,,,,,,,both,,,6430.0200,964.5000,WELLCARE,WELLCARE MEDICAID,6430.02,,,,,,,1659.5900,6430.0200,percent of total billed charges,"100% of $6,430.02 in Billed Charges for Rev 272 = $6,430.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLERBALL HF RESECT,272,RC,27200002,CDM,,,,,,both,,,1153.6000,173.0400,AETNA,AETNA,492.59,,,,,,,297.7400,1153.6000,percent of total billed charges,"42.7% of $1,153.60 in Billed Charges for Rev 272 = $492.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLERBALL HF RESECT,272,RC,27200002,CDM,,,,,,both,,,1153.6000,173.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,807.52,,,,,,,297.7400,1153.6000,percent of total billed charges,"Rev 272 $1,153.60 in Billed Charges at 70% = $807.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLERBALL HF RESECT,272,RC,27200002,CDM,,,,,,both,,,1153.6000,173.0400,CIGNA HEALTHCARE,CIGNA HMO,481.05,,,,,,,297.7400,1153.6000,percent of total billed charges,"41.7% of $1,153.60 in Billed Charges for Rev 272 = $481.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLERBALL HF RESECT,272,RC,27200002,CDM,,,,,,both,,,1153.6000,173.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,535.27,,,,,,,297.7400,1153.6000,percent of total billed charges,"46.4% of $1,153.60 in Billed Charges for Rev 272 = $535.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLERBALL HF RESECT,272,RC,27200002,CDM,,,,,,both,,,1153.6000,173.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,481.05,,,,,,,297.7400,1153.6000,percent of total billed charges,"41.7% of $1,153.60 in Billed Charges for Rev 272 = $481.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLERBALL HF RESECT,272,RC,27200002,CDM,,,,,,both,,,1153.6000,173.0400,CIGNA HEALTHCARE,CIGNA PPO,481.05,,,,,,,297.7400,1153.6000,percent of total billed charges,"41.7% of $1,153.60 in Billed Charges for Rev 272 = $481.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLERBALL HF RESECT,272,RC,27200002,CDM,,,,,,both,,,1153.6000,173.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1038.24,,,,,,,297.7400,1153.6000,percent of total billed charges,"90% of $1,153.60 in Billed Charges for Rev 272 = $1,038.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLERBALL HF RESECT,272,RC,27200002,CDM,,,,,,both,,,1153.6000,173.0400,MEDCOST,MEDCOST VHN,549.00,,,,,,,297.7400,1153.6000,percent of total billed charges,"47.59% of $1,153.60 in Billed Charges for Rev 272 = $549.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLERBALL HF RESECT,272,RC,27200002,CDM,,,,,,both,,,1153.6000,173.0400,SENTARA HEALTH,SENTARA HEALTH,297.74,,,,,,,297.7400,1153.6000,percent of total billed charges,"25.81% of $1,153.60 in Billed Charges for Rev 272 = $297.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLERBALL HF RESECT,272,RC,27200002,CDM,,,,,,both,,,1153.6000,173.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1153.60,,,,,,,297.7400,1153.6000,percent of total billed charges,"100% of $1,153.60 in Billed Charges for Rev 272 = $1,153.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLERBALL HF RESECT,272,RC,27200002,CDM,,,,,,both,,,1153.6000,173.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,576.80,,,,,,,297.7400,1153.6000,percent of total billed charges,"Rev 272 $1,153.60 in Billed Charges at 50% = $576.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLERBALL HF RESECT,272,RC,27200002,CDM,,,,,,both,,,1153.6000,173.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,372.61,,,,,,,297.7400,1153.6000,other,"32.3% of $1,153.60 in Billed Charges for Rev 272 = $372.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE ROLLERBALL HF RESECT,272,RC,27200002,CDM,,,,,,both,,,1153.6000,173.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,354.16,,,,,,,297.7400,1153.6000,other,"30.7% of $1,153.60 in Billed Charges for Rev 272 = $354.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE ROLLERBALL HF RESECT,272,RC,27200002,CDM,,,,,,both,,,1153.6000,173.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,372.61,,,,,,,297.7400,1153.6000,percent of total billed charges,"32.3% of $1,153.60 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE ROLLERBALL HF RESECT,272,RC,27200002,CDM,,,,,,both,,,1153.6000,173.0400,WELLCARE,WELLCARE MEDICAID,1153.60,,,,,,,297.7400,1153.6000,percent of total billed charges,"100% of $1,153.60 in Billed Charges for Rev 272 = $1,153.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SINGLE CASE,272,RC,27200002,CDM,,,,,,both,,,1269.4100,190.4100,AETNA,AETNA,542.04,,,,,,,327.6300,1269.4100,percent of total billed charges,"42.7% of $1,269.41 in Billed Charges for Rev 272 = $542.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SINGLE CASE,272,RC,27200002,CDM,,,,,,both,,,1269.4100,190.4100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,888.59,,,,,,,327.6300,1269.4100,percent of total billed charges,"Rev 272 $1,269.41 in Billed Charges at 70% = $888.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SINGLE CASE,272,RC,27200002,CDM,,,,,,both,,,1269.4100,190.4100,CIGNA HEALTHCARE,CIGNA HMO,529.34,,,,,,,327.6300,1269.4100,percent of total billed charges,"41.7% of $1,269.41 in Billed Charges for Rev 272 = $529.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SINGLE CASE,272,RC,27200002,CDM,,,,,,both,,,1269.4100,190.4100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,589.01,,,,,,,327.6300,1269.4100,percent of total billed charges,"46.4% of $1,269.41 in Billed Charges for Rev 272 = $589.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SINGLE CASE,272,RC,27200002,CDM,,,,,,both,,,1269.4100,190.4100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,529.34,,,,,,,327.6300,1269.4100,percent of total billed charges,"41.7% of $1,269.41 in Billed Charges for Rev 272 = $529.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SINGLE CASE,272,RC,27200002,CDM,,,,,,both,,,1269.4100,190.4100,CIGNA HEALTHCARE,CIGNA PPO,529.34,,,,,,,327.6300,1269.4100,percent of total billed charges,"41.7% of $1,269.41 in Billed Charges for Rev 272 = $529.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SINGLE CASE,272,RC,27200002,CDM,,,,,,both,,,1269.4100,190.4100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1142.47,,,,,,,327.6300,1269.4100,percent of total billed charges,"90% of $1,269.41 in Billed Charges for Rev 272 = $1,142.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SINGLE CASE,272,RC,27200002,CDM,,,,,,both,,,1269.4100,190.4100,MEDCOST,MEDCOST VHN,604.11,,,,,,,327.6300,1269.4100,percent of total billed charges,"47.59% of $1,269.41 in Billed Charges for Rev 272 = $604.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SINGLE CASE,272,RC,27200002,CDM,,,,,,both,,,1269.4100,190.4100,SENTARA HEALTH,SENTARA HEALTH,327.63,,,,,,,327.6300,1269.4100,percent of total billed charges,"25.81% of $1,269.41 in Billed Charges for Rev 272 = $327.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SINGLE CASE,272,RC,27200002,CDM,,,,,,both,,,1269.4100,190.4100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1269.41,,,,,,,327.6300,1269.4100,percent of total billed charges,"100% of $1,269.41 in Billed Charges for Rev 272 = $1,269.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SINGLE CASE,272,RC,27200002,CDM,,,,,,both,,,1269.4100,190.4100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,634.71,,,,,,,327.6300,1269.4100,percent of total billed charges,"Rev 272 $1,269.41 in Billed Charges at 50% = $634.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SINGLE CASE,272,RC,27200002,CDM,,,,,,both,,,1269.4100,190.4100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,410.02,,,,,,,327.6300,1269.4100,other,"32.3% of $1,269.41 in Billed Charges for Rev 272 = $410.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE SINGLE CASE,272,RC,27200002,CDM,,,,,,both,,,1269.4100,190.4100,UNITED HEALTHCARE,UHC HERITAGE SELECT,389.71,,,,,,,327.6300,1269.4100,other,"30.7% of $1,269.41 in Billed Charges for Rev 272 = $389.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE SINGLE CASE,272,RC,27200002,CDM,,,,,,both,,,1269.4100,190.4100,UNITED HEALTHCARE,UNITED HEALTHCARE,410.02,,,,,,,327.6300,1269.4100,percent of total billed charges,"32.3% of $1,269.41 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SINGLE CASE,272,RC,27200002,CDM,,,,,,both,,,1269.4100,190.4100,WELLCARE,WELLCARE MEDICAID,1269.41,,,,,,,327.6300,1269.4100,percent of total billed charges,"100% of $1,269.41 in Billed Charges for Rev 272 = $1,269.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTION VAPR ARCTIC CHISEL TIP WITH INTEGRATED HANDPIECE,272,RC,,,,,,,,both,,,9388.9700,1408.3500,AETNA,AETNA,4009.09,,,,,,,2423.2900,9388.9700,percent of total billed charges,"42.7% of $9,388.97 in Billed Charges for Rev 272 = $4,009.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTION VAPR ARCTIC CHISEL TIP WITH INTEGRATED HANDPIECE,272,RC,,,,,,,,both,,,9388.9700,1408.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6572.28,,,,,,,2423.2900,9388.9700,percent of total billed charges,"Rev 272 $9,388.97 in Billed Charges at 70% = $6,572.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTION VAPR ARCTIC CHISEL TIP WITH INTEGRATED HANDPIECE,272,RC,,,,,,,,both,,,9388.9700,1408.3500,CIGNA HEALTHCARE,CIGNA HMO,3915.20,,,,,,,2423.2900,9388.9700,percent of total billed charges,"41.7% of $9,388.97 in Billed Charges for Rev 272 = $3,915.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTION VAPR ARCTIC CHISEL TIP WITH INTEGRATED HANDPIECE,272,RC,,,,,,,,both,,,9388.9700,1408.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4356.48,,,,,,,2423.2900,9388.9700,percent of total billed charges,"46.4% of $9,388.97 in Billed Charges for Rev 272 = $4,356.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTION VAPR ARCTIC CHISEL TIP WITH INTEGRATED HANDPIECE,272,RC,,,,,,,,both,,,9388.9700,1408.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3915.20,,,,,,,2423.2900,9388.9700,percent of total billed charges,"41.7% of $9,388.97 in Billed Charges for Rev 272 = $3,915.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTION VAPR ARCTIC CHISEL TIP WITH INTEGRATED HANDPIECE,272,RC,,,,,,,,both,,,9388.9700,1408.3500,CIGNA HEALTHCARE,CIGNA PPO,3915.20,,,,,,,2423.2900,9388.9700,percent of total billed charges,"41.7% of $9,388.97 in Billed Charges for Rev 272 = $3,915.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTION VAPR ARCTIC CHISEL TIP WITH INTEGRATED HANDPIECE,272,RC,,,,,,,,both,,,9388.9700,1408.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8450.07,,,,,,,2423.2900,9388.9700,percent of total billed charges,"90% of $9,388.97 in Billed Charges for Rev 272 = $8,450.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTION VAPR ARCTIC CHISEL TIP WITH INTEGRATED HANDPIECE,272,RC,,,,,,,,both,,,9388.9700,1408.3500,MEDCOST,MEDCOST VHN,4468.21,,,,,,,2423.2900,9388.9700,percent of total billed charges,"47.59% of $9,388.97 in Billed Charges for Rev 272 = $4,468.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTION VAPR ARCTIC CHISEL TIP WITH INTEGRATED HANDPIECE,272,RC,,,,,,,,both,,,9388.9700,1408.3500,SENTARA HEALTH,SENTARA HEALTH,2423.29,,,,,,,2423.2900,9388.9700,percent of total billed charges,"25.81% of $9,388.97 in Billed Charges for Rev 272 = $2,423.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTION VAPR ARCTIC CHISEL TIP WITH INTEGRATED HANDPIECE,272,RC,,,,,,,,both,,,9388.9700,1408.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9388.97,,,,,,,2423.2900,9388.9700,percent of total billed charges,"100% of $9,388.97 in Billed Charges for Rev 272 = $9,388.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTION VAPR ARCTIC CHISEL TIP WITH INTEGRATED HANDPIECE,272,RC,,,,,,,,both,,,9388.9700,1408.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4694.49,,,,,,,2423.2900,9388.9700,percent of total billed charges,"Rev 272 $9,388.97 in Billed Charges at 50% = $4,694.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTION VAPR ARCTIC CHISEL TIP WITH INTEGRATED HANDPIECE,272,RC,,,,,,,,both,,,9388.9700,1408.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3032.64,,,,,,,2423.2900,9388.9700,other,"32.3% of $9,388.97 in Billed Charges for Rev 272 = $3,032.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE SUCTION VAPR ARCTIC CHISEL TIP WITH INTEGRATED HANDPIECE,272,RC,,,,,,,,both,,,9388.9700,1408.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2882.41,,,,,,,2423.2900,9388.9700,other,"30.7% of $9,388.97 in Billed Charges for Rev 272 = $2,882.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE SUCTION VAPR ARCTIC CHISEL TIP WITH INTEGRATED HANDPIECE,272,RC,,,,,,,,both,,,9388.9700,1408.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,3032.64,,,,,,,2423.2900,9388.9700,percent of total billed charges,"32.3% of $9,388.97 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTION VAPR ARCTIC CHISEL TIP WITH INTEGRATED HANDPIECE,272,RC,,,,,,,,both,,,9388.9700,1408.3500,WELLCARE,WELLCARE MEDICAID,9388.97,,,,,,,2423.2900,9388.9700,percent of total billed charges,"100% of $9,388.97 in Billed Charges for Rev 272 = $9,388.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTIONVAPR TRIPOLAR 90DEG,272,RC,,,,,,,,both,,,4821.8900,723.2800,AETNA,AETNA,2058.95,,,,,,,1244.5300,4821.8900,percent of total billed charges,"42.7% of $4,821.89 in Billed Charges for Rev 272 = $2,058.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTIONVAPR TRIPOLAR 90DEG,272,RC,,,,,,,,both,,,4821.8900,723.2800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3375.32,,,,,,,1244.5300,4821.8900,percent of total billed charges,"Rev 272 $4,821.89 in Billed Charges at 70% = $3,375.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTIONVAPR TRIPOLAR 90DEG,272,RC,,,,,,,,both,,,4821.8900,723.2800,CIGNA HEALTHCARE,CIGNA HMO,2010.73,,,,,,,1244.5300,4821.8900,percent of total billed charges,"41.7% of $4,821.89 in Billed Charges for Rev 272 = $2,010.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTIONVAPR TRIPOLAR 90DEG,272,RC,,,,,,,,both,,,4821.8900,723.2800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2237.36,,,,,,,1244.5300,4821.8900,percent of total billed charges,"46.4% of $4,821.89 in Billed Charges for Rev 272 = $2,237.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTIONVAPR TRIPOLAR 90DEG,272,RC,,,,,,,,both,,,4821.8900,723.2800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2010.73,,,,,,,1244.5300,4821.8900,percent of total billed charges,"41.7% of $4,821.89 in Billed Charges for Rev 272 = $2,010.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTIONVAPR TRIPOLAR 90DEG,272,RC,,,,,,,,both,,,4821.8900,723.2800,CIGNA HEALTHCARE,CIGNA PPO,2010.73,,,,,,,1244.5300,4821.8900,percent of total billed charges,"41.7% of $4,821.89 in Billed Charges for Rev 272 = $2,010.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTIONVAPR TRIPOLAR 90DEG,272,RC,,,,,,,,both,,,4821.8900,723.2800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4339.70,,,,,,,1244.5300,4821.8900,percent of total billed charges,"90% of $4,821.89 in Billed Charges for Rev 272 = $4,339.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTIONVAPR TRIPOLAR 90DEG,272,RC,,,,,,,,both,,,4821.8900,723.2800,MEDCOST,MEDCOST VHN,2294.74,,,,,,,1244.5300,4821.8900,percent of total billed charges,"47.59% of $4,821.89 in Billed Charges for Rev 272 = $2,294.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTIONVAPR TRIPOLAR 90DEG,272,RC,,,,,,,,both,,,4821.8900,723.2800,SENTARA HEALTH,SENTARA HEALTH,1244.53,,,,,,,1244.5300,4821.8900,percent of total billed charges,"25.81% of $4,821.89 in Billed Charges for Rev 272 = $1,244.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTIONVAPR TRIPOLAR 90DEG,272,RC,,,,,,,,both,,,4821.8900,723.2800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4821.89,,,,,,,1244.5300,4821.8900,percent of total billed charges,"100% of $4,821.89 in Billed Charges for Rev 272 = $4,821.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTIONVAPR TRIPOLAR 90DEG,272,RC,,,,,,,,both,,,4821.8900,723.2800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2410.95,,,,,,,1244.5300,4821.8900,percent of total billed charges,"Rev 272 $4,821.89 in Billed Charges at 50% = $2,410.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTIONVAPR TRIPOLAR 90DEG,272,RC,,,,,,,,both,,,4821.8900,723.2800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1557.47,,,,,,,1244.5300,4821.8900,other,"32.3% of $4,821.89 in Billed Charges for Rev 272 = $1,557.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE SUCTIONVAPR TRIPOLAR 90DEG,272,RC,,,,,,,,both,,,4821.8900,723.2800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1480.32,,,,,,,1244.5300,4821.8900,other,"30.7% of $4,821.89 in Billed Charges for Rev 272 = $1,480.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE SUCTIONVAPR TRIPOLAR 90DEG,272,RC,,,,,,,,both,,,4821.8900,723.2800,UNITED HEALTHCARE,UNITED HEALTHCARE,1557.47,,,,,,,1244.5300,4821.8900,percent of total billed charges,"32.3% of $4,821.89 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE SUCTIONVAPR TRIPOLAR 90DEG,272,RC,,,,,,,,both,,,4821.8900,723.2800,WELLCARE,WELLCARE MEDICAID,4821.89,,,,,,,1244.5300,4821.8900,percent of total billed charges,"100% of $4,821.89 in Billed Charges for Rev 272 = $4,821.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELEVIEW 5 AMP 10ML,272,RC,27200002,CDM,,,,,,both,,,867.0200,130.0500,AETNA,AETNA,370.22,,,,,,,223.7800,867.0200,percent of total billed charges,42.7% of $867.02 in Billed Charges for Rev 272 = $370.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELEVIEW 5 AMP 10ML,272,RC,27200002,CDM,,,,,,both,,,867.0200,130.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,606.91,,,,,,,223.7800,867.0200,percent of total billed charges,Rev 272 $867.02 in Billed Charges at 70% = $606.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELEVIEW 5 AMP 10ML,272,RC,27200002,CDM,,,,,,both,,,867.0200,130.0500,CIGNA HEALTHCARE,CIGNA HMO,361.55,,,,,,,223.7800,867.0200,percent of total billed charges,41.7% of $867.02 in Billed Charges for Rev 272 = $361.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELEVIEW 5 AMP 10ML,272,RC,27200002,CDM,,,,,,both,,,867.0200,130.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,402.30,,,,,,,223.7800,867.0200,percent of total billed charges,46.4% of $867.02 in Billed Charges for Rev 272 = $402.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELEVIEW 5 AMP 10ML,272,RC,27200002,CDM,,,,,,both,,,867.0200,130.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,361.55,,,,,,,223.7800,867.0200,percent of total billed charges,41.7% of $867.02 in Billed Charges for Rev 272 = $361.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELEVIEW 5 AMP 10ML,272,RC,27200002,CDM,,,,,,both,,,867.0200,130.0500,CIGNA HEALTHCARE,CIGNA PPO,361.55,,,,,,,223.7800,867.0200,percent of total billed charges,41.7% of $867.02 in Billed Charges for Rev 272 = $361.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELEVIEW 5 AMP 10ML,272,RC,27200002,CDM,,,,,,both,,,867.0200,130.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,780.32,,,,,,,223.7800,867.0200,percent of total billed charges,90% of $867.02 in Billed Charges for Rev 272 = $780.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELEVIEW 5 AMP 10ML,272,RC,27200002,CDM,,,,,,both,,,867.0200,130.0500,MEDCOST,MEDCOST VHN,412.61,,,,,,,223.7800,867.0200,percent of total billed charges,47.59% of $867.02 in Billed Charges for Rev 272 = $412.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELEVIEW 5 AMP 10ML,272,RC,27200002,CDM,,,,,,both,,,867.0200,130.0500,SENTARA HEALTH,SENTARA HEALTH,223.78,,,,,,,223.7800,867.0200,percent of total billed charges,25.81% of $867.02 in Billed Charges for Rev 272 = $223.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELEVIEW 5 AMP 10ML,272,RC,27200002,CDM,,,,,,both,,,867.0200,130.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",867.02,,,,,,,223.7800,867.0200,percent of total billed charges,100% of $867.02 in Billed Charges for Rev 272 = $867.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELEVIEW 5 AMP 10ML,272,RC,27200002,CDM,,,,,,both,,,867.0200,130.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,433.51,,,,,,,223.7800,867.0200,percent of total billed charges,Rev 272 $867.02 in Billed Charges at 50% = $433.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELEVIEW 5 AMP 10ML,272,RC,27200002,CDM,,,,,,both,,,867.0200,130.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,280.05,,,,,,,223.7800,867.0200,other,32.3% of $867.02 in Billed Charges for Rev 272 = $280.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ELEVIEW 5 AMP 10ML,272,RC,27200002,CDM,,,,,,both,,,867.0200,130.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,266.18,,,,,,,223.7800,867.0200,other,30.7% of $867.02 in Billed Charges for Rev 272 = $266.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ELEVIEW 5 AMP 10ML,272,RC,27200002,CDM,,,,,,both,,,867.0200,130.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,280.05,,,,,,,223.7800,867.0200,percent of total billed charges,32.3% of $867.02 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELEVIEW 5 AMP 10ML,272,RC,27200002,CDM,,,,,,both,,,867.0200,130.0500,WELLCARE,WELLCARE MEDICAID,867.02,,,,,,,223.7800,867.0200,percent of total billed charges,100% of $867.02 in Billed Charges for Rev 272 = $867.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FORCEP GRASP STONE REMOV 2.8,272,RC,27200002,CDM,,,,,,both,,,2679.2400,401.8900,AETNA,AETNA,1144.04,,,,,,,691.5100,2679.2400,percent of total billed charges,"42.7% of $2,679.24 in Billed Charges for Rev 272 = $1,144.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP GRASP STONE REMOV 2.8,272,RC,27200002,CDM,,,,,,both,,,2679.2400,401.8900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1875.47,,,,,,,691.5100,2679.2400,percent of total billed charges,"Rev 272 $2,679.24 in Billed Charges at 70% = $1,875.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP GRASP STONE REMOV 2.8,272,RC,27200002,CDM,,,,,,both,,,2679.2400,401.8900,CIGNA HEALTHCARE,CIGNA HMO,1117.24,,,,,,,691.5100,2679.2400,percent of total billed charges,"41.7% of $2,679.24 in Billed Charges for Rev 272 = $1,117.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP GRASP STONE REMOV 2.8,272,RC,27200002,CDM,,,,,,both,,,2679.2400,401.8900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1243.17,,,,,,,691.5100,2679.2400,percent of total billed charges,"46.4% of $2,679.24 in Billed Charges for Rev 272 = $1,243.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP GRASP STONE REMOV 2.8,272,RC,27200002,CDM,,,,,,both,,,2679.2400,401.8900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1117.24,,,,,,,691.5100,2679.2400,percent of total billed charges,"41.7% of $2,679.24 in Billed Charges for Rev 272 = $1,117.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP GRASP STONE REMOV 2.8,272,RC,27200002,CDM,,,,,,both,,,2679.2400,401.8900,CIGNA HEALTHCARE,CIGNA PPO,1117.24,,,,,,,691.5100,2679.2400,percent of total billed charges,"41.7% of $2,679.24 in Billed Charges for Rev 272 = $1,117.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP GRASP STONE REMOV 2.8,272,RC,27200002,CDM,,,,,,both,,,2679.2400,401.8900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2411.32,,,,,,,691.5100,2679.2400,percent of total billed charges,"90% of $2,679.24 in Billed Charges for Rev 272 = $2,411.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP GRASP STONE REMOV 2.8,272,RC,27200002,CDM,,,,,,both,,,2679.2400,401.8900,MEDCOST,MEDCOST VHN,1275.05,,,,,,,691.5100,2679.2400,percent of total billed charges,"47.59% of $2,679.24 in Billed Charges for Rev 272 = $1,275.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP GRASP STONE REMOV 2.8,272,RC,27200002,CDM,,,,,,both,,,2679.2400,401.8900,SENTARA HEALTH,SENTARA HEALTH,691.51,,,,,,,691.5100,2679.2400,percent of total billed charges,"25.81% of $2,679.24 in Billed Charges for Rev 272 = $691.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP GRASP STONE REMOV 2.8,272,RC,27200002,CDM,,,,,,both,,,2679.2400,401.8900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2679.24,,,,,,,691.5100,2679.2400,percent of total billed charges,"100% of $2,679.24 in Billed Charges for Rev 272 = $2,679.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP GRASP STONE REMOV 2.8,272,RC,27200002,CDM,,,,,,both,,,2679.2400,401.8900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1339.62,,,,,,,691.5100,2679.2400,percent of total billed charges,"Rev 272 $2,679.24 in Billed Charges at 50% = $1,339.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP GRASP STONE REMOV 2.8,272,RC,27200002,CDM,,,,,,both,,,2679.2400,401.8900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,865.39,,,,,,,691.5100,2679.2400,other,"32.3% of $2,679.24 in Billed Charges for Rev 272 = $865.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP GRASP STONE REMOV 2.8,272,RC,27200002,CDM,,,,,,both,,,2679.2400,401.8900,UNITED HEALTHCARE,UHC HERITAGE SELECT,822.53,,,,,,,691.5100,2679.2400,other,"30.7% of $2,679.24 in Billed Charges for Rev 272 = $822.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP GRASP STONE REMOV 2.8,272,RC,27200002,CDM,,,,,,both,,,2679.2400,401.8900,UNITED HEALTHCARE,UNITED HEALTHCARE,865.39,,,,,,,691.5100,2679.2400,percent of total billed charges,"32.3% of $2,679.24 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP GRASP STONE REMOV 2.8,272,RC,27200002,CDM,,,,,,both,,,2679.2400,401.8900,WELLCARE,WELLCARE MEDICAID,2679.24,,,,,,,691.5100,2679.2400,percent of total billed charges,"100% of $2,679.24 in Billed Charges for Rev 272 = $2,679.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LONG TIP 8MM,272,RC,,,,,,,,both,,,1361.4800,204.2200,AETNA,AETNA,581.35,,,,,,,351.4000,1361.4800,percent of total billed charges,"42.7% of $1,361.48 in Billed Charges for Rev 272 = $581.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LONG TIP 8MM,272,RC,,,,,,,,both,,,1361.4800,204.2200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,953.04,,,,,,,351.4000,1361.4800,percent of total billed charges,"Rev 272 $1,361.48 in Billed Charges at 70% = $953.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LONG TIP 8MM,272,RC,,,,,,,,both,,,1361.4800,204.2200,CIGNA HEALTHCARE,CIGNA HMO,567.74,,,,,,,351.4000,1361.4800,percent of total billed charges,"41.7% of $1,361.48 in Billed Charges for Rev 272 = $567.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LONG TIP 8MM,272,RC,,,,,,,,both,,,1361.4800,204.2200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,631.73,,,,,,,351.4000,1361.4800,percent of total billed charges,"46.4% of $1,361.48 in Billed Charges for Rev 272 = $631.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LONG TIP 8MM,272,RC,,,,,,,,both,,,1361.4800,204.2200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,567.74,,,,,,,351.4000,1361.4800,percent of total billed charges,"41.7% of $1,361.48 in Billed Charges for Rev 272 = $567.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LONG TIP 8MM,272,RC,,,,,,,,both,,,1361.4800,204.2200,CIGNA HEALTHCARE,CIGNA PPO,567.74,,,,,,,351.4000,1361.4800,percent of total billed charges,"41.7% of $1,361.48 in Billed Charges for Rev 272 = $567.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LONG TIP 8MM,272,RC,,,,,,,,both,,,1361.4800,204.2200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1225.33,,,,,,,351.4000,1361.4800,percent of total billed charges,"90% of $1,361.48 in Billed Charges for Rev 272 = $1,225.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LONG TIP 8MM,272,RC,,,,,,,,both,,,1361.4800,204.2200,MEDCOST,MEDCOST VHN,647.93,,,,,,,351.4000,1361.4800,percent of total billed charges,"47.59% of $1,361.48 in Billed Charges for Rev 272 = $647.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LONG TIP 8MM,272,RC,,,,,,,,both,,,1361.4800,204.2200,SENTARA HEALTH,SENTARA HEALTH,351.40,,,,,,,351.4000,1361.4800,percent of total billed charges,"25.81% of $1,361.48 in Billed Charges for Rev 272 = $351.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LONG TIP 8MM,272,RC,,,,,,,,both,,,1361.4800,204.2200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1361.48,,,,,,,351.4000,1361.4800,percent of total billed charges,"100% of $1,361.48 in Billed Charges for Rev 272 = $1,361.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LONG TIP 8MM,272,RC,,,,,,,,both,,,1361.4800,204.2200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,680.74,,,,,,,351.4000,1361.4800,percent of total billed charges,"Rev 272 $1,361.48 in Billed Charges at 50% = $680.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LONG TIP 8MM,272,RC,,,,,,,,both,,,1361.4800,204.2200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,439.76,,,,,,,351.4000,1361.4800,other,"32.3% of $1,361.48 in Billed Charges for Rev 272 = $439.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP LONG TIP 8MM,272,RC,,,,,,,,both,,,1361.4800,204.2200,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.97,,,,,,,351.4000,1361.4800,other,"30.7% of $1,361.48 in Billed Charges for Rev 272 = $417.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCEP LONG TIP 8MM,272,RC,,,,,,,,both,,,1361.4800,204.2200,UNITED HEALTHCARE,UNITED HEALTHCARE,439.76,,,,,,,351.4000,1361.4800,percent of total billed charges,"32.3% of $1,361.48 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCEP LONG TIP 8MM,272,RC,,,,,,,,both,,,1361.4800,204.2200,WELLCARE,WELLCARE MEDICAID,1361.48,,,,,,,351.4000,1361.4800,percent of total billed charges,"100% of $1,361.48 in Billed Charges for Rev 272 = $1,361.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP II 10MM PISTOL 17665 SURPASS SEE LN 100292,272,RC,27200002,CDM,,,,,,both,,,4494.4700,674.1700,AETNA,AETNA,1919.14,,,,,,,1160.0200,4494.4700,percent of total billed charges,"42.7% of $4,494.47 in Billed Charges for Rev 272 = $1,919.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP II 10MM PISTOL 17665 SURPASS SEE LN 100292,272,RC,27200002,CDM,,,,,,both,,,4494.4700,674.1700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3146.13,,,,,,,1160.0200,4494.4700,percent of total billed charges,"Rev 272 $4,494.47 in Billed Charges at 70% = $3,146.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP II 10MM PISTOL 17665 SURPASS SEE LN 100292,272,RC,27200002,CDM,,,,,,both,,,4494.4700,674.1700,CIGNA HEALTHCARE,CIGNA HMO,1874.19,,,,,,,1160.0200,4494.4700,percent of total billed charges,"41.7% of $4,494.47 in Billed Charges for Rev 272 = $1,874.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP II 10MM PISTOL 17665 SURPASS SEE LN 100292,272,RC,27200002,CDM,,,,,,both,,,4494.4700,674.1700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2085.43,,,,,,,1160.0200,4494.4700,percent of total billed charges,"46.4% of $4,494.47 in Billed Charges for Rev 272 = $2,085.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP II 10MM PISTOL 17665 SURPASS SEE LN 100292,272,RC,27200002,CDM,,,,,,both,,,4494.4700,674.1700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1874.19,,,,,,,1160.0200,4494.4700,percent of total billed charges,"41.7% of $4,494.47 in Billed Charges for Rev 272 = $1,874.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP II 10MM PISTOL 17665 SURPASS SEE LN 100292,272,RC,27200002,CDM,,,,,,both,,,4494.4700,674.1700,CIGNA HEALTHCARE,CIGNA PPO,1874.19,,,,,,,1160.0200,4494.4700,percent of total billed charges,"41.7% of $4,494.47 in Billed Charges for Rev 272 = $1,874.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP II 10MM PISTOL 17665 SURPASS SEE LN 100292,272,RC,27200002,CDM,,,,,,both,,,4494.4700,674.1700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4045.02,,,,,,,1160.0200,4494.4700,percent of total billed charges,"90% of $4,494.47 in Billed Charges for Rev 272 = $4,045.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP II 10MM PISTOL 17665 SURPASS SEE LN 100292,272,RC,27200002,CDM,,,,,,both,,,4494.4700,674.1700,MEDCOST,MEDCOST VHN,2138.92,,,,,,,1160.0200,4494.4700,percent of total billed charges,"47.59% of $4,494.47 in Billed Charges for Rev 272 = $2,138.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP II 10MM PISTOL 17665 SURPASS SEE LN 100292,272,RC,27200002,CDM,,,,,,both,,,4494.4700,674.1700,SENTARA HEALTH,SENTARA HEALTH,1160.02,,,,,,,1160.0200,4494.4700,percent of total billed charges,"25.81% of $4,494.47 in Billed Charges for Rev 272 = $1,160.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP II 10MM PISTOL 17665 SURPASS SEE LN 100292,272,RC,27200002,CDM,,,,,,both,,,4494.4700,674.1700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4494.47,,,,,,,1160.0200,4494.4700,percent of total billed charges,"100% of $4,494.47 in Billed Charges for Rev 272 = $4,494.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP II 10MM PISTOL 17665 SURPASS SEE LN 100292,272,RC,27200002,CDM,,,,,,both,,,4494.4700,674.1700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2247.24,,,,,,,1160.0200,4494.4700,percent of total billed charges,"Rev 272 $4,494.47 in Billed Charges at 50% = $2,247.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP II 10MM PISTOL 17665 SURPASS SEE LN 100292,272,RC,27200002,CDM,,,,,,both,,,4494.4700,674.1700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1451.71,,,,,,,1160.0200,4494.4700,other,"32.3% of $4,494.47 in Billed Charges for Rev 272 = $1,451.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENDO CLIP II 10MM PISTOL 17665 SURPASS SEE LN 100292,272,RC,27200002,CDM,,,,,,both,,,4494.4700,674.1700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1379.80,,,,,,,1160.0200,4494.4700,other,"30.7% of $4,494.47 in Billed Charges for Rev 272 = $1,379.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENDO CLIP II 10MM PISTOL 17665 SURPASS SEE LN 100292,272,RC,27200002,CDM,,,,,,both,,,4494.4700,674.1700,UNITED HEALTHCARE,UNITED HEALTHCARE,1451.71,,,,,,,1160.0200,4494.4700,percent of total billed charges,"32.3% of $4,494.47 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP II 10MM PISTOL 17665 SURPASS SEE LN 100292,272,RC,27200002,CDM,,,,,,both,,,4494.4700,674.1700,WELLCARE,WELLCARE MEDICAID,4494.47,,,,,,,1160.0200,4494.4700,percent of total billed charges,"100% of $4,494.47 in Billed Charges for Rev 272 = $4,494.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IPS CUTTING W/PLANNING,272,RC,27200002,CDM,,,,,,both,,,87240.8500,13086.1300,AETNA,AETNA,37251.84,,,,,,,22516.8600,87240.8500,percent of total billed charges,"42.7% of $87,240.85 in Billed Charges for Rev 272 = $37,251.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IPS CUTTING W/PLANNING,272,RC,27200002,CDM,,,,,,both,,,87240.8500,13086.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,61068.60,,,,,,,22516.8600,87240.8500,percent of total billed charges,"Rev 272 $87,240.85 in Billed Charges at 70% = $61,068.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IPS CUTTING W/PLANNING,272,RC,27200002,CDM,,,,,,both,,,87240.8500,13086.1300,CIGNA HEALTHCARE,CIGNA HMO,36379.43,,,,,,,22516.8600,87240.8500,percent of total billed charges,"41.7% of $87,240.85 in Billed Charges for Rev 272 = $36,379.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IPS CUTTING W/PLANNING,272,RC,27200002,CDM,,,,,,both,,,87240.8500,13086.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,40479.75,,,,,,,22516.8600,87240.8500,percent of total billed charges,"46.4% of $87,240.85 in Billed Charges for Rev 272 = $40,479.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IPS CUTTING W/PLANNING,272,RC,27200002,CDM,,,,,,both,,,87240.8500,13086.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,36379.43,,,,,,,22516.8600,87240.8500,percent of total billed charges,"41.7% of $87,240.85 in Billed Charges for Rev 272 = $36,379.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IPS CUTTING W/PLANNING,272,RC,27200002,CDM,,,,,,both,,,87240.8500,13086.1300,CIGNA HEALTHCARE,CIGNA PPO,36379.43,,,,,,,22516.8600,87240.8500,percent of total billed charges,"41.7% of $87,240.85 in Billed Charges for Rev 272 = $36,379.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IPS CUTTING W/PLANNING,272,RC,27200002,CDM,,,,,,both,,,87240.8500,13086.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,78516.77,,,,,,,22516.8600,87240.8500,percent of total billed charges,"90% of $87,240.85 in Billed Charges for Rev 272 = $78,516.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IPS CUTTING W/PLANNING,272,RC,27200002,CDM,,,,,,both,,,87240.8500,13086.1300,MEDCOST,MEDCOST VHN,41517.92,,,,,,,22516.8600,87240.8500,percent of total billed charges,"47.59% of $87,240.85 in Billed Charges for Rev 272 = $41,517.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IPS CUTTING W/PLANNING,272,RC,27200002,CDM,,,,,,both,,,87240.8500,13086.1300,SENTARA HEALTH,SENTARA HEALTH,22516.86,,,,,,,22516.8600,87240.8500,percent of total billed charges,"25.81% of $87,240.85 in Billed Charges for Rev 272 = $22,516.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IPS CUTTING W/PLANNING,272,RC,27200002,CDM,,,,,,both,,,87240.8500,13086.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",87240.85,,,,,,,22516.8600,87240.8500,percent of total billed charges,"100% of $87,240.85 in Billed Charges for Rev 272 = $87,240.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IPS CUTTING W/PLANNING,272,RC,27200002,CDM,,,,,,both,,,87240.8500,13086.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,43620.43,,,,,,,22516.8600,87240.8500,percent of total billed charges,"Rev 272 $87,240.85 in Billed Charges at 50% = $43,620.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IPS CUTTING W/PLANNING,272,RC,27200002,CDM,,,,,,both,,,87240.8500,13086.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,28178.79,,,,,,,22516.8600,87240.8500,other,"32.3% of $87,240.85 in Billed Charges for Rev 272 = $28,178.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE IPS CUTTING W/PLANNING,272,RC,27200002,CDM,,,,,,both,,,87240.8500,13086.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,26782.94,,,,,,,22516.8600,87240.8500,other,"30.7% of $87,240.85 in Billed Charges for Rev 272 = $26,782.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE IPS CUTTING W/PLANNING,272,RC,27200002,CDM,,,,,,both,,,87240.8500,13086.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,28178.79,,,,,,,22516.8600,87240.8500,percent of total billed charges,"32.3% of $87,240.85 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE IPS CUTTING W/PLANNING,272,RC,27200002,CDM,,,,,,both,,,87240.8500,13086.1300,WELLCARE,WELLCARE MEDICAID,87240.85,,,,,,,22516.8600,87240.8500,percent of total billed charges,"100% of $87,240.85 in Billed Charges for Rev 272 = $87,240.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE NEEDLE ENDOCAVITY BAUER,270,RC,,,,,,,,both,,,2074.2000,311.1300,AETNA,AETNA,885.68,,,,,,,535.3500,2074.2000,percent of total billed charges,"42.7% of $2,074.20 in Billed Charges for Rev 270 = $885.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE NEEDLE ENDOCAVITY BAUER,270,RC,,,,,,,,both,,,2074.2000,311.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1451.94,,,,,,,535.3500,2074.2000,percent of total billed charges,"Rev 270 $2,074.20 in Billed Charges at 70% = $1,451.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE NEEDLE ENDOCAVITY BAUER,270,RC,,,,,,,,both,,,2074.2000,311.1300,CIGNA HEALTHCARE,CIGNA HMO,864.94,,,,,,,535.3500,2074.2000,percent of total billed charges,"41.7% of $2,074.20 in Billed Charges for Rev 270 = $864.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE NEEDLE ENDOCAVITY BAUER,270,RC,,,,,,,,both,,,2074.2000,311.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,962.43,,,,,,,535.3500,2074.2000,percent of total billed charges,"46.4% of $2,074.20 in Billed Charges for Rev 270 = $962.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE NEEDLE ENDOCAVITY BAUER,270,RC,,,,,,,,both,,,2074.2000,311.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,864.94,,,,,,,535.3500,2074.2000,percent of total billed charges,"41.7% of $2,074.20 in Billed Charges for Rev 270 = $864.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE NEEDLE ENDOCAVITY BAUER,270,RC,,,,,,,,both,,,2074.2000,311.1300,CIGNA HEALTHCARE,CIGNA PPO,864.94,,,,,,,535.3500,2074.2000,percent of total billed charges,"41.7% of $2,074.20 in Billed Charges for Rev 270 = $864.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE NEEDLE ENDOCAVITY BAUER,270,RC,,,,,,,,both,,,2074.2000,311.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1866.78,,,,,,,535.3500,2074.2000,percent of total billed charges,"90% of $2,074.20 in Billed Charges for Rev 270 = $1,866.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE NEEDLE ENDOCAVITY BAUER,270,RC,,,,,,,,both,,,2074.2000,311.1300,MEDCOST,MEDCOST VHN,987.11,,,,,,,535.3500,2074.2000,percent of total billed charges,"47.59% of $2,074.20 in Billed Charges for Rev 270 = $987.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE NEEDLE ENDOCAVITY BAUER,270,RC,,,,,,,,both,,,2074.2000,311.1300,SENTARA HEALTH,SENTARA HEALTH,535.35,,,,,,,535.3500,2074.2000,percent of total billed charges,"25.81% of $2,074.20 in Billed Charges for Rev 270 = $535.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE NEEDLE ENDOCAVITY BAUER,270,RC,,,,,,,,both,,,2074.2000,311.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2074.20,,,,,,,535.3500,2074.2000,percent of total billed charges,"100% of $2,074.20 in Billed Charges for Rev 270 = $2,074.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE NEEDLE ENDOCAVITY BAUER,270,RC,,,,,,,,both,,,2074.2000,311.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1037.10,,,,,,,535.3500,2074.2000,percent of total billed charges,"Rev 270 $2,074.20 in Billed Charges at 50% = $1,037.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE NEEDLE ENDOCAVITY BAUER,270,RC,,,,,,,,both,,,2074.2000,311.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,669.97,,,,,,,535.3500,2074.2000,other,"32.3% of $2,074.20 in Billed Charges for Rev 270 = $669.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE NEEDLE ENDOCAVITY BAUER,270,RC,,,,,,,,both,,,2074.2000,311.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,636.78,,,,,,,535.3500,2074.2000,other,"30.7% of $2,074.20 in Billed Charges for Rev 270 = $636.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE NEEDLE ENDOCAVITY BAUER,270,RC,,,,,,,,both,,,2074.2000,311.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,669.97,,,,,,,535.3500,2074.2000,percent of total billed charges,"32.3% of $2,074.20 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE NEEDLE ENDOCAVITY BAUER,270,RC,,,,,,,,both,,,2074.2000,311.1300,WELLCARE,WELLCARE MEDICAID,2074.20,,,,,,,535.3500,2074.2000,percent of total billed charges,"100% of $2,074.20 in Billed Charges for Rev 270 = $2,074.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ORTHOG IPP COMPLEX TI 00163 LP,272,RC,,,,,,,,both,,,37242.2600,5586.3400,AETNA,AETNA,15902.45,,,,,,,9612.2300,37242.2600,percent of total billed charges,"42.7% of $37,242.26 in Billed Charges for Rev 272 = $15,902.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ORTHOG IPP COMPLEX TI 00163 LP,272,RC,,,,,,,,both,,,37242.2600,5586.3400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,26069.58,,,,,,,9612.2300,37242.2600,percent of total billed charges,"Rev 272 $37,242.26 in Billed Charges at 70% = $26,069.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ORTHOG IPP COMPLEX TI 00163 LP,272,RC,,,,,,,,both,,,37242.2600,5586.3400,CIGNA HEALTHCARE,CIGNA HMO,15530.02,,,,,,,9612.2300,37242.2600,percent of total billed charges,"41.7% of $37,242.26 in Billed Charges for Rev 272 = $15,530.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ORTHOG IPP COMPLEX TI 00163 LP,272,RC,,,,,,,,both,,,37242.2600,5586.3400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,17280.41,,,,,,,9612.2300,37242.2600,percent of total billed charges,"46.4% of $37,242.26 in Billed Charges for Rev 272 = $17,280.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ORTHOG IPP COMPLEX TI 00163 LP,272,RC,,,,,,,,both,,,37242.2600,5586.3400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,15530.02,,,,,,,9612.2300,37242.2600,percent of total billed charges,"41.7% of $37,242.26 in Billed Charges for Rev 272 = $15,530.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ORTHOG IPP COMPLEX TI 00163 LP,272,RC,,,,,,,,both,,,37242.2600,5586.3400,CIGNA HEALTHCARE,CIGNA PPO,15530.02,,,,,,,9612.2300,37242.2600,percent of total billed charges,"41.7% of $37,242.26 in Billed Charges for Rev 272 = $15,530.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ORTHOG IPP COMPLEX TI 00163 LP,272,RC,,,,,,,,both,,,37242.2600,5586.3400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,33518.03,,,,,,,9612.2300,37242.2600,percent of total billed charges,"90% of $37,242.26 in Billed Charges for Rev 272 = $33,518.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ORTHOG IPP COMPLEX TI 00163 LP,272,RC,,,,,,,,both,,,37242.2600,5586.3400,MEDCOST,MEDCOST VHN,17723.59,,,,,,,9612.2300,37242.2600,percent of total billed charges,"47.59% of $37,242.26 in Billed Charges for Rev 272 = $17,723.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ORTHOG IPP COMPLEX TI 00163 LP,272,RC,,,,,,,,both,,,37242.2600,5586.3400,SENTARA HEALTH,SENTARA HEALTH,9612.23,,,,,,,9612.2300,37242.2600,percent of total billed charges,"25.81% of $37,242.26 in Billed Charges for Rev 272 = $9,612.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ORTHOG IPP COMPLEX TI 00163 LP,272,RC,,,,,,,,both,,,37242.2600,5586.3400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",37242.26,,,,,,,9612.2300,37242.2600,percent of total billed charges,"100% of $37,242.26 in Billed Charges for Rev 272 = $37,242.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ORTHOG IPP COMPLEX TI 00163 LP,272,RC,,,,,,,,both,,,37242.2600,5586.3400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,18621.13,,,,,,,9612.2300,37242.2600,percent of total billed charges,"Rev 272 $37,242.26 in Billed Charges at 50% = $18,621.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ORTHOG IPP COMPLEX TI 00163 LP,272,RC,,,,,,,,both,,,37242.2600,5586.3400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12029.25,,,,,,,9612.2300,37242.2600,other,"32.3% of $37,242.26 in Billed Charges for Rev 272 = $12,029.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE ORTHOG IPP COMPLEX TI 00163 LP,272,RC,,,,,,,,both,,,37242.2600,5586.3400,UNITED HEALTHCARE,UHC HERITAGE SELECT,11433.37,,,,,,,9612.2300,37242.2600,other,"30.7% of $37,242.26 in Billed Charges for Rev 272 = $11,433.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE ORTHOG IPP COMPLEX TI 00163 LP,272,RC,,,,,,,,both,,,37242.2600,5586.3400,UNITED HEALTHCARE,UNITED HEALTHCARE,12029.25,,,,,,,9612.2300,37242.2600,percent of total billed charges,"32.3% of $37,242.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ORTHOG IPP COMPLEX TI 00163 LP,272,RC,,,,,,,,both,,,37242.2600,5586.3400,WELLCARE,WELLCARE MEDICAID,37242.26,,,,,,,9612.2300,37242.2600,percent of total billed charges,"100% of $37,242.26 in Billed Charges for Rev 272 = $37,242.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIXATION DEVICE OPENSTRAP W/20,272,RC,27200002,CDM,,,,,,both,,,5396.6400,809.5000,AETNA,AETNA,2304.37,,,,,,,1392.8700,5396.6400,percent of total billed charges,"42.7% of $5,396.64 in Billed Charges for Rev 272 = $2,304.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIXATION DEVICE OPENSTRAP W/20,272,RC,27200002,CDM,,,,,,both,,,5396.6400,809.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3777.65,,,,,,,1392.8700,5396.6400,percent of total billed charges,"Rev 272 $5,396.64 in Billed Charges at 70% = $3,777.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIXATION DEVICE OPENSTRAP W/20,272,RC,27200002,CDM,,,,,,both,,,5396.6400,809.5000,CIGNA HEALTHCARE,CIGNA HMO,2250.40,,,,,,,1392.8700,5396.6400,percent of total billed charges,"41.7% of $5,396.64 in Billed Charges for Rev 272 = $2,250.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIXATION DEVICE OPENSTRAP W/20,272,RC,27200002,CDM,,,,,,both,,,5396.6400,809.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2504.04,,,,,,,1392.8700,5396.6400,percent of total billed charges,"46.4% of $5,396.64 in Billed Charges for Rev 272 = $2,504.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIXATION DEVICE OPENSTRAP W/20,272,RC,27200002,CDM,,,,,,both,,,5396.6400,809.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2250.40,,,,,,,1392.8700,5396.6400,percent of total billed charges,"41.7% of $5,396.64 in Billed Charges for Rev 272 = $2,250.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIXATION DEVICE OPENSTRAP W/20,272,RC,27200002,CDM,,,,,,both,,,5396.6400,809.5000,CIGNA HEALTHCARE,CIGNA PPO,2250.40,,,,,,,1392.8700,5396.6400,percent of total billed charges,"41.7% of $5,396.64 in Billed Charges for Rev 272 = $2,250.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIXATION DEVICE OPENSTRAP W/20,272,RC,27200002,CDM,,,,,,both,,,5396.6400,809.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4856.98,,,,,,,1392.8700,5396.6400,percent of total billed charges,"90% of $5,396.64 in Billed Charges for Rev 272 = $4,856.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIXATION DEVICE OPENSTRAP W/20,272,RC,27200002,CDM,,,,,,both,,,5396.6400,809.5000,MEDCOST,MEDCOST VHN,2568.26,,,,,,,1392.8700,5396.6400,percent of total billed charges,"47.59% of $5,396.64 in Billed Charges for Rev 272 = $2,568.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIXATION DEVICE OPENSTRAP W/20,272,RC,27200002,CDM,,,,,,both,,,5396.6400,809.5000,SENTARA HEALTH,SENTARA HEALTH,1392.87,,,,,,,1392.8700,5396.6400,percent of total billed charges,"25.81% of $5,396.64 in Billed Charges for Rev 272 = $1,392.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIXATION DEVICE OPENSTRAP W/20,272,RC,27200002,CDM,,,,,,both,,,5396.6400,809.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5396.64,,,,,,,1392.8700,5396.6400,percent of total billed charges,"100% of $5,396.64 in Billed Charges for Rev 272 = $5,396.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIXATION DEVICE OPENSTRAP W/20,272,RC,27200002,CDM,,,,,,both,,,5396.6400,809.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2698.32,,,,,,,1392.8700,5396.6400,percent of total billed charges,"Rev 272 $5,396.64 in Billed Charges at 50% = $2,698.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIXATION DEVICE OPENSTRAP W/20,272,RC,27200002,CDM,,,,,,both,,,5396.6400,809.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1743.11,,,,,,,1392.8700,5396.6400,other,"32.3% of $5,396.64 in Billed Charges for Rev 272 = $1,743.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIXATION DEVICE OPENSTRAP W/20,272,RC,27200002,CDM,,,,,,both,,,5396.6400,809.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1656.77,,,,,,,1392.8700,5396.6400,other,"30.7% of $5,396.64 in Billed Charges for Rev 272 = $1,656.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIXATION DEVICE OPENSTRAP W/20,272,RC,27200002,CDM,,,,,,both,,,5396.6400,809.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,1743.11,,,,,,,1392.8700,5396.6400,percent of total billed charges,"32.3% of $5,396.64 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIXATION DEVICE OPENSTRAP W/20,272,RC,27200002,CDM,,,,,,both,,,5396.6400,809.5000,WELLCARE,WELLCARE MEDICAID,5396.64,,,,,,,1392.8700,5396.6400,percent of total billed charges,"100% of $5,396.64 in Billed Charges for Rev 272 = $5,396.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3 X 75MM,272,RC,27200002,CDM,,,,,,both,,,1400.0900,210.0100,AETNA,AETNA,597.84,,,,,,,361.3600,1400.0900,percent of total billed charges,"42.7% of $1,400.09 in Billed Charges for Rev 272 = $597.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3 X 75MM,272,RC,27200002,CDM,,,,,,both,,,1400.0900,210.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,980.06,,,,,,,361.3600,1400.0900,percent of total billed charges,"Rev 272 $1,400.09 in Billed Charges at 70% = $980.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3 X 75MM,272,RC,27200002,CDM,,,,,,both,,,1400.0900,210.0100,CIGNA HEALTHCARE,CIGNA HMO,583.84,,,,,,,361.3600,1400.0900,percent of total billed charges,"41.7% of $1,400.09 in Billed Charges for Rev 272 = $583.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3 X 75MM,272,RC,27200002,CDM,,,,,,both,,,1400.0900,210.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,649.64,,,,,,,361.3600,1400.0900,percent of total billed charges,"46.4% of $1,400.09 in Billed Charges for Rev 272 = $649.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3 X 75MM,272,RC,27200002,CDM,,,,,,both,,,1400.0900,210.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,583.84,,,,,,,361.3600,1400.0900,percent of total billed charges,"41.7% of $1,400.09 in Billed Charges for Rev 272 = $583.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3 X 75MM,272,RC,27200002,CDM,,,,,,both,,,1400.0900,210.0100,CIGNA HEALTHCARE,CIGNA PPO,583.84,,,,,,,361.3600,1400.0900,percent of total billed charges,"41.7% of $1,400.09 in Billed Charges for Rev 272 = $583.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3 X 75MM,272,RC,27200002,CDM,,,,,,both,,,1400.0900,210.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1260.08,,,,,,,361.3600,1400.0900,percent of total billed charges,"90% of $1,400.09 in Billed Charges for Rev 272 = $1,260.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3 X 75MM,272,RC,27200002,CDM,,,,,,both,,,1400.0900,210.0100,MEDCOST,MEDCOST VHN,666.30,,,,,,,361.3600,1400.0900,percent of total billed charges,"47.59% of $1,400.09 in Billed Charges for Rev 272 = $666.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3 X 75MM,272,RC,27200002,CDM,,,,,,both,,,1400.0900,210.0100,SENTARA HEALTH,SENTARA HEALTH,361.36,,,,,,,361.3600,1400.0900,percent of total billed charges,"25.81% of $1,400.09 in Billed Charges for Rev 272 = $361.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3 X 75MM,272,RC,27200002,CDM,,,,,,both,,,1400.0900,210.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1400.09,,,,,,,361.3600,1400.0900,percent of total billed charges,"100% of $1,400.09 in Billed Charges for Rev 272 = $1,400.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3 X 75MM,272,RC,27200002,CDM,,,,,,both,,,1400.0900,210.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,700.05,,,,,,,361.3600,1400.0900,percent of total billed charges,"Rev 272 $1,400.09 in Billed Charges at 50% = $700.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3 X 75MM,272,RC,27200002,CDM,,,,,,both,,,1400.0900,210.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,452.23,,,,,,,361.3600,1400.0900,other,"32.3% of $1,400.09 in Billed Charges for Rev 272 = $452.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE PIN 3 X 75MM,272,RC,27200002,CDM,,,,,,both,,,1400.0900,210.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,429.83,,,,,,,361.3600,1400.0900,other,"30.7% of $1,400.09 in Billed Charges for Rev 272 = $429.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE PIN 3 X 75MM,272,RC,27200002,CDM,,,,,,both,,,1400.0900,210.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,452.23,,,,,,,361.3600,1400.0900,percent of total billed charges,"32.3% of $1,400.09 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3 X 75MM,272,RC,27200002,CDM,,,,,,both,,,1400.0900,210.0100,WELLCARE,WELLCARE MEDICAID,1400.09,,,,,,,361.3600,1400.0900,percent of total billed charges,"100% of $1,400.09 in Billed Charges for Rev 272 = $1,400.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2 X 343 BRAD PT TH,272,RC,,,,,,,,both,,,1564.3600,234.6500,AETNA,AETNA,667.98,,,,,,,403.7600,1564.3600,percent of total billed charges,"42.7% of $1,564.36 in Billed Charges for Rev 272 = $667.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2 X 343 BRAD PT TH,272,RC,,,,,,,,both,,,1564.3600,234.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1095.05,,,,,,,403.7600,1564.3600,percent of total billed charges,"Rev 272 $1,564.36 in Billed Charges at 70% = $1,095.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2 X 343 BRAD PT TH,272,RC,,,,,,,,both,,,1564.3600,234.6500,CIGNA HEALTHCARE,CIGNA HMO,652.34,,,,,,,403.7600,1564.3600,percent of total billed charges,"41.7% of $1,564.36 in Billed Charges for Rev 272 = $652.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2 X 343 BRAD PT TH,272,RC,,,,,,,,both,,,1564.3600,234.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,725.86,,,,,,,403.7600,1564.3600,percent of total billed charges,"46.4% of $1,564.36 in Billed Charges for Rev 272 = $725.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2 X 343 BRAD PT TH,272,RC,,,,,,,,both,,,1564.3600,234.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,652.34,,,,,,,403.7600,1564.3600,percent of total billed charges,"41.7% of $1,564.36 in Billed Charges for Rev 272 = $652.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2 X 343 BRAD PT TH,272,RC,,,,,,,,both,,,1564.3600,234.6500,CIGNA HEALTHCARE,CIGNA PPO,652.34,,,,,,,403.7600,1564.3600,percent of total billed charges,"41.7% of $1,564.36 in Billed Charges for Rev 272 = $652.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2 X 343 BRAD PT TH,272,RC,,,,,,,,both,,,1564.3600,234.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1407.92,,,,,,,403.7600,1564.3600,percent of total billed charges,"90% of $1,564.36 in Billed Charges for Rev 272 = $1,407.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2 X 343 BRAD PT TH,272,RC,,,,,,,,both,,,1564.3600,234.6500,MEDCOST,MEDCOST VHN,744.48,,,,,,,403.7600,1564.3600,percent of total billed charges,"47.59% of $1,564.36 in Billed Charges for Rev 272 = $744.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2 X 343 BRAD PT TH,272,RC,,,,,,,,both,,,1564.3600,234.6500,SENTARA HEALTH,SENTARA HEALTH,403.76,,,,,,,403.7600,1564.3600,percent of total billed charges,"25.81% of $1,564.36 in Billed Charges for Rev 272 = $403.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2 X 343 BRAD PT TH,272,RC,,,,,,,,both,,,1564.3600,234.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1564.36,,,,,,,403.7600,1564.3600,percent of total billed charges,"100% of $1,564.36 in Billed Charges for Rev 272 = $1,564.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2 X 343 BRAD PT TH,272,RC,,,,,,,,both,,,1564.3600,234.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,782.18,,,,,,,403.7600,1564.3600,percent of total billed charges,"Rev 272 $1,564.36 in Billed Charges at 50% = $782.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2 X 343 BRAD PT TH,272,RC,,,,,,,,both,,,1564.3600,234.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,505.29,,,,,,,403.7600,1564.3600,other,"32.3% of $1,564.36 in Billed Charges for Rev 272 = $505.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE PIN 3.2 X 343 BRAD PT TH,272,RC,,,,,,,,both,,,1564.3600,234.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,480.26,,,,,,,403.7600,1564.3600,other,"30.7% of $1,564.36 in Billed Charges for Rev 272 = $480.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE PIN 3.2 X 343 BRAD PT TH,272,RC,,,,,,,,both,,,1564.3600,234.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,505.29,,,,,,,403.7600,1564.3600,percent of total billed charges,"32.3% of $1,564.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2 X 343 BRAD PT TH,272,RC,,,,,,,,both,,,1564.3600,234.6500,WELLCARE,WELLCARE MEDICAID,1564.36,,,,,,,403.7600,1564.3600,percent of total billed charges,"100% of $1,564.36 in Billed Charges for Rev 272 = $1,564.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2X343MM,272,RC,,,,,,,,both,,,1615.9100,242.3900,AETNA,AETNA,689.99,,,,,,,417.0700,1615.9100,percent of total billed charges,"42.7% of $1,615.91 in Billed Charges for Rev 272 = $689.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2X343MM,272,RC,,,,,,,,both,,,1615.9100,242.3900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1131.14,,,,,,,417.0700,1615.9100,percent of total billed charges,"Rev 272 $1,615.91 in Billed Charges at 70% = $1,131.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2X343MM,272,RC,,,,,,,,both,,,1615.9100,242.3900,CIGNA HEALTHCARE,CIGNA HMO,673.83,,,,,,,417.0700,1615.9100,percent of total billed charges,"41.7% of $1,615.91 in Billed Charges for Rev 272 = $673.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2X343MM,272,RC,,,,,,,,both,,,1615.9100,242.3900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,749.78,,,,,,,417.0700,1615.9100,percent of total billed charges,"46.4% of $1,615.91 in Billed Charges for Rev 272 = $749.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2X343MM,272,RC,,,,,,,,both,,,1615.9100,242.3900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,673.83,,,,,,,417.0700,1615.9100,percent of total billed charges,"41.7% of $1,615.91 in Billed Charges for Rev 272 = $673.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2X343MM,272,RC,,,,,,,,both,,,1615.9100,242.3900,CIGNA HEALTHCARE,CIGNA PPO,673.83,,,,,,,417.0700,1615.9100,percent of total billed charges,"41.7% of $1,615.91 in Billed Charges for Rev 272 = $673.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2X343MM,272,RC,,,,,,,,both,,,1615.9100,242.3900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1454.32,,,,,,,417.0700,1615.9100,percent of total billed charges,"90% of $1,615.91 in Billed Charges for Rev 272 = $1,454.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2X343MM,272,RC,,,,,,,,both,,,1615.9100,242.3900,MEDCOST,MEDCOST VHN,769.01,,,,,,,417.0700,1615.9100,percent of total billed charges,"47.59% of $1,615.91 in Billed Charges for Rev 272 = $769.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2X343MM,272,RC,,,,,,,,both,,,1615.9100,242.3900,SENTARA HEALTH,SENTARA HEALTH,417.07,,,,,,,417.0700,1615.9100,percent of total billed charges,"25.81% of $1,615.91 in Billed Charges for Rev 272 = $417.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2X343MM,272,RC,,,,,,,,both,,,1615.9100,242.3900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1615.91,,,,,,,417.0700,1615.9100,percent of total billed charges,"100% of $1,615.91 in Billed Charges for Rev 272 = $1,615.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2X343MM,272,RC,,,,,,,,both,,,1615.9100,242.3900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,807.96,,,,,,,417.0700,1615.9100,percent of total billed charges,"Rev 272 $1,615.91 in Billed Charges at 50% = $807.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2X343MM,272,RC,,,,,,,,both,,,1615.9100,242.3900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,521.94,,,,,,,417.0700,1615.9100,other,"32.3% of $1,615.91 in Billed Charges for Rev 272 = $521.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE PIN 3.2X343MM,272,RC,,,,,,,,both,,,1615.9100,242.3900,UNITED HEALTHCARE,UHC HERITAGE SELECT,496.08,,,,,,,417.0700,1615.9100,other,"30.7% of $1,615.91 in Billed Charges for Rev 272 = $496.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE PIN 3.2X343MM,272,RC,,,,,,,,both,,,1615.9100,242.3900,UNITED HEALTHCARE,UNITED HEALTHCARE,521.94,,,,,,,417.0700,1615.9100,percent of total billed charges,"32.3% of $1,615.91 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN 3.2X343MM,272,RC,,,,,,,,both,,,1615.9100,242.3900,WELLCARE,WELLCARE MEDICAID,1615.91,,,,,,,417.0700,1615.9100,percent of total billed charges,"100% of $1,615.91 in Billed Charges for Rev 272 = $1,615.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE PIN THREADED 6 INCH,272,RC,,,,,,,,both,,,387.3600,58.1000,AETNA,AETNA,165.40,,,,,,,99.9800,387.3600,percent of total billed charges,42.7% of $387.36 in Billed Charges for Rev 272 = $165.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN THREADED 6 INCH,272,RC,,,,,,,,both,,,387.3600,58.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,271.15,,,,,,,99.9800,387.3600,percent of total billed charges,Rev 272 $387.36 in Billed Charges at 70% = $271.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN THREADED 6 INCH,272,RC,,,,,,,,both,,,387.3600,58.1000,CIGNA HEALTHCARE,CIGNA HMO,161.53,,,,,,,99.9800,387.3600,percent of total billed charges,41.7% of $387.36 in Billed Charges for Rev 272 = $161.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN THREADED 6 INCH,272,RC,,,,,,,,both,,,387.3600,58.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,179.74,,,,,,,99.9800,387.3600,percent of total billed charges,46.4% of $387.36 in Billed Charges for Rev 272 = $179.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN THREADED 6 INCH,272,RC,,,,,,,,both,,,387.3600,58.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,161.53,,,,,,,99.9800,387.3600,percent of total billed charges,41.7% of $387.36 in Billed Charges for Rev 272 = $161.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN THREADED 6 INCH,272,RC,,,,,,,,both,,,387.3600,58.1000,CIGNA HEALTHCARE,CIGNA PPO,161.53,,,,,,,99.9800,387.3600,percent of total billed charges,41.7% of $387.36 in Billed Charges for Rev 272 = $161.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN THREADED 6 INCH,272,RC,,,,,,,,both,,,387.3600,58.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,348.62,,,,,,,99.9800,387.3600,percent of total billed charges,90% of $387.36 in Billed Charges for Rev 272 = $348.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN THREADED 6 INCH,272,RC,,,,,,,,both,,,387.3600,58.1000,MEDCOST,MEDCOST VHN,184.34,,,,,,,99.9800,387.3600,percent of total billed charges,47.59% of $387.36 in Billed Charges for Rev 272 = $184.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN THREADED 6 INCH,272,RC,,,,,,,,both,,,387.3600,58.1000,SENTARA HEALTH,SENTARA HEALTH,99.98,,,,,,,99.9800,387.3600,percent of total billed charges,25.81% of $387.36 in Billed Charges for Rev 272 = $99.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN THREADED 6 INCH,272,RC,,,,,,,,both,,,387.3600,58.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",387.36,,,,,,,99.9800,387.3600,percent of total billed charges,100% of $387.36 in Billed Charges for Rev 272 = $387.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN THREADED 6 INCH,272,RC,,,,,,,,both,,,387.3600,58.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,193.68,,,,,,,99.9800,387.3600,percent of total billed charges,Rev 272 $387.36 in Billed Charges at 50% = $193.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN THREADED 6 INCH,272,RC,,,,,,,,both,,,387.3600,58.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,125.12,,,,,,,99.9800,387.3600,other,32.3% of $387.36 in Billed Charges for Rev 272 = $125.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GUIDE PIN THREADED 6 INCH,272,RC,,,,,,,,both,,,387.3600,58.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,118.92,,,,,,,99.9800,387.3600,other,30.7% of $387.36 in Billed Charges for Rev 272 = $118.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GUIDE PIN THREADED 6 INCH,272,RC,,,,,,,,both,,,387.3600,58.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,125.12,,,,,,,99.9800,387.3600,percent of total billed charges,32.3% of $387.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE PIN THREADED 6 INCH,272,RC,,,,,,,,both,,,387.3600,58.1000,WELLCARE,WELLCARE MEDICAID,387.36,,,,,,,99.9800,387.3600,percent of total billed charges,100% of $387.36 in Billed Charges for Rev 272 = $387.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOGARTY HYDRAJAW INSERTS,272,RC,,,,,,,,both,,,365.5800,54.8400,AETNA,AETNA,156.10,,,,,,,94.3600,365.5800,percent of total billed charges,42.7% of $365.58 in Billed Charges for Rev 272 = $156.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOGARTY HYDRAJAW INSERTS,272,RC,,,,,,,,both,,,365.5800,54.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,255.91,,,,,,,94.3600,365.5800,percent of total billed charges,Rev 272 $365.58 in Billed Charges at 70% = $255.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOGARTY HYDRAJAW INSERTS,272,RC,,,,,,,,both,,,365.5800,54.8400,CIGNA HEALTHCARE,CIGNA HMO,152.45,,,,,,,94.3600,365.5800,percent of total billed charges,41.7% of $365.58 in Billed Charges for Rev 272 = $152.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOGARTY HYDRAJAW INSERTS,272,RC,,,,,,,,both,,,365.5800,54.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,169.63,,,,,,,94.3600,365.5800,percent of total billed charges,46.4% of $365.58 in Billed Charges for Rev 272 = $169.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOGARTY HYDRAJAW INSERTS,272,RC,,,,,,,,both,,,365.5800,54.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,152.45,,,,,,,94.3600,365.5800,percent of total billed charges,41.7% of $365.58 in Billed Charges for Rev 272 = $152.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOGARTY HYDRAJAW INSERTS,272,RC,,,,,,,,both,,,365.5800,54.8400,CIGNA HEALTHCARE,CIGNA PPO,152.45,,,,,,,94.3600,365.5800,percent of total billed charges,41.7% of $365.58 in Billed Charges for Rev 272 = $152.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOGARTY HYDRAJAW INSERTS,272,RC,,,,,,,,both,,,365.5800,54.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,329.02,,,,,,,94.3600,365.5800,percent of total billed charges,90% of $365.58 in Billed Charges for Rev 272 = $329.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOGARTY HYDRAJAW INSERTS,272,RC,,,,,,,,both,,,365.5800,54.8400,MEDCOST,MEDCOST VHN,173.98,,,,,,,94.3600,365.5800,percent of total billed charges,47.59% of $365.58 in Billed Charges for Rev 272 = $173.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOGARTY HYDRAJAW INSERTS,272,RC,,,,,,,,both,,,365.5800,54.8400,SENTARA HEALTH,SENTARA HEALTH,94.36,,,,,,,94.3600,365.5800,percent of total billed charges,25.81% of $365.58 in Billed Charges for Rev 272 = $94.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOGARTY HYDRAJAW INSERTS,272,RC,,,,,,,,both,,,365.5800,54.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",365.58,,,,,,,94.3600,365.5800,percent of total billed charges,100% of $365.58 in Billed Charges for Rev 272 = $365.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOGARTY HYDRAJAW INSERTS,272,RC,,,,,,,,both,,,365.5800,54.8400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,182.79,,,,,,,94.3600,365.5800,percent of total billed charges,Rev 272 $365.58 in Billed Charges at 50% = $182.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOGARTY HYDRAJAW INSERTS,272,RC,,,,,,,,both,,,365.5800,54.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,118.08,,,,,,,94.3600,365.5800,other,32.3% of $365.58 in Billed Charges for Rev 272 = $118.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
FOGARTY HYDRAJAW INSERTS,272,RC,,,,,,,,both,,,365.5800,54.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,112.23,,,,,,,94.3600,365.5800,other,30.7% of $365.58 in Billed Charges for Rev 272 = $112.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
FOGARTY HYDRAJAW INSERTS,272,RC,,,,,,,,both,,,365.5800,54.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,118.08,,,,,,,94.3600,365.5800,percent of total billed charges,32.3% of $365.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOGARTY HYDRAJAW INSERTS,272,RC,,,,,,,,both,,,365.5800,54.8400,WELLCARE,WELLCARE MEDICAID,365.58,,,,,,,94.3600,365.5800,percent of total billed charges,100% of $365.58 in Billed Charges for Rev 272 = $365.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOOTPLATE SHOE GOLDENBERG 140914,272,RC,,,,,,,,both,,,2752.6700,412.9000,AETNA,AETNA,1175.39,,,,,,,710.4600,2752.6700,percent of total billed charges,"42.7% of $2,752.67 in Billed Charges for Rev 272 = $1,175.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FOOTPLATE SHOE GOLDENBERG 140914,272,RC,,,,,,,,both,,,2752.6700,412.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1926.87,,,,,,,710.4600,2752.6700,percent of total billed charges,"Rev 272 $2,752.67 in Billed Charges at 70% = $1,926.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FOOTPLATE SHOE GOLDENBERG 140914,272,RC,,,,,,,,both,,,2752.6700,412.9000,CIGNA HEALTHCARE,CIGNA HMO,1147.86,,,,,,,710.4600,2752.6700,percent of total billed charges,"41.7% of $2,752.67 in Billed Charges for Rev 272 = $1,147.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FOOTPLATE SHOE GOLDENBERG 140914,272,RC,,,,,,,,both,,,2752.6700,412.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1277.24,,,,,,,710.4600,2752.6700,percent of total billed charges,"46.4% of $2,752.67 in Billed Charges for Rev 272 = $1,277.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FOOTPLATE SHOE GOLDENBERG 140914,272,RC,,,,,,,,both,,,2752.6700,412.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1147.86,,,,,,,710.4600,2752.6700,percent of total billed charges,"41.7% of $2,752.67 in Billed Charges for Rev 272 = $1,147.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FOOTPLATE SHOE GOLDENBERG 140914,272,RC,,,,,,,,both,,,2752.6700,412.9000,CIGNA HEALTHCARE,CIGNA PPO,1147.86,,,,,,,710.4600,2752.6700,percent of total billed charges,"41.7% of $2,752.67 in Billed Charges for Rev 272 = $1,147.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FOOTPLATE SHOE GOLDENBERG 140914,272,RC,,,,,,,,both,,,2752.6700,412.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2477.40,,,,,,,710.4600,2752.6700,percent of total billed charges,"90% of $2,752.67 in Billed Charges for Rev 272 = $2,477.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FOOTPLATE SHOE GOLDENBERG 140914,272,RC,,,,,,,,both,,,2752.6700,412.9000,MEDCOST,MEDCOST VHN,1310.00,,,,,,,710.4600,2752.6700,percent of total billed charges,"47.59% of $2,752.67 in Billed Charges for Rev 272 = $1,310.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FOOTPLATE SHOE GOLDENBERG 140914,272,RC,,,,,,,,both,,,2752.6700,412.9000,SENTARA HEALTH,SENTARA HEALTH,710.46,,,,,,,710.4600,2752.6700,percent of total billed charges,"25.81% of $2,752.67 in Billed Charges for Rev 272 = $710.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FOOTPLATE SHOE GOLDENBERG 140914,272,RC,,,,,,,,both,,,2752.6700,412.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2752.67,,,,,,,710.4600,2752.6700,percent of total billed charges,"100% of $2,752.67 in Billed Charges for Rev 272 = $2,752.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FOOTPLATE SHOE GOLDENBERG 140914,272,RC,,,,,,,,both,,,2752.6700,412.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1376.34,,,,,,,710.4600,2752.6700,percent of total billed charges,"Rev 272 $2,752.67 in Billed Charges at 50% = $1,376.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FOOTPLATE SHOE GOLDENBERG 140914,272,RC,,,,,,,,both,,,2752.6700,412.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,889.11,,,,,,,710.4600,2752.6700,other,"32.3% of $2,752.67 in Billed Charges for Rev 272 = $889.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FOOTPLATE SHOE GOLDENBERG 140914,272,RC,,,,,,,,both,,,2752.6700,412.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,845.07,,,,,,,710.4600,2752.6700,other,"30.7% of $2,752.67 in Billed Charges for Rev 272 = $845.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FOOTPLATE SHOE GOLDENBERG 140914,272,RC,,,,,,,,both,,,2752.6700,412.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,889.11,,,,,,,710.4600,2752.6700,percent of total billed charges,"32.3% of $2,752.67 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FOOTPLATE SHOE GOLDENBERG 140914,272,RC,,,,,,,,both,,,2752.6700,412.9000,WELLCARE,WELLCARE MEDICAID,2752.67,,,,,,,710.4600,2752.6700,percent of total billed charges,"100% of $2,752.67 in Billed Charges for Rev 272 = $2,752.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCE BIPOLAR 8MM IS4000 12 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2559.0400,383.8600,AETNA,AETNA,1092.71,,,,,,,660.4900,2559.0400,percent of total billed charges,"42.7% of $2,559.04 in Billed Charges for Rev 272 = $1,092.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCE BIPOLAR 8MM IS4000 12 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2559.0400,383.8600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1791.33,,,,,,,660.4900,2559.0400,percent of total billed charges,"Rev 272 $2,559.04 in Billed Charges at 70% = $1,791.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCE BIPOLAR 8MM IS4000 12 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2559.0400,383.8600,CIGNA HEALTHCARE,CIGNA HMO,1067.12,,,,,,,660.4900,2559.0400,percent of total billed charges,"41.7% of $2,559.04 in Billed Charges for Rev 272 = $1,067.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCE BIPOLAR 8MM IS4000 12 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2559.0400,383.8600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1187.39,,,,,,,660.4900,2559.0400,percent of total billed charges,"46.4% of $2,559.04 in Billed Charges for Rev 272 = $1,187.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCE BIPOLAR 8MM IS4000 12 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2559.0400,383.8600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1067.12,,,,,,,660.4900,2559.0400,percent of total billed charges,"41.7% of $2,559.04 in Billed Charges for Rev 272 = $1,067.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCE BIPOLAR 8MM IS4000 12 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2559.0400,383.8600,CIGNA HEALTHCARE,CIGNA PPO,1067.12,,,,,,,660.4900,2559.0400,percent of total billed charges,"41.7% of $2,559.04 in Billed Charges for Rev 272 = $1,067.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCE BIPOLAR 8MM IS4000 12 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2559.0400,383.8600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2303.14,,,,,,,660.4900,2559.0400,percent of total billed charges,"90% of $2,559.04 in Billed Charges for Rev 272 = $2,303.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCE BIPOLAR 8MM IS4000 12 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2559.0400,383.8600,MEDCOST,MEDCOST VHN,1217.85,,,,,,,660.4900,2559.0400,percent of total billed charges,"47.59% of $2,559.04 in Billed Charges for Rev 272 = $1,217.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCE BIPOLAR 8MM IS4000 12 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2559.0400,383.8600,SENTARA HEALTH,SENTARA HEALTH,660.49,,,,,,,660.4900,2559.0400,percent of total billed charges,"25.81% of $2,559.04 in Billed Charges for Rev 272 = $660.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCE BIPOLAR 8MM IS4000 12 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2559.0400,383.8600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2559.04,,,,,,,660.4900,2559.0400,percent of total billed charges,"100% of $2,559.04 in Billed Charges for Rev 272 = $2,559.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCE BIPOLAR 8MM IS4000 12 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2559.0400,383.8600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1279.52,,,,,,,660.4900,2559.0400,percent of total billed charges,"Rev 272 $2,559.04 in Billed Charges at 50% = $1,279.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCE BIPOLAR 8MM IS4000 12 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2559.0400,383.8600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,826.57,,,,,,,660.4900,2559.0400,other,"32.3% of $2,559.04 in Billed Charges for Rev 272 = $826.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCE BIPOLAR 8MM IS4000 12 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2559.0400,383.8600,UNITED HEALTHCARE,UHC HERITAGE SELECT,785.63,,,,,,,660.4900,2559.0400,other,"30.7% of $2,559.04 in Billed Charges for Rev 272 = $785.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FORCE BIPOLAR 8MM IS4000 12 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2559.0400,383.8600,UNITED HEALTHCARE,UNITED HEALTHCARE,826.57,,,,,,,660.4900,2559.0400,percent of total billed charges,"32.3% of $2,559.04 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FORCE BIPOLAR 8MM IS4000 12 USES DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2559.0400,383.8600,WELLCARE,WELLCARE MEDICAID,2559.04,,,,,,,660.4900,2559.0400,percent of total billed charges,"100% of $2,559.04 in Billed Charges for Rev 272 = $2,559.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT INFINITY,272,RC,27200002,CDM,,,,,,both,,,10339.8900,1550.9800,AETNA,AETNA,4415.13,,,,,,,2668.7300,10339.8900,percent of total billed charges,"42.7% of $10,339.89 in Billed Charges for Rev 272 = $4,415.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT INFINITY,272,RC,27200002,CDM,,,,,,both,,,10339.8900,1550.9800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7237.92,,,,,,,2668.7300,10339.8900,percent of total billed charges,"Rev 272 $10,339.89 in Billed Charges at 70% = $7,237.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT INFINITY,272,RC,27200002,CDM,,,,,,both,,,10339.8900,1550.9800,CIGNA HEALTHCARE,CIGNA HMO,4311.73,,,,,,,2668.7300,10339.8900,percent of total billed charges,"41.7% of $10,339.89 in Billed Charges for Rev 272 = $4,311.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT INFINITY,272,RC,27200002,CDM,,,,,,both,,,10339.8900,1550.9800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4797.71,,,,,,,2668.7300,10339.8900,percent of total billed charges,"46.4% of $10,339.89 in Billed Charges for Rev 272 = $4,797.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT INFINITY,272,RC,27200002,CDM,,,,,,both,,,10339.8900,1550.9800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4311.73,,,,,,,2668.7300,10339.8900,percent of total billed charges,"41.7% of $10,339.89 in Billed Charges for Rev 272 = $4,311.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT INFINITY,272,RC,27200002,CDM,,,,,,both,,,10339.8900,1550.9800,CIGNA HEALTHCARE,CIGNA PPO,4311.73,,,,,,,2668.7300,10339.8900,percent of total billed charges,"41.7% of $10,339.89 in Billed Charges for Rev 272 = $4,311.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT INFINITY,272,RC,27200002,CDM,,,,,,both,,,10339.8900,1550.9800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9305.90,,,,,,,2668.7300,10339.8900,percent of total billed charges,"90% of $10,339.89 in Billed Charges for Rev 272 = $9,305.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT INFINITY,272,RC,27200002,CDM,,,,,,both,,,10339.8900,1550.9800,MEDCOST,MEDCOST VHN,4920.75,,,,,,,2668.7300,10339.8900,percent of total billed charges,"47.59% of $10,339.89 in Billed Charges for Rev 272 = $4,920.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT INFINITY,272,RC,27200002,CDM,,,,,,both,,,10339.8900,1550.9800,SENTARA HEALTH,SENTARA HEALTH,2668.73,,,,,,,2668.7300,10339.8900,percent of total billed charges,"25.81% of $10,339.89 in Billed Charges for Rev 272 = $2,668.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT INFINITY,272,RC,27200002,CDM,,,,,,both,,,10339.8900,1550.9800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10339.89,,,,,,,2668.7300,10339.8900,percent of total billed charges,"100% of $10,339.89 in Billed Charges for Rev 272 = $10,339.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT INFINITY,272,RC,27200002,CDM,,,,,,both,,,10339.8900,1550.9800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5169.95,,,,,,,2668.7300,10339.8900,percent of total billed charges,"Rev 272 $10,339.89 in Billed Charges at 50% = $5,169.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT INFINITY,272,RC,27200002,CDM,,,,,,both,,,10339.8900,1550.9800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3339.78,,,,,,,2668.7300,10339.8900,other,"32.3% of $10,339.89 in Billed Charges for Rev 272 = $3,339.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE ALIGNMENT INFINITY,272,RC,27200002,CDM,,,,,,both,,,10339.8900,1550.9800,UNITED HEALTHCARE,UHC HERITAGE SELECT,3174.35,,,,,,,2668.7300,10339.8900,other,"30.7% of $10,339.89 in Billed Charges for Rev 272 = $3,174.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE ALIGNMENT INFINITY,272,RC,27200002,CDM,,,,,,both,,,10339.8900,1550.9800,UNITED HEALTHCARE,UNITED HEALTHCARE,3339.78,,,,,,,2668.7300,10339.8900,percent of total billed charges,"32.3% of $10,339.89 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT INFINITY,272,RC,27200002,CDM,,,,,,both,,,10339.8900,1550.9800,WELLCARE,WELLCARE MEDICAID,10339.89,,,,,,,2668.7300,10339.8900,percent of total billed charges,"100% of $10,339.89 in Billed Charges for Rev 272 = $10,339.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,2274.2600,341.1400,AETNA,AETNA,971.11,,,,,,,586.9900,2274.2600,percent of total billed charges,"42.7% of $2,274.26 in Billed Charges for Rev 272 = $971.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,2274.2600,341.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1591.98,,,,,,,586.9900,2274.2600,percent of total billed charges,"Rev 272 $2,274.26 in Billed Charges at 70% = $1,591.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,2274.2600,341.1400,CIGNA HEALTHCARE,CIGNA HMO,948.37,,,,,,,586.9900,2274.2600,percent of total billed charges,"41.7% of $2,274.26 in Billed Charges for Rev 272 = $948.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,2274.2600,341.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1055.26,,,,,,,586.9900,2274.2600,percent of total billed charges,"46.4% of $2,274.26 in Billed Charges for Rev 272 = $1,055.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,2274.2600,341.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,948.37,,,,,,,586.9900,2274.2600,percent of total billed charges,"41.7% of $2,274.26 in Billed Charges for Rev 272 = $948.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,2274.2600,341.1400,CIGNA HEALTHCARE,CIGNA PPO,948.37,,,,,,,586.9900,2274.2600,percent of total billed charges,"41.7% of $2,274.26 in Billed Charges for Rev 272 = $948.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,2274.2600,341.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2046.83,,,,,,,586.9900,2274.2600,percent of total billed charges,"90% of $2,274.26 in Billed Charges for Rev 272 = $2,046.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,2274.2600,341.1400,MEDCOST,MEDCOST VHN,1082.32,,,,,,,586.9900,2274.2600,percent of total billed charges,"47.59% of $2,274.26 in Billed Charges for Rev 272 = $1,082.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,2274.2600,341.1400,SENTARA HEALTH,SENTARA HEALTH,586.99,,,,,,,586.9900,2274.2600,percent of total billed charges,"25.81% of $2,274.26 in Billed Charges for Rev 272 = $586.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,2274.2600,341.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2274.26,,,,,,,586.9900,2274.2600,percent of total billed charges,"100% of $2,274.26 in Billed Charges for Rev 272 = $2,274.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,2274.2600,341.1400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1137.13,,,,,,,586.9900,2274.2600,percent of total billed charges,"Rev 272 $2,274.26 in Billed Charges at 50% = $1,137.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,2274.2600,341.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,734.59,,,,,,,586.9900,2274.2600,other,"32.3% of $2,274.26 in Billed Charges for Rev 272 = $734.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,2274.2600,341.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,698.20,,,,,,,586.9900,2274.2600,other,"30.7% of $2,274.26 in Billed Charges for Rev 272 = $698.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,2274.2600,341.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,734.59,,,,,,,586.9900,2274.2600,percent of total billed charges,"32.3% of $2,274.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ROD BALL TIP 3.0 X 1000,272,RC,,,,,,,,both,,,2274.2600,341.1400,WELLCARE,WELLCARE MEDICAID,2274.26,,,,,,,586.9900,2274.2600,percent of total billed charges,"100% of $2,274.26 in Billed Charges for Rev 272 = $2,274.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE SIZING CONT COMPRESSION IMPLANT,272,RC,,,,,,,,both,,,359.5600,53.9300,AETNA,AETNA,153.53,,,,,,,92.8000,359.5600,percent of total billed charges,42.7% of $359.56 in Billed Charges for Rev 272 = $153.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE SIZING CONT COMPRESSION IMPLANT,272,RC,,,,,,,,both,,,359.5600,53.9300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,251.69,,,,,,,92.8000,359.5600,percent of total billed charges,Rev 272 $359.56 in Billed Charges at 70% = $251.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE SIZING CONT COMPRESSION IMPLANT,272,RC,,,,,,,,both,,,359.5600,53.9300,CIGNA HEALTHCARE,CIGNA HMO,149.94,,,,,,,92.8000,359.5600,percent of total billed charges,41.7% of $359.56 in Billed Charges for Rev 272 = $149.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE SIZING CONT COMPRESSION IMPLANT,272,RC,,,,,,,,both,,,359.5600,53.9300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,166.84,,,,,,,92.8000,359.5600,percent of total billed charges,46.4% of $359.56 in Billed Charges for Rev 272 = $166.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE SIZING CONT COMPRESSION IMPLANT,272,RC,,,,,,,,both,,,359.5600,53.9300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,149.94,,,,,,,92.8000,359.5600,percent of total billed charges,41.7% of $359.56 in Billed Charges for Rev 272 = $149.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE SIZING CONT COMPRESSION IMPLANT,272,RC,,,,,,,,both,,,359.5600,53.9300,CIGNA HEALTHCARE,CIGNA PPO,149.94,,,,,,,92.8000,359.5600,percent of total billed charges,41.7% of $359.56 in Billed Charges for Rev 272 = $149.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE SIZING CONT COMPRESSION IMPLANT,272,RC,,,,,,,,both,,,359.5600,53.9300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,323.60,,,,,,,92.8000,359.5600,percent of total billed charges,90% of $359.56 in Billed Charges for Rev 272 = $323.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE SIZING CONT COMPRESSION IMPLANT,272,RC,,,,,,,,both,,,359.5600,53.9300,MEDCOST,MEDCOST VHN,171.11,,,,,,,92.8000,359.5600,percent of total billed charges,47.59% of $359.56 in Billed Charges for Rev 272 = $171.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE SIZING CONT COMPRESSION IMPLANT,272,RC,,,,,,,,both,,,359.5600,53.9300,SENTARA HEALTH,SENTARA HEALTH,92.80,,,,,,,92.8000,359.5600,percent of total billed charges,25.81% of $359.56 in Billed Charges for Rev 272 = $92.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE SIZING CONT COMPRESSION IMPLANT,272,RC,,,,,,,,both,,,359.5600,53.9300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",359.56,,,,,,,92.8000,359.5600,percent of total billed charges,100% of $359.56 in Billed Charges for Rev 272 = $359.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE SIZING CONT COMPRESSION IMPLANT,272,RC,,,,,,,,both,,,359.5600,53.9300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,179.78,,,,,,,92.8000,359.5600,percent of total billed charges,Rev 272 $359.56 in Billed Charges at 50% = $179.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE SIZING CONT COMPRESSION IMPLANT,272,RC,,,,,,,,both,,,359.5600,53.9300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,116.14,,,,,,,92.8000,359.5600,other,32.3% of $359.56 in Billed Charges for Rev 272 = $116.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GUIDE SIZING CONT COMPRESSION IMPLANT,272,RC,,,,,,,,both,,,359.5600,53.9300,UNITED HEALTHCARE,UHC HERITAGE SELECT,110.38,,,,,,,92.8000,359.5600,other,30.7% of $359.56 in Billed Charges for Rev 272 = $110.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GUIDE SIZING CONT COMPRESSION IMPLANT,272,RC,,,,,,,,both,,,359.5600,53.9300,UNITED HEALTHCARE,UNITED HEALTHCARE,116.14,,,,,,,92.8000,359.5600,percent of total billed charges,32.3% of $359.56 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE SIZING CONT COMPRESSION IMPLANT,272,RC,,,,,,,,both,,,359.5600,53.9300,WELLCARE,WELLCARE MEDICAID,359.56,,,,,,,92.8000,359.5600,percent of total billed charges,100% of $359.56 in Billed Charges for Rev 272 = $359.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,4268.7000,640.3100,AETNA,AETNA,1822.73,,,,,,,1101.7500,4268.7000,percent of total billed charges,"42.7% of $4,268.70 in Billed Charges for Rev 272 = $1,822.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,4268.7000,640.3100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2988.09,,,,,,,1101.7500,4268.7000,percent of total billed charges,"Rev 272 $4,268.70 in Billed Charges at 70% = $2,988.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,4268.7000,640.3100,CIGNA HEALTHCARE,CIGNA HMO,1780.05,,,,,,,1101.7500,4268.7000,percent of total billed charges,"41.7% of $4,268.70 in Billed Charges for Rev 272 = $1,780.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,4268.7000,640.3100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1980.68,,,,,,,1101.7500,4268.7000,percent of total billed charges,"46.4% of $4,268.70 in Billed Charges for Rev 272 = $1,980.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,4268.7000,640.3100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1780.05,,,,,,,1101.7500,4268.7000,percent of total billed charges,"41.7% of $4,268.70 in Billed Charges for Rev 272 = $1,780.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,4268.7000,640.3100,CIGNA HEALTHCARE,CIGNA PPO,1780.05,,,,,,,1101.7500,4268.7000,percent of total billed charges,"41.7% of $4,268.70 in Billed Charges for Rev 272 = $1,780.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,4268.7000,640.3100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3841.83,,,,,,,1101.7500,4268.7000,percent of total billed charges,"90% of $4,268.70 in Billed Charges for Rev 272 = $3,841.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,4268.7000,640.3100,MEDCOST,MEDCOST VHN,2031.47,,,,,,,1101.7500,4268.7000,percent of total billed charges,"47.59% of $4,268.70 in Billed Charges for Rev 272 = $2,031.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,4268.7000,640.3100,SENTARA HEALTH,SENTARA HEALTH,1101.75,,,,,,,1101.7500,4268.7000,percent of total billed charges,"25.81% of $4,268.70 in Billed Charges for Rev 272 = $1,101.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,4268.7000,640.3100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4268.70,,,,,,,1101.7500,4268.7000,percent of total billed charges,"100% of $4,268.70 in Billed Charges for Rev 272 = $4,268.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,4268.7000,640.3100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2134.35,,,,,,,1101.7500,4268.7000,percent of total billed charges,"Rev 272 $4,268.70 in Billed Charges at 50% = $2,134.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,4268.7000,640.3100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1378.79,,,,,,,1101.7500,4268.7000,other,"32.3% of $4,268.70 in Billed Charges for Rev 272 = $1,378.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,4268.7000,640.3100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1310.49,,,,,,,1101.7500,4268.7000,other,"30.7% of $4,268.70 in Billed Charges for Rev 272 = $1,310.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,4268.7000,640.3100,UNITED HEALTHCARE,UNITED HEALTHCARE,1378.79,,,,,,,1101.7500,4268.7000,percent of total billed charges,"32.3% of $4,268.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA 25 FR FEMORAL VENOUS,272,RC,27200002,CDM,,,,,,both,,,4268.7000,640.3100,WELLCARE,WELLCARE MEDICAID,4268.70,,,,,,,1101.7500,4268.7000,percent of total billed charges,"100% of $4,268.70 in Billed Charges for Rev 272 = $4,268.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA SMALL,272,RC,,,,,,,,both,,,23728.8500,3559.3300,AETNA,AETNA,10132.22,,,,,,,6124.4200,23728.8500,percent of total billed charges,"42.7% of $23,728.85 in Billed Charges for Rev 272 = $10,132.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA SMALL,272,RC,,,,,,,,both,,,23728.8500,3559.3300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,16610.20,,,,,,,6124.4200,23728.8500,percent of total billed charges,"Rev 272 $23,728.85 in Billed Charges at 70% = $16,610.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA SMALL,272,RC,,,,,,,,both,,,23728.8500,3559.3300,CIGNA HEALTHCARE,CIGNA HMO,9894.93,,,,,,,6124.4200,23728.8500,percent of total billed charges,"41.7% of $23,728.85 in Billed Charges for Rev 272 = $9,894.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA SMALL,272,RC,,,,,,,,both,,,23728.8500,3559.3300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11010.19,,,,,,,6124.4200,23728.8500,percent of total billed charges,"46.4% of $23,728.85 in Billed Charges for Rev 272 = $11,010.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA SMALL,272,RC,,,,,,,,both,,,23728.8500,3559.3300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9894.93,,,,,,,6124.4200,23728.8500,percent of total billed charges,"41.7% of $23,728.85 in Billed Charges for Rev 272 = $9,894.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA SMALL,272,RC,,,,,,,,both,,,23728.8500,3559.3300,CIGNA HEALTHCARE,CIGNA PPO,9894.93,,,,,,,6124.4200,23728.8500,percent of total billed charges,"41.7% of $23,728.85 in Billed Charges for Rev 272 = $9,894.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA SMALL,272,RC,,,,,,,,both,,,23728.8500,3559.3300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,21355.97,,,,,,,6124.4200,23728.8500,percent of total billed charges,"90% of $23,728.85 in Billed Charges for Rev 272 = $21,355.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA SMALL,272,RC,,,,,,,,both,,,23728.8500,3559.3300,MEDCOST,MEDCOST VHN,11292.56,,,,,,,6124.4200,23728.8500,percent of total billed charges,"47.59% of $23,728.85 in Billed Charges for Rev 272 = $11,292.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA SMALL,272,RC,,,,,,,,both,,,23728.8500,3559.3300,SENTARA HEALTH,SENTARA HEALTH,6124.42,,,,,,,6124.4200,23728.8500,percent of total billed charges,"25.81% of $23,728.85 in Billed Charges for Rev 272 = $6,124.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA SMALL,272,RC,,,,,,,,both,,,23728.8500,3559.3300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",23728.85,,,,,,,6124.4200,23728.8500,percent of total billed charges,"100% of $23,728.85 in Billed Charges for Rev 272 = $23,728.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA SMALL,272,RC,,,,,,,,both,,,23728.8500,3559.3300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11864.43,,,,,,,6124.4200,23728.8500,percent of total billed charges,"Rev 272 $23,728.85 in Billed Charges at 50% = $11,864.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA SMALL,272,RC,,,,,,,,both,,,23728.8500,3559.3300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7664.42,,,,,,,6124.4200,23728.8500,other,"32.3% of $23,728.85 in Billed Charges for Rev 272 = $7,664.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE CUTTING EXTRA SMALL,272,RC,,,,,,,,both,,,23728.8500,3559.3300,UNITED HEALTHCARE,UHC HERITAGE SELECT,7284.76,,,,,,,6124.4200,23728.8500,other,"30.7% of $23,728.85 in Billed Charges for Rev 272 = $7,284.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE CUTTING EXTRA SMALL,272,RC,,,,,,,,both,,,23728.8500,3559.3300,UNITED HEALTHCARE,UNITED HEALTHCARE,7664.42,,,,,,,6124.4200,23728.8500,percent of total billed charges,"32.3% of $23,728.85 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA SMALL,272,RC,,,,,,,,both,,,23728.8500,3559.3300,WELLCARE,WELLCARE MEDICAID,23728.85,,,,,,,6124.4200,23728.8500,percent of total billed charges,"100% of $23,728.85 in Billed Charges for Rev 272 = $23,728.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING IPS RECON EXTRA LG,272,RC,27200002,CDM,,,,,,both,,,44543.4500,6681.5200,AETNA,AETNA,19020.05,,,,,,,11496.6600,44543.4500,percent of total billed charges,"42.7% of $44,543.45 in Billed Charges for Rev 272 = $19,020.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING IPS RECON EXTRA LG,272,RC,27200002,CDM,,,,,,both,,,44543.4500,6681.5200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,31180.42,,,,,,,11496.6600,44543.4500,percent of total billed charges,"Rev 272 $44,543.45 in Billed Charges at 70% = $31,180.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING IPS RECON EXTRA LG,272,RC,27200002,CDM,,,,,,both,,,44543.4500,6681.5200,CIGNA HEALTHCARE,CIGNA HMO,18574.62,,,,,,,11496.6600,44543.4500,percent of total billed charges,"41.7% of $44,543.45 in Billed Charges for Rev 272 = $18,574.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING IPS RECON EXTRA LG,272,RC,27200002,CDM,,,,,,both,,,44543.4500,6681.5200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,20668.16,,,,,,,11496.6600,44543.4500,percent of total billed charges,"46.4% of $44,543.45 in Billed Charges for Rev 272 = $20,668.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING IPS RECON EXTRA LG,272,RC,27200002,CDM,,,,,,both,,,44543.4500,6681.5200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,18574.62,,,,,,,11496.6600,44543.4500,percent of total billed charges,"41.7% of $44,543.45 in Billed Charges for Rev 272 = $18,574.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING IPS RECON EXTRA LG,272,RC,27200002,CDM,,,,,,both,,,44543.4500,6681.5200,CIGNA HEALTHCARE,CIGNA PPO,18574.62,,,,,,,11496.6600,44543.4500,percent of total billed charges,"41.7% of $44,543.45 in Billed Charges for Rev 272 = $18,574.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING IPS RECON EXTRA LG,272,RC,27200002,CDM,,,,,,both,,,44543.4500,6681.5200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,40089.11,,,,,,,11496.6600,44543.4500,percent of total billed charges,"90% of $44,543.45 in Billed Charges for Rev 272 = $40,089.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING IPS RECON EXTRA LG,272,RC,27200002,CDM,,,,,,both,,,44543.4500,6681.5200,MEDCOST,MEDCOST VHN,21198.23,,,,,,,11496.6600,44543.4500,percent of total billed charges,"47.59% of $44,543.45 in Billed Charges for Rev 272 = $21,198.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING IPS RECON EXTRA LG,272,RC,27200002,CDM,,,,,,both,,,44543.4500,6681.5200,SENTARA HEALTH,SENTARA HEALTH,11496.66,,,,,,,11496.6600,44543.4500,percent of total billed charges,"25.81% of $44,543.45 in Billed Charges for Rev 272 = $11,496.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING IPS RECON EXTRA LG,272,RC,27200002,CDM,,,,,,both,,,44543.4500,6681.5200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",44543.45,,,,,,,11496.6600,44543.4500,percent of total billed charges,"100% of $44,543.45 in Billed Charges for Rev 272 = $44,543.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING IPS RECON EXTRA LG,272,RC,27200002,CDM,,,,,,both,,,44543.4500,6681.5200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22271.73,,,,,,,11496.6600,44543.4500,percent of total billed charges,"Rev 272 $44,543.45 in Billed Charges at 50% = $22,271.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING IPS RECON EXTRA LG,272,RC,27200002,CDM,,,,,,both,,,44543.4500,6681.5200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,14387.53,,,,,,,11496.6600,44543.4500,other,"32.3% of $44,543.45 in Billed Charges for Rev 272 = $14,387.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE CUTTING IPS RECON EXTRA LG,272,RC,27200002,CDM,,,,,,both,,,44543.4500,6681.5200,UNITED HEALTHCARE,UHC HERITAGE SELECT,13674.84,,,,,,,11496.6600,44543.4500,other,"30.7% of $44,543.45 in Billed Charges for Rev 272 = $13,674.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE CUTTING IPS RECON EXTRA LG,272,RC,27200002,CDM,,,,,,both,,,44543.4500,6681.5200,UNITED HEALTHCARE,UNITED HEALTHCARE,14387.53,,,,,,,11496.6600,44543.4500,percent of total billed charges,"32.3% of $44,543.45 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING IPS RECON EXTRA LG,272,RC,27200002,CDM,,,,,,both,,,44543.4500,6681.5200,WELLCARE,WELLCARE MEDICAID,44543.45,,,,,,,11496.6600,44543.4500,percent of total billed charges,"100% of $44,543.45 in Billed Charges for Rev 272 = $44,543.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING VISIONAIRE LEGION LT,272,RC,,,,,,,,both,,,2722.3900,408.3600,AETNA,AETNA,1162.46,,,,,,,702.6500,2722.3900,percent of total billed charges,"42.7% of $2,722.39 in Billed Charges for Rev 272 = $1,162.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING VISIONAIRE LEGION LT,272,RC,,,,,,,,both,,,2722.3900,408.3600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1905.67,,,,,,,702.6500,2722.3900,percent of total billed charges,"Rev 272 $2,722.39 in Billed Charges at 70% = $1,905.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING VISIONAIRE LEGION LT,272,RC,,,,,,,,both,,,2722.3900,408.3600,CIGNA HEALTHCARE,CIGNA HMO,1135.24,,,,,,,702.6500,2722.3900,percent of total billed charges,"41.7% of $2,722.39 in Billed Charges for Rev 272 = $1,135.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING VISIONAIRE LEGION LT,272,RC,,,,,,,,both,,,2722.3900,408.3600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1263.19,,,,,,,702.6500,2722.3900,percent of total billed charges,"46.4% of $2,722.39 in Billed Charges for Rev 272 = $1,263.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING VISIONAIRE LEGION LT,272,RC,,,,,,,,both,,,2722.3900,408.3600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1135.24,,,,,,,702.6500,2722.3900,percent of total billed charges,"41.7% of $2,722.39 in Billed Charges for Rev 272 = $1,135.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING VISIONAIRE LEGION LT,272,RC,,,,,,,,both,,,2722.3900,408.3600,CIGNA HEALTHCARE,CIGNA PPO,1135.24,,,,,,,702.6500,2722.3900,percent of total billed charges,"41.7% of $2,722.39 in Billed Charges for Rev 272 = $1,135.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING VISIONAIRE LEGION LT,272,RC,,,,,,,,both,,,2722.3900,408.3600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2450.15,,,,,,,702.6500,2722.3900,percent of total billed charges,"90% of $2,722.39 in Billed Charges for Rev 272 = $2,450.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING VISIONAIRE LEGION LT,272,RC,,,,,,,,both,,,2722.3900,408.3600,MEDCOST,MEDCOST VHN,1295.59,,,,,,,702.6500,2722.3900,percent of total billed charges,"47.59% of $2,722.39 in Billed Charges for Rev 272 = $1,295.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING VISIONAIRE LEGION LT,272,RC,,,,,,,,both,,,2722.3900,408.3600,SENTARA HEALTH,SENTARA HEALTH,702.65,,,,,,,702.6500,2722.3900,percent of total billed charges,"25.81% of $2,722.39 in Billed Charges for Rev 272 = $702.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING VISIONAIRE LEGION LT,272,RC,,,,,,,,both,,,2722.3900,408.3600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2722.39,,,,,,,702.6500,2722.3900,percent of total billed charges,"100% of $2,722.39 in Billed Charges for Rev 272 = $2,722.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING VISIONAIRE LEGION LT,272,RC,,,,,,,,both,,,2722.3900,408.3600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1361.20,,,,,,,702.6500,2722.3900,percent of total billed charges,"Rev 272 $2,722.39 in Billed Charges at 50% = $1,361.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING VISIONAIRE LEGION LT,272,RC,,,,,,,,both,,,2722.3900,408.3600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,879.33,,,,,,,702.6500,2722.3900,other,"32.3% of $2,722.39 in Billed Charges for Rev 272 = $879.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE CUTTING VISIONAIRE LEGION LT,272,RC,,,,,,,,both,,,2722.3900,408.3600,UNITED HEALTHCARE,UHC HERITAGE SELECT,835.77,,,,,,,702.6500,2722.3900,other,"30.7% of $2,722.39 in Billed Charges for Rev 272 = $835.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE CUTTING VISIONAIRE LEGION LT,272,RC,,,,,,,,both,,,2722.3900,408.3600,UNITED HEALTHCARE,UNITED HEALTHCARE,879.33,,,,,,,702.6500,2722.3900,percent of total billed charges,"32.3% of $2,722.39 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING VISIONAIRE LEGION LT,272,RC,,,,,,,,both,,,2722.3900,408.3600,WELLCARE,WELLCARE MEDICAID,2722.39,,,,,,,702.6500,2722.3900,percent of total billed charges,"100% of $2,722.39 in Billed Charges for Rev 272 = $2,722.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING W PLANNING RECON,272,RC,,,,,,,,both,,,57631.6500,8644.7500,AETNA,AETNA,24608.71,,,,,,,14874.7300,57631.6500,percent of total billed charges,"42.7% of $57,631.65 in Billed Charges for Rev 272 = $24,608.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING W PLANNING RECON,272,RC,,,,,,,,both,,,57631.6500,8644.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,40342.16,,,,,,,14874.7300,57631.6500,percent of total billed charges,"Rev 272 $57,631.65 in Billed Charges at 70% = $40,342.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING W PLANNING RECON,272,RC,,,,,,,,both,,,57631.6500,8644.7500,CIGNA HEALTHCARE,CIGNA HMO,24032.40,,,,,,,14874.7300,57631.6500,percent of total billed charges,"41.7% of $57,631.65 in Billed Charges for Rev 272 = $24,032.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING W PLANNING RECON,272,RC,,,,,,,,both,,,57631.6500,8644.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,26741.09,,,,,,,14874.7300,57631.6500,percent of total billed charges,"46.4% of $57,631.65 in Billed Charges for Rev 272 = $26,741.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING W PLANNING RECON,272,RC,,,,,,,,both,,,57631.6500,8644.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,24032.40,,,,,,,14874.7300,57631.6500,percent of total billed charges,"41.7% of $57,631.65 in Billed Charges for Rev 272 = $24,032.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING W PLANNING RECON,272,RC,,,,,,,,both,,,57631.6500,8644.7500,CIGNA HEALTHCARE,CIGNA PPO,24032.40,,,,,,,14874.7300,57631.6500,percent of total billed charges,"41.7% of $57,631.65 in Billed Charges for Rev 272 = $24,032.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING W PLANNING RECON,272,RC,,,,,,,,both,,,57631.6500,8644.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,51868.49,,,,,,,14874.7300,57631.6500,percent of total billed charges,"90% of $57,631.65 in Billed Charges for Rev 272 = $51,868.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING W PLANNING RECON,272,RC,,,,,,,,both,,,57631.6500,8644.7500,MEDCOST,MEDCOST VHN,27426.90,,,,,,,14874.7300,57631.6500,percent of total billed charges,"47.59% of $57,631.65 in Billed Charges for Rev 272 = $27,426.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING W PLANNING RECON,272,RC,,,,,,,,both,,,57631.6500,8644.7500,SENTARA HEALTH,SENTARA HEALTH,14874.73,,,,,,,14874.7300,57631.6500,percent of total billed charges,"25.81% of $57,631.65 in Billed Charges for Rev 272 = $14,874.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING W PLANNING RECON,272,RC,,,,,,,,both,,,57631.6500,8644.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",57631.65,,,,,,,14874.7300,57631.6500,percent of total billed charges,"100% of $57,631.65 in Billed Charges for Rev 272 = $57,631.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING W PLANNING RECON,272,RC,,,,,,,,both,,,57631.6500,8644.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,28815.83,,,,,,,14874.7300,57631.6500,percent of total billed charges,"Rev 272 $57,631.65 in Billed Charges at 50% = $28,815.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING W PLANNING RECON,272,RC,,,,,,,,both,,,57631.6500,8644.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,18615.02,,,,,,,14874.7300,57631.6500,other,"32.3% of $57,631.65 in Billed Charges for Rev 272 = $18,615.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE CUTTING W PLANNING RECON,272,RC,,,,,,,,both,,,57631.6500,8644.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,17692.92,,,,,,,14874.7300,57631.6500,other,"30.7% of $57,631.65 in Billed Charges for Rev 272 = $17,692.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE CUTTING W PLANNING RECON,272,RC,,,,,,,,both,,,57631.6500,8644.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,18615.02,,,,,,,14874.7300,57631.6500,percent of total billed charges,"32.3% of $57,631.65 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING W PLANNING RECON,272,RC,,,,,,,,both,,,57631.6500,8644.7500,WELLCARE,WELLCARE MEDICAID,57631.65,,,,,,,14874.7300,57631.6500,percent of total billed charges,"100% of $57,631.65 in Billed Charges for Rev 272 = $57,631.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA AND INTRODUCER AFFIRM TROCAR TIP,272,RC,,,,,,,,both,,,2800.1700,420.0300,AETNA,AETNA,1195.67,,,,,,,722.7200,2800.1700,percent of total billed charges,"42.7% of $2,800.17 in Billed Charges for Rev 272 = $1,195.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA AND INTRODUCER AFFIRM TROCAR TIP,272,RC,,,,,,,,both,,,2800.1700,420.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1960.12,,,,,,,722.7200,2800.1700,percent of total billed charges,"Rev 272 $2,800.17 in Billed Charges at 70% = $1,960.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA AND INTRODUCER AFFIRM TROCAR TIP,272,RC,,,,,,,,both,,,2800.1700,420.0300,CIGNA HEALTHCARE,CIGNA HMO,1167.67,,,,,,,722.7200,2800.1700,percent of total billed charges,"41.7% of $2,800.17 in Billed Charges for Rev 272 = $1,167.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA AND INTRODUCER AFFIRM TROCAR TIP,272,RC,,,,,,,,both,,,2800.1700,420.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1299.28,,,,,,,722.7200,2800.1700,percent of total billed charges,"46.4% of $2,800.17 in Billed Charges for Rev 272 = $1,299.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA AND INTRODUCER AFFIRM TROCAR TIP,272,RC,,,,,,,,both,,,2800.1700,420.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1167.67,,,,,,,722.7200,2800.1700,percent of total billed charges,"41.7% of $2,800.17 in Billed Charges for Rev 272 = $1,167.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA AND INTRODUCER AFFIRM TROCAR TIP,272,RC,,,,,,,,both,,,2800.1700,420.0300,CIGNA HEALTHCARE,CIGNA PPO,1167.67,,,,,,,722.7200,2800.1700,percent of total billed charges,"41.7% of $2,800.17 in Billed Charges for Rev 272 = $1,167.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA AND INTRODUCER AFFIRM TROCAR TIP,272,RC,,,,,,,,both,,,2800.1700,420.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2520.15,,,,,,,722.7200,2800.1700,percent of total billed charges,"90% of $2,800.17 in Billed Charges for Rev 272 = $2,520.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA AND INTRODUCER AFFIRM TROCAR TIP,272,RC,,,,,,,,both,,,2800.1700,420.0300,MEDCOST,MEDCOST VHN,1332.60,,,,,,,722.7200,2800.1700,percent of total billed charges,"47.59% of $2,800.17 in Billed Charges for Rev 272 = $1,332.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA AND INTRODUCER AFFIRM TROCAR TIP,272,RC,,,,,,,,both,,,2800.1700,420.0300,SENTARA HEALTH,SENTARA HEALTH,722.72,,,,,,,722.7200,2800.1700,percent of total billed charges,"25.81% of $2,800.17 in Billed Charges for Rev 272 = $722.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA AND INTRODUCER AFFIRM TROCAR TIP,272,RC,,,,,,,,both,,,2800.1700,420.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2800.17,,,,,,,722.7200,2800.1700,percent of total billed charges,"100% of $2,800.17 in Billed Charges for Rev 272 = $2,800.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA AND INTRODUCER AFFIRM TROCAR TIP,272,RC,,,,,,,,both,,,2800.1700,420.0300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1400.09,,,,,,,722.7200,2800.1700,percent of total billed charges,"Rev 272 $2,800.17 in Billed Charges at 50% = $1,400.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA AND INTRODUCER AFFIRM TROCAR TIP,272,RC,,,,,,,,both,,,2800.1700,420.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,904.45,,,,,,,722.7200,2800.1700,other,"32.3% of $2,800.17 in Billed Charges for Rev 272 = $904.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA AND INTRODUCER AFFIRM TROCAR TIP,272,RC,,,,,,,,both,,,2800.1700,420.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,859.65,,,,,,,722.7200,2800.1700,other,"30.7% of $2,800.17 in Billed Charges for Rev 272 = $859.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA AND INTRODUCER AFFIRM TROCAR TIP,272,RC,,,,,,,,both,,,2800.1700,420.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,904.45,,,,,,,722.7200,2800.1700,percent of total billed charges,"32.3% of $2,800.17 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA AND INTRODUCER AFFIRM TROCAR TIP,272,RC,,,,,,,,both,,,2800.1700,420.0300,WELLCARE,WELLCARE MEDICAID,2800.17,,,,,,,722.7200,2800.1700,percent of total billed charges,"100% of $2,800.17 in Billed Charges for Rev 272 = $2,800.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL DOUBLE 5.0 X 2.8MM,272,RC,,,,,,,,both,,,6537.4600,980.6200,AETNA,AETNA,2791.50,,,,,,,1687.3200,6537.4600,percent of total billed charges,"42.7% of $6,537.46 in Billed Charges for Rev 272 = $2,791.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL DOUBLE 5.0 X 2.8MM,272,RC,,,,,,,,both,,,6537.4600,980.6200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4576.22,,,,,,,1687.3200,6537.4600,percent of total billed charges,"Rev 272 $6,537.46 in Billed Charges at 70% = $4,576.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL DOUBLE 5.0 X 2.8MM,272,RC,,,,,,,,both,,,6537.4600,980.6200,CIGNA HEALTHCARE,CIGNA HMO,2726.12,,,,,,,1687.3200,6537.4600,percent of total billed charges,"41.7% of $6,537.46 in Billed Charges for Rev 272 = $2,726.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL DOUBLE 5.0 X 2.8MM,272,RC,,,,,,,,both,,,6537.4600,980.6200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3033.38,,,,,,,1687.3200,6537.4600,percent of total billed charges,"46.4% of $6,537.46 in Billed Charges for Rev 272 = $3,033.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL DOUBLE 5.0 X 2.8MM,272,RC,,,,,,,,both,,,6537.4600,980.6200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2726.12,,,,,,,1687.3200,6537.4600,percent of total billed charges,"41.7% of $6,537.46 in Billed Charges for Rev 272 = $2,726.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL DOUBLE 5.0 X 2.8MM,272,RC,,,,,,,,both,,,6537.4600,980.6200,CIGNA HEALTHCARE,CIGNA PPO,2726.12,,,,,,,1687.3200,6537.4600,percent of total billed charges,"41.7% of $6,537.46 in Billed Charges for Rev 272 = $2,726.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL DOUBLE 5.0 X 2.8MM,272,RC,,,,,,,,both,,,6537.4600,980.6200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5883.71,,,,,,,1687.3200,6537.4600,percent of total billed charges,"90% of $6,537.46 in Billed Charges for Rev 272 = $5,883.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL DOUBLE 5.0 X 2.8MM,272,RC,,,,,,,,both,,,6537.4600,980.6200,MEDCOST,MEDCOST VHN,3111.18,,,,,,,1687.3200,6537.4600,percent of total billed charges,"47.59% of $6,537.46 in Billed Charges for Rev 272 = $3,111.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL DOUBLE 5.0 X 2.8MM,272,RC,,,,,,,,both,,,6537.4600,980.6200,SENTARA HEALTH,SENTARA HEALTH,1687.32,,,,,,,1687.3200,6537.4600,percent of total billed charges,"25.81% of $6,537.46 in Billed Charges for Rev 272 = $1,687.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL DOUBLE 5.0 X 2.8MM,272,RC,,,,,,,,both,,,6537.4600,980.6200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6537.46,,,,,,,1687.3200,6537.4600,percent of total billed charges,"100% of $6,537.46 in Billed Charges for Rev 272 = $6,537.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL DOUBLE 5.0 X 2.8MM,272,RC,,,,,,,,both,,,6537.4600,980.6200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3268.73,,,,,,,1687.3200,6537.4600,percent of total billed charges,"Rev 272 $6,537.46 in Billed Charges at 50% = $3,268.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL DOUBLE 5.0 X 2.8MM,272,RC,,,,,,,,both,,,6537.4600,980.6200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2111.60,,,,,,,1687.3200,6537.4600,other,"32.3% of $6,537.46 in Billed Charges for Rev 272 = $2,111.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE DRILL DOUBLE 5.0 X 2.8MM,272,RC,,,,,,,,both,,,6537.4600,980.6200,UNITED HEALTHCARE,UHC HERITAGE SELECT,2007.00,,,,,,,1687.3200,6537.4600,other,"30.7% of $6,537.46 in Billed Charges for Rev 272 = $2,007.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE DRILL DOUBLE 5.0 X 2.8MM,272,RC,,,,,,,,both,,,6537.4600,980.6200,UNITED HEALTHCARE,UNITED HEALTHCARE,2111.60,,,,,,,1687.3200,6537.4600,percent of total billed charges,"32.3% of $6,537.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL DOUBLE 5.0 X 2.8MM,272,RC,,,,,,,,both,,,6537.4600,980.6200,WELLCARE,WELLCARE MEDICAID,6537.46,,,,,,,1687.3200,6537.4600,percent of total billed charges,"100% of $6,537.46 in Billed Charges for Rev 272 = $6,537.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL VARIABLE ANGLE 2.7 MM,272,RC,27200002,CDM,,,,,,both,,,6278.7100,941.8100,AETNA,AETNA,2681.01,,,,,,,1620.5400,6278.7100,percent of total billed charges,"42.7% of $6,278.71 in Billed Charges for Rev 272 = $2,681.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL VARIABLE ANGLE 2.7 MM,272,RC,27200002,CDM,,,,,,both,,,6278.7100,941.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4395.10,,,,,,,1620.5400,6278.7100,percent of total billed charges,"Rev 272 $6,278.71 in Billed Charges at 70% = $4,395.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL VARIABLE ANGLE 2.7 MM,272,RC,27200002,CDM,,,,,,both,,,6278.7100,941.8100,CIGNA HEALTHCARE,CIGNA HMO,2618.22,,,,,,,1620.5400,6278.7100,percent of total billed charges,"41.7% of $6,278.71 in Billed Charges for Rev 272 = $2,618.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL VARIABLE ANGLE 2.7 MM,272,RC,27200002,CDM,,,,,,both,,,6278.7100,941.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2913.32,,,,,,,1620.5400,6278.7100,percent of total billed charges,"46.4% of $6,278.71 in Billed Charges for Rev 272 = $2,913.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL VARIABLE ANGLE 2.7 MM,272,RC,27200002,CDM,,,,,,both,,,6278.7100,941.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2618.22,,,,,,,1620.5400,6278.7100,percent of total billed charges,"41.7% of $6,278.71 in Billed Charges for Rev 272 = $2,618.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL VARIABLE ANGLE 2.7 MM,272,RC,27200002,CDM,,,,,,both,,,6278.7100,941.8100,CIGNA HEALTHCARE,CIGNA PPO,2618.22,,,,,,,1620.5400,6278.7100,percent of total billed charges,"41.7% of $6,278.71 in Billed Charges for Rev 272 = $2,618.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL VARIABLE ANGLE 2.7 MM,272,RC,27200002,CDM,,,,,,both,,,6278.7100,941.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5650.84,,,,,,,1620.5400,6278.7100,percent of total billed charges,"90% of $6,278.71 in Billed Charges for Rev 272 = $5,650.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL VARIABLE ANGLE 2.7 MM,272,RC,27200002,CDM,,,,,,both,,,6278.7100,941.8100,MEDCOST,MEDCOST VHN,2988.04,,,,,,,1620.5400,6278.7100,percent of total billed charges,"47.59% of $6,278.71 in Billed Charges for Rev 272 = $2,988.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL VARIABLE ANGLE 2.7 MM,272,RC,27200002,CDM,,,,,,both,,,6278.7100,941.8100,SENTARA HEALTH,SENTARA HEALTH,1620.54,,,,,,,1620.5400,6278.7100,percent of total billed charges,"25.81% of $6,278.71 in Billed Charges for Rev 272 = $1,620.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL VARIABLE ANGLE 2.7 MM,272,RC,27200002,CDM,,,,,,both,,,6278.7100,941.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6278.71,,,,,,,1620.5400,6278.7100,percent of total billed charges,"100% of $6,278.71 in Billed Charges for Rev 272 = $6,278.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL VARIABLE ANGLE 2.7 MM,272,RC,27200002,CDM,,,,,,both,,,6278.7100,941.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3139.36,,,,,,,1620.5400,6278.7100,percent of total billed charges,"Rev 272 $6,278.71 in Billed Charges at 50% = $3,139.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL VARIABLE ANGLE 2.7 MM,272,RC,27200002,CDM,,,,,,both,,,6278.7100,941.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2028.02,,,,,,,1620.5400,6278.7100,other,"32.3% of $6,278.71 in Billed Charges for Rev 272 = $2,028.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE DRILL VARIABLE ANGLE 2.7 MM,272,RC,27200002,CDM,,,,,,both,,,6278.7100,941.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1927.56,,,,,,,1620.5400,6278.7100,other,"30.7% of $6,278.71 in Billed Charges for Rev 272 = $1,927.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE DRILL VARIABLE ANGLE 2.7 MM,272,RC,27200002,CDM,,,,,,both,,,6278.7100,941.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,2028.02,,,,,,,1620.5400,6278.7100,percent of total billed charges,"32.3% of $6,278.71 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DRILL VARIABLE ANGLE 2.7 MM,272,RC,27200002,CDM,,,,,,both,,,6278.7100,941.8100,WELLCARE,WELLCARE MEDICAID,6278.71,,,,,,,1620.5400,6278.7100,percent of total billed charges,"100% of $6,278.71 in Billed Charges for Rev 272 = $6,278.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BINDER ABD 4 PANEL 30-45 INCHES,270,RC,27000204,CDM,,,,,,both,,,81.0000,12.1500,AETNA,AETNA,34.59,,,,,,,20.9100,81.0000,percent of total billed charges,42.7% of $81.00 in Billed Charges for Rev 270 = $34.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 30-45 INCHES,270,RC,27000204,CDM,,,,,,both,,,81.0000,12.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,56.70,,,,,,,20.9100,81.0000,percent of total billed charges,Rev 270 $81.00 in Billed Charges at 70% = $56.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 30-45 INCHES,270,RC,27000204,CDM,,,,,,both,,,81.0000,12.1500,CIGNA HEALTHCARE,CIGNA HMO,33.78,,,,,,,20.9100,81.0000,percent of total billed charges,41.7% of $81.00 in Billed Charges for Rev 270 = $33.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 30-45 INCHES,270,RC,27000204,CDM,,,,,,both,,,81.0000,12.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,37.58,,,,,,,20.9100,81.0000,percent of total billed charges,46.4% of $81.00 in Billed Charges for Rev 270 = $37.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 30-45 INCHES,270,RC,27000204,CDM,,,,,,both,,,81.0000,12.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,33.78,,,,,,,20.9100,81.0000,percent of total billed charges,41.7% of $81.00 in Billed Charges for Rev 270 = $33.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 30-45 INCHES,270,RC,27000204,CDM,,,,,,both,,,81.0000,12.1500,CIGNA HEALTHCARE,CIGNA PPO,33.78,,,,,,,20.9100,81.0000,percent of total billed charges,41.7% of $81.00 in Billed Charges for Rev 270 = $33.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 30-45 INCHES,270,RC,27000204,CDM,,,,,,both,,,81.0000,12.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,72.90,,,,,,,20.9100,81.0000,percent of total billed charges,90% of $81.00 in Billed Charges for Rev 270 = $72.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 30-45 INCHES,270,RC,27000204,CDM,,,,,,both,,,81.0000,12.1500,MEDCOST,MEDCOST VHN,38.55,,,,,,,20.9100,81.0000,percent of total billed charges,47.59% of $81.00 in Billed Charges for Rev 270 = $38.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 30-45 INCHES,270,RC,27000204,CDM,,,,,,both,,,81.0000,12.1500,SENTARA HEALTH,SENTARA HEALTH,20.91,,,,,,,20.9100,81.0000,percent of total billed charges,25.81% of $81.00 in Billed Charges for Rev 270 = $20.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 30-45 INCHES,270,RC,27000204,CDM,,,,,,both,,,81.0000,12.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",81.00,,,,,,,20.9100,81.0000,percent of total billed charges,100% of $81.00 in Billed Charges for Rev 270 = $81.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 30-45 INCHES,270,RC,27000204,CDM,,,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,40.50,,,,,,,20.9100,81.0000,percent of total billed charges,Rev 270 $81.00 in Billed Charges at 50% = $40.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 30-45 INCHES,270,RC,27000204,CDM,,,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,26.16,,,,,,,20.9100,81.0000,other,32.3% of $81.00 in Billed Charges for Rev 270 = $26.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BINDER ABD 4 PANEL 30-45 INCHES,270,RC,27000204,CDM,,,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,24.87,,,,,,,20.9100,81.0000,other,30.7% of $81.00 in Billed Charges for Rev 270 = $24.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BINDER ABD 4 PANEL 30-45 INCHES,270,RC,27000204,CDM,,,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,26.16,,,,,,,20.9100,81.0000,percent of total billed charges,32.3% of $81.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 30-45 INCHES,270,RC,27000204,CDM,,,,,,both,,,81.0000,12.1500,WELLCARE,WELLCARE MEDICAID,81.00,,,,,,,20.9100,81.0000,percent of total billed charges,100% of $81.00 in Billed Charges for Rev 270 = $81.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 64-74 INCHES,270,RC,27000206,CDM,,,,,,both,,,98.0000,14.7000,AETNA,AETNA,41.85,,,,,,,25.2900,98.0000,percent of total billed charges,42.7% of $98.00 in Billed Charges for Rev 270 = $41.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 64-74 INCHES,270,RC,27000206,CDM,,,,,,both,,,98.0000,14.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,68.60,,,,,,,25.2900,98.0000,percent of total billed charges,Rev 270 $98.00 in Billed Charges at 70% = $68.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 64-74 INCHES,270,RC,27000206,CDM,,,,,,both,,,98.0000,14.7000,CIGNA HEALTHCARE,CIGNA HMO,40.87,,,,,,,25.2900,98.0000,percent of total billed charges,41.7% of $98.00 in Billed Charges for Rev 270 = $40.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 64-74 INCHES,270,RC,27000206,CDM,,,,,,both,,,98.0000,14.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,45.47,,,,,,,25.2900,98.0000,percent of total billed charges,46.4% of $98.00 in Billed Charges for Rev 270 = $45.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 64-74 INCHES,270,RC,27000206,CDM,,,,,,both,,,98.0000,14.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,40.87,,,,,,,25.2900,98.0000,percent of total billed charges,41.7% of $98.00 in Billed Charges for Rev 270 = $40.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 64-74 INCHES,270,RC,27000206,CDM,,,,,,both,,,98.0000,14.7000,CIGNA HEALTHCARE,CIGNA PPO,40.87,,,,,,,25.2900,98.0000,percent of total billed charges,41.7% of $98.00 in Billed Charges for Rev 270 = $40.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 64-74 INCHES,270,RC,27000206,CDM,,,,,,both,,,98.0000,14.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,88.20,,,,,,,25.2900,98.0000,percent of total billed charges,90% of $98.00 in Billed Charges for Rev 270 = $88.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 64-74 INCHES,270,RC,27000206,CDM,,,,,,both,,,98.0000,14.7000,MEDCOST,MEDCOST VHN,46.64,,,,,,,25.2900,98.0000,percent of total billed charges,47.59% of $98.00 in Billed Charges for Rev 270 = $46.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 64-74 INCHES,270,RC,27000206,CDM,,,,,,both,,,98.0000,14.7000,SENTARA HEALTH,SENTARA HEALTH,25.29,,,,,,,25.2900,98.0000,percent of total billed charges,25.81% of $98.00 in Billed Charges for Rev 270 = $25.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 64-74 INCHES,270,RC,27000206,CDM,,,,,,both,,,98.0000,14.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",98.00,,,,,,,25.2900,98.0000,percent of total billed charges,100% of $98.00 in Billed Charges for Rev 270 = $98.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 64-74 INCHES,270,RC,27000206,CDM,,,,,,both,,,98.0000,14.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,49.00,,,,,,,25.2900,98.0000,percent of total billed charges,Rev 270 $98.00 in Billed Charges at 50% = $49.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 64-74 INCHES,270,RC,27000206,CDM,,,,,,both,,,98.0000,14.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,31.65,,,,,,,25.2900,98.0000,other,32.3% of $98.00 in Billed Charges for Rev 270 = $31.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BINDER ABD 4 PANEL 64-74 INCHES,270,RC,27000206,CDM,,,,,,both,,,98.0000,14.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,30.09,,,,,,,25.2900,98.0000,other,30.7% of $98.00 in Billed Charges for Rev 270 = $30.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BINDER ABD 4 PANEL 64-74 INCHES,270,RC,27000206,CDM,,,,,,both,,,98.0000,14.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,31.65,,,,,,,25.2900,98.0000,percent of total billed charges,32.3% of $98.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 64-74 INCHES,270,RC,27000206,CDM,,,,,,both,,,98.0000,14.7000,WELLCARE,WELLCARE MEDICAID,98.00,,,,,,,25.2900,98.0000,percent of total billed charges,100% of $98.00 in Billed Charges for Rev 270 = $98.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 75-84 INCHES,270,RC,27000207,CDM,,,,,,both,,,103.0000,15.4500,AETNA,AETNA,43.98,,,,,,,26.5800,103.0000,percent of total billed charges,42.7% of $103.00 in Billed Charges for Rev 270 = $43.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 75-84 INCHES,270,RC,27000207,CDM,,,,,,both,,,103.0000,15.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,72.10,,,,,,,26.5800,103.0000,percent of total billed charges,Rev 270 $103.00 in Billed Charges at 70% = $72.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 75-84 INCHES,270,RC,27000207,CDM,,,,,,both,,,103.0000,15.4500,CIGNA HEALTHCARE,CIGNA HMO,42.95,,,,,,,26.5800,103.0000,percent of total billed charges,41.7% of $103.00 in Billed Charges for Rev 270 = $42.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 75-84 INCHES,270,RC,27000207,CDM,,,,,,both,,,103.0000,15.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,47.79,,,,,,,26.5800,103.0000,percent of total billed charges,46.4% of $103.00 in Billed Charges for Rev 270 = $47.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 75-84 INCHES,270,RC,27000207,CDM,,,,,,both,,,103.0000,15.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,42.95,,,,,,,26.5800,103.0000,percent of total billed charges,41.7% of $103.00 in Billed Charges for Rev 270 = $42.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 75-84 INCHES,270,RC,27000207,CDM,,,,,,both,,,103.0000,15.4500,CIGNA HEALTHCARE,CIGNA PPO,42.95,,,,,,,26.5800,103.0000,percent of total billed charges,41.7% of $103.00 in Billed Charges for Rev 270 = $42.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 75-84 INCHES,270,RC,27000207,CDM,,,,,,both,,,103.0000,15.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,92.70,,,,,,,26.5800,103.0000,percent of total billed charges,90% of $103.00 in Billed Charges for Rev 270 = $92.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 75-84 INCHES,270,RC,27000207,CDM,,,,,,both,,,103.0000,15.4500,MEDCOST,MEDCOST VHN,49.02,,,,,,,26.5800,103.0000,percent of total billed charges,47.59% of $103.00 in Billed Charges for Rev 270 = $49.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 75-84 INCHES,270,RC,27000207,CDM,,,,,,both,,,103.0000,15.4500,SENTARA HEALTH,SENTARA HEALTH,26.58,,,,,,,26.5800,103.0000,percent of total billed charges,25.81% of $103.00 in Billed Charges for Rev 270 = $26.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 75-84 INCHES,270,RC,27000207,CDM,,,,,,both,,,103.0000,15.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",103.00,,,,,,,26.5800,103.0000,percent of total billed charges,100% of $103.00 in Billed Charges for Rev 270 = $103.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 75-84 INCHES,270,RC,27000207,CDM,,,,,,both,,,103.0000,15.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,51.50,,,,,,,26.5800,103.0000,percent of total billed charges,Rev 270 $103.00 in Billed Charges at 50% = $51.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 75-84 INCHES,270,RC,27000207,CDM,,,,,,both,,,103.0000,15.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,33.27,,,,,,,26.5800,103.0000,other,32.3% of $103.00 in Billed Charges for Rev 270 = $33.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BINDER ABD 4 PANEL 75-84 INCHES,270,RC,27000207,CDM,,,,,,both,,,103.0000,15.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,31.62,,,,,,,26.5800,103.0000,other,30.7% of $103.00 in Billed Charges for Rev 270 = $31.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BINDER ABD 4 PANEL 75-84 INCHES,270,RC,27000207,CDM,,,,,,both,,,103.0000,15.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,33.27,,,,,,,26.5800,103.0000,percent of total billed charges,32.3% of $103.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 75-84 INCHES,270,RC,27000207,CDM,,,,,,both,,,103.0000,15.4500,WELLCARE,WELLCARE MEDICAID,103.00,,,,,,,26.5800,103.0000,percent of total billed charges,100% of $103.00 in Billed Charges for Rev 270 = $103.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 46-62 LF,270,RC,27000044,CDM,,,,,,both,,,104.0000,15.6000,AETNA,AETNA,44.41,,,,,,,26.8400,104.0000,percent of total billed charges,42.7% of $104.00 in Billed Charges for Rev 270 = $44.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 46-62 LF,270,RC,27000044,CDM,,,,,,both,,,104.0000,15.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,72.80,,,,,,,26.8400,104.0000,percent of total billed charges,Rev 270 $104.00 in Billed Charges at 70% = $72.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 46-62 LF,270,RC,27000044,CDM,,,,,,both,,,104.0000,15.6000,CIGNA HEALTHCARE,CIGNA HMO,43.37,,,,,,,26.8400,104.0000,percent of total billed charges,41.7% of $104.00 in Billed Charges for Rev 270 = $43.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 46-62 LF,270,RC,27000044,CDM,,,,,,both,,,104.0000,15.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,48.26,,,,,,,26.8400,104.0000,percent of total billed charges,46.4% of $104.00 in Billed Charges for Rev 270 = $48.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 46-62 LF,270,RC,27000044,CDM,,,,,,both,,,104.0000,15.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,43.37,,,,,,,26.8400,104.0000,percent of total billed charges,41.7% of $104.00 in Billed Charges for Rev 270 = $43.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 46-62 LF,270,RC,27000044,CDM,,,,,,both,,,104.0000,15.6000,CIGNA HEALTHCARE,CIGNA PPO,43.37,,,,,,,26.8400,104.0000,percent of total billed charges,41.7% of $104.00 in Billed Charges for Rev 270 = $43.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 46-62 LF,270,RC,27000044,CDM,,,,,,both,,,104.0000,15.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,93.60,,,,,,,26.8400,104.0000,percent of total billed charges,90% of $104.00 in Billed Charges for Rev 270 = $93.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 46-62 LF,270,RC,27000044,CDM,,,,,,both,,,104.0000,15.6000,MEDCOST,MEDCOST VHN,49.49,,,,,,,26.8400,104.0000,percent of total billed charges,47.59% of $104.00 in Billed Charges for Rev 270 = $49.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 46-62 LF,270,RC,27000044,CDM,,,,,,both,,,104.0000,15.6000,SENTARA HEALTH,SENTARA HEALTH,26.84,,,,,,,26.8400,104.0000,percent of total billed charges,25.81% of $104.00 in Billed Charges for Rev 270 = $26.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 46-62 LF,270,RC,27000044,CDM,,,,,,both,,,104.0000,15.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",104.00,,,,,,,26.8400,104.0000,percent of total billed charges,100% of $104.00 in Billed Charges for Rev 270 = $104.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 46-62 LF,270,RC,27000044,CDM,,,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,52.00,,,,,,,26.8400,104.0000,percent of total billed charges,Rev 270 $104.00 in Billed Charges at 50% = $52.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 46-62 LF,270,RC,27000044,CDM,,,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,33.59,,,,,,,26.8400,104.0000,other,32.3% of $104.00 in Billed Charges for Rev 270 = $33.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BINDER ABD 46-62 LF,270,RC,27000044,CDM,,,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,31.93,,,,,,,26.8400,104.0000,other,30.7% of $104.00 in Billed Charges for Rev 270 = $31.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BINDER ABD 46-62 LF,270,RC,27000044,CDM,,,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,33.59,,,,,,,26.8400,104.0000,percent of total billed charges,32.3% of $104.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 46-62 LF,270,RC,27000044,CDM,,,,,,both,,,104.0000,15.6000,WELLCARE,WELLCARE MEDICAID,104.00,,,,,,,26.8400,104.0000,percent of total billed charges,100% of $104.00 in Billed Charges for Rev 270 = $104.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABDOMINAL,270,RC,27000134,CDM,,,,,,both,,,88.0000,13.2000,AETNA,AETNA,37.58,,,,,,,22.7100,88.0000,percent of total billed charges,42.7% of $88.00 in Billed Charges for Rev 270 = $37.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABDOMINAL,270,RC,27000134,CDM,,,,,,both,,,88.0000,13.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,61.60,,,,,,,22.7100,88.0000,percent of total billed charges,Rev 270 $88.00 in Billed Charges at 70% = $61.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABDOMINAL,270,RC,27000134,CDM,,,,,,both,,,88.0000,13.2000,CIGNA HEALTHCARE,CIGNA HMO,36.70,,,,,,,22.7100,88.0000,percent of total billed charges,41.7% of $88.00 in Billed Charges for Rev 270 = $36.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABDOMINAL,270,RC,27000134,CDM,,,,,,both,,,88.0000,13.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,40.83,,,,,,,22.7100,88.0000,percent of total billed charges,46.4% of $88.00 in Billed Charges for Rev 270 = $40.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABDOMINAL,270,RC,27000134,CDM,,,,,,both,,,88.0000,13.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,36.70,,,,,,,22.7100,88.0000,percent of total billed charges,41.7% of $88.00 in Billed Charges for Rev 270 = $36.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABDOMINAL,270,RC,27000134,CDM,,,,,,both,,,88.0000,13.2000,CIGNA HEALTHCARE,CIGNA PPO,36.70,,,,,,,22.7100,88.0000,percent of total billed charges,41.7% of $88.00 in Billed Charges for Rev 270 = $36.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABDOMINAL,270,RC,27000134,CDM,,,,,,both,,,88.0000,13.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,79.20,,,,,,,22.7100,88.0000,percent of total billed charges,90% of $88.00 in Billed Charges for Rev 270 = $79.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABDOMINAL,270,RC,27000134,CDM,,,,,,both,,,88.0000,13.2000,MEDCOST,MEDCOST VHN,41.88,,,,,,,22.7100,88.0000,percent of total billed charges,47.59% of $88.00 in Billed Charges for Rev 270 = $41.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABDOMINAL,270,RC,27000134,CDM,,,,,,both,,,88.0000,13.2000,SENTARA HEALTH,SENTARA HEALTH,22.71,,,,,,,22.7100,88.0000,percent of total billed charges,25.81% of $88.00 in Billed Charges for Rev 270 = $22.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABDOMINAL,270,RC,27000134,CDM,,,,,,both,,,88.0000,13.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",88.00,,,,,,,22.7100,88.0000,percent of total billed charges,100% of $88.00 in Billed Charges for Rev 270 = $88.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABDOMINAL,270,RC,27000134,CDM,,,,,,both,,,88.0000,13.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,44.00,,,,,,,22.7100,88.0000,percent of total billed charges,Rev 270 $88.00 in Billed Charges at 50% = $44.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABDOMINAL,270,RC,27000134,CDM,,,,,,both,,,88.0000,13.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,28.42,,,,,,,22.7100,88.0000,other,32.3% of $88.00 in Billed Charges for Rev 270 = $28.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BINDER ABDOMINAL,270,RC,27000134,CDM,,,,,,both,,,88.0000,13.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,27.02,,,,,,,22.7100,88.0000,other,30.7% of $88.00 in Billed Charges for Rev 270 = $27.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BINDER ABDOMINAL,270,RC,27000134,CDM,,,,,,both,,,88.0000,13.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,28.42,,,,,,,22.7100,88.0000,percent of total billed charges,32.3% of $88.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABDOMINAL,270,RC,27000134,CDM,,,,,,both,,,88.0000,13.2000,WELLCARE,WELLCARE MEDICAID,88.00,,,,,,,22.7100,88.0000,percent of total billed charges,100% of $88.00 in Billed Charges for Rev 270 = $88.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CANNULA ERCP CONTOUR ULTRA TAP,272,RC,27200002,CDM,,,,,,both,,,1146.1000,171.9200,AETNA,AETNA,489.38,,,,,,,295.8100,1146.1000,percent of total billed charges,"42.7% of $1,146.10 in Billed Charges for Rev 272 = $489.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP CONTOUR ULTRA TAP,272,RC,27200002,CDM,,,,,,both,,,1146.1000,171.9200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,802.27,,,,,,,295.8100,1146.1000,percent of total billed charges,"Rev 272 $1,146.10 in Billed Charges at 70% = $802.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP CONTOUR ULTRA TAP,272,RC,27200002,CDM,,,,,,both,,,1146.1000,171.9200,CIGNA HEALTHCARE,CIGNA HMO,477.92,,,,,,,295.8100,1146.1000,percent of total billed charges,"41.7% of $1,146.10 in Billed Charges for Rev 272 = $477.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP CONTOUR ULTRA TAP,272,RC,27200002,CDM,,,,,,both,,,1146.1000,171.9200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,531.79,,,,,,,295.8100,1146.1000,percent of total billed charges,"46.4% of $1,146.10 in Billed Charges for Rev 272 = $531.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP CONTOUR ULTRA TAP,272,RC,27200002,CDM,,,,,,both,,,1146.1000,171.9200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,477.92,,,,,,,295.8100,1146.1000,percent of total billed charges,"41.7% of $1,146.10 in Billed Charges for Rev 272 = $477.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP CONTOUR ULTRA TAP,272,RC,27200002,CDM,,,,,,both,,,1146.1000,171.9200,CIGNA HEALTHCARE,CIGNA PPO,477.92,,,,,,,295.8100,1146.1000,percent of total billed charges,"41.7% of $1,146.10 in Billed Charges for Rev 272 = $477.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP CONTOUR ULTRA TAP,272,RC,27200002,CDM,,,,,,both,,,1146.1000,171.9200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1031.49,,,,,,,295.8100,1146.1000,percent of total billed charges,"90% of $1,146.10 in Billed Charges for Rev 272 = $1,031.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP CONTOUR ULTRA TAP,272,RC,27200002,CDM,,,,,,both,,,1146.1000,171.9200,MEDCOST,MEDCOST VHN,545.43,,,,,,,295.8100,1146.1000,percent of total billed charges,"47.59% of $1,146.10 in Billed Charges for Rev 272 = $545.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP CONTOUR ULTRA TAP,272,RC,27200002,CDM,,,,,,both,,,1146.1000,171.9200,SENTARA HEALTH,SENTARA HEALTH,295.81,,,,,,,295.8100,1146.1000,percent of total billed charges,"25.81% of $1,146.10 in Billed Charges for Rev 272 = $295.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP CONTOUR ULTRA TAP,272,RC,27200002,CDM,,,,,,both,,,1146.1000,171.9200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1146.10,,,,,,,295.8100,1146.1000,percent of total billed charges,"100% of $1,146.10 in Billed Charges for Rev 272 = $1,146.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP CONTOUR ULTRA TAP,272,RC,27200002,CDM,,,,,,both,,,1146.1000,171.9200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,573.05,,,,,,,295.8100,1146.1000,percent of total billed charges,"Rev 272 $1,146.10 in Billed Charges at 50% = $573.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP CONTOUR ULTRA TAP,272,RC,27200002,CDM,,,,,,both,,,1146.1000,171.9200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,370.19,,,,,,,295.8100,1146.1000,other,"32.3% of $1,146.10 in Billed Charges for Rev 272 = $370.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA ERCP CONTOUR ULTRA TAP,272,RC,27200002,CDM,,,,,,both,,,1146.1000,171.9200,UNITED HEALTHCARE,UHC HERITAGE SELECT,351.85,,,,,,,295.8100,1146.1000,other,"30.7% of $1,146.10 in Billed Charges for Rev 272 = $351.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA ERCP CONTOUR ULTRA TAP,272,RC,27200002,CDM,,,,,,both,,,1146.1000,171.9200,UNITED HEALTHCARE,UNITED HEALTHCARE,370.19,,,,,,,295.8100,1146.1000,percent of total billed charges,"32.3% of $1,146.10 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA ERCP CONTOUR ULTRA TAP,272,RC,27200002,CDM,,,,,,both,,,1146.1000,171.9200,WELLCARE,WELLCARE MEDICAID,1146.10,,,,,,,295.8100,1146.1000,percent of total billed charges,"100% of $1,146.10 in Billed Charges for Rev 272 = $1,146.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY 20FR,272,RC,27200002,CDM,,,,,,both,,,2802.1400,420.3200,AETNA,AETNA,1196.51,,,,,,,723.2300,2802.1400,percent of total billed charges,"42.7% of $2,802.14 in Billed Charges for Rev 272 = $1,196.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY 20FR,272,RC,27200002,CDM,,,,,,both,,,2802.1400,420.3200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1961.50,,,,,,,723.2300,2802.1400,percent of total billed charges,"Rev 272 $2,802.14 in Billed Charges at 70% = $1,961.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY 20FR,272,RC,27200002,CDM,,,,,,both,,,2802.1400,420.3200,CIGNA HEALTHCARE,CIGNA HMO,1168.49,,,,,,,723.2300,2802.1400,percent of total billed charges,"41.7% of $2,802.14 in Billed Charges for Rev 272 = $1,168.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY 20FR,272,RC,27200002,CDM,,,,,,both,,,2802.1400,420.3200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1300.19,,,,,,,723.2300,2802.1400,percent of total billed charges,"46.4% of $2,802.14 in Billed Charges for Rev 272 = $1,300.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY 20FR,272,RC,27200002,CDM,,,,,,both,,,2802.1400,420.3200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1168.49,,,,,,,723.2300,2802.1400,percent of total billed charges,"41.7% of $2,802.14 in Billed Charges for Rev 272 = $1,168.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY 20FR,272,RC,27200002,CDM,,,,,,both,,,2802.1400,420.3200,CIGNA HEALTHCARE,CIGNA PPO,1168.49,,,,,,,723.2300,2802.1400,percent of total billed charges,"41.7% of $2,802.14 in Billed Charges for Rev 272 = $1,168.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY 20FR,272,RC,27200002,CDM,,,,,,both,,,2802.1400,420.3200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2521.93,,,,,,,723.2300,2802.1400,percent of total billed charges,"90% of $2,802.14 in Billed Charges for Rev 272 = $2,521.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY 20FR,272,RC,27200002,CDM,,,,,,both,,,2802.1400,420.3200,MEDCOST,MEDCOST VHN,1333.54,,,,,,,723.2300,2802.1400,percent of total billed charges,"47.59% of $2,802.14 in Billed Charges for Rev 272 = $1,333.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY 20FR,272,RC,27200002,CDM,,,,,,both,,,2802.1400,420.3200,SENTARA HEALTH,SENTARA HEALTH,723.23,,,,,,,723.2300,2802.1400,percent of total billed charges,"25.81% of $2,802.14 in Billed Charges for Rev 272 = $723.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY 20FR,272,RC,27200002,CDM,,,,,,both,,,2802.1400,420.3200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2802.14,,,,,,,723.2300,2802.1400,percent of total billed charges,"100% of $2,802.14 in Billed Charges for Rev 272 = $2,802.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY 20FR,272,RC,27200002,CDM,,,,,,both,,,2802.1400,420.3200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1401.07,,,,,,,723.2300,2802.1400,percent of total billed charges,"Rev 272 $2,802.14 in Billed Charges at 50% = $1,401.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY 20FR,272,RC,27200002,CDM,,,,,,both,,,2802.1400,420.3200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,905.09,,,,,,,723.2300,2802.1400,other,"32.3% of $2,802.14 in Billed Charges for Rev 272 = $905.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA FEMORAL ARTERY 20FR,272,RC,27200002,CDM,,,,,,both,,,2802.1400,420.3200,UNITED HEALTHCARE,UHC HERITAGE SELECT,860.26,,,,,,,723.2300,2802.1400,other,"30.7% of $2,802.14 in Billed Charges for Rev 272 = $860.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CANNULA FEMORAL ARTERY 20FR,272,RC,27200002,CDM,,,,,,both,,,2802.1400,420.3200,UNITED HEALTHCARE,UNITED HEALTHCARE,905.09,,,,,,,723.2300,2802.1400,percent of total billed charges,"32.3% of $2,802.14 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CANNULA FEMORAL ARTERY 20FR,272,RC,27200002,CDM,,,,,,both,,,2802.1400,420.3200,WELLCARE,WELLCARE MEDICAID,2802.14,,,,,,,723.2300,2802.1400,percent of total billed charges,"100% of $2,802.14 in Billed Charges for Rev 272 = $2,802.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER INTHRILL,272,RC,27200002,CDM,,,,,,both,,,22816.2000,3422.4300,AETNA,AETNA,9742.52,,,,,,,5888.8600,22816.2000,percent of total billed charges,"42.7% of $22,816.20 in Billed Charges for Rev 272 = $9,742.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER INTHRILL,272,RC,27200002,CDM,,,,,,both,,,22816.2000,3422.4300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,15971.34,,,,,,,5888.8600,22816.2000,percent of total billed charges,"Rev 272 $22,816.20 in Billed Charges at 70% = $15,971.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER INTHRILL,272,RC,27200002,CDM,,,,,,both,,,22816.2000,3422.4300,CIGNA HEALTHCARE,CIGNA HMO,9514.36,,,,,,,5888.8600,22816.2000,percent of total billed charges,"41.7% of $22,816.20 in Billed Charges for Rev 272 = $9,514.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER INTHRILL,272,RC,27200002,CDM,,,,,,both,,,22816.2000,3422.4300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10586.72,,,,,,,5888.8600,22816.2000,percent of total billed charges,"46.4% of $22,816.20 in Billed Charges for Rev 272 = $10,586.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER INTHRILL,272,RC,27200002,CDM,,,,,,both,,,22816.2000,3422.4300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9514.36,,,,,,,5888.8600,22816.2000,percent of total billed charges,"41.7% of $22,816.20 in Billed Charges for Rev 272 = $9,514.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER INTHRILL,272,RC,27200002,CDM,,,,,,both,,,22816.2000,3422.4300,CIGNA HEALTHCARE,CIGNA PPO,9514.36,,,,,,,5888.8600,22816.2000,percent of total billed charges,"41.7% of $22,816.20 in Billed Charges for Rev 272 = $9,514.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER INTHRILL,272,RC,27200002,CDM,,,,,,both,,,22816.2000,3422.4300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,20534.58,,,,,,,5888.8600,22816.2000,percent of total billed charges,"90% of $22,816.20 in Billed Charges for Rev 272 = $20,534.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER INTHRILL,272,RC,27200002,CDM,,,,,,both,,,22816.2000,3422.4300,MEDCOST,MEDCOST VHN,10858.23,,,,,,,5888.8600,22816.2000,percent of total billed charges,"47.59% of $22,816.20 in Billed Charges for Rev 272 = $10,858.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER INTHRILL,272,RC,27200002,CDM,,,,,,both,,,22816.2000,3422.4300,SENTARA HEALTH,SENTARA HEALTH,5888.86,,,,,,,5888.8600,22816.2000,percent of total billed charges,"25.81% of $22,816.20 in Billed Charges for Rev 272 = $5,888.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER INTHRILL,272,RC,27200002,CDM,,,,,,both,,,22816.2000,3422.4300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",22816.20,,,,,,,5888.8600,22816.2000,percent of total billed charges,"100% of $22,816.20 in Billed Charges for Rev 272 = $22,816.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER INTHRILL,272,RC,27200002,CDM,,,,,,both,,,22816.2000,3422.4300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11408.10,,,,,,,5888.8600,22816.2000,percent of total billed charges,"Rev 272 $22,816.20 in Billed Charges at 50% = $11,408.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER INTHRILL,272,RC,27200002,CDM,,,,,,both,,,22816.2000,3422.4300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7369.63,,,,,,,5888.8600,22816.2000,other,"32.3% of $22,816.20 in Billed Charges for Rev 272 = $7,369.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATHETER INTHRILL,272,RC,27200002,CDM,,,,,,both,,,22816.2000,3422.4300,UNITED HEALTHCARE,UHC HERITAGE SELECT,7004.57,,,,,,,5888.8600,22816.2000,other,"30.7% of $22,816.20 in Billed Charges for Rev 272 = $7,004.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATHETER INTHRILL,272,RC,27200002,CDM,,,,,,both,,,22816.2000,3422.4300,UNITED HEALTHCARE,UNITED HEALTHCARE,7369.63,,,,,,,5888.8600,22816.2000,percent of total billed charges,"32.3% of $22,816.20 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER INTHRILL,272,RC,27200002,CDM,,,,,,both,,,22816.2000,3422.4300,WELLCARE,WELLCARE MEDICAID,22816.20,,,,,,,5888.8600,22816.2000,percent of total billed charges,"100% of $22,816.20 in Billed Charges for Rev 272 = $22,816.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER KIT EDGE FT 190 2.7MM,272,RC,27200002,CDM,,,,,,both,,,16158.0200,2423.7000,AETNA,AETNA,6899.47,,,,,,,4170.3900,16158.0200,percent of total billed charges,"42.7% of $16,158.02 in Billed Charges for Rev 272 = $6,899.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER KIT EDGE FT 190 2.7MM,272,RC,27200002,CDM,,,,,,both,,,16158.0200,2423.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11310.61,,,,,,,4170.3900,16158.0200,percent of total billed charges,"Rev 272 $16,158.02 in Billed Charges at 70% = $11,310.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER KIT EDGE FT 190 2.7MM,272,RC,27200002,CDM,,,,,,both,,,16158.0200,2423.7000,CIGNA HEALTHCARE,CIGNA HMO,6737.89,,,,,,,4170.3900,16158.0200,percent of total billed charges,"41.7% of $16,158.02 in Billed Charges for Rev 272 = $6,737.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER KIT EDGE FT 190 2.7MM,272,RC,27200002,CDM,,,,,,both,,,16158.0200,2423.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7497.32,,,,,,,4170.3900,16158.0200,percent of total billed charges,"46.4% of $16,158.02 in Billed Charges for Rev 272 = $7,497.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER KIT EDGE FT 190 2.7MM,272,RC,27200002,CDM,,,,,,both,,,16158.0200,2423.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6737.89,,,,,,,4170.3900,16158.0200,percent of total billed charges,"41.7% of $16,158.02 in Billed Charges for Rev 272 = $6,737.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER KIT EDGE FT 190 2.7MM,272,RC,27200002,CDM,,,,,,both,,,16158.0200,2423.7000,CIGNA HEALTHCARE,CIGNA PPO,6737.89,,,,,,,4170.3900,16158.0200,percent of total billed charges,"41.7% of $16,158.02 in Billed Charges for Rev 272 = $6,737.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER KIT EDGE FT 190 2.7MM,272,RC,27200002,CDM,,,,,,both,,,16158.0200,2423.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,14542.22,,,,,,,4170.3900,16158.0200,percent of total billed charges,"90% of $16,158.02 in Billed Charges for Rev 272 = $14,542.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER KIT EDGE FT 190 2.7MM,272,RC,27200002,CDM,,,,,,both,,,16158.0200,2423.7000,MEDCOST,MEDCOST VHN,7689.60,,,,,,,4170.3900,16158.0200,percent of total billed charges,"47.59% of $16,158.02 in Billed Charges for Rev 272 = $7,689.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER KIT EDGE FT 190 2.7MM,272,RC,27200002,CDM,,,,,,both,,,16158.0200,2423.7000,SENTARA HEALTH,SENTARA HEALTH,4170.39,,,,,,,4170.3900,16158.0200,percent of total billed charges,"25.81% of $16,158.02 in Billed Charges for Rev 272 = $4,170.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER KIT EDGE FT 190 2.7MM,272,RC,27200002,CDM,,,,,,both,,,16158.0200,2423.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",16158.02,,,,,,,4170.3900,16158.0200,percent of total billed charges,"100% of $16,158.02 in Billed Charges for Rev 272 = $16,158.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER KIT EDGE FT 190 2.7MM,272,RC,27200002,CDM,,,,,,both,,,16158.0200,2423.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8079.01,,,,,,,4170.3900,16158.0200,percent of total billed charges,"Rev 272 $16,158.02 in Billed Charges at 50% = $8,079.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER KIT EDGE FT 190 2.7MM,272,RC,27200002,CDM,,,,,,both,,,16158.0200,2423.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5219.04,,,,,,,4170.3900,16158.0200,other,"32.3% of $16,158.02 in Billed Charges for Rev 272 = $5,219.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATHETER KIT EDGE FT 190 2.7MM,272,RC,27200002,CDM,,,,,,both,,,16158.0200,2423.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,4960.51,,,,,,,4170.3900,16158.0200,other,"30.7% of $16,158.02 in Billed Charges for Rev 272 = $4,960.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATHETER KIT EDGE FT 190 2.7MM,272,RC,27200002,CDM,,,,,,both,,,16158.0200,2423.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,5219.04,,,,,,,4170.3900,16158.0200,percent of total billed charges,"32.3% of $16,158.02 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER KIT EDGE FT 190 2.7MM,272,RC,27200002,CDM,,,,,,both,,,16158.0200,2423.7000,WELLCARE,WELLCARE MEDICAID,16158.02,,,,,,,4170.3900,16158.0200,percent of total billed charges,"100% of $16,158.02 in Billed Charges for Rev 272 = $16,158.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BIORESORBABLE VAS SCAFF/STUDY DEV,278,RC,27800476,CDM,,,,,,both,,,1.0000,0.1500,AETNA,AETNA,0.48,,,,,,,0.2600,1.0000,percent of total billed charges,48% of $1.00 in Billed Charges for Rev 278 = $0.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIORESORBABLE VAS SCAFF/STUDY DEV,278,RC,27800476,CDM,,,,,,both,,,1.0000,0.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,0.50,,,,,,,0.2600,1.0000,percent of total billed charges,50% of $1.00 in Billed Charges for Rev 278 = $0.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIORESORBABLE VAS SCAFF/STUDY DEV,278,RC,27800476,CDM,,,,,,both,,,1.0000,0.1500,CIGNA HEALTHCARE,CIGNA HMO,0.42,,,,,,,0.2600,1.0000,percent of total billed charges,41.7% of $1.00 in Billed Charges for Rev 278 = $0.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIORESORBABLE VAS SCAFF/STUDY DEV,278,RC,27800476,CDM,,,,,,both,,,1.0000,0.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,0.40,,,,,,,0.2600,1.0000,percent of total billed charges,40% of $1.00 in Billed Charges for Rev 278 = $0.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIORESORBABLE VAS SCAFF/STUDY DEV,278,RC,27800476,CDM,,,,,,both,,,1.0000,0.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,0.42,,,,,,,0.2600,1.0000,percent of total billed charges,41.7% of $1.00 in Billed Charges for Rev 278 = $0.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIORESORBABLE VAS SCAFF/STUDY DEV,278,RC,27800476,CDM,,,,,,both,,,1.0000,0.1500,CIGNA HEALTHCARE,CIGNA PPO,0.42,,,,,,,0.2600,1.0000,percent of total billed charges,41.7% of $1.00 in Billed Charges for Rev 278 = $0.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIORESORBABLE VAS SCAFF/STUDY DEV,278,RC,27800476,CDM,,,,,,both,,,1.0000,0.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,0.90,,,,,,,0.2600,1.0000,percent of total billed charges,90% of $1.00 in Billed Charges for Rev 278 = $0.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIORESORBABLE VAS SCAFF/STUDY DEV,278,RC,27800476,CDM,,,,,,both,,,1.0000,0.1500,MEDCOST,MEDCOST VHN,0.48,,,,,,,0.2600,1.0000,percent of total billed charges,47.59% of $1.00 in Billed Charges for Rev 278 = $0.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIORESORBABLE VAS SCAFF/STUDY DEV,278,RC,27800476,CDM,,,,,,both,,,1.0000,0.1500,SENTARA HEALTH,SENTARA HEALTH,0.26,,,,,,,0.2600,1.0000,percent of total billed charges,25.81% of $1.00 in Billed Charges for Rev 278 = $0.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIORESORBABLE VAS SCAFF/STUDY DEV,278,RC,27800476,CDM,,,,,,both,,,1.0000,0.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1.00,,,,,,,0.2600,1.0000,percent of total billed charges,100% of $1.00 in Billed Charges for Rev 278 = $1.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIORESORBABLE VAS SCAFF/STUDY DEV,278,RC,27800476,CDM,,,,,,both,,,1.0000,0.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,0.50,,,,,,,0.2600,1.0000,percent of total billed charges,Rev 278 $1.00 in Billed Charges at 50% = $0.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIORESORBABLE VAS SCAFF/STUDY DEV,278,RC,27800476,CDM,,,,,,both,,,1.0000,0.1500,WELLCARE,WELLCARE MEDICAID,1.00,,,,,,,0.2600,1.0000,percent of total billed charges,100% of $1.00 in Billed Charges for Rev 278 = $1.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE SAGITTAL 4118-127-90,272,RC,27200128,CDM,,,,,,both,,,400.0000,60.0000,AETNA,AETNA,170.80,,,,,,,103.2400,400.0000,percent of total billed charges,42.7% of $400.00 in Billed Charges for Rev 272 = $170.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE SAGITTAL 4118-127-90,272,RC,27200128,CDM,,,,,,both,,,400.0000,60.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,280.00,,,,,,,103.2400,400.0000,percent of total billed charges,Rev 272 $400.00 in Billed Charges at 70% = $280.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE SAGITTAL 4118-127-90,272,RC,27200128,CDM,,,,,,both,,,400.0000,60.0000,CIGNA HEALTHCARE,CIGNA HMO,166.80,,,,,,,103.2400,400.0000,percent of total billed charges,41.7% of $400.00 in Billed Charges for Rev 272 = $166.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE SAGITTAL 4118-127-90,272,RC,27200128,CDM,,,,,,both,,,400.0000,60.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,185.60,,,,,,,103.2400,400.0000,percent of total billed charges,46.4% of $400.00 in Billed Charges for Rev 272 = $185.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE SAGITTAL 4118-127-90,272,RC,27200128,CDM,,,,,,both,,,400.0000,60.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,166.80,,,,,,,103.2400,400.0000,percent of total billed charges,41.7% of $400.00 in Billed Charges for Rev 272 = $166.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE SAGITTAL 4118-127-90,272,RC,27200128,CDM,,,,,,both,,,400.0000,60.0000,CIGNA HEALTHCARE,CIGNA PPO,166.80,,,,,,,103.2400,400.0000,percent of total billed charges,41.7% of $400.00 in Billed Charges for Rev 272 = $166.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE SAGITTAL 4118-127-90,272,RC,27200128,CDM,,,,,,both,,,400.0000,60.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,360.00,,,,,,,103.2400,400.0000,percent of total billed charges,90% of $400.00 in Billed Charges for Rev 272 = $360.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE SAGITTAL 4118-127-90,272,RC,27200128,CDM,,,,,,both,,,400.0000,60.0000,MEDCOST,MEDCOST VHN,190.36,,,,,,,103.2400,400.0000,percent of total billed charges,47.59% of $400.00 in Billed Charges for Rev 272 = $190.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE SAGITTAL 4118-127-90,272,RC,27200128,CDM,,,,,,both,,,400.0000,60.0000,SENTARA HEALTH,SENTARA HEALTH,103.24,,,,,,,103.2400,400.0000,percent of total billed charges,25.81% of $400.00 in Billed Charges for Rev 272 = $103.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE SAGITTAL 4118-127-90,272,RC,27200128,CDM,,,,,,both,,,400.0000,60.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",400.00,,,,,,,103.2400,400.0000,percent of total billed charges,100% of $400.00 in Billed Charges for Rev 272 = $400.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE SAGITTAL 4118-127-90,272,RC,27200128,CDM,,,,,,both,,,400.0000,60.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,200.00,,,,,,,103.2400,400.0000,percent of total billed charges,Rev 272 $400.00 in Billed Charges at 50% = $200.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE SAGITTAL 4118-127-90,272,RC,27200128,CDM,,,,,,both,,,400.0000,60.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,129.20,,,,,,,103.2400,400.0000,other,32.3% of $400.00 in Billed Charges for Rev 272 = $129.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLADE SAGITTAL 4118-127-90,272,RC,27200128,CDM,,,,,,both,,,400.0000,60.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,122.80,,,,,,,103.2400,400.0000,other,30.7% of $400.00 in Billed Charges for Rev 272 = $122.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLADE SAGITTAL 4118-127-90,272,RC,27200128,CDM,,,,,,both,,,400.0000,60.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,129.20,,,,,,,103.2400,400.0000,percent of total billed charges,32.3% of $400.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE SAGITTAL 4118-127-90,272,RC,27200128,CDM,,,,,,both,,,400.0000,60.0000,WELLCARE,WELLCARE MEDICAID,400.00,,,,,,,103.2400,400.0000,percent of total billed charges,100% of $400.00 in Billed Charges for Rev 272 = $400.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD BAG-SINGLE,270,RC,27000260,CDM,,,,,,both,,,19.0000,2.8500,AETNA,AETNA,8.11,,,,,,,4.9000,19.0000,percent of total billed charges,42.7% of $19.00 in Billed Charges for Rev 270 = $8.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD BAG-SINGLE,270,RC,27000260,CDM,,,,,,both,,,19.0000,2.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,13.30,,,,,,,4.9000,19.0000,percent of total billed charges,Rev 270 $19.00 in Billed Charges at 70% = $13.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD BAG-SINGLE,270,RC,27000260,CDM,,,,,,both,,,19.0000,2.8500,CIGNA HEALTHCARE,CIGNA HMO,7.92,,,,,,,4.9000,19.0000,percent of total billed charges,41.7% of $19.00 in Billed Charges for Rev 270 = $7.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD BAG-SINGLE,270,RC,27000260,CDM,,,,,,both,,,19.0000,2.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8.82,,,,,,,4.9000,19.0000,percent of total billed charges,46.4% of $19.00 in Billed Charges for Rev 270 = $8.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD BAG-SINGLE,270,RC,27000260,CDM,,,,,,both,,,19.0000,2.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7.92,,,,,,,4.9000,19.0000,percent of total billed charges,41.7% of $19.00 in Billed Charges for Rev 270 = $7.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD BAG-SINGLE,270,RC,27000260,CDM,,,,,,both,,,19.0000,2.8500,CIGNA HEALTHCARE,CIGNA PPO,7.92,,,,,,,4.9000,19.0000,percent of total billed charges,41.7% of $19.00 in Billed Charges for Rev 270 = $7.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD BAG-SINGLE,270,RC,27000260,CDM,,,,,,both,,,19.0000,2.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,17.10,,,,,,,4.9000,19.0000,percent of total billed charges,90% of $19.00 in Billed Charges for Rev 270 = $17.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD BAG-SINGLE,270,RC,27000260,CDM,,,,,,both,,,19.0000,2.8500,MEDCOST,MEDCOST VHN,9.04,,,,,,,4.9000,19.0000,percent of total billed charges,47.59% of $19.00 in Billed Charges for Rev 270 = $9.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD BAG-SINGLE,270,RC,27000260,CDM,,,,,,both,,,19.0000,2.8500,SENTARA HEALTH,SENTARA HEALTH,4.90,,,,,,,4.9000,19.0000,percent of total billed charges,25.81% of $19.00 in Billed Charges for Rev 270 = $4.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD BAG-SINGLE,270,RC,27000260,CDM,,,,,,both,,,19.0000,2.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",19.00,,,,,,,4.9000,19.0000,percent of total billed charges,100% of $19.00 in Billed Charges for Rev 270 = $19.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD BAG-SINGLE,270,RC,27000260,CDM,,,,,,both,,,19.0000,2.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9.50,,,,,,,4.9000,19.0000,percent of total billed charges,Rev 270 $19.00 in Billed Charges at 50% = $9.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD BAG-SINGLE,270,RC,27000260,CDM,,,,,,both,,,19.0000,2.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,6.14,,,,,,,4.9000,19.0000,other,32.3% of $19.00 in Billed Charges for Rev 270 = $6.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD BAG-SINGLE,270,RC,27000260,CDM,,,,,,both,,,19.0000,2.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,5.83,,,,,,,4.9000,19.0000,other,30.7% of $19.00 in Billed Charges for Rev 270 = $5.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOOD BAG-SINGLE,270,RC,27000260,CDM,,,,,,both,,,19.0000,2.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,6.14,,,,,,,4.9000,19.0000,percent of total billed charges,32.3% of $19.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOOD BAG-SINGLE,270,RC,27000260,CDM,,,,,,both,,,19.0000,2.8500,WELLCARE,WELLCARE MEDICAID,19.00,,,,,,,4.9000,19.0000,percent of total billed charges,100% of $19.00 in Billed Charges for Rev 270 = $19.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BONE BIOPSY DEVICE KYPHX,272,RC,27200464,CDM,,,,,,both,,,2714.0000,407.1000,AETNA,AETNA,1158.88,,,,,,,700.4800,2714.0000,percent of total billed charges,"42.7% of $2,714.00 in Billed Charges for Rev 272 = $1,158.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BONE BIOPSY DEVICE KYPHX,272,RC,27200464,CDM,,,,,,both,,,2714.0000,407.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1899.80,,,,,,,700.4800,2714.0000,percent of total billed charges,"Rev 272 $2,714.00 in Billed Charges at 70% = $1,899.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BONE BIOPSY DEVICE KYPHX,272,RC,27200464,CDM,,,,,,both,,,2714.0000,407.1000,CIGNA HEALTHCARE,CIGNA HMO,1131.74,,,,,,,700.4800,2714.0000,percent of total billed charges,"41.7% of $2,714.00 in Billed Charges for Rev 272 = $1,131.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BONE BIOPSY DEVICE KYPHX,272,RC,27200464,CDM,,,,,,both,,,2714.0000,407.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1259.30,,,,,,,700.4800,2714.0000,percent of total billed charges,"46.4% of $2,714.00 in Billed Charges for Rev 272 = $1,259.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BONE BIOPSY DEVICE KYPHX,272,RC,27200464,CDM,,,,,,both,,,2714.0000,407.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1131.74,,,,,,,700.4800,2714.0000,percent of total billed charges,"41.7% of $2,714.00 in Billed Charges for Rev 272 = $1,131.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BONE BIOPSY DEVICE KYPHX,272,RC,27200464,CDM,,,,,,both,,,2714.0000,407.1000,CIGNA HEALTHCARE,CIGNA PPO,1131.74,,,,,,,700.4800,2714.0000,percent of total billed charges,"41.7% of $2,714.00 in Billed Charges for Rev 272 = $1,131.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BONE BIOPSY DEVICE KYPHX,272,RC,27200464,CDM,,,,,,both,,,2714.0000,407.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2442.60,,,,,,,700.4800,2714.0000,percent of total billed charges,"90% of $2,714.00 in Billed Charges for Rev 272 = $2,442.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BONE BIOPSY DEVICE KYPHX,272,RC,27200464,CDM,,,,,,both,,,2714.0000,407.1000,MEDCOST,MEDCOST VHN,1291.59,,,,,,,700.4800,2714.0000,percent of total billed charges,"47.59% of $2,714.00 in Billed Charges for Rev 272 = $1,291.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BONE BIOPSY DEVICE KYPHX,272,RC,27200464,CDM,,,,,,both,,,2714.0000,407.1000,SENTARA HEALTH,SENTARA HEALTH,700.48,,,,,,,700.4800,2714.0000,percent of total billed charges,"25.81% of $2,714.00 in Billed Charges for Rev 272 = $700.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BONE BIOPSY DEVICE KYPHX,272,RC,27200464,CDM,,,,,,both,,,2714.0000,407.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2714.00,,,,,,,700.4800,2714.0000,percent of total billed charges,"100% of $2,714.00 in Billed Charges for Rev 272 = $2,714.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BONE BIOPSY DEVICE KYPHX,272,RC,27200464,CDM,,,,,,both,,,2714.0000,407.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1357.00,,,,,,,700.4800,2714.0000,percent of total billed charges,"Rev 272 $2,714.00 in Billed Charges at 50% = $1,357.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BONE BIOPSY DEVICE KYPHX,272,RC,27200464,CDM,,,,,,both,,,2714.0000,407.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,876.62,,,,,,,700.4800,2714.0000,other,"32.3% of $2,714.00 in Billed Charges for Rev 272 = $876.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BONE BIOPSY DEVICE KYPHX,272,RC,27200464,CDM,,,,,,both,,,2714.0000,407.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,833.20,,,,,,,700.4800,2714.0000,other,"30.7% of $2,714.00 in Billed Charges for Rev 272 = $833.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BONE BIOPSY DEVICE KYPHX,272,RC,27200464,CDM,,,,,,both,,,2714.0000,407.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,876.62,,,,,,,700.4800,2714.0000,percent of total billed charges,"32.3% of $2,714.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BONE BIOPSY DEVICE KYPHX,272,RC,27200464,CDM,,,,,,both,,,2714.0000,407.1000,WELLCARE,WELLCARE MEDICAID,2714.00,,,,,,,700.4800,2714.0000,percent of total billed charges,"100% of $2,714.00 in Billed Charges for Rev 272 = $2,714.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BOOT WALKER SHT LEG LG,270,RC,27000085,CDM,,,,,,both,,,371.0000,55.6500,AETNA,AETNA,158.42,,,,,,,95.7600,371.0000,percent of total billed charges,42.7% of $371.00 in Billed Charges for Rev 270 = $158.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT WALKER SHT LEG LG,270,RC,27000085,CDM,,,,,,both,,,371.0000,55.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,259.70,,,,,,,95.7600,371.0000,percent of total billed charges,Rev 270 $371.00 in Billed Charges at 70% = $259.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT WALKER SHT LEG LG,270,RC,27000085,CDM,,,,,,both,,,371.0000,55.6500,CIGNA HEALTHCARE,CIGNA HMO,154.71,,,,,,,95.7600,371.0000,percent of total billed charges,41.7% of $371.00 in Billed Charges for Rev 270 = $154.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT WALKER SHT LEG LG,270,RC,27000085,CDM,,,,,,both,,,371.0000,55.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,172.14,,,,,,,95.7600,371.0000,percent of total billed charges,46.4% of $371.00 in Billed Charges for Rev 270 = $172.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT WALKER SHT LEG LG,270,RC,27000085,CDM,,,,,,both,,,371.0000,55.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,154.71,,,,,,,95.7600,371.0000,percent of total billed charges,41.7% of $371.00 in Billed Charges for Rev 270 = $154.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT WALKER SHT LEG LG,270,RC,27000085,CDM,,,,,,both,,,371.0000,55.6500,CIGNA HEALTHCARE,CIGNA PPO,154.71,,,,,,,95.7600,371.0000,percent of total billed charges,41.7% of $371.00 in Billed Charges for Rev 270 = $154.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT WALKER SHT LEG LG,270,RC,27000085,CDM,,,,,,both,,,371.0000,55.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,333.90,,,,,,,95.7600,371.0000,percent of total billed charges,90% of $371.00 in Billed Charges for Rev 270 = $333.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT WALKER SHT LEG LG,270,RC,27000085,CDM,,,,,,both,,,371.0000,55.6500,MEDCOST,MEDCOST VHN,176.56,,,,,,,95.7600,371.0000,percent of total billed charges,47.59% of $371.00 in Billed Charges for Rev 270 = $176.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT WALKER SHT LEG LG,270,RC,27000085,CDM,,,,,,both,,,371.0000,55.6500,SENTARA HEALTH,SENTARA HEALTH,95.76,,,,,,,95.7600,371.0000,percent of total billed charges,25.81% of $371.00 in Billed Charges for Rev 270 = $95.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT WALKER SHT LEG LG,270,RC,27000085,CDM,,,,,,both,,,371.0000,55.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",371.00,,,,,,,95.7600,371.0000,percent of total billed charges,100% of $371.00 in Billed Charges for Rev 270 = $371.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT WALKER SHT LEG LG,270,RC,27000085,CDM,,,,,,both,,,371.0000,55.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,185.50,,,,,,,95.7600,371.0000,percent of total billed charges,Rev 270 $371.00 in Billed Charges at 50% = $185.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT WALKER SHT LEG LG,270,RC,27000085,CDM,,,,,,both,,,371.0000,55.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,119.83,,,,,,,95.7600,371.0000,other,32.3% of $371.00 in Billed Charges for Rev 270 = $119.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BOOT WALKER SHT LEG LG,270,RC,27000085,CDM,,,,,,both,,,371.0000,55.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,113.90,,,,,,,95.7600,371.0000,other,30.7% of $371.00 in Billed Charges for Rev 270 = $113.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BOOT WALKER SHT LEG LG,270,RC,27000085,CDM,,,,,,both,,,371.0000,55.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,119.83,,,,,,,95.7600,371.0000,percent of total billed charges,32.3% of $371.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT WALKER SHT LEG LG,270,RC,27000085,CDM,,,,,,both,,,371.0000,55.6500,WELLCARE,WELLCARE MEDICAID,371.00,,,,,,,95.7600,371.0000,percent of total billed charges,100% of $371.00 in Billed Charges for Rev 270 = $371.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOTTLE DRAIN PLEURX,272,RC,27200473,CDM,,,,,,both,,,282.0000,42.3000,AETNA,AETNA,120.41,,,,,,,72.7800,282.0000,percent of total billed charges,42.7% of $282.00 in Billed Charges for Rev 272 = $120.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOTTLE DRAIN PLEURX,272,RC,27200473,CDM,,,,,,both,,,282.0000,42.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,197.40,,,,,,,72.7800,282.0000,percent of total billed charges,Rev 272 $282.00 in Billed Charges at 70% = $197.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOTTLE DRAIN PLEURX,272,RC,27200473,CDM,,,,,,both,,,282.0000,42.3000,CIGNA HEALTHCARE,CIGNA HMO,117.59,,,,,,,72.7800,282.0000,percent of total billed charges,41.7% of $282.00 in Billed Charges for Rev 272 = $117.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOTTLE DRAIN PLEURX,272,RC,27200473,CDM,,,,,,both,,,282.0000,42.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,130.85,,,,,,,72.7800,282.0000,percent of total billed charges,46.4% of $282.00 in Billed Charges for Rev 272 = $130.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOTTLE DRAIN PLEURX,272,RC,27200473,CDM,,,,,,both,,,282.0000,42.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,117.59,,,,,,,72.7800,282.0000,percent of total billed charges,41.7% of $282.00 in Billed Charges for Rev 272 = $117.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOTTLE DRAIN PLEURX,272,RC,27200473,CDM,,,,,,both,,,282.0000,42.3000,CIGNA HEALTHCARE,CIGNA PPO,117.59,,,,,,,72.7800,282.0000,percent of total billed charges,41.7% of $282.00 in Billed Charges for Rev 272 = $117.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOTTLE DRAIN PLEURX,272,RC,27200473,CDM,,,,,,both,,,282.0000,42.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,253.80,,,,,,,72.7800,282.0000,percent of total billed charges,90% of $282.00 in Billed Charges for Rev 272 = $253.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOTTLE DRAIN PLEURX,272,RC,27200473,CDM,,,,,,both,,,282.0000,42.3000,MEDCOST,MEDCOST VHN,134.20,,,,,,,72.7800,282.0000,percent of total billed charges,47.59% of $282.00 in Billed Charges for Rev 272 = $134.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOTTLE DRAIN PLEURX,272,RC,27200473,CDM,,,,,,both,,,282.0000,42.3000,SENTARA HEALTH,SENTARA HEALTH,72.78,,,,,,,72.7800,282.0000,percent of total billed charges,25.81% of $282.00 in Billed Charges for Rev 272 = $72.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOTTLE DRAIN PLEURX,272,RC,27200473,CDM,,,,,,both,,,282.0000,42.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",282.00,,,,,,,72.7800,282.0000,percent of total billed charges,100% of $282.00 in Billed Charges for Rev 272 = $282.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOTTLE DRAIN PLEURX,272,RC,27200473,CDM,,,,,,both,,,282.0000,42.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,141.00,,,,,,,72.7800,282.0000,percent of total billed charges,Rev 272 $282.00 in Billed Charges at 50% = $141.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOTTLE DRAIN PLEURX,272,RC,27200473,CDM,,,,,,both,,,282.0000,42.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,91.09,,,,,,,72.7800,282.0000,other,32.3% of $282.00 in Billed Charges for Rev 272 = $91.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BOTTLE DRAIN PLEURX,272,RC,27200473,CDM,,,,,,both,,,282.0000,42.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,86.57,,,,,,,72.7800,282.0000,other,30.7% of $282.00 in Billed Charges for Rev 272 = $86.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BOTTLE DRAIN PLEURX,272,RC,27200473,CDM,,,,,,both,,,282.0000,42.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,91.09,,,,,,,72.7800,282.0000,percent of total billed charges,32.3% of $282.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOTTLE DRAIN PLEURX,272,RC,27200473,CDM,,,,,,both,,,282.0000,42.3000,WELLCARE,WELLCARE MEDICAID,282.00,,,,,,,72.7800,282.0000,percent of total billed charges,100% of $282.00 in Billed Charges for Rev 272 = $282.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BP BREASTPUMP SPRING EXPRESS MAN,270,RC,27000169,CDM,,,,,,both,,,114.0000,17.1000,AETNA,AETNA,48.68,,,,,,,29.4200,114.0000,percent of total billed charges,42.7% of $114.00 in Billed Charges for Rev 270 = $48.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BP BREASTPUMP SPRING EXPRESS MAN,270,RC,27000169,CDM,,,,,,both,,,114.0000,17.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,79.80,,,,,,,29.4200,114.0000,percent of total billed charges,Rev 270 $114.00 in Billed Charges at 70% = $79.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BP BREASTPUMP SPRING EXPRESS MAN,270,RC,27000169,CDM,,,,,,both,,,114.0000,17.1000,CIGNA HEALTHCARE,CIGNA HMO,47.54,,,,,,,29.4200,114.0000,percent of total billed charges,41.7% of $114.00 in Billed Charges for Rev 270 = $47.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BP BREASTPUMP SPRING EXPRESS MAN,270,RC,27000169,CDM,,,,,,both,,,114.0000,17.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,52.90,,,,,,,29.4200,114.0000,percent of total billed charges,46.4% of $114.00 in Billed Charges for Rev 270 = $52.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BP BREASTPUMP SPRING EXPRESS MAN,270,RC,27000169,CDM,,,,,,both,,,114.0000,17.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,47.54,,,,,,,29.4200,114.0000,percent of total billed charges,41.7% of $114.00 in Billed Charges for Rev 270 = $47.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BP BREASTPUMP SPRING EXPRESS MAN,270,RC,27000169,CDM,,,,,,both,,,114.0000,17.1000,CIGNA HEALTHCARE,CIGNA PPO,47.54,,,,,,,29.4200,114.0000,percent of total billed charges,41.7% of $114.00 in Billed Charges for Rev 270 = $47.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BP BREASTPUMP SPRING EXPRESS MAN,270,RC,27000169,CDM,,,,,,both,,,114.0000,17.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,102.60,,,,,,,29.4200,114.0000,percent of total billed charges,90% of $114.00 in Billed Charges for Rev 270 = $102.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BP BREASTPUMP SPRING EXPRESS MAN,270,RC,27000169,CDM,,,,,,both,,,114.0000,17.1000,MEDCOST,MEDCOST VHN,54.25,,,,,,,29.4200,114.0000,percent of total billed charges,47.59% of $114.00 in Billed Charges for Rev 270 = $54.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BP BREASTPUMP SPRING EXPRESS MAN,270,RC,27000169,CDM,,,,,,both,,,114.0000,17.1000,SENTARA HEALTH,SENTARA HEALTH,29.42,,,,,,,29.4200,114.0000,percent of total billed charges,25.81% of $114.00 in Billed Charges for Rev 270 = $29.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BP BREASTPUMP SPRING EXPRESS MAN,270,RC,27000169,CDM,,,,,,both,,,114.0000,17.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",114.00,,,,,,,29.4200,114.0000,percent of total billed charges,100% of $114.00 in Billed Charges for Rev 270 = $114.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BP BREASTPUMP SPRING EXPRESS MAN,270,RC,27000169,CDM,,,,,,both,,,114.0000,17.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,57.00,,,,,,,29.4200,114.0000,percent of total billed charges,Rev 270 $114.00 in Billed Charges at 50% = $57.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BP BREASTPUMP SPRING EXPRESS MAN,270,RC,27000169,CDM,,,,,,both,,,114.0000,17.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,36.82,,,,,,,29.4200,114.0000,other,32.3% of $114.00 in Billed Charges for Rev 270 = $36.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BP BREASTPUMP SPRING EXPRESS MAN,270,RC,27000169,CDM,,,,,,both,,,114.0000,17.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,35.00,,,,,,,29.4200,114.0000,other,30.7% of $114.00 in Billed Charges for Rev 270 = $35.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BP BREASTPUMP SPRING EXPRESS MAN,270,RC,27000169,CDM,,,,,,both,,,114.0000,17.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,36.82,,,,,,,29.4200,114.0000,percent of total billed charges,32.3% of $114.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BP BREASTPUMP SPRING EXPRESS MAN,270,RC,27000169,CDM,,,,,,both,,,114.0000,17.1000,WELLCARE,WELLCARE MEDICAID,114.00,,,,,,,29.4200,114.0000,percent of total billed charges,100% of $114.00 in Billed Charges for Rev 270 = $114.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRACE ANKLE STAB ORTHOSIS BL LRG,272,RC,27200131,CDM,,,,,,both,,,125.0000,18.7500,AETNA,AETNA,53.38,,,,,,,32.2600,125.0000,percent of total billed charges,42.7% of $125.00 in Billed Charges for Rev 272 = $53.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRACE ANKLE STAB ORTHOSIS BL LRG,272,RC,27200131,CDM,,,,,,both,,,125.0000,18.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,87.50,,,,,,,32.2600,125.0000,percent of total billed charges,Rev 272 $125.00 in Billed Charges at 70% = $87.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRACE ANKLE STAB ORTHOSIS BL LRG,272,RC,27200131,CDM,,,,,,both,,,125.0000,18.7500,CIGNA HEALTHCARE,CIGNA HMO,52.13,,,,,,,32.2600,125.0000,percent of total billed charges,41.7% of $125.00 in Billed Charges for Rev 272 = $52.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRACE ANKLE STAB ORTHOSIS BL LRG,272,RC,27200131,CDM,,,,,,both,,,125.0000,18.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,58.00,,,,,,,32.2600,125.0000,percent of total billed charges,46.4% of $125.00 in Billed Charges for Rev 272 = $58.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRACE ANKLE STAB ORTHOSIS BL LRG,272,RC,27200131,CDM,,,,,,both,,,125.0000,18.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,52.13,,,,,,,32.2600,125.0000,percent of total billed charges,41.7% of $125.00 in Billed Charges for Rev 272 = $52.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRACE ANKLE STAB ORTHOSIS BL LRG,272,RC,27200131,CDM,,,,,,both,,,125.0000,18.7500,CIGNA HEALTHCARE,CIGNA PPO,52.13,,,,,,,32.2600,125.0000,percent of total billed charges,41.7% of $125.00 in Billed Charges for Rev 272 = $52.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRACE ANKLE STAB ORTHOSIS BL LRG,272,RC,27200131,CDM,,,,,,both,,,125.0000,18.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,112.50,,,,,,,32.2600,125.0000,percent of total billed charges,90% of $125.00 in Billed Charges for Rev 272 = $112.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRACE ANKLE STAB ORTHOSIS BL LRG,272,RC,27200131,CDM,,,,,,both,,,125.0000,18.7500,MEDCOST,MEDCOST VHN,59.49,,,,,,,32.2600,125.0000,percent of total billed charges,47.59% of $125.00 in Billed Charges for Rev 272 = $59.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRACE ANKLE STAB ORTHOSIS BL LRG,272,RC,27200131,CDM,,,,,,both,,,125.0000,18.7500,SENTARA HEALTH,SENTARA HEALTH,32.26,,,,,,,32.2600,125.0000,percent of total billed charges,25.81% of $125.00 in Billed Charges for Rev 272 = $32.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRACE ANKLE STAB ORTHOSIS BL LRG,272,RC,27200131,CDM,,,,,,both,,,125.0000,18.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",125.00,,,,,,,32.2600,125.0000,percent of total billed charges,100% of $125.00 in Billed Charges for Rev 272 = $125.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRACE ANKLE STAB ORTHOSIS BL LRG,272,RC,27200131,CDM,,,,,,both,,,125.0000,18.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,62.50,,,,,,,32.2600,125.0000,percent of total billed charges,Rev 272 $125.00 in Billed Charges at 50% = $62.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRACE ANKLE STAB ORTHOSIS BL LRG,272,RC,27200131,CDM,,,,,,both,,,125.0000,18.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,40.38,,,,,,,32.2600,125.0000,other,32.3% of $125.00 in Billed Charges for Rev 272 = $40.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRACE ANKLE STAB ORTHOSIS BL LRG,272,RC,27200131,CDM,,,,,,both,,,125.0000,18.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,38.38,,,,,,,32.2600,125.0000,other,30.7% of $125.00 in Billed Charges for Rev 272 = $38.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRACE ANKLE STAB ORTHOSIS BL LRG,272,RC,27200131,CDM,,,,,,both,,,125.0000,18.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,40.38,,,,,,,32.2600,125.0000,percent of total billed charges,32.3% of $125.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRACE ANKLE STAB ORTHOSIS BL LRG,272,RC,27200131,CDM,,,,,,both,,,125.0000,18.7500,WELLCARE,WELLCARE MEDICAID,125.00,,,,,,,32.2600,125.0000,percent of total billed charges,100% of $125.00 in Billed Charges for Rev 272 = $125.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BREAST SHELL,270,RC,27000079,CDM,,,,,,both,,,57.0000,8.5500,AETNA,AETNA,24.34,,,,,,,14.7100,57.0000,percent of total billed charges,42.7% of $57.00 in Billed Charges for Rev 270 = $24.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BREAST SHELL,270,RC,27000079,CDM,,,,,,both,,,57.0000,8.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,39.90,,,,,,,14.7100,57.0000,percent of total billed charges,Rev 270 $57.00 in Billed Charges at 70% = $39.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BREAST SHELL,270,RC,27000079,CDM,,,,,,both,,,57.0000,8.5500,CIGNA HEALTHCARE,CIGNA HMO,23.77,,,,,,,14.7100,57.0000,percent of total billed charges,41.7% of $57.00 in Billed Charges for Rev 270 = $23.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BREAST SHELL,270,RC,27000079,CDM,,,,,,both,,,57.0000,8.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,26.45,,,,,,,14.7100,57.0000,percent of total billed charges,46.4% of $57.00 in Billed Charges for Rev 270 = $26.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BREAST SHELL,270,RC,27000079,CDM,,,,,,both,,,57.0000,8.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,23.77,,,,,,,14.7100,57.0000,percent of total billed charges,41.7% of $57.00 in Billed Charges for Rev 270 = $23.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BREAST SHELL,270,RC,27000079,CDM,,,,,,both,,,57.0000,8.5500,CIGNA HEALTHCARE,CIGNA PPO,23.77,,,,,,,14.7100,57.0000,percent of total billed charges,41.7% of $57.00 in Billed Charges for Rev 270 = $23.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BREAST SHELL,270,RC,27000079,CDM,,,,,,both,,,57.0000,8.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,51.30,,,,,,,14.7100,57.0000,percent of total billed charges,90% of $57.00 in Billed Charges for Rev 270 = $51.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BREAST SHELL,270,RC,27000079,CDM,,,,,,both,,,57.0000,8.5500,MEDCOST,MEDCOST VHN,27.13,,,,,,,14.7100,57.0000,percent of total billed charges,47.59% of $57.00 in Billed Charges for Rev 270 = $27.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BREAST SHELL,270,RC,27000079,CDM,,,,,,both,,,57.0000,8.5500,SENTARA HEALTH,SENTARA HEALTH,14.71,,,,,,,14.7100,57.0000,percent of total billed charges,25.81% of $57.00 in Billed Charges for Rev 270 = $14.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BREAST SHELL,270,RC,27000079,CDM,,,,,,both,,,57.0000,8.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",57.00,,,,,,,14.7100,57.0000,percent of total billed charges,100% of $57.00 in Billed Charges for Rev 270 = $57.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BREAST SHELL,270,RC,27000079,CDM,,,,,,both,,,57.0000,8.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,28.50,,,,,,,14.7100,57.0000,percent of total billed charges,Rev 270 $57.00 in Billed Charges at 50% = $28.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BREAST SHELL,270,RC,27000079,CDM,,,,,,both,,,57.0000,8.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,18.41,,,,,,,14.7100,57.0000,other,32.3% of $57.00 in Billed Charges for Rev 270 = $18.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BREAST SHELL,270,RC,27000079,CDM,,,,,,both,,,57.0000,8.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,17.50,,,,,,,14.7100,57.0000,other,30.7% of $57.00 in Billed Charges for Rev 270 = $17.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BREAST SHELL,270,RC,27000079,CDM,,,,,,both,,,57.0000,8.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,18.41,,,,,,,14.7100,57.0000,percent of total billed charges,32.3% of $57.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BREAST SHELL,270,RC,27000079,CDM,,,,,,both,,,57.0000,8.5500,WELLCARE,WELLCARE MEDICAID,57.00,,,,,,,14.7100,57.0000,percent of total billed charges,100% of $57.00 in Billed Charges for Rev 270 = $57.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRMC VIP SUITE,999,RC,99900003,CDM,,,,,,both,,,875.0000,131.2500,AETNA,AETNA,373.63,,,,,,,144.3800,875.0000,percent of total billed charges,42.7% of $875.00 in Billed Charges for Rev 999 = $373.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRMC VIP SUITE,999,RC,99900003,CDM,,,,,,both,,,875.0000,131.2500,BLUE CROSS,ANTHEM EXCHANGE,144.38,,,,,,,144.3800,875.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRMC VIP SUITE,999,RC,99900003,CDM,,,,,,both,,,875.0000,131.2500,BLUE CROSS,ANTHEM HMO,144.38,,,,,,,144.3800,875.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRMC VIP SUITE,999,RC,99900003,CDM,,,,,,both,,,875.0000,131.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",144.38,,,,,,,144.3800,875.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRMC VIP SUITE,999,RC,99900003,CDM,,,,,,both,,,875.0000,131.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,612.50,,,,,,,144.3800,875.0000,percent of total billed charges,Rev 999 $875.00 in Billed Charges at 70% = $612.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRMC VIP SUITE,999,RC,99900003,CDM,,,,,,both,,,875.0000,131.2500,CIGNA HEALTHCARE,CIGNA HMO,364.88,,,,,,,144.3800,875.0000,percent of total billed charges,41.7% of $875.00 in Billed Charges for Rev 999 = $364.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRMC VIP SUITE,999,RC,99900003,CDM,,,,,,both,,,875.0000,131.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,406.00,,,,,,,144.3800,875.0000,percent of total billed charges,46.4% of $875.00 in Billed Charges for Rev 999 = $406.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRMC VIP SUITE,999,RC,99900003,CDM,,,,,,both,,,875.0000,131.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,364.88,,,,,,,144.3800,875.0000,percent of total billed charges,41.7% of $875.00 in Billed Charges for Rev 999 = $364.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRMC VIP SUITE,999,RC,99900003,CDM,,,,,,both,,,875.0000,131.2500,CIGNA HEALTHCARE,CIGNA PPO,364.88,,,,,,,144.3800,875.0000,percent of total billed charges,41.7% of $875.00 in Billed Charges for Rev 999 = $364.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRMC VIP SUITE,999,RC,99900003,CDM,,,,,,both,,,875.0000,131.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,787.50,,,,,,,144.3800,875.0000,percent of total billed charges,90% of $875.00 in Billed Charges for Rev 999 = $787.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRMC VIP SUITE,999,RC,99900003,CDM,,,,,,both,,,875.0000,131.2500,MEDCOST,MEDCOST VHN,416.41,,,,,,,144.3800,875.0000,percent of total billed charges,47.59% of $875.00 in Billed Charges for Rev 999 = $416.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRMC VIP SUITE,999,RC,99900003,CDM,,,,,,both,,,875.0000,131.2500,SENTARA HEALTH,SENTARA HEALTH,225.84,,,,,,,144.3800,875.0000,percent of total billed charges,25.81% of $875.00 in Billed Charges for Rev 999 = $225.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRMC VIP SUITE,999,RC,99900003,CDM,,,,,,both,,,875.0000,131.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",875.00,,,,,,,144.3800,875.0000,percent of total billed charges,100% of $875.00 in Billed Charges for Rev 999 = $875.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRMC VIP SUITE,999,RC,99900003,CDM,,,,,,both,,,875.0000,131.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,437.50,,,,,,,144.3800,875.0000,percent of total billed charges,Rev 999 $875.00 in Billed Charges at 50% = $437.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRMC VIP SUITE,999,RC,99900003,CDM,,,,,,both,,,875.0000,131.2500,WELLCARE,WELLCARE MEDICAID,875.00,,,,,,,144.3800,875.0000,percent of total billed charges,100% of $875.00 in Billed Charges for Rev 999 = $875.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC C SECTION EACH ADD NEONATE,722,RC,72200002,CDM,,,,,,both,,,1594.0000,239.1000,AETNA,AETNA,680.64,,,,,,,12.0000,1594.0000,percent of total billed charges,"42.7% of $1,594.00 in Billed Charges for Rev 722 = $680.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC C SECTION EACH ADD NEONATE,722,RC,72200002,CDM,,,,,,both,,,1594.0000,239.1000,BLUE CROSS,ANTHEM EXCHANGE,263.01,,,,,,,12.0000,1594.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC C SECTION EACH ADD NEONATE,722,RC,72200002,CDM,,,,,,both,,,1594.0000,239.1000,BLUE CROSS,ANTHEM HMO,263.01,,,,,,,12.0000,1594.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC C SECTION EACH ADD NEONATE,722,RC,72200002,CDM,,,,,,both,,,1594.0000,239.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",263.01,,,,,,,12.0000,1594.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC C SECTION EACH ADD NEONATE,722,RC,72200002,CDM,,,,,,both,,,1594.0000,239.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1115.80,,,,,,,12.0000,1594.0000,percent of total billed charges,"Rev 722 $1,594.00 in Billed Charges at 70% = $1,115.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC C SECTION EACH ADD NEONATE,722,RC,72200002,CDM,,,,,,both,,,1594.0000,239.1000,BLUE CROSS,BLUE CROSS E NETWORK,46.00,,,,,,,12.0000,1594.0000,other,Rev 722 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC C SECTION EACH ADD NEONATE,722,RC,72200002,CDM,,,,,,both,,,1594.0000,239.1000,BLUE CROSS,BLUE CROSS P NETWORK,46.00,,,,,,,12.0000,1594.0000,other,Rev 722 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC C SECTION EACH ADD NEONATE,722,RC,72200002,CDM,,,,,,both,,,1594.0000,239.1000,BLUE CROSS,BLUE CROSS S NETWORK,46.00,,,,,,,12.0000,1594.0000,other,Rev 722 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC C SECTION EACH ADD NEONATE,722,RC,72200002,CDM,,,,,,both,,,1594.0000,239.1000,BLUE CROSS,TENNCARE BLUE CARE,12.00,,,,,,,12.0000,1594.0000,other,Rev 722 Qty 1 * $12.00 = $12.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC C SECTION EACH ADD NEONATE,722,RC,72200002,CDM,,,,,,both,,,1594.0000,239.1000,BLUE CROSS,TENNCARE BLUE SELECT,12.00,,,,,,,12.0000,1594.0000,other,Rev 722 Qty 1 * $12.00 = $12.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC C SECTION EACH ADD NEONATE,722,RC,72200002,CDM,,,,,,both,,,1594.0000,239.1000,CIGNA HEALTHCARE,CIGNA HMO,664.70,,,,,,,12.0000,1594.0000,percent of total billed charges,"41.7% of $1,594.00 in Billed Charges for Rev 722 = $664.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC C SECTION EACH ADD NEONATE,722,RC,72200002,CDM,,,,,,both,,,1594.0000,239.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,739.62,,,,,,,12.0000,1594.0000,percent of total billed charges,"46.4% of $1,594.00 in Billed Charges for Rev 722 = $739.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC C SECTION EACH ADD NEONATE,722,RC,72200002,CDM,,,,,,both,,,1594.0000,239.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,664.70,,,,,,,12.0000,1594.0000,percent of total billed charges,"41.7% of $1,594.00 in Billed Charges for Rev 722 = $664.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC C SECTION EACH ADD NEONATE,722,RC,72200002,CDM,,,,,,both,,,1594.0000,239.1000,CIGNA HEALTHCARE,CIGNA PPO,664.70,,,,,,,12.0000,1594.0000,percent of total billed charges,"41.7% of $1,594.00 in Billed Charges for Rev 722 = $664.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC C SECTION EACH ADD NEONATE,722,RC,72200002,CDM,,,,,,both,,,1594.0000,239.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1434.60,,,,,,,12.0000,1594.0000,percent of total billed charges,"90% of $1,594.00 in Billed Charges for Rev 722 = $1,434.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC C SECTION EACH ADD NEONATE,722,RC,72200002,CDM,,,,,,both,,,1594.0000,239.1000,MEDCOST,MEDCOST VHN,758.58,,,,,,,12.0000,1594.0000,percent of total billed charges,"47.59% of $1,594.00 in Billed Charges for Rev 722 = $758.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC C SECTION EACH ADD NEONATE,722,RC,72200002,CDM,,,,,,both,,,1594.0000,239.1000,SENTARA HEALTH,SENTARA HEALTH,411.41,,,,,,,12.0000,1594.0000,percent of total billed charges,"25.81% of $1,594.00 in Billed Charges for Rev 722 = $411.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC C SECTION EACH ADD NEONATE,722,RC,72200002,CDM,,,,,,both,,,1594.0000,239.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1594.00,,,,,,,12.0000,1594.0000,percent of total billed charges,"100% of $1,594.00 in Billed Charges for Rev 722 = $1,594.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC C SECTION EACH ADD NEONATE,722,RC,72200002,CDM,,,,,,both,,,1594.0000,239.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,797.00,,,,,,,12.0000,1594.0000,percent of total billed charges,"Rev 722 $1,594.00 in Billed Charges at 50% = $797.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC C SECTION EACH ADD NEONATE,722,RC,72200002,CDM,,,,,,both,,,1594.0000,239.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,259.00,,,,,,,12.0000,1594.0000,other,Rev 722 1 Visit at $259.00 per Visit = $259.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC C SECTION EACH ADD NEONATE,722,RC,72200002,CDM,,,,,,both,,,1594.0000,239.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,247.00,,,,,,,12.0000,1594.0000,other,Rev 722 1 Visit at $247.00 per Visit = $247.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC C SECTION EACH ADD NEONATE,722,RC,72200002,CDM,,,,,,both,,,1594.0000,239.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,408.00,,,,,,,12.0000,1594.0000,other,Rev 722 1 Visit at $408.00 per Visit = $408.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC C SECTION EACH ADD NEONATE,722,RC,72200002,CDM,,,,,,both,,,1594.0000,239.1000,WELLCARE,WELLCARE MEDICAID,1594.00,,,,,,,12.0000,1594.0000,percent of total billed charges,"100% of $1,594.00 in Billed Charges for Rev 722 = $1,594.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CABLE (HEX.OCT.DECA) 401972,272,RC,27200475,CDM,,,,,,both,,,545.0000,81.7500,AETNA,AETNA,232.72,,,,,,,140.6600,545.0000,percent of total billed charges,42.7% of $545.00 in Billed Charges for Rev 272 = $232.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE (HEX.OCT.DECA) 401972,272,RC,27200475,CDM,,,,,,both,,,545.0000,81.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,381.50,,,,,,,140.6600,545.0000,percent of total billed charges,Rev 272 $545.00 in Billed Charges at 70% = $381.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE (HEX.OCT.DECA) 401972,272,RC,27200475,CDM,,,,,,both,,,545.0000,81.7500,CIGNA HEALTHCARE,CIGNA HMO,227.27,,,,,,,140.6600,545.0000,percent of total billed charges,41.7% of $545.00 in Billed Charges for Rev 272 = $227.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE (HEX.OCT.DECA) 401972,272,RC,27200475,CDM,,,,,,both,,,545.0000,81.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,252.88,,,,,,,140.6600,545.0000,percent of total billed charges,46.4% of $545.00 in Billed Charges for Rev 272 = $252.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE (HEX.OCT.DECA) 401972,272,RC,27200475,CDM,,,,,,both,,,545.0000,81.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,227.27,,,,,,,140.6600,545.0000,percent of total billed charges,41.7% of $545.00 in Billed Charges for Rev 272 = $227.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE (HEX.OCT.DECA) 401972,272,RC,27200475,CDM,,,,,,both,,,545.0000,81.7500,CIGNA HEALTHCARE,CIGNA PPO,227.27,,,,,,,140.6600,545.0000,percent of total billed charges,41.7% of $545.00 in Billed Charges for Rev 272 = $227.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE (HEX.OCT.DECA) 401972,272,RC,27200475,CDM,,,,,,both,,,545.0000,81.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,490.50,,,,,,,140.6600,545.0000,percent of total billed charges,90% of $545.00 in Billed Charges for Rev 272 = $490.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE (HEX.OCT.DECA) 401972,272,RC,27200475,CDM,,,,,,both,,,545.0000,81.7500,MEDCOST,MEDCOST VHN,259.37,,,,,,,140.6600,545.0000,percent of total billed charges,47.59% of $545.00 in Billed Charges for Rev 272 = $259.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE (HEX.OCT.DECA) 401972,272,RC,27200475,CDM,,,,,,both,,,545.0000,81.7500,SENTARA HEALTH,SENTARA HEALTH,140.66,,,,,,,140.6600,545.0000,percent of total billed charges,25.81% of $545.00 in Billed Charges for Rev 272 = $140.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE (HEX.OCT.DECA) 401972,272,RC,27200475,CDM,,,,,,both,,,545.0000,81.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",545.00,,,,,,,140.6600,545.0000,percent of total billed charges,100% of $545.00 in Billed Charges for Rev 272 = $545.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE (HEX.OCT.DECA) 401972,272,RC,27200475,CDM,,,,,,both,,,545.0000,81.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,272.50,,,,,,,140.6600,545.0000,percent of total billed charges,Rev 272 $545.00 in Billed Charges at 50% = $272.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE (HEX.OCT.DECA) 401972,272,RC,27200475,CDM,,,,,,both,,,545.0000,81.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,176.04,,,,,,,140.6600,545.0000,other,32.3% of $545.00 in Billed Charges for Rev 272 = $176.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CABLE (HEX.OCT.DECA) 401972,272,RC,27200475,CDM,,,,,,both,,,545.0000,81.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,167.32,,,,,,,140.6600,545.0000,other,30.7% of $545.00 in Billed Charges for Rev 272 = $167.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CABLE (HEX.OCT.DECA) 401972,272,RC,27200475,CDM,,,,,,both,,,545.0000,81.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,176.04,,,,,,,140.6600,545.0000,percent of total billed charges,32.3% of $545.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE (HEX.OCT.DECA) 401972,272,RC,27200475,CDM,,,,,,both,,,545.0000,81.7500,WELLCARE,WELLCARE MEDICAID,545.00,,,,,,,140.6600,545.0000,percent of total billed charges,100% of $545.00 in Billed Charges for Rev 272 = $545.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ONQ SILVERSOAKER 5IN,272,RC,,,,,,,,both,,,520.6200,78.0900,AETNA,AETNA,222.30,,,,,,,134.3700,520.6200,percent of total billed charges,42.7% of $520.62 in Billed Charges for Rev 272 = $222.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ONQ SILVERSOAKER 5IN,272,RC,,,,,,,,both,,,520.6200,78.0900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,364.43,,,,,,,134.3700,520.6200,percent of total billed charges,Rev 272 $520.62 in Billed Charges at 70% = $364.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ONQ SILVERSOAKER 5IN,272,RC,,,,,,,,both,,,520.6200,78.0900,CIGNA HEALTHCARE,CIGNA HMO,217.10,,,,,,,134.3700,520.6200,percent of total billed charges,41.7% of $520.62 in Billed Charges for Rev 272 = $217.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ONQ SILVERSOAKER 5IN,272,RC,,,,,,,,both,,,520.6200,78.0900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,241.57,,,,,,,134.3700,520.6200,percent of total billed charges,46.4% of $520.62 in Billed Charges for Rev 272 = $241.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ONQ SILVERSOAKER 5IN,272,RC,,,,,,,,both,,,520.6200,78.0900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,217.10,,,,,,,134.3700,520.6200,percent of total billed charges,41.7% of $520.62 in Billed Charges for Rev 272 = $217.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ONQ SILVERSOAKER 5IN,272,RC,,,,,,,,both,,,520.6200,78.0900,CIGNA HEALTHCARE,CIGNA PPO,217.10,,,,,,,134.3700,520.6200,percent of total billed charges,41.7% of $520.62 in Billed Charges for Rev 272 = $217.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ONQ SILVERSOAKER 5IN,272,RC,,,,,,,,both,,,520.6200,78.0900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,468.56,,,,,,,134.3700,520.6200,percent of total billed charges,90% of $520.62 in Billed Charges for Rev 272 = $468.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ONQ SILVERSOAKER 5IN,272,RC,,,,,,,,both,,,520.6200,78.0900,MEDCOST,MEDCOST VHN,247.76,,,,,,,134.3700,520.6200,percent of total billed charges,47.59% of $520.62 in Billed Charges for Rev 272 = $247.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ONQ SILVERSOAKER 5IN,272,RC,,,,,,,,both,,,520.6200,78.0900,SENTARA HEALTH,SENTARA HEALTH,134.37,,,,,,,134.3700,520.6200,percent of total billed charges,25.81% of $520.62 in Billed Charges for Rev 272 = $134.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ONQ SILVERSOAKER 5IN,272,RC,,,,,,,,both,,,520.6200,78.0900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",520.62,,,,,,,134.3700,520.6200,percent of total billed charges,100% of $520.62 in Billed Charges for Rev 272 = $520.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ONQ SILVERSOAKER 5IN,272,RC,,,,,,,,both,,,520.6200,78.0900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,260.31,,,,,,,134.3700,520.6200,percent of total billed charges,Rev 272 $520.62 in Billed Charges at 50% = $260.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ONQ SILVERSOAKER 5IN,272,RC,,,,,,,,both,,,520.6200,78.0900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,168.16,,,,,,,134.3700,520.6200,other,32.3% of $520.62 in Billed Charges for Rev 272 = $168.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATHETER ONQ SILVERSOAKER 5IN,272,RC,,,,,,,,both,,,520.6200,78.0900,UNITED HEALTHCARE,UHC HERITAGE SELECT,159.83,,,,,,,134.3700,520.6200,other,30.7% of $520.62 in Billed Charges for Rev 272 = $159.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATHETER ONQ SILVERSOAKER 5IN,272,RC,,,,,,,,both,,,520.6200,78.0900,UNITED HEALTHCARE,UNITED HEALTHCARE,168.16,,,,,,,134.3700,520.6200,percent of total billed charges,32.3% of $520.62 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER ONQ SILVERSOAKER 5IN,272,RC,,,,,,,,both,,,520.6200,78.0900,WELLCARE,WELLCARE MEDICAID,520.62,,,,,,,134.3700,520.6200,percent of total billed charges,100% of $520.62 in Billed Charges for Rev 272 = $520.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER PASSER 8591-38,272,RC,27200002,CDM,,,,,,both,,,902.2800,135.3400,AETNA,AETNA,385.27,,,,,,,232.8800,902.2800,percent of total billed charges,42.7% of $902.28 in Billed Charges for Rev 272 = $385.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER PASSER 8591-38,272,RC,27200002,CDM,,,,,,both,,,902.2800,135.3400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,631.60,,,,,,,232.8800,902.2800,percent of total billed charges,Rev 272 $902.28 in Billed Charges at 70% = $631.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER PASSER 8591-38,272,RC,27200002,CDM,,,,,,both,,,902.2800,135.3400,CIGNA HEALTHCARE,CIGNA HMO,376.25,,,,,,,232.8800,902.2800,percent of total billed charges,41.7% of $902.28 in Billed Charges for Rev 272 = $376.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER PASSER 8591-38,272,RC,27200002,CDM,,,,,,both,,,902.2800,135.3400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,418.66,,,,,,,232.8800,902.2800,percent of total billed charges,46.4% of $902.28 in Billed Charges for Rev 272 = $418.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER PASSER 8591-38,272,RC,27200002,CDM,,,,,,both,,,902.2800,135.3400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,376.25,,,,,,,232.8800,902.2800,percent of total billed charges,41.7% of $902.28 in Billed Charges for Rev 272 = $376.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER PASSER 8591-38,272,RC,27200002,CDM,,,,,,both,,,902.2800,135.3400,CIGNA HEALTHCARE,CIGNA PPO,376.25,,,,,,,232.8800,902.2800,percent of total billed charges,41.7% of $902.28 in Billed Charges for Rev 272 = $376.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER PASSER 8591-38,272,RC,27200002,CDM,,,,,,both,,,902.2800,135.3400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,812.05,,,,,,,232.8800,902.2800,percent of total billed charges,90% of $902.28 in Billed Charges for Rev 272 = $812.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER PASSER 8591-38,272,RC,27200002,CDM,,,,,,both,,,902.2800,135.3400,MEDCOST,MEDCOST VHN,429.40,,,,,,,232.8800,902.2800,percent of total billed charges,47.59% of $902.28 in Billed Charges for Rev 272 = $429.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER PASSER 8591-38,272,RC,27200002,CDM,,,,,,both,,,902.2800,135.3400,SENTARA HEALTH,SENTARA HEALTH,232.88,,,,,,,232.8800,902.2800,percent of total billed charges,25.81% of $902.28 in Billed Charges for Rev 272 = $232.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER PASSER 8591-38,272,RC,27200002,CDM,,,,,,both,,,902.2800,135.3400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",902.28,,,,,,,232.8800,902.2800,percent of total billed charges,100% of $902.28 in Billed Charges for Rev 272 = $902.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER PASSER 8591-38,272,RC,27200002,CDM,,,,,,both,,,902.2800,135.3400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,451.14,,,,,,,232.8800,902.2800,percent of total billed charges,Rev 272 $902.28 in Billed Charges at 50% = $451.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER PASSER 8591-38,272,RC,27200002,CDM,,,,,,both,,,902.2800,135.3400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,291.44,,,,,,,232.8800,902.2800,other,32.3% of $902.28 in Billed Charges for Rev 272 = $291.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATHETER PASSER 8591-38,272,RC,27200002,CDM,,,,,,both,,,902.2800,135.3400,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,232.8800,902.2800,other,30.7% of $902.28 in Billed Charges for Rev 272 = $277.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CATHETER PASSER 8591-38,272,RC,27200002,CDM,,,,,,both,,,902.2800,135.3400,UNITED HEALTHCARE,UNITED HEALTHCARE,291.44,,,,,,,232.8800,902.2800,percent of total billed charges,32.3% of $902.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER PASSER 8591-38,272,RC,27200002,CDM,,,,,,both,,,902.2800,135.3400,WELLCARE,WELLCARE MEDICAID,902.28,,,,,,,232.8800,902.2800,percent of total billed charges,100% of $902.28 in Billed Charges for Rev 272 = $902.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CATHETER SYSTEM LOADING EVOLUT FX,272,RC,27200002,CDM,,,,,,both,,,4044.6900,606.7000,AETNA,AETNA,1727.08,,,,,,,1043.9300,4044.6900,percent of total billed charges,"42.7% of $4,044.69 in Billed Charges for Rev 272 = $1,727.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER SYSTEM LOADING EVOLUT FX,272,RC,27200002,CDM,,,,,,both,,,4044.6900,606.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2831.28,,,,,,,1043.9300,4044.6900,percent of total billed charges,"Rev 272 $4,044.69 in Billed Charges at 70% = $2,831.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER SYSTEM LOADING EVOLUT FX,272,RC,27200002,CDM,,,,,,both,,,4044.6900,606.7000,CIGNA HEALTHCARE,CIGNA HMO,1686.64,,,,,,,1043.9300,4044.6900,percent of total billed charges,"41.7% of $4,044.69 in Billed Charges for Rev 272 = $1,686.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER SYSTEM LOADING EVOLUT FX,272,RC,27200002,CDM,,,,,,both,,,4044.6900,606.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1876.74,,,,,,,1043.9300,4044.6900,percent of total billed charges,"46.4% of $4,044.69 in Billed Charges for Rev 272 = $1,876.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER SYSTEM LOADING EVOLUT FX,272,RC,27200002,CDM,,,,,,both,,,4044.6900,606.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1686.64,,,,,,,1043.9300,4044.6900,percent of total billed charges,"41.7% of $4,044.69 in Billed Charges for Rev 272 = $1,686.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER SYSTEM LOADING EVOLUT FX,272,RC,27200002,CDM,,,,,,both,,,4044.6900,606.7000,CIGNA HEALTHCARE,CIGNA PPO,1686.64,,,,,,,1043.9300,4044.6900,percent of total billed charges,"41.7% of $4,044.69 in Billed Charges for Rev 272 = $1,686.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER SYSTEM LOADING EVOLUT FX,272,RC,27200002,CDM,,,,,,both,,,4044.6900,606.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3640.22,,,,,,,1043.9300,4044.6900,percent of total billed charges,"90% of $4,044.69 in Billed Charges for Rev 272 = $3,640.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER SYSTEM LOADING EVOLUT FX,272,RC,27200002,CDM,,,,,,both,,,4044.6900,606.7000,MEDCOST,MEDCOST VHN,1924.87,,,,,,,1043.9300,4044.6900,percent of total billed charges,"47.59% of $4,044.69 in Billed Charges for Rev 272 = $1,924.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER SYSTEM LOADING EVOLUT FX,272,RC,27200002,CDM,,,,,,both,,,4044.6900,606.7000,SENTARA HEALTH,SENTARA HEALTH,1043.93,,,,,,,1043.9300,4044.6900,percent of total billed charges,"25.81% of $4,044.69 in Billed Charges for Rev 272 = $1,043.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER SYSTEM LOADING EVOLUT FX,272,RC,27200002,CDM,,,,,,both,,,4044.6900,606.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4044.69,,,,,,,1043.9300,4044.6900,percent of total billed charges,"100% of $4,044.69 in Billed Charges for Rev 272 = $4,044.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER SYSTEM LOADING EVOLUT FX,272,RC,27200002,CDM,,,,,,both,,,4044.6900,606.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2022.35,,,,,,,1043.9300,4044.6900,percent of total billed charges,"Rev 272 $4,044.69 in Billed Charges at 50% = $2,022.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER SYSTEM LOADING EVOLUT FX,272,RC,27200002,CDM,,,,,,both,,,4044.6900,606.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1306.43,,,,,,,1043.9300,4044.6900,other,"32.3% of $4,044.69 in Billed Charges for Rev 272 = $1,306.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATHETER SYSTEM LOADING EVOLUT FX,272,RC,27200002,CDM,,,,,,both,,,4044.6900,606.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1241.72,,,,,,,1043.9300,4044.6900,other,"30.7% of $4,044.69 in Billed Charges for Rev 272 = $1,241.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATHETER SYSTEM LOADING EVOLUT FX,272,RC,27200002,CDM,,,,,,both,,,4044.6900,606.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,1306.43,,,,,,,1043.9300,4044.6900,percent of total billed charges,"32.3% of $4,044.69 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER SYSTEM LOADING EVOLUT FX,272,RC,27200002,CDM,,,,,,both,,,4044.6900,606.7000,WELLCARE,WELLCARE MEDICAID,4044.69,,,,,,,1043.9300,4044.6900,percent of total billed charges,"100% of $4,044.69 in Billed Charges for Rev 272 = $4,044.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER VAN SCHIE SEEKING BEACON TIP,272,RC,27200002,CDM,,,,,,both,,,1737.0400,260.5600,AETNA,AETNA,741.72,,,,,,,448.3300,1737.0400,percent of total billed charges,"42.7% of $1,737.04 in Billed Charges for Rev 272 = $741.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER VAN SCHIE SEEKING BEACON TIP,272,RC,27200002,CDM,,,,,,both,,,1737.0400,260.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1215.93,,,,,,,448.3300,1737.0400,percent of total billed charges,"Rev 272 $1,737.04 in Billed Charges at 70% = $1,215.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER VAN SCHIE SEEKING BEACON TIP,272,RC,27200002,CDM,,,,,,both,,,1737.0400,260.5600,CIGNA HEALTHCARE,CIGNA HMO,724.35,,,,,,,448.3300,1737.0400,percent of total billed charges,"41.7% of $1,737.04 in Billed Charges for Rev 272 = $724.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER VAN SCHIE SEEKING BEACON TIP,272,RC,27200002,CDM,,,,,,both,,,1737.0400,260.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,805.99,,,,,,,448.3300,1737.0400,percent of total billed charges,"46.4% of $1,737.04 in Billed Charges for Rev 272 = $805.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER VAN SCHIE SEEKING BEACON TIP,272,RC,27200002,CDM,,,,,,both,,,1737.0400,260.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,724.35,,,,,,,448.3300,1737.0400,percent of total billed charges,"41.7% of $1,737.04 in Billed Charges for Rev 272 = $724.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER VAN SCHIE SEEKING BEACON TIP,272,RC,27200002,CDM,,,,,,both,,,1737.0400,260.5600,CIGNA HEALTHCARE,CIGNA PPO,724.35,,,,,,,448.3300,1737.0400,percent of total billed charges,"41.7% of $1,737.04 in Billed Charges for Rev 272 = $724.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER VAN SCHIE SEEKING BEACON TIP,272,RC,27200002,CDM,,,,,,both,,,1737.0400,260.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1563.34,,,,,,,448.3300,1737.0400,percent of total billed charges,"90% of $1,737.04 in Billed Charges for Rev 272 = $1,563.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER VAN SCHIE SEEKING BEACON TIP,272,RC,27200002,CDM,,,,,,both,,,1737.0400,260.5600,MEDCOST,MEDCOST VHN,826.66,,,,,,,448.3300,1737.0400,percent of total billed charges,"47.59% of $1,737.04 in Billed Charges for Rev 272 = $826.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER VAN SCHIE SEEKING BEACON TIP,272,RC,27200002,CDM,,,,,,both,,,1737.0400,260.5600,SENTARA HEALTH,SENTARA HEALTH,448.33,,,,,,,448.3300,1737.0400,percent of total billed charges,"25.81% of $1,737.04 in Billed Charges for Rev 272 = $448.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER VAN SCHIE SEEKING BEACON TIP,272,RC,27200002,CDM,,,,,,both,,,1737.0400,260.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1737.04,,,,,,,448.3300,1737.0400,percent of total billed charges,"100% of $1,737.04 in Billed Charges for Rev 272 = $1,737.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER VAN SCHIE SEEKING BEACON TIP,272,RC,27200002,CDM,,,,,,both,,,1737.0400,260.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,868.52,,,,,,,448.3300,1737.0400,percent of total billed charges,"Rev 272 $1,737.04 in Billed Charges at 50% = $868.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER VAN SCHIE SEEKING BEACON TIP,272,RC,27200002,CDM,,,,,,both,,,1737.0400,260.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,561.06,,,,,,,448.3300,1737.0400,other,"32.3% of $1,737.04 in Billed Charges for Rev 272 = $561.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATHETER VAN SCHIE SEEKING BEACON TIP,272,RC,27200002,CDM,,,,,,both,,,1737.0400,260.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,533.27,,,,,,,448.3300,1737.0400,other,"30.7% of $1,737.04 in Billed Charges for Rev 272 = $533.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CATHETER VAN SCHIE SEEKING BEACON TIP,272,RC,27200002,CDM,,,,,,both,,,1737.0400,260.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,561.06,,,,,,,448.3300,1737.0400,percent of total billed charges,"32.3% of $1,737.04 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CATHETER VAN SCHIE SEEKING BEACON TIP,272,RC,27200002,CDM,,,,,,both,,,1737.0400,260.5600,WELLCARE,WELLCARE MEDICAID,1737.04,,,,,,,448.3300,1737.0400,percent of total billed charges,"100% of $1,737.04 in Billed Charges for Rev 272 = $1,737.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CABLE 34 PN RD TO 25 PN RD 10FT,272,RC,27200478,CDM,,,,,,both,,,1367.0000,205.0500,AETNA,AETNA,583.71,,,,,,,352.8200,1367.0000,percent of total billed charges,"42.7% of $1,367.00 in Billed Charges for Rev 272 = $583.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CABLE 34 PN RD TO 25 PN RD 10FT,272,RC,27200478,CDM,,,,,,both,,,1367.0000,205.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,956.90,,,,,,,352.8200,1367.0000,percent of total billed charges,"Rev 272 $1,367.00 in Billed Charges at 70% = $956.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CABLE 34 PN RD TO 25 PN RD 10FT,272,RC,27200478,CDM,,,,,,both,,,1367.0000,205.0500,CIGNA HEALTHCARE,CIGNA HMO,570.04,,,,,,,352.8200,1367.0000,percent of total billed charges,"41.7% of $1,367.00 in Billed Charges for Rev 272 = $570.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CABLE 34 PN RD TO 25 PN RD 10FT,272,RC,27200478,CDM,,,,,,both,,,1367.0000,205.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,634.29,,,,,,,352.8200,1367.0000,percent of total billed charges,"46.4% of $1,367.00 in Billed Charges for Rev 272 = $634.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CABLE 34 PN RD TO 25 PN RD 10FT,272,RC,27200478,CDM,,,,,,both,,,1367.0000,205.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,570.04,,,,,,,352.8200,1367.0000,percent of total billed charges,"41.7% of $1,367.00 in Billed Charges for Rev 272 = $570.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CABLE 34 PN RD TO 25 PN RD 10FT,272,RC,27200478,CDM,,,,,,both,,,1367.0000,205.0500,CIGNA HEALTHCARE,CIGNA PPO,570.04,,,,,,,352.8200,1367.0000,percent of total billed charges,"41.7% of $1,367.00 in Billed Charges for Rev 272 = $570.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CABLE 34 PN RD TO 25 PN RD 10FT,272,RC,27200478,CDM,,,,,,both,,,1367.0000,205.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1230.30,,,,,,,352.8200,1367.0000,percent of total billed charges,"90% of $1,367.00 in Billed Charges for Rev 272 = $1,230.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CABLE 34 PN RD TO 25 PN RD 10FT,272,RC,27200478,CDM,,,,,,both,,,1367.0000,205.0500,MEDCOST,MEDCOST VHN,650.56,,,,,,,352.8200,1367.0000,percent of total billed charges,"47.59% of $1,367.00 in Billed Charges for Rev 272 = $650.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CABLE 34 PN RD TO 25 PN RD 10FT,272,RC,27200478,CDM,,,,,,both,,,1367.0000,205.0500,SENTARA HEALTH,SENTARA HEALTH,352.82,,,,,,,352.8200,1367.0000,percent of total billed charges,"25.81% of $1,367.00 in Billed Charges for Rev 272 = $352.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CABLE 34 PN RD TO 25 PN RD 10FT,272,RC,27200478,CDM,,,,,,both,,,1367.0000,205.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1367.00,,,,,,,352.8200,1367.0000,percent of total billed charges,"100% of $1,367.00 in Billed Charges for Rev 272 = $1,367.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CABLE 34 PN RD TO 25 PN RD 10FT,272,RC,27200478,CDM,,,,,,both,,,1367.0000,205.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,683.50,,,,,,,352.8200,1367.0000,percent of total billed charges,"Rev 272 $1,367.00 in Billed Charges at 50% = $683.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CABLE 34 PN RD TO 25 PN RD 10FT,272,RC,27200478,CDM,,,,,,both,,,1367.0000,205.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,441.54,,,,,,,352.8200,1367.0000,other,"32.3% of $1,367.00 in Billed Charges for Rev 272 = $441.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CABLE 34 PN RD TO 25 PN RD 10FT,272,RC,27200478,CDM,,,,,,both,,,1367.0000,205.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,419.67,,,,,,,352.8200,1367.0000,other,"30.7% of $1,367.00 in Billed Charges for Rev 272 = $419.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CABLE 34 PN RD TO 25 PN RD 10FT,272,RC,27200478,CDM,,,,,,both,,,1367.0000,205.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,441.54,,,,,,,352.8200,1367.0000,percent of total billed charges,"32.3% of $1,367.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CABLE 34 PN RD TO 25 PN RD 10FT,272,RC,27200478,CDM,,,,,,both,,,1367.0000,205.0500,WELLCARE,WELLCARE MEDICAID,1367.00,,,,,,,352.8200,1367.0000,percent of total billed charges,"100% of $1,367.00 in Billed Charges for Rev 272 = $1,367.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CABLE 4 PIN BLUE 401981,272,RC,27200479,CDM,,,,,,both,,,402.0000,60.3000,AETNA,AETNA,171.65,,,,,,,103.7600,402.0000,percent of total billed charges,42.7% of $402.00 in Billed Charges for Rev 272 = $171.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 4 PIN BLUE 401981,272,RC,27200479,CDM,,,,,,both,,,402.0000,60.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,281.40,,,,,,,103.7600,402.0000,percent of total billed charges,Rev 272 $402.00 in Billed Charges at 70% = $281.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 4 PIN BLUE 401981,272,RC,27200479,CDM,,,,,,both,,,402.0000,60.3000,CIGNA HEALTHCARE,CIGNA HMO,167.63,,,,,,,103.7600,402.0000,percent of total billed charges,41.7% of $402.00 in Billed Charges for Rev 272 = $167.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 4 PIN BLUE 401981,272,RC,27200479,CDM,,,,,,both,,,402.0000,60.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,186.53,,,,,,,103.7600,402.0000,percent of total billed charges,46.4% of $402.00 in Billed Charges for Rev 272 = $186.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 4 PIN BLUE 401981,272,RC,27200479,CDM,,,,,,both,,,402.0000,60.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,167.63,,,,,,,103.7600,402.0000,percent of total billed charges,41.7% of $402.00 in Billed Charges for Rev 272 = $167.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 4 PIN BLUE 401981,272,RC,27200479,CDM,,,,,,both,,,402.0000,60.3000,CIGNA HEALTHCARE,CIGNA PPO,167.63,,,,,,,103.7600,402.0000,percent of total billed charges,41.7% of $402.00 in Billed Charges for Rev 272 = $167.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 4 PIN BLUE 401981,272,RC,27200479,CDM,,,,,,both,,,402.0000,60.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,361.80,,,,,,,103.7600,402.0000,percent of total billed charges,90% of $402.00 in Billed Charges for Rev 272 = $361.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 4 PIN BLUE 401981,272,RC,27200479,CDM,,,,,,both,,,402.0000,60.3000,MEDCOST,MEDCOST VHN,191.31,,,,,,,103.7600,402.0000,percent of total billed charges,47.59% of $402.00 in Billed Charges for Rev 272 = $191.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 4 PIN BLUE 401981,272,RC,27200479,CDM,,,,,,both,,,402.0000,60.3000,SENTARA HEALTH,SENTARA HEALTH,103.76,,,,,,,103.7600,402.0000,percent of total billed charges,25.81% of $402.00 in Billed Charges for Rev 272 = $103.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 4 PIN BLUE 401981,272,RC,27200479,CDM,,,,,,both,,,402.0000,60.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",402.00,,,,,,,103.7600,402.0000,percent of total billed charges,100% of $402.00 in Billed Charges for Rev 272 = $402.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 4 PIN BLUE 401981,272,RC,27200479,CDM,,,,,,both,,,402.0000,60.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,201.00,,,,,,,103.7600,402.0000,percent of total billed charges,Rev 272 $402.00 in Billed Charges at 50% = $201.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 4 PIN BLUE 401981,272,RC,27200479,CDM,,,,,,both,,,402.0000,60.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,129.85,,,,,,,103.7600,402.0000,other,32.3% of $402.00 in Billed Charges for Rev 272 = $129.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CABLE 4 PIN BLUE 401981,272,RC,27200479,CDM,,,,,,both,,,402.0000,60.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,123.41,,,,,,,103.7600,402.0000,other,30.7% of $402.00 in Billed Charges for Rev 272 = $123.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CABLE 4 PIN BLUE 401981,272,RC,27200479,CDM,,,,,,both,,,402.0000,60.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,129.85,,,,,,,103.7600,402.0000,percent of total billed charges,32.3% of $402.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 4 PIN BLUE 401981,272,RC,27200479,CDM,,,,,,both,,,402.0000,60.3000,WELLCARE,WELLCARE MEDICAID,402.00,,,,,,,103.7600,402.0000,percent of total billed charges,100% of $402.00 in Billed Charges for Rev 272 = $402.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC DIAGNOSTIC,272,RC,27200484,CDM,,,,,,both,,,78.0000,11.7000,AETNA,AETNA,33.31,,,,,,,20.1300,78.0000,percent of total billed charges,42.7% of $78.00 in Billed Charges for Rev 272 = $33.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC DIAGNOSTIC,272,RC,27200484,CDM,,,,,,both,,,78.0000,11.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,54.60,,,,,,,20.1300,78.0000,percent of total billed charges,Rev 272 $78.00 in Billed Charges at 70% = $54.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC DIAGNOSTIC,272,RC,27200484,CDM,,,,,,both,,,78.0000,11.7000,CIGNA HEALTHCARE,CIGNA HMO,32.53,,,,,,,20.1300,78.0000,percent of total billed charges,41.7% of $78.00 in Billed Charges for Rev 272 = $32.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC DIAGNOSTIC,272,RC,27200484,CDM,,,,,,both,,,78.0000,11.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,36.19,,,,,,,20.1300,78.0000,percent of total billed charges,46.4% of $78.00 in Billed Charges for Rev 272 = $36.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC DIAGNOSTIC,272,RC,27200484,CDM,,,,,,both,,,78.0000,11.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,32.53,,,,,,,20.1300,78.0000,percent of total billed charges,41.7% of $78.00 in Billed Charges for Rev 272 = $32.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC DIAGNOSTIC,272,RC,27200484,CDM,,,,,,both,,,78.0000,11.7000,CIGNA HEALTHCARE,CIGNA PPO,32.53,,,,,,,20.1300,78.0000,percent of total billed charges,41.7% of $78.00 in Billed Charges for Rev 272 = $32.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC DIAGNOSTIC,272,RC,27200484,CDM,,,,,,both,,,78.0000,11.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,70.20,,,,,,,20.1300,78.0000,percent of total billed charges,90% of $78.00 in Billed Charges for Rev 272 = $70.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC DIAGNOSTIC,272,RC,27200484,CDM,,,,,,both,,,78.0000,11.7000,MEDCOST,MEDCOST VHN,37.12,,,,,,,20.1300,78.0000,percent of total billed charges,47.59% of $78.00 in Billed Charges for Rev 272 = $37.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC DIAGNOSTIC,272,RC,27200484,CDM,,,,,,both,,,78.0000,11.7000,SENTARA HEALTH,SENTARA HEALTH,20.13,,,,,,,20.1300,78.0000,percent of total billed charges,25.81% of $78.00 in Billed Charges for Rev 272 = $20.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC DIAGNOSTIC,272,RC,27200484,CDM,,,,,,both,,,78.0000,11.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",78.00,,,,,,,20.1300,78.0000,percent of total billed charges,100% of $78.00 in Billed Charges for Rev 272 = $78.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC DIAGNOSTIC,272,RC,27200484,CDM,,,,,,both,,,78.0000,11.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,39.00,,,,,,,20.1300,78.0000,percent of total billed charges,Rev 272 $78.00 in Billed Charges at 50% = $39.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC DIAGNOSTIC,272,RC,27200484,CDM,,,,,,both,,,78.0000,11.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,25.19,,,,,,,20.1300,78.0000,other,32.3% of $78.00 in Billed Charges for Rev 272 = $25.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIAC DIAGNOSTIC,272,RC,27200484,CDM,,,,,,both,,,78.0000,11.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,23.95,,,,,,,20.1300,78.0000,other,30.7% of $78.00 in Billed Charges for Rev 272 = $23.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIAC DIAGNOSTIC,272,RC,27200484,CDM,,,,,,both,,,78.0000,11.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,25.19,,,,,,,20.1300,78.0000,percent of total billed charges,32.3% of $78.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC DIAGNOSTIC,272,RC,27200484,CDM,,,,,,both,,,78.0000,11.7000,WELLCARE,WELLCARE MEDICAID,78.00,,,,,,,20.1300,78.0000,percent of total billed charges,100% of $78.00 in Billed Charges for Rev 272 = $78.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC SUTURE,272,RC,27201676,CDM,,,,,,both,,,571.0000,85.6500,AETNA,AETNA,243.82,,,,,,,147.3800,571.0000,percent of total billed charges,42.7% of $571.00 in Billed Charges for Rev 272 = $243.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC SUTURE,272,RC,27201676,CDM,,,,,,both,,,571.0000,85.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,399.70,,,,,,,147.3800,571.0000,percent of total billed charges,Rev 272 $571.00 in Billed Charges at 70% = $399.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC SUTURE,272,RC,27201676,CDM,,,,,,both,,,571.0000,85.6500,CIGNA HEALTHCARE,CIGNA HMO,238.11,,,,,,,147.3800,571.0000,percent of total billed charges,41.7% of $571.00 in Billed Charges for Rev 272 = $238.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC SUTURE,272,RC,27201676,CDM,,,,,,both,,,571.0000,85.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,264.94,,,,,,,147.3800,571.0000,percent of total billed charges,46.4% of $571.00 in Billed Charges for Rev 272 = $264.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC SUTURE,272,RC,27201676,CDM,,,,,,both,,,571.0000,85.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,238.11,,,,,,,147.3800,571.0000,percent of total billed charges,41.7% of $571.00 in Billed Charges for Rev 272 = $238.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC SUTURE,272,RC,27201676,CDM,,,,,,both,,,571.0000,85.6500,CIGNA HEALTHCARE,CIGNA PPO,238.11,,,,,,,147.3800,571.0000,percent of total billed charges,41.7% of $571.00 in Billed Charges for Rev 272 = $238.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC SUTURE,272,RC,27201676,CDM,,,,,,both,,,571.0000,85.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,513.90,,,,,,,147.3800,571.0000,percent of total billed charges,90% of $571.00 in Billed Charges for Rev 272 = $513.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC SUTURE,272,RC,27201676,CDM,,,,,,both,,,571.0000,85.6500,MEDCOST,MEDCOST VHN,271.74,,,,,,,147.3800,571.0000,percent of total billed charges,47.59% of $571.00 in Billed Charges for Rev 272 = $271.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC SUTURE,272,RC,27201676,CDM,,,,,,both,,,571.0000,85.6500,SENTARA HEALTH,SENTARA HEALTH,147.38,,,,,,,147.3800,571.0000,percent of total billed charges,25.81% of $571.00 in Billed Charges for Rev 272 = $147.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC SUTURE,272,RC,27201676,CDM,,,,,,both,,,571.0000,85.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",571.00,,,,,,,147.3800,571.0000,percent of total billed charges,100% of $571.00 in Billed Charges for Rev 272 = $571.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC SUTURE,272,RC,27201676,CDM,,,,,,both,,,571.0000,85.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,285.50,,,,,,,147.3800,571.0000,percent of total billed charges,Rev 272 $571.00 in Billed Charges at 50% = $285.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC SUTURE,272,RC,27201676,CDM,,,,,,both,,,571.0000,85.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,184.43,,,,,,,147.3800,571.0000,other,32.3% of $571.00 in Billed Charges for Rev 272 = $184.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIAC SUTURE,272,RC,27201676,CDM,,,,,,both,,,571.0000,85.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,175.30,,,,,,,147.3800,571.0000,other,30.7% of $571.00 in Billed Charges for Rev 272 = $175.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIAC SUTURE,272,RC,27201676,CDM,,,,,,both,,,571.0000,85.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,184.43,,,,,,,147.3800,571.0000,percent of total billed charges,32.3% of $571.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC SUTURE,272,RC,27201676,CDM,,,,,,both,,,571.0000,85.6500,WELLCARE,WELLCARE MEDICAID,571.00,,,,,,,147.3800,571.0000,percent of total billed charges,100% of $571.00 in Billed Charges for Rev 272 = $571.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST AIR UNIVERSAL,270,RC,27000175,CDM,,,,,,both,,,144.0000,21.6000,AETNA,AETNA,61.49,,,,,,,37.1700,144.0000,percent of total billed charges,42.7% of $144.00 in Billed Charges for Rev 270 = $61.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST AIR UNIVERSAL,270,RC,27000175,CDM,,,,,,both,,,144.0000,21.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,100.80,,,,,,,37.1700,144.0000,percent of total billed charges,Rev 270 $144.00 in Billed Charges at 70% = $100.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST AIR UNIVERSAL,270,RC,27000175,CDM,,,,,,both,,,144.0000,21.6000,CIGNA HEALTHCARE,CIGNA HMO,60.05,,,,,,,37.1700,144.0000,percent of total billed charges,41.7% of $144.00 in Billed Charges for Rev 270 = $60.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST AIR UNIVERSAL,270,RC,27000175,CDM,,,,,,both,,,144.0000,21.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,66.82,,,,,,,37.1700,144.0000,percent of total billed charges,46.4% of $144.00 in Billed Charges for Rev 270 = $66.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST AIR UNIVERSAL,270,RC,27000175,CDM,,,,,,both,,,144.0000,21.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,60.05,,,,,,,37.1700,144.0000,percent of total billed charges,41.7% of $144.00 in Billed Charges for Rev 270 = $60.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST AIR UNIVERSAL,270,RC,27000175,CDM,,,,,,both,,,144.0000,21.6000,CIGNA HEALTHCARE,CIGNA PPO,60.05,,,,,,,37.1700,144.0000,percent of total billed charges,41.7% of $144.00 in Billed Charges for Rev 270 = $60.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST AIR UNIVERSAL,270,RC,27000175,CDM,,,,,,both,,,144.0000,21.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,129.60,,,,,,,37.1700,144.0000,percent of total billed charges,90% of $144.00 in Billed Charges for Rev 270 = $129.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST AIR UNIVERSAL,270,RC,27000175,CDM,,,,,,both,,,144.0000,21.6000,MEDCOST,MEDCOST VHN,68.53,,,,,,,37.1700,144.0000,percent of total billed charges,47.59% of $144.00 in Billed Charges for Rev 270 = $68.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST AIR UNIVERSAL,270,RC,27000175,CDM,,,,,,both,,,144.0000,21.6000,SENTARA HEALTH,SENTARA HEALTH,37.17,,,,,,,37.1700,144.0000,percent of total billed charges,25.81% of $144.00 in Billed Charges for Rev 270 = $37.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST AIR UNIVERSAL,270,RC,27000175,CDM,,,,,,both,,,144.0000,21.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",144.00,,,,,,,37.1700,144.0000,percent of total billed charges,100% of $144.00 in Billed Charges for Rev 270 = $144.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST AIR UNIVERSAL,270,RC,27000175,CDM,,,,,,both,,,144.0000,21.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,72.00,,,,,,,37.1700,144.0000,percent of total billed charges,Rev 270 $144.00 in Billed Charges at 50% = $72.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST AIR UNIVERSAL,270,RC,27000175,CDM,,,,,,both,,,144.0000,21.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,46.51,,,,,,,37.1700,144.0000,other,32.3% of $144.00 in Billed Charges for Rev 270 = $46.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST AIR UNIVERSAL,270,RC,27000175,CDM,,,,,,both,,,144.0000,21.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,44.21,,,,,,,37.1700,144.0000,other,30.7% of $144.00 in Billed Charges for Rev 270 = $44.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST AIR UNIVERSAL,270,RC,27000175,CDM,,,,,,both,,,144.0000,21.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,46.51,,,,,,,37.1700,144.0000,percent of total billed charges,32.3% of $144.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST AIR UNIVERSAL,270,RC,27000175,CDM,,,,,,both,,,144.0000,21.6000,WELLCARE,WELLCARE MEDICAID,144.00,,,,,,,37.1700,144.0000,percent of total billed charges,100% of $144.00 in Billed Charges for Rev 270 = $144.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH 5FR 65CM PIGTAIL SIZING,272,RC,27201700,CDM,,,,,,both,,,314.0000,47.1000,AETNA,AETNA,134.08,,,,,,,81.0400,314.0000,percent of total billed charges,42.7% of $314.00 in Billed Charges for Rev 272 = $134.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH 5FR 65CM PIGTAIL SIZING,272,RC,27201700,CDM,,,,,,both,,,314.0000,47.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,219.80,,,,,,,81.0400,314.0000,percent of total billed charges,Rev 272 $314.00 in Billed Charges at 70% = $219.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH 5FR 65CM PIGTAIL SIZING,272,RC,27201700,CDM,,,,,,both,,,314.0000,47.1000,CIGNA HEALTHCARE,CIGNA HMO,130.94,,,,,,,81.0400,314.0000,percent of total billed charges,41.7% of $314.00 in Billed Charges for Rev 272 = $130.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH 5FR 65CM PIGTAIL SIZING,272,RC,27201700,CDM,,,,,,both,,,314.0000,47.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,145.70,,,,,,,81.0400,314.0000,percent of total billed charges,46.4% of $314.00 in Billed Charges for Rev 272 = $145.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH 5FR 65CM PIGTAIL SIZING,272,RC,27201700,CDM,,,,,,both,,,314.0000,47.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,130.94,,,,,,,81.0400,314.0000,percent of total billed charges,41.7% of $314.00 in Billed Charges for Rev 272 = $130.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH 5FR 65CM PIGTAIL SIZING,272,RC,27201700,CDM,,,,,,both,,,314.0000,47.1000,CIGNA HEALTHCARE,CIGNA PPO,130.94,,,,,,,81.0400,314.0000,percent of total billed charges,41.7% of $314.00 in Billed Charges for Rev 272 = $130.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH 5FR 65CM PIGTAIL SIZING,272,RC,27201700,CDM,,,,,,both,,,314.0000,47.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,282.60,,,,,,,81.0400,314.0000,percent of total billed charges,90% of $314.00 in Billed Charges for Rev 272 = $282.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH 5FR 65CM PIGTAIL SIZING,272,RC,27201700,CDM,,,,,,both,,,314.0000,47.1000,MEDCOST,MEDCOST VHN,149.43,,,,,,,81.0400,314.0000,percent of total billed charges,47.59% of $314.00 in Billed Charges for Rev 272 = $149.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH 5FR 65CM PIGTAIL SIZING,272,RC,27201700,CDM,,,,,,both,,,314.0000,47.1000,SENTARA HEALTH,SENTARA HEALTH,81.04,,,,,,,81.0400,314.0000,percent of total billed charges,25.81% of $314.00 in Billed Charges for Rev 272 = $81.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH 5FR 65CM PIGTAIL SIZING,272,RC,27201700,CDM,,,,,,both,,,314.0000,47.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",314.00,,,,,,,81.0400,314.0000,percent of total billed charges,100% of $314.00 in Billed Charges for Rev 272 = $314.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH 5FR 65CM PIGTAIL SIZING,272,RC,27201700,CDM,,,,,,both,,,314.0000,47.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,157.00,,,,,,,81.0400,314.0000,percent of total billed charges,Rev 272 $314.00 in Billed Charges at 50% = $157.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH 5FR 65CM PIGTAIL SIZING,272,RC,27201700,CDM,,,,,,both,,,314.0000,47.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,101.42,,,,,,,81.0400,314.0000,other,32.3% of $314.00 in Billed Charges for Rev 272 = $101.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH 5FR 65CM PIGTAIL SIZING,272,RC,27201700,CDM,,,,,,both,,,314.0000,47.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,96.40,,,,,,,81.0400,314.0000,other,30.7% of $314.00 in Billed Charges for Rev 272 = $96.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH 5FR 65CM PIGTAIL SIZING,272,RC,27201700,CDM,,,,,,both,,,314.0000,47.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,101.42,,,,,,,81.0400,314.0000,percent of total billed charges,32.3% of $314.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH 5FR 65CM PIGTAIL SIZING,272,RC,27201700,CDM,,,,,,both,,,314.0000,47.1000,WELLCARE,WELLCARE MEDICAID,314.00,,,,,,,81.0400,314.0000,percent of total billed charges,100% of $314.00 in Billed Charges for Rev 272 = $314.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERY SET FA04020,270,RC,27000075,CDM,,,,,,both,,,74.0000,11.1000,AETNA,AETNA,31.60,,,,,,,19.1000,74.0000,percent of total billed charges,42.7% of $74.00 in Billed Charges for Rev 270 = $31.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERY SET FA04020,270,RC,27000075,CDM,,,,,,both,,,74.0000,11.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,51.80,,,,,,,19.1000,74.0000,percent of total billed charges,Rev 270 $74.00 in Billed Charges at 70% = $51.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERY SET FA04020,270,RC,27000075,CDM,,,,,,both,,,74.0000,11.1000,CIGNA HEALTHCARE,CIGNA HMO,30.86,,,,,,,19.1000,74.0000,percent of total billed charges,41.7% of $74.00 in Billed Charges for Rev 270 = $30.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERY SET FA04020,270,RC,27000075,CDM,,,,,,both,,,74.0000,11.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,34.34,,,,,,,19.1000,74.0000,percent of total billed charges,46.4% of $74.00 in Billed Charges for Rev 270 = $34.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERY SET FA04020,270,RC,27000075,CDM,,,,,,both,,,74.0000,11.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,30.86,,,,,,,19.1000,74.0000,percent of total billed charges,41.7% of $74.00 in Billed Charges for Rev 270 = $30.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERY SET FA04020,270,RC,27000075,CDM,,,,,,both,,,74.0000,11.1000,CIGNA HEALTHCARE,CIGNA PPO,30.86,,,,,,,19.1000,74.0000,percent of total billed charges,41.7% of $74.00 in Billed Charges for Rev 270 = $30.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERY SET FA04020,270,RC,27000075,CDM,,,,,,both,,,74.0000,11.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,66.60,,,,,,,19.1000,74.0000,percent of total billed charges,90% of $74.00 in Billed Charges for Rev 270 = $66.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERY SET FA04020,270,RC,27000075,CDM,,,,,,both,,,74.0000,11.1000,MEDCOST,MEDCOST VHN,35.22,,,,,,,19.1000,74.0000,percent of total billed charges,47.59% of $74.00 in Billed Charges for Rev 270 = $35.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERY SET FA04020,270,RC,27000075,CDM,,,,,,both,,,74.0000,11.1000,SENTARA HEALTH,SENTARA HEALTH,19.10,,,,,,,19.1000,74.0000,percent of total billed charges,25.81% of $74.00 in Billed Charges for Rev 270 = $19.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERY SET FA04020,270,RC,27000075,CDM,,,,,,both,,,74.0000,11.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",74.00,,,,,,,19.1000,74.0000,percent of total billed charges,100% of $74.00 in Billed Charges for Rev 270 = $74.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERY SET FA04020,270,RC,27000075,CDM,,,,,,both,,,74.0000,11.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,37.00,,,,,,,19.1000,74.0000,percent of total billed charges,Rev 270 $74.00 in Billed Charges at 50% = $37.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERY SET FA04020,270,RC,27000075,CDM,,,,,,both,,,74.0000,11.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,23.90,,,,,,,19.1000,74.0000,other,32.3% of $74.00 in Billed Charges for Rev 270 = $23.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH ARTERY SET FA04020,270,RC,27000075,CDM,,,,,,both,,,74.0000,11.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,22.72,,,,,,,19.1000,74.0000,other,30.7% of $74.00 in Billed Charges for Rev 270 = $22.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH ARTERY SET FA04020,270,RC,27000075,CDM,,,,,,both,,,74.0000,11.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,23.90,,,,,,,19.1000,74.0000,percent of total billed charges,32.3% of $74.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERY SET FA04020,270,RC,27000075,CDM,,,,,,both,,,74.0000,11.1000,WELLCARE,WELLCARE MEDICAID,74.00,,,,,,,19.1000,74.0000,percent of total billed charges,100% of $74.00 in Billed Charges for Rev 270 = $74.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON WDG PRESSURE,272,RC,27200492,CDM,,,,,,both,,,222.0000,33.3000,AETNA,AETNA,94.79,,,,,,,57.3000,222.0000,percent of total billed charges,42.7% of $222.00 in Billed Charges for Rev 272 = $94.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON WDG PRESSURE,272,RC,27200492,CDM,,,,,,both,,,222.0000,33.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,155.40,,,,,,,57.3000,222.0000,percent of total billed charges,Rev 272 $222.00 in Billed Charges at 70% = $155.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON WDG PRESSURE,272,RC,27200492,CDM,,,,,,both,,,222.0000,33.3000,CIGNA HEALTHCARE,CIGNA HMO,92.57,,,,,,,57.3000,222.0000,percent of total billed charges,41.7% of $222.00 in Billed Charges for Rev 272 = $92.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON WDG PRESSURE,272,RC,27200492,CDM,,,,,,both,,,222.0000,33.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,103.01,,,,,,,57.3000,222.0000,percent of total billed charges,46.4% of $222.00 in Billed Charges for Rev 272 = $103.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON WDG PRESSURE,272,RC,27200492,CDM,,,,,,both,,,222.0000,33.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,92.57,,,,,,,57.3000,222.0000,percent of total billed charges,41.7% of $222.00 in Billed Charges for Rev 272 = $92.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON WDG PRESSURE,272,RC,27200492,CDM,,,,,,both,,,222.0000,33.3000,CIGNA HEALTHCARE,CIGNA PPO,92.57,,,,,,,57.3000,222.0000,percent of total billed charges,41.7% of $222.00 in Billed Charges for Rev 272 = $92.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON WDG PRESSURE,272,RC,27200492,CDM,,,,,,both,,,222.0000,33.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,199.80,,,,,,,57.3000,222.0000,percent of total billed charges,90% of $222.00 in Billed Charges for Rev 272 = $199.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON WDG PRESSURE,272,RC,27200492,CDM,,,,,,both,,,222.0000,33.3000,MEDCOST,MEDCOST VHN,105.65,,,,,,,57.3000,222.0000,percent of total billed charges,47.59% of $222.00 in Billed Charges for Rev 272 = $105.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON WDG PRESSURE,272,RC,27200492,CDM,,,,,,both,,,222.0000,33.3000,SENTARA HEALTH,SENTARA HEALTH,57.30,,,,,,,57.3000,222.0000,percent of total billed charges,25.81% of $222.00 in Billed Charges for Rev 272 = $57.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON WDG PRESSURE,272,RC,27200492,CDM,,,,,,both,,,222.0000,33.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",222.00,,,,,,,57.3000,222.0000,percent of total billed charges,100% of $222.00 in Billed Charges for Rev 272 = $222.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON WDG PRESSURE,272,RC,27200492,CDM,,,,,,both,,,222.0000,33.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,111.00,,,,,,,57.3000,222.0000,percent of total billed charges,Rev 272 $222.00 in Billed Charges at 50% = $111.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON WDG PRESSURE,272,RC,27200492,CDM,,,,,,both,,,222.0000,33.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,71.71,,,,,,,57.3000,222.0000,other,32.3% of $222.00 in Billed Charges for Rev 272 = $71.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH BALLOON WDG PRESSURE,272,RC,27200492,CDM,,,,,,both,,,222.0000,33.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,68.15,,,,,,,57.3000,222.0000,other,30.7% of $222.00 in Billed Charges for Rev 272 = $68.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH BALLOON WDG PRESSURE,272,RC,27200492,CDM,,,,,,both,,,222.0000,33.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,71.71,,,,,,,57.3000,222.0000,percent of total billed charges,32.3% of $222.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON WDG PRESSURE,272,RC,27200492,CDM,,,,,,both,,,222.0000,33.3000,WELLCARE,WELLCARE MEDICAID,222.00,,,,,,,57.3000,222.0000,percent of total billed charges,100% of $222.00 in Billed Charges for Rev 272 = $222.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CARD DIAG MULTIPACK,272,RC,27200494,CDM,,,,,,both,,,286.0000,42.9000,AETNA,AETNA,122.12,,,,,,,73.8200,286.0000,percent of total billed charges,42.7% of $286.00 in Billed Charges for Rev 272 = $122.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CARD DIAG MULTIPACK,272,RC,27200494,CDM,,,,,,both,,,286.0000,42.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,200.20,,,,,,,73.8200,286.0000,percent of total billed charges,Rev 272 $286.00 in Billed Charges at 70% = $200.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CARD DIAG MULTIPACK,272,RC,27200494,CDM,,,,,,both,,,286.0000,42.9000,CIGNA HEALTHCARE,CIGNA HMO,119.26,,,,,,,73.8200,286.0000,percent of total billed charges,41.7% of $286.00 in Billed Charges for Rev 272 = $119.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CARD DIAG MULTIPACK,272,RC,27200494,CDM,,,,,,both,,,286.0000,42.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,132.70,,,,,,,73.8200,286.0000,percent of total billed charges,46.4% of $286.00 in Billed Charges for Rev 272 = $132.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CARD DIAG MULTIPACK,272,RC,27200494,CDM,,,,,,both,,,286.0000,42.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,119.26,,,,,,,73.8200,286.0000,percent of total billed charges,41.7% of $286.00 in Billed Charges for Rev 272 = $119.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CARD DIAG MULTIPACK,272,RC,27200494,CDM,,,,,,both,,,286.0000,42.9000,CIGNA HEALTHCARE,CIGNA PPO,119.26,,,,,,,73.8200,286.0000,percent of total billed charges,41.7% of $286.00 in Billed Charges for Rev 272 = $119.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CARD DIAG MULTIPACK,272,RC,27200494,CDM,,,,,,both,,,286.0000,42.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,257.40,,,,,,,73.8200,286.0000,percent of total billed charges,90% of $286.00 in Billed Charges for Rev 272 = $257.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CARD DIAG MULTIPACK,272,RC,27200494,CDM,,,,,,both,,,286.0000,42.9000,MEDCOST,MEDCOST VHN,136.11,,,,,,,73.8200,286.0000,percent of total billed charges,47.59% of $286.00 in Billed Charges for Rev 272 = $136.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CARD DIAG MULTIPACK,272,RC,27200494,CDM,,,,,,both,,,286.0000,42.9000,SENTARA HEALTH,SENTARA HEALTH,73.82,,,,,,,73.8200,286.0000,percent of total billed charges,25.81% of $286.00 in Billed Charges for Rev 272 = $73.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CARD DIAG MULTIPACK,272,RC,27200494,CDM,,,,,,both,,,286.0000,42.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",286.00,,,,,,,73.8200,286.0000,percent of total billed charges,100% of $286.00 in Billed Charges for Rev 272 = $286.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CARD DIAG MULTIPACK,272,RC,27200494,CDM,,,,,,both,,,286.0000,42.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,143.00,,,,,,,73.8200,286.0000,percent of total billed charges,Rev 272 $286.00 in Billed Charges at 50% = $143.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CARD DIAG MULTIPACK,272,RC,27200494,CDM,,,,,,both,,,286.0000,42.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,92.38,,,,,,,73.8200,286.0000,other,32.3% of $286.00 in Billed Charges for Rev 272 = $92.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH CARD DIAG MULTIPACK,272,RC,27200494,CDM,,,,,,both,,,286.0000,42.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,87.80,,,,,,,73.8200,286.0000,other,30.7% of $286.00 in Billed Charges for Rev 272 = $87.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH CARD DIAG MULTIPACK,272,RC,27200494,CDM,,,,,,both,,,286.0000,42.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,92.38,,,,,,,73.8200,286.0000,percent of total billed charges,32.3% of $286.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CARD DIAG MULTIPACK,272,RC,27200494,CDM,,,,,,both,,,286.0000,42.9000,WELLCARE,WELLCARE MEDICAID,286.00,,,,,,,73.8200,286.0000,percent of total billed charges,100% of $286.00 in Billed Charges for Rev 272 = $286.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC FLOTRAC SENS 60""LINE W/ADULT VAMP",272,RC,27201719,CDM,,,,,,both,,,1663.0000,249.4500,AETNA,AETNA,710.10,,,,,,,429.2200,1663.0000,percent of total billed charges,"42.7% of $1,663.00 in Billed Charges for Rev 272 = $710.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"HC FLOTRAC SENS 60""LINE W/ADULT VAMP",272,RC,27201719,CDM,,,,,,both,,,1663.0000,249.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1164.10,,,,,,,429.2200,1663.0000,percent of total billed charges,"Rev 272 $1,663.00 in Billed Charges at 70% = $1,164.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"HC FLOTRAC SENS 60""LINE W/ADULT VAMP",272,RC,27201719,CDM,,,,,,both,,,1663.0000,249.4500,CIGNA HEALTHCARE,CIGNA HMO,693.47,,,,,,,429.2200,1663.0000,percent of total billed charges,"41.7% of $1,663.00 in Billed Charges for Rev 272 = $693.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"HC FLOTRAC SENS 60""LINE W/ADULT VAMP",272,RC,27201719,CDM,,,,,,both,,,1663.0000,249.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,771.63,,,,,,,429.2200,1663.0000,percent of total billed charges,"46.4% of $1,663.00 in Billed Charges for Rev 272 = $771.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"HC FLOTRAC SENS 60""LINE W/ADULT VAMP",272,RC,27201719,CDM,,,,,,both,,,1663.0000,249.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,693.47,,,,,,,429.2200,1663.0000,percent of total billed charges,"41.7% of $1,663.00 in Billed Charges for Rev 272 = $693.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"HC FLOTRAC SENS 60""LINE W/ADULT VAMP",272,RC,27201719,CDM,,,,,,both,,,1663.0000,249.4500,CIGNA HEALTHCARE,CIGNA PPO,693.47,,,,,,,429.2200,1663.0000,percent of total billed charges,"41.7% of $1,663.00 in Billed Charges for Rev 272 = $693.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"HC FLOTRAC SENS 60""LINE W/ADULT VAMP",272,RC,27201719,CDM,,,,,,both,,,1663.0000,249.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1496.70,,,,,,,429.2200,1663.0000,percent of total billed charges,"90% of $1,663.00 in Billed Charges for Rev 272 = $1,496.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"HC FLOTRAC SENS 60""LINE W/ADULT VAMP",272,RC,27201719,CDM,,,,,,both,,,1663.0000,249.4500,MEDCOST,MEDCOST VHN,791.42,,,,,,,429.2200,1663.0000,percent of total billed charges,"47.59% of $1,663.00 in Billed Charges for Rev 272 = $791.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"HC FLOTRAC SENS 60""LINE W/ADULT VAMP",272,RC,27201719,CDM,,,,,,both,,,1663.0000,249.4500,SENTARA HEALTH,SENTARA HEALTH,429.22,,,,,,,429.2200,1663.0000,percent of total billed charges,"25.81% of $1,663.00 in Billed Charges for Rev 272 = $429.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"HC FLOTRAC SENS 60""LINE W/ADULT VAMP",272,RC,27201719,CDM,,,,,,both,,,1663.0000,249.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1663.00,,,,,,,429.2200,1663.0000,percent of total billed charges,"100% of $1,663.00 in Billed Charges for Rev 272 = $1,663.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"HC FLOTRAC SENS 60""LINE W/ADULT VAMP",272,RC,27201719,CDM,,,,,,both,,,1663.0000,249.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,831.50,,,,,,,429.2200,1663.0000,percent of total billed charges,"Rev 272 $1,663.00 in Billed Charges at 50% = $831.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"HC FLOTRAC SENS 60""LINE W/ADULT VAMP",272,RC,27201719,CDM,,,,,,both,,,1663.0000,249.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,537.15,,,,,,,429.2200,1663.0000,other,"32.3% of $1,663.00 in Billed Charges for Rev 272 = $537.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
"HC FLOTRAC SENS 60""LINE W/ADULT VAMP",272,RC,27201719,CDM,,,,,,both,,,1663.0000,249.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,510.54,,,,,,,429.2200,1663.0000,other,"30.7% of $1,663.00 in Billed Charges for Rev 272 = $510.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
"HC FLOTRAC SENS 60""LINE W/ADULT VAMP",272,RC,27201719,CDM,,,,,,both,,,1663.0000,249.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,537.15,,,,,,,429.2200,1663.0000,percent of total billed charges,"32.3% of $1,663.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"HC FLOTRAC SENS 60""LINE W/ADULT VAMP",272,RC,27201719,CDM,,,,,,both,,,1663.0000,249.4500,WELLCARE,WELLCARE MEDICAID,1663.00,,,,,,,429.2200,1663.0000,percent of total billed charges,"100% of $1,663.00 in Billed Charges for Rev 272 = $1,663.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FOAM AVITENE ULTRA 8CMX12.5CMX3MM,272,RC,27200700,CDM,,,,,,both,,,155.0000,23.2500,AETNA,AETNA,66.19,,,,,,,40.0100,155.0000,percent of total billed charges,42.7% of $155.00 in Billed Charges for Rev 272 = $66.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FOAM AVITENE ULTRA 8CMX12.5CMX3MM,272,RC,27200700,CDM,,,,,,both,,,155.0000,23.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,108.50,,,,,,,40.0100,155.0000,percent of total billed charges,Rev 272 $155.00 in Billed Charges at 70% = $108.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FOAM AVITENE ULTRA 8CMX12.5CMX3MM,272,RC,27200700,CDM,,,,,,both,,,155.0000,23.2500,CIGNA HEALTHCARE,CIGNA HMO,64.64,,,,,,,40.0100,155.0000,percent of total billed charges,41.7% of $155.00 in Billed Charges for Rev 272 = $64.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FOAM AVITENE ULTRA 8CMX12.5CMX3MM,272,RC,27200700,CDM,,,,,,both,,,155.0000,23.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,71.92,,,,,,,40.0100,155.0000,percent of total billed charges,46.4% of $155.00 in Billed Charges for Rev 272 = $71.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FOAM AVITENE ULTRA 8CMX12.5CMX3MM,272,RC,27200700,CDM,,,,,,both,,,155.0000,23.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,64.64,,,,,,,40.0100,155.0000,percent of total billed charges,41.7% of $155.00 in Billed Charges for Rev 272 = $64.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FOAM AVITENE ULTRA 8CMX12.5CMX3MM,272,RC,27200700,CDM,,,,,,both,,,155.0000,23.2500,CIGNA HEALTHCARE,CIGNA PPO,64.64,,,,,,,40.0100,155.0000,percent of total billed charges,41.7% of $155.00 in Billed Charges for Rev 272 = $64.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FOAM AVITENE ULTRA 8CMX12.5CMX3MM,272,RC,27200700,CDM,,,,,,both,,,155.0000,23.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,139.50,,,,,,,40.0100,155.0000,percent of total billed charges,90% of $155.00 in Billed Charges for Rev 272 = $139.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FOAM AVITENE ULTRA 8CMX12.5CMX3MM,272,RC,27200700,CDM,,,,,,both,,,155.0000,23.2500,MEDCOST,MEDCOST VHN,73.76,,,,,,,40.0100,155.0000,percent of total billed charges,47.59% of $155.00 in Billed Charges for Rev 272 = $73.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FOAM AVITENE ULTRA 8CMX12.5CMX3MM,272,RC,27200700,CDM,,,,,,both,,,155.0000,23.2500,SENTARA HEALTH,SENTARA HEALTH,40.01,,,,,,,40.0100,155.0000,percent of total billed charges,25.81% of $155.00 in Billed Charges for Rev 272 = $40.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FOAM AVITENE ULTRA 8CMX12.5CMX3MM,272,RC,27200700,CDM,,,,,,both,,,155.0000,23.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",155.00,,,,,,,40.0100,155.0000,percent of total billed charges,100% of $155.00 in Billed Charges for Rev 272 = $155.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FOAM AVITENE ULTRA 8CMX12.5CMX3MM,272,RC,27200700,CDM,,,,,,both,,,155.0000,23.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,77.50,,,,,,,40.0100,155.0000,percent of total billed charges,Rev 272 $155.00 in Billed Charges at 50% = $77.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FOAM AVITENE ULTRA 8CMX12.5CMX3MM,272,RC,27200700,CDM,,,,,,both,,,155.0000,23.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,50.07,,,,,,,40.0100,155.0000,other,32.3% of $155.00 in Billed Charges for Rev 272 = $50.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FOAM AVITENE ULTRA 8CMX12.5CMX3MM,272,RC,27200700,CDM,,,,,,both,,,155.0000,23.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,47.59,,,,,,,40.0100,155.0000,other,30.7% of $155.00 in Billed Charges for Rev 272 = $47.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FOAM AVITENE ULTRA 8CMX12.5CMX3MM,272,RC,27200700,CDM,,,,,,both,,,155.0000,23.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,50.07,,,,,,,40.0100,155.0000,percent of total billed charges,32.3% of $155.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FOAM AVITENE ULTRA 8CMX12.5CMX3MM,272,RC,27200700,CDM,,,,,,both,,,155.0000,23.2500,WELLCARE,WELLCARE MEDICAID,155.00,,,,,,,40.0100,155.0000,percent of total billed charges,100% of $155.00 in Billed Charges for Rev 272 = $155.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FORCEP BX FB231DA,272,RC,27200701,CDM,,,,,,both,,,352.0000,52.8000,AETNA,AETNA,150.30,,,,,,,90.8500,352.0000,percent of total billed charges,42.7% of $352.00 in Billed Charges for Rev 272 = $150.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FORCEP BX FB231DA,272,RC,27200701,CDM,,,,,,both,,,352.0000,52.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,246.40,,,,,,,90.8500,352.0000,percent of total billed charges,Rev 272 $352.00 in Billed Charges at 70% = $246.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FORCEP BX FB231DA,272,RC,27200701,CDM,,,,,,both,,,352.0000,52.8000,CIGNA HEALTHCARE,CIGNA HMO,146.78,,,,,,,90.8500,352.0000,percent of total billed charges,41.7% of $352.00 in Billed Charges for Rev 272 = $146.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FORCEP BX FB231DA,272,RC,27200701,CDM,,,,,,both,,,352.0000,52.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,163.33,,,,,,,90.8500,352.0000,percent of total billed charges,46.4% of $352.00 in Billed Charges for Rev 272 = $163.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FORCEP BX FB231DA,272,RC,27200701,CDM,,,,,,both,,,352.0000,52.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,146.78,,,,,,,90.8500,352.0000,percent of total billed charges,41.7% of $352.00 in Billed Charges for Rev 272 = $146.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FORCEP BX FB231DA,272,RC,27200701,CDM,,,,,,both,,,352.0000,52.8000,CIGNA HEALTHCARE,CIGNA PPO,146.78,,,,,,,90.8500,352.0000,percent of total billed charges,41.7% of $352.00 in Billed Charges for Rev 272 = $146.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FORCEP BX FB231DA,272,RC,27200701,CDM,,,,,,both,,,352.0000,52.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,316.80,,,,,,,90.8500,352.0000,percent of total billed charges,90% of $352.00 in Billed Charges for Rev 272 = $316.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FORCEP BX FB231DA,272,RC,27200701,CDM,,,,,,both,,,352.0000,52.8000,MEDCOST,MEDCOST VHN,167.52,,,,,,,90.8500,352.0000,percent of total billed charges,47.59% of $352.00 in Billed Charges for Rev 272 = $167.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FORCEP BX FB231DA,272,RC,27200701,CDM,,,,,,both,,,352.0000,52.8000,SENTARA HEALTH,SENTARA HEALTH,90.85,,,,,,,90.8500,352.0000,percent of total billed charges,25.81% of $352.00 in Billed Charges for Rev 272 = $90.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FORCEP BX FB231DA,272,RC,27200701,CDM,,,,,,both,,,352.0000,52.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",352.00,,,,,,,90.8500,352.0000,percent of total billed charges,100% of $352.00 in Billed Charges for Rev 272 = $352.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FORCEP BX FB231DA,272,RC,27200701,CDM,,,,,,both,,,352.0000,52.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,176.00,,,,,,,90.8500,352.0000,percent of total billed charges,Rev 272 $352.00 in Billed Charges at 50% = $176.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FORCEP BX FB231DA,272,RC,27200701,CDM,,,,,,both,,,352.0000,52.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,113.70,,,,,,,90.8500,352.0000,other,32.3% of $352.00 in Billed Charges for Rev 272 = $113.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FORCEP BX FB231DA,272,RC,27200701,CDM,,,,,,both,,,352.0000,52.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,108.06,,,,,,,90.8500,352.0000,other,30.7% of $352.00 in Billed Charges for Rev 272 = $108.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FORCEP BX FB231DA,272,RC,27200701,CDM,,,,,,both,,,352.0000,52.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,113.70,,,,,,,90.8500,352.0000,percent of total billed charges,32.3% of $352.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FORCEP BX FB231DA,272,RC,27200701,CDM,,,,,,both,,,352.0000,52.8000,WELLCARE,WELLCARE MEDICAID,352.00,,,,,,,90.8500,352.0000,percent of total billed charges,100% of $352.00 in Billed Charges for Rev 272 = $352.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GAUZE OWENS STERILE,272,RC,27200703,CDM,,,,,,both,,,23.0000,3.4500,AETNA,AETNA,9.82,,,,,,,5.9400,23.0000,percent of total billed charges,42.7% of $23.00 in Billed Charges for Rev 272 = $9.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GAUZE OWENS STERILE,272,RC,27200703,CDM,,,,,,both,,,23.0000,3.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,16.10,,,,,,,5.9400,23.0000,percent of total billed charges,Rev 272 $23.00 in Billed Charges at 70% = $16.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GAUZE OWENS STERILE,272,RC,27200703,CDM,,,,,,both,,,23.0000,3.4500,CIGNA HEALTHCARE,CIGNA HMO,9.59,,,,,,,5.9400,23.0000,percent of total billed charges,41.7% of $23.00 in Billed Charges for Rev 272 = $9.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GAUZE OWENS STERILE,272,RC,27200703,CDM,,,,,,both,,,23.0000,3.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10.67,,,,,,,5.9400,23.0000,percent of total billed charges,46.4% of $23.00 in Billed Charges for Rev 272 = $10.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GAUZE OWENS STERILE,272,RC,27200703,CDM,,,,,,both,,,23.0000,3.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9.59,,,,,,,5.9400,23.0000,percent of total billed charges,41.7% of $23.00 in Billed Charges for Rev 272 = $9.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GAUZE OWENS STERILE,272,RC,27200703,CDM,,,,,,both,,,23.0000,3.4500,CIGNA HEALTHCARE,CIGNA PPO,9.59,,,,,,,5.9400,23.0000,percent of total billed charges,41.7% of $23.00 in Billed Charges for Rev 272 = $9.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GAUZE OWENS STERILE,272,RC,27200703,CDM,,,,,,both,,,23.0000,3.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,20.70,,,,,,,5.9400,23.0000,percent of total billed charges,90% of $23.00 in Billed Charges for Rev 272 = $20.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GAUZE OWENS STERILE,272,RC,27200703,CDM,,,,,,both,,,23.0000,3.4500,MEDCOST,MEDCOST VHN,10.95,,,,,,,5.9400,23.0000,percent of total billed charges,47.59% of $23.00 in Billed Charges for Rev 272 = $10.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GAUZE OWENS STERILE,272,RC,27200703,CDM,,,,,,both,,,23.0000,3.4500,SENTARA HEALTH,SENTARA HEALTH,5.94,,,,,,,5.9400,23.0000,percent of total billed charges,25.81% of $23.00 in Billed Charges for Rev 272 = $5.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GAUZE OWENS STERILE,272,RC,27200703,CDM,,,,,,both,,,23.0000,3.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",23.00,,,,,,,5.9400,23.0000,percent of total billed charges,100% of $23.00 in Billed Charges for Rev 272 = $23.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GAUZE OWENS STERILE,272,RC,27200703,CDM,,,,,,both,,,23.0000,3.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11.50,,,,,,,5.9400,23.0000,percent of total billed charges,Rev 272 $23.00 in Billed Charges at 50% = $11.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GAUZE OWENS STERILE,272,RC,27200703,CDM,,,,,,both,,,23.0000,3.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7.43,,,,,,,5.9400,23.0000,other,32.3% of $23.00 in Billed Charges for Rev 272 = $7.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GAUZE OWENS STERILE,272,RC,27200703,CDM,,,,,,both,,,23.0000,3.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7.06,,,,,,,5.9400,23.0000,other,30.7% of $23.00 in Billed Charges for Rev 272 = $7.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GAUZE OWENS STERILE,272,RC,27200703,CDM,,,,,,both,,,23.0000,3.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,7.43,,,,,,,5.9400,23.0000,percent of total billed charges,32.3% of $23.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GAUZE OWENS STERILE,272,RC,27200703,CDM,,,,,,both,,,23.0000,3.4500,WELLCARE,WELLCARE MEDICAID,23.00,,,,,,,5.9400,23.0000,percent of total billed charges,100% of $23.00 in Billed Charges for Rev 272 = $23.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GEL SOLOSITE,272,RC,27200706,CDM,,,,,,both,,,53.0000,7.9500,AETNA,AETNA,22.63,,,,,,,13.6800,53.0000,percent of total billed charges,42.7% of $53.00 in Billed Charges for Rev 272 = $22.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GEL SOLOSITE,272,RC,27200706,CDM,,,,,,both,,,53.0000,7.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,37.10,,,,,,,13.6800,53.0000,percent of total billed charges,Rev 272 $53.00 in Billed Charges at 70% = $37.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GEL SOLOSITE,272,RC,27200706,CDM,,,,,,both,,,53.0000,7.9500,CIGNA HEALTHCARE,CIGNA HMO,22.10,,,,,,,13.6800,53.0000,percent of total billed charges,41.7% of $53.00 in Billed Charges for Rev 272 = $22.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GEL SOLOSITE,272,RC,27200706,CDM,,,,,,both,,,53.0000,7.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,24.59,,,,,,,13.6800,53.0000,percent of total billed charges,46.4% of $53.00 in Billed Charges for Rev 272 = $24.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GEL SOLOSITE,272,RC,27200706,CDM,,,,,,both,,,53.0000,7.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,22.10,,,,,,,13.6800,53.0000,percent of total billed charges,41.7% of $53.00 in Billed Charges for Rev 272 = $22.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GEL SOLOSITE,272,RC,27200706,CDM,,,,,,both,,,53.0000,7.9500,CIGNA HEALTHCARE,CIGNA PPO,22.10,,,,,,,13.6800,53.0000,percent of total billed charges,41.7% of $53.00 in Billed Charges for Rev 272 = $22.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GEL SOLOSITE,272,RC,27200706,CDM,,,,,,both,,,53.0000,7.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,47.70,,,,,,,13.6800,53.0000,percent of total billed charges,90% of $53.00 in Billed Charges for Rev 272 = $47.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GEL SOLOSITE,272,RC,27200706,CDM,,,,,,both,,,53.0000,7.9500,MEDCOST,MEDCOST VHN,25.22,,,,,,,13.6800,53.0000,percent of total billed charges,47.59% of $53.00 in Billed Charges for Rev 272 = $25.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GEL SOLOSITE,272,RC,27200706,CDM,,,,,,both,,,53.0000,7.9500,SENTARA HEALTH,SENTARA HEALTH,13.68,,,,,,,13.6800,53.0000,percent of total billed charges,25.81% of $53.00 in Billed Charges for Rev 272 = $13.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GEL SOLOSITE,272,RC,27200706,CDM,,,,,,both,,,53.0000,7.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",53.00,,,,,,,13.6800,53.0000,percent of total billed charges,100% of $53.00 in Billed Charges for Rev 272 = $53.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GEL SOLOSITE,272,RC,27200706,CDM,,,,,,both,,,53.0000,7.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,26.50,,,,,,,13.6800,53.0000,percent of total billed charges,Rev 272 $53.00 in Billed Charges at 50% = $26.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GEL SOLOSITE,272,RC,27200706,CDM,,,,,,both,,,53.0000,7.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,17.12,,,,,,,13.6800,53.0000,other,32.3% of $53.00 in Billed Charges for Rev 272 = $17.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GEL SOLOSITE,272,RC,27200706,CDM,,,,,,both,,,53.0000,7.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,16.27,,,,,,,13.6800,53.0000,other,30.7% of $53.00 in Billed Charges for Rev 272 = $16.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GEL SOLOSITE,272,RC,27200706,CDM,,,,,,both,,,53.0000,7.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,17.12,,,,,,,13.6800,53.0000,percent of total billed charges,32.3% of $53.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GEL SOLOSITE,272,RC,27200706,CDM,,,,,,both,,,53.0000,7.9500,WELLCARE,WELLCARE MEDICAID,53.00,,,,,,,13.6800,53.0000,percent of total billed charges,100% of $53.00 in Billed Charges for Rev 272 = $53.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GENERAL OB ROOM DLY SEMI,122,RC,12200001,CDM,,,,,,inpatient,,,2354.0000,353.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,121.7600,2354.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC GENERAL OB ROOM DLY SEMI,122,RC,12200001,CDM,,,,,,inpatient,,,2354.0000,353.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2118.60,,,,,,,121.7600,2354.0000,percent of total billed charges,"90% of $2,354.00 in Billed Charges for Rev 122 = $2,118.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GENERAL OB ROOM DLY SEMI,122,RC,12200001,CDM,,,,,,inpatient,,,2354.0000,353.1000,MEDCOST,MEDCOST VHN,1120.27,,,,,,,121.7600,2354.0000,percent of total billed charges,"47.59% of $2,354.00 in Billed Charges for Rev 122 = $1,120.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GENERAL OB ROOM DLY SEMI,122,RC,12200001,CDM,,,,,,inpatient,,,2354.0000,353.1000,SENTARA HEALTH,SENTARA HEALTH,877.57,,,,,,,121.7600,2354.0000,percent of total billed charges,"37.28% of $2,354.00 in Billed Charges for Rev 122 = $877.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GENERAL OB ROOM DLY SEMI,122,RC,12200001,CDM,,,,,,inpatient,,,2354.0000,353.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2354.00,,,,,,,121.7600,2354.0000,percent of total billed charges,"100% of $2,354.00 in Billed Charges for Rev 122 = $2,354.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GENERAL PED ROOM DLY SEMI,123,RC,12300001,CDM,,,,,,inpatient,,,2354.0000,353.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,121.7600,2354.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC GENERAL PED ROOM DLY SEMI,123,RC,12300001,CDM,,,,,,inpatient,,,2354.0000,353.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2118.60,,,,,,,121.7600,2354.0000,percent of total billed charges,"90% of $2,354.00 in Billed Charges for Rev 123 = $2,118.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GENERAL PED ROOM DLY SEMI,123,RC,12300001,CDM,,,,,,inpatient,,,2354.0000,353.1000,MEDCOST,MEDCOST VHN,1120.27,,,,,,,121.7600,2354.0000,percent of total billed charges,"47.59% of $2,354.00 in Billed Charges for Rev 123 = $1,120.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GENERAL PED ROOM DLY SEMI,123,RC,12300001,CDM,,,,,,inpatient,,,2354.0000,353.1000,SENTARA HEALTH,SENTARA HEALTH,877.57,,,,,,,121.7600,2354.0000,percent of total billed charges,"37.28% of $2,354.00 in Billed Charges for Rev 123 = $877.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GENERAL PED ROOM DLY SEMI,123,RC,12300001,CDM,,,,,,inpatient,,,2354.0000,353.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2354.00,,,,,,,121.7600,2354.0000,percent of total billed charges,"100% of $2,354.00 in Billed Charges for Rev 123 = $2,354.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURVETTE  SURGICAL 11G,272,RC,,,,,,,,both,,,5425.0700,813.7600,AETNA,AETNA,2316.50,,,,,,,1400.2100,5425.0700,percent of total billed charges,"42.7% of $5,425.07 in Billed Charges for Rev 272 = $2,316.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURVETTE  SURGICAL 11G,272,RC,,,,,,,,both,,,5425.0700,813.7600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3797.55,,,,,,,1400.2100,5425.0700,percent of total billed charges,"Rev 272 $5,425.07 in Billed Charges at 70% = $3,797.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURVETTE  SURGICAL 11G,272,RC,,,,,,,,both,,,5425.0700,813.7600,CIGNA HEALTHCARE,CIGNA HMO,2262.25,,,,,,,1400.2100,5425.0700,percent of total billed charges,"41.7% of $5,425.07 in Billed Charges for Rev 272 = $2,262.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURVETTE  SURGICAL 11G,272,RC,,,,,,,,both,,,5425.0700,813.7600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2517.23,,,,,,,1400.2100,5425.0700,percent of total billed charges,"46.4% of $5,425.07 in Billed Charges for Rev 272 = $2,517.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURVETTE  SURGICAL 11G,272,RC,,,,,,,,both,,,5425.0700,813.7600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2262.25,,,,,,,1400.2100,5425.0700,percent of total billed charges,"41.7% of $5,425.07 in Billed Charges for Rev 272 = $2,262.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURVETTE  SURGICAL 11G,272,RC,,,,,,,,both,,,5425.0700,813.7600,CIGNA HEALTHCARE,CIGNA PPO,2262.25,,,,,,,1400.2100,5425.0700,percent of total billed charges,"41.7% of $5,425.07 in Billed Charges for Rev 272 = $2,262.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURVETTE  SURGICAL 11G,272,RC,,,,,,,,both,,,5425.0700,813.7600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4882.56,,,,,,,1400.2100,5425.0700,percent of total billed charges,"90% of $5,425.07 in Billed Charges for Rev 272 = $4,882.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURVETTE  SURGICAL 11G,272,RC,,,,,,,,both,,,5425.0700,813.7600,MEDCOST,MEDCOST VHN,2581.79,,,,,,,1400.2100,5425.0700,percent of total billed charges,"47.59% of $5,425.07 in Billed Charges for Rev 272 = $2,581.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURVETTE  SURGICAL 11G,272,RC,,,,,,,,both,,,5425.0700,813.7600,SENTARA HEALTH,SENTARA HEALTH,1400.21,,,,,,,1400.2100,5425.0700,percent of total billed charges,"25.81% of $5,425.07 in Billed Charges for Rev 272 = $1,400.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURVETTE  SURGICAL 11G,272,RC,,,,,,,,both,,,5425.0700,813.7600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5425.07,,,,,,,1400.2100,5425.0700,percent of total billed charges,"100% of $5,425.07 in Billed Charges for Rev 272 = $5,425.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURVETTE  SURGICAL 11G,272,RC,,,,,,,,both,,,5425.0700,813.7600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2712.54,,,,,,,1400.2100,5425.0700,percent of total billed charges,"Rev 272 $5,425.07 in Billed Charges at 50% = $2,712.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURVETTE  SURGICAL 11G,272,RC,,,,,,,,both,,,5425.0700,813.7600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1752.30,,,,,,,1400.2100,5425.0700,other,"32.3% of $5,425.07 in Billed Charges for Rev 272 = $1,752.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CURVETTE  SURGICAL 11G,272,RC,,,,,,,,both,,,5425.0700,813.7600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1665.50,,,,,,,1400.2100,5425.0700,other,"30.7% of $5,425.07 in Billed Charges for Rev 272 = $1,665.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CURVETTE  SURGICAL 11G,272,RC,,,,,,,,both,,,5425.0700,813.7600,UNITED HEALTHCARE,UNITED HEALTHCARE,1752.30,,,,,,,1400.2100,5425.0700,percent of total billed charges,"32.3% of $5,425.07 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CURVETTE  SURGICAL 11G,272,RC,,,,,,,,both,,,5425.0700,813.7600,WELLCARE,WELLCARE MEDICAID,5425.07,,,,,,,1400.2100,5425.0700,percent of total billed charges,"100% of $5,425.07 in Billed Charges for Rev 272 = $5,425.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER DRIVER VASCULAR,272,RC,,,,,,,,both,,,38760.0600,5814.0100,AETNA,AETNA,16550.55,,,,,,,10003.9700,38760.0600,percent of total billed charges,"42.7% of $38,760.06 in Billed Charges for Rev 272 = $16,550.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER DRIVER VASCULAR,272,RC,,,,,,,,both,,,38760.0600,5814.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,27132.04,,,,,,,10003.9700,38760.0600,percent of total billed charges,"Rev 272 $38,760.06 in Billed Charges at 70% = $27,132.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER DRIVER VASCULAR,272,RC,,,,,,,,both,,,38760.0600,5814.0100,CIGNA HEALTHCARE,CIGNA HMO,16162.95,,,,,,,10003.9700,38760.0600,percent of total billed charges,"41.7% of $38,760.06 in Billed Charges for Rev 272 = $16,162.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER DRIVER VASCULAR,272,RC,,,,,,,,both,,,38760.0600,5814.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,17984.67,,,,,,,10003.9700,38760.0600,percent of total billed charges,"46.4% of $38,760.06 in Billed Charges for Rev 272 = $17,984.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER DRIVER VASCULAR,272,RC,,,,,,,,both,,,38760.0600,5814.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,16162.95,,,,,,,10003.9700,38760.0600,percent of total billed charges,"41.7% of $38,760.06 in Billed Charges for Rev 272 = $16,162.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER DRIVER VASCULAR,272,RC,,,,,,,,both,,,38760.0600,5814.0100,CIGNA HEALTHCARE,CIGNA PPO,16162.95,,,,,,,10003.9700,38760.0600,percent of total billed charges,"41.7% of $38,760.06 in Billed Charges for Rev 272 = $16,162.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER DRIVER VASCULAR,272,RC,,,,,,,,both,,,38760.0600,5814.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,34884.05,,,,,,,10003.9700,38760.0600,percent of total billed charges,"90% of $38,760.06 in Billed Charges for Rev 272 = $34,884.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER DRIVER VASCULAR,272,RC,,,,,,,,both,,,38760.0600,5814.0100,MEDCOST,MEDCOST VHN,18445.91,,,,,,,10003.9700,38760.0600,percent of total billed charges,"47.59% of $38,760.06 in Billed Charges for Rev 272 = $18,445.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER DRIVER VASCULAR,272,RC,,,,,,,,both,,,38760.0600,5814.0100,SENTARA HEALTH,SENTARA HEALTH,10003.97,,,,,,,10003.9700,38760.0600,percent of total billed charges,"25.81% of $38,760.06 in Billed Charges for Rev 272 = $10,003.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER DRIVER VASCULAR,272,RC,,,,,,,,both,,,38760.0600,5814.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",38760.06,,,,,,,10003.9700,38760.0600,percent of total billed charges,"100% of $38,760.06 in Billed Charges for Rev 272 = $38,760.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER DRIVER VASCULAR,272,RC,,,,,,,,both,,,38760.0600,5814.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,19380.03,,,,,,,10003.9700,38760.0600,percent of total billed charges,"Rev 272 $38,760.06 in Billed Charges at 50% = $19,380.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER DRIVER VASCULAR,272,RC,,,,,,,,both,,,38760.0600,5814.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12519.50,,,,,,,10003.9700,38760.0600,other,"32.3% of $38,760.06 in Billed Charges for Rev 272 = $12,519.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTER DRIVER VASCULAR,272,RC,,,,,,,,both,,,38760.0600,5814.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,11899.34,,,,,,,10003.9700,38760.0600,other,"30.7% of $38,760.06 in Billed Charges for Rev 272 = $11,899.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTER DRIVER VASCULAR,272,RC,,,,,,,,both,,,38760.0600,5814.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,12519.50,,,,,,,10003.9700,38760.0600,percent of total billed charges,"32.3% of $38,760.06 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER DRIVER VASCULAR,272,RC,,,,,,,,both,,,38760.0600,5814.0100,WELLCARE,WELLCARE MEDICAID,38760.06,,,,,,,10003.9700,38760.0600,percent of total billed charges,"100% of $38,760.06 in Billed Charges for Rev 272 = $38,760.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,963.8000,144.5700,AETNA,AETNA,411.54,,,,,,,248.7600,963.8000,percent of total billed charges,42.7% of $963.80 in Billed Charges for Rev 272 = $411.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,963.8000,144.5700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,674.66,,,,,,,248.7600,963.8000,percent of total billed charges,Rev 272 $963.80 in Billed Charges at 70% = $674.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,963.8000,144.5700,CIGNA HEALTHCARE,CIGNA HMO,401.90,,,,,,,248.7600,963.8000,percent of total billed charges,41.7% of $963.80 in Billed Charges for Rev 272 = $401.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,963.8000,144.5700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,447.20,,,,,,,248.7600,963.8000,percent of total billed charges,46.4% of $963.80 in Billed Charges for Rev 272 = $447.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,963.8000,144.5700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,401.90,,,,,,,248.7600,963.8000,percent of total billed charges,41.7% of $963.80 in Billed Charges for Rev 272 = $401.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,963.8000,144.5700,CIGNA HEALTHCARE,CIGNA PPO,401.90,,,,,,,248.7600,963.8000,percent of total billed charges,41.7% of $963.80 in Billed Charges for Rev 272 = $401.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,963.8000,144.5700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,867.42,,,,,,,248.7600,963.8000,percent of total billed charges,90% of $963.80 in Billed Charges for Rev 272 = $867.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,963.8000,144.5700,MEDCOST,MEDCOST VHN,458.67,,,,,,,248.7600,963.8000,percent of total billed charges,47.59% of $963.80 in Billed Charges for Rev 272 = $458.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,963.8000,144.5700,SENTARA HEALTH,SENTARA HEALTH,248.76,,,,,,,248.7600,963.8000,percent of total billed charges,25.81% of $963.80 in Billed Charges for Rev 272 = $248.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,963.8000,144.5700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",963.80,,,,,,,248.7600,963.8000,percent of total billed charges,100% of $963.80 in Billed Charges for Rev 272 = $963.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,963.8000,144.5700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,481.90,,,,,,,248.7600,963.8000,percent of total billed charges,Rev 272 $963.80 in Billed Charges at 50% = $481.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,963.8000,144.5700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,311.31,,,,,,,248.7600,963.8000,other,32.3% of $963.80 in Billed Charges for Rev 272 = $311.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,963.8000,144.5700,UNITED HEALTHCARE,UHC HERITAGE SELECT,295.89,,,,,,,248.7600,963.8000,other,30.7% of $963.80 in Billed Charges for Rev 272 = $295.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,963.8000,144.5700,UNITED HEALTHCARE,UNITED HEALTHCARE,311.31,,,,,,,248.7600,963.8000,percent of total billed charges,32.3% of $963.80 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,963.8000,144.5700,WELLCARE,WELLCARE MEDICAID,963.80,,,,,,,248.7600,963.8000,percent of total billed charges,100% of $963.80 in Billed Charges for Rev 272 = $963.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,1234.3600,185.1500,AETNA,AETNA,527.07,,,,,,,318.5900,1234.3600,percent of total billed charges,"42.7% of $1,234.36 in Billed Charges for Rev 272 = $527.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,1234.3600,185.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,864.05,,,,,,,318.5900,1234.3600,percent of total billed charges,"Rev 272 $1,234.36 in Billed Charges at 70% = $864.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,1234.3600,185.1500,CIGNA HEALTHCARE,CIGNA HMO,514.73,,,,,,,318.5900,1234.3600,percent of total billed charges,"41.7% of $1,234.36 in Billed Charges for Rev 272 = $514.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,1234.3600,185.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,572.74,,,,,,,318.5900,1234.3600,percent of total billed charges,"46.4% of $1,234.36 in Billed Charges for Rev 272 = $572.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,1234.3600,185.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,514.73,,,,,,,318.5900,1234.3600,percent of total billed charges,"41.7% of $1,234.36 in Billed Charges for Rev 272 = $514.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,1234.3600,185.1500,CIGNA HEALTHCARE,CIGNA PPO,514.73,,,,,,,318.5900,1234.3600,percent of total billed charges,"41.7% of $1,234.36 in Billed Charges for Rev 272 = $514.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,1234.3600,185.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1110.92,,,,,,,318.5900,1234.3600,percent of total billed charges,"90% of $1,234.36 in Billed Charges for Rev 272 = $1,110.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,1234.3600,185.1500,MEDCOST,MEDCOST VHN,587.43,,,,,,,318.5900,1234.3600,percent of total billed charges,"47.59% of $1,234.36 in Billed Charges for Rev 272 = $587.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,1234.3600,185.1500,SENTARA HEALTH,SENTARA HEALTH,318.59,,,,,,,318.5900,1234.3600,percent of total billed charges,"25.81% of $1,234.36 in Billed Charges for Rev 272 = $318.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,1234.3600,185.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1234.36,,,,,,,318.5900,1234.3600,percent of total billed charges,"100% of $1,234.36 in Billed Charges for Rev 272 = $1,234.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,1234.3600,185.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,617.18,,,,,,,318.5900,1234.3600,percent of total billed charges,"Rev 272 $1,234.36 in Billed Charges at 50% = $617.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,1234.3600,185.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,398.70,,,,,,,318.5900,1234.3600,other,"32.3% of $1,234.36 in Billed Charges for Rev 272 = $398.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,1234.3600,185.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,378.95,,,,,,,318.5900,1234.3600,other,"30.7% of $1,234.36 in Billed Charges for Rev 272 = $378.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,1234.3600,185.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,398.70,,,,,,,318.5900,1234.3600,percent of total billed charges,"32.3% of $1,234.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CUTTER LINEAR RELOAD 45MM WHIT,272,RC,27200002,CDM,,,,,,both,,,1234.3600,185.1500,WELLCARE,WELLCARE MEDICAID,1234.36,,,,,,,318.5900,1234.3600,percent of total billed charges,"100% of $1,234.36 in Billed Charges for Rev 272 = $1,234.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET LITHOTRIPTOR 1415491,272,RC,27200713,CDM,,,,,,both,,,832.0000,124.8000,AETNA,AETNA,355.26,,,,,,,214.7400,832.0000,percent of total billed charges,42.7% of $832.00 in Billed Charges for Rev 272 = $355.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BASKET LITHOTRIPTOR 1415491,272,RC,27200713,CDM,,,,,,both,,,832.0000,124.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,582.40,,,,,,,214.7400,832.0000,percent of total billed charges,Rev 272 $832.00 in Billed Charges at 70% = $582.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BASKET LITHOTRIPTOR 1415491,272,RC,27200713,CDM,,,,,,both,,,832.0000,124.8000,CIGNA HEALTHCARE,CIGNA HMO,346.94,,,,,,,214.7400,832.0000,percent of total billed charges,41.7% of $832.00 in Billed Charges for Rev 272 = $346.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BASKET LITHOTRIPTOR 1415491,272,RC,27200713,CDM,,,,,,both,,,832.0000,124.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,386.05,,,,,,,214.7400,832.0000,percent of total billed charges,46.4% of $832.00 in Billed Charges for Rev 272 = $386.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BASKET LITHOTRIPTOR 1415491,272,RC,27200713,CDM,,,,,,both,,,832.0000,124.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,346.94,,,,,,,214.7400,832.0000,percent of total billed charges,41.7% of $832.00 in Billed Charges for Rev 272 = $346.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BASKET LITHOTRIPTOR 1415491,272,RC,27200713,CDM,,,,,,both,,,832.0000,124.8000,CIGNA HEALTHCARE,CIGNA PPO,346.94,,,,,,,214.7400,832.0000,percent of total billed charges,41.7% of $832.00 in Billed Charges for Rev 272 = $346.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BASKET LITHOTRIPTOR 1415491,272,RC,27200713,CDM,,,,,,both,,,832.0000,124.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,748.80,,,,,,,214.7400,832.0000,percent of total billed charges,90% of $832.00 in Billed Charges for Rev 272 = $748.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BASKET LITHOTRIPTOR 1415491,272,RC,27200713,CDM,,,,,,both,,,832.0000,124.8000,MEDCOST,MEDCOST VHN,395.95,,,,,,,214.7400,832.0000,percent of total billed charges,47.59% of $832.00 in Billed Charges for Rev 272 = $395.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BASKET LITHOTRIPTOR 1415491,272,RC,27200713,CDM,,,,,,both,,,832.0000,124.8000,SENTARA HEALTH,SENTARA HEALTH,214.74,,,,,,,214.7400,832.0000,percent of total billed charges,25.81% of $832.00 in Billed Charges for Rev 272 = $214.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BASKET LITHOTRIPTOR 1415491,272,RC,27200713,CDM,,,,,,both,,,832.0000,124.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",832.00,,,,,,,214.7400,832.0000,percent of total billed charges,100% of $832.00 in Billed Charges for Rev 272 = $832.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BASKET LITHOTRIPTOR 1415491,272,RC,27200713,CDM,,,,,,both,,,832.0000,124.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,416.00,,,,,,,214.7400,832.0000,percent of total billed charges,Rev 272 $832.00 in Billed Charges at 50% = $416.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BASKET LITHOTRIPTOR 1415491,272,RC,27200713,CDM,,,,,,both,,,832.0000,124.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,268.74,,,,,,,214.7400,832.0000,other,32.3% of $832.00 in Billed Charges for Rev 272 = $268.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI BASKET LITHOTRIPTOR 1415491,272,RC,27200713,CDM,,,,,,both,,,832.0000,124.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,255.42,,,,,,,214.7400,832.0000,other,30.7% of $832.00 in Billed Charges for Rev 272 = $255.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI BASKET LITHOTRIPTOR 1415491,272,RC,27200713,CDM,,,,,,both,,,832.0000,124.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,268.74,,,,,,,214.7400,832.0000,percent of total billed charges,32.3% of $832.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BASKET LITHOTRIPTOR 1415491,272,RC,27200713,CDM,,,,,,both,,,832.0000,124.8000,WELLCARE,WELLCARE MEDICAID,832.00,,,,,,,214.7400,832.0000,percent of total billed charges,100% of $832.00 in Billed Charges for Rev 272 = $832.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY ERCP,272,RC,27200716,CDM,,,,,,both,,,321.0000,48.1500,AETNA,AETNA,137.07,,,,,,,82.8500,321.0000,percent of total billed charges,42.7% of $321.00 in Billed Charges for Rev 272 = $137.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY ERCP,272,RC,27200716,CDM,,,,,,both,,,321.0000,48.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,224.70,,,,,,,82.8500,321.0000,percent of total billed charges,Rev 272 $321.00 in Billed Charges at 70% = $224.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY ERCP,272,RC,27200716,CDM,,,,,,both,,,321.0000,48.1500,CIGNA HEALTHCARE,CIGNA HMO,133.86,,,,,,,82.8500,321.0000,percent of total billed charges,41.7% of $321.00 in Billed Charges for Rev 272 = $133.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY ERCP,272,RC,27200716,CDM,,,,,,both,,,321.0000,48.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,148.94,,,,,,,82.8500,321.0000,percent of total billed charges,46.4% of $321.00 in Billed Charges for Rev 272 = $148.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY ERCP,272,RC,27200716,CDM,,,,,,both,,,321.0000,48.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,133.86,,,,,,,82.8500,321.0000,percent of total billed charges,41.7% of $321.00 in Billed Charges for Rev 272 = $133.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY ERCP,272,RC,27200716,CDM,,,,,,both,,,321.0000,48.1500,CIGNA HEALTHCARE,CIGNA PPO,133.86,,,,,,,82.8500,321.0000,percent of total billed charges,41.7% of $321.00 in Billed Charges for Rev 272 = $133.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY ERCP,272,RC,27200716,CDM,,,,,,both,,,321.0000,48.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,288.90,,,,,,,82.8500,321.0000,percent of total billed charges,90% of $321.00 in Billed Charges for Rev 272 = $288.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY ERCP,272,RC,27200716,CDM,,,,,,both,,,321.0000,48.1500,MEDCOST,MEDCOST VHN,152.76,,,,,,,82.8500,321.0000,percent of total billed charges,47.59% of $321.00 in Billed Charges for Rev 272 = $152.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY ERCP,272,RC,27200716,CDM,,,,,,both,,,321.0000,48.1500,SENTARA HEALTH,SENTARA HEALTH,82.85,,,,,,,82.8500,321.0000,percent of total billed charges,25.81% of $321.00 in Billed Charges for Rev 272 = $82.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY ERCP,272,RC,27200716,CDM,,,,,,both,,,321.0000,48.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",321.00,,,,,,,82.8500,321.0000,percent of total billed charges,100% of $321.00 in Billed Charges for Rev 272 = $321.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY ERCP,272,RC,27200716,CDM,,,,,,both,,,321.0000,48.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,160.50,,,,,,,82.8500,321.0000,percent of total billed charges,Rev 272 $321.00 in Billed Charges at 50% = $160.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY ERCP,272,RC,27200716,CDM,,,,,,both,,,321.0000,48.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,103.68,,,,,,,82.8500,321.0000,other,32.3% of $321.00 in Billed Charges for Rev 272 = $103.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI BRUSH CYTOLOGY ERCP,272,RC,27200716,CDM,,,,,,both,,,321.0000,48.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,98.55,,,,,,,82.8500,321.0000,other,30.7% of $321.00 in Billed Charges for Rev 272 = $98.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI BRUSH CYTOLOGY ERCP,272,RC,27200716,CDM,,,,,,both,,,321.0000,48.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,103.68,,,,,,,82.8500,321.0000,percent of total billed charges,32.3% of $321.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY ERCP,272,RC,27200716,CDM,,,,,,both,,,321.0000,48.1500,WELLCARE,WELLCARE MEDICAID,321.00,,,,,,,82.8500,321.0000,percent of total billed charges,100% of $321.00 in Billed Charges for Rev 272 = $321.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY RAPID EXCH#4500,272,RC,27200717,CDM,,,,,,both,,,543.0000,81.4500,AETNA,AETNA,231.86,,,,,,,140.1500,543.0000,percent of total billed charges,42.7% of $543.00 in Billed Charges for Rev 272 = $231.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY RAPID EXCH#4500,272,RC,27200717,CDM,,,,,,both,,,543.0000,81.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,380.10,,,,,,,140.1500,543.0000,percent of total billed charges,Rev 272 $543.00 in Billed Charges at 70% = $380.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY RAPID EXCH#4500,272,RC,27200717,CDM,,,,,,both,,,543.0000,81.4500,CIGNA HEALTHCARE,CIGNA HMO,226.43,,,,,,,140.1500,543.0000,percent of total billed charges,41.7% of $543.00 in Billed Charges for Rev 272 = $226.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY RAPID EXCH#4500,272,RC,27200717,CDM,,,,,,both,,,543.0000,81.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,251.95,,,,,,,140.1500,543.0000,percent of total billed charges,46.4% of $543.00 in Billed Charges for Rev 272 = $251.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY RAPID EXCH#4500,272,RC,27200717,CDM,,,,,,both,,,543.0000,81.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,226.43,,,,,,,140.1500,543.0000,percent of total billed charges,41.7% of $543.00 in Billed Charges for Rev 272 = $226.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY RAPID EXCH#4500,272,RC,27200717,CDM,,,,,,both,,,543.0000,81.4500,CIGNA HEALTHCARE,CIGNA PPO,226.43,,,,,,,140.1500,543.0000,percent of total billed charges,41.7% of $543.00 in Billed Charges for Rev 272 = $226.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY RAPID EXCH#4500,272,RC,27200717,CDM,,,,,,both,,,543.0000,81.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,488.70,,,,,,,140.1500,543.0000,percent of total billed charges,90% of $543.00 in Billed Charges for Rev 272 = $488.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY RAPID EXCH#4500,272,RC,27200717,CDM,,,,,,both,,,543.0000,81.4500,MEDCOST,MEDCOST VHN,258.41,,,,,,,140.1500,543.0000,percent of total billed charges,47.59% of $543.00 in Billed Charges for Rev 272 = $258.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY RAPID EXCH#4500,272,RC,27200717,CDM,,,,,,both,,,543.0000,81.4500,SENTARA HEALTH,SENTARA HEALTH,140.15,,,,,,,140.1500,543.0000,percent of total billed charges,25.81% of $543.00 in Billed Charges for Rev 272 = $140.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY RAPID EXCH#4500,272,RC,27200717,CDM,,,,,,both,,,543.0000,81.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",543.00,,,,,,,140.1500,543.0000,percent of total billed charges,100% of $543.00 in Billed Charges for Rev 272 = $543.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY RAPID EXCH#4500,272,RC,27200717,CDM,,,,,,both,,,543.0000,81.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,271.50,,,,,,,140.1500,543.0000,percent of total billed charges,Rev 272 $543.00 in Billed Charges at 50% = $271.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY RAPID EXCH#4500,272,RC,27200717,CDM,,,,,,both,,,543.0000,81.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,175.39,,,,,,,140.1500,543.0000,other,32.3% of $543.00 in Billed Charges for Rev 272 = $175.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI BRUSH CYTOLOGY RAPID EXCH#4500,272,RC,27200717,CDM,,,,,,both,,,543.0000,81.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,166.70,,,,,,,140.1500,543.0000,other,30.7% of $543.00 in Billed Charges for Rev 272 = $166.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI BRUSH CYTOLOGY RAPID EXCH#4500,272,RC,27200717,CDM,,,,,,both,,,543.0000,81.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,175.39,,,,,,,140.1500,543.0000,percent of total billed charges,32.3% of $543.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BRUSH CYTOLOGY RAPID EXCH#4500,272,RC,27200717,CDM,,,,,,both,,,543.0000,81.4500,WELLCARE,WELLCARE MEDICAID,543.00,,,,,,,140.1500,543.0000,percent of total billed charges,100% of $543.00 in Billed Charges for Rev 272 = $543.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CAPSULE BRAVO 901281011,272,RC,27200721,CDM,,,,,,both,,,926.0000,138.9000,AETNA,AETNA,395.40,,,,,,,239.0000,926.0000,percent of total billed charges,42.7% of $926.00 in Billed Charges for Rev 272 = $395.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CAPSULE BRAVO 901281011,272,RC,27200721,CDM,,,,,,both,,,926.0000,138.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,648.20,,,,,,,239.0000,926.0000,percent of total billed charges,Rev 272 $926.00 in Billed Charges at 70% = $648.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CAPSULE BRAVO 901281011,272,RC,27200721,CDM,,,,,,both,,,926.0000,138.9000,CIGNA HEALTHCARE,CIGNA HMO,386.14,,,,,,,239.0000,926.0000,percent of total billed charges,41.7% of $926.00 in Billed Charges for Rev 272 = $386.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CAPSULE BRAVO 901281011,272,RC,27200721,CDM,,,,,,both,,,926.0000,138.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,429.66,,,,,,,239.0000,926.0000,percent of total billed charges,46.4% of $926.00 in Billed Charges for Rev 272 = $429.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CAPSULE BRAVO 901281011,272,RC,27200721,CDM,,,,,,both,,,926.0000,138.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,386.14,,,,,,,239.0000,926.0000,percent of total billed charges,41.7% of $926.00 in Billed Charges for Rev 272 = $386.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CAPSULE BRAVO 901281011,272,RC,27200721,CDM,,,,,,both,,,926.0000,138.9000,CIGNA HEALTHCARE,CIGNA PPO,386.14,,,,,,,239.0000,926.0000,percent of total billed charges,41.7% of $926.00 in Billed Charges for Rev 272 = $386.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CAPSULE BRAVO 901281011,272,RC,27200721,CDM,,,,,,both,,,926.0000,138.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,833.40,,,,,,,239.0000,926.0000,percent of total billed charges,90% of $926.00 in Billed Charges for Rev 272 = $833.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CAPSULE BRAVO 901281011,272,RC,27200721,CDM,,,,,,both,,,926.0000,138.9000,MEDCOST,MEDCOST VHN,440.68,,,,,,,239.0000,926.0000,percent of total billed charges,47.59% of $926.00 in Billed Charges for Rev 272 = $440.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CAPSULE BRAVO 901281011,272,RC,27200721,CDM,,,,,,both,,,926.0000,138.9000,SENTARA HEALTH,SENTARA HEALTH,239.00,,,,,,,239.0000,926.0000,percent of total billed charges,25.81% of $926.00 in Billed Charges for Rev 272 = $239.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CAPSULE BRAVO 901281011,272,RC,27200721,CDM,,,,,,both,,,926.0000,138.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",926.00,,,,,,,239.0000,926.0000,percent of total billed charges,100% of $926.00 in Billed Charges for Rev 272 = $926.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CAPSULE BRAVO 901281011,272,RC,27200721,CDM,,,,,,both,,,926.0000,138.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,463.00,,,,,,,239.0000,926.0000,percent of total billed charges,Rev 272 $926.00 in Billed Charges at 50% = $463.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CAPSULE BRAVO 901281011,272,RC,27200721,CDM,,,,,,both,,,926.0000,138.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,299.10,,,,,,,239.0000,926.0000,other,32.3% of $926.00 in Billed Charges for Rev 272 = $299.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI CAPSULE BRAVO 901281011,272,RC,27200721,CDM,,,,,,both,,,926.0000,138.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,284.28,,,,,,,239.0000,926.0000,other,30.7% of $926.00 in Billed Charges for Rev 272 = $284.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI CAPSULE BRAVO 901281011,272,RC,27200721,CDM,,,,,,both,,,926.0000,138.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,299.10,,,,,,,239.0000,926.0000,percent of total billed charges,32.3% of $926.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CAPSULE BRAVO 901281011,272,RC,27200721,CDM,,,,,,both,,,926.0000,138.9000,WELLCARE,WELLCARE MEDICAID,926.00,,,,,,,239.0000,926.0000,percent of total billed charges,100% of $926.00 in Billed Charges for Rev 272 = $926.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH ABLATION 25MM,272,RC,27200722,CDM,,,,,,both,,,2890.0000,433.5000,AETNA,AETNA,1234.03,,,,,,,745.9100,2890.0000,percent of total billed charges,"42.7% of $2,890.00 in Billed Charges for Rev 272 = $1,234.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI CATH ABLATION 25MM,272,RC,27200722,CDM,,,,,,both,,,2890.0000,433.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2023.00,,,,,,,745.9100,2890.0000,percent of total billed charges,"Rev 272 $2,890.00 in Billed Charges at 70% = $2,023.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI CATH ABLATION 25MM,272,RC,27200722,CDM,,,,,,both,,,2890.0000,433.5000,CIGNA HEALTHCARE,CIGNA HMO,1205.13,,,,,,,745.9100,2890.0000,percent of total billed charges,"41.7% of $2,890.00 in Billed Charges for Rev 272 = $1,205.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI CATH ABLATION 25MM,272,RC,27200722,CDM,,,,,,both,,,2890.0000,433.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1340.96,,,,,,,745.9100,2890.0000,percent of total billed charges,"46.4% of $2,890.00 in Billed Charges for Rev 272 = $1,340.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI CATH ABLATION 25MM,272,RC,27200722,CDM,,,,,,both,,,2890.0000,433.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1205.13,,,,,,,745.9100,2890.0000,percent of total billed charges,"41.7% of $2,890.00 in Billed Charges for Rev 272 = $1,205.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI CATH ABLATION 25MM,272,RC,27200722,CDM,,,,,,both,,,2890.0000,433.5000,CIGNA HEALTHCARE,CIGNA PPO,1205.13,,,,,,,745.9100,2890.0000,percent of total billed charges,"41.7% of $2,890.00 in Billed Charges for Rev 272 = $1,205.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI CATH ABLATION 25MM,272,RC,27200722,CDM,,,,,,both,,,2890.0000,433.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2601.00,,,,,,,745.9100,2890.0000,percent of total billed charges,"90% of $2,890.00 in Billed Charges for Rev 272 = $2,601.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI CATH ABLATION 25MM,272,RC,27200722,CDM,,,,,,both,,,2890.0000,433.5000,MEDCOST,MEDCOST VHN,1375.35,,,,,,,745.9100,2890.0000,percent of total billed charges,"47.59% of $2,890.00 in Billed Charges for Rev 272 = $1,375.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI CATH ABLATION 25MM,272,RC,27200722,CDM,,,,,,both,,,2890.0000,433.5000,SENTARA HEALTH,SENTARA HEALTH,745.91,,,,,,,745.9100,2890.0000,percent of total billed charges,"25.81% of $2,890.00 in Billed Charges for Rev 272 = $745.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI CATH ABLATION 25MM,272,RC,27200722,CDM,,,,,,both,,,2890.0000,433.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2890.00,,,,,,,745.9100,2890.0000,percent of total billed charges,"100% of $2,890.00 in Billed Charges for Rev 272 = $2,890.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI CATH ABLATION 25MM,272,RC,27200722,CDM,,,,,,both,,,2890.0000,433.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1445.00,,,,,,,745.9100,2890.0000,percent of total billed charges,"Rev 272 $2,890.00 in Billed Charges at 50% = $1,445.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI CATH ABLATION 25MM,272,RC,27200722,CDM,,,,,,both,,,2890.0000,433.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,933.47,,,,,,,745.9100,2890.0000,other,"32.3% of $2,890.00 in Billed Charges for Rev 272 = $933.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC GI CATH ABLATION 25MM,272,RC,27200722,CDM,,,,,,both,,,2890.0000,433.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,887.23,,,,,,,745.9100,2890.0000,other,"30.7% of $2,890.00 in Billed Charges for Rev 272 = $887.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC GI CATH ABLATION 25MM,272,RC,27200722,CDM,,,,,,both,,,2890.0000,433.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,933.47,,,,,,,745.9100,2890.0000,percent of total billed charges,"32.3% of $2,890.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI CATH ABLATION 25MM,272,RC,27200722,CDM,,,,,,both,,,2890.0000,433.5000,WELLCARE,WELLCARE MEDICAID,2890.00,,,,,,,745.9100,2890.0000,percent of total billed charges,"100% of $2,890.00 in Billed Charges for Rev 272 = $2,890.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI CATH ERCP METAL TIP 1415160,272,RC,27200723,CDM,,,,,,both,,,235.0000,35.2500,AETNA,AETNA,100.35,,,,,,,60.6500,235.0000,percent of total billed charges,42.7% of $235.00 in Billed Charges for Rev 272 = $100.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH ERCP METAL TIP 1415160,272,RC,27200723,CDM,,,,,,both,,,235.0000,35.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,164.50,,,,,,,60.6500,235.0000,percent of total billed charges,Rev 272 $235.00 in Billed Charges at 70% = $164.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH ERCP METAL TIP 1415160,272,RC,27200723,CDM,,,,,,both,,,235.0000,35.2500,CIGNA HEALTHCARE,CIGNA HMO,98.00,,,,,,,60.6500,235.0000,percent of total billed charges,41.7% of $235.00 in Billed Charges for Rev 272 = $98.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH ERCP METAL TIP 1415160,272,RC,27200723,CDM,,,,,,both,,,235.0000,35.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,109.04,,,,,,,60.6500,235.0000,percent of total billed charges,46.4% of $235.00 in Billed Charges for Rev 272 = $109.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH ERCP METAL TIP 1415160,272,RC,27200723,CDM,,,,,,both,,,235.0000,35.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,98.00,,,,,,,60.6500,235.0000,percent of total billed charges,41.7% of $235.00 in Billed Charges for Rev 272 = $98.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH ERCP METAL TIP 1415160,272,RC,27200723,CDM,,,,,,both,,,235.0000,35.2500,CIGNA HEALTHCARE,CIGNA PPO,98.00,,,,,,,60.6500,235.0000,percent of total billed charges,41.7% of $235.00 in Billed Charges for Rev 272 = $98.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH ERCP METAL TIP 1415160,272,RC,27200723,CDM,,,,,,both,,,235.0000,35.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,211.50,,,,,,,60.6500,235.0000,percent of total billed charges,90% of $235.00 in Billed Charges for Rev 272 = $211.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH ERCP METAL TIP 1415160,272,RC,27200723,CDM,,,,,,both,,,235.0000,35.2500,MEDCOST,MEDCOST VHN,111.84,,,,,,,60.6500,235.0000,percent of total billed charges,47.59% of $235.00 in Billed Charges for Rev 272 = $111.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH ERCP METAL TIP 1415160,272,RC,27200723,CDM,,,,,,both,,,235.0000,35.2500,SENTARA HEALTH,SENTARA HEALTH,60.65,,,,,,,60.6500,235.0000,percent of total billed charges,25.81% of $235.00 in Billed Charges for Rev 272 = $60.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH ERCP METAL TIP 1415160,272,RC,27200723,CDM,,,,,,both,,,235.0000,35.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",235.00,,,,,,,60.6500,235.0000,percent of total billed charges,100% of $235.00 in Billed Charges for Rev 272 = $235.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH ERCP METAL TIP 1415160,272,RC,27200723,CDM,,,,,,both,,,235.0000,35.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,117.50,,,,,,,60.6500,235.0000,percent of total billed charges,Rev 272 $235.00 in Billed Charges at 50% = $117.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH ERCP METAL TIP 1415160,272,RC,27200723,CDM,,,,,,both,,,235.0000,35.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,75.91,,,,,,,60.6500,235.0000,other,32.3% of $235.00 in Billed Charges for Rev 272 = $75.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI CATH ERCP METAL TIP 1415160,272,RC,27200723,CDM,,,,,,both,,,235.0000,35.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,72.15,,,,,,,60.6500,235.0000,other,30.7% of $235.00 in Billed Charges for Rev 272 = $72.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI CATH ERCP METAL TIP 1415160,272,RC,27200723,CDM,,,,,,both,,,235.0000,35.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,75.91,,,,,,,60.6500,235.0000,percent of total billed charges,32.3% of $235.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH ERCP METAL TIP 1415160,272,RC,27200723,CDM,,,,,,both,,,235.0000,35.2500,WELLCARE,WELLCARE MEDICAID,235.00,,,,,,,60.6500,235.0000,percent of total billed charges,100% of $235.00 in Billed Charges for Rev 272 = $235.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH HEMOSTASIS INTERJECT,272,RC,27200726,CDM,,,,,,both,,,207.0000,31.0500,AETNA,AETNA,88.39,,,,,,,53.4300,207.0000,percent of total billed charges,42.7% of $207.00 in Billed Charges for Rev 272 = $88.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH HEMOSTASIS INTERJECT,272,RC,27200726,CDM,,,,,,both,,,207.0000,31.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,144.90,,,,,,,53.4300,207.0000,percent of total billed charges,Rev 272 $207.00 in Billed Charges at 70% = $144.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH HEMOSTASIS INTERJECT,272,RC,27200726,CDM,,,,,,both,,,207.0000,31.0500,CIGNA HEALTHCARE,CIGNA HMO,86.32,,,,,,,53.4300,207.0000,percent of total billed charges,41.7% of $207.00 in Billed Charges for Rev 272 = $86.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH HEMOSTASIS INTERJECT,272,RC,27200726,CDM,,,,,,both,,,207.0000,31.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,96.05,,,,,,,53.4300,207.0000,percent of total billed charges,46.4% of $207.00 in Billed Charges for Rev 272 = $96.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH HEMOSTASIS INTERJECT,272,RC,27200726,CDM,,,,,,both,,,207.0000,31.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,86.32,,,,,,,53.4300,207.0000,percent of total billed charges,41.7% of $207.00 in Billed Charges for Rev 272 = $86.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH HEMOSTASIS INTERJECT,272,RC,27200726,CDM,,,,,,both,,,207.0000,31.0500,CIGNA HEALTHCARE,CIGNA PPO,86.32,,,,,,,53.4300,207.0000,percent of total billed charges,41.7% of $207.00 in Billed Charges for Rev 272 = $86.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH HEMOSTASIS INTERJECT,272,RC,27200726,CDM,,,,,,both,,,207.0000,31.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,186.30,,,,,,,53.4300,207.0000,percent of total billed charges,90% of $207.00 in Billed Charges for Rev 272 = $186.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH HEMOSTASIS INTERJECT,272,RC,27200726,CDM,,,,,,both,,,207.0000,31.0500,MEDCOST,MEDCOST VHN,98.51,,,,,,,53.4300,207.0000,percent of total billed charges,47.59% of $207.00 in Billed Charges for Rev 272 = $98.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH HEMOSTASIS INTERJECT,272,RC,27200726,CDM,,,,,,both,,,207.0000,31.0500,SENTARA HEALTH,SENTARA HEALTH,53.43,,,,,,,53.4300,207.0000,percent of total billed charges,25.81% of $207.00 in Billed Charges for Rev 272 = $53.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH HEMOSTASIS INTERJECT,272,RC,27200726,CDM,,,,,,both,,,207.0000,31.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",207.00,,,,,,,53.4300,207.0000,percent of total billed charges,100% of $207.00 in Billed Charges for Rev 272 = $207.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH HEMOSTASIS INTERJECT,272,RC,27200726,CDM,,,,,,both,,,207.0000,31.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,103.50,,,,,,,53.4300,207.0000,percent of total billed charges,Rev 272 $207.00 in Billed Charges at 50% = $103.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH HEMOSTASIS INTERJECT,272,RC,27200726,CDM,,,,,,both,,,207.0000,31.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,66.86,,,,,,,53.4300,207.0000,other,32.3% of $207.00 in Billed Charges for Rev 272 = $66.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI CATH HEMOSTASIS INTERJECT,272,RC,27200726,CDM,,,,,,both,,,207.0000,31.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,63.55,,,,,,,53.4300,207.0000,other,30.7% of $207.00 in Billed Charges for Rev 272 = $63.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI CATH HEMOSTASIS INTERJECT,272,RC,27200726,CDM,,,,,,both,,,207.0000,31.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,66.86,,,,,,,53.4300,207.0000,percent of total billed charges,32.3% of $207.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CATH HEMOSTASIS INTERJECT,272,RC,27200726,CDM,,,,,,both,,,207.0000,31.0500,WELLCARE,WELLCARE MEDICAID,207.00,,,,,,,53.4300,207.0000,percent of total billed charges,100% of $207.00 in Billed Charges for Rev 272 = $207.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CLIP RESOLUTION M00522612,272,RC,27200727,CDM,,,,,,both,,,679.0000,101.8500,AETNA,AETNA,289.93,,,,,,,175.2500,679.0000,percent of total billed charges,42.7% of $679.00 in Billed Charges for Rev 272 = $289.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CLIP RESOLUTION M00522612,272,RC,27200727,CDM,,,,,,both,,,679.0000,101.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,475.30,,,,,,,175.2500,679.0000,percent of total billed charges,Rev 272 $679.00 in Billed Charges at 70% = $475.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CLIP RESOLUTION M00522612,272,RC,27200727,CDM,,,,,,both,,,679.0000,101.8500,CIGNA HEALTHCARE,CIGNA HMO,283.14,,,,,,,175.2500,679.0000,percent of total billed charges,41.7% of $679.00 in Billed Charges for Rev 272 = $283.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CLIP RESOLUTION M00522612,272,RC,27200727,CDM,,,,,,both,,,679.0000,101.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,315.06,,,,,,,175.2500,679.0000,percent of total billed charges,46.4% of $679.00 in Billed Charges for Rev 272 = $315.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CLIP RESOLUTION M00522612,272,RC,27200727,CDM,,,,,,both,,,679.0000,101.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,283.14,,,,,,,175.2500,679.0000,percent of total billed charges,41.7% of $679.00 in Billed Charges for Rev 272 = $283.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CLIP RESOLUTION M00522612,272,RC,27200727,CDM,,,,,,both,,,679.0000,101.8500,CIGNA HEALTHCARE,CIGNA PPO,283.14,,,,,,,175.2500,679.0000,percent of total billed charges,41.7% of $679.00 in Billed Charges for Rev 272 = $283.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CLIP RESOLUTION M00522612,272,RC,27200727,CDM,,,,,,both,,,679.0000,101.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,611.10,,,,,,,175.2500,679.0000,percent of total billed charges,90% of $679.00 in Billed Charges for Rev 272 = $611.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CLIP RESOLUTION M00522612,272,RC,27200727,CDM,,,,,,both,,,679.0000,101.8500,MEDCOST,MEDCOST VHN,323.14,,,,,,,175.2500,679.0000,percent of total billed charges,47.59% of $679.00 in Billed Charges for Rev 272 = $323.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CLIP RESOLUTION M00522612,272,RC,27200727,CDM,,,,,,both,,,679.0000,101.8500,SENTARA HEALTH,SENTARA HEALTH,175.25,,,,,,,175.2500,679.0000,percent of total billed charges,25.81% of $679.00 in Billed Charges for Rev 272 = $175.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CLIP RESOLUTION M00522612,272,RC,27200727,CDM,,,,,,both,,,679.0000,101.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",679.00,,,,,,,175.2500,679.0000,percent of total billed charges,100% of $679.00 in Billed Charges for Rev 272 = $679.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CLIP RESOLUTION M00522612,272,RC,27200727,CDM,,,,,,both,,,679.0000,101.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,339.50,,,,,,,175.2500,679.0000,percent of total billed charges,Rev 272 $679.00 in Billed Charges at 50% = $339.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CLIP RESOLUTION M00522612,272,RC,27200727,CDM,,,,,,both,,,679.0000,101.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,219.32,,,,,,,175.2500,679.0000,other,32.3% of $679.00 in Billed Charges for Rev 272 = $219.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI CLIP RESOLUTION M00522612,272,RC,27200727,CDM,,,,,,both,,,679.0000,101.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,208.45,,,,,,,175.2500,679.0000,other,30.7% of $679.00 in Billed Charges for Rev 272 = $208.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI CLIP RESOLUTION M00522612,272,RC,27200727,CDM,,,,,,both,,,679.0000,101.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,219.32,,,,,,,175.2500,679.0000,percent of total billed charges,32.3% of $679.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CLIP RESOLUTION M00522612,272,RC,27200727,CDM,,,,,,both,,,679.0000,101.8500,WELLCARE,WELLCARE MEDICAID,679.00,,,,,,,175.2500,679.0000,percent of total billed charges,100% of $679.00 in Billed Charges for Rev 272 = $679.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE CLIP FIXING,272,RC,27200728,CDM,,,,,,both,,,215.0000,32.2500,AETNA,AETNA,91.81,,,,,,,55.4900,215.0000,percent of total billed charges,42.7% of $215.00 in Billed Charges for Rev 272 = $91.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE CLIP FIXING,272,RC,27200728,CDM,,,,,,both,,,215.0000,32.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,150.50,,,,,,,55.4900,215.0000,percent of total billed charges,Rev 272 $215.00 in Billed Charges at 70% = $150.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE CLIP FIXING,272,RC,27200728,CDM,,,,,,both,,,215.0000,32.2500,CIGNA HEALTHCARE,CIGNA HMO,89.66,,,,,,,55.4900,215.0000,percent of total billed charges,41.7% of $215.00 in Billed Charges for Rev 272 = $89.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE CLIP FIXING,272,RC,27200728,CDM,,,,,,both,,,215.0000,32.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,99.76,,,,,,,55.4900,215.0000,percent of total billed charges,46.4% of $215.00 in Billed Charges for Rev 272 = $99.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE CLIP FIXING,272,RC,27200728,CDM,,,,,,both,,,215.0000,32.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,89.66,,,,,,,55.4900,215.0000,percent of total billed charges,41.7% of $215.00 in Billed Charges for Rev 272 = $89.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE CLIP FIXING,272,RC,27200728,CDM,,,,,,both,,,215.0000,32.2500,CIGNA HEALTHCARE,CIGNA PPO,89.66,,,,,,,55.4900,215.0000,percent of total billed charges,41.7% of $215.00 in Billed Charges for Rev 272 = $89.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE CLIP FIXING,272,RC,27200728,CDM,,,,,,both,,,215.0000,32.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,193.50,,,,,,,55.4900,215.0000,percent of total billed charges,90% of $215.00 in Billed Charges for Rev 272 = $193.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE CLIP FIXING,272,RC,27200728,CDM,,,,,,both,,,215.0000,32.2500,MEDCOST,MEDCOST VHN,102.32,,,,,,,55.4900,215.0000,percent of total billed charges,47.59% of $215.00 in Billed Charges for Rev 272 = $102.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE CLIP FIXING,272,RC,27200728,CDM,,,,,,both,,,215.0000,32.2500,SENTARA HEALTH,SENTARA HEALTH,55.49,,,,,,,55.4900,215.0000,percent of total billed charges,25.81% of $215.00 in Billed Charges for Rev 272 = $55.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE CLIP FIXING,272,RC,27200728,CDM,,,,,,both,,,215.0000,32.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",215.00,,,,,,,55.4900,215.0000,percent of total billed charges,100% of $215.00 in Billed Charges for Rev 272 = $215.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE CLIP FIXING,272,RC,27200728,CDM,,,,,,both,,,215.0000,32.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,107.50,,,,,,,55.4900,215.0000,percent of total billed charges,Rev 272 $215.00 in Billed Charges at 50% = $107.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE CLIP FIXING,272,RC,27200728,CDM,,,,,,both,,,215.0000,32.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,69.45,,,,,,,55.4900,215.0000,other,32.3% of $215.00 in Billed Charges for Rev 272 = $69.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI DEVICE CLIP FIXING,272,RC,27200728,CDM,,,,,,both,,,215.0000,32.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,66.01,,,,,,,55.4900,215.0000,other,30.7% of $215.00 in Billed Charges for Rev 272 = $66.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI DEVICE CLIP FIXING,272,RC,27200728,CDM,,,,,,both,,,215.0000,32.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,69.45,,,,,,,55.4900,215.0000,percent of total billed charges,32.3% of $215.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE CLIP FIXING,272,RC,27200728,CDM,,,,,,both,,,215.0000,32.2500,WELLCARE,WELLCARE MEDICAID,215.00,,,,,,,55.4900,215.0000,percent of total billed charges,100% of $215.00 in Billed Charges for Rev 272 = $215.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE ENDO LOOP DISP,272,RC,27200729,CDM,,,,,,both,,,414.0000,62.1000,AETNA,AETNA,176.78,,,,,,,106.8500,414.0000,percent of total billed charges,42.7% of $414.00 in Billed Charges for Rev 272 = $176.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE ENDO LOOP DISP,272,RC,27200729,CDM,,,,,,both,,,414.0000,62.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,289.80,,,,,,,106.8500,414.0000,percent of total billed charges,Rev 272 $414.00 in Billed Charges at 70% = $289.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE ENDO LOOP DISP,272,RC,27200729,CDM,,,,,,both,,,414.0000,62.1000,CIGNA HEALTHCARE,CIGNA HMO,172.64,,,,,,,106.8500,414.0000,percent of total billed charges,41.7% of $414.00 in Billed Charges for Rev 272 = $172.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE ENDO LOOP DISP,272,RC,27200729,CDM,,,,,,both,,,414.0000,62.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,192.10,,,,,,,106.8500,414.0000,percent of total billed charges,46.4% of $414.00 in Billed Charges for Rev 272 = $192.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE ENDO LOOP DISP,272,RC,27200729,CDM,,,,,,both,,,414.0000,62.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,172.64,,,,,,,106.8500,414.0000,percent of total billed charges,41.7% of $414.00 in Billed Charges for Rev 272 = $172.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE ENDO LOOP DISP,272,RC,27200729,CDM,,,,,,both,,,414.0000,62.1000,CIGNA HEALTHCARE,CIGNA PPO,172.64,,,,,,,106.8500,414.0000,percent of total billed charges,41.7% of $414.00 in Billed Charges for Rev 272 = $172.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE ENDO LOOP DISP,272,RC,27200729,CDM,,,,,,both,,,414.0000,62.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,372.60,,,,,,,106.8500,414.0000,percent of total billed charges,90% of $414.00 in Billed Charges for Rev 272 = $372.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE ENDO LOOP DISP,272,RC,27200729,CDM,,,,,,both,,,414.0000,62.1000,MEDCOST,MEDCOST VHN,197.02,,,,,,,106.8500,414.0000,percent of total billed charges,47.59% of $414.00 in Billed Charges for Rev 272 = $197.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE ENDO LOOP DISP,272,RC,27200729,CDM,,,,,,both,,,414.0000,62.1000,SENTARA HEALTH,SENTARA HEALTH,106.85,,,,,,,106.8500,414.0000,percent of total billed charges,25.81% of $414.00 in Billed Charges for Rev 272 = $106.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE ENDO LOOP DISP,272,RC,27200729,CDM,,,,,,both,,,414.0000,62.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",414.00,,,,,,,106.8500,414.0000,percent of total billed charges,100% of $414.00 in Billed Charges for Rev 272 = $414.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE ENDO LOOP DISP,272,RC,27200729,CDM,,,,,,both,,,414.0000,62.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,207.00,,,,,,,106.8500,414.0000,percent of total billed charges,Rev 272 $414.00 in Billed Charges at 50% = $207.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE ENDO LOOP DISP,272,RC,27200729,CDM,,,,,,both,,,414.0000,62.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,133.72,,,,,,,106.8500,414.0000,other,32.3% of $414.00 in Billed Charges for Rev 272 = $133.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI DEVICE ENDO LOOP DISP,272,RC,27200729,CDM,,,,,,both,,,414.0000,62.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,127.10,,,,,,,106.8500,414.0000,other,30.7% of $414.00 in Billed Charges for Rev 272 = $127.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI DEVICE ENDO LOOP DISP,272,RC,27200729,CDM,,,,,,both,,,414.0000,62.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,133.72,,,,,,,106.8500,414.0000,percent of total billed charges,32.3% of $414.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI DEVICE ENDO LOOP DISP,272,RC,27200729,CDM,,,,,,both,,,414.0000,62.1000,WELLCARE,WELLCARE MEDICAID,414.00,,,,,,,106.8500,414.0000,percent of total billed charges,100% of $414.00 in Billed Charges for Rev 272 = $414.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW LG CAPAC,272,RC,27200734,CDM,,,,,,both,,,391.0000,58.6500,AETNA,AETNA,166.96,,,,,,,100.9200,391.0000,percent of total billed charges,42.7% of $391.00 in Billed Charges for Rev 272 = $166.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW LG CAPAC,272,RC,27200734,CDM,,,,,,both,,,391.0000,58.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,273.70,,,,,,,100.9200,391.0000,percent of total billed charges,Rev 272 $391.00 in Billed Charges at 70% = $273.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW LG CAPAC,272,RC,27200734,CDM,,,,,,both,,,391.0000,58.6500,CIGNA HEALTHCARE,CIGNA HMO,163.05,,,,,,,100.9200,391.0000,percent of total billed charges,41.7% of $391.00 in Billed Charges for Rev 272 = $163.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW LG CAPAC,272,RC,27200734,CDM,,,,,,both,,,391.0000,58.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,181.42,,,,,,,100.9200,391.0000,percent of total billed charges,46.4% of $391.00 in Billed Charges for Rev 272 = $181.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW LG CAPAC,272,RC,27200734,CDM,,,,,,both,,,391.0000,58.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,163.05,,,,,,,100.9200,391.0000,percent of total billed charges,41.7% of $391.00 in Billed Charges for Rev 272 = $163.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW LG CAPAC,272,RC,27200734,CDM,,,,,,both,,,391.0000,58.6500,CIGNA HEALTHCARE,CIGNA PPO,163.05,,,,,,,100.9200,391.0000,percent of total billed charges,41.7% of $391.00 in Billed Charges for Rev 272 = $163.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW LG CAPAC,272,RC,27200734,CDM,,,,,,both,,,391.0000,58.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,351.90,,,,,,,100.9200,391.0000,percent of total billed charges,90% of $391.00 in Billed Charges for Rev 272 = $351.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW LG CAPAC,272,RC,27200734,CDM,,,,,,both,,,391.0000,58.6500,MEDCOST,MEDCOST VHN,186.08,,,,,,,100.9200,391.0000,percent of total billed charges,47.59% of $391.00 in Billed Charges for Rev 272 = $186.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW LG CAPAC,272,RC,27200734,CDM,,,,,,both,,,391.0000,58.6500,SENTARA HEALTH,SENTARA HEALTH,100.92,,,,,,,100.9200,391.0000,percent of total billed charges,25.81% of $391.00 in Billed Charges for Rev 272 = $100.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW LG CAPAC,272,RC,27200734,CDM,,,,,,both,,,391.0000,58.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",391.00,,,,,,,100.9200,391.0000,percent of total billed charges,100% of $391.00 in Billed Charges for Rev 272 = $391.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW LG CAPAC,272,RC,27200734,CDM,,,,,,both,,,391.0000,58.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,195.50,,,,,,,100.9200,391.0000,percent of total billed charges,Rev 272 $391.00 in Billed Charges at 50% = $195.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW LG CAPAC,272,RC,27200734,CDM,,,,,,both,,,391.0000,58.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,126.29,,,,,,,100.9200,391.0000,other,32.3% of $391.00 in Billed Charges for Rev 272 = $126.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI FORCEP RADIAL JAW LG CAPAC,272,RC,27200734,CDM,,,,,,both,,,391.0000,58.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,120.04,,,,,,,100.9200,391.0000,other,30.7% of $391.00 in Billed Charges for Rev 272 = $120.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI FORCEP RADIAL JAW LG CAPAC,272,RC,27200734,CDM,,,,,,both,,,391.0000,58.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,126.29,,,,,,,100.9200,391.0000,percent of total billed charges,32.3% of $391.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW LG CAPAC,272,RC,27200734,CDM,,,,,,both,,,391.0000,58.6500,WELLCARE,WELLCARE MEDICAID,391.00,,,,,,,100.9200,391.0000,percent of total billed charges,100% of $391.00 in Billed Charges for Rev 272 = $391.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW W NEEDLE,272,RC,27200735,CDM,,,,,,both,,,132.0000,19.8000,AETNA,AETNA,56.36,,,,,,,34.0700,132.0000,percent of total billed charges,42.7% of $132.00 in Billed Charges for Rev 272 = $56.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW W NEEDLE,272,RC,27200735,CDM,,,,,,both,,,132.0000,19.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,92.40,,,,,,,34.0700,132.0000,percent of total billed charges,Rev 272 $132.00 in Billed Charges at 70% = $92.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW W NEEDLE,272,RC,27200735,CDM,,,,,,both,,,132.0000,19.8000,CIGNA HEALTHCARE,CIGNA HMO,55.04,,,,,,,34.0700,132.0000,percent of total billed charges,41.7% of $132.00 in Billed Charges for Rev 272 = $55.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW W NEEDLE,272,RC,27200735,CDM,,,,,,both,,,132.0000,19.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,61.25,,,,,,,34.0700,132.0000,percent of total billed charges,46.4% of $132.00 in Billed Charges for Rev 272 = $61.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW W NEEDLE,272,RC,27200735,CDM,,,,,,both,,,132.0000,19.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,55.04,,,,,,,34.0700,132.0000,percent of total billed charges,41.7% of $132.00 in Billed Charges for Rev 272 = $55.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW W NEEDLE,272,RC,27200735,CDM,,,,,,both,,,132.0000,19.8000,CIGNA HEALTHCARE,CIGNA PPO,55.04,,,,,,,34.0700,132.0000,percent of total billed charges,41.7% of $132.00 in Billed Charges for Rev 272 = $55.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW W NEEDLE,272,RC,27200735,CDM,,,,,,both,,,132.0000,19.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,118.80,,,,,,,34.0700,132.0000,percent of total billed charges,90% of $132.00 in Billed Charges for Rev 272 = $118.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW W NEEDLE,272,RC,27200735,CDM,,,,,,both,,,132.0000,19.8000,MEDCOST,MEDCOST VHN,62.82,,,,,,,34.0700,132.0000,percent of total billed charges,47.59% of $132.00 in Billed Charges for Rev 272 = $62.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW W NEEDLE,272,RC,27200735,CDM,,,,,,both,,,132.0000,19.8000,SENTARA HEALTH,SENTARA HEALTH,34.07,,,,,,,34.0700,132.0000,percent of total billed charges,25.81% of $132.00 in Billed Charges for Rev 272 = $34.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW W NEEDLE,272,RC,27200735,CDM,,,,,,both,,,132.0000,19.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",132.00,,,,,,,34.0700,132.0000,percent of total billed charges,100% of $132.00 in Billed Charges for Rev 272 = $132.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW W NEEDLE,272,RC,27200735,CDM,,,,,,both,,,132.0000,19.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,66.00,,,,,,,34.0700,132.0000,percent of total billed charges,Rev 272 $132.00 in Billed Charges at 50% = $66.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW W NEEDLE,272,RC,27200735,CDM,,,,,,both,,,132.0000,19.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,42.64,,,,,,,34.0700,132.0000,other,32.3% of $132.00 in Billed Charges for Rev 272 = $42.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI FORCEP RADIAL JAW W NEEDLE,272,RC,27200735,CDM,,,,,,both,,,132.0000,19.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,40.52,,,,,,,34.0700,132.0000,other,30.7% of $132.00 in Billed Charges for Rev 272 = $40.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI FORCEP RADIAL JAW W NEEDLE,272,RC,27200735,CDM,,,,,,both,,,132.0000,19.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,42.64,,,,,,,34.0700,132.0000,percent of total billed charges,32.3% of $132.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW W NEEDLE,272,RC,27200735,CDM,,,,,,both,,,132.0000,19.8000,WELLCARE,WELLCARE MEDICAID,132.00,,,,,,,34.0700,132.0000,percent of total billed charges,100% of $132.00 in Billed Charges for Rev 272 = $132.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI GUIDEWIRE ACCESS 2H 1415518,270,RC,27000093,CDM,,,,,,both,,,438.0000,65.7000,AETNA,AETNA,187.03,,,,,,,113.0500,438.0000,percent of total billed charges,42.7% of $438.00 in Billed Charges for Rev 270 = $187.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI GUIDEWIRE ACCESS 2H 1415518,270,RC,27000093,CDM,,,,,,both,,,438.0000,65.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,306.60,,,,,,,113.0500,438.0000,percent of total billed charges,Rev 270 $438.00 in Billed Charges at 70% = $306.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI GUIDEWIRE ACCESS 2H 1415518,270,RC,27000093,CDM,,,,,,both,,,438.0000,65.7000,CIGNA HEALTHCARE,CIGNA HMO,182.65,,,,,,,113.0500,438.0000,percent of total billed charges,41.7% of $438.00 in Billed Charges for Rev 270 = $182.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI GUIDEWIRE ACCESS 2H 1415518,270,RC,27000093,CDM,,,,,,both,,,438.0000,65.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,203.23,,,,,,,113.0500,438.0000,percent of total billed charges,46.4% of $438.00 in Billed Charges for Rev 270 = $203.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI GUIDEWIRE ACCESS 2H 1415518,270,RC,27000093,CDM,,,,,,both,,,438.0000,65.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,182.65,,,,,,,113.0500,438.0000,percent of total billed charges,41.7% of $438.00 in Billed Charges for Rev 270 = $182.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI GUIDEWIRE ACCESS 2H 1415518,270,RC,27000093,CDM,,,,,,both,,,438.0000,65.7000,CIGNA HEALTHCARE,CIGNA PPO,182.65,,,,,,,113.0500,438.0000,percent of total billed charges,41.7% of $438.00 in Billed Charges for Rev 270 = $182.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI GUIDEWIRE ACCESS 2H 1415518,270,RC,27000093,CDM,,,,,,both,,,438.0000,65.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,394.20,,,,,,,113.0500,438.0000,percent of total billed charges,90% of $438.00 in Billed Charges for Rev 270 = $394.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI GUIDEWIRE ACCESS 2H 1415518,270,RC,27000093,CDM,,,,,,both,,,438.0000,65.7000,MEDCOST,MEDCOST VHN,208.44,,,,,,,113.0500,438.0000,percent of total billed charges,47.59% of $438.00 in Billed Charges for Rev 270 = $208.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI GUIDEWIRE ACCESS 2H 1415518,270,RC,27000093,CDM,,,,,,both,,,438.0000,65.7000,SENTARA HEALTH,SENTARA HEALTH,113.05,,,,,,,113.0500,438.0000,percent of total billed charges,25.81% of $438.00 in Billed Charges for Rev 270 = $113.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI GUIDEWIRE ACCESS 2H 1415518,270,RC,27000093,CDM,,,,,,both,,,438.0000,65.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",438.00,,,,,,,113.0500,438.0000,percent of total billed charges,100% of $438.00 in Billed Charges for Rev 270 = $438.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI GUIDEWIRE ACCESS 2H 1415518,270,RC,27000093,CDM,,,,,,both,,,438.0000,65.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,219.00,,,,,,,113.0500,438.0000,percent of total billed charges,Rev 270 $438.00 in Billed Charges at 50% = $219.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI GUIDEWIRE ACCESS 2H 1415518,270,RC,27000093,CDM,,,,,,both,,,438.0000,65.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,141.47,,,,,,,113.0500,438.0000,other,32.3% of $438.00 in Billed Charges for Rev 270 = $141.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI GUIDEWIRE ACCESS 2H 1415518,270,RC,27000093,CDM,,,,,,both,,,438.0000,65.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,134.47,,,,,,,113.0500,438.0000,other,30.7% of $438.00 in Billed Charges for Rev 270 = $134.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI GUIDEWIRE ACCESS 2H 1415518,270,RC,27000093,CDM,,,,,,both,,,438.0000,65.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,141.47,,,,,,,113.0500,438.0000,percent of total billed charges,32.3% of $438.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI GUIDEWIRE ACCESS 2H 1415518,270,RC,27000093,CDM,,,,,,both,,,438.0000,65.7000,WELLCARE,WELLCARE MEDICAID,438.00,,,,,,,113.0500,438.0000,percent of total billed charges,100% of $438.00 in Billed Charges for Rev 270 = $438.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRODOME G-TUBE,270,RC,27000108,CDM,,,,,,both,,,487.0000,73.0500,AETNA,AETNA,207.95,,,,,,,125.6900,487.0000,percent of total billed charges,42.7% of $487.00 in Billed Charges for Rev 270 = $207.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRODOME G-TUBE,270,RC,27000108,CDM,,,,,,both,,,487.0000,73.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,340.90,,,,,,,125.6900,487.0000,percent of total billed charges,Rev 270 $487.00 in Billed Charges at 70% = $340.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRODOME G-TUBE,270,RC,27000108,CDM,,,,,,both,,,487.0000,73.0500,CIGNA HEALTHCARE,CIGNA HMO,203.08,,,,,,,125.6900,487.0000,percent of total billed charges,41.7% of $487.00 in Billed Charges for Rev 270 = $203.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRODOME G-TUBE,270,RC,27000108,CDM,,,,,,both,,,487.0000,73.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,225.97,,,,,,,125.6900,487.0000,percent of total billed charges,46.4% of $487.00 in Billed Charges for Rev 270 = $225.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRODOME G-TUBE,270,RC,27000108,CDM,,,,,,both,,,487.0000,73.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,203.08,,,,,,,125.6900,487.0000,percent of total billed charges,41.7% of $487.00 in Billed Charges for Rev 270 = $203.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRODOME G-TUBE,270,RC,27000108,CDM,,,,,,both,,,487.0000,73.0500,CIGNA HEALTHCARE,CIGNA PPO,203.08,,,,,,,125.6900,487.0000,percent of total billed charges,41.7% of $487.00 in Billed Charges for Rev 270 = $203.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRODOME G-TUBE,270,RC,27000108,CDM,,,,,,both,,,487.0000,73.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,438.30,,,,,,,125.6900,487.0000,percent of total billed charges,90% of $487.00 in Billed Charges for Rev 270 = $438.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRODOME G-TUBE,270,RC,27000108,CDM,,,,,,both,,,487.0000,73.0500,MEDCOST,MEDCOST VHN,231.76,,,,,,,125.6900,487.0000,percent of total billed charges,47.59% of $487.00 in Billed Charges for Rev 270 = $231.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRODOME G-TUBE,270,RC,27000108,CDM,,,,,,both,,,487.0000,73.0500,SENTARA HEALTH,SENTARA HEALTH,125.69,,,,,,,125.6900,487.0000,percent of total billed charges,25.81% of $487.00 in Billed Charges for Rev 270 = $125.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRODOME G-TUBE,270,RC,27000108,CDM,,,,,,both,,,487.0000,73.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",487.00,,,,,,,125.6900,487.0000,percent of total billed charges,100% of $487.00 in Billed Charges for Rev 270 = $487.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRODOME G-TUBE,270,RC,27000108,CDM,,,,,,both,,,487.0000,73.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,243.50,,,,,,,125.6900,487.0000,percent of total billed charges,Rev 270 $487.00 in Billed Charges at 50% = $243.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRODOME G-TUBE,270,RC,27000108,CDM,,,,,,both,,,487.0000,73.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,157.30,,,,,,,125.6900,487.0000,other,32.3% of $487.00 in Billed Charges for Rev 270 = $157.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI KIT GASTRODOME G-TUBE,270,RC,27000108,CDM,,,,,,both,,,487.0000,73.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,149.51,,,,,,,125.6900,487.0000,other,30.7% of $487.00 in Billed Charges for Rev 270 = $149.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI KIT GASTRODOME G-TUBE,270,RC,27000108,CDM,,,,,,both,,,487.0000,73.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,157.30,,,,,,,125.6900,487.0000,percent of total billed charges,32.3% of $487.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRODOME G-TUBE,270,RC,27000108,CDM,,,,,,both,,,487.0000,73.0500,WELLCARE,WELLCARE MEDICAID,487.00,,,,,,,125.6900,487.0000,percent of total billed charges,100% of $487.00 in Billed Charges for Rev 270 = $487.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT INFLATION GUN ALLIANCE,270,RC,27000098,CDM,,,,,,both,,,186.0000,27.9000,AETNA,AETNA,79.42,,,,,,,48.0100,186.0000,percent of total billed charges,42.7% of $186.00 in Billed Charges for Rev 270 = $79.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT INFLATION GUN ALLIANCE,270,RC,27000098,CDM,,,,,,both,,,186.0000,27.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,130.20,,,,,,,48.0100,186.0000,percent of total billed charges,Rev 270 $186.00 in Billed Charges at 70% = $130.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT INFLATION GUN ALLIANCE,270,RC,27000098,CDM,,,,,,both,,,186.0000,27.9000,CIGNA HEALTHCARE,CIGNA HMO,77.56,,,,,,,48.0100,186.0000,percent of total billed charges,41.7% of $186.00 in Billed Charges for Rev 270 = $77.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT INFLATION GUN ALLIANCE,270,RC,27000098,CDM,,,,,,both,,,186.0000,27.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,86.30,,,,,,,48.0100,186.0000,percent of total billed charges,46.4% of $186.00 in Billed Charges for Rev 270 = $86.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT INFLATION GUN ALLIANCE,270,RC,27000098,CDM,,,,,,both,,,186.0000,27.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,77.56,,,,,,,48.0100,186.0000,percent of total billed charges,41.7% of $186.00 in Billed Charges for Rev 270 = $77.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT INFLATION GUN ALLIANCE,270,RC,27000098,CDM,,,,,,both,,,186.0000,27.9000,CIGNA HEALTHCARE,CIGNA PPO,77.56,,,,,,,48.0100,186.0000,percent of total billed charges,41.7% of $186.00 in Billed Charges for Rev 270 = $77.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT INFLATION GUN ALLIANCE,270,RC,27000098,CDM,,,,,,both,,,186.0000,27.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,167.40,,,,,,,48.0100,186.0000,percent of total billed charges,90% of $186.00 in Billed Charges for Rev 270 = $167.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT INFLATION GUN ALLIANCE,270,RC,27000098,CDM,,,,,,both,,,186.0000,27.9000,MEDCOST,MEDCOST VHN,88.52,,,,,,,48.0100,186.0000,percent of total billed charges,47.59% of $186.00 in Billed Charges for Rev 270 = $88.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT INFLATION GUN ALLIANCE,270,RC,27000098,CDM,,,,,,both,,,186.0000,27.9000,SENTARA HEALTH,SENTARA HEALTH,48.01,,,,,,,48.0100,186.0000,percent of total billed charges,25.81% of $186.00 in Billed Charges for Rev 270 = $48.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT INFLATION GUN ALLIANCE,270,RC,27000098,CDM,,,,,,both,,,186.0000,27.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",186.00,,,,,,,48.0100,186.0000,percent of total billed charges,100% of $186.00 in Billed Charges for Rev 270 = $186.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT INFLATION GUN ALLIANCE,270,RC,27000098,CDM,,,,,,both,,,186.0000,27.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,93.00,,,,,,,48.0100,186.0000,percent of total billed charges,Rev 270 $186.00 in Billed Charges at 50% = $93.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT INFLATION GUN ALLIANCE,270,RC,27000098,CDM,,,,,,both,,,186.0000,27.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,60.08,,,,,,,48.0100,186.0000,other,32.3% of $186.00 in Billed Charges for Rev 270 = $60.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI KIT INFLATION GUN ALLIANCE,270,RC,27000098,CDM,,,,,,both,,,186.0000,27.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,57.10,,,,,,,48.0100,186.0000,other,30.7% of $186.00 in Billed Charges for Rev 270 = $57.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI KIT INFLATION GUN ALLIANCE,270,RC,27000098,CDM,,,,,,both,,,186.0000,27.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,60.08,,,,,,,48.0100,186.0000,percent of total billed charges,32.3% of $186.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT INFLATION GUN ALLIANCE,270,RC,27000098,CDM,,,,,,both,,,186.0000,27.9000,WELLCARE,WELLCARE MEDICAID,186.00,,,,,,,48.0100,186.0000,percent of total billed charges,100% of $186.00 in Billed Charges for Rev 270 = $186.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT JEJUNAL FEEDING 1415111,270,RC,27000091,CDM,,,,,,both,,,290.0000,43.5000,AETNA,AETNA,123.83,,,,,,,74.8500,290.0000,percent of total billed charges,42.7% of $290.00 in Billed Charges for Rev 270 = $123.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT JEJUNAL FEEDING 1415111,270,RC,27000091,CDM,,,,,,both,,,290.0000,43.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,203.00,,,,,,,74.8500,290.0000,percent of total billed charges,Rev 270 $290.00 in Billed Charges at 70% = $203.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT JEJUNAL FEEDING 1415111,270,RC,27000091,CDM,,,,,,both,,,290.0000,43.5000,CIGNA HEALTHCARE,CIGNA HMO,120.93,,,,,,,74.8500,290.0000,percent of total billed charges,41.7% of $290.00 in Billed Charges for Rev 270 = $120.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT JEJUNAL FEEDING 1415111,270,RC,27000091,CDM,,,,,,both,,,290.0000,43.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,134.56,,,,,,,74.8500,290.0000,percent of total billed charges,46.4% of $290.00 in Billed Charges for Rev 270 = $134.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT JEJUNAL FEEDING 1415111,270,RC,27000091,CDM,,,,,,both,,,290.0000,43.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,120.93,,,,,,,74.8500,290.0000,percent of total billed charges,41.7% of $290.00 in Billed Charges for Rev 270 = $120.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT JEJUNAL FEEDING 1415111,270,RC,27000091,CDM,,,,,,both,,,290.0000,43.5000,CIGNA HEALTHCARE,CIGNA PPO,120.93,,,,,,,74.8500,290.0000,percent of total billed charges,41.7% of $290.00 in Billed Charges for Rev 270 = $120.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT JEJUNAL FEEDING 1415111,270,RC,27000091,CDM,,,,,,both,,,290.0000,43.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,261.00,,,,,,,74.8500,290.0000,percent of total billed charges,90% of $290.00 in Billed Charges for Rev 270 = $261.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT JEJUNAL FEEDING 1415111,270,RC,27000091,CDM,,,,,,both,,,290.0000,43.5000,MEDCOST,MEDCOST VHN,138.01,,,,,,,74.8500,290.0000,percent of total billed charges,47.59% of $290.00 in Billed Charges for Rev 270 = $138.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT JEJUNAL FEEDING 1415111,270,RC,27000091,CDM,,,,,,both,,,290.0000,43.5000,SENTARA HEALTH,SENTARA HEALTH,74.85,,,,,,,74.8500,290.0000,percent of total billed charges,25.81% of $290.00 in Billed Charges for Rev 270 = $74.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT JEJUNAL FEEDING 1415111,270,RC,27000091,CDM,,,,,,both,,,290.0000,43.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",290.00,,,,,,,74.8500,290.0000,percent of total billed charges,100% of $290.00 in Billed Charges for Rev 270 = $290.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT JEJUNAL FEEDING 1415111,270,RC,27000091,CDM,,,,,,both,,,290.0000,43.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,145.00,,,,,,,74.8500,290.0000,percent of total billed charges,Rev 270 $290.00 in Billed Charges at 50% = $145.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT JEJUNAL FEEDING 1415111,270,RC,27000091,CDM,,,,,,both,,,290.0000,43.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,93.67,,,,,,,74.8500,290.0000,other,32.3% of $290.00 in Billed Charges for Rev 270 = $93.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI KIT JEJUNAL FEEDING 1415111,270,RC,27000091,CDM,,,,,,both,,,290.0000,43.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,89.03,,,,,,,74.8500,290.0000,other,30.7% of $290.00 in Billed Charges for Rev 270 = $89.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI KIT JEJUNAL FEEDING 1415111,270,RC,27000091,CDM,,,,,,both,,,290.0000,43.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,93.67,,,,,,,74.8500,290.0000,percent of total billed charges,32.3% of $290.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT JEJUNAL FEEDING 1415111,270,RC,27000091,CDM,,,,,,both,,,290.0000,43.5000,WELLCARE,WELLCARE MEDICAID,290.00,,,,,,,74.8500,290.0000,percent of total billed charges,100% of $290.00 in Billed Charges for Rev 270 = $290.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT LIGATOR SIX SHOOTER MBL-6,270,RC,27000120,CDM,,,,,,both,,,890.0000,133.5000,AETNA,AETNA,380.03,,,,,,,229.7100,890.0000,percent of total billed charges,42.7% of $890.00 in Billed Charges for Rev 270 = $380.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT LIGATOR SIX SHOOTER MBL-6,270,RC,27000120,CDM,,,,,,both,,,890.0000,133.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,623.00,,,,,,,229.7100,890.0000,percent of total billed charges,Rev 270 $890.00 in Billed Charges at 70% = $623.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT LIGATOR SIX SHOOTER MBL-6,270,RC,27000120,CDM,,,,,,both,,,890.0000,133.5000,CIGNA HEALTHCARE,CIGNA HMO,371.13,,,,,,,229.7100,890.0000,percent of total billed charges,41.7% of $890.00 in Billed Charges for Rev 270 = $371.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT LIGATOR SIX SHOOTER MBL-6,270,RC,27000120,CDM,,,,,,both,,,890.0000,133.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,412.96,,,,,,,229.7100,890.0000,percent of total billed charges,46.4% of $890.00 in Billed Charges for Rev 270 = $412.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT LIGATOR SIX SHOOTER MBL-6,270,RC,27000120,CDM,,,,,,both,,,890.0000,133.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,371.13,,,,,,,229.7100,890.0000,percent of total billed charges,41.7% of $890.00 in Billed Charges for Rev 270 = $371.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT LIGATOR SIX SHOOTER MBL-6,270,RC,27000120,CDM,,,,,,both,,,890.0000,133.5000,CIGNA HEALTHCARE,CIGNA PPO,371.13,,,,,,,229.7100,890.0000,percent of total billed charges,41.7% of $890.00 in Billed Charges for Rev 270 = $371.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT LIGATOR SIX SHOOTER MBL-6,270,RC,27000120,CDM,,,,,,both,,,890.0000,133.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,801.00,,,,,,,229.7100,890.0000,percent of total billed charges,90% of $890.00 in Billed Charges for Rev 270 = $801.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT LIGATOR SIX SHOOTER MBL-6,270,RC,27000120,CDM,,,,,,both,,,890.0000,133.5000,MEDCOST,MEDCOST VHN,423.55,,,,,,,229.7100,890.0000,percent of total billed charges,47.59% of $890.00 in Billed Charges for Rev 270 = $423.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT LIGATOR SIX SHOOTER MBL-6,270,RC,27000120,CDM,,,,,,both,,,890.0000,133.5000,SENTARA HEALTH,SENTARA HEALTH,229.71,,,,,,,229.7100,890.0000,percent of total billed charges,25.81% of $890.00 in Billed Charges for Rev 270 = $229.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT LIGATOR SIX SHOOTER MBL-6,270,RC,27000120,CDM,,,,,,both,,,890.0000,133.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",890.00,,,,,,,229.7100,890.0000,percent of total billed charges,100% of $890.00 in Billed Charges for Rev 270 = $890.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT LIGATOR SIX SHOOTER MBL-6,270,RC,27000120,CDM,,,,,,both,,,890.0000,133.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,445.00,,,,,,,229.7100,890.0000,percent of total billed charges,Rev 270 $890.00 in Billed Charges at 50% = $445.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT LIGATOR SIX SHOOTER MBL-6,270,RC,27000120,CDM,,,,,,both,,,890.0000,133.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,287.47,,,,,,,229.7100,890.0000,other,32.3% of $890.00 in Billed Charges for Rev 270 = $287.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI KIT LIGATOR SIX SHOOTER MBL-6,270,RC,27000120,CDM,,,,,,both,,,890.0000,133.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,273.23,,,,,,,229.7100,890.0000,other,30.7% of $890.00 in Billed Charges for Rev 270 = $273.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI KIT LIGATOR SIX SHOOTER MBL-6,270,RC,27000120,CDM,,,,,,both,,,890.0000,133.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,287.47,,,,,,,229.7100,890.0000,percent of total billed charges,32.3% of $890.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT LIGATOR SIX SHOOTER MBL-6,270,RC,27000120,CDM,,,,,,both,,,890.0000,133.5000,WELLCARE,WELLCARE MEDICAID,890.00,,,,,,,229.7100,890.0000,percent of total billed charges,100% of $890.00 in Billed Charges for Rev 270 = $890.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT PEG 20FR SAFETY PULL #6672,270,RC,27000122,CDM,,,,,,both,,,875.0000,131.2500,AETNA,AETNA,373.63,,,,,,,225.8400,875.0000,percent of total billed charges,42.7% of $875.00 in Billed Charges for Rev 270 = $373.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT PEG 20FR SAFETY PULL #6672,270,RC,27000122,CDM,,,,,,both,,,875.0000,131.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,612.50,,,,,,,225.8400,875.0000,percent of total billed charges,Rev 270 $875.00 in Billed Charges at 70% = $612.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT PEG 20FR SAFETY PULL #6672,270,RC,27000122,CDM,,,,,,both,,,875.0000,131.2500,CIGNA HEALTHCARE,CIGNA HMO,364.88,,,,,,,225.8400,875.0000,percent of total billed charges,41.7% of $875.00 in Billed Charges for Rev 270 = $364.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT PEG 20FR SAFETY PULL #6672,270,RC,27000122,CDM,,,,,,both,,,875.0000,131.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,406.00,,,,,,,225.8400,875.0000,percent of total billed charges,46.4% of $875.00 in Billed Charges for Rev 270 = $406.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT PEG 20FR SAFETY PULL #6672,270,RC,27000122,CDM,,,,,,both,,,875.0000,131.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,364.88,,,,,,,225.8400,875.0000,percent of total billed charges,41.7% of $875.00 in Billed Charges for Rev 270 = $364.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT PEG 20FR SAFETY PULL #6672,270,RC,27000122,CDM,,,,,,both,,,875.0000,131.2500,CIGNA HEALTHCARE,CIGNA PPO,364.88,,,,,,,225.8400,875.0000,percent of total billed charges,41.7% of $875.00 in Billed Charges for Rev 270 = $364.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT PEG 20FR SAFETY PULL #6672,270,RC,27000122,CDM,,,,,,both,,,875.0000,131.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,787.50,,,,,,,225.8400,875.0000,percent of total billed charges,90% of $875.00 in Billed Charges for Rev 270 = $787.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT PEG 20FR SAFETY PULL #6672,270,RC,27000122,CDM,,,,,,both,,,875.0000,131.2500,MEDCOST,MEDCOST VHN,416.41,,,,,,,225.8400,875.0000,percent of total billed charges,47.59% of $875.00 in Billed Charges for Rev 270 = $416.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT PEG 20FR SAFETY PULL #6672,270,RC,27000122,CDM,,,,,,both,,,875.0000,131.2500,SENTARA HEALTH,SENTARA HEALTH,225.84,,,,,,,225.8400,875.0000,percent of total billed charges,25.81% of $875.00 in Billed Charges for Rev 270 = $225.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT PEG 20FR SAFETY PULL #6672,270,RC,27000122,CDM,,,,,,both,,,875.0000,131.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",875.00,,,,,,,225.8400,875.0000,percent of total billed charges,100% of $875.00 in Billed Charges for Rev 270 = $875.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT PEG 20FR SAFETY PULL #6672,270,RC,27000122,CDM,,,,,,both,,,875.0000,131.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,437.50,,,,,,,225.8400,875.0000,percent of total billed charges,Rev 270 $875.00 in Billed Charges at 50% = $437.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT PEG 20FR SAFETY PULL #6672,270,RC,27000122,CDM,,,,,,both,,,875.0000,131.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,282.63,,,,,,,225.8400,875.0000,other,32.3% of $875.00 in Billed Charges for Rev 270 = $282.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI KIT PEG 20FR SAFETY PULL #6672,270,RC,27000122,CDM,,,,,,both,,,875.0000,131.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,268.63,,,,,,,225.8400,875.0000,other,30.7% of $875.00 in Billed Charges for Rev 270 = $268.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI KIT PEG 20FR SAFETY PULL #6672,270,RC,27000122,CDM,,,,,,both,,,875.0000,131.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,282.63,,,,,,,225.8400,875.0000,percent of total billed charges,32.3% of $875.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT PEG 20FR SAFETY PULL #6672,270,RC,27000122,CDM,,,,,,both,,,875.0000,131.2500,WELLCARE,WELLCARE MEDICAID,875.00,,,,,,,225.8400,875.0000,percent of total billed charges,100% of $875.00 in Billed Charges for Rev 270 = $875.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI LIGATOR SUPERVIEW 7 M00542253,272,RC,27200745,CDM,,,,,,both,,,768.0000,115.2000,AETNA,AETNA,327.94,,,,,,,198.2200,768.0000,percent of total billed charges,42.7% of $768.00 in Billed Charges for Rev 272 = $327.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI LIGATOR SUPERVIEW 7 M00542253,272,RC,27200745,CDM,,,,,,both,,,768.0000,115.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,537.60,,,,,,,198.2200,768.0000,percent of total billed charges,Rev 272 $768.00 in Billed Charges at 70% = $537.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI LIGATOR SUPERVIEW 7 M00542253,272,RC,27200745,CDM,,,,,,both,,,768.0000,115.2000,CIGNA HEALTHCARE,CIGNA HMO,320.26,,,,,,,198.2200,768.0000,percent of total billed charges,41.7% of $768.00 in Billed Charges for Rev 272 = $320.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI LIGATOR SUPERVIEW 7 M00542253,272,RC,27200745,CDM,,,,,,both,,,768.0000,115.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,356.35,,,,,,,198.2200,768.0000,percent of total billed charges,46.4% of $768.00 in Billed Charges for Rev 272 = $356.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI LIGATOR SUPERVIEW 7 M00542253,272,RC,27200745,CDM,,,,,,both,,,768.0000,115.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,320.26,,,,,,,198.2200,768.0000,percent of total billed charges,41.7% of $768.00 in Billed Charges for Rev 272 = $320.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI LIGATOR SUPERVIEW 7 M00542253,272,RC,27200745,CDM,,,,,,both,,,768.0000,115.2000,CIGNA HEALTHCARE,CIGNA PPO,320.26,,,,,,,198.2200,768.0000,percent of total billed charges,41.7% of $768.00 in Billed Charges for Rev 272 = $320.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI LIGATOR SUPERVIEW 7 M00542253,272,RC,27200745,CDM,,,,,,both,,,768.0000,115.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,691.20,,,,,,,198.2200,768.0000,percent of total billed charges,90% of $768.00 in Billed Charges for Rev 272 = $691.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI LIGATOR SUPERVIEW 7 M00542253,272,RC,27200745,CDM,,,,,,both,,,768.0000,115.2000,MEDCOST,MEDCOST VHN,365.49,,,,,,,198.2200,768.0000,percent of total billed charges,47.59% of $768.00 in Billed Charges for Rev 272 = $365.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI LIGATOR SUPERVIEW 7 M00542253,272,RC,27200745,CDM,,,,,,both,,,768.0000,115.2000,SENTARA HEALTH,SENTARA HEALTH,198.22,,,,,,,198.2200,768.0000,percent of total billed charges,25.81% of $768.00 in Billed Charges for Rev 272 = $198.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI LIGATOR SUPERVIEW 7 M00542253,272,RC,27200745,CDM,,,,,,both,,,768.0000,115.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",768.00,,,,,,,198.2200,768.0000,percent of total billed charges,100% of $768.00 in Billed Charges for Rev 272 = $768.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI LIGATOR SUPERVIEW 7 M00542253,272,RC,27200745,CDM,,,,,,both,,,768.0000,115.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,384.00,,,,,,,198.2200,768.0000,percent of total billed charges,Rev 272 $768.00 in Billed Charges at 50% = $384.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI LIGATOR SUPERVIEW 7 M00542253,272,RC,27200745,CDM,,,,,,both,,,768.0000,115.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,248.06,,,,,,,198.2200,768.0000,other,32.3% of $768.00 in Billed Charges for Rev 272 = $248.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI LIGATOR SUPERVIEW 7 M00542253,272,RC,27200745,CDM,,,,,,both,,,768.0000,115.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,235.78,,,,,,,198.2200,768.0000,other,30.7% of $768.00 in Billed Charges for Rev 272 = $235.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI LIGATOR SUPERVIEW 7 M00542253,272,RC,27200745,CDM,,,,,,both,,,768.0000,115.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,248.06,,,,,,,198.2200,768.0000,percent of total billed charges,32.3% of $768.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI LIGATOR SUPERVIEW 7 M00542253,272,RC,27200745,CDM,,,,,,both,,,768.0000,115.2000,WELLCARE,WELLCARE MEDICAID,768.00,,,,,,,198.2200,768.0000,percent of total billed charges,100% of $768.00 in Billed Charges for Rev 272 = $768.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE INTRODUCER HBIN-22,272,RC,27200746,CDM,,,,,,both,,,327.0000,49.0500,AETNA,AETNA,139.63,,,,,,,84.4000,327.0000,percent of total billed charges,42.7% of $327.00 in Billed Charges for Rev 272 = $139.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE INTRODUCER HBIN-22,272,RC,27200746,CDM,,,,,,both,,,327.0000,49.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,228.90,,,,,,,84.4000,327.0000,percent of total billed charges,Rev 272 $327.00 in Billed Charges at 70% = $228.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE INTRODUCER HBIN-22,272,RC,27200746,CDM,,,,,,both,,,327.0000,49.0500,CIGNA HEALTHCARE,CIGNA HMO,136.36,,,,,,,84.4000,327.0000,percent of total billed charges,41.7% of $327.00 in Billed Charges for Rev 272 = $136.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE INTRODUCER HBIN-22,272,RC,27200746,CDM,,,,,,both,,,327.0000,49.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,151.73,,,,,,,84.4000,327.0000,percent of total billed charges,46.4% of $327.00 in Billed Charges for Rev 272 = $151.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE INTRODUCER HBIN-22,272,RC,27200746,CDM,,,,,,both,,,327.0000,49.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,136.36,,,,,,,84.4000,327.0000,percent of total billed charges,41.7% of $327.00 in Billed Charges for Rev 272 = $136.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE INTRODUCER HBIN-22,272,RC,27200746,CDM,,,,,,both,,,327.0000,49.0500,CIGNA HEALTHCARE,CIGNA PPO,136.36,,,,,,,84.4000,327.0000,percent of total billed charges,41.7% of $327.00 in Billed Charges for Rev 272 = $136.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE INTRODUCER HBIN-22,272,RC,27200746,CDM,,,,,,both,,,327.0000,49.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,294.30,,,,,,,84.4000,327.0000,percent of total billed charges,90% of $327.00 in Billed Charges for Rev 272 = $294.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE INTRODUCER HBIN-22,272,RC,27200746,CDM,,,,,,both,,,327.0000,49.0500,MEDCOST,MEDCOST VHN,155.62,,,,,,,84.4000,327.0000,percent of total billed charges,47.59% of $327.00 in Billed Charges for Rev 272 = $155.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE INTRODUCER HBIN-22,272,RC,27200746,CDM,,,,,,both,,,327.0000,49.0500,SENTARA HEALTH,SENTARA HEALTH,84.40,,,,,,,84.4000,327.0000,percent of total billed charges,25.81% of $327.00 in Billed Charges for Rev 272 = $84.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE INTRODUCER HBIN-22,272,RC,27200746,CDM,,,,,,both,,,327.0000,49.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",327.00,,,,,,,84.4000,327.0000,percent of total billed charges,100% of $327.00 in Billed Charges for Rev 272 = $327.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE INTRODUCER HBIN-22,272,RC,27200746,CDM,,,,,,both,,,327.0000,49.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,163.50,,,,,,,84.4000,327.0000,percent of total billed charges,Rev 272 $327.00 in Billed Charges at 50% = $163.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE INTRODUCER HBIN-22,272,RC,27200746,CDM,,,,,,both,,,327.0000,49.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,105.62,,,,,,,84.4000,327.0000,other,32.3% of $327.00 in Billed Charges for Rev 272 = $105.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI NEEDLE INTRODUCER HBIN-22,272,RC,27200746,CDM,,,,,,both,,,327.0000,49.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,100.39,,,,,,,84.4000,327.0000,other,30.7% of $327.00 in Billed Charges for Rev 272 = $100.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI NEEDLE INTRODUCER HBIN-22,272,RC,27200746,CDM,,,,,,both,,,327.0000,49.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,105.62,,,,,,,84.4000,327.0000,percent of total billed charges,32.3% of $327.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE INTRODUCER HBIN-22,272,RC,27200746,CDM,,,,,,both,,,327.0000,49.0500,WELLCARE,WELLCARE MEDICAID,327.00,,,,,,,84.4000,327.0000,percent of total billed charges,100% of $327.00 in Billed Charges for Rev 272 = $327.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE SCLEROTHERAPY VARIJECT,272,RC,27200747,CDM,,,,,,both,,,202.0000,30.3000,AETNA,AETNA,86.25,,,,,,,52.1400,202.0000,percent of total billed charges,42.7% of $202.00 in Billed Charges for Rev 272 = $86.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE SCLEROTHERAPY VARIJECT,272,RC,27200747,CDM,,,,,,both,,,202.0000,30.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,141.40,,,,,,,52.1400,202.0000,percent of total billed charges,Rev 272 $202.00 in Billed Charges at 70% = $141.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE SCLEROTHERAPY VARIJECT,272,RC,27200747,CDM,,,,,,both,,,202.0000,30.3000,CIGNA HEALTHCARE,CIGNA HMO,84.23,,,,,,,52.1400,202.0000,percent of total billed charges,41.7% of $202.00 in Billed Charges for Rev 272 = $84.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE SCLEROTHERAPY VARIJECT,272,RC,27200747,CDM,,,,,,both,,,202.0000,30.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,93.73,,,,,,,52.1400,202.0000,percent of total billed charges,46.4% of $202.00 in Billed Charges for Rev 272 = $93.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE SCLEROTHERAPY VARIJECT,272,RC,27200747,CDM,,,,,,both,,,202.0000,30.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,84.23,,,,,,,52.1400,202.0000,percent of total billed charges,41.7% of $202.00 in Billed Charges for Rev 272 = $84.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE SCLEROTHERAPY VARIJECT,272,RC,27200747,CDM,,,,,,both,,,202.0000,30.3000,CIGNA HEALTHCARE,CIGNA PPO,84.23,,,,,,,52.1400,202.0000,percent of total billed charges,41.7% of $202.00 in Billed Charges for Rev 272 = $84.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE SCLEROTHERAPY VARIJECT,272,RC,27200747,CDM,,,,,,both,,,202.0000,30.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,181.80,,,,,,,52.1400,202.0000,percent of total billed charges,90% of $202.00 in Billed Charges for Rev 272 = $181.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE SCLEROTHERAPY VARIJECT,272,RC,27200747,CDM,,,,,,both,,,202.0000,30.3000,MEDCOST,MEDCOST VHN,96.13,,,,,,,52.1400,202.0000,percent of total billed charges,47.59% of $202.00 in Billed Charges for Rev 272 = $96.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE SCLEROTHERAPY VARIJECT,272,RC,27200747,CDM,,,,,,both,,,202.0000,30.3000,SENTARA HEALTH,SENTARA HEALTH,52.14,,,,,,,52.1400,202.0000,percent of total billed charges,25.81% of $202.00 in Billed Charges for Rev 272 = $52.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE SCLEROTHERAPY VARIJECT,272,RC,27200747,CDM,,,,,,both,,,202.0000,30.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",202.00,,,,,,,52.1400,202.0000,percent of total billed charges,100% of $202.00 in Billed Charges for Rev 272 = $202.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE SCLEROTHERAPY VARIJECT,272,RC,27200747,CDM,,,,,,both,,,202.0000,30.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,101.00,,,,,,,52.1400,202.0000,percent of total billed charges,Rev 272 $202.00 in Billed Charges at 50% = $101.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE SCLEROTHERAPY VARIJECT,272,RC,27200747,CDM,,,,,,both,,,202.0000,30.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,65.25,,,,,,,52.1400,202.0000,other,32.3% of $202.00 in Billed Charges for Rev 272 = $65.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI NEEDLE SCLEROTHERAPY VARIJECT,272,RC,27200747,CDM,,,,,,both,,,202.0000,30.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,62.01,,,,,,,52.1400,202.0000,other,30.7% of $202.00 in Billed Charges for Rev 272 = $62.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI NEEDLE SCLEROTHERAPY VARIJECT,272,RC,27200747,CDM,,,,,,both,,,202.0000,30.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,65.25,,,,,,,52.1400,202.0000,percent of total billed charges,32.3% of $202.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE SCLEROTHERAPY VARIJECT,272,RC,27200747,CDM,,,,,,both,,,202.0000,30.3000,WELLCARE,WELLCARE MEDICAID,202.00,,,,,,,52.1400,202.0000,percent of total billed charges,100% of $202.00 in Billed Charges for Rev 272 = $202.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 4.5F 300CM 219,272,RC,27200750,CDM,,,,,,both,,,982.0000,147.3000,AETNA,AETNA,419.31,,,,,,,253.4500,982.0000,percent of total billed charges,42.7% of $982.00 in Billed Charges for Rev 272 = $419.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 4.5F 300CM 219,272,RC,27200750,CDM,,,,,,both,,,982.0000,147.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,687.40,,,,,,,253.4500,982.0000,percent of total billed charges,Rev 272 $982.00 in Billed Charges at 70% = $687.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 4.5F 300CM 219,272,RC,27200750,CDM,,,,,,both,,,982.0000,147.3000,CIGNA HEALTHCARE,CIGNA HMO,409.49,,,,,,,253.4500,982.0000,percent of total billed charges,41.7% of $982.00 in Billed Charges for Rev 272 = $409.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 4.5F 300CM 219,272,RC,27200750,CDM,,,,,,both,,,982.0000,147.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,455.65,,,,,,,253.4500,982.0000,percent of total billed charges,46.4% of $982.00 in Billed Charges for Rev 272 = $455.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 4.5F 300CM 219,272,RC,27200750,CDM,,,,,,both,,,982.0000,147.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,409.49,,,,,,,253.4500,982.0000,percent of total billed charges,41.7% of $982.00 in Billed Charges for Rev 272 = $409.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 4.5F 300CM 219,272,RC,27200750,CDM,,,,,,both,,,982.0000,147.3000,CIGNA HEALTHCARE,CIGNA PPO,409.49,,,,,,,253.4500,982.0000,percent of total billed charges,41.7% of $982.00 in Billed Charges for Rev 272 = $409.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 4.5F 300CM 219,272,RC,27200750,CDM,,,,,,both,,,982.0000,147.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,883.80,,,,,,,253.4500,982.0000,percent of total billed charges,90% of $982.00 in Billed Charges for Rev 272 = $883.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 4.5F 300CM 219,272,RC,27200750,CDM,,,,,,both,,,982.0000,147.3000,MEDCOST,MEDCOST VHN,467.33,,,,,,,253.4500,982.0000,percent of total billed charges,47.59% of $982.00 in Billed Charges for Rev 272 = $467.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 4.5F 300CM 219,272,RC,27200750,CDM,,,,,,both,,,982.0000,147.3000,SENTARA HEALTH,SENTARA HEALTH,253.45,,,,,,,253.4500,982.0000,percent of total billed charges,25.81% of $982.00 in Billed Charges for Rev 272 = $253.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 4.5F 300CM 219,272,RC,27200750,CDM,,,,,,both,,,982.0000,147.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",982.00,,,,,,,253.4500,982.0000,percent of total billed charges,100% of $982.00 in Billed Charges for Rev 272 = $982.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 4.5F 300CM 219,272,RC,27200750,CDM,,,,,,both,,,982.0000,147.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,491.00,,,,,,,253.4500,982.0000,percent of total billed charges,Rev 272 $982.00 in Billed Charges at 50% = $491.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 4.5F 300CM 219,272,RC,27200750,CDM,,,,,,both,,,982.0000,147.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,317.19,,,,,,,253.4500,982.0000,other,32.3% of $982.00 in Billed Charges for Rev 272 = $317.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI PROBE ARGON 4.5F 300CM 219,272,RC,27200750,CDM,,,,,,both,,,982.0000,147.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,301.47,,,,,,,253.4500,982.0000,other,30.7% of $982.00 in Billed Charges for Rev 272 = $301.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI PROBE ARGON 4.5F 300CM 219,272,RC,27200750,CDM,,,,,,both,,,982.0000,147.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,317.19,,,,,,,253.4500,982.0000,percent of total billed charges,32.3% of $982.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 4.5F 300CM 219,272,RC,27200750,CDM,,,,,,both,,,982.0000,147.3000,WELLCARE,WELLCARE MEDICAID,982.00,,,,,,,253.4500,982.0000,percent of total billed charges,100% of $982.00 in Billed Charges for Rev 272 = $982.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL GALACTO 90BENT 30GA GIU30,272,RC,27200945,CDM,,,,,,both,,,120.0000,18.0000,AETNA,AETNA,51.24,,,,,,,30.9700,120.0000,percent of total billed charges,42.7% of $120.00 in Billed Charges for Rev 272 = $51.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL GALACTO 90BENT 30GA GIU30,272,RC,27200945,CDM,,,,,,both,,,120.0000,18.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,84.00,,,,,,,30.9700,120.0000,percent of total billed charges,Rev 272 $120.00 in Billed Charges at 70% = $84.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL GALACTO 90BENT 30GA GIU30,272,RC,27200945,CDM,,,,,,both,,,120.0000,18.0000,CIGNA HEALTHCARE,CIGNA HMO,50.04,,,,,,,30.9700,120.0000,percent of total billed charges,41.7% of $120.00 in Billed Charges for Rev 272 = $50.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL GALACTO 90BENT 30GA GIU30,272,RC,27200945,CDM,,,,,,both,,,120.0000,18.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,55.68,,,,,,,30.9700,120.0000,percent of total billed charges,46.4% of $120.00 in Billed Charges for Rev 272 = $55.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL GALACTO 90BENT 30GA GIU30,272,RC,27200945,CDM,,,,,,both,,,120.0000,18.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,50.04,,,,,,,30.9700,120.0000,percent of total billed charges,41.7% of $120.00 in Billed Charges for Rev 272 = $50.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL GALACTO 90BENT 30GA GIU30,272,RC,27200945,CDM,,,,,,both,,,120.0000,18.0000,CIGNA HEALTHCARE,CIGNA PPO,50.04,,,,,,,30.9700,120.0000,percent of total billed charges,41.7% of $120.00 in Billed Charges for Rev 272 = $50.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL GALACTO 90BENT 30GA GIU30,272,RC,27200945,CDM,,,,,,both,,,120.0000,18.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,108.00,,,,,,,30.9700,120.0000,percent of total billed charges,90% of $120.00 in Billed Charges for Rev 272 = $108.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL GALACTO 90BENT 30GA GIU30,272,RC,27200945,CDM,,,,,,both,,,120.0000,18.0000,MEDCOST,MEDCOST VHN,57.11,,,,,,,30.9700,120.0000,percent of total billed charges,47.59% of $120.00 in Billed Charges for Rev 272 = $57.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL GALACTO 90BENT 30GA GIU30,272,RC,27200945,CDM,,,,,,both,,,120.0000,18.0000,SENTARA HEALTH,SENTARA HEALTH,30.97,,,,,,,30.9700,120.0000,percent of total billed charges,25.81% of $120.00 in Billed Charges for Rev 272 = $30.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL GALACTO 90BENT 30GA GIU30,272,RC,27200945,CDM,,,,,,both,,,120.0000,18.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",120.00,,,,,,,30.9700,120.0000,percent of total billed charges,100% of $120.00 in Billed Charges for Rev 272 = $120.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL GALACTO 90BENT 30GA GIU30,272,RC,27200945,CDM,,,,,,both,,,120.0000,18.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,60.00,,,,,,,30.9700,120.0000,percent of total billed charges,Rev 272 $120.00 in Billed Charges at 50% = $60.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL GALACTO 90BENT 30GA GIU30,272,RC,27200945,CDM,,,,,,both,,,120.0000,18.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,38.76,,,,,,,30.9700,120.0000,other,32.3% of $120.00 in Billed Charges for Rev 272 = $38.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NDL GALACTO 90BENT 30GA GIU30,272,RC,27200945,CDM,,,,,,both,,,120.0000,18.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,36.84,,,,,,,30.9700,120.0000,other,30.7% of $120.00 in Billed Charges for Rev 272 = $36.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NDL GALACTO 90BENT 30GA GIU30,272,RC,27200945,CDM,,,,,,both,,,120.0000,18.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,38.76,,,,,,,30.9700,120.0000,percent of total billed charges,32.3% of $120.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL GALACTO 90BENT 30GA GIU30,272,RC,27200945,CDM,,,,,,both,,,120.0000,18.0000,WELLCARE,WELLCARE MEDICAID,120.00,,,,,,,30.9700,120.0000,percent of total billed charges,100% of $120.00 in Billed Charges for Rev 272 = $120.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 5FR MICROPUNCTURE,272,RC,27200948,CDM,,,,,,both,,,123.0000,18.4500,AETNA,AETNA,52.52,,,,,,,31.7500,123.0000,percent of total billed charges,42.7% of $123.00 in Billed Charges for Rev 272 = $52.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 5FR MICROPUNCTURE,272,RC,27200948,CDM,,,,,,both,,,123.0000,18.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,86.10,,,,,,,31.7500,123.0000,percent of total billed charges,Rev 272 $123.00 in Billed Charges at 70% = $86.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 5FR MICROPUNCTURE,272,RC,27200948,CDM,,,,,,both,,,123.0000,18.4500,CIGNA HEALTHCARE,CIGNA HMO,51.29,,,,,,,31.7500,123.0000,percent of total billed charges,41.7% of $123.00 in Billed Charges for Rev 272 = $51.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 5FR MICROPUNCTURE,272,RC,27200948,CDM,,,,,,both,,,123.0000,18.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,57.07,,,,,,,31.7500,123.0000,percent of total billed charges,46.4% of $123.00 in Billed Charges for Rev 272 = $57.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 5FR MICROPUNCTURE,272,RC,27200948,CDM,,,,,,both,,,123.0000,18.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,51.29,,,,,,,31.7500,123.0000,percent of total billed charges,41.7% of $123.00 in Billed Charges for Rev 272 = $51.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 5FR MICROPUNCTURE,272,RC,27200948,CDM,,,,,,both,,,123.0000,18.4500,CIGNA HEALTHCARE,CIGNA PPO,51.29,,,,,,,31.7500,123.0000,percent of total billed charges,41.7% of $123.00 in Billed Charges for Rev 272 = $51.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 5FR MICROPUNCTURE,272,RC,27200948,CDM,,,,,,both,,,123.0000,18.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,110.70,,,,,,,31.7500,123.0000,percent of total billed charges,90% of $123.00 in Billed Charges for Rev 272 = $110.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 5FR MICROPUNCTURE,272,RC,27200948,CDM,,,,,,both,,,123.0000,18.4500,MEDCOST,MEDCOST VHN,58.54,,,,,,,31.7500,123.0000,percent of total billed charges,47.59% of $123.00 in Billed Charges for Rev 272 = $58.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 5FR MICROPUNCTURE,272,RC,27200948,CDM,,,,,,both,,,123.0000,18.4500,SENTARA HEALTH,SENTARA HEALTH,31.75,,,,,,,31.7500,123.0000,percent of total billed charges,25.81% of $123.00 in Billed Charges for Rev 272 = $31.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 5FR MICROPUNCTURE,272,RC,27200948,CDM,,,,,,both,,,123.0000,18.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",123.00,,,,,,,31.7500,123.0000,percent of total billed charges,100% of $123.00 in Billed Charges for Rev 272 = $123.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 5FR MICROPUNCTURE,272,RC,27200948,CDM,,,,,,both,,,123.0000,18.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,61.50,,,,,,,31.7500,123.0000,percent of total billed charges,Rev 272 $123.00 in Billed Charges at 50% = $61.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 5FR MICROPUNCTURE,272,RC,27200948,CDM,,,,,,both,,,123.0000,18.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,39.73,,,,,,,31.7500,123.0000,other,32.3% of $123.00 in Billed Charges for Rev 272 = $39.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE 5FR MICROPUNCTURE,272,RC,27200948,CDM,,,,,,both,,,123.0000,18.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,37.76,,,,,,,31.7500,123.0000,other,30.7% of $123.00 in Billed Charges for Rev 272 = $37.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE 5FR MICROPUNCTURE,272,RC,27200948,CDM,,,,,,both,,,123.0000,18.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,39.73,,,,,,,31.7500,123.0000,percent of total billed charges,32.3% of $123.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 5FR MICROPUNCTURE,272,RC,27200948,CDM,,,,,,both,,,123.0000,18.4500,WELLCARE,WELLCARE MEDICAID,123.00,,,,,,,31.7500,123.0000,percent of total billed charges,100% of $123.00 in Billed Charges for Rev 272 = $123.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING NASOPORE 8CM,272,RC,27200002,CDM,,,,,,both,,,2312.6300,346.8900,AETNA,AETNA,987.49,,,,,,,596.8900,2312.6300,percent of total billed charges,"42.7% of $2,312.63 in Billed Charges for Rev 272 = $987.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM,272,RC,27200002,CDM,,,,,,both,,,2312.6300,346.8900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1618.84,,,,,,,596.8900,2312.6300,percent of total billed charges,"Rev 272 $2,312.63 in Billed Charges at 70% = $1,618.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM,272,RC,27200002,CDM,,,,,,both,,,2312.6300,346.8900,CIGNA HEALTHCARE,CIGNA HMO,964.37,,,,,,,596.8900,2312.6300,percent of total billed charges,"41.7% of $2,312.63 in Billed Charges for Rev 272 = $964.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM,272,RC,27200002,CDM,,,,,,both,,,2312.6300,346.8900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1073.06,,,,,,,596.8900,2312.6300,percent of total billed charges,"46.4% of $2,312.63 in Billed Charges for Rev 272 = $1,073.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM,272,RC,27200002,CDM,,,,,,both,,,2312.6300,346.8900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,964.37,,,,,,,596.8900,2312.6300,percent of total billed charges,"41.7% of $2,312.63 in Billed Charges for Rev 272 = $964.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM,272,RC,27200002,CDM,,,,,,both,,,2312.6300,346.8900,CIGNA HEALTHCARE,CIGNA PPO,964.37,,,,,,,596.8900,2312.6300,percent of total billed charges,"41.7% of $2,312.63 in Billed Charges for Rev 272 = $964.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM,272,RC,27200002,CDM,,,,,,both,,,2312.6300,346.8900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2081.37,,,,,,,596.8900,2312.6300,percent of total billed charges,"90% of $2,312.63 in Billed Charges for Rev 272 = $2,081.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM,272,RC,27200002,CDM,,,,,,both,,,2312.6300,346.8900,MEDCOST,MEDCOST VHN,1100.58,,,,,,,596.8900,2312.6300,percent of total billed charges,"47.59% of $2,312.63 in Billed Charges for Rev 272 = $1,100.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM,272,RC,27200002,CDM,,,,,,both,,,2312.6300,346.8900,SENTARA HEALTH,SENTARA HEALTH,596.89,,,,,,,596.8900,2312.6300,percent of total billed charges,"25.81% of $2,312.63 in Billed Charges for Rev 272 = $596.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM,272,RC,27200002,CDM,,,,,,both,,,2312.6300,346.8900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2312.63,,,,,,,596.8900,2312.6300,percent of total billed charges,"100% of $2,312.63 in Billed Charges for Rev 272 = $2,312.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM,272,RC,27200002,CDM,,,,,,both,,,2312.6300,346.8900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1156.32,,,,,,,596.8900,2312.6300,percent of total billed charges,"Rev 272 $2,312.63 in Billed Charges at 50% = $1,156.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM,272,RC,27200002,CDM,,,,,,both,,,2312.6300,346.8900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,746.98,,,,,,,596.8900,2312.6300,other,"32.3% of $2,312.63 in Billed Charges for Rev 272 = $746.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING NASOPORE 8CM,272,RC,27200002,CDM,,,,,,both,,,2312.6300,346.8900,UNITED HEALTHCARE,UHC HERITAGE SELECT,709.98,,,,,,,596.8900,2312.6300,other,"30.7% of $2,312.63 in Billed Charges for Rev 272 = $709.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING NASOPORE 8CM,272,RC,27200002,CDM,,,,,,both,,,2312.6300,346.8900,UNITED HEALTHCARE,UNITED HEALTHCARE,746.98,,,,,,,596.8900,2312.6300,percent of total billed charges,"32.3% of $2,312.63 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING NASOPORE 8CM,272,RC,27200002,CDM,,,,,,both,,,2312.6300,346.8900,WELLCARE,WELLCARE MEDICAID,2312.63,,,,,,,596.8900,2312.6300,percent of total billed charges,"100% of $2,312.63 in Billed Charges for Rev 272 = $2,312.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE BIOPSY,272,RC,27200950,CDM,,,,,,both,,,110.0000,16.5000,AETNA,AETNA,46.97,,,,,,,28.3900,110.0000,percent of total billed charges,42.7% of $110.00 in Billed Charges for Rev 272 = $46.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY,272,RC,27200950,CDM,,,,,,both,,,110.0000,16.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,77.00,,,,,,,28.3900,110.0000,percent of total billed charges,Rev 272 $110.00 in Billed Charges at 70% = $77.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY,272,RC,27200950,CDM,,,,,,both,,,110.0000,16.5000,CIGNA HEALTHCARE,CIGNA HMO,45.87,,,,,,,28.3900,110.0000,percent of total billed charges,41.7% of $110.00 in Billed Charges for Rev 272 = $45.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY,272,RC,27200950,CDM,,,,,,both,,,110.0000,16.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,51.04,,,,,,,28.3900,110.0000,percent of total billed charges,46.4% of $110.00 in Billed Charges for Rev 272 = $51.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY,272,RC,27200950,CDM,,,,,,both,,,110.0000,16.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,45.87,,,,,,,28.3900,110.0000,percent of total billed charges,41.7% of $110.00 in Billed Charges for Rev 272 = $45.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY,272,RC,27200950,CDM,,,,,,both,,,110.0000,16.5000,CIGNA HEALTHCARE,CIGNA PPO,45.87,,,,,,,28.3900,110.0000,percent of total billed charges,41.7% of $110.00 in Billed Charges for Rev 272 = $45.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY,272,RC,27200950,CDM,,,,,,both,,,110.0000,16.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,99.00,,,,,,,28.3900,110.0000,percent of total billed charges,90% of $110.00 in Billed Charges for Rev 272 = $99.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY,272,RC,27200950,CDM,,,,,,both,,,110.0000,16.5000,MEDCOST,MEDCOST VHN,52.35,,,,,,,28.3900,110.0000,percent of total billed charges,47.59% of $110.00 in Billed Charges for Rev 272 = $52.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY,272,RC,27200950,CDM,,,,,,both,,,110.0000,16.5000,SENTARA HEALTH,SENTARA HEALTH,28.39,,,,,,,28.3900,110.0000,percent of total billed charges,25.81% of $110.00 in Billed Charges for Rev 272 = $28.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY,272,RC,27200950,CDM,,,,,,both,,,110.0000,16.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",110.00,,,,,,,28.3900,110.0000,percent of total billed charges,100% of $110.00 in Billed Charges for Rev 272 = $110.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY,272,RC,27200950,CDM,,,,,,both,,,110.0000,16.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,55.00,,,,,,,28.3900,110.0000,percent of total billed charges,Rev 272 $110.00 in Billed Charges at 50% = $55.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY,272,RC,27200950,CDM,,,,,,both,,,110.0000,16.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,35.53,,,,,,,28.3900,110.0000,other,32.3% of $110.00 in Billed Charges for Rev 272 = $35.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE BIOPSY,272,RC,27200950,CDM,,,,,,both,,,110.0000,16.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,33.77,,,,,,,28.3900,110.0000,other,30.7% of $110.00 in Billed Charges for Rev 272 = $33.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE BIOPSY,272,RC,27200950,CDM,,,,,,both,,,110.0000,16.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,35.53,,,,,,,28.3900,110.0000,percent of total billed charges,32.3% of $110.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY,272,RC,27200950,CDM,,,,,,both,,,110.0000,16.5000,WELLCARE,WELLCARE MEDICAID,110.00,,,,,,,28.3900,110.0000,percent of total billed charges,100% of $110.00 in Billed Charges for Rev 272 = $110.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X09,272,RC,27200951,CDM,,,,,,both,,,102.0000,15.3000,AETNA,AETNA,43.55,,,,,,,26.3300,102.0000,percent of total billed charges,42.7% of $102.00 in Billed Charges for Rev 272 = $43.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X09,272,RC,27200951,CDM,,,,,,both,,,102.0000,15.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,71.40,,,,,,,26.3300,102.0000,percent of total billed charges,Rev 272 $102.00 in Billed Charges at 70% = $71.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X09,272,RC,27200951,CDM,,,,,,both,,,102.0000,15.3000,CIGNA HEALTHCARE,CIGNA HMO,42.53,,,,,,,26.3300,102.0000,percent of total billed charges,41.7% of $102.00 in Billed Charges for Rev 272 = $42.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X09,272,RC,27200951,CDM,,,,,,both,,,102.0000,15.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,47.33,,,,,,,26.3300,102.0000,percent of total billed charges,46.4% of $102.00 in Billed Charges for Rev 272 = $47.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X09,272,RC,27200951,CDM,,,,,,both,,,102.0000,15.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,42.53,,,,,,,26.3300,102.0000,percent of total billed charges,41.7% of $102.00 in Billed Charges for Rev 272 = $42.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X09,272,RC,27200951,CDM,,,,,,both,,,102.0000,15.3000,CIGNA HEALTHCARE,CIGNA PPO,42.53,,,,,,,26.3300,102.0000,percent of total billed charges,41.7% of $102.00 in Billed Charges for Rev 272 = $42.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X09,272,RC,27200951,CDM,,,,,,both,,,102.0000,15.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,91.80,,,,,,,26.3300,102.0000,percent of total billed charges,90% of $102.00 in Billed Charges for Rev 272 = $91.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X09,272,RC,27200951,CDM,,,,,,both,,,102.0000,15.3000,MEDCOST,MEDCOST VHN,48.54,,,,,,,26.3300,102.0000,percent of total billed charges,47.59% of $102.00 in Billed Charges for Rev 272 = $48.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X09,272,RC,27200951,CDM,,,,,,both,,,102.0000,15.3000,SENTARA HEALTH,SENTARA HEALTH,26.33,,,,,,,26.3300,102.0000,percent of total billed charges,25.81% of $102.00 in Billed Charges for Rev 272 = $26.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X09,272,RC,27200951,CDM,,,,,,both,,,102.0000,15.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",102.00,,,,,,,26.3300,102.0000,percent of total billed charges,100% of $102.00 in Billed Charges for Rev 272 = $102.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X09,272,RC,27200951,CDM,,,,,,both,,,102.0000,15.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,51.00,,,,,,,26.3300,102.0000,percent of total billed charges,Rev 272 $102.00 in Billed Charges at 50% = $51.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X09,272,RC,27200951,CDM,,,,,,both,,,102.0000,15.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,32.95,,,,,,,26.3300,102.0000,other,32.3% of $102.00 in Billed Charges for Rev 272 = $32.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE BIOPSY CHIBA 22X09,272,RC,27200951,CDM,,,,,,both,,,102.0000,15.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,31.31,,,,,,,26.3300,102.0000,other,30.7% of $102.00 in Billed Charges for Rev 272 = $31.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE BIOPSY CHIBA 22X09,272,RC,27200951,CDM,,,,,,both,,,102.0000,15.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,32.95,,,,,,,26.3300,102.0000,percent of total billed charges,32.3% of $102.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X09,272,RC,27200951,CDM,,,,,,both,,,102.0000,15.3000,WELLCARE,WELLCARE MEDICAID,102.00,,,,,,,26.3300,102.0000,percent of total billed charges,100% of $102.00 in Billed Charges for Rev 272 = $102.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM BIOPINCE,272,RC,27200954,CDM,,,,,,both,,,245.0000,36.7500,AETNA,AETNA,104.62,,,,,,,63.2300,245.0000,percent of total billed charges,42.7% of $245.00 in Billed Charges for Rev 272 = $104.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM BIOPINCE,272,RC,27200954,CDM,,,,,,both,,,245.0000,36.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,171.50,,,,,,,63.2300,245.0000,percent of total billed charges,Rev 272 $245.00 in Billed Charges at 70% = $171.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM BIOPINCE,272,RC,27200954,CDM,,,,,,both,,,245.0000,36.7500,CIGNA HEALTHCARE,CIGNA HMO,102.17,,,,,,,63.2300,245.0000,percent of total billed charges,41.7% of $245.00 in Billed Charges for Rev 272 = $102.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM BIOPINCE,272,RC,27200954,CDM,,,,,,both,,,245.0000,36.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,113.68,,,,,,,63.2300,245.0000,percent of total billed charges,46.4% of $245.00 in Billed Charges for Rev 272 = $113.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM BIOPINCE,272,RC,27200954,CDM,,,,,,both,,,245.0000,36.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,102.17,,,,,,,63.2300,245.0000,percent of total billed charges,41.7% of $245.00 in Billed Charges for Rev 272 = $102.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM BIOPINCE,272,RC,27200954,CDM,,,,,,both,,,245.0000,36.7500,CIGNA HEALTHCARE,CIGNA PPO,102.17,,,,,,,63.2300,245.0000,percent of total billed charges,41.7% of $245.00 in Billed Charges for Rev 272 = $102.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM BIOPINCE,272,RC,27200954,CDM,,,,,,both,,,245.0000,36.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,220.50,,,,,,,63.2300,245.0000,percent of total billed charges,90% of $245.00 in Billed Charges for Rev 272 = $220.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM BIOPINCE,272,RC,27200954,CDM,,,,,,both,,,245.0000,36.7500,MEDCOST,MEDCOST VHN,116.60,,,,,,,63.2300,245.0000,percent of total billed charges,47.59% of $245.00 in Billed Charges for Rev 272 = $116.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM BIOPINCE,272,RC,27200954,CDM,,,,,,both,,,245.0000,36.7500,SENTARA HEALTH,SENTARA HEALTH,63.23,,,,,,,63.2300,245.0000,percent of total billed charges,25.81% of $245.00 in Billed Charges for Rev 272 = $63.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM BIOPINCE,272,RC,27200954,CDM,,,,,,both,,,245.0000,36.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",245.00,,,,,,,63.2300,245.0000,percent of total billed charges,100% of $245.00 in Billed Charges for Rev 272 = $245.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM BIOPINCE,272,RC,27200954,CDM,,,,,,both,,,245.0000,36.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,122.50,,,,,,,63.2300,245.0000,percent of total billed charges,Rev 272 $245.00 in Billed Charges at 50% = $122.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM BIOPINCE,272,RC,27200954,CDM,,,,,,both,,,245.0000,36.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,79.14,,,,,,,63.2300,245.0000,other,32.3% of $245.00 in Billed Charges for Rev 272 = $79.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE BX 10 15CM BIOPINCE,272,RC,27200954,CDM,,,,,,both,,,245.0000,36.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,75.22,,,,,,,63.2300,245.0000,other,30.7% of $245.00 in Billed Charges for Rev 272 = $75.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE BX 10 15CM BIOPINCE,272,RC,27200954,CDM,,,,,,both,,,245.0000,36.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,79.14,,,,,,,63.2300,245.0000,percent of total billed charges,32.3% of $245.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM BIOPINCE,272,RC,27200954,CDM,,,,,,both,,,245.0000,36.7500,WELLCARE,WELLCARE MEDICAID,245.00,,,,,,,63.2300,245.0000,percent of total billed charges,100% of $245.00 in Billed Charges for Rev 272 = $245.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X07 CM,272,RC,27200959,CDM,,,,,,both,,,22.0000,3.3000,AETNA,AETNA,9.39,,,,,,,5.6800,22.0000,percent of total billed charges,42.7% of $22.00 in Billed Charges for Rev 272 = $9.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X07 CM,272,RC,27200959,CDM,,,,,,both,,,22.0000,3.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,15.40,,,,,,,5.6800,22.0000,percent of total billed charges,Rev 272 $22.00 in Billed Charges at 70% = $15.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X07 CM,272,RC,27200959,CDM,,,,,,both,,,22.0000,3.3000,CIGNA HEALTHCARE,CIGNA HMO,9.17,,,,,,,5.6800,22.0000,percent of total billed charges,41.7% of $22.00 in Billed Charges for Rev 272 = $9.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X07 CM,272,RC,27200959,CDM,,,,,,both,,,22.0000,3.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10.21,,,,,,,5.6800,22.0000,percent of total billed charges,46.4% of $22.00 in Billed Charges for Rev 272 = $10.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X07 CM,272,RC,27200959,CDM,,,,,,both,,,22.0000,3.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9.17,,,,,,,5.6800,22.0000,percent of total billed charges,41.7% of $22.00 in Billed Charges for Rev 272 = $9.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X07 CM,272,RC,27200959,CDM,,,,,,both,,,22.0000,3.3000,CIGNA HEALTHCARE,CIGNA PPO,9.17,,,,,,,5.6800,22.0000,percent of total billed charges,41.7% of $22.00 in Billed Charges for Rev 272 = $9.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X07 CM,272,RC,27200959,CDM,,,,,,both,,,22.0000,3.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,19.80,,,,,,,5.6800,22.0000,percent of total billed charges,90% of $22.00 in Billed Charges for Rev 272 = $19.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X07 CM,272,RC,27200959,CDM,,,,,,both,,,22.0000,3.3000,MEDCOST,MEDCOST VHN,10.47,,,,,,,5.6800,22.0000,percent of total billed charges,47.59% of $22.00 in Billed Charges for Rev 272 = $10.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X07 CM,272,RC,27200959,CDM,,,,,,both,,,22.0000,3.3000,SENTARA HEALTH,SENTARA HEALTH,5.68,,,,,,,5.6800,22.0000,percent of total billed charges,25.81% of $22.00 in Billed Charges for Rev 272 = $5.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X07 CM,272,RC,27200959,CDM,,,,,,both,,,22.0000,3.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",22.00,,,,,,,5.6800,22.0000,percent of total billed charges,100% of $22.00 in Billed Charges for Rev 272 = $22.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X07 CM,272,RC,27200959,CDM,,,,,,both,,,22.0000,3.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11.00,,,,,,,5.6800,22.0000,percent of total billed charges,Rev 272 $22.00 in Billed Charges at 50% = $11.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X07 CM,272,RC,27200959,CDM,,,,,,both,,,22.0000,3.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7.11,,,,,,,5.6800,22.0000,other,32.3% of $22.00 in Billed Charges for Rev 272 = $7.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE BX TRUGUIDE 19X07 CM,272,RC,27200959,CDM,,,,,,both,,,22.0000,3.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,6.75,,,,,,,5.6800,22.0000,other,30.7% of $22.00 in Billed Charges for Rev 272 = $6.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE BX TRUGUIDE 19X07 CM,272,RC,27200959,CDM,,,,,,both,,,22.0000,3.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,7.11,,,,,,,5.6800,22.0000,percent of total billed charges,32.3% of $22.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X07 CM,272,RC,27200959,CDM,,,,,,both,,,22.0000,3.3000,WELLCARE,WELLCARE MEDICAID,22.00,,,,,,,5.6800,22.0000,percent of total billed charges,100% of $22.00 in Billed Charges for Rev 272 = $22.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X13 CM,272,RC,27200960,CDM,,,,,,both,,,75.0000,11.2500,AETNA,AETNA,32.03,,,,,,,19.3600,75.0000,percent of total billed charges,42.7% of $75.00 in Billed Charges for Rev 272 = $32.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X13 CM,272,RC,27200960,CDM,,,,,,both,,,75.0000,11.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,52.50,,,,,,,19.3600,75.0000,percent of total billed charges,Rev 272 $75.00 in Billed Charges at 70% = $52.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X13 CM,272,RC,27200960,CDM,,,,,,both,,,75.0000,11.2500,CIGNA HEALTHCARE,CIGNA HMO,31.28,,,,,,,19.3600,75.0000,percent of total billed charges,41.7% of $75.00 in Billed Charges for Rev 272 = $31.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X13 CM,272,RC,27200960,CDM,,,,,,both,,,75.0000,11.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,34.80,,,,,,,19.3600,75.0000,percent of total billed charges,46.4% of $75.00 in Billed Charges for Rev 272 = $34.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X13 CM,272,RC,27200960,CDM,,,,,,both,,,75.0000,11.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,31.28,,,,,,,19.3600,75.0000,percent of total billed charges,41.7% of $75.00 in Billed Charges for Rev 272 = $31.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X13 CM,272,RC,27200960,CDM,,,,,,both,,,75.0000,11.2500,CIGNA HEALTHCARE,CIGNA PPO,31.28,,,,,,,19.3600,75.0000,percent of total billed charges,41.7% of $75.00 in Billed Charges for Rev 272 = $31.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X13 CM,272,RC,27200960,CDM,,,,,,both,,,75.0000,11.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,67.50,,,,,,,19.3600,75.0000,percent of total billed charges,90% of $75.00 in Billed Charges for Rev 272 = $67.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X13 CM,272,RC,27200960,CDM,,,,,,both,,,75.0000,11.2500,MEDCOST,MEDCOST VHN,35.69,,,,,,,19.3600,75.0000,percent of total billed charges,47.59% of $75.00 in Billed Charges for Rev 272 = $35.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X13 CM,272,RC,27200960,CDM,,,,,,both,,,75.0000,11.2500,SENTARA HEALTH,SENTARA HEALTH,19.36,,,,,,,19.3600,75.0000,percent of total billed charges,25.81% of $75.00 in Billed Charges for Rev 272 = $19.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X13 CM,272,RC,27200960,CDM,,,,,,both,,,75.0000,11.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",75.00,,,,,,,19.3600,75.0000,percent of total billed charges,100% of $75.00 in Billed Charges for Rev 272 = $75.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X13 CM,272,RC,27200960,CDM,,,,,,both,,,75.0000,11.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,37.50,,,,,,,19.3600,75.0000,percent of total billed charges,Rev 272 $75.00 in Billed Charges at 50% = $37.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X13 CM,272,RC,27200960,CDM,,,,,,both,,,75.0000,11.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,24.23,,,,,,,19.3600,75.0000,other,32.3% of $75.00 in Billed Charges for Rev 272 = $24.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE BX TRUGUIDE 19X13 CM,272,RC,27200960,CDM,,,,,,both,,,75.0000,11.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,23.03,,,,,,,19.3600,75.0000,other,30.7% of $75.00 in Billed Charges for Rev 272 = $23.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE BX TRUGUIDE 19X13 CM,272,RC,27200960,CDM,,,,,,both,,,75.0000,11.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,24.23,,,,,,,19.3600,75.0000,percent of total billed charges,32.3% of $75.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TRUGUIDE 19X13 CM,272,RC,27200960,CDM,,,,,,both,,,75.0000,11.2500,WELLCARE,WELLCARE MEDICAID,75.00,,,,,,,19.3600,75.0000,percent of total billed charges,100% of $75.00 in Billed Charges for Rev 272 = $75.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOS INFUS 18GX3CM,272,RC,27202269,CDM,,,,,,both,,,488.0000,73.2000,AETNA,AETNA,208.38,,,,,,,125.9500,488.0000,percent of total billed charges,42.7% of $488.00 in Billed Charges for Rev 272 = $208.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOS INFUS 18GX3CM,272,RC,27202269,CDM,,,,,,both,,,488.0000,73.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,341.60,,,,,,,125.9500,488.0000,percent of total billed charges,Rev 272 $488.00 in Billed Charges at 70% = $341.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOS INFUS 18GX3CM,272,RC,27202269,CDM,,,,,,both,,,488.0000,73.2000,CIGNA HEALTHCARE,CIGNA HMO,203.50,,,,,,,125.9500,488.0000,percent of total billed charges,41.7% of $488.00 in Billed Charges for Rev 272 = $203.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOS INFUS 18GX3CM,272,RC,27202269,CDM,,,,,,both,,,488.0000,73.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,226.43,,,,,,,125.9500,488.0000,percent of total billed charges,46.4% of $488.00 in Billed Charges for Rev 272 = $226.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOS INFUS 18GX3CM,272,RC,27202269,CDM,,,,,,both,,,488.0000,73.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,203.50,,,,,,,125.9500,488.0000,percent of total billed charges,41.7% of $488.00 in Billed Charges for Rev 272 = $203.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOS INFUS 18GX3CM,272,RC,27202269,CDM,,,,,,both,,,488.0000,73.2000,CIGNA HEALTHCARE,CIGNA PPO,203.50,,,,,,,125.9500,488.0000,percent of total billed charges,41.7% of $488.00 in Billed Charges for Rev 272 = $203.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOS INFUS 18GX3CM,272,RC,27202269,CDM,,,,,,both,,,488.0000,73.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,439.20,,,,,,,125.9500,488.0000,percent of total billed charges,90% of $488.00 in Billed Charges for Rev 272 = $439.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOS INFUS 18GX3CM,272,RC,27202269,CDM,,,,,,both,,,488.0000,73.2000,MEDCOST,MEDCOST VHN,232.24,,,,,,,125.9500,488.0000,percent of total billed charges,47.59% of $488.00 in Billed Charges for Rev 272 = $232.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOS INFUS 18GX3CM,272,RC,27202269,CDM,,,,,,both,,,488.0000,73.2000,SENTARA HEALTH,SENTARA HEALTH,125.95,,,,,,,125.9500,488.0000,percent of total billed charges,25.81% of $488.00 in Billed Charges for Rev 272 = $125.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOS INFUS 18GX3CM,272,RC,27202269,CDM,,,,,,both,,,488.0000,73.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",488.00,,,,,,,125.9500,488.0000,percent of total billed charges,100% of $488.00 in Billed Charges for Rev 272 = $488.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOS INFUS 18GX3CM,272,RC,27202269,CDM,,,,,,both,,,488.0000,73.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,244.00,,,,,,,125.9500,488.0000,percent of total billed charges,Rev 272 $488.00 in Billed Charges at 50% = $244.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOS INFUS 18GX3CM,272,RC,27202269,CDM,,,,,,both,,,488.0000,73.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,157.62,,,,,,,125.9500,488.0000,other,32.3% of $488.00 in Billed Charges for Rev 272 = $157.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE INTRAOS INFUS 18GX3CM,272,RC,27202269,CDM,,,,,,both,,,488.0000,73.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,149.82,,,,,,,125.9500,488.0000,other,30.7% of $488.00 in Billed Charges for Rev 272 = $149.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE INTRAOS INFUS 18GX3CM,272,RC,27202269,CDM,,,,,,both,,,488.0000,73.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,157.62,,,,,,,125.9500,488.0000,percent of total billed charges,32.3% of $488.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOS INFUS 18GX3CM,272,RC,27202269,CDM,,,,,,both,,,488.0000,73.2000,WELLCARE,WELLCARE MEDICAID,488.00,,,,,,,125.9500,488.0000,percent of total billed charges,100% of $488.00 in Billed Charges for Rev 272 = $488.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOSSEOUS 15GA,272,RC,27200964,CDM,,,,,,both,,,263.0000,39.4500,AETNA,AETNA,112.30,,,,,,,67.8800,263.0000,percent of total billed charges,42.7% of $263.00 in Billed Charges for Rev 272 = $112.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOSSEOUS 15GA,272,RC,27200964,CDM,,,,,,both,,,263.0000,39.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,184.10,,,,,,,67.8800,263.0000,percent of total billed charges,Rev 272 $263.00 in Billed Charges at 70% = $184.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOSSEOUS 15GA,272,RC,27200964,CDM,,,,,,both,,,263.0000,39.4500,CIGNA HEALTHCARE,CIGNA HMO,109.67,,,,,,,67.8800,263.0000,percent of total billed charges,41.7% of $263.00 in Billed Charges for Rev 272 = $109.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOSSEOUS 15GA,272,RC,27200964,CDM,,,,,,both,,,263.0000,39.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,122.03,,,,,,,67.8800,263.0000,percent of total billed charges,46.4% of $263.00 in Billed Charges for Rev 272 = $122.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOSSEOUS 15GA,272,RC,27200964,CDM,,,,,,both,,,263.0000,39.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,109.67,,,,,,,67.8800,263.0000,percent of total billed charges,41.7% of $263.00 in Billed Charges for Rev 272 = $109.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOSSEOUS 15GA,272,RC,27200964,CDM,,,,,,both,,,263.0000,39.4500,CIGNA HEALTHCARE,CIGNA PPO,109.67,,,,,,,67.8800,263.0000,percent of total billed charges,41.7% of $263.00 in Billed Charges for Rev 272 = $109.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOSSEOUS 15GA,272,RC,27200964,CDM,,,,,,both,,,263.0000,39.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,236.70,,,,,,,67.8800,263.0000,percent of total billed charges,90% of $263.00 in Billed Charges for Rev 272 = $236.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOSSEOUS 15GA,272,RC,27200964,CDM,,,,,,both,,,263.0000,39.4500,MEDCOST,MEDCOST VHN,125.16,,,,,,,67.8800,263.0000,percent of total billed charges,47.59% of $263.00 in Billed Charges for Rev 272 = $125.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOSSEOUS 15GA,272,RC,27200964,CDM,,,,,,both,,,263.0000,39.4500,SENTARA HEALTH,SENTARA HEALTH,67.88,,,,,,,67.8800,263.0000,percent of total billed charges,25.81% of $263.00 in Billed Charges for Rev 272 = $67.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOSSEOUS 15GA,272,RC,27200964,CDM,,,,,,both,,,263.0000,39.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",263.00,,,,,,,67.8800,263.0000,percent of total billed charges,100% of $263.00 in Billed Charges for Rev 272 = $263.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOSSEOUS 15GA,272,RC,27200964,CDM,,,,,,both,,,263.0000,39.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,131.50,,,,,,,67.8800,263.0000,percent of total billed charges,Rev 272 $263.00 in Billed Charges at 50% = $131.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOSSEOUS 15GA,272,RC,27200964,CDM,,,,,,both,,,263.0000,39.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,84.95,,,,,,,67.8800,263.0000,other,32.3% of $263.00 in Billed Charges for Rev 272 = $84.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE INTRAOSSEOUS 15GA,272,RC,27200964,CDM,,,,,,both,,,263.0000,39.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,80.74,,,,,,,67.8800,263.0000,other,30.7% of $263.00 in Billed Charges for Rev 272 = $80.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE INTRAOSSEOUS 15GA,272,RC,27200964,CDM,,,,,,both,,,263.0000,39.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,84.95,,,,,,,67.8800,263.0000,percent of total billed charges,32.3% of $263.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INTRAOSSEOUS 15GA,272,RC,27200964,CDM,,,,,,both,,,263.0000,39.4500,WELLCARE,WELLCARE MEDICAID,263.00,,,,,,,67.8800,263.0000,percent of total billed charges,100% of $263.00 in Billed Charges for Rev 272 = $263.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE MAMMOTOME 8GA,272,RC,27200966,CDM,,,,,,both,,,1052.0000,157.8000,AETNA,AETNA,449.20,,,,,,,271.5200,1052.0000,percent of total billed charges,"42.7% of $1,052.00 in Billed Charges for Rev 272 = $449.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE MAMMOTOME 8GA,272,RC,27200966,CDM,,,,,,both,,,1052.0000,157.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,736.40,,,,,,,271.5200,1052.0000,percent of total billed charges,"Rev 272 $1,052.00 in Billed Charges at 70% = $736.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE MAMMOTOME 8GA,272,RC,27200966,CDM,,,,,,both,,,1052.0000,157.8000,CIGNA HEALTHCARE,CIGNA HMO,438.68,,,,,,,271.5200,1052.0000,percent of total billed charges,"41.7% of $1,052.00 in Billed Charges for Rev 272 = $438.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE MAMMOTOME 8GA,272,RC,27200966,CDM,,,,,,both,,,1052.0000,157.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,488.13,,,,,,,271.5200,1052.0000,percent of total billed charges,"46.4% of $1,052.00 in Billed Charges for Rev 272 = $488.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE MAMMOTOME 8GA,272,RC,27200966,CDM,,,,,,both,,,1052.0000,157.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,438.68,,,,,,,271.5200,1052.0000,percent of total billed charges,"41.7% of $1,052.00 in Billed Charges for Rev 272 = $438.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE MAMMOTOME 8GA,272,RC,27200966,CDM,,,,,,both,,,1052.0000,157.8000,CIGNA HEALTHCARE,CIGNA PPO,438.68,,,,,,,271.5200,1052.0000,percent of total billed charges,"41.7% of $1,052.00 in Billed Charges for Rev 272 = $438.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE MAMMOTOME 8GA,272,RC,27200966,CDM,,,,,,both,,,1052.0000,157.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,946.80,,,,,,,271.5200,1052.0000,percent of total billed charges,"90% of $1,052.00 in Billed Charges for Rev 272 = $946.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE MAMMOTOME 8GA,272,RC,27200966,CDM,,,,,,both,,,1052.0000,157.8000,MEDCOST,MEDCOST VHN,500.65,,,,,,,271.5200,1052.0000,percent of total billed charges,"47.59% of $1,052.00 in Billed Charges for Rev 272 = $500.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE MAMMOTOME 8GA,272,RC,27200966,CDM,,,,,,both,,,1052.0000,157.8000,SENTARA HEALTH,SENTARA HEALTH,271.52,,,,,,,271.5200,1052.0000,percent of total billed charges,"25.81% of $1,052.00 in Billed Charges for Rev 272 = $271.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE MAMMOTOME 8GA,272,RC,27200966,CDM,,,,,,both,,,1052.0000,157.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1052.00,,,,,,,271.5200,1052.0000,percent of total billed charges,"100% of $1,052.00 in Billed Charges for Rev 272 = $1,052.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE MAMMOTOME 8GA,272,RC,27200966,CDM,,,,,,both,,,1052.0000,157.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,526.00,,,,,,,271.5200,1052.0000,percent of total billed charges,"Rev 272 $1,052.00 in Billed Charges at 50% = $526.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE MAMMOTOME 8GA,272,RC,27200966,CDM,,,,,,both,,,1052.0000,157.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,339.80,,,,,,,271.5200,1052.0000,other,"32.3% of $1,052.00 in Billed Charges for Rev 272 = $339.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NEEDLE MAMMOTOME 8GA,272,RC,27200966,CDM,,,,,,both,,,1052.0000,157.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,322.96,,,,,,,271.5200,1052.0000,other,"30.7% of $1,052.00 in Billed Charges for Rev 272 = $322.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NEEDLE MAMMOTOME 8GA,272,RC,27200966,CDM,,,,,,both,,,1052.0000,157.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,339.80,,,,,,,271.5200,1052.0000,percent of total billed charges,"32.3% of $1,052.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE MAMMOTOME 8GA,272,RC,27200966,CDM,,,,,,both,,,1052.0000,157.8000,WELLCARE,WELLCARE MEDICAID,1052.00,,,,,,,271.5200,1052.0000,percent of total billed charges,"100% of $1,052.00 in Billed Charges for Rev 272 = $1,052.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE VARICES INJECTION DISP,272,RC,27200971,CDM,,,,,,both,,,159.0000,23.8500,AETNA,AETNA,67.89,,,,,,,41.0400,159.0000,percent of total billed charges,42.7% of $159.00 in Billed Charges for Rev 272 = $67.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE VARICES INJECTION DISP,272,RC,27200971,CDM,,,,,,both,,,159.0000,23.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,111.30,,,,,,,41.0400,159.0000,percent of total billed charges,Rev 272 $159.00 in Billed Charges at 70% = $111.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE VARICES INJECTION DISP,272,RC,27200971,CDM,,,,,,both,,,159.0000,23.8500,CIGNA HEALTHCARE,CIGNA HMO,66.30,,,,,,,41.0400,159.0000,percent of total billed charges,41.7% of $159.00 in Billed Charges for Rev 272 = $66.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE VARICES INJECTION DISP,272,RC,27200971,CDM,,,,,,both,,,159.0000,23.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,73.78,,,,,,,41.0400,159.0000,percent of total billed charges,46.4% of $159.00 in Billed Charges for Rev 272 = $73.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE VARICES INJECTION DISP,272,RC,27200971,CDM,,,,,,both,,,159.0000,23.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,66.30,,,,,,,41.0400,159.0000,percent of total billed charges,41.7% of $159.00 in Billed Charges for Rev 272 = $66.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE VARICES INJECTION DISP,272,RC,27200971,CDM,,,,,,both,,,159.0000,23.8500,CIGNA HEALTHCARE,CIGNA PPO,66.30,,,,,,,41.0400,159.0000,percent of total billed charges,41.7% of $159.00 in Billed Charges for Rev 272 = $66.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE VARICES INJECTION DISP,272,RC,27200971,CDM,,,,,,both,,,159.0000,23.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,143.10,,,,,,,41.0400,159.0000,percent of total billed charges,90% of $159.00 in Billed Charges for Rev 272 = $143.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE VARICES INJECTION DISP,272,RC,27200971,CDM,,,,,,both,,,159.0000,23.8500,MEDCOST,MEDCOST VHN,75.67,,,,,,,41.0400,159.0000,percent of total billed charges,47.59% of $159.00 in Billed Charges for Rev 272 = $75.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE VARICES INJECTION DISP,272,RC,27200971,CDM,,,,,,both,,,159.0000,23.8500,SENTARA HEALTH,SENTARA HEALTH,41.04,,,,,,,41.0400,159.0000,percent of total billed charges,25.81% of $159.00 in Billed Charges for Rev 272 = $41.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE VARICES INJECTION DISP,272,RC,27200971,CDM,,,,,,both,,,159.0000,23.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",159.00,,,,,,,41.0400,159.0000,percent of total billed charges,100% of $159.00 in Billed Charges for Rev 272 = $159.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE VARICES INJECTION DISP,272,RC,27200971,CDM,,,,,,both,,,159.0000,23.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,79.50,,,,,,,41.0400,159.0000,percent of total billed charges,Rev 272 $159.00 in Billed Charges at 50% = $79.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE VARICES INJECTION DISP,272,RC,27200971,CDM,,,,,,both,,,159.0000,23.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,51.36,,,,,,,41.0400,159.0000,other,32.3% of $159.00 in Billed Charges for Rev 272 = $51.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE VARICES INJECTION DISP,272,RC,27200971,CDM,,,,,,both,,,159.0000,23.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,48.81,,,,,,,41.0400,159.0000,other,30.7% of $159.00 in Billed Charges for Rev 272 = $48.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE VARICES INJECTION DISP,272,RC,27200971,CDM,,,,,,both,,,159.0000,23.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,51.36,,,,,,,41.0400,159.0000,percent of total billed charges,32.3% of $159.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE VARICES INJECTION DISP,272,RC,27200971,CDM,,,,,,both,,,159.0000,23.8500,WELLCARE,WELLCARE MEDICAID,159.00,,,,,,,41.0400,159.0000,percent of total billed charges,100% of $159.00 in Billed Charges for Rev 272 = $159.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NELLIX ACCESSORY KIT,272,RC,27202035,CDM,,,,,,both,,,1769.0000,265.3500,AETNA,AETNA,755.36,,,,,,,456.5800,1769.0000,percent of total billed charges,"42.7% of $1,769.00 in Billed Charges for Rev 272 = $755.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX ACCESSORY KIT,272,RC,27202035,CDM,,,,,,both,,,1769.0000,265.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1238.30,,,,,,,456.5800,1769.0000,percent of total billed charges,"Rev 272 $1,769.00 in Billed Charges at 70% = $1,238.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX ACCESSORY KIT,272,RC,27202035,CDM,,,,,,both,,,1769.0000,265.3500,CIGNA HEALTHCARE,CIGNA HMO,737.67,,,,,,,456.5800,1769.0000,percent of total billed charges,"41.7% of $1,769.00 in Billed Charges for Rev 272 = $737.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX ACCESSORY KIT,272,RC,27202035,CDM,,,,,,both,,,1769.0000,265.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,820.82,,,,,,,456.5800,1769.0000,percent of total billed charges,"46.4% of $1,769.00 in Billed Charges for Rev 272 = $820.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX ACCESSORY KIT,272,RC,27202035,CDM,,,,,,both,,,1769.0000,265.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,737.67,,,,,,,456.5800,1769.0000,percent of total billed charges,"41.7% of $1,769.00 in Billed Charges for Rev 272 = $737.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX ACCESSORY KIT,272,RC,27202035,CDM,,,,,,both,,,1769.0000,265.3500,CIGNA HEALTHCARE,CIGNA PPO,737.67,,,,,,,456.5800,1769.0000,percent of total billed charges,"41.7% of $1,769.00 in Billed Charges for Rev 272 = $737.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX ACCESSORY KIT,272,RC,27202035,CDM,,,,,,both,,,1769.0000,265.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1592.10,,,,,,,456.5800,1769.0000,percent of total billed charges,"90% of $1,769.00 in Billed Charges for Rev 272 = $1,592.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX ACCESSORY KIT,272,RC,27202035,CDM,,,,,,both,,,1769.0000,265.3500,MEDCOST,MEDCOST VHN,841.87,,,,,,,456.5800,1769.0000,percent of total billed charges,"47.59% of $1,769.00 in Billed Charges for Rev 272 = $841.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX ACCESSORY KIT,272,RC,27202035,CDM,,,,,,both,,,1769.0000,265.3500,SENTARA HEALTH,SENTARA HEALTH,456.58,,,,,,,456.5800,1769.0000,percent of total billed charges,"25.81% of $1,769.00 in Billed Charges for Rev 272 = $456.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX ACCESSORY KIT,272,RC,27202035,CDM,,,,,,both,,,1769.0000,265.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1769.00,,,,,,,456.5800,1769.0000,percent of total billed charges,"100% of $1,769.00 in Billed Charges for Rev 272 = $1,769.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX ACCESSORY KIT,272,RC,27202035,CDM,,,,,,both,,,1769.0000,265.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,884.50,,,,,,,456.5800,1769.0000,percent of total billed charges,"Rev 272 $1,769.00 in Billed Charges at 50% = $884.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX ACCESSORY KIT,272,RC,27202035,CDM,,,,,,both,,,1769.0000,265.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,571.39,,,,,,,456.5800,1769.0000,other,"32.3% of $1,769.00 in Billed Charges for Rev 272 = $571.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NELLIX ACCESSORY KIT,272,RC,27202035,CDM,,,,,,both,,,1769.0000,265.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,543.08,,,,,,,456.5800,1769.0000,other,"30.7% of $1,769.00 in Billed Charges for Rev 272 = $543.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NELLIX ACCESSORY KIT,272,RC,27202035,CDM,,,,,,both,,,1769.0000,265.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,571.39,,,,,,,456.5800,1769.0000,percent of total billed charges,"32.3% of $1,769.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX ACCESSORY KIT,272,RC,27202035,CDM,,,,,,both,,,1769.0000,265.3500,WELLCARE,WELLCARE MEDICAID,1769.00,,,,,,,456.5800,1769.0000,percent of total billed charges,"100% of $1,769.00 in Billed Charges for Rev 272 = $1,769.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 40 ML,272,RC,27202033,CDM,,,,,,both,,,1175.0000,176.2500,AETNA,AETNA,501.73,,,,,,,303.2700,1175.0000,percent of total billed charges,"42.7% of $1,175.00 in Billed Charges for Rev 272 = $501.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 40 ML,272,RC,27202033,CDM,,,,,,both,,,1175.0000,176.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,822.50,,,,,,,303.2700,1175.0000,percent of total billed charges,"Rev 272 $1,175.00 in Billed Charges at 70% = $822.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 40 ML,272,RC,27202033,CDM,,,,,,both,,,1175.0000,176.2500,CIGNA HEALTHCARE,CIGNA HMO,489.98,,,,,,,303.2700,1175.0000,percent of total billed charges,"41.7% of $1,175.00 in Billed Charges for Rev 272 = $489.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 40 ML,272,RC,27202033,CDM,,,,,,both,,,1175.0000,176.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,545.20,,,,,,,303.2700,1175.0000,percent of total billed charges,"46.4% of $1,175.00 in Billed Charges for Rev 272 = $545.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 40 ML,272,RC,27202033,CDM,,,,,,both,,,1175.0000,176.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,489.98,,,,,,,303.2700,1175.0000,percent of total billed charges,"41.7% of $1,175.00 in Billed Charges for Rev 272 = $489.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 40 ML,272,RC,27202033,CDM,,,,,,both,,,1175.0000,176.2500,CIGNA HEALTHCARE,CIGNA PPO,489.98,,,,,,,303.2700,1175.0000,percent of total billed charges,"41.7% of $1,175.00 in Billed Charges for Rev 272 = $489.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 40 ML,272,RC,27202033,CDM,,,,,,both,,,1175.0000,176.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1057.50,,,,,,,303.2700,1175.0000,percent of total billed charges,"90% of $1,175.00 in Billed Charges for Rev 272 = $1,057.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 40 ML,272,RC,27202033,CDM,,,,,,both,,,1175.0000,176.2500,MEDCOST,MEDCOST VHN,559.18,,,,,,,303.2700,1175.0000,percent of total billed charges,"47.59% of $1,175.00 in Billed Charges for Rev 272 = $559.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 40 ML,272,RC,27202033,CDM,,,,,,both,,,1175.0000,176.2500,SENTARA HEALTH,SENTARA HEALTH,303.27,,,,,,,303.2700,1175.0000,percent of total billed charges,"25.81% of $1,175.00 in Billed Charges for Rev 272 = $303.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 40 ML,272,RC,27202033,CDM,,,,,,both,,,1175.0000,176.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1175.00,,,,,,,303.2700,1175.0000,percent of total billed charges,"100% of $1,175.00 in Billed Charges for Rev 272 = $1,175.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 40 ML,272,RC,27202033,CDM,,,,,,both,,,1175.0000,176.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,587.50,,,,,,,303.2700,1175.0000,percent of total billed charges,"Rev 272 $1,175.00 in Billed Charges at 50% = $587.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 40 ML,272,RC,27202033,CDM,,,,,,both,,,1175.0000,176.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,379.53,,,,,,,303.2700,1175.0000,other,"32.3% of $1,175.00 in Billed Charges for Rev 272 = $379.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NELLIX POLYMER CARTRIDGE 40 ML,272,RC,27202033,CDM,,,,,,both,,,1175.0000,176.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,360.73,,,,,,,303.2700,1175.0000,other,"30.7% of $1,175.00 in Billed Charges for Rev 272 = $360.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NELLIX POLYMER CARTRIDGE 40 ML,272,RC,27202033,CDM,,,,,,both,,,1175.0000,176.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,379.53,,,,,,,303.2700,1175.0000,percent of total billed charges,"32.3% of $1,175.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 40 ML,272,RC,27202033,CDM,,,,,,both,,,1175.0000,176.2500,WELLCARE,WELLCARE MEDICAID,1175.00,,,,,,,303.2700,1175.0000,percent of total billed charges,"100% of $1,175.00 in Billed Charges for Rev 272 = $1,175.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PICO 14 15X20CM,272,RC,27200002,CDM,,,,,,both,,,9053.8800,1358.0800,AETNA,AETNA,3866.01,,,,,,,2336.8100,9053.8800,percent of total billed charges,"42.7% of $9,053.88 in Billed Charges for Rev 272 = $3,866.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PICO 14 15X20CM,272,RC,27200002,CDM,,,,,,both,,,9053.8800,1358.0800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6337.72,,,,,,,2336.8100,9053.8800,percent of total billed charges,"Rev 272 $9,053.88 in Billed Charges at 70% = $6,337.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PICO 14 15X20CM,272,RC,27200002,CDM,,,,,,both,,,9053.8800,1358.0800,CIGNA HEALTHCARE,CIGNA HMO,3775.47,,,,,,,2336.8100,9053.8800,percent of total billed charges,"41.7% of $9,053.88 in Billed Charges for Rev 272 = $3,775.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PICO 14 15X20CM,272,RC,27200002,CDM,,,,,,both,,,9053.8800,1358.0800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4201.00,,,,,,,2336.8100,9053.8800,percent of total billed charges,"46.4% of $9,053.88 in Billed Charges for Rev 272 = $4,201.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PICO 14 15X20CM,272,RC,27200002,CDM,,,,,,both,,,9053.8800,1358.0800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3775.47,,,,,,,2336.8100,9053.8800,percent of total billed charges,"41.7% of $9,053.88 in Billed Charges for Rev 272 = $3,775.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PICO 14 15X20CM,272,RC,27200002,CDM,,,,,,both,,,9053.8800,1358.0800,CIGNA HEALTHCARE,CIGNA PPO,3775.47,,,,,,,2336.8100,9053.8800,percent of total billed charges,"41.7% of $9,053.88 in Billed Charges for Rev 272 = $3,775.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PICO 14 15X20CM,272,RC,27200002,CDM,,,,,,both,,,9053.8800,1358.0800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8148.49,,,,,,,2336.8100,9053.8800,percent of total billed charges,"90% of $9,053.88 in Billed Charges for Rev 272 = $8,148.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PICO 14 15X20CM,272,RC,27200002,CDM,,,,,,both,,,9053.8800,1358.0800,MEDCOST,MEDCOST VHN,4308.74,,,,,,,2336.8100,9053.8800,percent of total billed charges,"47.59% of $9,053.88 in Billed Charges for Rev 272 = $4,308.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PICO 14 15X20CM,272,RC,27200002,CDM,,,,,,both,,,9053.8800,1358.0800,SENTARA HEALTH,SENTARA HEALTH,2336.81,,,,,,,2336.8100,9053.8800,percent of total billed charges,"25.81% of $9,053.88 in Billed Charges for Rev 272 = $2,336.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PICO 14 15X20CM,272,RC,27200002,CDM,,,,,,both,,,9053.8800,1358.0800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9053.88,,,,,,,2336.8100,9053.8800,percent of total billed charges,"100% of $9,053.88 in Billed Charges for Rev 272 = $9,053.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PICO 14 15X20CM,272,RC,27200002,CDM,,,,,,both,,,9053.8800,1358.0800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4526.94,,,,,,,2336.8100,9053.8800,percent of total billed charges,"Rev 272 $9,053.88 in Billed Charges at 50% = $4,526.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PICO 14 15X20CM,272,RC,27200002,CDM,,,,,,both,,,9053.8800,1358.0800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2924.40,,,,,,,2336.8100,9053.8800,other,"32.3% of $9,053.88 in Billed Charges for Rev 272 = $2,924.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING PICO 14 15X20CM,272,RC,27200002,CDM,,,,,,both,,,9053.8800,1358.0800,UNITED HEALTHCARE,UHC HERITAGE SELECT,2779.54,,,,,,,2336.8100,9053.8800,other,"30.7% of $9,053.88 in Billed Charges for Rev 272 = $2,779.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING PICO 14 15X20CM,272,RC,27200002,CDM,,,,,,both,,,9053.8800,1358.0800,UNITED HEALTHCARE,UNITED HEALTHCARE,2924.40,,,,,,,2336.8100,9053.8800,percent of total billed charges,"32.3% of $9,053.88 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PICO 14 15X20CM,272,RC,27200002,CDM,,,,,,both,,,9053.8800,1358.0800,WELLCARE,WELLCARE MEDICAID,9053.88,,,,,,,2336.8100,9053.8800,percent of total billed charges,"100% of $9,053.88 in Billed Charges for Rev 272 = $9,053.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PREVENA INCISION MGT PRE1001US,272,RC,27200002,CDM,,,,,,both,,,5124.3100,768.6500,AETNA,AETNA,2188.08,,,,,,,1322.5800,5124.3100,percent of total billed charges,"42.7% of $5,124.31 in Billed Charges for Rev 272 = $2,188.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PREVENA INCISION MGT PRE1001US,272,RC,27200002,CDM,,,,,,both,,,5124.3100,768.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3587.02,,,,,,,1322.5800,5124.3100,percent of total billed charges,"Rev 272 $5,124.31 in Billed Charges at 70% = $3,587.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PREVENA INCISION MGT PRE1001US,272,RC,27200002,CDM,,,,,,both,,,5124.3100,768.6500,CIGNA HEALTHCARE,CIGNA HMO,2136.84,,,,,,,1322.5800,5124.3100,percent of total billed charges,"41.7% of $5,124.31 in Billed Charges for Rev 272 = $2,136.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PREVENA INCISION MGT PRE1001US,272,RC,27200002,CDM,,,,,,both,,,5124.3100,768.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2377.68,,,,,,,1322.5800,5124.3100,percent of total billed charges,"46.4% of $5,124.31 in Billed Charges for Rev 272 = $2,377.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PREVENA INCISION MGT PRE1001US,272,RC,27200002,CDM,,,,,,both,,,5124.3100,768.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2136.84,,,,,,,1322.5800,5124.3100,percent of total billed charges,"41.7% of $5,124.31 in Billed Charges for Rev 272 = $2,136.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PREVENA INCISION MGT PRE1001US,272,RC,27200002,CDM,,,,,,both,,,5124.3100,768.6500,CIGNA HEALTHCARE,CIGNA PPO,2136.84,,,,,,,1322.5800,5124.3100,percent of total billed charges,"41.7% of $5,124.31 in Billed Charges for Rev 272 = $2,136.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PREVENA INCISION MGT PRE1001US,272,RC,27200002,CDM,,,,,,both,,,5124.3100,768.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4611.88,,,,,,,1322.5800,5124.3100,percent of total billed charges,"90% of $5,124.31 in Billed Charges for Rev 272 = $4,611.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PREVENA INCISION MGT PRE1001US,272,RC,27200002,CDM,,,,,,both,,,5124.3100,768.6500,MEDCOST,MEDCOST VHN,2438.66,,,,,,,1322.5800,5124.3100,percent of total billed charges,"47.59% of $5,124.31 in Billed Charges for Rev 272 = $2,438.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PREVENA INCISION MGT PRE1001US,272,RC,27200002,CDM,,,,,,both,,,5124.3100,768.6500,SENTARA HEALTH,SENTARA HEALTH,1322.58,,,,,,,1322.5800,5124.3100,percent of total billed charges,"25.81% of $5,124.31 in Billed Charges for Rev 272 = $1,322.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PREVENA INCISION MGT PRE1001US,272,RC,27200002,CDM,,,,,,both,,,5124.3100,768.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5124.31,,,,,,,1322.5800,5124.3100,percent of total billed charges,"100% of $5,124.31 in Billed Charges for Rev 272 = $5,124.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PREVENA INCISION MGT PRE1001US,272,RC,27200002,CDM,,,,,,both,,,5124.3100,768.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2562.16,,,,,,,1322.5800,5124.3100,percent of total billed charges,"Rev 272 $5,124.31 in Billed Charges at 50% = $2,562.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PREVENA INCISION MGT PRE1001US,272,RC,27200002,CDM,,,,,,both,,,5124.3100,768.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1655.15,,,,,,,1322.5800,5124.3100,other,"32.3% of $5,124.31 in Billed Charges for Rev 272 = $1,655.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING PREVENA INCISION MGT PRE1001US,272,RC,27200002,CDM,,,,,,both,,,5124.3100,768.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1573.16,,,,,,,1322.5800,5124.3100,other,"30.7% of $5,124.31 in Billed Charges for Rev 272 = $1,573.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING PREVENA INCISION MGT PRE1001US,272,RC,27200002,CDM,,,,,,both,,,5124.3100,768.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,1655.15,,,,,,,1322.5800,5124.3100,percent of total billed charges,"32.3% of $5,124.31 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING PREVENA INCISION MGT PRE1001US,272,RC,27200002,CDM,,,,,,both,,,5124.3100,768.6500,WELLCARE,WELLCARE MEDICAID,5124.31,,,,,,,1322.5800,5124.3100,percent of total billed charges,"100% of $5,124.31 in Billed Charges for Rev 272 = $5,124.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUICKCLOT PLUS 12X12 3 PLY,272,RC,27200002,CDM,,,,,,both,,,2757.8000,413.6700,AETNA,AETNA,1177.58,,,,,,,711.7900,2757.8000,percent of total billed charges,"42.7% of $2,757.80 in Billed Charges for Rev 272 = $1,177.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUICKCLOT PLUS 12X12 3 PLY,272,RC,27200002,CDM,,,,,,both,,,2757.8000,413.6700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1930.46,,,,,,,711.7900,2757.8000,percent of total billed charges,"Rev 272 $2,757.80 in Billed Charges at 70% = $1,930.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUICKCLOT PLUS 12X12 3 PLY,272,RC,27200002,CDM,,,,,,both,,,2757.8000,413.6700,CIGNA HEALTHCARE,CIGNA HMO,1150.00,,,,,,,711.7900,2757.8000,percent of total billed charges,"41.7% of $2,757.80 in Billed Charges for Rev 272 = $1,150.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUICKCLOT PLUS 12X12 3 PLY,272,RC,27200002,CDM,,,,,,both,,,2757.8000,413.6700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1279.62,,,,,,,711.7900,2757.8000,percent of total billed charges,"46.4% of $2,757.80 in Billed Charges for Rev 272 = $1,279.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUICKCLOT PLUS 12X12 3 PLY,272,RC,27200002,CDM,,,,,,both,,,2757.8000,413.6700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1150.00,,,,,,,711.7900,2757.8000,percent of total billed charges,"41.7% of $2,757.80 in Billed Charges for Rev 272 = $1,150.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUICKCLOT PLUS 12X12 3 PLY,272,RC,27200002,CDM,,,,,,both,,,2757.8000,413.6700,CIGNA HEALTHCARE,CIGNA PPO,1150.00,,,,,,,711.7900,2757.8000,percent of total billed charges,"41.7% of $2,757.80 in Billed Charges for Rev 272 = $1,150.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUICKCLOT PLUS 12X12 3 PLY,272,RC,27200002,CDM,,,,,,both,,,2757.8000,413.6700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2482.02,,,,,,,711.7900,2757.8000,percent of total billed charges,"90% of $2,757.80 in Billed Charges for Rev 272 = $2,482.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUICKCLOT PLUS 12X12 3 PLY,272,RC,27200002,CDM,,,,,,both,,,2757.8000,413.6700,MEDCOST,MEDCOST VHN,1312.44,,,,,,,711.7900,2757.8000,percent of total billed charges,"47.59% of $2,757.80 in Billed Charges for Rev 272 = $1,312.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUICKCLOT PLUS 12X12 3 PLY,272,RC,27200002,CDM,,,,,,both,,,2757.8000,413.6700,SENTARA HEALTH,SENTARA HEALTH,711.79,,,,,,,711.7900,2757.8000,percent of total billed charges,"25.81% of $2,757.80 in Billed Charges for Rev 272 = $711.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUICKCLOT PLUS 12X12 3 PLY,272,RC,27200002,CDM,,,,,,both,,,2757.8000,413.6700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2757.80,,,,,,,711.7900,2757.8000,percent of total billed charges,"100% of $2,757.80 in Billed Charges for Rev 272 = $2,757.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUICKCLOT PLUS 12X12 3 PLY,272,RC,27200002,CDM,,,,,,both,,,2757.8000,413.6700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1378.90,,,,,,,711.7900,2757.8000,percent of total billed charges,"Rev 272 $2,757.80 in Billed Charges at 50% = $1,378.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUICKCLOT PLUS 12X12 3 PLY,272,RC,27200002,CDM,,,,,,both,,,2757.8000,413.6700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,890.77,,,,,,,711.7900,2757.8000,other,"32.3% of $2,757.80 in Billed Charges for Rev 272 = $890.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING QUICKCLOT PLUS 12X12 3 PLY,272,RC,27200002,CDM,,,,,,both,,,2757.8000,413.6700,UNITED HEALTHCARE,UHC HERITAGE SELECT,846.64,,,,,,,711.7900,2757.8000,other,"30.7% of $2,757.80 in Billed Charges for Rev 272 = $846.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING QUICKCLOT PLUS 12X12 3 PLY,272,RC,27200002,CDM,,,,,,both,,,2757.8000,413.6700,UNITED HEALTHCARE,UNITED HEALTHCARE,890.77,,,,,,,711.7900,2757.8000,percent of total billed charges,"32.3% of $2,757.80 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUICKCLOT PLUS 12X12 3 PLY,272,RC,27200002,CDM,,,,,,both,,,2757.8000,413.6700,WELLCARE,WELLCARE MEDICAID,2757.80,,,,,,,711.7900,2757.8000,percent of total billed charges,"100% of $2,757.80 in Billed Charges for Rev 272 = $2,757.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEPTUNE PAD,272,RC,27202089,CDM,,,,,,both,,,773.0000,115.9500,AETNA,AETNA,330.07,,,,,,,199.5100,773.0000,percent of total billed charges,42.7% of $773.00 in Billed Charges for Rev 272 = $330.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEPTUNE PAD,272,RC,27202089,CDM,,,,,,both,,,773.0000,115.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,541.10,,,,,,,199.5100,773.0000,percent of total billed charges,Rev 272 $773.00 in Billed Charges at 70% = $541.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEPTUNE PAD,272,RC,27202089,CDM,,,,,,both,,,773.0000,115.9500,CIGNA HEALTHCARE,CIGNA HMO,322.34,,,,,,,199.5100,773.0000,percent of total billed charges,41.7% of $773.00 in Billed Charges for Rev 272 = $322.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEPTUNE PAD,272,RC,27202089,CDM,,,,,,both,,,773.0000,115.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,358.67,,,,,,,199.5100,773.0000,percent of total billed charges,46.4% of $773.00 in Billed Charges for Rev 272 = $358.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEPTUNE PAD,272,RC,27202089,CDM,,,,,,both,,,773.0000,115.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,322.34,,,,,,,199.5100,773.0000,percent of total billed charges,41.7% of $773.00 in Billed Charges for Rev 272 = $322.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEPTUNE PAD,272,RC,27202089,CDM,,,,,,both,,,773.0000,115.9500,CIGNA HEALTHCARE,CIGNA PPO,322.34,,,,,,,199.5100,773.0000,percent of total billed charges,41.7% of $773.00 in Billed Charges for Rev 272 = $322.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEPTUNE PAD,272,RC,27202089,CDM,,,,,,both,,,773.0000,115.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,695.70,,,,,,,199.5100,773.0000,percent of total billed charges,90% of $773.00 in Billed Charges for Rev 272 = $695.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEPTUNE PAD,272,RC,27202089,CDM,,,,,,both,,,773.0000,115.9500,MEDCOST,MEDCOST VHN,367.87,,,,,,,199.5100,773.0000,percent of total billed charges,47.59% of $773.00 in Billed Charges for Rev 272 = $367.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEPTUNE PAD,272,RC,27202089,CDM,,,,,,both,,,773.0000,115.9500,SENTARA HEALTH,SENTARA HEALTH,199.51,,,,,,,199.5100,773.0000,percent of total billed charges,25.81% of $773.00 in Billed Charges for Rev 272 = $199.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEPTUNE PAD,272,RC,27202089,CDM,,,,,,both,,,773.0000,115.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",773.00,,,,,,,199.5100,773.0000,percent of total billed charges,100% of $773.00 in Billed Charges for Rev 272 = $773.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEPTUNE PAD,272,RC,27202089,CDM,,,,,,both,,,773.0000,115.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,386.50,,,,,,,199.5100,773.0000,percent of total billed charges,Rev 272 $773.00 in Billed Charges at 50% = $386.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEPTUNE PAD,272,RC,27202089,CDM,,,,,,both,,,773.0000,115.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,249.68,,,,,,,199.5100,773.0000,other,32.3% of $773.00 in Billed Charges for Rev 272 = $249.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEPTUNE PAD,272,RC,27202089,CDM,,,,,,both,,,773.0000,115.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,237.31,,,,,,,199.5100,773.0000,other,30.7% of $773.00 in Billed Charges for Rev 272 = $237.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEPTUNE PAD,272,RC,27202089,CDM,,,,,,both,,,773.0000,115.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,249.68,,,,,,,199.5100,773.0000,percent of total billed charges,32.3% of $773.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEPTUNE PAD,272,RC,27202089,CDM,,,,,,both,,,773.0000,115.9500,WELLCARE,WELLCARE MEDICAID,773.00,,,,,,,199.5100,773.0000,percent of total billed charges,100% of $773.00 in Billed Charges for Rev 272 = $773.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEURO BAG EDMS DRAIN BECKER,270,RC,27000083,CDM,,,,,,both,,,132.0000,19.8000,AETNA,AETNA,56.36,,,,,,,34.0700,132.0000,percent of total billed charges,42.7% of $132.00 in Billed Charges for Rev 270 = $56.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEURO BAG EDMS DRAIN BECKER,270,RC,27000083,CDM,,,,,,both,,,132.0000,19.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,92.40,,,,,,,34.0700,132.0000,percent of total billed charges,Rev 270 $132.00 in Billed Charges at 70% = $92.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEURO BAG EDMS DRAIN BECKER,270,RC,27000083,CDM,,,,,,both,,,132.0000,19.8000,CIGNA HEALTHCARE,CIGNA HMO,55.04,,,,,,,34.0700,132.0000,percent of total billed charges,41.7% of $132.00 in Billed Charges for Rev 270 = $55.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEURO BAG EDMS DRAIN BECKER,270,RC,27000083,CDM,,,,,,both,,,132.0000,19.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,61.25,,,,,,,34.0700,132.0000,percent of total billed charges,46.4% of $132.00 in Billed Charges for Rev 270 = $61.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEURO BAG EDMS DRAIN BECKER,270,RC,27000083,CDM,,,,,,both,,,132.0000,19.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,55.04,,,,,,,34.0700,132.0000,percent of total billed charges,41.7% of $132.00 in Billed Charges for Rev 270 = $55.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEURO BAG EDMS DRAIN BECKER,270,RC,27000083,CDM,,,,,,both,,,132.0000,19.8000,CIGNA HEALTHCARE,CIGNA PPO,55.04,,,,,,,34.0700,132.0000,percent of total billed charges,41.7% of $132.00 in Billed Charges for Rev 270 = $55.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEURO BAG EDMS DRAIN BECKER,270,RC,27000083,CDM,,,,,,both,,,132.0000,19.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,118.80,,,,,,,34.0700,132.0000,percent of total billed charges,90% of $132.00 in Billed Charges for Rev 270 = $118.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEURO BAG EDMS DRAIN BECKER,270,RC,27000083,CDM,,,,,,both,,,132.0000,19.8000,MEDCOST,MEDCOST VHN,62.82,,,,,,,34.0700,132.0000,percent of total billed charges,47.59% of $132.00 in Billed Charges for Rev 270 = $62.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEURO BAG EDMS DRAIN BECKER,270,RC,27000083,CDM,,,,,,both,,,132.0000,19.8000,SENTARA HEALTH,SENTARA HEALTH,34.07,,,,,,,34.0700,132.0000,percent of total billed charges,25.81% of $132.00 in Billed Charges for Rev 270 = $34.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEURO BAG EDMS DRAIN BECKER,270,RC,27000083,CDM,,,,,,both,,,132.0000,19.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",132.00,,,,,,,34.0700,132.0000,percent of total billed charges,100% of $132.00 in Billed Charges for Rev 270 = $132.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEURO BAG EDMS DRAIN BECKER,270,RC,27000083,CDM,,,,,,both,,,132.0000,19.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,66.00,,,,,,,34.0700,132.0000,percent of total billed charges,Rev 270 $132.00 in Billed Charges at 50% = $66.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEURO BAG EDMS DRAIN BECKER,270,RC,27000083,CDM,,,,,,both,,,132.0000,19.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,42.64,,,,,,,34.0700,132.0000,other,32.3% of $132.00 in Billed Charges for Rev 270 = $42.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO BAG EDMS DRAIN BECKER,270,RC,27000083,CDM,,,,,,both,,,132.0000,19.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,40.52,,,,,,,34.0700,132.0000,other,30.7% of $132.00 in Billed Charges for Rev 270 = $40.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO BAG EDMS DRAIN BECKER,270,RC,27000083,CDM,,,,,,both,,,132.0000,19.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,42.64,,,,,,,34.0700,132.0000,percent of total billed charges,32.3% of $132.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEURO BAG EDMS DRAIN BECKER,270,RC,27000083,CDM,,,,,,both,,,132.0000,19.8000,WELLCARE,WELLCARE MEDICAID,132.00,,,,,,,34.0700,132.0000,percent of total billed charges,100% of $132.00 in Billed Charges for Rev 270 = $132.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NMR BX 8G 115M,272,RC,27200894,CDM,,,,,,both,,,2239.0000,335.8500,AETNA,AETNA,956.05,,,,,,,577.8900,2239.0000,percent of total billed charges,"42.7% of $2,239.00 in Billed Charges for Rev 272 = $956.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NMR BX 8G 115M,272,RC,27200894,CDM,,,,,,both,,,2239.0000,335.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1567.30,,,,,,,577.8900,2239.0000,percent of total billed charges,"Rev 272 $2,239.00 in Billed Charges at 70% = $1,567.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NMR BX 8G 115M,272,RC,27200894,CDM,,,,,,both,,,2239.0000,335.8500,CIGNA HEALTHCARE,CIGNA HMO,933.66,,,,,,,577.8900,2239.0000,percent of total billed charges,"41.7% of $2,239.00 in Billed Charges for Rev 272 = $933.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NMR BX 8G 115M,272,RC,27200894,CDM,,,,,,both,,,2239.0000,335.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1038.90,,,,,,,577.8900,2239.0000,percent of total billed charges,"46.4% of $2,239.00 in Billed Charges for Rev 272 = $1,038.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NMR BX 8G 115M,272,RC,27200894,CDM,,,,,,both,,,2239.0000,335.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,933.66,,,,,,,577.8900,2239.0000,percent of total billed charges,"41.7% of $2,239.00 in Billed Charges for Rev 272 = $933.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NMR BX 8G 115M,272,RC,27200894,CDM,,,,,,both,,,2239.0000,335.8500,CIGNA HEALTHCARE,CIGNA PPO,933.66,,,,,,,577.8900,2239.0000,percent of total billed charges,"41.7% of $2,239.00 in Billed Charges for Rev 272 = $933.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NMR BX 8G 115M,272,RC,27200894,CDM,,,,,,both,,,2239.0000,335.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2015.10,,,,,,,577.8900,2239.0000,percent of total billed charges,"90% of $2,239.00 in Billed Charges for Rev 272 = $2,015.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NMR BX 8G 115M,272,RC,27200894,CDM,,,,,,both,,,2239.0000,335.8500,MEDCOST,MEDCOST VHN,1065.54,,,,,,,577.8900,2239.0000,percent of total billed charges,"47.59% of $2,239.00 in Billed Charges for Rev 272 = $1,065.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NMR BX 8G 115M,272,RC,27200894,CDM,,,,,,both,,,2239.0000,335.8500,SENTARA HEALTH,SENTARA HEALTH,577.89,,,,,,,577.8900,2239.0000,percent of total billed charges,"25.81% of $2,239.00 in Billed Charges for Rev 272 = $577.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NMR BX 8G 115M,272,RC,27200894,CDM,,,,,,both,,,2239.0000,335.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2239.00,,,,,,,577.8900,2239.0000,percent of total billed charges,"100% of $2,239.00 in Billed Charges for Rev 272 = $2,239.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NMR BX 8G 115M,272,RC,27200894,CDM,,,,,,both,,,2239.0000,335.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1119.50,,,,,,,577.8900,2239.0000,percent of total billed charges,"Rev 272 $2,239.00 in Billed Charges at 50% = $1,119.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NMR BX 8G 115M,272,RC,27200894,CDM,,,,,,both,,,2239.0000,335.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,723.20,,,,,,,577.8900,2239.0000,other,"32.3% of $2,239.00 in Billed Charges for Rev 272 = $723.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NMR BX 8G 115M,272,RC,27200894,CDM,,,,,,both,,,2239.0000,335.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,687.37,,,,,,,577.8900,2239.0000,other,"30.7% of $2,239.00 in Billed Charges for Rev 272 = $687.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NMR BX 8G 115M,272,RC,27200894,CDM,,,,,,both,,,2239.0000,335.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,723.20,,,,,,,577.8900,2239.0000,percent of total billed charges,"32.3% of $2,239.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NMR BX 8G 115M,272,RC,27200894,CDM,,,,,,both,,,2239.0000,335.8500,WELLCARE,WELLCARE MEDICAID,2239.00,,,,,,,577.8900,2239.0000,percent of total billed charges,"100% of $2,239.00 in Billed Charges for Rev 272 = $2,239.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP AGLEA VCF PREMIER 20P KYPHO,272,RC,27201378,CDM,,,,,,both,,,7271.0000,1090.6500,AETNA,AETNA,3104.72,,,,,,,1876.6500,7271.0000,percent of total billed charges,"42.7% of $7,271.00 in Billed Charges for Rev 272 = $3,104.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP AGLEA VCF PREMIER 20P KYPHO,272,RC,27201378,CDM,,,,,,both,,,7271.0000,1090.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5089.70,,,,,,,1876.6500,7271.0000,percent of total billed charges,"Rev 272 $7,271.00 in Billed Charges at 70% = $5,089.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP AGLEA VCF PREMIER 20P KYPHO,272,RC,27201378,CDM,,,,,,both,,,7271.0000,1090.6500,CIGNA HEALTHCARE,CIGNA HMO,3032.01,,,,,,,1876.6500,7271.0000,percent of total billed charges,"41.7% of $7,271.00 in Billed Charges for Rev 272 = $3,032.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP AGLEA VCF PREMIER 20P KYPHO,272,RC,27201378,CDM,,,,,,both,,,7271.0000,1090.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3373.74,,,,,,,1876.6500,7271.0000,percent of total billed charges,"46.4% of $7,271.00 in Billed Charges for Rev 272 = $3,373.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP AGLEA VCF PREMIER 20P KYPHO,272,RC,27201378,CDM,,,,,,both,,,7271.0000,1090.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3032.01,,,,,,,1876.6500,7271.0000,percent of total billed charges,"41.7% of $7,271.00 in Billed Charges for Rev 272 = $3,032.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP AGLEA VCF PREMIER 20P KYPHO,272,RC,27201378,CDM,,,,,,both,,,7271.0000,1090.6500,CIGNA HEALTHCARE,CIGNA PPO,3032.01,,,,,,,1876.6500,7271.0000,percent of total billed charges,"41.7% of $7,271.00 in Billed Charges for Rev 272 = $3,032.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP AGLEA VCF PREMIER 20P KYPHO,272,RC,27201378,CDM,,,,,,both,,,7271.0000,1090.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6543.90,,,,,,,1876.6500,7271.0000,percent of total billed charges,"90% of $7,271.00 in Billed Charges for Rev 272 = $6,543.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP AGLEA VCF PREMIER 20P KYPHO,272,RC,27201378,CDM,,,,,,both,,,7271.0000,1090.6500,MEDCOST,MEDCOST VHN,3460.27,,,,,,,1876.6500,7271.0000,percent of total billed charges,"47.59% of $7,271.00 in Billed Charges for Rev 272 = $3,460.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP AGLEA VCF PREMIER 20P KYPHO,272,RC,27201378,CDM,,,,,,both,,,7271.0000,1090.6500,SENTARA HEALTH,SENTARA HEALTH,1876.65,,,,,,,1876.6500,7271.0000,percent of total billed charges,"25.81% of $7,271.00 in Billed Charges for Rev 272 = $1,876.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP AGLEA VCF PREMIER 20P KYPHO,272,RC,27201378,CDM,,,,,,both,,,7271.0000,1090.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7271.00,,,,,,,1876.6500,7271.0000,percent of total billed charges,"100% of $7,271.00 in Billed Charges for Rev 272 = $7,271.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP AGLEA VCF PREMIER 20P KYPHO,272,RC,27201378,CDM,,,,,,both,,,7271.0000,1090.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3635.50,,,,,,,1876.6500,7271.0000,percent of total billed charges,"Rev 272 $7,271.00 in Billed Charges at 50% = $3,635.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP AGLEA VCF PREMIER 20P KYPHO,272,RC,27201378,CDM,,,,,,both,,,7271.0000,1090.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2348.53,,,,,,,1876.6500,7271.0000,other,"32.3% of $7,271.00 in Billed Charges for Rev 272 = $2,348.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NSP AGLEA VCF PREMIER 20P KYPHO,272,RC,27201378,CDM,,,,,,both,,,7271.0000,1090.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2232.20,,,,,,,1876.6500,7271.0000,other,"30.7% of $7,271.00 in Billed Charges for Rev 272 = $2,232.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NSP AGLEA VCF PREMIER 20P KYPHO,272,RC,27201378,CDM,,,,,,both,,,7271.0000,1090.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,2348.53,,,,,,,1876.6500,7271.0000,percent of total billed charges,"32.3% of $7,271.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP AGLEA VCF PREMIER 20P KYPHO,272,RC,27201378,CDM,,,,,,both,,,7271.0000,1090.6500,WELLCARE,WELLCARE MEDICAID,7271.00,,,,,,,1876.6500,7271.0000,percent of total billed charges,"100% of $7,271.00 in Billed Charges for Rev 272 = $7,271.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP ALGEA CEMENT MIXER KYPHO,272,RC,27201374,CDM,,,,,,both,,,394.0000,59.1000,AETNA,AETNA,168.24,,,,,,,101.6900,394.0000,percent of total billed charges,42.7% of $394.00 in Billed Charges for Rev 272 = $168.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA CEMENT MIXER KYPHO,272,RC,27201374,CDM,,,,,,both,,,394.0000,59.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,275.80,,,,,,,101.6900,394.0000,percent of total billed charges,Rev 272 $394.00 in Billed Charges at 70% = $275.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA CEMENT MIXER KYPHO,272,RC,27201374,CDM,,,,,,both,,,394.0000,59.1000,CIGNA HEALTHCARE,CIGNA HMO,164.30,,,,,,,101.6900,394.0000,percent of total billed charges,41.7% of $394.00 in Billed Charges for Rev 272 = $164.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA CEMENT MIXER KYPHO,272,RC,27201374,CDM,,,,,,both,,,394.0000,59.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,182.82,,,,,,,101.6900,394.0000,percent of total billed charges,46.4% of $394.00 in Billed Charges for Rev 272 = $182.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA CEMENT MIXER KYPHO,272,RC,27201374,CDM,,,,,,both,,,394.0000,59.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,164.30,,,,,,,101.6900,394.0000,percent of total billed charges,41.7% of $394.00 in Billed Charges for Rev 272 = $164.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA CEMENT MIXER KYPHO,272,RC,27201374,CDM,,,,,,both,,,394.0000,59.1000,CIGNA HEALTHCARE,CIGNA PPO,164.30,,,,,,,101.6900,394.0000,percent of total billed charges,41.7% of $394.00 in Billed Charges for Rev 272 = $164.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA CEMENT MIXER KYPHO,272,RC,27201374,CDM,,,,,,both,,,394.0000,59.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,354.60,,,,,,,101.6900,394.0000,percent of total billed charges,90% of $394.00 in Billed Charges for Rev 272 = $354.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA CEMENT MIXER KYPHO,272,RC,27201374,CDM,,,,,,both,,,394.0000,59.1000,MEDCOST,MEDCOST VHN,187.50,,,,,,,101.6900,394.0000,percent of total billed charges,47.59% of $394.00 in Billed Charges for Rev 272 = $187.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA CEMENT MIXER KYPHO,272,RC,27201374,CDM,,,,,,both,,,394.0000,59.1000,SENTARA HEALTH,SENTARA HEALTH,101.69,,,,,,,101.6900,394.0000,percent of total billed charges,25.81% of $394.00 in Billed Charges for Rev 272 = $101.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA CEMENT MIXER KYPHO,272,RC,27201374,CDM,,,,,,both,,,394.0000,59.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",394.00,,,,,,,101.6900,394.0000,percent of total billed charges,100% of $394.00 in Billed Charges for Rev 272 = $394.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA CEMENT MIXER KYPHO,272,RC,27201374,CDM,,,,,,both,,,394.0000,59.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,197.00,,,,,,,101.6900,394.0000,percent of total billed charges,Rev 272 $394.00 in Billed Charges at 50% = $197.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA CEMENT MIXER KYPHO,272,RC,27201374,CDM,,,,,,both,,,394.0000,59.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,127.26,,,,,,,101.6900,394.0000,other,32.3% of $394.00 in Billed Charges for Rev 272 = $127.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NSP ALGEA CEMENT MIXER KYPHO,272,RC,27201374,CDM,,,,,,both,,,394.0000,59.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,120.96,,,,,,,101.6900,394.0000,other,30.7% of $394.00 in Billed Charges for Rev 272 = $120.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NSP ALGEA CEMENT MIXER KYPHO,272,RC,27201374,CDM,,,,,,both,,,394.0000,59.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,127.26,,,,,,,101.6900,394.0000,percent of total billed charges,32.3% of $394.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA CEMENT MIXER KYPHO,272,RC,27201374,CDM,,,,,,both,,,394.0000,59.1000,WELLCARE,WELLCARE MEDICAID,394.00,,,,,,,101.6900,394.0000,percent of total billed charges,100% of $394.00 in Billed Charges for Rev 272 = $394.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 4 8FR,272,RC,27200076,CDM,,,,,,both,,,45.0000,6.7500,AETNA,AETNA,19.22,,,,,,,11.6100,45.0000,percent of total billed charges,42.7% of $45.00 in Billed Charges for Rev 272 = $19.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 4 8FR,272,RC,27200076,CDM,,,,,,both,,,45.0000,6.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,31.50,,,,,,,11.6100,45.0000,percent of total billed charges,Rev 272 $45.00 in Billed Charges at 70% = $31.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 4 8FR,272,RC,27200076,CDM,,,,,,both,,,45.0000,6.7500,CIGNA HEALTHCARE,CIGNA HMO,18.77,,,,,,,11.6100,45.0000,percent of total billed charges,41.7% of $45.00 in Billed Charges for Rev 272 = $18.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 4 8FR,272,RC,27200076,CDM,,,,,,both,,,45.0000,6.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,20.88,,,,,,,11.6100,45.0000,percent of total billed charges,46.4% of $45.00 in Billed Charges for Rev 272 = $20.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 4 8FR,272,RC,27200076,CDM,,,,,,both,,,45.0000,6.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,18.77,,,,,,,11.6100,45.0000,percent of total billed charges,41.7% of $45.00 in Billed Charges for Rev 272 = $18.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 4 8FR,272,RC,27200076,CDM,,,,,,both,,,45.0000,6.7500,CIGNA HEALTHCARE,CIGNA PPO,18.77,,,,,,,11.6100,45.0000,percent of total billed charges,41.7% of $45.00 in Billed Charges for Rev 272 = $18.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 4 8FR,272,RC,27200076,CDM,,,,,,both,,,45.0000,6.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,40.50,,,,,,,11.6100,45.0000,percent of total billed charges,90% of $45.00 in Billed Charges for Rev 272 = $40.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 4 8FR,272,RC,27200076,CDM,,,,,,both,,,45.0000,6.7500,MEDCOST,MEDCOST VHN,21.42,,,,,,,11.6100,45.0000,percent of total billed charges,47.59% of $45.00 in Billed Charges for Rev 272 = $21.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 4 8FR,272,RC,27200076,CDM,,,,,,both,,,45.0000,6.7500,SENTARA HEALTH,SENTARA HEALTH,11.61,,,,,,,11.6100,45.0000,percent of total billed charges,25.81% of $45.00 in Billed Charges for Rev 272 = $11.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 4 8FR,272,RC,27200076,CDM,,,,,,both,,,45.0000,6.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",45.00,,,,,,,11.6100,45.0000,percent of total billed charges,100% of $45.00 in Billed Charges for Rev 272 = $45.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 4 8FR,272,RC,27200076,CDM,,,,,,both,,,45.0000,6.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.50,,,,,,,11.6100,45.0000,percent of total billed charges,Rev 272 $45.00 in Billed Charges at 50% = $22.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 4 8FR,272,RC,27200076,CDM,,,,,,both,,,45.0000,6.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,14.54,,,,,,,11.6100,45.0000,other,32.3% of $45.00 in Billed Charges for Rev 272 = $14.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NSP INTROD DILATOR 4 8FR,272,RC,27200076,CDM,,,,,,both,,,45.0000,6.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,13.82,,,,,,,11.6100,45.0000,other,30.7% of $45.00 in Billed Charges for Rev 272 = $13.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NSP INTROD DILATOR 4 8FR,272,RC,27200076,CDM,,,,,,both,,,45.0000,6.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,14.54,,,,,,,11.6100,45.0000,percent of total billed charges,32.3% of $45.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 4 8FR,272,RC,27200076,CDM,,,,,,both,,,45.0000,6.7500,WELLCARE,WELLCARE MEDICAID,45.00,,,,,,,11.6100,45.0000,percent of total billed charges,100% of $45.00 in Billed Charges for Rev 272 = $45.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP POWERPULSE Y SPIKE SET,272,RC,27200906,CDM,,,,,,both,,,185.0000,27.7500,AETNA,AETNA,79.00,,,,,,,47.7500,185.0000,percent of total billed charges,42.7% of $185.00 in Billed Charges for Rev 272 = $79.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP POWERPULSE Y SPIKE SET,272,RC,27200906,CDM,,,,,,both,,,185.0000,27.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,129.50,,,,,,,47.7500,185.0000,percent of total billed charges,Rev 272 $185.00 in Billed Charges at 70% = $129.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP POWERPULSE Y SPIKE SET,272,RC,27200906,CDM,,,,,,both,,,185.0000,27.7500,CIGNA HEALTHCARE,CIGNA HMO,77.15,,,,,,,47.7500,185.0000,percent of total billed charges,41.7% of $185.00 in Billed Charges for Rev 272 = $77.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP POWERPULSE Y SPIKE SET,272,RC,27200906,CDM,,,,,,both,,,185.0000,27.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,85.84,,,,,,,47.7500,185.0000,percent of total billed charges,46.4% of $185.00 in Billed Charges for Rev 272 = $85.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP POWERPULSE Y SPIKE SET,272,RC,27200906,CDM,,,,,,both,,,185.0000,27.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,77.15,,,,,,,47.7500,185.0000,percent of total billed charges,41.7% of $185.00 in Billed Charges for Rev 272 = $77.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP POWERPULSE Y SPIKE SET,272,RC,27200906,CDM,,,,,,both,,,185.0000,27.7500,CIGNA HEALTHCARE,CIGNA PPO,77.15,,,,,,,47.7500,185.0000,percent of total billed charges,41.7% of $185.00 in Billed Charges for Rev 272 = $77.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP POWERPULSE Y SPIKE SET,272,RC,27200906,CDM,,,,,,both,,,185.0000,27.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,166.50,,,,,,,47.7500,185.0000,percent of total billed charges,90% of $185.00 in Billed Charges for Rev 272 = $166.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP POWERPULSE Y SPIKE SET,272,RC,27200906,CDM,,,,,,both,,,185.0000,27.7500,MEDCOST,MEDCOST VHN,88.04,,,,,,,47.7500,185.0000,percent of total billed charges,47.59% of $185.00 in Billed Charges for Rev 272 = $88.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP POWERPULSE Y SPIKE SET,272,RC,27200906,CDM,,,,,,both,,,185.0000,27.7500,SENTARA HEALTH,SENTARA HEALTH,47.75,,,,,,,47.7500,185.0000,percent of total billed charges,25.81% of $185.00 in Billed Charges for Rev 272 = $47.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP POWERPULSE Y SPIKE SET,272,RC,27200906,CDM,,,,,,both,,,185.0000,27.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",185.00,,,,,,,47.7500,185.0000,percent of total billed charges,100% of $185.00 in Billed Charges for Rev 272 = $185.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP POWERPULSE Y SPIKE SET,272,RC,27200906,CDM,,,,,,both,,,185.0000,27.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,92.50,,,,,,,47.7500,185.0000,percent of total billed charges,Rev 272 $185.00 in Billed Charges at 50% = $92.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP POWERPULSE Y SPIKE SET,272,RC,27200906,CDM,,,,,,both,,,185.0000,27.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,59.76,,,,,,,47.7500,185.0000,other,32.3% of $185.00 in Billed Charges for Rev 272 = $59.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NSP POWERPULSE Y SPIKE SET,272,RC,27200906,CDM,,,,,,both,,,185.0000,27.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,56.80,,,,,,,47.7500,185.0000,other,30.7% of $185.00 in Billed Charges for Rev 272 = $56.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NSP POWERPULSE Y SPIKE SET,272,RC,27200906,CDM,,,,,,both,,,185.0000,27.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,59.76,,,,,,,47.7500,185.0000,percent of total billed charges,32.3% of $185.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP POWERPULSE Y SPIKE SET,272,RC,27200906,CDM,,,,,,both,,,185.0000,27.7500,WELLCARE,WELLCARE MEDICAID,185.00,,,,,,,47.7500,185.0000,percent of total billed charges,100% of $185.00 in Billed Charges for Rev 272 = $185.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP TRAY BX 4380,272,RC,27201174,CDM,,,,,,both,,,74.0000,11.1000,AETNA,AETNA,31.60,,,,,,,19.1000,74.0000,percent of total billed charges,42.7% of $74.00 in Billed Charges for Rev 272 = $31.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP TRAY BX 4380,272,RC,27201174,CDM,,,,,,both,,,74.0000,11.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,51.80,,,,,,,19.1000,74.0000,percent of total billed charges,Rev 272 $74.00 in Billed Charges at 70% = $51.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP TRAY BX 4380,272,RC,27201174,CDM,,,,,,both,,,74.0000,11.1000,CIGNA HEALTHCARE,CIGNA HMO,30.86,,,,,,,19.1000,74.0000,percent of total billed charges,41.7% of $74.00 in Billed Charges for Rev 272 = $30.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP TRAY BX 4380,272,RC,27201174,CDM,,,,,,both,,,74.0000,11.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,34.34,,,,,,,19.1000,74.0000,percent of total billed charges,46.4% of $74.00 in Billed Charges for Rev 272 = $34.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP TRAY BX 4380,272,RC,27201174,CDM,,,,,,both,,,74.0000,11.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,30.86,,,,,,,19.1000,74.0000,percent of total billed charges,41.7% of $74.00 in Billed Charges for Rev 272 = $30.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP TRAY BX 4380,272,RC,27201174,CDM,,,,,,both,,,74.0000,11.1000,CIGNA HEALTHCARE,CIGNA PPO,30.86,,,,,,,19.1000,74.0000,percent of total billed charges,41.7% of $74.00 in Billed Charges for Rev 272 = $30.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP TRAY BX 4380,272,RC,27201174,CDM,,,,,,both,,,74.0000,11.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,66.60,,,,,,,19.1000,74.0000,percent of total billed charges,90% of $74.00 in Billed Charges for Rev 272 = $66.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP TRAY BX 4380,272,RC,27201174,CDM,,,,,,both,,,74.0000,11.1000,MEDCOST,MEDCOST VHN,35.22,,,,,,,19.1000,74.0000,percent of total billed charges,47.59% of $74.00 in Billed Charges for Rev 272 = $35.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP TRAY BX 4380,272,RC,27201174,CDM,,,,,,both,,,74.0000,11.1000,SENTARA HEALTH,SENTARA HEALTH,19.10,,,,,,,19.1000,74.0000,percent of total billed charges,25.81% of $74.00 in Billed Charges for Rev 272 = $19.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP TRAY BX 4380,272,RC,27201174,CDM,,,,,,both,,,74.0000,11.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",74.00,,,,,,,19.1000,74.0000,percent of total billed charges,100% of $74.00 in Billed Charges for Rev 272 = $74.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP TRAY BX 4380,272,RC,27201174,CDM,,,,,,both,,,74.0000,11.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,37.00,,,,,,,19.1000,74.0000,percent of total billed charges,Rev 272 $74.00 in Billed Charges at 50% = $37.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP TRAY BX 4380,272,RC,27201174,CDM,,,,,,both,,,74.0000,11.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,23.90,,,,,,,19.1000,74.0000,other,32.3% of $74.00 in Billed Charges for Rev 272 = $23.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NSP TRAY BX 4380,272,RC,27201174,CDM,,,,,,both,,,74.0000,11.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,22.72,,,,,,,19.1000,74.0000,other,30.7% of $74.00 in Billed Charges for Rev 272 = $22.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NSP TRAY BX 4380,272,RC,27201174,CDM,,,,,,both,,,74.0000,11.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,23.90,,,,,,,19.1000,74.0000,percent of total billed charges,32.3% of $74.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP TRAY BX 4380,272,RC,27201174,CDM,,,,,,both,,,74.0000,11.1000,WELLCARE,WELLCARE MEDICAID,74.00,,,,,,,19.1000,74.0000,percent of total billed charges,100% of $74.00 in Billed Charges for Rev 272 = $74.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NURSERY LEVEL 1 ROOM DLY,171,RC,17100001,CDM,,,,,,inpatient,,,2052.0000,307.8000,AETNA,AETNA,661.00,,,,,,,121.7600,2052.0000,per diem,$661.00 for 1 day = $661.00 for Rev 171
HC NURSERY LEVEL 1 ROOM DLY,171,RC,17100001,CDM,,,,,,inpatient,,,2052.0000,307.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,121.7600,2052.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC NURSERY LEVEL 1 ROOM DLY,171,RC,17100001,CDM,,,,,,inpatient,,,2052.0000,307.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1846.80,,,,,,,121.7600,2052.0000,percent of total billed charges,"90% of $2,052.00 in Billed Charges for Rev 171 = $1,846.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NURSERY LEVEL 1 ROOM DLY,171,RC,17100001,CDM,,,,,,inpatient,,,2052.0000,307.8000,MEDCOST,MEDCOST VHN,976.55,,,,,,,121.7600,2052.0000,percent of total billed charges,"47.59% of $2,052.00 in Billed Charges for Rev 171 = $976.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NURSERY LEVEL 1 ROOM DLY,171,RC,17100001,CDM,,,,,,inpatient,,,2052.0000,307.8000,SENTARA HEALTH,SENTARA HEALTH,764.99,,,,,,,121.7600,2052.0000,percent of total billed charges,"37.28% of $2,052.00 in Billed Charges for Rev 171 = $764.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NURSERY LEVEL 1 ROOM DLY,171,RC,17100001,CDM,,,,,,inpatient,,,2052.0000,307.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2052.00,,,,,,,121.7600,2052.0000,percent of total billed charges,"100% of $2,052.00 in Billed Charges for Rev 171 = $2,052.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NURSERY LEVEL 2 ROOM DLY,172,RC,17200001,CDM,,,,,,inpatient,,,2258.0000,338.7000,AETNA,AETNA,661.00,,,,,,,121.7600,2258.0000,per diem,$661.00 for 1 day = $661.00 for Rev 172
HC NURSERY LEVEL 2 ROOM DLY,172,RC,17200001,CDM,,,,,,inpatient,,,2258.0000,338.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,121.7600,2258.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC NURSERY LEVEL 2 ROOM DLY,172,RC,17200001,CDM,,,,,,inpatient,,,2258.0000,338.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2032.20,,,,,,,121.7600,2258.0000,percent of total billed charges,"90% of $2,258.00 in Billed Charges for Rev 172 = $2,032.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NURSERY LEVEL 2 ROOM DLY,172,RC,17200001,CDM,,,,,,inpatient,,,2258.0000,338.7000,MEDCOST,MEDCOST VHN,1074.58,,,,,,,121.7600,2258.0000,percent of total billed charges,"47.59% of $2,258.00 in Billed Charges for Rev 172 = $1,074.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NURSERY LEVEL 2 ROOM DLY,172,RC,17200001,CDM,,,,,,inpatient,,,2258.0000,338.7000,SENTARA HEALTH,SENTARA HEALTH,841.78,,,,,,,121.7600,2258.0000,percent of total billed charges,"37.28% of $2,258.00 in Billed Charges for Rev 172 = $841.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NURSERY LEVEL 2 ROOM DLY,172,RC,17200001,CDM,,,,,,inpatient,,,2258.0000,338.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2258.00,,,,,,,121.7600,2258.0000,percent of total billed charges,"100% of $2,258.00 in Billed Charges for Rev 172 = $2,258.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NURSERY LEVEL 3 ROOM DLY,173,RC,17300001,CDM,,,,,,inpatient,,,2484.0000,372.6000,AETNA,AETNA,2211.00,,,,,,,121.7600,2484.0000,per diem,"$2,211.00 for 1 day = $2,211.00 for Rev 173"
HC NURSERY LEVEL 3 ROOM DLY,173,RC,17300001,CDM,,,,,,inpatient,,,2484.0000,372.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,121.7600,2484.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC NURSERY LEVEL 3 ROOM DLY,173,RC,17300001,CDM,,,,,,inpatient,,,2484.0000,372.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2235.60,,,,,,,121.7600,2484.0000,percent of total billed charges,"90% of $2,484.00 in Billed Charges for Rev 173 = $2,235.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NURSERY LEVEL 3 ROOM DLY,173,RC,17300001,CDM,,,,,,inpatient,,,2484.0000,372.6000,MEDCOST,MEDCOST VHN,1182.14,,,,,,,121.7600,2484.0000,percent of total billed charges,"47.59% of $2,484.00 in Billed Charges for Rev 173 = $1,182.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NURSERY LEVEL 3 ROOM DLY,173,RC,17300001,CDM,,,,,,inpatient,,,2484.0000,372.6000,SENTARA HEALTH,SENTARA HEALTH,926.04,,,,,,,121.7600,2484.0000,percent of total billed charges,"37.28% of $2,484.00 in Billed Charges for Rev 173 = $926.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NURSERY LEVEL 3 ROOM DLY,173,RC,17300001,CDM,,,,,,inpatient,,,2484.0000,372.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2484.00,,,,,,,121.7600,2484.0000,percent of total billed charges,"100% of $2,484.00 in Billed Charges for Rev 173 = $2,484.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUIKCLOT CONTROL+ 8 X 8 2 PLY,272,RC,27200002,CDM,,,,,,both,,,1697.1100,254.5700,AETNA,AETNA,724.67,,,,,,,438.0200,1697.1100,percent of total billed charges,"42.7% of $1,697.11 in Billed Charges for Rev 272 = $724.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUIKCLOT CONTROL+ 8 X 8 2 PLY,272,RC,27200002,CDM,,,,,,both,,,1697.1100,254.5700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1187.98,,,,,,,438.0200,1697.1100,percent of total billed charges,"Rev 272 $1,697.11 in Billed Charges at 70% = $1,187.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUIKCLOT CONTROL+ 8 X 8 2 PLY,272,RC,27200002,CDM,,,,,,both,,,1697.1100,254.5700,CIGNA HEALTHCARE,CIGNA HMO,707.69,,,,,,,438.0200,1697.1100,percent of total billed charges,"41.7% of $1,697.11 in Billed Charges for Rev 272 = $707.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUIKCLOT CONTROL+ 8 X 8 2 PLY,272,RC,27200002,CDM,,,,,,both,,,1697.1100,254.5700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,787.46,,,,,,,438.0200,1697.1100,percent of total billed charges,"46.4% of $1,697.11 in Billed Charges for Rev 272 = $787.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUIKCLOT CONTROL+ 8 X 8 2 PLY,272,RC,27200002,CDM,,,,,,both,,,1697.1100,254.5700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,707.69,,,,,,,438.0200,1697.1100,percent of total billed charges,"41.7% of $1,697.11 in Billed Charges for Rev 272 = $707.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUIKCLOT CONTROL+ 8 X 8 2 PLY,272,RC,27200002,CDM,,,,,,both,,,1697.1100,254.5700,CIGNA HEALTHCARE,CIGNA PPO,707.69,,,,,,,438.0200,1697.1100,percent of total billed charges,"41.7% of $1,697.11 in Billed Charges for Rev 272 = $707.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUIKCLOT CONTROL+ 8 X 8 2 PLY,272,RC,27200002,CDM,,,,,,both,,,1697.1100,254.5700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1527.40,,,,,,,438.0200,1697.1100,percent of total billed charges,"90% of $1,697.11 in Billed Charges for Rev 272 = $1,527.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUIKCLOT CONTROL+ 8 X 8 2 PLY,272,RC,27200002,CDM,,,,,,both,,,1697.1100,254.5700,MEDCOST,MEDCOST VHN,807.65,,,,,,,438.0200,1697.1100,percent of total billed charges,"47.59% of $1,697.11 in Billed Charges for Rev 272 = $807.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUIKCLOT CONTROL+ 8 X 8 2 PLY,272,RC,27200002,CDM,,,,,,both,,,1697.1100,254.5700,SENTARA HEALTH,SENTARA HEALTH,438.02,,,,,,,438.0200,1697.1100,percent of total billed charges,"25.81% of $1,697.11 in Billed Charges for Rev 272 = $438.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUIKCLOT CONTROL+ 8 X 8 2 PLY,272,RC,27200002,CDM,,,,,,both,,,1697.1100,254.5700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1697.11,,,,,,,438.0200,1697.1100,percent of total billed charges,"100% of $1,697.11 in Billed Charges for Rev 272 = $1,697.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUIKCLOT CONTROL+ 8 X 8 2 PLY,272,RC,27200002,CDM,,,,,,both,,,1697.1100,254.5700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,848.56,,,,,,,438.0200,1697.1100,percent of total billed charges,"Rev 272 $1,697.11 in Billed Charges at 50% = $848.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUIKCLOT CONTROL+ 8 X 8 2 PLY,272,RC,27200002,CDM,,,,,,both,,,1697.1100,254.5700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,548.17,,,,,,,438.0200,1697.1100,other,"32.3% of $1,697.11 in Billed Charges for Rev 272 = $548.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING QUIKCLOT CONTROL+ 8 X 8 2 PLY,272,RC,27200002,CDM,,,,,,both,,,1697.1100,254.5700,UNITED HEALTHCARE,UHC HERITAGE SELECT,521.01,,,,,,,438.0200,1697.1100,other,"30.7% of $1,697.11 in Billed Charges for Rev 272 = $521.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING QUIKCLOT CONTROL+ 8 X 8 2 PLY,272,RC,27200002,CDM,,,,,,both,,,1697.1100,254.5700,UNITED HEALTHCARE,UNITED HEALTHCARE,548.17,,,,,,,438.0200,1697.1100,percent of total billed charges,"32.3% of $1,697.11 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING QUIKCLOT CONTROL+ 8 X 8 2 PLY,272,RC,27200002,CDM,,,,,,both,,,1697.1100,254.5700,WELLCARE,WELLCARE MEDICAID,1697.11,,,,,,,438.0200,1697.1100,percent of total billed charges,"100% of $1,697.11 in Billed Charges for Rev 272 = $1,697.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SURGICAL PREVENA 5/PK,272,RC,27200002,CDM,,,,,,both,,,3042.0200,456.3000,AETNA,AETNA,1298.94,,,,,,,785.1500,3042.0200,percent of total billed charges,"42.7% of $3,042.02 in Billed Charges for Rev 272 = $1,298.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SURGICAL PREVENA 5/PK,272,RC,27200002,CDM,,,,,,both,,,3042.0200,456.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2129.41,,,,,,,785.1500,3042.0200,percent of total billed charges,"Rev 272 $3,042.02 in Billed Charges at 70% = $2,129.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SURGICAL PREVENA 5/PK,272,RC,27200002,CDM,,,,,,both,,,3042.0200,456.3000,CIGNA HEALTHCARE,CIGNA HMO,1268.52,,,,,,,785.1500,3042.0200,percent of total billed charges,"41.7% of $3,042.02 in Billed Charges for Rev 272 = $1,268.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SURGICAL PREVENA 5/PK,272,RC,27200002,CDM,,,,,,both,,,3042.0200,456.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1411.50,,,,,,,785.1500,3042.0200,percent of total billed charges,"46.4% of $3,042.02 in Billed Charges for Rev 272 = $1,411.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SURGICAL PREVENA 5/PK,272,RC,27200002,CDM,,,,,,both,,,3042.0200,456.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1268.52,,,,,,,785.1500,3042.0200,percent of total billed charges,"41.7% of $3,042.02 in Billed Charges for Rev 272 = $1,268.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SURGICAL PREVENA 5/PK,272,RC,27200002,CDM,,,,,,both,,,3042.0200,456.3000,CIGNA HEALTHCARE,CIGNA PPO,1268.52,,,,,,,785.1500,3042.0200,percent of total billed charges,"41.7% of $3,042.02 in Billed Charges for Rev 272 = $1,268.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SURGICAL PREVENA 5/PK,272,RC,27200002,CDM,,,,,,both,,,3042.0200,456.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2737.82,,,,,,,785.1500,3042.0200,percent of total billed charges,"90% of $3,042.02 in Billed Charges for Rev 272 = $2,737.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SURGICAL PREVENA 5/PK,272,RC,27200002,CDM,,,,,,both,,,3042.0200,456.3000,MEDCOST,MEDCOST VHN,1447.70,,,,,,,785.1500,3042.0200,percent of total billed charges,"47.59% of $3,042.02 in Billed Charges for Rev 272 = $1,447.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SURGICAL PREVENA 5/PK,272,RC,27200002,CDM,,,,,,both,,,3042.0200,456.3000,SENTARA HEALTH,SENTARA HEALTH,785.15,,,,,,,785.1500,3042.0200,percent of total billed charges,"25.81% of $3,042.02 in Billed Charges for Rev 272 = $785.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SURGICAL PREVENA 5/PK,272,RC,27200002,CDM,,,,,,both,,,3042.0200,456.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3042.02,,,,,,,785.1500,3042.0200,percent of total billed charges,"100% of $3,042.02 in Billed Charges for Rev 272 = $3,042.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SURGICAL PREVENA 5/PK,272,RC,27200002,CDM,,,,,,both,,,3042.0200,456.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1521.01,,,,,,,785.1500,3042.0200,percent of total billed charges,"Rev 272 $3,042.02 in Billed Charges at 50% = $1,521.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SURGICAL PREVENA 5/PK,272,RC,27200002,CDM,,,,,,both,,,3042.0200,456.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,982.57,,,,,,,785.1500,3042.0200,other,"32.3% of $3,042.02 in Billed Charges for Rev 272 = $982.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING SURGICAL PREVENA 5/PK,272,RC,27200002,CDM,,,,,,both,,,3042.0200,456.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,933.90,,,,,,,785.1500,3042.0200,other,"30.7% of $3,042.02 in Billed Charges for Rev 272 = $933.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRESSING SURGICAL PREVENA 5/PK,272,RC,27200002,CDM,,,,,,both,,,3042.0200,456.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,982.57,,,,,,,785.1500,3042.0200,percent of total billed charges,"32.3% of $3,042.02 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SURGICAL PREVENA 5/PK,272,RC,27200002,CDM,,,,,,both,,,3042.0200,456.3000,WELLCARE,WELLCARE MEDICAID,3042.02,,,,,,,785.1500,3042.0200,percent of total billed charges,"100% of $3,042.02 in Billed Charges for Rev 272 = $3,042.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT INTERCONTINENTAL  5.5,272,RC,,,,,,,,both,,,6264.0800,939.6100,AETNA,AETNA,2674.76,,,,,,,1616.7600,6264.0800,percent of total billed charges,"42.7% of $6,264.08 in Billed Charges for Rev 272 = $2,674.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT INTERCONTINENTAL  5.5,272,RC,,,,,,,,both,,,6264.0800,939.6100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4384.86,,,,,,,1616.7600,6264.0800,percent of total billed charges,"Rev 272 $6,264.08 in Billed Charges at 70% = $4,384.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT INTERCONTINENTAL  5.5,272,RC,,,,,,,,both,,,6264.0800,939.6100,CIGNA HEALTHCARE,CIGNA HMO,2612.12,,,,,,,1616.7600,6264.0800,percent of total billed charges,"41.7% of $6,264.08 in Billed Charges for Rev 272 = $2,612.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT INTERCONTINENTAL  5.5,272,RC,,,,,,,,both,,,6264.0800,939.6100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2906.53,,,,,,,1616.7600,6264.0800,percent of total billed charges,"46.4% of $6,264.08 in Billed Charges for Rev 272 = $2,906.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT INTERCONTINENTAL  5.5,272,RC,,,,,,,,both,,,6264.0800,939.6100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2612.12,,,,,,,1616.7600,6264.0800,percent of total billed charges,"41.7% of $6,264.08 in Billed Charges for Rev 272 = $2,612.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT INTERCONTINENTAL  5.5,272,RC,,,,,,,,both,,,6264.0800,939.6100,CIGNA HEALTHCARE,CIGNA PPO,2612.12,,,,,,,1616.7600,6264.0800,percent of total billed charges,"41.7% of $6,264.08 in Billed Charges for Rev 272 = $2,612.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT INTERCONTINENTAL  5.5,272,RC,,,,,,,,both,,,6264.0800,939.6100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5637.67,,,,,,,1616.7600,6264.0800,percent of total billed charges,"90% of $6,264.08 in Billed Charges for Rev 272 = $5,637.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT INTERCONTINENTAL  5.5,272,RC,,,,,,,,both,,,6264.0800,939.6100,MEDCOST,MEDCOST VHN,2981.08,,,,,,,1616.7600,6264.0800,percent of total billed charges,"47.59% of $6,264.08 in Billed Charges for Rev 272 = $2,981.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT INTERCONTINENTAL  5.5,272,RC,,,,,,,,both,,,6264.0800,939.6100,SENTARA HEALTH,SENTARA HEALTH,1616.76,,,,,,,1616.7600,6264.0800,percent of total billed charges,"25.81% of $6,264.08 in Billed Charges for Rev 272 = $1,616.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT INTERCONTINENTAL  5.5,272,RC,,,,,,,,both,,,6264.0800,939.6100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6264.08,,,,,,,1616.7600,6264.0800,percent of total billed charges,"100% of $6,264.08 in Billed Charges for Rev 272 = $6,264.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT INTERCONTINENTAL  5.5,272,RC,,,,,,,,both,,,6264.0800,939.6100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3132.04,,,,,,,1616.7600,6264.0800,percent of total billed charges,"Rev 272 $6,264.08 in Billed Charges at 50% = $3,132.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT INTERCONTINENTAL  5.5,272,RC,,,,,,,,both,,,6264.0800,939.6100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2023.30,,,,,,,1616.7600,6264.0800,other,"32.3% of $6,264.08 in Billed Charges for Rev 272 = $2,023.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT INTERCONTINENTAL  5.5,272,RC,,,,,,,,both,,,6264.0800,939.6100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1923.07,,,,,,,1616.7600,6264.0800,other,"30.7% of $6,264.08 in Billed Charges for Rev 272 = $1,923.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT INTERCONTINENTAL  5.5,272,RC,,,,,,,,both,,,6264.0800,939.6100,UNITED HEALTHCARE,UNITED HEALTHCARE,2023.30,,,,,,,1616.7600,6264.0800,percent of total billed charges,"32.3% of $6,264.08 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT INTERCONTINENTAL  5.5,272,RC,,,,,,,,both,,,6264.0800,939.6100,WELLCARE,WELLCARE MEDICAID,6264.08,,,,,,,1616.7600,6264.0800,percent of total billed charges,"100% of $6,264.08 in Billed Charges for Rev 272 = $6,264.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LISFRANC 2.6MM,272,RC,,,,,,,,both,,,2219.3900,332.9100,AETNA,AETNA,947.68,,,,,,,572.8200,2219.3900,percent of total billed charges,"42.7% of $2,219.39 in Billed Charges for Rev 272 = $947.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LISFRANC 2.6MM,272,RC,,,,,,,,both,,,2219.3900,332.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1553.57,,,,,,,572.8200,2219.3900,percent of total billed charges,"Rev 272 $2,219.39 in Billed Charges at 70% = $1,553.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LISFRANC 2.6MM,272,RC,,,,,,,,both,,,2219.3900,332.9100,CIGNA HEALTHCARE,CIGNA HMO,925.49,,,,,,,572.8200,2219.3900,percent of total billed charges,"41.7% of $2,219.39 in Billed Charges for Rev 272 = $925.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LISFRANC 2.6MM,272,RC,,,,,,,,both,,,2219.3900,332.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1029.80,,,,,,,572.8200,2219.3900,percent of total billed charges,"46.4% of $2,219.39 in Billed Charges for Rev 272 = $1,029.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LISFRANC 2.6MM,272,RC,,,,,,,,both,,,2219.3900,332.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,925.49,,,,,,,572.8200,2219.3900,percent of total billed charges,"41.7% of $2,219.39 in Billed Charges for Rev 272 = $925.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LISFRANC 2.6MM,272,RC,,,,,,,,both,,,2219.3900,332.9100,CIGNA HEALTHCARE,CIGNA PPO,925.49,,,,,,,572.8200,2219.3900,percent of total billed charges,"41.7% of $2,219.39 in Billed Charges for Rev 272 = $925.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LISFRANC 2.6MM,272,RC,,,,,,,,both,,,2219.3900,332.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1997.45,,,,,,,572.8200,2219.3900,percent of total billed charges,"90% of $2,219.39 in Billed Charges for Rev 272 = $1,997.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LISFRANC 2.6MM,272,RC,,,,,,,,both,,,2219.3900,332.9100,MEDCOST,MEDCOST VHN,1056.21,,,,,,,572.8200,2219.3900,percent of total billed charges,"47.59% of $2,219.39 in Billed Charges for Rev 272 = $1,056.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LISFRANC 2.6MM,272,RC,,,,,,,,both,,,2219.3900,332.9100,SENTARA HEALTH,SENTARA HEALTH,572.82,,,,,,,572.8200,2219.3900,percent of total billed charges,"25.81% of $2,219.39 in Billed Charges for Rev 272 = $572.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LISFRANC 2.6MM,272,RC,,,,,,,,both,,,2219.3900,332.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2219.39,,,,,,,572.8200,2219.3900,percent of total billed charges,"100% of $2,219.39 in Billed Charges for Rev 272 = $2,219.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LISFRANC 2.6MM,272,RC,,,,,,,,both,,,2219.3900,332.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1109.70,,,,,,,572.8200,2219.3900,percent of total billed charges,"Rev 272 $2,219.39 in Billed Charges at 50% = $1,109.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LISFRANC 2.6MM,272,RC,,,,,,,,both,,,2219.3900,332.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,716.86,,,,,,,572.8200,2219.3900,other,"32.3% of $2,219.39 in Billed Charges for Rev 272 = $716.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT LISFRANC 2.6MM,272,RC,,,,,,,,both,,,2219.3900,332.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,681.35,,,,,,,572.8200,2219.3900,other,"30.7% of $2,219.39 in Billed Charges for Rev 272 = $681.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT LISFRANC 2.6MM,272,RC,,,,,,,,both,,,2219.3900,332.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,716.86,,,,,,,572.8200,2219.3900,percent of total billed charges,"32.3% of $2,219.39 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LISFRANC 2.6MM,272,RC,,,,,,,,both,,,2219.3900,332.9100,WELLCARE,WELLCARE MEDICAID,2219.39,,,,,,,572.8200,2219.3900,percent of total billed charges,"100% of $2,219.39 in Billed Charges for Rev 272 = $2,219.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLING ARM,270,RC,27000147,CDM,,,,,,both,,,30.0000,4.5000,AETNA,AETNA,12.81,,,,,,,7.7400,30.0000,percent of total billed charges,42.7% of $30.00 in Billed Charges for Rev 270 = $12.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM,270,RC,27000147,CDM,,,,,,both,,,30.0000,4.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,21.00,,,,,,,7.7400,30.0000,percent of total billed charges,Rev 270 $30.00 in Billed Charges at 70% = $21.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM,270,RC,27000147,CDM,,,,,,both,,,30.0000,4.5000,CIGNA HEALTHCARE,CIGNA HMO,12.51,,,,,,,7.7400,30.0000,percent of total billed charges,41.7% of $30.00 in Billed Charges for Rev 270 = $12.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM,270,RC,27000147,CDM,,,,,,both,,,30.0000,4.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,13.92,,,,,,,7.7400,30.0000,percent of total billed charges,46.4% of $30.00 in Billed Charges for Rev 270 = $13.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM,270,RC,27000147,CDM,,,,,,both,,,30.0000,4.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,12.51,,,,,,,7.7400,30.0000,percent of total billed charges,41.7% of $30.00 in Billed Charges for Rev 270 = $12.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM,270,RC,27000147,CDM,,,,,,both,,,30.0000,4.5000,CIGNA HEALTHCARE,CIGNA PPO,12.51,,,,,,,7.7400,30.0000,percent of total billed charges,41.7% of $30.00 in Billed Charges for Rev 270 = $12.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM,270,RC,27000147,CDM,,,,,,both,,,30.0000,4.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,27.00,,,,,,,7.7400,30.0000,percent of total billed charges,90% of $30.00 in Billed Charges for Rev 270 = $27.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM,270,RC,27000147,CDM,,,,,,both,,,30.0000,4.5000,MEDCOST,MEDCOST VHN,14.28,,,,,,,7.7400,30.0000,percent of total billed charges,47.59% of $30.00 in Billed Charges for Rev 270 = $14.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM,270,RC,27000147,CDM,,,,,,both,,,30.0000,4.5000,SENTARA HEALTH,SENTARA HEALTH,7.74,,,,,,,7.7400,30.0000,percent of total billed charges,25.81% of $30.00 in Billed Charges for Rev 270 = $7.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM,270,RC,27000147,CDM,,,,,,both,,,30.0000,4.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",30.00,,,,,,,7.7400,30.0000,percent of total billed charges,100% of $30.00 in Billed Charges for Rev 270 = $30.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM,270,RC,27000147,CDM,,,,,,both,,,30.0000,4.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,15.00,,,,,,,7.7400,30.0000,percent of total billed charges,Rev 270 $30.00 in Billed Charges at 50% = $15.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM,270,RC,27000147,CDM,,,,,,both,,,30.0000,4.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,9.69,,,,,,,7.7400,30.0000,other,32.3% of $30.00 in Billed Charges for Rev 270 = $9.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLING ARM,270,RC,27000147,CDM,,,,,,both,,,30.0000,4.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,9.21,,,,,,,7.7400,30.0000,other,30.7% of $30.00 in Billed Charges for Rev 270 = $9.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLING ARM,270,RC,27000147,CDM,,,,,,both,,,30.0000,4.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,9.69,,,,,,,7.7400,30.0000,percent of total billed charges,32.3% of $30.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM,270,RC,27000147,CDM,,,,,,both,,,30.0000,4.5000,WELLCARE,WELLCARE MEDICAID,30.00,,,,,,,7.7400,30.0000,percent of total billed charges,100% of $30.00 in Billed Charges for Rev 270 = $30.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM ELEVATED W ICE BAG59157,270,RC,27000118,CDM,,,,,,both,,,85.0000,12.7500,AETNA,AETNA,36.30,,,,,,,21.9400,85.0000,percent of total billed charges,42.7% of $85.00 in Billed Charges for Rev 270 = $36.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM ELEVATED W ICE BAG59157,270,RC,27000118,CDM,,,,,,both,,,85.0000,12.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,59.50,,,,,,,21.9400,85.0000,percent of total billed charges,Rev 270 $85.00 in Billed Charges at 70% = $59.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM ELEVATED W ICE BAG59157,270,RC,27000118,CDM,,,,,,both,,,85.0000,12.7500,CIGNA HEALTHCARE,CIGNA HMO,35.45,,,,,,,21.9400,85.0000,percent of total billed charges,41.7% of $85.00 in Billed Charges for Rev 270 = $35.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM ELEVATED W ICE BAG59157,270,RC,27000118,CDM,,,,,,both,,,85.0000,12.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,39.44,,,,,,,21.9400,85.0000,percent of total billed charges,46.4% of $85.00 in Billed Charges for Rev 270 = $39.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM ELEVATED W ICE BAG59157,270,RC,27000118,CDM,,,,,,both,,,85.0000,12.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,35.45,,,,,,,21.9400,85.0000,percent of total billed charges,41.7% of $85.00 in Billed Charges for Rev 270 = $35.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM ELEVATED W ICE BAG59157,270,RC,27000118,CDM,,,,,,both,,,85.0000,12.7500,CIGNA HEALTHCARE,CIGNA PPO,35.45,,,,,,,21.9400,85.0000,percent of total billed charges,41.7% of $85.00 in Billed Charges for Rev 270 = $35.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM ELEVATED W ICE BAG59157,270,RC,27000118,CDM,,,,,,both,,,85.0000,12.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,76.50,,,,,,,21.9400,85.0000,percent of total billed charges,90% of $85.00 in Billed Charges for Rev 270 = $76.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM ELEVATED W ICE BAG59157,270,RC,27000118,CDM,,,,,,both,,,85.0000,12.7500,MEDCOST,MEDCOST VHN,40.45,,,,,,,21.9400,85.0000,percent of total billed charges,47.59% of $85.00 in Billed Charges for Rev 270 = $40.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM ELEVATED W ICE BAG59157,270,RC,27000118,CDM,,,,,,both,,,85.0000,12.7500,SENTARA HEALTH,SENTARA HEALTH,21.94,,,,,,,21.9400,85.0000,percent of total billed charges,25.81% of $85.00 in Billed Charges for Rev 270 = $21.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM ELEVATED W ICE BAG59157,270,RC,27000118,CDM,,,,,,both,,,85.0000,12.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",85.00,,,,,,,21.9400,85.0000,percent of total billed charges,100% of $85.00 in Billed Charges for Rev 270 = $85.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM ELEVATED W ICE BAG59157,270,RC,27000118,CDM,,,,,,both,,,85.0000,12.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,42.50,,,,,,,21.9400,85.0000,percent of total billed charges,Rev 270 $85.00 in Billed Charges at 50% = $42.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM ELEVATED W ICE BAG59157,270,RC,27000118,CDM,,,,,,both,,,85.0000,12.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,27.46,,,,,,,21.9400,85.0000,other,32.3% of $85.00 in Billed Charges for Rev 270 = $27.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLING ARM ELEVATED W ICE BAG59157,270,RC,27000118,CDM,,,,,,both,,,85.0000,12.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,26.10,,,,,,,21.9400,85.0000,other,30.7% of $85.00 in Billed Charges for Rev 270 = $26.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLING ARM ELEVATED W ICE BAG59157,270,RC,27000118,CDM,,,,,,both,,,85.0000,12.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,27.46,,,,,,,21.9400,85.0000,percent of total billed charges,32.3% of $85.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM ELEVATED W ICE BAG59157,270,RC,27000118,CDM,,,,,,both,,,85.0000,12.7500,WELLCARE,WELLCARE MEDICAID,85.00,,,,,,,21.9400,85.0000,percent of total billed charges,100% of $85.00 in Billed Charges for Rev 270 = $85.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEX 5%/LACTATED RINGERS 1000ML,258,RC,25800016,CDM,,,,,,both,,,54.0000,8.1000,AETNA,AETNA,23.06,,,,,,,13.9400,54.0000,percent of total billed charges,42.7% of $54.00 in Billed Charges for Rev 258 = $23.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEX 5%/LACTATED RINGERS 1000ML,258,RC,25800016,CDM,,,,,,both,,,54.0000,8.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,37.80,,,,,,,13.9400,54.0000,percent of total billed charges,Rev 258 $54.00 in Billed Charges at 70% = $37.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEX 5%/LACTATED RINGERS 1000ML,258,RC,25800016,CDM,,,,,,both,,,54.0000,8.1000,CIGNA HEALTHCARE,CIGNA HMO,22.52,,,,,,,13.9400,54.0000,percent of total billed charges,41.7% of $54.00 in Billed Charges for Rev 258 = $22.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEX 5%/LACTATED RINGERS 1000ML,258,RC,25800016,CDM,,,,,,both,,,54.0000,8.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,25.06,,,,,,,13.9400,54.0000,percent of total billed charges,46.4% of $54.00 in Billed Charges for Rev 258 = $25.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEX 5%/LACTATED RINGERS 1000ML,258,RC,25800016,CDM,,,,,,both,,,54.0000,8.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,22.52,,,,,,,13.9400,54.0000,percent of total billed charges,41.7% of $54.00 in Billed Charges for Rev 258 = $22.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEX 5%/LACTATED RINGERS 1000ML,258,RC,25800016,CDM,,,,,,both,,,54.0000,8.1000,CIGNA HEALTHCARE,CIGNA PPO,22.52,,,,,,,13.9400,54.0000,percent of total billed charges,41.7% of $54.00 in Billed Charges for Rev 258 = $22.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEX 5%/LACTATED RINGERS 1000ML,258,RC,25800016,CDM,,,,,,both,,,54.0000,8.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,48.60,,,,,,,13.9400,54.0000,percent of total billed charges,90% of $54.00 in Billed Charges for Rev 258 = $48.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEX 5%/LACTATED RINGERS 1000ML,258,RC,25800016,CDM,,,,,,both,,,54.0000,8.1000,MEDCOST,MEDCOST VHN,25.70,,,,,,,13.9400,54.0000,percent of total billed charges,47.59% of $54.00 in Billed Charges for Rev 258 = $25.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEX 5%/LACTATED RINGERS 1000ML,258,RC,25800016,CDM,,,,,,both,,,54.0000,8.1000,SENTARA HEALTH,SENTARA HEALTH,13.94,,,,,,,13.9400,54.0000,percent of total billed charges,25.81% of $54.00 in Billed Charges for Rev 258 = $13.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEX 5%/LACTATED RINGERS 1000ML,258,RC,25800016,CDM,,,,,,both,,,54.0000,8.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",54.00,,,,,,,13.9400,54.0000,percent of total billed charges,100% of $54.00 in Billed Charges for Rev 258 = $54.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEX 5%/LACTATED RINGERS 1000ML,258,RC,25800016,CDM,,,,,,both,,,54.0000,8.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,27.00,,,,,,,13.9400,54.0000,percent of total billed charges,Rev 258 $54.00 in Billed Charges at 50% = $27.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEX 5%/LACTATED RINGERS 1000ML,258,RC,25800016,CDM,,,,,,both,,,54.0000,8.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,17.44,,,,,,,13.9400,54.0000,other,32.3% of $54.00 in Billed Charges for Rev 258 = $17.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SOL DEX 5%/LACTATED RINGERS 1000ML,258,RC,25800016,CDM,,,,,,both,,,54.0000,8.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,16.58,,,,,,,13.9400,54.0000,other,30.7% of $54.00 in Billed Charges for Rev 258 = $16.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SOL DEX 5%/LACTATED RINGERS 1000ML,258,RC,25800016,CDM,,,,,,both,,,54.0000,8.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,17.44,,,,,,,13.9400,54.0000,percent of total billed charges,32.3% of $54.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEX 5%/LACTATED RINGERS 1000ML,258,RC,25800016,CDM,,,,,,both,,,54.0000,8.1000,WELLCARE,WELLCARE MEDICAID,54.00,,,,,,,13.9400,54.0000,percent of total billed charges,100% of $54.00 in Billed Charges for Rev 258 = $54.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEXTROSE 5% 100ML PARTIAL FILL,258,RC,25800006,CDM,,,,,,both,,,24.0000,3.6000,AETNA,AETNA,10.25,,,,,,,6.1900,24.0000,percent of total billed charges,42.7% of $24.00 in Billed Charges for Rev 258 = $10.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEXTROSE 5% 100ML PARTIAL FILL,258,RC,25800006,CDM,,,,,,both,,,24.0000,3.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,16.80,,,,,,,6.1900,24.0000,percent of total billed charges,Rev 258 $24.00 in Billed Charges at 70% = $16.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEXTROSE 5% 100ML PARTIAL FILL,258,RC,25800006,CDM,,,,,,both,,,24.0000,3.6000,CIGNA HEALTHCARE,CIGNA HMO,10.01,,,,,,,6.1900,24.0000,percent of total billed charges,41.7% of $24.00 in Billed Charges for Rev 258 = $10.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEXTROSE 5% 100ML PARTIAL FILL,258,RC,25800006,CDM,,,,,,both,,,24.0000,3.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11.14,,,,,,,6.1900,24.0000,percent of total billed charges,46.4% of $24.00 in Billed Charges for Rev 258 = $11.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEXTROSE 5% 100ML PARTIAL FILL,258,RC,25800006,CDM,,,,,,both,,,24.0000,3.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,10.01,,,,,,,6.1900,24.0000,percent of total billed charges,41.7% of $24.00 in Billed Charges for Rev 258 = $10.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEXTROSE 5% 100ML PARTIAL FILL,258,RC,25800006,CDM,,,,,,both,,,24.0000,3.6000,CIGNA HEALTHCARE,CIGNA PPO,10.01,,,,,,,6.1900,24.0000,percent of total billed charges,41.7% of $24.00 in Billed Charges for Rev 258 = $10.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEXTROSE 5% 100ML PARTIAL FILL,258,RC,25800006,CDM,,,,,,both,,,24.0000,3.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,21.60,,,,,,,6.1900,24.0000,percent of total billed charges,90% of $24.00 in Billed Charges for Rev 258 = $21.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEXTROSE 5% 100ML PARTIAL FILL,258,RC,25800006,CDM,,,,,,both,,,24.0000,3.6000,MEDCOST,MEDCOST VHN,11.42,,,,,,,6.1900,24.0000,percent of total billed charges,47.59% of $24.00 in Billed Charges for Rev 258 = $11.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEXTROSE 5% 100ML PARTIAL FILL,258,RC,25800006,CDM,,,,,,both,,,24.0000,3.6000,SENTARA HEALTH,SENTARA HEALTH,6.19,,,,,,,6.1900,24.0000,percent of total billed charges,25.81% of $24.00 in Billed Charges for Rev 258 = $6.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEXTROSE 5% 100ML PARTIAL FILL,258,RC,25800006,CDM,,,,,,both,,,24.0000,3.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",24.00,,,,,,,6.1900,24.0000,percent of total billed charges,100% of $24.00 in Billed Charges for Rev 258 = $24.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEXTROSE 5% 100ML PARTIAL FILL,258,RC,25800006,CDM,,,,,,both,,,24.0000,3.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,12.00,,,,,,,6.1900,24.0000,percent of total billed charges,Rev 258 $24.00 in Billed Charges at 50% = $12.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEXTROSE 5% 100ML PARTIAL FILL,258,RC,25800006,CDM,,,,,,both,,,24.0000,3.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7.75,,,,,,,6.1900,24.0000,other,32.3% of $24.00 in Billed Charges for Rev 258 = $7.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SOL DEXTROSE 5% 100ML PARTIAL FILL,258,RC,25800006,CDM,,,,,,both,,,24.0000,3.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,7.37,,,,,,,6.1900,24.0000,other,30.7% of $24.00 in Billed Charges for Rev 258 = $7.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SOL DEXTROSE 5% 100ML PARTIAL FILL,258,RC,25800006,CDM,,,,,,both,,,24.0000,3.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,7.75,,,,,,,6.1900,24.0000,percent of total billed charges,32.3% of $24.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL DEXTROSE 5% 100ML PARTIAL FILL,258,RC,25800006,CDM,,,,,,both,,,24.0000,3.6000,WELLCARE,WELLCARE MEDICAID,24.00,,,,,,,6.1900,24.0000,percent of total billed charges,100% of $24.00 in Billed Charges for Rev 258 = $24.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRILL BIT LONG 4.3,272,RC,,,,,,,,both,,,1173.8900,176.0800,AETNA,AETNA,501.25,,,,,,,302.9800,1173.8900,percent of total billed charges,"42.7% of $1,173.89 in Billed Charges for Rev 272 = $501.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 4.3,272,RC,,,,,,,,both,,,1173.8900,176.0800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,821.72,,,,,,,302.9800,1173.8900,percent of total billed charges,"Rev 272 $1,173.89 in Billed Charges at 70% = $821.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 4.3,272,RC,,,,,,,,both,,,1173.8900,176.0800,CIGNA HEALTHCARE,CIGNA HMO,489.51,,,,,,,302.9800,1173.8900,percent of total billed charges,"41.7% of $1,173.89 in Billed Charges for Rev 272 = $489.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 4.3,272,RC,,,,,,,,both,,,1173.8900,176.0800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,544.69,,,,,,,302.9800,1173.8900,percent of total billed charges,"46.4% of $1,173.89 in Billed Charges for Rev 272 = $544.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 4.3,272,RC,,,,,,,,both,,,1173.8900,176.0800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,489.51,,,,,,,302.9800,1173.8900,percent of total billed charges,"41.7% of $1,173.89 in Billed Charges for Rev 272 = $489.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 4.3,272,RC,,,,,,,,both,,,1173.8900,176.0800,CIGNA HEALTHCARE,CIGNA PPO,489.51,,,,,,,302.9800,1173.8900,percent of total billed charges,"41.7% of $1,173.89 in Billed Charges for Rev 272 = $489.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 4.3,272,RC,,,,,,,,both,,,1173.8900,176.0800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1056.50,,,,,,,302.9800,1173.8900,percent of total billed charges,"90% of $1,173.89 in Billed Charges for Rev 272 = $1,056.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 4.3,272,RC,,,,,,,,both,,,1173.8900,176.0800,MEDCOST,MEDCOST VHN,558.65,,,,,,,302.9800,1173.8900,percent of total billed charges,"47.59% of $1,173.89 in Billed Charges for Rev 272 = $558.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 4.3,272,RC,,,,,,,,both,,,1173.8900,176.0800,SENTARA HEALTH,SENTARA HEALTH,302.98,,,,,,,302.9800,1173.8900,percent of total billed charges,"25.81% of $1,173.89 in Billed Charges for Rev 272 = $302.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 4.3,272,RC,,,,,,,,both,,,1173.8900,176.0800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1173.89,,,,,,,302.9800,1173.8900,percent of total billed charges,"100% of $1,173.89 in Billed Charges for Rev 272 = $1,173.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 4.3,272,RC,,,,,,,,both,,,1173.8900,176.0800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,586.95,,,,,,,302.9800,1173.8900,percent of total billed charges,"Rev 272 $1,173.89 in Billed Charges at 50% = $586.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 4.3,272,RC,,,,,,,,both,,,1173.8900,176.0800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,379.17,,,,,,,302.9800,1173.8900,other,"32.3% of $1,173.89 in Billed Charges for Rev 272 = $379.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT LONG 4.3,272,RC,,,,,,,,both,,,1173.8900,176.0800,UNITED HEALTHCARE,UHC HERITAGE SELECT,360.38,,,,,,,302.9800,1173.8900,other,"30.7% of $1,173.89 in Billed Charges for Rev 272 = $360.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL BIT LONG 4.3,272,RC,,,,,,,,both,,,1173.8900,176.0800,UNITED HEALTHCARE,UNITED HEALTHCARE,379.17,,,,,,,302.9800,1173.8900,percent of total billed charges,"32.3% of $1,173.89 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL BIT LONG 4.3,272,RC,,,,,,,,both,,,1173.8900,176.0800,WELLCARE,WELLCARE MEDICAID,1173.89,,,,,,,302.9800,1173.8900,percent of total billed charges,"100% of $1,173.89 in Billed Charges for Rev 272 = $1,173.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.4MM,272,RC,,,,,,,,both,,,1946.8400,292.0300,AETNA,AETNA,831.30,,,,,,,502.4800,1946.8400,percent of total billed charges,"42.7% of $1,946.84 in Billed Charges for Rev 272 = $831.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.4MM,272,RC,,,,,,,,both,,,1946.8400,292.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1362.79,,,,,,,502.4800,1946.8400,percent of total billed charges,"Rev 272 $1,946.84 in Billed Charges at 70% = $1,362.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.4MM,272,RC,,,,,,,,both,,,1946.8400,292.0300,CIGNA HEALTHCARE,CIGNA HMO,811.83,,,,,,,502.4800,1946.8400,percent of total billed charges,"41.7% of $1,946.84 in Billed Charges for Rev 272 = $811.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.4MM,272,RC,,,,,,,,both,,,1946.8400,292.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,903.33,,,,,,,502.4800,1946.8400,percent of total billed charges,"46.4% of $1,946.84 in Billed Charges for Rev 272 = $903.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.4MM,272,RC,,,,,,,,both,,,1946.8400,292.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,811.83,,,,,,,502.4800,1946.8400,percent of total billed charges,"41.7% of $1,946.84 in Billed Charges for Rev 272 = $811.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.4MM,272,RC,,,,,,,,both,,,1946.8400,292.0300,CIGNA HEALTHCARE,CIGNA PPO,811.83,,,,,,,502.4800,1946.8400,percent of total billed charges,"41.7% of $1,946.84 in Billed Charges for Rev 272 = $811.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.4MM,272,RC,,,,,,,,both,,,1946.8400,292.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1752.16,,,,,,,502.4800,1946.8400,percent of total billed charges,"90% of $1,946.84 in Billed Charges for Rev 272 = $1,752.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.4MM,272,RC,,,,,,,,both,,,1946.8400,292.0300,MEDCOST,MEDCOST VHN,926.50,,,,,,,502.4800,1946.8400,percent of total billed charges,"47.59% of $1,946.84 in Billed Charges for Rev 272 = $926.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.4MM,272,RC,,,,,,,,both,,,1946.8400,292.0300,SENTARA HEALTH,SENTARA HEALTH,502.48,,,,,,,502.4800,1946.8400,percent of total billed charges,"25.81% of $1,946.84 in Billed Charges for Rev 272 = $502.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.4MM,272,RC,,,,,,,,both,,,1946.8400,292.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1946.84,,,,,,,502.4800,1946.8400,percent of total billed charges,"100% of $1,946.84 in Billed Charges for Rev 272 = $1,946.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.4MM,272,RC,,,,,,,,both,,,1946.8400,292.0300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,973.42,,,,,,,502.4800,1946.8400,percent of total billed charges,"Rev 272 $1,946.84 in Billed Charges at 50% = $973.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.4MM,272,RC,,,,,,,,both,,,1946.8400,292.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,628.83,,,,,,,502.4800,1946.8400,other,"32.3% of $1,946.84 in Billed Charges for Rev 272 = $628.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL CANNULATED 2.4MM,272,RC,,,,,,,,both,,,1946.8400,292.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,597.68,,,,,,,502.4800,1946.8400,other,"30.7% of $1,946.84 in Billed Charges for Rev 272 = $597.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL CANNULATED 2.4MM,272,RC,,,,,,,,both,,,1946.8400,292.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,628.83,,,,,,,502.4800,1946.8400,percent of total billed charges,"32.3% of $1,946.84 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.4MM,272,RC,,,,,,,,both,,,1946.8400,292.0300,WELLCARE,WELLCARE MEDICAID,1946.84,,,,,,,502.4800,1946.8400,percent of total billed charges,"100% of $1,946.84 in Billed Charges for Rev 272 = $1,946.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.7,272,RC,,,,,,,,both,,,1871.9700,280.8000,AETNA,AETNA,799.33,,,,,,,483.1600,1871.9700,percent of total billed charges,"42.7% of $1,871.97 in Billed Charges for Rev 272 = $799.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.7,272,RC,,,,,,,,both,,,1871.9700,280.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1310.38,,,,,,,483.1600,1871.9700,percent of total billed charges,"Rev 272 $1,871.97 in Billed Charges at 70% = $1,310.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.7,272,RC,,,,,,,,both,,,1871.9700,280.8000,CIGNA HEALTHCARE,CIGNA HMO,780.61,,,,,,,483.1600,1871.9700,percent of total billed charges,"41.7% of $1,871.97 in Billed Charges for Rev 272 = $780.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.7,272,RC,,,,,,,,both,,,1871.9700,280.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,868.59,,,,,,,483.1600,1871.9700,percent of total billed charges,"46.4% of $1,871.97 in Billed Charges for Rev 272 = $868.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.7,272,RC,,,,,,,,both,,,1871.9700,280.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,780.61,,,,,,,483.1600,1871.9700,percent of total billed charges,"41.7% of $1,871.97 in Billed Charges for Rev 272 = $780.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.7,272,RC,,,,,,,,both,,,1871.9700,280.8000,CIGNA HEALTHCARE,CIGNA PPO,780.61,,,,,,,483.1600,1871.9700,percent of total billed charges,"41.7% of $1,871.97 in Billed Charges for Rev 272 = $780.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.7,272,RC,,,,,,,,both,,,1871.9700,280.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1684.77,,,,,,,483.1600,1871.9700,percent of total billed charges,"90% of $1,871.97 in Billed Charges for Rev 272 = $1,684.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.7,272,RC,,,,,,,,both,,,1871.9700,280.8000,MEDCOST,MEDCOST VHN,890.87,,,,,,,483.1600,1871.9700,percent of total billed charges,"47.59% of $1,871.97 in Billed Charges for Rev 272 = $890.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.7,272,RC,,,,,,,,both,,,1871.9700,280.8000,SENTARA HEALTH,SENTARA HEALTH,483.16,,,,,,,483.1600,1871.9700,percent of total billed charges,"25.81% of $1,871.97 in Billed Charges for Rev 272 = $483.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.7,272,RC,,,,,,,,both,,,1871.9700,280.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1871.97,,,,,,,483.1600,1871.9700,percent of total billed charges,"100% of $1,871.97 in Billed Charges for Rev 272 = $1,871.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.7,272,RC,,,,,,,,both,,,1871.9700,280.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,935.99,,,,,,,483.1600,1871.9700,percent of total billed charges,"Rev 272 $1,871.97 in Billed Charges at 50% = $935.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.7,272,RC,,,,,,,,both,,,1871.9700,280.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,604.65,,,,,,,483.1600,1871.9700,other,"32.3% of $1,871.97 in Billed Charges for Rev 272 = $604.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL CANNULATED 2.7,272,RC,,,,,,,,both,,,1871.9700,280.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,574.69,,,,,,,483.1600,1871.9700,other,"30.7% of $1,871.97 in Billed Charges for Rev 272 = $574.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
DRILL CANNULATED 2.7,272,RC,,,,,,,,both,,,1871.9700,280.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,604.65,,,,,,,483.1600,1871.9700,percent of total billed charges,"32.3% of $1,871.97 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRILL CANNULATED 2.7,272,RC,,,,,,,,both,,,1871.9700,280.8000,WELLCARE,WELLCARE MEDICAID,1871.97,,,,,,,483.1600,1871.9700,percent of total billed charges,"100% of $1,871.97 in Billed Charges for Rev 272 = $1,871.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SOL NACL 0.9% 100ML PARTIAL FILL,258,RC,25800011,CDM,,,,,,both,,,25.0000,3.7500,AETNA,AETNA,10.68,,,,,,,6.4500,25.0000,percent of total billed charges,42.7% of $25.00 in Billed Charges for Rev 258 = $10.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL NACL 0.9% 100ML PARTIAL FILL,258,RC,25800011,CDM,,,,,,both,,,25.0000,3.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,17.50,,,,,,,6.4500,25.0000,percent of total billed charges,Rev 258 $25.00 in Billed Charges at 70% = $17.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL NACL 0.9% 100ML PARTIAL FILL,258,RC,25800011,CDM,,,,,,both,,,25.0000,3.7500,CIGNA HEALTHCARE,CIGNA HMO,10.43,,,,,,,6.4500,25.0000,percent of total billed charges,41.7% of $25.00 in Billed Charges for Rev 258 = $10.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL NACL 0.9% 100ML PARTIAL FILL,258,RC,25800011,CDM,,,,,,both,,,25.0000,3.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11.60,,,,,,,6.4500,25.0000,percent of total billed charges,46.4% of $25.00 in Billed Charges for Rev 258 = $11.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL NACL 0.9% 100ML PARTIAL FILL,258,RC,25800011,CDM,,,,,,both,,,25.0000,3.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,10.43,,,,,,,6.4500,25.0000,percent of total billed charges,41.7% of $25.00 in Billed Charges for Rev 258 = $10.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL NACL 0.9% 100ML PARTIAL FILL,258,RC,25800011,CDM,,,,,,both,,,25.0000,3.7500,CIGNA HEALTHCARE,CIGNA PPO,10.43,,,,,,,6.4500,25.0000,percent of total billed charges,41.7% of $25.00 in Billed Charges for Rev 258 = $10.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL NACL 0.9% 100ML PARTIAL FILL,258,RC,25800011,CDM,,,,,,both,,,25.0000,3.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,22.50,,,,,,,6.4500,25.0000,percent of total billed charges,90% of $25.00 in Billed Charges for Rev 258 = $22.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL NACL 0.9% 100ML PARTIAL FILL,258,RC,25800011,CDM,,,,,,both,,,25.0000,3.7500,MEDCOST,MEDCOST VHN,11.90,,,,,,,6.4500,25.0000,percent of total billed charges,47.59% of $25.00 in Billed Charges for Rev 258 = $11.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL NACL 0.9% 100ML PARTIAL FILL,258,RC,25800011,CDM,,,,,,both,,,25.0000,3.7500,SENTARA HEALTH,SENTARA HEALTH,6.45,,,,,,,6.4500,25.0000,percent of total billed charges,25.81% of $25.00 in Billed Charges for Rev 258 = $6.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL NACL 0.9% 100ML PARTIAL FILL,258,RC,25800011,CDM,,,,,,both,,,25.0000,3.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",25.00,,,,,,,6.4500,25.0000,percent of total billed charges,100% of $25.00 in Billed Charges for Rev 258 = $25.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL NACL 0.9% 100ML PARTIAL FILL,258,RC,25800011,CDM,,,,,,both,,,25.0000,3.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,12.50,,,,,,,6.4500,25.0000,percent of total billed charges,Rev 258 $25.00 in Billed Charges at 50% = $12.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL NACL 0.9% 100ML PARTIAL FILL,258,RC,25800011,CDM,,,,,,both,,,25.0000,3.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,8.08,,,,,,,6.4500,25.0000,other,32.3% of $25.00 in Billed Charges for Rev 258 = $8.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SOL NACL 0.9% 100ML PARTIAL FILL,258,RC,25800011,CDM,,,,,,both,,,25.0000,3.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7.68,,,,,,,6.4500,25.0000,other,30.7% of $25.00 in Billed Charges for Rev 258 = $7.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SOL NACL 0.9% 100ML PARTIAL FILL,258,RC,25800011,CDM,,,,,,both,,,25.0000,3.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,8.08,,,,,,,6.4500,25.0000,percent of total billed charges,32.3% of $25.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SOL NACL 0.9% 100ML PARTIAL FILL,258,RC,25800011,CDM,,,,,,both,,,25.0000,3.7500,WELLCARE,WELLCARE MEDICAID,25.00,,,,,,,6.4500,25.0000,percent of total billed charges,100% of $25.00 in Billed Charges for Rev 258 = $25.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201228,CDM,,,,,,both,,,42.0000,6.3000,AETNA,AETNA,17.93,,,,,,,10.8400,42.0000,percent of total billed charges,42.7% of $42.00 in Billed Charges for Rev 272 = $17.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201228,CDM,,,,,,both,,,42.0000,6.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,29.40,,,,,,,10.8400,42.0000,percent of total billed charges,Rev 272 $42.00 in Billed Charges at 70% = $29.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201228,CDM,,,,,,both,,,42.0000,6.3000,CIGNA HEALTHCARE,CIGNA HMO,17.51,,,,,,,10.8400,42.0000,percent of total billed charges,41.7% of $42.00 in Billed Charges for Rev 272 = $17.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201228,CDM,,,,,,both,,,42.0000,6.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,19.49,,,,,,,10.8400,42.0000,percent of total billed charges,46.4% of $42.00 in Billed Charges for Rev 272 = $19.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201228,CDM,,,,,,both,,,42.0000,6.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,17.51,,,,,,,10.8400,42.0000,percent of total billed charges,41.7% of $42.00 in Billed Charges for Rev 272 = $17.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201228,CDM,,,,,,both,,,42.0000,6.3000,CIGNA HEALTHCARE,CIGNA PPO,17.51,,,,,,,10.8400,42.0000,percent of total billed charges,41.7% of $42.00 in Billed Charges for Rev 272 = $17.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201228,CDM,,,,,,both,,,42.0000,6.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,37.80,,,,,,,10.8400,42.0000,percent of total billed charges,90% of $42.00 in Billed Charges for Rev 272 = $37.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201228,CDM,,,,,,both,,,42.0000,6.3000,MEDCOST,MEDCOST VHN,19.99,,,,,,,10.8400,42.0000,percent of total billed charges,47.59% of $42.00 in Billed Charges for Rev 272 = $19.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201228,CDM,,,,,,both,,,42.0000,6.3000,SENTARA HEALTH,SENTARA HEALTH,10.84,,,,,,,10.8400,42.0000,percent of total billed charges,25.81% of $42.00 in Billed Charges for Rev 272 = $10.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201228,CDM,,,,,,both,,,42.0000,6.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",42.00,,,,,,,10.8400,42.0000,percent of total billed charges,100% of $42.00 in Billed Charges for Rev 272 = $42.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201228,CDM,,,,,,both,,,42.0000,6.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,21.00,,,,,,,10.8400,42.0000,percent of total billed charges,Rev 272 $42.00 in Billed Charges at 50% = $21.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201228,CDM,,,,,,both,,,42.0000,6.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13.57,,,,,,,10.8400,42.0000,other,32.3% of $42.00 in Billed Charges for Rev 272 = $13.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE GASTRIC LAVAGE,272,RC,27201228,CDM,,,,,,both,,,42.0000,6.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,12.89,,,,,,,10.8400,42.0000,other,30.7% of $42.00 in Billed Charges for Rev 272 = $12.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE GASTRIC LAVAGE,272,RC,27201228,CDM,,,,,,both,,,42.0000,6.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,13.57,,,,,,,10.8400,42.0000,percent of total billed charges,32.3% of $42.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201228,CDM,,,,,,both,,,42.0000,6.3000,WELLCARE,WELLCARE MEDICAID,42.00,,,,,,,10.8400,42.0000,percent of total billed charges,100% of $42.00 in Billed Charges for Rev 272 = $42.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 18FR,272,RC,27202062,CDM,,,,,,both,,,898.0000,134.7000,AETNA,AETNA,383.45,,,,,,,231.7700,898.0000,percent of total billed charges,42.7% of $898.00 in Billed Charges for Rev 272 = $383.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 18FR,272,RC,27202062,CDM,,,,,,both,,,898.0000,134.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,628.60,,,,,,,231.7700,898.0000,percent of total billed charges,Rev 272 $898.00 in Billed Charges at 70% = $628.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 18FR,272,RC,27202062,CDM,,,,,,both,,,898.0000,134.7000,CIGNA HEALTHCARE,CIGNA HMO,374.47,,,,,,,231.7700,898.0000,percent of total billed charges,41.7% of $898.00 in Billed Charges for Rev 272 = $374.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 18FR,272,RC,27202062,CDM,,,,,,both,,,898.0000,134.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,416.67,,,,,,,231.7700,898.0000,percent of total billed charges,46.4% of $898.00 in Billed Charges for Rev 272 = $416.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 18FR,272,RC,27202062,CDM,,,,,,both,,,898.0000,134.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,374.47,,,,,,,231.7700,898.0000,percent of total billed charges,41.7% of $898.00 in Billed Charges for Rev 272 = $374.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 18FR,272,RC,27202062,CDM,,,,,,both,,,898.0000,134.7000,CIGNA HEALTHCARE,CIGNA PPO,374.47,,,,,,,231.7700,898.0000,percent of total billed charges,41.7% of $898.00 in Billed Charges for Rev 272 = $374.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 18FR,272,RC,27202062,CDM,,,,,,both,,,898.0000,134.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,808.20,,,,,,,231.7700,898.0000,percent of total billed charges,90% of $898.00 in Billed Charges for Rev 272 = $808.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 18FR,272,RC,27202062,CDM,,,,,,both,,,898.0000,134.7000,MEDCOST,MEDCOST VHN,427.36,,,,,,,231.7700,898.0000,percent of total billed charges,47.59% of $898.00 in Billed Charges for Rev 272 = $427.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 18FR,272,RC,27202062,CDM,,,,,,both,,,898.0000,134.7000,SENTARA HEALTH,SENTARA HEALTH,231.77,,,,,,,231.7700,898.0000,percent of total billed charges,25.81% of $898.00 in Billed Charges for Rev 272 = $231.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 18FR,272,RC,27202062,CDM,,,,,,both,,,898.0000,134.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",898.00,,,,,,,231.7700,898.0000,percent of total billed charges,100% of $898.00 in Billed Charges for Rev 272 = $898.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 18FR,272,RC,27202062,CDM,,,,,,both,,,898.0000,134.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,449.00,,,,,,,231.7700,898.0000,percent of total billed charges,Rev 272 $898.00 in Billed Charges at 50% = $449.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 18FR,272,RC,27202062,CDM,,,,,,both,,,898.0000,134.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,290.05,,,,,,,231.7700,898.0000,other,32.3% of $898.00 in Billed Charges for Rev 272 = $290.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE MIC TRANSGASTRIC JEJUNAL 18FR,272,RC,27202062,CDM,,,,,,both,,,898.0000,134.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,275.69,,,,,,,231.7700,898.0000,other,30.7% of $898.00 in Billed Charges for Rev 272 = $275.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE MIC TRANSGASTRIC JEJUNAL 18FR,272,RC,27202062,CDM,,,,,,both,,,898.0000,134.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,290.05,,,,,,,231.7700,898.0000,percent of total billed charges,32.3% of $898.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 18FR,272,RC,27202062,CDM,,,,,,both,,,898.0000,134.7000,WELLCARE,WELLCARE MEDICAID,898.00,,,,,,,231.7700,898.0000,percent of total billed charges,100% of $898.00 in Billed Charges for Rev 272 = $898.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 22FR,272,RC,27202063,CDM,,,,,,both,,,885.0000,132.7500,AETNA,AETNA,377.90,,,,,,,228.4200,885.0000,percent of total billed charges,42.7% of $885.00 in Billed Charges for Rev 272 = $377.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 22FR,272,RC,27202063,CDM,,,,,,both,,,885.0000,132.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,619.50,,,,,,,228.4200,885.0000,percent of total billed charges,Rev 272 $885.00 in Billed Charges at 70% = $619.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 22FR,272,RC,27202063,CDM,,,,,,both,,,885.0000,132.7500,CIGNA HEALTHCARE,CIGNA HMO,369.05,,,,,,,228.4200,885.0000,percent of total billed charges,41.7% of $885.00 in Billed Charges for Rev 272 = $369.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 22FR,272,RC,27202063,CDM,,,,,,both,,,885.0000,132.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,410.64,,,,,,,228.4200,885.0000,percent of total billed charges,46.4% of $885.00 in Billed Charges for Rev 272 = $410.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 22FR,272,RC,27202063,CDM,,,,,,both,,,885.0000,132.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,369.05,,,,,,,228.4200,885.0000,percent of total billed charges,41.7% of $885.00 in Billed Charges for Rev 272 = $369.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 22FR,272,RC,27202063,CDM,,,,,,both,,,885.0000,132.7500,CIGNA HEALTHCARE,CIGNA PPO,369.05,,,,,,,228.4200,885.0000,percent of total billed charges,41.7% of $885.00 in Billed Charges for Rev 272 = $369.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 22FR,272,RC,27202063,CDM,,,,,,both,,,885.0000,132.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,796.50,,,,,,,228.4200,885.0000,percent of total billed charges,90% of $885.00 in Billed Charges for Rev 272 = $796.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 22FR,272,RC,27202063,CDM,,,,,,both,,,885.0000,132.7500,MEDCOST,MEDCOST VHN,421.17,,,,,,,228.4200,885.0000,percent of total billed charges,47.59% of $885.00 in Billed Charges for Rev 272 = $421.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 22FR,272,RC,27202063,CDM,,,,,,both,,,885.0000,132.7500,SENTARA HEALTH,SENTARA HEALTH,228.42,,,,,,,228.4200,885.0000,percent of total billed charges,25.81% of $885.00 in Billed Charges for Rev 272 = $228.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 22FR,272,RC,27202063,CDM,,,,,,both,,,885.0000,132.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",885.00,,,,,,,228.4200,885.0000,percent of total billed charges,100% of $885.00 in Billed Charges for Rev 272 = $885.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 22FR,272,RC,27202063,CDM,,,,,,both,,,885.0000,132.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,442.50,,,,,,,228.4200,885.0000,percent of total billed charges,Rev 272 $885.00 in Billed Charges at 50% = $442.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 22FR,272,RC,27202063,CDM,,,,,,both,,,885.0000,132.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,285.86,,,,,,,228.4200,885.0000,other,32.3% of $885.00 in Billed Charges for Rev 272 = $285.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE MIC TRANSGASTRIC JEJUNAL 22FR,272,RC,27202063,CDM,,,,,,both,,,885.0000,132.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,271.70,,,,,,,228.4200,885.0000,other,30.7% of $885.00 in Billed Charges for Rev 272 = $271.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE MIC TRANSGASTRIC JEJUNAL 22FR,272,RC,27202063,CDM,,,,,,both,,,885.0000,132.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,285.86,,,,,,,228.4200,885.0000,percent of total billed charges,32.3% of $885.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC TRANSGASTRIC JEJUNAL 22FR,272,RC,27202063,CDM,,,,,,both,,,885.0000,132.7500,WELLCARE,WELLCARE MEDICAID,885.00,,,,,,,228.4200,885.0000,percent of total billed charges,100% of $885.00 in Billed Charges for Rev 272 = $885.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE NASAL AMT BRIDLE 10FR,272,RC,27202297,CDM,,,,,,both,,,918.0000,137.7000,AETNA,AETNA,391.99,,,,,,,236.9400,918.0000,percent of total billed charges,42.7% of $918.00 in Billed Charges for Rev 272 = $391.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE NASAL AMT BRIDLE 10FR,272,RC,27202297,CDM,,,,,,both,,,918.0000,137.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,642.60,,,,,,,236.9400,918.0000,percent of total billed charges,Rev 272 $918.00 in Billed Charges at 70% = $642.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE NASAL AMT BRIDLE 10FR,272,RC,27202297,CDM,,,,,,both,,,918.0000,137.7000,CIGNA HEALTHCARE,CIGNA HMO,382.81,,,,,,,236.9400,918.0000,percent of total billed charges,41.7% of $918.00 in Billed Charges for Rev 272 = $382.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE NASAL AMT BRIDLE 10FR,272,RC,27202297,CDM,,,,,,both,,,918.0000,137.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,425.95,,,,,,,236.9400,918.0000,percent of total billed charges,46.4% of $918.00 in Billed Charges for Rev 272 = $425.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE NASAL AMT BRIDLE 10FR,272,RC,27202297,CDM,,,,,,both,,,918.0000,137.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,382.81,,,,,,,236.9400,918.0000,percent of total billed charges,41.7% of $918.00 in Billed Charges for Rev 272 = $382.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE NASAL AMT BRIDLE 10FR,272,RC,27202297,CDM,,,,,,both,,,918.0000,137.7000,CIGNA HEALTHCARE,CIGNA PPO,382.81,,,,,,,236.9400,918.0000,percent of total billed charges,41.7% of $918.00 in Billed Charges for Rev 272 = $382.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE NASAL AMT BRIDLE 10FR,272,RC,27202297,CDM,,,,,,both,,,918.0000,137.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,826.20,,,,,,,236.9400,918.0000,percent of total billed charges,90% of $918.00 in Billed Charges for Rev 272 = $826.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE NASAL AMT BRIDLE 10FR,272,RC,27202297,CDM,,,,,,both,,,918.0000,137.7000,MEDCOST,MEDCOST VHN,436.88,,,,,,,236.9400,918.0000,percent of total billed charges,47.59% of $918.00 in Billed Charges for Rev 272 = $436.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE NASAL AMT BRIDLE 10FR,272,RC,27202297,CDM,,,,,,both,,,918.0000,137.7000,SENTARA HEALTH,SENTARA HEALTH,236.94,,,,,,,236.9400,918.0000,percent of total billed charges,25.81% of $918.00 in Billed Charges for Rev 272 = $236.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE NASAL AMT BRIDLE 10FR,272,RC,27202297,CDM,,,,,,both,,,918.0000,137.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",918.00,,,,,,,236.9400,918.0000,percent of total billed charges,100% of $918.00 in Billed Charges for Rev 272 = $918.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE NASAL AMT BRIDLE 10FR,272,RC,27202297,CDM,,,,,,both,,,918.0000,137.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,459.00,,,,,,,236.9400,918.0000,percent of total billed charges,Rev 272 $918.00 in Billed Charges at 50% = $459.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE NASAL AMT BRIDLE 10FR,272,RC,27202297,CDM,,,,,,both,,,918.0000,137.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,296.51,,,,,,,236.9400,918.0000,other,32.3% of $918.00 in Billed Charges for Rev 272 = $296.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE NASAL AMT BRIDLE 10FR,272,RC,27202297,CDM,,,,,,both,,,918.0000,137.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,281.83,,,,,,,236.9400,918.0000,other,30.7% of $918.00 in Billed Charges for Rev 272 = $281.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE NASAL AMT BRIDLE 10FR,272,RC,27202297,CDM,,,,,,both,,,918.0000,137.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,296.51,,,,,,,236.9400,918.0000,percent of total billed charges,32.3% of $918.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE NASAL AMT BRIDLE 10FR,272,RC,27202297,CDM,,,,,,both,,,918.0000,137.7000,WELLCARE,WELLCARE MEDICAID,918.00,,,,,,,236.9400,918.0000,percent of total billed charges,100% of $918.00 in Billed Charges for Rev 272 = $918.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE RECTAL 24FR,270,RC,27000028,CDM,,,,,,both,,,14.0000,2.1000,AETNA,AETNA,5.98,,,,,,,3.6100,14.0000,percent of total billed charges,42.7% of $14.00 in Billed Charges for Rev 270 = $5.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE RECTAL 24FR,270,RC,27000028,CDM,,,,,,both,,,14.0000,2.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9.80,,,,,,,3.6100,14.0000,percent of total billed charges,Rev 270 $14.00 in Billed Charges at 70% = $9.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE RECTAL 24FR,270,RC,27000028,CDM,,,,,,both,,,14.0000,2.1000,CIGNA HEALTHCARE,CIGNA HMO,5.84,,,,,,,3.6100,14.0000,percent of total billed charges,41.7% of $14.00 in Billed Charges for Rev 270 = $5.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE RECTAL 24FR,270,RC,27000028,CDM,,,,,,both,,,14.0000,2.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6.50,,,,,,,3.6100,14.0000,percent of total billed charges,46.4% of $14.00 in Billed Charges for Rev 270 = $6.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE RECTAL 24FR,270,RC,27000028,CDM,,,,,,both,,,14.0000,2.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5.84,,,,,,,3.6100,14.0000,percent of total billed charges,41.7% of $14.00 in Billed Charges for Rev 270 = $5.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE RECTAL 24FR,270,RC,27000028,CDM,,,,,,both,,,14.0000,2.1000,CIGNA HEALTHCARE,CIGNA PPO,5.84,,,,,,,3.6100,14.0000,percent of total billed charges,41.7% of $14.00 in Billed Charges for Rev 270 = $5.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE RECTAL 24FR,270,RC,27000028,CDM,,,,,,both,,,14.0000,2.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12.60,,,,,,,3.6100,14.0000,percent of total billed charges,90% of $14.00 in Billed Charges for Rev 270 = $12.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE RECTAL 24FR,270,RC,27000028,CDM,,,,,,both,,,14.0000,2.1000,MEDCOST,MEDCOST VHN,6.66,,,,,,,3.6100,14.0000,percent of total billed charges,47.59% of $14.00 in Billed Charges for Rev 270 = $6.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE RECTAL 24FR,270,RC,27000028,CDM,,,,,,both,,,14.0000,2.1000,SENTARA HEALTH,SENTARA HEALTH,3.61,,,,,,,3.6100,14.0000,percent of total billed charges,25.81% of $14.00 in Billed Charges for Rev 270 = $3.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE RECTAL 24FR,270,RC,27000028,CDM,,,,,,both,,,14.0000,2.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",14.00,,,,,,,3.6100,14.0000,percent of total billed charges,100% of $14.00 in Billed Charges for Rev 270 = $14.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE RECTAL 24FR,270,RC,27000028,CDM,,,,,,both,,,14.0000,2.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7.00,,,,,,,3.6100,14.0000,percent of total billed charges,Rev 270 $14.00 in Billed Charges at 50% = $7.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE RECTAL 24FR,270,RC,27000028,CDM,,,,,,both,,,14.0000,2.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4.52,,,,,,,3.6100,14.0000,other,32.3% of $14.00 in Billed Charges for Rev 270 = $4.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE RECTAL 24FR,270,RC,27000028,CDM,,,,,,both,,,14.0000,2.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,4.30,,,,,,,3.6100,14.0000,other,30.7% of $14.00 in Billed Charges for Rev 270 = $4.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE RECTAL 24FR,270,RC,27000028,CDM,,,,,,both,,,14.0000,2.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,4.52,,,,,,,3.6100,14.0000,percent of total billed charges,32.3% of $14.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE RECTAL 24FR,270,RC,27000028,CDM,,,,,,both,,,14.0000,2.1000,WELLCARE,WELLCARE MEDICAID,14.00,,,,,,,3.6100,14.0000,percent of total billed charges,100% of $14.00 in Billed Charges for Rev 270 = $14.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RADIOLUCENT ADULT MULTI-FUNCTION,272,RC,27200002,CDM,,,,,,both,,,600.1500,90.0200,AETNA,AETNA,256.26,,,,,,,154.9000,600.1500,percent of total billed charges,42.7% of $600.15 in Billed Charges for Rev 272 = $256.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RADIOLUCENT ADULT MULTI-FUNCTION,272,RC,27200002,CDM,,,,,,both,,,600.1500,90.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,420.11,,,,,,,154.9000,600.1500,percent of total billed charges,Rev 272 $600.15 in Billed Charges at 70% = $420.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RADIOLUCENT ADULT MULTI-FUNCTION,272,RC,27200002,CDM,,,,,,both,,,600.1500,90.0200,CIGNA HEALTHCARE,CIGNA HMO,250.26,,,,,,,154.9000,600.1500,percent of total billed charges,41.7% of $600.15 in Billed Charges for Rev 272 = $250.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RADIOLUCENT ADULT MULTI-FUNCTION,272,RC,27200002,CDM,,,,,,both,,,600.1500,90.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,278.47,,,,,,,154.9000,600.1500,percent of total billed charges,46.4% of $600.15 in Billed Charges for Rev 272 = $278.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RADIOLUCENT ADULT MULTI-FUNCTION,272,RC,27200002,CDM,,,,,,both,,,600.1500,90.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,250.26,,,,,,,154.9000,600.1500,percent of total billed charges,41.7% of $600.15 in Billed Charges for Rev 272 = $250.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RADIOLUCENT ADULT MULTI-FUNCTION,272,RC,27200002,CDM,,,,,,both,,,600.1500,90.0200,CIGNA HEALTHCARE,CIGNA PPO,250.26,,,,,,,154.9000,600.1500,percent of total billed charges,41.7% of $600.15 in Billed Charges for Rev 272 = $250.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RADIOLUCENT ADULT MULTI-FUNCTION,272,RC,27200002,CDM,,,,,,both,,,600.1500,90.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,540.14,,,,,,,154.9000,600.1500,percent of total billed charges,90% of $600.15 in Billed Charges for Rev 272 = $540.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RADIOLUCENT ADULT MULTI-FUNCTION,272,RC,27200002,CDM,,,,,,both,,,600.1500,90.0200,MEDCOST,MEDCOST VHN,285.61,,,,,,,154.9000,600.1500,percent of total billed charges,47.59% of $600.15 in Billed Charges for Rev 272 = $285.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RADIOLUCENT ADULT MULTI-FUNCTION,272,RC,27200002,CDM,,,,,,both,,,600.1500,90.0200,SENTARA HEALTH,SENTARA HEALTH,154.90,,,,,,,154.9000,600.1500,percent of total billed charges,25.81% of $600.15 in Billed Charges for Rev 272 = $154.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RADIOLUCENT ADULT MULTI-FUNCTION,272,RC,27200002,CDM,,,,,,both,,,600.1500,90.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",600.15,,,,,,,154.9000,600.1500,percent of total billed charges,100% of $600.15 in Billed Charges for Rev 272 = $600.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RADIOLUCENT ADULT MULTI-FUNCTION,272,RC,27200002,CDM,,,,,,both,,,600.1500,90.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,300.08,,,,,,,154.9000,600.1500,percent of total billed charges,Rev 272 $600.15 in Billed Charges at 50% = $300.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RADIOLUCENT ADULT MULTI-FUNCTION,272,RC,27200002,CDM,,,,,,both,,,600.1500,90.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,193.85,,,,,,,154.9000,600.1500,other,32.3% of $600.15 in Billed Charges for Rev 272 = $193.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ELECTRODE RADIOLUCENT ADULT MULTI-FUNCTION,272,RC,27200002,CDM,,,,,,both,,,600.1500,90.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,184.25,,,,,,,154.9000,600.1500,other,30.7% of $600.15 in Billed Charges for Rev 272 = $184.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ELECTRODE RADIOLUCENT ADULT MULTI-FUNCTION,272,RC,27200002,CDM,,,,,,both,,,600.1500,90.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,193.85,,,,,,,154.9000,600.1500,percent of total billed charges,32.3% of $600.15 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RADIOLUCENT ADULT MULTI-FUNCTION,272,RC,27200002,CDM,,,,,,both,,,600.1500,90.0200,WELLCARE,WELLCARE MEDICAID,600.15,,,,,,,154.9000,600.1500,percent of total billed charges,100% of $600.15 in Billed Charges for Rev 272 = $600.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RT ANGLE KNIFE 24FR,272,RC,,,,,,,,both,,,958.2800,143.7400,AETNA,AETNA,409.19,,,,,,,247.3300,958.2800,percent of total billed charges,42.7% of $958.28 in Billed Charges for Rev 272 = $409.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RT ANGLE KNIFE 24FR,272,RC,,,,,,,,both,,,958.2800,143.7400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,670.80,,,,,,,247.3300,958.2800,percent of total billed charges,Rev 272 $958.28 in Billed Charges at 70% = $670.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RT ANGLE KNIFE 24FR,272,RC,,,,,,,,both,,,958.2800,143.7400,CIGNA HEALTHCARE,CIGNA HMO,399.60,,,,,,,247.3300,958.2800,percent of total billed charges,41.7% of $958.28 in Billed Charges for Rev 272 = $399.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RT ANGLE KNIFE 24FR,272,RC,,,,,,,,both,,,958.2800,143.7400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,444.64,,,,,,,247.3300,958.2800,percent of total billed charges,46.4% of $958.28 in Billed Charges for Rev 272 = $444.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RT ANGLE KNIFE 24FR,272,RC,,,,,,,,both,,,958.2800,143.7400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,399.60,,,,,,,247.3300,958.2800,percent of total billed charges,41.7% of $958.28 in Billed Charges for Rev 272 = $399.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RT ANGLE KNIFE 24FR,272,RC,,,,,,,,both,,,958.2800,143.7400,CIGNA HEALTHCARE,CIGNA PPO,399.60,,,,,,,247.3300,958.2800,percent of total billed charges,41.7% of $958.28 in Billed Charges for Rev 272 = $399.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RT ANGLE KNIFE 24FR,272,RC,,,,,,,,both,,,958.2800,143.7400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,862.45,,,,,,,247.3300,958.2800,percent of total billed charges,90% of $958.28 in Billed Charges for Rev 272 = $862.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RT ANGLE KNIFE 24FR,272,RC,,,,,,,,both,,,958.2800,143.7400,MEDCOST,MEDCOST VHN,456.05,,,,,,,247.3300,958.2800,percent of total billed charges,47.59% of $958.28 in Billed Charges for Rev 272 = $456.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RT ANGLE KNIFE 24FR,272,RC,,,,,,,,both,,,958.2800,143.7400,SENTARA HEALTH,SENTARA HEALTH,247.33,,,,,,,247.3300,958.2800,percent of total billed charges,25.81% of $958.28 in Billed Charges for Rev 272 = $247.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RT ANGLE KNIFE 24FR,272,RC,,,,,,,,both,,,958.2800,143.7400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",958.28,,,,,,,247.3300,958.2800,percent of total billed charges,100% of $958.28 in Billed Charges for Rev 272 = $958.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RT ANGLE KNIFE 24FR,272,RC,,,,,,,,both,,,958.2800,143.7400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,479.14,,,,,,,247.3300,958.2800,percent of total billed charges,Rev 272 $958.28 in Billed Charges at 50% = $479.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RT ANGLE KNIFE 24FR,272,RC,,,,,,,,both,,,958.2800,143.7400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,309.52,,,,,,,247.3300,958.2800,other,32.3% of $958.28 in Billed Charges for Rev 272 = $309.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ELECTRODE RT ANGLE KNIFE 24FR,272,RC,,,,,,,,both,,,958.2800,143.7400,UNITED HEALTHCARE,UHC HERITAGE SELECT,294.19,,,,,,,247.3300,958.2800,other,30.7% of $958.28 in Billed Charges for Rev 272 = $294.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ELECTRODE RT ANGLE KNIFE 24FR,272,RC,,,,,,,,both,,,958.2800,143.7400,UNITED HEALTHCARE,UNITED HEALTHCARE,309.52,,,,,,,247.3300,958.2800,percent of total billed charges,32.3% of $958.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE RT ANGLE KNIFE 24FR,272,RC,,,,,,,,both,,,958.2800,143.7400,WELLCARE,WELLCARE MEDICAID,958.28,,,,,,,247.3300,958.2800,percent of total billed charges,100% of $958.28 in Billed Charges for Rev 272 = $958.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE REPLACE GASTROS,272,RC,27201233,CDM,,,,,,both,,,315.0000,47.2500,AETNA,AETNA,134.51,,,,,,,81.3000,315.0000,percent of total billed charges,42.7% of $315.00 in Billed Charges for Rev 272 = $134.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE REPLACE GASTROS,272,RC,27201233,CDM,,,,,,both,,,315.0000,47.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,220.50,,,,,,,81.3000,315.0000,percent of total billed charges,Rev 272 $315.00 in Billed Charges at 70% = $220.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE REPLACE GASTROS,272,RC,27201233,CDM,,,,,,both,,,315.0000,47.2500,CIGNA HEALTHCARE,CIGNA HMO,131.36,,,,,,,81.3000,315.0000,percent of total billed charges,41.7% of $315.00 in Billed Charges for Rev 272 = $131.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE REPLACE GASTROS,272,RC,27201233,CDM,,,,,,both,,,315.0000,47.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,146.16,,,,,,,81.3000,315.0000,percent of total billed charges,46.4% of $315.00 in Billed Charges for Rev 272 = $146.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE REPLACE GASTROS,272,RC,27201233,CDM,,,,,,both,,,315.0000,47.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,131.36,,,,,,,81.3000,315.0000,percent of total billed charges,41.7% of $315.00 in Billed Charges for Rev 272 = $131.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE REPLACE GASTROS,272,RC,27201233,CDM,,,,,,both,,,315.0000,47.2500,CIGNA HEALTHCARE,CIGNA PPO,131.36,,,,,,,81.3000,315.0000,percent of total billed charges,41.7% of $315.00 in Billed Charges for Rev 272 = $131.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE REPLACE GASTROS,272,RC,27201233,CDM,,,,,,both,,,315.0000,47.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,283.50,,,,,,,81.3000,315.0000,percent of total billed charges,90% of $315.00 in Billed Charges for Rev 272 = $283.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE REPLACE GASTROS,272,RC,27201233,CDM,,,,,,both,,,315.0000,47.2500,MEDCOST,MEDCOST VHN,149.91,,,,,,,81.3000,315.0000,percent of total billed charges,47.59% of $315.00 in Billed Charges for Rev 272 = $149.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE REPLACE GASTROS,272,RC,27201233,CDM,,,,,,both,,,315.0000,47.2500,SENTARA HEALTH,SENTARA HEALTH,81.30,,,,,,,81.3000,315.0000,percent of total billed charges,25.81% of $315.00 in Billed Charges for Rev 272 = $81.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE REPLACE GASTROS,272,RC,27201233,CDM,,,,,,both,,,315.0000,47.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",315.00,,,,,,,81.3000,315.0000,percent of total billed charges,100% of $315.00 in Billed Charges for Rev 272 = $315.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE REPLACE GASTROS,272,RC,27201233,CDM,,,,,,both,,,315.0000,47.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,157.50,,,,,,,81.3000,315.0000,percent of total billed charges,Rev 272 $315.00 in Billed Charges at 50% = $157.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE REPLACE GASTROS,272,RC,27201233,CDM,,,,,,both,,,315.0000,47.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,101.75,,,,,,,81.3000,315.0000,other,32.3% of $315.00 in Billed Charges for Rev 272 = $101.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE REPLACE GASTROS,272,RC,27201233,CDM,,,,,,both,,,315.0000,47.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,96.71,,,,,,,81.3000,315.0000,other,30.7% of $315.00 in Billed Charges for Rev 272 = $96.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE REPLACE GASTROS,272,RC,27201233,CDM,,,,,,both,,,315.0000,47.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,101.75,,,,,,,81.3000,315.0000,percent of total billed charges,32.3% of $315.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE REPLACE GASTROS,272,RC,27201233,CDM,,,,,,both,,,315.0000,47.2500,WELLCARE,WELLCARE MEDICAID,315.00,,,,,,,81.3000,315.0000,percent of total billed charges,100% of $315.00 in Billed Charges for Rev 272 = $315.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 12FR ANTI REFLUX,272,RC,27201234,CDM,,,,,,both,,,34.0000,5.1000,AETNA,AETNA,14.52,,,,,,,8.7800,34.0000,percent of total billed charges,42.7% of $34.00 in Billed Charges for Rev 272 = $14.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 12FR ANTI REFLUX,272,RC,27201234,CDM,,,,,,both,,,34.0000,5.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,23.80,,,,,,,8.7800,34.0000,percent of total billed charges,Rev 272 $34.00 in Billed Charges at 70% = $23.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 12FR ANTI REFLUX,272,RC,27201234,CDM,,,,,,both,,,34.0000,5.1000,CIGNA HEALTHCARE,CIGNA HMO,14.18,,,,,,,8.7800,34.0000,percent of total billed charges,41.7% of $34.00 in Billed Charges for Rev 272 = $14.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 12FR ANTI REFLUX,272,RC,27201234,CDM,,,,,,both,,,34.0000,5.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,15.78,,,,,,,8.7800,34.0000,percent of total billed charges,46.4% of $34.00 in Billed Charges for Rev 272 = $15.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 12FR ANTI REFLUX,272,RC,27201234,CDM,,,,,,both,,,34.0000,5.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,14.18,,,,,,,8.7800,34.0000,percent of total billed charges,41.7% of $34.00 in Billed Charges for Rev 272 = $14.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 12FR ANTI REFLUX,272,RC,27201234,CDM,,,,,,both,,,34.0000,5.1000,CIGNA HEALTHCARE,CIGNA PPO,14.18,,,,,,,8.7800,34.0000,percent of total billed charges,41.7% of $34.00 in Billed Charges for Rev 272 = $14.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 12FR ANTI REFLUX,272,RC,27201234,CDM,,,,,,both,,,34.0000,5.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,30.60,,,,,,,8.7800,34.0000,percent of total billed charges,90% of $34.00 in Billed Charges for Rev 272 = $30.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 12FR ANTI REFLUX,272,RC,27201234,CDM,,,,,,both,,,34.0000,5.1000,MEDCOST,MEDCOST VHN,16.18,,,,,,,8.7800,34.0000,percent of total billed charges,47.59% of $34.00 in Billed Charges for Rev 272 = $16.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 12FR ANTI REFLUX,272,RC,27201234,CDM,,,,,,both,,,34.0000,5.1000,SENTARA HEALTH,SENTARA HEALTH,8.78,,,,,,,8.7800,34.0000,percent of total billed charges,25.81% of $34.00 in Billed Charges for Rev 272 = $8.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 12FR ANTI REFLUX,272,RC,27201234,CDM,,,,,,both,,,34.0000,5.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",34.00,,,,,,,8.7800,34.0000,percent of total billed charges,100% of $34.00 in Billed Charges for Rev 272 = $34.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 12FR ANTI REFLUX,272,RC,27201234,CDM,,,,,,both,,,34.0000,5.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,17.00,,,,,,,8.7800,34.0000,percent of total billed charges,Rev 272 $34.00 in Billed Charges at 50% = $17.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 12FR ANTI REFLUX,272,RC,27201234,CDM,,,,,,both,,,34.0000,5.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,10.98,,,,,,,8.7800,34.0000,other,32.3% of $34.00 in Billed Charges for Rev 272 = $10.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE SALEM SUMP 12FR ANTI REFLUX,272,RC,27201234,CDM,,,,,,both,,,34.0000,5.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,10.44,,,,,,,8.7800,34.0000,other,30.7% of $34.00 in Billed Charges for Rev 272 = $10.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE SALEM SUMP 12FR ANTI REFLUX,272,RC,27201234,CDM,,,,,,both,,,34.0000,5.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,10.98,,,,,,,8.7800,34.0000,percent of total billed charges,32.3% of $34.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 12FR ANTI REFLUX,272,RC,27201234,CDM,,,,,,both,,,34.0000,5.1000,WELLCARE,WELLCARE MEDICAID,34.00,,,,,,,8.7800,34.0000,percent of total billed charges,100% of $34.00 in Billed Charges for Rev 272 = $34.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 16FR,272,RC,27201235,CDM,,,,,,both,,,9.0000,1.3500,AETNA,AETNA,3.84,,,,,,,2.3200,9.0000,percent of total billed charges,42.7% of $9.00 in Billed Charges for Rev 272 = $3.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 16FR,272,RC,27201235,CDM,,,,,,both,,,9.0000,1.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6.30,,,,,,,2.3200,9.0000,percent of total billed charges,Rev 272 $9.00 in Billed Charges at 70% = $6.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 16FR,272,RC,27201235,CDM,,,,,,both,,,9.0000,1.3500,CIGNA HEALTHCARE,CIGNA HMO,3.75,,,,,,,2.3200,9.0000,percent of total billed charges,41.7% of $9.00 in Billed Charges for Rev 272 = $3.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 16FR,272,RC,27201235,CDM,,,,,,both,,,9.0000,1.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4.18,,,,,,,2.3200,9.0000,percent of total billed charges,46.4% of $9.00 in Billed Charges for Rev 272 = $4.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 16FR,272,RC,27201235,CDM,,,,,,both,,,9.0000,1.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3.75,,,,,,,2.3200,9.0000,percent of total billed charges,41.7% of $9.00 in Billed Charges for Rev 272 = $3.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 16FR,272,RC,27201235,CDM,,,,,,both,,,9.0000,1.3500,CIGNA HEALTHCARE,CIGNA PPO,3.75,,,,,,,2.3200,9.0000,percent of total billed charges,41.7% of $9.00 in Billed Charges for Rev 272 = $3.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 16FR,272,RC,27201235,CDM,,,,,,both,,,9.0000,1.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8.10,,,,,,,2.3200,9.0000,percent of total billed charges,90% of $9.00 in Billed Charges for Rev 272 = $8.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 16FR,272,RC,27201235,CDM,,,,,,both,,,9.0000,1.3500,MEDCOST,MEDCOST VHN,4.28,,,,,,,2.3200,9.0000,percent of total billed charges,47.59% of $9.00 in Billed Charges for Rev 272 = $4.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 16FR,272,RC,27201235,CDM,,,,,,both,,,9.0000,1.3500,SENTARA HEALTH,SENTARA HEALTH,2.32,,,,,,,2.3200,9.0000,percent of total billed charges,25.81% of $9.00 in Billed Charges for Rev 272 = $2.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 16FR,272,RC,27201235,CDM,,,,,,both,,,9.0000,1.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9.00,,,,,,,2.3200,9.0000,percent of total billed charges,100% of $9.00 in Billed Charges for Rev 272 = $9.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 16FR,272,RC,27201235,CDM,,,,,,both,,,9.0000,1.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4.50,,,,,,,2.3200,9.0000,percent of total billed charges,Rev 272 $9.00 in Billed Charges at 50% = $4.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 16FR,272,RC,27201235,CDM,,,,,,both,,,9.0000,1.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2.91,,,,,,,2.3200,9.0000,other,32.3% of $9.00 in Billed Charges for Rev 272 = $2.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE SALEM SUMP 16FR,272,RC,27201235,CDM,,,,,,both,,,9.0000,1.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2.76,,,,,,,2.3200,9.0000,other,30.7% of $9.00 in Billed Charges for Rev 272 = $2.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE SALEM SUMP 16FR,272,RC,27201235,CDM,,,,,,both,,,9.0000,1.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,2.91,,,,,,,2.3200,9.0000,percent of total billed charges,32.3% of $9.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SALEM SUMP 16FR,272,RC,27201235,CDM,,,,,,both,,,9.0000,1.3500,WELLCARE,WELLCARE MEDICAID,9.00,,,,,,,2.3200,9.0000,percent of total billed charges,100% of $9.00 in Billed Charges for Rev 272 = $9.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH,272,RC,27201237,CDM,,,,,,both,,,212.0000,31.8000,AETNA,AETNA,90.52,,,,,,,54.7200,212.0000,percent of total billed charges,42.7% of $212.00 in Billed Charges for Rev 272 = $90.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH,272,RC,27201237,CDM,,,,,,both,,,212.0000,31.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,148.40,,,,,,,54.7200,212.0000,percent of total billed charges,Rev 272 $212.00 in Billed Charges at 70% = $148.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH,272,RC,27201237,CDM,,,,,,both,,,212.0000,31.8000,CIGNA HEALTHCARE,CIGNA HMO,88.40,,,,,,,54.7200,212.0000,percent of total billed charges,41.7% of $212.00 in Billed Charges for Rev 272 = $88.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH,272,RC,27201237,CDM,,,,,,both,,,212.0000,31.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,98.37,,,,,,,54.7200,212.0000,percent of total billed charges,46.4% of $212.00 in Billed Charges for Rev 272 = $98.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH,272,RC,27201237,CDM,,,,,,both,,,212.0000,31.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,88.40,,,,,,,54.7200,212.0000,percent of total billed charges,41.7% of $212.00 in Billed Charges for Rev 272 = $88.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH,272,RC,27201237,CDM,,,,,,both,,,212.0000,31.8000,CIGNA HEALTHCARE,CIGNA PPO,88.40,,,,,,,54.7200,212.0000,percent of total billed charges,41.7% of $212.00 in Billed Charges for Rev 272 = $88.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH,272,RC,27201237,CDM,,,,,,both,,,212.0000,31.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,190.80,,,,,,,54.7200,212.0000,percent of total billed charges,90% of $212.00 in Billed Charges for Rev 272 = $190.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH,272,RC,27201237,CDM,,,,,,both,,,212.0000,31.8000,MEDCOST,MEDCOST VHN,100.89,,,,,,,54.7200,212.0000,percent of total billed charges,47.59% of $212.00 in Billed Charges for Rev 272 = $100.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH,272,RC,27201237,CDM,,,,,,both,,,212.0000,31.8000,SENTARA HEALTH,SENTARA HEALTH,54.72,,,,,,,54.7200,212.0000,percent of total billed charges,25.81% of $212.00 in Billed Charges for Rev 272 = $54.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH,272,RC,27201237,CDM,,,,,,both,,,212.0000,31.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",212.00,,,,,,,54.7200,212.0000,percent of total billed charges,100% of $212.00 in Billed Charges for Rev 272 = $212.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH,272,RC,27201237,CDM,,,,,,both,,,212.0000,31.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,106.00,,,,,,,54.7200,212.0000,percent of total billed charges,Rev 272 $212.00 in Billed Charges at 50% = $106.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH,272,RC,27201237,CDM,,,,,,both,,,212.0000,31.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,68.48,,,,,,,54.7200,212.0000,other,32.3% of $212.00 in Billed Charges for Rev 272 = $68.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE SHILEY TRACH,272,RC,27201237,CDM,,,,,,both,,,212.0000,31.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,65.08,,,,,,,54.7200,212.0000,other,30.7% of $212.00 in Billed Charges for Rev 272 = $65.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE SHILEY TRACH,272,RC,27201237,CDM,,,,,,both,,,212.0000,31.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,68.48,,,,,,,54.7200,212.0000,percent of total billed charges,32.3% of $212.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH,272,RC,27201237,CDM,,,,,,both,,,212.0000,31.8000,WELLCARE,WELLCARE MEDICAID,212.00,,,,,,,54.7200,212.0000,percent of total billed charges,100% of $212.00 in Billed Charges for Rev 272 = $212.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH FENES 4-10,272,RC,27201239,CDM,,,,,,both,,,279.0000,41.8500,AETNA,AETNA,119.13,,,,,,,72.0100,279.0000,percent of total billed charges,42.7% of $279.00 in Billed Charges for Rev 272 = $119.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH FENES 4-10,272,RC,27201239,CDM,,,,,,both,,,279.0000,41.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,195.30,,,,,,,72.0100,279.0000,percent of total billed charges,Rev 272 $279.00 in Billed Charges at 70% = $195.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH FENES 4-10,272,RC,27201239,CDM,,,,,,both,,,279.0000,41.8500,CIGNA HEALTHCARE,CIGNA HMO,116.34,,,,,,,72.0100,279.0000,percent of total billed charges,41.7% of $279.00 in Billed Charges for Rev 272 = $116.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH FENES 4-10,272,RC,27201239,CDM,,,,,,both,,,279.0000,41.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,129.46,,,,,,,72.0100,279.0000,percent of total billed charges,46.4% of $279.00 in Billed Charges for Rev 272 = $129.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH FENES 4-10,272,RC,27201239,CDM,,,,,,both,,,279.0000,41.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,116.34,,,,,,,72.0100,279.0000,percent of total billed charges,41.7% of $279.00 in Billed Charges for Rev 272 = $116.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH FENES 4-10,272,RC,27201239,CDM,,,,,,both,,,279.0000,41.8500,CIGNA HEALTHCARE,CIGNA PPO,116.34,,,,,,,72.0100,279.0000,percent of total billed charges,41.7% of $279.00 in Billed Charges for Rev 272 = $116.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH FENES 4-10,272,RC,27201239,CDM,,,,,,both,,,279.0000,41.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,251.10,,,,,,,72.0100,279.0000,percent of total billed charges,90% of $279.00 in Billed Charges for Rev 272 = $251.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH FENES 4-10,272,RC,27201239,CDM,,,,,,both,,,279.0000,41.8500,MEDCOST,MEDCOST VHN,132.78,,,,,,,72.0100,279.0000,percent of total billed charges,47.59% of $279.00 in Billed Charges for Rev 272 = $132.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH FENES 4-10,272,RC,27201239,CDM,,,,,,both,,,279.0000,41.8500,SENTARA HEALTH,SENTARA HEALTH,72.01,,,,,,,72.0100,279.0000,percent of total billed charges,25.81% of $279.00 in Billed Charges for Rev 272 = $72.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH FENES 4-10,272,RC,27201239,CDM,,,,,,both,,,279.0000,41.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",279.00,,,,,,,72.0100,279.0000,percent of total billed charges,100% of $279.00 in Billed Charges for Rev 272 = $279.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH FENES 4-10,272,RC,27201239,CDM,,,,,,both,,,279.0000,41.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,139.50,,,,,,,72.0100,279.0000,percent of total billed charges,Rev 272 $279.00 in Billed Charges at 50% = $139.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH FENES 4-10,272,RC,27201239,CDM,,,,,,both,,,279.0000,41.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,90.12,,,,,,,72.0100,279.0000,other,32.3% of $279.00 in Billed Charges for Rev 272 = $90.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE SHILEY TRACH FENES 4-10,272,RC,27201239,CDM,,,,,,both,,,279.0000,41.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,85.65,,,,,,,72.0100,279.0000,other,30.7% of $279.00 in Billed Charges for Rev 272 = $85.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE SHILEY TRACH FENES 4-10,272,RC,27201239,CDM,,,,,,both,,,279.0000,41.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,90.12,,,,,,,72.0100,279.0000,percent of total billed charges,32.3% of $279.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH FENES 4-10,272,RC,27201239,CDM,,,,,,both,,,279.0000,41.8500,WELLCARE,WELLCARE MEDICAID,279.00,,,,,,,72.0100,279.0000,percent of total billed charges,100% of $279.00 in Billed Charges for Rev 272 = $279.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH LPC 4-10,272,RC,27201240,CDM,,,,,,both,,,317.0000,47.5500,AETNA,AETNA,135.36,,,,,,,81.8200,317.0000,percent of total billed charges,42.7% of $317.00 in Billed Charges for Rev 272 = $135.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH LPC 4-10,272,RC,27201240,CDM,,,,,,both,,,317.0000,47.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,221.90,,,,,,,81.8200,317.0000,percent of total billed charges,Rev 272 $317.00 in Billed Charges at 70% = $221.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH LPC 4-10,272,RC,27201240,CDM,,,,,,both,,,317.0000,47.5500,CIGNA HEALTHCARE,CIGNA HMO,132.19,,,,,,,81.8200,317.0000,percent of total billed charges,41.7% of $317.00 in Billed Charges for Rev 272 = $132.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH LPC 4-10,272,RC,27201240,CDM,,,,,,both,,,317.0000,47.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,147.09,,,,,,,81.8200,317.0000,percent of total billed charges,46.4% of $317.00 in Billed Charges for Rev 272 = $147.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH LPC 4-10,272,RC,27201240,CDM,,,,,,both,,,317.0000,47.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,132.19,,,,,,,81.8200,317.0000,percent of total billed charges,41.7% of $317.00 in Billed Charges for Rev 272 = $132.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH LPC 4-10,272,RC,27201240,CDM,,,,,,both,,,317.0000,47.5500,CIGNA HEALTHCARE,CIGNA PPO,132.19,,,,,,,81.8200,317.0000,percent of total billed charges,41.7% of $317.00 in Billed Charges for Rev 272 = $132.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH LPC 4-10,272,RC,27201240,CDM,,,,,,both,,,317.0000,47.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,285.30,,,,,,,81.8200,317.0000,percent of total billed charges,90% of $317.00 in Billed Charges for Rev 272 = $285.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH LPC 4-10,272,RC,27201240,CDM,,,,,,both,,,317.0000,47.5500,MEDCOST,MEDCOST VHN,150.86,,,,,,,81.8200,317.0000,percent of total billed charges,47.59% of $317.00 in Billed Charges for Rev 272 = $150.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH LPC 4-10,272,RC,27201240,CDM,,,,,,both,,,317.0000,47.5500,SENTARA HEALTH,SENTARA HEALTH,81.82,,,,,,,81.8200,317.0000,percent of total billed charges,25.81% of $317.00 in Billed Charges for Rev 272 = $81.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH LPC 4-10,272,RC,27201240,CDM,,,,,,both,,,317.0000,47.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",317.00,,,,,,,81.8200,317.0000,percent of total billed charges,100% of $317.00 in Billed Charges for Rev 272 = $317.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH LPC 4-10,272,RC,27201240,CDM,,,,,,both,,,317.0000,47.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,158.50,,,,,,,81.8200,317.0000,percent of total billed charges,Rev 272 $317.00 in Billed Charges at 50% = $158.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH LPC 4-10,272,RC,27201240,CDM,,,,,,both,,,317.0000,47.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,102.39,,,,,,,81.8200,317.0000,other,32.3% of $317.00 in Billed Charges for Rev 272 = $102.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE SHILEY TRACH LPC 4-10,272,RC,27201240,CDM,,,,,,both,,,317.0000,47.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,97.32,,,,,,,81.8200,317.0000,other,30.7% of $317.00 in Billed Charges for Rev 272 = $97.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE SHILEY TRACH LPC 4-10,272,RC,27201240,CDM,,,,,,both,,,317.0000,47.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,102.39,,,,,,,81.8200,317.0000,percent of total billed charges,32.3% of $317.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH LPC 4-10,272,RC,27201240,CDM,,,,,,both,,,317.0000,47.5500,WELLCARE,WELLCARE MEDICAID,317.00,,,,,,,81.8200,317.0000,percent of total billed charges,100% of $317.00 in Billed Charges for Rev 272 = $317.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 8LPC,272,RC,27201242,CDM,,,,,,both,,,248.0000,37.2000,AETNA,AETNA,105.90,,,,,,,64.0100,248.0000,percent of total billed charges,42.7% of $248.00 in Billed Charges for Rev 272 = $105.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 8LPC,272,RC,27201242,CDM,,,,,,both,,,248.0000,37.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,173.60,,,,,,,64.0100,248.0000,percent of total billed charges,Rev 272 $248.00 in Billed Charges at 70% = $173.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 8LPC,272,RC,27201242,CDM,,,,,,both,,,248.0000,37.2000,CIGNA HEALTHCARE,CIGNA HMO,103.42,,,,,,,64.0100,248.0000,percent of total billed charges,41.7% of $248.00 in Billed Charges for Rev 272 = $103.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 8LPC,272,RC,27201242,CDM,,,,,,both,,,248.0000,37.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,115.07,,,,,,,64.0100,248.0000,percent of total billed charges,46.4% of $248.00 in Billed Charges for Rev 272 = $115.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 8LPC,272,RC,27201242,CDM,,,,,,both,,,248.0000,37.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,103.42,,,,,,,64.0100,248.0000,percent of total billed charges,41.7% of $248.00 in Billed Charges for Rev 272 = $103.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 8LPC,272,RC,27201242,CDM,,,,,,both,,,248.0000,37.2000,CIGNA HEALTHCARE,CIGNA PPO,103.42,,,,,,,64.0100,248.0000,percent of total billed charges,41.7% of $248.00 in Billed Charges for Rev 272 = $103.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 8LPC,272,RC,27201242,CDM,,,,,,both,,,248.0000,37.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,223.20,,,,,,,64.0100,248.0000,percent of total billed charges,90% of $248.00 in Billed Charges for Rev 272 = $223.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 8LPC,272,RC,27201242,CDM,,,,,,both,,,248.0000,37.2000,MEDCOST,MEDCOST VHN,118.02,,,,,,,64.0100,248.0000,percent of total billed charges,47.59% of $248.00 in Billed Charges for Rev 272 = $118.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 8LPC,272,RC,27201242,CDM,,,,,,both,,,248.0000,37.2000,SENTARA HEALTH,SENTARA HEALTH,64.01,,,,,,,64.0100,248.0000,percent of total billed charges,25.81% of $248.00 in Billed Charges for Rev 272 = $64.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 8LPC,272,RC,27201242,CDM,,,,,,both,,,248.0000,37.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",248.00,,,,,,,64.0100,248.0000,percent of total billed charges,100% of $248.00 in Billed Charges for Rev 272 = $248.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 8LPC,272,RC,27201242,CDM,,,,,,both,,,248.0000,37.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,124.00,,,,,,,64.0100,248.0000,percent of total billed charges,Rev 272 $248.00 in Billed Charges at 50% = $124.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 8LPC,272,RC,27201242,CDM,,,,,,both,,,248.0000,37.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,80.10,,,,,,,64.0100,248.0000,other,32.3% of $248.00 in Billed Charges for Rev 272 = $80.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE TRACH 8LPC,272,RC,27201242,CDM,,,,,,both,,,248.0000,37.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,76.14,,,,,,,64.0100,248.0000,other,30.7% of $248.00 in Billed Charges for Rev 272 = $76.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE TRACH 8LPC,272,RC,27201242,CDM,,,,,,both,,,248.0000,37.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,80.10,,,,,,,64.0100,248.0000,percent of total billed charges,32.3% of $248.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 8LPC,272,RC,27201242,CDM,,,,,,both,,,248.0000,37.2000,WELLCARE,WELLCARE MEDICAID,248.00,,,,,,,64.0100,248.0000,percent of total billed charges,100% of $248.00 in Billed Charges for Rev 272 = $248.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED,272,RC,27201243,CDM,,,,,,both,,,197.0000,29.5500,AETNA,AETNA,84.12,,,,,,,50.8500,197.0000,percent of total billed charges,42.7% of $197.00 in Billed Charges for Rev 272 = $84.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED,272,RC,27201243,CDM,,,,,,both,,,197.0000,29.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,137.90,,,,,,,50.8500,197.0000,percent of total billed charges,Rev 272 $197.00 in Billed Charges at 70% = $137.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED,272,RC,27201243,CDM,,,,,,both,,,197.0000,29.5500,CIGNA HEALTHCARE,CIGNA HMO,82.15,,,,,,,50.8500,197.0000,percent of total billed charges,41.7% of $197.00 in Billed Charges for Rev 272 = $82.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED,272,RC,27201243,CDM,,,,,,both,,,197.0000,29.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,91.41,,,,,,,50.8500,197.0000,percent of total billed charges,46.4% of $197.00 in Billed Charges for Rev 272 = $91.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED,272,RC,27201243,CDM,,,,,,both,,,197.0000,29.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,82.15,,,,,,,50.8500,197.0000,percent of total billed charges,41.7% of $197.00 in Billed Charges for Rev 272 = $82.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED,272,RC,27201243,CDM,,,,,,both,,,197.0000,29.5500,CIGNA HEALTHCARE,CIGNA PPO,82.15,,,,,,,50.8500,197.0000,percent of total billed charges,41.7% of $197.00 in Billed Charges for Rev 272 = $82.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED,272,RC,27201243,CDM,,,,,,both,,,197.0000,29.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,177.30,,,,,,,50.8500,197.0000,percent of total billed charges,90% of $197.00 in Billed Charges for Rev 272 = $177.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED,272,RC,27201243,CDM,,,,,,both,,,197.0000,29.5500,MEDCOST,MEDCOST VHN,93.75,,,,,,,50.8500,197.0000,percent of total billed charges,47.59% of $197.00 in Billed Charges for Rev 272 = $93.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED,272,RC,27201243,CDM,,,,,,both,,,197.0000,29.5500,SENTARA HEALTH,SENTARA HEALTH,50.85,,,,,,,50.8500,197.0000,percent of total billed charges,25.81% of $197.00 in Billed Charges for Rev 272 = $50.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED,272,RC,27201243,CDM,,,,,,both,,,197.0000,29.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",197.00,,,,,,,50.8500,197.0000,percent of total billed charges,100% of $197.00 in Billed Charges for Rev 272 = $197.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED,272,RC,27201243,CDM,,,,,,both,,,197.0000,29.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,98.50,,,,,,,50.8500,197.0000,percent of total billed charges,Rev 272 $197.00 in Billed Charges at 50% = $98.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED,272,RC,27201243,CDM,,,,,,both,,,197.0000,29.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,63.63,,,,,,,50.8500,197.0000,other,32.3% of $197.00 in Billed Charges for Rev 272 = $63.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE TRACH CUFFED,272,RC,27201243,CDM,,,,,,both,,,197.0000,29.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,60.48,,,,,,,50.8500,197.0000,other,30.7% of $197.00 in Billed Charges for Rev 272 = $60.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE TRACH CUFFED,272,RC,27201243,CDM,,,,,,both,,,197.0000,29.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,63.63,,,,,,,50.8500,197.0000,percent of total billed charges,32.3% of $197.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED,272,RC,27201243,CDM,,,,,,both,,,197.0000,29.5500,WELLCARE,WELLCARE MEDICAID,197.00,,,,,,,50.8500,197.0000,percent of total billed charges,100% of $197.00 in Billed Charges for Rev 272 = $197.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED X-LGT DISTAL7.0,272,RC,27201248,CDM,,,,,,both,,,293.0000,43.9500,AETNA,AETNA,125.11,,,,,,,75.6200,293.0000,percent of total billed charges,42.7% of $293.00 in Billed Charges for Rev 272 = $125.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED X-LGT DISTAL7.0,272,RC,27201248,CDM,,,,,,both,,,293.0000,43.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,205.10,,,,,,,75.6200,293.0000,percent of total billed charges,Rev 272 $293.00 in Billed Charges at 70% = $205.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED X-LGT DISTAL7.0,272,RC,27201248,CDM,,,,,,both,,,293.0000,43.9500,CIGNA HEALTHCARE,CIGNA HMO,122.18,,,,,,,75.6200,293.0000,percent of total billed charges,41.7% of $293.00 in Billed Charges for Rev 272 = $122.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED X-LGT DISTAL7.0,272,RC,27201248,CDM,,,,,,both,,,293.0000,43.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,135.95,,,,,,,75.6200,293.0000,percent of total billed charges,46.4% of $293.00 in Billed Charges for Rev 272 = $135.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED X-LGT DISTAL7.0,272,RC,27201248,CDM,,,,,,both,,,293.0000,43.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,122.18,,,,,,,75.6200,293.0000,percent of total billed charges,41.7% of $293.00 in Billed Charges for Rev 272 = $122.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED X-LGT DISTAL7.0,272,RC,27201248,CDM,,,,,,both,,,293.0000,43.9500,CIGNA HEALTHCARE,CIGNA PPO,122.18,,,,,,,75.6200,293.0000,percent of total billed charges,41.7% of $293.00 in Billed Charges for Rev 272 = $122.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED X-LGT DISTAL7.0,272,RC,27201248,CDM,,,,,,both,,,293.0000,43.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,263.70,,,,,,,75.6200,293.0000,percent of total billed charges,90% of $293.00 in Billed Charges for Rev 272 = $263.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED X-LGT DISTAL7.0,272,RC,27201248,CDM,,,,,,both,,,293.0000,43.9500,MEDCOST,MEDCOST VHN,139.44,,,,,,,75.6200,293.0000,percent of total billed charges,47.59% of $293.00 in Billed Charges for Rev 272 = $139.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED X-LGT DISTAL7.0,272,RC,27201248,CDM,,,,,,both,,,293.0000,43.9500,SENTARA HEALTH,SENTARA HEALTH,75.62,,,,,,,75.6200,293.0000,percent of total billed charges,25.81% of $293.00 in Billed Charges for Rev 272 = $75.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED X-LGT DISTAL7.0,272,RC,27201248,CDM,,,,,,both,,,293.0000,43.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",293.00,,,,,,,75.6200,293.0000,percent of total billed charges,100% of $293.00 in Billed Charges for Rev 272 = $293.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED X-LGT DISTAL7.0,272,RC,27201248,CDM,,,,,,both,,,293.0000,43.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,146.50,,,,,,,75.6200,293.0000,percent of total billed charges,Rev 272 $293.00 in Billed Charges at 50% = $146.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED X-LGT DISTAL7.0,272,RC,27201248,CDM,,,,,,both,,,293.0000,43.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,94.64,,,,,,,75.6200,293.0000,other,32.3% of $293.00 in Billed Charges for Rev 272 = $94.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE TRACH CUFFED X-LGT DISTAL7.0,272,RC,27201248,CDM,,,,,,both,,,293.0000,43.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,89.95,,,,,,,75.6200,293.0000,other,30.7% of $293.00 in Billed Charges for Rev 272 = $89.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE TRACH CUFFED X-LGT DISTAL7.0,272,RC,27201248,CDM,,,,,,both,,,293.0000,43.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,94.64,,,,,,,75.6200,293.0000,percent of total billed charges,32.3% of $293.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED X-LGT DISTAL7.0,272,RC,27201248,CDM,,,,,,both,,,293.0000,43.9500,WELLCARE,WELLCARE MEDICAID,293.00,,,,,,,75.6200,293.0000,percent of total billed charges,100% of $293.00 in Billed Charges for Rev 272 = $293.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH EXTENDED LENGTH 5FR-9F,272,RC,27201250,CDM,,,,,,both,,,309.0000,46.3500,AETNA,AETNA,131.94,,,,,,,79.7500,309.0000,percent of total billed charges,42.7% of $309.00 in Billed Charges for Rev 272 = $131.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH EXTENDED LENGTH 5FR-9F,272,RC,27201250,CDM,,,,,,both,,,309.0000,46.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,216.30,,,,,,,79.7500,309.0000,percent of total billed charges,Rev 272 $309.00 in Billed Charges at 70% = $216.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH EXTENDED LENGTH 5FR-9F,272,RC,27201250,CDM,,,,,,both,,,309.0000,46.3500,CIGNA HEALTHCARE,CIGNA HMO,128.85,,,,,,,79.7500,309.0000,percent of total billed charges,41.7% of $309.00 in Billed Charges for Rev 272 = $128.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH EXTENDED LENGTH 5FR-9F,272,RC,27201250,CDM,,,,,,both,,,309.0000,46.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,143.38,,,,,,,79.7500,309.0000,percent of total billed charges,46.4% of $309.00 in Billed Charges for Rev 272 = $143.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH EXTENDED LENGTH 5FR-9F,272,RC,27201250,CDM,,,,,,both,,,309.0000,46.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,128.85,,,,,,,79.7500,309.0000,percent of total billed charges,41.7% of $309.00 in Billed Charges for Rev 272 = $128.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH EXTENDED LENGTH 5FR-9F,272,RC,27201250,CDM,,,,,,both,,,309.0000,46.3500,CIGNA HEALTHCARE,CIGNA PPO,128.85,,,,,,,79.7500,309.0000,percent of total billed charges,41.7% of $309.00 in Billed Charges for Rev 272 = $128.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH EXTENDED LENGTH 5FR-9F,272,RC,27201250,CDM,,,,,,both,,,309.0000,46.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,278.10,,,,,,,79.7500,309.0000,percent of total billed charges,90% of $309.00 in Billed Charges for Rev 272 = $278.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH EXTENDED LENGTH 5FR-9F,272,RC,27201250,CDM,,,,,,both,,,309.0000,46.3500,MEDCOST,MEDCOST VHN,147.05,,,,,,,79.7500,309.0000,percent of total billed charges,47.59% of $309.00 in Billed Charges for Rev 272 = $147.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH EXTENDED LENGTH 5FR-9F,272,RC,27201250,CDM,,,,,,both,,,309.0000,46.3500,SENTARA HEALTH,SENTARA HEALTH,79.75,,,,,,,79.7500,309.0000,percent of total billed charges,25.81% of $309.00 in Billed Charges for Rev 272 = $79.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH EXTENDED LENGTH 5FR-9F,272,RC,27201250,CDM,,,,,,both,,,309.0000,46.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",309.00,,,,,,,79.7500,309.0000,percent of total billed charges,100% of $309.00 in Billed Charges for Rev 272 = $309.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH EXTENDED LENGTH 5FR-9F,272,RC,27201250,CDM,,,,,,both,,,309.0000,46.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,154.50,,,,,,,79.7500,309.0000,percent of total billed charges,Rev 272 $309.00 in Billed Charges at 50% = $154.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH EXTENDED LENGTH 5FR-9F,272,RC,27201250,CDM,,,,,,both,,,309.0000,46.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,99.81,,,,,,,79.7500,309.0000,other,32.3% of $309.00 in Billed Charges for Rev 272 = $99.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE TRACH EXTENDED LENGTH 5FR-9F,272,RC,27201250,CDM,,,,,,both,,,309.0000,46.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,94.86,,,,,,,79.7500,309.0000,other,30.7% of $309.00 in Billed Charges for Rev 272 = $94.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE TRACH EXTENDED LENGTH 5FR-9F,272,RC,27201250,CDM,,,,,,both,,,309.0000,46.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,99.81,,,,,,,79.7500,309.0000,percent of total billed charges,32.3% of $309.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH EXTENDED LENGTH 5FR-9F,272,RC,27201250,CDM,,,,,,both,,,309.0000,46.3500,WELLCARE,WELLCARE MEDICAID,309.00,,,,,,,79.7500,309.0000,percent of total billed charges,100% of $309.00 in Billed Charges for Rev 272 = $309.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ELECTRODE W/HANDCONTROLS 90DEG 228147,272,RC,27200002,CDM,,,,,,both,,,4194.6500,629.2000,AETNA,AETNA,1791.12,,,,,,,1082.6400,4194.6500,percent of total billed charges,"42.7% of $4,194.65 in Billed Charges for Rev 272 = $1,791.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE W/HANDCONTROLS 90DEG 228147,272,RC,27200002,CDM,,,,,,both,,,4194.6500,629.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2936.26,,,,,,,1082.6400,4194.6500,percent of total billed charges,"Rev 272 $4,194.65 in Billed Charges at 70% = $2,936.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE W/HANDCONTROLS 90DEG 228147,272,RC,27200002,CDM,,,,,,both,,,4194.6500,629.2000,CIGNA HEALTHCARE,CIGNA HMO,1749.17,,,,,,,1082.6400,4194.6500,percent of total billed charges,"41.7% of $4,194.65 in Billed Charges for Rev 272 = $1,749.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE W/HANDCONTROLS 90DEG 228147,272,RC,27200002,CDM,,,,,,both,,,4194.6500,629.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1946.32,,,,,,,1082.6400,4194.6500,percent of total billed charges,"46.4% of $4,194.65 in Billed Charges for Rev 272 = $1,946.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE W/HANDCONTROLS 90DEG 228147,272,RC,27200002,CDM,,,,,,both,,,4194.6500,629.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1749.17,,,,,,,1082.6400,4194.6500,percent of total billed charges,"41.7% of $4,194.65 in Billed Charges for Rev 272 = $1,749.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE W/HANDCONTROLS 90DEG 228147,272,RC,27200002,CDM,,,,,,both,,,4194.6500,629.2000,CIGNA HEALTHCARE,CIGNA PPO,1749.17,,,,,,,1082.6400,4194.6500,percent of total billed charges,"41.7% of $4,194.65 in Billed Charges for Rev 272 = $1,749.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE W/HANDCONTROLS 90DEG 228147,272,RC,27200002,CDM,,,,,,both,,,4194.6500,629.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3775.19,,,,,,,1082.6400,4194.6500,percent of total billed charges,"90% of $4,194.65 in Billed Charges for Rev 272 = $3,775.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE W/HANDCONTROLS 90DEG 228147,272,RC,27200002,CDM,,,,,,both,,,4194.6500,629.2000,MEDCOST,MEDCOST VHN,1996.23,,,,,,,1082.6400,4194.6500,percent of total billed charges,"47.59% of $4,194.65 in Billed Charges for Rev 272 = $1,996.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE W/HANDCONTROLS 90DEG 228147,272,RC,27200002,CDM,,,,,,both,,,4194.6500,629.2000,SENTARA HEALTH,SENTARA HEALTH,1082.64,,,,,,,1082.6400,4194.6500,percent of total billed charges,"25.81% of $4,194.65 in Billed Charges for Rev 272 = $1,082.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE W/HANDCONTROLS 90DEG 228147,272,RC,27200002,CDM,,,,,,both,,,4194.6500,629.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4194.65,,,,,,,1082.6400,4194.6500,percent of total billed charges,"100% of $4,194.65 in Billed Charges for Rev 272 = $4,194.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE W/HANDCONTROLS 90DEG 228147,272,RC,27200002,CDM,,,,,,both,,,4194.6500,629.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2097.33,,,,,,,1082.6400,4194.6500,percent of total billed charges,"Rev 272 $4,194.65 in Billed Charges at 50% = $2,097.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE W/HANDCONTROLS 90DEG 228147,272,RC,27200002,CDM,,,,,,both,,,4194.6500,629.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1354.87,,,,,,,1082.6400,4194.6500,other,"32.3% of $4,194.65 in Billed Charges for Rev 272 = $1,354.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE W/HANDCONTROLS 90DEG 228147,272,RC,27200002,CDM,,,,,,both,,,4194.6500,629.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1287.76,,,,,,,1082.6400,4194.6500,other,"30.7% of $4,194.65 in Billed Charges for Rev 272 = $1,287.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ELECTRODE W/HANDCONTROLS 90DEG 228147,272,RC,27200002,CDM,,,,,,both,,,4194.6500,629.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,1354.87,,,,,,,1082.6400,4194.6500,percent of total billed charges,"32.3% of $4,194.65 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ELECTRODE W/HANDCONTROLS 90DEG 228147,272,RC,27200002,CDM,,,,,,both,,,4194.6500,629.2000,WELLCARE,WELLCARE MEDICAID,4194.65,,,,,,,1082.6400,4194.6500,percent of total billed charges,"100% of $4,194.65 in Billed Charges for Rev 272 = $4,194.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CATCH XL ECATCH15,272,RC,27200002,CDM,,,,,,both,,,3370.8500,505.6300,AETNA,AETNA,1439.35,,,,,,,870.0200,3370.8500,percent of total billed charges,"42.7% of $3,370.85 in Billed Charges for Rev 272 = $1,439.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CATCH XL ECATCH15,272,RC,27200002,CDM,,,,,,both,,,3370.8500,505.6300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2359.60,,,,,,,870.0200,3370.8500,percent of total billed charges,"Rev 272 $3,370.85 in Billed Charges at 70% = $2,359.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CATCH XL ECATCH15,272,RC,27200002,CDM,,,,,,both,,,3370.8500,505.6300,CIGNA HEALTHCARE,CIGNA HMO,1405.64,,,,,,,870.0200,3370.8500,percent of total billed charges,"41.7% of $3,370.85 in Billed Charges for Rev 272 = $1,405.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CATCH XL ECATCH15,272,RC,27200002,CDM,,,,,,both,,,3370.8500,505.6300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1564.07,,,,,,,870.0200,3370.8500,percent of total billed charges,"46.4% of $3,370.85 in Billed Charges for Rev 272 = $1,564.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CATCH XL ECATCH15,272,RC,27200002,CDM,,,,,,both,,,3370.8500,505.6300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1405.64,,,,,,,870.0200,3370.8500,percent of total billed charges,"41.7% of $3,370.85 in Billed Charges for Rev 272 = $1,405.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CATCH XL ECATCH15,272,RC,27200002,CDM,,,,,,both,,,3370.8500,505.6300,CIGNA HEALTHCARE,CIGNA PPO,1405.64,,,,,,,870.0200,3370.8500,percent of total billed charges,"41.7% of $3,370.85 in Billed Charges for Rev 272 = $1,405.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CATCH XL ECATCH15,272,RC,27200002,CDM,,,,,,both,,,3370.8500,505.6300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3033.77,,,,,,,870.0200,3370.8500,percent of total billed charges,"90% of $3,370.85 in Billed Charges for Rev 272 = $3,033.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CATCH XL ECATCH15,272,RC,27200002,CDM,,,,,,both,,,3370.8500,505.6300,MEDCOST,MEDCOST VHN,1604.19,,,,,,,870.0200,3370.8500,percent of total billed charges,"47.59% of $3,370.85 in Billed Charges for Rev 272 = $1,604.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CATCH XL ECATCH15,272,RC,27200002,CDM,,,,,,both,,,3370.8500,505.6300,SENTARA HEALTH,SENTARA HEALTH,870.02,,,,,,,870.0200,3370.8500,percent of total billed charges,"25.81% of $3,370.85 in Billed Charges for Rev 272 = $870.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CATCH XL ECATCH15,272,RC,27200002,CDM,,,,,,both,,,3370.8500,505.6300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3370.85,,,,,,,870.0200,3370.8500,percent of total billed charges,"100% of $3,370.85 in Billed Charges for Rev 272 = $3,370.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CATCH XL ECATCH15,272,RC,27200002,CDM,,,,,,both,,,3370.8500,505.6300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1685.43,,,,,,,870.0200,3370.8500,percent of total billed charges,"Rev 272 $3,370.85 in Billed Charges at 50% = $1,685.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CATCH XL ECATCH15,272,RC,27200002,CDM,,,,,,both,,,3370.8500,505.6300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1088.78,,,,,,,870.0200,3370.8500,other,"32.3% of $3,370.85 in Billed Charges for Rev 272 = $1,088.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENDO CATCH XL ECATCH15,272,RC,27200002,CDM,,,,,,both,,,3370.8500,505.6300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1034.85,,,,,,,870.0200,3370.8500,other,"30.7% of $3,370.85 in Billed Charges for Rev 272 = $1,034.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENDO CATCH XL ECATCH15,272,RC,27200002,CDM,,,,,,both,,,3370.8500,505.6300,UNITED HEALTHCARE,UNITED HEALTHCARE,1088.78,,,,,,,870.0200,3370.8500,percent of total billed charges,"32.3% of $3,370.85 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CATCH XL ECATCH15,272,RC,27200002,CDM,,,,,,both,,,3370.8500,505.6300,WELLCARE,WELLCARE MEDICAID,3370.85,,,,,,,870.0200,3370.8500,percent of total billed charges,"100% of $3,370.85 in Billed Charges for Rev 272 = $3,370.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP 10MM SURPASS SEE LN 11864,272,RC,27200002,CDM,,,,,,both,,,26702.2800,4005.3400,AETNA,AETNA,11401.87,,,,,,,6891.8600,26702.2800,percent of total billed charges,"42.7% of $26,702.28 in Billed Charges for Rev 272 = $11,401.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP 10MM SURPASS SEE LN 11864,272,RC,27200002,CDM,,,,,,both,,,26702.2800,4005.3400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,18691.60,,,,,,,6891.8600,26702.2800,percent of total billed charges,"Rev 272 $26,702.28 in Billed Charges at 70% = $18,691.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP 10MM SURPASS SEE LN 11864,272,RC,27200002,CDM,,,,,,both,,,26702.2800,4005.3400,CIGNA HEALTHCARE,CIGNA HMO,11134.85,,,,,,,6891.8600,26702.2800,percent of total billed charges,"41.7% of $26,702.28 in Billed Charges for Rev 272 = $11,134.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP 10MM SURPASS SEE LN 11864,272,RC,27200002,CDM,,,,,,both,,,26702.2800,4005.3400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12389.86,,,,,,,6891.8600,26702.2800,percent of total billed charges,"46.4% of $26,702.28 in Billed Charges for Rev 272 = $12,389.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP 10MM SURPASS SEE LN 11864,272,RC,27200002,CDM,,,,,,both,,,26702.2800,4005.3400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11134.85,,,,,,,6891.8600,26702.2800,percent of total billed charges,"41.7% of $26,702.28 in Billed Charges for Rev 272 = $11,134.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP 10MM SURPASS SEE LN 11864,272,RC,27200002,CDM,,,,,,both,,,26702.2800,4005.3400,CIGNA HEALTHCARE,CIGNA PPO,11134.85,,,,,,,6891.8600,26702.2800,percent of total billed charges,"41.7% of $26,702.28 in Billed Charges for Rev 272 = $11,134.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP 10MM SURPASS SEE LN 11864,272,RC,27200002,CDM,,,,,,both,,,26702.2800,4005.3400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,24032.05,,,,,,,6891.8600,26702.2800,percent of total billed charges,"90% of $26,702.28 in Billed Charges for Rev 272 = $24,032.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP 10MM SURPASS SEE LN 11864,272,RC,27200002,CDM,,,,,,both,,,26702.2800,4005.3400,MEDCOST,MEDCOST VHN,12707.62,,,,,,,6891.8600,26702.2800,percent of total billed charges,"47.59% of $26,702.28 in Billed Charges for Rev 272 = $12,707.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP 10MM SURPASS SEE LN 11864,272,RC,27200002,CDM,,,,,,both,,,26702.2800,4005.3400,SENTARA HEALTH,SENTARA HEALTH,6891.86,,,,,,,6891.8600,26702.2800,percent of total billed charges,"25.81% of $26,702.28 in Billed Charges for Rev 272 = $6,891.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP 10MM SURPASS SEE LN 11864,272,RC,27200002,CDM,,,,,,both,,,26702.2800,4005.3400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",26702.28,,,,,,,6891.8600,26702.2800,percent of total billed charges,"100% of $26,702.28 in Billed Charges for Rev 272 = $26,702.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP 10MM SURPASS SEE LN 11864,272,RC,27200002,CDM,,,,,,both,,,26702.2800,4005.3400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,13351.14,,,,,,,6891.8600,26702.2800,percent of total billed charges,"Rev 272 $26,702.28 in Billed Charges at 50% = $13,351.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP 10MM SURPASS SEE LN 11864,272,RC,27200002,CDM,,,,,,both,,,26702.2800,4005.3400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,8624.84,,,,,,,6891.8600,26702.2800,other,"32.3% of $26,702.28 in Billed Charges for Rev 272 = $8,624.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENDO CLIP 10MM SURPASS SEE LN 11864,272,RC,27200002,CDM,,,,,,both,,,26702.2800,4005.3400,UNITED HEALTHCARE,UHC HERITAGE SELECT,8197.60,,,,,,,6891.8600,26702.2800,other,"30.7% of $26,702.28 in Billed Charges for Rev 272 = $8,197.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ENDO CLIP 10MM SURPASS SEE LN 11864,272,RC,27200002,CDM,,,,,,both,,,26702.2800,4005.3400,UNITED HEALTHCARE,UNITED HEALTHCARE,8624.84,,,,,,,6891.8600,26702.2800,percent of total billed charges,"32.3% of $26,702.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ENDO CLIP 10MM SURPASS SEE LN 11864,272,RC,27200002,CDM,,,,,,both,,,26702.2800,4005.3400,WELLCARE,WELLCARE MEDICAID,26702.28,,,,,,,6891.8600,26702.2800,percent of total billed charges,"100% of $26,702.28 in Billed Charges for Rev 272 = $26,702.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBE TRACH XLONG SHILEY,270,RC,27000197,CDM,,,,,,both,,,160.0000,24.0000,AETNA,AETNA,68.32,,,,,,,41.3000,160.0000,percent of total billed charges,42.7% of $160.00 in Billed Charges for Rev 270 = $68.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH XLONG SHILEY,270,RC,27000197,CDM,,,,,,both,,,160.0000,24.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,112.00,,,,,,,41.3000,160.0000,percent of total billed charges,Rev 270 $160.00 in Billed Charges at 70% = $112.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH XLONG SHILEY,270,RC,27000197,CDM,,,,,,both,,,160.0000,24.0000,CIGNA HEALTHCARE,CIGNA HMO,66.72,,,,,,,41.3000,160.0000,percent of total billed charges,41.7% of $160.00 in Billed Charges for Rev 270 = $66.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH XLONG SHILEY,270,RC,27000197,CDM,,,,,,both,,,160.0000,24.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,74.24,,,,,,,41.3000,160.0000,percent of total billed charges,46.4% of $160.00 in Billed Charges for Rev 270 = $74.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH XLONG SHILEY,270,RC,27000197,CDM,,,,,,both,,,160.0000,24.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,66.72,,,,,,,41.3000,160.0000,percent of total billed charges,41.7% of $160.00 in Billed Charges for Rev 270 = $66.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH XLONG SHILEY,270,RC,27000197,CDM,,,,,,both,,,160.0000,24.0000,CIGNA HEALTHCARE,CIGNA PPO,66.72,,,,,,,41.3000,160.0000,percent of total billed charges,41.7% of $160.00 in Billed Charges for Rev 270 = $66.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH XLONG SHILEY,270,RC,27000197,CDM,,,,,,both,,,160.0000,24.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,144.00,,,,,,,41.3000,160.0000,percent of total billed charges,90% of $160.00 in Billed Charges for Rev 270 = $144.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH XLONG SHILEY,270,RC,27000197,CDM,,,,,,both,,,160.0000,24.0000,MEDCOST,MEDCOST VHN,76.14,,,,,,,41.3000,160.0000,percent of total billed charges,47.59% of $160.00 in Billed Charges for Rev 270 = $76.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH XLONG SHILEY,270,RC,27000197,CDM,,,,,,both,,,160.0000,24.0000,SENTARA HEALTH,SENTARA HEALTH,41.30,,,,,,,41.3000,160.0000,percent of total billed charges,25.81% of $160.00 in Billed Charges for Rev 270 = $41.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH XLONG SHILEY,270,RC,27000197,CDM,,,,,,both,,,160.0000,24.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",160.00,,,,,,,41.3000,160.0000,percent of total billed charges,100% of $160.00 in Billed Charges for Rev 270 = $160.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH XLONG SHILEY,270,RC,27000197,CDM,,,,,,both,,,160.0000,24.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,80.00,,,,,,,41.3000,160.0000,percent of total billed charges,Rev 270 $160.00 in Billed Charges at 50% = $80.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH XLONG SHILEY,270,RC,27000197,CDM,,,,,,both,,,160.0000,24.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,51.68,,,,,,,41.3000,160.0000,other,32.3% of $160.00 in Billed Charges for Rev 270 = $51.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE TRACH XLONG SHILEY,270,RC,27000197,CDM,,,,,,both,,,160.0000,24.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,49.12,,,,,,,41.3000,160.0000,other,30.7% of $160.00 in Billed Charges for Rev 270 = $49.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE TRACH XLONG SHILEY,270,RC,27000197,CDM,,,,,,both,,,160.0000,24.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,51.68,,,,,,,41.3000,160.0000,percent of total billed charges,32.3% of $160.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH XLONG SHILEY,270,RC,27000197,CDM,,,,,,both,,,160.0000,24.0000,WELLCARE,WELLCARE MEDICAID,160.00,,,,,,,41.3000,160.0000,percent of total billed charges,100% of $160.00 in Billed Charges for Rev 270 = $160.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBING ASPIRATION PENUMBRA,272,RC,27201255,CDM,,,,,,both,,,1374.0000,206.1000,AETNA,AETNA,586.70,,,,,,,354.6300,1374.0000,percent of total billed charges,"42.7% of $1,374.00 in Billed Charges for Rev 272 = $586.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBING ASPIRATION PENUMBRA,272,RC,27201255,CDM,,,,,,both,,,1374.0000,206.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,961.80,,,,,,,354.6300,1374.0000,percent of total billed charges,"Rev 272 $1,374.00 in Billed Charges at 70% = $961.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBING ASPIRATION PENUMBRA,272,RC,27201255,CDM,,,,,,both,,,1374.0000,206.1000,CIGNA HEALTHCARE,CIGNA HMO,572.96,,,,,,,354.6300,1374.0000,percent of total billed charges,"41.7% of $1,374.00 in Billed Charges for Rev 272 = $572.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBING ASPIRATION PENUMBRA,272,RC,27201255,CDM,,,,,,both,,,1374.0000,206.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,637.54,,,,,,,354.6300,1374.0000,percent of total billed charges,"46.4% of $1,374.00 in Billed Charges for Rev 272 = $637.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBING ASPIRATION PENUMBRA,272,RC,27201255,CDM,,,,,,both,,,1374.0000,206.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,572.96,,,,,,,354.6300,1374.0000,percent of total billed charges,"41.7% of $1,374.00 in Billed Charges for Rev 272 = $572.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBING ASPIRATION PENUMBRA,272,RC,27201255,CDM,,,,,,both,,,1374.0000,206.1000,CIGNA HEALTHCARE,CIGNA PPO,572.96,,,,,,,354.6300,1374.0000,percent of total billed charges,"41.7% of $1,374.00 in Billed Charges for Rev 272 = $572.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBING ASPIRATION PENUMBRA,272,RC,27201255,CDM,,,,,,both,,,1374.0000,206.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1236.60,,,,,,,354.6300,1374.0000,percent of total billed charges,"90% of $1,374.00 in Billed Charges for Rev 272 = $1,236.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBING ASPIRATION PENUMBRA,272,RC,27201255,CDM,,,,,,both,,,1374.0000,206.1000,MEDCOST,MEDCOST VHN,653.89,,,,,,,354.6300,1374.0000,percent of total billed charges,"47.59% of $1,374.00 in Billed Charges for Rev 272 = $653.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBING ASPIRATION PENUMBRA,272,RC,27201255,CDM,,,,,,both,,,1374.0000,206.1000,SENTARA HEALTH,SENTARA HEALTH,354.63,,,,,,,354.6300,1374.0000,percent of total billed charges,"25.81% of $1,374.00 in Billed Charges for Rev 272 = $354.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBING ASPIRATION PENUMBRA,272,RC,27201255,CDM,,,,,,both,,,1374.0000,206.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1374.00,,,,,,,354.6300,1374.0000,percent of total billed charges,"100% of $1,374.00 in Billed Charges for Rev 272 = $1,374.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBING ASPIRATION PENUMBRA,272,RC,27201255,CDM,,,,,,both,,,1374.0000,206.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,687.00,,,,,,,354.6300,1374.0000,percent of total billed charges,"Rev 272 $1,374.00 in Billed Charges at 50% = $687.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBING ASPIRATION PENUMBRA,272,RC,27201255,CDM,,,,,,both,,,1374.0000,206.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,443.80,,,,,,,354.6300,1374.0000,other,"32.3% of $1,374.00 in Billed Charges for Rev 272 = $443.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUBING ASPIRATION PENUMBRA,272,RC,27201255,CDM,,,,,,both,,,1374.0000,206.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,421.82,,,,,,,354.6300,1374.0000,other,"30.7% of $1,374.00 in Billed Charges for Rev 272 = $421.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUBING ASPIRATION PENUMBRA,272,RC,27201255,CDM,,,,,,both,,,1374.0000,206.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,443.80,,,,,,,354.6300,1374.0000,percent of total billed charges,"32.3% of $1,374.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBING ASPIRATION PENUMBRA,272,RC,27201255,CDM,,,,,,both,,,1374.0000,206.1000,WELLCARE,WELLCARE MEDICAID,1374.00,,,,,,,354.6300,1374.0000,percent of total billed charges,"100% of $1,374.00 in Billed Charges for Rev 272 = $1,374.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUNNELING TOOL 6996T,272,RC,27201257,CDM,,,,,,both,,,1857.0000,278.5500,AETNA,AETNA,792.94,,,,,,,479.2900,1857.0000,percent of total billed charges,"42.7% of $1,857.00 in Billed Charges for Rev 272 = $792.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUNNELING TOOL 6996T,272,RC,27201257,CDM,,,,,,both,,,1857.0000,278.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1299.90,,,,,,,479.2900,1857.0000,percent of total billed charges,"Rev 272 $1,857.00 in Billed Charges at 70% = $1,299.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUNNELING TOOL 6996T,272,RC,27201257,CDM,,,,,,both,,,1857.0000,278.5500,CIGNA HEALTHCARE,CIGNA HMO,774.37,,,,,,,479.2900,1857.0000,percent of total billed charges,"41.7% of $1,857.00 in Billed Charges for Rev 272 = $774.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUNNELING TOOL 6996T,272,RC,27201257,CDM,,,,,,both,,,1857.0000,278.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,861.65,,,,,,,479.2900,1857.0000,percent of total billed charges,"46.4% of $1,857.00 in Billed Charges for Rev 272 = $861.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUNNELING TOOL 6996T,272,RC,27201257,CDM,,,,,,both,,,1857.0000,278.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,774.37,,,,,,,479.2900,1857.0000,percent of total billed charges,"41.7% of $1,857.00 in Billed Charges for Rev 272 = $774.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUNNELING TOOL 6996T,272,RC,27201257,CDM,,,,,,both,,,1857.0000,278.5500,CIGNA HEALTHCARE,CIGNA PPO,774.37,,,,,,,479.2900,1857.0000,percent of total billed charges,"41.7% of $1,857.00 in Billed Charges for Rev 272 = $774.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUNNELING TOOL 6996T,272,RC,27201257,CDM,,,,,,both,,,1857.0000,278.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1671.30,,,,,,,479.2900,1857.0000,percent of total billed charges,"90% of $1,857.00 in Billed Charges for Rev 272 = $1,671.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUNNELING TOOL 6996T,272,RC,27201257,CDM,,,,,,both,,,1857.0000,278.5500,MEDCOST,MEDCOST VHN,883.75,,,,,,,479.2900,1857.0000,percent of total billed charges,"47.59% of $1,857.00 in Billed Charges for Rev 272 = $883.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUNNELING TOOL 6996T,272,RC,27201257,CDM,,,,,,both,,,1857.0000,278.5500,SENTARA HEALTH,SENTARA HEALTH,479.29,,,,,,,479.2900,1857.0000,percent of total billed charges,"25.81% of $1,857.00 in Billed Charges for Rev 272 = $479.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUNNELING TOOL 6996T,272,RC,27201257,CDM,,,,,,both,,,1857.0000,278.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1857.00,,,,,,,479.2900,1857.0000,percent of total billed charges,"100% of $1,857.00 in Billed Charges for Rev 272 = $1,857.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUNNELING TOOL 6996T,272,RC,27201257,CDM,,,,,,both,,,1857.0000,278.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,928.50,,,,,,,479.2900,1857.0000,percent of total billed charges,"Rev 272 $1,857.00 in Billed Charges at 50% = $928.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUNNELING TOOL 6996T,272,RC,27201257,CDM,,,,,,both,,,1857.0000,278.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,599.81,,,,,,,479.2900,1857.0000,other,"32.3% of $1,857.00 in Billed Charges for Rev 272 = $599.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUNNELING TOOL 6996T,272,RC,27201257,CDM,,,,,,both,,,1857.0000,278.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,570.10,,,,,,,479.2900,1857.0000,other,"30.7% of $1,857.00 in Billed Charges for Rev 272 = $570.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUNNELING TOOL 6996T,272,RC,27201257,CDM,,,,,,both,,,1857.0000,278.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,599.81,,,,,,,479.2900,1857.0000,percent of total billed charges,"32.3% of $1,857.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUNNELING TOOL 6996T,272,RC,27201257,CDM,,,,,,both,,,1857.0000,278.5500,WELLCARE,WELLCARE MEDICAID,1857.00,,,,,,,479.2900,1857.0000,percent of total billed charges,"100% of $1,857.00 in Billed Charges for Rev 272 = $1,857.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC URINE DRAINAGE SYS CLOSED,270,RC,27000035,CDM,,,,,,both,,,35.0000,5.2500,AETNA,AETNA,14.95,,,,,,,9.0300,35.0000,percent of total billed charges,42.7% of $35.00 in Billed Charges for Rev 270 = $14.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC URINE DRAINAGE SYS CLOSED,270,RC,27000035,CDM,,,,,,both,,,35.0000,5.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,24.50,,,,,,,9.0300,35.0000,percent of total billed charges,Rev 270 $35.00 in Billed Charges at 70% = $24.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC URINE DRAINAGE SYS CLOSED,270,RC,27000035,CDM,,,,,,both,,,35.0000,5.2500,CIGNA HEALTHCARE,CIGNA HMO,14.60,,,,,,,9.0300,35.0000,percent of total billed charges,41.7% of $35.00 in Billed Charges for Rev 270 = $14.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC URINE DRAINAGE SYS CLOSED,270,RC,27000035,CDM,,,,,,both,,,35.0000,5.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,16.24,,,,,,,9.0300,35.0000,percent of total billed charges,46.4% of $35.00 in Billed Charges for Rev 270 = $16.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC URINE DRAINAGE SYS CLOSED,270,RC,27000035,CDM,,,,,,both,,,35.0000,5.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,14.60,,,,,,,9.0300,35.0000,percent of total billed charges,41.7% of $35.00 in Billed Charges for Rev 270 = $14.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC URINE DRAINAGE SYS CLOSED,270,RC,27000035,CDM,,,,,,both,,,35.0000,5.2500,CIGNA HEALTHCARE,CIGNA PPO,14.60,,,,,,,9.0300,35.0000,percent of total billed charges,41.7% of $35.00 in Billed Charges for Rev 270 = $14.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC URINE DRAINAGE SYS CLOSED,270,RC,27000035,CDM,,,,,,both,,,35.0000,5.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,31.50,,,,,,,9.0300,35.0000,percent of total billed charges,90% of $35.00 in Billed Charges for Rev 270 = $31.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC URINE DRAINAGE SYS CLOSED,270,RC,27000035,CDM,,,,,,both,,,35.0000,5.2500,MEDCOST,MEDCOST VHN,16.66,,,,,,,9.0300,35.0000,percent of total billed charges,47.59% of $35.00 in Billed Charges for Rev 270 = $16.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC URINE DRAINAGE SYS CLOSED,270,RC,27000035,CDM,,,,,,both,,,35.0000,5.2500,SENTARA HEALTH,SENTARA HEALTH,9.03,,,,,,,9.0300,35.0000,percent of total billed charges,25.81% of $35.00 in Billed Charges for Rev 270 = $9.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC URINE DRAINAGE SYS CLOSED,270,RC,27000035,CDM,,,,,,both,,,35.0000,5.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",35.00,,,,,,,9.0300,35.0000,percent of total billed charges,100% of $35.00 in Billed Charges for Rev 270 = $35.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC URINE DRAINAGE SYS CLOSED,270,RC,27000035,CDM,,,,,,both,,,35.0000,5.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,17.50,,,,,,,9.0300,35.0000,percent of total billed charges,Rev 270 $35.00 in Billed Charges at 50% = $17.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC URINE DRAINAGE SYS CLOSED,270,RC,27000035,CDM,,,,,,both,,,35.0000,5.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,11.31,,,,,,,9.0300,35.0000,other,32.3% of $35.00 in Billed Charges for Rev 270 = $11.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URINE DRAINAGE SYS CLOSED,270,RC,27000035,CDM,,,,,,both,,,35.0000,5.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,10.75,,,,,,,9.0300,35.0000,other,30.7% of $35.00 in Billed Charges for Rev 270 = $10.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URINE DRAINAGE SYS CLOSED,270,RC,27000035,CDM,,,,,,both,,,35.0000,5.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,11.31,,,,,,,9.0300,35.0000,percent of total billed charges,32.3% of $35.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC URINE DRAINAGE SYS CLOSED,270,RC,27000035,CDM,,,,,,both,,,35.0000,5.2500,WELLCARE,WELLCARE MEDICAID,35.00,,,,,,,9.0300,35.0000,percent of total billed charges,100% of $35.00 in Billed Charges for Rev 270 = $35.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VAGINAL DELIVERY EACH ADD NEONATE,724,RC,72400003,CDM,,,,,,both,,,1130.0000,169.5000,AETNA,AETNA,482.51,,,,,,,46.0000,1130.0000,percent of total billed charges,"42.7% of $1,130.00 in Billed Charges for Rev 724 = $482.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VAGINAL DELIVERY EACH ADD NEONATE,724,RC,72400003,CDM,,,,,,both,,,1130.0000,169.5000,BLUE CROSS,ANTHEM EXCHANGE,186.45,,,,,,,46.0000,1130.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY EACH ADD NEONATE,724,RC,72400003,CDM,,,,,,both,,,1130.0000,169.5000,BLUE CROSS,ANTHEM HMO,186.45,,,,,,,46.0000,1130.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY EACH ADD NEONATE,724,RC,72400003,CDM,,,,,,both,,,1130.0000,169.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",186.45,,,,,,,46.0000,1130.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY EACH ADD NEONATE,724,RC,72400003,CDM,,,,,,both,,,1130.0000,169.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,791.00,,,,,,,46.0000,1130.0000,percent of total billed charges,"Rev 724 $1,130.00 in Billed Charges at 70% = $791.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VAGINAL DELIVERY EACH ADD NEONATE,724,RC,72400003,CDM,,,,,,both,,,1130.0000,169.5000,BLUE CROSS,BLUE CROSS E NETWORK,46.00,,,,,,,46.0000,1130.0000,other,Rev 724 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY EACH ADD NEONATE,724,RC,72400003,CDM,,,,,,both,,,1130.0000,169.5000,BLUE CROSS,BLUE CROSS P NETWORK,46.00,,,,,,,46.0000,1130.0000,other,Rev 724 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY EACH ADD NEONATE,724,RC,72400003,CDM,,,,,,both,,,1130.0000,169.5000,BLUE CROSS,BLUE CROSS S NETWORK,46.00,,,,,,,46.0000,1130.0000,other,Rev 724 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY EACH ADD NEONATE,724,RC,72400003,CDM,,,,,,both,,,1130.0000,169.5000,CIGNA HEALTHCARE,CIGNA HMO,471.21,,,,,,,46.0000,1130.0000,percent of total billed charges,"41.7% of $1,130.00 in Billed Charges for Rev 724 = $471.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VAGINAL DELIVERY EACH ADD NEONATE,724,RC,72400003,CDM,,,,,,both,,,1130.0000,169.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,524.32,,,,,,,46.0000,1130.0000,percent of total billed charges,"46.4% of $1,130.00 in Billed Charges for Rev 724 = $524.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VAGINAL DELIVERY EACH ADD NEONATE,724,RC,72400003,CDM,,,,,,both,,,1130.0000,169.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,471.21,,,,,,,46.0000,1130.0000,percent of total billed charges,"41.7% of $1,130.00 in Billed Charges for Rev 724 = $471.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VAGINAL DELIVERY EACH ADD NEONATE,724,RC,72400003,CDM,,,,,,both,,,1130.0000,169.5000,CIGNA HEALTHCARE,CIGNA PPO,471.21,,,,,,,46.0000,1130.0000,percent of total billed charges,"41.7% of $1,130.00 in Billed Charges for Rev 724 = $471.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VAGINAL DELIVERY EACH ADD NEONATE,724,RC,72400003,CDM,,,,,,both,,,1130.0000,169.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1017.00,,,,,,,46.0000,1130.0000,percent of total billed charges,"90% of $1,130.00 in Billed Charges for Rev 724 = $1,017.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VAGINAL DELIVERY EACH ADD NEONATE,724,RC,72400003,CDM,,,,,,both,,,1130.0000,169.5000,MEDCOST,MEDCOST VHN,537.77,,,,,,,46.0000,1130.0000,percent of total billed charges,"47.59% of $1,130.00 in Billed Charges for Rev 724 = $537.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VAGINAL DELIVERY EACH ADD NEONATE,724,RC,72400003,CDM,,,,,,both,,,1130.0000,169.5000,SENTARA HEALTH,SENTARA HEALTH,291.65,,,,,,,46.0000,1130.0000,percent of total billed charges,"25.81% of $1,130.00 in Billed Charges for Rev 724 = $291.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VAGINAL DELIVERY EACH ADD NEONATE,724,RC,72400003,CDM,,,,,,both,,,1130.0000,169.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1130.00,,,,,,,46.0000,1130.0000,percent of total billed charges,"100% of $1,130.00 in Billed Charges for Rev 724 = $1,130.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VAGINAL DELIVERY EACH ADD NEONATE,724,RC,72400003,CDM,,,,,,both,,,1130.0000,169.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,565.00,,,,,,,46.0000,1130.0000,percent of total billed charges,"Rev 724 $1,130.00 in Billed Charges at 50% = $565.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VAGINAL DELIVERY EACH ADD NEONATE,724,RC,72400003,CDM,,,,,,both,,,1130.0000,169.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,259.00,,,,,,,46.0000,1130.0000,other,Rev 724 1 Visit at $259.00 per Visit = $259.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY EACH ADD NEONATE,724,RC,72400003,CDM,,,,,,both,,,1130.0000,169.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,247.00,,,,,,,46.0000,1130.0000,other,Rev 724 1 Visit at $247.00 per Visit = $247.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY EACH ADD NEONATE,724,RC,72400003,CDM,,,,,,both,,,1130.0000,169.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,408.00,,,,,,,46.0000,1130.0000,other,Rev 724 1 Visit at $408.00 per Visit = $408.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VAGINAL DELIVERY EACH ADD NEONATE,724,RC,72400003,CDM,,,,,,both,,,1130.0000,169.5000,WELLCARE,WELLCARE MEDICAID,1130.00,,,,,,,46.0000,1130.0000,percent of total billed charges,"100% of $1,130.00 in Billed Charges for Rev 724 = $1,130.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE ROTATING HEMOSTATIC,272,RC,27201262,CDM,,,,,,both,,,137.0000,20.5500,AETNA,AETNA,58.50,,,,,,,35.3600,137.0000,percent of total billed charges,42.7% of $137.00 in Billed Charges for Rev 272 = $58.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ROTATING HEMOSTATIC,272,RC,27201262,CDM,,,,,,both,,,137.0000,20.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,95.90,,,,,,,35.3600,137.0000,percent of total billed charges,Rev 272 $137.00 in Billed Charges at 70% = $95.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ROTATING HEMOSTATIC,272,RC,27201262,CDM,,,,,,both,,,137.0000,20.5500,CIGNA HEALTHCARE,CIGNA HMO,57.13,,,,,,,35.3600,137.0000,percent of total billed charges,41.7% of $137.00 in Billed Charges for Rev 272 = $57.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ROTATING HEMOSTATIC,272,RC,27201262,CDM,,,,,,both,,,137.0000,20.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,63.57,,,,,,,35.3600,137.0000,percent of total billed charges,46.4% of $137.00 in Billed Charges for Rev 272 = $63.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ROTATING HEMOSTATIC,272,RC,27201262,CDM,,,,,,both,,,137.0000,20.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,57.13,,,,,,,35.3600,137.0000,percent of total billed charges,41.7% of $137.00 in Billed Charges for Rev 272 = $57.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ROTATING HEMOSTATIC,272,RC,27201262,CDM,,,,,,both,,,137.0000,20.5500,CIGNA HEALTHCARE,CIGNA PPO,57.13,,,,,,,35.3600,137.0000,percent of total billed charges,41.7% of $137.00 in Billed Charges for Rev 272 = $57.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ROTATING HEMOSTATIC,272,RC,27201262,CDM,,,,,,both,,,137.0000,20.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,123.30,,,,,,,35.3600,137.0000,percent of total billed charges,90% of $137.00 in Billed Charges for Rev 272 = $123.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ROTATING HEMOSTATIC,272,RC,27201262,CDM,,,,,,both,,,137.0000,20.5500,MEDCOST,MEDCOST VHN,65.20,,,,,,,35.3600,137.0000,percent of total billed charges,47.59% of $137.00 in Billed Charges for Rev 272 = $65.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ROTATING HEMOSTATIC,272,RC,27201262,CDM,,,,,,both,,,137.0000,20.5500,SENTARA HEALTH,SENTARA HEALTH,35.36,,,,,,,35.3600,137.0000,percent of total billed charges,25.81% of $137.00 in Billed Charges for Rev 272 = $35.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ROTATING HEMOSTATIC,272,RC,27201262,CDM,,,,,,both,,,137.0000,20.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",137.00,,,,,,,35.3600,137.0000,percent of total billed charges,100% of $137.00 in Billed Charges for Rev 272 = $137.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ROTATING HEMOSTATIC,272,RC,27201262,CDM,,,,,,both,,,137.0000,20.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,68.50,,,,,,,35.3600,137.0000,percent of total billed charges,Rev 272 $137.00 in Billed Charges at 50% = $68.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ROTATING HEMOSTATIC,272,RC,27201262,CDM,,,,,,both,,,137.0000,20.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,44.25,,,,,,,35.3600,137.0000,other,32.3% of $137.00 in Billed Charges for Rev 272 = $44.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VALVE ROTATING HEMOSTATIC,272,RC,27201262,CDM,,,,,,both,,,137.0000,20.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,42.06,,,,,,,35.3600,137.0000,other,30.7% of $137.00 in Billed Charges for Rev 272 = $42.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VALVE ROTATING HEMOSTATIC,272,RC,27201262,CDM,,,,,,both,,,137.0000,20.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,44.25,,,,,,,35.3600,137.0000,percent of total billed charges,32.3% of $137.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ROTATING HEMOSTATIC,272,RC,27201262,CDM,,,,,,both,,,137.0000,20.5500,WELLCARE,WELLCARE MEDICAID,137.00,,,,,,,35.3600,137.0000,percent of total billed charges,100% of $137.00 in Billed Charges for Rev 272 = $137.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE TRANSAPICAL ASCENDRA  23-29MM,278,RC,27801475,CDM,,,,,,both,,,86250.0000,12937.5000,AETNA,AETNA,41400.00,,,,,,,6123.7500,86250.0000,percent of total billed charges,"48% of $86,250.00 in Billed Charges for Rev 278 = $41,400.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE TRANSAPICAL ASCENDRA  23-29MM,278,RC,27801475,CDM,,,,,,both,,,86250.0000,12937.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,43125.00,,,,,,,6123.7500,86250.0000,percent of total billed charges,"50% of $86,250.00 in Billed Charges for Rev 278 = $43,125.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE TRANSAPICAL ASCENDRA  23-29MM,278,RC,27801475,CDM,,,,,,both,,,86250.0000,12937.5000,CIGNA HEALTHCARE,CIGNA HMO,35966.25,,,,,,,6123.7500,86250.0000,percent of total billed charges,"41.7% of $86,250.00 in Billed Charges for Rev 278 = $35,966.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE TRANSAPICAL ASCENDRA  23-29MM,278,RC,27801475,CDM,,,,,,both,,,86250.0000,12937.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,34500.00,,,,,,,6123.7500,86250.0000,percent of total billed charges,"40% of $86,250.00 in Billed Charges for Rev 278 = $34,500.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE TRANSAPICAL ASCENDRA  23-29MM,278,RC,27801475,CDM,,,,,,both,,,86250.0000,12937.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,35966.25,,,,,,,6123.7500,86250.0000,percent of total billed charges,"41.7% of $86,250.00 in Billed Charges for Rev 278 = $35,966.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE TRANSAPICAL ASCENDRA  23-29MM,278,RC,27801475,CDM,,,,,,both,,,86250.0000,12937.5000,CIGNA HEALTHCARE,CIGNA PPO,35966.25,,,,,,,6123.7500,86250.0000,percent of total billed charges,"41.7% of $86,250.00 in Billed Charges for Rev 278 = $35,966.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE TRANSAPICAL ASCENDRA  23-29MM,278,RC,27801475,CDM,,,,,,both,,,86250.0000,12937.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,77625.00,,,,,,,6123.7500,86250.0000,percent of total billed charges,"90% of $86,250.00 in Billed Charges for Rev 278 = $77,625.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE TRANSAPICAL ASCENDRA  23-29MM,278,RC,27801475,CDM,,,,,,both,,,86250.0000,12937.5000,MEDCOST,MEDCOST VHN,41046.38,,,,,,,6123.7500,86250.0000,percent of total billed charges,"47.59% of $86,250.00 in Billed Charges for Rev 278 = $41,046.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE TRANSAPICAL ASCENDRA  23-29MM,278,RC,27801475,CDM,,,,,,both,,,86250.0000,12937.5000,SENTARA HEALTH,SENTARA HEALTH,22261.13,,,,,,,6123.7500,86250.0000,percent of total billed charges,"25.81% of $86,250.00 in Billed Charges for Rev 278 = $22,261.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE TRANSAPICAL ASCENDRA  23-29MM,278,RC,27801475,CDM,,,,,,both,,,86250.0000,12937.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",86250.00,,,,,,,6123.7500,86250.0000,percent of total billed charges,"100% of $86,250.00 in Billed Charges for Rev 278 = $86,250.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE TRANSAPICAL ASCENDRA  23-29MM,278,RC,27801475,CDM,,,,,,both,,,86250.0000,12937.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,43125.00,,,,,,,6123.7500,86250.0000,percent of total billed charges,"Rev 278 $86,250.00 in Billed Charges at 50% = $43,125.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE TRANSAPICAL ASCENDRA  23-29MM,278,RC,27801475,CDM,,,,,,both,,,86250.0000,12937.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,6468.75,,,,,,,6123.7500,86250.0000,percent of total billed charges,"7.5% of $86,250.00 in Billed Charges for Rev 278 = $6,468.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE TRANSAPICAL ASCENDRA  23-29MM,278,RC,27801475,CDM,,,,,,both,,,86250.0000,12937.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,6123.75,,,,,,,6123.7500,86250.0000,percent of total billed charges,"7.1% of $86,250.00 in Billed Charges for Rev 278 = $6,123.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE TRANSAPICAL ASCENDRA  23-29MM,278,RC,27801475,CDM,,,,,,both,,,86250.0000,12937.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,6123.75,,,,,,,6123.7500,86250.0000,percent of total billed charges,"7.1% of $86,250.00 in Billed Charges for Rev 278 = $6,123.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE TRANSAPICAL ASCENDRA  23-29MM,278,RC,27801475,CDM,,,,,,both,,,86250.0000,12937.5000,WELLCARE,WELLCARE MEDICAID,86250.00,,,,,,,6123.7500,86250.0000,percent of total billed charges,"100% of $86,250.00 in Billed Charges for Rev 278 = $86,250.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VASCULAR PLUG II,278,RC,27800048,CDM,,,,,,both,,,2548.0000,382.2000,AETNA,AETNA,1223.04,,,,,,,657.6400,2548.0000,percent of total billed charges,"48% of $2,548.00 in Billed Charges for Rev 278 = $1,223.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VASCULAR PLUG II,278,RC,27800048,CDM,,,,,,both,,,2548.0000,382.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1274.00,,,,,,,657.6400,2548.0000,percent of total billed charges,"50% of $2,548.00 in Billed Charges for Rev 278 = $1,274.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VASCULAR PLUG II,278,RC,27800048,CDM,,,,,,both,,,2548.0000,382.2000,CIGNA HEALTHCARE,CIGNA HMO,1062.52,,,,,,,657.6400,2548.0000,percent of total billed charges,"41.7% of $2,548.00 in Billed Charges for Rev 278 = $1,062.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VASCULAR PLUG II,278,RC,27800048,CDM,,,,,,both,,,2548.0000,382.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1019.20,,,,,,,657.6400,2548.0000,percent of total billed charges,"40% of $2,548.00 in Billed Charges for Rev 278 = $1,019.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VASCULAR PLUG II,278,RC,27800048,CDM,,,,,,both,,,2548.0000,382.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1062.52,,,,,,,657.6400,2548.0000,percent of total billed charges,"41.7% of $2,548.00 in Billed Charges for Rev 278 = $1,062.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VASCULAR PLUG II,278,RC,27800048,CDM,,,,,,both,,,2548.0000,382.2000,CIGNA HEALTHCARE,CIGNA PPO,1062.52,,,,,,,657.6400,2548.0000,percent of total billed charges,"41.7% of $2,548.00 in Billed Charges for Rev 278 = $1,062.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VASCULAR PLUG II,278,RC,27800048,CDM,,,,,,both,,,2548.0000,382.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2293.20,,,,,,,657.6400,2548.0000,percent of total billed charges,"90% of $2,548.00 in Billed Charges for Rev 278 = $2,293.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VASCULAR PLUG II,278,RC,27800048,CDM,,,,,,both,,,2548.0000,382.2000,MEDCOST,MEDCOST VHN,1212.59,,,,,,,657.6400,2548.0000,percent of total billed charges,"47.59% of $2,548.00 in Billed Charges for Rev 278 = $1,212.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VASCULAR PLUG II,278,RC,27800048,CDM,,,,,,both,,,2548.0000,382.2000,SENTARA HEALTH,SENTARA HEALTH,657.64,,,,,,,657.6400,2548.0000,percent of total billed charges,"25.81% of $2,548.00 in Billed Charges for Rev 278 = $657.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VASCULAR PLUG II,278,RC,27800048,CDM,,,,,,both,,,2548.0000,382.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2548.00,,,,,,,657.6400,2548.0000,percent of total billed charges,"100% of $2,548.00 in Billed Charges for Rev 278 = $2,548.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VASCULAR PLUG II,278,RC,27800048,CDM,,,,,,both,,,2548.0000,382.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1274.00,,,,,,,657.6400,2548.0000,percent of total billed charges,"Rev 278 $2,548.00 in Billed Charges at 50% = $1,274.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VASCULAR PLUG II,278,RC,27800048,CDM,,,,,,both,,,2548.0000,382.2000,WELLCARE,WELLCARE MEDICAID,2548.00,,,,,,,657.6400,2548.0000,percent of total billed charges,"100% of $2,548.00 in Billed Charges for Rev 278 = $2,548.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT (STERILE) FEMORAL/TIBIAL CHECKPOINT,272,RC,27200002,CDM,,,,,,both,,,884.1300,132.6200,AETNA,AETNA,377.52,,,,,,,228.1900,884.1300,percent of total billed charges,42.7% of $884.13 in Billed Charges for Rev 272 = $377.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT (STERILE) FEMORAL/TIBIAL CHECKPOINT,272,RC,27200002,CDM,,,,,,both,,,884.1300,132.6200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,618.89,,,,,,,228.1900,884.1300,percent of total billed charges,Rev 272 $884.13 in Billed Charges at 70% = $618.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT (STERILE) FEMORAL/TIBIAL CHECKPOINT,272,RC,27200002,CDM,,,,,,both,,,884.1300,132.6200,CIGNA HEALTHCARE,CIGNA HMO,368.68,,,,,,,228.1900,884.1300,percent of total billed charges,41.7% of $884.13 in Billed Charges for Rev 272 = $368.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT (STERILE) FEMORAL/TIBIAL CHECKPOINT,272,RC,27200002,CDM,,,,,,both,,,884.1300,132.6200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,410.24,,,,,,,228.1900,884.1300,percent of total billed charges,46.4% of $884.13 in Billed Charges for Rev 272 = $410.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT (STERILE) FEMORAL/TIBIAL CHECKPOINT,272,RC,27200002,CDM,,,,,,both,,,884.1300,132.6200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,368.68,,,,,,,228.1900,884.1300,percent of total billed charges,41.7% of $884.13 in Billed Charges for Rev 272 = $368.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT (STERILE) FEMORAL/TIBIAL CHECKPOINT,272,RC,27200002,CDM,,,,,,both,,,884.1300,132.6200,CIGNA HEALTHCARE,CIGNA PPO,368.68,,,,,,,228.1900,884.1300,percent of total billed charges,41.7% of $884.13 in Billed Charges for Rev 272 = $368.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT (STERILE) FEMORAL/TIBIAL CHECKPOINT,272,RC,27200002,CDM,,,,,,both,,,884.1300,132.6200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,795.72,,,,,,,228.1900,884.1300,percent of total billed charges,90% of $884.13 in Billed Charges for Rev 272 = $795.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT (STERILE) FEMORAL/TIBIAL CHECKPOINT,272,RC,27200002,CDM,,,,,,both,,,884.1300,132.6200,MEDCOST,MEDCOST VHN,420.76,,,,,,,228.1900,884.1300,percent of total billed charges,47.59% of $884.13 in Billed Charges for Rev 272 = $420.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT (STERILE) FEMORAL/TIBIAL CHECKPOINT,272,RC,27200002,CDM,,,,,,both,,,884.1300,132.6200,SENTARA HEALTH,SENTARA HEALTH,228.19,,,,,,,228.1900,884.1300,percent of total billed charges,25.81% of $884.13 in Billed Charges for Rev 272 = $228.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT (STERILE) FEMORAL/TIBIAL CHECKPOINT,272,RC,27200002,CDM,,,,,,both,,,884.1300,132.6200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",884.13,,,,,,,228.1900,884.1300,percent of total billed charges,100% of $884.13 in Billed Charges for Rev 272 = $884.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT (STERILE) FEMORAL/TIBIAL CHECKPOINT,272,RC,27200002,CDM,,,,,,both,,,884.1300,132.6200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,442.07,,,,,,,228.1900,884.1300,percent of total billed charges,Rev 272 $884.13 in Billed Charges at 50% = $442.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT (STERILE) FEMORAL/TIBIAL CHECKPOINT,272,RC,27200002,CDM,,,,,,both,,,884.1300,132.6200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,285.57,,,,,,,228.1900,884.1300,other,32.3% of $884.13 in Billed Charges for Rev 272 = $285.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT (STERILE) FEMORAL/TIBIAL CHECKPOINT,272,RC,27200002,CDM,,,,,,both,,,884.1300,132.6200,UNITED HEALTHCARE,UHC HERITAGE SELECT,271.43,,,,,,,228.1900,884.1300,other,30.7% of $884.13 in Billed Charges for Rev 272 = $271.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT (STERILE) FEMORAL/TIBIAL CHECKPOINT,272,RC,27200002,CDM,,,,,,both,,,884.1300,132.6200,UNITED HEALTHCARE,UNITED HEALTHCARE,285.57,,,,,,,228.1900,884.1300,percent of total billed charges,32.3% of $884.13 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT (STERILE) FEMORAL/TIBIAL CHECKPOINT,272,RC,27200002,CDM,,,,,,both,,,884.1300,132.6200,WELLCARE,WELLCARE MEDICAID,884.13,,,,,,,228.1900,884.1300,percent of total billed charges,100% of $884.13 in Billed Charges for Rev 272 = $884.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBERRING #2 3MM,272,RC,27200002,CDM,,,,,,both,,,1794.1800,269.1300,AETNA,AETNA,766.11,,,,,,,463.0800,1794.1800,percent of total billed charges,"42.7% of $1,794.18 in Billed Charges for Rev 272 = $766.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERRING #2 3MM,272,RC,27200002,CDM,,,,,,both,,,1794.1800,269.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1255.93,,,,,,,463.0800,1794.1800,percent of total billed charges,"Rev 272 $1,794.18 in Billed Charges at 70% = $1,255.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERRING #2 3MM,272,RC,27200002,CDM,,,,,,both,,,1794.1800,269.1300,CIGNA HEALTHCARE,CIGNA HMO,748.17,,,,,,,463.0800,1794.1800,percent of total billed charges,"41.7% of $1,794.18 in Billed Charges for Rev 272 = $748.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERRING #2 3MM,272,RC,27200002,CDM,,,,,,both,,,1794.1800,269.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,832.50,,,,,,,463.0800,1794.1800,percent of total billed charges,"46.4% of $1,794.18 in Billed Charges for Rev 272 = $832.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERRING #2 3MM,272,RC,27200002,CDM,,,,,,both,,,1794.1800,269.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,748.17,,,,,,,463.0800,1794.1800,percent of total billed charges,"41.7% of $1,794.18 in Billed Charges for Rev 272 = $748.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERRING #2 3MM,272,RC,27200002,CDM,,,,,,both,,,1794.1800,269.1300,CIGNA HEALTHCARE,CIGNA PPO,748.17,,,,,,,463.0800,1794.1800,percent of total billed charges,"41.7% of $1,794.18 in Billed Charges for Rev 272 = $748.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERRING #2 3MM,272,RC,27200002,CDM,,,,,,both,,,1794.1800,269.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1614.76,,,,,,,463.0800,1794.1800,percent of total billed charges,"90% of $1,794.18 in Billed Charges for Rev 272 = $1,614.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERRING #2 3MM,272,RC,27200002,CDM,,,,,,both,,,1794.1800,269.1300,MEDCOST,MEDCOST VHN,853.85,,,,,,,463.0800,1794.1800,percent of total billed charges,"47.59% of $1,794.18 in Billed Charges for Rev 272 = $853.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERRING #2 3MM,272,RC,27200002,CDM,,,,,,both,,,1794.1800,269.1300,SENTARA HEALTH,SENTARA HEALTH,463.08,,,,,,,463.0800,1794.1800,percent of total billed charges,"25.81% of $1,794.18 in Billed Charges for Rev 272 = $463.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERRING #2 3MM,272,RC,27200002,CDM,,,,,,both,,,1794.1800,269.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1794.18,,,,,,,463.0800,1794.1800,percent of total billed charges,"100% of $1,794.18 in Billed Charges for Rev 272 = $1,794.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERRING #2 3MM,272,RC,27200002,CDM,,,,,,both,,,1794.1800,269.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,897.09,,,,,,,463.0800,1794.1800,percent of total billed charges,"Rev 272 $1,794.18 in Billed Charges at 50% = $897.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERRING #2 3MM,272,RC,27200002,CDM,,,,,,both,,,1794.1800,269.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,579.52,,,,,,,463.0800,1794.1800,other,"32.3% of $1,794.18 in Billed Charges for Rev 272 = $579.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBERRING #2 3MM,272,RC,27200002,CDM,,,,,,both,,,1794.1800,269.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,550.81,,,,,,,463.0800,1794.1800,other,"30.7% of $1,794.18 in Billed Charges for Rev 272 = $550.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBERRING #2 3MM,272,RC,27200002,CDM,,,,,,both,,,1794.1800,269.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,579.52,,,,,,,463.0800,1794.1800,percent of total billed charges,"32.3% of $1,794.18 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERRING #2 3MM,272,RC,27200002,CDM,,,,,,both,,,1794.1800,269.1300,WELLCARE,WELLCARE MEDICAID,1794.18,,,,,,,463.0800,1794.1800,percent of total billed charges,"100% of $1,794.18 in Billed Charges for Rev 272 = $1,794.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERTAPE STERNAL CLOSURE X6 WITH FIBERTAP CERCLAGE DISPOSABLE TENSIONER,272,RC,27200002,CDM,,,,,,both,,,18439.6400,2765.9500,AETNA,AETNA,7873.73,,,,,,,4759.2700,18439.6400,percent of total billed charges,"42.7% of $18,439.64 in Billed Charges for Rev 272 = $7,873.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERTAPE STERNAL CLOSURE X6 WITH FIBERTAP CERCLAGE DISPOSABLE TENSIONER,272,RC,27200002,CDM,,,,,,both,,,18439.6400,2765.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,12907.75,,,,,,,4759.2700,18439.6400,percent of total billed charges,"Rev 272 $18,439.64 in Billed Charges at 70% = $12,907.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERTAPE STERNAL CLOSURE X6 WITH FIBERTAP CERCLAGE DISPOSABLE TENSIONER,272,RC,27200002,CDM,,,,,,both,,,18439.6400,2765.9500,CIGNA HEALTHCARE,CIGNA HMO,7689.33,,,,,,,4759.2700,18439.6400,percent of total billed charges,"41.7% of $18,439.64 in Billed Charges for Rev 272 = $7,689.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERTAPE STERNAL CLOSURE X6 WITH FIBERTAP CERCLAGE DISPOSABLE TENSIONER,272,RC,27200002,CDM,,,,,,both,,,18439.6400,2765.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8555.99,,,,,,,4759.2700,18439.6400,percent of total billed charges,"46.4% of $18,439.64 in Billed Charges for Rev 272 = $8,555.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERTAPE STERNAL CLOSURE X6 WITH FIBERTAP CERCLAGE DISPOSABLE TENSIONER,272,RC,27200002,CDM,,,,,,both,,,18439.6400,2765.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7689.33,,,,,,,4759.2700,18439.6400,percent of total billed charges,"41.7% of $18,439.64 in Billed Charges for Rev 272 = $7,689.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERTAPE STERNAL CLOSURE X6 WITH FIBERTAP CERCLAGE DISPOSABLE TENSIONER,272,RC,27200002,CDM,,,,,,both,,,18439.6400,2765.9500,CIGNA HEALTHCARE,CIGNA PPO,7689.33,,,,,,,4759.2700,18439.6400,percent of total billed charges,"41.7% of $18,439.64 in Billed Charges for Rev 272 = $7,689.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERTAPE STERNAL CLOSURE X6 WITH FIBERTAP CERCLAGE DISPOSABLE TENSIONER,272,RC,27200002,CDM,,,,,,both,,,18439.6400,2765.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,16595.68,,,,,,,4759.2700,18439.6400,percent of total billed charges,"90% of $18,439.64 in Billed Charges for Rev 272 = $16,595.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERTAPE STERNAL CLOSURE X6 WITH FIBERTAP CERCLAGE DISPOSABLE TENSIONER,272,RC,27200002,CDM,,,,,,both,,,18439.6400,2765.9500,MEDCOST,MEDCOST VHN,8775.42,,,,,,,4759.2700,18439.6400,percent of total billed charges,"47.59% of $18,439.64 in Billed Charges for Rev 272 = $8,775.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERTAPE STERNAL CLOSURE X6 WITH FIBERTAP CERCLAGE DISPOSABLE TENSIONER,272,RC,27200002,CDM,,,,,,both,,,18439.6400,2765.9500,SENTARA HEALTH,SENTARA HEALTH,4759.27,,,,,,,4759.2700,18439.6400,percent of total billed charges,"25.81% of $18,439.64 in Billed Charges for Rev 272 = $4,759.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERTAPE STERNAL CLOSURE X6 WITH FIBERTAP CERCLAGE DISPOSABLE TENSIONER,272,RC,27200002,CDM,,,,,,both,,,18439.6400,2765.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",18439.64,,,,,,,4759.2700,18439.6400,percent of total billed charges,"100% of $18,439.64 in Billed Charges for Rev 272 = $18,439.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERTAPE STERNAL CLOSURE X6 WITH FIBERTAP CERCLAGE DISPOSABLE TENSIONER,272,RC,27200002,CDM,,,,,,both,,,18439.6400,2765.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9219.82,,,,,,,4759.2700,18439.6400,percent of total billed charges,"Rev 272 $18,439.64 in Billed Charges at 50% = $9,219.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERTAPE STERNAL CLOSURE X6 WITH FIBERTAP CERCLAGE DISPOSABLE TENSIONER,272,RC,27200002,CDM,,,,,,both,,,18439.6400,2765.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5956.00,,,,,,,4759.2700,18439.6400,other,"32.3% of $18,439.64 in Billed Charges for Rev 272 = $5,956.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBERTAPE STERNAL CLOSURE X6 WITH FIBERTAP CERCLAGE DISPOSABLE TENSIONER,272,RC,27200002,CDM,,,,,,both,,,18439.6400,2765.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,5660.97,,,,,,,4759.2700,18439.6400,other,"30.7% of $18,439.64 in Billed Charges for Rev 272 = $5,660.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBERTAPE STERNAL CLOSURE X6 WITH FIBERTAP CERCLAGE DISPOSABLE TENSIONER,272,RC,27200002,CDM,,,,,,both,,,18439.6400,2765.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,5956.00,,,,,,,4759.2700,18439.6400,percent of total billed charges,"32.3% of $18,439.64 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERTAPE STERNAL CLOSURE X6 WITH FIBERTAP CERCLAGE DISPOSABLE TENSIONER,272,RC,27200002,CDM,,,,,,both,,,18439.6400,2765.9500,WELLCARE,WELLCARE MEDICAID,18439.64,,,,,,,4759.2700,18439.6400,percent of total billed charges,"100% of $18,439.64 in Billed Charges for Rev 272 = $18,439.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBERWIRE 2-0 WITH CT-2 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,269.6500,40.4500,AETNA,AETNA,115.14,,,,,,,69.6000,269.6500,percent of total billed charges,42.7% of $269.65 in Billed Charges for Rev 272 = $115.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBERWIRE 2-0 WITH CT-2 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,269.6500,40.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,188.76,,,,,,,69.6000,269.6500,percent of total billed charges,Rev 272 $269.65 in Billed Charges at 70% = $188.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBERWIRE 2-0 WITH CT-2 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,269.6500,40.4500,CIGNA HEALTHCARE,CIGNA HMO,112.44,,,,,,,69.6000,269.6500,percent of total billed charges,41.7% of $269.65 in Billed Charges for Rev 272 = $112.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBERWIRE 2-0 WITH CT-2 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,269.6500,40.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,125.12,,,,,,,69.6000,269.6500,percent of total billed charges,46.4% of $269.65 in Billed Charges for Rev 272 = $125.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBERWIRE 2-0 WITH CT-2 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,269.6500,40.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,112.44,,,,,,,69.6000,269.6500,percent of total billed charges,41.7% of $269.65 in Billed Charges for Rev 272 = $112.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBERWIRE 2-0 WITH CT-2 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,269.6500,40.4500,CIGNA HEALTHCARE,CIGNA PPO,112.44,,,,,,,69.6000,269.6500,percent of total billed charges,41.7% of $269.65 in Billed Charges for Rev 272 = $112.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBERWIRE 2-0 WITH CT-2 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,269.6500,40.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,242.69,,,,,,,69.6000,269.6500,percent of total billed charges,90% of $269.65 in Billed Charges for Rev 272 = $242.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBERWIRE 2-0 WITH CT-2 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,269.6500,40.4500,MEDCOST,MEDCOST VHN,128.33,,,,,,,69.6000,269.6500,percent of total billed charges,47.59% of $269.65 in Billed Charges for Rev 272 = $128.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBERWIRE 2-0 WITH CT-2 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,269.6500,40.4500,SENTARA HEALTH,SENTARA HEALTH,69.60,,,,,,,69.6000,269.6500,percent of total billed charges,25.81% of $269.65 in Billed Charges for Rev 272 = $69.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBERWIRE 2-0 WITH CT-2 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,269.6500,40.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",269.65,,,,,,,69.6000,269.6500,percent of total billed charges,100% of $269.65 in Billed Charges for Rev 272 = $269.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBERWIRE 2-0 WITH CT-2 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,269.6500,40.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,134.83,,,,,,,69.6000,269.6500,percent of total billed charges,Rev 272 $269.65 in Billed Charges at 50% = $134.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBERWIRE 2-0 WITH CT-2 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,269.6500,40.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,87.10,,,,,,,69.6000,269.6500,other,32.3% of $269.65 in Billed Charges for Rev 272 = $87.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
FIBERWIRE 2-0 WITH CT-2 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,269.6500,40.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,82.78,,,,,,,69.6000,269.6500,other,30.7% of $269.65 in Billed Charges for Rev 272 = $82.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
FIBERWIRE 2-0 WITH CT-2 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,269.6500,40.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,87.10,,,,,,,69.6000,269.6500,percent of total billed charges,32.3% of $269.65 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBERWIRE 2-0 WITH CT-2 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,269.6500,40.4500,WELLCARE,WELLCARE MEDICAID,269.65,,,,,,,69.6000,269.6500,percent of total billed charges,100% of $269.65 in Billed Charges for Rev 272 = $269.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBRILLAR 4X4,272,RC,27200002,CDM,,,,,,both,,,1057.5400,158.6300,AETNA,AETNA,451.57,,,,,,,272.9500,1057.5400,percent of total billed charges,"42.7% of $1,057.54 in Billed Charges for Rev 272 = $451.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBRILLAR 4X4,272,RC,27200002,CDM,,,,,,both,,,1057.5400,158.6300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,740.28,,,,,,,272.9500,1057.5400,percent of total billed charges,"Rev 272 $1,057.54 in Billed Charges at 70% = $740.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBRILLAR 4X4,272,RC,27200002,CDM,,,,,,both,,,1057.5400,158.6300,CIGNA HEALTHCARE,CIGNA HMO,440.99,,,,,,,272.9500,1057.5400,percent of total billed charges,"41.7% of $1,057.54 in Billed Charges for Rev 272 = $440.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBRILLAR 4X4,272,RC,27200002,CDM,,,,,,both,,,1057.5400,158.6300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,490.70,,,,,,,272.9500,1057.5400,percent of total billed charges,"46.4% of $1,057.54 in Billed Charges for Rev 272 = $490.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBRILLAR 4X4,272,RC,27200002,CDM,,,,,,both,,,1057.5400,158.6300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,440.99,,,,,,,272.9500,1057.5400,percent of total billed charges,"41.7% of $1,057.54 in Billed Charges for Rev 272 = $440.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBRILLAR 4X4,272,RC,27200002,CDM,,,,,,both,,,1057.5400,158.6300,CIGNA HEALTHCARE,CIGNA PPO,440.99,,,,,,,272.9500,1057.5400,percent of total billed charges,"41.7% of $1,057.54 in Billed Charges for Rev 272 = $440.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBRILLAR 4X4,272,RC,27200002,CDM,,,,,,both,,,1057.5400,158.6300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,951.79,,,,,,,272.9500,1057.5400,percent of total billed charges,"90% of $1,057.54 in Billed Charges for Rev 272 = $951.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBRILLAR 4X4,272,RC,27200002,CDM,,,,,,both,,,1057.5400,158.6300,MEDCOST,MEDCOST VHN,503.28,,,,,,,272.9500,1057.5400,percent of total billed charges,"47.59% of $1,057.54 in Billed Charges for Rev 272 = $503.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBRILLAR 4X4,272,RC,27200002,CDM,,,,,,both,,,1057.5400,158.6300,SENTARA HEALTH,SENTARA HEALTH,272.95,,,,,,,272.9500,1057.5400,percent of total billed charges,"25.81% of $1,057.54 in Billed Charges for Rev 272 = $272.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBRILLAR 4X4,272,RC,27200002,CDM,,,,,,both,,,1057.5400,158.6300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1057.54,,,,,,,272.9500,1057.5400,percent of total billed charges,"100% of $1,057.54 in Billed Charges for Rev 272 = $1,057.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBRILLAR 4X4,272,RC,27200002,CDM,,,,,,both,,,1057.5400,158.6300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,528.77,,,,,,,272.9500,1057.5400,percent of total billed charges,"Rev 272 $1,057.54 in Billed Charges at 50% = $528.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBRILLAR 4X4,272,RC,27200002,CDM,,,,,,both,,,1057.5400,158.6300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,341.59,,,,,,,272.9500,1057.5400,other,"32.3% of $1,057.54 in Billed Charges for Rev 272 = $341.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBRILLAR 4X4,272,RC,27200002,CDM,,,,,,both,,,1057.5400,158.6300,UNITED HEALTHCARE,UHC HERITAGE SELECT,324.66,,,,,,,272.9500,1057.5400,other,"30.7% of $1,057.54 in Billed Charges for Rev 272 = $324.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
FIBRILLAR 4X4,272,RC,27200002,CDM,,,,,,both,,,1057.5400,158.6300,UNITED HEALTHCARE,UNITED HEALTHCARE,341.59,,,,,,,272.9500,1057.5400,percent of total billed charges,"32.3% of $1,057.54 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBRILLAR 4X4,272,RC,27200002,CDM,,,,,,both,,,1057.5400,158.6300,WELLCARE,WELLCARE MEDICAID,1057.54,,,,,,,272.9500,1057.5400,percent of total billed charges,"100% of $1,057.54 in Billed Charges for Rev 272 = $1,057.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FIBRILLAR HEMO 1X2,272,RC,27200002,CDM,,,,,,both,,,464.1900,69.6300,AETNA,AETNA,198.21,,,,,,,119.8100,464.1900,percent of total billed charges,42.7% of $464.19 in Billed Charges for Rev 272 = $198.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBRILLAR HEMO 1X2,272,RC,27200002,CDM,,,,,,both,,,464.1900,69.6300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,324.93,,,,,,,119.8100,464.1900,percent of total billed charges,Rev 272 $464.19 in Billed Charges at 70% = $324.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBRILLAR HEMO 1X2,272,RC,27200002,CDM,,,,,,both,,,464.1900,69.6300,CIGNA HEALTHCARE,CIGNA HMO,193.57,,,,,,,119.8100,464.1900,percent of total billed charges,41.7% of $464.19 in Billed Charges for Rev 272 = $193.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBRILLAR HEMO 1X2,272,RC,27200002,CDM,,,,,,both,,,464.1900,69.6300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,215.38,,,,,,,119.8100,464.1900,percent of total billed charges,46.4% of $464.19 in Billed Charges for Rev 272 = $215.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBRILLAR HEMO 1X2,272,RC,27200002,CDM,,,,,,both,,,464.1900,69.6300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,193.57,,,,,,,119.8100,464.1900,percent of total billed charges,41.7% of $464.19 in Billed Charges for Rev 272 = $193.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBRILLAR HEMO 1X2,272,RC,27200002,CDM,,,,,,both,,,464.1900,69.6300,CIGNA HEALTHCARE,CIGNA PPO,193.57,,,,,,,119.8100,464.1900,percent of total billed charges,41.7% of $464.19 in Billed Charges for Rev 272 = $193.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBRILLAR HEMO 1X2,272,RC,27200002,CDM,,,,,,both,,,464.1900,69.6300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,417.77,,,,,,,119.8100,464.1900,percent of total billed charges,90% of $464.19 in Billed Charges for Rev 272 = $417.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBRILLAR HEMO 1X2,272,RC,27200002,CDM,,,,,,both,,,464.1900,69.6300,MEDCOST,MEDCOST VHN,220.91,,,,,,,119.8100,464.1900,percent of total billed charges,47.59% of $464.19 in Billed Charges for Rev 272 = $220.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBRILLAR HEMO 1X2,272,RC,27200002,CDM,,,,,,both,,,464.1900,69.6300,SENTARA HEALTH,SENTARA HEALTH,119.81,,,,,,,119.8100,464.1900,percent of total billed charges,25.81% of $464.19 in Billed Charges for Rev 272 = $119.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBRILLAR HEMO 1X2,272,RC,27200002,CDM,,,,,,both,,,464.1900,69.6300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",464.19,,,,,,,119.8100,464.1900,percent of total billed charges,100% of $464.19 in Billed Charges for Rev 272 = $464.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBRILLAR HEMO 1X2,272,RC,27200002,CDM,,,,,,both,,,464.1900,69.6300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,232.10,,,,,,,119.8100,464.1900,percent of total billed charges,Rev 272 $464.19 in Billed Charges at 50% = $232.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBRILLAR HEMO 1X2,272,RC,27200002,CDM,,,,,,both,,,464.1900,69.6300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,149.93,,,,,,,119.8100,464.1900,other,32.3% of $464.19 in Billed Charges for Rev 272 = $149.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
FIBRILLAR HEMO 1X2,272,RC,27200002,CDM,,,,,,both,,,464.1900,69.6300,UNITED HEALTHCARE,UHC HERITAGE SELECT,142.51,,,,,,,119.8100,464.1900,other,30.7% of $464.19 in Billed Charges for Rev 272 = $142.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
FIBRILLAR HEMO 1X2,272,RC,27200002,CDM,,,,,,both,,,464.1900,69.6300,UNITED HEALTHCARE,UNITED HEALTHCARE,149.93,,,,,,,119.8100,464.1900,percent of total billed charges,32.3% of $464.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FIBRILLAR HEMO 1X2,272,RC,27200002,CDM,,,,,,both,,,464.1900,69.6300,WELLCARE,WELLCARE MEDICAID,464.19,,,,,,,119.8100,464.1900,percent of total billed charges,100% of $464.19 in Billed Charges for Rev 272 = $464.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ABLATION PROBE,272,RC,27200002,CDM,,,,,,both,,,24247.4000,3637.1100,AETNA,AETNA,10353.64,,,,,,,6258.2500,24247.4000,percent of total billed charges,"42.7% of $24,247.40 in Billed Charges for Rev 272 = $10,353.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ABLATION PROBE,272,RC,27200002,CDM,,,,,,both,,,24247.4000,3637.1100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,16973.18,,,,,,,6258.2500,24247.4000,percent of total billed charges,"Rev 272 $24,247.40 in Billed Charges at 70% = $16,973.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ABLATION PROBE,272,RC,27200002,CDM,,,,,,both,,,24247.4000,3637.1100,CIGNA HEALTHCARE,CIGNA HMO,10111.17,,,,,,,6258.2500,24247.4000,percent of total billed charges,"41.7% of $24,247.40 in Billed Charges for Rev 272 = $10,111.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ABLATION PROBE,272,RC,27200002,CDM,,,,,,both,,,24247.4000,3637.1100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11250.79,,,,,,,6258.2500,24247.4000,percent of total billed charges,"46.4% of $24,247.40 in Billed Charges for Rev 272 = $11,250.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ABLATION PROBE,272,RC,27200002,CDM,,,,,,both,,,24247.4000,3637.1100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,10111.17,,,,,,,6258.2500,24247.4000,percent of total billed charges,"41.7% of $24,247.40 in Billed Charges for Rev 272 = $10,111.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ABLATION PROBE,272,RC,27200002,CDM,,,,,,both,,,24247.4000,3637.1100,CIGNA HEALTHCARE,CIGNA PPO,10111.17,,,,,,,6258.2500,24247.4000,percent of total billed charges,"41.7% of $24,247.40 in Billed Charges for Rev 272 = $10,111.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ABLATION PROBE,272,RC,27200002,CDM,,,,,,both,,,24247.4000,3637.1100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,21822.66,,,,,,,6258.2500,24247.4000,percent of total billed charges,"90% of $24,247.40 in Billed Charges for Rev 272 = $21,822.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ABLATION PROBE,272,RC,27200002,CDM,,,,,,both,,,24247.4000,3637.1100,MEDCOST,MEDCOST VHN,11539.34,,,,,,,6258.2500,24247.4000,percent of total billed charges,"47.59% of $24,247.40 in Billed Charges for Rev 272 = $11,539.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ABLATION PROBE,272,RC,27200002,CDM,,,,,,both,,,24247.4000,3637.1100,SENTARA HEALTH,SENTARA HEALTH,6258.25,,,,,,,6258.2500,24247.4000,percent of total billed charges,"25.81% of $24,247.40 in Billed Charges for Rev 272 = $6,258.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ABLATION PROBE,272,RC,27200002,CDM,,,,,,both,,,24247.4000,3637.1100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",24247.40,,,,,,,6258.2500,24247.4000,percent of total billed charges,"100% of $24,247.40 in Billed Charges for Rev 272 = $24,247.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ABLATION PROBE,272,RC,27200002,CDM,,,,,,both,,,24247.4000,3637.1100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,12123.70,,,,,,,6258.2500,24247.4000,percent of total billed charges,"Rev 272 $24,247.40 in Billed Charges at 50% = $12,123.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ABLATION PROBE,272,RC,27200002,CDM,,,,,,both,,,24247.4000,3637.1100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7831.91,,,,,,,6258.2500,24247.4000,other,"32.3% of $24,247.40 in Billed Charges for Rev 272 = $7,831.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ABLATION PROBE,272,RC,27200002,CDM,,,,,,both,,,24247.4000,3637.1100,UNITED HEALTHCARE,UHC HERITAGE SELECT,7443.95,,,,,,,6258.2500,24247.4000,other,"30.7% of $24,247.40 in Billed Charges for Rev 272 = $7,443.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ABLATION PROBE,272,RC,27200002,CDM,,,,,,both,,,24247.4000,3637.1100,UNITED HEALTHCARE,UNITED HEALTHCARE,7831.91,,,,,,,6258.2500,24247.4000,percent of total billed charges,"32.3% of $24,247.40 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ABLATION PROBE,272,RC,27200002,CDM,,,,,,both,,,24247.4000,3637.1100,WELLCARE,WELLCARE MEDICAID,24247.40,,,,,,,6258.2500,24247.4000,percent of total billed charges,"100% of $24,247.40 in Billed Charges for Rev 272 = $24,247.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS 10GA BEVEL TIP,272,RC,,,,,,,,both,,,1536.9800,230.5500,AETNA,AETNA,656.29,,,,,,,396.6900,1536.9800,percent of total billed charges,"42.7% of $1,536.98 in Billed Charges for Rev 272 = $656.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS 10GA BEVEL TIP,272,RC,,,,,,,,both,,,1536.9800,230.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1075.89,,,,,,,396.6900,1536.9800,percent of total billed charges,"Rev 272 $1,536.98 in Billed Charges at 70% = $1,075.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS 10GA BEVEL TIP,272,RC,,,,,,,,both,,,1536.9800,230.5500,CIGNA HEALTHCARE,CIGNA HMO,640.92,,,,,,,396.6900,1536.9800,percent of total billed charges,"41.7% of $1,536.98 in Billed Charges for Rev 272 = $640.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS 10GA BEVEL TIP,272,RC,,,,,,,,both,,,1536.9800,230.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,713.16,,,,,,,396.6900,1536.9800,percent of total billed charges,"46.4% of $1,536.98 in Billed Charges for Rev 272 = $713.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS 10GA BEVEL TIP,272,RC,,,,,,,,both,,,1536.9800,230.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,640.92,,,,,,,396.6900,1536.9800,percent of total billed charges,"41.7% of $1,536.98 in Billed Charges for Rev 272 = $640.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS 10GA BEVEL TIP,272,RC,,,,,,,,both,,,1536.9800,230.5500,CIGNA HEALTHCARE,CIGNA PPO,640.92,,,,,,,396.6900,1536.9800,percent of total billed charges,"41.7% of $1,536.98 in Billed Charges for Rev 272 = $640.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS 10GA BEVEL TIP,272,RC,,,,,,,,both,,,1536.9800,230.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1383.28,,,,,,,396.6900,1536.9800,percent of total billed charges,"90% of $1,536.98 in Billed Charges for Rev 272 = $1,383.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS 10GA BEVEL TIP,272,RC,,,,,,,,both,,,1536.9800,230.5500,MEDCOST,MEDCOST VHN,731.45,,,,,,,396.6900,1536.9800,percent of total billed charges,"47.59% of $1,536.98 in Billed Charges for Rev 272 = $731.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS 10GA BEVEL TIP,272,RC,,,,,,,,both,,,1536.9800,230.5500,SENTARA HEALTH,SENTARA HEALTH,396.69,,,,,,,396.6900,1536.9800,percent of total billed charges,"25.81% of $1,536.98 in Billed Charges for Rev 272 = $396.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS 10GA BEVEL TIP,272,RC,,,,,,,,both,,,1536.9800,230.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1536.98,,,,,,,396.6900,1536.9800,percent of total billed charges,"100% of $1,536.98 in Billed Charges for Rev 272 = $1,536.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS 10GA BEVEL TIP,272,RC,,,,,,,,both,,,1536.9800,230.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,768.49,,,,,,,396.6900,1536.9800,percent of total billed charges,"Rev 272 $1,536.98 in Billed Charges at 50% = $768.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS 10GA BEVEL TIP,272,RC,,,,,,,,both,,,1536.9800,230.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,496.44,,,,,,,396.6900,1536.9800,other,"32.3% of $1,536.98 in Billed Charges for Rev 272 = $496.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ACCESS 10GA BEVEL TIP,272,RC,,,,,,,,both,,,1536.9800,230.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.85,,,,,,,396.6900,1536.9800,other,"30.7% of $1,536.98 in Billed Charges for Rev 272 = $471.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ACCESS 10GA BEVEL TIP,272,RC,,,,,,,,both,,,1536.9800,230.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,496.44,,,,,,,396.6900,1536.9800,percent of total billed charges,"32.3% of $1,536.98 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS 10GA BEVEL TIP,272,RC,,,,,,,,both,,,1536.9800,230.5500,WELLCARE,WELLCARE MEDICAID,1536.98,,,,,,,396.6900,1536.9800,percent of total billed charges,"100% of $1,536.98 in Billed Charges for Rev 272 = $1,536.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS MAS ALIF,272,RC,27200002,CDM,,,,,,both,,,26383.8200,3957.5700,AETNA,AETNA,11265.89,,,,,,,6809.6600,26383.8200,percent of total billed charges,"42.7% of $26,383.82 in Billed Charges for Rev 272 = $11,265.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS MAS ALIF,272,RC,27200002,CDM,,,,,,both,,,26383.8200,3957.5700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,18468.67,,,,,,,6809.6600,26383.8200,percent of total billed charges,"Rev 272 $26,383.82 in Billed Charges at 70% = $18,468.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS MAS ALIF,272,RC,27200002,CDM,,,,,,both,,,26383.8200,3957.5700,CIGNA HEALTHCARE,CIGNA HMO,11002.05,,,,,,,6809.6600,26383.8200,percent of total billed charges,"41.7% of $26,383.82 in Billed Charges for Rev 272 = $11,002.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS MAS ALIF,272,RC,27200002,CDM,,,,,,both,,,26383.8200,3957.5700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12242.09,,,,,,,6809.6600,26383.8200,percent of total billed charges,"46.4% of $26,383.82 in Billed Charges for Rev 272 = $12,242.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS MAS ALIF,272,RC,27200002,CDM,,,,,,both,,,26383.8200,3957.5700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11002.05,,,,,,,6809.6600,26383.8200,percent of total billed charges,"41.7% of $26,383.82 in Billed Charges for Rev 272 = $11,002.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS MAS ALIF,272,RC,27200002,CDM,,,,,,both,,,26383.8200,3957.5700,CIGNA HEALTHCARE,CIGNA PPO,11002.05,,,,,,,6809.6600,26383.8200,percent of total billed charges,"41.7% of $26,383.82 in Billed Charges for Rev 272 = $11,002.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS MAS ALIF,272,RC,27200002,CDM,,,,,,both,,,26383.8200,3957.5700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,23745.44,,,,,,,6809.6600,26383.8200,percent of total billed charges,"90% of $26,383.82 in Billed Charges for Rev 272 = $23,745.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS MAS ALIF,272,RC,27200002,CDM,,,,,,both,,,26383.8200,3957.5700,MEDCOST,MEDCOST VHN,12556.06,,,,,,,6809.6600,26383.8200,percent of total billed charges,"47.59% of $26,383.82 in Billed Charges for Rev 272 = $12,556.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS MAS ALIF,272,RC,27200002,CDM,,,,,,both,,,26383.8200,3957.5700,SENTARA HEALTH,SENTARA HEALTH,6809.66,,,,,,,6809.6600,26383.8200,percent of total billed charges,"25.81% of $26,383.82 in Billed Charges for Rev 272 = $6,809.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS MAS ALIF,272,RC,27200002,CDM,,,,,,both,,,26383.8200,3957.5700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",26383.82,,,,,,,6809.6600,26383.8200,percent of total billed charges,"100% of $26,383.82 in Billed Charges for Rev 272 = $26,383.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS MAS ALIF,272,RC,27200002,CDM,,,,,,both,,,26383.8200,3957.5700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,13191.91,,,,,,,6809.6600,26383.8200,percent of total billed charges,"Rev 272 $26,383.82 in Billed Charges at 50% = $13,191.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS MAS ALIF,272,RC,27200002,CDM,,,,,,both,,,26383.8200,3957.5700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,8521.97,,,,,,,6809.6600,26383.8200,other,"32.3% of $26,383.82 in Billed Charges for Rev 272 = $8,521.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ACCESS MAS ALIF,272,RC,27200002,CDM,,,,,,both,,,26383.8200,3957.5700,UNITED HEALTHCARE,UHC HERITAGE SELECT,8099.83,,,,,,,6809.6600,26383.8200,other,"30.7% of $26,383.82 in Billed Charges for Rev 272 = $8,099.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ACCESS MAS ALIF,272,RC,27200002,CDM,,,,,,both,,,26383.8200,3957.5700,UNITED HEALTHCARE,UNITED HEALTHCARE,8521.97,,,,,,,6809.6600,26383.8200,percent of total billed charges,"32.3% of $26,383.82 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS MAS ALIF,272,RC,27200002,CDM,,,,,,both,,,26383.8200,3957.5700,WELLCARE,WELLCARE MEDICAID,26383.82,,,,,,,6809.6600,26383.8200,percent of total billed charges,"100% of $26,383.82 in Billed Charges for Rev 272 = $26,383.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS NAVIGATION PEDICLE 9733497NAV,272,RC,,,,,,,,both,,,5678.1200,851.7200,AETNA,AETNA,2424.56,,,,,,,1465.5200,5678.1200,percent of total billed charges,"42.7% of $5,678.12 in Billed Charges for Rev 272 = $2,424.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS NAVIGATION PEDICLE 9733497NAV,272,RC,,,,,,,,both,,,5678.1200,851.7200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3974.68,,,,,,,1465.5200,5678.1200,percent of total billed charges,"Rev 272 $5,678.12 in Billed Charges at 70% = $3,974.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS NAVIGATION PEDICLE 9733497NAV,272,RC,,,,,,,,both,,,5678.1200,851.7200,CIGNA HEALTHCARE,CIGNA HMO,2367.78,,,,,,,1465.5200,5678.1200,percent of total billed charges,"41.7% of $5,678.12 in Billed Charges for Rev 272 = $2,367.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS NAVIGATION PEDICLE 9733497NAV,272,RC,,,,,,,,both,,,5678.1200,851.7200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2634.65,,,,,,,1465.5200,5678.1200,percent of total billed charges,"46.4% of $5,678.12 in Billed Charges for Rev 272 = $2,634.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS NAVIGATION PEDICLE 9733497NAV,272,RC,,,,,,,,both,,,5678.1200,851.7200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2367.78,,,,,,,1465.5200,5678.1200,percent of total billed charges,"41.7% of $5,678.12 in Billed Charges for Rev 272 = $2,367.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS NAVIGATION PEDICLE 9733497NAV,272,RC,,,,,,,,both,,,5678.1200,851.7200,CIGNA HEALTHCARE,CIGNA PPO,2367.78,,,,,,,1465.5200,5678.1200,percent of total billed charges,"41.7% of $5,678.12 in Billed Charges for Rev 272 = $2,367.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS NAVIGATION PEDICLE 9733497NAV,272,RC,,,,,,,,both,,,5678.1200,851.7200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5110.31,,,,,,,1465.5200,5678.1200,percent of total billed charges,"90% of $5,678.12 in Billed Charges for Rev 272 = $5,110.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS NAVIGATION PEDICLE 9733497NAV,272,RC,,,,,,,,both,,,5678.1200,851.7200,MEDCOST,MEDCOST VHN,2702.22,,,,,,,1465.5200,5678.1200,percent of total billed charges,"47.59% of $5,678.12 in Billed Charges for Rev 272 = $2,702.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS NAVIGATION PEDICLE 9733497NAV,272,RC,,,,,,,,both,,,5678.1200,851.7200,SENTARA HEALTH,SENTARA HEALTH,1465.52,,,,,,,1465.5200,5678.1200,percent of total billed charges,"25.81% of $5,678.12 in Billed Charges for Rev 272 = $1,465.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS NAVIGATION PEDICLE 9733497NAV,272,RC,,,,,,,,both,,,5678.1200,851.7200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5678.12,,,,,,,1465.5200,5678.1200,percent of total billed charges,"100% of $5,678.12 in Billed Charges for Rev 272 = $5,678.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS NAVIGATION PEDICLE 9733497NAV,272,RC,,,,,,,,both,,,5678.1200,851.7200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2839.06,,,,,,,1465.5200,5678.1200,percent of total billed charges,"Rev 272 $5,678.12 in Billed Charges at 50% = $2,839.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS NAVIGATION PEDICLE 9733497NAV,272,RC,,,,,,,,both,,,5678.1200,851.7200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1834.03,,,,,,,1465.5200,5678.1200,other,"32.3% of $5,678.12 in Billed Charges for Rev 272 = $1,834.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ACCESS NAVIGATION PEDICLE 9733497NAV,272,RC,,,,,,,,both,,,5678.1200,851.7200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1743.18,,,,,,,1465.5200,5678.1200,other,"30.7% of $5,678.12 in Billed Charges for Rev 272 = $1,743.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ACCESS NAVIGATION PEDICLE 9733497NAV,272,RC,,,,,,,,both,,,5678.1200,851.7200,UNITED HEALTHCARE,UNITED HEALTHCARE,1834.03,,,,,,,1465.5200,5678.1200,percent of total billed charges,"32.3% of $5,678.12 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESS NAVIGATION PEDICLE 9733497NAV,272,RC,,,,,,,,both,,,5678.1200,851.7200,WELLCARE,WELLCARE MEDICAID,5678.12,,,,,,,1465.5200,5678.1200,percent of total billed charges,"100% of $5,678.12 in Billed Charges for Rev 272 = $5,678.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,16541.7500,2481.2600,AETNA,AETNA,7063.33,,,,,,,4269.4300,16541.7500,percent of total billed charges,"42.7% of $16,541.75 in Billed Charges for Rev 272 = $7,063.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,16541.7500,2481.2600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11579.23,,,,,,,4269.4300,16541.7500,percent of total billed charges,"Rev 272 $16,541.75 in Billed Charges at 70% = $11,579.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,16541.7500,2481.2600,CIGNA HEALTHCARE,CIGNA HMO,6897.91,,,,,,,4269.4300,16541.7500,percent of total billed charges,"41.7% of $16,541.75 in Billed Charges for Rev 272 = $6,897.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,16541.7500,2481.2600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7675.37,,,,,,,4269.4300,16541.7500,percent of total billed charges,"46.4% of $16,541.75 in Billed Charges for Rev 272 = $7,675.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,16541.7500,2481.2600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6897.91,,,,,,,4269.4300,16541.7500,percent of total billed charges,"41.7% of $16,541.75 in Billed Charges for Rev 272 = $6,897.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,16541.7500,2481.2600,CIGNA HEALTHCARE,CIGNA PPO,6897.91,,,,,,,4269.4300,16541.7500,percent of total billed charges,"41.7% of $16,541.75 in Billed Charges for Rev 272 = $6,897.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,16541.7500,2481.2600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,14887.58,,,,,,,4269.4300,16541.7500,percent of total billed charges,"90% of $16,541.75 in Billed Charges for Rev 272 = $14,887.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,16541.7500,2481.2600,MEDCOST,MEDCOST VHN,7872.22,,,,,,,4269.4300,16541.7500,percent of total billed charges,"47.59% of $16,541.75 in Billed Charges for Rev 272 = $7,872.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,16541.7500,2481.2600,SENTARA HEALTH,SENTARA HEALTH,4269.43,,,,,,,4269.4300,16541.7500,percent of total billed charges,"25.81% of $16,541.75 in Billed Charges for Rev 272 = $4,269.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,16541.7500,2481.2600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",16541.75,,,,,,,4269.4300,16541.7500,percent of total billed charges,"100% of $16,541.75 in Billed Charges for Rev 272 = $16,541.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,16541.7500,2481.2600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8270.88,,,,,,,4269.4300,16541.7500,percent of total billed charges,"Rev 272 $16,541.75 in Billed Charges at 50% = $8,270.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,16541.7500,2481.2600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5342.99,,,,,,,4269.4300,16541.7500,other,"32.3% of $16,541.75 in Billed Charges for Rev 272 = $5,342.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,16541.7500,2481.2600,UNITED HEALTHCARE,UHC HERITAGE SELECT,5078.32,,,,,,,4269.4300,16541.7500,other,"30.7% of $16,541.75 in Billed Charges for Rev 272 = $5,078.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,16541.7500,2481.2600,UNITED HEALTHCARE,UNITED HEALTHCARE,5342.99,,,,,,,4269.4300,16541.7500,percent of total billed charges,"32.3% of $16,541.75 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,16541.7500,2481.2600,WELLCARE,WELLCARE MEDICAID,16541.75,,,,,,,4269.4300,16541.7500,percent of total billed charges,"100% of $16,541.75 in Billed Charges for Rev 272 = $16,541.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,2779.4300,416.9100,AETNA,AETNA,1186.82,,,,,,,717.3700,2779.4300,percent of total billed charges,"42.7% of $2,779.43 in Billed Charges for Rev 272 = $1,186.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,2779.4300,416.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1945.60,,,,,,,717.3700,2779.4300,percent of total billed charges,"Rev 272 $2,779.43 in Billed Charges at 70% = $1,945.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,2779.4300,416.9100,CIGNA HEALTHCARE,CIGNA HMO,1159.02,,,,,,,717.3700,2779.4300,percent of total billed charges,"41.7% of $2,779.43 in Billed Charges for Rev 272 = $1,159.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,2779.4300,416.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1289.66,,,,,,,717.3700,2779.4300,percent of total billed charges,"46.4% of $2,779.43 in Billed Charges for Rev 272 = $1,289.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,2779.4300,416.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1159.02,,,,,,,717.3700,2779.4300,percent of total billed charges,"41.7% of $2,779.43 in Billed Charges for Rev 272 = $1,159.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,2779.4300,416.9100,CIGNA HEALTHCARE,CIGNA PPO,1159.02,,,,,,,717.3700,2779.4300,percent of total billed charges,"41.7% of $2,779.43 in Billed Charges for Rev 272 = $1,159.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,2779.4300,416.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2501.49,,,,,,,717.3700,2779.4300,percent of total billed charges,"90% of $2,779.43 in Billed Charges for Rev 272 = $2,501.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,2779.4300,416.9100,MEDCOST,MEDCOST VHN,1322.73,,,,,,,717.3700,2779.4300,percent of total billed charges,"47.59% of $2,779.43 in Billed Charges for Rev 272 = $1,322.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,2779.4300,416.9100,SENTARA HEALTH,SENTARA HEALTH,717.37,,,,,,,717.3700,2779.4300,percent of total billed charges,"25.81% of $2,779.43 in Billed Charges for Rev 272 = $717.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,2779.4300,416.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2779.43,,,,,,,717.3700,2779.4300,percent of total billed charges,"100% of $2,779.43 in Billed Charges for Rev 272 = $2,779.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,2779.4300,416.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1389.72,,,,,,,717.3700,2779.4300,percent of total billed charges,"Rev 272 $2,779.43 in Billed Charges at 50% = $1,389.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,2779.4300,416.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,897.76,,,,,,,717.3700,2779.4300,other,"32.3% of $2,779.43 in Billed Charges for Rev 272 = $897.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,2779.4300,416.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,853.29,,,,,,,717.3700,2779.4300,other,"30.7% of $2,779.43 in Billed Charges for Rev 272 = $853.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,2779.4300,416.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,897.76,,,,,,,717.3700,2779.4300,percent of total billed charges,"32.3% of $2,779.43 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,2779.4300,416.9100,WELLCARE,WELLCARE MEDICAID,2779.43,,,,,,,717.3700,2779.4300,percent of total billed charges,"100% of $2,779.43 in Billed Charges for Rev 272 = $2,779.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,11667.3800,1750.1100,AETNA,AETNA,4981.97,,,,,,,3011.3500,11667.3800,percent of total billed charges,"42.7% of $11,667.38 in Billed Charges for Rev 272 = $4,981.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,11667.3800,1750.1100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8167.17,,,,,,,3011.3500,11667.3800,percent of total billed charges,"Rev 272 $11,667.38 in Billed Charges at 70% = $8,167.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,11667.3800,1750.1100,CIGNA HEALTHCARE,CIGNA HMO,4865.30,,,,,,,3011.3500,11667.3800,percent of total billed charges,"41.7% of $11,667.38 in Billed Charges for Rev 272 = $4,865.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,11667.3800,1750.1100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5413.66,,,,,,,3011.3500,11667.3800,percent of total billed charges,"46.4% of $11,667.38 in Billed Charges for Rev 272 = $5,413.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,11667.3800,1750.1100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4865.30,,,,,,,3011.3500,11667.3800,percent of total billed charges,"41.7% of $11,667.38 in Billed Charges for Rev 272 = $4,865.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,11667.3800,1750.1100,CIGNA HEALTHCARE,CIGNA PPO,4865.30,,,,,,,3011.3500,11667.3800,percent of total billed charges,"41.7% of $11,667.38 in Billed Charges for Rev 272 = $4,865.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,11667.3800,1750.1100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10500.64,,,,,,,3011.3500,11667.3800,percent of total billed charges,"90% of $11,667.38 in Billed Charges for Rev 272 = $10,500.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,11667.3800,1750.1100,MEDCOST,MEDCOST VHN,5552.51,,,,,,,3011.3500,11667.3800,percent of total billed charges,"47.59% of $11,667.38 in Billed Charges for Rev 272 = $5,552.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,11667.3800,1750.1100,SENTARA HEALTH,SENTARA HEALTH,3011.35,,,,,,,3011.3500,11667.3800,percent of total billed charges,"25.81% of $11,667.38 in Billed Charges for Rev 272 = $3,011.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,11667.3800,1750.1100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11667.38,,,,,,,3011.3500,11667.3800,percent of total billed charges,"100% of $11,667.38 in Billed Charges for Rev 272 = $11,667.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,11667.3800,1750.1100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5833.69,,,,,,,3011.3500,11667.3800,percent of total billed charges,"Rev 272 $11,667.38 in Billed Charges at 50% = $5,833.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,11667.3800,1750.1100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3768.56,,,,,,,3011.3500,11667.3800,other,"32.3% of $11,667.38 in Billed Charges for Rev 272 = $3,768.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,11667.3800,1750.1100,UNITED HEALTHCARE,UHC HERITAGE SELECT,3581.89,,,,,,,3011.3500,11667.3800,other,"30.7% of $11,667.38 in Billed Charges for Rev 272 = $3,581.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,11667.3800,1750.1100,UNITED HEALTHCARE,UNITED HEALTHCARE,3768.56,,,,,,,3011.3500,11667.3800,percent of total billed charges,"32.3% of $11,667.38 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACL REPAIR AR1897S,272,RC,27200002,CDM,,,,,,both,,,11667.3800,1750.1100,WELLCARE,WELLCARE MEDICAID,11667.38,,,,,,,3011.3500,11667.3800,percent of total billed charges,"100% of $11,667.38 in Billed Charges for Rev 272 = $11,667.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
FOLLOWER PHILLIPS 16FR,272,RC,,,,,,,,both,,,561.4000,84.2100,AETNA,AETNA,239.72,,,,,,,144.9000,561.4000,percent of total billed charges,42.7% of $561.40 in Billed Charges for Rev 272 = $239.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOLLOWER PHILLIPS 16FR,272,RC,,,,,,,,both,,,561.4000,84.2100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,392.98,,,,,,,144.9000,561.4000,percent of total billed charges,Rev 272 $561.40 in Billed Charges at 70% = $392.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOLLOWER PHILLIPS 16FR,272,RC,,,,,,,,both,,,561.4000,84.2100,CIGNA HEALTHCARE,CIGNA HMO,234.10,,,,,,,144.9000,561.4000,percent of total billed charges,41.7% of $561.40 in Billed Charges for Rev 272 = $234.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOLLOWER PHILLIPS 16FR,272,RC,,,,,,,,both,,,561.4000,84.2100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,260.49,,,,,,,144.9000,561.4000,percent of total billed charges,46.4% of $561.40 in Billed Charges for Rev 272 = $260.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOLLOWER PHILLIPS 16FR,272,RC,,,,,,,,both,,,561.4000,84.2100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,234.10,,,,,,,144.9000,561.4000,percent of total billed charges,41.7% of $561.40 in Billed Charges for Rev 272 = $234.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOLLOWER PHILLIPS 16FR,272,RC,,,,,,,,both,,,561.4000,84.2100,CIGNA HEALTHCARE,CIGNA PPO,234.10,,,,,,,144.9000,561.4000,percent of total billed charges,41.7% of $561.40 in Billed Charges for Rev 272 = $234.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOLLOWER PHILLIPS 16FR,272,RC,,,,,,,,both,,,561.4000,84.2100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,505.26,,,,,,,144.9000,561.4000,percent of total billed charges,90% of $561.40 in Billed Charges for Rev 272 = $505.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOLLOWER PHILLIPS 16FR,272,RC,,,,,,,,both,,,561.4000,84.2100,MEDCOST,MEDCOST VHN,267.17,,,,,,,144.9000,561.4000,percent of total billed charges,47.59% of $561.40 in Billed Charges for Rev 272 = $267.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOLLOWER PHILLIPS 16FR,272,RC,,,,,,,,both,,,561.4000,84.2100,SENTARA HEALTH,SENTARA HEALTH,144.90,,,,,,,144.9000,561.4000,percent of total billed charges,25.81% of $561.40 in Billed Charges for Rev 272 = $144.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOLLOWER PHILLIPS 16FR,272,RC,,,,,,,,both,,,561.4000,84.2100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",561.40,,,,,,,144.9000,561.4000,percent of total billed charges,100% of $561.40 in Billed Charges for Rev 272 = $561.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOLLOWER PHILLIPS 16FR,272,RC,,,,,,,,both,,,561.4000,84.2100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,280.70,,,,,,,144.9000,561.4000,percent of total billed charges,Rev 272 $561.40 in Billed Charges at 50% = $280.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOLLOWER PHILLIPS 16FR,272,RC,,,,,,,,both,,,561.4000,84.2100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,181.33,,,,,,,144.9000,561.4000,other,32.3% of $561.40 in Billed Charges for Rev 272 = $181.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
FOLLOWER PHILLIPS 16FR,272,RC,,,,,,,,both,,,561.4000,84.2100,UNITED HEALTHCARE,UHC HERITAGE SELECT,172.35,,,,,,,144.9000,561.4000,other,30.7% of $561.40 in Billed Charges for Rev 272 = $172.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
FOLLOWER PHILLIPS 16FR,272,RC,,,,,,,,both,,,561.4000,84.2100,UNITED HEALTHCARE,UNITED HEALTHCARE,181.33,,,,,,,144.9000,561.4000,percent of total billed charges,32.3% of $561.40 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
FOLLOWER PHILLIPS 16FR,272,RC,,,,,,,,both,,,561.4000,84.2100,WELLCARE,WELLCARE MEDICAID,561.40,,,,,,,144.9000,561.4000,percent of total billed charges,100% of $561.40 in Billed Charges for Rev 272 = $561.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE 22MM HELI-FX,272,RC,27200002,CDM,,,,,,both,,,19359.1300,2903.8700,AETNA,AETNA,8266.35,,,,,,,4996.5900,19359.1300,percent of total billed charges,"42.7% of $19,359.13 in Billed Charges for Rev 272 = $8,266.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE 22MM HELI-FX,272,RC,27200002,CDM,,,,,,both,,,19359.1300,2903.8700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,13551.39,,,,,,,4996.5900,19359.1300,percent of total billed charges,"Rev 272 $19,359.13 in Billed Charges at 70% = $13,551.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE 22MM HELI-FX,272,RC,27200002,CDM,,,,,,both,,,19359.1300,2903.8700,CIGNA HEALTHCARE,CIGNA HMO,8072.76,,,,,,,4996.5900,19359.1300,percent of total billed charges,"41.7% of $19,359.13 in Billed Charges for Rev 272 = $8,072.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE 22MM HELI-FX,272,RC,27200002,CDM,,,,,,both,,,19359.1300,2903.8700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8982.64,,,,,,,4996.5900,19359.1300,percent of total billed charges,"46.4% of $19,359.13 in Billed Charges for Rev 272 = $8,982.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE 22MM HELI-FX,272,RC,27200002,CDM,,,,,,both,,,19359.1300,2903.8700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8072.76,,,,,,,4996.5900,19359.1300,percent of total billed charges,"41.7% of $19,359.13 in Billed Charges for Rev 272 = $8,072.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE 22MM HELI-FX,272,RC,27200002,CDM,,,,,,both,,,19359.1300,2903.8700,CIGNA HEALTHCARE,CIGNA PPO,8072.76,,,,,,,4996.5900,19359.1300,percent of total billed charges,"41.7% of $19,359.13 in Billed Charges for Rev 272 = $8,072.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE 22MM HELI-FX,272,RC,27200002,CDM,,,,,,both,,,19359.1300,2903.8700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,17423.22,,,,,,,4996.5900,19359.1300,percent of total billed charges,"90% of $19,359.13 in Billed Charges for Rev 272 = $17,423.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE 22MM HELI-FX,272,RC,27200002,CDM,,,,,,both,,,19359.1300,2903.8700,MEDCOST,MEDCOST VHN,9213.01,,,,,,,4996.5900,19359.1300,percent of total billed charges,"47.59% of $19,359.13 in Billed Charges for Rev 272 = $9,213.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE 22MM HELI-FX,272,RC,27200002,CDM,,,,,,both,,,19359.1300,2903.8700,SENTARA HEALTH,SENTARA HEALTH,4996.59,,,,,,,4996.5900,19359.1300,percent of total billed charges,"25.81% of $19,359.13 in Billed Charges for Rev 272 = $4,996.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE 22MM HELI-FX,272,RC,27200002,CDM,,,,,,both,,,19359.1300,2903.8700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",19359.13,,,,,,,4996.5900,19359.1300,percent of total billed charges,"100% of $19,359.13 in Billed Charges for Rev 272 = $19,359.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE 22MM HELI-FX,272,RC,27200002,CDM,,,,,,both,,,19359.1300,2903.8700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9679.57,,,,,,,4996.5900,19359.1300,percent of total billed charges,"Rev 272 $19,359.13 in Billed Charges at 50% = $9,679.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE 22MM HELI-FX,272,RC,27200002,CDM,,,,,,both,,,19359.1300,2903.8700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,6253.00,,,,,,,4996.5900,19359.1300,other,"32.3% of $19,359.13 in Billed Charges for Rev 272 = $6,253.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE 22MM HELI-FX,272,RC,27200002,CDM,,,,,,both,,,19359.1300,2903.8700,UNITED HEALTHCARE,UHC HERITAGE SELECT,5943.25,,,,,,,4996.5900,19359.1300,other,"30.7% of $19,359.13 in Billed Charges for Rev 272 = $5,943.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE 22MM HELI-FX,272,RC,27200002,CDM,,,,,,both,,,19359.1300,2903.8700,UNITED HEALTHCARE,UNITED HEALTHCARE,6253.00,,,,,,,4996.5900,19359.1300,percent of total billed charges,"32.3% of $19,359.13 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE 22MM HELI-FX,272,RC,27200002,CDM,,,,,,both,,,19359.1300,2903.8700,WELLCARE,WELLCARE MEDICAID,19359.13,,,,,,,4996.5900,19359.1300,percent of total billed charges,"100% of $19,359.13 in Billed Charges for Rev 272 = $19,359.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT TIBIA,272,RC,27200002,CDM,,,,,,both,,,8646.3000,1296.9500,AETNA,AETNA,3691.97,,,,,,,2231.6100,8646.3000,percent of total billed charges,"42.7% of $8,646.30 in Billed Charges for Rev 272 = $3,691.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT TIBIA,272,RC,27200002,CDM,,,,,,both,,,8646.3000,1296.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6052.41,,,,,,,2231.6100,8646.3000,percent of total billed charges,"Rev 272 $8,646.30 in Billed Charges at 70% = $6,052.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT TIBIA,272,RC,27200002,CDM,,,,,,both,,,8646.3000,1296.9500,CIGNA HEALTHCARE,CIGNA HMO,3605.51,,,,,,,2231.6100,8646.3000,percent of total billed charges,"41.7% of $8,646.30 in Billed Charges for Rev 272 = $3,605.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT TIBIA,272,RC,27200002,CDM,,,,,,both,,,8646.3000,1296.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4011.88,,,,,,,2231.6100,8646.3000,percent of total billed charges,"46.4% of $8,646.30 in Billed Charges for Rev 272 = $4,011.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT TIBIA,272,RC,27200002,CDM,,,,,,both,,,8646.3000,1296.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3605.51,,,,,,,2231.6100,8646.3000,percent of total billed charges,"41.7% of $8,646.30 in Billed Charges for Rev 272 = $3,605.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT TIBIA,272,RC,27200002,CDM,,,,,,both,,,8646.3000,1296.9500,CIGNA HEALTHCARE,CIGNA PPO,3605.51,,,,,,,2231.6100,8646.3000,percent of total billed charges,"41.7% of $8,646.30 in Billed Charges for Rev 272 = $3,605.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT TIBIA,272,RC,27200002,CDM,,,,,,both,,,8646.3000,1296.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7781.67,,,,,,,2231.6100,8646.3000,percent of total billed charges,"90% of $8,646.30 in Billed Charges for Rev 272 = $7,781.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT TIBIA,272,RC,27200002,CDM,,,,,,both,,,8646.3000,1296.9500,MEDCOST,MEDCOST VHN,4114.77,,,,,,,2231.6100,8646.3000,percent of total billed charges,"47.59% of $8,646.30 in Billed Charges for Rev 272 = $4,114.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT TIBIA,272,RC,27200002,CDM,,,,,,both,,,8646.3000,1296.9500,SENTARA HEALTH,SENTARA HEALTH,2231.61,,,,,,,2231.6100,8646.3000,percent of total billed charges,"25.81% of $8,646.30 in Billed Charges for Rev 272 = $2,231.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT TIBIA,272,RC,27200002,CDM,,,,,,both,,,8646.3000,1296.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8646.30,,,,,,,2231.6100,8646.3000,percent of total billed charges,"100% of $8,646.30 in Billed Charges for Rev 272 = $8,646.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT TIBIA,272,RC,27200002,CDM,,,,,,both,,,8646.3000,1296.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4323.15,,,,,,,2231.6100,8646.3000,percent of total billed charges,"Rev 272 $8,646.30 in Billed Charges at 50% = $4,323.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT TIBIA,272,RC,27200002,CDM,,,,,,both,,,8646.3000,1296.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2792.75,,,,,,,2231.6100,8646.3000,other,"32.3% of $8,646.30 in Billed Charges for Rev 272 = $2,792.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE ALIGNMENT TIBIA,272,RC,27200002,CDM,,,,,,both,,,8646.3000,1296.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2654.41,,,,,,,2231.6100,8646.3000,other,"30.7% of $8,646.30 in Billed Charges for Rev 272 = $2,654.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE ALIGNMENT TIBIA,272,RC,27200002,CDM,,,,,,both,,,8646.3000,1296.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,2792.75,,,,,,,2231.6100,8646.3000,percent of total billed charges,"32.3% of $8,646.30 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE ALIGNMENT TIBIA,272,RC,27200002,CDM,,,,,,both,,,8646.3000,1296.9500,WELLCARE,WELLCARE MEDICAID,8646.30,,,,,,,2231.6100,8646.3000,percent of total billed charges,"100% of $8,646.30 in Billed Charges for Rev 272 = $8,646.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE BALL TIP 600MM,272,RC,,,,,,,,both,,,1764.8300,264.7200,AETNA,AETNA,753.58,,,,,,,455.5000,1764.8300,percent of total billed charges,"42.7% of $1,764.83 in Billed Charges for Rev 272 = $753.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE BALL TIP 600MM,272,RC,,,,,,,,both,,,1764.8300,264.7200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1235.38,,,,,,,455.5000,1764.8300,percent of total billed charges,"Rev 272 $1,764.83 in Billed Charges at 70% = $1,235.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE BALL TIP 600MM,272,RC,,,,,,,,both,,,1764.8300,264.7200,CIGNA HEALTHCARE,CIGNA HMO,735.93,,,,,,,455.5000,1764.8300,percent of total billed charges,"41.7% of $1,764.83 in Billed Charges for Rev 272 = $735.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE BALL TIP 600MM,272,RC,,,,,,,,both,,,1764.8300,264.7200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,818.88,,,,,,,455.5000,1764.8300,percent of total billed charges,"46.4% of $1,764.83 in Billed Charges for Rev 272 = $818.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE BALL TIP 600MM,272,RC,,,,,,,,both,,,1764.8300,264.7200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,735.93,,,,,,,455.5000,1764.8300,percent of total billed charges,"41.7% of $1,764.83 in Billed Charges for Rev 272 = $735.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE BALL TIP 600MM,272,RC,,,,,,,,both,,,1764.8300,264.7200,CIGNA HEALTHCARE,CIGNA PPO,735.93,,,,,,,455.5000,1764.8300,percent of total billed charges,"41.7% of $1,764.83 in Billed Charges for Rev 272 = $735.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE BALL TIP 600MM,272,RC,,,,,,,,both,,,1764.8300,264.7200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1588.35,,,,,,,455.5000,1764.8300,percent of total billed charges,"90% of $1,764.83 in Billed Charges for Rev 272 = $1,588.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE BALL TIP 600MM,272,RC,,,,,,,,both,,,1764.8300,264.7200,MEDCOST,MEDCOST VHN,839.88,,,,,,,455.5000,1764.8300,percent of total billed charges,"47.59% of $1,764.83 in Billed Charges for Rev 272 = $839.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE BALL TIP 600MM,272,RC,,,,,,,,both,,,1764.8300,264.7200,SENTARA HEALTH,SENTARA HEALTH,455.50,,,,,,,455.5000,1764.8300,percent of total billed charges,"25.81% of $1,764.83 in Billed Charges for Rev 272 = $455.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE BALL TIP 600MM,272,RC,,,,,,,,both,,,1764.8300,264.7200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1764.83,,,,,,,455.5000,1764.8300,percent of total billed charges,"100% of $1,764.83 in Billed Charges for Rev 272 = $1,764.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE BALL TIP 600MM,272,RC,,,,,,,,both,,,1764.8300,264.7200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,882.42,,,,,,,455.5000,1764.8300,percent of total billed charges,"Rev 272 $1,764.83 in Billed Charges at 50% = $882.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE BALL TIP 600MM,272,RC,,,,,,,,both,,,1764.8300,264.7200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,570.04,,,,,,,455.5000,1764.8300,other,"32.3% of $1,764.83 in Billed Charges for Rev 272 = $570.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE BALL TIP 600MM,272,RC,,,,,,,,both,,,1764.8300,264.7200,UNITED HEALTHCARE,UHC HERITAGE SELECT,541.80,,,,,,,455.5000,1764.8300,other,"30.7% of $1,764.83 in Billed Charges for Rev 272 = $541.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE BALL TIP 600MM,272,RC,,,,,,,,both,,,1764.8300,264.7200,UNITED HEALTHCARE,UNITED HEALTHCARE,570.04,,,,,,,455.5000,1764.8300,percent of total billed charges,"32.3% of $1,764.83 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE BALL TIP 600MM,272,RC,,,,,,,,both,,,1764.8300,264.7200,WELLCARE,WELLCARE MEDICAID,1764.83,,,,,,,455.5000,1764.8300,percent of total billed charges,"100% of $1,764.83 in Billed Charges for Rev 272 = $1,764.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADVANCED CEMENT MIXING,272,RC,27200002,CDM,,,,,,both,,,2065.3800,309.8100,AETNA,AETNA,881.92,,,,,,,533.0700,2065.3800,percent of total billed charges,"42.7% of $2,065.38 in Billed Charges for Rev 272 = $881.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADVANCED CEMENT MIXING,272,RC,27200002,CDM,,,,,,both,,,2065.3800,309.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1445.77,,,,,,,533.0700,2065.3800,percent of total billed charges,"Rev 272 $2,065.38 in Billed Charges at 70% = $1,445.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADVANCED CEMENT MIXING,272,RC,27200002,CDM,,,,,,both,,,2065.3800,309.8100,CIGNA HEALTHCARE,CIGNA HMO,861.26,,,,,,,533.0700,2065.3800,percent of total billed charges,"41.7% of $2,065.38 in Billed Charges for Rev 272 = $861.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADVANCED CEMENT MIXING,272,RC,27200002,CDM,,,,,,both,,,2065.3800,309.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,958.34,,,,,,,533.0700,2065.3800,percent of total billed charges,"46.4% of $2,065.38 in Billed Charges for Rev 272 = $958.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADVANCED CEMENT MIXING,272,RC,27200002,CDM,,,,,,both,,,2065.3800,309.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,861.26,,,,,,,533.0700,2065.3800,percent of total billed charges,"41.7% of $2,065.38 in Billed Charges for Rev 272 = $861.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADVANCED CEMENT MIXING,272,RC,27200002,CDM,,,,,,both,,,2065.3800,309.8100,CIGNA HEALTHCARE,CIGNA PPO,861.26,,,,,,,533.0700,2065.3800,percent of total billed charges,"41.7% of $2,065.38 in Billed Charges for Rev 272 = $861.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADVANCED CEMENT MIXING,272,RC,27200002,CDM,,,,,,both,,,2065.3800,309.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1858.84,,,,,,,533.0700,2065.3800,percent of total billed charges,"90% of $2,065.38 in Billed Charges for Rev 272 = $1,858.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADVANCED CEMENT MIXING,272,RC,27200002,CDM,,,,,,both,,,2065.3800,309.8100,MEDCOST,MEDCOST VHN,982.91,,,,,,,533.0700,2065.3800,percent of total billed charges,"47.59% of $2,065.38 in Billed Charges for Rev 272 = $982.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADVANCED CEMENT MIXING,272,RC,27200002,CDM,,,,,,both,,,2065.3800,309.8100,SENTARA HEALTH,SENTARA HEALTH,533.07,,,,,,,533.0700,2065.3800,percent of total billed charges,"25.81% of $2,065.38 in Billed Charges for Rev 272 = $533.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADVANCED CEMENT MIXING,272,RC,27200002,CDM,,,,,,both,,,2065.3800,309.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2065.38,,,,,,,533.0700,2065.3800,percent of total billed charges,"100% of $2,065.38 in Billed Charges for Rev 272 = $2,065.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADVANCED CEMENT MIXING,272,RC,27200002,CDM,,,,,,both,,,2065.3800,309.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1032.69,,,,,,,533.0700,2065.3800,percent of total billed charges,"Rev 272 $2,065.38 in Billed Charges at 50% = $1,032.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADVANCED CEMENT MIXING,272,RC,27200002,CDM,,,,,,both,,,2065.3800,309.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,667.12,,,,,,,533.0700,2065.3800,other,"32.3% of $2,065.38 in Billed Charges for Rev 272 = $667.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ADVANCED CEMENT MIXING,272,RC,27200002,CDM,,,,,,both,,,2065.3800,309.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,634.07,,,,,,,533.0700,2065.3800,other,"30.7% of $2,065.38 in Billed Charges for Rev 272 = $634.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ADVANCED CEMENT MIXING,272,RC,27200002,CDM,,,,,,both,,,2065.3800,309.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,667.12,,,,,,,533.0700,2065.3800,percent of total billed charges,"32.3% of $2,065.38 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADVANCED CEMENT MIXING,272,RC,27200002,CDM,,,,,,both,,,2065.3800,309.8100,WELLCARE,WELLCARE MEDICAID,2065.38,,,,,,,533.0700,2065.3800,percent of total billed charges,"100% of $2,065.38 in Billed Charges for Rev 272 = $2,065.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT AFFIRM ADDITIONAL LEVEL PERMIER 20P,272,RC,,,,,,,,both,,,15400.9400,2310.1400,AETNA,AETNA,6576.20,,,,,,,3974.9800,15400.9400,percent of total billed charges,"42.7% of $15,400.94 in Billed Charges for Rev 272 = $6,576.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT AFFIRM ADDITIONAL LEVEL PERMIER 20P,272,RC,,,,,,,,both,,,15400.9400,2310.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,10780.66,,,,,,,3974.9800,15400.9400,percent of total billed charges,"Rev 272 $15,400.94 in Billed Charges at 70% = $10,780.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT AFFIRM ADDITIONAL LEVEL PERMIER 20P,272,RC,,,,,,,,both,,,15400.9400,2310.1400,CIGNA HEALTHCARE,CIGNA HMO,6422.19,,,,,,,3974.9800,15400.9400,percent of total billed charges,"41.7% of $15,400.94 in Billed Charges for Rev 272 = $6,422.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT AFFIRM ADDITIONAL LEVEL PERMIER 20P,272,RC,,,,,,,,both,,,15400.9400,2310.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7146.04,,,,,,,3974.9800,15400.9400,percent of total billed charges,"46.4% of $15,400.94 in Billed Charges for Rev 272 = $7,146.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT AFFIRM ADDITIONAL LEVEL PERMIER 20P,272,RC,,,,,,,,both,,,15400.9400,2310.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6422.19,,,,,,,3974.9800,15400.9400,percent of total billed charges,"41.7% of $15,400.94 in Billed Charges for Rev 272 = $6,422.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT AFFIRM ADDITIONAL LEVEL PERMIER 20P,272,RC,,,,,,,,both,,,15400.9400,2310.1400,CIGNA HEALTHCARE,CIGNA PPO,6422.19,,,,,,,3974.9800,15400.9400,percent of total billed charges,"41.7% of $15,400.94 in Billed Charges for Rev 272 = $6,422.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT AFFIRM ADDITIONAL LEVEL PERMIER 20P,272,RC,,,,,,,,both,,,15400.9400,2310.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13860.85,,,,,,,3974.9800,15400.9400,percent of total billed charges,"90% of $15,400.94 in Billed Charges for Rev 272 = $13,860.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT AFFIRM ADDITIONAL LEVEL PERMIER 20P,272,RC,,,,,,,,both,,,15400.9400,2310.1400,MEDCOST,MEDCOST VHN,7329.31,,,,,,,3974.9800,15400.9400,percent of total billed charges,"47.59% of $15,400.94 in Billed Charges for Rev 272 = $7,329.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT AFFIRM ADDITIONAL LEVEL PERMIER 20P,272,RC,,,,,,,,both,,,15400.9400,2310.1400,SENTARA HEALTH,SENTARA HEALTH,3974.98,,,,,,,3974.9800,15400.9400,percent of total billed charges,"25.81% of $15,400.94 in Billed Charges for Rev 272 = $3,974.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT AFFIRM ADDITIONAL LEVEL PERMIER 20P,272,RC,,,,,,,,both,,,15400.9400,2310.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15400.94,,,,,,,3974.9800,15400.9400,percent of total billed charges,"100% of $15,400.94 in Billed Charges for Rev 272 = $15,400.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT AFFIRM ADDITIONAL LEVEL PERMIER 20P,272,RC,,,,,,,,both,,,15400.9400,2310.1400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7700.47,,,,,,,3974.9800,15400.9400,percent of total billed charges,"Rev 272 $15,400.94 in Billed Charges at 50% = $7,700.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT AFFIRM ADDITIONAL LEVEL PERMIER 20P,272,RC,,,,,,,,both,,,15400.9400,2310.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4974.50,,,,,,,3974.9800,15400.9400,other,"32.3% of $15,400.94 in Billed Charges for Rev 272 = $4,974.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT AFFIRM ADDITIONAL LEVEL PERMIER 20P,272,RC,,,,,,,,both,,,15400.9400,2310.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,4728.09,,,,,,,3974.9800,15400.9400,other,"30.7% of $15,400.94 in Billed Charges for Rev 272 = $4,728.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT AFFIRM ADDITIONAL LEVEL PERMIER 20P,272,RC,,,,,,,,both,,,15400.9400,2310.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,4974.50,,,,,,,3974.9800,15400.9400,percent of total billed charges,"32.3% of $15,400.94 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT AFFIRM ADDITIONAL LEVEL PERMIER 20P,272,RC,,,,,,,,both,,,15400.9400,2310.1400,WELLCARE,WELLCARE MEDICAID,15400.94,,,,,,,3974.9800,15400.9400,percent of total billed charges,"100% of $15,400.94 in Billed Charges for Rev 272 = $15,400.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CS 115 DEGREES 47CM,272,RC,27200002,CDM,,,,,,both,,,3783.3400,567.5000,AETNA,AETNA,1615.49,,,,,,,976.4800,3783.3400,percent of total billed charges,"42.7% of $3,783.34 in Billed Charges for Rev 272 = $1,615.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CS 115 DEGREES 47CM,272,RC,27200002,CDM,,,,,,both,,,3783.3400,567.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2648.34,,,,,,,976.4800,3783.3400,percent of total billed charges,"Rev 272 $3,783.34 in Billed Charges at 70% = $2,648.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CS 115 DEGREES 47CM,272,RC,27200002,CDM,,,,,,both,,,3783.3400,567.5000,CIGNA HEALTHCARE,CIGNA HMO,1577.65,,,,,,,976.4800,3783.3400,percent of total billed charges,"41.7% of $3,783.34 in Billed Charges for Rev 272 = $1,577.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CS 115 DEGREES 47CM,272,RC,27200002,CDM,,,,,,both,,,3783.3400,567.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1755.47,,,,,,,976.4800,3783.3400,percent of total billed charges,"46.4% of $3,783.34 in Billed Charges for Rev 272 = $1,755.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CS 115 DEGREES 47CM,272,RC,27200002,CDM,,,,,,both,,,3783.3400,567.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1577.65,,,,,,,976.4800,3783.3400,percent of total billed charges,"41.7% of $3,783.34 in Billed Charges for Rev 272 = $1,577.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CS 115 DEGREES 47CM,272,RC,27200002,CDM,,,,,,both,,,3783.3400,567.5000,CIGNA HEALTHCARE,CIGNA PPO,1577.65,,,,,,,976.4800,3783.3400,percent of total billed charges,"41.7% of $3,783.34 in Billed Charges for Rev 272 = $1,577.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CS 115 DEGREES 47CM,272,RC,27200002,CDM,,,,,,both,,,3783.3400,567.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3405.01,,,,,,,976.4800,3783.3400,percent of total billed charges,"90% of $3,783.34 in Billed Charges for Rev 272 = $3,405.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CS 115 DEGREES 47CM,272,RC,27200002,CDM,,,,,,both,,,3783.3400,567.5000,MEDCOST,MEDCOST VHN,1800.49,,,,,,,976.4800,3783.3400,percent of total billed charges,"47.59% of $3,783.34 in Billed Charges for Rev 272 = $1,800.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CS 115 DEGREES 47CM,272,RC,27200002,CDM,,,,,,both,,,3783.3400,567.5000,SENTARA HEALTH,SENTARA HEALTH,976.48,,,,,,,976.4800,3783.3400,percent of total billed charges,"25.81% of $3,783.34 in Billed Charges for Rev 272 = $976.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CS 115 DEGREES 47CM,272,RC,27200002,CDM,,,,,,both,,,3783.3400,567.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3783.34,,,,,,,976.4800,3783.3400,percent of total billed charges,"100% of $3,783.34 in Billed Charges for Rev 272 = $3,783.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CS 115 DEGREES 47CM,272,RC,27200002,CDM,,,,,,both,,,3783.3400,567.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1891.67,,,,,,,976.4800,3783.3400,percent of total billed charges,"Rev 272 $3,783.34 in Billed Charges at 50% = $1,891.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CS 115 DEGREES 47CM,272,RC,27200002,CDM,,,,,,both,,,3783.3400,567.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1222.02,,,,,,,976.4800,3783.3400,other,"32.3% of $3,783.34 in Billed Charges for Rev 272 = $1,222.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE CS 115 DEGREES 47CM,272,RC,27200002,CDM,,,,,,both,,,3783.3400,567.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1161.49,,,,,,,976.4800,3783.3400,other,"30.7% of $3,783.34 in Billed Charges for Rev 272 = $1,161.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE CS 115 DEGREES 47CM,272,RC,27200002,CDM,,,,,,both,,,3783.3400,567.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,1222.02,,,,,,,976.4800,3783.3400,percent of total billed charges,"32.3% of $3,783.34 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CS 115 DEGREES 47CM,272,RC,27200002,CDM,,,,,,both,,,3783.3400,567.5000,WELLCARE,WELLCARE MEDICAID,3783.34,,,,,,,976.4800,3783.3400,percent of total billed charges,"100% of $3,783.34 in Billed Charges for Rev 272 = $3,783.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA LARGE,272,RC,,,,,,,,both,,,40395.0500,6059.2600,AETNA,AETNA,17248.69,,,,,,,10425.9600,40395.0500,percent of total billed charges,"42.7% of $40,395.05 in Billed Charges for Rev 272 = $17,248.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA LARGE,272,RC,,,,,,,,both,,,40395.0500,6059.2600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,28276.54,,,,,,,10425.9600,40395.0500,percent of total billed charges,"Rev 272 $40,395.05 in Billed Charges at 70% = $28,276.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA LARGE,272,RC,,,,,,,,both,,,40395.0500,6059.2600,CIGNA HEALTHCARE,CIGNA HMO,16844.74,,,,,,,10425.9600,40395.0500,percent of total billed charges,"41.7% of $40,395.05 in Billed Charges for Rev 272 = $16,844.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA LARGE,272,RC,,,,,,,,both,,,40395.0500,6059.2600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,18743.30,,,,,,,10425.9600,40395.0500,percent of total billed charges,"46.4% of $40,395.05 in Billed Charges for Rev 272 = $18,743.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA LARGE,272,RC,,,,,,,,both,,,40395.0500,6059.2600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,16844.74,,,,,,,10425.9600,40395.0500,percent of total billed charges,"41.7% of $40,395.05 in Billed Charges for Rev 272 = $16,844.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA LARGE,272,RC,,,,,,,,both,,,40395.0500,6059.2600,CIGNA HEALTHCARE,CIGNA PPO,16844.74,,,,,,,10425.9600,40395.0500,percent of total billed charges,"41.7% of $40,395.05 in Billed Charges for Rev 272 = $16,844.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA LARGE,272,RC,,,,,,,,both,,,40395.0500,6059.2600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,36355.55,,,,,,,10425.9600,40395.0500,percent of total billed charges,"90% of $40,395.05 in Billed Charges for Rev 272 = $36,355.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA LARGE,272,RC,,,,,,,,both,,,40395.0500,6059.2600,MEDCOST,MEDCOST VHN,19224.00,,,,,,,10425.9600,40395.0500,percent of total billed charges,"47.59% of $40,395.05 in Billed Charges for Rev 272 = $19,224.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA LARGE,272,RC,,,,,,,,both,,,40395.0500,6059.2600,SENTARA HEALTH,SENTARA HEALTH,10425.96,,,,,,,10425.9600,40395.0500,percent of total billed charges,"25.81% of $40,395.05 in Billed Charges for Rev 272 = $10,425.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA LARGE,272,RC,,,,,,,,both,,,40395.0500,6059.2600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",40395.05,,,,,,,10425.9600,40395.0500,percent of total billed charges,"100% of $40,395.05 in Billed Charges for Rev 272 = $40,395.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA LARGE,272,RC,,,,,,,,both,,,40395.0500,6059.2600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,20197.53,,,,,,,10425.9600,40395.0500,percent of total billed charges,"Rev 272 $40,395.05 in Billed Charges at 50% = $20,197.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA LARGE,272,RC,,,,,,,,both,,,40395.0500,6059.2600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13047.60,,,,,,,10425.9600,40395.0500,other,"32.3% of $40,395.05 in Billed Charges for Rev 272 = $13,047.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE CUTTING EXTRA LARGE,272,RC,,,,,,,,both,,,40395.0500,6059.2600,UNITED HEALTHCARE,UHC HERITAGE SELECT,12401.28,,,,,,,10425.9600,40395.0500,other,"30.7% of $40,395.05 in Billed Charges for Rev 272 = $12,401.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
GUIDE CUTTING EXTRA LARGE,272,RC,,,,,,,,both,,,40395.0500,6059.2600,UNITED HEALTHCARE,UNITED HEALTHCARE,13047.60,,,,,,,10425.9600,40395.0500,percent of total billed charges,"32.3% of $40,395.05 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE CUTTING EXTRA LARGE,272,RC,,,,,,,,both,,,40395.0500,6059.2600,WELLCARE,WELLCARE MEDICAID,40395.05,,,,,,,10425.9600,40395.0500,percent of total billed charges,"100% of $40,395.05 in Billed Charges for Rev 272 = $40,395.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG SAFETY PULL 20F ENDOVIVE W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,1946.3800,291.9600,AETNA,AETNA,831.10,,,,,,,502.3600,1946.3800,percent of total billed charges,"42.7% of $1,946.38 in Billed Charges for Rev 272 = $831.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG SAFETY PULL 20F ENDOVIVE W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,1946.3800,291.9600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1362.47,,,,,,,502.3600,1946.3800,percent of total billed charges,"Rev 272 $1,946.38 in Billed Charges at 70% = $1,362.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG SAFETY PULL 20F ENDOVIVE W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,1946.3800,291.9600,CIGNA HEALTHCARE,CIGNA HMO,811.64,,,,,,,502.3600,1946.3800,percent of total billed charges,"41.7% of $1,946.38 in Billed Charges for Rev 272 = $811.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG SAFETY PULL 20F ENDOVIVE W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,1946.3800,291.9600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,903.12,,,,,,,502.3600,1946.3800,percent of total billed charges,"46.4% of $1,946.38 in Billed Charges for Rev 272 = $903.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG SAFETY PULL 20F ENDOVIVE W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,1946.3800,291.9600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,811.64,,,,,,,502.3600,1946.3800,percent of total billed charges,"41.7% of $1,946.38 in Billed Charges for Rev 272 = $811.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG SAFETY PULL 20F ENDOVIVE W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,1946.3800,291.9600,CIGNA HEALTHCARE,CIGNA PPO,811.64,,,,,,,502.3600,1946.3800,percent of total billed charges,"41.7% of $1,946.38 in Billed Charges for Rev 272 = $811.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG SAFETY PULL 20F ENDOVIVE W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,1946.3800,291.9600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1751.74,,,,,,,502.3600,1946.3800,percent of total billed charges,"90% of $1,946.38 in Billed Charges for Rev 272 = $1,751.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG SAFETY PULL 20F ENDOVIVE W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,1946.3800,291.9600,MEDCOST,MEDCOST VHN,926.28,,,,,,,502.3600,1946.3800,percent of total billed charges,"47.59% of $1,946.38 in Billed Charges for Rev 272 = $926.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG SAFETY PULL 20F ENDOVIVE W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,1946.3800,291.9600,SENTARA HEALTH,SENTARA HEALTH,502.36,,,,,,,502.3600,1946.3800,percent of total billed charges,"25.81% of $1,946.38 in Billed Charges for Rev 272 = $502.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG SAFETY PULL 20F ENDOVIVE W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,1946.3800,291.9600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1946.38,,,,,,,502.3600,1946.3800,percent of total billed charges,"100% of $1,946.38 in Billed Charges for Rev 272 = $1,946.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG SAFETY PULL 20F ENDOVIVE W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,1946.3800,291.9600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,973.19,,,,,,,502.3600,1946.3800,percent of total billed charges,"Rev 272 $1,946.38 in Billed Charges at 50% = $973.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG SAFETY PULL 20F ENDOVIVE W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,1946.3800,291.9600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,628.68,,,,,,,502.3600,1946.3800,other,"32.3% of $1,946.38 in Billed Charges for Rev 272 = $628.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PEG SAFETY PULL 20F ENDOVIVE W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,1946.3800,291.9600,UNITED HEALTHCARE,UHC HERITAGE SELECT,597.54,,,,,,,502.3600,1946.3800,other,"30.7% of $1,946.38 in Billed Charges for Rev 272 = $597.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PEG SAFETY PULL 20F ENDOVIVE W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,1946.3800,291.9600,UNITED HEALTHCARE,UNITED HEALTHCARE,628.68,,,,,,,502.3600,1946.3800,percent of total billed charges,"32.3% of $1,946.38 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG SAFETY PULL 20F ENDOVIVE W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,1946.3800,291.9600,WELLCARE,WELLCARE MEDICAID,1946.38,,,,,,,502.3600,1946.3800,percent of total billed charges,"100% of $1,946.38 in Billed Charges for Rev 272 = $1,946.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERCUTANEOUS FOR 3.0 KNOTLESS,272,RC,27200002,CDM,,,,,,both,,,4376.5600,656.4800,AETNA,AETNA,1868.79,,,,,,,1129.5900,4376.5600,percent of total billed charges,"42.7% of $4,376.56 in Billed Charges for Rev 272 = $1,868.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERCUTANEOUS FOR 3.0 KNOTLESS,272,RC,27200002,CDM,,,,,,both,,,4376.5600,656.4800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3063.59,,,,,,,1129.5900,4376.5600,percent of total billed charges,"Rev 272 $4,376.56 in Billed Charges at 70% = $3,063.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERCUTANEOUS FOR 3.0 KNOTLESS,272,RC,27200002,CDM,,,,,,both,,,4376.5600,656.4800,CIGNA HEALTHCARE,CIGNA HMO,1825.03,,,,,,,1129.5900,4376.5600,percent of total billed charges,"41.7% of $4,376.56 in Billed Charges for Rev 272 = $1,825.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERCUTANEOUS FOR 3.0 KNOTLESS,272,RC,27200002,CDM,,,,,,both,,,4376.5600,656.4800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2030.72,,,,,,,1129.5900,4376.5600,percent of total billed charges,"46.4% of $4,376.56 in Billed Charges for Rev 272 = $2,030.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERCUTANEOUS FOR 3.0 KNOTLESS,272,RC,27200002,CDM,,,,,,both,,,4376.5600,656.4800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1825.03,,,,,,,1129.5900,4376.5600,percent of total billed charges,"41.7% of $4,376.56 in Billed Charges for Rev 272 = $1,825.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERCUTANEOUS FOR 3.0 KNOTLESS,272,RC,27200002,CDM,,,,,,both,,,4376.5600,656.4800,CIGNA HEALTHCARE,CIGNA PPO,1825.03,,,,,,,1129.5900,4376.5600,percent of total billed charges,"41.7% of $4,376.56 in Billed Charges for Rev 272 = $1,825.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERCUTANEOUS FOR 3.0 KNOTLESS,272,RC,27200002,CDM,,,,,,both,,,4376.5600,656.4800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3938.90,,,,,,,1129.5900,4376.5600,percent of total billed charges,"90% of $4,376.56 in Billed Charges for Rev 272 = $3,938.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERCUTANEOUS FOR 3.0 KNOTLESS,272,RC,27200002,CDM,,,,,,both,,,4376.5600,656.4800,MEDCOST,MEDCOST VHN,2082.80,,,,,,,1129.5900,4376.5600,percent of total billed charges,"47.59% of $4,376.56 in Billed Charges for Rev 272 = $2,082.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERCUTANEOUS FOR 3.0 KNOTLESS,272,RC,27200002,CDM,,,,,,both,,,4376.5600,656.4800,SENTARA HEALTH,SENTARA HEALTH,1129.59,,,,,,,1129.5900,4376.5600,percent of total billed charges,"25.81% of $4,376.56 in Billed Charges for Rev 272 = $1,129.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERCUTANEOUS FOR 3.0 KNOTLESS,272,RC,27200002,CDM,,,,,,both,,,4376.5600,656.4800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4376.56,,,,,,,1129.5900,4376.5600,percent of total billed charges,"100% of $4,376.56 in Billed Charges for Rev 272 = $4,376.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERCUTANEOUS FOR 3.0 KNOTLESS,272,RC,27200002,CDM,,,,,,both,,,4376.5600,656.4800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2188.28,,,,,,,1129.5900,4376.5600,percent of total billed charges,"Rev 272 $4,376.56 in Billed Charges at 50% = $2,188.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERCUTANEOUS FOR 3.0 KNOTLESS,272,RC,27200002,CDM,,,,,,both,,,4376.5600,656.4800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1413.63,,,,,,,1129.5900,4376.5600,other,"32.3% of $4,376.56 in Billed Charges for Rev 272 = $1,413.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PERCUTANEOUS FOR 3.0 KNOTLESS,272,RC,27200002,CDM,,,,,,both,,,4376.5600,656.4800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1343.60,,,,,,,1129.5900,4376.5600,other,"30.7% of $4,376.56 in Billed Charges for Rev 272 = $1,343.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PERCUTANEOUS FOR 3.0 KNOTLESS,272,RC,27200002,CDM,,,,,,both,,,4376.5600,656.4800,UNITED HEALTHCARE,UNITED HEALTHCARE,1413.63,,,,,,,1129.5900,4376.5600,percent of total billed charges,"32.3% of $4,376.56 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERCUTANEOUS FOR 3.0 KNOTLESS,272,RC,27200002,CDM,,,,,,both,,,4376.5600,656.4800,WELLCARE,WELLCARE MEDICAID,4376.56,,,,,,,1129.5900,4376.5600,percent of total billed charges,"100% of $4,376.56 in Billed Charges for Rev 272 = $4,376.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERFUSION ECMO 17FR,272,RC,27200002,CDM,,,,,,both,,,3798.9000,569.8400,AETNA,AETNA,1622.13,,,,,,,980.5000,3798.9000,percent of total billed charges,"42.7% of $3,798.90 in Billed Charges for Rev 272 = $1,622.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERFUSION ECMO 17FR,272,RC,27200002,CDM,,,,,,both,,,3798.9000,569.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2659.23,,,,,,,980.5000,3798.9000,percent of total billed charges,"Rev 272 $3,798.90 in Billed Charges at 70% = $2,659.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERFUSION ECMO 17FR,272,RC,27200002,CDM,,,,,,both,,,3798.9000,569.8400,CIGNA HEALTHCARE,CIGNA HMO,1584.14,,,,,,,980.5000,3798.9000,percent of total billed charges,"41.7% of $3,798.90 in Billed Charges for Rev 272 = $1,584.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERFUSION ECMO 17FR,272,RC,27200002,CDM,,,,,,both,,,3798.9000,569.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1762.69,,,,,,,980.5000,3798.9000,percent of total billed charges,"46.4% of $3,798.90 in Billed Charges for Rev 272 = $1,762.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERFUSION ECMO 17FR,272,RC,27200002,CDM,,,,,,both,,,3798.9000,569.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1584.14,,,,,,,980.5000,3798.9000,percent of total billed charges,"41.7% of $3,798.90 in Billed Charges for Rev 272 = $1,584.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERFUSION ECMO 17FR,272,RC,27200002,CDM,,,,,,both,,,3798.9000,569.8400,CIGNA HEALTHCARE,CIGNA PPO,1584.14,,,,,,,980.5000,3798.9000,percent of total billed charges,"41.7% of $3,798.90 in Billed Charges for Rev 272 = $1,584.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERFUSION ECMO 17FR,272,RC,27200002,CDM,,,,,,both,,,3798.9000,569.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3419.01,,,,,,,980.5000,3798.9000,percent of total billed charges,"90% of $3,798.90 in Billed Charges for Rev 272 = $3,419.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERFUSION ECMO 17FR,272,RC,27200002,CDM,,,,,,both,,,3798.9000,569.8400,MEDCOST,MEDCOST VHN,1807.90,,,,,,,980.5000,3798.9000,percent of total billed charges,"47.59% of $3,798.90 in Billed Charges for Rev 272 = $1,807.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERFUSION ECMO 17FR,272,RC,27200002,CDM,,,,,,both,,,3798.9000,569.8400,SENTARA HEALTH,SENTARA HEALTH,980.50,,,,,,,980.5000,3798.9000,percent of total billed charges,"25.81% of $3,798.90 in Billed Charges for Rev 272 = $980.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERFUSION ECMO 17FR,272,RC,27200002,CDM,,,,,,both,,,3798.9000,569.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3798.90,,,,,,,980.5000,3798.9000,percent of total billed charges,"100% of $3,798.90 in Billed Charges for Rev 272 = $3,798.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERFUSION ECMO 17FR,272,RC,27200002,CDM,,,,,,both,,,3798.9000,569.8400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1899.45,,,,,,,980.5000,3798.9000,percent of total billed charges,"Rev 272 $3,798.90 in Billed Charges at 50% = $1,899.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERFUSION ECMO 17FR,272,RC,27200002,CDM,,,,,,both,,,3798.9000,569.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1227.04,,,,,,,980.5000,3798.9000,other,"32.3% of $3,798.90 in Billed Charges for Rev 272 = $1,227.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PERFUSION ECMO 17FR,272,RC,27200002,CDM,,,,,,both,,,3798.9000,569.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1166.26,,,,,,,980.5000,3798.9000,other,"30.7% of $3,798.90 in Billed Charges for Rev 272 = $1,166.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PERFUSION ECMO 17FR,272,RC,27200002,CDM,,,,,,both,,,3798.9000,569.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,1227.04,,,,,,,980.5000,3798.9000,percent of total billed charges,"32.3% of $3,798.90 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERFUSION ECMO 17FR,272,RC,27200002,CDM,,,,,,both,,,3798.9000,569.8400,WELLCARE,WELLCARE MEDICAID,3798.90,,,,,,,980.5000,3798.9000,percent of total billed charges,"100% of $3,798.90 in Billed Charges for Rev 272 = $3,798.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GUIDE DUOFLEX SPRING WIRE AW04235,272,RC,27200002,CDM,,,,,,both,,,95.0000,14.2500,AETNA,AETNA,40.57,,,,,,,24.5200,95.0000,percent of total billed charges,42.7% of $95.00 in Billed Charges for Rev 272 = $40.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE DUOFLEX SPRING WIRE AW04235,272,RC,27200002,CDM,,,,,,both,,,95.0000,14.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,66.50,,,,,,,24.5200,95.0000,percent of total billed charges,Rev 272 $95.00 in Billed Charges at 70% = $66.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE DUOFLEX SPRING WIRE AW04235,272,RC,27200002,CDM,,,,,,both,,,95.0000,14.2500,CIGNA HEALTHCARE,CIGNA HMO,39.62,,,,,,,24.5200,95.0000,percent of total billed charges,41.7% of $95.00 in Billed Charges for Rev 272 = $39.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE DUOFLEX SPRING WIRE AW04235,272,RC,27200002,CDM,,,,,,both,,,95.0000,14.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,44.08,,,,,,,24.5200,95.0000,percent of total billed charges,46.4% of $95.00 in Billed Charges for Rev 272 = $44.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE DUOFLEX SPRING WIRE AW04235,272,RC,27200002,CDM,,,,,,both,,,95.0000,14.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,39.62,,,,,,,24.5200,95.0000,percent of total billed charges,41.7% of $95.00 in Billed Charges for Rev 272 = $39.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE DUOFLEX SPRING WIRE AW04235,272,RC,27200002,CDM,,,,,,both,,,95.0000,14.2500,CIGNA HEALTHCARE,CIGNA PPO,39.62,,,,,,,24.5200,95.0000,percent of total billed charges,41.7% of $95.00 in Billed Charges for Rev 272 = $39.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE DUOFLEX SPRING WIRE AW04235,272,RC,27200002,CDM,,,,,,both,,,95.0000,14.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,85.50,,,,,,,24.5200,95.0000,percent of total billed charges,90% of $95.00 in Billed Charges for Rev 272 = $85.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE DUOFLEX SPRING WIRE AW04235,272,RC,27200002,CDM,,,,,,both,,,95.0000,14.2500,MEDCOST,MEDCOST VHN,45.21,,,,,,,24.5200,95.0000,percent of total billed charges,47.59% of $95.00 in Billed Charges for Rev 272 = $45.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE DUOFLEX SPRING WIRE AW04235,272,RC,27200002,CDM,,,,,,both,,,95.0000,14.2500,SENTARA HEALTH,SENTARA HEALTH,24.52,,,,,,,24.5200,95.0000,percent of total billed charges,25.81% of $95.00 in Billed Charges for Rev 272 = $24.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE DUOFLEX SPRING WIRE AW04235,272,RC,27200002,CDM,,,,,,both,,,95.0000,14.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",95.00,,,,,,,24.5200,95.0000,percent of total billed charges,100% of $95.00 in Billed Charges for Rev 272 = $95.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE DUOFLEX SPRING WIRE AW04235,272,RC,27200002,CDM,,,,,,both,,,95.0000,14.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,47.50,,,,,,,24.5200,95.0000,percent of total billed charges,Rev 272 $95.00 in Billed Charges at 50% = $47.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE DUOFLEX SPRING WIRE AW04235,272,RC,27200002,CDM,,,,,,both,,,95.0000,14.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,30.69,,,,,,,24.5200,95.0000,other,32.3% of $95.00 in Billed Charges for Rev 272 = $30.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GUIDE DUOFLEX SPRING WIRE AW04235,272,RC,27200002,CDM,,,,,,both,,,95.0000,14.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,29.17,,,,,,,24.5200,95.0000,other,30.7% of $95.00 in Billed Charges for Rev 272 = $29.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
GUIDE DUOFLEX SPRING WIRE AW04235,272,RC,27200002,CDM,,,,,,both,,,95.0000,14.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,30.69,,,,,,,24.5200,95.0000,percent of total billed charges,32.3% of $95.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GUIDE DUOFLEX SPRING WIRE AW04235,272,RC,27200002,CDM,,,,,,both,,,95.0000,14.2500,WELLCARE,WELLCARE MEDICAID,95.00,,,,,,,24.5200,95.0000,percent of total billed charges,100% of $95.00 in Billed Charges for Rev 272 = $95.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PLATELET ENRICHED PROTIEN (PRP) GPS III DISPOSABLE,272,RC,,,,,,,,both,,,6741.1500,1011.1700,AETNA,AETNA,2878.47,,,,,,,1739.8900,6741.1500,percent of total billed charges,"42.7% of $6,741.15 in Billed Charges for Rev 272 = $2,878.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLATELET ENRICHED PROTIEN (PRP) GPS III DISPOSABLE,272,RC,,,,,,,,both,,,6741.1500,1011.1700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4718.81,,,,,,,1739.8900,6741.1500,percent of total billed charges,"Rev 272 $6,741.15 in Billed Charges at 70% = $4,718.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLATELET ENRICHED PROTIEN (PRP) GPS III DISPOSABLE,272,RC,,,,,,,,both,,,6741.1500,1011.1700,CIGNA HEALTHCARE,CIGNA HMO,2811.06,,,,,,,1739.8900,6741.1500,percent of total billed charges,"41.7% of $6,741.15 in Billed Charges for Rev 272 = $2,811.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLATELET ENRICHED PROTIEN (PRP) GPS III DISPOSABLE,272,RC,,,,,,,,both,,,6741.1500,1011.1700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3127.89,,,,,,,1739.8900,6741.1500,percent of total billed charges,"46.4% of $6,741.15 in Billed Charges for Rev 272 = $3,127.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLATELET ENRICHED PROTIEN (PRP) GPS III DISPOSABLE,272,RC,,,,,,,,both,,,6741.1500,1011.1700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2811.06,,,,,,,1739.8900,6741.1500,percent of total billed charges,"41.7% of $6,741.15 in Billed Charges for Rev 272 = $2,811.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLATELET ENRICHED PROTIEN (PRP) GPS III DISPOSABLE,272,RC,,,,,,,,both,,,6741.1500,1011.1700,CIGNA HEALTHCARE,CIGNA PPO,2811.06,,,,,,,1739.8900,6741.1500,percent of total billed charges,"41.7% of $6,741.15 in Billed Charges for Rev 272 = $2,811.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLATELET ENRICHED PROTIEN (PRP) GPS III DISPOSABLE,272,RC,,,,,,,,both,,,6741.1500,1011.1700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6067.04,,,,,,,1739.8900,6741.1500,percent of total billed charges,"90% of $6,741.15 in Billed Charges for Rev 272 = $6,067.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLATELET ENRICHED PROTIEN (PRP) GPS III DISPOSABLE,272,RC,,,,,,,,both,,,6741.1500,1011.1700,MEDCOST,MEDCOST VHN,3208.11,,,,,,,1739.8900,6741.1500,percent of total billed charges,"47.59% of $6,741.15 in Billed Charges for Rev 272 = $3,208.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLATELET ENRICHED PROTIEN (PRP) GPS III DISPOSABLE,272,RC,,,,,,,,both,,,6741.1500,1011.1700,SENTARA HEALTH,SENTARA HEALTH,1739.89,,,,,,,1739.8900,6741.1500,percent of total billed charges,"25.81% of $6,741.15 in Billed Charges for Rev 272 = $1,739.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLATELET ENRICHED PROTIEN (PRP) GPS III DISPOSABLE,272,RC,,,,,,,,both,,,6741.1500,1011.1700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6741.15,,,,,,,1739.8900,6741.1500,percent of total billed charges,"100% of $6,741.15 in Billed Charges for Rev 272 = $6,741.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLATELET ENRICHED PROTIEN (PRP) GPS III DISPOSABLE,272,RC,,,,,,,,both,,,6741.1500,1011.1700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3370.58,,,,,,,1739.8900,6741.1500,percent of total billed charges,"Rev 272 $6,741.15 in Billed Charges at 50% = $3,370.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLATELET ENRICHED PROTIEN (PRP) GPS III DISPOSABLE,272,RC,,,,,,,,both,,,6741.1500,1011.1700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2177.39,,,,,,,1739.8900,6741.1500,other,"32.3% of $6,741.15 in Billed Charges for Rev 272 = $2,177.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PLATELET ENRICHED PROTIEN (PRP) GPS III DISPOSABLE,272,RC,,,,,,,,both,,,6741.1500,1011.1700,UNITED HEALTHCARE,UHC HERITAGE SELECT,2069.53,,,,,,,1739.8900,6741.1500,other,"30.7% of $6,741.15 in Billed Charges for Rev 272 = $2,069.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PLATELET ENRICHED PROTIEN (PRP) GPS III DISPOSABLE,272,RC,,,,,,,,both,,,6741.1500,1011.1700,UNITED HEALTHCARE,UNITED HEALTHCARE,2177.39,,,,,,,1739.8900,6741.1500,percent of total billed charges,"32.3% of $6,741.15 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLATELET ENRICHED PROTIEN (PRP) GPS III DISPOSABLE,272,RC,,,,,,,,both,,,6741.1500,1011.1700,WELLCARE,WELLCARE MEDICAID,6741.15,,,,,,,1739.8900,6741.1500,percent of total billed charges,"100% of $6,741.15 in Billed Charges for Rev 272 = $6,741.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLUERX PROCEDURE,272,RC,,,,,,,,both,,,9590.2700,1438.5400,AETNA,AETNA,4095.05,,,,,,,2475.2500,9590.2700,percent of total billed charges,"42.7% of $9,590.27 in Billed Charges for Rev 272 = $4,095.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLUERX PROCEDURE,272,RC,,,,,,,,both,,,9590.2700,1438.5400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6713.19,,,,,,,2475.2500,9590.2700,percent of total billed charges,"Rev 272 $9,590.27 in Billed Charges at 70% = $6,713.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLUERX PROCEDURE,272,RC,,,,,,,,both,,,9590.2700,1438.5400,CIGNA HEALTHCARE,CIGNA HMO,3999.14,,,,,,,2475.2500,9590.2700,percent of total billed charges,"41.7% of $9,590.27 in Billed Charges for Rev 272 = $3,999.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLUERX PROCEDURE,272,RC,,,,,,,,both,,,9590.2700,1438.5400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4449.89,,,,,,,2475.2500,9590.2700,percent of total billed charges,"46.4% of $9,590.27 in Billed Charges for Rev 272 = $4,449.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLUERX PROCEDURE,272,RC,,,,,,,,both,,,9590.2700,1438.5400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3999.14,,,,,,,2475.2500,9590.2700,percent of total billed charges,"41.7% of $9,590.27 in Billed Charges for Rev 272 = $3,999.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLUERX PROCEDURE,272,RC,,,,,,,,both,,,9590.2700,1438.5400,CIGNA HEALTHCARE,CIGNA PPO,3999.14,,,,,,,2475.2500,9590.2700,percent of total billed charges,"41.7% of $9,590.27 in Billed Charges for Rev 272 = $3,999.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLUERX PROCEDURE,272,RC,,,,,,,,both,,,9590.2700,1438.5400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8631.24,,,,,,,2475.2500,9590.2700,percent of total billed charges,"90% of $9,590.27 in Billed Charges for Rev 272 = $8,631.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLUERX PROCEDURE,272,RC,,,,,,,,both,,,9590.2700,1438.5400,MEDCOST,MEDCOST VHN,4564.01,,,,,,,2475.2500,9590.2700,percent of total billed charges,"47.59% of $9,590.27 in Billed Charges for Rev 272 = $4,564.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLUERX PROCEDURE,272,RC,,,,,,,,both,,,9590.2700,1438.5400,SENTARA HEALTH,SENTARA HEALTH,2475.25,,,,,,,2475.2500,9590.2700,percent of total billed charges,"25.81% of $9,590.27 in Billed Charges for Rev 272 = $2,475.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLUERX PROCEDURE,272,RC,,,,,,,,both,,,9590.2700,1438.5400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9590.27,,,,,,,2475.2500,9590.2700,percent of total billed charges,"100% of $9,590.27 in Billed Charges for Rev 272 = $9,590.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLUERX PROCEDURE,272,RC,,,,,,,,both,,,9590.2700,1438.5400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4795.14,,,,,,,2475.2500,9590.2700,percent of total billed charges,"Rev 272 $9,590.27 in Billed Charges at 50% = $4,795.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLUERX PROCEDURE,272,RC,,,,,,,,both,,,9590.2700,1438.5400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3097.66,,,,,,,2475.2500,9590.2700,other,"32.3% of $9,590.27 in Billed Charges for Rev 272 = $3,097.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PLUERX PROCEDURE,272,RC,,,,,,,,both,,,9590.2700,1438.5400,UNITED HEALTHCARE,UHC HERITAGE SELECT,2944.21,,,,,,,2475.2500,9590.2700,other,"30.7% of $9,590.27 in Billed Charges for Rev 272 = $2,944.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PLUERX PROCEDURE,272,RC,,,,,,,,both,,,9590.2700,1438.5400,UNITED HEALTHCARE,UNITED HEALTHCARE,3097.66,,,,,,,2475.2500,9590.2700,percent of total billed charges,"32.3% of $9,590.27 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PLUERX PROCEDURE,272,RC,,,,,,,,both,,,9590.2700,1438.5400,WELLCARE,WELLCARE MEDICAID,9590.27,,,,,,,2475.2500,9590.2700,percent of total billed charges,"100% of $9,590.27 in Billed Charges for Rev 272 = $9,590.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BINDER ABD 4 PANEL 85-94 INCHES,270,RC,27000208,CDM,,,,,,both,,,111.0000,16.6500,AETNA,AETNA,47.40,,,,,,,28.6500,111.0000,percent of total billed charges,42.7% of $111.00 in Billed Charges for Rev 270 = $47.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 85-94 INCHES,270,RC,27000208,CDM,,,,,,both,,,111.0000,16.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,77.70,,,,,,,28.6500,111.0000,percent of total billed charges,Rev 270 $111.00 in Billed Charges at 70% = $77.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 85-94 INCHES,270,RC,27000208,CDM,,,,,,both,,,111.0000,16.6500,CIGNA HEALTHCARE,CIGNA HMO,46.29,,,,,,,28.6500,111.0000,percent of total billed charges,41.7% of $111.00 in Billed Charges for Rev 270 = $46.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 85-94 INCHES,270,RC,27000208,CDM,,,,,,both,,,111.0000,16.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,51.50,,,,,,,28.6500,111.0000,percent of total billed charges,46.4% of $111.00 in Billed Charges for Rev 270 = $51.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 85-94 INCHES,270,RC,27000208,CDM,,,,,,both,,,111.0000,16.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,46.29,,,,,,,28.6500,111.0000,percent of total billed charges,41.7% of $111.00 in Billed Charges for Rev 270 = $46.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 85-94 INCHES,270,RC,27000208,CDM,,,,,,both,,,111.0000,16.6500,CIGNA HEALTHCARE,CIGNA PPO,46.29,,,,,,,28.6500,111.0000,percent of total billed charges,41.7% of $111.00 in Billed Charges for Rev 270 = $46.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 85-94 INCHES,270,RC,27000208,CDM,,,,,,both,,,111.0000,16.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,99.90,,,,,,,28.6500,111.0000,percent of total billed charges,90% of $111.00 in Billed Charges for Rev 270 = $99.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 85-94 INCHES,270,RC,27000208,CDM,,,,,,both,,,111.0000,16.6500,MEDCOST,MEDCOST VHN,52.82,,,,,,,28.6500,111.0000,percent of total billed charges,47.59% of $111.00 in Billed Charges for Rev 270 = $52.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 85-94 INCHES,270,RC,27000208,CDM,,,,,,both,,,111.0000,16.6500,SENTARA HEALTH,SENTARA HEALTH,28.65,,,,,,,28.6500,111.0000,percent of total billed charges,25.81% of $111.00 in Billed Charges for Rev 270 = $28.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 85-94 INCHES,270,RC,27000208,CDM,,,,,,both,,,111.0000,16.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",111.00,,,,,,,28.6500,111.0000,percent of total billed charges,100% of $111.00 in Billed Charges for Rev 270 = $111.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 85-94 INCHES,270,RC,27000208,CDM,,,,,,both,,,111.0000,16.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,55.50,,,,,,,28.6500,111.0000,percent of total billed charges,Rev 270 $111.00 in Billed Charges at 50% = $55.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 85-94 INCHES,270,RC,27000208,CDM,,,,,,both,,,111.0000,16.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,35.85,,,,,,,28.6500,111.0000,other,32.3% of $111.00 in Billed Charges for Rev 270 = $35.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BINDER ABD 4 PANEL 85-94 INCHES,270,RC,27000208,CDM,,,,,,both,,,111.0000,16.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,34.08,,,,,,,28.6500,111.0000,other,30.7% of $111.00 in Billed Charges for Rev 270 = $34.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BINDER ABD 4 PANEL 85-94 INCHES,270,RC,27000208,CDM,,,,,,both,,,111.0000,16.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,35.85,,,,,,,28.6500,111.0000,percent of total billed charges,32.3% of $111.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 4 PANEL 85-94 INCHES,270,RC,27000208,CDM,,,,,,both,,,111.0000,16.6500,WELLCARE,WELLCARE MEDICAID,111.00,,,,,,,28.6500,111.0000,percent of total billed charges,100% of $111.00 in Billed Charges for Rev 270 = $111.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 5 PANEL 30-70 INCHES,270,RC,27000209,CDM,,,,,,both,,,148.0000,22.2000,AETNA,AETNA,63.20,,,,,,,38.2000,148.0000,percent of total billed charges,42.7% of $148.00 in Billed Charges for Rev 270 = $63.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 5 PANEL 30-70 INCHES,270,RC,27000209,CDM,,,,,,both,,,148.0000,22.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,103.60,,,,,,,38.2000,148.0000,percent of total billed charges,Rev 270 $148.00 in Billed Charges at 70% = $103.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 5 PANEL 30-70 INCHES,270,RC,27000209,CDM,,,,,,both,,,148.0000,22.2000,CIGNA HEALTHCARE,CIGNA HMO,61.72,,,,,,,38.2000,148.0000,percent of total billed charges,41.7% of $148.00 in Billed Charges for Rev 270 = $61.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 5 PANEL 30-70 INCHES,270,RC,27000209,CDM,,,,,,both,,,148.0000,22.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,68.67,,,,,,,38.2000,148.0000,percent of total billed charges,46.4% of $148.00 in Billed Charges for Rev 270 = $68.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 5 PANEL 30-70 INCHES,270,RC,27000209,CDM,,,,,,both,,,148.0000,22.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,61.72,,,,,,,38.2000,148.0000,percent of total billed charges,41.7% of $148.00 in Billed Charges for Rev 270 = $61.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 5 PANEL 30-70 INCHES,270,RC,27000209,CDM,,,,,,both,,,148.0000,22.2000,CIGNA HEALTHCARE,CIGNA PPO,61.72,,,,,,,38.2000,148.0000,percent of total billed charges,41.7% of $148.00 in Billed Charges for Rev 270 = $61.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 5 PANEL 30-70 INCHES,270,RC,27000209,CDM,,,,,,both,,,148.0000,22.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,133.20,,,,,,,38.2000,148.0000,percent of total billed charges,90% of $148.00 in Billed Charges for Rev 270 = $133.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 5 PANEL 30-70 INCHES,270,RC,27000209,CDM,,,,,,both,,,148.0000,22.2000,MEDCOST,MEDCOST VHN,70.43,,,,,,,38.2000,148.0000,percent of total billed charges,47.59% of $148.00 in Billed Charges for Rev 270 = $70.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 5 PANEL 30-70 INCHES,270,RC,27000209,CDM,,,,,,both,,,148.0000,22.2000,SENTARA HEALTH,SENTARA HEALTH,38.20,,,,,,,38.2000,148.0000,percent of total billed charges,25.81% of $148.00 in Billed Charges for Rev 270 = $38.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 5 PANEL 30-70 INCHES,270,RC,27000209,CDM,,,,,,both,,,148.0000,22.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",148.00,,,,,,,38.2000,148.0000,percent of total billed charges,100% of $148.00 in Billed Charges for Rev 270 = $148.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 5 PANEL 30-70 INCHES,270,RC,27000209,CDM,,,,,,both,,,148.0000,22.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,74.00,,,,,,,38.2000,148.0000,percent of total billed charges,Rev 270 $148.00 in Billed Charges at 50% = $74.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 5 PANEL 30-70 INCHES,270,RC,27000209,CDM,,,,,,both,,,148.0000,22.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,47.80,,,,,,,38.2000,148.0000,other,32.3% of $148.00 in Billed Charges for Rev 270 = $47.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BINDER ABD 5 PANEL 30-70 INCHES,270,RC,27000209,CDM,,,,,,both,,,148.0000,22.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,45.44,,,,,,,38.2000,148.0000,other,30.7% of $148.00 in Billed Charges for Rev 270 = $45.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BINDER ABD 5 PANEL 30-70 INCHES,270,RC,27000209,CDM,,,,,,both,,,148.0000,22.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,47.80,,,,,,,38.2000,148.0000,percent of total billed charges,32.3% of $148.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BINDER ABD 5 PANEL 30-70 INCHES,270,RC,27000209,CDM,,,,,,both,,,148.0000,22.2000,WELLCARE,WELLCARE MEDICAID,148.00,,,,,,,38.2000,148.0000,percent of total billed charges,100% of $148.00 in Billed Charges for Rev 270 = $148.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADDER W/URINE METER16 DISP,272,RC,27200461,CDM,,,,,,both,,,131.0000,19.6500,AETNA,AETNA,55.94,,,,,,,33.8100,131.0000,percent of total billed charges,42.7% of $131.00 in Billed Charges for Rev 272 = $55.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADDER W/URINE METER16 DISP,272,RC,27200461,CDM,,,,,,both,,,131.0000,19.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,91.70,,,,,,,33.8100,131.0000,percent of total billed charges,Rev 272 $131.00 in Billed Charges at 70% = $91.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADDER W/URINE METER16 DISP,272,RC,27200461,CDM,,,,,,both,,,131.0000,19.6500,CIGNA HEALTHCARE,CIGNA HMO,54.63,,,,,,,33.8100,131.0000,percent of total billed charges,41.7% of $131.00 in Billed Charges for Rev 272 = $54.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADDER W/URINE METER16 DISP,272,RC,27200461,CDM,,,,,,both,,,131.0000,19.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,60.78,,,,,,,33.8100,131.0000,percent of total billed charges,46.4% of $131.00 in Billed Charges for Rev 272 = $60.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADDER W/URINE METER16 DISP,272,RC,27200461,CDM,,,,,,both,,,131.0000,19.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,54.63,,,,,,,33.8100,131.0000,percent of total billed charges,41.7% of $131.00 in Billed Charges for Rev 272 = $54.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADDER W/URINE METER16 DISP,272,RC,27200461,CDM,,,,,,both,,,131.0000,19.6500,CIGNA HEALTHCARE,CIGNA PPO,54.63,,,,,,,33.8100,131.0000,percent of total billed charges,41.7% of $131.00 in Billed Charges for Rev 272 = $54.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADDER W/URINE METER16 DISP,272,RC,27200461,CDM,,,,,,both,,,131.0000,19.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,117.90,,,,,,,33.8100,131.0000,percent of total billed charges,90% of $131.00 in Billed Charges for Rev 272 = $117.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADDER W/URINE METER16 DISP,272,RC,27200461,CDM,,,,,,both,,,131.0000,19.6500,MEDCOST,MEDCOST VHN,62.34,,,,,,,33.8100,131.0000,percent of total billed charges,47.59% of $131.00 in Billed Charges for Rev 272 = $62.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADDER W/URINE METER16 DISP,272,RC,27200461,CDM,,,,,,both,,,131.0000,19.6500,SENTARA HEALTH,SENTARA HEALTH,33.81,,,,,,,33.8100,131.0000,percent of total billed charges,25.81% of $131.00 in Billed Charges for Rev 272 = $33.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADDER W/URINE METER16 DISP,272,RC,27200461,CDM,,,,,,both,,,131.0000,19.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",131.00,,,,,,,33.8100,131.0000,percent of total billed charges,100% of $131.00 in Billed Charges for Rev 272 = $131.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADDER W/URINE METER16 DISP,272,RC,27200461,CDM,,,,,,both,,,131.0000,19.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,65.50,,,,,,,33.8100,131.0000,percent of total billed charges,Rev 272 $131.00 in Billed Charges at 50% = $65.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADDER W/URINE METER16 DISP,272,RC,27200461,CDM,,,,,,both,,,131.0000,19.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,42.31,,,,,,,33.8100,131.0000,other,32.3% of $131.00 in Billed Charges for Rev 272 = $42.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLADDER W/URINE METER16 DISP,272,RC,27200461,CDM,,,,,,both,,,131.0000,19.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,40.22,,,,,,,33.8100,131.0000,other,30.7% of $131.00 in Billed Charges for Rev 272 = $40.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLADDER W/URINE METER16 DISP,272,RC,27200461,CDM,,,,,,both,,,131.0000,19.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,42.31,,,,,,,33.8100,131.0000,percent of total billed charges,32.3% of $131.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADDER W/URINE METER16 DISP,272,RC,27200461,CDM,,,,,,both,,,131.0000,19.6500,WELLCARE,WELLCARE MEDICAID,131.00,,,,,,,33.8100,131.0000,percent of total billed charges,100% of $131.00 in Billed Charges for Rev 272 = $131.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE 9 X 25MM 2296 3 525,272,RC,27200125,CDM,,,,,,both,,,191.0000,28.6500,AETNA,AETNA,81.56,,,,,,,49.3000,191.0000,percent of total billed charges,42.7% of $191.00 in Billed Charges for Rev 272 = $81.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE 9 X 25MM 2296 3 525,272,RC,27200125,CDM,,,,,,both,,,191.0000,28.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,133.70,,,,,,,49.3000,191.0000,percent of total billed charges,Rev 272 $191.00 in Billed Charges at 70% = $133.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE 9 X 25MM 2296 3 525,272,RC,27200125,CDM,,,,,,both,,,191.0000,28.6500,CIGNA HEALTHCARE,CIGNA HMO,79.65,,,,,,,49.3000,191.0000,percent of total billed charges,41.7% of $191.00 in Billed Charges for Rev 272 = $79.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE 9 X 25MM 2296 3 525,272,RC,27200125,CDM,,,,,,both,,,191.0000,28.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,88.62,,,,,,,49.3000,191.0000,percent of total billed charges,46.4% of $191.00 in Billed Charges for Rev 272 = $88.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE 9 X 25MM 2296 3 525,272,RC,27200125,CDM,,,,,,both,,,191.0000,28.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,79.65,,,,,,,49.3000,191.0000,percent of total billed charges,41.7% of $191.00 in Billed Charges for Rev 272 = $79.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE 9 X 25MM 2296 3 525,272,RC,27200125,CDM,,,,,,both,,,191.0000,28.6500,CIGNA HEALTHCARE,CIGNA PPO,79.65,,,,,,,49.3000,191.0000,percent of total billed charges,41.7% of $191.00 in Billed Charges for Rev 272 = $79.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE 9 X 25MM 2296 3 525,272,RC,27200125,CDM,,,,,,both,,,191.0000,28.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,171.90,,,,,,,49.3000,191.0000,percent of total billed charges,90% of $191.00 in Billed Charges for Rev 272 = $171.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE 9 X 25MM 2296 3 525,272,RC,27200125,CDM,,,,,,both,,,191.0000,28.6500,MEDCOST,MEDCOST VHN,90.90,,,,,,,49.3000,191.0000,percent of total billed charges,47.59% of $191.00 in Billed Charges for Rev 272 = $90.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE 9 X 25MM 2296 3 525,272,RC,27200125,CDM,,,,,,both,,,191.0000,28.6500,SENTARA HEALTH,SENTARA HEALTH,49.30,,,,,,,49.3000,191.0000,percent of total billed charges,25.81% of $191.00 in Billed Charges for Rev 272 = $49.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE 9 X 25MM 2296 3 525,272,RC,27200125,CDM,,,,,,both,,,191.0000,28.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",191.00,,,,,,,49.3000,191.0000,percent of total billed charges,100% of $191.00 in Billed Charges for Rev 272 = $191.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE 9 X 25MM 2296 3 525,272,RC,27200125,CDM,,,,,,both,,,191.0000,28.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,95.50,,,,,,,49.3000,191.0000,percent of total billed charges,Rev 272 $191.00 in Billed Charges at 50% = $95.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE 9 X 25MM 2296 3 525,272,RC,27200125,CDM,,,,,,both,,,191.0000,28.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,61.69,,,,,,,49.3000,191.0000,other,32.3% of $191.00 in Billed Charges for Rev 272 = $61.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLADE 9 X 25MM 2296 3 525,272,RC,27200125,CDM,,,,,,both,,,191.0000,28.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,58.64,,,,,,,49.3000,191.0000,other,30.7% of $191.00 in Billed Charges for Rev 272 = $58.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLADE 9 X 25MM 2296 3 525,272,RC,27200125,CDM,,,,,,both,,,191.0000,28.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,61.69,,,,,,,49.3000,191.0000,percent of total billed charges,32.3% of $191.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE 9 X 25MM 2296 3 525,272,RC,27200125,CDM,,,,,,both,,,191.0000,28.6500,WELLCARE,WELLCARE MEDICAID,191.00,,,,,,,49.3000,191.0000,percent of total billed charges,100% of $191.00 in Billed Charges for Rev 272 = $191.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE AVER MEDIUM DISP,272,RC,27200126,CDM,,,,,,both,,,188.0000,28.2000,AETNA,AETNA,80.28,,,,,,,48.5200,188.0000,percent of total billed charges,42.7% of $188.00 in Billed Charges for Rev 272 = $80.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE AVER MEDIUM DISP,272,RC,27200126,CDM,,,,,,both,,,188.0000,28.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,131.60,,,,,,,48.5200,188.0000,percent of total billed charges,Rev 272 $188.00 in Billed Charges at 70% = $131.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE AVER MEDIUM DISP,272,RC,27200126,CDM,,,,,,both,,,188.0000,28.2000,CIGNA HEALTHCARE,CIGNA HMO,78.40,,,,,,,48.5200,188.0000,percent of total billed charges,41.7% of $188.00 in Billed Charges for Rev 272 = $78.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE AVER MEDIUM DISP,272,RC,27200126,CDM,,,,,,both,,,188.0000,28.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,87.23,,,,,,,48.5200,188.0000,percent of total billed charges,46.4% of $188.00 in Billed Charges for Rev 272 = $87.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE AVER MEDIUM DISP,272,RC,27200126,CDM,,,,,,both,,,188.0000,28.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,78.40,,,,,,,48.5200,188.0000,percent of total billed charges,41.7% of $188.00 in Billed Charges for Rev 272 = $78.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE AVER MEDIUM DISP,272,RC,27200126,CDM,,,,,,both,,,188.0000,28.2000,CIGNA HEALTHCARE,CIGNA PPO,78.40,,,,,,,48.5200,188.0000,percent of total billed charges,41.7% of $188.00 in Billed Charges for Rev 272 = $78.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE AVER MEDIUM DISP,272,RC,27200126,CDM,,,,,,both,,,188.0000,28.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,169.20,,,,,,,48.5200,188.0000,percent of total billed charges,90% of $188.00 in Billed Charges for Rev 272 = $169.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE AVER MEDIUM DISP,272,RC,27200126,CDM,,,,,,both,,,188.0000,28.2000,MEDCOST,MEDCOST VHN,89.47,,,,,,,48.5200,188.0000,percent of total billed charges,47.59% of $188.00 in Billed Charges for Rev 272 = $89.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE AVER MEDIUM DISP,272,RC,27200126,CDM,,,,,,both,,,188.0000,28.2000,SENTARA HEALTH,SENTARA HEALTH,48.52,,,,,,,48.5200,188.0000,percent of total billed charges,25.81% of $188.00 in Billed Charges for Rev 272 = $48.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE AVER MEDIUM DISP,272,RC,27200126,CDM,,,,,,both,,,188.0000,28.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",188.00,,,,,,,48.5200,188.0000,percent of total billed charges,100% of $188.00 in Billed Charges for Rev 272 = $188.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE AVER MEDIUM DISP,272,RC,27200126,CDM,,,,,,both,,,188.0000,28.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,94.00,,,,,,,48.5200,188.0000,percent of total billed charges,Rev 272 $188.00 in Billed Charges at 50% = $94.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE AVER MEDIUM DISP,272,RC,27200126,CDM,,,,,,both,,,188.0000,28.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,60.72,,,,,,,48.5200,188.0000,other,32.3% of $188.00 in Billed Charges for Rev 272 = $60.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLADE AVER MEDIUM DISP,272,RC,27200126,CDM,,,,,,both,,,188.0000,28.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,57.72,,,,,,,48.5200,188.0000,other,30.7% of $188.00 in Billed Charges for Rev 272 = $57.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLADE AVER MEDIUM DISP,272,RC,27200126,CDM,,,,,,both,,,188.0000,28.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,60.72,,,,,,,48.5200,188.0000,percent of total billed charges,32.3% of $188.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE AVER MEDIUM DISP,272,RC,27200126,CDM,,,,,,both,,,188.0000,28.2000,WELLCARE,WELLCARE MEDICAID,188.00,,,,,,,48.5200,188.0000,percent of total billed charges,100% of $188.00 in Billed Charges for Rev 272 = $188.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE INTUBATION GLDSCOPE ALL SZS,272,RC,27200127,CDM,,,,,,both,,,98.0000,14.7000,AETNA,AETNA,41.85,,,,,,,25.2900,98.0000,percent of total billed charges,42.7% of $98.00 in Billed Charges for Rev 272 = $41.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE INTUBATION GLDSCOPE ALL SZS,272,RC,27200127,CDM,,,,,,both,,,98.0000,14.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,68.60,,,,,,,25.2900,98.0000,percent of total billed charges,Rev 272 $98.00 in Billed Charges at 70% = $68.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE INTUBATION GLDSCOPE ALL SZS,272,RC,27200127,CDM,,,,,,both,,,98.0000,14.7000,CIGNA HEALTHCARE,CIGNA HMO,40.87,,,,,,,25.2900,98.0000,percent of total billed charges,41.7% of $98.00 in Billed Charges for Rev 272 = $40.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE INTUBATION GLDSCOPE ALL SZS,272,RC,27200127,CDM,,,,,,both,,,98.0000,14.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,45.47,,,,,,,25.2900,98.0000,percent of total billed charges,46.4% of $98.00 in Billed Charges for Rev 272 = $45.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE INTUBATION GLDSCOPE ALL SZS,272,RC,27200127,CDM,,,,,,both,,,98.0000,14.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,40.87,,,,,,,25.2900,98.0000,percent of total billed charges,41.7% of $98.00 in Billed Charges for Rev 272 = $40.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE INTUBATION GLDSCOPE ALL SZS,272,RC,27200127,CDM,,,,,,both,,,98.0000,14.7000,CIGNA HEALTHCARE,CIGNA PPO,40.87,,,,,,,25.2900,98.0000,percent of total billed charges,41.7% of $98.00 in Billed Charges for Rev 272 = $40.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE INTUBATION GLDSCOPE ALL SZS,272,RC,27200127,CDM,,,,,,both,,,98.0000,14.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,88.20,,,,,,,25.2900,98.0000,percent of total billed charges,90% of $98.00 in Billed Charges for Rev 272 = $88.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE INTUBATION GLDSCOPE ALL SZS,272,RC,27200127,CDM,,,,,,both,,,98.0000,14.7000,MEDCOST,MEDCOST VHN,46.64,,,,,,,25.2900,98.0000,percent of total billed charges,47.59% of $98.00 in Billed Charges for Rev 272 = $46.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE INTUBATION GLDSCOPE ALL SZS,272,RC,27200127,CDM,,,,,,both,,,98.0000,14.7000,SENTARA HEALTH,SENTARA HEALTH,25.29,,,,,,,25.2900,98.0000,percent of total billed charges,25.81% of $98.00 in Billed Charges for Rev 272 = $25.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE INTUBATION GLDSCOPE ALL SZS,272,RC,27200127,CDM,,,,,,both,,,98.0000,14.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",98.00,,,,,,,25.2900,98.0000,percent of total billed charges,100% of $98.00 in Billed Charges for Rev 272 = $98.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE INTUBATION GLDSCOPE ALL SZS,272,RC,27200127,CDM,,,,,,both,,,98.0000,14.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,49.00,,,,,,,25.2900,98.0000,percent of total billed charges,Rev 272 $98.00 in Billed Charges at 50% = $49.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE INTUBATION GLDSCOPE ALL SZS,272,RC,27200127,CDM,,,,,,both,,,98.0000,14.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,31.65,,,,,,,25.2900,98.0000,other,32.3% of $98.00 in Billed Charges for Rev 272 = $31.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLADE INTUBATION GLDSCOPE ALL SZS,272,RC,27200127,CDM,,,,,,both,,,98.0000,14.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,30.09,,,,,,,25.2900,98.0000,other,30.7% of $98.00 in Billed Charges for Rev 272 = $30.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLADE INTUBATION GLDSCOPE ALL SZS,272,RC,27200127,CDM,,,,,,both,,,98.0000,14.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,31.65,,,,,,,25.2900,98.0000,percent of total billed charges,32.3% of $98.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLADE INTUBATION GLDSCOPE ALL SZS,272,RC,27200127,CDM,,,,,,both,,,98.0000,14.7000,WELLCARE,WELLCARE MEDICAID,98.00,,,,,,,25.2900,98.0000,percent of total billed charges,100% of $98.00 in Billed Charges for Rev 272 = $98.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOCKER ENDOBRONCHIAL EZ,272,RC,27201725,CDM,,,,,,both,,,742.0000,111.3000,AETNA,AETNA,316.83,,,,,,,191.5100,742.0000,percent of total billed charges,42.7% of $742.00 in Billed Charges for Rev 272 = $316.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOCKER ENDOBRONCHIAL EZ,272,RC,27201725,CDM,,,,,,both,,,742.0000,111.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,519.40,,,,,,,191.5100,742.0000,percent of total billed charges,Rev 272 $742.00 in Billed Charges at 70% = $519.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOCKER ENDOBRONCHIAL EZ,272,RC,27201725,CDM,,,,,,both,,,742.0000,111.3000,CIGNA HEALTHCARE,CIGNA HMO,309.41,,,,,,,191.5100,742.0000,percent of total billed charges,41.7% of $742.00 in Billed Charges for Rev 272 = $309.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOCKER ENDOBRONCHIAL EZ,272,RC,27201725,CDM,,,,,,both,,,742.0000,111.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,344.29,,,,,,,191.5100,742.0000,percent of total billed charges,46.4% of $742.00 in Billed Charges for Rev 272 = $344.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOCKER ENDOBRONCHIAL EZ,272,RC,27201725,CDM,,,,,,both,,,742.0000,111.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,309.41,,,,,,,191.5100,742.0000,percent of total billed charges,41.7% of $742.00 in Billed Charges for Rev 272 = $309.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOCKER ENDOBRONCHIAL EZ,272,RC,27201725,CDM,,,,,,both,,,742.0000,111.3000,CIGNA HEALTHCARE,CIGNA PPO,309.41,,,,,,,191.5100,742.0000,percent of total billed charges,41.7% of $742.00 in Billed Charges for Rev 272 = $309.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOCKER ENDOBRONCHIAL EZ,272,RC,27201725,CDM,,,,,,both,,,742.0000,111.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,667.80,,,,,,,191.5100,742.0000,percent of total billed charges,90% of $742.00 in Billed Charges for Rev 272 = $667.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOCKER ENDOBRONCHIAL EZ,272,RC,27201725,CDM,,,,,,both,,,742.0000,111.3000,MEDCOST,MEDCOST VHN,353.12,,,,,,,191.5100,742.0000,percent of total billed charges,47.59% of $742.00 in Billed Charges for Rev 272 = $353.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOCKER ENDOBRONCHIAL EZ,272,RC,27201725,CDM,,,,,,both,,,742.0000,111.3000,SENTARA HEALTH,SENTARA HEALTH,191.51,,,,,,,191.5100,742.0000,percent of total billed charges,25.81% of $742.00 in Billed Charges for Rev 272 = $191.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOCKER ENDOBRONCHIAL EZ,272,RC,27201725,CDM,,,,,,both,,,742.0000,111.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",742.00,,,,,,,191.5100,742.0000,percent of total billed charges,100% of $742.00 in Billed Charges for Rev 272 = $742.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOCKER ENDOBRONCHIAL EZ,272,RC,27201725,CDM,,,,,,both,,,742.0000,111.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,371.00,,,,,,,191.5100,742.0000,percent of total billed charges,Rev 272 $742.00 in Billed Charges at 50% = $371.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOCKER ENDOBRONCHIAL EZ,272,RC,27201725,CDM,,,,,,both,,,742.0000,111.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,239.67,,,,,,,191.5100,742.0000,other,32.3% of $742.00 in Billed Charges for Rev 272 = $239.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOCKER ENDOBRONCHIAL EZ,272,RC,27201725,CDM,,,,,,both,,,742.0000,111.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,227.79,,,,,,,191.5100,742.0000,other,30.7% of $742.00 in Billed Charges for Rev 272 = $227.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BLOCKER ENDOBRONCHIAL EZ,272,RC,27201725,CDM,,,,,,both,,,742.0000,111.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,239.67,,,,,,,191.5100,742.0000,percent of total billed charges,32.3% of $742.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BLOCKER ENDOBRONCHIAL EZ,272,RC,27201725,CDM,,,,,,both,,,742.0000,111.3000,WELLCARE,WELLCARE MEDICAID,742.00,,,,,,,191.5100,742.0000,percent of total billed charges,100% of $742.00 in Billed Charges for Rev 272 = $742.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT POST OP,270,RC,27000141,CDM,,,,,,both,,,63.0000,9.4500,AETNA,AETNA,26.90,,,,,,,16.2600,63.0000,percent of total billed charges,42.7% of $63.00 in Billed Charges for Rev 270 = $26.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT POST OP,270,RC,27000141,CDM,,,,,,both,,,63.0000,9.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,44.10,,,,,,,16.2600,63.0000,percent of total billed charges,Rev 270 $63.00 in Billed Charges at 70% = $44.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT POST OP,270,RC,27000141,CDM,,,,,,both,,,63.0000,9.4500,CIGNA HEALTHCARE,CIGNA HMO,26.27,,,,,,,16.2600,63.0000,percent of total billed charges,41.7% of $63.00 in Billed Charges for Rev 270 = $26.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT POST OP,270,RC,27000141,CDM,,,,,,both,,,63.0000,9.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,29.23,,,,,,,16.2600,63.0000,percent of total billed charges,46.4% of $63.00 in Billed Charges for Rev 270 = $29.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT POST OP,270,RC,27000141,CDM,,,,,,both,,,63.0000,9.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,26.27,,,,,,,16.2600,63.0000,percent of total billed charges,41.7% of $63.00 in Billed Charges for Rev 270 = $26.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT POST OP,270,RC,27000141,CDM,,,,,,both,,,63.0000,9.4500,CIGNA HEALTHCARE,CIGNA PPO,26.27,,,,,,,16.2600,63.0000,percent of total billed charges,41.7% of $63.00 in Billed Charges for Rev 270 = $26.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT POST OP,270,RC,27000141,CDM,,,,,,both,,,63.0000,9.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,56.70,,,,,,,16.2600,63.0000,percent of total billed charges,90% of $63.00 in Billed Charges for Rev 270 = $56.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT POST OP,270,RC,27000141,CDM,,,,,,both,,,63.0000,9.4500,MEDCOST,MEDCOST VHN,29.98,,,,,,,16.2600,63.0000,percent of total billed charges,47.59% of $63.00 in Billed Charges for Rev 270 = $29.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT POST OP,270,RC,27000141,CDM,,,,,,both,,,63.0000,9.4500,SENTARA HEALTH,SENTARA HEALTH,16.26,,,,,,,16.2600,63.0000,percent of total billed charges,25.81% of $63.00 in Billed Charges for Rev 270 = $16.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT POST OP,270,RC,27000141,CDM,,,,,,both,,,63.0000,9.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",63.00,,,,,,,16.2600,63.0000,percent of total billed charges,100% of $63.00 in Billed Charges for Rev 270 = $63.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT POST OP,270,RC,27000141,CDM,,,,,,both,,,63.0000,9.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,31.50,,,,,,,16.2600,63.0000,percent of total billed charges,Rev 270 $63.00 in Billed Charges at 50% = $31.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT POST OP,270,RC,27000141,CDM,,,,,,both,,,63.0000,9.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,20.35,,,,,,,16.2600,63.0000,other,32.3% of $63.00 in Billed Charges for Rev 270 = $20.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BOOT POST OP,270,RC,27000141,CDM,,,,,,both,,,63.0000,9.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,19.34,,,,,,,16.2600,63.0000,other,30.7% of $63.00 in Billed Charges for Rev 270 = $19.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BOOT POST OP,270,RC,27000141,CDM,,,,,,both,,,63.0000,9.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,20.35,,,,,,,16.2600,63.0000,percent of total billed charges,32.3% of $63.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOOT POST OP,270,RC,27000141,CDM,,,,,,both,,,63.0000,9.4500,WELLCARE,WELLCARE MEDICAID,63.00,,,,,,,16.2600,63.0000,percent of total billed charges,100% of $63.00 in Billed Charges for Rev 270 = $63.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOWL BONE CEMENT MIX 206-15,272,RC,27200474,CDM,,,,,,both,,,299.0000,44.8500,AETNA,AETNA,127.67,,,,,,,77.1700,299.0000,percent of total billed charges,42.7% of $299.00 in Billed Charges for Rev 272 = $127.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOWL BONE CEMENT MIX 206-15,272,RC,27200474,CDM,,,,,,both,,,299.0000,44.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,209.30,,,,,,,77.1700,299.0000,percent of total billed charges,Rev 272 $299.00 in Billed Charges at 70% = $209.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOWL BONE CEMENT MIX 206-15,272,RC,27200474,CDM,,,,,,both,,,299.0000,44.8500,CIGNA HEALTHCARE,CIGNA HMO,124.68,,,,,,,77.1700,299.0000,percent of total billed charges,41.7% of $299.00 in Billed Charges for Rev 272 = $124.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOWL BONE CEMENT MIX 206-15,272,RC,27200474,CDM,,,,,,both,,,299.0000,44.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,138.74,,,,,,,77.1700,299.0000,percent of total billed charges,46.4% of $299.00 in Billed Charges for Rev 272 = $138.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOWL BONE CEMENT MIX 206-15,272,RC,27200474,CDM,,,,,,both,,,299.0000,44.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,124.68,,,,,,,77.1700,299.0000,percent of total billed charges,41.7% of $299.00 in Billed Charges for Rev 272 = $124.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOWL BONE CEMENT MIX 206-15,272,RC,27200474,CDM,,,,,,both,,,299.0000,44.8500,CIGNA HEALTHCARE,CIGNA PPO,124.68,,,,,,,77.1700,299.0000,percent of total billed charges,41.7% of $299.00 in Billed Charges for Rev 272 = $124.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOWL BONE CEMENT MIX 206-15,272,RC,27200474,CDM,,,,,,both,,,299.0000,44.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,269.10,,,,,,,77.1700,299.0000,percent of total billed charges,90% of $299.00 in Billed Charges for Rev 272 = $269.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOWL BONE CEMENT MIX 206-15,272,RC,27200474,CDM,,,,,,both,,,299.0000,44.8500,MEDCOST,MEDCOST VHN,142.29,,,,,,,77.1700,299.0000,percent of total billed charges,47.59% of $299.00 in Billed Charges for Rev 272 = $142.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOWL BONE CEMENT MIX 206-15,272,RC,27200474,CDM,,,,,,both,,,299.0000,44.8500,SENTARA HEALTH,SENTARA HEALTH,77.17,,,,,,,77.1700,299.0000,percent of total billed charges,25.81% of $299.00 in Billed Charges for Rev 272 = $77.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOWL BONE CEMENT MIX 206-15,272,RC,27200474,CDM,,,,,,both,,,299.0000,44.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",299.00,,,,,,,77.1700,299.0000,percent of total billed charges,100% of $299.00 in Billed Charges for Rev 272 = $299.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOWL BONE CEMENT MIX 206-15,272,RC,27200474,CDM,,,,,,both,,,299.0000,44.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,149.50,,,,,,,77.1700,299.0000,percent of total billed charges,Rev 272 $299.00 in Billed Charges at 50% = $149.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOWL BONE CEMENT MIX 206-15,272,RC,27200474,CDM,,,,,,both,,,299.0000,44.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,96.58,,,,,,,77.1700,299.0000,other,32.3% of $299.00 in Billed Charges for Rev 272 = $96.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BOWL BONE CEMENT MIX 206-15,272,RC,27200474,CDM,,,,,,both,,,299.0000,44.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,91.79,,,,,,,77.1700,299.0000,other,30.7% of $299.00 in Billed Charges for Rev 272 = $91.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BOWL BONE CEMENT MIX 206-15,272,RC,27200474,CDM,,,,,,both,,,299.0000,44.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,96.58,,,,,,,77.1700,299.0000,percent of total billed charges,32.3% of $299.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BOWL BONE CEMENT MIX 206-15,272,RC,27200474,CDM,,,,,,both,,,299.0000,44.8500,WELLCARE,WELLCARE MEDICAID,299.00,,,,,,,77.1700,299.0000,percent of total billed charges,100% of $299.00 in Billed Charges for Rev 272 = $299.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRUSH CYTOLOGY,272,RC,27200132,CDM,,,,,,both,,,103.0000,15.4500,AETNA,AETNA,43.98,,,,,,,26.5800,103.0000,percent of total billed charges,42.7% of $103.00 in Billed Charges for Rev 272 = $43.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRUSH CYTOLOGY,272,RC,27200132,CDM,,,,,,both,,,103.0000,15.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,72.10,,,,,,,26.5800,103.0000,percent of total billed charges,Rev 272 $103.00 in Billed Charges at 70% = $72.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRUSH CYTOLOGY,272,RC,27200132,CDM,,,,,,both,,,103.0000,15.4500,CIGNA HEALTHCARE,CIGNA HMO,42.95,,,,,,,26.5800,103.0000,percent of total billed charges,41.7% of $103.00 in Billed Charges for Rev 272 = $42.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRUSH CYTOLOGY,272,RC,27200132,CDM,,,,,,both,,,103.0000,15.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,47.79,,,,,,,26.5800,103.0000,percent of total billed charges,46.4% of $103.00 in Billed Charges for Rev 272 = $47.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRUSH CYTOLOGY,272,RC,27200132,CDM,,,,,,both,,,103.0000,15.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,42.95,,,,,,,26.5800,103.0000,percent of total billed charges,41.7% of $103.00 in Billed Charges for Rev 272 = $42.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRUSH CYTOLOGY,272,RC,27200132,CDM,,,,,,both,,,103.0000,15.4500,CIGNA HEALTHCARE,CIGNA PPO,42.95,,,,,,,26.5800,103.0000,percent of total billed charges,41.7% of $103.00 in Billed Charges for Rev 272 = $42.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRUSH CYTOLOGY,272,RC,27200132,CDM,,,,,,both,,,103.0000,15.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,92.70,,,,,,,26.5800,103.0000,percent of total billed charges,90% of $103.00 in Billed Charges for Rev 272 = $92.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRUSH CYTOLOGY,272,RC,27200132,CDM,,,,,,both,,,103.0000,15.4500,MEDCOST,MEDCOST VHN,49.02,,,,,,,26.5800,103.0000,percent of total billed charges,47.59% of $103.00 in Billed Charges for Rev 272 = $49.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRUSH CYTOLOGY,272,RC,27200132,CDM,,,,,,both,,,103.0000,15.4500,SENTARA HEALTH,SENTARA HEALTH,26.58,,,,,,,26.5800,103.0000,percent of total billed charges,25.81% of $103.00 in Billed Charges for Rev 272 = $26.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRUSH CYTOLOGY,272,RC,27200132,CDM,,,,,,both,,,103.0000,15.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",103.00,,,,,,,26.5800,103.0000,percent of total billed charges,100% of $103.00 in Billed Charges for Rev 272 = $103.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRUSH CYTOLOGY,272,RC,27200132,CDM,,,,,,both,,,103.0000,15.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,51.50,,,,,,,26.5800,103.0000,percent of total billed charges,Rev 272 $103.00 in Billed Charges at 50% = $51.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRUSH CYTOLOGY,272,RC,27200132,CDM,,,,,,both,,,103.0000,15.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,33.27,,,,,,,26.5800,103.0000,other,32.3% of $103.00 in Billed Charges for Rev 272 = $33.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRUSH CYTOLOGY,272,RC,27200132,CDM,,,,,,both,,,103.0000,15.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,31.62,,,,,,,26.5800,103.0000,other,30.7% of $103.00 in Billed Charges for Rev 272 = $31.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRUSH CYTOLOGY,272,RC,27200132,CDM,,,,,,both,,,103.0000,15.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,33.27,,,,,,,26.5800,103.0000,percent of total billed charges,32.3% of $103.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BRUSH CYTOLOGY,272,RC,27200132,CDM,,,,,,both,,,103.0000,15.4500,WELLCARE,WELLCARE MEDICAID,103.00,,,,,,,26.5800,103.0000,percent of total billed charges,100% of $103.00 in Billed Charges for Rev 272 = $103.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BUTTON TRACH,270,RC,27000060,CDM,,,,,,both,,,489.0000,73.3500,AETNA,AETNA,208.80,,,,,,,126.2100,489.0000,percent of total billed charges,42.7% of $489.00 in Billed Charges for Rev 270 = $208.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BUTTON TRACH,270,RC,27000060,CDM,,,,,,both,,,489.0000,73.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,342.30,,,,,,,126.2100,489.0000,percent of total billed charges,Rev 270 $489.00 in Billed Charges at 70% = $342.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BUTTON TRACH,270,RC,27000060,CDM,,,,,,both,,,489.0000,73.3500,CIGNA HEALTHCARE,CIGNA HMO,203.91,,,,,,,126.2100,489.0000,percent of total billed charges,41.7% of $489.00 in Billed Charges for Rev 270 = $203.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BUTTON TRACH,270,RC,27000060,CDM,,,,,,both,,,489.0000,73.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,226.90,,,,,,,126.2100,489.0000,percent of total billed charges,46.4% of $489.00 in Billed Charges for Rev 270 = $226.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BUTTON TRACH,270,RC,27000060,CDM,,,,,,both,,,489.0000,73.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,203.91,,,,,,,126.2100,489.0000,percent of total billed charges,41.7% of $489.00 in Billed Charges for Rev 270 = $203.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BUTTON TRACH,270,RC,27000060,CDM,,,,,,both,,,489.0000,73.3500,CIGNA HEALTHCARE,CIGNA PPO,203.91,,,,,,,126.2100,489.0000,percent of total billed charges,41.7% of $489.00 in Billed Charges for Rev 270 = $203.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BUTTON TRACH,270,RC,27000060,CDM,,,,,,both,,,489.0000,73.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,440.10,,,,,,,126.2100,489.0000,percent of total billed charges,90% of $489.00 in Billed Charges for Rev 270 = $440.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BUTTON TRACH,270,RC,27000060,CDM,,,,,,both,,,489.0000,73.3500,MEDCOST,MEDCOST VHN,232.72,,,,,,,126.2100,489.0000,percent of total billed charges,47.59% of $489.00 in Billed Charges for Rev 270 = $232.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BUTTON TRACH,270,RC,27000060,CDM,,,,,,both,,,489.0000,73.3500,SENTARA HEALTH,SENTARA HEALTH,126.21,,,,,,,126.2100,489.0000,percent of total billed charges,25.81% of $489.00 in Billed Charges for Rev 270 = $126.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BUTTON TRACH,270,RC,27000060,CDM,,,,,,both,,,489.0000,73.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",489.00,,,,,,,126.2100,489.0000,percent of total billed charges,100% of $489.00 in Billed Charges for Rev 270 = $489.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BUTTON TRACH,270,RC,27000060,CDM,,,,,,both,,,489.0000,73.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,244.50,,,,,,,126.2100,489.0000,percent of total billed charges,Rev 270 $489.00 in Billed Charges at 50% = $244.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BUTTON TRACH,270,RC,27000060,CDM,,,,,,both,,,489.0000,73.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,157.95,,,,,,,126.2100,489.0000,other,32.3% of $489.00 in Billed Charges for Rev 270 = $157.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BUTTON TRACH,270,RC,27000060,CDM,,,,,,both,,,489.0000,73.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,150.12,,,,,,,126.2100,489.0000,other,30.7% of $489.00 in Billed Charges for Rev 270 = $150.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BUTTON TRACH,270,RC,27000060,CDM,,,,,,both,,,489.0000,73.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,157.95,,,,,,,126.2100,489.0000,percent of total billed charges,32.3% of $489.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BUTTON TRACH,270,RC,27000060,CDM,,,,,,both,,,489.0000,73.3500,WELLCARE,WELLCARE MEDICAID,489.00,,,,,,,126.2100,489.0000,percent of total billed charges,100% of $489.00 in Billed Charges for Rev 270 = $489.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,5183.4300,777.5100,AETNA,AETNA,2213.32,,,,,,,1337.8400,5183.4300,percent of total billed charges,"42.7% of $5,183.43 in Billed Charges for Rev 272 = $2,213.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,5183.4300,777.5100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3628.40,,,,,,,1337.8400,5183.4300,percent of total billed charges,"Rev 272 $5,183.43 in Billed Charges at 70% = $3,628.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,5183.4300,777.5100,CIGNA HEALTHCARE,CIGNA HMO,2161.49,,,,,,,1337.8400,5183.4300,percent of total billed charges,"41.7% of $5,183.43 in Billed Charges for Rev 272 = $2,161.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,5183.4300,777.5100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2405.11,,,,,,,1337.8400,5183.4300,percent of total billed charges,"46.4% of $5,183.43 in Billed Charges for Rev 272 = $2,405.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,5183.4300,777.5100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2161.49,,,,,,,1337.8400,5183.4300,percent of total billed charges,"41.7% of $5,183.43 in Billed Charges for Rev 272 = $2,161.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,5183.4300,777.5100,CIGNA HEALTHCARE,CIGNA PPO,2161.49,,,,,,,1337.8400,5183.4300,percent of total billed charges,"41.7% of $5,183.43 in Billed Charges for Rev 272 = $2,161.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,5183.4300,777.5100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4665.09,,,,,,,1337.8400,5183.4300,percent of total billed charges,"90% of $5,183.43 in Billed Charges for Rev 272 = $4,665.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,5183.4300,777.5100,MEDCOST,MEDCOST VHN,2466.79,,,,,,,1337.8400,5183.4300,percent of total billed charges,"47.59% of $5,183.43 in Billed Charges for Rev 272 = $2,466.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,5183.4300,777.5100,SENTARA HEALTH,SENTARA HEALTH,1337.84,,,,,,,1337.8400,5183.4300,percent of total billed charges,"25.81% of $5,183.43 in Billed Charges for Rev 272 = $1,337.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,5183.4300,777.5100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5183.43,,,,,,,1337.8400,5183.4300,percent of total billed charges,"100% of $5,183.43 in Billed Charges for Rev 272 = $5,183.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,5183.4300,777.5100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2591.72,,,,,,,1337.8400,5183.4300,percent of total billed charges,"Rev 272 $5,183.43 in Billed Charges at 50% = $2,591.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,5183.4300,777.5100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1674.25,,,,,,,1337.8400,5183.4300,other,"32.3% of $5,183.43 in Billed Charges for Rev 272 = $1,674.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,5183.4300,777.5100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1591.31,,,,,,,1337.8400,5183.4300,other,"30.7% of $5,183.43 in Billed Charges for Rev 272 = $1,591.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,5183.4300,777.5100,UNITED HEALTHCARE,UNITED HEALTHCARE,1674.25,,,,,,,1337.8400,5183.4300,percent of total billed charges,"32.3% of $5,183.43 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,5183.4300,777.5100,WELLCARE,WELLCARE MEDICAID,5183.43,,,,,,,1337.8400,5183.4300,percent of total billed charges,"100% of $5,183.43 in Billed Charges for Rev 272 = $5,183.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,373.5600,56.0300,AETNA,AETNA,159.51,,,,,,,96.4200,373.5600,percent of total billed charges,42.7% of $373.56 in Billed Charges for Rev 272 = $159.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,373.5600,56.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,261.49,,,,,,,96.4200,373.5600,percent of total billed charges,Rev 272 $373.56 in Billed Charges at 70% = $261.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,373.5600,56.0300,CIGNA HEALTHCARE,CIGNA HMO,155.77,,,,,,,96.4200,373.5600,percent of total billed charges,41.7% of $373.56 in Billed Charges for Rev 272 = $155.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,373.5600,56.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,173.33,,,,,,,96.4200,373.5600,percent of total billed charges,46.4% of $373.56 in Billed Charges for Rev 272 = $173.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,373.5600,56.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,155.77,,,,,,,96.4200,373.5600,percent of total billed charges,41.7% of $373.56 in Billed Charges for Rev 272 = $155.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,373.5600,56.0300,CIGNA HEALTHCARE,CIGNA PPO,155.77,,,,,,,96.4200,373.5600,percent of total billed charges,41.7% of $373.56 in Billed Charges for Rev 272 = $155.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,373.5600,56.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,336.20,,,,,,,96.4200,373.5600,percent of total billed charges,90% of $373.56 in Billed Charges for Rev 272 = $336.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,373.5600,56.0300,MEDCOST,MEDCOST VHN,177.78,,,,,,,96.4200,373.5600,percent of total billed charges,47.59% of $373.56 in Billed Charges for Rev 272 = $177.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,373.5600,56.0300,SENTARA HEALTH,SENTARA HEALTH,96.42,,,,,,,96.4200,373.5600,percent of total billed charges,25.81% of $373.56 in Billed Charges for Rev 272 = $96.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,373.5600,56.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",373.56,,,,,,,96.4200,373.5600,percent of total billed charges,100% of $373.56 in Billed Charges for Rev 272 = $373.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,373.5600,56.0300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,186.78,,,,,,,96.4200,373.5600,percent of total billed charges,Rev 272 $373.56 in Billed Charges at 50% = $186.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,373.5600,56.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,120.66,,,,,,,96.4200,373.5600,other,32.3% of $373.56 in Billed Charges for Rev 272 = $120.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,373.5600,56.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,114.68,,,,,,,96.4200,373.5600,other,30.7% of $373.56 in Billed Charges for Rev 272 = $114.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,373.5600,56.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,120.66,,,,,,,96.4200,373.5600,percent of total billed charges,32.3% of $373.56 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,373.5600,56.0300,WELLCARE,WELLCARE MEDICAID,373.56,,,,,,,96.4200,373.5600,percent of total billed charges,100% of $373.56 in Billed Charges for Rev 272 = $373.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 10 5454S,272,RC,27200476,CDM,,,,,,both,,,548.0000,82.2000,AETNA,AETNA,234.00,,,,,,,141.4400,548.0000,percent of total billed charges,42.7% of $548.00 in Billed Charges for Rev 272 = $234.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 10 5454S,272,RC,27200476,CDM,,,,,,both,,,548.0000,82.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,383.60,,,,,,,141.4400,548.0000,percent of total billed charges,Rev 272 $548.00 in Billed Charges at 70% = $383.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 10 5454S,272,RC,27200476,CDM,,,,,,both,,,548.0000,82.2000,CIGNA HEALTHCARE,CIGNA HMO,228.52,,,,,,,141.4400,548.0000,percent of total billed charges,41.7% of $548.00 in Billed Charges for Rev 272 = $228.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 10 5454S,272,RC,27200476,CDM,,,,,,both,,,548.0000,82.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,254.27,,,,,,,141.4400,548.0000,percent of total billed charges,46.4% of $548.00 in Billed Charges for Rev 272 = $254.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 10 5454S,272,RC,27200476,CDM,,,,,,both,,,548.0000,82.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.52,,,,,,,141.4400,548.0000,percent of total billed charges,41.7% of $548.00 in Billed Charges for Rev 272 = $228.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 10 5454S,272,RC,27200476,CDM,,,,,,both,,,548.0000,82.2000,CIGNA HEALTHCARE,CIGNA PPO,228.52,,,,,,,141.4400,548.0000,percent of total billed charges,41.7% of $548.00 in Billed Charges for Rev 272 = $228.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 10 5454S,272,RC,27200476,CDM,,,,,,both,,,548.0000,82.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,493.20,,,,,,,141.4400,548.0000,percent of total billed charges,90% of $548.00 in Billed Charges for Rev 272 = $493.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 10 5454S,272,RC,27200476,CDM,,,,,,both,,,548.0000,82.2000,MEDCOST,MEDCOST VHN,260.79,,,,,,,141.4400,548.0000,percent of total billed charges,47.59% of $548.00 in Billed Charges for Rev 272 = $260.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 10 5454S,272,RC,27200476,CDM,,,,,,both,,,548.0000,82.2000,SENTARA HEALTH,SENTARA HEALTH,141.44,,,,,,,141.4400,548.0000,percent of total billed charges,25.81% of $548.00 in Billed Charges for Rev 272 = $141.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 10 5454S,272,RC,27200476,CDM,,,,,,both,,,548.0000,82.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",548.00,,,,,,,141.4400,548.0000,percent of total billed charges,100% of $548.00 in Billed Charges for Rev 272 = $548.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 10 5454S,272,RC,27200476,CDM,,,,,,both,,,548.0000,82.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,274.00,,,,,,,141.4400,548.0000,percent of total billed charges,Rev 272 $548.00 in Billed Charges at 50% = $274.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 10 5454S,272,RC,27200476,CDM,,,,,,both,,,548.0000,82.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,177.00,,,,,,,141.4400,548.0000,other,32.3% of $548.00 in Billed Charges for Rev 272 = $177.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CABLE 10 5454S,272,RC,27200476,CDM,,,,,,both,,,548.0000,82.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,168.24,,,,,,,141.4400,548.0000,other,30.7% of $548.00 in Billed Charges for Rev 272 = $168.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CABLE 10 5454S,272,RC,27200476,CDM,,,,,,both,,,548.0000,82.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,177.00,,,,,,,141.4400,548.0000,percent of total billed charges,32.3% of $548.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE 10 5454S,272,RC,27200476,CDM,,,,,,both,,,548.0000,82.2000,WELLCARE,WELLCARE MEDICAID,548.00,,,,,,,141.4400,548.0000,percent of total billed charges,100% of $548.00 in Billed Charges for Rev 272 = $548.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION 85641,272,RC,27200481,CDM,,,,,,both,,,657.0000,98.5500,AETNA,AETNA,280.54,,,,,,,169.5700,657.0000,percent of total billed charges,42.7% of $657.00 in Billed Charges for Rev 272 = $280.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION 85641,272,RC,27200481,CDM,,,,,,both,,,657.0000,98.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,459.90,,,,,,,169.5700,657.0000,percent of total billed charges,Rev 272 $657.00 in Billed Charges at 70% = $459.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION 85641,272,RC,27200481,CDM,,,,,,both,,,657.0000,98.5500,CIGNA HEALTHCARE,CIGNA HMO,273.97,,,,,,,169.5700,657.0000,percent of total billed charges,41.7% of $657.00 in Billed Charges for Rev 272 = $273.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION 85641,272,RC,27200481,CDM,,,,,,both,,,657.0000,98.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,304.85,,,,,,,169.5700,657.0000,percent of total billed charges,46.4% of $657.00 in Billed Charges for Rev 272 = $304.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION 85641,272,RC,27200481,CDM,,,,,,both,,,657.0000,98.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,273.97,,,,,,,169.5700,657.0000,percent of total billed charges,41.7% of $657.00 in Billed Charges for Rev 272 = $273.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION 85641,272,RC,27200481,CDM,,,,,,both,,,657.0000,98.5500,CIGNA HEALTHCARE,CIGNA PPO,273.97,,,,,,,169.5700,657.0000,percent of total billed charges,41.7% of $657.00 in Billed Charges for Rev 272 = $273.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION 85641,272,RC,27200481,CDM,,,,,,both,,,657.0000,98.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,591.30,,,,,,,169.5700,657.0000,percent of total billed charges,90% of $657.00 in Billed Charges for Rev 272 = $591.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION 85641,272,RC,27200481,CDM,,,,,,both,,,657.0000,98.5500,MEDCOST,MEDCOST VHN,312.67,,,,,,,169.5700,657.0000,percent of total billed charges,47.59% of $657.00 in Billed Charges for Rev 272 = $312.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION 85641,272,RC,27200481,CDM,,,,,,both,,,657.0000,98.5500,SENTARA HEALTH,SENTARA HEALTH,169.57,,,,,,,169.5700,657.0000,percent of total billed charges,25.81% of $657.00 in Billed Charges for Rev 272 = $169.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION 85641,272,RC,27200481,CDM,,,,,,both,,,657.0000,98.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",657.00,,,,,,,169.5700,657.0000,percent of total billed charges,100% of $657.00 in Billed Charges for Rev 272 = $657.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION 85641,272,RC,27200481,CDM,,,,,,both,,,657.0000,98.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,328.50,,,,,,,169.5700,657.0000,percent of total billed charges,Rev 272 $657.00 in Billed Charges at 50% = $328.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION 85641,272,RC,27200481,CDM,,,,,,both,,,657.0000,98.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,212.21,,,,,,,169.5700,657.0000,other,32.3% of $657.00 in Billed Charges for Rev 272 = $212.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CABLE ABLATION 85641,272,RC,27200481,CDM,,,,,,both,,,657.0000,98.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,201.70,,,,,,,169.5700,657.0000,other,30.7% of $657.00 in Billed Charges for Rev 272 = $201.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CABLE ABLATION 85641,272,RC,27200481,CDM,,,,,,both,,,657.0000,98.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,212.21,,,,,,,169.5700,657.0000,percent of total billed charges,32.3% of $657.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION 85641,272,RC,27200481,CDM,,,,,,both,,,657.0000,98.5500,WELLCARE,WELLCARE MEDICAID,657.00,,,,,,,169.5700,657.0000,percent of total billed charges,100% of $657.00 in Billed Charges for Rev 272 = $657.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION CRYO 2035U,272,RC,27200482,CDM,,,,,,both,,,812.0000,121.8000,AETNA,AETNA,346.72,,,,,,,209.5800,812.0000,percent of total billed charges,42.7% of $812.00 in Billed Charges for Rev 272 = $346.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION CRYO 2035U,272,RC,27200482,CDM,,,,,,both,,,812.0000,121.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,568.40,,,,,,,209.5800,812.0000,percent of total billed charges,Rev 272 $812.00 in Billed Charges at 70% = $568.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION CRYO 2035U,272,RC,27200482,CDM,,,,,,both,,,812.0000,121.8000,CIGNA HEALTHCARE,CIGNA HMO,338.60,,,,,,,209.5800,812.0000,percent of total billed charges,41.7% of $812.00 in Billed Charges for Rev 272 = $338.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION CRYO 2035U,272,RC,27200482,CDM,,,,,,both,,,812.0000,121.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,376.77,,,,,,,209.5800,812.0000,percent of total billed charges,46.4% of $812.00 in Billed Charges for Rev 272 = $376.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION CRYO 2035U,272,RC,27200482,CDM,,,,,,both,,,812.0000,121.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,338.60,,,,,,,209.5800,812.0000,percent of total billed charges,41.7% of $812.00 in Billed Charges for Rev 272 = $338.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION CRYO 2035U,272,RC,27200482,CDM,,,,,,both,,,812.0000,121.8000,CIGNA HEALTHCARE,CIGNA PPO,338.60,,,,,,,209.5800,812.0000,percent of total billed charges,41.7% of $812.00 in Billed Charges for Rev 272 = $338.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION CRYO 2035U,272,RC,27200482,CDM,,,,,,both,,,812.0000,121.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,730.80,,,,,,,209.5800,812.0000,percent of total billed charges,90% of $812.00 in Billed Charges for Rev 272 = $730.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION CRYO 2035U,272,RC,27200482,CDM,,,,,,both,,,812.0000,121.8000,MEDCOST,MEDCOST VHN,386.43,,,,,,,209.5800,812.0000,percent of total billed charges,47.59% of $812.00 in Billed Charges for Rev 272 = $386.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION CRYO 2035U,272,RC,27200482,CDM,,,,,,both,,,812.0000,121.8000,SENTARA HEALTH,SENTARA HEALTH,209.58,,,,,,,209.5800,812.0000,percent of total billed charges,25.81% of $812.00 in Billed Charges for Rev 272 = $209.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION CRYO 2035U,272,RC,27200482,CDM,,,,,,both,,,812.0000,121.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",812.00,,,,,,,209.5800,812.0000,percent of total billed charges,100% of $812.00 in Billed Charges for Rev 272 = $812.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION CRYO 2035U,272,RC,27200482,CDM,,,,,,both,,,812.0000,121.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,406.00,,,,,,,209.5800,812.0000,percent of total billed charges,Rev 272 $812.00 in Billed Charges at 50% = $406.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION CRYO 2035U,272,RC,27200482,CDM,,,,,,both,,,812.0000,121.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,262.28,,,,,,,209.5800,812.0000,other,32.3% of $812.00 in Billed Charges for Rev 272 = $262.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CABLE ABLATION CRYO 2035U,272,RC,27200482,CDM,,,,,,both,,,812.0000,121.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,249.28,,,,,,,209.5800,812.0000,other,30.7% of $812.00 in Billed Charges for Rev 272 = $249.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CABLE ABLATION CRYO 2035U,272,RC,27200482,CDM,,,,,,both,,,812.0000,121.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,262.28,,,,,,,209.5800,812.0000,percent of total billed charges,32.3% of $812.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE ABLATION CRYO 2035U,272,RC,27200482,CDM,,,,,,both,,,812.0000,121.8000,WELLCARE,WELLCARE MEDICAID,812.00,,,,,,,209.5800,812.0000,percent of total billed charges,100% of $812.00 in Billed Charges for Rev 272 = $812.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE R/F CONNECTOR,272,RC,27201380,CDM,,,,,,both,,,190.0000,28.5000,AETNA,AETNA,81.13,,,,,,,49.0400,190.0000,percent of total billed charges,42.7% of $190.00 in Billed Charges for Rev 272 = $81.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE R/F CONNECTOR,272,RC,27201380,CDM,,,,,,both,,,190.0000,28.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,133.00,,,,,,,49.0400,190.0000,percent of total billed charges,Rev 272 $190.00 in Billed Charges at 70% = $133.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE R/F CONNECTOR,272,RC,27201380,CDM,,,,,,both,,,190.0000,28.5000,CIGNA HEALTHCARE,CIGNA HMO,79.23,,,,,,,49.0400,190.0000,percent of total billed charges,41.7% of $190.00 in Billed Charges for Rev 272 = $79.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE R/F CONNECTOR,272,RC,27201380,CDM,,,,,,both,,,190.0000,28.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,88.16,,,,,,,49.0400,190.0000,percent of total billed charges,46.4% of $190.00 in Billed Charges for Rev 272 = $88.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE R/F CONNECTOR,272,RC,27201380,CDM,,,,,,both,,,190.0000,28.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,79.23,,,,,,,49.0400,190.0000,percent of total billed charges,41.7% of $190.00 in Billed Charges for Rev 272 = $79.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE R/F CONNECTOR,272,RC,27201380,CDM,,,,,,both,,,190.0000,28.5000,CIGNA HEALTHCARE,CIGNA PPO,79.23,,,,,,,49.0400,190.0000,percent of total billed charges,41.7% of $190.00 in Billed Charges for Rev 272 = $79.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE R/F CONNECTOR,272,RC,27201380,CDM,,,,,,both,,,190.0000,28.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,171.00,,,,,,,49.0400,190.0000,percent of total billed charges,90% of $190.00 in Billed Charges for Rev 272 = $171.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE R/F CONNECTOR,272,RC,27201380,CDM,,,,,,both,,,190.0000,28.5000,MEDCOST,MEDCOST VHN,90.42,,,,,,,49.0400,190.0000,percent of total billed charges,47.59% of $190.00 in Billed Charges for Rev 272 = $90.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE R/F CONNECTOR,272,RC,27201380,CDM,,,,,,both,,,190.0000,28.5000,SENTARA HEALTH,SENTARA HEALTH,49.04,,,,,,,49.0400,190.0000,percent of total billed charges,25.81% of $190.00 in Billed Charges for Rev 272 = $49.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE R/F CONNECTOR,272,RC,27201380,CDM,,,,,,both,,,190.0000,28.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",190.00,,,,,,,49.0400,190.0000,percent of total billed charges,100% of $190.00 in Billed Charges for Rev 272 = $190.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE R/F CONNECTOR,272,RC,27201380,CDM,,,,,,both,,,190.0000,28.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,95.00,,,,,,,49.0400,190.0000,percent of total billed charges,Rev 272 $190.00 in Billed Charges at 50% = $95.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE R/F CONNECTOR,272,RC,27201380,CDM,,,,,,both,,,190.0000,28.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,61.37,,,,,,,49.0400,190.0000,other,32.3% of $190.00 in Billed Charges for Rev 272 = $61.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CABLE R/F CONNECTOR,272,RC,27201380,CDM,,,,,,both,,,190.0000,28.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,58.33,,,,,,,49.0400,190.0000,other,30.7% of $190.00 in Billed Charges for Rev 272 = $58.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CABLE R/F CONNECTOR,272,RC,27201380,CDM,,,,,,both,,,190.0000,28.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,61.37,,,,,,,49.0400,190.0000,percent of total billed charges,32.3% of $190.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE R/F CONNECTOR,272,RC,27201380,CDM,,,,,,both,,,190.0000,28.5000,WELLCARE,WELLCARE MEDICAID,190.00,,,,,,,49.0400,190.0000,percent of total billed charges,100% of $190.00 in Billed Charges for Rev 272 = $190.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE TEMP 3F ABLATION 651,272,RC,27200483,CDM,,,,,,both,,,877.0000,131.5500,AETNA,AETNA,374.48,,,,,,,226.3500,877.0000,percent of total billed charges,42.7% of $877.00 in Billed Charges for Rev 272 = $374.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE TEMP 3F ABLATION 651,272,RC,27200483,CDM,,,,,,both,,,877.0000,131.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,613.90,,,,,,,226.3500,877.0000,percent of total billed charges,Rev 272 $877.00 in Billed Charges at 70% = $613.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE TEMP 3F ABLATION 651,272,RC,27200483,CDM,,,,,,both,,,877.0000,131.5500,CIGNA HEALTHCARE,CIGNA HMO,365.71,,,,,,,226.3500,877.0000,percent of total billed charges,41.7% of $877.00 in Billed Charges for Rev 272 = $365.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE TEMP 3F ABLATION 651,272,RC,27200483,CDM,,,,,,both,,,877.0000,131.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,406.93,,,,,,,226.3500,877.0000,percent of total billed charges,46.4% of $877.00 in Billed Charges for Rev 272 = $406.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE TEMP 3F ABLATION 651,272,RC,27200483,CDM,,,,,,both,,,877.0000,131.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,365.71,,,,,,,226.3500,877.0000,percent of total billed charges,41.7% of $877.00 in Billed Charges for Rev 272 = $365.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE TEMP 3F ABLATION 651,272,RC,27200483,CDM,,,,,,both,,,877.0000,131.5500,CIGNA HEALTHCARE,CIGNA PPO,365.71,,,,,,,226.3500,877.0000,percent of total billed charges,41.7% of $877.00 in Billed Charges for Rev 272 = $365.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE TEMP 3F ABLATION 651,272,RC,27200483,CDM,,,,,,both,,,877.0000,131.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,789.30,,,,,,,226.3500,877.0000,percent of total billed charges,90% of $877.00 in Billed Charges for Rev 272 = $789.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE TEMP 3F ABLATION 651,272,RC,27200483,CDM,,,,,,both,,,877.0000,131.5500,MEDCOST,MEDCOST VHN,417.36,,,,,,,226.3500,877.0000,percent of total billed charges,47.59% of $877.00 in Billed Charges for Rev 272 = $417.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE TEMP 3F ABLATION 651,272,RC,27200483,CDM,,,,,,both,,,877.0000,131.5500,SENTARA HEALTH,SENTARA HEALTH,226.35,,,,,,,226.3500,877.0000,percent of total billed charges,25.81% of $877.00 in Billed Charges for Rev 272 = $226.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE TEMP 3F ABLATION 651,272,RC,27200483,CDM,,,,,,both,,,877.0000,131.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",877.00,,,,,,,226.3500,877.0000,percent of total billed charges,100% of $877.00 in Billed Charges for Rev 272 = $877.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE TEMP 3F ABLATION 651,272,RC,27200483,CDM,,,,,,both,,,877.0000,131.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,438.50,,,,,,,226.3500,877.0000,percent of total billed charges,Rev 272 $877.00 in Billed Charges at 50% = $438.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE TEMP 3F ABLATION 651,272,RC,27200483,CDM,,,,,,both,,,877.0000,131.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,283.27,,,,,,,226.3500,877.0000,other,32.3% of $877.00 in Billed Charges for Rev 272 = $283.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CABLE TEMP 3F ABLATION 651,272,RC,27200483,CDM,,,,,,both,,,877.0000,131.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,269.24,,,,,,,226.3500,877.0000,other,30.7% of $877.00 in Billed Charges for Rev 272 = $269.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CABLE TEMP 3F ABLATION 651,272,RC,27200483,CDM,,,,,,both,,,877.0000,131.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,283.27,,,,,,,226.3500,877.0000,percent of total billed charges,32.3% of $877.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CABLE TEMP 3F ABLATION 651,272,RC,27200483,CDM,,,,,,both,,,877.0000,131.5500,WELLCARE,WELLCARE MEDICAID,877.00,,,,,,,226.3500,877.0000,percent of total billed charges,100% of $877.00 in Billed Charges for Rev 272 = $877.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAGE STEALTH CERVICAL PEEK 6MM DP10-1416607,278,RC,27801510,CDM,,,,,,both,,,2426.0000,363.9000,AETNA,AETNA,1164.48,,,,,,,626.1500,2426.0000,percent of total billed charges,"48% of $2,426.00 in Billed Charges for Rev 278 = $1,164.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CAGE STEALTH CERVICAL PEEK 6MM DP10-1416607,278,RC,27801510,CDM,,,,,,both,,,2426.0000,363.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1213.00,,,,,,,626.1500,2426.0000,percent of total billed charges,"50% of $2,426.00 in Billed Charges for Rev 278 = $1,213.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CAGE STEALTH CERVICAL PEEK 6MM DP10-1416607,278,RC,27801510,CDM,,,,,,both,,,2426.0000,363.9000,CIGNA HEALTHCARE,CIGNA HMO,1011.64,,,,,,,626.1500,2426.0000,percent of total billed charges,"41.7% of $2,426.00 in Billed Charges for Rev 278 = $1,011.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CAGE STEALTH CERVICAL PEEK 6MM DP10-1416607,278,RC,27801510,CDM,,,,,,both,,,2426.0000,363.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,970.40,,,,,,,626.1500,2426.0000,percent of total billed charges,"40% of $2,426.00 in Billed Charges for Rev 278 = $970.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CAGE STEALTH CERVICAL PEEK 6MM DP10-1416607,278,RC,27801510,CDM,,,,,,both,,,2426.0000,363.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1011.64,,,,,,,626.1500,2426.0000,percent of total billed charges,"41.7% of $2,426.00 in Billed Charges for Rev 278 = $1,011.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CAGE STEALTH CERVICAL PEEK 6MM DP10-1416607,278,RC,27801510,CDM,,,,,,both,,,2426.0000,363.9000,CIGNA HEALTHCARE,CIGNA PPO,1011.64,,,,,,,626.1500,2426.0000,percent of total billed charges,"41.7% of $2,426.00 in Billed Charges for Rev 278 = $1,011.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CAGE STEALTH CERVICAL PEEK 6MM DP10-1416607,278,RC,27801510,CDM,,,,,,both,,,2426.0000,363.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2183.40,,,,,,,626.1500,2426.0000,percent of total billed charges,"90% of $2,426.00 in Billed Charges for Rev 278 = $2,183.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CAGE STEALTH CERVICAL PEEK 6MM DP10-1416607,278,RC,27801510,CDM,,,,,,both,,,2426.0000,363.9000,MEDCOST,MEDCOST VHN,1154.53,,,,,,,626.1500,2426.0000,percent of total billed charges,"47.59% of $2,426.00 in Billed Charges for Rev 278 = $1,154.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CAGE STEALTH CERVICAL PEEK 6MM DP10-1416607,278,RC,27801510,CDM,,,,,,both,,,2426.0000,363.9000,SENTARA HEALTH,SENTARA HEALTH,626.15,,,,,,,626.1500,2426.0000,percent of total billed charges,"25.81% of $2,426.00 in Billed Charges for Rev 278 = $626.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CAGE STEALTH CERVICAL PEEK 6MM DP10-1416607,278,RC,27801510,CDM,,,,,,both,,,2426.0000,363.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2426.00,,,,,,,626.1500,2426.0000,percent of total billed charges,"100% of $2,426.00 in Billed Charges for Rev 278 = $2,426.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CAGE STEALTH CERVICAL PEEK 6MM DP10-1416607,278,RC,27801510,CDM,,,,,,both,,,2426.0000,363.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1213.00,,,,,,,626.1500,2426.0000,percent of total billed charges,"Rev 278 $2,426.00 in Billed Charges at 50% = $1,213.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CAGE STEALTH CERVICAL PEEK 6MM DP10-1416607,278,RC,27801510,CDM,,,,,,both,,,2426.0000,363.9000,WELLCARE,WELLCARE MEDICAID,2426.00,,,,,,,626.1500,2426.0000,percent of total billed charges,"100% of $2,426.00 in Billed Charges for Rev 278 = $2,426.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CANNISTER RENASYS EZ PLUS 800ML,270,RC,27000124,CDM,,,,,,both,,,127.0000,19.0500,AETNA,AETNA,54.23,,,,,,,32.7800,127.0000,percent of total billed charges,42.7% of $127.00 in Billed Charges for Rev 270 = $54.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CANNISTER RENASYS EZ PLUS 800ML,270,RC,27000124,CDM,,,,,,both,,,127.0000,19.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,88.90,,,,,,,32.7800,127.0000,percent of total billed charges,Rev 270 $127.00 in Billed Charges at 70% = $88.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CANNISTER RENASYS EZ PLUS 800ML,270,RC,27000124,CDM,,,,,,both,,,127.0000,19.0500,CIGNA HEALTHCARE,CIGNA HMO,52.96,,,,,,,32.7800,127.0000,percent of total billed charges,41.7% of $127.00 in Billed Charges for Rev 270 = $52.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CANNISTER RENASYS EZ PLUS 800ML,270,RC,27000124,CDM,,,,,,both,,,127.0000,19.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,58.93,,,,,,,32.7800,127.0000,percent of total billed charges,46.4% of $127.00 in Billed Charges for Rev 270 = $58.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CANNISTER RENASYS EZ PLUS 800ML,270,RC,27000124,CDM,,,,,,both,,,127.0000,19.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,52.96,,,,,,,32.7800,127.0000,percent of total billed charges,41.7% of $127.00 in Billed Charges for Rev 270 = $52.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CANNISTER RENASYS EZ PLUS 800ML,270,RC,27000124,CDM,,,,,,both,,,127.0000,19.0500,CIGNA HEALTHCARE,CIGNA PPO,52.96,,,,,,,32.7800,127.0000,percent of total billed charges,41.7% of $127.00 in Billed Charges for Rev 270 = $52.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CANNISTER RENASYS EZ PLUS 800ML,270,RC,27000124,CDM,,,,,,both,,,127.0000,19.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,114.30,,,,,,,32.7800,127.0000,percent of total billed charges,90% of $127.00 in Billed Charges for Rev 270 = $114.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CANNISTER RENASYS EZ PLUS 800ML,270,RC,27000124,CDM,,,,,,both,,,127.0000,19.0500,MEDCOST,MEDCOST VHN,60.44,,,,,,,32.7800,127.0000,percent of total billed charges,47.59% of $127.00 in Billed Charges for Rev 270 = $60.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CANNISTER RENASYS EZ PLUS 800ML,270,RC,27000124,CDM,,,,,,both,,,127.0000,19.0500,SENTARA HEALTH,SENTARA HEALTH,32.78,,,,,,,32.7800,127.0000,percent of total billed charges,25.81% of $127.00 in Billed Charges for Rev 270 = $32.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CANNISTER RENASYS EZ PLUS 800ML,270,RC,27000124,CDM,,,,,,both,,,127.0000,19.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",127.00,,,,,,,32.7800,127.0000,percent of total billed charges,100% of $127.00 in Billed Charges for Rev 270 = $127.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CANNISTER RENASYS EZ PLUS 800ML,270,RC,27000124,CDM,,,,,,both,,,127.0000,19.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,63.50,,,,,,,32.7800,127.0000,percent of total billed charges,Rev 270 $127.00 in Billed Charges at 50% = $63.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CANNISTER RENASYS EZ PLUS 800ML,270,RC,27000124,CDM,,,,,,both,,,127.0000,19.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,41.02,,,,,,,32.7800,127.0000,other,32.3% of $127.00 in Billed Charges for Rev 270 = $41.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CANNISTER RENASYS EZ PLUS 800ML,270,RC,27000124,CDM,,,,,,both,,,127.0000,19.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,38.99,,,,,,,32.7800,127.0000,other,30.7% of $127.00 in Billed Charges for Rev 270 = $38.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CANNISTER RENASYS EZ PLUS 800ML,270,RC,27000124,CDM,,,,,,both,,,127.0000,19.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,41.02,,,,,,,32.7800,127.0000,percent of total billed charges,32.3% of $127.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CANNISTER RENASYS EZ PLUS 800ML,270,RC,27000124,CDM,,,,,,both,,,127.0000,19.0500,WELLCARE,WELLCARE MEDICAID,127.00,,,,,,,32.7800,127.0000,percent of total billed charges,100% of $127.00 in Billed Charges for Rev 270 = $127.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC REHAB PHASE III,943,RC,94300003,CDM,,,,,,both,,,3.0000,0.4500,AETNA,AETNA,1.28,,,,,,,0.7700,3.0000,percent of total billed charges,42.7% of $3.00 in Billed Charges for Rev 943 = $1.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC REHAB PHASE III,943,RC,94300003,CDM,,,,,,both,,,3.0000,0.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3.00,,,,,,,0.7700,3.0000,other,Rev 943 1 Visit at $116.00 per Visit = $116.00 (Limited to $3.00 in Billed Charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIAC REHAB PHASE III,943,RC,94300003,CDM,,,,,,both,,,3.0000,0.4500,CIGNA HEALTHCARE,CIGNA HMO,1.25,,,,,,,0.7700,3.0000,percent of total billed charges,41.7% of $3.00 in Billed Charges for Rev 943 = $1.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC REHAB PHASE III,943,RC,94300003,CDM,,,,,,both,,,3.0000,0.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1.39,,,,,,,0.7700,3.0000,percent of total billed charges,46.4% of $3.00 in Billed Charges for Rev 943 = $1.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC REHAB PHASE III,943,RC,94300003,CDM,,,,,,both,,,3.0000,0.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1.25,,,,,,,0.7700,3.0000,percent of total billed charges,41.7% of $3.00 in Billed Charges for Rev 943 = $1.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC REHAB PHASE III,943,RC,94300003,CDM,,,,,,both,,,3.0000,0.4500,CIGNA HEALTHCARE,CIGNA PPO,1.25,,,,,,,0.7700,3.0000,percent of total billed charges,41.7% of $3.00 in Billed Charges for Rev 943 = $1.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC REHAB PHASE III,943,RC,94300003,CDM,,,,,,both,,,3.0000,0.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2.70,,,,,,,0.7700,3.0000,percent of total billed charges,90% of $3.00 in Billed Charges for Rev 943 = $2.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC REHAB PHASE III,943,RC,94300003,CDM,,,,,,both,,,3.0000,0.4500,MEDCOST,MEDCOST VHN,1.43,,,,,,,0.7700,3.0000,percent of total billed charges,47.59% of $3.00 in Billed Charges for Rev 943 = $1.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC REHAB PHASE III,943,RC,94300003,CDM,,,,,,both,,,3.0000,0.4500,SENTARA HEALTH,SENTARA HEALTH,0.77,,,,,,,0.7700,3.0000,percent of total billed charges,25.81% of $3.00 in Billed Charges for Rev 943 = $0.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC REHAB PHASE III,943,RC,94300003,CDM,,,,,,both,,,3.0000,0.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3.00,,,,,,,0.7700,3.0000,percent of total billed charges,100% of $3.00 in Billed Charges for Rev 943 = $3.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC REHAB PHASE III,943,RC,94300003,CDM,,,,,,both,,,3.0000,0.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1.50,,,,,,,0.7700,3.0000,percent of total billed charges,Rev 943 $3.00 in Billed Charges at 50% = $1.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARDIAC REHAB PHASE III,943,RC,94300003,CDM,,,,,,both,,,3.0000,0.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3.00,,,,,,,0.7700,3.0000,other,"Rev 943 1 Visit at $163.00 per Visit = $163.00 (Service Line reduced to $3.00, claim capped at $3.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARDIAC REHAB PHASE III,943,RC,94300003,CDM,,,,,,both,,,3.0000,0.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3.00,,,,,,,0.7700,3.0000,other,"Rev 943 1 Visit at $157.00 per Visit = $157.00 (Service Line reduced to $3.00, claim capped at $3.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARDIAC REHAB PHASE III,943,RC,94300003,CDM,,,,,,both,,,3.0000,0.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,3.00,,,,,,,0.7700,3.0000,other,"Rev 943 1 Visit at $259.00 per Visit = $259.00 (Service Line reduced to $3.00, claim capped at $3.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARDIAC REHAB PHASE III,943,RC,94300003,CDM,,,,,,both,,,3.0000,0.4500,WELLCARE,WELLCARE MEDICAID,3.00,,,,,,,0.7700,3.0000,percent of total billed charges,100% of $3.00 in Billed Charges for Rev 943 = $3.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH AIRWAY C-CAE-19.0-83,272,RC,27202237,CDM,,,,,,both,,,578.0000,86.7000,AETNA,AETNA,246.81,,,,,,,149.1800,578.0000,percent of total billed charges,42.7% of $578.00 in Billed Charges for Rev 272 = $246.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH AIRWAY C-CAE-19.0-83,272,RC,27202237,CDM,,,,,,both,,,578.0000,86.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,404.60,,,,,,,149.1800,578.0000,percent of total billed charges,Rev 272 $578.00 in Billed Charges at 70% = $404.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH AIRWAY C-CAE-19.0-83,272,RC,27202237,CDM,,,,,,both,,,578.0000,86.7000,CIGNA HEALTHCARE,CIGNA HMO,241.03,,,,,,,149.1800,578.0000,percent of total billed charges,41.7% of $578.00 in Billed Charges for Rev 272 = $241.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH AIRWAY C-CAE-19.0-83,272,RC,27202237,CDM,,,,,,both,,,578.0000,86.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,268.19,,,,,,,149.1800,578.0000,percent of total billed charges,46.4% of $578.00 in Billed Charges for Rev 272 = $268.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH AIRWAY C-CAE-19.0-83,272,RC,27202237,CDM,,,,,,both,,,578.0000,86.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,241.03,,,,,,,149.1800,578.0000,percent of total billed charges,41.7% of $578.00 in Billed Charges for Rev 272 = $241.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH AIRWAY C-CAE-19.0-83,272,RC,27202237,CDM,,,,,,both,,,578.0000,86.7000,CIGNA HEALTHCARE,CIGNA PPO,241.03,,,,,,,149.1800,578.0000,percent of total billed charges,41.7% of $578.00 in Billed Charges for Rev 272 = $241.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH AIRWAY C-CAE-19.0-83,272,RC,27202237,CDM,,,,,,both,,,578.0000,86.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,520.20,,,,,,,149.1800,578.0000,percent of total billed charges,90% of $578.00 in Billed Charges for Rev 272 = $520.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH AIRWAY C-CAE-19.0-83,272,RC,27202237,CDM,,,,,,both,,,578.0000,86.7000,MEDCOST,MEDCOST VHN,275.07,,,,,,,149.1800,578.0000,percent of total billed charges,47.59% of $578.00 in Billed Charges for Rev 272 = $275.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH AIRWAY C-CAE-19.0-83,272,RC,27202237,CDM,,,,,,both,,,578.0000,86.7000,SENTARA HEALTH,SENTARA HEALTH,149.18,,,,,,,149.1800,578.0000,percent of total billed charges,25.81% of $578.00 in Billed Charges for Rev 272 = $149.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH AIRWAY C-CAE-19.0-83,272,RC,27202237,CDM,,,,,,both,,,578.0000,86.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",578.00,,,,,,,149.1800,578.0000,percent of total billed charges,100% of $578.00 in Billed Charges for Rev 272 = $578.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH AIRWAY C-CAE-19.0-83,272,RC,27202237,CDM,,,,,,both,,,578.0000,86.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,289.00,,,,,,,149.1800,578.0000,percent of total billed charges,Rev 272 $578.00 in Billed Charges at 50% = $289.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH AIRWAY C-CAE-19.0-83,272,RC,27202237,CDM,,,,,,both,,,578.0000,86.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,186.69,,,,,,,149.1800,578.0000,other,32.3% of $578.00 in Billed Charges for Rev 272 = $186.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH AIRWAY C-CAE-19.0-83,272,RC,27202237,CDM,,,,,,both,,,578.0000,86.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,177.45,,,,,,,149.1800,578.0000,other,30.7% of $578.00 in Billed Charges for Rev 272 = $177.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH AIRWAY C-CAE-19.0-83,272,RC,27202237,CDM,,,,,,both,,,578.0000,86.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,186.69,,,,,,,149.1800,578.0000,percent of total billed charges,32.3% of $578.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH AIRWAY C-CAE-19.0-83,272,RC,27202237,CDM,,,,,,both,,,578.0000,86.7000,WELLCARE,WELLCARE MEDICAID,578.00,,,,,,,149.1800,578.0000,percent of total billed charges,100% of $578.00 in Billed Charges for Rev 272 = $578.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERIAL LINE 20 GA PTFE KIT,272,RC,27201507,CDM,,,,,,both,,,60.0000,9.0000,AETNA,AETNA,25.62,,,,,,,15.4900,60.0000,percent of total billed charges,42.7% of $60.00 in Billed Charges for Rev 272 = $25.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERIAL LINE 20 GA PTFE KIT,272,RC,27201507,CDM,,,,,,both,,,60.0000,9.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,42.00,,,,,,,15.4900,60.0000,percent of total billed charges,Rev 272 $60.00 in Billed Charges at 70% = $42.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERIAL LINE 20 GA PTFE KIT,272,RC,27201507,CDM,,,,,,both,,,60.0000,9.0000,CIGNA HEALTHCARE,CIGNA HMO,25.02,,,,,,,15.4900,60.0000,percent of total billed charges,41.7% of $60.00 in Billed Charges for Rev 272 = $25.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERIAL LINE 20 GA PTFE KIT,272,RC,27201507,CDM,,,,,,both,,,60.0000,9.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,27.84,,,,,,,15.4900,60.0000,percent of total billed charges,46.4% of $60.00 in Billed Charges for Rev 272 = $27.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERIAL LINE 20 GA PTFE KIT,272,RC,27201507,CDM,,,,,,both,,,60.0000,9.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,25.02,,,,,,,15.4900,60.0000,percent of total billed charges,41.7% of $60.00 in Billed Charges for Rev 272 = $25.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERIAL LINE 20 GA PTFE KIT,272,RC,27201507,CDM,,,,,,both,,,60.0000,9.0000,CIGNA HEALTHCARE,CIGNA PPO,25.02,,,,,,,15.4900,60.0000,percent of total billed charges,41.7% of $60.00 in Billed Charges for Rev 272 = $25.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERIAL LINE 20 GA PTFE KIT,272,RC,27201507,CDM,,,,,,both,,,60.0000,9.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,54.00,,,,,,,15.4900,60.0000,percent of total billed charges,90% of $60.00 in Billed Charges for Rev 272 = $54.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERIAL LINE 20 GA PTFE KIT,272,RC,27201507,CDM,,,,,,both,,,60.0000,9.0000,MEDCOST,MEDCOST VHN,28.55,,,,,,,15.4900,60.0000,percent of total billed charges,47.59% of $60.00 in Billed Charges for Rev 272 = $28.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERIAL LINE 20 GA PTFE KIT,272,RC,27201507,CDM,,,,,,both,,,60.0000,9.0000,SENTARA HEALTH,SENTARA HEALTH,15.49,,,,,,,15.4900,60.0000,percent of total billed charges,25.81% of $60.00 in Billed Charges for Rev 272 = $15.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERIAL LINE 20 GA PTFE KIT,272,RC,27201507,CDM,,,,,,both,,,60.0000,9.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",60.00,,,,,,,15.4900,60.0000,percent of total billed charges,100% of $60.00 in Billed Charges for Rev 272 = $60.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERIAL LINE 20 GA PTFE KIT,272,RC,27201507,CDM,,,,,,both,,,60.0000,9.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,30.00,,,,,,,15.4900,60.0000,percent of total billed charges,Rev 272 $60.00 in Billed Charges at 50% = $30.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERIAL LINE 20 GA PTFE KIT,272,RC,27201507,CDM,,,,,,both,,,60.0000,9.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,19.38,,,,,,,15.4900,60.0000,other,32.3% of $60.00 in Billed Charges for Rev 272 = $19.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH ARTERIAL LINE 20 GA PTFE KIT,272,RC,27201507,CDM,,,,,,both,,,60.0000,9.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,18.42,,,,,,,15.4900,60.0000,other,30.7% of $60.00 in Billed Charges for Rev 272 = $18.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH ARTERIAL LINE 20 GA PTFE KIT,272,RC,27201507,CDM,,,,,,both,,,60.0000,9.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,19.38,,,,,,,15.4900,60.0000,percent of total billed charges,32.3% of $60.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ARTERIAL LINE 20 GA PTFE KIT,272,RC,27201507,CDM,,,,,,both,,,60.0000,9.0000,WELLCARE,WELLCARE MEDICAID,60.00,,,,,,,15.4900,60.0000,percent of total billed charges,100% of $60.00 in Billed Charges for Rev 272 = $60.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON INOUE 28MM,272,RC,27201977,CDM,,,,,,both,,,6104.0000,915.6000,AETNA,AETNA,2606.41,,,,,,,1575.4400,6104.0000,percent of total billed charges,"42.7% of $6,104.00 in Billed Charges for Rev 272 = $2,606.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH BALLOON INOUE 28MM,272,RC,27201977,CDM,,,,,,both,,,6104.0000,915.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4272.80,,,,,,,1575.4400,6104.0000,percent of total billed charges,"Rev 272 $6,104.00 in Billed Charges at 70% = $4,272.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH BALLOON INOUE 28MM,272,RC,27201977,CDM,,,,,,both,,,6104.0000,915.6000,CIGNA HEALTHCARE,CIGNA HMO,2545.37,,,,,,,1575.4400,6104.0000,percent of total billed charges,"41.7% of $6,104.00 in Billed Charges for Rev 272 = $2,545.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH BALLOON INOUE 28MM,272,RC,27201977,CDM,,,,,,both,,,6104.0000,915.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2832.26,,,,,,,1575.4400,6104.0000,percent of total billed charges,"46.4% of $6,104.00 in Billed Charges for Rev 272 = $2,832.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH BALLOON INOUE 28MM,272,RC,27201977,CDM,,,,,,both,,,6104.0000,915.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2545.37,,,,,,,1575.4400,6104.0000,percent of total billed charges,"41.7% of $6,104.00 in Billed Charges for Rev 272 = $2,545.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH BALLOON INOUE 28MM,272,RC,27201977,CDM,,,,,,both,,,6104.0000,915.6000,CIGNA HEALTHCARE,CIGNA PPO,2545.37,,,,,,,1575.4400,6104.0000,percent of total billed charges,"41.7% of $6,104.00 in Billed Charges for Rev 272 = $2,545.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH BALLOON INOUE 28MM,272,RC,27201977,CDM,,,,,,both,,,6104.0000,915.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5493.60,,,,,,,1575.4400,6104.0000,percent of total billed charges,"90% of $6,104.00 in Billed Charges for Rev 272 = $5,493.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH BALLOON INOUE 28MM,272,RC,27201977,CDM,,,,,,both,,,6104.0000,915.6000,MEDCOST,MEDCOST VHN,2904.89,,,,,,,1575.4400,6104.0000,percent of total billed charges,"47.59% of $6,104.00 in Billed Charges for Rev 272 = $2,904.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH BALLOON INOUE 28MM,272,RC,27201977,CDM,,,,,,both,,,6104.0000,915.6000,SENTARA HEALTH,SENTARA HEALTH,1575.44,,,,,,,1575.4400,6104.0000,percent of total billed charges,"25.81% of $6,104.00 in Billed Charges for Rev 272 = $1,575.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH BALLOON INOUE 28MM,272,RC,27201977,CDM,,,,,,both,,,6104.0000,915.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6104.00,,,,,,,1575.4400,6104.0000,percent of total billed charges,"100% of $6,104.00 in Billed Charges for Rev 272 = $6,104.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH BALLOON INOUE 28MM,272,RC,27201977,CDM,,,,,,both,,,6104.0000,915.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3052.00,,,,,,,1575.4400,6104.0000,percent of total billed charges,"Rev 272 $6,104.00 in Billed Charges at 50% = $3,052.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH BALLOON INOUE 28MM,272,RC,27201977,CDM,,,,,,both,,,6104.0000,915.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1971.59,,,,,,,1575.4400,6104.0000,other,"32.3% of $6,104.00 in Billed Charges for Rev 272 = $1,971.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH BALLOON INOUE 28MM,272,RC,27201977,CDM,,,,,,both,,,6104.0000,915.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1873.93,,,,,,,1575.4400,6104.0000,other,"30.7% of $6,104.00 in Billed Charges for Rev 272 = $1,873.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH BALLOON INOUE 28MM,272,RC,27201977,CDM,,,,,,both,,,6104.0000,915.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,1971.59,,,,,,,1575.4400,6104.0000,percent of total billed charges,"32.3% of $6,104.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH BALLOON INOUE 28MM,272,RC,27201977,CDM,,,,,,both,,,6104.0000,915.6000,WELLCARE,WELLCARE MEDICAID,6104.00,,,,,,,1575.4400,6104.0000,percent of total billed charges,"100% of $6,104.00 in Billed Charges for Rev 272 = $6,104.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABL SPINE LIF BATTALION,272,RC,27200002,CDM,,,,,,both,,,6896.7200,1034.5100,AETNA,AETNA,2944.90,,,,,,,1780.0400,6896.7200,percent of total billed charges,"42.7% of $6,896.72 in Billed Charges for Rev 272 = $2,944.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABL SPINE LIF BATTALION,272,RC,27200002,CDM,,,,,,both,,,6896.7200,1034.5100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4827.70,,,,,,,1780.0400,6896.7200,percent of total billed charges,"Rev 272 $6,896.72 in Billed Charges at 70% = $4,827.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABL SPINE LIF BATTALION,272,RC,27200002,CDM,,,,,,both,,,6896.7200,1034.5100,CIGNA HEALTHCARE,CIGNA HMO,2875.93,,,,,,,1780.0400,6896.7200,percent of total billed charges,"41.7% of $6,896.72 in Billed Charges for Rev 272 = $2,875.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABL SPINE LIF BATTALION,272,RC,27200002,CDM,,,,,,both,,,6896.7200,1034.5100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3200.08,,,,,,,1780.0400,6896.7200,percent of total billed charges,"46.4% of $6,896.72 in Billed Charges for Rev 272 = $3,200.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABL SPINE LIF BATTALION,272,RC,27200002,CDM,,,,,,both,,,6896.7200,1034.5100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2875.93,,,,,,,1780.0400,6896.7200,percent of total billed charges,"41.7% of $6,896.72 in Billed Charges for Rev 272 = $2,875.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABL SPINE LIF BATTALION,272,RC,27200002,CDM,,,,,,both,,,6896.7200,1034.5100,CIGNA HEALTHCARE,CIGNA PPO,2875.93,,,,,,,1780.0400,6896.7200,percent of total billed charges,"41.7% of $6,896.72 in Billed Charges for Rev 272 = $2,875.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABL SPINE LIF BATTALION,272,RC,27200002,CDM,,,,,,both,,,6896.7200,1034.5100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6207.05,,,,,,,1780.0400,6896.7200,percent of total billed charges,"90% of $6,896.72 in Billed Charges for Rev 272 = $6,207.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABL SPINE LIF BATTALION,272,RC,27200002,CDM,,,,,,both,,,6896.7200,1034.5100,MEDCOST,MEDCOST VHN,3282.15,,,,,,,1780.0400,6896.7200,percent of total billed charges,"47.59% of $6,896.72 in Billed Charges for Rev 272 = $3,282.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABL SPINE LIF BATTALION,272,RC,27200002,CDM,,,,,,both,,,6896.7200,1034.5100,SENTARA HEALTH,SENTARA HEALTH,1780.04,,,,,,,1780.0400,6896.7200,percent of total billed charges,"25.81% of $6,896.72 in Billed Charges for Rev 272 = $1,780.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABL SPINE LIF BATTALION,272,RC,27200002,CDM,,,,,,both,,,6896.7200,1034.5100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6896.72,,,,,,,1780.0400,6896.7200,percent of total billed charges,"100% of $6,896.72 in Billed Charges for Rev 272 = $6,896.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABL SPINE LIF BATTALION,272,RC,27200002,CDM,,,,,,both,,,6896.7200,1034.5100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3448.36,,,,,,,1780.0400,6896.7200,percent of total billed charges,"Rev 272 $6,896.72 in Billed Charges at 50% = $3,448.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABL SPINE LIF BATTALION,272,RC,27200002,CDM,,,,,,both,,,6896.7200,1034.5100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2227.64,,,,,,,1780.0400,6896.7200,other,"32.3% of $6,896.72 in Billed Charges for Rev 272 = $2,227.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGHT CABL SPINE LIF BATTALION,272,RC,27200002,CDM,,,,,,both,,,6896.7200,1034.5100,UNITED HEALTHCARE,UHC HERITAGE SELECT,2117.29,,,,,,,1780.0400,6896.7200,other,"30.7% of $6,896.72 in Billed Charges for Rev 272 = $2,117.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGHT CABL SPINE LIF BATTALION,272,RC,27200002,CDM,,,,,,both,,,6896.7200,1034.5100,UNITED HEALTHCARE,UNITED HEALTHCARE,2227.64,,,,,,,1780.0400,6896.7200,percent of total billed charges,"32.3% of $6,896.72 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABL SPINE LIF BATTALION,272,RC,27200002,CDM,,,,,,both,,,6896.7200,1034.5100,WELLCARE,WELLCARE MEDICAID,6896.72,,,,,,,1780.0400,6896.7200,percent of total billed charges,"100% of $6,896.72 in Billed Charges for Rev 272 = $6,896.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABLE TIP BATTALION LLIF BIFURCATED,272,RC,,,,,,,,both,,,6232.4500,934.8700,AETNA,AETNA,2661.26,,,,,,,1608.6000,6232.4500,percent of total billed charges,"42.7% of $6,232.45 in Billed Charges for Rev 272 = $2,661.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABLE TIP BATTALION LLIF BIFURCATED,272,RC,,,,,,,,both,,,6232.4500,934.8700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4362.72,,,,,,,1608.6000,6232.4500,percent of total billed charges,"Rev 272 $6,232.45 in Billed Charges at 70% = $4,362.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABLE TIP BATTALION LLIF BIFURCATED,272,RC,,,,,,,,both,,,6232.4500,934.8700,CIGNA HEALTHCARE,CIGNA HMO,2598.93,,,,,,,1608.6000,6232.4500,percent of total billed charges,"41.7% of $6,232.45 in Billed Charges for Rev 272 = $2,598.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABLE TIP BATTALION LLIF BIFURCATED,272,RC,,,,,,,,both,,,6232.4500,934.8700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2891.86,,,,,,,1608.6000,6232.4500,percent of total billed charges,"46.4% of $6,232.45 in Billed Charges for Rev 272 = $2,891.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABLE TIP BATTALION LLIF BIFURCATED,272,RC,,,,,,,,both,,,6232.4500,934.8700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2598.93,,,,,,,1608.6000,6232.4500,percent of total billed charges,"41.7% of $6,232.45 in Billed Charges for Rev 272 = $2,598.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABLE TIP BATTALION LLIF BIFURCATED,272,RC,,,,,,,,both,,,6232.4500,934.8700,CIGNA HEALTHCARE,CIGNA PPO,2598.93,,,,,,,1608.6000,6232.4500,percent of total billed charges,"41.7% of $6,232.45 in Billed Charges for Rev 272 = $2,598.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABLE TIP BATTALION LLIF BIFURCATED,272,RC,,,,,,,,both,,,6232.4500,934.8700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5609.21,,,,,,,1608.6000,6232.4500,percent of total billed charges,"90% of $6,232.45 in Billed Charges for Rev 272 = $5,609.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABLE TIP BATTALION LLIF BIFURCATED,272,RC,,,,,,,,both,,,6232.4500,934.8700,MEDCOST,MEDCOST VHN,2966.02,,,,,,,1608.6000,6232.4500,percent of total billed charges,"47.59% of $6,232.45 in Billed Charges for Rev 272 = $2,966.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABLE TIP BATTALION LLIF BIFURCATED,272,RC,,,,,,,,both,,,6232.4500,934.8700,SENTARA HEALTH,SENTARA HEALTH,1608.60,,,,,,,1608.6000,6232.4500,percent of total billed charges,"25.81% of $6,232.45 in Billed Charges for Rev 272 = $1,608.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABLE TIP BATTALION LLIF BIFURCATED,272,RC,,,,,,,,both,,,6232.4500,934.8700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6232.45,,,,,,,1608.6000,6232.4500,percent of total billed charges,"100% of $6,232.45 in Billed Charges for Rev 272 = $6,232.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABLE TIP BATTALION LLIF BIFURCATED,272,RC,,,,,,,,both,,,6232.4500,934.8700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3116.23,,,,,,,1608.6000,6232.4500,percent of total billed charges,"Rev 272 $6,232.45 in Billed Charges at 50% = $3,116.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABLE TIP BATTALION LLIF BIFURCATED,272,RC,,,,,,,,both,,,6232.4500,934.8700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2013.08,,,,,,,1608.6000,6232.4500,other,"32.3% of $6,232.45 in Billed Charges for Rev 272 = $2,013.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGHT CABLE TIP BATTALION LLIF BIFURCATED,272,RC,,,,,,,,both,,,6232.4500,934.8700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1913.36,,,,,,,1608.6000,6232.4500,other,"30.7% of $6,232.45 in Billed Charges for Rev 272 = $1,913.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGHT CABLE TIP BATTALION LLIF BIFURCATED,272,RC,,,,,,,,both,,,6232.4500,934.8700,UNITED HEALTHCARE,UNITED HEALTHCARE,2013.08,,,,,,,1608.6000,6232.4500,percent of total billed charges,"32.3% of $6,232.45 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGHT CABLE TIP BATTALION LLIF BIFURCATED,272,RC,,,,,,,,both,,,6232.4500,934.8700,WELLCARE,WELLCARE MEDICAID,6232.45,,,,,,,1608.6000,6232.4500,percent of total billed charges,"100% of $6,232.45 in Billed Charges for Rev 272 = $6,232.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LITHOTRIPTOR LITHCRUSH 30MM,272,RC,,,,,,,,both,,,3197.2800,479.5900,AETNA,AETNA,1365.24,,,,,,,825.2200,3197.2800,percent of total billed charges,"42.7% of $3,197.28 in Billed Charges for Rev 272 = $1,365.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LITHOTRIPTOR LITHCRUSH 30MM,272,RC,,,,,,,,both,,,3197.2800,479.5900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2238.10,,,,,,,825.2200,3197.2800,percent of total billed charges,"Rev 272 $3,197.28 in Billed Charges at 70% = $2,238.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LITHOTRIPTOR LITHCRUSH 30MM,272,RC,,,,,,,,both,,,3197.2800,479.5900,CIGNA HEALTHCARE,CIGNA HMO,1333.27,,,,,,,825.2200,3197.2800,percent of total billed charges,"41.7% of $3,197.28 in Billed Charges for Rev 272 = $1,333.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LITHOTRIPTOR LITHCRUSH 30MM,272,RC,,,,,,,,both,,,3197.2800,479.5900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1483.54,,,,,,,825.2200,3197.2800,percent of total billed charges,"46.4% of $3,197.28 in Billed Charges for Rev 272 = $1,483.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LITHOTRIPTOR LITHCRUSH 30MM,272,RC,,,,,,,,both,,,3197.2800,479.5900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1333.27,,,,,,,825.2200,3197.2800,percent of total billed charges,"41.7% of $3,197.28 in Billed Charges for Rev 272 = $1,333.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LITHOTRIPTOR LITHCRUSH 30MM,272,RC,,,,,,,,both,,,3197.2800,479.5900,CIGNA HEALTHCARE,CIGNA PPO,1333.27,,,,,,,825.2200,3197.2800,percent of total billed charges,"41.7% of $3,197.28 in Billed Charges for Rev 272 = $1,333.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LITHOTRIPTOR LITHCRUSH 30MM,272,RC,,,,,,,,both,,,3197.2800,479.5900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2877.55,,,,,,,825.2200,3197.2800,percent of total billed charges,"90% of $3,197.28 in Billed Charges for Rev 272 = $2,877.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LITHOTRIPTOR LITHCRUSH 30MM,272,RC,,,,,,,,both,,,3197.2800,479.5900,MEDCOST,MEDCOST VHN,1521.59,,,,,,,825.2200,3197.2800,percent of total billed charges,"47.59% of $3,197.28 in Billed Charges for Rev 272 = $1,521.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LITHOTRIPTOR LITHCRUSH 30MM,272,RC,,,,,,,,both,,,3197.2800,479.5900,SENTARA HEALTH,SENTARA HEALTH,825.22,,,,,,,825.2200,3197.2800,percent of total billed charges,"25.81% of $3,197.28 in Billed Charges for Rev 272 = $825.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LITHOTRIPTOR LITHCRUSH 30MM,272,RC,,,,,,,,both,,,3197.2800,479.5900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3197.28,,,,,,,825.2200,3197.2800,percent of total billed charges,"100% of $3,197.28 in Billed Charges for Rev 272 = $3,197.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LITHOTRIPTOR LITHCRUSH 30MM,272,RC,,,,,,,,both,,,3197.2800,479.5900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1598.64,,,,,,,825.2200,3197.2800,percent of total billed charges,"Rev 272 $3,197.28 in Billed Charges at 50% = $1,598.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LITHOTRIPTOR LITHCRUSH 30MM,272,RC,,,,,,,,both,,,3197.2800,479.5900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1032.72,,,,,,,825.2200,3197.2800,other,"32.3% of $3,197.28 in Billed Charges for Rev 272 = $1,032.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LITHOTRIPTOR LITHCRUSH 30MM,272,RC,,,,,,,,both,,,3197.2800,479.5900,UNITED HEALTHCARE,UHC HERITAGE SELECT,981.57,,,,,,,825.2200,3197.2800,other,"30.7% of $3,197.28 in Billed Charges for Rev 272 = $981.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LITHOTRIPTOR LITHCRUSH 30MM,272,RC,,,,,,,,both,,,3197.2800,479.5900,UNITED HEALTHCARE,UNITED HEALTHCARE,1032.72,,,,,,,825.2200,3197.2800,percent of total billed charges,"32.3% of $3,197.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LITHOTRIPTOR LITHCRUSH 30MM,272,RC,,,,,,,,both,,,3197.2800,479.5900,WELLCARE,WELLCARE MEDICAID,3197.28,,,,,,,825.2200,3197.2800,percent of total billed charges,"100% of $3,197.28 in Billed Charges for Rev 272 = $3,197.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LUBRICANT ROTAGLIDE,272,RC,27200002,CDM,,,,,,both,,,921.9800,138.3000,AETNA,AETNA,393.69,,,,,,,237.9600,921.9800,percent of total billed charges,42.7% of $921.98 in Billed Charges for Rev 272 = $393.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LUBRICANT ROTAGLIDE,272,RC,27200002,CDM,,,,,,both,,,921.9800,138.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,645.39,,,,,,,237.9600,921.9800,percent of total billed charges,Rev 272 $921.98 in Billed Charges at 70% = $645.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LUBRICANT ROTAGLIDE,272,RC,27200002,CDM,,,,,,both,,,921.9800,138.3000,CIGNA HEALTHCARE,CIGNA HMO,384.47,,,,,,,237.9600,921.9800,percent of total billed charges,41.7% of $921.98 in Billed Charges for Rev 272 = $384.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LUBRICANT ROTAGLIDE,272,RC,27200002,CDM,,,,,,both,,,921.9800,138.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,427.80,,,,,,,237.9600,921.9800,percent of total billed charges,46.4% of $921.98 in Billed Charges for Rev 272 = $427.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LUBRICANT ROTAGLIDE,272,RC,27200002,CDM,,,,,,both,,,921.9800,138.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,384.47,,,,,,,237.9600,921.9800,percent of total billed charges,41.7% of $921.98 in Billed Charges for Rev 272 = $384.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LUBRICANT ROTAGLIDE,272,RC,27200002,CDM,,,,,,both,,,921.9800,138.3000,CIGNA HEALTHCARE,CIGNA PPO,384.47,,,,,,,237.9600,921.9800,percent of total billed charges,41.7% of $921.98 in Billed Charges for Rev 272 = $384.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LUBRICANT ROTAGLIDE,272,RC,27200002,CDM,,,,,,both,,,921.9800,138.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,829.78,,,,,,,237.9600,921.9800,percent of total billed charges,90% of $921.98 in Billed Charges for Rev 272 = $829.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LUBRICANT ROTAGLIDE,272,RC,27200002,CDM,,,,,,both,,,921.9800,138.3000,MEDCOST,MEDCOST VHN,438.77,,,,,,,237.9600,921.9800,percent of total billed charges,47.59% of $921.98 in Billed Charges for Rev 272 = $438.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LUBRICANT ROTAGLIDE,272,RC,27200002,CDM,,,,,,both,,,921.9800,138.3000,SENTARA HEALTH,SENTARA HEALTH,237.96,,,,,,,237.9600,921.9800,percent of total billed charges,25.81% of $921.98 in Billed Charges for Rev 272 = $237.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LUBRICANT ROTAGLIDE,272,RC,27200002,CDM,,,,,,both,,,921.9800,138.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",921.98,,,,,,,237.9600,921.9800,percent of total billed charges,100% of $921.98 in Billed Charges for Rev 272 = $921.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LUBRICANT ROTAGLIDE,272,RC,27200002,CDM,,,,,,both,,,921.9800,138.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,460.99,,,,,,,237.9600,921.9800,percent of total billed charges,Rev 272 $921.98 in Billed Charges at 50% = $460.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LUBRICANT ROTAGLIDE,272,RC,27200002,CDM,,,,,,both,,,921.9800,138.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,297.80,,,,,,,237.9600,921.9800,other,32.3% of $921.98 in Billed Charges for Rev 272 = $297.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
LUBRICANT ROTAGLIDE,272,RC,27200002,CDM,,,,,,both,,,921.9800,138.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,283.05,,,,,,,237.9600,921.9800,other,30.7% of $921.98 in Billed Charges for Rev 272 = $283.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
LUBRICANT ROTAGLIDE,272,RC,27200002,CDM,,,,,,both,,,921.9800,138.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,297.80,,,,,,,237.9600,921.9800,percent of total billed charges,32.3% of $921.98 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LUBRICANT ROTAGLIDE,272,RC,27200002,CDM,,,,,,both,,,921.9800,138.3000,WELLCARE,WELLCARE MEDICAID,921.98,,,,,,,237.9600,921.9800,percent of total billed charges,100% of $921.98 in Billed Charges for Rev 272 = $921.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON PACING.,272,RC,27200491,CDM,,,,,,both,,,546.0000,81.9000,AETNA,AETNA,233.14,,,,,,,140.9200,546.0000,percent of total billed charges,42.7% of $546.00 in Billed Charges for Rev 272 = $233.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON PACING.,272,RC,27200491,CDM,,,,,,both,,,546.0000,81.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,382.20,,,,,,,140.9200,546.0000,percent of total billed charges,Rev 272 $546.00 in Billed Charges at 70% = $382.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON PACING.,272,RC,27200491,CDM,,,,,,both,,,546.0000,81.9000,CIGNA HEALTHCARE,CIGNA HMO,227.68,,,,,,,140.9200,546.0000,percent of total billed charges,41.7% of $546.00 in Billed Charges for Rev 272 = $227.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON PACING.,272,RC,27200491,CDM,,,,,,both,,,546.0000,81.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,253.34,,,,,,,140.9200,546.0000,percent of total billed charges,46.4% of $546.00 in Billed Charges for Rev 272 = $253.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON PACING.,272,RC,27200491,CDM,,,,,,both,,,546.0000,81.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,227.68,,,,,,,140.9200,546.0000,percent of total billed charges,41.7% of $546.00 in Billed Charges for Rev 272 = $227.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON PACING.,272,RC,27200491,CDM,,,,,,both,,,546.0000,81.9000,CIGNA HEALTHCARE,CIGNA PPO,227.68,,,,,,,140.9200,546.0000,percent of total billed charges,41.7% of $546.00 in Billed Charges for Rev 272 = $227.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON PACING.,272,RC,27200491,CDM,,,,,,both,,,546.0000,81.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,491.40,,,,,,,140.9200,546.0000,percent of total billed charges,90% of $546.00 in Billed Charges for Rev 272 = $491.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON PACING.,272,RC,27200491,CDM,,,,,,both,,,546.0000,81.9000,MEDCOST,MEDCOST VHN,259.84,,,,,,,140.9200,546.0000,percent of total billed charges,47.59% of $546.00 in Billed Charges for Rev 272 = $259.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON PACING.,272,RC,27200491,CDM,,,,,,both,,,546.0000,81.9000,SENTARA HEALTH,SENTARA HEALTH,140.92,,,,,,,140.9200,546.0000,percent of total billed charges,25.81% of $546.00 in Billed Charges for Rev 272 = $140.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON PACING.,272,RC,27200491,CDM,,,,,,both,,,546.0000,81.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",546.00,,,,,,,140.9200,546.0000,percent of total billed charges,100% of $546.00 in Billed Charges for Rev 272 = $546.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON PACING.,272,RC,27200491,CDM,,,,,,both,,,546.0000,81.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,273.00,,,,,,,140.9200,546.0000,percent of total billed charges,Rev 272 $546.00 in Billed Charges at 50% = $273.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON PACING.,272,RC,27200491,CDM,,,,,,both,,,546.0000,81.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,176.36,,,,,,,140.9200,546.0000,other,32.3% of $546.00 in Billed Charges for Rev 272 = $176.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH BALLOON PACING.,272,RC,27200491,CDM,,,,,,both,,,546.0000,81.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,167.62,,,,,,,140.9200,546.0000,other,30.7% of $546.00 in Billed Charges for Rev 272 = $167.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH BALLOON PACING.,272,RC,27200491,CDM,,,,,,both,,,546.0000,81.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,176.36,,,,,,,140.9200,546.0000,percent of total billed charges,32.3% of $546.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON PACING.,272,RC,27200491,CDM,,,,,,both,,,546.0000,81.9000,WELLCARE,WELLCARE MEDICAID,546.00,,,,,,,140.9200,546.0000,percent of total billed charges,100% of $546.00 in Billed Charges for Rev 272 = $546.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH BALLOON SENSATION PLUS FIBEROPTIC IAB,278,RC,27800642,CDM,,,,,,both,,,2748.0000,412.2000,AETNA,AETNA,1319.04,,,,,,,709.2600,2748.0000,percent of total billed charges,"48% of $2,748.00 in Billed Charges for Rev 278 = $1,319.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH BALLOON SENSATION PLUS FIBEROPTIC IAB,278,RC,27800642,CDM,,,,,,both,,,2748.0000,412.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1374.00,,,,,,,709.2600,2748.0000,percent of total billed charges,"50% of $2,748.00 in Billed Charges for Rev 278 = $1,374.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH BALLOON SENSATION PLUS FIBEROPTIC IAB,278,RC,27800642,CDM,,,,,,both,,,2748.0000,412.2000,CIGNA HEALTHCARE,CIGNA HMO,1145.92,,,,,,,709.2600,2748.0000,percent of total billed charges,"41.7% of $2,748.00 in Billed Charges for Rev 278 = $1,145.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH BALLOON SENSATION PLUS FIBEROPTIC IAB,278,RC,27800642,CDM,,,,,,both,,,2748.0000,412.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1099.20,,,,,,,709.2600,2748.0000,percent of total billed charges,"40% of $2,748.00 in Billed Charges for Rev 278 = $1,099.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH BALLOON SENSATION PLUS FIBEROPTIC IAB,278,RC,27800642,CDM,,,,,,both,,,2748.0000,412.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1145.92,,,,,,,709.2600,2748.0000,percent of total billed charges,"41.7% of $2,748.00 in Billed Charges for Rev 278 = $1,145.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH BALLOON SENSATION PLUS FIBEROPTIC IAB,278,RC,27800642,CDM,,,,,,both,,,2748.0000,412.2000,CIGNA HEALTHCARE,CIGNA PPO,1145.92,,,,,,,709.2600,2748.0000,percent of total billed charges,"41.7% of $2,748.00 in Billed Charges for Rev 278 = $1,145.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH BALLOON SENSATION PLUS FIBEROPTIC IAB,278,RC,27800642,CDM,,,,,,both,,,2748.0000,412.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2473.20,,,,,,,709.2600,2748.0000,percent of total billed charges,"90% of $2,748.00 in Billed Charges for Rev 278 = $2,473.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH BALLOON SENSATION PLUS FIBEROPTIC IAB,278,RC,27800642,CDM,,,,,,both,,,2748.0000,412.2000,MEDCOST,MEDCOST VHN,1307.77,,,,,,,709.2600,2748.0000,percent of total billed charges,"47.59% of $2,748.00 in Billed Charges for Rev 278 = $1,307.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH BALLOON SENSATION PLUS FIBEROPTIC IAB,278,RC,27800642,CDM,,,,,,both,,,2748.0000,412.2000,SENTARA HEALTH,SENTARA HEALTH,709.26,,,,,,,709.2600,2748.0000,percent of total billed charges,"25.81% of $2,748.00 in Billed Charges for Rev 278 = $709.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH BALLOON SENSATION PLUS FIBEROPTIC IAB,278,RC,27800642,CDM,,,,,,both,,,2748.0000,412.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2748.00,,,,,,,709.2600,2748.0000,percent of total billed charges,"100% of $2,748.00 in Billed Charges for Rev 278 = $2,748.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH BALLOON SENSATION PLUS FIBEROPTIC IAB,278,RC,27800642,CDM,,,,,,both,,,2748.0000,412.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1374.00,,,,,,,709.2600,2748.0000,percent of total billed charges,"Rev 278 $2,748.00 in Billed Charges at 50% = $1,374.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH BALLOON SENSATION PLUS FIBEROPTIC IAB,278,RC,27800642,CDM,,,,,,both,,,2748.0000,412.2000,WELLCARE,WELLCARE MEDICAID,2748.00,,,,,,,709.2600,2748.0000,percent of total billed charges,"100% of $2,748.00 in Billed Charges for Rev 278 = $2,748.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CAMINO 110-4G EACH,272,RC,27200144,CDM,,,,,,both,,,1760.0000,264.0000,AETNA,AETNA,751.52,,,,,,,454.2600,1760.0000,percent of total billed charges,"42.7% of $1,760.00 in Billed Charges for Rev 272 = $751.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CAMINO 110-4G EACH,272,RC,27200144,CDM,,,,,,both,,,1760.0000,264.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1232.00,,,,,,,454.2600,1760.0000,percent of total billed charges,"Rev 272 $1,760.00 in Billed Charges at 70% = $1,232.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CAMINO 110-4G EACH,272,RC,27200144,CDM,,,,,,both,,,1760.0000,264.0000,CIGNA HEALTHCARE,CIGNA HMO,733.92,,,,,,,454.2600,1760.0000,percent of total billed charges,"41.7% of $1,760.00 in Billed Charges for Rev 272 = $733.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CAMINO 110-4G EACH,272,RC,27200144,CDM,,,,,,both,,,1760.0000,264.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,816.64,,,,,,,454.2600,1760.0000,percent of total billed charges,"46.4% of $1,760.00 in Billed Charges for Rev 272 = $816.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CAMINO 110-4G EACH,272,RC,27200144,CDM,,,,,,both,,,1760.0000,264.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,733.92,,,,,,,454.2600,1760.0000,percent of total billed charges,"41.7% of $1,760.00 in Billed Charges for Rev 272 = $733.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CAMINO 110-4G EACH,272,RC,27200144,CDM,,,,,,both,,,1760.0000,264.0000,CIGNA HEALTHCARE,CIGNA PPO,733.92,,,,,,,454.2600,1760.0000,percent of total billed charges,"41.7% of $1,760.00 in Billed Charges for Rev 272 = $733.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CAMINO 110-4G EACH,272,RC,27200144,CDM,,,,,,both,,,1760.0000,264.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1584.00,,,,,,,454.2600,1760.0000,percent of total billed charges,"90% of $1,760.00 in Billed Charges for Rev 272 = $1,584.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CAMINO 110-4G EACH,272,RC,27200144,CDM,,,,,,both,,,1760.0000,264.0000,MEDCOST,MEDCOST VHN,837.58,,,,,,,454.2600,1760.0000,percent of total billed charges,"47.59% of $1,760.00 in Billed Charges for Rev 272 = $837.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CAMINO 110-4G EACH,272,RC,27200144,CDM,,,,,,both,,,1760.0000,264.0000,SENTARA HEALTH,SENTARA HEALTH,454.26,,,,,,,454.2600,1760.0000,percent of total billed charges,"25.81% of $1,760.00 in Billed Charges for Rev 272 = $454.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CAMINO 110-4G EACH,272,RC,27200144,CDM,,,,,,both,,,1760.0000,264.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1760.00,,,,,,,454.2600,1760.0000,percent of total billed charges,"100% of $1,760.00 in Billed Charges for Rev 272 = $1,760.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CAMINO 110-4G EACH,272,RC,27200144,CDM,,,,,,both,,,1760.0000,264.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,880.00,,,,,,,454.2600,1760.0000,percent of total billed charges,"Rev 272 $1,760.00 in Billed Charges at 50% = $880.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CAMINO 110-4G EACH,272,RC,27200144,CDM,,,,,,both,,,1760.0000,264.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,568.48,,,,,,,454.2600,1760.0000,other,"32.3% of $1,760.00 in Billed Charges for Rev 272 = $568.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH CAMINO 110-4G EACH,272,RC,27200144,CDM,,,,,,both,,,1760.0000,264.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,540.32,,,,,,,454.2600,1760.0000,other,"30.7% of $1,760.00 in Billed Charges for Rev 272 = $540.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH CAMINO 110-4G EACH,272,RC,27200144,CDM,,,,,,both,,,1760.0000,264.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,568.48,,,,,,,454.2600,1760.0000,percent of total billed charges,"32.3% of $1,760.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CAMINO 110-4G EACH,272,RC,27200144,CDM,,,,,,both,,,1760.0000,264.0000,WELLCARE,WELLCARE MEDICAID,1760.00,,,,,,,454.2600,1760.0000,percent of total billed charges,"100% of $1,760.00 in Billed Charges for Rev 272 = $1,760.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CEN VEN MULTILUMEN KIT,272,RC,27200145,CDM,,,,,,both,,,26.0000,3.9000,AETNA,AETNA,11.10,,,,,,,6.7100,26.0000,percent of total billed charges,42.7% of $26.00 in Billed Charges for Rev 272 = $11.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CEN VEN MULTILUMEN KIT,272,RC,27200145,CDM,,,,,,both,,,26.0000,3.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,18.20,,,,,,,6.7100,26.0000,percent of total billed charges,Rev 272 $26.00 in Billed Charges at 70% = $18.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CEN VEN MULTILUMEN KIT,272,RC,27200145,CDM,,,,,,both,,,26.0000,3.9000,CIGNA HEALTHCARE,CIGNA HMO,10.84,,,,,,,6.7100,26.0000,percent of total billed charges,41.7% of $26.00 in Billed Charges for Rev 272 = $10.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CEN VEN MULTILUMEN KIT,272,RC,27200145,CDM,,,,,,both,,,26.0000,3.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12.06,,,,,,,6.7100,26.0000,percent of total billed charges,46.4% of $26.00 in Billed Charges for Rev 272 = $12.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CEN VEN MULTILUMEN KIT,272,RC,27200145,CDM,,,,,,both,,,26.0000,3.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,10.84,,,,,,,6.7100,26.0000,percent of total billed charges,41.7% of $26.00 in Billed Charges for Rev 272 = $10.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CEN VEN MULTILUMEN KIT,272,RC,27200145,CDM,,,,,,both,,,26.0000,3.9000,CIGNA HEALTHCARE,CIGNA PPO,10.84,,,,,,,6.7100,26.0000,percent of total billed charges,41.7% of $26.00 in Billed Charges for Rev 272 = $10.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CEN VEN MULTILUMEN KIT,272,RC,27200145,CDM,,,,,,both,,,26.0000,3.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,23.40,,,,,,,6.7100,26.0000,percent of total billed charges,90% of $26.00 in Billed Charges for Rev 272 = $23.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CEN VEN MULTILUMEN KIT,272,RC,27200145,CDM,,,,,,both,,,26.0000,3.9000,MEDCOST,MEDCOST VHN,12.37,,,,,,,6.7100,26.0000,percent of total billed charges,47.59% of $26.00 in Billed Charges for Rev 272 = $12.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CEN VEN MULTILUMEN KIT,272,RC,27200145,CDM,,,,,,both,,,26.0000,3.9000,SENTARA HEALTH,SENTARA HEALTH,6.71,,,,,,,6.7100,26.0000,percent of total billed charges,25.81% of $26.00 in Billed Charges for Rev 272 = $6.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CEN VEN MULTILUMEN KIT,272,RC,27200145,CDM,,,,,,both,,,26.0000,3.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",26.00,,,,,,,6.7100,26.0000,percent of total billed charges,100% of $26.00 in Billed Charges for Rev 272 = $26.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CEN VEN MULTILUMEN KIT,272,RC,27200145,CDM,,,,,,both,,,26.0000,3.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,13.00,,,,,,,6.7100,26.0000,percent of total billed charges,Rev 272 $26.00 in Billed Charges at 50% = $13.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CEN VEN MULTILUMEN KIT,272,RC,27200145,CDM,,,,,,both,,,26.0000,3.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,8.40,,,,,,,6.7100,26.0000,other,32.3% of $26.00 in Billed Charges for Rev 272 = $8.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH CEN VEN MULTILUMEN KIT,272,RC,27200145,CDM,,,,,,both,,,26.0000,3.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,7.98,,,,,,,6.7100,26.0000,other,30.7% of $26.00 in Billed Charges for Rev 272 = $7.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH CEN VEN MULTILUMEN KIT,272,RC,27200145,CDM,,,,,,both,,,26.0000,3.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,8.40,,,,,,,6.7100,26.0000,percent of total billed charges,32.3% of $26.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH CEN VEN MULTILUMEN KIT,272,RC,27200145,CDM,,,,,,both,,,26.0000,3.9000,WELLCARE,WELLCARE MEDICAID,26.00,,,,,,,6.7100,26.0000,percent of total billed charges,100% of $26.00 in Billed Charges for Rev 272 = $26.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP PLUS 11163,270,RC,27000125,CDM,,,,,,both,,,380.0000,57.0000,AETNA,AETNA,162.26,,,,,,,98.0800,380.0000,percent of total billed charges,42.7% of $380.00 in Billed Charges for Rev 270 = $162.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP PLUS 11163,270,RC,27000125,CDM,,,,,,both,,,380.0000,57.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,266.00,,,,,,,98.0800,380.0000,percent of total billed charges,Rev 270 $380.00 in Billed Charges at 70% = $266.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP PLUS 11163,270,RC,27000125,CDM,,,,,,both,,,380.0000,57.0000,CIGNA HEALTHCARE,CIGNA HMO,158.46,,,,,,,98.0800,380.0000,percent of total billed charges,41.7% of $380.00 in Billed Charges for Rev 270 = $158.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP PLUS 11163,270,RC,27000125,CDM,,,,,,both,,,380.0000,57.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,176.32,,,,,,,98.0800,380.0000,percent of total billed charges,46.4% of $380.00 in Billed Charges for Rev 270 = $176.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP PLUS 11163,270,RC,27000125,CDM,,,,,,both,,,380.0000,57.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,158.46,,,,,,,98.0800,380.0000,percent of total billed charges,41.7% of $380.00 in Billed Charges for Rev 270 = $158.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP PLUS 11163,270,RC,27000125,CDM,,,,,,both,,,380.0000,57.0000,CIGNA HEALTHCARE,CIGNA PPO,158.46,,,,,,,98.0800,380.0000,percent of total billed charges,41.7% of $380.00 in Billed Charges for Rev 270 = $158.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP PLUS 11163,270,RC,27000125,CDM,,,,,,both,,,380.0000,57.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,342.00,,,,,,,98.0800,380.0000,percent of total billed charges,90% of $380.00 in Billed Charges for Rev 270 = $342.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP PLUS 11163,270,RC,27000125,CDM,,,,,,both,,,380.0000,57.0000,MEDCOST,MEDCOST VHN,180.84,,,,,,,98.0800,380.0000,percent of total billed charges,47.59% of $380.00 in Billed Charges for Rev 270 = $180.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP PLUS 11163,270,RC,27000125,CDM,,,,,,both,,,380.0000,57.0000,SENTARA HEALTH,SENTARA HEALTH,98.08,,,,,,,98.0800,380.0000,percent of total billed charges,25.81% of $380.00 in Billed Charges for Rev 270 = $98.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP PLUS 11163,270,RC,27000125,CDM,,,,,,both,,,380.0000,57.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",380.00,,,,,,,98.0800,380.0000,percent of total billed charges,100% of $380.00 in Billed Charges for Rev 270 = $380.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP PLUS 11163,270,RC,27000125,CDM,,,,,,both,,,380.0000,57.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,190.00,,,,,,,98.0800,380.0000,percent of total billed charges,Rev 270 $380.00 in Billed Charges at 50% = $190.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP PLUS 11163,270,RC,27000125,CDM,,,,,,both,,,380.0000,57.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,122.74,,,,,,,98.0800,380.0000,other,32.3% of $380.00 in Billed Charges for Rev 270 = $122.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEMOSTOP PLUS 11163,270,RC,27000125,CDM,,,,,,both,,,380.0000,57.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,116.66,,,,,,,98.0800,380.0000,other,30.7% of $380.00 in Billed Charges for Rev 270 = $116.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEMOSTOP PLUS 11163,270,RC,27000125,CDM,,,,,,both,,,380.0000,57.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,122.74,,,,,,,98.0800,380.0000,percent of total billed charges,32.3% of $380.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP PLUS 11163,270,RC,27000125,CDM,,,,,,both,,,380.0000,57.0000,WELLCARE,WELLCARE MEDICAID,380.00,,,,,,,98.0800,380.0000,percent of total billed charges,100% of $380.00 in Billed Charges for Rev 270 = $380.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FIBRILLAR SURGICELE 2X4 1962,272,RC,27201677,CDM,,,,,,both,,,1617.0000,242.5500,AETNA,AETNA,690.46,,,,,,,417.3500,1617.0000,percent of total billed charges,"42.7% of $1,617.00 in Billed Charges for Rev 272 = $690.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FIBRILLAR SURGICELE 2X4 1962,272,RC,27201677,CDM,,,,,,both,,,1617.0000,242.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1131.90,,,,,,,417.3500,1617.0000,percent of total billed charges,"Rev 272 $1,617.00 in Billed Charges at 70% = $1,131.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FIBRILLAR SURGICELE 2X4 1962,272,RC,27201677,CDM,,,,,,both,,,1617.0000,242.5500,CIGNA HEALTHCARE,CIGNA HMO,674.29,,,,,,,417.3500,1617.0000,percent of total billed charges,"41.7% of $1,617.00 in Billed Charges for Rev 272 = $674.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FIBRILLAR SURGICELE 2X4 1962,272,RC,27201677,CDM,,,,,,both,,,1617.0000,242.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,750.29,,,,,,,417.3500,1617.0000,percent of total billed charges,"46.4% of $1,617.00 in Billed Charges for Rev 272 = $750.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FIBRILLAR SURGICELE 2X4 1962,272,RC,27201677,CDM,,,,,,both,,,1617.0000,242.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,674.29,,,,,,,417.3500,1617.0000,percent of total billed charges,"41.7% of $1,617.00 in Billed Charges for Rev 272 = $674.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FIBRILLAR SURGICELE 2X4 1962,272,RC,27201677,CDM,,,,,,both,,,1617.0000,242.5500,CIGNA HEALTHCARE,CIGNA PPO,674.29,,,,,,,417.3500,1617.0000,percent of total billed charges,"41.7% of $1,617.00 in Billed Charges for Rev 272 = $674.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FIBRILLAR SURGICELE 2X4 1962,272,RC,27201677,CDM,,,,,,both,,,1617.0000,242.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1455.30,,,,,,,417.3500,1617.0000,percent of total billed charges,"90% of $1,617.00 in Billed Charges for Rev 272 = $1,455.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FIBRILLAR SURGICELE 2X4 1962,272,RC,27201677,CDM,,,,,,both,,,1617.0000,242.5500,MEDCOST,MEDCOST VHN,769.53,,,,,,,417.3500,1617.0000,percent of total billed charges,"47.59% of $1,617.00 in Billed Charges for Rev 272 = $769.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FIBRILLAR SURGICELE 2X4 1962,272,RC,27201677,CDM,,,,,,both,,,1617.0000,242.5500,SENTARA HEALTH,SENTARA HEALTH,417.35,,,,,,,417.3500,1617.0000,percent of total billed charges,"25.81% of $1,617.00 in Billed Charges for Rev 272 = $417.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FIBRILLAR SURGICELE 2X4 1962,272,RC,27201677,CDM,,,,,,both,,,1617.0000,242.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1617.00,,,,,,,417.3500,1617.0000,percent of total billed charges,"100% of $1,617.00 in Billed Charges for Rev 272 = $1,617.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FIBRILLAR SURGICELE 2X4 1962,272,RC,27201677,CDM,,,,,,both,,,1617.0000,242.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,808.50,,,,,,,417.3500,1617.0000,percent of total billed charges,"Rev 272 $1,617.00 in Billed Charges at 50% = $808.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FIBRILLAR SURGICELE 2X4 1962,272,RC,27201677,CDM,,,,,,both,,,1617.0000,242.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,522.29,,,,,,,417.3500,1617.0000,other,"32.3% of $1,617.00 in Billed Charges for Rev 272 = $522.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FIBRILLAR SURGICELE 2X4 1962,272,RC,27201677,CDM,,,,,,both,,,1617.0000,242.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,496.42,,,,,,,417.3500,1617.0000,other,"30.7% of $1,617.00 in Billed Charges for Rev 272 = $496.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FIBRILLAR SURGICELE 2X4 1962,272,RC,27201677,CDM,,,,,,both,,,1617.0000,242.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,522.29,,,,,,,417.3500,1617.0000,percent of total billed charges,"32.3% of $1,617.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FIBRILLAR SURGICELE 2X4 1962,272,RC,27201677,CDM,,,,,,both,,,1617.0000,242.5500,WELLCARE,WELLCARE MEDICAID,1617.00,,,,,,,417.3500,1617.0000,percent of total billed charges,"100% of $1,617.00 in Billed Charges for Rev 272 = $1,617.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GENERAL PED ROOM DLY PRV,113,RC,11300001,CDM,,,,,,inpatient,,,2354.0000,353.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,121.7600,2354.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC GENERAL PED ROOM DLY PRV,113,RC,11300001,CDM,,,,,,inpatient,,,2354.0000,353.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2118.60,,,,,,,121.7600,2354.0000,percent of total billed charges,"90% of $2,354.00 in Billed Charges for Rev 113 = $2,118.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GENERAL PED ROOM DLY PRV,113,RC,11300001,CDM,,,,,,inpatient,,,2354.0000,353.1000,MEDCOST,MEDCOST VHN,1120.27,,,,,,,121.7600,2354.0000,percent of total billed charges,"47.59% of $2,354.00 in Billed Charges for Rev 113 = $1,120.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GENERAL PED ROOM DLY PRV,113,RC,11300001,CDM,,,,,,inpatient,,,2354.0000,353.1000,SENTARA HEALTH,SENTARA HEALTH,877.57,,,,,,,121.7600,2354.0000,percent of total billed charges,"37.28% of $2,354.00 in Billed Charges for Rev 113 = $877.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GENERAL PED ROOM DLY PRV,113,RC,11300001,CDM,,,,,,inpatient,,,2354.0000,353.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2354.00,,,,,,,121.7600,2354.0000,percent of total billed charges,"100% of $2,354.00 in Billed Charges for Rev 113 = $2,354.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE KOH-EFFICIENT RUMI II 2.5 CM,272,RC,27200002,CDM,,,,,,both,,,2042.1300,306.3200,AETNA,AETNA,871.99,,,,,,,527.0700,2042.1300,percent of total billed charges,"42.7% of $2,042.13 in Billed Charges for Rev 272 = $871.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE KOH-EFFICIENT RUMI II 2.5 CM,272,RC,27200002,CDM,,,,,,both,,,2042.1300,306.3200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1429.49,,,,,,,527.0700,2042.1300,percent of total billed charges,"Rev 272 $2,042.13 in Billed Charges at 70% = $1,429.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE KOH-EFFICIENT RUMI II 2.5 CM,272,RC,27200002,CDM,,,,,,both,,,2042.1300,306.3200,CIGNA HEALTHCARE,CIGNA HMO,851.57,,,,,,,527.0700,2042.1300,percent of total billed charges,"41.7% of $2,042.13 in Billed Charges for Rev 272 = $851.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE KOH-EFFICIENT RUMI II 2.5 CM,272,RC,27200002,CDM,,,,,,both,,,2042.1300,306.3200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,947.55,,,,,,,527.0700,2042.1300,percent of total billed charges,"46.4% of $2,042.13 in Billed Charges for Rev 272 = $947.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE KOH-EFFICIENT RUMI II 2.5 CM,272,RC,27200002,CDM,,,,,,both,,,2042.1300,306.3200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,851.57,,,,,,,527.0700,2042.1300,percent of total billed charges,"41.7% of $2,042.13 in Billed Charges for Rev 272 = $851.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE KOH-EFFICIENT RUMI II 2.5 CM,272,RC,27200002,CDM,,,,,,both,,,2042.1300,306.3200,CIGNA HEALTHCARE,CIGNA PPO,851.57,,,,,,,527.0700,2042.1300,percent of total billed charges,"41.7% of $2,042.13 in Billed Charges for Rev 272 = $851.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE KOH-EFFICIENT RUMI II 2.5 CM,272,RC,27200002,CDM,,,,,,both,,,2042.1300,306.3200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1837.92,,,,,,,527.0700,2042.1300,percent of total billed charges,"90% of $2,042.13 in Billed Charges for Rev 272 = $1,837.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE KOH-EFFICIENT RUMI II 2.5 CM,272,RC,27200002,CDM,,,,,,both,,,2042.1300,306.3200,MEDCOST,MEDCOST VHN,971.85,,,,,,,527.0700,2042.1300,percent of total billed charges,"47.59% of $2,042.13 in Billed Charges for Rev 272 = $971.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE KOH-EFFICIENT RUMI II 2.5 CM,272,RC,27200002,CDM,,,,,,both,,,2042.1300,306.3200,SENTARA HEALTH,SENTARA HEALTH,527.07,,,,,,,527.0700,2042.1300,percent of total billed charges,"25.81% of $2,042.13 in Billed Charges for Rev 272 = $527.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE KOH-EFFICIENT RUMI II 2.5 CM,272,RC,27200002,CDM,,,,,,both,,,2042.1300,306.3200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2042.13,,,,,,,527.0700,2042.1300,percent of total billed charges,"100% of $2,042.13 in Billed Charges for Rev 272 = $2,042.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE KOH-EFFICIENT RUMI II 2.5 CM,272,RC,27200002,CDM,,,,,,both,,,2042.1300,306.3200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1021.07,,,,,,,527.0700,2042.1300,percent of total billed charges,"Rev 272 $2,042.13 in Billed Charges at 50% = $1,021.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE KOH-EFFICIENT RUMI II 2.5 CM,272,RC,27200002,CDM,,,,,,both,,,2042.1300,306.3200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,659.61,,,,,,,527.0700,2042.1300,other,"32.3% of $2,042.13 in Billed Charges for Rev 272 = $659.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MANIPULATOR UTERINE KOH-EFFICIENT RUMI II 2.5 CM,272,RC,27200002,CDM,,,,,,both,,,2042.1300,306.3200,UNITED HEALTHCARE,UHC HERITAGE SELECT,626.93,,,,,,,527.0700,2042.1300,other,"30.7% of $2,042.13 in Billed Charges for Rev 272 = $626.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MANIPULATOR UTERINE KOH-EFFICIENT RUMI II 2.5 CM,272,RC,27200002,CDM,,,,,,both,,,2042.1300,306.3200,UNITED HEALTHCARE,UNITED HEALTHCARE,659.61,,,,,,,527.0700,2042.1300,percent of total billed charges,"32.3% of $2,042.13 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE KOH-EFFICIENT RUMI II 2.5 CM,272,RC,27200002,CDM,,,,,,both,,,2042.1300,306.3200,WELLCARE,WELLCARE MEDICAID,2042.13,,,,,,,527.0700,2042.1300,percent of total billed charges,"100% of $2,042.13 in Billed Charges for Rev 272 = $2,042.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANES FILTER BLOOD TRANSFUS SQ40S,272,RC,27201391,CDM,,,,,,both,,,47.0000,7.0500,AETNA,AETNA,20.07,,,,,,,12.1300,47.0000,percent of total billed charges,42.7% of $47.00 in Billed Charges for Rev 272 = $20.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES FILTER BLOOD TRANSFUS SQ40S,272,RC,27201391,CDM,,,,,,both,,,47.0000,7.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,32.90,,,,,,,12.1300,47.0000,percent of total billed charges,Rev 272 $47.00 in Billed Charges at 70% = $32.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES FILTER BLOOD TRANSFUS SQ40S,272,RC,27201391,CDM,,,,,,both,,,47.0000,7.0500,CIGNA HEALTHCARE,CIGNA HMO,19.60,,,,,,,12.1300,47.0000,percent of total billed charges,41.7% of $47.00 in Billed Charges for Rev 272 = $19.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES FILTER BLOOD TRANSFUS SQ40S,272,RC,27201391,CDM,,,,,,both,,,47.0000,7.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,21.81,,,,,,,12.1300,47.0000,percent of total billed charges,46.4% of $47.00 in Billed Charges for Rev 272 = $21.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES FILTER BLOOD TRANSFUS SQ40S,272,RC,27201391,CDM,,,,,,both,,,47.0000,7.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,19.60,,,,,,,12.1300,47.0000,percent of total billed charges,41.7% of $47.00 in Billed Charges for Rev 272 = $19.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES FILTER BLOOD TRANSFUS SQ40S,272,RC,27201391,CDM,,,,,,both,,,47.0000,7.0500,CIGNA HEALTHCARE,CIGNA PPO,19.60,,,,,,,12.1300,47.0000,percent of total billed charges,41.7% of $47.00 in Billed Charges for Rev 272 = $19.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES FILTER BLOOD TRANSFUS SQ40S,272,RC,27201391,CDM,,,,,,both,,,47.0000,7.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,42.30,,,,,,,12.1300,47.0000,percent of total billed charges,90% of $47.00 in Billed Charges for Rev 272 = $42.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES FILTER BLOOD TRANSFUS SQ40S,272,RC,27201391,CDM,,,,,,both,,,47.0000,7.0500,MEDCOST,MEDCOST VHN,22.37,,,,,,,12.1300,47.0000,percent of total billed charges,47.59% of $47.00 in Billed Charges for Rev 272 = $22.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES FILTER BLOOD TRANSFUS SQ40S,272,RC,27201391,CDM,,,,,,both,,,47.0000,7.0500,SENTARA HEALTH,SENTARA HEALTH,12.13,,,,,,,12.1300,47.0000,percent of total billed charges,25.81% of $47.00 in Billed Charges for Rev 272 = $12.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES FILTER BLOOD TRANSFUS SQ40S,272,RC,27201391,CDM,,,,,,both,,,47.0000,7.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",47.00,,,,,,,12.1300,47.0000,percent of total billed charges,100% of $47.00 in Billed Charges for Rev 272 = $47.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES FILTER BLOOD TRANSFUS SQ40S,272,RC,27201391,CDM,,,,,,both,,,47.0000,7.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,23.50,,,,,,,12.1300,47.0000,percent of total billed charges,Rev 272 $47.00 in Billed Charges at 50% = $23.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES FILTER BLOOD TRANSFUS SQ40S,272,RC,27201391,CDM,,,,,,both,,,47.0000,7.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,15.18,,,,,,,12.1300,47.0000,other,32.3% of $47.00 in Billed Charges for Rev 272 = $15.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES FILTER BLOOD TRANSFUS SQ40S,272,RC,27201391,CDM,,,,,,both,,,47.0000,7.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,14.43,,,,,,,12.1300,47.0000,other,30.7% of $47.00 in Billed Charges for Rev 272 = $14.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES FILTER BLOOD TRANSFUS SQ40S,272,RC,27201391,CDM,,,,,,both,,,47.0000,7.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,15.18,,,,,,,12.1300,47.0000,percent of total billed charges,32.3% of $47.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES FILTER BLOOD TRANSFUS SQ40S,272,RC,27201391,CDM,,,,,,both,,,47.0000,7.0500,WELLCARE,WELLCARE MEDICAID,47.00,,,,,,,12.1300,47.0000,percent of total billed charges,100% of $47.00 in Billed Charges for Rev 272 = $47.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT CATH 16G CVP AK-04400,272,RC,27201390,CDM,,,,,,both,,,14.0000,2.1000,AETNA,AETNA,5.98,,,,,,,3.6100,14.0000,percent of total billed charges,42.7% of $14.00 in Billed Charges for Rev 272 = $5.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT CATH 16G CVP AK-04400,272,RC,27201390,CDM,,,,,,both,,,14.0000,2.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9.80,,,,,,,3.6100,14.0000,percent of total billed charges,Rev 272 $14.00 in Billed Charges at 70% = $9.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT CATH 16G CVP AK-04400,272,RC,27201390,CDM,,,,,,both,,,14.0000,2.1000,CIGNA HEALTHCARE,CIGNA HMO,5.84,,,,,,,3.6100,14.0000,percent of total billed charges,41.7% of $14.00 in Billed Charges for Rev 272 = $5.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT CATH 16G CVP AK-04400,272,RC,27201390,CDM,,,,,,both,,,14.0000,2.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6.50,,,,,,,3.6100,14.0000,percent of total billed charges,46.4% of $14.00 in Billed Charges for Rev 272 = $6.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT CATH 16G CVP AK-04400,272,RC,27201390,CDM,,,,,,both,,,14.0000,2.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5.84,,,,,,,3.6100,14.0000,percent of total billed charges,41.7% of $14.00 in Billed Charges for Rev 272 = $5.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT CATH 16G CVP AK-04400,272,RC,27201390,CDM,,,,,,both,,,14.0000,2.1000,CIGNA HEALTHCARE,CIGNA PPO,5.84,,,,,,,3.6100,14.0000,percent of total billed charges,41.7% of $14.00 in Billed Charges for Rev 272 = $5.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT CATH 16G CVP AK-04400,272,RC,27201390,CDM,,,,,,both,,,14.0000,2.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12.60,,,,,,,3.6100,14.0000,percent of total billed charges,90% of $14.00 in Billed Charges for Rev 272 = $12.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT CATH 16G CVP AK-04400,272,RC,27201390,CDM,,,,,,both,,,14.0000,2.1000,MEDCOST,MEDCOST VHN,6.66,,,,,,,3.6100,14.0000,percent of total billed charges,47.59% of $14.00 in Billed Charges for Rev 272 = $6.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT CATH 16G CVP AK-04400,272,RC,27201390,CDM,,,,,,both,,,14.0000,2.1000,SENTARA HEALTH,SENTARA HEALTH,3.61,,,,,,,3.6100,14.0000,percent of total billed charges,25.81% of $14.00 in Billed Charges for Rev 272 = $3.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT CATH 16G CVP AK-04400,272,RC,27201390,CDM,,,,,,both,,,14.0000,2.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",14.00,,,,,,,3.6100,14.0000,percent of total billed charges,100% of $14.00 in Billed Charges for Rev 272 = $14.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT CATH 16G CVP AK-04400,272,RC,27201390,CDM,,,,,,both,,,14.0000,2.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7.00,,,,,,,3.6100,14.0000,percent of total billed charges,Rev 272 $14.00 in Billed Charges at 50% = $7.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT CATH 16G CVP AK-04400,272,RC,27201390,CDM,,,,,,both,,,14.0000,2.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4.52,,,,,,,3.6100,14.0000,other,32.3% of $14.00 in Billed Charges for Rev 272 = $4.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES KIT CATH 16G CVP AK-04400,272,RC,27201390,CDM,,,,,,both,,,14.0000,2.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,4.30,,,,,,,3.6100,14.0000,other,30.7% of $14.00 in Billed Charges for Rev 272 = $4.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES KIT CATH 16G CVP AK-04400,272,RC,27201390,CDM,,,,,,both,,,14.0000,2.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,4.52,,,,,,,3.6100,14.0000,percent of total billed charges,32.3% of $14.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT CATH 16G CVP AK-04400,272,RC,27201390,CDM,,,,,,both,,,14.0000,2.1000,WELLCARE,WELLCARE MEDICAID,14.00,,,,,,,3.6100,14.0000,percent of total billed charges,100% of $14.00 in Billed Charges for Rev 272 = $14.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LASER TUBE,272,RC,27201479,CDM,,,,,,both,,,200.0000,30.0000,AETNA,AETNA,85.40,,,,,,,51.6200,200.0000,percent of total billed charges,42.7% of $200.00 in Billed Charges for Rev 272 = $85.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LASER TUBE,272,RC,27201479,CDM,,,,,,both,,,200.0000,30.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,140.00,,,,,,,51.6200,200.0000,percent of total billed charges,Rev 272 $200.00 in Billed Charges at 70% = $140.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LASER TUBE,272,RC,27201479,CDM,,,,,,both,,,200.0000,30.0000,CIGNA HEALTHCARE,CIGNA HMO,83.40,,,,,,,51.6200,200.0000,percent of total billed charges,41.7% of $200.00 in Billed Charges for Rev 272 = $83.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LASER TUBE,272,RC,27201479,CDM,,,,,,both,,,200.0000,30.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,92.80,,,,,,,51.6200,200.0000,percent of total billed charges,46.4% of $200.00 in Billed Charges for Rev 272 = $92.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LASER TUBE,272,RC,27201479,CDM,,,,,,both,,,200.0000,30.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,83.40,,,,,,,51.6200,200.0000,percent of total billed charges,41.7% of $200.00 in Billed Charges for Rev 272 = $83.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LASER TUBE,272,RC,27201479,CDM,,,,,,both,,,200.0000,30.0000,CIGNA HEALTHCARE,CIGNA PPO,83.40,,,,,,,51.6200,200.0000,percent of total billed charges,41.7% of $200.00 in Billed Charges for Rev 272 = $83.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LASER TUBE,272,RC,27201479,CDM,,,,,,both,,,200.0000,30.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,180.00,,,,,,,51.6200,200.0000,percent of total billed charges,90% of $200.00 in Billed Charges for Rev 272 = $180.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LASER TUBE,272,RC,27201479,CDM,,,,,,both,,,200.0000,30.0000,MEDCOST,MEDCOST VHN,95.18,,,,,,,51.6200,200.0000,percent of total billed charges,47.59% of $200.00 in Billed Charges for Rev 272 = $95.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LASER TUBE,272,RC,27201479,CDM,,,,,,both,,,200.0000,30.0000,SENTARA HEALTH,SENTARA HEALTH,51.62,,,,,,,51.6200,200.0000,percent of total billed charges,25.81% of $200.00 in Billed Charges for Rev 272 = $51.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LASER TUBE,272,RC,27201479,CDM,,,,,,both,,,200.0000,30.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",200.00,,,,,,,51.6200,200.0000,percent of total billed charges,100% of $200.00 in Billed Charges for Rev 272 = $200.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LASER TUBE,272,RC,27201479,CDM,,,,,,both,,,200.0000,30.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,100.00,,,,,,,51.6200,200.0000,percent of total billed charges,Rev 272 $200.00 in Billed Charges at 50% = $100.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LASER TUBE,272,RC,27201479,CDM,,,,,,both,,,200.0000,30.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,64.60,,,,,,,51.6200,200.0000,other,32.3% of $200.00 in Billed Charges for Rev 272 = $64.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES LASER TUBE,272,RC,27201479,CDM,,,,,,both,,,200.0000,30.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,61.40,,,,,,,51.6200,200.0000,other,30.7% of $200.00 in Billed Charges for Rev 272 = $61.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES LASER TUBE,272,RC,27201479,CDM,,,,,,both,,,200.0000,30.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,64.60,,,,,,,51.6200,200.0000,percent of total billed charges,32.3% of $200.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LASER TUBE,272,RC,27201479,CDM,,,,,,both,,,200.0000,30.0000,WELLCARE,WELLCARE MEDICAID,200.00,,,,,,,51.6200,200.0000,percent of total billed charges,100% of $200.00 in Billed Charges for Rev 272 = $200.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LMA MASK AIRWAY DISP,272,RC,27201476,CDM,,,,,,both,,,86.0000,12.9000,AETNA,AETNA,36.72,,,,,,,22.2000,86.0000,percent of total billed charges,42.7% of $86.00 in Billed Charges for Rev 272 = $36.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LMA MASK AIRWAY DISP,272,RC,27201476,CDM,,,,,,both,,,86.0000,12.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,60.20,,,,,,,22.2000,86.0000,percent of total billed charges,Rev 272 $86.00 in Billed Charges at 70% = $60.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LMA MASK AIRWAY DISP,272,RC,27201476,CDM,,,,,,both,,,86.0000,12.9000,CIGNA HEALTHCARE,CIGNA HMO,35.86,,,,,,,22.2000,86.0000,percent of total billed charges,41.7% of $86.00 in Billed Charges for Rev 272 = $35.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LMA MASK AIRWAY DISP,272,RC,27201476,CDM,,,,,,both,,,86.0000,12.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,39.90,,,,,,,22.2000,86.0000,percent of total billed charges,46.4% of $86.00 in Billed Charges for Rev 272 = $39.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LMA MASK AIRWAY DISP,272,RC,27201476,CDM,,,,,,both,,,86.0000,12.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,35.86,,,,,,,22.2000,86.0000,percent of total billed charges,41.7% of $86.00 in Billed Charges for Rev 272 = $35.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LMA MASK AIRWAY DISP,272,RC,27201476,CDM,,,,,,both,,,86.0000,12.9000,CIGNA HEALTHCARE,CIGNA PPO,35.86,,,,,,,22.2000,86.0000,percent of total billed charges,41.7% of $86.00 in Billed Charges for Rev 272 = $35.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LMA MASK AIRWAY DISP,272,RC,27201476,CDM,,,,,,both,,,86.0000,12.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,77.40,,,,,,,22.2000,86.0000,percent of total billed charges,90% of $86.00 in Billed Charges for Rev 272 = $77.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LMA MASK AIRWAY DISP,272,RC,27201476,CDM,,,,,,both,,,86.0000,12.9000,MEDCOST,MEDCOST VHN,40.93,,,,,,,22.2000,86.0000,percent of total billed charges,47.59% of $86.00 in Billed Charges for Rev 272 = $40.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LMA MASK AIRWAY DISP,272,RC,27201476,CDM,,,,,,both,,,86.0000,12.9000,SENTARA HEALTH,SENTARA HEALTH,22.20,,,,,,,22.2000,86.0000,percent of total billed charges,25.81% of $86.00 in Billed Charges for Rev 272 = $22.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LMA MASK AIRWAY DISP,272,RC,27201476,CDM,,,,,,both,,,86.0000,12.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",86.00,,,,,,,22.2000,86.0000,percent of total billed charges,100% of $86.00 in Billed Charges for Rev 272 = $86.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LMA MASK AIRWAY DISP,272,RC,27201476,CDM,,,,,,both,,,86.0000,12.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,43.00,,,,,,,22.2000,86.0000,percent of total billed charges,Rev 272 $86.00 in Billed Charges at 50% = $43.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LMA MASK AIRWAY DISP,272,RC,27201476,CDM,,,,,,both,,,86.0000,12.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,27.78,,,,,,,22.2000,86.0000,other,32.3% of $86.00 in Billed Charges for Rev 272 = $27.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES LMA MASK AIRWAY DISP,272,RC,27201476,CDM,,,,,,both,,,86.0000,12.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,26.40,,,,,,,22.2000,86.0000,other,30.7% of $86.00 in Billed Charges for Rev 272 = $26.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES LMA MASK AIRWAY DISP,272,RC,27201476,CDM,,,,,,both,,,86.0000,12.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,27.78,,,,,,,22.2000,86.0000,percent of total billed charges,32.3% of $86.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES LMA MASK AIRWAY DISP,272,RC,27201476,CDM,,,,,,both,,,86.0000,12.9000,WELLCARE,WELLCARE MEDICAID,86.00,,,,,,,22.2000,86.0000,percent of total billed charges,100% of $86.00 in Billed Charges for Rev 272 = $86.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES ORA RANGER STD FLOW SET,270,RC,27000262,CDM,,,,,,both,,,82.0000,12.3000,AETNA,AETNA,35.01,,,,,,,21.1600,82.0000,percent of total billed charges,42.7% of $82.00 in Billed Charges for Rev 270 = $35.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES ORA RANGER STD FLOW SET,270,RC,27000262,CDM,,,,,,both,,,82.0000,12.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,57.40,,,,,,,21.1600,82.0000,percent of total billed charges,Rev 270 $82.00 in Billed Charges at 70% = $57.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES ORA RANGER STD FLOW SET,270,RC,27000262,CDM,,,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA HMO,34.19,,,,,,,21.1600,82.0000,percent of total billed charges,41.7% of $82.00 in Billed Charges for Rev 270 = $34.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES ORA RANGER STD FLOW SET,270,RC,27000262,CDM,,,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,38.05,,,,,,,21.1600,82.0000,percent of total billed charges,46.4% of $82.00 in Billed Charges for Rev 270 = $38.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES ORA RANGER STD FLOW SET,270,RC,27000262,CDM,,,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,34.19,,,,,,,21.1600,82.0000,percent of total billed charges,41.7% of $82.00 in Billed Charges for Rev 270 = $34.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES ORA RANGER STD FLOW SET,270,RC,27000262,CDM,,,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA PPO,34.19,,,,,,,21.1600,82.0000,percent of total billed charges,41.7% of $82.00 in Billed Charges for Rev 270 = $34.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES ORA RANGER STD FLOW SET,270,RC,27000262,CDM,,,,,,both,,,82.0000,12.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,73.80,,,,,,,21.1600,82.0000,percent of total billed charges,90% of $82.00 in Billed Charges for Rev 270 = $73.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES ORA RANGER STD FLOW SET,270,RC,27000262,CDM,,,,,,both,,,82.0000,12.3000,MEDCOST,MEDCOST VHN,39.02,,,,,,,21.1600,82.0000,percent of total billed charges,47.59% of $82.00 in Billed Charges for Rev 270 = $39.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES ORA RANGER STD FLOW SET,270,RC,27000262,CDM,,,,,,both,,,82.0000,12.3000,SENTARA HEALTH,SENTARA HEALTH,21.16,,,,,,,21.1600,82.0000,percent of total billed charges,25.81% of $82.00 in Billed Charges for Rev 270 = $21.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES ORA RANGER STD FLOW SET,270,RC,27000262,CDM,,,,,,both,,,82.0000,12.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",82.00,,,,,,,21.1600,82.0000,percent of total billed charges,100% of $82.00 in Billed Charges for Rev 270 = $82.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES ORA RANGER STD FLOW SET,270,RC,27000262,CDM,,,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,41.00,,,,,,,21.1600,82.0000,percent of total billed charges,Rev 270 $82.00 in Billed Charges at 50% = $41.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES ORA RANGER STD FLOW SET,270,RC,27000262,CDM,,,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,26.49,,,,,,,21.1600,82.0000,other,32.3% of $82.00 in Billed Charges for Rev 270 = $26.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES ORA RANGER STD FLOW SET,270,RC,27000262,CDM,,,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,25.17,,,,,,,21.1600,82.0000,other,30.7% of $82.00 in Billed Charges for Rev 270 = $25.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES ORA RANGER STD FLOW SET,270,RC,27000262,CDM,,,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,26.49,,,,,,,21.1600,82.0000,percent of total billed charges,32.3% of $82.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES ORA RANGER STD FLOW SET,270,RC,27000262,CDM,,,,,,both,,,82.0000,12.3000,WELLCARE,WELLCARE MEDICAID,82.00,,,,,,,21.1600,82.0000,percent of total billed charges,100% of $82.00 in Billed Charges for Rev 270 = $82.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES REINFORCED ENDO TUBE EMG,272,RC,27201396,CDM,,,,,,both,,,765.0000,114.7500,AETNA,AETNA,326.66,,,,,,,197.4500,765.0000,percent of total billed charges,42.7% of $765.00 in Billed Charges for Rev 272 = $326.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES REINFORCED ENDO TUBE EMG,272,RC,27201396,CDM,,,,,,both,,,765.0000,114.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,535.50,,,,,,,197.4500,765.0000,percent of total billed charges,Rev 272 $765.00 in Billed Charges at 70% = $535.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES REINFORCED ENDO TUBE EMG,272,RC,27201396,CDM,,,,,,both,,,765.0000,114.7500,CIGNA HEALTHCARE,CIGNA HMO,319.01,,,,,,,197.4500,765.0000,percent of total billed charges,41.7% of $765.00 in Billed Charges for Rev 272 = $319.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES REINFORCED ENDO TUBE EMG,272,RC,27201396,CDM,,,,,,both,,,765.0000,114.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,354.96,,,,,,,197.4500,765.0000,percent of total billed charges,46.4% of $765.00 in Billed Charges for Rev 272 = $354.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES REINFORCED ENDO TUBE EMG,272,RC,27201396,CDM,,,,,,both,,,765.0000,114.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,319.01,,,,,,,197.4500,765.0000,percent of total billed charges,41.7% of $765.00 in Billed Charges for Rev 272 = $319.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES REINFORCED ENDO TUBE EMG,272,RC,27201396,CDM,,,,,,both,,,765.0000,114.7500,CIGNA HEALTHCARE,CIGNA PPO,319.01,,,,,,,197.4500,765.0000,percent of total billed charges,41.7% of $765.00 in Billed Charges for Rev 272 = $319.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES REINFORCED ENDO TUBE EMG,272,RC,27201396,CDM,,,,,,both,,,765.0000,114.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,688.50,,,,,,,197.4500,765.0000,percent of total billed charges,90% of $765.00 in Billed Charges for Rev 272 = $688.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES REINFORCED ENDO TUBE EMG,272,RC,27201396,CDM,,,,,,both,,,765.0000,114.7500,MEDCOST,MEDCOST VHN,364.06,,,,,,,197.4500,765.0000,percent of total billed charges,47.59% of $765.00 in Billed Charges for Rev 272 = $364.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES REINFORCED ENDO TUBE EMG,272,RC,27201396,CDM,,,,,,both,,,765.0000,114.7500,SENTARA HEALTH,SENTARA HEALTH,197.45,,,,,,,197.4500,765.0000,percent of total billed charges,25.81% of $765.00 in Billed Charges for Rev 272 = $197.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES REINFORCED ENDO TUBE EMG,272,RC,27201396,CDM,,,,,,both,,,765.0000,114.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",765.00,,,,,,,197.4500,765.0000,percent of total billed charges,100% of $765.00 in Billed Charges for Rev 272 = $765.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES REINFORCED ENDO TUBE EMG,272,RC,27201396,CDM,,,,,,both,,,765.0000,114.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,382.50,,,,,,,197.4500,765.0000,percent of total billed charges,Rev 272 $765.00 in Billed Charges at 50% = $382.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES REINFORCED ENDO TUBE EMG,272,RC,27201396,CDM,,,,,,both,,,765.0000,114.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,247.10,,,,,,,197.4500,765.0000,other,32.3% of $765.00 in Billed Charges for Rev 272 = $247.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES REINFORCED ENDO TUBE EMG,272,RC,27201396,CDM,,,,,,both,,,765.0000,114.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,234.86,,,,,,,197.4500,765.0000,other,30.7% of $765.00 in Billed Charges for Rev 272 = $234.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES REINFORCED ENDO TUBE EMG,272,RC,27201396,CDM,,,,,,both,,,765.0000,114.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,247.10,,,,,,,197.4500,765.0000,percent of total billed charges,32.3% of $765.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES REINFORCED ENDO TUBE EMG,272,RC,27201396,CDM,,,,,,both,,,765.0000,114.7500,WELLCARE,WELLCARE MEDICAID,765.00,,,,,,,197.4500,765.0000,percent of total billed charges,100% of $765.00 in Billed Charges for Rev 272 = $765.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SPINAL EPIDURAL NEEDLE SET,272,RC,27201482,CDM,,,,,,both,,,480.0000,72.0000,AETNA,AETNA,204.96,,,,,,,123.8900,480.0000,percent of total billed charges,42.7% of $480.00 in Billed Charges for Rev 272 = $204.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SPINAL EPIDURAL NEEDLE SET,272,RC,27201482,CDM,,,,,,both,,,480.0000,72.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,336.00,,,,,,,123.8900,480.0000,percent of total billed charges,Rev 272 $480.00 in Billed Charges at 70% = $336.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SPINAL EPIDURAL NEEDLE SET,272,RC,27201482,CDM,,,,,,both,,,480.0000,72.0000,CIGNA HEALTHCARE,CIGNA HMO,200.16,,,,,,,123.8900,480.0000,percent of total billed charges,41.7% of $480.00 in Billed Charges for Rev 272 = $200.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SPINAL EPIDURAL NEEDLE SET,272,RC,27201482,CDM,,,,,,both,,,480.0000,72.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,222.72,,,,,,,123.8900,480.0000,percent of total billed charges,46.4% of $480.00 in Billed Charges for Rev 272 = $222.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SPINAL EPIDURAL NEEDLE SET,272,RC,27201482,CDM,,,,,,both,,,480.0000,72.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,200.16,,,,,,,123.8900,480.0000,percent of total billed charges,41.7% of $480.00 in Billed Charges for Rev 272 = $200.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SPINAL EPIDURAL NEEDLE SET,272,RC,27201482,CDM,,,,,,both,,,480.0000,72.0000,CIGNA HEALTHCARE,CIGNA PPO,200.16,,,,,,,123.8900,480.0000,percent of total billed charges,41.7% of $480.00 in Billed Charges for Rev 272 = $200.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SPINAL EPIDURAL NEEDLE SET,272,RC,27201482,CDM,,,,,,both,,,480.0000,72.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,432.00,,,,,,,123.8900,480.0000,percent of total billed charges,90% of $480.00 in Billed Charges for Rev 272 = $432.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SPINAL EPIDURAL NEEDLE SET,272,RC,27201482,CDM,,,,,,both,,,480.0000,72.0000,MEDCOST,MEDCOST VHN,228.43,,,,,,,123.8900,480.0000,percent of total billed charges,47.59% of $480.00 in Billed Charges for Rev 272 = $228.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SPINAL EPIDURAL NEEDLE SET,272,RC,27201482,CDM,,,,,,both,,,480.0000,72.0000,SENTARA HEALTH,SENTARA HEALTH,123.89,,,,,,,123.8900,480.0000,percent of total billed charges,25.81% of $480.00 in Billed Charges for Rev 272 = $123.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SPINAL EPIDURAL NEEDLE SET,272,RC,27201482,CDM,,,,,,both,,,480.0000,72.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",480.00,,,,,,,123.8900,480.0000,percent of total billed charges,100% of $480.00 in Billed Charges for Rev 272 = $480.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SPINAL EPIDURAL NEEDLE SET,272,RC,27201482,CDM,,,,,,both,,,480.0000,72.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,240.00,,,,,,,123.8900,480.0000,percent of total billed charges,Rev 272 $480.00 in Billed Charges at 50% = $240.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SPINAL EPIDURAL NEEDLE SET,272,RC,27201482,CDM,,,,,,both,,,480.0000,72.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,155.04,,,,,,,123.8900,480.0000,other,32.3% of $480.00 in Billed Charges for Rev 272 = $155.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES SPINAL EPIDURAL NEEDLE SET,272,RC,27201482,CDM,,,,,,both,,,480.0000,72.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,147.36,,,,,,,123.8900,480.0000,other,30.7% of $480.00 in Billed Charges for Rev 272 = $147.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES SPINAL EPIDURAL NEEDLE SET,272,RC,27201482,CDM,,,,,,both,,,480.0000,72.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,155.04,,,,,,,123.8900,480.0000,percent of total billed charges,32.3% of $480.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SPINAL EPIDURAL NEEDLE SET,272,RC,27201482,CDM,,,,,,both,,,480.0000,72.0000,WELLCARE,WELLCARE MEDICAID,480.00,,,,,,,123.8900,480.0000,percent of total billed charges,100% of $480.00 in Billed Charges for Rev 272 = $480.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA EACH ADD'L 15 MINS,370,RC,37000202,CDM,,,,,,both,,,523.0000,78.4500,AETNA,AETNA,223.32,,,,,,,134.9900,523.0000,percent of total billed charges,42.7% of $523.00 in Billed Charges for Rev 370 = $223.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA EACH ADD'L 15 MINS,370,RC,37000202,CDM,,,,,,both,,,523.0000,78.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,366.10,,,,,,,134.9900,523.0000,percent of total billed charges,Rev 370 $523.00 in Billed Charges at 70% = $366.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA EACH ADD'L 15 MINS,370,RC,37000202,CDM,,,,,,both,,,523.0000,78.4500,CIGNA HEALTHCARE,CIGNA HMO,218.09,,,,,,,134.9900,523.0000,percent of total billed charges,41.7% of $523.00 in Billed Charges for Rev 370 = $218.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA EACH ADD'L 15 MINS,370,RC,37000202,CDM,,,,,,both,,,523.0000,78.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,242.67,,,,,,,134.9900,523.0000,percent of total billed charges,46.4% of $523.00 in Billed Charges for Rev 370 = $242.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA EACH ADD'L 15 MINS,370,RC,37000202,CDM,,,,,,both,,,523.0000,78.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,218.09,,,,,,,134.9900,523.0000,percent of total billed charges,41.7% of $523.00 in Billed Charges for Rev 370 = $218.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA EACH ADD'L 15 MINS,370,RC,37000202,CDM,,,,,,both,,,523.0000,78.4500,CIGNA HEALTHCARE,CIGNA PPO,218.09,,,,,,,134.9900,523.0000,percent of total billed charges,41.7% of $523.00 in Billed Charges for Rev 370 = $218.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA EACH ADD'L 15 MINS,370,RC,37000202,CDM,,,,,,both,,,523.0000,78.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,470.70,,,,,,,134.9900,523.0000,percent of total billed charges,90% of $523.00 in Billed Charges for Rev 370 = $470.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA EACH ADD'L 15 MINS,370,RC,37000202,CDM,,,,,,both,,,523.0000,78.4500,MEDCOST,MEDCOST VHN,248.90,,,,,,,134.9900,523.0000,percent of total billed charges,47.59% of $523.00 in Billed Charges for Rev 370 = $248.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA EACH ADD'L 15 MINS,370,RC,37000202,CDM,,,,,,both,,,523.0000,78.4500,SENTARA HEALTH,SENTARA HEALTH,134.99,,,,,,,134.9900,523.0000,percent of total billed charges,25.81% of $523.00 in Billed Charges for Rev 370 = $134.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA EACH ADD'L 15 MINS,370,RC,37000202,CDM,,,,,,both,,,523.0000,78.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",523.00,,,,,,,134.9900,523.0000,percent of total billed charges,100% of $523.00 in Billed Charges for Rev 370 = $523.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA EACH ADD'L 15 MINS,370,RC,37000202,CDM,,,,,,both,,,523.0000,78.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,261.50,,,,,,,134.9900,523.0000,percent of total billed charges,Rev 370 $523.00 in Billed Charges at 50% = $261.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA EACH ADD'L 15 MINS,370,RC,37000202,CDM,,,,,,both,,,523.0000,78.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,168.93,,,,,,,134.9900,523.0000,other,32.3% of $523.00 in Billed Charges for Rev 370 = $168.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANESTHESIA EACH ADD'L 15 MINS,370,RC,37000202,CDM,,,,,,both,,,523.0000,78.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,160.56,,,,,,,134.9900,523.0000,other,30.7% of $523.00 in Billed Charges for Rev 370 = $160.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANESTHESIA EACH ADD'L 15 MINS,370,RC,37000202,CDM,,,,,,both,,,523.0000,78.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,168.93,,,,,,,134.9900,523.0000,percent of total billed charges,32.3% of $523.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA EACH ADD'L 15 MINS,370,RC,37000202,CDM,,,,,,both,,,523.0000,78.4500,WELLCARE,WELLCARE MEDICAID,523.00,,,,,,,134.9900,523.0000,percent of total billed charges,100% of $523.00 in Billed Charges for Rev 370 = $523.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA INITIAL 30 MINS,370,RC,37000201,CDM,,,,,,both,,,1428.0000,214.2000,AETNA,AETNA,609.76,,,,,,,368.5700,1428.0000,percent of total billed charges,"42.7% of $1,428.00 in Billed Charges for Rev 370 = $609.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANESTHESIA INITIAL 30 MINS,370,RC,37000201,CDM,,,,,,both,,,1428.0000,214.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,999.60,,,,,,,368.5700,1428.0000,percent of total billed charges,"Rev 370 $1,428.00 in Billed Charges at 70% = $999.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANESTHESIA INITIAL 30 MINS,370,RC,37000201,CDM,,,,,,both,,,1428.0000,214.2000,CIGNA HEALTHCARE,CIGNA HMO,595.48,,,,,,,368.5700,1428.0000,percent of total billed charges,"41.7% of $1,428.00 in Billed Charges for Rev 370 = $595.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANESTHESIA INITIAL 30 MINS,370,RC,37000201,CDM,,,,,,both,,,1428.0000,214.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,662.59,,,,,,,368.5700,1428.0000,percent of total billed charges,"46.4% of $1,428.00 in Billed Charges for Rev 370 = $662.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANESTHESIA INITIAL 30 MINS,370,RC,37000201,CDM,,,,,,both,,,1428.0000,214.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,595.48,,,,,,,368.5700,1428.0000,percent of total billed charges,"41.7% of $1,428.00 in Billed Charges for Rev 370 = $595.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANESTHESIA INITIAL 30 MINS,370,RC,37000201,CDM,,,,,,both,,,1428.0000,214.2000,CIGNA HEALTHCARE,CIGNA PPO,595.48,,,,,,,368.5700,1428.0000,percent of total billed charges,"41.7% of $1,428.00 in Billed Charges for Rev 370 = $595.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANESTHESIA INITIAL 30 MINS,370,RC,37000201,CDM,,,,,,both,,,1428.0000,214.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1285.20,,,,,,,368.5700,1428.0000,percent of total billed charges,"90% of $1,428.00 in Billed Charges for Rev 370 = $1,285.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANESTHESIA INITIAL 30 MINS,370,RC,37000201,CDM,,,,,,both,,,1428.0000,214.2000,MEDCOST,MEDCOST VHN,679.59,,,,,,,368.5700,1428.0000,percent of total billed charges,"47.59% of $1,428.00 in Billed Charges for Rev 370 = $679.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANESTHESIA INITIAL 30 MINS,370,RC,37000201,CDM,,,,,,both,,,1428.0000,214.2000,SENTARA HEALTH,SENTARA HEALTH,368.57,,,,,,,368.5700,1428.0000,percent of total billed charges,"25.81% of $1,428.00 in Billed Charges for Rev 370 = $368.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANESTHESIA INITIAL 30 MINS,370,RC,37000201,CDM,,,,,,both,,,1428.0000,214.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1428.00,,,,,,,368.5700,1428.0000,percent of total billed charges,"100% of $1,428.00 in Billed Charges for Rev 370 = $1,428.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANESTHESIA INITIAL 30 MINS,370,RC,37000201,CDM,,,,,,both,,,1428.0000,214.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,714.00,,,,,,,368.5700,1428.0000,percent of total billed charges,"Rev 370 $1,428.00 in Billed Charges at 50% = $714.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANESTHESIA INITIAL 30 MINS,370,RC,37000201,CDM,,,,,,both,,,1428.0000,214.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,461.24,,,,,,,368.5700,1428.0000,other,"32.3% of $1,428.00 in Billed Charges for Rev 370 = $461.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANESTHESIA INITIAL 30 MINS,370,RC,37000201,CDM,,,,,,both,,,1428.0000,214.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,438.40,,,,,,,368.5700,1428.0000,other,"30.7% of $1,428.00 in Billed Charges for Rev 370 = $438.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANESTHESIA INITIAL 30 MINS,370,RC,37000201,CDM,,,,,,both,,,1428.0000,214.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,461.24,,,,,,,368.5700,1428.0000,percent of total billed charges,"32.3% of $1,428.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANESTHESIA INITIAL 30 MINS,370,RC,37000201,CDM,,,,,,both,,,1428.0000,214.2000,WELLCARE,WELLCARE MEDICAID,1428.00,,,,,,,368.5700,1428.0000,percent of total billed charges,"100% of $1,428.00 in Billed Charges for Rev 370 = $1,428.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANEWRX IL LIMB 8.5X12 13 14 15 16,278,RC,27800486,CDM,,,,,,both,,,8778.0000,1316.7000,AETNA,AETNA,4213.44,,,,,,,2265.6000,8778.0000,percent of total billed charges,"48% of $8,778.00 in Billed Charges for Rev 278 = $4,213.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANEWRX IL LIMB 8.5X12 13 14 15 16,278,RC,27800486,CDM,,,,,,both,,,8778.0000,1316.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4389.00,,,,,,,2265.6000,8778.0000,percent of total billed charges,"50% of $8,778.00 in Billed Charges for Rev 278 = $4,389.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANEWRX IL LIMB 8.5X12 13 14 15 16,278,RC,27800486,CDM,,,,,,both,,,8778.0000,1316.7000,CIGNA HEALTHCARE,CIGNA HMO,3660.43,,,,,,,2265.6000,8778.0000,percent of total billed charges,"41.7% of $8,778.00 in Billed Charges for Rev 278 = $3,660.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANEWRX IL LIMB 8.5X12 13 14 15 16,278,RC,27800486,CDM,,,,,,both,,,8778.0000,1316.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3511.20,,,,,,,2265.6000,8778.0000,percent of total billed charges,"40% of $8,778.00 in Billed Charges for Rev 278 = $3,511.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANEWRX IL LIMB 8.5X12 13 14 15 16,278,RC,27800486,CDM,,,,,,both,,,8778.0000,1316.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3660.43,,,,,,,2265.6000,8778.0000,percent of total billed charges,"41.7% of $8,778.00 in Billed Charges for Rev 278 = $3,660.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANEWRX IL LIMB 8.5X12 13 14 15 16,278,RC,27800486,CDM,,,,,,both,,,8778.0000,1316.7000,CIGNA HEALTHCARE,CIGNA PPO,3660.43,,,,,,,2265.6000,8778.0000,percent of total billed charges,"41.7% of $8,778.00 in Billed Charges for Rev 278 = $3,660.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANEWRX IL LIMB 8.5X12 13 14 15 16,278,RC,27800486,CDM,,,,,,both,,,8778.0000,1316.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7900.20,,,,,,,2265.6000,8778.0000,percent of total billed charges,"90% of $8,778.00 in Billed Charges for Rev 278 = $7,900.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANEWRX IL LIMB 8.5X12 13 14 15 16,278,RC,27800486,CDM,,,,,,both,,,8778.0000,1316.7000,MEDCOST,MEDCOST VHN,4177.45,,,,,,,2265.6000,8778.0000,percent of total billed charges,"47.59% of $8,778.00 in Billed Charges for Rev 278 = $4,177.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANEWRX IL LIMB 8.5X12 13 14 15 16,278,RC,27800486,CDM,,,,,,both,,,8778.0000,1316.7000,SENTARA HEALTH,SENTARA HEALTH,2265.60,,,,,,,2265.6000,8778.0000,percent of total billed charges,"25.81% of $8,778.00 in Billed Charges for Rev 278 = $2,265.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANEWRX IL LIMB 8.5X12 13 14 15 16,278,RC,27800486,CDM,,,,,,both,,,8778.0000,1316.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8778.00,,,,,,,2265.6000,8778.0000,percent of total billed charges,"100% of $8,778.00 in Billed Charges for Rev 278 = $8,778.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANEWRX IL LIMB 8.5X12 13 14 15 16,278,RC,27800486,CDM,,,,,,both,,,8778.0000,1316.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4389.00,,,,,,,2265.6000,8778.0000,percent of total billed charges,"Rev 278 $8,778.00 in Billed Charges at 50% = $4,389.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANEWRX IL LIMB 8.5X12 13 14 15 16,278,RC,27800486,CDM,,,,,,both,,,8778.0000,1316.7000,WELLCARE,WELLCARE MEDICAID,8778.00,,,,,,,2265.6000,8778.0000,percent of total billed charges,"100% of $8,778.00 in Billed Charges for Rev 278 = $8,778.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANEWRX IL LMB 11.5X12 13 14 15 16,278,RC,27800487,CDM,,,,,,both,,,9197.0000,1379.5500,AETNA,AETNA,4414.56,,,,,,,2373.7500,9197.0000,percent of total billed charges,"48% of $9,197.00 in Billed Charges for Rev 278 = $4,414.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANEWRX IL LMB 11.5X12 13 14 15 16,278,RC,27800487,CDM,,,,,,both,,,9197.0000,1379.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4598.50,,,,,,,2373.7500,9197.0000,percent of total billed charges,"50% of $9,197.00 in Billed Charges for Rev 278 = $4,598.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANEWRX IL LMB 11.5X12 13 14 15 16,278,RC,27800487,CDM,,,,,,both,,,9197.0000,1379.5500,CIGNA HEALTHCARE,CIGNA HMO,3835.15,,,,,,,2373.7500,9197.0000,percent of total billed charges,"41.7% of $9,197.00 in Billed Charges for Rev 278 = $3,835.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANEWRX IL LMB 11.5X12 13 14 15 16,278,RC,27800487,CDM,,,,,,both,,,9197.0000,1379.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3678.80,,,,,,,2373.7500,9197.0000,percent of total billed charges,"40% of $9,197.00 in Billed Charges for Rev 278 = $3,678.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANEWRX IL LMB 11.5X12 13 14 15 16,278,RC,27800487,CDM,,,,,,both,,,9197.0000,1379.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3835.15,,,,,,,2373.7500,9197.0000,percent of total billed charges,"41.7% of $9,197.00 in Billed Charges for Rev 278 = $3,835.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANEWRX IL LMB 11.5X12 13 14 15 16,278,RC,27800487,CDM,,,,,,both,,,9197.0000,1379.5500,CIGNA HEALTHCARE,CIGNA PPO,3835.15,,,,,,,2373.7500,9197.0000,percent of total billed charges,"41.7% of $9,197.00 in Billed Charges for Rev 278 = $3,835.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANEWRX IL LMB 11.5X12 13 14 15 16,278,RC,27800487,CDM,,,,,,both,,,9197.0000,1379.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8277.30,,,,,,,2373.7500,9197.0000,percent of total billed charges,"90% of $9,197.00 in Billed Charges for Rev 278 = $8,277.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANEWRX IL LMB 11.5X12 13 14 15 16,278,RC,27800487,CDM,,,,,,both,,,9197.0000,1379.5500,MEDCOST,MEDCOST VHN,4376.85,,,,,,,2373.7500,9197.0000,percent of total billed charges,"47.59% of $9,197.00 in Billed Charges for Rev 278 = $4,376.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANEWRX IL LMB 11.5X12 13 14 15 16,278,RC,27800487,CDM,,,,,,both,,,9197.0000,1379.5500,SENTARA HEALTH,SENTARA HEALTH,2373.75,,,,,,,2373.7500,9197.0000,percent of total billed charges,"25.81% of $9,197.00 in Billed Charges for Rev 278 = $2,373.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANEWRX IL LMB 11.5X12 13 14 15 16,278,RC,27800487,CDM,,,,,,both,,,9197.0000,1379.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9197.00,,,,,,,2373.7500,9197.0000,percent of total billed charges,"100% of $9,197.00 in Billed Charges for Rev 278 = $9,197.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANEWRX IL LMB 11.5X12 13 14 15 16,278,RC,27800487,CDM,,,,,,both,,,9197.0000,1379.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4598.50,,,,,,,2373.7500,9197.0000,percent of total billed charges,"Rev 278 $9,197.00 in Billed Charges at 50% = $4,598.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANEWRX IL LMB 11.5X12 13 14 15 16,278,RC,27800487,CDM,,,,,,both,,,9197.0000,1379.5500,WELLCARE,WELLCARE MEDICAID,9197.00,,,,,,,2373.7500,9197.0000,percent of total billed charges,"100% of $9,197.00 in Billed Charges for Rev 278 = $9,197.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BALLOON 34MM,272,RC,27200707,CDM,,,,,,both,,,510.0000,76.5000,AETNA,AETNA,217.77,,,,,,,131.6300,510.0000,percent of total billed charges,42.7% of $510.00 in Billed Charges for Rev 272 = $217.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BALLOON 34MM,272,RC,27200707,CDM,,,,,,both,,,510.0000,76.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,357.00,,,,,,,131.6300,510.0000,percent of total billed charges,Rev 272 $510.00 in Billed Charges at 70% = $357.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BALLOON 34MM,272,RC,27200707,CDM,,,,,,both,,,510.0000,76.5000,CIGNA HEALTHCARE,CIGNA HMO,212.67,,,,,,,131.6300,510.0000,percent of total billed charges,41.7% of $510.00 in Billed Charges for Rev 272 = $212.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BALLOON 34MM,272,RC,27200707,CDM,,,,,,both,,,510.0000,76.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,236.64,,,,,,,131.6300,510.0000,percent of total billed charges,46.4% of $510.00 in Billed Charges for Rev 272 = $236.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BALLOON 34MM,272,RC,27200707,CDM,,,,,,both,,,510.0000,76.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,212.67,,,,,,,131.6300,510.0000,percent of total billed charges,41.7% of $510.00 in Billed Charges for Rev 272 = $212.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BALLOON 34MM,272,RC,27200707,CDM,,,,,,both,,,510.0000,76.5000,CIGNA HEALTHCARE,CIGNA PPO,212.67,,,,,,,131.6300,510.0000,percent of total billed charges,41.7% of $510.00 in Billed Charges for Rev 272 = $212.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BALLOON 34MM,272,RC,27200707,CDM,,,,,,both,,,510.0000,76.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,459.00,,,,,,,131.6300,510.0000,percent of total billed charges,90% of $510.00 in Billed Charges for Rev 272 = $459.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BALLOON 34MM,272,RC,27200707,CDM,,,,,,both,,,510.0000,76.5000,MEDCOST,MEDCOST VHN,242.71,,,,,,,131.6300,510.0000,percent of total billed charges,47.59% of $510.00 in Billed Charges for Rev 272 = $242.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BALLOON 34MM,272,RC,27200707,CDM,,,,,,both,,,510.0000,76.5000,SENTARA HEALTH,SENTARA HEALTH,131.63,,,,,,,131.6300,510.0000,percent of total billed charges,25.81% of $510.00 in Billed Charges for Rev 272 = $131.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BALLOON 34MM,272,RC,27200707,CDM,,,,,,both,,,510.0000,76.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",510.00,,,,,,,131.6300,510.0000,percent of total billed charges,100% of $510.00 in Billed Charges for Rev 272 = $510.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BALLOON 34MM,272,RC,27200707,CDM,,,,,,both,,,510.0000,76.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,255.00,,,,,,,131.6300,510.0000,percent of total billed charges,Rev 272 $510.00 in Billed Charges at 50% = $255.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BALLOON 34MM,272,RC,27200707,CDM,,,,,,both,,,510.0000,76.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,164.73,,,,,,,131.6300,510.0000,other,32.3% of $510.00 in Billed Charges for Rev 272 = $164.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI BALLOON 34MM,272,RC,27200707,CDM,,,,,,both,,,510.0000,76.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,156.57,,,,,,,131.6300,510.0000,other,30.7% of $510.00 in Billed Charges for Rev 272 = $156.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI BALLOON 34MM,272,RC,27200707,CDM,,,,,,both,,,510.0000,76.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,164.73,,,,,,,131.6300,510.0000,percent of total billed charges,32.3% of $510.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BALLOON 34MM,272,RC,27200707,CDM,,,,,,both,,,510.0000,76.5000,WELLCARE,WELLCARE MEDICAID,510.00,,,,,,,131.6300,510.0000,percent of total billed charges,100% of $510.00 in Billed Charges for Rev 272 = $510.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI BASKET TRAPEZ010RX #M00510870,272,RC,27200714,CDM,,,,,,both,,,1122.0000,168.3000,AETNA,AETNA,479.09,,,,,,,289.5900,1122.0000,percent of total billed charges,"42.7% of $1,122.00 in Billed Charges for Rev 272 = $479.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET TRAPEZ010RX #M00510870,272,RC,27200714,CDM,,,,,,both,,,1122.0000,168.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,785.40,,,,,,,289.5900,1122.0000,percent of total billed charges,"Rev 272 $1,122.00 in Billed Charges at 70% = $785.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET TRAPEZ010RX #M00510870,272,RC,27200714,CDM,,,,,,both,,,1122.0000,168.3000,CIGNA HEALTHCARE,CIGNA HMO,467.87,,,,,,,289.5900,1122.0000,percent of total billed charges,"41.7% of $1,122.00 in Billed Charges for Rev 272 = $467.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET TRAPEZ010RX #M00510870,272,RC,27200714,CDM,,,,,,both,,,1122.0000,168.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,520.61,,,,,,,289.5900,1122.0000,percent of total billed charges,"46.4% of $1,122.00 in Billed Charges for Rev 272 = $520.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET TRAPEZ010RX #M00510870,272,RC,27200714,CDM,,,,,,both,,,1122.0000,168.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,467.87,,,,,,,289.5900,1122.0000,percent of total billed charges,"41.7% of $1,122.00 in Billed Charges for Rev 272 = $467.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET TRAPEZ010RX #M00510870,272,RC,27200714,CDM,,,,,,both,,,1122.0000,168.3000,CIGNA HEALTHCARE,CIGNA PPO,467.87,,,,,,,289.5900,1122.0000,percent of total billed charges,"41.7% of $1,122.00 in Billed Charges for Rev 272 = $467.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET TRAPEZ010RX #M00510870,272,RC,27200714,CDM,,,,,,both,,,1122.0000,168.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1009.80,,,,,,,289.5900,1122.0000,percent of total billed charges,"90% of $1,122.00 in Billed Charges for Rev 272 = $1,009.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET TRAPEZ010RX #M00510870,272,RC,27200714,CDM,,,,,,both,,,1122.0000,168.3000,MEDCOST,MEDCOST VHN,533.96,,,,,,,289.5900,1122.0000,percent of total billed charges,"47.59% of $1,122.00 in Billed Charges for Rev 272 = $533.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET TRAPEZ010RX #M00510870,272,RC,27200714,CDM,,,,,,both,,,1122.0000,168.3000,SENTARA HEALTH,SENTARA HEALTH,289.59,,,,,,,289.5900,1122.0000,percent of total billed charges,"25.81% of $1,122.00 in Billed Charges for Rev 272 = $289.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET TRAPEZ010RX #M00510870,272,RC,27200714,CDM,,,,,,both,,,1122.0000,168.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1122.00,,,,,,,289.5900,1122.0000,percent of total billed charges,"100% of $1,122.00 in Billed Charges for Rev 272 = $1,122.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET TRAPEZ010RX #M00510870,272,RC,27200714,CDM,,,,,,both,,,1122.0000,168.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,561.00,,,,,,,289.5900,1122.0000,percent of total billed charges,"Rev 272 $1,122.00 in Billed Charges at 50% = $561.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET TRAPEZ010RX #M00510870,272,RC,27200714,CDM,,,,,,both,,,1122.0000,168.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,362.41,,,,,,,289.5900,1122.0000,other,"32.3% of $1,122.00 in Billed Charges for Rev 272 = $362.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC GI BASKET TRAPEZ010RX #M00510870,272,RC,27200714,CDM,,,,,,both,,,1122.0000,168.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,344.45,,,,,,,289.5900,1122.0000,other,"30.7% of $1,122.00 in Billed Charges for Rev 272 = $344.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC GI BASKET TRAPEZ010RX #M00510870,272,RC,27200714,CDM,,,,,,both,,,1122.0000,168.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,362.41,,,,,,,289.5900,1122.0000,percent of total billed charges,"32.3% of $1,122.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET TRAPEZ010RX #M00510870,272,RC,27200714,CDM,,,,,,both,,,1122.0000,168.3000,WELLCARE,WELLCARE MEDICAID,1122.00,,,,,,,289.5900,1122.0000,percent of total billed charges,"100% of $1,122.00 in Billed Charges for Rev 272 = $1,122.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET ZEROTIP 1.0MM #5132,272,RC,27200715,CDM,,,,,,both,,,1008.0000,151.2000,AETNA,AETNA,430.42,,,,,,,260.1600,1008.0000,percent of total billed charges,"42.7% of $1,008.00 in Billed Charges for Rev 272 = $430.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET ZEROTIP 1.0MM #5132,272,RC,27200715,CDM,,,,,,both,,,1008.0000,151.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,705.60,,,,,,,260.1600,1008.0000,percent of total billed charges,"Rev 272 $1,008.00 in Billed Charges at 70% = $705.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET ZEROTIP 1.0MM #5132,272,RC,27200715,CDM,,,,,,both,,,1008.0000,151.2000,CIGNA HEALTHCARE,CIGNA HMO,420.34,,,,,,,260.1600,1008.0000,percent of total billed charges,"41.7% of $1,008.00 in Billed Charges for Rev 272 = $420.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET ZEROTIP 1.0MM #5132,272,RC,27200715,CDM,,,,,,both,,,1008.0000,151.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,467.71,,,,,,,260.1600,1008.0000,percent of total billed charges,"46.4% of $1,008.00 in Billed Charges for Rev 272 = $467.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET ZEROTIP 1.0MM #5132,272,RC,27200715,CDM,,,,,,both,,,1008.0000,151.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,420.34,,,,,,,260.1600,1008.0000,percent of total billed charges,"41.7% of $1,008.00 in Billed Charges for Rev 272 = $420.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET ZEROTIP 1.0MM #5132,272,RC,27200715,CDM,,,,,,both,,,1008.0000,151.2000,CIGNA HEALTHCARE,CIGNA PPO,420.34,,,,,,,260.1600,1008.0000,percent of total billed charges,"41.7% of $1,008.00 in Billed Charges for Rev 272 = $420.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET ZEROTIP 1.0MM #5132,272,RC,27200715,CDM,,,,,,both,,,1008.0000,151.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,907.20,,,,,,,260.1600,1008.0000,percent of total billed charges,"90% of $1,008.00 in Billed Charges for Rev 272 = $907.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET ZEROTIP 1.0MM #5132,272,RC,27200715,CDM,,,,,,both,,,1008.0000,151.2000,MEDCOST,MEDCOST VHN,479.71,,,,,,,260.1600,1008.0000,percent of total billed charges,"47.59% of $1,008.00 in Billed Charges for Rev 272 = $479.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET ZEROTIP 1.0MM #5132,272,RC,27200715,CDM,,,,,,both,,,1008.0000,151.2000,SENTARA HEALTH,SENTARA HEALTH,260.16,,,,,,,260.1600,1008.0000,percent of total billed charges,"25.81% of $1,008.00 in Billed Charges for Rev 272 = $260.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET ZEROTIP 1.0MM #5132,272,RC,27200715,CDM,,,,,,both,,,1008.0000,151.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1008.00,,,,,,,260.1600,1008.0000,percent of total billed charges,"100% of $1,008.00 in Billed Charges for Rev 272 = $1,008.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET ZEROTIP 1.0MM #5132,272,RC,27200715,CDM,,,,,,both,,,1008.0000,151.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,504.00,,,,,,,260.1600,1008.0000,percent of total billed charges,"Rev 272 $1,008.00 in Billed Charges at 50% = $504.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET ZEROTIP 1.0MM #5132,272,RC,27200715,CDM,,,,,,both,,,1008.0000,151.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,325.58,,,,,,,260.1600,1008.0000,other,"32.3% of $1,008.00 in Billed Charges for Rev 272 = $325.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC GI BASKET ZEROTIP 1.0MM #5132,272,RC,27200715,CDM,,,,,,both,,,1008.0000,151.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,309.46,,,,,,,260.1600,1008.0000,other,"30.7% of $1,008.00 in Billed Charges for Rev 272 = $309.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC GI BASKET ZEROTIP 1.0MM #5132,272,RC,27200715,CDM,,,,,,both,,,1008.0000,151.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,325.58,,,,,,,260.1600,1008.0000,percent of total billed charges,"32.3% of $1,008.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI BASKET ZEROTIP 1.0MM #5132,272,RC,27200715,CDM,,,,,,both,,,1008.0000,151.2000,WELLCARE,WELLCARE MEDICAID,1008.00,,,,,,,260.1600,1008.0000,percent of total billed charges,"100% of $1,008.00 in Billed Charges for Rev 272 = $1,008.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI CANNULA XL RAPID EXCHANGE#4582,272,RC,27200720,CDM,,,,,,both,,,380.0000,57.0000,AETNA,AETNA,162.26,,,,,,,98.0800,380.0000,percent of total billed charges,42.7% of $380.00 in Billed Charges for Rev 272 = $162.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CANNULA XL RAPID EXCHANGE#4582,272,RC,27200720,CDM,,,,,,both,,,380.0000,57.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,266.00,,,,,,,98.0800,380.0000,percent of total billed charges,Rev 272 $380.00 in Billed Charges at 70% = $266.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CANNULA XL RAPID EXCHANGE#4582,272,RC,27200720,CDM,,,,,,both,,,380.0000,57.0000,CIGNA HEALTHCARE,CIGNA HMO,158.46,,,,,,,98.0800,380.0000,percent of total billed charges,41.7% of $380.00 in Billed Charges for Rev 272 = $158.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CANNULA XL RAPID EXCHANGE#4582,272,RC,27200720,CDM,,,,,,both,,,380.0000,57.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,176.32,,,,,,,98.0800,380.0000,percent of total billed charges,46.4% of $380.00 in Billed Charges for Rev 272 = $176.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CANNULA XL RAPID EXCHANGE#4582,272,RC,27200720,CDM,,,,,,both,,,380.0000,57.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,158.46,,,,,,,98.0800,380.0000,percent of total billed charges,41.7% of $380.00 in Billed Charges for Rev 272 = $158.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CANNULA XL RAPID EXCHANGE#4582,272,RC,27200720,CDM,,,,,,both,,,380.0000,57.0000,CIGNA HEALTHCARE,CIGNA PPO,158.46,,,,,,,98.0800,380.0000,percent of total billed charges,41.7% of $380.00 in Billed Charges for Rev 272 = $158.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CANNULA XL RAPID EXCHANGE#4582,272,RC,27200720,CDM,,,,,,both,,,380.0000,57.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,342.00,,,,,,,98.0800,380.0000,percent of total billed charges,90% of $380.00 in Billed Charges for Rev 272 = $342.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CANNULA XL RAPID EXCHANGE#4582,272,RC,27200720,CDM,,,,,,both,,,380.0000,57.0000,MEDCOST,MEDCOST VHN,180.84,,,,,,,98.0800,380.0000,percent of total billed charges,47.59% of $380.00 in Billed Charges for Rev 272 = $180.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CANNULA XL RAPID EXCHANGE#4582,272,RC,27200720,CDM,,,,,,both,,,380.0000,57.0000,SENTARA HEALTH,SENTARA HEALTH,98.08,,,,,,,98.0800,380.0000,percent of total billed charges,25.81% of $380.00 in Billed Charges for Rev 272 = $98.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CANNULA XL RAPID EXCHANGE#4582,272,RC,27200720,CDM,,,,,,both,,,380.0000,57.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",380.00,,,,,,,98.0800,380.0000,percent of total billed charges,100% of $380.00 in Billed Charges for Rev 272 = $380.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CANNULA XL RAPID EXCHANGE#4582,272,RC,27200720,CDM,,,,,,both,,,380.0000,57.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,190.00,,,,,,,98.0800,380.0000,percent of total billed charges,Rev 272 $380.00 in Billed Charges at 50% = $190.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CANNULA XL RAPID EXCHANGE#4582,272,RC,27200720,CDM,,,,,,both,,,380.0000,57.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,122.74,,,,,,,98.0800,380.0000,other,32.3% of $380.00 in Billed Charges for Rev 272 = $122.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI CANNULA XL RAPID EXCHANGE#4582,272,RC,27200720,CDM,,,,,,both,,,380.0000,57.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,116.66,,,,,,,98.0800,380.0000,other,30.7% of $380.00 in Billed Charges for Rev 272 = $116.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI CANNULA XL RAPID EXCHANGE#4582,272,RC,27200720,CDM,,,,,,both,,,380.0000,57.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,122.74,,,,,,,98.0800,380.0000,percent of total billed charges,32.3% of $380.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI CANNULA XL RAPID EXCHANGE#4582,272,RC,27200720,CDM,,,,,,both,,,380.0000,57.0000,WELLCARE,WELLCARE MEDICAID,380.00,,,,,,,98.0800,380.0000,percent of total billed charges,100% of $380.00 in Billed Charges for Rev 272 = $380.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FIBER LASER DIODE DSLF-60,272,RC,27200730,CDM,,,,,,both,,,613.0000,91.9500,AETNA,AETNA,261.75,,,,,,,158.2200,613.0000,percent of total billed charges,42.7% of $613.00 in Billed Charges for Rev 272 = $261.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FIBER LASER DIODE DSLF-60,272,RC,27200730,CDM,,,,,,both,,,613.0000,91.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,429.10,,,,,,,158.2200,613.0000,percent of total billed charges,Rev 272 $613.00 in Billed Charges at 70% = $429.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FIBER LASER DIODE DSLF-60,272,RC,27200730,CDM,,,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA HMO,255.62,,,,,,,158.2200,613.0000,percent of total billed charges,41.7% of $613.00 in Billed Charges for Rev 272 = $255.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FIBER LASER DIODE DSLF-60,272,RC,27200730,CDM,,,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,284.43,,,,,,,158.2200,613.0000,percent of total billed charges,46.4% of $613.00 in Billed Charges for Rev 272 = $284.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FIBER LASER DIODE DSLF-60,272,RC,27200730,CDM,,,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,255.62,,,,,,,158.2200,613.0000,percent of total billed charges,41.7% of $613.00 in Billed Charges for Rev 272 = $255.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FIBER LASER DIODE DSLF-60,272,RC,27200730,CDM,,,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA PPO,255.62,,,,,,,158.2200,613.0000,percent of total billed charges,41.7% of $613.00 in Billed Charges for Rev 272 = $255.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FIBER LASER DIODE DSLF-60,272,RC,27200730,CDM,,,,,,both,,,613.0000,91.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,551.70,,,,,,,158.2200,613.0000,percent of total billed charges,90% of $613.00 in Billed Charges for Rev 272 = $551.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FIBER LASER DIODE DSLF-60,272,RC,27200730,CDM,,,,,,both,,,613.0000,91.9500,MEDCOST,MEDCOST VHN,291.73,,,,,,,158.2200,613.0000,percent of total billed charges,47.59% of $613.00 in Billed Charges for Rev 272 = $291.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FIBER LASER DIODE DSLF-60,272,RC,27200730,CDM,,,,,,both,,,613.0000,91.9500,SENTARA HEALTH,SENTARA HEALTH,158.22,,,,,,,158.2200,613.0000,percent of total billed charges,25.81% of $613.00 in Billed Charges for Rev 272 = $158.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FIBER LASER DIODE DSLF-60,272,RC,27200730,CDM,,,,,,both,,,613.0000,91.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",613.00,,,,,,,158.2200,613.0000,percent of total billed charges,100% of $613.00 in Billed Charges for Rev 272 = $613.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FIBER LASER DIODE DSLF-60,272,RC,27200730,CDM,,,,,,both,,,613.0000,91.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,306.50,,,,,,,158.2200,613.0000,percent of total billed charges,Rev 272 $613.00 in Billed Charges at 50% = $306.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FIBER LASER DIODE DSLF-60,272,RC,27200730,CDM,,,,,,both,,,613.0000,91.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,198.00,,,,,,,158.2200,613.0000,other,32.3% of $613.00 in Billed Charges for Rev 272 = $198.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI FIBER LASER DIODE DSLF-60,272,RC,27200730,CDM,,,,,,both,,,613.0000,91.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,188.19,,,,,,,158.2200,613.0000,other,30.7% of $613.00 in Billed Charges for Rev 272 = $188.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI FIBER LASER DIODE DSLF-60,272,RC,27200730,CDM,,,,,,both,,,613.0000,91.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,198.00,,,,,,,158.2200,613.0000,percent of total billed charges,32.3% of $613.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FIBER LASER DIODE DSLF-60,272,RC,27200730,CDM,,,,,,both,,,613.0000,91.9500,WELLCARE,WELLCARE MEDICAID,613.00,,,,,,,158.2200,613.0000,percent of total billed charges,100% of $613.00 in Billed Charges for Rev 272 = $613.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP HOT BIOPSY RADIAL141515,272,RC,27200731,CDM,,,,,,both,,,435.0000,65.2500,AETNA,AETNA,185.75,,,,,,,112.2700,435.0000,percent of total billed charges,42.7% of $435.00 in Billed Charges for Rev 272 = $185.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP HOT BIOPSY RADIAL141515,272,RC,27200731,CDM,,,,,,both,,,435.0000,65.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,304.50,,,,,,,112.2700,435.0000,percent of total billed charges,Rev 272 $435.00 in Billed Charges at 70% = $304.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP HOT BIOPSY RADIAL141515,272,RC,27200731,CDM,,,,,,both,,,435.0000,65.2500,CIGNA HEALTHCARE,CIGNA HMO,181.40,,,,,,,112.2700,435.0000,percent of total billed charges,41.7% of $435.00 in Billed Charges for Rev 272 = $181.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP HOT BIOPSY RADIAL141515,272,RC,27200731,CDM,,,,,,both,,,435.0000,65.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,201.84,,,,,,,112.2700,435.0000,percent of total billed charges,46.4% of $435.00 in Billed Charges for Rev 272 = $201.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP HOT BIOPSY RADIAL141515,272,RC,27200731,CDM,,,,,,both,,,435.0000,65.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,181.40,,,,,,,112.2700,435.0000,percent of total billed charges,41.7% of $435.00 in Billed Charges for Rev 272 = $181.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP HOT BIOPSY RADIAL141515,272,RC,27200731,CDM,,,,,,both,,,435.0000,65.2500,CIGNA HEALTHCARE,CIGNA PPO,181.40,,,,,,,112.2700,435.0000,percent of total billed charges,41.7% of $435.00 in Billed Charges for Rev 272 = $181.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP HOT BIOPSY RADIAL141515,272,RC,27200731,CDM,,,,,,both,,,435.0000,65.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,391.50,,,,,,,112.2700,435.0000,percent of total billed charges,90% of $435.00 in Billed Charges for Rev 272 = $391.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP HOT BIOPSY RADIAL141515,272,RC,27200731,CDM,,,,,,both,,,435.0000,65.2500,MEDCOST,MEDCOST VHN,207.02,,,,,,,112.2700,435.0000,percent of total billed charges,47.59% of $435.00 in Billed Charges for Rev 272 = $207.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP HOT BIOPSY RADIAL141515,272,RC,27200731,CDM,,,,,,both,,,435.0000,65.2500,SENTARA HEALTH,SENTARA HEALTH,112.27,,,,,,,112.2700,435.0000,percent of total billed charges,25.81% of $435.00 in Billed Charges for Rev 272 = $112.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP HOT BIOPSY RADIAL141515,272,RC,27200731,CDM,,,,,,both,,,435.0000,65.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",435.00,,,,,,,112.2700,435.0000,percent of total billed charges,100% of $435.00 in Billed Charges for Rev 272 = $435.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP HOT BIOPSY RADIAL141515,272,RC,27200731,CDM,,,,,,both,,,435.0000,65.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,217.50,,,,,,,112.2700,435.0000,percent of total billed charges,Rev 272 $435.00 in Billed Charges at 50% = $217.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP HOT BIOPSY RADIAL141515,272,RC,27200731,CDM,,,,,,both,,,435.0000,65.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,140.51,,,,,,,112.2700,435.0000,other,32.3% of $435.00 in Billed Charges for Rev 272 = $140.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI FORCEP HOT BIOPSY RADIAL141515,272,RC,27200731,CDM,,,,,,both,,,435.0000,65.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,133.55,,,,,,,112.2700,435.0000,other,30.7% of $435.00 in Billed Charges for Rev 272 = $133.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI FORCEP HOT BIOPSY RADIAL141515,272,RC,27200731,CDM,,,,,,both,,,435.0000,65.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,140.51,,,,,,,112.2700,435.0000,percent of total billed charges,32.3% of $435.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP HOT BIOPSY RADIAL141515,272,RC,27200731,CDM,,,,,,both,,,435.0000,65.2500,WELLCARE,WELLCARE MEDICAID,435.00,,,,,,,112.2700,435.0000,percent of total billed charges,100% of $435.00 in Billed Charges for Rev 272 = $435.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW,272,RC,27200732,CDM,,,,,,both,,,310.0000,46.5000,AETNA,AETNA,132.37,,,,,,,80.0100,310.0000,percent of total billed charges,42.7% of $310.00 in Billed Charges for Rev 272 = $132.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW,272,RC,27200732,CDM,,,,,,both,,,310.0000,46.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,217.00,,,,,,,80.0100,310.0000,percent of total billed charges,Rev 272 $310.00 in Billed Charges at 70% = $217.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW,272,RC,27200732,CDM,,,,,,both,,,310.0000,46.5000,CIGNA HEALTHCARE,CIGNA HMO,129.27,,,,,,,80.0100,310.0000,percent of total billed charges,41.7% of $310.00 in Billed Charges for Rev 272 = $129.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW,272,RC,27200732,CDM,,,,,,both,,,310.0000,46.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,143.84,,,,,,,80.0100,310.0000,percent of total billed charges,46.4% of $310.00 in Billed Charges for Rev 272 = $143.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW,272,RC,27200732,CDM,,,,,,both,,,310.0000,46.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,129.27,,,,,,,80.0100,310.0000,percent of total billed charges,41.7% of $310.00 in Billed Charges for Rev 272 = $129.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW,272,RC,27200732,CDM,,,,,,both,,,310.0000,46.5000,CIGNA HEALTHCARE,CIGNA PPO,129.27,,,,,,,80.0100,310.0000,percent of total billed charges,41.7% of $310.00 in Billed Charges for Rev 272 = $129.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW,272,RC,27200732,CDM,,,,,,both,,,310.0000,46.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,279.00,,,,,,,80.0100,310.0000,percent of total billed charges,90% of $310.00 in Billed Charges for Rev 272 = $279.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW,272,RC,27200732,CDM,,,,,,both,,,310.0000,46.5000,MEDCOST,MEDCOST VHN,147.53,,,,,,,80.0100,310.0000,percent of total billed charges,47.59% of $310.00 in Billed Charges for Rev 272 = $147.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW,272,RC,27200732,CDM,,,,,,both,,,310.0000,46.5000,SENTARA HEALTH,SENTARA HEALTH,80.01,,,,,,,80.0100,310.0000,percent of total billed charges,25.81% of $310.00 in Billed Charges for Rev 272 = $80.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW,272,RC,27200732,CDM,,,,,,both,,,310.0000,46.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",310.00,,,,,,,80.0100,310.0000,percent of total billed charges,100% of $310.00 in Billed Charges for Rev 272 = $310.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW,272,RC,27200732,CDM,,,,,,both,,,310.0000,46.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,155.00,,,,,,,80.0100,310.0000,percent of total billed charges,Rev 272 $310.00 in Billed Charges at 50% = $155.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW,272,RC,27200732,CDM,,,,,,both,,,310.0000,46.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,100.13,,,,,,,80.0100,310.0000,other,32.3% of $310.00 in Billed Charges for Rev 272 = $100.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI FORCEP RADIAL JAW,272,RC,27200732,CDM,,,,,,both,,,310.0000,46.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,95.17,,,,,,,80.0100,310.0000,other,30.7% of $310.00 in Billed Charges for Rev 272 = $95.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI FORCEP RADIAL JAW,272,RC,27200732,CDM,,,,,,both,,,310.0000,46.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,100.13,,,,,,,80.0100,310.0000,percent of total billed charges,32.3% of $310.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW,272,RC,27200732,CDM,,,,,,both,,,310.0000,46.5000,WELLCARE,WELLCARE MEDICAID,310.00,,,,,,,80.0100,310.0000,percent of total billed charges,100% of $310.00 in Billed Charges for Rev 272 = $310.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW 3 BRONCH,272,RC,27200733,CDM,,,,,,both,,,376.0000,56.4000,AETNA,AETNA,160.55,,,,,,,97.0500,376.0000,percent of total billed charges,42.7% of $376.00 in Billed Charges for Rev 272 = $160.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW 3 BRONCH,272,RC,27200733,CDM,,,,,,both,,,376.0000,56.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,263.20,,,,,,,97.0500,376.0000,percent of total billed charges,Rev 272 $376.00 in Billed Charges at 70% = $263.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW 3 BRONCH,272,RC,27200733,CDM,,,,,,both,,,376.0000,56.4000,CIGNA HEALTHCARE,CIGNA HMO,156.79,,,,,,,97.0500,376.0000,percent of total billed charges,41.7% of $376.00 in Billed Charges for Rev 272 = $156.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW 3 BRONCH,272,RC,27200733,CDM,,,,,,both,,,376.0000,56.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,174.46,,,,,,,97.0500,376.0000,percent of total billed charges,46.4% of $376.00 in Billed Charges for Rev 272 = $174.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW 3 BRONCH,272,RC,27200733,CDM,,,,,,both,,,376.0000,56.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,156.79,,,,,,,97.0500,376.0000,percent of total billed charges,41.7% of $376.00 in Billed Charges for Rev 272 = $156.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW 3 BRONCH,272,RC,27200733,CDM,,,,,,both,,,376.0000,56.4000,CIGNA HEALTHCARE,CIGNA PPO,156.79,,,,,,,97.0500,376.0000,percent of total billed charges,41.7% of $376.00 in Billed Charges for Rev 272 = $156.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW 3 BRONCH,272,RC,27200733,CDM,,,,,,both,,,376.0000,56.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,338.40,,,,,,,97.0500,376.0000,percent of total billed charges,90% of $376.00 in Billed Charges for Rev 272 = $338.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW 3 BRONCH,272,RC,27200733,CDM,,,,,,both,,,376.0000,56.4000,MEDCOST,MEDCOST VHN,178.94,,,,,,,97.0500,376.0000,percent of total billed charges,47.59% of $376.00 in Billed Charges for Rev 272 = $178.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW 3 BRONCH,272,RC,27200733,CDM,,,,,,both,,,376.0000,56.4000,SENTARA HEALTH,SENTARA HEALTH,97.05,,,,,,,97.0500,376.0000,percent of total billed charges,25.81% of $376.00 in Billed Charges for Rev 272 = $97.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW 3 BRONCH,272,RC,27200733,CDM,,,,,,both,,,376.0000,56.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",376.00,,,,,,,97.0500,376.0000,percent of total billed charges,100% of $376.00 in Billed Charges for Rev 272 = $376.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW 3 BRONCH,272,RC,27200733,CDM,,,,,,both,,,376.0000,56.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,188.00,,,,,,,97.0500,376.0000,percent of total billed charges,Rev 272 $376.00 in Billed Charges at 50% = $188.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW 3 BRONCH,272,RC,27200733,CDM,,,,,,both,,,376.0000,56.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,121.45,,,,,,,97.0500,376.0000,other,32.3% of $376.00 in Billed Charges for Rev 272 = $121.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI FORCEP RADIAL JAW 3 BRONCH,272,RC,27200733,CDM,,,,,,both,,,376.0000,56.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,115.43,,,,,,,97.0500,376.0000,other,30.7% of $376.00 in Billed Charges for Rev 272 = $115.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI FORCEP RADIAL JAW 3 BRONCH,272,RC,27200733,CDM,,,,,,both,,,376.0000,56.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,121.45,,,,,,,97.0500,376.0000,percent of total billed charges,32.3% of $376.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI FORCEP RADIAL JAW 3 BRONCH,272,RC,27200733,CDM,,,,,,both,,,376.0000,56.4000,WELLCARE,WELLCARE MEDICAID,376.00,,,,,,,97.0500,376.0000,percent of total billed charges,100% of $376.00 in Billed Charges for Rev 272 = $376.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT FLEXIFLO LAP G F18 #51174,270,RC,27000096,CDM,,,,,,both,,,679.0000,101.8500,AETNA,AETNA,289.93,,,,,,,175.2500,679.0000,percent of total billed charges,42.7% of $679.00 in Billed Charges for Rev 270 = $289.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT FLEXIFLO LAP G F18 #51174,270,RC,27000096,CDM,,,,,,both,,,679.0000,101.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,475.30,,,,,,,175.2500,679.0000,percent of total billed charges,Rev 270 $679.00 in Billed Charges at 70% = $475.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT FLEXIFLO LAP G F18 #51174,270,RC,27000096,CDM,,,,,,both,,,679.0000,101.8500,CIGNA HEALTHCARE,CIGNA HMO,283.14,,,,,,,175.2500,679.0000,percent of total billed charges,41.7% of $679.00 in Billed Charges for Rev 270 = $283.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT FLEXIFLO LAP G F18 #51174,270,RC,27000096,CDM,,,,,,both,,,679.0000,101.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,315.06,,,,,,,175.2500,679.0000,percent of total billed charges,46.4% of $679.00 in Billed Charges for Rev 270 = $315.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT FLEXIFLO LAP G F18 #51174,270,RC,27000096,CDM,,,,,,both,,,679.0000,101.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,283.14,,,,,,,175.2500,679.0000,percent of total billed charges,41.7% of $679.00 in Billed Charges for Rev 270 = $283.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT FLEXIFLO LAP G F18 #51174,270,RC,27000096,CDM,,,,,,both,,,679.0000,101.8500,CIGNA HEALTHCARE,CIGNA PPO,283.14,,,,,,,175.2500,679.0000,percent of total billed charges,41.7% of $679.00 in Billed Charges for Rev 270 = $283.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT FLEXIFLO LAP G F18 #51174,270,RC,27000096,CDM,,,,,,both,,,679.0000,101.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,611.10,,,,,,,175.2500,679.0000,percent of total billed charges,90% of $679.00 in Billed Charges for Rev 270 = $611.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT FLEXIFLO LAP G F18 #51174,270,RC,27000096,CDM,,,,,,both,,,679.0000,101.8500,MEDCOST,MEDCOST VHN,323.14,,,,,,,175.2500,679.0000,percent of total billed charges,47.59% of $679.00 in Billed Charges for Rev 270 = $323.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT FLEXIFLO LAP G F18 #51174,270,RC,27000096,CDM,,,,,,both,,,679.0000,101.8500,SENTARA HEALTH,SENTARA HEALTH,175.25,,,,,,,175.2500,679.0000,percent of total billed charges,25.81% of $679.00 in Billed Charges for Rev 270 = $175.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT FLEXIFLO LAP G F18 #51174,270,RC,27000096,CDM,,,,,,both,,,679.0000,101.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",679.00,,,,,,,175.2500,679.0000,percent of total billed charges,100% of $679.00 in Billed Charges for Rev 270 = $679.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT FLEXIFLO LAP G F18 #51174,270,RC,27000096,CDM,,,,,,both,,,679.0000,101.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,339.50,,,,,,,175.2500,679.0000,percent of total billed charges,Rev 270 $679.00 in Billed Charges at 50% = $339.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT FLEXIFLO LAP G F18 #51174,270,RC,27000096,CDM,,,,,,both,,,679.0000,101.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,219.32,,,,,,,175.2500,679.0000,other,32.3% of $679.00 in Billed Charges for Rev 270 = $219.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI KIT FLEXIFLO LAP G F18 #51174,270,RC,27000096,CDM,,,,,,both,,,679.0000,101.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,208.45,,,,,,,175.2500,679.0000,other,30.7% of $679.00 in Billed Charges for Rev 270 = $208.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI KIT FLEXIFLO LAP G F18 #51174,270,RC,27000096,CDM,,,,,,both,,,679.0000,101.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,219.32,,,,,,,175.2500,679.0000,percent of total billed charges,32.3% of $679.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT FLEXIFLO LAP G F18 #51174,270,RC,27000096,CDM,,,,,,both,,,679.0000,101.8500,WELLCARE,WELLCARE MEDICAID,679.00,,,,,,,175.2500,679.0000,percent of total billed charges,100% of $679.00 in Billed Charges for Rev 270 = $679.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRIC LAVAGE 34FR,270,RC,27000101,CDM,,,,,,both,,,45.0000,6.7500,AETNA,AETNA,19.22,,,,,,,11.6100,45.0000,percent of total billed charges,42.7% of $45.00 in Billed Charges for Rev 270 = $19.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRIC LAVAGE 34FR,270,RC,27000101,CDM,,,,,,both,,,45.0000,6.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,31.50,,,,,,,11.6100,45.0000,percent of total billed charges,Rev 270 $45.00 in Billed Charges at 70% = $31.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRIC LAVAGE 34FR,270,RC,27000101,CDM,,,,,,both,,,45.0000,6.7500,CIGNA HEALTHCARE,CIGNA HMO,18.77,,,,,,,11.6100,45.0000,percent of total billed charges,41.7% of $45.00 in Billed Charges for Rev 270 = $18.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRIC LAVAGE 34FR,270,RC,27000101,CDM,,,,,,both,,,45.0000,6.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,20.88,,,,,,,11.6100,45.0000,percent of total billed charges,46.4% of $45.00 in Billed Charges for Rev 270 = $20.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRIC LAVAGE 34FR,270,RC,27000101,CDM,,,,,,both,,,45.0000,6.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,18.77,,,,,,,11.6100,45.0000,percent of total billed charges,41.7% of $45.00 in Billed Charges for Rev 270 = $18.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRIC LAVAGE 34FR,270,RC,27000101,CDM,,,,,,both,,,45.0000,6.7500,CIGNA HEALTHCARE,CIGNA PPO,18.77,,,,,,,11.6100,45.0000,percent of total billed charges,41.7% of $45.00 in Billed Charges for Rev 270 = $18.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRIC LAVAGE 34FR,270,RC,27000101,CDM,,,,,,both,,,45.0000,6.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,40.50,,,,,,,11.6100,45.0000,percent of total billed charges,90% of $45.00 in Billed Charges for Rev 270 = $40.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRIC LAVAGE 34FR,270,RC,27000101,CDM,,,,,,both,,,45.0000,6.7500,MEDCOST,MEDCOST VHN,21.42,,,,,,,11.6100,45.0000,percent of total billed charges,47.59% of $45.00 in Billed Charges for Rev 270 = $21.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRIC LAVAGE 34FR,270,RC,27000101,CDM,,,,,,both,,,45.0000,6.7500,SENTARA HEALTH,SENTARA HEALTH,11.61,,,,,,,11.6100,45.0000,percent of total billed charges,25.81% of $45.00 in Billed Charges for Rev 270 = $11.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRIC LAVAGE 34FR,270,RC,27000101,CDM,,,,,,both,,,45.0000,6.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",45.00,,,,,,,11.6100,45.0000,percent of total billed charges,100% of $45.00 in Billed Charges for Rev 270 = $45.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRIC LAVAGE 34FR,270,RC,27000101,CDM,,,,,,both,,,45.0000,6.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.50,,,,,,,11.6100,45.0000,percent of total billed charges,Rev 270 $45.00 in Billed Charges at 50% = $22.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRIC LAVAGE 34FR,270,RC,27000101,CDM,,,,,,both,,,45.0000,6.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,14.54,,,,,,,11.6100,45.0000,other,32.3% of $45.00 in Billed Charges for Rev 270 = $14.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI KIT GASTRIC LAVAGE 34FR,270,RC,27000101,CDM,,,,,,both,,,45.0000,6.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,13.82,,,,,,,11.6100,45.0000,other,30.7% of $45.00 in Billed Charges for Rev 270 = $13.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI KIT GASTRIC LAVAGE 34FR,270,RC,27000101,CDM,,,,,,both,,,45.0000,6.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,14.54,,,,,,,11.6100,45.0000,percent of total billed charges,32.3% of $45.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRIC LAVAGE 34FR,270,RC,27000101,CDM,,,,,,both,,,45.0000,6.7500,WELLCARE,WELLCARE MEDICAID,45.00,,,,,,,11.6100,45.0000,percent of total billed charges,100% of $45.00 in Billed Charges for Rev 270 = $45.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRO 20FR REPLACE,270,RC,27000095,CDM,,,,,,both,,,224.0000,33.6000,AETNA,AETNA,95.65,,,,,,,57.8100,224.0000,percent of total billed charges,42.7% of $224.00 in Billed Charges for Rev 270 = $95.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRO 20FR REPLACE,270,RC,27000095,CDM,,,,,,both,,,224.0000,33.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,156.80,,,,,,,57.8100,224.0000,percent of total billed charges,Rev 270 $224.00 in Billed Charges at 70% = $156.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRO 20FR REPLACE,270,RC,27000095,CDM,,,,,,both,,,224.0000,33.6000,CIGNA HEALTHCARE,CIGNA HMO,93.41,,,,,,,57.8100,224.0000,percent of total billed charges,41.7% of $224.00 in Billed Charges for Rev 270 = $93.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRO 20FR REPLACE,270,RC,27000095,CDM,,,,,,both,,,224.0000,33.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,103.94,,,,,,,57.8100,224.0000,percent of total billed charges,46.4% of $224.00 in Billed Charges for Rev 270 = $103.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRO 20FR REPLACE,270,RC,27000095,CDM,,,,,,both,,,224.0000,33.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,93.41,,,,,,,57.8100,224.0000,percent of total billed charges,41.7% of $224.00 in Billed Charges for Rev 270 = $93.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRO 20FR REPLACE,270,RC,27000095,CDM,,,,,,both,,,224.0000,33.6000,CIGNA HEALTHCARE,CIGNA PPO,93.41,,,,,,,57.8100,224.0000,percent of total billed charges,41.7% of $224.00 in Billed Charges for Rev 270 = $93.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRO 20FR REPLACE,270,RC,27000095,CDM,,,,,,both,,,224.0000,33.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,201.60,,,,,,,57.8100,224.0000,percent of total billed charges,90% of $224.00 in Billed Charges for Rev 270 = $201.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRO 20FR REPLACE,270,RC,27000095,CDM,,,,,,both,,,224.0000,33.6000,MEDCOST,MEDCOST VHN,106.60,,,,,,,57.8100,224.0000,percent of total billed charges,47.59% of $224.00 in Billed Charges for Rev 270 = $106.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRO 20FR REPLACE,270,RC,27000095,CDM,,,,,,both,,,224.0000,33.6000,SENTARA HEALTH,SENTARA HEALTH,57.81,,,,,,,57.8100,224.0000,percent of total billed charges,25.81% of $224.00 in Billed Charges for Rev 270 = $57.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRO 20FR REPLACE,270,RC,27000095,CDM,,,,,,both,,,224.0000,33.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",224.00,,,,,,,57.8100,224.0000,percent of total billed charges,100% of $224.00 in Billed Charges for Rev 270 = $224.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRO 20FR REPLACE,270,RC,27000095,CDM,,,,,,both,,,224.0000,33.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,112.00,,,,,,,57.8100,224.0000,percent of total billed charges,Rev 270 $224.00 in Billed Charges at 50% = $112.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRO 20FR REPLACE,270,RC,27000095,CDM,,,,,,both,,,224.0000,33.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,72.35,,,,,,,57.8100,224.0000,other,32.3% of $224.00 in Billed Charges for Rev 270 = $72.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI KIT GASTRO 20FR REPLACE,270,RC,27000095,CDM,,,,,,both,,,224.0000,33.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,68.77,,,,,,,57.8100,224.0000,other,30.7% of $224.00 in Billed Charges for Rev 270 = $68.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI KIT GASTRO 20FR REPLACE,270,RC,27000095,CDM,,,,,,both,,,224.0000,33.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,72.35,,,,,,,57.8100,224.0000,percent of total billed charges,32.3% of $224.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT GASTRO 20FR REPLACE,270,RC,27000095,CDM,,,,,,both,,,224.0000,33.6000,WELLCARE,WELLCARE MEDICAID,224.00,,,,,,,57.8100,224.0000,percent of total billed charges,100% of $224.00 in Billed Charges for Rev 270 = $224.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLIER W/ ENDOANCHOR HELI-FX SA-85,272,RC,27800568,CDM,,,,,,both,,,12606.0000,1890.9000,AETNA,AETNA,5382.76,,,,,,,3253.6100,12606.0000,percent of total billed charges,"42.7% of $12,606.00 in Billed Charges for Rev 272 = $5,382.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPLIER W/ ENDOANCHOR HELI-FX SA-85,272,RC,27800568,CDM,,,,,,both,,,12606.0000,1890.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8824.20,,,,,,,3253.6100,12606.0000,percent of total billed charges,"Rev 272 $12,606.00 in Billed Charges at 70% = $8,824.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPLIER W/ ENDOANCHOR HELI-FX SA-85,272,RC,27800568,CDM,,,,,,both,,,12606.0000,1890.9000,CIGNA HEALTHCARE,CIGNA HMO,5256.70,,,,,,,3253.6100,12606.0000,percent of total billed charges,"41.7% of $12,606.00 in Billed Charges for Rev 272 = $5,256.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPLIER W/ ENDOANCHOR HELI-FX SA-85,272,RC,27800568,CDM,,,,,,both,,,12606.0000,1890.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5849.18,,,,,,,3253.6100,12606.0000,percent of total billed charges,"46.4% of $12,606.00 in Billed Charges for Rev 272 = $5,849.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPLIER W/ ENDOANCHOR HELI-FX SA-85,272,RC,27800568,CDM,,,,,,both,,,12606.0000,1890.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5256.70,,,,,,,3253.6100,12606.0000,percent of total billed charges,"41.7% of $12,606.00 in Billed Charges for Rev 272 = $5,256.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPLIER W/ ENDOANCHOR HELI-FX SA-85,272,RC,27800568,CDM,,,,,,both,,,12606.0000,1890.9000,CIGNA HEALTHCARE,CIGNA PPO,5256.70,,,,,,,3253.6100,12606.0000,percent of total billed charges,"41.7% of $12,606.00 in Billed Charges for Rev 272 = $5,256.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPLIER W/ ENDOANCHOR HELI-FX SA-85,272,RC,27800568,CDM,,,,,,both,,,12606.0000,1890.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11345.40,,,,,,,3253.6100,12606.0000,percent of total billed charges,"90% of $12,606.00 in Billed Charges for Rev 272 = $11,345.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPLIER W/ ENDOANCHOR HELI-FX SA-85,272,RC,27800568,CDM,,,,,,both,,,12606.0000,1890.9000,MEDCOST,MEDCOST VHN,5999.20,,,,,,,3253.6100,12606.0000,percent of total billed charges,"47.59% of $12,606.00 in Billed Charges for Rev 272 = $5,999.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPLIER W/ ENDOANCHOR HELI-FX SA-85,272,RC,27800568,CDM,,,,,,both,,,12606.0000,1890.9000,SENTARA HEALTH,SENTARA HEALTH,3253.61,,,,,,,3253.6100,12606.0000,percent of total billed charges,"25.81% of $12,606.00 in Billed Charges for Rev 272 = $3,253.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPLIER W/ ENDOANCHOR HELI-FX SA-85,272,RC,27800568,CDM,,,,,,both,,,12606.0000,1890.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12606.00,,,,,,,3253.6100,12606.0000,percent of total billed charges,"100% of $12,606.00 in Billed Charges for Rev 272 = $12,606.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPLIER W/ ENDOANCHOR HELI-FX SA-85,272,RC,27800568,CDM,,,,,,both,,,12606.0000,1890.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6303.00,,,,,,,3253.6100,12606.0000,percent of total billed charges,"Rev 272 $12,606.00 in Billed Charges at 50% = $6,303.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPLIER W/ ENDOANCHOR HELI-FX SA-85,272,RC,27800568,CDM,,,,,,both,,,12606.0000,1890.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4071.74,,,,,,,3253.6100,12606.0000,other,"32.3% of $12,606.00 in Billed Charges for Rev 272 = $4,071.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLIER W/ ENDOANCHOR HELI-FX SA-85,272,RC,27800568,CDM,,,,,,both,,,12606.0000,1890.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3870.04,,,,,,,3253.6100,12606.0000,other,"30.7% of $12,606.00 in Billed Charges for Rev 272 = $3,870.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLIER W/ ENDOANCHOR HELI-FX SA-85,272,RC,27800568,CDM,,,,,,both,,,12606.0000,1890.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,4071.74,,,,,,,3253.6100,12606.0000,percent of total billed charges,"32.3% of $12,606.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPLIER W/ ENDOANCHOR HELI-FX SA-85,272,RC,27800568,CDM,,,,,,both,,,12606.0000,1890.9000,WELLCARE,WELLCARE MEDICAID,12606.00,,,,,,,3253.6100,12606.0000,percent of total billed charges,"100% of $12,606.00 in Billed Charges for Rev 272 = $12,606.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARISTA 1G SM0005,272,RC,27201660,CDM,,,,,,both,,,1818.0000,272.7000,AETNA,AETNA,776.29,,,,,,,469.2300,1818.0000,percent of total billed charges,"42.7% of $1,818.00 in Billed Charges for Rev 272 = $776.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARISTA 1G SM0005,272,RC,27201660,CDM,,,,,,both,,,1818.0000,272.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1272.60,,,,,,,469.2300,1818.0000,percent of total billed charges,"Rev 272 $1,818.00 in Billed Charges at 70% = $1,272.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARISTA 1G SM0005,272,RC,27201660,CDM,,,,,,both,,,1818.0000,272.7000,CIGNA HEALTHCARE,CIGNA HMO,758.11,,,,,,,469.2300,1818.0000,percent of total billed charges,"41.7% of $1,818.00 in Billed Charges for Rev 272 = $758.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARISTA 1G SM0005,272,RC,27201660,CDM,,,,,,both,,,1818.0000,272.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,843.55,,,,,,,469.2300,1818.0000,percent of total billed charges,"46.4% of $1,818.00 in Billed Charges for Rev 272 = $843.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARISTA 1G SM0005,272,RC,27201660,CDM,,,,,,both,,,1818.0000,272.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,758.11,,,,,,,469.2300,1818.0000,percent of total billed charges,"41.7% of $1,818.00 in Billed Charges for Rev 272 = $758.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARISTA 1G SM0005,272,RC,27201660,CDM,,,,,,both,,,1818.0000,272.7000,CIGNA HEALTHCARE,CIGNA PPO,758.11,,,,,,,469.2300,1818.0000,percent of total billed charges,"41.7% of $1,818.00 in Billed Charges for Rev 272 = $758.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARISTA 1G SM0005,272,RC,27201660,CDM,,,,,,both,,,1818.0000,272.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1636.20,,,,,,,469.2300,1818.0000,percent of total billed charges,"90% of $1,818.00 in Billed Charges for Rev 272 = $1,636.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARISTA 1G SM0005,272,RC,27201660,CDM,,,,,,both,,,1818.0000,272.7000,MEDCOST,MEDCOST VHN,865.19,,,,,,,469.2300,1818.0000,percent of total billed charges,"47.59% of $1,818.00 in Billed Charges for Rev 272 = $865.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARISTA 1G SM0005,272,RC,27201660,CDM,,,,,,both,,,1818.0000,272.7000,SENTARA HEALTH,SENTARA HEALTH,469.23,,,,,,,469.2300,1818.0000,percent of total billed charges,"25.81% of $1,818.00 in Billed Charges for Rev 272 = $469.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARISTA 1G SM0005,272,RC,27201660,CDM,,,,,,both,,,1818.0000,272.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1818.00,,,,,,,469.2300,1818.0000,percent of total billed charges,"100% of $1,818.00 in Billed Charges for Rev 272 = $1,818.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARISTA 1G SM0005,272,RC,27201660,CDM,,,,,,both,,,1818.0000,272.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,909.00,,,,,,,469.2300,1818.0000,percent of total billed charges,"Rev 272 $1,818.00 in Billed Charges at 50% = $909.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARISTA 1G SM0005,272,RC,27201660,CDM,,,,,,both,,,1818.0000,272.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,587.21,,,,,,,469.2300,1818.0000,other,"32.3% of $1,818.00 in Billed Charges for Rev 272 = $587.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARISTA 1G SM0005,272,RC,27201660,CDM,,,,,,both,,,1818.0000,272.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,558.13,,,,,,,469.2300,1818.0000,other,"30.7% of $1,818.00 in Billed Charges for Rev 272 = $558.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARISTA 1G SM0005,272,RC,27201660,CDM,,,,,,both,,,1818.0000,272.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,587.21,,,,,,,469.2300,1818.0000,percent of total billed charges,"32.3% of $1,818.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARISTA 1G SM0005,272,RC,27201660,CDM,,,,,,both,,,1818.0000,272.7000,WELLCARE,WELLCARE MEDICAID,1818.00,,,,,,,469.2300,1818.0000,percent of total billed charges,"100% of $1,818.00 in Billed Charges for Rev 272 = $1,818.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROSCOPY TUBING #87K,272,RC,27200456,CDM,,,,,,both,,,340.0000,51.0000,AETNA,AETNA,145.18,,,,,,,87.7500,340.0000,percent of total billed charges,42.7% of $340.00 in Billed Charges for Rev 272 = $145.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTHROSCOPY TUBING #87K,272,RC,27200456,CDM,,,,,,both,,,340.0000,51.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,238.00,,,,,,,87.7500,340.0000,percent of total billed charges,Rev 272 $340.00 in Billed Charges at 70% = $238.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTHROSCOPY TUBING #87K,272,RC,27200456,CDM,,,,,,both,,,340.0000,51.0000,CIGNA HEALTHCARE,CIGNA HMO,141.78,,,,,,,87.7500,340.0000,percent of total billed charges,41.7% of $340.00 in Billed Charges for Rev 272 = $141.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTHROSCOPY TUBING #87K,272,RC,27200456,CDM,,,,,,both,,,340.0000,51.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,157.76,,,,,,,87.7500,340.0000,percent of total billed charges,46.4% of $340.00 in Billed Charges for Rev 272 = $157.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTHROSCOPY TUBING #87K,272,RC,27200456,CDM,,,,,,both,,,340.0000,51.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,141.78,,,,,,,87.7500,340.0000,percent of total billed charges,41.7% of $340.00 in Billed Charges for Rev 272 = $141.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTHROSCOPY TUBING #87K,272,RC,27200456,CDM,,,,,,both,,,340.0000,51.0000,CIGNA HEALTHCARE,CIGNA PPO,141.78,,,,,,,87.7500,340.0000,percent of total billed charges,41.7% of $340.00 in Billed Charges for Rev 272 = $141.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTHROSCOPY TUBING #87K,272,RC,27200456,CDM,,,,,,both,,,340.0000,51.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,306.00,,,,,,,87.7500,340.0000,percent of total billed charges,90% of $340.00 in Billed Charges for Rev 272 = $306.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTHROSCOPY TUBING #87K,272,RC,27200456,CDM,,,,,,both,,,340.0000,51.0000,MEDCOST,MEDCOST VHN,161.81,,,,,,,87.7500,340.0000,percent of total billed charges,47.59% of $340.00 in Billed Charges for Rev 272 = $161.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTHROSCOPY TUBING #87K,272,RC,27200456,CDM,,,,,,both,,,340.0000,51.0000,SENTARA HEALTH,SENTARA HEALTH,87.75,,,,,,,87.7500,340.0000,percent of total billed charges,25.81% of $340.00 in Billed Charges for Rev 272 = $87.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTHROSCOPY TUBING #87K,272,RC,27200456,CDM,,,,,,both,,,340.0000,51.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",340.00,,,,,,,87.7500,340.0000,percent of total billed charges,100% of $340.00 in Billed Charges for Rev 272 = $340.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTHROSCOPY TUBING #87K,272,RC,27200456,CDM,,,,,,both,,,340.0000,51.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,170.00,,,,,,,87.7500,340.0000,percent of total billed charges,Rev 272 $340.00 in Billed Charges at 50% = $170.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTHROSCOPY TUBING #87K,272,RC,27200456,CDM,,,,,,both,,,340.0000,51.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,109.82,,,,,,,87.7500,340.0000,other,32.3% of $340.00 in Billed Charges for Rev 272 = $109.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROSCOPY TUBING #87K,272,RC,27200456,CDM,,,,,,both,,,340.0000,51.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,104.38,,,,,,,87.7500,340.0000,other,30.7% of $340.00 in Billed Charges for Rev 272 = $104.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROSCOPY TUBING #87K,272,RC,27200456,CDM,,,,,,both,,,340.0000,51.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,109.82,,,,,,,87.7500,340.0000,percent of total billed charges,32.3% of $340.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTHROSCOPY TUBING #87K,272,RC,27200456,CDM,,,,,,both,,,340.0000,51.0000,WELLCARE,WELLCARE MEDICAID,340.00,,,,,,,87.7500,340.0000,percent of total billed charges,100% of $340.00 in Billed Charges for Rev 272 = $340.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTIC SUN,272,RC,27202234,CDM,,,,,,both,,,11116.0000,1667.4000,AETNA,AETNA,4746.53,,,,,,,2869.0400,11116.0000,percent of total billed charges,"42.7% of $11,116.00 in Billed Charges for Rev 272 = $4,746.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTIC SUN,272,RC,27202234,CDM,,,,,,both,,,11116.0000,1667.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7781.20,,,,,,,2869.0400,11116.0000,percent of total billed charges,"Rev 272 $11,116.00 in Billed Charges at 70% = $7,781.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTIC SUN,272,RC,27202234,CDM,,,,,,both,,,11116.0000,1667.4000,CIGNA HEALTHCARE,CIGNA HMO,4635.37,,,,,,,2869.0400,11116.0000,percent of total billed charges,"41.7% of $11,116.00 in Billed Charges for Rev 272 = $4,635.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTIC SUN,272,RC,27202234,CDM,,,,,,both,,,11116.0000,1667.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5157.82,,,,,,,2869.0400,11116.0000,percent of total billed charges,"46.4% of $11,116.00 in Billed Charges for Rev 272 = $5,157.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTIC SUN,272,RC,27202234,CDM,,,,,,both,,,11116.0000,1667.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4635.37,,,,,,,2869.0400,11116.0000,percent of total billed charges,"41.7% of $11,116.00 in Billed Charges for Rev 272 = $4,635.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTIC SUN,272,RC,27202234,CDM,,,,,,both,,,11116.0000,1667.4000,CIGNA HEALTHCARE,CIGNA PPO,4635.37,,,,,,,2869.0400,11116.0000,percent of total billed charges,"41.7% of $11,116.00 in Billed Charges for Rev 272 = $4,635.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTIC SUN,272,RC,27202234,CDM,,,,,,both,,,11116.0000,1667.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10004.40,,,,,,,2869.0400,11116.0000,percent of total billed charges,"90% of $11,116.00 in Billed Charges for Rev 272 = $10,004.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTIC SUN,272,RC,27202234,CDM,,,,,,both,,,11116.0000,1667.4000,MEDCOST,MEDCOST VHN,5290.10,,,,,,,2869.0400,11116.0000,percent of total billed charges,"47.59% of $11,116.00 in Billed Charges for Rev 272 = $5,290.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTIC SUN,272,RC,27202234,CDM,,,,,,both,,,11116.0000,1667.4000,SENTARA HEALTH,SENTARA HEALTH,2869.04,,,,,,,2869.0400,11116.0000,percent of total billed charges,"25.81% of $11,116.00 in Billed Charges for Rev 272 = $2,869.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTIC SUN,272,RC,27202234,CDM,,,,,,both,,,11116.0000,1667.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11116.00,,,,,,,2869.0400,11116.0000,percent of total billed charges,"100% of $11,116.00 in Billed Charges for Rev 272 = $11,116.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTIC SUN,272,RC,27202234,CDM,,,,,,both,,,11116.0000,1667.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5558.00,,,,,,,2869.0400,11116.0000,percent of total billed charges,"Rev 272 $11,116.00 in Billed Charges at 50% = $5,558.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTIC SUN,272,RC,27202234,CDM,,,,,,both,,,11116.0000,1667.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3590.47,,,,,,,2869.0400,11116.0000,other,"32.3% of $11,116.00 in Billed Charges for Rev 272 = $3,590.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTIC SUN,272,RC,27202234,CDM,,,,,,both,,,11116.0000,1667.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3412.61,,,,,,,2869.0400,11116.0000,other,"30.7% of $11,116.00 in Billed Charges for Rev 272 = $3,412.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTIC SUN,272,RC,27202234,CDM,,,,,,both,,,11116.0000,1667.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,3590.47,,,,,,,2869.0400,11116.0000,percent of total billed charges,"32.3% of $11,116.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTIC SUN,272,RC,27202234,CDM,,,,,,both,,,11116.0000,1667.4000,WELLCARE,WELLCARE MEDICAID,11116.00,,,,,,,2869.0400,11116.0000,percent of total billed charges,"100% of $11,116.00 in Billed Charges for Rev 272 = $11,116.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIRATOR GASTRIC 6FR,272,RC,27210677,CDM,,,,,,both,,,281.0000,42.1500,AETNA,AETNA,119.99,,,,,,,72.5300,281.0000,percent of total billed charges,42.7% of $281.00 in Billed Charges for Rev 272 = $119.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASPIRATOR GASTRIC 6FR,272,RC,27210677,CDM,,,,,,both,,,281.0000,42.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,196.70,,,,,,,72.5300,281.0000,percent of total billed charges,Rev 272 $281.00 in Billed Charges at 70% = $196.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASPIRATOR GASTRIC 6FR,272,RC,27210677,CDM,,,,,,both,,,281.0000,42.1500,CIGNA HEALTHCARE,CIGNA HMO,117.18,,,,,,,72.5300,281.0000,percent of total billed charges,41.7% of $281.00 in Billed Charges for Rev 272 = $117.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASPIRATOR GASTRIC 6FR,272,RC,27210677,CDM,,,,,,both,,,281.0000,42.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,130.38,,,,,,,72.5300,281.0000,percent of total billed charges,46.4% of $281.00 in Billed Charges for Rev 272 = $130.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASPIRATOR GASTRIC 6FR,272,RC,27210677,CDM,,,,,,both,,,281.0000,42.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,117.18,,,,,,,72.5300,281.0000,percent of total billed charges,41.7% of $281.00 in Billed Charges for Rev 272 = $117.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASPIRATOR GASTRIC 6FR,272,RC,27210677,CDM,,,,,,both,,,281.0000,42.1500,CIGNA HEALTHCARE,CIGNA PPO,117.18,,,,,,,72.5300,281.0000,percent of total billed charges,41.7% of $281.00 in Billed Charges for Rev 272 = $117.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASPIRATOR GASTRIC 6FR,272,RC,27210677,CDM,,,,,,both,,,281.0000,42.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,252.90,,,,,,,72.5300,281.0000,percent of total billed charges,90% of $281.00 in Billed Charges for Rev 272 = $252.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASPIRATOR GASTRIC 6FR,272,RC,27210677,CDM,,,,,,both,,,281.0000,42.1500,MEDCOST,MEDCOST VHN,133.73,,,,,,,72.5300,281.0000,percent of total billed charges,47.59% of $281.00 in Billed Charges for Rev 272 = $133.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASPIRATOR GASTRIC 6FR,272,RC,27210677,CDM,,,,,,both,,,281.0000,42.1500,SENTARA HEALTH,SENTARA HEALTH,72.53,,,,,,,72.5300,281.0000,percent of total billed charges,25.81% of $281.00 in Billed Charges for Rev 272 = $72.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASPIRATOR GASTRIC 6FR,272,RC,27210677,CDM,,,,,,both,,,281.0000,42.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",281.00,,,,,,,72.5300,281.0000,percent of total billed charges,100% of $281.00 in Billed Charges for Rev 272 = $281.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASPIRATOR GASTRIC 6FR,272,RC,27210677,CDM,,,,,,both,,,281.0000,42.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,140.50,,,,,,,72.5300,281.0000,percent of total billed charges,Rev 272 $281.00 in Billed Charges at 50% = $140.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASPIRATOR GASTRIC 6FR,272,RC,27210677,CDM,,,,,,both,,,281.0000,42.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,90.76,,,,,,,72.5300,281.0000,other,32.3% of $281.00 in Billed Charges for Rev 272 = $90.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATOR GASTRIC 6FR,272,RC,27210677,CDM,,,,,,both,,,281.0000,42.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,86.27,,,,,,,72.5300,281.0000,other,30.7% of $281.00 in Billed Charges for Rev 272 = $86.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATOR GASTRIC 6FR,272,RC,27210677,CDM,,,,,,both,,,281.0000,42.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,90.76,,,,,,,72.5300,281.0000,percent of total billed charges,32.3% of $281.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASPIRATOR GASTRIC 6FR,272,RC,27210677,CDM,,,,,,both,,,281.0000,42.1500,WELLCARE,WELLCARE MEDICAID,281.00,,,,,,,72.5300,281.0000,percent of total billed charges,100% of $281.00 in Billed Charges for Rev 272 = $281.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ATHERECTOMY VIPER WIRE ADVANCE,272,RC,27201643,CDM,,,,,,both,,,2275.0000,341.2500,AETNA,AETNA,971.43,,,,,,,587.1800,2275.0000,percent of total billed charges,"42.7% of $2,275.00 in Billed Charges for Rev 272 = $971.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERECTOMY VIPER WIRE ADVANCE,272,RC,27201643,CDM,,,,,,both,,,2275.0000,341.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1592.50,,,,,,,587.1800,2275.0000,percent of total billed charges,"Rev 272 $2,275.00 in Billed Charges at 70% = $1,592.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERECTOMY VIPER WIRE ADVANCE,272,RC,27201643,CDM,,,,,,both,,,2275.0000,341.2500,CIGNA HEALTHCARE,CIGNA HMO,948.68,,,,,,,587.1800,2275.0000,percent of total billed charges,"41.7% of $2,275.00 in Billed Charges for Rev 272 = $948.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERECTOMY VIPER WIRE ADVANCE,272,RC,27201643,CDM,,,,,,both,,,2275.0000,341.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1055.60,,,,,,,587.1800,2275.0000,percent of total billed charges,"46.4% of $2,275.00 in Billed Charges for Rev 272 = $1,055.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERECTOMY VIPER WIRE ADVANCE,272,RC,27201643,CDM,,,,,,both,,,2275.0000,341.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,948.68,,,,,,,587.1800,2275.0000,percent of total billed charges,"41.7% of $2,275.00 in Billed Charges for Rev 272 = $948.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERECTOMY VIPER WIRE ADVANCE,272,RC,27201643,CDM,,,,,,both,,,2275.0000,341.2500,CIGNA HEALTHCARE,CIGNA PPO,948.68,,,,,,,587.1800,2275.0000,percent of total billed charges,"41.7% of $2,275.00 in Billed Charges for Rev 272 = $948.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERECTOMY VIPER WIRE ADVANCE,272,RC,27201643,CDM,,,,,,both,,,2275.0000,341.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2047.50,,,,,,,587.1800,2275.0000,percent of total billed charges,"90% of $2,275.00 in Billed Charges for Rev 272 = $2,047.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERECTOMY VIPER WIRE ADVANCE,272,RC,27201643,CDM,,,,,,both,,,2275.0000,341.2500,MEDCOST,MEDCOST VHN,1082.67,,,,,,,587.1800,2275.0000,percent of total billed charges,"47.59% of $2,275.00 in Billed Charges for Rev 272 = $1,082.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERECTOMY VIPER WIRE ADVANCE,272,RC,27201643,CDM,,,,,,both,,,2275.0000,341.2500,SENTARA HEALTH,SENTARA HEALTH,587.18,,,,,,,587.1800,2275.0000,percent of total billed charges,"25.81% of $2,275.00 in Billed Charges for Rev 272 = $587.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERECTOMY VIPER WIRE ADVANCE,272,RC,27201643,CDM,,,,,,both,,,2275.0000,341.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2275.00,,,,,,,587.1800,2275.0000,percent of total billed charges,"100% of $2,275.00 in Billed Charges for Rev 272 = $2,275.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERECTOMY VIPER WIRE ADVANCE,272,RC,27201643,CDM,,,,,,both,,,2275.0000,341.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1137.50,,,,,,,587.1800,2275.0000,percent of total billed charges,"Rev 272 $2,275.00 in Billed Charges at 50% = $1,137.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERECTOMY VIPER WIRE ADVANCE,272,RC,27201643,CDM,,,,,,both,,,2275.0000,341.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,734.83,,,,,,,587.1800,2275.0000,other,"32.3% of $2,275.00 in Billed Charges for Rev 272 = $734.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHERECTOMY VIPER WIRE ADVANCE,272,RC,27201643,CDM,,,,,,both,,,2275.0000,341.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,698.43,,,,,,,587.1800,2275.0000,other,"30.7% of $2,275.00 in Billed Charges for Rev 272 = $698.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHERECTOMY VIPER WIRE ADVANCE,272,RC,27201643,CDM,,,,,,both,,,2275.0000,341.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,734.83,,,,,,,587.1800,2275.0000,percent of total billed charges,"32.3% of $2,275.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERECTOMY VIPER WIRE ADVANCE,272,RC,27201643,CDM,,,,,,both,,,2275.0000,341.2500,WELLCARE,WELLCARE MEDICAID,2275.00,,,,,,,587.1800,2275.0000,percent of total billed charges,"100% of $2,275.00 in Billed Charges for Rev 272 = $2,275.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BAG DRAINAGE EDS3 CODMAN 821732,272,RC,27200102,CDM,,,,,,both,,,149.0000,22.3500,AETNA,AETNA,63.62,,,,,,,38.4600,149.0000,percent of total billed charges,42.7% of $149.00 in Billed Charges for Rev 272 = $63.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE EDS3 CODMAN 821732,272,RC,27200102,CDM,,,,,,both,,,149.0000,22.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,104.30,,,,,,,38.4600,149.0000,percent of total billed charges,Rev 272 $149.00 in Billed Charges at 70% = $104.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE EDS3 CODMAN 821732,272,RC,27200102,CDM,,,,,,both,,,149.0000,22.3500,CIGNA HEALTHCARE,CIGNA HMO,62.13,,,,,,,38.4600,149.0000,percent of total billed charges,41.7% of $149.00 in Billed Charges for Rev 272 = $62.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE EDS3 CODMAN 821732,272,RC,27200102,CDM,,,,,,both,,,149.0000,22.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,69.14,,,,,,,38.4600,149.0000,percent of total billed charges,46.4% of $149.00 in Billed Charges for Rev 272 = $69.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE EDS3 CODMAN 821732,272,RC,27200102,CDM,,,,,,both,,,149.0000,22.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,62.13,,,,,,,38.4600,149.0000,percent of total billed charges,41.7% of $149.00 in Billed Charges for Rev 272 = $62.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE EDS3 CODMAN 821732,272,RC,27200102,CDM,,,,,,both,,,149.0000,22.3500,CIGNA HEALTHCARE,CIGNA PPO,62.13,,,,,,,38.4600,149.0000,percent of total billed charges,41.7% of $149.00 in Billed Charges for Rev 272 = $62.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE EDS3 CODMAN 821732,272,RC,27200102,CDM,,,,,,both,,,149.0000,22.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,134.10,,,,,,,38.4600,149.0000,percent of total billed charges,90% of $149.00 in Billed Charges for Rev 272 = $134.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE EDS3 CODMAN 821732,272,RC,27200102,CDM,,,,,,both,,,149.0000,22.3500,MEDCOST,MEDCOST VHN,70.91,,,,,,,38.4600,149.0000,percent of total billed charges,47.59% of $149.00 in Billed Charges for Rev 272 = $70.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE EDS3 CODMAN 821732,272,RC,27200102,CDM,,,,,,both,,,149.0000,22.3500,SENTARA HEALTH,SENTARA HEALTH,38.46,,,,,,,38.4600,149.0000,percent of total billed charges,25.81% of $149.00 in Billed Charges for Rev 272 = $38.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE EDS3 CODMAN 821732,272,RC,27200102,CDM,,,,,,both,,,149.0000,22.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",149.00,,,,,,,38.4600,149.0000,percent of total billed charges,100% of $149.00 in Billed Charges for Rev 272 = $149.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE EDS3 CODMAN 821732,272,RC,27200102,CDM,,,,,,both,,,149.0000,22.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,74.50,,,,,,,38.4600,149.0000,percent of total billed charges,Rev 272 $149.00 in Billed Charges at 50% = $74.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE EDS3 CODMAN 821732,272,RC,27200102,CDM,,,,,,both,,,149.0000,22.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,48.13,,,,,,,38.4600,149.0000,other,32.3% of $149.00 in Billed Charges for Rev 272 = $48.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BAG DRAINAGE EDS3 CODMAN 821732,272,RC,27200102,CDM,,,,,,both,,,149.0000,22.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,45.74,,,,,,,38.4600,149.0000,other,30.7% of $149.00 in Billed Charges for Rev 272 = $45.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BAG DRAINAGE EDS3 CODMAN 821732,272,RC,27200102,CDM,,,,,,both,,,149.0000,22.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,48.13,,,,,,,38.4600,149.0000,percent of total billed charges,32.3% of $149.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE EDS3 CODMAN 821732,272,RC,27200102,CDM,,,,,,both,,,149.0000,22.3500,WELLCARE,WELLCARE MEDICAID,149.00,,,,,,,38.4600,149.0000,percent of total billed charges,100% of $149.00 in Billed Charges for Rev 272 = $149.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE URINARY 400ML,270,RC,27000218,CDM,,,,,,both,,,56.0000,8.4000,AETNA,AETNA,23.91,,,,,,,14.4500,56.0000,percent of total billed charges,42.7% of $56.00 in Billed Charges for Rev 270 = $23.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE URINARY 400ML,270,RC,27000218,CDM,,,,,,both,,,56.0000,8.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,39.20,,,,,,,14.4500,56.0000,percent of total billed charges,Rev 270 $56.00 in Billed Charges at 70% = $39.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE URINARY 400ML,270,RC,27000218,CDM,,,,,,both,,,56.0000,8.4000,CIGNA HEALTHCARE,CIGNA HMO,23.35,,,,,,,14.4500,56.0000,percent of total billed charges,41.7% of $56.00 in Billed Charges for Rev 270 = $23.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE URINARY 400ML,270,RC,27000218,CDM,,,,,,both,,,56.0000,8.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,25.98,,,,,,,14.4500,56.0000,percent of total billed charges,46.4% of $56.00 in Billed Charges for Rev 270 = $25.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE URINARY 400ML,270,RC,27000218,CDM,,,,,,both,,,56.0000,8.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,23.35,,,,,,,14.4500,56.0000,percent of total billed charges,41.7% of $56.00 in Billed Charges for Rev 270 = $23.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE URINARY 400ML,270,RC,27000218,CDM,,,,,,both,,,56.0000,8.4000,CIGNA HEALTHCARE,CIGNA PPO,23.35,,,,,,,14.4500,56.0000,percent of total billed charges,41.7% of $56.00 in Billed Charges for Rev 270 = $23.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE URINARY 400ML,270,RC,27000218,CDM,,,,,,both,,,56.0000,8.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,50.40,,,,,,,14.4500,56.0000,percent of total billed charges,90% of $56.00 in Billed Charges for Rev 270 = $50.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE URINARY 400ML,270,RC,27000218,CDM,,,,,,both,,,56.0000,8.4000,MEDCOST,MEDCOST VHN,26.65,,,,,,,14.4500,56.0000,percent of total billed charges,47.59% of $56.00 in Billed Charges for Rev 270 = $26.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE URINARY 400ML,270,RC,27000218,CDM,,,,,,both,,,56.0000,8.4000,SENTARA HEALTH,SENTARA HEALTH,14.45,,,,,,,14.4500,56.0000,percent of total billed charges,25.81% of $56.00 in Billed Charges for Rev 270 = $14.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE URINARY 400ML,270,RC,27000218,CDM,,,,,,both,,,56.0000,8.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",56.00,,,,,,,14.4500,56.0000,percent of total billed charges,100% of $56.00 in Billed Charges for Rev 270 = $56.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE URINARY 400ML,270,RC,27000218,CDM,,,,,,both,,,56.0000,8.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,28.00,,,,,,,14.4500,56.0000,percent of total billed charges,Rev 270 $56.00 in Billed Charges at 50% = $28.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE URINARY 400ML,270,RC,27000218,CDM,,,,,,both,,,56.0000,8.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,18.09,,,,,,,14.4500,56.0000,other,32.3% of $56.00 in Billed Charges for Rev 270 = $18.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BAG DRAINAGE URINARY 400ML,270,RC,27000218,CDM,,,,,,both,,,56.0000,8.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,17.19,,,,,,,14.4500,56.0000,other,30.7% of $56.00 in Billed Charges for Rev 270 = $17.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BAG DRAINAGE URINARY 400ML,270,RC,27000218,CDM,,,,,,both,,,56.0000,8.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,18.09,,,,,,,14.4500,56.0000,percent of total billed charges,32.3% of $56.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE URINARY 400ML,270,RC,27000218,CDM,,,,,,both,,,56.0000,8.4000,WELLCARE,WELLCARE MEDICAID,56.00,,,,,,,14.4500,56.0000,percent of total billed charges,100% of $56.00 in Billed Charges for Rev 270 = $56.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG LEG COMBO PACK,270,RC,27000214,CDM,,,,,,both,,,44.0000,6.6000,AETNA,AETNA,18.79,,,,,,,11.3600,44.0000,percent of total billed charges,42.7% of $44.00 in Billed Charges for Rev 270 = $18.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG LEG COMBO PACK,270,RC,27000214,CDM,,,,,,both,,,44.0000,6.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,30.80,,,,,,,11.3600,44.0000,percent of total billed charges,Rev 270 $44.00 in Billed Charges at 70% = $30.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG LEG COMBO PACK,270,RC,27000214,CDM,,,,,,both,,,44.0000,6.6000,CIGNA HEALTHCARE,CIGNA HMO,18.35,,,,,,,11.3600,44.0000,percent of total billed charges,41.7% of $44.00 in Billed Charges for Rev 270 = $18.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG LEG COMBO PACK,270,RC,27000214,CDM,,,,,,both,,,44.0000,6.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,20.42,,,,,,,11.3600,44.0000,percent of total billed charges,46.4% of $44.00 in Billed Charges for Rev 270 = $20.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG LEG COMBO PACK,270,RC,27000214,CDM,,,,,,both,,,44.0000,6.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,18.35,,,,,,,11.3600,44.0000,percent of total billed charges,41.7% of $44.00 in Billed Charges for Rev 270 = $18.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG LEG COMBO PACK,270,RC,27000214,CDM,,,,,,both,,,44.0000,6.6000,CIGNA HEALTHCARE,CIGNA PPO,18.35,,,,,,,11.3600,44.0000,percent of total billed charges,41.7% of $44.00 in Billed Charges for Rev 270 = $18.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG LEG COMBO PACK,270,RC,27000214,CDM,,,,,,both,,,44.0000,6.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,39.60,,,,,,,11.3600,44.0000,percent of total billed charges,90% of $44.00 in Billed Charges for Rev 270 = $39.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG LEG COMBO PACK,270,RC,27000214,CDM,,,,,,both,,,44.0000,6.6000,MEDCOST,MEDCOST VHN,20.94,,,,,,,11.3600,44.0000,percent of total billed charges,47.59% of $44.00 in Billed Charges for Rev 270 = $20.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG LEG COMBO PACK,270,RC,27000214,CDM,,,,,,both,,,44.0000,6.6000,SENTARA HEALTH,SENTARA HEALTH,11.36,,,,,,,11.3600,44.0000,percent of total billed charges,25.81% of $44.00 in Billed Charges for Rev 270 = $11.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG LEG COMBO PACK,270,RC,27000214,CDM,,,,,,both,,,44.0000,6.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",44.00,,,,,,,11.3600,44.0000,percent of total billed charges,100% of $44.00 in Billed Charges for Rev 270 = $44.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG LEG COMBO PACK,270,RC,27000214,CDM,,,,,,both,,,44.0000,6.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.00,,,,,,,11.3600,44.0000,percent of total billed charges,Rev 270 $44.00 in Billed Charges at 50% = $22.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG LEG COMBO PACK,270,RC,27000214,CDM,,,,,,both,,,44.0000,6.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,14.21,,,,,,,11.3600,44.0000,other,32.3% of $44.00 in Billed Charges for Rev 270 = $14.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BAG LEG COMBO PACK,270,RC,27000214,CDM,,,,,,both,,,44.0000,6.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,13.51,,,,,,,11.3600,44.0000,other,30.7% of $44.00 in Billed Charges for Rev 270 = $13.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BAG LEG COMBO PACK,270,RC,27000214,CDM,,,,,,both,,,44.0000,6.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,14.21,,,,,,,11.3600,44.0000,percent of total billed charges,32.3% of $44.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG LEG COMBO PACK,270,RC,27000214,CDM,,,,,,both,,,44.0000,6.6000,WELLCARE,WELLCARE MEDICAID,44.00,,,,,,,11.3600,44.0000,percent of total billed charges,100% of $44.00 in Billed Charges for Rev 270 = $44.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT RAPID REFILL ERCP,270,RC,27000115,CDM,,,,,,both,,,129.0000,19.3500,AETNA,AETNA,55.08,,,,,,,33.2900,129.0000,percent of total billed charges,42.7% of $129.00 in Billed Charges for Rev 270 = $55.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT RAPID REFILL ERCP,270,RC,27000115,CDM,,,,,,both,,,129.0000,19.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,90.30,,,,,,,33.2900,129.0000,percent of total billed charges,Rev 270 $129.00 in Billed Charges at 70% = $90.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT RAPID REFILL ERCP,270,RC,27000115,CDM,,,,,,both,,,129.0000,19.3500,CIGNA HEALTHCARE,CIGNA HMO,53.79,,,,,,,33.2900,129.0000,percent of total billed charges,41.7% of $129.00 in Billed Charges for Rev 270 = $53.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT RAPID REFILL ERCP,270,RC,27000115,CDM,,,,,,both,,,129.0000,19.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,59.86,,,,,,,33.2900,129.0000,percent of total billed charges,46.4% of $129.00 in Billed Charges for Rev 270 = $59.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT RAPID REFILL ERCP,270,RC,27000115,CDM,,,,,,both,,,129.0000,19.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,53.79,,,,,,,33.2900,129.0000,percent of total billed charges,41.7% of $129.00 in Billed Charges for Rev 270 = $53.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT RAPID REFILL ERCP,270,RC,27000115,CDM,,,,,,both,,,129.0000,19.3500,CIGNA HEALTHCARE,CIGNA PPO,53.79,,,,,,,33.2900,129.0000,percent of total billed charges,41.7% of $129.00 in Billed Charges for Rev 270 = $53.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT RAPID REFILL ERCP,270,RC,27000115,CDM,,,,,,both,,,129.0000,19.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,116.10,,,,,,,33.2900,129.0000,percent of total billed charges,90% of $129.00 in Billed Charges for Rev 270 = $116.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT RAPID REFILL ERCP,270,RC,27000115,CDM,,,,,,both,,,129.0000,19.3500,MEDCOST,MEDCOST VHN,61.39,,,,,,,33.2900,129.0000,percent of total billed charges,47.59% of $129.00 in Billed Charges for Rev 270 = $61.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT RAPID REFILL ERCP,270,RC,27000115,CDM,,,,,,both,,,129.0000,19.3500,SENTARA HEALTH,SENTARA HEALTH,33.29,,,,,,,33.2900,129.0000,percent of total billed charges,25.81% of $129.00 in Billed Charges for Rev 270 = $33.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT RAPID REFILL ERCP,270,RC,27000115,CDM,,,,,,both,,,129.0000,19.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",129.00,,,,,,,33.2900,129.0000,percent of total billed charges,100% of $129.00 in Billed Charges for Rev 270 = $129.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT RAPID REFILL ERCP,270,RC,27000115,CDM,,,,,,both,,,129.0000,19.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,64.50,,,,,,,33.2900,129.0000,percent of total billed charges,Rev 270 $129.00 in Billed Charges at 50% = $64.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT RAPID REFILL ERCP,270,RC,27000115,CDM,,,,,,both,,,129.0000,19.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,41.67,,,,,,,33.2900,129.0000,other,32.3% of $129.00 in Billed Charges for Rev 270 = $41.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI KIT RAPID REFILL ERCP,270,RC,27000115,CDM,,,,,,both,,,129.0000,19.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,39.60,,,,,,,33.2900,129.0000,other,30.7% of $129.00 in Billed Charges for Rev 270 = $39.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI KIT RAPID REFILL ERCP,270,RC,27000115,CDM,,,,,,both,,,129.0000,19.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,41.67,,,,,,,33.2900,129.0000,percent of total billed charges,32.3% of $129.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI KIT RAPID REFILL ERCP,270,RC,27000115,CDM,,,,,,both,,,129.0000,19.3500,WELLCARE,WELLCARE MEDICAID,129.00,,,,,,,33.2900,129.0000,percent of total billed charges,100% of $129.00 in Billed Charges for Rev 270 = $129.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI LIGATOR SUPERVIEW 1415543,272,RC,27200744,CDM,,,,,,both,,,1195.0000,179.2500,AETNA,AETNA,510.27,,,,,,,308.4300,1195.0000,percent of total billed charges,"42.7% of $1,195.00 in Billed Charges for Rev 272 = $510.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI LIGATOR SUPERVIEW 1415543,272,RC,27200744,CDM,,,,,,both,,,1195.0000,179.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,836.50,,,,,,,308.4300,1195.0000,percent of total billed charges,"Rev 272 $1,195.00 in Billed Charges at 70% = $836.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI LIGATOR SUPERVIEW 1415543,272,RC,27200744,CDM,,,,,,both,,,1195.0000,179.2500,CIGNA HEALTHCARE,CIGNA HMO,498.32,,,,,,,308.4300,1195.0000,percent of total billed charges,"41.7% of $1,195.00 in Billed Charges for Rev 272 = $498.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI LIGATOR SUPERVIEW 1415543,272,RC,27200744,CDM,,,,,,both,,,1195.0000,179.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,554.48,,,,,,,308.4300,1195.0000,percent of total billed charges,"46.4% of $1,195.00 in Billed Charges for Rev 272 = $554.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI LIGATOR SUPERVIEW 1415543,272,RC,27200744,CDM,,,,,,both,,,1195.0000,179.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,498.32,,,,,,,308.4300,1195.0000,percent of total billed charges,"41.7% of $1,195.00 in Billed Charges for Rev 272 = $498.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI LIGATOR SUPERVIEW 1415543,272,RC,27200744,CDM,,,,,,both,,,1195.0000,179.2500,CIGNA HEALTHCARE,CIGNA PPO,498.32,,,,,,,308.4300,1195.0000,percent of total billed charges,"41.7% of $1,195.00 in Billed Charges for Rev 272 = $498.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI LIGATOR SUPERVIEW 1415543,272,RC,27200744,CDM,,,,,,both,,,1195.0000,179.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1075.50,,,,,,,308.4300,1195.0000,percent of total billed charges,"90% of $1,195.00 in Billed Charges for Rev 272 = $1,075.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI LIGATOR SUPERVIEW 1415543,272,RC,27200744,CDM,,,,,,both,,,1195.0000,179.2500,MEDCOST,MEDCOST VHN,568.70,,,,,,,308.4300,1195.0000,percent of total billed charges,"47.59% of $1,195.00 in Billed Charges for Rev 272 = $568.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI LIGATOR SUPERVIEW 1415543,272,RC,27200744,CDM,,,,,,both,,,1195.0000,179.2500,SENTARA HEALTH,SENTARA HEALTH,308.43,,,,,,,308.4300,1195.0000,percent of total billed charges,"25.81% of $1,195.00 in Billed Charges for Rev 272 = $308.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI LIGATOR SUPERVIEW 1415543,272,RC,27200744,CDM,,,,,,both,,,1195.0000,179.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1195.00,,,,,,,308.4300,1195.0000,percent of total billed charges,"100% of $1,195.00 in Billed Charges for Rev 272 = $1,195.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI LIGATOR SUPERVIEW 1415543,272,RC,27200744,CDM,,,,,,both,,,1195.0000,179.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,597.50,,,,,,,308.4300,1195.0000,percent of total billed charges,"Rev 272 $1,195.00 in Billed Charges at 50% = $597.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI LIGATOR SUPERVIEW 1415543,272,RC,27200744,CDM,,,,,,both,,,1195.0000,179.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,385.99,,,,,,,308.4300,1195.0000,other,"32.3% of $1,195.00 in Billed Charges for Rev 272 = $385.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC GI LIGATOR SUPERVIEW 1415543,272,RC,27200744,CDM,,,,,,both,,,1195.0000,179.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,366.87,,,,,,,308.4300,1195.0000,other,"30.7% of $1,195.00 in Billed Charges for Rev 272 = $366.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC GI LIGATOR SUPERVIEW 1415543,272,RC,27200744,CDM,,,,,,both,,,1195.0000,179.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,385.99,,,,,,,308.4300,1195.0000,percent of total billed charges,"32.3% of $1,195.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI LIGATOR SUPERVIEW 1415543,272,RC,27200744,CDM,,,,,,both,,,1195.0000,179.2500,WELLCARE,WELLCARE MEDICAID,1195.00,,,,,,,308.4300,1195.0000,percent of total billed charges,"100% of $1,195.00 in Billed Charges for Rev 272 = $1,195.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI NEEDLE TRANSBRONCH WANG #6412,272,RC,27200748,CDM,,,,,,both,,,441.0000,66.1500,AETNA,AETNA,188.31,,,,,,,113.8200,441.0000,percent of total billed charges,42.7% of $441.00 in Billed Charges for Rev 272 = $188.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE TRANSBRONCH WANG #6412,272,RC,27200748,CDM,,,,,,both,,,441.0000,66.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,308.70,,,,,,,113.8200,441.0000,percent of total billed charges,Rev 272 $441.00 in Billed Charges at 70% = $308.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE TRANSBRONCH WANG #6412,272,RC,27200748,CDM,,,,,,both,,,441.0000,66.1500,CIGNA HEALTHCARE,CIGNA HMO,183.90,,,,,,,113.8200,441.0000,percent of total billed charges,41.7% of $441.00 in Billed Charges for Rev 272 = $183.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE TRANSBRONCH WANG #6412,272,RC,27200748,CDM,,,,,,both,,,441.0000,66.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,204.62,,,,,,,113.8200,441.0000,percent of total billed charges,46.4% of $441.00 in Billed Charges for Rev 272 = $204.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE TRANSBRONCH WANG #6412,272,RC,27200748,CDM,,,,,,both,,,441.0000,66.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,183.90,,,,,,,113.8200,441.0000,percent of total billed charges,41.7% of $441.00 in Billed Charges for Rev 272 = $183.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE TRANSBRONCH WANG #6412,272,RC,27200748,CDM,,,,,,both,,,441.0000,66.1500,CIGNA HEALTHCARE,CIGNA PPO,183.90,,,,,,,113.8200,441.0000,percent of total billed charges,41.7% of $441.00 in Billed Charges for Rev 272 = $183.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE TRANSBRONCH WANG #6412,272,RC,27200748,CDM,,,,,,both,,,441.0000,66.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,396.90,,,,,,,113.8200,441.0000,percent of total billed charges,90% of $441.00 in Billed Charges for Rev 272 = $396.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE TRANSBRONCH WANG #6412,272,RC,27200748,CDM,,,,,,both,,,441.0000,66.1500,MEDCOST,MEDCOST VHN,209.87,,,,,,,113.8200,441.0000,percent of total billed charges,47.59% of $441.00 in Billed Charges for Rev 272 = $209.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE TRANSBRONCH WANG #6412,272,RC,27200748,CDM,,,,,,both,,,441.0000,66.1500,SENTARA HEALTH,SENTARA HEALTH,113.82,,,,,,,113.8200,441.0000,percent of total billed charges,25.81% of $441.00 in Billed Charges for Rev 272 = $113.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE TRANSBRONCH WANG #6412,272,RC,27200748,CDM,,,,,,both,,,441.0000,66.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",441.00,,,,,,,113.8200,441.0000,percent of total billed charges,100% of $441.00 in Billed Charges for Rev 272 = $441.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE TRANSBRONCH WANG #6412,272,RC,27200748,CDM,,,,,,both,,,441.0000,66.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,220.50,,,,,,,113.8200,441.0000,percent of total billed charges,Rev 272 $441.00 in Billed Charges at 50% = $220.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE TRANSBRONCH WANG #6412,272,RC,27200748,CDM,,,,,,both,,,441.0000,66.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,142.44,,,,,,,113.8200,441.0000,other,32.3% of $441.00 in Billed Charges for Rev 272 = $142.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI NEEDLE TRANSBRONCH WANG #6412,272,RC,27200748,CDM,,,,,,both,,,441.0000,66.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,135.39,,,,,,,113.8200,441.0000,other,30.7% of $441.00 in Billed Charges for Rev 272 = $135.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI NEEDLE TRANSBRONCH WANG #6412,272,RC,27200748,CDM,,,,,,both,,,441.0000,66.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,142.44,,,,,,,113.8200,441.0000,percent of total billed charges,32.3% of $441.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NEEDLE TRANSBRONCH WANG #6412,272,RC,27200748,CDM,,,,,,both,,,441.0000,66.1500,WELLCARE,WELLCARE MEDICAID,441.00,,,,,,,113.8200,441.0000,percent of total billed charges,100% of $441.00 in Billed Charges for Rev 272 = $441.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NET ROTH POLYP RETRIEVAL,272,RC,27200749,CDM,,,,,,both,,,264.0000,39.6000,AETNA,AETNA,112.73,,,,,,,68.1400,264.0000,percent of total billed charges,42.7% of $264.00 in Billed Charges for Rev 272 = $112.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NET ROTH POLYP RETRIEVAL,272,RC,27200749,CDM,,,,,,both,,,264.0000,39.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,184.80,,,,,,,68.1400,264.0000,percent of total billed charges,Rev 272 $264.00 in Billed Charges at 70% = $184.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NET ROTH POLYP RETRIEVAL,272,RC,27200749,CDM,,,,,,both,,,264.0000,39.6000,CIGNA HEALTHCARE,CIGNA HMO,110.09,,,,,,,68.1400,264.0000,percent of total billed charges,41.7% of $264.00 in Billed Charges for Rev 272 = $110.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NET ROTH POLYP RETRIEVAL,272,RC,27200749,CDM,,,,,,both,,,264.0000,39.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,122.50,,,,,,,68.1400,264.0000,percent of total billed charges,46.4% of $264.00 in Billed Charges for Rev 272 = $122.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NET ROTH POLYP RETRIEVAL,272,RC,27200749,CDM,,,,,,both,,,264.0000,39.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,110.09,,,,,,,68.1400,264.0000,percent of total billed charges,41.7% of $264.00 in Billed Charges for Rev 272 = $110.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NET ROTH POLYP RETRIEVAL,272,RC,27200749,CDM,,,,,,both,,,264.0000,39.6000,CIGNA HEALTHCARE,CIGNA PPO,110.09,,,,,,,68.1400,264.0000,percent of total billed charges,41.7% of $264.00 in Billed Charges for Rev 272 = $110.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NET ROTH POLYP RETRIEVAL,272,RC,27200749,CDM,,,,,,both,,,264.0000,39.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,237.60,,,,,,,68.1400,264.0000,percent of total billed charges,90% of $264.00 in Billed Charges for Rev 272 = $237.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NET ROTH POLYP RETRIEVAL,272,RC,27200749,CDM,,,,,,both,,,264.0000,39.6000,MEDCOST,MEDCOST VHN,125.64,,,,,,,68.1400,264.0000,percent of total billed charges,47.59% of $264.00 in Billed Charges for Rev 272 = $125.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NET ROTH POLYP RETRIEVAL,272,RC,27200749,CDM,,,,,,both,,,264.0000,39.6000,SENTARA HEALTH,SENTARA HEALTH,68.14,,,,,,,68.1400,264.0000,percent of total billed charges,25.81% of $264.00 in Billed Charges for Rev 272 = $68.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NET ROTH POLYP RETRIEVAL,272,RC,27200749,CDM,,,,,,both,,,264.0000,39.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",264.00,,,,,,,68.1400,264.0000,percent of total billed charges,100% of $264.00 in Billed Charges for Rev 272 = $264.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NET ROTH POLYP RETRIEVAL,272,RC,27200749,CDM,,,,,,both,,,264.0000,39.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,132.00,,,,,,,68.1400,264.0000,percent of total billed charges,Rev 272 $264.00 in Billed Charges at 50% = $132.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NET ROTH POLYP RETRIEVAL,272,RC,27200749,CDM,,,,,,both,,,264.0000,39.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,85.27,,,,,,,68.1400,264.0000,other,32.3% of $264.00 in Billed Charges for Rev 272 = $85.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI NET ROTH POLYP RETRIEVAL,272,RC,27200749,CDM,,,,,,both,,,264.0000,39.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,81.05,,,,,,,68.1400,264.0000,other,30.7% of $264.00 in Billed Charges for Rev 272 = $81.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI NET ROTH POLYP RETRIEVAL,272,RC,27200749,CDM,,,,,,both,,,264.0000,39.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,85.27,,,,,,,68.1400,264.0000,percent of total billed charges,32.3% of $264.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI NET ROTH POLYP RETRIEVAL,272,RC,27200749,CDM,,,,,,both,,,264.0000,39.6000,WELLCARE,WELLCARE MEDICAID,264.00,,,,,,,68.1400,264.0000,percent of total billed charges,100% of $264.00 in Billed Charges for Rev 272 = $264.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 6.9F 220CM 214,272,RC,27200751,CDM,,,,,,both,,,908.0000,136.2000,AETNA,AETNA,387.72,,,,,,,234.3500,908.0000,percent of total billed charges,42.7% of $908.00 in Billed Charges for Rev 272 = $387.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 6.9F 220CM 214,272,RC,27200751,CDM,,,,,,both,,,908.0000,136.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,635.60,,,,,,,234.3500,908.0000,percent of total billed charges,Rev 272 $908.00 in Billed Charges at 70% = $635.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 6.9F 220CM 214,272,RC,27200751,CDM,,,,,,both,,,908.0000,136.2000,CIGNA HEALTHCARE,CIGNA HMO,378.64,,,,,,,234.3500,908.0000,percent of total billed charges,41.7% of $908.00 in Billed Charges for Rev 272 = $378.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 6.9F 220CM 214,272,RC,27200751,CDM,,,,,,both,,,908.0000,136.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,421.31,,,,,,,234.3500,908.0000,percent of total billed charges,46.4% of $908.00 in Billed Charges for Rev 272 = $421.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 6.9F 220CM 214,272,RC,27200751,CDM,,,,,,both,,,908.0000,136.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,378.64,,,,,,,234.3500,908.0000,percent of total billed charges,41.7% of $908.00 in Billed Charges for Rev 272 = $378.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 6.9F 220CM 214,272,RC,27200751,CDM,,,,,,both,,,908.0000,136.2000,CIGNA HEALTHCARE,CIGNA PPO,378.64,,,,,,,234.3500,908.0000,percent of total billed charges,41.7% of $908.00 in Billed Charges for Rev 272 = $378.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 6.9F 220CM 214,272,RC,27200751,CDM,,,,,,both,,,908.0000,136.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,817.20,,,,,,,234.3500,908.0000,percent of total billed charges,90% of $908.00 in Billed Charges for Rev 272 = $817.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 6.9F 220CM 214,272,RC,27200751,CDM,,,,,,both,,,908.0000,136.2000,MEDCOST,MEDCOST VHN,432.12,,,,,,,234.3500,908.0000,percent of total billed charges,47.59% of $908.00 in Billed Charges for Rev 272 = $432.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 6.9F 220CM 214,272,RC,27200751,CDM,,,,,,both,,,908.0000,136.2000,SENTARA HEALTH,SENTARA HEALTH,234.35,,,,,,,234.3500,908.0000,percent of total billed charges,25.81% of $908.00 in Billed Charges for Rev 272 = $234.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 6.9F 220CM 214,272,RC,27200751,CDM,,,,,,both,,,908.0000,136.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",908.00,,,,,,,234.3500,908.0000,percent of total billed charges,100% of $908.00 in Billed Charges for Rev 272 = $908.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 6.9F 220CM 214,272,RC,27200751,CDM,,,,,,both,,,908.0000,136.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,454.00,,,,,,,234.3500,908.0000,percent of total billed charges,Rev 272 $908.00 in Billed Charges at 50% = $454.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 6.9F 220CM 214,272,RC,27200751,CDM,,,,,,both,,,908.0000,136.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,293.28,,,,,,,234.3500,908.0000,other,32.3% of $908.00 in Billed Charges for Rev 272 = $293.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI PROBE ARGON 6.9F 220CM 214,272,RC,27200751,CDM,,,,,,both,,,908.0000,136.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,278.76,,,,,,,234.3500,908.0000,other,30.7% of $908.00 in Billed Charges for Rev 272 = $278.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI PROBE ARGON 6.9F 220CM 214,272,RC,27200751,CDM,,,,,,both,,,908.0000,136.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,293.28,,,,,,,234.3500,908.0000,percent of total billed charges,32.3% of $908.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE ARGON 6.9F 220CM 214,272,RC,27200751,CDM,,,,,,both,,,908.0000,136.2000,WELLCARE,WELLCARE MEDICAID,908.00,,,,,,,234.3500,908.0000,percent of total billed charges,100% of $908.00 in Billed Charges for Rev 272 = $908.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE GOLD 7FR #6015,272,RC,27200752,CDM,,,,,,both,,,921.0000,138.1500,AETNA,AETNA,393.27,,,,,,,237.7100,921.0000,percent of total billed charges,42.7% of $921.00 in Billed Charges for Rev 272 = $393.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE GOLD 7FR #6015,272,RC,27200752,CDM,,,,,,both,,,921.0000,138.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,644.70,,,,,,,237.7100,921.0000,percent of total billed charges,Rev 272 $921.00 in Billed Charges at 70% = $644.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE GOLD 7FR #6015,272,RC,27200752,CDM,,,,,,both,,,921.0000,138.1500,CIGNA HEALTHCARE,CIGNA HMO,384.06,,,,,,,237.7100,921.0000,percent of total billed charges,41.7% of $921.00 in Billed Charges for Rev 272 = $384.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE GOLD 7FR #6015,272,RC,27200752,CDM,,,,,,both,,,921.0000,138.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,427.34,,,,,,,237.7100,921.0000,percent of total billed charges,46.4% of $921.00 in Billed Charges for Rev 272 = $427.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE GOLD 7FR #6015,272,RC,27200752,CDM,,,,,,both,,,921.0000,138.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,384.06,,,,,,,237.7100,921.0000,percent of total billed charges,41.7% of $921.00 in Billed Charges for Rev 272 = $384.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE GOLD 7FR #6015,272,RC,27200752,CDM,,,,,,both,,,921.0000,138.1500,CIGNA HEALTHCARE,CIGNA PPO,384.06,,,,,,,237.7100,921.0000,percent of total billed charges,41.7% of $921.00 in Billed Charges for Rev 272 = $384.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE GOLD 7FR #6015,272,RC,27200752,CDM,,,,,,both,,,921.0000,138.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,828.90,,,,,,,237.7100,921.0000,percent of total billed charges,90% of $921.00 in Billed Charges for Rev 272 = $828.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE GOLD 7FR #6015,272,RC,27200752,CDM,,,,,,both,,,921.0000,138.1500,MEDCOST,MEDCOST VHN,438.30,,,,,,,237.7100,921.0000,percent of total billed charges,47.59% of $921.00 in Billed Charges for Rev 272 = $438.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE GOLD 7FR #6015,272,RC,27200752,CDM,,,,,,both,,,921.0000,138.1500,SENTARA HEALTH,SENTARA HEALTH,237.71,,,,,,,237.7100,921.0000,percent of total billed charges,25.81% of $921.00 in Billed Charges for Rev 272 = $237.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE GOLD 7FR #6015,272,RC,27200752,CDM,,,,,,both,,,921.0000,138.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",921.00,,,,,,,237.7100,921.0000,percent of total billed charges,100% of $921.00 in Billed Charges for Rev 272 = $921.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE GOLD 7FR #6015,272,RC,27200752,CDM,,,,,,both,,,921.0000,138.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,460.50,,,,,,,237.7100,921.0000,percent of total billed charges,Rev 272 $921.00 in Billed Charges at 50% = $460.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE GOLD 7FR #6015,272,RC,27200752,CDM,,,,,,both,,,921.0000,138.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,297.48,,,,,,,237.7100,921.0000,other,32.3% of $921.00 in Billed Charges for Rev 272 = $297.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI PROBE GOLD 7FR #6015,272,RC,27200752,CDM,,,,,,both,,,921.0000,138.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,282.75,,,,,,,237.7100,921.0000,other,30.7% of $921.00 in Billed Charges for Rev 272 = $282.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI PROBE GOLD 7FR #6015,272,RC,27200752,CDM,,,,,,both,,,921.0000,138.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,297.48,,,,,,,237.7100,921.0000,percent of total billed charges,32.3% of $921.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI PROBE GOLD 7FR #6015,272,RC,27200752,CDM,,,,,,both,,,921.0000,138.1500,WELLCARE,WELLCARE MEDICAID,921.00,,,,,,,237.7100,921.0000,percent of total billed charges,100% of $921.00 in Billed Charges for Rev 272 = $921.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL BX TEMNO 20G,272,RC,27200943,CDM,,,,,,both,,,182.0000,27.3000,AETNA,AETNA,77.71,,,,,,,46.9700,182.0000,percent of total billed charges,42.7% of $182.00 in Billed Charges for Rev 272 = $77.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL BX TEMNO 20G,272,RC,27200943,CDM,,,,,,both,,,182.0000,27.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,127.40,,,,,,,46.9700,182.0000,percent of total billed charges,Rev 272 $182.00 in Billed Charges at 70% = $127.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL BX TEMNO 20G,272,RC,27200943,CDM,,,,,,both,,,182.0000,27.3000,CIGNA HEALTHCARE,CIGNA HMO,75.89,,,,,,,46.9700,182.0000,percent of total billed charges,41.7% of $182.00 in Billed Charges for Rev 272 = $75.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL BX TEMNO 20G,272,RC,27200943,CDM,,,,,,both,,,182.0000,27.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,84.45,,,,,,,46.9700,182.0000,percent of total billed charges,46.4% of $182.00 in Billed Charges for Rev 272 = $84.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL BX TEMNO 20G,272,RC,27200943,CDM,,,,,,both,,,182.0000,27.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,75.89,,,,,,,46.9700,182.0000,percent of total billed charges,41.7% of $182.00 in Billed Charges for Rev 272 = $75.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL BX TEMNO 20G,272,RC,27200943,CDM,,,,,,both,,,182.0000,27.3000,CIGNA HEALTHCARE,CIGNA PPO,75.89,,,,,,,46.9700,182.0000,percent of total billed charges,41.7% of $182.00 in Billed Charges for Rev 272 = $75.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL BX TEMNO 20G,272,RC,27200943,CDM,,,,,,both,,,182.0000,27.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,163.80,,,,,,,46.9700,182.0000,percent of total billed charges,90% of $182.00 in Billed Charges for Rev 272 = $163.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL BX TEMNO 20G,272,RC,27200943,CDM,,,,,,both,,,182.0000,27.3000,MEDCOST,MEDCOST VHN,86.61,,,,,,,46.9700,182.0000,percent of total billed charges,47.59% of $182.00 in Billed Charges for Rev 272 = $86.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL BX TEMNO 20G,272,RC,27200943,CDM,,,,,,both,,,182.0000,27.3000,SENTARA HEALTH,SENTARA HEALTH,46.97,,,,,,,46.9700,182.0000,percent of total billed charges,25.81% of $182.00 in Billed Charges for Rev 272 = $46.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL BX TEMNO 20G,272,RC,27200943,CDM,,,,,,both,,,182.0000,27.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",182.00,,,,,,,46.9700,182.0000,percent of total billed charges,100% of $182.00 in Billed Charges for Rev 272 = $182.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL BX TEMNO 20G,272,RC,27200943,CDM,,,,,,both,,,182.0000,27.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,91.00,,,,,,,46.9700,182.0000,percent of total billed charges,Rev 272 $182.00 in Billed Charges at 50% = $91.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL BX TEMNO 20G,272,RC,27200943,CDM,,,,,,both,,,182.0000,27.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,58.79,,,,,,,46.9700,182.0000,other,32.3% of $182.00 in Billed Charges for Rev 272 = $58.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NDL BX TEMNO 20G,272,RC,27200943,CDM,,,,,,both,,,182.0000,27.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,55.87,,,,,,,46.9700,182.0000,other,30.7% of $182.00 in Billed Charges for Rev 272 = $55.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NDL BX TEMNO 20G,272,RC,27200943,CDM,,,,,,both,,,182.0000,27.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,58.79,,,,,,,46.9700,182.0000,percent of total billed charges,32.3% of $182.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NDL BX TEMNO 20G,272,RC,27200943,CDM,,,,,,both,,,182.0000,27.3000,WELLCARE,WELLCARE MEDICAID,182.00,,,,,,,46.9700,182.0000,percent of total billed charges,100% of $182.00 in Billed Charges for Rev 272 = $182.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 4FR MICROPUNCTURE,272,RC,27200947,CDM,,,,,,both,,,173.0000,25.9500,AETNA,AETNA,73.87,,,,,,,44.6500,173.0000,percent of total billed charges,42.7% of $173.00 in Billed Charges for Rev 272 = $73.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 4FR MICROPUNCTURE,272,RC,27200947,CDM,,,,,,both,,,173.0000,25.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,121.10,,,,,,,44.6500,173.0000,percent of total billed charges,Rev 272 $173.00 in Billed Charges at 70% = $121.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 4FR MICROPUNCTURE,272,RC,27200947,CDM,,,,,,both,,,173.0000,25.9500,CIGNA HEALTHCARE,CIGNA HMO,72.14,,,,,,,44.6500,173.0000,percent of total billed charges,41.7% of $173.00 in Billed Charges for Rev 272 = $72.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 4FR MICROPUNCTURE,272,RC,27200947,CDM,,,,,,both,,,173.0000,25.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,80.27,,,,,,,44.6500,173.0000,percent of total billed charges,46.4% of $173.00 in Billed Charges for Rev 272 = $80.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 4FR MICROPUNCTURE,272,RC,27200947,CDM,,,,,,both,,,173.0000,25.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,72.14,,,,,,,44.6500,173.0000,percent of total billed charges,41.7% of $173.00 in Billed Charges for Rev 272 = $72.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 4FR MICROPUNCTURE,272,RC,27200947,CDM,,,,,,both,,,173.0000,25.9500,CIGNA HEALTHCARE,CIGNA PPO,72.14,,,,,,,44.6500,173.0000,percent of total billed charges,41.7% of $173.00 in Billed Charges for Rev 272 = $72.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 4FR MICROPUNCTURE,272,RC,27200947,CDM,,,,,,both,,,173.0000,25.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,155.70,,,,,,,44.6500,173.0000,percent of total billed charges,90% of $173.00 in Billed Charges for Rev 272 = $155.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 4FR MICROPUNCTURE,272,RC,27200947,CDM,,,,,,both,,,173.0000,25.9500,MEDCOST,MEDCOST VHN,82.33,,,,,,,44.6500,173.0000,percent of total billed charges,47.59% of $173.00 in Billed Charges for Rev 272 = $82.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 4FR MICROPUNCTURE,272,RC,27200947,CDM,,,,,,both,,,173.0000,25.9500,SENTARA HEALTH,SENTARA HEALTH,44.65,,,,,,,44.6500,173.0000,percent of total billed charges,25.81% of $173.00 in Billed Charges for Rev 272 = $44.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 4FR MICROPUNCTURE,272,RC,27200947,CDM,,,,,,both,,,173.0000,25.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",173.00,,,,,,,44.6500,173.0000,percent of total billed charges,100% of $173.00 in Billed Charges for Rev 272 = $173.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 4FR MICROPUNCTURE,272,RC,27200947,CDM,,,,,,both,,,173.0000,25.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,86.50,,,,,,,44.6500,173.0000,percent of total billed charges,Rev 272 $173.00 in Billed Charges at 50% = $86.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 4FR MICROPUNCTURE,272,RC,27200947,CDM,,,,,,both,,,173.0000,25.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,55.88,,,,,,,44.6500,173.0000,other,32.3% of $173.00 in Billed Charges for Rev 272 = $55.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE 4FR MICROPUNCTURE,272,RC,27200947,CDM,,,,,,both,,,173.0000,25.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,53.11,,,,,,,44.6500,173.0000,other,30.7% of $173.00 in Billed Charges for Rev 272 = $53.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE 4FR MICROPUNCTURE,272,RC,27200947,CDM,,,,,,both,,,173.0000,25.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,55.88,,,,,,,44.6500,173.0000,percent of total billed charges,32.3% of $173.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE 4FR MICROPUNCTURE,272,RC,27200947,CDM,,,,,,both,,,173.0000,25.9500,WELLCARE,WELLCARE MEDICAID,173.00,,,,,,,44.6500,173.0000,percent of total billed charges,100% of $173.00 in Billed Charges for Rev 272 = $173.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE ASPIRATION NA41101321,272,RC,27200949,CDM,,,,,,both,,,1185.0000,177.7500,AETNA,AETNA,506.00,,,,,,,305.8500,1185.0000,percent of total billed charges,"42.7% of $1,185.00 in Billed Charges for Rev 272 = $506.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE ASPIRATION NA41101321,272,RC,27200949,CDM,,,,,,both,,,1185.0000,177.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,829.50,,,,,,,305.8500,1185.0000,percent of total billed charges,"Rev 272 $1,185.00 in Billed Charges at 70% = $829.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE ASPIRATION NA41101321,272,RC,27200949,CDM,,,,,,both,,,1185.0000,177.7500,CIGNA HEALTHCARE,CIGNA HMO,494.15,,,,,,,305.8500,1185.0000,percent of total billed charges,"41.7% of $1,185.00 in Billed Charges for Rev 272 = $494.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE ASPIRATION NA41101321,272,RC,27200949,CDM,,,,,,both,,,1185.0000,177.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,549.84,,,,,,,305.8500,1185.0000,percent of total billed charges,"46.4% of $1,185.00 in Billed Charges for Rev 272 = $549.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE ASPIRATION NA41101321,272,RC,27200949,CDM,,,,,,both,,,1185.0000,177.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,494.15,,,,,,,305.8500,1185.0000,percent of total billed charges,"41.7% of $1,185.00 in Billed Charges for Rev 272 = $494.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE ASPIRATION NA41101321,272,RC,27200949,CDM,,,,,,both,,,1185.0000,177.7500,CIGNA HEALTHCARE,CIGNA PPO,494.15,,,,,,,305.8500,1185.0000,percent of total billed charges,"41.7% of $1,185.00 in Billed Charges for Rev 272 = $494.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE ASPIRATION NA41101321,272,RC,27200949,CDM,,,,,,both,,,1185.0000,177.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1066.50,,,,,,,305.8500,1185.0000,percent of total billed charges,"90% of $1,185.00 in Billed Charges for Rev 272 = $1,066.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE ASPIRATION NA41101321,272,RC,27200949,CDM,,,,,,both,,,1185.0000,177.7500,MEDCOST,MEDCOST VHN,563.94,,,,,,,305.8500,1185.0000,percent of total billed charges,"47.59% of $1,185.00 in Billed Charges for Rev 272 = $563.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE ASPIRATION NA41101321,272,RC,27200949,CDM,,,,,,both,,,1185.0000,177.7500,SENTARA HEALTH,SENTARA HEALTH,305.85,,,,,,,305.8500,1185.0000,percent of total billed charges,"25.81% of $1,185.00 in Billed Charges for Rev 272 = $305.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE ASPIRATION NA41101321,272,RC,27200949,CDM,,,,,,both,,,1185.0000,177.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1185.00,,,,,,,305.8500,1185.0000,percent of total billed charges,"100% of $1,185.00 in Billed Charges for Rev 272 = $1,185.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE ASPIRATION NA41101321,272,RC,27200949,CDM,,,,,,both,,,1185.0000,177.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,592.50,,,,,,,305.8500,1185.0000,percent of total billed charges,"Rev 272 $1,185.00 in Billed Charges at 50% = $592.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE ASPIRATION NA41101321,272,RC,27200949,CDM,,,,,,both,,,1185.0000,177.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,382.76,,,,,,,305.8500,1185.0000,other,"32.3% of $1,185.00 in Billed Charges for Rev 272 = $382.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NEEDLE ASPIRATION NA41101321,272,RC,27200949,CDM,,,,,,both,,,1185.0000,177.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,363.80,,,,,,,305.8500,1185.0000,other,"30.7% of $1,185.00 in Billed Charges for Rev 272 = $363.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NEEDLE ASPIRATION NA41101321,272,RC,27200949,CDM,,,,,,both,,,1185.0000,177.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,382.76,,,,,,,305.8500,1185.0000,percent of total billed charges,"32.3% of $1,185.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE ASPIRATION NA41101321,272,RC,27200949,CDM,,,,,,both,,,1185.0000,177.7500,WELLCARE,WELLCARE MEDICAID,1185.00,,,,,,,305.8500,1185.0000,percent of total billed charges,"100% of $1,185.00 in Billed Charges for Rev 272 = $1,185.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE BIOPSY CHIBA 22X20,272,RC,27200952,CDM,,,,,,both,,,92.0000,13.8000,AETNA,AETNA,39.28,,,,,,,23.7500,92.0000,percent of total billed charges,42.7% of $92.00 in Billed Charges for Rev 272 = $39.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X20,272,RC,27200952,CDM,,,,,,both,,,92.0000,13.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,64.40,,,,,,,23.7500,92.0000,percent of total billed charges,Rev 272 $92.00 in Billed Charges at 70% = $64.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X20,272,RC,27200952,CDM,,,,,,both,,,92.0000,13.8000,CIGNA HEALTHCARE,CIGNA HMO,38.36,,,,,,,23.7500,92.0000,percent of total billed charges,41.7% of $92.00 in Billed Charges for Rev 272 = $38.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X20,272,RC,27200952,CDM,,,,,,both,,,92.0000,13.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,42.69,,,,,,,23.7500,92.0000,percent of total billed charges,46.4% of $92.00 in Billed Charges for Rev 272 = $42.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X20,272,RC,27200952,CDM,,,,,,both,,,92.0000,13.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,38.36,,,,,,,23.7500,92.0000,percent of total billed charges,41.7% of $92.00 in Billed Charges for Rev 272 = $38.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X20,272,RC,27200952,CDM,,,,,,both,,,92.0000,13.8000,CIGNA HEALTHCARE,CIGNA PPO,38.36,,,,,,,23.7500,92.0000,percent of total billed charges,41.7% of $92.00 in Billed Charges for Rev 272 = $38.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X20,272,RC,27200952,CDM,,,,,,both,,,92.0000,13.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,82.80,,,,,,,23.7500,92.0000,percent of total billed charges,90% of $92.00 in Billed Charges for Rev 272 = $82.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X20,272,RC,27200952,CDM,,,,,,both,,,92.0000,13.8000,MEDCOST,MEDCOST VHN,43.78,,,,,,,23.7500,92.0000,percent of total billed charges,47.59% of $92.00 in Billed Charges for Rev 272 = $43.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X20,272,RC,27200952,CDM,,,,,,both,,,92.0000,13.8000,SENTARA HEALTH,SENTARA HEALTH,23.75,,,,,,,23.7500,92.0000,percent of total billed charges,25.81% of $92.00 in Billed Charges for Rev 272 = $23.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X20,272,RC,27200952,CDM,,,,,,both,,,92.0000,13.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",92.00,,,,,,,23.7500,92.0000,percent of total billed charges,100% of $92.00 in Billed Charges for Rev 272 = $92.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X20,272,RC,27200952,CDM,,,,,,both,,,92.0000,13.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,46.00,,,,,,,23.7500,92.0000,percent of total billed charges,Rev 272 $92.00 in Billed Charges at 50% = $46.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X20,272,RC,27200952,CDM,,,,,,both,,,92.0000,13.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,29.72,,,,,,,23.7500,92.0000,other,32.3% of $92.00 in Billed Charges for Rev 272 = $29.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE BIOPSY CHIBA 22X20,272,RC,27200952,CDM,,,,,,both,,,92.0000,13.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,28.24,,,,,,,23.7500,92.0000,other,30.7% of $92.00 in Billed Charges for Rev 272 = $28.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE BIOPSY CHIBA 22X20,272,RC,27200952,CDM,,,,,,both,,,92.0000,13.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,29.72,,,,,,,23.7500,92.0000,percent of total billed charges,32.3% of $92.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BIOPSY CHIBA 22X20,272,RC,27200952,CDM,,,,,,both,,,92.0000,13.8000,WELLCARE,WELLCARE MEDICAID,92.00,,,,,,,23.7500,92.0000,percent of total billed charges,100% of $92.00 in Billed Charges for Rev 272 = $92.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BROCKENBROUGH DISP,272,RC,27200953,CDM,,,,,,both,,,1036.0000,155.4000,AETNA,AETNA,442.37,,,,,,,267.3900,1036.0000,percent of total billed charges,"42.7% of $1,036.00 in Billed Charges for Rev 272 = $442.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE BROCKENBROUGH DISP,272,RC,27200953,CDM,,,,,,both,,,1036.0000,155.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,725.20,,,,,,,267.3900,1036.0000,percent of total billed charges,"Rev 272 $1,036.00 in Billed Charges at 70% = $725.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE BROCKENBROUGH DISP,272,RC,27200953,CDM,,,,,,both,,,1036.0000,155.4000,CIGNA HEALTHCARE,CIGNA HMO,432.01,,,,,,,267.3900,1036.0000,percent of total billed charges,"41.7% of $1,036.00 in Billed Charges for Rev 272 = $432.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE BROCKENBROUGH DISP,272,RC,27200953,CDM,,,,,,both,,,1036.0000,155.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,480.70,,,,,,,267.3900,1036.0000,percent of total billed charges,"46.4% of $1,036.00 in Billed Charges for Rev 272 = $480.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE BROCKENBROUGH DISP,272,RC,27200953,CDM,,,,,,both,,,1036.0000,155.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,432.01,,,,,,,267.3900,1036.0000,percent of total billed charges,"41.7% of $1,036.00 in Billed Charges for Rev 272 = $432.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE BROCKENBROUGH DISP,272,RC,27200953,CDM,,,,,,both,,,1036.0000,155.4000,CIGNA HEALTHCARE,CIGNA PPO,432.01,,,,,,,267.3900,1036.0000,percent of total billed charges,"41.7% of $1,036.00 in Billed Charges for Rev 272 = $432.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE BROCKENBROUGH DISP,272,RC,27200953,CDM,,,,,,both,,,1036.0000,155.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,932.40,,,,,,,267.3900,1036.0000,percent of total billed charges,"90% of $1,036.00 in Billed Charges for Rev 272 = $932.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE BROCKENBROUGH DISP,272,RC,27200953,CDM,,,,,,both,,,1036.0000,155.4000,MEDCOST,MEDCOST VHN,493.03,,,,,,,267.3900,1036.0000,percent of total billed charges,"47.59% of $1,036.00 in Billed Charges for Rev 272 = $493.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE BROCKENBROUGH DISP,272,RC,27200953,CDM,,,,,,both,,,1036.0000,155.4000,SENTARA HEALTH,SENTARA HEALTH,267.39,,,,,,,267.3900,1036.0000,percent of total billed charges,"25.81% of $1,036.00 in Billed Charges for Rev 272 = $267.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE BROCKENBROUGH DISP,272,RC,27200953,CDM,,,,,,both,,,1036.0000,155.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1036.00,,,,,,,267.3900,1036.0000,percent of total billed charges,"100% of $1,036.00 in Billed Charges for Rev 272 = $1,036.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE BROCKENBROUGH DISP,272,RC,27200953,CDM,,,,,,both,,,1036.0000,155.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,518.00,,,,,,,267.3900,1036.0000,percent of total billed charges,"Rev 272 $1,036.00 in Billed Charges at 50% = $518.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE BROCKENBROUGH DISP,272,RC,27200953,CDM,,,,,,both,,,1036.0000,155.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,334.63,,,,,,,267.3900,1036.0000,other,"32.3% of $1,036.00 in Billed Charges for Rev 272 = $334.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NEEDLE BROCKENBROUGH DISP,272,RC,27200953,CDM,,,,,,both,,,1036.0000,155.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,318.05,,,,,,,267.3900,1036.0000,other,"30.7% of $1,036.00 in Billed Charges for Rev 272 = $318.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NEEDLE BROCKENBROUGH DISP,272,RC,27200953,CDM,,,,,,both,,,1036.0000,155.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,334.63,,,,,,,267.3900,1036.0000,percent of total billed charges,"32.3% of $1,036.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE BROCKENBROUGH DISP,272,RC,27200953,CDM,,,,,,both,,,1036.0000,155.4000,WELLCARE,WELLCARE MEDICAID,1036.00,,,,,,,267.3900,1036.0000,percent of total billed charges,"100% of $1,036.00 in Billed Charges for Rev 272 = $1,036.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE BX 10 15CM TEMNO,272,RC,27200955,CDM,,,,,,both,,,227.0000,34.0500,AETNA,AETNA,96.93,,,,,,,58.5900,227.0000,percent of total billed charges,42.7% of $227.00 in Billed Charges for Rev 272 = $96.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM TEMNO,272,RC,27200955,CDM,,,,,,both,,,227.0000,34.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,158.90,,,,,,,58.5900,227.0000,percent of total billed charges,Rev 272 $227.00 in Billed Charges at 70% = $158.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM TEMNO,272,RC,27200955,CDM,,,,,,both,,,227.0000,34.0500,CIGNA HEALTHCARE,CIGNA HMO,94.66,,,,,,,58.5900,227.0000,percent of total billed charges,41.7% of $227.00 in Billed Charges for Rev 272 = $94.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM TEMNO,272,RC,27200955,CDM,,,,,,both,,,227.0000,34.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,105.33,,,,,,,58.5900,227.0000,percent of total billed charges,46.4% of $227.00 in Billed Charges for Rev 272 = $105.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM TEMNO,272,RC,27200955,CDM,,,,,,both,,,227.0000,34.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,94.66,,,,,,,58.5900,227.0000,percent of total billed charges,41.7% of $227.00 in Billed Charges for Rev 272 = $94.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM TEMNO,272,RC,27200955,CDM,,,,,,both,,,227.0000,34.0500,CIGNA HEALTHCARE,CIGNA PPO,94.66,,,,,,,58.5900,227.0000,percent of total billed charges,41.7% of $227.00 in Billed Charges for Rev 272 = $94.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM TEMNO,272,RC,27200955,CDM,,,,,,both,,,227.0000,34.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,204.30,,,,,,,58.5900,227.0000,percent of total billed charges,90% of $227.00 in Billed Charges for Rev 272 = $204.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM TEMNO,272,RC,27200955,CDM,,,,,,both,,,227.0000,34.0500,MEDCOST,MEDCOST VHN,108.03,,,,,,,58.5900,227.0000,percent of total billed charges,47.59% of $227.00 in Billed Charges for Rev 272 = $108.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM TEMNO,272,RC,27200955,CDM,,,,,,both,,,227.0000,34.0500,SENTARA HEALTH,SENTARA HEALTH,58.59,,,,,,,58.5900,227.0000,percent of total billed charges,25.81% of $227.00 in Billed Charges for Rev 272 = $58.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM TEMNO,272,RC,27200955,CDM,,,,,,both,,,227.0000,34.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",227.00,,,,,,,58.5900,227.0000,percent of total billed charges,100% of $227.00 in Billed Charges for Rev 272 = $227.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM TEMNO,272,RC,27200955,CDM,,,,,,both,,,227.0000,34.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,113.50,,,,,,,58.5900,227.0000,percent of total billed charges,Rev 272 $227.00 in Billed Charges at 50% = $113.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM TEMNO,272,RC,27200955,CDM,,,,,,both,,,227.0000,34.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,73.32,,,,,,,58.5900,227.0000,other,32.3% of $227.00 in Billed Charges for Rev 272 = $73.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE BX 10 15CM TEMNO,272,RC,27200955,CDM,,,,,,both,,,227.0000,34.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,69.69,,,,,,,58.5900,227.0000,other,30.7% of $227.00 in Billed Charges for Rev 272 = $69.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE BX 10 15CM TEMNO,272,RC,27200955,CDM,,,,,,both,,,227.0000,34.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,73.32,,,,,,,58.5900,227.0000,percent of total billed charges,32.3% of $227.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX 10 15CM TEMNO,272,RC,27200955,CDM,,,,,,both,,,227.0000,34.0500,WELLCARE,WELLCARE MEDICAID,227.00,,,,,,,58.5900,227.0000,percent of total billed charges,100% of $227.00 in Billed Charges for Rev 272 = $227.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX CORE/BARD 20X10,272,RC,27200956,CDM,,,,,,both,,,107.0000,16.0500,AETNA,AETNA,45.69,,,,,,,27.6200,107.0000,percent of total billed charges,42.7% of $107.00 in Billed Charges for Rev 272 = $45.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX CORE/BARD 20X10,272,RC,27200956,CDM,,,,,,both,,,107.0000,16.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,74.90,,,,,,,27.6200,107.0000,percent of total billed charges,Rev 272 $107.00 in Billed Charges at 70% = $74.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX CORE/BARD 20X10,272,RC,27200956,CDM,,,,,,both,,,107.0000,16.0500,CIGNA HEALTHCARE,CIGNA HMO,44.62,,,,,,,27.6200,107.0000,percent of total billed charges,41.7% of $107.00 in Billed Charges for Rev 272 = $44.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX CORE/BARD 20X10,272,RC,27200956,CDM,,,,,,both,,,107.0000,16.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,49.65,,,,,,,27.6200,107.0000,percent of total billed charges,46.4% of $107.00 in Billed Charges for Rev 272 = $49.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX CORE/BARD 20X10,272,RC,27200956,CDM,,,,,,both,,,107.0000,16.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,44.62,,,,,,,27.6200,107.0000,percent of total billed charges,41.7% of $107.00 in Billed Charges for Rev 272 = $44.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX CORE/BARD 20X10,272,RC,27200956,CDM,,,,,,both,,,107.0000,16.0500,CIGNA HEALTHCARE,CIGNA PPO,44.62,,,,,,,27.6200,107.0000,percent of total billed charges,41.7% of $107.00 in Billed Charges for Rev 272 = $44.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX CORE/BARD 20X10,272,RC,27200956,CDM,,,,,,both,,,107.0000,16.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,96.30,,,,,,,27.6200,107.0000,percent of total billed charges,90% of $107.00 in Billed Charges for Rev 272 = $96.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX CORE/BARD 20X10,272,RC,27200956,CDM,,,,,,both,,,107.0000,16.0500,MEDCOST,MEDCOST VHN,50.92,,,,,,,27.6200,107.0000,percent of total billed charges,47.59% of $107.00 in Billed Charges for Rev 272 = $50.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX CORE/BARD 20X10,272,RC,27200956,CDM,,,,,,both,,,107.0000,16.0500,SENTARA HEALTH,SENTARA HEALTH,27.62,,,,,,,27.6200,107.0000,percent of total billed charges,25.81% of $107.00 in Billed Charges for Rev 272 = $27.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX CORE/BARD 20X10,272,RC,27200956,CDM,,,,,,both,,,107.0000,16.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",107.00,,,,,,,27.6200,107.0000,percent of total billed charges,100% of $107.00 in Billed Charges for Rev 272 = $107.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX CORE/BARD 20X10,272,RC,27200956,CDM,,,,,,both,,,107.0000,16.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,53.50,,,,,,,27.6200,107.0000,percent of total billed charges,Rev 272 $107.00 in Billed Charges at 50% = $53.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX CORE/BARD 20X10,272,RC,27200956,CDM,,,,,,both,,,107.0000,16.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,34.56,,,,,,,27.6200,107.0000,other,32.3% of $107.00 in Billed Charges for Rev 272 = $34.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE BX CORE/BARD 20X10,272,RC,27200956,CDM,,,,,,both,,,107.0000,16.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,32.85,,,,,,,27.6200,107.0000,other,30.7% of $107.00 in Billed Charges for Rev 272 = $32.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE BX CORE/BARD 20X10,272,RC,27200956,CDM,,,,,,both,,,107.0000,16.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,34.56,,,,,,,27.6200,107.0000,percent of total billed charges,32.3% of $107.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX CORE/BARD 20X10,272,RC,27200956,CDM,,,,,,both,,,107.0000,16.0500,WELLCARE,WELLCARE MEDICAID,107.00,,,,,,,27.6200,107.0000,percent of total billed charges,100% of $107.00 in Billed Charges for Rev 272 = $107.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG REPLACEMENT ORTHO EVAC,272,RC,27200103,CDM,,,,,,both,,,567.0000,85.0500,AETNA,AETNA,242.11,,,,,,,146.3400,567.0000,percent of total billed charges,42.7% of $567.00 in Billed Charges for Rev 272 = $242.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG REPLACEMENT ORTHO EVAC,272,RC,27200103,CDM,,,,,,both,,,567.0000,85.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,396.90,,,,,,,146.3400,567.0000,percent of total billed charges,Rev 272 $567.00 in Billed Charges at 70% = $396.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG REPLACEMENT ORTHO EVAC,272,RC,27200103,CDM,,,,,,both,,,567.0000,85.0500,CIGNA HEALTHCARE,CIGNA HMO,236.44,,,,,,,146.3400,567.0000,percent of total billed charges,41.7% of $567.00 in Billed Charges for Rev 272 = $236.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG REPLACEMENT ORTHO EVAC,272,RC,27200103,CDM,,,,,,both,,,567.0000,85.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,263.09,,,,,,,146.3400,567.0000,percent of total billed charges,46.4% of $567.00 in Billed Charges for Rev 272 = $263.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG REPLACEMENT ORTHO EVAC,272,RC,27200103,CDM,,,,,,both,,,567.0000,85.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,236.44,,,,,,,146.3400,567.0000,percent of total billed charges,41.7% of $567.00 in Billed Charges for Rev 272 = $236.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG REPLACEMENT ORTHO EVAC,272,RC,27200103,CDM,,,,,,both,,,567.0000,85.0500,CIGNA HEALTHCARE,CIGNA PPO,236.44,,,,,,,146.3400,567.0000,percent of total billed charges,41.7% of $567.00 in Billed Charges for Rev 272 = $236.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG REPLACEMENT ORTHO EVAC,272,RC,27200103,CDM,,,,,,both,,,567.0000,85.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,510.30,,,,,,,146.3400,567.0000,percent of total billed charges,90% of $567.00 in Billed Charges for Rev 272 = $510.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG REPLACEMENT ORTHO EVAC,272,RC,27200103,CDM,,,,,,both,,,567.0000,85.0500,MEDCOST,MEDCOST VHN,269.84,,,,,,,146.3400,567.0000,percent of total billed charges,47.59% of $567.00 in Billed Charges for Rev 272 = $269.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG REPLACEMENT ORTHO EVAC,272,RC,27200103,CDM,,,,,,both,,,567.0000,85.0500,SENTARA HEALTH,SENTARA HEALTH,146.34,,,,,,,146.3400,567.0000,percent of total billed charges,25.81% of $567.00 in Billed Charges for Rev 272 = $146.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG REPLACEMENT ORTHO EVAC,272,RC,27200103,CDM,,,,,,both,,,567.0000,85.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",567.00,,,,,,,146.3400,567.0000,percent of total billed charges,100% of $567.00 in Billed Charges for Rev 272 = $567.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG REPLACEMENT ORTHO EVAC,272,RC,27200103,CDM,,,,,,both,,,567.0000,85.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,283.50,,,,,,,146.3400,567.0000,percent of total billed charges,Rev 272 $567.00 in Billed Charges at 50% = $283.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG REPLACEMENT ORTHO EVAC,272,RC,27200103,CDM,,,,,,both,,,567.0000,85.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,183.14,,,,,,,146.3400,567.0000,other,32.3% of $567.00 in Billed Charges for Rev 272 = $183.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BAG REPLACEMENT ORTHO EVAC,272,RC,27200103,CDM,,,,,,both,,,567.0000,85.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,174.07,,,,,,,146.3400,567.0000,other,30.7% of $567.00 in Billed Charges for Rev 272 = $174.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BAG REPLACEMENT ORTHO EVAC,272,RC,27200103,CDM,,,,,,both,,,567.0000,85.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,183.14,,,,,,,146.3400,567.0000,percent of total billed charges,32.3% of $567.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG REPLACEMENT ORTHO EVAC,272,RC,27200103,CDM,,,,,,both,,,567.0000,85.0500,WELLCARE,WELLCARE MEDICAID,567.00,,,,,,,146.3400,567.0000,percent of total billed charges,100% of $567.00 in Billed Charges for Rev 272 = $567.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG TRANSFUSION AUTO CHEST EA,270,RC,27000094,CDM,,,,,,both,,,164.0000,24.6000,AETNA,AETNA,70.03,,,,,,,42.3300,164.0000,percent of total billed charges,42.7% of $164.00 in Billed Charges for Rev 270 = $70.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG TRANSFUSION AUTO CHEST EA,270,RC,27000094,CDM,,,,,,both,,,164.0000,24.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,114.80,,,,,,,42.3300,164.0000,percent of total billed charges,Rev 270 $164.00 in Billed Charges at 70% = $114.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG TRANSFUSION AUTO CHEST EA,270,RC,27000094,CDM,,,,,,both,,,164.0000,24.6000,CIGNA HEALTHCARE,CIGNA HMO,68.39,,,,,,,42.3300,164.0000,percent of total billed charges,41.7% of $164.00 in Billed Charges for Rev 270 = $68.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG TRANSFUSION AUTO CHEST EA,270,RC,27000094,CDM,,,,,,both,,,164.0000,24.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,76.10,,,,,,,42.3300,164.0000,percent of total billed charges,46.4% of $164.00 in Billed Charges for Rev 270 = $76.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG TRANSFUSION AUTO CHEST EA,270,RC,27000094,CDM,,,,,,both,,,164.0000,24.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,68.39,,,,,,,42.3300,164.0000,percent of total billed charges,41.7% of $164.00 in Billed Charges for Rev 270 = $68.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG TRANSFUSION AUTO CHEST EA,270,RC,27000094,CDM,,,,,,both,,,164.0000,24.6000,CIGNA HEALTHCARE,CIGNA PPO,68.39,,,,,,,42.3300,164.0000,percent of total billed charges,41.7% of $164.00 in Billed Charges for Rev 270 = $68.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG TRANSFUSION AUTO CHEST EA,270,RC,27000094,CDM,,,,,,both,,,164.0000,24.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,147.60,,,,,,,42.3300,164.0000,percent of total billed charges,90% of $164.00 in Billed Charges for Rev 270 = $147.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG TRANSFUSION AUTO CHEST EA,270,RC,27000094,CDM,,,,,,both,,,164.0000,24.6000,MEDCOST,MEDCOST VHN,78.05,,,,,,,42.3300,164.0000,percent of total billed charges,47.59% of $164.00 in Billed Charges for Rev 270 = $78.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG TRANSFUSION AUTO CHEST EA,270,RC,27000094,CDM,,,,,,both,,,164.0000,24.6000,SENTARA HEALTH,SENTARA HEALTH,42.33,,,,,,,42.3300,164.0000,percent of total billed charges,25.81% of $164.00 in Billed Charges for Rev 270 = $42.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG TRANSFUSION AUTO CHEST EA,270,RC,27000094,CDM,,,,,,both,,,164.0000,24.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",164.00,,,,,,,42.3300,164.0000,percent of total billed charges,100% of $164.00 in Billed Charges for Rev 270 = $164.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG TRANSFUSION AUTO CHEST EA,270,RC,27000094,CDM,,,,,,both,,,164.0000,24.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,82.00,,,,,,,42.3300,164.0000,percent of total billed charges,Rev 270 $164.00 in Billed Charges at 50% = $82.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG TRANSFUSION AUTO CHEST EA,270,RC,27000094,CDM,,,,,,both,,,164.0000,24.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,52.97,,,,,,,42.3300,164.0000,other,32.3% of $164.00 in Billed Charges for Rev 270 = $52.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BAG TRANSFUSION AUTO CHEST EA,270,RC,27000094,CDM,,,,,,both,,,164.0000,24.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,50.35,,,,,,,42.3300,164.0000,other,30.7% of $164.00 in Billed Charges for Rev 270 = $50.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BAG TRANSFUSION AUTO CHEST EA,270,RC,27000094,CDM,,,,,,both,,,164.0000,24.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,52.97,,,,,,,42.3300,164.0000,percent of total billed charges,32.3% of $164.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG TRANSFUSION AUTO CHEST EA,270,RC,27000094,CDM,,,,,,both,,,164.0000,24.6000,WELLCARE,WELLCARE MEDICAID,164.00,,,,,,,42.3300,164.0000,percent of total billed charges,100% of $164.00 in Billed Charges for Rev 270 = $164.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAL SENS 7F FO IAB CATH 34CC,278,RC,27800072,CDM,,,,,,both,,,2880.0000,432.0000,AETNA,AETNA,1382.40,,,,,,,743.3300,2880.0000,percent of total billed charges,"48% of $2,880.00 in Billed Charges for Rev 278 = $1,382.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BAL SENS 7F FO IAB CATH 34CC,278,RC,27800072,CDM,,,,,,both,,,2880.0000,432.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1440.00,,,,,,,743.3300,2880.0000,percent of total billed charges,"50% of $2,880.00 in Billed Charges for Rev 278 = $1,440.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BAL SENS 7F FO IAB CATH 34CC,278,RC,27800072,CDM,,,,,,both,,,2880.0000,432.0000,CIGNA HEALTHCARE,CIGNA HMO,1200.96,,,,,,,743.3300,2880.0000,percent of total billed charges,"41.7% of $2,880.00 in Billed Charges for Rev 278 = $1,200.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BAL SENS 7F FO IAB CATH 34CC,278,RC,27800072,CDM,,,,,,both,,,2880.0000,432.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1152.00,,,,,,,743.3300,2880.0000,percent of total billed charges,"40% of $2,880.00 in Billed Charges for Rev 278 = $1,152.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BAL SENS 7F FO IAB CATH 34CC,278,RC,27800072,CDM,,,,,,both,,,2880.0000,432.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1200.96,,,,,,,743.3300,2880.0000,percent of total billed charges,"41.7% of $2,880.00 in Billed Charges for Rev 278 = $1,200.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BAL SENS 7F FO IAB CATH 34CC,278,RC,27800072,CDM,,,,,,both,,,2880.0000,432.0000,CIGNA HEALTHCARE,CIGNA PPO,1200.96,,,,,,,743.3300,2880.0000,percent of total billed charges,"41.7% of $2,880.00 in Billed Charges for Rev 278 = $1,200.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BAL SENS 7F FO IAB CATH 34CC,278,RC,27800072,CDM,,,,,,both,,,2880.0000,432.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2592.00,,,,,,,743.3300,2880.0000,percent of total billed charges,"90% of $2,880.00 in Billed Charges for Rev 278 = $2,592.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BAL SENS 7F FO IAB CATH 34CC,278,RC,27800072,CDM,,,,,,both,,,2880.0000,432.0000,MEDCOST,MEDCOST VHN,1370.59,,,,,,,743.3300,2880.0000,percent of total billed charges,"47.59% of $2,880.00 in Billed Charges for Rev 278 = $1,370.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BAL SENS 7F FO IAB CATH 34CC,278,RC,27800072,CDM,,,,,,both,,,2880.0000,432.0000,SENTARA HEALTH,SENTARA HEALTH,743.33,,,,,,,743.3300,2880.0000,percent of total billed charges,"25.81% of $2,880.00 in Billed Charges for Rev 278 = $743.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BAL SENS 7F FO IAB CATH 34CC,278,RC,27800072,CDM,,,,,,both,,,2880.0000,432.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2880.00,,,,,,,743.3300,2880.0000,percent of total billed charges,"100% of $2,880.00 in Billed Charges for Rev 278 = $2,880.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BAL SENS 7F FO IAB CATH 34CC,278,RC,27800072,CDM,,,,,,both,,,2880.0000,432.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1440.00,,,,,,,743.3300,2880.0000,percent of total billed charges,"Rev 278 $2,880.00 in Billed Charges at 50% = $1,440.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BAL SENS 7F FO IAB CATH 34CC,278,RC,27800072,CDM,,,,,,both,,,2880.0000,432.0000,WELLCARE,WELLCARE MEDICAID,2880.00,,,,,,,743.3300,2880.0000,percent of total billed charges,"100% of $2,880.00 in Billed Charges for Rev 278 = $2,880.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"HC BANDAGE ACE 6"" STRL AVID",272,RC,27200120,CDM,,,,,,both,,,41.0000,6.1500,AETNA,AETNA,17.51,,,,,,,10.5800,41.0000,percent of total billed charges,42.7% of $41.00 in Billed Charges for Rev 272 = $17.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC BANDAGE ACE 6"" STRL AVID",272,RC,27200120,CDM,,,,,,both,,,41.0000,6.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,28.70,,,,,,,10.5800,41.0000,percent of total billed charges,Rev 272 $41.00 in Billed Charges at 70% = $28.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC BANDAGE ACE 6"" STRL AVID",272,RC,27200120,CDM,,,,,,both,,,41.0000,6.1500,CIGNA HEALTHCARE,CIGNA HMO,17.10,,,,,,,10.5800,41.0000,percent of total billed charges,41.7% of $41.00 in Billed Charges for Rev 272 = $17.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC BANDAGE ACE 6"" STRL AVID",272,RC,27200120,CDM,,,,,,both,,,41.0000,6.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,19.02,,,,,,,10.5800,41.0000,percent of total billed charges,46.4% of $41.00 in Billed Charges for Rev 272 = $19.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC BANDAGE ACE 6"" STRL AVID",272,RC,27200120,CDM,,,,,,both,,,41.0000,6.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,17.10,,,,,,,10.5800,41.0000,percent of total billed charges,41.7% of $41.00 in Billed Charges for Rev 272 = $17.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC BANDAGE ACE 6"" STRL AVID",272,RC,27200120,CDM,,,,,,both,,,41.0000,6.1500,CIGNA HEALTHCARE,CIGNA PPO,17.10,,,,,,,10.5800,41.0000,percent of total billed charges,41.7% of $41.00 in Billed Charges for Rev 272 = $17.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC BANDAGE ACE 6"" STRL AVID",272,RC,27200120,CDM,,,,,,both,,,41.0000,6.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,36.90,,,,,,,10.5800,41.0000,percent of total billed charges,90% of $41.00 in Billed Charges for Rev 272 = $36.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC BANDAGE ACE 6"" STRL AVID",272,RC,27200120,CDM,,,,,,both,,,41.0000,6.1500,MEDCOST,MEDCOST VHN,19.51,,,,,,,10.5800,41.0000,percent of total billed charges,47.59% of $41.00 in Billed Charges for Rev 272 = $19.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC BANDAGE ACE 6"" STRL AVID",272,RC,27200120,CDM,,,,,,both,,,41.0000,6.1500,SENTARA HEALTH,SENTARA HEALTH,10.58,,,,,,,10.5800,41.0000,percent of total billed charges,25.81% of $41.00 in Billed Charges for Rev 272 = $10.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC BANDAGE ACE 6"" STRL AVID",272,RC,27200120,CDM,,,,,,both,,,41.0000,6.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",41.00,,,,,,,10.5800,41.0000,percent of total billed charges,100% of $41.00 in Billed Charges for Rev 272 = $41.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC BANDAGE ACE 6"" STRL AVID",272,RC,27200120,CDM,,,,,,both,,,41.0000,6.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,20.50,,,,,,,10.5800,41.0000,percent of total billed charges,Rev 272 $41.00 in Billed Charges at 50% = $20.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC BANDAGE ACE 6"" STRL AVID",272,RC,27200120,CDM,,,,,,both,,,41.0000,6.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13.24,,,,,,,10.5800,41.0000,other,32.3% of $41.00 in Billed Charges for Rev 272 = $13.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
"HC BANDAGE ACE 6"" STRL AVID",272,RC,27200120,CDM,,,,,,both,,,41.0000,6.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,12.59,,,,,,,10.5800,41.0000,other,30.7% of $41.00 in Billed Charges for Rev 272 = $12.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
"HC BANDAGE ACE 6"" STRL AVID",272,RC,27200120,CDM,,,,,,both,,,41.0000,6.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,13.24,,,,,,,10.5800,41.0000,percent of total billed charges,32.3% of $41.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC BANDAGE ACE 6"" STRL AVID",272,RC,27200120,CDM,,,,,,both,,,41.0000,6.1500,WELLCARE,WELLCARE MEDICAID,41.00,,,,,,,10.5800,41.0000,percent of total billed charges,100% of $41.00 in Billed Charges for Rev 272 = $41.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BARRIER SKIN W FLANGE,272,RC,27200123,CDM,,,,,,both,,,25.0000,3.7500,AETNA,AETNA,10.68,,,,,,,6.4500,25.0000,percent of total billed charges,42.7% of $25.00 in Billed Charges for Rev 272 = $10.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BARRIER SKIN W FLANGE,272,RC,27200123,CDM,,,,,,both,,,25.0000,3.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,17.50,,,,,,,6.4500,25.0000,percent of total billed charges,Rev 272 $25.00 in Billed Charges at 70% = $17.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BARRIER SKIN W FLANGE,272,RC,27200123,CDM,,,,,,both,,,25.0000,3.7500,CIGNA HEALTHCARE,CIGNA HMO,10.43,,,,,,,6.4500,25.0000,percent of total billed charges,41.7% of $25.00 in Billed Charges for Rev 272 = $10.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BARRIER SKIN W FLANGE,272,RC,27200123,CDM,,,,,,both,,,25.0000,3.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11.60,,,,,,,6.4500,25.0000,percent of total billed charges,46.4% of $25.00 in Billed Charges for Rev 272 = $11.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BARRIER SKIN W FLANGE,272,RC,27200123,CDM,,,,,,both,,,25.0000,3.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,10.43,,,,,,,6.4500,25.0000,percent of total billed charges,41.7% of $25.00 in Billed Charges for Rev 272 = $10.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BARRIER SKIN W FLANGE,272,RC,27200123,CDM,,,,,,both,,,25.0000,3.7500,CIGNA HEALTHCARE,CIGNA PPO,10.43,,,,,,,6.4500,25.0000,percent of total billed charges,41.7% of $25.00 in Billed Charges for Rev 272 = $10.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BARRIER SKIN W FLANGE,272,RC,27200123,CDM,,,,,,both,,,25.0000,3.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,22.50,,,,,,,6.4500,25.0000,percent of total billed charges,90% of $25.00 in Billed Charges for Rev 272 = $22.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BARRIER SKIN W FLANGE,272,RC,27200123,CDM,,,,,,both,,,25.0000,3.7500,MEDCOST,MEDCOST VHN,11.90,,,,,,,6.4500,25.0000,percent of total billed charges,47.59% of $25.00 in Billed Charges for Rev 272 = $11.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BARRIER SKIN W FLANGE,272,RC,27200123,CDM,,,,,,both,,,25.0000,3.7500,SENTARA HEALTH,SENTARA HEALTH,6.45,,,,,,,6.4500,25.0000,percent of total billed charges,25.81% of $25.00 in Billed Charges for Rev 272 = $6.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BARRIER SKIN W FLANGE,272,RC,27200123,CDM,,,,,,both,,,25.0000,3.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",25.00,,,,,,,6.4500,25.0000,percent of total billed charges,100% of $25.00 in Billed Charges for Rev 272 = $25.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BARRIER SKIN W FLANGE,272,RC,27200123,CDM,,,,,,both,,,25.0000,3.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,12.50,,,,,,,6.4500,25.0000,percent of total billed charges,Rev 272 $25.00 in Billed Charges at 50% = $12.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BARRIER SKIN W FLANGE,272,RC,27200123,CDM,,,,,,both,,,25.0000,3.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,8.08,,,,,,,6.4500,25.0000,other,32.3% of $25.00 in Billed Charges for Rev 272 = $8.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BARRIER SKIN W FLANGE,272,RC,27200123,CDM,,,,,,both,,,25.0000,3.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7.68,,,,,,,6.4500,25.0000,other,30.7% of $25.00 in Billed Charges for Rev 272 = $7.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BARRIER SKIN W FLANGE,272,RC,27200123,CDM,,,,,,both,,,25.0000,3.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,8.08,,,,,,,6.4500,25.0000,percent of total billed charges,32.3% of $25.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BARRIER SKIN W FLANGE,272,RC,27200123,CDM,,,,,,both,,,25.0000,3.7500,WELLCARE,WELLCARE MEDICAID,25.00,,,,,,,6.4500,25.0000,percent of total billed charges,100% of $25.00 in Billed Charges for Rev 272 = $25.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BASKET RETRIEVAL FG57D,272,RC,27200124,CDM,,,,,,both,,,1103.0000,165.4500,AETNA,AETNA,470.98,,,,,,,284.6800,1103.0000,percent of total billed charges,"42.7% of $1,103.00 in Billed Charges for Rev 272 = $470.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BASKET RETRIEVAL FG57D,272,RC,27200124,CDM,,,,,,both,,,1103.0000,165.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,772.10,,,,,,,284.6800,1103.0000,percent of total billed charges,"Rev 272 $1,103.00 in Billed Charges at 70% = $772.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BASKET RETRIEVAL FG57D,272,RC,27200124,CDM,,,,,,both,,,1103.0000,165.4500,CIGNA HEALTHCARE,CIGNA HMO,459.95,,,,,,,284.6800,1103.0000,percent of total billed charges,"41.7% of $1,103.00 in Billed Charges for Rev 272 = $459.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BASKET RETRIEVAL FG57D,272,RC,27200124,CDM,,,,,,both,,,1103.0000,165.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,511.79,,,,,,,284.6800,1103.0000,percent of total billed charges,"46.4% of $1,103.00 in Billed Charges for Rev 272 = $511.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BASKET RETRIEVAL FG57D,272,RC,27200124,CDM,,,,,,both,,,1103.0000,165.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,459.95,,,,,,,284.6800,1103.0000,percent of total billed charges,"41.7% of $1,103.00 in Billed Charges for Rev 272 = $459.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BASKET RETRIEVAL FG57D,272,RC,27200124,CDM,,,,,,both,,,1103.0000,165.4500,CIGNA HEALTHCARE,CIGNA PPO,459.95,,,,,,,284.6800,1103.0000,percent of total billed charges,"41.7% of $1,103.00 in Billed Charges for Rev 272 = $459.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BASKET RETRIEVAL FG57D,272,RC,27200124,CDM,,,,,,both,,,1103.0000,165.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,992.70,,,,,,,284.6800,1103.0000,percent of total billed charges,"90% of $1,103.00 in Billed Charges for Rev 272 = $992.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BASKET RETRIEVAL FG57D,272,RC,27200124,CDM,,,,,,both,,,1103.0000,165.4500,MEDCOST,MEDCOST VHN,524.92,,,,,,,284.6800,1103.0000,percent of total billed charges,"47.59% of $1,103.00 in Billed Charges for Rev 272 = $524.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BASKET RETRIEVAL FG57D,272,RC,27200124,CDM,,,,,,both,,,1103.0000,165.4500,SENTARA HEALTH,SENTARA HEALTH,284.68,,,,,,,284.6800,1103.0000,percent of total billed charges,"25.81% of $1,103.00 in Billed Charges for Rev 272 = $284.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BASKET RETRIEVAL FG57D,272,RC,27200124,CDM,,,,,,both,,,1103.0000,165.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1103.00,,,,,,,284.6800,1103.0000,percent of total billed charges,"100% of $1,103.00 in Billed Charges for Rev 272 = $1,103.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BASKET RETRIEVAL FG57D,272,RC,27200124,CDM,,,,,,both,,,1103.0000,165.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,551.50,,,,,,,284.6800,1103.0000,percent of total billed charges,"Rev 272 $1,103.00 in Billed Charges at 50% = $551.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BASKET RETRIEVAL FG57D,272,RC,27200124,CDM,,,,,,both,,,1103.0000,165.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,356.27,,,,,,,284.6800,1103.0000,other,"32.3% of $1,103.00 in Billed Charges for Rev 272 = $356.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BASKET RETRIEVAL FG57D,272,RC,27200124,CDM,,,,,,both,,,1103.0000,165.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,338.62,,,,,,,284.6800,1103.0000,other,"30.7% of $1,103.00 in Billed Charges for Rev 272 = $338.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BASKET RETRIEVAL FG57D,272,RC,27200124,CDM,,,,,,both,,,1103.0000,165.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,356.27,,,,,,,284.6800,1103.0000,percent of total billed charges,"32.3% of $1,103.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BASKET RETRIEVAL FG57D,272,RC,27200124,CDM,,,,,,both,,,1103.0000,165.4500,WELLCARE,WELLCARE MEDICAID,1103.00,,,,,,,284.6800,1103.0000,percent of total billed charges,"100% of $1,103.00 in Billed Charges for Rev 272 = $1,103.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BELT RIB FEMALE,270,RC,27000139,CDM,,,,,,both,,,42.0000,6.3000,AETNA,AETNA,17.93,,,,,,,10.8400,42.0000,percent of total billed charges,42.7% of $42.00 in Billed Charges for Rev 270 = $17.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB FEMALE,270,RC,27000139,CDM,,,,,,both,,,42.0000,6.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,29.40,,,,,,,10.8400,42.0000,percent of total billed charges,Rev 270 $42.00 in Billed Charges at 70% = $29.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB FEMALE,270,RC,27000139,CDM,,,,,,both,,,42.0000,6.3000,CIGNA HEALTHCARE,CIGNA HMO,17.51,,,,,,,10.8400,42.0000,percent of total billed charges,41.7% of $42.00 in Billed Charges for Rev 270 = $17.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB FEMALE,270,RC,27000139,CDM,,,,,,both,,,42.0000,6.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,19.49,,,,,,,10.8400,42.0000,percent of total billed charges,46.4% of $42.00 in Billed Charges for Rev 270 = $19.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB FEMALE,270,RC,27000139,CDM,,,,,,both,,,42.0000,6.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,17.51,,,,,,,10.8400,42.0000,percent of total billed charges,41.7% of $42.00 in Billed Charges for Rev 270 = $17.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB FEMALE,270,RC,27000139,CDM,,,,,,both,,,42.0000,6.3000,CIGNA HEALTHCARE,CIGNA PPO,17.51,,,,,,,10.8400,42.0000,percent of total billed charges,41.7% of $42.00 in Billed Charges for Rev 270 = $17.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB FEMALE,270,RC,27000139,CDM,,,,,,both,,,42.0000,6.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,37.80,,,,,,,10.8400,42.0000,percent of total billed charges,90% of $42.00 in Billed Charges for Rev 270 = $37.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB FEMALE,270,RC,27000139,CDM,,,,,,both,,,42.0000,6.3000,MEDCOST,MEDCOST VHN,19.99,,,,,,,10.8400,42.0000,percent of total billed charges,47.59% of $42.00 in Billed Charges for Rev 270 = $19.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB FEMALE,270,RC,27000139,CDM,,,,,,both,,,42.0000,6.3000,SENTARA HEALTH,SENTARA HEALTH,10.84,,,,,,,10.8400,42.0000,percent of total billed charges,25.81% of $42.00 in Billed Charges for Rev 270 = $10.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB FEMALE,270,RC,27000139,CDM,,,,,,both,,,42.0000,6.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",42.00,,,,,,,10.8400,42.0000,percent of total billed charges,100% of $42.00 in Billed Charges for Rev 270 = $42.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB FEMALE,270,RC,27000139,CDM,,,,,,both,,,42.0000,6.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,21.00,,,,,,,10.8400,42.0000,percent of total billed charges,Rev 270 $42.00 in Billed Charges at 50% = $21.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB FEMALE,270,RC,27000139,CDM,,,,,,both,,,42.0000,6.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13.57,,,,,,,10.8400,42.0000,other,32.3% of $42.00 in Billed Charges for Rev 270 = $13.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BELT RIB FEMALE,270,RC,27000139,CDM,,,,,,both,,,42.0000,6.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,12.89,,,,,,,10.8400,42.0000,other,30.7% of $42.00 in Billed Charges for Rev 270 = $12.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BELT RIB FEMALE,270,RC,27000139,CDM,,,,,,both,,,42.0000,6.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,13.57,,,,,,,10.8400,42.0000,percent of total billed charges,32.3% of $42.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB FEMALE,270,RC,27000139,CDM,,,,,,both,,,42.0000,6.3000,WELLCARE,WELLCARE MEDICAID,42.00,,,,,,,10.8400,42.0000,percent of total billed charges,100% of $42.00 in Billed Charges for Rev 270 = $42.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING KIT V.A.C. PEEL AND PLACE LARGE,272,RC,27202320,CDM,,,,,,both,,,1334.0000,200.1000,AETNA,AETNA,569.62,,,,,,,344.3100,1334.0000,percent of total billed charges,"42.7% of $1,334.00 in Billed Charges for Rev 272 = $569.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE LARGE,272,RC,27202320,CDM,,,,,,both,,,1334.0000,200.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,933.80,,,,,,,344.3100,1334.0000,percent of total billed charges,"Rev 272 $1,334.00 in Billed Charges at 70% = $933.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE LARGE,272,RC,27202320,CDM,,,,,,both,,,1334.0000,200.1000,CIGNA HEALTHCARE,CIGNA HMO,556.28,,,,,,,344.3100,1334.0000,percent of total billed charges,"41.7% of $1,334.00 in Billed Charges for Rev 272 = $556.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE LARGE,272,RC,27202320,CDM,,,,,,both,,,1334.0000,200.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,618.98,,,,,,,344.3100,1334.0000,percent of total billed charges,"46.4% of $1,334.00 in Billed Charges for Rev 272 = $618.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE LARGE,272,RC,27202320,CDM,,,,,,both,,,1334.0000,200.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,556.28,,,,,,,344.3100,1334.0000,percent of total billed charges,"41.7% of $1,334.00 in Billed Charges for Rev 272 = $556.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE LARGE,272,RC,27202320,CDM,,,,,,both,,,1334.0000,200.1000,CIGNA HEALTHCARE,CIGNA PPO,556.28,,,,,,,344.3100,1334.0000,percent of total billed charges,"41.7% of $1,334.00 in Billed Charges for Rev 272 = $556.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE LARGE,272,RC,27202320,CDM,,,,,,both,,,1334.0000,200.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1200.60,,,,,,,344.3100,1334.0000,percent of total billed charges,"90% of $1,334.00 in Billed Charges for Rev 272 = $1,200.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE LARGE,272,RC,27202320,CDM,,,,,,both,,,1334.0000,200.1000,MEDCOST,MEDCOST VHN,634.85,,,,,,,344.3100,1334.0000,percent of total billed charges,"47.59% of $1,334.00 in Billed Charges for Rev 272 = $634.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE LARGE,272,RC,27202320,CDM,,,,,,both,,,1334.0000,200.1000,SENTARA HEALTH,SENTARA HEALTH,344.31,,,,,,,344.3100,1334.0000,percent of total billed charges,"25.81% of $1,334.00 in Billed Charges for Rev 272 = $344.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE LARGE,272,RC,27202320,CDM,,,,,,both,,,1334.0000,200.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1334.00,,,,,,,344.3100,1334.0000,percent of total billed charges,"100% of $1,334.00 in Billed Charges for Rev 272 = $1,334.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE LARGE,272,RC,27202320,CDM,,,,,,both,,,1334.0000,200.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,667.00,,,,,,,344.3100,1334.0000,percent of total billed charges,"Rev 272 $1,334.00 in Billed Charges at 50% = $667.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE LARGE,272,RC,27202320,CDM,,,,,,both,,,1334.0000,200.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,430.88,,,,,,,344.3100,1334.0000,other,"32.3% of $1,334.00 in Billed Charges for Rev 272 = $430.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DRESSING KIT V.A.C. PEEL AND PLACE LARGE,272,RC,27202320,CDM,,,,,,both,,,1334.0000,200.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,409.54,,,,,,,344.3100,1334.0000,other,"30.7% of $1,334.00 in Billed Charges for Rev 272 = $409.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DRESSING KIT V.A.C. PEEL AND PLACE LARGE,272,RC,27202320,CDM,,,,,,both,,,1334.0000,200.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,430.88,,,,,,,344.3100,1334.0000,percent of total billed charges,"32.3% of $1,334.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE LARGE,272,RC,27202320,CDM,,,,,,both,,,1334.0000,200.1000,WELLCARE,WELLCARE MEDICAID,1334.00,,,,,,,344.3100,1334.0000,percent of total billed charges,"100% of $1,334.00 in Billed Charges for Rev 272 = $1,334.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE MEDIUM,272,RC,27202321,CDM,,,,,,both,,,1106.0000,165.9000,AETNA,AETNA,472.26,,,,,,,285.4600,1106.0000,percent of total billed charges,"42.7% of $1,106.00 in Billed Charges for Rev 272 = $472.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE MEDIUM,272,RC,27202321,CDM,,,,,,both,,,1106.0000,165.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,774.20,,,,,,,285.4600,1106.0000,percent of total billed charges,"Rev 272 $1,106.00 in Billed Charges at 70% = $774.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE MEDIUM,272,RC,27202321,CDM,,,,,,both,,,1106.0000,165.9000,CIGNA HEALTHCARE,CIGNA HMO,461.20,,,,,,,285.4600,1106.0000,percent of total billed charges,"41.7% of $1,106.00 in Billed Charges for Rev 272 = $461.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE MEDIUM,272,RC,27202321,CDM,,,,,,both,,,1106.0000,165.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,513.18,,,,,,,285.4600,1106.0000,percent of total billed charges,"46.4% of $1,106.00 in Billed Charges for Rev 272 = $513.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE MEDIUM,272,RC,27202321,CDM,,,,,,both,,,1106.0000,165.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,461.20,,,,,,,285.4600,1106.0000,percent of total billed charges,"41.7% of $1,106.00 in Billed Charges for Rev 272 = $461.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE MEDIUM,272,RC,27202321,CDM,,,,,,both,,,1106.0000,165.9000,CIGNA HEALTHCARE,CIGNA PPO,461.20,,,,,,,285.4600,1106.0000,percent of total billed charges,"41.7% of $1,106.00 in Billed Charges for Rev 272 = $461.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE MEDIUM,272,RC,27202321,CDM,,,,,,both,,,1106.0000,165.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,995.40,,,,,,,285.4600,1106.0000,percent of total billed charges,"90% of $1,106.00 in Billed Charges for Rev 272 = $995.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE MEDIUM,272,RC,27202321,CDM,,,,,,both,,,1106.0000,165.9000,MEDCOST,MEDCOST VHN,526.35,,,,,,,285.4600,1106.0000,percent of total billed charges,"47.59% of $1,106.00 in Billed Charges for Rev 272 = $526.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE MEDIUM,272,RC,27202321,CDM,,,,,,both,,,1106.0000,165.9000,SENTARA HEALTH,SENTARA HEALTH,285.46,,,,,,,285.4600,1106.0000,percent of total billed charges,"25.81% of $1,106.00 in Billed Charges for Rev 272 = $285.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE MEDIUM,272,RC,27202321,CDM,,,,,,both,,,1106.0000,165.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1106.00,,,,,,,285.4600,1106.0000,percent of total billed charges,"100% of $1,106.00 in Billed Charges for Rev 272 = $1,106.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE MEDIUM,272,RC,27202321,CDM,,,,,,both,,,1106.0000,165.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,553.00,,,,,,,285.4600,1106.0000,percent of total billed charges,"Rev 272 $1,106.00 in Billed Charges at 50% = $553.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE MEDIUM,272,RC,27202321,CDM,,,,,,both,,,1106.0000,165.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,357.24,,,,,,,285.4600,1106.0000,other,"32.3% of $1,106.00 in Billed Charges for Rev 272 = $357.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DRESSING KIT V.A.C. PEEL AND PLACE MEDIUM,272,RC,27202321,CDM,,,,,,both,,,1106.0000,165.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,339.54,,,,,,,285.4600,1106.0000,other,"30.7% of $1,106.00 in Billed Charges for Rev 272 = $339.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DRESSING KIT V.A.C. PEEL AND PLACE MEDIUM,272,RC,27202321,CDM,,,,,,both,,,1106.0000,165.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,357.24,,,,,,,285.4600,1106.0000,percent of total billed charges,"32.3% of $1,106.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING KIT V.A.C. PEEL AND PLACE MEDIUM,272,RC,27202321,CDM,,,,,,both,,,1106.0000,165.9000,WELLCARE,WELLCARE MEDICAID,1106.00,,,,,,,285.4600,1106.0000,percent of total billed charges,"100% of $1,106.00 in Billed Charges for Rev 272 = $1,106.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE BX TEMNO COAXIAL,272,RC,27200958,CDM,,,,,,both,,,301.0000,45.1500,AETNA,AETNA,128.53,,,,,,,77.6900,301.0000,percent of total billed charges,42.7% of $301.00 in Billed Charges for Rev 272 = $128.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TEMNO COAXIAL,272,RC,27200958,CDM,,,,,,both,,,301.0000,45.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,210.70,,,,,,,77.6900,301.0000,percent of total billed charges,Rev 272 $301.00 in Billed Charges at 70% = $210.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TEMNO COAXIAL,272,RC,27200958,CDM,,,,,,both,,,301.0000,45.1500,CIGNA HEALTHCARE,CIGNA HMO,125.52,,,,,,,77.6900,301.0000,percent of total billed charges,41.7% of $301.00 in Billed Charges for Rev 272 = $125.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TEMNO COAXIAL,272,RC,27200958,CDM,,,,,,both,,,301.0000,45.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,139.66,,,,,,,77.6900,301.0000,percent of total billed charges,46.4% of $301.00 in Billed Charges for Rev 272 = $139.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TEMNO COAXIAL,272,RC,27200958,CDM,,,,,,both,,,301.0000,45.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,125.52,,,,,,,77.6900,301.0000,percent of total billed charges,41.7% of $301.00 in Billed Charges for Rev 272 = $125.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TEMNO COAXIAL,272,RC,27200958,CDM,,,,,,both,,,301.0000,45.1500,CIGNA HEALTHCARE,CIGNA PPO,125.52,,,,,,,77.6900,301.0000,percent of total billed charges,41.7% of $301.00 in Billed Charges for Rev 272 = $125.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TEMNO COAXIAL,272,RC,27200958,CDM,,,,,,both,,,301.0000,45.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,270.90,,,,,,,77.6900,301.0000,percent of total billed charges,90% of $301.00 in Billed Charges for Rev 272 = $270.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TEMNO COAXIAL,272,RC,27200958,CDM,,,,,,both,,,301.0000,45.1500,MEDCOST,MEDCOST VHN,143.25,,,,,,,77.6900,301.0000,percent of total billed charges,47.59% of $301.00 in Billed Charges for Rev 272 = $143.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TEMNO COAXIAL,272,RC,27200958,CDM,,,,,,both,,,301.0000,45.1500,SENTARA HEALTH,SENTARA HEALTH,77.69,,,,,,,77.6900,301.0000,percent of total billed charges,25.81% of $301.00 in Billed Charges for Rev 272 = $77.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TEMNO COAXIAL,272,RC,27200958,CDM,,,,,,both,,,301.0000,45.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",301.00,,,,,,,77.6900,301.0000,percent of total billed charges,100% of $301.00 in Billed Charges for Rev 272 = $301.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TEMNO COAXIAL,272,RC,27200958,CDM,,,,,,both,,,301.0000,45.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,150.50,,,,,,,77.6900,301.0000,percent of total billed charges,Rev 272 $301.00 in Billed Charges at 50% = $150.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TEMNO COAXIAL,272,RC,27200958,CDM,,,,,,both,,,301.0000,45.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,97.22,,,,,,,77.6900,301.0000,other,32.3% of $301.00 in Billed Charges for Rev 272 = $97.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE BX TEMNO COAXIAL,272,RC,27200958,CDM,,,,,,both,,,301.0000,45.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,92.41,,,,,,,77.6900,301.0000,other,30.7% of $301.00 in Billed Charges for Rev 272 = $92.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE BX TEMNO COAXIAL,272,RC,27200958,CDM,,,,,,both,,,301.0000,45.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,97.22,,,,,,,77.6900,301.0000,percent of total billed charges,32.3% of $301.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE BX TEMNO COAXIAL,272,RC,27200958,CDM,,,,,,both,,,301.0000,45.1500,WELLCARE,WELLCARE MEDICAID,301.00,,,,,,,77.6900,301.0000,percent of total billed charges,100% of $301.00 in Billed Charges for Rev 272 = $301.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE COAXIAL ACH 14GX11CM,272,RC,27200962,CDM,,,,,,both,,,234.0000,35.1000,AETNA,AETNA,99.92,,,,,,,60.4000,234.0000,percent of total billed charges,42.7% of $234.00 in Billed Charges for Rev 272 = $99.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE COAXIAL ACH 14GX11CM,272,RC,27200962,CDM,,,,,,both,,,234.0000,35.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,163.80,,,,,,,60.4000,234.0000,percent of total billed charges,Rev 272 $234.00 in Billed Charges at 70% = $163.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE COAXIAL ACH 14GX11CM,272,RC,27200962,CDM,,,,,,both,,,234.0000,35.1000,CIGNA HEALTHCARE,CIGNA HMO,97.58,,,,,,,60.4000,234.0000,percent of total billed charges,41.7% of $234.00 in Billed Charges for Rev 272 = $97.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE COAXIAL ACH 14GX11CM,272,RC,27200962,CDM,,,,,,both,,,234.0000,35.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,108.58,,,,,,,60.4000,234.0000,percent of total billed charges,46.4% of $234.00 in Billed Charges for Rev 272 = $108.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE COAXIAL ACH 14GX11CM,272,RC,27200962,CDM,,,,,,both,,,234.0000,35.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,97.58,,,,,,,60.4000,234.0000,percent of total billed charges,41.7% of $234.00 in Billed Charges for Rev 272 = $97.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE COAXIAL ACH 14GX11CM,272,RC,27200962,CDM,,,,,,both,,,234.0000,35.1000,CIGNA HEALTHCARE,CIGNA PPO,97.58,,,,,,,60.4000,234.0000,percent of total billed charges,41.7% of $234.00 in Billed Charges for Rev 272 = $97.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE COAXIAL ACH 14GX11CM,272,RC,27200962,CDM,,,,,,both,,,234.0000,35.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,210.60,,,,,,,60.4000,234.0000,percent of total billed charges,90% of $234.00 in Billed Charges for Rev 272 = $210.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE COAXIAL ACH 14GX11CM,272,RC,27200962,CDM,,,,,,both,,,234.0000,35.1000,MEDCOST,MEDCOST VHN,111.36,,,,,,,60.4000,234.0000,percent of total billed charges,47.59% of $234.00 in Billed Charges for Rev 272 = $111.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE COAXIAL ACH 14GX11CM,272,RC,27200962,CDM,,,,,,both,,,234.0000,35.1000,SENTARA HEALTH,SENTARA HEALTH,60.40,,,,,,,60.4000,234.0000,percent of total billed charges,25.81% of $234.00 in Billed Charges for Rev 272 = $60.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE COAXIAL ACH 14GX11CM,272,RC,27200962,CDM,,,,,,both,,,234.0000,35.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",234.00,,,,,,,60.4000,234.0000,percent of total billed charges,100% of $234.00 in Billed Charges for Rev 272 = $234.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE COAXIAL ACH 14GX11CM,272,RC,27200962,CDM,,,,,,both,,,234.0000,35.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,117.00,,,,,,,60.4000,234.0000,percent of total billed charges,Rev 272 $234.00 in Billed Charges at 50% = $117.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE COAXIAL ACH 14GX11CM,272,RC,27200962,CDM,,,,,,both,,,234.0000,35.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,75.58,,,,,,,60.4000,234.0000,other,32.3% of $234.00 in Billed Charges for Rev 272 = $75.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE COAXIAL ACH 14GX11CM,272,RC,27200962,CDM,,,,,,both,,,234.0000,35.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,71.84,,,,,,,60.4000,234.0000,other,30.7% of $234.00 in Billed Charges for Rev 272 = $71.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE COAXIAL ACH 14GX11CM,272,RC,27200962,CDM,,,,,,both,,,234.0000,35.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,75.58,,,,,,,60.4000,234.0000,percent of total billed charges,32.3% of $234.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE COAXIAL ACH 14GX11CM,272,RC,27200962,CDM,,,,,,both,,,234.0000,35.1000,WELLCARE,WELLCARE MEDICAID,234.00,,,,,,,60.4000,234.0000,percent of total billed charges,100% of $234.00 in Billed Charges for Rev 272 = $234.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INSUFFLATION 120CM C2201,272,RC,27200963,CDM,,,,,,both,,,88.0000,13.2000,AETNA,AETNA,37.58,,,,,,,22.7100,88.0000,percent of total billed charges,42.7% of $88.00 in Billed Charges for Rev 272 = $37.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INSUFFLATION 120CM C2201,272,RC,27200963,CDM,,,,,,both,,,88.0000,13.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,61.60,,,,,,,22.7100,88.0000,percent of total billed charges,Rev 272 $88.00 in Billed Charges at 70% = $61.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INSUFFLATION 120CM C2201,272,RC,27200963,CDM,,,,,,both,,,88.0000,13.2000,CIGNA HEALTHCARE,CIGNA HMO,36.70,,,,,,,22.7100,88.0000,percent of total billed charges,41.7% of $88.00 in Billed Charges for Rev 272 = $36.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INSUFFLATION 120CM C2201,272,RC,27200963,CDM,,,,,,both,,,88.0000,13.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,40.83,,,,,,,22.7100,88.0000,percent of total billed charges,46.4% of $88.00 in Billed Charges for Rev 272 = $40.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INSUFFLATION 120CM C2201,272,RC,27200963,CDM,,,,,,both,,,88.0000,13.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,36.70,,,,,,,22.7100,88.0000,percent of total billed charges,41.7% of $88.00 in Billed Charges for Rev 272 = $36.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INSUFFLATION 120CM C2201,272,RC,27200963,CDM,,,,,,both,,,88.0000,13.2000,CIGNA HEALTHCARE,CIGNA PPO,36.70,,,,,,,22.7100,88.0000,percent of total billed charges,41.7% of $88.00 in Billed Charges for Rev 272 = $36.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INSUFFLATION 120CM C2201,272,RC,27200963,CDM,,,,,,both,,,88.0000,13.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,79.20,,,,,,,22.7100,88.0000,percent of total billed charges,90% of $88.00 in Billed Charges for Rev 272 = $79.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INSUFFLATION 120CM C2201,272,RC,27200963,CDM,,,,,,both,,,88.0000,13.2000,MEDCOST,MEDCOST VHN,41.88,,,,,,,22.7100,88.0000,percent of total billed charges,47.59% of $88.00 in Billed Charges for Rev 272 = $41.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INSUFFLATION 120CM C2201,272,RC,27200963,CDM,,,,,,both,,,88.0000,13.2000,SENTARA HEALTH,SENTARA HEALTH,22.71,,,,,,,22.7100,88.0000,percent of total billed charges,25.81% of $88.00 in Billed Charges for Rev 272 = $22.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INSUFFLATION 120CM C2201,272,RC,27200963,CDM,,,,,,both,,,88.0000,13.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",88.00,,,,,,,22.7100,88.0000,percent of total billed charges,100% of $88.00 in Billed Charges for Rev 272 = $88.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INSUFFLATION 120CM C2201,272,RC,27200963,CDM,,,,,,both,,,88.0000,13.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,44.00,,,,,,,22.7100,88.0000,percent of total billed charges,Rev 272 $88.00 in Billed Charges at 50% = $44.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INSUFFLATION 120CM C2201,272,RC,27200963,CDM,,,,,,both,,,88.0000,13.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,28.42,,,,,,,22.7100,88.0000,other,32.3% of $88.00 in Billed Charges for Rev 272 = $28.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE INSUFFLATION 120CM C2201,272,RC,27200963,CDM,,,,,,both,,,88.0000,13.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,27.02,,,,,,,22.7100,88.0000,other,30.7% of $88.00 in Billed Charges for Rev 272 = $27.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE INSUFFLATION 120CM C2201,272,RC,27200963,CDM,,,,,,both,,,88.0000,13.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,28.42,,,,,,,22.7100,88.0000,percent of total billed charges,32.3% of $88.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE INSUFFLATION 120CM C2201,272,RC,27200963,CDM,,,,,,both,,,88.0000,13.2000,WELLCARE,WELLCARE MEDICAID,88.00,,,,,,,22.7100,88.0000,percent of total billed charges,100% of $88.00 in Billed Charges for Rev 272 = $88.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE KYPHO ALL BX,272,RC,27200965,CDM,,,,,,both,,,569.0000,85.3500,AETNA,AETNA,242.96,,,,,,,146.8600,569.0000,percent of total billed charges,42.7% of $569.00 in Billed Charges for Rev 272 = $242.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE KYPHO ALL BX,272,RC,27200965,CDM,,,,,,both,,,569.0000,85.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,398.30,,,,,,,146.8600,569.0000,percent of total billed charges,Rev 272 $569.00 in Billed Charges at 70% = $398.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE KYPHO ALL BX,272,RC,27200965,CDM,,,,,,both,,,569.0000,85.3500,CIGNA HEALTHCARE,CIGNA HMO,237.27,,,,,,,146.8600,569.0000,percent of total billed charges,41.7% of $569.00 in Billed Charges for Rev 272 = $237.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE KYPHO ALL BX,272,RC,27200965,CDM,,,,,,both,,,569.0000,85.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,264.02,,,,,,,146.8600,569.0000,percent of total billed charges,46.4% of $569.00 in Billed Charges for Rev 272 = $264.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE KYPHO ALL BX,272,RC,27200965,CDM,,,,,,both,,,569.0000,85.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,237.27,,,,,,,146.8600,569.0000,percent of total billed charges,41.7% of $569.00 in Billed Charges for Rev 272 = $237.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE KYPHO ALL BX,272,RC,27200965,CDM,,,,,,both,,,569.0000,85.3500,CIGNA HEALTHCARE,CIGNA PPO,237.27,,,,,,,146.8600,569.0000,percent of total billed charges,41.7% of $569.00 in Billed Charges for Rev 272 = $237.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE KYPHO ALL BX,272,RC,27200965,CDM,,,,,,both,,,569.0000,85.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,512.10,,,,,,,146.8600,569.0000,percent of total billed charges,90% of $569.00 in Billed Charges for Rev 272 = $512.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE KYPHO ALL BX,272,RC,27200965,CDM,,,,,,both,,,569.0000,85.3500,MEDCOST,MEDCOST VHN,270.79,,,,,,,146.8600,569.0000,percent of total billed charges,47.59% of $569.00 in Billed Charges for Rev 272 = $270.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE KYPHO ALL BX,272,RC,27200965,CDM,,,,,,both,,,569.0000,85.3500,SENTARA HEALTH,SENTARA HEALTH,146.86,,,,,,,146.8600,569.0000,percent of total billed charges,25.81% of $569.00 in Billed Charges for Rev 272 = $146.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE KYPHO ALL BX,272,RC,27200965,CDM,,,,,,both,,,569.0000,85.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",569.00,,,,,,,146.8600,569.0000,percent of total billed charges,100% of $569.00 in Billed Charges for Rev 272 = $569.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE KYPHO ALL BX,272,RC,27200965,CDM,,,,,,both,,,569.0000,85.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,284.50,,,,,,,146.8600,569.0000,percent of total billed charges,Rev 272 $569.00 in Billed Charges at 50% = $284.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE KYPHO ALL BX,272,RC,27200965,CDM,,,,,,both,,,569.0000,85.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,183.79,,,,,,,146.8600,569.0000,other,32.3% of $569.00 in Billed Charges for Rev 272 = $183.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE KYPHO ALL BX,272,RC,27200965,CDM,,,,,,both,,,569.0000,85.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,174.68,,,,,,,146.8600,569.0000,other,30.7% of $569.00 in Billed Charges for Rev 272 = $174.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE KYPHO ALL BX,272,RC,27200965,CDM,,,,,,both,,,569.0000,85.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,183.79,,,,,,,146.8600,569.0000,percent of total billed charges,32.3% of $569.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE KYPHO ALL BX,272,RC,27200965,CDM,,,,,,both,,,569.0000,85.3500,WELLCARE,WELLCARE MEDICAID,569.00,,,,,,,146.8600,569.0000,percent of total billed charges,100% of $569.00 in Billed Charges for Rev 272 = $569.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE MAMMOTOME BX 11GA,272,RC,27200967,CDM,,,,,,both,,,841.0000,126.1500,AETNA,AETNA,359.11,,,,,,,217.0600,841.0000,percent of total billed charges,42.7% of $841.00 in Billed Charges for Rev 272 = $359.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE MAMMOTOME BX 11GA,272,RC,27200967,CDM,,,,,,both,,,841.0000,126.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,588.70,,,,,,,217.0600,841.0000,percent of total billed charges,Rev 272 $841.00 in Billed Charges at 70% = $588.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE MAMMOTOME BX 11GA,272,RC,27200967,CDM,,,,,,both,,,841.0000,126.1500,CIGNA HEALTHCARE,CIGNA HMO,350.70,,,,,,,217.0600,841.0000,percent of total billed charges,41.7% of $841.00 in Billed Charges for Rev 272 = $350.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE MAMMOTOME BX 11GA,272,RC,27200967,CDM,,,,,,both,,,841.0000,126.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,390.22,,,,,,,217.0600,841.0000,percent of total billed charges,46.4% of $841.00 in Billed Charges for Rev 272 = $390.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE MAMMOTOME BX 11GA,272,RC,27200967,CDM,,,,,,both,,,841.0000,126.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,350.70,,,,,,,217.0600,841.0000,percent of total billed charges,41.7% of $841.00 in Billed Charges for Rev 272 = $350.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE MAMMOTOME BX 11GA,272,RC,27200967,CDM,,,,,,both,,,841.0000,126.1500,CIGNA HEALTHCARE,CIGNA PPO,350.70,,,,,,,217.0600,841.0000,percent of total billed charges,41.7% of $841.00 in Billed Charges for Rev 272 = $350.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE MAMMOTOME BX 11GA,272,RC,27200967,CDM,,,,,,both,,,841.0000,126.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,756.90,,,,,,,217.0600,841.0000,percent of total billed charges,90% of $841.00 in Billed Charges for Rev 272 = $756.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE MAMMOTOME BX 11GA,272,RC,27200967,CDM,,,,,,both,,,841.0000,126.1500,MEDCOST,MEDCOST VHN,400.23,,,,,,,217.0600,841.0000,percent of total billed charges,47.59% of $841.00 in Billed Charges for Rev 272 = $400.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE MAMMOTOME BX 11GA,272,RC,27200967,CDM,,,,,,both,,,841.0000,126.1500,SENTARA HEALTH,SENTARA HEALTH,217.06,,,,,,,217.0600,841.0000,percent of total billed charges,25.81% of $841.00 in Billed Charges for Rev 272 = $217.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE MAMMOTOME BX 11GA,272,RC,27200967,CDM,,,,,,both,,,841.0000,126.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",841.00,,,,,,,217.0600,841.0000,percent of total billed charges,100% of $841.00 in Billed Charges for Rev 272 = $841.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE MAMMOTOME BX 11GA,272,RC,27200967,CDM,,,,,,both,,,841.0000,126.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,420.50,,,,,,,217.0600,841.0000,percent of total billed charges,Rev 272 $841.00 in Billed Charges at 50% = $420.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE MAMMOTOME BX 11GA,272,RC,27200967,CDM,,,,,,both,,,841.0000,126.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,271.64,,,,,,,217.0600,841.0000,other,32.3% of $841.00 in Billed Charges for Rev 272 = $271.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE MAMMOTOME BX 11GA,272,RC,27200967,CDM,,,,,,both,,,841.0000,126.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,258.19,,,,,,,217.0600,841.0000,other,30.7% of $841.00 in Billed Charges for Rev 272 = $258.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE MAMMOTOME BX 11GA,272,RC,27200967,CDM,,,,,,both,,,841.0000,126.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,271.64,,,,,,,217.0600,841.0000,percent of total billed charges,32.3% of $841.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE MAMMOTOME BX 11GA,272,RC,27200967,CDM,,,,,,both,,,841.0000,126.1500,WELLCARE,WELLCARE MEDICAID,841.00,,,,,,,217.0600,841.0000,percent of total billed charges,100% of $841.00 in Billed Charges for Rev 272 = $841.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE TEMNO BX 20/15,272,RC,27200968,CDM,,,,,,both,,,218.0000,32.7000,AETNA,AETNA,93.09,,,,,,,56.2700,218.0000,percent of total billed charges,42.7% of $218.00 in Billed Charges for Rev 272 = $93.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE TEMNO BX 20/15,272,RC,27200968,CDM,,,,,,both,,,218.0000,32.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,152.60,,,,,,,56.2700,218.0000,percent of total billed charges,Rev 272 $218.00 in Billed Charges at 70% = $152.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE TEMNO BX 20/15,272,RC,27200968,CDM,,,,,,both,,,218.0000,32.7000,CIGNA HEALTHCARE,CIGNA HMO,90.91,,,,,,,56.2700,218.0000,percent of total billed charges,41.7% of $218.00 in Billed Charges for Rev 272 = $90.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE TEMNO BX 20/15,272,RC,27200968,CDM,,,,,,both,,,218.0000,32.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,101.15,,,,,,,56.2700,218.0000,percent of total billed charges,46.4% of $218.00 in Billed Charges for Rev 272 = $101.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE TEMNO BX 20/15,272,RC,27200968,CDM,,,,,,both,,,218.0000,32.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,90.91,,,,,,,56.2700,218.0000,percent of total billed charges,41.7% of $218.00 in Billed Charges for Rev 272 = $90.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE TEMNO BX 20/15,272,RC,27200968,CDM,,,,,,both,,,218.0000,32.7000,CIGNA HEALTHCARE,CIGNA PPO,90.91,,,,,,,56.2700,218.0000,percent of total billed charges,41.7% of $218.00 in Billed Charges for Rev 272 = $90.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE TEMNO BX 20/15,272,RC,27200968,CDM,,,,,,both,,,218.0000,32.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,196.20,,,,,,,56.2700,218.0000,percent of total billed charges,90% of $218.00 in Billed Charges for Rev 272 = $196.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE TEMNO BX 20/15,272,RC,27200968,CDM,,,,,,both,,,218.0000,32.7000,MEDCOST,MEDCOST VHN,103.75,,,,,,,56.2700,218.0000,percent of total billed charges,47.59% of $218.00 in Billed Charges for Rev 272 = $103.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE TEMNO BX 20/15,272,RC,27200968,CDM,,,,,,both,,,218.0000,32.7000,SENTARA HEALTH,SENTARA HEALTH,56.27,,,,,,,56.2700,218.0000,percent of total billed charges,25.81% of $218.00 in Billed Charges for Rev 272 = $56.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE TEMNO BX 20/15,272,RC,27200968,CDM,,,,,,both,,,218.0000,32.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",218.00,,,,,,,56.2700,218.0000,percent of total billed charges,100% of $218.00 in Billed Charges for Rev 272 = $218.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE TEMNO BX 20/15,272,RC,27200968,CDM,,,,,,both,,,218.0000,32.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,56.2700,218.0000,percent of total billed charges,Rev 272 $218.00 in Billed Charges at 50% = $109.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE TEMNO BX 20/15,272,RC,27200968,CDM,,,,,,both,,,218.0000,32.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,70.41,,,,,,,56.2700,218.0000,other,32.3% of $218.00 in Billed Charges for Rev 272 = $70.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE TEMNO BX 20/15,272,RC,27200968,CDM,,,,,,both,,,218.0000,32.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,66.93,,,,,,,56.2700,218.0000,other,30.7% of $218.00 in Billed Charges for Rev 272 = $66.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEEDLE TEMNO BX 20/15,272,RC,27200968,CDM,,,,,,both,,,218.0000,32.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,70.41,,,,,,,56.2700,218.0000,percent of total billed charges,32.3% of $218.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE TEMNO BX 20/15,272,RC,27200968,CDM,,,,,,both,,,218.0000,32.7000,WELLCARE,WELLCARE MEDICAID,218.00,,,,,,,56.2700,218.0000,percent of total billed charges,100% of $218.00 in Billed Charges for Rev 272 = $218.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEEDLE TRANSSEPTAL ALL SIZES,272,RC,27200970,CDM,,,,,,both,,,1086.0000,162.9000,AETNA,AETNA,463.72,,,,,,,280.3000,1086.0000,percent of total billed charges,"42.7% of $1,086.00 in Billed Charges for Rev 272 = $463.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE TRANSSEPTAL ALL SIZES,272,RC,27200970,CDM,,,,,,both,,,1086.0000,162.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,760.20,,,,,,,280.3000,1086.0000,percent of total billed charges,"Rev 272 $1,086.00 in Billed Charges at 70% = $760.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE TRANSSEPTAL ALL SIZES,272,RC,27200970,CDM,,,,,,both,,,1086.0000,162.9000,CIGNA HEALTHCARE,CIGNA HMO,452.86,,,,,,,280.3000,1086.0000,percent of total billed charges,"41.7% of $1,086.00 in Billed Charges for Rev 272 = $452.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE TRANSSEPTAL ALL SIZES,272,RC,27200970,CDM,,,,,,both,,,1086.0000,162.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,503.90,,,,,,,280.3000,1086.0000,percent of total billed charges,"46.4% of $1,086.00 in Billed Charges for Rev 272 = $503.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE TRANSSEPTAL ALL SIZES,272,RC,27200970,CDM,,,,,,both,,,1086.0000,162.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,452.86,,,,,,,280.3000,1086.0000,percent of total billed charges,"41.7% of $1,086.00 in Billed Charges for Rev 272 = $452.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE TRANSSEPTAL ALL SIZES,272,RC,27200970,CDM,,,,,,both,,,1086.0000,162.9000,CIGNA HEALTHCARE,CIGNA PPO,452.86,,,,,,,280.3000,1086.0000,percent of total billed charges,"41.7% of $1,086.00 in Billed Charges for Rev 272 = $452.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE TRANSSEPTAL ALL SIZES,272,RC,27200970,CDM,,,,,,both,,,1086.0000,162.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,977.40,,,,,,,280.3000,1086.0000,percent of total billed charges,"90% of $1,086.00 in Billed Charges for Rev 272 = $977.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE TRANSSEPTAL ALL SIZES,272,RC,27200970,CDM,,,,,,both,,,1086.0000,162.9000,MEDCOST,MEDCOST VHN,516.83,,,,,,,280.3000,1086.0000,percent of total billed charges,"47.59% of $1,086.00 in Billed Charges for Rev 272 = $516.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE TRANSSEPTAL ALL SIZES,272,RC,27200970,CDM,,,,,,both,,,1086.0000,162.9000,SENTARA HEALTH,SENTARA HEALTH,280.30,,,,,,,280.3000,1086.0000,percent of total billed charges,"25.81% of $1,086.00 in Billed Charges for Rev 272 = $280.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE TRANSSEPTAL ALL SIZES,272,RC,27200970,CDM,,,,,,both,,,1086.0000,162.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1086.00,,,,,,,280.3000,1086.0000,percent of total billed charges,"100% of $1,086.00 in Billed Charges for Rev 272 = $1,086.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE TRANSSEPTAL ALL SIZES,272,RC,27200970,CDM,,,,,,both,,,1086.0000,162.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,543.00,,,,,,,280.3000,1086.0000,percent of total billed charges,"Rev 272 $1,086.00 in Billed Charges at 50% = $543.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE TRANSSEPTAL ALL SIZES,272,RC,27200970,CDM,,,,,,both,,,1086.0000,162.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,350.78,,,,,,,280.3000,1086.0000,other,"32.3% of $1,086.00 in Billed Charges for Rev 272 = $350.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NEEDLE TRANSSEPTAL ALL SIZES,272,RC,27200970,CDM,,,,,,both,,,1086.0000,162.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,333.40,,,,,,,280.3000,1086.0000,other,"30.7% of $1,086.00 in Billed Charges for Rev 272 = $333.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NEEDLE TRANSSEPTAL ALL SIZES,272,RC,27200970,CDM,,,,,,both,,,1086.0000,162.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,350.78,,,,,,,280.3000,1086.0000,percent of total billed charges,"32.3% of $1,086.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEEDLE TRANSSEPTAL ALL SIZES,272,RC,27200970,CDM,,,,,,both,,,1086.0000,162.9000,WELLCARE,WELLCARE MEDICAID,1086.00,,,,,,,280.3000,1086.0000,percent of total billed charges,"100% of $1,086.00 in Billed Charges for Rev 272 = $1,086.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 70 ML,272,RC,27202034,CDM,,,,,,both,,,1804.0000,270.6000,AETNA,AETNA,770.31,,,,,,,465.6100,1804.0000,percent of total billed charges,"42.7% of $1,804.00 in Billed Charges for Rev 272 = $770.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 70 ML,272,RC,27202034,CDM,,,,,,both,,,1804.0000,270.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1262.80,,,,,,,465.6100,1804.0000,percent of total billed charges,"Rev 272 $1,804.00 in Billed Charges at 70% = $1,262.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 70 ML,272,RC,27202034,CDM,,,,,,both,,,1804.0000,270.6000,CIGNA HEALTHCARE,CIGNA HMO,752.27,,,,,,,465.6100,1804.0000,percent of total billed charges,"41.7% of $1,804.00 in Billed Charges for Rev 272 = $752.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 70 ML,272,RC,27202034,CDM,,,,,,both,,,1804.0000,270.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,837.06,,,,,,,465.6100,1804.0000,percent of total billed charges,"46.4% of $1,804.00 in Billed Charges for Rev 272 = $837.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 70 ML,272,RC,27202034,CDM,,,,,,both,,,1804.0000,270.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,752.27,,,,,,,465.6100,1804.0000,percent of total billed charges,"41.7% of $1,804.00 in Billed Charges for Rev 272 = $752.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 70 ML,272,RC,27202034,CDM,,,,,,both,,,1804.0000,270.6000,CIGNA HEALTHCARE,CIGNA PPO,752.27,,,,,,,465.6100,1804.0000,percent of total billed charges,"41.7% of $1,804.00 in Billed Charges for Rev 272 = $752.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 70 ML,272,RC,27202034,CDM,,,,,,both,,,1804.0000,270.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1623.60,,,,,,,465.6100,1804.0000,percent of total billed charges,"90% of $1,804.00 in Billed Charges for Rev 272 = $1,623.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 70 ML,272,RC,27202034,CDM,,,,,,both,,,1804.0000,270.6000,MEDCOST,MEDCOST VHN,858.52,,,,,,,465.6100,1804.0000,percent of total billed charges,"47.59% of $1,804.00 in Billed Charges for Rev 272 = $858.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 70 ML,272,RC,27202034,CDM,,,,,,both,,,1804.0000,270.6000,SENTARA HEALTH,SENTARA HEALTH,465.61,,,,,,,465.6100,1804.0000,percent of total billed charges,"25.81% of $1,804.00 in Billed Charges for Rev 272 = $465.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 70 ML,272,RC,27202034,CDM,,,,,,both,,,1804.0000,270.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1804.00,,,,,,,465.6100,1804.0000,percent of total billed charges,"100% of $1,804.00 in Billed Charges for Rev 272 = $1,804.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 70 ML,272,RC,27202034,CDM,,,,,,both,,,1804.0000,270.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,902.00,,,,,,,465.6100,1804.0000,percent of total billed charges,"Rev 272 $1,804.00 in Billed Charges at 50% = $902.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 70 ML,272,RC,27202034,CDM,,,,,,both,,,1804.0000,270.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,582.69,,,,,,,465.6100,1804.0000,other,"32.3% of $1,804.00 in Billed Charges for Rev 272 = $582.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NELLIX POLYMER CARTRIDGE 70 ML,272,RC,27202034,CDM,,,,,,both,,,1804.0000,270.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,553.83,,,,,,,465.6100,1804.0000,other,"30.7% of $1,804.00 in Billed Charges for Rev 272 = $553.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NELLIX POLYMER CARTRIDGE 70 ML,272,RC,27202034,CDM,,,,,,both,,,1804.0000,270.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,582.69,,,,,,,465.6100,1804.0000,percent of total billed charges,"32.3% of $1,804.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NELLIX POLYMER CARTRIDGE 70 ML,272,RC,27202034,CDM,,,,,,both,,,1804.0000,270.6000,WELLCARE,WELLCARE MEDICAID,1804.00,,,,,,,465.6100,1804.0000,percent of total billed charges,"100% of $1,804.00 in Billed Charges for Rev 272 = $1,804.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEURO OLM INTERCRANIAL,272,RC,27200972,CDM,,,,,,both,,,1602.0000,240.3000,AETNA,AETNA,684.05,,,,,,,413.4800,1602.0000,percent of total billed charges,"42.7% of $1,602.00 in Billed Charges for Rev 272 = $684.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEURO OLM INTERCRANIAL,272,RC,27200972,CDM,,,,,,both,,,1602.0000,240.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1121.40,,,,,,,413.4800,1602.0000,percent of total billed charges,"Rev 272 $1,602.00 in Billed Charges at 70% = $1,121.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEURO OLM INTERCRANIAL,272,RC,27200972,CDM,,,,,,both,,,1602.0000,240.3000,CIGNA HEALTHCARE,CIGNA HMO,668.03,,,,,,,413.4800,1602.0000,percent of total billed charges,"41.7% of $1,602.00 in Billed Charges for Rev 272 = $668.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEURO OLM INTERCRANIAL,272,RC,27200972,CDM,,,,,,both,,,1602.0000,240.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,743.33,,,,,,,413.4800,1602.0000,percent of total billed charges,"46.4% of $1,602.00 in Billed Charges for Rev 272 = $743.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEURO OLM INTERCRANIAL,272,RC,27200972,CDM,,,,,,both,,,1602.0000,240.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,668.03,,,,,,,413.4800,1602.0000,percent of total billed charges,"41.7% of $1,602.00 in Billed Charges for Rev 272 = $668.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEURO OLM INTERCRANIAL,272,RC,27200972,CDM,,,,,,both,,,1602.0000,240.3000,CIGNA HEALTHCARE,CIGNA PPO,668.03,,,,,,,413.4800,1602.0000,percent of total billed charges,"41.7% of $1,602.00 in Billed Charges for Rev 272 = $668.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEURO OLM INTERCRANIAL,272,RC,27200972,CDM,,,,,,both,,,1602.0000,240.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1441.80,,,,,,,413.4800,1602.0000,percent of total billed charges,"90% of $1,602.00 in Billed Charges for Rev 272 = $1,441.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEURO OLM INTERCRANIAL,272,RC,27200972,CDM,,,,,,both,,,1602.0000,240.3000,MEDCOST,MEDCOST VHN,762.39,,,,,,,413.4800,1602.0000,percent of total billed charges,"47.59% of $1,602.00 in Billed Charges for Rev 272 = $762.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEURO OLM INTERCRANIAL,272,RC,27200972,CDM,,,,,,both,,,1602.0000,240.3000,SENTARA HEALTH,SENTARA HEALTH,413.48,,,,,,,413.4800,1602.0000,percent of total billed charges,"25.81% of $1,602.00 in Billed Charges for Rev 272 = $413.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEURO OLM INTERCRANIAL,272,RC,27200972,CDM,,,,,,both,,,1602.0000,240.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1602.00,,,,,,,413.4800,1602.0000,percent of total billed charges,"100% of $1,602.00 in Billed Charges for Rev 272 = $1,602.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEURO OLM INTERCRANIAL,272,RC,27200972,CDM,,,,,,both,,,1602.0000,240.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,801.00,,,,,,,413.4800,1602.0000,percent of total billed charges,"Rev 272 $1,602.00 in Billed Charges at 50% = $801.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEURO OLM INTERCRANIAL,272,RC,27200972,CDM,,,,,,both,,,1602.0000,240.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,517.45,,,,,,,413.4800,1602.0000,other,"32.3% of $1,602.00 in Billed Charges for Rev 272 = $517.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NEURO OLM INTERCRANIAL,272,RC,27200972,CDM,,,,,,both,,,1602.0000,240.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,491.81,,,,,,,413.4800,1602.0000,other,"30.7% of $1,602.00 in Billed Charges for Rev 272 = $491.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NEURO OLM INTERCRANIAL,272,RC,27200972,CDM,,,,,,both,,,1602.0000,240.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,517.45,,,,,,,413.4800,1602.0000,percent of total billed charges,"32.3% of $1,602.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEURO OLM INTERCRANIAL,272,RC,27200972,CDM,,,,,,both,,,1602.0000,240.3000,WELLCARE,WELLCARE MEDICAID,1602.00,,,,,,,413.4800,1602.0000,percent of total billed charges,"100% of $1,602.00 in Billed Charges for Rev 272 = $1,602.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP ALGEA NEEDLE BIOPSY KYPHO,272,RC,27201373,CDM,,,,,,both,,,492.0000,73.8000,AETNA,AETNA,210.08,,,,,,,126.9900,492.0000,percent of total billed charges,42.7% of $492.00 in Billed Charges for Rev 272 = $210.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA NEEDLE BIOPSY KYPHO,272,RC,27201373,CDM,,,,,,both,,,492.0000,73.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,344.40,,,,,,,126.9900,492.0000,percent of total billed charges,Rev 272 $492.00 in Billed Charges at 70% = $344.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA NEEDLE BIOPSY KYPHO,272,RC,27201373,CDM,,,,,,both,,,492.0000,73.8000,CIGNA HEALTHCARE,CIGNA HMO,205.16,,,,,,,126.9900,492.0000,percent of total billed charges,41.7% of $492.00 in Billed Charges for Rev 272 = $205.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA NEEDLE BIOPSY KYPHO,272,RC,27201373,CDM,,,,,,both,,,492.0000,73.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,228.29,,,,,,,126.9900,492.0000,percent of total billed charges,46.4% of $492.00 in Billed Charges for Rev 272 = $228.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA NEEDLE BIOPSY KYPHO,272,RC,27201373,CDM,,,,,,both,,,492.0000,73.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,205.16,,,,,,,126.9900,492.0000,percent of total billed charges,41.7% of $492.00 in Billed Charges for Rev 272 = $205.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA NEEDLE BIOPSY KYPHO,272,RC,27201373,CDM,,,,,,both,,,492.0000,73.8000,CIGNA HEALTHCARE,CIGNA PPO,205.16,,,,,,,126.9900,492.0000,percent of total billed charges,41.7% of $492.00 in Billed Charges for Rev 272 = $205.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA NEEDLE BIOPSY KYPHO,272,RC,27201373,CDM,,,,,,both,,,492.0000,73.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,442.80,,,,,,,126.9900,492.0000,percent of total billed charges,90% of $492.00 in Billed Charges for Rev 272 = $442.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA NEEDLE BIOPSY KYPHO,272,RC,27201373,CDM,,,,,,both,,,492.0000,73.8000,MEDCOST,MEDCOST VHN,234.14,,,,,,,126.9900,492.0000,percent of total billed charges,47.59% of $492.00 in Billed Charges for Rev 272 = $234.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA NEEDLE BIOPSY KYPHO,272,RC,27201373,CDM,,,,,,both,,,492.0000,73.8000,SENTARA HEALTH,SENTARA HEALTH,126.99,,,,,,,126.9900,492.0000,percent of total billed charges,25.81% of $492.00 in Billed Charges for Rev 272 = $126.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA NEEDLE BIOPSY KYPHO,272,RC,27201373,CDM,,,,,,both,,,492.0000,73.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",492.00,,,,,,,126.9900,492.0000,percent of total billed charges,100% of $492.00 in Billed Charges for Rev 272 = $492.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA NEEDLE BIOPSY KYPHO,272,RC,27201373,CDM,,,,,,both,,,492.0000,73.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,246.00,,,,,,,126.9900,492.0000,percent of total billed charges,Rev 272 $492.00 in Billed Charges at 50% = $246.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA NEEDLE BIOPSY KYPHO,272,RC,27201373,CDM,,,,,,both,,,492.0000,73.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,158.92,,,,,,,126.9900,492.0000,other,32.3% of $492.00 in Billed Charges for Rev 272 = $158.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NSP ALGEA NEEDLE BIOPSY KYPHO,272,RC,27201373,CDM,,,,,,both,,,492.0000,73.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,151.04,,,,,,,126.9900,492.0000,other,30.7% of $492.00 in Billed Charges for Rev 272 = $151.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NSP ALGEA NEEDLE BIOPSY KYPHO,272,RC,27201373,CDM,,,,,,both,,,492.0000,73.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,158.92,,,,,,,126.9900,492.0000,percent of total billed charges,32.3% of $492.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA NEEDLE BIOPSY KYPHO,272,RC,27201373,CDM,,,,,,both,,,492.0000,73.8000,WELLCARE,WELLCARE MEDICAID,492.00,,,,,,,126.9900,492.0000,percent of total billed charges,100% of $492.00 in Billed Charges for Rev 272 = $492.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP ALGEA PACK FILLER KYPHO,272,RC,27201375,CDM,,,,,,both,,,2426.0000,363.9000,AETNA,AETNA,1035.90,,,,,,,626.1500,2426.0000,percent of total billed charges,"42.7% of $2,426.00 in Billed Charges for Rev 272 = $1,035.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP ALGEA PACK FILLER KYPHO,272,RC,27201375,CDM,,,,,,both,,,2426.0000,363.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1698.20,,,,,,,626.1500,2426.0000,percent of total billed charges,"Rev 272 $2,426.00 in Billed Charges at 70% = $1,698.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP ALGEA PACK FILLER KYPHO,272,RC,27201375,CDM,,,,,,both,,,2426.0000,363.9000,CIGNA HEALTHCARE,CIGNA HMO,1011.64,,,,,,,626.1500,2426.0000,percent of total billed charges,"41.7% of $2,426.00 in Billed Charges for Rev 272 = $1,011.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP ALGEA PACK FILLER KYPHO,272,RC,27201375,CDM,,,,,,both,,,2426.0000,363.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1125.66,,,,,,,626.1500,2426.0000,percent of total billed charges,"46.4% of $2,426.00 in Billed Charges for Rev 272 = $1,125.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP ALGEA PACK FILLER KYPHO,272,RC,27201375,CDM,,,,,,both,,,2426.0000,363.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1011.64,,,,,,,626.1500,2426.0000,percent of total billed charges,"41.7% of $2,426.00 in Billed Charges for Rev 272 = $1,011.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP ALGEA PACK FILLER KYPHO,272,RC,27201375,CDM,,,,,,both,,,2426.0000,363.9000,CIGNA HEALTHCARE,CIGNA PPO,1011.64,,,,,,,626.1500,2426.0000,percent of total billed charges,"41.7% of $2,426.00 in Billed Charges for Rev 272 = $1,011.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP ALGEA PACK FILLER KYPHO,272,RC,27201375,CDM,,,,,,both,,,2426.0000,363.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2183.40,,,,,,,626.1500,2426.0000,percent of total billed charges,"90% of $2,426.00 in Billed Charges for Rev 272 = $2,183.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP ALGEA PACK FILLER KYPHO,272,RC,27201375,CDM,,,,,,both,,,2426.0000,363.9000,MEDCOST,MEDCOST VHN,1154.53,,,,,,,626.1500,2426.0000,percent of total billed charges,"47.59% of $2,426.00 in Billed Charges for Rev 272 = $1,154.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP ALGEA PACK FILLER KYPHO,272,RC,27201375,CDM,,,,,,both,,,2426.0000,363.9000,SENTARA HEALTH,SENTARA HEALTH,626.15,,,,,,,626.1500,2426.0000,percent of total billed charges,"25.81% of $2,426.00 in Billed Charges for Rev 272 = $626.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP ALGEA PACK FILLER KYPHO,272,RC,27201375,CDM,,,,,,both,,,2426.0000,363.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2426.00,,,,,,,626.1500,2426.0000,percent of total billed charges,"100% of $2,426.00 in Billed Charges for Rev 272 = $2,426.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP ALGEA PACK FILLER KYPHO,272,RC,27201375,CDM,,,,,,both,,,2426.0000,363.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1213.00,,,,,,,626.1500,2426.0000,percent of total billed charges,"Rev 272 $2,426.00 in Billed Charges at 50% = $1,213.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP ALGEA PACK FILLER KYPHO,272,RC,27201375,CDM,,,,,,both,,,2426.0000,363.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,783.60,,,,,,,626.1500,2426.0000,other,"32.3% of $2,426.00 in Billed Charges for Rev 272 = $783.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NSP ALGEA PACK FILLER KYPHO,272,RC,27201375,CDM,,,,,,both,,,2426.0000,363.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,744.78,,,,,,,626.1500,2426.0000,other,"30.7% of $2,426.00 in Billed Charges for Rev 272 = $744.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NSP ALGEA PACK FILLER KYPHO,272,RC,27201375,CDM,,,,,,both,,,2426.0000,363.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,783.60,,,,,,,626.1500,2426.0000,percent of total billed charges,"32.3% of $2,426.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP ALGEA PACK FILLER KYPHO,272,RC,27201375,CDM,,,,,,both,,,2426.0000,363.9000,WELLCARE,WELLCARE MEDICAID,2426.00,,,,,,,626.1500,2426.0000,percent of total billed charges,"100% of $2,426.00 in Billed Charges for Rev 272 = $2,426.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRESSING MEPILEX AG 8X20IN FOA,272,RC,27202241,CDM,,,,,,both,,,605.0000,90.7500,AETNA,AETNA,258.34,,,,,,,156.1500,605.0000,percent of total billed charges,42.7% of $605.00 in Billed Charges for Rev 272 = $258.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING MEPILEX AG 8X20IN FOA,272,RC,27202241,CDM,,,,,,both,,,605.0000,90.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,423.50,,,,,,,156.1500,605.0000,percent of total billed charges,Rev 272 $605.00 in Billed Charges at 70% = $423.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING MEPILEX AG 8X20IN FOA,272,RC,27202241,CDM,,,,,,both,,,605.0000,90.7500,CIGNA HEALTHCARE,CIGNA HMO,252.29,,,,,,,156.1500,605.0000,percent of total billed charges,41.7% of $605.00 in Billed Charges for Rev 272 = $252.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING MEPILEX AG 8X20IN FOA,272,RC,27202241,CDM,,,,,,both,,,605.0000,90.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,280.72,,,,,,,156.1500,605.0000,percent of total billed charges,46.4% of $605.00 in Billed Charges for Rev 272 = $280.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING MEPILEX AG 8X20IN FOA,272,RC,27202241,CDM,,,,,,both,,,605.0000,90.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,252.29,,,,,,,156.1500,605.0000,percent of total billed charges,41.7% of $605.00 in Billed Charges for Rev 272 = $252.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING MEPILEX AG 8X20IN FOA,272,RC,27202241,CDM,,,,,,both,,,605.0000,90.7500,CIGNA HEALTHCARE,CIGNA PPO,252.29,,,,,,,156.1500,605.0000,percent of total billed charges,41.7% of $605.00 in Billed Charges for Rev 272 = $252.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING MEPILEX AG 8X20IN FOA,272,RC,27202241,CDM,,,,,,both,,,605.0000,90.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,544.50,,,,,,,156.1500,605.0000,percent of total billed charges,90% of $605.00 in Billed Charges for Rev 272 = $544.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING MEPILEX AG 8X20IN FOA,272,RC,27202241,CDM,,,,,,both,,,605.0000,90.7500,MEDCOST,MEDCOST VHN,287.92,,,,,,,156.1500,605.0000,percent of total billed charges,47.59% of $605.00 in Billed Charges for Rev 272 = $287.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING MEPILEX AG 8X20IN FOA,272,RC,27202241,CDM,,,,,,both,,,605.0000,90.7500,SENTARA HEALTH,SENTARA HEALTH,156.15,,,,,,,156.1500,605.0000,percent of total billed charges,25.81% of $605.00 in Billed Charges for Rev 272 = $156.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING MEPILEX AG 8X20IN FOA,272,RC,27202241,CDM,,,,,,both,,,605.0000,90.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",605.00,,,,,,,156.1500,605.0000,percent of total billed charges,100% of $605.00 in Billed Charges for Rev 272 = $605.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING MEPILEX AG 8X20IN FOA,272,RC,27202241,CDM,,,,,,both,,,605.0000,90.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,302.50,,,,,,,156.1500,605.0000,percent of total billed charges,Rev 272 $605.00 in Billed Charges at 50% = $302.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING MEPILEX AG 8X20IN FOA,272,RC,27202241,CDM,,,,,,both,,,605.0000,90.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,195.42,,,,,,,156.1500,605.0000,other,32.3% of $605.00 in Billed Charges for Rev 272 = $195.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING MEPILEX AG 8X20IN FOA,272,RC,27202241,CDM,,,,,,both,,,605.0000,90.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,185.74,,,,,,,156.1500,605.0000,other,30.7% of $605.00 in Billed Charges for Rev 272 = $185.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING MEPILEX AG 8X20IN FOA,272,RC,27202241,CDM,,,,,,both,,,605.0000,90.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,195.42,,,,,,,156.1500,605.0000,percent of total billed charges,32.3% of $605.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING MEPILEX AG 8X20IN FOA,272,RC,27202241,CDM,,,,,,both,,,605.0000,90.7500,WELLCARE,WELLCARE MEDICAID,605.00,,,,,,,156.1500,605.0000,percent of total billed charges,100% of $605.00 in Billed Charges for Rev 272 = $605.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING TRANS TEGADERM 4X10,272,RC,27200678,CDM,,,,,,both,,,8.0000,1.2000,AETNA,AETNA,3.42,,,,,,,2.0600,8.0000,percent of total billed charges,42.7% of $8.00 in Billed Charges for Rev 272 = $3.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING TRANS TEGADERM 4X10,272,RC,27200678,CDM,,,,,,both,,,8.0000,1.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5.60,,,,,,,2.0600,8.0000,percent of total billed charges,Rev 272 $8.00 in Billed Charges at 70% = $5.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING TRANS TEGADERM 4X10,272,RC,27200678,CDM,,,,,,both,,,8.0000,1.2000,CIGNA HEALTHCARE,CIGNA HMO,3.34,,,,,,,2.0600,8.0000,percent of total billed charges,41.7% of $8.00 in Billed Charges for Rev 272 = $3.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING TRANS TEGADERM 4X10,272,RC,27200678,CDM,,,,,,both,,,8.0000,1.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3.71,,,,,,,2.0600,8.0000,percent of total billed charges,46.4% of $8.00 in Billed Charges for Rev 272 = $3.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING TRANS TEGADERM 4X10,272,RC,27200678,CDM,,,,,,both,,,8.0000,1.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3.34,,,,,,,2.0600,8.0000,percent of total billed charges,41.7% of $8.00 in Billed Charges for Rev 272 = $3.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING TRANS TEGADERM 4X10,272,RC,27200678,CDM,,,,,,both,,,8.0000,1.2000,CIGNA HEALTHCARE,CIGNA PPO,3.34,,,,,,,2.0600,8.0000,percent of total billed charges,41.7% of $8.00 in Billed Charges for Rev 272 = $3.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING TRANS TEGADERM 4X10,272,RC,27200678,CDM,,,,,,both,,,8.0000,1.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7.20,,,,,,,2.0600,8.0000,percent of total billed charges,90% of $8.00 in Billed Charges for Rev 272 = $7.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING TRANS TEGADERM 4X10,272,RC,27200678,CDM,,,,,,both,,,8.0000,1.2000,MEDCOST,MEDCOST VHN,3.81,,,,,,,2.0600,8.0000,percent of total billed charges,47.59% of $8.00 in Billed Charges for Rev 272 = $3.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING TRANS TEGADERM 4X10,272,RC,27200678,CDM,,,,,,both,,,8.0000,1.2000,SENTARA HEALTH,SENTARA HEALTH,2.06,,,,,,,2.0600,8.0000,percent of total billed charges,25.81% of $8.00 in Billed Charges for Rev 272 = $2.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING TRANS TEGADERM 4X10,272,RC,27200678,CDM,,,,,,both,,,8.0000,1.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8.00,,,,,,,2.0600,8.0000,percent of total billed charges,100% of $8.00 in Billed Charges for Rev 272 = $8.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING TRANS TEGADERM 4X10,272,RC,27200678,CDM,,,,,,both,,,8.0000,1.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4.00,,,,,,,2.0600,8.0000,percent of total billed charges,Rev 272 $8.00 in Billed Charges at 50% = $4.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING TRANS TEGADERM 4X10,272,RC,27200678,CDM,,,,,,both,,,8.0000,1.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2.58,,,,,,,2.0600,8.0000,other,32.3% of $8.00 in Billed Charges for Rev 272 = $2.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING TRANS TEGADERM 4X10,272,RC,27200678,CDM,,,,,,both,,,8.0000,1.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2.46,,,,,,,2.0600,8.0000,other,30.7% of $8.00 in Billed Charges for Rev 272 = $2.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING TRANS TEGADERM 4X10,272,RC,27200678,CDM,,,,,,both,,,8.0000,1.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,2.58,,,,,,,2.0600,8.0000,percent of total billed charges,32.3% of $8.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING TRANS TEGADERM 4X10,272,RC,27200678,CDM,,,,,,both,,,8.0000,1.2000,WELLCARE,WELLCARE MEDICAID,8.00,,,,,,,2.0600,8.0000,percent of total billed charges,100% of $8.00 in Billed Charges for Rev 272 = $8.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EKOS ALL MACH 4,272,RC,27200680,CDM,,,,,,both,,,7789.0000,1168.3500,AETNA,AETNA,3325.90,,,,,,,2010.3400,7789.0000,percent of total billed charges,"42.7% of $7,789.00 in Billed Charges for Rev 272 = $3,325.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EKOS ALL MACH 4,272,RC,27200680,CDM,,,,,,both,,,7789.0000,1168.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5452.30,,,,,,,2010.3400,7789.0000,percent of total billed charges,"Rev 272 $7,789.00 in Billed Charges at 70% = $5,452.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EKOS ALL MACH 4,272,RC,27200680,CDM,,,,,,both,,,7789.0000,1168.3500,CIGNA HEALTHCARE,CIGNA HMO,3248.01,,,,,,,2010.3400,7789.0000,percent of total billed charges,"41.7% of $7,789.00 in Billed Charges for Rev 272 = $3,248.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EKOS ALL MACH 4,272,RC,27200680,CDM,,,,,,both,,,7789.0000,1168.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3614.10,,,,,,,2010.3400,7789.0000,percent of total billed charges,"46.4% of $7,789.00 in Billed Charges for Rev 272 = $3,614.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EKOS ALL MACH 4,272,RC,27200680,CDM,,,,,,both,,,7789.0000,1168.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3248.01,,,,,,,2010.3400,7789.0000,percent of total billed charges,"41.7% of $7,789.00 in Billed Charges for Rev 272 = $3,248.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EKOS ALL MACH 4,272,RC,27200680,CDM,,,,,,both,,,7789.0000,1168.3500,CIGNA HEALTHCARE,CIGNA PPO,3248.01,,,,,,,2010.3400,7789.0000,percent of total billed charges,"41.7% of $7,789.00 in Billed Charges for Rev 272 = $3,248.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EKOS ALL MACH 4,272,RC,27200680,CDM,,,,,,both,,,7789.0000,1168.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7010.10,,,,,,,2010.3400,7789.0000,percent of total billed charges,"90% of $7,789.00 in Billed Charges for Rev 272 = $7,010.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EKOS ALL MACH 4,272,RC,27200680,CDM,,,,,,both,,,7789.0000,1168.3500,MEDCOST,MEDCOST VHN,3706.79,,,,,,,2010.3400,7789.0000,percent of total billed charges,"47.59% of $7,789.00 in Billed Charges for Rev 272 = $3,706.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EKOS ALL MACH 4,272,RC,27200680,CDM,,,,,,both,,,7789.0000,1168.3500,SENTARA HEALTH,SENTARA HEALTH,2010.34,,,,,,,2010.3400,7789.0000,percent of total billed charges,"25.81% of $7,789.00 in Billed Charges for Rev 272 = $2,010.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EKOS ALL MACH 4,272,RC,27200680,CDM,,,,,,both,,,7789.0000,1168.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7789.00,,,,,,,2010.3400,7789.0000,percent of total billed charges,"100% of $7,789.00 in Billed Charges for Rev 272 = $7,789.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EKOS ALL MACH 4,272,RC,27200680,CDM,,,,,,both,,,7789.0000,1168.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3894.50,,,,,,,2010.3400,7789.0000,percent of total billed charges,"Rev 272 $7,789.00 in Billed Charges at 50% = $3,894.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EKOS ALL MACH 4,272,RC,27200680,CDM,,,,,,both,,,7789.0000,1168.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2515.85,,,,,,,2010.3400,7789.0000,other,"32.3% of $7,789.00 in Billed Charges for Rev 272 = $2,515.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EKOS ALL MACH 4,272,RC,27200680,CDM,,,,,,both,,,7789.0000,1168.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2391.22,,,,,,,2010.3400,7789.0000,other,"30.7% of $7,789.00 in Billed Charges for Rev 272 = $2,391.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EKOS ALL MACH 4,272,RC,27200680,CDM,,,,,,both,,,7789.0000,1168.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,2515.85,,,,,,,2010.3400,7789.0000,percent of total billed charges,"32.3% of $7,789.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EKOS ALL MACH 4,272,RC,27200680,CDM,,,,,,both,,,7789.0000,1168.3500,WELLCARE,WELLCARE MEDICAID,7789.00,,,,,,,2010.3400,7789.0000,percent of total billed charges,"100% of $7,789.00 in Billed Charges for Rev 272 = $7,789.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP INTROD DILATOR 9 14FR,272,RC,27200077,CDM,,,,,,both,,,43.0000,6.4500,AETNA,AETNA,18.36,,,,,,,11.1000,43.0000,percent of total billed charges,42.7% of $43.00 in Billed Charges for Rev 272 = $18.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 9 14FR,272,RC,27200077,CDM,,,,,,both,,,43.0000,6.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,30.10,,,,,,,11.1000,43.0000,percent of total billed charges,Rev 272 $43.00 in Billed Charges at 70% = $30.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 9 14FR,272,RC,27200077,CDM,,,,,,both,,,43.0000,6.4500,CIGNA HEALTHCARE,CIGNA HMO,17.93,,,,,,,11.1000,43.0000,percent of total billed charges,41.7% of $43.00 in Billed Charges for Rev 272 = $17.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 9 14FR,272,RC,27200077,CDM,,,,,,both,,,43.0000,6.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,19.95,,,,,,,11.1000,43.0000,percent of total billed charges,46.4% of $43.00 in Billed Charges for Rev 272 = $19.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 9 14FR,272,RC,27200077,CDM,,,,,,both,,,43.0000,6.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,17.93,,,,,,,11.1000,43.0000,percent of total billed charges,41.7% of $43.00 in Billed Charges for Rev 272 = $17.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 9 14FR,272,RC,27200077,CDM,,,,,,both,,,43.0000,6.4500,CIGNA HEALTHCARE,CIGNA PPO,17.93,,,,,,,11.1000,43.0000,percent of total billed charges,41.7% of $43.00 in Billed Charges for Rev 272 = $17.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 9 14FR,272,RC,27200077,CDM,,,,,,both,,,43.0000,6.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,38.70,,,,,,,11.1000,43.0000,percent of total billed charges,90% of $43.00 in Billed Charges for Rev 272 = $38.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 9 14FR,272,RC,27200077,CDM,,,,,,both,,,43.0000,6.4500,MEDCOST,MEDCOST VHN,20.46,,,,,,,11.1000,43.0000,percent of total billed charges,47.59% of $43.00 in Billed Charges for Rev 272 = $20.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 9 14FR,272,RC,27200077,CDM,,,,,,both,,,43.0000,6.4500,SENTARA HEALTH,SENTARA HEALTH,11.10,,,,,,,11.1000,43.0000,percent of total billed charges,25.81% of $43.00 in Billed Charges for Rev 272 = $11.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 9 14FR,272,RC,27200077,CDM,,,,,,both,,,43.0000,6.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",43.00,,,,,,,11.1000,43.0000,percent of total billed charges,100% of $43.00 in Billed Charges for Rev 272 = $43.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 9 14FR,272,RC,27200077,CDM,,,,,,both,,,43.0000,6.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,21.50,,,,,,,11.1000,43.0000,percent of total billed charges,Rev 272 $43.00 in Billed Charges at 50% = $21.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 9 14FR,272,RC,27200077,CDM,,,,,,both,,,43.0000,6.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13.89,,,,,,,11.1000,43.0000,other,32.3% of $43.00 in Billed Charges for Rev 272 = $13.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NSP INTROD DILATOR 9 14FR,272,RC,27200077,CDM,,,,,,both,,,43.0000,6.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,13.20,,,,,,,11.1000,43.0000,other,30.7% of $43.00 in Billed Charges for Rev 272 = $13.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NSP INTROD DILATOR 9 14FR,272,RC,27200077,CDM,,,,,,both,,,43.0000,6.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,13.89,,,,,,,11.1000,43.0000,percent of total billed charges,32.3% of $43.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP INTROD DILATOR 9 14FR,272,RC,27200077,CDM,,,,,,both,,,43.0000,6.4500,WELLCARE,WELLCARE MEDICAID,43.00,,,,,,,11.1000,43.0000,percent of total billed charges,100% of $43.00 in Billed Charges for Rev 272 = $43.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NSP KYPHO 10 2 FIRST FX,272,RC,27200899,CDM,,,,,,both,,,9762.0000,1464.3000,AETNA,AETNA,4168.37,,,,,,,2519.5700,9762.0000,percent of total billed charges,"42.7% of $9,762.00 in Billed Charges for Rev 272 = $4,168.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 10 2 FIRST FX,272,RC,27200899,CDM,,,,,,both,,,9762.0000,1464.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6833.40,,,,,,,2519.5700,9762.0000,percent of total billed charges,"Rev 272 $9,762.00 in Billed Charges at 70% = $6,833.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 10 2 FIRST FX,272,RC,27200899,CDM,,,,,,both,,,9762.0000,1464.3000,CIGNA HEALTHCARE,CIGNA HMO,4070.75,,,,,,,2519.5700,9762.0000,percent of total billed charges,"41.7% of $9,762.00 in Billed Charges for Rev 272 = $4,070.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 10 2 FIRST FX,272,RC,27200899,CDM,,,,,,both,,,9762.0000,1464.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4529.57,,,,,,,2519.5700,9762.0000,percent of total billed charges,"46.4% of $9,762.00 in Billed Charges for Rev 272 = $4,529.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 10 2 FIRST FX,272,RC,27200899,CDM,,,,,,both,,,9762.0000,1464.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4070.75,,,,,,,2519.5700,9762.0000,percent of total billed charges,"41.7% of $9,762.00 in Billed Charges for Rev 272 = $4,070.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 10 2 FIRST FX,272,RC,27200899,CDM,,,,,,both,,,9762.0000,1464.3000,CIGNA HEALTHCARE,CIGNA PPO,4070.75,,,,,,,2519.5700,9762.0000,percent of total billed charges,"41.7% of $9,762.00 in Billed Charges for Rev 272 = $4,070.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 10 2 FIRST FX,272,RC,27200899,CDM,,,,,,both,,,9762.0000,1464.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8785.80,,,,,,,2519.5700,9762.0000,percent of total billed charges,"90% of $9,762.00 in Billed Charges for Rev 272 = $8,785.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 10 2 FIRST FX,272,RC,27200899,CDM,,,,,,both,,,9762.0000,1464.3000,MEDCOST,MEDCOST VHN,4645.74,,,,,,,2519.5700,9762.0000,percent of total billed charges,"47.59% of $9,762.00 in Billed Charges for Rev 272 = $4,645.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 10 2 FIRST FX,272,RC,27200899,CDM,,,,,,both,,,9762.0000,1464.3000,SENTARA HEALTH,SENTARA HEALTH,2519.57,,,,,,,2519.5700,9762.0000,percent of total billed charges,"25.81% of $9,762.00 in Billed Charges for Rev 272 = $2,519.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 10 2 FIRST FX,272,RC,27200899,CDM,,,,,,both,,,9762.0000,1464.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9762.00,,,,,,,2519.5700,9762.0000,percent of total billed charges,"100% of $9,762.00 in Billed Charges for Rev 272 = $9,762.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 10 2 FIRST FX,272,RC,27200899,CDM,,,,,,both,,,9762.0000,1464.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4881.00,,,,,,,2519.5700,9762.0000,percent of total billed charges,"Rev 272 $9,762.00 in Billed Charges at 50% = $4,881.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 10 2 FIRST FX,272,RC,27200899,CDM,,,,,,both,,,9762.0000,1464.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3153.13,,,,,,,2519.5700,9762.0000,other,"32.3% of $9,762.00 in Billed Charges for Rev 272 = $3,153.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NSP KYPHO 10 2 FIRST FX,272,RC,27200899,CDM,,,,,,both,,,9762.0000,1464.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2996.93,,,,,,,2519.5700,9762.0000,other,"30.7% of $9,762.00 in Billed Charges for Rev 272 = $2,996.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NSP KYPHO 10 2 FIRST FX,272,RC,27200899,CDM,,,,,,both,,,9762.0000,1464.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,3153.13,,,,,,,2519.5700,9762.0000,percent of total billed charges,"32.3% of $9,762.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 10 2 FIRST FX,272,RC,27200899,CDM,,,,,,both,,,9762.0000,1464.3000,WELLCARE,WELLCARE MEDICAID,9762.00,,,,,,,2519.5700,9762.0000,percent of total billed charges,"100% of $9,762.00 in Billed Charges for Rev 272 = $9,762.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 15 2 FIRST FX,272,RC,27200900,CDM,,,,,,both,,,10019.0000,1502.8500,AETNA,AETNA,4278.11,,,,,,,2585.9000,10019.0000,percent of total billed charges,"42.7% of $10,019.00 in Billed Charges for Rev 272 = $4,278.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 15 2 FIRST FX,272,RC,27200900,CDM,,,,,,both,,,10019.0000,1502.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7013.30,,,,,,,2585.9000,10019.0000,percent of total billed charges,"Rev 272 $10,019.00 in Billed Charges at 70% = $7,013.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 15 2 FIRST FX,272,RC,27200900,CDM,,,,,,both,,,10019.0000,1502.8500,CIGNA HEALTHCARE,CIGNA HMO,4177.92,,,,,,,2585.9000,10019.0000,percent of total billed charges,"41.7% of $10,019.00 in Billed Charges for Rev 272 = $4,177.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 15 2 FIRST FX,272,RC,27200900,CDM,,,,,,both,,,10019.0000,1502.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4648.82,,,,,,,2585.9000,10019.0000,percent of total billed charges,"46.4% of $10,019.00 in Billed Charges for Rev 272 = $4,648.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 15 2 FIRST FX,272,RC,27200900,CDM,,,,,,both,,,10019.0000,1502.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4177.92,,,,,,,2585.9000,10019.0000,percent of total billed charges,"41.7% of $10,019.00 in Billed Charges for Rev 272 = $4,177.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 15 2 FIRST FX,272,RC,27200900,CDM,,,,,,both,,,10019.0000,1502.8500,CIGNA HEALTHCARE,CIGNA PPO,4177.92,,,,,,,2585.9000,10019.0000,percent of total billed charges,"41.7% of $10,019.00 in Billed Charges for Rev 272 = $4,177.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 15 2 FIRST FX,272,RC,27200900,CDM,,,,,,both,,,10019.0000,1502.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9017.10,,,,,,,2585.9000,10019.0000,percent of total billed charges,"90% of $10,019.00 in Billed Charges for Rev 272 = $9,017.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 15 2 FIRST FX,272,RC,27200900,CDM,,,,,,both,,,10019.0000,1502.8500,MEDCOST,MEDCOST VHN,4768.04,,,,,,,2585.9000,10019.0000,percent of total billed charges,"47.59% of $10,019.00 in Billed Charges for Rev 272 = $4,768.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 15 2 FIRST FX,272,RC,27200900,CDM,,,,,,both,,,10019.0000,1502.8500,SENTARA HEALTH,SENTARA HEALTH,2585.90,,,,,,,2585.9000,10019.0000,percent of total billed charges,"25.81% of $10,019.00 in Billed Charges for Rev 272 = $2,585.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 15 2 FIRST FX,272,RC,27200900,CDM,,,,,,both,,,10019.0000,1502.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10019.00,,,,,,,2585.9000,10019.0000,percent of total billed charges,"100% of $10,019.00 in Billed Charges for Rev 272 = $10,019.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 15 2 FIRST FX,272,RC,27200900,CDM,,,,,,both,,,10019.0000,1502.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5009.50,,,,,,,2585.9000,10019.0000,percent of total billed charges,"Rev 272 $10,019.00 in Billed Charges at 50% = $5,009.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 15 2 FIRST FX,272,RC,27200900,CDM,,,,,,both,,,10019.0000,1502.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3236.14,,,,,,,2585.9000,10019.0000,other,"32.3% of $10,019.00 in Billed Charges for Rev 272 = $3,236.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NSP KYPHO 15 2 FIRST FX,272,RC,27200900,CDM,,,,,,both,,,10019.0000,1502.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3075.83,,,,,,,2585.9000,10019.0000,other,"30.7% of $10,019.00 in Billed Charges for Rev 272 = $3,075.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NSP KYPHO 15 2 FIRST FX,272,RC,27200900,CDM,,,,,,both,,,10019.0000,1502.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,3236.14,,,,,,,2585.9000,10019.0000,percent of total billed charges,"32.3% of $10,019.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 15 2 FIRST FX,272,RC,27200900,CDM,,,,,,both,,,10019.0000,1502.8500,WELLCARE,WELLCARE MEDICAID,10019.00,,,,,,,2585.9000,10019.0000,percent of total billed charges,"100% of $10,019.00 in Billed Charges for Rev 272 = $10,019.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 20 3 FIRST FX,272,RC,27200901,CDM,,,,,,both,,,9900.0000,1485.0000,AETNA,AETNA,4227.30,,,,,,,2555.1900,9900.0000,percent of total billed charges,"42.7% of $9,900.00 in Billed Charges for Rev 272 = $4,227.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 20 3 FIRST FX,272,RC,27200901,CDM,,,,,,both,,,9900.0000,1485.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6930.00,,,,,,,2555.1900,9900.0000,percent of total billed charges,"Rev 272 $9,900.00 in Billed Charges at 70% = $6,930.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 20 3 FIRST FX,272,RC,27200901,CDM,,,,,,both,,,9900.0000,1485.0000,CIGNA HEALTHCARE,CIGNA HMO,4128.30,,,,,,,2555.1900,9900.0000,percent of total billed charges,"41.7% of $9,900.00 in Billed Charges for Rev 272 = $4,128.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 20 3 FIRST FX,272,RC,27200901,CDM,,,,,,both,,,9900.0000,1485.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4593.60,,,,,,,2555.1900,9900.0000,percent of total billed charges,"46.4% of $9,900.00 in Billed Charges for Rev 272 = $4,593.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 20 3 FIRST FX,272,RC,27200901,CDM,,,,,,both,,,9900.0000,1485.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4128.30,,,,,,,2555.1900,9900.0000,percent of total billed charges,"41.7% of $9,900.00 in Billed Charges for Rev 272 = $4,128.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 20 3 FIRST FX,272,RC,27200901,CDM,,,,,,both,,,9900.0000,1485.0000,CIGNA HEALTHCARE,CIGNA PPO,4128.30,,,,,,,2555.1900,9900.0000,percent of total billed charges,"41.7% of $9,900.00 in Billed Charges for Rev 272 = $4,128.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 20 3 FIRST FX,272,RC,27200901,CDM,,,,,,both,,,9900.0000,1485.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8910.00,,,,,,,2555.1900,9900.0000,percent of total billed charges,"90% of $9,900.00 in Billed Charges for Rev 272 = $8,910.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 20 3 FIRST FX,272,RC,27200901,CDM,,,,,,both,,,9900.0000,1485.0000,MEDCOST,MEDCOST VHN,4711.41,,,,,,,2555.1900,9900.0000,percent of total billed charges,"47.59% of $9,900.00 in Billed Charges for Rev 272 = $4,711.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 20 3 FIRST FX,272,RC,27200901,CDM,,,,,,both,,,9900.0000,1485.0000,SENTARA HEALTH,SENTARA HEALTH,2555.19,,,,,,,2555.1900,9900.0000,percent of total billed charges,"25.81% of $9,900.00 in Billed Charges for Rev 272 = $2,555.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 20 3 FIRST FX,272,RC,27200901,CDM,,,,,,both,,,9900.0000,1485.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9900.00,,,,,,,2555.1900,9900.0000,percent of total billed charges,"100% of $9,900.00 in Billed Charges for Rev 272 = $9,900.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 20 3 FIRST FX,272,RC,27200901,CDM,,,,,,both,,,9900.0000,1485.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4950.00,,,,,,,2555.1900,9900.0000,percent of total billed charges,"Rev 272 $9,900.00 in Billed Charges at 50% = $4,950.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 20 3 FIRST FX,272,RC,27200901,CDM,,,,,,both,,,9900.0000,1485.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3197.70,,,,,,,2555.1900,9900.0000,other,"32.3% of $9,900.00 in Billed Charges for Rev 272 = $3,197.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NSP KYPHO 20 3 FIRST FX,272,RC,27200901,CDM,,,,,,both,,,9900.0000,1485.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3039.30,,,,,,,2555.1900,9900.0000,other,"30.7% of $9,900.00 in Billed Charges for Rev 272 = $3,039.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NSP KYPHO 20 3 FIRST FX,272,RC,27200901,CDM,,,,,,both,,,9900.0000,1485.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,3197.70,,,,,,,2555.1900,9900.0000,percent of total billed charges,"32.3% of $9,900.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NSP KYPHO 20 3 FIRST FX,272,RC,27200901,CDM,,,,,,both,,,9900.0000,1485.0000,WELLCARE,WELLCARE MEDICAID,9900.00,,,,,,,2555.1900,9900.0000,percent of total billed charges,"100% of $9,900.00 in Billed Charges for Rev 272 = $9,900.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NURSERY LEVEL 4 ROOM DLY,174,RC,17400001,CDM,,,,,,inpatient,,,2733.0000,409.9500,AETNA,AETNA,2211.00,,,,,,,121.7600,2733.0000,per diem,"$2,211.00 for 1 day = $2,211.00 for Rev 174"
HC NURSERY LEVEL 4 ROOM DLY,174,RC,17400001,CDM,,,,,,inpatient,,,2733.0000,409.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,121.7600,2733.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC NURSERY LEVEL 4 ROOM DLY,174,RC,17400001,CDM,,,,,,inpatient,,,2733.0000,409.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2459.70,,,,,,,121.7600,2733.0000,percent of total billed charges,"90% of $2,733.00 in Billed Charges for Rev 174 = $2,459.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NURSERY LEVEL 4 ROOM DLY,174,RC,17400001,CDM,,,,,,inpatient,,,2733.0000,409.9500,MEDCOST,MEDCOST VHN,1300.63,,,,,,,121.7600,2733.0000,percent of total billed charges,"47.59% of $2,733.00 in Billed Charges for Rev 174 = $1,300.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NURSERY LEVEL 4 ROOM DLY,174,RC,17400001,CDM,,,,,,inpatient,,,2733.0000,409.9500,SENTARA HEALTH,SENTARA HEALTH,1018.86,,,,,,,121.7600,2733.0000,percent of total billed charges,"37.28% of $2,733.00 in Billed Charges for Rev 174 = $1,018.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NURSERY LEVEL 4 ROOM DLY,174,RC,17400001,CDM,,,,,,inpatient,,,2733.0000,409.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2733.00,,,,,,,121.7600,2733.0000,percent of total billed charges,"100% of $2,733.00 in Billed Charges for Rev 174 = $2,733.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NUS  BXNDL ACHIEVE 14G CA1411,272,RC,27201731,CDM,,,,,,both,,,771.0000,115.6500,AETNA,AETNA,329.22,,,,,,,199.0000,771.0000,percent of total billed charges,42.7% of $771.00 in Billed Charges for Rev 272 = $329.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS  BXNDL ACHIEVE 14G CA1411,272,RC,27201731,CDM,,,,,,both,,,771.0000,115.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,539.70,,,,,,,199.0000,771.0000,percent of total billed charges,Rev 272 $771.00 in Billed Charges at 70% = $539.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS  BXNDL ACHIEVE 14G CA1411,272,RC,27201731,CDM,,,,,,both,,,771.0000,115.6500,CIGNA HEALTHCARE,CIGNA HMO,321.51,,,,,,,199.0000,771.0000,percent of total billed charges,41.7% of $771.00 in Billed Charges for Rev 272 = $321.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS  BXNDL ACHIEVE 14G CA1411,272,RC,27201731,CDM,,,,,,both,,,771.0000,115.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,357.74,,,,,,,199.0000,771.0000,percent of total billed charges,46.4% of $771.00 in Billed Charges for Rev 272 = $357.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS  BXNDL ACHIEVE 14G CA1411,272,RC,27201731,CDM,,,,,,both,,,771.0000,115.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,321.51,,,,,,,199.0000,771.0000,percent of total billed charges,41.7% of $771.00 in Billed Charges for Rev 272 = $321.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS  BXNDL ACHIEVE 14G CA1411,272,RC,27201731,CDM,,,,,,both,,,771.0000,115.6500,CIGNA HEALTHCARE,CIGNA PPO,321.51,,,,,,,199.0000,771.0000,percent of total billed charges,41.7% of $771.00 in Billed Charges for Rev 272 = $321.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS  BXNDL ACHIEVE 14G CA1411,272,RC,27201731,CDM,,,,,,both,,,771.0000,115.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,693.90,,,,,,,199.0000,771.0000,percent of total billed charges,90% of $771.00 in Billed Charges for Rev 272 = $693.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS  BXNDL ACHIEVE 14G CA1411,272,RC,27201731,CDM,,,,,,both,,,771.0000,115.6500,MEDCOST,MEDCOST VHN,366.92,,,,,,,199.0000,771.0000,percent of total billed charges,47.59% of $771.00 in Billed Charges for Rev 272 = $366.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS  BXNDL ACHIEVE 14G CA1411,272,RC,27201731,CDM,,,,,,both,,,771.0000,115.6500,SENTARA HEALTH,SENTARA HEALTH,199.00,,,,,,,199.0000,771.0000,percent of total billed charges,25.81% of $771.00 in Billed Charges for Rev 272 = $199.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS  BXNDL ACHIEVE 14G CA1411,272,RC,27201731,CDM,,,,,,both,,,771.0000,115.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",771.00,,,,,,,199.0000,771.0000,percent of total billed charges,100% of $771.00 in Billed Charges for Rev 272 = $771.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS  BXNDL ACHIEVE 14G CA1411,272,RC,27201731,CDM,,,,,,both,,,771.0000,115.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,385.50,,,,,,,199.0000,771.0000,percent of total billed charges,Rev 272 $771.00 in Billed Charges at 50% = $385.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS  BXNDL ACHIEVE 14G CA1411,272,RC,27201731,CDM,,,,,,both,,,771.0000,115.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,249.03,,,,,,,199.0000,771.0000,other,32.3% of $771.00 in Billed Charges for Rev 272 = $249.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUS  BXNDL ACHIEVE 14G CA1411,272,RC,27201731,CDM,,,,,,both,,,771.0000,115.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,236.70,,,,,,,199.0000,771.0000,other,30.7% of $771.00 in Billed Charges for Rev 272 = $236.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUS  BXNDL ACHIEVE 14G CA1411,272,RC,27201731,CDM,,,,,,both,,,771.0000,115.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,249.03,,,,,,,199.0000,771.0000,percent of total billed charges,32.3% of $771.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS  BXNDL ACHIEVE 14G CA1411,272,RC,27201731,CDM,,,,,,both,,,771.0000,115.6500,WELLCARE,WELLCARE MEDICAID,771.00,,,,,,,199.0000,771.0000,percent of total billed charges,100% of $771.00 in Billed Charges for Rev 272 = $771.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS MONOPTY BIOPSY 16G,272,RC,27200904,CDM,,,,,,both,,,311.0000,46.6500,AETNA,AETNA,132.80,,,,,,,80.2700,311.0000,percent of total billed charges,42.7% of $311.00 in Billed Charges for Rev 272 = $132.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS MONOPTY BIOPSY 16G,272,RC,27200904,CDM,,,,,,both,,,311.0000,46.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,217.70,,,,,,,80.2700,311.0000,percent of total billed charges,Rev 272 $311.00 in Billed Charges at 70% = $217.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS MONOPTY BIOPSY 16G,272,RC,27200904,CDM,,,,,,both,,,311.0000,46.6500,CIGNA HEALTHCARE,CIGNA HMO,129.69,,,,,,,80.2700,311.0000,percent of total billed charges,41.7% of $311.00 in Billed Charges for Rev 272 = $129.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS MONOPTY BIOPSY 16G,272,RC,27200904,CDM,,,,,,both,,,311.0000,46.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,144.30,,,,,,,80.2700,311.0000,percent of total billed charges,46.4% of $311.00 in Billed Charges for Rev 272 = $144.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS MONOPTY BIOPSY 16G,272,RC,27200904,CDM,,,,,,both,,,311.0000,46.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,129.69,,,,,,,80.2700,311.0000,percent of total billed charges,41.7% of $311.00 in Billed Charges for Rev 272 = $129.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS MONOPTY BIOPSY 16G,272,RC,27200904,CDM,,,,,,both,,,311.0000,46.6500,CIGNA HEALTHCARE,CIGNA PPO,129.69,,,,,,,80.2700,311.0000,percent of total billed charges,41.7% of $311.00 in Billed Charges for Rev 272 = $129.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS MONOPTY BIOPSY 16G,272,RC,27200904,CDM,,,,,,both,,,311.0000,46.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,279.90,,,,,,,80.2700,311.0000,percent of total billed charges,90% of $311.00 in Billed Charges for Rev 272 = $279.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS MONOPTY BIOPSY 16G,272,RC,27200904,CDM,,,,,,both,,,311.0000,46.6500,MEDCOST,MEDCOST VHN,148.00,,,,,,,80.2700,311.0000,percent of total billed charges,47.59% of $311.00 in Billed Charges for Rev 272 = $148.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS MONOPTY BIOPSY 16G,272,RC,27200904,CDM,,,,,,both,,,311.0000,46.6500,SENTARA HEALTH,SENTARA HEALTH,80.27,,,,,,,80.2700,311.0000,percent of total billed charges,25.81% of $311.00 in Billed Charges for Rev 272 = $80.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS MONOPTY BIOPSY 16G,272,RC,27200904,CDM,,,,,,both,,,311.0000,46.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",311.00,,,,,,,80.2700,311.0000,percent of total billed charges,100% of $311.00 in Billed Charges for Rev 272 = $311.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS MONOPTY BIOPSY 16G,272,RC,27200904,CDM,,,,,,both,,,311.0000,46.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,155.50,,,,,,,80.2700,311.0000,percent of total billed charges,Rev 272 $311.00 in Billed Charges at 50% = $155.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS MONOPTY BIOPSY 16G,272,RC,27200904,CDM,,,,,,both,,,311.0000,46.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,100.45,,,,,,,80.2700,311.0000,other,32.3% of $311.00 in Billed Charges for Rev 272 = $100.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUS MONOPTY BIOPSY 16G,272,RC,27200904,CDM,,,,,,both,,,311.0000,46.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,95.48,,,,,,,80.2700,311.0000,other,30.7% of $311.00 in Billed Charges for Rev 272 = $95.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUS MONOPTY BIOPSY 16G,272,RC,27200904,CDM,,,,,,both,,,311.0000,46.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,100.45,,,,,,,80.2700,311.0000,percent of total billed charges,32.3% of $311.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS MONOPTY BIOPSY 16G,272,RC,27200904,CDM,,,,,,both,,,311.0000,46.6500,WELLCARE,WELLCARE MEDICAID,311.00,,,,,,,80.2700,311.0000,percent of total billed charges,100% of $311.00 in Billed Charges for Rev 272 = $311.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX 18GX15CM,272,RC,27201732,CDM,,,,,,both,,,267.0000,40.0500,AETNA,AETNA,114.01,,,,,,,68.9100,267.0000,percent of total billed charges,42.7% of $267.00 in Billed Charges for Rev 272 = $114.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX 18GX15CM,272,RC,27201732,CDM,,,,,,both,,,267.0000,40.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,186.90,,,,,,,68.9100,267.0000,percent of total billed charges,Rev 272 $267.00 in Billed Charges at 70% = $186.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX 18GX15CM,272,RC,27201732,CDM,,,,,,both,,,267.0000,40.0500,CIGNA HEALTHCARE,CIGNA HMO,111.34,,,,,,,68.9100,267.0000,percent of total billed charges,41.7% of $267.00 in Billed Charges for Rev 272 = $111.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX 18GX15CM,272,RC,27201732,CDM,,,,,,both,,,267.0000,40.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,123.89,,,,,,,68.9100,267.0000,percent of total billed charges,46.4% of $267.00 in Billed Charges for Rev 272 = $123.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX 18GX15CM,272,RC,27201732,CDM,,,,,,both,,,267.0000,40.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,111.34,,,,,,,68.9100,267.0000,percent of total billed charges,41.7% of $267.00 in Billed Charges for Rev 272 = $111.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX 18GX15CM,272,RC,27201732,CDM,,,,,,both,,,267.0000,40.0500,CIGNA HEALTHCARE,CIGNA PPO,111.34,,,,,,,68.9100,267.0000,percent of total billed charges,41.7% of $267.00 in Billed Charges for Rev 272 = $111.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX 18GX15CM,272,RC,27201732,CDM,,,,,,both,,,267.0000,40.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,240.30,,,,,,,68.9100,267.0000,percent of total billed charges,90% of $267.00 in Billed Charges for Rev 272 = $240.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX 18GX15CM,272,RC,27201732,CDM,,,,,,both,,,267.0000,40.0500,MEDCOST,MEDCOST VHN,127.07,,,,,,,68.9100,267.0000,percent of total billed charges,47.59% of $267.00 in Billed Charges for Rev 272 = $127.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX 18GX15CM,272,RC,27201732,CDM,,,,,,both,,,267.0000,40.0500,SENTARA HEALTH,SENTARA HEALTH,68.91,,,,,,,68.9100,267.0000,percent of total billed charges,25.81% of $267.00 in Billed Charges for Rev 272 = $68.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX 18GX15CM,272,RC,27201732,CDM,,,,,,both,,,267.0000,40.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",267.00,,,,,,,68.9100,267.0000,percent of total billed charges,100% of $267.00 in Billed Charges for Rev 272 = $267.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX 18GX15CM,272,RC,27201732,CDM,,,,,,both,,,267.0000,40.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,133.50,,,,,,,68.9100,267.0000,percent of total billed charges,Rev 272 $267.00 in Billed Charges at 50% = $133.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX 18GX15CM,272,RC,27201732,CDM,,,,,,both,,,267.0000,40.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,86.24,,,,,,,68.9100,267.0000,other,32.3% of $267.00 in Billed Charges for Rev 272 = $86.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUS NDL BX 18GX15CM,272,RC,27201732,CDM,,,,,,both,,,267.0000,40.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,81.97,,,,,,,68.9100,267.0000,other,30.7% of $267.00 in Billed Charges for Rev 272 = $81.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUS NDL BX 18GX15CM,272,RC,27201732,CDM,,,,,,both,,,267.0000,40.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,86.24,,,,,,,68.9100,267.0000,percent of total billed charges,32.3% of $267.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX 18GX15CM,272,RC,27201732,CDM,,,,,,both,,,267.0000,40.0500,WELLCARE,WELLCARE MEDICAID,267.00,,,,,,,68.9100,267.0000,percent of total billed charges,100% of $267.00 in Billed Charges for Rev 272 = $267.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD THIGH,270,RC,27000026,CDM,,,,,,both,,,230.0000,34.5000,AETNA,AETNA,98.21,,,,,,,59.3600,230.0000,percent of total billed charges,42.7% of $230.00 in Billed Charges for Rev 270 = $98.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD THIGH,270,RC,27000026,CDM,,,,,,both,,,230.0000,34.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,161.00,,,,,,,59.3600,230.0000,percent of total billed charges,Rev 270 $230.00 in Billed Charges at 70% = $161.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD THIGH,270,RC,27000026,CDM,,,,,,both,,,230.0000,34.5000,CIGNA HEALTHCARE,CIGNA HMO,95.91,,,,,,,59.3600,230.0000,percent of total billed charges,41.7% of $230.00 in Billed Charges for Rev 270 = $95.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD THIGH,270,RC,27000026,CDM,,,,,,both,,,230.0000,34.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,106.72,,,,,,,59.3600,230.0000,percent of total billed charges,46.4% of $230.00 in Billed Charges for Rev 270 = $106.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD THIGH,270,RC,27000026,CDM,,,,,,both,,,230.0000,34.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,95.91,,,,,,,59.3600,230.0000,percent of total billed charges,41.7% of $230.00 in Billed Charges for Rev 270 = $95.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD THIGH,270,RC,27000026,CDM,,,,,,both,,,230.0000,34.5000,CIGNA HEALTHCARE,CIGNA PPO,95.91,,,,,,,59.3600,230.0000,percent of total billed charges,41.7% of $230.00 in Billed Charges for Rev 270 = $95.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD THIGH,270,RC,27000026,CDM,,,,,,both,,,230.0000,34.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,207.00,,,,,,,59.3600,230.0000,percent of total billed charges,90% of $230.00 in Billed Charges for Rev 270 = $207.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD THIGH,270,RC,27000026,CDM,,,,,,both,,,230.0000,34.5000,MEDCOST,MEDCOST VHN,109.46,,,,,,,59.3600,230.0000,percent of total billed charges,47.59% of $230.00 in Billed Charges for Rev 270 = $109.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD THIGH,270,RC,27000026,CDM,,,,,,both,,,230.0000,34.5000,SENTARA HEALTH,SENTARA HEALTH,59.36,,,,,,,59.3600,230.0000,percent of total billed charges,25.81% of $230.00 in Billed Charges for Rev 270 = $59.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD THIGH,270,RC,27000026,CDM,,,,,,both,,,230.0000,34.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",230.00,,,,,,,59.3600,230.0000,percent of total billed charges,100% of $230.00 in Billed Charges for Rev 270 = $230.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD THIGH,270,RC,27000026,CDM,,,,,,both,,,230.0000,34.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,115.00,,,,,,,59.3600,230.0000,percent of total billed charges,Rev 270 $230.00 in Billed Charges at 50% = $115.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD THIGH,270,RC,27000026,CDM,,,,,,both,,,230.0000,34.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,74.29,,,,,,,59.3600,230.0000,other,32.3% of $230.00 in Billed Charges for Rev 270 = $74.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLEEVE SCD THIGH,270,RC,27000026,CDM,,,,,,both,,,230.0000,34.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,70.61,,,,,,,59.3600,230.0000,other,30.7% of $230.00 in Billed Charges for Rev 270 = $70.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLEEVE SCD THIGH,270,RC,27000026,CDM,,,,,,both,,,230.0000,34.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,74.29,,,,,,,59.3600,230.0000,percent of total billed charges,32.3% of $230.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD THIGH,270,RC,27000026,CDM,,,,,,both,,,230.0000,34.5000,WELLCARE,WELLCARE MEDICAID,230.00,,,,,,,59.3600,230.0000,percent of total billed charges,100% of $230.00 in Billed Charges for Rev 270 = $230.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOL L C BEADS ALL SIZES,272,RC,27200685,CDM,,,,,,both,,,4668.0000,700.2000,AETNA,AETNA,1993.24,,,,,,,1204.8100,4668.0000,percent of total billed charges,"42.7% of $4,668.00 in Billed Charges for Rev 272 = $1,993.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL L C BEADS ALL SIZES,272,RC,27200685,CDM,,,,,,both,,,4668.0000,700.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3267.60,,,,,,,1204.8100,4668.0000,percent of total billed charges,"Rev 272 $4,668.00 in Billed Charges at 70% = $3,267.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL L C BEADS ALL SIZES,272,RC,27200685,CDM,,,,,,both,,,4668.0000,700.2000,CIGNA HEALTHCARE,CIGNA HMO,1946.56,,,,,,,1204.8100,4668.0000,percent of total billed charges,"41.7% of $4,668.00 in Billed Charges for Rev 272 = $1,946.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL L C BEADS ALL SIZES,272,RC,27200685,CDM,,,,,,both,,,4668.0000,700.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2165.95,,,,,,,1204.8100,4668.0000,percent of total billed charges,"46.4% of $4,668.00 in Billed Charges for Rev 272 = $2,165.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL L C BEADS ALL SIZES,272,RC,27200685,CDM,,,,,,both,,,4668.0000,700.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1946.56,,,,,,,1204.8100,4668.0000,percent of total billed charges,"41.7% of $4,668.00 in Billed Charges for Rev 272 = $1,946.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL L C BEADS ALL SIZES,272,RC,27200685,CDM,,,,,,both,,,4668.0000,700.2000,CIGNA HEALTHCARE,CIGNA PPO,1946.56,,,,,,,1204.8100,4668.0000,percent of total billed charges,"41.7% of $4,668.00 in Billed Charges for Rev 272 = $1,946.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL L C BEADS ALL SIZES,272,RC,27200685,CDM,,,,,,both,,,4668.0000,700.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4201.20,,,,,,,1204.8100,4668.0000,percent of total billed charges,"90% of $4,668.00 in Billed Charges for Rev 272 = $4,201.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL L C BEADS ALL SIZES,272,RC,27200685,CDM,,,,,,both,,,4668.0000,700.2000,MEDCOST,MEDCOST VHN,2221.50,,,,,,,1204.8100,4668.0000,percent of total billed charges,"47.59% of $4,668.00 in Billed Charges for Rev 272 = $2,221.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL L C BEADS ALL SIZES,272,RC,27200685,CDM,,,,,,both,,,4668.0000,700.2000,SENTARA HEALTH,SENTARA HEALTH,1204.81,,,,,,,1204.8100,4668.0000,percent of total billed charges,"25.81% of $4,668.00 in Billed Charges for Rev 272 = $1,204.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL L C BEADS ALL SIZES,272,RC,27200685,CDM,,,,,,both,,,4668.0000,700.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4668.00,,,,,,,1204.8100,4668.0000,percent of total billed charges,"100% of $4,668.00 in Billed Charges for Rev 272 = $4,668.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL L C BEADS ALL SIZES,272,RC,27200685,CDM,,,,,,both,,,4668.0000,700.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2334.00,,,,,,,1204.8100,4668.0000,percent of total billed charges,"Rev 272 $4,668.00 in Billed Charges at 50% = $2,334.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL L C BEADS ALL SIZES,272,RC,27200685,CDM,,,,,,both,,,4668.0000,700.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1507.76,,,,,,,1204.8100,4668.0000,other,"32.3% of $4,668.00 in Billed Charges for Rev 272 = $1,507.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EMBOL L C BEADS ALL SIZES,272,RC,27200685,CDM,,,,,,both,,,4668.0000,700.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1433.08,,,,,,,1204.8100,4668.0000,other,"30.7% of $4,668.00 in Billed Charges for Rev 272 = $1,433.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EMBOL L C BEADS ALL SIZES,272,RC,27200685,CDM,,,,,,both,,,4668.0000,700.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,1507.76,,,,,,,1204.8100,4668.0000,percent of total billed charges,"32.3% of $4,668.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL L C BEADS ALL SIZES,272,RC,27200685,CDM,,,,,,both,,,4668.0000,700.2000,WELLCARE,WELLCARE MEDICAID,4668.00,,,,,,,1204.8100,4668.0000,percent of total billed charges,"100% of $4,668.00 in Billed Charges for Rev 272 = $4,668.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL QUADRASPHERE,272,RC,27201706,CDM,,,,,,both,,,4528.0000,679.2000,AETNA,AETNA,1933.46,,,,,,,1168.6800,4528.0000,percent of total billed charges,"42.7% of $4,528.00 in Billed Charges for Rev 272 = $1,933.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL QUADRASPHERE,272,RC,27201706,CDM,,,,,,both,,,4528.0000,679.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3169.60,,,,,,,1168.6800,4528.0000,percent of total billed charges,"Rev 272 $4,528.00 in Billed Charges at 70% = $3,169.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL QUADRASPHERE,272,RC,27201706,CDM,,,,,,both,,,4528.0000,679.2000,CIGNA HEALTHCARE,CIGNA HMO,1888.18,,,,,,,1168.6800,4528.0000,percent of total billed charges,"41.7% of $4,528.00 in Billed Charges for Rev 272 = $1,888.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL QUADRASPHERE,272,RC,27201706,CDM,,,,,,both,,,4528.0000,679.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2100.99,,,,,,,1168.6800,4528.0000,percent of total billed charges,"46.4% of $4,528.00 in Billed Charges for Rev 272 = $2,100.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL QUADRASPHERE,272,RC,27201706,CDM,,,,,,both,,,4528.0000,679.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1888.18,,,,,,,1168.6800,4528.0000,percent of total billed charges,"41.7% of $4,528.00 in Billed Charges for Rev 272 = $1,888.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL QUADRASPHERE,272,RC,27201706,CDM,,,,,,both,,,4528.0000,679.2000,CIGNA HEALTHCARE,CIGNA PPO,1888.18,,,,,,,1168.6800,4528.0000,percent of total billed charges,"41.7% of $4,528.00 in Billed Charges for Rev 272 = $1,888.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL QUADRASPHERE,272,RC,27201706,CDM,,,,,,both,,,4528.0000,679.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4075.20,,,,,,,1168.6800,4528.0000,percent of total billed charges,"90% of $4,528.00 in Billed Charges for Rev 272 = $4,075.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL QUADRASPHERE,272,RC,27201706,CDM,,,,,,both,,,4528.0000,679.2000,MEDCOST,MEDCOST VHN,2154.88,,,,,,,1168.6800,4528.0000,percent of total billed charges,"47.59% of $4,528.00 in Billed Charges for Rev 272 = $2,154.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL QUADRASPHERE,272,RC,27201706,CDM,,,,,,both,,,4528.0000,679.2000,SENTARA HEALTH,SENTARA HEALTH,1168.68,,,,,,,1168.6800,4528.0000,percent of total billed charges,"25.81% of $4,528.00 in Billed Charges for Rev 272 = $1,168.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL QUADRASPHERE,272,RC,27201706,CDM,,,,,,both,,,4528.0000,679.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4528.00,,,,,,,1168.6800,4528.0000,percent of total billed charges,"100% of $4,528.00 in Billed Charges for Rev 272 = $4,528.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL QUADRASPHERE,272,RC,27201706,CDM,,,,,,both,,,4528.0000,679.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2264.00,,,,,,,1168.6800,4528.0000,percent of total billed charges,"Rev 272 $4,528.00 in Billed Charges at 50% = $2,264.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL QUADRASPHERE,272,RC,27201706,CDM,,,,,,both,,,4528.0000,679.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1462.54,,,,,,,1168.6800,4528.0000,other,"32.3% of $4,528.00 in Billed Charges for Rev 272 = $1,462.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EMBOL QUADRASPHERE,272,RC,27201706,CDM,,,,,,both,,,4528.0000,679.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1390.10,,,,,,,1168.6800,4528.0000,other,"30.7% of $4,528.00 in Billed Charges for Rev 272 = $1,390.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EMBOL QUADRASPHERE,272,RC,27201706,CDM,,,,,,both,,,4528.0000,679.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,1462.54,,,,,,,1168.6800,4528.0000,percent of total billed charges,"32.3% of $4,528.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL QUADRASPHERE,272,RC,27201706,CDM,,,,,,both,,,4528.0000,679.2000,WELLCARE,WELLCARE MEDICAID,4528.00,,,,,,,1168.6800,4528.0000,percent of total billed charges,"100% of $4,528.00 in Billed Charges for Rev 272 = $4,528.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOLI COIL HELICAL MICRO,272,RC,27200687,CDM,,,,,,both,,,1324.0000,198.6000,AETNA,AETNA,565.35,,,,,,,341.7200,1324.0000,percent of total billed charges,"42.7% of $1,324.00 in Billed Charges for Rev 272 = $565.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOLI COIL HELICAL MICRO,272,RC,27200687,CDM,,,,,,both,,,1324.0000,198.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,926.80,,,,,,,341.7200,1324.0000,percent of total billed charges,"Rev 272 $1,324.00 in Billed Charges at 70% = $926.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOLI COIL HELICAL MICRO,272,RC,27200687,CDM,,,,,,both,,,1324.0000,198.6000,CIGNA HEALTHCARE,CIGNA HMO,552.11,,,,,,,341.7200,1324.0000,percent of total billed charges,"41.7% of $1,324.00 in Billed Charges for Rev 272 = $552.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOLI COIL HELICAL MICRO,272,RC,27200687,CDM,,,,,,both,,,1324.0000,198.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,614.34,,,,,,,341.7200,1324.0000,percent of total billed charges,"46.4% of $1,324.00 in Billed Charges for Rev 272 = $614.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOLI COIL HELICAL MICRO,272,RC,27200687,CDM,,,,,,both,,,1324.0000,198.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,552.11,,,,,,,341.7200,1324.0000,percent of total billed charges,"41.7% of $1,324.00 in Billed Charges for Rev 272 = $552.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOLI COIL HELICAL MICRO,272,RC,27200687,CDM,,,,,,both,,,1324.0000,198.6000,CIGNA HEALTHCARE,CIGNA PPO,552.11,,,,,,,341.7200,1324.0000,percent of total billed charges,"41.7% of $1,324.00 in Billed Charges for Rev 272 = $552.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOLI COIL HELICAL MICRO,272,RC,27200687,CDM,,,,,,both,,,1324.0000,198.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1191.60,,,,,,,341.7200,1324.0000,percent of total billed charges,"90% of $1,324.00 in Billed Charges for Rev 272 = $1,191.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOLI COIL HELICAL MICRO,272,RC,27200687,CDM,,,,,,both,,,1324.0000,198.6000,MEDCOST,MEDCOST VHN,630.09,,,,,,,341.7200,1324.0000,percent of total billed charges,"47.59% of $1,324.00 in Billed Charges for Rev 272 = $630.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOLI COIL HELICAL MICRO,272,RC,27200687,CDM,,,,,,both,,,1324.0000,198.6000,SENTARA HEALTH,SENTARA HEALTH,341.72,,,,,,,341.7200,1324.0000,percent of total billed charges,"25.81% of $1,324.00 in Billed Charges for Rev 272 = $341.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOLI COIL HELICAL MICRO,272,RC,27200687,CDM,,,,,,both,,,1324.0000,198.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1324.00,,,,,,,341.7200,1324.0000,percent of total billed charges,"100% of $1,324.00 in Billed Charges for Rev 272 = $1,324.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOLI COIL HELICAL MICRO,272,RC,27200687,CDM,,,,,,both,,,1324.0000,198.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,662.00,,,,,,,341.7200,1324.0000,percent of total billed charges,"Rev 272 $1,324.00 in Billed Charges at 50% = $662.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOLI COIL HELICAL MICRO,272,RC,27200687,CDM,,,,,,both,,,1324.0000,198.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,427.65,,,,,,,341.7200,1324.0000,other,"32.3% of $1,324.00 in Billed Charges for Rev 272 = $427.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EMBOLI COIL HELICAL MICRO,272,RC,27200687,CDM,,,,,,both,,,1324.0000,198.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,406.47,,,,,,,341.7200,1324.0000,other,"30.7% of $1,324.00 in Billed Charges for Rev 272 = $406.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EMBOLI COIL HELICAL MICRO,272,RC,27200687,CDM,,,,,,both,,,1324.0000,198.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,427.65,,,,,,,341.7200,1324.0000,percent of total billed charges,"32.3% of $1,324.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOLI COIL HELICAL MICRO,272,RC,27200687,CDM,,,,,,both,,,1324.0000,198.6000,WELLCARE,WELLCARE MEDICAID,1324.00,,,,,,,341.7200,1324.0000,percent of total billed charges,"100% of $1,324.00 in Billed Charges for Rev 272 = $1,324.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMR CRICOTHYR CATH C-TCCS-400,272,RC,27200690,CDM,,,,,,both,,,512.0000,76.8000,AETNA,AETNA,218.62,,,,,,,132.1500,512.0000,percent of total billed charges,42.7% of $512.00 in Billed Charges for Rev 272 = $218.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMR CRICOTHYR CATH C-TCCS-400,272,RC,27200690,CDM,,,,,,both,,,512.0000,76.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,358.40,,,,,,,132.1500,512.0000,percent of total billed charges,Rev 272 $512.00 in Billed Charges at 70% = $358.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMR CRICOTHYR CATH C-TCCS-400,272,RC,27200690,CDM,,,,,,both,,,512.0000,76.8000,CIGNA HEALTHCARE,CIGNA HMO,213.50,,,,,,,132.1500,512.0000,percent of total billed charges,41.7% of $512.00 in Billed Charges for Rev 272 = $213.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMR CRICOTHYR CATH C-TCCS-400,272,RC,27200690,CDM,,,,,,both,,,512.0000,76.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,237.57,,,,,,,132.1500,512.0000,percent of total billed charges,46.4% of $512.00 in Billed Charges for Rev 272 = $237.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMR CRICOTHYR CATH C-TCCS-400,272,RC,27200690,CDM,,,,,,both,,,512.0000,76.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,213.50,,,,,,,132.1500,512.0000,percent of total billed charges,41.7% of $512.00 in Billed Charges for Rev 272 = $213.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMR CRICOTHYR CATH C-TCCS-400,272,RC,27200690,CDM,,,,,,both,,,512.0000,76.8000,CIGNA HEALTHCARE,CIGNA PPO,213.50,,,,,,,132.1500,512.0000,percent of total billed charges,41.7% of $512.00 in Billed Charges for Rev 272 = $213.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMR CRICOTHYR CATH C-TCCS-400,272,RC,27200690,CDM,,,,,,both,,,512.0000,76.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,460.80,,,,,,,132.1500,512.0000,percent of total billed charges,90% of $512.00 in Billed Charges for Rev 272 = $460.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMR CRICOTHYR CATH C-TCCS-400,272,RC,27200690,CDM,,,,,,both,,,512.0000,76.8000,MEDCOST,MEDCOST VHN,243.66,,,,,,,132.1500,512.0000,percent of total billed charges,47.59% of $512.00 in Billed Charges for Rev 272 = $243.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMR CRICOTHYR CATH C-TCCS-400,272,RC,27200690,CDM,,,,,,both,,,512.0000,76.8000,SENTARA HEALTH,SENTARA HEALTH,132.15,,,,,,,132.1500,512.0000,percent of total billed charges,25.81% of $512.00 in Billed Charges for Rev 272 = $132.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMR CRICOTHYR CATH C-TCCS-400,272,RC,27200690,CDM,,,,,,both,,,512.0000,76.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",512.00,,,,,,,132.1500,512.0000,percent of total billed charges,100% of $512.00 in Billed Charges for Rev 272 = $512.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMR CRICOTHYR CATH C-TCCS-400,272,RC,27200690,CDM,,,,,,both,,,512.0000,76.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,256.00,,,,,,,132.1500,512.0000,percent of total billed charges,Rev 272 $512.00 in Billed Charges at 50% = $256.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMR CRICOTHYR CATH C-TCCS-400,272,RC,27200690,CDM,,,,,,both,,,512.0000,76.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,165.38,,,,,,,132.1500,512.0000,other,32.3% of $512.00 in Billed Charges for Rev 272 = $165.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EMR CRICOTHYR CATH C-TCCS-400,272,RC,27200690,CDM,,,,,,both,,,512.0000,76.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,157.18,,,,,,,132.1500,512.0000,other,30.7% of $512.00 in Billed Charges for Rev 272 = $157.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EMR CRICOTHYR CATH C-TCCS-400,272,RC,27200690,CDM,,,,,,both,,,512.0000,76.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,165.38,,,,,,,132.1500,512.0000,percent of total billed charges,32.3% of $512.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMR CRICOTHYR CATH C-TCCS-400,272,RC,27200690,CDM,,,,,,both,,,512.0000,76.8000,WELLCARE,WELLCARE MEDICAID,512.00,,,,,,,132.1500,512.0000,percent of total billed charges,100% of $512.00 in Billed Charges for Rev 272 = $512.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENVELOPE TYRX ABSORABLE ANTIBACTERIAL LARGE NONRESEARCH,278,RC,27800608,CDM,,,,,,both,,,2714.0000,407.1000,AETNA,AETNA,1302.72,,,,,,,700.4800,2714.0000,percent of total billed charges,"48% of $2,714.00 in Billed Charges for Rev 278 = $1,302.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVELOPE TYRX ABSORABLE ANTIBACTERIAL LARGE NONRESEARCH,278,RC,27800608,CDM,,,,,,both,,,2714.0000,407.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1357.00,,,,,,,700.4800,2714.0000,percent of total billed charges,"50% of $2,714.00 in Billed Charges for Rev 278 = $1,357.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVELOPE TYRX ABSORABLE ANTIBACTERIAL LARGE NONRESEARCH,278,RC,27800608,CDM,,,,,,both,,,2714.0000,407.1000,CIGNA HEALTHCARE,CIGNA HMO,1131.74,,,,,,,700.4800,2714.0000,percent of total billed charges,"41.7% of $2,714.00 in Billed Charges for Rev 278 = $1,131.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVELOPE TYRX ABSORABLE ANTIBACTERIAL LARGE NONRESEARCH,278,RC,27800608,CDM,,,,,,both,,,2714.0000,407.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1085.60,,,,,,,700.4800,2714.0000,percent of total billed charges,"40% of $2,714.00 in Billed Charges for Rev 278 = $1,085.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVELOPE TYRX ABSORABLE ANTIBACTERIAL LARGE NONRESEARCH,278,RC,27800608,CDM,,,,,,both,,,2714.0000,407.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1131.74,,,,,,,700.4800,2714.0000,percent of total billed charges,"41.7% of $2,714.00 in Billed Charges for Rev 278 = $1,131.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVELOPE TYRX ABSORABLE ANTIBACTERIAL LARGE NONRESEARCH,278,RC,27800608,CDM,,,,,,both,,,2714.0000,407.1000,CIGNA HEALTHCARE,CIGNA PPO,1131.74,,,,,,,700.4800,2714.0000,percent of total billed charges,"41.7% of $2,714.00 in Billed Charges for Rev 278 = $1,131.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVELOPE TYRX ABSORABLE ANTIBACTERIAL LARGE NONRESEARCH,278,RC,27800608,CDM,,,,,,both,,,2714.0000,407.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2442.60,,,,,,,700.4800,2714.0000,percent of total billed charges,"90% of $2,714.00 in Billed Charges for Rev 278 = $2,442.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVELOPE TYRX ABSORABLE ANTIBACTERIAL LARGE NONRESEARCH,278,RC,27800608,CDM,,,,,,both,,,2714.0000,407.1000,MEDCOST,MEDCOST VHN,1291.59,,,,,,,700.4800,2714.0000,percent of total billed charges,"47.59% of $2,714.00 in Billed Charges for Rev 278 = $1,291.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVELOPE TYRX ABSORABLE ANTIBACTERIAL LARGE NONRESEARCH,278,RC,27800608,CDM,,,,,,both,,,2714.0000,407.1000,SENTARA HEALTH,SENTARA HEALTH,700.48,,,,,,,700.4800,2714.0000,percent of total billed charges,"25.81% of $2,714.00 in Billed Charges for Rev 278 = $700.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVELOPE TYRX ABSORABLE ANTIBACTERIAL LARGE NONRESEARCH,278,RC,27800608,CDM,,,,,,both,,,2714.0000,407.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2714.00,,,,,,,700.4800,2714.0000,percent of total billed charges,"100% of $2,714.00 in Billed Charges for Rev 278 = $2,714.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVELOPE TYRX ABSORABLE ANTIBACTERIAL LARGE NONRESEARCH,278,RC,27800608,CDM,,,,,,both,,,2714.0000,407.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1357.00,,,,,,,700.4800,2714.0000,percent of total billed charges,"Rev 278 $2,714.00 in Billed Charges at 50% = $1,357.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVELOPE TYRX ABSORABLE ANTIBACTERIAL LARGE NONRESEARCH,278,RC,27800608,CDM,,,,,,both,,,2714.0000,407.1000,WELLCARE,WELLCARE MEDICAID,2714.00,,,,,,,700.4800,2714.0000,percent of total billed charges,"100% of $2,714.00 in Billed Charges for Rev 278 = $2,714.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R DELIVERY SYSTEM,278,RC,27800533,CDM,,,,,,both,,,17511.0000,2626.6500,AETNA,AETNA,8405.28,,,,,,,1243.2800,17511.0000,percent of total billed charges,"48% of $17,511.00 in Billed Charges for Rev 278 = $8,405.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R DELIVERY SYSTEM,278,RC,27800533,CDM,,,,,,both,,,17511.0000,2626.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8755.50,,,,,,,1243.2800,17511.0000,percent of total billed charges,"50% of $17,511.00 in Billed Charges for Rev 278 = $8,755.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R DELIVERY SYSTEM,278,RC,27800533,CDM,,,,,,both,,,17511.0000,2626.6500,CIGNA HEALTHCARE,CIGNA HMO,7302.09,,,,,,,1243.2800,17511.0000,percent of total billed charges,"41.7% of $17,511.00 in Billed Charges for Rev 278 = $7,302.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R DELIVERY SYSTEM,278,RC,27800533,CDM,,,,,,both,,,17511.0000,2626.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7004.40,,,,,,,1243.2800,17511.0000,percent of total billed charges,"40% of $17,511.00 in Billed Charges for Rev 278 = $7,004.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R DELIVERY SYSTEM,278,RC,27800533,CDM,,,,,,both,,,17511.0000,2626.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7302.09,,,,,,,1243.2800,17511.0000,percent of total billed charges,"41.7% of $17,511.00 in Billed Charges for Rev 278 = $7,302.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R DELIVERY SYSTEM,278,RC,27800533,CDM,,,,,,both,,,17511.0000,2626.6500,CIGNA HEALTHCARE,CIGNA PPO,7302.09,,,,,,,1243.2800,17511.0000,percent of total billed charges,"41.7% of $17,511.00 in Billed Charges for Rev 278 = $7,302.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R DELIVERY SYSTEM,278,RC,27800533,CDM,,,,,,both,,,17511.0000,2626.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,15759.90,,,,,,,1243.2800,17511.0000,percent of total billed charges,"90% of $17,511.00 in Billed Charges for Rev 278 = $15,759.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R DELIVERY SYSTEM,278,RC,27800533,CDM,,,,,,both,,,17511.0000,2626.6500,MEDCOST,MEDCOST VHN,8333.48,,,,,,,1243.2800,17511.0000,percent of total billed charges,"47.59% of $17,511.00 in Billed Charges for Rev 278 = $8,333.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R DELIVERY SYSTEM,278,RC,27800533,CDM,,,,,,both,,,17511.0000,2626.6500,SENTARA HEALTH,SENTARA HEALTH,4519.59,,,,,,,1243.2800,17511.0000,percent of total billed charges,"25.81% of $17,511.00 in Billed Charges for Rev 278 = $4,519.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R DELIVERY SYSTEM,278,RC,27800533,CDM,,,,,,both,,,17511.0000,2626.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",17511.00,,,,,,,1243.2800,17511.0000,percent of total billed charges,"100% of $17,511.00 in Billed Charges for Rev 278 = $17,511.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R DELIVERY SYSTEM,278,RC,27800533,CDM,,,,,,both,,,17511.0000,2626.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8755.50,,,,,,,1243.2800,17511.0000,percent of total billed charges,"Rev 278 $17,511.00 in Billed Charges at 50% = $8,755.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R DELIVERY SYSTEM,278,RC,27800533,CDM,,,,,,both,,,17511.0000,2626.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1313.33,,,,,,,1243.2800,17511.0000,percent of total billed charges,"7.5% of $17,511.00 in Billed Charges for Rev 278 = $1,313.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R DELIVERY SYSTEM,278,RC,27800533,CDM,,,,,,both,,,17511.0000,2626.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1243.28,,,,,,,1243.2800,17511.0000,percent of total billed charges,"7.1% of $17,511.00 in Billed Charges for Rev 278 = $1,243.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R DELIVERY SYSTEM,278,RC,27800533,CDM,,,,,,both,,,17511.0000,2626.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,1243.28,,,,,,,1243.2800,17511.0000,percent of total billed charges,"7.1% of $17,511.00 in Billed Charges for Rev 278 = $1,243.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R DELIVERY SYSTEM,278,RC,27800533,CDM,,,,,,both,,,17511.0000,2626.6500,WELLCARE,WELLCARE MEDICAID,17511.00,,,,,,,1243.2800,17511.0000,percent of total billed charges,"100% of $17,511.00 in Billed Charges for Rev 278 = $17,511.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R LOADING SYSTEM 23MM 26 29 MM,278,RC,27800534,CDM,,,,,,both,,,1804.0000,270.6000,AETNA,AETNA,865.92,,,,,,,465.6100,1804.0000,percent of total billed charges,"48% of $1,804.00 in Billed Charges for Rev 278 = $865.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R LOADING SYSTEM 23MM 26 29 MM,278,RC,27800534,CDM,,,,,,both,,,1804.0000,270.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,902.00,,,,,,,465.6100,1804.0000,percent of total billed charges,"50% of $1,804.00 in Billed Charges for Rev 278 = $902.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R LOADING SYSTEM 23MM 26 29 MM,278,RC,27800534,CDM,,,,,,both,,,1804.0000,270.6000,CIGNA HEALTHCARE,CIGNA HMO,752.27,,,,,,,465.6100,1804.0000,percent of total billed charges,"41.7% of $1,804.00 in Billed Charges for Rev 278 = $752.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R LOADING SYSTEM 23MM 26 29 MM,278,RC,27800534,CDM,,,,,,both,,,1804.0000,270.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,721.60,,,,,,,465.6100,1804.0000,percent of total billed charges,"40% of $1,804.00 in Billed Charges for Rev 278 = $721.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R LOADING SYSTEM 23MM 26 29 MM,278,RC,27800534,CDM,,,,,,both,,,1804.0000,270.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,752.27,,,,,,,465.6100,1804.0000,percent of total billed charges,"41.7% of $1,804.00 in Billed Charges for Rev 278 = $752.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R LOADING SYSTEM 23MM 26 29 MM,278,RC,27800534,CDM,,,,,,both,,,1804.0000,270.6000,CIGNA HEALTHCARE,CIGNA PPO,752.27,,,,,,,465.6100,1804.0000,percent of total billed charges,"41.7% of $1,804.00 in Billed Charges for Rev 278 = $752.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R LOADING SYSTEM 23MM 26 29 MM,278,RC,27800534,CDM,,,,,,both,,,1804.0000,270.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1623.60,,,,,,,465.6100,1804.0000,percent of total billed charges,"90% of $1,804.00 in Billed Charges for Rev 278 = $1,623.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R LOADING SYSTEM 23MM 26 29 MM,278,RC,27800534,CDM,,,,,,both,,,1804.0000,270.6000,MEDCOST,MEDCOST VHN,858.52,,,,,,,465.6100,1804.0000,percent of total billed charges,"47.59% of $1,804.00 in Billed Charges for Rev 278 = $858.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R LOADING SYSTEM 23MM 26 29 MM,278,RC,27800534,CDM,,,,,,both,,,1804.0000,270.6000,SENTARA HEALTH,SENTARA HEALTH,465.61,,,,,,,465.6100,1804.0000,percent of total billed charges,"25.81% of $1,804.00 in Billed Charges for Rev 278 = $465.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R LOADING SYSTEM 23MM 26 29 MM,278,RC,27800534,CDM,,,,,,both,,,1804.0000,270.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1804.00,,,,,,,465.6100,1804.0000,percent of total billed charges,"100% of $1,804.00 in Billed Charges for Rev 278 = $1,804.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R LOADING SYSTEM 23MM 26 29 MM,278,RC,27800534,CDM,,,,,,both,,,1804.0000,270.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,902.00,,,,,,,465.6100,1804.0000,percent of total billed charges,"Rev 278 $1,804.00 in Billed Charges at 50% = $902.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENVEO R LOADING SYSTEM 23MM 26 29 MM,278,RC,27800534,CDM,,,,,,both,,,1804.0000,270.6000,WELLCARE,WELLCARE MEDICAID,1804.00,,,,,,,465.6100,1804.0000,percent of total billed charges,"100% of $1,804.00 in Billed Charges for Rev 278 = $1,804.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDURAL SERVICE,370,RC,37000266,CDM,,,,,,both,,,1158.0000,173.7000,AETNA,AETNA,494.47,,,,,,,298.8800,1158.0000,percent of total billed charges,"42.7% of $1,158.00 in Billed Charges for Rev 370 = $494.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDURAL SERVICE,370,RC,37000266,CDM,,,,,,both,,,1158.0000,173.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,810.60,,,,,,,298.8800,1158.0000,percent of total billed charges,"Rev 370 $1,158.00 in Billed Charges at 70% = $810.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDURAL SERVICE,370,RC,37000266,CDM,,,,,,both,,,1158.0000,173.7000,CIGNA HEALTHCARE,CIGNA HMO,482.89,,,,,,,298.8800,1158.0000,percent of total billed charges,"41.7% of $1,158.00 in Billed Charges for Rev 370 = $482.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDURAL SERVICE,370,RC,37000266,CDM,,,,,,both,,,1158.0000,173.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,537.31,,,,,,,298.8800,1158.0000,percent of total billed charges,"46.4% of $1,158.00 in Billed Charges for Rev 370 = $537.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDURAL SERVICE,370,RC,37000266,CDM,,,,,,both,,,1158.0000,173.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,482.89,,,,,,,298.8800,1158.0000,percent of total billed charges,"41.7% of $1,158.00 in Billed Charges for Rev 370 = $482.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDURAL SERVICE,370,RC,37000266,CDM,,,,,,both,,,1158.0000,173.7000,CIGNA HEALTHCARE,CIGNA PPO,482.89,,,,,,,298.8800,1158.0000,percent of total billed charges,"41.7% of $1,158.00 in Billed Charges for Rev 370 = $482.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDURAL SERVICE,370,RC,37000266,CDM,,,,,,both,,,1158.0000,173.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1042.20,,,,,,,298.8800,1158.0000,percent of total billed charges,"90% of $1,158.00 in Billed Charges for Rev 370 = $1,042.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDURAL SERVICE,370,RC,37000266,CDM,,,,,,both,,,1158.0000,173.7000,MEDCOST,MEDCOST VHN,551.09,,,,,,,298.8800,1158.0000,percent of total billed charges,"47.59% of $1,158.00 in Billed Charges for Rev 370 = $551.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDURAL SERVICE,370,RC,37000266,CDM,,,,,,both,,,1158.0000,173.7000,SENTARA HEALTH,SENTARA HEALTH,298.88,,,,,,,298.8800,1158.0000,percent of total billed charges,"25.81% of $1,158.00 in Billed Charges for Rev 370 = $298.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDURAL SERVICE,370,RC,37000266,CDM,,,,,,both,,,1158.0000,173.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1158.00,,,,,,,298.8800,1158.0000,percent of total billed charges,"100% of $1,158.00 in Billed Charges for Rev 370 = $1,158.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDURAL SERVICE,370,RC,37000266,CDM,,,,,,both,,,1158.0000,173.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,579.00,,,,,,,298.8800,1158.0000,percent of total billed charges,"Rev 370 $1,158.00 in Billed Charges at 50% = $579.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDURAL SERVICE,370,RC,37000266,CDM,,,,,,both,,,1158.0000,173.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,374.03,,,,,,,298.8800,1158.0000,other,"32.3% of $1,158.00 in Billed Charges for Rev 370 = $374.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDURAL SERVICE,370,RC,37000266,CDM,,,,,,both,,,1158.0000,173.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,355.51,,,,,,,298.8800,1158.0000,other,"30.7% of $1,158.00 in Billed Charges for Rev 370 = $355.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDURAL SERVICE,370,RC,37000266,CDM,,,,,,both,,,1158.0000,173.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,374.03,,,,,,,298.8800,1158.0000,percent of total billed charges,"32.3% of $1,158.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDURAL SERVICE,370,RC,37000266,CDM,,,,,,both,,,1158.0000,173.7000,WELLCARE,WELLCARE MEDICAID,1158.00,,,,,,,298.8800,1158.0000,percent of total billed charges,"100% of $1,158.00 in Billed Charges for Rev 370 = $1,158.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCLUDER AAA ILIAC EXTENDER,278,RC,27800613,CDM,,,,,,both,,,7829.0000,1174.3500,AETNA,AETNA,3757.92,,,,,,,2020.6600,7829.0000,percent of total billed charges,"48% of $7,829.00 in Billed Charges for Rev 278 = $3,757.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCLUDER AAA ILIAC EXTENDER,278,RC,27800613,CDM,,,,,,both,,,7829.0000,1174.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3914.50,,,,,,,2020.6600,7829.0000,percent of total billed charges,"50% of $7,829.00 in Billed Charges for Rev 278 = $3,914.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCLUDER AAA ILIAC EXTENDER,278,RC,27800613,CDM,,,,,,both,,,7829.0000,1174.3500,CIGNA HEALTHCARE,CIGNA HMO,3264.69,,,,,,,2020.6600,7829.0000,percent of total billed charges,"41.7% of $7,829.00 in Billed Charges for Rev 278 = $3,264.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCLUDER AAA ILIAC EXTENDER,278,RC,27800613,CDM,,,,,,both,,,7829.0000,1174.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3131.60,,,,,,,2020.6600,7829.0000,percent of total billed charges,"40% of $7,829.00 in Billed Charges for Rev 278 = $3,131.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCLUDER AAA ILIAC EXTENDER,278,RC,27800613,CDM,,,,,,both,,,7829.0000,1174.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3264.69,,,,,,,2020.6600,7829.0000,percent of total billed charges,"41.7% of $7,829.00 in Billed Charges for Rev 278 = $3,264.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCLUDER AAA ILIAC EXTENDER,278,RC,27800613,CDM,,,,,,both,,,7829.0000,1174.3500,CIGNA HEALTHCARE,CIGNA PPO,3264.69,,,,,,,2020.6600,7829.0000,percent of total billed charges,"41.7% of $7,829.00 in Billed Charges for Rev 278 = $3,264.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCLUDER AAA ILIAC EXTENDER,278,RC,27800613,CDM,,,,,,both,,,7829.0000,1174.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7046.10,,,,,,,2020.6600,7829.0000,percent of total billed charges,"90% of $7,829.00 in Billed Charges for Rev 278 = $7,046.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCLUDER AAA ILIAC EXTENDER,278,RC,27800613,CDM,,,,,,both,,,7829.0000,1174.3500,MEDCOST,MEDCOST VHN,3725.82,,,,,,,2020.6600,7829.0000,percent of total billed charges,"47.59% of $7,829.00 in Billed Charges for Rev 278 = $3,725.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCLUDER AAA ILIAC EXTENDER,278,RC,27800613,CDM,,,,,,both,,,7829.0000,1174.3500,SENTARA HEALTH,SENTARA HEALTH,2020.66,,,,,,,2020.6600,7829.0000,percent of total billed charges,"25.81% of $7,829.00 in Billed Charges for Rev 278 = $2,020.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCLUDER AAA ILIAC EXTENDER,278,RC,27800613,CDM,,,,,,both,,,7829.0000,1174.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7829.00,,,,,,,2020.6600,7829.0000,percent of total billed charges,"100% of $7,829.00 in Billed Charges for Rev 278 = $7,829.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCLUDER AAA ILIAC EXTENDER,278,RC,27800613,CDM,,,,,,both,,,7829.0000,1174.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3914.50,,,,,,,2020.6600,7829.0000,percent of total billed charges,"Rev 278 $7,829.00 in Billed Charges at 50% = $3,914.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCLUDER AAA ILIAC EXTENDER,278,RC,27800613,CDM,,,,,,both,,,7829.0000,1174.3500,WELLCARE,WELLCARE MEDICAID,7829.00,,,,,,,2020.6600,7829.0000,percent of total billed charges,"100% of $7,829.00 in Billed Charges for Rev 278 = $7,829.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXTENDER LEAD BULLDOG,272,RC,27200695,CDM,,,,,,both,,,1019.0000,152.8500,AETNA,AETNA,435.11,,,,,,,263.0000,1019.0000,percent of total billed charges,"42.7% of $1,019.00 in Billed Charges for Rev 272 = $435.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXTENDER LEAD BULLDOG,272,RC,27200695,CDM,,,,,,both,,,1019.0000,152.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,713.30,,,,,,,263.0000,1019.0000,percent of total billed charges,"Rev 272 $1,019.00 in Billed Charges at 70% = $713.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXTENDER LEAD BULLDOG,272,RC,27200695,CDM,,,,,,both,,,1019.0000,152.8500,CIGNA HEALTHCARE,CIGNA HMO,424.92,,,,,,,263.0000,1019.0000,percent of total billed charges,"41.7% of $1,019.00 in Billed Charges for Rev 272 = $424.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXTENDER LEAD BULLDOG,272,RC,27200695,CDM,,,,,,both,,,1019.0000,152.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,472.82,,,,,,,263.0000,1019.0000,percent of total billed charges,"46.4% of $1,019.00 in Billed Charges for Rev 272 = $472.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXTENDER LEAD BULLDOG,272,RC,27200695,CDM,,,,,,both,,,1019.0000,152.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,424.92,,,,,,,263.0000,1019.0000,percent of total billed charges,"41.7% of $1,019.00 in Billed Charges for Rev 272 = $424.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXTENDER LEAD BULLDOG,272,RC,27200695,CDM,,,,,,both,,,1019.0000,152.8500,CIGNA HEALTHCARE,CIGNA PPO,424.92,,,,,,,263.0000,1019.0000,percent of total billed charges,"41.7% of $1,019.00 in Billed Charges for Rev 272 = $424.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXTENDER LEAD BULLDOG,272,RC,27200695,CDM,,,,,,both,,,1019.0000,152.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,917.10,,,,,,,263.0000,1019.0000,percent of total billed charges,"90% of $1,019.00 in Billed Charges for Rev 272 = $917.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXTENDER LEAD BULLDOG,272,RC,27200695,CDM,,,,,,both,,,1019.0000,152.8500,MEDCOST,MEDCOST VHN,484.94,,,,,,,263.0000,1019.0000,percent of total billed charges,"47.59% of $1,019.00 in Billed Charges for Rev 272 = $484.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXTENDER LEAD BULLDOG,272,RC,27200695,CDM,,,,,,both,,,1019.0000,152.8500,SENTARA HEALTH,SENTARA HEALTH,263.00,,,,,,,263.0000,1019.0000,percent of total billed charges,"25.81% of $1,019.00 in Billed Charges for Rev 272 = $263.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXTENDER LEAD BULLDOG,272,RC,27200695,CDM,,,,,,both,,,1019.0000,152.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1019.00,,,,,,,263.0000,1019.0000,percent of total billed charges,"100% of $1,019.00 in Billed Charges for Rev 272 = $1,019.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXTENDER LEAD BULLDOG,272,RC,27200695,CDM,,,,,,both,,,1019.0000,152.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,509.50,,,,,,,263.0000,1019.0000,percent of total billed charges,"Rev 272 $1,019.00 in Billed Charges at 50% = $509.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXTENDER LEAD BULLDOG,272,RC,27200695,CDM,,,,,,both,,,1019.0000,152.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,329.14,,,,,,,263.0000,1019.0000,other,"32.3% of $1,019.00 in Billed Charges for Rev 272 = $329.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXTENDER LEAD BULLDOG,272,RC,27200695,CDM,,,,,,both,,,1019.0000,152.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,312.83,,,,,,,263.0000,1019.0000,other,"30.7% of $1,019.00 in Billed Charges for Rev 272 = $312.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXTENDER LEAD BULLDOG,272,RC,27200695,CDM,,,,,,both,,,1019.0000,152.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,329.14,,,,,,,263.0000,1019.0000,percent of total billed charges,"32.3% of $1,019.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXTENDER LEAD BULLDOG,272,RC,27200695,CDM,,,,,,both,,,1019.0000,152.8500,WELLCARE,WELLCARE MEDICAID,1019.00,,,,,,,263.0000,1019.0000,percent of total billed charges,"100% of $1,019.00 in Billed Charges for Rev 272 = $1,019.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLING & SWATHE LG,270,RC,27000070,CDM,,,,,,both,,,72.0000,10.8000,AETNA,AETNA,30.74,,,,,,,18.5800,72.0000,percent of total billed charges,42.7% of $72.00 in Billed Charges for Rev 270 = $30.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING & SWATHE LG,270,RC,27000070,CDM,,,,,,both,,,72.0000,10.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,50.40,,,,,,,18.5800,72.0000,percent of total billed charges,Rev 270 $72.00 in Billed Charges at 70% = $50.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING & SWATHE LG,270,RC,27000070,CDM,,,,,,both,,,72.0000,10.8000,CIGNA HEALTHCARE,CIGNA HMO,30.02,,,,,,,18.5800,72.0000,percent of total billed charges,41.7% of $72.00 in Billed Charges for Rev 270 = $30.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING & SWATHE LG,270,RC,27000070,CDM,,,,,,both,,,72.0000,10.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,33.41,,,,,,,18.5800,72.0000,percent of total billed charges,46.4% of $72.00 in Billed Charges for Rev 270 = $33.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING & SWATHE LG,270,RC,27000070,CDM,,,,,,both,,,72.0000,10.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,30.02,,,,,,,18.5800,72.0000,percent of total billed charges,41.7% of $72.00 in Billed Charges for Rev 270 = $30.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING & SWATHE LG,270,RC,27000070,CDM,,,,,,both,,,72.0000,10.8000,CIGNA HEALTHCARE,CIGNA PPO,30.02,,,,,,,18.5800,72.0000,percent of total billed charges,41.7% of $72.00 in Billed Charges for Rev 270 = $30.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING & SWATHE LG,270,RC,27000070,CDM,,,,,,both,,,72.0000,10.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,64.80,,,,,,,18.5800,72.0000,percent of total billed charges,90% of $72.00 in Billed Charges for Rev 270 = $64.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING & SWATHE LG,270,RC,27000070,CDM,,,,,,both,,,72.0000,10.8000,MEDCOST,MEDCOST VHN,34.26,,,,,,,18.5800,72.0000,percent of total billed charges,47.59% of $72.00 in Billed Charges for Rev 270 = $34.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING & SWATHE LG,270,RC,27000070,CDM,,,,,,both,,,72.0000,10.8000,SENTARA HEALTH,SENTARA HEALTH,18.58,,,,,,,18.5800,72.0000,percent of total billed charges,25.81% of $72.00 in Billed Charges for Rev 270 = $18.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING & SWATHE LG,270,RC,27000070,CDM,,,,,,both,,,72.0000,10.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",72.00,,,,,,,18.5800,72.0000,percent of total billed charges,100% of $72.00 in Billed Charges for Rev 270 = $72.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING & SWATHE LG,270,RC,27000070,CDM,,,,,,both,,,72.0000,10.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,36.00,,,,,,,18.5800,72.0000,percent of total billed charges,Rev 270 $72.00 in Billed Charges at 50% = $36.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING & SWATHE LG,270,RC,27000070,CDM,,,,,,both,,,72.0000,10.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,23.26,,,,,,,18.5800,72.0000,other,32.3% of $72.00 in Billed Charges for Rev 270 = $23.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLING & SWATHE LG,270,RC,27000070,CDM,,,,,,both,,,72.0000,10.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,22.10,,,,,,,18.5800,72.0000,other,30.7% of $72.00 in Billed Charges for Rev 270 = $22.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLING & SWATHE LG,270,RC,27000070,CDM,,,,,,both,,,72.0000,10.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,23.26,,,,,,,18.5800,72.0000,percent of total billed charges,32.3% of $72.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING & SWATHE LG,270,RC,27000070,CDM,,,,,,both,,,72.0000,10.8000,WELLCARE,WELLCARE MEDICAID,72.00,,,,,,,18.5800,72.0000,percent of total billed charges,100% of $72.00 in Billed Charges for Rev 270 = $72.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM LARGE,270,RC,27000037,CDM,,,,,,both,,,41.0000,6.1500,AETNA,AETNA,17.51,,,,,,,10.5800,41.0000,percent of total billed charges,42.7% of $41.00 in Billed Charges for Rev 270 = $17.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM LARGE,270,RC,27000037,CDM,,,,,,both,,,41.0000,6.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,28.70,,,,,,,10.5800,41.0000,percent of total billed charges,Rev 270 $41.00 in Billed Charges at 70% = $28.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM LARGE,270,RC,27000037,CDM,,,,,,both,,,41.0000,6.1500,CIGNA HEALTHCARE,CIGNA HMO,17.10,,,,,,,10.5800,41.0000,percent of total billed charges,41.7% of $41.00 in Billed Charges for Rev 270 = $17.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM LARGE,270,RC,27000037,CDM,,,,,,both,,,41.0000,6.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,19.02,,,,,,,10.5800,41.0000,percent of total billed charges,46.4% of $41.00 in Billed Charges for Rev 270 = $19.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM LARGE,270,RC,27000037,CDM,,,,,,both,,,41.0000,6.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,17.10,,,,,,,10.5800,41.0000,percent of total billed charges,41.7% of $41.00 in Billed Charges for Rev 270 = $17.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM LARGE,270,RC,27000037,CDM,,,,,,both,,,41.0000,6.1500,CIGNA HEALTHCARE,CIGNA PPO,17.10,,,,,,,10.5800,41.0000,percent of total billed charges,41.7% of $41.00 in Billed Charges for Rev 270 = $17.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM LARGE,270,RC,27000037,CDM,,,,,,both,,,41.0000,6.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,36.90,,,,,,,10.5800,41.0000,percent of total billed charges,90% of $41.00 in Billed Charges for Rev 270 = $36.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM LARGE,270,RC,27000037,CDM,,,,,,both,,,41.0000,6.1500,MEDCOST,MEDCOST VHN,19.51,,,,,,,10.5800,41.0000,percent of total billed charges,47.59% of $41.00 in Billed Charges for Rev 270 = $19.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM LARGE,270,RC,27000037,CDM,,,,,,both,,,41.0000,6.1500,SENTARA HEALTH,SENTARA HEALTH,10.58,,,,,,,10.5800,41.0000,percent of total billed charges,25.81% of $41.00 in Billed Charges for Rev 270 = $10.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM LARGE,270,RC,27000037,CDM,,,,,,both,,,41.0000,6.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",41.00,,,,,,,10.5800,41.0000,percent of total billed charges,100% of $41.00 in Billed Charges for Rev 270 = $41.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM LARGE,270,RC,27000037,CDM,,,,,,both,,,41.0000,6.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,20.50,,,,,,,10.5800,41.0000,percent of total billed charges,Rev 270 $41.00 in Billed Charges at 50% = $20.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM LARGE,270,RC,27000037,CDM,,,,,,both,,,41.0000,6.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13.24,,,,,,,10.5800,41.0000,other,32.3% of $41.00 in Billed Charges for Rev 270 = $13.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLING ARM LARGE,270,RC,27000037,CDM,,,,,,both,,,41.0000,6.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,12.59,,,,,,,10.5800,41.0000,other,30.7% of $41.00 in Billed Charges for Rev 270 = $12.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLING ARM LARGE,270,RC,27000037,CDM,,,,,,both,,,41.0000,6.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,13.24,,,,,,,10.5800,41.0000,percent of total billed charges,32.3% of $41.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLING ARM LARGE,270,RC,27000037,CDM,,,,,,both,,,41.0000,6.1500,WELLCARE,WELLCARE MEDICAID,41.00,,,,,,,10.5800,41.0000,percent of total billed charges,100% of $41.00 in Billed Charges for Rev 270 = $41.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC F-IDC .035 INTRLCK 2D/360 18-20MM X 40CM,272,RC,27201999,CDM,,,,,,both,,,2578.0000,386.7000,AETNA,AETNA,1100.81,,,,,,,665.3800,2578.0000,percent of total billed charges,"42.7% of $2,578.00 in Billed Charges for Rev 272 = $1,100.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC .035 INTRLCK 2D/360 18-20MM X 40CM,272,RC,27201999,CDM,,,,,,both,,,2578.0000,386.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1804.60,,,,,,,665.3800,2578.0000,percent of total billed charges,"Rev 272 $2,578.00 in Billed Charges at 70% = $1,804.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC .035 INTRLCK 2D/360 18-20MM X 40CM,272,RC,27201999,CDM,,,,,,both,,,2578.0000,386.7000,CIGNA HEALTHCARE,CIGNA HMO,1075.03,,,,,,,665.3800,2578.0000,percent of total billed charges,"41.7% of $2,578.00 in Billed Charges for Rev 272 = $1,075.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC .035 INTRLCK 2D/360 18-20MM X 40CM,272,RC,27201999,CDM,,,,,,both,,,2578.0000,386.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1196.19,,,,,,,665.3800,2578.0000,percent of total billed charges,"46.4% of $2,578.00 in Billed Charges for Rev 272 = $1,196.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC .035 INTRLCK 2D/360 18-20MM X 40CM,272,RC,27201999,CDM,,,,,,both,,,2578.0000,386.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1075.03,,,,,,,665.3800,2578.0000,percent of total billed charges,"41.7% of $2,578.00 in Billed Charges for Rev 272 = $1,075.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC .035 INTRLCK 2D/360 18-20MM X 40CM,272,RC,27201999,CDM,,,,,,both,,,2578.0000,386.7000,CIGNA HEALTHCARE,CIGNA PPO,1075.03,,,,,,,665.3800,2578.0000,percent of total billed charges,"41.7% of $2,578.00 in Billed Charges for Rev 272 = $1,075.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC .035 INTRLCK 2D/360 18-20MM X 40CM,272,RC,27201999,CDM,,,,,,both,,,2578.0000,386.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2320.20,,,,,,,665.3800,2578.0000,percent of total billed charges,"90% of $2,578.00 in Billed Charges for Rev 272 = $2,320.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC .035 INTRLCK 2D/360 18-20MM X 40CM,272,RC,27201999,CDM,,,,,,both,,,2578.0000,386.7000,MEDCOST,MEDCOST VHN,1226.87,,,,,,,665.3800,2578.0000,percent of total billed charges,"47.59% of $2,578.00 in Billed Charges for Rev 272 = $1,226.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC .035 INTRLCK 2D/360 18-20MM X 40CM,272,RC,27201999,CDM,,,,,,both,,,2578.0000,386.7000,SENTARA HEALTH,SENTARA HEALTH,665.38,,,,,,,665.3800,2578.0000,percent of total billed charges,"25.81% of $2,578.00 in Billed Charges for Rev 272 = $665.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC .035 INTRLCK 2D/360 18-20MM X 40CM,272,RC,27201999,CDM,,,,,,both,,,2578.0000,386.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2578.00,,,,,,,665.3800,2578.0000,percent of total billed charges,"100% of $2,578.00 in Billed Charges for Rev 272 = $2,578.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC .035 INTRLCK 2D/360 18-20MM X 40CM,272,RC,27201999,CDM,,,,,,both,,,2578.0000,386.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1289.00,,,,,,,665.3800,2578.0000,percent of total billed charges,"Rev 272 $2,578.00 in Billed Charges at 50% = $1,289.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC .035 INTRLCK 2D/360 18-20MM X 40CM,272,RC,27201999,CDM,,,,,,both,,,2578.0000,386.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,832.69,,,,,,,665.3800,2578.0000,other,"32.3% of $2,578.00 in Billed Charges for Rev 272 = $832.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC F-IDC .035 INTRLCK 2D/360 18-20MM X 40CM,272,RC,27201999,CDM,,,,,,both,,,2578.0000,386.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,791.45,,,,,,,665.3800,2578.0000,other,"30.7% of $2,578.00 in Billed Charges for Rev 272 = $791.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC F-IDC .035 INTRLCK 2D/360 18-20MM X 40CM,272,RC,27201999,CDM,,,,,,both,,,2578.0000,386.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,832.69,,,,,,,665.3800,2578.0000,percent of total billed charges,"32.3% of $2,578.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC .035 INTRLCK 2D/360 18-20MM X 40CM,272,RC,27201999,CDM,,,,,,both,,,2578.0000,386.7000,WELLCARE,WELLCARE MEDICAID,2578.00,,,,,,,665.3800,2578.0000,percent of total billed charges,"100% of $2,578.00 in Billed Charges for Rev 272 = $2,578.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FEMOSTOP,270,RC,27000179,CDM,,,,,,both,,,396.0000,59.4000,AETNA,AETNA,169.09,,,,,,,102.2100,396.0000,percent of total billed charges,42.7% of $396.00 in Billed Charges for Rev 270 = $169.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP,270,RC,27000179,CDM,,,,,,both,,,396.0000,59.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,277.20,,,,,,,102.2100,396.0000,percent of total billed charges,Rev 270 $396.00 in Billed Charges at 70% = $277.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP,270,RC,27000179,CDM,,,,,,both,,,396.0000,59.4000,CIGNA HEALTHCARE,CIGNA HMO,165.13,,,,,,,102.2100,396.0000,percent of total billed charges,41.7% of $396.00 in Billed Charges for Rev 270 = $165.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP,270,RC,27000179,CDM,,,,,,both,,,396.0000,59.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,183.74,,,,,,,102.2100,396.0000,percent of total billed charges,46.4% of $396.00 in Billed Charges for Rev 270 = $183.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP,270,RC,27000179,CDM,,,,,,both,,,396.0000,59.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,165.13,,,,,,,102.2100,396.0000,percent of total billed charges,41.7% of $396.00 in Billed Charges for Rev 270 = $165.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP,270,RC,27000179,CDM,,,,,,both,,,396.0000,59.4000,CIGNA HEALTHCARE,CIGNA PPO,165.13,,,,,,,102.2100,396.0000,percent of total billed charges,41.7% of $396.00 in Billed Charges for Rev 270 = $165.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP,270,RC,27000179,CDM,,,,,,both,,,396.0000,59.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,356.40,,,,,,,102.2100,396.0000,percent of total billed charges,90% of $396.00 in Billed Charges for Rev 270 = $356.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP,270,RC,27000179,CDM,,,,,,both,,,396.0000,59.4000,MEDCOST,MEDCOST VHN,188.46,,,,,,,102.2100,396.0000,percent of total billed charges,47.59% of $396.00 in Billed Charges for Rev 270 = $188.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP,270,RC,27000179,CDM,,,,,,both,,,396.0000,59.4000,SENTARA HEALTH,SENTARA HEALTH,102.21,,,,,,,102.2100,396.0000,percent of total billed charges,25.81% of $396.00 in Billed Charges for Rev 270 = $102.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP,270,RC,27000179,CDM,,,,,,both,,,396.0000,59.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",396.00,,,,,,,102.2100,396.0000,percent of total billed charges,100% of $396.00 in Billed Charges for Rev 270 = $396.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP,270,RC,27000179,CDM,,,,,,both,,,396.0000,59.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,198.00,,,,,,,102.2100,396.0000,percent of total billed charges,Rev 270 $396.00 in Billed Charges at 50% = $198.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP,270,RC,27000179,CDM,,,,,,both,,,396.0000,59.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,127.91,,,,,,,102.2100,396.0000,other,32.3% of $396.00 in Billed Charges for Rev 270 = $127.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEMOSTOP,270,RC,27000179,CDM,,,,,,both,,,396.0000,59.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,121.57,,,,,,,102.2100,396.0000,other,30.7% of $396.00 in Billed Charges for Rev 270 = $121.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEMOSTOP,270,RC,27000179,CDM,,,,,,both,,,396.0000,59.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,127.91,,,,,,,102.2100,396.0000,percent of total billed charges,32.3% of $396.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FEMOSTOP,270,RC,27000179,CDM,,,,,,both,,,396.0000,59.4000,WELLCARE,WELLCARE MEDICAID,396.00,,,,,,,102.2100,396.0000,percent of total billed charges,100% of $396.00 in Billed Charges for Rev 270 = $396.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEVEL 4 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100027,CDM,,,,,,both,,,6597.0000,989.5500,AETNA,AETNA,2816.92,,,,,,,175.0000,6597.0000,percent of total billed charges,"42.7% of $6,597.00 in Billed Charges for Rev 361 = $2,816.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 4 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100027,CDM,,,,,,both,,,6597.0000,989.5500,BLUE CROSS,ANTHEM EXCHANGE,1088.51,,,,,,,175.0000,6597.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 4 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100027,CDM,,,,,,both,,,6597.0000,989.5500,BLUE CROSS,ANTHEM HMO,1088.51,,,,,,,175.0000,6597.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 4 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100027,CDM,,,,,,both,,,6597.0000,989.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1088.51,,,,,,,175.0000,6597.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 4 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100027,CDM,,,,,,both,,,6597.0000,989.5500,CIGNA HEALTHCARE,CIGNA HMO,228.00,,,,,,,175.0000,6597.0000,case rate,Rev 361 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 4 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100027,CDM,,,,,,both,,,6597.0000,989.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.00,,,,,,,175.0000,6597.0000,case rate,Rev 361 ASG Rate of $175.00 at 100% of $175.00 = $175.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 4 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100027,CDM,,,,,,both,,,6597.0000,989.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.00,,,,,,,175.0000,6597.0000,case rate,Rev 361 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 4 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100027,CDM,,,,,,both,,,6597.0000,989.5500,CIGNA HEALTHCARE,CIGNA PPO,228.00,,,,,,,175.0000,6597.0000,case rate,Rev 361 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 4 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100027,CDM,,,,,,both,,,6597.0000,989.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5937.30,,,,,,,175.0000,6597.0000,percent of total billed charges,"90% of $6,597.00 in Billed Charges for Rev 361 = $5,937.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 4 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100027,CDM,,,,,,both,,,6597.0000,989.5500,MEDCOST,MEDCOST VHN,3139.51,,,,,,,175.0000,6597.0000,percent of total billed charges,"47.59% of $6,597.00 in Billed Charges for Rev 361 = $3,139.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 4 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100027,CDM,,,,,,both,,,6597.0000,989.5500,SENTARA HEALTH,SENTARA HEALTH,1702.69,,,,,,,175.0000,6597.0000,percent of total billed charges,"25.81% of $6,597.00 in Billed Charges for Rev 361 = $1,702.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 4 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100027,CDM,,,,,,both,,,6597.0000,989.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6597.00,,,,,,,175.0000,6597.0000,percent of total billed charges,"100% of $6,597.00 in Billed Charges for Rev 361 = $6,597.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 4 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100027,CDM,,,,,,both,,,6597.0000,989.5500,WELLCARE,WELLCARE MEDICAID,6597.00,,,,,,,175.0000,6597.0000,percent of total billed charges,"100% of $6,597.00 in Billed Charges for Rev 361 = $6,597.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 4 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000007,CDM,,,,,,both,,,8600.0000,1290.0000,AETNA,AETNA,3672.20,,,,,,,175.0000,8600.0000,percent of total billed charges,"42.7% of $8,600.00 in Billed Charges for Rev 360 = $3,672.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 4 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000007,CDM,,,,,,both,,,8600.0000,1290.0000,BLUE CROSS,ANTHEM EXCHANGE,1419.00,,,,,,,175.0000,8600.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 4 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000007,CDM,,,,,,both,,,8600.0000,1290.0000,BLUE CROSS,ANTHEM HMO,1419.00,,,,,,,175.0000,8600.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 4 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000007,CDM,,,,,,both,,,8600.0000,1290.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1419.00,,,,,,,175.0000,8600.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 4 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000007,CDM,,,,,,both,,,8600.0000,1290.0000,CIGNA HEALTHCARE,CIGNA HMO,228.00,,,,,,,175.0000,8600.0000,case rate,Rev 360 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 4 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000007,CDM,,,,,,both,,,8600.0000,1290.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.00,,,,,,,175.0000,8600.0000,case rate,Rev 360 ASG Rate of $175.00 at 100% of $175.00 = $175.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 4 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000007,CDM,,,,,,both,,,8600.0000,1290.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.00,,,,,,,175.0000,8600.0000,case rate,Rev 360 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 4 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000007,CDM,,,,,,both,,,8600.0000,1290.0000,CIGNA HEALTHCARE,CIGNA PPO,228.00,,,,,,,175.0000,8600.0000,case rate,Rev 360 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 4 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000007,CDM,,,,,,both,,,8600.0000,1290.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7740.00,,,,,,,175.0000,8600.0000,percent of total billed charges,"90% of $8,600.00 in Billed Charges for Rev 360 = $7,740.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 4 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000007,CDM,,,,,,both,,,8600.0000,1290.0000,MEDCOST,MEDCOST VHN,4092.74,,,,,,,175.0000,8600.0000,percent of total billed charges,"47.59% of $8,600.00 in Billed Charges for Rev 360 = $4,092.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 4 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000007,CDM,,,,,,both,,,8600.0000,1290.0000,SENTARA HEALTH,SENTARA HEALTH,2219.66,,,,,,,175.0000,8600.0000,percent of total billed charges,"25.81% of $8,600.00 in Billed Charges for Rev 360 = $2,219.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 4 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000007,CDM,,,,,,both,,,8600.0000,1290.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8600.00,,,,,,,175.0000,8600.0000,percent of total billed charges,"100% of $8,600.00 in Billed Charges for Rev 360 = $8,600.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 4 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000007,CDM,,,,,,both,,,8600.0000,1290.0000,WELLCARE,WELLCARE MEDICAID,8600.00,,,,,,,175.0000,8600.0000,percent of total billed charges,"100% of $8,600.00 in Billed Charges for Rev 360 = $8,600.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 GI PROCEDURE & SETUP EA ADDL 15 MINS,750,RC,75000014,CDM,,,,,,both,,,2034.0000,305.1000,AETNA,AETNA,868.52,,,,,,,175.0000,2034.0000,percent of total billed charges,"42.7% of $2,034.00 in Billed Charges for Rev 750 = $868.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 GI PROCEDURE & SETUP EA ADDL 15 MINS,750,RC,75000014,CDM,,,,,,both,,,2034.0000,305.1000,BLUE CROSS,ANTHEM EXCHANGE,335.61,,,,,,,175.0000,2034.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 GI PROCEDURE & SETUP EA ADDL 15 MINS,750,RC,75000014,CDM,,,,,,both,,,2034.0000,305.1000,BLUE CROSS,ANTHEM HMO,335.61,,,,,,,175.0000,2034.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 GI PROCEDURE & SETUP EA ADDL 15 MINS,750,RC,75000014,CDM,,,,,,both,,,2034.0000,305.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",335.61,,,,,,,175.0000,2034.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 GI PROCEDURE & SETUP EA ADDL 15 MINS,750,RC,75000014,CDM,,,,,,both,,,2034.0000,305.1000,CIGNA HEALTHCARE,CIGNA HMO,228.00,,,,,,,175.0000,2034.0000,case rate,Rev 750 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 GI PROCEDURE & SETUP EA ADDL 15 MINS,750,RC,75000014,CDM,,,,,,both,,,2034.0000,305.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.00,,,,,,,175.0000,2034.0000,case rate,Rev 750 ASG Rate of $175.00 at 100% of $175.00 = $175.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 GI PROCEDURE & SETUP EA ADDL 15 MINS,750,RC,75000014,CDM,,,,,,both,,,2034.0000,305.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.00,,,,,,,175.0000,2034.0000,case rate,Rev 750 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 GI PROCEDURE & SETUP EA ADDL 15 MINS,750,RC,75000014,CDM,,,,,,both,,,2034.0000,305.1000,CIGNA HEALTHCARE,CIGNA PPO,228.00,,,,,,,175.0000,2034.0000,case rate,Rev 750 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 GI PROCEDURE & SETUP EA ADDL 15 MINS,750,RC,75000014,CDM,,,,,,both,,,2034.0000,305.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1830.60,,,,,,,175.0000,2034.0000,percent of total billed charges,"90% of $2,034.00 in Billed Charges for Rev 750 = $1,830.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 GI PROCEDURE & SETUP EA ADDL 15 MINS,750,RC,75000014,CDM,,,,,,both,,,2034.0000,305.1000,MEDCOST,MEDCOST VHN,967.98,,,,,,,175.0000,2034.0000,percent of total billed charges,"47.59% of $2,034.00 in Billed Charges for Rev 750 = $967.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 GI PROCEDURE & SETUP EA ADDL 15 MINS,750,RC,75000014,CDM,,,,,,both,,,2034.0000,305.1000,SENTARA HEALTH,SENTARA HEALTH,524.98,,,,,,,175.0000,2034.0000,percent of total billed charges,"25.81% of $2,034.00 in Billed Charges for Rev 750 = $524.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 GI PROCEDURE & SETUP EA ADDL 15 MINS,750,RC,75000014,CDM,,,,,,both,,,2034.0000,305.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2034.00,,,,,,,175.0000,2034.0000,percent of total billed charges,"100% of $2,034.00 in Billed Charges for Rev 750 = $2,034.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 GI PROCEDURE & SETUP EA ADDL 15 MINS,750,RC,75000014,CDM,,,,,,both,,,2034.0000,305.1000,WELLCARE,WELLCARE MEDICAID,2034.00,,,,,,,175.0000,2034.0000,percent of total billed charges,"100% of $2,034.00 in Billed Charges for Rev 750 = $2,034.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 NON-GI PROCEDURE & SETUP EA ADDL 15 MINS,361,RC,36100438,CDM,,,,,,both,,,2716.0000,407.4000,AETNA,AETNA,1159.73,,,,,,,175.0000,2716.0000,percent of total billed charges,"42.7% of $2,716.00 in Billed Charges for Rev 361 = $1,159.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 NON-GI PROCEDURE & SETUP EA ADDL 15 MINS,361,RC,36100438,CDM,,,,,,both,,,2716.0000,407.4000,BLUE CROSS,ANTHEM EXCHANGE,448.14,,,,,,,175.0000,2716.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 NON-GI PROCEDURE & SETUP EA ADDL 15 MINS,361,RC,36100438,CDM,,,,,,both,,,2716.0000,407.4000,BLUE CROSS,ANTHEM HMO,448.14,,,,,,,175.0000,2716.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 NON-GI PROCEDURE & SETUP EA ADDL 15 MINS,361,RC,36100438,CDM,,,,,,both,,,2716.0000,407.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",448.14,,,,,,,175.0000,2716.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 NON-GI PROCEDURE & SETUP EA ADDL 15 MINS,361,RC,36100438,CDM,,,,,,both,,,2716.0000,407.4000,CIGNA HEALTHCARE,CIGNA HMO,228.00,,,,,,,175.0000,2716.0000,case rate,Rev 361 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 NON-GI PROCEDURE & SETUP EA ADDL 15 MINS,361,RC,36100438,CDM,,,,,,both,,,2716.0000,407.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.00,,,,,,,175.0000,2716.0000,case rate,Rev 361 ASG Rate of $175.00 at 100% of $175.00 = $175.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 NON-GI PROCEDURE & SETUP EA ADDL 15 MINS,361,RC,36100438,CDM,,,,,,both,,,2716.0000,407.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.00,,,,,,,175.0000,2716.0000,case rate,Rev 361 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 NON-GI PROCEDURE & SETUP EA ADDL 15 MINS,361,RC,36100438,CDM,,,,,,both,,,2716.0000,407.4000,CIGNA HEALTHCARE,CIGNA PPO,228.00,,,,,,,175.0000,2716.0000,case rate,Rev 361 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 NON-GI PROCEDURE & SETUP EA ADDL 15 MINS,361,RC,36100438,CDM,,,,,,both,,,2716.0000,407.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2444.40,,,,,,,175.0000,2716.0000,percent of total billed charges,"90% of $2,716.00 in Billed Charges for Rev 361 = $2,444.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 NON-GI PROCEDURE & SETUP EA ADDL 15 MINS,361,RC,36100438,CDM,,,,,,both,,,2716.0000,407.4000,MEDCOST,MEDCOST VHN,1292.54,,,,,,,175.0000,2716.0000,percent of total billed charges,"47.59% of $2,716.00 in Billed Charges for Rev 361 = $1,292.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 NON-GI PROCEDURE & SETUP EA ADDL 15 MINS,361,RC,36100438,CDM,,,,,,both,,,2716.0000,407.4000,SENTARA HEALTH,SENTARA HEALTH,701.00,,,,,,,175.0000,2716.0000,percent of total billed charges,"25.81% of $2,716.00 in Billed Charges for Rev 361 = $701.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 NON-GI PROCEDURE & SETUP EA ADDL 15 MINS,361,RC,36100438,CDM,,,,,,both,,,2716.0000,407.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2716.00,,,,,,,175.0000,2716.0000,percent of total billed charges,"100% of $2,716.00 in Billed Charges for Rev 361 = $2,716.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 NON-GI PROCEDURE & SETUP EA ADDL 15 MINS,361,RC,36100438,CDM,,,,,,both,,,2716.0000,407.4000,WELLCARE,WELLCARE MEDICAID,2716.00,,,,,,,175.0000,2716.0000,percent of total billed charges,"100% of $2,716.00 in Billed Charges for Rev 361 = $2,716.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000010,CDM,,,,,,both,,,3589.0000,538.3500,AETNA,AETNA,1532.50,,,,,,,175.0000,3589.0000,percent of total billed charges,"42.7% of $3,589.00 in Billed Charges for Rev 360 = $1,532.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000010,CDM,,,,,,both,,,3589.0000,538.3500,BLUE CROSS,ANTHEM EXCHANGE,592.19,,,,,,,175.0000,3589.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000010,CDM,,,,,,both,,,3589.0000,538.3500,BLUE CROSS,ANTHEM HMO,592.19,,,,,,,175.0000,3589.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000010,CDM,,,,,,both,,,3589.0000,538.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",592.19,,,,,,,175.0000,3589.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000010,CDM,,,,,,both,,,3589.0000,538.3500,CIGNA HEALTHCARE,CIGNA HMO,228.00,,,,,,,175.0000,3589.0000,case rate,Rev 360 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000010,CDM,,,,,,both,,,3589.0000,538.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.00,,,,,,,175.0000,3589.0000,case rate,Rev 360 ASG Rate of $175.00 at 100% of $175.00 = $175.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000010,CDM,,,,,,both,,,3589.0000,538.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.00,,,,,,,175.0000,3589.0000,case rate,Rev 360 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000010,CDM,,,,,,both,,,3589.0000,538.3500,CIGNA HEALTHCARE,CIGNA PPO,228.00,,,,,,,175.0000,3589.0000,case rate,Rev 360 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000010,CDM,,,,,,both,,,3589.0000,538.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3230.10,,,,,,,175.0000,3589.0000,percent of total billed charges,"90% of $3,589.00 in Billed Charges for Rev 360 = $3,230.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000010,CDM,,,,,,both,,,3589.0000,538.3500,MEDCOST,MEDCOST VHN,1708.01,,,,,,,175.0000,3589.0000,percent of total billed charges,"47.59% of $3,589.00 in Billed Charges for Rev 360 = $1,708.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000010,CDM,,,,,,both,,,3589.0000,538.3500,SENTARA HEALTH,SENTARA HEALTH,926.32,,,,,,,175.0000,3589.0000,percent of total billed charges,"25.81% of $3,589.00 in Billed Charges for Rev 360 = $926.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000010,CDM,,,,,,both,,,3589.0000,538.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3589.00,,,,,,,175.0000,3589.0000,percent of total billed charges,"100% of $3,589.00 in Billed Charges for Rev 360 = $3,589.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000010,CDM,,,,,,both,,,3589.0000,538.3500,WELLCARE,WELLCARE MEDICAID,3589.00,,,,,,,175.0000,3589.0000,percent of total billed charges,"100% of $3,589.00 in Billed Charges for Rev 360 = $3,589.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LITHOTRIPSY ESWL UNILAT,790,RC,36000102,CDM,,,,,,both,,,15234.0000,2285.1000,AETNA,AETNA,6504.92,,,,,,,2513.6100,15234.0000,percent of total billed charges,"42.7% of $15,234.00 in Billed Charges for Rev 790 = $6,504.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LITHOTRIPSY ESWL UNILAT,790,RC,36000102,CDM,,,,,,both,,,15234.0000,2285.1000,BLUE CROSS,ANTHEM EXCHANGE,2513.61,,,,,,,2513.6100,15234.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LITHOTRIPSY ESWL UNILAT,790,RC,36000102,CDM,,,,,,both,,,15234.0000,2285.1000,BLUE CROSS,ANTHEM HMO,2513.61,,,,,,,2513.6100,15234.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LITHOTRIPSY ESWL UNILAT,790,RC,36000102,CDM,,,,,,both,,,15234.0000,2285.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2513.61,,,,,,,2513.6100,15234.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LITHOTRIPSY ESWL UNILAT,790,RC,36000102,CDM,,,,,,both,,,15234.0000,2285.1000,CIGNA HEALTHCARE,CIGNA HMO,11204.00,,,,,,,2513.6100,15234.0000,case rate,"Rev 790 at Case Rate $11,204.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LITHOTRIPSY ESWL UNILAT,790,RC,36000102,CDM,,,,,,both,,,15234.0000,2285.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8442.00,,,,,,,2513.6100,15234.0000,case rate,"Rev 790 at Case Rate $8,442.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LITHOTRIPSY ESWL UNILAT,790,RC,36000102,CDM,,,,,,both,,,15234.0000,2285.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11204.00,,,,,,,2513.6100,15234.0000,case rate,"Rev 790 at Case Rate $11,204.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LITHOTRIPSY ESWL UNILAT,790,RC,36000102,CDM,,,,,,both,,,15234.0000,2285.1000,CIGNA HEALTHCARE,CIGNA PPO,11204.00,,,,,,,2513.6100,15234.0000,case rate,"Rev 790 at Case Rate $11,204.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LITHOTRIPSY ESWL UNILAT,790,RC,36000102,CDM,,,,,,both,,,15234.0000,2285.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13710.60,,,,,,,2513.6100,15234.0000,percent of total billed charges,"90% of $15,234.00 in Billed Charges for Rev 790 = $13,710.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LITHOTRIPSY ESWL UNILAT,790,RC,36000102,CDM,,,,,,both,,,15234.0000,2285.1000,MEDCOST,MEDCOST VHN,7249.86,,,,,,,2513.6100,15234.0000,percent of total billed charges,"47.59% of $15,234.00 in Billed Charges for Rev 790 = $7,249.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LITHOTRIPSY ESWL UNILAT,790,RC,36000102,CDM,,,,,,both,,,15234.0000,2285.1000,SENTARA HEALTH,SENTARA HEALTH,3931.90,,,,,,,2513.6100,15234.0000,percent of total billed charges,"25.81% of $15,234.00 in Billed Charges for Rev 790 = $3,931.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LITHOTRIPSY ESWL UNILAT,790,RC,36000102,CDM,,,,,,both,,,15234.0000,2285.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15234.00,,,,,,,2513.6100,15234.0000,percent of total billed charges,"100% of $15,234.00 in Billed Charges for Rev 790 = $15,234.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LITHOTRIPSY ESWL UNILAT,790,RC,36000102,CDM,,,,,,both,,,15234.0000,2285.1000,WELLCARE,WELLCARE MEDICAID,15234.00,,,,,,,2513.6100,15234.0000,percent of total billed charges,"100% of $15,234.00 in Billed Charges for Rev 790 = $15,234.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMO PROBE 11GA NEEDLE,272,RC,27200929,CDM,,,,,,both,,,726.0000,108.9000,AETNA,AETNA,310.00,,,,,,,187.3800,726.0000,percent of total billed charges,42.7% of $726.00 in Billed Charges for Rev 272 = $310.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MAMMO PROBE 11GA NEEDLE,272,RC,27200929,CDM,,,,,,both,,,726.0000,108.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,508.20,,,,,,,187.3800,726.0000,percent of total billed charges,Rev 272 $726.00 in Billed Charges at 70% = $508.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MAMMO PROBE 11GA NEEDLE,272,RC,27200929,CDM,,,,,,both,,,726.0000,108.9000,CIGNA HEALTHCARE,CIGNA HMO,302.74,,,,,,,187.3800,726.0000,percent of total billed charges,41.7% of $726.00 in Billed Charges for Rev 272 = $302.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MAMMO PROBE 11GA NEEDLE,272,RC,27200929,CDM,,,,,,both,,,726.0000,108.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,336.86,,,,,,,187.3800,726.0000,percent of total billed charges,46.4% of $726.00 in Billed Charges for Rev 272 = $336.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MAMMO PROBE 11GA NEEDLE,272,RC,27200929,CDM,,,,,,both,,,726.0000,108.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,302.74,,,,,,,187.3800,726.0000,percent of total billed charges,41.7% of $726.00 in Billed Charges for Rev 272 = $302.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MAMMO PROBE 11GA NEEDLE,272,RC,27200929,CDM,,,,,,both,,,726.0000,108.9000,CIGNA HEALTHCARE,CIGNA PPO,302.74,,,,,,,187.3800,726.0000,percent of total billed charges,41.7% of $726.00 in Billed Charges for Rev 272 = $302.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MAMMO PROBE 11GA NEEDLE,272,RC,27200929,CDM,,,,,,both,,,726.0000,108.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,653.40,,,,,,,187.3800,726.0000,percent of total billed charges,90% of $726.00 in Billed Charges for Rev 272 = $653.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MAMMO PROBE 11GA NEEDLE,272,RC,27200929,CDM,,,,,,both,,,726.0000,108.9000,MEDCOST,MEDCOST VHN,345.50,,,,,,,187.3800,726.0000,percent of total billed charges,47.59% of $726.00 in Billed Charges for Rev 272 = $345.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MAMMO PROBE 11GA NEEDLE,272,RC,27200929,CDM,,,,,,both,,,726.0000,108.9000,SENTARA HEALTH,SENTARA HEALTH,187.38,,,,,,,187.3800,726.0000,percent of total billed charges,25.81% of $726.00 in Billed Charges for Rev 272 = $187.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MAMMO PROBE 11GA NEEDLE,272,RC,27200929,CDM,,,,,,both,,,726.0000,108.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",726.00,,,,,,,187.3800,726.0000,percent of total billed charges,100% of $726.00 in Billed Charges for Rev 272 = $726.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MAMMO PROBE 11GA NEEDLE,272,RC,27200929,CDM,,,,,,both,,,726.0000,108.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,363.00,,,,,,,187.3800,726.0000,percent of total billed charges,Rev 272 $726.00 in Billed Charges at 50% = $363.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MAMMO PROBE 11GA NEEDLE,272,RC,27200929,CDM,,,,,,both,,,726.0000,108.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,234.50,,,,,,,187.3800,726.0000,other,32.3% of $726.00 in Billed Charges for Rev 272 = $234.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MAMMO PROBE 11GA NEEDLE,272,RC,27200929,CDM,,,,,,both,,,726.0000,108.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,222.88,,,,,,,187.3800,726.0000,other,30.7% of $726.00 in Billed Charges for Rev 272 = $222.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MAMMO PROBE 11GA NEEDLE,272,RC,27200929,CDM,,,,,,both,,,726.0000,108.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,234.50,,,,,,,187.3800,726.0000,percent of total billed charges,32.3% of $726.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MAMMO PROBE 11GA NEEDLE,272,RC,27200929,CDM,,,,,,both,,,726.0000,108.9000,WELLCARE,WELLCARE MEDICAID,726.00,,,,,,,187.3800,726.0000,percent of total billed charges,100% of $726.00 in Billed Charges for Rev 272 = $726.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MAMMO PROBE 8GA NEEDLE,272,RC,27200930,CDM,,,,,,both,,,1051.0000,157.6500,AETNA,AETNA,448.78,,,,,,,271.2600,1051.0000,percent of total billed charges,"42.7% of $1,051.00 in Billed Charges for Rev 272 = $448.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMO PROBE 8GA NEEDLE,272,RC,27200930,CDM,,,,,,both,,,1051.0000,157.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,735.70,,,,,,,271.2600,1051.0000,percent of total billed charges,"Rev 272 $1,051.00 in Billed Charges at 70% = $735.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMO PROBE 8GA NEEDLE,272,RC,27200930,CDM,,,,,,both,,,1051.0000,157.6500,CIGNA HEALTHCARE,CIGNA HMO,438.27,,,,,,,271.2600,1051.0000,percent of total billed charges,"41.7% of $1,051.00 in Billed Charges for Rev 272 = $438.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMO PROBE 8GA NEEDLE,272,RC,27200930,CDM,,,,,,both,,,1051.0000,157.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,487.66,,,,,,,271.2600,1051.0000,percent of total billed charges,"46.4% of $1,051.00 in Billed Charges for Rev 272 = $487.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMO PROBE 8GA NEEDLE,272,RC,27200930,CDM,,,,,,both,,,1051.0000,157.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,438.27,,,,,,,271.2600,1051.0000,percent of total billed charges,"41.7% of $1,051.00 in Billed Charges for Rev 272 = $438.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMO PROBE 8GA NEEDLE,272,RC,27200930,CDM,,,,,,both,,,1051.0000,157.6500,CIGNA HEALTHCARE,CIGNA PPO,438.27,,,,,,,271.2600,1051.0000,percent of total billed charges,"41.7% of $1,051.00 in Billed Charges for Rev 272 = $438.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMO PROBE 8GA NEEDLE,272,RC,27200930,CDM,,,,,,both,,,1051.0000,157.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,945.90,,,,,,,271.2600,1051.0000,percent of total billed charges,"90% of $1,051.00 in Billed Charges for Rev 272 = $945.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMO PROBE 8GA NEEDLE,272,RC,27200930,CDM,,,,,,both,,,1051.0000,157.6500,MEDCOST,MEDCOST VHN,500.17,,,,,,,271.2600,1051.0000,percent of total billed charges,"47.59% of $1,051.00 in Billed Charges for Rev 272 = $500.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMO PROBE 8GA NEEDLE,272,RC,27200930,CDM,,,,,,both,,,1051.0000,157.6500,SENTARA HEALTH,SENTARA HEALTH,271.26,,,,,,,271.2600,1051.0000,percent of total billed charges,"25.81% of $1,051.00 in Billed Charges for Rev 272 = $271.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMO PROBE 8GA NEEDLE,272,RC,27200930,CDM,,,,,,both,,,1051.0000,157.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1051.00,,,,,,,271.2600,1051.0000,percent of total billed charges,"100% of $1,051.00 in Billed Charges for Rev 272 = $1,051.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMO PROBE 8GA NEEDLE,272,RC,27200930,CDM,,,,,,both,,,1051.0000,157.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,525.50,,,,,,,271.2600,1051.0000,percent of total billed charges,"Rev 272 $1,051.00 in Billed Charges at 50% = $525.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMO PROBE 8GA NEEDLE,272,RC,27200930,CDM,,,,,,both,,,1051.0000,157.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,339.47,,,,,,,271.2600,1051.0000,other,"32.3% of $1,051.00 in Billed Charges for Rev 272 = $339.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MAMMO PROBE 8GA NEEDLE,272,RC,27200930,CDM,,,,,,both,,,1051.0000,157.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,322.66,,,,,,,271.2600,1051.0000,other,"30.7% of $1,051.00 in Billed Charges for Rev 272 = $322.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MAMMO PROBE 8GA NEEDLE,272,RC,27200930,CDM,,,,,,both,,,1051.0000,157.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,339.47,,,,,,,271.2600,1051.0000,percent of total billed charges,"32.3% of $1,051.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMO PROBE 8GA NEEDLE,272,RC,27200930,CDM,,,,,,both,,,1051.0000,157.6500,WELLCARE,WELLCARE MEDICAID,1051.00,,,,,,,271.2600,1051.0000,percent of total billed charges,"100% of $1,051.00 in Billed Charges for Rev 272 = $1,051.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MANIFOLD DISP CORONARY,272,RC,27200931,CDM,,,,,,both,,,68.0000,10.2000,AETNA,AETNA,29.04,,,,,,,17.5500,68.0000,percent of total billed charges,42.7% of $68.00 in Billed Charges for Rev 272 = $29.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MANIFOLD DISP CORONARY,272,RC,27200931,CDM,,,,,,both,,,68.0000,10.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,47.60,,,,,,,17.5500,68.0000,percent of total billed charges,Rev 272 $68.00 in Billed Charges at 70% = $47.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MANIFOLD DISP CORONARY,272,RC,27200931,CDM,,,,,,both,,,68.0000,10.2000,CIGNA HEALTHCARE,CIGNA HMO,28.36,,,,,,,17.5500,68.0000,percent of total billed charges,41.7% of $68.00 in Billed Charges for Rev 272 = $28.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MANIFOLD DISP CORONARY,272,RC,27200931,CDM,,,,,,both,,,68.0000,10.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,31.55,,,,,,,17.5500,68.0000,percent of total billed charges,46.4% of $68.00 in Billed Charges for Rev 272 = $31.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MANIFOLD DISP CORONARY,272,RC,27200931,CDM,,,,,,both,,,68.0000,10.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,28.36,,,,,,,17.5500,68.0000,percent of total billed charges,41.7% of $68.00 in Billed Charges for Rev 272 = $28.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MANIFOLD DISP CORONARY,272,RC,27200931,CDM,,,,,,both,,,68.0000,10.2000,CIGNA HEALTHCARE,CIGNA PPO,28.36,,,,,,,17.5500,68.0000,percent of total billed charges,41.7% of $68.00 in Billed Charges for Rev 272 = $28.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MANIFOLD DISP CORONARY,272,RC,27200931,CDM,,,,,,both,,,68.0000,10.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,61.20,,,,,,,17.5500,68.0000,percent of total billed charges,90% of $68.00 in Billed Charges for Rev 272 = $61.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MANIFOLD DISP CORONARY,272,RC,27200931,CDM,,,,,,both,,,68.0000,10.2000,MEDCOST,MEDCOST VHN,32.36,,,,,,,17.5500,68.0000,percent of total billed charges,47.59% of $68.00 in Billed Charges for Rev 272 = $32.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MANIFOLD DISP CORONARY,272,RC,27200931,CDM,,,,,,both,,,68.0000,10.2000,SENTARA HEALTH,SENTARA HEALTH,17.55,,,,,,,17.5500,68.0000,percent of total billed charges,25.81% of $68.00 in Billed Charges for Rev 272 = $17.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MANIFOLD DISP CORONARY,272,RC,27200931,CDM,,,,,,both,,,68.0000,10.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",68.00,,,,,,,17.5500,68.0000,percent of total billed charges,100% of $68.00 in Billed Charges for Rev 272 = $68.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MANIFOLD DISP CORONARY,272,RC,27200931,CDM,,,,,,both,,,68.0000,10.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,34.00,,,,,,,17.5500,68.0000,percent of total billed charges,Rev 272 $68.00 in Billed Charges at 50% = $34.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MANIFOLD DISP CORONARY,272,RC,27200931,CDM,,,,,,both,,,68.0000,10.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,21.96,,,,,,,17.5500,68.0000,other,32.3% of $68.00 in Billed Charges for Rev 272 = $21.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MANIFOLD DISP CORONARY,272,RC,27200931,CDM,,,,,,both,,,68.0000,10.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,20.88,,,,,,,17.5500,68.0000,other,30.7% of $68.00 in Billed Charges for Rev 272 = $20.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MANIFOLD DISP CORONARY,272,RC,27200931,CDM,,,,,,both,,,68.0000,10.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,21.96,,,,,,,17.5500,68.0000,percent of total billed charges,32.3% of $68.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MANIFOLD DISP CORONARY,272,RC,27200931,CDM,,,,,,both,,,68.0000,10.2000,WELLCARE,WELLCARE MEDICAID,68.00,,,,,,,17.5500,68.0000,percent of total billed charges,100% of $68.00 in Billed Charges for Rev 272 = $68.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MED/SURG/GYN ROOM DLY SEMI,121,RC,12100001,CDM,,,,,,inpatient,,,2354.0000,353.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,121.7600,2354.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC MED/SURG/GYN ROOM DLY SEMI,121,RC,12100001,CDM,,,,,,inpatient,,,2354.0000,353.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2118.60,,,,,,,121.7600,2354.0000,percent of total billed charges,"90% of $2,354.00 in Billed Charges for Rev 121 = $2,118.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MED/SURG/GYN ROOM DLY SEMI,121,RC,12100001,CDM,,,,,,inpatient,,,2354.0000,353.1000,MEDCOST,MEDCOST VHN,1120.27,,,,,,,121.7600,2354.0000,percent of total billed charges,"47.59% of $2,354.00 in Billed Charges for Rev 121 = $1,120.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MED/SURG/GYN ROOM DLY SEMI,121,RC,12100001,CDM,,,,,,inpatient,,,2354.0000,353.1000,SENTARA HEALTH,SENTARA HEALTH,877.57,,,,,,,121.7600,2354.0000,percent of total billed charges,"37.28% of $2,354.00 in Billed Charges for Rev 121 = $877.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MED/SURG/GYN ROOM DLY SEMI,121,RC,12100001,CDM,,,,,,inpatient,,,2354.0000,353.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2354.00,,,,,,,121.7600,2354.0000,percent of total billed charges,"100% of $2,354.00 in Billed Charges for Rev 121 = $2,354.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MIC G-20 ONTRODUCER 98424,272,RC,27200934,CDM,,,,,,both,,,821.0000,123.1500,AETNA,AETNA,350.57,,,,,,,211.9000,821.0000,percent of total billed charges,42.7% of $821.00 in Billed Charges for Rev 272 = $350.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC G-20 ONTRODUCER 98424,272,RC,27200934,CDM,,,,,,both,,,821.0000,123.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,574.70,,,,,,,211.9000,821.0000,percent of total billed charges,Rev 272 $821.00 in Billed Charges at 70% = $574.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC G-20 ONTRODUCER 98424,272,RC,27200934,CDM,,,,,,both,,,821.0000,123.1500,CIGNA HEALTHCARE,CIGNA HMO,342.36,,,,,,,211.9000,821.0000,percent of total billed charges,41.7% of $821.00 in Billed Charges for Rev 272 = $342.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC G-20 ONTRODUCER 98424,272,RC,27200934,CDM,,,,,,both,,,821.0000,123.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,380.94,,,,,,,211.9000,821.0000,percent of total billed charges,46.4% of $821.00 in Billed Charges for Rev 272 = $380.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC G-20 ONTRODUCER 98424,272,RC,27200934,CDM,,,,,,both,,,821.0000,123.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,342.36,,,,,,,211.9000,821.0000,percent of total billed charges,41.7% of $821.00 in Billed Charges for Rev 272 = $342.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC G-20 ONTRODUCER 98424,272,RC,27200934,CDM,,,,,,both,,,821.0000,123.1500,CIGNA HEALTHCARE,CIGNA PPO,342.36,,,,,,,211.9000,821.0000,percent of total billed charges,41.7% of $821.00 in Billed Charges for Rev 272 = $342.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC G-20 ONTRODUCER 98424,272,RC,27200934,CDM,,,,,,both,,,821.0000,123.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,738.90,,,,,,,211.9000,821.0000,percent of total billed charges,90% of $821.00 in Billed Charges for Rev 272 = $738.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC G-20 ONTRODUCER 98424,272,RC,27200934,CDM,,,,,,both,,,821.0000,123.1500,MEDCOST,MEDCOST VHN,390.71,,,,,,,211.9000,821.0000,percent of total billed charges,47.59% of $821.00 in Billed Charges for Rev 272 = $390.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC G-20 ONTRODUCER 98424,272,RC,27200934,CDM,,,,,,both,,,821.0000,123.1500,SENTARA HEALTH,SENTARA HEALTH,211.90,,,,,,,211.9000,821.0000,percent of total billed charges,25.81% of $821.00 in Billed Charges for Rev 272 = $211.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC G-20 ONTRODUCER 98424,272,RC,27200934,CDM,,,,,,both,,,821.0000,123.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",821.00,,,,,,,211.9000,821.0000,percent of total billed charges,100% of $821.00 in Billed Charges for Rev 272 = $821.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC G-20 ONTRODUCER 98424,272,RC,27200934,CDM,,,,,,both,,,821.0000,123.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,410.50,,,,,,,211.9000,821.0000,percent of total billed charges,Rev 272 $821.00 in Billed Charges at 50% = $410.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC G-20 ONTRODUCER 98424,272,RC,27200934,CDM,,,,,,both,,,821.0000,123.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,265.18,,,,,,,211.9000,821.0000,other,32.3% of $821.00 in Billed Charges for Rev 272 = $265.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MIC G-20 ONTRODUCER 98424,272,RC,27200934,CDM,,,,,,both,,,821.0000,123.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,252.05,,,,,,,211.9000,821.0000,other,30.7% of $821.00 in Billed Charges for Rev 272 = $252.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MIC G-20 ONTRODUCER 98424,272,RC,27200934,CDM,,,,,,both,,,821.0000,123.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,265.18,,,,,,,211.9000,821.0000,percent of total billed charges,32.3% of $821.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC G-20 ONTRODUCER 98424,272,RC,27200934,CDM,,,,,,both,,,821.0000,123.1500,WELLCARE,WELLCARE MEDICAID,821.00,,,,,,,211.9000,821.0000,percent of total billed charges,100% of $821.00 in Billed Charges for Rev 272 = $821.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC GASTRO FEEDING TUBE,272,RC,27200935,CDM,,,,,,both,,,166.0000,24.9000,AETNA,AETNA,70.88,,,,,,,42.8400,166.0000,percent of total billed charges,42.7% of $166.00 in Billed Charges for Rev 272 = $70.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC GASTRO FEEDING TUBE,272,RC,27200935,CDM,,,,,,both,,,166.0000,24.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,116.20,,,,,,,42.8400,166.0000,percent of total billed charges,Rev 272 $166.00 in Billed Charges at 70% = $116.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC GASTRO FEEDING TUBE,272,RC,27200935,CDM,,,,,,both,,,166.0000,24.9000,CIGNA HEALTHCARE,CIGNA HMO,69.22,,,,,,,42.8400,166.0000,percent of total billed charges,41.7% of $166.00 in Billed Charges for Rev 272 = $69.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC GASTRO FEEDING TUBE,272,RC,27200935,CDM,,,,,,both,,,166.0000,24.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,77.02,,,,,,,42.8400,166.0000,percent of total billed charges,46.4% of $166.00 in Billed Charges for Rev 272 = $77.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC GASTRO FEEDING TUBE,272,RC,27200935,CDM,,,,,,both,,,166.0000,24.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,69.22,,,,,,,42.8400,166.0000,percent of total billed charges,41.7% of $166.00 in Billed Charges for Rev 272 = $69.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC GASTRO FEEDING TUBE,272,RC,27200935,CDM,,,,,,both,,,166.0000,24.9000,CIGNA HEALTHCARE,CIGNA PPO,69.22,,,,,,,42.8400,166.0000,percent of total billed charges,41.7% of $166.00 in Billed Charges for Rev 272 = $69.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC GASTRO FEEDING TUBE,272,RC,27200935,CDM,,,,,,both,,,166.0000,24.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,149.40,,,,,,,42.8400,166.0000,percent of total billed charges,90% of $166.00 in Billed Charges for Rev 272 = $149.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC GASTRO FEEDING TUBE,272,RC,27200935,CDM,,,,,,both,,,166.0000,24.9000,MEDCOST,MEDCOST VHN,79.00,,,,,,,42.8400,166.0000,percent of total billed charges,47.59% of $166.00 in Billed Charges for Rev 272 = $79.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC GASTRO FEEDING TUBE,272,RC,27200935,CDM,,,,,,both,,,166.0000,24.9000,SENTARA HEALTH,SENTARA HEALTH,42.84,,,,,,,42.8400,166.0000,percent of total billed charges,25.81% of $166.00 in Billed Charges for Rev 272 = $42.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC GASTRO FEEDING TUBE,272,RC,27200935,CDM,,,,,,both,,,166.0000,24.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",166.00,,,,,,,42.8400,166.0000,percent of total billed charges,100% of $166.00 in Billed Charges for Rev 272 = $166.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC GASTRO FEEDING TUBE,272,RC,27200935,CDM,,,,,,both,,,166.0000,24.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,83.00,,,,,,,42.8400,166.0000,percent of total billed charges,Rev 272 $166.00 in Billed Charges at 50% = $83.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC GASTRO FEEDING TUBE,272,RC,27200935,CDM,,,,,,both,,,166.0000,24.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,53.62,,,,,,,42.8400,166.0000,other,32.3% of $166.00 in Billed Charges for Rev 272 = $53.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MIC GASTRO FEEDING TUBE,272,RC,27200935,CDM,,,,,,both,,,166.0000,24.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,50.96,,,,,,,42.8400,166.0000,other,30.7% of $166.00 in Billed Charges for Rev 272 = $50.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MIC GASTRO FEEDING TUBE,272,RC,27200935,CDM,,,,,,both,,,166.0000,24.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,53.62,,,,,,,42.8400,166.0000,percent of total billed charges,32.3% of $166.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MIC GASTRO FEEDING TUBE,272,RC,27200935,CDM,,,,,,both,,,166.0000,24.9000,WELLCARE,WELLCARE MEDICAID,166.00,,,,,,,42.8400,166.0000,percent of total billed charges,100% of $166.00 in Billed Charges for Rev 272 = $166.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE JEJUNAL 12FR,272,RC,27202099,CDM,,,,,,both,,,564.0000,84.6000,AETNA,AETNA,240.83,,,,,,,145.5700,564.0000,percent of total billed charges,42.7% of $564.00 in Billed Charges for Rev 272 = $240.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE JEJUNAL 12FR,272,RC,27202099,CDM,,,,,,both,,,564.0000,84.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,394.80,,,,,,,145.5700,564.0000,percent of total billed charges,Rev 272 $564.00 in Billed Charges at 70% = $394.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE JEJUNAL 12FR,272,RC,27202099,CDM,,,,,,both,,,564.0000,84.6000,CIGNA HEALTHCARE,CIGNA HMO,235.19,,,,,,,145.5700,564.0000,percent of total billed charges,41.7% of $564.00 in Billed Charges for Rev 272 = $235.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE JEJUNAL 12FR,272,RC,27202099,CDM,,,,,,both,,,564.0000,84.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,261.70,,,,,,,145.5700,564.0000,percent of total billed charges,46.4% of $564.00 in Billed Charges for Rev 272 = $261.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE JEJUNAL 12FR,272,RC,27202099,CDM,,,,,,both,,,564.0000,84.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,235.19,,,,,,,145.5700,564.0000,percent of total billed charges,41.7% of $564.00 in Billed Charges for Rev 272 = $235.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE JEJUNAL 12FR,272,RC,27202099,CDM,,,,,,both,,,564.0000,84.6000,CIGNA HEALTHCARE,CIGNA PPO,235.19,,,,,,,145.5700,564.0000,percent of total billed charges,41.7% of $564.00 in Billed Charges for Rev 272 = $235.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE JEJUNAL 12FR,272,RC,27202099,CDM,,,,,,both,,,564.0000,84.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,507.60,,,,,,,145.5700,564.0000,percent of total billed charges,90% of $564.00 in Billed Charges for Rev 272 = $507.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE JEJUNAL 12FR,272,RC,27202099,CDM,,,,,,both,,,564.0000,84.6000,MEDCOST,MEDCOST VHN,268.41,,,,,,,145.5700,564.0000,percent of total billed charges,47.59% of $564.00 in Billed Charges for Rev 272 = $268.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE JEJUNAL 12FR,272,RC,27202099,CDM,,,,,,both,,,564.0000,84.6000,SENTARA HEALTH,SENTARA HEALTH,145.57,,,,,,,145.5700,564.0000,percent of total billed charges,25.81% of $564.00 in Billed Charges for Rev 272 = $145.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE JEJUNAL 12FR,272,RC,27202099,CDM,,,,,,both,,,564.0000,84.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",564.00,,,,,,,145.5700,564.0000,percent of total billed charges,100% of $564.00 in Billed Charges for Rev 272 = $564.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE JEJUNAL 12FR,272,RC,27202099,CDM,,,,,,both,,,564.0000,84.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,282.00,,,,,,,145.5700,564.0000,percent of total billed charges,Rev 272 $564.00 in Billed Charges at 50% = $282.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE JEJUNAL 12FR,272,RC,27202099,CDM,,,,,,both,,,564.0000,84.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,182.17,,,,,,,145.5700,564.0000,other,32.3% of $564.00 in Billed Charges for Rev 272 = $182.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE JEJUNAL 12FR,272,RC,27202099,CDM,,,,,,both,,,564.0000,84.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,173.15,,,,,,,145.5700,564.0000,other,30.7% of $564.00 in Billed Charges for Rev 272 = $173.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE JEJUNAL 12FR,272,RC,27202099,CDM,,,,,,both,,,564.0000,84.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,182.17,,,,,,,145.5700,564.0000,percent of total billed charges,32.3% of $564.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE JEJUNAL 12FR,272,RC,27202099,CDM,,,,,,both,,,564.0000,84.6000,WELLCARE,WELLCARE MEDICAID,564.00,,,,,,,145.5700,564.0000,percent of total billed charges,100% of $564.00 in Billed Charges for Rev 272 = $564.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC JEJUNAL 18FR,272,RC,27202061,CDM,,,,,,both,,,529.0000,79.3500,AETNA,AETNA,225.88,,,,,,,136.5300,529.0000,percent of total billed charges,42.7% of $529.00 in Billed Charges for Rev 272 = $225.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC JEJUNAL 18FR,272,RC,27202061,CDM,,,,,,both,,,529.0000,79.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,370.30,,,,,,,136.5300,529.0000,percent of total billed charges,Rev 272 $529.00 in Billed Charges at 70% = $370.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC JEJUNAL 18FR,272,RC,27202061,CDM,,,,,,both,,,529.0000,79.3500,CIGNA HEALTHCARE,CIGNA HMO,220.59,,,,,,,136.5300,529.0000,percent of total billed charges,41.7% of $529.00 in Billed Charges for Rev 272 = $220.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC JEJUNAL 18FR,272,RC,27202061,CDM,,,,,,both,,,529.0000,79.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,245.46,,,,,,,136.5300,529.0000,percent of total billed charges,46.4% of $529.00 in Billed Charges for Rev 272 = $245.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC JEJUNAL 18FR,272,RC,27202061,CDM,,,,,,both,,,529.0000,79.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,220.59,,,,,,,136.5300,529.0000,percent of total billed charges,41.7% of $529.00 in Billed Charges for Rev 272 = $220.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC JEJUNAL 18FR,272,RC,27202061,CDM,,,,,,both,,,529.0000,79.3500,CIGNA HEALTHCARE,CIGNA PPO,220.59,,,,,,,136.5300,529.0000,percent of total billed charges,41.7% of $529.00 in Billed Charges for Rev 272 = $220.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC JEJUNAL 18FR,272,RC,27202061,CDM,,,,,,both,,,529.0000,79.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,476.10,,,,,,,136.5300,529.0000,percent of total billed charges,90% of $529.00 in Billed Charges for Rev 272 = $476.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC JEJUNAL 18FR,272,RC,27202061,CDM,,,,,,both,,,529.0000,79.3500,MEDCOST,MEDCOST VHN,251.75,,,,,,,136.5300,529.0000,percent of total billed charges,47.59% of $529.00 in Billed Charges for Rev 272 = $251.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC JEJUNAL 18FR,272,RC,27202061,CDM,,,,,,both,,,529.0000,79.3500,SENTARA HEALTH,SENTARA HEALTH,136.53,,,,,,,136.5300,529.0000,percent of total billed charges,25.81% of $529.00 in Billed Charges for Rev 272 = $136.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC JEJUNAL 18FR,272,RC,27202061,CDM,,,,,,both,,,529.0000,79.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",529.00,,,,,,,136.5300,529.0000,percent of total billed charges,100% of $529.00 in Billed Charges for Rev 272 = $529.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC JEJUNAL 18FR,272,RC,27202061,CDM,,,,,,both,,,529.0000,79.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,264.50,,,,,,,136.5300,529.0000,percent of total billed charges,Rev 272 $529.00 in Billed Charges at 50% = $264.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC JEJUNAL 18FR,272,RC,27202061,CDM,,,,,,both,,,529.0000,79.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,170.87,,,,,,,136.5300,529.0000,other,32.3% of $529.00 in Billed Charges for Rev 272 = $170.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE MIC JEJUNAL 18FR,272,RC,27202061,CDM,,,,,,both,,,529.0000,79.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,162.40,,,,,,,136.5300,529.0000,other,30.7% of $529.00 in Billed Charges for Rev 272 = $162.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE MIC JEJUNAL 18FR,272,RC,27202061,CDM,,,,,,both,,,529.0000,79.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,170.87,,,,,,,136.5300,529.0000,percent of total billed charges,32.3% of $529.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE MIC JEJUNAL 18FR,272,RC,27202061,CDM,,,,,,both,,,529.0000,79.3500,WELLCARE,WELLCARE MEDICAID,529.00,,,,,,,136.5300,529.0000,percent of total billed charges,100% of $529.00 in Billed Charges for Rev 272 = $529.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH CANNULA,272,RC,27201238,CDM,,,,,,both,,,210.0000,31.5000,AETNA,AETNA,89.67,,,,,,,54.2000,210.0000,percent of total billed charges,42.7% of $210.00 in Billed Charges for Rev 272 = $89.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH CANNULA,272,RC,27201238,CDM,,,,,,both,,,210.0000,31.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,147.00,,,,,,,54.2000,210.0000,percent of total billed charges,Rev 272 $210.00 in Billed Charges at 70% = $147.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH CANNULA,272,RC,27201238,CDM,,,,,,both,,,210.0000,31.5000,CIGNA HEALTHCARE,CIGNA HMO,87.57,,,,,,,54.2000,210.0000,percent of total billed charges,41.7% of $210.00 in Billed Charges for Rev 272 = $87.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH CANNULA,272,RC,27201238,CDM,,,,,,both,,,210.0000,31.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,97.44,,,,,,,54.2000,210.0000,percent of total billed charges,46.4% of $210.00 in Billed Charges for Rev 272 = $97.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH CANNULA,272,RC,27201238,CDM,,,,,,both,,,210.0000,31.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,87.57,,,,,,,54.2000,210.0000,percent of total billed charges,41.7% of $210.00 in Billed Charges for Rev 272 = $87.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH CANNULA,272,RC,27201238,CDM,,,,,,both,,,210.0000,31.5000,CIGNA HEALTHCARE,CIGNA PPO,87.57,,,,,,,54.2000,210.0000,percent of total billed charges,41.7% of $210.00 in Billed Charges for Rev 272 = $87.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH CANNULA,272,RC,27201238,CDM,,,,,,both,,,210.0000,31.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,189.00,,,,,,,54.2000,210.0000,percent of total billed charges,90% of $210.00 in Billed Charges for Rev 272 = $189.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH CANNULA,272,RC,27201238,CDM,,,,,,both,,,210.0000,31.5000,MEDCOST,MEDCOST VHN,99.94,,,,,,,54.2000,210.0000,percent of total billed charges,47.59% of $210.00 in Billed Charges for Rev 272 = $99.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH CANNULA,272,RC,27201238,CDM,,,,,,both,,,210.0000,31.5000,SENTARA HEALTH,SENTARA HEALTH,54.20,,,,,,,54.2000,210.0000,percent of total billed charges,25.81% of $210.00 in Billed Charges for Rev 272 = $54.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH CANNULA,272,RC,27201238,CDM,,,,,,both,,,210.0000,31.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",210.00,,,,,,,54.2000,210.0000,percent of total billed charges,100% of $210.00 in Billed Charges for Rev 272 = $210.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH CANNULA,272,RC,27201238,CDM,,,,,,both,,,210.0000,31.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,105.00,,,,,,,54.2000,210.0000,percent of total billed charges,Rev 272 $210.00 in Billed Charges at 50% = $105.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH CANNULA,272,RC,27201238,CDM,,,,,,both,,,210.0000,31.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,67.83,,,,,,,54.2000,210.0000,other,32.3% of $210.00 in Billed Charges for Rev 272 = $67.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE SHILEY TRACH CANNULA,272,RC,27201238,CDM,,,,,,both,,,210.0000,31.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,64.47,,,,,,,54.2000,210.0000,other,30.7% of $210.00 in Billed Charges for Rev 272 = $64.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE SHILEY TRACH CANNULA,272,RC,27201238,CDM,,,,,,both,,,210.0000,31.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,67.83,,,,,,,54.2000,210.0000,percent of total billed charges,32.3% of $210.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SHILEY TRACH CANNULA,272,RC,27201238,CDM,,,,,,both,,,210.0000,31.5000,WELLCARE,WELLCARE MEDICAID,210.00,,,,,,,54.2000,210.0000,percent of total billed charges,100% of $210.00 in Billed Charges for Rev 272 = $210.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORED CORONARY CARE ROOM DLY,214,RC,21400001,CDM,,,,,,inpatient,,,3588.0000,538.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,121.7600,3588.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC MONITORED CORONARY CARE ROOM DLY,214,RC,21400001,CDM,,,,,,inpatient,,,3588.0000,538.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3229.20,,,,,,,121.7600,3588.0000,percent of total billed charges,"90% of $3,588.00 in Billed Charges for Rev 214 = $3,229.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MONITORED CORONARY CARE ROOM DLY,214,RC,21400001,CDM,,,,,,inpatient,,,3588.0000,538.2000,MEDCOST,MEDCOST VHN,1707.53,,,,,,,121.7600,3588.0000,percent of total billed charges,"47.59% of $3,588.00 in Billed Charges for Rev 214 = $1,707.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MONITORED CORONARY CARE ROOM DLY,214,RC,21400001,CDM,,,,,,inpatient,,,3588.0000,538.2000,SENTARA HEALTH,SENTARA HEALTH,1337.61,,,,,,,121.7600,3588.0000,percent of total billed charges,"37.28% of $3,588.00 in Billed Charges for Rev 214 = $1,337.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MONITORED CORONARY CARE ROOM DLY,214,RC,21400001,CDM,,,,,,inpatient,,,3588.0000,538.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3588.00,,,,,,,121.7600,3588.0000,percent of total billed charges,"100% of $3,588.00 in Billed Charges for Rev 214 = $3,588.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MONITORED ROOM DLY,206,RC,20600001,CDM,,,,,,inpatient,,,3588.0000,538.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,121.7600,3588.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC MONITORED ROOM DLY,206,RC,20600001,CDM,,,,,,inpatient,,,3588.0000,538.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3229.20,,,,,,,121.7600,3588.0000,percent of total billed charges,"90% of $3,588.00 in Billed Charges for Rev 206 = $3,229.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MONITORED ROOM DLY,206,RC,20600001,CDM,,,,,,inpatient,,,3588.0000,538.2000,MEDCOST,MEDCOST VHN,1707.53,,,,,,,121.7600,3588.0000,percent of total billed charges,"47.59% of $3,588.00 in Billed Charges for Rev 206 = $1,707.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MONITORED ROOM DLY,206,RC,20600001,CDM,,,,,,inpatient,,,3588.0000,538.2000,SENTARA HEALTH,SENTARA HEALTH,1337.61,,,,,,,121.7600,3588.0000,percent of total billed charges,"37.28% of $3,588.00 in Billed Charges for Rev 206 = $1,337.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MONITORED ROOM DLY,206,RC,20600001,CDM,,,,,,inpatient,,,3588.0000,538.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3588.00,,,,,,,121.7600,3588.0000,percent of total billed charges,"100% of $3,588.00 in Billed Charges for Rev 206 = $3,588.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET CRICOTHYROTOMY CATH 4MM CT,272,RC,27202275,CDM,,,,,,both,,,1676.0000,251.4000,AETNA,AETNA,715.65,,,,,,,432.5800,1676.0000,percent of total billed charges,"42.7% of $1,676.00 in Billed Charges for Rev 272 = $715.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET CRICOTHYROTOMY CATH 4MM CT,272,RC,27202275,CDM,,,,,,both,,,1676.0000,251.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1173.20,,,,,,,432.5800,1676.0000,percent of total billed charges,"Rev 272 $1,676.00 in Billed Charges at 70% = $1,173.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET CRICOTHYROTOMY CATH 4MM CT,272,RC,27202275,CDM,,,,,,both,,,1676.0000,251.4000,CIGNA HEALTHCARE,CIGNA HMO,698.89,,,,,,,432.5800,1676.0000,percent of total billed charges,"41.7% of $1,676.00 in Billed Charges for Rev 272 = $698.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET CRICOTHYROTOMY CATH 4MM CT,272,RC,27202275,CDM,,,,,,both,,,1676.0000,251.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,777.66,,,,,,,432.5800,1676.0000,percent of total billed charges,"46.4% of $1,676.00 in Billed Charges for Rev 272 = $777.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET CRICOTHYROTOMY CATH 4MM CT,272,RC,27202275,CDM,,,,,,both,,,1676.0000,251.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,698.89,,,,,,,432.5800,1676.0000,percent of total billed charges,"41.7% of $1,676.00 in Billed Charges for Rev 272 = $698.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET CRICOTHYROTOMY CATH 4MM CT,272,RC,27202275,CDM,,,,,,both,,,1676.0000,251.4000,CIGNA HEALTHCARE,CIGNA PPO,698.89,,,,,,,432.5800,1676.0000,percent of total billed charges,"41.7% of $1,676.00 in Billed Charges for Rev 272 = $698.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET CRICOTHYROTOMY CATH 4MM CT,272,RC,27202275,CDM,,,,,,both,,,1676.0000,251.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1508.40,,,,,,,432.5800,1676.0000,percent of total billed charges,"90% of $1,676.00 in Billed Charges for Rev 272 = $1,508.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET CRICOTHYROTOMY CATH 4MM CT,272,RC,27202275,CDM,,,,,,both,,,1676.0000,251.4000,MEDCOST,MEDCOST VHN,797.61,,,,,,,432.5800,1676.0000,percent of total billed charges,"47.59% of $1,676.00 in Billed Charges for Rev 272 = $797.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET CRICOTHYROTOMY CATH 4MM CT,272,RC,27202275,CDM,,,,,,both,,,1676.0000,251.4000,SENTARA HEALTH,SENTARA HEALTH,432.58,,,,,,,432.5800,1676.0000,percent of total billed charges,"25.81% of $1,676.00 in Billed Charges for Rev 272 = $432.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET CRICOTHYROTOMY CATH 4MM CT,272,RC,27202275,CDM,,,,,,both,,,1676.0000,251.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1676.00,,,,,,,432.5800,1676.0000,percent of total billed charges,"100% of $1,676.00 in Billed Charges for Rev 272 = $1,676.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET CRICOTHYROTOMY CATH 4MM CT,272,RC,27202275,CDM,,,,,,both,,,1676.0000,251.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,838.00,,,,,,,432.5800,1676.0000,percent of total billed charges,"Rev 272 $1,676.00 in Billed Charges at 50% = $838.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET CRICOTHYROTOMY CATH 4MM CT,272,RC,27202275,CDM,,,,,,both,,,1676.0000,251.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,541.35,,,,,,,432.5800,1676.0000,other,"32.3% of $1,676.00 in Billed Charges for Rev 272 = $541.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SET CRICOTHYROTOMY CATH 4MM CT,272,RC,27202275,CDM,,,,,,both,,,1676.0000,251.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,514.53,,,,,,,432.5800,1676.0000,other,"30.7% of $1,676.00 in Billed Charges for Rev 272 = $514.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SET CRICOTHYROTOMY CATH 4MM CT,272,RC,27202275,CDM,,,,,,both,,,1676.0000,251.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,541.35,,,,,,,432.5800,1676.0000,percent of total billed charges,"32.3% of $1,676.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET CRICOTHYROTOMY CATH 4MM CT,272,RC,27202275,CDM,,,,,,both,,,1676.0000,251.4000,WELLCARE,WELLCARE MEDICAID,1676.00,,,,,,,432.5800,1676.0000,percent of total billed charges,"100% of $1,676.00 in Billed Charges for Rev 272 = $1,676.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET DRAIN ATRIUM CHEST DRAIN,272,RC,27201036,CDM,,,,,,both,,,154.0000,23.1000,AETNA,AETNA,65.76,,,,,,,39.7500,154.0000,percent of total billed charges,42.7% of $154.00 in Billed Charges for Rev 272 = $65.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN ATRIUM CHEST DRAIN,272,RC,27201036,CDM,,,,,,both,,,154.0000,23.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,107.80,,,,,,,39.7500,154.0000,percent of total billed charges,Rev 272 $154.00 in Billed Charges at 70% = $107.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN ATRIUM CHEST DRAIN,272,RC,27201036,CDM,,,,,,both,,,154.0000,23.1000,CIGNA HEALTHCARE,CIGNA HMO,64.22,,,,,,,39.7500,154.0000,percent of total billed charges,41.7% of $154.00 in Billed Charges for Rev 272 = $64.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN ATRIUM CHEST DRAIN,272,RC,27201036,CDM,,,,,,both,,,154.0000,23.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,71.46,,,,,,,39.7500,154.0000,percent of total billed charges,46.4% of $154.00 in Billed Charges for Rev 272 = $71.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN ATRIUM CHEST DRAIN,272,RC,27201036,CDM,,,,,,both,,,154.0000,23.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,64.22,,,,,,,39.7500,154.0000,percent of total billed charges,41.7% of $154.00 in Billed Charges for Rev 272 = $64.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN ATRIUM CHEST DRAIN,272,RC,27201036,CDM,,,,,,both,,,154.0000,23.1000,CIGNA HEALTHCARE,CIGNA PPO,64.22,,,,,,,39.7500,154.0000,percent of total billed charges,41.7% of $154.00 in Billed Charges for Rev 272 = $64.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN ATRIUM CHEST DRAIN,272,RC,27201036,CDM,,,,,,both,,,154.0000,23.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,138.60,,,,,,,39.7500,154.0000,percent of total billed charges,90% of $154.00 in Billed Charges for Rev 272 = $138.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN ATRIUM CHEST DRAIN,272,RC,27201036,CDM,,,,,,both,,,154.0000,23.1000,MEDCOST,MEDCOST VHN,73.29,,,,,,,39.7500,154.0000,percent of total billed charges,47.59% of $154.00 in Billed Charges for Rev 272 = $73.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN ATRIUM CHEST DRAIN,272,RC,27201036,CDM,,,,,,both,,,154.0000,23.1000,SENTARA HEALTH,SENTARA HEALTH,39.75,,,,,,,39.7500,154.0000,percent of total billed charges,25.81% of $154.00 in Billed Charges for Rev 272 = $39.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN ATRIUM CHEST DRAIN,272,RC,27201036,CDM,,,,,,both,,,154.0000,23.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",154.00,,,,,,,39.7500,154.0000,percent of total billed charges,100% of $154.00 in Billed Charges for Rev 272 = $154.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN ATRIUM CHEST DRAIN,272,RC,27201036,CDM,,,,,,both,,,154.0000,23.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,77.00,,,,,,,39.7500,154.0000,percent of total billed charges,Rev 272 $154.00 in Billed Charges at 50% = $77.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN ATRIUM CHEST DRAIN,272,RC,27201036,CDM,,,,,,both,,,154.0000,23.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,49.74,,,,,,,39.7500,154.0000,other,32.3% of $154.00 in Billed Charges for Rev 272 = $49.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SET DRAIN ATRIUM CHEST DRAIN,272,RC,27201036,CDM,,,,,,both,,,154.0000,23.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,47.28,,,,,,,39.7500,154.0000,other,30.7% of $154.00 in Billed Charges for Rev 272 = $47.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SET DRAIN ATRIUM CHEST DRAIN,272,RC,27201036,CDM,,,,,,both,,,154.0000,23.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,49.74,,,,,,,39.7500,154.0000,percent of total billed charges,32.3% of $154.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN ATRIUM CHEST DRAIN,272,RC,27201036,CDM,,,,,,both,,,154.0000,23.1000,WELLCARE,WELLCARE MEDICAID,154.00,,,,,,,39.7500,154.0000,percent of total billed charges,100% of $154.00 in Billed Charges for Rev 272 = $154.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN EXT. AND MONITORING,272,RC,27202276,CDM,,,,,,both,,,3715.0000,557.2500,AETNA,AETNA,1586.31,,,,,,,958.8400,3715.0000,percent of total billed charges,"42.7% of $3,715.00 in Billed Charges for Rev 272 = $1,586.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET DRAIN EXT. AND MONITORING,272,RC,27202276,CDM,,,,,,both,,,3715.0000,557.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2600.50,,,,,,,958.8400,3715.0000,percent of total billed charges,"Rev 272 $3,715.00 in Billed Charges at 70% = $2,600.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET DRAIN EXT. AND MONITORING,272,RC,27202276,CDM,,,,,,both,,,3715.0000,557.2500,CIGNA HEALTHCARE,CIGNA HMO,1549.16,,,,,,,958.8400,3715.0000,percent of total billed charges,"41.7% of $3,715.00 in Billed Charges for Rev 272 = $1,549.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET DRAIN EXT. AND MONITORING,272,RC,27202276,CDM,,,,,,both,,,3715.0000,557.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1723.76,,,,,,,958.8400,3715.0000,percent of total billed charges,"46.4% of $3,715.00 in Billed Charges for Rev 272 = $1,723.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET DRAIN EXT. AND MONITORING,272,RC,27202276,CDM,,,,,,both,,,3715.0000,557.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1549.16,,,,,,,958.8400,3715.0000,percent of total billed charges,"41.7% of $3,715.00 in Billed Charges for Rev 272 = $1,549.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET DRAIN EXT. AND MONITORING,272,RC,27202276,CDM,,,,,,both,,,3715.0000,557.2500,CIGNA HEALTHCARE,CIGNA PPO,1549.16,,,,,,,958.8400,3715.0000,percent of total billed charges,"41.7% of $3,715.00 in Billed Charges for Rev 272 = $1,549.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET DRAIN EXT. AND MONITORING,272,RC,27202276,CDM,,,,,,both,,,3715.0000,557.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3343.50,,,,,,,958.8400,3715.0000,percent of total billed charges,"90% of $3,715.00 in Billed Charges for Rev 272 = $3,343.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET DRAIN EXT. AND MONITORING,272,RC,27202276,CDM,,,,,,both,,,3715.0000,557.2500,MEDCOST,MEDCOST VHN,1767.97,,,,,,,958.8400,3715.0000,percent of total billed charges,"47.59% of $3,715.00 in Billed Charges for Rev 272 = $1,767.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET DRAIN EXT. AND MONITORING,272,RC,27202276,CDM,,,,,,both,,,3715.0000,557.2500,SENTARA HEALTH,SENTARA HEALTH,958.84,,,,,,,958.8400,3715.0000,percent of total billed charges,"25.81% of $3,715.00 in Billed Charges for Rev 272 = $958.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET DRAIN EXT. AND MONITORING,272,RC,27202276,CDM,,,,,,both,,,3715.0000,557.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3715.00,,,,,,,958.8400,3715.0000,percent of total billed charges,"100% of $3,715.00 in Billed Charges for Rev 272 = $3,715.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET DRAIN EXT. AND MONITORING,272,RC,27202276,CDM,,,,,,both,,,3715.0000,557.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1857.50,,,,,,,958.8400,3715.0000,percent of total billed charges,"Rev 272 $3,715.00 in Billed Charges at 50% = $1,857.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET DRAIN EXT. AND MONITORING,272,RC,27202276,CDM,,,,,,both,,,3715.0000,557.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1199.95,,,,,,,958.8400,3715.0000,other,"32.3% of $3,715.00 in Billed Charges for Rev 272 = $1,199.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SET DRAIN EXT. AND MONITORING,272,RC,27202276,CDM,,,,,,both,,,3715.0000,557.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1140.51,,,,,,,958.8400,3715.0000,other,"30.7% of $3,715.00 in Billed Charges for Rev 272 = $1,140.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SET DRAIN EXT. AND MONITORING,272,RC,27202276,CDM,,,,,,both,,,3715.0000,557.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1199.95,,,,,,,958.8400,3715.0000,percent of total billed charges,"32.3% of $3,715.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET DRAIN EXT. AND MONITORING,272,RC,27202276,CDM,,,,,,both,,,3715.0000,557.2500,WELLCARE,WELLCARE MEDICAID,3715.00,,,,,,,958.8400,3715.0000,percent of total billed charges,"100% of $3,715.00 in Billed Charges for Rev 272 = $3,715.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBE SUMP 14FR NG,272,RC,27201241,CDM,,,,,,both,,,18.0000,2.7000,AETNA,AETNA,7.69,,,,,,,4.6500,18.0000,percent of total billed charges,42.7% of $18.00 in Billed Charges for Rev 272 = $7.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SUMP 14FR NG,272,RC,27201241,CDM,,,,,,both,,,18.0000,2.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,12.60,,,,,,,4.6500,18.0000,percent of total billed charges,Rev 272 $18.00 in Billed Charges at 70% = $12.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SUMP 14FR NG,272,RC,27201241,CDM,,,,,,both,,,18.0000,2.7000,CIGNA HEALTHCARE,CIGNA HMO,7.51,,,,,,,4.6500,18.0000,percent of total billed charges,41.7% of $18.00 in Billed Charges for Rev 272 = $7.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SUMP 14FR NG,272,RC,27201241,CDM,,,,,,both,,,18.0000,2.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8.35,,,,,,,4.6500,18.0000,percent of total billed charges,46.4% of $18.00 in Billed Charges for Rev 272 = $8.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SUMP 14FR NG,272,RC,27201241,CDM,,,,,,both,,,18.0000,2.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7.51,,,,,,,4.6500,18.0000,percent of total billed charges,41.7% of $18.00 in Billed Charges for Rev 272 = $7.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SUMP 14FR NG,272,RC,27201241,CDM,,,,,,both,,,18.0000,2.7000,CIGNA HEALTHCARE,CIGNA PPO,7.51,,,,,,,4.6500,18.0000,percent of total billed charges,41.7% of $18.00 in Billed Charges for Rev 272 = $7.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SUMP 14FR NG,272,RC,27201241,CDM,,,,,,both,,,18.0000,2.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,16.20,,,,,,,4.6500,18.0000,percent of total billed charges,90% of $18.00 in Billed Charges for Rev 272 = $16.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SUMP 14FR NG,272,RC,27201241,CDM,,,,,,both,,,18.0000,2.7000,MEDCOST,MEDCOST VHN,8.57,,,,,,,4.6500,18.0000,percent of total billed charges,47.59% of $18.00 in Billed Charges for Rev 272 = $8.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SUMP 14FR NG,272,RC,27201241,CDM,,,,,,both,,,18.0000,2.7000,SENTARA HEALTH,SENTARA HEALTH,4.65,,,,,,,4.6500,18.0000,percent of total billed charges,25.81% of $18.00 in Billed Charges for Rev 272 = $4.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SUMP 14FR NG,272,RC,27201241,CDM,,,,,,both,,,18.0000,2.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",18.00,,,,,,,4.6500,18.0000,percent of total billed charges,100% of $18.00 in Billed Charges for Rev 272 = $18.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SUMP 14FR NG,272,RC,27201241,CDM,,,,,,both,,,18.0000,2.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9.00,,,,,,,4.6500,18.0000,percent of total billed charges,Rev 272 $18.00 in Billed Charges at 50% = $9.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SUMP 14FR NG,272,RC,27201241,CDM,,,,,,both,,,18.0000,2.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5.81,,,,,,,4.6500,18.0000,other,32.3% of $18.00 in Billed Charges for Rev 272 = $5.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE SUMP 14FR NG,272,RC,27201241,CDM,,,,,,both,,,18.0000,2.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,5.53,,,,,,,4.6500,18.0000,other,30.7% of $18.00 in Billed Charges for Rev 272 = $5.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE SUMP 14FR NG,272,RC,27201241,CDM,,,,,,both,,,18.0000,2.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,5.81,,,,,,,4.6500,18.0000,percent of total billed charges,32.3% of $18.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE SUMP 14FR NG,272,RC,27201241,CDM,,,,,,both,,,18.0000,2.7000,WELLCARE,WELLCARE MEDICAID,18.00,,,,,,,4.6500,18.0000,percent of total billed charges,100% of $18.00 in Billed Charges for Rev 272 = $18.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 7.0MM PROXIMAL XL,272,RC,27202323,CDM,,,,,,both,,,552.0000,82.8000,AETNA,AETNA,235.70,,,,,,,142.4700,552.0000,percent of total billed charges,42.7% of $552.00 in Billed Charges for Rev 272 = $235.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 7.0MM PROXIMAL XL,272,RC,27202323,CDM,,,,,,both,,,552.0000,82.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,386.40,,,,,,,142.4700,552.0000,percent of total billed charges,Rev 272 $552.00 in Billed Charges at 70% = $386.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 7.0MM PROXIMAL XL,272,RC,27202323,CDM,,,,,,both,,,552.0000,82.8000,CIGNA HEALTHCARE,CIGNA HMO,230.18,,,,,,,142.4700,552.0000,percent of total billed charges,41.7% of $552.00 in Billed Charges for Rev 272 = $230.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 7.0MM PROXIMAL XL,272,RC,27202323,CDM,,,,,,both,,,552.0000,82.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,256.13,,,,,,,142.4700,552.0000,percent of total billed charges,46.4% of $552.00 in Billed Charges for Rev 272 = $256.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 7.0MM PROXIMAL XL,272,RC,27202323,CDM,,,,,,both,,,552.0000,82.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,230.18,,,,,,,142.4700,552.0000,percent of total billed charges,41.7% of $552.00 in Billed Charges for Rev 272 = $230.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 7.0MM PROXIMAL XL,272,RC,27202323,CDM,,,,,,both,,,552.0000,82.8000,CIGNA HEALTHCARE,CIGNA PPO,230.18,,,,,,,142.4700,552.0000,percent of total billed charges,41.7% of $552.00 in Billed Charges for Rev 272 = $230.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 7.0MM PROXIMAL XL,272,RC,27202323,CDM,,,,,,both,,,552.0000,82.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,496.80,,,,,,,142.4700,552.0000,percent of total billed charges,90% of $552.00 in Billed Charges for Rev 272 = $496.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 7.0MM PROXIMAL XL,272,RC,27202323,CDM,,,,,,both,,,552.0000,82.8000,MEDCOST,MEDCOST VHN,262.70,,,,,,,142.4700,552.0000,percent of total billed charges,47.59% of $552.00 in Billed Charges for Rev 272 = $262.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 7.0MM PROXIMAL XL,272,RC,27202323,CDM,,,,,,both,,,552.0000,82.8000,SENTARA HEALTH,SENTARA HEALTH,142.47,,,,,,,142.4700,552.0000,percent of total billed charges,25.81% of $552.00 in Billed Charges for Rev 272 = $142.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 7.0MM PROXIMAL XL,272,RC,27202323,CDM,,,,,,both,,,552.0000,82.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",552.00,,,,,,,142.4700,552.0000,percent of total billed charges,100% of $552.00 in Billed Charges for Rev 272 = $552.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 7.0MM PROXIMAL XL,272,RC,27202323,CDM,,,,,,both,,,552.0000,82.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,276.00,,,,,,,142.4700,552.0000,percent of total billed charges,Rev 272 $552.00 in Billed Charges at 50% = $276.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 7.0MM PROXIMAL XL,272,RC,27202323,CDM,,,,,,both,,,552.0000,82.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,178.30,,,,,,,142.4700,552.0000,other,32.3% of $552.00 in Billed Charges for Rev 272 = $178.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE TRACH 7.0MM PROXIMAL XL,272,RC,27202323,CDM,,,,,,both,,,552.0000,82.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,169.46,,,,,,,142.4700,552.0000,other,30.7% of $552.00 in Billed Charges for Rev 272 = $169.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE TRACH 7.0MM PROXIMAL XL,272,RC,27202323,CDM,,,,,,both,,,552.0000,82.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,178.30,,,,,,,142.4700,552.0000,percent of total billed charges,32.3% of $552.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH 7.0MM PROXIMAL XL,272,RC,27202323,CDM,,,,,,both,,,552.0000,82.8000,WELLCARE,WELLCARE MEDICAID,552.00,,,,,,,142.4700,552.0000,percent of total billed charges,100% of $552.00 in Billed Charges for Rev 272 = $552.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED FEN 7.0,272,RC,27201246,CDM,,,,,,both,,,232.0000,34.8000,AETNA,AETNA,99.06,,,,,,,59.8800,232.0000,percent of total billed charges,42.7% of $232.00 in Billed Charges for Rev 272 = $99.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED FEN 7.0,272,RC,27201246,CDM,,,,,,both,,,232.0000,34.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,162.40,,,,,,,59.8800,232.0000,percent of total billed charges,Rev 272 $232.00 in Billed Charges at 70% = $162.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED FEN 7.0,272,RC,27201246,CDM,,,,,,both,,,232.0000,34.8000,CIGNA HEALTHCARE,CIGNA HMO,96.74,,,,,,,59.8800,232.0000,percent of total billed charges,41.7% of $232.00 in Billed Charges for Rev 272 = $96.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED FEN 7.0,272,RC,27201246,CDM,,,,,,both,,,232.0000,34.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,107.65,,,,,,,59.8800,232.0000,percent of total billed charges,46.4% of $232.00 in Billed Charges for Rev 272 = $107.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED FEN 7.0,272,RC,27201246,CDM,,,,,,both,,,232.0000,34.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,96.74,,,,,,,59.8800,232.0000,percent of total billed charges,41.7% of $232.00 in Billed Charges for Rev 272 = $96.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED FEN 7.0,272,RC,27201246,CDM,,,,,,both,,,232.0000,34.8000,CIGNA HEALTHCARE,CIGNA PPO,96.74,,,,,,,59.8800,232.0000,percent of total billed charges,41.7% of $232.00 in Billed Charges for Rev 272 = $96.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED FEN 7.0,272,RC,27201246,CDM,,,,,,both,,,232.0000,34.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,208.80,,,,,,,59.8800,232.0000,percent of total billed charges,90% of $232.00 in Billed Charges for Rev 272 = $208.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED FEN 7.0,272,RC,27201246,CDM,,,,,,both,,,232.0000,34.8000,MEDCOST,MEDCOST VHN,110.41,,,,,,,59.8800,232.0000,percent of total billed charges,47.59% of $232.00 in Billed Charges for Rev 272 = $110.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED FEN 7.0,272,RC,27201246,CDM,,,,,,both,,,232.0000,34.8000,SENTARA HEALTH,SENTARA HEALTH,59.88,,,,,,,59.8800,232.0000,percent of total billed charges,25.81% of $232.00 in Billed Charges for Rev 272 = $59.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED FEN 7.0,272,RC,27201246,CDM,,,,,,both,,,232.0000,34.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",232.00,,,,,,,59.8800,232.0000,percent of total billed charges,100% of $232.00 in Billed Charges for Rev 272 = $232.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED FEN 7.0,272,RC,27201246,CDM,,,,,,both,,,232.0000,34.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,116.00,,,,,,,59.8800,232.0000,percent of total billed charges,Rev 272 $232.00 in Billed Charges at 50% = $116.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED FEN 7.0,272,RC,27201246,CDM,,,,,,both,,,232.0000,34.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,74.94,,,,,,,59.8800,232.0000,other,32.3% of $232.00 in Billed Charges for Rev 272 = $74.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE TRACH CUFFED FEN 7.0,272,RC,27201246,CDM,,,,,,both,,,232.0000,34.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,71.22,,,,,,,59.8800,232.0000,other,30.7% of $232.00 in Billed Charges for Rev 272 = $71.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE TRACH CUFFED FEN 7.0,272,RC,27201246,CDM,,,,,,both,,,232.0000,34.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,74.94,,,,,,,59.8800,232.0000,percent of total billed charges,32.3% of $232.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH CUFFED FEN 7.0,272,RC,27201246,CDM,,,,,,both,,,232.0000,34.8000,WELLCARE,WELLCARE MEDICAID,232.00,,,,,,,59.8800,232.0000,percent of total billed charges,100% of $232.00 in Billed Charges for Rev 272 = $232.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH MUIR NON VENT PT #005,272,RC,27201251,CDM,,,,,,both,,,288.0000,43.2000,AETNA,AETNA,122.98,,,,,,,74.3300,288.0000,percent of total billed charges,42.7% of $288.00 in Billed Charges for Rev 272 = $122.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH MUIR NON VENT PT #005,272,RC,27201251,CDM,,,,,,both,,,288.0000,43.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,201.60,,,,,,,74.3300,288.0000,percent of total billed charges,Rev 272 $288.00 in Billed Charges at 70% = $201.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH MUIR NON VENT PT #005,272,RC,27201251,CDM,,,,,,both,,,288.0000,43.2000,CIGNA HEALTHCARE,CIGNA HMO,120.10,,,,,,,74.3300,288.0000,percent of total billed charges,41.7% of $288.00 in Billed Charges for Rev 272 = $120.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH MUIR NON VENT PT #005,272,RC,27201251,CDM,,,,,,both,,,288.0000,43.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,133.63,,,,,,,74.3300,288.0000,percent of total billed charges,46.4% of $288.00 in Billed Charges for Rev 272 = $133.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH MUIR NON VENT PT #005,272,RC,27201251,CDM,,,,,,both,,,288.0000,43.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,120.10,,,,,,,74.3300,288.0000,percent of total billed charges,41.7% of $288.00 in Billed Charges for Rev 272 = $120.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH MUIR NON VENT PT #005,272,RC,27201251,CDM,,,,,,both,,,288.0000,43.2000,CIGNA HEALTHCARE,CIGNA PPO,120.10,,,,,,,74.3300,288.0000,percent of total billed charges,41.7% of $288.00 in Billed Charges for Rev 272 = $120.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH MUIR NON VENT PT #005,272,RC,27201251,CDM,,,,,,both,,,288.0000,43.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,259.20,,,,,,,74.3300,288.0000,percent of total billed charges,90% of $288.00 in Billed Charges for Rev 272 = $259.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH MUIR NON VENT PT #005,272,RC,27201251,CDM,,,,,,both,,,288.0000,43.2000,MEDCOST,MEDCOST VHN,137.06,,,,,,,74.3300,288.0000,percent of total billed charges,47.59% of $288.00 in Billed Charges for Rev 272 = $137.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH MUIR NON VENT PT #005,272,RC,27201251,CDM,,,,,,both,,,288.0000,43.2000,SENTARA HEALTH,SENTARA HEALTH,74.33,,,,,,,74.3300,288.0000,percent of total billed charges,25.81% of $288.00 in Billed Charges for Rev 272 = $74.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH MUIR NON VENT PT #005,272,RC,27201251,CDM,,,,,,both,,,288.0000,43.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",288.00,,,,,,,74.3300,288.0000,percent of total billed charges,100% of $288.00 in Billed Charges for Rev 272 = $288.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH MUIR NON VENT PT #005,272,RC,27201251,CDM,,,,,,both,,,288.0000,43.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,144.00,,,,,,,74.3300,288.0000,percent of total billed charges,Rev 272 $288.00 in Billed Charges at 50% = $144.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH MUIR NON VENT PT #005,272,RC,27201251,CDM,,,,,,both,,,288.0000,43.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,93.02,,,,,,,74.3300,288.0000,other,32.3% of $288.00 in Billed Charges for Rev 272 = $93.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE TRACH MUIR NON VENT PT #005,272,RC,27201251,CDM,,,,,,both,,,288.0000,43.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,88.42,,,,,,,74.3300,288.0000,other,30.7% of $288.00 in Billed Charges for Rev 272 = $88.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE TRACH MUIR NON VENT PT #005,272,RC,27201251,CDM,,,,,,both,,,288.0000,43.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,93.02,,,,,,,74.3300,288.0000,percent of total billed charges,32.3% of $288.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE TRACH MUIR NON VENT PT #005,272,RC,27201251,CDM,,,,,,both,,,288.0000,43.2000,WELLCARE,WELLCARE MEDICAID,288.00,,,,,,,74.3300,288.0000,percent of total billed charges,100% of $288.00 in Billed Charges for Rev 272 = $288.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBING COOL POINT 85785,272,RC,27201256,CDM,,,,,,both,,,519.0000,77.8500,AETNA,AETNA,221.61,,,,,,,133.9500,519.0000,percent of total billed charges,42.7% of $519.00 in Billed Charges for Rev 272 = $221.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBING COOL POINT 85785,272,RC,27201256,CDM,,,,,,both,,,519.0000,77.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,363.30,,,,,,,133.9500,519.0000,percent of total billed charges,Rev 272 $519.00 in Billed Charges at 70% = $363.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBING COOL POINT 85785,272,RC,27201256,CDM,,,,,,both,,,519.0000,77.8500,CIGNA HEALTHCARE,CIGNA HMO,216.42,,,,,,,133.9500,519.0000,percent of total billed charges,41.7% of $519.00 in Billed Charges for Rev 272 = $216.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBING COOL POINT 85785,272,RC,27201256,CDM,,,,,,both,,,519.0000,77.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,240.82,,,,,,,133.9500,519.0000,percent of total billed charges,46.4% of $519.00 in Billed Charges for Rev 272 = $240.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBING COOL POINT 85785,272,RC,27201256,CDM,,,,,,both,,,519.0000,77.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,216.42,,,,,,,133.9500,519.0000,percent of total billed charges,41.7% of $519.00 in Billed Charges for Rev 272 = $216.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBING COOL POINT 85785,272,RC,27201256,CDM,,,,,,both,,,519.0000,77.8500,CIGNA HEALTHCARE,CIGNA PPO,216.42,,,,,,,133.9500,519.0000,percent of total billed charges,41.7% of $519.00 in Billed Charges for Rev 272 = $216.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBING COOL POINT 85785,272,RC,27201256,CDM,,,,,,both,,,519.0000,77.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,467.10,,,,,,,133.9500,519.0000,percent of total billed charges,90% of $519.00 in Billed Charges for Rev 272 = $467.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBING COOL POINT 85785,272,RC,27201256,CDM,,,,,,both,,,519.0000,77.8500,MEDCOST,MEDCOST VHN,246.99,,,,,,,133.9500,519.0000,percent of total billed charges,47.59% of $519.00 in Billed Charges for Rev 272 = $246.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBING COOL POINT 85785,272,RC,27201256,CDM,,,,,,both,,,519.0000,77.8500,SENTARA HEALTH,SENTARA HEALTH,133.95,,,,,,,133.9500,519.0000,percent of total billed charges,25.81% of $519.00 in Billed Charges for Rev 272 = $133.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBING COOL POINT 85785,272,RC,27201256,CDM,,,,,,both,,,519.0000,77.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",519.00,,,,,,,133.9500,519.0000,percent of total billed charges,100% of $519.00 in Billed Charges for Rev 272 = $519.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBING COOL POINT 85785,272,RC,27201256,CDM,,,,,,both,,,519.0000,77.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,259.50,,,,,,,133.9500,519.0000,percent of total billed charges,Rev 272 $519.00 in Billed Charges at 50% = $259.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBING COOL POINT 85785,272,RC,27201256,CDM,,,,,,both,,,519.0000,77.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,167.64,,,,,,,133.9500,519.0000,other,32.3% of $519.00 in Billed Charges for Rev 272 = $167.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBING COOL POINT 85785,272,RC,27201256,CDM,,,,,,both,,,519.0000,77.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,159.33,,,,,,,133.9500,519.0000,other,30.7% of $519.00 in Billed Charges for Rev 272 = $159.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBING COOL POINT 85785,272,RC,27201256,CDM,,,,,,both,,,519.0000,77.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,167.64,,,,,,,133.9500,519.0000,percent of total billed charges,32.3% of $519.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBING COOL POINT 85785,272,RC,27201256,CDM,,,,,,both,,,519.0000,77.8500,WELLCARE,WELLCARE MEDICAID,519.00,,,,,,,133.9500,519.0000,percent of total billed charges,100% of $519.00 in Billed Charges for Rev 272 = $519.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET ENTEROCLYSIS CK,272,RC,27201037,CDM,,,,,,both,,,609.0000,91.3500,AETNA,AETNA,260.04,,,,,,,157.1800,609.0000,percent of total billed charges,42.7% of $609.00 in Billed Charges for Rev 272 = $260.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET ENTEROCLYSIS CK,272,RC,27201037,CDM,,,,,,both,,,609.0000,91.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,426.30,,,,,,,157.1800,609.0000,percent of total billed charges,Rev 272 $609.00 in Billed Charges at 70% = $426.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET ENTEROCLYSIS CK,272,RC,27201037,CDM,,,,,,both,,,609.0000,91.3500,CIGNA HEALTHCARE,CIGNA HMO,253.95,,,,,,,157.1800,609.0000,percent of total billed charges,41.7% of $609.00 in Billed Charges for Rev 272 = $253.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET ENTEROCLYSIS CK,272,RC,27201037,CDM,,,,,,both,,,609.0000,91.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,282.58,,,,,,,157.1800,609.0000,percent of total billed charges,46.4% of $609.00 in Billed Charges for Rev 272 = $282.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET ENTEROCLYSIS CK,272,RC,27201037,CDM,,,,,,both,,,609.0000,91.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,253.95,,,,,,,157.1800,609.0000,percent of total billed charges,41.7% of $609.00 in Billed Charges for Rev 272 = $253.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET ENTEROCLYSIS CK,272,RC,27201037,CDM,,,,,,both,,,609.0000,91.3500,CIGNA HEALTHCARE,CIGNA PPO,253.95,,,,,,,157.1800,609.0000,percent of total billed charges,41.7% of $609.00 in Billed Charges for Rev 272 = $253.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET ENTEROCLYSIS CK,272,RC,27201037,CDM,,,,,,both,,,609.0000,91.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,548.10,,,,,,,157.1800,609.0000,percent of total billed charges,90% of $609.00 in Billed Charges for Rev 272 = $548.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET ENTEROCLYSIS CK,272,RC,27201037,CDM,,,,,,both,,,609.0000,91.3500,MEDCOST,MEDCOST VHN,289.82,,,,,,,157.1800,609.0000,percent of total billed charges,47.59% of $609.00 in Billed Charges for Rev 272 = $289.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET ENTEROCLYSIS CK,272,RC,27201037,CDM,,,,,,both,,,609.0000,91.3500,SENTARA HEALTH,SENTARA HEALTH,157.18,,,,,,,157.1800,609.0000,percent of total billed charges,25.81% of $609.00 in Billed Charges for Rev 272 = $157.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET ENTEROCLYSIS CK,272,RC,27201037,CDM,,,,,,both,,,609.0000,91.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",609.00,,,,,,,157.1800,609.0000,percent of total billed charges,100% of $609.00 in Billed Charges for Rev 272 = $609.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET ENTEROCLYSIS CK,272,RC,27201037,CDM,,,,,,both,,,609.0000,91.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,304.50,,,,,,,157.1800,609.0000,percent of total billed charges,Rev 272 $609.00 in Billed Charges at 50% = $304.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET ENTEROCLYSIS CK,272,RC,27201037,CDM,,,,,,both,,,609.0000,91.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,196.71,,,,,,,157.1800,609.0000,other,32.3% of $609.00 in Billed Charges for Rev 272 = $196.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SET ENTEROCLYSIS CK,272,RC,27201037,CDM,,,,,,both,,,609.0000,91.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,186.96,,,,,,,157.1800,609.0000,other,30.7% of $609.00 in Billed Charges for Rev 272 = $186.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SET ENTEROCLYSIS CK,272,RC,27201037,CDM,,,,,,both,,,609.0000,91.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,196.71,,,,,,,157.1800,609.0000,percent of total billed charges,32.3% of $609.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET ENTEROCLYSIS CK,272,RC,27201037,CDM,,,,,,both,,,609.0000,91.3500,WELLCARE,WELLCARE MEDICAID,609.00,,,,,,,157.1800,609.0000,percent of total billed charges,100% of $609.00 in Billed Charges for Rev 272 = $609.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET PNEUMOTHORAX INTRODUCER 10.2 FR X 30CM,272,RC,27202277,CDM,,,,,,both,,,1381.0000,207.1500,AETNA,AETNA,589.69,,,,,,,356.4400,1381.0000,percent of total billed charges,"42.7% of $1,381.00 in Billed Charges for Rev 272 = $589.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PNEUMOTHORAX INTRODUCER 10.2 FR X 30CM,272,RC,27202277,CDM,,,,,,both,,,1381.0000,207.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,966.70,,,,,,,356.4400,1381.0000,percent of total billed charges,"Rev 272 $1,381.00 in Billed Charges at 70% = $966.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PNEUMOTHORAX INTRODUCER 10.2 FR X 30CM,272,RC,27202277,CDM,,,,,,both,,,1381.0000,207.1500,CIGNA HEALTHCARE,CIGNA HMO,575.88,,,,,,,356.4400,1381.0000,percent of total billed charges,"41.7% of $1,381.00 in Billed Charges for Rev 272 = $575.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PNEUMOTHORAX INTRODUCER 10.2 FR X 30CM,272,RC,27202277,CDM,,,,,,both,,,1381.0000,207.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,640.78,,,,,,,356.4400,1381.0000,percent of total billed charges,"46.4% of $1,381.00 in Billed Charges for Rev 272 = $640.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PNEUMOTHORAX INTRODUCER 10.2 FR X 30CM,272,RC,27202277,CDM,,,,,,both,,,1381.0000,207.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,575.88,,,,,,,356.4400,1381.0000,percent of total billed charges,"41.7% of $1,381.00 in Billed Charges for Rev 272 = $575.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PNEUMOTHORAX INTRODUCER 10.2 FR X 30CM,272,RC,27202277,CDM,,,,,,both,,,1381.0000,207.1500,CIGNA HEALTHCARE,CIGNA PPO,575.88,,,,,,,356.4400,1381.0000,percent of total billed charges,"41.7% of $1,381.00 in Billed Charges for Rev 272 = $575.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PNEUMOTHORAX INTRODUCER 10.2 FR X 30CM,272,RC,27202277,CDM,,,,,,both,,,1381.0000,207.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1242.90,,,,,,,356.4400,1381.0000,percent of total billed charges,"90% of $1,381.00 in Billed Charges for Rev 272 = $1,242.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PNEUMOTHORAX INTRODUCER 10.2 FR X 30CM,272,RC,27202277,CDM,,,,,,both,,,1381.0000,207.1500,MEDCOST,MEDCOST VHN,657.22,,,,,,,356.4400,1381.0000,percent of total billed charges,"47.59% of $1,381.00 in Billed Charges for Rev 272 = $657.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PNEUMOTHORAX INTRODUCER 10.2 FR X 30CM,272,RC,27202277,CDM,,,,,,both,,,1381.0000,207.1500,SENTARA HEALTH,SENTARA HEALTH,356.44,,,,,,,356.4400,1381.0000,percent of total billed charges,"25.81% of $1,381.00 in Billed Charges for Rev 272 = $356.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PNEUMOTHORAX INTRODUCER 10.2 FR X 30CM,272,RC,27202277,CDM,,,,,,both,,,1381.0000,207.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1381.00,,,,,,,356.4400,1381.0000,percent of total billed charges,"100% of $1,381.00 in Billed Charges for Rev 272 = $1,381.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PNEUMOTHORAX INTRODUCER 10.2 FR X 30CM,272,RC,27202277,CDM,,,,,,both,,,1381.0000,207.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,690.50,,,,,,,356.4400,1381.0000,percent of total billed charges,"Rev 272 $1,381.00 in Billed Charges at 50% = $690.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PNEUMOTHORAX INTRODUCER 10.2 FR X 30CM,272,RC,27202277,CDM,,,,,,both,,,1381.0000,207.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,446.06,,,,,,,356.4400,1381.0000,other,"32.3% of $1,381.00 in Billed Charges for Rev 272 = $446.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SET PNEUMOTHORAX INTRODUCER 10.2 FR X 30CM,272,RC,27202277,CDM,,,,,,both,,,1381.0000,207.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,423.97,,,,,,,356.4400,1381.0000,other,"30.7% of $1,381.00 in Billed Charges for Rev 272 = $423.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SET PNEUMOTHORAX INTRODUCER 10.2 FR X 30CM,272,RC,27202277,CDM,,,,,,both,,,1381.0000,207.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,446.06,,,,,,,356.4400,1381.0000,percent of total billed charges,"32.3% of $1,381.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PNEUMOTHORAX INTRODUCER 10.2 FR X 30CM,272,RC,27202277,CDM,,,,,,both,,,1381.0000,207.1500,WELLCARE,WELLCARE MEDICAID,1381.00,,,,,,,356.4400,1381.0000,percent of total billed charges,"100% of $1,381.00 in Billed Charges for Rev 272 = $1,381.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PRISMAFLEX ST-100,272,RC,27202232,CDM,,,,,,both,,,9432.0000,1414.8000,AETNA,AETNA,4027.46,,,,,,,2434.4000,9432.0000,percent of total billed charges,"42.7% of $9,432.00 in Billed Charges for Rev 272 = $4,027.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PRISMAFLEX ST-100,272,RC,27202232,CDM,,,,,,both,,,9432.0000,1414.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6602.40,,,,,,,2434.4000,9432.0000,percent of total billed charges,"Rev 272 $9,432.00 in Billed Charges at 70% = $6,602.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PRISMAFLEX ST-100,272,RC,27202232,CDM,,,,,,both,,,9432.0000,1414.8000,CIGNA HEALTHCARE,CIGNA HMO,3933.14,,,,,,,2434.4000,9432.0000,percent of total billed charges,"41.7% of $9,432.00 in Billed Charges for Rev 272 = $3,933.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PRISMAFLEX ST-100,272,RC,27202232,CDM,,,,,,both,,,9432.0000,1414.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4376.45,,,,,,,2434.4000,9432.0000,percent of total billed charges,"46.4% of $9,432.00 in Billed Charges for Rev 272 = $4,376.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PRISMAFLEX ST-100,272,RC,27202232,CDM,,,,,,both,,,9432.0000,1414.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3933.14,,,,,,,2434.4000,9432.0000,percent of total billed charges,"41.7% of $9,432.00 in Billed Charges for Rev 272 = $3,933.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PRISMAFLEX ST-100,272,RC,27202232,CDM,,,,,,both,,,9432.0000,1414.8000,CIGNA HEALTHCARE,CIGNA PPO,3933.14,,,,,,,2434.4000,9432.0000,percent of total billed charges,"41.7% of $9,432.00 in Billed Charges for Rev 272 = $3,933.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PRISMAFLEX ST-100,272,RC,27202232,CDM,,,,,,both,,,9432.0000,1414.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8488.80,,,,,,,2434.4000,9432.0000,percent of total billed charges,"90% of $9,432.00 in Billed Charges for Rev 272 = $8,488.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PRISMAFLEX ST-100,272,RC,27202232,CDM,,,,,,both,,,9432.0000,1414.8000,MEDCOST,MEDCOST VHN,4488.69,,,,,,,2434.4000,9432.0000,percent of total billed charges,"47.59% of $9,432.00 in Billed Charges for Rev 272 = $4,488.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PRISMAFLEX ST-100,272,RC,27202232,CDM,,,,,,both,,,9432.0000,1414.8000,SENTARA HEALTH,SENTARA HEALTH,2434.40,,,,,,,2434.4000,9432.0000,percent of total billed charges,"25.81% of $9,432.00 in Billed Charges for Rev 272 = $2,434.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PRISMAFLEX ST-100,272,RC,27202232,CDM,,,,,,both,,,9432.0000,1414.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9432.00,,,,,,,2434.4000,9432.0000,percent of total billed charges,"100% of $9,432.00 in Billed Charges for Rev 272 = $9,432.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PRISMAFLEX ST-100,272,RC,27202232,CDM,,,,,,both,,,9432.0000,1414.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4716.00,,,,,,,2434.4000,9432.0000,percent of total billed charges,"Rev 272 $9,432.00 in Billed Charges at 50% = $4,716.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PRISMAFLEX ST-100,272,RC,27202232,CDM,,,,,,both,,,9432.0000,1414.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3046.54,,,,,,,2434.4000,9432.0000,other,"32.3% of $9,432.00 in Billed Charges for Rev 272 = $3,046.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SET PRISMAFLEX ST-100,272,RC,27202232,CDM,,,,,,both,,,9432.0000,1414.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2895.62,,,,,,,2434.4000,9432.0000,other,"30.7% of $9,432.00 in Billed Charges for Rev 272 = $2,895.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SET PRISMAFLEX ST-100,272,RC,27202232,CDM,,,,,,both,,,9432.0000,1414.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,3046.54,,,,,,,2434.4000,9432.0000,percent of total billed charges,"32.3% of $9,432.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET PRISMAFLEX ST-100,272,RC,27202232,CDM,,,,,,both,,,9432.0000,1414.8000,WELLCARE,WELLCARE MEDICAID,9432.00,,,,,,,2434.4000,9432.0000,percent of total billed charges,"100% of $9,432.00 in Billed Charges for Rev 272 = $9,432.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET QUICK PRESSURE MONITOR 295,272,RC,27202278,CDM,,,,,,both,,,1281.0000,192.1500,AETNA,AETNA,546.99,,,,,,,330.6300,1281.0000,percent of total billed charges,"42.7% of $1,281.00 in Billed Charges for Rev 272 = $546.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET QUICK PRESSURE MONITOR 295,272,RC,27202278,CDM,,,,,,both,,,1281.0000,192.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,896.70,,,,,,,330.6300,1281.0000,percent of total billed charges,"Rev 272 $1,281.00 in Billed Charges at 70% = $896.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET QUICK PRESSURE MONITOR 295,272,RC,27202278,CDM,,,,,,both,,,1281.0000,192.1500,CIGNA HEALTHCARE,CIGNA HMO,534.18,,,,,,,330.6300,1281.0000,percent of total billed charges,"41.7% of $1,281.00 in Billed Charges for Rev 272 = $534.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET QUICK PRESSURE MONITOR 295,272,RC,27202278,CDM,,,,,,both,,,1281.0000,192.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,594.38,,,,,,,330.6300,1281.0000,percent of total billed charges,"46.4% of $1,281.00 in Billed Charges for Rev 272 = $594.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET QUICK PRESSURE MONITOR 295,272,RC,27202278,CDM,,,,,,both,,,1281.0000,192.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,534.18,,,,,,,330.6300,1281.0000,percent of total billed charges,"41.7% of $1,281.00 in Billed Charges for Rev 272 = $534.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET QUICK PRESSURE MONITOR 295,272,RC,27202278,CDM,,,,,,both,,,1281.0000,192.1500,CIGNA HEALTHCARE,CIGNA PPO,534.18,,,,,,,330.6300,1281.0000,percent of total billed charges,"41.7% of $1,281.00 in Billed Charges for Rev 272 = $534.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET QUICK PRESSURE MONITOR 295,272,RC,27202278,CDM,,,,,,both,,,1281.0000,192.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1152.90,,,,,,,330.6300,1281.0000,percent of total billed charges,"90% of $1,281.00 in Billed Charges for Rev 272 = $1,152.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET QUICK PRESSURE MONITOR 295,272,RC,27202278,CDM,,,,,,both,,,1281.0000,192.1500,MEDCOST,MEDCOST VHN,609.63,,,,,,,330.6300,1281.0000,percent of total billed charges,"47.59% of $1,281.00 in Billed Charges for Rev 272 = $609.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET QUICK PRESSURE MONITOR 295,272,RC,27202278,CDM,,,,,,both,,,1281.0000,192.1500,SENTARA HEALTH,SENTARA HEALTH,330.63,,,,,,,330.6300,1281.0000,percent of total billed charges,"25.81% of $1,281.00 in Billed Charges for Rev 272 = $330.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET QUICK PRESSURE MONITOR 295,272,RC,27202278,CDM,,,,,,both,,,1281.0000,192.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1281.00,,,,,,,330.6300,1281.0000,percent of total billed charges,"100% of $1,281.00 in Billed Charges for Rev 272 = $1,281.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET QUICK PRESSURE MONITOR 295,272,RC,27202278,CDM,,,,,,both,,,1281.0000,192.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,640.50,,,,,,,330.6300,1281.0000,percent of total billed charges,"Rev 272 $1,281.00 in Billed Charges at 50% = $640.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET QUICK PRESSURE MONITOR 295,272,RC,27202278,CDM,,,,,,both,,,1281.0000,192.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,413.76,,,,,,,330.6300,1281.0000,other,"32.3% of $1,281.00 in Billed Charges for Rev 272 = $413.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SET QUICK PRESSURE MONITOR 295,272,RC,27202278,CDM,,,,,,both,,,1281.0000,192.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,393.27,,,,,,,330.6300,1281.0000,other,"30.7% of $1,281.00 in Billed Charges for Rev 272 = $393.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SET QUICK PRESSURE MONITOR 295,272,RC,27202278,CDM,,,,,,both,,,1281.0000,192.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,413.76,,,,,,,330.6300,1281.0000,percent of total billed charges,"32.3% of $1,281.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET QUICK PRESSURE MONITOR 295,272,RC,27202278,CDM,,,,,,both,,,1281.0000,192.1500,WELLCARE,WELLCARE MEDICAID,1281.00,,,,,,,330.6300,1281.0000,percent of total billed charges,"100% of $1,281.00 in Billed Charges for Rev 272 = $1,281.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TIPS HASKAL ACCESS,272,RC,27201041,CDM,,,,,,both,,,2053.0000,307.9500,AETNA,AETNA,876.63,,,,,,,529.8800,2053.0000,percent of total billed charges,"42.7% of $2,053.00 in Billed Charges for Rev 272 = $876.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TIPS HASKAL ACCESS,272,RC,27201041,CDM,,,,,,both,,,2053.0000,307.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1437.10,,,,,,,529.8800,2053.0000,percent of total billed charges,"Rev 272 $2,053.00 in Billed Charges at 70% = $1,437.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TIPS HASKAL ACCESS,272,RC,27201041,CDM,,,,,,both,,,2053.0000,307.9500,CIGNA HEALTHCARE,CIGNA HMO,856.10,,,,,,,529.8800,2053.0000,percent of total billed charges,"41.7% of $2,053.00 in Billed Charges for Rev 272 = $856.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TIPS HASKAL ACCESS,272,RC,27201041,CDM,,,,,,both,,,2053.0000,307.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,952.59,,,,,,,529.8800,2053.0000,percent of total billed charges,"46.4% of $2,053.00 in Billed Charges for Rev 272 = $952.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TIPS HASKAL ACCESS,272,RC,27201041,CDM,,,,,,both,,,2053.0000,307.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,856.10,,,,,,,529.8800,2053.0000,percent of total billed charges,"41.7% of $2,053.00 in Billed Charges for Rev 272 = $856.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TIPS HASKAL ACCESS,272,RC,27201041,CDM,,,,,,both,,,2053.0000,307.9500,CIGNA HEALTHCARE,CIGNA PPO,856.10,,,,,,,529.8800,2053.0000,percent of total billed charges,"41.7% of $2,053.00 in Billed Charges for Rev 272 = $856.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TIPS HASKAL ACCESS,272,RC,27201041,CDM,,,,,,both,,,2053.0000,307.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1847.70,,,,,,,529.8800,2053.0000,percent of total billed charges,"90% of $2,053.00 in Billed Charges for Rev 272 = $1,847.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TIPS HASKAL ACCESS,272,RC,27201041,CDM,,,,,,both,,,2053.0000,307.9500,MEDCOST,MEDCOST VHN,977.02,,,,,,,529.8800,2053.0000,percent of total billed charges,"47.59% of $2,053.00 in Billed Charges for Rev 272 = $977.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TIPS HASKAL ACCESS,272,RC,27201041,CDM,,,,,,both,,,2053.0000,307.9500,SENTARA HEALTH,SENTARA HEALTH,529.88,,,,,,,529.8800,2053.0000,percent of total billed charges,"25.81% of $2,053.00 in Billed Charges for Rev 272 = $529.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TIPS HASKAL ACCESS,272,RC,27201041,CDM,,,,,,both,,,2053.0000,307.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2053.00,,,,,,,529.8800,2053.0000,percent of total billed charges,"100% of $2,053.00 in Billed Charges for Rev 272 = $2,053.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TIPS HASKAL ACCESS,272,RC,27201041,CDM,,,,,,both,,,2053.0000,307.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1026.50,,,,,,,529.8800,2053.0000,percent of total billed charges,"Rev 272 $2,053.00 in Billed Charges at 50% = $1,026.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TIPS HASKAL ACCESS,272,RC,27201041,CDM,,,,,,both,,,2053.0000,307.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,663.12,,,,,,,529.8800,2053.0000,other,"32.3% of $2,053.00 in Billed Charges for Rev 272 = $663.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SET TIPS HASKAL ACCESS,272,RC,27201041,CDM,,,,,,both,,,2053.0000,307.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,630.27,,,,,,,529.8800,2053.0000,other,"30.7% of $2,053.00 in Billed Charges for Rev 272 = $630.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SET TIPS HASKAL ACCESS,272,RC,27201041,CDM,,,,,,both,,,2053.0000,307.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,663.12,,,,,,,529.8800,2053.0000,percent of total billed charges,"32.3% of $2,053.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TIPS HASKAL ACCESS,272,RC,27201041,CDM,,,,,,both,,,2053.0000,307.9500,WELLCARE,WELLCARE MEDICAID,2053.00,,,,,,,529.8800,2053.0000,percent of total billed charges,"100% of $2,053.00 in Billed Charges for Rev 272 = $2,053.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH EXCH,270,RC,27000106,CDM,,,,,,both,,,857.0000,128.5500,AETNA,AETNA,365.94,,,,,,,221.1900,857.0000,percent of total billed charges,42.7% of $857.00 in Billed Charges for Rev 270 = $365.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH EXCH,270,RC,27000106,CDM,,,,,,both,,,857.0000,128.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,599.90,,,,,,,221.1900,857.0000,percent of total billed charges,Rev 270 $857.00 in Billed Charges at 70% = $599.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH EXCH,270,RC,27000106,CDM,,,,,,both,,,857.0000,128.5500,CIGNA HEALTHCARE,CIGNA HMO,357.37,,,,,,,221.1900,857.0000,percent of total billed charges,41.7% of $857.00 in Billed Charges for Rev 270 = $357.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH EXCH,270,RC,27000106,CDM,,,,,,both,,,857.0000,128.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,397.65,,,,,,,221.1900,857.0000,percent of total billed charges,46.4% of $857.00 in Billed Charges for Rev 270 = $397.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH EXCH,270,RC,27000106,CDM,,,,,,both,,,857.0000,128.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,357.37,,,,,,,221.1900,857.0000,percent of total billed charges,41.7% of $857.00 in Billed Charges for Rev 270 = $357.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH EXCH,270,RC,27000106,CDM,,,,,,both,,,857.0000,128.5500,CIGNA HEALTHCARE,CIGNA PPO,357.37,,,,,,,221.1900,857.0000,percent of total billed charges,41.7% of $857.00 in Billed Charges for Rev 270 = $357.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH EXCH,270,RC,27000106,CDM,,,,,,both,,,857.0000,128.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,771.30,,,,,,,221.1900,857.0000,percent of total billed charges,90% of $857.00 in Billed Charges for Rev 270 = $771.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH EXCH,270,RC,27000106,CDM,,,,,,both,,,857.0000,128.5500,MEDCOST,MEDCOST VHN,407.85,,,,,,,221.1900,857.0000,percent of total billed charges,47.59% of $857.00 in Billed Charges for Rev 270 = $407.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH EXCH,270,RC,27000106,CDM,,,,,,both,,,857.0000,128.5500,SENTARA HEALTH,SENTARA HEALTH,221.19,,,,,,,221.1900,857.0000,percent of total billed charges,25.81% of $857.00 in Billed Charges for Rev 270 = $221.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH EXCH,270,RC,27000106,CDM,,,,,,both,,,857.0000,128.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",857.00,,,,,,,221.1900,857.0000,percent of total billed charges,100% of $857.00 in Billed Charges for Rev 270 = $857.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH EXCH,270,RC,27000106,CDM,,,,,,both,,,857.0000,128.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,428.50,,,,,,,221.1900,857.0000,percent of total billed charges,Rev 270 $857.00 in Billed Charges at 50% = $428.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH EXCH,270,RC,27000106,CDM,,,,,,both,,,857.0000,128.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,276.81,,,,,,,221.1900,857.0000,other,32.3% of $857.00 in Billed Charges for Rev 270 = $276.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SET TRACH EXCH,270,RC,27000106,CDM,,,,,,both,,,857.0000,128.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,263.10,,,,,,,221.1900,857.0000,other,30.7% of $857.00 in Billed Charges for Rev 270 = $263.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SET TRACH EXCH,270,RC,27000106,CDM,,,,,,both,,,857.0000,128.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,276.81,,,,,,,221.1900,857.0000,percent of total billed charges,32.3% of $857.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH EXCH,270,RC,27000106,CDM,,,,,,both,,,857.0000,128.5500,WELLCARE,WELLCARE MEDICAID,857.00,,,,,,,221.1900,857.0000,percent of total billed charges,100% of $857.00 in Billed Charges for Rev 270 = $857.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH WEINMANN C-PTIS-100-,272,RC,27202280,CDM,,,,,,both,,,1954.0000,293.1000,AETNA,AETNA,834.36,,,,,,,504.3300,1954.0000,percent of total billed charges,"42.7% of $1,954.00 in Billed Charges for Rev 272 = $834.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH WEINMANN C-PTIS-100-,272,RC,27202280,CDM,,,,,,both,,,1954.0000,293.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1367.80,,,,,,,504.3300,1954.0000,percent of total billed charges,"Rev 272 $1,954.00 in Billed Charges at 70% = $1,367.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH WEINMANN C-PTIS-100-,272,RC,27202280,CDM,,,,,,both,,,1954.0000,293.1000,CIGNA HEALTHCARE,CIGNA HMO,814.82,,,,,,,504.3300,1954.0000,percent of total billed charges,"41.7% of $1,954.00 in Billed Charges for Rev 272 = $814.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH WEINMANN C-PTIS-100-,272,RC,27202280,CDM,,,,,,both,,,1954.0000,293.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,906.66,,,,,,,504.3300,1954.0000,percent of total billed charges,"46.4% of $1,954.00 in Billed Charges for Rev 272 = $906.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH WEINMANN C-PTIS-100-,272,RC,27202280,CDM,,,,,,both,,,1954.0000,293.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,814.82,,,,,,,504.3300,1954.0000,percent of total billed charges,"41.7% of $1,954.00 in Billed Charges for Rev 272 = $814.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH WEINMANN C-PTIS-100-,272,RC,27202280,CDM,,,,,,both,,,1954.0000,293.1000,CIGNA HEALTHCARE,CIGNA PPO,814.82,,,,,,,504.3300,1954.0000,percent of total billed charges,"41.7% of $1,954.00 in Billed Charges for Rev 272 = $814.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH WEINMANN C-PTIS-100-,272,RC,27202280,CDM,,,,,,both,,,1954.0000,293.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1758.60,,,,,,,504.3300,1954.0000,percent of total billed charges,"90% of $1,954.00 in Billed Charges for Rev 272 = $1,758.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH WEINMANN C-PTIS-100-,272,RC,27202280,CDM,,,,,,both,,,1954.0000,293.1000,MEDCOST,MEDCOST VHN,929.91,,,,,,,504.3300,1954.0000,percent of total billed charges,"47.59% of $1,954.00 in Billed Charges for Rev 272 = $929.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH WEINMANN C-PTIS-100-,272,RC,27202280,CDM,,,,,,both,,,1954.0000,293.1000,SENTARA HEALTH,SENTARA HEALTH,504.33,,,,,,,504.3300,1954.0000,percent of total billed charges,"25.81% of $1,954.00 in Billed Charges for Rev 272 = $504.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH WEINMANN C-PTIS-100-,272,RC,27202280,CDM,,,,,,both,,,1954.0000,293.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1954.00,,,,,,,504.3300,1954.0000,percent of total billed charges,"100% of $1,954.00 in Billed Charges for Rev 272 = $1,954.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH WEINMANN C-PTIS-100-,272,RC,27202280,CDM,,,,,,both,,,1954.0000,293.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,977.00,,,,,,,504.3300,1954.0000,percent of total billed charges,"Rev 272 $1,954.00 in Billed Charges at 50% = $977.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH WEINMANN C-PTIS-100-,272,RC,27202280,CDM,,,,,,both,,,1954.0000,293.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,631.14,,,,,,,504.3300,1954.0000,other,"32.3% of $1,954.00 in Billed Charges for Rev 272 = $631.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SET TRACH WEINMANN C-PTIS-100-,272,RC,27202280,CDM,,,,,,both,,,1954.0000,293.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,599.88,,,,,,,504.3300,1954.0000,other,"30.7% of $1,954.00 in Billed Charges for Rev 272 = $599.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SET TRACH WEINMANN C-PTIS-100-,272,RC,27202280,CDM,,,,,,both,,,1954.0000,293.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,631.14,,,,,,,504.3300,1954.0000,percent of total billed charges,"32.3% of $1,954.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH WEINMANN C-PTIS-100-,272,RC,27202280,CDM,,,,,,both,,,1954.0000,293.1000,WELLCARE,WELLCARE MEDICAID,1954.00,,,,,,,504.3300,1954.0000,percent of total billed charges,"100% of $1,954.00 in Billed Charges for Rev 272 = $1,954.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SINGLE USE HOVER MAT,272,RC,27202226,CDM,,,,,,both,,,642.0000,96.3000,AETNA,AETNA,274.13,,,,,,,165.7000,642.0000,percent of total billed charges,42.7% of $642.00 in Billed Charges for Rev 272 = $274.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SINGLE USE HOVER MAT,272,RC,27202226,CDM,,,,,,both,,,642.0000,96.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,449.40,,,,,,,165.7000,642.0000,percent of total billed charges,Rev 272 $642.00 in Billed Charges at 70% = $449.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SINGLE USE HOVER MAT,272,RC,27202226,CDM,,,,,,both,,,642.0000,96.3000,CIGNA HEALTHCARE,CIGNA HMO,267.71,,,,,,,165.7000,642.0000,percent of total billed charges,41.7% of $642.00 in Billed Charges for Rev 272 = $267.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SINGLE USE HOVER MAT,272,RC,27202226,CDM,,,,,,both,,,642.0000,96.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,297.89,,,,,,,165.7000,642.0000,percent of total billed charges,46.4% of $642.00 in Billed Charges for Rev 272 = $297.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SINGLE USE HOVER MAT,272,RC,27202226,CDM,,,,,,both,,,642.0000,96.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,267.71,,,,,,,165.7000,642.0000,percent of total billed charges,41.7% of $642.00 in Billed Charges for Rev 272 = $267.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SINGLE USE HOVER MAT,272,RC,27202226,CDM,,,,,,both,,,642.0000,96.3000,CIGNA HEALTHCARE,CIGNA PPO,267.71,,,,,,,165.7000,642.0000,percent of total billed charges,41.7% of $642.00 in Billed Charges for Rev 272 = $267.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SINGLE USE HOVER MAT,272,RC,27202226,CDM,,,,,,both,,,642.0000,96.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,577.80,,,,,,,165.7000,642.0000,percent of total billed charges,90% of $642.00 in Billed Charges for Rev 272 = $577.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SINGLE USE HOVER MAT,272,RC,27202226,CDM,,,,,,both,,,642.0000,96.3000,MEDCOST,MEDCOST VHN,305.53,,,,,,,165.7000,642.0000,percent of total billed charges,47.59% of $642.00 in Billed Charges for Rev 272 = $305.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SINGLE USE HOVER MAT,272,RC,27202226,CDM,,,,,,both,,,642.0000,96.3000,SENTARA HEALTH,SENTARA HEALTH,165.70,,,,,,,165.7000,642.0000,percent of total billed charges,25.81% of $642.00 in Billed Charges for Rev 272 = $165.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SINGLE USE HOVER MAT,272,RC,27202226,CDM,,,,,,both,,,642.0000,96.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",642.00,,,,,,,165.7000,642.0000,percent of total billed charges,100% of $642.00 in Billed Charges for Rev 272 = $642.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SINGLE USE HOVER MAT,272,RC,27202226,CDM,,,,,,both,,,642.0000,96.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,321.00,,,,,,,165.7000,642.0000,percent of total billed charges,Rev 272 $642.00 in Billed Charges at 50% = $321.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SINGLE USE HOVER MAT,272,RC,27202226,CDM,,,,,,both,,,642.0000,96.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,207.37,,,,,,,165.7000,642.0000,other,32.3% of $642.00 in Billed Charges for Rev 272 = $207.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SINGLE USE HOVER MAT,272,RC,27202226,CDM,,,,,,both,,,642.0000,96.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,197.09,,,,,,,165.7000,642.0000,other,30.7% of $642.00 in Billed Charges for Rev 272 = $197.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SINGLE USE HOVER MAT,272,RC,27202226,CDM,,,,,,both,,,642.0000,96.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,207.37,,,,,,,165.7000,642.0000,percent of total billed charges,32.3% of $642.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SINGLE USE HOVER MAT,272,RC,27202226,CDM,,,,,,both,,,642.0000,96.3000,WELLCARE,WELLCARE MEDICAID,642.00,,,,,,,165.7000,642.0000,percent of total billed charges,100% of $642.00 in Billed Charges for Rev 272 = $642.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR MISC 10 BOX,272,RC,27201087,CDM,,,,,,both,,,70.0000,10.5000,AETNA,AETNA,29.89,,,,,,,18.0700,70.0000,percent of total billed charges,42.7% of $70.00 in Billed Charges for Rev 272 = $29.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR MISC 10 BOX,272,RC,27201087,CDM,,,,,,both,,,70.0000,10.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,49.00,,,,,,,18.0700,70.0000,percent of total billed charges,Rev 272 $70.00 in Billed Charges at 70% = $49.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR MISC 10 BOX,272,RC,27201087,CDM,,,,,,both,,,70.0000,10.5000,CIGNA HEALTHCARE,CIGNA HMO,29.19,,,,,,,18.0700,70.0000,percent of total billed charges,41.7% of $70.00 in Billed Charges for Rev 272 = $29.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR MISC 10 BOX,272,RC,27201087,CDM,,,,,,both,,,70.0000,10.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,32.48,,,,,,,18.0700,70.0000,percent of total billed charges,46.4% of $70.00 in Billed Charges for Rev 272 = $32.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR MISC 10 BOX,272,RC,27201087,CDM,,,,,,both,,,70.0000,10.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,29.19,,,,,,,18.0700,70.0000,percent of total billed charges,41.7% of $70.00 in Billed Charges for Rev 272 = $29.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR MISC 10 BOX,272,RC,27201087,CDM,,,,,,both,,,70.0000,10.5000,CIGNA HEALTHCARE,CIGNA PPO,29.19,,,,,,,18.0700,70.0000,percent of total billed charges,41.7% of $70.00 in Billed Charges for Rev 272 = $29.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR MISC 10 BOX,272,RC,27201087,CDM,,,,,,both,,,70.0000,10.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,63.00,,,,,,,18.0700,70.0000,percent of total billed charges,90% of $70.00 in Billed Charges for Rev 272 = $63.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR MISC 10 BOX,272,RC,27201087,CDM,,,,,,both,,,70.0000,10.5000,MEDCOST,MEDCOST VHN,33.31,,,,,,,18.0700,70.0000,percent of total billed charges,47.59% of $70.00 in Billed Charges for Rev 272 = $33.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR MISC 10 BOX,272,RC,27201087,CDM,,,,,,both,,,70.0000,10.5000,SENTARA HEALTH,SENTARA HEALTH,18.07,,,,,,,18.0700,70.0000,percent of total billed charges,25.81% of $70.00 in Billed Charges for Rev 272 = $18.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR MISC 10 BOX,272,RC,27201087,CDM,,,,,,both,,,70.0000,10.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",70.00,,,,,,,18.0700,70.0000,percent of total billed charges,100% of $70.00 in Billed Charges for Rev 272 = $70.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR MISC 10 BOX,272,RC,27201087,CDM,,,,,,both,,,70.0000,10.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,35.00,,,,,,,18.0700,70.0000,percent of total billed charges,Rev 272 $70.00 in Billed Charges at 50% = $35.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR MISC 10 BOX,272,RC,27201087,CDM,,,,,,both,,,70.0000,10.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,22.61,,,,,,,18.0700,70.0000,other,32.3% of $70.00 in Billed Charges for Rev 272 = $22.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SITESEER 4FR MISC 10 BOX,272,RC,27201087,CDM,,,,,,both,,,70.0000,10.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,21.49,,,,,,,18.0700,70.0000,other,30.7% of $70.00 in Billed Charges for Rev 272 = $21.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SITESEER 4FR MISC 10 BOX,272,RC,27201087,CDM,,,,,,both,,,70.0000,10.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,22.61,,,,,,,18.0700,70.0000,percent of total billed charges,32.3% of $70.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR MISC 10 BOX,272,RC,27201087,CDM,,,,,,both,,,70.0000,10.5000,WELLCARE,WELLCARE MEDICAID,70.00,,,,,,,18.0700,70.0000,percent of total billed charges,100% of $70.00 in Billed Charges for Rev 272 = $70.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE,270,RC,27000025,CDM,,,,,,both,,,120.0000,18.0000,AETNA,AETNA,51.24,,,,,,,30.9700,120.0000,percent of total billed charges,42.7% of $120.00 in Billed Charges for Rev 270 = $51.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE,270,RC,27000025,CDM,,,,,,both,,,120.0000,18.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,84.00,,,,,,,30.9700,120.0000,percent of total billed charges,Rev 270 $120.00 in Billed Charges at 70% = $84.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE,270,RC,27000025,CDM,,,,,,both,,,120.0000,18.0000,CIGNA HEALTHCARE,CIGNA HMO,50.04,,,,,,,30.9700,120.0000,percent of total billed charges,41.7% of $120.00 in Billed Charges for Rev 270 = $50.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE,270,RC,27000025,CDM,,,,,,both,,,120.0000,18.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,55.68,,,,,,,30.9700,120.0000,percent of total billed charges,46.4% of $120.00 in Billed Charges for Rev 270 = $55.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE,270,RC,27000025,CDM,,,,,,both,,,120.0000,18.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,50.04,,,,,,,30.9700,120.0000,percent of total billed charges,41.7% of $120.00 in Billed Charges for Rev 270 = $50.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE,270,RC,27000025,CDM,,,,,,both,,,120.0000,18.0000,CIGNA HEALTHCARE,CIGNA PPO,50.04,,,,,,,30.9700,120.0000,percent of total billed charges,41.7% of $120.00 in Billed Charges for Rev 270 = $50.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE,270,RC,27000025,CDM,,,,,,both,,,120.0000,18.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,108.00,,,,,,,30.9700,120.0000,percent of total billed charges,90% of $120.00 in Billed Charges for Rev 270 = $108.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE,270,RC,27000025,CDM,,,,,,both,,,120.0000,18.0000,MEDCOST,MEDCOST VHN,57.11,,,,,,,30.9700,120.0000,percent of total billed charges,47.59% of $120.00 in Billed Charges for Rev 270 = $57.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE,270,RC,27000025,CDM,,,,,,both,,,120.0000,18.0000,SENTARA HEALTH,SENTARA HEALTH,30.97,,,,,,,30.9700,120.0000,percent of total billed charges,25.81% of $120.00 in Billed Charges for Rev 270 = $30.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE,270,RC,27000025,CDM,,,,,,both,,,120.0000,18.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",120.00,,,,,,,30.9700,120.0000,percent of total billed charges,100% of $120.00 in Billed Charges for Rev 270 = $120.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE,270,RC,27000025,CDM,,,,,,both,,,120.0000,18.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,60.00,,,,,,,30.9700,120.0000,percent of total billed charges,Rev 270 $120.00 in Billed Charges at 50% = $60.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE,270,RC,27000025,CDM,,,,,,both,,,120.0000,18.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,38.76,,,,,,,30.9700,120.0000,other,32.3% of $120.00 in Billed Charges for Rev 270 = $38.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLEEVE SCD KNEE,270,RC,27000025,CDM,,,,,,both,,,120.0000,18.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,36.84,,,,,,,30.9700,120.0000,other,30.7% of $120.00 in Billed Charges for Rev 270 = $36.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLEEVE SCD KNEE,270,RC,27000025,CDM,,,,,,both,,,120.0000,18.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,38.76,,,,,,,30.9700,120.0000,percent of total billed charges,32.3% of $120.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE,270,RC,27000025,CDM,,,,,,both,,,120.0000,18.0000,WELLCARE,WELLCARE MEDICAID,120.00,,,,,,,30.9700,120.0000,percent of total billed charges,100% of $120.00 in Billed Charges for Rev 270 = $120.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY PROC BREAST BX,272,RC,27201197,CDM,,,,,,both,,,83.0000,12.4500,AETNA,AETNA,35.44,,,,,,,21.4200,83.0000,percent of total billed charges,42.7% of $83.00 in Billed Charges for Rev 272 = $35.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY PROC BREAST BX,272,RC,27201197,CDM,,,,,,both,,,83.0000,12.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,58.10,,,,,,,21.4200,83.0000,percent of total billed charges,Rev 272 $83.00 in Billed Charges at 70% = $58.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY PROC BREAST BX,272,RC,27201197,CDM,,,,,,both,,,83.0000,12.4500,CIGNA HEALTHCARE,CIGNA HMO,34.61,,,,,,,21.4200,83.0000,percent of total billed charges,41.7% of $83.00 in Billed Charges for Rev 272 = $34.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY PROC BREAST BX,272,RC,27201197,CDM,,,,,,both,,,83.0000,12.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,38.51,,,,,,,21.4200,83.0000,percent of total billed charges,46.4% of $83.00 in Billed Charges for Rev 272 = $38.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY PROC BREAST BX,272,RC,27201197,CDM,,,,,,both,,,83.0000,12.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,34.61,,,,,,,21.4200,83.0000,percent of total billed charges,41.7% of $83.00 in Billed Charges for Rev 272 = $34.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY PROC BREAST BX,272,RC,27201197,CDM,,,,,,both,,,83.0000,12.4500,CIGNA HEALTHCARE,CIGNA PPO,34.61,,,,,,,21.4200,83.0000,percent of total billed charges,41.7% of $83.00 in Billed Charges for Rev 272 = $34.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY PROC BREAST BX,272,RC,27201197,CDM,,,,,,both,,,83.0000,12.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,74.70,,,,,,,21.4200,83.0000,percent of total billed charges,90% of $83.00 in Billed Charges for Rev 272 = $74.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY PROC BREAST BX,272,RC,27201197,CDM,,,,,,both,,,83.0000,12.4500,MEDCOST,MEDCOST VHN,39.50,,,,,,,21.4200,83.0000,percent of total billed charges,47.59% of $83.00 in Billed Charges for Rev 272 = $39.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY PROC BREAST BX,272,RC,27201197,CDM,,,,,,both,,,83.0000,12.4500,SENTARA HEALTH,SENTARA HEALTH,21.42,,,,,,,21.4200,83.0000,percent of total billed charges,25.81% of $83.00 in Billed Charges for Rev 272 = $21.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY PROC BREAST BX,272,RC,27201197,CDM,,,,,,both,,,83.0000,12.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",83.00,,,,,,,21.4200,83.0000,percent of total billed charges,100% of $83.00 in Billed Charges for Rev 272 = $83.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY PROC BREAST BX,272,RC,27201197,CDM,,,,,,both,,,83.0000,12.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,41.50,,,,,,,21.4200,83.0000,percent of total billed charges,Rev 272 $83.00 in Billed Charges at 50% = $41.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY PROC BREAST BX,272,RC,27201197,CDM,,,,,,both,,,83.0000,12.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,26.81,,,,,,,21.4200,83.0000,other,32.3% of $83.00 in Billed Charges for Rev 272 = $26.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRAY PROC BREAST BX,272,RC,27201197,CDM,,,,,,both,,,83.0000,12.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,25.48,,,,,,,21.4200,83.0000,other,30.7% of $83.00 in Billed Charges for Rev 272 = $25.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRAY PROC BREAST BX,272,RC,27201197,CDM,,,,,,both,,,83.0000,12.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,26.81,,,,,,,21.4200,83.0000,percent of total billed charges,32.3% of $83.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY PROC BREAST BX,272,RC,27201197,CDM,,,,,,both,,,83.0000,12.4500,WELLCARE,WELLCARE MEDICAID,83.00,,,,,,,21.4200,83.0000,percent of total billed charges,100% of $83.00 in Billed Charges for Rev 272 = $83.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TURBO-TANDEM 7F 2X4MM,272,RC,27201258,CDM,,,,,,both,,,9154.0000,1373.1000,AETNA,AETNA,3908.76,,,,,,,2362.6500,9154.0000,percent of total billed charges,"42.7% of $9,154.00 in Billed Charges for Rev 272 = $3,908.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TURBO-TANDEM 7F 2X4MM,272,RC,27201258,CDM,,,,,,both,,,9154.0000,1373.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6407.80,,,,,,,2362.6500,9154.0000,percent of total billed charges,"Rev 272 $9,154.00 in Billed Charges at 70% = $6,407.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TURBO-TANDEM 7F 2X4MM,272,RC,27201258,CDM,,,,,,both,,,9154.0000,1373.1000,CIGNA HEALTHCARE,CIGNA HMO,3817.22,,,,,,,2362.6500,9154.0000,percent of total billed charges,"41.7% of $9,154.00 in Billed Charges for Rev 272 = $3,817.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TURBO-TANDEM 7F 2X4MM,272,RC,27201258,CDM,,,,,,both,,,9154.0000,1373.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4247.46,,,,,,,2362.6500,9154.0000,percent of total billed charges,"46.4% of $9,154.00 in Billed Charges for Rev 272 = $4,247.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TURBO-TANDEM 7F 2X4MM,272,RC,27201258,CDM,,,,,,both,,,9154.0000,1373.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3817.22,,,,,,,2362.6500,9154.0000,percent of total billed charges,"41.7% of $9,154.00 in Billed Charges for Rev 272 = $3,817.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TURBO-TANDEM 7F 2X4MM,272,RC,27201258,CDM,,,,,,both,,,9154.0000,1373.1000,CIGNA HEALTHCARE,CIGNA PPO,3817.22,,,,,,,2362.6500,9154.0000,percent of total billed charges,"41.7% of $9,154.00 in Billed Charges for Rev 272 = $3,817.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TURBO-TANDEM 7F 2X4MM,272,RC,27201258,CDM,,,,,,both,,,9154.0000,1373.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8238.60,,,,,,,2362.6500,9154.0000,percent of total billed charges,"90% of $9,154.00 in Billed Charges for Rev 272 = $8,238.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TURBO-TANDEM 7F 2X4MM,272,RC,27201258,CDM,,,,,,both,,,9154.0000,1373.1000,MEDCOST,MEDCOST VHN,4356.39,,,,,,,2362.6500,9154.0000,percent of total billed charges,"47.59% of $9,154.00 in Billed Charges for Rev 272 = $4,356.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TURBO-TANDEM 7F 2X4MM,272,RC,27201258,CDM,,,,,,both,,,9154.0000,1373.1000,SENTARA HEALTH,SENTARA HEALTH,2362.65,,,,,,,2362.6500,9154.0000,percent of total billed charges,"25.81% of $9,154.00 in Billed Charges for Rev 272 = $2,362.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TURBO-TANDEM 7F 2X4MM,272,RC,27201258,CDM,,,,,,both,,,9154.0000,1373.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9154.00,,,,,,,2362.6500,9154.0000,percent of total billed charges,"100% of $9,154.00 in Billed Charges for Rev 272 = $9,154.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TURBO-TANDEM 7F 2X4MM,272,RC,27201258,CDM,,,,,,both,,,9154.0000,1373.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4577.00,,,,,,,2362.6500,9154.0000,percent of total billed charges,"Rev 272 $9,154.00 in Billed Charges at 50% = $4,577.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TURBO-TANDEM 7F 2X4MM,272,RC,27201258,CDM,,,,,,both,,,9154.0000,1373.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2956.74,,,,,,,2362.6500,9154.0000,other,"32.3% of $9,154.00 in Billed Charges for Rev 272 = $2,956.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TURBO-TANDEM 7F 2X4MM,272,RC,27201258,CDM,,,,,,both,,,9154.0000,1373.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2810.28,,,,,,,2362.6500,9154.0000,other,"30.7% of $9,154.00 in Billed Charges for Rev 272 = $2,810.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TURBO-TANDEM 7F 2X4MM,272,RC,27201258,CDM,,,,,,both,,,9154.0000,1373.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,2956.74,,,,,,,2362.6500,9154.0000,percent of total billed charges,"32.3% of $9,154.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TURBO-TANDEM 7F 2X4MM,272,RC,27201258,CDM,,,,,,both,,,9154.0000,1373.1000,WELLCARE,WELLCARE MEDICAID,9154.00,,,,,,,2362.6500,9154.0000,percent of total billed charges,"100% of $9,154.00 in Billed Charges for Rev 272 = $9,154.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC U78036MYNX GRIP VASC CLOS DEV 6/7FR,272,RC,27201259,CDM,,,,,,both,,,944.0000,141.6000,AETNA,AETNA,403.09,,,,,,,243.6500,944.0000,percent of total billed charges,42.7% of $944.00 in Billed Charges for Rev 272 = $403.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC U78036MYNX GRIP VASC CLOS DEV 6/7FR,272,RC,27201259,CDM,,,,,,both,,,944.0000,141.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,660.80,,,,,,,243.6500,944.0000,percent of total billed charges,Rev 272 $944.00 in Billed Charges at 70% = $660.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC U78036MYNX GRIP VASC CLOS DEV 6/7FR,272,RC,27201259,CDM,,,,,,both,,,944.0000,141.6000,CIGNA HEALTHCARE,CIGNA HMO,393.65,,,,,,,243.6500,944.0000,percent of total billed charges,41.7% of $944.00 in Billed Charges for Rev 272 = $393.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC U78036MYNX GRIP VASC CLOS DEV 6/7FR,272,RC,27201259,CDM,,,,,,both,,,944.0000,141.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,438.02,,,,,,,243.6500,944.0000,percent of total billed charges,46.4% of $944.00 in Billed Charges for Rev 272 = $438.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC U78036MYNX GRIP VASC CLOS DEV 6/7FR,272,RC,27201259,CDM,,,,,,both,,,944.0000,141.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,393.65,,,,,,,243.6500,944.0000,percent of total billed charges,41.7% of $944.00 in Billed Charges for Rev 272 = $393.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC U78036MYNX GRIP VASC CLOS DEV 6/7FR,272,RC,27201259,CDM,,,,,,both,,,944.0000,141.6000,CIGNA HEALTHCARE,CIGNA PPO,393.65,,,,,,,243.6500,944.0000,percent of total billed charges,41.7% of $944.00 in Billed Charges for Rev 272 = $393.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC U78036MYNX GRIP VASC CLOS DEV 6/7FR,272,RC,27201259,CDM,,,,,,both,,,944.0000,141.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,849.60,,,,,,,243.6500,944.0000,percent of total billed charges,90% of $944.00 in Billed Charges for Rev 272 = $849.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC U78036MYNX GRIP VASC CLOS DEV 6/7FR,272,RC,27201259,CDM,,,,,,both,,,944.0000,141.6000,MEDCOST,MEDCOST VHN,449.25,,,,,,,243.6500,944.0000,percent of total billed charges,47.59% of $944.00 in Billed Charges for Rev 272 = $449.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC U78036MYNX GRIP VASC CLOS DEV 6/7FR,272,RC,27201259,CDM,,,,,,both,,,944.0000,141.6000,SENTARA HEALTH,SENTARA HEALTH,243.65,,,,,,,243.6500,944.0000,percent of total billed charges,25.81% of $944.00 in Billed Charges for Rev 272 = $243.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC U78036MYNX GRIP VASC CLOS DEV 6/7FR,272,RC,27201259,CDM,,,,,,both,,,944.0000,141.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",944.00,,,,,,,243.6500,944.0000,percent of total billed charges,100% of $944.00 in Billed Charges for Rev 272 = $944.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC U78036MYNX GRIP VASC CLOS DEV 6/7FR,272,RC,27201259,CDM,,,,,,both,,,944.0000,141.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,472.00,,,,,,,243.6500,944.0000,percent of total billed charges,Rev 272 $944.00 in Billed Charges at 50% = $472.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC U78036MYNX GRIP VASC CLOS DEV 6/7FR,272,RC,27201259,CDM,,,,,,both,,,944.0000,141.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,304.91,,,,,,,243.6500,944.0000,other,32.3% of $944.00 in Billed Charges for Rev 272 = $304.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC U78036MYNX GRIP VASC CLOS DEV 6/7FR,272,RC,27201259,CDM,,,,,,both,,,944.0000,141.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,289.81,,,,,,,243.6500,944.0000,other,30.7% of $944.00 in Billed Charges for Rev 272 = $289.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC U78036MYNX GRIP VASC CLOS DEV 6/7FR,272,RC,27201259,CDM,,,,,,both,,,944.0000,141.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,304.91,,,,,,,243.6500,944.0000,percent of total billed charges,32.3% of $944.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC U78036MYNX GRIP VASC CLOS DEV 6/7FR,272,RC,27201259,CDM,,,,,,both,,,944.0000,141.6000,WELLCARE,WELLCARE MEDICAID,944.00,,,,,,,243.6500,944.0000,percent of total billed charges,100% of $944.00 in Billed Charges for Rev 272 = $944.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ALARIS CAP,272,RC,27201260,CDM,,,,,,both,,,29.0000,4.3500,AETNA,AETNA,12.38,,,,,,,7.4800,29.0000,percent of total billed charges,42.7% of $29.00 in Billed Charges for Rev 272 = $12.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ALARIS CAP,272,RC,27201260,CDM,,,,,,both,,,29.0000,4.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,20.30,,,,,,,7.4800,29.0000,percent of total billed charges,Rev 272 $29.00 in Billed Charges at 70% = $20.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ALARIS CAP,272,RC,27201260,CDM,,,,,,both,,,29.0000,4.3500,CIGNA HEALTHCARE,CIGNA HMO,12.09,,,,,,,7.4800,29.0000,percent of total billed charges,41.7% of $29.00 in Billed Charges for Rev 272 = $12.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ALARIS CAP,272,RC,27201260,CDM,,,,,,both,,,29.0000,4.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,13.46,,,,,,,7.4800,29.0000,percent of total billed charges,46.4% of $29.00 in Billed Charges for Rev 272 = $13.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ALARIS CAP,272,RC,27201260,CDM,,,,,,both,,,29.0000,4.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,12.09,,,,,,,7.4800,29.0000,percent of total billed charges,41.7% of $29.00 in Billed Charges for Rev 272 = $12.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ALARIS CAP,272,RC,27201260,CDM,,,,,,both,,,29.0000,4.3500,CIGNA HEALTHCARE,CIGNA PPO,12.09,,,,,,,7.4800,29.0000,percent of total billed charges,41.7% of $29.00 in Billed Charges for Rev 272 = $12.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ALARIS CAP,272,RC,27201260,CDM,,,,,,both,,,29.0000,4.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,26.10,,,,,,,7.4800,29.0000,percent of total billed charges,90% of $29.00 in Billed Charges for Rev 272 = $26.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ALARIS CAP,272,RC,27201260,CDM,,,,,,both,,,29.0000,4.3500,MEDCOST,MEDCOST VHN,13.80,,,,,,,7.4800,29.0000,percent of total billed charges,47.59% of $29.00 in Billed Charges for Rev 272 = $13.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ALARIS CAP,272,RC,27201260,CDM,,,,,,both,,,29.0000,4.3500,SENTARA HEALTH,SENTARA HEALTH,7.48,,,,,,,7.4800,29.0000,percent of total billed charges,25.81% of $29.00 in Billed Charges for Rev 272 = $7.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ALARIS CAP,272,RC,27201260,CDM,,,,,,both,,,29.0000,4.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",29.00,,,,,,,7.4800,29.0000,percent of total billed charges,100% of $29.00 in Billed Charges for Rev 272 = $29.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ALARIS CAP,272,RC,27201260,CDM,,,,,,both,,,29.0000,4.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14.50,,,,,,,7.4800,29.0000,percent of total billed charges,Rev 272 $29.00 in Billed Charges at 50% = $14.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ALARIS CAP,272,RC,27201260,CDM,,,,,,both,,,29.0000,4.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,9.37,,,,,,,7.4800,29.0000,other,32.3% of $29.00 in Billed Charges for Rev 272 = $9.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VALVE ALARIS CAP,272,RC,27201260,CDM,,,,,,both,,,29.0000,4.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,8.90,,,,,,,7.4800,29.0000,other,30.7% of $29.00 in Billed Charges for Rev 272 = $8.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VALVE ALARIS CAP,272,RC,27201260,CDM,,,,,,both,,,29.0000,4.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,9.37,,,,,,,7.4800,29.0000,percent of total billed charges,32.3% of $29.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE ALARIS CAP,272,RC,27201260,CDM,,,,,,both,,,29.0000,4.3500,WELLCARE,WELLCARE MEDICAID,29.00,,,,,,,7.4800,29.0000,percent of total billed charges,100% of $29.00 in Billed Charges for Rev 272 = $29.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE EVOLUT R TRANSCATHETER AORTIC VALVE 23MM TO 29MM,278,RC,27800532,CDM,,,,,,both,,,79616.0000,11942.4000,AETNA,AETNA,38215.68,,,,,,,5652.7400,79616.0000,percent of total billed charges,"48% of $79,616.00 in Billed Charges for Rev 278 = $38,215.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE EVOLUT R TRANSCATHETER AORTIC VALVE 23MM TO 29MM,278,RC,27800532,CDM,,,,,,both,,,79616.0000,11942.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,39808.00,,,,,,,5652.7400,79616.0000,percent of total billed charges,"50% of $79,616.00 in Billed Charges for Rev 278 = $39,808.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE EVOLUT R TRANSCATHETER AORTIC VALVE 23MM TO 29MM,278,RC,27800532,CDM,,,,,,both,,,79616.0000,11942.4000,CIGNA HEALTHCARE,CIGNA HMO,33199.87,,,,,,,5652.7400,79616.0000,percent of total billed charges,"41.7% of $79,616.00 in Billed Charges for Rev 278 = $33,199.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE EVOLUT R TRANSCATHETER AORTIC VALVE 23MM TO 29MM,278,RC,27800532,CDM,,,,,,both,,,79616.0000,11942.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,31846.40,,,,,,,5652.7400,79616.0000,percent of total billed charges,"40% of $79,616.00 in Billed Charges for Rev 278 = $31,846.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE EVOLUT R TRANSCATHETER AORTIC VALVE 23MM TO 29MM,278,RC,27800532,CDM,,,,,,both,,,79616.0000,11942.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,33199.87,,,,,,,5652.7400,79616.0000,percent of total billed charges,"41.7% of $79,616.00 in Billed Charges for Rev 278 = $33,199.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE EVOLUT R TRANSCATHETER AORTIC VALVE 23MM TO 29MM,278,RC,27800532,CDM,,,,,,both,,,79616.0000,11942.4000,CIGNA HEALTHCARE,CIGNA PPO,33199.87,,,,,,,5652.7400,79616.0000,percent of total billed charges,"41.7% of $79,616.00 in Billed Charges for Rev 278 = $33,199.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE EVOLUT R TRANSCATHETER AORTIC VALVE 23MM TO 29MM,278,RC,27800532,CDM,,,,,,both,,,79616.0000,11942.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,71654.40,,,,,,,5652.7400,79616.0000,percent of total billed charges,"90% of $79,616.00 in Billed Charges for Rev 278 = $71,654.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE EVOLUT R TRANSCATHETER AORTIC VALVE 23MM TO 29MM,278,RC,27800532,CDM,,,,,,both,,,79616.0000,11942.4000,MEDCOST,MEDCOST VHN,37889.25,,,,,,,5652.7400,79616.0000,percent of total billed charges,"47.59% of $79,616.00 in Billed Charges for Rev 278 = $37,889.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE EVOLUT R TRANSCATHETER AORTIC VALVE 23MM TO 29MM,278,RC,27800532,CDM,,,,,,both,,,79616.0000,11942.4000,SENTARA HEALTH,SENTARA HEALTH,20548.89,,,,,,,5652.7400,79616.0000,percent of total billed charges,"25.81% of $79,616.00 in Billed Charges for Rev 278 = $20,548.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE EVOLUT R TRANSCATHETER AORTIC VALVE 23MM TO 29MM,278,RC,27800532,CDM,,,,,,both,,,79616.0000,11942.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",79616.00,,,,,,,5652.7400,79616.0000,percent of total billed charges,"100% of $79,616.00 in Billed Charges for Rev 278 = $79,616.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE EVOLUT R TRANSCATHETER AORTIC VALVE 23MM TO 29MM,278,RC,27800532,CDM,,,,,,both,,,79616.0000,11942.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,39808.00,,,,,,,5652.7400,79616.0000,percent of total billed charges,"Rev 278 $79,616.00 in Billed Charges at 50% = $39,808.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE EVOLUT R TRANSCATHETER AORTIC VALVE 23MM TO 29MM,278,RC,27800532,CDM,,,,,,both,,,79616.0000,11942.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5971.20,,,,,,,5652.7400,79616.0000,percent of total billed charges,"7.5% of $79,616.00 in Billed Charges for Rev 278 = $5,971.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE EVOLUT R TRANSCATHETER AORTIC VALVE 23MM TO 29MM,278,RC,27800532,CDM,,,,,,both,,,79616.0000,11942.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,5652.74,,,,,,,5652.7400,79616.0000,percent of total billed charges,"7.1% of $79,616.00 in Billed Charges for Rev 278 = $5,652.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE EVOLUT R TRANSCATHETER AORTIC VALVE 23MM TO 29MM,278,RC,27800532,CDM,,,,,,both,,,79616.0000,11942.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,5652.74,,,,,,,5652.7400,79616.0000,percent of total billed charges,"7.1% of $79,616.00 in Billed Charges for Rev 278 = $5,652.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE EVOLUT R TRANSCATHETER AORTIC VALVE 23MM TO 29MM,278,RC,27800532,CDM,,,,,,both,,,79616.0000,11942.4000,WELLCARE,WELLCARE MEDICAID,79616.00,,,,,,,5652.7400,79616.0000,percent of total billed charges,"100% of $79,616.00 in Billed Charges for Rev 278 = $79,616.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE HEIMLICH CHEST DRAIN 373460,272,RC,27201261,CDM,,,,,,both,,,111.0000,16.6500,AETNA,AETNA,47.40,,,,,,,28.6500,111.0000,percent of total billed charges,42.7% of $111.00 in Billed Charges for Rev 272 = $47.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE HEIMLICH CHEST DRAIN 373460,272,RC,27201261,CDM,,,,,,both,,,111.0000,16.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,77.70,,,,,,,28.6500,111.0000,percent of total billed charges,Rev 272 $111.00 in Billed Charges at 70% = $77.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE HEIMLICH CHEST DRAIN 373460,272,RC,27201261,CDM,,,,,,both,,,111.0000,16.6500,CIGNA HEALTHCARE,CIGNA HMO,46.29,,,,,,,28.6500,111.0000,percent of total billed charges,41.7% of $111.00 in Billed Charges for Rev 272 = $46.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE HEIMLICH CHEST DRAIN 373460,272,RC,27201261,CDM,,,,,,both,,,111.0000,16.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,51.50,,,,,,,28.6500,111.0000,percent of total billed charges,46.4% of $111.00 in Billed Charges for Rev 272 = $51.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE HEIMLICH CHEST DRAIN 373460,272,RC,27201261,CDM,,,,,,both,,,111.0000,16.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,46.29,,,,,,,28.6500,111.0000,percent of total billed charges,41.7% of $111.00 in Billed Charges for Rev 272 = $46.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE HEIMLICH CHEST DRAIN 373460,272,RC,27201261,CDM,,,,,,both,,,111.0000,16.6500,CIGNA HEALTHCARE,CIGNA PPO,46.29,,,,,,,28.6500,111.0000,percent of total billed charges,41.7% of $111.00 in Billed Charges for Rev 272 = $46.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE HEIMLICH CHEST DRAIN 373460,272,RC,27201261,CDM,,,,,,both,,,111.0000,16.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,99.90,,,,,,,28.6500,111.0000,percent of total billed charges,90% of $111.00 in Billed Charges for Rev 272 = $99.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE HEIMLICH CHEST DRAIN 373460,272,RC,27201261,CDM,,,,,,both,,,111.0000,16.6500,MEDCOST,MEDCOST VHN,52.82,,,,,,,28.6500,111.0000,percent of total billed charges,47.59% of $111.00 in Billed Charges for Rev 272 = $52.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE HEIMLICH CHEST DRAIN 373460,272,RC,27201261,CDM,,,,,,both,,,111.0000,16.6500,SENTARA HEALTH,SENTARA HEALTH,28.65,,,,,,,28.6500,111.0000,percent of total billed charges,25.81% of $111.00 in Billed Charges for Rev 272 = $28.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE HEIMLICH CHEST DRAIN 373460,272,RC,27201261,CDM,,,,,,both,,,111.0000,16.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",111.00,,,,,,,28.6500,111.0000,percent of total billed charges,100% of $111.00 in Billed Charges for Rev 272 = $111.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE HEIMLICH CHEST DRAIN 373460,272,RC,27201261,CDM,,,,,,both,,,111.0000,16.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,55.50,,,,,,,28.6500,111.0000,percent of total billed charges,Rev 272 $111.00 in Billed Charges at 50% = $55.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE HEIMLICH CHEST DRAIN 373460,272,RC,27201261,CDM,,,,,,both,,,111.0000,16.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,35.85,,,,,,,28.6500,111.0000,other,32.3% of $111.00 in Billed Charges for Rev 272 = $35.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VALVE HEIMLICH CHEST DRAIN 373460,272,RC,27201261,CDM,,,,,,both,,,111.0000,16.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,34.08,,,,,,,28.6500,111.0000,other,30.7% of $111.00 in Billed Charges for Rev 272 = $34.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VALVE HEIMLICH CHEST DRAIN 373460,272,RC,27201261,CDM,,,,,,both,,,111.0000,16.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,35.85,,,,,,,28.6500,111.0000,percent of total billed charges,32.3% of $111.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE HEIMLICH CHEST DRAIN 373460,272,RC,27201261,CDM,,,,,,both,,,111.0000,16.6500,WELLCARE,WELLCARE MEDICAID,111.00,,,,,,,28.6500,111.0000,percent of total billed charges,100% of $111.00 in Billed Charges for Rev 272 = $111.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VALVE SAPIEN 3 TRANSAPICAL DELIVERY SYSTEM 23MM TO 29 MM,278,RC,27800531,CDM,,,,,,both,,,86353.0000,12952.9500,AETNA,AETNA,41449.44,,,,,,,6131.0600,86353.0000,percent of total billed charges,"48% of $86,353.00 in Billed Charges for Rev 278 = $41,449.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE SAPIEN 3 TRANSAPICAL DELIVERY SYSTEM 23MM TO 29 MM,278,RC,27800531,CDM,,,,,,both,,,86353.0000,12952.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,43176.50,,,,,,,6131.0600,86353.0000,percent of total billed charges,"50% of $86,353.00 in Billed Charges for Rev 278 = $43,176.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE SAPIEN 3 TRANSAPICAL DELIVERY SYSTEM 23MM TO 29 MM,278,RC,27800531,CDM,,,,,,both,,,86353.0000,12952.9500,CIGNA HEALTHCARE,CIGNA HMO,36009.20,,,,,,,6131.0600,86353.0000,percent of total billed charges,"41.7% of $86,353.00 in Billed Charges for Rev 278 = $36,009.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE SAPIEN 3 TRANSAPICAL DELIVERY SYSTEM 23MM TO 29 MM,278,RC,27800531,CDM,,,,,,both,,,86353.0000,12952.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,34541.20,,,,,,,6131.0600,86353.0000,percent of total billed charges,"40% of $86,353.00 in Billed Charges for Rev 278 = $34,541.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE SAPIEN 3 TRANSAPICAL DELIVERY SYSTEM 23MM TO 29 MM,278,RC,27800531,CDM,,,,,,both,,,86353.0000,12952.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,36009.20,,,,,,,6131.0600,86353.0000,percent of total billed charges,"41.7% of $86,353.00 in Billed Charges for Rev 278 = $36,009.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE SAPIEN 3 TRANSAPICAL DELIVERY SYSTEM 23MM TO 29 MM,278,RC,27800531,CDM,,,,,,both,,,86353.0000,12952.9500,CIGNA HEALTHCARE,CIGNA PPO,36009.20,,,,,,,6131.0600,86353.0000,percent of total billed charges,"41.7% of $86,353.00 in Billed Charges for Rev 278 = $36,009.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE SAPIEN 3 TRANSAPICAL DELIVERY SYSTEM 23MM TO 29 MM,278,RC,27800531,CDM,,,,,,both,,,86353.0000,12952.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,77717.70,,,,,,,6131.0600,86353.0000,percent of total billed charges,"90% of $86,353.00 in Billed Charges for Rev 278 = $77,717.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE SAPIEN 3 TRANSAPICAL DELIVERY SYSTEM 23MM TO 29 MM,278,RC,27800531,CDM,,,,,,both,,,86353.0000,12952.9500,MEDCOST,MEDCOST VHN,41095.39,,,,,,,6131.0600,86353.0000,percent of total billed charges,"47.59% of $86,353.00 in Billed Charges for Rev 278 = $41,095.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE SAPIEN 3 TRANSAPICAL DELIVERY SYSTEM 23MM TO 29 MM,278,RC,27800531,CDM,,,,,,both,,,86353.0000,12952.9500,SENTARA HEALTH,SENTARA HEALTH,22287.71,,,,,,,6131.0600,86353.0000,percent of total billed charges,"25.81% of $86,353.00 in Billed Charges for Rev 278 = $22,287.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE SAPIEN 3 TRANSAPICAL DELIVERY SYSTEM 23MM TO 29 MM,278,RC,27800531,CDM,,,,,,both,,,86353.0000,12952.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",86353.00,,,,,,,6131.0600,86353.0000,percent of total billed charges,"100% of $86,353.00 in Billed Charges for Rev 278 = $86,353.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE SAPIEN 3 TRANSAPICAL DELIVERY SYSTEM 23MM TO 29 MM,278,RC,27800531,CDM,,,,,,both,,,86353.0000,12952.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,43176.50,,,,,,,6131.0600,86353.0000,percent of total billed charges,"Rev 278 $86,353.00 in Billed Charges at 50% = $43,176.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE SAPIEN 3 TRANSAPICAL DELIVERY SYSTEM 23MM TO 29 MM,278,RC,27800531,CDM,,,,,,both,,,86353.0000,12952.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,6476.48,,,,,,,6131.0600,86353.0000,percent of total billed charges,"7.5% of $86,353.00 in Billed Charges for Rev 278 = $6,476.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE SAPIEN 3 TRANSAPICAL DELIVERY SYSTEM 23MM TO 29 MM,278,RC,27800531,CDM,,,,,,both,,,86353.0000,12952.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,6131.06,,,,,,,6131.0600,86353.0000,percent of total billed charges,"7.1% of $86,353.00 in Billed Charges for Rev 278 = $6,131.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE SAPIEN 3 TRANSAPICAL DELIVERY SYSTEM 23MM TO 29 MM,278,RC,27800531,CDM,,,,,,both,,,86353.0000,12952.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,6131.06,,,,,,,6131.0600,86353.0000,percent of total billed charges,"7.1% of $86,353.00 in Billed Charges for Rev 278 = $6,131.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VALVE SAPIEN 3 TRANSAPICAL DELIVERY SYSTEM 23MM TO 29 MM,278,RC,27800531,CDM,,,,,,both,,,86353.0000,12952.9500,WELLCARE,WELLCARE MEDICAID,86353.00,,,,,,,6131.0600,86353.0000,percent of total billed charges,"100% of $86,353.00 in Billed Charges for Rev 278 = $86,353.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENTRICULOSTOMY DRILL,272,RC,27201263,CDM,,,,,,both,,,1075.0000,161.2500,AETNA,AETNA,459.03,,,,,,,277.4600,1075.0000,percent of total billed charges,"42.7% of $1,075.00 in Billed Charges for Rev 272 = $459.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENTRICULOSTOMY DRILL,272,RC,27201263,CDM,,,,,,both,,,1075.0000,161.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,752.50,,,,,,,277.4600,1075.0000,percent of total billed charges,"Rev 272 $1,075.00 in Billed Charges at 70% = $752.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENTRICULOSTOMY DRILL,272,RC,27201263,CDM,,,,,,both,,,1075.0000,161.2500,CIGNA HEALTHCARE,CIGNA HMO,448.28,,,,,,,277.4600,1075.0000,percent of total billed charges,"41.7% of $1,075.00 in Billed Charges for Rev 272 = $448.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENTRICULOSTOMY DRILL,272,RC,27201263,CDM,,,,,,both,,,1075.0000,161.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,498.80,,,,,,,277.4600,1075.0000,percent of total billed charges,"46.4% of $1,075.00 in Billed Charges for Rev 272 = $498.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENTRICULOSTOMY DRILL,272,RC,27201263,CDM,,,,,,both,,,1075.0000,161.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,448.28,,,,,,,277.4600,1075.0000,percent of total billed charges,"41.7% of $1,075.00 in Billed Charges for Rev 272 = $448.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENTRICULOSTOMY DRILL,272,RC,27201263,CDM,,,,,,both,,,1075.0000,161.2500,CIGNA HEALTHCARE,CIGNA PPO,448.28,,,,,,,277.4600,1075.0000,percent of total billed charges,"41.7% of $1,075.00 in Billed Charges for Rev 272 = $448.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENTRICULOSTOMY DRILL,272,RC,27201263,CDM,,,,,,both,,,1075.0000,161.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,967.50,,,,,,,277.4600,1075.0000,percent of total billed charges,"90% of $1,075.00 in Billed Charges for Rev 272 = $967.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENTRICULOSTOMY DRILL,272,RC,27201263,CDM,,,,,,both,,,1075.0000,161.2500,MEDCOST,MEDCOST VHN,511.59,,,,,,,277.4600,1075.0000,percent of total billed charges,"47.59% of $1,075.00 in Billed Charges for Rev 272 = $511.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENTRICULOSTOMY DRILL,272,RC,27201263,CDM,,,,,,both,,,1075.0000,161.2500,SENTARA HEALTH,SENTARA HEALTH,277.46,,,,,,,277.4600,1075.0000,percent of total billed charges,"25.81% of $1,075.00 in Billed Charges for Rev 272 = $277.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENTRICULOSTOMY DRILL,272,RC,27201263,CDM,,,,,,both,,,1075.0000,161.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1075.00,,,,,,,277.4600,1075.0000,percent of total billed charges,"100% of $1,075.00 in Billed Charges for Rev 272 = $1,075.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENTRICULOSTOMY DRILL,272,RC,27201263,CDM,,,,,,both,,,1075.0000,161.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,537.50,,,,,,,277.4600,1075.0000,percent of total billed charges,"Rev 272 $1,075.00 in Billed Charges at 50% = $537.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENTRICULOSTOMY DRILL,272,RC,27201263,CDM,,,,,,both,,,1075.0000,161.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,347.23,,,,,,,277.4600,1075.0000,other,"32.3% of $1,075.00 in Billed Charges for Rev 272 = $347.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC VENTRICULOSTOMY DRILL,272,RC,27201263,CDM,,,,,,both,,,1075.0000,161.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,330.03,,,,,,,277.4600,1075.0000,other,"30.7% of $1,075.00 in Billed Charges for Rev 272 = $330.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC VENTRICULOSTOMY DRILL,272,RC,27201263,CDM,,,,,,both,,,1075.0000,161.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,347.23,,,,,,,277.4600,1075.0000,percent of total billed charges,"32.3% of $1,075.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENTRICULOSTOMY DRILL,272,RC,27201263,CDM,,,,,,both,,,1075.0000,161.2500,WELLCARE,WELLCARE MEDICAID,1075.00,,,,,,,277.4600,1075.0000,percent of total billed charges,"100% of $1,075.00 in Billed Charges for Rev 272 = $1,075.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY  3550-45,272,RC,27200002,CDM,,,,,,both,,,601.5200,90.2300,AETNA,AETNA,256.85,,,,,,,155.2500,601.5200,percent of total billed charges,42.7% of $601.52 in Billed Charges for Rev 272 = $256.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ACCESSORY  3550-45,272,RC,27200002,CDM,,,,,,both,,,601.5200,90.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,421.06,,,,,,,155.2500,601.5200,percent of total billed charges,Rev 272 $601.52 in Billed Charges at 70% = $421.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ACCESSORY  3550-45,272,RC,27200002,CDM,,,,,,both,,,601.5200,90.2300,CIGNA HEALTHCARE,CIGNA HMO,250.83,,,,,,,155.2500,601.5200,percent of total billed charges,41.7% of $601.52 in Billed Charges for Rev 272 = $250.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ACCESSORY  3550-45,272,RC,27200002,CDM,,,,,,both,,,601.5200,90.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,279.11,,,,,,,155.2500,601.5200,percent of total billed charges,46.4% of $601.52 in Billed Charges for Rev 272 = $279.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ACCESSORY  3550-45,272,RC,27200002,CDM,,,,,,both,,,601.5200,90.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,250.83,,,,,,,155.2500,601.5200,percent of total billed charges,41.7% of $601.52 in Billed Charges for Rev 272 = $250.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ACCESSORY  3550-45,272,RC,27200002,CDM,,,,,,both,,,601.5200,90.2300,CIGNA HEALTHCARE,CIGNA PPO,250.83,,,,,,,155.2500,601.5200,percent of total billed charges,41.7% of $601.52 in Billed Charges for Rev 272 = $250.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ACCESSORY  3550-45,272,RC,27200002,CDM,,,,,,both,,,601.5200,90.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,541.37,,,,,,,155.2500,601.5200,percent of total billed charges,90% of $601.52 in Billed Charges for Rev 272 = $541.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ACCESSORY  3550-45,272,RC,27200002,CDM,,,,,,both,,,601.5200,90.2300,MEDCOST,MEDCOST VHN,286.26,,,,,,,155.2500,601.5200,percent of total billed charges,47.59% of $601.52 in Billed Charges for Rev 272 = $286.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ACCESSORY  3550-45,272,RC,27200002,CDM,,,,,,both,,,601.5200,90.2300,SENTARA HEALTH,SENTARA HEALTH,155.25,,,,,,,155.2500,601.5200,percent of total billed charges,25.81% of $601.52 in Billed Charges for Rev 272 = $155.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ACCESSORY  3550-45,272,RC,27200002,CDM,,,,,,both,,,601.5200,90.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",601.52,,,,,,,155.2500,601.5200,percent of total billed charges,100% of $601.52 in Billed Charges for Rev 272 = $601.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ACCESSORY  3550-45,272,RC,27200002,CDM,,,,,,both,,,601.5200,90.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,300.76,,,,,,,155.2500,601.5200,percent of total billed charges,Rev 272 $601.52 in Billed Charges at 50% = $300.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ACCESSORY  3550-45,272,RC,27200002,CDM,,,,,,both,,,601.5200,90.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,194.29,,,,,,,155.2500,601.5200,other,32.3% of $601.52 in Billed Charges for Rev 272 = $194.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT ACCESSORY  3550-45,272,RC,27200002,CDM,,,,,,both,,,601.5200,90.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,184.67,,,,,,,155.2500,601.5200,other,30.7% of $601.52 in Billed Charges for Rev 272 = $184.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT ACCESSORY  3550-45,272,RC,27200002,CDM,,,,,,both,,,601.5200,90.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,194.29,,,,,,,155.2500,601.5200,percent of total billed charges,32.3% of $601.52 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ACCESSORY  3550-45,272,RC,27200002,CDM,,,,,,both,,,601.5200,90.2300,WELLCARE,WELLCARE MEDICAID,601.52,,,,,,,155.2500,601.5200,percent of total billed charges,100% of $601.52 in Billed Charges for Rev 272 = $601.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL ADULT 20X3 1/2,270,RC,27000064,CDM,,,,,,both,,,54.0000,8.1000,AETNA,AETNA,23.06,,,,,,,13.9400,54.0000,percent of total billed charges,42.7% of $54.00 in Billed Charges for Rev 270 = $23.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL ADULT 20X3 1/2,270,RC,27000064,CDM,,,,,,both,,,54.0000,8.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,37.80,,,,,,,13.9400,54.0000,percent of total billed charges,Rev 270 $54.00 in Billed Charges at 70% = $37.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL ADULT 20X3 1/2,270,RC,27000064,CDM,,,,,,both,,,54.0000,8.1000,CIGNA HEALTHCARE,CIGNA HMO,22.52,,,,,,,13.9400,54.0000,percent of total billed charges,41.7% of $54.00 in Billed Charges for Rev 270 = $22.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL ADULT 20X3 1/2,270,RC,27000064,CDM,,,,,,both,,,54.0000,8.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,25.06,,,,,,,13.9400,54.0000,percent of total billed charges,46.4% of $54.00 in Billed Charges for Rev 270 = $25.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL ADULT 20X3 1/2,270,RC,27000064,CDM,,,,,,both,,,54.0000,8.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,22.52,,,,,,,13.9400,54.0000,percent of total billed charges,41.7% of $54.00 in Billed Charges for Rev 270 = $22.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL ADULT 20X3 1/2,270,RC,27000064,CDM,,,,,,both,,,54.0000,8.1000,CIGNA HEALTHCARE,CIGNA PPO,22.52,,,,,,,13.9400,54.0000,percent of total billed charges,41.7% of $54.00 in Billed Charges for Rev 270 = $22.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL ADULT 20X3 1/2,270,RC,27000064,CDM,,,,,,both,,,54.0000,8.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,48.60,,,,,,,13.9400,54.0000,percent of total billed charges,90% of $54.00 in Billed Charges for Rev 270 = $48.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL ADULT 20X3 1/2,270,RC,27000064,CDM,,,,,,both,,,54.0000,8.1000,MEDCOST,MEDCOST VHN,25.70,,,,,,,13.9400,54.0000,percent of total billed charges,47.59% of $54.00 in Billed Charges for Rev 270 = $25.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL ADULT 20X3 1/2,270,RC,27000064,CDM,,,,,,both,,,54.0000,8.1000,SENTARA HEALTH,SENTARA HEALTH,13.94,,,,,,,13.9400,54.0000,percent of total billed charges,25.81% of $54.00 in Billed Charges for Rev 270 = $13.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL ADULT 20X3 1/2,270,RC,27000064,CDM,,,,,,both,,,54.0000,8.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",54.00,,,,,,,13.9400,54.0000,percent of total billed charges,100% of $54.00 in Billed Charges for Rev 270 = $54.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL ADULT 20X3 1/2,270,RC,27000064,CDM,,,,,,both,,,54.0000,8.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,27.00,,,,,,,13.9400,54.0000,percent of total billed charges,Rev 270 $54.00 in Billed Charges at 50% = $27.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL ADULT 20X3 1/2,270,RC,27000064,CDM,,,,,,both,,,54.0000,8.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,17.44,,,,,,,13.9400,54.0000,other,32.3% of $54.00 in Billed Charges for Rev 270 = $17.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRAY SPINAL ADULT 20X3 1/2,270,RC,27000064,CDM,,,,,,both,,,54.0000,8.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,16.58,,,,,,,13.9400,54.0000,other,30.7% of $54.00 in Billed Charges for Rev 270 = $16.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRAY SPINAL ADULT 20X3 1/2,270,RC,27000064,CDM,,,,,,both,,,54.0000,8.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,17.44,,,,,,,13.9400,54.0000,percent of total billed charges,32.3% of $54.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL ADULT 20X3 1/2,270,RC,27000064,CDM,,,,,,both,,,54.0000,8.1000,WELLCARE,WELLCARE MEDICAID,54.00,,,,,,,13.9400,54.0000,percent of total billed charges,100% of $54.00 in Billed Charges for Rev 270 = $54.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY THORACENTESIS W CATH,272,RC,27201201,CDM,,,,,,both,,,118.0000,17.7000,AETNA,AETNA,50.39,,,,,,,30.4600,118.0000,percent of total billed charges,42.7% of $118.00 in Billed Charges for Rev 272 = $50.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY THORACENTESIS W CATH,272,RC,27201201,CDM,,,,,,both,,,118.0000,17.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,82.60,,,,,,,30.4600,118.0000,percent of total billed charges,Rev 272 $118.00 in Billed Charges at 70% = $82.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY THORACENTESIS W CATH,272,RC,27201201,CDM,,,,,,both,,,118.0000,17.7000,CIGNA HEALTHCARE,CIGNA HMO,49.21,,,,,,,30.4600,118.0000,percent of total billed charges,41.7% of $118.00 in Billed Charges for Rev 272 = $49.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY THORACENTESIS W CATH,272,RC,27201201,CDM,,,,,,both,,,118.0000,17.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,54.75,,,,,,,30.4600,118.0000,percent of total billed charges,46.4% of $118.00 in Billed Charges for Rev 272 = $54.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY THORACENTESIS W CATH,272,RC,27201201,CDM,,,,,,both,,,118.0000,17.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,49.21,,,,,,,30.4600,118.0000,percent of total billed charges,41.7% of $118.00 in Billed Charges for Rev 272 = $49.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY THORACENTESIS W CATH,272,RC,27201201,CDM,,,,,,both,,,118.0000,17.7000,CIGNA HEALTHCARE,CIGNA PPO,49.21,,,,,,,30.4600,118.0000,percent of total billed charges,41.7% of $118.00 in Billed Charges for Rev 272 = $49.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY THORACENTESIS W CATH,272,RC,27201201,CDM,,,,,,both,,,118.0000,17.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,106.20,,,,,,,30.4600,118.0000,percent of total billed charges,90% of $118.00 in Billed Charges for Rev 272 = $106.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY THORACENTESIS W CATH,272,RC,27201201,CDM,,,,,,both,,,118.0000,17.7000,MEDCOST,MEDCOST VHN,56.16,,,,,,,30.4600,118.0000,percent of total billed charges,47.59% of $118.00 in Billed Charges for Rev 272 = $56.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY THORACENTESIS W CATH,272,RC,27201201,CDM,,,,,,both,,,118.0000,17.7000,SENTARA HEALTH,SENTARA HEALTH,30.46,,,,,,,30.4600,118.0000,percent of total billed charges,25.81% of $118.00 in Billed Charges for Rev 272 = $30.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY THORACENTESIS W CATH,272,RC,27201201,CDM,,,,,,both,,,118.0000,17.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",118.00,,,,,,,30.4600,118.0000,percent of total billed charges,100% of $118.00 in Billed Charges for Rev 272 = $118.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY THORACENTESIS W CATH,272,RC,27201201,CDM,,,,,,both,,,118.0000,17.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,59.00,,,,,,,30.4600,118.0000,percent of total billed charges,Rev 272 $118.00 in Billed Charges at 50% = $59.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY THORACENTESIS W CATH,272,RC,27201201,CDM,,,,,,both,,,118.0000,17.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,38.11,,,,,,,30.4600,118.0000,other,32.3% of $118.00 in Billed Charges for Rev 272 = $38.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRAY THORACENTESIS W CATH,272,RC,27201201,CDM,,,,,,both,,,118.0000,17.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,36.23,,,,,,,30.4600,118.0000,other,30.7% of $118.00 in Billed Charges for Rev 272 = $36.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRAY THORACENTESIS W CATH,272,RC,27201201,CDM,,,,,,both,,,118.0000,17.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,38.11,,,,,,,30.4600,118.0000,percent of total billed charges,32.3% of $118.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY THORACENTESIS W CATH,272,RC,27201201,CDM,,,,,,both,,,118.0000,17.7000,WELLCARE,WELLCARE MEDICAID,118.00,,,,,,,30.4600,118.0000,percent of total billed charges,100% of $118.00 in Billed Charges for Rev 272 = $118.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY TRU CLOSE VENT 13F 10CM,272,RC,27202292,CDM,,,,,,both,,,2127.0000,319.0500,AETNA,AETNA,908.23,,,,,,,548.9800,2127.0000,percent of total billed charges,"42.7% of $2,127.00 in Billed Charges for Rev 272 = $908.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRAY TRU CLOSE VENT 13F 10CM,272,RC,27202292,CDM,,,,,,both,,,2127.0000,319.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1488.90,,,,,,,548.9800,2127.0000,percent of total billed charges,"Rev 272 $2,127.00 in Billed Charges at 70% = $1,488.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRAY TRU CLOSE VENT 13F 10CM,272,RC,27202292,CDM,,,,,,both,,,2127.0000,319.0500,CIGNA HEALTHCARE,CIGNA HMO,886.96,,,,,,,548.9800,2127.0000,percent of total billed charges,"41.7% of $2,127.00 in Billed Charges for Rev 272 = $886.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRAY TRU CLOSE VENT 13F 10CM,272,RC,27202292,CDM,,,,,,both,,,2127.0000,319.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,986.93,,,,,,,548.9800,2127.0000,percent of total billed charges,"46.4% of $2,127.00 in Billed Charges for Rev 272 = $986.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRAY TRU CLOSE VENT 13F 10CM,272,RC,27202292,CDM,,,,,,both,,,2127.0000,319.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,886.96,,,,,,,548.9800,2127.0000,percent of total billed charges,"41.7% of $2,127.00 in Billed Charges for Rev 272 = $886.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRAY TRU CLOSE VENT 13F 10CM,272,RC,27202292,CDM,,,,,,both,,,2127.0000,319.0500,CIGNA HEALTHCARE,CIGNA PPO,886.96,,,,,,,548.9800,2127.0000,percent of total billed charges,"41.7% of $2,127.00 in Billed Charges for Rev 272 = $886.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRAY TRU CLOSE VENT 13F 10CM,272,RC,27202292,CDM,,,,,,both,,,2127.0000,319.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1914.30,,,,,,,548.9800,2127.0000,percent of total billed charges,"90% of $2,127.00 in Billed Charges for Rev 272 = $1,914.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRAY TRU CLOSE VENT 13F 10CM,272,RC,27202292,CDM,,,,,,both,,,2127.0000,319.0500,MEDCOST,MEDCOST VHN,1012.24,,,,,,,548.9800,2127.0000,percent of total billed charges,"47.59% of $2,127.00 in Billed Charges for Rev 272 = $1,012.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRAY TRU CLOSE VENT 13F 10CM,272,RC,27202292,CDM,,,,,,both,,,2127.0000,319.0500,SENTARA HEALTH,SENTARA HEALTH,548.98,,,,,,,548.9800,2127.0000,percent of total billed charges,"25.81% of $2,127.00 in Billed Charges for Rev 272 = $548.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRAY TRU CLOSE VENT 13F 10CM,272,RC,27202292,CDM,,,,,,both,,,2127.0000,319.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2127.00,,,,,,,548.9800,2127.0000,percent of total billed charges,"100% of $2,127.00 in Billed Charges for Rev 272 = $2,127.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRAY TRU CLOSE VENT 13F 10CM,272,RC,27202292,CDM,,,,,,both,,,2127.0000,319.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1063.50,,,,,,,548.9800,2127.0000,percent of total billed charges,"Rev 272 $2,127.00 in Billed Charges at 50% = $1,063.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRAY TRU CLOSE VENT 13F 10CM,272,RC,27202292,CDM,,,,,,both,,,2127.0000,319.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,687.02,,,,,,,548.9800,2127.0000,other,"32.3% of $2,127.00 in Billed Charges for Rev 272 = $687.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRAY TRU CLOSE VENT 13F 10CM,272,RC,27202292,CDM,,,,,,both,,,2127.0000,319.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,652.99,,,,,,,548.9800,2127.0000,other,"30.7% of $2,127.00 in Billed Charges for Rev 272 = $652.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRAY TRU CLOSE VENT 13F 10CM,272,RC,27202292,CDM,,,,,,both,,,2127.0000,319.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,687.02,,,,,,,548.9800,2127.0000,percent of total billed charges,"32.3% of $2,127.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRAY TRU CLOSE VENT 13F 10CM,272,RC,27202292,CDM,,,,,,both,,,2127.0000,319.0500,WELLCARE,WELLCARE MEDICAID,2127.00,,,,,,,548.9800,2127.0000,percent of total billed charges,"100% of $2,127.00 in Billed Charges for Rev 272 = $2,127.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRAY UMB VESSEL 3.5 5.0 160119,272,RC,27201203,CDM,,,,,,both,,,330.0000,49.5000,AETNA,AETNA,140.91,,,,,,,85.1700,330.0000,percent of total billed charges,42.7% of $330.00 in Billed Charges for Rev 272 = $140.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMB VESSEL 3.5 5.0 160119,272,RC,27201203,CDM,,,,,,both,,,330.0000,49.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,231.00,,,,,,,85.1700,330.0000,percent of total billed charges,Rev 272 $330.00 in Billed Charges at 70% = $231.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMB VESSEL 3.5 5.0 160119,272,RC,27201203,CDM,,,,,,both,,,330.0000,49.5000,CIGNA HEALTHCARE,CIGNA HMO,137.61,,,,,,,85.1700,330.0000,percent of total billed charges,41.7% of $330.00 in Billed Charges for Rev 272 = $137.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMB VESSEL 3.5 5.0 160119,272,RC,27201203,CDM,,,,,,both,,,330.0000,49.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,153.12,,,,,,,85.1700,330.0000,percent of total billed charges,46.4% of $330.00 in Billed Charges for Rev 272 = $153.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMB VESSEL 3.5 5.0 160119,272,RC,27201203,CDM,,,,,,both,,,330.0000,49.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,137.61,,,,,,,85.1700,330.0000,percent of total billed charges,41.7% of $330.00 in Billed Charges for Rev 272 = $137.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMB VESSEL 3.5 5.0 160119,272,RC,27201203,CDM,,,,,,both,,,330.0000,49.5000,CIGNA HEALTHCARE,CIGNA PPO,137.61,,,,,,,85.1700,330.0000,percent of total billed charges,41.7% of $330.00 in Billed Charges for Rev 272 = $137.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMB VESSEL 3.5 5.0 160119,272,RC,27201203,CDM,,,,,,both,,,330.0000,49.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,297.00,,,,,,,85.1700,330.0000,percent of total billed charges,90% of $330.00 in Billed Charges for Rev 272 = $297.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMB VESSEL 3.5 5.0 160119,272,RC,27201203,CDM,,,,,,both,,,330.0000,49.5000,MEDCOST,MEDCOST VHN,157.05,,,,,,,85.1700,330.0000,percent of total billed charges,47.59% of $330.00 in Billed Charges for Rev 272 = $157.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMB VESSEL 3.5 5.0 160119,272,RC,27201203,CDM,,,,,,both,,,330.0000,49.5000,SENTARA HEALTH,SENTARA HEALTH,85.17,,,,,,,85.1700,330.0000,percent of total billed charges,25.81% of $330.00 in Billed Charges for Rev 272 = $85.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMB VESSEL 3.5 5.0 160119,272,RC,27201203,CDM,,,,,,both,,,330.0000,49.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",330.00,,,,,,,85.1700,330.0000,percent of total billed charges,100% of $330.00 in Billed Charges for Rev 272 = $330.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMB VESSEL 3.5 5.0 160119,272,RC,27201203,CDM,,,,,,both,,,330.0000,49.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,165.00,,,,,,,85.1700,330.0000,percent of total billed charges,Rev 272 $330.00 in Billed Charges at 50% = $165.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMB VESSEL 3.5 5.0 160119,272,RC,27201203,CDM,,,,,,both,,,330.0000,49.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,106.59,,,,,,,85.1700,330.0000,other,32.3% of $330.00 in Billed Charges for Rev 272 = $106.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRAY UMB VESSEL 3.5 5.0 160119,272,RC,27201203,CDM,,,,,,both,,,330.0000,49.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,101.31,,,,,,,85.1700,330.0000,other,30.7% of $330.00 in Billed Charges for Rev 272 = $101.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRAY UMB VESSEL 3.5 5.0 160119,272,RC,27201203,CDM,,,,,,both,,,330.0000,49.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,106.59,,,,,,,85.1700,330.0000,percent of total billed charges,32.3% of $330.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMB VESSEL 3.5 5.0 160119,272,RC,27201203,CDM,,,,,,both,,,330.0000,49.5000,WELLCARE,WELLCARE MEDICAID,330.00,,,,,,,85.1700,330.0000,percent of total billed charges,100% of $330.00 in Billed Charges for Rev 272 = $330.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMBILICAL VESSEL,272,RC,27201204,CDM,,,,,,both,,,206.0000,30.9000,AETNA,AETNA,87.96,,,,,,,53.1700,206.0000,percent of total billed charges,42.7% of $206.00 in Billed Charges for Rev 272 = $87.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMBILICAL VESSEL,272,RC,27201204,CDM,,,,,,both,,,206.0000,30.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,144.20,,,,,,,53.1700,206.0000,percent of total billed charges,Rev 272 $206.00 in Billed Charges at 70% = $144.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMBILICAL VESSEL,272,RC,27201204,CDM,,,,,,both,,,206.0000,30.9000,CIGNA HEALTHCARE,CIGNA HMO,85.90,,,,,,,53.1700,206.0000,percent of total billed charges,41.7% of $206.00 in Billed Charges for Rev 272 = $85.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMBILICAL VESSEL,272,RC,27201204,CDM,,,,,,both,,,206.0000,30.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,95.58,,,,,,,53.1700,206.0000,percent of total billed charges,46.4% of $206.00 in Billed Charges for Rev 272 = $95.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMBILICAL VESSEL,272,RC,27201204,CDM,,,,,,both,,,206.0000,30.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,85.90,,,,,,,53.1700,206.0000,percent of total billed charges,41.7% of $206.00 in Billed Charges for Rev 272 = $85.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMBILICAL VESSEL,272,RC,27201204,CDM,,,,,,both,,,206.0000,30.9000,CIGNA HEALTHCARE,CIGNA PPO,85.90,,,,,,,53.1700,206.0000,percent of total billed charges,41.7% of $206.00 in Billed Charges for Rev 272 = $85.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMBILICAL VESSEL,272,RC,27201204,CDM,,,,,,both,,,206.0000,30.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,185.40,,,,,,,53.1700,206.0000,percent of total billed charges,90% of $206.00 in Billed Charges for Rev 272 = $185.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMBILICAL VESSEL,272,RC,27201204,CDM,,,,,,both,,,206.0000,30.9000,MEDCOST,MEDCOST VHN,98.04,,,,,,,53.1700,206.0000,percent of total billed charges,47.59% of $206.00 in Billed Charges for Rev 272 = $98.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMBILICAL VESSEL,272,RC,27201204,CDM,,,,,,both,,,206.0000,30.9000,SENTARA HEALTH,SENTARA HEALTH,53.17,,,,,,,53.1700,206.0000,percent of total billed charges,25.81% of $206.00 in Billed Charges for Rev 272 = $53.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMBILICAL VESSEL,272,RC,27201204,CDM,,,,,,both,,,206.0000,30.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",206.00,,,,,,,53.1700,206.0000,percent of total billed charges,100% of $206.00 in Billed Charges for Rev 272 = $206.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMBILICAL VESSEL,272,RC,27201204,CDM,,,,,,both,,,206.0000,30.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,103.00,,,,,,,53.1700,206.0000,percent of total billed charges,Rev 272 $206.00 in Billed Charges at 50% = $103.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMBILICAL VESSEL,272,RC,27201204,CDM,,,,,,both,,,206.0000,30.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,66.54,,,,,,,53.1700,206.0000,other,32.3% of $206.00 in Billed Charges for Rev 272 = $66.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRAY UMBILICAL VESSEL,272,RC,27201204,CDM,,,,,,both,,,206.0000,30.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,63.24,,,,,,,53.1700,206.0000,other,30.7% of $206.00 in Billed Charges for Rev 272 = $63.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRAY UMBILICAL VESSEL,272,RC,27201204,CDM,,,,,,both,,,206.0000,30.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,66.54,,,,,,,53.1700,206.0000,percent of total billed charges,32.3% of $206.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY UMBILICAL VESSEL,272,RC,27201204,CDM,,,,,,both,,,206.0000,30.9000,WELLCARE,WELLCARE MEDICAID,206.00,,,,,,,53.1700,206.0000,percent of total billed charges,100% of $206.00 in Billed Charges for Rev 272 = $206.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER 7000,270,RC,27000058,CDM,,,,,,both,,,51.0000,7.6500,AETNA,AETNA,21.78,,,,,,,13.1600,51.0000,percent of total billed charges,42.7% of $51.00 in Billed Charges for Rev 270 = $21.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER 7000,270,RC,27000058,CDM,,,,,,both,,,51.0000,7.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,35.70,,,,,,,13.1600,51.0000,percent of total billed charges,Rev 270 $51.00 in Billed Charges at 70% = $35.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER 7000,270,RC,27000058,CDM,,,,,,both,,,51.0000,7.6500,CIGNA HEALTHCARE,CIGNA HMO,21.27,,,,,,,13.1600,51.0000,percent of total billed charges,41.7% of $51.00 in Billed Charges for Rev 270 = $21.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER 7000,270,RC,27000058,CDM,,,,,,both,,,51.0000,7.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,23.66,,,,,,,13.1600,51.0000,percent of total billed charges,46.4% of $51.00 in Billed Charges for Rev 270 = $23.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER 7000,270,RC,27000058,CDM,,,,,,both,,,51.0000,7.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,21.27,,,,,,,13.1600,51.0000,percent of total billed charges,41.7% of $51.00 in Billed Charges for Rev 270 = $21.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER 7000,270,RC,27000058,CDM,,,,,,both,,,51.0000,7.6500,CIGNA HEALTHCARE,CIGNA PPO,21.27,,,,,,,13.1600,51.0000,percent of total billed charges,41.7% of $51.00 in Billed Charges for Rev 270 = $21.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER 7000,270,RC,27000058,CDM,,,,,,both,,,51.0000,7.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,45.90,,,,,,,13.1600,51.0000,percent of total billed charges,90% of $51.00 in Billed Charges for Rev 270 = $45.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER 7000,270,RC,27000058,CDM,,,,,,both,,,51.0000,7.6500,MEDCOST,MEDCOST VHN,24.27,,,,,,,13.1600,51.0000,percent of total billed charges,47.59% of $51.00 in Billed Charges for Rev 270 = $24.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER 7000,270,RC,27000058,CDM,,,,,,both,,,51.0000,7.6500,SENTARA HEALTH,SENTARA HEALTH,13.16,,,,,,,13.1600,51.0000,percent of total billed charges,25.81% of $51.00 in Billed Charges for Rev 270 = $13.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER 7000,270,RC,27000058,CDM,,,,,,both,,,51.0000,7.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",51.00,,,,,,,13.1600,51.0000,percent of total billed charges,100% of $51.00 in Billed Charges for Rev 270 = $51.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER 7000,270,RC,27000058,CDM,,,,,,both,,,51.0000,7.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,25.50,,,,,,,13.1600,51.0000,percent of total billed charges,Rev 270 $51.00 in Billed Charges at 50% = $25.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER 7000,270,RC,27000058,CDM,,,,,,both,,,51.0000,7.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,16.47,,,,,,,13.1600,51.0000,other,32.3% of $51.00 in Billed Charges for Rev 270 = $16.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRAY URINE METER 7000,270,RC,27000058,CDM,,,,,,both,,,51.0000,7.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,15.66,,,,,,,13.1600,51.0000,other,30.7% of $51.00 in Billed Charges for Rev 270 = $15.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRAY URINE METER 7000,270,RC,27000058,CDM,,,,,,both,,,51.0000,7.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,16.47,,,,,,,13.1600,51.0000,percent of total billed charges,32.3% of $51.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER 7000,270,RC,27000058,CDM,,,,,,both,,,51.0000,7.6500,WELLCARE,WELLCARE MEDICAID,51.00,,,,,,,13.1600,51.0000,percent of total billed charges,100% of $51.00 in Billed Charges for Rev 270 = $51.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLUNT TIP 12MM CO718,272,RC,27201210,CDM,,,,,,both,,,151.0000,22.6500,AETNA,AETNA,64.48,,,,,,,38.9700,151.0000,percent of total billed charges,42.7% of $151.00 in Billed Charges for Rev 272 = $64.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLUNT TIP 12MM CO718,272,RC,27201210,CDM,,,,,,both,,,151.0000,22.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,105.70,,,,,,,38.9700,151.0000,percent of total billed charges,Rev 272 $151.00 in Billed Charges at 70% = $105.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLUNT TIP 12MM CO718,272,RC,27201210,CDM,,,,,,both,,,151.0000,22.6500,CIGNA HEALTHCARE,CIGNA HMO,62.97,,,,,,,38.9700,151.0000,percent of total billed charges,41.7% of $151.00 in Billed Charges for Rev 272 = $62.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLUNT TIP 12MM CO718,272,RC,27201210,CDM,,,,,,both,,,151.0000,22.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,70.06,,,,,,,38.9700,151.0000,percent of total billed charges,46.4% of $151.00 in Billed Charges for Rev 272 = $70.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLUNT TIP 12MM CO718,272,RC,27201210,CDM,,,,,,both,,,151.0000,22.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,62.97,,,,,,,38.9700,151.0000,percent of total billed charges,41.7% of $151.00 in Billed Charges for Rev 272 = $62.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLUNT TIP 12MM CO718,272,RC,27201210,CDM,,,,,,both,,,151.0000,22.6500,CIGNA HEALTHCARE,CIGNA PPO,62.97,,,,,,,38.9700,151.0000,percent of total billed charges,41.7% of $151.00 in Billed Charges for Rev 272 = $62.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLUNT TIP 12MM CO718,272,RC,27201210,CDM,,,,,,both,,,151.0000,22.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,135.90,,,,,,,38.9700,151.0000,percent of total billed charges,90% of $151.00 in Billed Charges for Rev 272 = $135.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLUNT TIP 12MM CO718,272,RC,27201210,CDM,,,,,,both,,,151.0000,22.6500,MEDCOST,MEDCOST VHN,71.86,,,,,,,38.9700,151.0000,percent of total billed charges,47.59% of $151.00 in Billed Charges for Rev 272 = $71.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLUNT TIP 12MM CO718,272,RC,27201210,CDM,,,,,,both,,,151.0000,22.6500,SENTARA HEALTH,SENTARA HEALTH,38.97,,,,,,,38.9700,151.0000,percent of total billed charges,25.81% of $151.00 in Billed Charges for Rev 272 = $38.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLUNT TIP 12MM CO718,272,RC,27201210,CDM,,,,,,both,,,151.0000,22.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",151.00,,,,,,,38.9700,151.0000,percent of total billed charges,100% of $151.00 in Billed Charges for Rev 272 = $151.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLUNT TIP 12MM CO718,272,RC,27201210,CDM,,,,,,both,,,151.0000,22.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,75.50,,,,,,,38.9700,151.0000,percent of total billed charges,Rev 272 $151.00 in Billed Charges at 50% = $75.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLUNT TIP 12MM CO718,272,RC,27201210,CDM,,,,,,both,,,151.0000,22.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,48.77,,,,,,,38.9700,151.0000,other,32.3% of $151.00 in Billed Charges for Rev 272 = $48.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TROCAR BLUNT TIP 12MM CO718,272,RC,27201210,CDM,,,,,,both,,,151.0000,22.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,46.36,,,,,,,38.9700,151.0000,other,30.7% of $151.00 in Billed Charges for Rev 272 = $46.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TROCAR BLUNT TIP 12MM CO718,272,RC,27201210,CDM,,,,,,both,,,151.0000,22.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,48.77,,,,,,,38.9700,151.0000,percent of total billed charges,32.3% of $151.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLUNT TIP 12MM CO718,272,RC,27201210,CDM,,,,,,both,,,151.0000,22.6500,WELLCARE,WELLCARE MEDICAID,151.00,,,,,,,38.9700,151.0000,percent of total billed charges,100% of $151.00 in Billed Charges for Rev 272 = $151.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR NON BLADED 10-11MM,272,RC,27201211,CDM,,,,,,both,,,531.0000,79.6500,AETNA,AETNA,226.74,,,,,,,137.0500,531.0000,percent of total billed charges,42.7% of $531.00 in Billed Charges for Rev 272 = $226.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR NON BLADED 10-11MM,272,RC,27201211,CDM,,,,,,both,,,531.0000,79.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,371.70,,,,,,,137.0500,531.0000,percent of total billed charges,Rev 272 $531.00 in Billed Charges at 70% = $371.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR NON BLADED 10-11MM,272,RC,27201211,CDM,,,,,,both,,,531.0000,79.6500,CIGNA HEALTHCARE,CIGNA HMO,221.43,,,,,,,137.0500,531.0000,percent of total billed charges,41.7% of $531.00 in Billed Charges for Rev 272 = $221.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR NON BLADED 10-11MM,272,RC,27201211,CDM,,,,,,both,,,531.0000,79.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,246.38,,,,,,,137.0500,531.0000,percent of total billed charges,46.4% of $531.00 in Billed Charges for Rev 272 = $246.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR NON BLADED 10-11MM,272,RC,27201211,CDM,,,,,,both,,,531.0000,79.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,221.43,,,,,,,137.0500,531.0000,percent of total billed charges,41.7% of $531.00 in Billed Charges for Rev 272 = $221.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR NON BLADED 10-11MM,272,RC,27201211,CDM,,,,,,both,,,531.0000,79.6500,CIGNA HEALTHCARE,CIGNA PPO,221.43,,,,,,,137.0500,531.0000,percent of total billed charges,41.7% of $531.00 in Billed Charges for Rev 272 = $221.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR NON BLADED 10-11MM,272,RC,27201211,CDM,,,,,,both,,,531.0000,79.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,477.90,,,,,,,137.0500,531.0000,percent of total billed charges,90% of $531.00 in Billed Charges for Rev 272 = $477.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR NON BLADED 10-11MM,272,RC,27201211,CDM,,,,,,both,,,531.0000,79.6500,MEDCOST,MEDCOST VHN,252.70,,,,,,,137.0500,531.0000,percent of total billed charges,47.59% of $531.00 in Billed Charges for Rev 272 = $252.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR NON BLADED 10-11MM,272,RC,27201211,CDM,,,,,,both,,,531.0000,79.6500,SENTARA HEALTH,SENTARA HEALTH,137.05,,,,,,,137.0500,531.0000,percent of total billed charges,25.81% of $531.00 in Billed Charges for Rev 272 = $137.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR NON BLADED 10-11MM,272,RC,27201211,CDM,,,,,,both,,,531.0000,79.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",531.00,,,,,,,137.0500,531.0000,percent of total billed charges,100% of $531.00 in Billed Charges for Rev 272 = $531.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR NON BLADED 10-11MM,272,RC,27201211,CDM,,,,,,both,,,531.0000,79.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,265.50,,,,,,,137.0500,531.0000,percent of total billed charges,Rev 272 $531.00 in Billed Charges at 50% = $265.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR NON BLADED 10-11MM,272,RC,27201211,CDM,,,,,,both,,,531.0000,79.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,171.51,,,,,,,137.0500,531.0000,other,32.3% of $531.00 in Billed Charges for Rev 272 = $171.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TROCAR NON BLADED 10-11MM,272,RC,27201211,CDM,,,,,,both,,,531.0000,79.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,163.02,,,,,,,137.0500,531.0000,other,30.7% of $531.00 in Billed Charges for Rev 272 = $163.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TROCAR NON BLADED 10-11MM,272,RC,27201211,CDM,,,,,,both,,,531.0000,79.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,171.51,,,,,,,137.0500,531.0000,percent of total billed charges,32.3% of $531.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR NON BLADED 10-11MM,272,RC,27201211,CDM,,,,,,both,,,531.0000,79.6500,WELLCARE,WELLCARE MEDICAID,531.00,,,,,,,137.0500,531.0000,percent of total billed charges,100% of $531.00 in Billed Charges for Rev 272 = $531.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,15712.0700,2356.8100,AETNA,AETNA,6709.05,,,,,,,4055.2900,15712.0700,percent of total billed charges,"42.7% of $15,712.07 in Billed Charges for Rev 272 = $6,709.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,15712.0700,2356.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,10998.45,,,,,,,4055.2900,15712.0700,percent of total billed charges,"Rev 272 $15,712.07 in Billed Charges at 70% = $10,998.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,15712.0700,2356.8100,CIGNA HEALTHCARE,CIGNA HMO,6551.93,,,,,,,4055.2900,15712.0700,percent of total billed charges,"41.7% of $15,712.07 in Billed Charges for Rev 272 = $6,551.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,15712.0700,2356.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7290.40,,,,,,,4055.2900,15712.0700,percent of total billed charges,"46.4% of $15,712.07 in Billed Charges for Rev 272 = $7,290.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,15712.0700,2356.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6551.93,,,,,,,4055.2900,15712.0700,percent of total billed charges,"41.7% of $15,712.07 in Billed Charges for Rev 272 = $6,551.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,15712.0700,2356.8100,CIGNA HEALTHCARE,CIGNA PPO,6551.93,,,,,,,4055.2900,15712.0700,percent of total billed charges,"41.7% of $15,712.07 in Billed Charges for Rev 272 = $6,551.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,15712.0700,2356.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,14140.86,,,,,,,4055.2900,15712.0700,percent of total billed charges,"90% of $15,712.07 in Billed Charges for Rev 272 = $14,140.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,15712.0700,2356.8100,MEDCOST,MEDCOST VHN,7477.37,,,,,,,4055.2900,15712.0700,percent of total billed charges,"47.59% of $15,712.07 in Billed Charges for Rev 272 = $7,477.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,15712.0700,2356.8100,SENTARA HEALTH,SENTARA HEALTH,4055.29,,,,,,,4055.2900,15712.0700,percent of total billed charges,"25.81% of $15,712.07 in Billed Charges for Rev 272 = $4,055.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,15712.0700,2356.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15712.07,,,,,,,4055.2900,15712.0700,percent of total billed charges,"100% of $15,712.07 in Billed Charges for Rev 272 = $15,712.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,15712.0700,2356.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7856.04,,,,,,,4055.2900,15712.0700,percent of total billed charges,"Rev 272 $15,712.07 in Billed Charges at 50% = $7,856.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,15712.0700,2356.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5075.00,,,,,,,4055.2900,15712.0700,other,"32.3% of $15,712.07 in Billed Charges for Rev 272 = $5,075.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,15712.0700,2356.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,4823.61,,,,,,,4055.2900,15712.0700,other,"30.7% of $15,712.07 in Billed Charges for Rev 272 = $4,823.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,15712.0700,2356.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,5075.00,,,,,,,4055.2900,15712.0700,percent of total billed charges,"32.3% of $15,712.07 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ACCESSORY 800,272,RC,,,,,,,,both,,,15712.0700,2356.8100,WELLCARE,WELLCARE MEDICAID,15712.07,,,,,,,4055.2900,15712.0700,percent of total billed charges,"100% of $15,712.07 in Billed Charges for Rev 272 = $15,712.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADULT ENDO TRACHEAL,272,RC,,,,,,,,both,,,1484.6900,222.7000,AETNA,AETNA,633.96,,,,,,,383.2000,1484.6900,percent of total billed charges,"42.7% of $1,484.69 in Billed Charges for Rev 272 = $633.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADULT ENDO TRACHEAL,272,RC,,,,,,,,both,,,1484.6900,222.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1039.28,,,,,,,383.2000,1484.6900,percent of total billed charges,"Rev 272 $1,484.69 in Billed Charges at 70% = $1,039.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADULT ENDO TRACHEAL,272,RC,,,,,,,,both,,,1484.6900,222.7000,CIGNA HEALTHCARE,CIGNA HMO,619.12,,,,,,,383.2000,1484.6900,percent of total billed charges,"41.7% of $1,484.69 in Billed Charges for Rev 272 = $619.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADULT ENDO TRACHEAL,272,RC,,,,,,,,both,,,1484.6900,222.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,688.90,,,,,,,383.2000,1484.6900,percent of total billed charges,"46.4% of $1,484.69 in Billed Charges for Rev 272 = $688.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADULT ENDO TRACHEAL,272,RC,,,,,,,,both,,,1484.6900,222.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,619.12,,,,,,,383.2000,1484.6900,percent of total billed charges,"41.7% of $1,484.69 in Billed Charges for Rev 272 = $619.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADULT ENDO TRACHEAL,272,RC,,,,,,,,both,,,1484.6900,222.7000,CIGNA HEALTHCARE,CIGNA PPO,619.12,,,,,,,383.2000,1484.6900,percent of total billed charges,"41.7% of $1,484.69 in Billed Charges for Rev 272 = $619.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADULT ENDO TRACHEAL,272,RC,,,,,,,,both,,,1484.6900,222.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1336.22,,,,,,,383.2000,1484.6900,percent of total billed charges,"90% of $1,484.69 in Billed Charges for Rev 272 = $1,336.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADULT ENDO TRACHEAL,272,RC,,,,,,,,both,,,1484.6900,222.7000,MEDCOST,MEDCOST VHN,706.56,,,,,,,383.2000,1484.6900,percent of total billed charges,"47.59% of $1,484.69 in Billed Charges for Rev 272 = $706.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADULT ENDO TRACHEAL,272,RC,,,,,,,,both,,,1484.6900,222.7000,SENTARA HEALTH,SENTARA HEALTH,383.20,,,,,,,383.2000,1484.6900,percent of total billed charges,"25.81% of $1,484.69 in Billed Charges for Rev 272 = $383.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADULT ENDO TRACHEAL,272,RC,,,,,,,,both,,,1484.6900,222.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1484.69,,,,,,,383.2000,1484.6900,percent of total billed charges,"100% of $1,484.69 in Billed Charges for Rev 272 = $1,484.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADULT ENDO TRACHEAL,272,RC,,,,,,,,both,,,1484.6900,222.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,742.35,,,,,,,383.2000,1484.6900,percent of total billed charges,"Rev 272 $1,484.69 in Billed Charges at 50% = $742.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADULT ENDO TRACHEAL,272,RC,,,,,,,,both,,,1484.6900,222.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,479.55,,,,,,,383.2000,1484.6900,other,"32.3% of $1,484.69 in Billed Charges for Rev 272 = $479.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ADULT ENDO TRACHEAL,272,RC,,,,,,,,both,,,1484.6900,222.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,455.80,,,,,,,383.2000,1484.6900,other,"30.7% of $1,484.69 in Billed Charges for Rev 272 = $455.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ADULT ENDO TRACHEAL,272,RC,,,,,,,,both,,,1484.6900,222.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,479.55,,,,,,,383.2000,1484.6900,percent of total billed charges,"32.3% of $1,484.69 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ADULT ENDO TRACHEAL,272,RC,,,,,,,,both,,,1484.6900,222.7000,WELLCARE,WELLCARE MEDICAID,1484.69,,,,,,,383.2000,1484.6900,percent of total billed charges,"100% of $1,484.69 in Billed Charges for Rev 272 = $1,484.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBE CHEST 24FR,272,RC,27201213,CDM,,,,,,both,,,101.0000,15.1500,AETNA,AETNA,43.13,,,,,,,26.0700,101.0000,percent of total billed charges,42.7% of $101.00 in Billed Charges for Rev 272 = $43.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CHEST 24FR,272,RC,27201213,CDM,,,,,,both,,,101.0000,15.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,70.70,,,,,,,26.0700,101.0000,percent of total billed charges,Rev 272 $101.00 in Billed Charges at 70% = $70.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CHEST 24FR,272,RC,27201213,CDM,,,,,,both,,,101.0000,15.1500,CIGNA HEALTHCARE,CIGNA HMO,42.12,,,,,,,26.0700,101.0000,percent of total billed charges,41.7% of $101.00 in Billed Charges for Rev 272 = $42.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CHEST 24FR,272,RC,27201213,CDM,,,,,,both,,,101.0000,15.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,46.86,,,,,,,26.0700,101.0000,percent of total billed charges,46.4% of $101.00 in Billed Charges for Rev 272 = $46.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CHEST 24FR,272,RC,27201213,CDM,,,,,,both,,,101.0000,15.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,42.12,,,,,,,26.0700,101.0000,percent of total billed charges,41.7% of $101.00 in Billed Charges for Rev 272 = $42.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CHEST 24FR,272,RC,27201213,CDM,,,,,,both,,,101.0000,15.1500,CIGNA HEALTHCARE,CIGNA PPO,42.12,,,,,,,26.0700,101.0000,percent of total billed charges,41.7% of $101.00 in Billed Charges for Rev 272 = $42.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CHEST 24FR,272,RC,27201213,CDM,,,,,,both,,,101.0000,15.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,90.90,,,,,,,26.0700,101.0000,percent of total billed charges,90% of $101.00 in Billed Charges for Rev 272 = $90.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CHEST 24FR,272,RC,27201213,CDM,,,,,,both,,,101.0000,15.1500,MEDCOST,MEDCOST VHN,48.07,,,,,,,26.0700,101.0000,percent of total billed charges,47.59% of $101.00 in Billed Charges for Rev 272 = $48.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CHEST 24FR,272,RC,27201213,CDM,,,,,,both,,,101.0000,15.1500,SENTARA HEALTH,SENTARA HEALTH,26.07,,,,,,,26.0700,101.0000,percent of total billed charges,25.81% of $101.00 in Billed Charges for Rev 272 = $26.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CHEST 24FR,272,RC,27201213,CDM,,,,,,both,,,101.0000,15.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",101.00,,,,,,,26.0700,101.0000,percent of total billed charges,100% of $101.00 in Billed Charges for Rev 272 = $101.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CHEST 24FR,272,RC,27201213,CDM,,,,,,both,,,101.0000,15.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,50.50,,,,,,,26.0700,101.0000,percent of total billed charges,Rev 272 $101.00 in Billed Charges at 50% = $50.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CHEST 24FR,272,RC,27201213,CDM,,,,,,both,,,101.0000,15.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,32.62,,,,,,,26.0700,101.0000,other,32.3% of $101.00 in Billed Charges for Rev 272 = $32.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE CHEST 24FR,272,RC,27201213,CDM,,,,,,both,,,101.0000,15.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,31.01,,,,,,,26.0700,101.0000,other,30.7% of $101.00 in Billed Charges for Rev 272 = $31.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE CHEST 24FR,272,RC,27201213,CDM,,,,,,both,,,101.0000,15.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,32.62,,,,,,,26.0700,101.0000,percent of total billed charges,32.3% of $101.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CHEST 24FR,272,RC,27201213,CDM,,,,,,both,,,101.0000,15.1500,WELLCARE,WELLCARE MEDICAID,101.00,,,,,,,26.0700,101.0000,percent of total billed charges,100% of $101.00 in Billed Charges for Rev 272 = $101.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CONNECTING FLAT DRAIN,272,RC,27201216,CDM,,,,,,both,,,48.0000,7.2000,AETNA,AETNA,20.50,,,,,,,12.3900,48.0000,percent of total billed charges,42.7% of $48.00 in Billed Charges for Rev 272 = $20.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CONNECTING FLAT DRAIN,272,RC,27201216,CDM,,,,,,both,,,48.0000,7.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,33.60,,,,,,,12.3900,48.0000,percent of total billed charges,Rev 272 $48.00 in Billed Charges at 70% = $33.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CONNECTING FLAT DRAIN,272,RC,27201216,CDM,,,,,,both,,,48.0000,7.2000,CIGNA HEALTHCARE,CIGNA HMO,20.02,,,,,,,12.3900,48.0000,percent of total billed charges,41.7% of $48.00 in Billed Charges for Rev 272 = $20.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CONNECTING FLAT DRAIN,272,RC,27201216,CDM,,,,,,both,,,48.0000,7.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,22.27,,,,,,,12.3900,48.0000,percent of total billed charges,46.4% of $48.00 in Billed Charges for Rev 272 = $22.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CONNECTING FLAT DRAIN,272,RC,27201216,CDM,,,,,,both,,,48.0000,7.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,20.02,,,,,,,12.3900,48.0000,percent of total billed charges,41.7% of $48.00 in Billed Charges for Rev 272 = $20.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CONNECTING FLAT DRAIN,272,RC,27201216,CDM,,,,,,both,,,48.0000,7.2000,CIGNA HEALTHCARE,CIGNA PPO,20.02,,,,,,,12.3900,48.0000,percent of total billed charges,41.7% of $48.00 in Billed Charges for Rev 272 = $20.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CONNECTING FLAT DRAIN,272,RC,27201216,CDM,,,,,,both,,,48.0000,7.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,43.20,,,,,,,12.3900,48.0000,percent of total billed charges,90% of $48.00 in Billed Charges for Rev 272 = $43.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CONNECTING FLAT DRAIN,272,RC,27201216,CDM,,,,,,both,,,48.0000,7.2000,MEDCOST,MEDCOST VHN,22.84,,,,,,,12.3900,48.0000,percent of total billed charges,47.59% of $48.00 in Billed Charges for Rev 272 = $22.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CONNECTING FLAT DRAIN,272,RC,27201216,CDM,,,,,,both,,,48.0000,7.2000,SENTARA HEALTH,SENTARA HEALTH,12.39,,,,,,,12.3900,48.0000,percent of total billed charges,25.81% of $48.00 in Billed Charges for Rev 272 = $12.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CONNECTING FLAT DRAIN,272,RC,27201216,CDM,,,,,,both,,,48.0000,7.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",48.00,,,,,,,12.3900,48.0000,percent of total billed charges,100% of $48.00 in Billed Charges for Rev 272 = $48.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CONNECTING FLAT DRAIN,272,RC,27201216,CDM,,,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,24.00,,,,,,,12.3900,48.0000,percent of total billed charges,Rev 272 $48.00 in Billed Charges at 50% = $24.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CONNECTING FLAT DRAIN,272,RC,27201216,CDM,,,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,15.50,,,,,,,12.3900,48.0000,other,32.3% of $48.00 in Billed Charges for Rev 272 = $15.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE CONNECTING FLAT DRAIN,272,RC,27201216,CDM,,,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,14.74,,,,,,,12.3900,48.0000,other,30.7% of $48.00 in Billed Charges for Rev 272 = $14.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE CONNECTING FLAT DRAIN,272,RC,27201216,CDM,,,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,15.50,,,,,,,12.3900,48.0000,percent of total billed charges,32.3% of $48.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CONNECTING FLAT DRAIN,272,RC,27201216,CDM,,,,,,both,,,48.0000,7.2000,WELLCARE,WELLCARE MEDICAID,48.00,,,,,,,12.3900,48.0000,percent of total billed charges,100% of $48.00 in Billed Charges for Rev 272 = $48.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING 18FR GASTR ENTER,272,RC,27201220,CDM,,,,,,both,,,884.0000,132.6000,AETNA,AETNA,377.47,,,,,,,228.1600,884.0000,percent of total billed charges,42.7% of $884.00 in Billed Charges for Rev 272 = $377.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING 18FR GASTR ENTER,272,RC,27201220,CDM,,,,,,both,,,884.0000,132.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,618.80,,,,,,,228.1600,884.0000,percent of total billed charges,Rev 272 $884.00 in Billed Charges at 70% = $618.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING 18FR GASTR ENTER,272,RC,27201220,CDM,,,,,,both,,,884.0000,132.6000,CIGNA HEALTHCARE,CIGNA HMO,368.63,,,,,,,228.1600,884.0000,percent of total billed charges,41.7% of $884.00 in Billed Charges for Rev 272 = $368.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING 18FR GASTR ENTER,272,RC,27201220,CDM,,,,,,both,,,884.0000,132.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,410.18,,,,,,,228.1600,884.0000,percent of total billed charges,46.4% of $884.00 in Billed Charges for Rev 272 = $410.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING 18FR GASTR ENTER,272,RC,27201220,CDM,,,,,,both,,,884.0000,132.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,368.63,,,,,,,228.1600,884.0000,percent of total billed charges,41.7% of $884.00 in Billed Charges for Rev 272 = $368.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING 18FR GASTR ENTER,272,RC,27201220,CDM,,,,,,both,,,884.0000,132.6000,CIGNA HEALTHCARE,CIGNA PPO,368.63,,,,,,,228.1600,884.0000,percent of total billed charges,41.7% of $884.00 in Billed Charges for Rev 272 = $368.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING 18FR GASTR ENTER,272,RC,27201220,CDM,,,,,,both,,,884.0000,132.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,795.60,,,,,,,228.1600,884.0000,percent of total billed charges,90% of $884.00 in Billed Charges for Rev 272 = $795.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING 18FR GASTR ENTER,272,RC,27201220,CDM,,,,,,both,,,884.0000,132.6000,MEDCOST,MEDCOST VHN,420.70,,,,,,,228.1600,884.0000,percent of total billed charges,47.59% of $884.00 in Billed Charges for Rev 272 = $420.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING 18FR GASTR ENTER,272,RC,27201220,CDM,,,,,,both,,,884.0000,132.6000,SENTARA HEALTH,SENTARA HEALTH,228.16,,,,,,,228.1600,884.0000,percent of total billed charges,25.81% of $884.00 in Billed Charges for Rev 272 = $228.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING 18FR GASTR ENTER,272,RC,27201220,CDM,,,,,,both,,,884.0000,132.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",884.00,,,,,,,228.1600,884.0000,percent of total billed charges,100% of $884.00 in Billed Charges for Rev 272 = $884.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING 18FR GASTR ENTER,272,RC,27201220,CDM,,,,,,both,,,884.0000,132.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,442.00,,,,,,,228.1600,884.0000,percent of total billed charges,Rev 272 $884.00 in Billed Charges at 50% = $442.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING 18FR GASTR ENTER,272,RC,27201220,CDM,,,,,,both,,,884.0000,132.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,285.53,,,,,,,228.1600,884.0000,other,32.3% of $884.00 in Billed Charges for Rev 272 = $285.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE FEEDING 18FR GASTR ENTER,272,RC,27201220,CDM,,,,,,both,,,884.0000,132.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,271.39,,,,,,,228.1600,884.0000,other,30.7% of $884.00 in Billed Charges for Rev 272 = $271.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE FEEDING 18FR GASTR ENTER,272,RC,27201220,CDM,,,,,,both,,,884.0000,132.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,285.53,,,,,,,228.1600,884.0000,percent of total billed charges,32.3% of $884.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING 18FR GASTR ENTER,272,RC,27201220,CDM,,,,,,both,,,884.0000,132.6000,WELLCARE,WELLCARE MEDICAID,884.00,,,,,,,228.1600,884.0000,percent of total billed charges,100% of $884.00 in Billed Charges for Rev 272 = $884.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING DOBBHOFF & STYLET,270,RC,27000073,CDM,,,,,,both,,,76.0000,11.4000,AETNA,AETNA,32.45,,,,,,,19.6200,76.0000,percent of total billed charges,42.7% of $76.00 in Billed Charges for Rev 270 = $32.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING DOBBHOFF & STYLET,270,RC,27000073,CDM,,,,,,both,,,76.0000,11.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,53.20,,,,,,,19.6200,76.0000,percent of total billed charges,Rev 270 $76.00 in Billed Charges at 70% = $53.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING DOBBHOFF & STYLET,270,RC,27000073,CDM,,,,,,both,,,76.0000,11.4000,CIGNA HEALTHCARE,CIGNA HMO,31.69,,,,,,,19.6200,76.0000,percent of total billed charges,41.7% of $76.00 in Billed Charges for Rev 270 = $31.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING DOBBHOFF & STYLET,270,RC,27000073,CDM,,,,,,both,,,76.0000,11.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,35.26,,,,,,,19.6200,76.0000,percent of total billed charges,46.4% of $76.00 in Billed Charges for Rev 270 = $35.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING DOBBHOFF & STYLET,270,RC,27000073,CDM,,,,,,both,,,76.0000,11.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,31.69,,,,,,,19.6200,76.0000,percent of total billed charges,41.7% of $76.00 in Billed Charges for Rev 270 = $31.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING DOBBHOFF & STYLET,270,RC,27000073,CDM,,,,,,both,,,76.0000,11.4000,CIGNA HEALTHCARE,CIGNA PPO,31.69,,,,,,,19.6200,76.0000,percent of total billed charges,41.7% of $76.00 in Billed Charges for Rev 270 = $31.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING DOBBHOFF & STYLET,270,RC,27000073,CDM,,,,,,both,,,76.0000,11.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,68.40,,,,,,,19.6200,76.0000,percent of total billed charges,90% of $76.00 in Billed Charges for Rev 270 = $68.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING DOBBHOFF & STYLET,270,RC,27000073,CDM,,,,,,both,,,76.0000,11.4000,MEDCOST,MEDCOST VHN,36.17,,,,,,,19.6200,76.0000,percent of total billed charges,47.59% of $76.00 in Billed Charges for Rev 270 = $36.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING DOBBHOFF & STYLET,270,RC,27000073,CDM,,,,,,both,,,76.0000,11.4000,SENTARA HEALTH,SENTARA HEALTH,19.62,,,,,,,19.6200,76.0000,percent of total billed charges,25.81% of $76.00 in Billed Charges for Rev 270 = $19.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING DOBBHOFF & STYLET,270,RC,27000073,CDM,,,,,,both,,,76.0000,11.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",76.00,,,,,,,19.6200,76.0000,percent of total billed charges,100% of $76.00 in Billed Charges for Rev 270 = $76.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING DOBBHOFF & STYLET,270,RC,27000073,CDM,,,,,,both,,,76.0000,11.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,38.00,,,,,,,19.6200,76.0000,percent of total billed charges,Rev 270 $76.00 in Billed Charges at 50% = $38.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING DOBBHOFF & STYLET,270,RC,27000073,CDM,,,,,,both,,,76.0000,11.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,24.55,,,,,,,19.6200,76.0000,other,32.3% of $76.00 in Billed Charges for Rev 270 = $24.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE FEEDING DOBBHOFF & STYLET,270,RC,27000073,CDM,,,,,,both,,,76.0000,11.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,23.33,,,,,,,19.6200,76.0000,other,30.7% of $76.00 in Billed Charges for Rev 270 = $23.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE FEEDING DOBBHOFF & STYLET,270,RC,27000073,CDM,,,,,,both,,,76.0000,11.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,24.55,,,,,,,19.6200,76.0000,percent of total billed charges,32.3% of $76.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING DOBBHOFF & STYLET,270,RC,27000073,CDM,,,,,,both,,,76.0000,11.4000,WELLCARE,WELLCARE MEDICAID,76.00,,,,,,,19.6200,76.0000,percent of total billed charges,100% of $76.00 in Billed Charges for Rev 270 = $76.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEDICLE ACCESS,272,RC,,,,,,,,both,,,6844.8600,1026.7300,AETNA,AETNA,2922.76,,,,,,,1766.6600,6844.8600,percent of total billed charges,"42.7% of $6,844.86 in Billed Charges for Rev 272 = $2,922.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEDICLE ACCESS,272,RC,,,,,,,,both,,,6844.8600,1026.7300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4791.40,,,,,,,1766.6600,6844.8600,percent of total billed charges,"Rev 272 $6,844.86 in Billed Charges at 70% = $4,791.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEDICLE ACCESS,272,RC,,,,,,,,both,,,6844.8600,1026.7300,CIGNA HEALTHCARE,CIGNA HMO,2854.31,,,,,,,1766.6600,6844.8600,percent of total billed charges,"41.7% of $6,844.86 in Billed Charges for Rev 272 = $2,854.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEDICLE ACCESS,272,RC,,,,,,,,both,,,6844.8600,1026.7300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3176.02,,,,,,,1766.6600,6844.8600,percent of total billed charges,"46.4% of $6,844.86 in Billed Charges for Rev 272 = $3,176.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEDICLE ACCESS,272,RC,,,,,,,,both,,,6844.8600,1026.7300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2854.31,,,,,,,1766.6600,6844.8600,percent of total billed charges,"41.7% of $6,844.86 in Billed Charges for Rev 272 = $2,854.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEDICLE ACCESS,272,RC,,,,,,,,both,,,6844.8600,1026.7300,CIGNA HEALTHCARE,CIGNA PPO,2854.31,,,,,,,1766.6600,6844.8600,percent of total billed charges,"41.7% of $6,844.86 in Billed Charges for Rev 272 = $2,854.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEDICLE ACCESS,272,RC,,,,,,,,both,,,6844.8600,1026.7300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6160.37,,,,,,,1766.6600,6844.8600,percent of total billed charges,"90% of $6,844.86 in Billed Charges for Rev 272 = $6,160.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEDICLE ACCESS,272,RC,,,,,,,,both,,,6844.8600,1026.7300,MEDCOST,MEDCOST VHN,3257.47,,,,,,,1766.6600,6844.8600,percent of total billed charges,"47.59% of $6,844.86 in Billed Charges for Rev 272 = $3,257.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEDICLE ACCESS,272,RC,,,,,,,,both,,,6844.8600,1026.7300,SENTARA HEALTH,SENTARA HEALTH,1766.66,,,,,,,1766.6600,6844.8600,percent of total billed charges,"25.81% of $6,844.86 in Billed Charges for Rev 272 = $1,766.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEDICLE ACCESS,272,RC,,,,,,,,both,,,6844.8600,1026.7300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6844.86,,,,,,,1766.6600,6844.8600,percent of total billed charges,"100% of $6,844.86 in Billed Charges for Rev 272 = $6,844.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEDICLE ACCESS,272,RC,,,,,,,,both,,,6844.8600,1026.7300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3422.43,,,,,,,1766.6600,6844.8600,percent of total billed charges,"Rev 272 $6,844.86 in Billed Charges at 50% = $3,422.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEDICLE ACCESS,272,RC,,,,,,,,both,,,6844.8600,1026.7300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2210.89,,,,,,,1766.6600,6844.8600,other,"32.3% of $6,844.86 in Billed Charges for Rev 272 = $2,210.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PEDICLE ACCESS,272,RC,,,,,,,,both,,,6844.8600,1026.7300,UNITED HEALTHCARE,UHC HERITAGE SELECT,2101.37,,,,,,,1766.6600,6844.8600,other,"30.7% of $6,844.86 in Billed Charges for Rev 272 = $2,101.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PEDICLE ACCESS,272,RC,,,,,,,,both,,,6844.8600,1026.7300,UNITED HEALTHCARE,UNITED HEALTHCARE,2210.89,,,,,,,1766.6600,6844.8600,percent of total billed charges,"32.3% of $6,844.86 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEDICLE ACCESS,272,RC,,,,,,,,both,,,6844.8600,1026.7300,WELLCARE,WELLCARE MEDICAID,6844.86,,,,,,,1766.6600,6844.8600,percent of total billed charges,"100% of $6,844.86 in Billed Charges for Rev 272 = $6,844.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG 20F ENDOVIVE SAFETY W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,2971.1900,445.6800,AETNA,AETNA,1268.70,,,,,,,766.8600,2971.1900,percent of total billed charges,"42.7% of $2,971.19 in Billed Charges for Rev 272 = $1,268.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG 20F ENDOVIVE SAFETY W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,2971.1900,445.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2079.83,,,,,,,766.8600,2971.1900,percent of total billed charges,"Rev 272 $2,971.19 in Billed Charges at 70% = $2,079.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG 20F ENDOVIVE SAFETY W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,2971.1900,445.6800,CIGNA HEALTHCARE,CIGNA HMO,1238.99,,,,,,,766.8600,2971.1900,percent of total billed charges,"41.7% of $2,971.19 in Billed Charges for Rev 272 = $1,238.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG 20F ENDOVIVE SAFETY W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,2971.1900,445.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1378.63,,,,,,,766.8600,2971.1900,percent of total billed charges,"46.4% of $2,971.19 in Billed Charges for Rev 272 = $1,378.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG 20F ENDOVIVE SAFETY W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,2971.1900,445.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1238.99,,,,,,,766.8600,2971.1900,percent of total billed charges,"41.7% of $2,971.19 in Billed Charges for Rev 272 = $1,238.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG 20F ENDOVIVE SAFETY W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,2971.1900,445.6800,CIGNA HEALTHCARE,CIGNA PPO,1238.99,,,,,,,766.8600,2971.1900,percent of total billed charges,"41.7% of $2,971.19 in Billed Charges for Rev 272 = $1,238.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG 20F ENDOVIVE SAFETY W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,2971.1900,445.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2674.07,,,,,,,766.8600,2971.1900,percent of total billed charges,"90% of $2,971.19 in Billed Charges for Rev 272 = $2,674.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG 20F ENDOVIVE SAFETY W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,2971.1900,445.6800,MEDCOST,MEDCOST VHN,1413.99,,,,,,,766.8600,2971.1900,percent of total billed charges,"47.59% of $2,971.19 in Billed Charges for Rev 272 = $1,413.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG 20F ENDOVIVE SAFETY W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,2971.1900,445.6800,SENTARA HEALTH,SENTARA HEALTH,766.86,,,,,,,766.8600,2971.1900,percent of total billed charges,"25.81% of $2,971.19 in Billed Charges for Rev 272 = $766.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG 20F ENDOVIVE SAFETY W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,2971.1900,445.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2971.19,,,,,,,766.8600,2971.1900,percent of total billed charges,"100% of $2,971.19 in Billed Charges for Rev 272 = $2,971.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG 20F ENDOVIVE SAFETY W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,2971.1900,445.6800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1485.60,,,,,,,766.8600,2971.1900,percent of total billed charges,"Rev 272 $2,971.19 in Billed Charges at 50% = $1,485.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG 20F ENDOVIVE SAFETY W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,2971.1900,445.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,959.69,,,,,,,766.8600,2971.1900,other,"32.3% of $2,971.19 in Billed Charges for Rev 272 = $959.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PEG 20F ENDOVIVE SAFETY W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,2971.1900,445.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,912.16,,,,,,,766.8600,2971.1900,other,"30.7% of $2,971.19 in Billed Charges for Rev 272 = $912.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PEG 20F ENDOVIVE SAFETY W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,2971.1900,445.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,959.69,,,,,,,766.8600,2971.1900,percent of total billed charges,"32.3% of $2,971.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG 20F ENDOVIVE SAFETY W/ENFIT,272,RC,27200002,CDM,,,,,,both,,,2971.1900,445.6800,WELLCARE,WELLCARE MEDICAID,2971.19,,,,,,,766.8600,2971.1900,percent of total billed charges,"100% of $2,971.19 in Billed Charges for Rev 272 = $2,971.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,574.4500,86.1700,AETNA,AETNA,245.29,,,,,,,148.2700,574.4500,percent of total billed charges,42.7% of $574.45 in Billed Charges for Rev 272 = $245.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,574.4500,86.1700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,402.12,,,,,,,148.2700,574.4500,percent of total billed charges,Rev 272 $574.45 in Billed Charges at 70% = $402.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,574.4500,86.1700,CIGNA HEALTHCARE,CIGNA HMO,239.55,,,,,,,148.2700,574.4500,percent of total billed charges,41.7% of $574.45 in Billed Charges for Rev 272 = $239.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,574.4500,86.1700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,266.54,,,,,,,148.2700,574.4500,percent of total billed charges,46.4% of $574.45 in Billed Charges for Rev 272 = $266.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,574.4500,86.1700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,239.55,,,,,,,148.2700,574.4500,percent of total billed charges,41.7% of $574.45 in Billed Charges for Rev 272 = $239.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,574.4500,86.1700,CIGNA HEALTHCARE,CIGNA PPO,239.55,,,,,,,148.2700,574.4500,percent of total billed charges,41.7% of $574.45 in Billed Charges for Rev 272 = $239.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,574.4500,86.1700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,517.01,,,,,,,148.2700,574.4500,percent of total billed charges,90% of $574.45 in Billed Charges for Rev 272 = $517.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,574.4500,86.1700,MEDCOST,MEDCOST VHN,273.38,,,,,,,148.2700,574.4500,percent of total billed charges,47.59% of $574.45 in Billed Charges for Rev 272 = $273.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,574.4500,86.1700,SENTARA HEALTH,SENTARA HEALTH,148.27,,,,,,,148.2700,574.4500,percent of total billed charges,25.81% of $574.45 in Billed Charges for Rev 272 = $148.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,574.4500,86.1700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",574.45,,,,,,,148.2700,574.4500,percent of total billed charges,100% of $574.45 in Billed Charges for Rev 272 = $574.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,574.4500,86.1700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,287.23,,,,,,,148.2700,574.4500,percent of total billed charges,Rev 272 $574.45 in Billed Charges at 50% = $287.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,574.4500,86.1700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,185.55,,,,,,,148.2700,574.4500,other,32.3% of $574.45 in Billed Charges for Rev 272 = $185.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,574.4500,86.1700,UNITED HEALTHCARE,UHC HERITAGE SELECT,176.36,,,,,,,148.2700,574.4500,other,30.7% of $574.45 in Billed Charges for Rev 272 = $176.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,574.4500,86.1700,UNITED HEALTHCARE,UNITED HEALTHCARE,185.55,,,,,,,148.2700,574.4500,percent of total billed charges,32.3% of $574.45 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,574.4500,86.1700,WELLCARE,WELLCARE MEDICAID,574.45,,,,,,,148.2700,574.4500,percent of total billed charges,100% of $574.45 in Billed Charges for Rev 272 = $574.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,12735.5900,1910.3400,AETNA,AETNA,5438.10,,,,,,,3287.0600,12735.5900,percent of total billed charges,"42.7% of $12,735.59 in Billed Charges for Rev 272 = $5,438.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,12735.5900,1910.3400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8914.91,,,,,,,3287.0600,12735.5900,percent of total billed charges,"Rev 272 $12,735.59 in Billed Charges at 70% = $8,914.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,12735.5900,1910.3400,CIGNA HEALTHCARE,CIGNA HMO,5310.74,,,,,,,3287.0600,12735.5900,percent of total billed charges,"41.7% of $12,735.59 in Billed Charges for Rev 272 = $5,310.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,12735.5900,1910.3400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5909.31,,,,,,,3287.0600,12735.5900,percent of total billed charges,"46.4% of $12,735.59 in Billed Charges for Rev 272 = $5,909.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,12735.5900,1910.3400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5310.74,,,,,,,3287.0600,12735.5900,percent of total billed charges,"41.7% of $12,735.59 in Billed Charges for Rev 272 = $5,310.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,12735.5900,1910.3400,CIGNA HEALTHCARE,CIGNA PPO,5310.74,,,,,,,3287.0600,12735.5900,percent of total billed charges,"41.7% of $12,735.59 in Billed Charges for Rev 272 = $5,310.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,12735.5900,1910.3400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11462.03,,,,,,,3287.0600,12735.5900,percent of total billed charges,"90% of $12,735.59 in Billed Charges for Rev 272 = $11,462.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,12735.5900,1910.3400,MEDCOST,MEDCOST VHN,6060.87,,,,,,,3287.0600,12735.5900,percent of total billed charges,"47.59% of $12,735.59 in Billed Charges for Rev 272 = $6,060.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,12735.5900,1910.3400,SENTARA HEALTH,SENTARA HEALTH,3287.06,,,,,,,3287.0600,12735.5900,percent of total billed charges,"25.81% of $12,735.59 in Billed Charges for Rev 272 = $3,287.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,12735.5900,1910.3400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12735.59,,,,,,,3287.0600,12735.5900,percent of total billed charges,"100% of $12,735.59 in Billed Charges for Rev 272 = $12,735.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,12735.5900,1910.3400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6367.80,,,,,,,3287.0600,12735.5900,percent of total billed charges,"Rev 272 $12,735.59 in Billed Charges at 50% = $6,367.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,12735.5900,1910.3400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4113.60,,,,,,,3287.0600,12735.5900,other,"32.3% of $12,735.59 in Billed Charges for Rev 272 = $4,113.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,12735.5900,1910.3400,UNITED HEALTHCARE,UHC HERITAGE SELECT,3909.83,,,,,,,3287.0600,12735.5900,other,"30.7% of $12,735.59 in Billed Charges for Rev 272 = $3,909.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,12735.5900,1910.3400,UNITED HEALTHCARE,UNITED HEALTHCARE,4113.60,,,,,,,3287.0600,12735.5900,percent of total billed charges,"32.3% of $12,735.59 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG CORFLO 16FR,272,RC,27200002,CDM,,,,,,both,,,12735.5900,1910.3400,WELLCARE,WELLCARE MEDICAID,12735.59,,,,,,,3287.0600,12735.5900,percent of total billed charges,"100% of $12,735.59 in Billed Charges for Rev 272 = $12,735.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PEG ENTAKE PUSH 20FR,272,RC,,,,,,,,both,,,806.5500,120.9800,AETNA,AETNA,344.40,,,,,,,208.1700,806.5500,percent of total billed charges,42.7% of $806.55 in Billed Charges for Rev 272 = $344.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG ENTAKE PUSH 20FR,272,RC,,,,,,,,both,,,806.5500,120.9800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,564.59,,,,,,,208.1700,806.5500,percent of total billed charges,Rev 272 $806.55 in Billed Charges at 70% = $564.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG ENTAKE PUSH 20FR,272,RC,,,,,,,,both,,,806.5500,120.9800,CIGNA HEALTHCARE,CIGNA HMO,336.33,,,,,,,208.1700,806.5500,percent of total billed charges,41.7% of $806.55 in Billed Charges for Rev 272 = $336.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG ENTAKE PUSH 20FR,272,RC,,,,,,,,both,,,806.5500,120.9800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,374.24,,,,,,,208.1700,806.5500,percent of total billed charges,46.4% of $806.55 in Billed Charges for Rev 272 = $374.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG ENTAKE PUSH 20FR,272,RC,,,,,,,,both,,,806.5500,120.9800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,336.33,,,,,,,208.1700,806.5500,percent of total billed charges,41.7% of $806.55 in Billed Charges for Rev 272 = $336.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG ENTAKE PUSH 20FR,272,RC,,,,,,,,both,,,806.5500,120.9800,CIGNA HEALTHCARE,CIGNA PPO,336.33,,,,,,,208.1700,806.5500,percent of total billed charges,41.7% of $806.55 in Billed Charges for Rev 272 = $336.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG ENTAKE PUSH 20FR,272,RC,,,,,,,,both,,,806.5500,120.9800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,725.90,,,,,,,208.1700,806.5500,percent of total billed charges,90% of $806.55 in Billed Charges for Rev 272 = $725.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG ENTAKE PUSH 20FR,272,RC,,,,,,,,both,,,806.5500,120.9800,MEDCOST,MEDCOST VHN,383.84,,,,,,,208.1700,806.5500,percent of total billed charges,47.59% of $806.55 in Billed Charges for Rev 272 = $383.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG ENTAKE PUSH 20FR,272,RC,,,,,,,,both,,,806.5500,120.9800,SENTARA HEALTH,SENTARA HEALTH,208.17,,,,,,,208.1700,806.5500,percent of total billed charges,25.81% of $806.55 in Billed Charges for Rev 272 = $208.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG ENTAKE PUSH 20FR,272,RC,,,,,,,,both,,,806.5500,120.9800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",806.55,,,,,,,208.1700,806.5500,percent of total billed charges,100% of $806.55 in Billed Charges for Rev 272 = $806.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG ENTAKE PUSH 20FR,272,RC,,,,,,,,both,,,806.5500,120.9800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,403.28,,,,,,,208.1700,806.5500,percent of total billed charges,Rev 272 $806.55 in Billed Charges at 50% = $403.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG ENTAKE PUSH 20FR,272,RC,,,,,,,,both,,,806.5500,120.9800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,260.52,,,,,,,208.1700,806.5500,other,32.3% of $806.55 in Billed Charges for Rev 272 = $260.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT PEG ENTAKE PUSH 20FR,272,RC,,,,,,,,both,,,806.5500,120.9800,UNITED HEALTHCARE,UHC HERITAGE SELECT,247.61,,,,,,,208.1700,806.5500,other,30.7% of $806.55 in Billed Charges for Rev 272 = $247.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT PEG ENTAKE PUSH 20FR,272,RC,,,,,,,,both,,,806.5500,120.9800,UNITED HEALTHCARE,UNITED HEALTHCARE,260.52,,,,,,,208.1700,806.5500,percent of total billed charges,32.3% of $806.55 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PEG ENTAKE PUSH 20FR,272,RC,,,,,,,,both,,,806.5500,120.9800,WELLCARE,WELLCARE MEDICAID,806.55,,,,,,,208.1700,806.5500,percent of total billed charges,100% of $806.55 in Billed Charges for Rev 272 = $806.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING TRANSGASTIC 18FR,272,RC,27202296,CDM,,,,,,both,,,2138.0000,320.7000,AETNA,AETNA,912.93,,,,,,,551.8200,2138.0000,percent of total billed charges,"42.7% of $2,138.00 in Billed Charges for Rev 272 = $912.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBE FEEDING TRANSGASTIC 18FR,272,RC,27202296,CDM,,,,,,both,,,2138.0000,320.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1496.60,,,,,,,551.8200,2138.0000,percent of total billed charges,"Rev 272 $2,138.00 in Billed Charges at 70% = $1,496.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBE FEEDING TRANSGASTIC 18FR,272,RC,27202296,CDM,,,,,,both,,,2138.0000,320.7000,CIGNA HEALTHCARE,CIGNA HMO,891.55,,,,,,,551.8200,2138.0000,percent of total billed charges,"41.7% of $2,138.00 in Billed Charges for Rev 272 = $891.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBE FEEDING TRANSGASTIC 18FR,272,RC,27202296,CDM,,,,,,both,,,2138.0000,320.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,992.03,,,,,,,551.8200,2138.0000,percent of total billed charges,"46.4% of $2,138.00 in Billed Charges for Rev 272 = $992.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBE FEEDING TRANSGASTIC 18FR,272,RC,27202296,CDM,,,,,,both,,,2138.0000,320.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,891.55,,,,,,,551.8200,2138.0000,percent of total billed charges,"41.7% of $2,138.00 in Billed Charges for Rev 272 = $891.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBE FEEDING TRANSGASTIC 18FR,272,RC,27202296,CDM,,,,,,both,,,2138.0000,320.7000,CIGNA HEALTHCARE,CIGNA PPO,891.55,,,,,,,551.8200,2138.0000,percent of total billed charges,"41.7% of $2,138.00 in Billed Charges for Rev 272 = $891.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBE FEEDING TRANSGASTIC 18FR,272,RC,27202296,CDM,,,,,,both,,,2138.0000,320.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1924.20,,,,,,,551.8200,2138.0000,percent of total billed charges,"90% of $2,138.00 in Billed Charges for Rev 272 = $1,924.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBE FEEDING TRANSGASTIC 18FR,272,RC,27202296,CDM,,,,,,both,,,2138.0000,320.7000,MEDCOST,MEDCOST VHN,1017.47,,,,,,,551.8200,2138.0000,percent of total billed charges,"47.59% of $2,138.00 in Billed Charges for Rev 272 = $1,017.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBE FEEDING TRANSGASTIC 18FR,272,RC,27202296,CDM,,,,,,both,,,2138.0000,320.7000,SENTARA HEALTH,SENTARA HEALTH,551.82,,,,,,,551.8200,2138.0000,percent of total billed charges,"25.81% of $2,138.00 in Billed Charges for Rev 272 = $551.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBE FEEDING TRANSGASTIC 18FR,272,RC,27202296,CDM,,,,,,both,,,2138.0000,320.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2138.00,,,,,,,551.8200,2138.0000,percent of total billed charges,"100% of $2,138.00 in Billed Charges for Rev 272 = $2,138.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBE FEEDING TRANSGASTIC 18FR,272,RC,27202296,CDM,,,,,,both,,,2138.0000,320.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1069.00,,,,,,,551.8200,2138.0000,percent of total billed charges,"Rev 272 $2,138.00 in Billed Charges at 50% = $1,069.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBE FEEDING TRANSGASTIC 18FR,272,RC,27202296,CDM,,,,,,both,,,2138.0000,320.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,690.57,,,,,,,551.8200,2138.0000,other,"32.3% of $2,138.00 in Billed Charges for Rev 272 = $690.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUBE FEEDING TRANSGASTIC 18FR,272,RC,27202296,CDM,,,,,,both,,,2138.0000,320.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,656.37,,,,,,,551.8200,2138.0000,other,"30.7% of $2,138.00 in Billed Charges for Rev 272 = $656.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUBE FEEDING TRANSGASTIC 18FR,272,RC,27202296,CDM,,,,,,both,,,2138.0000,320.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,690.57,,,,,,,551.8200,2138.0000,percent of total billed charges,"32.3% of $2,138.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBE FEEDING TRANSGASTIC 18FR,272,RC,27202296,CDM,,,,,,both,,,2138.0000,320.7000,WELLCARE,WELLCARE MEDICAID,2138.00,,,,,,,551.8200,2138.0000,percent of total billed charges,"100% of $2,138.00 in Billed Charges for Rev 272 = $2,138.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBE FLEXIFLO GASTRO,270,RC,27000259,CDM,,,,,,both,,,203.0000,30.4500,AETNA,AETNA,86.68,,,,,,,52.3900,203.0000,percent of total billed charges,42.7% of $203.00 in Billed Charges for Rev 270 = $86.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FLEXIFLO GASTRO,270,RC,27000259,CDM,,,,,,both,,,203.0000,30.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,142.10,,,,,,,52.3900,203.0000,percent of total billed charges,Rev 270 $203.00 in Billed Charges at 70% = $142.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FLEXIFLO GASTRO,270,RC,27000259,CDM,,,,,,both,,,203.0000,30.4500,CIGNA HEALTHCARE,CIGNA HMO,84.65,,,,,,,52.3900,203.0000,percent of total billed charges,41.7% of $203.00 in Billed Charges for Rev 270 = $84.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FLEXIFLO GASTRO,270,RC,27000259,CDM,,,,,,both,,,203.0000,30.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,94.19,,,,,,,52.3900,203.0000,percent of total billed charges,46.4% of $203.00 in Billed Charges for Rev 270 = $94.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FLEXIFLO GASTRO,270,RC,27000259,CDM,,,,,,both,,,203.0000,30.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,84.65,,,,,,,52.3900,203.0000,percent of total billed charges,41.7% of $203.00 in Billed Charges for Rev 270 = $84.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FLEXIFLO GASTRO,270,RC,27000259,CDM,,,,,,both,,,203.0000,30.4500,CIGNA HEALTHCARE,CIGNA PPO,84.65,,,,,,,52.3900,203.0000,percent of total billed charges,41.7% of $203.00 in Billed Charges for Rev 270 = $84.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FLEXIFLO GASTRO,270,RC,27000259,CDM,,,,,,both,,,203.0000,30.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,182.70,,,,,,,52.3900,203.0000,percent of total billed charges,90% of $203.00 in Billed Charges for Rev 270 = $182.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FLEXIFLO GASTRO,270,RC,27000259,CDM,,,,,,both,,,203.0000,30.4500,MEDCOST,MEDCOST VHN,96.61,,,,,,,52.3900,203.0000,percent of total billed charges,47.59% of $203.00 in Billed Charges for Rev 270 = $96.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FLEXIFLO GASTRO,270,RC,27000259,CDM,,,,,,both,,,203.0000,30.4500,SENTARA HEALTH,SENTARA HEALTH,52.39,,,,,,,52.3900,203.0000,percent of total billed charges,25.81% of $203.00 in Billed Charges for Rev 270 = $52.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FLEXIFLO GASTRO,270,RC,27000259,CDM,,,,,,both,,,203.0000,30.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",203.00,,,,,,,52.3900,203.0000,percent of total billed charges,100% of $203.00 in Billed Charges for Rev 270 = $203.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FLEXIFLO GASTRO,270,RC,27000259,CDM,,,,,,both,,,203.0000,30.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,101.50,,,,,,,52.3900,203.0000,percent of total billed charges,Rev 270 $203.00 in Billed Charges at 50% = $101.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FLEXIFLO GASTRO,270,RC,27000259,CDM,,,,,,both,,,203.0000,30.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,65.57,,,,,,,52.3900,203.0000,other,32.3% of $203.00 in Billed Charges for Rev 270 = $65.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE FLEXIFLO GASTRO,270,RC,27000259,CDM,,,,,,both,,,203.0000,30.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,62.32,,,,,,,52.3900,203.0000,other,30.7% of $203.00 in Billed Charges for Rev 270 = $62.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE FLEXIFLO GASTRO,270,RC,27000259,CDM,,,,,,both,,,203.0000,30.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,65.57,,,,,,,52.3900,203.0000,percent of total billed charges,32.3% of $203.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FLEXIFLO GASTRO,270,RC,27000259,CDM,,,,,,both,,,203.0000,30.4500,WELLCARE,WELLCARE MEDICAID,203.00,,,,,,,52.3900,203.0000,percent of total billed charges,100% of $203.00 in Billed Charges for Rev 270 = $203.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201229,CDM,,,,,,both,,,40.0000,6.0000,AETNA,AETNA,17.08,,,,,,,10.3200,40.0000,percent of total billed charges,42.7% of $40.00 in Billed Charges for Rev 272 = $17.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201229,CDM,,,,,,both,,,40.0000,6.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,28.00,,,,,,,10.3200,40.0000,percent of total billed charges,Rev 272 $40.00 in Billed Charges at 70% = $28.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201229,CDM,,,,,,both,,,40.0000,6.0000,CIGNA HEALTHCARE,CIGNA HMO,16.68,,,,,,,10.3200,40.0000,percent of total billed charges,41.7% of $40.00 in Billed Charges for Rev 272 = $16.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201229,CDM,,,,,,both,,,40.0000,6.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,18.56,,,,,,,10.3200,40.0000,percent of total billed charges,46.4% of $40.00 in Billed Charges for Rev 272 = $18.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201229,CDM,,,,,,both,,,40.0000,6.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,16.68,,,,,,,10.3200,40.0000,percent of total billed charges,41.7% of $40.00 in Billed Charges for Rev 272 = $16.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201229,CDM,,,,,,both,,,40.0000,6.0000,CIGNA HEALTHCARE,CIGNA PPO,16.68,,,,,,,10.3200,40.0000,percent of total billed charges,41.7% of $40.00 in Billed Charges for Rev 272 = $16.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201229,CDM,,,,,,both,,,40.0000,6.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,36.00,,,,,,,10.3200,40.0000,percent of total billed charges,90% of $40.00 in Billed Charges for Rev 272 = $36.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201229,CDM,,,,,,both,,,40.0000,6.0000,MEDCOST,MEDCOST VHN,19.04,,,,,,,10.3200,40.0000,percent of total billed charges,47.59% of $40.00 in Billed Charges for Rev 272 = $19.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201229,CDM,,,,,,both,,,40.0000,6.0000,SENTARA HEALTH,SENTARA HEALTH,10.32,,,,,,,10.3200,40.0000,percent of total billed charges,25.81% of $40.00 in Billed Charges for Rev 272 = $10.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201229,CDM,,,,,,both,,,40.0000,6.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",40.00,,,,,,,10.3200,40.0000,percent of total billed charges,100% of $40.00 in Billed Charges for Rev 272 = $40.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201229,CDM,,,,,,both,,,40.0000,6.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,20.00,,,,,,,10.3200,40.0000,percent of total billed charges,Rev 272 $40.00 in Billed Charges at 50% = $20.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201229,CDM,,,,,,both,,,40.0000,6.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12.92,,,,,,,10.3200,40.0000,other,32.3% of $40.00 in Billed Charges for Rev 272 = $12.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE GASTRIC LAVAGE,272,RC,27201229,CDM,,,,,,both,,,40.0000,6.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,12.28,,,,,,,10.3200,40.0000,other,30.7% of $40.00 in Billed Charges for Rev 272 = $12.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE GASTRIC LAVAGE,272,RC,27201229,CDM,,,,,,both,,,40.0000,6.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,12.92,,,,,,,10.3200,40.0000,percent of total billed charges,32.3% of $40.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE GASTRIC LAVAGE,272,RC,27201229,CDM,,,,,,both,,,40.0000,6.0000,WELLCARE,WELLCARE MEDICAID,40.00,,,,,,,10.3200,40.0000,percent of total billed charges,100% of $40.00 in Billed Charges for Rev 272 = $40.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
INSERT INTRACK 66MM,272,RC,,,,,,,,both,,,5341.0700,801.1600,AETNA,AETNA,2280.64,,,,,,,1378.5300,5341.0700,percent of total billed charges,"42.7% of $5,341.07 in Billed Charges for Rev 272 = $2,280.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSERT INTRACK 66MM,272,RC,,,,,,,,both,,,5341.0700,801.1600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3738.75,,,,,,,1378.5300,5341.0700,percent of total billed charges,"Rev 272 $5,341.07 in Billed Charges at 70% = $3,738.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSERT INTRACK 66MM,272,RC,,,,,,,,both,,,5341.0700,801.1600,CIGNA HEALTHCARE,CIGNA HMO,2227.23,,,,,,,1378.5300,5341.0700,percent of total billed charges,"41.7% of $5,341.07 in Billed Charges for Rev 272 = $2,227.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSERT INTRACK 66MM,272,RC,,,,,,,,both,,,5341.0700,801.1600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2478.26,,,,,,,1378.5300,5341.0700,percent of total billed charges,"46.4% of $5,341.07 in Billed Charges for Rev 272 = $2,478.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSERT INTRACK 66MM,272,RC,,,,,,,,both,,,5341.0700,801.1600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2227.23,,,,,,,1378.5300,5341.0700,percent of total billed charges,"41.7% of $5,341.07 in Billed Charges for Rev 272 = $2,227.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSERT INTRACK 66MM,272,RC,,,,,,,,both,,,5341.0700,801.1600,CIGNA HEALTHCARE,CIGNA PPO,2227.23,,,,,,,1378.5300,5341.0700,percent of total billed charges,"41.7% of $5,341.07 in Billed Charges for Rev 272 = $2,227.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSERT INTRACK 66MM,272,RC,,,,,,,,both,,,5341.0700,801.1600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4806.96,,,,,,,1378.5300,5341.0700,percent of total billed charges,"90% of $5,341.07 in Billed Charges for Rev 272 = $4,806.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSERT INTRACK 66MM,272,RC,,,,,,,,both,,,5341.0700,801.1600,MEDCOST,MEDCOST VHN,2541.82,,,,,,,1378.5300,5341.0700,percent of total billed charges,"47.59% of $5,341.07 in Billed Charges for Rev 272 = $2,541.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSERT INTRACK 66MM,272,RC,,,,,,,,both,,,5341.0700,801.1600,SENTARA HEALTH,SENTARA HEALTH,1378.53,,,,,,,1378.5300,5341.0700,percent of total billed charges,"25.81% of $5,341.07 in Billed Charges for Rev 272 = $1,378.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSERT INTRACK 66MM,272,RC,,,,,,,,both,,,5341.0700,801.1600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5341.07,,,,,,,1378.5300,5341.0700,percent of total billed charges,"100% of $5,341.07 in Billed Charges for Rev 272 = $5,341.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSERT INTRACK 66MM,272,RC,,,,,,,,both,,,5341.0700,801.1600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2670.54,,,,,,,1378.5300,5341.0700,percent of total billed charges,"Rev 272 $5,341.07 in Billed Charges at 50% = $2,670.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSERT INTRACK 66MM,272,RC,,,,,,,,both,,,5341.0700,801.1600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1725.17,,,,,,,1378.5300,5341.0700,other,"32.3% of $5,341.07 in Billed Charges for Rev 272 = $1,725.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
INSERT INTRACK 66MM,272,RC,,,,,,,,both,,,5341.0700,801.1600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1639.71,,,,,,,1378.5300,5341.0700,other,"30.7% of $5,341.07 in Billed Charges for Rev 272 = $1,639.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
INSERT INTRACK 66MM,272,RC,,,,,,,,both,,,5341.0700,801.1600,UNITED HEALTHCARE,UNITED HEALTHCARE,1725.17,,,,,,,1378.5300,5341.0700,percent of total billed charges,"32.3% of $5,341.07 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSERT INTRACK 66MM,272,RC,,,,,,,,both,,,5341.0700,801.1600,WELLCARE,WELLCARE MEDICAID,5341.07,,,,,,,1378.5300,5341.0700,percent of total billed charges,"100% of $5,341.07 in Billed Charges for Rev 272 = $5,341.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INST DISP PERFUSE  ORTHOPEDIC HIP DECOMPRESSION,272,RC,,,,,,,,both,,,18201.1100,2730.1700,AETNA,AETNA,7771.87,,,,,,,4697.7100,18201.1100,percent of total billed charges,"42.7% of $18,201.11 in Billed Charges for Rev 272 = $7,771.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INST DISP PERFUSE  ORTHOPEDIC HIP DECOMPRESSION,272,RC,,,,,,,,both,,,18201.1100,2730.1700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,12740.78,,,,,,,4697.7100,18201.1100,percent of total billed charges,"Rev 272 $18,201.11 in Billed Charges at 70% = $12,740.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INST DISP PERFUSE  ORTHOPEDIC HIP DECOMPRESSION,272,RC,,,,,,,,both,,,18201.1100,2730.1700,CIGNA HEALTHCARE,CIGNA HMO,7589.86,,,,,,,4697.7100,18201.1100,percent of total billed charges,"41.7% of $18,201.11 in Billed Charges for Rev 272 = $7,589.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INST DISP PERFUSE  ORTHOPEDIC HIP DECOMPRESSION,272,RC,,,,,,,,both,,,18201.1100,2730.1700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8445.32,,,,,,,4697.7100,18201.1100,percent of total billed charges,"46.4% of $18,201.11 in Billed Charges for Rev 272 = $8,445.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INST DISP PERFUSE  ORTHOPEDIC HIP DECOMPRESSION,272,RC,,,,,,,,both,,,18201.1100,2730.1700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7589.86,,,,,,,4697.7100,18201.1100,percent of total billed charges,"41.7% of $18,201.11 in Billed Charges for Rev 272 = $7,589.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INST DISP PERFUSE  ORTHOPEDIC HIP DECOMPRESSION,272,RC,,,,,,,,both,,,18201.1100,2730.1700,CIGNA HEALTHCARE,CIGNA PPO,7589.86,,,,,,,4697.7100,18201.1100,percent of total billed charges,"41.7% of $18,201.11 in Billed Charges for Rev 272 = $7,589.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INST DISP PERFUSE  ORTHOPEDIC HIP DECOMPRESSION,272,RC,,,,,,,,both,,,18201.1100,2730.1700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,16381.00,,,,,,,4697.7100,18201.1100,percent of total billed charges,"90% of $18,201.11 in Billed Charges for Rev 272 = $16,381.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INST DISP PERFUSE  ORTHOPEDIC HIP DECOMPRESSION,272,RC,,,,,,,,both,,,18201.1100,2730.1700,MEDCOST,MEDCOST VHN,8661.91,,,,,,,4697.7100,18201.1100,percent of total billed charges,"47.59% of $18,201.11 in Billed Charges for Rev 272 = $8,661.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INST DISP PERFUSE  ORTHOPEDIC HIP DECOMPRESSION,272,RC,,,,,,,,both,,,18201.1100,2730.1700,SENTARA HEALTH,SENTARA HEALTH,4697.71,,,,,,,4697.7100,18201.1100,percent of total billed charges,"25.81% of $18,201.11 in Billed Charges for Rev 272 = $4,697.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INST DISP PERFUSE  ORTHOPEDIC HIP DECOMPRESSION,272,RC,,,,,,,,both,,,18201.1100,2730.1700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",18201.11,,,,,,,4697.7100,18201.1100,percent of total billed charges,"100% of $18,201.11 in Billed Charges for Rev 272 = $18,201.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INST DISP PERFUSE  ORTHOPEDIC HIP DECOMPRESSION,272,RC,,,,,,,,both,,,18201.1100,2730.1700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9100.56,,,,,,,4697.7100,18201.1100,percent of total billed charges,"Rev 272 $18,201.11 in Billed Charges at 50% = $9,100.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INST DISP PERFUSE  ORTHOPEDIC HIP DECOMPRESSION,272,RC,,,,,,,,both,,,18201.1100,2730.1700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5878.96,,,,,,,4697.7100,18201.1100,other,"32.3% of $18,201.11 in Billed Charges for Rev 272 = $5,878.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
INST DISP PERFUSE  ORTHOPEDIC HIP DECOMPRESSION,272,RC,,,,,,,,both,,,18201.1100,2730.1700,UNITED HEALTHCARE,UHC HERITAGE SELECT,5587.74,,,,,,,4697.7100,18201.1100,other,"30.7% of $18,201.11 in Billed Charges for Rev 272 = $5,587.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
INST DISP PERFUSE  ORTHOPEDIC HIP DECOMPRESSION,272,RC,,,,,,,,both,,,18201.1100,2730.1700,UNITED HEALTHCARE,UNITED HEALTHCARE,5878.96,,,,,,,4697.7100,18201.1100,percent of total billed charges,"32.3% of $18,201.11 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INST DISP PERFUSE  ORTHOPEDIC HIP DECOMPRESSION,272,RC,,,,,,,,both,,,18201.1100,2730.1700,WELLCARE,WELLCARE MEDICAID,18201.11,,,,,,,4697.7100,18201.1100,percent of total billed charges,"100% of $18,201.11 in Billed Charges for Rev 272 = $18,201.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERICARDIOCENTESIS,272,RC,27800429,CDM,,,,,,both,,,3860.0900,579.0100,AETNA,AETNA,1648.26,,,,,,,996.2900,3860.0900,percent of total billed charges,"42.7% of $3,860.09 in Billed Charges for Rev 272 = $1,648.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERICARDIOCENTESIS,272,RC,27800429,CDM,,,,,,both,,,3860.0900,579.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2702.06,,,,,,,996.2900,3860.0900,percent of total billed charges,"Rev 272 $3,860.09 in Billed Charges at 70% = $2,702.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERICARDIOCENTESIS,272,RC,27800429,CDM,,,,,,both,,,3860.0900,579.0100,CIGNA HEALTHCARE,CIGNA HMO,1609.66,,,,,,,996.2900,3860.0900,percent of total billed charges,"41.7% of $3,860.09 in Billed Charges for Rev 272 = $1,609.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERICARDIOCENTESIS,272,RC,27800429,CDM,,,,,,both,,,3860.0900,579.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1791.08,,,,,,,996.2900,3860.0900,percent of total billed charges,"46.4% of $3,860.09 in Billed Charges for Rev 272 = $1,791.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERICARDIOCENTESIS,272,RC,27800429,CDM,,,,,,both,,,3860.0900,579.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1609.66,,,,,,,996.2900,3860.0900,percent of total billed charges,"41.7% of $3,860.09 in Billed Charges for Rev 272 = $1,609.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERICARDIOCENTESIS,272,RC,27800429,CDM,,,,,,both,,,3860.0900,579.0100,CIGNA HEALTHCARE,CIGNA PPO,1609.66,,,,,,,996.2900,3860.0900,percent of total billed charges,"41.7% of $3,860.09 in Billed Charges for Rev 272 = $1,609.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERICARDIOCENTESIS,272,RC,27800429,CDM,,,,,,both,,,3860.0900,579.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3474.08,,,,,,,996.2900,3860.0900,percent of total billed charges,"90% of $3,860.09 in Billed Charges for Rev 272 = $3,474.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERICARDIOCENTESIS,272,RC,27800429,CDM,,,,,,both,,,3860.0900,579.0100,MEDCOST,MEDCOST VHN,1837.02,,,,,,,996.2900,3860.0900,percent of total billed charges,"47.59% of $3,860.09 in Billed Charges for Rev 272 = $1,837.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERICARDIOCENTESIS,272,RC,27800429,CDM,,,,,,both,,,3860.0900,579.0100,SENTARA HEALTH,SENTARA HEALTH,996.29,,,,,,,996.2900,3860.0900,percent of total billed charges,"25.81% of $3,860.09 in Billed Charges for Rev 272 = $996.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERICARDIOCENTESIS,272,RC,27800429,CDM,,,,,,both,,,3860.0900,579.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3860.09,,,,,,,996.2900,3860.0900,percent of total billed charges,"100% of $3,860.09 in Billed Charges for Rev 272 = $3,860.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERICARDIOCENTESIS,272,RC,27800429,CDM,,,,,,both,,,3860.0900,579.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1930.05,,,,,,,996.2900,3860.0900,percent of total billed charges,"Rev 272 $3,860.09 in Billed Charges at 50% = $1,930.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERICARDIOCENTESIS,272,RC,27800429,CDM,,,,,,both,,,3860.0900,579.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1246.81,,,,,,,996.2900,3860.0900,other,"32.3% of $3,860.09 in Billed Charges for Rev 272 = $1,246.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PERICARDIOCENTESIS,272,RC,27800429,CDM,,,,,,both,,,3860.0900,579.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1185.05,,,,,,,996.2900,3860.0900,other,"30.7% of $3,860.09 in Billed Charges for Rev 272 = $1,185.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PERICARDIOCENTESIS,272,RC,27800429,CDM,,,,,,both,,,3860.0900,579.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,1246.81,,,,,,,996.2900,3860.0900,percent of total billed charges,"32.3% of $3,860.09 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PERICARDIOCENTESIS,272,RC,27800429,CDM,,,,,,both,,,3860.0900,579.0100,WELLCARE,WELLCARE MEDICAID,3860.09,,,,,,,996.2900,3860.0900,percent of total billed charges,"100% of $3,860.09 in Billed Charges for Rev 272 = $3,860.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PIN MOD GLENOID 2.4MM DRILL TIP GUIDE,272,RC,27200002,CDM,,,,,,both,,,6917.4600,1037.6200,AETNA,AETNA,2953.76,,,,,,,1785.4000,6917.4600,percent of total billed charges,"42.7% of $6,917.46 in Billed Charges for Rev 272 = $2,953.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PIN MOD GLENOID 2.4MM DRILL TIP GUIDE,272,RC,27200002,CDM,,,,,,both,,,6917.4600,1037.6200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4842.22,,,,,,,1785.4000,6917.4600,percent of total billed charges,"Rev 272 $6,917.46 in Billed Charges at 70% = $4,842.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PIN MOD GLENOID 2.4MM DRILL TIP GUIDE,272,RC,27200002,CDM,,,,,,both,,,6917.4600,1037.6200,CIGNA HEALTHCARE,CIGNA HMO,2884.58,,,,,,,1785.4000,6917.4600,percent of total billed charges,"41.7% of $6,917.46 in Billed Charges for Rev 272 = $2,884.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PIN MOD GLENOID 2.4MM DRILL TIP GUIDE,272,RC,27200002,CDM,,,,,,both,,,6917.4600,1037.6200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3209.70,,,,,,,1785.4000,6917.4600,percent of total billed charges,"46.4% of $6,917.46 in Billed Charges for Rev 272 = $3,209.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PIN MOD GLENOID 2.4MM DRILL TIP GUIDE,272,RC,27200002,CDM,,,,,,both,,,6917.4600,1037.6200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2884.58,,,,,,,1785.4000,6917.4600,percent of total billed charges,"41.7% of $6,917.46 in Billed Charges for Rev 272 = $2,884.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PIN MOD GLENOID 2.4MM DRILL TIP GUIDE,272,RC,27200002,CDM,,,,,,both,,,6917.4600,1037.6200,CIGNA HEALTHCARE,CIGNA PPO,2884.58,,,,,,,1785.4000,6917.4600,percent of total billed charges,"41.7% of $6,917.46 in Billed Charges for Rev 272 = $2,884.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PIN MOD GLENOID 2.4MM DRILL TIP GUIDE,272,RC,27200002,CDM,,,,,,both,,,6917.4600,1037.6200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6225.71,,,,,,,1785.4000,6917.4600,percent of total billed charges,"90% of $6,917.46 in Billed Charges for Rev 272 = $6,225.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PIN MOD GLENOID 2.4MM DRILL TIP GUIDE,272,RC,27200002,CDM,,,,,,both,,,6917.4600,1037.6200,MEDCOST,MEDCOST VHN,3292.02,,,,,,,1785.4000,6917.4600,percent of total billed charges,"47.59% of $6,917.46 in Billed Charges for Rev 272 = $3,292.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PIN MOD GLENOID 2.4MM DRILL TIP GUIDE,272,RC,27200002,CDM,,,,,,both,,,6917.4600,1037.6200,SENTARA HEALTH,SENTARA HEALTH,1785.40,,,,,,,1785.4000,6917.4600,percent of total billed charges,"25.81% of $6,917.46 in Billed Charges for Rev 272 = $1,785.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PIN MOD GLENOID 2.4MM DRILL TIP GUIDE,272,RC,27200002,CDM,,,,,,both,,,6917.4600,1037.6200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6917.46,,,,,,,1785.4000,6917.4600,percent of total billed charges,"100% of $6,917.46 in Billed Charges for Rev 272 = $6,917.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PIN MOD GLENOID 2.4MM DRILL TIP GUIDE,272,RC,27200002,CDM,,,,,,both,,,6917.4600,1037.6200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3458.73,,,,,,,1785.4000,6917.4600,percent of total billed charges,"Rev 272 $6,917.46 in Billed Charges at 50% = $3,458.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PIN MOD GLENOID 2.4MM DRILL TIP GUIDE,272,RC,27200002,CDM,,,,,,both,,,6917.4600,1037.6200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2234.34,,,,,,,1785.4000,6917.4600,other,"32.3% of $6,917.46 in Billed Charges for Rev 272 = $2,234.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PIN MOD GLENOID 2.4MM DRILL TIP GUIDE,272,RC,27200002,CDM,,,,,,both,,,6917.4600,1037.6200,UNITED HEALTHCARE,UHC HERITAGE SELECT,2123.66,,,,,,,1785.4000,6917.4600,other,"30.7% of $6,917.46 in Billed Charges for Rev 272 = $2,123.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PIN MOD GLENOID 2.4MM DRILL TIP GUIDE,272,RC,27200002,CDM,,,,,,both,,,6917.4600,1037.6200,UNITED HEALTHCARE,UNITED HEALTHCARE,2234.34,,,,,,,1785.4000,6917.4600,percent of total billed charges,"32.3% of $6,917.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PIN MOD GLENOID 2.4MM DRILL TIP GUIDE,272,RC,27200002,CDM,,,,,,both,,,6917.4600,1037.6200,WELLCARE,WELLCARE MEDICAID,6917.46,,,,,,,1785.4000,6917.4600,percent of total billed charges,"100% of $6,917.46 in Billed Charges for Rev 272 = $6,917.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT POST CRANIO CATH 110-4G,272,RC,,,,,,,,both,,,9941.2300,1491.1800,AETNA,AETNA,4244.91,,,,,,,2565.8300,9941.2300,percent of total billed charges,"42.7% of $9,941.23 in Billed Charges for Rev 272 = $4,244.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT POST CRANIO CATH 110-4G,272,RC,,,,,,,,both,,,9941.2300,1491.1800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6958.86,,,,,,,2565.8300,9941.2300,percent of total billed charges,"Rev 272 $9,941.23 in Billed Charges at 70% = $6,958.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT POST CRANIO CATH 110-4G,272,RC,,,,,,,,both,,,9941.2300,1491.1800,CIGNA HEALTHCARE,CIGNA HMO,4145.49,,,,,,,2565.8300,9941.2300,percent of total billed charges,"41.7% of $9,941.23 in Billed Charges for Rev 272 = $4,145.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT POST CRANIO CATH 110-4G,272,RC,,,,,,,,both,,,9941.2300,1491.1800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4612.73,,,,,,,2565.8300,9941.2300,percent of total billed charges,"46.4% of $9,941.23 in Billed Charges for Rev 272 = $4,612.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT POST CRANIO CATH 110-4G,272,RC,,,,,,,,both,,,9941.2300,1491.1800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4145.49,,,,,,,2565.8300,9941.2300,percent of total billed charges,"41.7% of $9,941.23 in Billed Charges for Rev 272 = $4,145.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT POST CRANIO CATH 110-4G,272,RC,,,,,,,,both,,,9941.2300,1491.1800,CIGNA HEALTHCARE,CIGNA PPO,4145.49,,,,,,,2565.8300,9941.2300,percent of total billed charges,"41.7% of $9,941.23 in Billed Charges for Rev 272 = $4,145.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT POST CRANIO CATH 110-4G,272,RC,,,,,,,,both,,,9941.2300,1491.1800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8947.11,,,,,,,2565.8300,9941.2300,percent of total billed charges,"90% of $9,941.23 in Billed Charges for Rev 272 = $8,947.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT POST CRANIO CATH 110-4G,272,RC,,,,,,,,both,,,9941.2300,1491.1800,MEDCOST,MEDCOST VHN,4731.03,,,,,,,2565.8300,9941.2300,percent of total billed charges,"47.59% of $9,941.23 in Billed Charges for Rev 272 = $4,731.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT POST CRANIO CATH 110-4G,272,RC,,,,,,,,both,,,9941.2300,1491.1800,SENTARA HEALTH,SENTARA HEALTH,2565.83,,,,,,,2565.8300,9941.2300,percent of total billed charges,"25.81% of $9,941.23 in Billed Charges for Rev 272 = $2,565.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT POST CRANIO CATH 110-4G,272,RC,,,,,,,,both,,,9941.2300,1491.1800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9941.23,,,,,,,2565.8300,9941.2300,percent of total billed charges,"100% of $9,941.23 in Billed Charges for Rev 272 = $9,941.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT POST CRANIO CATH 110-4G,272,RC,,,,,,,,both,,,9941.2300,1491.1800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4970.62,,,,,,,2565.8300,9941.2300,percent of total billed charges,"Rev 272 $9,941.23 in Billed Charges at 50% = $4,970.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT POST CRANIO CATH 110-4G,272,RC,,,,,,,,both,,,9941.2300,1491.1800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3211.02,,,,,,,2565.8300,9941.2300,other,"32.3% of $9,941.23 in Billed Charges for Rev 272 = $3,211.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT POST CRANIO CATH 110-4G,272,RC,,,,,,,,both,,,9941.2300,1491.1800,UNITED HEALTHCARE,UHC HERITAGE SELECT,3051.96,,,,,,,2565.8300,9941.2300,other,"30.7% of $9,941.23 in Billed Charges for Rev 272 = $3,051.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT POST CRANIO CATH 110-4G,272,RC,,,,,,,,both,,,9941.2300,1491.1800,UNITED HEALTHCARE,UNITED HEALTHCARE,3211.02,,,,,,,2565.8300,9941.2300,percent of total billed charges,"32.3% of $9,941.23 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT POST CRANIO CATH 110-4G,272,RC,,,,,,,,both,,,9941.2300,1491.1800,WELLCARE,WELLCARE MEDICAID,9941.23,,,,,,,2565.8300,9941.2300,percent of total billed charges,"100% of $9,941.23 in Billed Charges for Rev 272 = $9,941.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT HARVESTER BONE AVITUS 5MM,272,RC,,,,,,,,both,,,13471.9300,2020.7900,AETNA,AETNA,5752.51,,,,,,,3477.1100,13471.9300,percent of total billed charges,"42.7% of $13,471.93 in Billed Charges for Rev 272 = $5,752.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT HARVESTER BONE AVITUS 5MM,272,RC,,,,,,,,both,,,13471.9300,2020.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9430.35,,,,,,,3477.1100,13471.9300,percent of total billed charges,"Rev 272 $13,471.93 in Billed Charges at 70% = $9,430.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT HARVESTER BONE AVITUS 5MM,272,RC,,,,,,,,both,,,13471.9300,2020.7900,CIGNA HEALTHCARE,CIGNA HMO,5617.79,,,,,,,3477.1100,13471.9300,percent of total billed charges,"41.7% of $13,471.93 in Billed Charges for Rev 272 = $5,617.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT HARVESTER BONE AVITUS 5MM,272,RC,,,,,,,,both,,,13471.9300,2020.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6250.98,,,,,,,3477.1100,13471.9300,percent of total billed charges,"46.4% of $13,471.93 in Billed Charges for Rev 272 = $6,250.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT HARVESTER BONE AVITUS 5MM,272,RC,,,,,,,,both,,,13471.9300,2020.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5617.79,,,,,,,3477.1100,13471.9300,percent of total billed charges,"41.7% of $13,471.93 in Billed Charges for Rev 272 = $5,617.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT HARVESTER BONE AVITUS 5MM,272,RC,,,,,,,,both,,,13471.9300,2020.7900,CIGNA HEALTHCARE,CIGNA PPO,5617.79,,,,,,,3477.1100,13471.9300,percent of total billed charges,"41.7% of $13,471.93 in Billed Charges for Rev 272 = $5,617.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT HARVESTER BONE AVITUS 5MM,272,RC,,,,,,,,both,,,13471.9300,2020.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12124.74,,,,,,,3477.1100,13471.9300,percent of total billed charges,"90% of $13,471.93 in Billed Charges for Rev 272 = $12,124.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT HARVESTER BONE AVITUS 5MM,272,RC,,,,,,,,both,,,13471.9300,2020.7900,MEDCOST,MEDCOST VHN,6411.29,,,,,,,3477.1100,13471.9300,percent of total billed charges,"47.59% of $13,471.93 in Billed Charges for Rev 272 = $6,411.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT HARVESTER BONE AVITUS 5MM,272,RC,,,,,,,,both,,,13471.9300,2020.7900,SENTARA HEALTH,SENTARA HEALTH,3477.11,,,,,,,3477.1100,13471.9300,percent of total billed charges,"25.81% of $13,471.93 in Billed Charges for Rev 272 = $3,477.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT HARVESTER BONE AVITUS 5MM,272,RC,,,,,,,,both,,,13471.9300,2020.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13471.93,,,,,,,3477.1100,13471.9300,percent of total billed charges,"100% of $13,471.93 in Billed Charges for Rev 272 = $13,471.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT HARVESTER BONE AVITUS 5MM,272,RC,,,,,,,,both,,,13471.9300,2020.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6735.97,,,,,,,3477.1100,13471.9300,percent of total billed charges,"Rev 272 $13,471.93 in Billed Charges at 50% = $6,735.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT HARVESTER BONE AVITUS 5MM,272,RC,,,,,,,,both,,,13471.9300,2020.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4351.43,,,,,,,3477.1100,13471.9300,other,"32.3% of $13,471.93 in Billed Charges for Rev 272 = $4,351.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
INSTRUMENT HARVESTER BONE AVITUS 5MM,272,RC,,,,,,,,both,,,13471.9300,2020.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,4135.88,,,,,,,3477.1100,13471.9300,other,"30.7% of $13,471.93 in Billed Charges for Rev 272 = $4,135.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
INSTRUMENT HARVESTER BONE AVITUS 5MM,272,RC,,,,,,,,both,,,13471.9300,2020.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,4351.43,,,,,,,3477.1100,13471.9300,percent of total billed charges,"32.3% of $13,471.93 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT HARVESTER BONE AVITUS 5MM,272,RC,,,,,,,,both,,,13471.9300,2020.7900,WELLCARE,WELLCARE MEDICAID,13471.93,,,,,,,3477.1100,13471.9300,percent of total billed charges,"100% of $13,471.93 in Billed Charges for Rev 272 = $13,471.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT PILOT HOLE CREATOR 11 X 20MM,272,RC,27200002,CDM,,,,,,both,,,8239.1400,1235.8700,AETNA,AETNA,3518.11,,,,,,,2126.5200,8239.1400,percent of total billed charges,"42.7% of $8,239.14 in Billed Charges for Rev 272 = $3,518.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT PILOT HOLE CREATOR 11 X 20MM,272,RC,27200002,CDM,,,,,,both,,,8239.1400,1235.8700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5767.40,,,,,,,2126.5200,8239.1400,percent of total billed charges,"Rev 272 $8,239.14 in Billed Charges at 70% = $5,767.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT PILOT HOLE CREATOR 11 X 20MM,272,RC,27200002,CDM,,,,,,both,,,8239.1400,1235.8700,CIGNA HEALTHCARE,CIGNA HMO,3435.72,,,,,,,2126.5200,8239.1400,percent of total billed charges,"41.7% of $8,239.14 in Billed Charges for Rev 272 = $3,435.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT PILOT HOLE CREATOR 11 X 20MM,272,RC,27200002,CDM,,,,,,both,,,8239.1400,1235.8700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3822.96,,,,,,,2126.5200,8239.1400,percent of total billed charges,"46.4% of $8,239.14 in Billed Charges for Rev 272 = $3,822.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT PILOT HOLE CREATOR 11 X 20MM,272,RC,27200002,CDM,,,,,,both,,,8239.1400,1235.8700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3435.72,,,,,,,2126.5200,8239.1400,percent of total billed charges,"41.7% of $8,239.14 in Billed Charges for Rev 272 = $3,435.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT PILOT HOLE CREATOR 11 X 20MM,272,RC,27200002,CDM,,,,,,both,,,8239.1400,1235.8700,CIGNA HEALTHCARE,CIGNA PPO,3435.72,,,,,,,2126.5200,8239.1400,percent of total billed charges,"41.7% of $8,239.14 in Billed Charges for Rev 272 = $3,435.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT PILOT HOLE CREATOR 11 X 20MM,272,RC,27200002,CDM,,,,,,both,,,8239.1400,1235.8700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7415.23,,,,,,,2126.5200,8239.1400,percent of total billed charges,"90% of $8,239.14 in Billed Charges for Rev 272 = $7,415.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT PILOT HOLE CREATOR 11 X 20MM,272,RC,27200002,CDM,,,,,,both,,,8239.1400,1235.8700,MEDCOST,MEDCOST VHN,3921.01,,,,,,,2126.5200,8239.1400,percent of total billed charges,"47.59% of $8,239.14 in Billed Charges for Rev 272 = $3,921.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT PILOT HOLE CREATOR 11 X 20MM,272,RC,27200002,CDM,,,,,,both,,,8239.1400,1235.8700,SENTARA HEALTH,SENTARA HEALTH,2126.52,,,,,,,2126.5200,8239.1400,percent of total billed charges,"25.81% of $8,239.14 in Billed Charges for Rev 272 = $2,126.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT PILOT HOLE CREATOR 11 X 20MM,272,RC,27200002,CDM,,,,,,both,,,8239.1400,1235.8700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8239.14,,,,,,,2126.5200,8239.1400,percent of total billed charges,"100% of $8,239.14 in Billed Charges for Rev 272 = $8,239.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT PILOT HOLE CREATOR 11 X 20MM,272,RC,27200002,CDM,,,,,,both,,,8239.1400,1235.8700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4119.57,,,,,,,2126.5200,8239.1400,percent of total billed charges,"Rev 272 $8,239.14 in Billed Charges at 50% = $4,119.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT PILOT HOLE CREATOR 11 X 20MM,272,RC,27200002,CDM,,,,,,both,,,8239.1400,1235.8700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2661.24,,,,,,,2126.5200,8239.1400,other,"32.3% of $8,239.14 in Billed Charges for Rev 272 = $2,661.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
INSTRUMENT PILOT HOLE CREATOR 11 X 20MM,272,RC,27200002,CDM,,,,,,both,,,8239.1400,1235.8700,UNITED HEALTHCARE,UHC HERITAGE SELECT,2529.42,,,,,,,2126.5200,8239.1400,other,"30.7% of $8,239.14 in Billed Charges for Rev 272 = $2,529.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
INSTRUMENT PILOT HOLE CREATOR 11 X 20MM,272,RC,27200002,CDM,,,,,,both,,,8239.1400,1235.8700,UNITED HEALTHCARE,UNITED HEALTHCARE,2661.24,,,,,,,2126.5200,8239.1400,percent of total billed charges,"32.3% of $8,239.14 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT PILOT HOLE CREATOR 11 X 20MM,272,RC,27200002,CDM,,,,,,both,,,8239.1400,1235.8700,WELLCARE,WELLCARE MEDICAID,8239.14,,,,,,,2126.5200,8239.1400,percent of total billed charges,"100% of $8,239.14 in Billed Charges for Rev 272 = $8,239.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT REDUCTION 100MM DISP,272,RC,27200002,CDM,,,,,,both,,,3163.1600,474.4700,AETNA,AETNA,1350.67,,,,,,,816.4100,3163.1600,percent of total billed charges,"42.7% of $3,163.16 in Billed Charges for Rev 272 = $1,350.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT REDUCTION 100MM DISP,272,RC,27200002,CDM,,,,,,both,,,3163.1600,474.4700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2214.21,,,,,,,816.4100,3163.1600,percent of total billed charges,"Rev 272 $3,163.16 in Billed Charges at 70% = $2,214.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT REDUCTION 100MM DISP,272,RC,27200002,CDM,,,,,,both,,,3163.1600,474.4700,CIGNA HEALTHCARE,CIGNA HMO,1319.04,,,,,,,816.4100,3163.1600,percent of total billed charges,"41.7% of $3,163.16 in Billed Charges for Rev 272 = $1,319.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT REDUCTION 100MM DISP,272,RC,27200002,CDM,,,,,,both,,,3163.1600,474.4700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1467.71,,,,,,,816.4100,3163.1600,percent of total billed charges,"46.4% of $3,163.16 in Billed Charges for Rev 272 = $1,467.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT REDUCTION 100MM DISP,272,RC,27200002,CDM,,,,,,both,,,3163.1600,474.4700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1319.04,,,,,,,816.4100,3163.1600,percent of total billed charges,"41.7% of $3,163.16 in Billed Charges for Rev 272 = $1,319.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT REDUCTION 100MM DISP,272,RC,27200002,CDM,,,,,,both,,,3163.1600,474.4700,CIGNA HEALTHCARE,CIGNA PPO,1319.04,,,,,,,816.4100,3163.1600,percent of total billed charges,"41.7% of $3,163.16 in Billed Charges for Rev 272 = $1,319.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT REDUCTION 100MM DISP,272,RC,27200002,CDM,,,,,,both,,,3163.1600,474.4700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2846.84,,,,,,,816.4100,3163.1600,percent of total billed charges,"90% of $3,163.16 in Billed Charges for Rev 272 = $2,846.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT REDUCTION 100MM DISP,272,RC,27200002,CDM,,,,,,both,,,3163.1600,474.4700,MEDCOST,MEDCOST VHN,1505.35,,,,,,,816.4100,3163.1600,percent of total billed charges,"47.59% of $3,163.16 in Billed Charges for Rev 272 = $1,505.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT REDUCTION 100MM DISP,272,RC,27200002,CDM,,,,,,both,,,3163.1600,474.4700,SENTARA HEALTH,SENTARA HEALTH,816.41,,,,,,,816.4100,3163.1600,percent of total billed charges,"25.81% of $3,163.16 in Billed Charges for Rev 272 = $816.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT REDUCTION 100MM DISP,272,RC,27200002,CDM,,,,,,both,,,3163.1600,474.4700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3163.16,,,,,,,816.4100,3163.1600,percent of total billed charges,"100% of $3,163.16 in Billed Charges for Rev 272 = $3,163.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT REDUCTION 100MM DISP,272,RC,27200002,CDM,,,,,,both,,,3163.1600,474.4700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1581.58,,,,,,,816.4100,3163.1600,percent of total billed charges,"Rev 272 $3,163.16 in Billed Charges at 50% = $1,581.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT REDUCTION 100MM DISP,272,RC,27200002,CDM,,,,,,both,,,3163.1600,474.4700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1021.70,,,,,,,816.4100,3163.1600,other,"32.3% of $3,163.16 in Billed Charges for Rev 272 = $1,021.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
INSTRUMENT REDUCTION 100MM DISP,272,RC,27200002,CDM,,,,,,both,,,3163.1600,474.4700,UNITED HEALTHCARE,UHC HERITAGE SELECT,971.09,,,,,,,816.4100,3163.1600,other,"30.7% of $3,163.16 in Billed Charges for Rev 272 = $971.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
INSTRUMENT REDUCTION 100MM DISP,272,RC,27200002,CDM,,,,,,both,,,3163.1600,474.4700,UNITED HEALTHCARE,UNITED HEALTHCARE,1021.70,,,,,,,816.4100,3163.1600,percent of total billed charges,"32.3% of $3,163.16 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT REDUCTION 100MM DISP,272,RC,27200002,CDM,,,,,,both,,,3163.1600,474.4700,WELLCARE,WELLCARE MEDICAID,3163.16,,,,,,,816.4100,3163.1600,percent of total billed charges,"100% of $3,163.16 in Billed Charges for Rev 272 = $3,163.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS MANDIBLE SUPPLEMENTAL MODEL HALF,272,RC,,,,,,,,both,,,13907.5100,2086.1300,AETNA,AETNA,5938.51,,,,,,,3589.5300,13907.5100,percent of total billed charges,"42.7% of $13,907.51 in Billed Charges for Rev 272 = $5,938.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS MANDIBLE SUPPLEMENTAL MODEL HALF,272,RC,,,,,,,,both,,,13907.5100,2086.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9735.26,,,,,,,3589.5300,13907.5100,percent of total billed charges,"Rev 272 $13,907.51 in Billed Charges at 70% = $9,735.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS MANDIBLE SUPPLEMENTAL MODEL HALF,272,RC,,,,,,,,both,,,13907.5100,2086.1300,CIGNA HEALTHCARE,CIGNA HMO,5799.43,,,,,,,3589.5300,13907.5100,percent of total billed charges,"41.7% of $13,907.51 in Billed Charges for Rev 272 = $5,799.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS MANDIBLE SUPPLEMENTAL MODEL HALF,272,RC,,,,,,,,both,,,13907.5100,2086.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6453.08,,,,,,,3589.5300,13907.5100,percent of total billed charges,"46.4% of $13,907.51 in Billed Charges for Rev 272 = $6,453.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS MANDIBLE SUPPLEMENTAL MODEL HALF,272,RC,,,,,,,,both,,,13907.5100,2086.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5799.43,,,,,,,3589.5300,13907.5100,percent of total billed charges,"41.7% of $13,907.51 in Billed Charges for Rev 272 = $5,799.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS MANDIBLE SUPPLEMENTAL MODEL HALF,272,RC,,,,,,,,both,,,13907.5100,2086.1300,CIGNA HEALTHCARE,CIGNA PPO,5799.43,,,,,,,3589.5300,13907.5100,percent of total billed charges,"41.7% of $13,907.51 in Billed Charges for Rev 272 = $5,799.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS MANDIBLE SUPPLEMENTAL MODEL HALF,272,RC,,,,,,,,both,,,13907.5100,2086.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12516.76,,,,,,,3589.5300,13907.5100,percent of total billed charges,"90% of $13,907.51 in Billed Charges for Rev 272 = $12,516.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS MANDIBLE SUPPLEMENTAL MODEL HALF,272,RC,,,,,,,,both,,,13907.5100,2086.1300,MEDCOST,MEDCOST VHN,6618.58,,,,,,,3589.5300,13907.5100,percent of total billed charges,"47.59% of $13,907.51 in Billed Charges for Rev 272 = $6,618.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS MANDIBLE SUPPLEMENTAL MODEL HALF,272,RC,,,,,,,,both,,,13907.5100,2086.1300,SENTARA HEALTH,SENTARA HEALTH,3589.53,,,,,,,3589.5300,13907.5100,percent of total billed charges,"25.81% of $13,907.51 in Billed Charges for Rev 272 = $3,589.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS MANDIBLE SUPPLEMENTAL MODEL HALF,272,RC,,,,,,,,both,,,13907.5100,2086.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13907.51,,,,,,,3589.5300,13907.5100,percent of total billed charges,"100% of $13,907.51 in Billed Charges for Rev 272 = $13,907.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS MANDIBLE SUPPLEMENTAL MODEL HALF,272,RC,,,,,,,,both,,,13907.5100,2086.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6953.76,,,,,,,3589.5300,13907.5100,percent of total billed charges,"Rev 272 $13,907.51 in Billed Charges at 50% = $6,953.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS MANDIBLE SUPPLEMENTAL MODEL HALF,272,RC,,,,,,,,both,,,13907.5100,2086.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4492.13,,,,,,,3589.5300,13907.5100,other,"32.3% of $13,907.51 in Billed Charges for Rev 272 = $4,492.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
IPS MANDIBLE SUPPLEMENTAL MODEL HALF,272,RC,,,,,,,,both,,,13907.5100,2086.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,4269.61,,,,,,,3589.5300,13907.5100,other,"30.7% of $13,907.51 in Billed Charges for Rev 272 = $4,269.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
IPS MANDIBLE SUPPLEMENTAL MODEL HALF,272,RC,,,,,,,,both,,,13907.5100,2086.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,4492.13,,,,,,,3589.5300,13907.5100,percent of total billed charges,"32.3% of $13,907.51 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS MANDIBLE SUPPLEMENTAL MODEL HALF,272,RC,,,,,,,,both,,,13907.5100,2086.1300,WELLCARE,WELLCARE MEDICAID,13907.51,,,,,,,3589.5300,13907.5100,percent of total billed charges,"100% of $13,907.51 in Billed Charges for Rev 272 = $13,907.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS SUPPLEMENTAL MODEL HALF SMALL 00006,272,RC,,,,,,,,both,,,13005.2300,1950.7800,AETNA,AETNA,5553.23,,,,,,,3356.6500,13005.2300,percent of total billed charges,"42.7% of $13,005.23 in Billed Charges for Rev 272 = $5,553.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS SUPPLEMENTAL MODEL HALF SMALL 00006,272,RC,,,,,,,,both,,,13005.2300,1950.7800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9103.66,,,,,,,3356.6500,13005.2300,percent of total billed charges,"Rev 272 $13,005.23 in Billed Charges at 70% = $9,103.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS SUPPLEMENTAL MODEL HALF SMALL 00006,272,RC,,,,,,,,both,,,13005.2300,1950.7800,CIGNA HEALTHCARE,CIGNA HMO,5423.18,,,,,,,3356.6500,13005.2300,percent of total billed charges,"41.7% of $13,005.23 in Billed Charges for Rev 272 = $5,423.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS SUPPLEMENTAL MODEL HALF SMALL 00006,272,RC,,,,,,,,both,,,13005.2300,1950.7800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6034.43,,,,,,,3356.6500,13005.2300,percent of total billed charges,"46.4% of $13,005.23 in Billed Charges for Rev 272 = $6,034.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS SUPPLEMENTAL MODEL HALF SMALL 00006,272,RC,,,,,,,,both,,,13005.2300,1950.7800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5423.18,,,,,,,3356.6500,13005.2300,percent of total billed charges,"41.7% of $13,005.23 in Billed Charges for Rev 272 = $5,423.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS SUPPLEMENTAL MODEL HALF SMALL 00006,272,RC,,,,,,,,both,,,13005.2300,1950.7800,CIGNA HEALTHCARE,CIGNA PPO,5423.18,,,,,,,3356.6500,13005.2300,percent of total billed charges,"41.7% of $13,005.23 in Billed Charges for Rev 272 = $5,423.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS SUPPLEMENTAL MODEL HALF SMALL 00006,272,RC,,,,,,,,both,,,13005.2300,1950.7800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11704.71,,,,,,,3356.6500,13005.2300,percent of total billed charges,"90% of $13,005.23 in Billed Charges for Rev 272 = $11,704.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS SUPPLEMENTAL MODEL HALF SMALL 00006,272,RC,,,,,,,,both,,,13005.2300,1950.7800,MEDCOST,MEDCOST VHN,6189.19,,,,,,,3356.6500,13005.2300,percent of total billed charges,"47.59% of $13,005.23 in Billed Charges for Rev 272 = $6,189.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS SUPPLEMENTAL MODEL HALF SMALL 00006,272,RC,,,,,,,,both,,,13005.2300,1950.7800,SENTARA HEALTH,SENTARA HEALTH,3356.65,,,,,,,3356.6500,13005.2300,percent of total billed charges,"25.81% of $13,005.23 in Billed Charges for Rev 272 = $3,356.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS SUPPLEMENTAL MODEL HALF SMALL 00006,272,RC,,,,,,,,both,,,13005.2300,1950.7800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13005.23,,,,,,,3356.6500,13005.2300,percent of total billed charges,"100% of $13,005.23 in Billed Charges for Rev 272 = $13,005.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS SUPPLEMENTAL MODEL HALF SMALL 00006,272,RC,,,,,,,,both,,,13005.2300,1950.7800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6502.62,,,,,,,3356.6500,13005.2300,percent of total billed charges,"Rev 272 $13,005.23 in Billed Charges at 50% = $6,502.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS SUPPLEMENTAL MODEL HALF SMALL 00006,272,RC,,,,,,,,both,,,13005.2300,1950.7800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4200.69,,,,,,,3356.6500,13005.2300,other,"32.3% of $13,005.23 in Billed Charges for Rev 272 = $4,200.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
IPS SUPPLEMENTAL MODEL HALF SMALL 00006,272,RC,,,,,,,,both,,,13005.2300,1950.7800,UNITED HEALTHCARE,UHC HERITAGE SELECT,3992.61,,,,,,,3356.6500,13005.2300,other,"30.7% of $13,005.23 in Billed Charges for Rev 272 = $3,992.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
IPS SUPPLEMENTAL MODEL HALF SMALL 00006,272,RC,,,,,,,,both,,,13005.2300,1950.7800,UNITED HEALTHCARE,UNITED HEALTHCARE,4200.69,,,,,,,3356.6500,13005.2300,percent of total billed charges,"32.3% of $13,005.23 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS SUPPLEMENTAL MODEL HALF SMALL 00006,272,RC,,,,,,,,both,,,13005.2300,1950.7800,WELLCARE,WELLCARE MEDICAID,13005.23,,,,,,,3356.6500,13005.2300,percent of total billed charges,"100% of $13,005.23 in Billed Charges for Rev 272 = $13,005.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
K-WIRE 0.90,272,RC,27200002,CDM,,,,,,both,,,318.6000,47.7900,AETNA,AETNA,136.04,,,,,,,82.2300,318.6000,percent of total billed charges,42.7% of $318.60 in Billed Charges for Rev 272 = $136.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 0.90,272,RC,27200002,CDM,,,,,,both,,,318.6000,47.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,223.02,,,,,,,82.2300,318.6000,percent of total billed charges,Rev 272 $318.60 in Billed Charges at 70% = $223.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 0.90,272,RC,27200002,CDM,,,,,,both,,,318.6000,47.7900,CIGNA HEALTHCARE,CIGNA HMO,132.86,,,,,,,82.2300,318.6000,percent of total billed charges,41.7% of $318.60 in Billed Charges for Rev 272 = $132.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 0.90,272,RC,27200002,CDM,,,,,,both,,,318.6000,47.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,147.83,,,,,,,82.2300,318.6000,percent of total billed charges,46.4% of $318.60 in Billed Charges for Rev 272 = $147.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 0.90,272,RC,27200002,CDM,,,,,,both,,,318.6000,47.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,132.86,,,,,,,82.2300,318.6000,percent of total billed charges,41.7% of $318.60 in Billed Charges for Rev 272 = $132.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 0.90,272,RC,27200002,CDM,,,,,,both,,,318.6000,47.7900,CIGNA HEALTHCARE,CIGNA PPO,132.86,,,,,,,82.2300,318.6000,percent of total billed charges,41.7% of $318.60 in Billed Charges for Rev 272 = $132.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 0.90,272,RC,27200002,CDM,,,,,,both,,,318.6000,47.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,286.74,,,,,,,82.2300,318.6000,percent of total billed charges,90% of $318.60 in Billed Charges for Rev 272 = $286.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 0.90,272,RC,27200002,CDM,,,,,,both,,,318.6000,47.7900,MEDCOST,MEDCOST VHN,151.62,,,,,,,82.2300,318.6000,percent of total billed charges,47.59% of $318.60 in Billed Charges for Rev 272 = $151.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 0.90,272,RC,27200002,CDM,,,,,,both,,,318.6000,47.7900,SENTARA HEALTH,SENTARA HEALTH,82.23,,,,,,,82.2300,318.6000,percent of total billed charges,25.81% of $318.60 in Billed Charges for Rev 272 = $82.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 0.90,272,RC,27200002,CDM,,,,,,both,,,318.6000,47.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",318.60,,,,,,,82.2300,318.6000,percent of total billed charges,100% of $318.60 in Billed Charges for Rev 272 = $318.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 0.90,272,RC,27200002,CDM,,,,,,both,,,318.6000,47.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,159.30,,,,,,,82.2300,318.6000,percent of total billed charges,Rev 272 $318.60 in Billed Charges at 50% = $159.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 0.90,272,RC,27200002,CDM,,,,,,both,,,318.6000,47.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,102.91,,,,,,,82.2300,318.6000,other,32.3% of $318.60 in Billed Charges for Rev 272 = $102.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
K-WIRE 0.90,272,RC,27200002,CDM,,,,,,both,,,318.6000,47.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,97.81,,,,,,,82.2300,318.6000,other,30.7% of $318.60 in Billed Charges for Rev 272 = $97.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
K-WIRE 0.90,272,RC,27200002,CDM,,,,,,both,,,318.6000,47.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,102.91,,,,,,,82.2300,318.6000,percent of total billed charges,32.3% of $318.60 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 0.90,272,RC,27200002,CDM,,,,,,both,,,318.6000,47.7900,WELLCARE,WELLCARE MEDICAID,318.60,,,,,,,82.2300,318.6000,percent of total billed charges,100% of $318.60 in Billed Charges for Rev 272 = $318.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT LAWSON RETROGRADE NEPHROST,272,RC,,,,,,,,both,,,3248.2000,487.2300,AETNA,AETNA,1386.98,,,,,,,838.3600,3248.2000,percent of total billed charges,"42.7% of $3,248.20 in Billed Charges for Rev 272 = $1,386.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LAWSON RETROGRADE NEPHROST,272,RC,,,,,,,,both,,,3248.2000,487.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2273.74,,,,,,,838.3600,3248.2000,percent of total billed charges,"Rev 272 $3,248.20 in Billed Charges at 70% = $2,273.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LAWSON RETROGRADE NEPHROST,272,RC,,,,,,,,both,,,3248.2000,487.2300,CIGNA HEALTHCARE,CIGNA HMO,1354.50,,,,,,,838.3600,3248.2000,percent of total billed charges,"41.7% of $3,248.20 in Billed Charges for Rev 272 = $1,354.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LAWSON RETROGRADE NEPHROST,272,RC,,,,,,,,both,,,3248.2000,487.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1507.16,,,,,,,838.3600,3248.2000,percent of total billed charges,"46.4% of $3,248.20 in Billed Charges for Rev 272 = $1,507.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LAWSON RETROGRADE NEPHROST,272,RC,,,,,,,,both,,,3248.2000,487.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1354.50,,,,,,,838.3600,3248.2000,percent of total billed charges,"41.7% of $3,248.20 in Billed Charges for Rev 272 = $1,354.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LAWSON RETROGRADE NEPHROST,272,RC,,,,,,,,both,,,3248.2000,487.2300,CIGNA HEALTHCARE,CIGNA PPO,1354.50,,,,,,,838.3600,3248.2000,percent of total billed charges,"41.7% of $3,248.20 in Billed Charges for Rev 272 = $1,354.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LAWSON RETROGRADE NEPHROST,272,RC,,,,,,,,both,,,3248.2000,487.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2923.38,,,,,,,838.3600,3248.2000,percent of total billed charges,"90% of $3,248.20 in Billed Charges for Rev 272 = $2,923.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LAWSON RETROGRADE NEPHROST,272,RC,,,,,,,,both,,,3248.2000,487.2300,MEDCOST,MEDCOST VHN,1545.82,,,,,,,838.3600,3248.2000,percent of total billed charges,"47.59% of $3,248.20 in Billed Charges for Rev 272 = $1,545.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LAWSON RETROGRADE NEPHROST,272,RC,,,,,,,,both,,,3248.2000,487.2300,SENTARA HEALTH,SENTARA HEALTH,838.36,,,,,,,838.3600,3248.2000,percent of total billed charges,"25.81% of $3,248.20 in Billed Charges for Rev 272 = $838.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LAWSON RETROGRADE NEPHROST,272,RC,,,,,,,,both,,,3248.2000,487.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3248.20,,,,,,,838.3600,3248.2000,percent of total billed charges,"100% of $3,248.20 in Billed Charges for Rev 272 = $3,248.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LAWSON RETROGRADE NEPHROST,272,RC,,,,,,,,both,,,3248.2000,487.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1624.10,,,,,,,838.3600,3248.2000,percent of total billed charges,"Rev 272 $3,248.20 in Billed Charges at 50% = $1,624.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LAWSON RETROGRADE NEPHROST,272,RC,,,,,,,,both,,,3248.2000,487.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1049.17,,,,,,,838.3600,3248.2000,other,"32.3% of $3,248.20 in Billed Charges for Rev 272 = $1,049.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT LAWSON RETROGRADE NEPHROST,272,RC,,,,,,,,both,,,3248.2000,487.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,997.20,,,,,,,838.3600,3248.2000,other,"30.7% of $3,248.20 in Billed Charges for Rev 272 = $997.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT LAWSON RETROGRADE NEPHROST,272,RC,,,,,,,,both,,,3248.2000,487.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,1049.17,,,,,,,838.3600,3248.2000,percent of total billed charges,"32.3% of $3,248.20 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LAWSON RETROGRADE NEPHROST,272,RC,,,,,,,,both,,,3248.2000,487.2300,WELLCARE,WELLCARE MEDICAID,3248.20,,,,,,,838.3600,3248.2000,percent of total billed charges,"100% of $3,248.20 in Billed Charges for Rev 272 = $3,248.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PRO-TOE VO INST,272,RC,,,,,,,,both,,,2457.9300,368.6900,AETNA,AETNA,1049.54,,,,,,,634.3900,2457.9300,percent of total billed charges,"42.7% of $2,457.93 in Billed Charges for Rev 272 = $1,049.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PRO-TOE VO INST,272,RC,,,,,,,,both,,,2457.9300,368.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1720.55,,,,,,,634.3900,2457.9300,percent of total billed charges,"Rev 272 $2,457.93 in Billed Charges at 70% = $1,720.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PRO-TOE VO INST,272,RC,,,,,,,,both,,,2457.9300,368.6900,CIGNA HEALTHCARE,CIGNA HMO,1024.96,,,,,,,634.3900,2457.9300,percent of total billed charges,"41.7% of $2,457.93 in Billed Charges for Rev 272 = $1,024.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PRO-TOE VO INST,272,RC,,,,,,,,both,,,2457.9300,368.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1140.48,,,,,,,634.3900,2457.9300,percent of total billed charges,"46.4% of $2,457.93 in Billed Charges for Rev 272 = $1,140.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PRO-TOE VO INST,272,RC,,,,,,,,both,,,2457.9300,368.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1024.96,,,,,,,634.3900,2457.9300,percent of total billed charges,"41.7% of $2,457.93 in Billed Charges for Rev 272 = $1,024.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PRO-TOE VO INST,272,RC,,,,,,,,both,,,2457.9300,368.6900,CIGNA HEALTHCARE,CIGNA PPO,1024.96,,,,,,,634.3900,2457.9300,percent of total billed charges,"41.7% of $2,457.93 in Billed Charges for Rev 272 = $1,024.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PRO-TOE VO INST,272,RC,,,,,,,,both,,,2457.9300,368.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2212.14,,,,,,,634.3900,2457.9300,percent of total billed charges,"90% of $2,457.93 in Billed Charges for Rev 272 = $2,212.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PRO-TOE VO INST,272,RC,,,,,,,,both,,,2457.9300,368.6900,MEDCOST,MEDCOST VHN,1169.73,,,,,,,634.3900,2457.9300,percent of total billed charges,"47.59% of $2,457.93 in Billed Charges for Rev 272 = $1,169.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PRO-TOE VO INST,272,RC,,,,,,,,both,,,2457.9300,368.6900,SENTARA HEALTH,SENTARA HEALTH,634.39,,,,,,,634.3900,2457.9300,percent of total billed charges,"25.81% of $2,457.93 in Billed Charges for Rev 272 = $634.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PRO-TOE VO INST,272,RC,,,,,,,,both,,,2457.9300,368.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2457.93,,,,,,,634.3900,2457.9300,percent of total billed charges,"100% of $2,457.93 in Billed Charges for Rev 272 = $2,457.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PRO-TOE VO INST,272,RC,,,,,,,,both,,,2457.9300,368.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1228.97,,,,,,,634.3900,2457.9300,percent of total billed charges,"Rev 272 $2,457.93 in Billed Charges at 50% = $1,228.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PRO-TOE VO INST,272,RC,,,,,,,,both,,,2457.9300,368.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,793.91,,,,,,,634.3900,2457.9300,other,"32.3% of $2,457.93 in Billed Charges for Rev 272 = $793.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PRO-TOE VO INST,272,RC,,,,,,,,both,,,2457.9300,368.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,754.58,,,,,,,634.3900,2457.9300,other,"30.7% of $2,457.93 in Billed Charges for Rev 272 = $754.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PRO-TOE VO INST,272,RC,,,,,,,,both,,,2457.9300,368.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,793.91,,,,,,,634.3900,2457.9300,percent of total billed charges,"32.3% of $2,457.93 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PRO-TOE VO INST,272,RC,,,,,,,,both,,,2457.9300,368.6900,WELLCARE,WELLCARE MEDICAID,2457.93,,,,,,,634.3900,2457.9300,percent of total billed charges,"100% of $2,457.93 in Billed Charges for Rev 272 = $2,457.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAND XP LATCH SEAL DIV 23CM,272,RC,27200002,CDM,,,,,,both,,,5188.0900,778.2100,AETNA,AETNA,2215.31,,,,,,,1339.0500,5188.0900,percent of total billed charges,"42.7% of $5,188.09 in Billed Charges for Rev 272 = $2,215.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAND XP LATCH SEAL DIV 23CM,272,RC,27200002,CDM,,,,,,both,,,5188.0900,778.2100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3631.66,,,,,,,1339.0500,5188.0900,percent of total billed charges,"Rev 272 $5,188.09 in Billed Charges at 70% = $3,631.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAND XP LATCH SEAL DIV 23CM,272,RC,27200002,CDM,,,,,,both,,,5188.0900,778.2100,CIGNA HEALTHCARE,CIGNA HMO,2163.43,,,,,,,1339.0500,5188.0900,percent of total billed charges,"41.7% of $5,188.09 in Billed Charges for Rev 272 = $2,163.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAND XP LATCH SEAL DIV 23CM,272,RC,27200002,CDM,,,,,,both,,,5188.0900,778.2100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2407.27,,,,,,,1339.0500,5188.0900,percent of total billed charges,"46.4% of $5,188.09 in Billed Charges for Rev 272 = $2,407.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAND XP LATCH SEAL DIV 23CM,272,RC,27200002,CDM,,,,,,both,,,5188.0900,778.2100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2163.43,,,,,,,1339.0500,5188.0900,percent of total billed charges,"41.7% of $5,188.09 in Billed Charges for Rev 272 = $2,163.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAND XP LATCH SEAL DIV 23CM,272,RC,27200002,CDM,,,,,,both,,,5188.0900,778.2100,CIGNA HEALTHCARE,CIGNA PPO,2163.43,,,,,,,1339.0500,5188.0900,percent of total billed charges,"41.7% of $5,188.09 in Billed Charges for Rev 272 = $2,163.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAND XP LATCH SEAL DIV 23CM,272,RC,27200002,CDM,,,,,,both,,,5188.0900,778.2100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4669.28,,,,,,,1339.0500,5188.0900,percent of total billed charges,"90% of $5,188.09 in Billed Charges for Rev 272 = $4,669.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAND XP LATCH SEAL DIV 23CM,272,RC,27200002,CDM,,,,,,both,,,5188.0900,778.2100,MEDCOST,MEDCOST VHN,2469.01,,,,,,,1339.0500,5188.0900,percent of total billed charges,"47.59% of $5,188.09 in Billed Charges for Rev 272 = $2,469.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAND XP LATCH SEAL DIV 23CM,272,RC,27200002,CDM,,,,,,both,,,5188.0900,778.2100,SENTARA HEALTH,SENTARA HEALTH,1339.05,,,,,,,1339.0500,5188.0900,percent of total billed charges,"25.81% of $5,188.09 in Billed Charges for Rev 272 = $1,339.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAND XP LATCH SEAL DIV 23CM,272,RC,27200002,CDM,,,,,,both,,,5188.0900,778.2100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5188.09,,,,,,,1339.0500,5188.0900,percent of total billed charges,"100% of $5,188.09 in Billed Charges for Rev 272 = $5,188.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAND XP LATCH SEAL DIV 23CM,272,RC,27200002,CDM,,,,,,both,,,5188.0900,778.2100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2594.05,,,,,,,1339.0500,5188.0900,percent of total billed charges,"Rev 272 $5,188.09 in Billed Charges at 50% = $2,594.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAND XP LATCH SEAL DIV 23CM,272,RC,27200002,CDM,,,,,,both,,,5188.0900,778.2100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1675.75,,,,,,,1339.0500,5188.0900,other,"32.3% of $5,188.09 in Billed Charges for Rev 272 = $1,675.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGASURE MARYLAND XP LATCH SEAL DIV 23CM,272,RC,27200002,CDM,,,,,,both,,,5188.0900,778.2100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1592.74,,,,,,,1339.0500,5188.0900,other,"30.7% of $5,188.09 in Billed Charges for Rev 272 = $1,592.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGASURE MARYLAND XP LATCH SEAL DIV 23CM,272,RC,27200002,CDM,,,,,,both,,,5188.0900,778.2100,UNITED HEALTHCARE,UNITED HEALTHCARE,1675.75,,,,,,,1339.0500,5188.0900,percent of total billed charges,"32.3% of $5,188.09 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAND XP LATCH SEAL DIV 23CM,272,RC,27200002,CDM,,,,,,both,,,5188.0900,778.2100,WELLCARE,WELLCARE MEDICAID,5188.09,,,,,,,1339.0500,5188.0900,percent of total billed charges,"100% of $5,188.09 in Billed Charges for Rev 272 = $5,188.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,3910.6100,586.5900,AETNA,AETNA,1669.83,,,,,,,1009.3300,3910.6100,percent of total billed charges,"42.7% of $3,910.61 in Billed Charges for Rev 272 = $1,669.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,3910.6100,586.5900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2737.43,,,,,,,1009.3300,3910.6100,percent of total billed charges,"Rev 272 $3,910.61 in Billed Charges at 70% = $2,737.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,3910.6100,586.5900,CIGNA HEALTHCARE,CIGNA HMO,1630.72,,,,,,,1009.3300,3910.6100,percent of total billed charges,"41.7% of $3,910.61 in Billed Charges for Rev 272 = $1,630.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,3910.6100,586.5900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1814.52,,,,,,,1009.3300,3910.6100,percent of total billed charges,"46.4% of $3,910.61 in Billed Charges for Rev 272 = $1,814.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,3910.6100,586.5900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1630.72,,,,,,,1009.3300,3910.6100,percent of total billed charges,"41.7% of $3,910.61 in Billed Charges for Rev 272 = $1,630.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,3910.6100,586.5900,CIGNA HEALTHCARE,CIGNA PPO,1630.72,,,,,,,1009.3300,3910.6100,percent of total billed charges,"41.7% of $3,910.61 in Billed Charges for Rev 272 = $1,630.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,3910.6100,586.5900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3519.55,,,,,,,1009.3300,3910.6100,percent of total billed charges,"90% of $3,910.61 in Billed Charges for Rev 272 = $3,519.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,3910.6100,586.5900,MEDCOST,MEDCOST VHN,1861.06,,,,,,,1009.3300,3910.6100,percent of total billed charges,"47.59% of $3,910.61 in Billed Charges for Rev 272 = $1,861.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,3910.6100,586.5900,SENTARA HEALTH,SENTARA HEALTH,1009.33,,,,,,,1009.3300,3910.6100,percent of total billed charges,"25.81% of $3,910.61 in Billed Charges for Rev 272 = $1,009.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,3910.6100,586.5900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3910.61,,,,,,,1009.3300,3910.6100,percent of total billed charges,"100% of $3,910.61 in Billed Charges for Rev 272 = $3,910.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,3910.6100,586.5900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1955.31,,,,,,,1009.3300,3910.6100,percent of total billed charges,"Rev 272 $3,910.61 in Billed Charges at 50% = $1,955.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,3910.6100,586.5900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1263.13,,,,,,,1009.3300,3910.6100,other,"32.3% of $3,910.61 in Billed Charges for Rev 272 = $1,263.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,3910.6100,586.5900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1200.56,,,,,,,1009.3300,3910.6100,other,"30.7% of $3,910.61 in Billed Charges for Rev 272 = $1,200.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,3910.6100,586.5900,UNITED HEALTHCARE,UNITED HEALTHCARE,1263.13,,,,,,,1009.3300,3910.6100,percent of total billed charges,"32.3% of $3,910.61 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE SMALL JAW A,272,RC,27200002,CDM,,,,,,both,,,3910.6100,586.5900,WELLCARE,WELLCARE MEDICAID,3910.61,,,,,,,1009.3300,3910.6100,percent of total billed charges,"100% of $3,910.61 in Billed Charges for Rev 272 = $3,910.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR ENDOSCOPIC 30MM,272,RC,27200002,CDM,,,,,,both,,,818.3300,122.7500,AETNA,AETNA,349.43,,,,,,,211.2100,818.3300,percent of total billed charges,42.7% of $818.33 in Billed Charges for Rev 272 = $349.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATOR ENDOSCOPIC 30MM,272,RC,27200002,CDM,,,,,,both,,,818.3300,122.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,572.83,,,,,,,211.2100,818.3300,percent of total billed charges,Rev 272 $818.33 in Billed Charges at 70% = $572.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATOR ENDOSCOPIC 30MM,272,RC,27200002,CDM,,,,,,both,,,818.3300,122.7500,CIGNA HEALTHCARE,CIGNA HMO,341.24,,,,,,,211.2100,818.3300,percent of total billed charges,41.7% of $818.33 in Billed Charges for Rev 272 = $341.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATOR ENDOSCOPIC 30MM,272,RC,27200002,CDM,,,,,,both,,,818.3300,122.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,379.71,,,,,,,211.2100,818.3300,percent of total billed charges,46.4% of $818.33 in Billed Charges for Rev 272 = $379.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATOR ENDOSCOPIC 30MM,272,RC,27200002,CDM,,,,,,both,,,818.3300,122.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,341.24,,,,,,,211.2100,818.3300,percent of total billed charges,41.7% of $818.33 in Billed Charges for Rev 272 = $341.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATOR ENDOSCOPIC 30MM,272,RC,27200002,CDM,,,,,,both,,,818.3300,122.7500,CIGNA HEALTHCARE,CIGNA PPO,341.24,,,,,,,211.2100,818.3300,percent of total billed charges,41.7% of $818.33 in Billed Charges for Rev 272 = $341.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATOR ENDOSCOPIC 30MM,272,RC,27200002,CDM,,,,,,both,,,818.3300,122.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,736.50,,,,,,,211.2100,818.3300,percent of total billed charges,90% of $818.33 in Billed Charges for Rev 272 = $736.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATOR ENDOSCOPIC 30MM,272,RC,27200002,CDM,,,,,,both,,,818.3300,122.7500,MEDCOST,MEDCOST VHN,389.44,,,,,,,211.2100,818.3300,percent of total billed charges,47.59% of $818.33 in Billed Charges for Rev 272 = $389.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATOR ENDOSCOPIC 30MM,272,RC,27200002,CDM,,,,,,both,,,818.3300,122.7500,SENTARA HEALTH,SENTARA HEALTH,211.21,,,,,,,211.2100,818.3300,percent of total billed charges,25.81% of $818.33 in Billed Charges for Rev 272 = $211.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATOR ENDOSCOPIC 30MM,272,RC,27200002,CDM,,,,,,both,,,818.3300,122.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",818.33,,,,,,,211.2100,818.3300,percent of total billed charges,100% of $818.33 in Billed Charges for Rev 272 = $818.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATOR ENDOSCOPIC 30MM,272,RC,27200002,CDM,,,,,,both,,,818.3300,122.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,409.17,,,,,,,211.2100,818.3300,percent of total billed charges,Rev 272 $818.33 in Billed Charges at 50% = $409.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATOR ENDOSCOPIC 30MM,272,RC,27200002,CDM,,,,,,both,,,818.3300,122.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,264.32,,,,,,,211.2100,818.3300,other,32.3% of $818.33 in Billed Charges for Rev 272 = $264.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
LIGATOR ENDOSCOPIC 30MM,272,RC,27200002,CDM,,,,,,both,,,818.3300,122.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,251.23,,,,,,,211.2100,818.3300,other,30.7% of $818.33 in Billed Charges for Rev 272 = $251.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
LIGATOR ENDOSCOPIC 30MM,272,RC,27200002,CDM,,,,,,both,,,818.3300,122.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,264.32,,,,,,,211.2100,818.3300,percent of total billed charges,32.3% of $818.33 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATOR ENDOSCOPIC 30MM,272,RC,27200002,CDM,,,,,,both,,,818.3300,122.7500,WELLCARE,WELLCARE MEDICAID,818.33,,,,,,,211.2100,818.3300,percent of total billed charges,100% of $818.33 in Billed Charges for Rev 272 = $818.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT MAXCESS 4,272,RC,,,,,,,,both,,,15556.5000,2333.4800,AETNA,AETNA,6642.63,,,,,,,4015.1300,15556.5000,percent of total billed charges,"42.7% of $15,556.50 in Billed Charges for Rev 272 = $6,642.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAXCESS 4,272,RC,,,,,,,,both,,,15556.5000,2333.4800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,10889.55,,,,,,,4015.1300,15556.5000,percent of total billed charges,"Rev 272 $15,556.50 in Billed Charges at 70% = $10,889.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAXCESS 4,272,RC,,,,,,,,both,,,15556.5000,2333.4800,CIGNA HEALTHCARE,CIGNA HMO,6487.06,,,,,,,4015.1300,15556.5000,percent of total billed charges,"41.7% of $15,556.50 in Billed Charges for Rev 272 = $6,487.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAXCESS 4,272,RC,,,,,,,,both,,,15556.5000,2333.4800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7218.22,,,,,,,4015.1300,15556.5000,percent of total billed charges,"46.4% of $15,556.50 in Billed Charges for Rev 272 = $7,218.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAXCESS 4,272,RC,,,,,,,,both,,,15556.5000,2333.4800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6487.06,,,,,,,4015.1300,15556.5000,percent of total billed charges,"41.7% of $15,556.50 in Billed Charges for Rev 272 = $6,487.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAXCESS 4,272,RC,,,,,,,,both,,,15556.5000,2333.4800,CIGNA HEALTHCARE,CIGNA PPO,6487.06,,,,,,,4015.1300,15556.5000,percent of total billed charges,"41.7% of $15,556.50 in Billed Charges for Rev 272 = $6,487.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAXCESS 4,272,RC,,,,,,,,both,,,15556.5000,2333.4800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,14000.85,,,,,,,4015.1300,15556.5000,percent of total billed charges,"90% of $15,556.50 in Billed Charges for Rev 272 = $14,000.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAXCESS 4,272,RC,,,,,,,,both,,,15556.5000,2333.4800,MEDCOST,MEDCOST VHN,7403.34,,,,,,,4015.1300,15556.5000,percent of total billed charges,"47.59% of $15,556.50 in Billed Charges for Rev 272 = $7,403.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAXCESS 4,272,RC,,,,,,,,both,,,15556.5000,2333.4800,SENTARA HEALTH,SENTARA HEALTH,4015.13,,,,,,,4015.1300,15556.5000,percent of total billed charges,"25.81% of $15,556.50 in Billed Charges for Rev 272 = $4,015.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAXCESS 4,272,RC,,,,,,,,both,,,15556.5000,2333.4800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15556.50,,,,,,,4015.1300,15556.5000,percent of total billed charges,"100% of $15,556.50 in Billed Charges for Rev 272 = $15,556.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAXCESS 4,272,RC,,,,,,,,both,,,15556.5000,2333.4800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7778.25,,,,,,,4015.1300,15556.5000,percent of total billed charges,"Rev 272 $15,556.50 in Billed Charges at 50% = $7,778.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAXCESS 4,272,RC,,,,,,,,both,,,15556.5000,2333.4800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5024.75,,,,,,,4015.1300,15556.5000,other,"32.3% of $15,556.50 in Billed Charges for Rev 272 = $5,024.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT MAXCESS 4,272,RC,,,,,,,,both,,,15556.5000,2333.4800,UNITED HEALTHCARE,UHC HERITAGE SELECT,4775.85,,,,,,,4015.1300,15556.5000,other,"30.7% of $15,556.50 in Billed Charges for Rev 272 = $4,775.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT MAXCESS 4,272,RC,,,,,,,,both,,,15556.5000,2333.4800,UNITED HEALTHCARE,UNITED HEALTHCARE,5024.75,,,,,,,4015.1300,15556.5000,percent of total billed charges,"32.3% of $15,556.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAXCESS 4,272,RC,,,,,,,,both,,,15556.5000,2333.4800,WELLCARE,WELLCARE MEDICAID,15556.50,,,,,,,4015.1300,15556.5000,percent of total billed charges,"100% of $15,556.50 in Billed Charges for Rev 272 = $15,556.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAZOR ROBOTICS X SPINE DISPOSABLE,272,RC,,,,,,,,both,,,14000.8500,2100.1300,AETNA,AETNA,5978.36,,,,,,,3613.6200,14000.8500,percent of total billed charges,"42.7% of $14,000.85 in Billed Charges for Rev 272 = $5,978.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAZOR ROBOTICS X SPINE DISPOSABLE,272,RC,,,,,,,,both,,,14000.8500,2100.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9800.60,,,,,,,3613.6200,14000.8500,percent of total billed charges,"Rev 272 $14,000.85 in Billed Charges at 70% = $9,800.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAZOR ROBOTICS X SPINE DISPOSABLE,272,RC,,,,,,,,both,,,14000.8500,2100.1300,CIGNA HEALTHCARE,CIGNA HMO,5838.35,,,,,,,3613.6200,14000.8500,percent of total billed charges,"41.7% of $14,000.85 in Billed Charges for Rev 272 = $5,838.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAZOR ROBOTICS X SPINE DISPOSABLE,272,RC,,,,,,,,both,,,14000.8500,2100.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6496.39,,,,,,,3613.6200,14000.8500,percent of total billed charges,"46.4% of $14,000.85 in Billed Charges for Rev 272 = $6,496.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAZOR ROBOTICS X SPINE DISPOSABLE,272,RC,,,,,,,,both,,,14000.8500,2100.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5838.35,,,,,,,3613.6200,14000.8500,percent of total billed charges,"41.7% of $14,000.85 in Billed Charges for Rev 272 = $5,838.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAZOR ROBOTICS X SPINE DISPOSABLE,272,RC,,,,,,,,both,,,14000.8500,2100.1300,CIGNA HEALTHCARE,CIGNA PPO,5838.35,,,,,,,3613.6200,14000.8500,percent of total billed charges,"41.7% of $14,000.85 in Billed Charges for Rev 272 = $5,838.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAZOR ROBOTICS X SPINE DISPOSABLE,272,RC,,,,,,,,both,,,14000.8500,2100.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12600.77,,,,,,,3613.6200,14000.8500,percent of total billed charges,"90% of $14,000.85 in Billed Charges for Rev 272 = $12,600.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAZOR ROBOTICS X SPINE DISPOSABLE,272,RC,,,,,,,,both,,,14000.8500,2100.1300,MEDCOST,MEDCOST VHN,6663.00,,,,,,,3613.6200,14000.8500,percent of total billed charges,"47.59% of $14,000.85 in Billed Charges for Rev 272 = $6,663.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAZOR ROBOTICS X SPINE DISPOSABLE,272,RC,,,,,,,,both,,,14000.8500,2100.1300,SENTARA HEALTH,SENTARA HEALTH,3613.62,,,,,,,3613.6200,14000.8500,percent of total billed charges,"25.81% of $14,000.85 in Billed Charges for Rev 272 = $3,613.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAZOR ROBOTICS X SPINE DISPOSABLE,272,RC,,,,,,,,both,,,14000.8500,2100.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",14000.85,,,,,,,3613.6200,14000.8500,percent of total billed charges,"100% of $14,000.85 in Billed Charges for Rev 272 = $14,000.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAZOR ROBOTICS X SPINE DISPOSABLE,272,RC,,,,,,,,both,,,14000.8500,2100.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7000.43,,,,,,,3613.6200,14000.8500,percent of total billed charges,"Rev 272 $14,000.85 in Billed Charges at 50% = $7,000.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAZOR ROBOTICS X SPINE DISPOSABLE,272,RC,,,,,,,,both,,,14000.8500,2100.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4522.27,,,,,,,3613.6200,14000.8500,other,"32.3% of $14,000.85 in Billed Charges for Rev 272 = $4,522.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT MAZOR ROBOTICS X SPINE DISPOSABLE,272,RC,,,,,,,,both,,,14000.8500,2100.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,4298.26,,,,,,,3613.6200,14000.8500,other,"30.7% of $14,000.85 in Billed Charges for Rev 272 = $4,298.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT MAZOR ROBOTICS X SPINE DISPOSABLE,272,RC,,,,,,,,both,,,14000.8500,2100.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,4522.27,,,,,,,3613.6200,14000.8500,percent of total billed charges,"32.3% of $14,000.85 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT MAZOR ROBOTICS X SPINE DISPOSABLE,272,RC,,,,,,,,both,,,14000.8500,2100.1300,WELLCARE,WELLCARE MEDICAID,14000.85,,,,,,,3613.6200,14000.8500,percent of total billed charges,"100% of $14,000.85 in Billed Charges for Rev 272 = $14,000.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 10 BANDS,272,RC,27200002,CDM,,,,,,both,,,3391.3200,508.7000,AETNA,AETNA,1448.09,,,,,,,875.3000,3391.3200,percent of total billed charges,"42.7% of $3,391.32 in Billed Charges for Rev 272 = $1,448.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 10 BANDS,272,RC,27200002,CDM,,,,,,both,,,3391.3200,508.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2373.92,,,,,,,875.3000,3391.3200,percent of total billed charges,"Rev 272 $3,391.32 in Billed Charges at 70% = $2,373.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 10 BANDS,272,RC,27200002,CDM,,,,,,both,,,3391.3200,508.7000,CIGNA HEALTHCARE,CIGNA HMO,1414.18,,,,,,,875.3000,3391.3200,percent of total billed charges,"41.7% of $3,391.32 in Billed Charges for Rev 272 = $1,414.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 10 BANDS,272,RC,27200002,CDM,,,,,,both,,,3391.3200,508.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1573.57,,,,,,,875.3000,3391.3200,percent of total billed charges,"46.4% of $3,391.32 in Billed Charges for Rev 272 = $1,573.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 10 BANDS,272,RC,27200002,CDM,,,,,,both,,,3391.3200,508.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1414.18,,,,,,,875.3000,3391.3200,percent of total billed charges,"41.7% of $3,391.32 in Billed Charges for Rev 272 = $1,414.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 10 BANDS,272,RC,27200002,CDM,,,,,,both,,,3391.3200,508.7000,CIGNA HEALTHCARE,CIGNA PPO,1414.18,,,,,,,875.3000,3391.3200,percent of total billed charges,"41.7% of $3,391.32 in Billed Charges for Rev 272 = $1,414.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 10 BANDS,272,RC,27200002,CDM,,,,,,both,,,3391.3200,508.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3052.19,,,,,,,875.3000,3391.3200,percent of total billed charges,"90% of $3,391.32 in Billed Charges for Rev 272 = $3,052.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 10 BANDS,272,RC,27200002,CDM,,,,,,both,,,3391.3200,508.7000,MEDCOST,MEDCOST VHN,1613.93,,,,,,,875.3000,3391.3200,percent of total billed charges,"47.59% of $3,391.32 in Billed Charges for Rev 272 = $1,613.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 10 BANDS,272,RC,27200002,CDM,,,,,,both,,,3391.3200,508.7000,SENTARA HEALTH,SENTARA HEALTH,875.30,,,,,,,875.3000,3391.3200,percent of total billed charges,"25.81% of $3,391.32 in Billed Charges for Rev 272 = $875.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 10 BANDS,272,RC,27200002,CDM,,,,,,both,,,3391.3200,508.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3391.32,,,,,,,875.3000,3391.3200,percent of total billed charges,"100% of $3,391.32 in Billed Charges for Rev 272 = $3,391.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 10 BANDS,272,RC,27200002,CDM,,,,,,both,,,3391.3200,508.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1695.66,,,,,,,875.3000,3391.3200,percent of total billed charges,"Rev 272 $3,391.32 in Billed Charges at 50% = $1,695.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 10 BANDS,272,RC,27200002,CDM,,,,,,both,,,3391.3200,508.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1095.40,,,,,,,875.3000,3391.3200,other,"32.3% of $3,391.32 in Billed Charges for Rev 272 = $1,095.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGATOR MULTI BAND 10 BANDS,272,RC,27200002,CDM,,,,,,both,,,3391.3200,508.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1041.14,,,,,,,875.3000,3391.3200,other,"30.7% of $3,391.32 in Billed Charges for Rev 272 = $1,041.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGATOR MULTI BAND 10 BANDS,272,RC,27200002,CDM,,,,,,both,,,3391.3200,508.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,1095.40,,,,,,,875.3000,3391.3200,percent of total billed charges,"32.3% of $3,391.32 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 10 BANDS,272,RC,27200002,CDM,,,,,,both,,,3391.3200,508.7000,WELLCARE,WELLCARE MEDICAID,3391.32,,,,,,,875.3000,3391.3200,percent of total billed charges,"100% of $3,391.32 in Billed Charges for Rev 272 = $3,391.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 6 SHOOTER,272,RC,27200002,CDM,,,,,,both,,,2343.8500,351.5800,AETNA,AETNA,1000.82,,,,,,,604.9500,2343.8500,percent of total billed charges,"42.7% of $2,343.85 in Billed Charges for Rev 272 = $1,000.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 6 SHOOTER,272,RC,27200002,CDM,,,,,,both,,,2343.8500,351.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1640.70,,,,,,,604.9500,2343.8500,percent of total billed charges,"Rev 272 $2,343.85 in Billed Charges at 70% = $1,640.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 6 SHOOTER,272,RC,27200002,CDM,,,,,,both,,,2343.8500,351.5800,CIGNA HEALTHCARE,CIGNA HMO,977.39,,,,,,,604.9500,2343.8500,percent of total billed charges,"41.7% of $2,343.85 in Billed Charges for Rev 272 = $977.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 6 SHOOTER,272,RC,27200002,CDM,,,,,,both,,,2343.8500,351.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1087.55,,,,,,,604.9500,2343.8500,percent of total billed charges,"46.4% of $2,343.85 in Billed Charges for Rev 272 = $1,087.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 6 SHOOTER,272,RC,27200002,CDM,,,,,,both,,,2343.8500,351.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,977.39,,,,,,,604.9500,2343.8500,percent of total billed charges,"41.7% of $2,343.85 in Billed Charges for Rev 272 = $977.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 6 SHOOTER,272,RC,27200002,CDM,,,,,,both,,,2343.8500,351.5800,CIGNA HEALTHCARE,CIGNA PPO,977.39,,,,,,,604.9500,2343.8500,percent of total billed charges,"41.7% of $2,343.85 in Billed Charges for Rev 272 = $977.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 6 SHOOTER,272,RC,27200002,CDM,,,,,,both,,,2343.8500,351.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2109.47,,,,,,,604.9500,2343.8500,percent of total billed charges,"90% of $2,343.85 in Billed Charges for Rev 272 = $2,109.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 6 SHOOTER,272,RC,27200002,CDM,,,,,,both,,,2343.8500,351.5800,MEDCOST,MEDCOST VHN,1115.44,,,,,,,604.9500,2343.8500,percent of total billed charges,"47.59% of $2,343.85 in Billed Charges for Rev 272 = $1,115.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 6 SHOOTER,272,RC,27200002,CDM,,,,,,both,,,2343.8500,351.5800,SENTARA HEALTH,SENTARA HEALTH,604.95,,,,,,,604.9500,2343.8500,percent of total billed charges,"25.81% of $2,343.85 in Billed Charges for Rev 272 = $604.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 6 SHOOTER,272,RC,27200002,CDM,,,,,,both,,,2343.8500,351.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2343.85,,,,,,,604.9500,2343.8500,percent of total billed charges,"100% of $2,343.85 in Billed Charges for Rev 272 = $2,343.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 6 SHOOTER,272,RC,27200002,CDM,,,,,,both,,,2343.8500,351.5800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1171.93,,,,,,,604.9500,2343.8500,percent of total billed charges,"Rev 272 $2,343.85 in Billed Charges at 50% = $1,171.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 6 SHOOTER,272,RC,27200002,CDM,,,,,,both,,,2343.8500,351.5800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,757.06,,,,,,,604.9500,2343.8500,other,"32.3% of $2,343.85 in Billed Charges for Rev 272 = $757.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGATOR MULTI BAND 6 SHOOTER,272,RC,27200002,CDM,,,,,,both,,,2343.8500,351.5800,UNITED HEALTHCARE,UHC HERITAGE SELECT,719.56,,,,,,,604.9500,2343.8500,other,"30.7% of $2,343.85 in Billed Charges for Rev 272 = $719.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGATOR MULTI BAND 6 SHOOTER,272,RC,27200002,CDM,,,,,,both,,,2343.8500,351.5800,UNITED HEALTHCARE,UNITED HEALTHCARE,757.06,,,,,,,604.9500,2343.8500,percent of total billed charges,"32.3% of $2,343.85 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATOR MULTI BAND 6 SHOOTER,272,RC,27200002,CDM,,,,,,both,,,2343.8500,351.5800,WELLCARE,WELLCARE MEDICAID,2343.85,,,,,,,604.9500,2343.8500,percent of total billed charges,"100% of $2,343.85 in Billed Charges for Rev 272 = $2,343.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,304.2800,45.6400,AETNA,AETNA,129.93,,,,,,,78.5300,304.2800,percent of total billed charges,42.7% of $304.28 in Billed Charges for Rev 272 = $129.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,304.2800,45.6400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,213.00,,,,,,,78.5300,304.2800,percent of total billed charges,Rev 272 $304.28 in Billed Charges at 70% = $213.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,304.2800,45.6400,CIGNA HEALTHCARE,CIGNA HMO,126.88,,,,,,,78.5300,304.2800,percent of total billed charges,41.7% of $304.28 in Billed Charges for Rev 272 = $126.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,304.2800,45.6400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,141.19,,,,,,,78.5300,304.2800,percent of total billed charges,46.4% of $304.28 in Billed Charges for Rev 272 = $141.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,304.2800,45.6400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,126.88,,,,,,,78.5300,304.2800,percent of total billed charges,41.7% of $304.28 in Billed Charges for Rev 272 = $126.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,304.2800,45.6400,CIGNA HEALTHCARE,CIGNA PPO,126.88,,,,,,,78.5300,304.2800,percent of total billed charges,41.7% of $304.28 in Billed Charges for Rev 272 = $126.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,304.2800,45.6400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,273.85,,,,,,,78.5300,304.2800,percent of total billed charges,90% of $304.28 in Billed Charges for Rev 272 = $273.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,304.2800,45.6400,MEDCOST,MEDCOST VHN,144.81,,,,,,,78.5300,304.2800,percent of total billed charges,47.59% of $304.28 in Billed Charges for Rev 272 = $144.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,304.2800,45.6400,SENTARA HEALTH,SENTARA HEALTH,78.53,,,,,,,78.5300,304.2800,percent of total billed charges,25.81% of $304.28 in Billed Charges for Rev 272 = $78.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,304.2800,45.6400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",304.28,,,,,,,78.5300,304.2800,percent of total billed charges,100% of $304.28 in Billed Charges for Rev 272 = $304.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,304.2800,45.6400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,152.14,,,,,,,78.5300,304.2800,percent of total billed charges,Rev 272 $304.28 in Billed Charges at 50% = $152.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,304.2800,45.6400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,98.28,,,,,,,78.5300,304.2800,other,32.3% of $304.28 in Billed Charges for Rev 272 = $98.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,304.2800,45.6400,UNITED HEALTHCARE,UHC HERITAGE SELECT,93.41,,,,,,,78.5300,304.2800,other,30.7% of $304.28 in Billed Charges for Rev 272 = $93.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,304.2800,45.6400,UNITED HEALTHCARE,UNITED HEALTHCARE,98.28,,,,,,,78.5300,304.2800,percent of total billed charges,32.3% of $304.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGATURE ENDOLOOP PDS II EZ10G,272,RC,27200002,CDM,,,,,,both,,,304.2800,45.6400,WELLCARE,WELLCARE MEDICAID,304.28,,,,,,,78.5300,304.2800,percent of total billed charges,100% of $304.28 in Billed Charges for Rev 272 = $304.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11305.3200,1695.8000,AETNA,AETNA,4827.37,,,,,,,2917.9000,11305.3200,percent of total billed charges,"42.7% of $11,305.32 in Billed Charges for Rev 272 = $4,827.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11305.3200,1695.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7913.72,,,,,,,2917.9000,11305.3200,percent of total billed charges,"Rev 272 $11,305.32 in Billed Charges at 70% = $7,913.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11305.3200,1695.8000,CIGNA HEALTHCARE,CIGNA HMO,4714.32,,,,,,,2917.9000,11305.3200,percent of total billed charges,"41.7% of $11,305.32 in Billed Charges for Rev 272 = $4,714.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11305.3200,1695.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5245.67,,,,,,,2917.9000,11305.3200,percent of total billed charges,"46.4% of $11,305.32 in Billed Charges for Rev 272 = $5,245.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11305.3200,1695.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4714.32,,,,,,,2917.9000,11305.3200,percent of total billed charges,"41.7% of $11,305.32 in Billed Charges for Rev 272 = $4,714.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11305.3200,1695.8000,CIGNA HEALTHCARE,CIGNA PPO,4714.32,,,,,,,2917.9000,11305.3200,percent of total billed charges,"41.7% of $11,305.32 in Billed Charges for Rev 272 = $4,714.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11305.3200,1695.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10174.79,,,,,,,2917.9000,11305.3200,percent of total billed charges,"90% of $11,305.32 in Billed Charges for Rev 272 = $10,174.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11305.3200,1695.8000,MEDCOST,MEDCOST VHN,5380.20,,,,,,,2917.9000,11305.3200,percent of total billed charges,"47.59% of $11,305.32 in Billed Charges for Rev 272 = $5,380.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11305.3200,1695.8000,SENTARA HEALTH,SENTARA HEALTH,2917.90,,,,,,,2917.9000,11305.3200,percent of total billed charges,"25.81% of $11,305.32 in Billed Charges for Rev 272 = $2,917.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11305.3200,1695.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11305.32,,,,,,,2917.9000,11305.3200,percent of total billed charges,"100% of $11,305.32 in Billed Charges for Rev 272 = $11,305.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11305.3200,1695.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5652.66,,,,,,,2917.9000,11305.3200,percent of total billed charges,"Rev 272 $11,305.32 in Billed Charges at 50% = $5,652.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11305.3200,1695.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3651.62,,,,,,,2917.9000,11305.3200,other,"32.3% of $11,305.32 in Billed Charges for Rev 272 = $3,651.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11305.3200,1695.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3470.73,,,,,,,2917.9000,11305.3200,other,"30.7% of $11,305.32 in Billed Charges for Rev 272 = $3,470.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11305.3200,1695.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,3651.62,,,,,,,2917.9000,11305.3200,percent of total billed charges,"32.3% of $11,305.32 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11305.3200,1695.8000,WELLCARE,WELLCARE MEDICAID,11305.32,,,,,,,2917.9000,11305.3200,percent of total billed charges,"100% of $11,305.32 in Billed Charges for Rev 272 = $11,305.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE V5 COMBO ABMBLATION ENDOMETRIAL,272,RC,27200002,CDM,,,,,,both,,,13319.8200,1997.9700,AETNA,AETNA,5687.56,,,,,,,3437.8500,13319.8200,percent of total billed charges,"42.7% of $13,319.82 in Billed Charges for Rev 272 = $5,687.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE V5 COMBO ABMBLATION ENDOMETRIAL,272,RC,27200002,CDM,,,,,,both,,,13319.8200,1997.9700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9323.87,,,,,,,3437.8500,13319.8200,percent of total billed charges,"Rev 272 $13,319.82 in Billed Charges at 70% = $9,323.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE V5 COMBO ABMBLATION ENDOMETRIAL,272,RC,27200002,CDM,,,,,,both,,,13319.8200,1997.9700,CIGNA HEALTHCARE,CIGNA HMO,5554.36,,,,,,,3437.8500,13319.8200,percent of total billed charges,"41.7% of $13,319.82 in Billed Charges for Rev 272 = $5,554.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE V5 COMBO ABMBLATION ENDOMETRIAL,272,RC,27200002,CDM,,,,,,both,,,13319.8200,1997.9700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6180.40,,,,,,,3437.8500,13319.8200,percent of total billed charges,"46.4% of $13,319.82 in Billed Charges for Rev 272 = $6,180.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE V5 COMBO ABMBLATION ENDOMETRIAL,272,RC,27200002,CDM,,,,,,both,,,13319.8200,1997.9700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5554.36,,,,,,,3437.8500,13319.8200,percent of total billed charges,"41.7% of $13,319.82 in Billed Charges for Rev 272 = $5,554.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE V5 COMBO ABMBLATION ENDOMETRIAL,272,RC,27200002,CDM,,,,,,both,,,13319.8200,1997.9700,CIGNA HEALTHCARE,CIGNA PPO,5554.36,,,,,,,3437.8500,13319.8200,percent of total billed charges,"41.7% of $13,319.82 in Billed Charges for Rev 272 = $5,554.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE V5 COMBO ABMBLATION ENDOMETRIAL,272,RC,27200002,CDM,,,,,,both,,,13319.8200,1997.9700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11987.84,,,,,,,3437.8500,13319.8200,percent of total billed charges,"90% of $13,319.82 in Billed Charges for Rev 272 = $11,987.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE V5 COMBO ABMBLATION ENDOMETRIAL,272,RC,27200002,CDM,,,,,,both,,,13319.8200,1997.9700,MEDCOST,MEDCOST VHN,6338.90,,,,,,,3437.8500,13319.8200,percent of total billed charges,"47.59% of $13,319.82 in Billed Charges for Rev 272 = $6,338.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE V5 COMBO ABMBLATION ENDOMETRIAL,272,RC,27200002,CDM,,,,,,both,,,13319.8200,1997.9700,SENTARA HEALTH,SENTARA HEALTH,3437.85,,,,,,,3437.8500,13319.8200,percent of total billed charges,"25.81% of $13,319.82 in Billed Charges for Rev 272 = $3,437.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE V5 COMBO ABMBLATION ENDOMETRIAL,272,RC,27200002,CDM,,,,,,both,,,13319.8200,1997.9700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13319.82,,,,,,,3437.8500,13319.8200,percent of total billed charges,"100% of $13,319.82 in Billed Charges for Rev 272 = $13,319.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE V5 COMBO ABMBLATION ENDOMETRIAL,272,RC,27200002,CDM,,,,,,both,,,13319.8200,1997.9700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6659.91,,,,,,,3437.8500,13319.8200,percent of total billed charges,"Rev 272 $13,319.82 in Billed Charges at 50% = $6,659.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE V5 COMBO ABMBLATION ENDOMETRIAL,272,RC,27200002,CDM,,,,,,both,,,13319.8200,1997.9700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4302.30,,,,,,,3437.8500,13319.8200,other,"32.3% of $13,319.82 in Billed Charges for Rev 272 = $4,302.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT NOVASURE V5 COMBO ABMBLATION ENDOMETRIAL,272,RC,27200002,CDM,,,,,,both,,,13319.8200,1997.9700,UNITED HEALTHCARE,UHC HERITAGE SELECT,4089.18,,,,,,,3437.8500,13319.8200,other,"30.7% of $13,319.82 in Billed Charges for Rev 272 = $4,089.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT NOVASURE V5 COMBO ABMBLATION ENDOMETRIAL,272,RC,27200002,CDM,,,,,,both,,,13319.8200,1997.9700,UNITED HEALTHCARE,UNITED HEALTHCARE,4302.30,,,,,,,3437.8500,13319.8200,percent of total billed charges,"32.3% of $13,319.82 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE V5 COMBO ABMBLATION ENDOMETRIAL,272,RC,27200002,CDM,,,,,,both,,,13319.8200,1997.9700,WELLCARE,WELLCARE MEDICAID,13319.82,,,,,,,3437.8500,13319.8200,percent of total billed charges,"100% of $13,319.82 in Billed Charges for Rev 272 = $13,319.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT OATS 2.0 12MM,272,RC,27200002,CDM,,,,,,both,,,12102.9600,1815.4400,AETNA,AETNA,5167.96,,,,,,,3123.7700,12102.9600,percent of total billed charges,"42.7% of $12,102.96 in Billed Charges for Rev 272 = $5,167.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT OATS 2.0 12MM,272,RC,27200002,CDM,,,,,,both,,,12102.9600,1815.4400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8472.07,,,,,,,3123.7700,12102.9600,percent of total billed charges,"Rev 272 $12,102.96 in Billed Charges at 70% = $8,472.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT OATS 2.0 12MM,272,RC,27200002,CDM,,,,,,both,,,12102.9600,1815.4400,CIGNA HEALTHCARE,CIGNA HMO,5046.93,,,,,,,3123.7700,12102.9600,percent of total billed charges,"41.7% of $12,102.96 in Billed Charges for Rev 272 = $5,046.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT OATS 2.0 12MM,272,RC,27200002,CDM,,,,,,both,,,12102.9600,1815.4400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5615.77,,,,,,,3123.7700,12102.9600,percent of total billed charges,"46.4% of $12,102.96 in Billed Charges for Rev 272 = $5,615.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT OATS 2.0 12MM,272,RC,27200002,CDM,,,,,,both,,,12102.9600,1815.4400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5046.93,,,,,,,3123.7700,12102.9600,percent of total billed charges,"41.7% of $12,102.96 in Billed Charges for Rev 272 = $5,046.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT OATS 2.0 12MM,272,RC,27200002,CDM,,,,,,both,,,12102.9600,1815.4400,CIGNA HEALTHCARE,CIGNA PPO,5046.93,,,,,,,3123.7700,12102.9600,percent of total billed charges,"41.7% of $12,102.96 in Billed Charges for Rev 272 = $5,046.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT OATS 2.0 12MM,272,RC,27200002,CDM,,,,,,both,,,12102.9600,1815.4400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10892.66,,,,,,,3123.7700,12102.9600,percent of total billed charges,"90% of $12,102.96 in Billed Charges for Rev 272 = $10,892.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT OATS 2.0 12MM,272,RC,27200002,CDM,,,,,,both,,,12102.9600,1815.4400,MEDCOST,MEDCOST VHN,5759.80,,,,,,,3123.7700,12102.9600,percent of total billed charges,"47.59% of $12,102.96 in Billed Charges for Rev 272 = $5,759.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT OATS 2.0 12MM,272,RC,27200002,CDM,,,,,,both,,,12102.9600,1815.4400,SENTARA HEALTH,SENTARA HEALTH,3123.77,,,,,,,3123.7700,12102.9600,percent of total billed charges,"25.81% of $12,102.96 in Billed Charges for Rev 272 = $3,123.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT OATS 2.0 12MM,272,RC,27200002,CDM,,,,,,both,,,12102.9600,1815.4400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12102.96,,,,,,,3123.7700,12102.9600,percent of total billed charges,"100% of $12,102.96 in Billed Charges for Rev 272 = $12,102.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT OATS 2.0 12MM,272,RC,27200002,CDM,,,,,,both,,,12102.9600,1815.4400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6051.48,,,,,,,3123.7700,12102.9600,percent of total billed charges,"Rev 272 $12,102.96 in Billed Charges at 50% = $6,051.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT OATS 2.0 12MM,272,RC,27200002,CDM,,,,,,both,,,12102.9600,1815.4400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3909.26,,,,,,,3123.7700,12102.9600,other,"32.3% of $12,102.96 in Billed Charges for Rev 272 = $3,909.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT OATS 2.0 12MM,272,RC,27200002,CDM,,,,,,both,,,12102.9600,1815.4400,UNITED HEALTHCARE,UHC HERITAGE SELECT,3715.61,,,,,,,3123.7700,12102.9600,other,"30.7% of $12,102.96 in Billed Charges for Rev 272 = $3,715.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT OATS 2.0 12MM,272,RC,27200002,CDM,,,,,,both,,,12102.9600,1815.4400,UNITED HEALTHCARE,UNITED HEALTHCARE,3909.26,,,,,,,3123.7700,12102.9600,percent of total billed charges,"32.3% of $12,102.96 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT OATS 2.0 12MM,272,RC,27200002,CDM,,,,,,both,,,12102.9600,1815.4400,WELLCARE,WELLCARE MEDICAID,12102.96,,,,,,,3123.7700,12102.9600,percent of total billed charges,"100% of $12,102.96 in Billed Charges for Rev 272 = $12,102.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE CLEARVIEW UM201,272,RC,27200002,CDM,,,,,,both,,,1076.3600,161.4500,AETNA,AETNA,459.61,,,,,,,277.8100,1076.3600,percent of total billed charges,"42.7% of $1,076.36 in Billed Charges for Rev 272 = $459.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE CLEARVIEW UM201,272,RC,27200002,CDM,,,,,,both,,,1076.3600,161.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,753.45,,,,,,,277.8100,1076.3600,percent of total billed charges,"Rev 272 $1,076.36 in Billed Charges at 70% = $753.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE CLEARVIEW UM201,272,RC,27200002,CDM,,,,,,both,,,1076.3600,161.4500,CIGNA HEALTHCARE,CIGNA HMO,448.84,,,,,,,277.8100,1076.3600,percent of total billed charges,"41.7% of $1,076.36 in Billed Charges for Rev 272 = $448.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE CLEARVIEW UM201,272,RC,27200002,CDM,,,,,,both,,,1076.3600,161.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,499.43,,,,,,,277.8100,1076.3600,percent of total billed charges,"46.4% of $1,076.36 in Billed Charges for Rev 272 = $499.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE CLEARVIEW UM201,272,RC,27200002,CDM,,,,,,both,,,1076.3600,161.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,448.84,,,,,,,277.8100,1076.3600,percent of total billed charges,"41.7% of $1,076.36 in Billed Charges for Rev 272 = $448.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE CLEARVIEW UM201,272,RC,27200002,CDM,,,,,,both,,,1076.3600,161.4500,CIGNA HEALTHCARE,CIGNA PPO,448.84,,,,,,,277.8100,1076.3600,percent of total billed charges,"41.7% of $1,076.36 in Billed Charges for Rev 272 = $448.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE CLEARVIEW UM201,272,RC,27200002,CDM,,,,,,both,,,1076.3600,161.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,968.72,,,,,,,277.8100,1076.3600,percent of total billed charges,"90% of $1,076.36 in Billed Charges for Rev 272 = $968.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE CLEARVIEW UM201,272,RC,27200002,CDM,,,,,,both,,,1076.3600,161.4500,MEDCOST,MEDCOST VHN,512.24,,,,,,,277.8100,1076.3600,percent of total billed charges,"47.59% of $1,076.36 in Billed Charges for Rev 272 = $512.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE CLEARVIEW UM201,272,RC,27200002,CDM,,,,,,both,,,1076.3600,161.4500,SENTARA HEALTH,SENTARA HEALTH,277.81,,,,,,,277.8100,1076.3600,percent of total billed charges,"25.81% of $1,076.36 in Billed Charges for Rev 272 = $277.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE CLEARVIEW UM201,272,RC,27200002,CDM,,,,,,both,,,1076.3600,161.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1076.36,,,,,,,277.8100,1076.3600,percent of total billed charges,"100% of $1,076.36 in Billed Charges for Rev 272 = $1,076.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE CLEARVIEW UM201,272,RC,27200002,CDM,,,,,,both,,,1076.3600,161.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,538.18,,,,,,,277.8100,1076.3600,percent of total billed charges,"Rev 272 $1,076.36 in Billed Charges at 50% = $538.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE CLEARVIEW UM201,272,RC,27200002,CDM,,,,,,both,,,1076.3600,161.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,347.66,,,,,,,277.8100,1076.3600,other,"32.3% of $1,076.36 in Billed Charges for Rev 272 = $347.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MANIPULATOR UTERINE CLEARVIEW UM201,272,RC,27200002,CDM,,,,,,both,,,1076.3600,161.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,330.44,,,,,,,277.8100,1076.3600,other,"30.7% of $1,076.36 in Billed Charges for Rev 272 = $330.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MANIPULATOR UTERINE CLEARVIEW UM201,272,RC,27200002,CDM,,,,,,both,,,1076.3600,161.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,347.66,,,,,,,277.8100,1076.3600,percent of total billed charges,"32.3% of $1,076.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MANIPULATOR UTERINE CLEARVIEW UM201,272,RC,27200002,CDM,,,,,,both,,,1076.3600,161.4500,WELLCARE,WELLCARE MEDICAID,1076.36,,,,,,,277.8100,1076.3600,percent of total billed charges,"100% of $1,076.36 in Billed Charges for Rev 272 = $1,076.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANES KIT MULTIMED SAFE SHARP LONG,272,RC,27201392,CDM,,,,,,both,,,396.0000,59.4000,AETNA,AETNA,169.09,,,,,,,102.2100,396.0000,percent of total billed charges,42.7% of $396.00 in Billed Charges for Rev 272 = $169.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT MULTIMED SAFE SHARP LONG,272,RC,27201392,CDM,,,,,,both,,,396.0000,59.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,277.20,,,,,,,102.2100,396.0000,percent of total billed charges,Rev 272 $396.00 in Billed Charges at 70% = $277.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT MULTIMED SAFE SHARP LONG,272,RC,27201392,CDM,,,,,,both,,,396.0000,59.4000,CIGNA HEALTHCARE,CIGNA HMO,165.13,,,,,,,102.2100,396.0000,percent of total billed charges,41.7% of $396.00 in Billed Charges for Rev 272 = $165.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT MULTIMED SAFE SHARP LONG,272,RC,27201392,CDM,,,,,,both,,,396.0000,59.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,183.74,,,,,,,102.2100,396.0000,percent of total billed charges,46.4% of $396.00 in Billed Charges for Rev 272 = $183.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT MULTIMED SAFE SHARP LONG,272,RC,27201392,CDM,,,,,,both,,,396.0000,59.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,165.13,,,,,,,102.2100,396.0000,percent of total billed charges,41.7% of $396.00 in Billed Charges for Rev 272 = $165.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT MULTIMED SAFE SHARP LONG,272,RC,27201392,CDM,,,,,,both,,,396.0000,59.4000,CIGNA HEALTHCARE,CIGNA PPO,165.13,,,,,,,102.2100,396.0000,percent of total billed charges,41.7% of $396.00 in Billed Charges for Rev 272 = $165.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT MULTIMED SAFE SHARP LONG,272,RC,27201392,CDM,,,,,,both,,,396.0000,59.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,356.40,,,,,,,102.2100,396.0000,percent of total billed charges,90% of $396.00 in Billed Charges for Rev 272 = $356.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT MULTIMED SAFE SHARP LONG,272,RC,27201392,CDM,,,,,,both,,,396.0000,59.4000,MEDCOST,MEDCOST VHN,188.46,,,,,,,102.2100,396.0000,percent of total billed charges,47.59% of $396.00 in Billed Charges for Rev 272 = $188.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT MULTIMED SAFE SHARP LONG,272,RC,27201392,CDM,,,,,,both,,,396.0000,59.4000,SENTARA HEALTH,SENTARA HEALTH,102.21,,,,,,,102.2100,396.0000,percent of total billed charges,25.81% of $396.00 in Billed Charges for Rev 272 = $102.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT MULTIMED SAFE SHARP LONG,272,RC,27201392,CDM,,,,,,both,,,396.0000,59.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",396.00,,,,,,,102.2100,396.0000,percent of total billed charges,100% of $396.00 in Billed Charges for Rev 272 = $396.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT MULTIMED SAFE SHARP LONG,272,RC,27201392,CDM,,,,,,both,,,396.0000,59.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,198.00,,,,,,,102.2100,396.0000,percent of total billed charges,Rev 272 $396.00 in Billed Charges at 50% = $198.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT MULTIMED SAFE SHARP LONG,272,RC,27201392,CDM,,,,,,both,,,396.0000,59.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,127.91,,,,,,,102.2100,396.0000,other,32.3% of $396.00 in Billed Charges for Rev 272 = $127.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES KIT MULTIMED SAFE SHARP LONG,272,RC,27201392,CDM,,,,,,both,,,396.0000,59.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,121.57,,,,,,,102.2100,396.0000,other,30.7% of $396.00 in Billed Charges for Rev 272 = $121.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES KIT MULTIMED SAFE SHARP LONG,272,RC,27201392,CDM,,,,,,both,,,396.0000,59.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,127.91,,,,,,,102.2100,396.0000,percent of total billed charges,32.3% of $396.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT MULTIMED SAFE SHARP LONG,272,RC,27201392,CDM,,,,,,both,,,396.0000,59.4000,WELLCARE,WELLCARE MEDICAID,396.00,,,,,,,102.2100,396.0000,percent of total billed charges,100% of $396.00 in Billed Charges for Rev 272 = $396.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT QUICK TRACH CRICOTHYROTO,272,RC,27201394,CDM,,,,,,both,,,523.0000,78.4500,AETNA,AETNA,223.32,,,,,,,134.9900,523.0000,percent of total billed charges,42.7% of $523.00 in Billed Charges for Rev 272 = $223.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT QUICK TRACH CRICOTHYROTO,272,RC,27201394,CDM,,,,,,both,,,523.0000,78.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,366.10,,,,,,,134.9900,523.0000,percent of total billed charges,Rev 272 $523.00 in Billed Charges at 70% = $366.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT QUICK TRACH CRICOTHYROTO,272,RC,27201394,CDM,,,,,,both,,,523.0000,78.4500,CIGNA HEALTHCARE,CIGNA HMO,218.09,,,,,,,134.9900,523.0000,percent of total billed charges,41.7% of $523.00 in Billed Charges for Rev 272 = $218.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT QUICK TRACH CRICOTHYROTO,272,RC,27201394,CDM,,,,,,both,,,523.0000,78.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,242.67,,,,,,,134.9900,523.0000,percent of total billed charges,46.4% of $523.00 in Billed Charges for Rev 272 = $242.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT QUICK TRACH CRICOTHYROTO,272,RC,27201394,CDM,,,,,,both,,,523.0000,78.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,218.09,,,,,,,134.9900,523.0000,percent of total billed charges,41.7% of $523.00 in Billed Charges for Rev 272 = $218.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT QUICK TRACH CRICOTHYROTO,272,RC,27201394,CDM,,,,,,both,,,523.0000,78.4500,CIGNA HEALTHCARE,CIGNA PPO,218.09,,,,,,,134.9900,523.0000,percent of total billed charges,41.7% of $523.00 in Billed Charges for Rev 272 = $218.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT QUICK TRACH CRICOTHYROTO,272,RC,27201394,CDM,,,,,,both,,,523.0000,78.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,470.70,,,,,,,134.9900,523.0000,percent of total billed charges,90% of $523.00 in Billed Charges for Rev 272 = $470.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT QUICK TRACH CRICOTHYROTO,272,RC,27201394,CDM,,,,,,both,,,523.0000,78.4500,MEDCOST,MEDCOST VHN,248.90,,,,,,,134.9900,523.0000,percent of total billed charges,47.59% of $523.00 in Billed Charges for Rev 272 = $248.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT QUICK TRACH CRICOTHYROTO,272,RC,27201394,CDM,,,,,,both,,,523.0000,78.4500,SENTARA HEALTH,SENTARA HEALTH,134.99,,,,,,,134.9900,523.0000,percent of total billed charges,25.81% of $523.00 in Billed Charges for Rev 272 = $134.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT QUICK TRACH CRICOTHYROTO,272,RC,27201394,CDM,,,,,,both,,,523.0000,78.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",523.00,,,,,,,134.9900,523.0000,percent of total billed charges,100% of $523.00 in Billed Charges for Rev 272 = $523.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT QUICK TRACH CRICOTHYROTO,272,RC,27201394,CDM,,,,,,both,,,523.0000,78.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,261.50,,,,,,,134.9900,523.0000,percent of total billed charges,Rev 272 $523.00 in Billed Charges at 50% = $261.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT QUICK TRACH CRICOTHYROTO,272,RC,27201394,CDM,,,,,,both,,,523.0000,78.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,168.93,,,,,,,134.9900,523.0000,other,32.3% of $523.00 in Billed Charges for Rev 272 = $168.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES KIT QUICK TRACH CRICOTHYROTO,272,RC,27201394,CDM,,,,,,both,,,523.0000,78.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,160.56,,,,,,,134.9900,523.0000,other,30.7% of $523.00 in Billed Charges for Rev 272 = $160.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES KIT QUICK TRACH CRICOTHYROTO,272,RC,27201394,CDM,,,,,,both,,,523.0000,78.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,168.93,,,,,,,134.9900,523.0000,percent of total billed charges,32.3% of $523.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT QUICK TRACH CRICOTHYROTO,272,RC,27201394,CDM,,,,,,both,,,523.0000,78.4500,WELLCARE,WELLCARE MEDICAID,523.00,,,,,,,134.9900,523.0000,percent of total billed charges,100% of $523.00 in Billed Charges for Rev 272 = $523.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT TWO LUMEN CVA AK21142SK,272,RC,27201485,CDM,,,,,,both,,,79.0000,11.8500,AETNA,AETNA,33.73,,,,,,,20.3900,79.0000,percent of total billed charges,42.7% of $79.00 in Billed Charges for Rev 272 = $33.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT TWO LUMEN CVA AK21142SK,272,RC,27201485,CDM,,,,,,both,,,79.0000,11.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,55.30,,,,,,,20.3900,79.0000,percent of total billed charges,Rev 272 $79.00 in Billed Charges at 70% = $55.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT TWO LUMEN CVA AK21142SK,272,RC,27201485,CDM,,,,,,both,,,79.0000,11.8500,CIGNA HEALTHCARE,CIGNA HMO,32.94,,,,,,,20.3900,79.0000,percent of total billed charges,41.7% of $79.00 in Billed Charges for Rev 272 = $32.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT TWO LUMEN CVA AK21142SK,272,RC,27201485,CDM,,,,,,both,,,79.0000,11.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,36.66,,,,,,,20.3900,79.0000,percent of total billed charges,46.4% of $79.00 in Billed Charges for Rev 272 = $36.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT TWO LUMEN CVA AK21142SK,272,RC,27201485,CDM,,,,,,both,,,79.0000,11.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,32.94,,,,,,,20.3900,79.0000,percent of total billed charges,41.7% of $79.00 in Billed Charges for Rev 272 = $32.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT TWO LUMEN CVA AK21142SK,272,RC,27201485,CDM,,,,,,both,,,79.0000,11.8500,CIGNA HEALTHCARE,CIGNA PPO,32.94,,,,,,,20.3900,79.0000,percent of total billed charges,41.7% of $79.00 in Billed Charges for Rev 272 = $32.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT TWO LUMEN CVA AK21142SK,272,RC,27201485,CDM,,,,,,both,,,79.0000,11.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,71.10,,,,,,,20.3900,79.0000,percent of total billed charges,90% of $79.00 in Billed Charges for Rev 272 = $71.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT TWO LUMEN CVA AK21142SK,272,RC,27201485,CDM,,,,,,both,,,79.0000,11.8500,MEDCOST,MEDCOST VHN,37.60,,,,,,,20.3900,79.0000,percent of total billed charges,47.59% of $79.00 in Billed Charges for Rev 272 = $37.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT TWO LUMEN CVA AK21142SK,272,RC,27201485,CDM,,,,,,both,,,79.0000,11.8500,SENTARA HEALTH,SENTARA HEALTH,20.39,,,,,,,20.3900,79.0000,percent of total billed charges,25.81% of $79.00 in Billed Charges for Rev 272 = $20.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT TWO LUMEN CVA AK21142SK,272,RC,27201485,CDM,,,,,,both,,,79.0000,11.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",79.00,,,,,,,20.3900,79.0000,percent of total billed charges,100% of $79.00 in Billed Charges for Rev 272 = $79.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT TWO LUMEN CVA AK21142SK,272,RC,27201485,CDM,,,,,,both,,,79.0000,11.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,39.50,,,,,,,20.3900,79.0000,percent of total billed charges,Rev 272 $79.00 in Billed Charges at 50% = $39.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT TWO LUMEN CVA AK21142SK,272,RC,27201485,CDM,,,,,,both,,,79.0000,11.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,25.52,,,,,,,20.3900,79.0000,other,32.3% of $79.00 in Billed Charges for Rev 272 = $25.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES KIT TWO LUMEN CVA AK21142SK,272,RC,27201485,CDM,,,,,,both,,,79.0000,11.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,24.25,,,,,,,20.3900,79.0000,other,30.7% of $79.00 in Billed Charges for Rev 272 = $24.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES KIT TWO LUMEN CVA AK21142SK,272,RC,27201485,CDM,,,,,,both,,,79.0000,11.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,25.52,,,,,,,20.3900,79.0000,percent of total billed charges,32.3% of $79.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES KIT TWO LUMEN CVA AK21142SK,272,RC,27201485,CDM,,,,,,both,,,79.0000,11.8500,WELLCARE,WELLCARE MEDICAID,79.00,,,,,,,20.3900,79.0000,percent of total billed charges,100% of $79.00 in Billed Charges for Rev 272 = $79.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET BLOOD SOL Y-TYPE 2C6723,272,RC,27201486,CDM,,,,,,both,,,30.0000,4.5000,AETNA,AETNA,12.81,,,,,,,7.7400,30.0000,percent of total billed charges,42.7% of $30.00 in Billed Charges for Rev 272 = $12.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET BLOOD SOL Y-TYPE 2C6723,272,RC,27201486,CDM,,,,,,both,,,30.0000,4.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,21.00,,,,,,,7.7400,30.0000,percent of total billed charges,Rev 272 $30.00 in Billed Charges at 70% = $21.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET BLOOD SOL Y-TYPE 2C6723,272,RC,27201486,CDM,,,,,,both,,,30.0000,4.5000,CIGNA HEALTHCARE,CIGNA HMO,12.51,,,,,,,7.7400,30.0000,percent of total billed charges,41.7% of $30.00 in Billed Charges for Rev 272 = $12.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET BLOOD SOL Y-TYPE 2C6723,272,RC,27201486,CDM,,,,,,both,,,30.0000,4.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,13.92,,,,,,,7.7400,30.0000,percent of total billed charges,46.4% of $30.00 in Billed Charges for Rev 272 = $13.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET BLOOD SOL Y-TYPE 2C6723,272,RC,27201486,CDM,,,,,,both,,,30.0000,4.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,12.51,,,,,,,7.7400,30.0000,percent of total billed charges,41.7% of $30.00 in Billed Charges for Rev 272 = $12.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET BLOOD SOL Y-TYPE 2C6723,272,RC,27201486,CDM,,,,,,both,,,30.0000,4.5000,CIGNA HEALTHCARE,CIGNA PPO,12.51,,,,,,,7.7400,30.0000,percent of total billed charges,41.7% of $30.00 in Billed Charges for Rev 272 = $12.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET BLOOD SOL Y-TYPE 2C6723,272,RC,27201486,CDM,,,,,,both,,,30.0000,4.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,27.00,,,,,,,7.7400,30.0000,percent of total billed charges,90% of $30.00 in Billed Charges for Rev 272 = $27.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET BLOOD SOL Y-TYPE 2C6723,272,RC,27201486,CDM,,,,,,both,,,30.0000,4.5000,MEDCOST,MEDCOST VHN,14.28,,,,,,,7.7400,30.0000,percent of total billed charges,47.59% of $30.00 in Billed Charges for Rev 272 = $14.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET BLOOD SOL Y-TYPE 2C6723,272,RC,27201486,CDM,,,,,,both,,,30.0000,4.5000,SENTARA HEALTH,SENTARA HEALTH,7.74,,,,,,,7.7400,30.0000,percent of total billed charges,25.81% of $30.00 in Billed Charges for Rev 272 = $7.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET BLOOD SOL Y-TYPE 2C6723,272,RC,27201486,CDM,,,,,,both,,,30.0000,4.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",30.00,,,,,,,7.7400,30.0000,percent of total billed charges,100% of $30.00 in Billed Charges for Rev 272 = $30.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET BLOOD SOL Y-TYPE 2C6723,272,RC,27201486,CDM,,,,,,both,,,30.0000,4.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,15.00,,,,,,,7.7400,30.0000,percent of total billed charges,Rev 272 $30.00 in Billed Charges at 50% = $15.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET BLOOD SOL Y-TYPE 2C6723,272,RC,27201486,CDM,,,,,,both,,,30.0000,4.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,9.69,,,,,,,7.7400,30.0000,other,32.3% of $30.00 in Billed Charges for Rev 272 = $9.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES SET BLOOD SOL Y-TYPE 2C6723,272,RC,27201486,CDM,,,,,,both,,,30.0000,4.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,9.21,,,,,,,7.7400,30.0000,other,30.7% of $30.00 in Billed Charges for Rev 272 = $9.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES SET BLOOD SOL Y-TYPE 2C6723,272,RC,27201486,CDM,,,,,,both,,,30.0000,4.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,9.69,,,,,,,7.7400,30.0000,percent of total billed charges,32.3% of $30.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET BLOOD SOL Y-TYPE 2C6723,272,RC,27201486,CDM,,,,,,both,,,30.0000,4.5000,WELLCARE,WELLCARE MEDICAID,30.00,,,,,,,7.7400,30.0000,percent of total billed charges,100% of $30.00 in Billed Charges for Rev 272 = $30.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET NERVE BLOCK CONTIPLEX,272,RC,27201478,CDM,,,,,,both,,,116.0000,17.4000,AETNA,AETNA,49.53,,,,,,,29.9400,116.0000,percent of total billed charges,42.7% of $116.00 in Billed Charges for Rev 272 = $49.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET NERVE BLOCK CONTIPLEX,272,RC,27201478,CDM,,,,,,both,,,116.0000,17.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,81.20,,,,,,,29.9400,116.0000,percent of total billed charges,Rev 272 $116.00 in Billed Charges at 70% = $81.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET NERVE BLOCK CONTIPLEX,272,RC,27201478,CDM,,,,,,both,,,116.0000,17.4000,CIGNA HEALTHCARE,CIGNA HMO,48.37,,,,,,,29.9400,116.0000,percent of total billed charges,41.7% of $116.00 in Billed Charges for Rev 272 = $48.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET NERVE BLOCK CONTIPLEX,272,RC,27201478,CDM,,,,,,both,,,116.0000,17.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,53.82,,,,,,,29.9400,116.0000,percent of total billed charges,46.4% of $116.00 in Billed Charges for Rev 272 = $53.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET NERVE BLOCK CONTIPLEX,272,RC,27201478,CDM,,,,,,both,,,116.0000,17.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,48.37,,,,,,,29.9400,116.0000,percent of total billed charges,41.7% of $116.00 in Billed Charges for Rev 272 = $48.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET NERVE BLOCK CONTIPLEX,272,RC,27201478,CDM,,,,,,both,,,116.0000,17.4000,CIGNA HEALTHCARE,CIGNA PPO,48.37,,,,,,,29.9400,116.0000,percent of total billed charges,41.7% of $116.00 in Billed Charges for Rev 272 = $48.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET NERVE BLOCK CONTIPLEX,272,RC,27201478,CDM,,,,,,both,,,116.0000,17.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,104.40,,,,,,,29.9400,116.0000,percent of total billed charges,90% of $116.00 in Billed Charges for Rev 272 = $104.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET NERVE BLOCK CONTIPLEX,272,RC,27201478,CDM,,,,,,both,,,116.0000,17.4000,MEDCOST,MEDCOST VHN,55.20,,,,,,,29.9400,116.0000,percent of total billed charges,47.59% of $116.00 in Billed Charges for Rev 272 = $55.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET NERVE BLOCK CONTIPLEX,272,RC,27201478,CDM,,,,,,both,,,116.0000,17.4000,SENTARA HEALTH,SENTARA HEALTH,29.94,,,,,,,29.9400,116.0000,percent of total billed charges,25.81% of $116.00 in Billed Charges for Rev 272 = $29.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET NERVE BLOCK CONTIPLEX,272,RC,27201478,CDM,,,,,,both,,,116.0000,17.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",116.00,,,,,,,29.9400,116.0000,percent of total billed charges,100% of $116.00 in Billed Charges for Rev 272 = $116.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET NERVE BLOCK CONTIPLEX,272,RC,27201478,CDM,,,,,,both,,,116.0000,17.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,58.00,,,,,,,29.9400,116.0000,percent of total billed charges,Rev 272 $116.00 in Billed Charges at 50% = $58.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET NERVE BLOCK CONTIPLEX,272,RC,27201478,CDM,,,,,,both,,,116.0000,17.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,37.47,,,,,,,29.9400,116.0000,other,32.3% of $116.00 in Billed Charges for Rev 272 = $37.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES SET NERVE BLOCK CONTIPLEX,272,RC,27201478,CDM,,,,,,both,,,116.0000,17.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,35.61,,,,,,,29.9400,116.0000,other,30.7% of $116.00 in Billed Charges for Rev 272 = $35.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES SET NERVE BLOCK CONTIPLEX,272,RC,27201478,CDM,,,,,,both,,,116.0000,17.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,37.47,,,,,,,29.9400,116.0000,percent of total billed charges,32.3% of $116.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SET NERVE BLOCK CONTIPLEX,272,RC,27201478,CDM,,,,,,both,,,116.0000,17.4000,WELLCARE,WELLCARE MEDICAID,116.00,,,,,,,29.9400,116.0000,percent of total billed charges,100% of $116.00 in Billed Charges for Rev 272 = $116.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES SYSTEM NERVE BLOCK ON Q,272,RC,27201487,CDM,,,,,,both,,,1264.0000,189.6000,AETNA,AETNA,539.73,,,,,,,326.2400,1264.0000,percent of total billed charges,"42.7% of $1,264.00 in Billed Charges for Rev 272 = $539.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANES SYSTEM NERVE BLOCK ON Q,272,RC,27201487,CDM,,,,,,both,,,1264.0000,189.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,884.80,,,,,,,326.2400,1264.0000,percent of total billed charges,"Rev 272 $1,264.00 in Billed Charges at 70% = $884.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANES SYSTEM NERVE BLOCK ON Q,272,RC,27201487,CDM,,,,,,both,,,1264.0000,189.6000,CIGNA HEALTHCARE,CIGNA HMO,527.09,,,,,,,326.2400,1264.0000,percent of total billed charges,"41.7% of $1,264.00 in Billed Charges for Rev 272 = $527.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANES SYSTEM NERVE BLOCK ON Q,272,RC,27201487,CDM,,,,,,both,,,1264.0000,189.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,586.50,,,,,,,326.2400,1264.0000,percent of total billed charges,"46.4% of $1,264.00 in Billed Charges for Rev 272 = $586.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANES SYSTEM NERVE BLOCK ON Q,272,RC,27201487,CDM,,,,,,both,,,1264.0000,189.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,527.09,,,,,,,326.2400,1264.0000,percent of total billed charges,"41.7% of $1,264.00 in Billed Charges for Rev 272 = $527.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANES SYSTEM NERVE BLOCK ON Q,272,RC,27201487,CDM,,,,,,both,,,1264.0000,189.6000,CIGNA HEALTHCARE,CIGNA PPO,527.09,,,,,,,326.2400,1264.0000,percent of total billed charges,"41.7% of $1,264.00 in Billed Charges for Rev 272 = $527.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANES SYSTEM NERVE BLOCK ON Q,272,RC,27201487,CDM,,,,,,both,,,1264.0000,189.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1137.60,,,,,,,326.2400,1264.0000,percent of total billed charges,"90% of $1,264.00 in Billed Charges for Rev 272 = $1,137.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANES SYSTEM NERVE BLOCK ON Q,272,RC,27201487,CDM,,,,,,both,,,1264.0000,189.6000,MEDCOST,MEDCOST VHN,601.54,,,,,,,326.2400,1264.0000,percent of total billed charges,"47.59% of $1,264.00 in Billed Charges for Rev 272 = $601.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANES SYSTEM NERVE BLOCK ON Q,272,RC,27201487,CDM,,,,,,both,,,1264.0000,189.6000,SENTARA HEALTH,SENTARA HEALTH,326.24,,,,,,,326.2400,1264.0000,percent of total billed charges,"25.81% of $1,264.00 in Billed Charges for Rev 272 = $326.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANES SYSTEM NERVE BLOCK ON Q,272,RC,27201487,CDM,,,,,,both,,,1264.0000,189.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1264.00,,,,,,,326.2400,1264.0000,percent of total billed charges,"100% of $1,264.00 in Billed Charges for Rev 272 = $1,264.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANES SYSTEM NERVE BLOCK ON Q,272,RC,27201487,CDM,,,,,,both,,,1264.0000,189.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,632.00,,,,,,,326.2400,1264.0000,percent of total billed charges,"Rev 272 $1,264.00 in Billed Charges at 50% = $632.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANES SYSTEM NERVE BLOCK ON Q,272,RC,27201487,CDM,,,,,,both,,,1264.0000,189.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,408.27,,,,,,,326.2400,1264.0000,other,"32.3% of $1,264.00 in Billed Charges for Rev 272 = $408.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANES SYSTEM NERVE BLOCK ON Q,272,RC,27201487,CDM,,,,,,both,,,1264.0000,189.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,388.05,,,,,,,326.2400,1264.0000,other,"30.7% of $1,264.00 in Billed Charges for Rev 272 = $388.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANES SYSTEM NERVE BLOCK ON Q,272,RC,27201487,CDM,,,,,,both,,,1264.0000,189.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,408.27,,,,,,,326.2400,1264.0000,percent of total billed charges,"32.3% of $1,264.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANES SYSTEM NERVE BLOCK ON Q,272,RC,27201487,CDM,,,,,,both,,,1264.0000,189.6000,WELLCARE,WELLCARE MEDICAID,1264.00,,,,,,,326.2400,1264.0000,percent of total billed charges,"100% of $1,264.00 in Billed Charges for Rev 272 = $1,264.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANES TAPSCOPE,272,RC,27201480,CDM,,,,,,both,,,249.0000,37.3500,AETNA,AETNA,106.32,,,,,,,64.2700,249.0000,percent of total billed charges,42.7% of $249.00 in Billed Charges for Rev 272 = $106.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES TAPSCOPE,272,RC,27201480,CDM,,,,,,both,,,249.0000,37.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,174.30,,,,,,,64.2700,249.0000,percent of total billed charges,Rev 272 $249.00 in Billed Charges at 70% = $174.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES TAPSCOPE,272,RC,27201480,CDM,,,,,,both,,,249.0000,37.3500,CIGNA HEALTHCARE,CIGNA HMO,103.83,,,,,,,64.2700,249.0000,percent of total billed charges,41.7% of $249.00 in Billed Charges for Rev 272 = $103.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES TAPSCOPE,272,RC,27201480,CDM,,,,,,both,,,249.0000,37.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,115.54,,,,,,,64.2700,249.0000,percent of total billed charges,46.4% of $249.00 in Billed Charges for Rev 272 = $115.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES TAPSCOPE,272,RC,27201480,CDM,,,,,,both,,,249.0000,37.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,103.83,,,,,,,64.2700,249.0000,percent of total billed charges,41.7% of $249.00 in Billed Charges for Rev 272 = $103.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES TAPSCOPE,272,RC,27201480,CDM,,,,,,both,,,249.0000,37.3500,CIGNA HEALTHCARE,CIGNA PPO,103.83,,,,,,,64.2700,249.0000,percent of total billed charges,41.7% of $249.00 in Billed Charges for Rev 272 = $103.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES TAPSCOPE,272,RC,27201480,CDM,,,,,,both,,,249.0000,37.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,224.10,,,,,,,64.2700,249.0000,percent of total billed charges,90% of $249.00 in Billed Charges for Rev 272 = $224.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES TAPSCOPE,272,RC,27201480,CDM,,,,,,both,,,249.0000,37.3500,MEDCOST,MEDCOST VHN,118.50,,,,,,,64.2700,249.0000,percent of total billed charges,47.59% of $249.00 in Billed Charges for Rev 272 = $118.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES TAPSCOPE,272,RC,27201480,CDM,,,,,,both,,,249.0000,37.3500,SENTARA HEALTH,SENTARA HEALTH,64.27,,,,,,,64.2700,249.0000,percent of total billed charges,25.81% of $249.00 in Billed Charges for Rev 272 = $64.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES TAPSCOPE,272,RC,27201480,CDM,,,,,,both,,,249.0000,37.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",249.00,,,,,,,64.2700,249.0000,percent of total billed charges,100% of $249.00 in Billed Charges for Rev 272 = $249.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES TAPSCOPE,272,RC,27201480,CDM,,,,,,both,,,249.0000,37.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,124.50,,,,,,,64.2700,249.0000,percent of total billed charges,Rev 272 $249.00 in Billed Charges at 50% = $124.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES TAPSCOPE,272,RC,27201480,CDM,,,,,,both,,,249.0000,37.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,80.43,,,,,,,64.2700,249.0000,other,32.3% of $249.00 in Billed Charges for Rev 272 = $80.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES TAPSCOPE,272,RC,27201480,CDM,,,,,,both,,,249.0000,37.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,76.44,,,,,,,64.2700,249.0000,other,30.7% of $249.00 in Billed Charges for Rev 272 = $76.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANES TAPSCOPE,272,RC,27201480,CDM,,,,,,both,,,249.0000,37.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,80.43,,,,,,,64.2700,249.0000,percent of total billed charges,32.3% of $249.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANES TAPSCOPE,272,RC,27201480,CDM,,,,,,both,,,249.0000,37.3500,WELLCARE,WELLCARE MEDICAID,249.00,,,,,,,64.2700,249.0000,percent of total billed charges,100% of $249.00 in Billed Charges for Rev 272 = $249.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA SUPPLIES LOCAL,370,RC,37000013,CDM,,,,,,both,,,398.0000,59.7000,AETNA,AETNA,169.95,,,,,,,102.7200,398.0000,percent of total billed charges,42.7% of $398.00 in Billed Charges for Rev 370 = $169.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA SUPPLIES LOCAL,370,RC,37000013,CDM,,,,,,both,,,398.0000,59.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,278.60,,,,,,,102.7200,398.0000,percent of total billed charges,Rev 370 $398.00 in Billed Charges at 70% = $278.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA SUPPLIES LOCAL,370,RC,37000013,CDM,,,,,,both,,,398.0000,59.7000,CIGNA HEALTHCARE,CIGNA HMO,165.97,,,,,,,102.7200,398.0000,percent of total billed charges,41.7% of $398.00 in Billed Charges for Rev 370 = $165.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA SUPPLIES LOCAL,370,RC,37000013,CDM,,,,,,both,,,398.0000,59.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,184.67,,,,,,,102.7200,398.0000,percent of total billed charges,46.4% of $398.00 in Billed Charges for Rev 370 = $184.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA SUPPLIES LOCAL,370,RC,37000013,CDM,,,,,,both,,,398.0000,59.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,165.97,,,,,,,102.7200,398.0000,percent of total billed charges,41.7% of $398.00 in Billed Charges for Rev 370 = $165.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA SUPPLIES LOCAL,370,RC,37000013,CDM,,,,,,both,,,398.0000,59.7000,CIGNA HEALTHCARE,CIGNA PPO,165.97,,,,,,,102.7200,398.0000,percent of total billed charges,41.7% of $398.00 in Billed Charges for Rev 370 = $165.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA SUPPLIES LOCAL,370,RC,37000013,CDM,,,,,,both,,,398.0000,59.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,358.20,,,,,,,102.7200,398.0000,percent of total billed charges,90% of $398.00 in Billed Charges for Rev 370 = $358.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA SUPPLIES LOCAL,370,RC,37000013,CDM,,,,,,both,,,398.0000,59.7000,MEDCOST,MEDCOST VHN,189.41,,,,,,,102.7200,398.0000,percent of total billed charges,47.59% of $398.00 in Billed Charges for Rev 370 = $189.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA SUPPLIES LOCAL,370,RC,37000013,CDM,,,,,,both,,,398.0000,59.7000,SENTARA HEALTH,SENTARA HEALTH,102.72,,,,,,,102.7200,398.0000,percent of total billed charges,25.81% of $398.00 in Billed Charges for Rev 370 = $102.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA SUPPLIES LOCAL,370,RC,37000013,CDM,,,,,,both,,,398.0000,59.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",398.00,,,,,,,102.7200,398.0000,percent of total billed charges,100% of $398.00 in Billed Charges for Rev 370 = $398.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA SUPPLIES LOCAL,370,RC,37000013,CDM,,,,,,both,,,398.0000,59.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,199.00,,,,,,,102.7200,398.0000,percent of total billed charges,Rev 370 $398.00 in Billed Charges at 50% = $199.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA SUPPLIES LOCAL,370,RC,37000013,CDM,,,,,,both,,,398.0000,59.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,128.55,,,,,,,102.7200,398.0000,other,32.3% of $398.00 in Billed Charges for Rev 370 = $128.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANESTHESIA SUPPLIES LOCAL,370,RC,37000013,CDM,,,,,,both,,,398.0000,59.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,122.19,,,,,,,102.7200,398.0000,other,30.7% of $398.00 in Billed Charges for Rev 370 = $122.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANESTHESIA SUPPLIES LOCAL,370,RC,37000013,CDM,,,,,,both,,,398.0000,59.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,128.55,,,,,,,102.7200,398.0000,percent of total billed charges,32.3% of $398.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANESTHESIA SUPPLIES LOCAL,370,RC,37000013,CDM,,,,,,both,,,398.0000,59.7000,WELLCARE,WELLCARE MEDICAID,398.00,,,,,,,102.7200,398.0000,percent of total billed charges,100% of $398.00 in Billed Charges for Rev 370 = $398.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANGIOVAC CANNULA 22F,272,RC,27202071,CDM,,,,,,both,,,30543.0000,4581.4500,AETNA,AETNA,13041.86,,,,,,,7883.1500,30543.0000,percent of total billed charges,"42.7% of $30,543.00 in Billed Charges for Rev 272 = $13,041.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOVAC CANNULA 22F,272,RC,27202071,CDM,,,,,,both,,,30543.0000,4581.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,21380.10,,,,,,,7883.1500,30543.0000,percent of total billed charges,"Rev 272 $30,543.00 in Billed Charges at 70% = $21,380.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOVAC CANNULA 22F,272,RC,27202071,CDM,,,,,,both,,,30543.0000,4581.4500,CIGNA HEALTHCARE,CIGNA HMO,12736.43,,,,,,,7883.1500,30543.0000,percent of total billed charges,"41.7% of $30,543.00 in Billed Charges for Rev 272 = $12,736.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOVAC CANNULA 22F,272,RC,27202071,CDM,,,,,,both,,,30543.0000,4581.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,14171.95,,,,,,,7883.1500,30543.0000,percent of total billed charges,"46.4% of $30,543.00 in Billed Charges for Rev 272 = $14,171.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOVAC CANNULA 22F,272,RC,27202071,CDM,,,,,,both,,,30543.0000,4581.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,12736.43,,,,,,,7883.1500,30543.0000,percent of total billed charges,"41.7% of $30,543.00 in Billed Charges for Rev 272 = $12,736.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOVAC CANNULA 22F,272,RC,27202071,CDM,,,,,,both,,,30543.0000,4581.4500,CIGNA HEALTHCARE,CIGNA PPO,12736.43,,,,,,,7883.1500,30543.0000,percent of total billed charges,"41.7% of $30,543.00 in Billed Charges for Rev 272 = $12,736.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOVAC CANNULA 22F,272,RC,27202071,CDM,,,,,,both,,,30543.0000,4581.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,27488.70,,,,,,,7883.1500,30543.0000,percent of total billed charges,"90% of $30,543.00 in Billed Charges for Rev 272 = $27,488.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOVAC CANNULA 22F,272,RC,27202071,CDM,,,,,,both,,,30543.0000,4581.4500,MEDCOST,MEDCOST VHN,14535.41,,,,,,,7883.1500,30543.0000,percent of total billed charges,"47.59% of $30,543.00 in Billed Charges for Rev 272 = $14,535.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOVAC CANNULA 22F,272,RC,27202071,CDM,,,,,,both,,,30543.0000,4581.4500,SENTARA HEALTH,SENTARA HEALTH,7883.15,,,,,,,7883.1500,30543.0000,percent of total billed charges,"25.81% of $30,543.00 in Billed Charges for Rev 272 = $7,883.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOVAC CANNULA 22F,272,RC,27202071,CDM,,,,,,both,,,30543.0000,4581.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",30543.00,,,,,,,7883.1500,30543.0000,percent of total billed charges,"100% of $30,543.00 in Billed Charges for Rev 272 = $30,543.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOVAC CANNULA 22F,272,RC,27202071,CDM,,,,,,both,,,30543.0000,4581.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,15271.50,,,,,,,7883.1500,30543.0000,percent of total billed charges,"Rev 272 $30,543.00 in Billed Charges at 50% = $15,271.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOVAC CANNULA 22F,272,RC,27202071,CDM,,,,,,both,,,30543.0000,4581.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,9865.39,,,,,,,7883.1500,30543.0000,other,"32.3% of $30,543.00 in Billed Charges for Rev 272 = $9,865.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIOVAC CANNULA 22F,272,RC,27202071,CDM,,,,,,both,,,30543.0000,4581.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,9376.70,,,,,,,7883.1500,30543.0000,other,"30.7% of $30,543.00 in Billed Charges for Rev 272 = $9,376.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIOVAC CANNULA 22F,272,RC,27202071,CDM,,,,,,both,,,30543.0000,4581.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,9865.39,,,,,,,7883.1500,30543.0000,percent of total billed charges,"32.3% of $30,543.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOVAC CANNULA 22F,272,RC,27202071,CDM,,,,,,both,,,30543.0000,4581.4500,WELLCARE,WELLCARE MEDICAID,30543.00,,,,,,,7883.1500,30543.0000,percent of total billed charges,"100% of $30,543.00 in Billed Charges for Rev 272 = $30,543.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPLIER MULTI CLIP ER420,272,RC,27200095,CDM,,,,,,both,,,515.0000,77.2500,AETNA,AETNA,219.91,,,,,,,132.9200,515.0000,percent of total billed charges,42.7% of $515.00 in Billed Charges for Rev 272 = $219.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLIER MULTI CLIP ER420,272,RC,27200095,CDM,,,,,,both,,,515.0000,77.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,360.50,,,,,,,132.9200,515.0000,percent of total billed charges,Rev 272 $515.00 in Billed Charges at 70% = $360.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLIER MULTI CLIP ER420,272,RC,27200095,CDM,,,,,,both,,,515.0000,77.2500,CIGNA HEALTHCARE,CIGNA HMO,214.76,,,,,,,132.9200,515.0000,percent of total billed charges,41.7% of $515.00 in Billed Charges for Rev 272 = $214.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLIER MULTI CLIP ER420,272,RC,27200095,CDM,,,,,,both,,,515.0000,77.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,238.96,,,,,,,132.9200,515.0000,percent of total billed charges,46.4% of $515.00 in Billed Charges for Rev 272 = $238.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLIER MULTI CLIP ER420,272,RC,27200095,CDM,,,,,,both,,,515.0000,77.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,214.76,,,,,,,132.9200,515.0000,percent of total billed charges,41.7% of $515.00 in Billed Charges for Rev 272 = $214.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLIER MULTI CLIP ER420,272,RC,27200095,CDM,,,,,,both,,,515.0000,77.2500,CIGNA HEALTHCARE,CIGNA PPO,214.76,,,,,,,132.9200,515.0000,percent of total billed charges,41.7% of $515.00 in Billed Charges for Rev 272 = $214.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLIER MULTI CLIP ER420,272,RC,27200095,CDM,,,,,,both,,,515.0000,77.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,463.50,,,,,,,132.9200,515.0000,percent of total billed charges,90% of $515.00 in Billed Charges for Rev 272 = $463.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLIER MULTI CLIP ER420,272,RC,27200095,CDM,,,,,,both,,,515.0000,77.2500,MEDCOST,MEDCOST VHN,245.09,,,,,,,132.9200,515.0000,percent of total billed charges,47.59% of $515.00 in Billed Charges for Rev 272 = $245.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLIER MULTI CLIP ER420,272,RC,27200095,CDM,,,,,,both,,,515.0000,77.2500,SENTARA HEALTH,SENTARA HEALTH,132.92,,,,,,,132.9200,515.0000,percent of total billed charges,25.81% of $515.00 in Billed Charges for Rev 272 = $132.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLIER MULTI CLIP ER420,272,RC,27200095,CDM,,,,,,both,,,515.0000,77.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",515.00,,,,,,,132.9200,515.0000,percent of total billed charges,100% of $515.00 in Billed Charges for Rev 272 = $515.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLIER MULTI CLIP ER420,272,RC,27200095,CDM,,,,,,both,,,515.0000,77.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,257.50,,,,,,,132.9200,515.0000,percent of total billed charges,Rev 272 $515.00 in Billed Charges at 50% = $257.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLIER MULTI CLIP ER420,272,RC,27200095,CDM,,,,,,both,,,515.0000,77.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,166.35,,,,,,,132.9200,515.0000,other,32.3% of $515.00 in Billed Charges for Rev 272 = $166.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLIER MULTI CLIP ER420,272,RC,27200095,CDM,,,,,,both,,,515.0000,77.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,158.11,,,,,,,132.9200,515.0000,other,30.7% of $515.00 in Billed Charges for Rev 272 = $158.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLIER MULTI CLIP ER420,272,RC,27200095,CDM,,,,,,both,,,515.0000,77.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,166.35,,,,,,,132.9200,515.0000,percent of total billed charges,32.3% of $515.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLIER MULTI CLIP ER420,272,RC,27200095,CDM,,,,,,both,,,515.0000,77.2500,WELLCARE,WELLCARE MEDICAID,515.00,,,,,,,132.9200,515.0000,percent of total billed charges,100% of $515.00 in Billed Charges for Rev 272 = $515.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARCTIC SUN UNIVERSAL,272,RC,27202233,CDM,,,,,,both,,,485.0000,72.7500,AETNA,AETNA,207.10,,,,,,,125.1800,485.0000,percent of total billed charges,42.7% of $485.00 in Billed Charges for Rev 272 = $207.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARCTIC SUN UNIVERSAL,272,RC,27202233,CDM,,,,,,both,,,485.0000,72.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,339.50,,,,,,,125.1800,485.0000,percent of total billed charges,Rev 272 $485.00 in Billed Charges at 70% = $339.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARCTIC SUN UNIVERSAL,272,RC,27202233,CDM,,,,,,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA HMO,202.25,,,,,,,125.1800,485.0000,percent of total billed charges,41.7% of $485.00 in Billed Charges for Rev 272 = $202.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARCTIC SUN UNIVERSAL,272,RC,27202233,CDM,,,,,,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,225.04,,,,,,,125.1800,485.0000,percent of total billed charges,46.4% of $485.00 in Billed Charges for Rev 272 = $225.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARCTIC SUN UNIVERSAL,272,RC,27202233,CDM,,,,,,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,202.25,,,,,,,125.1800,485.0000,percent of total billed charges,41.7% of $485.00 in Billed Charges for Rev 272 = $202.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARCTIC SUN UNIVERSAL,272,RC,27202233,CDM,,,,,,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA PPO,202.25,,,,,,,125.1800,485.0000,percent of total billed charges,41.7% of $485.00 in Billed Charges for Rev 272 = $202.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARCTIC SUN UNIVERSAL,272,RC,27202233,CDM,,,,,,both,,,485.0000,72.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,436.50,,,,,,,125.1800,485.0000,percent of total billed charges,90% of $485.00 in Billed Charges for Rev 272 = $436.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARCTIC SUN UNIVERSAL,272,RC,27202233,CDM,,,,,,both,,,485.0000,72.7500,MEDCOST,MEDCOST VHN,230.81,,,,,,,125.1800,485.0000,percent of total billed charges,47.59% of $485.00 in Billed Charges for Rev 272 = $230.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARCTIC SUN UNIVERSAL,272,RC,27202233,CDM,,,,,,both,,,485.0000,72.7500,SENTARA HEALTH,SENTARA HEALTH,125.18,,,,,,,125.1800,485.0000,percent of total billed charges,25.81% of $485.00 in Billed Charges for Rev 272 = $125.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARCTIC SUN UNIVERSAL,272,RC,27202233,CDM,,,,,,both,,,485.0000,72.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",485.00,,,,,,,125.1800,485.0000,percent of total billed charges,100% of $485.00 in Billed Charges for Rev 272 = $485.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARCTIC SUN UNIVERSAL,272,RC,27202233,CDM,,,,,,both,,,485.0000,72.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,242.50,,,,,,,125.1800,485.0000,percent of total billed charges,Rev 272 $485.00 in Billed Charges at 50% = $242.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARCTIC SUN UNIVERSAL,272,RC,27202233,CDM,,,,,,both,,,485.0000,72.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,156.66,,,,,,,125.1800,485.0000,other,32.3% of $485.00 in Billed Charges for Rev 272 = $156.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARCTIC SUN UNIVERSAL,272,RC,27202233,CDM,,,,,,both,,,485.0000,72.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,148.90,,,,,,,125.1800,485.0000,other,30.7% of $485.00 in Billed Charges for Rev 272 = $148.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARCTIC SUN UNIVERSAL,272,RC,27202233,CDM,,,,,,both,,,485.0000,72.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,156.66,,,,,,,125.1800,485.0000,percent of total billed charges,32.3% of $485.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARCTIC SUN UNIVERSAL,272,RC,27202233,CDM,,,,,,both,,,485.0000,72.7500,WELLCARE,WELLCARE MEDICAID,485.00,,,,,,,125.1800,485.0000,percent of total billed charges,100% of $485.00 in Billed Charges for Rev 272 = $485.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASAHI ASTATO/REGALIA/TREASURE,272,RC,27201648,CDM,,,,,,both,,,689.0000,103.3500,AETNA,AETNA,294.20,,,,,,,177.8300,689.0000,percent of total billed charges,42.7% of $689.00 in Billed Charges for Rev 272 = $294.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASAHI ASTATO/REGALIA/TREASURE,272,RC,27201648,CDM,,,,,,both,,,689.0000,103.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,482.30,,,,,,,177.8300,689.0000,percent of total billed charges,Rev 272 $689.00 in Billed Charges at 70% = $482.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASAHI ASTATO/REGALIA/TREASURE,272,RC,27201648,CDM,,,,,,both,,,689.0000,103.3500,CIGNA HEALTHCARE,CIGNA HMO,287.31,,,,,,,177.8300,689.0000,percent of total billed charges,41.7% of $689.00 in Billed Charges for Rev 272 = $287.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASAHI ASTATO/REGALIA/TREASURE,272,RC,27201648,CDM,,,,,,both,,,689.0000,103.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,319.70,,,,,,,177.8300,689.0000,percent of total billed charges,46.4% of $689.00 in Billed Charges for Rev 272 = $319.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASAHI ASTATO/REGALIA/TREASURE,272,RC,27201648,CDM,,,,,,both,,,689.0000,103.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,287.31,,,,,,,177.8300,689.0000,percent of total billed charges,41.7% of $689.00 in Billed Charges for Rev 272 = $287.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASAHI ASTATO/REGALIA/TREASURE,272,RC,27201648,CDM,,,,,,both,,,689.0000,103.3500,CIGNA HEALTHCARE,CIGNA PPO,287.31,,,,,,,177.8300,689.0000,percent of total billed charges,41.7% of $689.00 in Billed Charges for Rev 272 = $287.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASAHI ASTATO/REGALIA/TREASURE,272,RC,27201648,CDM,,,,,,both,,,689.0000,103.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,620.10,,,,,,,177.8300,689.0000,percent of total billed charges,90% of $689.00 in Billed Charges for Rev 272 = $620.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASAHI ASTATO/REGALIA/TREASURE,272,RC,27201648,CDM,,,,,,both,,,689.0000,103.3500,MEDCOST,MEDCOST VHN,327.90,,,,,,,177.8300,689.0000,percent of total billed charges,47.59% of $689.00 in Billed Charges for Rev 272 = $327.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASAHI ASTATO/REGALIA/TREASURE,272,RC,27201648,CDM,,,,,,both,,,689.0000,103.3500,SENTARA HEALTH,SENTARA HEALTH,177.83,,,,,,,177.8300,689.0000,percent of total billed charges,25.81% of $689.00 in Billed Charges for Rev 272 = $177.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASAHI ASTATO/REGALIA/TREASURE,272,RC,27201648,CDM,,,,,,both,,,689.0000,103.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",689.00,,,,,,,177.8300,689.0000,percent of total billed charges,100% of $689.00 in Billed Charges for Rev 272 = $689.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASAHI ASTATO/REGALIA/TREASURE,272,RC,27201648,CDM,,,,,,both,,,689.0000,103.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,344.50,,,,,,,177.8300,689.0000,percent of total billed charges,Rev 272 $689.00 in Billed Charges at 50% = $344.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASAHI ASTATO/REGALIA/TREASURE,272,RC,27201648,CDM,,,,,,both,,,689.0000,103.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,222.55,,,,,,,177.8300,689.0000,other,32.3% of $689.00 in Billed Charges for Rev 272 = $222.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASAHI ASTATO/REGALIA/TREASURE,272,RC,27201648,CDM,,,,,,both,,,689.0000,103.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,211.52,,,,,,,177.8300,689.0000,other,30.7% of $689.00 in Billed Charges for Rev 272 = $211.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASAHI ASTATO/REGALIA/TREASURE,272,RC,27201648,CDM,,,,,,both,,,689.0000,103.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,222.55,,,,,,,177.8300,689.0000,percent of total billed charges,32.3% of $689.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASAHI ASTATO/REGALIA/TREASURE,272,RC,27201648,CDM,,,,,,both,,,689.0000,103.3500,WELLCARE,WELLCARE MEDICAID,689.00,,,,,,,177.8300,689.0000,percent of total billed charges,100% of $689.00 in Billed Charges for Rev 272 = $689.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AZUR CX 35 DETACHABLE FRAMING COIL,278,RC,27800598,CDM,,,,,,both,,,3716.0000,557.4000,AETNA,AETNA,1783.68,,,,,,,959.1000,3716.0000,percent of total billed charges,"48% of $3,716.00 in Billed Charges for Rev 278 = $1,783.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AZUR CX 35 DETACHABLE FRAMING COIL,278,RC,27800598,CDM,,,,,,both,,,3716.0000,557.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1858.00,,,,,,,959.1000,3716.0000,percent of total billed charges,"50% of $3,716.00 in Billed Charges for Rev 278 = $1,858.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AZUR CX 35 DETACHABLE FRAMING COIL,278,RC,27800598,CDM,,,,,,both,,,3716.0000,557.4000,CIGNA HEALTHCARE,CIGNA HMO,1549.57,,,,,,,959.1000,3716.0000,percent of total billed charges,"41.7% of $3,716.00 in Billed Charges for Rev 278 = $1,549.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AZUR CX 35 DETACHABLE FRAMING COIL,278,RC,27800598,CDM,,,,,,both,,,3716.0000,557.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1486.40,,,,,,,959.1000,3716.0000,percent of total billed charges,"40% of $3,716.00 in Billed Charges for Rev 278 = $1,486.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AZUR CX 35 DETACHABLE FRAMING COIL,278,RC,27800598,CDM,,,,,,both,,,3716.0000,557.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1549.57,,,,,,,959.1000,3716.0000,percent of total billed charges,"41.7% of $3,716.00 in Billed Charges for Rev 278 = $1,549.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AZUR CX 35 DETACHABLE FRAMING COIL,278,RC,27800598,CDM,,,,,,both,,,3716.0000,557.4000,CIGNA HEALTHCARE,CIGNA PPO,1549.57,,,,,,,959.1000,3716.0000,percent of total billed charges,"41.7% of $3,716.00 in Billed Charges for Rev 278 = $1,549.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AZUR CX 35 DETACHABLE FRAMING COIL,278,RC,27800598,CDM,,,,,,both,,,3716.0000,557.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3344.40,,,,,,,959.1000,3716.0000,percent of total billed charges,"90% of $3,716.00 in Billed Charges for Rev 278 = $3,344.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AZUR CX 35 DETACHABLE FRAMING COIL,278,RC,27800598,CDM,,,,,,both,,,3716.0000,557.4000,MEDCOST,MEDCOST VHN,1768.44,,,,,,,959.1000,3716.0000,percent of total billed charges,"47.59% of $3,716.00 in Billed Charges for Rev 278 = $1,768.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AZUR CX 35 DETACHABLE FRAMING COIL,278,RC,27800598,CDM,,,,,,both,,,3716.0000,557.4000,SENTARA HEALTH,SENTARA HEALTH,959.10,,,,,,,959.1000,3716.0000,percent of total billed charges,"25.81% of $3,716.00 in Billed Charges for Rev 278 = $959.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AZUR CX 35 DETACHABLE FRAMING COIL,278,RC,27800598,CDM,,,,,,both,,,3716.0000,557.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3716.00,,,,,,,959.1000,3716.0000,percent of total billed charges,"100% of $3,716.00 in Billed Charges for Rev 278 = $3,716.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AZUR CX 35 DETACHABLE FRAMING COIL,278,RC,27800598,CDM,,,,,,both,,,3716.0000,557.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1858.00,,,,,,,959.1000,3716.0000,percent of total billed charges,"Rev 278 $3,716.00 in Billed Charges at 50% = $1,858.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AZUR CX 35 DETACHABLE FRAMING COIL,278,RC,27800598,CDM,,,,,,both,,,3716.0000,557.4000,WELLCARE,WELLCARE MEDICAID,3716.00,,,,,,,959.1000,3716.0000,percent of total billed charges,"100% of $3,716.00 in Billed Charges for Rev 278 = $3,716.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BAG AMBU ADULT,270,RC,27000109,CDM,,,,,,both,,,86.0000,12.9000,AETNA,AETNA,36.72,,,,,,,22.2000,86.0000,percent of total billed charges,42.7% of $86.00 in Billed Charges for Rev 270 = $36.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG AMBU ADULT,270,RC,27000109,CDM,,,,,,both,,,86.0000,12.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,60.20,,,,,,,22.2000,86.0000,percent of total billed charges,Rev 270 $86.00 in Billed Charges at 70% = $60.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG AMBU ADULT,270,RC,27000109,CDM,,,,,,both,,,86.0000,12.9000,CIGNA HEALTHCARE,CIGNA HMO,35.86,,,,,,,22.2000,86.0000,percent of total billed charges,41.7% of $86.00 in Billed Charges for Rev 270 = $35.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG AMBU ADULT,270,RC,27000109,CDM,,,,,,both,,,86.0000,12.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,39.90,,,,,,,22.2000,86.0000,percent of total billed charges,46.4% of $86.00 in Billed Charges for Rev 270 = $39.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG AMBU ADULT,270,RC,27000109,CDM,,,,,,both,,,86.0000,12.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,35.86,,,,,,,22.2000,86.0000,percent of total billed charges,41.7% of $86.00 in Billed Charges for Rev 270 = $35.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG AMBU ADULT,270,RC,27000109,CDM,,,,,,both,,,86.0000,12.9000,CIGNA HEALTHCARE,CIGNA PPO,35.86,,,,,,,22.2000,86.0000,percent of total billed charges,41.7% of $86.00 in Billed Charges for Rev 270 = $35.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG AMBU ADULT,270,RC,27000109,CDM,,,,,,both,,,86.0000,12.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,77.40,,,,,,,22.2000,86.0000,percent of total billed charges,90% of $86.00 in Billed Charges for Rev 270 = $77.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG AMBU ADULT,270,RC,27000109,CDM,,,,,,both,,,86.0000,12.9000,MEDCOST,MEDCOST VHN,40.93,,,,,,,22.2000,86.0000,percent of total billed charges,47.59% of $86.00 in Billed Charges for Rev 270 = $40.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG AMBU ADULT,270,RC,27000109,CDM,,,,,,both,,,86.0000,12.9000,SENTARA HEALTH,SENTARA HEALTH,22.20,,,,,,,22.2000,86.0000,percent of total billed charges,25.81% of $86.00 in Billed Charges for Rev 270 = $22.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG AMBU ADULT,270,RC,27000109,CDM,,,,,,both,,,86.0000,12.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",86.00,,,,,,,22.2000,86.0000,percent of total billed charges,100% of $86.00 in Billed Charges for Rev 270 = $86.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG AMBU ADULT,270,RC,27000109,CDM,,,,,,both,,,86.0000,12.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,43.00,,,,,,,22.2000,86.0000,percent of total billed charges,Rev 270 $86.00 in Billed Charges at 50% = $43.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG AMBU ADULT,270,RC,27000109,CDM,,,,,,both,,,86.0000,12.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,27.78,,,,,,,22.2000,86.0000,other,32.3% of $86.00 in Billed Charges for Rev 270 = $27.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BAG AMBU ADULT,270,RC,27000109,CDM,,,,,,both,,,86.0000,12.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,26.40,,,,,,,22.2000,86.0000,other,30.7% of $86.00 in Billed Charges for Rev 270 = $26.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BAG AMBU ADULT,270,RC,27000109,CDM,,,,,,both,,,86.0000,12.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,27.78,,,,,,,22.2000,86.0000,percent of total billed charges,32.3% of $86.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG AMBU ADULT,270,RC,27000109,CDM,,,,,,both,,,86.0000,12.9000,WELLCARE,WELLCARE MEDICAID,86.00,,,,,,,22.2000,86.0000,percent of total billed charges,100% of $86.00 in Billed Charges for Rev 270 = $86.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG BILE,270,RC,27000138,CDM,,,,,,both,,,64.0000,9.6000,AETNA,AETNA,27.33,,,,,,,16.5200,64.0000,percent of total billed charges,42.7% of $64.00 in Billed Charges for Rev 270 = $27.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG BILE,270,RC,27000138,CDM,,,,,,both,,,64.0000,9.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,44.80,,,,,,,16.5200,64.0000,percent of total billed charges,Rev 270 $64.00 in Billed Charges at 70% = $44.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG BILE,270,RC,27000138,CDM,,,,,,both,,,64.0000,9.6000,CIGNA HEALTHCARE,CIGNA HMO,26.69,,,,,,,16.5200,64.0000,percent of total billed charges,41.7% of $64.00 in Billed Charges for Rev 270 = $26.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG BILE,270,RC,27000138,CDM,,,,,,both,,,64.0000,9.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,29.70,,,,,,,16.5200,64.0000,percent of total billed charges,46.4% of $64.00 in Billed Charges for Rev 270 = $29.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG BILE,270,RC,27000138,CDM,,,,,,both,,,64.0000,9.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,26.69,,,,,,,16.5200,64.0000,percent of total billed charges,41.7% of $64.00 in Billed Charges for Rev 270 = $26.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG BILE,270,RC,27000138,CDM,,,,,,both,,,64.0000,9.6000,CIGNA HEALTHCARE,CIGNA PPO,26.69,,,,,,,16.5200,64.0000,percent of total billed charges,41.7% of $64.00 in Billed Charges for Rev 270 = $26.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG BILE,270,RC,27000138,CDM,,,,,,both,,,64.0000,9.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,57.60,,,,,,,16.5200,64.0000,percent of total billed charges,90% of $64.00 in Billed Charges for Rev 270 = $57.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG BILE,270,RC,27000138,CDM,,,,,,both,,,64.0000,9.6000,MEDCOST,MEDCOST VHN,30.46,,,,,,,16.5200,64.0000,percent of total billed charges,47.59% of $64.00 in Billed Charges for Rev 270 = $30.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG BILE,270,RC,27000138,CDM,,,,,,both,,,64.0000,9.6000,SENTARA HEALTH,SENTARA HEALTH,16.52,,,,,,,16.5200,64.0000,percent of total billed charges,25.81% of $64.00 in Billed Charges for Rev 270 = $16.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG BILE,270,RC,27000138,CDM,,,,,,both,,,64.0000,9.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",64.00,,,,,,,16.5200,64.0000,percent of total billed charges,100% of $64.00 in Billed Charges for Rev 270 = $64.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG BILE,270,RC,27000138,CDM,,,,,,both,,,64.0000,9.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,32.00,,,,,,,16.5200,64.0000,percent of total billed charges,Rev 270 $64.00 in Billed Charges at 50% = $32.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG BILE,270,RC,27000138,CDM,,,,,,both,,,64.0000,9.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,20.67,,,,,,,16.5200,64.0000,other,32.3% of $64.00 in Billed Charges for Rev 270 = $20.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BAG BILE,270,RC,27000138,CDM,,,,,,both,,,64.0000,9.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,19.65,,,,,,,16.5200,64.0000,other,30.7% of $64.00 in Billed Charges for Rev 270 = $19.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BAG BILE,270,RC,27000138,CDM,,,,,,both,,,64.0000,9.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,20.67,,,,,,,16.5200,64.0000,percent of total billed charges,32.3% of $64.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG BILE,270,RC,27000138,CDM,,,,,,both,,,64.0000,9.6000,WELLCARE,WELLCARE MEDICAID,64.00,,,,,,,16.5200,64.0000,percent of total billed charges,100% of $64.00 in Billed Charges for Rev 270 = $64.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG CATH DRAINAGE DISP 2000,272,RC,27200100,CDM,,,,,,both,,,37.0000,5.5500,AETNA,AETNA,15.80,,,,,,,9.5500,37.0000,percent of total billed charges,42.7% of $37.00 in Billed Charges for Rev 272 = $15.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG CATH DRAINAGE DISP 2000,272,RC,27200100,CDM,,,,,,both,,,37.0000,5.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,25.90,,,,,,,9.5500,37.0000,percent of total billed charges,Rev 272 $37.00 in Billed Charges at 70% = $25.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG CATH DRAINAGE DISP 2000,272,RC,27200100,CDM,,,,,,both,,,37.0000,5.5500,CIGNA HEALTHCARE,CIGNA HMO,15.43,,,,,,,9.5500,37.0000,percent of total billed charges,41.7% of $37.00 in Billed Charges for Rev 272 = $15.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG CATH DRAINAGE DISP 2000,272,RC,27200100,CDM,,,,,,both,,,37.0000,5.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,17.17,,,,,,,9.5500,37.0000,percent of total billed charges,46.4% of $37.00 in Billed Charges for Rev 272 = $17.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG CATH DRAINAGE DISP 2000,272,RC,27200100,CDM,,,,,,both,,,37.0000,5.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,15.43,,,,,,,9.5500,37.0000,percent of total billed charges,41.7% of $37.00 in Billed Charges for Rev 272 = $15.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG CATH DRAINAGE DISP 2000,272,RC,27200100,CDM,,,,,,both,,,37.0000,5.5500,CIGNA HEALTHCARE,CIGNA PPO,15.43,,,,,,,9.5500,37.0000,percent of total billed charges,41.7% of $37.00 in Billed Charges for Rev 272 = $15.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG CATH DRAINAGE DISP 2000,272,RC,27200100,CDM,,,,,,both,,,37.0000,5.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,33.30,,,,,,,9.5500,37.0000,percent of total billed charges,90% of $37.00 in Billed Charges for Rev 272 = $33.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG CATH DRAINAGE DISP 2000,272,RC,27200100,CDM,,,,,,both,,,37.0000,5.5500,MEDCOST,MEDCOST VHN,17.61,,,,,,,9.5500,37.0000,percent of total billed charges,47.59% of $37.00 in Billed Charges for Rev 272 = $17.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG CATH DRAINAGE DISP 2000,272,RC,27200100,CDM,,,,,,both,,,37.0000,5.5500,SENTARA HEALTH,SENTARA HEALTH,9.55,,,,,,,9.5500,37.0000,percent of total billed charges,25.81% of $37.00 in Billed Charges for Rev 272 = $9.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG CATH DRAINAGE DISP 2000,272,RC,27200100,CDM,,,,,,both,,,37.0000,5.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",37.00,,,,,,,9.5500,37.0000,percent of total billed charges,100% of $37.00 in Billed Charges for Rev 272 = $37.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG CATH DRAINAGE DISP 2000,272,RC,27200100,CDM,,,,,,both,,,37.0000,5.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,18.50,,,,,,,9.5500,37.0000,percent of total billed charges,Rev 272 $37.00 in Billed Charges at 50% = $18.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG CATH DRAINAGE DISP 2000,272,RC,27200100,CDM,,,,,,both,,,37.0000,5.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,11.95,,,,,,,9.5500,37.0000,other,32.3% of $37.00 in Billed Charges for Rev 272 = $11.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BAG CATH DRAINAGE DISP 2000,272,RC,27200100,CDM,,,,,,both,,,37.0000,5.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,11.36,,,,,,,9.5500,37.0000,other,30.7% of $37.00 in Billed Charges for Rev 272 = $11.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BAG CATH DRAINAGE DISP 2000,272,RC,27200100,CDM,,,,,,both,,,37.0000,5.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,11.95,,,,,,,9.5500,37.0000,percent of total billed charges,32.3% of $37.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG CATH DRAINAGE DISP 2000,272,RC,27200100,CDM,,,,,,both,,,37.0000,5.5500,WELLCARE,WELLCARE MEDICAID,37.00,,,,,,,9.5500,37.0000,percent of total billed charges,100% of $37.00 in Billed Charges for Rev 272 = $37.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAIN URINE METER,272,RC,27200101,CDM,,,,,,both,,,76.0000,11.4000,AETNA,AETNA,32.45,,,,,,,19.6200,76.0000,percent of total billed charges,42.7% of $76.00 in Billed Charges for Rev 272 = $32.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAIN URINE METER,272,RC,27200101,CDM,,,,,,both,,,76.0000,11.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,53.20,,,,,,,19.6200,76.0000,percent of total billed charges,Rev 272 $76.00 in Billed Charges at 70% = $53.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAIN URINE METER,272,RC,27200101,CDM,,,,,,both,,,76.0000,11.4000,CIGNA HEALTHCARE,CIGNA HMO,31.69,,,,,,,19.6200,76.0000,percent of total billed charges,41.7% of $76.00 in Billed Charges for Rev 272 = $31.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAIN URINE METER,272,RC,27200101,CDM,,,,,,both,,,76.0000,11.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,35.26,,,,,,,19.6200,76.0000,percent of total billed charges,46.4% of $76.00 in Billed Charges for Rev 272 = $35.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAIN URINE METER,272,RC,27200101,CDM,,,,,,both,,,76.0000,11.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,31.69,,,,,,,19.6200,76.0000,percent of total billed charges,41.7% of $76.00 in Billed Charges for Rev 272 = $31.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAIN URINE METER,272,RC,27200101,CDM,,,,,,both,,,76.0000,11.4000,CIGNA HEALTHCARE,CIGNA PPO,31.69,,,,,,,19.6200,76.0000,percent of total billed charges,41.7% of $76.00 in Billed Charges for Rev 272 = $31.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAIN URINE METER,272,RC,27200101,CDM,,,,,,both,,,76.0000,11.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,68.40,,,,,,,19.6200,76.0000,percent of total billed charges,90% of $76.00 in Billed Charges for Rev 272 = $68.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAIN URINE METER,272,RC,27200101,CDM,,,,,,both,,,76.0000,11.4000,MEDCOST,MEDCOST VHN,36.17,,,,,,,19.6200,76.0000,percent of total billed charges,47.59% of $76.00 in Billed Charges for Rev 272 = $36.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAIN URINE METER,272,RC,27200101,CDM,,,,,,both,,,76.0000,11.4000,SENTARA HEALTH,SENTARA HEALTH,19.62,,,,,,,19.6200,76.0000,percent of total billed charges,25.81% of $76.00 in Billed Charges for Rev 272 = $19.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAIN URINE METER,272,RC,27200101,CDM,,,,,,both,,,76.0000,11.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",76.00,,,,,,,19.6200,76.0000,percent of total billed charges,100% of $76.00 in Billed Charges for Rev 272 = $76.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAIN URINE METER,272,RC,27200101,CDM,,,,,,both,,,76.0000,11.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,38.00,,,,,,,19.6200,76.0000,percent of total billed charges,Rev 272 $76.00 in Billed Charges at 50% = $38.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAIN URINE METER,272,RC,27200101,CDM,,,,,,both,,,76.0000,11.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,24.55,,,,,,,19.6200,76.0000,other,32.3% of $76.00 in Billed Charges for Rev 272 = $24.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BAG DRAIN URINE METER,272,RC,27200101,CDM,,,,,,both,,,76.0000,11.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,23.33,,,,,,,19.6200,76.0000,other,30.7% of $76.00 in Billed Charges for Rev 272 = $23.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BAG DRAIN URINE METER,272,RC,27200101,CDM,,,,,,both,,,76.0000,11.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,24.55,,,,,,,19.6200,76.0000,percent of total billed charges,32.3% of $76.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAIN URINE METER,272,RC,27200101,CDM,,,,,,both,,,76.0000,11.4000,WELLCARE,WELLCARE MEDICAID,76.00,,,,,,,19.6200,76.0000,percent of total billed charges,100% of $76.00 in Billed Charges for Rev 272 = $76.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGACLIP SINGLE 10.5 LARGE,272,RC,27200002,CDM,,,,,,both,,,947.0800,142.0600,AETNA,AETNA,404.40,,,,,,,244.4400,947.0800,percent of total billed charges,42.7% of $947.08 in Billed Charges for Rev 272 = $404.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGACLIP SINGLE 10.5 LARGE,272,RC,27200002,CDM,,,,,,both,,,947.0800,142.0600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,662.96,,,,,,,244.4400,947.0800,percent of total billed charges,Rev 272 $947.08 in Billed Charges at 70% = $662.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGACLIP SINGLE 10.5 LARGE,272,RC,27200002,CDM,,,,,,both,,,947.0800,142.0600,CIGNA HEALTHCARE,CIGNA HMO,394.93,,,,,,,244.4400,947.0800,percent of total billed charges,41.7% of $947.08 in Billed Charges for Rev 272 = $394.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGACLIP SINGLE 10.5 LARGE,272,RC,27200002,CDM,,,,,,both,,,947.0800,142.0600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,439.45,,,,,,,244.4400,947.0800,percent of total billed charges,46.4% of $947.08 in Billed Charges for Rev 272 = $439.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGACLIP SINGLE 10.5 LARGE,272,RC,27200002,CDM,,,,,,both,,,947.0800,142.0600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,394.93,,,,,,,244.4400,947.0800,percent of total billed charges,41.7% of $947.08 in Billed Charges for Rev 272 = $394.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGACLIP SINGLE 10.5 LARGE,272,RC,27200002,CDM,,,,,,both,,,947.0800,142.0600,CIGNA HEALTHCARE,CIGNA PPO,394.93,,,,,,,244.4400,947.0800,percent of total billed charges,41.7% of $947.08 in Billed Charges for Rev 272 = $394.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGACLIP SINGLE 10.5 LARGE,272,RC,27200002,CDM,,,,,,both,,,947.0800,142.0600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,852.37,,,,,,,244.4400,947.0800,percent of total billed charges,90% of $947.08 in Billed Charges for Rev 272 = $852.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGACLIP SINGLE 10.5 LARGE,272,RC,27200002,CDM,,,,,,both,,,947.0800,142.0600,MEDCOST,MEDCOST VHN,450.72,,,,,,,244.4400,947.0800,percent of total billed charges,47.59% of $947.08 in Billed Charges for Rev 272 = $450.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGACLIP SINGLE 10.5 LARGE,272,RC,27200002,CDM,,,,,,both,,,947.0800,142.0600,SENTARA HEALTH,SENTARA HEALTH,244.44,,,,,,,244.4400,947.0800,percent of total billed charges,25.81% of $947.08 in Billed Charges for Rev 272 = $244.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGACLIP SINGLE 10.5 LARGE,272,RC,27200002,CDM,,,,,,both,,,947.0800,142.0600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",947.08,,,,,,,244.4400,947.0800,percent of total billed charges,100% of $947.08 in Billed Charges for Rev 272 = $947.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGACLIP SINGLE 10.5 LARGE,272,RC,27200002,CDM,,,,,,both,,,947.0800,142.0600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,473.54,,,,,,,244.4400,947.0800,percent of total billed charges,Rev 272 $947.08 in Billed Charges at 50% = $473.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGACLIP SINGLE 10.5 LARGE,272,RC,27200002,CDM,,,,,,both,,,947.0800,142.0600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,305.91,,,,,,,244.4400,947.0800,other,32.3% of $947.08 in Billed Charges for Rev 272 = $305.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
LIGACLIP SINGLE 10.5 LARGE,272,RC,27200002,CDM,,,,,,both,,,947.0800,142.0600,UNITED HEALTHCARE,UHC HERITAGE SELECT,290.75,,,,,,,244.4400,947.0800,other,30.7% of $947.08 in Billed Charges for Rev 272 = $290.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
LIGACLIP SINGLE 10.5 LARGE,272,RC,27200002,CDM,,,,,,both,,,947.0800,142.0600,UNITED HEALTHCARE,UNITED HEALTHCARE,305.91,,,,,,,244.4400,947.0800,percent of total billed charges,32.3% of $947.08 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGACLIP SINGLE 10.5 LARGE,272,RC,27200002,CDM,,,,,,both,,,947.0800,142.0600,WELLCARE,WELLCARE MEDICAID,947.08,,,,,,,244.4400,947.0800,percent of total billed charges,100% of $947.08 in Billed Charges for Rev 272 = $947.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LIGASURE ATLAS 10CM LS1037,272,RC,27200002,CDM,,,,,,both,,,3469.5000,520.4300,AETNA,AETNA,1481.48,,,,,,,895.4800,3469.5000,percent of total billed charges,"42.7% of $3,469.50 in Billed Charges for Rev 272 = $1,481.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ATLAS 10CM LS1037,272,RC,27200002,CDM,,,,,,both,,,3469.5000,520.4300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2428.65,,,,,,,895.4800,3469.5000,percent of total billed charges,"Rev 272 $3,469.50 in Billed Charges at 70% = $2,428.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ATLAS 10CM LS1037,272,RC,27200002,CDM,,,,,,both,,,3469.5000,520.4300,CIGNA HEALTHCARE,CIGNA HMO,1446.78,,,,,,,895.4800,3469.5000,percent of total billed charges,"41.7% of $3,469.50 in Billed Charges for Rev 272 = $1,446.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ATLAS 10CM LS1037,272,RC,27200002,CDM,,,,,,both,,,3469.5000,520.4300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1609.85,,,,,,,895.4800,3469.5000,percent of total billed charges,"46.4% of $3,469.50 in Billed Charges for Rev 272 = $1,609.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ATLAS 10CM LS1037,272,RC,27200002,CDM,,,,,,both,,,3469.5000,520.4300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1446.78,,,,,,,895.4800,3469.5000,percent of total billed charges,"41.7% of $3,469.50 in Billed Charges for Rev 272 = $1,446.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ATLAS 10CM LS1037,272,RC,27200002,CDM,,,,,,both,,,3469.5000,520.4300,CIGNA HEALTHCARE,CIGNA PPO,1446.78,,,,,,,895.4800,3469.5000,percent of total billed charges,"41.7% of $3,469.50 in Billed Charges for Rev 272 = $1,446.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ATLAS 10CM LS1037,272,RC,27200002,CDM,,,,,,both,,,3469.5000,520.4300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3122.55,,,,,,,895.4800,3469.5000,percent of total billed charges,"90% of $3,469.50 in Billed Charges for Rev 272 = $3,122.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ATLAS 10CM LS1037,272,RC,27200002,CDM,,,,,,both,,,3469.5000,520.4300,MEDCOST,MEDCOST VHN,1651.14,,,,,,,895.4800,3469.5000,percent of total billed charges,"47.59% of $3,469.50 in Billed Charges for Rev 272 = $1,651.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ATLAS 10CM LS1037,272,RC,27200002,CDM,,,,,,both,,,3469.5000,520.4300,SENTARA HEALTH,SENTARA HEALTH,895.48,,,,,,,895.4800,3469.5000,percent of total billed charges,"25.81% of $3,469.50 in Billed Charges for Rev 272 = $895.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ATLAS 10CM LS1037,272,RC,27200002,CDM,,,,,,both,,,3469.5000,520.4300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3469.50,,,,,,,895.4800,3469.5000,percent of total billed charges,"100% of $3,469.50 in Billed Charges for Rev 272 = $3,469.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ATLAS 10CM LS1037,272,RC,27200002,CDM,,,,,,both,,,3469.5000,520.4300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1734.75,,,,,,,895.4800,3469.5000,percent of total billed charges,"Rev 272 $3,469.50 in Billed Charges at 50% = $1,734.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ATLAS 10CM LS1037,272,RC,27200002,CDM,,,,,,both,,,3469.5000,520.4300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1120.65,,,,,,,895.4800,3469.5000,other,"32.3% of $3,469.50 in Billed Charges for Rev 272 = $1,120.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGASURE ATLAS 10CM LS1037,272,RC,27200002,CDM,,,,,,both,,,3469.5000,520.4300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1065.14,,,,,,,895.4800,3469.5000,other,"30.7% of $3,469.50 in Billed Charges for Rev 272 = $1,065.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGASURE ATLAS 10CM LS1037,272,RC,27200002,CDM,,,,,,both,,,3469.5000,520.4300,UNITED HEALTHCARE,UNITED HEALTHCARE,1120.65,,,,,,,895.4800,3469.5000,percent of total billed charges,"32.3% of $3,469.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ATLAS 10CM LS1037,272,RC,27200002,CDM,,,,,,both,,,3469.5000,520.4300,WELLCARE,WELLCARE MEDICAID,3469.50,,,,,,,895.4800,3469.5000,percent of total billed charges,"100% of $3,469.50 in Billed Charges for Rev 272 = $3,469.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BAG DRAINAGE VENTRICULAR,270,RC,27000177,CDM,,,,,,both,,,75.0000,11.2500,AETNA,AETNA,32.03,,,,,,,19.3600,75.0000,percent of total billed charges,42.7% of $75.00 in Billed Charges for Rev 270 = $32.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE VENTRICULAR,270,RC,27000177,CDM,,,,,,both,,,75.0000,11.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,52.50,,,,,,,19.3600,75.0000,percent of total billed charges,Rev 270 $75.00 in Billed Charges at 70% = $52.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE VENTRICULAR,270,RC,27000177,CDM,,,,,,both,,,75.0000,11.2500,CIGNA HEALTHCARE,CIGNA HMO,31.28,,,,,,,19.3600,75.0000,percent of total billed charges,41.7% of $75.00 in Billed Charges for Rev 270 = $31.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE VENTRICULAR,270,RC,27000177,CDM,,,,,,both,,,75.0000,11.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,34.80,,,,,,,19.3600,75.0000,percent of total billed charges,46.4% of $75.00 in Billed Charges for Rev 270 = $34.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE VENTRICULAR,270,RC,27000177,CDM,,,,,,both,,,75.0000,11.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,31.28,,,,,,,19.3600,75.0000,percent of total billed charges,41.7% of $75.00 in Billed Charges for Rev 270 = $31.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE VENTRICULAR,270,RC,27000177,CDM,,,,,,both,,,75.0000,11.2500,CIGNA HEALTHCARE,CIGNA PPO,31.28,,,,,,,19.3600,75.0000,percent of total billed charges,41.7% of $75.00 in Billed Charges for Rev 270 = $31.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE VENTRICULAR,270,RC,27000177,CDM,,,,,,both,,,75.0000,11.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,67.50,,,,,,,19.3600,75.0000,percent of total billed charges,90% of $75.00 in Billed Charges for Rev 270 = $67.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE VENTRICULAR,270,RC,27000177,CDM,,,,,,both,,,75.0000,11.2500,MEDCOST,MEDCOST VHN,35.69,,,,,,,19.3600,75.0000,percent of total billed charges,47.59% of $75.00 in Billed Charges for Rev 270 = $35.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE VENTRICULAR,270,RC,27000177,CDM,,,,,,both,,,75.0000,11.2500,SENTARA HEALTH,SENTARA HEALTH,19.36,,,,,,,19.3600,75.0000,percent of total billed charges,25.81% of $75.00 in Billed Charges for Rev 270 = $19.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE VENTRICULAR,270,RC,27000177,CDM,,,,,,both,,,75.0000,11.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",75.00,,,,,,,19.3600,75.0000,percent of total billed charges,100% of $75.00 in Billed Charges for Rev 270 = $75.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE VENTRICULAR,270,RC,27000177,CDM,,,,,,both,,,75.0000,11.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,37.50,,,,,,,19.3600,75.0000,percent of total billed charges,Rev 270 $75.00 in Billed Charges at 50% = $37.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE VENTRICULAR,270,RC,27000177,CDM,,,,,,both,,,75.0000,11.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,24.23,,,,,,,19.3600,75.0000,other,32.3% of $75.00 in Billed Charges for Rev 270 = $24.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BAG DRAINAGE VENTRICULAR,270,RC,27000177,CDM,,,,,,both,,,75.0000,11.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,23.03,,,,,,,19.3600,75.0000,other,30.7% of $75.00 in Billed Charges for Rev 270 = $23.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BAG DRAINAGE VENTRICULAR,270,RC,27000177,CDM,,,,,,both,,,75.0000,11.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,24.23,,,,,,,19.3600,75.0000,percent of total billed charges,32.3% of $75.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BAG DRAINAGE VENTRICULAR,270,RC,27000177,CDM,,,,,,both,,,75.0000,11.2500,WELLCARE,WELLCARE MEDICAID,75.00,,,,,,,19.3600,75.0000,percent of total billed charges,100% of $75.00 in Billed Charges for Rev 270 = $75.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON ANGIOSCULPT OTW 100MM,272,RC,27200471,CDM,,,,,,both,,,3344.0000,501.6000,AETNA,AETNA,1427.89,,,,,,,863.0900,3344.0000,percent of total billed charges,"42.7% of $3,344.00 in Billed Charges for Rev 272 = $1,427.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BALLOON ANGIOSCULPT OTW 100MM,272,RC,27200471,CDM,,,,,,both,,,3344.0000,501.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2340.80,,,,,,,863.0900,3344.0000,percent of total billed charges,"Rev 272 $3,344.00 in Billed Charges at 70% = $2,340.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BALLOON ANGIOSCULPT OTW 100MM,272,RC,27200471,CDM,,,,,,both,,,3344.0000,501.6000,CIGNA HEALTHCARE,CIGNA HMO,1394.45,,,,,,,863.0900,3344.0000,percent of total billed charges,"41.7% of $3,344.00 in Billed Charges for Rev 272 = $1,394.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BALLOON ANGIOSCULPT OTW 100MM,272,RC,27200471,CDM,,,,,,both,,,3344.0000,501.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1551.62,,,,,,,863.0900,3344.0000,percent of total billed charges,"46.4% of $3,344.00 in Billed Charges for Rev 272 = $1,551.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BALLOON ANGIOSCULPT OTW 100MM,272,RC,27200471,CDM,,,,,,both,,,3344.0000,501.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1394.45,,,,,,,863.0900,3344.0000,percent of total billed charges,"41.7% of $3,344.00 in Billed Charges for Rev 272 = $1,394.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BALLOON ANGIOSCULPT OTW 100MM,272,RC,27200471,CDM,,,,,,both,,,3344.0000,501.6000,CIGNA HEALTHCARE,CIGNA PPO,1394.45,,,,,,,863.0900,3344.0000,percent of total billed charges,"41.7% of $3,344.00 in Billed Charges for Rev 272 = $1,394.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BALLOON ANGIOSCULPT OTW 100MM,272,RC,27200471,CDM,,,,,,both,,,3344.0000,501.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3009.60,,,,,,,863.0900,3344.0000,percent of total billed charges,"90% of $3,344.00 in Billed Charges for Rev 272 = $3,009.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BALLOON ANGIOSCULPT OTW 100MM,272,RC,27200471,CDM,,,,,,both,,,3344.0000,501.6000,MEDCOST,MEDCOST VHN,1591.41,,,,,,,863.0900,3344.0000,percent of total billed charges,"47.59% of $3,344.00 in Billed Charges for Rev 272 = $1,591.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BALLOON ANGIOSCULPT OTW 100MM,272,RC,27200471,CDM,,,,,,both,,,3344.0000,501.6000,SENTARA HEALTH,SENTARA HEALTH,863.09,,,,,,,863.0900,3344.0000,percent of total billed charges,"25.81% of $3,344.00 in Billed Charges for Rev 272 = $863.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BALLOON ANGIOSCULPT OTW 100MM,272,RC,27200471,CDM,,,,,,both,,,3344.0000,501.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3344.00,,,,,,,863.0900,3344.0000,percent of total billed charges,"100% of $3,344.00 in Billed Charges for Rev 272 = $3,344.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BALLOON ANGIOSCULPT OTW 100MM,272,RC,27200471,CDM,,,,,,both,,,3344.0000,501.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1672.00,,,,,,,863.0900,3344.0000,percent of total billed charges,"Rev 272 $3,344.00 in Billed Charges at 50% = $1,672.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BALLOON ANGIOSCULPT OTW 100MM,272,RC,27200471,CDM,,,,,,both,,,3344.0000,501.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1080.11,,,,,,,863.0900,3344.0000,other,"32.3% of $3,344.00 in Billed Charges for Rev 272 = $1,080.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BALLOON ANGIOSCULPT OTW 100MM,272,RC,27200471,CDM,,,,,,both,,,3344.0000,501.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1026.61,,,,,,,863.0900,3344.0000,other,"30.7% of $3,344.00 in Billed Charges for Rev 272 = $1,026.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BALLOON ANGIOSCULPT OTW 100MM,272,RC,27200471,CDM,,,,,,both,,,3344.0000,501.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,1080.11,,,,,,,863.0900,3344.0000,percent of total billed charges,"32.3% of $3,344.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BALLOON ANGIOSCULPT OTW 100MM,272,RC,27200471,CDM,,,,,,both,,,3344.0000,501.6000,WELLCARE,WELLCARE MEDICAID,3344.00,,,,,,,863.0900,3344.0000,percent of total billed charges,"100% of $3,344.00 in Billed Charges for Rev 272 = $3,344.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BALLOON ARROW WEDGE PRESSURE CATH 5FR 110CM,272,RC,27202115,CDM,,,,,,both,,,469.0000,70.3500,AETNA,AETNA,200.26,,,,,,,121.0500,469.0000,percent of total billed charges,42.7% of $469.00 in Billed Charges for Rev 272 = $200.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON ARROW WEDGE PRESSURE CATH 5FR 110CM,272,RC,27202115,CDM,,,,,,both,,,469.0000,70.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,328.30,,,,,,,121.0500,469.0000,percent of total billed charges,Rev 272 $469.00 in Billed Charges at 70% = $328.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON ARROW WEDGE PRESSURE CATH 5FR 110CM,272,RC,27202115,CDM,,,,,,both,,,469.0000,70.3500,CIGNA HEALTHCARE,CIGNA HMO,195.57,,,,,,,121.0500,469.0000,percent of total billed charges,41.7% of $469.00 in Billed Charges for Rev 272 = $195.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON ARROW WEDGE PRESSURE CATH 5FR 110CM,272,RC,27202115,CDM,,,,,,both,,,469.0000,70.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,217.62,,,,,,,121.0500,469.0000,percent of total billed charges,46.4% of $469.00 in Billed Charges for Rev 272 = $217.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON ARROW WEDGE PRESSURE CATH 5FR 110CM,272,RC,27202115,CDM,,,,,,both,,,469.0000,70.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,195.57,,,,,,,121.0500,469.0000,percent of total billed charges,41.7% of $469.00 in Billed Charges for Rev 272 = $195.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON ARROW WEDGE PRESSURE CATH 5FR 110CM,272,RC,27202115,CDM,,,,,,both,,,469.0000,70.3500,CIGNA HEALTHCARE,CIGNA PPO,195.57,,,,,,,121.0500,469.0000,percent of total billed charges,41.7% of $469.00 in Billed Charges for Rev 272 = $195.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON ARROW WEDGE PRESSURE CATH 5FR 110CM,272,RC,27202115,CDM,,,,,,both,,,469.0000,70.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,422.10,,,,,,,121.0500,469.0000,percent of total billed charges,90% of $469.00 in Billed Charges for Rev 272 = $422.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON ARROW WEDGE PRESSURE CATH 5FR 110CM,272,RC,27202115,CDM,,,,,,both,,,469.0000,70.3500,MEDCOST,MEDCOST VHN,223.20,,,,,,,121.0500,469.0000,percent of total billed charges,47.59% of $469.00 in Billed Charges for Rev 272 = $223.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON ARROW WEDGE PRESSURE CATH 5FR 110CM,272,RC,27202115,CDM,,,,,,both,,,469.0000,70.3500,SENTARA HEALTH,SENTARA HEALTH,121.05,,,,,,,121.0500,469.0000,percent of total billed charges,25.81% of $469.00 in Billed Charges for Rev 272 = $121.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON ARROW WEDGE PRESSURE CATH 5FR 110CM,272,RC,27202115,CDM,,,,,,both,,,469.0000,70.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",469.00,,,,,,,121.0500,469.0000,percent of total billed charges,100% of $469.00 in Billed Charges for Rev 272 = $469.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON ARROW WEDGE PRESSURE CATH 5FR 110CM,272,RC,27202115,CDM,,,,,,both,,,469.0000,70.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,234.50,,,,,,,121.0500,469.0000,percent of total billed charges,Rev 272 $469.00 in Billed Charges at 50% = $234.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON ARROW WEDGE PRESSURE CATH 5FR 110CM,272,RC,27202115,CDM,,,,,,both,,,469.0000,70.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,151.49,,,,,,,121.0500,469.0000,other,32.3% of $469.00 in Billed Charges for Rev 272 = $151.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BALLOON ARROW WEDGE PRESSURE CATH 5FR 110CM,272,RC,27202115,CDM,,,,,,both,,,469.0000,70.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,143.98,,,,,,,121.0500,469.0000,other,30.7% of $469.00 in Billed Charges for Rev 272 = $143.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BALLOON ARROW WEDGE PRESSURE CATH 5FR 110CM,272,RC,27202115,CDM,,,,,,both,,,469.0000,70.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,151.49,,,,,,,121.0500,469.0000,percent of total billed charges,32.3% of $469.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON ARROW WEDGE PRESSURE CATH 5FR 110CM,272,RC,27202115,CDM,,,,,,both,,,469.0000,70.3500,WELLCARE,WELLCARE MEDICAID,469.00,,,,,,,121.0500,469.0000,percent of total billed charges,100% of $469.00 in Billed Charges for Rev 272 = $469.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON FLOTATION PACING CATH,272,RC,27202139,CDM,,,,,,both,,,805.0000,120.7500,AETNA,AETNA,343.74,,,,,,,207.7700,805.0000,percent of total billed charges,42.7% of $805.00 in Billed Charges for Rev 272 = $343.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON FLOTATION PACING CATH,272,RC,27202139,CDM,,,,,,both,,,805.0000,120.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,563.50,,,,,,,207.7700,805.0000,percent of total billed charges,Rev 272 $805.00 in Billed Charges at 70% = $563.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON FLOTATION PACING CATH,272,RC,27202139,CDM,,,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA HMO,335.69,,,,,,,207.7700,805.0000,percent of total billed charges,41.7% of $805.00 in Billed Charges for Rev 272 = $335.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON FLOTATION PACING CATH,272,RC,27202139,CDM,,,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,373.52,,,,,,,207.7700,805.0000,percent of total billed charges,46.4% of $805.00 in Billed Charges for Rev 272 = $373.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON FLOTATION PACING CATH,272,RC,27202139,CDM,,,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,335.69,,,,,,,207.7700,805.0000,percent of total billed charges,41.7% of $805.00 in Billed Charges for Rev 272 = $335.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON FLOTATION PACING CATH,272,RC,27202139,CDM,,,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA PPO,335.69,,,,,,,207.7700,805.0000,percent of total billed charges,41.7% of $805.00 in Billed Charges for Rev 272 = $335.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON FLOTATION PACING CATH,272,RC,27202139,CDM,,,,,,both,,,805.0000,120.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,724.50,,,,,,,207.7700,805.0000,percent of total billed charges,90% of $805.00 in Billed Charges for Rev 272 = $724.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON FLOTATION PACING CATH,272,RC,27202139,CDM,,,,,,both,,,805.0000,120.7500,MEDCOST,MEDCOST VHN,383.10,,,,,,,207.7700,805.0000,percent of total billed charges,47.59% of $805.00 in Billed Charges for Rev 272 = $383.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON FLOTATION PACING CATH,272,RC,27202139,CDM,,,,,,both,,,805.0000,120.7500,SENTARA HEALTH,SENTARA HEALTH,207.77,,,,,,,207.7700,805.0000,percent of total billed charges,25.81% of $805.00 in Billed Charges for Rev 272 = $207.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON FLOTATION PACING CATH,272,RC,27202139,CDM,,,,,,both,,,805.0000,120.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",805.00,,,,,,,207.7700,805.0000,percent of total billed charges,100% of $805.00 in Billed Charges for Rev 272 = $805.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON FLOTATION PACING CATH,272,RC,27202139,CDM,,,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,402.50,,,,,,,207.7700,805.0000,percent of total billed charges,Rev 272 $805.00 in Billed Charges at 50% = $402.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON FLOTATION PACING CATH,272,RC,27202139,CDM,,,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,260.02,,,,,,,207.7700,805.0000,other,32.3% of $805.00 in Billed Charges for Rev 272 = $260.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BALLOON FLOTATION PACING CATH,272,RC,27202139,CDM,,,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,247.14,,,,,,,207.7700,805.0000,other,30.7% of $805.00 in Billed Charges for Rev 272 = $247.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BALLOON FLOTATION PACING CATH,272,RC,27202139,CDM,,,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,260.02,,,,,,,207.7700,805.0000,percent of total billed charges,32.3% of $805.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BALLOON FLOTATION PACING CATH,272,RC,27202139,CDM,,,,,,both,,,805.0000,120.7500,WELLCARE,WELLCARE MEDICAID,805.00,,,,,,,207.7700,805.0000,percent of total billed charges,100% of $805.00 in Billed Charges for Rev 272 = $805.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB MALE,270,RC,27000140,CDM,,,,,,both,,,60.0000,9.0000,AETNA,AETNA,25.62,,,,,,,15.4900,60.0000,percent of total billed charges,42.7% of $60.00 in Billed Charges for Rev 270 = $25.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB MALE,270,RC,27000140,CDM,,,,,,both,,,60.0000,9.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,42.00,,,,,,,15.4900,60.0000,percent of total billed charges,Rev 270 $60.00 in Billed Charges at 70% = $42.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB MALE,270,RC,27000140,CDM,,,,,,both,,,60.0000,9.0000,CIGNA HEALTHCARE,CIGNA HMO,25.02,,,,,,,15.4900,60.0000,percent of total billed charges,41.7% of $60.00 in Billed Charges for Rev 270 = $25.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB MALE,270,RC,27000140,CDM,,,,,,both,,,60.0000,9.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,27.84,,,,,,,15.4900,60.0000,percent of total billed charges,46.4% of $60.00 in Billed Charges for Rev 270 = $27.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB MALE,270,RC,27000140,CDM,,,,,,both,,,60.0000,9.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,25.02,,,,,,,15.4900,60.0000,percent of total billed charges,41.7% of $60.00 in Billed Charges for Rev 270 = $25.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB MALE,270,RC,27000140,CDM,,,,,,both,,,60.0000,9.0000,CIGNA HEALTHCARE,CIGNA PPO,25.02,,,,,,,15.4900,60.0000,percent of total billed charges,41.7% of $60.00 in Billed Charges for Rev 270 = $25.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB MALE,270,RC,27000140,CDM,,,,,,both,,,60.0000,9.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,54.00,,,,,,,15.4900,60.0000,percent of total billed charges,90% of $60.00 in Billed Charges for Rev 270 = $54.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB MALE,270,RC,27000140,CDM,,,,,,both,,,60.0000,9.0000,MEDCOST,MEDCOST VHN,28.55,,,,,,,15.4900,60.0000,percent of total billed charges,47.59% of $60.00 in Billed Charges for Rev 270 = $28.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB MALE,270,RC,27000140,CDM,,,,,,both,,,60.0000,9.0000,SENTARA HEALTH,SENTARA HEALTH,15.49,,,,,,,15.4900,60.0000,percent of total billed charges,25.81% of $60.00 in Billed Charges for Rev 270 = $15.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB MALE,270,RC,27000140,CDM,,,,,,both,,,60.0000,9.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",60.00,,,,,,,15.4900,60.0000,percent of total billed charges,100% of $60.00 in Billed Charges for Rev 270 = $60.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB MALE,270,RC,27000140,CDM,,,,,,both,,,60.0000,9.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,30.00,,,,,,,15.4900,60.0000,percent of total billed charges,Rev 270 $60.00 in Billed Charges at 50% = $30.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB MALE,270,RC,27000140,CDM,,,,,,both,,,60.0000,9.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,19.38,,,,,,,15.4900,60.0000,other,32.3% of $60.00 in Billed Charges for Rev 270 = $19.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BELT RIB MALE,270,RC,27000140,CDM,,,,,,both,,,60.0000,9.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,18.42,,,,,,,15.4900,60.0000,other,30.7% of $60.00 in Billed Charges for Rev 270 = $18.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BELT RIB MALE,270,RC,27000140,CDM,,,,,,both,,,60.0000,9.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,19.38,,,,,,,15.4900,60.0000,percent of total billed charges,32.3% of $60.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BELT RIB MALE,270,RC,27000140,CDM,,,,,,both,,,60.0000,9.0000,WELLCARE,WELLCARE MEDICAID,60.00,,,,,,,15.4900,60.0000,percent of total billed charges,100% of $60.00 in Billed Charges for Rev 270 = $60.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING HYDROGEL 4X4 82400,272,RC,27200668,CDM,,,,,,both,,,21.0000,3.1500,AETNA,AETNA,8.97,,,,,,,5.4200,21.0000,percent of total billed charges,42.7% of $21.00 in Billed Charges for Rev 272 = $8.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING HYDROGEL 4X4 82400,272,RC,27200668,CDM,,,,,,both,,,21.0000,3.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,14.70,,,,,,,5.4200,21.0000,percent of total billed charges,Rev 272 $21.00 in Billed Charges at 70% = $14.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING HYDROGEL 4X4 82400,272,RC,27200668,CDM,,,,,,both,,,21.0000,3.1500,CIGNA HEALTHCARE,CIGNA HMO,8.76,,,,,,,5.4200,21.0000,percent of total billed charges,41.7% of $21.00 in Billed Charges for Rev 272 = $8.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING HYDROGEL 4X4 82400,272,RC,27200668,CDM,,,,,,both,,,21.0000,3.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,9.74,,,,,,,5.4200,21.0000,percent of total billed charges,46.4% of $21.00 in Billed Charges for Rev 272 = $9.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING HYDROGEL 4X4 82400,272,RC,27200668,CDM,,,,,,both,,,21.0000,3.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8.76,,,,,,,5.4200,21.0000,percent of total billed charges,41.7% of $21.00 in Billed Charges for Rev 272 = $8.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING HYDROGEL 4X4 82400,272,RC,27200668,CDM,,,,,,both,,,21.0000,3.1500,CIGNA HEALTHCARE,CIGNA PPO,8.76,,,,,,,5.4200,21.0000,percent of total billed charges,41.7% of $21.00 in Billed Charges for Rev 272 = $8.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING HYDROGEL 4X4 82400,272,RC,27200668,CDM,,,,,,both,,,21.0000,3.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,18.90,,,,,,,5.4200,21.0000,percent of total billed charges,90% of $21.00 in Billed Charges for Rev 272 = $18.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING HYDROGEL 4X4 82400,272,RC,27200668,CDM,,,,,,both,,,21.0000,3.1500,MEDCOST,MEDCOST VHN,9.99,,,,,,,5.4200,21.0000,percent of total billed charges,47.59% of $21.00 in Billed Charges for Rev 272 = $9.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING HYDROGEL 4X4 82400,272,RC,27200668,CDM,,,,,,both,,,21.0000,3.1500,SENTARA HEALTH,SENTARA HEALTH,5.42,,,,,,,5.4200,21.0000,percent of total billed charges,25.81% of $21.00 in Billed Charges for Rev 272 = $5.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING HYDROGEL 4X4 82400,272,RC,27200668,CDM,,,,,,both,,,21.0000,3.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",21.00,,,,,,,5.4200,21.0000,percent of total billed charges,100% of $21.00 in Billed Charges for Rev 272 = $21.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING HYDROGEL 4X4 82400,272,RC,27200668,CDM,,,,,,both,,,21.0000,3.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,10.50,,,,,,,5.4200,21.0000,percent of total billed charges,Rev 272 $21.00 in Billed Charges at 50% = $10.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING HYDROGEL 4X4 82400,272,RC,27200668,CDM,,,,,,both,,,21.0000,3.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,6.78,,,,,,,5.4200,21.0000,other,32.3% of $21.00 in Billed Charges for Rev 272 = $6.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING HYDROGEL 4X4 82400,272,RC,27200668,CDM,,,,,,both,,,21.0000,3.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,6.45,,,,,,,5.4200,21.0000,other,30.7% of $21.00 in Billed Charges for Rev 272 = $6.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING HYDROGEL 4X4 82400,272,RC,27200668,CDM,,,,,,both,,,21.0000,3.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,6.78,,,,,,,5.4200,21.0000,percent of total billed charges,32.3% of $21.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING HYDROGEL 4X4 82400,272,RC,27200668,CDM,,,,,,both,,,21.0000,3.1500,WELLCARE,WELLCARE MEDICAID,21.00,,,,,,,5.4200,21.0000,percent of total billed charges,100% of $21.00 in Billed Charges for Rev 272 = $21.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,20.5400,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 70110 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,20.5400,462.0000,fee schedule,APG 00471 Proc 70110 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,20.5400,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,20.5400,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,20.5400,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,206.78,,,,,,,20.5400,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,20.5400,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,20.5400,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,20.5400,462.0000,fee schedule,APG 00471 Proc 70110 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,20.5400,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,20.5400,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,20.5400,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,38.56,,,,,,,20.5400,462.0000,fee schedule,$38.56 from Fee Schedule BLDTM_23 for Rev 320 Proc 70110 * Qty 1 = $38.56 at 100% = $38.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,79.87,,,,,,,20.5400,462.0000,fee schedule,$24.96 from Fee Schedule BCFSC for Rev 320 Proc 70110 * Qty 1 = $24.96 at 320% = $79.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,20.5400,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,81.62,,,,,,,20.5400,462.0000,fee schedule,$24.96 from Fee Schedule BCFSC for Rev 320 Proc 70110 * Qty 1 = $24.96 at 327% = $81.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,81.62,,,,,,,20.5400,462.0000,fee schedule,$24.96 from Fee Schedule BCFSC for Rev 320 Proc 70110 * Qty 1 = $24.96 at 327% = $81.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,20.54,,,,,,,20.5400,462.0000,fee schedule,$17.71 from Fee Schedule TC_24 for Rev 320 Proc 70110 * Qty 1 = $17.71 at 116% = $20.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,20.54,,,,,,,20.5400,462.0000,fee schedule,$17.71 from Fee Schedule TC_24 for Rev 320 Proc 70110 * Qty 1 = $17.71 at 116% = $20.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,20.5400,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70110 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,59.88,,,,,,,20.5400,462.0000,fee schedule,$59.88 from Fee Schedule CGIFP_25LR for Rev 320 Proc 70110 * Qty 1 = $59.88 at 100% = $59.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,20.5400,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,20.5400,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70110 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,20.5400,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70110 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,20.5400,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,20.5400,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 70110 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,94.85,,,,,,,20.5400,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,20.5400,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,20.5400,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 70110 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,20.5400,462.0000,fee schedule,APG 00471 Proc 70110 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,20.5400,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,20.5400,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,20.5400,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,20.5400,462.0000,fee schedule,APG 00471 Proc 70110 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,20.5400,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 70110 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,20.5400,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,20.5400,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 70110 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,20.5400,462.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 70110 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,20.5400,462.0000,other,Rev 320 Proc 70110 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,20.5400,462.0000,other,Rev 320 Proc 70110 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,20.5400,462.0000,other,Rev 320 Proc 70110 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,20.5400,462.0000,fee schedule,APG 00471 Proc 70110 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,20.5400,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,20.5400,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,20.5400,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 70110 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MANDIBLE JAW 4 VIEW+,70110,CPT,320,RC,32000002,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,20.5400,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING MICRODON,272,RC,27200670,CDM,,,,,,both,,,4.0000,0.6000,AETNA,AETNA,1.71,,,,,,,1.0300,4.0000,percent of total billed charges,42.7% of $4.00 in Billed Charges for Rev 272 = $1.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING MICRODON,272,RC,27200670,CDM,,,,,,both,,,4.0000,0.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2.80,,,,,,,1.0300,4.0000,percent of total billed charges,Rev 272 $4.00 in Billed Charges at 70% = $2.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING MICRODON,272,RC,27200670,CDM,,,,,,both,,,4.0000,0.6000,CIGNA HEALTHCARE,CIGNA HMO,1.67,,,,,,,1.0300,4.0000,percent of total billed charges,41.7% of $4.00 in Billed Charges for Rev 272 = $1.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING MICRODON,272,RC,27200670,CDM,,,,,,both,,,4.0000,0.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1.86,,,,,,,1.0300,4.0000,percent of total billed charges,46.4% of $4.00 in Billed Charges for Rev 272 = $1.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING MICRODON,272,RC,27200670,CDM,,,,,,both,,,4.0000,0.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1.67,,,,,,,1.0300,4.0000,percent of total billed charges,41.7% of $4.00 in Billed Charges for Rev 272 = $1.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING MICRODON,272,RC,27200670,CDM,,,,,,both,,,4.0000,0.6000,CIGNA HEALTHCARE,CIGNA PPO,1.67,,,,,,,1.0300,4.0000,percent of total billed charges,41.7% of $4.00 in Billed Charges for Rev 272 = $1.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING MICRODON,272,RC,27200670,CDM,,,,,,both,,,4.0000,0.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3.60,,,,,,,1.0300,4.0000,percent of total billed charges,90% of $4.00 in Billed Charges for Rev 272 = $3.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING MICRODON,272,RC,27200670,CDM,,,,,,both,,,4.0000,0.6000,MEDCOST,MEDCOST VHN,1.90,,,,,,,1.0300,4.0000,percent of total billed charges,47.59% of $4.00 in Billed Charges for Rev 272 = $1.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING MICRODON,272,RC,27200670,CDM,,,,,,both,,,4.0000,0.6000,SENTARA HEALTH,SENTARA HEALTH,1.03,,,,,,,1.0300,4.0000,percent of total billed charges,25.81% of $4.00 in Billed Charges for Rev 272 = $1.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING MICRODON,272,RC,27200670,CDM,,,,,,both,,,4.0000,0.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4.00,,,,,,,1.0300,4.0000,percent of total billed charges,100% of $4.00 in Billed Charges for Rev 272 = $4.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING MICRODON,272,RC,27200670,CDM,,,,,,both,,,4.0000,0.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2.00,,,,,,,1.0300,4.0000,percent of total billed charges,Rev 272 $4.00 in Billed Charges at 50% = $2.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING MICRODON,272,RC,27200670,CDM,,,,,,both,,,4.0000,0.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1.29,,,,,,,1.0300,4.0000,other,32.3% of $4.00 in Billed Charges for Rev 272 = $1.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING MICRODON,272,RC,27200670,CDM,,,,,,both,,,4.0000,0.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1.23,,,,,,,1.0300,4.0000,other,30.7% of $4.00 in Billed Charges for Rev 272 = $1.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING MICRODON,272,RC,27200670,CDM,,,,,,both,,,4.0000,0.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,1.29,,,,,,,1.0300,4.0000,percent of total billed charges,32.3% of $4.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING MICRODON,272,RC,27200670,CDM,,,,,,both,,,4.0000,0.6000,WELLCARE,WELLCARE MEDICAID,4.00,,,,,,,1.0300,4.0000,percent of total billed charges,100% of $4.00 in Billed Charges for Rev 272 = $4.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING PROFORE 4 LAY 66020016,272,RC,27200673,CDM,,,,,,both,,,85.0000,12.7500,AETNA,AETNA,36.30,,,,,,,21.9400,85.0000,percent of total billed charges,42.7% of $85.00 in Billed Charges for Rev 272 = $36.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING PROFORE 4 LAY 66020016,272,RC,27200673,CDM,,,,,,both,,,85.0000,12.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,59.50,,,,,,,21.9400,85.0000,percent of total billed charges,Rev 272 $85.00 in Billed Charges at 70% = $59.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING PROFORE 4 LAY 66020016,272,RC,27200673,CDM,,,,,,both,,,85.0000,12.7500,CIGNA HEALTHCARE,CIGNA HMO,35.45,,,,,,,21.9400,85.0000,percent of total billed charges,41.7% of $85.00 in Billed Charges for Rev 272 = $35.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING PROFORE 4 LAY 66020016,272,RC,27200673,CDM,,,,,,both,,,85.0000,12.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,39.44,,,,,,,21.9400,85.0000,percent of total billed charges,46.4% of $85.00 in Billed Charges for Rev 272 = $39.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING PROFORE 4 LAY 66020016,272,RC,27200673,CDM,,,,,,both,,,85.0000,12.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,35.45,,,,,,,21.9400,85.0000,percent of total billed charges,41.7% of $85.00 in Billed Charges for Rev 272 = $35.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING PROFORE 4 LAY 66020016,272,RC,27200673,CDM,,,,,,both,,,85.0000,12.7500,CIGNA HEALTHCARE,CIGNA PPO,35.45,,,,,,,21.9400,85.0000,percent of total billed charges,41.7% of $85.00 in Billed Charges for Rev 272 = $35.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING PROFORE 4 LAY 66020016,272,RC,27200673,CDM,,,,,,both,,,85.0000,12.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,76.50,,,,,,,21.9400,85.0000,percent of total billed charges,90% of $85.00 in Billed Charges for Rev 272 = $76.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING PROFORE 4 LAY 66020016,272,RC,27200673,CDM,,,,,,both,,,85.0000,12.7500,MEDCOST,MEDCOST VHN,40.45,,,,,,,21.9400,85.0000,percent of total billed charges,47.59% of $85.00 in Billed Charges for Rev 272 = $40.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING PROFORE 4 LAY 66020016,272,RC,27200673,CDM,,,,,,both,,,85.0000,12.7500,SENTARA HEALTH,SENTARA HEALTH,21.94,,,,,,,21.9400,85.0000,percent of total billed charges,25.81% of $85.00 in Billed Charges for Rev 272 = $21.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING PROFORE 4 LAY 66020016,272,RC,27200673,CDM,,,,,,both,,,85.0000,12.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",85.00,,,,,,,21.9400,85.0000,percent of total billed charges,100% of $85.00 in Billed Charges for Rev 272 = $85.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING PROFORE 4 LAY 66020016,272,RC,27200673,CDM,,,,,,both,,,85.0000,12.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,42.50,,,,,,,21.9400,85.0000,percent of total billed charges,Rev 272 $85.00 in Billed Charges at 50% = $42.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING PROFORE 4 LAY 66020016,272,RC,27200673,CDM,,,,,,both,,,85.0000,12.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,27.46,,,,,,,21.9400,85.0000,other,32.3% of $85.00 in Billed Charges for Rev 272 = $27.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING PROFORE 4 LAY 66020016,272,RC,27200673,CDM,,,,,,both,,,85.0000,12.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,26.10,,,,,,,21.9400,85.0000,other,30.7% of $85.00 in Billed Charges for Rev 272 = $26.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING PROFORE 4 LAY 66020016,272,RC,27200673,CDM,,,,,,both,,,85.0000,12.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,27.46,,,,,,,21.9400,85.0000,percent of total billed charges,32.3% of $85.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING PROFORE 4 LAY 66020016,272,RC,27200673,CDM,,,,,,both,,,85.0000,12.7500,WELLCARE,WELLCARE MEDICAID,85.00,,,,,,,21.9400,85.0000,percent of total billed charges,100% of $85.00 in Billed Charges for Rev 272 = $85.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRILL BIT 2.5MM AR-8916-06,272,RC,27210678,CDM,,,,,,both,,,335.0000,50.2500,AETNA,AETNA,143.05,,,,,,,86.4600,335.0000,percent of total billed charges,42.7% of $335.00 in Billed Charges for Rev 272 = $143.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRILL BIT 2.5MM AR-8916-06,272,RC,27210678,CDM,,,,,,both,,,335.0000,50.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,234.50,,,,,,,86.4600,335.0000,percent of total billed charges,Rev 272 $335.00 in Billed Charges at 70% = $234.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRILL BIT 2.5MM AR-8916-06,272,RC,27210678,CDM,,,,,,both,,,335.0000,50.2500,CIGNA HEALTHCARE,CIGNA HMO,139.70,,,,,,,86.4600,335.0000,percent of total billed charges,41.7% of $335.00 in Billed Charges for Rev 272 = $139.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRILL BIT 2.5MM AR-8916-06,272,RC,27210678,CDM,,,,,,both,,,335.0000,50.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,155.44,,,,,,,86.4600,335.0000,percent of total billed charges,46.4% of $335.00 in Billed Charges for Rev 272 = $155.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRILL BIT 2.5MM AR-8916-06,272,RC,27210678,CDM,,,,,,both,,,335.0000,50.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,139.70,,,,,,,86.4600,335.0000,percent of total billed charges,41.7% of $335.00 in Billed Charges for Rev 272 = $139.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRILL BIT 2.5MM AR-8916-06,272,RC,27210678,CDM,,,,,,both,,,335.0000,50.2500,CIGNA HEALTHCARE,CIGNA PPO,139.70,,,,,,,86.4600,335.0000,percent of total billed charges,41.7% of $335.00 in Billed Charges for Rev 272 = $139.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRILL BIT 2.5MM AR-8916-06,272,RC,27210678,CDM,,,,,,both,,,335.0000,50.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,301.50,,,,,,,86.4600,335.0000,percent of total billed charges,90% of $335.00 in Billed Charges for Rev 272 = $301.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRILL BIT 2.5MM AR-8916-06,272,RC,27210678,CDM,,,,,,both,,,335.0000,50.2500,MEDCOST,MEDCOST VHN,159.43,,,,,,,86.4600,335.0000,percent of total billed charges,47.59% of $335.00 in Billed Charges for Rev 272 = $159.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRILL BIT 2.5MM AR-8916-06,272,RC,27210678,CDM,,,,,,both,,,335.0000,50.2500,SENTARA HEALTH,SENTARA HEALTH,86.46,,,,,,,86.4600,335.0000,percent of total billed charges,25.81% of $335.00 in Billed Charges for Rev 272 = $86.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRILL BIT 2.5MM AR-8916-06,272,RC,27210678,CDM,,,,,,both,,,335.0000,50.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",335.00,,,,,,,86.4600,335.0000,percent of total billed charges,100% of $335.00 in Billed Charges for Rev 272 = $335.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRILL BIT 2.5MM AR-8916-06,272,RC,27210678,CDM,,,,,,both,,,335.0000,50.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,167.50,,,,,,,86.4600,335.0000,percent of total billed charges,Rev 272 $335.00 in Billed Charges at 50% = $167.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRILL BIT 2.5MM AR-8916-06,272,RC,27210678,CDM,,,,,,both,,,335.0000,50.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,108.21,,,,,,,86.4600,335.0000,other,32.3% of $335.00 in Billed Charges for Rev 272 = $108.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRILL BIT 2.5MM AR-8916-06,272,RC,27210678,CDM,,,,,,both,,,335.0000,50.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,102.85,,,,,,,86.4600,335.0000,other,30.7% of $335.00 in Billed Charges for Rev 272 = $102.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRILL BIT 2.5MM AR-8916-06,272,RC,27210678,CDM,,,,,,both,,,335.0000,50.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,108.21,,,,,,,86.4600,335.0000,percent of total billed charges,32.3% of $335.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRILL BIT 2.5MM AR-8916-06,272,RC,27210678,CDM,,,,,,both,,,335.0000,50.2500,WELLCARE,WELLCARE MEDICAID,335.00,,,,,,,86.4600,335.0000,percent of total billed charges,100% of $335.00 in Billed Charges for Rev 272 = $335.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRIVER POWER G3 EZ-IO,272,RC,27202242,CDM,,,,,,both,,,1406.0000,210.9000,AETNA,AETNA,600.36,,,,,,,362.8900,1406.0000,percent of total billed charges,"42.7% of $1,406.00 in Billed Charges for Rev 272 = $600.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRIVER POWER G3 EZ-IO,272,RC,27202242,CDM,,,,,,both,,,1406.0000,210.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,984.20,,,,,,,362.8900,1406.0000,percent of total billed charges,"Rev 272 $1,406.00 in Billed Charges at 70% = $984.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRIVER POWER G3 EZ-IO,272,RC,27202242,CDM,,,,,,both,,,1406.0000,210.9000,CIGNA HEALTHCARE,CIGNA HMO,586.30,,,,,,,362.8900,1406.0000,percent of total billed charges,"41.7% of $1,406.00 in Billed Charges for Rev 272 = $586.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRIVER POWER G3 EZ-IO,272,RC,27202242,CDM,,,,,,both,,,1406.0000,210.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,652.38,,,,,,,362.8900,1406.0000,percent of total billed charges,"46.4% of $1,406.00 in Billed Charges for Rev 272 = $652.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRIVER POWER G3 EZ-IO,272,RC,27202242,CDM,,,,,,both,,,1406.0000,210.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,586.30,,,,,,,362.8900,1406.0000,percent of total billed charges,"41.7% of $1,406.00 in Billed Charges for Rev 272 = $586.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRIVER POWER G3 EZ-IO,272,RC,27202242,CDM,,,,,,both,,,1406.0000,210.9000,CIGNA HEALTHCARE,CIGNA PPO,586.30,,,,,,,362.8900,1406.0000,percent of total billed charges,"41.7% of $1,406.00 in Billed Charges for Rev 272 = $586.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRIVER POWER G3 EZ-IO,272,RC,27202242,CDM,,,,,,both,,,1406.0000,210.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1265.40,,,,,,,362.8900,1406.0000,percent of total billed charges,"90% of $1,406.00 in Billed Charges for Rev 272 = $1,265.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRIVER POWER G3 EZ-IO,272,RC,27202242,CDM,,,,,,both,,,1406.0000,210.9000,MEDCOST,MEDCOST VHN,669.12,,,,,,,362.8900,1406.0000,percent of total billed charges,"47.59% of $1,406.00 in Billed Charges for Rev 272 = $669.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRIVER POWER G3 EZ-IO,272,RC,27202242,CDM,,,,,,both,,,1406.0000,210.9000,SENTARA HEALTH,SENTARA HEALTH,362.89,,,,,,,362.8900,1406.0000,percent of total billed charges,"25.81% of $1,406.00 in Billed Charges for Rev 272 = $362.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRIVER POWER G3 EZ-IO,272,RC,27202242,CDM,,,,,,both,,,1406.0000,210.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1406.00,,,,,,,362.8900,1406.0000,percent of total billed charges,"100% of $1,406.00 in Billed Charges for Rev 272 = $1,406.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRIVER POWER G3 EZ-IO,272,RC,27202242,CDM,,,,,,both,,,1406.0000,210.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,703.00,,,,,,,362.8900,1406.0000,percent of total billed charges,"Rev 272 $1,406.00 in Billed Charges at 50% = $703.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRIVER POWER G3 EZ-IO,272,RC,27202242,CDM,,,,,,both,,,1406.0000,210.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,454.14,,,,,,,362.8900,1406.0000,other,"32.3% of $1,406.00 in Billed Charges for Rev 272 = $454.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DRIVER POWER G3 EZ-IO,272,RC,27202242,CDM,,,,,,both,,,1406.0000,210.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,431.64,,,,,,,362.8900,1406.0000,other,"30.7% of $1,406.00 in Billed Charges for Rev 272 = $431.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DRIVER POWER G3 EZ-IO,272,RC,27202242,CDM,,,,,,both,,,1406.0000,210.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,454.14,,,,,,,362.8900,1406.0000,percent of total billed charges,"32.3% of $1,406.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRIVER POWER G3 EZ-IO,272,RC,27202242,CDM,,,,,,both,,,1406.0000,210.9000,WELLCARE,WELLCARE MEDICAID,1406.00,,,,,,,362.8900,1406.0000,percent of total billed charges,"100% of $1,406.00 in Billed Charges for Rev 272 = $1,406.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ELECTRODE INDIFFERENT,272,RC,27200681,CDM,,,,,,both,,,579.0000,86.8500,AETNA,AETNA,247.23,,,,,,,149.4400,579.0000,percent of total billed charges,42.7% of $579.00 in Billed Charges for Rev 272 = $247.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ELECTRODE INDIFFERENT,272,RC,27200681,CDM,,,,,,both,,,579.0000,86.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,405.30,,,,,,,149.4400,579.0000,percent of total billed charges,Rev 272 $579.00 in Billed Charges at 70% = $405.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ELECTRODE INDIFFERENT,272,RC,27200681,CDM,,,,,,both,,,579.0000,86.8500,CIGNA HEALTHCARE,CIGNA HMO,241.44,,,,,,,149.4400,579.0000,percent of total billed charges,41.7% of $579.00 in Billed Charges for Rev 272 = $241.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ELECTRODE INDIFFERENT,272,RC,27200681,CDM,,,,,,both,,,579.0000,86.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,268.66,,,,,,,149.4400,579.0000,percent of total billed charges,46.4% of $579.00 in Billed Charges for Rev 272 = $268.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ELECTRODE INDIFFERENT,272,RC,27200681,CDM,,,,,,both,,,579.0000,86.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,241.44,,,,,,,149.4400,579.0000,percent of total billed charges,41.7% of $579.00 in Billed Charges for Rev 272 = $241.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ELECTRODE INDIFFERENT,272,RC,27200681,CDM,,,,,,both,,,579.0000,86.8500,CIGNA HEALTHCARE,CIGNA PPO,241.44,,,,,,,149.4400,579.0000,percent of total billed charges,41.7% of $579.00 in Billed Charges for Rev 272 = $241.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ELECTRODE INDIFFERENT,272,RC,27200681,CDM,,,,,,both,,,579.0000,86.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,521.10,,,,,,,149.4400,579.0000,percent of total billed charges,90% of $579.00 in Billed Charges for Rev 272 = $521.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ELECTRODE INDIFFERENT,272,RC,27200681,CDM,,,,,,both,,,579.0000,86.8500,MEDCOST,MEDCOST VHN,275.55,,,,,,,149.4400,579.0000,percent of total billed charges,47.59% of $579.00 in Billed Charges for Rev 272 = $275.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ELECTRODE INDIFFERENT,272,RC,27200681,CDM,,,,,,both,,,579.0000,86.8500,SENTARA HEALTH,SENTARA HEALTH,149.44,,,,,,,149.4400,579.0000,percent of total billed charges,25.81% of $579.00 in Billed Charges for Rev 272 = $149.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ELECTRODE INDIFFERENT,272,RC,27200681,CDM,,,,,,both,,,579.0000,86.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",579.00,,,,,,,149.4400,579.0000,percent of total billed charges,100% of $579.00 in Billed Charges for Rev 272 = $579.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ELECTRODE INDIFFERENT,272,RC,27200681,CDM,,,,,,both,,,579.0000,86.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,289.50,,,,,,,149.4400,579.0000,percent of total billed charges,Rev 272 $579.00 in Billed Charges at 50% = $289.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ELECTRODE INDIFFERENT,272,RC,27200681,CDM,,,,,,both,,,579.0000,86.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,187.02,,,,,,,149.4400,579.0000,other,32.3% of $579.00 in Billed Charges for Rev 272 = $187.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ELECTRODE INDIFFERENT,272,RC,27200681,CDM,,,,,,both,,,579.0000,86.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,177.75,,,,,,,149.4400,579.0000,other,30.7% of $579.00 in Billed Charges for Rev 272 = $177.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ELECTRODE INDIFFERENT,272,RC,27200681,CDM,,,,,,both,,,579.0000,86.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,187.02,,,,,,,149.4400,579.0000,percent of total billed charges,32.3% of $579.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ELECTRODE INDIFFERENT,272,RC,27200681,CDM,,,,,,both,,,579.0000,86.8500,WELLCARE,WELLCARE MEDICAID,579.00,,,,,,,149.4400,579.0000,percent of total billed charges,100% of $579.00 in Billed Charges for Rev 272 = $579.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOL CONTOUR PART ALL SIZES,272,RC,27200683,CDM,,,,,,both,,,1331.0000,199.6500,AETNA,AETNA,568.34,,,,,,,343.5300,1331.0000,percent of total billed charges,"42.7% of $1,331.00 in Billed Charges for Rev 272 = $568.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL CONTOUR PART ALL SIZES,272,RC,27200683,CDM,,,,,,both,,,1331.0000,199.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,931.70,,,,,,,343.5300,1331.0000,percent of total billed charges,"Rev 272 $1,331.00 in Billed Charges at 70% = $931.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL CONTOUR PART ALL SIZES,272,RC,27200683,CDM,,,,,,both,,,1331.0000,199.6500,CIGNA HEALTHCARE,CIGNA HMO,555.03,,,,,,,343.5300,1331.0000,percent of total billed charges,"41.7% of $1,331.00 in Billed Charges for Rev 272 = $555.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL CONTOUR PART ALL SIZES,272,RC,27200683,CDM,,,,,,both,,,1331.0000,199.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,617.58,,,,,,,343.5300,1331.0000,percent of total billed charges,"46.4% of $1,331.00 in Billed Charges for Rev 272 = $617.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL CONTOUR PART ALL SIZES,272,RC,27200683,CDM,,,,,,both,,,1331.0000,199.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,555.03,,,,,,,343.5300,1331.0000,percent of total billed charges,"41.7% of $1,331.00 in Billed Charges for Rev 272 = $555.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL CONTOUR PART ALL SIZES,272,RC,27200683,CDM,,,,,,both,,,1331.0000,199.6500,CIGNA HEALTHCARE,CIGNA PPO,555.03,,,,,,,343.5300,1331.0000,percent of total billed charges,"41.7% of $1,331.00 in Billed Charges for Rev 272 = $555.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL CONTOUR PART ALL SIZES,272,RC,27200683,CDM,,,,,,both,,,1331.0000,199.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1197.90,,,,,,,343.5300,1331.0000,percent of total billed charges,"90% of $1,331.00 in Billed Charges for Rev 272 = $1,197.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL CONTOUR PART ALL SIZES,272,RC,27200683,CDM,,,,,,both,,,1331.0000,199.6500,MEDCOST,MEDCOST VHN,633.42,,,,,,,343.5300,1331.0000,percent of total billed charges,"47.59% of $1,331.00 in Billed Charges for Rev 272 = $633.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL CONTOUR PART ALL SIZES,272,RC,27200683,CDM,,,,,,both,,,1331.0000,199.6500,SENTARA HEALTH,SENTARA HEALTH,343.53,,,,,,,343.5300,1331.0000,percent of total billed charges,"25.81% of $1,331.00 in Billed Charges for Rev 272 = $343.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL CONTOUR PART ALL SIZES,272,RC,27200683,CDM,,,,,,both,,,1331.0000,199.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1331.00,,,,,,,343.5300,1331.0000,percent of total billed charges,"100% of $1,331.00 in Billed Charges for Rev 272 = $1,331.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL CONTOUR PART ALL SIZES,272,RC,27200683,CDM,,,,,,both,,,1331.0000,199.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,665.50,,,,,,,343.5300,1331.0000,percent of total billed charges,"Rev 272 $1,331.00 in Billed Charges at 50% = $665.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL CONTOUR PART ALL SIZES,272,RC,27200683,CDM,,,,,,both,,,1331.0000,199.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,429.91,,,,,,,343.5300,1331.0000,other,"32.3% of $1,331.00 in Billed Charges for Rev 272 = $429.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EMBOL CONTOUR PART ALL SIZES,272,RC,27200683,CDM,,,,,,both,,,1331.0000,199.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,408.62,,,,,,,343.5300,1331.0000,other,"30.7% of $1,331.00 in Billed Charges for Rev 272 = $408.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EMBOL CONTOUR PART ALL SIZES,272,RC,27200683,CDM,,,,,,both,,,1331.0000,199.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,429.91,,,,,,,343.5300,1331.0000,percent of total billed charges,"32.3% of $1,331.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL CONTOUR PART ALL SIZES,272,RC,27200683,CDM,,,,,,both,,,1331.0000,199.6500,WELLCARE,WELLCARE MEDICAID,1331.00,,,,,,,343.5300,1331.0000,percent of total billed charges,"100% of $1,331.00 in Billed Charges for Rev 272 = $1,331.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL EMBOGOLD ALL SIZES,272,RC,27200684,CDM,,,,,,both,,,1181.0000,177.1500,AETNA,AETNA,504.29,,,,,,,304.8200,1181.0000,percent of total billed charges,"42.7% of $1,181.00 in Billed Charges for Rev 272 = $504.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL EMBOGOLD ALL SIZES,272,RC,27200684,CDM,,,,,,both,,,1181.0000,177.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,826.70,,,,,,,304.8200,1181.0000,percent of total billed charges,"Rev 272 $1,181.00 in Billed Charges at 70% = $826.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL EMBOGOLD ALL SIZES,272,RC,27200684,CDM,,,,,,both,,,1181.0000,177.1500,CIGNA HEALTHCARE,CIGNA HMO,492.48,,,,,,,304.8200,1181.0000,percent of total billed charges,"41.7% of $1,181.00 in Billed Charges for Rev 272 = $492.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL EMBOGOLD ALL SIZES,272,RC,27200684,CDM,,,,,,both,,,1181.0000,177.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,547.98,,,,,,,304.8200,1181.0000,percent of total billed charges,"46.4% of $1,181.00 in Billed Charges for Rev 272 = $547.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL EMBOGOLD ALL SIZES,272,RC,27200684,CDM,,,,,,both,,,1181.0000,177.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,492.48,,,,,,,304.8200,1181.0000,percent of total billed charges,"41.7% of $1,181.00 in Billed Charges for Rev 272 = $492.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL EMBOGOLD ALL SIZES,272,RC,27200684,CDM,,,,,,both,,,1181.0000,177.1500,CIGNA HEALTHCARE,CIGNA PPO,492.48,,,,,,,304.8200,1181.0000,percent of total billed charges,"41.7% of $1,181.00 in Billed Charges for Rev 272 = $492.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL EMBOGOLD ALL SIZES,272,RC,27200684,CDM,,,,,,both,,,1181.0000,177.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1062.90,,,,,,,304.8200,1181.0000,percent of total billed charges,"90% of $1,181.00 in Billed Charges for Rev 272 = $1,062.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL EMBOGOLD ALL SIZES,272,RC,27200684,CDM,,,,,,both,,,1181.0000,177.1500,MEDCOST,MEDCOST VHN,562.04,,,,,,,304.8200,1181.0000,percent of total billed charges,"47.59% of $1,181.00 in Billed Charges for Rev 272 = $562.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL EMBOGOLD ALL SIZES,272,RC,27200684,CDM,,,,,,both,,,1181.0000,177.1500,SENTARA HEALTH,SENTARA HEALTH,304.82,,,,,,,304.8200,1181.0000,percent of total billed charges,"25.81% of $1,181.00 in Billed Charges for Rev 272 = $304.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL EMBOGOLD ALL SIZES,272,RC,27200684,CDM,,,,,,both,,,1181.0000,177.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1181.00,,,,,,,304.8200,1181.0000,percent of total billed charges,"100% of $1,181.00 in Billed Charges for Rev 272 = $1,181.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL EMBOGOLD ALL SIZES,272,RC,27200684,CDM,,,,,,both,,,1181.0000,177.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,590.50,,,,,,,304.8200,1181.0000,percent of total billed charges,"Rev 272 $1,181.00 in Billed Charges at 50% = $590.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL EMBOGOLD ALL SIZES,272,RC,27200684,CDM,,,,,,both,,,1181.0000,177.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,381.46,,,,,,,304.8200,1181.0000,other,"32.3% of $1,181.00 in Billed Charges for Rev 272 = $381.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EMBOL EMBOGOLD ALL SIZES,272,RC,27200684,CDM,,,,,,both,,,1181.0000,177.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,362.57,,,,,,,304.8200,1181.0000,other,"30.7% of $1,181.00 in Billed Charges for Rev 272 = $362.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EMBOL EMBOGOLD ALL SIZES,272,RC,27200684,CDM,,,,,,both,,,1181.0000,177.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,381.46,,,,,,,304.8200,1181.0000,percent of total billed charges,"32.3% of $1,181.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOL EMBOGOLD ALL SIZES,272,RC,27200684,CDM,,,,,,both,,,1181.0000,177.1500,WELLCARE,WELLCARE MEDICAID,1181.00,,,,,,,304.8200,1181.0000,percent of total billed charges,"100% of $1,181.00 in Billed Charges for Rev 272 = $1,181.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EMBOLI COIL,272,RC,27200686,CDM,,,,,,both,,,289.0000,43.3500,AETNA,AETNA,123.40,,,,,,,74.5900,289.0000,percent of total billed charges,42.7% of $289.00 in Billed Charges for Rev 272 = $123.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI COIL,272,RC,27200686,CDM,,,,,,both,,,289.0000,43.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,202.30,,,,,,,74.5900,289.0000,percent of total billed charges,Rev 272 $289.00 in Billed Charges at 70% = $202.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI COIL,272,RC,27200686,CDM,,,,,,both,,,289.0000,43.3500,CIGNA HEALTHCARE,CIGNA HMO,120.51,,,,,,,74.5900,289.0000,percent of total billed charges,41.7% of $289.00 in Billed Charges for Rev 272 = $120.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI COIL,272,RC,27200686,CDM,,,,,,both,,,289.0000,43.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,134.10,,,,,,,74.5900,289.0000,percent of total billed charges,46.4% of $289.00 in Billed Charges for Rev 272 = $134.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI COIL,272,RC,27200686,CDM,,,,,,both,,,289.0000,43.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,120.51,,,,,,,74.5900,289.0000,percent of total billed charges,41.7% of $289.00 in Billed Charges for Rev 272 = $120.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI COIL,272,RC,27200686,CDM,,,,,,both,,,289.0000,43.3500,CIGNA HEALTHCARE,CIGNA PPO,120.51,,,,,,,74.5900,289.0000,percent of total billed charges,41.7% of $289.00 in Billed Charges for Rev 272 = $120.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI COIL,272,RC,27200686,CDM,,,,,,both,,,289.0000,43.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,260.10,,,,,,,74.5900,289.0000,percent of total billed charges,90% of $289.00 in Billed Charges for Rev 272 = $260.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI COIL,272,RC,27200686,CDM,,,,,,both,,,289.0000,43.3500,MEDCOST,MEDCOST VHN,137.54,,,,,,,74.5900,289.0000,percent of total billed charges,47.59% of $289.00 in Billed Charges for Rev 272 = $137.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI COIL,272,RC,27200686,CDM,,,,,,both,,,289.0000,43.3500,SENTARA HEALTH,SENTARA HEALTH,74.59,,,,,,,74.5900,289.0000,percent of total billed charges,25.81% of $289.00 in Billed Charges for Rev 272 = $74.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI COIL,272,RC,27200686,CDM,,,,,,both,,,289.0000,43.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",289.00,,,,,,,74.5900,289.0000,percent of total billed charges,100% of $289.00 in Billed Charges for Rev 272 = $289.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI COIL,272,RC,27200686,CDM,,,,,,both,,,289.0000,43.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,144.50,,,,,,,74.5900,289.0000,percent of total billed charges,Rev 272 $289.00 in Billed Charges at 50% = $144.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI COIL,272,RC,27200686,CDM,,,,,,both,,,289.0000,43.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,93.35,,,,,,,74.5900,289.0000,other,32.3% of $289.00 in Billed Charges for Rev 272 = $93.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EMBOLI COIL,272,RC,27200686,CDM,,,,,,both,,,289.0000,43.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,88.72,,,,,,,74.5900,289.0000,other,30.7% of $289.00 in Billed Charges for Rev 272 = $88.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EMBOLI COIL,272,RC,27200686,CDM,,,,,,both,,,289.0000,43.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,93.35,,,,,,,74.5900,289.0000,percent of total billed charges,32.3% of $289.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI COIL,272,RC,27200686,CDM,,,,,,both,,,289.0000,43.3500,WELLCARE,WELLCARE MEDICAID,289.00,,,,,,,74.5900,289.0000,percent of total billed charges,100% of $289.00 in Billed Charges for Rev 272 = $289.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI COIL TORNADO,278,RC,27800201,CDM,,,,,,both,,,459.0000,68.8500,AETNA,AETNA,220.32,,,,,,,118.4700,459.0000,percent of total billed charges,48% of $459.00 in Billed Charges for Rev 278 = $220.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI COIL TORNADO,278,RC,27800201,CDM,,,,,,both,,,459.0000,68.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,229.50,,,,,,,118.4700,459.0000,percent of total billed charges,50% of $459.00 in Billed Charges for Rev 278 = $229.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI COIL TORNADO,278,RC,27800201,CDM,,,,,,both,,,459.0000,68.8500,CIGNA HEALTHCARE,CIGNA HMO,191.40,,,,,,,118.4700,459.0000,percent of total billed charges,41.7% of $459.00 in Billed Charges for Rev 278 = $191.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI COIL TORNADO,278,RC,27800201,CDM,,,,,,both,,,459.0000,68.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,183.60,,,,,,,118.4700,459.0000,percent of total billed charges,40% of $459.00 in Billed Charges for Rev 278 = $183.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI COIL TORNADO,278,RC,27800201,CDM,,,,,,both,,,459.0000,68.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,191.40,,,,,,,118.4700,459.0000,percent of total billed charges,41.7% of $459.00 in Billed Charges for Rev 278 = $191.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI COIL TORNADO,278,RC,27800201,CDM,,,,,,both,,,459.0000,68.8500,CIGNA HEALTHCARE,CIGNA PPO,191.40,,,,,,,118.4700,459.0000,percent of total billed charges,41.7% of $459.00 in Billed Charges for Rev 278 = $191.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI COIL TORNADO,278,RC,27800201,CDM,,,,,,both,,,459.0000,68.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,413.10,,,,,,,118.4700,459.0000,percent of total billed charges,90% of $459.00 in Billed Charges for Rev 278 = $413.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI COIL TORNADO,278,RC,27800201,CDM,,,,,,both,,,459.0000,68.8500,MEDCOST,MEDCOST VHN,218.44,,,,,,,118.4700,459.0000,percent of total billed charges,47.59% of $459.00 in Billed Charges for Rev 278 = $218.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI COIL TORNADO,278,RC,27800201,CDM,,,,,,both,,,459.0000,68.8500,SENTARA HEALTH,SENTARA HEALTH,118.47,,,,,,,118.4700,459.0000,percent of total billed charges,25.81% of $459.00 in Billed Charges for Rev 278 = $118.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI COIL TORNADO,278,RC,27800201,CDM,,,,,,both,,,459.0000,68.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",459.00,,,,,,,118.4700,459.0000,percent of total billed charges,100% of $459.00 in Billed Charges for Rev 278 = $459.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI COIL TORNADO,278,RC,27800201,CDM,,,,,,both,,,459.0000,68.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,229.50,,,,,,,118.4700,459.0000,percent of total billed charges,Rev 278 $459.00 in Billed Charges at 50% = $229.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI COIL TORNADO,278,RC,27800201,CDM,,,,,,both,,,459.0000,68.8500,WELLCARE,WELLCARE MEDICAID,459.00,,,,,,,118.4700,459.0000,percent of total billed charges,100% of $459.00 in Billed Charges for Rev 278 = $459.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI GELFOAM,272,RC,27200689,CDM,,,,,,both,,,130.0000,19.5000,AETNA,AETNA,55.51,,,,,,,33.5500,130.0000,percent of total billed charges,42.7% of $130.00 in Billed Charges for Rev 272 = $55.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI GELFOAM,272,RC,27200689,CDM,,,,,,both,,,130.0000,19.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,91.00,,,,,,,33.5500,130.0000,percent of total billed charges,Rev 272 $130.00 in Billed Charges at 70% = $91.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI GELFOAM,272,RC,27200689,CDM,,,,,,both,,,130.0000,19.5000,CIGNA HEALTHCARE,CIGNA HMO,54.21,,,,,,,33.5500,130.0000,percent of total billed charges,41.7% of $130.00 in Billed Charges for Rev 272 = $54.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI GELFOAM,272,RC,27200689,CDM,,,,,,both,,,130.0000,19.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,60.32,,,,,,,33.5500,130.0000,percent of total billed charges,46.4% of $130.00 in Billed Charges for Rev 272 = $60.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI GELFOAM,272,RC,27200689,CDM,,,,,,both,,,130.0000,19.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,54.21,,,,,,,33.5500,130.0000,percent of total billed charges,41.7% of $130.00 in Billed Charges for Rev 272 = $54.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI GELFOAM,272,RC,27200689,CDM,,,,,,both,,,130.0000,19.5000,CIGNA HEALTHCARE,CIGNA PPO,54.21,,,,,,,33.5500,130.0000,percent of total billed charges,41.7% of $130.00 in Billed Charges for Rev 272 = $54.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI GELFOAM,272,RC,27200689,CDM,,,,,,both,,,130.0000,19.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,117.00,,,,,,,33.5500,130.0000,percent of total billed charges,90% of $130.00 in Billed Charges for Rev 272 = $117.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI GELFOAM,272,RC,27200689,CDM,,,,,,both,,,130.0000,19.5000,MEDCOST,MEDCOST VHN,61.87,,,,,,,33.5500,130.0000,percent of total billed charges,47.59% of $130.00 in Billed Charges for Rev 272 = $61.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI GELFOAM,272,RC,27200689,CDM,,,,,,both,,,130.0000,19.5000,SENTARA HEALTH,SENTARA HEALTH,33.55,,,,,,,33.5500,130.0000,percent of total billed charges,25.81% of $130.00 in Billed Charges for Rev 272 = $33.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI GELFOAM,272,RC,27200689,CDM,,,,,,both,,,130.0000,19.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",130.00,,,,,,,33.5500,130.0000,percent of total billed charges,100% of $130.00 in Billed Charges for Rev 272 = $130.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI GELFOAM,272,RC,27200689,CDM,,,,,,both,,,130.0000,19.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,65.00,,,,,,,33.5500,130.0000,percent of total billed charges,Rev 272 $130.00 in Billed Charges at 50% = $65.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI GELFOAM,272,RC,27200689,CDM,,,,,,both,,,130.0000,19.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,41.99,,,,,,,33.5500,130.0000,other,32.3% of $130.00 in Billed Charges for Rev 272 = $41.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EMBOLI GELFOAM,272,RC,27200689,CDM,,,,,,both,,,130.0000,19.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,39.91,,,,,,,33.5500,130.0000,other,30.7% of $130.00 in Billed Charges for Rev 272 = $39.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EMBOLI GELFOAM,272,RC,27200689,CDM,,,,,,both,,,130.0000,19.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,41.99,,,,,,,33.5500,130.0000,percent of total billed charges,32.3% of $130.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EMBOLI GELFOAM,272,RC,27200689,CDM,,,,,,both,,,130.0000,19.5000,WELLCARE,WELLCARE MEDICAID,130.00,,,,,,,33.5500,130.0000,percent of total billed charges,100% of $130.00 in Billed Charges for Rev 272 = $130.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENDOPATH OBTURATOR 35NLT,272,RC,27200692,CDM,,,,,,both,,,259.0000,38.8500,AETNA,AETNA,110.59,,,,,,,66.8500,259.0000,percent of total billed charges,42.7% of $259.00 in Billed Charges for Rev 272 = $110.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENDOPATH OBTURATOR 35NLT,272,RC,27200692,CDM,,,,,,both,,,259.0000,38.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,181.30,,,,,,,66.8500,259.0000,percent of total billed charges,Rev 272 $259.00 in Billed Charges at 70% = $181.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENDOPATH OBTURATOR 35NLT,272,RC,27200692,CDM,,,,,,both,,,259.0000,38.8500,CIGNA HEALTHCARE,CIGNA HMO,108.00,,,,,,,66.8500,259.0000,percent of total billed charges,41.7% of $259.00 in Billed Charges for Rev 272 = $108.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENDOPATH OBTURATOR 35NLT,272,RC,27200692,CDM,,,,,,both,,,259.0000,38.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,120.18,,,,,,,66.8500,259.0000,percent of total billed charges,46.4% of $259.00 in Billed Charges for Rev 272 = $120.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENDOPATH OBTURATOR 35NLT,272,RC,27200692,CDM,,,,,,both,,,259.0000,38.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,108.00,,,,,,,66.8500,259.0000,percent of total billed charges,41.7% of $259.00 in Billed Charges for Rev 272 = $108.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENDOPATH OBTURATOR 35NLT,272,RC,27200692,CDM,,,,,,both,,,259.0000,38.8500,CIGNA HEALTHCARE,CIGNA PPO,108.00,,,,,,,66.8500,259.0000,percent of total billed charges,41.7% of $259.00 in Billed Charges for Rev 272 = $108.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENDOPATH OBTURATOR 35NLT,272,RC,27200692,CDM,,,,,,both,,,259.0000,38.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,233.10,,,,,,,66.8500,259.0000,percent of total billed charges,90% of $259.00 in Billed Charges for Rev 272 = $233.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENDOPATH OBTURATOR 35NLT,272,RC,27200692,CDM,,,,,,both,,,259.0000,38.8500,MEDCOST,MEDCOST VHN,123.26,,,,,,,66.8500,259.0000,percent of total billed charges,47.59% of $259.00 in Billed Charges for Rev 272 = $123.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENDOPATH OBTURATOR 35NLT,272,RC,27200692,CDM,,,,,,both,,,259.0000,38.8500,SENTARA HEALTH,SENTARA HEALTH,66.85,,,,,,,66.8500,259.0000,percent of total billed charges,25.81% of $259.00 in Billed Charges for Rev 272 = $66.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENDOPATH OBTURATOR 35NLT,272,RC,27200692,CDM,,,,,,both,,,259.0000,38.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",259.00,,,,,,,66.8500,259.0000,percent of total billed charges,100% of $259.00 in Billed Charges for Rev 272 = $259.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENDOPATH OBTURATOR 35NLT,272,RC,27200692,CDM,,,,,,both,,,259.0000,38.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,129.50,,,,,,,66.8500,259.0000,percent of total billed charges,Rev 272 $259.00 in Billed Charges at 50% = $129.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENDOPATH OBTURATOR 35NLT,272,RC,27200692,CDM,,,,,,both,,,259.0000,38.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,83.66,,,,,,,66.8500,259.0000,other,32.3% of $259.00 in Billed Charges for Rev 272 = $83.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOPATH OBTURATOR 35NLT,272,RC,27200692,CDM,,,,,,both,,,259.0000,38.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,79.51,,,,,,,66.8500,259.0000,other,30.7% of $259.00 in Billed Charges for Rev 272 = $79.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOPATH OBTURATOR 35NLT,272,RC,27200692,CDM,,,,,,both,,,259.0000,38.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,83.66,,,,,,,66.8500,259.0000,percent of total billed charges,32.3% of $259.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENDOPATH OBTURATOR 35NLT,272,RC,27200692,CDM,,,,,,both,,,259.0000,38.8500,WELLCARE,WELLCARE MEDICAID,259.00,,,,,,,66.8500,259.0000,percent of total billed charges,100% of $259.00 in Billed Charges for Rev 272 = $259.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,17.4500,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 70160 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,17.4500,462.0000,fee schedule,APG 00471 Proc 70160 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,172.12,,,,,,,17.4500,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,17.4500,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,17.4500,462.0000,fee schedule,APG 00471 Proc 70160 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,17.4500,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,29.30,,,,,,,17.4500,462.0000,fee schedule,$29.30 from Fee Schedule BLDTM_23 for Rev 320 Proc 70160 * Qty 1 = $29.30 at 100% = $29.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,73.70,,,,,,,17.4500,462.0000,fee schedule,$23.03 from Fee Schedule BCFSC for Rev 320 Proc 70160 * Qty 1 = $23.03 at 320% = $73.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,17.4500,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,75.31,,,,,,,17.4500,462.0000,fee schedule,$23.03 from Fee Schedule BCFSC for Rev 320 Proc 70160 * Qty 1 = $23.03 at 327% = $75.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,75.31,,,,,,,17.4500,462.0000,fee schedule,$23.03 from Fee Schedule BCFSC for Rev 320 Proc 70160 * Qty 1 = $23.03 at 327% = $75.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,17.45,,,,,,,17.4500,462.0000,fee schedule,$15.04 from Fee Schedule TC_24 for Rev 320 Proc 70160 * Qty 1 = $15.04 at 116% = $17.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,17.45,,,,,,,17.4500,462.0000,fee schedule,$15.04 from Fee Schedule TC_24 for Rev 320 Proc 70160 * Qty 1 = $15.04 at 116% = $17.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,17.4500,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70160 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,55.50,,,,,,,17.4500,462.0000,fee schedule,$55.50 from Fee Schedule CGIFP_25LR for Rev 320 Proc 70160 * Qty 1 = $55.50 at 100% = $55.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,17.4500,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,17.4500,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70160 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,17.4500,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70160 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,17.4500,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,17.4500,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 70160 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,17.4500,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 70160 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,17.4500,462.0000,fee schedule,APG 00471 Proc 70160 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,17.4500,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,17.4500,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,17.4500,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,17.4500,462.0000,fee schedule,APG 00471 Proc 70160 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,17.4500,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 70160 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,17.4500,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 70160 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,17.4500,462.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 70160 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,17.4500,462.0000,other,Rev 320 Proc 70160 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,17.4500,462.0000,other,Rev 320 Proc 70160 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,17.4500,462.0000,other,Rev 320 Proc 70160 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,17.4500,462.0000,fee schedule,APG 00471 Proc 70160 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,17.4500,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 70160 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX NASAL BONE 3 VIEWS,70160,CPT,320,RC,32000009,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,17.4500,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,AETNA,AETNA,438.10,,,,,,,31.0000,1026.0000,percent of total billed charges,"42.7% of $1,026.00 in Billed Charges for Rev 320 Proc 70170 = $438.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,166.44,,,,,,,31.0000,1026.0000,fee schedule,APG 00389 Proc 70170 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 104% = $166.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,216.48,,,,,,,31.0000,1026.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,AETNA,AETNA HEALTHCARE MEDICARE,216.48,,,,,,,31.0000,1026.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,216.48,,,,,,,31.0000,1026.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,AMBETTER,AMBETTER,471.92,,,,,,,31.0000,1026.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,225.14,,,,,,,31.0000,1026.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,BLUE CROSS,ANTHEM EXCHANGE,532.97,,,,,,,31.0000,1026.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,164.84,,,,,,,31.0000,1026.0000,fee schedule,APG 00389 Proc 70170 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,BLUE CROSS,ANTHEM HMO,566.25,,,,,,,31.0000,1026.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,222.97,,,,,,,31.0000,1026.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",666.14,,,,,,,31.0000,1026.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,58.70,,,,,,,31.0000,1026.0000,fee schedule,$58.70 from Fee Schedule BLDTM_23 for Rev 320 Proc 70170 * Qty 1 = $58.70 at 100% = $58.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,BLUE CROSS,BLUE CROSS E NETWORK,110.66,,,,,,,31.0000,1026.0000,fee schedule,$34.58 from Fee Schedule BCFSC for Rev 320 Proc 70170 * Qty 1 = $34.58 at 320% = $110.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,BLUE CROSS,BLUE CROSS MEDICARE,225.14,,,,,,,31.0000,1026.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,BLUE CROSS,BLUE CROSS P NETWORK,113.08,,,,,,,31.0000,1026.0000,fee schedule,$34.58 from Fee Schedule BCFSC for Rev 320 Proc 70170 * Qty 1 = $34.58 at 327% = $113.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,BLUE CROSS,BLUE CROSS S NETWORK,113.08,,,,,,,31.0000,1026.0000,fee schedule,$34.58 from Fee Schedule BCFSC for Rev 320 Proc 70170 * Qty 1 = $34.58 at 327% = $113.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,BLUE CROSS,TENNCARE BLUE CARE,31.00,,,,,,,31.0000,1026.0000,fee schedule,$26.72 from Fee Schedule TC_24 for Rev 320 Proc 70170 * Qty 1 = $26.72 at 116% = $31.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,BLUE CROSS,TENNCARE BLUE SELECT,31.00,,,,,,,31.0000,1026.0000,fee schedule,$26.72 from Fee Schedule TC_24 for Rev 320 Proc 70170 * Qty 1 = $26.72 at 116% = $31.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,CIGNA HEALTHCARE,CIGNA HMO,894.80,,,,,,,31.0000,1026.0000,fee schedule,$894.80 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70170 * Qty 1 = $894.80 at 100% = $894.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,64.54,,,,,,,31.0000,1026.0000,fee schedule,$64.54 from Fee Schedule CGIFP_25LR for Rev 320 Proc 70170 * Qty 1 = $64.54 at 100% = $64.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,227.30,,,,,,,31.0000,1026.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,894.80,,,,,,,31.0000,1026.0000,fee schedule,$894.80 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70170 * Qty 1 = $894.80 at 100% = $894.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,CIGNA HEALTHCARE,CIGNA PPO,894.80,,,,,,,31.0000,1026.0000,fee schedule,$894.80 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70170 * Qty 1 = $894.80 at 100% = $894.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,227.30,,,,,,,31.0000,1026.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,923.40,,,,,,,31.0000,1026.0000,percent of total billed charges,"90% of $1,026.00 in Billed Charges for Rev 320 Proc 70170 = $923.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,HUMANA,HUMANA MEDICARE,216.48,,,,,,,31.0000,1026.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,216.48,,,,,,,31.0000,1026.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,MEDCOST,MEDCOST VHN,488.27,,,,,,,31.0000,1026.0000,percent of total billed charges,"47.59% of $1,026.00 in Billed Charges for Rev 320 Proc 70170 = $488.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,168.04,,,,,,,31.0000,1026.0000,fee schedule,APG 00389 Proc 70170 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 105% = $168.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,227.30,,,,,,,31.0000,1026.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,227.30,,,,,,,31.0000,1026.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,NHC ADVANTAGE,NHC ADVANTAGE,227.30,,,,,,,31.0000,1026.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,165.00,,,,,,,31.0000,1026.0000,fee schedule,APG 00389 Proc 70170 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 103.1% = $165.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,SENTARA HEALTH,SENTARA HEALTH,264.81,,,,,,,31.0000,1026.0000,percent of total billed charges,"25.81% of $1,026.00 in Billed Charges for Rev 320 Proc 70170 = $264.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,SENTARA HEALTH,SENTARA MEDICARE,216.48,,,,,,,31.0000,1026.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1026.00,,,,,,,31.0000,1026.0000,percent of total billed charges,"100% of $1,026.00 in Billed Charges for Rev 320 Proc 70170 = $1,026.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,118.21,,,,,,,31.0000,1026.0000,fee schedule,$236.42 from Fee Schedule TCUHC24 for Rev 320 Proc 70170 * Qty 1 = $236.42 at 50% = $118.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,31.0000,1026.0000,other,Rev 320 Proc 70170 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,31.0000,1026.0000,other,Rev 320 Proc 70170 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,31.0000,1026.0000,other,Rev 320 Proc 70170 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,164.84,,,,,,,31.0000,1026.0000,fee schedule,APG 00389 Proc 70170 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,216.48,,,,,,,31.0000,1026.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,216.48,,,,,,,31.0000,1026.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,WELLCARE,WELLCARE MEDICAID,1026.00,,,,,,,31.0000,1026.0000,percent of total billed charges,"100% of $1,026.00 in Billed Charges for Rev 320 Proc 70170 = $1,026.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DACRYOCSTOGRAPY NASOLACRIMAL DUCT RAD S&I,70170,CPT,320,RC,32000307,CDM,,,,both,,,1026.0000,153.9000,WELLCARE,WELLCARE MEDICARE,229.47,,,,,,,31.0000,1026.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,AETNA,AETNA,99.06,,,,,,,20.5400,232.0000,percent of total billed charges,42.7% of $232.00 in Billed Charges for Rev 320 Proc 70210 = $99.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,20.5400,232.0000,fee schedule,APG 00471 Proc 70210 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,20.5400,232.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,20.5400,232.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,20.5400,232.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,AMBETTER,AMBETTER,172.12,,,,,,,20.5400,232.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,20.5400,232.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,20.5400,232.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,20.5400,232.0000,fee schedule,APG 00471 Proc 70210 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,20.5400,232.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,20.5400,232.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",232.00,,,,,,,20.5400,232.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,33.08,,,,,,,20.5400,232.0000,fee schedule,$33.08 from Fee Schedule BLDTM_23 for Rev 320 Proc 70210 * Qty 1 = $33.08 at 100% = $33.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,BLUE CROSS,BLUE CROSS E NETWORK,64.42,,,,,,,20.5400,232.0000,fee schedule,$20.13 from Fee Schedule BCFSC for Rev 320 Proc 70210 * Qty 1 = $20.13 at 320% = $64.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,20.5400,232.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,BLUE CROSS,BLUE CROSS P NETWORK,65.83,,,,,,,20.5400,232.0000,fee schedule,$20.13 from Fee Schedule BCFSC for Rev 320 Proc 70210 * Qty 1 = $20.13 at 327% = $65.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,BLUE CROSS,BLUE CROSS S NETWORK,65.83,,,,,,,20.5400,232.0000,fee schedule,$20.13 from Fee Schedule BCFSC for Rev 320 Proc 70210 * Qty 1 = $20.13 at 327% = $65.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,BLUE CROSS,TENNCARE BLUE CARE,20.54,,,,,,,20.5400,232.0000,fee schedule,$17.71 from Fee Schedule TC_24 for Rev 320 Proc 70210 * Qty 1 = $17.71 at 116% = $20.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,BLUE CROSS,TENNCARE BLUE SELECT,20.54,,,,,,,20.5400,232.0000,fee schedule,$17.71 from Fee Schedule TC_24 for Rev 320 Proc 70210 * Qty 1 = $17.71 at 116% = $20.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,20.5400,232.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70210 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,44.85,,,,,,,20.5400,232.0000,fee schedule,$44.85 from Fee Schedule CGIFP_25LR for Rev 320 Proc 70210 * Qty 1 = $44.85 at 100% = $44.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,20.5400,232.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,20.5400,232.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70210 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,20.5400,232.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70210 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,20.5400,232.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,208.80,,,,,,,20.5400,232.0000,percent of total billed charges,90% of $232.00 in Billed Charges for Rev 320 Proc 70210 = $208.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,HUMANA,HUMANA MEDICARE,78.96,,,,,,,20.5400,232.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,20.5400,232.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,MEDCOST,MEDCOST VHN,110.41,,,,,,,20.5400,232.0000,percent of total billed charges,47.59% of $232.00 in Billed Charges for Rev 320 Proc 70210 = $110.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,20.5400,232.0000,fee schedule,APG 00471 Proc 70210 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,20.5400,232.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,20.5400,232.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,20.5400,232.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,20.5400,232.0000,fee schedule,APG 00471 Proc 70210 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,SENTARA HEALTH,SENTARA HEALTH,59.88,,,,,,,20.5400,232.0000,percent of total billed charges,25.81% of $232.00 in Billed Charges for Rev 320 Proc 70210 = $59.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,20.5400,232.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",232.00,,,,,,,20.5400,232.0000,percent of total billed charges,100% of $232.00 in Billed Charges for Rev 320 Proc 70210 = $232.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,20.5400,232.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 70210 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,232.00,,,,,,,20.5400,232.0000,other,"Rev 320 Proc 70210 1 Visit at $233.00 per Visit = $233.00 (Service Line reduced to $232.00, claim capped at $232.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,20.5400,232.0000,other,Rev 320 Proc 70210 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,232.00,,,,,,,20.5400,232.0000,other,"Rev 320 Proc 70210 1 Visit at $370.00 per Visit = $370.00 (Service Line reduced to $232.00, claim capped at $232.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,20.5400,232.0000,fee schedule,APG 00471 Proc 70210 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,20.5400,232.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,20.5400,232.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,WELLCARE,WELLCARE MEDICAID,232.00,,,,,,,20.5400,232.0000,percent of total billed charges,100% of $232.00 in Billed Charges for Rev 320 Proc 70210 = $232.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SINUSES <3 VIEW,70210,CPT,320,RC,32000012,CDM,,,,both,,,232.0000,34.8000,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,20.5400,232.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,13.8600,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 70240 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,13.8600,462.0000,fee schedule,APG 00471 Proc 70240 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,13.8600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,13.8600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,13.8600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,172.12,,,,,,,13.8600,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,13.8600,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,13.8600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,13.8600,462.0000,fee schedule,APG 00471 Proc 70240 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,13.8600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,13.8600,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,13.8600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,27.28,,,,,,,13.8600,462.0000,fee schedule,$27.28 from Fee Schedule BLDTM_23 for Rev 320 Proc 70240 * Qty 1 = $27.28 at 100% = $27.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,61.34,,,,,,,13.8600,462.0000,fee schedule,$19.17 from Fee Schedule BCFSC for Rev 320 Proc 70240 * Qty 1 = $19.17 at 320% = $61.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,13.8600,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,62.69,,,,,,,13.8600,462.0000,fee schedule,$19.17 from Fee Schedule BCFSC for Rev 320 Proc 70240 * Qty 1 = $19.17 at 327% = $62.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,62.69,,,,,,,13.8600,462.0000,fee schedule,$19.17 from Fee Schedule BCFSC for Rev 320 Proc 70240 * Qty 1 = $19.17 at 327% = $62.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,13.86,,,,,,,13.8600,462.0000,fee schedule,$11.95 from Fee Schedule TC_24 for Rev 320 Proc 70240 * Qty 1 = $11.95 at 116% = $13.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,13.86,,,,,,,13.8600,462.0000,fee schedule,$11.95 from Fee Schedule TC_24 for Rev 320 Proc 70240 * Qty 1 = $11.95 at 116% = $13.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,13.8600,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70240 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,44.85,,,,,,,13.8600,462.0000,fee schedule,$44.85 from Fee Schedule CGIFP_25LR for Rev 320 Proc 70240 * Qty 1 = $44.85 at 100% = $44.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,13.8600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,13.8600,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70240 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,13.8600,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70240 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,13.8600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,13.8600,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 70240 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,78.96,,,,,,,13.8600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,13.8600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,13.8600,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 70240 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,13.8600,462.0000,fee schedule,APG 00471 Proc 70240 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,13.8600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,13.8600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,13.8600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,13.8600,462.0000,fee schedule,APG 00471 Proc 70240 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,13.8600,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 70240 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,13.8600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,13.8600,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 70240 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,13.8600,462.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 70240 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,13.8600,462.0000,other,Rev 320 Proc 70240 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,13.8600,462.0000,other,Rev 320 Proc 70240 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,13.8600,462.0000,other,Rev 320 Proc 70240 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,13.8600,462.0000,fee schedule,APG 00471 Proc 70240 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,13.8600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,13.8600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,13.8600,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 70240 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SELLA TURCICA,70240,CPT,320,RC,32000014,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,13.8600,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA,187.45,,,,,,,20.5400,439.0000,percent of total billed charges,42.7% of $439.00 in Billed Charges for Rev 320 Proc 70250 = $187.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,20.5400,439.0000,fee schedule,APG 00471 Proc 70250 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,20.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,20.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,20.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,AMBETTER,AMBETTER,206.78,,,,,,,20.5400,439.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,20.5400,439.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,20.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,20.5400,439.0000,fee schedule,APG 00471 Proc 70250 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,20.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,20.5400,439.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,20.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,38.16,,,,,,,20.5400,439.0000,fee schedule,$38.16 from Fee Schedule BLDTM_23 for Rev 320 Proc 70250 * Qty 1 = $38.16 at 100% = $38.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS E NETWORK,72.67,,,,,,,20.5400,439.0000,fee schedule,$22.71 from Fee Schedule BCFSC for Rev 320 Proc 70250 * Qty 1 = $22.71 at 320% = $72.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,20.5400,439.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS P NETWORK,74.26,,,,,,,20.5400,439.0000,fee schedule,$22.71 from Fee Schedule BCFSC for Rev 320 Proc 70250 * Qty 1 = $22.71 at 327% = $74.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS S NETWORK,74.26,,,,,,,20.5400,439.0000,fee schedule,$22.71 from Fee Schedule BCFSC for Rev 320 Proc 70250 * Qty 1 = $22.71 at 327% = $74.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,TENNCARE BLUE CARE,20.54,,,,,,,20.5400,439.0000,fee schedule,$17.71 from Fee Schedule TC_24 for Rev 320 Proc 70250 * Qty 1 = $17.71 at 116% = $20.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,TENNCARE BLUE SELECT,20.54,,,,,,,20.5400,439.0000,fee schedule,$17.71 from Fee Schedule TC_24 for Rev 320 Proc 70250 * Qty 1 = $17.71 at 116% = $20.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,20.5400,439.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70250 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,51.11,,,,,,,20.5400,439.0000,fee schedule,$51.11 from Fee Schedule CGIFP_25LR for Rev 320 Proc 70250 * Qty 1 = $51.11 at 100% = $51.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,20.5400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,20.5400,439.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70250 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,20.5400,439.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70250 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,20.5400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,395.10,,,,,,,20.5400,439.0000,percent of total billed charges,90% of $439.00 in Billed Charges for Rev 320 Proc 70250 = $395.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,HUMANA,HUMANA MEDICARE,94.85,,,,,,,20.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,20.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,MEDCOST,MEDCOST VHN,208.92,,,,,,,20.5400,439.0000,percent of total billed charges,47.59% of $439.00 in Billed Charges for Rev 320 Proc 70250 = $208.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,20.5400,439.0000,fee schedule,APG 00471 Proc 70250 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,20.5400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,20.5400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,20.5400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,20.5400,439.0000,fee schedule,APG 00471 Proc 70250 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,SENTARA HEALTH,SENTARA HEALTH,113.31,,,,,,,20.5400,439.0000,percent of total billed charges,25.81% of $439.00 in Billed Charges for Rev 320 Proc 70250 = $113.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,20.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",439.00,,,,,,,20.5400,439.0000,percent of total billed charges,100% of $439.00 in Billed Charges for Rev 320 Proc 70250 = $439.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,20.5400,439.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 70250 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,20.5400,439.0000,other,Rev 320 Proc 70250 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,20.5400,439.0000,other,Rev 320 Proc 70250 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,20.5400,439.0000,other,Rev 320 Proc 70250 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,20.5400,439.0000,fee schedule,APG 00471 Proc 70250 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,20.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,20.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,WELLCARE,WELLCARE MEDICAID,439.00,,,,,,,20.5400,439.0000,percent of total billed charges,100% of $439.00 in Billed Charges for Rev 320 Proc 70250 = $439.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SKULL LTD <4 VIEW,70250,CPT,320,RC,32000015,CDM,,,,both,,,439.0000,65.8500,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,20.5400,439.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,29.3600,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 70260 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,29.3600,462.0000,fee schedule,APG 00471 Proc 70260 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,29.3600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,29.3600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,29.3600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,206.78,,,,,,,29.3600,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,29.3600,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,29.3600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,29.3600,462.0000,fee schedule,APG 00471 Proc 70260 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,29.3600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,29.3600,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,29.3600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,54.30,,,,,,,29.3600,462.0000,fee schedule,$54.30 from Fee Schedule BLDTM_23 for Rev 320 Proc 70260 * Qty 1 = $54.30 at 100% = $54.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,89.12,,,,,,,29.3600,462.0000,fee schedule,$27.85 from Fee Schedule BCFSC for Rev 320 Proc 70260 * Qty 1 = $27.85 at 320% = $89.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,29.3600,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,91.07,,,,,,,29.3600,462.0000,fee schedule,$27.85 from Fee Schedule BCFSC for Rev 320 Proc 70260 * Qty 1 = $27.85 at 327% = $91.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,91.07,,,,,,,29.3600,462.0000,fee schedule,$27.85 from Fee Schedule BCFSC for Rev 320 Proc 70260 * Qty 1 = $27.85 at 327% = $91.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,29.36,,,,,,,29.3600,462.0000,fee schedule,$25.31 from Fee Schedule TC_24 for Rev 320 Proc 70260 * Qty 1 = $25.31 at 116% = $29.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,29.36,,,,,,,29.3600,462.0000,fee schedule,$25.31 from Fee Schedule TC_24 for Rev 320 Proc 70260 * Qty 1 = $25.31 at 116% = $29.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,285.67,,,,,,,29.3600,462.0000,fee schedule,$285.67 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70260 * Qty 1 = $285.67 at 100% = $285.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,58.63,,,,,,,29.3600,462.0000,fee schedule,$58.63 from Fee Schedule CGIFP_25LR for Rev 320 Proc 70260 * Qty 1 = $58.63 at 100% = $58.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,29.3600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,285.67,,,,,,,29.3600,462.0000,fee schedule,$285.67 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70260 * Qty 1 = $285.67 at 100% = $285.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,285.67,,,,,,,29.3600,462.0000,fee schedule,$285.67 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70260 * Qty 1 = $285.67 at 100% = $285.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,29.3600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,29.3600,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 70260 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,94.85,,,,,,,29.3600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,29.3600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,29.3600,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 70260 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,29.3600,462.0000,fee schedule,APG 00471 Proc 70260 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,29.3600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,29.3600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,29.3600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,29.3600,462.0000,fee schedule,APG 00471 Proc 70260 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,29.3600,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 70260 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,29.3600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,29.3600,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 70260 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,37.74,,,,,,,29.3600,462.0000,fee schedule,$75.48 from Fee Schedule TCUHC24 for Rev 320 Proc 70260 * Qty 1 = $75.48 at 50% = $37.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,29.3600,462.0000,other,Rev 320 Proc 70260 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,29.3600,462.0000,other,Rev 320 Proc 70260 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,29.3600,462.0000,other,Rev 320 Proc 70260 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,29.3600,462.0000,fee schedule,APG 00471 Proc 70260 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,29.3600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,29.3600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,29.3600,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 70260 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SKULL COMP 4 VIEW+*,70260,CPT,320,RC,32000016,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,29.3600,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOPROSTHESIS THORAC CNFRMBL,278,RC,27800206,CDM,,,,,,both,,,39144.0000,5871.6000,AETNA,AETNA,18789.12,,,,,,,2779.2200,39144.0000,percent of total billed charges,"48% of $39,144.00 in Billed Charges for Rev 278 = $18,789.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOPROSTHESIS THORAC CNFRMBL,278,RC,27800206,CDM,,,,,,both,,,39144.0000,5871.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,19572.00,,,,,,,2779.2200,39144.0000,percent of total billed charges,"50% of $39,144.00 in Billed Charges for Rev 278 = $19,572.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOPROSTHESIS THORAC CNFRMBL,278,RC,27800206,CDM,,,,,,both,,,39144.0000,5871.6000,CIGNA HEALTHCARE,CIGNA HMO,16323.05,,,,,,,2779.2200,39144.0000,percent of total billed charges,"41.7% of $39,144.00 in Billed Charges for Rev 278 = $16,323.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOPROSTHESIS THORAC CNFRMBL,278,RC,27800206,CDM,,,,,,both,,,39144.0000,5871.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,15657.60,,,,,,,2779.2200,39144.0000,percent of total billed charges,"40% of $39,144.00 in Billed Charges for Rev 278 = $15,657.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOPROSTHESIS THORAC CNFRMBL,278,RC,27800206,CDM,,,,,,both,,,39144.0000,5871.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,16323.05,,,,,,,2779.2200,39144.0000,percent of total billed charges,"41.7% of $39,144.00 in Billed Charges for Rev 278 = $16,323.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOPROSTHESIS THORAC CNFRMBL,278,RC,27800206,CDM,,,,,,both,,,39144.0000,5871.6000,CIGNA HEALTHCARE,CIGNA PPO,16323.05,,,,,,,2779.2200,39144.0000,percent of total billed charges,"41.7% of $39,144.00 in Billed Charges for Rev 278 = $16,323.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOPROSTHESIS THORAC CNFRMBL,278,RC,27800206,CDM,,,,,,both,,,39144.0000,5871.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,35229.60,,,,,,,2779.2200,39144.0000,percent of total billed charges,"90% of $39,144.00 in Billed Charges for Rev 278 = $35,229.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOPROSTHESIS THORAC CNFRMBL,278,RC,27800206,CDM,,,,,,both,,,39144.0000,5871.6000,MEDCOST,MEDCOST VHN,18628.63,,,,,,,2779.2200,39144.0000,percent of total billed charges,"47.59% of $39,144.00 in Billed Charges for Rev 278 = $18,628.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOPROSTHESIS THORAC CNFRMBL,278,RC,27800206,CDM,,,,,,both,,,39144.0000,5871.6000,SENTARA HEALTH,SENTARA HEALTH,10103.07,,,,,,,2779.2200,39144.0000,percent of total billed charges,"25.81% of $39,144.00 in Billed Charges for Rev 278 = $10,103.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOPROSTHESIS THORAC CNFRMBL,278,RC,27800206,CDM,,,,,,both,,,39144.0000,5871.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",39144.00,,,,,,,2779.2200,39144.0000,percent of total billed charges,"100% of $39,144.00 in Billed Charges for Rev 278 = $39,144.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOPROSTHESIS THORAC CNFRMBL,278,RC,27800206,CDM,,,,,,both,,,39144.0000,5871.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,19572.00,,,,,,,2779.2200,39144.0000,percent of total billed charges,"Rev 278 $39,144.00 in Billed Charges at 50% = $19,572.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOPROSTHESIS THORAC CNFRMBL,278,RC,27800206,CDM,,,,,,both,,,39144.0000,5871.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2935.80,,,,,,,2779.2200,39144.0000,percent of total billed charges,"7.5% of $39,144.00 in Billed Charges for Rev 278 = $2,935.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOPROSTHESIS THORAC CNFRMBL,278,RC,27800206,CDM,,,,,,both,,,39144.0000,5871.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2779.22,,,,,,,2779.2200,39144.0000,percent of total billed charges,"7.1% of $39,144.00 in Billed Charges for Rev 278 = $2,779.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOPROSTHESIS THORAC CNFRMBL,278,RC,27800206,CDM,,,,,,both,,,39144.0000,5871.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,2779.22,,,,,,,2779.2200,39144.0000,percent of total billed charges,"7.1% of $39,144.00 in Billed Charges for Rev 278 = $2,779.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOPROSTHESIS THORAC CNFRMBL,278,RC,27800206,CDM,,,,,,both,,,39144.0000,5871.6000,WELLCARE,WELLCARE MEDICAID,39144.00,,,,,,,2779.2200,39144.0000,percent of total billed charges,"100% of $39,144.00 in Billed Charges for Rev 278 = $39,144.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENGAGE TR KIT 5/6FR,272,RC,27200693,CDM,,,,,,both,,,192.0000,28.8000,AETNA,AETNA,81.98,,,,,,,49.5600,192.0000,percent of total billed charges,42.7% of $192.00 in Billed Charges for Rev 272 = $81.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENGAGE TR KIT 5/6FR,272,RC,27200693,CDM,,,,,,both,,,192.0000,28.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,134.40,,,,,,,49.5600,192.0000,percent of total billed charges,Rev 272 $192.00 in Billed Charges at 70% = $134.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENGAGE TR KIT 5/6FR,272,RC,27200693,CDM,,,,,,both,,,192.0000,28.8000,CIGNA HEALTHCARE,CIGNA HMO,80.06,,,,,,,49.5600,192.0000,percent of total billed charges,41.7% of $192.00 in Billed Charges for Rev 272 = $80.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENGAGE TR KIT 5/6FR,272,RC,27200693,CDM,,,,,,both,,,192.0000,28.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,89.09,,,,,,,49.5600,192.0000,percent of total billed charges,46.4% of $192.00 in Billed Charges for Rev 272 = $89.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENGAGE TR KIT 5/6FR,272,RC,27200693,CDM,,,,,,both,,,192.0000,28.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,80.06,,,,,,,49.5600,192.0000,percent of total billed charges,41.7% of $192.00 in Billed Charges for Rev 272 = $80.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENGAGE TR KIT 5/6FR,272,RC,27200693,CDM,,,,,,both,,,192.0000,28.8000,CIGNA HEALTHCARE,CIGNA PPO,80.06,,,,,,,49.5600,192.0000,percent of total billed charges,41.7% of $192.00 in Billed Charges for Rev 272 = $80.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENGAGE TR KIT 5/6FR,272,RC,27200693,CDM,,,,,,both,,,192.0000,28.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,172.80,,,,,,,49.5600,192.0000,percent of total billed charges,90% of $192.00 in Billed Charges for Rev 272 = $172.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENGAGE TR KIT 5/6FR,272,RC,27200693,CDM,,,,,,both,,,192.0000,28.8000,MEDCOST,MEDCOST VHN,91.37,,,,,,,49.5600,192.0000,percent of total billed charges,47.59% of $192.00 in Billed Charges for Rev 272 = $91.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENGAGE TR KIT 5/6FR,272,RC,27200693,CDM,,,,,,both,,,192.0000,28.8000,SENTARA HEALTH,SENTARA HEALTH,49.56,,,,,,,49.5600,192.0000,percent of total billed charges,25.81% of $192.00 in Billed Charges for Rev 272 = $49.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENGAGE TR KIT 5/6FR,272,RC,27200693,CDM,,,,,,both,,,192.0000,28.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",192.00,,,,,,,49.5600,192.0000,percent of total billed charges,100% of $192.00 in Billed Charges for Rev 272 = $192.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENGAGE TR KIT 5/6FR,272,RC,27200693,CDM,,,,,,both,,,192.0000,28.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,96.00,,,,,,,49.5600,192.0000,percent of total billed charges,Rev 272 $192.00 in Billed Charges at 50% = $96.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENGAGE TR KIT 5/6FR,272,RC,27200693,CDM,,,,,,both,,,192.0000,28.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,62.02,,,,,,,49.5600,192.0000,other,32.3% of $192.00 in Billed Charges for Rev 272 = $62.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENGAGE TR KIT 5/6FR,272,RC,27200693,CDM,,,,,,both,,,192.0000,28.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,58.94,,,,,,,49.5600,192.0000,other,30.7% of $192.00 in Billed Charges for Rev 272 = $58.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENGAGE TR KIT 5/6FR,272,RC,27200693,CDM,,,,,,both,,,192.0000,28.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,62.02,,,,,,,49.5600,192.0000,percent of total billed charges,32.3% of $192.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ENGAGE TR KIT 5/6FR,272,RC,27200693,CDM,,,,,,both,,,192.0000,28.8000,WELLCARE,WELLCARE MEDICAID,192.00,,,,,,,49.5600,192.0000,percent of total billed charges,100% of $192.00 in Billed Charges for Rev 272 = $192.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXIMO STUDY CATHETER B-LASER HYBRID 2.0MM OTW X 150CM IDE G170104,624,RC,62400004,CDM,,,,,,both,,,1.0000,0.1500,AETNA,AETNA,0.43,,,,,,,0.2600,1.0000,percent of total billed charges,42.7% of $1.00 in Billed Charges for Rev 624 = $0.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXIMO STUDY CATHETER B-LASER HYBRID 2.0MM OTW X 150CM IDE G170104,624,RC,62400004,CDM,,,,,,both,,,1.0000,0.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,0.70,,,,,,,0.2600,1.0000,percent of total billed charges,Rev 624 $1.00 in Billed Charges at 70% = $0.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXIMO STUDY CATHETER B-LASER HYBRID 2.0MM OTW X 150CM IDE G170104,624,RC,62400004,CDM,,,,,,both,,,1.0000,0.1500,CIGNA HEALTHCARE,CIGNA HMO,0.42,,,,,,,0.2600,1.0000,percent of total billed charges,41.7% of $1.00 in Billed Charges for Rev 624 = $0.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXIMO STUDY CATHETER B-LASER HYBRID 2.0MM OTW X 150CM IDE G170104,624,RC,62400004,CDM,,,,,,both,,,1.0000,0.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,0.46,,,,,,,0.2600,1.0000,percent of total billed charges,46.4% of $1.00 in Billed Charges for Rev 624 = $0.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXIMO STUDY CATHETER B-LASER HYBRID 2.0MM OTW X 150CM IDE G170104,624,RC,62400004,CDM,,,,,,both,,,1.0000,0.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,0.42,,,,,,,0.2600,1.0000,percent of total billed charges,41.7% of $1.00 in Billed Charges for Rev 624 = $0.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXIMO STUDY CATHETER B-LASER HYBRID 2.0MM OTW X 150CM IDE G170104,624,RC,62400004,CDM,,,,,,both,,,1.0000,0.1500,CIGNA HEALTHCARE,CIGNA PPO,0.42,,,,,,,0.2600,1.0000,percent of total billed charges,41.7% of $1.00 in Billed Charges for Rev 624 = $0.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXIMO STUDY CATHETER B-LASER HYBRID 2.0MM OTW X 150CM IDE G170104,624,RC,62400004,CDM,,,,,,both,,,1.0000,0.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,0.90,,,,,,,0.2600,1.0000,percent of total billed charges,90% of $1.00 in Billed Charges for Rev 624 = $0.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXIMO STUDY CATHETER B-LASER HYBRID 2.0MM OTW X 150CM IDE G170104,624,RC,62400004,CDM,,,,,,both,,,1.0000,0.1500,MEDCOST,MEDCOST VHN,0.48,,,,,,,0.2600,1.0000,percent of total billed charges,47.59% of $1.00 in Billed Charges for Rev 624 = $0.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXIMO STUDY CATHETER B-LASER HYBRID 2.0MM OTW X 150CM IDE G170104,624,RC,62400004,CDM,,,,,,both,,,1.0000,0.1500,SENTARA HEALTH,SENTARA HEALTH,0.26,,,,,,,0.2600,1.0000,percent of total billed charges,25.81% of $1.00 in Billed Charges for Rev 624 = $0.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXIMO STUDY CATHETER B-LASER HYBRID 2.0MM OTW X 150CM IDE G170104,624,RC,62400004,CDM,,,,,,both,,,1.0000,0.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1.00,,,,,,,0.2600,1.0000,percent of total billed charges,100% of $1.00 in Billed Charges for Rev 624 = $1.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXIMO STUDY CATHETER B-LASER HYBRID 2.0MM OTW X 150CM IDE G170104,624,RC,62400004,CDM,,,,,,both,,,1.0000,0.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,0.50,,,,,,,0.2600,1.0000,percent of total billed charges,Rev 624 $1.00 in Billed Charges at 50% = $0.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXIMO STUDY CATHETER B-LASER HYBRID 2.0MM OTW X 150CM IDE G170104,624,RC,62400004,CDM,,,,,,both,,,1.0000,0.1500,WELLCARE,WELLCARE MEDICAID,1.00,,,,,,,0.2600,1.0000,percent of total billed charges,100% of $1.00 in Billed Charges for Rev 624 = $1.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXTRACTOR VACUUM KIWI,272,RC,27200696,CDM,,,,,,both,,,81.0000,12.1500,AETNA,AETNA,34.59,,,,,,,20.9100,81.0000,percent of total billed charges,42.7% of $81.00 in Billed Charges for Rev 272 = $34.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXTRACTOR VACUUM KIWI,272,RC,27200696,CDM,,,,,,both,,,81.0000,12.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,56.70,,,,,,,20.9100,81.0000,percent of total billed charges,Rev 272 $81.00 in Billed Charges at 70% = $56.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXTRACTOR VACUUM KIWI,272,RC,27200696,CDM,,,,,,both,,,81.0000,12.1500,CIGNA HEALTHCARE,CIGNA HMO,33.78,,,,,,,20.9100,81.0000,percent of total billed charges,41.7% of $81.00 in Billed Charges for Rev 272 = $33.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXTRACTOR VACUUM KIWI,272,RC,27200696,CDM,,,,,,both,,,81.0000,12.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,37.58,,,,,,,20.9100,81.0000,percent of total billed charges,46.4% of $81.00 in Billed Charges for Rev 272 = $37.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXTRACTOR VACUUM KIWI,272,RC,27200696,CDM,,,,,,both,,,81.0000,12.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,33.78,,,,,,,20.9100,81.0000,percent of total billed charges,41.7% of $81.00 in Billed Charges for Rev 272 = $33.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXTRACTOR VACUUM KIWI,272,RC,27200696,CDM,,,,,,both,,,81.0000,12.1500,CIGNA HEALTHCARE,CIGNA PPO,33.78,,,,,,,20.9100,81.0000,percent of total billed charges,41.7% of $81.00 in Billed Charges for Rev 272 = $33.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXTRACTOR VACUUM KIWI,272,RC,27200696,CDM,,,,,,both,,,81.0000,12.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,72.90,,,,,,,20.9100,81.0000,percent of total billed charges,90% of $81.00 in Billed Charges for Rev 272 = $72.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXTRACTOR VACUUM KIWI,272,RC,27200696,CDM,,,,,,both,,,81.0000,12.1500,MEDCOST,MEDCOST VHN,38.55,,,,,,,20.9100,81.0000,percent of total billed charges,47.59% of $81.00 in Billed Charges for Rev 272 = $38.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXTRACTOR VACUUM KIWI,272,RC,27200696,CDM,,,,,,both,,,81.0000,12.1500,SENTARA HEALTH,SENTARA HEALTH,20.91,,,,,,,20.9100,81.0000,percent of total billed charges,25.81% of $81.00 in Billed Charges for Rev 272 = $20.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXTRACTOR VACUUM KIWI,272,RC,27200696,CDM,,,,,,both,,,81.0000,12.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",81.00,,,,,,,20.9100,81.0000,percent of total billed charges,100% of $81.00 in Billed Charges for Rev 272 = $81.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXTRACTOR VACUUM KIWI,272,RC,27200696,CDM,,,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,40.50,,,,,,,20.9100,81.0000,percent of total billed charges,Rev 272 $81.00 in Billed Charges at 50% = $40.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXTRACTOR VACUUM KIWI,272,RC,27200696,CDM,,,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,26.16,,,,,,,20.9100,81.0000,other,32.3% of $81.00 in Billed Charges for Rev 272 = $26.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTRACTOR VACUUM KIWI,272,RC,27200696,CDM,,,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,24.87,,,,,,,20.9100,81.0000,other,30.7% of $81.00 in Billed Charges for Rev 272 = $24.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTRACTOR VACUUM KIWI,272,RC,27200696,CDM,,,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,26.16,,,,,,,20.9100,81.0000,percent of total billed charges,32.3% of $81.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXTRACTOR VACUUM KIWI,272,RC,27200696,CDM,,,,,,both,,,81.0000,12.1500,WELLCARE,WELLCARE MEDICAID,81.00,,,,,,,20.9100,81.0000,percent of total billed charges,100% of $81.00 in Billed Charges for Rev 272 = $81.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC F-IDC 2D 18-20MM X 50CM,272,RC,27202002,CDM,,,,,,both,,,2898.0000,434.7000,AETNA,AETNA,1237.45,,,,,,,747.9700,2898.0000,percent of total billed charges,"42.7% of $2,898.00 in Billed Charges for Rev 272 = $1,237.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 18-20MM X 50CM,272,RC,27202002,CDM,,,,,,both,,,2898.0000,434.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2028.60,,,,,,,747.9700,2898.0000,percent of total billed charges,"Rev 272 $2,898.00 in Billed Charges at 70% = $2,028.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 18-20MM X 50CM,272,RC,27202002,CDM,,,,,,both,,,2898.0000,434.7000,CIGNA HEALTHCARE,CIGNA HMO,1208.47,,,,,,,747.9700,2898.0000,percent of total billed charges,"41.7% of $2,898.00 in Billed Charges for Rev 272 = $1,208.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 18-20MM X 50CM,272,RC,27202002,CDM,,,,,,both,,,2898.0000,434.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1344.67,,,,,,,747.9700,2898.0000,percent of total billed charges,"46.4% of $2,898.00 in Billed Charges for Rev 272 = $1,344.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 18-20MM X 50CM,272,RC,27202002,CDM,,,,,,both,,,2898.0000,434.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1208.47,,,,,,,747.9700,2898.0000,percent of total billed charges,"41.7% of $2,898.00 in Billed Charges for Rev 272 = $1,208.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 18-20MM X 50CM,272,RC,27202002,CDM,,,,,,both,,,2898.0000,434.7000,CIGNA HEALTHCARE,CIGNA PPO,1208.47,,,,,,,747.9700,2898.0000,percent of total billed charges,"41.7% of $2,898.00 in Billed Charges for Rev 272 = $1,208.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 18-20MM X 50CM,272,RC,27202002,CDM,,,,,,both,,,2898.0000,434.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2608.20,,,,,,,747.9700,2898.0000,percent of total billed charges,"90% of $2,898.00 in Billed Charges for Rev 272 = $2,608.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 18-20MM X 50CM,272,RC,27202002,CDM,,,,,,both,,,2898.0000,434.7000,MEDCOST,MEDCOST VHN,1379.16,,,,,,,747.9700,2898.0000,percent of total billed charges,"47.59% of $2,898.00 in Billed Charges for Rev 272 = $1,379.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 18-20MM X 50CM,272,RC,27202002,CDM,,,,,,both,,,2898.0000,434.7000,SENTARA HEALTH,SENTARA HEALTH,747.97,,,,,,,747.9700,2898.0000,percent of total billed charges,"25.81% of $2,898.00 in Billed Charges for Rev 272 = $747.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 18-20MM X 50CM,272,RC,27202002,CDM,,,,,,both,,,2898.0000,434.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2898.00,,,,,,,747.9700,2898.0000,percent of total billed charges,"100% of $2,898.00 in Billed Charges for Rev 272 = $2,898.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 18-20MM X 50CM,272,RC,27202002,CDM,,,,,,both,,,2898.0000,434.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1449.00,,,,,,,747.9700,2898.0000,percent of total billed charges,"Rev 272 $2,898.00 in Billed Charges at 50% = $1,449.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 18-20MM X 50CM,272,RC,27202002,CDM,,,,,,both,,,2898.0000,434.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,936.05,,,,,,,747.9700,2898.0000,other,"32.3% of $2,898.00 in Billed Charges for Rev 272 = $936.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC F-IDC 2D 18-20MM X 50CM,272,RC,27202002,CDM,,,,,,both,,,2898.0000,434.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,889.69,,,,,,,747.9700,2898.0000,other,"30.7% of $2,898.00 in Billed Charges for Rev 272 = $889.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC F-IDC 2D 18-20MM X 50CM,272,RC,27202002,CDM,,,,,,both,,,2898.0000,434.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,936.05,,,,,,,747.9700,2898.0000,percent of total billed charges,"32.3% of $2,898.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 18-20MM X 50CM,272,RC,27202002,CDM,,,,,,both,,,2898.0000,434.7000,WELLCARE,WELLCARE MEDICAID,2898.00,,,,,,,747.9700,2898.0000,percent of total billed charges,"100% of $2,898.00 in Billed Charges for Rev 272 = $2,898.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 4-5MM X 8-15CM,272,RC,27202000,CDM,,,,,,both,,,1822.0000,273.3000,AETNA,AETNA,777.99,,,,,,,470.2600,1822.0000,percent of total billed charges,"42.7% of $1,822.00 in Billed Charges for Rev 272 = $777.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 4-5MM X 8-15CM,272,RC,27202000,CDM,,,,,,both,,,1822.0000,273.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1275.40,,,,,,,470.2600,1822.0000,percent of total billed charges,"Rev 272 $1,822.00 in Billed Charges at 70% = $1,275.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 4-5MM X 8-15CM,272,RC,27202000,CDM,,,,,,both,,,1822.0000,273.3000,CIGNA HEALTHCARE,CIGNA HMO,759.77,,,,,,,470.2600,1822.0000,percent of total billed charges,"41.7% of $1,822.00 in Billed Charges for Rev 272 = $759.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 4-5MM X 8-15CM,272,RC,27202000,CDM,,,,,,both,,,1822.0000,273.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,845.41,,,,,,,470.2600,1822.0000,percent of total billed charges,"46.4% of $1,822.00 in Billed Charges for Rev 272 = $845.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 4-5MM X 8-15CM,272,RC,27202000,CDM,,,,,,both,,,1822.0000,273.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,759.77,,,,,,,470.2600,1822.0000,percent of total billed charges,"41.7% of $1,822.00 in Billed Charges for Rev 272 = $759.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 4-5MM X 8-15CM,272,RC,27202000,CDM,,,,,,both,,,1822.0000,273.3000,CIGNA HEALTHCARE,CIGNA PPO,759.77,,,,,,,470.2600,1822.0000,percent of total billed charges,"41.7% of $1,822.00 in Billed Charges for Rev 272 = $759.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 4-5MM X 8-15CM,272,RC,27202000,CDM,,,,,,both,,,1822.0000,273.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1639.80,,,,,,,470.2600,1822.0000,percent of total billed charges,"90% of $1,822.00 in Billed Charges for Rev 272 = $1,639.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 4-5MM X 8-15CM,272,RC,27202000,CDM,,,,,,both,,,1822.0000,273.3000,MEDCOST,MEDCOST VHN,867.09,,,,,,,470.2600,1822.0000,percent of total billed charges,"47.59% of $1,822.00 in Billed Charges for Rev 272 = $867.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 4-5MM X 8-15CM,272,RC,27202000,CDM,,,,,,both,,,1822.0000,273.3000,SENTARA HEALTH,SENTARA HEALTH,470.26,,,,,,,470.2600,1822.0000,percent of total billed charges,"25.81% of $1,822.00 in Billed Charges for Rev 272 = $470.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 4-5MM X 8-15CM,272,RC,27202000,CDM,,,,,,both,,,1822.0000,273.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1822.00,,,,,,,470.2600,1822.0000,percent of total billed charges,"100% of $1,822.00 in Billed Charges for Rev 272 = $1,822.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 4-5MM X 8-15CM,272,RC,27202000,CDM,,,,,,both,,,1822.0000,273.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,911.00,,,,,,,470.2600,1822.0000,percent of total billed charges,"Rev 272 $1,822.00 in Billed Charges at 50% = $911.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 4-5MM X 8-15CM,272,RC,27202000,CDM,,,,,,both,,,1822.0000,273.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,588.51,,,,,,,470.2600,1822.0000,other,"32.3% of $1,822.00 in Billed Charges for Rev 272 = $588.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC F-IDC 2D 4-5MM X 8-15CM,272,RC,27202000,CDM,,,,,,both,,,1822.0000,273.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,559.35,,,,,,,470.2600,1822.0000,other,"30.7% of $1,822.00 in Billed Charges for Rev 272 = $559.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC F-IDC 2D 4-5MM X 8-15CM,272,RC,27202000,CDM,,,,,,both,,,1822.0000,273.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,588.51,,,,,,,470.2600,1822.0000,percent of total billed charges,"32.3% of $1,822.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 4-5MM X 8-15CM,272,RC,27202000,CDM,,,,,,both,,,1822.0000,273.3000,WELLCARE,WELLCARE MEDICAID,1822.00,,,,,,,470.2600,1822.0000,percent of total billed charges,"100% of $1,822.00 in Billed Charges for Rev 272 = $1,822.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 6-14MM X 20-30CM,272,RC,27202001,CDM,,,,,,both,,,1908.0000,286.2000,AETNA,AETNA,814.72,,,,,,,492.4500,1908.0000,percent of total billed charges,"42.7% of $1,908.00 in Billed Charges for Rev 272 = $814.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 6-14MM X 20-30CM,272,RC,27202001,CDM,,,,,,both,,,1908.0000,286.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1335.60,,,,,,,492.4500,1908.0000,percent of total billed charges,"Rev 272 $1,908.00 in Billed Charges at 70% = $1,335.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 6-14MM X 20-30CM,272,RC,27202001,CDM,,,,,,both,,,1908.0000,286.2000,CIGNA HEALTHCARE,CIGNA HMO,795.64,,,,,,,492.4500,1908.0000,percent of total billed charges,"41.7% of $1,908.00 in Billed Charges for Rev 272 = $795.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 6-14MM X 20-30CM,272,RC,27202001,CDM,,,,,,both,,,1908.0000,286.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,885.31,,,,,,,492.4500,1908.0000,percent of total billed charges,"46.4% of $1,908.00 in Billed Charges for Rev 272 = $885.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 6-14MM X 20-30CM,272,RC,27202001,CDM,,,,,,both,,,1908.0000,286.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,795.64,,,,,,,492.4500,1908.0000,percent of total billed charges,"41.7% of $1,908.00 in Billed Charges for Rev 272 = $795.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 6-14MM X 20-30CM,272,RC,27202001,CDM,,,,,,both,,,1908.0000,286.2000,CIGNA HEALTHCARE,CIGNA PPO,795.64,,,,,,,492.4500,1908.0000,percent of total billed charges,"41.7% of $1,908.00 in Billed Charges for Rev 272 = $795.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 6-14MM X 20-30CM,272,RC,27202001,CDM,,,,,,both,,,1908.0000,286.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1717.20,,,,,,,492.4500,1908.0000,percent of total billed charges,"90% of $1,908.00 in Billed Charges for Rev 272 = $1,717.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 6-14MM X 20-30CM,272,RC,27202001,CDM,,,,,,both,,,1908.0000,286.2000,MEDCOST,MEDCOST VHN,908.02,,,,,,,492.4500,1908.0000,percent of total billed charges,"47.59% of $1,908.00 in Billed Charges for Rev 272 = $908.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 6-14MM X 20-30CM,272,RC,27202001,CDM,,,,,,both,,,1908.0000,286.2000,SENTARA HEALTH,SENTARA HEALTH,492.45,,,,,,,492.4500,1908.0000,percent of total billed charges,"25.81% of $1,908.00 in Billed Charges for Rev 272 = $492.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 6-14MM X 20-30CM,272,RC,27202001,CDM,,,,,,both,,,1908.0000,286.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1908.00,,,,,,,492.4500,1908.0000,percent of total billed charges,"100% of $1,908.00 in Billed Charges for Rev 272 = $1,908.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 6-14MM X 20-30CM,272,RC,27202001,CDM,,,,,,both,,,1908.0000,286.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,954.00,,,,,,,492.4500,1908.0000,percent of total billed charges,"Rev 272 $1,908.00 in Billed Charges at 50% = $954.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 6-14MM X 20-30CM,272,RC,27202001,CDM,,,,,,both,,,1908.0000,286.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,616.28,,,,,,,492.4500,1908.0000,other,"32.3% of $1,908.00 in Billed Charges for Rev 272 = $616.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC F-IDC 2D 6-14MM X 20-30CM,272,RC,27202001,CDM,,,,,,both,,,1908.0000,286.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,585.76,,,,,,,492.4500,1908.0000,other,"30.7% of $1,908.00 in Billed Charges for Rev 272 = $585.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC F-IDC 2D 6-14MM X 20-30CM,272,RC,27202001,CDM,,,,,,both,,,1908.0000,286.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,616.28,,,,,,,492.4500,1908.0000,percent of total billed charges,"32.3% of $1,908.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC F-IDC 2D 6-14MM X 20-30CM,272,RC,27202001,CDM,,,,,,both,,,1908.0000,286.2000,WELLCARE,WELLCARE MEDICAID,1908.00,,,,,,,492.4500,1908.0000,percent of total billed charges,"100% of $1,908.00 in Billed Charges for Rev 272 = $1,908.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 4 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000008,CDM,,,,,,both,,,3010.0000,451.5000,AETNA,AETNA,1285.27,,,,,,,175.0000,3010.0000,percent of total billed charges,"42.7% of $3,010.00 in Billed Charges for Rev 360 = $1,285.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 4 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000008,CDM,,,,,,both,,,3010.0000,451.5000,BLUE CROSS,ANTHEM EXCHANGE,496.65,,,,,,,175.0000,3010.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 4 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000008,CDM,,,,,,both,,,3010.0000,451.5000,BLUE CROSS,ANTHEM HMO,496.65,,,,,,,175.0000,3010.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 4 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000008,CDM,,,,,,both,,,3010.0000,451.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",496.65,,,,,,,175.0000,3010.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 4 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000008,CDM,,,,,,both,,,3010.0000,451.5000,CIGNA HEALTHCARE,CIGNA HMO,228.00,,,,,,,175.0000,3010.0000,case rate,Rev 360 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 4 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000008,CDM,,,,,,both,,,3010.0000,451.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.00,,,,,,,175.0000,3010.0000,case rate,Rev 360 ASG Rate of $175.00 at 100% of $175.00 = $175.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 4 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000008,CDM,,,,,,both,,,3010.0000,451.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.00,,,,,,,175.0000,3010.0000,case rate,Rev 360 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 4 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000008,CDM,,,,,,both,,,3010.0000,451.5000,CIGNA HEALTHCARE,CIGNA PPO,228.00,,,,,,,175.0000,3010.0000,case rate,Rev 360 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 4 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000008,CDM,,,,,,both,,,3010.0000,451.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2709.00,,,,,,,175.0000,3010.0000,percent of total billed charges,"90% of $3,010.00 in Billed Charges for Rev 360 = $2,709.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 4 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000008,CDM,,,,,,both,,,3010.0000,451.5000,MEDCOST,MEDCOST VHN,1432.46,,,,,,,175.0000,3010.0000,percent of total billed charges,"47.59% of $3,010.00 in Billed Charges for Rev 360 = $1,432.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 4 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000008,CDM,,,,,,both,,,3010.0000,451.5000,SENTARA HEALTH,SENTARA HEALTH,776.88,,,,,,,175.0000,3010.0000,percent of total billed charges,"25.81% of $3,010.00 in Billed Charges for Rev 360 = $776.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 4 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000008,CDM,,,,,,both,,,3010.0000,451.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3010.00,,,,,,,175.0000,3010.0000,percent of total billed charges,"100% of $3,010.00 in Billed Charges for Rev 360 = $3,010.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 4 OR ROOM & SETUP EA ADDL 15 MINS,360,RC,36000008,CDM,,,,,,both,,,3010.0000,451.5000,WELLCARE,WELLCARE MEDICAID,3010.00,,,,,,,175.0000,3010.0000,percent of total billed charges,"100% of $3,010.00 in Billed Charges for Rev 360 = $3,010.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 GI PROCEDURE & SETUP INITIAL 30 MINS,750,RC,75000013,CDM,,,,,,both,,,5935.0000,890.2500,AETNA,AETNA,2534.25,,,,,,,175.0000,5935.0000,percent of total billed charges,"42.7% of $5,935.00 in Billed Charges for Rev 750 = $2,534.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 GI PROCEDURE & SETUP INITIAL 30 MINS,750,RC,75000013,CDM,,,,,,both,,,5935.0000,890.2500,BLUE CROSS,ANTHEM EXCHANGE,979.28,,,,,,,175.0000,5935.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 GI PROCEDURE & SETUP INITIAL 30 MINS,750,RC,75000013,CDM,,,,,,both,,,5935.0000,890.2500,BLUE CROSS,ANTHEM HMO,979.28,,,,,,,175.0000,5935.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 GI PROCEDURE & SETUP INITIAL 30 MINS,750,RC,75000013,CDM,,,,,,both,,,5935.0000,890.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",979.28,,,,,,,175.0000,5935.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 GI PROCEDURE & SETUP INITIAL 30 MINS,750,RC,75000013,CDM,,,,,,both,,,5935.0000,890.2500,CIGNA HEALTHCARE,CIGNA HMO,228.00,,,,,,,175.0000,5935.0000,case rate,Rev 750 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 GI PROCEDURE & SETUP INITIAL 30 MINS,750,RC,75000013,CDM,,,,,,both,,,5935.0000,890.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.00,,,,,,,175.0000,5935.0000,case rate,Rev 750 ASG Rate of $175.00 at 100% of $175.00 = $175.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 GI PROCEDURE & SETUP INITIAL 30 MINS,750,RC,75000013,CDM,,,,,,both,,,5935.0000,890.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.00,,,,,,,175.0000,5935.0000,case rate,Rev 750 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 GI PROCEDURE & SETUP INITIAL 30 MINS,750,RC,75000013,CDM,,,,,,both,,,5935.0000,890.2500,CIGNA HEALTHCARE,CIGNA PPO,228.00,,,,,,,175.0000,5935.0000,case rate,Rev 750 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 GI PROCEDURE & SETUP INITIAL 30 MINS,750,RC,75000013,CDM,,,,,,both,,,5935.0000,890.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5341.50,,,,,,,175.0000,5935.0000,percent of total billed charges,"90% of $5,935.00 in Billed Charges for Rev 750 = $5,341.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 GI PROCEDURE & SETUP INITIAL 30 MINS,750,RC,75000013,CDM,,,,,,both,,,5935.0000,890.2500,MEDCOST,MEDCOST VHN,2824.47,,,,,,,175.0000,5935.0000,percent of total billed charges,"47.59% of $5,935.00 in Billed Charges for Rev 750 = $2,824.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 GI PROCEDURE & SETUP INITIAL 30 MINS,750,RC,75000013,CDM,,,,,,both,,,5935.0000,890.2500,SENTARA HEALTH,SENTARA HEALTH,1531.82,,,,,,,175.0000,5935.0000,percent of total billed charges,"25.81% of $5,935.00 in Billed Charges for Rev 750 = $1,531.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 GI PROCEDURE & SETUP INITIAL 30 MINS,750,RC,75000013,CDM,,,,,,both,,,5935.0000,890.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5935.00,,,,,,,175.0000,5935.0000,percent of total billed charges,"100% of $5,935.00 in Billed Charges for Rev 750 = $5,935.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 GI PROCEDURE & SETUP INITIAL 30 MINS,750,RC,75000013,CDM,,,,,,both,,,5935.0000,890.2500,WELLCARE,WELLCARE MEDICAID,5935.00,,,,,,,175.0000,5935.0000,percent of total billed charges,"100% of $5,935.00 in Billed Charges for Rev 750 = $5,935.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100437,CDM,,,,,,both,,,7109.0000,1066.3500,AETNA,AETNA,3035.54,,,,,,,175.0000,7109.0000,percent of total billed charges,"42.7% of $7,109.00 in Billed Charges for Rev 361 = $3,035.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100437,CDM,,,,,,both,,,7109.0000,1066.3500,BLUE CROSS,ANTHEM EXCHANGE,1172.99,,,,,,,175.0000,7109.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100437,CDM,,,,,,both,,,7109.0000,1066.3500,BLUE CROSS,ANTHEM HMO,1172.99,,,,,,,175.0000,7109.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100437,CDM,,,,,,both,,,7109.0000,1066.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1172.99,,,,,,,175.0000,7109.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100437,CDM,,,,,,both,,,7109.0000,1066.3500,CIGNA HEALTHCARE,CIGNA HMO,228.00,,,,,,,175.0000,7109.0000,case rate,Rev 361 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100437,CDM,,,,,,both,,,7109.0000,1066.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.00,,,,,,,175.0000,7109.0000,case rate,Rev 361 ASG Rate of $175.00 at 100% of $175.00 = $175.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100437,CDM,,,,,,both,,,7109.0000,1066.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.00,,,,,,,175.0000,7109.0000,case rate,Rev 361 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100437,CDM,,,,,,both,,,7109.0000,1066.3500,CIGNA HEALTHCARE,CIGNA PPO,228.00,,,,,,,175.0000,7109.0000,case rate,Rev 361 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100437,CDM,,,,,,both,,,7109.0000,1066.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6398.10,,,,,,,175.0000,7109.0000,percent of total billed charges,"90% of $7,109.00 in Billed Charges for Rev 361 = $6,398.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100437,CDM,,,,,,both,,,7109.0000,1066.3500,MEDCOST,MEDCOST VHN,3383.17,,,,,,,175.0000,7109.0000,percent of total billed charges,"47.59% of $7,109.00 in Billed Charges for Rev 361 = $3,383.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100437,CDM,,,,,,both,,,7109.0000,1066.3500,SENTARA HEALTH,SENTARA HEALTH,1834.83,,,,,,,175.0000,7109.0000,percent of total billed charges,"25.81% of $7,109.00 in Billed Charges for Rev 361 = $1,834.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100437,CDM,,,,,,both,,,7109.0000,1066.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7109.00,,,,,,,175.0000,7109.0000,percent of total billed charges,"100% of $7,109.00 in Billed Charges for Rev 361 = $7,109.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 NON-GI PROCEDURE & SETUP INITIAL 30 MINS,361,RC,36100437,CDM,,,,,,both,,,7109.0000,1066.3500,WELLCARE,WELLCARE MEDICAID,7109.00,,,,,,,175.0000,7109.0000,percent of total billed charges,"100% of $7,109.00 in Billed Charges for Rev 361 = $7,109.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000009,CDM,,,,,,both,,,10253.0000,1537.9500,AETNA,AETNA,4378.03,,,,,,,175.0000,10253.0000,percent of total billed charges,"42.7% of $10,253.00 in Billed Charges for Rev 360 = $4,378.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000009,CDM,,,,,,both,,,10253.0000,1537.9500,BLUE CROSS,ANTHEM EXCHANGE,1691.75,,,,,,,175.0000,10253.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000009,CDM,,,,,,both,,,10253.0000,1537.9500,BLUE CROSS,ANTHEM HMO,1691.75,,,,,,,175.0000,10253.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000009,CDM,,,,,,both,,,10253.0000,1537.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1691.75,,,,,,,175.0000,10253.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000009,CDM,,,,,,both,,,10253.0000,1537.9500,CIGNA HEALTHCARE,CIGNA HMO,228.00,,,,,,,175.0000,10253.0000,case rate,Rev 360 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000009,CDM,,,,,,both,,,10253.0000,1537.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.00,,,,,,,175.0000,10253.0000,case rate,Rev 360 ASG Rate of $175.00 at 100% of $175.00 = $175.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000009,CDM,,,,,,both,,,10253.0000,1537.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.00,,,,,,,175.0000,10253.0000,case rate,Rev 360 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000009,CDM,,,,,,both,,,10253.0000,1537.9500,CIGNA HEALTHCARE,CIGNA PPO,228.00,,,,,,,175.0000,10253.0000,case rate,Rev 360 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEVEL 5 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000009,CDM,,,,,,both,,,10253.0000,1537.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9227.70,,,,,,,175.0000,10253.0000,percent of total billed charges,"90% of $10,253.00 in Billed Charges for Rev 360 = $9,227.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000009,CDM,,,,,,both,,,10253.0000,1537.9500,MEDCOST,MEDCOST VHN,4879.40,,,,,,,175.0000,10253.0000,percent of total billed charges,"47.59% of $10,253.00 in Billed Charges for Rev 360 = $4,879.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000009,CDM,,,,,,both,,,10253.0000,1537.9500,SENTARA HEALTH,SENTARA HEALTH,2646.30,,,,,,,175.0000,10253.0000,percent of total billed charges,"25.81% of $10,253.00 in Billed Charges for Rev 360 = $2,646.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000009,CDM,,,,,,both,,,10253.0000,1537.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10253.00,,,,,,,175.0000,10253.0000,percent of total billed charges,"100% of $10,253.00 in Billed Charges for Rev 360 = $10,253.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEVEL 5 OR ROOM & SETUP INITIAL 30 MINS,360,RC,36000009,CDM,,,,,,both,,,10253.0000,1537.9500,WELLCARE,WELLCARE MEDICAID,10253.00,,,,,,,175.0000,10253.0000,percent of total billed charges,"100% of $10,253.00 in Billed Charges for Rev 360 = $10,253.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LIFE VEST STUDY DEVICE,272,RC,27201777,CDM,,,,,,both,,,1.0000,0.1500,AETNA,AETNA,0.43,,,,,,,0.2600,1.0000,percent of total billed charges,42.7% of $1.00 in Billed Charges for Rev 272 = $0.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIFE VEST STUDY DEVICE,272,RC,27201777,CDM,,,,,,both,,,1.0000,0.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,0.70,,,,,,,0.2600,1.0000,percent of total billed charges,Rev 272 $1.00 in Billed Charges at 70% = $0.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIFE VEST STUDY DEVICE,272,RC,27201777,CDM,,,,,,both,,,1.0000,0.1500,CIGNA HEALTHCARE,CIGNA HMO,0.42,,,,,,,0.2600,1.0000,percent of total billed charges,41.7% of $1.00 in Billed Charges for Rev 272 = $0.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIFE VEST STUDY DEVICE,272,RC,27201777,CDM,,,,,,both,,,1.0000,0.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,0.46,,,,,,,0.2600,1.0000,percent of total billed charges,46.4% of $1.00 in Billed Charges for Rev 272 = $0.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIFE VEST STUDY DEVICE,272,RC,27201777,CDM,,,,,,both,,,1.0000,0.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,0.42,,,,,,,0.2600,1.0000,percent of total billed charges,41.7% of $1.00 in Billed Charges for Rev 272 = $0.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIFE VEST STUDY DEVICE,272,RC,27201777,CDM,,,,,,both,,,1.0000,0.1500,CIGNA HEALTHCARE,CIGNA PPO,0.42,,,,,,,0.2600,1.0000,percent of total billed charges,41.7% of $1.00 in Billed Charges for Rev 272 = $0.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIFE VEST STUDY DEVICE,272,RC,27201777,CDM,,,,,,both,,,1.0000,0.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,0.90,,,,,,,0.2600,1.0000,percent of total billed charges,90% of $1.00 in Billed Charges for Rev 272 = $0.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIFE VEST STUDY DEVICE,272,RC,27201777,CDM,,,,,,both,,,1.0000,0.1500,MEDCOST,MEDCOST VHN,0.48,,,,,,,0.2600,1.0000,percent of total billed charges,47.59% of $1.00 in Billed Charges for Rev 272 = $0.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIFE VEST STUDY DEVICE,272,RC,27201777,CDM,,,,,,both,,,1.0000,0.1500,SENTARA HEALTH,SENTARA HEALTH,0.26,,,,,,,0.2600,1.0000,percent of total billed charges,25.81% of $1.00 in Billed Charges for Rev 272 = $0.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIFE VEST STUDY DEVICE,272,RC,27201777,CDM,,,,,,both,,,1.0000,0.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1.00,,,,,,,0.2600,1.0000,percent of total billed charges,100% of $1.00 in Billed Charges for Rev 272 = $1.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIFE VEST STUDY DEVICE,272,RC,27201777,CDM,,,,,,both,,,1.0000,0.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,0.50,,,,,,,0.2600,1.0000,percent of total billed charges,Rev 272 $1.00 in Billed Charges at 50% = $0.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIFE VEST STUDY DEVICE,272,RC,27201777,CDM,,,,,,both,,,1.0000,0.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,0.32,,,,,,,0.2600,1.0000,other,32.3% of $1.00 in Billed Charges for Rev 272 = $0.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LIFE VEST STUDY DEVICE,272,RC,27201777,CDM,,,,,,both,,,1.0000,0.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,0.31,,,,,,,0.2600,1.0000,other,30.7% of $1.00 in Billed Charges for Rev 272 = $0.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LIFE VEST STUDY DEVICE,272,RC,27201777,CDM,,,,,,both,,,1.0000,0.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,0.32,,,,,,,0.2600,1.0000,percent of total billed charges,32.3% of $1.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIFE VEST STUDY DEVICE,272,RC,27201777,CDM,,,,,,both,,,1.0000,0.1500,WELLCARE,WELLCARE MEDICAID,1.00,,,,,,,0.2600,1.0000,percent of total billed charges,100% of $1.00 in Billed Charges for Rev 272 = $1.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIGACLIP MULTI LAPRSCPC AL326,272,RC,27200926,CDM,,,,,,both,,,581.0000,87.1500,AETNA,AETNA,248.09,,,,,,,149.9600,581.0000,percent of total billed charges,42.7% of $581.00 in Billed Charges for Rev 272 = $248.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIGACLIP MULTI LAPRSCPC AL326,272,RC,27200926,CDM,,,,,,both,,,581.0000,87.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,406.70,,,,,,,149.9600,581.0000,percent of total billed charges,Rev 272 $581.00 in Billed Charges at 70% = $406.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIGACLIP MULTI LAPRSCPC AL326,272,RC,27200926,CDM,,,,,,both,,,581.0000,87.1500,CIGNA HEALTHCARE,CIGNA HMO,242.28,,,,,,,149.9600,581.0000,percent of total billed charges,41.7% of $581.00 in Billed Charges for Rev 272 = $242.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIGACLIP MULTI LAPRSCPC AL326,272,RC,27200926,CDM,,,,,,both,,,581.0000,87.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,269.58,,,,,,,149.9600,581.0000,percent of total billed charges,46.4% of $581.00 in Billed Charges for Rev 272 = $269.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIGACLIP MULTI LAPRSCPC AL326,272,RC,27200926,CDM,,,,,,both,,,581.0000,87.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,242.28,,,,,,,149.9600,581.0000,percent of total billed charges,41.7% of $581.00 in Billed Charges for Rev 272 = $242.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIGACLIP MULTI LAPRSCPC AL326,272,RC,27200926,CDM,,,,,,both,,,581.0000,87.1500,CIGNA HEALTHCARE,CIGNA PPO,242.28,,,,,,,149.9600,581.0000,percent of total billed charges,41.7% of $581.00 in Billed Charges for Rev 272 = $242.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIGACLIP MULTI LAPRSCPC AL326,272,RC,27200926,CDM,,,,,,both,,,581.0000,87.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,522.90,,,,,,,149.9600,581.0000,percent of total billed charges,90% of $581.00 in Billed Charges for Rev 272 = $522.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIGACLIP MULTI LAPRSCPC AL326,272,RC,27200926,CDM,,,,,,both,,,581.0000,87.1500,MEDCOST,MEDCOST VHN,276.50,,,,,,,149.9600,581.0000,percent of total billed charges,47.59% of $581.00 in Billed Charges for Rev 272 = $276.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIGACLIP MULTI LAPRSCPC AL326,272,RC,27200926,CDM,,,,,,both,,,581.0000,87.1500,SENTARA HEALTH,SENTARA HEALTH,149.96,,,,,,,149.9600,581.0000,percent of total billed charges,25.81% of $581.00 in Billed Charges for Rev 272 = $149.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIGACLIP MULTI LAPRSCPC AL326,272,RC,27200926,CDM,,,,,,both,,,581.0000,87.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",581.00,,,,,,,149.9600,581.0000,percent of total billed charges,100% of $581.00 in Billed Charges for Rev 272 = $581.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIGACLIP MULTI LAPRSCPC AL326,272,RC,27200926,CDM,,,,,,both,,,581.0000,87.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,290.50,,,,,,,149.9600,581.0000,percent of total billed charges,Rev 272 $581.00 in Billed Charges at 50% = $290.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIGACLIP MULTI LAPRSCPC AL326,272,RC,27200926,CDM,,,,,,both,,,581.0000,87.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,187.66,,,,,,,149.9600,581.0000,other,32.3% of $581.00 in Billed Charges for Rev 272 = $187.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LIGACLIP MULTI LAPRSCPC AL326,272,RC,27200926,CDM,,,,,,both,,,581.0000,87.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,178.37,,,,,,,149.9600,581.0000,other,30.7% of $581.00 in Billed Charges for Rev 272 = $178.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LIGACLIP MULTI LAPRSCPC AL326,272,RC,27200926,CDM,,,,,,both,,,581.0000,87.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,187.66,,,,,,,149.9600,581.0000,percent of total billed charges,32.3% of $581.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LIGACLIP MULTI LAPRSCPC AL326,272,RC,27200926,CDM,,,,,,both,,,581.0000,87.1500,WELLCARE,WELLCARE MEDICAID,581.00,,,,,,,149.9600,581.0000,percent of total billed charges,100% of $581.00 in Billed Charges for Rev 272 = $581.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LITHOTRIPSY ESWL BILAT,790,RC,36000103,CDM,,,,,,both,,,19043.0000,2856.4500,AETNA,AETNA,8131.36,,,,,,,3142.1000,19043.0000,percent of total billed charges,"42.7% of $19,043.00 in Billed Charges for Rev 790 = $8,131.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LITHOTRIPSY ESWL BILAT,790,RC,36000103,CDM,,,,,,both,,,19043.0000,2856.4500,BLUE CROSS,ANTHEM EXCHANGE,3142.10,,,,,,,3142.1000,19043.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LITHOTRIPSY ESWL BILAT,790,RC,36000103,CDM,,,,,,both,,,19043.0000,2856.4500,BLUE CROSS,ANTHEM HMO,3142.10,,,,,,,3142.1000,19043.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LITHOTRIPSY ESWL BILAT,790,RC,36000103,CDM,,,,,,both,,,19043.0000,2856.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3142.10,,,,,,,3142.1000,19043.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LITHOTRIPSY ESWL BILAT,790,RC,36000103,CDM,,,,,,both,,,19043.0000,2856.4500,CIGNA HEALTHCARE,CIGNA HMO,11204.00,,,,,,,3142.1000,19043.0000,case rate,"Rev 790 at Case Rate $11,204.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LITHOTRIPSY ESWL BILAT,790,RC,36000103,CDM,,,,,,both,,,19043.0000,2856.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8442.00,,,,,,,3142.1000,19043.0000,case rate,"Rev 790 at Case Rate $8,442.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LITHOTRIPSY ESWL BILAT,790,RC,36000103,CDM,,,,,,both,,,19043.0000,2856.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11204.00,,,,,,,3142.1000,19043.0000,case rate,"Rev 790 at Case Rate $11,204.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LITHOTRIPSY ESWL BILAT,790,RC,36000103,CDM,,,,,,both,,,19043.0000,2856.4500,CIGNA HEALTHCARE,CIGNA PPO,11204.00,,,,,,,3142.1000,19043.0000,case rate,"Rev 790 at Case Rate $11,204.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LITHOTRIPSY ESWL BILAT,790,RC,36000103,CDM,,,,,,both,,,19043.0000,2856.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,17138.70,,,,,,,3142.1000,19043.0000,percent of total billed charges,"90% of $19,043.00 in Billed Charges for Rev 790 = $17,138.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LITHOTRIPSY ESWL BILAT,790,RC,36000103,CDM,,,,,,both,,,19043.0000,2856.4500,MEDCOST,MEDCOST VHN,9062.56,,,,,,,3142.1000,19043.0000,percent of total billed charges,"47.59% of $19,043.00 in Billed Charges for Rev 790 = $9,062.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LITHOTRIPSY ESWL BILAT,790,RC,36000103,CDM,,,,,,both,,,19043.0000,2856.4500,SENTARA HEALTH,SENTARA HEALTH,4915.00,,,,,,,3142.1000,19043.0000,percent of total billed charges,"25.81% of $19,043.00 in Billed Charges for Rev 790 = $4,915.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LITHOTRIPSY ESWL BILAT,790,RC,36000103,CDM,,,,,,both,,,19043.0000,2856.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",19043.00,,,,,,,3142.1000,19043.0000,percent of total billed charges,"100% of $19,043.00 in Billed Charges for Rev 790 = $19,043.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LITHOTRIPSY ESWL BILAT,790,RC,36000103,CDM,,,,,,both,,,19043.0000,2856.4500,WELLCARE,WELLCARE MEDICAID,19043.00,,,,,,,3142.1000,19043.0000,percent of total billed charges,"100% of $19,043.00 in Billed Charges for Rev 790 = $19,043.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LONG TERM CARE DLY PRV,119,RC,11900002,CDM,,,,,,inpatient,,,291.0000,43.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,108.4800,291.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC LONG TERM CARE DLY PRV,119,RC,11900002,CDM,,,,,,inpatient,,,291.0000,43.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,261.90,,,,,,,108.4800,291.0000,percent of total billed charges,90% of $291.00 in Billed Charges for Rev 119 = $261.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LONG TERM CARE DLY PRV,119,RC,11900002,CDM,,,,,,inpatient,,,291.0000,43.6500,MEDCOST,MEDCOST VHN,138.49,,,,,,,108.4800,291.0000,percent of total billed charges,47.59% of $291.00 in Billed Charges for Rev 119 = $138.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LONG TERM CARE DLY PRV,119,RC,11900002,CDM,,,,,,inpatient,,,291.0000,43.6500,SENTARA HEALTH,SENTARA HEALTH,108.48,,,,,,,108.4800,291.0000,percent of total billed charges,37.28% of $291.00 in Billed Charges for Rev 119 = $108.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LONG TERM CARE DLY PRV,119,RC,11900002,CDM,,,,,,inpatient,,,291.0000,43.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",291.00,,,,,,,108.4800,291.0000,percent of total billed charges,100% of $291.00 in Billed Charges for Rev 119 = $291.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LONG TERM CARE DLY SEMI,129,RC,12900002,CDM,,,,,,inpatient,,,291.0000,43.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,108.4800,291.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC LONG TERM CARE DLY SEMI,129,RC,12900002,CDM,,,,,,inpatient,,,291.0000,43.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,261.90,,,,,,,108.4800,291.0000,percent of total billed charges,90% of $291.00 in Billed Charges for Rev 129 = $261.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LONG TERM CARE DLY SEMI,129,RC,12900002,CDM,,,,,,inpatient,,,291.0000,43.6500,MEDCOST,MEDCOST VHN,138.49,,,,,,,108.4800,291.0000,percent of total billed charges,47.59% of $291.00 in Billed Charges for Rev 129 = $138.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LONG TERM CARE DLY SEMI,129,RC,12900002,CDM,,,,,,inpatient,,,291.0000,43.6500,SENTARA HEALTH,SENTARA HEALTH,108.48,,,,,,,108.4800,291.0000,percent of total billed charges,37.28% of $291.00 in Billed Charges for Rev 129 = $108.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LONG TERM CARE DLY SEMI,129,RC,12900002,CDM,,,,,,inpatient,,,291.0000,43.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",291.00,,,,,,,108.4800,291.0000,percent of total billed charges,100% of $291.00 in Billed Charges for Rev 129 = $291.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MAMMOSTAR BX MARKER,272,RC,27202090,CDM,,,,,,both,,,2345.0000,351.7500,AETNA,AETNA,1001.32,,,,,,,605.2400,2345.0000,percent of total billed charges,"42.7% of $2,345.00 in Billed Charges for Rev 272 = $1,001.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMOSTAR BX MARKER,272,RC,27202090,CDM,,,,,,both,,,2345.0000,351.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1641.50,,,,,,,605.2400,2345.0000,percent of total billed charges,"Rev 272 $2,345.00 in Billed Charges at 70% = $1,641.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMOSTAR BX MARKER,272,RC,27202090,CDM,,,,,,both,,,2345.0000,351.7500,CIGNA HEALTHCARE,CIGNA HMO,977.87,,,,,,,605.2400,2345.0000,percent of total billed charges,"41.7% of $2,345.00 in Billed Charges for Rev 272 = $977.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMOSTAR BX MARKER,272,RC,27202090,CDM,,,,,,both,,,2345.0000,351.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1088.08,,,,,,,605.2400,2345.0000,percent of total billed charges,"46.4% of $2,345.00 in Billed Charges for Rev 272 = $1,088.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMOSTAR BX MARKER,272,RC,27202090,CDM,,,,,,both,,,2345.0000,351.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,977.87,,,,,,,605.2400,2345.0000,percent of total billed charges,"41.7% of $2,345.00 in Billed Charges for Rev 272 = $977.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMOSTAR BX MARKER,272,RC,27202090,CDM,,,,,,both,,,2345.0000,351.7500,CIGNA HEALTHCARE,CIGNA PPO,977.87,,,,,,,605.2400,2345.0000,percent of total billed charges,"41.7% of $2,345.00 in Billed Charges for Rev 272 = $977.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMOSTAR BX MARKER,272,RC,27202090,CDM,,,,,,both,,,2345.0000,351.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2110.50,,,,,,,605.2400,2345.0000,percent of total billed charges,"90% of $2,345.00 in Billed Charges for Rev 272 = $2,110.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMOSTAR BX MARKER,272,RC,27202090,CDM,,,,,,both,,,2345.0000,351.7500,MEDCOST,MEDCOST VHN,1115.99,,,,,,,605.2400,2345.0000,percent of total billed charges,"47.59% of $2,345.00 in Billed Charges for Rev 272 = $1,115.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMOSTAR BX MARKER,272,RC,27202090,CDM,,,,,,both,,,2345.0000,351.7500,SENTARA HEALTH,SENTARA HEALTH,605.24,,,,,,,605.2400,2345.0000,percent of total billed charges,"25.81% of $2,345.00 in Billed Charges for Rev 272 = $605.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMOSTAR BX MARKER,272,RC,27202090,CDM,,,,,,both,,,2345.0000,351.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2345.00,,,,,,,605.2400,2345.0000,percent of total billed charges,"100% of $2,345.00 in Billed Charges for Rev 272 = $2,345.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMOSTAR BX MARKER,272,RC,27202090,CDM,,,,,,both,,,2345.0000,351.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1172.50,,,,,,,605.2400,2345.0000,percent of total billed charges,"Rev 272 $2,345.00 in Billed Charges at 50% = $1,172.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMOSTAR BX MARKER,272,RC,27202090,CDM,,,,,,both,,,2345.0000,351.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,757.44,,,,,,,605.2400,2345.0000,other,"32.3% of $2,345.00 in Billed Charges for Rev 272 = $757.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MAMMOSTAR BX MARKER,272,RC,27202090,CDM,,,,,,both,,,2345.0000,351.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,719.92,,,,,,,605.2400,2345.0000,other,"30.7% of $2,345.00 in Billed Charges for Rev 272 = $719.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MAMMOSTAR BX MARKER,272,RC,27202090,CDM,,,,,,both,,,2345.0000,351.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,757.44,,,,,,,605.2400,2345.0000,percent of total billed charges,"32.3% of $2,345.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MAMMOSTAR BX MARKER,272,RC,27202090,CDM,,,,,,both,,,2345.0000,351.7500,WELLCARE,WELLCARE MEDICAID,2345.00,,,,,,,605.2400,2345.0000,percent of total billed charges,"100% of $2,345.00 in Billed Charges for Rev 272 = $2,345.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,13.8600,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 70360 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,13.8600,462.0000,fee schedule,APG 00471 Proc 70360 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,13.8600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,13.8600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,13.8600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,172.12,,,,,,,13.8600,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,13.8600,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,13.8600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,13.8600,462.0000,fee schedule,APG 00471 Proc 70360 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,13.8600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,13.8600,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,13.8600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,26.12,,,,,,,13.8600,462.0000,fee schedule,$26.12 from Fee Schedule BLDTM_23 for Rev 320 Proc 70360 * Qty 1 = $26.12 at 100% = $26.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,60.32,,,,,,,13.8600,462.0000,fee schedule,$18.85 from Fee Schedule BCFSC for Rev 320 Proc 70360 * Qty 1 = $18.85 at 320% = $60.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,13.8600,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,61.64,,,,,,,13.8600,462.0000,fee schedule,$18.85 from Fee Schedule BCFSC for Rev 320 Proc 70360 * Qty 1 = $18.85 at 327% = $61.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,61.64,,,,,,,13.8600,462.0000,fee schedule,$18.85 from Fee Schedule BCFSC for Rev 320 Proc 70360 * Qty 1 = $18.85 at 327% = $61.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,13.86,,,,,,,13.8600,462.0000,fee schedule,$11.95 from Fee Schedule TC_24 for Rev 320 Proc 70360 * Qty 1 = $11.95 at 116% = $13.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,13.86,,,,,,,13.8600,462.0000,fee schedule,$11.95 from Fee Schedule TC_24 for Rev 320 Proc 70360 * Qty 1 = $11.95 at 116% = $13.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,13.8600,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70360 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,42.34,,,,,,,13.8600,462.0000,fee schedule,$42.34 from Fee Schedule CGIFP_25LR for Rev 320 Proc 70360 * Qty 1 = $42.34 at 100% = $42.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,13.8600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,13.8600,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70360 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,13.8600,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70360 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,13.8600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,13.8600,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 70360 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,78.96,,,,,,,13.8600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,13.8600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,13.8600,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 70360 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,13.8600,462.0000,fee schedule,APG 00471 Proc 70360 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,13.8600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,13.8600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,13.8600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,13.8600,462.0000,fee schedule,APG 00471 Proc 70360 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,13.8600,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 70360 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,13.8600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,13.8600,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 70360 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,13.8600,462.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 70360 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,13.8600,462.0000,other,Rev 320 Proc 70360 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,13.8600,462.0000,other,Rev 320 Proc 70360 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,13.8600,462.0000,other,Rev 320 Proc 70360 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,13.8600,462.0000,fee schedule,APG 00471 Proc 70360 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,13.8600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,13.8600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,13.8600,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 70360 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX NECK SOFT TISSUE,70360,CPT,320,RC,32000020,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,13.8600,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,AETNA,AETNA,181.90,,,,,,,42.7200,426.0000,percent of total billed charges,42.7% of $426.00 in Billed Charges for Rev 320 Proc 70370 = $181.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,42.7200,426.0000,fee schedule,APG 00471 Proc 70370 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,42.7200,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,42.7200,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,42.7200,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,AMBETTER,AMBETTER,172.12,,,,,,,42.7200,426.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,42.7200,426.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,42.7200,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,42.7200,426.0000,fee schedule,APG 00471 Proc 70370 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,42.7200,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,42.7200,426.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,42.7200,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,69.13,,,,,,,42.7200,426.0000,fee schedule,$69.13 from Fee Schedule BLDTM_23 for Rev 320 Proc 70370 * Qty 1 = $69.13 at 100% = $69.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,BLUE CROSS E NETWORK,190.02,,,,,,,42.7200,426.0000,fee schedule,$59.38 from Fee Schedule BCFSC for Rev 320 Proc 70370 * Qty 1 = $59.38 at 320% = $190.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,42.7200,426.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,BLUE CROSS P NETWORK,194.17,,,,,,,42.7200,426.0000,fee schedule,$59.38 from Fee Schedule BCFSC for Rev 320 Proc 70370 * Qty 1 = $59.38 at 327% = $194.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,BLUE CROSS S NETWORK,194.17,,,,,,,42.7200,426.0000,fee schedule,$59.38 from Fee Schedule BCFSC for Rev 320 Proc 70370 * Qty 1 = $59.38 at 327% = $194.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,TENNCARE BLUE CARE,42.72,,,,,,,42.7200,426.0000,fee schedule,$36.83 from Fee Schedule TC_24 for Rev 320 Proc 70370 * Qty 1 = $36.83 at 116% = $42.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,TENNCARE BLUE SELECT,42.72,,,,,,,42.7200,426.0000,fee schedule,$36.83 from Fee Schedule TC_24 for Rev 320 Proc 70370 * Qty 1 = $36.83 at 116% = $42.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,CIGNA HEALTHCARE,CIGNA HMO,333.59,,,,,,,42.7200,426.0000,fee schedule,$333.59 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70370 * Qty 1 = $333.59 at 100% = $333.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,168.87,,,,,,,42.7200,426.0000,fee schedule,$168.87 from Fee Schedule CGIFP_25LR for Rev 320 Proc 70370 * Qty 1 = $168.87 at 100% = $168.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,42.7200,426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,333.59,,,,,,,42.7200,426.0000,fee schedule,$333.59 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70370 * Qty 1 = $333.59 at 100% = $333.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,CIGNA HEALTHCARE,CIGNA PPO,333.59,,,,,,,42.7200,426.0000,fee schedule,$333.59 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70370 * Qty 1 = $333.59 at 100% = $333.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,42.7200,426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,383.40,,,,,,,42.7200,426.0000,percent of total billed charges,90% of $426.00 in Billed Charges for Rev 320 Proc 70370 = $383.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,HUMANA,HUMANA MEDICARE,78.96,,,,,,,42.7200,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,42.7200,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,MEDCOST,MEDCOST VHN,202.73,,,,,,,42.7200,426.0000,percent of total billed charges,47.59% of $426.00 in Billed Charges for Rev 320 Proc 70370 = $202.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,42.7200,426.0000,fee schedule,APG 00471 Proc 70370 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,42.7200,426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,42.7200,426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,42.7200,426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,42.7200,426.0000,fee schedule,APG 00471 Proc 70370 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,SENTARA HEALTH,SENTARA HEALTH,109.95,,,,,,,42.7200,426.0000,percent of total billed charges,25.81% of $426.00 in Billed Charges for Rev 320 Proc 70370 = $109.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,42.7200,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",426.00,,,,,,,42.7200,426.0000,percent of total billed charges,100% of $426.00 in Billed Charges for Rev 320 Proc 70370 = $426.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,44.07,,,,,,,42.7200,426.0000,fee schedule,$88.14 from Fee Schedule TCUHC24 for Rev 320 Proc 70370 * Qty 1 = $88.14 at 50% = $44.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,42.7200,426.0000,other,Rev 320 Proc 70370 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,42.7200,426.0000,other,Rev 320 Proc 70370 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,42.7200,426.0000,other,Rev 320 Proc 70370 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,42.7200,426.0000,fee schedule,APG 00471 Proc 70370 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,42.7200,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,42.7200,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,WELLCARE,WELLCARE MEDICAID,426.00,,,,,,,42.7200,426.0000,percent of total billed charges,100% of $426.00 in Billed Charges for Rev 320 Proc 70370 = $426.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX LARYNX PHARYNX W FLUORO,70370,CPT,320,RC,32000021,CDM,,,,both,,,426.0000,63.9000,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,42.7200,426.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,AETNA,AETNA,164.82,,,,,,,22.1900,386.0000,percent of total billed charges,42.7% of $386.00 in Billed Charges for Rev 320 Proc 70380 = $164.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,22.1900,386.0000,fee schedule,APG 00471 Proc 70380 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,22.1900,386.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,22.1900,386.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,22.1900,386.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,AMBETTER,AMBETTER,172.12,,,,,,,22.1900,386.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,22.1900,386.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,22.1900,386.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,22.1900,386.0000,fee schedule,APG 00471 Proc 70380 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,22.1900,386.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,22.1900,386.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,22.1900,386.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,35.89,,,,,,,22.1900,386.0000,fee schedule,$35.89 from Fee Schedule BLDTM_23 for Rev 320 Proc 70380 * Qty 1 = $35.89 at 100% = $35.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,BLUE CROSS,BLUE CROSS E NETWORK,85.02,,,,,,,22.1900,386.0000,fee schedule,$26.57 from Fee Schedule BCFSC for Rev 320 Proc 70380 * Qty 1 = $26.57 at 320% = $85.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,22.1900,386.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,BLUE CROSS,BLUE CROSS P NETWORK,86.88,,,,,,,22.1900,386.0000,fee schedule,$26.57 from Fee Schedule BCFSC for Rev 320 Proc 70380 * Qty 1 = $26.57 at 327% = $86.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,BLUE CROSS,BLUE CROSS S NETWORK,86.88,,,,,,,22.1900,386.0000,fee schedule,$26.57 from Fee Schedule BCFSC for Rev 320 Proc 70380 * Qty 1 = $26.57 at 327% = $86.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,BLUE CROSS,TENNCARE BLUE CARE,22.19,,,,,,,22.1900,386.0000,fee schedule,$19.13 from Fee Schedule TC_24 for Rev 320 Proc 70380 * Qty 1 = $19.13 at 116% = $22.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,BLUE CROSS,TENNCARE BLUE SELECT,22.19,,,,,,,22.1900,386.0000,fee schedule,$19.13 from Fee Schedule TC_24 for Rev 320 Proc 70380 * Qty 1 = $19.13 at 116% = $22.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,22.1900,386.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70380 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,55.50,,,,,,,22.1900,386.0000,fee schedule,$55.50 from Fee Schedule CGIFP_25LR for Rev 320 Proc 70380 * Qty 1 = $55.50 at 100% = $55.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,22.1900,386.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,22.1900,386.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70380 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,22.1900,386.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70380 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,22.1900,386.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,347.40,,,,,,,22.1900,386.0000,percent of total billed charges,90% of $386.00 in Billed Charges for Rev 320 Proc 70380 = $347.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,HUMANA,HUMANA MEDICARE,78.96,,,,,,,22.1900,386.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,22.1900,386.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,MEDCOST,MEDCOST VHN,183.70,,,,,,,22.1900,386.0000,percent of total billed charges,47.59% of $386.00 in Billed Charges for Rev 320 Proc 70380 = $183.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,22.1900,386.0000,fee schedule,APG 00471 Proc 70380 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,22.1900,386.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,22.1900,386.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,22.1900,386.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,22.1900,386.0000,fee schedule,APG 00471 Proc 70380 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,SENTARA HEALTH,SENTARA HEALTH,99.63,,,,,,,22.1900,386.0000,percent of total billed charges,25.81% of $386.00 in Billed Charges for Rev 320 Proc 70380 = $99.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,22.1900,386.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",386.00,,,,,,,22.1900,386.0000,percent of total billed charges,100% of $386.00 in Billed Charges for Rev 320 Proc 70380 = $386.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,22.1900,386.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 70380 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,22.1900,386.0000,other,Rev 320 Proc 70380 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,22.1900,386.0000,other,Rev 320 Proc 70380 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,22.1900,386.0000,other,Rev 320 Proc 70380 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,22.1900,386.0000,fee schedule,APG 00471 Proc 70380 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,22.1900,386.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,22.1900,386.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,WELLCARE,WELLCARE MEDICAID,386.00,,,,,,,22.1900,386.0000,percent of total billed charges,100% of $386.00 in Billed Charges for Rev 320 Proc 70380 = $386.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SALIVARY GLAND CALCULUS DEPOS,70380,CPT,320,RC,32000022,CDM,,,,both,,,386.0000,57.9000,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,22.1900,386.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,AETNA,AETNA,442.37,,,,,,,58.5600,1036.0000,percent of total billed charges,"42.7% of $1,036.00 in Billed Charges for Rev 320 Proc 70390 = $442.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,166.44,,,,,,,58.5600,1036.0000,fee schedule,APG 00389 Proc 70390 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 104% = $166.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,216.48,,,,,,,58.5600,1036.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,AETNA,AETNA HEALTHCARE MEDICARE,216.48,,,,,,,58.5600,1036.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,216.48,,,,,,,58.5600,1036.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,AMBETTER,AMBETTER,471.92,,,,,,,58.5600,1036.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,225.14,,,,,,,58.5600,1036.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,BLUE CROSS,ANTHEM EXCHANGE,532.97,,,,,,,58.5600,1036.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,164.84,,,,,,,58.5600,1036.0000,fee schedule,APG 00389 Proc 70390 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,BLUE CROSS,ANTHEM HMO,566.25,,,,,,,58.5600,1036.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,222.97,,,,,,,58.5600,1036.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",666.14,,,,,,,58.5600,1036.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,98.47,,,,,,,58.5600,1036.0000,fee schedule,$98.47 from Fee Schedule BLDTM_23 for Rev 320 Proc 70390 * Qty 1 = $98.47 at 100% = $98.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,BLUE CROSS,BLUE CROSS E NETWORK,239.42,,,,,,,58.5600,1036.0000,fee schedule,$74.82 from Fee Schedule BCFSC for Rev 320 Proc 70390 * Qty 1 = $74.82 at 320% = $239.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,BLUE CROSS,BLUE CROSS MEDICARE,225.14,,,,,,,58.5600,1036.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,BLUE CROSS,BLUE CROSS P NETWORK,244.66,,,,,,,58.5600,1036.0000,fee schedule,$74.82 from Fee Schedule BCFSC for Rev 320 Proc 70390 * Qty 1 = $74.82 at 327% = $244.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,BLUE CROSS,BLUE CROSS S NETWORK,244.66,,,,,,,58.5600,1036.0000,fee schedule,$74.82 from Fee Schedule BCFSC for Rev 320 Proc 70390 * Qty 1 = $74.82 at 327% = $244.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,BLUE CROSS,TENNCARE BLUE CARE,58.56,,,,,,,58.5600,1036.0000,fee schedule,$50.48 from Fee Schedule TC_24 for Rev 320 Proc 70390 * Qty 1 = $50.48 at 116% = $58.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,BLUE CROSS,TENNCARE BLUE SELECT,58.56,,,,,,,58.5600,1036.0000,fee schedule,$50.48 from Fee Schedule TC_24 for Rev 320 Proc 70390 * Qty 1 = $50.48 at 116% = $58.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,CIGNA HEALTHCARE,CIGNA HMO,894.80,,,,,,,58.5600,1036.0000,fee schedule,$894.80 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70390 * Qty 1 = $894.80 at 100% = $894.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,183.90,,,,,,,58.5600,1036.0000,fee schedule,$183.90 from Fee Schedule CGIFP_25LR for Rev 320 Proc 70390 * Qty 1 = $183.90 at 100% = $183.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,227.30,,,,,,,58.5600,1036.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,894.80,,,,,,,58.5600,1036.0000,fee schedule,$894.80 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70390 * Qty 1 = $894.80 at 100% = $894.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,CIGNA HEALTHCARE,CIGNA PPO,894.80,,,,,,,58.5600,1036.0000,fee schedule,$894.80 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70390 * Qty 1 = $894.80 at 100% = $894.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,227.30,,,,,,,58.5600,1036.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,932.40,,,,,,,58.5600,1036.0000,percent of total billed charges,"90% of $1,036.00 in Billed Charges for Rev 320 Proc 70390 = $932.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,HUMANA,HUMANA MEDICARE,216.48,,,,,,,58.5600,1036.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,216.48,,,,,,,58.5600,1036.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,MEDCOST,MEDCOST VHN,493.03,,,,,,,58.5600,1036.0000,percent of total billed charges,"47.59% of $1,036.00 in Billed Charges for Rev 320 Proc 70390 = $493.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,168.04,,,,,,,58.5600,1036.0000,fee schedule,APG 00389 Proc 70390 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 105% = $168.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,227.30,,,,,,,58.5600,1036.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,227.30,,,,,,,58.5600,1036.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,NHC ADVANTAGE,NHC ADVANTAGE,227.30,,,,,,,58.5600,1036.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,165.00,,,,,,,58.5600,1036.0000,fee schedule,APG 00389 Proc 70390 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 103.1% = $165.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,SENTARA HEALTH,SENTARA HEALTH,267.39,,,,,,,58.5600,1036.0000,percent of total billed charges,"25.81% of $1,036.00 in Billed Charges for Rev 320 Proc 70390 = $267.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,SENTARA HEALTH,SENTARA MEDICARE,216.48,,,,,,,58.5600,1036.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1036.00,,,,,,,58.5600,1036.0000,percent of total billed charges,"100% of $1,036.00 in Billed Charges for Rev 320 Proc 70390 = $1,036.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,118.21,,,,,,,58.5600,1036.0000,fee schedule,$236.42 from Fee Schedule TCUHC24 for Rev 320 Proc 70390 * Qty 1 = $236.42 at 50% = $118.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,58.5600,1036.0000,other,Rev 320 Proc 70390 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,58.5600,1036.0000,other,Rev 320 Proc 70390 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,58.5600,1036.0000,other,Rev 320 Proc 70390 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,164.84,,,,,,,58.5600,1036.0000,fee schedule,APG 00389 Proc 70390 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,216.48,,,,,,,58.5600,1036.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,216.48,,,,,,,58.5600,1036.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,WELLCARE,WELLCARE MEDICAID,1036.00,,,,,,,58.5600,1036.0000,percent of total billed charges,"100% of $1,036.00 in Billed Charges for Rev 320 Proc 70390 = $1,036.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX SIALOGRAM,70390,CPT,320,RC,32000023,CDM,,,,both,,,1036.0000,155.4000,WELLCARE,WELLCARE MEDICARE,229.47,,,,,,,58.5600,1036.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,AETNA,AETNA,207.10,,,,,,,18.9100,485.0000,percent of total billed charges,42.7% of $485.00 in Billed Charges for Rev 320 Proc 73030 Mod 50 = $207.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,119.42,,,,,,,18.9100,485.0000,fee schedule,APG 00471 Proc 73030 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 104% = $119.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,AMBETTER,AMBETTER,172.12,,,,,,,18.9100,485.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,18.9100,485.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,118.27,,,,,,,18.9100,485.0000,fee schedule,APG 00471 Proc 73030 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 103% = $118.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,18.9100,485.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,31.58,,,,,,,18.9100,485.0000,fee schedule,$31.58 from Fee Schedule BLDTM_23 for Rev 320 Proc 73030 Mod 50 * Qty 1 = $31.58 at 100% = $31.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,BLUE CROSS E NETWORK,61.34,,,,,,,18.9100,485.0000,fee schedule,$19.17 from Fee Schedule BCFSC for Rev 320 Proc 73030 Mod 50 * Qty 1 = $19.17 at 320% = $61.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,18.9100,485.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,BLUE CROSS P NETWORK,62.69,,,,,,,18.9100,485.0000,fee schedule,$19.17 from Fee Schedule BCFSC for Rev 320 Proc 73030 Mod 50 * Qty 1 = $19.17 at 327% = $62.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,BLUE CROSS S NETWORK,62.69,,,,,,,18.9100,485.0000,fee schedule,$19.17 from Fee Schedule BCFSC for Rev 320 Proc 73030 Mod 50 * Qty 1 = $19.17 at 327% = $62.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,TENNCARE BLUE CARE,18.91,,,,,,,18.9100,485.0000,fee schedule,$16.30 from Fee Schedule TC_24 for Rev 320 Proc 73030 Mod 50 * Qty 1 = $16.30 at 116% = $18.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,TENNCARE BLUE SELECT,18.91,,,,,,,18.9100,485.0000,fee schedule,$16.30 from Fee Schedule TC_24 for Rev 320 Proc 73030 Mod 50 * Qty 1 = $16.30 at 116% = $18.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,18.9100,485.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73030 Mod 50 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,48.61,,,,,,,18.9100,485.0000,fee schedule,$48.61 from Fee Schedule CGIFP_25LR for Rev 320 Proc 73030 Mod 50 * Qty 1 = $48.61 at 100% = $48.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,18.9100,485.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,18.9100,485.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73030 Mod 50 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,18.9100,485.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73030 Mod 50 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,18.9100,485.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,436.50,,,,,,,18.9100,485.0000,percent of total billed charges,90% of $485.00 in Billed Charges for Rev 320 Proc 73030 Mod 50 = $436.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,HUMANA,HUMANA MEDICARE,78.96,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,MEDCOST,MEDCOST VHN,230.81,,,,,,,18.9100,485.0000,percent of total billed charges,47.59% of $485.00 in Billed Charges for Rev 320 Proc 73030 Mod 50 = $230.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,120.56,,,,,,,18.9100,485.0000,fee schedule,APG 00471 Proc 73030 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 100% = $114.82... $114.82 at 105% = $120.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,18.9100,485.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,18.9100,485.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,18.9100,485.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,118.38,,,,,,,18.9100,485.0000,fee schedule,APG 00471 Proc 73030 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 100% = $114.82... $114.82 at 103.1% = $118.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,SENTARA HEALTH,SENTARA HEALTH,125.18,,,,,,,18.9100,485.0000,percent of total billed charges,25.81% of $485.00 in Billed Charges for Rev 320 Proc 73030 Mod 50 = $125.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",485.00,,,,,,,18.9100,485.0000,percent of total billed charges,100% of $485.00 in Billed Charges for Rev 320 Proc 73030 Mod 50 = $485.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,18.9100,485.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 73030 Mod 50 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,18.9100,485.0000,other,Rev 320 Proc 73030 Mod 50 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,18.9100,485.0000,other,Rev 320 Proc 73030 Mod 50 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,18.9100,485.0000,other,Rev 320 Proc 73030 Mod 50 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,118.27,,,,,,,18.9100,485.0000,fee schedule,APG 00471 Proc 73030 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 103% = $118.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,WELLCARE,WELLCARE MEDICAID,485.00,,,,,,,18.9100,485.0000,percent of total billed charges,100% of $485.00 in Billed Charges for Rev 320 Proc 73030 Mod 50 = $485.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SHOULDER 2 VIEW * BILAT,73030,CPT,320,RC,32000073,CDM,,,50,both,,,485.0000,72.7500,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,18.9100,485.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,AETNA,AETNA,217.34,,,,,,,18.9100,509.0000,percent of total billed charges,42.7% of $509.00 in Billed Charges for Rev 320 Proc 73030 = $217.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,18.9100,509.0000,fee schedule,APG 00471 Proc 73030 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,18.9100,509.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,18.9100,509.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,18.9100,509.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,AMBETTER,AMBETTER,172.12,,,,,,,18.9100,509.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,18.9100,509.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,18.9100,509.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,18.9100,509.0000,fee schedule,APG 00471 Proc 73030 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,18.9100,509.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,18.9100,509.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,18.9100,509.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,31.58,,,,,,,18.9100,509.0000,fee schedule,$31.58 from Fee Schedule BLDTM_23 for Rev 320 Proc 73030 * Qty 1 = $31.58 at 100% = $31.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,BLUE CROSS,BLUE CROSS E NETWORK,61.34,,,,,,,18.9100,509.0000,fee schedule,$19.17 from Fee Schedule BCFSC for Rev 320 Proc 73030 * Qty 1 = $19.17 at 320% = $61.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,18.9100,509.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,BLUE CROSS,BLUE CROSS P NETWORK,62.69,,,,,,,18.9100,509.0000,fee schedule,$19.17 from Fee Schedule BCFSC for Rev 320 Proc 73030 * Qty 1 = $19.17 at 327% = $62.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,BLUE CROSS,BLUE CROSS S NETWORK,62.69,,,,,,,18.9100,509.0000,fee schedule,$19.17 from Fee Schedule BCFSC for Rev 320 Proc 73030 * Qty 1 = $19.17 at 327% = $62.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,BLUE CROSS,TENNCARE BLUE CARE,18.91,,,,,,,18.9100,509.0000,fee schedule,$16.30 from Fee Schedule TC_24 for Rev 320 Proc 73030 * Qty 1 = $16.30 at 116% = $18.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,BLUE CROSS,TENNCARE BLUE SELECT,18.91,,,,,,,18.9100,509.0000,fee schedule,$16.30 from Fee Schedule TC_24 for Rev 320 Proc 73030 * Qty 1 = $16.30 at 116% = $18.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,18.9100,509.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73030 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,48.61,,,,,,,18.9100,509.0000,fee schedule,$48.61 from Fee Schedule CGIFP_25LR for Rev 320 Proc 73030 * Qty 1 = $48.61 at 100% = $48.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,18.9100,509.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,18.9100,509.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73030 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,18.9100,509.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73030 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,18.9100,509.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,458.10,,,,,,,18.9100,509.0000,percent of total billed charges,90% of $509.00 in Billed Charges for Rev 320 Proc 73030 = $458.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,HUMANA,HUMANA MEDICARE,78.96,,,,,,,18.9100,509.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,18.9100,509.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,MEDCOST,MEDCOST VHN,242.23,,,,,,,18.9100,509.0000,percent of total billed charges,47.59% of $509.00 in Billed Charges for Rev 320 Proc 73030 = $242.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,18.9100,509.0000,fee schedule,APG 00471 Proc 73030 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,18.9100,509.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,18.9100,509.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,18.9100,509.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,18.9100,509.0000,fee schedule,APG 00471 Proc 73030 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,SENTARA HEALTH,SENTARA HEALTH,131.37,,,,,,,18.9100,509.0000,percent of total billed charges,25.81% of $509.00 in Billed Charges for Rev 320 Proc 73030 = $131.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,18.9100,509.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",509.00,,,,,,,18.9100,509.0000,percent of total billed charges,100% of $509.00 in Billed Charges for Rev 320 Proc 73030 = $509.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,18.9100,509.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 73030 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,18.9100,509.0000,other,Rev 320 Proc 73030 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,18.9100,509.0000,other,Rev 320 Proc 73030 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,18.9100,509.0000,other,Rev 320 Proc 73030 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,18.9100,509.0000,fee schedule,APG 00471 Proc 73030 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,18.9100,509.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,18.9100,509.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,WELLCARE,WELLCARE MEDICAID,509.00,,,,,,,18.9100,509.0000,percent of total billed charges,100% of $509.00 in Billed Charges for Rev 320 Proc 73030 = $509.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SHOULDER 2 VIEW+,73030,CPT,320,RC,32000074,CDM,,,,both,,,509.0000,76.3500,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,18.9100,509.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MATT HOVER SINGLE USE 34,272,RC,27202329,CDM,,,,,,both,,,612.0000,91.8000,AETNA,AETNA,261.32,,,,,,,157.9600,612.0000,percent of total billed charges,42.7% of $612.00 in Billed Charges for Rev 272 = $261.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 34,272,RC,27202329,CDM,,,,,,both,,,612.0000,91.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,428.40,,,,,,,157.9600,612.0000,percent of total billed charges,Rev 272 $612.00 in Billed Charges at 70% = $428.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 34,272,RC,27202329,CDM,,,,,,both,,,612.0000,91.8000,CIGNA HEALTHCARE,CIGNA HMO,255.20,,,,,,,157.9600,612.0000,percent of total billed charges,41.7% of $612.00 in Billed Charges for Rev 272 = $255.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 34,272,RC,27202329,CDM,,,,,,both,,,612.0000,91.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,283.97,,,,,,,157.9600,612.0000,percent of total billed charges,46.4% of $612.00 in Billed Charges for Rev 272 = $283.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 34,272,RC,27202329,CDM,,,,,,both,,,612.0000,91.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,255.20,,,,,,,157.9600,612.0000,percent of total billed charges,41.7% of $612.00 in Billed Charges for Rev 272 = $255.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 34,272,RC,27202329,CDM,,,,,,both,,,612.0000,91.8000,CIGNA HEALTHCARE,CIGNA PPO,255.20,,,,,,,157.9600,612.0000,percent of total billed charges,41.7% of $612.00 in Billed Charges for Rev 272 = $255.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 34,272,RC,27202329,CDM,,,,,,both,,,612.0000,91.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,550.80,,,,,,,157.9600,612.0000,percent of total billed charges,90% of $612.00 in Billed Charges for Rev 272 = $550.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 34,272,RC,27202329,CDM,,,,,,both,,,612.0000,91.8000,MEDCOST,MEDCOST VHN,291.25,,,,,,,157.9600,612.0000,percent of total billed charges,47.59% of $612.00 in Billed Charges for Rev 272 = $291.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 34,272,RC,27202329,CDM,,,,,,both,,,612.0000,91.8000,SENTARA HEALTH,SENTARA HEALTH,157.96,,,,,,,157.9600,612.0000,percent of total billed charges,25.81% of $612.00 in Billed Charges for Rev 272 = $157.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 34,272,RC,27202329,CDM,,,,,,both,,,612.0000,91.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",612.00,,,,,,,157.9600,612.0000,percent of total billed charges,100% of $612.00 in Billed Charges for Rev 272 = $612.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 34,272,RC,27202329,CDM,,,,,,both,,,612.0000,91.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,306.00,,,,,,,157.9600,612.0000,percent of total billed charges,Rev 272 $612.00 in Billed Charges at 50% = $306.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 34,272,RC,27202329,CDM,,,,,,both,,,612.0000,91.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,197.68,,,,,,,157.9600,612.0000,other,32.3% of $612.00 in Billed Charges for Rev 272 = $197.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MATT HOVER SINGLE USE 34,272,RC,27202329,CDM,,,,,,both,,,612.0000,91.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,187.88,,,,,,,157.9600,612.0000,other,30.7% of $612.00 in Billed Charges for Rev 272 = $187.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MATT HOVER SINGLE USE 34,272,RC,27202329,CDM,,,,,,both,,,612.0000,91.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,197.68,,,,,,,157.9600,612.0000,percent of total billed charges,32.3% of $612.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 34,272,RC,27202329,CDM,,,,,,both,,,612.0000,91.8000,WELLCARE,WELLCARE MEDICAID,612.00,,,,,,,157.9600,612.0000,percent of total billed charges,100% of $612.00 in Billed Charges for Rev 272 = $612.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 39,272,RC,27202268,CDM,,,,,,both,,,727.0000,109.0500,AETNA,AETNA,310.43,,,,,,,187.6400,727.0000,percent of total billed charges,42.7% of $727.00 in Billed Charges for Rev 272 = $310.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 39,272,RC,27202268,CDM,,,,,,both,,,727.0000,109.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,508.90,,,,,,,187.6400,727.0000,percent of total billed charges,Rev 272 $727.00 in Billed Charges at 70% = $508.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 39,272,RC,27202268,CDM,,,,,,both,,,727.0000,109.0500,CIGNA HEALTHCARE,CIGNA HMO,303.16,,,,,,,187.6400,727.0000,percent of total billed charges,41.7% of $727.00 in Billed Charges for Rev 272 = $303.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 39,272,RC,27202268,CDM,,,,,,both,,,727.0000,109.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,337.33,,,,,,,187.6400,727.0000,percent of total billed charges,46.4% of $727.00 in Billed Charges for Rev 272 = $337.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 39,272,RC,27202268,CDM,,,,,,both,,,727.0000,109.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,303.16,,,,,,,187.6400,727.0000,percent of total billed charges,41.7% of $727.00 in Billed Charges for Rev 272 = $303.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 39,272,RC,27202268,CDM,,,,,,both,,,727.0000,109.0500,CIGNA HEALTHCARE,CIGNA PPO,303.16,,,,,,,187.6400,727.0000,percent of total billed charges,41.7% of $727.00 in Billed Charges for Rev 272 = $303.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 39,272,RC,27202268,CDM,,,,,,both,,,727.0000,109.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,654.30,,,,,,,187.6400,727.0000,percent of total billed charges,90% of $727.00 in Billed Charges for Rev 272 = $654.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 39,272,RC,27202268,CDM,,,,,,both,,,727.0000,109.0500,MEDCOST,MEDCOST VHN,345.98,,,,,,,187.6400,727.0000,percent of total billed charges,47.59% of $727.00 in Billed Charges for Rev 272 = $345.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 39,272,RC,27202268,CDM,,,,,,both,,,727.0000,109.0500,SENTARA HEALTH,SENTARA HEALTH,187.64,,,,,,,187.6400,727.0000,percent of total billed charges,25.81% of $727.00 in Billed Charges for Rev 272 = $187.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 39,272,RC,27202268,CDM,,,,,,both,,,727.0000,109.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",727.00,,,,,,,187.6400,727.0000,percent of total billed charges,100% of $727.00 in Billed Charges for Rev 272 = $727.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 39,272,RC,27202268,CDM,,,,,,both,,,727.0000,109.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,363.50,,,,,,,187.6400,727.0000,percent of total billed charges,Rev 272 $727.00 in Billed Charges at 50% = $363.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 39,272,RC,27202268,CDM,,,,,,both,,,727.0000,109.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,234.82,,,,,,,187.6400,727.0000,other,32.3% of $727.00 in Billed Charges for Rev 272 = $234.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MATT HOVER SINGLE USE 39,272,RC,27202268,CDM,,,,,,both,,,727.0000,109.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,223.19,,,,,,,187.6400,727.0000,other,30.7% of $727.00 in Billed Charges for Rev 272 = $223.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MATT HOVER SINGLE USE 39,272,RC,27202268,CDM,,,,,,both,,,727.0000,109.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,234.82,,,,,,,187.6400,727.0000,percent of total billed charges,32.3% of $727.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MATT HOVER SINGLE USE 39,272,RC,27202268,CDM,,,,,,both,,,727.0000,109.0500,WELLCARE,WELLCARE MEDICAID,727.00,,,,,,,187.6400,727.0000,percent of total billed charges,100% of $727.00 in Billed Charges for Rev 272 = $727.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MED/SURG/GYN ROOM DLY PRV,111,RC,11100001,CDM,,,,,,inpatient,,,2354.0000,353.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,121.7600,2354.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC MED/SURG/GYN ROOM DLY PRV,111,RC,11100001,CDM,,,,,,inpatient,,,2354.0000,353.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2118.60,,,,,,,121.7600,2354.0000,percent of total billed charges,"90% of $2,354.00 in Billed Charges for Rev 111 = $2,118.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MED/SURG/GYN ROOM DLY PRV,111,RC,11100001,CDM,,,,,,inpatient,,,2354.0000,353.1000,MEDCOST,MEDCOST VHN,1120.27,,,,,,,121.7600,2354.0000,percent of total billed charges,"47.59% of $2,354.00 in Billed Charges for Rev 111 = $1,120.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MED/SURG/GYN ROOM DLY PRV,111,RC,11100001,CDM,,,,,,inpatient,,,2354.0000,353.1000,SENTARA HEALTH,SENTARA HEALTH,877.57,,,,,,,121.7600,2354.0000,percent of total billed charges,"37.28% of $2,354.00 in Billed Charges for Rev 111 = $877.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MED/SURG/GYN ROOM DLY PRV,111,RC,11100001,CDM,,,,,,inpatient,,,2354.0000,353.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2354.00,,,,,,,121.7600,2354.0000,percent of total billed charges,"100% of $2,354.00 in Billed Charges for Rev 111 = $2,354.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MEDRAD SYRINGE 150ML 150-FT-Q,272,RC,27200932,CDM,,,,,,both,,,35.0000,5.2500,AETNA,AETNA,14.95,,,,,,,9.0300,35.0000,percent of total billed charges,42.7% of $35.00 in Billed Charges for Rev 272 = $14.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDRAD SYRINGE 150ML 150-FT-Q,272,RC,27200932,CDM,,,,,,both,,,35.0000,5.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,24.50,,,,,,,9.0300,35.0000,percent of total billed charges,Rev 272 $35.00 in Billed Charges at 70% = $24.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDRAD SYRINGE 150ML 150-FT-Q,272,RC,27200932,CDM,,,,,,both,,,35.0000,5.2500,CIGNA HEALTHCARE,CIGNA HMO,14.60,,,,,,,9.0300,35.0000,percent of total billed charges,41.7% of $35.00 in Billed Charges for Rev 272 = $14.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDRAD SYRINGE 150ML 150-FT-Q,272,RC,27200932,CDM,,,,,,both,,,35.0000,5.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,16.24,,,,,,,9.0300,35.0000,percent of total billed charges,46.4% of $35.00 in Billed Charges for Rev 272 = $16.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDRAD SYRINGE 150ML 150-FT-Q,272,RC,27200932,CDM,,,,,,both,,,35.0000,5.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,14.60,,,,,,,9.0300,35.0000,percent of total billed charges,41.7% of $35.00 in Billed Charges for Rev 272 = $14.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDRAD SYRINGE 150ML 150-FT-Q,272,RC,27200932,CDM,,,,,,both,,,35.0000,5.2500,CIGNA HEALTHCARE,CIGNA PPO,14.60,,,,,,,9.0300,35.0000,percent of total billed charges,41.7% of $35.00 in Billed Charges for Rev 272 = $14.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDRAD SYRINGE 150ML 150-FT-Q,272,RC,27200932,CDM,,,,,,both,,,35.0000,5.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,31.50,,,,,,,9.0300,35.0000,percent of total billed charges,90% of $35.00 in Billed Charges for Rev 272 = $31.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDRAD SYRINGE 150ML 150-FT-Q,272,RC,27200932,CDM,,,,,,both,,,35.0000,5.2500,MEDCOST,MEDCOST VHN,16.66,,,,,,,9.0300,35.0000,percent of total billed charges,47.59% of $35.00 in Billed Charges for Rev 272 = $16.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDRAD SYRINGE 150ML 150-FT-Q,272,RC,27200932,CDM,,,,,,both,,,35.0000,5.2500,SENTARA HEALTH,SENTARA HEALTH,9.03,,,,,,,9.0300,35.0000,percent of total billed charges,25.81% of $35.00 in Billed Charges for Rev 272 = $9.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDRAD SYRINGE 150ML 150-FT-Q,272,RC,27200932,CDM,,,,,,both,,,35.0000,5.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",35.00,,,,,,,9.0300,35.0000,percent of total billed charges,100% of $35.00 in Billed Charges for Rev 272 = $35.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDRAD SYRINGE 150ML 150-FT-Q,272,RC,27200932,CDM,,,,,,both,,,35.0000,5.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,17.50,,,,,,,9.0300,35.0000,percent of total billed charges,Rev 272 $35.00 in Billed Charges at 50% = $17.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDRAD SYRINGE 150ML 150-FT-Q,272,RC,27200932,CDM,,,,,,both,,,35.0000,5.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,11.31,,,,,,,9.0300,35.0000,other,32.3% of $35.00 in Billed Charges for Rev 272 = $11.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MEDRAD SYRINGE 150ML 150-FT-Q,272,RC,27200932,CDM,,,,,,both,,,35.0000,5.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,10.75,,,,,,,9.0300,35.0000,other,30.7% of $35.00 in Billed Charges for Rev 272 = $10.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MEDRAD SYRINGE 150ML 150-FT-Q,272,RC,27200932,CDM,,,,,,both,,,35.0000,5.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,11.31,,,,,,,9.0300,35.0000,percent of total billed charges,32.3% of $35.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDRAD SYRINGE 150ML 150-FT-Q,272,RC,27200932,CDM,,,,,,both,,,35.0000,5.2500,WELLCARE,WELLCARE MEDICAID,35.00,,,,,,,9.0300,35.0000,percent of total billed charges,100% of $35.00 in Billed Charges for Rev 272 = $35.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDTRONIC DISP CABLES,272,RC,27200933,CDM,,,,,,both,,,148.0000,22.2000,AETNA,AETNA,63.20,,,,,,,38.2000,148.0000,percent of total billed charges,42.7% of $148.00 in Billed Charges for Rev 272 = $63.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDTRONIC DISP CABLES,272,RC,27200933,CDM,,,,,,both,,,148.0000,22.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,103.60,,,,,,,38.2000,148.0000,percent of total billed charges,Rev 272 $148.00 in Billed Charges at 70% = $103.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDTRONIC DISP CABLES,272,RC,27200933,CDM,,,,,,both,,,148.0000,22.2000,CIGNA HEALTHCARE,CIGNA HMO,61.72,,,,,,,38.2000,148.0000,percent of total billed charges,41.7% of $148.00 in Billed Charges for Rev 272 = $61.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDTRONIC DISP CABLES,272,RC,27200933,CDM,,,,,,both,,,148.0000,22.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,68.67,,,,,,,38.2000,148.0000,percent of total billed charges,46.4% of $148.00 in Billed Charges for Rev 272 = $68.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDTRONIC DISP CABLES,272,RC,27200933,CDM,,,,,,both,,,148.0000,22.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,61.72,,,,,,,38.2000,148.0000,percent of total billed charges,41.7% of $148.00 in Billed Charges for Rev 272 = $61.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDTRONIC DISP CABLES,272,RC,27200933,CDM,,,,,,both,,,148.0000,22.2000,CIGNA HEALTHCARE,CIGNA PPO,61.72,,,,,,,38.2000,148.0000,percent of total billed charges,41.7% of $148.00 in Billed Charges for Rev 272 = $61.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDTRONIC DISP CABLES,272,RC,27200933,CDM,,,,,,both,,,148.0000,22.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,133.20,,,,,,,38.2000,148.0000,percent of total billed charges,90% of $148.00 in Billed Charges for Rev 272 = $133.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDTRONIC DISP CABLES,272,RC,27200933,CDM,,,,,,both,,,148.0000,22.2000,MEDCOST,MEDCOST VHN,70.43,,,,,,,38.2000,148.0000,percent of total billed charges,47.59% of $148.00 in Billed Charges for Rev 272 = $70.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDTRONIC DISP CABLES,272,RC,27200933,CDM,,,,,,both,,,148.0000,22.2000,SENTARA HEALTH,SENTARA HEALTH,38.20,,,,,,,38.2000,148.0000,percent of total billed charges,25.81% of $148.00 in Billed Charges for Rev 272 = $38.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDTRONIC DISP CABLES,272,RC,27200933,CDM,,,,,,both,,,148.0000,22.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",148.00,,,,,,,38.2000,148.0000,percent of total billed charges,100% of $148.00 in Billed Charges for Rev 272 = $148.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDTRONIC DISP CABLES,272,RC,27200933,CDM,,,,,,both,,,148.0000,22.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,74.00,,,,,,,38.2000,148.0000,percent of total billed charges,Rev 272 $148.00 in Billed Charges at 50% = $74.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDTRONIC DISP CABLES,272,RC,27200933,CDM,,,,,,both,,,148.0000,22.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,47.80,,,,,,,38.2000,148.0000,other,32.3% of $148.00 in Billed Charges for Rev 272 = $47.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MEDTRONIC DISP CABLES,272,RC,27200933,CDM,,,,,,both,,,148.0000,22.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,45.44,,,,,,,38.2000,148.0000,other,30.7% of $148.00 in Billed Charges for Rev 272 = $45.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MEDTRONIC DISP CABLES,272,RC,27200933,CDM,,,,,,both,,,148.0000,22.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,47.80,,,,,,,38.2000,148.0000,percent of total billed charges,32.3% of $148.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MEDTRONIC DISP CABLES,272,RC,27200933,CDM,,,,,,both,,,148.0000,22.2000,WELLCARE,WELLCARE MEDICAID,148.00,,,,,,,38.2000,148.0000,percent of total billed charges,100% of $148.00 in Billed Charges for Rev 272 = $148.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METER URINE,270,RC,27000185,CDM,,,,,,both,,,58.0000,8.7000,AETNA,AETNA,24.77,,,,,,,14.9700,58.0000,percent of total billed charges,42.7% of $58.00 in Billed Charges for Rev 270 = $24.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METER URINE,270,RC,27000185,CDM,,,,,,both,,,58.0000,8.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,40.60,,,,,,,14.9700,58.0000,percent of total billed charges,Rev 270 $58.00 in Billed Charges at 70% = $40.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METER URINE,270,RC,27000185,CDM,,,,,,both,,,58.0000,8.7000,CIGNA HEALTHCARE,CIGNA HMO,24.19,,,,,,,14.9700,58.0000,percent of total billed charges,41.7% of $58.00 in Billed Charges for Rev 270 = $24.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METER URINE,270,RC,27000185,CDM,,,,,,both,,,58.0000,8.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,26.91,,,,,,,14.9700,58.0000,percent of total billed charges,46.4% of $58.00 in Billed Charges for Rev 270 = $26.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METER URINE,270,RC,27000185,CDM,,,,,,both,,,58.0000,8.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,24.19,,,,,,,14.9700,58.0000,percent of total billed charges,41.7% of $58.00 in Billed Charges for Rev 270 = $24.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METER URINE,270,RC,27000185,CDM,,,,,,both,,,58.0000,8.7000,CIGNA HEALTHCARE,CIGNA PPO,24.19,,,,,,,14.9700,58.0000,percent of total billed charges,41.7% of $58.00 in Billed Charges for Rev 270 = $24.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METER URINE,270,RC,27000185,CDM,,,,,,both,,,58.0000,8.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,52.20,,,,,,,14.9700,58.0000,percent of total billed charges,90% of $58.00 in Billed Charges for Rev 270 = $52.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METER URINE,270,RC,27000185,CDM,,,,,,both,,,58.0000,8.7000,MEDCOST,MEDCOST VHN,27.60,,,,,,,14.9700,58.0000,percent of total billed charges,47.59% of $58.00 in Billed Charges for Rev 270 = $27.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METER URINE,270,RC,27000185,CDM,,,,,,both,,,58.0000,8.7000,SENTARA HEALTH,SENTARA HEALTH,14.97,,,,,,,14.9700,58.0000,percent of total billed charges,25.81% of $58.00 in Billed Charges for Rev 270 = $14.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METER URINE,270,RC,27000185,CDM,,,,,,both,,,58.0000,8.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",58.00,,,,,,,14.9700,58.0000,percent of total billed charges,100% of $58.00 in Billed Charges for Rev 270 = $58.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METER URINE,270,RC,27000185,CDM,,,,,,both,,,58.0000,8.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,29.00,,,,,,,14.9700,58.0000,percent of total billed charges,Rev 270 $58.00 in Billed Charges at 50% = $29.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METER URINE,270,RC,27000185,CDM,,,,,,both,,,58.0000,8.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,18.73,,,,,,,14.9700,58.0000,other,32.3% of $58.00 in Billed Charges for Rev 270 = $18.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METER URINE,270,RC,27000185,CDM,,,,,,both,,,58.0000,8.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,17.81,,,,,,,14.9700,58.0000,other,30.7% of $58.00 in Billed Charges for Rev 270 = $17.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METER URINE,270,RC,27000185,CDM,,,,,,both,,,58.0000,8.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,18.73,,,,,,,14.9700,58.0000,percent of total billed charges,32.3% of $58.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METER URINE,270,RC,27000185,CDM,,,,,,both,,,58.0000,8.7000,WELLCARE,WELLCARE MEDICAID,58.00,,,,,,,14.9700,58.0000,percent of total billed charges,100% of $58.00 in Billed Charges for Rev 270 = $58.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MICROCATHETER LANTERN,272,RC,27201979,CDM,,,,,,both,,,1971.0000,295.6500,AETNA,AETNA,841.62,,,,,,,508.7200,1971.0000,percent of total billed charges,"42.7% of $1,971.00 in Billed Charges for Rev 272 = $841.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MICROCATHETER LANTERN,272,RC,27201979,CDM,,,,,,both,,,1971.0000,295.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1379.70,,,,,,,508.7200,1971.0000,percent of total billed charges,"Rev 272 $1,971.00 in Billed Charges at 70% = $1,379.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MICROCATHETER LANTERN,272,RC,27201979,CDM,,,,,,both,,,1971.0000,295.6500,CIGNA HEALTHCARE,CIGNA HMO,821.91,,,,,,,508.7200,1971.0000,percent of total billed charges,"41.7% of $1,971.00 in Billed Charges for Rev 272 = $821.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MICROCATHETER LANTERN,272,RC,27201979,CDM,,,,,,both,,,1971.0000,295.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,914.54,,,,,,,508.7200,1971.0000,percent of total billed charges,"46.4% of $1,971.00 in Billed Charges for Rev 272 = $914.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MICROCATHETER LANTERN,272,RC,27201979,CDM,,,,,,both,,,1971.0000,295.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,821.91,,,,,,,508.7200,1971.0000,percent of total billed charges,"41.7% of $1,971.00 in Billed Charges for Rev 272 = $821.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MICROCATHETER LANTERN,272,RC,27201979,CDM,,,,,,both,,,1971.0000,295.6500,CIGNA HEALTHCARE,CIGNA PPO,821.91,,,,,,,508.7200,1971.0000,percent of total billed charges,"41.7% of $1,971.00 in Billed Charges for Rev 272 = $821.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MICROCATHETER LANTERN,272,RC,27201979,CDM,,,,,,both,,,1971.0000,295.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1773.90,,,,,,,508.7200,1971.0000,percent of total billed charges,"90% of $1,971.00 in Billed Charges for Rev 272 = $1,773.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MICROCATHETER LANTERN,272,RC,27201979,CDM,,,,,,both,,,1971.0000,295.6500,MEDCOST,MEDCOST VHN,938.00,,,,,,,508.7200,1971.0000,percent of total billed charges,"47.59% of $1,971.00 in Billed Charges for Rev 272 = $938.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MICROCATHETER LANTERN,272,RC,27201979,CDM,,,,,,both,,,1971.0000,295.6500,SENTARA HEALTH,SENTARA HEALTH,508.72,,,,,,,508.7200,1971.0000,percent of total billed charges,"25.81% of $1,971.00 in Billed Charges for Rev 272 = $508.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MICROCATHETER LANTERN,272,RC,27201979,CDM,,,,,,both,,,1971.0000,295.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1971.00,,,,,,,508.7200,1971.0000,percent of total billed charges,"100% of $1,971.00 in Billed Charges for Rev 272 = $1,971.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MICROCATHETER LANTERN,272,RC,27201979,CDM,,,,,,both,,,1971.0000,295.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,985.50,,,,,,,508.7200,1971.0000,percent of total billed charges,"Rev 272 $1,971.00 in Billed Charges at 50% = $985.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MICROCATHETER LANTERN,272,RC,27201979,CDM,,,,,,both,,,1971.0000,295.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,636.63,,,,,,,508.7200,1971.0000,other,"32.3% of $1,971.00 in Billed Charges for Rev 272 = $636.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MICROCATHETER LANTERN,272,RC,27201979,CDM,,,,,,both,,,1971.0000,295.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,605.10,,,,,,,508.7200,1971.0000,other,"30.7% of $1,971.00 in Billed Charges for Rev 272 = $605.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MICROCATHETER LANTERN,272,RC,27201979,CDM,,,,,,both,,,1971.0000,295.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,636.63,,,,,,,508.7200,1971.0000,percent of total billed charges,"32.3% of $1,971.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MICROCATHETER LANTERN,272,RC,27201979,CDM,,,,,,both,,,1971.0000,295.6500,WELLCARE,WELLCARE MEDICAID,1971.00,,,,,,,508.7200,1971.0000,percent of total billed charges,"100% of $1,971.00 in Billed Charges for Rev 272 = $1,971.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MONITOR QUICK STICK PRESS 295.2,270,RC,27000077,CDM,,,,,,both,,,342.0000,51.3000,AETNA,AETNA,146.03,,,,,,,88.2700,342.0000,percent of total billed charges,42.7% of $342.00 in Billed Charges for Rev 270 = $146.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITOR QUICK STICK PRESS 295.2,270,RC,27000077,CDM,,,,,,both,,,342.0000,51.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,239.40,,,,,,,88.2700,342.0000,percent of total billed charges,Rev 270 $342.00 in Billed Charges at 70% = $239.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITOR QUICK STICK PRESS 295.2,270,RC,27000077,CDM,,,,,,both,,,342.0000,51.3000,CIGNA HEALTHCARE,CIGNA HMO,142.61,,,,,,,88.2700,342.0000,percent of total billed charges,41.7% of $342.00 in Billed Charges for Rev 270 = $142.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITOR QUICK STICK PRESS 295.2,270,RC,27000077,CDM,,,,,,both,,,342.0000,51.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,158.69,,,,,,,88.2700,342.0000,percent of total billed charges,46.4% of $342.00 in Billed Charges for Rev 270 = $158.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITOR QUICK STICK PRESS 295.2,270,RC,27000077,CDM,,,,,,both,,,342.0000,51.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,142.61,,,,,,,88.2700,342.0000,percent of total billed charges,41.7% of $342.00 in Billed Charges for Rev 270 = $142.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITOR QUICK STICK PRESS 295.2,270,RC,27000077,CDM,,,,,,both,,,342.0000,51.3000,CIGNA HEALTHCARE,CIGNA PPO,142.61,,,,,,,88.2700,342.0000,percent of total billed charges,41.7% of $342.00 in Billed Charges for Rev 270 = $142.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITOR QUICK STICK PRESS 295.2,270,RC,27000077,CDM,,,,,,both,,,342.0000,51.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,307.80,,,,,,,88.2700,342.0000,percent of total billed charges,90% of $342.00 in Billed Charges for Rev 270 = $307.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITOR QUICK STICK PRESS 295.2,270,RC,27000077,CDM,,,,,,both,,,342.0000,51.3000,MEDCOST,MEDCOST VHN,162.76,,,,,,,88.2700,342.0000,percent of total billed charges,47.59% of $342.00 in Billed Charges for Rev 270 = $162.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITOR QUICK STICK PRESS 295.2,270,RC,27000077,CDM,,,,,,both,,,342.0000,51.3000,SENTARA HEALTH,SENTARA HEALTH,88.27,,,,,,,88.2700,342.0000,percent of total billed charges,25.81% of $342.00 in Billed Charges for Rev 270 = $88.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITOR QUICK STICK PRESS 295.2,270,RC,27000077,CDM,,,,,,both,,,342.0000,51.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",342.00,,,,,,,88.2700,342.0000,percent of total billed charges,100% of $342.00 in Billed Charges for Rev 270 = $342.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITOR QUICK STICK PRESS 295.2,270,RC,27000077,CDM,,,,,,both,,,342.0000,51.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,171.00,,,,,,,88.2700,342.0000,percent of total billed charges,Rev 270 $342.00 in Billed Charges at 50% = $171.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITOR QUICK STICK PRESS 295.2,270,RC,27000077,CDM,,,,,,both,,,342.0000,51.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,110.47,,,,,,,88.2700,342.0000,other,32.3% of $342.00 in Billed Charges for Rev 270 = $110.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MONITOR QUICK STICK PRESS 295.2,270,RC,27000077,CDM,,,,,,both,,,342.0000,51.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,104.99,,,,,,,88.2700,342.0000,other,30.7% of $342.00 in Billed Charges for Rev 270 = $104.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MONITOR QUICK STICK PRESS 295.2,270,RC,27000077,CDM,,,,,,both,,,342.0000,51.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,110.47,,,,,,,88.2700,342.0000,percent of total billed charges,32.3% of $342.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITOR QUICK STICK PRESS 295.2,270,RC,27000077,CDM,,,,,,both,,,342.0000,51.3000,WELLCARE,WELLCARE MEDICAID,342.00,,,,,,,88.2700,342.0000,percent of total billed charges,100% of $342.00 in Billed Charges for Rev 270 = $342.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER SINGLE,272,RC,27200939,CDM,,,,,,both,,,64.0000,9.6000,AETNA,AETNA,27.33,,,,,,,16.5200,64.0000,percent of total billed charges,42.7% of $64.00 in Billed Charges for Rev 272 = $27.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER SINGLE,272,RC,27200939,CDM,,,,,,both,,,64.0000,9.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,44.80,,,,,,,16.5200,64.0000,percent of total billed charges,Rev 272 $64.00 in Billed Charges at 70% = $44.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER SINGLE,272,RC,27200939,CDM,,,,,,both,,,64.0000,9.6000,CIGNA HEALTHCARE,CIGNA HMO,26.69,,,,,,,16.5200,64.0000,percent of total billed charges,41.7% of $64.00 in Billed Charges for Rev 272 = $26.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER SINGLE,272,RC,27200939,CDM,,,,,,both,,,64.0000,9.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,29.70,,,,,,,16.5200,64.0000,percent of total billed charges,46.4% of $64.00 in Billed Charges for Rev 272 = $29.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER SINGLE,272,RC,27200939,CDM,,,,,,both,,,64.0000,9.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,26.69,,,,,,,16.5200,64.0000,percent of total billed charges,41.7% of $64.00 in Billed Charges for Rev 272 = $26.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER SINGLE,272,RC,27200939,CDM,,,,,,both,,,64.0000,9.6000,CIGNA HEALTHCARE,CIGNA PPO,26.69,,,,,,,16.5200,64.0000,percent of total billed charges,41.7% of $64.00 in Billed Charges for Rev 272 = $26.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER SINGLE,272,RC,27200939,CDM,,,,,,both,,,64.0000,9.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,57.60,,,,,,,16.5200,64.0000,percent of total billed charges,90% of $64.00 in Billed Charges for Rev 272 = $57.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER SINGLE,272,RC,27200939,CDM,,,,,,both,,,64.0000,9.6000,MEDCOST,MEDCOST VHN,30.46,,,,,,,16.5200,64.0000,percent of total billed charges,47.59% of $64.00 in Billed Charges for Rev 272 = $30.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER SINGLE,272,RC,27200939,CDM,,,,,,both,,,64.0000,9.6000,SENTARA HEALTH,SENTARA HEALTH,16.52,,,,,,,16.5200,64.0000,percent of total billed charges,25.81% of $64.00 in Billed Charges for Rev 272 = $16.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER SINGLE,272,RC,27200939,CDM,,,,,,both,,,64.0000,9.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",64.00,,,,,,,16.5200,64.0000,percent of total billed charges,100% of $64.00 in Billed Charges for Rev 272 = $64.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER SINGLE,272,RC,27200939,CDM,,,,,,both,,,64.0000,9.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,32.00,,,,,,,16.5200,64.0000,percent of total billed charges,Rev 272 $64.00 in Billed Charges at 50% = $32.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER SINGLE,272,RC,27200939,CDM,,,,,,both,,,64.0000,9.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,20.67,,,,,,,16.5200,64.0000,other,32.3% of $64.00 in Billed Charges for Rev 272 = $20.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MONITORING TRANSDUCER SINGLE,272,RC,27200939,CDM,,,,,,both,,,64.0000,9.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,19.65,,,,,,,16.5200,64.0000,other,30.7% of $64.00 in Billed Charges for Rev 272 = $19.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MONITORING TRANSDUCER SINGLE,272,RC,27200939,CDM,,,,,,both,,,64.0000,9.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,20.67,,,,,,,16.5200,64.0000,percent of total billed charges,32.3% of $64.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER SINGLE,272,RC,27200939,CDM,,,,,,both,,,64.0000,9.6000,WELLCARE,WELLCARE MEDICAID,64.00,,,,,,,16.5200,64.0000,percent of total billed charges,100% of $64.00 in Billed Charges for Rev 272 = $64.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER TRIPLE,272,RC,27200940,CDM,,,,,,both,,,145.0000,21.7500,AETNA,AETNA,61.92,,,,,,,37.4200,145.0000,percent of total billed charges,42.7% of $145.00 in Billed Charges for Rev 272 = $61.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER TRIPLE,272,RC,27200940,CDM,,,,,,both,,,145.0000,21.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,101.50,,,,,,,37.4200,145.0000,percent of total billed charges,Rev 272 $145.00 in Billed Charges at 70% = $101.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER TRIPLE,272,RC,27200940,CDM,,,,,,both,,,145.0000,21.7500,CIGNA HEALTHCARE,CIGNA HMO,60.47,,,,,,,37.4200,145.0000,percent of total billed charges,41.7% of $145.00 in Billed Charges for Rev 272 = $60.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER TRIPLE,272,RC,27200940,CDM,,,,,,both,,,145.0000,21.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,67.28,,,,,,,37.4200,145.0000,percent of total billed charges,46.4% of $145.00 in Billed Charges for Rev 272 = $67.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER TRIPLE,272,RC,27200940,CDM,,,,,,both,,,145.0000,21.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,60.47,,,,,,,37.4200,145.0000,percent of total billed charges,41.7% of $145.00 in Billed Charges for Rev 272 = $60.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER TRIPLE,272,RC,27200940,CDM,,,,,,both,,,145.0000,21.7500,CIGNA HEALTHCARE,CIGNA PPO,60.47,,,,,,,37.4200,145.0000,percent of total billed charges,41.7% of $145.00 in Billed Charges for Rev 272 = $60.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER TRIPLE,272,RC,27200940,CDM,,,,,,both,,,145.0000,21.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,130.50,,,,,,,37.4200,145.0000,percent of total billed charges,90% of $145.00 in Billed Charges for Rev 272 = $130.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER TRIPLE,272,RC,27200940,CDM,,,,,,both,,,145.0000,21.7500,MEDCOST,MEDCOST VHN,69.01,,,,,,,37.4200,145.0000,percent of total billed charges,47.59% of $145.00 in Billed Charges for Rev 272 = $69.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER TRIPLE,272,RC,27200940,CDM,,,,,,both,,,145.0000,21.7500,SENTARA HEALTH,SENTARA HEALTH,37.42,,,,,,,37.4200,145.0000,percent of total billed charges,25.81% of $145.00 in Billed Charges for Rev 272 = $37.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER TRIPLE,272,RC,27200940,CDM,,,,,,both,,,145.0000,21.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",145.00,,,,,,,37.4200,145.0000,percent of total billed charges,100% of $145.00 in Billed Charges for Rev 272 = $145.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER TRIPLE,272,RC,27200940,CDM,,,,,,both,,,145.0000,21.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,72.50,,,,,,,37.4200,145.0000,percent of total billed charges,Rev 272 $145.00 in Billed Charges at 50% = $72.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER TRIPLE,272,RC,27200940,CDM,,,,,,both,,,145.0000,21.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,46.84,,,,,,,37.4200,145.0000,other,32.3% of $145.00 in Billed Charges for Rev 272 = $46.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MONITORING TRANSDUCER TRIPLE,272,RC,27200940,CDM,,,,,,both,,,145.0000,21.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,44.52,,,,,,,37.4200,145.0000,other,30.7% of $145.00 in Billed Charges for Rev 272 = $44.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MONITORING TRANSDUCER TRIPLE,272,RC,27200940,CDM,,,,,,both,,,145.0000,21.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,46.84,,,,,,,37.4200,145.0000,percent of total billed charges,32.3% of $145.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MONITORING TRANSDUCER TRIPLE,272,RC,27200940,CDM,,,,,,both,,,145.0000,21.7500,WELLCARE,WELLCARE MEDICAID,145.00,,,,,,,37.4200,145.0000,percent of total billed charges,100% of $145.00 in Billed Charges for Rev 272 = $145.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MR MAMMOTOME 8GA,272,RC,27201713,CDM,,,,,,both,,,1945.0000,291.7500,AETNA,AETNA,830.52,,,,,,,502.0000,1945.0000,percent of total billed charges,"42.7% of $1,945.00 in Billed Charges for Rev 272 = $830.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR MAMMOTOME 8GA,272,RC,27201713,CDM,,,,,,both,,,1945.0000,291.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1361.50,,,,,,,502.0000,1945.0000,percent of total billed charges,"Rev 272 $1,945.00 in Billed Charges at 70% = $1,361.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR MAMMOTOME 8GA,272,RC,27201713,CDM,,,,,,both,,,1945.0000,291.7500,CIGNA HEALTHCARE,CIGNA HMO,811.07,,,,,,,502.0000,1945.0000,percent of total billed charges,"41.7% of $1,945.00 in Billed Charges for Rev 272 = $811.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR MAMMOTOME 8GA,272,RC,27201713,CDM,,,,,,both,,,1945.0000,291.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,902.48,,,,,,,502.0000,1945.0000,percent of total billed charges,"46.4% of $1,945.00 in Billed Charges for Rev 272 = $902.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR MAMMOTOME 8GA,272,RC,27201713,CDM,,,,,,both,,,1945.0000,291.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,811.07,,,,,,,502.0000,1945.0000,percent of total billed charges,"41.7% of $1,945.00 in Billed Charges for Rev 272 = $811.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR MAMMOTOME 8GA,272,RC,27201713,CDM,,,,,,both,,,1945.0000,291.7500,CIGNA HEALTHCARE,CIGNA PPO,811.07,,,,,,,502.0000,1945.0000,percent of total billed charges,"41.7% of $1,945.00 in Billed Charges for Rev 272 = $811.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR MAMMOTOME 8GA,272,RC,27201713,CDM,,,,,,both,,,1945.0000,291.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1750.50,,,,,,,502.0000,1945.0000,percent of total billed charges,"90% of $1,945.00 in Billed Charges for Rev 272 = $1,750.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR MAMMOTOME 8GA,272,RC,27201713,CDM,,,,,,both,,,1945.0000,291.7500,MEDCOST,MEDCOST VHN,925.63,,,,,,,502.0000,1945.0000,percent of total billed charges,"47.59% of $1,945.00 in Billed Charges for Rev 272 = $925.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR MAMMOTOME 8GA,272,RC,27201713,CDM,,,,,,both,,,1945.0000,291.7500,SENTARA HEALTH,SENTARA HEALTH,502.00,,,,,,,502.0000,1945.0000,percent of total billed charges,"25.81% of $1,945.00 in Billed Charges for Rev 272 = $502.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR MAMMOTOME 8GA,272,RC,27201713,CDM,,,,,,both,,,1945.0000,291.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1945.00,,,,,,,502.0000,1945.0000,percent of total billed charges,"100% of $1,945.00 in Billed Charges for Rev 272 = $1,945.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR MAMMOTOME 8GA,272,RC,27201713,CDM,,,,,,both,,,1945.0000,291.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,972.50,,,,,,,502.0000,1945.0000,percent of total billed charges,"Rev 272 $1,945.00 in Billed Charges at 50% = $972.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR MAMMOTOME 8GA,272,RC,27201713,CDM,,,,,,both,,,1945.0000,291.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,628.24,,,,,,,502.0000,1945.0000,other,"32.3% of $1,945.00 in Billed Charges for Rev 272 = $628.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR MAMMOTOME 8GA,272,RC,27201713,CDM,,,,,,both,,,1945.0000,291.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,597.12,,,,,,,502.0000,1945.0000,other,"30.7% of $1,945.00 in Billed Charges for Rev 272 = $597.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR MAMMOTOME 8GA,272,RC,27201713,CDM,,,,,,both,,,1945.0000,291.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,628.24,,,,,,,502.0000,1945.0000,percent of total billed charges,"32.3% of $1,945.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR MAMMOTOME 8GA,272,RC,27201713,CDM,,,,,,both,,,1945.0000,291.7500,WELLCARE,WELLCARE MEDICAID,1945.00,,,,,,,502.0000,1945.0000,percent of total billed charges,"100% of $1,945.00 in Billed Charges for Rev 272 = $1,945.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,AETNA,AETNA,187.45,,,,,,,18.9100,439.0000,percent of total billed charges,42.7% of $439.00 in Billed Charges for Rev 320 Proc 73060 Mod 52 = $187.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,39.81,,,,,,,18.9100,439.0000,fee schedule,"APG 00471 Proc 73060 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment), Adjusted by (0.5 / 1) = $38.27 at 104% = $39.81. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,39.48,,,,,,,18.9100,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,AETNA,AETNA HEALTHCARE MEDICARE,39.48,,,,,,,18.9100,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,39.48,,,,,,,18.9100,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,AMBETTER,AMBETTER,86.06,,,,,,,18.9100,439.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,41.06,,,,,,,18.9100,439.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM EXCHANGE,97.20,,,,,,,18.9100,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,39.42,,,,,,,18.9100,439.0000,fee schedule,"APG 00471 Proc 73060 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment), Adjusted by (0.5 / 1) = $38.27 at 103% = $39.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM HMO,103.27,,,,,,,18.9100,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,40.66,,,,,,,18.9100,439.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",121.48,,,,,,,18.9100,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,31.22,,,,,,,18.9100,439.0000,fee schedule,$31.22 from Fee Schedule BLDTM_23 for Rev 320 Proc 73060 Mod 52 * Qty 1 = $31.22 at 100% = $31.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS E NETWORK,59.26,,,,,,,18.9100,439.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73060 Mod 52 * Qty 1 = $18.52 at 320% = $59.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS MEDICARE,41.06,,,,,,,18.9100,439.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS P NETWORK,60.56,,,,,,,18.9100,439.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73060 Mod 52 * Qty 1 = $18.52 at 327% = $60.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS S NETWORK,60.56,,,,,,,18.9100,439.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73060 Mod 52 * Qty 1 = $18.52 at 327% = $60.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,BLUE CROSS,TENNCARE BLUE CARE,18.91,,,,,,,18.9100,439.0000,fee schedule,$16.30 from Fee Schedule TC_24 for Rev 320 Proc 73060 Mod 52 * Qty 1 = $16.30 at 116% = $18.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,BLUE CROSS,TENNCARE BLUE SELECT,18.91,,,,,,,18.9100,439.0000,fee schedule,$16.30 from Fee Schedule TC_24 for Rev 320 Proc 73060 Mod 52 * Qty 1 = $16.30 at 116% = $18.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,18.9100,439.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73060 Mod 52 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,45.48,,,,,,,18.9100,439.0000,fee schedule,$45.48 from Fee Schedule CGIFP_25LR for Rev 320 Proc 73060 Mod 52 * Qty 1 = $45.48 at 100% = $45.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,41.45,,,,,,,18.9100,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,18.9100,439.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73060 Mod 52 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,18.9100,439.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73060 Mod 52 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,41.45,,,,,,,18.9100,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,395.10,,,,,,,18.9100,439.0000,percent of total billed charges,90% of $439.00 in Billed Charges for Rev 320 Proc 73060 Mod 52 = $395.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,HUMANA,HUMANA MEDICARE,39.48,,,,,,,18.9100,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,39.48,,,,,,,18.9100,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,MEDCOST,MEDCOST VHN,208.92,,,,,,,18.9100,439.0000,percent of total billed charges,47.59% of $439.00 in Billed Charges for Rev 320 Proc 73060 Mod 52 = $208.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,40.18,,,,,,,18.9100,439.0000,fee schedule,"APG 00471 Proc 73060 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment), Adjusted by (0.5 / 1) = $38.27 at 100% = $38.27... $38.27 at 105% = $40.18 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,41.45,,,,,,,18.9100,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,41.45,,,,,,,18.9100,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,NHC ADVANTAGE,NHC ADVANTAGE,41.45,,,,,,,18.9100,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,39.46,,,,,,,18.9100,439.0000,fee schedule,"APG 00471 Proc 73060 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment), Adjusted by (0.5 / 1) = $38.27 at 100% = $38.27... $38.27 at 103.1% = $39.46 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,SENTARA HEALTH,SENTARA HEALTH,113.31,,,,,,,18.9100,439.0000,percent of total billed charges,25.81% of $439.00 in Billed Charges for Rev 320 Proc 73060 Mod 52 = $113.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,SENTARA HEALTH,SENTARA MEDICARE,39.48,,,,,,,18.9100,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",439.00,,,,,,,18.9100,439.0000,percent of total billed charges,100% of $439.00 in Billed Charges for Rev 320 Proc 73060 Mod 52 = $439.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,18.9100,439.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 73060 Mod 52 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,18.9100,439.0000,other,Rev 320 Proc 73060 Mod 52 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,18.9100,439.0000,other,Rev 320 Proc 73060 Mod 52 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,18.9100,439.0000,other,Rev 320 Proc 73060 Mod 52 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,39.42,,,,,,,18.9100,439.0000,fee schedule,"APG 00471 Proc 73060 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment), Adjusted by (0.5 / 1) = $38.27 at 103% = $39.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,39.48,,,,,,,18.9100,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,39.48,,,,,,,18.9100,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,WELLCARE,WELLCARE MEDICAID,439.00,,,,,,,18.9100,439.0000,percent of total billed charges,100% of $439.00 in Billed Charges for Rev 320 Proc 73060 Mod 52 = $439.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HUMERUS 1 VIEW,73060,CPT,320,RC,32000077,CDM,,,52,both,,,439.0000,65.8500,WELLCARE,WELLCARE MEDICARE,41.85,,,,,,,18.9100,439.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,AETNA,AETNA,207.10,,,,,,,18.9100,485.0000,percent of total billed charges,42.7% of $485.00 in Billed Charges for Rev 320 Proc 73060 Mod 50 = $207.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,119.42,,,,,,,18.9100,485.0000,fee schedule,APG 00471 Proc 73060 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 104% = $119.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,AMBETTER,AMBETTER,172.12,,,,,,,18.9100,485.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,18.9100,485.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,118.27,,,,,,,18.9100,485.0000,fee schedule,APG 00471 Proc 73060 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 103% = $118.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,18.9100,485.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,31.22,,,,,,,18.9100,485.0000,fee schedule,$31.22 from Fee Schedule BLDTM_23 for Rev 320 Proc 73060 Mod 50 * Qty 1 = $31.22 at 100% = $31.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,BLUE CROSS E NETWORK,59.26,,,,,,,18.9100,485.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73060 Mod 50 * Qty 1 = $18.52 at 320% = $59.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,18.9100,485.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,BLUE CROSS P NETWORK,60.56,,,,,,,18.9100,485.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73060 Mod 50 * Qty 1 = $18.52 at 327% = $60.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,BLUE CROSS S NETWORK,60.56,,,,,,,18.9100,485.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73060 Mod 50 * Qty 1 = $18.52 at 327% = $60.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,TENNCARE BLUE CARE,18.91,,,,,,,18.9100,485.0000,fee schedule,$16.30 from Fee Schedule TC_24 for Rev 320 Proc 73060 Mod 50 * Qty 1 = $16.30 at 116% = $18.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,TENNCARE BLUE SELECT,18.91,,,,,,,18.9100,485.0000,fee schedule,$16.30 from Fee Schedule TC_24 for Rev 320 Proc 73060 Mod 50 * Qty 1 = $16.30 at 116% = $18.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,18.9100,485.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73060 Mod 50 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,45.48,,,,,,,18.9100,485.0000,fee schedule,$45.48 from Fee Schedule CGIFP_25LR for Rev 320 Proc 73060 Mod 50 * Qty 1 = $45.48 at 100% = $45.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,18.9100,485.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,18.9100,485.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73060 Mod 50 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,18.9100,485.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73060 Mod 50 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,18.9100,485.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,436.50,,,,,,,18.9100,485.0000,percent of total billed charges,90% of $485.00 in Billed Charges for Rev 320 Proc 73060 Mod 50 = $436.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,HUMANA,HUMANA MEDICARE,78.96,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,MEDCOST,MEDCOST VHN,230.81,,,,,,,18.9100,485.0000,percent of total billed charges,47.59% of $485.00 in Billed Charges for Rev 320 Proc 73060 Mod 50 = $230.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,120.56,,,,,,,18.9100,485.0000,fee schedule,APG 00471 Proc 73060 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 100% = $114.82... $114.82 at 105% = $120.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,18.9100,485.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,18.9100,485.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,18.9100,485.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,118.38,,,,,,,18.9100,485.0000,fee schedule,APG 00471 Proc 73060 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 100% = $114.82... $114.82 at 103.1% = $118.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,SENTARA HEALTH,SENTARA HEALTH,125.18,,,,,,,18.9100,485.0000,percent of total billed charges,25.81% of $485.00 in Billed Charges for Rev 320 Proc 73060 Mod 50 = $125.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",485.00,,,,,,,18.9100,485.0000,percent of total billed charges,100% of $485.00 in Billed Charges for Rev 320 Proc 73060 Mod 50 = $485.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,18.9100,485.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 73060 Mod 50 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,18.9100,485.0000,other,Rev 320 Proc 73060 Mod 50 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,18.9100,485.0000,other,Rev 320 Proc 73060 Mod 50 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,18.9100,485.0000,other,Rev 320 Proc 73060 Mod 50 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,118.27,,,,,,,18.9100,485.0000,fee schedule,APG 00471 Proc 73060 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 103% = $118.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,WELLCARE,WELLCARE MEDICAID,485.00,,,,,,,18.9100,485.0000,percent of total billed charges,100% of $485.00 in Billed Charges for Rev 320 Proc 73060 Mod 50 = $485.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HUMERUS 2 VIEW+ BILAT,73060,CPT,320,RC,32000079,CDM,,,50,both,,,485.0000,72.7500,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,18.9100,485.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,AETNA,AETNA,178.06,,,,,,,17.4500,417.0000,percent of total billed charges,42.7% of $417.00 in Billed Charges for Rev 320 Proc 73070 Mod 52 = $178.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,39.81,,,,,,,17.4500,417.0000,fee schedule,"APG 00471 Proc 73070 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment), Adjusted by (0.5 / 1) = $38.27 at 104% = $39.81. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,39.48,,,,,,,17.4500,417.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,AETNA,AETNA HEALTHCARE MEDICARE,39.48,,,,,,,17.4500,417.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,39.48,,,,,,,17.4500,417.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,AMBETTER,AMBETTER,86.06,,,,,,,17.4500,417.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,41.06,,,,,,,17.4500,417.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,BLUE CROSS,ANTHEM EXCHANGE,97.20,,,,,,,17.4500,417.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,39.42,,,,,,,17.4500,417.0000,fee schedule,"APG 00471 Proc 73070 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment), Adjusted by (0.5 / 1) = $38.27 at 103% = $39.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,BLUE CROSS,ANTHEM HMO,103.27,,,,,,,17.4500,417.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,40.66,,,,,,,17.4500,417.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",121.48,,,,,,,17.4500,417.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,28.11,,,,,,,17.4500,417.0000,fee schedule,$28.11 from Fee Schedule BLDTM_23 for Rev 320 Proc 73070 Mod 52 * Qty 1 = $28.11 at 100% = $28.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,BLUE CROSS,BLUE CROSS E NETWORK,59.26,,,,,,,17.4500,417.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73070 Mod 52 * Qty 1 = $18.52 at 320% = $59.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,BLUE CROSS,BLUE CROSS MEDICARE,41.06,,,,,,,17.4500,417.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,BLUE CROSS,BLUE CROSS P NETWORK,60.56,,,,,,,17.4500,417.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73070 Mod 52 * Qty 1 = $18.52 at 327% = $60.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,BLUE CROSS,BLUE CROSS S NETWORK,60.56,,,,,,,17.4500,417.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73070 Mod 52 * Qty 1 = $18.52 at 327% = $60.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,BLUE CROSS,TENNCARE BLUE CARE,17.45,,,,,,,17.4500,417.0000,fee schedule,$15.04 from Fee Schedule TC_24 for Rev 320 Proc 73070 Mod 52 * Qty 1 = $15.04 at 116% = $17.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,BLUE CROSS,TENNCARE BLUE SELECT,17.45,,,,,,,17.4500,417.0000,fee schedule,$15.04 from Fee Schedule TC_24 for Rev 320 Proc 73070 Mod 52 * Qty 1 = $15.04 at 116% = $17.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,17.4500,417.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73070 Mod 52 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,39.84,,,,,,,17.4500,417.0000,fee schedule,$39.84 from Fee Schedule CGIFP_25LR for Rev 320 Proc 73070 Mod 52 * Qty 1 = $39.84 at 100% = $39.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,41.45,,,,,,,17.4500,417.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,17.4500,417.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73070 Mod 52 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,17.4500,417.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73070 Mod 52 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,41.45,,,,,,,17.4500,417.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,375.30,,,,,,,17.4500,417.0000,percent of total billed charges,90% of $417.00 in Billed Charges for Rev 320 Proc 73070 Mod 52 = $375.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,HUMANA,HUMANA MEDICARE,39.48,,,,,,,17.4500,417.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,39.48,,,,,,,17.4500,417.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,MEDCOST,MEDCOST VHN,198.45,,,,,,,17.4500,417.0000,percent of total billed charges,47.59% of $417.00 in Billed Charges for Rev 320 Proc 73070 Mod 52 = $198.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,40.18,,,,,,,17.4500,417.0000,fee schedule,"APG 00471 Proc 73070 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment), Adjusted by (0.5 / 1) = $38.27 at 100% = $38.27... $38.27 at 105% = $40.18 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,41.45,,,,,,,17.4500,417.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,41.45,,,,,,,17.4500,417.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,NHC ADVANTAGE,NHC ADVANTAGE,41.45,,,,,,,17.4500,417.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,39.46,,,,,,,17.4500,417.0000,fee schedule,"APG 00471 Proc 73070 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment), Adjusted by (0.5 / 1) = $38.27 at 100% = $38.27... $38.27 at 103.1% = $39.46 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,SENTARA HEALTH,SENTARA HEALTH,107.63,,,,,,,17.4500,417.0000,percent of total billed charges,25.81% of $417.00 in Billed Charges for Rev 320 Proc 73070 Mod 52 = $107.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,SENTARA HEALTH,SENTARA MEDICARE,39.48,,,,,,,17.4500,417.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",417.00,,,,,,,17.4500,417.0000,percent of total billed charges,100% of $417.00 in Billed Charges for Rev 320 Proc 73070 Mod 52 = $417.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,17.4500,417.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 73070 Mod 52 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,17.4500,417.0000,other,Rev 320 Proc 73070 Mod 52 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,17.4500,417.0000,other,Rev 320 Proc 73070 Mod 52 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,17.4500,417.0000,other,Rev 320 Proc 73070 Mod 52 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,39.42,,,,,,,17.4500,417.0000,fee schedule,"APG 00471 Proc 73070 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment), Adjusted by (0.5 / 1) = $38.27 at 103% = $39.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,39.48,,,,,,,17.4500,417.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,39.48,,,,,,,17.4500,417.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,WELLCARE,WELLCARE MEDICAID,417.00,,,,,,,17.4500,417.0000,percent of total billed charges,100% of $417.00 in Billed Charges for Rev 320 Proc 73070 Mod 52 = $417.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 1 VIEW,73070,CPT,320,RC,32000080,CDM,,,52,both,,,417.0000,62.5500,WELLCARE,WELLCARE MEDICARE,41.85,,,,,,,17.4500,417.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,17.4500,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 73070 Mod 50 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,119.42,,,,,,,17.4500,462.0000,fee schedule,APG 00471 Proc 73070 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 104% = $119.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,AMBETTER,AMBETTER,172.12,,,,,,,17.4500,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,17.4500,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,118.27,,,,,,,17.4500,462.0000,fee schedule,APG 00471 Proc 73070 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 103% = $118.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,17.4500,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,28.11,,,,,,,17.4500,462.0000,fee schedule,$28.11 from Fee Schedule BLDTM_23 for Rev 320 Proc 73070 Mod 50 * Qty 1 = $28.11 at 100% = $28.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,59.26,,,,,,,17.4500,462.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73070 Mod 50 * Qty 1 = $18.52 at 320% = $59.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,17.4500,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,60.56,,,,,,,17.4500,462.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73070 Mod 50 * Qty 1 = $18.52 at 327% = $60.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,60.56,,,,,,,17.4500,462.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73070 Mod 50 * Qty 1 = $18.52 at 327% = $60.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,17.45,,,,,,,17.4500,462.0000,fee schedule,$15.04 from Fee Schedule TC_24 for Rev 320 Proc 73070 Mod 50 * Qty 1 = $15.04 at 116% = $17.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,17.45,,,,,,,17.4500,462.0000,fee schedule,$15.04 from Fee Schedule TC_24 for Rev 320 Proc 73070 Mod 50 * Qty 1 = $15.04 at 116% = $17.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,17.4500,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73070 Mod 50 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,39.84,,,,,,,17.4500,462.0000,fee schedule,$39.84 from Fee Schedule CGIFP_25LR for Rev 320 Proc 73070 Mod 50 * Qty 1 = $39.84 at 100% = $39.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,17.4500,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,17.4500,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73070 Mod 50 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,17.4500,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73070 Mod 50 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,17.4500,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,17.4500,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 73070 Mod 50 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,17.4500,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 73070 Mod 50 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,120.56,,,,,,,17.4500,462.0000,fee schedule,APG 00471 Proc 73070 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 100% = $114.82... $114.82 at 105% = $120.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,17.4500,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,17.4500,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,17.4500,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,118.38,,,,,,,17.4500,462.0000,fee schedule,APG 00471 Proc 73070 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 100% = $114.82... $114.82 at 103.1% = $118.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,17.4500,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 73070 Mod 50 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,17.4500,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 73070 Mod 50 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,17.4500,462.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 73070 Mod 50 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,17.4500,462.0000,other,Rev 320 Proc 73070 Mod 50 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,17.4500,462.0000,other,Rev 320 Proc 73070 Mod 50 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,17.4500,462.0000,other,Rev 320 Proc 73070 Mod 50 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,118.27,,,,,,,17.4500,462.0000,fee schedule,APG 00471 Proc 73070 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 103% = $118.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,17.4500,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 73070 Mod 50 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 1 VIEW BILAT,73070,CPT,320,RC,32000325,CDM,,,50,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,17.4500,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,AETNA,AETNA,207.10,,,,,,,18.9100,485.0000,percent of total billed charges,42.7% of $485.00 in Billed Charges for Rev 320 Proc 73080 = $207.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,18.9100,485.0000,fee schedule,APG 00471 Proc 73080 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,AMBETTER,AMBETTER,172.12,,,,,,,18.9100,485.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,18.9100,485.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,18.9100,485.0000,fee schedule,APG 00471 Proc 73080 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,18.9100,485.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,31.22,,,,,,,18.9100,485.0000,fee schedule,$31.22 from Fee Schedule BLDTM_23 for Rev 320 Proc 73080 * Qty 1 = $31.22 at 100% = $31.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,BLUE CROSS,BLUE CROSS E NETWORK,72.67,,,,,,,18.9100,485.0000,fee schedule,$22.71 from Fee Schedule BCFSC for Rev 320 Proc 73080 * Qty 1 = $22.71 at 320% = $72.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,18.9100,485.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,BLUE CROSS,BLUE CROSS P NETWORK,74.26,,,,,,,18.9100,485.0000,fee schedule,$22.71 from Fee Schedule BCFSC for Rev 320 Proc 73080 * Qty 1 = $22.71 at 327% = $74.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,BLUE CROSS,BLUE CROSS S NETWORK,74.26,,,,,,,18.9100,485.0000,fee schedule,$22.71 from Fee Schedule BCFSC for Rev 320 Proc 73080 * Qty 1 = $22.71 at 327% = $74.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,BLUE CROSS,TENNCARE BLUE CARE,18.91,,,,,,,18.9100,485.0000,fee schedule,$16.30 from Fee Schedule TC_24 for Rev 320 Proc 73080 * Qty 1 = $16.30 at 116% = $18.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,BLUE CROSS,TENNCARE BLUE SELECT,18.91,,,,,,,18.9100,485.0000,fee schedule,$16.30 from Fee Schedule TC_24 for Rev 320 Proc 73080 * Qty 1 = $16.30 at 116% = $18.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,18.9100,485.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73080 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,46.10,,,,,,,18.9100,485.0000,fee schedule,$46.10 from Fee Schedule CGIFP_25LR for Rev 320 Proc 73080 * Qty 1 = $46.10 at 100% = $46.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,18.9100,485.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,18.9100,485.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73080 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,18.9100,485.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73080 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,18.9100,485.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,436.50,,,,,,,18.9100,485.0000,percent of total billed charges,90% of $485.00 in Billed Charges for Rev 320 Proc 73080 = $436.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,HUMANA,HUMANA MEDICARE,78.96,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,MEDCOST,MEDCOST VHN,230.81,,,,,,,18.9100,485.0000,percent of total billed charges,47.59% of $485.00 in Billed Charges for Rev 320 Proc 73080 = $230.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,18.9100,485.0000,fee schedule,APG 00471 Proc 73080 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,18.9100,485.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,18.9100,485.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,18.9100,485.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,18.9100,485.0000,fee schedule,APG 00471 Proc 73080 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,SENTARA HEALTH,SENTARA HEALTH,125.18,,,,,,,18.9100,485.0000,percent of total billed charges,25.81% of $485.00 in Billed Charges for Rev 320 Proc 73080 = $125.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",485.00,,,,,,,18.9100,485.0000,percent of total billed charges,100% of $485.00 in Billed Charges for Rev 320 Proc 73080 = $485.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,18.9100,485.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 73080 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,18.9100,485.0000,other,Rev 320 Proc 73080 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,18.9100,485.0000,other,Rev 320 Proc 73080 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,18.9100,485.0000,other,Rev 320 Proc 73080 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,18.9100,485.0000,fee schedule,APG 00471 Proc 73080 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,18.9100,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,WELLCARE,WELLCARE MEDICAID,485.00,,,,,,,18.9100,485.0000,percent of total billed charges,100% of $485.00 in Billed Charges for Rev 320 Proc 73080 = $485.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 3 VIEW+,73080,CPT,320,RC,32000083,CDM,,,,both,,,485.0000,72.7500,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,18.9100,485.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NCB GALACTOGRAM,272,RC,27200897,CDM,,,,,,both,,,287.0000,43.0500,AETNA,AETNA,122.55,,,,,,,74.0700,287.0000,percent of total billed charges,42.7% of $287.00 in Billed Charges for Rev 272 = $122.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCB GALACTOGRAM,272,RC,27200897,CDM,,,,,,both,,,287.0000,43.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,200.90,,,,,,,74.0700,287.0000,percent of total billed charges,Rev 272 $287.00 in Billed Charges at 70% = $200.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCB GALACTOGRAM,272,RC,27200897,CDM,,,,,,both,,,287.0000,43.0500,CIGNA HEALTHCARE,CIGNA HMO,119.68,,,,,,,74.0700,287.0000,percent of total billed charges,41.7% of $287.00 in Billed Charges for Rev 272 = $119.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCB GALACTOGRAM,272,RC,27200897,CDM,,,,,,both,,,287.0000,43.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,133.17,,,,,,,74.0700,287.0000,percent of total billed charges,46.4% of $287.00 in Billed Charges for Rev 272 = $133.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCB GALACTOGRAM,272,RC,27200897,CDM,,,,,,both,,,287.0000,43.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,119.68,,,,,,,74.0700,287.0000,percent of total billed charges,41.7% of $287.00 in Billed Charges for Rev 272 = $119.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCB GALACTOGRAM,272,RC,27200897,CDM,,,,,,both,,,287.0000,43.0500,CIGNA HEALTHCARE,CIGNA PPO,119.68,,,,,,,74.0700,287.0000,percent of total billed charges,41.7% of $287.00 in Billed Charges for Rev 272 = $119.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCB GALACTOGRAM,272,RC,27200897,CDM,,,,,,both,,,287.0000,43.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,258.30,,,,,,,74.0700,287.0000,percent of total billed charges,90% of $287.00 in Billed Charges for Rev 272 = $258.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCB GALACTOGRAM,272,RC,27200897,CDM,,,,,,both,,,287.0000,43.0500,MEDCOST,MEDCOST VHN,136.58,,,,,,,74.0700,287.0000,percent of total billed charges,47.59% of $287.00 in Billed Charges for Rev 272 = $136.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCB GALACTOGRAM,272,RC,27200897,CDM,,,,,,both,,,287.0000,43.0500,SENTARA HEALTH,SENTARA HEALTH,74.07,,,,,,,74.0700,287.0000,percent of total billed charges,25.81% of $287.00 in Billed Charges for Rev 272 = $74.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCB GALACTOGRAM,272,RC,27200897,CDM,,,,,,both,,,287.0000,43.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",287.00,,,,,,,74.0700,287.0000,percent of total billed charges,100% of $287.00 in Billed Charges for Rev 272 = $287.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCB GALACTOGRAM,272,RC,27200897,CDM,,,,,,both,,,287.0000,43.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,143.50,,,,,,,74.0700,287.0000,percent of total billed charges,Rev 272 $287.00 in Billed Charges at 50% = $143.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCB GALACTOGRAM,272,RC,27200897,CDM,,,,,,both,,,287.0000,43.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,92.70,,,,,,,74.0700,287.0000,other,32.3% of $287.00 in Billed Charges for Rev 272 = $92.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NCB GALACTOGRAM,272,RC,27200897,CDM,,,,,,both,,,287.0000,43.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,88.11,,,,,,,74.0700,287.0000,other,30.7% of $287.00 in Billed Charges for Rev 272 = $88.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NCB GALACTOGRAM,272,RC,27200897,CDM,,,,,,both,,,287.0000,43.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,92.70,,,,,,,74.0700,287.0000,percent of total billed charges,32.3% of $287.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCB GALACTOGRAM,272,RC,27200897,CDM,,,,,,both,,,287.0000,43.0500,WELLCARE,WELLCARE MEDICAID,287.00,,,,,,,74.0700,287.0000,percent of total billed charges,100% of $287.00 in Billed Charges for Rev 272 = $287.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NCB NDL EVIVAA 9 GA 20MM,272,RC,27201728,CDM,,,,,,both,,,1090.0000,163.5000,AETNA,AETNA,465.43,,,,,,,281.3300,1090.0000,percent of total billed charges,"42.7% of $1,090.00 in Billed Charges for Rev 272 = $465.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NCB NDL EVIVAA 9 GA 20MM,272,RC,27201728,CDM,,,,,,both,,,1090.0000,163.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,763.00,,,,,,,281.3300,1090.0000,percent of total billed charges,"Rev 272 $1,090.00 in Billed Charges at 70% = $763.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NCB NDL EVIVAA 9 GA 20MM,272,RC,27201728,CDM,,,,,,both,,,1090.0000,163.5000,CIGNA HEALTHCARE,CIGNA HMO,454.53,,,,,,,281.3300,1090.0000,percent of total billed charges,"41.7% of $1,090.00 in Billed Charges for Rev 272 = $454.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NCB NDL EVIVAA 9 GA 20MM,272,RC,27201728,CDM,,,,,,both,,,1090.0000,163.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,505.76,,,,,,,281.3300,1090.0000,percent of total billed charges,"46.4% of $1,090.00 in Billed Charges for Rev 272 = $505.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NCB NDL EVIVAA 9 GA 20MM,272,RC,27201728,CDM,,,,,,both,,,1090.0000,163.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,454.53,,,,,,,281.3300,1090.0000,percent of total billed charges,"41.7% of $1,090.00 in Billed Charges for Rev 272 = $454.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NCB NDL EVIVAA 9 GA 20MM,272,RC,27201728,CDM,,,,,,both,,,1090.0000,163.5000,CIGNA HEALTHCARE,CIGNA PPO,454.53,,,,,,,281.3300,1090.0000,percent of total billed charges,"41.7% of $1,090.00 in Billed Charges for Rev 272 = $454.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NCB NDL EVIVAA 9 GA 20MM,272,RC,27201728,CDM,,,,,,both,,,1090.0000,163.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,981.00,,,,,,,281.3300,1090.0000,percent of total billed charges,"90% of $1,090.00 in Billed Charges for Rev 272 = $981.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NCB NDL EVIVAA 9 GA 20MM,272,RC,27201728,CDM,,,,,,both,,,1090.0000,163.5000,MEDCOST,MEDCOST VHN,518.73,,,,,,,281.3300,1090.0000,percent of total billed charges,"47.59% of $1,090.00 in Billed Charges for Rev 272 = $518.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NCB NDL EVIVAA 9 GA 20MM,272,RC,27201728,CDM,,,,,,both,,,1090.0000,163.5000,SENTARA HEALTH,SENTARA HEALTH,281.33,,,,,,,281.3300,1090.0000,percent of total billed charges,"25.81% of $1,090.00 in Billed Charges for Rev 272 = $281.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NCB NDL EVIVAA 9 GA 20MM,272,RC,27201728,CDM,,,,,,both,,,1090.0000,163.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1090.00,,,,,,,281.3300,1090.0000,percent of total billed charges,"100% of $1,090.00 in Billed Charges for Rev 272 = $1,090.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NCB NDL EVIVAA 9 GA 20MM,272,RC,27201728,CDM,,,,,,both,,,1090.0000,163.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,545.00,,,,,,,281.3300,1090.0000,percent of total billed charges,"Rev 272 $1,090.00 in Billed Charges at 50% = $545.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NCB NDL EVIVAA 9 GA 20MM,272,RC,27201728,CDM,,,,,,both,,,1090.0000,163.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,352.07,,,,,,,281.3300,1090.0000,other,"32.3% of $1,090.00 in Billed Charges for Rev 272 = $352.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NCB NDL EVIVAA 9 GA 20MM,272,RC,27201728,CDM,,,,,,both,,,1090.0000,163.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,334.63,,,,,,,281.3300,1090.0000,other,"30.7% of $1,090.00 in Billed Charges for Rev 272 = $334.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NCB NDL EVIVAA 9 GA 20MM,272,RC,27201728,CDM,,,,,,both,,,1090.0000,163.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,352.07,,,,,,,281.3300,1090.0000,percent of total billed charges,"32.3% of $1,090.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NCB NDL EVIVAA 9 GA 20MM,272,RC,27201728,CDM,,,,,,both,,,1090.0000,163.5000,WELLCARE,WELLCARE MEDICAID,1090.00,,,,,,,281.3300,1090.0000,percent of total billed charges,"100% of $1,090.00 in Billed Charges for Rev 272 = $1,090.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET DILUTION PRISMA M60,270,RC,27000116,CDM,,,,,,both,,,508.0000,76.2000,AETNA,AETNA,216.92,,,,,,,131.1100,508.0000,percent of total billed charges,42.7% of $508.00 in Billed Charges for Rev 270 = $216.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DILUTION PRISMA M60,270,RC,27000116,CDM,,,,,,both,,,508.0000,76.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,355.60,,,,,,,131.1100,508.0000,percent of total billed charges,Rev 270 $508.00 in Billed Charges at 70% = $355.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DILUTION PRISMA M60,270,RC,27000116,CDM,,,,,,both,,,508.0000,76.2000,CIGNA HEALTHCARE,CIGNA HMO,211.84,,,,,,,131.1100,508.0000,percent of total billed charges,41.7% of $508.00 in Billed Charges for Rev 270 = $211.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DILUTION PRISMA M60,270,RC,27000116,CDM,,,,,,both,,,508.0000,76.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,235.71,,,,,,,131.1100,508.0000,percent of total billed charges,46.4% of $508.00 in Billed Charges for Rev 270 = $235.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DILUTION PRISMA M60,270,RC,27000116,CDM,,,,,,both,,,508.0000,76.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,211.84,,,,,,,131.1100,508.0000,percent of total billed charges,41.7% of $508.00 in Billed Charges for Rev 270 = $211.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DILUTION PRISMA M60,270,RC,27000116,CDM,,,,,,both,,,508.0000,76.2000,CIGNA HEALTHCARE,CIGNA PPO,211.84,,,,,,,131.1100,508.0000,percent of total billed charges,41.7% of $508.00 in Billed Charges for Rev 270 = $211.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DILUTION PRISMA M60,270,RC,27000116,CDM,,,,,,both,,,508.0000,76.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,457.20,,,,,,,131.1100,508.0000,percent of total billed charges,90% of $508.00 in Billed Charges for Rev 270 = $457.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DILUTION PRISMA M60,270,RC,27000116,CDM,,,,,,both,,,508.0000,76.2000,MEDCOST,MEDCOST VHN,241.76,,,,,,,131.1100,508.0000,percent of total billed charges,47.59% of $508.00 in Billed Charges for Rev 270 = $241.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DILUTION PRISMA M60,270,RC,27000116,CDM,,,,,,both,,,508.0000,76.2000,SENTARA HEALTH,SENTARA HEALTH,131.11,,,,,,,131.1100,508.0000,percent of total billed charges,25.81% of $508.00 in Billed Charges for Rev 270 = $131.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DILUTION PRISMA M60,270,RC,27000116,CDM,,,,,,both,,,508.0000,76.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",508.00,,,,,,,131.1100,508.0000,percent of total billed charges,100% of $508.00 in Billed Charges for Rev 270 = $508.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DILUTION PRISMA M60,270,RC,27000116,CDM,,,,,,both,,,508.0000,76.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,254.00,,,,,,,131.1100,508.0000,percent of total billed charges,Rev 270 $508.00 in Billed Charges at 50% = $254.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DILUTION PRISMA M60,270,RC,27000116,CDM,,,,,,both,,,508.0000,76.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,164.08,,,,,,,131.1100,508.0000,other,32.3% of $508.00 in Billed Charges for Rev 270 = $164.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SET DILUTION PRISMA M60,270,RC,27000116,CDM,,,,,,both,,,508.0000,76.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,155.96,,,,,,,131.1100,508.0000,other,30.7% of $508.00 in Billed Charges for Rev 270 = $155.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SET DILUTION PRISMA M60,270,RC,27000116,CDM,,,,,,both,,,508.0000,76.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,164.08,,,,,,,131.1100,508.0000,percent of total billed charges,32.3% of $508.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DILUTION PRISMA M60,270,RC,27000116,CDM,,,,,,both,,,508.0000,76.2000,WELLCARE,WELLCARE MEDICAID,508.00,,,,,,,131.1100,508.0000,percent of total billed charges,100% of $508.00 in Billed Charges for Rev 270 = $508.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN EXTERNAL CSF,270,RC,27000100,CDM,,,,,,both,,,902.0000,135.3000,AETNA,AETNA,385.15,,,,,,,232.8100,902.0000,percent of total billed charges,42.7% of $902.00 in Billed Charges for Rev 270 = $385.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN EXTERNAL CSF,270,RC,27000100,CDM,,,,,,both,,,902.0000,135.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,631.40,,,,,,,232.8100,902.0000,percent of total billed charges,Rev 270 $902.00 in Billed Charges at 70% = $631.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN EXTERNAL CSF,270,RC,27000100,CDM,,,,,,both,,,902.0000,135.3000,CIGNA HEALTHCARE,CIGNA HMO,376.13,,,,,,,232.8100,902.0000,percent of total billed charges,41.7% of $902.00 in Billed Charges for Rev 270 = $376.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN EXTERNAL CSF,270,RC,27000100,CDM,,,,,,both,,,902.0000,135.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,418.53,,,,,,,232.8100,902.0000,percent of total billed charges,46.4% of $902.00 in Billed Charges for Rev 270 = $418.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN EXTERNAL CSF,270,RC,27000100,CDM,,,,,,both,,,902.0000,135.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,376.13,,,,,,,232.8100,902.0000,percent of total billed charges,41.7% of $902.00 in Billed Charges for Rev 270 = $376.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN EXTERNAL CSF,270,RC,27000100,CDM,,,,,,both,,,902.0000,135.3000,CIGNA HEALTHCARE,CIGNA PPO,376.13,,,,,,,232.8100,902.0000,percent of total billed charges,41.7% of $902.00 in Billed Charges for Rev 270 = $376.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN EXTERNAL CSF,270,RC,27000100,CDM,,,,,,both,,,902.0000,135.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,811.80,,,,,,,232.8100,902.0000,percent of total billed charges,90% of $902.00 in Billed Charges for Rev 270 = $811.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN EXTERNAL CSF,270,RC,27000100,CDM,,,,,,both,,,902.0000,135.3000,MEDCOST,MEDCOST VHN,429.26,,,,,,,232.8100,902.0000,percent of total billed charges,47.59% of $902.00 in Billed Charges for Rev 270 = $429.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN EXTERNAL CSF,270,RC,27000100,CDM,,,,,,both,,,902.0000,135.3000,SENTARA HEALTH,SENTARA HEALTH,232.81,,,,,,,232.8100,902.0000,percent of total billed charges,25.81% of $902.00 in Billed Charges for Rev 270 = $232.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN EXTERNAL CSF,270,RC,27000100,CDM,,,,,,both,,,902.0000,135.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",902.00,,,,,,,232.8100,902.0000,percent of total billed charges,100% of $902.00 in Billed Charges for Rev 270 = $902.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN EXTERNAL CSF,270,RC,27000100,CDM,,,,,,both,,,902.0000,135.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,451.00,,,,,,,232.8100,902.0000,percent of total billed charges,Rev 270 $902.00 in Billed Charges at 50% = $451.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN EXTERNAL CSF,270,RC,27000100,CDM,,,,,,both,,,902.0000,135.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,291.35,,,,,,,232.8100,902.0000,other,32.3% of $902.00 in Billed Charges for Rev 270 = $291.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SET DRAIN EXTERNAL CSF,270,RC,27000100,CDM,,,,,,both,,,902.0000,135.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,276.91,,,,,,,232.8100,902.0000,other,30.7% of $902.00 in Billed Charges for Rev 270 = $276.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SET DRAIN EXTERNAL CSF,270,RC,27000100,CDM,,,,,,both,,,902.0000,135.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,291.35,,,,,,,232.8100,902.0000,percent of total billed charges,32.3% of $902.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET DRAIN EXTERNAL CSF,270,RC,27000100,CDM,,,,,,both,,,902.0000,135.3000,WELLCARE,WELLCARE MEDICAID,902.00,,,,,,,232.8100,902.0000,percent of total billed charges,100% of $902.00 in Billed Charges for Rev 270 = $902.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH PERC INTRO,270,RC,27000107,CDM,,,,,,both,,,874.0000,131.1000,AETNA,AETNA,373.20,,,,,,,225.5800,874.0000,percent of total billed charges,42.7% of $874.00 in Billed Charges for Rev 270 = $373.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH PERC INTRO,270,RC,27000107,CDM,,,,,,both,,,874.0000,131.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,611.80,,,,,,,225.5800,874.0000,percent of total billed charges,Rev 270 $874.00 in Billed Charges at 70% = $611.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH PERC INTRO,270,RC,27000107,CDM,,,,,,both,,,874.0000,131.1000,CIGNA HEALTHCARE,CIGNA HMO,364.46,,,,,,,225.5800,874.0000,percent of total billed charges,41.7% of $874.00 in Billed Charges for Rev 270 = $364.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH PERC INTRO,270,RC,27000107,CDM,,,,,,both,,,874.0000,131.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,405.54,,,,,,,225.5800,874.0000,percent of total billed charges,46.4% of $874.00 in Billed Charges for Rev 270 = $405.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH PERC INTRO,270,RC,27000107,CDM,,,,,,both,,,874.0000,131.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,364.46,,,,,,,225.5800,874.0000,percent of total billed charges,41.7% of $874.00 in Billed Charges for Rev 270 = $364.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH PERC INTRO,270,RC,27000107,CDM,,,,,,both,,,874.0000,131.1000,CIGNA HEALTHCARE,CIGNA PPO,364.46,,,,,,,225.5800,874.0000,percent of total billed charges,41.7% of $874.00 in Billed Charges for Rev 270 = $364.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH PERC INTRO,270,RC,27000107,CDM,,,,,,both,,,874.0000,131.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,786.60,,,,,,,225.5800,874.0000,percent of total billed charges,90% of $874.00 in Billed Charges for Rev 270 = $786.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH PERC INTRO,270,RC,27000107,CDM,,,,,,both,,,874.0000,131.1000,MEDCOST,MEDCOST VHN,415.94,,,,,,,225.5800,874.0000,percent of total billed charges,47.59% of $874.00 in Billed Charges for Rev 270 = $415.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH PERC INTRO,270,RC,27000107,CDM,,,,,,both,,,874.0000,131.1000,SENTARA HEALTH,SENTARA HEALTH,225.58,,,,,,,225.5800,874.0000,percent of total billed charges,25.81% of $874.00 in Billed Charges for Rev 270 = $225.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH PERC INTRO,270,RC,27000107,CDM,,,,,,both,,,874.0000,131.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",874.00,,,,,,,225.5800,874.0000,percent of total billed charges,100% of $874.00 in Billed Charges for Rev 270 = $874.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH PERC INTRO,270,RC,27000107,CDM,,,,,,both,,,874.0000,131.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,437.00,,,,,,,225.5800,874.0000,percent of total billed charges,Rev 270 $874.00 in Billed Charges at 50% = $437.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH PERC INTRO,270,RC,27000107,CDM,,,,,,both,,,874.0000,131.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,282.30,,,,,,,225.5800,874.0000,other,32.3% of $874.00 in Billed Charges for Rev 270 = $282.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SET TRACH PERC INTRO,270,RC,27000107,CDM,,,,,,both,,,874.0000,131.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,268.32,,,,,,,225.5800,874.0000,other,30.7% of $874.00 in Billed Charges for Rev 270 = $268.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SET TRACH PERC INTRO,270,RC,27000107,CDM,,,,,,both,,,874.0000,131.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,282.30,,,,,,,225.5800,874.0000,percent of total billed charges,32.3% of $874.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SET TRACH PERC INTRO,270,RC,27000107,CDM,,,,,,both,,,874.0000,131.1000,WELLCARE,WELLCARE MEDICAID,874.00,,,,,,,225.5800,874.0000,percent of total billed charges,100% of $874.00 in Billed Charges for Rev 270 = $874.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,AETNA,AETNA,519.66,,,,,,,68.9900,1217.0000,percent of total billed charges,"42.7% of $1,217.00 in Billed Charges for Rev 320 Proc 73085 = $519.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,166.44,,,,,,,68.9900,1217.0000,fee schedule,APG 00389 Proc 73085 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 104% = $166.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,316.52,,,,,,,68.9900,1217.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,AETNA,AETNA HEALTHCARE MEDICARE,316.52,,,,,,,68.9900,1217.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,316.52,,,,,,,68.9900,1217.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,AMBETTER,AMBETTER,690.02,,,,,,,68.9900,1217.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,329.19,,,,,,,68.9900,1217.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,BLUE CROSS,ANTHEM EXCHANGE,779.29,,,,,,,68.9900,1217.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,164.84,,,,,,,68.9900,1217.0000,fee schedule,APG 00389 Proc 73085 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,BLUE CROSS,ANTHEM HMO,827.95,,,,,,,68.9900,1217.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,326.02,,,,,,,68.9900,1217.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",974.01,,,,,,,68.9900,1217.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,121.01,,,,,,,68.9900,1217.0000,fee schedule,$121.01 from Fee Schedule BLDTM_23 for Rev 320 Proc 73085 * Qty 1 = $121.01 at 100% = $121.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,BLUE CROSS,BLUE CROSS E NETWORK,213.70,,,,,,,68.9900,1217.0000,fee schedule,$66.78 from Fee Schedule BCFSC for Rev 320 Proc 73085 * Qty 1 = $66.78 at 320% = $213.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,BLUE CROSS,BLUE CROSS MEDICARE,329.19,,,,,,,68.9900,1217.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,BLUE CROSS,BLUE CROSS P NETWORK,218.37,,,,,,,68.9900,1217.0000,fee schedule,$66.78 from Fee Schedule BCFSC for Rev 320 Proc 73085 * Qty 1 = $66.78 at 327% = $218.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,BLUE CROSS,BLUE CROSS S NETWORK,218.37,,,,,,,68.9900,1217.0000,fee schedule,$66.78 from Fee Schedule BCFSC for Rev 320 Proc 73085 * Qty 1 = $66.78 at 327% = $218.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,BLUE CROSS,TENNCARE BLUE CARE,68.99,,,,,,,68.9900,1217.0000,fee schedule,$59.47 from Fee Schedule TC_24 for Rev 320 Proc 73085 * Qty 1 = $59.47 at 116% = $68.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,BLUE CROSS,TENNCARE BLUE SELECT,68.99,,,,,,,68.9900,1217.0000,fee schedule,$59.47 from Fee Schedule TC_24 for Rev 320 Proc 73085 * Qty 1 = $59.47 at 116% = $68.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,CIGNA HEALTHCARE,CIGNA HMO,1061.93,,,,,,,68.9900,1217.0000,fee schedule,"$1,061.93 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73085 * Qty 1 = $1,061.93 at 100% = $1,061.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,140.05,,,,,,,68.9900,1217.0000,fee schedule,$140.05 from Fee Schedule CGIFP_25LR for Rev 320 Proc 73085 * Qty 1 = $140.05 at 100% = $140.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,332.35,,,,,,,68.9900,1217.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1061.93,,,,,,,68.9900,1217.0000,fee schedule,"$1,061.93 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73085 * Qty 1 = $1,061.93 at 100% = $1,061.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,CIGNA HEALTHCARE,CIGNA PPO,1061.93,,,,,,,68.9900,1217.0000,fee schedule,"$1,061.93 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73085 * Qty 1 = $1,061.93 at 100% = $1,061.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,332.35,,,,,,,68.9900,1217.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1095.30,,,,,,,68.9900,1217.0000,percent of total billed charges,"90% of $1,217.00 in Billed Charges for Rev 320 Proc 73085 = $1,095.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,HUMANA,HUMANA MEDICARE,316.52,,,,,,,68.9900,1217.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,316.52,,,,,,,68.9900,1217.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,MEDCOST,MEDCOST VHN,579.17,,,,,,,68.9900,1217.0000,percent of total billed charges,"47.59% of $1,217.00 in Billed Charges for Rev 320 Proc 73085 = $579.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,168.04,,,,,,,68.9900,1217.0000,fee schedule,APG 00389 Proc 73085 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 105% = $168.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,332.35,,,,,,,68.9900,1217.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,332.35,,,,,,,68.9900,1217.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,NHC ADVANTAGE,NHC ADVANTAGE,332.35,,,,,,,68.9900,1217.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,165.00,,,,,,,68.9900,1217.0000,fee schedule,APG 00389 Proc 73085 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 103.1% = $165.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,SENTARA HEALTH,SENTARA HEALTH,314.11,,,,,,,68.9900,1217.0000,percent of total billed charges,"25.81% of $1,217.00 in Billed Charges for Rev 320 Proc 73085 = $314.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,SENTARA HEALTH,SENTARA MEDICARE,316.52,,,,,,,68.9900,1217.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1217.00,,,,,,,68.9900,1217.0000,percent of total billed charges,"100% of $1,217.00 in Billed Charges for Rev 320 Proc 73085 = $1,217.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,140.29,,,,,,,68.9900,1217.0000,fee schedule,$280.58 from Fee Schedule TCUHC24 for Rev 320 Proc 73085 * Qty 1 = $280.58 at 50% = $140.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,68.9900,1217.0000,other,Rev 320 Proc 73085 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,68.9900,1217.0000,other,Rev 320 Proc 73085 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,68.9900,1217.0000,other,Rev 320 Proc 73085 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,164.84,,,,,,,68.9900,1217.0000,fee schedule,APG 00389 Proc 73085 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,316.52,,,,,,,68.9900,1217.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,316.52,,,,,,,68.9900,1217.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,WELLCARE,WELLCARE MEDICAID,1217.00,,,,,,,68.9900,1217.0000,percent of total billed charges,"100% of $1,217.00 in Billed Charges for Rev 320 Proc 73085 = $1,217.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROGRAM ELBOW,73085,CPT,320,RC,32000085,CDM,,,,both,,,1217.0000,182.5500,WELLCARE,WELLCARE MEDICARE,335.52,,,,,,,68.9900,1217.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,AETNA,AETNA,187.45,,,,,,,17.4500,439.0000,percent of total billed charges,42.7% of $439.00 in Billed Charges for Rev 320 Proc 73090 Mod 52 = $187.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,39.81,,,,,,,17.4500,439.0000,fee schedule,"APG 00471 Proc 73090 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment), Adjusted by (0.5 / 1) = $38.27 at 104% = $39.81. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,39.48,,,,,,,17.4500,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,AETNA,AETNA HEALTHCARE MEDICARE,39.48,,,,,,,17.4500,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,39.48,,,,,,,17.4500,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,AMBETTER,AMBETTER,86.06,,,,,,,17.4500,439.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,41.06,,,,,,,17.4500,439.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM EXCHANGE,97.20,,,,,,,17.4500,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,39.42,,,,,,,17.4500,439.0000,fee schedule,"APG 00471 Proc 73090 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment), Adjusted by (0.5 / 1) = $38.27 at 103% = $39.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM HMO,103.27,,,,,,,17.4500,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,40.66,,,,,,,17.4500,439.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",121.48,,,,,,,17.4500,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,28.50,,,,,,,17.4500,439.0000,fee schedule,$28.50 from Fee Schedule BLDTM_23 for Rev 320 Proc 73090 Mod 52 * Qty 1 = $28.50 at 100% = $28.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS E NETWORK,57.22,,,,,,,17.4500,439.0000,fee schedule,$17.88 from Fee Schedule BCFSC for Rev 320 Proc 73090 Mod 52 * Qty 1 = $17.88 at 320% = $57.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS MEDICARE,41.06,,,,,,,17.4500,439.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS P NETWORK,58.47,,,,,,,17.4500,439.0000,fee schedule,$17.88 from Fee Schedule BCFSC for Rev 320 Proc 73090 Mod 52 * Qty 1 = $17.88 at 327% = $58.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS S NETWORK,58.47,,,,,,,17.4500,439.0000,fee schedule,$17.88 from Fee Schedule BCFSC for Rev 320 Proc 73090 Mod 52 * Qty 1 = $17.88 at 327% = $58.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,BLUE CROSS,TENNCARE BLUE CARE,17.45,,,,,,,17.4500,439.0000,fee schedule,$15.04 from Fee Schedule TC_24 for Rev 320 Proc 73090 Mod 52 * Qty 1 = $15.04 at 116% = $17.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,BLUE CROSS,TENNCARE BLUE SELECT,17.45,,,,,,,17.4500,439.0000,fee schedule,$15.04 from Fee Schedule TC_24 for Rev 320 Proc 73090 Mod 52 * Qty 1 = $15.04 at 116% = $17.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,17.4500,439.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73090 Mod 52 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,40.47,,,,,,,17.4500,439.0000,fee schedule,$40.47 from Fee Schedule CGIFP_25LR for Rev 320 Proc 73090 Mod 52 * Qty 1 = $40.47 at 100% = $40.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,41.45,,,,,,,17.4500,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,17.4500,439.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73090 Mod 52 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,17.4500,439.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73090 Mod 52 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,41.45,,,,,,,17.4500,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,395.10,,,,,,,17.4500,439.0000,percent of total billed charges,90% of $439.00 in Billed Charges for Rev 320 Proc 73090 Mod 52 = $395.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,HUMANA,HUMANA MEDICARE,39.48,,,,,,,17.4500,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,39.48,,,,,,,17.4500,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,MEDCOST,MEDCOST VHN,208.92,,,,,,,17.4500,439.0000,percent of total billed charges,47.59% of $439.00 in Billed Charges for Rev 320 Proc 73090 Mod 52 = $208.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,40.18,,,,,,,17.4500,439.0000,fee schedule,"APG 00471 Proc 73090 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment), Adjusted by (0.5 / 1) = $38.27 at 100% = $38.27... $38.27 at 105% = $40.18 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,41.45,,,,,,,17.4500,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,41.45,,,,,,,17.4500,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,NHC ADVANTAGE,NHC ADVANTAGE,41.45,,,,,,,17.4500,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,39.46,,,,,,,17.4500,439.0000,fee schedule,"APG 00471 Proc 73090 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment), Adjusted by (0.5 / 1) = $38.27 at 100% = $38.27... $38.27 at 103.1% = $39.46 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,SENTARA HEALTH,SENTARA HEALTH,113.31,,,,,,,17.4500,439.0000,percent of total billed charges,25.81% of $439.00 in Billed Charges for Rev 320 Proc 73090 Mod 52 = $113.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,SENTARA HEALTH,SENTARA MEDICARE,39.48,,,,,,,17.4500,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",439.00,,,,,,,17.4500,439.0000,percent of total billed charges,100% of $439.00 in Billed Charges for Rev 320 Proc 73090 Mod 52 = $439.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,17.4500,439.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 73090 Mod 52 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,17.4500,439.0000,other,Rev 320 Proc 73090 Mod 52 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,17.4500,439.0000,other,Rev 320 Proc 73090 Mod 52 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,17.4500,439.0000,other,Rev 320 Proc 73090 Mod 52 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,39.42,,,,,,,17.4500,439.0000,fee schedule,"APG 00471 Proc 73090 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment), Adjusted by (0.5 / 1) = $38.27 at 103% = $39.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,39.48,,,,,,,17.4500,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,39.48,,,,,,,17.4500,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,WELLCARE,WELLCARE MEDICAID,439.00,,,,,,,17.4500,439.0000,percent of total billed charges,100% of $439.00 in Billed Charges for Rev 320 Proc 73090 Mod 52 = $439.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FOREARM 1 VIEW,73090,CPT,320,RC,32000086,CDM,,,52,both,,,439.0000,65.8500,WELLCARE,WELLCARE MEDICARE,41.85,,,,,,,17.4500,439.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,16.4800,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 73092 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,16.4800,462.0000,fee schedule,APG 00471 Proc 73092 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,16.4800,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,16.4800,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,16.4800,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,206.78,,,,,,,16.4800,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,16.4800,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,16.4800,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,16.4800,462.0000,fee schedule,APG 00471 Proc 73092 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,16.4800,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,16.4800,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,16.4800,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,28.04,,,,,,,16.4800,462.0000,fee schedule,$28.04 from Fee Schedule BLDTM_23 for Rev 320 Proc 73092 * Qty 1 = $28.04 at 100% = $28.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,59.26,,,,,,,16.4800,462.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73092 * Qty 1 = $18.52 at 320% = $59.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,16.4800,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,60.56,,,,,,,16.4800,462.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73092 * Qty 1 = $18.52 at 327% = $60.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,60.56,,,,,,,16.4800,462.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73092 * Qty 1 = $18.52 at 327% = $60.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,16.48,,,,,,,16.4800,462.0000,fee schedule,$14.21 from Fee Schedule TC_24 for Rev 320 Proc 73092 * Qty 1 = $14.21 at 116% = $16.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,16.48,,,,,,,16.4800,462.0000,fee schedule,$14.21 from Fee Schedule TC_24 for Rev 320 Proc 73092 * Qty 1 = $14.21 at 116% = $16.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,16.4800,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73092 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,44.85,,,,,,,16.4800,462.0000,fee schedule,$44.85 from Fee Schedule CGIFP_25LR for Rev 320 Proc 73092 * Qty 1 = $44.85 at 100% = $44.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,16.4800,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,16.4800,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73092 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,16.4800,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73092 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,16.4800,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,16.4800,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 73092 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,94.85,,,,,,,16.4800,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,16.4800,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,16.4800,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 73092 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,16.4800,462.0000,fee schedule,APG 00471 Proc 73092 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,16.4800,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,16.4800,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,16.4800,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,16.4800,462.0000,fee schedule,APG 00471 Proc 73092 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,16.4800,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 73092 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,16.4800,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,16.4800,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 73092 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,16.4800,462.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 73092 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,16.4800,462.0000,other,Rev 320 Proc 73092 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,16.4800,462.0000,other,Rev 320 Proc 73092 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,16.4800,462.0000,other,Rev 320 Proc 73092 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,16.4800,462.0000,fee schedule,APG 00471 Proc 73092 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,16.4800,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,16.4800,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,16.4800,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 73092 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX EXTREM UPPER INFANT 2 VIEW UNILAT,73092,CPT,320,RC,32000089,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,16.4800,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,AETNA,AETNA,178.06,,,,,,,16.4800,417.0000,percent of total billed charges,42.7% of $417.00 in Billed Charges for Rev 320 Proc 73100 Mod 52 = $178.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,39.81,,,,,,,16.4800,417.0000,fee schedule,"APG 00471 Proc 73100 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment), Adjusted by (0.5 / 1) = $38.27 at 104% = $39.81. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,39.48,,,,,,,16.4800,417.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,AETNA,AETNA HEALTHCARE MEDICARE,39.48,,,,,,,16.4800,417.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,39.48,,,,,,,16.4800,417.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,AMBETTER,AMBETTER,86.06,,,,,,,16.4800,417.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,41.06,,,,,,,16.4800,417.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,BLUE CROSS,ANTHEM EXCHANGE,97.20,,,,,,,16.4800,417.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,39.42,,,,,,,16.4800,417.0000,fee schedule,"APG 00471 Proc 73100 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment), Adjusted by (0.5 / 1) = $38.27 at 103% = $39.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,BLUE CROSS,ANTHEM HMO,103.27,,,,,,,16.4800,417.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,40.66,,,,,,,16.4800,417.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",121.48,,,,,,,16.4800,417.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,27.27,,,,,,,16.4800,417.0000,fee schedule,$27.27 from Fee Schedule BLDTM_23 for Rev 320 Proc 73100 Mod 52 * Qty 1 = $27.27 at 100% = $27.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,BLUE CROSS,BLUE CROSS E NETWORK,65.44,,,,,,,16.4800,417.0000,fee schedule,$20.45 from Fee Schedule BCFSC for Rev 320 Proc 73100 Mod 52 * Qty 1 = $20.45 at 320% = $65.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,BLUE CROSS,BLUE CROSS MEDICARE,41.06,,,,,,,16.4800,417.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,BLUE CROSS,BLUE CROSS P NETWORK,66.87,,,,,,,16.4800,417.0000,fee schedule,$20.45 from Fee Schedule BCFSC for Rev 320 Proc 73100 Mod 52 * Qty 1 = $20.45 at 327% = $66.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,BLUE CROSS,BLUE CROSS S NETWORK,66.87,,,,,,,16.4800,417.0000,fee schedule,$20.45 from Fee Schedule BCFSC for Rev 320 Proc 73100 Mod 52 * Qty 1 = $20.45 at 327% = $66.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,BLUE CROSS,TENNCARE BLUE CARE,16.48,,,,,,,16.4800,417.0000,fee schedule,$14.21 from Fee Schedule TC_24 for Rev 320 Proc 73100 Mod 52 * Qty 1 = $14.21 at 116% = $16.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,BLUE CROSS,TENNCARE BLUE SELECT,16.48,,,,,,,16.4800,417.0000,fee schedule,$14.21 from Fee Schedule TC_24 for Rev 320 Proc 73100 Mod 52 * Qty 1 = $14.21 at 116% = $16.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,16.4800,417.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73100 Mod 52 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,48.61,,,,,,,16.4800,417.0000,fee schedule,$48.61 from Fee Schedule CGIFP_25LR for Rev 320 Proc 73100 Mod 52 * Qty 1 = $48.61 at 100% = $48.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,41.45,,,,,,,16.4800,417.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,16.4800,417.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73100 Mod 52 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,16.4800,417.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73100 Mod 52 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,41.45,,,,,,,16.4800,417.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,375.30,,,,,,,16.4800,417.0000,percent of total billed charges,90% of $417.00 in Billed Charges for Rev 320 Proc 73100 Mod 52 = $375.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,HUMANA,HUMANA MEDICARE,39.48,,,,,,,16.4800,417.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,39.48,,,,,,,16.4800,417.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,MEDCOST,MEDCOST VHN,198.45,,,,,,,16.4800,417.0000,percent of total billed charges,47.59% of $417.00 in Billed Charges for Rev 320 Proc 73100 Mod 52 = $198.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,40.18,,,,,,,16.4800,417.0000,fee schedule,"APG 00471 Proc 73100 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment), Adjusted by (0.5 / 1) = $38.27 at 100% = $38.27... $38.27 at 105% = $40.18 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,41.45,,,,,,,16.4800,417.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,41.45,,,,,,,16.4800,417.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,NHC ADVANTAGE,NHC ADVANTAGE,41.45,,,,,,,16.4800,417.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,39.46,,,,,,,16.4800,417.0000,fee schedule,"APG 00471 Proc 73100 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment), Adjusted by (0.5 / 1) = $38.27 at 100% = $38.27... $38.27 at 103.1% = $39.46 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,SENTARA HEALTH,SENTARA HEALTH,107.63,,,,,,,16.4800,417.0000,percent of total billed charges,25.81% of $417.00 in Billed Charges for Rev 320 Proc 73100 Mod 52 = $107.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,SENTARA HEALTH,SENTARA MEDICARE,39.48,,,,,,,16.4800,417.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",417.00,,,,,,,16.4800,417.0000,percent of total billed charges,100% of $417.00 in Billed Charges for Rev 320 Proc 73100 Mod 52 = $417.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,16.4800,417.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 73100 Mod 52 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,16.4800,417.0000,other,Rev 320 Proc 73100 Mod 52 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,16.4800,417.0000,other,Rev 320 Proc 73100 Mod 52 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,16.4800,417.0000,other,Rev 320 Proc 73100 Mod 52 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,39.42,,,,,,,16.4800,417.0000,fee schedule,"APG 00471 Proc 73100 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment), Adjusted by (0.5 / 1) = $38.27 at 103% = $39.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,39.48,,,,,,,16.4800,417.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,39.48,,,,,,,16.4800,417.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,WELLCARE,WELLCARE MEDICAID,417.00,,,,,,,16.4800,417.0000,percent of total billed charges,100% of $417.00 in Billed Charges for Rev 320 Proc 73100 Mod 52 = $417.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX WRIST 1 VIEW,73100,CPT,320,RC,32000090,CDM,,,52,both,,,417.0000,62.5500,WELLCARE,WELLCARE MEDICARE,41.85,,,,,,,16.4800,417.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SET TRACH PERC INTRO BLUE RHIN,272,RC,27202279,CDM,,,,,,both,,,2708.0000,406.2000,AETNA,AETNA,1156.32,,,,,,,698.9300,2708.0000,percent of total billed charges,"42.7% of $2,708.00 in Billed Charges for Rev 272 = $1,156.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH PERC INTRO BLUE RHIN,272,RC,27202279,CDM,,,,,,both,,,2708.0000,406.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1895.60,,,,,,,698.9300,2708.0000,percent of total billed charges,"Rev 272 $2,708.00 in Billed Charges at 70% = $1,895.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH PERC INTRO BLUE RHIN,272,RC,27202279,CDM,,,,,,both,,,2708.0000,406.2000,CIGNA HEALTHCARE,CIGNA HMO,1129.24,,,,,,,698.9300,2708.0000,percent of total billed charges,"41.7% of $2,708.00 in Billed Charges for Rev 272 = $1,129.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH PERC INTRO BLUE RHIN,272,RC,27202279,CDM,,,,,,both,,,2708.0000,406.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1256.51,,,,,,,698.9300,2708.0000,percent of total billed charges,"46.4% of $2,708.00 in Billed Charges for Rev 272 = $1,256.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH PERC INTRO BLUE RHIN,272,RC,27202279,CDM,,,,,,both,,,2708.0000,406.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1129.24,,,,,,,698.9300,2708.0000,percent of total billed charges,"41.7% of $2,708.00 in Billed Charges for Rev 272 = $1,129.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH PERC INTRO BLUE RHIN,272,RC,27202279,CDM,,,,,,both,,,2708.0000,406.2000,CIGNA HEALTHCARE,CIGNA PPO,1129.24,,,,,,,698.9300,2708.0000,percent of total billed charges,"41.7% of $2,708.00 in Billed Charges for Rev 272 = $1,129.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH PERC INTRO BLUE RHIN,272,RC,27202279,CDM,,,,,,both,,,2708.0000,406.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2437.20,,,,,,,698.9300,2708.0000,percent of total billed charges,"90% of $2,708.00 in Billed Charges for Rev 272 = $2,437.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH PERC INTRO BLUE RHIN,272,RC,27202279,CDM,,,,,,both,,,2708.0000,406.2000,MEDCOST,MEDCOST VHN,1288.74,,,,,,,698.9300,2708.0000,percent of total billed charges,"47.59% of $2,708.00 in Billed Charges for Rev 272 = $1,288.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH PERC INTRO BLUE RHIN,272,RC,27202279,CDM,,,,,,both,,,2708.0000,406.2000,SENTARA HEALTH,SENTARA HEALTH,698.93,,,,,,,698.9300,2708.0000,percent of total billed charges,"25.81% of $2,708.00 in Billed Charges for Rev 272 = $698.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH PERC INTRO BLUE RHIN,272,RC,27202279,CDM,,,,,,both,,,2708.0000,406.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2708.00,,,,,,,698.9300,2708.0000,percent of total billed charges,"100% of $2,708.00 in Billed Charges for Rev 272 = $2,708.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH PERC INTRO BLUE RHIN,272,RC,27202279,CDM,,,,,,both,,,2708.0000,406.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1354.00,,,,,,,698.9300,2708.0000,percent of total billed charges,"Rev 272 $2,708.00 in Billed Charges at 50% = $1,354.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH PERC INTRO BLUE RHIN,272,RC,27202279,CDM,,,,,,both,,,2708.0000,406.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,874.68,,,,,,,698.9300,2708.0000,other,"32.3% of $2,708.00 in Billed Charges for Rev 272 = $874.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SET TRACH PERC INTRO BLUE RHIN,272,RC,27202279,CDM,,,,,,both,,,2708.0000,406.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,831.36,,,,,,,698.9300,2708.0000,other,"30.7% of $2,708.00 in Billed Charges for Rev 272 = $831.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SET TRACH PERC INTRO BLUE RHIN,272,RC,27202279,CDM,,,,,,both,,,2708.0000,406.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,874.68,,,,,,,698.9300,2708.0000,percent of total billed charges,"32.3% of $2,708.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SET TRACH PERC INTRO BLUE RHIN,272,RC,27202279,CDM,,,,,,both,,,2708.0000,406.2000,WELLCARE,WELLCARE MEDICAID,2708.00,,,,,,,698.9300,2708.0000,percent of total billed charges,"100% of $2,708.00 in Billed Charges for Rev 272 = $2,708.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHEARS COAG 5M DISP LCSC5HA,272,RC,27201042,CDM,,,,,,both,,,1321.0000,198.1500,AETNA,AETNA,564.07,,,,,,,340.9500,1321.0000,percent of total billed charges,"42.7% of $1,321.00 in Billed Charges for Rev 272 = $564.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHEARS COAG 5M DISP LCSC5HA,272,RC,27201042,CDM,,,,,,both,,,1321.0000,198.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,924.70,,,,,,,340.9500,1321.0000,percent of total billed charges,"Rev 272 $1,321.00 in Billed Charges at 70% = $924.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHEARS COAG 5M DISP LCSC5HA,272,RC,27201042,CDM,,,,,,both,,,1321.0000,198.1500,CIGNA HEALTHCARE,CIGNA HMO,550.86,,,,,,,340.9500,1321.0000,percent of total billed charges,"41.7% of $1,321.00 in Billed Charges for Rev 272 = $550.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHEARS COAG 5M DISP LCSC5HA,272,RC,27201042,CDM,,,,,,both,,,1321.0000,198.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,612.94,,,,,,,340.9500,1321.0000,percent of total billed charges,"46.4% of $1,321.00 in Billed Charges for Rev 272 = $612.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHEARS COAG 5M DISP LCSC5HA,272,RC,27201042,CDM,,,,,,both,,,1321.0000,198.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,550.86,,,,,,,340.9500,1321.0000,percent of total billed charges,"41.7% of $1,321.00 in Billed Charges for Rev 272 = $550.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHEARS COAG 5M DISP LCSC5HA,272,RC,27201042,CDM,,,,,,both,,,1321.0000,198.1500,CIGNA HEALTHCARE,CIGNA PPO,550.86,,,,,,,340.9500,1321.0000,percent of total billed charges,"41.7% of $1,321.00 in Billed Charges for Rev 272 = $550.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHEARS COAG 5M DISP LCSC5HA,272,RC,27201042,CDM,,,,,,both,,,1321.0000,198.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1188.90,,,,,,,340.9500,1321.0000,percent of total billed charges,"90% of $1,321.00 in Billed Charges for Rev 272 = $1,188.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHEARS COAG 5M DISP LCSC5HA,272,RC,27201042,CDM,,,,,,both,,,1321.0000,198.1500,MEDCOST,MEDCOST VHN,628.66,,,,,,,340.9500,1321.0000,percent of total billed charges,"47.59% of $1,321.00 in Billed Charges for Rev 272 = $628.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHEARS COAG 5M DISP LCSC5HA,272,RC,27201042,CDM,,,,,,both,,,1321.0000,198.1500,SENTARA HEALTH,SENTARA HEALTH,340.95,,,,,,,340.9500,1321.0000,percent of total billed charges,"25.81% of $1,321.00 in Billed Charges for Rev 272 = $340.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHEARS COAG 5M DISP LCSC5HA,272,RC,27201042,CDM,,,,,,both,,,1321.0000,198.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1321.00,,,,,,,340.9500,1321.0000,percent of total billed charges,"100% of $1,321.00 in Billed Charges for Rev 272 = $1,321.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHEARS COAG 5M DISP LCSC5HA,272,RC,27201042,CDM,,,,,,both,,,1321.0000,198.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,660.50,,,,,,,340.9500,1321.0000,percent of total billed charges,"Rev 272 $1,321.00 in Billed Charges at 50% = $660.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHEARS COAG 5M DISP LCSC5HA,272,RC,27201042,CDM,,,,,,both,,,1321.0000,198.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,426.68,,,,,,,340.9500,1321.0000,other,"32.3% of $1,321.00 in Billed Charges for Rev 272 = $426.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHEARS COAG 5M DISP LCSC5HA,272,RC,27201042,CDM,,,,,,both,,,1321.0000,198.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,405.55,,,,,,,340.9500,1321.0000,other,"30.7% of $1,321.00 in Billed Charges for Rev 272 = $405.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHEARS COAG 5M DISP LCSC5HA,272,RC,27201042,CDM,,,,,,both,,,1321.0000,198.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,426.68,,,,,,,340.9500,1321.0000,percent of total billed charges,"32.3% of $1,321.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHEARS COAG 5M DISP LCSC5HA,272,RC,27201042,CDM,,,,,,both,,,1321.0000,198.1500,WELLCARE,WELLCARE MEDICAID,1321.00,,,,,,,340.9500,1321.0000,percent of total billed charges,"100% of $1,321.00 in Billed Charges for Rev 272 = $1,321.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHEATH ATTAIN II ALL SZS,272,RC,27201051,CDM,,,,,,both,,,238.0000,35.7000,AETNA,AETNA,101.63,,,,,,,61.4300,238.0000,percent of total billed charges,42.7% of $238.00 in Billed Charges for Rev 272 = $101.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH ATTAIN II ALL SZS,272,RC,27201051,CDM,,,,,,both,,,238.0000,35.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,166.60,,,,,,,61.4300,238.0000,percent of total billed charges,Rev 272 $238.00 in Billed Charges at 70% = $166.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH ATTAIN II ALL SZS,272,RC,27201051,CDM,,,,,,both,,,238.0000,35.7000,CIGNA HEALTHCARE,CIGNA HMO,99.25,,,,,,,61.4300,238.0000,percent of total billed charges,41.7% of $238.00 in Billed Charges for Rev 272 = $99.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH ATTAIN II ALL SZS,272,RC,27201051,CDM,,,,,,both,,,238.0000,35.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,110.43,,,,,,,61.4300,238.0000,percent of total billed charges,46.4% of $238.00 in Billed Charges for Rev 272 = $110.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH ATTAIN II ALL SZS,272,RC,27201051,CDM,,,,,,both,,,238.0000,35.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,99.25,,,,,,,61.4300,238.0000,percent of total billed charges,41.7% of $238.00 in Billed Charges for Rev 272 = $99.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH ATTAIN II ALL SZS,272,RC,27201051,CDM,,,,,,both,,,238.0000,35.7000,CIGNA HEALTHCARE,CIGNA PPO,99.25,,,,,,,61.4300,238.0000,percent of total billed charges,41.7% of $238.00 in Billed Charges for Rev 272 = $99.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH ATTAIN II ALL SZS,272,RC,27201051,CDM,,,,,,both,,,238.0000,35.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,214.20,,,,,,,61.4300,238.0000,percent of total billed charges,90% of $238.00 in Billed Charges for Rev 272 = $214.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH ATTAIN II ALL SZS,272,RC,27201051,CDM,,,,,,both,,,238.0000,35.7000,MEDCOST,MEDCOST VHN,113.26,,,,,,,61.4300,238.0000,percent of total billed charges,47.59% of $238.00 in Billed Charges for Rev 272 = $113.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH ATTAIN II ALL SZS,272,RC,27201051,CDM,,,,,,both,,,238.0000,35.7000,SENTARA HEALTH,SENTARA HEALTH,61.43,,,,,,,61.4300,238.0000,percent of total billed charges,25.81% of $238.00 in Billed Charges for Rev 272 = $61.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH ATTAIN II ALL SZS,272,RC,27201051,CDM,,,,,,both,,,238.0000,35.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",238.00,,,,,,,61.4300,238.0000,percent of total billed charges,100% of $238.00 in Billed Charges for Rev 272 = $238.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH ATTAIN II ALL SZS,272,RC,27201051,CDM,,,,,,both,,,238.0000,35.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,119.00,,,,,,,61.4300,238.0000,percent of total billed charges,Rev 272 $238.00 in Billed Charges at 50% = $119.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH ATTAIN II ALL SZS,272,RC,27201051,CDM,,,,,,both,,,238.0000,35.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,76.87,,,,,,,61.4300,238.0000,other,32.3% of $238.00 in Billed Charges for Rev 272 = $76.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHEATH ATTAIN II ALL SZS,272,RC,27201051,CDM,,,,,,both,,,238.0000,35.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,73.07,,,,,,,61.4300,238.0000,other,30.7% of $238.00 in Billed Charges for Rev 272 = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHEATH ATTAIN II ALL SZS,272,RC,27201051,CDM,,,,,,both,,,238.0000,35.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,76.87,,,,,,,61.4300,238.0000,percent of total billed charges,32.3% of $238.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH ATTAIN II ALL SZS,272,RC,27201051,CDM,,,,,,both,,,238.0000,35.7000,WELLCARE,WELLCARE MEDICAID,238.00,,,,,,,61.4300,238.0000,percent of total billed charges,100% of $238.00 in Billed Charges for Rev 272 = $238.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH SHUTTLE SELECT ALL,272,RC,27201081,CDM,,,,,,both,,,524.0000,78.6000,AETNA,AETNA,223.75,,,,,,,135.2400,524.0000,percent of total billed charges,42.7% of $524.00 in Billed Charges for Rev 272 = $223.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH SHUTTLE SELECT ALL,272,RC,27201081,CDM,,,,,,both,,,524.0000,78.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,366.80,,,,,,,135.2400,524.0000,percent of total billed charges,Rev 272 $524.00 in Billed Charges at 70% = $366.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH SHUTTLE SELECT ALL,272,RC,27201081,CDM,,,,,,both,,,524.0000,78.6000,CIGNA HEALTHCARE,CIGNA HMO,218.51,,,,,,,135.2400,524.0000,percent of total billed charges,41.7% of $524.00 in Billed Charges for Rev 272 = $218.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH SHUTTLE SELECT ALL,272,RC,27201081,CDM,,,,,,both,,,524.0000,78.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,243.14,,,,,,,135.2400,524.0000,percent of total billed charges,46.4% of $524.00 in Billed Charges for Rev 272 = $243.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH SHUTTLE SELECT ALL,272,RC,27201081,CDM,,,,,,both,,,524.0000,78.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,218.51,,,,,,,135.2400,524.0000,percent of total billed charges,41.7% of $524.00 in Billed Charges for Rev 272 = $218.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH SHUTTLE SELECT ALL,272,RC,27201081,CDM,,,,,,both,,,524.0000,78.6000,CIGNA HEALTHCARE,CIGNA PPO,218.51,,,,,,,135.2400,524.0000,percent of total billed charges,41.7% of $524.00 in Billed Charges for Rev 272 = $218.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH SHUTTLE SELECT ALL,272,RC,27201081,CDM,,,,,,both,,,524.0000,78.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,471.60,,,,,,,135.2400,524.0000,percent of total billed charges,90% of $524.00 in Billed Charges for Rev 272 = $471.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH SHUTTLE SELECT ALL,272,RC,27201081,CDM,,,,,,both,,,524.0000,78.6000,MEDCOST,MEDCOST VHN,249.37,,,,,,,135.2400,524.0000,percent of total billed charges,47.59% of $524.00 in Billed Charges for Rev 272 = $249.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH SHUTTLE SELECT ALL,272,RC,27201081,CDM,,,,,,both,,,524.0000,78.6000,SENTARA HEALTH,SENTARA HEALTH,135.24,,,,,,,135.2400,524.0000,percent of total billed charges,25.81% of $524.00 in Billed Charges for Rev 272 = $135.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH SHUTTLE SELECT ALL,272,RC,27201081,CDM,,,,,,both,,,524.0000,78.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",524.00,,,,,,,135.2400,524.0000,percent of total billed charges,100% of $524.00 in Billed Charges for Rev 272 = $524.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH SHUTTLE SELECT ALL,272,RC,27201081,CDM,,,,,,both,,,524.0000,78.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,262.00,,,,,,,135.2400,524.0000,percent of total billed charges,Rev 272 $524.00 in Billed Charges at 50% = $262.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH SHUTTLE SELECT ALL,272,RC,27201081,CDM,,,,,,both,,,524.0000,78.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,169.25,,,,,,,135.2400,524.0000,other,32.3% of $524.00 in Billed Charges for Rev 272 = $169.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHEATH SHUTTLE SELECT ALL,272,RC,27201081,CDM,,,,,,both,,,524.0000,78.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,160.87,,,,,,,135.2400,524.0000,other,30.7% of $524.00 in Billed Charges for Rev 272 = $160.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHEATH SHUTTLE SELECT ALL,272,RC,27201081,CDM,,,,,,both,,,524.0000,78.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,169.25,,,,,,,135.2400,524.0000,percent of total billed charges,32.3% of $524.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH SHUTTLE SELECT ALL,272,RC,27201081,CDM,,,,,,both,,,524.0000,78.6000,WELLCARE,WELLCARE MEDICAID,524.00,,,,,,,135.2400,524.0000,percent of total billed charges,100% of $524.00 in Billed Charges for Rev 272 = $524.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH URO LARGE,270,RC,27000030,CDM,,,,,,both,,,67.0000,10.0500,AETNA,AETNA,28.61,,,,,,,17.2900,67.0000,percent of total billed charges,42.7% of $67.00 in Billed Charges for Rev 270 = $28.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH URO LARGE,270,RC,27000030,CDM,,,,,,both,,,67.0000,10.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,46.90,,,,,,,17.2900,67.0000,percent of total billed charges,Rev 270 $67.00 in Billed Charges at 70% = $46.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH URO LARGE,270,RC,27000030,CDM,,,,,,both,,,67.0000,10.0500,CIGNA HEALTHCARE,CIGNA HMO,27.94,,,,,,,17.2900,67.0000,percent of total billed charges,41.7% of $67.00 in Billed Charges for Rev 270 = $27.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH URO LARGE,270,RC,27000030,CDM,,,,,,both,,,67.0000,10.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,31.09,,,,,,,17.2900,67.0000,percent of total billed charges,46.4% of $67.00 in Billed Charges for Rev 270 = $31.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH URO LARGE,270,RC,27000030,CDM,,,,,,both,,,67.0000,10.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,27.94,,,,,,,17.2900,67.0000,percent of total billed charges,41.7% of $67.00 in Billed Charges for Rev 270 = $27.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH URO LARGE,270,RC,27000030,CDM,,,,,,both,,,67.0000,10.0500,CIGNA HEALTHCARE,CIGNA PPO,27.94,,,,,,,17.2900,67.0000,percent of total billed charges,41.7% of $67.00 in Billed Charges for Rev 270 = $27.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH URO LARGE,270,RC,27000030,CDM,,,,,,both,,,67.0000,10.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,60.30,,,,,,,17.2900,67.0000,percent of total billed charges,90% of $67.00 in Billed Charges for Rev 270 = $60.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH URO LARGE,270,RC,27000030,CDM,,,,,,both,,,67.0000,10.0500,MEDCOST,MEDCOST VHN,31.89,,,,,,,17.2900,67.0000,percent of total billed charges,47.59% of $67.00 in Billed Charges for Rev 270 = $31.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH URO LARGE,270,RC,27000030,CDM,,,,,,both,,,67.0000,10.0500,SENTARA HEALTH,SENTARA HEALTH,17.29,,,,,,,17.2900,67.0000,percent of total billed charges,25.81% of $67.00 in Billed Charges for Rev 270 = $17.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH URO LARGE,270,RC,27000030,CDM,,,,,,both,,,67.0000,10.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",67.00,,,,,,,17.2900,67.0000,percent of total billed charges,100% of $67.00 in Billed Charges for Rev 270 = $67.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH URO LARGE,270,RC,27000030,CDM,,,,,,both,,,67.0000,10.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,33.50,,,,,,,17.2900,67.0000,percent of total billed charges,Rev 270 $67.00 in Billed Charges at 50% = $33.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH URO LARGE,270,RC,27000030,CDM,,,,,,both,,,67.0000,10.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,21.64,,,,,,,17.2900,67.0000,other,32.3% of $67.00 in Billed Charges for Rev 270 = $21.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHEATH URO LARGE,270,RC,27000030,CDM,,,,,,both,,,67.0000,10.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,20.57,,,,,,,17.2900,67.0000,other,30.7% of $67.00 in Billed Charges for Rev 270 = $20.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHEATH URO LARGE,270,RC,27000030,CDM,,,,,,both,,,67.0000,10.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,21.64,,,,,,,17.2900,67.0000,percent of total billed charges,32.3% of $67.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHEATH URO LARGE,270,RC,27000030,CDM,,,,,,both,,,67.0000,10.0500,WELLCARE,WELLCARE MEDICAID,67.00,,,,,,,17.2900,67.0000,percent of total billed charges,100% of $67.00 in Billed Charges for Rev 270 = $67.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHOCKWAVE M5 IVL CATH,272,RC,27202105,CDM,,,,,,both,,,6579.0000,986.8500,AETNA,AETNA,2809.23,,,,,,,1698.0400,6579.0000,percent of total billed charges,"42.7% of $6,579.00 in Billed Charges for Rev 272 = $2,809.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHOCKWAVE M5 IVL CATH,272,RC,27202105,CDM,,,,,,both,,,6579.0000,986.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4605.30,,,,,,,1698.0400,6579.0000,percent of total billed charges,"Rev 272 $6,579.00 in Billed Charges at 70% = $4,605.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHOCKWAVE M5 IVL CATH,272,RC,27202105,CDM,,,,,,both,,,6579.0000,986.8500,CIGNA HEALTHCARE,CIGNA HMO,2743.44,,,,,,,1698.0400,6579.0000,percent of total billed charges,"41.7% of $6,579.00 in Billed Charges for Rev 272 = $2,743.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHOCKWAVE M5 IVL CATH,272,RC,27202105,CDM,,,,,,both,,,6579.0000,986.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3052.66,,,,,,,1698.0400,6579.0000,percent of total billed charges,"46.4% of $6,579.00 in Billed Charges for Rev 272 = $3,052.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHOCKWAVE M5 IVL CATH,272,RC,27202105,CDM,,,,,,both,,,6579.0000,986.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2743.44,,,,,,,1698.0400,6579.0000,percent of total billed charges,"41.7% of $6,579.00 in Billed Charges for Rev 272 = $2,743.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHOCKWAVE M5 IVL CATH,272,RC,27202105,CDM,,,,,,both,,,6579.0000,986.8500,CIGNA HEALTHCARE,CIGNA PPO,2743.44,,,,,,,1698.0400,6579.0000,percent of total billed charges,"41.7% of $6,579.00 in Billed Charges for Rev 272 = $2,743.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHOCKWAVE M5 IVL CATH,272,RC,27202105,CDM,,,,,,both,,,6579.0000,986.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5921.10,,,,,,,1698.0400,6579.0000,percent of total billed charges,"90% of $6,579.00 in Billed Charges for Rev 272 = $5,921.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHOCKWAVE M5 IVL CATH,272,RC,27202105,CDM,,,,,,both,,,6579.0000,986.8500,MEDCOST,MEDCOST VHN,3130.95,,,,,,,1698.0400,6579.0000,percent of total billed charges,"47.59% of $6,579.00 in Billed Charges for Rev 272 = $3,130.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHOCKWAVE M5 IVL CATH,272,RC,27202105,CDM,,,,,,both,,,6579.0000,986.8500,SENTARA HEALTH,SENTARA HEALTH,1698.04,,,,,,,1698.0400,6579.0000,percent of total billed charges,"25.81% of $6,579.00 in Billed Charges for Rev 272 = $1,698.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHOCKWAVE M5 IVL CATH,272,RC,27202105,CDM,,,,,,both,,,6579.0000,986.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6579.00,,,,,,,1698.0400,6579.0000,percent of total billed charges,"100% of $6,579.00 in Billed Charges for Rev 272 = $6,579.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHOCKWAVE M5 IVL CATH,272,RC,27202105,CDM,,,,,,both,,,6579.0000,986.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3289.50,,,,,,,1698.0400,6579.0000,percent of total billed charges,"Rev 272 $6,579.00 in Billed Charges at 50% = $3,289.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHOCKWAVE M5 IVL CATH,272,RC,27202105,CDM,,,,,,both,,,6579.0000,986.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2125.02,,,,,,,1698.0400,6579.0000,other,"32.3% of $6,579.00 in Billed Charges for Rev 272 = $2,125.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHOCKWAVE M5 IVL CATH,272,RC,27202105,CDM,,,,,,both,,,6579.0000,986.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2019.75,,,,,,,1698.0400,6579.0000,other,"30.7% of $6,579.00 in Billed Charges for Rev 272 = $2,019.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHOCKWAVE M5 IVL CATH,272,RC,27202105,CDM,,,,,,both,,,6579.0000,986.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,2125.02,,,,,,,1698.0400,6579.0000,percent of total billed charges,"32.3% of $6,579.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHOCKWAVE M5 IVL CATH,272,RC,27202105,CDM,,,,,,both,,,6579.0000,986.8500,WELLCARE,WELLCARE MEDICAID,6579.00,,,,,,,1698.0400,6579.0000,percent of total billed charges,"100% of $6,579.00 in Billed Charges for Rev 272 = $6,579.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SITESEER 4FR ANGIO-KIT,272,RC,27201086,CDM,,,,,,both,,,142.0000,21.3000,AETNA,AETNA,60.63,,,,,,,36.6500,142.0000,percent of total billed charges,42.7% of $142.00 in Billed Charges for Rev 272 = $60.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR ANGIO-KIT,272,RC,27201086,CDM,,,,,,both,,,142.0000,21.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,99.40,,,,,,,36.6500,142.0000,percent of total billed charges,Rev 272 $142.00 in Billed Charges at 70% = $99.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR ANGIO-KIT,272,RC,27201086,CDM,,,,,,both,,,142.0000,21.3000,CIGNA HEALTHCARE,CIGNA HMO,59.21,,,,,,,36.6500,142.0000,percent of total billed charges,41.7% of $142.00 in Billed Charges for Rev 272 = $59.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR ANGIO-KIT,272,RC,27201086,CDM,,,,,,both,,,142.0000,21.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,65.89,,,,,,,36.6500,142.0000,percent of total billed charges,46.4% of $142.00 in Billed Charges for Rev 272 = $65.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR ANGIO-KIT,272,RC,27201086,CDM,,,,,,both,,,142.0000,21.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,59.21,,,,,,,36.6500,142.0000,percent of total billed charges,41.7% of $142.00 in Billed Charges for Rev 272 = $59.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR ANGIO-KIT,272,RC,27201086,CDM,,,,,,both,,,142.0000,21.3000,CIGNA HEALTHCARE,CIGNA PPO,59.21,,,,,,,36.6500,142.0000,percent of total billed charges,41.7% of $142.00 in Billed Charges for Rev 272 = $59.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR ANGIO-KIT,272,RC,27201086,CDM,,,,,,both,,,142.0000,21.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,127.80,,,,,,,36.6500,142.0000,percent of total billed charges,90% of $142.00 in Billed Charges for Rev 272 = $127.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR ANGIO-KIT,272,RC,27201086,CDM,,,,,,both,,,142.0000,21.3000,MEDCOST,MEDCOST VHN,67.58,,,,,,,36.6500,142.0000,percent of total billed charges,47.59% of $142.00 in Billed Charges for Rev 272 = $67.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR ANGIO-KIT,272,RC,27201086,CDM,,,,,,both,,,142.0000,21.3000,SENTARA HEALTH,SENTARA HEALTH,36.65,,,,,,,36.6500,142.0000,percent of total billed charges,25.81% of $142.00 in Billed Charges for Rev 272 = $36.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR ANGIO-KIT,272,RC,27201086,CDM,,,,,,both,,,142.0000,21.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",142.00,,,,,,,36.6500,142.0000,percent of total billed charges,100% of $142.00 in Billed Charges for Rev 272 = $142.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR ANGIO-KIT,272,RC,27201086,CDM,,,,,,both,,,142.0000,21.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,71.00,,,,,,,36.6500,142.0000,percent of total billed charges,Rev 272 $142.00 in Billed Charges at 50% = $71.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR ANGIO-KIT,272,RC,27201086,CDM,,,,,,both,,,142.0000,21.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,45.87,,,,,,,36.6500,142.0000,other,32.3% of $142.00 in Billed Charges for Rev 272 = $45.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SITESEER 4FR ANGIO-KIT,272,RC,27201086,CDM,,,,,,both,,,142.0000,21.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,43.59,,,,,,,36.6500,142.0000,other,30.7% of $142.00 in Billed Charges for Rev 272 = $43.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SITESEER 4FR ANGIO-KIT,272,RC,27201086,CDM,,,,,,both,,,142.0000,21.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,45.87,,,,,,,36.6500,142.0000,percent of total billed charges,32.3% of $142.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SITESEER 4FR ANGIO-KIT,272,RC,27201086,CDM,,,,,,both,,,142.0000,21.3000,WELLCARE,WELLCARE MEDICAID,142.00,,,,,,,36.6500,142.0000,percent of total billed charges,100% of $142.00 in Billed Charges for Rev 272 = $142.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIZING BALLON II 24 FR 9-SB-O-O24,272,RC,27201738,CDM,,,,,,both,,,1029.0000,154.3500,AETNA,AETNA,439.38,,,,,,,265.5800,1029.0000,percent of total billed charges,"42.7% of $1,029.00 in Billed Charges for Rev 272 = $439.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIZING BALLON II 24 FR 9-SB-O-O24,272,RC,27201738,CDM,,,,,,both,,,1029.0000,154.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,720.30,,,,,,,265.5800,1029.0000,percent of total billed charges,"Rev 272 $1,029.00 in Billed Charges at 70% = $720.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIZING BALLON II 24 FR 9-SB-O-O24,272,RC,27201738,CDM,,,,,,both,,,1029.0000,154.3500,CIGNA HEALTHCARE,CIGNA HMO,429.09,,,,,,,265.5800,1029.0000,percent of total billed charges,"41.7% of $1,029.00 in Billed Charges for Rev 272 = $429.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIZING BALLON II 24 FR 9-SB-O-O24,272,RC,27201738,CDM,,,,,,both,,,1029.0000,154.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,477.46,,,,,,,265.5800,1029.0000,percent of total billed charges,"46.4% of $1,029.00 in Billed Charges for Rev 272 = $477.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIZING BALLON II 24 FR 9-SB-O-O24,272,RC,27201738,CDM,,,,,,both,,,1029.0000,154.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,429.09,,,,,,,265.5800,1029.0000,percent of total billed charges,"41.7% of $1,029.00 in Billed Charges for Rev 272 = $429.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIZING BALLON II 24 FR 9-SB-O-O24,272,RC,27201738,CDM,,,,,,both,,,1029.0000,154.3500,CIGNA HEALTHCARE,CIGNA PPO,429.09,,,,,,,265.5800,1029.0000,percent of total billed charges,"41.7% of $1,029.00 in Billed Charges for Rev 272 = $429.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIZING BALLON II 24 FR 9-SB-O-O24,272,RC,27201738,CDM,,,,,,both,,,1029.0000,154.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,926.10,,,,,,,265.5800,1029.0000,percent of total billed charges,"90% of $1,029.00 in Billed Charges for Rev 272 = $926.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIZING BALLON II 24 FR 9-SB-O-O24,272,RC,27201738,CDM,,,,,,both,,,1029.0000,154.3500,MEDCOST,MEDCOST VHN,489.70,,,,,,,265.5800,1029.0000,percent of total billed charges,"47.59% of $1,029.00 in Billed Charges for Rev 272 = $489.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIZING BALLON II 24 FR 9-SB-O-O24,272,RC,27201738,CDM,,,,,,both,,,1029.0000,154.3500,SENTARA HEALTH,SENTARA HEALTH,265.58,,,,,,,265.5800,1029.0000,percent of total billed charges,"25.81% of $1,029.00 in Billed Charges for Rev 272 = $265.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIZING BALLON II 24 FR 9-SB-O-O24,272,RC,27201738,CDM,,,,,,both,,,1029.0000,154.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1029.00,,,,,,,265.5800,1029.0000,percent of total billed charges,"100% of $1,029.00 in Billed Charges for Rev 272 = $1,029.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIZING BALLON II 24 FR 9-SB-O-O24,272,RC,27201738,CDM,,,,,,both,,,1029.0000,154.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,514.50,,,,,,,265.5800,1029.0000,percent of total billed charges,"Rev 272 $1,029.00 in Billed Charges at 50% = $514.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIZING BALLON II 24 FR 9-SB-O-O24,272,RC,27201738,CDM,,,,,,both,,,1029.0000,154.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,332.37,,,,,,,265.5800,1029.0000,other,"32.3% of $1,029.00 in Billed Charges for Rev 272 = $332.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIZING BALLON II 24 FR 9-SB-O-O24,272,RC,27201738,CDM,,,,,,both,,,1029.0000,154.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,315.90,,,,,,,265.5800,1029.0000,other,"30.7% of $1,029.00 in Billed Charges for Rev 272 = $315.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIZING BALLON II 24 FR 9-SB-O-O24,272,RC,27201738,CDM,,,,,,both,,,1029.0000,154.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,332.37,,,,,,,265.5800,1029.0000,percent of total billed charges,"32.3% of $1,029.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SIZING BALLON II 24 FR 9-SB-O-O24,272,RC,27201738,CDM,,,,,,both,,,1029.0000,154.3500,WELLCARE,WELLCARE MEDICAID,1029.00,,,,,,,265.5800,1029.0000,percent of total billed charges,"100% of $1,029.00 in Billed Charges for Rev 272 = $1,029.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKILLED LEVEL 1 ROOM DLY,191,RC,19100001,CDM,,,,,,inpatient,,,1348.0000,202.2000,AETNA,AETNA,787.00,,,,,,,118.2100,1348.0000,per diem,$787.00 for 1 day = $787.00 for Rev 191
HC SKILLED LEVEL 1 ROOM DLY,191,RC,19100001,CDM,,,,,,inpatient,,,1348.0000,202.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,118.2100,1348.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC SKILLED LEVEL 1 ROOM DLY,191,RC,19100001,CDM,,,,,,inpatient,,,1348.0000,202.2000,BLUE CROSS,BLUE CROSS E NETWORK,330.00,,,,,,,118.2100,1348.0000,per diem,$330.00 for 1 day = $330.00 for Rev 191
HC SKILLED LEVEL 1 ROOM DLY,191,RC,19100001,CDM,,,,,,inpatient,,,1348.0000,202.2000,BLUE CROSS,BLUE CROSS P NETWORK,338.00,,,,,,,118.2100,1348.0000,per diem,$338.00 for 1 day = $338.00 for Rev 191
HC SKILLED LEVEL 1 ROOM DLY,191,RC,19100001,CDM,,,,,,inpatient,,,1348.0000,202.2000,BLUE CROSS,BLUE CROSS S NETWORK,338.00,,,,,,,118.2100,1348.0000,per diem,$338.00 for 1 day = $338.00 for Rev 191
HC SKILLED LEVEL 1 ROOM DLY,191,RC,19100001,CDM,,,,,,inpatient,,,1348.0000,202.2000,CIGNA HEALTHCARE,CIGNA HMO,1305.00,,,,,,,118.2100,1348.0000,per diem,"$1,305.00 for 1 day = $1,305.00 for Rev 191"
HC SKILLED LEVEL 1 ROOM DLY,191,RC,19100001,CDM,,,,,,inpatient,,,1348.0000,202.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,933.00,,,,,,,118.2100,1348.0000,per diem,$933.00 for 1 day = $933.00 for Rev 191
HC SKILLED LEVEL 1 ROOM DLY,191,RC,19100001,CDM,,,,,,inpatient,,,1348.0000,202.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1305.00,,,,,,,118.2100,1348.0000,per diem,"$1,305.00 for 1 day = $1,305.00 for Rev 191"
HC SKILLED LEVEL 1 ROOM DLY,191,RC,19100001,CDM,,,,,,inpatient,,,1348.0000,202.2000,CIGNA HEALTHCARE,CIGNA PPO,1305.00,,,,,,,118.2100,1348.0000,per diem,"$1,305.00 for 1 day = $1,305.00 for Rev 191"
HC SKILLED LEVEL 1 ROOM DLY,191,RC,19100001,CDM,,,,,,inpatient,,,1348.0000,202.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1213.20,,,,,,,118.2100,1348.0000,percent of total billed charges,"90% of $1,348.00 in Billed Charges for Rev 191 = $1,213.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKILLED LEVEL 1 ROOM DLY,191,RC,19100001,CDM,,,,,,inpatient,,,1348.0000,202.2000,MEDCOST,MEDCOST VHN,641.51,,,,,,,118.2100,1348.0000,percent of total billed charges,"47.59% of $1,348.00 in Billed Charges for Rev 191 = $641.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKILLED LEVEL 1 ROOM DLY,191,RC,19100001,CDM,,,,,,inpatient,,,1348.0000,202.2000,SENTARA HEALTH,SENTARA HEALTH,502.53,,,,,,,118.2100,1348.0000,percent of total billed charges,"37.28% of $1,348.00 in Billed Charges for Rev 191 = $502.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKILLED LEVEL 1 ROOM DLY,191,RC,19100001,CDM,,,,,,inpatient,,,1348.0000,202.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1348.00,,,,,,,118.2100,1348.0000,percent of total billed charges,"100% of $1,348.00 in Billed Charges for Rev 191 = $1,348.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKILLED LEVEL 1 ROOM DLY,191,RC,19100001,CDM,,,,,,inpatient,,,1348.0000,202.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,118.21,,,,,,,118.2100,1348.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,AETNA,AETNA,1722.09,,,,,,,169.2100,4033.0000,percent of total billed charges,"42.7% of $4,033.00 in Billed Charges for Rev 610 Proc 74181 = $1,722.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,343.24,,,,,,,169.2100,4033.0000,fee schedule,APG 00293 Proc 74181 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 104% = $343.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,216.48,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,AETNA,AETNA HEALTHCARE MEDICARE,216.48,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,216.48,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,AMBETTER,AMBETTER,471.92,,,,,,,169.2100,4033.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,225.14,,,,,,,169.2100,4033.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,ANTHEM EXCHANGE,532.97,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,339.94,,,,,,,169.2100,4033.0000,fee schedule,APG 00293 Proc 74181 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 103% = $339.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,ANTHEM HMO,566.25,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,222.97,,,,,,,169.2100,4033.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",666.14,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,706.81,,,,,,,169.2100,4033.0000,fee schedule,$706.81 from Fee Schedule BLDTM_23 for Rev 610 Proc 74181 * Qty 1 = $706.81 at 100% = $706.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,BLUE CROSS E NETWORK,764.42,,,,,,,169.2100,4033.0000,fee schedule,$238.88 from Fee Schedule BCFSD for Rev 610 Proc 74181 * Qty 1 = $238.88 at 320% = $764.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,BLUE CROSS MEDICARE,225.14,,,,,,,169.2100,4033.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,BLUE CROSS P NETWORK,781.14,,,,,,,169.2100,4033.0000,fee schedule,$238.88 from Fee Schedule BCFSD for Rev 610 Proc 74181 * Qty 1 = $238.88 at 327% = $781.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,BLUE CROSS S NETWORK,781.14,,,,,,,169.2100,4033.0000,fee schedule,$238.88 from Fee Schedule BCFSD for Rev 610 Proc 74181 * Qty 1 = $238.88 at 327% = $781.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,TENNCARE BLUE CARE,368.16,,,,,,,169.2100,4033.0000,fee schedule,$317.38 from Fee Schedule TC_24 for Rev 610 Proc 74181 * Qty 1 = $317.38 at 116% = $368.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,TENNCARE BLUE SELECT,368.16,,,,,,,169.2100,4033.0000,fee schedule,$317.38 from Fee Schedule TC_24 for Rev 610 Proc 74181 * Qty 1 = $317.38 at 116% = $368.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,CIGNA HEALTHCARE,CIGNA HMO,1215.00,,,,,,,169.2100,4033.0000,other,"Rev 610 Proc 74181 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,786.00,,,,,,,169.2100,4033.0000,other,Rev 610 Proc 74181 Qty 1 * $786.00 = $786.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,227.30,,,,,,,169.2100,4033.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1215.00,,,,,,,169.2100,4033.0000,other,"Rev 610 Proc 74181 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,CIGNA HEALTHCARE,CIGNA PPO,1215.00,,,,,,,169.2100,4033.0000,other,"Rev 610 Proc 74181 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,227.30,,,,,,,169.2100,4033.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3629.70,,,,,,,169.2100,4033.0000,percent of total billed charges,"90% of $4,033.00 in Billed Charges for Rev 610 Proc 74181 = $3,629.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,HUMANA,HUMANA MEDICARE,216.48,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,216.48,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,MEDCOST,MEDCOST VHN,1919.30,,,,,,,169.2100,4033.0000,percent of total billed charges,"47.59% of $4,033.00 in Billed Charges for Rev 610 Proc 74181 = $1,919.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,346.54,,,,,,,169.2100,4033.0000,fee schedule,APG 00293 Proc 74181 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 100% = $330.04... $330.04 at 105% = $346.54 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,227.30,,,,,,,169.2100,4033.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,227.30,,,,,,,169.2100,4033.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,NHC ADVANTAGE,NHC ADVANTAGE,227.30,,,,,,,169.2100,4033.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,340.27,,,,,,,169.2100,4033.0000,fee schedule,APG 00293 Proc 74181 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 100% = $330.04... $330.04 at 103.1% = $340.27 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,SENTARA HEALTH,SENTARA HEALTH,1040.92,,,,,,,169.2100,4033.0000,percent of total billed charges,"25.81% of $4,033.00 in Billed Charges for Rev 610 Proc 74181 = $1,040.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,SENTARA HEALTH,SENTARA MEDICARE,216.48,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4033.00,,,,,,,169.2100,4033.0000,percent of total billed charges,"100% of $4,033.00 in Billed Charges for Rev 610 Proc 74181 = $4,033.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,169.21,,,,,,,169.2100,4033.0000,fee schedule,$338.41 from Fee Schedule TCUHC24 for Rev 610 Proc 74181 * Qty 1 = $338.41 at 50% = $169.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2559.00,,,,,,,169.2100,4033.0000,other,"Rev 610 Proc 74181 1 Visit at $2,559.00 per Visit = $2,559.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2448.00,,,,,,,169.2100,4033.0000,other,"Rev 610 Proc 74181 1 Visit at $2,448.00 per Visit = $2,448.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,4033.00,,,,,,,169.2100,4033.0000,other,"Rev 610 Proc 74181 1 Visit at $4,035.00 per Visit = $4,035.00 (Service Line reduced to $4,033.00, claim capped at $4,033.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,339.94,,,,,,,169.2100,4033.0000,fee schedule,APG 00293 Proc 74181 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 103% = $339.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,216.48,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,216.48,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,WELLCARE,WELLCARE MEDICAID,4033.00,,,,,,,169.2100,4033.0000,percent of total billed charges,"100% of $4,033.00 in Billed Charges for Rev 610 Proc 74181 = $4,033.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR ABDOMEN WO CON,74181,CPT,610,RC,61000029,CDM,,,,both,,,4033.0000,604.9500,WELLCARE,WELLCARE MEDICARE,229.47,,,,,,,169.2100,4033.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,AETNA,AETNA,1812.62,,,,,,,217.9200,4245.0000,percent of total billed charges,"42.7% of $4,245.00 in Billed Charges for Rev 610 Proc 74182 = $1,812.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,577.20,,,,,,,217.9200,4245.0000,fee schedule,APG 00295 Proc 74182 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 104% = $577.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,316.52,,,,,,,217.9200,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,AETNA,AETNA HEALTHCARE MEDICARE,316.52,,,,,,,217.9200,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,316.52,,,,,,,217.9200,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,AMBETTER,AMBETTER,690.02,,,,,,,217.9200,4245.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,329.19,,,,,,,217.9200,4245.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,ANTHEM EXCHANGE,779.29,,,,,,,217.9200,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,571.65,,,,,,,217.9200,4245.0000,fee schedule,APG 00295 Proc 74182 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 103% = $571.65. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,ANTHEM HMO,827.95,,,,,,,217.9200,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,326.02,,,,,,,217.9200,4245.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",974.01,,,,,,,217.9200,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,905.60,,,,,,,217.9200,4245.0000,fee schedule,$905.60 from Fee Schedule BLDTM_23 for Rev 610 Proc 74182 * Qty 1 = $905.60 at 100% = $905.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,BLUE CROSS E NETWORK,1093.82,,,,,,,217.9200,4245.0000,fee schedule,"$341.82 from Fee Schedule BCFSD for Rev 610 Proc 74182 * Qty 1 = $341.82 at 320% = $1,093.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,BLUE CROSS MEDICARE,329.19,,,,,,,217.9200,4245.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,BLUE CROSS P NETWORK,1117.75,,,,,,,217.9200,4245.0000,fee schedule,"$341.82 from Fee Schedule BCFSD for Rev 610 Proc 74182 * Qty 1 = $341.82 at 327% = $1,117.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,BLUE CROSS S NETWORK,1117.75,,,,,,,217.9200,4245.0000,fee schedule,"$341.82 from Fee Schedule BCFSD for Rev 610 Proc 74182 * Qty 1 = $341.82 at 327% = $1,117.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,TENNCARE BLUE CARE,441.75,,,,,,,217.9200,4245.0000,fee schedule,$380.82 from Fee Schedule TC_24 for Rev 610 Proc 74182 * Qty 1 = $380.82 at 116% = $441.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,TENNCARE BLUE SELECT,441.75,,,,,,,217.9200,4245.0000,fee schedule,$380.82 from Fee Schedule TC_24 for Rev 610 Proc 74182 * Qty 1 = $380.82 at 116% = $441.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,CIGNA HEALTHCARE,CIGNA HMO,1215.00,,,,,,,217.9200,4245.0000,other,"Rev 610 Proc 74182 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,786.00,,,,,,,217.9200,4245.0000,other,Rev 610 Proc 74182 Qty 1 * $786.00 = $786.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,332.35,,,,,,,217.9200,4245.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1215.00,,,,,,,217.9200,4245.0000,other,"Rev 610 Proc 74182 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,CIGNA HEALTHCARE,CIGNA PPO,1215.00,,,,,,,217.9200,4245.0000,other,"Rev 610 Proc 74182 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,332.35,,,,,,,217.9200,4245.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3820.50,,,,,,,217.9200,4245.0000,percent of total billed charges,"90% of $4,245.00 in Billed Charges for Rev 610 Proc 74182 = $3,820.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,HUMANA,HUMANA MEDICARE,316.52,,,,,,,217.9200,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,316.52,,,,,,,217.9200,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,MEDCOST,MEDCOST VHN,2020.20,,,,,,,217.9200,4245.0000,percent of total billed charges,"47.59% of $4,245.00 in Billed Charges for Rev 610 Proc 74182 = $2,020.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,582.75,,,,,,,217.9200,4245.0000,fee schedule,APG 00295 Proc 74182 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 100% = $555.00... $555.00 at 105% = $582.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,332.35,,,,,,,217.9200,4245.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,332.35,,,,,,,217.9200,4245.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,NHC ADVANTAGE,NHC ADVANTAGE,332.35,,,,,,,217.9200,4245.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,572.21,,,,,,,217.9200,4245.0000,fee schedule,APG 00295 Proc 74182 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 100% = $555.00... $555.00 at 103.1% = $572.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,SENTARA HEALTH,SENTARA HEALTH,1095.63,,,,,,,217.9200,4245.0000,percent of total billed charges,"25.81% of $4,245.00 in Billed Charges for Rev 610 Proc 74182 = $1,095.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,SENTARA HEALTH,SENTARA MEDICARE,316.52,,,,,,,217.9200,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4245.00,,,,,,,217.9200,4245.0000,percent of total billed charges,"100% of $4,245.00 in Billed Charges for Rev 610 Proc 74182 = $4,245.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,217.92,,,,,,,217.9200,4245.0000,fee schedule,$435.84 from Fee Schedule TCUHC24 for Rev 610 Proc 74182 * Qty 1 = $435.84 at 50% = $217.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2559.00,,,,,,,217.9200,4245.0000,other,"Rev 610 Proc 74182 1 Visit at $2,559.00 per Visit = $2,559.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2448.00,,,,,,,217.9200,4245.0000,other,"Rev 610 Proc 74182 1 Visit at $2,448.00 per Visit = $2,448.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,4035.00,,,,,,,217.9200,4245.0000,other,"Rev 610 Proc 74182 1 Visit at $4,035.00 per Visit = $4,035.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,571.65,,,,,,,217.9200,4245.0000,fee schedule,APG 00295 Proc 74182 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 103% = $571.65. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,316.52,,,,,,,217.9200,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,316.52,,,,,,,217.9200,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,WELLCARE,WELLCARE MEDICAID,4245.00,,,,,,,217.9200,4245.0000,percent of total billed charges,"100% of $4,245.00 in Billed Charges for Rev 610 Proc 74182 = $4,245.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR ABDOMEN W CON,74182,CPT,610,RC,61000030,CDM,,,,both,,,4245.0000,636.7500,WELLCARE,WELLCARE MEDICARE,335.52,,,,,,,217.9200,4245.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,AETNA,AETNA,1812.62,,,,,,,229.6400,4245.0000,percent of total billed charges,"42.7% of $4,245.00 in Billed Charges for Rev 618 Proc 74185 = $1,812.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,731.55,,,,,,,229.6400,4245.0000,fee schedule,APG 00282 Proc 74185 at $836.60 (Base Rate) * 0.8408 (Relative Weight) = $703.41 (Total Line Payment) at 104% = $731.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,ANTHEM EXCHANGE,229.64,,,,,,,229.6400,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,724.52,,,,,,,229.6400,4245.0000,fee schedule,APG 00282 Proc 74185 at $836.60 (Base Rate) * 0.8408 (Relative Weight) = $703.41 (Total Line Payment) at 103% = $724.52. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,ANTHEM HMO,229.64,,,,,,,229.6400,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",229.64,,,,,,,229.6400,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,720.89,,,,,,,229.6400,4245.0000,fee schedule,$720.89 from Fee Schedule BLDTM_23 for Rev 618 Proc 74185 * Qty 1 = $720.89 at 100% = $720.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,BLUE CROSS E NETWORK,960.00,,,,,,,229.6400,4245.0000,fee schedule,$300.00 from Fee Schedule BCFSD for Rev 618 Proc 74185 * Qty 1 = $300.00 at 320% = $960.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,BLUE CROSS P NETWORK,981.00,,,,,,,229.6400,4245.0000,fee schedule,$300.00 from Fee Schedule BCFSD for Rev 618 Proc 74185 * Qty 1 = $300.00 at 327% = $981.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,BLUE CROSS S NETWORK,981.00,,,,,,,229.6400,4245.0000,fee schedule,$300.00 from Fee Schedule BCFSD for Rev 618 Proc 74185 * Qty 1 = $300.00 at 327% = $981.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,TENNCARE BLUE CARE,363.42,,,,,,,229.6400,4245.0000,fee schedule,$313.29 from Fee Schedule TC_24 for Rev 618 Proc 74185 * Qty 1 = $313.29 at 116% = $363.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,TENNCARE BLUE SELECT,363.42,,,,,,,229.6400,4245.0000,fee schedule,$313.29 from Fee Schedule TC_24 for Rev 618 Proc 74185 * Qty 1 = $313.29 at 116% = $363.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,CIGNA HEALTHCARE,CIGNA HMO,1215.00,,,,,,,229.6400,4245.0000,other,"Rev 618 Proc 74185 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,786.00,,,,,,,229.6400,4245.0000,other,Rev 618 Proc 74185 Qty 1 * $786.00 = $786.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1215.00,,,,,,,229.6400,4245.0000,other,"Rev 618 Proc 74185 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,CIGNA HEALTHCARE,CIGNA PPO,1215.00,,,,,,,229.6400,4245.0000,other,"Rev 618 Proc 74185 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3820.50,,,,,,,229.6400,4245.0000,percent of total billed charges,"90% of $4,245.00 in Billed Charges for Rev 618 Proc 74185 = $3,820.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,MEDCOST,MEDCOST VHN,2020.20,,,,,,,229.6400,4245.0000,percent of total billed charges,"47.59% of $4,245.00 in Billed Charges for Rev 618 Proc 74185 = $2,020.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,738.58,,,,,,,229.6400,4245.0000,fee schedule,APG 00282 Proc 74185 at $836.60 (Base Rate) * 0.8408 (Relative Weight) = $703.41 (Total Line Payment) at 100% = $703.41... $703.41 at 105% = $738.58 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,725.22,,,,,,,229.6400,4245.0000,fee schedule,APG 00282 Proc 74185 at $836.60 (Base Rate) * 0.8408 (Relative Weight) = $703.41 (Total Line Payment) at 100% = $703.41... $703.41 at 103.1% = $725.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,SENTARA HEALTH,SENTARA HEALTH,1095.63,,,,,,,229.6400,4245.0000,percent of total billed charges,"25.81% of $4,245.00 in Billed Charges for Rev 618 Proc 74185 = $1,095.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4245.00,,,,,,,229.6400,4245.0000,percent of total billed charges,"100% of $4,245.00 in Billed Charges for Rev 618 Proc 74185 = $4,245.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2559.00,,,,,,,229.6400,4245.0000,other,"Rev 618 Proc 74185 1 Visit at $2,559.00 per Visit = $2,559.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2448.00,,,,,,,229.6400,4245.0000,other,"Rev 618 Proc 74185 1 Visit at $2,448.00 per Visit = $2,448.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,4035.00,,,,,,,229.6400,4245.0000,other,"Rev 618 Proc 74185 1 Visit at $4,035.00 per Visit = $4,035.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,724.52,,,,,,,229.6400,4245.0000,fee schedule,APG 00282 Proc 74185 at $836.60 (Base Rate) * 0.8408 (Relative Weight) = $703.41 (Total Line Payment) at 103% = $724.52. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA ABD WOW CONT,74185,CPT,618,RC,61800003,CDM,,,,both,,,4245.0000,636.7500,WELLCARE,WELLCARE MEDICAID,4245.00,,,,,,,229.6400,4245.0000,percent of total billed charges,"100% of $4,245.00 in Billed Charges for Rev 618 Proc 74185 = $4,245.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,AETNA,AETNA,438.10,,,,,,,42.1000,1080.7300,percent of total billed charges,"42.7% of $1,026.00 in Billed Charges for Rev 320 Proc 74190 = $438.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,166.44,,,,,,,42.1000,1080.7300,fee schedule,APG 00389 Proc 74190 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 104% = $166.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,495.75,,,,,,,42.1000,1080.7300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,AETNA,AETNA HEALTHCARE MEDICARE,495.75,,,,,,,42.1000,1080.7300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,495.75,,,,,,,42.1000,1080.7300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,AMBETTER,AMBETTER,1080.73,,,,,,,42.1000,1080.7300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,515.58,,,,,,,42.1000,1080.7300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,BLUE CROSS,ANTHEM EXCHANGE,1026.00,,,,,,,42.1000,1080.7300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,164.84,,,,,,,42.1000,1080.7300,fee schedule,APG 00389 Proc 74190 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,BLUE CROSS,ANTHEM HMO,1026.00,,,,,,,42.1000,1080.7300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,510.62,,,,,,,42.1000,1080.7300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1026.00,,,,,,,42.1000,1080.7300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,82.13,,,,,,,42.1000,1080.7300,fee schedule,$82.13 from Fee Schedule BLDTM_23 for Rev 320 Proc 74190 * Qty 1 = $82.13 at 100% = $82.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,BLUE CROSS,BLUE CROSS E NETWORK,151.55,,,,,,,42.1000,1080.7300,fee schedule,$47.36 from Fee Schedule BCFSC for Rev 320 Proc 74190 * Qty 1 = $47.36 at 320% = $151.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,BLUE CROSS,BLUE CROSS MEDICARE,515.58,,,,,,,42.1000,1080.7300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,BLUE CROSS,BLUE CROSS P NETWORK,154.87,,,,,,,42.1000,1080.7300,fee schedule,$47.36 from Fee Schedule BCFSC for Rev 320 Proc 74190 * Qty 1 = $47.36 at 327% = $154.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,BLUE CROSS,BLUE CROSS S NETWORK,154.87,,,,,,,42.1000,1080.7300,fee schedule,$47.36 from Fee Schedule BCFSC for Rev 320 Proc 74190 * Qty 1 = $47.36 at 327% = $154.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,BLUE CROSS,TENNCARE BLUE CARE,42.10,,,,,,,42.1000,1080.7300,fee schedule,$36.29 from Fee Schedule TC_24 for Rev 320 Proc 74190 * Qty 1 = $36.29 at 116% = $42.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,BLUE CROSS,TENNCARE BLUE SELECT,42.10,,,,,,,42.1000,1080.7300,fee schedule,$36.29 from Fee Schedule TC_24 for Rev 320 Proc 74190 * Qty 1 = $36.29 at 116% = $42.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,CIGNA HEALTHCARE,CIGNA HMO,894.80,,,,,,,42.1000,1080.7300,fee schedule,$894.80 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74190 * Qty 1 = $894.80 at 100% = $894.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,60.15,,,,,,,42.1000,1080.7300,fee schedule,$60.15 from Fee Schedule CGIFP_25LR for Rev 320 Proc 74190 * Qty 1 = $60.15 at 100% = $60.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,520.54,,,,,,,42.1000,1080.7300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,894.80,,,,,,,42.1000,1080.7300,fee schedule,$894.80 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74190 * Qty 1 = $894.80 at 100% = $894.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,CIGNA HEALTHCARE,CIGNA PPO,894.80,,,,,,,42.1000,1080.7300,fee schedule,$894.80 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74190 * Qty 1 = $894.80 at 100% = $894.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,520.54,,,,,,,42.1000,1080.7300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,923.40,,,,,,,42.1000,1080.7300,percent of total billed charges,"90% of $1,026.00 in Billed Charges for Rev 320 Proc 74190 = $923.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,HUMANA,HUMANA MEDICARE,495.75,,,,,,,42.1000,1080.7300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,495.75,,,,,,,42.1000,1080.7300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,MEDCOST,MEDCOST VHN,488.27,,,,,,,42.1000,1080.7300,percent of total billed charges,"47.59% of $1,026.00 in Billed Charges for Rev 320 Proc 74190 = $488.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,168.04,,,,,,,42.1000,1080.7300,fee schedule,APG 00389 Proc 74190 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 105% = $168.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,520.54,,,,,,,42.1000,1080.7300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,520.54,,,,,,,42.1000,1080.7300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,NHC ADVANTAGE,NHC ADVANTAGE,520.54,,,,,,,42.1000,1080.7300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,165.00,,,,,,,42.1000,1080.7300,fee schedule,APG 00389 Proc 74190 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 103.1% = $165.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,SENTARA HEALTH,SENTARA HEALTH,264.81,,,,,,,42.1000,1080.7300,percent of total billed charges,"25.81% of $1,026.00 in Billed Charges for Rev 320 Proc 74190 = $264.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,SENTARA HEALTH,SENTARA MEDICARE,495.75,,,,,,,42.1000,1080.7300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1026.00,,,,,,,42.1000,1080.7300,percent of total billed charges,"100% of $1,026.00 in Billed Charges for Rev 320 Proc 74190 = $1,026.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,118.21,,,,,,,42.1000,1080.7300,fee schedule,$236.42 from Fee Schedule TCUHC24 for Rev 320 Proc 74190 * Qty 1 = $236.42 at 50% = $118.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,42.1000,1080.7300,other,Rev 320 Proc 74190 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,42.1000,1080.7300,other,Rev 320 Proc 74190 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,42.1000,1080.7300,other,Rev 320 Proc 74190 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,164.84,,,,,,,42.1000,1080.7300,fee schedule,APG 00389 Proc 74190 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,495.75,,,,,,,42.1000,1080.7300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,495.75,,,,,,,42.1000,1080.7300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,WELLCARE,WELLCARE MEDICAID,1026.00,,,,,,,42.1000,1080.7300,percent of total billed charges,"100% of $1,026.00 in Billed Charges for Rev 320 Proc 74190 = $1,026.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERITONEOGRAM INJ DIALY CATH,74190,CPT,320,RC,32000145,CDM,,,,both,,,1026.0000,153.9000,WELLCARE,WELLCARE MEDICARE,525.49,,,,,,,42.1000,1080.7300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKILLED LEVEL 2 ROOM DLY,192,RC,19200001,CDM,,,,,,inpatient,,,1484.0000,222.6000,AETNA,AETNA,787.00,,,,,,,118.2100,1484.0000,per diem,$787.00 for 1 day = $787.00 for Rev 192
HC SKILLED LEVEL 2 ROOM DLY,192,RC,19200001,CDM,,,,,,inpatient,,,1484.0000,222.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,118.2100,1484.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC SKILLED LEVEL 2 ROOM DLY,192,RC,19200001,CDM,,,,,,inpatient,,,1484.0000,222.6000,BLUE CROSS,BLUE CROSS E NETWORK,435.00,,,,,,,118.2100,1484.0000,per diem,$435.00 for 1 day = $435.00 for Rev 192
HC SKILLED LEVEL 2 ROOM DLY,192,RC,19200001,CDM,,,,,,inpatient,,,1484.0000,222.6000,BLUE CROSS,BLUE CROSS P NETWORK,445.00,,,,,,,118.2100,1484.0000,per diem,$445.00 for 1 day = $445.00 for Rev 192
HC SKILLED LEVEL 2 ROOM DLY,192,RC,19200001,CDM,,,,,,inpatient,,,1484.0000,222.6000,BLUE CROSS,BLUE CROSS S NETWORK,445.00,,,,,,,118.2100,1484.0000,per diem,$445.00 for 1 day = $445.00 for Rev 192
HC SKILLED LEVEL 2 ROOM DLY,192,RC,19200001,CDM,,,,,,inpatient,,,1484.0000,222.6000,CIGNA HEALTHCARE,CIGNA HMO,1305.00,,,,,,,118.2100,1484.0000,per diem,"$1,305.00 for 1 day = $1,305.00 for Rev 192"
HC SKILLED LEVEL 2 ROOM DLY,192,RC,19200001,CDM,,,,,,inpatient,,,1484.0000,222.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,933.00,,,,,,,118.2100,1484.0000,per diem,$933.00 for 1 day = $933.00 for Rev 192
HC SKILLED LEVEL 2 ROOM DLY,192,RC,19200001,CDM,,,,,,inpatient,,,1484.0000,222.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1305.00,,,,,,,118.2100,1484.0000,per diem,"$1,305.00 for 1 day = $1,305.00 for Rev 192"
HC SKILLED LEVEL 2 ROOM DLY,192,RC,19200001,CDM,,,,,,inpatient,,,1484.0000,222.6000,CIGNA HEALTHCARE,CIGNA PPO,1305.00,,,,,,,118.2100,1484.0000,per diem,"$1,305.00 for 1 day = $1,305.00 for Rev 192"
HC SKILLED LEVEL 2 ROOM DLY,192,RC,19200001,CDM,,,,,,inpatient,,,1484.0000,222.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1335.60,,,,,,,118.2100,1484.0000,percent of total billed charges,"90% of $1,484.00 in Billed Charges for Rev 192 = $1,335.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKILLED LEVEL 2 ROOM DLY,192,RC,19200001,CDM,,,,,,inpatient,,,1484.0000,222.6000,MEDCOST,MEDCOST VHN,706.24,,,,,,,118.2100,1484.0000,percent of total billed charges,"47.59% of $1,484.00 in Billed Charges for Rev 192 = $706.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKILLED LEVEL 2 ROOM DLY,192,RC,19200001,CDM,,,,,,inpatient,,,1484.0000,222.6000,SENTARA HEALTH,SENTARA HEALTH,553.24,,,,,,,118.2100,1484.0000,percent of total billed charges,"37.28% of $1,484.00 in Billed Charges for Rev 192 = $553.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKILLED LEVEL 2 ROOM DLY,192,RC,19200001,CDM,,,,,,inpatient,,,1484.0000,222.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1484.00,,,,,,,118.2100,1484.0000,percent of total billed charges,"100% of $1,484.00 in Billed Charges for Rev 192 = $1,484.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKILLED LEVEL 2 ROOM DLY,192,RC,19200001,CDM,,,,,,inpatient,,,1484.0000,222.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,118.21,,,,,,,118.2100,1484.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate
HC SKILLED LEVEL 3 ROOM DLY,193,RC,19300001,CDM,,,,,,inpatient,,,1633.0000,244.9500,AETNA,AETNA,787.00,,,,,,,118.2100,1633.0000,per diem,$787.00 for 1 day = $787.00 for Rev 193
HC SKILLED LEVEL 3 ROOM DLY,193,RC,19300001,CDM,,,,,,inpatient,,,1633.0000,244.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,118.2100,1633.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC SKILLED LEVEL 3 ROOM DLY,193,RC,19300001,CDM,,,,,,inpatient,,,1633.0000,244.9500,BLUE CROSS,BLUE CROSS E NETWORK,737.00,,,,,,,118.2100,1633.0000,per diem,$737.00 for 1 day = $737.00 for Rev 193
HC SKILLED LEVEL 3 ROOM DLY,193,RC,19300001,CDM,,,,,,inpatient,,,1633.0000,244.9500,BLUE CROSS,BLUE CROSS P NETWORK,754.00,,,,,,,118.2100,1633.0000,per diem,$754.00 for 1 day = $754.00 for Rev 193
HC SKILLED LEVEL 3 ROOM DLY,193,RC,19300001,CDM,,,,,,inpatient,,,1633.0000,244.9500,BLUE CROSS,BLUE CROSS S NETWORK,754.00,,,,,,,118.2100,1633.0000,per diem,$754.00 for 1 day = $754.00 for Rev 193
HC SKILLED LEVEL 3 ROOM DLY,193,RC,19300001,CDM,,,,,,inpatient,,,1633.0000,244.9500,CIGNA HEALTHCARE,CIGNA HMO,1305.00,,,,,,,118.2100,1633.0000,per diem,"$1,305.00 for 1 day = $1,305.00 for Rev 193"
HC SKILLED LEVEL 3 ROOM DLY,193,RC,19300001,CDM,,,,,,inpatient,,,1633.0000,244.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,933.00,,,,,,,118.2100,1633.0000,per diem,$933.00 for 1 day = $933.00 for Rev 193
HC SKILLED LEVEL 3 ROOM DLY,193,RC,19300001,CDM,,,,,,inpatient,,,1633.0000,244.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1305.00,,,,,,,118.2100,1633.0000,per diem,"$1,305.00 for 1 day = $1,305.00 for Rev 193"
HC SKILLED LEVEL 3 ROOM DLY,193,RC,19300001,CDM,,,,,,inpatient,,,1633.0000,244.9500,CIGNA HEALTHCARE,CIGNA PPO,1305.00,,,,,,,118.2100,1633.0000,per diem,"$1,305.00 for 1 day = $1,305.00 for Rev 193"
HC SKILLED LEVEL 3 ROOM DLY,193,RC,19300001,CDM,,,,,,inpatient,,,1633.0000,244.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1469.70,,,,,,,118.2100,1633.0000,percent of total billed charges,"90% of $1,633.00 in Billed Charges for Rev 193 = $1,469.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKILLED LEVEL 3 ROOM DLY,193,RC,19300001,CDM,,,,,,inpatient,,,1633.0000,244.9500,MEDCOST,MEDCOST VHN,777.14,,,,,,,118.2100,1633.0000,percent of total billed charges,"47.59% of $1,633.00 in Billed Charges for Rev 193 = $777.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKILLED LEVEL 3 ROOM DLY,193,RC,19300001,CDM,,,,,,inpatient,,,1633.0000,244.9500,SENTARA HEALTH,SENTARA HEALTH,608.78,,,,,,,118.2100,1633.0000,percent of total billed charges,"37.28% of $1,633.00 in Billed Charges for Rev 193 = $608.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKILLED LEVEL 3 ROOM DLY,193,RC,19300001,CDM,,,,,,inpatient,,,1633.0000,244.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1633.00,,,,,,,118.2100,1633.0000,percent of total billed charges,"100% of $1,633.00 in Billed Charges for Rev 193 = $1,633.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKILLED LEVEL 3 ROOM DLY,193,RC,19300001,CDM,,,,,,inpatient,,,1633.0000,244.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,118.21,,,,,,,118.2100,1633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate
HC SKILLED LEVEL 4 ROOM DLY,194,RC,19400001,CDM,,,,,,inpatient,,,1798.0000,269.7000,AETNA,AETNA,787.00,,,,,,,118.2100,1798.0000,per diem,$787.00 for 1 day = $787.00 for Rev 194
HC SKILLED LEVEL 4 ROOM DLY,194,RC,19400001,CDM,,,,,,inpatient,,,1798.0000,269.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,118.2100,1798.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC SKILLED LEVEL 4 ROOM DLY,194,RC,19400001,CDM,,,,,,inpatient,,,1798.0000,269.7000,CIGNA HEALTHCARE,CIGNA HMO,1305.00,,,,,,,118.2100,1798.0000,per diem,"$1,305.00 for 1 day = $1,305.00 for Rev 194"
HC SKILLED LEVEL 4 ROOM DLY,194,RC,19400001,CDM,,,,,,inpatient,,,1798.0000,269.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,933.00,,,,,,,118.2100,1798.0000,per diem,$933.00 for 1 day = $933.00 for Rev 194
HC SKILLED LEVEL 4 ROOM DLY,194,RC,19400001,CDM,,,,,,inpatient,,,1798.0000,269.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1305.00,,,,,,,118.2100,1798.0000,per diem,"$1,305.00 for 1 day = $1,305.00 for Rev 194"
HC SKILLED LEVEL 4 ROOM DLY,194,RC,19400001,CDM,,,,,,inpatient,,,1798.0000,269.7000,CIGNA HEALTHCARE,CIGNA PPO,1305.00,,,,,,,118.2100,1798.0000,per diem,"$1,305.00 for 1 day = $1,305.00 for Rev 194"
HC SKILLED LEVEL 4 ROOM DLY,194,RC,19400001,CDM,,,,,,inpatient,,,1798.0000,269.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1618.20,,,,,,,118.2100,1798.0000,percent of total billed charges,"90% of $1,798.00 in Billed Charges for Rev 194 = $1,618.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKILLED LEVEL 4 ROOM DLY,194,RC,19400001,CDM,,,,,,inpatient,,,1798.0000,269.7000,MEDCOST,MEDCOST VHN,855.67,,,,,,,118.2100,1798.0000,percent of total billed charges,"47.59% of $1,798.00 in Billed Charges for Rev 194 = $855.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKILLED LEVEL 4 ROOM DLY,194,RC,19400001,CDM,,,,,,inpatient,,,1798.0000,269.7000,SENTARA HEALTH,SENTARA HEALTH,670.29,,,,,,,118.2100,1798.0000,percent of total billed charges,"37.28% of $1,798.00 in Billed Charges for Rev 194 = $670.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKILLED LEVEL 4 ROOM DLY,194,RC,19400001,CDM,,,,,,inpatient,,,1798.0000,269.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1798.00,,,,,,,118.2100,1798.0000,percent of total billed charges,"100% of $1,798.00 in Billed Charges for Rev 194 = $1,798.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKILLED LEVEL 4 ROOM DLY,194,RC,19400001,CDM,,,,,,inpatient,,,1798.0000,269.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,118.21,,,,,,,118.2100,1798.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate
HC SLEEVE SCD KNEE LG 9789,270,RC,27000055,CDM,,,,,,both,,,207.0000,31.0500,AETNA,AETNA,88.39,,,,,,,53.4300,207.0000,percent of total billed charges,42.7% of $207.00 in Billed Charges for Rev 270 = $88.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE LG 9789,270,RC,27000055,CDM,,,,,,both,,,207.0000,31.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,144.90,,,,,,,53.4300,207.0000,percent of total billed charges,Rev 270 $207.00 in Billed Charges at 70% = $144.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE LG 9789,270,RC,27000055,CDM,,,,,,both,,,207.0000,31.0500,CIGNA HEALTHCARE,CIGNA HMO,86.32,,,,,,,53.4300,207.0000,percent of total billed charges,41.7% of $207.00 in Billed Charges for Rev 270 = $86.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE LG 9789,270,RC,27000055,CDM,,,,,,both,,,207.0000,31.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,96.05,,,,,,,53.4300,207.0000,percent of total billed charges,46.4% of $207.00 in Billed Charges for Rev 270 = $96.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE LG 9789,270,RC,27000055,CDM,,,,,,both,,,207.0000,31.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,86.32,,,,,,,53.4300,207.0000,percent of total billed charges,41.7% of $207.00 in Billed Charges for Rev 270 = $86.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE LG 9789,270,RC,27000055,CDM,,,,,,both,,,207.0000,31.0500,CIGNA HEALTHCARE,CIGNA PPO,86.32,,,,,,,53.4300,207.0000,percent of total billed charges,41.7% of $207.00 in Billed Charges for Rev 270 = $86.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE LG 9789,270,RC,27000055,CDM,,,,,,both,,,207.0000,31.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,186.30,,,,,,,53.4300,207.0000,percent of total billed charges,90% of $207.00 in Billed Charges for Rev 270 = $186.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE LG 9789,270,RC,27000055,CDM,,,,,,both,,,207.0000,31.0500,MEDCOST,MEDCOST VHN,98.51,,,,,,,53.4300,207.0000,percent of total billed charges,47.59% of $207.00 in Billed Charges for Rev 270 = $98.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE LG 9789,270,RC,27000055,CDM,,,,,,both,,,207.0000,31.0500,SENTARA HEALTH,SENTARA HEALTH,53.43,,,,,,,53.4300,207.0000,percent of total billed charges,25.81% of $207.00 in Billed Charges for Rev 270 = $53.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE LG 9789,270,RC,27000055,CDM,,,,,,both,,,207.0000,31.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",207.00,,,,,,,53.4300,207.0000,percent of total billed charges,100% of $207.00 in Billed Charges for Rev 270 = $207.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE LG 9789,270,RC,27000055,CDM,,,,,,both,,,207.0000,31.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,103.50,,,,,,,53.4300,207.0000,percent of total billed charges,Rev 270 $207.00 in Billed Charges at 50% = $103.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE LG 9789,270,RC,27000055,CDM,,,,,,both,,,207.0000,31.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,66.86,,,,,,,53.4300,207.0000,other,32.3% of $207.00 in Billed Charges for Rev 270 = $66.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLEEVE SCD KNEE LG 9789,270,RC,27000055,CDM,,,,,,both,,,207.0000,31.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,63.55,,,,,,,53.4300,207.0000,other,30.7% of $207.00 in Billed Charges for Rev 270 = $63.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLEEVE SCD KNEE LG 9789,270,RC,27000055,CDM,,,,,,both,,,207.0000,31.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,66.86,,,,,,,53.4300,207.0000,percent of total billed charges,32.3% of $207.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLEEVE SCD KNEE LG 9789,270,RC,27000055,CDM,,,,,,both,,,207.0000,31.0500,WELLCARE,WELLCARE MEDICAID,207.00,,,,,,,53.4300,207.0000,percent of total billed charges,100% of $207.00 in Billed Charges for Rev 270 = $207.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL,270,RC,27000087,CDM,,,,,,both,,,105.0000,15.7500,AETNA,AETNA,44.84,,,,,,,27.1000,105.0000,percent of total billed charges,42.7% of $105.00 in Billed Charges for Rev 270 = $44.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL,270,RC,27000087,CDM,,,,,,both,,,105.0000,15.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,73.50,,,,,,,27.1000,105.0000,percent of total billed charges,Rev 270 $105.00 in Billed Charges at 70% = $73.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL,270,RC,27000087,CDM,,,,,,both,,,105.0000,15.7500,CIGNA HEALTHCARE,CIGNA HMO,43.79,,,,,,,27.1000,105.0000,percent of total billed charges,41.7% of $105.00 in Billed Charges for Rev 270 = $43.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL,270,RC,27000087,CDM,,,,,,both,,,105.0000,15.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,48.72,,,,,,,27.1000,105.0000,percent of total billed charges,46.4% of $105.00 in Billed Charges for Rev 270 = $48.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL,270,RC,27000087,CDM,,,,,,both,,,105.0000,15.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,43.79,,,,,,,27.1000,105.0000,percent of total billed charges,41.7% of $105.00 in Billed Charges for Rev 270 = $43.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL,270,RC,27000087,CDM,,,,,,both,,,105.0000,15.7500,CIGNA HEALTHCARE,CIGNA PPO,43.79,,,,,,,27.1000,105.0000,percent of total billed charges,41.7% of $105.00 in Billed Charges for Rev 270 = $43.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL,270,RC,27000087,CDM,,,,,,both,,,105.0000,15.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,94.50,,,,,,,27.1000,105.0000,percent of total billed charges,90% of $105.00 in Billed Charges for Rev 270 = $94.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL,270,RC,27000087,CDM,,,,,,both,,,105.0000,15.7500,MEDCOST,MEDCOST VHN,49.97,,,,,,,27.1000,105.0000,percent of total billed charges,47.59% of $105.00 in Billed Charges for Rev 270 = $49.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL,270,RC,27000087,CDM,,,,,,both,,,105.0000,15.7500,SENTARA HEALTH,SENTARA HEALTH,27.10,,,,,,,27.1000,105.0000,percent of total billed charges,25.81% of $105.00 in Billed Charges for Rev 270 = $27.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL,270,RC,27000087,CDM,,,,,,both,,,105.0000,15.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",105.00,,,,,,,27.1000,105.0000,percent of total billed charges,100% of $105.00 in Billed Charges for Rev 270 = $105.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL,270,RC,27000087,CDM,,,,,,both,,,105.0000,15.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,52.50,,,,,,,27.1000,105.0000,percent of total billed charges,Rev 270 $105.00 in Billed Charges at 50% = $52.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL,270,RC,27000087,CDM,,,,,,both,,,105.0000,15.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,33.92,,,,,,,27.1000,105.0000,other,32.3% of $105.00 in Billed Charges for Rev 270 = $33.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRAY SPINAL,270,RC,27000087,CDM,,,,,,both,,,105.0000,15.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,32.24,,,,,,,27.1000,105.0000,other,30.7% of $105.00 in Billed Charges for Rev 270 = $32.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRAY SPINAL,270,RC,27000087,CDM,,,,,,both,,,105.0000,15.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,33.92,,,,,,,27.1000,105.0000,percent of total billed charges,32.3% of $105.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY SPINAL,270,RC,27000087,CDM,,,,,,both,,,105.0000,15.7500,WELLCARE,WELLCARE MEDICAID,105.00,,,,,,,27.1000,105.0000,percent of total billed charges,100% of $105.00 in Billed Charges for Rev 270 = $105.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SMALL INTESTINE FOLLOW THRU STDY,74248,CPT,320,RC,32000323,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,40.5900,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 74248 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SMALL INTESTINE FOLLOW THRU STDY,74248,CPT,320,RC,32000323,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,166.44,,,,,,,40.5900,462.0000,fee schedule,APG 00389 Proc 74248 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 104% = $166.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL INTESTINE FOLLOW THRU STDY,74248,CPT,320,RC,32000323,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,164.84,,,,,,,40.5900,462.0000,fee schedule,APG 00389 Proc 74248 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL INTESTINE FOLLOW THRU STDY,74248,CPT,320,RC,32000323,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,323.40,,,,,,,40.5900,462.0000,percent of total billed charges,Rev 320 Proc 74248 $462.00 in Billed Charges at 70% = $323.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SMALL INTESTINE FOLLOW THRU STDY,74248,CPT,320,RC,32000323,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,137.79,,,,,,,40.5900,462.0000,fee schedule,$43.06 from Fee Schedule BCFSC for Rev 320 Proc 74248 * Qty 1 = $43.06 at 320% = $137.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL INTESTINE FOLLOW THRU STDY,74248,CPT,320,RC,32000323,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,140.81,,,,,,,40.5900,462.0000,fee schedule,$43.06 from Fee Schedule BCFSC for Rev 320 Proc 74248 * Qty 1 = $43.06 at 327% = $140.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL INTESTINE FOLLOW THRU STDY,74248,CPT,320,RC,32000323,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,140.81,,,,,,,40.5900,462.0000,fee schedule,$43.06 from Fee Schedule BCFSC for Rev 320 Proc 74248 * Qty 1 = $43.06 at 327% = $140.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL INTESTINE FOLLOW THRU STDY,74248,CPT,320,RC,32000323,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,40.59,,,,,,,40.5900,462.0000,fee schedule,$34.99 from Fee Schedule TC_24 for Rev 320 Proc 74248 * Qty 1 = $34.99 at 116% = $40.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL INTESTINE FOLLOW THRU STDY,74248,CPT,320,RC,32000323,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,40.59,,,,,,,40.5900,462.0000,fee schedule,$34.99 from Fee Schedule TC_24 for Rev 320 Proc 74248 * Qty 1 = $34.99 at 116% = $40.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL INTESTINE FOLLOW THRU STDY,74248,CPT,320,RC,32000323,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,192.65,,,,,,,40.5900,462.0000,percent of total billed charges,Rev 320 Proc 74248 $462.00 in Billed Charges at 41.7% = $192.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SMALL INTESTINE FOLLOW THRU STDY,74248,CPT,320,RC,32000323,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,192.65,,,,,,,40.5900,462.0000,percent of total billed charges,Rev 320 Proc 74248 $462.00 in Billed Charges at 41.7% = $192.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SMALL INTESTINE FOLLOW THRU STDY,74248,CPT,320,RC,32000323,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,192.65,,,,,,,40.5900,462.0000,percent of total billed charges,Rev 320 Proc 74248 $462.00 in Billed Charges at 41.7% = $192.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SMALL INTESTINE FOLLOW THRU STDY,74248,CPT,320,RC,32000323,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,40.5900,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 74248 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SMALL INTESTINE FOLLOW THRU STDY,74248,CPT,320,RC,32000323,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,40.5900,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 74248 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SMALL INTESTINE FOLLOW THRU STDY,74248,CPT,320,RC,32000323,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,168.04,,,,,,,40.5900,462.0000,fee schedule,APG 00389 Proc 74248 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 105% = $168.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL INTESTINE FOLLOW THRU STDY,74248,CPT,320,RC,32000323,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,165.00,,,,,,,40.5900,462.0000,fee schedule,APG 00389 Proc 74248 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 103.1% = $165.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL INTESTINE FOLLOW THRU STDY,74248,CPT,320,RC,32000323,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,40.5900,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 74248 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SMALL INTESTINE FOLLOW THRU STDY,74248,CPT,320,RC,32000323,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,40.5900,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 74248 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SMALL INTESTINE FOLLOW THRU STDY,74248,CPT,320,RC,32000323,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,40.5900,462.0000,other,Rev 320 Proc 74248 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL INTESTINE FOLLOW THRU STDY,74248,CPT,320,RC,32000323,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,40.5900,462.0000,other,Rev 320 Proc 74248 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL INTESTINE FOLLOW THRU STDY,74248,CPT,320,RC,32000323,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,40.5900,462.0000,other,Rev 320 Proc 74248 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL INTESTINE FOLLOW THRU STDY,74248,CPT,320,RC,32000323,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,164.84,,,,,,,40.5900,462.0000,fee schedule,APG 00389 Proc 74248 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL INTESTINE FOLLOW THRU STDY,74248,CPT,320,RC,32000323,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,40.5900,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 74248 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,AETNA,AETNA,748.96,,,,,,,42.1000,1754.0000,percent of total billed charges,"42.7% of $1,754.00 in Billed Charges for Rev 320 Proc 74251 = $748.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,166.44,,,,,,,42.1000,1754.0000,fee schedule,APG 00389 Proc 74251 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 104% = $166.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,159.14,,,,,,,42.1000,1754.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,AETNA,AETNA HEALTHCARE MEDICARE,159.14,,,,,,,42.1000,1754.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,159.14,,,,,,,42.1000,1754.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,AMBETTER,AMBETTER,346.92,,,,,,,42.1000,1754.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,165.50,,,,,,,42.1000,1754.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,BLUE CROSS,ANTHEM EXCHANGE,391.81,,,,,,,42.1000,1754.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,164.84,,,,,,,42.1000,1754.0000,fee schedule,APG 00389 Proc 74251 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,BLUE CROSS,ANTHEM HMO,416.27,,,,,,,42.1000,1754.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,163.91,,,,,,,42.1000,1754.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",489.70,,,,,,,42.1000,1754.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,84.50,,,,,,,42.1000,1754.0000,fee schedule,$84.50 from Fee Schedule BLDTM_23 for Rev 320 Proc 74251 * Qty 1 = $84.50 at 100% = $84.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,BLUE CROSS,BLUE CROSS E NETWORK,1116.48,,,,,,,42.1000,1754.0000,fee schedule,"$348.90 from Fee Schedule BCFSC for Rev 320 Proc 74251 * Qty 1 = $348.90 at 320% = $1,116.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,BLUE CROSS,BLUE CROSS MEDICARE,165.50,,,,,,,42.1000,1754.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,BLUE CROSS,BLUE CROSS P NETWORK,1140.90,,,,,,,42.1000,1754.0000,fee schedule,"$348.90 from Fee Schedule BCFSC for Rev 320 Proc 74251 * Qty 1 = $348.90 at 327% = $1,140.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,BLUE CROSS,BLUE CROSS S NETWORK,1140.90,,,,,,,42.1000,1754.0000,fee schedule,"$348.90 from Fee Schedule BCFSC for Rev 320 Proc 74251 * Qty 1 = $348.90 at 327% = $1,140.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,BLUE CROSS,TENNCARE BLUE CARE,42.10,,,,,,,42.1000,1754.0000,fee schedule,$36.29 from Fee Schedule TC_24 for Rev 320 Proc 74251 * Qty 1 = $36.29 at 116% = $42.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,BLUE CROSS,TENNCARE BLUE SELECT,42.10,,,,,,,42.1000,1754.0000,fee schedule,$36.29 from Fee Schedule TC_24 for Rev 320 Proc 74251 * Qty 1 = $36.29 at 116% = $42.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,CIGNA HEALTHCARE,CIGNA HMO,538.23,,,,,,,42.1000,1754.0000,fee schedule,$538.23 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74251 * Qty 1 = $538.23 at 100% = $538.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,577.86,,,,,,,42.1000,1754.0000,fee schedule,$577.86 from Fee Schedule CGIFP_25LR for Rev 320 Proc 74251 * Qty 1 = $577.86 at 100% = $577.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,167.09,,,,,,,42.1000,1754.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,538.23,,,,,,,42.1000,1754.0000,fee schedule,$538.23 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74251 * Qty 1 = $538.23 at 100% = $538.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,CIGNA HEALTHCARE,CIGNA PPO,538.23,,,,,,,42.1000,1754.0000,fee schedule,$538.23 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74251 * Qty 1 = $538.23 at 100% = $538.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,167.09,,,,,,,42.1000,1754.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1578.60,,,,,,,42.1000,1754.0000,percent of total billed charges,"90% of $1,754.00 in Billed Charges for Rev 320 Proc 74251 = $1,578.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,HUMANA,HUMANA MEDICARE,159.14,,,,,,,42.1000,1754.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,159.14,,,,,,,42.1000,1754.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,MEDCOST,MEDCOST VHN,834.73,,,,,,,42.1000,1754.0000,percent of total billed charges,"47.59% of $1,754.00 in Billed Charges for Rev 320 Proc 74251 = $834.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,168.04,,,,,,,42.1000,1754.0000,fee schedule,APG 00389 Proc 74251 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 105% = $168.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,167.09,,,,,,,42.1000,1754.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,167.09,,,,,,,42.1000,1754.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,NHC ADVANTAGE,NHC ADVANTAGE,167.09,,,,,,,42.1000,1754.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,165.00,,,,,,,42.1000,1754.0000,fee schedule,APG 00389 Proc 74251 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 103.1% = $165.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,SENTARA HEALTH,SENTARA HEALTH,452.71,,,,,,,42.1000,1754.0000,percent of total billed charges,"25.81% of $1,754.00 in Billed Charges for Rev 320 Proc 74251 = $452.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,SENTARA HEALTH,SENTARA MEDICARE,159.14,,,,,,,42.1000,1754.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1754.00,,,,,,,42.1000,1754.0000,percent of total billed charges,"100% of $1,754.00 in Billed Charges for Rev 320 Proc 74251 = $1,754.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,71.11,,,,,,,42.1000,1754.0000,fee schedule,$142.21 from Fee Schedule TCUHC24 for Rev 320 Proc 74251 * Qty 1 = $142.21 at 50% = $71.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,42.1000,1754.0000,other,Rev 320 Proc 74251 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,42.1000,1754.0000,other,Rev 320 Proc 74251 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,42.1000,1754.0000,other,Rev 320 Proc 74251 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,164.84,,,,,,,42.1000,1754.0000,fee schedule,APG 00389 Proc 74251 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,159.14,,,,,,,42.1000,1754.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,159.14,,,,,,,42.1000,1754.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,WELLCARE,WELLCARE MEDICAID,1754.00,,,,,,,42.1000,1754.0000,percent of total billed charges,"100% of $1,754.00 in Billed Charges for Rev 320 Proc 74251 = $1,754.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX SMALL BOWEL INCL MULTI SRL & SCT ABD DBL CONT INCL GLUCAGON ADMIN,74251,CPT,320,RC,32000156,CDM,,,,both,,,1754.0000,263.1000,WELLCARE,WELLCARE MEDICARE,168.69,,,,,,,42.1000,1754.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,AETNA,AETNA,206.24,,,,,,,42.9200,483.0000,percent of total billed charges,42.7% of $483.00 in Billed Charges for Rev 320 Proc 74283 = $206.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,166.44,,,,,,,42.9200,483.0000,fee schedule,APG 00389 Proc 74283 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 104% = $166.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,159.14,,,,,,,42.9200,483.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,AETNA,AETNA HEALTHCARE MEDICARE,159.14,,,,,,,42.9200,483.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,159.14,,,,,,,42.9200,483.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,AMBETTER,AMBETTER,346.92,,,,,,,42.9200,483.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,165.50,,,,,,,42.9200,483.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,BLUE CROSS,ANTHEM EXCHANGE,391.81,,,,,,,42.9200,483.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,164.84,,,,,,,42.9200,483.0000,fee schedule,APG 00389 Proc 74283 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,BLUE CROSS,ANTHEM HMO,416.27,,,,,,,42.9200,483.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,163.91,,,,,,,42.9200,483.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",483.00,,,,,,,42.9200,483.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,209.10,,,,,,,42.9200,483.0000,fee schedule,$209.10 from Fee Schedule BLDTM_23 for Rev 320 Proc 74283 * Qty 1 = $209.10 at 100% = $209.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,BLUE CROSS,BLUE CROSS E NETWORK,307.36,,,,,,,42.9200,483.0000,fee schedule,$96.05 from Fee Schedule BCFSC for Rev 320 Proc 74283 * Qty 1 = $96.05 at 320% = $307.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,BLUE CROSS,BLUE CROSS MEDICARE,165.50,,,,,,,42.9200,483.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,BLUE CROSS,BLUE CROSS P NETWORK,314.08,,,,,,,42.9200,483.0000,fee schedule,$96.05 from Fee Schedule BCFSC for Rev 320 Proc 74283 * Qty 1 = $96.05 at 327% = $314.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,BLUE CROSS,BLUE CROSS S NETWORK,314.08,,,,,,,42.9200,483.0000,fee schedule,$96.05 from Fee Schedule BCFSC for Rev 320 Proc 74283 * Qty 1 = $96.05 at 327% = $314.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,BLUE CROSS,TENNCARE BLUE CARE,84.17,,,,,,,42.9200,483.0000,fee schedule,$72.56 from Fee Schedule TC_24 for Rev 320 Proc 74283 * Qty 1 = $72.56 at 116% = $84.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,BLUE CROSS,TENNCARE BLUE SELECT,84.17,,,,,,,42.9200,483.0000,fee schedule,$72.56 from Fee Schedule TC_24 for Rev 320 Proc 74283 * Qty 1 = $72.56 at 116% = $84.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,CIGNA HEALTHCARE,CIGNA HMO,324.85,,,,,,,42.9200,483.0000,fee schedule,$324.85 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74283 * Qty 1 = $324.85 at 100% = $324.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,293.51,,,,,,,42.9200,483.0000,fee schedule,$293.51 from Fee Schedule CGIFP_25LR for Rev 320 Proc 74283 * Qty 1 = $293.51 at 100% = $293.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,167.09,,,,,,,42.9200,483.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,324.85,,,,,,,42.9200,483.0000,fee schedule,$324.85 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74283 * Qty 1 = $324.85 at 100% = $324.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,CIGNA HEALTHCARE,CIGNA PPO,324.85,,,,,,,42.9200,483.0000,fee schedule,$324.85 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74283 * Qty 1 = $324.85 at 100% = $324.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,167.09,,,,,,,42.9200,483.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,434.70,,,,,,,42.9200,483.0000,percent of total billed charges,90% of $483.00 in Billed Charges for Rev 320 Proc 74283 = $434.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,HUMANA,HUMANA MEDICARE,159.14,,,,,,,42.9200,483.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,159.14,,,,,,,42.9200,483.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,MEDCOST,MEDCOST VHN,229.86,,,,,,,42.9200,483.0000,percent of total billed charges,47.59% of $483.00 in Billed Charges for Rev 320 Proc 74283 = $229.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,168.04,,,,,,,42.9200,483.0000,fee schedule,APG 00389 Proc 74283 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 105% = $168.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,167.09,,,,,,,42.9200,483.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,167.09,,,,,,,42.9200,483.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,NHC ADVANTAGE,NHC ADVANTAGE,167.09,,,,,,,42.9200,483.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,165.00,,,,,,,42.9200,483.0000,fee schedule,APG 00389 Proc 74283 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 103.1% = $165.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,SENTARA HEALTH,SENTARA HEALTH,124.66,,,,,,,42.9200,483.0000,percent of total billed charges,25.81% of $483.00 in Billed Charges for Rev 320 Proc 74283 = $124.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,SENTARA HEALTH,SENTARA MEDICARE,159.14,,,,,,,42.9200,483.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",483.00,,,,,,,42.9200,483.0000,percent of total billed charges,100% of $483.00 in Billed Charges for Rev 320 Proc 74283 = $483.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,42.92,,,,,,,42.9200,483.0000,fee schedule,$85.83 from Fee Schedule TCUHC24 for Rev 320 Proc 74283 * Qty 1 = $85.83 at 50% = $42.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,42.9200,483.0000,other,Rev 320 Proc 74283 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,42.9200,483.0000,other,Rev 320 Proc 74283 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,42.9200,483.0000,other,Rev 320 Proc 74283 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,164.84,,,,,,,42.9200,483.0000,fee schedule,APG 00389 Proc 74283 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,159.14,,,,,,,42.9200,483.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,159.14,,,,,,,42.9200,483.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,WELLCARE,WELLCARE MEDICAID,483.00,,,,,,,42.9200,483.0000,percent of total billed charges,100% of $483.00 in Billed Charges for Rev 320 Proc 74283 = $483.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX BARIUM ENEMA INTUSSUSCEPTION,74283,CPT,320,RC,32000161,CDM,,,,both,,,483.0000,72.4500,WELLCARE,WELLCARE MEDICARE,168.69,,,,,,,42.9200,483.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,AETNA,AETNA,281.82,,,,,,,49.5600,660.0000,percent of total billed charges,42.7% of $660.00 in Billed Charges for Rev 402 Proc 76831 = $281.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,236.48,,,,,,,49.5600,660.0000,fee schedule,APG 00289 Proc 76831 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 104% = $236.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,216.48,,,,,,,49.5600,660.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,AETNA,AETNA HEALTHCARE MEDICARE,216.48,,,,,,,49.5600,660.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,ALLCARE MEDICARE,ALLCARE MEDICARE,216.48,,,,,,,49.5600,660.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,AMBETTER,AMBETTER,471.92,,,,,,,49.5600,660.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,225.14,,,,,,,49.5600,660.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,BLUE CROSS,ANTHEM EXCHANGE,532.97,,,,,,,49.5600,660.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,234.21,,,,,,,49.5600,660.0000,fee schedule,APG 00289 Proc 76831 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 103% = $234.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,BLUE CROSS,ANTHEM HMO,566.25,,,,,,,49.5600,660.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,222.97,,,,,,,49.5600,660.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",660.00,,,,,,,49.5600,660.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,89.02,,,,,,,49.5600,660.0000,fee schedule,$89.02 from Fee Schedule BLDTM_23 for Rev 402 Proc 76831 * Qty 1 = $89.02 at 100% = $89.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,BLUE CROSS,BLUE CROSS E NETWORK,253.82,,,,,,,49.5600,660.0000,fee schedule,$79.32 from Fee Schedule BCFSC for Rev 402 Proc 76831 * Qty 1 = $79.32 at 320% = $253.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,BLUE CROSS,BLUE CROSS MEDICARE,225.14,,,,,,,49.5600,660.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,BLUE CROSS,BLUE CROSS P NETWORK,259.38,,,,,,,49.5600,660.0000,fee schedule,$79.32 from Fee Schedule BCFSC for Rev 402 Proc 76831 * Qty 1 = $79.32 at 327% = $259.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,BLUE CROSS,BLUE CROSS S NETWORK,259.38,,,,,,,49.5600,660.0000,fee schedule,$79.32 from Fee Schedule BCFSC for Rev 402 Proc 76831 * Qty 1 = $79.32 at 327% = $259.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,BLUE CROSS,TENNCARE BLUE CARE,49.56,,,,,,,49.5600,660.0000,fee schedule,$42.72 from Fee Schedule TC_24 for Rev 402 Proc 76831 * Qty 1 = $42.72 at 116% = $49.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,BLUE CROSS,TENNCARE BLUE SELECT,49.56,,,,,,,49.5600,660.0000,fee schedule,$42.72 from Fee Schedule TC_24 for Rev 402 Proc 76831 * Qty 1 = $42.72 at 116% = $49.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,CIGNA HEALTHCARE,CIGNA HMO,575.78,,,,,,,49.5600,660.0000,fee schedule,$575.78 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76831 * Qty 1 = $575.78 at 100% = $575.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,154.46,,,,,,,49.5600,660.0000,fee schedule,$154.46 from Fee Schedule CGIFP_25LR for Rev 402 Proc 76831 * Qty 1 = $154.46 at 100% = $154.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,CIGNA HEALTHCARE,CIGNA MEDICARE,227.30,,,,,,,49.5600,660.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,575.78,,,,,,,49.5600,660.0000,fee schedule,$575.78 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76831 * Qty 1 = $575.78 at 100% = $575.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,CIGNA HEALTHCARE,CIGNA PPO,575.78,,,,,,,49.5600,660.0000,fee schedule,$575.78 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76831 * Qty 1 = $575.78 at 100% = $575.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,227.30,,,,,,,49.5600,660.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,594.00,,,,,,,49.5600,660.0000,percent of total billed charges,90% of $660.00 in Billed Charges for Rev 402 Proc 76831 = $594.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,HUMANA,HUMANA MEDICARE,216.48,,,,,,,49.5600,660.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,216.48,,,,,,,49.5600,660.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,MEDCOST,MEDCOST VHN,314.09,,,,,,,49.5600,660.0000,percent of total billed charges,47.59% of $660.00 in Billed Charges for Rev 402 Proc 76831 = $314.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,238.76,,,,,,,49.5600,660.0000,fee schedule,APG 00289 Proc 76831 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 100% = $227.39... $227.39 at 105% = $238.76 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,227.30,,,,,,,49.5600,660.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,227.30,,,,,,,49.5600,660.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,NHC ADVANTAGE,NHC ADVANTAGE,227.30,,,,,,,49.5600,660.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,234.44,,,,,,,49.5600,660.0000,fee schedule,APG 00289 Proc 76831 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 100% = $227.39... $227.39 at 103.1% = $234.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,SENTARA HEALTH,SENTARA HEALTH,170.35,,,,,,,49.5600,660.0000,percent of total billed charges,25.81% of $660.00 in Billed Charges for Rev 402 Proc 76831 = $170.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,SENTARA HEALTH,SENTARA MEDICARE,216.48,,,,,,,49.5600,660.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",660.00,,,,,,,49.5600,660.0000,percent of total billed charges,100% of $660.00 in Billed Charges for Rev 402 Proc 76831 = $660.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,76.07,,,,,,,49.5600,660.0000,fee schedule,$152.13 from Fee Schedule TCUHC24 for Rev 402 Proc 76831 * Qty 1 = $152.13 at 50% = $76.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,49.5600,660.0000,other,Rev 402 Proc 76831 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,49.5600,660.0000,other,Rev 402 Proc 76831 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,660.00,,,,,,,49.5600,660.0000,other,"Rev 402 Proc 76831 1 Visit at $687.00 per Visit = $687.00 (Service Line reduced to $660.00, claim capped at $660.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,234.21,,,,,,,49.5600,660.0000,fee schedule,APG 00289 Proc 76831 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 103% = $234.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,216.48,,,,,,,49.5600,660.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,216.48,,,,,,,49.5600,660.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,WELLCARE,WELLCARE MEDICAID,660.00,,,,,,,49.5600,660.0000,percent of total billed charges,100% of $660.00 in Billed Charges for Rev 402 Proc 76831 = $660.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US SONOHYSTEROGRAPHY W COLOR FLOW,76831,CPT,402,RC,40200039,CDM,,,,both,,,660.0000,99.0000,WELLCARE,WELLCARE MEDICARE,229.47,,,,,,,49.5600,660.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRAY URINE METER FOLEY,270,RC,27000076,CDM,,,,,,both,,,79.0000,11.8500,AETNA,AETNA,33.73,,,,,,,20.3900,79.0000,percent of total billed charges,42.7% of $79.00 in Billed Charges for Rev 270 = $33.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER FOLEY,270,RC,27000076,CDM,,,,,,both,,,79.0000,11.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,55.30,,,,,,,20.3900,79.0000,percent of total billed charges,Rev 270 $79.00 in Billed Charges at 70% = $55.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER FOLEY,270,RC,27000076,CDM,,,,,,both,,,79.0000,11.8500,CIGNA HEALTHCARE,CIGNA HMO,32.94,,,,,,,20.3900,79.0000,percent of total billed charges,41.7% of $79.00 in Billed Charges for Rev 270 = $32.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER FOLEY,270,RC,27000076,CDM,,,,,,both,,,79.0000,11.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,36.66,,,,,,,20.3900,79.0000,percent of total billed charges,46.4% of $79.00 in Billed Charges for Rev 270 = $36.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER FOLEY,270,RC,27000076,CDM,,,,,,both,,,79.0000,11.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,32.94,,,,,,,20.3900,79.0000,percent of total billed charges,41.7% of $79.00 in Billed Charges for Rev 270 = $32.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER FOLEY,270,RC,27000076,CDM,,,,,,both,,,79.0000,11.8500,CIGNA HEALTHCARE,CIGNA PPO,32.94,,,,,,,20.3900,79.0000,percent of total billed charges,41.7% of $79.00 in Billed Charges for Rev 270 = $32.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER FOLEY,270,RC,27000076,CDM,,,,,,both,,,79.0000,11.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,71.10,,,,,,,20.3900,79.0000,percent of total billed charges,90% of $79.00 in Billed Charges for Rev 270 = $71.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER FOLEY,270,RC,27000076,CDM,,,,,,both,,,79.0000,11.8500,MEDCOST,MEDCOST VHN,37.60,,,,,,,20.3900,79.0000,percent of total billed charges,47.59% of $79.00 in Billed Charges for Rev 270 = $37.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER FOLEY,270,RC,27000076,CDM,,,,,,both,,,79.0000,11.8500,SENTARA HEALTH,SENTARA HEALTH,20.39,,,,,,,20.3900,79.0000,percent of total billed charges,25.81% of $79.00 in Billed Charges for Rev 270 = $20.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER FOLEY,270,RC,27000076,CDM,,,,,,both,,,79.0000,11.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",79.00,,,,,,,20.3900,79.0000,percent of total billed charges,100% of $79.00 in Billed Charges for Rev 270 = $79.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER FOLEY,270,RC,27000076,CDM,,,,,,both,,,79.0000,11.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,39.50,,,,,,,20.3900,79.0000,percent of total billed charges,Rev 270 $79.00 in Billed Charges at 50% = $39.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER FOLEY,270,RC,27000076,CDM,,,,,,both,,,79.0000,11.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,25.52,,,,,,,20.3900,79.0000,other,32.3% of $79.00 in Billed Charges for Rev 270 = $25.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRAY URINE METER FOLEY,270,RC,27000076,CDM,,,,,,both,,,79.0000,11.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,24.25,,,,,,,20.3900,79.0000,other,30.7% of $79.00 in Billed Charges for Rev 270 = $24.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRAY URINE METER FOLEY,270,RC,27000076,CDM,,,,,,both,,,79.0000,11.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,25.52,,,,,,,20.3900,79.0000,percent of total billed charges,32.3% of $79.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAY URINE METER FOLEY,270,RC,27000076,CDM,,,,,,both,,,79.0000,11.8500,WELLCARE,WELLCARE MEDICAID,79.00,,,,,,,20.3900,79.0000,percent of total billed charges,100% of $79.00 in Billed Charges for Rev 270 = $79.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRIPLE LUMEN CV 7FR 20 CM,272,RC,27201207,CDM,,,,,,both,,,558.0000,83.7000,AETNA,AETNA,238.27,,,,,,,144.0200,558.0000,percent of total billed charges,42.7% of $558.00 in Billed Charges for Rev 272 = $238.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRIPLE LUMEN CV 7FR 20 CM,272,RC,27201207,CDM,,,,,,both,,,558.0000,83.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,390.60,,,,,,,144.0200,558.0000,percent of total billed charges,Rev 272 $558.00 in Billed Charges at 70% = $390.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRIPLE LUMEN CV 7FR 20 CM,272,RC,27201207,CDM,,,,,,both,,,558.0000,83.7000,CIGNA HEALTHCARE,CIGNA HMO,232.69,,,,,,,144.0200,558.0000,percent of total billed charges,41.7% of $558.00 in Billed Charges for Rev 272 = $232.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRIPLE LUMEN CV 7FR 20 CM,272,RC,27201207,CDM,,,,,,both,,,558.0000,83.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,258.91,,,,,,,144.0200,558.0000,percent of total billed charges,46.4% of $558.00 in Billed Charges for Rev 272 = $258.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRIPLE LUMEN CV 7FR 20 CM,272,RC,27201207,CDM,,,,,,both,,,558.0000,83.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,232.69,,,,,,,144.0200,558.0000,percent of total billed charges,41.7% of $558.00 in Billed Charges for Rev 272 = $232.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRIPLE LUMEN CV 7FR 20 CM,272,RC,27201207,CDM,,,,,,both,,,558.0000,83.7000,CIGNA HEALTHCARE,CIGNA PPO,232.69,,,,,,,144.0200,558.0000,percent of total billed charges,41.7% of $558.00 in Billed Charges for Rev 272 = $232.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRIPLE LUMEN CV 7FR 20 CM,272,RC,27201207,CDM,,,,,,both,,,558.0000,83.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,502.20,,,,,,,144.0200,558.0000,percent of total billed charges,90% of $558.00 in Billed Charges for Rev 272 = $502.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRIPLE LUMEN CV 7FR 20 CM,272,RC,27201207,CDM,,,,,,both,,,558.0000,83.7000,MEDCOST,MEDCOST VHN,265.55,,,,,,,144.0200,558.0000,percent of total billed charges,47.59% of $558.00 in Billed Charges for Rev 272 = $265.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRIPLE LUMEN CV 7FR 20 CM,272,RC,27201207,CDM,,,,,,both,,,558.0000,83.7000,SENTARA HEALTH,SENTARA HEALTH,144.02,,,,,,,144.0200,558.0000,percent of total billed charges,25.81% of $558.00 in Billed Charges for Rev 272 = $144.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRIPLE LUMEN CV 7FR 20 CM,272,RC,27201207,CDM,,,,,,both,,,558.0000,83.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",558.00,,,,,,,144.0200,558.0000,percent of total billed charges,100% of $558.00 in Billed Charges for Rev 272 = $558.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRIPLE LUMEN CV 7FR 20 CM,272,RC,27201207,CDM,,,,,,both,,,558.0000,83.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,279.00,,,,,,,144.0200,558.0000,percent of total billed charges,Rev 272 $558.00 in Billed Charges at 50% = $279.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRIPLE LUMEN CV 7FR 20 CM,272,RC,27201207,CDM,,,,,,both,,,558.0000,83.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,180.23,,,,,,,144.0200,558.0000,other,32.3% of $558.00 in Billed Charges for Rev 272 = $180.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRIPLE LUMEN CV 7FR 20 CM,272,RC,27201207,CDM,,,,,,both,,,558.0000,83.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,171.31,,,,,,,144.0200,558.0000,other,30.7% of $558.00 in Billed Charges for Rev 272 = $171.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRIPLE LUMEN CV 7FR 20 CM,272,RC,27201207,CDM,,,,,,both,,,558.0000,83.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,180.23,,,,,,,144.0200,558.0000,percent of total billed charges,32.3% of $558.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRIPLE LUMEN CV 7FR 20 CM,272,RC,27201207,CDM,,,,,,both,,,558.0000,83.7000,WELLCARE,WELLCARE MEDICAID,558.00,,,,,,,144.0200,558.0000,percent of total billed charges,100% of $558.00 in Billed Charges for Rev 272 = $558.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR 11X10 OPT. NON HAND CO116,272,RC,27201208,CDM,,,,,,both,,,189.0000,28.3500,AETNA,AETNA,80.70,,,,,,,48.7800,189.0000,percent of total billed charges,42.7% of $189.00 in Billed Charges for Rev 272 = $80.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR 11X10 OPT. NON HAND CO116,272,RC,27201208,CDM,,,,,,both,,,189.0000,28.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,132.30,,,,,,,48.7800,189.0000,percent of total billed charges,Rev 272 $189.00 in Billed Charges at 70% = $132.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR 11X10 OPT. NON HAND CO116,272,RC,27201208,CDM,,,,,,both,,,189.0000,28.3500,CIGNA HEALTHCARE,CIGNA HMO,78.81,,,,,,,48.7800,189.0000,percent of total billed charges,41.7% of $189.00 in Billed Charges for Rev 272 = $78.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR 11X10 OPT. NON HAND CO116,272,RC,27201208,CDM,,,,,,both,,,189.0000,28.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,87.70,,,,,,,48.7800,189.0000,percent of total billed charges,46.4% of $189.00 in Billed Charges for Rev 272 = $87.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR 11X10 OPT. NON HAND CO116,272,RC,27201208,CDM,,,,,,both,,,189.0000,28.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,78.81,,,,,,,48.7800,189.0000,percent of total billed charges,41.7% of $189.00 in Billed Charges for Rev 272 = $78.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR 11X10 OPT. NON HAND CO116,272,RC,27201208,CDM,,,,,,both,,,189.0000,28.3500,CIGNA HEALTHCARE,CIGNA PPO,78.81,,,,,,,48.7800,189.0000,percent of total billed charges,41.7% of $189.00 in Billed Charges for Rev 272 = $78.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR 11X10 OPT. NON HAND CO116,272,RC,27201208,CDM,,,,,,both,,,189.0000,28.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,170.10,,,,,,,48.7800,189.0000,percent of total billed charges,90% of $189.00 in Billed Charges for Rev 272 = $170.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR 11X10 OPT. NON HAND CO116,272,RC,27201208,CDM,,,,,,both,,,189.0000,28.3500,MEDCOST,MEDCOST VHN,89.95,,,,,,,48.7800,189.0000,percent of total billed charges,47.59% of $189.00 in Billed Charges for Rev 272 = $89.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR 11X10 OPT. NON HAND CO116,272,RC,27201208,CDM,,,,,,both,,,189.0000,28.3500,SENTARA HEALTH,SENTARA HEALTH,48.78,,,,,,,48.7800,189.0000,percent of total billed charges,25.81% of $189.00 in Billed Charges for Rev 272 = $48.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR 11X10 OPT. NON HAND CO116,272,RC,27201208,CDM,,,,,,both,,,189.0000,28.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",189.00,,,,,,,48.7800,189.0000,percent of total billed charges,100% of $189.00 in Billed Charges for Rev 272 = $189.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR 11X10 OPT. NON HAND CO116,272,RC,27201208,CDM,,,,,,both,,,189.0000,28.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,94.50,,,,,,,48.7800,189.0000,percent of total billed charges,Rev 272 $189.00 in Billed Charges at 50% = $94.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR 11X10 OPT. NON HAND CO116,272,RC,27201208,CDM,,,,,,both,,,189.0000,28.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,61.05,,,,,,,48.7800,189.0000,other,32.3% of $189.00 in Billed Charges for Rev 272 = $61.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TROCAR 11X10 OPT. NON HAND CO116,272,RC,27201208,CDM,,,,,,both,,,189.0000,28.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,58.02,,,,,,,48.7800,189.0000,other,30.7% of $189.00 in Billed Charges for Rev 272 = $58.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TROCAR 11X10 OPT. NON HAND CO116,272,RC,27201208,CDM,,,,,,both,,,189.0000,28.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,61.05,,,,,,,48.7800,189.0000,percent of total billed charges,32.3% of $189.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR 11X10 OPT. NON HAND CO116,272,RC,27201208,CDM,,,,,,both,,,189.0000,28.3500,WELLCARE,WELLCARE MEDICAID,189.00,,,,,,,48.7800,189.0000,percent of total billed charges,100% of $189.00 in Billed Charges for Rev 272 = $189.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLADELESS 35HL,272,RC,27201209,CDM,,,,,,both,,,290.0000,43.5000,AETNA,AETNA,123.83,,,,,,,74.8500,290.0000,percent of total billed charges,42.7% of $290.00 in Billed Charges for Rev 272 = $123.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLADELESS 35HL,272,RC,27201209,CDM,,,,,,both,,,290.0000,43.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,203.00,,,,,,,74.8500,290.0000,percent of total billed charges,Rev 272 $290.00 in Billed Charges at 70% = $203.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLADELESS 35HL,272,RC,27201209,CDM,,,,,,both,,,290.0000,43.5000,CIGNA HEALTHCARE,CIGNA HMO,120.93,,,,,,,74.8500,290.0000,percent of total billed charges,41.7% of $290.00 in Billed Charges for Rev 272 = $120.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLADELESS 35HL,272,RC,27201209,CDM,,,,,,both,,,290.0000,43.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,134.56,,,,,,,74.8500,290.0000,percent of total billed charges,46.4% of $290.00 in Billed Charges for Rev 272 = $134.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLADELESS 35HL,272,RC,27201209,CDM,,,,,,both,,,290.0000,43.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,120.93,,,,,,,74.8500,290.0000,percent of total billed charges,41.7% of $290.00 in Billed Charges for Rev 272 = $120.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLADELESS 35HL,272,RC,27201209,CDM,,,,,,both,,,290.0000,43.5000,CIGNA HEALTHCARE,CIGNA PPO,120.93,,,,,,,74.8500,290.0000,percent of total billed charges,41.7% of $290.00 in Billed Charges for Rev 272 = $120.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLADELESS 35HL,272,RC,27201209,CDM,,,,,,both,,,290.0000,43.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,261.00,,,,,,,74.8500,290.0000,percent of total billed charges,90% of $290.00 in Billed Charges for Rev 272 = $261.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLADELESS 35HL,272,RC,27201209,CDM,,,,,,both,,,290.0000,43.5000,MEDCOST,MEDCOST VHN,138.01,,,,,,,74.8500,290.0000,percent of total billed charges,47.59% of $290.00 in Billed Charges for Rev 272 = $138.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLADELESS 35HL,272,RC,27201209,CDM,,,,,,both,,,290.0000,43.5000,SENTARA HEALTH,SENTARA HEALTH,74.85,,,,,,,74.8500,290.0000,percent of total billed charges,25.81% of $290.00 in Billed Charges for Rev 272 = $74.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLADELESS 35HL,272,RC,27201209,CDM,,,,,,both,,,290.0000,43.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",290.00,,,,,,,74.8500,290.0000,percent of total billed charges,100% of $290.00 in Billed Charges for Rev 272 = $290.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLADELESS 35HL,272,RC,27201209,CDM,,,,,,both,,,290.0000,43.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,145.00,,,,,,,74.8500,290.0000,percent of total billed charges,Rev 272 $290.00 in Billed Charges at 50% = $145.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLADELESS 35HL,272,RC,27201209,CDM,,,,,,both,,,290.0000,43.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,93.67,,,,,,,74.8500,290.0000,other,32.3% of $290.00 in Billed Charges for Rev 272 = $93.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TROCAR BLADELESS 35HL,272,RC,27201209,CDM,,,,,,both,,,290.0000,43.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,89.03,,,,,,,74.8500,290.0000,other,30.7% of $290.00 in Billed Charges for Rev 272 = $89.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TROCAR BLADELESS 35HL,272,RC,27201209,CDM,,,,,,both,,,290.0000,43.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,93.67,,,,,,,74.8500,290.0000,percent of total billed charges,32.3% of $290.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TROCAR BLADELESS 35HL,272,RC,27201209,CDM,,,,,,both,,,290.0000,43.5000,WELLCARE,WELLCARE MEDICAID,290.00,,,,,,,74.8500,290.0000,percent of total billed charges,100% of $290.00 in Billed Charges for Rev 272 = $290.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CORPAK NON WEIGHTED 10FR,270,RC,27000210,CDM,,,,,,both,,,123.0000,18.4500,AETNA,AETNA,52.52,,,,,,,31.7500,123.0000,percent of total billed charges,42.7% of $123.00 in Billed Charges for Rev 270 = $52.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CORPAK NON WEIGHTED 10FR,270,RC,27000210,CDM,,,,,,both,,,123.0000,18.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,86.10,,,,,,,31.7500,123.0000,percent of total billed charges,Rev 270 $123.00 in Billed Charges at 70% = $86.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CORPAK NON WEIGHTED 10FR,270,RC,27000210,CDM,,,,,,both,,,123.0000,18.4500,CIGNA HEALTHCARE,CIGNA HMO,51.29,,,,,,,31.7500,123.0000,percent of total billed charges,41.7% of $123.00 in Billed Charges for Rev 270 = $51.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CORPAK NON WEIGHTED 10FR,270,RC,27000210,CDM,,,,,,both,,,123.0000,18.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,57.07,,,,,,,31.7500,123.0000,percent of total billed charges,46.4% of $123.00 in Billed Charges for Rev 270 = $57.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CORPAK NON WEIGHTED 10FR,270,RC,27000210,CDM,,,,,,both,,,123.0000,18.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,51.29,,,,,,,31.7500,123.0000,percent of total billed charges,41.7% of $123.00 in Billed Charges for Rev 270 = $51.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CORPAK NON WEIGHTED 10FR,270,RC,27000210,CDM,,,,,,both,,,123.0000,18.4500,CIGNA HEALTHCARE,CIGNA PPO,51.29,,,,,,,31.7500,123.0000,percent of total billed charges,41.7% of $123.00 in Billed Charges for Rev 270 = $51.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CORPAK NON WEIGHTED 10FR,270,RC,27000210,CDM,,,,,,both,,,123.0000,18.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,110.70,,,,,,,31.7500,123.0000,percent of total billed charges,90% of $123.00 in Billed Charges for Rev 270 = $110.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CORPAK NON WEIGHTED 10FR,270,RC,27000210,CDM,,,,,,both,,,123.0000,18.4500,MEDCOST,MEDCOST VHN,58.54,,,,,,,31.7500,123.0000,percent of total billed charges,47.59% of $123.00 in Billed Charges for Rev 270 = $58.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CORPAK NON WEIGHTED 10FR,270,RC,27000210,CDM,,,,,,both,,,123.0000,18.4500,SENTARA HEALTH,SENTARA HEALTH,31.75,,,,,,,31.7500,123.0000,percent of total billed charges,25.81% of $123.00 in Billed Charges for Rev 270 = $31.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CORPAK NON WEIGHTED 10FR,270,RC,27000210,CDM,,,,,,both,,,123.0000,18.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",123.00,,,,,,,31.7500,123.0000,percent of total billed charges,100% of $123.00 in Billed Charges for Rev 270 = $123.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CORPAK NON WEIGHTED 10FR,270,RC,27000210,CDM,,,,,,both,,,123.0000,18.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,61.50,,,,,,,31.7500,123.0000,percent of total billed charges,Rev 270 $123.00 in Billed Charges at 50% = $61.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CORPAK NON WEIGHTED 10FR,270,RC,27000210,CDM,,,,,,both,,,123.0000,18.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,39.73,,,,,,,31.7500,123.0000,other,32.3% of $123.00 in Billed Charges for Rev 270 = $39.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE CORPAK NON WEIGHTED 10FR,270,RC,27000210,CDM,,,,,,both,,,123.0000,18.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,37.76,,,,,,,31.7500,123.0000,other,30.7% of $123.00 in Billed Charges for Rev 270 = $37.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE CORPAK NON WEIGHTED 10FR,270,RC,27000210,CDM,,,,,,both,,,123.0000,18.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,39.73,,,,,,,31.7500,123.0000,percent of total billed charges,32.3% of $123.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE CORPAK NON WEIGHTED 10FR,270,RC,27000210,CDM,,,,,,both,,,123.0000,18.4500,WELLCARE,WELLCARE MEDICAID,123.00,,,,,,,31.7500,123.0000,percent of total billed charges,100% of $123.00 in Billed Charges for Rev 270 = $123.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA,289.08,,,,,,,48.1600,677.0000,percent of total billed charges,42.7% of $677.00 in Billed Charges for Rev 402 Proc 76872 = $289.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,156.09,,,,,,,48.1600,677.0000,fee schedule,APG 00288 Proc 76872 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 104% = $156.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,AMBETTER,AMBETTER,206.78,,,,,,,48.1600,677.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,48.1600,677.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,154.59,,,,,,,48.1600,677.0000,fee schedule,APG 00288 Proc 76872 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 103% = $154.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,48.1600,677.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,89.04,,,,,,,48.1600,677.0000,fee schedule,$89.04 from Fee Schedule BLDTM_23 for Rev 402 Proc 76872 * Qty 1 = $89.04 at 100% = $89.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS E NETWORK,169.41,,,,,,,48.1600,677.0000,fee schedule,$52.94 from Fee Schedule BCFSC for Rev 402 Proc 76872 * Qty 1 = $52.94 at 320% = $169.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,48.1600,677.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS P NETWORK,173.11,,,,,,,48.1600,677.0000,fee schedule,$52.94 from Fee Schedule BCFSC for Rev 402 Proc 76872 * Qty 1 = $52.94 at 327% = $173.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS S NETWORK,173.11,,,,,,,48.1600,677.0000,fee schedule,$52.94 from Fee Schedule BCFSC for Rev 402 Proc 76872 * Qty 1 = $52.94 at 327% = $173.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE CARE,50.23,,,,,,,48.1600,677.0000,fee schedule,$43.30 from Fee Schedule TC_24 for Rev 402 Proc 76872 * Qty 1 = $43.30 at 116% = $50.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE SELECT,50.23,,,,,,,48.1600,677.0000,fee schedule,$43.30 from Fee Schedule TC_24 for Rev 402 Proc 76872 * Qty 1 = $43.30 at 116% = $50.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA HMO,364.51,,,,,,,48.1600,677.0000,fee schedule,$364.51 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76872 * Qty 1 = $364.51 at 100% = $364.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,317.69,,,,,,,48.1600,677.0000,fee schedule,$317.69 from Fee Schedule CGIFP_25LR for Rev 402 Proc 76872 * Qty 1 = $317.69 at 100% = $317.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,48.1600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,364.51,,,,,,,48.1600,677.0000,fee schedule,$364.51 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76872 * Qty 1 = $364.51 at 100% = $364.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA PPO,364.51,,,,,,,48.1600,677.0000,fee schedule,$364.51 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76872 * Qty 1 = $364.51 at 100% = $364.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,48.1600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,609.30,,,,,,,48.1600,677.0000,percent of total billed charges,90% of $677.00 in Billed Charges for Rev 402 Proc 76872 = $609.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,HUMANA,HUMANA MEDICARE,94.85,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,MEDCOST,MEDCOST VHN,322.18,,,,,,,48.1600,677.0000,percent of total billed charges,47.59% of $677.00 in Billed Charges for Rev 402 Proc 76872 = $322.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,157.59,,,,,,,48.1600,677.0000,fee schedule,APG 00288 Proc 76872 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 100% = $150.09... $150.09 at 105% = $157.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,48.1600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,48.1600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,48.1600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,154.74,,,,,,,48.1600,677.0000,fee schedule,APG 00288 Proc 76872 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 100% = $150.09... $150.09 at 103.1% = $154.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,SENTARA HEALTH,SENTARA HEALTH,174.73,,,,,,,48.1600,677.0000,percent of total billed charges,25.81% of $677.00 in Billed Charges for Rev 402 Proc 76872 = $174.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",677.00,,,,,,,48.1600,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76872 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,48.16,,,,,,,48.1600,677.0000,fee schedule,$96.31 from Fee Schedule TCUHC24 for Rev 402 Proc 76872 * Qty 1 = $96.31 at 50% = $48.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,48.1600,677.0000,other,Rev 402 Proc 76872 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,48.1600,677.0000,other,Rev 402 Proc 76872 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,677.00,,,,,,,48.1600,677.0000,other,"Rev 402 Proc 76872 1 Visit at $687.00 per Visit = $687.00 (Service Line reduced to $677.00, claim capped at $677.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,154.59,,,,,,,48.1600,677.0000,fee schedule,APG 00288 Proc 76872 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 103% = $154.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,WELLCARE,WELLCARE MEDICAID,677.00,,,,,,,48.1600,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76872 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US TRANSRECTAL,76872,CPT,402,RC,40200043,CDM,,,,both,,,677.0000,101.5500,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,48.1600,677.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,AETNA,AETNA,267.30,,,,,,,48.1600,626.0000,percent of total billed charges,42.7% of $626.00 in Billed Charges for Rev 402 Proc 76873 = $267.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,236.48,,,,,,,48.1600,626.0000,fee schedule,APG 00289 Proc 76873 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 104% = $236.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,48.1600,626.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,48.1600,626.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,48.1600,626.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,AMBETTER,AMBETTER,206.78,,,,,,,48.1600,626.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,48.1600,626.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,48.1600,626.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,234.21,,,,,,,48.1600,626.0000,fee schedule,APG 00289 Proc 76873 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 103% = $234.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,48.1600,626.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,48.1600,626.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,48.1600,626.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,178.92,,,,,,,48.1600,626.0000,fee schedule,$178.92 from Fee Schedule BLDTM_23 for Rev 402 Proc 76873 * Qty 1 = $178.92 at 100% = $178.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,BLUE CROSS,BLUE CROSS E NETWORK,270.30,,,,,,,48.1600,626.0000,fee schedule,$84.47 from Fee Schedule BCFSC for Rev 402 Proc 76873 * Qty 1 = $84.47 at 320% = $270.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,48.1600,626.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,BLUE CROSS,BLUE CROSS P NETWORK,276.22,,,,,,,48.1600,626.0000,fee schedule,$84.47 from Fee Schedule BCFSC for Rev 402 Proc 76873 * Qty 1 = $84.47 at 327% = $276.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,BLUE CROSS,BLUE CROSS S NETWORK,276.22,,,,,,,48.1600,626.0000,fee schedule,$84.47 from Fee Schedule BCFSC for Rev 402 Proc 76873 * Qty 1 = $84.47 at 327% = $276.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,BLUE CROSS,TENNCARE BLUE CARE,71.89,,,,,,,48.1600,626.0000,fee schedule,$61.97 from Fee Schedule TC_24 for Rev 402 Proc 76873 * Qty 1 = $61.97 at 116% = $71.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,BLUE CROSS,TENNCARE BLUE SELECT,71.89,,,,,,,48.1600,626.0000,fee schedule,$61.97 from Fee Schedule TC_24 for Rev 402 Proc 76873 * Qty 1 = $61.97 at 116% = $71.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,CIGNA HEALTHCARE,CIGNA HMO,364.51,,,,,,,48.1600,626.0000,fee schedule,$364.51 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76873 * Qty 1 = $364.51 at 100% = $364.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,188.04,,,,,,,48.1600,626.0000,fee schedule,$188.04 from Fee Schedule CGIFP_25LR for Rev 402 Proc 76873 * Qty 1 = $188.04 at 100% = $188.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,48.1600,626.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,364.51,,,,,,,48.1600,626.0000,fee schedule,$364.51 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76873 * Qty 1 = $364.51 at 100% = $364.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,CIGNA HEALTHCARE,CIGNA PPO,364.51,,,,,,,48.1600,626.0000,fee schedule,$364.51 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76873 * Qty 1 = $364.51 at 100% = $364.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,48.1600,626.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,563.40,,,,,,,48.1600,626.0000,percent of total billed charges,90% of $626.00 in Billed Charges for Rev 402 Proc 76873 = $563.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,HUMANA,HUMANA MEDICARE,94.85,,,,,,,48.1600,626.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,48.1600,626.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,MEDCOST,MEDCOST VHN,297.91,,,,,,,48.1600,626.0000,percent of total billed charges,47.59% of $626.00 in Billed Charges for Rev 402 Proc 76873 = $297.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,238.76,,,,,,,48.1600,626.0000,fee schedule,APG 00289 Proc 76873 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 100% = $227.39... $227.39 at 105% = $238.76 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,48.1600,626.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,48.1600,626.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,48.1600,626.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,234.44,,,,,,,48.1600,626.0000,fee schedule,APG 00289 Proc 76873 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 100% = $227.39... $227.39 at 103.1% = $234.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,SENTARA HEALTH,SENTARA HEALTH,161.57,,,,,,,48.1600,626.0000,percent of total billed charges,25.81% of $626.00 in Billed Charges for Rev 402 Proc 76873 = $161.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,48.1600,626.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",626.00,,,,,,,48.1600,626.0000,percent of total billed charges,100% of $626.00 in Billed Charges for Rev 402 Proc 76873 = $626.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,48.16,,,,,,,48.1600,626.0000,fee schedule,$96.31 from Fee Schedule TCUHC24 for Rev 402 Proc 76873 * Qty 1 = $96.31 at 50% = $48.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,48.1600,626.0000,other,Rev 402 Proc 76873 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,48.1600,626.0000,other,Rev 402 Proc 76873 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,626.00,,,,,,,48.1600,626.0000,other,"Rev 402 Proc 76873 1 Visit at $687.00 per Visit = $687.00 (Service Line reduced to $626.00, claim capped at $626.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,234.21,,,,,,,48.1600,626.0000,fee schedule,APG 00289 Proc 76873 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 103% = $234.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,48.1600,626.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,48.1600,626.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,WELLCARE,WELLCARE MEDICAID,626.00,,,,,,,48.1600,626.0000,percent of total billed charges,100% of $626.00 in Billed Charges for Rev 402 Proc 76873 = $626.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US PROSTATE MAPPING,76873,CPT,402,RC,40200067,CDM,,,,both,,,626.0000,93.9000,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,48.1600,626.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA,289.08,,,,,,,20.4200,677.0000,percent of total billed charges,42.7% of $677.00 in Billed Charges for Rev 402 Proc 76881 = $289.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,156.09,,,,,,,20.4200,677.0000,fee schedule,APG 00288 Proc 76881 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 104% = $156.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,20.4200,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,20.4200,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,20.4200,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,AMBETTER,AMBETTER,206.78,,,,,,,20.4200,677.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,20.4200,677.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,20.4200,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,154.59,,,,,,,20.4200,677.0000,fee schedule,APG 00288 Proc 76881 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 103% = $154.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,20.4200,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,20.4200,677.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,20.4200,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,81.42,,,,,,,20.4200,677.0000,fee schedule,$81.42 from Fee Schedule BLDTM_23 for Rev 402 Proc 76881 * Qty 1 = $81.42 at 100% = $81.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS E NETWORK,251.78,,,,,,,20.4200,677.0000,fee schedule,$78.68 from Fee Schedule BCFSC for Rev 402 Proc 76881 * Qty 1 = $78.68 at 320% = $251.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,20.4200,677.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS P NETWORK,257.28,,,,,,,20.4200,677.0000,fee schedule,$78.68 from Fee Schedule BCFSC for Rev 402 Proc 76881 * Qty 1 = $78.68 at 327% = $257.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS S NETWORK,257.28,,,,,,,20.4200,677.0000,fee schedule,$78.68 from Fee Schedule BCFSC for Rev 402 Proc 76881 * Qty 1 = $78.68 at 327% = $257.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE CARE,76.73,,,,,,,20.4200,677.0000,fee schedule,$66.15 from Fee Schedule TC_24 for Rev 402 Proc 76881 * Qty 1 = $66.15 at 116% = $76.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE SELECT,76.73,,,,,,,20.4200,677.0000,fee schedule,$66.15 from Fee Schedule TC_24 for Rev 402 Proc 76881 * Qty 1 = $66.15 at 116% = $76.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA HMO,364.51,,,,,,,20.4200,677.0000,fee schedule,$364.51 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76881 * Qty 1 = $364.51 at 100% = $364.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,20.42,,,,,,,20.4200,677.0000,fee schedule,$20.42 from Fee Schedule CGIFP_25LR for Rev 402 Proc 76881 * Qty 1 = $20.42 at 100% = $20.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,20.4200,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,364.51,,,,,,,20.4200,677.0000,fee schedule,$364.51 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76881 * Qty 1 = $364.51 at 100% = $364.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA PPO,364.51,,,,,,,20.4200,677.0000,fee schedule,$364.51 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76881 * Qty 1 = $364.51 at 100% = $364.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,20.4200,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,609.30,,,,,,,20.4200,677.0000,percent of total billed charges,90% of $677.00 in Billed Charges for Rev 402 Proc 76881 = $609.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,HUMANA,HUMANA MEDICARE,94.85,,,,,,,20.4200,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,20.4200,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,MEDCOST,MEDCOST VHN,322.18,,,,,,,20.4200,677.0000,percent of total billed charges,47.59% of $677.00 in Billed Charges for Rev 402 Proc 76881 = $322.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,157.59,,,,,,,20.4200,677.0000,fee schedule,APG 00288 Proc 76881 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 100% = $150.09... $150.09 at 105% = $157.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,20.4200,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,20.4200,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,20.4200,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,154.74,,,,,,,20.4200,677.0000,fee schedule,APG 00288 Proc 76881 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 100% = $150.09... $150.09 at 103.1% = $154.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,SENTARA HEALTH,SENTARA HEALTH,174.73,,,,,,,20.4200,677.0000,percent of total billed charges,25.81% of $677.00 in Billed Charges for Rev 402 Proc 76881 = $174.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,20.4200,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",677.00,,,,,,,20.4200,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76881 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,48.16,,,,,,,20.4200,677.0000,fee schedule,$96.31 from Fee Schedule TCUHC24 for Rev 402 Proc 76881 * Qty 1 = $96.31 at 50% = $48.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,20.4200,677.0000,other,Rev 402 Proc 76881 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,20.4200,677.0000,other,Rev 402 Proc 76881 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,677.00,,,,,,,20.4200,677.0000,other,"Rev 402 Proc 76881 1 Visit at $687.00 per Visit = $687.00 (Service Line reduced to $677.00, claim capped at $677.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,154.59,,,,,,,20.4200,677.0000,fee schedule,APG 00288 Proc 76881 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 103% = $154.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,20.4200,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,20.4200,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,WELLCARE,WELLCARE MEDICAID,677.00,,,,,,,20.4200,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76881 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US COMPLETE JOINT,76881,CPT,402,RC,40200044,CDM,,,,both,,,677.0000,101.5500,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,20.4200,677.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,AETNA,AETNA,289.08,,,,,,,8.9600,677.0000,percent of total billed charges,42.7% of $677.00 in Billed Charges for Rev 402 Proc 76882 Mod 50 = $289.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,234.13,,,,,,,8.9600,677.0000,fee schedule,APG 00288 Proc 76882 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 150% Mod Percentage = $225.13 at 104% = $234.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,8.9600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,8.9600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,8.9600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,AMBETTER,AMBETTER,206.78,,,,,,,8.9600,677.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,8.9600,677.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,8.9600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,231.88,,,,,,,8.9600,677.0000,fee schedule,APG 00288 Proc 76882 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 150% Mod Percentage = $225.13 at 103% = $231.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,8.9600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,8.9600,677.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,8.9600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9.51,,,,,,,8.9600,677.0000,fee schedule,$9.51 from Fee Schedule BLDTM_23 for Rev 402 Proc 76882 Mod 50 * Qty 1 = $9.51 at 100% = $9.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS E NETWORK,31.49,,,,,,,8.9600,677.0000,fee schedule,$9.84 from Fee Schedule BCFSC for Rev 402 Proc 76882 Mod 50 * Qty 1 = $9.84 at 320% = $31.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,8.9600,677.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS P NETWORK,32.18,,,,,,,8.9600,677.0000,fee schedule,$9.84 from Fee Schedule BCFSC for Rev 402 Proc 76882 Mod 50 * Qty 1 = $9.84 at 327% = $32.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS S NETWORK,32.18,,,,,,,8.9600,677.0000,fee schedule,$9.84 from Fee Schedule BCFSC for Rev 402 Proc 76882 Mod 50 * Qty 1 = $9.84 at 327% = $32.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE CARE,8.96,,,,,,,8.9600,677.0000,fee schedule,$7.72 from Fee Schedule TC_24 for Rev 402 Proc 76882 Mod 50 * Qty 1 = $7.72 at 116% = $8.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE SELECT,8.96,,,,,,,8.9600,677.0000,fee schedule,$7.72 from Fee Schedule TC_24 for Rev 402 Proc 76882 Mod 50 * Qty 1 = $7.72 at 116% = $8.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA HMO,238.14,,,,,,,8.9600,677.0000,fee schedule,$238.14 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76882 Mod 50 * Qty 1 = $238.14 at 100% = $238.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,58.00,,,,,,,8.9600,677.0000,fee schedule,$58.00 from Fee Schedule CGIFP_25LR for Rev 402 Proc 76882 Mod 50 * Qty 1 = $58.00 at 100% = $58.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,8.9600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,238.14,,,,,,,8.9600,677.0000,fee schedule,$238.14 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76882 Mod 50 * Qty 1 = $238.14 at 100% = $238.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA PPO,238.14,,,,,,,8.9600,677.0000,fee schedule,$238.14 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76882 Mod 50 * Qty 1 = $238.14 at 100% = $238.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,8.9600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,609.30,,,,,,,8.9600,677.0000,percent of total billed charges,90% of $677.00 in Billed Charges for Rev 402 Proc 76882 Mod 50 = $609.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,HUMANA,HUMANA MEDICARE,94.85,,,,,,,8.9600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,8.9600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,MEDCOST,MEDCOST VHN,322.18,,,,,,,8.9600,677.0000,percent of total billed charges,47.59% of $677.00 in Billed Charges for Rev 402 Proc 76882 Mod 50 = $322.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,236.39,,,,,,,8.9600,677.0000,fee schedule,APG 00288 Proc 76882 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 150% Mod Percentage = $225.13 at 100% = $225.13... $225.13 at 105% = $236.39 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,8.9600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,8.9600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,8.9600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,232.11,,,,,,,8.9600,677.0000,fee schedule,APG 00288 Proc 76882 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 150% Mod Percentage = $225.13 at 100% = $225.13... $225.13 at 103.1% = $232.11 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,SENTARA HEALTH,SENTARA HEALTH,174.73,,,,,,,8.9600,677.0000,percent of total billed charges,25.81% of $677.00 in Billed Charges for Rev 402 Proc 76882 Mod 50 = $174.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,8.9600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",677.00,,,,,,,8.9600,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76882 Mod 50 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,31.46,,,,,,,8.9600,677.0000,fee schedule,$62.92 from Fee Schedule TCUHC24 for Rev 402 Proc 76882 Mod 50 * Qty 1 = $62.92 at 50% = $31.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,8.9600,677.0000,other,Rev 402 Proc 76882 Mod 50 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,8.9600,677.0000,other,Rev 402 Proc 76882 Mod 50 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,677.00,,,,,,,8.9600,677.0000,other,"Rev 402 Proc 76882 Mod 50 1 Visit at $687.00 per Visit = $687.00 (Service Line reduced to $677.00, claim capped at $677.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,231.88,,,,,,,8.9600,677.0000,fee schedule,APG 00288 Proc 76882 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 150% Mod Percentage = $225.13 at 103% = $231.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,8.9600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,8.9600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,WELLCARE,WELLCARE MEDICAID,677.00,,,,,,,8.9600,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76882 Mod 50 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S) BILAT,76882,CPT,402,RC,40200072,CDM,,,50,both,,,677.0000,101.5500,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,8.9600,677.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA,289.08,,,,,,,12.4400,677.0000,percent of total billed charges,42.7% of $677.00 in Billed Charges for Rev 402 Proc 76883 = $289.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,156.09,,,,,,,12.4400,677.0000,fee schedule,APG 00288 Proc 76883 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 104% = $156.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,12.4400,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,12.4400,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,12.4400,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,AMBETTER,AMBETTER,206.78,,,,,,,12.4400,677.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,12.4400,677.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,12.4400,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,154.59,,,,,,,12.4400,677.0000,fee schedule,APG 00288 Proc 76883 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 103% = $154.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,12.4400,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,12.4400,677.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,12.4400,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,473.90,,,,,,,12.4400,677.0000,percent of total billed charges,Rev 402 Proc 76883 $677.00 in Billed Charges at 70% = $473.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS E NETWORK,42.24,,,,,,,12.4400,677.0000,fee schedule,$13.20 from Fee Schedule BCFSC for Rev 402 Proc 76883 * Qty 1 = $13.20 at 320% = $42.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,12.4400,677.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS P NETWORK,43.16,,,,,,,12.4400,677.0000,fee schedule,$13.20 from Fee Schedule BCFSC for Rev 402 Proc 76883 * Qty 1 = $13.20 at 327% = $43.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS S NETWORK,43.16,,,,,,,12.4400,677.0000,fee schedule,$13.20 from Fee Schedule BCFSC for Rev 402 Proc 76883 * Qty 1 = $13.20 at 327% = $43.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE CARE,12.44,,,,,,,12.4400,677.0000,fee schedule,$10.72 from Fee Schedule TC_24 for Rev 402 Proc 76883 * Qty 1 = $10.72 at 116% = $12.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE SELECT,12.44,,,,,,,12.4400,677.0000,fee schedule,$10.72 from Fee Schedule TC_24 for Rev 402 Proc 76883 * Qty 1 = $10.72 at 116% = $12.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA HMO,282.31,,,,,,,12.4400,677.0000,percent of total billed charges,Rev 402 Proc 76883 $677.00 in Billed Charges at 41.7% = $282.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,26.69,,,,,,,12.4400,677.0000,fee schedule,$26.69 from Fee Schedule CGIFP_25LR for Rev 402 Proc 76883 * Qty 1 = $26.69 at 100% = $26.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,12.4400,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,282.31,,,,,,,12.4400,677.0000,percent of total billed charges,Rev 402 Proc 76883 $677.00 in Billed Charges at 41.7% = $282.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA PPO,282.31,,,,,,,12.4400,677.0000,percent of total billed charges,Rev 402 Proc 76883 $677.00 in Billed Charges at 41.7% = $282.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,12.4400,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,609.30,,,,,,,12.4400,677.0000,percent of total billed charges,90% of $677.00 in Billed Charges for Rev 402 Proc 76883 = $609.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,HUMANA,HUMANA MEDICARE,94.85,,,,,,,12.4400,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,12.4400,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,MEDCOST,MEDCOST VHN,322.18,,,,,,,12.4400,677.0000,percent of total billed charges,47.59% of $677.00 in Billed Charges for Rev 402 Proc 76883 = $322.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,157.59,,,,,,,12.4400,677.0000,fee schedule,APG 00288 Proc 76883 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 100% = $150.09... $150.09 at 105% = $157.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,12.4400,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,12.4400,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,12.4400,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,154.74,,,,,,,12.4400,677.0000,fee schedule,APG 00288 Proc 76883 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 100% = $150.09... $150.09 at 103.1% = $154.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,SENTARA HEALTH,SENTARA HEALTH,174.73,,,,,,,12.4400,677.0000,percent of total billed charges,25.81% of $677.00 in Billed Charges for Rev 402 Proc 76883 = $174.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,12.4400,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",677.00,,,,,,,12.4400,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76883 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,53.44,,,,,,,12.4400,677.0000,fee schedule,$106.88 from Fee Schedule TCUHC24 for Rev 402 Proc 76883 * Qty 1 = $106.88 at 50% = $53.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,12.4400,677.0000,other,Rev 402 Proc 76883 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,12.4400,677.0000,other,Rev 402 Proc 76883 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,677.00,,,,,,,12.4400,677.0000,other,"Rev 402 Proc 76883 1 Visit at $687.00 per Visit = $687.00 (Service Line reduced to $677.00, claim capped at $677.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,154.59,,,,,,,12.4400,677.0000,fee schedule,APG 00288 Proc 76883 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 103% = $154.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,12.4400,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,12.4400,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,WELLCARE,WELLCARE MEDICAID,677.00,,,,,,,12.4400,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76883 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY,76883,CPT,402,RC,40200084,CDM,,,,both,,,677.0000,101.5500,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,12.4400,677.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA,289.08,,,,,,,31.4600,677.0000,percent of total billed charges,42.7% of $677.00 in Billed Charges for Rev 402 Proc 76885 = $289.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,156.09,,,,,,,31.4600,677.0000,fee schedule,APG 00288 Proc 76885 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 104% = $156.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,31.4600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,31.4600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,31.4600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,AMBETTER,AMBETTER,172.12,,,,,,,31.4600,677.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,31.4600,677.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,31.4600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,154.59,,,,,,,31.4600,677.0000,fee schedule,APG 00288 Proc 76885 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 103% = $154.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,31.4600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,31.4600,677.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,31.4600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,89.73,,,,,,,31.4600,677.0000,fee schedule,$89.73 from Fee Schedule BLDTM_23 for Rev 402 Proc 76885 * Qty 1 = $89.73 at 100% = $89.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS E NETWORK,323.84,,,,,,,31.4600,677.0000,fee schedule,$101.20 from Fee Schedule BCFSC for Rev 402 Proc 76885 * Qty 1 = $101.20 at 320% = $323.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,31.4600,677.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS P NETWORK,330.92,,,,,,,31.4600,677.0000,fee schedule,$101.20 from Fee Schedule BCFSC for Rev 402 Proc 76885 * Qty 1 = $101.20 at 327% = $330.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS S NETWORK,330.92,,,,,,,31.4600,677.0000,fee schedule,$101.20 from Fee Schedule BCFSC for Rev 402 Proc 76885 * Qty 1 = $101.20 at 327% = $330.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE CARE,49.56,,,,,,,31.4600,677.0000,fee schedule,$42.72 from Fee Schedule TC_24 for Rev 402 Proc 76885 * Qty 1 = $42.72 at 116% = $49.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE SELECT,49.56,,,,,,,31.4600,677.0000,fee schedule,$42.72 from Fee Schedule TC_24 for Rev 402 Proc 76885 * Qty 1 = $42.72 at 116% = $49.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA HMO,238.14,,,,,,,31.4600,677.0000,fee schedule,$238.14 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76885 * Qty 1 = $238.14 at 100% = $238.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,189.29,,,,,,,31.4600,677.0000,fee schedule,$189.29 from Fee Schedule CGIFP_25LR for Rev 402 Proc 76885 * Qty 1 = $189.29 at 100% = $189.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,31.4600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,238.14,,,,,,,31.4600,677.0000,fee schedule,$238.14 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76885 * Qty 1 = $238.14 at 100% = $238.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA PPO,238.14,,,,,,,31.4600,677.0000,fee schedule,$238.14 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76885 * Qty 1 = $238.14 at 100% = $238.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,31.4600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,609.30,,,,,,,31.4600,677.0000,percent of total billed charges,90% of $677.00 in Billed Charges for Rev 402 Proc 76885 = $609.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,HUMANA,HUMANA MEDICARE,78.96,,,,,,,31.4600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,31.4600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,MEDCOST,MEDCOST VHN,322.18,,,,,,,31.4600,677.0000,percent of total billed charges,47.59% of $677.00 in Billed Charges for Rev 402 Proc 76885 = $322.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,157.59,,,,,,,31.4600,677.0000,fee schedule,APG 00288 Proc 76885 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 100% = $150.09... $150.09 at 105% = $157.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,31.4600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,31.4600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,31.4600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,154.74,,,,,,,31.4600,677.0000,fee schedule,APG 00288 Proc 76885 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 100% = $150.09... $150.09 at 103.1% = $154.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,SENTARA HEALTH,SENTARA HEALTH,174.73,,,,,,,31.4600,677.0000,percent of total billed charges,25.81% of $677.00 in Billed Charges for Rev 402 Proc 76885 = $174.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,31.4600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",677.00,,,,,,,31.4600,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76885 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,31.46,,,,,,,31.4600,677.0000,fee schedule,$62.92 from Fee Schedule TCUHC24 for Rev 402 Proc 76885 * Qty 1 = $62.92 at 50% = $31.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,31.4600,677.0000,other,Rev 402 Proc 76885 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,31.4600,677.0000,other,Rev 402 Proc 76885 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,677.00,,,,,,,31.4600,677.0000,other,"Rev 402 Proc 76885 1 Visit at $687.00 per Visit = $687.00 (Service Line reduced to $677.00, claim capped at $677.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,154.59,,,,,,,31.4600,677.0000,fee schedule,APG 00288 Proc 76885 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 103% = $154.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,31.4600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,31.4600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,WELLCARE,WELLCARE MEDICAID,677.00,,,,,,,31.4600,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76885 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US HIP INFANT W MANIPULATION,76885,CPT,402,RC,40200048,CDM,,,,both,,,677.0000,101.5500,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,31.4600,677.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE DISP LMA,270,RC,27000171,CDM,,,,,,both,,,96.0000,14.4000,AETNA,AETNA,40.99,,,,,,,24.7800,96.0000,percent of total billed charges,42.7% of $96.00 in Billed Charges for Rev 270 = $40.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE DISP LMA,270,RC,27000171,CDM,,,,,,both,,,96.0000,14.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,67.20,,,,,,,24.7800,96.0000,percent of total billed charges,Rev 270 $96.00 in Billed Charges at 70% = $67.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE DISP LMA,270,RC,27000171,CDM,,,,,,both,,,96.0000,14.4000,CIGNA HEALTHCARE,CIGNA HMO,40.03,,,,,,,24.7800,96.0000,percent of total billed charges,41.7% of $96.00 in Billed Charges for Rev 270 = $40.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE DISP LMA,270,RC,27000171,CDM,,,,,,both,,,96.0000,14.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,44.54,,,,,,,24.7800,96.0000,percent of total billed charges,46.4% of $96.00 in Billed Charges for Rev 270 = $44.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE DISP LMA,270,RC,27000171,CDM,,,,,,both,,,96.0000,14.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,40.03,,,,,,,24.7800,96.0000,percent of total billed charges,41.7% of $96.00 in Billed Charges for Rev 270 = $40.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE DISP LMA,270,RC,27000171,CDM,,,,,,both,,,96.0000,14.4000,CIGNA HEALTHCARE,CIGNA PPO,40.03,,,,,,,24.7800,96.0000,percent of total billed charges,41.7% of $96.00 in Billed Charges for Rev 270 = $40.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE DISP LMA,270,RC,27000171,CDM,,,,,,both,,,96.0000,14.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,86.40,,,,,,,24.7800,96.0000,percent of total billed charges,90% of $96.00 in Billed Charges for Rev 270 = $86.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE DISP LMA,270,RC,27000171,CDM,,,,,,both,,,96.0000,14.4000,MEDCOST,MEDCOST VHN,45.69,,,,,,,24.7800,96.0000,percent of total billed charges,47.59% of $96.00 in Billed Charges for Rev 270 = $45.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE DISP LMA,270,RC,27000171,CDM,,,,,,both,,,96.0000,14.4000,SENTARA HEALTH,SENTARA HEALTH,24.78,,,,,,,24.7800,96.0000,percent of total billed charges,25.81% of $96.00 in Billed Charges for Rev 270 = $24.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE DISP LMA,270,RC,27000171,CDM,,,,,,both,,,96.0000,14.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",96.00,,,,,,,24.7800,96.0000,percent of total billed charges,100% of $96.00 in Billed Charges for Rev 270 = $96.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE DISP LMA,270,RC,27000171,CDM,,,,,,both,,,96.0000,14.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,48.00,,,,,,,24.7800,96.0000,percent of total billed charges,Rev 270 $96.00 in Billed Charges at 50% = $48.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE DISP LMA,270,RC,27000171,CDM,,,,,,both,,,96.0000,14.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,31.01,,,,,,,24.7800,96.0000,other,32.3% of $96.00 in Billed Charges for Rev 270 = $31.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE DISP LMA,270,RC,27000171,CDM,,,,,,both,,,96.0000,14.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,29.47,,,,,,,24.7800,96.0000,other,30.7% of $96.00 in Billed Charges for Rev 270 = $29.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE DISP LMA,270,RC,27000171,CDM,,,,,,both,,,96.0000,14.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,31.01,,,,,,,24.7800,96.0000,percent of total billed charges,32.3% of $96.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE DISP LMA,270,RC,27000171,CDM,,,,,,both,,,96.0000,14.4000,WELLCARE,WELLCARE MEDICAID,96.00,,,,,,,24.7800,96.0000,percent of total billed charges,100% of $96.00 in Billed Charges for Rev 270 = $96.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MAGNAPORTS,272,RC,27201221,CDM,,,,,,both,,,105.0000,15.7500,AETNA,AETNA,44.84,,,,,,,27.1000,105.0000,percent of total billed charges,42.7% of $105.00 in Billed Charges for Rev 272 = $44.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MAGNAPORTS,272,RC,27201221,CDM,,,,,,both,,,105.0000,15.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,73.50,,,,,,,27.1000,105.0000,percent of total billed charges,Rev 272 $105.00 in Billed Charges at 70% = $73.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MAGNAPORTS,272,RC,27201221,CDM,,,,,,both,,,105.0000,15.7500,CIGNA HEALTHCARE,CIGNA HMO,43.79,,,,,,,27.1000,105.0000,percent of total billed charges,41.7% of $105.00 in Billed Charges for Rev 272 = $43.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MAGNAPORTS,272,RC,27201221,CDM,,,,,,both,,,105.0000,15.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,48.72,,,,,,,27.1000,105.0000,percent of total billed charges,46.4% of $105.00 in Billed Charges for Rev 272 = $48.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MAGNAPORTS,272,RC,27201221,CDM,,,,,,both,,,105.0000,15.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,43.79,,,,,,,27.1000,105.0000,percent of total billed charges,41.7% of $105.00 in Billed Charges for Rev 272 = $43.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MAGNAPORTS,272,RC,27201221,CDM,,,,,,both,,,105.0000,15.7500,CIGNA HEALTHCARE,CIGNA PPO,43.79,,,,,,,27.1000,105.0000,percent of total billed charges,41.7% of $105.00 in Billed Charges for Rev 272 = $43.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MAGNAPORTS,272,RC,27201221,CDM,,,,,,both,,,105.0000,15.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,94.50,,,,,,,27.1000,105.0000,percent of total billed charges,90% of $105.00 in Billed Charges for Rev 272 = $94.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MAGNAPORTS,272,RC,27201221,CDM,,,,,,both,,,105.0000,15.7500,MEDCOST,MEDCOST VHN,49.97,,,,,,,27.1000,105.0000,percent of total billed charges,47.59% of $105.00 in Billed Charges for Rev 272 = $49.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MAGNAPORTS,272,RC,27201221,CDM,,,,,,both,,,105.0000,15.7500,SENTARA HEALTH,SENTARA HEALTH,27.10,,,,,,,27.1000,105.0000,percent of total billed charges,25.81% of $105.00 in Billed Charges for Rev 272 = $27.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MAGNAPORTS,272,RC,27201221,CDM,,,,,,both,,,105.0000,15.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",105.00,,,,,,,27.1000,105.0000,percent of total billed charges,100% of $105.00 in Billed Charges for Rev 272 = $105.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MAGNAPORTS,272,RC,27201221,CDM,,,,,,both,,,105.0000,15.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,52.50,,,,,,,27.1000,105.0000,percent of total billed charges,Rev 272 $105.00 in Billed Charges at 50% = $52.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MAGNAPORTS,272,RC,27201221,CDM,,,,,,both,,,105.0000,15.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,33.92,,,,,,,27.1000,105.0000,other,32.3% of $105.00 in Billed Charges for Rev 272 = $33.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE FEEDING ALL MAGNAPORTS,272,RC,27201221,CDM,,,,,,both,,,105.0000,15.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,32.24,,,,,,,27.1000,105.0000,other,30.7% of $105.00 in Billed Charges for Rev 272 = $32.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE FEEDING ALL MAGNAPORTS,272,RC,27201221,CDM,,,,,,both,,,105.0000,15.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,33.92,,,,,,,27.1000,105.0000,percent of total billed charges,32.3% of $105.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MAGNAPORTS,272,RC,27201221,CDM,,,,,,both,,,105.0000,15.7500,WELLCARE,WELLCARE MEDICAID,105.00,,,,,,,27.1000,105.0000,percent of total billed charges,100% of $105.00 in Billed Charges for Rev 272 = $105.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MIC JEJUNAL,272,RC,27201222,CDM,,,,,,both,,,554.0000,83.1000,AETNA,AETNA,236.56,,,,,,,142.9900,554.0000,percent of total billed charges,42.7% of $554.00 in Billed Charges for Rev 272 = $236.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MIC JEJUNAL,272,RC,27201222,CDM,,,,,,both,,,554.0000,83.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,387.80,,,,,,,142.9900,554.0000,percent of total billed charges,Rev 272 $554.00 in Billed Charges at 70% = $387.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MIC JEJUNAL,272,RC,27201222,CDM,,,,,,both,,,554.0000,83.1000,CIGNA HEALTHCARE,CIGNA HMO,231.02,,,,,,,142.9900,554.0000,percent of total billed charges,41.7% of $554.00 in Billed Charges for Rev 272 = $231.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MIC JEJUNAL,272,RC,27201222,CDM,,,,,,both,,,554.0000,83.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,257.06,,,,,,,142.9900,554.0000,percent of total billed charges,46.4% of $554.00 in Billed Charges for Rev 272 = $257.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MIC JEJUNAL,272,RC,27201222,CDM,,,,,,both,,,554.0000,83.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,231.02,,,,,,,142.9900,554.0000,percent of total billed charges,41.7% of $554.00 in Billed Charges for Rev 272 = $231.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MIC JEJUNAL,272,RC,27201222,CDM,,,,,,both,,,554.0000,83.1000,CIGNA HEALTHCARE,CIGNA PPO,231.02,,,,,,,142.9900,554.0000,percent of total billed charges,41.7% of $554.00 in Billed Charges for Rev 272 = $231.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MIC JEJUNAL,272,RC,27201222,CDM,,,,,,both,,,554.0000,83.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,498.60,,,,,,,142.9900,554.0000,percent of total billed charges,90% of $554.00 in Billed Charges for Rev 272 = $498.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MIC JEJUNAL,272,RC,27201222,CDM,,,,,,both,,,554.0000,83.1000,MEDCOST,MEDCOST VHN,263.65,,,,,,,142.9900,554.0000,percent of total billed charges,47.59% of $554.00 in Billed Charges for Rev 272 = $263.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MIC JEJUNAL,272,RC,27201222,CDM,,,,,,both,,,554.0000,83.1000,SENTARA HEALTH,SENTARA HEALTH,142.99,,,,,,,142.9900,554.0000,percent of total billed charges,25.81% of $554.00 in Billed Charges for Rev 272 = $142.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MIC JEJUNAL,272,RC,27201222,CDM,,,,,,both,,,554.0000,83.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",554.00,,,,,,,142.9900,554.0000,percent of total billed charges,100% of $554.00 in Billed Charges for Rev 272 = $554.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MIC JEJUNAL,272,RC,27201222,CDM,,,,,,both,,,554.0000,83.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,277.00,,,,,,,142.9900,554.0000,percent of total billed charges,Rev 272 $554.00 in Billed Charges at 50% = $277.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MIC JEJUNAL,272,RC,27201222,CDM,,,,,,both,,,554.0000,83.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,178.94,,,,,,,142.9900,554.0000,other,32.3% of $554.00 in Billed Charges for Rev 272 = $178.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE FEEDING ALL MIC JEJUNAL,272,RC,27201222,CDM,,,,,,both,,,554.0000,83.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,170.08,,,,,,,142.9900,554.0000,other,30.7% of $554.00 in Billed Charges for Rev 272 = $170.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE FEEDING ALL MIC JEJUNAL,272,RC,27201222,CDM,,,,,,both,,,554.0000,83.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,178.94,,,,,,,142.9900,554.0000,percent of total billed charges,32.3% of $554.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING ALL MIC JEJUNAL,272,RC,27201222,CDM,,,,,,both,,,554.0000,83.1000,WELLCARE,WELLCARE MEDICAID,554.00,,,,,,,142.9900,554.0000,percent of total billed charges,100% of $554.00 in Billed Charges for Rev 272 = $554.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING CORFLO,272,RC,27201223,CDM,,,,,,both,,,223.0000,33.4500,AETNA,AETNA,95.22,,,,,,,57.5600,223.0000,percent of total billed charges,42.7% of $223.00 in Billed Charges for Rev 272 = $95.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING CORFLO,272,RC,27201223,CDM,,,,,,both,,,223.0000,33.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,156.10,,,,,,,57.5600,223.0000,percent of total billed charges,Rev 272 $223.00 in Billed Charges at 70% = $156.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING CORFLO,272,RC,27201223,CDM,,,,,,both,,,223.0000,33.4500,CIGNA HEALTHCARE,CIGNA HMO,92.99,,,,,,,57.5600,223.0000,percent of total billed charges,41.7% of $223.00 in Billed Charges for Rev 272 = $92.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING CORFLO,272,RC,27201223,CDM,,,,,,both,,,223.0000,33.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,103.47,,,,,,,57.5600,223.0000,percent of total billed charges,46.4% of $223.00 in Billed Charges for Rev 272 = $103.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING CORFLO,272,RC,27201223,CDM,,,,,,both,,,223.0000,33.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,92.99,,,,,,,57.5600,223.0000,percent of total billed charges,41.7% of $223.00 in Billed Charges for Rev 272 = $92.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING CORFLO,272,RC,27201223,CDM,,,,,,both,,,223.0000,33.4500,CIGNA HEALTHCARE,CIGNA PPO,92.99,,,,,,,57.5600,223.0000,percent of total billed charges,41.7% of $223.00 in Billed Charges for Rev 272 = $92.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING CORFLO,272,RC,27201223,CDM,,,,,,both,,,223.0000,33.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,200.70,,,,,,,57.5600,223.0000,percent of total billed charges,90% of $223.00 in Billed Charges for Rev 272 = $200.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING CORFLO,272,RC,27201223,CDM,,,,,,both,,,223.0000,33.4500,MEDCOST,MEDCOST VHN,106.13,,,,,,,57.5600,223.0000,percent of total billed charges,47.59% of $223.00 in Billed Charges for Rev 272 = $106.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING CORFLO,272,RC,27201223,CDM,,,,,,both,,,223.0000,33.4500,SENTARA HEALTH,SENTARA HEALTH,57.56,,,,,,,57.5600,223.0000,percent of total billed charges,25.81% of $223.00 in Billed Charges for Rev 272 = $57.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING CORFLO,272,RC,27201223,CDM,,,,,,both,,,223.0000,33.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",223.00,,,,,,,57.5600,223.0000,percent of total billed charges,100% of $223.00 in Billed Charges for Rev 272 = $223.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING CORFLO,272,RC,27201223,CDM,,,,,,both,,,223.0000,33.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,111.50,,,,,,,57.5600,223.0000,percent of total billed charges,Rev 272 $223.00 in Billed Charges at 50% = $111.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING CORFLO,272,RC,27201223,CDM,,,,,,both,,,223.0000,33.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,72.03,,,,,,,57.5600,223.0000,other,32.3% of $223.00 in Billed Charges for Rev 272 = $72.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE FEEDING CORFLO,272,RC,27201223,CDM,,,,,,both,,,223.0000,33.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,68.46,,,,,,,57.5600,223.0000,other,30.7% of $223.00 in Billed Charges for Rev 272 = $68.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE FEEDING CORFLO,272,RC,27201223,CDM,,,,,,both,,,223.0000,33.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,72.03,,,,,,,57.5600,223.0000,percent of total billed charges,32.3% of $223.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING CORFLO,272,RC,27201223,CDM,,,,,,both,,,223.0000,33.4500,WELLCARE,WELLCARE MEDICAID,223.00,,,,,,,57.5600,223.0000,percent of total billed charges,100% of $223.00 in Billed Charges for Rev 272 = $223.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING NASOGASTRIC W/ELECTROMAGNETIC TRANSMITTING,272,RC,27202314,CDM,,,,,,both,,,87.0000,13.0500,AETNA,AETNA,37.15,,,,,,,22.4500,87.0000,percent of total billed charges,42.7% of $87.00 in Billed Charges for Rev 272 = $37.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING NASOGASTRIC W/ELECTROMAGNETIC TRANSMITTING,272,RC,27202314,CDM,,,,,,both,,,87.0000,13.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,60.90,,,,,,,22.4500,87.0000,percent of total billed charges,Rev 272 $87.00 in Billed Charges at 70% = $60.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING NASOGASTRIC W/ELECTROMAGNETIC TRANSMITTING,272,RC,27202314,CDM,,,,,,both,,,87.0000,13.0500,CIGNA HEALTHCARE,CIGNA HMO,36.28,,,,,,,22.4500,87.0000,percent of total billed charges,41.7% of $87.00 in Billed Charges for Rev 272 = $36.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING NASOGASTRIC W/ELECTROMAGNETIC TRANSMITTING,272,RC,27202314,CDM,,,,,,both,,,87.0000,13.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,40.37,,,,,,,22.4500,87.0000,percent of total billed charges,46.4% of $87.00 in Billed Charges for Rev 272 = $40.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING NASOGASTRIC W/ELECTROMAGNETIC TRANSMITTING,272,RC,27202314,CDM,,,,,,both,,,87.0000,13.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,36.28,,,,,,,22.4500,87.0000,percent of total billed charges,41.7% of $87.00 in Billed Charges for Rev 272 = $36.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING NASOGASTRIC W/ELECTROMAGNETIC TRANSMITTING,272,RC,27202314,CDM,,,,,,both,,,87.0000,13.0500,CIGNA HEALTHCARE,CIGNA PPO,36.28,,,,,,,22.4500,87.0000,percent of total billed charges,41.7% of $87.00 in Billed Charges for Rev 272 = $36.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING NASOGASTRIC W/ELECTROMAGNETIC TRANSMITTING,272,RC,27202314,CDM,,,,,,both,,,87.0000,13.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,78.30,,,,,,,22.4500,87.0000,percent of total billed charges,90% of $87.00 in Billed Charges for Rev 272 = $78.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING NASOGASTRIC W/ELECTROMAGNETIC TRANSMITTING,272,RC,27202314,CDM,,,,,,both,,,87.0000,13.0500,MEDCOST,MEDCOST VHN,41.40,,,,,,,22.4500,87.0000,percent of total billed charges,47.59% of $87.00 in Billed Charges for Rev 272 = $41.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING NASOGASTRIC W/ELECTROMAGNETIC TRANSMITTING,272,RC,27202314,CDM,,,,,,both,,,87.0000,13.0500,SENTARA HEALTH,SENTARA HEALTH,22.45,,,,,,,22.4500,87.0000,percent of total billed charges,25.81% of $87.00 in Billed Charges for Rev 272 = $22.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING NASOGASTRIC W/ELECTROMAGNETIC TRANSMITTING,272,RC,27202314,CDM,,,,,,both,,,87.0000,13.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",87.00,,,,,,,22.4500,87.0000,percent of total billed charges,100% of $87.00 in Billed Charges for Rev 272 = $87.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING NASOGASTRIC W/ELECTROMAGNETIC TRANSMITTING,272,RC,27202314,CDM,,,,,,both,,,87.0000,13.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,43.50,,,,,,,22.4500,87.0000,percent of total billed charges,Rev 272 $87.00 in Billed Charges at 50% = $43.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING NASOGASTRIC W/ELECTROMAGNETIC TRANSMITTING,272,RC,27202314,CDM,,,,,,both,,,87.0000,13.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,28.10,,,,,,,22.4500,87.0000,other,32.3% of $87.00 in Billed Charges for Rev 272 = $28.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE FEEDING NASOGASTRIC W/ELECTROMAGNETIC TRANSMITTING,272,RC,27202314,CDM,,,,,,both,,,87.0000,13.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,26.71,,,,,,,22.4500,87.0000,other,30.7% of $87.00 in Billed Charges for Rev 272 = $26.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE FEEDING NASOGASTRIC W/ELECTROMAGNETIC TRANSMITTING,272,RC,27202314,CDM,,,,,,both,,,87.0000,13.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,28.10,,,,,,,22.4500,87.0000,percent of total billed charges,32.3% of $87.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TUBE FEEDING NASOGASTRIC W/ELECTROMAGNETIC TRANSMITTING,272,RC,27202314,CDM,,,,,,both,,,87.0000,13.0500,WELLCARE,WELLCARE MEDICAID,87.00,,,,,,,22.4500,87.0000,percent of total billed charges,100% of $87.00 in Billed Charges for Rev 272 = $87.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
INFLATION DEVICE ENCORE,272,RC,27200002,CDM,,,,,,both,,,1430.6800,214.6000,AETNA,AETNA,610.90,,,,,,,369.2600,1430.6800,percent of total billed charges,"42.7% of $1,430.68 in Billed Charges for Rev 272 = $610.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INFLATION DEVICE ENCORE,272,RC,27200002,CDM,,,,,,both,,,1430.6800,214.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1001.48,,,,,,,369.2600,1430.6800,percent of total billed charges,"Rev 272 $1,430.68 in Billed Charges at 70% = $1,001.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INFLATION DEVICE ENCORE,272,RC,27200002,CDM,,,,,,both,,,1430.6800,214.6000,CIGNA HEALTHCARE,CIGNA HMO,596.59,,,,,,,369.2600,1430.6800,percent of total billed charges,"41.7% of $1,430.68 in Billed Charges for Rev 272 = $596.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INFLATION DEVICE ENCORE,272,RC,27200002,CDM,,,,,,both,,,1430.6800,214.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,663.84,,,,,,,369.2600,1430.6800,percent of total billed charges,"46.4% of $1,430.68 in Billed Charges for Rev 272 = $663.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INFLATION DEVICE ENCORE,272,RC,27200002,CDM,,,,,,both,,,1430.6800,214.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,596.59,,,,,,,369.2600,1430.6800,percent of total billed charges,"41.7% of $1,430.68 in Billed Charges for Rev 272 = $596.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INFLATION DEVICE ENCORE,272,RC,27200002,CDM,,,,,,both,,,1430.6800,214.6000,CIGNA HEALTHCARE,CIGNA PPO,596.59,,,,,,,369.2600,1430.6800,percent of total billed charges,"41.7% of $1,430.68 in Billed Charges for Rev 272 = $596.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INFLATION DEVICE ENCORE,272,RC,27200002,CDM,,,,,,both,,,1430.6800,214.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1287.61,,,,,,,369.2600,1430.6800,percent of total billed charges,"90% of $1,430.68 in Billed Charges for Rev 272 = $1,287.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INFLATION DEVICE ENCORE,272,RC,27200002,CDM,,,,,,both,,,1430.6800,214.6000,MEDCOST,MEDCOST VHN,680.86,,,,,,,369.2600,1430.6800,percent of total billed charges,"47.59% of $1,430.68 in Billed Charges for Rev 272 = $680.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INFLATION DEVICE ENCORE,272,RC,27200002,CDM,,,,,,both,,,1430.6800,214.6000,SENTARA HEALTH,SENTARA HEALTH,369.26,,,,,,,369.2600,1430.6800,percent of total billed charges,"25.81% of $1,430.68 in Billed Charges for Rev 272 = $369.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INFLATION DEVICE ENCORE,272,RC,27200002,CDM,,,,,,both,,,1430.6800,214.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1430.68,,,,,,,369.2600,1430.6800,percent of total billed charges,"100% of $1,430.68 in Billed Charges for Rev 272 = $1,430.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INFLATION DEVICE ENCORE,272,RC,27200002,CDM,,,,,,both,,,1430.6800,214.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,715.34,,,,,,,369.2600,1430.6800,percent of total billed charges,"Rev 272 $1,430.68 in Billed Charges at 50% = $715.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INFLATION DEVICE ENCORE,272,RC,27200002,CDM,,,,,,both,,,1430.6800,214.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,462.11,,,,,,,369.2600,1430.6800,other,"32.3% of $1,430.68 in Billed Charges for Rev 272 = $462.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
INFLATION DEVICE ENCORE,272,RC,27200002,CDM,,,,,,both,,,1430.6800,214.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,439.22,,,,,,,369.2600,1430.6800,other,"30.7% of $1,430.68 in Billed Charges for Rev 272 = $439.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
INFLATION DEVICE ENCORE,272,RC,27200002,CDM,,,,,,both,,,1430.6800,214.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,462.11,,,,,,,369.2600,1430.6800,percent of total billed charges,"32.3% of $1,430.68 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INFLATION DEVICE ENCORE,272,RC,27200002,CDM,,,,,,both,,,1430.6800,214.6000,WELLCARE,WELLCARE MEDICAID,1430.68,,,,,,,369.2600,1430.6800,percent of total billed charges,"100% of $1,430.68 in Billed Charges for Rev 272 = $1,430.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US GUIDE VASCULAR ACCESS,76937,CPT,402,RC,40200051,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA,289.08,,,,,,,13.8600,677.0000,percent of total billed charges,42.7% of $677.00 in Billed Charges for Rev 402 Proc 76937 = $289.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDE VASCULAR ACCESS,76937,CPT,402,RC,40200051,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,155.05,,,,,,,13.8600,677.0000,fee schedule,APG 00472 Proc 76937 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 104% = $155.05. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE VASCULAR ACCESS,76937,CPT,402,RC,40200051,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,153.55,,,,,,,13.8600,677.0000,fee schedule,APG 00472 Proc 76937 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 103% = $153.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE VASCULAR ACCESS,76937,CPT,402,RC,40200051,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,24.59,,,,,,,13.8600,677.0000,fee schedule,$24.59 from Fee Schedule BLDTM_23 for Rev 402 Proc 76937 * Qty 1 = $24.59 at 100% = $24.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE VASCULAR ACCESS,76937,CPT,402,RC,40200051,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS E NETWORK,60.32,,,,,,,13.8600,677.0000,fee schedule,$18.85 from Fee Schedule BCFSC for Rev 402 Proc 76937 * Qty 1 = $18.85 at 320% = $60.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE VASCULAR ACCESS,76937,CPT,402,RC,40200051,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS P NETWORK,61.64,,,,,,,13.8600,677.0000,fee schedule,$18.85 from Fee Schedule BCFSC for Rev 402 Proc 76937 * Qty 1 = $18.85 at 327% = $61.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE VASCULAR ACCESS,76937,CPT,402,RC,40200051,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS S NETWORK,61.64,,,,,,,13.8600,677.0000,fee schedule,$18.85 from Fee Schedule BCFSC for Rev 402 Proc 76937 * Qty 1 = $18.85 at 327% = $61.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE VASCULAR ACCESS,76937,CPT,402,RC,40200051,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE CARE,13.86,,,,,,,13.8600,677.0000,fee schedule,$11.95 from Fee Schedule TC_24 for Rev 402 Proc 76937 * Qty 1 = $11.95 at 116% = $13.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE VASCULAR ACCESS,76937,CPT,402,RC,40200051,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE SELECT,13.86,,,,,,,13.8600,677.0000,fee schedule,$11.95 from Fee Schedule TC_24 for Rev 402 Proc 76937 * Qty 1 = $11.95 at 116% = $13.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE VASCULAR ACCESS,76937,CPT,402,RC,40200051,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA HMO,282.31,,,,,,,13.8600,677.0000,percent of total billed charges,Rev 402 Proc 76937 $677.00 in Billed Charges at 41.7% = $282.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDE VASCULAR ACCESS,76937,CPT,402,RC,40200051,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,282.31,,,,,,,13.8600,677.0000,percent of total billed charges,Rev 402 Proc 76937 $677.00 in Billed Charges at 41.7% = $282.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDE VASCULAR ACCESS,76937,CPT,402,RC,40200051,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA PPO,282.31,,,,,,,13.8600,677.0000,percent of total billed charges,Rev 402 Proc 76937 $677.00 in Billed Charges at 41.7% = $282.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDE VASCULAR ACCESS,76937,CPT,402,RC,40200051,CDM,,,,both,,,677.0000,101.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,609.30,,,,,,,13.8600,677.0000,percent of total billed charges,90% of $677.00 in Billed Charges for Rev 402 Proc 76937 = $609.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDE VASCULAR ACCESS,76937,CPT,402,RC,40200051,CDM,,,,both,,,677.0000,101.5500,MEDCOST,MEDCOST VHN,322.18,,,,,,,13.8600,677.0000,percent of total billed charges,47.59% of $677.00 in Billed Charges for Rev 402 Proc 76937 = $322.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDE VASCULAR ACCESS,76937,CPT,402,RC,40200051,CDM,,,,both,,,677.0000,101.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,156.53,,,,,,,13.8600,677.0000,fee schedule,APG 00472 Proc 76937 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 100% = $149.08... $149.08 at 105% = $156.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE VASCULAR ACCESS,76937,CPT,402,RC,40200051,CDM,,,,both,,,677.0000,101.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,153.70,,,,,,,13.8600,677.0000,fee schedule,APG 00472 Proc 76937 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 100% = $149.08... $149.08 at 103.1% = $153.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE VASCULAR ACCESS,76937,CPT,402,RC,40200051,CDM,,,,both,,,677.0000,101.5500,SENTARA HEALTH,SENTARA HEALTH,174.73,,,,,,,13.8600,677.0000,percent of total billed charges,25.81% of $677.00 in Billed Charges for Rev 402 Proc 76937 = $174.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDE VASCULAR ACCESS,76937,CPT,402,RC,40200051,CDM,,,,both,,,677.0000,101.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",677.00,,,,,,,13.8600,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76937 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDE VASCULAR ACCESS,76937,CPT,402,RC,40200051,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,13.8600,677.0000,other,Rev 402 Proc 76937 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE VASCULAR ACCESS,76937,CPT,402,RC,40200051,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,13.8600,677.0000,other,Rev 402 Proc 76937 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE VASCULAR ACCESS,76937,CPT,402,RC,40200051,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,677.00,,,,,,,13.8600,677.0000,other,"Rev 402 Proc 76937 1 Visit at $687.00 per Visit = $687.00 (Service Line reduced to $677.00, claim capped at $677.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE VASCULAR ACCESS,76937,CPT,402,RC,40200051,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,153.55,,,,,,,13.8600,677.0000,fee schedule,APG 00472 Proc 76937 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 103% = $153.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE VASCULAR ACCESS,76937,CPT,402,RC,40200051,CDM,,,,both,,,677.0000,101.5500,WELLCARE,WELLCARE MEDICAID,677.00,,,,,,,13.8600,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76937 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE TISSUE ABLATION,76940,CPT,402,RC,40200073,CDM,,,,both,,,611.0000,91.6500,AETNA,AETNA,260.90,,,,,,,54.3900,611.0000,percent of total billed charges,42.7% of $611.00 in Billed Charges for Rev 402 Proc 76940 = $260.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE TISSUE ABLATION,76940,CPT,402,RC,40200073,CDM,,,,both,,,611.0000,91.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,155.05,,,,,,,54.3900,611.0000,fee schedule,APG 00472 Proc 76940 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 104% = $155.05. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE TISSUE ABLATION,76940,CPT,402,RC,40200073,CDM,,,,both,,,611.0000,91.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,153.55,,,,,,,54.3900,611.0000,fee schedule,APG 00472 Proc 76940 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 103% = $153.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE TISSUE ABLATION,76940,CPT,402,RC,40200073,CDM,,,,both,,,611.0000,91.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,127.09,,,,,,,54.3900,611.0000,fee schedule,$127.09 from Fee Schedule BLDTM_23 for Rev 402 Proc 76940 * Qty 1 = $127.09 at 100% = $127.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE TISSUE ABLATION,76940,CPT,402,RC,40200073,CDM,,,,both,,,611.0000,91.6500,BLUE CROSS,BLUE CROSS E NETWORK,194.46,,,,,,,54.3900,611.0000,fee schedule,$60.77 from Fee Schedule BCFSC for Rev 402 Proc 76940 * Qty 1 = $60.77 at 320% = $194.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE TISSUE ABLATION,76940,CPT,402,RC,40200073,CDM,,,,both,,,611.0000,91.6500,BLUE CROSS,BLUE CROSS P NETWORK,198.72,,,,,,,54.3900,611.0000,fee schedule,$60.77 from Fee Schedule BCFSC for Rev 402 Proc 76940 * Qty 1 = $60.77 at 327% = $198.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE TISSUE ABLATION,76940,CPT,402,RC,40200073,CDM,,,,both,,,611.0000,91.6500,BLUE CROSS,BLUE CROSS S NETWORK,198.72,,,,,,,54.3900,611.0000,fee schedule,$60.77 from Fee Schedule BCFSC for Rev 402 Proc 76940 * Qty 1 = $60.77 at 327% = $198.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE TISSUE ABLATION,76940,CPT,402,RC,40200073,CDM,,,,both,,,611.0000,91.6500,BLUE CROSS,TENNCARE BLUE CARE,54.39,,,,,,,54.3900,611.0000,fee schedule,$46.89 from Fee Schedule TC_24 for Rev 402 Proc 76940 * Qty 1 = $46.89 at 116% = $54.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE TISSUE ABLATION,76940,CPT,402,RC,40200073,CDM,,,,both,,,611.0000,91.6500,BLUE CROSS,TENNCARE BLUE SELECT,54.39,,,,,,,54.3900,611.0000,fee schedule,$46.89 from Fee Schedule TC_24 for Rev 402 Proc 76940 * Qty 1 = $46.89 at 116% = $54.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE TISSUE ABLATION,76940,CPT,402,RC,40200073,CDM,,,,both,,,611.0000,91.6500,CIGNA HEALTHCARE,CIGNA HMO,254.79,,,,,,,54.3900,611.0000,percent of total billed charges,Rev 402 Proc 76940 $611.00 in Billed Charges at 41.7% = $254.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE TISSUE ABLATION,76940,CPT,402,RC,40200073,CDM,,,,both,,,611.0000,91.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,254.79,,,,,,,54.3900,611.0000,percent of total billed charges,Rev 402 Proc 76940 $611.00 in Billed Charges at 41.7% = $254.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE TISSUE ABLATION,76940,CPT,402,RC,40200073,CDM,,,,both,,,611.0000,91.6500,CIGNA HEALTHCARE,CIGNA PPO,254.79,,,,,,,54.3900,611.0000,percent of total billed charges,Rev 402 Proc 76940 $611.00 in Billed Charges at 41.7% = $254.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE TISSUE ABLATION,76940,CPT,402,RC,40200073,CDM,,,,both,,,611.0000,91.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,549.90,,,,,,,54.3900,611.0000,percent of total billed charges,90% of $611.00 in Billed Charges for Rev 402 Proc 76940 = $549.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE TISSUE ABLATION,76940,CPT,402,RC,40200073,CDM,,,,both,,,611.0000,91.6500,MEDCOST,MEDCOST VHN,290.77,,,,,,,54.3900,611.0000,percent of total billed charges,47.59% of $611.00 in Billed Charges for Rev 402 Proc 76940 = $290.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE TISSUE ABLATION,76940,CPT,402,RC,40200073,CDM,,,,both,,,611.0000,91.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,156.53,,,,,,,54.3900,611.0000,fee schedule,APG 00472 Proc 76940 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 100% = $149.08... $149.08 at 105% = $156.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE TISSUE ABLATION,76940,CPT,402,RC,40200073,CDM,,,,both,,,611.0000,91.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,153.70,,,,,,,54.3900,611.0000,fee schedule,APG 00472 Proc 76940 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 100% = $149.08... $149.08 at 103.1% = $153.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE TISSUE ABLATION,76940,CPT,402,RC,40200073,CDM,,,,both,,,611.0000,91.6500,SENTARA HEALTH,SENTARA HEALTH,157.70,,,,,,,54.3900,611.0000,percent of total billed charges,25.81% of $611.00 in Billed Charges for Rev 402 Proc 76940 = $157.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE TISSUE ABLATION,76940,CPT,402,RC,40200073,CDM,,,,both,,,611.0000,91.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",611.00,,,,,,,54.3900,611.0000,percent of total billed charges,100% of $611.00 in Billed Charges for Rev 402 Proc 76940 = $611.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE TISSUE ABLATION,76940,CPT,402,RC,40200073,CDM,,,,both,,,611.0000,91.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,54.3900,611.0000,other,Rev 402 Proc 76940 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE TISSUE ABLATION,76940,CPT,402,RC,40200073,CDM,,,,both,,,611.0000,91.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,54.3900,611.0000,other,Rev 402 Proc 76940 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE TISSUE ABLATION,76940,CPT,402,RC,40200073,CDM,,,,both,,,611.0000,91.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,611.00,,,,,,,54.3900,611.0000,other,"Rev 402 Proc 76940 1 Visit at $687.00 per Visit = $687.00 (Service Line reduced to $611.00, claim capped at $611.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDANCE TISSUE ABLATION,76940,CPT,402,RC,40200073,CDM,,,,both,,,611.0000,91.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,153.55,,,,,,,54.3900,611.0000,fee schedule,APG 00472 Proc 76940 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 103% = $153.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE TISSUE ABLATION,76940,CPT,402,RC,40200073,CDM,,,,both,,,611.0000,91.6500,WELLCARE,WELLCARE MEDICAID,611.00,,,,,,,54.3900,611.0000,percent of total billed charges,100% of $611.00 in Billed Charges for Rev 402 Proc 76940 = $611.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE NEEDLE PLACEMENT SI,76942,CPT,402,RC,40200052,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA,289.08,,,,,,,50.2300,677.0000,percent of total billed charges,42.7% of $677.00 in Billed Charges for Rev 402 Proc 76942 = $289.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE NEEDLE PLACEMENT SI,76942,CPT,402,RC,40200052,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,155.05,,,,,,,50.2300,677.0000,fee schedule,APG 00472 Proc 76942 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 104% = $155.05. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE NEEDLE PLACEMENT SI,76942,CPT,402,RC,40200052,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,153.55,,,,,,,50.2300,677.0000,fee schedule,APG 00472 Proc 76942 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 103% = $153.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE NEEDLE PLACEMENT SI,76942,CPT,402,RC,40200052,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,87.26,,,,,,,50.2300,677.0000,fee schedule,$87.26 from Fee Schedule BLDTM_23 for Rev 402 Proc 76942 * Qty 1 = $87.26 at 100% = $87.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE NEEDLE PLACEMENT SI,76942,CPT,402,RC,40200052,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS E NETWORK,114.88,,,,,,,50.2300,677.0000,fee schedule,$35.90 from Fee Schedule BCFSC for Rev 402 Proc 76942 * Qty 1 = $35.90 at 320% = $114.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE NEEDLE PLACEMENT SI,76942,CPT,402,RC,40200052,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS P NETWORK,117.39,,,,,,,50.2300,677.0000,fee schedule,$35.90 from Fee Schedule BCFSC for Rev 402 Proc 76942 * Qty 1 = $35.90 at 327% = $117.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE NEEDLE PLACEMENT SI,76942,CPT,402,RC,40200052,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS S NETWORK,117.39,,,,,,,50.2300,677.0000,fee schedule,$35.90 from Fee Schedule BCFSC for Rev 402 Proc 76942 * Qty 1 = $35.90 at 327% = $117.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE NEEDLE PLACEMENT SI,76942,CPT,402,RC,40200052,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE CARE,50.23,,,,,,,50.2300,677.0000,fee schedule,$43.30 from Fee Schedule TC_24 for Rev 402 Proc 76942 * Qty 1 = $43.30 at 116% = $50.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE NEEDLE PLACEMENT SI,76942,CPT,402,RC,40200052,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE SELECT,50.23,,,,,,,50.2300,677.0000,fee schedule,$43.30 from Fee Schedule TC_24 for Rev 402 Proc 76942 * Qty 1 = $43.30 at 116% = $50.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE NEEDLE PLACEMENT SI,76942,CPT,402,RC,40200052,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA HMO,282.31,,,,,,,50.2300,677.0000,percent of total billed charges,Rev 402 Proc 76942 $677.00 in Billed Charges at 41.7% = $282.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE NEEDLE PLACEMENT SI,76942,CPT,402,RC,40200052,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,282.31,,,,,,,50.2300,677.0000,percent of total billed charges,Rev 402 Proc 76942 $677.00 in Billed Charges at 41.7% = $282.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE NEEDLE PLACEMENT SI,76942,CPT,402,RC,40200052,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA PPO,282.31,,,,,,,50.2300,677.0000,percent of total billed charges,Rev 402 Proc 76942 $677.00 in Billed Charges at 41.7% = $282.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE NEEDLE PLACEMENT SI,76942,CPT,402,RC,40200052,CDM,,,,both,,,677.0000,101.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,609.30,,,,,,,50.2300,677.0000,percent of total billed charges,90% of $677.00 in Billed Charges for Rev 402 Proc 76942 = $609.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE NEEDLE PLACEMENT SI,76942,CPT,402,RC,40200052,CDM,,,,both,,,677.0000,101.5500,MEDCOST,MEDCOST VHN,322.18,,,,,,,50.2300,677.0000,percent of total billed charges,47.59% of $677.00 in Billed Charges for Rev 402 Proc 76942 = $322.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE NEEDLE PLACEMENT SI,76942,CPT,402,RC,40200052,CDM,,,,both,,,677.0000,101.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,156.53,,,,,,,50.2300,677.0000,fee schedule,APG 00472 Proc 76942 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 100% = $149.08... $149.08 at 105% = $156.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE NEEDLE PLACEMENT SI,76942,CPT,402,RC,40200052,CDM,,,,both,,,677.0000,101.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,153.70,,,,,,,50.2300,677.0000,fee schedule,APG 00472 Proc 76942 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 100% = $149.08... $149.08 at 103.1% = $153.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE NEEDLE PLACEMENT SI,76942,CPT,402,RC,40200052,CDM,,,,both,,,677.0000,101.5500,SENTARA HEALTH,SENTARA HEALTH,174.73,,,,,,,50.2300,677.0000,percent of total billed charges,25.81% of $677.00 in Billed Charges for Rev 402 Proc 76942 = $174.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE NEEDLE PLACEMENT SI,76942,CPT,402,RC,40200052,CDM,,,,both,,,677.0000,101.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",677.00,,,,,,,50.2300,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76942 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE NEEDLE PLACEMENT SI,76942,CPT,402,RC,40200052,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,50.2300,677.0000,other,Rev 402 Proc 76942 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE NEEDLE PLACEMENT SI,76942,CPT,402,RC,40200052,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,50.2300,677.0000,other,Rev 402 Proc 76942 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE NEEDLE PLACEMENT SI,76942,CPT,402,RC,40200052,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,677.00,,,,,,,50.2300,677.0000,other,"Rev 402 Proc 76942 1 Visit at $687.00 per Visit = $687.00 (Service Line reduced to $677.00, claim capped at $677.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDANCE NEEDLE PLACEMENT SI,76942,CPT,402,RC,40200052,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,153.55,,,,,,,50.2300,677.0000,fee schedule,APG 00472 Proc 76942 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 103% = $153.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE NEEDLE PLACEMENT SI,76942,CPT,402,RC,40200052,CDM,,,,both,,,677.0000,101.5500,WELLCARE,WELLCARE MEDICAID,677.00,,,,,,,50.2300,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76942 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US AMNIOCENTESIS SI,76946,CPT,402,RC,40200059,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA,289.08,,,,,,,37.6600,677.0000,percent of total billed charges,42.7% of $677.00 in Billed Charges for Rev 402 Proc 76946 = $289.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US AMNIOCENTESIS SI,76946,CPT,402,RC,40200059,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,155.05,,,,,,,37.6600,677.0000,fee schedule,APG 00472 Proc 76946 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 104% = $155.05. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US AMNIOCENTESIS SI,76946,CPT,402,RC,40200059,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,153.55,,,,,,,37.6600,677.0000,fee schedule,APG 00472 Proc 76946 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 103% = $153.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US AMNIOCENTESIS SI,76946,CPT,402,RC,40200059,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,72.05,,,,,,,37.6600,677.0000,fee schedule,$72.05 from Fee Schedule BLDTM_23 for Rev 402 Proc 76946 * Qty 1 = $72.05 at 100% = $72.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US AMNIOCENTESIS SI,76946,CPT,402,RC,40200059,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS E NETWORK,37.66,,,,,,,37.6600,677.0000,fee schedule,$11.77 from Fee Schedule BCFSC for Rev 402 Proc 76946 * Qty 1 = $11.77 at 320% = $37.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US AMNIOCENTESIS SI,76946,CPT,402,RC,40200059,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS P NETWORK,38.49,,,,,,,37.6600,677.0000,fee schedule,$11.77 from Fee Schedule BCFSC for Rev 402 Proc 76946 * Qty 1 = $11.77 at 327% = $38.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US AMNIOCENTESIS SI,76946,CPT,402,RC,40200059,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS S NETWORK,38.49,,,,,,,37.6600,677.0000,fee schedule,$11.77 from Fee Schedule BCFSC for Rev 402 Proc 76946 * Qty 1 = $11.77 at 327% = $38.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US AMNIOCENTESIS SI,76946,CPT,402,RC,40200059,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE CARE,50.23,,,,,,,37.6600,677.0000,fee schedule,$43.30 from Fee Schedule TC_24 for Rev 402 Proc 76946 * Qty 1 = $43.30 at 116% = $50.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US AMNIOCENTESIS SI,76946,CPT,402,RC,40200059,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE SELECT,50.23,,,,,,,37.6600,677.0000,fee schedule,$43.30 from Fee Schedule TC_24 for Rev 402 Proc 76946 * Qty 1 = $43.30 at 116% = $50.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US AMNIOCENTESIS SI,76946,CPT,402,RC,40200059,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA HMO,282.31,,,,,,,37.6600,677.0000,percent of total billed charges,Rev 402 Proc 76946 $677.00 in Billed Charges at 41.7% = $282.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US AMNIOCENTESIS SI,76946,CPT,402,RC,40200059,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,282.31,,,,,,,37.6600,677.0000,percent of total billed charges,Rev 402 Proc 76946 $677.00 in Billed Charges at 41.7% = $282.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US AMNIOCENTESIS SI,76946,CPT,402,RC,40200059,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA PPO,282.31,,,,,,,37.6600,677.0000,percent of total billed charges,Rev 402 Proc 76946 $677.00 in Billed Charges at 41.7% = $282.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US AMNIOCENTESIS SI,76946,CPT,402,RC,40200059,CDM,,,,both,,,677.0000,101.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,609.30,,,,,,,37.6600,677.0000,percent of total billed charges,90% of $677.00 in Billed Charges for Rev 402 Proc 76946 = $609.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US AMNIOCENTESIS SI,76946,CPT,402,RC,40200059,CDM,,,,both,,,677.0000,101.5500,MEDCOST,MEDCOST VHN,322.18,,,,,,,37.6600,677.0000,percent of total billed charges,47.59% of $677.00 in Billed Charges for Rev 402 Proc 76946 = $322.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US AMNIOCENTESIS SI,76946,CPT,402,RC,40200059,CDM,,,,both,,,677.0000,101.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,156.53,,,,,,,37.6600,677.0000,fee schedule,APG 00472 Proc 76946 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 100% = $149.08... $149.08 at 105% = $156.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US AMNIOCENTESIS SI,76946,CPT,402,RC,40200059,CDM,,,,both,,,677.0000,101.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,153.70,,,,,,,37.6600,677.0000,fee schedule,APG 00472 Proc 76946 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 100% = $149.08... $149.08 at 103.1% = $153.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US AMNIOCENTESIS SI,76946,CPT,402,RC,40200059,CDM,,,,both,,,677.0000,101.5500,SENTARA HEALTH,SENTARA HEALTH,174.73,,,,,,,37.6600,677.0000,percent of total billed charges,25.81% of $677.00 in Billed Charges for Rev 402 Proc 76946 = $174.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US AMNIOCENTESIS SI,76946,CPT,402,RC,40200059,CDM,,,,both,,,677.0000,101.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",677.00,,,,,,,37.6600,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76946 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US AMNIOCENTESIS SI,76946,CPT,402,RC,40200059,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,37.6600,677.0000,other,Rev 402 Proc 76946 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US AMNIOCENTESIS SI,76946,CPT,402,RC,40200059,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,37.6600,677.0000,other,Rev 402 Proc 76946 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US AMNIOCENTESIS SI,76946,CPT,402,RC,40200059,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,677.00,,,,,,,37.6600,677.0000,other,"Rev 402 Proc 76946 1 Visit at $687.00 per Visit = $687.00 (Service Line reduced to $677.00, claim capped at $677.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US AMNIOCENTESIS SI,76946,CPT,402,RC,40200059,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,153.55,,,,,,,37.6600,677.0000,fee schedule,APG 00472 Proc 76946 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 103% = $153.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US AMNIOCENTESIS SI,76946,CPT,402,RC,40200059,CDM,,,,both,,,677.0000,101.5500,WELLCARE,WELLCARE MEDICAID,677.00,,,,,,,37.6600,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76946 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUID INTERSTITIAL RADIOELEM APPL,76965,CPT,402,RC,40200076,CDM,,,,both,,,1117.0000,167.5500,AETNA,AETNA,476.96,,,,,,,67.5200,1117.0000,percent of total billed charges,"42.7% of $1,117.00 in Billed Charges for Rev 402 Proc 76965 = $476.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US GUID INTERSTITIAL RADIOELEM APPL,76965,CPT,402,RC,40200076,CDM,,,,both,,,1117.0000,167.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,155.05,,,,,,,67.5200,1117.0000,fee schedule,APG 00472 Proc 76965 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 104% = $155.05. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID INTERSTITIAL RADIOELEM APPL,76965,CPT,402,RC,40200076,CDM,,,,both,,,1117.0000,167.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,153.55,,,,,,,67.5200,1117.0000,fee schedule,APG 00472 Proc 76965 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 103% = $153.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID INTERSTITIAL RADIOELEM APPL,76965,CPT,402,RC,40200076,CDM,,,,both,,,1117.0000,167.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,286.00,,,,,,,67.5200,1117.0000,fee schedule,$286.00 from Fee Schedule BLDTM_23 for Rev 402 Proc 76965 * Qty 1 = $286.00 at 100% = $286.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID INTERSTITIAL RADIOELEM APPL,76965,CPT,402,RC,40200076,CDM,,,,both,,,1117.0000,167.5500,BLUE CROSS,BLUE CROSS E NETWORK,67.52,,,,,,,67.5200,1117.0000,fee schedule,$21.10 from Fee Schedule BCFSC for Rev 402 Proc 76965 * Qty 1 = $21.10 at 320% = $67.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID INTERSTITIAL RADIOELEM APPL,76965,CPT,402,RC,40200076,CDM,,,,both,,,1117.0000,167.5500,BLUE CROSS,BLUE CROSS P NETWORK,69.00,,,,,,,67.5200,1117.0000,fee schedule,$21.10 from Fee Schedule BCFSC for Rev 402 Proc 76965 * Qty 1 = $21.10 at 327% = $69.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID INTERSTITIAL RADIOELEM APPL,76965,CPT,402,RC,40200076,CDM,,,,both,,,1117.0000,167.5500,BLUE CROSS,BLUE CROSS S NETWORK,69.00,,,,,,,67.5200,1117.0000,fee schedule,$21.10 from Fee Schedule BCFSC for Rev 402 Proc 76965 * Qty 1 = $21.10 at 327% = $69.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID INTERSTITIAL RADIOELEM APPL,76965,CPT,402,RC,40200076,CDM,,,,both,,,1117.0000,167.5500,BLUE CROSS,TENNCARE BLUE CARE,298.39,,,,,,,67.5200,1117.0000,fee schedule,$257.23 from Fee Schedule TC_24 for Rev 402 Proc 76965 * Qty 1 = $257.23 at 116% = $298.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID INTERSTITIAL RADIOELEM APPL,76965,CPT,402,RC,40200076,CDM,,,,both,,,1117.0000,167.5500,BLUE CROSS,TENNCARE BLUE SELECT,298.39,,,,,,,67.5200,1117.0000,fee schedule,$257.23 from Fee Schedule TC_24 for Rev 402 Proc 76965 * Qty 1 = $257.23 at 116% = $298.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID INTERSTITIAL RADIOELEM APPL,76965,CPT,402,RC,40200076,CDM,,,,both,,,1117.0000,167.5500,CIGNA HEALTHCARE,CIGNA HMO,465.79,,,,,,,67.5200,1117.0000,percent of total billed charges,"Rev 402 Proc 76965 $1,117.00 in Billed Charges at 41.7% = $465.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US GUID INTERSTITIAL RADIOELEM APPL,76965,CPT,402,RC,40200076,CDM,,,,both,,,1117.0000,167.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,465.79,,,,,,,67.5200,1117.0000,percent of total billed charges,"Rev 402 Proc 76965 $1,117.00 in Billed Charges at 41.7% = $465.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US GUID INTERSTITIAL RADIOELEM APPL,76965,CPT,402,RC,40200076,CDM,,,,both,,,1117.0000,167.5500,CIGNA HEALTHCARE,CIGNA PPO,465.79,,,,,,,67.5200,1117.0000,percent of total billed charges,"Rev 402 Proc 76965 $1,117.00 in Billed Charges at 41.7% = $465.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US GUID INTERSTITIAL RADIOELEM APPL,76965,CPT,402,RC,40200076,CDM,,,,both,,,1117.0000,167.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1005.30,,,,,,,67.5200,1117.0000,percent of total billed charges,"90% of $1,117.00 in Billed Charges for Rev 402 Proc 76965 = $1,005.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US GUID INTERSTITIAL RADIOELEM APPL,76965,CPT,402,RC,40200076,CDM,,,,both,,,1117.0000,167.5500,MEDCOST,MEDCOST VHN,531.58,,,,,,,67.5200,1117.0000,percent of total billed charges,"47.59% of $1,117.00 in Billed Charges for Rev 402 Proc 76965 = $531.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US GUID INTERSTITIAL RADIOELEM APPL,76965,CPT,402,RC,40200076,CDM,,,,both,,,1117.0000,167.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,156.53,,,,,,,67.5200,1117.0000,fee schedule,APG 00472 Proc 76965 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 100% = $149.08... $149.08 at 105% = $156.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID INTERSTITIAL RADIOELEM APPL,76965,CPT,402,RC,40200076,CDM,,,,both,,,1117.0000,167.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,153.70,,,,,,,67.5200,1117.0000,fee schedule,APG 00472 Proc 76965 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 100% = $149.08... $149.08 at 103.1% = $153.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID INTERSTITIAL RADIOELEM APPL,76965,CPT,402,RC,40200076,CDM,,,,both,,,1117.0000,167.5500,SENTARA HEALTH,SENTARA HEALTH,288.30,,,,,,,67.5200,1117.0000,percent of total billed charges,"25.81% of $1,117.00 in Billed Charges for Rev 402 Proc 76965 = $288.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US GUID INTERSTITIAL RADIOELEM APPL,76965,CPT,402,RC,40200076,CDM,,,,both,,,1117.0000,167.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1117.00,,,,,,,67.5200,1117.0000,percent of total billed charges,"100% of $1,117.00 in Billed Charges for Rev 402 Proc 76965 = $1,117.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US GUID INTERSTITIAL RADIOELEM APPL,76965,CPT,402,RC,40200076,CDM,,,,both,,,1117.0000,167.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,67.5200,1117.0000,other,Rev 402 Proc 76965 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID INTERSTITIAL RADIOELEM APPL,76965,CPT,402,RC,40200076,CDM,,,,both,,,1117.0000,167.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,67.5200,1117.0000,other,Rev 402 Proc 76965 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID INTERSTITIAL RADIOELEM APPL,76965,CPT,402,RC,40200076,CDM,,,,both,,,1117.0000,167.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,687.00,,,,,,,67.5200,1117.0000,other,Rev 402 Proc 76965 1 Visit at $687.00 per Visit = $687.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID INTERSTITIAL RADIOELEM APPL,76965,CPT,402,RC,40200076,CDM,,,,both,,,1117.0000,167.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,153.55,,,,,,,67.5200,1117.0000,fee schedule,APG 00472 Proc 76965 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 103% = $153.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID INTERSTITIAL RADIOELEM APPL,76965,CPT,402,RC,40200076,CDM,,,,both,,,1117.0000,167.5500,WELLCARE,WELLCARE MEDICAID,1117.00,,,,,,,67.5200,1117.0000,percent of total billed charges,"100% of $1,117.00 in Billed Charges for Rev 402 Proc 76965 = $1,117.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA,289.08,,,,,,,56.2600,677.0000,percent of total billed charges,42.7% of $677.00 in Billed Charges for Rev 402 Proc 76981 = $289.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,156.09,,,,,,,56.2600,677.0000,fee schedule,APG 00288 Proc 76981 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 104% = $156.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,56.2600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,56.2600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,56.2600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,AMBETTER,AMBETTER,206.78,,,,,,,56.2600,677.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,56.2600,677.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,56.2600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,154.59,,,,,,,56.2600,677.0000,fee schedule,APG 00288 Proc 76981 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 103% = $154.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,56.2600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,56.2600,677.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,56.2600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,473.90,,,,,,,56.2600,677.0000,percent of total billed charges,Rev 402 Proc 76981 $677.00 in Billed Charges at 70% = $473.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS E NETWORK,227.14,,,,,,,56.2600,677.0000,fee schedule,$70.98 from Fee Schedule BCFSC for Rev 402 Proc 76981 * Qty 1 = $70.98 at 320% = $227.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,56.2600,677.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS P NETWORK,232.10,,,,,,,56.2600,677.0000,fee schedule,$70.98 from Fee Schedule BCFSC for Rev 402 Proc 76981 * Qty 1 = $70.98 at 327% = $232.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS S NETWORK,232.10,,,,,,,56.2600,677.0000,fee schedule,$70.98 from Fee Schedule BCFSC for Rev 402 Proc 76981 * Qty 1 = $70.98 at 327% = $232.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE CARE,66.90,,,,,,,56.2600,677.0000,fee schedule,$57.67 from Fee Schedule TC_24 for Rev 402 Proc 76981 * Qty 1 = $57.67 at 116% = $66.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE SELECT,66.90,,,,,,,56.2600,677.0000,fee schedule,$57.67 from Fee Schedule TC_24 for Rev 402 Proc 76981 * Qty 1 = $57.67 at 116% = $66.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA HMO,282.31,,,,,,,56.2600,677.0000,percent of total billed charges,Rev 402 Proc 76981 $677.00 in Billed Charges at 41.7% = $282.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,143.19,,,,,,,56.2600,677.0000,fee schedule,$143.19 from Fee Schedule CGIFP_25LR for Rev 402 Proc 76981 * Qty 1 = $143.19 at 100% = $143.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,56.2600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,282.31,,,,,,,56.2600,677.0000,percent of total billed charges,Rev 402 Proc 76981 $677.00 in Billed Charges at 41.7% = $282.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA PPO,282.31,,,,,,,56.2600,677.0000,percent of total billed charges,Rev 402 Proc 76981 $677.00 in Billed Charges at 41.7% = $282.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,56.2600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,609.30,,,,,,,56.2600,677.0000,percent of total billed charges,90% of $677.00 in Billed Charges for Rev 402 Proc 76981 = $609.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,HUMANA,HUMANA MEDICARE,94.85,,,,,,,56.2600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,56.2600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,MEDCOST,MEDCOST VHN,322.18,,,,,,,56.2600,677.0000,percent of total billed charges,47.59% of $677.00 in Billed Charges for Rev 402 Proc 76981 = $322.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,157.59,,,,,,,56.2600,677.0000,fee schedule,APG 00288 Proc 76981 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 100% = $150.09... $150.09 at 105% = $157.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,56.2600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,56.2600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,56.2600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,154.74,,,,,,,56.2600,677.0000,fee schedule,APG 00288 Proc 76981 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 100% = $150.09... $150.09 at 103.1% = $154.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,SENTARA HEALTH,SENTARA HEALTH,174.73,,,,,,,56.2600,677.0000,percent of total billed charges,25.81% of $677.00 in Billed Charges for Rev 402 Proc 76981 = $174.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,56.2600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",677.00,,,,,,,56.2600,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76981 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,56.26,,,,,,,56.2600,677.0000,fee schedule,$112.51 from Fee Schedule TCUHC24 for Rev 402 Proc 76981 * Qty 1 = $112.51 at 50% = $56.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,56.2600,677.0000,other,Rev 402 Proc 76981 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,56.2600,677.0000,other,Rev 402 Proc 76981 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,677.00,,,,,,,56.2600,677.0000,other,"Rev 402 Proc 76981 1 Visit at $687.00 per Visit = $687.00 (Service Line reduced to $677.00, claim capped at $677.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,154.59,,,,,,,56.2600,677.0000,fee schedule,APG 00288 Proc 76981 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 103% = $154.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,56.2600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,56.2600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,WELLCARE,WELLCARE MEDICAID,677.00,,,,,,,56.2600,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76981 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US ELASTOGRAPHY PARENCHYMA,76981,CPT,402,RC,40200080,CDM,,,,both,,,677.0000,101.5500,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,56.2600,677.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,AETNA,AETNA,432.98,,,,,,,56.2600,1014.0000,percent of total billed charges,"42.7% of $1,014.00 in Billed Charges for Rev 402 Proc 76982 = $432.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,156.09,,,,,,,56.2600,1014.0000,fee schedule,APG 00288 Proc 76982 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 104% = $156.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,56.2600,1014.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,56.2600,1014.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,56.2600,1014.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,AMBETTER,AMBETTER,206.78,,,,,,,56.2600,1014.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,56.2600,1014.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,56.2600,1014.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,154.59,,,,,,,56.2600,1014.0000,fee schedule,APG 00288 Proc 76982 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 103% = $154.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,56.2600,1014.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,56.2600,1014.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,56.2600,1014.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,709.80,,,,,,,56.2600,1014.0000,percent of total billed charges,"Rev 402 Proc 76982 $1,014.00 in Billed Charges at 70% = $709.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,BLUE CROSS,BLUE CROSS E NETWORK,193.89,,,,,,,56.2600,1014.0000,fee schedule,$60.59 from Fee Schedule BCFSC for Rev 402 Proc 76982 * Qty 1 = $60.59 at 320% = $193.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,56.2600,1014.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,BLUE CROSS,BLUE CROSS P NETWORK,198.13,,,,,,,56.2600,1014.0000,fee schedule,$60.59 from Fee Schedule BCFSC for Rev 402 Proc 76982 * Qty 1 = $60.59 at 327% = $198.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,BLUE CROSS,BLUE CROSS S NETWORK,198.13,,,,,,,56.2600,1014.0000,fee schedule,$60.59 from Fee Schedule BCFSC for Rev 402 Proc 76982 * Qty 1 = $60.59 at 327% = $198.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,BLUE CROSS,TENNCARE BLUE CARE,57.11,,,,,,,56.2600,1014.0000,fee schedule,$49.23 from Fee Schedule TC_24 for Rev 402 Proc 76982 * Qty 1 = $49.23 at 116% = $57.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,BLUE CROSS,TENNCARE BLUE SELECT,57.11,,,,,,,56.2600,1014.0000,fee schedule,$49.23 from Fee Schedule TC_24 for Rev 402 Proc 76982 * Qty 1 = $49.23 at 116% = $57.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,CIGNA HEALTHCARE,CIGNA HMO,422.84,,,,,,,56.2600,1014.0000,percent of total billed charges,"Rev 402 Proc 76982 $1,014.00 in Billed Charges at 41.7% = $422.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,122.52,,,,,,,56.2600,1014.0000,fee schedule,$122.52 from Fee Schedule CGIFP_25LR for Rev 402 Proc 76982 * Qty 1 = $122.52 at 100% = $122.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,56.2600,1014.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,422.84,,,,,,,56.2600,1014.0000,percent of total billed charges,"Rev 402 Proc 76982 $1,014.00 in Billed Charges at 41.7% = $422.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,CIGNA HEALTHCARE,CIGNA PPO,422.84,,,,,,,56.2600,1014.0000,percent of total billed charges,"Rev 402 Proc 76982 $1,014.00 in Billed Charges at 41.7% = $422.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,56.2600,1014.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,912.60,,,,,,,56.2600,1014.0000,percent of total billed charges,"90% of $1,014.00 in Billed Charges for Rev 402 Proc 76982 = $912.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,HUMANA,HUMANA MEDICARE,94.85,,,,,,,56.2600,1014.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,56.2600,1014.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,MEDCOST,MEDCOST VHN,482.56,,,,,,,56.2600,1014.0000,percent of total billed charges,"47.59% of $1,014.00 in Billed Charges for Rev 402 Proc 76982 = $482.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,157.59,,,,,,,56.2600,1014.0000,fee schedule,APG 00288 Proc 76982 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 100% = $150.09... $150.09 at 105% = $157.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,56.2600,1014.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,56.2600,1014.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,56.2600,1014.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,154.74,,,,,,,56.2600,1014.0000,fee schedule,APG 00288 Proc 76982 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 100% = $150.09... $150.09 at 103.1% = $154.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,SENTARA HEALTH,SENTARA HEALTH,261.71,,,,,,,56.2600,1014.0000,percent of total billed charges,"25.81% of $1,014.00 in Billed Charges for Rev 402 Proc 76982 = $261.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,56.2600,1014.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1014.00,,,,,,,56.2600,1014.0000,percent of total billed charges,"100% of $1,014.00 in Billed Charges for Rev 402 Proc 76982 = $1,014.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,56.26,,,,,,,56.2600,1014.0000,fee schedule,$112.51 from Fee Schedule TCUHC24 for Rev 402 Proc 76982 * Qty 1 = $112.51 at 50% = $56.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,56.2600,1014.0000,other,Rev 402 Proc 76982 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,56.2600,1014.0000,other,Rev 402 Proc 76982 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,687.00,,,,,,,56.2600,1014.0000,other,Rev 402 Proc 76982 1 Visit at $687.00 per Visit = $687.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,154.59,,,,,,,56.2600,1014.0000,fee schedule,APG 00288 Proc 76982 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 103% = $154.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,56.2600,1014.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,56.2600,1014.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,WELLCARE,WELLCARE MEDICAID,1014.00,,,,,,,56.2600,1014.0000,percent of total billed charges,"100% of $1,014.00 in Billed Charges for Rev 402 Proc 76982 = $1,014.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US ELASTOGRAPHY 1ST LESION,76982,CPT,402,RC,40200081,CDM,,,,both,,,1014.0000,152.1000,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,56.2600,1014.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY EA ADDL LESION,76983,CPT,402,RC,40200082,CDM,,,,both,,,609.0000,91.3500,AETNA,AETNA,260.04,,,,,,,29.0800,609.0000,percent of total billed charges,42.7% of $609.00 in Billed Charges for Rev 402 Proc 76983 = $260.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US ELASTOGRAPHY EA ADDL LESION,76983,CPT,402,RC,40200082,CDM,,,,both,,,609.0000,91.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,156.09,,,,,,,29.0800,609.0000,fee schedule,APG 00288 Proc 76983 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 104% = $156.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY EA ADDL LESION,76983,CPT,402,RC,40200082,CDM,,,,both,,,609.0000,91.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,154.59,,,,,,,29.0800,609.0000,fee schedule,APG 00288 Proc 76983 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 103% = $154.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY EA ADDL LESION,76983,CPT,402,RC,40200082,CDM,,,,both,,,609.0000,91.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,426.30,,,,,,,29.0800,609.0000,percent of total billed charges,Rev 402 Proc 76983 $609.00 in Billed Charges at 70% = $426.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US ELASTOGRAPHY EA ADDL LESION,76983,CPT,402,RC,40200082,CDM,,,,both,,,609.0000,91.3500,BLUE CROSS,BLUE CROSS E NETWORK,98.72,,,,,,,29.0800,609.0000,fee schedule,$30.85 from Fee Schedule BCFSC for Rev 402 Proc 76983 * Qty 1 = $30.85 at 320% = $98.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY EA ADDL LESION,76983,CPT,402,RC,40200082,CDM,,,,both,,,609.0000,91.3500,BLUE CROSS,BLUE CROSS P NETWORK,100.88,,,,,,,29.0800,609.0000,fee schedule,$30.85 from Fee Schedule BCFSC for Rev 402 Proc 76983 * Qty 1 = $30.85 at 327% = $100.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY EA ADDL LESION,76983,CPT,402,RC,40200082,CDM,,,,both,,,609.0000,91.3500,BLUE CROSS,BLUE CROSS S NETWORK,100.88,,,,,,,29.0800,609.0000,fee schedule,$30.85 from Fee Schedule BCFSC for Rev 402 Proc 76983 * Qty 1 = $30.85 at 327% = $100.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY EA ADDL LESION,76983,CPT,402,RC,40200082,CDM,,,,both,,,609.0000,91.3500,BLUE CROSS,TENNCARE BLUE CARE,29.08,,,,,,,29.0800,609.0000,fee schedule,$25.07 from Fee Schedule TC_24 for Rev 402 Proc 76983 * Qty 1 = $25.07 at 116% = $29.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY EA ADDL LESION,76983,CPT,402,RC,40200082,CDM,,,,both,,,609.0000,91.3500,BLUE CROSS,TENNCARE BLUE SELECT,29.08,,,,,,,29.0800,609.0000,fee schedule,$25.07 from Fee Schedule TC_24 for Rev 402 Proc 76983 * Qty 1 = $25.07 at 116% = $29.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY EA ADDL LESION,76983,CPT,402,RC,40200082,CDM,,,,both,,,609.0000,91.3500,CIGNA HEALTHCARE,CIGNA HMO,253.95,,,,,,,29.0800,609.0000,percent of total billed charges,Rev 402 Proc 76983 $609.00 in Billed Charges at 41.7% = $253.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US ELASTOGRAPHY EA ADDL LESION,76983,CPT,402,RC,40200082,CDM,,,,both,,,609.0000,91.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,253.95,,,,,,,29.0800,609.0000,percent of total billed charges,Rev 402 Proc 76983 $609.00 in Billed Charges at 41.7% = $253.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US ELASTOGRAPHY EA ADDL LESION,76983,CPT,402,RC,40200082,CDM,,,,both,,,609.0000,91.3500,CIGNA HEALTHCARE,CIGNA PPO,253.95,,,,,,,29.0800,609.0000,percent of total billed charges,Rev 402 Proc 76983 $609.00 in Billed Charges at 41.7% = $253.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US ELASTOGRAPHY EA ADDL LESION,76983,CPT,402,RC,40200082,CDM,,,,both,,,609.0000,91.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,548.10,,,,,,,29.0800,609.0000,percent of total billed charges,90% of $609.00 in Billed Charges for Rev 402 Proc 76983 = $548.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US ELASTOGRAPHY EA ADDL LESION,76983,CPT,402,RC,40200082,CDM,,,,both,,,609.0000,91.3500,MEDCOST,MEDCOST VHN,289.82,,,,,,,29.0800,609.0000,percent of total billed charges,47.59% of $609.00 in Billed Charges for Rev 402 Proc 76983 = $289.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US ELASTOGRAPHY EA ADDL LESION,76983,CPT,402,RC,40200082,CDM,,,,both,,,609.0000,91.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,157.59,,,,,,,29.0800,609.0000,fee schedule,APG 00288 Proc 76983 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 100% = $150.09... $150.09 at 105% = $157.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY EA ADDL LESION,76983,CPT,402,RC,40200082,CDM,,,,both,,,609.0000,91.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,154.74,,,,,,,29.0800,609.0000,fee schedule,APG 00288 Proc 76983 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 100% = $150.09... $150.09 at 103.1% = $154.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY EA ADDL LESION,76983,CPT,402,RC,40200082,CDM,,,,both,,,609.0000,91.3500,SENTARA HEALTH,SENTARA HEALTH,157.18,,,,,,,29.0800,609.0000,percent of total billed charges,25.81% of $609.00 in Billed Charges for Rev 402 Proc 76983 = $157.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US ELASTOGRAPHY EA ADDL LESION,76983,CPT,402,RC,40200082,CDM,,,,both,,,609.0000,91.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",609.00,,,,,,,29.0800,609.0000,percent of total billed charges,100% of $609.00 in Billed Charges for Rev 402 Proc 76983 = $609.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US ELASTOGRAPHY EA ADDL LESION,76983,CPT,402,RC,40200082,CDM,,,,both,,,609.0000,91.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,29.0800,609.0000,other,Rev 402 Proc 76983 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY EA ADDL LESION,76983,CPT,402,RC,40200082,CDM,,,,both,,,609.0000,91.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,29.0800,609.0000,other,Rev 402 Proc 76983 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY EA ADDL LESION,76983,CPT,402,RC,40200082,CDM,,,,both,,,609.0000,91.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,609.00,,,,,,,29.0800,609.0000,other,"Rev 402 Proc 76983 1 Visit at $687.00 per Visit = $687.00 (Service Line reduced to $609.00, claim capped at $609.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US ELASTOGRAPHY EA ADDL LESION,76983,CPT,402,RC,40200082,CDM,,,,both,,,609.0000,91.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,154.59,,,,,,,29.0800,609.0000,fee schedule,APG 00288 Proc 76983 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 103% = $154.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US ELASTOGRAPHY EA ADDL LESION,76983,CPT,402,RC,40200082,CDM,,,,both,,,609.0000,91.3500,WELLCARE,WELLCARE MEDICAID,609.00,,,,,,,29.0800,609.0000,percent of total billed charges,100% of $609.00 in Billed Charges for Rev 402 Proc 76983 = $609.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE INTRAOPERATIVE,76998,CPT,402,RC,40200061,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA,289.08,,,,,,,44.2500,677.0000,percent of total billed charges,42.7% of $677.00 in Billed Charges for Rev 402 Proc 76998 = $289.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE INTRAOPERATIVE,76998,CPT,402,RC,40200061,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,155.05,,,,,,,44.2500,677.0000,fee schedule,APG 00472 Proc 76998 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 104% = $155.05. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE INTRAOPERATIVE,76998,CPT,402,RC,40200061,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,153.55,,,,,,,44.2500,677.0000,fee schedule,APG 00472 Proc 76998 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 103% = $153.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE INTRAOPERATIVE,76998,CPT,402,RC,40200061,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,473.90,,,,,,,44.2500,677.0000,percent of total billed charges,Rev 402 Proc 76998 $677.00 in Billed Charges at 70% = $473.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE INTRAOPERATIVE,76998,CPT,402,RC,40200061,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS E NETWORK,305.34,,,,,,,44.2500,677.0000,fee schedule,$95.42 from Fee Schedule BCFSC for Rev 402 Proc 76998 * Qty 1 = $95.42 at 320% = $305.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE INTRAOPERATIVE,76998,CPT,402,RC,40200061,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS P NETWORK,312.02,,,,,,,44.2500,677.0000,fee schedule,$95.42 from Fee Schedule BCFSC for Rev 402 Proc 76998 * Qty 1 = $95.42 at 327% = $312.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE INTRAOPERATIVE,76998,CPT,402,RC,40200061,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS S NETWORK,312.02,,,,,,,44.2500,677.0000,fee schedule,$95.42 from Fee Schedule BCFSC for Rev 402 Proc 76998 * Qty 1 = $95.42 at 327% = $312.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE INTRAOPERATIVE,76998,CPT,402,RC,40200061,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE CARE,44.25,,,,,,,44.2500,677.0000,fee schedule,$38.15 from Fee Schedule TC_24 for Rev 402 Proc 76998 * Qty 1 = $38.15 at 116% = $44.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE INTRAOPERATIVE,76998,CPT,402,RC,40200061,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE SELECT,44.25,,,,,,,44.2500,677.0000,fee schedule,$38.15 from Fee Schedule TC_24 for Rev 402 Proc 76998 * Qty 1 = $38.15 at 116% = $44.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE INTRAOPERATIVE,76998,CPT,402,RC,40200061,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA HMO,282.31,,,,,,,44.2500,677.0000,percent of total billed charges,Rev 402 Proc 76998 $677.00 in Billed Charges at 41.7% = $282.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE INTRAOPERATIVE,76998,CPT,402,RC,40200061,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,282.31,,,,,,,44.2500,677.0000,percent of total billed charges,Rev 402 Proc 76998 $677.00 in Billed Charges at 41.7% = $282.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE INTRAOPERATIVE,76998,CPT,402,RC,40200061,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA PPO,282.31,,,,,,,44.2500,677.0000,percent of total billed charges,Rev 402 Proc 76998 $677.00 in Billed Charges at 41.7% = $282.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE INTRAOPERATIVE,76998,CPT,402,RC,40200061,CDM,,,,both,,,677.0000,101.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,609.30,,,,,,,44.2500,677.0000,percent of total billed charges,90% of $677.00 in Billed Charges for Rev 402 Proc 76998 = $609.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE INTRAOPERATIVE,76998,CPT,402,RC,40200061,CDM,,,,both,,,677.0000,101.5500,MEDCOST,MEDCOST VHN,322.18,,,,,,,44.2500,677.0000,percent of total billed charges,47.59% of $677.00 in Billed Charges for Rev 402 Proc 76998 = $322.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE INTRAOPERATIVE,76998,CPT,402,RC,40200061,CDM,,,,both,,,677.0000,101.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,156.53,,,,,,,44.2500,677.0000,fee schedule,APG 00472 Proc 76998 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 100% = $149.08... $149.08 at 105% = $156.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE INTRAOPERATIVE,76998,CPT,402,RC,40200061,CDM,,,,both,,,677.0000,101.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,153.70,,,,,,,44.2500,677.0000,fee schedule,APG 00472 Proc 76998 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 100% = $149.08... $149.08 at 103.1% = $153.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE INTRAOPERATIVE,76998,CPT,402,RC,40200061,CDM,,,,both,,,677.0000,101.5500,SENTARA HEALTH,SENTARA HEALTH,174.73,,,,,,,44.2500,677.0000,percent of total billed charges,25.81% of $677.00 in Billed Charges for Rev 402 Proc 76998 = $174.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE INTRAOPERATIVE,76998,CPT,402,RC,40200061,CDM,,,,both,,,677.0000,101.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",677.00,,,,,,,44.2500,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76998 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDANCE INTRAOPERATIVE,76998,CPT,402,RC,40200061,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,44.2500,677.0000,other,Rev 402 Proc 76998 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE INTRAOPERATIVE,76998,CPT,402,RC,40200061,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,44.2500,677.0000,other,Rev 402 Proc 76998 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE INTRAOPERATIVE,76998,CPT,402,RC,40200061,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,677.00,,,,,,,44.2500,677.0000,other,"Rev 402 Proc 76998 1 Visit at $687.00 per Visit = $687.00 (Service Line reduced to $677.00, claim capped at $677.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDANCE INTRAOPERATIVE,76998,CPT,402,RC,40200061,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,153.55,,,,,,,44.2500,677.0000,fee schedule,APG 00472 Proc 76998 at $836.60 (Base Rate) * 0.1782 (Relative Weight) = $149.08 (Total Line Payment) at 103% = $153.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDANCE INTRAOPERATIVE,76998,CPT,402,RC,40200061,CDM,,,,both,,,677.0000,101.5500,WELLCARE,WELLCARE MEDICAID,677.00,,,,,,,44.2500,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76998 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLUORO GUIDANCE VEIN DEVICE,77001,CPT,320,RC,32000244,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,52.5600,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 77001 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLUORO GUIDANCE VEIN DEVICE,77001,CPT,320,RC,32000244,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,292.78,,,,,,,52.5600,462.0000,fee schedule,APG 00474 Proc 77001 at $836.60 (Base Rate) * 0.3365 (Relative Weight) = $281.52 (Total Line Payment) at 104% = $292.78. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDANCE VEIN DEVICE,77001,CPT,320,RC,32000244,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,289.96,,,,,,,52.5600,462.0000,fee schedule,APG 00474 Proc 77001 at $836.60 (Base Rate) * 0.3365 (Relative Weight) = $281.52 (Total Line Payment) at 103% = $289.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDANCE VEIN DEVICE,77001,CPT,320,RC,32000244,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,55.77,,,,,,,52.5600,462.0000,fee schedule,$55.77 from Fee Schedule BLDTM_23 for Rev 320 Proc 77001 * Qty 1 = $55.77 at 100% = $55.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDANCE VEIN DEVICE,77001,CPT,320,RC,32000244,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,173.54,,,,,,,52.5600,462.0000,fee schedule,$54.23 from Fee Schedule BCFSC for Rev 320 Proc 77001 * Qty 1 = $54.23 at 320% = $173.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDANCE VEIN DEVICE,77001,CPT,320,RC,32000244,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,177.33,,,,,,,52.5600,462.0000,fee schedule,$54.23 from Fee Schedule BCFSC for Rev 320 Proc 77001 * Qty 1 = $54.23 at 327% = $177.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDANCE VEIN DEVICE,77001,CPT,320,RC,32000244,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,177.33,,,,,,,52.5600,462.0000,fee schedule,$54.23 from Fee Schedule BCFSC for Rev 320 Proc 77001 * Qty 1 = $54.23 at 327% = $177.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDANCE VEIN DEVICE,77001,CPT,320,RC,32000244,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,52.56,,,,,,,52.5600,462.0000,fee schedule,$45.31 from Fee Schedule TC_24 for Rev 320 Proc 77001 * Qty 1 = $45.31 at 116% = $52.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDANCE VEIN DEVICE,77001,CPT,320,RC,32000244,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,52.56,,,,,,,52.5600,462.0000,fee schedule,$45.31 from Fee Schedule TC_24 for Rev 320 Proc 77001 * Qty 1 = $45.31 at 116% = $52.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDANCE VEIN DEVICE,77001,CPT,320,RC,32000244,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,192.65,,,,,,,52.5600,462.0000,percent of total billed charges,Rev 320 Proc 77001 $462.00 in Billed Charges at 41.7% = $192.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLUORO GUIDANCE VEIN DEVICE,77001,CPT,320,RC,32000244,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,192.65,,,,,,,52.5600,462.0000,percent of total billed charges,Rev 320 Proc 77001 $462.00 in Billed Charges at 41.7% = $192.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLUORO GUIDANCE VEIN DEVICE,77001,CPT,320,RC,32000244,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,192.65,,,,,,,52.5600,462.0000,percent of total billed charges,Rev 320 Proc 77001 $462.00 in Billed Charges at 41.7% = $192.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLUORO GUIDANCE VEIN DEVICE,77001,CPT,320,RC,32000244,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,52.5600,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 77001 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLUORO GUIDANCE VEIN DEVICE,77001,CPT,320,RC,32000244,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,52.5600,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 77001 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLUORO GUIDANCE VEIN DEVICE,77001,CPT,320,RC,32000244,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,295.60,,,,,,,52.5600,462.0000,fee schedule,APG 00474 Proc 77001 at $836.60 (Base Rate) * 0.3365 (Relative Weight) = $281.52 (Total Line Payment) at 100% = $281.52... $281.52 at 105% = $295.60 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDANCE VEIN DEVICE,77001,CPT,320,RC,32000244,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,290.25,,,,,,,52.5600,462.0000,fee schedule,APG 00474 Proc 77001 at $836.60 (Base Rate) * 0.3365 (Relative Weight) = $281.52 (Total Line Payment) at 100% = $281.52... $281.52 at 103.1% = $290.25 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDANCE VEIN DEVICE,77001,CPT,320,RC,32000244,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,52.5600,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 77001 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLUORO GUIDANCE VEIN DEVICE,77001,CPT,320,RC,32000244,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,52.5600,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 77001 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLUORO GUIDANCE VEIN DEVICE,77001,CPT,320,RC,32000244,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,52.5600,462.0000,other,Rev 320 Proc 77001 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDANCE VEIN DEVICE,77001,CPT,320,RC,32000244,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,52.5600,462.0000,other,Rev 320 Proc 77001 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDANCE VEIN DEVICE,77001,CPT,320,RC,32000244,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,52.5600,462.0000,other,Rev 320 Proc 77001 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDANCE VEIN DEVICE,77001,CPT,320,RC,32000244,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,289.96,,,,,,,52.5600,462.0000,fee schedule,APG 00474 Proc 77001 at $836.60 (Base Rate) * 0.3365 (Relative Weight) = $281.52 (Total Line Payment) at 103% = $289.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDANCE VEIN DEVICE,77001,CPT,320,RC,32000244,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,52.5600,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 77001 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA,1287.41,,,,,,,127.0800,3015.0000,percent of total billed charges,"42.7% of $3,015.00 in Billed Charges for Rev 341 Proc 78606 = $1,287.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,528.56,,,,,,,127.0800,3015.0000,fee schedule,APG 00331 Proc 78606 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 104% = $528.56. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,492.62,,,,,,,127.0800,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA HEALTHCARE MEDICARE,492.62,,,,,,,127.0800,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,492.62,,,,,,,127.0800,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,AMBETTER,AMBETTER,1073.92,,,,,,,127.0800,3015.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,512.33,,,,,,,127.0800,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM EXCHANGE,1212.87,,,,,,,127.0800,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,523.48,,,,,,,127.0800,3015.0000,fee schedule,APG 00331 Proc 78606 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 103% = $523.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HMO,1288.60,,,,,,,127.0800,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,507.40,,,,,,,127.0800,3015.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1515.92,,,,,,,127.0800,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,230.01,,,,,,,127.0800,3015.0000,fee schedule,$230.01 from Fee Schedule BLDTM_23 for Rev 341 Proc 78606 * Qty 1 = $230.01 at 100% = $230.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS E NETWORK,875.78,,,,,,,127.0800,3015.0000,fee schedule,$273.68 from Fee Schedule BCFSC for Rev 341 Proc 78606 * Qty 1 = $273.68 at 320% = $875.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS MEDICARE,512.33,,,,,,,127.0800,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS P NETWORK,894.93,,,,,,,127.0800,3015.0000,fee schedule,$273.68 from Fee Schedule BCFSC for Rev 341 Proc 78606 * Qty 1 = $273.68 at 327% = $894.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS S NETWORK,894.93,,,,,,,127.0800,3015.0000,fee schedule,$273.68 from Fee Schedule BCFSC for Rev 341 Proc 78606 * Qty 1 = $273.68 at 327% = $894.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE CARE,127.08,,,,,,,127.0800,3015.0000,fee schedule,$109.55 from Fee Schedule TC_24 for Rev 341 Proc 78606 * Qty 1 = $109.55 at 116% = $127.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE SELECT,127.08,,,,,,,127.0800,3015.0000,fee schedule,$109.55 from Fee Schedule TC_24 for Rev 341 Proc 78606 * Qty 1 = $109.55 at 116% = $127.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA HMO,2322.41,,,,,,,127.0800,3015.0000,fee schedule,"$2,322.41 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78606 * Qty 1 = $2,322.41 at 100% = $2,322.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,509.62,,,,,,,127.0800,3015.0000,fee schedule,$509.62 from Fee Schedule CGIFP_25LR for Rev 341 Proc 78606 * Qty 1 = $509.62 at 100% = $509.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,517.25,,,,,,,127.0800,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2322.41,,,,,,,127.0800,3015.0000,fee schedule,"$2,322.41 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78606 * Qty 1 = $2,322.41 at 100% = $2,322.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA PPO,2322.41,,,,,,,127.0800,3015.0000,fee schedule,"$2,322.41 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78606 * Qty 1 = $2,322.41 at 100% = $2,322.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,517.25,,,,,,,127.0800,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2713.50,,,,,,,127.0800,3015.0000,percent of total billed charges,"90% of $3,015.00 in Billed Charges for Rev 341 Proc 78606 = $2,713.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,HUMANA,HUMANA MEDICARE,492.62,,,,,,,127.0800,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,492.62,,,,,,,127.0800,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,MEDCOST,MEDCOST VHN,1434.84,,,,,,,127.0800,3015.0000,percent of total billed charges,"47.59% of $3,015.00 in Billed Charges for Rev 341 Proc 78606 = $1,434.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,533.64,,,,,,,127.0800,3015.0000,fee schedule,APG 00331 Proc 78606 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 100% = $508.23... $508.23 at 105% = $533.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,517.25,,,,,,,127.0800,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,517.25,,,,,,,127.0800,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,NHC ADVANTAGE,NHC ADVANTAGE,517.25,,,,,,,127.0800,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,523.99,,,,,,,127.0800,3015.0000,fee schedule,APG 00331 Proc 78606 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 100% = $508.23... $508.23 at 103.1% = $523.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA HEALTH,778.17,,,,,,,127.0800,3015.0000,percent of total billed charges,"25.81% of $3,015.00 in Billed Charges for Rev 341 Proc 78606 = $778.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA MEDICARE,492.62,,,,,,,127.0800,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3015.00,,,,,,,127.0800,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 341 Proc 78606 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,306.81,,,,,,,127.0800,3015.0000,fee schedule,$613.62 from Fee Schedule TCUHC24 for Rev 341 Proc 78606 * Qty 1 = $613.62 at 50% = $306.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,810.00,,,,,,,127.0800,3015.0000,other,Rev 341 Proc 78606 1 Visit at $810.00 per Visit = $810.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,774.00,,,,,,,127.0800,3015.0000,other,Rev 341 Proc 78606 1 Visit at $774.00 per Visit = $774.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1599.00,,,,,,,127.0800,3015.0000,other,"Rev 341 Proc 78606 1 Visit at $1,599.00 per Visit = $1,599.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,523.48,,,,,,,127.0800,3015.0000,fee schedule,APG 00331 Proc 78606 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 103% = $523.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,492.62,,,,,,,127.0800,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,492.62,,,,,,,127.0800,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICAID,3015.00,,,,,,,127.0800,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 341 Proc 78606 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM BRAIN SCAN 4VW MIN W FLOW,78606,CPT,341,RC,34100048,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICARE,522.18,,,,,,,127.0800,3015.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,AETNA,AETNA,4354.97,,,,,,,367.9200,10199.0000,percent of total billed charges,"42.7% of $10,199.00 in Billed Charges for Rev 404 Proc 78608 = $4,354.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1998.10,,,,,,,367.9200,10199.0000,fee schedule,"APG 00290 Proc 78608 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 104% = $1,998.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1297.36,,,,,,,367.9200,10199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,AETNA,AETNA HEALTHCARE MEDICARE,1297.36,,,,,,,367.9200,10199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,1297.36,,,,,,,367.9200,10199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,AMBETTER,AMBETTER,2828.23,,,,,,,367.9200,10199.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1349.25,,,,,,,367.9200,10199.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,BLUE CROSS,ANTHEM EXCHANGE,3194.16,,,,,,,367.9200,10199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1978.89,,,,,,,367.9200,10199.0000,fee schedule,"APG 00290 Proc 78608 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 103% = $1,978.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,BLUE CROSS,ANTHEM HMO,3393.61,,,,,,,367.9200,10199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1336.28,,,,,,,367.9200,10199.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3992.26,,,,,,,367.9200,10199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,367.92,,,,,,,367.9200,10199.0000,fee schedule,$367.92 from Fee Schedule BLDTM_23 for Rev 404 Proc 78608 * Qty 1 = $367.92 at 100% = $367.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,BLUE CROSS,BLUE CROSS E NETWORK,3263.36,,,,,,,367.9200,10199.0000,fee schedule,"$1,019.80 from Fee Schedule BCFSC for Rev 404 Proc 78608 * Qty 1 = $1,019.80 at 320% = $3,263.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,BLUE CROSS,BLUE CROSS MEDICARE,1349.25,,,,,,,367.9200,10199.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,BLUE CROSS,BLUE CROSS P NETWORK,3334.75,,,,,,,367.9200,10199.0000,fee schedule,"$1,019.80 from Fee Schedule BCFSC for Rev 404 Proc 78608 * Qty 1 = $1,019.80 at 327% = $3,334.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,BLUE CROSS,BLUE CROSS S NETWORK,3334.75,,,,,,,367.9200,10199.0000,fee schedule,"$1,019.80 from Fee Schedule BCFSC for Rev 404 Proc 78608 * Qty 1 = $1,019.80 at 327% = $3,334.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,BLUE CROSS,TENNCARE BLUE CARE,1075.70,,,,,,,367.9200,10199.0000,fee schedule,"$927.33 from Fee Schedule TC_24 for Rev 404 Proc 78608 * Qty 1 = $927.33 at 116% = $1,075.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,BLUE CROSS,TENNCARE BLUE SELECT,1075.70,,,,,,,367.9200,10199.0000,fee schedule,"$927.33 from Fee Schedule TC_24 for Rev 404 Proc 78608 * Qty 1 = $927.33 at 116% = $1,075.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,CIGNA HEALTHCARE,CIGNA HMO,3924.62,,,,,,,367.9200,10199.0000,fee schedule,"$3,924.62 from Fee Schedule CIGWHS_23 for Rev 404 Proc 78608 * Qty 1 = $3,924.62 at 100% = $3,924.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,914.41,,,,,,,367.9200,10199.0000,fee schedule,$914.41 from Fee Schedule CGIFP_25LR for Rev 404 Proc 78608 * Qty 1 = $914.41 at 100% = $914.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,1362.22,,,,,,,367.9200,10199.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3924.62,,,,,,,367.9200,10199.0000,fee schedule,"$3,924.62 from Fee Schedule CIGWHS_23 for Rev 404 Proc 78608 * Qty 1 = $3,924.62 at 100% = $3,924.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,CIGNA HEALTHCARE,CIGNA PPO,3924.62,,,,,,,367.9200,10199.0000,fee schedule,"$3,924.62 from Fee Schedule CIGWHS_23 for Rev 404 Proc 78608 * Qty 1 = $3,924.62 at 100% = $3,924.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1362.22,,,,,,,367.9200,10199.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9179.10,,,,,,,367.9200,10199.0000,percent of total billed charges,"90% of $10,199.00 in Billed Charges for Rev 404 Proc 78608 = $9,179.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,HUMANA,HUMANA MEDICARE,1297.36,,,,,,,367.9200,10199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1297.36,,,,,,,367.9200,10199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,MEDCOST,MEDCOST VHN,4853.70,,,,,,,367.9200,10199.0000,percent of total billed charges,"47.59% of $10,199.00 in Billed Charges for Rev 404 Proc 78608 = $4,853.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2017.31,,,,,,,367.9200,10199.0000,fee schedule,"APG 00290 Proc 78608 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 100% = $1,921.25... $1,921.25 at 105% = $2,017.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1362.22,,,,,,,367.9200,10199.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1362.22,,,,,,,367.9200,10199.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,NHC ADVANTAGE,NHC ADVANTAGE,1362.22,,,,,,,367.9200,10199.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1980.81,,,,,,,367.9200,10199.0000,fee schedule,"APG 00290 Proc 78608 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 100% = $1,921.25... $1,921.25 at 103.1% = $1,980.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,SENTARA HEALTH,SENTARA HEALTH,2632.36,,,,,,,367.9200,10199.0000,percent of total billed charges,"25.81% of $10,199.00 in Billed Charges for Rev 404 Proc 78608 = $2,632.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,SENTARA HEALTH,SENTARA MEDICARE,1297.36,,,,,,,367.9200,10199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10199.00,,,,,,,367.9200,10199.0000,percent of total billed charges,"100% of $10,199.00 in Billed Charges for Rev 404 Proc 78608 = $10,199.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,518.48,,,,,,,367.9200,10199.0000,fee schedule,"$1,036.95 from Fee Schedule TCUHC24 for Rev 404 Proc 78608 * Qty 1 = $1,036.95 at 50% = $518.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4136.00,,,,,,,367.9200,10199.0000,other,"Rev 404 Proc 78608 1 Visit at $4,136.00 per Visit = $4,136.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3957.00,,,,,,,367.9200,10199.0000,other,"Rev 404 Proc 78608 1 Visit at $3,957.00 per Visit = $3,957.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,6522.00,,,,,,,367.9200,10199.0000,other,"Rev 404 Proc 78608 1 Visit at $6,522.00 per Visit = $6,522.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1978.89,,,,,,,367.9200,10199.0000,fee schedule,"APG 00290 Proc 78608 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 103% = $1,978.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1297.36,,,,,,,367.9200,10199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1297.36,,,,,,,367.9200,10199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,WELLCARE,WELLCARE MEDICAID,10199.00,,,,,,,367.9200,10199.0000,percent of total billed charges,"100% of $10,199.00 in Billed Charges for Rev 404 Proc 78608 = $10,199.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET BRAIN IMAG METABOLIC,78608,CPT,404,RC,40400003,CDM,,,,both,,,10199.0000,1529.8500,WELLCARE,WELLCARE MEDICARE,1375.20,,,,,,,367.9200,10199.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
INSTRUMENT OSTEOCONDRAL FLAP REPAIR,272,RC,27200002,CDM,,,,,,both,,,3546.8800,532.0300,AETNA,AETNA,1514.52,,,,,,,915.4500,3546.8800,percent of total billed charges,"42.7% of $3,546.88 in Billed Charges for Rev 272 = $1,514.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT OSTEOCONDRAL FLAP REPAIR,272,RC,27200002,CDM,,,,,,both,,,3546.8800,532.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2482.82,,,,,,,915.4500,3546.8800,percent of total billed charges,"Rev 272 $3,546.88 in Billed Charges at 70% = $2,482.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT OSTEOCONDRAL FLAP REPAIR,272,RC,27200002,CDM,,,,,,both,,,3546.8800,532.0300,CIGNA HEALTHCARE,CIGNA HMO,1479.05,,,,,,,915.4500,3546.8800,percent of total billed charges,"41.7% of $3,546.88 in Billed Charges for Rev 272 = $1,479.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT OSTEOCONDRAL FLAP REPAIR,272,RC,27200002,CDM,,,,,,both,,,3546.8800,532.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1645.75,,,,,,,915.4500,3546.8800,percent of total billed charges,"46.4% of $3,546.88 in Billed Charges for Rev 272 = $1,645.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT OSTEOCONDRAL FLAP REPAIR,272,RC,27200002,CDM,,,,,,both,,,3546.8800,532.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1479.05,,,,,,,915.4500,3546.8800,percent of total billed charges,"41.7% of $3,546.88 in Billed Charges for Rev 272 = $1,479.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT OSTEOCONDRAL FLAP REPAIR,272,RC,27200002,CDM,,,,,,both,,,3546.8800,532.0300,CIGNA HEALTHCARE,CIGNA PPO,1479.05,,,,,,,915.4500,3546.8800,percent of total billed charges,"41.7% of $3,546.88 in Billed Charges for Rev 272 = $1,479.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT OSTEOCONDRAL FLAP REPAIR,272,RC,27200002,CDM,,,,,,both,,,3546.8800,532.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3192.19,,,,,,,915.4500,3546.8800,percent of total billed charges,"90% of $3,546.88 in Billed Charges for Rev 272 = $3,192.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT OSTEOCONDRAL FLAP REPAIR,272,RC,27200002,CDM,,,,,,both,,,3546.8800,532.0300,MEDCOST,MEDCOST VHN,1687.96,,,,,,,915.4500,3546.8800,percent of total billed charges,"47.59% of $3,546.88 in Billed Charges for Rev 272 = $1,687.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT OSTEOCONDRAL FLAP REPAIR,272,RC,27200002,CDM,,,,,,both,,,3546.8800,532.0300,SENTARA HEALTH,SENTARA HEALTH,915.45,,,,,,,915.4500,3546.8800,percent of total billed charges,"25.81% of $3,546.88 in Billed Charges for Rev 272 = $915.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT OSTEOCONDRAL FLAP REPAIR,272,RC,27200002,CDM,,,,,,both,,,3546.8800,532.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3546.88,,,,,,,915.4500,3546.8800,percent of total billed charges,"100% of $3,546.88 in Billed Charges for Rev 272 = $3,546.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT OSTEOCONDRAL FLAP REPAIR,272,RC,27200002,CDM,,,,,,both,,,3546.8800,532.0300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1773.44,,,,,,,915.4500,3546.8800,percent of total billed charges,"Rev 272 $3,546.88 in Billed Charges at 50% = $1,773.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT OSTEOCONDRAL FLAP REPAIR,272,RC,27200002,CDM,,,,,,both,,,3546.8800,532.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1145.64,,,,,,,915.4500,3546.8800,other,"32.3% of $3,546.88 in Billed Charges for Rev 272 = $1,145.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
INSTRUMENT OSTEOCONDRAL FLAP REPAIR,272,RC,27200002,CDM,,,,,,both,,,3546.8800,532.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1088.89,,,,,,,915.4500,3546.8800,other,"30.7% of $3,546.88 in Billed Charges for Rev 272 = $1,088.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
INSTRUMENT OSTEOCONDRAL FLAP REPAIR,272,RC,27200002,CDM,,,,,,both,,,3546.8800,532.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,1145.64,,,,,,,915.4500,3546.8800,percent of total billed charges,"32.3% of $3,546.88 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INSTRUMENT OSTEOCONDRAL FLAP REPAIR,272,RC,27200002,CDM,,,,,,both,,,3546.8800,532.0300,WELLCARE,WELLCARE MEDICAID,3546.88,,,,,,,915.4500,3546.8800,percent of total billed charges,"100% of $3,546.88 in Billed Charges for Rev 272 = $3,546.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA,1287.41,,,,,,,51.8600,3015.0000,percent of total billed charges,"42.7% of $3,015.00 in Billed Charges for Rev 341 Proc 78610 = $1,287.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,528.56,,,,,,,51.8600,3015.0000,fee schedule,APG 00331 Proc 78610 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 104% = $528.56. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,492.62,,,,,,,51.8600,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA HEALTHCARE MEDICARE,492.62,,,,,,,51.8600,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,492.62,,,,,,,51.8600,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,AMBETTER,AMBETTER,1073.92,,,,,,,51.8600,3015.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,512.33,,,,,,,51.8600,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM EXCHANGE,1212.87,,,,,,,51.8600,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,523.48,,,,,,,51.8600,3015.0000,fee schedule,APG 00331 Proc 78610 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 103% = $523.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HMO,1288.60,,,,,,,51.8600,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,507.40,,,,,,,51.8600,3015.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1515.92,,,,,,,51.8600,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,97.21,,,,,,,51.8600,3015.0000,fee schedule,$97.21 from Fee Schedule BLDTM_23 for Rev 341 Proc 78610 * Qty 1 = $97.21 at 100% = $97.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS E NETWORK,467.10,,,,,,,51.8600,3015.0000,fee schedule,$145.97 from Fee Schedule BCFSC for Rev 341 Proc 78610 * Qty 1 = $145.97 at 320% = $467.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS MEDICARE,512.33,,,,,,,51.8600,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS P NETWORK,477.32,,,,,,,51.8600,3015.0000,fee schedule,$145.97 from Fee Schedule BCFSC for Rev 341 Proc 78610 * Qty 1 = $145.97 at 327% = $477.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS S NETWORK,477.32,,,,,,,51.8600,3015.0000,fee schedule,$145.97 from Fee Schedule BCFSC for Rev 341 Proc 78610 * Qty 1 = $145.97 at 327% = $477.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE CARE,51.86,,,,,,,51.8600,3015.0000,fee schedule,$44.71 from Fee Schedule TC_24 for Rev 341 Proc 78610 * Qty 1 = $44.71 at 116% = $51.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE SELECT,51.86,,,,,,,51.8600,3015.0000,fee schedule,$44.71 from Fee Schedule TC_24 for Rev 341 Proc 78610 * Qty 1 = $44.71 at 116% = $51.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA HMO,910.80,,,,,,,51.8600,3015.0000,fee schedule,$910.80 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78610 * Qty 1 = $910.80 at 100% = $910.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,277.74,,,,,,,51.8600,3015.0000,fee schedule,$277.74 from Fee Schedule CGIFP_25LR for Rev 341 Proc 78610 * Qty 1 = $277.74 at 100% = $277.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,517.25,,,,,,,51.8600,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,910.80,,,,,,,51.8600,3015.0000,fee schedule,$910.80 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78610 * Qty 1 = $910.80 at 100% = $910.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA PPO,910.80,,,,,,,51.8600,3015.0000,fee schedule,$910.80 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78610 * Qty 1 = $910.80 at 100% = $910.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,517.25,,,,,,,51.8600,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2713.50,,,,,,,51.8600,3015.0000,percent of total billed charges,"90% of $3,015.00 in Billed Charges for Rev 341 Proc 78610 = $2,713.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,HUMANA,HUMANA MEDICARE,492.62,,,,,,,51.8600,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,492.62,,,,,,,51.8600,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,MEDCOST,MEDCOST VHN,1434.84,,,,,,,51.8600,3015.0000,percent of total billed charges,"47.59% of $3,015.00 in Billed Charges for Rev 341 Proc 78610 = $1,434.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,533.64,,,,,,,51.8600,3015.0000,fee schedule,APG 00331 Proc 78610 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 100% = $508.23... $508.23 at 105% = $533.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,517.25,,,,,,,51.8600,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,517.25,,,,,,,51.8600,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,NHC ADVANTAGE,NHC ADVANTAGE,517.25,,,,,,,51.8600,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,523.99,,,,,,,51.8600,3015.0000,fee schedule,APG 00331 Proc 78610 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 100% = $508.23... $508.23 at 103.1% = $523.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA HEALTH,778.17,,,,,,,51.8600,3015.0000,percent of total billed charges,"25.81% of $3,015.00 in Billed Charges for Rev 341 Proc 78610 = $778.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA MEDICARE,492.62,,,,,,,51.8600,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3015.00,,,,,,,51.8600,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 341 Proc 78610 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,120.33,,,,,,,51.8600,3015.0000,fee schedule,$240.65 from Fee Schedule TCUHC24 for Rev 341 Proc 78610 * Qty 1 = $240.65 at 50% = $120.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,810.00,,,,,,,51.8600,3015.0000,other,Rev 341 Proc 78610 1 Visit at $810.00 per Visit = $810.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,774.00,,,,,,,51.8600,3015.0000,other,Rev 341 Proc 78610 1 Visit at $774.00 per Visit = $774.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1599.00,,,,,,,51.8600,3015.0000,other,"Rev 341 Proc 78610 1 Visit at $1,599.00 per Visit = $1,599.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,523.48,,,,,,,51.8600,3015.0000,fee schedule,APG 00331 Proc 78610 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 103% = $523.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,492.62,,,,,,,51.8600,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,492.62,,,,,,,51.8600,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICAID,3015.00,,,,,,,51.8600,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 341 Proc 78610 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM BRAIN VASCULAR FLOW ONLY*,78610,CPT,341,RC,34100049,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICARE,522.18,,,,,,,51.8600,3015.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA,1287.41,,,,,,,165.2400,3015.0000,percent of total billed charges,"42.7% of $3,015.00 in Billed Charges for Rev 341 Proc 78630 = $1,287.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1302.66,,,,,,,165.2400,3015.0000,fee schedule,"APG 00332 Proc 78630 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 104% = $1,302.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,492.62,,,,,,,165.2400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA HEALTHCARE MEDICARE,492.62,,,,,,,165.2400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,492.62,,,,,,,165.2400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,AMBETTER,AMBETTER,1073.92,,,,,,,165.2400,3015.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,512.33,,,,,,,165.2400,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM EXCHANGE,1212.87,,,,,,,165.2400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1290.13,,,,,,,165.2400,3015.0000,fee schedule,"APG 00332 Proc 78630 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 103% = $1,290.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HMO,1288.60,,,,,,,165.2400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,507.40,,,,,,,165.2400,3015.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1515.92,,,,,,,165.2400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,289.35,,,,,,,165.2400,3015.0000,fee schedule,$289.35 from Fee Schedule BLDTM_23 for Rev 341 Proc 78630 * Qty 1 = $289.35 at 100% = $289.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS E NETWORK,892.22,,,,,,,165.2400,3015.0000,fee schedule,$278.82 from Fee Schedule BCFSC for Rev 341 Proc 78630 * Qty 1 = $278.82 at 320% = $892.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS MEDICARE,512.33,,,,,,,165.2400,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS P NETWORK,911.74,,,,,,,165.2400,3015.0000,fee schedule,$278.82 from Fee Schedule BCFSC for Rev 341 Proc 78630 * Qty 1 = $278.82 at 327% = $911.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS S NETWORK,911.74,,,,,,,165.2400,3015.0000,fee schedule,$278.82 from Fee Schedule BCFSC for Rev 341 Proc 78630 * Qty 1 = $278.82 at 327% = $911.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE CARE,165.24,,,,,,,165.2400,3015.0000,fee schedule,$142.45 from Fee Schedule TC_24 for Rev 341 Proc 78630 * Qty 1 = $142.45 at 116% = $165.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE SELECT,165.24,,,,,,,165.2400,3015.0000,fee schedule,$142.45 from Fee Schedule TC_24 for Rev 341 Proc 78630 * Qty 1 = $142.45 at 116% = $165.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA HMO,2322.41,,,,,,,165.2400,3015.0000,fee schedule,"$2,322.41 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78630 * Qty 1 = $2,322.41 at 100% = $2,322.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,518.38,,,,,,,165.2400,3015.0000,fee schedule,$518.38 from Fee Schedule CGIFP_25LR for Rev 341 Proc 78630 * Qty 1 = $518.38 at 100% = $518.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,517.25,,,,,,,165.2400,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2322.41,,,,,,,165.2400,3015.0000,fee schedule,"$2,322.41 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78630 * Qty 1 = $2,322.41 at 100% = $2,322.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA PPO,2322.41,,,,,,,165.2400,3015.0000,fee schedule,"$2,322.41 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78630 * Qty 1 = $2,322.41 at 100% = $2,322.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,517.25,,,,,,,165.2400,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2713.50,,,,,,,165.2400,3015.0000,percent of total billed charges,"90% of $3,015.00 in Billed Charges for Rev 341 Proc 78630 = $2,713.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,HUMANA,HUMANA MEDICARE,492.62,,,,,,,165.2400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,492.62,,,,,,,165.2400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,MEDCOST,MEDCOST VHN,1434.84,,,,,,,165.2400,3015.0000,percent of total billed charges,"47.59% of $3,015.00 in Billed Charges for Rev 341 Proc 78630 = $1,434.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1315.19,,,,,,,165.2400,3015.0000,fee schedule,"APG 00332 Proc 78630 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 100% = $1,252.56... $1,252.56 at 105% = $1,315.19 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,517.25,,,,,,,165.2400,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,517.25,,,,,,,165.2400,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,NHC ADVANTAGE,NHC ADVANTAGE,517.25,,,,,,,165.2400,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1291.39,,,,,,,165.2400,3015.0000,fee schedule,"APG 00332 Proc 78630 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 100% = $1,252.56... $1,252.56 at 103.1% = $1,291.39 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA HEALTH,778.17,,,,,,,165.2400,3015.0000,percent of total billed charges,"25.81% of $3,015.00 in Billed Charges for Rev 341 Proc 78630 = $778.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA MEDICARE,492.62,,,,,,,165.2400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3015.00,,,,,,,165.2400,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 341 Proc 78630 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,306.81,,,,,,,165.2400,3015.0000,fee schedule,$613.62 from Fee Schedule TCUHC24 for Rev 341 Proc 78630 * Qty 1 = $613.62 at 50% = $306.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,810.00,,,,,,,165.2400,3015.0000,other,Rev 341 Proc 78630 1 Visit at $810.00 per Visit = $810.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,774.00,,,,,,,165.2400,3015.0000,other,Rev 341 Proc 78630 1 Visit at $774.00 per Visit = $774.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1599.00,,,,,,,165.2400,3015.0000,other,"Rev 341 Proc 78630 1 Visit at $1,599.00 per Visit = $1,599.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1290.13,,,,,,,165.2400,3015.0000,fee schedule,"APG 00332 Proc 78630 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 103% = $1,290.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,492.62,,,,,,,165.2400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,492.62,,,,,,,165.2400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICAID,3015.00,,,,,,,165.2400,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 341 Proc 78630 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM CISTERNOGRAM,78630,CPT,341,RC,34100050,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICARE,522.18,,,,,,,165.2400,3015.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,AETNA,AETNA,1192.18,,,,,,,152.3500,2792.0000,percent of total billed charges,"42.7% of $2,792.00 in Billed Charges for Rev 341 Proc 78650 = $1,192.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1302.66,,,,,,,152.3500,2792.0000,fee schedule,"APG 00332 Proc 78650 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 104% = $1,302.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1174.60,,,,,,,152.3500,2792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,AETNA,AETNA HEALTHCARE MEDICARE,1174.60,,,,,,,152.3500,2792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,1174.60,,,,,,,152.3500,2792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,AMBETTER,AMBETTER,2560.63,,,,,,,152.3500,2792.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1221.59,,,,,,,152.3500,2792.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,ANTHEM EXCHANGE,2792.00,,,,,,,152.3500,2792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1290.13,,,,,,,152.3500,2792.0000,fee schedule,"APG 00332 Proc 78650 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 103% = $1,290.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,ANTHEM HMO,2792.00,,,,,,,152.3500,2792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1209.84,,,,,,,152.3500,2792.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2792.00,,,,,,,152.3500,2792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,265.25,,,,,,,152.3500,2792.0000,fee schedule,$265.25 from Fee Schedule BLDTM_23 for Rev 341 Proc 78650 * Qty 1 = $265.25 at 100% = $265.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,BLUE CROSS E NETWORK,896.35,,,,,,,152.3500,2792.0000,fee schedule,$280.11 from Fee Schedule BCFSC for Rev 341 Proc 78650 * Qty 1 = $280.11 at 320% = $896.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,BLUE CROSS MEDICARE,1221.59,,,,,,,152.3500,2792.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,BLUE CROSS P NETWORK,915.96,,,,,,,152.3500,2792.0000,fee schedule,$280.11 from Fee Schedule BCFSC for Rev 341 Proc 78650 * Qty 1 = $280.11 at 327% = $915.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,BLUE CROSS S NETWORK,915.96,,,,,,,152.3500,2792.0000,fee schedule,$280.11 from Fee Schedule BCFSC for Rev 341 Proc 78650 * Qty 1 = $280.11 at 327% = $915.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,TENNCARE BLUE CARE,152.35,,,,,,,152.3500,2792.0000,fee schedule,$131.34 from Fee Schedule TC_24 for Rev 341 Proc 78650 * Qty 1 = $131.34 at 116% = $152.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,TENNCARE BLUE SELECT,152.35,,,,,,,152.3500,2792.0000,fee schedule,$131.34 from Fee Schedule TC_24 for Rev 341 Proc 78650 * Qty 1 = $131.34 at 116% = $152.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,CIGNA HEALTHCARE,CIGNA HMO,2322.41,,,,,,,152.3500,2792.0000,fee schedule,"$2,322.41 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78650 * Qty 1 = $2,322.41 at 100% = $2,322.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,418.80,,,,,,,152.3500,2792.0000,fee schedule,$418.80 from Fee Schedule CGIFP_25LR for Rev 341 Proc 78650 * Qty 1 = $418.80 at 100% = $418.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,1233.33,,,,,,,152.3500,2792.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2322.41,,,,,,,152.3500,2792.0000,fee schedule,"$2,322.41 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78650 * Qty 1 = $2,322.41 at 100% = $2,322.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,CIGNA HEALTHCARE,CIGNA PPO,2322.41,,,,,,,152.3500,2792.0000,fee schedule,"$2,322.41 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78650 * Qty 1 = $2,322.41 at 100% = $2,322.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1233.33,,,,,,,152.3500,2792.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2512.80,,,,,,,152.3500,2792.0000,percent of total billed charges,"90% of $2,792.00 in Billed Charges for Rev 341 Proc 78650 = $2,512.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,HUMANA,HUMANA MEDICARE,1174.60,,,,,,,152.3500,2792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1174.60,,,,,,,152.3500,2792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,MEDCOST,MEDCOST VHN,1328.71,,,,,,,152.3500,2792.0000,percent of total billed charges,"47.59% of $2,792.00 in Billed Charges for Rev 341 Proc 78650 = $1,328.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1315.19,,,,,,,152.3500,2792.0000,fee schedule,"APG 00332 Proc 78650 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 100% = $1,252.56... $1,252.56 at 105% = $1,315.19 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1233.33,,,,,,,152.3500,2792.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1233.33,,,,,,,152.3500,2792.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,NHC ADVANTAGE,NHC ADVANTAGE,1233.33,,,,,,,152.3500,2792.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1291.39,,,,,,,152.3500,2792.0000,fee schedule,"APG 00332 Proc 78650 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 100% = $1,252.56... $1,252.56 at 103.1% = $1,291.39 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,SENTARA HEALTH,SENTARA HEALTH,720.62,,,,,,,152.3500,2792.0000,percent of total billed charges,"25.81% of $2,792.00 in Billed Charges for Rev 341 Proc 78650 = $720.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,SENTARA HEALTH,SENTARA MEDICARE,1174.60,,,,,,,152.3500,2792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2792.00,,,,,,,152.3500,2792.0000,percent of total billed charges,"100% of $2,792.00 in Billed Charges for Rev 341 Proc 78650 = $2,792.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,306.81,,,,,,,152.3500,2792.0000,fee schedule,$613.62 from Fee Schedule TCUHC24 for Rev 341 Proc 78650 * Qty 1 = $613.62 at 50% = $306.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,810.00,,,,,,,152.3500,2792.0000,other,Rev 341 Proc 78650 1 Visit at $810.00 per Visit = $810.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,774.00,,,,,,,152.3500,2792.0000,other,Rev 341 Proc 78650 1 Visit at $774.00 per Visit = $774.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,1599.00,,,,,,,152.3500,2792.0000,other,"Rev 341 Proc 78650 1 Visit at $1,599.00 per Visit = $1,599.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1290.13,,,,,,,152.3500,2792.0000,fee schedule,"APG 00332 Proc 78650 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 103% = $1,290.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1174.60,,,,,,,152.3500,2792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1174.60,,,,,,,152.3500,2792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,WELLCARE,WELLCARE MEDICAID,2792.00,,,,,,,152.3500,2792.0000,percent of total billed charges,"100% of $2,792.00 in Billed Charges for Rev 341 Proc 78650 = $2,792.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM CSF LEAKAGE DETECT LOC,78650,CPT,341,RC,34100052,CDM,,,,both,,,2792.0000,418.8000,WELLCARE,WELLCARE MEDICARE,1245.08,,,,,,,152.3500,2792.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA,1287.41,,,,,,,99.8400,3015.0000,percent of total billed charges,"42.7% of $3,015.00 in Billed Charges for Rev 341 Proc 78700 = $1,287.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,528.56,,,,,,,99.8400,3015.0000,fee schedule,APG 00331 Proc 78700 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 104% = $528.56. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,362.70,,,,,,,99.8400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA HEALTHCARE MEDICARE,362.70,,,,,,,99.8400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,362.70,,,,,,,99.8400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,AMBETTER,AMBETTER,790.69,,,,,,,99.8400,3015.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,377.21,,,,,,,99.8400,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM EXCHANGE,893.00,,,,,,,99.8400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,523.48,,,,,,,99.8400,3015.0000,fee schedule,APG 00331 Proc 78700 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 103% = $523.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HMO,948.76,,,,,,,99.8400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,373.58,,,,,,,99.8400,3015.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1116.13,,,,,,,99.8400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,165.60,,,,,,,99.8400,3015.0000,fee schedule,$165.60 from Fee Schedule BLDTM_23 for Rev 341 Proc 78700 * Qty 1 = $165.60 at 100% = $165.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS E NETWORK,444.45,,,,,,,99.8400,3015.0000,fee schedule,$138.89 from Fee Schedule BCFSC for Rev 341 Proc 78700 * Qty 1 = $138.89 at 320% = $444.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS MEDICARE,377.21,,,,,,,99.8400,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS P NETWORK,454.17,,,,,,,99.8400,3015.0000,fee schedule,$138.89 from Fee Schedule BCFSC for Rev 341 Proc 78700 * Qty 1 = $138.89 at 327% = $454.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS S NETWORK,454.17,,,,,,,99.8400,3015.0000,fee schedule,$138.89 from Fee Schedule BCFSC for Rev 341 Proc 78700 * Qty 1 = $138.89 at 327% = $454.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE CARE,99.84,,,,,,,99.8400,3015.0000,fee schedule,$86.07 from Fee Schedule TC_24 for Rev 341 Proc 78700 * Qty 1 = $86.07 at 116% = $99.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE SELECT,99.84,,,,,,,99.8400,3015.0000,fee schedule,$86.07 from Fee Schedule TC_24 for Rev 341 Proc 78700 * Qty 1 = $86.07 at 116% = $99.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA HMO,1206.05,,,,,,,99.8400,3015.0000,fee schedule,"$1,206.05 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78700 * Qty 1 = $1,206.05 at 100% = $1,206.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,258.32,,,,,,,99.8400,3015.0000,fee schedule,$258.32 from Fee Schedule CGIFP_25LR for Rev 341 Proc 78700 * Qty 1 = $258.32 at 100% = $258.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,380.84,,,,,,,99.8400,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1206.05,,,,,,,99.8400,3015.0000,fee schedule,"$1,206.05 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78700 * Qty 1 = $1,206.05 at 100% = $1,206.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA PPO,1206.05,,,,,,,99.8400,3015.0000,fee schedule,"$1,206.05 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78700 * Qty 1 = $1,206.05 at 100% = $1,206.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,380.84,,,,,,,99.8400,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2713.50,,,,,,,99.8400,3015.0000,percent of total billed charges,"90% of $3,015.00 in Billed Charges for Rev 341 Proc 78700 = $2,713.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,HUMANA,HUMANA MEDICARE,362.70,,,,,,,99.8400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,362.70,,,,,,,99.8400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,MEDCOST,MEDCOST VHN,1434.84,,,,,,,99.8400,3015.0000,percent of total billed charges,"47.59% of $3,015.00 in Billed Charges for Rev 341 Proc 78700 = $1,434.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,533.64,,,,,,,99.8400,3015.0000,fee schedule,APG 00331 Proc 78700 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 100% = $508.23... $508.23 at 105% = $533.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,380.84,,,,,,,99.8400,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,380.84,,,,,,,99.8400,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,NHC ADVANTAGE,NHC ADVANTAGE,380.84,,,,,,,99.8400,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,523.99,,,,,,,99.8400,3015.0000,fee schedule,APG 00331 Proc 78700 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 100% = $508.23... $508.23 at 103.1% = $523.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA HEALTH,778.17,,,,,,,99.8400,3015.0000,percent of total billed charges,"25.81% of $3,015.00 in Billed Charges for Rev 341 Proc 78700 = $778.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA MEDICARE,362.70,,,,,,,99.8400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3015.00,,,,,,,99.8400,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 341 Proc 78700 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,159.33,,,,,,,99.8400,3015.0000,fee schedule,$318.66 from Fee Schedule TCUHC24 for Rev 341 Proc 78700 * Qty 1 = $318.66 at 50% = $159.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,810.00,,,,,,,99.8400,3015.0000,other,Rev 341 Proc 78700 1 Visit at $810.00 per Visit = $810.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,774.00,,,,,,,99.8400,3015.0000,other,Rev 341 Proc 78700 1 Visit at $774.00 per Visit = $774.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1599.00,,,,,,,99.8400,3015.0000,other,"Rev 341 Proc 78700 1 Visit at $1,599.00 per Visit = $1,599.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,523.48,,,,,,,99.8400,3015.0000,fee schedule,APG 00331 Proc 78700 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 103% = $523.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,362.70,,,,,,,99.8400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,362.70,,,,,,,99.8400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICAID,3015.00,,,,,,,99.8400,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 341 Proc 78700 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM KIDNEY IMAGING MORPHOLOGY,78700,CPT,341,RC,34100053,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICARE,384.46,,,,,,,99.8400,3015.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,AETNA,AETNA,1192.18,,,,,,,116.9600,2792.0000,percent of total billed charges,"42.7% of $2,792.00 in Billed Charges for Rev 341 Proc 78701 = $1,192.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,528.56,,,,,,,116.9600,2792.0000,fee schedule,APG 00331 Proc 78701 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 104% = $528.56. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,362.70,,,,,,,116.9600,2792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,AETNA,AETNA HEALTHCARE MEDICARE,362.70,,,,,,,116.9600,2792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,362.70,,,,,,,116.9600,2792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,AMBETTER,AMBETTER,790.69,,,,,,,116.9600,2792.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,377.21,,,,,,,116.9600,2792.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,ANTHEM EXCHANGE,893.00,,,,,,,116.9600,2792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,523.48,,,,,,,116.9600,2792.0000,fee schedule,APG 00331 Proc 78701 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 103% = $523.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,ANTHEM HMO,948.76,,,,,,,116.9600,2792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,373.58,,,,,,,116.9600,2792.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1116.13,,,,,,,116.9600,2792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,191.07,,,,,,,116.9600,2792.0000,fee schedule,$191.07 from Fee Schedule BLDTM_23 for Rev 341 Proc 78701 * Qty 1 = $191.07 at 100% = $191.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,BLUE CROSS E NETWORK,555.62,,,,,,,116.9600,2792.0000,fee schedule,$173.63 from Fee Schedule BCFSC for Rev 341 Proc 78701 * Qty 1 = $173.63 at 320% = $555.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,BLUE CROSS MEDICARE,377.21,,,,,,,116.9600,2792.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,BLUE CROSS P NETWORK,567.77,,,,,,,116.9600,2792.0000,fee schedule,$173.63 from Fee Schedule BCFSC for Rev 341 Proc 78701 * Qty 1 = $173.63 at 327% = $567.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,BLUE CROSS S NETWORK,567.77,,,,,,,116.9600,2792.0000,fee schedule,$173.63 from Fee Schedule BCFSC for Rev 341 Proc 78701 * Qty 1 = $173.63 at 327% = $567.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,TENNCARE BLUE CARE,116.96,,,,,,,116.9600,2792.0000,fee schedule,$100.83 from Fee Schedule TC_24 for Rev 341 Proc 78701 * Qty 1 = $100.83 at 116% = $116.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,TENNCARE BLUE SELECT,116.96,,,,,,,116.9600,2792.0000,fee schedule,$100.83 from Fee Schedule TC_24 for Rev 341 Proc 78701 * Qty 1 = $100.83 at 116% = $116.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,CIGNA HEALTHCARE,CIGNA HMO,1206.05,,,,,,,116.9600,2792.0000,fee schedule,"$1,206.05 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78701 * Qty 1 = $1,206.05 at 100% = $1,206.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,347.26,,,,,,,116.9600,2792.0000,fee schedule,$347.26 from Fee Schedule CGIFP_25LR for Rev 341 Proc 78701 * Qty 1 = $347.26 at 100% = $347.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,380.84,,,,,,,116.9600,2792.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1206.05,,,,,,,116.9600,2792.0000,fee schedule,"$1,206.05 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78701 * Qty 1 = $1,206.05 at 100% = $1,206.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,CIGNA HEALTHCARE,CIGNA PPO,1206.05,,,,,,,116.9600,2792.0000,fee schedule,"$1,206.05 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78701 * Qty 1 = $1,206.05 at 100% = $1,206.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,380.84,,,,,,,116.9600,2792.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2512.80,,,,,,,116.9600,2792.0000,percent of total billed charges,"90% of $2,792.00 in Billed Charges for Rev 341 Proc 78701 = $2,512.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,HUMANA,HUMANA MEDICARE,362.70,,,,,,,116.9600,2792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,362.70,,,,,,,116.9600,2792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,MEDCOST,MEDCOST VHN,1328.71,,,,,,,116.9600,2792.0000,percent of total billed charges,"47.59% of $2,792.00 in Billed Charges for Rev 341 Proc 78701 = $1,328.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,533.64,,,,,,,116.9600,2792.0000,fee schedule,APG 00331 Proc 78701 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 100% = $508.23... $508.23 at 105% = $533.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,380.84,,,,,,,116.9600,2792.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,380.84,,,,,,,116.9600,2792.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,NHC ADVANTAGE,NHC ADVANTAGE,380.84,,,,,,,116.9600,2792.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,523.99,,,,,,,116.9600,2792.0000,fee schedule,APG 00331 Proc 78701 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 100% = $508.23... $508.23 at 103.1% = $523.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,SENTARA HEALTH,SENTARA HEALTH,720.62,,,,,,,116.9600,2792.0000,percent of total billed charges,"25.81% of $2,792.00 in Billed Charges for Rev 341 Proc 78701 = $720.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,SENTARA HEALTH,SENTARA MEDICARE,362.70,,,,,,,116.9600,2792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2792.00,,,,,,,116.9600,2792.0000,percent of total billed charges,"100% of $2,792.00 in Billed Charges for Rev 341 Proc 78701 = $2,792.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,159.33,,,,,,,116.9600,2792.0000,fee schedule,$318.66 from Fee Schedule TCUHC24 for Rev 341 Proc 78701 * Qty 1 = $318.66 at 50% = $159.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,810.00,,,,,,,116.9600,2792.0000,other,Rev 341 Proc 78701 1 Visit at $810.00 per Visit = $810.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,774.00,,,,,,,116.9600,2792.0000,other,Rev 341 Proc 78701 1 Visit at $774.00 per Visit = $774.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,1599.00,,,,,,,116.9600,2792.0000,other,"Rev 341 Proc 78701 1 Visit at $1,599.00 per Visit = $1,599.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,523.48,,,,,,,116.9600,2792.0000,fee schedule,APG 00331 Proc 78701 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 103% = $523.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,362.70,,,,,,,116.9600,2792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,362.70,,,,,,,116.9600,2792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,WELLCARE,WELLCARE MEDICAID,2792.00,,,,,,,116.9600,2792.0000,percent of total billed charges,"100% of $2,792.00 in Billed Charges for Rev 341 Proc 78701 = $2,792.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIDNEY IMAGING W VASCULAR FLOW,78701,CPT,341,RC,34100081,CDM,,,,both,,,2792.0000,418.8000,WELLCARE,WELLCARE MEDICARE,384.46,,,,,,,116.9600,2792.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA,1287.41,,,,,,,145.1400,3015.0000,percent of total billed charges,"42.7% of $3,015.00 in Billed Charges for Rev 341 Proc 78708 = $1,287.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,528.56,,,,,,,145.1400,3015.0000,fee schedule,APG 00331 Proc 78708 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 104% = $528.56. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,492.62,,,,,,,145.1400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA HEALTHCARE MEDICARE,492.62,,,,,,,145.1400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,492.62,,,,,,,145.1400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,AMBETTER,AMBETTER,1073.92,,,,,,,145.1400,3015.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,512.33,,,,,,,145.1400,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM EXCHANGE,1212.87,,,,,,,145.1400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,523.48,,,,,,,145.1400,3015.0000,fee schedule,APG 00331 Proc 78708 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 103% = $523.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HMO,1288.60,,,,,,,145.1400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,507.40,,,,,,,145.1400,3015.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1515.92,,,,,,,145.1400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,274.79,,,,,,,145.1400,3015.0000,fee schedule,$274.79 from Fee Schedule BLDTM_23 for Rev 341 Proc 78708 * Qty 1 = $274.79 at 100% = $274.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS E NETWORK,334.30,,,,,,,145.1400,3015.0000,fee schedule,$104.47 from Fee Schedule BCFSC for Rev 341 Proc 78708 * Qty 1 = $104.47 at 320% = $334.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS MEDICARE,512.33,,,,,,,145.1400,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS P NETWORK,341.62,,,,,,,145.1400,3015.0000,fee schedule,$104.47 from Fee Schedule BCFSC for Rev 341 Proc 78708 * Qty 1 = $104.47 at 327% = $341.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS S NETWORK,341.62,,,,,,,145.1400,3015.0000,fee schedule,$104.47 from Fee Schedule BCFSC for Rev 341 Proc 78708 * Qty 1 = $104.47 at 327% = $341.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE CARE,145.14,,,,,,,145.1400,3015.0000,fee schedule,$125.12 from Fee Schedule TC_24 for Rev 341 Proc 78708 * Qty 1 = $125.12 at 116% = $145.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE SELECT,145.14,,,,,,,145.1400,3015.0000,fee schedule,$125.12 from Fee Schedule TC_24 for Rev 341 Proc 78708 * Qty 1 = $125.12 at 116% = $145.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA HMO,1206.05,,,,,,,145.1400,3015.0000,fee schedule,"$1,206.05 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78708 * Qty 1 = $1,206.05 at 100% = $1,206.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,224.25,,,,,,,145.1400,3015.0000,fee schedule,$224.25 from Fee Schedule CGIFP_25LR for Rev 341 Proc 78708 * Qty 1 = $224.25 at 100% = $224.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,517.25,,,,,,,145.1400,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1206.05,,,,,,,145.1400,3015.0000,fee schedule,"$1,206.05 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78708 * Qty 1 = $1,206.05 at 100% = $1,206.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA PPO,1206.05,,,,,,,145.1400,3015.0000,fee schedule,"$1,206.05 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78708 * Qty 1 = $1,206.05 at 100% = $1,206.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,517.25,,,,,,,145.1400,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2713.50,,,,,,,145.1400,3015.0000,percent of total billed charges,"90% of $3,015.00 in Billed Charges for Rev 341 Proc 78708 = $2,713.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,HUMANA,HUMANA MEDICARE,492.62,,,,,,,145.1400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,492.62,,,,,,,145.1400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,MEDCOST,MEDCOST VHN,1434.84,,,,,,,145.1400,3015.0000,percent of total billed charges,"47.59% of $3,015.00 in Billed Charges for Rev 341 Proc 78708 = $1,434.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,533.64,,,,,,,145.1400,3015.0000,fee schedule,APG 00331 Proc 78708 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 100% = $508.23... $508.23 at 105% = $533.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,517.25,,,,,,,145.1400,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,517.25,,,,,,,145.1400,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,NHC ADVANTAGE,NHC ADVANTAGE,517.25,,,,,,,145.1400,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,523.99,,,,,,,145.1400,3015.0000,fee schedule,APG 00331 Proc 78708 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 100% = $508.23... $508.23 at 103.1% = $523.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA HEALTH,778.17,,,,,,,145.1400,3015.0000,percent of total billed charges,"25.81% of $3,015.00 in Billed Charges for Rev 341 Proc 78708 = $778.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA MEDICARE,492.62,,,,,,,145.1400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3015.00,,,,,,,145.1400,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 341 Proc 78708 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,159.33,,,,,,,145.1400,3015.0000,fee schedule,$318.66 from Fee Schedule TCUHC24 for Rev 341 Proc 78708 * Qty 1 = $318.66 at 50% = $159.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,810.00,,,,,,,145.1400,3015.0000,other,Rev 341 Proc 78708 1 Visit at $810.00 per Visit = $810.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,774.00,,,,,,,145.1400,3015.0000,other,Rev 341 Proc 78708 1 Visit at $774.00 per Visit = $774.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1599.00,,,,,,,145.1400,3015.0000,other,"Rev 341 Proc 78708 1 Visit at $1,599.00 per Visit = $1,599.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,523.48,,,,,,,145.1400,3015.0000,fee schedule,APG 00331 Proc 78708 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 103% = $523.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,492.62,,,,,,,145.1400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,492.62,,,,,,,145.1400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICAID,3015.00,,,,,,,145.1400,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 341 Proc 78708 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM RENAL FLOW FCT W MEDS,78708,CPT,341,RC,34100055,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICARE,522.18,,,,,,,145.1400,3015.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA,1287.41,,,,,,,145.1400,3015.0000,percent of total billed charges,"42.7% of $3,015.00 in Billed Charges for Rev 341 Proc 78709 = $1,287.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,528.56,,,,,,,145.1400,3015.0000,fee schedule,APG 00331 Proc 78709 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 104% = $528.56. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,492.62,,,,,,,145.1400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA HEALTHCARE MEDICARE,492.62,,,,,,,145.1400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,492.62,,,,,,,145.1400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,AMBETTER,AMBETTER,1073.92,,,,,,,145.1400,3015.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,512.33,,,,,,,145.1400,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM EXCHANGE,1212.87,,,,,,,145.1400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,523.48,,,,,,,145.1400,3015.0000,fee schedule,APG 00331 Proc 78709 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 103% = $523.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HMO,1288.60,,,,,,,145.1400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,507.40,,,,,,,145.1400,3015.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1515.92,,,,,,,145.1400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,284.34,,,,,,,145.1400,3015.0000,fee schedule,$284.34 from Fee Schedule BLDTM_23 for Rev 341 Proc 78709 * Qty 1 = $284.34 at 100% = $284.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS E NETWORK,872.67,,,,,,,145.1400,3015.0000,fee schedule,$272.71 from Fee Schedule BCFSC for Rev 341 Proc 78709 * Qty 1 = $272.71 at 320% = $872.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS MEDICARE,512.33,,,,,,,145.1400,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS P NETWORK,891.76,,,,,,,145.1400,3015.0000,fee schedule,$272.71 from Fee Schedule BCFSC for Rev 341 Proc 78709 * Qty 1 = $272.71 at 327% = $891.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS S NETWORK,891.76,,,,,,,145.1400,3015.0000,fee schedule,$272.71 from Fee Schedule BCFSC for Rev 341 Proc 78709 * Qty 1 = $272.71 at 327% = $891.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE CARE,145.14,,,,,,,145.1400,3015.0000,fee schedule,$125.12 from Fee Schedule TC_24 for Rev 341 Proc 78709 * Qty 1 = $125.12 at 116% = $145.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE SELECT,145.14,,,,,,,145.1400,3015.0000,fee schedule,$125.12 from Fee Schedule TC_24 for Rev 341 Proc 78709 * Qty 1 = $125.12 at 116% = $145.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA HMO,1206.05,,,,,,,145.1400,3015.0000,fee schedule,"$1,206.05 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78709 * Qty 1 = $1,206.05 at 100% = $1,206.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,512.75,,,,,,,145.1400,3015.0000,fee schedule,$512.75 from Fee Schedule CGIFP_25LR for Rev 341 Proc 78709 * Qty 1 = $512.75 at 100% = $512.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,517.25,,,,,,,145.1400,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1206.05,,,,,,,145.1400,3015.0000,fee schedule,"$1,206.05 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78709 * Qty 1 = $1,206.05 at 100% = $1,206.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA PPO,1206.05,,,,,,,145.1400,3015.0000,fee schedule,"$1,206.05 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78709 * Qty 1 = $1,206.05 at 100% = $1,206.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,517.25,,,,,,,145.1400,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2713.50,,,,,,,145.1400,3015.0000,percent of total billed charges,"90% of $3,015.00 in Billed Charges for Rev 341 Proc 78709 = $2,713.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,HUMANA,HUMANA MEDICARE,492.62,,,,,,,145.1400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,492.62,,,,,,,145.1400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,MEDCOST,MEDCOST VHN,1434.84,,,,,,,145.1400,3015.0000,percent of total billed charges,"47.59% of $3,015.00 in Billed Charges for Rev 341 Proc 78709 = $1,434.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,533.64,,,,,,,145.1400,3015.0000,fee schedule,APG 00331 Proc 78709 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 100% = $508.23... $508.23 at 105% = $533.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,517.25,,,,,,,145.1400,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,517.25,,,,,,,145.1400,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,NHC ADVANTAGE,NHC ADVANTAGE,517.25,,,,,,,145.1400,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,523.99,,,,,,,145.1400,3015.0000,fee schedule,APG 00331 Proc 78709 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 100% = $508.23... $508.23 at 103.1% = $523.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA HEALTH,778.17,,,,,,,145.1400,3015.0000,percent of total billed charges,"25.81% of $3,015.00 in Billed Charges for Rev 341 Proc 78709 = $778.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA MEDICARE,492.62,,,,,,,145.1400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3015.00,,,,,,,145.1400,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 341 Proc 78709 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,159.33,,,,,,,145.1400,3015.0000,fee schedule,$318.66 from Fee Schedule TCUHC24 for Rev 341 Proc 78709 * Qty 1 = $318.66 at 50% = $159.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,810.00,,,,,,,145.1400,3015.0000,other,Rev 341 Proc 78709 1 Visit at $810.00 per Visit = $810.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,774.00,,,,,,,145.1400,3015.0000,other,Rev 341 Proc 78709 1 Visit at $774.00 per Visit = $774.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1599.00,,,,,,,145.1400,3015.0000,other,"Rev 341 Proc 78709 1 Visit at $1,599.00 per Visit = $1,599.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,523.48,,,,,,,145.1400,3015.0000,fee schedule,APG 00331 Proc 78709 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 103% = $523.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,492.62,,,,,,,145.1400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,492.62,,,,,,,145.1400,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICAID,3015.00,,,,,,,145.1400,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 341 Proc 78709 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM RENAL FLOW FCT WOW MEDS*,78709,CPT,341,RC,34100056,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICARE,522.18,,,,,,,145.1400,3015.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,AETNA,AETNA,520.09,,,,,,,69.6500,1218.0000,percent of total billed charges,"42.7% of $1,218.00 in Billed Charges for Rev 340 Proc 78740 = $520.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,528.56,,,,,,,69.6500,1218.0000,fee schedule,APG 00331 Proc 78740 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 104% = $528.56. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,362.70,,,,,,,69.6500,1218.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,AETNA,AETNA HEALTHCARE MEDICARE,362.70,,,,,,,69.6500,1218.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,362.70,,,,,,,69.6500,1218.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,AMBETTER,AMBETTER,790.69,,,,,,,69.6500,1218.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,377.21,,,,,,,69.6500,1218.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,BLUE CROSS,ANTHEM EXCHANGE,893.00,,,,,,,69.6500,1218.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,523.48,,,,,,,69.6500,1218.0000,fee schedule,APG 00331 Proc 78740 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 103% = $523.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,BLUE CROSS,ANTHEM HMO,948.76,,,,,,,69.6500,1218.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,373.58,,,,,,,69.6500,1218.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1116.13,,,,,,,69.6500,1218.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,132.02,,,,,,,69.6500,1218.0000,fee schedule,$132.02 from Fee Schedule BLDTM_23 for Rev 340 Proc 78740 * Qty 1 = $132.02 at 100% = $132.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,BLUE CROSS,BLUE CROSS E NETWORK,562.82,,,,,,,69.6500,1218.0000,fee schedule,$175.88 from Fee Schedule BCFSC for Rev 340 Proc 78740 * Qty 1 = $175.88 at 320% = $562.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,BLUE CROSS,BLUE CROSS MEDICARE,377.21,,,,,,,69.6500,1218.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,BLUE CROSS,BLUE CROSS P NETWORK,575.13,,,,,,,69.6500,1218.0000,fee schedule,$175.88 from Fee Schedule BCFSC for Rev 340 Proc 78740 * Qty 1 = $175.88 at 327% = $575.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,BLUE CROSS,BLUE CROSS S NETWORK,575.13,,,,,,,69.6500,1218.0000,fee schedule,$175.88 from Fee Schedule BCFSC for Rev 340 Proc 78740 * Qty 1 = $175.88 at 327% = $575.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,BLUE CROSS,TENNCARE BLUE CARE,69.65,,,,,,,69.6500,1218.0000,fee schedule,$60.04 from Fee Schedule TC_24 for Rev 340 Proc 78740 * Qty 1 = $60.04 at 116% = $69.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,BLUE CROSS,TENNCARE BLUE SELECT,69.65,,,,,,,69.6500,1218.0000,fee schedule,$60.04 from Fee Schedule TC_24 for Rev 340 Proc 78740 * Qty 1 = $60.04 at 116% = $69.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,CIGNA HEALTHCARE,CIGNA HMO,1206.05,,,,,,,69.6500,1218.0000,fee schedule,"$1,206.05 from Fee Schedule CIGWHS_23 for Rev 340 Proc 78740 * Qty 1 = $1,206.05 at 100% = $1,206.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,345.38,,,,,,,69.6500,1218.0000,fee schedule,$345.38 from Fee Schedule CGIFP_25LR for Rev 340 Proc 78740 * Qty 1 = $345.38 at 100% = $345.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,380.84,,,,,,,69.6500,1218.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1206.05,,,,,,,69.6500,1218.0000,fee schedule,"$1,206.05 from Fee Schedule CIGWHS_23 for Rev 340 Proc 78740 * Qty 1 = $1,206.05 at 100% = $1,206.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,CIGNA HEALTHCARE,CIGNA PPO,1206.05,,,,,,,69.6500,1218.0000,fee schedule,"$1,206.05 from Fee Schedule CIGWHS_23 for Rev 340 Proc 78740 * Qty 1 = $1,206.05 at 100% = $1,206.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,380.84,,,,,,,69.6500,1218.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1096.20,,,,,,,69.6500,1218.0000,percent of total billed charges,"90% of $1,218.00 in Billed Charges for Rev 340 Proc 78740 = $1,096.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,HUMANA,HUMANA MEDICARE,362.70,,,,,,,69.6500,1218.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,362.70,,,,,,,69.6500,1218.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,MEDCOST,MEDCOST VHN,579.65,,,,,,,69.6500,1218.0000,percent of total billed charges,"47.59% of $1,218.00 in Billed Charges for Rev 340 Proc 78740 = $579.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,533.64,,,,,,,69.6500,1218.0000,fee schedule,APG 00331 Proc 78740 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 100% = $508.23... $508.23 at 105% = $533.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,380.84,,,,,,,69.6500,1218.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,380.84,,,,,,,69.6500,1218.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,NHC ADVANTAGE,NHC ADVANTAGE,380.84,,,,,,,69.6500,1218.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,523.99,,,,,,,69.6500,1218.0000,fee schedule,APG 00331 Proc 78740 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 100% = $508.23... $508.23 at 103.1% = $523.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,SENTARA HEALTH,SENTARA HEALTH,314.37,,,,,,,69.6500,1218.0000,percent of total billed charges,"25.81% of $1,218.00 in Billed Charges for Rev 340 Proc 78740 = $314.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,SENTARA HEALTH,SENTARA MEDICARE,362.70,,,,,,,69.6500,1218.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1218.00,,,,,,,69.6500,1218.0000,percent of total billed charges,"100% of $1,218.00 in Billed Charges for Rev 340 Proc 78740 = $1,218.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,159.33,,,,,,,69.6500,1218.0000,fee schedule,$318.66 from Fee Schedule TCUHC24 for Rev 340 Proc 78740 * Qty 1 = $318.66 at 50% = $159.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,810.00,,,,,,,69.6500,1218.0000,other,Rev 340 Proc 78740 1 Visit at $810.00 per Visit = $810.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,774.00,,,,,,,69.6500,1218.0000,other,Rev 340 Proc 78740 1 Visit at $774.00 per Visit = $774.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,1218.00,,,,,,,69.6500,1218.0000,other,"Rev 340 Proc 78740 1 Visit at $1,599.00 per Visit = $1,599.00 (Service Line reduced to $1,218.00, claim capped at $1,218.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,523.48,,,,,,,69.6500,1218.0000,fee schedule,APG 00331 Proc 78740 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 103% = $523.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,362.70,,,,,,,69.6500,1218.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,362.70,,,,,,,69.6500,1218.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,WELLCARE,WELLCARE MEDICAID,1218.00,,,,,,,69.6500,1218.0000,percent of total billed charges,"100% of $1,218.00 in Billed Charges for Rev 340 Proc 78740 = $1,218.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM,78740,CPT,340,RC,34000003,CDM,,,,both,,,1218.0000,182.7000,WELLCARE,WELLCARE MEDICARE,384.46,,,,,,,69.6500,1218.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
INTRAOPERATIVE NEUOMONITORING,272,RC,27200002,CDM,,,,,,both,,,4926.2300,738.9300,AETNA,AETNA,2103.50,,,,,,,1271.4600,4926.2300,percent of total billed charges,"42.7% of $4,926.23 in Billed Charges for Rev 272 = $2,103.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INTRAOPERATIVE NEUOMONITORING,272,RC,27200002,CDM,,,,,,both,,,4926.2300,738.9300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3448.36,,,,,,,1271.4600,4926.2300,percent of total billed charges,"Rev 272 $4,926.23 in Billed Charges at 70% = $3,448.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INTRAOPERATIVE NEUOMONITORING,272,RC,27200002,CDM,,,,,,both,,,4926.2300,738.9300,CIGNA HEALTHCARE,CIGNA HMO,2054.24,,,,,,,1271.4600,4926.2300,percent of total billed charges,"41.7% of $4,926.23 in Billed Charges for Rev 272 = $2,054.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INTRAOPERATIVE NEUOMONITORING,272,RC,27200002,CDM,,,,,,both,,,4926.2300,738.9300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2285.77,,,,,,,1271.4600,4926.2300,percent of total billed charges,"46.4% of $4,926.23 in Billed Charges for Rev 272 = $2,285.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INTRAOPERATIVE NEUOMONITORING,272,RC,27200002,CDM,,,,,,both,,,4926.2300,738.9300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2054.24,,,,,,,1271.4600,4926.2300,percent of total billed charges,"41.7% of $4,926.23 in Billed Charges for Rev 272 = $2,054.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INTRAOPERATIVE NEUOMONITORING,272,RC,27200002,CDM,,,,,,both,,,4926.2300,738.9300,CIGNA HEALTHCARE,CIGNA PPO,2054.24,,,,,,,1271.4600,4926.2300,percent of total billed charges,"41.7% of $4,926.23 in Billed Charges for Rev 272 = $2,054.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INTRAOPERATIVE NEUOMONITORING,272,RC,27200002,CDM,,,,,,both,,,4926.2300,738.9300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4433.61,,,,,,,1271.4600,4926.2300,percent of total billed charges,"90% of $4,926.23 in Billed Charges for Rev 272 = $4,433.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INTRAOPERATIVE NEUOMONITORING,272,RC,27200002,CDM,,,,,,both,,,4926.2300,738.9300,MEDCOST,MEDCOST VHN,2344.39,,,,,,,1271.4600,4926.2300,percent of total billed charges,"47.59% of $4,926.23 in Billed Charges for Rev 272 = $2,344.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INTRAOPERATIVE NEUOMONITORING,272,RC,27200002,CDM,,,,,,both,,,4926.2300,738.9300,SENTARA HEALTH,SENTARA HEALTH,1271.46,,,,,,,1271.4600,4926.2300,percent of total billed charges,"25.81% of $4,926.23 in Billed Charges for Rev 272 = $1,271.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INTRAOPERATIVE NEUOMONITORING,272,RC,27200002,CDM,,,,,,both,,,4926.2300,738.9300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4926.23,,,,,,,1271.4600,4926.2300,percent of total billed charges,"100% of $4,926.23 in Billed Charges for Rev 272 = $4,926.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INTRAOPERATIVE NEUOMONITORING,272,RC,27200002,CDM,,,,,,both,,,4926.2300,738.9300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2463.12,,,,,,,1271.4600,4926.2300,percent of total billed charges,"Rev 272 $4,926.23 in Billed Charges at 50% = $2,463.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INTRAOPERATIVE NEUOMONITORING,272,RC,27200002,CDM,,,,,,both,,,4926.2300,738.9300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1591.17,,,,,,,1271.4600,4926.2300,other,"32.3% of $4,926.23 in Billed Charges for Rev 272 = $1,591.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
INTRAOPERATIVE NEUOMONITORING,272,RC,27200002,CDM,,,,,,both,,,4926.2300,738.9300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1512.35,,,,,,,1271.4600,4926.2300,other,"30.7% of $4,926.23 in Billed Charges for Rev 272 = $1,512.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
INTRAOPERATIVE NEUOMONITORING,272,RC,27200002,CDM,,,,,,both,,,4926.2300,738.9300,UNITED HEALTHCARE,UNITED HEALTHCARE,1591.17,,,,,,,1271.4600,4926.2300,percent of total billed charges,"32.3% of $4,926.23 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
INTRAOPERATIVE NEUOMONITORING,272,RC,27200002,CDM,,,,,,both,,,4926.2300,738.9300,WELLCARE,WELLCARE MEDICAID,4926.23,,,,,,,1271.4600,4926.2300,percent of total billed charges,"100% of $4,926.23 in Billed Charges for Rev 272 = $4,926.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS CRYSTAL CRANIUM MODEL,272,RC,27200002,CDM,,,,,,both,,,58181.3100,8727.2000,AETNA,AETNA,24843.42,,,,,,,15016.6000,58181.3100,percent of total billed charges,"42.7% of $58,181.31 in Billed Charges for Rev 272 = $24,843.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS CRYSTAL CRANIUM MODEL,272,RC,27200002,CDM,,,,,,both,,,58181.3100,8727.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,40726.92,,,,,,,15016.6000,58181.3100,percent of total billed charges,"Rev 272 $58,181.31 in Billed Charges at 70% = $40,726.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS CRYSTAL CRANIUM MODEL,272,RC,27200002,CDM,,,,,,both,,,58181.3100,8727.2000,CIGNA HEALTHCARE,CIGNA HMO,24261.61,,,,,,,15016.6000,58181.3100,percent of total billed charges,"41.7% of $58,181.31 in Billed Charges for Rev 272 = $24,261.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS CRYSTAL CRANIUM MODEL,272,RC,27200002,CDM,,,,,,both,,,58181.3100,8727.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,26996.13,,,,,,,15016.6000,58181.3100,percent of total billed charges,"46.4% of $58,181.31 in Billed Charges for Rev 272 = $26,996.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS CRYSTAL CRANIUM MODEL,272,RC,27200002,CDM,,,,,,both,,,58181.3100,8727.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,24261.61,,,,,,,15016.6000,58181.3100,percent of total billed charges,"41.7% of $58,181.31 in Billed Charges for Rev 272 = $24,261.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS CRYSTAL CRANIUM MODEL,272,RC,27200002,CDM,,,,,,both,,,58181.3100,8727.2000,CIGNA HEALTHCARE,CIGNA PPO,24261.61,,,,,,,15016.6000,58181.3100,percent of total billed charges,"41.7% of $58,181.31 in Billed Charges for Rev 272 = $24,261.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS CRYSTAL CRANIUM MODEL,272,RC,27200002,CDM,,,,,,both,,,58181.3100,8727.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,52363.18,,,,,,,15016.6000,58181.3100,percent of total billed charges,"90% of $58,181.31 in Billed Charges for Rev 272 = $52,363.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS CRYSTAL CRANIUM MODEL,272,RC,27200002,CDM,,,,,,both,,,58181.3100,8727.2000,MEDCOST,MEDCOST VHN,27688.49,,,,,,,15016.6000,58181.3100,percent of total billed charges,"47.59% of $58,181.31 in Billed Charges for Rev 272 = $27,688.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS CRYSTAL CRANIUM MODEL,272,RC,27200002,CDM,,,,,,both,,,58181.3100,8727.2000,SENTARA HEALTH,SENTARA HEALTH,15016.60,,,,,,,15016.6000,58181.3100,percent of total billed charges,"25.81% of $58,181.31 in Billed Charges for Rev 272 = $15,016.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS CRYSTAL CRANIUM MODEL,272,RC,27200002,CDM,,,,,,both,,,58181.3100,8727.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",58181.31,,,,,,,15016.6000,58181.3100,percent of total billed charges,"100% of $58,181.31 in Billed Charges for Rev 272 = $58,181.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS CRYSTAL CRANIUM MODEL,272,RC,27200002,CDM,,,,,,both,,,58181.3100,8727.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,29090.66,,,,,,,15016.6000,58181.3100,percent of total billed charges,"Rev 272 $58,181.31 in Billed Charges at 50% = $29,090.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS CRYSTAL CRANIUM MODEL,272,RC,27200002,CDM,,,,,,both,,,58181.3100,8727.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,18792.56,,,,,,,15016.6000,58181.3100,other,"32.3% of $58,181.31 in Billed Charges for Rev 272 = $18,792.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
IPS CRYSTAL CRANIUM MODEL,272,RC,27200002,CDM,,,,,,both,,,58181.3100,8727.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,17861.66,,,,,,,15016.6000,58181.3100,other,"30.7% of $58,181.31 in Billed Charges for Rev 272 = $17,861.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
IPS CRYSTAL CRANIUM MODEL,272,RC,27200002,CDM,,,,,,both,,,58181.3100,8727.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,18792.56,,,,,,,15016.6000,58181.3100,percent of total billed charges,"32.3% of $58,181.31 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
IPS CRYSTAL CRANIUM MODEL,272,RC,27200002,CDM,,,,,,both,,,58181.3100,8727.2000,WELLCARE,WELLCARE MEDICAID,58181.31,,,,,,,15016.6000,58181.3100,percent of total billed charges,"100% of $58,181.31 in Billed Charges for Rev 272 = $58,181.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
JURGAN PINBALL W062-GN WO62-GN,272,RC,,,,,,,,both,,,159.0200,23.8500,AETNA,AETNA,67.90,,,,,,,41.0400,159.0200,percent of total billed charges,42.7% of $159.02 in Billed Charges for Rev 272 = $67.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
JURGAN PINBALL W062-GN WO62-GN,272,RC,,,,,,,,both,,,159.0200,23.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,111.31,,,,,,,41.0400,159.0200,percent of total billed charges,Rev 272 $159.02 in Billed Charges at 70% = $111.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
JURGAN PINBALL W062-GN WO62-GN,272,RC,,,,,,,,both,,,159.0200,23.8500,CIGNA HEALTHCARE,CIGNA HMO,66.31,,,,,,,41.0400,159.0200,percent of total billed charges,41.7% of $159.02 in Billed Charges for Rev 272 = $66.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
JURGAN PINBALL W062-GN WO62-GN,272,RC,,,,,,,,both,,,159.0200,23.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,73.79,,,,,,,41.0400,159.0200,percent of total billed charges,46.4% of $159.02 in Billed Charges for Rev 272 = $73.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
JURGAN PINBALL W062-GN WO62-GN,272,RC,,,,,,,,both,,,159.0200,23.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,66.31,,,,,,,41.0400,159.0200,percent of total billed charges,41.7% of $159.02 in Billed Charges for Rev 272 = $66.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
JURGAN PINBALL W062-GN WO62-GN,272,RC,,,,,,,,both,,,159.0200,23.8500,CIGNA HEALTHCARE,CIGNA PPO,66.31,,,,,,,41.0400,159.0200,percent of total billed charges,41.7% of $159.02 in Billed Charges for Rev 272 = $66.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
JURGAN PINBALL W062-GN WO62-GN,272,RC,,,,,,,,both,,,159.0200,23.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,143.12,,,,,,,41.0400,159.0200,percent of total billed charges,90% of $159.02 in Billed Charges for Rev 272 = $143.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
JURGAN PINBALL W062-GN WO62-GN,272,RC,,,,,,,,both,,,159.0200,23.8500,MEDCOST,MEDCOST VHN,75.68,,,,,,,41.0400,159.0200,percent of total billed charges,47.59% of $159.02 in Billed Charges for Rev 272 = $75.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
JURGAN PINBALL W062-GN WO62-GN,272,RC,,,,,,,,both,,,159.0200,23.8500,SENTARA HEALTH,SENTARA HEALTH,41.04,,,,,,,41.0400,159.0200,percent of total billed charges,25.81% of $159.02 in Billed Charges for Rev 272 = $41.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
JURGAN PINBALL W062-GN WO62-GN,272,RC,,,,,,,,both,,,159.0200,23.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",159.02,,,,,,,41.0400,159.0200,percent of total billed charges,100% of $159.02 in Billed Charges for Rev 272 = $159.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
JURGAN PINBALL W062-GN WO62-GN,272,RC,,,,,,,,both,,,159.0200,23.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,79.51,,,,,,,41.0400,159.0200,percent of total billed charges,Rev 272 $159.02 in Billed Charges at 50% = $79.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
JURGAN PINBALL W062-GN WO62-GN,272,RC,,,,,,,,both,,,159.0200,23.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,51.36,,,,,,,41.0400,159.0200,other,32.3% of $159.02 in Billed Charges for Rev 272 = $51.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
JURGAN PINBALL W062-GN WO62-GN,272,RC,,,,,,,,both,,,159.0200,23.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,48.82,,,,,,,41.0400,159.0200,other,30.7% of $159.02 in Billed Charges for Rev 272 = $48.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
JURGAN PINBALL W062-GN WO62-GN,272,RC,,,,,,,,both,,,159.0200,23.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,51.36,,,,,,,41.0400,159.0200,percent of total billed charges,32.3% of $159.02 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
JURGAN PINBALL W062-GN WO62-GN,272,RC,,,,,,,,both,,,159.0200,23.8500,WELLCARE,WELLCARE MEDICAID,159.02,,,,,,,41.0400,159.0200,percent of total billed charges,100% of $159.02 in Billed Charges for Rev 272 = $159.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 1.65X500MM SHARP THREDED,272,RC,27200002,CDM,,,,,,both,,,694.8600,104.2300,AETNA,AETNA,296.71,,,,,,,179.3400,694.8600,percent of total billed charges,42.7% of $694.86 in Billed Charges for Rev 272 = $296.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 1.65X500MM SHARP THREDED,272,RC,27200002,CDM,,,,,,both,,,694.8600,104.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,486.40,,,,,,,179.3400,694.8600,percent of total billed charges,Rev 272 $694.86 in Billed Charges at 70% = $486.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 1.65X500MM SHARP THREDED,272,RC,27200002,CDM,,,,,,both,,,694.8600,104.2300,CIGNA HEALTHCARE,CIGNA HMO,289.76,,,,,,,179.3400,694.8600,percent of total billed charges,41.7% of $694.86 in Billed Charges for Rev 272 = $289.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 1.65X500MM SHARP THREDED,272,RC,27200002,CDM,,,,,,both,,,694.8600,104.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,322.42,,,,,,,179.3400,694.8600,percent of total billed charges,46.4% of $694.86 in Billed Charges for Rev 272 = $322.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 1.65X500MM SHARP THREDED,272,RC,27200002,CDM,,,,,,both,,,694.8600,104.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,289.76,,,,,,,179.3400,694.8600,percent of total billed charges,41.7% of $694.86 in Billed Charges for Rev 272 = $289.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 1.65X500MM SHARP THREDED,272,RC,27200002,CDM,,,,,,both,,,694.8600,104.2300,CIGNA HEALTHCARE,CIGNA PPO,289.76,,,,,,,179.3400,694.8600,percent of total billed charges,41.7% of $694.86 in Billed Charges for Rev 272 = $289.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 1.65X500MM SHARP THREDED,272,RC,27200002,CDM,,,,,,both,,,694.8600,104.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,625.37,,,,,,,179.3400,694.8600,percent of total billed charges,90% of $694.86 in Billed Charges for Rev 272 = $625.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 1.65X500MM SHARP THREDED,272,RC,27200002,CDM,,,,,,both,,,694.8600,104.2300,MEDCOST,MEDCOST VHN,330.68,,,,,,,179.3400,694.8600,percent of total billed charges,47.59% of $694.86 in Billed Charges for Rev 272 = $330.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 1.65X500MM SHARP THREDED,272,RC,27200002,CDM,,,,,,both,,,694.8600,104.2300,SENTARA HEALTH,SENTARA HEALTH,179.34,,,,,,,179.3400,694.8600,percent of total billed charges,25.81% of $694.86 in Billed Charges for Rev 272 = $179.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 1.65X500MM SHARP THREDED,272,RC,27200002,CDM,,,,,,both,,,694.8600,104.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",694.86,,,,,,,179.3400,694.8600,percent of total billed charges,100% of $694.86 in Billed Charges for Rev 272 = $694.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 1.65X500MM SHARP THREDED,272,RC,27200002,CDM,,,,,,both,,,694.8600,104.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,347.43,,,,,,,179.3400,694.8600,percent of total billed charges,Rev 272 $694.86 in Billed Charges at 50% = $347.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 1.65X500MM SHARP THREDED,272,RC,27200002,CDM,,,,,,both,,,694.8600,104.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,224.44,,,,,,,179.3400,694.8600,other,32.3% of $694.86 in Billed Charges for Rev 272 = $224.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
K-WIRE 1.65X500MM SHARP THREDED,272,RC,27200002,CDM,,,,,,both,,,694.8600,104.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,213.32,,,,,,,179.3400,694.8600,other,30.7% of $694.86 in Billed Charges for Rev 272 = $213.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
K-WIRE 1.65X500MM SHARP THREDED,272,RC,27200002,CDM,,,,,,both,,,694.8600,104.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,224.44,,,,,,,179.3400,694.8600,percent of total billed charges,32.3% of $694.86 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
K-WIRE 1.65X500MM SHARP THREDED,272,RC,27200002,CDM,,,,,,both,,,694.8600,104.2300,WELLCARE,WELLCARE MEDICAID,694.86,,,,,,,179.3400,694.8600,percent of total billed charges,100% of $694.86 in Billed Charges for Rev 272 = $694.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KCI PREVENA PLUS INCISION MANAGEMENT SYSTEM PRE4001US,272,RC,27200002,CDM,,,,,,both,,,6728.9100,1009.3400,AETNA,AETNA,2873.24,,,,,,,1736.7300,6728.9100,percent of total billed charges,"42.7% of $6,728.91 in Billed Charges for Rev 272 = $2,873.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KCI PREVENA PLUS INCISION MANAGEMENT SYSTEM PRE4001US,272,RC,27200002,CDM,,,,,,both,,,6728.9100,1009.3400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4710.24,,,,,,,1736.7300,6728.9100,percent of total billed charges,"Rev 272 $6,728.91 in Billed Charges at 70% = $4,710.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KCI PREVENA PLUS INCISION MANAGEMENT SYSTEM PRE4001US,272,RC,27200002,CDM,,,,,,both,,,6728.9100,1009.3400,CIGNA HEALTHCARE,CIGNA HMO,2805.96,,,,,,,1736.7300,6728.9100,percent of total billed charges,"41.7% of $6,728.91 in Billed Charges for Rev 272 = $2,805.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KCI PREVENA PLUS INCISION MANAGEMENT SYSTEM PRE4001US,272,RC,27200002,CDM,,,,,,both,,,6728.9100,1009.3400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3122.21,,,,,,,1736.7300,6728.9100,percent of total billed charges,"46.4% of $6,728.91 in Billed Charges for Rev 272 = $3,122.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KCI PREVENA PLUS INCISION MANAGEMENT SYSTEM PRE4001US,272,RC,27200002,CDM,,,,,,both,,,6728.9100,1009.3400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2805.96,,,,,,,1736.7300,6728.9100,percent of total billed charges,"41.7% of $6,728.91 in Billed Charges for Rev 272 = $2,805.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KCI PREVENA PLUS INCISION MANAGEMENT SYSTEM PRE4001US,272,RC,27200002,CDM,,,,,,both,,,6728.9100,1009.3400,CIGNA HEALTHCARE,CIGNA PPO,2805.96,,,,,,,1736.7300,6728.9100,percent of total billed charges,"41.7% of $6,728.91 in Billed Charges for Rev 272 = $2,805.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KCI PREVENA PLUS INCISION MANAGEMENT SYSTEM PRE4001US,272,RC,27200002,CDM,,,,,,both,,,6728.9100,1009.3400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6056.02,,,,,,,1736.7300,6728.9100,percent of total billed charges,"90% of $6,728.91 in Billed Charges for Rev 272 = $6,056.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KCI PREVENA PLUS INCISION MANAGEMENT SYSTEM PRE4001US,272,RC,27200002,CDM,,,,,,both,,,6728.9100,1009.3400,MEDCOST,MEDCOST VHN,3202.29,,,,,,,1736.7300,6728.9100,percent of total billed charges,"47.59% of $6,728.91 in Billed Charges for Rev 272 = $3,202.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KCI PREVENA PLUS INCISION MANAGEMENT SYSTEM PRE4001US,272,RC,27200002,CDM,,,,,,both,,,6728.9100,1009.3400,SENTARA HEALTH,SENTARA HEALTH,1736.73,,,,,,,1736.7300,6728.9100,percent of total billed charges,"25.81% of $6,728.91 in Billed Charges for Rev 272 = $1,736.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KCI PREVENA PLUS INCISION MANAGEMENT SYSTEM PRE4001US,272,RC,27200002,CDM,,,,,,both,,,6728.9100,1009.3400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6728.91,,,,,,,1736.7300,6728.9100,percent of total billed charges,"100% of $6,728.91 in Billed Charges for Rev 272 = $6,728.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KCI PREVENA PLUS INCISION MANAGEMENT SYSTEM PRE4001US,272,RC,27200002,CDM,,,,,,both,,,6728.9100,1009.3400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3364.46,,,,,,,1736.7300,6728.9100,percent of total billed charges,"Rev 272 $6,728.91 in Billed Charges at 50% = $3,364.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KCI PREVENA PLUS INCISION MANAGEMENT SYSTEM PRE4001US,272,RC,27200002,CDM,,,,,,both,,,6728.9100,1009.3400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2173.44,,,,,,,1736.7300,6728.9100,other,"32.3% of $6,728.91 in Billed Charges for Rev 272 = $2,173.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KCI PREVENA PLUS INCISION MANAGEMENT SYSTEM PRE4001US,272,RC,27200002,CDM,,,,,,both,,,6728.9100,1009.3400,UNITED HEALTHCARE,UHC HERITAGE SELECT,2065.78,,,,,,,1736.7300,6728.9100,other,"30.7% of $6,728.91 in Billed Charges for Rev 272 = $2,065.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KCI PREVENA PLUS INCISION MANAGEMENT SYSTEM PRE4001US,272,RC,27200002,CDM,,,,,,both,,,6728.9100,1009.3400,UNITED HEALTHCARE,UNITED HEALTHCARE,2173.44,,,,,,,1736.7300,6728.9100,percent of total billed charges,"32.3% of $6,728.91 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KCI PREVENA PLUS INCISION MANAGEMENT SYSTEM PRE4001US,272,RC,27200002,CDM,,,,,,both,,,6728.9100,1009.3400,WELLCARE,WELLCARE MEDICAID,6728.91,,,,,,,1736.7300,6728.9100,percent of total billed charges,"100% of $6,728.91 in Billed Charges for Rev 272 = $6,728.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA,1287.41,,,,,,,181.7300,3015.0000,percent of total billed charges,"42.7% of $3,015.00 in Billed Charges for Rev 341 Proc 78802 = $1,287.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1302.66,,,,,,,181.7300,3015.0000,fee schedule,"APG 00332 Proc 78802 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 104% = $1,302.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,492.62,,,,,,,181.7300,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA HEALTHCARE MEDICARE,492.62,,,,,,,181.7300,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,492.62,,,,,,,181.7300,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,AMBETTER,AMBETTER,1073.92,,,,,,,181.7300,3015.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,512.33,,,,,,,181.7300,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM EXCHANGE,1212.87,,,,,,,181.7300,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1290.13,,,,,,,181.7300,3015.0000,fee schedule,"APG 00332 Proc 78802 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 103% = $1,290.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HMO,1288.60,,,,,,,181.7300,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,507.40,,,,,,,181.7300,3015.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1515.92,,,,,,,181.7300,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,326.29,,,,,,,181.7300,3015.0000,fee schedule,$326.29 from Fee Schedule BLDTM_23 for Rev 341 Proc 78802 * Qty 1 = $326.29 at 100% = $326.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS E NETWORK,822.24,,,,,,,181.7300,3015.0000,fee schedule,$256.95 from Fee Schedule BCFSC for Rev 341 Proc 78802 * Qty 1 = $256.95 at 320% = $822.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS MEDICARE,512.33,,,,,,,181.7300,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS P NETWORK,840.23,,,,,,,181.7300,3015.0000,fee schedule,$256.95 from Fee Schedule BCFSC for Rev 341 Proc 78802 * Qty 1 = $256.95 at 327% = $840.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS S NETWORK,840.23,,,,,,,181.7300,3015.0000,fee schedule,$256.95 from Fee Schedule BCFSC for Rev 341 Proc 78802 * Qty 1 = $256.95 at 327% = $840.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE CARE,181.73,,,,,,,181.7300,3015.0000,fee schedule,$156.66 from Fee Schedule TC_24 for Rev 341 Proc 78802 * Qty 1 = $156.66 at 116% = $181.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE SELECT,181.73,,,,,,,181.7300,3015.0000,fee schedule,$156.66 from Fee Schedule TC_24 for Rev 341 Proc 78802 * Qty 1 = $156.66 at 116% = $181.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA HMO,1863.85,,,,,,,181.7300,3015.0000,fee schedule,"$1,863.85 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78802 * Qty 1 = $1,863.85 at 100% = $1,863.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,459.37,,,,,,,181.7300,3015.0000,fee schedule,$459.37 from Fee Schedule CGIFP_25LR for Rev 341 Proc 78802 * Qty 1 = $459.37 at 100% = $459.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,517.25,,,,,,,181.7300,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1863.85,,,,,,,181.7300,3015.0000,fee schedule,"$1,863.85 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78802 * Qty 1 = $1,863.85 at 100% = $1,863.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA PPO,1863.85,,,,,,,181.7300,3015.0000,fee schedule,"$1,863.85 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78802 * Qty 1 = $1,863.85 at 100% = $1,863.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,517.25,,,,,,,181.7300,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2713.50,,,,,,,181.7300,3015.0000,percent of total billed charges,"90% of $3,015.00 in Billed Charges for Rev 341 Proc 78802 = $2,713.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,HUMANA,HUMANA MEDICARE,492.62,,,,,,,181.7300,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,492.62,,,,,,,181.7300,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,MEDCOST,MEDCOST VHN,1434.84,,,,,,,181.7300,3015.0000,percent of total billed charges,"47.59% of $3,015.00 in Billed Charges for Rev 341 Proc 78802 = $1,434.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1315.19,,,,,,,181.7300,3015.0000,fee schedule,"APG 00332 Proc 78802 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 100% = $1,252.56... $1,252.56 at 105% = $1,315.19 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,517.25,,,,,,,181.7300,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,517.25,,,,,,,181.7300,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,NHC ADVANTAGE,NHC ADVANTAGE,517.25,,,,,,,181.7300,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1291.39,,,,,,,181.7300,3015.0000,fee schedule,"APG 00332 Proc 78802 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 100% = $1,252.56... $1,252.56 at 103.1% = $1,291.39 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA HEALTH,778.17,,,,,,,181.7300,3015.0000,percent of total billed charges,"25.81% of $3,015.00 in Billed Charges for Rev 341 Proc 78802 = $778.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA MEDICARE,492.62,,,,,,,181.7300,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3015.00,,,,,,,181.7300,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 341 Proc 78802 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,246.23,,,,,,,181.7300,3015.0000,fee schedule,$492.46 from Fee Schedule TCUHC24 for Rev 341 Proc 78802 * Qty 1 = $492.46 at 50% = $246.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,810.00,,,,,,,181.7300,3015.0000,other,Rev 341 Proc 78802 1 Visit at $810.00 per Visit = $810.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,774.00,,,,,,,181.7300,3015.0000,other,Rev 341 Proc 78802 1 Visit at $774.00 per Visit = $774.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1599.00,,,,,,,181.7300,3015.0000,other,"Rev 341 Proc 78802 1 Visit at $1,599.00 per Visit = $1,599.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1290.13,,,,,,,181.7300,3015.0000,fee schedule,"APG 00332 Proc 78802 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 103% = $1,290.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,492.62,,,,,,,181.7300,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,492.62,,,,,,,181.7300,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICAID,3015.00,,,,,,,181.7300,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 341 Proc 78802 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY SNGL DAY IMG,78802,CPT,341,RC,34100083,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICARE,522.18,,,,,,,181.7300,3015.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,AETNA,AETNA,5515.56,,,,,,,518.4800,12917.0000,percent of total billed charges,"42.7% of $12,917.00 in Billed Charges for Rev 404 Proc 78813 = $5,515.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1998.10,,,,,,,518.4800,12917.0000,fee schedule,"APG 00290 Proc 78813 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 104% = $1,998.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1297.36,,,,,,,518.4800,12917.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,AETNA,AETNA HEALTHCARE MEDICARE,1297.36,,,,,,,518.4800,12917.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,1297.36,,,,,,,518.4800,12917.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,AMBETTER,AMBETTER,2828.23,,,,,,,518.4800,12917.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1349.25,,,,,,,518.4800,12917.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,BLUE CROSS,ANTHEM EXCHANGE,3194.16,,,,,,,518.4800,12917.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1978.89,,,,,,,518.4800,12917.0000,fee schedule,"APG 00290 Proc 78813 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 103% = $1,978.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,BLUE CROSS,ANTHEM HMO,3393.61,,,,,,,518.4800,12917.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1336.28,,,,,,,518.4800,12917.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3992.26,,,,,,,518.4800,12917.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1821.57,,,,,,,518.4800,12917.0000,fee schedule,"$1,821.57 from Fee Schedule BLDTM_23 for Rev 404 Proc 78813 * Qty 1 = $1,821.57 at 100% = $1,821.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,BLUE CROSS,BLUE CROSS E NETWORK,4895.07,,,,,,,518.4800,12917.0000,fee schedule,"$1,529.71 from Fee Schedule BCFSC for Rev 404 Proc 78813 * Qty 1 = $1,529.71 at 320% = $4,895.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,BLUE CROSS,BLUE CROSS MEDICARE,1349.25,,,,,,,518.4800,12917.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,BLUE CROSS,BLUE CROSS P NETWORK,5002.15,,,,,,,518.4800,12917.0000,fee schedule,"$1,529.71 from Fee Schedule BCFSC for Rev 404 Proc 78813 * Qty 1 = $1,529.71 at 327% = $5,002.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,BLUE CROSS,BLUE CROSS S NETWORK,5002.15,,,,,,,518.4800,12917.0000,fee schedule,"$1,529.71 from Fee Schedule BCFSC for Rev 404 Proc 78813 * Qty 1 = $1,529.71 at 327% = $5,002.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,BLUE CROSS,TENNCARE BLUE CARE,877.32,,,,,,,518.4800,12917.0000,fee schedule,$756.31 from Fee Schedule TC_24 for Rev 404 Proc 78813 * Qty 1 = $756.31 at 116% = $877.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,BLUE CROSS,TENNCARE BLUE SELECT,877.32,,,,,,,518.4800,12917.0000,fee schedule,$756.31 from Fee Schedule TC_24 for Rev 404 Proc 78813 * Qty 1 = $756.31 at 116% = $877.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,CIGNA HEALTHCARE,CIGNA HMO,3924.62,,,,,,,518.4800,12917.0000,fee schedule,"$3,924.62 from Fee Schedule CIGWHS_23 for Rev 404 Proc 78813 * Qty 1 = $3,924.62 at 100% = $3,924.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1215.79,,,,,,,518.4800,12917.0000,fee schedule,"$1,215.79 from Fee Schedule CGIFP_25LR for Rev 404 Proc 78813 * Qty 1 = $1,215.79 at 100% = $1,215.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,1362.22,,,,,,,518.4800,12917.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3924.62,,,,,,,518.4800,12917.0000,fee schedule,"$3,924.62 from Fee Schedule CIGWHS_23 for Rev 404 Proc 78813 * Qty 1 = $3,924.62 at 100% = $3,924.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,CIGNA HEALTHCARE,CIGNA PPO,3924.62,,,,,,,518.4800,12917.0000,fee schedule,"$3,924.62 from Fee Schedule CIGWHS_23 for Rev 404 Proc 78813 * Qty 1 = $3,924.62 at 100% = $3,924.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1362.22,,,,,,,518.4800,12917.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11625.30,,,,,,,518.4800,12917.0000,percent of total billed charges,"90% of $12,917.00 in Billed Charges for Rev 404 Proc 78813 = $11,625.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,HUMANA,HUMANA MEDICARE,1297.36,,,,,,,518.4800,12917.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1297.36,,,,,,,518.4800,12917.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,MEDCOST,MEDCOST VHN,6147.20,,,,,,,518.4800,12917.0000,percent of total billed charges,"47.59% of $12,917.00 in Billed Charges for Rev 404 Proc 78813 = $6,147.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2017.31,,,,,,,518.4800,12917.0000,fee schedule,"APG 00290 Proc 78813 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 100% = $1,921.25... $1,921.25 at 105% = $2,017.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1362.22,,,,,,,518.4800,12917.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1362.22,,,,,,,518.4800,12917.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,NHC ADVANTAGE,NHC ADVANTAGE,1362.22,,,,,,,518.4800,12917.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1980.81,,,,,,,518.4800,12917.0000,fee schedule,"APG 00290 Proc 78813 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 100% = $1,921.25... $1,921.25 at 103.1% = $1,980.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,SENTARA HEALTH,SENTARA HEALTH,3333.88,,,,,,,518.4800,12917.0000,percent of total billed charges,"25.81% of $12,917.00 in Billed Charges for Rev 404 Proc 78813 = $3,333.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,SENTARA HEALTH,SENTARA MEDICARE,1297.36,,,,,,,518.4800,12917.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12917.00,,,,,,,518.4800,12917.0000,percent of total billed charges,"100% of $12,917.00 in Billed Charges for Rev 404 Proc 78813 = $12,917.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,518.48,,,,,,,518.4800,12917.0000,fee schedule,"$1,036.95 from Fee Schedule TCUHC24 for Rev 404 Proc 78813 * Qty 1 = $1,036.95 at 50% = $518.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4136.00,,,,,,,518.4800,12917.0000,other,"Rev 404 Proc 78813 1 Visit at $4,136.00 per Visit = $4,136.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3957.00,,,,,,,518.4800,12917.0000,other,"Rev 404 Proc 78813 1 Visit at $3,957.00 per Visit = $3,957.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,6522.00,,,,,,,518.4800,12917.0000,other,"Rev 404 Proc 78813 1 Visit at $6,522.00 per Visit = $6,522.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1978.89,,,,,,,518.4800,12917.0000,fee schedule,"APG 00290 Proc 78813 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 103% = $1,978.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1297.36,,,,,,,518.4800,12917.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1297.36,,,,,,,518.4800,12917.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,WELLCARE,WELLCARE MEDICAID,12917.00,,,,,,,518.4800,12917.0000,percent of total billed charges,"100% of $12,917.00 in Billed Charges for Rev 404 Proc 78813 = $12,917.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET IMAGING WHOLE BODY,78813,CPT,404,RC,40400007,CDM,,,,both,,,12917.0000,1937.5500,WELLCARE,WELLCARE MEDICARE,1375.20,,,,,,,518.4800,12917.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,AETNA,AETNA,4375.90,,,,,,,518.4800,10248.0000,percent of total billed charges,"42.7% of $10,248.00 in Billed Charges for Rev 404 Proc 78815 = $4,375.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1998.10,,,,,,,518.4800,10248.0000,fee schedule,"APG 00290 Proc 78815 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 104% = $1,998.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1297.36,,,,,,,518.4800,10248.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,AETNA,AETNA HEALTHCARE MEDICARE,1297.36,,,,,,,518.4800,10248.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,1297.36,,,,,,,518.4800,10248.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,AMBETTER,AMBETTER,2828.23,,,,,,,518.4800,10248.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1349.25,,,,,,,518.4800,10248.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,BLUE CROSS,ANTHEM EXCHANGE,3194.16,,,,,,,518.4800,10248.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1978.89,,,,,,,518.4800,10248.0000,fee schedule,"APG 00290 Proc 78815 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 103% = $1,978.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,BLUE CROSS,ANTHEM HMO,3393.61,,,,,,,518.4800,10248.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1336.28,,,,,,,518.4800,10248.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3992.26,,,,,,,518.4800,10248.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1804.90,,,,,,,518.4800,10248.0000,fee schedule,"$1,804.90 from Fee Schedule BLDTM_23 for Rev 404 Proc 78815 * Qty 1 = $1,804.90 at 100% = $1,804.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,BLUE CROSS,BLUE CROSS E NETWORK,6526.78,,,,,,,518.4800,10248.0000,fee schedule,"$2,039.62 from Fee Schedule BCFSC for Rev 404 Proc 78815 * Qty 1 = $2,039.62 at 320% = $6,526.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,BLUE CROSS,BLUE CROSS MEDICARE,1349.25,,,,,,,518.4800,10248.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,BLUE CROSS,BLUE CROSS P NETWORK,6669.56,,,,,,,518.4800,10248.0000,fee schedule,"$2,039.62 from Fee Schedule BCFSC for Rev 404 Proc 78815 * Qty 1 = $2,039.62 at 327% = $6,669.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,BLUE CROSS,BLUE CROSS S NETWORK,6669.56,,,,,,,518.4800,10248.0000,fee schedule,"$2,039.62 from Fee Schedule BCFSC for Rev 404 Proc 78815 * Qty 1 = $2,039.62 at 327% = $6,669.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,BLUE CROSS,TENNCARE BLUE CARE,877.32,,,,,,,518.4800,10248.0000,fee schedule,$756.31 from Fee Schedule TC_24 for Rev 404 Proc 78815 * Qty 1 = $756.31 at 116% = $877.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,BLUE CROSS,TENNCARE BLUE SELECT,877.32,,,,,,,518.4800,10248.0000,fee schedule,$756.31 from Fee Schedule TC_24 for Rev 404 Proc 78815 * Qty 1 = $756.31 at 116% = $877.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,CIGNA HEALTHCARE,CIGNA HMO,3924.62,,,,,,,518.4800,10248.0000,fee schedule,"$3,924.62 from Fee Schedule CIGWHS_23 for Rev 404 Proc 78815 * Qty 1 = $3,924.62 at 100% = $3,924.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1499.50,,,,,,,518.4800,10248.0000,fee schedule,"$1,499.50 from Fee Schedule CGIFP_25LR for Rev 404 Proc 78815 * Qty 1 = $1,499.50 at 100% = $1,499.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,1362.22,,,,,,,518.4800,10248.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3924.62,,,,,,,518.4800,10248.0000,fee schedule,"$3,924.62 from Fee Schedule CIGWHS_23 for Rev 404 Proc 78815 * Qty 1 = $3,924.62 at 100% = $3,924.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,CIGNA HEALTHCARE,CIGNA PPO,3924.62,,,,,,,518.4800,10248.0000,fee schedule,"$3,924.62 from Fee Schedule CIGWHS_23 for Rev 404 Proc 78815 * Qty 1 = $3,924.62 at 100% = $3,924.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1362.22,,,,,,,518.4800,10248.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9223.20,,,,,,,518.4800,10248.0000,percent of total billed charges,"90% of $10,248.00 in Billed Charges for Rev 404 Proc 78815 = $9,223.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,HUMANA,HUMANA MEDICARE,1297.36,,,,,,,518.4800,10248.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1297.36,,,,,,,518.4800,10248.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,MEDCOST,MEDCOST VHN,4877.02,,,,,,,518.4800,10248.0000,percent of total billed charges,"47.59% of $10,248.00 in Billed Charges for Rev 404 Proc 78815 = $4,877.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2017.31,,,,,,,518.4800,10248.0000,fee schedule,"APG 00290 Proc 78815 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 100% = $1,921.25... $1,921.25 at 105% = $2,017.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1362.22,,,,,,,518.4800,10248.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1362.22,,,,,,,518.4800,10248.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,NHC ADVANTAGE,NHC ADVANTAGE,1362.22,,,,,,,518.4800,10248.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1980.81,,,,,,,518.4800,10248.0000,fee schedule,"APG 00290 Proc 78815 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 100% = $1,921.25... $1,921.25 at 103.1% = $1,980.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,SENTARA HEALTH,SENTARA HEALTH,2645.01,,,,,,,518.4800,10248.0000,percent of total billed charges,"25.81% of $10,248.00 in Billed Charges for Rev 404 Proc 78815 = $2,645.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,SENTARA HEALTH,SENTARA MEDICARE,1297.36,,,,,,,518.4800,10248.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10248.00,,,,,,,518.4800,10248.0000,percent of total billed charges,"100% of $10,248.00 in Billed Charges for Rev 404 Proc 78815 = $10,248.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,518.48,,,,,,,518.4800,10248.0000,fee schedule,"$1,036.95 from Fee Schedule TCUHC24 for Rev 404 Proc 78815 * Qty 1 = $1,036.95 at 50% = $518.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4136.00,,,,,,,518.4800,10248.0000,other,"Rev 404 Proc 78815 1 Visit at $4,136.00 per Visit = $4,136.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3957.00,,,,,,,518.4800,10248.0000,other,"Rev 404 Proc 78815 1 Visit at $3,957.00 per Visit = $3,957.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,6522.00,,,,,,,518.4800,10248.0000,other,"Rev 404 Proc 78815 1 Visit at $6,522.00 per Visit = $6,522.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1978.89,,,,,,,518.4800,10248.0000,fee schedule,"APG 00290 Proc 78815 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 103% = $1,978.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1297.36,,,,,,,518.4800,10248.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1297.36,,,,,,,518.4800,10248.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,WELLCARE,WELLCARE MEDICAID,10248.00,,,,,,,518.4800,10248.0000,percent of total billed charges,"100% of $10,248.00 in Billed Charges for Rev 404 Proc 78815 = $10,248.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET CT SKULL BASE TO MID THIGH,78815,CPT,404,RC,40400009,CDM,,,,both,,,10248.0000,1537.2000,WELLCARE,WELLCARE MEDICARE,1375.20,,,,,,,518.4800,10248.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT LAPAROSCOPIC GASTROSTOMY 10237,272,RC,27200002,CDM,,,,,,both,,,2471.6200,370.7400,AETNA,AETNA,1055.38,,,,,,,637.9300,2471.6200,percent of total billed charges,"42.7% of $2,471.62 in Billed Charges for Rev 272 = $1,055.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LAPAROSCOPIC GASTROSTOMY 10237,272,RC,27200002,CDM,,,,,,both,,,2471.6200,370.7400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1730.13,,,,,,,637.9300,2471.6200,percent of total billed charges,"Rev 272 $2,471.62 in Billed Charges at 70% = $1,730.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LAPAROSCOPIC GASTROSTOMY 10237,272,RC,27200002,CDM,,,,,,both,,,2471.6200,370.7400,CIGNA HEALTHCARE,CIGNA HMO,1030.67,,,,,,,637.9300,2471.6200,percent of total billed charges,"41.7% of $2,471.62 in Billed Charges for Rev 272 = $1,030.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LAPAROSCOPIC GASTROSTOMY 10237,272,RC,27200002,CDM,,,,,,both,,,2471.6200,370.7400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1146.83,,,,,,,637.9300,2471.6200,percent of total billed charges,"46.4% of $2,471.62 in Billed Charges for Rev 272 = $1,146.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LAPAROSCOPIC GASTROSTOMY 10237,272,RC,27200002,CDM,,,,,,both,,,2471.6200,370.7400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1030.67,,,,,,,637.9300,2471.6200,percent of total billed charges,"41.7% of $2,471.62 in Billed Charges for Rev 272 = $1,030.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LAPAROSCOPIC GASTROSTOMY 10237,272,RC,27200002,CDM,,,,,,both,,,2471.6200,370.7400,CIGNA HEALTHCARE,CIGNA PPO,1030.67,,,,,,,637.9300,2471.6200,percent of total billed charges,"41.7% of $2,471.62 in Billed Charges for Rev 272 = $1,030.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LAPAROSCOPIC GASTROSTOMY 10237,272,RC,27200002,CDM,,,,,,both,,,2471.6200,370.7400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2224.46,,,,,,,637.9300,2471.6200,percent of total billed charges,"90% of $2,471.62 in Billed Charges for Rev 272 = $2,224.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LAPAROSCOPIC GASTROSTOMY 10237,272,RC,27200002,CDM,,,,,,both,,,2471.6200,370.7400,MEDCOST,MEDCOST VHN,1176.24,,,,,,,637.9300,2471.6200,percent of total billed charges,"47.59% of $2,471.62 in Billed Charges for Rev 272 = $1,176.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LAPAROSCOPIC GASTROSTOMY 10237,272,RC,27200002,CDM,,,,,,both,,,2471.6200,370.7400,SENTARA HEALTH,SENTARA HEALTH,637.93,,,,,,,637.9300,2471.6200,percent of total billed charges,"25.81% of $2,471.62 in Billed Charges for Rev 272 = $637.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LAPAROSCOPIC GASTROSTOMY 10237,272,RC,27200002,CDM,,,,,,both,,,2471.6200,370.7400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2471.62,,,,,,,637.9300,2471.6200,percent of total billed charges,"100% of $2,471.62 in Billed Charges for Rev 272 = $2,471.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LAPAROSCOPIC GASTROSTOMY 10237,272,RC,27200002,CDM,,,,,,both,,,2471.6200,370.7400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1235.81,,,,,,,637.9300,2471.6200,percent of total billed charges,"Rev 272 $2,471.62 in Billed Charges at 50% = $1,235.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LAPAROSCOPIC GASTROSTOMY 10237,272,RC,27200002,CDM,,,,,,both,,,2471.6200,370.7400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,798.33,,,,,,,637.9300,2471.6200,other,"32.3% of $2,471.62 in Billed Charges for Rev 272 = $798.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT LAPAROSCOPIC GASTROSTOMY 10237,272,RC,27200002,CDM,,,,,,both,,,2471.6200,370.7400,UNITED HEALTHCARE,UHC HERITAGE SELECT,758.79,,,,,,,637.9300,2471.6200,other,"30.7% of $2,471.62 in Billed Charges for Rev 272 = $758.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT LAPAROSCOPIC GASTROSTOMY 10237,272,RC,27200002,CDM,,,,,,both,,,2471.6200,370.7400,UNITED HEALTHCARE,UNITED HEALTHCARE,798.33,,,,,,,637.9300,2471.6200,percent of total billed charges,"32.3% of $2,471.62 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LAPAROSCOPIC GASTROSTOMY 10237,272,RC,27200002,CDM,,,,,,both,,,2471.6200,370.7400,WELLCARE,WELLCARE MEDICAID,2471.62,,,,,,,637.9300,2471.6200,percent of total billed charges,"100% of $2,471.62 in Billed Charges for Rev 272 = $2,471.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LATERAL SUPPORT,272,RC,,,,,,,,both,,,13378.5900,2006.7900,AETNA,AETNA,5712.66,,,,,,,3453.0100,13378.5900,percent of total billed charges,"42.7% of $13,378.59 in Billed Charges for Rev 272 = $5,712.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LATERAL SUPPORT,272,RC,,,,,,,,both,,,13378.5900,2006.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9365.01,,,,,,,3453.0100,13378.5900,percent of total billed charges,"Rev 272 $13,378.59 in Billed Charges at 70% = $9,365.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LATERAL SUPPORT,272,RC,,,,,,,,both,,,13378.5900,2006.7900,CIGNA HEALTHCARE,CIGNA HMO,5578.87,,,,,,,3453.0100,13378.5900,percent of total billed charges,"41.7% of $13,378.59 in Billed Charges for Rev 272 = $5,578.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LATERAL SUPPORT,272,RC,,,,,,,,both,,,13378.5900,2006.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6207.67,,,,,,,3453.0100,13378.5900,percent of total billed charges,"46.4% of $13,378.59 in Billed Charges for Rev 272 = $6,207.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LATERAL SUPPORT,272,RC,,,,,,,,both,,,13378.5900,2006.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5578.87,,,,,,,3453.0100,13378.5900,percent of total billed charges,"41.7% of $13,378.59 in Billed Charges for Rev 272 = $5,578.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LATERAL SUPPORT,272,RC,,,,,,,,both,,,13378.5900,2006.7900,CIGNA HEALTHCARE,CIGNA PPO,5578.87,,,,,,,3453.0100,13378.5900,percent of total billed charges,"41.7% of $13,378.59 in Billed Charges for Rev 272 = $5,578.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LATERAL SUPPORT,272,RC,,,,,,,,both,,,13378.5900,2006.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12040.73,,,,,,,3453.0100,13378.5900,percent of total billed charges,"90% of $13,378.59 in Billed Charges for Rev 272 = $12,040.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LATERAL SUPPORT,272,RC,,,,,,,,both,,,13378.5900,2006.7900,MEDCOST,MEDCOST VHN,6366.87,,,,,,,3453.0100,13378.5900,percent of total billed charges,"47.59% of $13,378.59 in Billed Charges for Rev 272 = $6,366.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LATERAL SUPPORT,272,RC,,,,,,,,both,,,13378.5900,2006.7900,SENTARA HEALTH,SENTARA HEALTH,3453.01,,,,,,,3453.0100,13378.5900,percent of total billed charges,"25.81% of $13,378.59 in Billed Charges for Rev 272 = $3,453.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LATERAL SUPPORT,272,RC,,,,,,,,both,,,13378.5900,2006.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13378.59,,,,,,,3453.0100,13378.5900,percent of total billed charges,"100% of $13,378.59 in Billed Charges for Rev 272 = $13,378.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LATERAL SUPPORT,272,RC,,,,,,,,both,,,13378.5900,2006.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6689.30,,,,,,,3453.0100,13378.5900,percent of total billed charges,"Rev 272 $13,378.59 in Billed Charges at 50% = $6,689.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LATERAL SUPPORT,272,RC,,,,,,,,both,,,13378.5900,2006.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4321.28,,,,,,,3453.0100,13378.5900,other,"32.3% of $13,378.59 in Billed Charges for Rev 272 = $4,321.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT LATERAL SUPPORT,272,RC,,,,,,,,both,,,13378.5900,2006.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,4107.23,,,,,,,3453.0100,13378.5900,other,"30.7% of $13,378.59 in Billed Charges for Rev 272 = $4,107.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT LATERAL SUPPORT,272,RC,,,,,,,,both,,,13378.5900,2006.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,4321.28,,,,,,,3453.0100,13378.5900,percent of total billed charges,"32.3% of $13,378.59 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LATERAL SUPPORT,272,RC,,,,,,,,both,,,13378.5900,2006.7900,WELLCARE,WELLCARE MEDICAID,13378.59,,,,,,,3453.0100,13378.5900,percent of total billed charges,"100% of $13,378.59 in Billed Charges for Rev 272 = $13,378.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LIPOGRAFTER MUSCULOSKELETAL,272,RC,27200002,CDM,,,,,,both,,,3891.7200,583.7600,AETNA,AETNA,1661.76,,,,,,,1004.4500,3891.7200,percent of total billed charges,"42.7% of $3,891.72 in Billed Charges for Rev 272 = $1,661.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LIPOGRAFTER MUSCULOSKELETAL,272,RC,27200002,CDM,,,,,,both,,,3891.7200,583.7600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2724.20,,,,,,,1004.4500,3891.7200,percent of total billed charges,"Rev 272 $3,891.72 in Billed Charges at 70% = $2,724.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LIPOGRAFTER MUSCULOSKELETAL,272,RC,27200002,CDM,,,,,,both,,,3891.7200,583.7600,CIGNA HEALTHCARE,CIGNA HMO,1622.85,,,,,,,1004.4500,3891.7200,percent of total billed charges,"41.7% of $3,891.72 in Billed Charges for Rev 272 = $1,622.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LIPOGRAFTER MUSCULOSKELETAL,272,RC,27200002,CDM,,,,,,both,,,3891.7200,583.7600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1805.76,,,,,,,1004.4500,3891.7200,percent of total billed charges,"46.4% of $3,891.72 in Billed Charges for Rev 272 = $1,805.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LIPOGRAFTER MUSCULOSKELETAL,272,RC,27200002,CDM,,,,,,both,,,3891.7200,583.7600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1622.85,,,,,,,1004.4500,3891.7200,percent of total billed charges,"41.7% of $3,891.72 in Billed Charges for Rev 272 = $1,622.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LIPOGRAFTER MUSCULOSKELETAL,272,RC,27200002,CDM,,,,,,both,,,3891.7200,583.7600,CIGNA HEALTHCARE,CIGNA PPO,1622.85,,,,,,,1004.4500,3891.7200,percent of total billed charges,"41.7% of $3,891.72 in Billed Charges for Rev 272 = $1,622.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LIPOGRAFTER MUSCULOSKELETAL,272,RC,27200002,CDM,,,,,,both,,,3891.7200,583.7600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3502.55,,,,,,,1004.4500,3891.7200,percent of total billed charges,"90% of $3,891.72 in Billed Charges for Rev 272 = $3,502.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LIPOGRAFTER MUSCULOSKELETAL,272,RC,27200002,CDM,,,,,,both,,,3891.7200,583.7600,MEDCOST,MEDCOST VHN,1852.07,,,,,,,1004.4500,3891.7200,percent of total billed charges,"47.59% of $3,891.72 in Billed Charges for Rev 272 = $1,852.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LIPOGRAFTER MUSCULOSKELETAL,272,RC,27200002,CDM,,,,,,both,,,3891.7200,583.7600,SENTARA HEALTH,SENTARA HEALTH,1004.45,,,,,,,1004.4500,3891.7200,percent of total billed charges,"25.81% of $3,891.72 in Billed Charges for Rev 272 = $1,004.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LIPOGRAFTER MUSCULOSKELETAL,272,RC,27200002,CDM,,,,,,both,,,3891.7200,583.7600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3891.72,,,,,,,1004.4500,3891.7200,percent of total billed charges,"100% of $3,891.72 in Billed Charges for Rev 272 = $3,891.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LIPOGRAFTER MUSCULOSKELETAL,272,RC,27200002,CDM,,,,,,both,,,3891.7200,583.7600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1945.86,,,,,,,1004.4500,3891.7200,percent of total billed charges,"Rev 272 $3,891.72 in Billed Charges at 50% = $1,945.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LIPOGRAFTER MUSCULOSKELETAL,272,RC,27200002,CDM,,,,,,both,,,3891.7200,583.7600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1257.03,,,,,,,1004.4500,3891.7200,other,"32.3% of $3,891.72 in Billed Charges for Rev 272 = $1,257.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT LIPOGRAFTER MUSCULOSKELETAL,272,RC,27200002,CDM,,,,,,both,,,3891.7200,583.7600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1194.76,,,,,,,1004.4500,3891.7200,other,"30.7% of $3,891.72 in Billed Charges for Rev 272 = $1,194.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT LIPOGRAFTER MUSCULOSKELETAL,272,RC,27200002,CDM,,,,,,both,,,3891.7200,583.7600,UNITED HEALTHCARE,UNITED HEALTHCARE,1257.03,,,,,,,1004.4500,3891.7200,percent of total billed charges,"32.3% of $3,891.72 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT LIPOGRAFTER MUSCULOSKELETAL,272,RC,27200002,CDM,,,,,,both,,,3891.7200,583.7600,WELLCARE,WELLCARE MEDICAID,3891.72,,,,,,,1004.4500,3891.7200,percent of total billed charges,"100% of $3,891.72 in Billed Charges for Rev 272 = $3,891.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC METHYLENEDIOXYAMPHETAMINES,80359,CPT,301,RC,30100396,CDM,,,,both,,,78.0000,11.7000,AETNA,AETNA,33.31,,,,,,,16.2000,78.0000,percent of total billed charges,42.7% of $78.00 in Billed Charges for Rev 301 Proc 80359 = $33.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHYLENEDIOXYAMPHETAMINES,80359,CPT,301,RC,30100396,CDM,,,,both,,,78.0000,11.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,16.36,,,,,,,16.2000,78.0000,fee schedule,APG 02040 Proc 80359 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 104% = $16.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHYLENEDIOXYAMPHETAMINES,80359,CPT,301,RC,30100396,CDM,,,,both,,,78.0000,11.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,16.20,,,,,,,16.2000,78.0000,fee schedule,APG 02040 Proc 80359 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHYLENEDIOXYAMPHETAMINES,80359,CPT,301,RC,30100396,CDM,,,,both,,,78.0000,11.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,54.60,,,,,,,16.2000,78.0000,percent of total billed charges,Rev 301 Proc 80359 $78.00 in Billed Charges at 70% = $54.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHYLENEDIOXYAMPHETAMINES,80359,CPT,301,RC,30100396,CDM,,,,both,,,78.0000,11.7000,CIGNA HEALTHCARE,CIGNA HMO,32.53,,,,,,,16.2000,78.0000,percent of total billed charges,Rev 301 Proc 80359 $78.00 in Billed Charges at 41.7% = $32.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHYLENEDIOXYAMPHETAMINES,80359,CPT,301,RC,30100396,CDM,,,,both,,,78.0000,11.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,33.38,,,,,,,16.2000,78.0000,percent of total billed charges,Rev 301 Proc 80359 $78.00 in Billed Charges at 42.8% = $33.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHYLENEDIOXYAMPHETAMINES,80359,CPT,301,RC,30100396,CDM,,,,both,,,78.0000,11.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,32.53,,,,,,,16.2000,78.0000,percent of total billed charges,Rev 301 Proc 80359 $78.00 in Billed Charges at 41.7% = $32.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHYLENEDIOXYAMPHETAMINES,80359,CPT,301,RC,30100396,CDM,,,,both,,,78.0000,11.7000,CIGNA HEALTHCARE,CIGNA PPO,32.53,,,,,,,16.2000,78.0000,percent of total billed charges,Rev 301 Proc 80359 $78.00 in Billed Charges at 41.7% = $32.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHYLENEDIOXYAMPHETAMINES,80359,CPT,301,RC,30100396,CDM,,,,both,,,78.0000,11.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,70.20,,,,,,,16.2000,78.0000,percent of total billed charges,90% of $78.00 in Billed Charges for Rev 301 Proc 80359 = $70.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHYLENEDIOXYAMPHETAMINES,80359,CPT,301,RC,30100396,CDM,,,,both,,,78.0000,11.7000,MEDCOST,MEDCOST VHN,37.12,,,,,,,16.2000,78.0000,percent of total billed charges,47.59% of $78.00 in Billed Charges for Rev 301 Proc 80359 = $37.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHYLENEDIOXYAMPHETAMINES,80359,CPT,301,RC,30100396,CDM,,,,both,,,78.0000,11.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,16.52,,,,,,,16.2000,78.0000,fee schedule,APG 02040 Proc 80359 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 105% = $16.52 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHYLENEDIOXYAMPHETAMINES,80359,CPT,301,RC,30100396,CDM,,,,both,,,78.0000,11.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,16.22,,,,,,,16.2000,78.0000,fee schedule,APG 02040 Proc 80359 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 103.1% = $16.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHYLENEDIOXYAMPHETAMINES,80359,CPT,301,RC,30100396,CDM,,,,both,,,78.0000,11.7000,SENTARA HEALTH,SENTARA HEALTH,20.13,,,,,,,16.2000,78.0000,percent of total billed charges,25.81% of $78.00 in Billed Charges for Rev 301 Proc 80359 = $20.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHYLENEDIOXYAMPHETAMINES,80359,CPT,301,RC,30100396,CDM,,,,both,,,78.0000,11.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",78.00,,,,,,,16.2000,78.0000,percent of total billed charges,100% of $78.00 in Billed Charges for Rev 301 Proc 80359 = $78.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHYLENEDIOXYAMPHETAMINES,80359,CPT,301,RC,30100396,CDM,,,,both,,,78.0000,11.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,16.20,,,,,,,16.2000,78.0000,fee schedule,APG 02040 Proc 80359 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHYLENEDIOXYAMPHETAMINES,80359,CPT,301,RC,30100396,CDM,,,,both,,,78.0000,11.7000,WELLCARE,WELLCARE MEDICAID,78.00,,,,,,,16.2000,78.0000,percent of total billed charges,100% of $78.00 in Billed Charges for Rev 301 Proc 80359 = $78.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIATES 1 OR MORE,80361,CPT,301,RC,30100398,CDM,,,,both,,,89.0000,13.3500,AETNA,AETNA,38.00,,,,,,,16.2000,89.0000,percent of total billed charges,42.7% of $89.00 in Billed Charges for Rev 301 Proc 80361 = $38.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIATES 1 OR MORE,80361,CPT,301,RC,30100398,CDM,,,,both,,,89.0000,13.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,16.36,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80361 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 104% = $16.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPIATES 1 OR MORE,80361,CPT,301,RC,30100398,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,16.20,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80361 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPIATES 1 OR MORE,80361,CPT,301,RC,30100398,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,62.30,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80361 $89.00 in Billed Charges at 70% = $62.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIATES 1 OR MORE,80361,CPT,301,RC,30100398,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA HMO,37.11,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80361 $89.00 in Billed Charges at 41.7% = $37.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIATES 1 OR MORE,80361,CPT,301,RC,30100398,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,38.09,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80361 $89.00 in Billed Charges at 42.8% = $38.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIATES 1 OR MORE,80361,CPT,301,RC,30100398,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,37.11,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80361 $89.00 in Billed Charges at 41.7% = $37.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIATES 1 OR MORE,80361,CPT,301,RC,30100398,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA PPO,37.11,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80361 $89.00 in Billed Charges at 41.7% = $37.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIATES 1 OR MORE,80361,CPT,301,RC,30100398,CDM,,,,both,,,89.0000,13.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,80.10,,,,,,,16.2000,89.0000,percent of total billed charges,90% of $89.00 in Billed Charges for Rev 301 Proc 80361 = $80.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIATES 1 OR MORE,80361,CPT,301,RC,30100398,CDM,,,,both,,,89.0000,13.3500,MEDCOST,MEDCOST VHN,42.36,,,,,,,16.2000,89.0000,percent of total billed charges,47.59% of $89.00 in Billed Charges for Rev 301 Proc 80361 = $42.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIATES 1 OR MORE,80361,CPT,301,RC,30100398,CDM,,,,both,,,89.0000,13.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,16.52,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80361 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 105% = $16.52 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPIATES 1 OR MORE,80361,CPT,301,RC,30100398,CDM,,,,both,,,89.0000,13.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,16.22,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80361 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 103.1% = $16.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPIATES 1 OR MORE,80361,CPT,301,RC,30100398,CDM,,,,both,,,89.0000,13.3500,SENTARA HEALTH,SENTARA HEALTH,22.97,,,,,,,16.2000,89.0000,percent of total billed charges,25.81% of $89.00 in Billed Charges for Rev 301 Proc 80361 = $22.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIATES 1 OR MORE,80361,CPT,301,RC,30100398,CDM,,,,both,,,89.0000,13.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",89.00,,,,,,,16.2000,89.0000,percent of total billed charges,100% of $89.00 in Billed Charges for Rev 301 Proc 80361 = $89.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIATES 1 OR MORE,80361,CPT,301,RC,30100398,CDM,,,,both,,,89.0000,13.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,16.20,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80361 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPIATES 1 OR MORE,80361,CPT,301,RC,30100398,CDM,,,,both,,,89.0000,13.3500,WELLCARE,WELLCARE MEDICAID,89.00,,,,,,,16.2000,89.0000,percent of total billed charges,100% of $89.00 in Billed Charges for Rev 301 Proc 80361 = $89.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOID &OPIATE ANALOG 5 OR MORE,80364,CPT,301,RC,30100401,CDM,,,,both,,,215.0000,32.2500,AETNA,AETNA,91.81,,,,,,,16.2000,215.0000,percent of total billed charges,42.7% of $215.00 in Billed Charges for Rev 301 Proc 80364 = $91.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOID &OPIATE ANALOG 5 OR MORE,80364,CPT,301,RC,30100401,CDM,,,,both,,,215.0000,32.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,16.36,,,,,,,16.2000,215.0000,fee schedule,APG 02040 Proc 80364 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 104% = $16.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPIOID &OPIATE ANALOG 5 OR MORE,80364,CPT,301,RC,30100401,CDM,,,,both,,,215.0000,32.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,16.20,,,,,,,16.2000,215.0000,fee schedule,APG 02040 Proc 80364 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPIOID &OPIATE ANALOG 5 OR MORE,80364,CPT,301,RC,30100401,CDM,,,,both,,,215.0000,32.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,150.50,,,,,,,16.2000,215.0000,percent of total billed charges,Rev 301 Proc 80364 $215.00 in Billed Charges at 70% = $150.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOID &OPIATE ANALOG 5 OR MORE,80364,CPT,301,RC,30100401,CDM,,,,both,,,215.0000,32.2500,CIGNA HEALTHCARE,CIGNA HMO,89.66,,,,,,,16.2000,215.0000,percent of total billed charges,Rev 301 Proc 80364 $215.00 in Billed Charges at 41.7% = $89.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOID &OPIATE ANALOG 5 OR MORE,80364,CPT,301,RC,30100401,CDM,,,,both,,,215.0000,32.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,92.02,,,,,,,16.2000,215.0000,percent of total billed charges,Rev 301 Proc 80364 $215.00 in Billed Charges at 42.8% = $92.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOID &OPIATE ANALOG 5 OR MORE,80364,CPT,301,RC,30100401,CDM,,,,both,,,215.0000,32.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,89.66,,,,,,,16.2000,215.0000,percent of total billed charges,Rev 301 Proc 80364 $215.00 in Billed Charges at 41.7% = $89.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOID &OPIATE ANALOG 5 OR MORE,80364,CPT,301,RC,30100401,CDM,,,,both,,,215.0000,32.2500,CIGNA HEALTHCARE,CIGNA PPO,89.66,,,,,,,16.2000,215.0000,percent of total billed charges,Rev 301 Proc 80364 $215.00 in Billed Charges at 41.7% = $89.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOID &OPIATE ANALOG 5 OR MORE,80364,CPT,301,RC,30100401,CDM,,,,both,,,215.0000,32.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,193.50,,,,,,,16.2000,215.0000,percent of total billed charges,90% of $215.00 in Billed Charges for Rev 301 Proc 80364 = $193.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOID &OPIATE ANALOG 5 OR MORE,80364,CPT,301,RC,30100401,CDM,,,,both,,,215.0000,32.2500,MEDCOST,MEDCOST VHN,102.32,,,,,,,16.2000,215.0000,percent of total billed charges,47.59% of $215.00 in Billed Charges for Rev 301 Proc 80364 = $102.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOID &OPIATE ANALOG 5 OR MORE,80364,CPT,301,RC,30100401,CDM,,,,both,,,215.0000,32.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,16.52,,,,,,,16.2000,215.0000,fee schedule,APG 02040 Proc 80364 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 105% = $16.52 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPIOID &OPIATE ANALOG 5 OR MORE,80364,CPT,301,RC,30100401,CDM,,,,both,,,215.0000,32.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,16.22,,,,,,,16.2000,215.0000,fee schedule,APG 02040 Proc 80364 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 103.1% = $16.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPIOID &OPIATE ANALOG 5 OR MORE,80364,CPT,301,RC,30100401,CDM,,,,both,,,215.0000,32.2500,SENTARA HEALTH,SENTARA HEALTH,55.49,,,,,,,16.2000,215.0000,percent of total billed charges,25.81% of $215.00 in Billed Charges for Rev 301 Proc 80364 = $55.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOID &OPIATE ANALOG 5 OR MORE,80364,CPT,301,RC,30100401,CDM,,,,both,,,215.0000,32.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",215.00,,,,,,,16.2000,215.0000,percent of total billed charges,100% of $215.00 in Billed Charges for Rev 301 Proc 80364 = $215.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOID &OPIATE ANALOG 5 OR MORE,80364,CPT,301,RC,30100401,CDM,,,,both,,,215.0000,32.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,16.20,,,,,,,16.2000,215.0000,fee schedule,APG 02040 Proc 80364 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPIOID &OPIATE ANALOG 5 OR MORE,80364,CPT,301,RC,30100401,CDM,,,,both,,,215.0000,32.2500,WELLCARE,WELLCARE MEDICAID,215.00,,,,,,,16.2000,215.0000,percent of total billed charges,100% of $215.00 in Billed Charges for Rev 301 Proc 80364 = $215.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OXYCODONE,80365,CPT,301,RC,30100402,CDM,,,,both,,,89.0000,13.3500,AETNA,AETNA,38.00,,,,,,,16.2000,89.0000,percent of total billed charges,42.7% of $89.00 in Billed Charges for Rev 301 Proc 80365 = $38.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OXYCODONE,80365,CPT,301,RC,30100402,CDM,,,,both,,,89.0000,13.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,16.36,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80365 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 104% = $16.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYCODONE,80365,CPT,301,RC,30100402,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,16.20,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80365 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYCODONE,80365,CPT,301,RC,30100402,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,62.30,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80365 $89.00 in Billed Charges at 70% = $62.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OXYCODONE,80365,CPT,301,RC,30100402,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA HMO,37.11,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80365 $89.00 in Billed Charges at 41.7% = $37.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OXYCODONE,80365,CPT,301,RC,30100402,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,38.09,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80365 $89.00 in Billed Charges at 42.8% = $38.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OXYCODONE,80365,CPT,301,RC,30100402,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,37.11,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80365 $89.00 in Billed Charges at 41.7% = $37.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OXYCODONE,80365,CPT,301,RC,30100402,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA PPO,37.11,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80365 $89.00 in Billed Charges at 41.7% = $37.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OXYCODONE,80365,CPT,301,RC,30100402,CDM,,,,both,,,89.0000,13.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,80.10,,,,,,,16.2000,89.0000,percent of total billed charges,90% of $89.00 in Billed Charges for Rev 301 Proc 80365 = $80.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OXYCODONE,80365,CPT,301,RC,30100402,CDM,,,,both,,,89.0000,13.3500,MEDCOST,MEDCOST VHN,42.36,,,,,,,16.2000,89.0000,percent of total billed charges,47.59% of $89.00 in Billed Charges for Rev 301 Proc 80365 = $42.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OXYCODONE,80365,CPT,301,RC,30100402,CDM,,,,both,,,89.0000,13.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,16.52,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80365 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 105% = $16.52 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYCODONE,80365,CPT,301,RC,30100402,CDM,,,,both,,,89.0000,13.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,16.22,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80365 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 103.1% = $16.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYCODONE,80365,CPT,301,RC,30100402,CDM,,,,both,,,89.0000,13.3500,SENTARA HEALTH,SENTARA HEALTH,22.97,,,,,,,16.2000,89.0000,percent of total billed charges,25.81% of $89.00 in Billed Charges for Rev 301 Proc 80365 = $22.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OXYCODONE,80365,CPT,301,RC,30100402,CDM,,,,both,,,89.0000,13.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",89.00,,,,,,,16.2000,89.0000,percent of total billed charges,100% of $89.00 in Billed Charges for Rev 301 Proc 80365 = $89.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OXYCODONE,80365,CPT,301,RC,30100402,CDM,,,,both,,,89.0000,13.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,16.20,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80365 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYCODONE,80365,CPT,301,RC,30100402,CDM,,,,both,,,89.0000,13.3500,WELLCARE,WELLCARE MEDICAID,89.00,,,,,,,16.2000,89.0000,percent of total billed charges,100% of $89.00 in Billed Charges for Rev 301 Proc 80365 = $89.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11798.7400,1769.8100,AETNA,AETNA,5038.06,,,,,,,3045.2500,11798.7400,percent of total billed charges,"42.7% of $11,798.74 in Billed Charges for Rev 272 = $5,038.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11798.7400,1769.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8259.12,,,,,,,3045.2500,11798.7400,percent of total billed charges,"Rev 272 $11,798.74 in Billed Charges at 70% = $8,259.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11798.7400,1769.8100,CIGNA HEALTHCARE,CIGNA HMO,4920.07,,,,,,,3045.2500,11798.7400,percent of total billed charges,"41.7% of $11,798.74 in Billed Charges for Rev 272 = $4,920.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11798.7400,1769.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5474.62,,,,,,,3045.2500,11798.7400,percent of total billed charges,"46.4% of $11,798.74 in Billed Charges for Rev 272 = $5,474.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11798.7400,1769.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4920.07,,,,,,,3045.2500,11798.7400,percent of total billed charges,"41.7% of $11,798.74 in Billed Charges for Rev 272 = $4,920.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11798.7400,1769.8100,CIGNA HEALTHCARE,CIGNA PPO,4920.07,,,,,,,3045.2500,11798.7400,percent of total billed charges,"41.7% of $11,798.74 in Billed Charges for Rev 272 = $4,920.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11798.7400,1769.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10618.87,,,,,,,3045.2500,11798.7400,percent of total billed charges,"90% of $11,798.74 in Billed Charges for Rev 272 = $10,618.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11798.7400,1769.8100,MEDCOST,MEDCOST VHN,5615.02,,,,,,,3045.2500,11798.7400,percent of total billed charges,"47.59% of $11,798.74 in Billed Charges for Rev 272 = $5,615.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11798.7400,1769.8100,SENTARA HEALTH,SENTARA HEALTH,3045.25,,,,,,,3045.2500,11798.7400,percent of total billed charges,"25.81% of $11,798.74 in Billed Charges for Rev 272 = $3,045.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11798.7400,1769.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11798.74,,,,,,,3045.2500,11798.7400,percent of total billed charges,"100% of $11,798.74 in Billed Charges for Rev 272 = $11,798.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11798.7400,1769.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5899.37,,,,,,,3045.2500,11798.7400,percent of total billed charges,"Rev 272 $11,798.74 in Billed Charges at 50% = $5,899.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11798.7400,1769.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3810.99,,,,,,,3045.2500,11798.7400,other,"32.3% of $11,798.74 in Billed Charges for Rev 272 = $3,810.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11798.7400,1769.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,3622.21,,,,,,,3045.2500,11798.7400,other,"30.7% of $11,798.74 in Billed Charges for Rev 272 = $3,622.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11798.7400,1769.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,3810.99,,,,,,,3045.2500,11798.7400,percent of total billed charges,"32.3% of $11,798.74 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT NOVASURE ABALATION,272,RC,27200002,CDM,,,,,,both,,,11798.7400,1769.8100,WELLCARE,WELLCARE MEDICAID,11798.74,,,,,,,3045.2500,11798.7400,percent of total billed charges,"100% of $11,798.74 in Billed Charges for Rev 272 = $11,798.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKELETAL MUSCLE RELAXANT 1 OR 2,80369,CPT,301,RC,30100406,CDM,,,,both,,,89.0000,13.3500,AETNA,AETNA,38.00,,,,,,,16.2000,89.0000,percent of total billed charges,42.7% of $89.00 in Billed Charges for Rev 301 Proc 80369 = $38.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SKELETAL MUSCLE RELAXANT 1 OR 2,80369,CPT,301,RC,30100406,CDM,,,,both,,,89.0000,13.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,16.36,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80369 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 104% = $16.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKELETAL MUSCLE RELAXANT 1 OR 2,80369,CPT,301,RC,30100406,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,16.20,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80369 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKELETAL MUSCLE RELAXANT 1 OR 2,80369,CPT,301,RC,30100406,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,62.30,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80369 $89.00 in Billed Charges at 70% = $62.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SKELETAL MUSCLE RELAXANT 1 OR 2,80369,CPT,301,RC,30100406,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA HMO,37.11,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80369 $89.00 in Billed Charges at 41.7% = $37.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SKELETAL MUSCLE RELAXANT 1 OR 2,80369,CPT,301,RC,30100406,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,38.09,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80369 $89.00 in Billed Charges at 42.8% = $38.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SKELETAL MUSCLE RELAXANT 1 OR 2,80369,CPT,301,RC,30100406,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,37.11,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80369 $89.00 in Billed Charges at 41.7% = $37.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SKELETAL MUSCLE RELAXANT 1 OR 2,80369,CPT,301,RC,30100406,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA PPO,37.11,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80369 $89.00 in Billed Charges at 41.7% = $37.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SKELETAL MUSCLE RELAXANT 1 OR 2,80369,CPT,301,RC,30100406,CDM,,,,both,,,89.0000,13.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,80.10,,,,,,,16.2000,89.0000,percent of total billed charges,90% of $89.00 in Billed Charges for Rev 301 Proc 80369 = $80.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SKELETAL MUSCLE RELAXANT 1 OR 2,80369,CPT,301,RC,30100406,CDM,,,,both,,,89.0000,13.3500,MEDCOST,MEDCOST VHN,42.36,,,,,,,16.2000,89.0000,percent of total billed charges,47.59% of $89.00 in Billed Charges for Rev 301 Proc 80369 = $42.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SKELETAL MUSCLE RELAXANT 1 OR 2,80369,CPT,301,RC,30100406,CDM,,,,both,,,89.0000,13.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,16.52,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80369 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 105% = $16.52 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKELETAL MUSCLE RELAXANT 1 OR 2,80369,CPT,301,RC,30100406,CDM,,,,both,,,89.0000,13.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,16.22,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80369 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 103.1% = $16.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKELETAL MUSCLE RELAXANT 1 OR 2,80369,CPT,301,RC,30100406,CDM,,,,both,,,89.0000,13.3500,SENTARA HEALTH,SENTARA HEALTH,22.97,,,,,,,16.2000,89.0000,percent of total billed charges,25.81% of $89.00 in Billed Charges for Rev 301 Proc 80369 = $22.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SKELETAL MUSCLE RELAXANT 1 OR 2,80369,CPT,301,RC,30100406,CDM,,,,both,,,89.0000,13.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",89.00,,,,,,,16.2000,89.0000,percent of total billed charges,100% of $89.00 in Billed Charges for Rev 301 Proc 80369 = $89.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SKELETAL MUSCLE RELAXANT 1 OR 2,80369,CPT,301,RC,30100406,CDM,,,,both,,,89.0000,13.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,16.20,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80369 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKELETAL MUSCLE RELAXANT 1 OR 2,80369,CPT,301,RC,30100406,CDM,,,,both,,,89.0000,13.3500,WELLCARE,WELLCARE MEDICAID,89.00,,,,,,,16.2000,89.0000,percent of total billed charges,100% of $89.00 in Billed Charges for Rev 301 Proc 80369 = $89.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SKELETAL MUSCLE RELAXANT 3 OR MORE,80370,CPT,301,RC,30100407,CDM,,,,both,,,89.0000,13.3500,AETNA,AETNA,38.00,,,,,,,16.2000,89.0000,percent of total billed charges,42.7% of $89.00 in Billed Charges for Rev 301 Proc 80370 = $38.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SKELETAL MUSCLE RELAXANT 3 OR MORE,80370,CPT,301,RC,30100407,CDM,,,,both,,,89.0000,13.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,16.36,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80370 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 104% = $16.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKELETAL MUSCLE RELAXANT 3 OR MORE,80370,CPT,301,RC,30100407,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,16.20,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80370 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKELETAL MUSCLE RELAXANT 3 OR MORE,80370,CPT,301,RC,30100407,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,62.30,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80370 $89.00 in Billed Charges at 70% = $62.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SKELETAL MUSCLE RELAXANT 3 OR MORE,80370,CPT,301,RC,30100407,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA HMO,37.11,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80370 $89.00 in Billed Charges at 41.7% = $37.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SKELETAL MUSCLE RELAXANT 3 OR MORE,80370,CPT,301,RC,30100407,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,38.09,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80370 $89.00 in Billed Charges at 42.8% = $38.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SKELETAL MUSCLE RELAXANT 3 OR MORE,80370,CPT,301,RC,30100407,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,37.11,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80370 $89.00 in Billed Charges at 41.7% = $37.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SKELETAL MUSCLE RELAXANT 3 OR MORE,80370,CPT,301,RC,30100407,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA PPO,37.11,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80370 $89.00 in Billed Charges at 41.7% = $37.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SKELETAL MUSCLE RELAXANT 3 OR MORE,80370,CPT,301,RC,30100407,CDM,,,,both,,,89.0000,13.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,80.10,,,,,,,16.2000,89.0000,percent of total billed charges,90% of $89.00 in Billed Charges for Rev 301 Proc 80370 = $80.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SKELETAL MUSCLE RELAXANT 3 OR MORE,80370,CPT,301,RC,30100407,CDM,,,,both,,,89.0000,13.3500,MEDCOST,MEDCOST VHN,42.36,,,,,,,16.2000,89.0000,percent of total billed charges,47.59% of $89.00 in Billed Charges for Rev 301 Proc 80370 = $42.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SKELETAL MUSCLE RELAXANT 3 OR MORE,80370,CPT,301,RC,30100407,CDM,,,,both,,,89.0000,13.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,16.52,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80370 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 105% = $16.52 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKELETAL MUSCLE RELAXANT 3 OR MORE,80370,CPT,301,RC,30100407,CDM,,,,both,,,89.0000,13.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,16.22,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80370 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 103.1% = $16.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKELETAL MUSCLE RELAXANT 3 OR MORE,80370,CPT,301,RC,30100407,CDM,,,,both,,,89.0000,13.3500,SENTARA HEALTH,SENTARA HEALTH,22.97,,,,,,,16.2000,89.0000,percent of total billed charges,25.81% of $89.00 in Billed Charges for Rev 301 Proc 80370 = $22.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SKELETAL MUSCLE RELAXANT 3 OR MORE,80370,CPT,301,RC,30100407,CDM,,,,both,,,89.0000,13.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",89.00,,,,,,,16.2000,89.0000,percent of total billed charges,100% of $89.00 in Billed Charges for Rev 301 Proc 80370 = $89.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SKELETAL MUSCLE RELAXANT 3 OR MORE,80370,CPT,301,RC,30100407,CDM,,,,both,,,89.0000,13.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,16.20,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80370 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKELETAL MUSCLE RELAXANT 3 OR MORE,80370,CPT,301,RC,30100407,CDM,,,,both,,,89.0000,13.3500,WELLCARE,WELLCARE MEDICAID,89.00,,,,,,,16.2000,89.0000,percent of total billed charges,100% of $89.00 in Billed Charges for Rev 301 Proc 80370 = $89.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TAPENTADOL,80372,CPT,301,RC,30100409,CDM,,,,both,,,98.0000,14.7000,AETNA,AETNA,41.85,,,,,,,16.2000,98.0000,percent of total billed charges,42.7% of $98.00 in Billed Charges for Rev 301 Proc 80372 = $41.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TAPENTADOL,80372,CPT,301,RC,30100409,CDM,,,,both,,,98.0000,14.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,16.36,,,,,,,16.2000,98.0000,fee schedule,APG 02040 Proc 80372 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 104% = $16.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAPENTADOL,80372,CPT,301,RC,30100409,CDM,,,,both,,,98.0000,14.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,16.20,,,,,,,16.2000,98.0000,fee schedule,APG 02040 Proc 80372 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAPENTADOL,80372,CPT,301,RC,30100409,CDM,,,,both,,,98.0000,14.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,68.60,,,,,,,16.2000,98.0000,percent of total billed charges,Rev 301 Proc 80372 $98.00 in Billed Charges at 70% = $68.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TAPENTADOL,80372,CPT,301,RC,30100409,CDM,,,,both,,,98.0000,14.7000,CIGNA HEALTHCARE,CIGNA HMO,40.87,,,,,,,16.2000,98.0000,percent of total billed charges,Rev 301 Proc 80372 $98.00 in Billed Charges at 41.7% = $40.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TAPENTADOL,80372,CPT,301,RC,30100409,CDM,,,,both,,,98.0000,14.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,41.94,,,,,,,16.2000,98.0000,percent of total billed charges,Rev 301 Proc 80372 $98.00 in Billed Charges at 42.8% = $41.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TAPENTADOL,80372,CPT,301,RC,30100409,CDM,,,,both,,,98.0000,14.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,40.87,,,,,,,16.2000,98.0000,percent of total billed charges,Rev 301 Proc 80372 $98.00 in Billed Charges at 41.7% = $40.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TAPENTADOL,80372,CPT,301,RC,30100409,CDM,,,,both,,,98.0000,14.7000,CIGNA HEALTHCARE,CIGNA PPO,40.87,,,,,,,16.2000,98.0000,percent of total billed charges,Rev 301 Proc 80372 $98.00 in Billed Charges at 41.7% = $40.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TAPENTADOL,80372,CPT,301,RC,30100409,CDM,,,,both,,,98.0000,14.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,88.20,,,,,,,16.2000,98.0000,percent of total billed charges,90% of $98.00 in Billed Charges for Rev 301 Proc 80372 = $88.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TAPENTADOL,80372,CPT,301,RC,30100409,CDM,,,,both,,,98.0000,14.7000,MEDCOST,MEDCOST VHN,46.64,,,,,,,16.2000,98.0000,percent of total billed charges,47.59% of $98.00 in Billed Charges for Rev 301 Proc 80372 = $46.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TAPENTADOL,80372,CPT,301,RC,30100409,CDM,,,,both,,,98.0000,14.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,16.52,,,,,,,16.2000,98.0000,fee schedule,APG 02040 Proc 80372 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 105% = $16.52 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAPENTADOL,80372,CPT,301,RC,30100409,CDM,,,,both,,,98.0000,14.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,16.22,,,,,,,16.2000,98.0000,fee schedule,APG 02040 Proc 80372 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 103.1% = $16.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAPENTADOL,80372,CPT,301,RC,30100409,CDM,,,,both,,,98.0000,14.7000,SENTARA HEALTH,SENTARA HEALTH,25.29,,,,,,,16.2000,98.0000,percent of total billed charges,25.81% of $98.00 in Billed Charges for Rev 301 Proc 80372 = $25.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TAPENTADOL,80372,CPT,301,RC,30100409,CDM,,,,both,,,98.0000,14.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",98.00,,,,,,,16.2000,98.0000,percent of total billed charges,100% of $98.00 in Billed Charges for Rev 301 Proc 80372 = $98.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TAPENTADOL,80372,CPT,301,RC,30100409,CDM,,,,both,,,98.0000,14.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,16.20,,,,,,,16.2000,98.0000,fee schedule,APG 02040 Proc 80372 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAPENTADOL,80372,CPT,301,RC,30100409,CDM,,,,both,,,98.0000,14.7000,WELLCARE,WELLCARE MEDICAID,98.00,,,,,,,16.2000,98.0000,percent of total billed charges,100% of $98.00 in Billed Charges for Rev 301 Proc 80372 = $98.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAMADOL,80373,CPT,301,RC,30100410,CDM,,,,both,,,89.0000,13.3500,AETNA,AETNA,38.00,,,,,,,16.2000,89.0000,percent of total billed charges,42.7% of $89.00 in Billed Charges for Rev 301 Proc 80373 = $38.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAMADOL,80373,CPT,301,RC,30100410,CDM,,,,both,,,89.0000,13.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,16.36,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80373 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 104% = $16.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRAMADOL,80373,CPT,301,RC,30100410,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,16.20,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80373 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRAMADOL,80373,CPT,301,RC,30100410,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,62.30,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80373 $89.00 in Billed Charges at 70% = $62.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAMADOL,80373,CPT,301,RC,30100410,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA HMO,37.11,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80373 $89.00 in Billed Charges at 41.7% = $37.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAMADOL,80373,CPT,301,RC,30100410,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,38.09,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80373 $89.00 in Billed Charges at 42.8% = $38.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAMADOL,80373,CPT,301,RC,30100410,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,37.11,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80373 $89.00 in Billed Charges at 41.7% = $37.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAMADOL,80373,CPT,301,RC,30100410,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA PPO,37.11,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80373 $89.00 in Billed Charges at 41.7% = $37.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAMADOL,80373,CPT,301,RC,30100410,CDM,,,,both,,,89.0000,13.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,80.10,,,,,,,16.2000,89.0000,percent of total billed charges,90% of $89.00 in Billed Charges for Rev 301 Proc 80373 = $80.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAMADOL,80373,CPT,301,RC,30100410,CDM,,,,both,,,89.0000,13.3500,MEDCOST,MEDCOST VHN,42.36,,,,,,,16.2000,89.0000,percent of total billed charges,47.59% of $89.00 in Billed Charges for Rev 301 Proc 80373 = $42.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAMADOL,80373,CPT,301,RC,30100410,CDM,,,,both,,,89.0000,13.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,16.52,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80373 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 105% = $16.52 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRAMADOL,80373,CPT,301,RC,30100410,CDM,,,,both,,,89.0000,13.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,16.22,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80373 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 103.1% = $16.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRAMADOL,80373,CPT,301,RC,30100410,CDM,,,,both,,,89.0000,13.3500,SENTARA HEALTH,SENTARA HEALTH,22.97,,,,,,,16.2000,89.0000,percent of total billed charges,25.81% of $89.00 in Billed Charges for Rev 301 Proc 80373 = $22.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAMADOL,80373,CPT,301,RC,30100410,CDM,,,,both,,,89.0000,13.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",89.00,,,,,,,16.2000,89.0000,percent of total billed charges,100% of $89.00 in Billed Charges for Rev 301 Proc 80373 = $89.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRAMADOL,80373,CPT,301,RC,30100410,CDM,,,,both,,,89.0000,13.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,16.20,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80373 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRAMADOL,80373,CPT,301,RC,30100410,CDM,,,,both,,,89.0000,13.3500,WELLCARE,WELLCARE MEDICAID,89.00,,,,,,,16.2000,89.0000,percent of total billed charges,100% of $89.00 in Billed Charges for Rev 301 Proc 80373 = $89.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PATELLA TEMPLATE,272,RC,27200002,CDM,,,,,,both,,,1912.2000,286.8300,AETNA,AETNA,816.51,,,,,,,493.5400,1912.2000,percent of total billed charges,"42.7% of $1,912.20 in Billed Charges for Rev 272 = $816.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATELLA TEMPLATE,272,RC,27200002,CDM,,,,,,both,,,1912.2000,286.8300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1338.54,,,,,,,493.5400,1912.2000,percent of total billed charges,"Rev 272 $1,912.20 in Billed Charges at 70% = $1,338.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATELLA TEMPLATE,272,RC,27200002,CDM,,,,,,both,,,1912.2000,286.8300,CIGNA HEALTHCARE,CIGNA HMO,797.39,,,,,,,493.5400,1912.2000,percent of total billed charges,"41.7% of $1,912.20 in Billed Charges for Rev 272 = $797.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATELLA TEMPLATE,272,RC,27200002,CDM,,,,,,both,,,1912.2000,286.8300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,887.26,,,,,,,493.5400,1912.2000,percent of total billed charges,"46.4% of $1,912.20 in Billed Charges for Rev 272 = $887.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATELLA TEMPLATE,272,RC,27200002,CDM,,,,,,both,,,1912.2000,286.8300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,797.39,,,,,,,493.5400,1912.2000,percent of total billed charges,"41.7% of $1,912.20 in Billed Charges for Rev 272 = $797.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATELLA TEMPLATE,272,RC,27200002,CDM,,,,,,both,,,1912.2000,286.8300,CIGNA HEALTHCARE,CIGNA PPO,797.39,,,,,,,493.5400,1912.2000,percent of total billed charges,"41.7% of $1,912.20 in Billed Charges for Rev 272 = $797.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATELLA TEMPLATE,272,RC,27200002,CDM,,,,,,both,,,1912.2000,286.8300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1720.98,,,,,,,493.5400,1912.2000,percent of total billed charges,"90% of $1,912.20 in Billed Charges for Rev 272 = $1,720.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATELLA TEMPLATE,272,RC,27200002,CDM,,,,,,both,,,1912.2000,286.8300,MEDCOST,MEDCOST VHN,910.02,,,,,,,493.5400,1912.2000,percent of total billed charges,"47.59% of $1,912.20 in Billed Charges for Rev 272 = $910.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATELLA TEMPLATE,272,RC,27200002,CDM,,,,,,both,,,1912.2000,286.8300,SENTARA HEALTH,SENTARA HEALTH,493.54,,,,,,,493.5400,1912.2000,percent of total billed charges,"25.81% of $1,912.20 in Billed Charges for Rev 272 = $493.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATELLA TEMPLATE,272,RC,27200002,CDM,,,,,,both,,,1912.2000,286.8300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1912.20,,,,,,,493.5400,1912.2000,percent of total billed charges,"100% of $1,912.20 in Billed Charges for Rev 272 = $1,912.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATELLA TEMPLATE,272,RC,27200002,CDM,,,,,,both,,,1912.2000,286.8300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,956.10,,,,,,,493.5400,1912.2000,percent of total billed charges,"Rev 272 $1,912.20 in Billed Charges at 50% = $956.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATELLA TEMPLATE,272,RC,27200002,CDM,,,,,,both,,,1912.2000,286.8300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,617.64,,,,,,,493.5400,1912.2000,other,"32.3% of $1,912.20 in Billed Charges for Rev 272 = $617.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PATELLA TEMPLATE,272,RC,27200002,CDM,,,,,,both,,,1912.2000,286.8300,UNITED HEALTHCARE,UHC HERITAGE SELECT,587.05,,,,,,,493.5400,1912.2000,other,"30.7% of $1,912.20 in Billed Charges for Rev 272 = $587.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PATELLA TEMPLATE,272,RC,27200002,CDM,,,,,,both,,,1912.2000,286.8300,UNITED HEALTHCARE,UNITED HEALTHCARE,617.64,,,,,,,493.5400,1912.2000,percent of total billed charges,"32.3% of $1,912.20 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATELLA TEMPLATE,272,RC,27200002,CDM,,,,,,both,,,1912.2000,286.8300,WELLCARE,WELLCARE MEDICAID,1912.20,,,,,,,493.5400,1912.2000,percent of total billed charges,"100% of $1,912.20 in Billed Charges for Rev 272 = $1,912.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATIENT LEVEL ONE THORACIC STERNAL,272,RC,27200002,CDM,,,,,,both,,,3453.5400,518.0300,AETNA,AETNA,1474.66,,,,,,,891.3600,3453.5400,percent of total billed charges,"42.7% of $3,453.54 in Billed Charges for Rev 272 = $1,474.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATIENT LEVEL ONE THORACIC STERNAL,272,RC,27200002,CDM,,,,,,both,,,3453.5400,518.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2417.48,,,,,,,891.3600,3453.5400,percent of total billed charges,"Rev 272 $3,453.54 in Billed Charges at 70% = $2,417.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATIENT LEVEL ONE THORACIC STERNAL,272,RC,27200002,CDM,,,,,,both,,,3453.5400,518.0300,CIGNA HEALTHCARE,CIGNA HMO,1440.13,,,,,,,891.3600,3453.5400,percent of total billed charges,"41.7% of $3,453.54 in Billed Charges for Rev 272 = $1,440.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATIENT LEVEL ONE THORACIC STERNAL,272,RC,27200002,CDM,,,,,,both,,,3453.5400,518.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1602.44,,,,,,,891.3600,3453.5400,percent of total billed charges,"46.4% of $3,453.54 in Billed Charges for Rev 272 = $1,602.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATIENT LEVEL ONE THORACIC STERNAL,272,RC,27200002,CDM,,,,,,both,,,3453.5400,518.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1440.13,,,,,,,891.3600,3453.5400,percent of total billed charges,"41.7% of $3,453.54 in Billed Charges for Rev 272 = $1,440.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATIENT LEVEL ONE THORACIC STERNAL,272,RC,27200002,CDM,,,,,,both,,,3453.5400,518.0300,CIGNA HEALTHCARE,CIGNA PPO,1440.13,,,,,,,891.3600,3453.5400,percent of total billed charges,"41.7% of $3,453.54 in Billed Charges for Rev 272 = $1,440.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATIENT LEVEL ONE THORACIC STERNAL,272,RC,27200002,CDM,,,,,,both,,,3453.5400,518.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3108.19,,,,,,,891.3600,3453.5400,percent of total billed charges,"90% of $3,453.54 in Billed Charges for Rev 272 = $3,108.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATIENT LEVEL ONE THORACIC STERNAL,272,RC,27200002,CDM,,,,,,both,,,3453.5400,518.0300,MEDCOST,MEDCOST VHN,1643.54,,,,,,,891.3600,3453.5400,percent of total billed charges,"47.59% of $3,453.54 in Billed Charges for Rev 272 = $1,643.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATIENT LEVEL ONE THORACIC STERNAL,272,RC,27200002,CDM,,,,,,both,,,3453.5400,518.0300,SENTARA HEALTH,SENTARA HEALTH,891.36,,,,,,,891.3600,3453.5400,percent of total billed charges,"25.81% of $3,453.54 in Billed Charges for Rev 272 = $891.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATIENT LEVEL ONE THORACIC STERNAL,272,RC,27200002,CDM,,,,,,both,,,3453.5400,518.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3453.54,,,,,,,891.3600,3453.5400,percent of total billed charges,"100% of $3,453.54 in Billed Charges for Rev 272 = $3,453.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATIENT LEVEL ONE THORACIC STERNAL,272,RC,27200002,CDM,,,,,,both,,,3453.5400,518.0300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1726.77,,,,,,,891.3600,3453.5400,percent of total billed charges,"Rev 272 $3,453.54 in Billed Charges at 50% = $1,726.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATIENT LEVEL ONE THORACIC STERNAL,272,RC,27200002,CDM,,,,,,both,,,3453.5400,518.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1115.49,,,,,,,891.3600,3453.5400,other,"32.3% of $3,453.54 in Billed Charges for Rev 272 = $1,115.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PATIENT LEVEL ONE THORACIC STERNAL,272,RC,27200002,CDM,,,,,,both,,,3453.5400,518.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1060.24,,,,,,,891.3600,3453.5400,other,"30.7% of $3,453.54 in Billed Charges for Rev 272 = $1,060.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PATIENT LEVEL ONE THORACIC STERNAL,272,RC,27200002,CDM,,,,,,both,,,3453.5400,518.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,1115.49,,,,,,,891.3600,3453.5400,percent of total billed charges,"32.3% of $3,453.54 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PATIENT LEVEL ONE THORACIC STERNAL,272,RC,27200002,CDM,,,,,,both,,,3453.5400,518.0300,WELLCARE,WELLCARE MEDICAID,3453.54,,,,,,,891.3600,3453.5400,percent of total billed charges,"100% of $3,453.54 in Billed Charges for Rev 272 = $3,453.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASER FIBER XPS-GL XPS-10-2400,272,RC,27200002,CDM,,,,,,both,,,10371.0000,1555.6500,AETNA,AETNA,4428.42,,,,,,,2676.7600,10371.0000,percent of total billed charges,"42.7% of $10,371.00 in Billed Charges for Rev 272 = $4,428.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASER FIBER XPS-GL XPS-10-2400,272,RC,27200002,CDM,,,,,,both,,,10371.0000,1555.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7259.70,,,,,,,2676.7600,10371.0000,percent of total billed charges,"Rev 272 $10,371.00 in Billed Charges at 70% = $7,259.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASER FIBER XPS-GL XPS-10-2400,272,RC,27200002,CDM,,,,,,both,,,10371.0000,1555.6500,CIGNA HEALTHCARE,CIGNA HMO,4324.71,,,,,,,2676.7600,10371.0000,percent of total billed charges,"41.7% of $10,371.00 in Billed Charges for Rev 272 = $4,324.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASER FIBER XPS-GL XPS-10-2400,272,RC,27200002,CDM,,,,,,both,,,10371.0000,1555.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4812.14,,,,,,,2676.7600,10371.0000,percent of total billed charges,"46.4% of $10,371.00 in Billed Charges for Rev 272 = $4,812.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASER FIBER XPS-GL XPS-10-2400,272,RC,27200002,CDM,,,,,,both,,,10371.0000,1555.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4324.71,,,,,,,2676.7600,10371.0000,percent of total billed charges,"41.7% of $10,371.00 in Billed Charges for Rev 272 = $4,324.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASER FIBER XPS-GL XPS-10-2400,272,RC,27200002,CDM,,,,,,both,,,10371.0000,1555.6500,CIGNA HEALTHCARE,CIGNA PPO,4324.71,,,,,,,2676.7600,10371.0000,percent of total billed charges,"41.7% of $10,371.00 in Billed Charges for Rev 272 = $4,324.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASER FIBER XPS-GL XPS-10-2400,272,RC,27200002,CDM,,,,,,both,,,10371.0000,1555.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9333.90,,,,,,,2676.7600,10371.0000,percent of total billed charges,"90% of $10,371.00 in Billed Charges for Rev 272 = $9,333.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASER FIBER XPS-GL XPS-10-2400,272,RC,27200002,CDM,,,,,,both,,,10371.0000,1555.6500,MEDCOST,MEDCOST VHN,4935.56,,,,,,,2676.7600,10371.0000,percent of total billed charges,"47.59% of $10,371.00 in Billed Charges for Rev 272 = $4,935.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASER FIBER XPS-GL XPS-10-2400,272,RC,27200002,CDM,,,,,,both,,,10371.0000,1555.6500,SENTARA HEALTH,SENTARA HEALTH,2676.76,,,,,,,2676.7600,10371.0000,percent of total billed charges,"25.81% of $10,371.00 in Billed Charges for Rev 272 = $2,676.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASER FIBER XPS-GL XPS-10-2400,272,RC,27200002,CDM,,,,,,both,,,10371.0000,1555.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10371.00,,,,,,,2676.7600,10371.0000,percent of total billed charges,"100% of $10,371.00 in Billed Charges for Rev 272 = $10,371.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASER FIBER XPS-GL XPS-10-2400,272,RC,27200002,CDM,,,,,,both,,,10371.0000,1555.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5185.50,,,,,,,2676.7600,10371.0000,percent of total billed charges,"Rev 272 $10,371.00 in Billed Charges at 50% = $5,185.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASER FIBER XPS-GL XPS-10-2400,272,RC,27200002,CDM,,,,,,both,,,10371.0000,1555.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3349.83,,,,,,,2676.7600,10371.0000,other,"32.3% of $10,371.00 in Billed Charges for Rev 272 = $3,349.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LASER FIBER XPS-GL XPS-10-2400,272,RC,27200002,CDM,,,,,,both,,,10371.0000,1555.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3183.90,,,,,,,2676.7600,10371.0000,other,"30.7% of $10,371.00 in Billed Charges for Rev 272 = $3,183.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LASER FIBER XPS-GL XPS-10-2400,272,RC,27200002,CDM,,,,,,both,,,10371.0000,1555.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,3349.83,,,,,,,2676.7600,10371.0000,percent of total billed charges,"32.3% of $10,371.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASER FIBER XPS-GL XPS-10-2400,272,RC,27200002,CDM,,,,,,both,,,10371.0000,1555.6500,WELLCARE,WELLCARE MEDICAID,10371.00,,,,,,,2676.7600,10371.0000,percent of total billed charges,"100% of $10,371.00 in Billed Charges for Rev 272 = $10,371.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STEREOISOMER ANALYSIS SGL DRUG CLASS,80374,CPT,301,RC,30100411,CDM,,,,both,,,47.0000,7.0500,AETNA,AETNA,20.07,,,,,,,12.1300,47.0000,percent of total billed charges,42.7% of $47.00 in Billed Charges for Rev 301 Proc 80374 = $20.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STEREOISOMER ANALYSIS SGL DRUG CLASS,80374,CPT,301,RC,30100411,CDM,,,,both,,,47.0000,7.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,16.36,,,,,,,12.1300,47.0000,fee schedule,APG 02040 Proc 80374 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 104% = $16.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STEREOISOMER ANALYSIS SGL DRUG CLASS,80374,CPT,301,RC,30100411,CDM,,,,both,,,47.0000,7.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,16.20,,,,,,,12.1300,47.0000,fee schedule,APG 02040 Proc 80374 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STEREOISOMER ANALYSIS SGL DRUG CLASS,80374,CPT,301,RC,30100411,CDM,,,,both,,,47.0000,7.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,32.90,,,,,,,12.1300,47.0000,percent of total billed charges,Rev 301 Proc 80374 $47.00 in Billed Charges at 70% = $32.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STEREOISOMER ANALYSIS SGL DRUG CLASS,80374,CPT,301,RC,30100411,CDM,,,,both,,,47.0000,7.0500,CIGNA HEALTHCARE,CIGNA HMO,19.60,,,,,,,12.1300,47.0000,percent of total billed charges,Rev 301 Proc 80374 $47.00 in Billed Charges at 41.7% = $19.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STEREOISOMER ANALYSIS SGL DRUG CLASS,80374,CPT,301,RC,30100411,CDM,,,,both,,,47.0000,7.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,20.12,,,,,,,12.1300,47.0000,percent of total billed charges,Rev 301 Proc 80374 $47.00 in Billed Charges at 42.8% = $20.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STEREOISOMER ANALYSIS SGL DRUG CLASS,80374,CPT,301,RC,30100411,CDM,,,,both,,,47.0000,7.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,19.60,,,,,,,12.1300,47.0000,percent of total billed charges,Rev 301 Proc 80374 $47.00 in Billed Charges at 41.7% = $19.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STEREOISOMER ANALYSIS SGL DRUG CLASS,80374,CPT,301,RC,30100411,CDM,,,,both,,,47.0000,7.0500,CIGNA HEALTHCARE,CIGNA PPO,19.60,,,,,,,12.1300,47.0000,percent of total billed charges,Rev 301 Proc 80374 $47.00 in Billed Charges at 41.7% = $19.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STEREOISOMER ANALYSIS SGL DRUG CLASS,80374,CPT,301,RC,30100411,CDM,,,,both,,,47.0000,7.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,42.30,,,,,,,12.1300,47.0000,percent of total billed charges,90% of $47.00 in Billed Charges for Rev 301 Proc 80374 = $42.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STEREOISOMER ANALYSIS SGL DRUG CLASS,80374,CPT,301,RC,30100411,CDM,,,,both,,,47.0000,7.0500,MEDCOST,MEDCOST VHN,22.37,,,,,,,12.1300,47.0000,percent of total billed charges,47.59% of $47.00 in Billed Charges for Rev 301 Proc 80374 = $22.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STEREOISOMER ANALYSIS SGL DRUG CLASS,80374,CPT,301,RC,30100411,CDM,,,,both,,,47.0000,7.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,16.52,,,,,,,12.1300,47.0000,fee schedule,APG 02040 Proc 80374 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 105% = $16.52 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STEREOISOMER ANALYSIS SGL DRUG CLASS,80374,CPT,301,RC,30100411,CDM,,,,both,,,47.0000,7.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,16.22,,,,,,,12.1300,47.0000,fee schedule,APG 02040 Proc 80374 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 103.1% = $16.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STEREOISOMER ANALYSIS SGL DRUG CLASS,80374,CPT,301,RC,30100411,CDM,,,,both,,,47.0000,7.0500,SENTARA HEALTH,SENTARA HEALTH,12.13,,,,,,,12.1300,47.0000,percent of total billed charges,25.81% of $47.00 in Billed Charges for Rev 301 Proc 80374 = $12.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STEREOISOMER ANALYSIS SGL DRUG CLASS,80374,CPT,301,RC,30100411,CDM,,,,both,,,47.0000,7.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",47.00,,,,,,,12.1300,47.0000,percent of total billed charges,100% of $47.00 in Billed Charges for Rev 301 Proc 80374 = $47.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STEREOISOMER ANALYSIS SGL DRUG CLASS,80374,CPT,301,RC,30100411,CDM,,,,both,,,47.0000,7.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,16.20,,,,,,,12.1300,47.0000,fee schedule,APG 02040 Proc 80374 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STEREOISOMER ANALYSIS SGL DRUG CLASS,80374,CPT,301,RC,30100411,CDM,,,,both,,,47.0000,7.0500,WELLCARE,WELLCARE MEDICAID,47.00,,,,,,,12.1300,47.0000,percent of total billed charges,100% of $47.00 in Billed Charges for Rev 301 Proc 80374 = $47.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRUG/SUBSTANCE DEFIN QUAL QUAN NOS 1-3,80375,CPT,301,RC,30100412,CDM,,,,both,,,47.0000,7.0500,AETNA,AETNA,20.07,,,,,,,12.1300,82.8300,percent of total billed charges,42.7% of $47.00 in Billed Charges for Rev 301 Proc 80375 = $20.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRUG/SUBSTANCE DEFIN QUAL QUAN NOS 1-3,80375,CPT,301,RC,30100412,CDM,,,,both,,,47.0000,7.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,82.05,,,,,,,12.1300,82.8300,fee schedule,APG 02041 Proc 80375 at $836.60 (Base Rate) * 0.0943 (Relative Weight) = $78.89 (Total Line Payment) at 104% = $82.05. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRUG/SUBSTANCE DEFIN QUAL QUAN NOS 1-3,80375,CPT,301,RC,30100412,CDM,,,,both,,,47.0000,7.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,47.00,,,,,,,12.1300,82.8300,fee schedule,"APG 02041 Proc 80375 at $836.60 (Base Rate) * 0.0943 (Relative Weight) = $78.89 (Total Line Payment) at 103% = $81.26 (Service Line reduced to $47.00, claim capped at $47.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DRUG/SUBSTANCE DEFIN QUAL QUAN NOS 1-3,80375,CPT,301,RC,30100412,CDM,,,,both,,,47.0000,7.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,32.90,,,,,,,12.1300,82.8300,percent of total billed charges,Rev 301 Proc 80375 $47.00 in Billed Charges at 70% = $32.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRUG/SUBSTANCE DEFIN QUAL QUAN NOS 1-3,80375,CPT,301,RC,30100412,CDM,,,,both,,,47.0000,7.0500,CIGNA HEALTHCARE,CIGNA HMO,19.60,,,,,,,12.1300,82.8300,percent of total billed charges,Rev 301 Proc 80375 $47.00 in Billed Charges at 41.7% = $19.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRUG/SUBSTANCE DEFIN QUAL QUAN NOS 1-3,80375,CPT,301,RC,30100412,CDM,,,,both,,,47.0000,7.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,20.12,,,,,,,12.1300,82.8300,percent of total billed charges,Rev 301 Proc 80375 $47.00 in Billed Charges at 42.8% = $20.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRUG/SUBSTANCE DEFIN QUAL QUAN NOS 1-3,80375,CPT,301,RC,30100412,CDM,,,,both,,,47.0000,7.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,19.60,,,,,,,12.1300,82.8300,percent of total billed charges,Rev 301 Proc 80375 $47.00 in Billed Charges at 41.7% = $19.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRUG/SUBSTANCE DEFIN QUAL QUAN NOS 1-3,80375,CPT,301,RC,30100412,CDM,,,,both,,,47.0000,7.0500,CIGNA HEALTHCARE,CIGNA PPO,19.60,,,,,,,12.1300,82.8300,percent of total billed charges,Rev 301 Proc 80375 $47.00 in Billed Charges at 41.7% = $19.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRUG/SUBSTANCE DEFIN QUAL QUAN NOS 1-3,80375,CPT,301,RC,30100412,CDM,,,,both,,,47.0000,7.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,42.30,,,,,,,12.1300,82.8300,percent of total billed charges,90% of $47.00 in Billed Charges for Rev 301 Proc 80375 = $42.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRUG/SUBSTANCE DEFIN QUAL QUAN NOS 1-3,80375,CPT,301,RC,30100412,CDM,,,,both,,,47.0000,7.0500,MEDCOST,MEDCOST VHN,22.37,,,,,,,12.1300,82.8300,percent of total billed charges,47.59% of $47.00 in Billed Charges for Rev 301 Proc 80375 = $22.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRUG/SUBSTANCE DEFIN QUAL QUAN NOS 1-3,80375,CPT,301,RC,30100412,CDM,,,,both,,,47.0000,7.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,82.83,,,,,,,12.1300,82.8300,fee schedule,APG 02041 Proc 80375 at $836.60 (Base Rate) * 0.0943 (Relative Weight) = $78.89 (Total Line Payment) at 100% = $78.89... $78.89 at 105% = $82.83 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRUG/SUBSTANCE DEFIN QUAL QUAN NOS 1-3,80375,CPT,301,RC,30100412,CDM,,,,both,,,47.0000,7.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,81.34,,,,,,,12.1300,82.8300,fee schedule,APG 02041 Proc 80375 at $836.60 (Base Rate) * 0.0943 (Relative Weight) = $78.89 (Total Line Payment) at 100% = $78.89... $78.89 at 103.1% = $81.34 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRUG/SUBSTANCE DEFIN QUAL QUAN NOS 1-3,80375,CPT,301,RC,30100412,CDM,,,,both,,,47.0000,7.0500,SENTARA HEALTH,SENTARA HEALTH,12.13,,,,,,,12.1300,82.8300,percent of total billed charges,25.81% of $47.00 in Billed Charges for Rev 301 Proc 80375 = $12.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRUG/SUBSTANCE DEFIN QUAL QUAN NOS 1-3,80375,CPT,301,RC,30100412,CDM,,,,both,,,47.0000,7.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",47.00,,,,,,,12.1300,82.8300,percent of total billed charges,100% of $47.00 in Billed Charges for Rev 301 Proc 80375 = $47.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRUG/SUBSTANCE DEFIN QUAL QUAN NOS 1-3,80375,CPT,301,RC,30100412,CDM,,,,both,,,47.0000,7.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,81.26,,,,,,,12.1300,82.8300,fee schedule,APG 02041 Proc 80375 at $836.60 (Base Rate) * 0.0943 (Relative Weight) = $78.89 (Total Line Payment) at 103% = $81.26. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRUG/SUBSTANCE DEFIN QUAL QUAN NOS 1-3,80375,CPT,301,RC,30100412,CDM,,,,both,,,47.0000,7.0500,WELLCARE,WELLCARE MEDICAID,47.00,,,,,,,12.1300,82.8300,percent of total billed charges,100% of $47.00 in Billed Charges for Rev 301 Proc 80375 = $47.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,AETNA,AETNA,640.50,,,,,,,87.7000,1500.0000,percent of total billed charges,"42.7% of $1,500.00 in Billed Charges for Rev 310 Proc 81305 = $640.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,189.06,,,,,,,87.7000,1500.0000,fee schedule,APG 00386 Proc 81305 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 104% = $189.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,175.40,,,,,,,87.7000,1500.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,AETNA,AETNA HEALTHCARE MEDICARE,175.40,,,,,,,87.7000,1500.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,ALLCARE MEDICARE,ALLCARE MEDICARE,175.40,,,,,,,87.7000,1500.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,AMBETTER,AMBETTER,382.37,,,,,,,87.7000,1500.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,AMERIGROUP,AMERIGROUP,87.70,,,,,,,87.7000,1500.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,182.42,,,,,,,87.7000,1500.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,BLUE CROSS,ANTHEM EXCHANGE,175.40,,,,,,,87.7000,1500.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,187.25,,,,,,,87.7000,1500.0000,fee schedule,APG 00386 Proc 81305 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,BLUE CROSS,ANTHEM HMO,175.40,,,,,,,87.7000,1500.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,180.66,,,,,,,87.7000,1500.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",175.40,,,,,,,87.7000,1500.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1050.00,,,,,,,87.7000,1500.0000,percent of total billed charges,"Rev 310 Proc 81305 $1,500.00 in Billed Charges at 70% = $1,050.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,BLUE CROSS,BLUE CROSS E NETWORK,561.28,,,,,,,87.7000,1500.0000,fee schedule,$175.40 from Fee Schedule BCFSB for Rev 310 Proc 81305 * Qty 1 = $175.40 at 320% = $561.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,BLUE CROSS,BLUE CROSS MEDICARE,182.42,,,,,,,87.7000,1500.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,BLUE CROSS,BLUE CROSS P NETWORK,573.56,,,,,,,87.7000,1500.0000,fee schedule,$175.40 from Fee Schedule BCFSB for Rev 310 Proc 81305 * Qty 1 = $175.40 at 327% = $573.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,BLUE CROSS,BLUE CROSS S NETWORK,573.56,,,,,,,87.7000,1500.0000,fee schedule,$175.40 from Fee Schedule BCFSB for Rev 310 Proc 81305 * Qty 1 = $175.40 at 327% = $573.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,BLUE CROSS,TENNCARE BLUE CARE,165.30,,,,,,,87.7000,1500.0000,fee schedule,$142.50 from Fee Schedule TC_24 for Rev 310 Proc 81305 * Qty 1 = $142.50 at 116% = $165.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,BLUE CROSS,TENNCARE BLUE SELECT,165.30,,,,,,,87.7000,1500.0000,fee schedule,$142.50 from Fee Schedule TC_24 for Rev 310 Proc 81305 * Qty 1 = $142.50 at 116% = $165.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,CIGNA HEALTHCARE,CIGNA HMO,625.50,,,,,,,87.7000,1500.0000,percent of total billed charges,"Rev 310 Proc 81305 $1,500.00 in Billed Charges at 41.7% = $625.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,386.87,,,,,,,87.7000,1500.0000,fee schedule,$386.87 from Fee Schedule CGIFP_25LR for Rev 310 Proc 81305 * Qty 1 = $386.87 at 100% = $386.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,CIGNA HEALTHCARE,CIGNA MEDICARE,184.17,,,,,,,87.7000,1500.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,625.50,,,,,,,87.7000,1500.0000,percent of total billed charges,"Rev 310 Proc 81305 $1,500.00 in Billed Charges at 41.7% = $625.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,CIGNA HEALTHCARE,CIGNA PPO,625.50,,,,,,,87.7000,1500.0000,percent of total billed charges,"Rev 310 Proc 81305 $1,500.00 in Billed Charges at 41.7% = $625.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,184.17,,,,,,,87.7000,1500.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1350.00,,,,,,,87.7000,1500.0000,percent of total billed charges,"90% of $1,500.00 in Billed Charges for Rev 310 Proc 81305 = $1,350.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,HUMANA,HUMANA MEDICARE,175.40,,,,,,,87.7000,1500.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,175.40,,,,,,,87.7000,1500.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,MEDCOST,MEDCOST VHN,713.85,,,,,,,87.7000,1500.0000,percent of total billed charges,"47.59% of $1,500.00 in Billed Charges for Rev 310 Proc 81305 = $713.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,190.88,,,,,,,87.7000,1500.0000,fee schedule,APG 00386 Proc 81305 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 105% = $190.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,184.17,,,,,,,87.7000,1500.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,184.17,,,,,,,87.7000,1500.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,NHC ADVANTAGE,NHC ADVANTAGE,184.17,,,,,,,87.7000,1500.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,187.43,,,,,,,87.7000,1500.0000,fee schedule,APG 00386 Proc 81305 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 103.1% = $187.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,SENTARA HEALTH,SENTARA HEALTH,387.15,,,,,,,87.7000,1500.0000,percent of total billed charges,"25.81% of $1,500.00 in Billed Charges for Rev 310 Proc 81305 = $387.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,SENTARA HEALTH,SENTARA MEDICARE,175.40,,,,,,,87.7000,1500.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1500.00,,,,,,,87.7000,1500.0000,percent of total billed charges,"100% of $1,500.00 in Billed Charges for Rev 310 Proc 81305 = $1,500.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,87.70,,,,,,,87.7000,1500.0000,fee schedule,$175.40 from Fee Schedule TCUHC24 for Rev 310 Proc 81305 * Qty 1 = $175.40 at 50% = $87.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,182.42,,,,,,,87.7000,1500.0000,fee schedule,$175.40 from Fee Schedule UHC_31910 for Rev 310 Proc 81305 * Qty 1 = $175.40 at 104% = $182.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,175.40,,,,,,,87.7000,1500.0000,fee schedule,$175.40 from Fee Schedule UHC_31910 for Rev 310 Proc 81305 * Qty 1 = $175.40 at 100% = $175.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,175.40,,,,,,,87.7000,1500.0000,fee schedule,$175.40 from Fee Schedule UHC_31910 for Rev 310 Proc 81305 * Qty 1 = $175.40 at 100% = $175.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,187.25,,,,,,,87.7000,1500.0000,fee schedule,APG 00386 Proc 81305 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,175.40,,,,,,,87.7000,1500.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,175.40,,,,,,,87.7000,1500.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,WELLCARE,WELLCARE MEDICAID,1500.00,,,,,,,87.7000,1500.0000,percent of total billed charges,"100% of $1,500.00 in Billed Charges for Rev 310 Proc 81305 = $1,500.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT,81305,CPT,310,RC,31000031,CDM,,,,both,,,1500.0000,225.0000,WELLCARE,WELLCARE MEDICARE,185.92,,,,,,,87.7000,1500.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,AETNA,AETNA,1033.34,,,,,,,103.6600,2420.0000,percent of total billed charges,"42.7% of $2,420.00 in Billed Charges for Rev 300 Proc 81315 = $1,033.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,189.06,,,,,,,103.6600,2420.0000,fee schedule,APG 00386 Proc 81315 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 104% = $189.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,207.31,,,,,,,103.6600,2420.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,AETNA,AETNA HEALTHCARE MEDICARE,207.31,,,,,,,103.6600,2420.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,ALLCARE MEDICARE,ALLCARE MEDICARE,207.31,,,,,,,103.6600,2420.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,AMBETTER,AMBETTER,451.94,,,,,,,103.6600,2420.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,AMERIGROUP,AMERIGROUP,103.66,,,,,,,103.6600,2420.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,215.60,,,,,,,103.6600,2420.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,BLUE CROSS,ANTHEM EXCHANGE,207.31,,,,,,,103.6600,2420.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,187.25,,,,,,,103.6600,2420.0000,fee schedule,APG 00386 Proc 81315 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,BLUE CROSS,ANTHEM HMO,207.31,,,,,,,103.6600,2420.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,213.53,,,,,,,103.6600,2420.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",207.31,,,,,,,103.6600,2420.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1694.00,,,,,,,103.6600,2420.0000,percent of total billed charges,"Rev 300 Proc 81315 $2,420.00 in Billed Charges at 70% = $1,694.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,BLUE CROSS,BLUE CROSS E NETWORK,905.06,,,,,,,103.6600,2420.0000,fee schedule,$282.83 from Fee Schedule BCFSB for Rev 300 Proc 81315 * Qty 1 = $282.83 at 320% = $905.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,BLUE CROSS,BLUE CROSS MEDICARE,215.60,,,,,,,103.6600,2420.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,BLUE CROSS,BLUE CROSS P NETWORK,924.85,,,,,,,103.6600,2420.0000,fee schedule,$282.83 from Fee Schedule BCFSB for Rev 300 Proc 81315 * Qty 1 = $282.83 at 327% = $924.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,BLUE CROSS,BLUE CROSS S NETWORK,924.85,,,,,,,103.6600,2420.0000,fee schedule,$282.83 from Fee Schedule BCFSB for Rev 300 Proc 81315 * Qty 1 = $282.83 at 327% = $924.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,BLUE CROSS,TENNCARE BLUE CARE,115.92,,,,,,,103.6600,2420.0000,fee schedule,$99.93 from Fee Schedule TC_24 for Rev 300 Proc 81315 * Qty 1 = $99.93 at 116% = $115.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,BLUE CROSS,TENNCARE BLUE SELECT,115.92,,,,,,,103.6600,2420.0000,fee schedule,$99.93 from Fee Schedule TC_24 for Rev 300 Proc 81315 * Qty 1 = $99.93 at 116% = $115.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,CIGNA HEALTHCARE,CIGNA HMO,1009.14,,,,,,,103.6600,2420.0000,percent of total billed charges,"Rev 300 Proc 81315 $2,420.00 in Billed Charges at 41.7% = $1,009.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,456.89,,,,,,,103.6600,2420.0000,fee schedule,$456.89 from Fee Schedule CGIFP_25LR for Rev 300 Proc 81315 * Qty 1 = $456.89 at 100% = $456.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,CIGNA HEALTHCARE,CIGNA MEDICARE,217.68,,,,,,,103.6600,2420.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1009.14,,,,,,,103.6600,2420.0000,percent of total billed charges,"Rev 300 Proc 81315 $2,420.00 in Billed Charges at 41.7% = $1,009.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,CIGNA HEALTHCARE,CIGNA PPO,1009.14,,,,,,,103.6600,2420.0000,percent of total billed charges,"Rev 300 Proc 81315 $2,420.00 in Billed Charges at 41.7% = $1,009.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,217.68,,,,,,,103.6600,2420.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2178.00,,,,,,,103.6600,2420.0000,percent of total billed charges,"90% of $2,420.00 in Billed Charges for Rev 300 Proc 81315 = $2,178.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,HUMANA,HUMANA MEDICARE,207.31,,,,,,,103.6600,2420.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,207.31,,,,,,,103.6600,2420.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,MEDCOST,MEDCOST VHN,1151.68,,,,,,,103.6600,2420.0000,percent of total billed charges,"47.59% of $2,420.00 in Billed Charges for Rev 300 Proc 81315 = $1,151.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,190.88,,,,,,,103.6600,2420.0000,fee schedule,APG 00386 Proc 81315 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 105% = $190.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,217.68,,,,,,,103.6600,2420.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,217.68,,,,,,,103.6600,2420.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,NHC ADVANTAGE,NHC ADVANTAGE,217.68,,,,,,,103.6600,2420.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,187.43,,,,,,,103.6600,2420.0000,fee schedule,APG 00386 Proc 81315 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 103.1% = $187.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,SENTARA HEALTH,SENTARA HEALTH,624.60,,,,,,,103.6600,2420.0000,percent of total billed charges,"25.81% of $2,420.00 in Billed Charges for Rev 300 Proc 81315 = $624.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,SENTARA HEALTH,SENTARA MEDICARE,207.31,,,,,,,103.6600,2420.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2420.00,,,,,,,103.6600,2420.0000,percent of total billed charges,"100% of $2,420.00 in Billed Charges for Rev 300 Proc 81315 = $2,420.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,141.42,,,,,,,103.6600,2420.0000,fee schedule,$282.83 from Fee Schedule TCUHC24 for Rev 300 Proc 81315 * Qty 1 = $282.83 at 50% = $141.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,215.60,,,,,,,103.6600,2420.0000,fee schedule,$207.31 from Fee Schedule UHC_31910 for Rev 300 Proc 81315 * Qty 1 = $207.31 at 104% = $215.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,207.31,,,,,,,103.6600,2420.0000,fee schedule,$207.31 from Fee Schedule UHC_31910 for Rev 300 Proc 81315 * Qty 1 = $207.31 at 100% = $207.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,207.31,,,,,,,103.6600,2420.0000,fee schedule,$207.31 from Fee Schedule UHC_31910 for Rev 300 Proc 81315 * Qty 1 = $207.31 at 100% = $207.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,187.25,,,,,,,103.6600,2420.0000,fee schedule,APG 00386 Proc 81315 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,207.31,,,,,,,103.6600,2420.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,207.31,,,,,,,103.6600,2420.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,WELLCARE,WELLCARE MEDICAID,2420.00,,,,,,,103.6600,2420.0000,percent of total billed charges,"100% of $2,420.00 in Billed Charges for Rev 300 Proc 81315 = $2,420.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANLYS PML/RAR COMMON BREAKPOINTS,81315,CPT,300,RC,30000065,CDM,,,,both,,,2420.0000,363.0000,WELLCARE,WELLCARE MEDICARE,219.75,,,,,,,103.6600,2420.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,AETNA,AETNA,495.75,,,,,,,47.1200,1161.0000,percent of total billed charges,"42.7% of $1,161.00 in Billed Charges for Rev 310 Proc 81319 = $495.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,189.06,,,,,,,47.1200,1161.0000,fee schedule,APG 00386 Proc 81319 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 104% = $189.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,203.50,,,,,,,47.1200,1161.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,AETNA,AETNA HEALTHCARE MEDICARE,203.50,,,,,,,47.1200,1161.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,203.50,,,,,,,47.1200,1161.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,AMBETTER,AMBETTER,443.63,,,,,,,47.1200,1161.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,AMERIGROUP,AMERIGROUP,101.75,,,,,,,47.1200,1161.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,211.64,,,,,,,47.1200,1161.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,BLUE CROSS,ANTHEM EXCHANGE,203.50,,,,,,,47.1200,1161.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,187.25,,,,,,,47.1200,1161.0000,fee schedule,APG 00386 Proc 81319 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,BLUE CROSS,ANTHEM HMO,203.50,,,,,,,47.1200,1161.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,209.61,,,,,,,47.1200,1161.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",203.50,,,,,,,47.1200,1161.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,812.70,,,,,,,47.1200,1161.0000,percent of total billed charges,"Rev 310 Proc 81319 $1,161.00 in Billed Charges at 70% = $812.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,BLUE CROSS,BLUE CROSS E NETWORK,709.31,,,,,,,47.1200,1161.0000,fee schedule,$221.66 from Fee Schedule BCFSB for Rev 310 Proc 81319 * Qty 1 = $221.66 at 320% = $709.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,BLUE CROSS,BLUE CROSS MEDICARE,211.64,,,,,,,47.1200,1161.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,BLUE CROSS,BLUE CROSS P NETWORK,724.83,,,,,,,47.1200,1161.0000,fee schedule,$221.66 from Fee Schedule BCFSB for Rev 310 Proc 81319 * Qty 1 = $221.66 at 327% = $724.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,BLUE CROSS,BLUE CROSS S NETWORK,724.83,,,,,,,47.1200,1161.0000,fee schedule,$221.66 from Fee Schedule BCFSB for Rev 310 Proc 81319 * Qty 1 = $221.66 at 327% = $724.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,BLUE CROSS,TENNCARE BLUE CARE,47.12,,,,,,,47.1200,1161.0000,fee schedule,$40.62 from Fee Schedule TC_24 for Rev 310 Proc 81319 * Qty 1 = $40.62 at 116% = $47.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,BLUE CROSS,TENNCARE BLUE SELECT,47.12,,,,,,,47.1200,1161.0000,fee schedule,$40.62 from Fee Schedule TC_24 for Rev 310 Proc 81319 * Qty 1 = $40.62 at 116% = $47.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,CIGNA HEALTHCARE,CIGNA HMO,484.14,,,,,,,47.1200,1161.0000,percent of total billed charges,"Rev 310 Proc 81319 $1,161.00 in Billed Charges at 41.7% = $484.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,448.23,,,,,,,47.1200,1161.0000,fee schedule,$448.23 from Fee Schedule CGIFP_25LR for Rev 310 Proc 81319 * Qty 1 = $448.23 at 100% = $448.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,213.68,,,,,,,47.1200,1161.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,484.14,,,,,,,47.1200,1161.0000,percent of total billed charges,"Rev 310 Proc 81319 $1,161.00 in Billed Charges at 41.7% = $484.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,CIGNA HEALTHCARE,CIGNA PPO,484.14,,,,,,,47.1200,1161.0000,percent of total billed charges,"Rev 310 Proc 81319 $1,161.00 in Billed Charges at 41.7% = $484.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,213.68,,,,,,,47.1200,1161.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1044.90,,,,,,,47.1200,1161.0000,percent of total billed charges,"90% of $1,161.00 in Billed Charges for Rev 310 Proc 81319 = $1,044.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,HUMANA,HUMANA MEDICARE,203.50,,,,,,,47.1200,1161.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,203.50,,,,,,,47.1200,1161.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,MEDCOST,MEDCOST VHN,552.52,,,,,,,47.1200,1161.0000,percent of total billed charges,"47.59% of $1,161.00 in Billed Charges for Rev 310 Proc 81319 = $552.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,190.88,,,,,,,47.1200,1161.0000,fee schedule,APG 00386 Proc 81319 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 105% = $190.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,213.68,,,,,,,47.1200,1161.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,213.68,,,,,,,47.1200,1161.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,NHC ADVANTAGE,NHC ADVANTAGE,213.68,,,,,,,47.1200,1161.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,187.43,,,,,,,47.1200,1161.0000,fee schedule,APG 00386 Proc 81319 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 103.1% = $187.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,SENTARA HEALTH,SENTARA HEALTH,299.65,,,,,,,47.1200,1161.0000,percent of total billed charges,"25.81% of $1,161.00 in Billed Charges for Rev 310 Proc 81319 = $299.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,SENTARA HEALTH,SENTARA MEDICARE,203.50,,,,,,,47.1200,1161.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1161.00,,,,,,,47.1200,1161.0000,percent of total billed charges,"100% of $1,161.00 in Billed Charges for Rev 310 Proc 81319 = $1,161.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,110.83,,,,,,,47.1200,1161.0000,fee schedule,$221.66 from Fee Schedule TCUHC24 for Rev 310 Proc 81319 * Qty 1 = $221.66 at 50% = $110.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,211.64,,,,,,,47.1200,1161.0000,fee schedule,$203.50 from Fee Schedule UHC_31910 for Rev 310 Proc 81319 * Qty 1 = $203.50 at 104% = $211.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,203.50,,,,,,,47.1200,1161.0000,fee schedule,$203.50 from Fee Schedule UHC_31910 for Rev 310 Proc 81319 * Qty 1 = $203.50 at 100% = $203.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,203.50,,,,,,,47.1200,1161.0000,fee schedule,$203.50 from Fee Schedule UHC_31910 for Rev 310 Proc 81319 * Qty 1 = $203.50 at 100% = $203.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,187.25,,,,,,,47.1200,1161.0000,fee schedule,APG 00386 Proc 81319 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,203.50,,,,,,,47.1200,1161.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,203.50,,,,,,,47.1200,1161.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,WELLCARE,WELLCARE MEDICAID,1161.00,,,,,,,47.1200,1161.0000,percent of total billed charges,"100% of $1,161.00 in Billed Charges for Rev 310 Proc 81319 = $1,161.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS,81319,CPT,310,RC,31000092,CDM,,,,both,,,1161.0000,174.1500,WELLCARE,WELLCARE MEDICARE,215.71,,,,,,,47.1200,1161.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
LASSO ROTATION 90 DEGREE,272,RC,27200002,CDM,,,,,,both,,,2727.5700,409.1400,AETNA,AETNA,1164.67,,,,,,,703.9900,2727.5700,percent of total billed charges,"42.7% of $2,727.57 in Billed Charges for Rev 272 = $1,164.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASSO ROTATION 90 DEGREE,272,RC,27200002,CDM,,,,,,both,,,2727.5700,409.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1909.30,,,,,,,703.9900,2727.5700,percent of total billed charges,"Rev 272 $2,727.57 in Billed Charges at 70% = $1,909.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASSO ROTATION 90 DEGREE,272,RC,27200002,CDM,,,,,,both,,,2727.5700,409.1400,CIGNA HEALTHCARE,CIGNA HMO,1137.40,,,,,,,703.9900,2727.5700,percent of total billed charges,"41.7% of $2,727.57 in Billed Charges for Rev 272 = $1,137.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASSO ROTATION 90 DEGREE,272,RC,27200002,CDM,,,,,,both,,,2727.5700,409.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1265.59,,,,,,,703.9900,2727.5700,percent of total billed charges,"46.4% of $2,727.57 in Billed Charges for Rev 272 = $1,265.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASSO ROTATION 90 DEGREE,272,RC,27200002,CDM,,,,,,both,,,2727.5700,409.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1137.40,,,,,,,703.9900,2727.5700,percent of total billed charges,"41.7% of $2,727.57 in Billed Charges for Rev 272 = $1,137.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASSO ROTATION 90 DEGREE,272,RC,27200002,CDM,,,,,,both,,,2727.5700,409.1400,CIGNA HEALTHCARE,CIGNA PPO,1137.40,,,,,,,703.9900,2727.5700,percent of total billed charges,"41.7% of $2,727.57 in Billed Charges for Rev 272 = $1,137.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASSO ROTATION 90 DEGREE,272,RC,27200002,CDM,,,,,,both,,,2727.5700,409.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2454.81,,,,,,,703.9900,2727.5700,percent of total billed charges,"90% of $2,727.57 in Billed Charges for Rev 272 = $2,454.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASSO ROTATION 90 DEGREE,272,RC,27200002,CDM,,,,,,both,,,2727.5700,409.1400,MEDCOST,MEDCOST VHN,1298.05,,,,,,,703.9900,2727.5700,percent of total billed charges,"47.59% of $2,727.57 in Billed Charges for Rev 272 = $1,298.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASSO ROTATION 90 DEGREE,272,RC,27200002,CDM,,,,,,both,,,2727.5700,409.1400,SENTARA HEALTH,SENTARA HEALTH,703.99,,,,,,,703.9900,2727.5700,percent of total billed charges,"25.81% of $2,727.57 in Billed Charges for Rev 272 = $703.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASSO ROTATION 90 DEGREE,272,RC,27200002,CDM,,,,,,both,,,2727.5700,409.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2727.57,,,,,,,703.9900,2727.5700,percent of total billed charges,"100% of $2,727.57 in Billed Charges for Rev 272 = $2,727.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASSO ROTATION 90 DEGREE,272,RC,27200002,CDM,,,,,,both,,,2727.5700,409.1400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1363.79,,,,,,,703.9900,2727.5700,percent of total billed charges,"Rev 272 $2,727.57 in Billed Charges at 50% = $1,363.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASSO ROTATION 90 DEGREE,272,RC,27200002,CDM,,,,,,both,,,2727.5700,409.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,881.01,,,,,,,703.9900,2727.5700,other,"32.3% of $2,727.57 in Billed Charges for Rev 272 = $881.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LASSO ROTATION 90 DEGREE,272,RC,27200002,CDM,,,,,,both,,,2727.5700,409.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,837.36,,,,,,,703.9900,2727.5700,other,"30.7% of $2,727.57 in Billed Charges for Rev 272 = $837.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LASSO ROTATION 90 DEGREE,272,RC,27200002,CDM,,,,,,both,,,2727.5700,409.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,881.01,,,,,,,703.9900,2727.5700,percent of total billed charges,"32.3% of $2,727.57 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LASSO ROTATION 90 DEGREE,272,RC,27200002,CDM,,,,,,both,,,2727.5700,409.1400,WELLCARE,WELLCARE MEDICAID,2727.57,,,,,,,703.9900,2727.5700,percent of total billed charges,"100% of $2,727.57 in Billed Charges for Rev 272 = $2,727.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LEAD SYSTEM TELEMETRY DL5 GE DIRECT CONNECT,272,RC,27200002,CDM,,,,,,both,,,117.6600,17.6500,AETNA,AETNA,50.24,,,,,,,30.3700,117.6600,percent of total billed charges,42.7% of $117.66 in Billed Charges for Rev 272 = $50.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LEAD SYSTEM TELEMETRY DL5 GE DIRECT CONNECT,272,RC,27200002,CDM,,,,,,both,,,117.6600,17.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,82.36,,,,,,,30.3700,117.6600,percent of total billed charges,Rev 272 $117.66 in Billed Charges at 70% = $82.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LEAD SYSTEM TELEMETRY DL5 GE DIRECT CONNECT,272,RC,27200002,CDM,,,,,,both,,,117.6600,17.6500,CIGNA HEALTHCARE,CIGNA HMO,49.06,,,,,,,30.3700,117.6600,percent of total billed charges,41.7% of $117.66 in Billed Charges for Rev 272 = $49.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LEAD SYSTEM TELEMETRY DL5 GE DIRECT CONNECT,272,RC,27200002,CDM,,,,,,both,,,117.6600,17.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,54.59,,,,,,,30.3700,117.6600,percent of total billed charges,46.4% of $117.66 in Billed Charges for Rev 272 = $54.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LEAD SYSTEM TELEMETRY DL5 GE DIRECT CONNECT,272,RC,27200002,CDM,,,,,,both,,,117.6600,17.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,49.06,,,,,,,30.3700,117.6600,percent of total billed charges,41.7% of $117.66 in Billed Charges for Rev 272 = $49.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LEAD SYSTEM TELEMETRY DL5 GE DIRECT CONNECT,272,RC,27200002,CDM,,,,,,both,,,117.6600,17.6500,CIGNA HEALTHCARE,CIGNA PPO,49.06,,,,,,,30.3700,117.6600,percent of total billed charges,41.7% of $117.66 in Billed Charges for Rev 272 = $49.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LEAD SYSTEM TELEMETRY DL5 GE DIRECT CONNECT,272,RC,27200002,CDM,,,,,,both,,,117.6600,17.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,105.89,,,,,,,30.3700,117.6600,percent of total billed charges,90% of $117.66 in Billed Charges for Rev 272 = $105.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LEAD SYSTEM TELEMETRY DL5 GE DIRECT CONNECT,272,RC,27200002,CDM,,,,,,both,,,117.6600,17.6500,MEDCOST,MEDCOST VHN,55.99,,,,,,,30.3700,117.6600,percent of total billed charges,47.59% of $117.66 in Billed Charges for Rev 272 = $55.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LEAD SYSTEM TELEMETRY DL5 GE DIRECT CONNECT,272,RC,27200002,CDM,,,,,,both,,,117.6600,17.6500,SENTARA HEALTH,SENTARA HEALTH,30.37,,,,,,,30.3700,117.6600,percent of total billed charges,25.81% of $117.66 in Billed Charges for Rev 272 = $30.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LEAD SYSTEM TELEMETRY DL5 GE DIRECT CONNECT,272,RC,27200002,CDM,,,,,,both,,,117.6600,17.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",117.66,,,,,,,30.3700,117.6600,percent of total billed charges,100% of $117.66 in Billed Charges for Rev 272 = $117.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LEAD SYSTEM TELEMETRY DL5 GE DIRECT CONNECT,272,RC,27200002,CDM,,,,,,both,,,117.6600,17.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,58.83,,,,,,,30.3700,117.6600,percent of total billed charges,Rev 272 $117.66 in Billed Charges at 50% = $58.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LEAD SYSTEM TELEMETRY DL5 GE DIRECT CONNECT,272,RC,27200002,CDM,,,,,,both,,,117.6600,17.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,38.00,,,,,,,30.3700,117.6600,other,32.3% of $117.66 in Billed Charges for Rev 272 = $38.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
LEAD SYSTEM TELEMETRY DL5 GE DIRECT CONNECT,272,RC,27200002,CDM,,,,,,both,,,117.6600,17.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,36.12,,,,,,,30.3700,117.6600,other,30.7% of $117.66 in Billed Charges for Rev 272 = $36.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
LEAD SYSTEM TELEMETRY DL5 GE DIRECT CONNECT,272,RC,27200002,CDM,,,,,,both,,,117.6600,17.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,38.00,,,,,,,30.3700,117.6600,percent of total billed charges,32.3% of $117.66 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LEAD SYSTEM TELEMETRY DL5 GE DIRECT CONNECT,272,RC,27200002,CDM,,,,,,both,,,117.6600,17.6500,WELLCARE,WELLCARE MEDICAID,117.66,,,,,,,30.3700,117.6600,percent of total billed charges,100% of $117.66 in Billed Charges for Rev 272 = $117.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
LENS 23.5 DPT.       CZ70BD,276,RC,,,,,,,,both,,,1555.6500,233.3500,AETNA,AETNA,746.71,,,,,,,401.5100,1555.6500,percent of total billed charges,"48% of $1,555.65 in Billed Charges for Rev 276 = $746.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LENS 23.5 DPT.       CZ70BD,276,RC,,,,,,,,both,,,1555.6500,233.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,777.83,,,,,,,401.5100,1555.6500,percent of total billed charges,"50% of $1,555.65 in Billed Charges for Rev 276 = $777.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LENS 23.5 DPT.       CZ70BD,276,RC,,,,,,,,both,,,1555.6500,233.3500,CIGNA HEALTHCARE,CIGNA HMO,648.71,,,,,,,401.5100,1555.6500,percent of total billed charges,"41.7% of $1,555.65 in Billed Charges for Rev 276 = $648.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LENS 23.5 DPT.       CZ70BD,276,RC,,,,,,,,both,,,1555.6500,233.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,622.26,,,,,,,401.5100,1555.6500,percent of total billed charges,"40% of $1,555.65 in Billed Charges for Rev 276 = $622.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LENS 23.5 DPT.       CZ70BD,276,RC,,,,,,,,both,,,1555.6500,233.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,648.71,,,,,,,401.5100,1555.6500,percent of total billed charges,"41.7% of $1,555.65 in Billed Charges for Rev 276 = $648.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LENS 23.5 DPT.       CZ70BD,276,RC,,,,,,,,both,,,1555.6500,233.3500,CIGNA HEALTHCARE,CIGNA PPO,648.71,,,,,,,401.5100,1555.6500,percent of total billed charges,"41.7% of $1,555.65 in Billed Charges for Rev 276 = $648.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LENS 23.5 DPT.       CZ70BD,276,RC,,,,,,,,both,,,1555.6500,233.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1400.09,,,,,,,401.5100,1555.6500,percent of total billed charges,"90% of $1,555.65 in Billed Charges for Rev 276 = $1,400.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LENS 23.5 DPT.       CZ70BD,276,RC,,,,,,,,both,,,1555.6500,233.3500,MEDCOST,MEDCOST VHN,740.33,,,,,,,401.5100,1555.6500,percent of total billed charges,"47.59% of $1,555.65 in Billed Charges for Rev 276 = $740.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LENS 23.5 DPT.       CZ70BD,276,RC,,,,,,,,both,,,1555.6500,233.3500,SENTARA HEALTH,SENTARA HEALTH,401.51,,,,,,,401.5100,1555.6500,percent of total billed charges,"25.81% of $1,555.65 in Billed Charges for Rev 276 = $401.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LENS 23.5 DPT.       CZ70BD,276,RC,,,,,,,,both,,,1555.6500,233.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1555.65,,,,,,,401.5100,1555.6500,percent of total billed charges,"100% of $1,555.65 in Billed Charges for Rev 276 = $1,555.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LENS 23.5 DPT.       CZ70BD,276,RC,,,,,,,,both,,,1555.6500,233.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,777.83,,,,,,,401.5100,1555.6500,percent of total billed charges,"Rev 276 $1,555.65 in Billed Charges at 50% = $777.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LENS 23.5 DPT.       CZ70BD,276,RC,,,,,,,,both,,,1555.6500,233.3500,WELLCARE,WELLCARE MEDICAID,1555.65,,,,,,,401.5100,1555.6500,percent of total billed charges,"100% of $1,555.65 in Billed Charges for Rev 276 = $1,555.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGACLIP W/ MECH STOP 7.5 IN SMALL,272,RC,,,,,,,,both,,,1252.8200,187.9200,AETNA,AETNA,534.95,,,,,,,323.3500,1252.8200,percent of total billed charges,"42.7% of $1,252.82 in Billed Charges for Rev 272 = $534.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGACLIP W/ MECH STOP 7.5 IN SMALL,272,RC,,,,,,,,both,,,1252.8200,187.9200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,876.97,,,,,,,323.3500,1252.8200,percent of total billed charges,"Rev 272 $1,252.82 in Billed Charges at 70% = $876.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGACLIP W/ MECH STOP 7.5 IN SMALL,272,RC,,,,,,,,both,,,1252.8200,187.9200,CIGNA HEALTHCARE,CIGNA HMO,522.43,,,,,,,323.3500,1252.8200,percent of total billed charges,"41.7% of $1,252.82 in Billed Charges for Rev 272 = $522.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGACLIP W/ MECH STOP 7.5 IN SMALL,272,RC,,,,,,,,both,,,1252.8200,187.9200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,581.31,,,,,,,323.3500,1252.8200,percent of total billed charges,"46.4% of $1,252.82 in Billed Charges for Rev 272 = $581.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGACLIP W/ MECH STOP 7.5 IN SMALL,272,RC,,,,,,,,both,,,1252.8200,187.9200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,522.43,,,,,,,323.3500,1252.8200,percent of total billed charges,"41.7% of $1,252.82 in Billed Charges for Rev 272 = $522.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGACLIP W/ MECH STOP 7.5 IN SMALL,272,RC,,,,,,,,both,,,1252.8200,187.9200,CIGNA HEALTHCARE,CIGNA PPO,522.43,,,,,,,323.3500,1252.8200,percent of total billed charges,"41.7% of $1,252.82 in Billed Charges for Rev 272 = $522.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGACLIP W/ MECH STOP 7.5 IN SMALL,272,RC,,,,,,,,both,,,1252.8200,187.9200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1127.54,,,,,,,323.3500,1252.8200,percent of total billed charges,"90% of $1,252.82 in Billed Charges for Rev 272 = $1,127.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGACLIP W/ MECH STOP 7.5 IN SMALL,272,RC,,,,,,,,both,,,1252.8200,187.9200,MEDCOST,MEDCOST VHN,596.22,,,,,,,323.3500,1252.8200,percent of total billed charges,"47.59% of $1,252.82 in Billed Charges for Rev 272 = $596.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGACLIP W/ MECH STOP 7.5 IN SMALL,272,RC,,,,,,,,both,,,1252.8200,187.9200,SENTARA HEALTH,SENTARA HEALTH,323.35,,,,,,,323.3500,1252.8200,percent of total billed charges,"25.81% of $1,252.82 in Billed Charges for Rev 272 = $323.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGACLIP W/ MECH STOP 7.5 IN SMALL,272,RC,,,,,,,,both,,,1252.8200,187.9200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1252.82,,,,,,,323.3500,1252.8200,percent of total billed charges,"100% of $1,252.82 in Billed Charges for Rev 272 = $1,252.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGACLIP W/ MECH STOP 7.5 IN SMALL,272,RC,,,,,,,,both,,,1252.8200,187.9200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,626.41,,,,,,,323.3500,1252.8200,percent of total billed charges,"Rev 272 $1,252.82 in Billed Charges at 50% = $626.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGACLIP W/ MECH STOP 7.5 IN SMALL,272,RC,,,,,,,,both,,,1252.8200,187.9200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,404.66,,,,,,,323.3500,1252.8200,other,"32.3% of $1,252.82 in Billed Charges for Rev 272 = $404.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGACLIP W/ MECH STOP 7.5 IN SMALL,272,RC,,,,,,,,both,,,1252.8200,187.9200,UNITED HEALTHCARE,UHC HERITAGE SELECT,384.62,,,,,,,323.3500,1252.8200,other,"30.7% of $1,252.82 in Billed Charges for Rev 272 = $384.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGACLIP W/ MECH STOP 7.5 IN SMALL,272,RC,,,,,,,,both,,,1252.8200,187.9200,UNITED HEALTHCARE,UNITED HEALTHCARE,404.66,,,,,,,323.3500,1252.8200,percent of total billed charges,"32.3% of $1,252.82 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGACLIP W/ MECH STOP 7.5 IN SMALL,272,RC,,,,,,,,both,,,1252.8200,187.9200,WELLCARE,WELLCARE MEDICAID,1252.82,,,,,,,323.3500,1252.8200,percent of total billed charges,"100% of $1,252.82 in Billed Charges for Rev 272 = $1,252.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ADVANCE,272,RC,27200002,CDM,,,,,,both,,,6081.2400,912.1900,AETNA,AETNA,2596.69,,,,,,,1569.5700,6081.2400,percent of total billed charges,"42.7% of $6,081.24 in Billed Charges for Rev 272 = $2,596.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ADVANCE,272,RC,27200002,CDM,,,,,,both,,,6081.2400,912.1900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4256.87,,,,,,,1569.5700,6081.2400,percent of total billed charges,"Rev 272 $6,081.24 in Billed Charges at 70% = $4,256.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ADVANCE,272,RC,27200002,CDM,,,,,,both,,,6081.2400,912.1900,CIGNA HEALTHCARE,CIGNA HMO,2535.88,,,,,,,1569.5700,6081.2400,percent of total billed charges,"41.7% of $6,081.24 in Billed Charges for Rev 272 = $2,535.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ADVANCE,272,RC,27200002,CDM,,,,,,both,,,6081.2400,912.1900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2821.70,,,,,,,1569.5700,6081.2400,percent of total billed charges,"46.4% of $6,081.24 in Billed Charges for Rev 272 = $2,821.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ADVANCE,272,RC,27200002,CDM,,,,,,both,,,6081.2400,912.1900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2535.88,,,,,,,1569.5700,6081.2400,percent of total billed charges,"41.7% of $6,081.24 in Billed Charges for Rev 272 = $2,535.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ADVANCE,272,RC,27200002,CDM,,,,,,both,,,6081.2400,912.1900,CIGNA HEALTHCARE,CIGNA PPO,2535.88,,,,,,,1569.5700,6081.2400,percent of total billed charges,"41.7% of $6,081.24 in Billed Charges for Rev 272 = $2,535.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ADVANCE,272,RC,27200002,CDM,,,,,,both,,,6081.2400,912.1900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5473.12,,,,,,,1569.5700,6081.2400,percent of total billed charges,"90% of $6,081.24 in Billed Charges for Rev 272 = $5,473.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ADVANCE,272,RC,27200002,CDM,,,,,,both,,,6081.2400,912.1900,MEDCOST,MEDCOST VHN,2894.06,,,,,,,1569.5700,6081.2400,percent of total billed charges,"47.59% of $6,081.24 in Billed Charges for Rev 272 = $2,894.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ADVANCE,272,RC,27200002,CDM,,,,,,both,,,6081.2400,912.1900,SENTARA HEALTH,SENTARA HEALTH,1569.57,,,,,,,1569.5700,6081.2400,percent of total billed charges,"25.81% of $6,081.24 in Billed Charges for Rev 272 = $1,569.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ADVANCE,272,RC,27200002,CDM,,,,,,both,,,6081.2400,912.1900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6081.24,,,,,,,1569.5700,6081.2400,percent of total billed charges,"100% of $6,081.24 in Billed Charges for Rev 272 = $6,081.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ADVANCE,272,RC,27200002,CDM,,,,,,both,,,6081.2400,912.1900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3040.62,,,,,,,1569.5700,6081.2400,percent of total billed charges,"Rev 272 $6,081.24 in Billed Charges at 50% = $3,040.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ADVANCE,272,RC,27200002,CDM,,,,,,both,,,6081.2400,912.1900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1964.24,,,,,,,1569.5700,6081.2400,other,"32.3% of $6,081.24 in Billed Charges for Rev 272 = $1,964.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGASURE ADVANCE,272,RC,27200002,CDM,,,,,,both,,,6081.2400,912.1900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1866.94,,,,,,,1569.5700,6081.2400,other,"30.7% of $6,081.24 in Billed Charges for Rev 272 = $1,866.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGASURE ADVANCE,272,RC,27200002,CDM,,,,,,both,,,6081.2400,912.1900,UNITED HEALTHCARE,UNITED HEALTHCARE,1964.24,,,,,,,1569.5700,6081.2400,percent of total billed charges,"32.3% of $6,081.24 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE ADVANCE,272,RC,27200002,CDM,,,,,,both,,,6081.2400,912.1900,WELLCARE,WELLCARE MEDICAID,6081.24,,,,,,,1569.5700,6081.2400,percent of total billed charges,"100% of $6,081.24 in Billed Charges for Rev 272 = $6,081.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,AETNA,AETNA,1343.77,,,,,,,115.9200,3147.0000,percent of total billed charges,"42.7% of $3,147.00 in Billed Charges for Rev 310 Proc 81321 = $1,343.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,771.31,,,,,,,115.9200,3147.0000,fee schedule,APG 02044 Proc 81321 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 104% = $771.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,600.00,,,,,,,115.9200,3147.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,AETNA,AETNA HEALTHCARE MEDICARE,600.00,,,,,,,115.9200,3147.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,600.00,,,,,,,115.9200,3147.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,AMBETTER,AMBETTER,1308.00,,,,,,,115.9200,3147.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,AMERIGROUP,AMERIGROUP,300.00,,,,,,,115.9200,3147.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,624.00,,,,,,,115.9200,3147.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,BLUE CROSS,ANTHEM EXCHANGE,600.00,,,,,,,115.9200,3147.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,763.90,,,,,,,115.9200,3147.0000,fee schedule,APG 02044 Proc 81321 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 103% = $763.90. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,BLUE CROSS,ANTHEM HMO,600.00,,,,,,,115.9200,3147.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,618.00,,,,,,,115.9200,3147.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",600.00,,,,,,,115.9200,3147.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2202.90,,,,,,,115.9200,3147.0000,percent of total billed charges,"Rev 310 Proc 81321 $3,147.00 in Billed Charges at 70% = $2,202.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,BLUE CROSS,BLUE CROSS E NETWORK,1922.24,,,,,,,115.9200,3147.0000,fee schedule,"$600.70 from Fee Schedule BCFSB for Rev 310 Proc 81321 * Qty 1 = $600.70 at 320% = $1,922.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,BLUE CROSS,BLUE CROSS MEDICARE,624.00,,,,,,,115.9200,3147.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,BLUE CROSS,BLUE CROSS P NETWORK,1964.29,,,,,,,115.9200,3147.0000,fee schedule,"$600.70 from Fee Schedule BCFSB for Rev 310 Proc 81321 * Qty 1 = $600.70 at 327% = $1,964.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,BLUE CROSS,BLUE CROSS S NETWORK,1964.29,,,,,,,115.9200,3147.0000,fee schedule,"$600.70 from Fee Schedule BCFSB for Rev 310 Proc 81321 * Qty 1 = $600.70 at 327% = $1,964.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,BLUE CROSS,TENNCARE BLUE CARE,115.92,,,,,,,115.9200,3147.0000,fee schedule,$99.93 from Fee Schedule TC_24 for Rev 310 Proc 81321 * Qty 1 = $99.93 at 116% = $115.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,BLUE CROSS,TENNCARE BLUE SELECT,115.92,,,,,,,115.9200,3147.0000,fee schedule,$99.93 from Fee Schedule TC_24 for Rev 310 Proc 81321 * Qty 1 = $99.93 at 116% = $115.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,CIGNA HEALTHCARE,CIGNA HMO,1312.30,,,,,,,115.9200,3147.0000,percent of total billed charges,"Rev 310 Proc 81321 $3,147.00 in Billed Charges at 41.7% = $1,312.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1322.30,,,,,,,115.9200,3147.0000,fee schedule,"$1,322.30 from Fee Schedule CGIFP_25LR for Rev 310 Proc 81321 * Qty 1 = $1,322.30 at 100% = $1,322.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,630.00,,,,,,,115.9200,3147.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1312.30,,,,,,,115.9200,3147.0000,percent of total billed charges,"Rev 310 Proc 81321 $3,147.00 in Billed Charges at 41.7% = $1,312.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,CIGNA HEALTHCARE,CIGNA PPO,1312.30,,,,,,,115.9200,3147.0000,percent of total billed charges,"Rev 310 Proc 81321 $3,147.00 in Billed Charges at 41.7% = $1,312.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,630.00,,,,,,,115.9200,3147.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2832.30,,,,,,,115.9200,3147.0000,percent of total billed charges,"90% of $3,147.00 in Billed Charges for Rev 310 Proc 81321 = $2,832.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,HUMANA,HUMANA MEDICARE,600.00,,,,,,,115.9200,3147.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,600.00,,,,,,,115.9200,3147.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,MEDCOST,MEDCOST VHN,1497.66,,,,,,,115.9200,3147.0000,percent of total billed charges,"47.59% of $3,147.00 in Billed Charges for Rev 310 Proc 81321 = $1,497.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,778.73,,,,,,,115.9200,3147.0000,fee schedule,APG 02044 Proc 81321 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 100% = $741.65... $741.65 at 105% = $778.73 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,630.00,,,,,,,115.9200,3147.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,630.00,,,,,,,115.9200,3147.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,NHC ADVANTAGE,NHC ADVANTAGE,630.00,,,,,,,115.9200,3147.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,764.64,,,,,,,115.9200,3147.0000,fee schedule,APG 02044 Proc 81321 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 100% = $741.65... $741.65 at 103.1% = $764.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,SENTARA HEALTH,SENTARA HEALTH,812.24,,,,,,,115.9200,3147.0000,percent of total billed charges,"25.81% of $3,147.00 in Billed Charges for Rev 310 Proc 81321 = $812.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,SENTARA HEALTH,SENTARA MEDICARE,600.00,,,,,,,115.9200,3147.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3147.00,,,,,,,115.9200,3147.0000,percent of total billed charges,"100% of $3,147.00 in Billed Charges for Rev 310 Proc 81321 = $3,147.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,300.35,,,,,,,115.9200,3147.0000,fee schedule,$600.70 from Fee Schedule TCUHC24 for Rev 310 Proc 81321 * Qty 1 = $600.70 at 50% = $300.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,624.00,,,,,,,115.9200,3147.0000,fee schedule,$600.00 from Fee Schedule UHC_31910 for Rev 310 Proc 81321 * Qty 1 = $600.00 at 104% = $624.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,600.00,,,,,,,115.9200,3147.0000,fee schedule,$600.00 from Fee Schedule UHC_31910 for Rev 310 Proc 81321 * Qty 1 = $600.00 at 100% = $600.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,600.00,,,,,,,115.9200,3147.0000,fee schedule,$600.00 from Fee Schedule UHC_31910 for Rev 310 Proc 81321 * Qty 1 = $600.00 at 100% = $600.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,763.90,,,,,,,115.9200,3147.0000,fee schedule,APG 02044 Proc 81321 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 103% = $763.90. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,600.00,,,,,,,115.9200,3147.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,600.00,,,,,,,115.9200,3147.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,WELLCARE,WELLCARE MEDICAID,3147.00,,,,,,,115.9200,3147.0000,percent of total billed charges,"100% of $3,147.00 in Billed Charges for Rev 310 Proc 81321 = $3,147.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS,81321,CPT,310,RC,31000093,CDM,,,,both,,,3147.0000,472.0500,WELLCARE,WELLCARE MEDICARE,636.00,,,,,,,115.9200,3147.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,AETNA,AETNA,275.42,,,,,,,115.9200,1406.1000,percent of total billed charges,42.7% of $645.00 in Billed Charges for Rev 310 Proc 81324 = $275.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,771.31,,,,,,,115.9200,1406.1000,fee schedule,APG 02044 Proc 81324 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 104% = $771.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,645.00,,,,,,,115.9200,1406.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,AETNA,AETNA HEALTHCARE MEDICARE,645.00,,,,,,,115.9200,1406.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,645.00,,,,,,,115.9200,1406.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,AMBETTER,AMBETTER,1406.10,,,,,,,115.9200,1406.1000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,AMERIGROUP,AMERIGROUP,322.50,,,,,,,115.9200,1406.1000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,645.00,,,,,,,115.9200,1406.1000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,ANTHEM EXCHANGE,645.00,,,,,,,115.9200,1406.1000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,645.00,,,,,,,115.9200,1406.1000,fee schedule,"APG 02044 Proc 81324 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 103% = $763.90 (Service Line reduced to $645.00, claim capped at $645.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,ANTHEM HMO,645.00,,,,,,,115.9200,1406.1000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,645.00,,,,,,,115.9200,1406.1000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",645.00,,,,,,,115.9200,1406.1000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,451.50,,,,,,,115.9200,1406.1000,percent of total billed charges,Rev 310 Proc 81324 $645.00 in Billed Charges at 70% = $451.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,BLUE CROSS E NETWORK,393.60,,,,,,,115.9200,1406.1000,fee schedule,$123.00 from Fee Schedule BCFSB for Rev 310 Proc 81324 * Qty 1 = $123.00 at 320% = $393.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,BLUE CROSS MEDICARE,670.80,,,,,,,115.9200,1406.1000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,BLUE CROSS P NETWORK,402.21,,,,,,,115.9200,1406.1000,fee schedule,$123.00 from Fee Schedule BCFSB for Rev 310 Proc 81324 * Qty 1 = $123.00 at 327% = $402.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,BLUE CROSS S NETWORK,402.21,,,,,,,115.9200,1406.1000,fee schedule,$123.00 from Fee Schedule BCFSB for Rev 310 Proc 81324 * Qty 1 = $123.00 at 327% = $402.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,TENNCARE BLUE CARE,115.92,,,,,,,115.9200,1406.1000,fee schedule,$99.93 from Fee Schedule TC_24 for Rev 310 Proc 81324 * Qty 1 = $99.93 at 116% = $115.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,TENNCARE BLUE SELECT,115.92,,,,,,,115.9200,1406.1000,fee schedule,$99.93 from Fee Schedule TC_24 for Rev 310 Proc 81324 * Qty 1 = $99.93 at 116% = $115.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,CIGNA HEALTHCARE,CIGNA HMO,268.97,,,,,,,115.9200,1406.1000,percent of total billed charges,Rev 310 Proc 81324 $645.00 in Billed Charges at 41.7% = $268.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,645.00,,,,,,,115.9200,1406.1000,fee schedule,"$1,671.64 from Fee Schedule CGIFP_25LR for Rev 310 Proc 81324 * Qty 1 = $1,671.64 at 100% = $1,671.64 (Limited to $645.00 in Billed Charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,645.00,,,,,,,115.9200,1406.1000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,268.97,,,,,,,115.9200,1406.1000,percent of total billed charges,Rev 310 Proc 81324 $645.00 in Billed Charges at 41.7% = $268.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,CIGNA HEALTHCARE,CIGNA PPO,268.97,,,,,,,115.9200,1406.1000,percent of total billed charges,Rev 310 Proc 81324 $645.00 in Billed Charges at 41.7% = $268.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,645.00,,,,,,,115.9200,1406.1000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,580.50,,,,,,,115.9200,1406.1000,percent of total billed charges,90% of $645.00 in Billed Charges for Rev 310 Proc 81324 = $580.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,HUMANA,HUMANA MEDICARE,645.00,,,,,,,115.9200,1406.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,645.00,,,,,,,115.9200,1406.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,MEDCOST,MEDCOST VHN,306.96,,,,,,,115.9200,1406.1000,percent of total billed charges,47.59% of $645.00 in Billed Charges for Rev 310 Proc 81324 = $306.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,778.73,,,,,,,115.9200,1406.1000,fee schedule,APG 02044 Proc 81324 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 100% = $741.65... $741.65 at 105% = $778.73 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,645.00,,,,,,,115.9200,1406.1000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,645.00,,,,,,,115.9200,1406.1000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,NHC ADVANTAGE,NHC ADVANTAGE,645.00,,,,,,,115.9200,1406.1000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,764.64,,,,,,,115.9200,1406.1000,fee schedule,APG 02044 Proc 81324 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 100% = $741.65... $741.65 at 103.1% = $764.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,SENTARA HEALTH,SENTARA HEALTH,166.47,,,,,,,115.9200,1406.1000,percent of total billed charges,25.81% of $645.00 in Billed Charges for Rev 310 Proc 81324 = $166.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,SENTARA HEALTH,SENTARA MEDICARE,645.00,,,,,,,115.9200,1406.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",645.00,,,,,,,115.9200,1406.1000,percent of total billed charges,100% of $645.00 in Billed Charges for Rev 310 Proc 81324 = $645.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,379.18,,,,,,,115.9200,1406.1000,fee schedule,$758.36 from Fee Schedule TCUHC24 for Rev 310 Proc 81324 * Qty 1 = $758.36 at 50% = $379.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,645.00,,,,,,,115.9200,1406.1000,fee schedule,"$758.36 from Fee Schedule UHC_31910 for Rev 310 Proc 81324 * Qty 1 = $758.36 at 104% = $788.69 (Service Line reduced to $645.00, claim capped at $645.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,645.00,,,,,,,115.9200,1406.1000,fee schedule,"$758.36 from Fee Schedule UHC_31910 for Rev 310 Proc 81324 * Qty 1 = $758.36 at 100% = $758.36 (Service Line reduced to $645.00, claim capped at $645.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,645.00,,,,,,,115.9200,1406.1000,fee schedule,"$758.36 from Fee Schedule UHC_31910 for Rev 310 Proc 81324 * Qty 1 = $758.36 at 100% = $758.36 (Service Line reduced to $645.00, claim capped at $645.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,763.90,,,,,,,115.9200,1406.1000,fee schedule,APG 02044 Proc 81324 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 103% = $763.90. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,645.00,,,,,,,115.9200,1406.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,645.00,,,,,,,115.9200,1406.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,WELLCARE,WELLCARE MEDICAID,645.00,,,,,,,115.9200,1406.1000,percent of total billed charges,100% of $645.00 in Billed Charges for Rev 310 Proc 81324 = $645.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS,81324,CPT,310,RC,31000095,CDM,,,,both,,,645.0000,96.7500,WELLCARE,WELLCARE MEDICARE,683.70,,,,,,,115.9200,1406.1000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,AETNA,AETNA,275.42,,,,,,,115.9200,1406.1000,percent of total billed charges,42.7% of $645.00 in Billed Charges for Rev 310 Proc 81325 = $275.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,771.31,,,,,,,115.9200,1406.1000,fee schedule,APG 02044 Proc 81325 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 104% = $771.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,645.00,,,,,,,115.9200,1406.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,AETNA,AETNA HEALTHCARE MEDICARE,645.00,,,,,,,115.9200,1406.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,645.00,,,,,,,115.9200,1406.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,AMBETTER,AMBETTER,1406.10,,,,,,,115.9200,1406.1000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,AMERIGROUP,AMERIGROUP,322.50,,,,,,,115.9200,1406.1000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,645.00,,,,,,,115.9200,1406.1000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,ANTHEM EXCHANGE,645.00,,,,,,,115.9200,1406.1000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,645.00,,,,,,,115.9200,1406.1000,fee schedule,"APG 02044 Proc 81325 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 103% = $763.90 (Service Line reduced to $645.00, claim capped at $645.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,ANTHEM HMO,645.00,,,,,,,115.9200,1406.1000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,645.00,,,,,,,115.9200,1406.1000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",645.00,,,,,,,115.9200,1406.1000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,451.50,,,,,,,115.9200,1406.1000,percent of total billed charges,Rev 310 Proc 81325 $645.00 in Billed Charges at 70% = $451.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,BLUE CROSS E NETWORK,393.60,,,,,,,115.9200,1406.1000,fee schedule,$123.00 from Fee Schedule BCFSB for Rev 310 Proc 81325 * Qty 1 = $123.00 at 320% = $393.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,BLUE CROSS MEDICARE,670.80,,,,,,,115.9200,1406.1000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,BLUE CROSS P NETWORK,402.21,,,,,,,115.9200,1406.1000,fee schedule,$123.00 from Fee Schedule BCFSB for Rev 310 Proc 81325 * Qty 1 = $123.00 at 327% = $402.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,BLUE CROSS S NETWORK,402.21,,,,,,,115.9200,1406.1000,fee schedule,$123.00 from Fee Schedule BCFSB for Rev 310 Proc 81325 * Qty 1 = $123.00 at 327% = $402.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,TENNCARE BLUE CARE,115.92,,,,,,,115.9200,1406.1000,fee schedule,$99.93 from Fee Schedule TC_24 for Rev 310 Proc 81325 * Qty 1 = $99.93 at 116% = $115.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,TENNCARE BLUE SELECT,115.92,,,,,,,115.9200,1406.1000,fee schedule,$99.93 from Fee Schedule TC_24 for Rev 310 Proc 81325 * Qty 1 = $99.93 at 116% = $115.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,CIGNA HEALTHCARE,CIGNA HMO,268.97,,,,,,,115.9200,1406.1000,percent of total billed charges,Rev 310 Proc 81325 $645.00 in Billed Charges at 41.7% = $268.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,645.00,,,,,,,115.9200,1406.1000,fee schedule,"$1,696.18 from Fee Schedule CGIFP_25LR for Rev 310 Proc 81325 * Qty 1 = $1,696.18 at 100% = $1,696.18 (Limited to $645.00 in Billed Charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,645.00,,,,,,,115.9200,1406.1000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,268.97,,,,,,,115.9200,1406.1000,percent of total billed charges,Rev 310 Proc 81325 $645.00 in Billed Charges at 41.7% = $268.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,CIGNA HEALTHCARE,CIGNA PPO,268.97,,,,,,,115.9200,1406.1000,percent of total billed charges,Rev 310 Proc 81325 $645.00 in Billed Charges at 41.7% = $268.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,645.00,,,,,,,115.9200,1406.1000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,580.50,,,,,,,115.9200,1406.1000,percent of total billed charges,90% of $645.00 in Billed Charges for Rev 310 Proc 81325 = $580.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,HUMANA,HUMANA MEDICARE,645.00,,,,,,,115.9200,1406.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,645.00,,,,,,,115.9200,1406.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,MEDCOST,MEDCOST VHN,306.96,,,,,,,115.9200,1406.1000,percent of total billed charges,47.59% of $645.00 in Billed Charges for Rev 310 Proc 81325 = $306.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,778.73,,,,,,,115.9200,1406.1000,fee schedule,APG 02044 Proc 81325 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 100% = $741.65... $741.65 at 105% = $778.73 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,645.00,,,,,,,115.9200,1406.1000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,645.00,,,,,,,115.9200,1406.1000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,NHC ADVANTAGE,NHC ADVANTAGE,645.00,,,,,,,115.9200,1406.1000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,764.64,,,,,,,115.9200,1406.1000,fee schedule,APG 02044 Proc 81325 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 100% = $741.65... $741.65 at 103.1% = $764.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,SENTARA HEALTH,SENTARA HEALTH,166.47,,,,,,,115.9200,1406.1000,percent of total billed charges,25.81% of $645.00 in Billed Charges for Rev 310 Proc 81325 = $166.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,SENTARA HEALTH,SENTARA MEDICARE,645.00,,,,,,,115.9200,1406.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",645.00,,,,,,,115.9200,1406.1000,percent of total billed charges,100% of $645.00 in Billed Charges for Rev 310 Proc 81325 = $645.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,384.79,,,,,,,115.9200,1406.1000,fee schedule,$769.58 from Fee Schedule TCUHC24 for Rev 310 Proc 81325 * Qty 1 = $769.58 at 50% = $384.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,645.00,,,,,,,115.9200,1406.1000,fee schedule,"$769.58 from Fee Schedule UHC_31910 for Rev 310 Proc 81325 * Qty 1 = $769.58 at 104% = $800.36 (Service Line reduced to $645.00, claim capped at $645.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,645.00,,,,,,,115.9200,1406.1000,fee schedule,"$769.58 from Fee Schedule UHC_31910 for Rev 310 Proc 81325 * Qty 1 = $769.58 at 100% = $769.58 (Service Line reduced to $645.00, claim capped at $645.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,645.00,,,,,,,115.9200,1406.1000,fee schedule,"$769.58 from Fee Schedule UHC_31910 for Rev 310 Proc 81325 * Qty 1 = $769.58 at 100% = $769.58 (Service Line reduced to $645.00, claim capped at $645.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,763.90,,,,,,,115.9200,1406.1000,fee schedule,APG 02044 Proc 81325 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 103% = $763.90. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,645.00,,,,,,,115.9200,1406.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,645.00,,,,,,,115.9200,1406.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,WELLCARE,WELLCARE MEDICAID,645.00,,,,,,,115.9200,1406.1000,percent of total billed charges,100% of $645.00 in Billed Charges for Rev 310 Proc 81325 = $645.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS,81325,CPT,310,RC,31000096,CDM,,,,both,,,645.0000,96.7500,WELLCARE,WELLCARE MEDICARE,683.70,,,,,,,115.9200,1406.1000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,AETNA,AETNA,151.59,,,,,,,41.8400,418.5600,percent of total billed charges,42.7% of $355.00 in Billed Charges for Rev 310 Proc 81327 = $151.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,189.06,,,,,,,41.8400,418.5600,fee schedule,APG 00386 Proc 81327 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 104% = $189.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,192.00,,,,,,,41.8400,418.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,AETNA,AETNA HEALTHCARE MEDICARE,192.00,,,,,,,41.8400,418.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,192.00,,,,,,,41.8400,418.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,AMBETTER,AMBETTER,418.56,,,,,,,41.8400,418.5600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,AMERIGROUP,AMERIGROUP,96.00,,,,,,,41.8400,418.5600,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,199.68,,,,,,,41.8400,418.5600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,BLUE CROSS,ANTHEM EXCHANGE,192.00,,,,,,,41.8400,418.5600,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,187.25,,,,,,,41.8400,418.5600,fee schedule,APG 00386 Proc 81327 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,BLUE CROSS,ANTHEM HMO,192.00,,,,,,,41.8400,418.5600,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,197.76,,,,,,,41.8400,418.5600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",192.00,,,,,,,41.8400,418.5600,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,248.50,,,,,,,41.8400,418.5600,percent of total billed charges,Rev 310 Proc 81327 $355.00 in Billed Charges at 70% = $248.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,BLUE CROSS,BLUE CROSS E NETWORK,267.74,,,,,,,41.8400,418.5600,fee schedule,$83.67 from Fee Schedule BCFSB for Rev 310 Proc 81327 * Qty 1 = $83.67 at 320% = $267.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,BLUE CROSS,BLUE CROSS MEDICARE,199.68,,,,,,,41.8400,418.5600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,BLUE CROSS,BLUE CROSS P NETWORK,273.60,,,,,,,41.8400,418.5600,fee schedule,$83.67 from Fee Schedule BCFSB for Rev 310 Proc 81327 * Qty 1 = $83.67 at 327% = $273.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,BLUE CROSS,BLUE CROSS S NETWORK,273.60,,,,,,,41.8400,418.5600,fee schedule,$83.67 from Fee Schedule BCFSB for Rev 310 Proc 81327 * Qty 1 = $83.67 at 327% = $273.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,BLUE CROSS,TENNCARE BLUE CARE,78.86,,,,,,,41.8400,418.5600,fee schedule,$67.98 from Fee Schedule TC_24 for Rev 310 Proc 81327 * Qty 1 = $67.98 at 116% = $78.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,BLUE CROSS,TENNCARE BLUE SELECT,78.86,,,,,,,41.8400,418.5600,fee schedule,$67.98 from Fee Schedule TC_24 for Rev 310 Proc 81327 * Qty 1 = $67.98 at 116% = $78.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,CIGNA HEALTHCARE,CIGNA HMO,148.04,,,,,,,41.8400,418.5600,percent of total billed charges,Rev 310 Proc 81327 $355.00 in Billed Charges at 41.7% = $148.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,355.00,,,,,,,41.8400,418.5600,fee schedule,$422.96 from Fee Schedule CGIFP_25LR for Rev 310 Proc 81327 * Qty 1 = $422.96 at 100% = $422.96 (Limited to $355.00 in Billed Charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,201.60,,,,,,,41.8400,418.5600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,148.04,,,,,,,41.8400,418.5600,percent of total billed charges,Rev 310 Proc 81327 $355.00 in Billed Charges at 41.7% = $148.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,CIGNA HEALTHCARE,CIGNA PPO,148.04,,,,,,,41.8400,418.5600,percent of total billed charges,Rev 310 Proc 81327 $355.00 in Billed Charges at 41.7% = $148.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,201.60,,,,,,,41.8400,418.5600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,319.50,,,,,,,41.8400,418.5600,percent of total billed charges,90% of $355.00 in Billed Charges for Rev 310 Proc 81327 = $319.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,HUMANA,HUMANA MEDICARE,192.00,,,,,,,41.8400,418.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,192.00,,,,,,,41.8400,418.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,MEDCOST,MEDCOST VHN,168.94,,,,,,,41.8400,418.5600,percent of total billed charges,47.59% of $355.00 in Billed Charges for Rev 310 Proc 81327 = $168.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,190.88,,,,,,,41.8400,418.5600,fee schedule,APG 00386 Proc 81327 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 105% = $190.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,201.60,,,,,,,41.8400,418.5600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,201.60,,,,,,,41.8400,418.5600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,NHC ADVANTAGE,NHC ADVANTAGE,201.60,,,,,,,41.8400,418.5600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,187.43,,,,,,,41.8400,418.5600,fee schedule,APG 00386 Proc 81327 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 103.1% = $187.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,SENTARA HEALTH,SENTARA HEALTH,91.63,,,,,,,41.8400,418.5600,percent of total billed charges,25.81% of $355.00 in Billed Charges for Rev 310 Proc 81327 = $91.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,SENTARA HEALTH,SENTARA MEDICARE,192.00,,,,,,,41.8400,418.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",355.00,,,,,,,41.8400,418.5600,percent of total billed charges,100% of $355.00 in Billed Charges for Rev 310 Proc 81327 = $355.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,41.84,,,,,,,41.8400,418.5600,fee schedule,$83.67 from Fee Schedule TCUHC24 for Rev 310 Proc 81327 * Qty 1 = $83.67 at 50% = $41.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,199.68,,,,,,,41.8400,418.5600,fee schedule,$192.00 from Fee Schedule UHC_31910 for Rev 310 Proc 81327 * Qty 1 = $192.00 at 104% = $199.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,192.00,,,,,,,41.8400,418.5600,fee schedule,$192.00 from Fee Schedule UHC_31910 for Rev 310 Proc 81327 * Qty 1 = $192.00 at 100% = $192.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,192.00,,,,,,,41.8400,418.5600,fee schedule,$192.00 from Fee Schedule UHC_31910 for Rev 310 Proc 81327 * Qty 1 = $192.00 at 100% = $192.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,187.25,,,,,,,41.8400,418.5600,fee schedule,APG 00386 Proc 81327 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,192.00,,,,,,,41.8400,418.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,192.00,,,,,,,41.8400,418.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,WELLCARE,WELLCARE MEDICAID,355.00,,,,,,,41.8400,418.5600,percent of total billed charges,100% of $355.00 in Billed Charges for Rev 310 Proc 81327 = $355.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEPT9 PROMOTER METHYLATION ANALYSIS,81327,CPT,310,RC,31000021,CDM,,,,both,,,355.0000,53.2500,WELLCARE,WELLCARE MEDICARE,203.52,,,,,,,41.8400,418.5600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,AETNA,AETNA,211.37,,,,,,,25.5400,495.0000,percent of total billed charges,42.7% of $495.00 in Billed Charges for Rev 300 Proc 81331 = $211.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,51.42,,,,,,,25.5400,495.0000,fee schedule,APG 00385 Proc 81331 at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 104% = $51.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,51.07,,,,,,,25.5400,495.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,AETNA,AETNA HEALTHCARE MEDICARE,51.07,,,,,,,25.5400,495.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,51.07,,,,,,,25.5400,495.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,AMBETTER,AMBETTER,111.33,,,,,,,25.5400,495.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,AMERIGROUP,AMERIGROUP,25.54,,,,,,,25.5400,495.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,53.11,,,,,,,25.5400,495.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,BLUE CROSS,ANTHEM EXCHANGE,51.07,,,,,,,25.5400,495.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,50.93,,,,,,,25.5400,495.0000,fee schedule,APG 00385 Proc 81331 at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 103% = $50.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,BLUE CROSS,ANTHEM HMO,51.07,,,,,,,25.5400,495.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,52.60,,,,,,,25.5400,495.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",51.07,,,,,,,25.5400,495.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,346.50,,,,,,,25.5400,495.0000,percent of total billed charges,Rev 300 Proc 81331 $495.00 in Billed Charges at 70% = $346.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,BLUE CROSS,BLUE CROSS E NETWORK,160.00,,,,,,,25.5400,495.0000,fee schedule,$50.00 from Fee Schedule BCFSB for Rev 300 Proc 81331 * Qty 1 = $50.00 at 320% = $160.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,BLUE CROSS,BLUE CROSS MEDICARE,53.11,,,,,,,25.5400,495.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,BLUE CROSS,BLUE CROSS P NETWORK,163.50,,,,,,,25.5400,495.0000,fee schedule,$50.00 from Fee Schedule BCFSB for Rev 300 Proc 81331 * Qty 1 = $50.00 at 327% = $163.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,BLUE CROSS,BLUE CROSS S NETWORK,163.50,,,,,,,25.5400,495.0000,fee schedule,$50.00 from Fee Schedule BCFSB for Rev 300 Proc 81331 * Qty 1 = $50.00 at 327% = $163.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,BLUE CROSS,TENNCARE BLUE CARE,47.12,,,,,,,25.5400,495.0000,fee schedule,$40.62 from Fee Schedule TC_24 for Rev 300 Proc 81331 * Qty 1 = $40.62 at 116% = $47.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,BLUE CROSS,TENNCARE BLUE SELECT,47.12,,,,,,,25.5400,495.0000,fee schedule,$40.62 from Fee Schedule TC_24 for Rev 300 Proc 81331 * Qty 1 = $40.62 at 116% = $47.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,CIGNA HEALTHCARE,CIGNA HMO,206.42,,,,,,,25.5400,495.0000,percent of total billed charges,Rev 300 Proc 81331 $495.00 in Billed Charges at 41.7% = $206.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,112.60,,,,,,,25.5400,495.0000,fee schedule,$112.60 from Fee Schedule CGIFP_25LR for Rev 300 Proc 81331 * Qty 1 = $112.60 at 100% = $112.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,53.62,,,,,,,25.5400,495.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,206.42,,,,,,,25.5400,495.0000,percent of total billed charges,Rev 300 Proc 81331 $495.00 in Billed Charges at 41.7% = $206.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,CIGNA HEALTHCARE,CIGNA PPO,206.42,,,,,,,25.5400,495.0000,percent of total billed charges,Rev 300 Proc 81331 $495.00 in Billed Charges at 41.7% = $206.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,53.62,,,,,,,25.5400,495.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,445.50,,,,,,,25.5400,495.0000,percent of total billed charges,90% of $495.00 in Billed Charges for Rev 300 Proc 81331 = $445.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,HUMANA,HUMANA MEDICARE,51.07,,,,,,,25.5400,495.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,51.07,,,,,,,25.5400,495.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,MEDCOST,MEDCOST VHN,235.57,,,,,,,25.5400,495.0000,percent of total billed charges,47.59% of $495.00 in Billed Charges for Rev 300 Proc 81331 = $235.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,51.91,,,,,,,25.5400,495.0000,fee schedule,APG 00385 Proc 81331 at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 100% = $49.44... $49.44 at 105% = $51.91 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,53.62,,,,,,,25.5400,495.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,53.62,,,,,,,25.5400,495.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,NHC ADVANTAGE,NHC ADVANTAGE,53.62,,,,,,,25.5400,495.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,50.97,,,,,,,25.5400,495.0000,fee schedule,APG 00385 Proc 81331 at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 100% = $49.44... $49.44 at 103.1% = $50.97 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,SENTARA HEALTH,SENTARA HEALTH,127.76,,,,,,,25.5400,495.0000,percent of total billed charges,25.81% of $495.00 in Billed Charges for Rev 300 Proc 81331 = $127.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,SENTARA HEALTH,SENTARA MEDICARE,51.07,,,,,,,25.5400,495.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",495.00,,,,,,,25.5400,495.0000,percent of total billed charges,100% of $495.00 in Billed Charges for Rev 300 Proc 81331 = $495.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,25.54,,,,,,,25.5400,495.0000,fee schedule,$51.07 from Fee Schedule TCUHC24 for Rev 300 Proc 81331 * Qty 1 = $51.07 at 50% = $25.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,53.11,,,,,,,25.5400,495.0000,fee schedule,$51.07 from Fee Schedule UHC_31910 for Rev 300 Proc 81331 * Qty 1 = $51.07 at 104% = $53.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,51.07,,,,,,,25.5400,495.0000,fee schedule,$51.07 from Fee Schedule UHC_31910 for Rev 300 Proc 81331 * Qty 1 = $51.07 at 100% = $51.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,51.07,,,,,,,25.5400,495.0000,fee schedule,$51.07 from Fee Schedule UHC_31910 for Rev 300 Proc 81331 * Qty 1 = $51.07 at 100% = $51.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,50.93,,,,,,,25.5400,495.0000,fee schedule,APG 00385 Proc 81331 at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 103% = $50.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,51.07,,,,,,,25.5400,495.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,51.07,,,,,,,25.5400,495.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,WELLCARE,WELLCARE MEDICAID,495.00,,,,,,,25.5400,495.0000,percent of total billed charges,100% of $495.00 in Billed Charges for Rev 300 Proc 81331 = $495.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANLYS GENE SNRPN/UBE3A METHYLAT,81331,CPT,300,RC,30000066,CDM,,,,both,,,495.0000,74.2500,WELLCARE,WELLCARE MEDICARE,54.13,,,,,,,25.5400,495.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,AETNA,AETNA,381.74,,,,,,,21.8300,894.0000,percent of total billed charges,42.7% of $894.00 in Billed Charges for Rev 300 Proc 81332 = $381.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,51.42,,,,,,,21.8300,894.0000,fee schedule,APG 00385 Proc 81332 at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 104% = $51.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,43.65,,,,,,,21.8300,894.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,AETNA,AETNA HEALTHCARE MEDICARE,43.65,,,,,,,21.8300,894.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,43.65,,,,,,,21.8300,894.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,AMBETTER,AMBETTER,95.16,,,,,,,21.8300,894.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,AMERIGROUP,AMERIGROUP,21.83,,,,,,,21.8300,894.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,45.40,,,,,,,21.8300,894.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,BLUE CROSS,ANTHEM EXCHANGE,43.65,,,,,,,21.8300,894.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,50.93,,,,,,,21.8300,894.0000,fee schedule,APG 00385 Proc 81332 at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 103% = $50.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,BLUE CROSS,ANTHEM HMO,43.65,,,,,,,21.8300,894.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,44.96,,,,,,,21.8300,894.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",43.65,,,,,,,21.8300,894.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,625.80,,,,,,,21.8300,894.0000,percent of total billed charges,Rev 300 Proc 81332 $894.00 in Billed Charges at 70% = $625.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,BLUE CROSS,BLUE CROSS E NETWORK,190.56,,,,,,,21.8300,894.0000,fee schedule,$59.55 from Fee Schedule BCFSB for Rev 300 Proc 81332 * Qty 1 = $59.55 at 320% = $190.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,BLUE CROSS,BLUE CROSS MEDICARE,45.40,,,,,,,21.8300,894.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,BLUE CROSS,BLUE CROSS P NETWORK,194.73,,,,,,,21.8300,894.0000,fee schedule,$59.55 from Fee Schedule BCFSB for Rev 300 Proc 81332 * Qty 1 = $59.55 at 327% = $194.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,BLUE CROSS,BLUE CROSS S NETWORK,194.73,,,,,,,21.8300,894.0000,fee schedule,$59.55 from Fee Schedule BCFSB for Rev 300 Proc 81332 * Qty 1 = $59.55 at 327% = $194.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,BLUE CROSS,TENNCARE BLUE CARE,47.12,,,,,,,21.8300,894.0000,fee schedule,$40.62 from Fee Schedule TC_24 for Rev 300 Proc 81332 * Qty 1 = $40.62 at 116% = $47.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,BLUE CROSS,TENNCARE BLUE SELECT,47.12,,,,,,,21.8300,894.0000,fee schedule,$40.62 from Fee Schedule TC_24 for Rev 300 Proc 81332 * Qty 1 = $40.62 at 116% = $47.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,CIGNA HEALTHCARE,CIGNA HMO,372.80,,,,,,,21.8300,894.0000,percent of total billed charges,Rev 300 Proc 81332 $894.00 in Billed Charges at 41.7% = $372.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,96.00,,,,,,,21.8300,894.0000,fee schedule,$96.00 from Fee Schedule CGIFP_25LR for Rev 300 Proc 81332 * Qty 1 = $96.00 at 100% = $96.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,45.83,,,,,,,21.8300,894.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,372.80,,,,,,,21.8300,894.0000,percent of total billed charges,Rev 300 Proc 81332 $894.00 in Billed Charges at 41.7% = $372.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,CIGNA HEALTHCARE,CIGNA PPO,372.80,,,,,,,21.8300,894.0000,percent of total billed charges,Rev 300 Proc 81332 $894.00 in Billed Charges at 41.7% = $372.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,45.83,,,,,,,21.8300,894.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,804.60,,,,,,,21.8300,894.0000,percent of total billed charges,90% of $894.00 in Billed Charges for Rev 300 Proc 81332 = $804.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,HUMANA,HUMANA MEDICARE,43.65,,,,,,,21.8300,894.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,43.65,,,,,,,21.8300,894.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,MEDCOST,MEDCOST VHN,425.45,,,,,,,21.8300,894.0000,percent of total billed charges,47.59% of $894.00 in Billed Charges for Rev 300 Proc 81332 = $425.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,51.91,,,,,,,21.8300,894.0000,fee schedule,APG 00385 Proc 81332 at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 100% = $49.44... $49.44 at 105% = $51.91 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,45.83,,,,,,,21.8300,894.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,45.83,,,,,,,21.8300,894.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,NHC ADVANTAGE,NHC ADVANTAGE,45.83,,,,,,,21.8300,894.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,50.97,,,,,,,21.8300,894.0000,fee schedule,APG 00385 Proc 81332 at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 100% = $49.44... $49.44 at 103.1% = $50.97 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,SENTARA HEALTH,SENTARA HEALTH,230.74,,,,,,,21.8300,894.0000,percent of total billed charges,25.81% of $894.00 in Billed Charges for Rev 300 Proc 81332 = $230.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,SENTARA HEALTH,SENTARA MEDICARE,43.65,,,,,,,21.8300,894.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",894.00,,,,,,,21.8300,894.0000,percent of total billed charges,100% of $894.00 in Billed Charges for Rev 300 Proc 81332 = $894.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,29.78,,,,,,,21.8300,894.0000,fee schedule,$59.55 from Fee Schedule TCUHC24 for Rev 300 Proc 81332 * Qty 1 = $59.55 at 50% = $29.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,45.40,,,,,,,21.8300,894.0000,fee schedule,$43.65 from Fee Schedule UHC_31910 for Rev 300 Proc 81332 * Qty 1 = $43.65 at 104% = $45.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,43.65,,,,,,,21.8300,894.0000,fee schedule,$43.65 from Fee Schedule UHC_31910 for Rev 300 Proc 81332 * Qty 1 = $43.65 at 100% = $43.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,43.65,,,,,,,21.8300,894.0000,fee schedule,$43.65 from Fee Schedule UHC_31910 for Rev 300 Proc 81332 * Qty 1 = $43.65 at 100% = $43.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,50.93,,,,,,,21.8300,894.0000,fee schedule,APG 00385 Proc 81332 at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 103% = $50.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,43.65,,,,,,,21.8300,894.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,43.65,,,,,,,21.8300,894.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,WELLCARE,WELLCARE MEDICAID,894.00,,,,,,,21.8300,894.0000,percent of total billed charges,100% of $894.00 in Billed Charges for Rev 300 Proc 81332 = $894.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANLYS GENE SERPINA1 COMMON VARIAN,81332,CPT,300,RC,30000067,CDM,,,,both,,,894.0000,134.1000,WELLCARE,WELLCARE MEDICARE,46.27,,,,,,,21.8300,894.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
LIGASURE BLUNT TIP 44CM,272,RC,27200002,CDM,,,,,,both,,,4599.3700,689.9100,AETNA,AETNA,1963.93,,,,,,,1187.1000,4599.3700,percent of total billed charges,"42.7% of $4,599.37 in Billed Charges for Rev 272 = $1,963.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE BLUNT TIP 44CM,272,RC,27200002,CDM,,,,,,both,,,4599.3700,689.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3219.56,,,,,,,1187.1000,4599.3700,percent of total billed charges,"Rev 272 $4,599.37 in Billed Charges at 70% = $3,219.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE BLUNT TIP 44CM,272,RC,27200002,CDM,,,,,,both,,,4599.3700,689.9100,CIGNA HEALTHCARE,CIGNA HMO,1917.94,,,,,,,1187.1000,4599.3700,percent of total billed charges,"41.7% of $4,599.37 in Billed Charges for Rev 272 = $1,917.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE BLUNT TIP 44CM,272,RC,27200002,CDM,,,,,,both,,,4599.3700,689.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2134.11,,,,,,,1187.1000,4599.3700,percent of total billed charges,"46.4% of $4,599.37 in Billed Charges for Rev 272 = $2,134.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE BLUNT TIP 44CM,272,RC,27200002,CDM,,,,,,both,,,4599.3700,689.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1917.94,,,,,,,1187.1000,4599.3700,percent of total billed charges,"41.7% of $4,599.37 in Billed Charges for Rev 272 = $1,917.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE BLUNT TIP 44CM,272,RC,27200002,CDM,,,,,,both,,,4599.3700,689.9100,CIGNA HEALTHCARE,CIGNA PPO,1917.94,,,,,,,1187.1000,4599.3700,percent of total billed charges,"41.7% of $4,599.37 in Billed Charges for Rev 272 = $1,917.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE BLUNT TIP 44CM,272,RC,27200002,CDM,,,,,,both,,,4599.3700,689.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4139.43,,,,,,,1187.1000,4599.3700,percent of total billed charges,"90% of $4,599.37 in Billed Charges for Rev 272 = $4,139.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE BLUNT TIP 44CM,272,RC,27200002,CDM,,,,,,both,,,4599.3700,689.9100,MEDCOST,MEDCOST VHN,2188.84,,,,,,,1187.1000,4599.3700,percent of total billed charges,"47.59% of $4,599.37 in Billed Charges for Rev 272 = $2,188.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE BLUNT TIP 44CM,272,RC,27200002,CDM,,,,,,both,,,4599.3700,689.9100,SENTARA HEALTH,SENTARA HEALTH,1187.10,,,,,,,1187.1000,4599.3700,percent of total billed charges,"25.81% of $4,599.37 in Billed Charges for Rev 272 = $1,187.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE BLUNT TIP 44CM,272,RC,27200002,CDM,,,,,,both,,,4599.3700,689.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4599.37,,,,,,,1187.1000,4599.3700,percent of total billed charges,"100% of $4,599.37 in Billed Charges for Rev 272 = $4,599.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE BLUNT TIP 44CM,272,RC,27200002,CDM,,,,,,both,,,4599.3700,689.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2299.69,,,,,,,1187.1000,4599.3700,percent of total billed charges,"Rev 272 $4,599.37 in Billed Charges at 50% = $2,299.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE BLUNT TIP 44CM,272,RC,27200002,CDM,,,,,,both,,,4599.3700,689.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1485.60,,,,,,,1187.1000,4599.3700,other,"32.3% of $4,599.37 in Billed Charges for Rev 272 = $1,485.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGASURE BLUNT TIP 44CM,272,RC,27200002,CDM,,,,,,both,,,4599.3700,689.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1412.01,,,,,,,1187.1000,4599.3700,other,"30.7% of $4,599.37 in Billed Charges for Rev 272 = $1,412.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGASURE BLUNT TIP 44CM,272,RC,27200002,CDM,,,,,,both,,,4599.3700,689.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,1485.60,,,,,,,1187.1000,4599.3700,percent of total billed charges,"32.3% of $4,599.37 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE BLUNT TIP 44CM,272,RC,27200002,CDM,,,,,,both,,,4599.3700,689.9100,WELLCARE,WELLCARE MEDICAID,4599.37,,,,,,,1187.1000,4599.3700,percent of total billed charges,"100% of $4,599.37 in Billed Charges for Rev 272 = $4,599.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE LHOOK 5MM 37CM,272,RC,27200002,CDM,,,,,,both,,,6199.8400,929.9800,AETNA,AETNA,2647.33,,,,,,,1600.1800,6199.8400,percent of total billed charges,"42.7% of $6,199.84 in Billed Charges for Rev 272 = $2,647.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE LHOOK 5MM 37CM,272,RC,27200002,CDM,,,,,,both,,,6199.8400,929.9800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4339.89,,,,,,,1600.1800,6199.8400,percent of total billed charges,"Rev 272 $6,199.84 in Billed Charges at 70% = $4,339.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE LHOOK 5MM 37CM,272,RC,27200002,CDM,,,,,,both,,,6199.8400,929.9800,CIGNA HEALTHCARE,CIGNA HMO,2585.33,,,,,,,1600.1800,6199.8400,percent of total billed charges,"41.7% of $6,199.84 in Billed Charges for Rev 272 = $2,585.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE LHOOK 5MM 37CM,272,RC,27200002,CDM,,,,,,both,,,6199.8400,929.9800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2876.73,,,,,,,1600.1800,6199.8400,percent of total billed charges,"46.4% of $6,199.84 in Billed Charges for Rev 272 = $2,876.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE LHOOK 5MM 37CM,272,RC,27200002,CDM,,,,,,both,,,6199.8400,929.9800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2585.33,,,,,,,1600.1800,6199.8400,percent of total billed charges,"41.7% of $6,199.84 in Billed Charges for Rev 272 = $2,585.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE LHOOK 5MM 37CM,272,RC,27200002,CDM,,,,,,both,,,6199.8400,929.9800,CIGNA HEALTHCARE,CIGNA PPO,2585.33,,,,,,,1600.1800,6199.8400,percent of total billed charges,"41.7% of $6,199.84 in Billed Charges for Rev 272 = $2,585.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE LHOOK 5MM 37CM,272,RC,27200002,CDM,,,,,,both,,,6199.8400,929.9800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5579.86,,,,,,,1600.1800,6199.8400,percent of total billed charges,"90% of $6,199.84 in Billed Charges for Rev 272 = $5,579.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE LHOOK 5MM 37CM,272,RC,27200002,CDM,,,,,,both,,,6199.8400,929.9800,MEDCOST,MEDCOST VHN,2950.50,,,,,,,1600.1800,6199.8400,percent of total billed charges,"47.59% of $6,199.84 in Billed Charges for Rev 272 = $2,950.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE LHOOK 5MM 37CM,272,RC,27200002,CDM,,,,,,both,,,6199.8400,929.9800,SENTARA HEALTH,SENTARA HEALTH,1600.18,,,,,,,1600.1800,6199.8400,percent of total billed charges,"25.81% of $6,199.84 in Billed Charges for Rev 272 = $1,600.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE LHOOK 5MM 37CM,272,RC,27200002,CDM,,,,,,both,,,6199.8400,929.9800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6199.84,,,,,,,1600.1800,6199.8400,percent of total billed charges,"100% of $6,199.84 in Billed Charges for Rev 272 = $6,199.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE LHOOK 5MM 37CM,272,RC,27200002,CDM,,,,,,both,,,6199.8400,929.9800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3099.92,,,,,,,1600.1800,6199.8400,percent of total billed charges,"Rev 272 $6,199.84 in Billed Charges at 50% = $3,099.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE LHOOK 5MM 37CM,272,RC,27200002,CDM,,,,,,both,,,6199.8400,929.9800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2002.55,,,,,,,1600.1800,6199.8400,other,"32.3% of $6,199.84 in Billed Charges for Rev 272 = $2,002.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGASURE LHOOK 5MM 37CM,272,RC,27200002,CDM,,,,,,both,,,6199.8400,929.9800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1903.35,,,,,,,1600.1800,6199.8400,other,"30.7% of $6,199.84 in Billed Charges for Rev 272 = $1,903.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGASURE LHOOK 5MM 37CM,272,RC,27200002,CDM,,,,,,both,,,6199.8400,929.9800,UNITED HEALTHCARE,UNITED HEALTHCARE,2002.55,,,,,,,1600.1800,6199.8400,percent of total billed charges,"32.3% of $6,199.84 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE LHOOK 5MM 37CM,272,RC,27200002,CDM,,,,,,both,,,6199.8400,929.9800,WELLCARE,WELLCARE MEDICAID,6199.84,,,,,,,1600.1800,6199.8400,percent of total billed charges,"100% of $6,199.84 in Billed Charges for Rev 272 = $6,199.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAD 5MM-44MM,272,RC,,,,,,,,both,,,27068.3100,4060.2500,AETNA,AETNA,11558.17,,,,,,,6986.3300,27068.3100,percent of total billed charges,"42.7% of $27,068.31 in Billed Charges for Rev 272 = $11,558.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAD 5MM-44MM,272,RC,,,,,,,,both,,,27068.3100,4060.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,18947.82,,,,,,,6986.3300,27068.3100,percent of total billed charges,"Rev 272 $27,068.31 in Billed Charges at 70% = $18,947.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAD 5MM-44MM,272,RC,,,,,,,,both,,,27068.3100,4060.2500,CIGNA HEALTHCARE,CIGNA HMO,11287.49,,,,,,,6986.3300,27068.3100,percent of total billed charges,"41.7% of $27,068.31 in Billed Charges for Rev 272 = $11,287.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAD 5MM-44MM,272,RC,,,,,,,,both,,,27068.3100,4060.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12559.70,,,,,,,6986.3300,27068.3100,percent of total billed charges,"46.4% of $27,068.31 in Billed Charges for Rev 272 = $12,559.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAD 5MM-44MM,272,RC,,,,,,,,both,,,27068.3100,4060.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11287.49,,,,,,,6986.3300,27068.3100,percent of total billed charges,"41.7% of $27,068.31 in Billed Charges for Rev 272 = $11,287.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAD 5MM-44MM,272,RC,,,,,,,,both,,,27068.3100,4060.2500,CIGNA HEALTHCARE,CIGNA PPO,11287.49,,,,,,,6986.3300,27068.3100,percent of total billed charges,"41.7% of $27,068.31 in Billed Charges for Rev 272 = $11,287.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAD 5MM-44MM,272,RC,,,,,,,,both,,,27068.3100,4060.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,24361.48,,,,,,,6986.3300,27068.3100,percent of total billed charges,"90% of $27,068.31 in Billed Charges for Rev 272 = $24,361.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAD 5MM-44MM,272,RC,,,,,,,,both,,,27068.3100,4060.2500,MEDCOST,MEDCOST VHN,12881.81,,,,,,,6986.3300,27068.3100,percent of total billed charges,"47.59% of $27,068.31 in Billed Charges for Rev 272 = $12,881.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAD 5MM-44MM,272,RC,,,,,,,,both,,,27068.3100,4060.2500,SENTARA HEALTH,SENTARA HEALTH,6986.33,,,,,,,6986.3300,27068.3100,percent of total billed charges,"25.81% of $27,068.31 in Billed Charges for Rev 272 = $6,986.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAD 5MM-44MM,272,RC,,,,,,,,both,,,27068.3100,4060.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",27068.31,,,,,,,6986.3300,27068.3100,percent of total billed charges,"100% of $27,068.31 in Billed Charges for Rev 272 = $27,068.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAD 5MM-44MM,272,RC,,,,,,,,both,,,27068.3100,4060.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,13534.16,,,,,,,6986.3300,27068.3100,percent of total billed charges,"Rev 272 $27,068.31 in Billed Charges at 50% = $13,534.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAD 5MM-44MM,272,RC,,,,,,,,both,,,27068.3100,4060.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,8743.06,,,,,,,6986.3300,27068.3100,other,"32.3% of $27,068.31 in Billed Charges for Rev 272 = $8,743.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGASURE MARYLAD 5MM-44MM,272,RC,,,,,,,,both,,,27068.3100,4060.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,8309.97,,,,,,,6986.3300,27068.3100,other,"30.7% of $27,068.31 in Billed Charges for Rev 272 = $8,309.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
LIGASURE MARYLAD 5MM-44MM,272,RC,,,,,,,,both,,,27068.3100,4060.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,8743.06,,,,,,,6986.3300,27068.3100,percent of total billed charges,"32.3% of $27,068.31 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
LIGASURE MARYLAD 5MM-44MM,272,RC,,,,,,,,both,,,27068.3100,4060.2500,WELLCARE,WELLCARE MEDICAID,27068.31,,,,,,,6986.3300,27068.3100,percent of total billed charges,"100% of $27,068.31 in Billed Charges for Rev 272 = $27,068.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,AETNA,AETNA,549.12,,,,,,,75.1700,1286.0000,percent of total billed charges,"42.7% of $1,286.00 in Billed Charges for Rev 310 Proc 81338 = $549.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,189.06,,,,,,,75.1700,1286.0000,fee schedule,APG 00386 Proc 81338 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 104% = $189.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,150.33,,,,,,,75.1700,1286.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,AETNA,AETNA HEALTHCARE MEDICARE,150.33,,,,,,,75.1700,1286.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,150.33,,,,,,,75.1700,1286.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,AMBETTER,AMBETTER,327.72,,,,,,,75.1700,1286.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,AMERIGROUP,AMERIGROUP,75.17,,,,,,,75.1700,1286.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,156.34,,,,,,,75.1700,1286.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,BLUE CROSS,ANTHEM EXCHANGE,150.33,,,,,,,75.1700,1286.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,187.25,,,,,,,75.1700,1286.0000,fee schedule,APG 00386 Proc 81338 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,BLUE CROSS,ANTHEM HMO,150.33,,,,,,,75.1700,1286.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,154.84,,,,,,,75.1700,1286.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",150.33,,,,,,,75.1700,1286.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,900.20,,,,,,,75.1700,1286.0000,percent of total billed charges,"Rev 310 Proc 81338 $1,286.00 in Billed Charges at 70% = $900.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,BLUE CROSS,BLUE CROSS E NETWORK,481.06,,,,,,,75.1700,1286.0000,fee schedule,$150.33 from Fee Schedule BCFSB for Rev 310 Proc 81338 * Qty 1 = $150.33 at 320% = $481.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,BLUE CROSS,BLUE CROSS MEDICARE,156.34,,,,,,,75.1700,1286.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,BLUE CROSS,BLUE CROSS P NETWORK,491.58,,,,,,,75.1700,1286.0000,fee schedule,$150.33 from Fee Schedule BCFSB for Rev 310 Proc 81338 * Qty 1 = $150.33 at 327% = $491.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,BLUE CROSS,BLUE CROSS S NETWORK,491.58,,,,,,,75.1700,1286.0000,fee schedule,$150.33 from Fee Schedule BCFSB for Rev 310 Proc 81338 * Qty 1 = $150.33 at 327% = $491.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,BLUE CROSS,TENNCARE BLUE CARE,141.68,,,,,,,75.1700,1286.0000,fee schedule,$122.14 from Fee Schedule TC_24 for Rev 310 Proc 81338 * Qty 1 = $122.14 at 116% = $141.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,BLUE CROSS,TENNCARE BLUE SELECT,141.68,,,,,,,75.1700,1286.0000,fee schedule,$122.14 from Fee Schedule TC_24 for Rev 310 Proc 81338 * Qty 1 = $122.14 at 116% = $141.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,CIGNA HEALTHCARE,CIGNA HMO,536.26,,,,,,,75.1700,1286.0000,percent of total billed charges,"Rev 310 Proc 81338 $1,286.00 in Billed Charges at 41.7% = $536.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,331.30,,,,,,,75.1700,1286.0000,fee schedule,$331.30 from Fee Schedule CGIFP_25LR for Rev 310 Proc 81338 * Qty 1 = $331.30 at 100% = $331.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,157.85,,,,,,,75.1700,1286.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,536.26,,,,,,,75.1700,1286.0000,percent of total billed charges,"Rev 310 Proc 81338 $1,286.00 in Billed Charges at 41.7% = $536.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,CIGNA HEALTHCARE,CIGNA PPO,536.26,,,,,,,75.1700,1286.0000,percent of total billed charges,"Rev 310 Proc 81338 $1,286.00 in Billed Charges at 41.7% = $536.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,157.85,,,,,,,75.1700,1286.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1157.40,,,,,,,75.1700,1286.0000,percent of total billed charges,"90% of $1,286.00 in Billed Charges for Rev 310 Proc 81338 = $1,157.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,HUMANA,HUMANA MEDICARE,150.33,,,,,,,75.1700,1286.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,150.33,,,,,,,75.1700,1286.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,MEDCOST,MEDCOST VHN,612.01,,,,,,,75.1700,1286.0000,percent of total billed charges,"47.59% of $1,286.00 in Billed Charges for Rev 310 Proc 81338 = $612.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,190.88,,,,,,,75.1700,1286.0000,fee schedule,APG 00386 Proc 81338 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 105% = $190.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,157.85,,,,,,,75.1700,1286.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,157.85,,,,,,,75.1700,1286.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,NHC ADVANTAGE,NHC ADVANTAGE,157.85,,,,,,,75.1700,1286.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,187.43,,,,,,,75.1700,1286.0000,fee schedule,APG 00386 Proc 81338 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 103.1% = $187.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,SENTARA HEALTH,SENTARA HEALTH,331.92,,,,,,,75.1700,1286.0000,percent of total billed charges,"25.81% of $1,286.00 in Billed Charges for Rev 310 Proc 81338 = $331.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,SENTARA HEALTH,SENTARA MEDICARE,150.33,,,,,,,75.1700,1286.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1286.00,,,,,,,75.1700,1286.0000,percent of total billed charges,"100% of $1,286.00 in Billed Charges for Rev 310 Proc 81338 = $1,286.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,75.17,,,,,,,75.1700,1286.0000,fee schedule,$150.33 from Fee Schedule TCUHC24 for Rev 310 Proc 81338 * Qty 1 = $150.33 at 50% = $75.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,156.34,,,,,,,75.1700,1286.0000,fee schedule,$150.33 from Fee Schedule UHC_31910 for Rev 310 Proc 81338 * Qty 1 = $150.33 at 104% = $156.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,150.33,,,,,,,75.1700,1286.0000,fee schedule,$150.33 from Fee Schedule UHC_31910 for Rev 310 Proc 81338 * Qty 1 = $150.33 at 100% = $150.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,150.33,,,,,,,75.1700,1286.0000,fee schedule,$150.33 from Fee Schedule UHC_31910 for Rev 310 Proc 81338 * Qty 1 = $150.33 at 100% = $150.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,187.25,,,,,,,75.1700,1286.0000,fee schedule,APG 00386 Proc 81338 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,150.33,,,,,,,75.1700,1286.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,150.33,,,,,,,75.1700,1286.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,WELLCARE,WELLCARE MEDICAID,1286.00,,,,,,,75.1700,1286.0000,percent of total billed charges,"100% of $1,286.00 in Billed Charges for Rev 310 Proc 81338 = $1,286.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MPL GENE ANALYSIS COMMON VARIANTS,81338,CPT,310,RC,31000039,CDM,,,,both,,,1286.0000,192.9000,WELLCARE,WELLCARE MEDICARE,159.35,,,,,,,75.1700,1286.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,AETNA,AETNA,77.29,,,,,,,10.5500,181.0000,percent of total billed charges,42.7% of $181.00 in Billed Charges for Rev 301 Proc 82172 = $77.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,14.27,,,,,,,10.5500,181.0000,fee schedule,APG 00400 Proc 82172 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 104% = $14.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,21.09,,,,,,,10.5500,181.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,AETNA,AETNA HEALTHCARE MEDICARE,21.09,,,,,,,10.5500,181.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,21.09,,,,,,,10.5500,181.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,AMBETTER,AMBETTER,45.98,,,,,,,10.5500,181.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,AMERIGROUP,AMERIGROUP,10.55,,,,,,,10.5500,181.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,21.93,,,,,,,10.5500,181.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,BLUE CROSS,ANTHEM EXCHANGE,21.09,,,,,,,10.5500,181.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,14.13,,,,,,,10.5500,181.0000,fee schedule,APG 00400 Proc 82172 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,BLUE CROSS,ANTHEM HMO,21.09,,,,,,,10.5500,181.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,21.72,,,,,,,10.5500,181.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",21.09,,,,,,,10.5500,181.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,50.57,,,,,,,10.5500,181.0000,fee schedule,$50.57 from Fee Schedule BLDTM_23 for Rev 301 Proc 82172 * Qty 1 = $50.57 at 100% = $50.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,BLUE CROSS,BLUE CROSS E NETWORK,67.65,,,,,,,10.5500,181.0000,fee schedule,$21.14 from Fee Schedule BCFSB for Rev 301 Proc 82172 * Qty 1 = $21.14 at 320% = $67.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,BLUE CROSS,BLUE CROSS MEDICARE,21.93,,,,,,,10.5500,181.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,BLUE CROSS,BLUE CROSS P NETWORK,69.13,,,,,,,10.5500,181.0000,fee schedule,$21.14 from Fee Schedule BCFSB for Rev 301 Proc 82172 * Qty 1 = $21.14 at 327% = $69.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,BLUE CROSS,BLUE CROSS S NETWORK,69.13,,,,,,,10.5500,181.0000,fee schedule,$21.14 from Fee Schedule BCFSB for Rev 301 Proc 82172 * Qty 1 = $21.14 at 327% = $69.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,BLUE CROSS,TENNCARE BLUE CARE,38.23,,,,,,,10.5500,181.0000,fee schedule,$32.96 from Fee Schedule TC_24 for Rev 301 Proc 82172 * Qty 1 = $32.96 at 116% = $38.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,BLUE CROSS,TENNCARE BLUE SELECT,38.23,,,,,,,10.5500,181.0000,fee schedule,$32.96 from Fee Schedule TC_24 for Rev 301 Proc 82172 * Qty 1 = $32.96 at 116% = $38.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,CIGNA HEALTHCARE,CIGNA HMO,62.36,,,,,,,10.5500,181.0000,fee schedule,$62.36 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82172 * Qty 1 = $62.36 at 100% = $62.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,46.19,,,,,,,10.5500,181.0000,fee schedule,$46.19 from Fee Schedule CGIFP_25LR for Rev 301 Proc 82172 * Qty 1 = $46.19 at 100% = $46.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,22.14,,,,,,,10.5500,181.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,62.36,,,,,,,10.5500,181.0000,fee schedule,$62.36 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82172 * Qty 1 = $62.36 at 100% = $62.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,CIGNA HEALTHCARE,CIGNA PPO,62.36,,,,,,,10.5500,181.0000,fee schedule,$62.36 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82172 * Qty 1 = $62.36 at 100% = $62.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,22.14,,,,,,,10.5500,181.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,162.90,,,,,,,10.5500,181.0000,percent of total billed charges,90% of $181.00 in Billed Charges for Rev 301 Proc 82172 = $162.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,HUMANA,HUMANA MEDICARE,21.09,,,,,,,10.5500,181.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,21.09,,,,,,,10.5500,181.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,MEDCOST,MEDCOST VHN,86.14,,,,,,,10.5500,181.0000,percent of total billed charges,47.59% of $181.00 in Billed Charges for Rev 301 Proc 82172 = $86.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,14.41,,,,,,,10.5500,181.0000,fee schedule,APG 00400 Proc 82172 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 105% = $14.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,22.14,,,,,,,10.5500,181.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,22.14,,,,,,,10.5500,181.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,NHC ADVANTAGE,NHC ADVANTAGE,22.14,,,,,,,10.5500,181.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,14.15,,,,,,,10.5500,181.0000,fee schedule,APG 00400 Proc 82172 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 103.1% = $14.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,SENTARA HEALTH,SENTARA HEALTH,46.72,,,,,,,10.5500,181.0000,percent of total billed charges,25.81% of $181.00 in Billed Charges for Rev 301 Proc 82172 = $46.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,SENTARA HEALTH,SENTARA MEDICARE,21.09,,,,,,,10.5500,181.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",181.00,,,,,,,10.5500,181.0000,percent of total billed charges,100% of $181.00 in Billed Charges for Rev 301 Proc 82172 = $181.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,10.98,,,,,,,10.5500,181.0000,fee schedule,$21.95 from Fee Schedule TCUHC24 for Rev 301 Proc 82172 * Qty 1 = $21.95 at 50% = $10.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,21.93,,,,,,,10.5500,181.0000,fee schedule,$21.09 from Fee Schedule UHC_31910 for Rev 301 Proc 82172 * Qty 1 = $21.09 at 104% = $21.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,21.09,,,,,,,10.5500,181.0000,fee schedule,$21.09 from Fee Schedule UHC_31910 for Rev 301 Proc 82172 * Qty 1 = $21.09 at 100% = $21.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,21.09,,,,,,,10.5500,181.0000,fee schedule,$21.09 from Fee Schedule UHC_31910 for Rev 301 Proc 82172 * Qty 1 = $21.09 at 100% = $21.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,14.13,,,,,,,10.5500,181.0000,fee schedule,APG 00400 Proc 82172 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,21.09,,,,,,,10.5500,181.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,21.09,,,,,,,10.5500,181.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,WELLCARE,WELLCARE MEDICAID,181.00,,,,,,,10.5500,181.0000,percent of total billed charges,100% of $181.00 in Billed Charges for Rev 301 Proc 82172 = $181.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APOLIPOPROTEIN EACH,82172,CPT,301,RC,30100058,CDM,,,,both,,,181.0000,27.1500,WELLCARE,WELLCARE MEDICARE,22.36,,,,,,,10.5500,181.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,AETNA,AETNA,94.79,,,,,,,9.4900,222.0000,percent of total billed charges,42.7% of $222.00 in Billed Charges for Rev 301 Proc 82175 = $94.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,14.36,,,,,,,9.4900,222.0000,fee schedule,APG 00404 Proc 82175 at $836.60 (Base Rate) * 0.0165 (Relative Weight) = $13.80 (Total Line Payment) at 104% = $14.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,18.97,,,,,,,9.4900,222.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,AETNA,AETNA HEALTHCARE MEDICARE,18.97,,,,,,,9.4900,222.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,18.97,,,,,,,9.4900,222.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,AMBETTER,AMBETTER,41.35,,,,,,,9.4900,222.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,AMERIGROUP,AMERIGROUP,9.49,,,,,,,9.4900,222.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,19.73,,,,,,,9.4900,222.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,BLUE CROSS,ANTHEM EXCHANGE,18.97,,,,,,,9.4900,222.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,14.22,,,,,,,9.4900,222.0000,fee schedule,APG 00404 Proc 82175 at $836.60 (Base Rate) * 0.0165 (Relative Weight) = $13.80 (Total Line Payment) at 103% = $14.22. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,BLUE CROSS,ANTHEM HMO,18.97,,,,,,,9.4900,222.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,19.54,,,,,,,9.4900,222.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",18.97,,,,,,,9.4900,222.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,63.57,,,,,,,9.4900,222.0000,fee schedule,$63.57 from Fee Schedule BLDTM_23 for Rev 301 Proc 82175 * Qty 1 = $63.57 at 100% = $63.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,BLUE CROSS,BLUE CROSS E NETWORK,82.85,,,,,,,9.4900,222.0000,fee schedule,$25.89 from Fee Schedule BCFSB for Rev 301 Proc 82175 * Qty 1 = $25.89 at 320% = $82.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,BLUE CROSS,BLUE CROSS MEDICARE,19.73,,,,,,,9.4900,222.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,BLUE CROSS,BLUE CROSS P NETWORK,84.66,,,,,,,9.4900,222.0000,fee schedule,$25.89 from Fee Schedule BCFSB for Rev 301 Proc 82175 * Qty 1 = $25.89 at 327% = $84.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,BLUE CROSS,BLUE CROSS S NETWORK,84.66,,,,,,,9.4900,222.0000,fee schedule,$25.89 from Fee Schedule BCFSB for Rev 301 Proc 82175 * Qty 1 = $25.89 at 327% = $84.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,BLUE CROSS,TENNCARE BLUE CARE,44.06,,,,,,,9.4900,222.0000,fee schedule,$37.98 from Fee Schedule TC_24 for Rev 301 Proc 82175 * Qty 1 = $37.98 at 116% = $44.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,BLUE CROSS,TENNCARE BLUE SELECT,44.06,,,,,,,9.4900,222.0000,fee schedule,$37.98 from Fee Schedule TC_24 for Rev 301 Proc 82175 * Qty 1 = $37.98 at 116% = $44.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,CIGNA HEALTHCARE,CIGNA HMO,76.34,,,,,,,9.4900,222.0000,fee schedule,$76.34 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82175 * Qty 1 = $76.34 at 100% = $76.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,41.86,,,,,,,9.4900,222.0000,fee schedule,$41.86 from Fee Schedule CGIFP_25LR for Rev 301 Proc 82175 * Qty 1 = $41.86 at 100% = $41.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,19.92,,,,,,,9.4900,222.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,76.34,,,,,,,9.4900,222.0000,fee schedule,$76.34 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82175 * Qty 1 = $76.34 at 100% = $76.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,CIGNA HEALTHCARE,CIGNA PPO,76.34,,,,,,,9.4900,222.0000,fee schedule,$76.34 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82175 * Qty 1 = $76.34 at 100% = $76.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,19.92,,,,,,,9.4900,222.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,199.80,,,,,,,9.4900,222.0000,percent of total billed charges,90% of $222.00 in Billed Charges for Rev 301 Proc 82175 = $199.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,HUMANA,HUMANA MEDICARE,18.97,,,,,,,9.4900,222.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,18.97,,,,,,,9.4900,222.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,MEDCOST,MEDCOST VHN,105.65,,,,,,,9.4900,222.0000,percent of total billed charges,47.59% of $222.00 in Billed Charges for Rev 301 Proc 82175 = $105.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,14.49,,,,,,,9.4900,222.0000,fee schedule,APG 00404 Proc 82175 at $836.60 (Base Rate) * 0.0165 (Relative Weight) = $13.80 (Total Line Payment) at 100% = $13.80... $13.80 at 105% = $14.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,19.92,,,,,,,9.4900,222.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,19.92,,,,,,,9.4900,222.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,NHC ADVANTAGE,NHC ADVANTAGE,19.92,,,,,,,9.4900,222.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,14.23,,,,,,,9.4900,222.0000,fee schedule,APG 00404 Proc 82175 at $836.60 (Base Rate) * 0.0165 (Relative Weight) = $13.80 (Total Line Payment) at 100% = $13.80... $13.80 at 103.1% = $14.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,SENTARA HEALTH,SENTARA HEALTH,57.30,,,,,,,9.4900,222.0000,percent of total billed charges,25.81% of $222.00 in Billed Charges for Rev 301 Proc 82175 = $57.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,SENTARA HEALTH,SENTARA MEDICARE,18.97,,,,,,,9.4900,222.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",222.00,,,,,,,9.4900,222.0000,percent of total billed charges,100% of $222.00 in Billed Charges for Rev 301 Proc 82175 = $222.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,13.44,,,,,,,9.4900,222.0000,fee schedule,$26.87 from Fee Schedule TCUHC24 for Rev 301 Proc 82175 * Qty 1 = $26.87 at 50% = $13.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,19.73,,,,,,,9.4900,222.0000,fee schedule,$18.97 from Fee Schedule UHC_31910 for Rev 301 Proc 82175 * Qty 1 = $18.97 at 104% = $19.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,18.97,,,,,,,9.4900,222.0000,fee schedule,$18.97 from Fee Schedule UHC_31910 for Rev 301 Proc 82175 * Qty 1 = $18.97 at 100% = $18.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,18.97,,,,,,,9.4900,222.0000,fee schedule,$18.97 from Fee Schedule UHC_31910 for Rev 301 Proc 82175 * Qty 1 = $18.97 at 100% = $18.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,14.22,,,,,,,9.4900,222.0000,fee schedule,APG 00404 Proc 82175 at $836.60 (Base Rate) * 0.0165 (Relative Weight) = $13.80 (Total Line Payment) at 103% = $14.22. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,18.97,,,,,,,9.4900,222.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,18.97,,,,,,,9.4900,222.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,WELLCARE,WELLCARE MEDICAID,222.00,,,,,,,9.4900,222.0000,percent of total billed charges,100% of $222.00 in Billed Charges for Rev 301 Proc 82175 = $222.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARSENIC,82175,CPT,301,RC,30100059,CDM,,,,both,,,222.0000,33.3000,WELLCARE,WELLCARE MEDICARE,20.11,,,,,,,9.4900,222.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,AETNA,AETNA,71.31,,,,,,,7.9500,167.0000,percent of total billed charges,42.7% of $167.00 in Billed Charges for Rev 301 Proc 82190 = $71.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,14.27,,,,,,,7.9500,167.0000,fee schedule,APG 00400 Proc 82190 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 104% = $14.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,15.90,,,,,,,7.9500,167.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,AETNA,AETNA HEALTHCARE MEDICARE,15.90,,,,,,,7.9500,167.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,15.90,,,,,,,7.9500,167.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,AMBETTER,AMBETTER,34.66,,,,,,,7.9500,167.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,AMERIGROUP,AMERIGROUP,7.95,,,,,,,7.9500,167.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,16.54,,,,,,,7.9500,167.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,BLUE CROSS,ANTHEM EXCHANGE,15.90,,,,,,,7.9500,167.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,14.13,,,,,,,7.9500,167.0000,fee schedule,APG 00400 Proc 82190 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,BLUE CROSS,ANTHEM HMO,15.90,,,,,,,7.9500,167.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,16.38,,,,,,,7.9500,167.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",15.90,,,,,,,7.9500,167.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,48.14,,,,,,,7.9500,167.0000,fee schedule,$48.14 from Fee Schedule BLDTM_23 for Rev 301 Proc 82190 * Qty 1 = $48.14 at 100% = $48.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,BLUE CROSS,BLUE CROSS E NETWORK,60.90,,,,,,,7.9500,167.0000,fee schedule,$19.03 from Fee Schedule BCFSB for Rev 301 Proc 82190 * Qty 1 = $19.03 at 320% = $60.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,BLUE CROSS,BLUE CROSS MEDICARE,16.54,,,,,,,7.9500,167.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,BLUE CROSS,BLUE CROSS P NETWORK,62.23,,,,,,,7.9500,167.0000,fee schedule,$19.03 from Fee Schedule BCFSB for Rev 301 Proc 82190 * Qty 1 = $19.03 at 327% = $62.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,BLUE CROSS,BLUE CROSS S NETWORK,62.23,,,,,,,7.9500,167.0000,fee schedule,$19.03 from Fee Schedule BCFSB for Rev 301 Proc 82190 * Qty 1 = $19.03 at 327% = $62.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,BLUE CROSS,TENNCARE BLUE CARE,21.03,,,,,,,7.9500,167.0000,fee schedule,$18.13 from Fee Schedule TC_24 for Rev 301 Proc 82190 * Qty 1 = $18.13 at 116% = $21.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,BLUE CROSS,TENNCARE BLUE SELECT,21.03,,,,,,,7.9500,167.0000,fee schedule,$18.13 from Fee Schedule TC_24 for Rev 301 Proc 82190 * Qty 1 = $18.13 at 116% = $21.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,CIGNA HEALTHCARE,CIGNA HMO,59.96,,,,,,,7.9500,167.0000,fee schedule,$59.96 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82190 * Qty 1 = $59.96 at 100% = $59.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,35.37,,,,,,,7.9500,167.0000,fee schedule,$35.37 from Fee Schedule CGIFP_25LR for Rev 301 Proc 82190 * Qty 1 = $35.37 at 100% = $35.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,16.70,,,,,,,7.9500,167.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,59.96,,,,,,,7.9500,167.0000,fee schedule,$59.96 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82190 * Qty 1 = $59.96 at 100% = $59.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,CIGNA HEALTHCARE,CIGNA PPO,59.96,,,,,,,7.9500,167.0000,fee schedule,$59.96 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82190 * Qty 1 = $59.96 at 100% = $59.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,16.70,,,,,,,7.9500,167.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,150.30,,,,,,,7.9500,167.0000,percent of total billed charges,90% of $167.00 in Billed Charges for Rev 301 Proc 82190 = $150.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,HUMANA,HUMANA MEDICARE,15.90,,,,,,,7.9500,167.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,15.90,,,,,,,7.9500,167.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,MEDCOST,MEDCOST VHN,79.48,,,,,,,7.9500,167.0000,percent of total billed charges,47.59% of $167.00 in Billed Charges for Rev 301 Proc 82190 = $79.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,14.41,,,,,,,7.9500,167.0000,fee schedule,APG 00400 Proc 82190 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 105% = $14.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,16.70,,,,,,,7.9500,167.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,16.70,,,,,,,7.9500,167.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,NHC ADVANTAGE,NHC ADVANTAGE,16.70,,,,,,,7.9500,167.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,14.15,,,,,,,7.9500,167.0000,fee schedule,APG 00400 Proc 82190 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 103.1% = $14.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,SENTARA HEALTH,SENTARA HEALTH,43.10,,,,,,,7.9500,167.0000,percent of total billed charges,25.81% of $167.00 in Billed Charges for Rev 301 Proc 82190 = $43.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,SENTARA HEALTH,SENTARA MEDICARE,15.90,,,,,,,7.9500,167.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",167.00,,,,,,,7.9500,167.0000,percent of total billed charges,100% of $167.00 in Billed Charges for Rev 301 Proc 82190 = $167.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,10.56,,,,,,,7.9500,167.0000,fee schedule,$21.11 from Fee Schedule TCUHC24 for Rev 301 Proc 82190 * Qty 1 = $21.11 at 50% = $10.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,16.54,,,,,,,7.9500,167.0000,fee schedule,$15.90 from Fee Schedule UHC_31910 for Rev 301 Proc 82190 * Qty 1 = $15.90 at 104% = $16.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,15.90,,,,,,,7.9500,167.0000,fee schedule,$15.90 from Fee Schedule UHC_31910 for Rev 301 Proc 82190 * Qty 1 = $15.90 at 100% = $15.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,15.90,,,,,,,7.9500,167.0000,fee schedule,$15.90 from Fee Schedule UHC_31910 for Rev 301 Proc 82190 * Qty 1 = $15.90 at 100% = $15.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,14.13,,,,,,,7.9500,167.0000,fee schedule,APG 00400 Proc 82190 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,15.90,,,,,,,7.9500,167.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,15.90,,,,,,,7.9500,167.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,WELLCARE,WELLCARE MEDICAID,167.00,,,,,,,7.9500,167.0000,percent of total billed charges,100% of $167.00 in Billed Charges for Rev 301 Proc 82190 = $167.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ATOMIC ABSORPTION SPECTROSCOPY EA ANALYTE,82190,CPT,301,RC,30100489,CDM,,,,both,,,167.0000,25.0500,WELLCARE,WELLCARE MEDICARE,16.85,,,,,,,7.9500,167.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,AETNA,AETNA,80.70,,,,,,,8.0900,189.0000,percent of total billed charges,42.7% of $189.00 in Billed Charges for Rev 301 Proc 82232 = $80.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15.66,,,,,,,8.0900,189.0000,fee schedule,APG 00398 Proc 82232 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 104% = $15.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,16.18,,,,,,,8.0900,189.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,AETNA,AETNA HEALTHCARE MEDICARE,16.18,,,,,,,8.0900,189.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,16.18,,,,,,,8.0900,189.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,AMBETTER,AMBETTER,35.27,,,,,,,8.0900,189.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,AMERIGROUP,AMERIGROUP,8.09,,,,,,,8.0900,189.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,16.83,,,,,,,8.0900,189.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,BLUE CROSS,ANTHEM EXCHANGE,16.18,,,,,,,8.0900,189.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15.51,,,,,,,8.0900,189.0000,fee schedule,APG 00398 Proc 82232 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,BLUE CROSS,ANTHEM HMO,16.18,,,,,,,8.0900,189.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,16.67,,,,,,,8.0900,189.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",16.18,,,,,,,8.0900,189.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,55.32,,,,,,,8.0900,189.0000,fee schedule,$55.32 from Fee Schedule BLDTM_23 for Rev 301 Proc 82232 * Qty 1 = $55.32 at 100% = $55.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,BLUE CROSS,BLUE CROSS E NETWORK,70.62,,,,,,,8.0900,189.0000,fee schedule,$22.07 from Fee Schedule BCFSB for Rev 301 Proc 82232 * Qty 1 = $22.07 at 320% = $70.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,BLUE CROSS,BLUE CROSS MEDICARE,16.83,,,,,,,8.0900,189.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,BLUE CROSS,BLUE CROSS P NETWORK,72.17,,,,,,,8.0900,189.0000,fee schedule,$22.07 from Fee Schedule BCFSB for Rev 301 Proc 82232 * Qty 1 = $22.07 at 327% = $72.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,BLUE CROSS,BLUE CROSS S NETWORK,72.17,,,,,,,8.0900,189.0000,fee schedule,$22.07 from Fee Schedule BCFSB for Rev 301 Proc 82232 * Qty 1 = $22.07 at 327% = $72.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,BLUE CROSS,TENNCARE BLUE CARE,27.69,,,,,,,8.0900,189.0000,fee schedule,$23.87 from Fee Schedule TC_24 for Rev 301 Proc 82232 * Qty 1 = $23.87 at 116% = $27.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,BLUE CROSS,TENNCARE BLUE SELECT,27.69,,,,,,,8.0900,189.0000,fee schedule,$23.87 from Fee Schedule TC_24 for Rev 301 Proc 82232 * Qty 1 = $23.87 at 116% = $27.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,CIGNA HEALTHCARE,CIGNA HMO,65.07,,,,,,,8.0900,189.0000,fee schedule,$65.07 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82232 * Qty 1 = $65.07 at 100% = $65.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,35.37,,,,,,,8.0900,189.0000,fee schedule,$35.37 from Fee Schedule CGIFP_25LR for Rev 301 Proc 82232 * Qty 1 = $35.37 at 100% = $35.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,16.99,,,,,,,8.0900,189.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,65.07,,,,,,,8.0900,189.0000,fee schedule,$65.07 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82232 * Qty 1 = $65.07 at 100% = $65.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,CIGNA HEALTHCARE,CIGNA PPO,65.07,,,,,,,8.0900,189.0000,fee schedule,$65.07 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82232 * Qty 1 = $65.07 at 100% = $65.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,16.99,,,,,,,8.0900,189.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,170.10,,,,,,,8.0900,189.0000,percent of total billed charges,90% of $189.00 in Billed Charges for Rev 301 Proc 82232 = $170.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,HUMANA,HUMANA MEDICARE,16.18,,,,,,,8.0900,189.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,16.18,,,,,,,8.0900,189.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,MEDCOST,MEDCOST VHN,89.95,,,,,,,8.0900,189.0000,percent of total billed charges,47.59% of $189.00 in Billed Charges for Rev 301 Proc 82232 = $89.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15.81,,,,,,,8.0900,189.0000,fee schedule,APG 00398 Proc 82232 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 105% = $15.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,16.99,,,,,,,8.0900,189.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,16.99,,,,,,,8.0900,189.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,NHC ADVANTAGE,NHC ADVANTAGE,16.99,,,,,,,8.0900,189.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15.53,,,,,,,8.0900,189.0000,fee schedule,APG 00398 Proc 82232 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 103.1% = $15.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,SENTARA HEALTH,SENTARA HEALTH,48.78,,,,,,,8.0900,189.0000,percent of total billed charges,25.81% of $189.00 in Billed Charges for Rev 301 Proc 82232 = $48.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,SENTARA HEALTH,SENTARA MEDICARE,16.18,,,,,,,8.0900,189.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",189.00,,,,,,,8.0900,189.0000,percent of total billed charges,100% of $189.00 in Billed Charges for Rev 301 Proc 82232 = $189.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11.46,,,,,,,8.0900,189.0000,fee schedule,$22.91 from Fee Schedule TCUHC24 for Rev 301 Proc 82232 * Qty 1 = $22.91 at 50% = $11.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,16.83,,,,,,,8.0900,189.0000,fee schedule,$16.18 from Fee Schedule UHC_31910 for Rev 301 Proc 82232 * Qty 1 = $16.18 at 104% = $16.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,16.18,,,,,,,8.0900,189.0000,fee schedule,$16.18 from Fee Schedule UHC_31910 for Rev 301 Proc 82232 * Qty 1 = $16.18 at 100% = $16.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,16.18,,,,,,,8.0900,189.0000,fee schedule,$16.18 from Fee Schedule UHC_31910 for Rev 301 Proc 82232 * Qty 1 = $16.18 at 100% = $16.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15.51,,,,,,,8.0900,189.0000,fee schedule,APG 00398 Proc 82232 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,16.18,,,,,,,8.0900,189.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,16.18,,,,,,,8.0900,189.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,WELLCARE,WELLCARE MEDICAID,189.00,,,,,,,8.0900,189.0000,percent of total billed charges,100% of $189.00 in Billed Charges for Rev 301 Proc 82232 = $189.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BETA 2 MICROGLOBULIN,82232,CPT,301,RC,30100062,CDM,,,,both,,,189.0000,28.3500,WELLCARE,WELLCARE MEDICARE,17.15,,,,,,,8.0900,189.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,AETNA,AETNA,82.41,,,,,,,8.5600,193.0000,percent of total billed charges,42.7% of $193.00 in Billed Charges for Rev 301 Proc 82239 = $82.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,14.27,,,,,,,8.5600,193.0000,fee schedule,APG 00400 Proc 82239 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 104% = $14.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,17.12,,,,,,,8.5600,193.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,AETNA,AETNA HEALTHCARE MEDICARE,17.12,,,,,,,8.5600,193.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,17.12,,,,,,,8.5600,193.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,AMBETTER,AMBETTER,37.32,,,,,,,8.5600,193.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,AMERIGROUP,AMERIGROUP,8.56,,,,,,,8.5600,193.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,17.80,,,,,,,8.5600,193.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,ANTHEM EXCHANGE,17.12,,,,,,,8.5600,193.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,14.13,,,,,,,8.5600,193.0000,fee schedule,APG 00400 Proc 82239 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,ANTHEM HMO,17.12,,,,,,,8.5600,193.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,17.63,,,,,,,8.5600,193.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",17.12,,,,,,,8.5600,193.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,55.46,,,,,,,8.5600,193.0000,fee schedule,$55.46 from Fee Schedule BLDTM_23 for Rev 301 Proc 82239 * Qty 1 = $55.46 at 100% = $55.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,BLUE CROSS E NETWORK,72.32,,,,,,,8.5600,193.0000,fee schedule,$22.60 from Fee Schedule BCFSB for Rev 301 Proc 82239 * Qty 1 = $22.60 at 320% = $72.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,BLUE CROSS MEDICARE,17.80,,,,,,,8.5600,193.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,BLUE CROSS P NETWORK,73.90,,,,,,,8.5600,193.0000,fee schedule,$22.60 from Fee Schedule BCFSB for Rev 301 Proc 82239 * Qty 1 = $22.60 at 327% = $73.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,BLUE CROSS S NETWORK,73.90,,,,,,,8.5600,193.0000,fee schedule,$22.60 from Fee Schedule BCFSB for Rev 301 Proc 82239 * Qty 1 = $22.60 at 327% = $73.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,TENNCARE BLUE CARE,20.35,,,,,,,8.5600,193.0000,fee schedule,$17.54 from Fee Schedule TC_24 for Rev 301 Proc 82239 * Qty 1 = $17.54 at 116% = $20.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,TENNCARE BLUE SELECT,20.35,,,,,,,8.5600,193.0000,fee schedule,$17.54 from Fee Schedule TC_24 for Rev 301 Proc 82239 * Qty 1 = $17.54 at 116% = $20.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,CIGNA HEALTHCARE,CIGNA HMO,68.91,,,,,,,8.5600,193.0000,fee schedule,$68.91 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82239 * Qty 1 = $68.91 at 100% = $68.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,37.53,,,,,,,8.5600,193.0000,fee schedule,$37.53 from Fee Schedule CGIFP_25LR for Rev 301 Proc 82239 * Qty 1 = $37.53 at 100% = $37.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,17.98,,,,,,,8.5600,193.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,68.91,,,,,,,8.5600,193.0000,fee schedule,$68.91 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82239 * Qty 1 = $68.91 at 100% = $68.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,CIGNA HEALTHCARE,CIGNA PPO,68.91,,,,,,,8.5600,193.0000,fee schedule,$68.91 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82239 * Qty 1 = $68.91 at 100% = $68.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,17.98,,,,,,,8.5600,193.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,173.70,,,,,,,8.5600,193.0000,percent of total billed charges,90% of $193.00 in Billed Charges for Rev 301 Proc 82239 = $173.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,HUMANA,HUMANA MEDICARE,17.12,,,,,,,8.5600,193.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,17.12,,,,,,,8.5600,193.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,MEDCOST,MEDCOST VHN,91.85,,,,,,,8.5600,193.0000,percent of total billed charges,47.59% of $193.00 in Billed Charges for Rev 301 Proc 82239 = $91.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,14.41,,,,,,,8.5600,193.0000,fee schedule,APG 00400 Proc 82239 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 105% = $14.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,17.98,,,,,,,8.5600,193.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,17.98,,,,,,,8.5600,193.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,NHC ADVANTAGE,NHC ADVANTAGE,17.98,,,,,,,8.5600,193.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,14.15,,,,,,,8.5600,193.0000,fee schedule,APG 00400 Proc 82239 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 103.1% = $14.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,SENTARA HEALTH,SENTARA HEALTH,49.81,,,,,,,8.5600,193.0000,percent of total billed charges,25.81% of $193.00 in Billed Charges for Rev 301 Proc 82239 = $49.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,SENTARA HEALTH,SENTARA MEDICARE,17.12,,,,,,,8.5600,193.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",193.00,,,,,,,8.5600,193.0000,percent of total billed charges,100% of $193.00 in Billed Charges for Rev 301 Proc 82239 = $193.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,12.13,,,,,,,8.5600,193.0000,fee schedule,$24.26 from Fee Schedule TCUHC24 for Rev 301 Proc 82239 * Qty 1 = $24.26 at 50% = $12.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,17.80,,,,,,,8.5600,193.0000,fee schedule,$17.12 from Fee Schedule UHC_31910 for Rev 301 Proc 82239 * Qty 1 = $17.12 at 104% = $17.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,17.12,,,,,,,8.5600,193.0000,fee schedule,$17.12 from Fee Schedule UHC_31910 for Rev 301 Proc 82239 * Qty 1 = $17.12 at 100% = $17.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,17.12,,,,,,,8.5600,193.0000,fee schedule,$17.12 from Fee Schedule UHC_31910 for Rev 301 Proc 82239 * Qty 1 = $17.12 at 100% = $17.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,14.13,,,,,,,8.5600,193.0000,fee schedule,APG 00400 Proc 82239 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,17.12,,,,,,,8.5600,193.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,17.12,,,,,,,8.5600,193.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,WELLCARE,WELLCARE MEDICAID,193.00,,,,,,,8.5600,193.0000,percent of total billed charges,100% of $193.00 in Billed Charges for Rev 301 Proc 82239 = $193.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BILE ACIDS TOTAL,82239,CPT,301,RC,30100063,CDM,,,,both,,,193.0000,28.9500,WELLCARE,WELLCARE MEDICARE,18.15,,,,,,,8.5600,193.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,AETNA,AETNA,187.88,,,,,,,20.5400,440.0000,percent of total billed charges,42.7% of $440.00 in Billed Charges for Rev 320 Proc 70120 = $187.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,20.5400,440.0000,fee schedule,APG 00471 Proc 70120 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,20.5400,440.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,20.5400,440.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,20.5400,440.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,AMBETTER,AMBETTER,206.78,,,,,,,20.5400,440.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,20.5400,440.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,20.5400,440.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,20.5400,440.0000,fee schedule,APG 00471 Proc 70120 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,20.5400,440.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,20.5400,440.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,20.5400,440.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,28.20,,,,,,,20.5400,440.0000,fee schedule,$28.20 from Fee Schedule BLDTM_23 for Rev 320 Proc 70120 * Qty 1 = $28.20 at 100% = $28.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,BLUE CROSS,BLUE CROSS E NETWORK,78.85,,,,,,,20.5400,440.0000,fee schedule,$24.64 from Fee Schedule BCFSC for Rev 320 Proc 70120 * Qty 1 = $24.64 at 320% = $78.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,20.5400,440.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,BLUE CROSS,BLUE CROSS P NETWORK,80.57,,,,,,,20.5400,440.0000,fee schedule,$24.64 from Fee Schedule BCFSC for Rev 320 Proc 70120 * Qty 1 = $24.64 at 327% = $80.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,BLUE CROSS,BLUE CROSS S NETWORK,80.57,,,,,,,20.5400,440.0000,fee schedule,$24.64 from Fee Schedule BCFSC for Rev 320 Proc 70120 * Qty 1 = $24.64 at 327% = $80.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,BLUE CROSS,TENNCARE BLUE CARE,20.54,,,,,,,20.5400,440.0000,fee schedule,$17.71 from Fee Schedule TC_24 for Rev 320 Proc 70120 * Qty 1 = $17.71 at 116% = $20.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,BLUE CROSS,TENNCARE BLUE SELECT,20.54,,,,,,,20.5400,440.0000,fee schedule,$17.71 from Fee Schedule TC_24 for Rev 320 Proc 70120 * Qty 1 = $17.71 at 116% = $20.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,20.5400,440.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70120 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,55.50,,,,,,,20.5400,440.0000,fee schedule,$55.50 from Fee Schedule CGIFP_25LR for Rev 320 Proc 70120 * Qty 1 = $55.50 at 100% = $55.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,20.5400,440.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,20.5400,440.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70120 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,20.5400,440.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70120 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,20.5400,440.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,396.00,,,,,,,20.5400,440.0000,percent of total billed charges,90% of $440.00 in Billed Charges for Rev 320 Proc 70120 = $396.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,HUMANA,HUMANA MEDICARE,94.85,,,,,,,20.5400,440.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,20.5400,440.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,MEDCOST,MEDCOST VHN,209.40,,,,,,,20.5400,440.0000,percent of total billed charges,47.59% of $440.00 in Billed Charges for Rev 320 Proc 70120 = $209.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,20.5400,440.0000,fee schedule,APG 00471 Proc 70120 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,20.5400,440.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,20.5400,440.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,20.5400,440.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,20.5400,440.0000,fee schedule,APG 00471 Proc 70120 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,SENTARA HEALTH,SENTARA HEALTH,113.56,,,,,,,20.5400,440.0000,percent of total billed charges,25.81% of $440.00 in Billed Charges for Rev 320 Proc 70120 = $113.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,20.5400,440.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",440.00,,,,,,,20.5400,440.0000,percent of total billed charges,100% of $440.00 in Billed Charges for Rev 320 Proc 70120 = $440.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,20.5400,440.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 70120 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,20.5400,440.0000,other,Rev 320 Proc 70120 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,20.5400,440.0000,other,Rev 320 Proc 70120 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,20.5400,440.0000,other,Rev 320 Proc 70120 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,20.5400,440.0000,fee schedule,APG 00471 Proc 70120 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,20.5400,440.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,20.5400,440.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,WELLCARE,WELLCARE MEDICAID,440.00,,,,,,,20.5400,440.0000,percent of total billed charges,100% of $440.00 in Billed Charges for Rev 320 Proc 70120 = $440.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MASTOIDS LESS THAN 3 VWS PER SIDE,70120,CPT,320,RC,32000305,CDM,,,,both,,,440.0000,66.0000,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,20.5400,440.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,22.4000,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 70130 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70130 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,206.78,,,,,,,22.4000,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,22.4000,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70130 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,22.4000,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,50.04,,,,,,,22.4000,462.0000,fee schedule,$50.04 from Fee Schedule BLDTM_23 for Rev 320 Proc 70130 * Qty 1 = $50.04 at 100% = $50.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,120.00,,,,,,,22.4000,462.0000,fee schedule,$37.50 from Fee Schedule BCFSC for Rev 320 Proc 70130 * Qty 1 = $37.50 at 320% = $120.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,22.4000,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,122.63,,,,,,,22.4000,462.0000,fee schedule,$37.50 from Fee Schedule BCFSC for Rev 320 Proc 70130 * Qty 1 = $37.50 at 327% = $122.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,122.63,,,,,,,22.4000,462.0000,fee schedule,$37.50 from Fee Schedule BCFSC for Rev 320 Proc 70130 * Qty 1 = $37.50 at 327% = $122.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,25.93,,,,,,,22.4000,462.0000,fee schedule,$22.35 from Fee Schedule TC_24 for Rev 320 Proc 70130 * Qty 1 = $22.35 at 116% = $25.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,25.93,,,,,,,22.4000,462.0000,fee schedule,$22.35 from Fee Schedule TC_24 for Rev 320 Proc 70130 * Qty 1 = $22.35 at 116% = $25.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,22.4000,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70130 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,86.19,,,,,,,22.4000,462.0000,fee schedule,$86.19 from Fee Schedule CGIFP_25LR for Rev 320 Proc 70130 * Qty 1 = $86.19 at 100% = $86.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,22.4000,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70130 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,22.4000,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70130 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,22.4000,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 70130 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,22.4000,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 70130 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70130 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70130 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,22.4000,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 70130 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,22.4000,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 70130 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,22.4000,462.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 70130 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,22.4000,462.0000,other,Rev 320 Proc 70130 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,22.4000,462.0000,other,Rev 320 Proc 70130 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,22.4000,462.0000,other,Rev 320 Proc 70130 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70130 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,22.4000,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 70130 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MASTOIDS COMPL MIN 3 VWS PER SIDE,70130,CPT,320,RC,32000003,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,22.4000,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,AETNA,AETNA,203.25,,,,,,,24.2900,1080.7300,percent of total billed charges,42.7% of $476.00 in Billed Charges for Rev 320 Proc 70134 = $203.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,24.2900,1080.7300,fee schedule,APG 00471 Proc 70134 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,476.00,,,,,,,24.2900,1080.7300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,AETNA,AETNA HEALTHCARE MEDICARE,476.00,,,,,,,24.2900,1080.7300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,476.00,,,,,,,24.2900,1080.7300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,AMBETTER,AMBETTER,1080.73,,,,,,,24.2900,1080.7300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,476.00,,,,,,,24.2900,1080.7300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,BLUE CROSS,ANTHEM EXCHANGE,476.00,,,,,,,24.2900,1080.7300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,24.2900,1080.7300,fee schedule,APG 00471 Proc 70134 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,BLUE CROSS,ANTHEM HMO,476.00,,,,,,,24.2900,1080.7300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,476.00,,,,,,,24.2900,1080.7300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",476.00,,,,,,,24.2900,1080.7300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,48.22,,,,,,,24.2900,1080.7300,fee schedule,$48.22 from Fee Schedule BLDTM_23 for Rev 320 Proc 70134 * Qty 1 = $48.22 at 100% = $48.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,BLUE CROSS,BLUE CROSS E NETWORK,109.73,,,,,,,24.2900,1080.7300,fee schedule,$34.29 from Fee Schedule BCFSC for Rev 320 Proc 70134 * Qty 1 = $34.29 at 320% = $109.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,BLUE CROSS,BLUE CROSS MEDICARE,515.58,,,,,,,24.2900,1080.7300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,BLUE CROSS,BLUE CROSS P NETWORK,112.13,,,,,,,24.2900,1080.7300,fee schedule,$34.29 from Fee Schedule BCFSC for Rev 320 Proc 70134 * Qty 1 = $34.29 at 327% = $112.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,BLUE CROSS,BLUE CROSS S NETWORK,112.13,,,,,,,24.2900,1080.7300,fee schedule,$34.29 from Fee Schedule BCFSC for Rev 320 Proc 70134 * Qty 1 = $34.29 at 327% = $112.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,BLUE CROSS,TENNCARE BLUE CARE,24.29,,,,,,,24.2900,1080.7300,fee schedule,$20.94 from Fee Schedule TC_24 for Rev 320 Proc 70134 * Qty 1 = $20.94 at 116% = $24.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,BLUE CROSS,TENNCARE BLUE SELECT,24.29,,,,,,,24.2900,1080.7300,fee schedule,$20.94 from Fee Schedule TC_24 for Rev 320 Proc 70134 * Qty 1 = $20.94 at 116% = $24.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,CIGNA HEALTHCARE,CIGNA HMO,285.67,,,,,,,24.2900,1080.7300,fee schedule,$285.67 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70134 * Qty 1 = $285.67 at 100% = $285.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,84.31,,,,,,,24.2900,1080.7300,fee schedule,$84.31 from Fee Schedule CGIFP_25LR for Rev 320 Proc 70134 * Qty 1 = $84.31 at 100% = $84.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,476.00,,,,,,,24.2900,1080.7300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,285.67,,,,,,,24.2900,1080.7300,fee schedule,$285.67 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70134 * Qty 1 = $285.67 at 100% = $285.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,CIGNA HEALTHCARE,CIGNA PPO,285.67,,,,,,,24.2900,1080.7300,fee schedule,$285.67 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70134 * Qty 1 = $285.67 at 100% = $285.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,476.00,,,,,,,24.2900,1080.7300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,428.40,,,,,,,24.2900,1080.7300,percent of total billed charges,90% of $476.00 in Billed Charges for Rev 320 Proc 70134 = $428.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,HUMANA,HUMANA MEDICARE,476.00,,,,,,,24.2900,1080.7300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,476.00,,,,,,,24.2900,1080.7300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,MEDCOST,MEDCOST VHN,226.53,,,,,,,24.2900,1080.7300,percent of total billed charges,47.59% of $476.00 in Billed Charges for Rev 320 Proc 70134 = $226.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,24.2900,1080.7300,fee schedule,APG 00471 Proc 70134 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,476.00,,,,,,,24.2900,1080.7300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,476.00,,,,,,,24.2900,1080.7300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,NHC ADVANTAGE,NHC ADVANTAGE,476.00,,,,,,,24.2900,1080.7300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,24.2900,1080.7300,fee schedule,APG 00471 Proc 70134 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,SENTARA HEALTH,SENTARA HEALTH,122.86,,,,,,,24.2900,1080.7300,percent of total billed charges,25.81% of $476.00 in Billed Charges for Rev 320 Proc 70134 = $122.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,SENTARA HEALTH,SENTARA MEDICARE,476.00,,,,,,,24.2900,1080.7300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",476.00,,,,,,,24.2900,1080.7300,percent of total billed charges,100% of $476.00 in Billed Charges for Rev 320 Proc 70134 = $476.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,37.74,,,,,,,24.2900,1080.7300,fee schedule,$75.48 from Fee Schedule TCUHC24 for Rev 320 Proc 70134 * Qty 1 = $75.48 at 50% = $37.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,24.2900,1080.7300,other,Rev 320 Proc 70134 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,24.2900,1080.7300,other,Rev 320 Proc 70134 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,24.2900,1080.7300,other,Rev 320 Proc 70134 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,24.2900,1080.7300,fee schedule,APG 00471 Proc 70134 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,476.00,,,,,,,24.2900,1080.7300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,476.00,,,,,,,24.2900,1080.7300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,WELLCARE,WELLCARE MEDICAID,476.00,,,,,,,24.2900,1080.7300,percent of total billed charges,100% of $476.00 in Billed Charges for Rev 320 Proc 70134 = $476.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX IAC INNER EAR,70134,CPT,320,RC,32000004,CDM,,,,both,,,476.0000,71.4000,WELLCARE,WELLCARE MEDICARE,525.49,,,,,,,24.2900,1080.7300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA,187.45,,,,,,,20.5400,439.0000,percent of total billed charges,42.7% of $439.00 in Billed Charges for Rev 320 Proc 70140 = $187.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,20.5400,439.0000,fee schedule,APG 00471 Proc 70140 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,20.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,20.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,20.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,AMBETTER,AMBETTER,172.12,,,,,,,20.5400,439.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,20.5400,439.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,20.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,20.5400,439.0000,fee schedule,APG 00471 Proc 70140 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,20.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,20.5400,439.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,20.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,35.22,,,,,,,20.5400,439.0000,fee schedule,$35.22 from Fee Schedule BLDTM_23 for Rev 320 Proc 70140 * Qty 1 = $35.22 at 100% = $35.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS E NETWORK,58.24,,,,,,,20.5400,439.0000,fee schedule,$18.20 from Fee Schedule BCFSC for Rev 320 Proc 70140 * Qty 1 = $18.20 at 320% = $58.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,20.5400,439.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS P NETWORK,59.51,,,,,,,20.5400,439.0000,fee schedule,$18.20 from Fee Schedule BCFSC for Rev 320 Proc 70140 * Qty 1 = $18.20 at 327% = $59.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS S NETWORK,59.51,,,,,,,20.5400,439.0000,fee schedule,$18.20 from Fee Schedule BCFSC for Rev 320 Proc 70140 * Qty 1 = $18.20 at 327% = $59.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,TENNCARE BLUE CARE,20.54,,,,,,,20.5400,439.0000,fee schedule,$17.71 from Fee Schedule TC_24 for Rev 320 Proc 70140 * Qty 1 = $17.71 at 116% = $20.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,TENNCARE BLUE SELECT,20.54,,,,,,,20.5400,439.0000,fee schedule,$17.71 from Fee Schedule TC_24 for Rev 320 Proc 70140 * Qty 1 = $17.71 at 116% = $20.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,20.5400,439.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70140 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,42.34,,,,,,,20.5400,439.0000,fee schedule,$42.34 from Fee Schedule CGIFP_25LR for Rev 320 Proc 70140 * Qty 1 = $42.34 at 100% = $42.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,20.5400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,20.5400,439.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70140 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,20.5400,439.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70140 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,20.5400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,395.10,,,,,,,20.5400,439.0000,percent of total billed charges,90% of $439.00 in Billed Charges for Rev 320 Proc 70140 = $395.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,HUMANA,HUMANA MEDICARE,78.96,,,,,,,20.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,20.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,MEDCOST,MEDCOST VHN,208.92,,,,,,,20.5400,439.0000,percent of total billed charges,47.59% of $439.00 in Billed Charges for Rev 320 Proc 70140 = $208.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,20.5400,439.0000,fee schedule,APG 00471 Proc 70140 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,20.5400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,20.5400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,20.5400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,20.5400,439.0000,fee schedule,APG 00471 Proc 70140 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,SENTARA HEALTH,SENTARA HEALTH,113.31,,,,,,,20.5400,439.0000,percent of total billed charges,25.81% of $439.00 in Billed Charges for Rev 320 Proc 70140 = $113.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,20.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",439.00,,,,,,,20.5400,439.0000,percent of total billed charges,100% of $439.00 in Billed Charges for Rev 320 Proc 70140 = $439.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,20.5400,439.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 70140 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,20.5400,439.0000,other,Rev 320 Proc 70140 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,20.5400,439.0000,other,Rev 320 Proc 70140 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,20.5400,439.0000,other,Rev 320 Proc 70140 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,20.5400,439.0000,fee schedule,APG 00471 Proc 70140 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,20.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,20.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,WELLCARE,WELLCARE MEDICAID,439.00,,,,,,,20.5400,439.0000,percent of total billed charges,100% of $439.00 in Billed Charges for Rev 320 Proc 70140 = $439.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FACIAL BONE <3 VIEWS,70140,CPT,320,RC,32000005,CDM,,,,both,,,439.0000,65.8500,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,20.5400,439.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,22.4000,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 70150 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70150 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,206.78,,,,,,,22.4000,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,22.4000,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70150 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,22.4000,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,45.78,,,,,,,22.4000,462.0000,fee schedule,$45.78 from Fee Schedule BLDTM_23 for Rev 320 Proc 70150 * Qty 1 = $45.78 at 100% = $45.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,87.07,,,,,,,22.4000,462.0000,fee schedule,$27.21 from Fee Schedule BCFSC for Rev 320 Proc 70150 * Qty 1 = $27.21 at 320% = $87.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,22.4000,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,88.98,,,,,,,22.4000,462.0000,fee schedule,$27.21 from Fee Schedule BCFSC for Rev 320 Proc 70150 * Qty 1 = $27.21 at 327% = $88.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,88.98,,,,,,,22.4000,462.0000,fee schedule,$27.21 from Fee Schedule BCFSC for Rev 320 Proc 70150 * Qty 1 = $27.21 at 327% = $88.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,25.93,,,,,,,22.4000,462.0000,fee schedule,$22.35 from Fee Schedule TC_24 for Rev 320 Proc 70150 * Qty 1 = $22.35 at 116% = $25.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,25.93,,,,,,,22.4000,462.0000,fee schedule,$22.35 from Fee Schedule TC_24 for Rev 320 Proc 70150 * Qty 1 = $22.35 at 116% = $25.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,22.4000,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70150 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,65.52,,,,,,,22.4000,462.0000,fee schedule,$65.52 from Fee Schedule CGIFP_25LR for Rev 320 Proc 70150 * Qty 1 = $65.52 at 100% = $65.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,22.4000,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70150 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,22.4000,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70150 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,22.4000,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 70150 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,22.4000,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 70150 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70150 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70150 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,22.4000,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 70150 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,22.4000,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 70150 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,22.4000,462.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 70150 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,22.4000,462.0000,other,Rev 320 Proc 70150 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,22.4000,462.0000,other,Rev 320 Proc 70150 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,22.4000,462.0000,other,Rev 320 Proc 70150 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70150 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,22.4000,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 70150 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FACIAL BONE COMPLT MIN 3 VIEWS,70150,CPT,320,RC,32000007,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,22.4000,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,20.5400,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 70190 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,20.5400,462.0000,fee schedule,APG 00471 Proc 70190 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,20.5400,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,20.5400,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,20.5400,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,172.12,,,,,,,20.5400,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,20.5400,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,20.5400,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,20.5400,462.0000,fee schedule,APG 00471 Proc 70190 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,20.5400,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,20.5400,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,20.5400,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,36.37,,,,,,,20.5400,462.0000,fee schedule,$36.37 from Fee Schedule BLDTM_23 for Rev 320 Proc 70190 * Qty 1 = $36.37 at 100% = $36.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,74.72,,,,,,,20.5400,462.0000,fee schedule,$23.35 from Fee Schedule BCFSC for Rev 320 Proc 70190 * Qty 1 = $23.35 at 320% = $74.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,20.5400,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,76.35,,,,,,,20.5400,462.0000,fee schedule,$23.35 from Fee Schedule BCFSC for Rev 320 Proc 70190 * Qty 1 = $23.35 at 327% = $76.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,76.35,,,,,,,20.5400,462.0000,fee schedule,$23.35 from Fee Schedule BCFSC for Rev 320 Proc 70190 * Qty 1 = $23.35 at 327% = $76.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,20.54,,,,,,,20.5400,462.0000,fee schedule,$17.71 from Fee Schedule TC_24 for Rev 320 Proc 70190 * Qty 1 = $17.71 at 116% = $20.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,20.54,,,,,,,20.5400,462.0000,fee schedule,$17.71 from Fee Schedule TC_24 for Rev 320 Proc 70190 * Qty 1 = $17.71 at 116% = $20.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,20.5400,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70190 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,50.49,,,,,,,20.5400,462.0000,fee schedule,$50.49 from Fee Schedule CGIFP_25LR for Rev 320 Proc 70190 * Qty 1 = $50.49 at 100% = $50.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,20.5400,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,20.5400,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70190 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,20.5400,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70190 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,20.5400,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,20.5400,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 70190 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,78.96,,,,,,,20.5400,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,20.5400,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,20.5400,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 70190 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,20.5400,462.0000,fee schedule,APG 00471 Proc 70190 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,20.5400,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,20.5400,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,20.5400,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,20.5400,462.0000,fee schedule,APG 00471 Proc 70190 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,20.5400,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 70190 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,20.5400,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,20.5400,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 70190 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,20.5400,462.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 70190 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,20.5400,462.0000,other,Rev 320 Proc 70190 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,20.5400,462.0000,other,Rev 320 Proc 70190 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,20.5400,462.0000,other,Rev 320 Proc 70190 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,20.5400,462.0000,fee schedule,APG 00471 Proc 70190 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,20.5400,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,20.5400,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,20.5400,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 70190 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX OPTIC FORAMINA EYE,70190,CPT,320,RC,32000010,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,20.5400,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,22.4000,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 70200 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70200 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,206.78,,,,,,,22.4000,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,22.4000,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70200 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,22.4000,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,46.57,,,,,,,22.4000,462.0000,fee schedule,$46.57 from Fee Schedule BLDTM_23 for Rev 320 Proc 70200 * Qty 1 = $46.57 at 100% = $46.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,87.07,,,,,,,22.4000,462.0000,fee schedule,$27.21 from Fee Schedule BCFSC for Rev 320 Proc 70200 * Qty 1 = $27.21 at 320% = $87.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,22.4000,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,88.98,,,,,,,22.4000,462.0000,fee schedule,$27.21 from Fee Schedule BCFSC for Rev 320 Proc 70200 * Qty 1 = $27.21 at 327% = $88.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,88.98,,,,,,,22.4000,462.0000,fee schedule,$27.21 from Fee Schedule BCFSC for Rev 320 Proc 70200 * Qty 1 = $27.21 at 327% = $88.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,25.93,,,,,,,22.4000,462.0000,fee schedule,$22.35 from Fee Schedule TC_24 for Rev 320 Proc 70200 * Qty 1 = $22.35 at 116% = $25.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,25.93,,,,,,,22.4000,462.0000,fee schedule,$22.35 from Fee Schedule TC_24 for Rev 320 Proc 70200 * Qty 1 = $22.35 at 116% = $25.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,22.4000,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70200 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,64.89,,,,,,,22.4000,462.0000,fee schedule,$64.89 from Fee Schedule CGIFP_25LR for Rev 320 Proc 70200 * Qty 1 = $64.89 at 100% = $64.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,22.4000,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70200 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,22.4000,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70200 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,22.4000,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 70200 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,22.4000,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 70200 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70200 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70200 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,22.4000,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 70200 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,22.4000,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 70200 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,22.4000,462.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 70200 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,22.4000,462.0000,other,Rev 320 Proc 70200 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,22.4000,462.0000,other,Rev 320 Proc 70200 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,22.4000,462.0000,other,Rev 320 Proc 70200 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70200 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,22.4000,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 70200 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ORBITS 4 VIEW,70200,CPT,320,RC,32000011,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,22.4000,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,22.4000,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 70220 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70220 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,172.12,,,,,,,22.4000,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,22.4000,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70220 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,22.4000,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,43.68,,,,,,,22.4000,462.0000,fee schedule,$43.68 from Fee Schedule BLDTM_23 for Rev 320 Proc 70220 * Qty 1 = $43.68 at 100% = $43.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,76.77,,,,,,,22.4000,462.0000,fee schedule,$23.99 from Fee Schedule BCFSC for Rev 320 Proc 70220 * Qty 1 = $23.99 at 320% = $76.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,22.4000,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,78.45,,,,,,,22.4000,462.0000,fee schedule,$23.99 from Fee Schedule BCFSC for Rev 320 Proc 70220 * Qty 1 = $23.99 at 327% = $78.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,78.45,,,,,,,22.4000,462.0000,fee schedule,$23.99 from Fee Schedule BCFSC for Rev 320 Proc 70220 * Qty 1 = $23.99 at 327% = $78.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,25.93,,,,,,,22.4000,462.0000,fee schedule,$22.35 from Fee Schedule TC_24 for Rev 320 Proc 70220 * Qty 1 = $22.35 at 116% = $25.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,25.93,,,,,,,22.4000,462.0000,fee schedule,$22.35 from Fee Schedule TC_24 for Rev 320 Proc 70220 * Qty 1 = $22.35 at 116% = $25.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,22.4000,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70220 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,51.11,,,,,,,22.4000,462.0000,fee schedule,$51.11 from Fee Schedule CGIFP_25LR for Rev 320 Proc 70220 * Qty 1 = $51.11 at 100% = $51.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,22.4000,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70220 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,22.4000,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70220 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,22.4000,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 70220 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,78.96,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,22.4000,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 70220 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70220 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70220 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,22.4000,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 70220 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,22.4000,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 70220 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,22.4000,462.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 70220 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,22.4000,462.0000,other,Rev 320 Proc 70220 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,22.4000,462.0000,other,Rev 320 Proc 70220 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,22.4000,462.0000,other,Rev 320 Proc 70220 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70220 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,22.4000,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 70220 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SINUSES COMP 3 VIEW,70220,CPT,320,RC,32000013,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,22.4000,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,AETNA,AETNA,25.19,,,,,,,2.5100,59.0000,percent of total billed charges,42.7% of $59.00 in Billed Charges for Rev 301 Proc 82247 = $25.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,6.44,,,,,,,2.5100,59.0000,fee schedule,APG 00402 Proc 82247 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 104% = $6.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5.02,,,,,,,2.5100,59.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,AETNA,AETNA HEALTHCARE MEDICARE,5.02,,,,,,,2.5100,59.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,5.02,,,,,,,2.5100,59.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,AMBETTER,AMBETTER,10.94,,,,,,,2.5100,59.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,AMERIGROUP,AMERIGROUP,2.51,,,,,,,2.5100,59.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,5.22,,,,,,,2.5100,59.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,BLUE CROSS,ANTHEM EXCHANGE,5.02,,,,,,,2.5100,59.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,6.38,,,,,,,2.5100,59.0000,fee schedule,APG 00402 Proc 82247 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,BLUE CROSS,ANTHEM HMO,5.02,,,,,,,2.5100,59.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5.17,,,,,,,2.5100,59.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5.02,,,,,,,2.5100,59.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,16.31,,,,,,,2.5100,59.0000,fee schedule,$16.31 from Fee Schedule BLDTM_23 for Rev 301 Proc 82247 * Qty 1 = $16.31 at 100% = $16.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,BLUE CROSS,BLUE CROSS E NETWORK,21.89,,,,,,,2.5100,59.0000,fee schedule,$6.84 from Fee Schedule BCFSB for Rev 301 Proc 82247 * Qty 1 = $6.84 at 320% = $21.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,BLUE CROSS,BLUE CROSS MEDICARE,5.22,,,,,,,2.5100,59.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,BLUE CROSS,BLUE CROSS P NETWORK,22.37,,,,,,,2.5100,59.0000,fee schedule,$6.84 from Fee Schedule BCFSB for Rev 301 Proc 82247 * Qty 1 = $6.84 at 327% = $22.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,BLUE CROSS,BLUE CROSS S NETWORK,22.37,,,,,,,2.5100,59.0000,fee schedule,$6.84 from Fee Schedule BCFSB for Rev 301 Proc 82247 * Qty 1 = $6.84 at 327% = $22.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,BLUE CROSS,TENNCARE BLUE CARE,10.16,,,,,,,2.5100,59.0000,fee schedule,$8.76 from Fee Schedule TC_24 for Rev 301 Proc 82247 * Qty 1 = $8.76 at 116% = $10.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,BLUE CROSS,TENNCARE BLUE SELECT,10.16,,,,,,,2.5100,59.0000,fee schedule,$8.76 from Fee Schedule TC_24 for Rev 301 Proc 82247 * Qty 1 = $8.76 at 116% = $10.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,CIGNA HEALTHCARE,CIGNA HMO,20.19,,,,,,,2.5100,59.0000,fee schedule,$20.19 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82247 * Qty 1 = $20.19 at 100% = $20.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10.83,,,,,,,2.5100,59.0000,fee schedule,$10.83 from Fee Schedule CGIFP_25LR for Rev 301 Proc 82247 * Qty 1 = $10.83 at 100% = $10.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,5.27,,,,,,,2.5100,59.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,20.19,,,,,,,2.5100,59.0000,fee schedule,$20.19 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82247 * Qty 1 = $20.19 at 100% = $20.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,CIGNA HEALTHCARE,CIGNA PPO,20.19,,,,,,,2.5100,59.0000,fee schedule,$20.19 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82247 * Qty 1 = $20.19 at 100% = $20.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,5.27,,,,,,,2.5100,59.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,53.10,,,,,,,2.5100,59.0000,percent of total billed charges,90% of $59.00 in Billed Charges for Rev 301 Proc 82247 = $53.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,HUMANA,HUMANA MEDICARE,5.02,,,,,,,2.5100,59.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5.02,,,,,,,2.5100,59.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,MEDCOST,MEDCOST VHN,28.08,,,,,,,2.5100,59.0000,percent of total billed charges,47.59% of $59.00 in Billed Charges for Rev 301 Proc 82247 = $28.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,6.50,,,,,,,2.5100,59.0000,fee schedule,APG 00402 Proc 82247 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 105% = $6.50 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,5.27,,,,,,,2.5100,59.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,5.27,,,,,,,2.5100,59.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,NHC ADVANTAGE,NHC ADVANTAGE,5.27,,,,,,,2.5100,59.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,6.38,,,,,,,2.5100,59.0000,fee schedule,APG 00402 Proc 82247 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 103.1% = $6.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,SENTARA HEALTH,SENTARA HEALTH,15.23,,,,,,,2.5100,59.0000,percent of total billed charges,25.81% of $59.00 in Billed Charges for Rev 301 Proc 82247 = $15.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,SENTARA HEALTH,SENTARA MEDICARE,5.02,,,,,,,2.5100,59.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",59.00,,,,,,,2.5100,59.0000,percent of total billed charges,100% of $59.00 in Billed Charges for Rev 301 Proc 82247 = $59.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3.55,,,,,,,2.5100,59.0000,fee schedule,$7.10 from Fee Schedule TCUHC24 for Rev 301 Proc 82247 * Qty 1 = $7.10 at 50% = $3.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5.22,,,,,,,2.5100,59.0000,fee schedule,$5.02 from Fee Schedule UHC_31910 for Rev 301 Proc 82247 * Qty 1 = $5.02 at 104% = $5.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,5.02,,,,,,,2.5100,59.0000,fee schedule,$5.02 from Fee Schedule UHC_31910 for Rev 301 Proc 82247 * Qty 1 = $5.02 at 100% = $5.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,5.02,,,,,,,2.5100,59.0000,fee schedule,$5.02 from Fee Schedule UHC_31910 for Rev 301 Proc 82247 * Qty 1 = $5.02 at 100% = $5.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,6.38,,,,,,,2.5100,59.0000,fee schedule,APG 00402 Proc 82247 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5.02,,,,,,,2.5100,59.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5.02,,,,,,,2.5100,59.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,WELLCARE,WELLCARE MEDICAID,59.00,,,,,,,2.5100,59.0000,percent of total billed charges,100% of $59.00 in Billed Charges for Rev 301 Proc 82247 = $59.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BILIRUBIN TOTAL,82247,CPT,301,RC,30100064,CDM,,,,both,,,59.0000,8.8500,WELLCARE,WELLCARE MEDICARE,5.32,,,,,,,2.5100,59.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,AETNA,AETNA,24.34,,,,,,,2.1900,57.0000,percent of total billed charges,42.7% of $57.00 in Billed Charges for Rev 301 Proc 82270 = $24.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,6.44,,,,,,,2.1900,57.0000,fee schedule,APG 00402 Proc 82270 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 104% = $6.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,4.38,,,,,,,2.1900,57.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,AETNA,AETNA HEALTHCARE MEDICARE,4.38,,,,,,,2.1900,57.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,4.38,,,,,,,2.1900,57.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,AMBETTER,AMBETTER,9.55,,,,,,,2.1900,57.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,AMERIGROUP,AMERIGROUP,2.19,,,,,,,2.1900,57.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,4.56,,,,,,,2.1900,57.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,BLUE CROSS,ANTHEM EXCHANGE,4.38,,,,,,,2.1900,57.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,6.38,,,,,,,2.1900,57.0000,fee schedule,APG 00402 Proc 82270 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,BLUE CROSS,ANTHEM HMO,4.38,,,,,,,2.1900,57.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,4.51,,,,,,,2.1900,57.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4.38,,,,,,,2.1900,57.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6.93,,,,,,,2.1900,57.0000,fee schedule,$6.93 from Fee Schedule BLDTM_23 for Rev 301 Proc 82270 * Qty 1 = $6.93 at 100% = $6.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,BLUE CROSS,BLUE CROSS E NETWORK,14.05,,,,,,,2.1900,57.0000,fee schedule,$4.39 from Fee Schedule BCFSB for Rev 301 Proc 82270 * Qty 1 = $4.39 at 320% = $14.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,BLUE CROSS,BLUE CROSS MEDICARE,4.56,,,,,,,2.1900,57.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,BLUE CROSS,BLUE CROSS P NETWORK,14.36,,,,,,,2.1900,57.0000,fee schedule,$4.39 from Fee Schedule BCFSB for Rev 301 Proc 82270 * Qty 1 = $4.39 at 327% = $14.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,BLUE CROSS,BLUE CROSS S NETWORK,14.36,,,,,,,2.1900,57.0000,fee schedule,$4.39 from Fee Schedule BCFSB for Rev 301 Proc 82270 * Qty 1 = $4.39 at 327% = $14.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,BLUE CROSS,TENNCARE BLUE CARE,5.52,,,,,,,2.1900,57.0000,fee schedule,$4.76 from Fee Schedule TC_24 for Rev 301 Proc 82270 * Qty 1 = $4.76 at 116% = $5.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,BLUE CROSS,TENNCARE BLUE SELECT,5.52,,,,,,,2.1900,57.0000,fee schedule,$4.76 from Fee Schedule TC_24 for Rev 301 Proc 82270 * Qty 1 = $4.76 at 116% = $5.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,CIGNA HEALTHCARE,CIGNA HMO,13.11,,,,,,,2.1900,57.0000,fee schedule,$13.11 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82270 * Qty 1 = $13.11 at 100% = $13.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,9.38,,,,,,,2.1900,57.0000,fee schedule,$9.38 from Fee Schedule CGIFP_25LR for Rev 301 Proc 82270 * Qty 1 = $9.38 at 100% = $9.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,4.60,,,,,,,2.1900,57.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,13.11,,,,,,,2.1900,57.0000,fee schedule,$13.11 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82270 * Qty 1 = $13.11 at 100% = $13.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,CIGNA HEALTHCARE,CIGNA PPO,13.11,,,,,,,2.1900,57.0000,fee schedule,$13.11 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82270 * Qty 1 = $13.11 at 100% = $13.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,4.60,,,,,,,2.1900,57.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,51.30,,,,,,,2.1900,57.0000,percent of total billed charges,90% of $57.00 in Billed Charges for Rev 301 Proc 82270 = $51.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,HUMANA,HUMANA MEDICARE,4.38,,,,,,,2.1900,57.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,4.38,,,,,,,2.1900,57.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,MEDCOST,MEDCOST VHN,27.13,,,,,,,2.1900,57.0000,percent of total billed charges,47.59% of $57.00 in Billed Charges for Rev 301 Proc 82270 = $27.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,6.50,,,,,,,2.1900,57.0000,fee schedule,APG 00402 Proc 82270 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 105% = $6.50 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,4.60,,,,,,,2.1900,57.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,4.60,,,,,,,2.1900,57.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,NHC ADVANTAGE,NHC ADVANTAGE,4.60,,,,,,,2.1900,57.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,6.38,,,,,,,2.1900,57.0000,fee schedule,APG 00402 Proc 82270 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 103.1% = $6.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,SENTARA HEALTH,SENTARA HEALTH,14.71,,,,,,,2.1900,57.0000,percent of total billed charges,25.81% of $57.00 in Billed Charges for Rev 301 Proc 82270 = $14.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,SENTARA HEALTH,SENTARA MEDICARE,4.38,,,,,,,2.1900,57.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",57.00,,,,,,,2.1900,57.0000,percent of total billed charges,100% of $57.00 in Billed Charges for Rev 301 Proc 82270 = $57.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2.31,,,,,,,2.1900,57.0000,fee schedule,$4.61 from Fee Schedule TCUHC24 for Rev 301 Proc 82270 * Qty 1 = $4.61 at 50% = $2.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4.56,,,,,,,2.1900,57.0000,fee schedule,$4.38 from Fee Schedule UHC_31910 for Rev 301 Proc 82270 * Qty 1 = $4.38 at 104% = $4.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,4.38,,,,,,,2.1900,57.0000,fee schedule,$4.38 from Fee Schedule UHC_31910 for Rev 301 Proc 82270 * Qty 1 = $4.38 at 100% = $4.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,4.38,,,,,,,2.1900,57.0000,fee schedule,$4.38 from Fee Schedule UHC_31910 for Rev 301 Proc 82270 * Qty 1 = $4.38 at 100% = $4.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,6.38,,,,,,,2.1900,57.0000,fee schedule,APG 00402 Proc 82270 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,4.38,,,,,,,2.1900,57.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,4.38,,,,,,,2.1900,57.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,WELLCARE,WELLCARE MEDICAID,57.00,,,,,,,2.1900,57.0000,percent of total billed charges,100% of $57.00 in Billed Charges for Rev 301 Proc 82270 = $57.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OCCULT BLOOD FECES SCREENING,82270,CPT,301,RC,30100067,CDM,,,,both,,,57.0000,8.5500,WELLCARE,WELLCARE MEDICARE,4.64,,,,,,,2.1900,57.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,AETNA,AETNA,16.23,,,,,,,2.1200,38.0000,percent of total billed charges,42.7% of $38.00 in Billed Charges for Rev 301 Proc 82272 = $16.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,6.44,,,,,,,2.1200,38.0000,fee schedule,APG 00402 Proc 82272 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 104% = $6.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,4.23,,,,,,,2.1200,38.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,AETNA,AETNA HEALTHCARE MEDICARE,4.23,,,,,,,2.1200,38.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,4.23,,,,,,,2.1200,38.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,AMBETTER,AMBETTER,9.22,,,,,,,2.1200,38.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,AMERIGROUP,AMERIGROUP,2.12,,,,,,,2.1200,38.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,4.40,,,,,,,2.1200,38.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,BLUE CROSS,ANTHEM EXCHANGE,4.23,,,,,,,2.1200,38.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,6.38,,,,,,,2.1200,38.0000,fee schedule,APG 00402 Proc 82272 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,BLUE CROSS,ANTHEM HMO,4.23,,,,,,,2.1200,38.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,4.36,,,,,,,2.1200,38.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4.23,,,,,,,2.1200,38.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4.49,,,,,,,2.1200,38.0000,fee schedule,$4.49 from Fee Schedule BLDTM_23 for Rev 301 Proc 82272 * Qty 1 = $4.49 at 100% = $4.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,BLUE CROSS,BLUE CROSS E NETWORK,14.05,,,,,,,2.1200,38.0000,fee schedule,$4.39 from Fee Schedule BCFSB for Rev 301 Proc 82272 * Qty 1 = $4.39 at 320% = $14.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,BLUE CROSS,BLUE CROSS MEDICARE,4.40,,,,,,,2.1200,38.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,BLUE CROSS,BLUE CROSS P NETWORK,14.36,,,,,,,2.1200,38.0000,fee schedule,$4.39 from Fee Schedule BCFSB for Rev 301 Proc 82272 * Qty 1 = $4.39 at 327% = $14.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,BLUE CROSS,BLUE CROSS S NETWORK,14.36,,,,,,,2.1200,38.0000,fee schedule,$4.39 from Fee Schedule BCFSB for Rev 301 Proc 82272 * Qty 1 = $4.39 at 327% = $14.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,BLUE CROSS,TENNCARE BLUE CARE,4.25,,,,,,,2.1200,38.0000,fee schedule,$3.66 from Fee Schedule TC_24 for Rev 301 Proc 82272 * Qty 1 = $3.66 at 116% = $4.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,BLUE CROSS,TENNCARE BLUE SELECT,4.25,,,,,,,2.1200,38.0000,fee schedule,$3.66 from Fee Schedule TC_24 for Rev 301 Proc 82272 * Qty 1 = $3.66 at 116% = $4.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,CIGNA HEALTHCARE,CIGNA HMO,13.11,,,,,,,2.1200,38.0000,fee schedule,$13.11 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82272 * Qty 1 = $13.11 at 100% = $13.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,9.38,,,,,,,2.1200,38.0000,fee schedule,$9.38 from Fee Schedule CGIFP_25LR for Rev 301 Proc 82272 * Qty 1 = $9.38 at 100% = $9.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,4.44,,,,,,,2.1200,38.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,13.11,,,,,,,2.1200,38.0000,fee schedule,$13.11 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82272 * Qty 1 = $13.11 at 100% = $13.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,CIGNA HEALTHCARE,CIGNA PPO,13.11,,,,,,,2.1200,38.0000,fee schedule,$13.11 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82272 * Qty 1 = $13.11 at 100% = $13.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,4.44,,,,,,,2.1200,38.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,34.20,,,,,,,2.1200,38.0000,percent of total billed charges,90% of $38.00 in Billed Charges for Rev 301 Proc 82272 = $34.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,HUMANA,HUMANA MEDICARE,4.23,,,,,,,2.1200,38.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,4.23,,,,,,,2.1200,38.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,MEDCOST,MEDCOST VHN,18.08,,,,,,,2.1200,38.0000,percent of total billed charges,47.59% of $38.00 in Billed Charges for Rev 301 Proc 82272 = $18.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,6.50,,,,,,,2.1200,38.0000,fee schedule,APG 00402 Proc 82272 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 105% = $6.50 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,4.44,,,,,,,2.1200,38.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,4.44,,,,,,,2.1200,38.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,NHC ADVANTAGE,NHC ADVANTAGE,4.44,,,,,,,2.1200,38.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,6.38,,,,,,,2.1200,38.0000,fee schedule,APG 00402 Proc 82272 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 103.1% = $6.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,SENTARA HEALTH,SENTARA HEALTH,9.81,,,,,,,2.1200,38.0000,percent of total billed charges,25.81% of $38.00 in Billed Charges for Rev 301 Proc 82272 = $9.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,SENTARA HEALTH,SENTARA MEDICARE,4.23,,,,,,,2.1200,38.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",38.00,,,,,,,2.1200,38.0000,percent of total billed charges,100% of $38.00 in Billed Charges for Rev 301 Proc 82272 = $38.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2.31,,,,,,,2.1200,38.0000,fee schedule,$4.61 from Fee Schedule TCUHC24 for Rev 301 Proc 82272 * Qty 1 = $4.61 at 50% = $2.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4.40,,,,,,,2.1200,38.0000,fee schedule,$4.23 from Fee Schedule UHC_31910 for Rev 301 Proc 82272 * Qty 1 = $4.23 at 104% = $4.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,4.23,,,,,,,2.1200,38.0000,fee schedule,$4.23 from Fee Schedule UHC_31910 for Rev 301 Proc 82272 * Qty 1 = $4.23 at 100% = $4.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,4.23,,,,,,,2.1200,38.0000,fee schedule,$4.23 from Fee Schedule UHC_31910 for Rev 301 Proc 82272 * Qty 1 = $4.23 at 100% = $4.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,6.38,,,,,,,2.1200,38.0000,fee schedule,APG 00402 Proc 82272 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,4.23,,,,,,,2.1200,38.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,4.23,,,,,,,2.1200,38.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,WELLCARE,WELLCARE MEDICAID,38.00,,,,,,,2.1200,38.0000,percent of total billed charges,100% of $38.00 in Billed Charges for Rev 301 Proc 82272 = $38.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OCCULT BLD FECES NONSCRN 1-3 SPEC,82272,CPT,301,RC,30100069,CDM,,,,both,,,38.0000,5.7000,WELLCARE,WELLCARE MEDICARE,4.48,,,,,,,2.1200,38.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,AETNA,AETNA,148.17,,,,,,,14.8000,347.0000,percent of total billed charges,42.7% of $347.00 in Billed Charges for Rev 301 Proc 82306 = $148.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,33.15,,,,,,,14.8000,347.0000,fee schedule,APG 00401 Proc 82306 at $836.60 (Base Rate) * 0.0381 (Relative Weight) = $31.87 (Total Line Payment) at 104% = $33.15. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,29.60,,,,,,,14.8000,347.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,AETNA,AETNA HEALTHCARE MEDICARE,29.60,,,,,,,14.8000,347.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,29.60,,,,,,,14.8000,347.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,AMBETTER,AMBETTER,64.53,,,,,,,14.8000,347.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,AMERIGROUP,AMERIGROUP,14.80,,,,,,,14.8000,347.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,30.78,,,,,,,14.8000,347.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,BLUE CROSS,ANTHEM EXCHANGE,29.60,,,,,,,14.8000,347.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,32.83,,,,,,,14.8000,347.0000,fee schedule,APG 00401 Proc 82306 at $836.60 (Base Rate) * 0.0381 (Relative Weight) = $31.87 (Total Line Payment) at 103% = $32.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,BLUE CROSS,ANTHEM HMO,29.60,,,,,,,14.8000,347.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,30.49,,,,,,,14.8000,347.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",29.60,,,,,,,14.8000,347.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,100.02,,,,,,,14.8000,347.0000,fee schedule,$100.02 from Fee Schedule BLDTM_23 for Rev 301 Proc 82306 * Qty 1 = $100.02 at 100% = $100.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,BLUE CROSS,BLUE CROSS E NETWORK,129.28,,,,,,,14.8000,347.0000,fee schedule,$40.40 from Fee Schedule BCFSB for Rev 301 Proc 82306 * Qty 1 = $40.40 at 320% = $129.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,BLUE CROSS,BLUE CROSS MEDICARE,30.78,,,,,,,14.8000,347.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,BLUE CROSS,BLUE CROSS P NETWORK,132.11,,,,,,,14.8000,347.0000,fee schedule,$40.40 from Fee Schedule BCFSB for Rev 301 Proc 82306 * Qty 1 = $40.40 at 327% = $132.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,BLUE CROSS,BLUE CROSS S NETWORK,132.11,,,,,,,14.8000,347.0000,fee schedule,$40.40 from Fee Schedule BCFSB for Rev 301 Proc 82306 * Qty 1 = $40.40 at 327% = $132.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,BLUE CROSS,TENNCARE BLUE CARE,65.70,,,,,,,14.8000,347.0000,fee schedule,$56.64 from Fee Schedule TC_24 for Rev 301 Proc 82306 * Qty 1 = $56.64 at 116% = $65.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,BLUE CROSS,TENNCARE BLUE SELECT,65.70,,,,,,,14.8000,347.0000,fee schedule,$56.64 from Fee Schedule TC_24 for Rev 301 Proc 82306 * Qty 1 = $56.64 at 116% = $65.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,CIGNA HEALTHCARE,CIGNA HMO,119.13,,,,,,,14.8000,347.0000,fee schedule,$119.13 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82306 * Qty 1 = $119.13 at 100% = $119.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,64.96,,,,,,,14.8000,347.0000,fee schedule,$64.96 from Fee Schedule CGIFP_25LR for Rev 301 Proc 82306 * Qty 1 = $64.96 at 100% = $64.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,31.08,,,,,,,14.8000,347.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,119.13,,,,,,,14.8000,347.0000,fee schedule,$119.13 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82306 * Qty 1 = $119.13 at 100% = $119.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,CIGNA HEALTHCARE,CIGNA PPO,119.13,,,,,,,14.8000,347.0000,fee schedule,$119.13 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82306 * Qty 1 = $119.13 at 100% = $119.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,31.08,,,,,,,14.8000,347.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,312.30,,,,,,,14.8000,347.0000,percent of total billed charges,90% of $347.00 in Billed Charges for Rev 301 Proc 82306 = $312.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,HUMANA,HUMANA MEDICARE,29.60,,,,,,,14.8000,347.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,29.60,,,,,,,14.8000,347.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,MEDCOST,MEDCOST VHN,165.14,,,,,,,14.8000,347.0000,percent of total billed charges,47.59% of $347.00 in Billed Charges for Rev 301 Proc 82306 = $165.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,33.46,,,,,,,14.8000,347.0000,fee schedule,APG 00401 Proc 82306 at $836.60 (Base Rate) * 0.0381 (Relative Weight) = $31.87 (Total Line Payment) at 100% = $31.87... $31.87 at 105% = $33.46 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,31.08,,,,,,,14.8000,347.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,31.08,,,,,,,14.8000,347.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,NHC ADVANTAGE,NHC ADVANTAGE,31.08,,,,,,,14.8000,347.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,32.86,,,,,,,14.8000,347.0000,fee schedule,APG 00401 Proc 82306 at $836.60 (Base Rate) * 0.0381 (Relative Weight) = $31.87 (Total Line Payment) at 100% = $31.87... $31.87 at 103.1% = $32.86 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,SENTARA HEALTH,SENTARA HEALTH,89.56,,,,,,,14.8000,347.0000,percent of total billed charges,25.81% of $347.00 in Billed Charges for Rev 301 Proc 82306 = $89.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,SENTARA HEALTH,SENTARA MEDICARE,29.60,,,,,,,14.8000,347.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",347.00,,,,,,,14.8000,347.0000,percent of total billed charges,100% of $347.00 in Billed Charges for Rev 301 Proc 82306 = $347.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,20.97,,,,,,,14.8000,347.0000,fee schedule,$41.94 from Fee Schedule TCUHC24 for Rev 301 Proc 82306 * Qty 1 = $41.94 at 50% = $20.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,30.78,,,,,,,14.8000,347.0000,fee schedule,$29.60 from Fee Schedule UHC_31910 for Rev 301 Proc 82306 * Qty 1 = $29.60 at 104% = $30.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,29.60,,,,,,,14.8000,347.0000,fee schedule,$29.60 from Fee Schedule UHC_31910 for Rev 301 Proc 82306 * Qty 1 = $29.60 at 100% = $29.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,29.60,,,,,,,14.8000,347.0000,fee schedule,$29.60 from Fee Schedule UHC_31910 for Rev 301 Proc 82306 * Qty 1 = $29.60 at 100% = $29.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,32.83,,,,,,,14.8000,347.0000,fee schedule,APG 00401 Proc 82306 at $836.60 (Base Rate) * 0.0381 (Relative Weight) = $31.87 (Total Line Payment) at 103% = $32.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,29.60,,,,,,,14.8000,347.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,29.60,,,,,,,14.8000,347.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,WELLCARE,WELLCARE MEDICAID,347.00,,,,,,,14.8000,347.0000,percent of total billed charges,100% of $347.00 in Billed Charges for Rev 301 Proc 82306 = $347.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VITAMIN D 25-OH,82306,CPT,301,RC,30100070,CDM,,,,both,,,347.0000,52.0500,WELLCARE,WELLCARE MEDICARE,31.38,,,,,,,14.8000,347.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,AETNA,AETNA,187.88,,,,,,,16.4800,440.0000,percent of total billed charges,42.7% of $440.00 in Billed Charges for Rev 320 Proc 70328 = $187.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,16.4800,440.0000,fee schedule,APG 00471 Proc 70328 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,16.4800,440.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,16.4800,440.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,16.4800,440.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,AMBETTER,AMBETTER,172.12,,,,,,,16.4800,440.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,16.4800,440.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,16.4800,440.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,16.4800,440.0000,fee schedule,APG 00471 Proc 70328 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,16.4800,440.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,16.4800,440.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,16.4800,440.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,29.82,,,,,,,16.4800,440.0000,fee schedule,$29.82 from Fee Schedule BLDTM_23 for Rev 320 Proc 70328 * Qty 1 = $29.82 at 100% = $29.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,BLUE CROSS,BLUE CROSS E NETWORK,65.44,,,,,,,16.4800,440.0000,fee schedule,$20.45 from Fee Schedule BCFSC for Rev 320 Proc 70328 * Qty 1 = $20.45 at 320% = $65.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,16.4800,440.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,BLUE CROSS,BLUE CROSS P NETWORK,66.87,,,,,,,16.4800,440.0000,fee schedule,$20.45 from Fee Schedule BCFSC for Rev 320 Proc 70328 * Qty 1 = $20.45 at 327% = $66.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,BLUE CROSS,BLUE CROSS S NETWORK,66.87,,,,,,,16.4800,440.0000,fee schedule,$20.45 from Fee Schedule BCFSC for Rev 320 Proc 70328 * Qty 1 = $20.45 at 327% = $66.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,BLUE CROSS,TENNCARE BLUE CARE,16.48,,,,,,,16.4800,440.0000,fee schedule,$14.21 from Fee Schedule TC_24 for Rev 320 Proc 70328 * Qty 1 = $14.21 at 116% = $16.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,BLUE CROSS,TENNCARE BLUE SELECT,16.48,,,,,,,16.4800,440.0000,fee schedule,$14.21 from Fee Schedule TC_24 for Rev 320 Proc 70328 * Qty 1 = $14.21 at 116% = $16.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,16.4800,440.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70328 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,48.61,,,,,,,16.4800,440.0000,fee schedule,$48.61 from Fee Schedule CGIFP_25LR for Rev 320 Proc 70328 * Qty 1 = $48.61 at 100% = $48.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,16.4800,440.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,16.4800,440.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70328 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,16.4800,440.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70328 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,16.4800,440.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,396.00,,,,,,,16.4800,440.0000,percent of total billed charges,90% of $440.00 in Billed Charges for Rev 320 Proc 70328 = $396.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,HUMANA,HUMANA MEDICARE,78.96,,,,,,,16.4800,440.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,16.4800,440.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,MEDCOST,MEDCOST VHN,209.40,,,,,,,16.4800,440.0000,percent of total billed charges,47.59% of $440.00 in Billed Charges for Rev 320 Proc 70328 = $209.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,16.4800,440.0000,fee schedule,APG 00471 Proc 70328 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,16.4800,440.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,16.4800,440.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,16.4800,440.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,16.4800,440.0000,fee schedule,APG 00471 Proc 70328 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,SENTARA HEALTH,SENTARA HEALTH,113.56,,,,,,,16.4800,440.0000,percent of total billed charges,25.81% of $440.00 in Billed Charges for Rev 320 Proc 70328 = $113.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,16.4800,440.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",440.00,,,,,,,16.4800,440.0000,percent of total billed charges,100% of $440.00 in Billed Charges for Rev 320 Proc 70328 = $440.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,16.4800,440.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 70328 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,16.4800,440.0000,other,Rev 320 Proc 70328 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,16.4800,440.0000,other,Rev 320 Proc 70328 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,16.4800,440.0000,other,Rev 320 Proc 70328 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,16.4800,440.0000,fee schedule,APG 00471 Proc 70328 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,16.4800,440.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,16.4800,440.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,WELLCARE,WELLCARE MEDICAID,440.00,,,,,,,16.4800,440.0000,percent of total billed charges,100% of $440.00 in Billed Charges for Rev 320 Proc 70328 = $440.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX TMJ UNILATERAL,70328,CPT,320,RC,32000269,CDM,,,,both,,,440.0000,66.0000,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,16.4800,440.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,22.4000,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 70330 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70330 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,172.12,,,,,,,22.4000,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,22.4000,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70330 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,22.4000,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,46.82,,,,,,,22.4000,462.0000,fee schedule,$46.82 from Fee Schedule BLDTM_23 for Rev 320 Proc 70330 * Qty 1 = $46.82 at 100% = $46.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,106.62,,,,,,,22.4000,462.0000,fee schedule,$33.32 from Fee Schedule BCFSC for Rev 320 Proc 70330 * Qty 1 = $33.32 at 320% = $106.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,22.4000,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,108.96,,,,,,,22.4000,462.0000,fee schedule,$33.32 from Fee Schedule BCFSC for Rev 320 Proc 70330 * Qty 1 = $33.32 at 327% = $108.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,108.96,,,,,,,22.4000,462.0000,fee schedule,$33.32 from Fee Schedule BCFSC for Rev 320 Proc 70330 * Qty 1 = $33.32 at 327% = $108.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,27.56,,,,,,,22.4000,462.0000,fee schedule,$23.76 from Fee Schedule TC_24 for Rev 320 Proc 70330 * Qty 1 = $23.76 at 116% = $27.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,27.56,,,,,,,22.4000,462.0000,fee schedule,$23.76 from Fee Schedule TC_24 for Rev 320 Proc 70330 * Qty 1 = $23.76 at 116% = $27.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,22.4000,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70330 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,78.05,,,,,,,22.4000,462.0000,fee schedule,$78.05 from Fee Schedule CGIFP_25LR for Rev 320 Proc 70330 * Qty 1 = $78.05 at 100% = $78.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,22.4000,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70330 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,22.4000,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70330 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,22.4000,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 70330 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,78.96,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,22.4000,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 70330 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70330 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70330 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,22.4000,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 70330 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,22.4000,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 70330 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,22.4000,462.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 70330 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,22.4000,462.0000,other,Rev 320 Proc 70330 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,22.4000,462.0000,other,Rev 320 Proc 70330 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,22.4000,462.0000,other,Rev 320 Proc 70330 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 70330 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,22.4000,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 70330 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX TMJ BILATERAL,70330,CPT,320,RC,32000017,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,22.4000,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,AETNA,AETNA,1812.62,,,,,,,169.2100,4245.0000,percent of total billed charges,"42.7% of $4,245.00 in Billed Charges for Rev 610 Proc 70336 = $1,812.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,343.24,,,,,,,169.2100,4245.0000,fee schedule,APG 00293 Proc 70336 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 104% = $343.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,216.48,,,,,,,169.2100,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,AETNA,AETNA HEALTHCARE MEDICARE,216.48,,,,,,,169.2100,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,216.48,,,,,,,169.2100,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,AMBETTER,AMBETTER,471.92,,,,,,,169.2100,4245.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,225.14,,,,,,,169.2100,4245.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,ANTHEM EXCHANGE,532.97,,,,,,,169.2100,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,339.94,,,,,,,169.2100,4245.0000,fee schedule,APG 00293 Proc 70336 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 103% = $339.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,ANTHEM HMO,566.25,,,,,,,169.2100,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,222.97,,,,,,,169.2100,4245.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",666.14,,,,,,,169.2100,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,684.48,,,,,,,169.2100,4245.0000,fee schedule,$684.48 from Fee Schedule BLDTM_23 for Rev 610 Proc 70336 * Qty 1 = $684.48 at 100% = $684.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,BLUE CROSS E NETWORK,725.31,,,,,,,169.2100,4245.0000,fee schedule,$226.66 from Fee Schedule BCFSD for Rev 610 Proc 70336 * Qty 1 = $226.66 at 320% = $725.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,BLUE CROSS MEDICARE,225.14,,,,,,,169.2100,4245.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,BLUE CROSS P NETWORK,741.18,,,,,,,169.2100,4245.0000,fee schedule,$226.66 from Fee Schedule BCFSD for Rev 610 Proc 70336 * Qty 1 = $226.66 at 327% = $741.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,BLUE CROSS S NETWORK,741.18,,,,,,,169.2100,4245.0000,fee schedule,$226.66 from Fee Schedule BCFSD for Rev 610 Proc 70336 * Qty 1 = $226.66 at 327% = $741.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,TENNCARE BLUE CARE,368.16,,,,,,,169.2100,4245.0000,fee schedule,$317.38 from Fee Schedule TC_24 for Rev 610 Proc 70336 * Qty 1 = $317.38 at 116% = $368.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,BLUE CROSS,TENNCARE BLUE SELECT,368.16,,,,,,,169.2100,4245.0000,fee schedule,$317.38 from Fee Schedule TC_24 for Rev 610 Proc 70336 * Qty 1 = $317.38 at 116% = $368.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,CIGNA HEALTHCARE,CIGNA HMO,1215.00,,,,,,,169.2100,4245.0000,other,"Rev 610 Proc 70336 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,786.00,,,,,,,169.2100,4245.0000,other,Rev 610 Proc 70336 Qty 1 * $786.00 = $786.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,227.30,,,,,,,169.2100,4245.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1215.00,,,,,,,169.2100,4245.0000,other,"Rev 610 Proc 70336 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,CIGNA HEALTHCARE,CIGNA PPO,1215.00,,,,,,,169.2100,4245.0000,other,"Rev 610 Proc 70336 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,227.30,,,,,,,169.2100,4245.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3820.50,,,,,,,169.2100,4245.0000,percent of total billed charges,"90% of $4,245.00 in Billed Charges for Rev 610 Proc 70336 = $3,820.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,HUMANA,HUMANA MEDICARE,216.48,,,,,,,169.2100,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,216.48,,,,,,,169.2100,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,MEDCOST,MEDCOST VHN,2020.20,,,,,,,169.2100,4245.0000,percent of total billed charges,"47.59% of $4,245.00 in Billed Charges for Rev 610 Proc 70336 = $2,020.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,346.54,,,,,,,169.2100,4245.0000,fee schedule,APG 00293 Proc 70336 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 100% = $330.04... $330.04 at 105% = $346.54 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,227.30,,,,,,,169.2100,4245.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,227.30,,,,,,,169.2100,4245.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,NHC ADVANTAGE,NHC ADVANTAGE,227.30,,,,,,,169.2100,4245.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,340.27,,,,,,,169.2100,4245.0000,fee schedule,APG 00293 Proc 70336 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 100% = $330.04... $330.04 at 103.1% = $340.27 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,SENTARA HEALTH,SENTARA HEALTH,1095.63,,,,,,,169.2100,4245.0000,percent of total billed charges,"25.81% of $4,245.00 in Billed Charges for Rev 610 Proc 70336 = $1,095.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,SENTARA HEALTH,SENTARA MEDICARE,216.48,,,,,,,169.2100,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4245.00,,,,,,,169.2100,4245.0000,percent of total billed charges,"100% of $4,245.00 in Billed Charges for Rev 610 Proc 70336 = $4,245.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,169.21,,,,,,,169.2100,4245.0000,fee schedule,$338.41 from Fee Schedule TCUHC24 for Rev 610 Proc 70336 * Qty 1 = $338.41 at 50% = $169.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2559.00,,,,,,,169.2100,4245.0000,other,"Rev 610 Proc 70336 1 Visit at $2,559.00 per Visit = $2,559.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2448.00,,,,,,,169.2100,4245.0000,other,"Rev 610 Proc 70336 1 Visit at $2,448.00 per Visit = $2,448.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,4035.00,,,,,,,169.2100,4245.0000,other,"Rev 610 Proc 70336 1 Visit at $4,035.00 per Visit = $4,035.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,339.94,,,,,,,169.2100,4245.0000,fee schedule,APG 00293 Proc 70336 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 103% = $339.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,216.48,,,,,,,169.2100,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,216.48,,,,,,,169.2100,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,WELLCARE,WELLCARE MEDICAID,4245.00,,,,,,,169.2100,4245.0000,percent of total billed charges,"100% of $4,245.00 in Billed Charges for Rev 610 Proc 70336 = $4,245.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR TMJ UNI OR BIL W/WO/WOW CON,70336,CPT,610,RC,61000001,CDM,,,,both,,,4245.0000,636.7500,WELLCARE,WELLCARE MEDICARE,229.47,,,,,,,169.2100,4245.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA,187.45,,,,,,,16.0400,439.0000,percent of total billed charges,42.7% of $439.00 in Billed Charges for Rev 320 Proc 70355 = $187.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,16.0400,439.0000,fee schedule,APG 00471 Proc 70355 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,16.0400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,16.0400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,16.0400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,AMBETTER,AMBETTER,172.12,,,,,,,16.0400,439.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,16.0400,439.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,16.0400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,16.0400,439.0000,fee schedule,APG 00471 Proc 70355 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,16.0400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,16.0400,439.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,16.0400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,33.79,,,,,,,16.0400,439.0000,fee schedule,$33.79 from Fee Schedule BLDTM_23 for Rev 320 Proc 70355 * Qty 1 = $33.79 at 100% = $33.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS E NETWORK,28.38,,,,,,,16.0400,439.0000,fee schedule,$8.87 from Fee Schedule BCFSC for Rev 320 Proc 70355 * Qty 1 = $8.87 at 320% = $28.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,16.0400,439.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS P NETWORK,29.00,,,,,,,16.0400,439.0000,fee schedule,$8.87 from Fee Schedule BCFSC for Rev 320 Proc 70355 * Qty 1 = $8.87 at 327% = $29.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS S NETWORK,29.00,,,,,,,16.0400,439.0000,fee schedule,$8.87 from Fee Schedule BCFSC for Rev 320 Proc 70355 * Qty 1 = $8.87 at 327% = $29.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,TENNCARE BLUE CARE,18.91,,,,,,,16.0400,439.0000,fee schedule,$16.30 from Fee Schedule TC_24 for Rev 320 Proc 70355 * Qty 1 = $16.30 at 116% = $18.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,TENNCARE BLUE SELECT,18.91,,,,,,,16.0400,439.0000,fee schedule,$16.30 from Fee Schedule TC_24 for Rev 320 Proc 70355 * Qty 1 = $16.30 at 116% = $18.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA HMO,121.38,,,,,,,16.0400,439.0000,fee schedule,$121.38 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70355 * Qty 1 = $121.38 at 100% = $121.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,16.04,,,,,,,16.0400,439.0000,fee schedule,$16.04 from Fee Schedule CGIFP_25LR for Rev 320 Proc 70355 * Qty 1 = $16.04 at 100% = $16.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,16.0400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,121.38,,,,,,,16.0400,439.0000,fee schedule,$121.38 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70355 * Qty 1 = $121.38 at 100% = $121.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA PPO,121.38,,,,,,,16.0400,439.0000,fee schedule,$121.38 from Fee Schedule CIGWHS_23 for Rev 320 Proc 70355 * Qty 1 = $121.38 at 100% = $121.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,16.0400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,395.10,,,,,,,16.0400,439.0000,percent of total billed charges,90% of $439.00 in Billed Charges for Rev 320 Proc 70355 = $395.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,HUMANA,HUMANA MEDICARE,78.96,,,,,,,16.0400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,16.0400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,MEDCOST,MEDCOST VHN,208.92,,,,,,,16.0400,439.0000,percent of total billed charges,47.59% of $439.00 in Billed Charges for Rev 320 Proc 70355 = $208.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,16.0400,439.0000,fee schedule,APG 00471 Proc 70355 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,16.0400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,16.0400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,16.0400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,16.0400,439.0000,fee schedule,APG 00471 Proc 70355 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,SENTARA HEALTH,SENTARA HEALTH,113.31,,,,,,,16.0400,439.0000,percent of total billed charges,25.81% of $439.00 in Billed Charges for Rev 320 Proc 70355 = $113.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,16.0400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",439.00,,,,,,,16.0400,439.0000,percent of total billed charges,100% of $439.00 in Billed Charges for Rev 320 Proc 70355 = $439.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,16.04,,,,,,,16.0400,439.0000,fee schedule,$32.07 from Fee Schedule TCUHC24 for Rev 320 Proc 70355 * Qty 1 = $32.07 at 50% = $16.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,16.0400,439.0000,other,Rev 320 Proc 70355 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,16.0400,439.0000,other,Rev 320 Proc 70355 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,16.0400,439.0000,other,Rev 320 Proc 70355 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,16.0400,439.0000,fee schedule,APG 00471 Proc 70355 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,16.0400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,16.0400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,WELLCARE,WELLCARE MEDICAID,439.00,,,,,,,16.0400,439.0000,percent of total billed charges,100% of $439.00 in Billed Charges for Rev 320 Proc 70355 = $439.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX MANDIBLE JAW ORTHOPANTOGRAM*,70355,CPT,320,RC,32000018,CDM,,,,both,,,439.0000,65.8500,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,16.0400,439.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,AETNA,AETNA,26.05,,,,,,,2.3100,61.0000,percent of total billed charges,42.7% of $61.00 in Billed Charges for Rev 301 Proc 82310 = $26.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,6.44,,,,,,,2.3100,61.0000,fee schedule,APG 00402 Proc 82310 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 104% = $6.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5.16,,,,,,,2.3100,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,AETNA,AETNA HEALTHCARE MEDICARE,5.16,,,,,,,2.3100,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,5.16,,,,,,,2.3100,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,AMBETTER,AMBETTER,11.25,,,,,,,2.3100,61.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,AMERIGROUP,AMERIGROUP,2.58,,,,,,,2.3100,61.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,5.37,,,,,,,2.3100,61.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,ANTHEM EXCHANGE,5.16,,,,,,,2.3100,61.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,6.38,,,,,,,2.3100,61.0000,fee schedule,APG 00402 Proc 82310 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,ANTHEM HMO,5.16,,,,,,,2.3100,61.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5.31,,,,,,,2.3100,61.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5.16,,,,,,,2.3100,61.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2.31,,,,,,,2.3100,61.0000,fee schedule,$2.31 from Fee Schedule BLDTM_23 for Rev 301 Proc 82310 * Qty 1 = $2.31 at 100% = $2.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS E NETWORK,22.53,,,,,,,2.3100,61.0000,fee schedule,$7.04 from Fee Schedule BCFSB for Rev 301 Proc 82310 * Qty 1 = $7.04 at 320% = $22.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS MEDICARE,5.37,,,,,,,2.3100,61.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS P NETWORK,23.02,,,,,,,2.3100,61.0000,fee schedule,$7.04 from Fee Schedule BCFSB for Rev 301 Proc 82310 * Qty 1 = $7.04 at 327% = $23.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS S NETWORK,23.02,,,,,,,2.3100,61.0000,fee schedule,$7.04 from Fee Schedule BCFSB for Rev 301 Proc 82310 * Qty 1 = $7.04 at 327% = $23.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,TENNCARE BLUE CARE,11.04,,,,,,,2.3100,61.0000,fee schedule,$9.52 from Fee Schedule TC_24 for Rev 301 Proc 82310 * Qty 1 = $9.52 at 116% = $11.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA HMO,20.76,,,,,,,2.3100,61.0000,fee schedule,$20.76 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82310 * Qty 1 = $20.76 at 100% = $20.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11.55,,,,,,,2.3100,61.0000,fee schedule,$11.55 from Fee Schedule CGIFP_25LR for Rev 301 Proc 82310 * Qty 1 = $11.55 at 100% = $11.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,5.42,,,,,,,2.3100,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,20.76,,,,,,,2.3100,61.0000,fee schedule,$20.76 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82310 * Qty 1 = $20.76 at 100% = $20.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA PPO,20.76,,,,,,,2.3100,61.0000,fee schedule,$20.76 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82310 * Qty 1 = $20.76 at 100% = $20.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,5.42,,,,,,,2.3100,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,54.90,,,,,,,2.3100,61.0000,percent of total billed charges,90% of $61.00 in Billed Charges for Rev 301 Proc 82310 = $54.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,HUMANA,HUMANA MEDICARE,5.16,,,,,,,2.3100,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5.16,,,,,,,2.3100,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,MEDCOST,MEDCOST VHN,29.03,,,,,,,2.3100,61.0000,percent of total billed charges,47.59% of $61.00 in Billed Charges for Rev 301 Proc 82310 = $29.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,6.50,,,,,,,2.3100,61.0000,fee schedule,APG 00402 Proc 82310 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 105% = $6.50 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,5.42,,,,,,,2.3100,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,5.42,,,,,,,2.3100,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,NHC ADVANTAGE,NHC ADVANTAGE,5.42,,,,,,,2.3100,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,6.38,,,,,,,2.3100,61.0000,fee schedule,APG 00402 Proc 82310 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 103.1% = $6.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,SENTARA HEALTH,SENTARA HEALTH,15.74,,,,,,,2.3100,61.0000,percent of total billed charges,25.81% of $61.00 in Billed Charges for Rev 301 Proc 82310 = $15.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,SENTARA HEALTH,SENTARA MEDICARE,5.16,,,,,,,2.3100,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",61.00,,,,,,,2.3100,61.0000,percent of total billed charges,100% of $61.00 in Billed Charges for Rev 301 Proc 82310 = $61.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3.65,,,,,,,2.3100,61.0000,fee schedule,$7.30 from Fee Schedule TCUHC24 for Rev 301 Proc 82310 * Qty 1 = $7.30 at 50% = $3.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5.37,,,,,,,2.3100,61.0000,fee schedule,$5.16 from Fee Schedule UHC_31910 for Rev 301 Proc 82310 * Qty 1 = $5.16 at 104% = $5.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,5.16,,,,,,,2.3100,61.0000,fee schedule,$5.16 from Fee Schedule UHC_31910 for Rev 301 Proc 82310 * Qty 1 = $5.16 at 100% = $5.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,5.16,,,,,,,2.3100,61.0000,fee schedule,$5.16 from Fee Schedule UHC_31910 for Rev 301 Proc 82310 * Qty 1 = $5.16 at 100% = $5.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,6.38,,,,,,,2.3100,61.0000,fee schedule,APG 00402 Proc 82310 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5.16,,,,,,,2.3100,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5.16,,,,,,,2.3100,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,WELLCARE,WELLCARE MEDICAID,61.00,,,,,,,2.3100,61.0000,percent of total billed charges,100% of $61.00 in Billed Charges for Rev 301 Proc 82310 = $61.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CALCIUM TOTAL,82310,CPT,301,RC,30100072,CDM,,,,both,,,61.0000,9.1500,WELLCARE,WELLCARE MEDICARE,5.47,,,,,,,2.3100,61.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,AETNA,AETNA,68.32,,,,,,,6.8400,160.0000,percent of total billed charges,42.7% of $160.00 in Billed Charges for Rev 301 Proc 82330 = $68.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,14.27,,,,,,,6.8400,160.0000,fee schedule,APG 00400 Proc 82330 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 104% = $14.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,13.68,,,,,,,6.8400,160.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,AETNA,AETNA HEALTHCARE MEDICARE,13.68,,,,,,,6.8400,160.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,ALLCARE MEDICARE,ALLCARE MEDICARE,13.68,,,,,,,6.8400,160.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,AMBETTER,AMBETTER,29.82,,,,,,,6.8400,160.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,AMERIGROUP,AMERIGROUP,6.84,,,,,,,6.8400,160.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,14.23,,,,,,,6.8400,160.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,BLUE CROSS,ANTHEM EXCHANGE,13.68,,,,,,,6.8400,160.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,14.13,,,,,,,6.8400,160.0000,fee schedule,APG 00400 Proc 82330 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,BLUE CROSS,ANTHEM HMO,13.68,,,,,,,6.8400,160.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,14.09,,,,,,,6.8400,160.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",13.68,,,,,,,6.8400,160.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,45.78,,,,,,,6.8400,160.0000,fee schedule,$45.78 from Fee Schedule BLDTM_23 for Rev 301 Proc 82330 * Qty 1 = $45.78 at 100% = $45.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,BLUE CROSS,BLUE CROSS E NETWORK,59.68,,,,,,,6.8400,160.0000,fee schedule,$18.65 from Fee Schedule BCFSB for Rev 301 Proc 82330 * Qty 1 = $18.65 at 320% = $59.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,BLUE CROSS,BLUE CROSS MEDICARE,14.23,,,,,,,6.8400,160.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,BLUE CROSS,BLUE CROSS P NETWORK,60.99,,,,,,,6.8400,160.0000,fee schedule,$18.65 from Fee Schedule BCFSB for Rev 301 Proc 82330 * Qty 1 = $18.65 at 327% = $60.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,BLUE CROSS,BLUE CROSS S NETWORK,60.99,,,,,,,6.8400,160.0000,fee schedule,$18.65 from Fee Schedule BCFSB for Rev 301 Proc 82330 * Qty 1 = $18.65 at 327% = $60.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,BLUE CROSS,TENNCARE BLUE CARE,27.81,,,,,,,6.8400,160.0000,fee schedule,$23.97 from Fee Schedule TC_24 for Rev 301 Proc 82330 * Qty 1 = $23.97 at 116% = $27.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,BLUE CROSS,TENNCARE BLUE SELECT,27.81,,,,,,,6.8400,160.0000,fee schedule,$23.97 from Fee Schedule TC_24 for Rev 301 Proc 82330 * Qty 1 = $23.97 at 116% = $27.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,CIGNA HEALTHCARE,CIGNA HMO,54.97,,,,,,,6.8400,160.0000,fee schedule,$54.97 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82330 * Qty 1 = $54.97 at 100% = $54.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,30.31,,,,,,,6.8400,160.0000,fee schedule,$30.31 from Fee Schedule CGIFP_25LR for Rev 301 Proc 82330 * Qty 1 = $30.31 at 100% = $30.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,CIGNA HEALTHCARE,CIGNA MEDICARE,14.36,,,,,,,6.8400,160.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,54.97,,,,,,,6.8400,160.0000,fee schedule,$54.97 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82330 * Qty 1 = $54.97 at 100% = $54.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,CIGNA HEALTHCARE,CIGNA PPO,54.97,,,,,,,6.8400,160.0000,fee schedule,$54.97 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82330 * Qty 1 = $54.97 at 100% = $54.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,14.36,,,,,,,6.8400,160.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,144.00,,,,,,,6.8400,160.0000,percent of total billed charges,90% of $160.00 in Billed Charges for Rev 301 Proc 82330 = $144.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,HUMANA,HUMANA MEDICARE,13.68,,,,,,,6.8400,160.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,13.68,,,,,,,6.8400,160.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,MEDCOST,MEDCOST VHN,76.14,,,,,,,6.8400,160.0000,percent of total billed charges,47.59% of $160.00 in Billed Charges for Rev 301 Proc 82330 = $76.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,14.41,,,,,,,6.8400,160.0000,fee schedule,APG 00400 Proc 82330 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 105% = $14.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,14.36,,,,,,,6.8400,160.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,14.36,,,,,,,6.8400,160.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,NHC ADVANTAGE,NHC ADVANTAGE,14.36,,,,,,,6.8400,160.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,14.15,,,,,,,6.8400,160.0000,fee schedule,APG 00400 Proc 82330 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 103.1% = $14.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,SENTARA HEALTH,SENTARA HEALTH,41.30,,,,,,,6.8400,160.0000,percent of total billed charges,25.81% of $160.00 in Billed Charges for Rev 301 Proc 82330 = $41.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,SENTARA HEALTH,SENTARA MEDICARE,13.68,,,,,,,6.8400,160.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",160.00,,,,,,,6.8400,160.0000,percent of total billed charges,100% of $160.00 in Billed Charges for Rev 301 Proc 82330 = $160.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9.68,,,,,,,6.8400,160.0000,fee schedule,$19.36 from Fee Schedule TCUHC24 for Rev 301 Proc 82330 * Qty 1 = $19.36 at 50% = $9.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,14.23,,,,,,,6.8400,160.0000,fee schedule,$13.68 from Fee Schedule UHC_31910 for Rev 301 Proc 82330 * Qty 1 = $13.68 at 104% = $14.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,13.68,,,,,,,6.8400,160.0000,fee schedule,$13.68 from Fee Schedule UHC_31910 for Rev 301 Proc 82330 * Qty 1 = $13.68 at 100% = $13.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,13.68,,,,,,,6.8400,160.0000,fee schedule,$13.68 from Fee Schedule UHC_31910 for Rev 301 Proc 82330 * Qty 1 = $13.68 at 100% = $13.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,14.13,,,,,,,6.8400,160.0000,fee schedule,APG 00400 Proc 82330 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,13.68,,,,,,,6.8400,160.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,13.68,,,,,,,6.8400,160.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,WELLCARE,WELLCARE MEDICAID,160.00,,,,,,,6.8400,160.0000,percent of total billed charges,100% of $160.00 in Billed Charges for Rev 301 Proc 82330 = $160.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CALCIUM IONIZED,82330,CPT,301,RC,30100073,CDM,,,,both,,,160.0000,24.0000,WELLCARE,WELLCARE MEDICARE,14.50,,,,,,,6.8400,160.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,AETNA,AETNA,29.89,,,,,,,3.0200,70.0000,percent of total billed charges,42.7% of $70.00 in Billed Charges for Rev 301 Proc 82340 = $29.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,6.44,,,,,,,3.0200,70.0000,fee schedule,APG 00402 Proc 82340 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 104% = $6.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,6.03,,,,,,,3.0200,70.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,AETNA,AETNA HEALTHCARE MEDICARE,6.03,,,,,,,3.0200,70.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,6.03,,,,,,,3.0200,70.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,AMBETTER,AMBETTER,13.15,,,,,,,3.0200,70.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,AMERIGROUP,AMERIGROUP,3.02,,,,,,,3.0200,70.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,6.27,,,,,,,3.0200,70.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,BLUE CROSS,ANTHEM EXCHANGE,6.03,,,,,,,3.0200,70.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,6.38,,,,,,,3.0200,70.0000,fee schedule,APG 00402 Proc 82340 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,BLUE CROSS,ANTHEM HMO,6.03,,,,,,,3.0200,70.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,6.21,,,,,,,3.0200,70.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",6.03,,,,,,,3.0200,70.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,20.35,,,,,,,3.0200,70.0000,fee schedule,$20.35 from Fee Schedule BLDTM_23 for Rev 301 Proc 82340 * Qty 1 = $20.35 at 100% = $20.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,BLUE CROSS,BLUE CROSS E NETWORK,26.34,,,,,,,3.0200,70.0000,fee schedule,$8.23 from Fee Schedule BCFSB for Rev 301 Proc 82340 * Qty 1 = $8.23 at 320% = $26.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,BLUE CROSS,BLUE CROSS MEDICARE,6.27,,,,,,,3.0200,70.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,BLUE CROSS,BLUE CROSS P NETWORK,26.91,,,,,,,3.0200,70.0000,fee schedule,$8.23 from Fee Schedule BCFSB for Rev 301 Proc 82340 * Qty 1 = $8.23 at 327% = $26.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,BLUE CROSS,BLUE CROSS S NETWORK,26.91,,,,,,,3.0200,70.0000,fee schedule,$8.23 from Fee Schedule BCFSB for Rev 301 Proc 82340 * Qty 1 = $8.23 at 327% = $26.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,BLUE CROSS,TENNCARE BLUE CARE,13.39,,,,,,,3.0200,70.0000,fee schedule,$11.54 from Fee Schedule TC_24 for Rev 301 Proc 82340 * Qty 1 = $11.54 at 116% = $13.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,BLUE CROSS,TENNCARE BLUE SELECT,13.39,,,,,,,3.0200,70.0000,fee schedule,$11.54 from Fee Schedule TC_24 for Rev 301 Proc 82340 * Qty 1 = $11.54 at 116% = $13.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,CIGNA HEALTHCARE,CIGNA HMO,24.25,,,,,,,3.0200,70.0000,fee schedule,$24.25 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82340 * Qty 1 = $24.25 at 100% = $24.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12.99,,,,,,,3.0200,70.0000,fee schedule,$12.99 from Fee Schedule CGIFP_25LR for Rev 301 Proc 82340 * Qty 1 = $12.99 at 100% = $12.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,6.33,,,,,,,3.0200,70.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,24.25,,,,,,,3.0200,70.0000,fee schedule,$24.25 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82340 * Qty 1 = $24.25 at 100% = $24.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,CIGNA HEALTHCARE,CIGNA PPO,24.25,,,,,,,3.0200,70.0000,fee schedule,$24.25 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82340 * Qty 1 = $24.25 at 100% = $24.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,6.33,,,,,,,3.0200,70.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,63.00,,,,,,,3.0200,70.0000,percent of total billed charges,90% of $70.00 in Billed Charges for Rev 301 Proc 82340 = $63.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,HUMANA,HUMANA MEDICARE,6.03,,,,,,,3.0200,70.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,6.03,,,,,,,3.0200,70.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,MEDCOST,MEDCOST VHN,33.31,,,,,,,3.0200,70.0000,percent of total billed charges,47.59% of $70.00 in Billed Charges for Rev 301 Proc 82340 = $33.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,6.50,,,,,,,3.0200,70.0000,fee schedule,APG 00402 Proc 82340 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 105% = $6.50 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,6.33,,,,,,,3.0200,70.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,6.33,,,,,,,3.0200,70.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,NHC ADVANTAGE,NHC ADVANTAGE,6.33,,,,,,,3.0200,70.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,6.38,,,,,,,3.0200,70.0000,fee schedule,APG 00402 Proc 82340 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 103.1% = $6.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,SENTARA HEALTH,SENTARA HEALTH,18.07,,,,,,,3.0200,70.0000,percent of total billed charges,25.81% of $70.00 in Billed Charges for Rev 301 Proc 82340 = $18.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,SENTARA HEALTH,SENTARA MEDICARE,6.03,,,,,,,3.0200,70.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",70.00,,,,,,,3.0200,70.0000,percent of total billed charges,100% of $70.00 in Billed Charges for Rev 301 Proc 82340 = $70.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4.27,,,,,,,3.0200,70.0000,fee schedule,$8.54 from Fee Schedule TCUHC24 for Rev 301 Proc 82340 * Qty 1 = $8.54 at 50% = $4.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,6.27,,,,,,,3.0200,70.0000,fee schedule,$6.03 from Fee Schedule UHC_31910 for Rev 301 Proc 82340 * Qty 1 = $6.03 at 104% = $6.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,6.03,,,,,,,3.0200,70.0000,fee schedule,$6.03 from Fee Schedule UHC_31910 for Rev 301 Proc 82340 * Qty 1 = $6.03 at 100% = $6.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,6.03,,,,,,,3.0200,70.0000,fee schedule,$6.03 from Fee Schedule UHC_31910 for Rev 301 Proc 82340 * Qty 1 = $6.03 at 100% = $6.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,6.38,,,,,,,3.0200,70.0000,fee schedule,APG 00402 Proc 82340 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,6.03,,,,,,,3.0200,70.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,6.03,,,,,,,3.0200,70.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,WELLCARE,WELLCARE MEDICAID,70.00,,,,,,,3.0200,70.0000,percent of total billed charges,100% of $70.00 in Billed Charges for Rev 301 Proc 82340 = $70.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CALCIUM URINE QUANT TIMED SPEC,82340,CPT,301,RC,30100074,CDM,,,,both,,,70.0000,10.5000,WELLCARE,WELLCARE MEDICARE,6.39,,,,,,,3.0200,70.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CCL ADAPTER 5866-23 45,272,RC,27200891,CDM,,,,,,both,,,796.0000,119.4000,AETNA,AETNA,339.89,,,,,,,205.4500,796.0000,percent of total billed charges,42.7% of $796.00 in Billed Charges for Rev 272 = $339.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL ADAPTER 5866-23 45,272,RC,27200891,CDM,,,,,,both,,,796.0000,119.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,557.20,,,,,,,205.4500,796.0000,percent of total billed charges,Rev 272 $796.00 in Billed Charges at 70% = $557.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL ADAPTER 5866-23 45,272,RC,27200891,CDM,,,,,,both,,,796.0000,119.4000,CIGNA HEALTHCARE,CIGNA HMO,331.93,,,,,,,205.4500,796.0000,percent of total billed charges,41.7% of $796.00 in Billed Charges for Rev 272 = $331.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL ADAPTER 5866-23 45,272,RC,27200891,CDM,,,,,,both,,,796.0000,119.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,369.34,,,,,,,205.4500,796.0000,percent of total billed charges,46.4% of $796.00 in Billed Charges for Rev 272 = $369.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL ADAPTER 5866-23 45,272,RC,27200891,CDM,,,,,,both,,,796.0000,119.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,331.93,,,,,,,205.4500,796.0000,percent of total billed charges,41.7% of $796.00 in Billed Charges for Rev 272 = $331.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL ADAPTER 5866-23 45,272,RC,27200891,CDM,,,,,,both,,,796.0000,119.4000,CIGNA HEALTHCARE,CIGNA PPO,331.93,,,,,,,205.4500,796.0000,percent of total billed charges,41.7% of $796.00 in Billed Charges for Rev 272 = $331.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL ADAPTER 5866-23 45,272,RC,27200891,CDM,,,,,,both,,,796.0000,119.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,716.40,,,,,,,205.4500,796.0000,percent of total billed charges,90% of $796.00 in Billed Charges for Rev 272 = $716.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL ADAPTER 5866-23 45,272,RC,27200891,CDM,,,,,,both,,,796.0000,119.4000,MEDCOST,MEDCOST VHN,378.82,,,,,,,205.4500,796.0000,percent of total billed charges,47.59% of $796.00 in Billed Charges for Rev 272 = $378.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL ADAPTER 5866-23 45,272,RC,27200891,CDM,,,,,,both,,,796.0000,119.4000,SENTARA HEALTH,SENTARA HEALTH,205.45,,,,,,,205.4500,796.0000,percent of total billed charges,25.81% of $796.00 in Billed Charges for Rev 272 = $205.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL ADAPTER 5866-23 45,272,RC,27200891,CDM,,,,,,both,,,796.0000,119.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",796.00,,,,,,,205.4500,796.0000,percent of total billed charges,100% of $796.00 in Billed Charges for Rev 272 = $796.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL ADAPTER 5866-23 45,272,RC,27200891,CDM,,,,,,both,,,796.0000,119.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,398.00,,,,,,,205.4500,796.0000,percent of total billed charges,Rev 272 $796.00 in Billed Charges at 50% = $398.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL ADAPTER 5866-23 45,272,RC,27200891,CDM,,,,,,both,,,796.0000,119.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,257.11,,,,,,,205.4500,796.0000,other,32.3% of $796.00 in Billed Charges for Rev 272 = $257.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CCL ADAPTER 5866-23 45,272,RC,27200891,CDM,,,,,,both,,,796.0000,119.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,244.37,,,,,,,205.4500,796.0000,other,30.7% of $796.00 in Billed Charges for Rev 272 = $244.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CCL ADAPTER 5866-23 45,272,RC,27200891,CDM,,,,,,both,,,796.0000,119.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,257.11,,,,,,,205.4500,796.0000,percent of total billed charges,32.3% of $796.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL ADAPTER 5866-23 45,272,RC,27200891,CDM,,,,,,both,,,796.0000,119.4000,WELLCARE,WELLCARE MEDICAID,796.00,,,,,,,205.4500,796.0000,percent of total billed charges,100% of $796.00 in Billed Charges for Rev 272 = $796.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,AETNA,AETNA,1513.72,,,,,,,94.8500,3545.0000,percent of total billed charges,"42.7% of $3,545.00 in Billed Charges for Rev 351 Proc 70450 = $1,513.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,459.22,,,,,,,94.8500,3545.0000,fee schedule,APG 00300 Proc 70450 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 104% = $459.22. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,94.8500,3545.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,94.8500,3545.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,94.8500,3545.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,AMBETTER,AMBETTER,206.78,,,,,,,94.8500,3545.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,94.8500,3545.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,94.8500,3545.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,454.80,,,,,,,94.8500,3545.0000,fee schedule,APG 00300 Proc 70450 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 103% = $454.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,94.8500,3545.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,94.8500,3545.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,94.8500,3545.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,283.30,,,,,,,94.8500,3545.0000,fee schedule,$283.30 from Fee Schedule BLDTM_23 for Rev 351 Proc 70450 * Qty 1 = $283.30 at 100% = $283.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,BLUE CROSS,BLUE CROSS E NETWORK,235.30,,,,,,,94.8500,3545.0000,fee schedule,$73.53 from Fee Schedule BCFSD for Rev 351 Proc 70450 * Qty 1 = $73.53 at 320% = $235.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,94.8500,3545.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,BLUE CROSS,BLUE CROSS P NETWORK,240.44,,,,,,,94.8500,3545.0000,fee schedule,$73.53 from Fee Schedule BCFSD for Rev 351 Proc 70450 * Qty 1 = $73.53 at 327% = $240.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,BLUE CROSS,BLUE CROSS S NETWORK,240.44,,,,,,,94.8500,3545.0000,fee schedule,$73.53 from Fee Schedule BCFSD for Rev 351 Proc 70450 * Qty 1 = $73.53 at 327% = $240.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,BLUE CROSS,TENNCARE BLUE CARE,155.13,,,,,,,94.8500,3545.0000,fee schedule,$133.73 from Fee Schedule TC_24 for Rev 351 Proc 70450 * Qty 1 = $133.73 at 116% = $155.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,BLUE CROSS,TENNCARE BLUE SELECT,155.13,,,,,,,94.8500,3545.0000,fee schedule,$133.73 from Fee Schedule TC_24 for Rev 351 Proc 70450 * Qty 1 = $133.73 at 116% = $155.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,CIGNA HEALTHCARE,CIGNA HMO,642.00,,,,,,,94.8500,3545.0000,other,Rev 351 Proc 70450 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,427.00,,,,,,,94.8500,3545.0000,other,Rev 351 Proc 70450 Qty 1 * $427.00 = $427.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,94.8500,3545.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,642.00,,,,,,,94.8500,3545.0000,other,Rev 351 Proc 70450 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,CIGNA HEALTHCARE,CIGNA PPO,642.00,,,,,,,94.8500,3545.0000,other,Rev 351 Proc 70450 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,94.8500,3545.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3190.50,,,,,,,94.8500,3545.0000,percent of total billed charges,"90% of $3,545.00 in Billed Charges for Rev 351 Proc 70450 = $3,190.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,HUMANA,HUMANA MEDICARE,94.85,,,,,,,94.8500,3545.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,94.8500,3545.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,MEDCOST,MEDCOST VHN,1687.07,,,,,,,94.8500,3545.0000,percent of total billed charges,"47.59% of $3,545.00 in Billed Charges for Rev 351 Proc 70450 = $1,687.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,463.64,,,,,,,94.8500,3545.0000,fee schedule,APG 00300 Proc 70450 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 100% = $441.56... $441.56 at 105% = $463.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,94.8500,3545.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,94.8500,3545.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,94.8500,3545.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,455.25,,,,,,,94.8500,3545.0000,fee schedule,APG 00300 Proc 70450 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 100% = $441.56... $441.56 at 103.1% = $455.25 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,SENTARA HEALTH,SENTARA HEALTH,914.96,,,,,,,94.8500,3545.0000,percent of total billed charges,"25.81% of $3,545.00 in Billed Charges for Rev 351 Proc 70450 = $914.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,94.8500,3545.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3545.00,,,,,,,94.8500,3545.0000,percent of total billed charges,"100% of $3,545.00 in Billed Charges for Rev 351 Proc 70450 = $3,545.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,95.95,,,,,,,94.8500,3545.0000,fee schedule,$191.89 from Fee Schedule TCUHC24 for Rev 351 Proc 70450 * Qty 1 = $191.89 at 50% = $95.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1919.00,,,,,,,94.8500,3545.0000,other,"Rev 351 Proc 70450 1 Visit at $1,919.00 per Visit = $1,919.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1835.00,,,,,,,94.8500,3545.0000,other,"Rev 351 Proc 70450 1 Visit at $1,835.00 per Visit = $1,835.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,3026.00,,,,,,,94.8500,3545.0000,other,"Rev 351 Proc 70450 1 Visit at $3,026.00 per Visit = $3,026.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,454.80,,,,,,,94.8500,3545.0000,fee schedule,APG 00300 Proc 70450 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 103% = $454.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,94.8500,3545.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,94.8500,3545.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,WELLCARE,WELLCARE MEDICAID,3545.00,,,,,,,94.8500,3545.0000,percent of total billed charges,"100% of $3,545.00 in Billed Charges for Rev 351 Proc 70450 = $3,545.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT HEAD/BRAIN WO CONTRAST,70450,CPT,351,RC,35100001,CDM,,,,both,,,3545.0000,531.7500,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,94.8500,3545.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,AETNA,AETNA,519.66,,,,,,,68.9900,1217.0000,percent of total billed charges,"42.7% of $1,217.00 in Billed Charges for Rev 320 Proc 73040 = $519.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,166.44,,,,,,,68.9900,1217.0000,fee schedule,APG 00389 Proc 73040 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 104% = $166.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,316.52,,,,,,,68.9900,1217.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,AETNA,AETNA HEALTHCARE MEDICARE,316.52,,,,,,,68.9900,1217.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,316.52,,,,,,,68.9900,1217.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,AMBETTER,AMBETTER,690.02,,,,,,,68.9900,1217.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,329.19,,,,,,,68.9900,1217.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,BLUE CROSS,ANTHEM EXCHANGE,779.29,,,,,,,68.9900,1217.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,164.84,,,,,,,68.9900,1217.0000,fee schedule,APG 00389 Proc 73040 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,BLUE CROSS,ANTHEM HMO,827.95,,,,,,,68.9900,1217.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,326.02,,,,,,,68.9900,1217.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",974.01,,,,,,,68.9900,1217.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,121.01,,,,,,,68.9900,1217.0000,fee schedule,$121.01 from Fee Schedule BLDTM_23 for Rev 320 Proc 73040 * Qty 1 = $121.01 at 100% = $121.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,BLUE CROSS,BLUE CROSS E NETWORK,227.07,,,,,,,68.9900,1217.0000,fee schedule,$70.96 from Fee Schedule BCFSC for Rev 320 Proc 73040 * Qty 1 = $70.96 at 320% = $227.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,BLUE CROSS,BLUE CROSS MEDICARE,329.19,,,,,,,68.9900,1217.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,BLUE CROSS,BLUE CROSS P NETWORK,232.04,,,,,,,68.9900,1217.0000,fee schedule,$70.96 from Fee Schedule BCFSC for Rev 320 Proc 73040 * Qty 1 = $70.96 at 327% = $232.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,BLUE CROSS,BLUE CROSS S NETWORK,232.04,,,,,,,68.9900,1217.0000,fee schedule,$70.96 from Fee Schedule BCFSC for Rev 320 Proc 73040 * Qty 1 = $70.96 at 327% = $232.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,BLUE CROSS,TENNCARE BLUE CARE,68.99,,,,,,,68.9900,1217.0000,fee schedule,$59.47 from Fee Schedule TC_24 for Rev 320 Proc 73040 * Qty 1 = $59.47 at 116% = $68.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,BLUE CROSS,TENNCARE BLUE SELECT,68.99,,,,,,,68.9900,1217.0000,fee schedule,$59.47 from Fee Schedule TC_24 for Rev 320 Proc 73040 * Qty 1 = $59.47 at 116% = $68.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,CIGNA HEALTHCARE,CIGNA HMO,1061.93,,,,,,,68.9900,1217.0000,fee schedule,"$1,061.93 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73040 * Qty 1 = $1,061.93 at 100% = $1,061.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,197.68,,,,,,,68.9900,1217.0000,fee schedule,$197.68 from Fee Schedule CGIFP_25LR for Rev 320 Proc 73040 * Qty 1 = $197.68 at 100% = $197.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,332.35,,,,,,,68.9900,1217.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1061.93,,,,,,,68.9900,1217.0000,fee schedule,"$1,061.93 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73040 * Qty 1 = $1,061.93 at 100% = $1,061.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,CIGNA HEALTHCARE,CIGNA PPO,1061.93,,,,,,,68.9900,1217.0000,fee schedule,"$1,061.93 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73040 * Qty 1 = $1,061.93 at 100% = $1,061.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,332.35,,,,,,,68.9900,1217.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1095.30,,,,,,,68.9900,1217.0000,percent of total billed charges,"90% of $1,217.00 in Billed Charges for Rev 320 Proc 73040 = $1,095.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,HUMANA,HUMANA MEDICARE,316.52,,,,,,,68.9900,1217.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,316.52,,,,,,,68.9900,1217.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,MEDCOST,MEDCOST VHN,579.17,,,,,,,68.9900,1217.0000,percent of total billed charges,"47.59% of $1,217.00 in Billed Charges for Rev 320 Proc 73040 = $579.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,168.04,,,,,,,68.9900,1217.0000,fee schedule,APG 00389 Proc 73040 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 105% = $168.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,332.35,,,,,,,68.9900,1217.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,332.35,,,,,,,68.9900,1217.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,NHC ADVANTAGE,NHC ADVANTAGE,332.35,,,,,,,68.9900,1217.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,165.00,,,,,,,68.9900,1217.0000,fee schedule,APG 00389 Proc 73040 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 103.1% = $165.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,SENTARA HEALTH,SENTARA HEALTH,314.11,,,,,,,68.9900,1217.0000,percent of total billed charges,"25.81% of $1,217.00 in Billed Charges for Rev 320 Proc 73040 = $314.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,SENTARA HEALTH,SENTARA MEDICARE,316.52,,,,,,,68.9900,1217.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1217.00,,,,,,,68.9900,1217.0000,percent of total billed charges,"100% of $1,217.00 in Billed Charges for Rev 320 Proc 73040 = $1,217.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,140.29,,,,,,,68.9900,1217.0000,fee schedule,$280.58 from Fee Schedule TCUHC24 for Rev 320 Proc 73040 * Qty 1 = $280.58 at 50% = $140.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,68.9900,1217.0000,other,Rev 320 Proc 73040 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,68.9900,1217.0000,other,Rev 320 Proc 73040 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,68.9900,1217.0000,other,Rev 320 Proc 73040 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,164.84,,,,,,,68.9900,1217.0000,fee schedule,APG 00389 Proc 73040 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,316.52,,,,,,,68.9900,1217.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,316.52,,,,,,,68.9900,1217.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,WELLCARE,WELLCARE MEDICAID,1217.00,,,,,,,68.9900,1217.0000,percent of total billed charges,"100% of $1,217.00 in Billed Charges for Rev 320 Proc 73040 = $1,217.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX ARTHROGRAM SHOULDER,73040,CPT,320,RC,32000075,CDM,,,,both,,,1217.0000,182.5500,WELLCARE,WELLCARE MEDICARE,335.52,,,,,,,68.9900,1217.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,22.1900,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 73050 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,22.1900,462.0000,fee schedule,APG 00471 Proc 73050 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,22.1900,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,22.1900,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,22.1900,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,172.12,,,,,,,22.1900,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,22.1900,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,22.1900,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,22.1900,462.0000,fee schedule,APG 00471 Proc 73050 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,22.1900,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,22.1900,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,22.1900,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,36.74,,,,,,,22.1900,462.0000,fee schedule,$36.74 from Fee Schedule BLDTM_23 for Rev 320 Proc 73050 * Qty 1 = $36.74 at 100% = $36.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,83.97,,,,,,,22.1900,462.0000,fee schedule,$26.24 from Fee Schedule BCFSC for Rev 320 Proc 73050 * Qty 1 = $26.24 at 320% = $83.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,22.1900,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,85.80,,,,,,,22.1900,462.0000,fee schedule,$26.24 from Fee Schedule BCFSC for Rev 320 Proc 73050 * Qty 1 = $26.24 at 327% = $85.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,85.80,,,,,,,22.1900,462.0000,fee schedule,$26.24 from Fee Schedule BCFSC for Rev 320 Proc 73050 * Qty 1 = $26.24 at 327% = $85.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,22.19,,,,,,,22.1900,462.0000,fee schedule,$19.13 from Fee Schedule TC_24 for Rev 320 Proc 73050 * Qty 1 = $19.13 at 116% = $22.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,22.19,,,,,,,22.1900,462.0000,fee schedule,$19.13 from Fee Schedule TC_24 for Rev 320 Proc 73050 * Qty 1 = $19.13 at 116% = $22.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,22.1900,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73050 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,37.33,,,,,,,22.1900,462.0000,fee schedule,$37.33 from Fee Schedule CGIFP_25LR for Rev 320 Proc 73050 * Qty 1 = $37.33 at 100% = $37.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,22.1900,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,22.1900,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73050 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,22.1900,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73050 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,22.1900,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,22.1900,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 73050 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,78.96,,,,,,,22.1900,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,22.1900,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,22.1900,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 73050 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,22.1900,462.0000,fee schedule,APG 00471 Proc 73050 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,22.1900,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,22.1900,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,22.1900,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,22.1900,462.0000,fee schedule,APG 00471 Proc 73050 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,22.1900,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 73050 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,22.1900,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,22.1900,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 73050 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,22.1900,462.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 73050 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,22.1900,462.0000,other,Rev 320 Proc 73050 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,22.1900,462.0000,other,Rev 320 Proc 73050 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,22.1900,462.0000,other,Rev 320 Proc 73050 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,22.1900,462.0000,fee schedule,APG 00471 Proc 73050 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,22.1900,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,22.1900,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,22.1900,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 73050 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ACROMIOCLAV JOINT BILAT,73050,CPT,320,RC,32000076,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,22.1900,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,18.9100,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 73060 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,18.9100,462.0000,fee schedule,APG 00471 Proc 73060 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,18.9100,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,18.9100,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,18.9100,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,172.12,,,,,,,18.9100,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,18.9100,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,18.9100,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,18.9100,462.0000,fee schedule,APG 00471 Proc 73060 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,18.9100,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,18.9100,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,18.9100,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,31.22,,,,,,,18.9100,462.0000,fee schedule,$31.22 from Fee Schedule BLDTM_23 for Rev 320 Proc 73060 * Qty 1 = $31.22 at 100% = $31.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,59.26,,,,,,,18.9100,462.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73060 * Qty 1 = $18.52 at 320% = $59.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,18.9100,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,60.56,,,,,,,18.9100,462.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73060 * Qty 1 = $18.52 at 327% = $60.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,60.56,,,,,,,18.9100,462.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73060 * Qty 1 = $18.52 at 327% = $60.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,18.91,,,,,,,18.9100,462.0000,fee schedule,$16.30 from Fee Schedule TC_24 for Rev 320 Proc 73060 * Qty 1 = $16.30 at 116% = $18.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,18.91,,,,,,,18.9100,462.0000,fee schedule,$16.30 from Fee Schedule TC_24 for Rev 320 Proc 73060 * Qty 1 = $16.30 at 116% = $18.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,18.9100,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73060 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,45.48,,,,,,,18.9100,462.0000,fee schedule,$45.48 from Fee Schedule CGIFP_25LR for Rev 320 Proc 73060 * Qty 1 = $45.48 at 100% = $45.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,18.9100,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,18.9100,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73060 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,18.9100,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73060 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,18.9100,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,18.9100,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 73060 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,78.96,,,,,,,18.9100,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,18.9100,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,18.9100,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 73060 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,18.9100,462.0000,fee schedule,APG 00471 Proc 73060 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,18.9100,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,18.9100,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,18.9100,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,18.9100,462.0000,fee schedule,APG 00471 Proc 73060 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,18.9100,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 73060 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,18.9100,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,18.9100,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 73060 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,18.9100,462.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 73060 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,18.9100,462.0000,other,Rev 320 Proc 73060 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,18.9100,462.0000,other,Rev 320 Proc 73060 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,18.9100,462.0000,other,Rev 320 Proc 73060 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,18.9100,462.0000,fee schedule,APG 00471 Proc 73060 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,18.9100,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,18.9100,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,18.9100,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 73060 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HUMERUS 2 VIEW+,73060,CPT,320,RC,32000078,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,18.9100,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CEMENT RADIOPAQ TOBRAMYCIN,272,RC,27200537,CDM,,,,,,both,,,1411.0000,211.6500,AETNA,AETNA,602.50,,,,,,,364.1800,1411.0000,percent of total billed charges,"42.7% of $1,411.00 in Billed Charges for Rev 272 = $602.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CEMENT RADIOPAQ TOBRAMYCIN,272,RC,27200537,CDM,,,,,,both,,,1411.0000,211.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,987.70,,,,,,,364.1800,1411.0000,percent of total billed charges,"Rev 272 $1,411.00 in Billed Charges at 70% = $987.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CEMENT RADIOPAQ TOBRAMYCIN,272,RC,27200537,CDM,,,,,,both,,,1411.0000,211.6500,CIGNA HEALTHCARE,CIGNA HMO,588.39,,,,,,,364.1800,1411.0000,percent of total billed charges,"41.7% of $1,411.00 in Billed Charges for Rev 272 = $588.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CEMENT RADIOPAQ TOBRAMYCIN,272,RC,27200537,CDM,,,,,,both,,,1411.0000,211.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,654.70,,,,,,,364.1800,1411.0000,percent of total billed charges,"46.4% of $1,411.00 in Billed Charges for Rev 272 = $654.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CEMENT RADIOPAQ TOBRAMYCIN,272,RC,27200537,CDM,,,,,,both,,,1411.0000,211.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,588.39,,,,,,,364.1800,1411.0000,percent of total billed charges,"41.7% of $1,411.00 in Billed Charges for Rev 272 = $588.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CEMENT RADIOPAQ TOBRAMYCIN,272,RC,27200537,CDM,,,,,,both,,,1411.0000,211.6500,CIGNA HEALTHCARE,CIGNA PPO,588.39,,,,,,,364.1800,1411.0000,percent of total billed charges,"41.7% of $1,411.00 in Billed Charges for Rev 272 = $588.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CEMENT RADIOPAQ TOBRAMYCIN,272,RC,27200537,CDM,,,,,,both,,,1411.0000,211.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1269.90,,,,,,,364.1800,1411.0000,percent of total billed charges,"90% of $1,411.00 in Billed Charges for Rev 272 = $1,269.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CEMENT RADIOPAQ TOBRAMYCIN,272,RC,27200537,CDM,,,,,,both,,,1411.0000,211.6500,MEDCOST,MEDCOST VHN,671.49,,,,,,,364.1800,1411.0000,percent of total billed charges,"47.59% of $1,411.00 in Billed Charges for Rev 272 = $671.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CEMENT RADIOPAQ TOBRAMYCIN,272,RC,27200537,CDM,,,,,,both,,,1411.0000,211.6500,SENTARA HEALTH,SENTARA HEALTH,364.18,,,,,,,364.1800,1411.0000,percent of total billed charges,"25.81% of $1,411.00 in Billed Charges for Rev 272 = $364.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CEMENT RADIOPAQ TOBRAMYCIN,272,RC,27200537,CDM,,,,,,both,,,1411.0000,211.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1411.00,,,,,,,364.1800,1411.0000,percent of total billed charges,"100% of $1,411.00 in Billed Charges for Rev 272 = $1,411.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CEMENT RADIOPAQ TOBRAMYCIN,272,RC,27200537,CDM,,,,,,both,,,1411.0000,211.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,705.50,,,,,,,364.1800,1411.0000,percent of total billed charges,"Rev 272 $1,411.00 in Billed Charges at 50% = $705.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CEMENT RADIOPAQ TOBRAMYCIN,272,RC,27200537,CDM,,,,,,both,,,1411.0000,211.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,455.75,,,,,,,364.1800,1411.0000,other,"32.3% of $1,411.00 in Billed Charges for Rev 272 = $455.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CEMENT RADIOPAQ TOBRAMYCIN,272,RC,27200537,CDM,,,,,,both,,,1411.0000,211.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,433.18,,,,,,,364.1800,1411.0000,other,"30.7% of $1,411.00 in Billed Charges for Rev 272 = $433.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CEMENT RADIOPAQ TOBRAMYCIN,272,RC,27200537,CDM,,,,,,both,,,1411.0000,211.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,455.75,,,,,,,364.1800,1411.0000,percent of total billed charges,"32.3% of $1,411.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CEMENT RADIOPAQ TOBRAMYCIN,272,RC,27200537,CDM,,,,,,both,,,1411.0000,211.6500,WELLCARE,WELLCARE MEDICAID,1411.00,,,,,,,364.1800,1411.0000,percent of total billed charges,"100% of $1,411.00 in Billed Charges for Rev 272 = $1,411.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CIRCUMCISION,723,RC,72300001,CDM,,,,,,both,,,714.0000,107.1000,AETNA,AETNA,304.88,,,,,,,46.0000,714.0000,percent of total billed charges,42.7% of $714.00 in Billed Charges for Rev 723 = $304.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CIRCUMCISION,723,RC,72300001,CDM,,,,,,both,,,714.0000,107.1000,BLUE CROSS,ANTHEM EXCHANGE,117.81,,,,,,,46.0000,714.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CIRCUMCISION,723,RC,72300001,CDM,,,,,,both,,,714.0000,107.1000,BLUE CROSS,ANTHEM HMO,117.81,,,,,,,46.0000,714.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CIRCUMCISION,723,RC,72300001,CDM,,,,,,both,,,714.0000,107.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",117.81,,,,,,,46.0000,714.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CIRCUMCISION,723,RC,72300001,CDM,,,,,,both,,,714.0000,107.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,499.80,,,,,,,46.0000,714.0000,percent of total billed charges,Rev 723 $714.00 in Billed Charges at 70% = $499.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CIRCUMCISION,723,RC,72300001,CDM,,,,,,both,,,714.0000,107.1000,BLUE CROSS,BLUE CROSS E NETWORK,46.00,,,,,,,46.0000,714.0000,other,Rev 723 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CIRCUMCISION,723,RC,72300001,CDM,,,,,,both,,,714.0000,107.1000,BLUE CROSS,BLUE CROSS P NETWORK,46.00,,,,,,,46.0000,714.0000,other,Rev 723 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CIRCUMCISION,723,RC,72300001,CDM,,,,,,both,,,714.0000,107.1000,BLUE CROSS,BLUE CROSS S NETWORK,46.00,,,,,,,46.0000,714.0000,other,Rev 723 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CIRCUMCISION,723,RC,72300001,CDM,,,,,,both,,,714.0000,107.1000,CIGNA HEALTHCARE,CIGNA HMO,297.74,,,,,,,46.0000,714.0000,percent of total billed charges,41.7% of $714.00 in Billed Charges for Rev 723 = $297.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CIRCUMCISION,723,RC,72300001,CDM,,,,,,both,,,714.0000,107.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,331.30,,,,,,,46.0000,714.0000,percent of total billed charges,46.4% of $714.00 in Billed Charges for Rev 723 = $331.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CIRCUMCISION,723,RC,72300001,CDM,,,,,,both,,,714.0000,107.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,297.74,,,,,,,46.0000,714.0000,percent of total billed charges,41.7% of $714.00 in Billed Charges for Rev 723 = $297.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CIRCUMCISION,723,RC,72300001,CDM,,,,,,both,,,714.0000,107.1000,CIGNA HEALTHCARE,CIGNA PPO,297.74,,,,,,,46.0000,714.0000,percent of total billed charges,41.7% of $714.00 in Billed Charges for Rev 723 = $297.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CIRCUMCISION,723,RC,72300001,CDM,,,,,,both,,,714.0000,107.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,642.60,,,,,,,46.0000,714.0000,percent of total billed charges,90% of $714.00 in Billed Charges for Rev 723 = $642.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CIRCUMCISION,723,RC,72300001,CDM,,,,,,both,,,714.0000,107.1000,MEDCOST,MEDCOST VHN,339.79,,,,,,,46.0000,714.0000,percent of total billed charges,47.59% of $714.00 in Billed Charges for Rev 723 = $339.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CIRCUMCISION,723,RC,72300001,CDM,,,,,,both,,,714.0000,107.1000,SENTARA HEALTH,SENTARA HEALTH,184.28,,,,,,,46.0000,714.0000,percent of total billed charges,25.81% of $714.00 in Billed Charges for Rev 723 = $184.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CIRCUMCISION,723,RC,72300001,CDM,,,,,,both,,,714.0000,107.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",714.00,,,,,,,46.0000,714.0000,percent of total billed charges,100% of $714.00 in Billed Charges for Rev 723 = $714.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CIRCUMCISION,723,RC,72300001,CDM,,,,,,both,,,714.0000,107.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,357.00,,,,,,,46.0000,714.0000,percent of total billed charges,Rev 723 $714.00 in Billed Charges at 50% = $357.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CIRCUMCISION,723,RC,72300001,CDM,,,,,,both,,,714.0000,107.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,230.62,,,,,,,46.0000,714.0000,other,32.3% of $714.00 in Billed Charges for Rev 723 = $230.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CIRCUMCISION,723,RC,72300001,CDM,,,,,,both,,,714.0000,107.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,219.20,,,,,,,46.0000,714.0000,other,30.7% of $714.00 in Billed Charges for Rev 723 = $219.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CIRCUMCISION,723,RC,72300001,CDM,,,,,,both,,,714.0000,107.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,230.62,,,,,,,46.0000,714.0000,percent of total billed charges,32.3% of $714.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CIRCUMCISION,723,RC,72300001,CDM,,,,,,both,,,714.0000,107.1000,WELLCARE,WELLCARE MEDICAID,714.00,,,,,,,46.0000,714.0000,percent of total billed charges,100% of $714.00 in Billed Charges for Rev 723 = $714.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL AZUR 018 DETACH 15X302,278,RC,27800508,CDM,,,,,,both,,,3004.0000,450.6000,AETNA,AETNA,1441.92,,,,,,,775.3300,3004.0000,percent of total billed charges,"48% of $3,004.00 in Billed Charges for Rev 278 = $1,441.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 15X302,278,RC,27800508,CDM,,,,,,both,,,3004.0000,450.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1502.00,,,,,,,775.3300,3004.0000,percent of total billed charges,"50% of $3,004.00 in Billed Charges for Rev 278 = $1,502.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 15X302,278,RC,27800508,CDM,,,,,,both,,,3004.0000,450.6000,CIGNA HEALTHCARE,CIGNA HMO,1252.67,,,,,,,775.3300,3004.0000,percent of total billed charges,"41.7% of $3,004.00 in Billed Charges for Rev 278 = $1,252.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 15X302,278,RC,27800508,CDM,,,,,,both,,,3004.0000,450.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1201.60,,,,,,,775.3300,3004.0000,percent of total billed charges,"40% of $3,004.00 in Billed Charges for Rev 278 = $1,201.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 15X302,278,RC,27800508,CDM,,,,,,both,,,3004.0000,450.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1252.67,,,,,,,775.3300,3004.0000,percent of total billed charges,"41.7% of $3,004.00 in Billed Charges for Rev 278 = $1,252.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 15X302,278,RC,27800508,CDM,,,,,,both,,,3004.0000,450.6000,CIGNA HEALTHCARE,CIGNA PPO,1252.67,,,,,,,775.3300,3004.0000,percent of total billed charges,"41.7% of $3,004.00 in Billed Charges for Rev 278 = $1,252.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 15X302,278,RC,27800508,CDM,,,,,,both,,,3004.0000,450.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2703.60,,,,,,,775.3300,3004.0000,percent of total billed charges,"90% of $3,004.00 in Billed Charges for Rev 278 = $2,703.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 15X302,278,RC,27800508,CDM,,,,,,both,,,3004.0000,450.6000,MEDCOST,MEDCOST VHN,1429.60,,,,,,,775.3300,3004.0000,percent of total billed charges,"47.59% of $3,004.00 in Billed Charges for Rev 278 = $1,429.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 15X302,278,RC,27800508,CDM,,,,,,both,,,3004.0000,450.6000,SENTARA HEALTH,SENTARA HEALTH,775.33,,,,,,,775.3300,3004.0000,percent of total billed charges,"25.81% of $3,004.00 in Billed Charges for Rev 278 = $775.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 15X302,278,RC,27800508,CDM,,,,,,both,,,3004.0000,450.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3004.00,,,,,,,775.3300,3004.0000,percent of total billed charges,"100% of $3,004.00 in Billed Charges for Rev 278 = $3,004.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 15X302,278,RC,27800508,CDM,,,,,,both,,,3004.0000,450.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1502.00,,,,,,,775.3300,3004.0000,percent of total billed charges,"Rev 278 $3,004.00 in Billed Charges at 50% = $1,502.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 15X302,278,RC,27800508,CDM,,,,,,both,,,3004.0000,450.6000,WELLCARE,WELLCARE MEDICAID,3004.00,,,,,,,775.3300,3004.0000,percent of total billed charges,"100% of $3,004.00 in Billed Charges for Rev 278 = $3,004.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 2X2 2X4 3X2 3X5 4X5,278,RC,27800504,CDM,,,,,,both,,,2268.0000,340.2000,AETNA,AETNA,1088.64,,,,,,,585.3700,2268.0000,percent of total billed charges,"48% of $2,268.00 in Billed Charges for Rev 278 = $1,088.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 2X2 2X4 3X2 3X5 4X5,278,RC,27800504,CDM,,,,,,both,,,2268.0000,340.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1134.00,,,,,,,585.3700,2268.0000,percent of total billed charges,"50% of $2,268.00 in Billed Charges for Rev 278 = $1,134.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 2X2 2X4 3X2 3X5 4X5,278,RC,27800504,CDM,,,,,,both,,,2268.0000,340.2000,CIGNA HEALTHCARE,CIGNA HMO,945.76,,,,,,,585.3700,2268.0000,percent of total billed charges,"41.7% of $2,268.00 in Billed Charges for Rev 278 = $945.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 2X2 2X4 3X2 3X5 4X5,278,RC,27800504,CDM,,,,,,both,,,2268.0000,340.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,907.20,,,,,,,585.3700,2268.0000,percent of total billed charges,"40% of $2,268.00 in Billed Charges for Rev 278 = $907.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 2X2 2X4 3X2 3X5 4X5,278,RC,27800504,CDM,,,,,,both,,,2268.0000,340.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,945.76,,,,,,,585.3700,2268.0000,percent of total billed charges,"41.7% of $2,268.00 in Billed Charges for Rev 278 = $945.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 2X2 2X4 3X2 3X5 4X5,278,RC,27800504,CDM,,,,,,both,,,2268.0000,340.2000,CIGNA HEALTHCARE,CIGNA PPO,945.76,,,,,,,585.3700,2268.0000,percent of total billed charges,"41.7% of $2,268.00 in Billed Charges for Rev 278 = $945.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 2X2 2X4 3X2 3X5 4X5,278,RC,27800504,CDM,,,,,,both,,,2268.0000,340.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2041.20,,,,,,,585.3700,2268.0000,percent of total billed charges,"90% of $2,268.00 in Billed Charges for Rev 278 = $2,041.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 2X2 2X4 3X2 3X5 4X5,278,RC,27800504,CDM,,,,,,both,,,2268.0000,340.2000,MEDCOST,MEDCOST VHN,1079.34,,,,,,,585.3700,2268.0000,percent of total billed charges,"47.59% of $2,268.00 in Billed Charges for Rev 278 = $1,079.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 2X2 2X4 3X2 3X5 4X5,278,RC,27800504,CDM,,,,,,both,,,2268.0000,340.2000,SENTARA HEALTH,SENTARA HEALTH,585.37,,,,,,,585.3700,2268.0000,percent of total billed charges,"25.81% of $2,268.00 in Billed Charges for Rev 278 = $585.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 2X2 2X4 3X2 3X5 4X5,278,RC,27800504,CDM,,,,,,both,,,2268.0000,340.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2268.00,,,,,,,585.3700,2268.0000,percent of total billed charges,"100% of $2,268.00 in Billed Charges for Rev 278 = $2,268.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 2X2 2X4 3X2 3X5 4X5,278,RC,27800504,CDM,,,,,,both,,,2268.0000,340.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1134.00,,,,,,,585.3700,2268.0000,percent of total billed charges,"Rev 278 $2,268.00 in Billed Charges at 50% = $1,134.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 2X2 2X4 3X2 3X5 4X5,278,RC,27800504,CDM,,,,,,both,,,2268.0000,340.2000,WELLCARE,WELLCARE MEDICAID,2268.00,,,,,,,585.3700,2268.0000,percent of total billed charges,"100% of $2,268.00 in Billed Charges for Rev 278 = $2,268.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 4X20 6X20 8X20,278,RC,27800506,CDM,,,,,,both,,,2732.0000,409.8000,AETNA,AETNA,1311.36,,,,,,,705.1300,2732.0000,percent of total billed charges,"48% of $2,732.00 in Billed Charges for Rev 278 = $1,311.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 4X20 6X20 8X20,278,RC,27800506,CDM,,,,,,both,,,2732.0000,409.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1366.00,,,,,,,705.1300,2732.0000,percent of total billed charges,"50% of $2,732.00 in Billed Charges for Rev 278 = $1,366.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 4X20 6X20 8X20,278,RC,27800506,CDM,,,,,,both,,,2732.0000,409.8000,CIGNA HEALTHCARE,CIGNA HMO,1139.24,,,,,,,705.1300,2732.0000,percent of total billed charges,"41.7% of $2,732.00 in Billed Charges for Rev 278 = $1,139.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 4X20 6X20 8X20,278,RC,27800506,CDM,,,,,,both,,,2732.0000,409.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1092.80,,,,,,,705.1300,2732.0000,percent of total billed charges,"40% of $2,732.00 in Billed Charges for Rev 278 = $1,092.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 4X20 6X20 8X20,278,RC,27800506,CDM,,,,,,both,,,2732.0000,409.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1139.24,,,,,,,705.1300,2732.0000,percent of total billed charges,"41.7% of $2,732.00 in Billed Charges for Rev 278 = $1,139.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 4X20 6X20 8X20,278,RC,27800506,CDM,,,,,,both,,,2732.0000,409.8000,CIGNA HEALTHCARE,CIGNA PPO,1139.24,,,,,,,705.1300,2732.0000,percent of total billed charges,"41.7% of $2,732.00 in Billed Charges for Rev 278 = $1,139.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 4X20 6X20 8X20,278,RC,27800506,CDM,,,,,,both,,,2732.0000,409.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2458.80,,,,,,,705.1300,2732.0000,percent of total billed charges,"90% of $2,732.00 in Billed Charges for Rev 278 = $2,458.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 4X20 6X20 8X20,278,RC,27800506,CDM,,,,,,both,,,2732.0000,409.8000,MEDCOST,MEDCOST VHN,1300.16,,,,,,,705.1300,2732.0000,percent of total billed charges,"47.59% of $2,732.00 in Billed Charges for Rev 278 = $1,300.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 4X20 6X20 8X20,278,RC,27800506,CDM,,,,,,both,,,2732.0000,409.8000,SENTARA HEALTH,SENTARA HEALTH,705.13,,,,,,,705.1300,2732.0000,percent of total billed charges,"25.81% of $2,732.00 in Billed Charges for Rev 278 = $705.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 4X20 6X20 8X20,278,RC,27800506,CDM,,,,,,both,,,2732.0000,409.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2732.00,,,,,,,705.1300,2732.0000,percent of total billed charges,"100% of $2,732.00 in Billed Charges for Rev 278 = $2,732.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 4X20 6X20 8X20,278,RC,27800506,CDM,,,,,,both,,,2732.0000,409.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1366.00,,,,,,,705.1300,2732.0000,percent of total billed charges,"Rev 278 $2,732.00 in Billed Charges at 50% = $1,366.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 4X20 6X20 8X20,278,RC,27800506,CDM,,,,,,both,,,2732.0000,409.8000,WELLCARE,WELLCARE MEDICAID,2732.00,,,,,,,705.1300,2732.0000,percent of total billed charges,"100% of $2,732.00 in Billed Charges for Rev 278 = $2,732.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 6X15 8X15 12X15,278,RC,27800507,CDM,,,,,,both,,,2594.0000,389.1000,AETNA,AETNA,1245.12,,,,,,,669.5100,2594.0000,percent of total billed charges,"48% of $2,594.00 in Billed Charges for Rev 278 = $1,245.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 6X15 8X15 12X15,278,RC,27800507,CDM,,,,,,both,,,2594.0000,389.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1297.00,,,,,,,669.5100,2594.0000,percent of total billed charges,"50% of $2,594.00 in Billed Charges for Rev 278 = $1,297.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 6X15 8X15 12X15,278,RC,27800507,CDM,,,,,,both,,,2594.0000,389.1000,CIGNA HEALTHCARE,CIGNA HMO,1081.70,,,,,,,669.5100,2594.0000,percent of total billed charges,"41.7% of $2,594.00 in Billed Charges for Rev 278 = $1,081.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 6X15 8X15 12X15,278,RC,27800507,CDM,,,,,,both,,,2594.0000,389.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1037.60,,,,,,,669.5100,2594.0000,percent of total billed charges,"40% of $2,594.00 in Billed Charges for Rev 278 = $1,037.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 6X15 8X15 12X15,278,RC,27800507,CDM,,,,,,both,,,2594.0000,389.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1081.70,,,,,,,669.5100,2594.0000,percent of total billed charges,"41.7% of $2,594.00 in Billed Charges for Rev 278 = $1,081.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 6X15 8X15 12X15,278,RC,27800507,CDM,,,,,,both,,,2594.0000,389.1000,CIGNA HEALTHCARE,CIGNA PPO,1081.70,,,,,,,669.5100,2594.0000,percent of total billed charges,"41.7% of $2,594.00 in Billed Charges for Rev 278 = $1,081.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 6X15 8X15 12X15,278,RC,27800507,CDM,,,,,,both,,,2594.0000,389.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2334.60,,,,,,,669.5100,2594.0000,percent of total billed charges,"90% of $2,594.00 in Billed Charges for Rev 278 = $2,334.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 6X15 8X15 12X15,278,RC,27800507,CDM,,,,,,both,,,2594.0000,389.1000,MEDCOST,MEDCOST VHN,1234.48,,,,,,,669.5100,2594.0000,percent of total billed charges,"47.59% of $2,594.00 in Billed Charges for Rev 278 = $1,234.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 6X15 8X15 12X15,278,RC,27800507,CDM,,,,,,both,,,2594.0000,389.1000,SENTARA HEALTH,SENTARA HEALTH,669.51,,,,,,,669.5100,2594.0000,percent of total billed charges,"25.81% of $2,594.00 in Billed Charges for Rev 278 = $669.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 6X15 8X15 12X15,278,RC,27800507,CDM,,,,,,both,,,2594.0000,389.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2594.00,,,,,,,669.5100,2594.0000,percent of total billed charges,"100% of $2,594.00 in Billed Charges for Rev 278 = $2,594.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 6X15 8X15 12X15,278,RC,27800507,CDM,,,,,,both,,,2594.0000,389.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1297.00,,,,,,,669.5100,2594.0000,percent of total billed charges,"Rev 278 $2,594.00 in Billed Charges at 50% = $1,297.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH 6X15 8X15 12X15,278,RC,27800507,CDM,,,,,,both,,,2594.0000,389.1000,WELLCARE,WELLCARE MEDICAID,2594.00,,,,,,,669.5100,2594.0000,percent of total billed charges,"100% of $2,594.00 in Billed Charges for Rev 278 = $2,594.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 10X26,278,RC,27800512,CDM,,,,,,both,,,2321.0000,348.1500,AETNA,AETNA,1114.08,,,,,,,599.0500,2321.0000,percent of total billed charges,"48% of $2,321.00 in Billed Charges for Rev 278 = $1,114.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 10X26,278,RC,27800512,CDM,,,,,,both,,,2321.0000,348.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1160.50,,,,,,,599.0500,2321.0000,percent of total billed charges,"50% of $2,321.00 in Billed Charges for Rev 278 = $1,160.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 10X26,278,RC,27800512,CDM,,,,,,both,,,2321.0000,348.1500,CIGNA HEALTHCARE,CIGNA HMO,967.86,,,,,,,599.0500,2321.0000,percent of total billed charges,"41.7% of $2,321.00 in Billed Charges for Rev 278 = $967.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 10X26,278,RC,27800512,CDM,,,,,,both,,,2321.0000,348.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,928.40,,,,,,,599.0500,2321.0000,percent of total billed charges,"40% of $2,321.00 in Billed Charges for Rev 278 = $928.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 10X26,278,RC,27800512,CDM,,,,,,both,,,2321.0000,348.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,967.86,,,,,,,599.0500,2321.0000,percent of total billed charges,"41.7% of $2,321.00 in Billed Charges for Rev 278 = $967.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 10X26,278,RC,27800512,CDM,,,,,,both,,,2321.0000,348.1500,CIGNA HEALTHCARE,CIGNA PPO,967.86,,,,,,,599.0500,2321.0000,percent of total billed charges,"41.7% of $2,321.00 in Billed Charges for Rev 278 = $967.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 10X26,278,RC,27800512,CDM,,,,,,both,,,2321.0000,348.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2088.90,,,,,,,599.0500,2321.0000,percent of total billed charges,"90% of $2,321.00 in Billed Charges for Rev 278 = $2,088.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 10X26,278,RC,27800512,CDM,,,,,,both,,,2321.0000,348.1500,MEDCOST,MEDCOST VHN,1104.56,,,,,,,599.0500,2321.0000,percent of total billed charges,"47.59% of $2,321.00 in Billed Charges for Rev 278 = $1,104.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 10X26,278,RC,27800512,CDM,,,,,,both,,,2321.0000,348.1500,SENTARA HEALTH,SENTARA HEALTH,599.05,,,,,,,599.0500,2321.0000,percent of total billed charges,"25.81% of $2,321.00 in Billed Charges for Rev 278 = $599.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 10X26,278,RC,27800512,CDM,,,,,,both,,,2321.0000,348.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2321.00,,,,,,,599.0500,2321.0000,percent of total billed charges,"100% of $2,321.00 in Billed Charges for Rev 278 = $2,321.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 10X26,278,RC,27800512,CDM,,,,,,both,,,2321.0000,348.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1160.50,,,,,,,599.0500,2321.0000,percent of total billed charges,"Rev 278 $2,321.00 in Billed Charges at 50% = $1,160.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 10X26,278,RC,27800512,CDM,,,,,,both,,,2321.0000,348.1500,WELLCARE,WELLCARE MEDICAID,2321.00,,,,,,,599.0500,2321.0000,percent of total billed charges,"100% of $2,321.00 in Billed Charges for Rev 278 = $2,321.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 14X34,278,RC,27800513,CDM,,,,,,both,,,2449.0000,367.3500,AETNA,AETNA,1175.52,,,,,,,632.0900,2449.0000,percent of total billed charges,"48% of $2,449.00 in Billed Charges for Rev 278 = $1,175.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 14X34,278,RC,27800513,CDM,,,,,,both,,,2449.0000,367.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1224.50,,,,,,,632.0900,2449.0000,percent of total billed charges,"50% of $2,449.00 in Billed Charges for Rev 278 = $1,224.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 14X34,278,RC,27800513,CDM,,,,,,both,,,2449.0000,367.3500,CIGNA HEALTHCARE,CIGNA HMO,1021.23,,,,,,,632.0900,2449.0000,percent of total billed charges,"41.7% of $2,449.00 in Billed Charges for Rev 278 = $1,021.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 14X34,278,RC,27800513,CDM,,,,,,both,,,2449.0000,367.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,979.60,,,,,,,632.0900,2449.0000,percent of total billed charges,"40% of $2,449.00 in Billed Charges for Rev 278 = $979.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 14X34,278,RC,27800513,CDM,,,,,,both,,,2449.0000,367.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1021.23,,,,,,,632.0900,2449.0000,percent of total billed charges,"41.7% of $2,449.00 in Billed Charges for Rev 278 = $1,021.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 14X34,278,RC,27800513,CDM,,,,,,both,,,2449.0000,367.3500,CIGNA HEALTHCARE,CIGNA PPO,1021.23,,,,,,,632.0900,2449.0000,percent of total billed charges,"41.7% of $2,449.00 in Billed Charges for Rev 278 = $1,021.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 14X34,278,RC,27800513,CDM,,,,,,both,,,2449.0000,367.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2204.10,,,,,,,632.0900,2449.0000,percent of total billed charges,"90% of $2,449.00 in Billed Charges for Rev 278 = $2,204.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 14X34,278,RC,27800513,CDM,,,,,,both,,,2449.0000,367.3500,MEDCOST,MEDCOST VHN,1165.48,,,,,,,632.0900,2449.0000,percent of total billed charges,"47.59% of $2,449.00 in Billed Charges for Rev 278 = $1,165.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 14X34,278,RC,27800513,CDM,,,,,,both,,,2449.0000,367.3500,SENTARA HEALTH,SENTARA HEALTH,632.09,,,,,,,632.0900,2449.0000,percent of total billed charges,"25.81% of $2,449.00 in Billed Charges for Rev 278 = $632.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 14X34,278,RC,27800513,CDM,,,,,,both,,,2449.0000,367.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2449.00,,,,,,,632.0900,2449.0000,percent of total billed charges,"100% of $2,449.00 in Billed Charges for Rev 278 = $2,449.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 14X34,278,RC,27800513,CDM,,,,,,both,,,2449.0000,367.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1224.50,,,,,,,632.0900,2449.0000,percent of total billed charges,"Rev 278 $2,449.00 in Billed Charges at 50% = $1,224.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 14X34,278,RC,27800513,CDM,,,,,,both,,,2449.0000,367.3500,WELLCARE,WELLCARE MEDICAID,2449.00,,,,,,,632.0900,2449.0000,percent of total billed charges,"100% of $2,449.00 in Billed Charges for Rev 278 = $2,449.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 8X20,278,RC,27800511,CDM,,,,,,both,,,2190.0000,328.5000,AETNA,AETNA,1051.20,,,,,,,565.2400,2190.0000,percent of total billed charges,"48% of $2,190.00 in Billed Charges for Rev 278 = $1,051.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 8X20,278,RC,27800511,CDM,,,,,,both,,,2190.0000,328.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1095.00,,,,,,,565.2400,2190.0000,percent of total billed charges,"50% of $2,190.00 in Billed Charges for Rev 278 = $1,095.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 8X20,278,RC,27800511,CDM,,,,,,both,,,2190.0000,328.5000,CIGNA HEALTHCARE,CIGNA HMO,913.23,,,,,,,565.2400,2190.0000,percent of total billed charges,"41.7% of $2,190.00 in Billed Charges for Rev 278 = $913.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 8X20,278,RC,27800511,CDM,,,,,,both,,,2190.0000,328.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,876.00,,,,,,,565.2400,2190.0000,percent of total billed charges,"40% of $2,190.00 in Billed Charges for Rev 278 = $876.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 8X20,278,RC,27800511,CDM,,,,,,both,,,2190.0000,328.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,913.23,,,,,,,565.2400,2190.0000,percent of total billed charges,"41.7% of $2,190.00 in Billed Charges for Rev 278 = $913.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 8X20,278,RC,27800511,CDM,,,,,,both,,,2190.0000,328.5000,CIGNA HEALTHCARE,CIGNA PPO,913.23,,,,,,,565.2400,2190.0000,percent of total billed charges,"41.7% of $2,190.00 in Billed Charges for Rev 278 = $913.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 8X20,278,RC,27800511,CDM,,,,,,both,,,2190.0000,328.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1971.00,,,,,,,565.2400,2190.0000,percent of total billed charges,"90% of $2,190.00 in Billed Charges for Rev 278 = $1,971.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 8X20,278,RC,27800511,CDM,,,,,,both,,,2190.0000,328.5000,MEDCOST,MEDCOST VHN,1042.22,,,,,,,565.2400,2190.0000,percent of total billed charges,"47.59% of $2,190.00 in Billed Charges for Rev 278 = $1,042.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 8X20,278,RC,27800511,CDM,,,,,,both,,,2190.0000,328.5000,SENTARA HEALTH,SENTARA HEALTH,565.24,,,,,,,565.2400,2190.0000,percent of total billed charges,"25.81% of $2,190.00 in Billed Charges for Rev 278 = $565.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 8X20,278,RC,27800511,CDM,,,,,,both,,,2190.0000,328.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2190.00,,,,,,,565.2400,2190.0000,percent of total billed charges,"100% of $2,190.00 in Billed Charges for Rev 278 = $2,190.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 8X20,278,RC,27800511,CDM,,,,,,both,,,2190.0000,328.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1095.00,,,,,,,565.2400,2190.0000,percent of total billed charges,"Rev 278 $2,190.00 in Billed Charges at 50% = $1,095.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 DETACH FRAM 8X20,278,RC,27800511,CDM,,,,,,both,,,2190.0000,328.5000,WELLCARE,WELLCARE MEDICAID,2190.00,,,,,,,565.2400,2190.0000,percent of total billed charges,"100% of $2,190.00 in Billed Charges for Rev 278 = $2,190.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 12X30 15X30 20X30,278,RC,27800503,CDM,,,,,,both,,,3610.0000,541.5000,AETNA,AETNA,1732.80,,,,,,,931.7400,3610.0000,percent of total billed charges,"48% of $3,610.00 in Billed Charges for Rev 278 = $1,732.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 12X30 15X30 20X30,278,RC,27800503,CDM,,,,,,both,,,3610.0000,541.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1805.00,,,,,,,931.7400,3610.0000,percent of total billed charges,"50% of $3,610.00 in Billed Charges for Rev 278 = $1,805.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 12X30 15X30 20X30,278,RC,27800503,CDM,,,,,,both,,,3610.0000,541.5000,CIGNA HEALTHCARE,CIGNA HMO,1505.37,,,,,,,931.7400,3610.0000,percent of total billed charges,"41.7% of $3,610.00 in Billed Charges for Rev 278 = $1,505.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 12X30 15X30 20X30,278,RC,27800503,CDM,,,,,,both,,,3610.0000,541.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1444.00,,,,,,,931.7400,3610.0000,percent of total billed charges,"40% of $3,610.00 in Billed Charges for Rev 278 = $1,444.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 12X30 15X30 20X30,278,RC,27800503,CDM,,,,,,both,,,3610.0000,541.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1505.37,,,,,,,931.7400,3610.0000,percent of total billed charges,"41.7% of $3,610.00 in Billed Charges for Rev 278 = $1,505.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 12X30 15X30 20X30,278,RC,27800503,CDM,,,,,,both,,,3610.0000,541.5000,CIGNA HEALTHCARE,CIGNA PPO,1505.37,,,,,,,931.7400,3610.0000,percent of total billed charges,"41.7% of $3,610.00 in Billed Charges for Rev 278 = $1,505.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 12X30 15X30 20X30,278,RC,27800503,CDM,,,,,,both,,,3610.0000,541.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3249.00,,,,,,,931.7400,3610.0000,percent of total billed charges,"90% of $3,610.00 in Billed Charges for Rev 278 = $3,249.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 12X30 15X30 20X30,278,RC,27800503,CDM,,,,,,both,,,3610.0000,541.5000,MEDCOST,MEDCOST VHN,1718.00,,,,,,,931.7400,3610.0000,percent of total billed charges,"47.59% of $3,610.00 in Billed Charges for Rev 278 = $1,718.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 12X30 15X30 20X30,278,RC,27800503,CDM,,,,,,both,,,3610.0000,541.5000,SENTARA HEALTH,SENTARA HEALTH,931.74,,,,,,,931.7400,3610.0000,percent of total billed charges,"25.81% of $3,610.00 in Billed Charges for Rev 278 = $931.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 12X30 15X30 20X30,278,RC,27800503,CDM,,,,,,both,,,3610.0000,541.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3610.00,,,,,,,931.7400,3610.0000,percent of total billed charges,"100% of $3,610.00 in Billed Charges for Rev 278 = $3,610.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 12X30 15X30 20X30,278,RC,27800503,CDM,,,,,,both,,,3610.0000,541.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1805.00,,,,,,,931.7400,3610.0000,percent of total billed charges,"Rev 278 $3,610.00 in Billed Charges at 50% = $1,805.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 12X30 15X30 20X30,278,RC,27800503,CDM,,,,,,both,,,3610.0000,541.5000,WELLCARE,WELLCARE MEDICAID,3610.00,,,,,,,931.7400,3610.0000,percent of total billed charges,"100% of $3,610.00 in Billed Charges for Rev 278 = $3,610.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 6X20 12X20 15X20 20X20,278,RC,27800502,CDM,,,,,,both,,,3385.0000,507.7500,AETNA,AETNA,1624.80,,,,,,,873.6700,3385.0000,percent of total billed charges,"48% of $3,385.00 in Billed Charges for Rev 278 = $1,624.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 6X20 12X20 15X20 20X20,278,RC,27800502,CDM,,,,,,both,,,3385.0000,507.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1692.50,,,,,,,873.6700,3385.0000,percent of total billed charges,"50% of $3,385.00 in Billed Charges for Rev 278 = $1,692.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 6X20 12X20 15X20 20X20,278,RC,27800502,CDM,,,,,,both,,,3385.0000,507.7500,CIGNA HEALTHCARE,CIGNA HMO,1411.55,,,,,,,873.6700,3385.0000,percent of total billed charges,"41.7% of $3,385.00 in Billed Charges for Rev 278 = $1,411.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 6X20 12X20 15X20 20X20,278,RC,27800502,CDM,,,,,,both,,,3385.0000,507.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1354.00,,,,,,,873.6700,3385.0000,percent of total billed charges,"40% of $3,385.00 in Billed Charges for Rev 278 = $1,354.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 6X20 12X20 15X20 20X20,278,RC,27800502,CDM,,,,,,both,,,3385.0000,507.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1411.55,,,,,,,873.6700,3385.0000,percent of total billed charges,"41.7% of $3,385.00 in Billed Charges for Rev 278 = $1,411.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 6X20 12X20 15X20 20X20,278,RC,27800502,CDM,,,,,,both,,,3385.0000,507.7500,CIGNA HEALTHCARE,CIGNA PPO,1411.55,,,,,,,873.6700,3385.0000,percent of total billed charges,"41.7% of $3,385.00 in Billed Charges for Rev 278 = $1,411.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 6X20 12X20 15X20 20X20,278,RC,27800502,CDM,,,,,,both,,,3385.0000,507.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3046.50,,,,,,,873.6700,3385.0000,percent of total billed charges,"90% of $3,385.00 in Billed Charges for Rev 278 = $3,046.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 6X20 12X20 15X20 20X20,278,RC,27800502,CDM,,,,,,both,,,3385.0000,507.7500,MEDCOST,MEDCOST VHN,1610.92,,,,,,,873.6700,3385.0000,percent of total billed charges,"47.59% of $3,385.00 in Billed Charges for Rev 278 = $1,610.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 6X20 12X20 15X20 20X20,278,RC,27800502,CDM,,,,,,both,,,3385.0000,507.7500,SENTARA HEALTH,SENTARA HEALTH,873.67,,,,,,,873.6700,3385.0000,percent of total billed charges,"25.81% of $3,385.00 in Billed Charges for Rev 278 = $873.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 6X20 12X20 15X20 20X20,278,RC,27800502,CDM,,,,,,both,,,3385.0000,507.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3385.00,,,,,,,873.6700,3385.0000,percent of total billed charges,"100% of $3,385.00 in Billed Charges for Rev 278 = $3,385.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 6X20 12X20 15X20 20X20,278,RC,27800502,CDM,,,,,,both,,,3385.0000,507.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1692.50,,,,,,,873.6700,3385.0000,percent of total billed charges,"Rev 278 $3,385.00 in Billed Charges at 50% = $1,692.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 6X20 12X20 15X20 20X20,278,RC,27800502,CDM,,,,,,both,,,3385.0000,507.7500,WELLCARE,WELLCARE MEDICAID,3385.00,,,,,,,873.6700,3385.0000,percent of total billed charges,"100% of $3,385.00 in Billed Charges for Rev 278 = $3,385.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA,187.45,,,,,,,17.4500,439.0000,percent of total billed charges,42.7% of $439.00 in Billed Charges for Rev 320 Proc 73070 = $187.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,17.4500,439.0000,fee schedule,APG 00471 Proc 73070 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,17.4500,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,17.4500,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,17.4500,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,AMBETTER,AMBETTER,172.12,,,,,,,17.4500,439.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,17.4500,439.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,17.4500,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,17.4500,439.0000,fee schedule,APG 00471 Proc 73070 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,17.4500,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,17.4500,439.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,17.4500,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,28.11,,,,,,,17.4500,439.0000,fee schedule,$28.11 from Fee Schedule BLDTM_23 for Rev 320 Proc 73070 * Qty 1 = $28.11 at 100% = $28.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS E NETWORK,59.26,,,,,,,17.4500,439.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73070 * Qty 1 = $18.52 at 320% = $59.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,17.4500,439.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS P NETWORK,60.56,,,,,,,17.4500,439.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73070 * Qty 1 = $18.52 at 327% = $60.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS S NETWORK,60.56,,,,,,,17.4500,439.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73070 * Qty 1 = $18.52 at 327% = $60.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,TENNCARE BLUE CARE,17.45,,,,,,,17.4500,439.0000,fee schedule,$15.04 from Fee Schedule TC_24 for Rev 320 Proc 73070 * Qty 1 = $15.04 at 116% = $17.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,TENNCARE BLUE SELECT,17.45,,,,,,,17.4500,439.0000,fee schedule,$15.04 from Fee Schedule TC_24 for Rev 320 Proc 73070 * Qty 1 = $15.04 at 116% = $17.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,17.4500,439.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73070 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,39.84,,,,,,,17.4500,439.0000,fee schedule,$39.84 from Fee Schedule CGIFP_25LR for Rev 320 Proc 73070 * Qty 1 = $39.84 at 100% = $39.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,17.4500,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,17.4500,439.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73070 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,17.4500,439.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73070 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,17.4500,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,395.10,,,,,,,17.4500,439.0000,percent of total billed charges,90% of $439.00 in Billed Charges for Rev 320 Proc 73070 = $395.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,HUMANA,HUMANA MEDICARE,78.96,,,,,,,17.4500,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,17.4500,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,MEDCOST,MEDCOST VHN,208.92,,,,,,,17.4500,439.0000,percent of total billed charges,47.59% of $439.00 in Billed Charges for Rev 320 Proc 73070 = $208.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,17.4500,439.0000,fee schedule,APG 00471 Proc 73070 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,17.4500,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,17.4500,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,17.4500,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,17.4500,439.0000,fee schedule,APG 00471 Proc 73070 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,SENTARA HEALTH,SENTARA HEALTH,113.31,,,,,,,17.4500,439.0000,percent of total billed charges,25.81% of $439.00 in Billed Charges for Rev 320 Proc 73070 = $113.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,17.4500,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",439.00,,,,,,,17.4500,439.0000,percent of total billed charges,100% of $439.00 in Billed Charges for Rev 320 Proc 73070 = $439.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,17.4500,439.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 73070 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,17.4500,439.0000,other,Rev 320 Proc 73070 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,17.4500,439.0000,other,Rev 320 Proc 73070 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,17.4500,439.0000,other,Rev 320 Proc 73070 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,17.4500,439.0000,fee schedule,APG 00471 Proc 73070 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,17.4500,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,17.4500,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,WELLCARE,WELLCARE MEDICAID,439.00,,,,,,,17.4500,439.0000,percent of total billed charges,100% of $439.00 in Billed Charges for Rev 320 Proc 73070 = $439.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 2 VIEWS,73070,CPT,320,RC,32000081,CDM,,,,both,,,439.0000,65.8500,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,17.4500,439.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,17.4500,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 73070 Mod 50 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,119.42,,,,,,,17.4500,462.0000,fee schedule,APG 00471 Proc 73070 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 104% = $119.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,AMBETTER,AMBETTER,172.12,,,,,,,17.4500,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,17.4500,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,118.27,,,,,,,17.4500,462.0000,fee schedule,APG 00471 Proc 73070 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 103% = $118.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,17.4500,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,28.11,,,,,,,17.4500,462.0000,fee schedule,$28.11 from Fee Schedule BLDTM_23 for Rev 320 Proc 73070 Mod 50 * Qty 1 = $28.11 at 100% = $28.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,59.26,,,,,,,17.4500,462.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73070 Mod 50 * Qty 1 = $18.52 at 320% = $59.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,17.4500,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,60.56,,,,,,,17.4500,462.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73070 Mod 50 * Qty 1 = $18.52 at 327% = $60.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,60.56,,,,,,,17.4500,462.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73070 Mod 50 * Qty 1 = $18.52 at 327% = $60.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,17.45,,,,,,,17.4500,462.0000,fee schedule,$15.04 from Fee Schedule TC_24 for Rev 320 Proc 73070 Mod 50 * Qty 1 = $15.04 at 116% = $17.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,17.45,,,,,,,17.4500,462.0000,fee schedule,$15.04 from Fee Schedule TC_24 for Rev 320 Proc 73070 Mod 50 * Qty 1 = $15.04 at 116% = $17.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,17.4500,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73070 Mod 50 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,39.84,,,,,,,17.4500,462.0000,fee schedule,$39.84 from Fee Schedule CGIFP_25LR for Rev 320 Proc 73070 Mod 50 * Qty 1 = $39.84 at 100% = $39.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,17.4500,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,17.4500,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73070 Mod 50 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,17.4500,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73070 Mod 50 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,17.4500,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,17.4500,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 73070 Mod 50 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,17.4500,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 73070 Mod 50 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,120.56,,,,,,,17.4500,462.0000,fee schedule,APG 00471 Proc 73070 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 100% = $114.82... $114.82 at 105% = $120.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,17.4500,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,17.4500,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,17.4500,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,118.38,,,,,,,17.4500,462.0000,fee schedule,APG 00471 Proc 73070 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 100% = $114.82... $114.82 at 103.1% = $118.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,17.4500,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 73070 Mod 50 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,17.4500,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 73070 Mod 50 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,17.4500,462.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 73070 Mod 50 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,17.4500,462.0000,other,Rev 320 Proc 73070 Mod 50 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,17.4500,462.0000,other,Rev 320 Proc 73070 Mod 50 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,17.4500,462.0000,other,Rev 320 Proc 73070 Mod 50 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,118.27,,,,,,,17.4500,462.0000,fee schedule,APG 00471 Proc 73070 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 103% = $118.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,17.4500,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 73070 Mod 50 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 2 VIEWS BILAT,73070,CPT,320,RC,32000082,CDM,,,50,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,17.4500,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,AETNA,AETNA,217.34,,,,,,,18.9100,509.0000,percent of total billed charges,42.7% of $509.00 in Billed Charges for Rev 320 Proc 73080 Mod 50 = $217.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,119.42,,,,,,,18.9100,509.0000,fee schedule,APG 00471 Proc 73080 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 104% = $119.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,18.9100,509.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,18.9100,509.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,18.9100,509.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,AMBETTER,AMBETTER,172.12,,,,,,,18.9100,509.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,18.9100,509.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,18.9100,509.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,118.27,,,,,,,18.9100,509.0000,fee schedule,APG 00471 Proc 73080 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 103% = $118.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,18.9100,509.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,18.9100,509.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,18.9100,509.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,31.22,,,,,,,18.9100,509.0000,fee schedule,$31.22 from Fee Schedule BLDTM_23 for Rev 320 Proc 73080 Mod 50 * Qty 1 = $31.22 at 100% = $31.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,BLUE CROSS,BLUE CROSS E NETWORK,72.67,,,,,,,18.9100,509.0000,fee schedule,$22.71 from Fee Schedule BCFSC for Rev 320 Proc 73080 Mod 50 * Qty 1 = $22.71 at 320% = $72.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,18.9100,509.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,BLUE CROSS,BLUE CROSS P NETWORK,74.26,,,,,,,18.9100,509.0000,fee schedule,$22.71 from Fee Schedule BCFSC for Rev 320 Proc 73080 Mod 50 * Qty 1 = $22.71 at 327% = $74.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,BLUE CROSS,BLUE CROSS S NETWORK,74.26,,,,,,,18.9100,509.0000,fee schedule,$22.71 from Fee Schedule BCFSC for Rev 320 Proc 73080 Mod 50 * Qty 1 = $22.71 at 327% = $74.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,BLUE CROSS,TENNCARE BLUE CARE,18.91,,,,,,,18.9100,509.0000,fee schedule,$16.30 from Fee Schedule TC_24 for Rev 320 Proc 73080 Mod 50 * Qty 1 = $16.30 at 116% = $18.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,BLUE CROSS,TENNCARE BLUE SELECT,18.91,,,,,,,18.9100,509.0000,fee schedule,$16.30 from Fee Schedule TC_24 for Rev 320 Proc 73080 Mod 50 * Qty 1 = $16.30 at 116% = $18.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,18.9100,509.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73080 Mod 50 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,46.10,,,,,,,18.9100,509.0000,fee schedule,$46.10 from Fee Schedule CGIFP_25LR for Rev 320 Proc 73080 Mod 50 * Qty 1 = $46.10 at 100% = $46.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,18.9100,509.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,18.9100,509.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73080 Mod 50 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,18.9100,509.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73080 Mod 50 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,18.9100,509.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,458.10,,,,,,,18.9100,509.0000,percent of total billed charges,90% of $509.00 in Billed Charges for Rev 320 Proc 73080 Mod 50 = $458.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,HUMANA,HUMANA MEDICARE,78.96,,,,,,,18.9100,509.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,18.9100,509.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,MEDCOST,MEDCOST VHN,242.23,,,,,,,18.9100,509.0000,percent of total billed charges,47.59% of $509.00 in Billed Charges for Rev 320 Proc 73080 Mod 50 = $242.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,120.56,,,,,,,18.9100,509.0000,fee schedule,APG 00471 Proc 73080 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 100% = $114.82... $114.82 at 105% = $120.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,18.9100,509.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,18.9100,509.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,18.9100,509.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,118.38,,,,,,,18.9100,509.0000,fee schedule,APG 00471 Proc 73080 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 100% = $114.82... $114.82 at 103.1% = $118.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,SENTARA HEALTH,SENTARA HEALTH,131.37,,,,,,,18.9100,509.0000,percent of total billed charges,25.81% of $509.00 in Billed Charges for Rev 320 Proc 73080 Mod 50 = $131.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,18.9100,509.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",509.00,,,,,,,18.9100,509.0000,percent of total billed charges,100% of $509.00 in Billed Charges for Rev 320 Proc 73080 Mod 50 = $509.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,18.9100,509.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 73080 Mod 50 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,18.9100,509.0000,other,Rev 320 Proc 73080 Mod 50 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,18.9100,509.0000,other,Rev 320 Proc 73080 Mod 50 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,18.9100,509.0000,other,Rev 320 Proc 73080 Mod 50 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,118.27,,,,,,,18.9100,509.0000,fee schedule,APG 00471 Proc 73080 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 103% = $118.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,18.9100,509.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,18.9100,509.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,WELLCARE,WELLCARE MEDICAID,509.00,,,,,,,18.9100,509.0000,percent of total billed charges,100% of $509.00 in Billed Charges for Rev 320 Proc 73080 Mod 50 = $509.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ELBOW 3 VIEW+ BILAT,73080,CPT,320,RC,32000084,CDM,,,50,both,,,509.0000,76.3500,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,18.9100,509.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,17.4500,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 73090 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,17.4500,462.0000,fee schedule,APG 00471 Proc 73090 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,172.12,,,,,,,17.4500,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,17.4500,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,17.4500,462.0000,fee schedule,APG 00471 Proc 73090 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,17.4500,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,28.50,,,,,,,17.4500,462.0000,fee schedule,$28.50 from Fee Schedule BLDTM_23 for Rev 320 Proc 73090 * Qty 1 = $28.50 at 100% = $28.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,57.22,,,,,,,17.4500,462.0000,fee schedule,$17.88 from Fee Schedule BCFSC for Rev 320 Proc 73090 * Qty 1 = $17.88 at 320% = $57.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,17.4500,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,58.47,,,,,,,17.4500,462.0000,fee schedule,$17.88 from Fee Schedule BCFSC for Rev 320 Proc 73090 * Qty 1 = $17.88 at 327% = $58.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,58.47,,,,,,,17.4500,462.0000,fee schedule,$17.88 from Fee Schedule BCFSC for Rev 320 Proc 73090 * Qty 1 = $17.88 at 327% = $58.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,17.45,,,,,,,17.4500,462.0000,fee schedule,$15.04 from Fee Schedule TC_24 for Rev 320 Proc 73090 * Qty 1 = $15.04 at 116% = $17.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,17.45,,,,,,,17.4500,462.0000,fee schedule,$15.04 from Fee Schedule TC_24 for Rev 320 Proc 73090 * Qty 1 = $15.04 at 116% = $17.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,17.4500,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73090 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,40.47,,,,,,,17.4500,462.0000,fee schedule,$40.47 from Fee Schedule CGIFP_25LR for Rev 320 Proc 73090 * Qty 1 = $40.47 at 100% = $40.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,17.4500,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,17.4500,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73090 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,17.4500,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73090 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,17.4500,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,17.4500,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 73090 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,17.4500,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 73090 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,17.4500,462.0000,fee schedule,APG 00471 Proc 73090 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,17.4500,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,17.4500,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,17.4500,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,17.4500,462.0000,fee schedule,APG 00471 Proc 73090 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,17.4500,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 73090 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,17.4500,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 73090 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,17.4500,462.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 73090 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,17.4500,462.0000,other,Rev 320 Proc 73090 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,17.4500,462.0000,other,Rev 320 Proc 73090 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,17.4500,462.0000,other,Rev 320 Proc 73090 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,17.4500,462.0000,fee schedule,APG 00471 Proc 73090 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,17.4500,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,17.4500,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 73090 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FOREARM 2 VIEWS,73090,CPT,320,RC,32000087,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,17.4500,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,AETNA,AETNA,207.10,,,,,,,17.4500,485.0000,percent of total billed charges,42.7% of $485.00 in Billed Charges for Rev 320 Proc 73090 Mod 50 = $207.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,119.42,,,,,,,17.4500,485.0000,fee schedule,APG 00471 Proc 73090 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 104% = $119.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,17.4500,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,17.4500,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,17.4500,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,AMBETTER,AMBETTER,172.12,,,,,,,17.4500,485.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,17.4500,485.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,17.4500,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,118.27,,,,,,,17.4500,485.0000,fee schedule,APG 00471 Proc 73090 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 103% = $118.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,17.4500,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,17.4500,485.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,17.4500,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,28.50,,,,,,,17.4500,485.0000,fee schedule,$28.50 from Fee Schedule BLDTM_23 for Rev 320 Proc 73090 Mod 50 * Qty 1 = $28.50 at 100% = $28.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,BLUE CROSS E NETWORK,57.22,,,,,,,17.4500,485.0000,fee schedule,$17.88 from Fee Schedule BCFSC for Rev 320 Proc 73090 Mod 50 * Qty 1 = $17.88 at 320% = $57.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,17.4500,485.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,BLUE CROSS P NETWORK,58.47,,,,,,,17.4500,485.0000,fee schedule,$17.88 from Fee Schedule BCFSC for Rev 320 Proc 73090 Mod 50 * Qty 1 = $17.88 at 327% = $58.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,BLUE CROSS S NETWORK,58.47,,,,,,,17.4500,485.0000,fee schedule,$17.88 from Fee Schedule BCFSC for Rev 320 Proc 73090 Mod 50 * Qty 1 = $17.88 at 327% = $58.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,TENNCARE BLUE CARE,17.45,,,,,,,17.4500,485.0000,fee schedule,$15.04 from Fee Schedule TC_24 for Rev 320 Proc 73090 Mod 50 * Qty 1 = $15.04 at 116% = $17.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,BLUE CROSS,TENNCARE BLUE SELECT,17.45,,,,,,,17.4500,485.0000,fee schedule,$15.04 from Fee Schedule TC_24 for Rev 320 Proc 73090 Mod 50 * Qty 1 = $15.04 at 116% = $17.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,17.4500,485.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73090 Mod 50 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,40.47,,,,,,,17.4500,485.0000,fee schedule,$40.47 from Fee Schedule CGIFP_25LR for Rev 320 Proc 73090 Mod 50 * Qty 1 = $40.47 at 100% = $40.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,17.4500,485.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,17.4500,485.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73090 Mod 50 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,17.4500,485.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73090 Mod 50 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,17.4500,485.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,436.50,,,,,,,17.4500,485.0000,percent of total billed charges,90% of $485.00 in Billed Charges for Rev 320 Proc 73090 Mod 50 = $436.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,HUMANA,HUMANA MEDICARE,78.96,,,,,,,17.4500,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,17.4500,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,MEDCOST,MEDCOST VHN,230.81,,,,,,,17.4500,485.0000,percent of total billed charges,47.59% of $485.00 in Billed Charges for Rev 320 Proc 73090 Mod 50 = $230.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,120.56,,,,,,,17.4500,485.0000,fee schedule,APG 00471 Proc 73090 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 100% = $114.82... $114.82 at 105% = $120.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,17.4500,485.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,17.4500,485.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,17.4500,485.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,118.38,,,,,,,17.4500,485.0000,fee schedule,APG 00471 Proc 73090 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 100% = $114.82... $114.82 at 103.1% = $118.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,SENTARA HEALTH,SENTARA HEALTH,125.18,,,,,,,17.4500,485.0000,percent of total billed charges,25.81% of $485.00 in Billed Charges for Rev 320 Proc 73090 Mod 50 = $125.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,17.4500,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",485.00,,,,,,,17.4500,485.0000,percent of total billed charges,100% of $485.00 in Billed Charges for Rev 320 Proc 73090 Mod 50 = $485.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,17.4500,485.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 73090 Mod 50 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,17.4500,485.0000,other,Rev 320 Proc 73090 Mod 50 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,17.4500,485.0000,other,Rev 320 Proc 73090 Mod 50 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,17.4500,485.0000,other,Rev 320 Proc 73090 Mod 50 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,118.27,,,,,,,17.4500,485.0000,fee schedule,APG 00471 Proc 73090 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 103% = $118.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,17.4500,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,17.4500,485.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,WELLCARE,WELLCARE MEDICAID,485.00,,,,,,,17.4500,485.0000,percent of total billed charges,100% of $485.00 in Billed Charges for Rev 320 Proc 73090 Mod 50 = $485.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX FOREARM 2 VIEWS BILAT,73090,CPT,320,RC,32000088,CDM,,,50,both,,,485.0000,72.7500,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,17.4500,485.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,AETNA,AETNA,273.71,,,,,,,16.4800,641.0000,percent of total billed charges,42.7% of $641.00 in Billed Charges for Rev 320 Proc 73092 Mod 50 = $273.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,119.42,,,,,,,16.4800,641.0000,fee schedule,APG 00471 Proc 73092 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 104% = $119.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,16.4800,641.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,16.4800,641.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,16.4800,641.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,AMBETTER,AMBETTER,206.78,,,,,,,16.4800,641.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,16.4800,641.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,16.4800,641.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,118.27,,,,,,,16.4800,641.0000,fee schedule,APG 00471 Proc 73092 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 103% = $118.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,16.4800,641.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,16.4800,641.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,16.4800,641.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,28.04,,,,,,,16.4800,641.0000,fee schedule,$28.04 from Fee Schedule BLDTM_23 for Rev 320 Proc 73092 Mod 50 * Qty 1 = $28.04 at 100% = $28.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,BLUE CROSS,BLUE CROSS E NETWORK,59.26,,,,,,,16.4800,641.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73092 Mod 50 * Qty 1 = $18.52 at 320% = $59.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,16.4800,641.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,BLUE CROSS,BLUE CROSS P NETWORK,60.56,,,,,,,16.4800,641.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73092 Mod 50 * Qty 1 = $18.52 at 327% = $60.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,BLUE CROSS,BLUE CROSS S NETWORK,60.56,,,,,,,16.4800,641.0000,fee schedule,$18.52 from Fee Schedule BCFSC for Rev 320 Proc 73092 Mod 50 * Qty 1 = $18.52 at 327% = $60.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,BLUE CROSS,TENNCARE BLUE CARE,16.48,,,,,,,16.4800,641.0000,fee schedule,$14.21 from Fee Schedule TC_24 for Rev 320 Proc 73092 Mod 50 * Qty 1 = $14.21 at 116% = $16.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,BLUE CROSS,TENNCARE BLUE SELECT,16.48,,,,,,,16.4800,641.0000,fee schedule,$14.21 from Fee Schedule TC_24 for Rev 320 Proc 73092 Mod 50 * Qty 1 = $14.21 at 116% = $16.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,16.4800,641.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73092 Mod 50 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,44.85,,,,,,,16.4800,641.0000,fee schedule,$44.85 from Fee Schedule CGIFP_25LR for Rev 320 Proc 73092 Mod 50 * Qty 1 = $44.85 at 100% = $44.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,16.4800,641.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,16.4800,641.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73092 Mod 50 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,16.4800,641.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 73092 Mod 50 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,16.4800,641.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,576.90,,,,,,,16.4800,641.0000,percent of total billed charges,90% of $641.00 in Billed Charges for Rev 320 Proc 73092 Mod 50 = $576.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,HUMANA,HUMANA MEDICARE,94.85,,,,,,,16.4800,641.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,16.4800,641.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,MEDCOST,MEDCOST VHN,305.05,,,,,,,16.4800,641.0000,percent of total billed charges,47.59% of $641.00 in Billed Charges for Rev 320 Proc 73092 Mod 50 = $305.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,120.56,,,,,,,16.4800,641.0000,fee schedule,APG 00471 Proc 73092 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 100% = $114.82... $114.82 at 105% = $120.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,16.4800,641.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,16.4800,641.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,16.4800,641.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,118.38,,,,,,,16.4800,641.0000,fee schedule,APG 00471 Proc 73092 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 100% = $114.82... $114.82 at 103.1% = $118.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,SENTARA HEALTH,SENTARA HEALTH,165.44,,,,,,,16.4800,641.0000,percent of total billed charges,25.81% of $641.00 in Billed Charges for Rev 320 Proc 73092 Mod 50 = $165.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,16.4800,641.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",641.00,,,,,,,16.4800,641.0000,percent of total billed charges,100% of $641.00 in Billed Charges for Rev 320 Proc 73092 Mod 50 = $641.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,16.4800,641.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 73092 Mod 50 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,16.4800,641.0000,other,Rev 320 Proc 73092 Mod 50 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,16.4800,641.0000,other,Rev 320 Proc 73092 Mod 50 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,16.4800,641.0000,other,Rev 320 Proc 73092 Mod 50 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,118.27,,,,,,,16.4800,641.0000,fee schedule,APG 00471 Proc 73092 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 150% Mod Percentage = $114.82 at 103% = $118.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,16.4800,641.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,16.4800,641.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,WELLCARE,WELLCARE MEDICAID,641.00,,,,,,,16.4800,641.0000,percent of total billed charges,100% of $641.00 in Billed Charges for Rev 320 Proc 73092 Mod 50 = $641.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX EXTREM UPPER INFANT 2 VIEW BILAT,73092,CPT,320,RC,32000304,CDM,,,50,both,,,641.0000,96.1500,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,16.4800,641.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COIL CONTROLLER DETACH COILS,272,RC,27200163,CDM,,,,,,both,,,700.0000,105.0000,AETNA,AETNA,298.90,,,,,,,180.6700,700.0000,percent of total billed charges,42.7% of $700.00 in Billed Charges for Rev 272 = $298.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL CONTROLLER DETACH COILS,272,RC,27200163,CDM,,,,,,both,,,700.0000,105.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,490.00,,,,,,,180.6700,700.0000,percent of total billed charges,Rev 272 $700.00 in Billed Charges at 70% = $490.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL CONTROLLER DETACH COILS,272,RC,27200163,CDM,,,,,,both,,,700.0000,105.0000,CIGNA HEALTHCARE,CIGNA HMO,291.90,,,,,,,180.6700,700.0000,percent of total billed charges,41.7% of $700.00 in Billed Charges for Rev 272 = $291.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL CONTROLLER DETACH COILS,272,RC,27200163,CDM,,,,,,both,,,700.0000,105.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,324.80,,,,,,,180.6700,700.0000,percent of total billed charges,46.4% of $700.00 in Billed Charges for Rev 272 = $324.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL CONTROLLER DETACH COILS,272,RC,27200163,CDM,,,,,,both,,,700.0000,105.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,291.90,,,,,,,180.6700,700.0000,percent of total billed charges,41.7% of $700.00 in Billed Charges for Rev 272 = $291.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL CONTROLLER DETACH COILS,272,RC,27200163,CDM,,,,,,both,,,700.0000,105.0000,CIGNA HEALTHCARE,CIGNA PPO,291.90,,,,,,,180.6700,700.0000,percent of total billed charges,41.7% of $700.00 in Billed Charges for Rev 272 = $291.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL CONTROLLER DETACH COILS,272,RC,27200163,CDM,,,,,,both,,,700.0000,105.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,630.00,,,,,,,180.6700,700.0000,percent of total billed charges,90% of $700.00 in Billed Charges for Rev 272 = $630.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL CONTROLLER DETACH COILS,272,RC,27200163,CDM,,,,,,both,,,700.0000,105.0000,MEDCOST,MEDCOST VHN,333.13,,,,,,,180.6700,700.0000,percent of total billed charges,47.59% of $700.00 in Billed Charges for Rev 272 = $333.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL CONTROLLER DETACH COILS,272,RC,27200163,CDM,,,,,,both,,,700.0000,105.0000,SENTARA HEALTH,SENTARA HEALTH,180.67,,,,,,,180.6700,700.0000,percent of total billed charges,25.81% of $700.00 in Billed Charges for Rev 272 = $180.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL CONTROLLER DETACH COILS,272,RC,27200163,CDM,,,,,,both,,,700.0000,105.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",700.00,,,,,,,180.6700,700.0000,percent of total billed charges,100% of $700.00 in Billed Charges for Rev 272 = $700.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL CONTROLLER DETACH COILS,272,RC,27200163,CDM,,,,,,both,,,700.0000,105.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,350.00,,,,,,,180.6700,700.0000,percent of total billed charges,Rev 272 $700.00 in Billed Charges at 50% = $350.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL CONTROLLER DETACH COILS,272,RC,27200163,CDM,,,,,,both,,,700.0000,105.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,226.10,,,,,,,180.6700,700.0000,other,32.3% of $700.00 in Billed Charges for Rev 272 = $226.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COIL CONTROLLER DETACH COILS,272,RC,27200163,CDM,,,,,,both,,,700.0000,105.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,214.90,,,,,,,180.6700,700.0000,other,30.7% of $700.00 in Billed Charges for Rev 272 = $214.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COIL CONTROLLER DETACH COILS,272,RC,27200163,CDM,,,,,,both,,,700.0000,105.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,226.10,,,,,,,180.6700,700.0000,percent of total billed charges,32.3% of $700.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL CONTROLLER DETACH COILS,272,RC,27200163,CDM,,,,,,both,,,700.0000,105.0000,WELLCARE,WELLCARE MEDICAID,700.00,,,,,,,180.6700,700.0000,percent of total billed charges,100% of $700.00 in Billed Charges for Rev 272 = $700.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL RUBY 50CM,278,RC,27800624,CDM,,,,,,both,,,4750.0000,712.5000,AETNA,AETNA,2280.00,,,,,,,1225.9800,4750.0000,percent of total billed charges,"48% of $4,750.00 in Billed Charges for Rev 278 = $2,280.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 50CM,278,RC,27800624,CDM,,,,,,both,,,4750.0000,712.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2375.00,,,,,,,1225.9800,4750.0000,percent of total billed charges,"50% of $4,750.00 in Billed Charges for Rev 278 = $2,375.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 50CM,278,RC,27800624,CDM,,,,,,both,,,4750.0000,712.5000,CIGNA HEALTHCARE,CIGNA HMO,1980.75,,,,,,,1225.9800,4750.0000,percent of total billed charges,"41.7% of $4,750.00 in Billed Charges for Rev 278 = $1,980.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 50CM,278,RC,27800624,CDM,,,,,,both,,,4750.0000,712.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1900.00,,,,,,,1225.9800,4750.0000,percent of total billed charges,"40% of $4,750.00 in Billed Charges for Rev 278 = $1,900.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 50CM,278,RC,27800624,CDM,,,,,,both,,,4750.0000,712.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1980.75,,,,,,,1225.9800,4750.0000,percent of total billed charges,"41.7% of $4,750.00 in Billed Charges for Rev 278 = $1,980.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 50CM,278,RC,27800624,CDM,,,,,,both,,,4750.0000,712.5000,CIGNA HEALTHCARE,CIGNA PPO,1980.75,,,,,,,1225.9800,4750.0000,percent of total billed charges,"41.7% of $4,750.00 in Billed Charges for Rev 278 = $1,980.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 50CM,278,RC,27800624,CDM,,,,,,both,,,4750.0000,712.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4275.00,,,,,,,1225.9800,4750.0000,percent of total billed charges,"90% of $4,750.00 in Billed Charges for Rev 278 = $4,275.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 50CM,278,RC,27800624,CDM,,,,,,both,,,4750.0000,712.5000,MEDCOST,MEDCOST VHN,2260.53,,,,,,,1225.9800,4750.0000,percent of total billed charges,"47.59% of $4,750.00 in Billed Charges for Rev 278 = $2,260.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 50CM,278,RC,27800624,CDM,,,,,,both,,,4750.0000,712.5000,SENTARA HEALTH,SENTARA HEALTH,1225.98,,,,,,,1225.9800,4750.0000,percent of total billed charges,"25.81% of $4,750.00 in Billed Charges for Rev 278 = $1,225.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 50CM,278,RC,27800624,CDM,,,,,,both,,,4750.0000,712.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4750.00,,,,,,,1225.9800,4750.0000,percent of total billed charges,"100% of $4,750.00 in Billed Charges for Rev 278 = $4,750.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 50CM,278,RC,27800624,CDM,,,,,,both,,,4750.0000,712.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2375.00,,,,,,,1225.9800,4750.0000,percent of total billed charges,"Rev 278 $4,750.00 in Billed Charges at 50% = $2,375.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 50CM,278,RC,27800624,CDM,,,,,,both,,,4750.0000,712.5000,WELLCARE,WELLCARE MEDICAID,4750.00,,,,,,,1225.9800,4750.0000,percent of total billed charges,"100% of $4,750.00 in Billed Charges for Rev 278 = $4,750.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COLD THERAPY UNIT T505,272,RC,27200561,CDM,,,,,,both,,,479.0000,71.8500,AETNA,AETNA,204.53,,,,,,,123.6300,479.0000,percent of total billed charges,42.7% of $479.00 in Billed Charges for Rev 272 = $204.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLD THERAPY UNIT T505,272,RC,27200561,CDM,,,,,,both,,,479.0000,71.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,335.30,,,,,,,123.6300,479.0000,percent of total billed charges,Rev 272 $479.00 in Billed Charges at 70% = $335.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLD THERAPY UNIT T505,272,RC,27200561,CDM,,,,,,both,,,479.0000,71.8500,CIGNA HEALTHCARE,CIGNA HMO,199.74,,,,,,,123.6300,479.0000,percent of total billed charges,41.7% of $479.00 in Billed Charges for Rev 272 = $199.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLD THERAPY UNIT T505,272,RC,27200561,CDM,,,,,,both,,,479.0000,71.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,222.26,,,,,,,123.6300,479.0000,percent of total billed charges,46.4% of $479.00 in Billed Charges for Rev 272 = $222.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLD THERAPY UNIT T505,272,RC,27200561,CDM,,,,,,both,,,479.0000,71.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,199.74,,,,,,,123.6300,479.0000,percent of total billed charges,41.7% of $479.00 in Billed Charges for Rev 272 = $199.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLD THERAPY UNIT T505,272,RC,27200561,CDM,,,,,,both,,,479.0000,71.8500,CIGNA HEALTHCARE,CIGNA PPO,199.74,,,,,,,123.6300,479.0000,percent of total billed charges,41.7% of $479.00 in Billed Charges for Rev 272 = $199.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLD THERAPY UNIT T505,272,RC,27200561,CDM,,,,,,both,,,479.0000,71.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,431.10,,,,,,,123.6300,479.0000,percent of total billed charges,90% of $479.00 in Billed Charges for Rev 272 = $431.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLD THERAPY UNIT T505,272,RC,27200561,CDM,,,,,,both,,,479.0000,71.8500,MEDCOST,MEDCOST VHN,227.96,,,,,,,123.6300,479.0000,percent of total billed charges,47.59% of $479.00 in Billed Charges for Rev 272 = $227.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLD THERAPY UNIT T505,272,RC,27200561,CDM,,,,,,both,,,479.0000,71.8500,SENTARA HEALTH,SENTARA HEALTH,123.63,,,,,,,123.6300,479.0000,percent of total billed charges,25.81% of $479.00 in Billed Charges for Rev 272 = $123.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLD THERAPY UNIT T505,272,RC,27200561,CDM,,,,,,both,,,479.0000,71.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",479.00,,,,,,,123.6300,479.0000,percent of total billed charges,100% of $479.00 in Billed Charges for Rev 272 = $479.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLD THERAPY UNIT T505,272,RC,27200561,CDM,,,,,,both,,,479.0000,71.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,239.50,,,,,,,123.6300,479.0000,percent of total billed charges,Rev 272 $479.00 in Billed Charges at 50% = $239.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLD THERAPY UNIT T505,272,RC,27200561,CDM,,,,,,both,,,479.0000,71.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,154.72,,,,,,,123.6300,479.0000,other,32.3% of $479.00 in Billed Charges for Rev 272 = $154.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COLD THERAPY UNIT T505,272,RC,27200561,CDM,,,,,,both,,,479.0000,71.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,147.05,,,,,,,123.6300,479.0000,other,30.7% of $479.00 in Billed Charges for Rev 272 = $147.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COLD THERAPY UNIT T505,272,RC,27200561,CDM,,,,,,both,,,479.0000,71.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,154.72,,,,,,,123.6300,479.0000,percent of total billed charges,32.3% of $479.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLD THERAPY UNIT T505,272,RC,27200561,CDM,,,,,,both,,,479.0000,71.8500,WELLCARE,WELLCARE MEDICAID,479.00,,,,,,,123.6300,479.0000,percent of total billed charges,100% of $479.00 in Billed Charges for Rev 272 = $479.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR SOFT CERVICAL (IP),270,RC,27000143,CDM,,,,,,both,,,53.0000,7.9500,AETNA,AETNA,22.63,,,,,,,13.6800,53.0000,percent of total billed charges,42.7% of $53.00 in Billed Charges for Rev 270 = $22.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR SOFT CERVICAL (IP),270,RC,27000143,CDM,,,,,,both,,,53.0000,7.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,37.10,,,,,,,13.6800,53.0000,percent of total billed charges,Rev 270 $53.00 in Billed Charges at 70% = $37.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR SOFT CERVICAL (IP),270,RC,27000143,CDM,,,,,,both,,,53.0000,7.9500,CIGNA HEALTHCARE,CIGNA HMO,22.10,,,,,,,13.6800,53.0000,percent of total billed charges,41.7% of $53.00 in Billed Charges for Rev 270 = $22.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR SOFT CERVICAL (IP),270,RC,27000143,CDM,,,,,,both,,,53.0000,7.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,24.59,,,,,,,13.6800,53.0000,percent of total billed charges,46.4% of $53.00 in Billed Charges for Rev 270 = $24.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR SOFT CERVICAL (IP),270,RC,27000143,CDM,,,,,,both,,,53.0000,7.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,22.10,,,,,,,13.6800,53.0000,percent of total billed charges,41.7% of $53.00 in Billed Charges for Rev 270 = $22.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR SOFT CERVICAL (IP),270,RC,27000143,CDM,,,,,,both,,,53.0000,7.9500,CIGNA HEALTHCARE,CIGNA PPO,22.10,,,,,,,13.6800,53.0000,percent of total billed charges,41.7% of $53.00 in Billed Charges for Rev 270 = $22.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR SOFT CERVICAL (IP),270,RC,27000143,CDM,,,,,,both,,,53.0000,7.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,47.70,,,,,,,13.6800,53.0000,percent of total billed charges,90% of $53.00 in Billed Charges for Rev 270 = $47.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR SOFT CERVICAL (IP),270,RC,27000143,CDM,,,,,,both,,,53.0000,7.9500,MEDCOST,MEDCOST VHN,25.22,,,,,,,13.6800,53.0000,percent of total billed charges,47.59% of $53.00 in Billed Charges for Rev 270 = $25.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR SOFT CERVICAL (IP),270,RC,27000143,CDM,,,,,,both,,,53.0000,7.9500,SENTARA HEALTH,SENTARA HEALTH,13.68,,,,,,,13.6800,53.0000,percent of total billed charges,25.81% of $53.00 in Billed Charges for Rev 270 = $13.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR SOFT CERVICAL (IP),270,RC,27000143,CDM,,,,,,both,,,53.0000,7.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",53.00,,,,,,,13.6800,53.0000,percent of total billed charges,100% of $53.00 in Billed Charges for Rev 270 = $53.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR SOFT CERVICAL (IP),270,RC,27000143,CDM,,,,,,both,,,53.0000,7.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,26.50,,,,,,,13.6800,53.0000,percent of total billed charges,Rev 270 $53.00 in Billed Charges at 50% = $26.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR SOFT CERVICAL (IP),270,RC,27000143,CDM,,,,,,both,,,53.0000,7.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,17.12,,,,,,,13.6800,53.0000,other,32.3% of $53.00 in Billed Charges for Rev 270 = $17.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COLLAR SOFT CERVICAL (IP),270,RC,27000143,CDM,,,,,,both,,,53.0000,7.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,16.27,,,,,,,13.6800,53.0000,other,30.7% of $53.00 in Billed Charges for Rev 270 = $16.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COLLAR SOFT CERVICAL (IP),270,RC,27000143,CDM,,,,,,both,,,53.0000,7.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,17.12,,,,,,,13.6800,53.0000,percent of total billed charges,32.3% of $53.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR SOFT CERVICAL (IP),270,RC,27000143,CDM,,,,,,both,,,53.0000,7.9500,WELLCARE,WELLCARE MEDICAID,53.00,,,,,,,13.6800,53.0000,percent of total billed charges,100% of $53.00 in Billed Charges for Rev 270 = $53.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COREVALVE 23-31MM,278,RC,27801451,CDM,,,,,,both,,,34487.0000,5173.0500,AETNA,AETNA,16553.76,,,,,,,2448.5800,34487.0000,percent of total billed charges,"48% of $34,487.00 in Billed Charges for Rev 278 = $16,553.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM,278,RC,27801451,CDM,,,,,,both,,,34487.0000,5173.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,17243.50,,,,,,,2448.5800,34487.0000,percent of total billed charges,"50% of $34,487.00 in Billed Charges for Rev 278 = $17,243.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM,278,RC,27801451,CDM,,,,,,both,,,34487.0000,5173.0500,CIGNA HEALTHCARE,CIGNA HMO,14381.08,,,,,,,2448.5800,34487.0000,percent of total billed charges,"41.7% of $34,487.00 in Billed Charges for Rev 278 = $14,381.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM,278,RC,27801451,CDM,,,,,,both,,,34487.0000,5173.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,13794.80,,,,,,,2448.5800,34487.0000,percent of total billed charges,"40% of $34,487.00 in Billed Charges for Rev 278 = $13,794.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM,278,RC,27801451,CDM,,,,,,both,,,34487.0000,5173.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,14381.08,,,,,,,2448.5800,34487.0000,percent of total billed charges,"41.7% of $34,487.00 in Billed Charges for Rev 278 = $14,381.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM,278,RC,27801451,CDM,,,,,,both,,,34487.0000,5173.0500,CIGNA HEALTHCARE,CIGNA PPO,14381.08,,,,,,,2448.5800,34487.0000,percent of total billed charges,"41.7% of $34,487.00 in Billed Charges for Rev 278 = $14,381.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM,278,RC,27801451,CDM,,,,,,both,,,34487.0000,5173.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,31038.30,,,,,,,2448.5800,34487.0000,percent of total billed charges,"90% of $34,487.00 in Billed Charges for Rev 278 = $31,038.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM,278,RC,27801451,CDM,,,,,,both,,,34487.0000,5173.0500,MEDCOST,MEDCOST VHN,16412.36,,,,,,,2448.5800,34487.0000,percent of total billed charges,"47.59% of $34,487.00 in Billed Charges for Rev 278 = $16,412.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM,278,RC,27801451,CDM,,,,,,both,,,34487.0000,5173.0500,SENTARA HEALTH,SENTARA HEALTH,8901.09,,,,,,,2448.5800,34487.0000,percent of total billed charges,"25.81% of $34,487.00 in Billed Charges for Rev 278 = $8,901.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM,278,RC,27801451,CDM,,,,,,both,,,34487.0000,5173.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",34487.00,,,,,,,2448.5800,34487.0000,percent of total billed charges,"100% of $34,487.00 in Billed Charges for Rev 278 = $34,487.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM,278,RC,27801451,CDM,,,,,,both,,,34487.0000,5173.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,17243.50,,,,,,,2448.5800,34487.0000,percent of total billed charges,"Rev 278 $34,487.00 in Billed Charges at 50% = $17,243.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM,278,RC,27801451,CDM,,,,,,both,,,34487.0000,5173.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2586.53,,,,,,,2448.5800,34487.0000,percent of total billed charges,"7.5% of $34,487.00 in Billed Charges for Rev 278 = $2,586.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM,278,RC,27801451,CDM,,,,,,both,,,34487.0000,5173.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2448.58,,,,,,,2448.5800,34487.0000,percent of total billed charges,"7.1% of $34,487.00 in Billed Charges for Rev 278 = $2,448.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM,278,RC,27801451,CDM,,,,,,both,,,34487.0000,5173.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,2448.58,,,,,,,2448.5800,34487.0000,percent of total billed charges,"7.1% of $34,487.00 in Billed Charges for Rev 278 = $2,448.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM,278,RC,27801451,CDM,,,,,,both,,,34487.0000,5173.0500,WELLCARE,WELLCARE MEDICAID,34487.00,,,,,,,2448.5800,34487.0000,percent of total billed charges,"100% of $34,487.00 in Billed Charges for Rev 278 = $34,487.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,AETNA,AETNA,1672.99,,,,,,,159.1400,3918.0000,percent of total billed charges,"42.7% of $3,918.00 in Billed Charges for Rev 352 Proc 74175 = $1,672.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,565.80,,,,,,,159.1400,3918.0000,fee schedule,APG 00302 Proc 74175 at $836.60 (Base Rate) * 0.6503 (Relative Weight) = $544.04 (Total Line Payment) at 104% = $565.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,159.14,,,,,,,159.1400,3918.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,AETNA,AETNA HEALTHCARE MEDICARE,159.14,,,,,,,159.1400,3918.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,159.14,,,,,,,159.1400,3918.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,AMBETTER,AMBETTER,346.92,,,,,,,159.1400,3918.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,165.50,,,,,,,159.1400,3918.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,BLUE CROSS,ANTHEM EXCHANGE,391.81,,,,,,,159.1400,3918.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,560.36,,,,,,,159.1400,3918.0000,fee schedule,APG 00302 Proc 74175 at $836.60 (Base Rate) * 0.6503 (Relative Weight) = $544.04 (Total Line Payment) at 103% = $560.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,BLUE CROSS,ANTHEM HMO,416.27,,,,,,,159.1400,3918.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,163.91,,,,,,,159.1400,3918.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",489.70,,,,,,,159.1400,3918.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,574.33,,,,,,,159.1400,3918.0000,fee schedule,$574.33 from Fee Schedule BLDTM_23 for Rev 352 Proc 74175 * Qty 1 = $574.33 at 100% = $574.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,BLUE CROSS,BLUE CROSS E NETWORK,843.68,,,,,,,159.1400,3918.0000,fee schedule,$263.65 from Fee Schedule BCFSD for Rev 352 Proc 74175 * Qty 1 = $263.65 at 320% = $843.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,BLUE CROSS,BLUE CROSS MEDICARE,165.50,,,,,,,159.1400,3918.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,BLUE CROSS,BLUE CROSS P NETWORK,862.14,,,,,,,159.1400,3918.0000,fee schedule,$263.65 from Fee Schedule BCFSD for Rev 352 Proc 74175 * Qty 1 = $263.65 at 327% = $862.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,BLUE CROSS,BLUE CROSS S NETWORK,862.14,,,,,,,159.1400,3918.0000,fee schedule,$263.65 from Fee Schedule BCFSD for Rev 352 Proc 74175 * Qty 1 = $263.65 at 327% = $862.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,BLUE CROSS,TENNCARE BLUE CARE,280.16,,,,,,,159.1400,3918.0000,fee schedule,$241.52 from Fee Schedule TC_24 for Rev 352 Proc 74175 * Qty 1 = $241.52 at 116% = $280.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,BLUE CROSS,TENNCARE BLUE SELECT,280.16,,,,,,,159.1400,3918.0000,fee schedule,$241.52 from Fee Schedule TC_24 for Rev 352 Proc 74175 * Qty 1 = $241.52 at 116% = $280.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,CIGNA HEALTHCARE,CIGNA HMO,642.00,,,,,,,159.1400,3918.0000,other,Rev 352 Proc 74175 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,427.00,,,,,,,159.1400,3918.0000,other,Rev 352 Proc 74175 Qty 1 * $427.00 = $427.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,167.09,,,,,,,159.1400,3918.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,642.00,,,,,,,159.1400,3918.0000,other,Rev 352 Proc 74175 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,CIGNA HEALTHCARE,CIGNA PPO,642.00,,,,,,,159.1400,3918.0000,other,Rev 352 Proc 74175 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,167.09,,,,,,,159.1400,3918.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3526.20,,,,,,,159.1400,3918.0000,percent of total billed charges,"90% of $3,918.00 in Billed Charges for Rev 352 Proc 74175 = $3,526.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,HUMANA,HUMANA MEDICARE,159.14,,,,,,,159.1400,3918.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,159.14,,,,,,,159.1400,3918.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,MEDCOST,MEDCOST VHN,1864.58,,,,,,,159.1400,3918.0000,percent of total billed charges,"47.59% of $3,918.00 in Billed Charges for Rev 352 Proc 74175 = $1,864.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,571.24,,,,,,,159.1400,3918.0000,fee schedule,APG 00302 Proc 74175 at $836.60 (Base Rate) * 0.6503 (Relative Weight) = $544.04 (Total Line Payment) at 100% = $544.04... $544.04 at 105% = $571.24 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,167.09,,,,,,,159.1400,3918.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,167.09,,,,,,,159.1400,3918.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,NHC ADVANTAGE,NHC ADVANTAGE,167.09,,,,,,,159.1400,3918.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,560.91,,,,,,,159.1400,3918.0000,fee schedule,APG 00302 Proc 74175 at $836.60 (Base Rate) * 0.6503 (Relative Weight) = $544.04 (Total Line Payment) at 100% = $544.04... $544.04 at 103.1% = $560.91 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,SENTARA HEALTH,SENTARA HEALTH,1011.24,,,,,,,159.1400,3918.0000,percent of total billed charges,"25.81% of $3,918.00 in Billed Charges for Rev 352 Proc 74175 = $1,011.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,SENTARA HEALTH,SENTARA MEDICARE,159.14,,,,,,,159.1400,3918.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3918.00,,,,,,,159.1400,3918.0000,percent of total billed charges,"100% of $3,918.00 in Billed Charges for Rev 352 Proc 74175 = $3,918.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,169.24,,,,,,,159.1400,3918.0000,fee schedule,$338.47 from Fee Schedule TCUHC24 for Rev 352 Proc 74175 * Qty 1 = $338.47 at 50% = $169.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1919.00,,,,,,,159.1400,3918.0000,other,"Rev 352 Proc 74175 1 Visit at $1,919.00 per Visit = $1,919.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1835.00,,,,,,,159.1400,3918.0000,other,"Rev 352 Proc 74175 1 Visit at $1,835.00 per Visit = $1,835.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,3026.00,,,,,,,159.1400,3918.0000,other,"Rev 352 Proc 74175 1 Visit at $3,026.00 per Visit = $3,026.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,560.36,,,,,,,159.1400,3918.0000,fee schedule,APG 00302 Proc 74175 at $836.60 (Base Rate) * 0.6503 (Relative Weight) = $544.04 (Total Line Payment) at 103% = $560.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,159.14,,,,,,,159.1400,3918.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,159.14,,,,,,,159.1400,3918.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,WELLCARE,WELLCARE MEDICAID,3918.00,,,,,,,159.1400,3918.0000,percent of total billed charges,"100% of $3,918.00 in Billed Charges for Rev 352 Proc 74175 = $3,918.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CTA ABDOMEN W CONTRAST,74175,CPT,352,RC,35200022,CDM,,,,both,,,3918.0000,587.7000,WELLCARE,WELLCARE MEDICARE,168.69,,,,,,,159.1400,3918.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,AETNA,AETNA,1513.72,,,,,,,117.2900,3545.0000,percent of total billed charges,"42.7% of $3,545.00 in Billed Charges for Rev 352 Proc 74176 = $1,513.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,459.22,,,,,,,117.2900,3545.0000,fee schedule,APG 00300 Proc 74176 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 104% = $459.22. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,216.48,,,,,,,117.2900,3545.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,AETNA,AETNA HEALTHCARE MEDICARE,216.48,,,,,,,117.2900,3545.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,216.48,,,,,,,117.2900,3545.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,AMBETTER,AMBETTER,471.92,,,,,,,117.2900,3545.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,225.14,,,,,,,117.2900,3545.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,BLUE CROSS,ANTHEM EXCHANGE,532.97,,,,,,,117.2900,3545.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,454.80,,,,,,,117.2900,3545.0000,fee schedule,APG 00300 Proc 74176 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 103% = $454.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,BLUE CROSS,ANTHEM HMO,566.25,,,,,,,117.2900,3545.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,222.97,,,,,,,117.2900,3545.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",666.14,,,,,,,117.2900,3545.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,124.45,,,,,,,117.2900,3545.0000,fee schedule,$124.45 from Fee Schedule BLDTM_23 for Rev 352 Proc 74176 * Qty 1 = $124.45 at 100% = $124.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,BLUE CROSS,BLUE CROSS E NETWORK,373.25,,,,,,,117.2900,3545.0000,fee schedule,$116.64 from Fee Schedule BCFSD for Rev 352 Proc 74176 * Qty 1 = $116.64 at 320% = $373.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,BLUE CROSS,BLUE CROSS MEDICARE,225.14,,,,,,,117.2900,3545.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,BLUE CROSS,BLUE CROSS P NETWORK,381.41,,,,,,,117.2900,3545.0000,fee schedule,$116.64 from Fee Schedule BCFSD for Rev 352 Proc 74176 * Qty 1 = $116.64 at 327% = $381.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,BLUE CROSS,BLUE CROSS S NETWORK,381.41,,,,,,,117.2900,3545.0000,fee schedule,$116.64 from Fee Schedule BCFSD for Rev 352 Proc 74176 * Qty 1 = $116.64 at 327% = $381.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,BLUE CROSS,TENNCARE BLUE CARE,117.29,,,,,,,117.2900,3545.0000,fee schedule,$101.11 from Fee Schedule TC_24 for Rev 352 Proc 74176 * Qty 1 = $101.11 at 116% = $117.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,BLUE CROSS,TENNCARE BLUE SELECT,117.29,,,,,,,117.2900,3545.0000,fee schedule,$101.11 from Fee Schedule TC_24 for Rev 352 Proc 74176 * Qty 1 = $101.11 at 116% = $117.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,CIGNA HEALTHCARE,CIGNA HMO,642.00,,,,,,,117.2900,3545.0000,other,Rev 352 Proc 74176 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,427.00,,,,,,,117.2900,3545.0000,other,Rev 352 Proc 74176 Qty 1 * $427.00 = $427.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,227.30,,,,,,,117.2900,3545.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,642.00,,,,,,,117.2900,3545.0000,other,Rev 352 Proc 74176 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,CIGNA HEALTHCARE,CIGNA PPO,642.00,,,,,,,117.2900,3545.0000,other,Rev 352 Proc 74176 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,227.30,,,,,,,117.2900,3545.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3190.50,,,,,,,117.2900,3545.0000,percent of total billed charges,"90% of $3,545.00 in Billed Charges for Rev 352 Proc 74176 = $3,190.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,HUMANA,HUMANA MEDICARE,216.48,,,,,,,117.2900,3545.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,216.48,,,,,,,117.2900,3545.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,MEDCOST,MEDCOST VHN,1687.07,,,,,,,117.2900,3545.0000,percent of total billed charges,"47.59% of $3,545.00 in Billed Charges for Rev 352 Proc 74176 = $1,687.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,463.64,,,,,,,117.2900,3545.0000,fee schedule,APG 00300 Proc 74176 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 100% = $441.56... $441.56 at 105% = $463.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,227.30,,,,,,,117.2900,3545.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,227.30,,,,,,,117.2900,3545.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,NHC ADVANTAGE,NHC ADVANTAGE,227.30,,,,,,,117.2900,3545.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,455.25,,,,,,,117.2900,3545.0000,fee schedule,APG 00300 Proc 74176 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 100% = $441.56... $441.56 at 103.1% = $455.25 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,SENTARA HEALTH,SENTARA HEALTH,914.96,,,,,,,117.2900,3545.0000,percent of total billed charges,"25.81% of $3,545.00 in Billed Charges for Rev 352 Proc 74176 = $914.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,SENTARA HEALTH,SENTARA MEDICARE,216.48,,,,,,,117.2900,3545.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3545.00,,,,,,,117.2900,3545.0000,percent of total billed charges,"100% of $3,545.00 in Billed Charges for Rev 352 Proc 74176 = $3,545.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,202.59,,,,,,,117.2900,3545.0000,fee schedule,$405.17 from Fee Schedule TCUHC24 for Rev 352 Proc 74176 * Qty 1 = $405.17 at 50% = $202.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1919.00,,,,,,,117.2900,3545.0000,other,"Rev 352 Proc 74176 1 Visit at $1,919.00 per Visit = $1,919.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1835.00,,,,,,,117.2900,3545.0000,other,"Rev 352 Proc 74176 1 Visit at $1,835.00 per Visit = $1,835.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,3026.00,,,,,,,117.2900,3545.0000,other,"Rev 352 Proc 74176 1 Visit at $3,026.00 per Visit = $3,026.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,454.80,,,,,,,117.2900,3545.0000,fee schedule,APG 00300 Proc 74176 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 103% = $454.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,216.48,,,,,,,117.2900,3545.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,216.48,,,,,,,117.2900,3545.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,WELLCARE,WELLCARE MEDICAID,3545.00,,,,,,,117.2900,3545.0000,percent of total billed charges,"100% of $3,545.00 in Billed Charges for Rev 352 Proc 74176 = $3,545.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT ABDOMEN/PELVIS WO CON,74176,CPT,352,RC,35200023,CDM,,,,both,,,3545.0000,531.7500,WELLCARE,WELLCARE MEDICARE,229.47,,,,,,,117.2900,3545.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,AETNA,AETNA,1593.14,,,,,,,223.8000,3731.0000,percent of total billed charges,"42.7% of $3,731.00 in Billed Charges for Rev 352 Proc 74177 = $1,593.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,459.22,,,,,,,223.8000,3731.0000,fee schedule,APG 00300 Proc 74177 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 104% = $459.22. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,316.52,,,,,,,223.8000,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,AETNA,AETNA HEALTHCARE MEDICARE,316.52,,,,,,,223.8000,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,316.52,,,,,,,223.8000,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,AMBETTER,AMBETTER,690.02,,,,,,,223.8000,3731.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,329.19,,,,,,,223.8000,3731.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,ANTHEM EXCHANGE,779.29,,,,,,,223.8000,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,454.80,,,,,,,223.8000,3731.0000,fee schedule,APG 00300 Proc 74177 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 103% = $454.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,ANTHEM HMO,827.95,,,,,,,223.8000,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,326.02,,,,,,,223.8000,3731.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",974.01,,,,,,,223.8000,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,237.47,,,,,,,223.8000,3731.0000,fee schedule,$237.47 from Fee Schedule BLDTM_23 for Rev 352 Proc 74177 * Qty 1 = $237.47 at 100% = $237.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,BLUE CROSS E NETWORK,673.82,,,,,,,223.8000,3731.0000,fee schedule,$210.57 from Fee Schedule BCFSD for Rev 352 Proc 74177 * Qty 1 = $210.57 at 320% = $673.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,BLUE CROSS MEDICARE,329.19,,,,,,,223.8000,3731.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,BLUE CROSS P NETWORK,688.56,,,,,,,223.8000,3731.0000,fee schedule,$210.57 from Fee Schedule BCFSD for Rev 352 Proc 74177 * Qty 1 = $210.57 at 327% = $688.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,BLUE CROSS S NETWORK,688.56,,,,,,,223.8000,3731.0000,fee schedule,$210.57 from Fee Schedule BCFSD for Rev 352 Proc 74177 * Qty 1 = $210.57 at 327% = $688.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,TENNCARE BLUE CARE,223.80,,,,,,,223.8000,3731.0000,fee schedule,$192.93 from Fee Schedule TC_24 for Rev 352 Proc 74177 * Qty 1 = $192.93 at 116% = $223.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,TENNCARE BLUE SELECT,223.80,,,,,,,223.8000,3731.0000,fee schedule,$192.93 from Fee Schedule TC_24 for Rev 352 Proc 74177 * Qty 1 = $192.93 at 116% = $223.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,CIGNA HEALTHCARE,CIGNA HMO,642.00,,,,,,,223.8000,3731.0000,other,Rev 352 Proc 74177 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,427.00,,,,,,,223.8000,3731.0000,other,Rev 352 Proc 74177 Qty 1 * $427.00 = $427.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,332.35,,,,,,,223.8000,3731.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,642.00,,,,,,,223.8000,3731.0000,other,Rev 352 Proc 74177 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,CIGNA HEALTHCARE,CIGNA PPO,642.00,,,,,,,223.8000,3731.0000,other,Rev 352 Proc 74177 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,332.35,,,,,,,223.8000,3731.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3357.90,,,,,,,223.8000,3731.0000,percent of total billed charges,"90% of $3,731.00 in Billed Charges for Rev 352 Proc 74177 = $3,357.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,HUMANA,HUMANA MEDICARE,316.52,,,,,,,223.8000,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,316.52,,,,,,,223.8000,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,MEDCOST,MEDCOST VHN,1775.58,,,,,,,223.8000,3731.0000,percent of total billed charges,"47.59% of $3,731.00 in Billed Charges for Rev 352 Proc 74177 = $1,775.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,463.64,,,,,,,223.8000,3731.0000,fee schedule,APG 00300 Proc 74177 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 100% = $441.56... $441.56 at 105% = $463.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,332.35,,,,,,,223.8000,3731.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,332.35,,,,,,,223.8000,3731.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,NHC ADVANTAGE,NHC ADVANTAGE,332.35,,,,,,,223.8000,3731.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,455.25,,,,,,,223.8000,3731.0000,fee schedule,APG 00300 Proc 74177 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 100% = $441.56... $441.56 at 103.1% = $455.25 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,SENTARA HEALTH,SENTARA HEALTH,962.97,,,,,,,223.8000,3731.0000,percent of total billed charges,"25.81% of $3,731.00 in Billed Charges for Rev 352 Proc 74177 = $962.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,SENTARA HEALTH,SENTARA MEDICARE,316.52,,,,,,,223.8000,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3731.00,,,,,,,223.8000,3731.0000,percent of total billed charges,"100% of $3,731.00 in Billed Charges for Rev 352 Proc 74177 = $3,731.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,290.27,,,,,,,223.8000,3731.0000,fee schedule,$580.54 from Fee Schedule TCUHC24 for Rev 352 Proc 74177 * Qty 1 = $580.54 at 50% = $290.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1919.00,,,,,,,223.8000,3731.0000,other,"Rev 352 Proc 74177 1 Visit at $1,919.00 per Visit = $1,919.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1835.00,,,,,,,223.8000,3731.0000,other,"Rev 352 Proc 74177 1 Visit at $1,835.00 per Visit = $1,835.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,3026.00,,,,,,,223.8000,3731.0000,other,"Rev 352 Proc 74177 1 Visit at $3,026.00 per Visit = $3,026.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,454.80,,,,,,,223.8000,3731.0000,fee schedule,APG 00300 Proc 74177 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 103% = $454.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,316.52,,,,,,,223.8000,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,316.52,,,,,,,223.8000,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,WELLCARE,WELLCARE MEDICAID,3731.00,,,,,,,223.8000,3731.0000,percent of total billed charges,"100% of $3,731.00 in Billed Charges for Rev 352 Proc 74177 = $3,731.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT ABDOMEN/PELVIS W CON,74177,CPT,352,RC,35200024,CDM,,,,both,,,3731.0000,559.6500,WELLCARE,WELLCARE MEDICARE,335.52,,,,,,,223.8000,3731.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,AETNA,AETNA,1672.99,,,,,,,290.2700,3918.0000,percent of total billed charges,"42.7% of $3,918.00 in Billed Charges for Rev 352 Proc 74178 = $1,672.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,459.22,,,,,,,290.2700,3918.0000,fee schedule,APG 00300 Proc 74178 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 104% = $459.22. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,316.52,,,,,,,290.2700,3918.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,AETNA,AETNA HEALTHCARE MEDICARE,316.52,,,,,,,290.2700,3918.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,316.52,,,,,,,290.2700,3918.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,AMBETTER,AMBETTER,690.02,,,,,,,290.2700,3918.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,329.19,,,,,,,290.2700,3918.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,BLUE CROSS,ANTHEM EXCHANGE,779.29,,,,,,,290.2700,3918.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,454.80,,,,,,,290.2700,3918.0000,fee schedule,APG 00300 Proc 74178 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 103% = $454.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,BLUE CROSS,ANTHEM HMO,827.95,,,,,,,290.2700,3918.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,326.02,,,,,,,290.2700,3918.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",974.01,,,,,,,290.2700,3918.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,313.89,,,,,,,290.2700,3918.0000,fee schedule,$313.89 from Fee Schedule BLDTM_23 for Rev 352 Proc 74178 * Qty 1 = $313.89 at 100% = $313.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,BLUE CROSS,BLUE CROSS E NETWORK,800.45,,,,,,,290.2700,3918.0000,fee schedule,$250.14 from Fee Schedule BCFSD for Rev 352 Proc 74178 * Qty 1 = $250.14 at 320% = $800.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,BLUE CROSS,BLUE CROSS MEDICARE,329.19,,,,,,,290.2700,3918.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,BLUE CROSS,BLUE CROSS P NETWORK,817.96,,,,,,,290.2700,3918.0000,fee schedule,$250.14 from Fee Schedule BCFSD for Rev 352 Proc 74178 * Qty 1 = $250.14 at 327% = $817.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,BLUE CROSS,BLUE CROSS S NETWORK,817.96,,,,,,,290.2700,3918.0000,fee schedule,$250.14 from Fee Schedule BCFSD for Rev 352 Proc 74178 * Qty 1 = $250.14 at 327% = $817.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,BLUE CROSS,TENNCARE BLUE CARE,295.81,,,,,,,290.2700,3918.0000,fee schedule,$255.01 from Fee Schedule TC_24 for Rev 352 Proc 74178 * Qty 1 = $255.01 at 116% = $295.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,BLUE CROSS,TENNCARE BLUE SELECT,295.81,,,,,,,290.2700,3918.0000,fee schedule,$255.01 from Fee Schedule TC_24 for Rev 352 Proc 74178 * Qty 1 = $255.01 at 116% = $295.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,CIGNA HEALTHCARE,CIGNA HMO,642.00,,,,,,,290.2700,3918.0000,other,Rev 352 Proc 74178 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,427.00,,,,,,,290.2700,3918.0000,other,Rev 352 Proc 74178 Qty 1 * $427.00 = $427.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,332.35,,,,,,,290.2700,3918.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,642.00,,,,,,,290.2700,3918.0000,other,Rev 352 Proc 74178 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,CIGNA HEALTHCARE,CIGNA PPO,642.00,,,,,,,290.2700,3918.0000,other,Rev 352 Proc 74178 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,332.35,,,,,,,290.2700,3918.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3526.20,,,,,,,290.2700,3918.0000,percent of total billed charges,"90% of $3,918.00 in Billed Charges for Rev 352 Proc 74178 = $3,526.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,HUMANA,HUMANA MEDICARE,316.52,,,,,,,290.2700,3918.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,316.52,,,,,,,290.2700,3918.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,MEDCOST,MEDCOST VHN,1864.58,,,,,,,290.2700,3918.0000,percent of total billed charges,"47.59% of $3,918.00 in Billed Charges for Rev 352 Proc 74178 = $1,864.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,463.64,,,,,,,290.2700,3918.0000,fee schedule,APG 00300 Proc 74178 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 100% = $441.56... $441.56 at 105% = $463.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,332.35,,,,,,,290.2700,3918.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,332.35,,,,,,,290.2700,3918.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,NHC ADVANTAGE,NHC ADVANTAGE,332.35,,,,,,,290.2700,3918.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,455.25,,,,,,,290.2700,3918.0000,fee schedule,APG 00300 Proc 74178 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 100% = $441.56... $441.56 at 103.1% = $455.25 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,SENTARA HEALTH,SENTARA HEALTH,1011.24,,,,,,,290.2700,3918.0000,percent of total billed charges,"25.81% of $3,918.00 in Billed Charges for Rev 352 Proc 74178 = $1,011.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,SENTARA HEALTH,SENTARA MEDICARE,316.52,,,,,,,290.2700,3918.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3918.00,,,,,,,290.2700,3918.0000,percent of total billed charges,"100% of $3,918.00 in Billed Charges for Rev 352 Proc 74178 = $3,918.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,290.27,,,,,,,290.2700,3918.0000,fee schedule,$580.54 from Fee Schedule TCUHC24 for Rev 352 Proc 74178 * Qty 1 = $580.54 at 50% = $290.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1919.00,,,,,,,290.2700,3918.0000,other,"Rev 352 Proc 74178 1 Visit at $1,919.00 per Visit = $1,919.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1835.00,,,,,,,290.2700,3918.0000,other,"Rev 352 Proc 74178 1 Visit at $1,835.00 per Visit = $1,835.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,3026.00,,,,,,,290.2700,3918.0000,other,"Rev 352 Proc 74178 1 Visit at $3,026.00 per Visit = $3,026.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,454.80,,,,,,,290.2700,3918.0000,fee schedule,APG 00300 Proc 74178 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 103% = $454.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,316.52,,,,,,,290.2700,3918.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,316.52,,,,,,,290.2700,3918.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,WELLCARE,WELLCARE MEDICAID,3918.00,,,,,,,290.2700,3918.0000,percent of total billed charges,"100% of $3,918.00 in Billed Charges for Rev 352 Proc 74178 = $3,918.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT ABD/PEL WOW CON,74178,CPT,352,RC,35200025,CDM,,,,both,,,3918.0000,587.7000,WELLCARE,WELLCARE MEDICARE,335.52,,,,,,,290.2700,3918.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,AETNA,AETNA,1903.14,,,,,,,267.0200,4457.0000,percent of total billed charges,"42.7% of $4,457.00 in Billed Charges for Rev 610 Proc 74183 = $1,903.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,577.20,,,,,,,267.0200,4457.0000,fee schedule,APG 00295 Proc 74183 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 104% = $577.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,316.52,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,AETNA,AETNA HEALTHCARE MEDICARE,316.52,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,316.52,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,AMBETTER,AMBETTER,690.02,,,,,,,267.0200,4457.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,329.19,,,,,,,267.0200,4457.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,ANTHEM EXCHANGE,779.29,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,571.65,,,,,,,267.0200,4457.0000,fee schedule,APG 00295 Proc 74183 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 103% = $571.65. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,ANTHEM HMO,827.95,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,326.02,,,,,,,267.0200,4457.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",974.01,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1675.92,,,,,,,267.0200,4457.0000,fee schedule,"$1,675.92 from Fee Schedule BLDTM_23 for Rev 610 Proc 74183 * Qty 1 = $1,675.92 at 100% = $1,675.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,BLUE CROSS E NETWORK,1178.24,,,,,,,267.0200,4457.0000,fee schedule,"$368.20 from Fee Schedule BCFSD for Rev 610 Proc 74183 * Qty 1 = $368.20 at 320% = $1,178.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,BLUE CROSS MEDICARE,329.19,,,,,,,267.0200,4457.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,BLUE CROSS P NETWORK,1204.01,,,,,,,267.0200,4457.0000,fee schedule,"$368.20 from Fee Schedule BCFSD for Rev 610 Proc 74183 * Qty 1 = $368.20 at 327% = $1,204.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,BLUE CROSS S NETWORK,1204.01,,,,,,,267.0200,4457.0000,fee schedule,"$368.20 from Fee Schedule BCFSD for Rev 610 Proc 74183 * Qty 1 = $368.20 at 327% = $1,204.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,TENNCARE BLUE CARE,817.52,,,,,,,267.0200,4457.0000,fee schedule,$704.76 from Fee Schedule TC_24 for Rev 610 Proc 74183 * Qty 1 = $704.76 at 116% = $817.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,TENNCARE BLUE SELECT,817.52,,,,,,,267.0200,4457.0000,fee schedule,$704.76 from Fee Schedule TC_24 for Rev 610 Proc 74183 * Qty 1 = $704.76 at 116% = $817.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,CIGNA HEALTHCARE,CIGNA HMO,1215.00,,,,,,,267.0200,4457.0000,other,"Rev 610 Proc 74183 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,786.00,,,,,,,267.0200,4457.0000,other,Rev 610 Proc 74183 Qty 1 * $786.00 = $786.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,332.35,,,,,,,267.0200,4457.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1215.00,,,,,,,267.0200,4457.0000,other,"Rev 610 Proc 74183 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,CIGNA HEALTHCARE,CIGNA PPO,1215.00,,,,,,,267.0200,4457.0000,other,"Rev 610 Proc 74183 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,332.35,,,,,,,267.0200,4457.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4011.30,,,,,,,267.0200,4457.0000,percent of total billed charges,"90% of $4,457.00 in Billed Charges for Rev 610 Proc 74183 = $4,011.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,HUMANA,HUMANA MEDICARE,316.52,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,316.52,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,MEDCOST,MEDCOST VHN,2121.09,,,,,,,267.0200,4457.0000,percent of total billed charges,"47.59% of $4,457.00 in Billed Charges for Rev 610 Proc 74183 = $2,121.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,582.75,,,,,,,267.0200,4457.0000,fee schedule,APG 00295 Proc 74183 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 100% = $555.00... $555.00 at 105% = $582.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,332.35,,,,,,,267.0200,4457.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,332.35,,,,,,,267.0200,4457.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,NHC ADVANTAGE,NHC ADVANTAGE,332.35,,,,,,,267.0200,4457.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,572.21,,,,,,,267.0200,4457.0000,fee schedule,APG 00295 Proc 74183 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 100% = $555.00... $555.00 at 103.1% = $572.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,SENTARA HEALTH,SENTARA HEALTH,1150.35,,,,,,,267.0200,4457.0000,percent of total billed charges,"25.81% of $4,457.00 in Billed Charges for Rev 610 Proc 74183 = $1,150.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,SENTARA HEALTH,SENTARA MEDICARE,316.52,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4457.00,,,,,,,267.0200,4457.0000,percent of total billed charges,"100% of $4,457.00 in Billed Charges for Rev 610 Proc 74183 = $4,457.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,267.02,,,,,,,267.0200,4457.0000,fee schedule,$534.03 from Fee Schedule TCUHC24 for Rev 610 Proc 74183 * Qty 1 = $534.03 at 50% = $267.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2559.00,,,,,,,267.0200,4457.0000,other,"Rev 610 Proc 74183 1 Visit at $2,559.00 per Visit = $2,559.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2448.00,,,,,,,267.0200,4457.0000,other,"Rev 610 Proc 74183 1 Visit at $2,448.00 per Visit = $2,448.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,4035.00,,,,,,,267.0200,4457.0000,other,"Rev 610 Proc 74183 1 Visit at $4,035.00 per Visit = $4,035.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,571.65,,,,,,,267.0200,4457.0000,fee schedule,APG 00295 Proc 74183 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 103% = $571.65. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,316.52,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,316.52,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,WELLCARE,WELLCARE MEDICAID,4457.00,,,,,,,267.0200,4457.0000,percent of total billed charges,"100% of $4,457.00 in Billed Charges for Rev 610 Proc 74183 = $4,457.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR ABDOMEN WOW CON,74183,CPT,610,RC,61000031,CDM,,,,both,,,4457.0000,668.5500,WELLCARE,WELLCARE MEDICARE,335.52,,,,,,,267.0200,4457.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIT MIC KEY 14-0.8 TO 14-2.0/18-1.0 TO 18-2.0 ENFIT,272,RC,27202191,CDM,,,,,,both,,,882.0000,132.3000,AETNA,AETNA,376.61,,,,,,,227.6400,882.0000,percent of total billed charges,42.7% of $882.00 in Billed Charges for Rev 272 = $376.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-0.8 TO 14-2.0/18-1.0 TO 18-2.0 ENFIT,272,RC,27202191,CDM,,,,,,both,,,882.0000,132.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,617.40,,,,,,,227.6400,882.0000,percent of total billed charges,Rev 272 $882.00 in Billed Charges at 70% = $617.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-0.8 TO 14-2.0/18-1.0 TO 18-2.0 ENFIT,272,RC,27202191,CDM,,,,,,both,,,882.0000,132.3000,CIGNA HEALTHCARE,CIGNA HMO,367.79,,,,,,,227.6400,882.0000,percent of total billed charges,41.7% of $882.00 in Billed Charges for Rev 272 = $367.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-0.8 TO 14-2.0/18-1.0 TO 18-2.0 ENFIT,272,RC,27202191,CDM,,,,,,both,,,882.0000,132.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,409.25,,,,,,,227.6400,882.0000,percent of total billed charges,46.4% of $882.00 in Billed Charges for Rev 272 = $409.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-0.8 TO 14-2.0/18-1.0 TO 18-2.0 ENFIT,272,RC,27202191,CDM,,,,,,both,,,882.0000,132.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,367.79,,,,,,,227.6400,882.0000,percent of total billed charges,41.7% of $882.00 in Billed Charges for Rev 272 = $367.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-0.8 TO 14-2.0/18-1.0 TO 18-2.0 ENFIT,272,RC,27202191,CDM,,,,,,both,,,882.0000,132.3000,CIGNA HEALTHCARE,CIGNA PPO,367.79,,,,,,,227.6400,882.0000,percent of total billed charges,41.7% of $882.00 in Billed Charges for Rev 272 = $367.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-0.8 TO 14-2.0/18-1.0 TO 18-2.0 ENFIT,272,RC,27202191,CDM,,,,,,both,,,882.0000,132.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,793.80,,,,,,,227.6400,882.0000,percent of total billed charges,90% of $882.00 in Billed Charges for Rev 272 = $793.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-0.8 TO 14-2.0/18-1.0 TO 18-2.0 ENFIT,272,RC,27202191,CDM,,,,,,both,,,882.0000,132.3000,MEDCOST,MEDCOST VHN,419.74,,,,,,,227.6400,882.0000,percent of total billed charges,47.59% of $882.00 in Billed Charges for Rev 272 = $419.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-0.8 TO 14-2.0/18-1.0 TO 18-2.0 ENFIT,272,RC,27202191,CDM,,,,,,both,,,882.0000,132.3000,SENTARA HEALTH,SENTARA HEALTH,227.64,,,,,,,227.6400,882.0000,percent of total billed charges,25.81% of $882.00 in Billed Charges for Rev 272 = $227.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-0.8 TO 14-2.0/18-1.0 TO 18-2.0 ENFIT,272,RC,27202191,CDM,,,,,,both,,,882.0000,132.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",882.00,,,,,,,227.6400,882.0000,percent of total billed charges,100% of $882.00 in Billed Charges for Rev 272 = $882.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-0.8 TO 14-2.0/18-1.0 TO 18-2.0 ENFIT,272,RC,27202191,CDM,,,,,,both,,,882.0000,132.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,441.00,,,,,,,227.6400,882.0000,percent of total billed charges,Rev 272 $882.00 in Billed Charges at 50% = $441.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-0.8 TO 14-2.0/18-1.0 TO 18-2.0 ENFIT,272,RC,27202191,CDM,,,,,,both,,,882.0000,132.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,284.89,,,,,,,227.6400,882.0000,other,32.3% of $882.00 in Billed Charges for Rev 272 = $284.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIT MIC KEY 14-0.8 TO 14-2.0/18-1.0 TO 18-2.0 ENFIT,272,RC,27202191,CDM,,,,,,both,,,882.0000,132.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,270.77,,,,,,,227.6400,882.0000,other,30.7% of $882.00 in Billed Charges for Rev 272 = $270.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIT MIC KEY 14-0.8 TO 14-2.0/18-1.0 TO 18-2.0 ENFIT,272,RC,27202191,CDM,,,,,,both,,,882.0000,132.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,284.89,,,,,,,227.6400,882.0000,percent of total billed charges,32.3% of $882.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-0.8 TO 14-2.0/18-1.0 TO 18-2.0 ENFIT,272,RC,27202191,CDM,,,,,,both,,,882.0000,132.3000,WELLCARE,WELLCARE MEDICAID,882.00,,,,,,,227.6400,882.0000,percent of total billed charges,100% of $882.00 in Billed Charges for Rev 272 = $882.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MONITORING INTERCRANIAL PRESSURE 110-4B,278,RC,27800833,CDM,,,,,,both,,,9038.0000,1355.7000,AETNA,AETNA,4338.24,,,,,,,2332.7100,9038.0000,percent of total billed charges,"48% of $9,038.00 in Billed Charges for Rev 278 = $4,338.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT MONITORING INTERCRANIAL PRESSURE 110-4B,278,RC,27800833,CDM,,,,,,both,,,9038.0000,1355.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4519.00,,,,,,,2332.7100,9038.0000,percent of total billed charges,"50% of $9,038.00 in Billed Charges for Rev 278 = $4,519.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT MONITORING INTERCRANIAL PRESSURE 110-4B,278,RC,27800833,CDM,,,,,,both,,,9038.0000,1355.7000,CIGNA HEALTHCARE,CIGNA HMO,3768.85,,,,,,,2332.7100,9038.0000,percent of total billed charges,"41.7% of $9,038.00 in Billed Charges for Rev 278 = $3,768.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT MONITORING INTERCRANIAL PRESSURE 110-4B,278,RC,27800833,CDM,,,,,,both,,,9038.0000,1355.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3615.20,,,,,,,2332.7100,9038.0000,percent of total billed charges,"40% of $9,038.00 in Billed Charges for Rev 278 = $3,615.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT MONITORING INTERCRANIAL PRESSURE 110-4B,278,RC,27800833,CDM,,,,,,both,,,9038.0000,1355.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3768.85,,,,,,,2332.7100,9038.0000,percent of total billed charges,"41.7% of $9,038.00 in Billed Charges for Rev 278 = $3,768.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT MONITORING INTERCRANIAL PRESSURE 110-4B,278,RC,27800833,CDM,,,,,,both,,,9038.0000,1355.7000,CIGNA HEALTHCARE,CIGNA PPO,3768.85,,,,,,,2332.7100,9038.0000,percent of total billed charges,"41.7% of $9,038.00 in Billed Charges for Rev 278 = $3,768.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT MONITORING INTERCRANIAL PRESSURE 110-4B,278,RC,27800833,CDM,,,,,,both,,,9038.0000,1355.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8134.20,,,,,,,2332.7100,9038.0000,percent of total billed charges,"90% of $9,038.00 in Billed Charges for Rev 278 = $8,134.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT MONITORING INTERCRANIAL PRESSURE 110-4B,278,RC,27800833,CDM,,,,,,both,,,9038.0000,1355.7000,MEDCOST,MEDCOST VHN,4301.18,,,,,,,2332.7100,9038.0000,percent of total billed charges,"47.59% of $9,038.00 in Billed Charges for Rev 278 = $4,301.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT MONITORING INTERCRANIAL PRESSURE 110-4B,278,RC,27800833,CDM,,,,,,both,,,9038.0000,1355.7000,SENTARA HEALTH,SENTARA HEALTH,2332.71,,,,,,,2332.7100,9038.0000,percent of total billed charges,"25.81% of $9,038.00 in Billed Charges for Rev 278 = $2,332.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT MONITORING INTERCRANIAL PRESSURE 110-4B,278,RC,27800833,CDM,,,,,,both,,,9038.0000,1355.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9038.00,,,,,,,2332.7100,9038.0000,percent of total billed charges,"100% of $9,038.00 in Billed Charges for Rev 278 = $9,038.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT MONITORING INTERCRANIAL PRESSURE 110-4B,278,RC,27800833,CDM,,,,,,both,,,9038.0000,1355.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4519.00,,,,,,,2332.7100,9038.0000,percent of total billed charges,"Rev 278 $9,038.00 in Billed Charges at 50% = $4,519.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT MONITORING INTERCRANIAL PRESSURE 110-4B,278,RC,27800833,CDM,,,,,,both,,,9038.0000,1355.7000,WELLCARE,WELLCARE MEDICAID,9038.00,,,,,,,2332.7100,9038.0000,percent of total billed charges,"100% of $9,038.00 in Billed Charges for Rev 278 = $9,038.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA WOUND MANAGEMENT,272,RC,27202261,CDM,,,,,,both,,,4662.0000,699.3000,AETNA,AETNA,1990.67,,,,,,,1203.2600,4662.0000,percent of total billed charges,"42.7% of $4,662.00 in Billed Charges for Rev 272 = $1,990.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA WOUND MANAGEMENT,272,RC,27202261,CDM,,,,,,both,,,4662.0000,699.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3263.40,,,,,,,1203.2600,4662.0000,percent of total billed charges,"Rev 272 $4,662.00 in Billed Charges at 70% = $3,263.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA WOUND MANAGEMENT,272,RC,27202261,CDM,,,,,,both,,,4662.0000,699.3000,CIGNA HEALTHCARE,CIGNA HMO,1944.05,,,,,,,1203.2600,4662.0000,percent of total billed charges,"41.7% of $4,662.00 in Billed Charges for Rev 272 = $1,944.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA WOUND MANAGEMENT,272,RC,27202261,CDM,,,,,,both,,,4662.0000,699.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2163.17,,,,,,,1203.2600,4662.0000,percent of total billed charges,"46.4% of $4,662.00 in Billed Charges for Rev 272 = $2,163.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA WOUND MANAGEMENT,272,RC,27202261,CDM,,,,,,both,,,4662.0000,699.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1944.05,,,,,,,1203.2600,4662.0000,percent of total billed charges,"41.7% of $4,662.00 in Billed Charges for Rev 272 = $1,944.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA WOUND MANAGEMENT,272,RC,27202261,CDM,,,,,,both,,,4662.0000,699.3000,CIGNA HEALTHCARE,CIGNA PPO,1944.05,,,,,,,1203.2600,4662.0000,percent of total billed charges,"41.7% of $4,662.00 in Billed Charges for Rev 272 = $1,944.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA WOUND MANAGEMENT,272,RC,27202261,CDM,,,,,,both,,,4662.0000,699.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4195.80,,,,,,,1203.2600,4662.0000,percent of total billed charges,"90% of $4,662.00 in Billed Charges for Rev 272 = $4,195.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA WOUND MANAGEMENT,272,RC,27202261,CDM,,,,,,both,,,4662.0000,699.3000,MEDCOST,MEDCOST VHN,2218.65,,,,,,,1203.2600,4662.0000,percent of total billed charges,"47.59% of $4,662.00 in Billed Charges for Rev 272 = $2,218.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA WOUND MANAGEMENT,272,RC,27202261,CDM,,,,,,both,,,4662.0000,699.3000,SENTARA HEALTH,SENTARA HEALTH,1203.26,,,,,,,1203.2600,4662.0000,percent of total billed charges,"25.81% of $4,662.00 in Billed Charges for Rev 272 = $1,203.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA WOUND MANAGEMENT,272,RC,27202261,CDM,,,,,,both,,,4662.0000,699.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4662.00,,,,,,,1203.2600,4662.0000,percent of total billed charges,"100% of $4,662.00 in Billed Charges for Rev 272 = $4,662.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA WOUND MANAGEMENT,272,RC,27202261,CDM,,,,,,both,,,4662.0000,699.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2331.00,,,,,,,1203.2600,4662.0000,percent of total billed charges,"Rev 272 $4,662.00 in Billed Charges at 50% = $2,331.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA WOUND MANAGEMENT,272,RC,27202261,CDM,,,,,,both,,,4662.0000,699.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1505.83,,,,,,,1203.2600,4662.0000,other,"32.3% of $4,662.00 in Billed Charges for Rev 272 = $1,505.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIT PREVENA WOUND MANAGEMENT,272,RC,27202261,CDM,,,,,,both,,,4662.0000,699.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1431.23,,,,,,,1203.2600,4662.0000,other,"30.7% of $4,662.00 in Billed Charges for Rev 272 = $1,431.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIT PREVENA WOUND MANAGEMENT,272,RC,27202261,CDM,,,,,,both,,,4662.0000,699.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,1505.83,,,,,,,1203.2600,4662.0000,percent of total billed charges,"32.3% of $4,662.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA WOUND MANAGEMENT,272,RC,27202261,CDM,,,,,,both,,,4662.0000,699.3000,WELLCARE,WELLCARE MEDICAID,4662.00,,,,,,,1203.2600,4662.0000,percent of total billed charges,"100% of $4,662.00 in Billed Charges for Rev 272 = $4,662.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,38.6600,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 74220 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,38.6600,462.0000,fee schedule,APG 00471 Proc 74220 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,159.14,,,,,,,38.6600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,159.14,,,,,,,38.6600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,159.14,,,,,,,38.6600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,346.92,,,,,,,38.6600,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,165.50,,,,,,,38.6600,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,391.81,,,,,,,38.6600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,38.6600,462.0000,fee schedule,APG 00471 Proc 74220 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,416.27,,,,,,,38.6600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,163.91,,,,,,,38.6600,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",462.00,,,,,,,38.6600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,70.39,,,,,,,38.6600,462.0000,fee schedule,$70.39 from Fee Schedule BLDTM_23 for Rev 320 Proc 74220 * Qty 1 = $70.39 at 100% = $70.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,201.34,,,,,,,38.6600,462.0000,fee schedule,$62.92 from Fee Schedule BCFSC for Rev 320 Proc 74220 * Qty 1 = $62.92 at 320% = $201.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,165.50,,,,,,,38.6600,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,205.75,,,,,,,38.6600,462.0000,fee schedule,$62.92 from Fee Schedule BCFSC for Rev 320 Proc 74220 * Qty 1 = $62.92 at 327% = $205.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,205.75,,,,,,,38.6600,462.0000,fee schedule,$62.92 from Fee Schedule BCFSC for Rev 320 Proc 74220 * Qty 1 = $62.92 at 327% = $205.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,38.66,,,,,,,38.6600,462.0000,fee schedule,$33.33 from Fee Schedule TC_24 for Rev 320 Proc 74220 * Qty 1 = $33.33 at 116% = $38.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,38.66,,,,,,,38.6600,462.0000,fee schedule,$33.33 from Fee Schedule TC_24 for Rev 320 Proc 74220 * Qty 1 = $33.33 at 116% = $38.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,324.85,,,,,,,38.6600,462.0000,fee schedule,$324.85 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74220 * Qty 1 = $324.85 at 100% = $324.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,130.03,,,,,,,38.6600,462.0000,fee schedule,$130.03 from Fee Schedule CGIFP_25LR for Rev 320 Proc 74220 * Qty 1 = $130.03 at 100% = $130.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,167.09,,,,,,,38.6600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,324.85,,,,,,,38.6600,462.0000,fee schedule,$324.85 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74220 * Qty 1 = $324.85 at 100% = $324.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,324.85,,,,,,,38.6600,462.0000,fee schedule,$324.85 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74220 * Qty 1 = $324.85 at 100% = $324.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,167.09,,,,,,,38.6600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,38.6600,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 74220 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,159.14,,,,,,,38.6600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,159.14,,,,,,,38.6600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,38.6600,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 74220 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,38.6600,462.0000,fee schedule,APG 00471 Proc 74220 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,167.09,,,,,,,38.6600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,167.09,,,,,,,38.6600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,167.09,,,,,,,38.6600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,38.6600,462.0000,fee schedule,APG 00471 Proc 74220 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,38.6600,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 74220 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,159.14,,,,,,,38.6600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,38.6600,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 74220 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,42.92,,,,,,,38.6600,462.0000,fee schedule,$85.83 from Fee Schedule TCUHC24 for Rev 320 Proc 74220 * Qty 1 = $85.83 at 50% = $42.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,38.6600,462.0000,other,Rev 320 Proc 74220 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,38.6600,462.0000,other,Rev 320 Proc 74220 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,38.6600,462.0000,other,Rev 320 Proc 74220 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,38.6600,462.0000,fee schedule,APG 00471 Proc 74220 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,159.14,,,,,,,38.6600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,159.14,,,,,,,38.6600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,38.6600,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 74220 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG SNGL CONT BA STDY,74220,CPT,320,RC,32000146,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,168.69,,,,,,,38.6600,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,AETNA,AETNA,209.23,,,,,,,63.0200,490.0000,percent of total billed charges,42.7% of $490.00 in Billed Charges for Rev 320 Proc 74221 = $209.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,166.44,,,,,,,63.0200,490.0000,fee schedule,APG 00389 Proc 74221 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 104% = $166.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,159.14,,,,,,,63.0200,490.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,AETNA,AETNA HEALTHCARE MEDICARE,159.14,,,,,,,63.0200,490.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,159.14,,,,,,,63.0200,490.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,AMBETTER,AMBETTER,346.92,,,,,,,63.0200,490.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,165.50,,,,,,,63.0200,490.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,BLUE CROSS,ANTHEM EXCHANGE,391.81,,,,,,,63.0200,490.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,164.84,,,,,,,63.0200,490.0000,fee schedule,APG 00389 Proc 74221 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,BLUE CROSS,ANTHEM HMO,416.27,,,,,,,63.0200,490.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,163.91,,,,,,,63.0200,490.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",489.70,,,,,,,63.0200,490.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,343.00,,,,,,,63.0200,490.0000,percent of total billed charges,Rev 320 Proc 74221 $490.00 in Billed Charges at 70% = $343.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,BLUE CROSS,BLUE CROSS E NETWORK,213.98,,,,,,,63.0200,490.0000,fee schedule,$66.87 from Fee Schedule BCFSC for Rev 320 Proc 74221 * Qty 1 = $66.87 at 320% = $213.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,BLUE CROSS,BLUE CROSS MEDICARE,165.50,,,,,,,63.0200,490.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,BLUE CROSS,BLUE CROSS P NETWORK,218.66,,,,,,,63.0200,490.0000,fee schedule,$66.87 from Fee Schedule BCFSC for Rev 320 Proc 74221 * Qty 1 = $66.87 at 327% = $218.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,BLUE CROSS,BLUE CROSS S NETWORK,218.66,,,,,,,63.0200,490.0000,fee schedule,$66.87 from Fee Schedule BCFSC for Rev 320 Proc 74221 * Qty 1 = $66.87 at 327% = $218.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,BLUE CROSS,TENNCARE BLUE CARE,63.02,,,,,,,63.0200,490.0000,fee schedule,$54.33 from Fee Schedule TC_24 for Rev 320 Proc 74221 * Qty 1 = $54.33 at 116% = $63.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,BLUE CROSS,TENNCARE BLUE SELECT,63.02,,,,,,,63.0200,490.0000,fee schedule,$54.33 from Fee Schedule TC_24 for Rev 320 Proc 74221 * Qty 1 = $54.33 at 116% = $63.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,CIGNA HEALTHCARE,CIGNA HMO,204.33,,,,,,,63.0200,490.0000,percent of total billed charges,Rev 320 Proc 74221 $490.00 in Billed Charges at 41.7% = $204.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,144.44,,,,,,,63.0200,490.0000,fee schedule,$144.44 from Fee Schedule CGIFP_25LR for Rev 320 Proc 74221 * Qty 1 = $144.44 at 100% = $144.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,167.09,,,,,,,63.0200,490.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,204.33,,,,,,,63.0200,490.0000,percent of total billed charges,Rev 320 Proc 74221 $490.00 in Billed Charges at 41.7% = $204.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,CIGNA HEALTHCARE,CIGNA PPO,204.33,,,,,,,63.0200,490.0000,percent of total billed charges,Rev 320 Proc 74221 $490.00 in Billed Charges at 41.7% = $204.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,167.09,,,,,,,63.0200,490.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,441.00,,,,,,,63.0200,490.0000,percent of total billed charges,90% of $490.00 in Billed Charges for Rev 320 Proc 74221 = $441.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,HUMANA,HUMANA MEDICARE,159.14,,,,,,,63.0200,490.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,159.14,,,,,,,63.0200,490.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,MEDCOST,MEDCOST VHN,233.19,,,,,,,63.0200,490.0000,percent of total billed charges,47.59% of $490.00 in Billed Charges for Rev 320 Proc 74221 = $233.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,168.04,,,,,,,63.0200,490.0000,fee schedule,APG 00389 Proc 74221 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 105% = $168.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,167.09,,,,,,,63.0200,490.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,167.09,,,,,,,63.0200,490.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,NHC ADVANTAGE,NHC ADVANTAGE,167.09,,,,,,,63.0200,490.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,165.00,,,,,,,63.0200,490.0000,fee schedule,APG 00389 Proc 74221 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 103.1% = $165.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,SENTARA HEALTH,SENTARA HEALTH,126.47,,,,,,,63.0200,490.0000,percent of total billed charges,25.81% of $490.00 in Billed Charges for Rev 320 Proc 74221 = $126.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,SENTARA HEALTH,SENTARA MEDICARE,159.14,,,,,,,63.0200,490.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",490.00,,,,,,,63.0200,490.0000,percent of total billed charges,100% of $490.00 in Billed Charges for Rev 320 Proc 74221 = $490.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,91.10,,,,,,,63.0200,490.0000,fee schedule,$182.20 from Fee Schedule TCUHC24 for Rev 320 Proc 74221 * Qty 1 = $182.20 at 50% = $91.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,63.0200,490.0000,other,Rev 320 Proc 74221 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,63.0200,490.0000,other,Rev 320 Proc 74221 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,63.0200,490.0000,other,Rev 320 Proc 74221 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,164.84,,,,,,,63.0200,490.0000,fee schedule,APG 00389 Proc 74221 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,159.14,,,,,,,63.0200,490.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,159.14,,,,,,,63.0200,490.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,WELLCARE,WELLCARE MEDICAID,490.00,,,,,,,63.0200,490.0000,percent of total billed charges,100% of $490.00 in Billed Charges for Rev 320 Proc 74221 = $490.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX ESOPHAGUS INCL SCT CHST & DELAY IMG DBL CONT STDY,74221,CPT,320,RC,32000322,CDM,,,,both,,,490.0000,73.5000,WELLCARE,WELLCARE MEDICARE,168.69,,,,,,,63.0200,490.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,42.7200,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 74230 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,166.44,,,,,,,42.7200,462.0000,fee schedule,APG 00389 Proc 74230 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 104% = $166.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,159.14,,,,,,,42.7200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,159.14,,,,,,,42.7200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,159.14,,,,,,,42.7200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,346.92,,,,,,,42.7200,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,165.50,,,,,,,42.7200,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,391.81,,,,,,,42.7200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,164.84,,,,,,,42.7200,462.0000,fee schedule,APG 00389 Proc 74230 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,416.27,,,,,,,42.7200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,163.91,,,,,,,42.7200,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",462.00,,,,,,,42.7200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,79.24,,,,,,,42.7200,462.0000,fee schedule,$79.24 from Fee Schedule BLDTM_23 for Rev 320 Proc 74230 * Qty 1 = $79.24 at 100% = $79.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,191.04,,,,,,,42.7200,462.0000,fee schedule,$59.70 from Fee Schedule BCFSC for Rev 320 Proc 74230 * Qty 1 = $59.70 at 320% = $191.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,165.50,,,,,,,42.7200,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,195.22,,,,,,,42.7200,462.0000,fee schedule,$59.70 from Fee Schedule BCFSC for Rev 320 Proc 74230 * Qty 1 = $59.70 at 327% = $195.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,195.22,,,,,,,42.7200,462.0000,fee schedule,$59.70 from Fee Schedule BCFSC for Rev 320 Proc 74230 * Qty 1 = $59.70 at 327% = $195.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,42.72,,,,,,,42.7200,462.0000,fee schedule,$36.83 from Fee Schedule TC_24 for Rev 320 Proc 74230 * Qty 1 = $36.83 at 116% = $42.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,42.72,,,,,,,42.7200,462.0000,fee schedule,$36.83 from Fee Schedule TC_24 for Rev 320 Proc 74230 * Qty 1 = $36.83 at 116% = $42.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,324.85,,,,,,,42.7200,462.0000,fee schedule,$324.85 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74230 * Qty 1 = $324.85 at 100% = $324.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,187.03,,,,,,,42.7200,462.0000,fee schedule,$187.03 from Fee Schedule CGIFP_25LR for Rev 320 Proc 74230 * Qty 1 = $187.03 at 100% = $187.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,167.09,,,,,,,42.7200,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,324.85,,,,,,,42.7200,462.0000,fee schedule,$324.85 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74230 * Qty 1 = $324.85 at 100% = $324.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,324.85,,,,,,,42.7200,462.0000,fee schedule,$324.85 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74230 * Qty 1 = $324.85 at 100% = $324.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,167.09,,,,,,,42.7200,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,42.7200,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 74230 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,159.14,,,,,,,42.7200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,159.14,,,,,,,42.7200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,42.7200,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 74230 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,168.04,,,,,,,42.7200,462.0000,fee schedule,APG 00389 Proc 74230 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 105% = $168.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,167.09,,,,,,,42.7200,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,167.09,,,,,,,42.7200,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,167.09,,,,,,,42.7200,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,165.00,,,,,,,42.7200,462.0000,fee schedule,APG 00389 Proc 74230 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 103.1% = $165.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,42.7200,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 74230 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,159.14,,,,,,,42.7200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,42.7200,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 74230 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,42.92,,,,,,,42.7200,462.0000,fee schedule,$85.83 from Fee Schedule TCUHC24 for Rev 320 Proc 74230 * Qty 1 = $85.83 at 50% = $42.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,42.7200,462.0000,other,Rev 320 Proc 74230 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,42.7200,462.0000,other,Rev 320 Proc 74230 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,42.7200,462.0000,other,Rev 320 Proc 74230 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,164.84,,,,,,,42.7200,462.0000,fee schedule,APG 00389 Proc 74230 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,159.14,,,,,,,42.7200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,159.14,,,,,,,42.7200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,42.7200,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 74230 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX SWALLOW FUNCT W CINE/VIDEORAD INCL SCT NECK & DELAY IMG CONT BA STDY,74230,CPT,320,RC,32000147,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,168.69,,,,,,,42.7200,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,42.9200,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 74240 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,166.44,,,,,,,42.9200,462.0000,fee schedule,APG 00389 Proc 74240 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 104% = $166.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,159.14,,,,,,,42.9200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,159.14,,,,,,,42.9200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,159.14,,,,,,,42.9200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,346.92,,,,,,,42.9200,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,165.50,,,,,,,42.9200,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,391.81,,,,,,,42.9200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,164.84,,,,,,,42.9200,462.0000,fee schedule,APG 00389 Proc 74240 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,416.27,,,,,,,42.9200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,163.91,,,,,,,42.9200,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",462.00,,,,,,,42.9200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,94.08,,,,,,,42.9200,462.0000,fee schedule,$94.08 from Fee Schedule BLDTM_23 for Rev 320 Proc 74240 * Qty 1 = $94.08 at 100% = $94.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,235.30,,,,,,,42.9200,462.0000,fee schedule,$73.53 from Fee Schedule BCFSC for Rev 320 Proc 74240 * Qty 1 = $73.53 at 320% = $235.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,165.50,,,,,,,42.9200,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,240.44,,,,,,,42.9200,462.0000,fee schedule,$73.53 from Fee Schedule BCFSC for Rev 320 Proc 74240 * Qty 1 = $73.53 at 327% = $240.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,240.44,,,,,,,42.9200,462.0000,fee schedule,$73.53 from Fee Schedule BCFSC for Rev 320 Proc 74240 * Qty 1 = $73.53 at 327% = $240.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,48.13,,,,,,,42.9200,462.0000,fee schedule,$41.49 from Fee Schedule TC_24 for Rev 320 Proc 74240 * Qty 1 = $41.49 at 116% = $48.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,48.13,,,,,,,42.9200,462.0000,fee schedule,$41.49 from Fee Schedule TC_24 for Rev 320 Proc 74240 * Qty 1 = $41.49 at 116% = $48.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,324.85,,,,,,,42.9200,462.0000,fee schedule,$324.85 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74240 * Qty 1 = $324.85 at 100% = $324.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,159.47,,,,,,,42.9200,462.0000,fee schedule,$159.47 from Fee Schedule CGIFP_25LR for Rev 320 Proc 74240 * Qty 1 = $159.47 at 100% = $159.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,167.09,,,,,,,42.9200,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,324.85,,,,,,,42.9200,462.0000,fee schedule,$324.85 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74240 * Qty 1 = $324.85 at 100% = $324.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,324.85,,,,,,,42.9200,462.0000,fee schedule,$324.85 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74240 * Qty 1 = $324.85 at 100% = $324.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,167.09,,,,,,,42.9200,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,42.9200,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 74240 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,159.14,,,,,,,42.9200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,159.14,,,,,,,42.9200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,42.9200,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 74240 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,168.04,,,,,,,42.9200,462.0000,fee schedule,APG 00389 Proc 74240 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 105% = $168.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,167.09,,,,,,,42.9200,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,167.09,,,,,,,42.9200,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,167.09,,,,,,,42.9200,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,165.00,,,,,,,42.9200,462.0000,fee schedule,APG 00389 Proc 74240 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 103.1% = $165.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,42.9200,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 74240 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,159.14,,,,,,,42.9200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,42.9200,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 74240 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,42.92,,,,,,,42.9200,462.0000,fee schedule,$85.83 from Fee Schedule TCUHC24 for Rev 320 Proc 74240 * Qty 1 = $85.83 at 50% = $42.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,42.9200,462.0000,other,Rev 320 Proc 74240 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,42.9200,462.0000,other,Rev 320 Proc 74240 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,42.9200,462.0000,other,Rev 320 Proc 74240 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,164.84,,,,,,,42.9200,462.0000,fee schedule,APG 00389 Proc 74240 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,159.14,,,,,,,42.9200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,159.14,,,,,,,42.9200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,42.9200,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 74240 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX UGI INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74240,CPT,320,RC,32000148,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,168.69,,,,,,,42.9200,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,AETNA,AETNA,187.03,,,,,,,42.9200,438.0000,percent of total billed charges,42.7% of $438.00 in Billed Charges for Rev 320 Proc 74246 = $187.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,166.44,,,,,,,42.9200,438.0000,fee schedule,APG 00389 Proc 74246 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 104% = $166.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,159.14,,,,,,,42.9200,438.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,AETNA,AETNA HEALTHCARE MEDICARE,159.14,,,,,,,42.9200,438.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,159.14,,,,,,,42.9200,438.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,AMBETTER,AMBETTER,346.92,,,,,,,42.9200,438.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,165.50,,,,,,,42.9200,438.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,BLUE CROSS,ANTHEM EXCHANGE,391.81,,,,,,,42.9200,438.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,164.84,,,,,,,42.9200,438.0000,fee schedule,APG 00389 Proc 74246 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,BLUE CROSS,ANTHEM HMO,416.27,,,,,,,42.9200,438.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,163.91,,,,,,,42.9200,438.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",438.00,,,,,,,42.9200,438.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,104.21,,,,,,,42.9200,438.0000,fee schedule,$104.21 from Fee Schedule BLDTM_23 for Rev 320 Proc 74246 * Qty 1 = $104.21 at 100% = $104.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,BLUE CROSS,BLUE CROSS E NETWORK,278.53,,,,,,,42.9200,438.0000,fee schedule,$87.04 from Fee Schedule BCFSC for Rev 320 Proc 74246 * Qty 1 = $87.04 at 320% = $278.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,BLUE CROSS,BLUE CROSS MEDICARE,165.50,,,,,,,42.9200,438.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,BLUE CROSS,BLUE CROSS P NETWORK,284.62,,,,,,,42.9200,438.0000,fee schedule,$87.04 from Fee Schedule BCFSC for Rev 320 Proc 74246 * Qty 1 = $87.04 at 327% = $284.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,BLUE CROSS,BLUE CROSS S NETWORK,284.62,,,,,,,42.9200,438.0000,fee schedule,$87.04 from Fee Schedule BCFSC for Rev 320 Proc 74246 * Qty 1 = $87.04 at 327% = $284.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,BLUE CROSS,TENNCARE BLUE CARE,54.15,,,,,,,42.9200,438.0000,fee schedule,$46.68 from Fee Schedule TC_24 for Rev 320 Proc 74246 * Qty 1 = $46.68 at 116% = $54.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,BLUE CROSS,TENNCARE BLUE SELECT,54.15,,,,,,,42.9200,438.0000,fee schedule,$46.68 from Fee Schedule TC_24 for Rev 320 Proc 74246 * Qty 1 = $46.68 at 116% = $54.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,CIGNA HEALTHCARE,CIGNA HMO,324.85,,,,,,,42.9200,438.0000,fee schedule,$324.85 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74246 * Qty 1 = $324.85 at 100% = $324.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,182.02,,,,,,,42.9200,438.0000,fee schedule,$182.02 from Fee Schedule CGIFP_25LR for Rev 320 Proc 74246 * Qty 1 = $182.02 at 100% = $182.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,167.09,,,,,,,42.9200,438.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,324.85,,,,,,,42.9200,438.0000,fee schedule,$324.85 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74246 * Qty 1 = $324.85 at 100% = $324.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,CIGNA HEALTHCARE,CIGNA PPO,324.85,,,,,,,42.9200,438.0000,fee schedule,$324.85 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74246 * Qty 1 = $324.85 at 100% = $324.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,167.09,,,,,,,42.9200,438.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,394.20,,,,,,,42.9200,438.0000,percent of total billed charges,90% of $438.00 in Billed Charges for Rev 320 Proc 74246 = $394.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,HUMANA,HUMANA MEDICARE,159.14,,,,,,,42.9200,438.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,159.14,,,,,,,42.9200,438.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,MEDCOST,MEDCOST VHN,208.44,,,,,,,42.9200,438.0000,percent of total billed charges,47.59% of $438.00 in Billed Charges for Rev 320 Proc 74246 = $208.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,168.04,,,,,,,42.9200,438.0000,fee schedule,APG 00389 Proc 74246 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 105% = $168.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,167.09,,,,,,,42.9200,438.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,167.09,,,,,,,42.9200,438.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,NHC ADVANTAGE,NHC ADVANTAGE,167.09,,,,,,,42.9200,438.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,165.00,,,,,,,42.9200,438.0000,fee schedule,APG 00389 Proc 74246 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 103.1% = $165.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,SENTARA HEALTH,SENTARA HEALTH,113.05,,,,,,,42.9200,438.0000,percent of total billed charges,25.81% of $438.00 in Billed Charges for Rev 320 Proc 74246 = $113.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,SENTARA HEALTH,SENTARA MEDICARE,159.14,,,,,,,42.9200,438.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",438.00,,,,,,,42.9200,438.0000,percent of total billed charges,100% of $438.00 in Billed Charges for Rev 320 Proc 74246 = $438.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,42.92,,,,,,,42.9200,438.0000,fee schedule,$85.83 from Fee Schedule TCUHC24 for Rev 320 Proc 74246 * Qty 1 = $85.83 at 50% = $42.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,42.9200,438.0000,other,Rev 320 Proc 74246 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,42.9200,438.0000,other,Rev 320 Proc 74246 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,42.9200,438.0000,other,Rev 320 Proc 74246 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,164.84,,,,,,,42.9200,438.0000,fee schedule,APG 00389 Proc 74246 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,159.14,,,,,,,42.9200,438.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,159.14,,,,,,,42.9200,438.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,WELLCARE,WELLCARE MEDICAID,438.00,,,,,,,42.9200,438.0000,percent of total billed charges,100% of $438.00 in Billed Charges for Rev 320 Proc 74246 = $438.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX UGI INCL SCT ABD & DELAY IMG DBL CONT STDY INCL GLUCAGON ADMIN,74246,CPT,320,RC,32000152,CDM,,,,both,,,438.0000,65.7000,WELLCARE,WELLCARE MEDICARE,168.69,,,,,,,42.9200,438.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,42.7200,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 74250 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,166.44,,,,,,,42.7200,462.0000,fee schedule,APG 00389 Proc 74250 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 104% = $166.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,159.14,,,,,,,42.7200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,159.14,,,,,,,42.7200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,159.14,,,,,,,42.7200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,346.92,,,,,,,42.7200,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,165.50,,,,,,,42.7200,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,391.81,,,,,,,42.7200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,164.84,,,,,,,42.7200,462.0000,fee schedule,APG 00389 Proc 74250 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,416.27,,,,,,,42.7200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,163.91,,,,,,,42.7200,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",462.00,,,,,,,42.7200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,75.29,,,,,,,42.7200,462.0000,fee schedule,$75.29 from Fee Schedule BLDTM_23 for Rev 320 Proc 74250 * Qty 1 = $75.29 at 100% = $75.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,249.73,,,,,,,42.7200,462.0000,fee schedule,$78.04 from Fee Schedule BCFSC for Rev 320 Proc 74250 * Qty 1 = $78.04 at 320% = $249.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,165.50,,,,,,,42.7200,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,255.19,,,,,,,42.7200,462.0000,fee schedule,$78.04 from Fee Schedule BCFSC for Rev 320 Proc 74250 * Qty 1 = $78.04 at 327% = $255.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,255.19,,,,,,,42.7200,462.0000,fee schedule,$78.04 from Fee Schedule BCFSC for Rev 320 Proc 74250 * Qty 1 = $78.04 at 327% = $255.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,42.72,,,,,,,42.7200,462.0000,fee schedule,$36.83 from Fee Schedule TC_24 for Rev 320 Proc 74250 * Qty 1 = $36.83 at 116% = $42.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,42.72,,,,,,,42.7200,462.0000,fee schedule,$36.83 from Fee Schedule TC_24 for Rev 320 Proc 74250 * Qty 1 = $36.83 at 116% = $42.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,324.85,,,,,,,42.7200,462.0000,fee schedule,$324.85 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74250 * Qty 1 = $324.85 at 100% = $324.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,157.59,,,,,,,42.7200,462.0000,fee schedule,$157.59 from Fee Schedule CGIFP_25LR for Rev 320 Proc 74250 * Qty 1 = $157.59 at 100% = $157.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,167.09,,,,,,,42.7200,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,324.85,,,,,,,42.7200,462.0000,fee schedule,$324.85 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74250 * Qty 1 = $324.85 at 100% = $324.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,324.85,,,,,,,42.7200,462.0000,fee schedule,$324.85 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74250 * Qty 1 = $324.85 at 100% = $324.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,167.09,,,,,,,42.7200,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,42.7200,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 74250 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,159.14,,,,,,,42.7200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,159.14,,,,,,,42.7200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,42.7200,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 74250 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,168.04,,,,,,,42.7200,462.0000,fee schedule,APG 00389 Proc 74250 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 105% = $168.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,167.09,,,,,,,42.7200,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,167.09,,,,,,,42.7200,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,167.09,,,,,,,42.7200,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,165.00,,,,,,,42.7200,462.0000,fee schedule,APG 00389 Proc 74250 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 103.1% = $165.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,42.7200,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 74250 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,159.14,,,,,,,42.7200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,42.7200,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 74250 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,42.92,,,,,,,42.7200,462.0000,fee schedule,$85.83 from Fee Schedule TCUHC24 for Rev 320 Proc 74250 * Qty 1 = $85.83 at 50% = $42.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,42.7200,462.0000,other,Rev 320 Proc 74250 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,42.7200,462.0000,other,Rev 320 Proc 74250 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,42.7200,462.0000,other,Rev 320 Proc 74250 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,164.84,,,,,,,42.7200,462.0000,fee schedule,APG 00389 Proc 74250 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,159.14,,,,,,,42.7200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,159.14,,,,,,,42.7200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,42.7200,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 74250 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMALL BOWEL INT SINGLE CONTRAST STUDY,74250,CPT,320,RC,32000155,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,168.69,,,,,,,42.7200,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,AETNA,AETNA,1593.14,,,,,,,94.8500,3731.0000,percent of total billed charges,"42.7% of $3,731.00 in Billed Charges for Rev 352 Proc 74261 = $1,593.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,152.44,,,,,,,94.8500,3731.0000,fee schedule,APG 00299 Proc 74261 at $836.60 (Base Rate) * 0.1752 (Relative Weight) = $146.57 (Total Line Payment) at 104% = $152.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,94.8500,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,94.8500,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,94.8500,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,AMBETTER,AMBETTER,206.78,,,,,,,94.8500,3731.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,94.8500,3731.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,94.8500,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,150.97,,,,,,,94.8500,3731.0000,fee schedule,APG 00299 Proc 74261 at $836.60 (Base Rate) * 0.1752 (Relative Weight) = $146.57 (Total Line Payment) at 103% = $150.97. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,94.8500,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,94.8500,3731.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,94.8500,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,280.14,,,,,,,94.8500,3731.0000,fee schedule,$280.14 from Fee Schedule BLDTM_23 for Rev 352 Proc 74261 * Qty 1 = $280.14 at 100% = $280.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,BLUE CROSS E NETWORK,1044.42,,,,,,,94.8500,3731.0000,fee schedule,"$326.38 from Fee Schedule BCFSD for Rev 352 Proc 74261 * Qty 1 = $326.38 at 320% = $1,044.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,94.8500,3731.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,BLUE CROSS P NETWORK,1067.26,,,,,,,94.8500,3731.0000,fee schedule,"$326.38 from Fee Schedule BCFSD for Rev 352 Proc 74261 * Qty 1 = $326.38 at 327% = $1,067.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,BLUE CROSS S NETWORK,1067.26,,,,,,,94.8500,3731.0000,fee schedule,"$326.38 from Fee Schedule BCFSD for Rev 352 Proc 74261 * Qty 1 = $326.38 at 327% = $1,067.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,TENNCARE BLUE CARE,249.92,,,,,,,94.8500,3731.0000,fee schedule,$215.45 from Fee Schedule TC_24 for Rev 352 Proc 74261 * Qty 1 = $215.45 at 116% = $249.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,TENNCARE BLUE SELECT,249.92,,,,,,,94.8500,3731.0000,fee schedule,$215.45 from Fee Schedule TC_24 for Rev 352 Proc 74261 * Qty 1 = $215.45 at 116% = $249.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,CIGNA HEALTHCARE,CIGNA HMO,642.00,,,,,,,94.8500,3731.0000,other,Rev 352 Proc 74261 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,427.00,,,,,,,94.8500,3731.0000,other,Rev 352 Proc 74261 Qty 1 * $427.00 = $427.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,94.8500,3731.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,642.00,,,,,,,94.8500,3731.0000,other,Rev 352 Proc 74261 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,CIGNA HEALTHCARE,CIGNA PPO,642.00,,,,,,,94.8500,3731.0000,other,Rev 352 Proc 74261 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,94.8500,3731.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3357.90,,,,,,,94.8500,3731.0000,percent of total billed charges,"90% of $3,731.00 in Billed Charges for Rev 352 Proc 74261 = $3,357.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,HUMANA,HUMANA MEDICARE,94.85,,,,,,,94.8500,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,94.8500,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,MEDCOST,MEDCOST VHN,1775.58,,,,,,,94.8500,3731.0000,percent of total billed charges,"47.59% of $3,731.00 in Billed Charges for Rev 352 Proc 74261 = $1,775.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,153.90,,,,,,,94.8500,3731.0000,fee schedule,APG 00299 Proc 74261 at $836.60 (Base Rate) * 0.1752 (Relative Weight) = $146.57 (Total Line Payment) at 100% = $146.57... $146.57 at 105% = $153.90 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,94.8500,3731.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,94.8500,3731.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,94.8500,3731.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,151.11,,,,,,,94.8500,3731.0000,fee schedule,APG 00299 Proc 74261 at $836.60 (Base Rate) * 0.1752 (Relative Weight) = $146.57 (Total Line Payment) at 100% = $146.57... $146.57 at 103.1% = $151.11 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,SENTARA HEALTH,SENTARA HEALTH,962.97,,,,,,,94.8500,3731.0000,percent of total billed charges,"25.81% of $3,731.00 in Billed Charges for Rev 352 Proc 74261 = $962.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,94.8500,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3731.00,,,,,,,94.8500,3731.0000,percent of total billed charges,"100% of $3,731.00 in Billed Charges for Rev 352 Proc 74261 = $3,731.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,95.95,,,,,,,94.8500,3731.0000,fee schedule,$191.89 from Fee Schedule TCUHC24 for Rev 352 Proc 74261 * Qty 1 = $191.89 at 50% = $95.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1919.00,,,,,,,94.8500,3731.0000,other,"Rev 352 Proc 74261 1 Visit at $1,919.00 per Visit = $1,919.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1835.00,,,,,,,94.8500,3731.0000,other,"Rev 352 Proc 74261 1 Visit at $1,835.00 per Visit = $1,835.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,3026.00,,,,,,,94.8500,3731.0000,other,"Rev 352 Proc 74261 1 Visit at $3,026.00 per Visit = $3,026.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,150.97,,,,,,,94.8500,3731.0000,fee schedule,APG 00299 Proc 74261 at $836.60 (Base Rate) * 0.1752 (Relative Weight) = $146.57 (Total Line Payment) at 103% = $150.97. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,94.8500,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,94.8500,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,WELLCARE,WELLCARE MEDICAID,3731.00,,,,,,,94.8500,3731.0000,percent of total billed charges,"100% of $3,731.00 in Billed Charges for Rev 352 Proc 74261 = $3,731.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT COLONOGRAPHY DIAG WO CONTRAST,74261,CPT,352,RC,35200026,CDM,,,,both,,,3731.0000,559.6500,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,94.8500,3731.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,AETNA,AETNA,1475.29,,,,,,,150.2500,3455.0000,percent of total billed charges,"42.7% of $3,455.00 in Billed Charges for Rev 352 Proc 74262 = $1,475.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,459.22,,,,,,,150.2500,3455.0000,fee schedule,APG 00300 Proc 74262 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 104% = $459.22. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,159.14,,,,,,,150.2500,3455.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,AETNA,AETNA HEALTHCARE MEDICARE,159.14,,,,,,,150.2500,3455.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,159.14,,,,,,,150.2500,3455.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,AMBETTER,AMBETTER,346.92,,,,,,,150.2500,3455.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,165.50,,,,,,,150.2500,3455.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,BLUE CROSS,ANTHEM EXCHANGE,391.81,,,,,,,150.2500,3455.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,454.80,,,,,,,150.2500,3455.0000,fee schedule,APG 00300 Proc 74262 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 103% = $454.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,BLUE CROSS,ANTHEM HMO,416.27,,,,,,,150.2500,3455.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,163.91,,,,,,,150.2500,3455.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",489.70,,,,,,,150.2500,3455.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,317.30,,,,,,,150.2500,3455.0000,fee schedule,$317.30 from Fee Schedule BLDTM_23 for Rev 352 Proc 74262 * Qty 1 = $317.30 at 100% = $317.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,BLUE CROSS,BLUE CROSS E NETWORK,1166.91,,,,,,,150.2500,3455.0000,fee schedule,"$364.66 from Fee Schedule BCFSD for Rev 352 Proc 74262 * Qty 1 = $364.66 at 320% = $1,166.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,BLUE CROSS,BLUE CROSS MEDICARE,165.50,,,,,,,150.2500,3455.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,BLUE CROSS,BLUE CROSS P NETWORK,1192.44,,,,,,,150.2500,3455.0000,fee schedule,"$364.66 from Fee Schedule BCFSD for Rev 352 Proc 74262 * Qty 1 = $364.66 at 327% = $1,192.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,BLUE CROSS,BLUE CROSS S NETWORK,1192.44,,,,,,,150.2500,3455.0000,fee schedule,"$364.66 from Fee Schedule BCFSD for Rev 352 Proc 74262 * Qty 1 = $364.66 at 327% = $1,192.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,BLUE CROSS,TENNCARE BLUE CARE,283.18,,,,,,,150.2500,3455.0000,fee schedule,$244.12 from Fee Schedule TC_24 for Rev 352 Proc 74262 * Qty 1 = $244.12 at 116% = $283.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,BLUE CROSS,TENNCARE BLUE SELECT,283.18,,,,,,,150.2500,3455.0000,fee schedule,$244.12 from Fee Schedule TC_24 for Rev 352 Proc 74262 * Qty 1 = $244.12 at 116% = $283.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,CIGNA HEALTHCARE,CIGNA HMO,642.00,,,,,,,150.2500,3455.0000,other,Rev 352 Proc 74262 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,427.00,,,,,,,150.2500,3455.0000,other,Rev 352 Proc 74262 Qty 1 * $427.00 = $427.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,167.09,,,,,,,150.2500,3455.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,642.00,,,,,,,150.2500,3455.0000,other,Rev 352 Proc 74262 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,CIGNA HEALTHCARE,CIGNA PPO,642.00,,,,,,,150.2500,3455.0000,other,Rev 352 Proc 74262 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,167.09,,,,,,,150.2500,3455.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3109.50,,,,,,,150.2500,3455.0000,percent of total billed charges,"90% of $3,455.00 in Billed Charges for Rev 352 Proc 74262 = $3,109.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,HUMANA,HUMANA MEDICARE,159.14,,,,,,,150.2500,3455.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,159.14,,,,,,,150.2500,3455.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,MEDCOST,MEDCOST VHN,1644.23,,,,,,,150.2500,3455.0000,percent of total billed charges,"47.59% of $3,455.00 in Billed Charges for Rev 352 Proc 74262 = $1,644.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,463.64,,,,,,,150.2500,3455.0000,fee schedule,APG 00300 Proc 74262 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 100% = $441.56... $441.56 at 105% = $463.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,167.09,,,,,,,150.2500,3455.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,167.09,,,,,,,150.2500,3455.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,NHC ADVANTAGE,NHC ADVANTAGE,167.09,,,,,,,150.2500,3455.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,455.25,,,,,,,150.2500,3455.0000,fee schedule,APG 00300 Proc 74262 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 100% = $441.56... $441.56 at 103.1% = $455.25 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,SENTARA HEALTH,SENTARA HEALTH,891.74,,,,,,,150.2500,3455.0000,percent of total billed charges,"25.81% of $3,455.00 in Billed Charges for Rev 352 Proc 74262 = $891.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,SENTARA HEALTH,SENTARA MEDICARE,159.14,,,,,,,150.2500,3455.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3455.00,,,,,,,150.2500,3455.0000,percent of total billed charges,"100% of $3,455.00 in Billed Charges for Rev 352 Proc 74262 = $3,455.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,150.25,,,,,,,150.2500,3455.0000,fee schedule,$300.49 from Fee Schedule TCUHC24 for Rev 352 Proc 74262 * Qty 1 = $300.49 at 50% = $150.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1919.00,,,,,,,150.2500,3455.0000,other,"Rev 352 Proc 74262 1 Visit at $1,919.00 per Visit = $1,919.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1835.00,,,,,,,150.2500,3455.0000,other,"Rev 352 Proc 74262 1 Visit at $1,835.00 per Visit = $1,835.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,3026.00,,,,,,,150.2500,3455.0000,other,"Rev 352 Proc 74262 1 Visit at $3,026.00 per Visit = $3,026.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,454.80,,,,,,,150.2500,3455.0000,fee schedule,APG 00300 Proc 74262 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 103% = $454.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,159.14,,,,,,,150.2500,3455.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,159.14,,,,,,,150.2500,3455.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,WELLCARE,WELLCARE MEDICAID,3455.00,,,,,,,150.2500,3455.0000,percent of total billed charges,"100% of $3,455.00 in Billed Charges for Rev 352 Proc 74262 = $3,455.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT COLONOGRAPHY DIAG WOW CONTRAST,74262,CPT,352,RC,35200027,CDM,,,,both,,,3455.0000,518.2500,WELLCARE,WELLCARE MEDICARE,168.69,,,,,,,150.2500,3455.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,AETNA,AETNA,243.39,,,,,,,42.9200,570.0000,percent of total billed charges,42.7% of $570.00 in Billed Charges for Rev 320 Proc 74270 = $243.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,166.44,,,,,,,42.9200,570.0000,fee schedule,APG 00389 Proc 74270 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 104% = $166.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,159.14,,,,,,,42.9200,570.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,AETNA,AETNA HEALTHCARE MEDICARE,159.14,,,,,,,42.9200,570.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,159.14,,,,,,,42.9200,570.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,AMBETTER,AMBETTER,346.92,,,,,,,42.9200,570.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,165.50,,,,,,,42.9200,570.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,BLUE CROSS,ANTHEM EXCHANGE,391.81,,,,,,,42.9200,570.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,164.84,,,,,,,42.9200,570.0000,fee schedule,APG 00389 Proc 74270 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,BLUE CROSS,ANTHEM HMO,416.27,,,,,,,42.9200,570.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,163.91,,,,,,,42.9200,570.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",489.70,,,,,,,42.9200,570.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,103.46,,,,,,,42.9200,570.0000,fee schedule,$103.46 from Fee Schedule BLDTM_23 for Rev 320 Proc 74270 * Qty 1 = $103.46 at 100% = $103.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,BLUE CROSS,BLUE CROSS E NETWORK,362.94,,,,,,,42.9200,570.0000,fee schedule,$113.42 from Fee Schedule BCFSC for Rev 320 Proc 74270 * Qty 1 = $113.42 at 320% = $362.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,BLUE CROSS,BLUE CROSS MEDICARE,165.50,,,,,,,42.9200,570.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,BLUE CROSS,BLUE CROSS P NETWORK,370.88,,,,,,,42.9200,570.0000,fee schedule,$113.42 from Fee Schedule BCFSC for Rev 320 Proc 74270 * Qty 1 = $113.42 at 327% = $370.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,BLUE CROSS,BLUE CROSS S NETWORK,370.88,,,,,,,42.9200,570.0000,fee schedule,$113.42 from Fee Schedule BCFSC for Rev 320 Proc 74270 * Qty 1 = $113.42 at 327% = $370.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,BLUE CROSS,TENNCARE BLUE CARE,55.94,,,,,,,42.9200,570.0000,fee schedule,$48.22 from Fee Schedule TC_24 for Rev 320 Proc 74270 * Qty 1 = $48.22 at 116% = $55.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,BLUE CROSS,TENNCARE BLUE SELECT,55.94,,,,,,,42.9200,570.0000,fee schedule,$48.22 from Fee Schedule TC_24 for Rev 320 Proc 74270 * Qty 1 = $48.22 at 116% = $55.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,CIGNA HEALTHCARE,CIGNA HMO,324.85,,,,,,,42.9200,570.0000,fee schedule,$324.85 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74270 * Qty 1 = $324.85 at 100% = $324.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,197.05,,,,,,,42.9200,570.0000,fee schedule,$197.05 from Fee Schedule CGIFP_25LR for Rev 320 Proc 74270 * Qty 1 = $197.05 at 100% = $197.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,167.09,,,,,,,42.9200,570.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,324.85,,,,,,,42.9200,570.0000,fee schedule,$324.85 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74270 * Qty 1 = $324.85 at 100% = $324.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,CIGNA HEALTHCARE,CIGNA PPO,324.85,,,,,,,42.9200,570.0000,fee schedule,$324.85 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74270 * Qty 1 = $324.85 at 100% = $324.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,167.09,,,,,,,42.9200,570.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,513.00,,,,,,,42.9200,570.0000,percent of total billed charges,90% of $570.00 in Billed Charges for Rev 320 Proc 74270 = $513.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,HUMANA,HUMANA MEDICARE,159.14,,,,,,,42.9200,570.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,159.14,,,,,,,42.9200,570.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,MEDCOST,MEDCOST VHN,271.26,,,,,,,42.9200,570.0000,percent of total billed charges,47.59% of $570.00 in Billed Charges for Rev 320 Proc 74270 = $271.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,168.04,,,,,,,42.9200,570.0000,fee schedule,APG 00389 Proc 74270 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 105% = $168.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,167.09,,,,,,,42.9200,570.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,167.09,,,,,,,42.9200,570.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,NHC ADVANTAGE,NHC ADVANTAGE,167.09,,,,,,,42.9200,570.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,165.00,,,,,,,42.9200,570.0000,fee schedule,APG 00389 Proc 74270 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 103.1% = $165.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,SENTARA HEALTH,SENTARA HEALTH,147.12,,,,,,,42.9200,570.0000,percent of total billed charges,25.81% of $570.00 in Billed Charges for Rev 320 Proc 74270 = $147.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,SENTARA HEALTH,SENTARA MEDICARE,159.14,,,,,,,42.9200,570.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",570.00,,,,,,,42.9200,570.0000,percent of total billed charges,100% of $570.00 in Billed Charges for Rev 320 Proc 74270 = $570.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,42.92,,,,,,,42.9200,570.0000,fee schedule,$85.83 from Fee Schedule TCUHC24 for Rev 320 Proc 74270 * Qty 1 = $85.83 at 50% = $42.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,42.9200,570.0000,other,Rev 320 Proc 74270 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,42.9200,570.0000,other,Rev 320 Proc 74270 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,42.9200,570.0000,other,Rev 320 Proc 74270 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,164.84,,,,,,,42.9200,570.0000,fee schedule,APG 00389 Proc 74270 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,159.14,,,,,,,42.9200,570.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,159.14,,,,,,,42.9200,570.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,WELLCARE,WELLCARE MEDICAID,570.00,,,,,,,42.9200,570.0000,percent of total billed charges,100% of $570.00 in Billed Charges for Rev 320 Proc 74270 = $570.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX COLON INCL SCT ABD & DELAY IMG SNGL CONT BA STDY,74270,CPT,320,RC,32000158,CDM,,,,both,,,570.0000,85.5000,WELLCARE,WELLCARE MEDICARE,168.69,,,,,,,42.9200,570.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,AETNA,AETNA,338.18,,,,,,,71.1100,792.0000,percent of total billed charges,42.7% of $792.00 in Billed Charges for Rev 320 Proc 74280 = $338.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,166.44,,,,,,,71.1100,792.0000,fee schedule,APG 00389 Proc 74280 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 104% = $166.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,159.14,,,,,,,71.1100,792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,AETNA,AETNA HEALTHCARE MEDICARE,159.14,,,,,,,71.1100,792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,159.14,,,,,,,71.1100,792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,AMBETTER,AMBETTER,346.92,,,,,,,71.1100,792.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,165.50,,,,,,,71.1100,792.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,BLUE CROSS,ANTHEM EXCHANGE,391.81,,,,,,,71.1100,792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,164.84,,,,,,,71.1100,792.0000,fee schedule,APG 00389 Proc 74280 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,BLUE CROSS,ANTHEM HMO,416.27,,,,,,,71.1100,792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,163.91,,,,,,,71.1100,792.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",489.70,,,,,,,71.1100,792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,140.00,,,,,,,71.1100,792.0000,fee schedule,$140.00 from Fee Schedule BLDTM_23 for Rev 320 Proc 74280 * Qty 1 = $140.00 at 100% = $140.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,BLUE CROSS,BLUE CROSS E NETWORK,503.97,,,,,,,71.1100,792.0000,fee schedule,$157.49 from Fee Schedule BCFSC for Rev 320 Proc 74280 * Qty 1 = $157.49 at 320% = $503.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,BLUE CROSS,BLUE CROSS MEDICARE,165.50,,,,,,,71.1100,792.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,BLUE CROSS,BLUE CROSS P NETWORK,514.99,,,,,,,71.1100,792.0000,fee schedule,$157.49 from Fee Schedule BCFSC for Rev 320 Proc 74280 * Qty 1 = $157.49 at 327% = $514.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,BLUE CROSS,BLUE CROSS S NETWORK,514.99,,,,,,,71.1100,792.0000,fee schedule,$157.49 from Fee Schedule BCFSC for Rev 320 Proc 74280 * Qty 1 = $157.49 at 327% = $514.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,BLUE CROSS,TENNCARE BLUE CARE,73.40,,,,,,,71.1100,792.0000,fee schedule,$63.28 from Fee Schedule TC_24 for Rev 320 Proc 74280 * Qty 1 = $63.28 at 116% = $73.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,BLUE CROSS,TENNCARE BLUE SELECT,73.40,,,,,,,71.1100,792.0000,fee schedule,$63.28 from Fee Schedule TC_24 for Rev 320 Proc 74280 * Qty 1 = $63.28 at 116% = $73.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,CIGNA HEALTHCARE,CIGNA HMO,538.23,,,,,,,71.1100,792.0000,fee schedule,$538.23 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74280 * Qty 1 = $538.23 at 100% = $538.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,301.40,,,,,,,71.1100,792.0000,fee schedule,$301.40 from Fee Schedule CGIFP_25LR for Rev 320 Proc 74280 * Qty 1 = $301.40 at 100% = $301.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,167.09,,,,,,,71.1100,792.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,538.23,,,,,,,71.1100,792.0000,fee schedule,$538.23 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74280 * Qty 1 = $538.23 at 100% = $538.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,CIGNA HEALTHCARE,CIGNA PPO,538.23,,,,,,,71.1100,792.0000,fee schedule,$538.23 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74280 * Qty 1 = $538.23 at 100% = $538.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,167.09,,,,,,,71.1100,792.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,712.80,,,,,,,71.1100,792.0000,percent of total billed charges,90% of $792.00 in Billed Charges for Rev 320 Proc 74280 = $712.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,HUMANA,HUMANA MEDICARE,159.14,,,,,,,71.1100,792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,159.14,,,,,,,71.1100,792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,MEDCOST,MEDCOST VHN,376.91,,,,,,,71.1100,792.0000,percent of total billed charges,47.59% of $792.00 in Billed Charges for Rev 320 Proc 74280 = $376.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,168.04,,,,,,,71.1100,792.0000,fee schedule,APG 00389 Proc 74280 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 105% = $168.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,167.09,,,,,,,71.1100,792.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,167.09,,,,,,,71.1100,792.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,NHC ADVANTAGE,NHC ADVANTAGE,167.09,,,,,,,71.1100,792.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,165.00,,,,,,,71.1100,792.0000,fee schedule,APG 00389 Proc 74280 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 103.1% = $165.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,SENTARA HEALTH,SENTARA HEALTH,204.42,,,,,,,71.1100,792.0000,percent of total billed charges,25.81% of $792.00 in Billed Charges for Rev 320 Proc 74280 = $204.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,SENTARA HEALTH,SENTARA MEDICARE,159.14,,,,,,,71.1100,792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",792.00,,,,,,,71.1100,792.0000,percent of total billed charges,100% of $792.00 in Billed Charges for Rev 320 Proc 74280 = $792.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,71.11,,,,,,,71.1100,792.0000,fee schedule,$142.21 from Fee Schedule TCUHC24 for Rev 320 Proc 74280 * Qty 1 = $142.21 at 50% = $71.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,71.1100,792.0000,other,Rev 320 Proc 74280 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,71.1100,792.0000,other,Rev 320 Proc 74280 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,71.1100,792.0000,other,Rev 320 Proc 74280 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,164.84,,,,,,,71.1100,792.0000,fee schedule,APG 00389 Proc 74280 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,159.14,,,,,,,71.1100,792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,159.14,,,,,,,71.1100,792.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,WELLCARE,WELLCARE MEDICAID,792.00,,,,,,,71.1100,792.0000,percent of total billed charges,100% of $792.00 in Billed Charges for Rev 320 Proc 74280 = $792.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX COLON INCL SCT ABD & DELAY IMG DBL CONT INCL GLUCAGON ADMIN,74280,CPT,320,RC,32000160,CDM,,,,both,,,792.0000,118.8000,WELLCARE,WELLCARE MEDICARE,168.69,,,,,,,71.1100,792.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIT PSI 9FR MAX BARRIER,272,RC,27202262,CDM,,,,,,both,,,784.0000,117.6000,AETNA,AETNA,334.77,,,,,,,202.3500,784.0000,percent of total billed charges,42.7% of $784.00 in Billed Charges for Rev 272 = $334.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT PSI 9FR MAX BARRIER,272,RC,27202262,CDM,,,,,,both,,,784.0000,117.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,548.80,,,,,,,202.3500,784.0000,percent of total billed charges,Rev 272 $784.00 in Billed Charges at 70% = $548.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT PSI 9FR MAX BARRIER,272,RC,27202262,CDM,,,,,,both,,,784.0000,117.6000,CIGNA HEALTHCARE,CIGNA HMO,326.93,,,,,,,202.3500,784.0000,percent of total billed charges,41.7% of $784.00 in Billed Charges for Rev 272 = $326.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT PSI 9FR MAX BARRIER,272,RC,27202262,CDM,,,,,,both,,,784.0000,117.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,363.78,,,,,,,202.3500,784.0000,percent of total billed charges,46.4% of $784.00 in Billed Charges for Rev 272 = $363.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT PSI 9FR MAX BARRIER,272,RC,27202262,CDM,,,,,,both,,,784.0000,117.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,326.93,,,,,,,202.3500,784.0000,percent of total billed charges,41.7% of $784.00 in Billed Charges for Rev 272 = $326.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT PSI 9FR MAX BARRIER,272,RC,27202262,CDM,,,,,,both,,,784.0000,117.6000,CIGNA HEALTHCARE,CIGNA PPO,326.93,,,,,,,202.3500,784.0000,percent of total billed charges,41.7% of $784.00 in Billed Charges for Rev 272 = $326.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT PSI 9FR MAX BARRIER,272,RC,27202262,CDM,,,,,,both,,,784.0000,117.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,705.60,,,,,,,202.3500,784.0000,percent of total billed charges,90% of $784.00 in Billed Charges for Rev 272 = $705.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT PSI 9FR MAX BARRIER,272,RC,27202262,CDM,,,,,,both,,,784.0000,117.6000,MEDCOST,MEDCOST VHN,373.11,,,,,,,202.3500,784.0000,percent of total billed charges,47.59% of $784.00 in Billed Charges for Rev 272 = $373.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT PSI 9FR MAX BARRIER,272,RC,27202262,CDM,,,,,,both,,,784.0000,117.6000,SENTARA HEALTH,SENTARA HEALTH,202.35,,,,,,,202.3500,784.0000,percent of total billed charges,25.81% of $784.00 in Billed Charges for Rev 272 = $202.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT PSI 9FR MAX BARRIER,272,RC,27202262,CDM,,,,,,both,,,784.0000,117.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",784.00,,,,,,,202.3500,784.0000,percent of total billed charges,100% of $784.00 in Billed Charges for Rev 272 = $784.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT PSI 9FR MAX BARRIER,272,RC,27202262,CDM,,,,,,both,,,784.0000,117.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,392.00,,,,,,,202.3500,784.0000,percent of total billed charges,Rev 272 $784.00 in Billed Charges at 50% = $392.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT PSI 9FR MAX BARRIER,272,RC,27202262,CDM,,,,,,both,,,784.0000,117.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,253.23,,,,,,,202.3500,784.0000,other,32.3% of $784.00 in Billed Charges for Rev 272 = $253.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIT PSI 9FR MAX BARRIER,272,RC,27202262,CDM,,,,,,both,,,784.0000,117.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,240.69,,,,,,,202.3500,784.0000,other,30.7% of $784.00 in Billed Charges for Rev 272 = $240.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIT PSI 9FR MAX BARRIER,272,RC,27202262,CDM,,,,,,both,,,784.0000,117.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,253.23,,,,,,,202.3500,784.0000,percent of total billed charges,32.3% of $784.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT PSI 9FR MAX BARRIER,272,RC,27202262,CDM,,,,,,both,,,784.0000,117.6000,WELLCARE,WELLCARE MEDICAID,784.00,,,,,,,202.3500,784.0000,percent of total billed charges,100% of $784.00 in Billed Charges for Rev 272 = $784.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT REPAIR BROVIAC 6.6FR,272,RC,27202263,CDM,,,,,,both,,,1771.0000,265.6500,AETNA,AETNA,756.22,,,,,,,457.1000,1771.0000,percent of total billed charges,"42.7% of $1,771.00 in Billed Charges for Rev 272 = $756.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT REPAIR BROVIAC 6.6FR,272,RC,27202263,CDM,,,,,,both,,,1771.0000,265.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1239.70,,,,,,,457.1000,1771.0000,percent of total billed charges,"Rev 272 $1,771.00 in Billed Charges at 70% = $1,239.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT REPAIR BROVIAC 6.6FR,272,RC,27202263,CDM,,,,,,both,,,1771.0000,265.6500,CIGNA HEALTHCARE,CIGNA HMO,738.51,,,,,,,457.1000,1771.0000,percent of total billed charges,"41.7% of $1,771.00 in Billed Charges for Rev 272 = $738.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT REPAIR BROVIAC 6.6FR,272,RC,27202263,CDM,,,,,,both,,,1771.0000,265.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,821.74,,,,,,,457.1000,1771.0000,percent of total billed charges,"46.4% of $1,771.00 in Billed Charges for Rev 272 = $821.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT REPAIR BROVIAC 6.6FR,272,RC,27202263,CDM,,,,,,both,,,1771.0000,265.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,738.51,,,,,,,457.1000,1771.0000,percent of total billed charges,"41.7% of $1,771.00 in Billed Charges for Rev 272 = $738.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT REPAIR BROVIAC 6.6FR,272,RC,27202263,CDM,,,,,,both,,,1771.0000,265.6500,CIGNA HEALTHCARE,CIGNA PPO,738.51,,,,,,,457.1000,1771.0000,percent of total billed charges,"41.7% of $1,771.00 in Billed Charges for Rev 272 = $738.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT REPAIR BROVIAC 6.6FR,272,RC,27202263,CDM,,,,,,both,,,1771.0000,265.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1593.90,,,,,,,457.1000,1771.0000,percent of total billed charges,"90% of $1,771.00 in Billed Charges for Rev 272 = $1,593.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT REPAIR BROVIAC 6.6FR,272,RC,27202263,CDM,,,,,,both,,,1771.0000,265.6500,MEDCOST,MEDCOST VHN,842.82,,,,,,,457.1000,1771.0000,percent of total billed charges,"47.59% of $1,771.00 in Billed Charges for Rev 272 = $842.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT REPAIR BROVIAC 6.6FR,272,RC,27202263,CDM,,,,,,both,,,1771.0000,265.6500,SENTARA HEALTH,SENTARA HEALTH,457.10,,,,,,,457.1000,1771.0000,percent of total billed charges,"25.81% of $1,771.00 in Billed Charges for Rev 272 = $457.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT REPAIR BROVIAC 6.6FR,272,RC,27202263,CDM,,,,,,both,,,1771.0000,265.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1771.00,,,,,,,457.1000,1771.0000,percent of total billed charges,"100% of $1,771.00 in Billed Charges for Rev 272 = $1,771.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT REPAIR BROVIAC 6.6FR,272,RC,27202263,CDM,,,,,,both,,,1771.0000,265.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,885.50,,,,,,,457.1000,1771.0000,percent of total billed charges,"Rev 272 $1,771.00 in Billed Charges at 50% = $885.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT REPAIR BROVIAC 6.6FR,272,RC,27202263,CDM,,,,,,both,,,1771.0000,265.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,572.03,,,,,,,457.1000,1771.0000,other,"32.3% of $1,771.00 in Billed Charges for Rev 272 = $572.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIT REPAIR BROVIAC 6.6FR,272,RC,27202263,CDM,,,,,,both,,,1771.0000,265.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,543.70,,,,,,,457.1000,1771.0000,other,"30.7% of $1,771.00 in Billed Charges for Rev 272 = $543.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIT REPAIR BROVIAC 6.6FR,272,RC,27202263,CDM,,,,,,both,,,1771.0000,265.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,572.03,,,,,,,457.1000,1771.0000,percent of total billed charges,"32.3% of $1,771.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT REPAIR BROVIAC 6.6FR,272,RC,27202263,CDM,,,,,,both,,,1771.0000,265.6500,WELLCARE,WELLCARE MEDICAID,1771.00,,,,,,,457.1000,1771.0000,percent of total billed charges,"100% of $1,771.00 in Billed Charges for Rev 272 = $1,771.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT TUBE FEEDING 14FR ENFIT,272,RC,27202328,CDM,,,,,,both,,,880.0000,132.0000,AETNA,AETNA,375.76,,,,,,,227.1300,880.0000,percent of total billed charges,42.7% of $880.00 in Billed Charges for Rev 272 = $375.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT TUBE FEEDING 14FR ENFIT,272,RC,27202328,CDM,,,,,,both,,,880.0000,132.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,616.00,,,,,,,227.1300,880.0000,percent of total billed charges,Rev 272 $880.00 in Billed Charges at 70% = $616.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT TUBE FEEDING 14FR ENFIT,272,RC,27202328,CDM,,,,,,both,,,880.0000,132.0000,CIGNA HEALTHCARE,CIGNA HMO,366.96,,,,,,,227.1300,880.0000,percent of total billed charges,41.7% of $880.00 in Billed Charges for Rev 272 = $366.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT TUBE FEEDING 14FR ENFIT,272,RC,27202328,CDM,,,,,,both,,,880.0000,132.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,408.32,,,,,,,227.1300,880.0000,percent of total billed charges,46.4% of $880.00 in Billed Charges for Rev 272 = $408.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT TUBE FEEDING 14FR ENFIT,272,RC,27202328,CDM,,,,,,both,,,880.0000,132.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,366.96,,,,,,,227.1300,880.0000,percent of total billed charges,41.7% of $880.00 in Billed Charges for Rev 272 = $366.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT TUBE FEEDING 14FR ENFIT,272,RC,27202328,CDM,,,,,,both,,,880.0000,132.0000,CIGNA HEALTHCARE,CIGNA PPO,366.96,,,,,,,227.1300,880.0000,percent of total billed charges,41.7% of $880.00 in Billed Charges for Rev 272 = $366.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT TUBE FEEDING 14FR ENFIT,272,RC,27202328,CDM,,,,,,both,,,880.0000,132.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,792.00,,,,,,,227.1300,880.0000,percent of total billed charges,90% of $880.00 in Billed Charges for Rev 272 = $792.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT TUBE FEEDING 14FR ENFIT,272,RC,27202328,CDM,,,,,,both,,,880.0000,132.0000,MEDCOST,MEDCOST VHN,418.79,,,,,,,227.1300,880.0000,percent of total billed charges,47.59% of $880.00 in Billed Charges for Rev 272 = $418.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT TUBE FEEDING 14FR ENFIT,272,RC,27202328,CDM,,,,,,both,,,880.0000,132.0000,SENTARA HEALTH,SENTARA HEALTH,227.13,,,,,,,227.1300,880.0000,percent of total billed charges,25.81% of $880.00 in Billed Charges for Rev 272 = $227.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT TUBE FEEDING 14FR ENFIT,272,RC,27202328,CDM,,,,,,both,,,880.0000,132.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",880.00,,,,,,,227.1300,880.0000,percent of total billed charges,100% of $880.00 in Billed Charges for Rev 272 = $880.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT TUBE FEEDING 14FR ENFIT,272,RC,27202328,CDM,,,,,,both,,,880.0000,132.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,440.00,,,,,,,227.1300,880.0000,percent of total billed charges,Rev 272 $880.00 in Billed Charges at 50% = $440.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT TUBE FEEDING 14FR ENFIT,272,RC,27202328,CDM,,,,,,both,,,880.0000,132.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,284.24,,,,,,,227.1300,880.0000,other,32.3% of $880.00 in Billed Charges for Rev 272 = $284.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIT TUBE FEEDING 14FR ENFIT,272,RC,27202328,CDM,,,,,,both,,,880.0000,132.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,270.16,,,,,,,227.1300,880.0000,other,30.7% of $880.00 in Billed Charges for Rev 272 = $270.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIT TUBE FEEDING 14FR ENFIT,272,RC,27202328,CDM,,,,,,both,,,880.0000,132.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,284.24,,,,,,,227.1300,880.0000,percent of total billed charges,32.3% of $880.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT TUBE FEEDING 14FR ENFIT,272,RC,27202328,CDM,,,,,,both,,,880.0000,132.0000,WELLCARE,WELLCARE MEDICAID,880.00,,,,,,,227.1300,880.0000,percent of total billed charges,100% of $880.00 in Billed Charges for Rev 272 = $880.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LABOR/DEL/REC SERVICE,724,RC,72400002,CDM,,,,,,both,,,9349.0000,1402.3500,AETNA,AETNA,3992.02,,,,,,,46.0000,9349.0000,percent of total billed charges,"42.7% of $9,349.00 in Billed Charges for Rev 724 = $3,992.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LABOR/DEL/REC SERVICE,724,RC,72400002,CDM,,,,,,both,,,9349.0000,1402.3500,BLUE CROSS,ANTHEM EXCHANGE,1542.59,,,,,,,46.0000,9349.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LABOR/DEL/REC SERVICE,724,RC,72400002,CDM,,,,,,both,,,9349.0000,1402.3500,BLUE CROSS,ANTHEM HMO,1542.59,,,,,,,46.0000,9349.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LABOR/DEL/REC SERVICE,724,RC,72400002,CDM,,,,,,both,,,9349.0000,1402.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1542.59,,,,,,,46.0000,9349.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LABOR/DEL/REC SERVICE,724,RC,72400002,CDM,,,,,,both,,,9349.0000,1402.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6544.30,,,,,,,46.0000,9349.0000,percent of total billed charges,"Rev 724 $9,349.00 in Billed Charges at 70% = $6,544.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LABOR/DEL/REC SERVICE,724,RC,72400002,CDM,,,,,,both,,,9349.0000,1402.3500,BLUE CROSS,BLUE CROSS E NETWORK,46.00,,,,,,,46.0000,9349.0000,other,Rev 724 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LABOR/DEL/REC SERVICE,724,RC,72400002,CDM,,,,,,both,,,9349.0000,1402.3500,BLUE CROSS,BLUE CROSS P NETWORK,46.00,,,,,,,46.0000,9349.0000,other,Rev 724 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LABOR/DEL/REC SERVICE,724,RC,72400002,CDM,,,,,,both,,,9349.0000,1402.3500,BLUE CROSS,BLUE CROSS S NETWORK,46.00,,,,,,,46.0000,9349.0000,other,Rev 724 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LABOR/DEL/REC SERVICE,724,RC,72400002,CDM,,,,,,both,,,9349.0000,1402.3500,CIGNA HEALTHCARE,CIGNA HMO,3898.53,,,,,,,46.0000,9349.0000,percent of total billed charges,"41.7% of $9,349.00 in Billed Charges for Rev 724 = $3,898.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LABOR/DEL/REC SERVICE,724,RC,72400002,CDM,,,,,,both,,,9349.0000,1402.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4337.94,,,,,,,46.0000,9349.0000,percent of total billed charges,"46.4% of $9,349.00 in Billed Charges for Rev 724 = $4,337.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LABOR/DEL/REC SERVICE,724,RC,72400002,CDM,,,,,,both,,,9349.0000,1402.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3898.53,,,,,,,46.0000,9349.0000,percent of total billed charges,"41.7% of $9,349.00 in Billed Charges for Rev 724 = $3,898.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LABOR/DEL/REC SERVICE,724,RC,72400002,CDM,,,,,,both,,,9349.0000,1402.3500,CIGNA HEALTHCARE,CIGNA PPO,3898.53,,,,,,,46.0000,9349.0000,percent of total billed charges,"41.7% of $9,349.00 in Billed Charges for Rev 724 = $3,898.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LABOR/DEL/REC SERVICE,724,RC,72400002,CDM,,,,,,both,,,9349.0000,1402.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8414.10,,,,,,,46.0000,9349.0000,percent of total billed charges,"90% of $9,349.00 in Billed Charges for Rev 724 = $8,414.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LABOR/DEL/REC SERVICE,724,RC,72400002,CDM,,,,,,both,,,9349.0000,1402.3500,MEDCOST,MEDCOST VHN,4449.19,,,,,,,46.0000,9349.0000,percent of total billed charges,"47.59% of $9,349.00 in Billed Charges for Rev 724 = $4,449.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LABOR/DEL/REC SERVICE,724,RC,72400002,CDM,,,,,,both,,,9349.0000,1402.3500,SENTARA HEALTH,SENTARA HEALTH,2412.98,,,,,,,46.0000,9349.0000,percent of total billed charges,"25.81% of $9,349.00 in Billed Charges for Rev 724 = $2,412.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LABOR/DEL/REC SERVICE,724,RC,72400002,CDM,,,,,,both,,,9349.0000,1402.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9349.00,,,,,,,46.0000,9349.0000,percent of total billed charges,"100% of $9,349.00 in Billed Charges for Rev 724 = $9,349.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LABOR/DEL/REC SERVICE,724,RC,72400002,CDM,,,,,,both,,,9349.0000,1402.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4674.50,,,,,,,46.0000,9349.0000,percent of total billed charges,"Rev 724 $9,349.00 in Billed Charges at 50% = $4,674.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LABOR/DEL/REC SERVICE,724,RC,72400002,CDM,,,,,,both,,,9349.0000,1402.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,259.00,,,,,,,46.0000,9349.0000,other,Rev 724 1 Visit at $259.00 per Visit = $259.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LABOR/DEL/REC SERVICE,724,RC,72400002,CDM,,,,,,both,,,9349.0000,1402.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,247.00,,,,,,,46.0000,9349.0000,other,Rev 724 1 Visit at $247.00 per Visit = $247.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LABOR/DEL/REC SERVICE,724,RC,72400002,CDM,,,,,,both,,,9349.0000,1402.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,408.00,,,,,,,46.0000,9349.0000,other,Rev 724 1 Visit at $408.00 per Visit = $408.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LABOR/DEL/REC SERVICE,724,RC,72400002,CDM,,,,,,both,,,9349.0000,1402.3500,WELLCARE,WELLCARE MEDICAID,9349.00,,,,,,,46.0000,9349.0000,percent of total billed charges,"100% of $9,349.00 in Billed Charges for Rev 724 = $9,349.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,AETNA,AETNA,181.90,,,,,,,24.2900,426.0000,percent of total billed charges,42.7% of $426.00 in Billed Charges for Rev 320 Proc 74290 = $181.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,166.44,,,,,,,24.2900,426.0000,fee schedule,APG 00389 Proc 74290 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 104% = $166.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,159.14,,,,,,,24.2900,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,AETNA,AETNA HEALTHCARE MEDICARE,159.14,,,,,,,24.2900,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,159.14,,,,,,,24.2900,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,AMBETTER,AMBETTER,346.92,,,,,,,24.2900,426.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,165.50,,,,,,,24.2900,426.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,ANTHEM EXCHANGE,391.81,,,,,,,24.2900,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,164.84,,,,,,,24.2900,426.0000,fee schedule,APG 00389 Proc 74290 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,ANTHEM HMO,416.27,,,,,,,24.2900,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,163.91,,,,,,,24.2900,426.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",426.00,,,,,,,24.2900,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,45.83,,,,,,,24.2900,426.0000,fee schedule,$45.83 from Fee Schedule BLDTM_23 for Rev 320 Proc 74290 * Qty 1 = $45.83 at 100% = $45.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,BLUE CROSS E NETWORK,159.14,,,,,,,24.2900,426.0000,fee schedule,$49.73 from Fee Schedule BCFSC for Rev 320 Proc 74290 * Qty 1 = $49.73 at 320% = $159.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,BLUE CROSS MEDICARE,165.50,,,,,,,24.2900,426.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,BLUE CROSS P NETWORK,162.62,,,,,,,24.2900,426.0000,fee schedule,$49.73 from Fee Schedule BCFSC for Rev 320 Proc 74290 * Qty 1 = $49.73 at 327% = $162.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,BLUE CROSS S NETWORK,162.62,,,,,,,24.2900,426.0000,fee schedule,$49.73 from Fee Schedule BCFSC for Rev 320 Proc 74290 * Qty 1 = $49.73 at 327% = $162.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,TENNCARE BLUE CARE,24.29,,,,,,,24.2900,426.0000,fee schedule,$20.94 from Fee Schedule TC_24 for Rev 320 Proc 74290 * Qty 1 = $20.94 at 116% = $24.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,TENNCARE BLUE SELECT,24.29,,,,,,,24.2900,426.0000,fee schedule,$20.94 from Fee Schedule TC_24 for Rev 320 Proc 74290 * Qty 1 = $20.94 at 116% = $24.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,CIGNA HEALTHCARE,CIGNA HMO,324.85,,,,,,,24.2900,426.0000,fee schedule,$324.85 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74290 * Qty 1 = $324.85 at 100% = $324.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,131.28,,,,,,,24.2900,426.0000,fee schedule,$131.28 from Fee Schedule CGIFP_25LR for Rev 320 Proc 74290 * Qty 1 = $131.28 at 100% = $131.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,167.09,,,,,,,24.2900,426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,324.85,,,,,,,24.2900,426.0000,fee schedule,$324.85 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74290 * Qty 1 = $324.85 at 100% = $324.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,CIGNA HEALTHCARE,CIGNA PPO,324.85,,,,,,,24.2900,426.0000,fee schedule,$324.85 from Fee Schedule CIGWHS_23 for Rev 320 Proc 74290 * Qty 1 = $324.85 at 100% = $324.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,167.09,,,,,,,24.2900,426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,383.40,,,,,,,24.2900,426.0000,percent of total billed charges,90% of $426.00 in Billed Charges for Rev 320 Proc 74290 = $383.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,HUMANA,HUMANA MEDICARE,159.14,,,,,,,24.2900,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,159.14,,,,,,,24.2900,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,MEDCOST,MEDCOST VHN,202.73,,,,,,,24.2900,426.0000,percent of total billed charges,47.59% of $426.00 in Billed Charges for Rev 320 Proc 74290 = $202.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,168.04,,,,,,,24.2900,426.0000,fee schedule,APG 00389 Proc 74290 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 105% = $168.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,167.09,,,,,,,24.2900,426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,167.09,,,,,,,24.2900,426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,NHC ADVANTAGE,NHC ADVANTAGE,167.09,,,,,,,24.2900,426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,165.00,,,,,,,24.2900,426.0000,fee schedule,APG 00389 Proc 74290 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 103.1% = $165.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,SENTARA HEALTH,SENTARA HEALTH,109.95,,,,,,,24.2900,426.0000,percent of total billed charges,25.81% of $426.00 in Billed Charges for Rev 320 Proc 74290 = $109.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,SENTARA HEALTH,SENTARA MEDICARE,159.14,,,,,,,24.2900,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",426.00,,,,,,,24.2900,426.0000,percent of total billed charges,100% of $426.00 in Billed Charges for Rev 320 Proc 74290 = $426.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,42.92,,,,,,,24.2900,426.0000,fee schedule,$85.83 from Fee Schedule TCUHC24 for Rev 320 Proc 74290 * Qty 1 = $85.83 at 50% = $42.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,24.2900,426.0000,other,Rev 320 Proc 74290 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,24.2900,426.0000,other,Rev 320 Proc 74290 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,24.2900,426.0000,other,Rev 320 Proc 74290 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,164.84,,,,,,,24.2900,426.0000,fee schedule,APG 00389 Proc 74290 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,159.14,,,,,,,24.2900,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,159.14,,,,,,,24.2900,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,WELLCARE,WELLCARE MEDICAID,426.00,,,,,,,24.2900,426.0000,percent of total billed charges,100% of $426.00 in Billed Charges for Rev 320 Proc 74290 = $426.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX GALLBLADDER*,74290,CPT,320,RC,32000162,CDM,,,,both,,,426.0000,63.9000,WELLCARE,WELLCARE MEDICARE,168.69,,,,,,,24.2900,426.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA,289.08,,,,,,,48.1600,677.0000,percent of total billed charges,42.7% of $677.00 in Billed Charges for Rev 402 Proc 76856 = $289.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,236.48,,,,,,,48.1600,677.0000,fee schedule,APG 00289 Proc 76856 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 104% = $236.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,AMBETTER,AMBETTER,206.78,,,,,,,48.1600,677.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,48.1600,677.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,234.21,,,,,,,48.1600,677.0000,fee schedule,APG 00289 Proc 76856 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 103% = $234.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,48.1600,677.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,88.70,,,,,,,48.1600,677.0000,fee schedule,$88.70 from Fee Schedule BLDTM_23 for Rev 402 Proc 76856 * Qty 1 = $88.70 at 100% = $88.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS E NETWORK,261.06,,,,,,,48.1600,677.0000,fee schedule,$81.58 from Fee Schedule BCFSC for Rev 402 Proc 76856 * Qty 1 = $81.58 at 320% = $261.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,48.1600,677.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS P NETWORK,266.77,,,,,,,48.1600,677.0000,fee schedule,$81.58 from Fee Schedule BCFSC for Rev 402 Proc 76856 * Qty 1 = $81.58 at 327% = $266.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS S NETWORK,266.77,,,,,,,48.1600,677.0000,fee schedule,$81.58 from Fee Schedule BCFSC for Rev 402 Proc 76856 * Qty 1 = $81.58 at 327% = $266.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE CARE,50.23,,,,,,,48.1600,677.0000,fee schedule,$43.30 from Fee Schedule TC_24 for Rev 402 Proc 76856 * Qty 1 = $43.30 at 116% = $50.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE SELECT,50.23,,,,,,,48.1600,677.0000,fee schedule,$43.30 from Fee Schedule TC_24 for Rev 402 Proc 76856 * Qty 1 = $43.30 at 116% = $50.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA HMO,364.51,,,,,,,48.1600,677.0000,fee schedule,$364.51 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76856 * Qty 1 = $364.51 at 100% = $364.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,137.55,,,,,,,48.1600,677.0000,fee schedule,$137.55 from Fee Schedule CGIFP_25LR for Rev 402 Proc 76856 * Qty 1 = $137.55 at 100% = $137.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,48.1600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,364.51,,,,,,,48.1600,677.0000,fee schedule,$364.51 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76856 * Qty 1 = $364.51 at 100% = $364.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA PPO,364.51,,,,,,,48.1600,677.0000,fee schedule,$364.51 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76856 * Qty 1 = $364.51 at 100% = $364.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,48.1600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,609.30,,,,,,,48.1600,677.0000,percent of total billed charges,90% of $677.00 in Billed Charges for Rev 402 Proc 76856 = $609.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,HUMANA,HUMANA MEDICARE,94.85,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,MEDCOST,MEDCOST VHN,322.18,,,,,,,48.1600,677.0000,percent of total billed charges,47.59% of $677.00 in Billed Charges for Rev 402 Proc 76856 = $322.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,238.76,,,,,,,48.1600,677.0000,fee schedule,APG 00289 Proc 76856 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 100% = $227.39... $227.39 at 105% = $238.76 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,48.1600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,48.1600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,48.1600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,234.44,,,,,,,48.1600,677.0000,fee schedule,APG 00289 Proc 76856 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 100% = $227.39... $227.39 at 103.1% = $234.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,SENTARA HEALTH,SENTARA HEALTH,174.73,,,,,,,48.1600,677.0000,percent of total billed charges,25.81% of $677.00 in Billed Charges for Rev 402 Proc 76856 = $174.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",677.00,,,,,,,48.1600,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76856 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,48.16,,,,,,,48.1600,677.0000,fee schedule,$96.31 from Fee Schedule TCUHC24 for Rev 402 Proc 76856 * Qty 1 = $96.31 at 50% = $48.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,48.1600,677.0000,other,Rev 402 Proc 76856 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,48.1600,677.0000,other,Rev 402 Proc 76856 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,677.00,,,,,,,48.1600,677.0000,other,"Rev 402 Proc 76856 1 Visit at $687.00 per Visit = $687.00 (Service Line reduced to $677.00, claim capped at $677.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,234.21,,,,,,,48.1600,677.0000,fee schedule,APG 00289 Proc 76856 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 103% = $234.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,WELLCARE,WELLCARE MEDICAID,677.00,,,,,,,48.1600,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76856 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US PELVIS NON OB,76856,CPT,402,RC,40200040,CDM,,,,both,,,677.0000,101.5500,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,48.1600,677.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA,289.08,,,,,,,31.4600,677.0000,percent of total billed charges,42.7% of $677.00 in Billed Charges for Rev 402 Proc 76857 = $289.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,156.09,,,,,,,31.4600,677.0000,fee schedule,APG 00288 Proc 76857 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 104% = $156.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,31.4600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,31.4600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,31.4600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,AMBETTER,AMBETTER,206.78,,,,,,,31.4600,677.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,31.4600,677.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,31.4600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,154.59,,,,,,,31.4600,677.0000,fee schedule,APG 00288 Proc 76857 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 103% = $154.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,31.4600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,31.4600,677.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,31.4600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,55.44,,,,,,,31.4600,677.0000,fee schedule,$55.44 from Fee Schedule BLDTM_23 for Rev 402 Proc 76857 * Qty 1 = $55.44 at 100% = $55.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS E NETWORK,100.45,,,,,,,31.4600,677.0000,fee schedule,$31.39 from Fee Schedule BCFSC for Rev 402 Proc 76857 * Qty 1 = $31.39 at 320% = $100.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,31.4600,677.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS P NETWORK,102.65,,,,,,,31.4600,677.0000,fee schedule,$31.39 from Fee Schedule BCFSC for Rev 402 Proc 76857 * Qty 1 = $31.39 at 327% = $102.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS S NETWORK,102.65,,,,,,,31.4600,677.0000,fee schedule,$31.39 from Fee Schedule BCFSC for Rev 402 Proc 76857 * Qty 1 = $31.39 at 327% = $102.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE CARE,34.41,,,,,,,31.4600,677.0000,fee schedule,$29.66 from Fee Schedule TC_24 for Rev 402 Proc 76857 * Qty 1 = $29.66 at 116% = $34.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE SELECT,34.41,,,,,,,31.4600,677.0000,fee schedule,$29.66 from Fee Schedule TC_24 for Rev 402 Proc 76857 * Qty 1 = $29.66 at 116% = $34.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA HMO,238.14,,,,,,,31.4600,677.0000,fee schedule,$238.14 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76857 * Qty 1 = $238.14 at 100% = $238.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,49.23,,,,,,,31.4600,677.0000,fee schedule,$49.23 from Fee Schedule CGIFP_25LR for Rev 402 Proc 76857 * Qty 1 = $49.23 at 100% = $49.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,31.4600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,238.14,,,,,,,31.4600,677.0000,fee schedule,$238.14 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76857 * Qty 1 = $238.14 at 100% = $238.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA PPO,238.14,,,,,,,31.4600,677.0000,fee schedule,$238.14 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76857 * Qty 1 = $238.14 at 100% = $238.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,31.4600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,609.30,,,,,,,31.4600,677.0000,percent of total billed charges,90% of $677.00 in Billed Charges for Rev 402 Proc 76857 = $609.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,HUMANA,HUMANA MEDICARE,94.85,,,,,,,31.4600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,31.4600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,MEDCOST,MEDCOST VHN,322.18,,,,,,,31.4600,677.0000,percent of total billed charges,47.59% of $677.00 in Billed Charges for Rev 402 Proc 76857 = $322.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,157.59,,,,,,,31.4600,677.0000,fee schedule,APG 00288 Proc 76857 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 100% = $150.09... $150.09 at 105% = $157.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,31.4600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,31.4600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,31.4600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,154.74,,,,,,,31.4600,677.0000,fee schedule,APG 00288 Proc 76857 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 100% = $150.09... $150.09 at 103.1% = $154.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,SENTARA HEALTH,SENTARA HEALTH,174.73,,,,,,,31.4600,677.0000,percent of total billed charges,25.81% of $677.00 in Billed Charges for Rev 402 Proc 76857 = $174.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,31.4600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",677.00,,,,,,,31.4600,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76857 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,31.46,,,,,,,31.4600,677.0000,fee schedule,$62.92 from Fee Schedule TCUHC24 for Rev 402 Proc 76857 * Qty 1 = $62.92 at 50% = $31.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,31.4600,677.0000,other,Rev 402 Proc 76857 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,31.4600,677.0000,other,Rev 402 Proc 76857 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,677.00,,,,,,,31.4600,677.0000,other,"Rev 402 Proc 76857 1 Visit at $687.00 per Visit = $687.00 (Service Line reduced to $677.00, claim capped at $677.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,154.59,,,,,,,31.4600,677.0000,fee schedule,APG 00288 Proc 76857 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 103% = $154.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,31.4600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,31.4600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,WELLCARE,WELLCARE MEDICAID,677.00,,,,,,,31.4600,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76857 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US PELVIS LTD FU,76857,CPT,402,RC,40200041,CDM,,,,both,,,677.0000,101.5500,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,31.4600,677.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA,289.08,,,,,,,48.1600,677.0000,percent of total billed charges,42.7% of $677.00 in Billed Charges for Rev 402 Proc 76870 = $289.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,156.09,,,,,,,48.1600,677.0000,fee schedule,APG 00288 Proc 76870 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 104% = $156.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,AMBETTER,AMBETTER,206.78,,,,,,,48.1600,677.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,48.1600,677.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,154.59,,,,,,,48.1600,677.0000,fee schedule,APG 00288 Proc 76870 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 103% = $154.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,48.1600,677.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,85.79,,,,,,,48.1600,677.0000,fee schedule,$85.79 from Fee Schedule BLDTM_23 for Rev 402 Proc 76870 * Qty 1 = $85.79 at 100% = $85.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS E NETWORK,121.06,,,,,,,48.1600,677.0000,fee schedule,$37.83 from Fee Schedule BCFSC for Rev 402 Proc 76870 * Qty 1 = $37.83 at 320% = $121.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,48.1600,677.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS P NETWORK,123.70,,,,,,,48.1600,677.0000,fee schedule,$37.83 from Fee Schedule BCFSC for Rev 402 Proc 76870 * Qty 1 = $37.83 at 327% = $123.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,BLUE CROSS S NETWORK,123.70,,,,,,,48.1600,677.0000,fee schedule,$37.83 from Fee Schedule BCFSC for Rev 402 Proc 76870 * Qty 1 = $37.83 at 327% = $123.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE CARE,50.23,,,,,,,48.1600,677.0000,fee schedule,$43.30 from Fee Schedule TC_24 for Rev 402 Proc 76870 * Qty 1 = $43.30 at 116% = $50.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,BLUE CROSS,TENNCARE BLUE SELECT,50.23,,,,,,,48.1600,677.0000,fee schedule,$43.30 from Fee Schedule TC_24 for Rev 402 Proc 76870 * Qty 1 = $43.30 at 116% = $50.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA HMO,364.51,,,,,,,48.1600,677.0000,fee schedule,$364.51 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76870 * Qty 1 = $364.51 at 100% = $364.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,131.91,,,,,,,48.1600,677.0000,fee schedule,$131.91 from Fee Schedule CGIFP_25LR for Rev 402 Proc 76870 * Qty 1 = $131.91 at 100% = $131.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,48.1600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,364.51,,,,,,,48.1600,677.0000,fee schedule,$364.51 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76870 * Qty 1 = $364.51 at 100% = $364.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,CIGNA HEALTHCARE,CIGNA PPO,364.51,,,,,,,48.1600,677.0000,fee schedule,$364.51 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76870 * Qty 1 = $364.51 at 100% = $364.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,48.1600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,609.30,,,,,,,48.1600,677.0000,percent of total billed charges,90% of $677.00 in Billed Charges for Rev 402 Proc 76870 = $609.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,HUMANA,HUMANA MEDICARE,94.85,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,MEDCOST,MEDCOST VHN,322.18,,,,,,,48.1600,677.0000,percent of total billed charges,47.59% of $677.00 in Billed Charges for Rev 402 Proc 76870 = $322.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,157.59,,,,,,,48.1600,677.0000,fee schedule,APG 00288 Proc 76870 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 100% = $150.09... $150.09 at 105% = $157.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,48.1600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,48.1600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,48.1600,677.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,154.74,,,,,,,48.1600,677.0000,fee schedule,APG 00288 Proc 76870 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 100% = $150.09... $150.09 at 103.1% = $154.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,SENTARA HEALTH,SENTARA HEALTH,174.73,,,,,,,48.1600,677.0000,percent of total billed charges,25.81% of $677.00 in Billed Charges for Rev 402 Proc 76870 = $174.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",677.00,,,,,,,48.1600,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76870 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,48.16,,,,,,,48.1600,677.0000,fee schedule,$96.31 from Fee Schedule TCUHC24 for Rev 402 Proc 76870 * Qty 1 = $96.31 at 50% = $48.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,48.1600,677.0000,other,Rev 402 Proc 76870 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,48.1600,677.0000,other,Rev 402 Proc 76870 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,677.00,,,,,,,48.1600,677.0000,other,"Rev 402 Proc 76870 1 Visit at $687.00 per Visit = $687.00 (Service Line reduced to $677.00, claim capped at $677.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,154.59,,,,,,,48.1600,677.0000,fee schedule,APG 00288 Proc 76870 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 103% = $154.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,48.1600,677.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,WELLCARE,WELLCARE MEDICAID,677.00,,,,,,,48.1600,677.0000,percent of total billed charges,100% of $677.00 in Billed Charges for Rev 402 Proc 76870 = $677.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US SCROTUM,76870,CPT,402,RC,40200042,CDM,,,,both,,,677.0000,101.5500,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,48.1600,677.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,AETNA,AETNA,274.56,,,,,,,8.9600,643.0000,percent of total billed charges,42.7% of $643.00 in Billed Charges for Rev 402 Proc 76882 = $274.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,156.09,,,,,,,8.9600,643.0000,fee schedule,APG 00288 Proc 76882 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 104% = $156.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,8.9600,643.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,8.9600,643.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,8.9600,643.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,AMBETTER,AMBETTER,206.78,,,,,,,8.9600,643.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,8.9600,643.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,8.9600,643.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,154.59,,,,,,,8.9600,643.0000,fee schedule,APG 00288 Proc 76882 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 103% = $154.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,8.9600,643.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,8.9600,643.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,8.9600,643.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9.51,,,,,,,8.9600,643.0000,fee schedule,$9.51 from Fee Schedule BLDTM_23 for Rev 402 Proc 76882 * Qty 1 = $9.51 at 100% = $9.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,BLUE CROSS,BLUE CROSS E NETWORK,31.49,,,,,,,8.9600,643.0000,fee schedule,$9.84 from Fee Schedule BCFSC for Rev 402 Proc 76882 * Qty 1 = $9.84 at 320% = $31.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,8.9600,643.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,BLUE CROSS,BLUE CROSS P NETWORK,32.18,,,,,,,8.9600,643.0000,fee schedule,$9.84 from Fee Schedule BCFSC for Rev 402 Proc 76882 * Qty 1 = $9.84 at 327% = $32.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,BLUE CROSS,BLUE CROSS S NETWORK,32.18,,,,,,,8.9600,643.0000,fee schedule,$9.84 from Fee Schedule BCFSC for Rev 402 Proc 76882 * Qty 1 = $9.84 at 327% = $32.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,BLUE CROSS,TENNCARE BLUE CARE,8.96,,,,,,,8.9600,643.0000,fee schedule,$7.72 from Fee Schedule TC_24 for Rev 402 Proc 76882 * Qty 1 = $7.72 at 116% = $8.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,BLUE CROSS,TENNCARE BLUE SELECT,8.96,,,,,,,8.9600,643.0000,fee schedule,$7.72 from Fee Schedule TC_24 for Rev 402 Proc 76882 * Qty 1 = $7.72 at 116% = $8.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,CIGNA HEALTHCARE,CIGNA HMO,238.14,,,,,,,8.9600,643.0000,fee schedule,$238.14 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76882 * Qty 1 = $238.14 at 100% = $238.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,58.00,,,,,,,8.9600,643.0000,fee schedule,$58.00 from Fee Schedule CGIFP_25LR for Rev 402 Proc 76882 * Qty 1 = $58.00 at 100% = $58.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,8.9600,643.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,238.14,,,,,,,8.9600,643.0000,fee schedule,$238.14 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76882 * Qty 1 = $238.14 at 100% = $238.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,CIGNA HEALTHCARE,CIGNA PPO,238.14,,,,,,,8.9600,643.0000,fee schedule,$238.14 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76882 * Qty 1 = $238.14 at 100% = $238.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,8.9600,643.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,578.70,,,,,,,8.9600,643.0000,percent of total billed charges,90% of $643.00 in Billed Charges for Rev 402 Proc 76882 = $578.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,HUMANA,HUMANA MEDICARE,94.85,,,,,,,8.9600,643.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,8.9600,643.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,MEDCOST,MEDCOST VHN,306.00,,,,,,,8.9600,643.0000,percent of total billed charges,47.59% of $643.00 in Billed Charges for Rev 402 Proc 76882 = $306.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,157.59,,,,,,,8.9600,643.0000,fee schedule,APG 00288 Proc 76882 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 100% = $150.09... $150.09 at 105% = $157.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,8.9600,643.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,8.9600,643.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,8.9600,643.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,154.74,,,,,,,8.9600,643.0000,fee schedule,APG 00288 Proc 76882 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 100% = $150.09... $150.09 at 103.1% = $154.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,SENTARA HEALTH,SENTARA HEALTH,165.96,,,,,,,8.9600,643.0000,percent of total billed charges,25.81% of $643.00 in Billed Charges for Rev 402 Proc 76882 = $165.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,8.9600,643.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",643.00,,,,,,,8.9600,643.0000,percent of total billed charges,100% of $643.00 in Billed Charges for Rev 402 Proc 76882 = $643.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,31.46,,,,,,,8.9600,643.0000,fee schedule,$62.92 from Fee Schedule TCUHC24 for Rev 402 Proc 76882 * Qty 1 = $62.92 at 50% = $31.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,8.9600,643.0000,other,Rev 402 Proc 76882 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,8.9600,643.0000,other,Rev 402 Proc 76882 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,643.00,,,,,,,8.9600,643.0000,other,"Rev 402 Proc 76882 1 Visit at $687.00 per Visit = $687.00 (Service Line reduced to $643.00, claim capped at $643.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,154.59,,,,,,,8.9600,643.0000,fee schedule,APG 00288 Proc 76882 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 103% = $154.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,8.9600,643.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,8.9600,643.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,WELLCARE,WELLCARE MEDICAID,643.00,,,,,,,8.9600,643.0000,percent of total billed charges,100% of $643.00 in Billed Charges for Rev 402 Proc 76882 = $643.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US LIMITED JOINT/NON-VAS EXT STRUCTURE(S),76882,CPT,402,RC,40200045,CDM,,,,both,,,643.0000,96.4500,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,8.9600,643.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LANGSTON DUAL LUMEN PIG,272,RC,27200911,CDM,,,,,,both,,,566.0000,84.9000,AETNA,AETNA,241.68,,,,,,,146.0800,566.0000,percent of total billed charges,42.7% of $566.00 in Billed Charges for Rev 272 = $241.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LANGSTON DUAL LUMEN PIG,272,RC,27200911,CDM,,,,,,both,,,566.0000,84.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,396.20,,,,,,,146.0800,566.0000,percent of total billed charges,Rev 272 $566.00 in Billed Charges at 70% = $396.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LANGSTON DUAL LUMEN PIG,272,RC,27200911,CDM,,,,,,both,,,566.0000,84.9000,CIGNA HEALTHCARE,CIGNA HMO,236.02,,,,,,,146.0800,566.0000,percent of total billed charges,41.7% of $566.00 in Billed Charges for Rev 272 = $236.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LANGSTON DUAL LUMEN PIG,272,RC,27200911,CDM,,,,,,both,,,566.0000,84.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,262.62,,,,,,,146.0800,566.0000,percent of total billed charges,46.4% of $566.00 in Billed Charges for Rev 272 = $262.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LANGSTON DUAL LUMEN PIG,272,RC,27200911,CDM,,,,,,both,,,566.0000,84.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,236.02,,,,,,,146.0800,566.0000,percent of total billed charges,41.7% of $566.00 in Billed Charges for Rev 272 = $236.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LANGSTON DUAL LUMEN PIG,272,RC,27200911,CDM,,,,,,both,,,566.0000,84.9000,CIGNA HEALTHCARE,CIGNA PPO,236.02,,,,,,,146.0800,566.0000,percent of total billed charges,41.7% of $566.00 in Billed Charges for Rev 272 = $236.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LANGSTON DUAL LUMEN PIG,272,RC,27200911,CDM,,,,,,both,,,566.0000,84.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,509.40,,,,,,,146.0800,566.0000,percent of total billed charges,90% of $566.00 in Billed Charges for Rev 272 = $509.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LANGSTON DUAL LUMEN PIG,272,RC,27200911,CDM,,,,,,both,,,566.0000,84.9000,MEDCOST,MEDCOST VHN,269.36,,,,,,,146.0800,566.0000,percent of total billed charges,47.59% of $566.00 in Billed Charges for Rev 272 = $269.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LANGSTON DUAL LUMEN PIG,272,RC,27200911,CDM,,,,,,both,,,566.0000,84.9000,SENTARA HEALTH,SENTARA HEALTH,146.08,,,,,,,146.0800,566.0000,percent of total billed charges,25.81% of $566.00 in Billed Charges for Rev 272 = $146.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LANGSTON DUAL LUMEN PIG,272,RC,27200911,CDM,,,,,,both,,,566.0000,84.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",566.00,,,,,,,146.0800,566.0000,percent of total billed charges,100% of $566.00 in Billed Charges for Rev 272 = $566.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LANGSTON DUAL LUMEN PIG,272,RC,27200911,CDM,,,,,,both,,,566.0000,84.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,283.00,,,,,,,146.0800,566.0000,percent of total billed charges,Rev 272 $566.00 in Billed Charges at 50% = $283.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LANGSTON DUAL LUMEN PIG,272,RC,27200911,CDM,,,,,,both,,,566.0000,84.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,182.82,,,,,,,146.0800,566.0000,other,32.3% of $566.00 in Billed Charges for Rev 272 = $182.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LANGSTON DUAL LUMEN PIG,272,RC,27200911,CDM,,,,,,both,,,566.0000,84.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,173.76,,,,,,,146.0800,566.0000,other,30.7% of $566.00 in Billed Charges for Rev 272 = $173.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LANGSTON DUAL LUMEN PIG,272,RC,27200911,CDM,,,,,,both,,,566.0000,84.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,182.82,,,,,,,146.0800,566.0000,percent of total billed charges,32.3% of $566.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LANGSTON DUAL LUMEN PIG,272,RC,27200911,CDM,,,,,,both,,,566.0000,84.9000,WELLCARE,WELLCARE MEDICAID,566.00,,,,,,,146.0800,566.0000,percent of total billed charges,100% of $566.00 in Billed Charges for Rev 272 = $566.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LASERFIBER SITEMARKS EVLT KIT,272,RC,27201526,CDM,,,,,,both,,,246.0000,36.9000,AETNA,AETNA,105.04,,,,,,,63.4900,246.0000,percent of total billed charges,42.7% of $246.00 in Billed Charges for Rev 272 = $105.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LASERFIBER SITEMARKS EVLT KIT,272,RC,27201526,CDM,,,,,,both,,,246.0000,36.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,172.20,,,,,,,63.4900,246.0000,percent of total billed charges,Rev 272 $246.00 in Billed Charges at 70% = $172.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LASERFIBER SITEMARKS EVLT KIT,272,RC,27201526,CDM,,,,,,both,,,246.0000,36.9000,CIGNA HEALTHCARE,CIGNA HMO,102.58,,,,,,,63.4900,246.0000,percent of total billed charges,41.7% of $246.00 in Billed Charges for Rev 272 = $102.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LASERFIBER SITEMARKS EVLT KIT,272,RC,27201526,CDM,,,,,,both,,,246.0000,36.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,114.14,,,,,,,63.4900,246.0000,percent of total billed charges,46.4% of $246.00 in Billed Charges for Rev 272 = $114.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LASERFIBER SITEMARKS EVLT KIT,272,RC,27201526,CDM,,,,,,both,,,246.0000,36.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,102.58,,,,,,,63.4900,246.0000,percent of total billed charges,41.7% of $246.00 in Billed Charges for Rev 272 = $102.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LASERFIBER SITEMARKS EVLT KIT,272,RC,27201526,CDM,,,,,,both,,,246.0000,36.9000,CIGNA HEALTHCARE,CIGNA PPO,102.58,,,,,,,63.4900,246.0000,percent of total billed charges,41.7% of $246.00 in Billed Charges for Rev 272 = $102.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LASERFIBER SITEMARKS EVLT KIT,272,RC,27201526,CDM,,,,,,both,,,246.0000,36.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,221.40,,,,,,,63.4900,246.0000,percent of total billed charges,90% of $246.00 in Billed Charges for Rev 272 = $221.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LASERFIBER SITEMARKS EVLT KIT,272,RC,27201526,CDM,,,,,,both,,,246.0000,36.9000,MEDCOST,MEDCOST VHN,117.07,,,,,,,63.4900,246.0000,percent of total billed charges,47.59% of $246.00 in Billed Charges for Rev 272 = $117.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LASERFIBER SITEMARKS EVLT KIT,272,RC,27201526,CDM,,,,,,both,,,246.0000,36.9000,SENTARA HEALTH,SENTARA HEALTH,63.49,,,,,,,63.4900,246.0000,percent of total billed charges,25.81% of $246.00 in Billed Charges for Rev 272 = $63.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LASERFIBER SITEMARKS EVLT KIT,272,RC,27201526,CDM,,,,,,both,,,246.0000,36.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",246.00,,,,,,,63.4900,246.0000,percent of total billed charges,100% of $246.00 in Billed Charges for Rev 272 = $246.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LASERFIBER SITEMARKS EVLT KIT,272,RC,27201526,CDM,,,,,,both,,,246.0000,36.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,123.00,,,,,,,63.4900,246.0000,percent of total billed charges,Rev 272 $246.00 in Billed Charges at 50% = $123.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LASERFIBER SITEMARKS EVLT KIT,272,RC,27201526,CDM,,,,,,both,,,246.0000,36.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,79.46,,,,,,,63.4900,246.0000,other,32.3% of $246.00 in Billed Charges for Rev 272 = $79.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LASERFIBER SITEMARKS EVLT KIT,272,RC,27201526,CDM,,,,,,both,,,246.0000,36.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,75.52,,,,,,,63.4900,246.0000,other,30.7% of $246.00 in Billed Charges for Rev 272 = $75.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LASERFIBER SITEMARKS EVLT KIT,272,RC,27201526,CDM,,,,,,both,,,246.0000,36.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,79.46,,,,,,,63.4900,246.0000,percent of total billed charges,32.3% of $246.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LASERFIBER SITEMARKS EVLT KIT,272,RC,27201526,CDM,,,,,,both,,,246.0000,36.9000,WELLCARE,WELLCARE MEDICAID,246.00,,,,,,,63.4900,246.0000,percent of total billed charges,100% of $246.00 in Billed Charges for Rev 272 = $246.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LASSO VARIABLE 7F 115CM,272,RC,27200913,CDM,,,,,,both,,,4615.0000,692.2500,AETNA,AETNA,1970.61,,,,,,,1191.1300,4615.0000,percent of total billed charges,"42.7% of $4,615.00 in Billed Charges for Rev 272 = $1,970.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LASSO VARIABLE 7F 115CM,272,RC,27200913,CDM,,,,,,both,,,4615.0000,692.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3230.50,,,,,,,1191.1300,4615.0000,percent of total billed charges,"Rev 272 $4,615.00 in Billed Charges at 70% = $3,230.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LASSO VARIABLE 7F 115CM,272,RC,27200913,CDM,,,,,,both,,,4615.0000,692.2500,CIGNA HEALTHCARE,CIGNA HMO,1924.46,,,,,,,1191.1300,4615.0000,percent of total billed charges,"41.7% of $4,615.00 in Billed Charges for Rev 272 = $1,924.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LASSO VARIABLE 7F 115CM,272,RC,27200913,CDM,,,,,,both,,,4615.0000,692.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2141.36,,,,,,,1191.1300,4615.0000,percent of total billed charges,"46.4% of $4,615.00 in Billed Charges for Rev 272 = $2,141.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LASSO VARIABLE 7F 115CM,272,RC,27200913,CDM,,,,,,both,,,4615.0000,692.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1924.46,,,,,,,1191.1300,4615.0000,percent of total billed charges,"41.7% of $4,615.00 in Billed Charges for Rev 272 = $1,924.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LASSO VARIABLE 7F 115CM,272,RC,27200913,CDM,,,,,,both,,,4615.0000,692.2500,CIGNA HEALTHCARE,CIGNA PPO,1924.46,,,,,,,1191.1300,4615.0000,percent of total billed charges,"41.7% of $4,615.00 in Billed Charges for Rev 272 = $1,924.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LASSO VARIABLE 7F 115CM,272,RC,27200913,CDM,,,,,,both,,,4615.0000,692.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4153.50,,,,,,,1191.1300,4615.0000,percent of total billed charges,"90% of $4,615.00 in Billed Charges for Rev 272 = $4,153.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LASSO VARIABLE 7F 115CM,272,RC,27200913,CDM,,,,,,both,,,4615.0000,692.2500,MEDCOST,MEDCOST VHN,2196.28,,,,,,,1191.1300,4615.0000,percent of total billed charges,"47.59% of $4,615.00 in Billed Charges for Rev 272 = $2,196.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LASSO VARIABLE 7F 115CM,272,RC,27200913,CDM,,,,,,both,,,4615.0000,692.2500,SENTARA HEALTH,SENTARA HEALTH,1191.13,,,,,,,1191.1300,4615.0000,percent of total billed charges,"25.81% of $4,615.00 in Billed Charges for Rev 272 = $1,191.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LASSO VARIABLE 7F 115CM,272,RC,27200913,CDM,,,,,,both,,,4615.0000,692.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4615.00,,,,,,,1191.1300,4615.0000,percent of total billed charges,"100% of $4,615.00 in Billed Charges for Rev 272 = $4,615.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LASSO VARIABLE 7F 115CM,272,RC,27200913,CDM,,,,,,both,,,4615.0000,692.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2307.50,,,,,,,1191.1300,4615.0000,percent of total billed charges,"Rev 272 $4,615.00 in Billed Charges at 50% = $2,307.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LASSO VARIABLE 7F 115CM,272,RC,27200913,CDM,,,,,,both,,,4615.0000,692.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1490.65,,,,,,,1191.1300,4615.0000,other,"32.3% of $4,615.00 in Billed Charges for Rev 272 = $1,490.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LASSO VARIABLE 7F 115CM,272,RC,27200913,CDM,,,,,,both,,,4615.0000,692.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1416.81,,,,,,,1191.1300,4615.0000,other,"30.7% of $4,615.00 in Billed Charges for Rev 272 = $1,416.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LASSO VARIABLE 7F 115CM,272,RC,27200913,CDM,,,,,,both,,,4615.0000,692.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1490.65,,,,,,,1191.1300,4615.0000,percent of total billed charges,"32.3% of $4,615.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LASSO VARIABLE 7F 115CM,272,RC,27200913,CDM,,,,,,both,,,4615.0000,692.2500,WELLCARE,WELLCARE MEDICAID,4615.00,,,,,,,1191.1300,4615.0000,percent of total billed charges,"100% of $4,615.00 in Billed Charges for Rev 272 = $4,615.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEAD LOCKING DEVICE E 518-039,272,RC,27200917,CDM,,,,,,both,,,4291.0000,643.6500,AETNA,AETNA,1832.26,,,,,,,1107.5100,4291.0000,percent of total billed charges,"42.7% of $4,291.00 in Billed Charges for Rev 272 = $1,832.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEAD LOCKING DEVICE E 518-039,272,RC,27200917,CDM,,,,,,both,,,4291.0000,643.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3003.70,,,,,,,1107.5100,4291.0000,percent of total billed charges,"Rev 272 $4,291.00 in Billed Charges at 70% = $3,003.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEAD LOCKING DEVICE E 518-039,272,RC,27200917,CDM,,,,,,both,,,4291.0000,643.6500,CIGNA HEALTHCARE,CIGNA HMO,1789.35,,,,,,,1107.5100,4291.0000,percent of total billed charges,"41.7% of $4,291.00 in Billed Charges for Rev 272 = $1,789.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEAD LOCKING DEVICE E 518-039,272,RC,27200917,CDM,,,,,,both,,,4291.0000,643.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1991.02,,,,,,,1107.5100,4291.0000,percent of total billed charges,"46.4% of $4,291.00 in Billed Charges for Rev 272 = $1,991.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEAD LOCKING DEVICE E 518-039,272,RC,27200917,CDM,,,,,,both,,,4291.0000,643.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1789.35,,,,,,,1107.5100,4291.0000,percent of total billed charges,"41.7% of $4,291.00 in Billed Charges for Rev 272 = $1,789.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEAD LOCKING DEVICE E 518-039,272,RC,27200917,CDM,,,,,,both,,,4291.0000,643.6500,CIGNA HEALTHCARE,CIGNA PPO,1789.35,,,,,,,1107.5100,4291.0000,percent of total billed charges,"41.7% of $4,291.00 in Billed Charges for Rev 272 = $1,789.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEAD LOCKING DEVICE E 518-039,272,RC,27200917,CDM,,,,,,both,,,4291.0000,643.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3861.90,,,,,,,1107.5100,4291.0000,percent of total billed charges,"90% of $4,291.00 in Billed Charges for Rev 272 = $3,861.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEAD LOCKING DEVICE E 518-039,272,RC,27200917,CDM,,,,,,both,,,4291.0000,643.6500,MEDCOST,MEDCOST VHN,2042.09,,,,,,,1107.5100,4291.0000,percent of total billed charges,"47.59% of $4,291.00 in Billed Charges for Rev 272 = $2,042.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEAD LOCKING DEVICE E 518-039,272,RC,27200917,CDM,,,,,,both,,,4291.0000,643.6500,SENTARA HEALTH,SENTARA HEALTH,1107.51,,,,,,,1107.5100,4291.0000,percent of total billed charges,"25.81% of $4,291.00 in Billed Charges for Rev 272 = $1,107.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEAD LOCKING DEVICE E 518-039,272,RC,27200917,CDM,,,,,,both,,,4291.0000,643.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4291.00,,,,,,,1107.5100,4291.0000,percent of total billed charges,"100% of $4,291.00 in Billed Charges for Rev 272 = $4,291.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEAD LOCKING DEVICE E 518-039,272,RC,27200917,CDM,,,,,,both,,,4291.0000,643.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2145.50,,,,,,,1107.5100,4291.0000,percent of total billed charges,"Rev 272 $4,291.00 in Billed Charges at 50% = $2,145.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEAD LOCKING DEVICE E 518-039,272,RC,27200917,CDM,,,,,,both,,,4291.0000,643.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1385.99,,,,,,,1107.5100,4291.0000,other,"32.3% of $4,291.00 in Billed Charges for Rev 272 = $1,385.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LEAD LOCKING DEVICE E 518-039,272,RC,27200917,CDM,,,,,,both,,,4291.0000,643.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1317.34,,,,,,,1107.5100,4291.0000,other,"30.7% of $4,291.00 in Billed Charges for Rev 272 = $1,317.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LEAD LOCKING DEVICE E 518-039,272,RC,27200917,CDM,,,,,,both,,,4291.0000,643.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,1385.99,,,,,,,1107.5100,4291.0000,percent of total billed charges,"32.3% of $4,291.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEAD LOCKING DEVICE E 518-039,272,RC,27200917,CDM,,,,,,both,,,4291.0000,643.6500,WELLCARE,WELLCARE MEDICAID,4291.00,,,,,,,1107.5100,4291.0000,percent of total billed charges,"100% of $4,291.00 in Billed Charges for Rev 272 = $4,291.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 070 NEURON DEL CATH,272,RC,27200991,CDM,,,,,,both,,,1838.0000,275.7000,AETNA,AETNA,784.83,,,,,,,474.3900,1838.0000,percent of total billed charges,"42.7% of $1,838.00 in Billed Charges for Rev 272 = $784.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 070 NEURON DEL CATH,272,RC,27200991,CDM,,,,,,both,,,1838.0000,275.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1286.60,,,,,,,474.3900,1838.0000,percent of total billed charges,"Rev 272 $1,838.00 in Billed Charges at 70% = $1,286.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 070 NEURON DEL CATH,272,RC,27200991,CDM,,,,,,both,,,1838.0000,275.7000,CIGNA HEALTHCARE,CIGNA HMO,766.45,,,,,,,474.3900,1838.0000,percent of total billed charges,"41.7% of $1,838.00 in Billed Charges for Rev 272 = $766.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 070 NEURON DEL CATH,272,RC,27200991,CDM,,,,,,both,,,1838.0000,275.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,852.83,,,,,,,474.3900,1838.0000,percent of total billed charges,"46.4% of $1,838.00 in Billed Charges for Rev 272 = $852.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 070 NEURON DEL CATH,272,RC,27200991,CDM,,,,,,both,,,1838.0000,275.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,766.45,,,,,,,474.3900,1838.0000,percent of total billed charges,"41.7% of $1,838.00 in Billed Charges for Rev 272 = $766.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 070 NEURON DEL CATH,272,RC,27200991,CDM,,,,,,both,,,1838.0000,275.7000,CIGNA HEALTHCARE,CIGNA PPO,766.45,,,,,,,474.3900,1838.0000,percent of total billed charges,"41.7% of $1,838.00 in Billed Charges for Rev 272 = $766.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 070 NEURON DEL CATH,272,RC,27200991,CDM,,,,,,both,,,1838.0000,275.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1654.20,,,,,,,474.3900,1838.0000,percent of total billed charges,"90% of $1,838.00 in Billed Charges for Rev 272 = $1,654.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 070 NEURON DEL CATH,272,RC,27200991,CDM,,,,,,both,,,1838.0000,275.7000,MEDCOST,MEDCOST VHN,874.70,,,,,,,474.3900,1838.0000,percent of total billed charges,"47.59% of $1,838.00 in Billed Charges for Rev 272 = $874.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 070 NEURON DEL CATH,272,RC,27200991,CDM,,,,,,both,,,1838.0000,275.7000,SENTARA HEALTH,SENTARA HEALTH,474.39,,,,,,,474.3900,1838.0000,percent of total billed charges,"25.81% of $1,838.00 in Billed Charges for Rev 272 = $474.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 070 NEURON DEL CATH,272,RC,27200991,CDM,,,,,,both,,,1838.0000,275.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1838.00,,,,,,,474.3900,1838.0000,percent of total billed charges,"100% of $1,838.00 in Billed Charges for Rev 272 = $1,838.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 070 NEURON DEL CATH,272,RC,27200991,CDM,,,,,,both,,,1838.0000,275.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,919.00,,,,,,,474.3900,1838.0000,percent of total billed charges,"Rev 272 $1,838.00 in Billed Charges at 50% = $919.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 070 NEURON DEL CATH,272,RC,27200991,CDM,,,,,,both,,,1838.0000,275.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,593.67,,,,,,,474.3900,1838.0000,other,"32.3% of $1,838.00 in Billed Charges for Rev 272 = $593.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PENUMBRA 070 NEURON DEL CATH,272,RC,27200991,CDM,,,,,,both,,,1838.0000,275.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,564.27,,,,,,,474.3900,1838.0000,other,"30.7% of $1,838.00 in Billed Charges for Rev 272 = $564.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PENUMBRA 070 NEURON DEL CATH,272,RC,27200991,CDM,,,,,,both,,,1838.0000,275.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,593.67,,,,,,,474.3900,1838.0000,percent of total billed charges,"32.3% of $1,838.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 070 NEURON DEL CATH,272,RC,27200991,CDM,,,,,,both,,,1838.0000,275.7000,WELLCARE,WELLCARE MEDICAID,1838.00,,,,,,,474.3900,1838.0000,percent of total billed charges,"100% of $1,838.00 in Billed Charges for Rev 272 = $1,838.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIUM BOVINE 4X4,278,RC,27800649,CDM,,,,,,both,,,1110.0000,166.5000,AETNA,AETNA,532.80,,,,,,,286.4900,1110.0000,percent of total billed charges,"48% of $1,110.00 in Billed Charges for Rev 278 = $532.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIUM BOVINE 4X4,278,RC,27800649,CDM,,,,,,both,,,1110.0000,166.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,555.00,,,,,,,286.4900,1110.0000,percent of total billed charges,"50% of $1,110.00 in Billed Charges for Rev 278 = $555.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIUM BOVINE 4X4,278,RC,27800649,CDM,,,,,,both,,,1110.0000,166.5000,CIGNA HEALTHCARE,CIGNA HMO,462.87,,,,,,,286.4900,1110.0000,percent of total billed charges,"41.7% of $1,110.00 in Billed Charges for Rev 278 = $462.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIUM BOVINE 4X4,278,RC,27800649,CDM,,,,,,both,,,1110.0000,166.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,444.00,,,,,,,286.4900,1110.0000,percent of total billed charges,"40% of $1,110.00 in Billed Charges for Rev 278 = $444.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIUM BOVINE 4X4,278,RC,27800649,CDM,,,,,,both,,,1110.0000,166.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,462.87,,,,,,,286.4900,1110.0000,percent of total billed charges,"41.7% of $1,110.00 in Billed Charges for Rev 278 = $462.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIUM BOVINE 4X4,278,RC,27800649,CDM,,,,,,both,,,1110.0000,166.5000,CIGNA HEALTHCARE,CIGNA PPO,462.87,,,,,,,286.4900,1110.0000,percent of total billed charges,"41.7% of $1,110.00 in Billed Charges for Rev 278 = $462.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIUM BOVINE 4X4,278,RC,27800649,CDM,,,,,,both,,,1110.0000,166.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,999.00,,,,,,,286.4900,1110.0000,percent of total billed charges,"90% of $1,110.00 in Billed Charges for Rev 278 = $999.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIUM BOVINE 4X4,278,RC,27800649,CDM,,,,,,both,,,1110.0000,166.5000,MEDCOST,MEDCOST VHN,528.25,,,,,,,286.4900,1110.0000,percent of total billed charges,"47.59% of $1,110.00 in Billed Charges for Rev 278 = $528.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIUM BOVINE 4X4,278,RC,27800649,CDM,,,,,,both,,,1110.0000,166.5000,SENTARA HEALTH,SENTARA HEALTH,286.49,,,,,,,286.4900,1110.0000,percent of total billed charges,"25.81% of $1,110.00 in Billed Charges for Rev 278 = $286.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIUM BOVINE 4X4,278,RC,27800649,CDM,,,,,,both,,,1110.0000,166.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1110.00,,,,,,,286.4900,1110.0000,percent of total billed charges,"100% of $1,110.00 in Billed Charges for Rev 278 = $1,110.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIUM BOVINE 4X4,278,RC,27800649,CDM,,,,,,both,,,1110.0000,166.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,555.00,,,,,,,286.4900,1110.0000,percent of total billed charges,"Rev 278 $1,110.00 in Billed Charges at 50% = $555.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIUM BOVINE 4X4,278,RC,27800649,CDM,,,,,,both,,,1110.0000,166.5000,WELLCARE,WELLCARE MEDICAID,1110.00,,,,,,,286.4900,1110.0000,percent of total billed charges,"100% of $1,110.00 in Billed Charges for Rev 278 = $1,110.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIUM BOVINE 6X8,278,RC,27800650,CDM,,,,,,both,,,1617.0000,242.5500,AETNA,AETNA,776.16,,,,,,,417.3500,1617.0000,percent of total billed charges,"48% of $1,617.00 in Billed Charges for Rev 278 = $776.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIUM BOVINE 6X8,278,RC,27800650,CDM,,,,,,both,,,1617.0000,242.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,808.50,,,,,,,417.3500,1617.0000,percent of total billed charges,"50% of $1,617.00 in Billed Charges for Rev 278 = $808.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIUM BOVINE 6X8,278,RC,27800650,CDM,,,,,,both,,,1617.0000,242.5500,CIGNA HEALTHCARE,CIGNA HMO,674.29,,,,,,,417.3500,1617.0000,percent of total billed charges,"41.7% of $1,617.00 in Billed Charges for Rev 278 = $674.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIUM BOVINE 6X8,278,RC,27800650,CDM,,,,,,both,,,1617.0000,242.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,646.80,,,,,,,417.3500,1617.0000,percent of total billed charges,"40% of $1,617.00 in Billed Charges for Rev 278 = $646.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIUM BOVINE 6X8,278,RC,27800650,CDM,,,,,,both,,,1617.0000,242.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,674.29,,,,,,,417.3500,1617.0000,percent of total billed charges,"41.7% of $1,617.00 in Billed Charges for Rev 278 = $674.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIUM BOVINE 6X8,278,RC,27800650,CDM,,,,,,both,,,1617.0000,242.5500,CIGNA HEALTHCARE,CIGNA PPO,674.29,,,,,,,417.3500,1617.0000,percent of total billed charges,"41.7% of $1,617.00 in Billed Charges for Rev 278 = $674.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIUM BOVINE 6X8,278,RC,27800650,CDM,,,,,,both,,,1617.0000,242.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1455.30,,,,,,,417.3500,1617.0000,percent of total billed charges,"90% of $1,617.00 in Billed Charges for Rev 278 = $1,455.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIUM BOVINE 6X8,278,RC,27800650,CDM,,,,,,both,,,1617.0000,242.5500,MEDCOST,MEDCOST VHN,769.53,,,,,,,417.3500,1617.0000,percent of total billed charges,"47.59% of $1,617.00 in Billed Charges for Rev 278 = $769.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIUM BOVINE 6X8,278,RC,27800650,CDM,,,,,,both,,,1617.0000,242.5500,SENTARA HEALTH,SENTARA HEALTH,417.35,,,,,,,417.3500,1617.0000,percent of total billed charges,"25.81% of $1,617.00 in Billed Charges for Rev 278 = $417.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIUM BOVINE 6X8,278,RC,27800650,CDM,,,,,,both,,,1617.0000,242.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1617.00,,,,,,,417.3500,1617.0000,percent of total billed charges,"100% of $1,617.00 in Billed Charges for Rev 278 = $1,617.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIUM BOVINE 6X8,278,RC,27800650,CDM,,,,,,both,,,1617.0000,242.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,808.50,,,,,,,417.3500,1617.0000,percent of total billed charges,"Rev 278 $1,617.00 in Billed Charges at 50% = $808.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIUM BOVINE 6X8,278,RC,27800650,CDM,,,,,,both,,,1617.0000,242.5500,WELLCARE,WELLCARE MEDICAID,1617.00,,,,,,,417.3500,1617.0000,percent of total billed charges,"100% of $1,617.00 in Billed Charges for Rev 278 = $1,617.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERITONEAL DIALYSIS TREATMENT,802,RC,80200001,CDM,,,,,,both,,,1316.0000,197.4000,AETNA,AETNA,561.93,,,,,,,339.6600,1316.0000,percent of total billed charges,"42.7% of $1,316.00 in Billed Charges for Rev 802 = $561.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERITONEAL DIALYSIS TREATMENT,802,RC,80200001,CDM,,,,,,both,,,1316.0000,197.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,921.20,,,,,,,339.6600,1316.0000,percent of total billed charges,"Rev 802 $1,316.00 in Billed Charges at 70% = $921.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERITONEAL DIALYSIS TREATMENT,802,RC,80200001,CDM,,,,,,both,,,1316.0000,197.4000,CIGNA HEALTHCARE,CIGNA HMO,548.77,,,,,,,339.6600,1316.0000,percent of total billed charges,"41.7% of $1,316.00 in Billed Charges for Rev 802 = $548.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERITONEAL DIALYSIS TREATMENT,802,RC,80200001,CDM,,,,,,both,,,1316.0000,197.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,610.62,,,,,,,339.6600,1316.0000,percent of total billed charges,"46.4% of $1,316.00 in Billed Charges for Rev 802 = $610.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERITONEAL DIALYSIS TREATMENT,802,RC,80200001,CDM,,,,,,both,,,1316.0000,197.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,548.77,,,,,,,339.6600,1316.0000,percent of total billed charges,"41.7% of $1,316.00 in Billed Charges for Rev 802 = $548.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERITONEAL DIALYSIS TREATMENT,802,RC,80200001,CDM,,,,,,both,,,1316.0000,197.4000,CIGNA HEALTHCARE,CIGNA PPO,548.77,,,,,,,339.6600,1316.0000,percent of total billed charges,"41.7% of $1,316.00 in Billed Charges for Rev 802 = $548.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERITONEAL DIALYSIS TREATMENT,802,RC,80200001,CDM,,,,,,both,,,1316.0000,197.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1184.40,,,,,,,339.6600,1316.0000,percent of total billed charges,"90% of $1,316.00 in Billed Charges for Rev 802 = $1,184.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERITONEAL DIALYSIS TREATMENT,802,RC,80200001,CDM,,,,,,both,,,1316.0000,197.4000,MEDCOST,MEDCOST VHN,626.28,,,,,,,339.6600,1316.0000,percent of total billed charges,"47.59% of $1,316.00 in Billed Charges for Rev 802 = $626.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERITONEAL DIALYSIS TREATMENT,802,RC,80200001,CDM,,,,,,both,,,1316.0000,197.4000,SENTARA HEALTH,SENTARA HEALTH,339.66,,,,,,,339.6600,1316.0000,percent of total billed charges,"25.81% of $1,316.00 in Billed Charges for Rev 802 = $339.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERITONEAL DIALYSIS TREATMENT,802,RC,80200001,CDM,,,,,,both,,,1316.0000,197.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1316.00,,,,,,,339.6600,1316.0000,percent of total billed charges,"100% of $1,316.00 in Billed Charges for Rev 802 = $1,316.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERITONEAL DIALYSIS TREATMENT,802,RC,80200001,CDM,,,,,,both,,,1316.0000,197.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,658.00,,,,,,,339.6600,1316.0000,percent of total billed charges,"Rev 802 $1,316.00 in Billed Charges at 50% = $658.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERITONEAL DIALYSIS TREATMENT,802,RC,80200001,CDM,,,,,,both,,,1316.0000,197.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,425.07,,,,,,,339.6600,1316.0000,other,"32.3% of $1,316.00 in Billed Charges for Rev 802 = $425.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERITONEAL DIALYSIS TREATMENT,802,RC,80200001,CDM,,,,,,both,,,1316.0000,197.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,404.01,,,,,,,339.6600,1316.0000,other,"30.7% of $1,316.00 in Billed Charges for Rev 802 = $404.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERITONEAL DIALYSIS TREATMENT,802,RC,80200001,CDM,,,,,,both,,,1316.0000,197.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,425.07,,,,,,,339.6600,1316.0000,percent of total billed charges,"32.3% of $1,316.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERITONEAL DIALYSIS TREATMENT,802,RC,80200001,CDM,,,,,,both,,,1316.0000,197.4000,WELLCARE,WELLCARE MEDICAID,1316.00,,,,,,,339.6600,1316.0000,percent of total billed charges,"100% of $1,316.00 in Billed Charges for Rev 802 = $1,316.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PICC 5F DUAL LUMEN MORPHEUS,272,RC,27200994,CDM,,,,,,both,,,890.0000,133.5000,AETNA,AETNA,380.03,,,,,,,229.7100,890.0000,percent of total billed charges,42.7% of $890.00 in Billed Charges for Rev 272 = $380.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PICC 5F DUAL LUMEN MORPHEUS,272,RC,27200994,CDM,,,,,,both,,,890.0000,133.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,623.00,,,,,,,229.7100,890.0000,percent of total billed charges,Rev 272 $890.00 in Billed Charges at 70% = $623.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PICC 5F DUAL LUMEN MORPHEUS,272,RC,27200994,CDM,,,,,,both,,,890.0000,133.5000,CIGNA HEALTHCARE,CIGNA HMO,371.13,,,,,,,229.7100,890.0000,percent of total billed charges,41.7% of $890.00 in Billed Charges for Rev 272 = $371.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PICC 5F DUAL LUMEN MORPHEUS,272,RC,27200994,CDM,,,,,,both,,,890.0000,133.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,412.96,,,,,,,229.7100,890.0000,percent of total billed charges,46.4% of $890.00 in Billed Charges for Rev 272 = $412.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PICC 5F DUAL LUMEN MORPHEUS,272,RC,27200994,CDM,,,,,,both,,,890.0000,133.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,371.13,,,,,,,229.7100,890.0000,percent of total billed charges,41.7% of $890.00 in Billed Charges for Rev 272 = $371.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PICC 5F DUAL LUMEN MORPHEUS,272,RC,27200994,CDM,,,,,,both,,,890.0000,133.5000,CIGNA HEALTHCARE,CIGNA PPO,371.13,,,,,,,229.7100,890.0000,percent of total billed charges,41.7% of $890.00 in Billed Charges for Rev 272 = $371.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PICC 5F DUAL LUMEN MORPHEUS,272,RC,27200994,CDM,,,,,,both,,,890.0000,133.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,801.00,,,,,,,229.7100,890.0000,percent of total billed charges,90% of $890.00 in Billed Charges for Rev 272 = $801.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PICC 5F DUAL LUMEN MORPHEUS,272,RC,27200994,CDM,,,,,,both,,,890.0000,133.5000,MEDCOST,MEDCOST VHN,423.55,,,,,,,229.7100,890.0000,percent of total billed charges,47.59% of $890.00 in Billed Charges for Rev 272 = $423.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PICC 5F DUAL LUMEN MORPHEUS,272,RC,27200994,CDM,,,,,,both,,,890.0000,133.5000,SENTARA HEALTH,SENTARA HEALTH,229.71,,,,,,,229.7100,890.0000,percent of total billed charges,25.81% of $890.00 in Billed Charges for Rev 272 = $229.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PICC 5F DUAL LUMEN MORPHEUS,272,RC,27200994,CDM,,,,,,both,,,890.0000,133.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",890.00,,,,,,,229.7100,890.0000,percent of total billed charges,100% of $890.00 in Billed Charges for Rev 272 = $890.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PICC 5F DUAL LUMEN MORPHEUS,272,RC,27200994,CDM,,,,,,both,,,890.0000,133.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,445.00,,,,,,,229.7100,890.0000,percent of total billed charges,Rev 272 $890.00 in Billed Charges at 50% = $445.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PICC 5F DUAL LUMEN MORPHEUS,272,RC,27200994,CDM,,,,,,both,,,890.0000,133.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,287.47,,,,,,,229.7100,890.0000,other,32.3% of $890.00 in Billed Charges for Rev 272 = $287.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC 5F DUAL LUMEN MORPHEUS,272,RC,27200994,CDM,,,,,,both,,,890.0000,133.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,273.23,,,,,,,229.7100,890.0000,other,30.7% of $890.00 in Billed Charges for Rev 272 = $273.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PICC 5F DUAL LUMEN MORPHEUS,272,RC,27200994,CDM,,,,,,both,,,890.0000,133.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,287.47,,,,,,,229.7100,890.0000,percent of total billed charges,32.3% of $890.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PICC 5F DUAL LUMEN MORPHEUS,272,RC,27200994,CDM,,,,,,both,,,890.0000,133.5000,WELLCARE,WELLCARE MEDICAID,890.00,,,,,,,229.7100,890.0000,percent of total billed charges,100% of $890.00 in Billed Charges for Rev 272 = $890.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PILLOW ABDUCTION,270,RC,27000135,CDM,,,,,,both,,,125.0000,18.7500,AETNA,AETNA,53.38,,,,,,,32.2600,125.0000,percent of total billed charges,42.7% of $125.00 in Billed Charges for Rev 270 = $53.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PILLOW ABDUCTION,270,RC,27000135,CDM,,,,,,both,,,125.0000,18.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,87.50,,,,,,,32.2600,125.0000,percent of total billed charges,Rev 270 $125.00 in Billed Charges at 70% = $87.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PILLOW ABDUCTION,270,RC,27000135,CDM,,,,,,both,,,125.0000,18.7500,CIGNA HEALTHCARE,CIGNA HMO,52.13,,,,,,,32.2600,125.0000,percent of total billed charges,41.7% of $125.00 in Billed Charges for Rev 270 = $52.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PILLOW ABDUCTION,270,RC,27000135,CDM,,,,,,both,,,125.0000,18.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,58.00,,,,,,,32.2600,125.0000,percent of total billed charges,46.4% of $125.00 in Billed Charges for Rev 270 = $58.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PILLOW ABDUCTION,270,RC,27000135,CDM,,,,,,both,,,125.0000,18.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,52.13,,,,,,,32.2600,125.0000,percent of total billed charges,41.7% of $125.00 in Billed Charges for Rev 270 = $52.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PILLOW ABDUCTION,270,RC,27000135,CDM,,,,,,both,,,125.0000,18.7500,CIGNA HEALTHCARE,CIGNA PPO,52.13,,,,,,,32.2600,125.0000,percent of total billed charges,41.7% of $125.00 in Billed Charges for Rev 270 = $52.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PILLOW ABDUCTION,270,RC,27000135,CDM,,,,,,both,,,125.0000,18.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,112.50,,,,,,,32.2600,125.0000,percent of total billed charges,90% of $125.00 in Billed Charges for Rev 270 = $112.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PILLOW ABDUCTION,270,RC,27000135,CDM,,,,,,both,,,125.0000,18.7500,MEDCOST,MEDCOST VHN,59.49,,,,,,,32.2600,125.0000,percent of total billed charges,47.59% of $125.00 in Billed Charges for Rev 270 = $59.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PILLOW ABDUCTION,270,RC,27000135,CDM,,,,,,both,,,125.0000,18.7500,SENTARA HEALTH,SENTARA HEALTH,32.26,,,,,,,32.2600,125.0000,percent of total billed charges,25.81% of $125.00 in Billed Charges for Rev 270 = $32.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PILLOW ABDUCTION,270,RC,27000135,CDM,,,,,,both,,,125.0000,18.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",125.00,,,,,,,32.2600,125.0000,percent of total billed charges,100% of $125.00 in Billed Charges for Rev 270 = $125.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PILLOW ABDUCTION,270,RC,27000135,CDM,,,,,,both,,,125.0000,18.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,62.50,,,,,,,32.2600,125.0000,percent of total billed charges,Rev 270 $125.00 in Billed Charges at 50% = $62.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PILLOW ABDUCTION,270,RC,27000135,CDM,,,,,,both,,,125.0000,18.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,40.38,,,,,,,32.2600,125.0000,other,32.3% of $125.00 in Billed Charges for Rev 270 = $40.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PILLOW ABDUCTION,270,RC,27000135,CDM,,,,,,both,,,125.0000,18.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,38.38,,,,,,,32.2600,125.0000,other,30.7% of $125.00 in Billed Charges for Rev 270 = $38.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PILLOW ABDUCTION,270,RC,27000135,CDM,,,,,,both,,,125.0000,18.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,40.38,,,,,,,32.2600,125.0000,percent of total billed charges,32.3% of $125.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PILLOW ABDUCTION,270,RC,27000135,CDM,,,,,,both,,,125.0000,18.7500,WELLCARE,WELLCARE MEDICAID,125.00,,,,,,,32.2600,125.0000,percent of total billed charges,100% of $125.00 in Billed Charges for Rev 270 = $125.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUR EVAC,272,RC,27201000,CDM,,,,,,both,,,575.0000,86.2500,AETNA,AETNA,245.53,,,,,,,148.4100,575.0000,percent of total billed charges,42.7% of $575.00 in Billed Charges for Rev 272 = $245.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUR EVAC,272,RC,27201000,CDM,,,,,,both,,,575.0000,86.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,402.50,,,,,,,148.4100,575.0000,percent of total billed charges,Rev 272 $575.00 in Billed Charges at 70% = $402.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUR EVAC,272,RC,27201000,CDM,,,,,,both,,,575.0000,86.2500,CIGNA HEALTHCARE,CIGNA HMO,239.78,,,,,,,148.4100,575.0000,percent of total billed charges,41.7% of $575.00 in Billed Charges for Rev 272 = $239.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUR EVAC,272,RC,27201000,CDM,,,,,,both,,,575.0000,86.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,266.80,,,,,,,148.4100,575.0000,percent of total billed charges,46.4% of $575.00 in Billed Charges for Rev 272 = $266.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUR EVAC,272,RC,27201000,CDM,,,,,,both,,,575.0000,86.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,239.78,,,,,,,148.4100,575.0000,percent of total billed charges,41.7% of $575.00 in Billed Charges for Rev 272 = $239.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUR EVAC,272,RC,27201000,CDM,,,,,,both,,,575.0000,86.2500,CIGNA HEALTHCARE,CIGNA PPO,239.78,,,,,,,148.4100,575.0000,percent of total billed charges,41.7% of $575.00 in Billed Charges for Rev 272 = $239.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUR EVAC,272,RC,27201000,CDM,,,,,,both,,,575.0000,86.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,517.50,,,,,,,148.4100,575.0000,percent of total billed charges,90% of $575.00 in Billed Charges for Rev 272 = $517.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUR EVAC,272,RC,27201000,CDM,,,,,,both,,,575.0000,86.2500,MEDCOST,MEDCOST VHN,273.64,,,,,,,148.4100,575.0000,percent of total billed charges,47.59% of $575.00 in Billed Charges for Rev 272 = $273.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUR EVAC,272,RC,27201000,CDM,,,,,,both,,,575.0000,86.2500,SENTARA HEALTH,SENTARA HEALTH,148.41,,,,,,,148.4100,575.0000,percent of total billed charges,25.81% of $575.00 in Billed Charges for Rev 272 = $148.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUR EVAC,272,RC,27201000,CDM,,,,,,both,,,575.0000,86.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",575.00,,,,,,,148.4100,575.0000,percent of total billed charges,100% of $575.00 in Billed Charges for Rev 272 = $575.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUR EVAC,272,RC,27201000,CDM,,,,,,both,,,575.0000,86.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,287.50,,,,,,,148.4100,575.0000,percent of total billed charges,Rev 272 $575.00 in Billed Charges at 50% = $287.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUR EVAC,272,RC,27201000,CDM,,,,,,both,,,575.0000,86.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,185.73,,,,,,,148.4100,575.0000,other,32.3% of $575.00 in Billed Charges for Rev 272 = $185.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEUR EVAC,272,RC,27201000,CDM,,,,,,both,,,575.0000,86.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,176.53,,,,,,,148.4100,575.0000,other,30.7% of $575.00 in Billed Charges for Rev 272 = $176.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEUR EVAC,272,RC,27201000,CDM,,,,,,both,,,575.0000,86.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,185.73,,,,,,,148.4100,575.0000,percent of total billed charges,32.3% of $575.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUR EVAC,272,RC,27201000,CDM,,,,,,both,,,575.0000,86.2500,WELLCARE,WELLCARE MEDICAID,575.00,,,,,,,148.4100,575.0000,percent of total billed charges,100% of $575.00 in Billed Charges for Rev 272 = $575.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,AETNA,AETNA,274.56,,,,,,,31.4600,643.0000,percent of total billed charges,42.7% of $643.00 in Billed Charges for Rev 402 Proc 76886 = $274.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,156.09,,,,,,,31.4600,643.0000,fee schedule,APG 00288 Proc 76886 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 104% = $156.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,31.4600,643.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,31.4600,643.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,31.4600,643.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,AMBETTER,AMBETTER,172.12,,,,,,,31.4600,643.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,31.4600,643.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,31.4600,643.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,154.59,,,,,,,31.4600,643.0000,fee schedule,APG 00288 Proc 76886 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 103% = $154.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,31.4600,643.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,31.4600,643.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,31.4600,643.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,80.20,,,,,,,31.4600,643.0000,fee schedule,$80.20 from Fee Schedule BLDTM_23 for Rev 402 Proc 76886 * Qty 1 = $80.20 at 100% = $80.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,BLUE CROSS,BLUE CROSS E NETWORK,221.92,,,,,,,31.4600,643.0000,fee schedule,$69.35 from Fee Schedule BCFSC for Rev 402 Proc 76886 * Qty 1 = $69.35 at 320% = $221.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,31.4600,643.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,BLUE CROSS,BLUE CROSS P NETWORK,226.77,,,,,,,31.4600,643.0000,fee schedule,$69.35 from Fee Schedule BCFSC for Rev 402 Proc 76886 * Qty 1 = $69.35 at 327% = $226.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,BLUE CROSS,BLUE CROSS S NETWORK,226.77,,,,,,,31.4600,643.0000,fee schedule,$69.35 from Fee Schedule BCFSC for Rev 402 Proc 76886 * Qty 1 = $69.35 at 327% = $226.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,BLUE CROSS,TENNCARE BLUE CARE,46.08,,,,,,,31.4600,643.0000,fee schedule,$39.72 from Fee Schedule TC_24 for Rev 402 Proc 76886 * Qty 1 = $39.72 at 116% = $46.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,BLUE CROSS,TENNCARE BLUE SELECT,46.08,,,,,,,31.4600,643.0000,fee schedule,$39.72 from Fee Schedule TC_24 for Rev 402 Proc 76886 * Qty 1 = $39.72 at 116% = $46.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,CIGNA HEALTHCARE,CIGNA HMO,238.14,,,,,,,31.4600,643.0000,fee schedule,$238.14 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76886 * Qty 1 = $238.14 at 100% = $238.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,132.54,,,,,,,31.4600,643.0000,fee schedule,$132.54 from Fee Schedule CGIFP_25LR for Rev 402 Proc 76886 * Qty 1 = $132.54 at 100% = $132.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,31.4600,643.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,238.14,,,,,,,31.4600,643.0000,fee schedule,$238.14 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76886 * Qty 1 = $238.14 at 100% = $238.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,CIGNA HEALTHCARE,CIGNA PPO,238.14,,,,,,,31.4600,643.0000,fee schedule,$238.14 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76886 * Qty 1 = $238.14 at 100% = $238.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,31.4600,643.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,578.70,,,,,,,31.4600,643.0000,percent of total billed charges,90% of $643.00 in Billed Charges for Rev 402 Proc 76886 = $578.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,HUMANA,HUMANA MEDICARE,78.96,,,,,,,31.4600,643.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,31.4600,643.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,MEDCOST,MEDCOST VHN,306.00,,,,,,,31.4600,643.0000,percent of total billed charges,47.59% of $643.00 in Billed Charges for Rev 402 Proc 76886 = $306.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,157.59,,,,,,,31.4600,643.0000,fee schedule,APG 00288 Proc 76886 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 100% = $150.09... $150.09 at 105% = $157.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,31.4600,643.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,31.4600,643.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,31.4600,643.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,154.74,,,,,,,31.4600,643.0000,fee schedule,APG 00288 Proc 76886 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 100% = $150.09... $150.09 at 103.1% = $154.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,SENTARA HEALTH,SENTARA HEALTH,165.96,,,,,,,31.4600,643.0000,percent of total billed charges,25.81% of $643.00 in Billed Charges for Rev 402 Proc 76886 = $165.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,31.4600,643.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",643.00,,,,,,,31.4600,643.0000,percent of total billed charges,100% of $643.00 in Billed Charges for Rev 402 Proc 76886 = $643.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,31.46,,,,,,,31.4600,643.0000,fee schedule,$62.92 from Fee Schedule TCUHC24 for Rev 402 Proc 76886 * Qty 1 = $62.92 at 50% = $31.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,31.4600,643.0000,other,Rev 402 Proc 76886 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,31.4600,643.0000,other,Rev 402 Proc 76886 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,643.00,,,,,,,31.4600,643.0000,other,"Rev 402 Proc 76886 1 Visit at $687.00 per Visit = $687.00 (Service Line reduced to $643.00, claim capped at $643.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,154.59,,,,,,,31.4600,643.0000,fee schedule,APG 00288 Proc 76886 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 103% = $154.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,31.4600,643.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,31.4600,643.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,WELLCARE,WELLCARE MEDICAID,643.00,,,,,,,31.4600,643.0000,percent of total billed charges,100% of $643.00 in Billed Charges for Rev 402 Proc 76886 = $643.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US HIP INFANT WO MANIPULATION,76886,CPT,402,RC,40200049,CDM,,,,both,,,643.0000,96.4500,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,31.4600,643.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,AETNA,AETNA,473.54,,,,,,,53.3300,1109.0000,percent of total billed charges,"42.7% of $1,109.00 in Billed Charges for Rev 402 Proc 76936 = $473.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,292.78,,,,,,,53.3300,1109.0000,fee schedule,APG 00474 Proc 76936 at $836.60 (Base Rate) * 0.3365 (Relative Weight) = $281.52 (Total Line Payment) at 104% = $292.78. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,195.90,,,,,,,53.3300,1109.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,AETNA,AETNA HEALTHCARE MEDICARE,195.90,,,,,,,53.3300,1109.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,195.90,,,,,,,53.3300,1109.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,AMBETTER,AMBETTER,427.07,,,,,,,53.3300,1109.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,203.74,,,,,,,53.3300,1109.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,BLUE CROSS,ANTHEM EXCHANGE,482.33,,,,,,,53.3300,1109.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,289.96,,,,,,,53.3300,1109.0000,fee schedule,APG 00474 Proc 76936 at $836.60 (Base Rate) * 0.3365 (Relative Weight) = $281.52 (Total Line Payment) at 103% = $289.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,BLUE CROSS,ANTHEM HMO,512.44,,,,,,,53.3300,1109.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,201.78,,,,,,,53.3300,1109.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",602.84,,,,,,,53.3300,1109.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,327.88,,,,,,,53.3300,1109.0000,fee schedule,$327.88 from Fee Schedule BLDTM_23 for Rev 402 Proc 76936 * Qty 1 = $327.88 at 100% = $327.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,BLUE CROSS,BLUE CROSS E NETWORK,506.05,,,,,,,53.3300,1109.0000,fee schedule,$158.14 from Fee Schedule BCFSC for Rev 402 Proc 76936 * Qty 1 = $158.14 at 320% = $506.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,BLUE CROSS,BLUE CROSS MEDICARE,203.74,,,,,,,53.3300,1109.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,BLUE CROSS,BLUE CROSS P NETWORK,517.12,,,,,,,53.3300,1109.0000,fee schedule,$158.14 from Fee Schedule BCFSC for Rev 402 Proc 76936 * Qty 1 = $158.14 at 327% = $517.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,BLUE CROSS,BLUE CROSS S NETWORK,517.12,,,,,,,53.3300,1109.0000,fee schedule,$158.14 from Fee Schedule BCFSC for Rev 402 Proc 76936 * Qty 1 = $158.14 at 327% = $517.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,BLUE CROSS,TENNCARE BLUE CARE,203.19,,,,,,,53.3300,1109.0000,fee schedule,$175.16 from Fee Schedule TC_24 for Rev 402 Proc 76936 * Qty 1 = $175.16 at 116% = $203.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,BLUE CROSS,TENNCARE BLUE SELECT,203.19,,,,,,,53.3300,1109.0000,fee schedule,$175.16 from Fee Schedule TC_24 for Rev 402 Proc 76936 * Qty 1 = $175.16 at 116% = $203.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,CIGNA HEALTHCARE,CIGNA HMO,403.68,,,,,,,53.3300,1109.0000,fee schedule,$403.68 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76936 * Qty 1 = $403.68 at 100% = $403.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,315.56,,,,,,,53.3300,1109.0000,fee schedule,$315.56 from Fee Schedule CGIFP_25LR for Rev 402 Proc 76936 * Qty 1 = $315.56 at 100% = $315.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,205.70,,,,,,,53.3300,1109.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,403.68,,,,,,,53.3300,1109.0000,fee schedule,$403.68 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76936 * Qty 1 = $403.68 at 100% = $403.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,CIGNA HEALTHCARE,CIGNA PPO,403.68,,,,,,,53.3300,1109.0000,fee schedule,$403.68 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76936 * Qty 1 = $403.68 at 100% = $403.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,205.70,,,,,,,53.3300,1109.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,998.10,,,,,,,53.3300,1109.0000,percent of total billed charges,"90% of $1,109.00 in Billed Charges for Rev 402 Proc 76936 = $998.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,HUMANA,HUMANA MEDICARE,195.90,,,,,,,53.3300,1109.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,195.90,,,,,,,53.3300,1109.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,MEDCOST,MEDCOST VHN,527.77,,,,,,,53.3300,1109.0000,percent of total billed charges,"47.59% of $1,109.00 in Billed Charges for Rev 402 Proc 76936 = $527.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,295.60,,,,,,,53.3300,1109.0000,fee schedule,APG 00474 Proc 76936 at $836.60 (Base Rate) * 0.3365 (Relative Weight) = $281.52 (Total Line Payment) at 100% = $281.52... $281.52 at 105% = $295.60 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,205.70,,,,,,,53.3300,1109.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,205.70,,,,,,,53.3300,1109.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,NHC ADVANTAGE,NHC ADVANTAGE,205.70,,,,,,,53.3300,1109.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,290.25,,,,,,,53.3300,1109.0000,fee schedule,APG 00474 Proc 76936 at $836.60 (Base Rate) * 0.3365 (Relative Weight) = $281.52 (Total Line Payment) at 100% = $281.52... $281.52 at 103.1% = $290.25 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,SENTARA HEALTH,SENTARA HEALTH,286.23,,,,,,,53.3300,1109.0000,percent of total billed charges,"25.81% of $1,109.00 in Billed Charges for Rev 402 Proc 76936 = $286.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,SENTARA HEALTH,SENTARA MEDICARE,195.90,,,,,,,53.3300,1109.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1109.00,,,,,,,53.3300,1109.0000,percent of total billed charges,"100% of $1,109.00 in Billed Charges for Rev 402 Proc 76936 = $1,109.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,53.33,,,,,,,53.3300,1109.0000,fee schedule,$106.66 from Fee Schedule TCUHC24 for Rev 402 Proc 76936 * Qty 1 = $106.66 at 50% = $53.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,53.3300,1109.0000,other,Rev 402 Proc 76936 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,53.3300,1109.0000,other,Rev 402 Proc 76936 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,687.00,,,,,,,53.3300,1109.0000,other,Rev 402 Proc 76936 1 Visit at $687.00 per Visit = $687.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,289.96,,,,,,,53.3300,1109.0000,fee schedule,APG 00474 Proc 76936 at $836.60 (Base Rate) * 0.3365 (Relative Weight) = $281.52 (Total Line Payment) at 103% = $289.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,195.90,,,,,,,53.3300,1109.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,195.90,,,,,,,53.3300,1109.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,WELLCARE,WELLCARE MEDICAID,1109.00,,,,,,,53.3300,1109.0000,percent of total billed charges,"100% of $1,109.00 in Billed Charges for Rev 402 Proc 76936 = $1,109.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US GUID CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL,76936,CPT,402,RC,40200075,CDM,,,,both,,,1109.0000,166.3500,WELLCARE,WELLCARE MEDICARE,207.66,,,,,,,53.3300,1109.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,AETNA,AETNA,567.06,,,,,,,100.8700,1328.0000,percent of total billed charges,"42.7% of $1,328.00 in Billed Charges for Rev 402 Proc 76978 = $567.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,236.48,,,,,,,100.8700,1328.0000,fee schedule,APG 00289 Proc 76978 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 104% = $236.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,316.52,,,,,,,100.8700,1328.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,AETNA,AETNA HEALTHCARE MEDICARE,316.52,,,,,,,100.8700,1328.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,316.52,,,,,,,100.8700,1328.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,AMBETTER,AMBETTER,690.02,,,,,,,100.8700,1328.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,329.19,,,,,,,100.8700,1328.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,BLUE CROSS,ANTHEM EXCHANGE,779.29,,,,,,,100.8700,1328.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,234.21,,,,,,,100.8700,1328.0000,fee schedule,APG 00289 Proc 76978 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 103% = $234.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,BLUE CROSS,ANTHEM HMO,827.95,,,,,,,100.8700,1328.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,326.02,,,,,,,100.8700,1328.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",974.01,,,,,,,100.8700,1328.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,929.60,,,,,,,100.8700,1328.0000,percent of total billed charges,"Rev 402 Proc 76978 $1,328.00 in Billed Charges at 70% = $929.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,BLUE CROSS,BLUE CROSS E NETWORK,714.46,,,,,,,100.8700,1328.0000,fee schedule,$223.27 from Fee Schedule BCFSC for Rev 402 Proc 76978 * Qty 1 = $223.27 at 320% = $714.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,BLUE CROSS,BLUE CROSS MEDICARE,329.19,,,,,,,100.8700,1328.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,BLUE CROSS,BLUE CROSS P NETWORK,730.09,,,,,,,100.8700,1328.0000,fee schedule,$223.27 from Fee Schedule BCFSC for Rev 402 Proc 76978 * Qty 1 = $223.27 at 327% = $730.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,BLUE CROSS,BLUE CROSS S NETWORK,730.09,,,,,,,100.8700,1328.0000,fee schedule,$223.27 from Fee Schedule BCFSC for Rev 402 Proc 76978 * Qty 1 = $223.27 at 327% = $730.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,BLUE CROSS,TENNCARE BLUE CARE,210.41,,,,,,,100.8700,1328.0000,fee schedule,$181.39 from Fee Schedule TC_24 for Rev 402 Proc 76978 * Qty 1 = $181.39 at 116% = $210.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,BLUE CROSS,TENNCARE BLUE SELECT,210.41,,,,,,,100.8700,1328.0000,fee schedule,$181.39 from Fee Schedule TC_24 for Rev 402 Proc 76978 * Qty 1 = $181.39 at 116% = $210.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,CIGNA HEALTHCARE,CIGNA HMO,553.78,,,,,,,100.8700,1328.0000,percent of total billed charges,"Rev 402 Proc 76978 $1,328.00 in Billed Charges at 41.7% = $553.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,273.22,,,,,,,100.8700,1328.0000,fee schedule,$273.22 from Fee Schedule CGIFP_25LR for Rev 402 Proc 76978 * Qty 1 = $273.22 at 100% = $273.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,332.35,,,,,,,100.8700,1328.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,553.78,,,,,,,100.8700,1328.0000,percent of total billed charges,"Rev 402 Proc 76978 $1,328.00 in Billed Charges at 41.7% = $553.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,CIGNA HEALTHCARE,CIGNA PPO,553.78,,,,,,,100.8700,1328.0000,percent of total billed charges,"Rev 402 Proc 76978 $1,328.00 in Billed Charges at 41.7% = $553.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,332.35,,,,,,,100.8700,1328.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1195.20,,,,,,,100.8700,1328.0000,percent of total billed charges,"90% of $1,328.00 in Billed Charges for Rev 402 Proc 76978 = $1,195.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,HUMANA,HUMANA MEDICARE,316.52,,,,,,,100.8700,1328.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,316.52,,,,,,,100.8700,1328.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,MEDCOST,MEDCOST VHN,632.00,,,,,,,100.8700,1328.0000,percent of total billed charges,"47.59% of $1,328.00 in Billed Charges for Rev 402 Proc 76978 = $632.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,238.76,,,,,,,100.8700,1328.0000,fee schedule,APG 00289 Proc 76978 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 100% = $227.39... $227.39 at 105% = $238.76 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,332.35,,,,,,,100.8700,1328.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,332.35,,,,,,,100.8700,1328.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,NHC ADVANTAGE,NHC ADVANTAGE,332.35,,,,,,,100.8700,1328.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,234.44,,,,,,,100.8700,1328.0000,fee schedule,APG 00289 Proc 76978 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 100% = $227.39... $227.39 at 103.1% = $234.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,SENTARA HEALTH,SENTARA HEALTH,342.76,,,,,,,100.8700,1328.0000,percent of total billed charges,"25.81% of $1,328.00 in Billed Charges for Rev 402 Proc 76978 = $342.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,SENTARA HEALTH,SENTARA MEDICARE,316.52,,,,,,,100.8700,1328.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1328.00,,,,,,,100.8700,1328.0000,percent of total billed charges,"100% of $1,328.00 in Billed Charges for Rev 402 Proc 76978 = $1,328.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,100.87,,,,,,,100.8700,1328.0000,fee schedule,$201.74 from Fee Schedule TCUHC24 for Rev 402 Proc 76978 * Qty 1 = $201.74 at 50% = $100.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,100.8700,1328.0000,other,Rev 402 Proc 76978 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,100.8700,1328.0000,other,Rev 402 Proc 76978 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,687.00,,,,,,,100.8700,1328.0000,other,Rev 402 Proc 76978 1 Visit at $687.00 per Visit = $687.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,234.21,,,,,,,100.8700,1328.0000,fee schedule,APG 00289 Proc 76978 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 103% = $234.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,316.52,,,,,,,100.8700,1328.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,316.52,,,,,,,100.8700,1328.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,WELLCARE,WELLCARE MEDICAID,1328.00,,,,,,,100.8700,1328.0000,percent of total billed charges,"100% of $1,328.00 in Billed Charges for Rev 402 Proc 76978 = $1,328.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US TRGT DYNAMIC MICROBUBBLE 1ST LESION,76978,CPT,402,RC,40200078,CDM,,,,both,,,1328.0000,199.2000,WELLCARE,WELLCARE MEDICARE,335.52,,,,,,,100.8700,1328.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PNEUMOTHORAX CATH CTPT100 SET,272,RC,27201004,CDM,,,,,,both,,,448.0000,67.2000,AETNA,AETNA,191.30,,,,,,,115.6300,448.0000,percent of total billed charges,42.7% of $448.00 in Billed Charges for Rev 272 = $191.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PNEUMOTHORAX CATH CTPT100 SET,272,RC,27201004,CDM,,,,,,both,,,448.0000,67.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,313.60,,,,,,,115.6300,448.0000,percent of total billed charges,Rev 272 $448.00 in Billed Charges at 70% = $313.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PNEUMOTHORAX CATH CTPT100 SET,272,RC,27201004,CDM,,,,,,both,,,448.0000,67.2000,CIGNA HEALTHCARE,CIGNA HMO,186.82,,,,,,,115.6300,448.0000,percent of total billed charges,41.7% of $448.00 in Billed Charges for Rev 272 = $186.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PNEUMOTHORAX CATH CTPT100 SET,272,RC,27201004,CDM,,,,,,both,,,448.0000,67.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,207.87,,,,,,,115.6300,448.0000,percent of total billed charges,46.4% of $448.00 in Billed Charges for Rev 272 = $207.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PNEUMOTHORAX CATH CTPT100 SET,272,RC,27201004,CDM,,,,,,both,,,448.0000,67.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,186.82,,,,,,,115.6300,448.0000,percent of total billed charges,41.7% of $448.00 in Billed Charges for Rev 272 = $186.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PNEUMOTHORAX CATH CTPT100 SET,272,RC,27201004,CDM,,,,,,both,,,448.0000,67.2000,CIGNA HEALTHCARE,CIGNA PPO,186.82,,,,,,,115.6300,448.0000,percent of total billed charges,41.7% of $448.00 in Billed Charges for Rev 272 = $186.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PNEUMOTHORAX CATH CTPT100 SET,272,RC,27201004,CDM,,,,,,both,,,448.0000,67.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,403.20,,,,,,,115.6300,448.0000,percent of total billed charges,90% of $448.00 in Billed Charges for Rev 272 = $403.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PNEUMOTHORAX CATH CTPT100 SET,272,RC,27201004,CDM,,,,,,both,,,448.0000,67.2000,MEDCOST,MEDCOST VHN,213.20,,,,,,,115.6300,448.0000,percent of total billed charges,47.59% of $448.00 in Billed Charges for Rev 272 = $213.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PNEUMOTHORAX CATH CTPT100 SET,272,RC,27201004,CDM,,,,,,both,,,448.0000,67.2000,SENTARA HEALTH,SENTARA HEALTH,115.63,,,,,,,115.6300,448.0000,percent of total billed charges,25.81% of $448.00 in Billed Charges for Rev 272 = $115.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PNEUMOTHORAX CATH CTPT100 SET,272,RC,27201004,CDM,,,,,,both,,,448.0000,67.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",448.00,,,,,,,115.6300,448.0000,percent of total billed charges,100% of $448.00 in Billed Charges for Rev 272 = $448.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PNEUMOTHORAX CATH CTPT100 SET,272,RC,27201004,CDM,,,,,,both,,,448.0000,67.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,224.00,,,,,,,115.6300,448.0000,percent of total billed charges,Rev 272 $448.00 in Billed Charges at 50% = $224.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PNEUMOTHORAX CATH CTPT100 SET,272,RC,27201004,CDM,,,,,,both,,,448.0000,67.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,144.70,,,,,,,115.6300,448.0000,other,32.3% of $448.00 in Billed Charges for Rev 272 = $144.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PNEUMOTHORAX CATH CTPT100 SET,272,RC,27201004,CDM,,,,,,both,,,448.0000,67.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,137.54,,,,,,,115.6300,448.0000,other,30.7% of $448.00 in Billed Charges for Rev 272 = $137.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PNEUMOTHORAX CATH CTPT100 SET,272,RC,27201004,CDM,,,,,,both,,,448.0000,67.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,144.70,,,,,,,115.6300,448.0000,percent of total billed charges,32.3% of $448.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PNEUMOTHORAX CATH CTPT100 SET,272,RC,27201004,CDM,,,,,,both,,,448.0000,67.2000,WELLCARE,WELLCARE MEDICAID,448.00,,,,,,,115.6300,448.0000,percent of total billed charges,100% of $448.00 in Billed Charges for Rev 272 = $448.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POST PUMP TRAINING 1 HR,942,RC,94200011,CDM,,,,,,both,,,181.0000,27.1500,AETNA,AETNA,77.29,,,,,,,46.7200,181.0000,percent of total billed charges,42.7% of $181.00 in Billed Charges for Rev 942 = $77.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POST PUMP TRAINING 1 HR,942,RC,94200011,CDM,,,,,,both,,,181.0000,27.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,126.70,,,,,,,46.7200,181.0000,percent of total billed charges,Rev 942 $181.00 in Billed Charges at 70% = $126.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POST PUMP TRAINING 1 HR,942,RC,94200011,CDM,,,,,,both,,,181.0000,27.1500,CIGNA HEALTHCARE,CIGNA HMO,75.48,,,,,,,46.7200,181.0000,percent of total billed charges,41.7% of $181.00 in Billed Charges for Rev 942 = $75.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POST PUMP TRAINING 1 HR,942,RC,94200011,CDM,,,,,,both,,,181.0000,27.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,83.98,,,,,,,46.7200,181.0000,percent of total billed charges,46.4% of $181.00 in Billed Charges for Rev 942 = $83.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POST PUMP TRAINING 1 HR,942,RC,94200011,CDM,,,,,,both,,,181.0000,27.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,75.48,,,,,,,46.7200,181.0000,percent of total billed charges,41.7% of $181.00 in Billed Charges for Rev 942 = $75.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POST PUMP TRAINING 1 HR,942,RC,94200011,CDM,,,,,,both,,,181.0000,27.1500,CIGNA HEALTHCARE,CIGNA PPO,75.48,,,,,,,46.7200,181.0000,percent of total billed charges,41.7% of $181.00 in Billed Charges for Rev 942 = $75.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POST PUMP TRAINING 1 HR,942,RC,94200011,CDM,,,,,,both,,,181.0000,27.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,162.90,,,,,,,46.7200,181.0000,percent of total billed charges,90% of $181.00 in Billed Charges for Rev 942 = $162.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POST PUMP TRAINING 1 HR,942,RC,94200011,CDM,,,,,,both,,,181.0000,27.1500,MEDCOST,MEDCOST VHN,86.14,,,,,,,46.7200,181.0000,percent of total billed charges,47.59% of $181.00 in Billed Charges for Rev 942 = $86.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POST PUMP TRAINING 1 HR,942,RC,94200011,CDM,,,,,,both,,,181.0000,27.1500,SENTARA HEALTH,SENTARA HEALTH,46.72,,,,,,,46.7200,181.0000,percent of total billed charges,25.81% of $181.00 in Billed Charges for Rev 942 = $46.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POST PUMP TRAINING 1 HR,942,RC,94200011,CDM,,,,,,both,,,181.0000,27.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",181.00,,,,,,,46.7200,181.0000,percent of total billed charges,100% of $181.00 in Billed Charges for Rev 942 = $181.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POST PUMP TRAINING 1 HR,942,RC,94200011,CDM,,,,,,both,,,181.0000,27.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,90.50,,,,,,,46.7200,181.0000,percent of total billed charges,Rev 942 $181.00 in Billed Charges at 50% = $90.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POST PUMP TRAINING 1 HR,942,RC,94200011,CDM,,,,,,both,,,181.0000,27.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,181.00,,,,,,,46.7200,181.0000,other,"Rev 942 1 Visit at $505.00 per Visit = $505.00 (Service Line reduced to $181.00, claim capped at $181.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC POST PUMP TRAINING 1 HR,942,RC,94200011,CDM,,,,,,both,,,181.0000,27.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,181.00,,,,,,,46.7200,181.0000,other,"Rev 942 1 Visit at $484.00 per Visit = $484.00 (Service Line reduced to $181.00, claim capped at $181.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC POST PUMP TRAINING 1 HR,942,RC,94200011,CDM,,,,,,both,,,181.0000,27.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,181.00,,,,,,,46.7200,181.0000,other,"Rev 942 1 Visit at $795.00 per Visit = $795.00 (Service Line reduced to $181.00, claim capped at $181.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC POST PUMP TRAINING 1 HR,942,RC,94200011,CDM,,,,,,both,,,181.0000,27.1500,WELLCARE,WELLCARE MEDICAID,181.00,,,,,,,46.7200,181.0000,percent of total billed charges,100% of $181.00 in Billed Charges for Rev 942 = $181.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH DRAIN 2 3/4"" EA 3804",270,RC,27000144,CDM,,,,,,both,,,12.0000,1.8000,AETNA,AETNA,5.12,,,,,,,3.1000,12.0000,percent of total billed charges,42.7% of $12.00 in Billed Charges for Rev 270 = $5.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH DRAIN 2 3/4"" EA 3804",270,RC,27000144,CDM,,,,,,both,,,12.0000,1.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8.40,,,,,,,3.1000,12.0000,percent of total billed charges,Rev 270 $12.00 in Billed Charges at 70% = $8.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH DRAIN 2 3/4"" EA 3804",270,RC,27000144,CDM,,,,,,both,,,12.0000,1.8000,CIGNA HEALTHCARE,CIGNA HMO,5.00,,,,,,,3.1000,12.0000,percent of total billed charges,41.7% of $12.00 in Billed Charges for Rev 270 = $5.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH DRAIN 2 3/4"" EA 3804",270,RC,27000144,CDM,,,,,,both,,,12.0000,1.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5.57,,,,,,,3.1000,12.0000,percent of total billed charges,46.4% of $12.00 in Billed Charges for Rev 270 = $5.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH DRAIN 2 3/4"" EA 3804",270,RC,27000144,CDM,,,,,,both,,,12.0000,1.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5.00,,,,,,,3.1000,12.0000,percent of total billed charges,41.7% of $12.00 in Billed Charges for Rev 270 = $5.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH DRAIN 2 3/4"" EA 3804",270,RC,27000144,CDM,,,,,,both,,,12.0000,1.8000,CIGNA HEALTHCARE,CIGNA PPO,5.00,,,,,,,3.1000,12.0000,percent of total billed charges,41.7% of $12.00 in Billed Charges for Rev 270 = $5.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH DRAIN 2 3/4"" EA 3804",270,RC,27000144,CDM,,,,,,both,,,12.0000,1.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10.80,,,,,,,3.1000,12.0000,percent of total billed charges,90% of $12.00 in Billed Charges for Rev 270 = $10.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH DRAIN 2 3/4"" EA 3804",270,RC,27000144,CDM,,,,,,both,,,12.0000,1.8000,MEDCOST,MEDCOST VHN,5.71,,,,,,,3.1000,12.0000,percent of total billed charges,47.59% of $12.00 in Billed Charges for Rev 270 = $5.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH DRAIN 2 3/4"" EA 3804",270,RC,27000144,CDM,,,,,,both,,,12.0000,1.8000,SENTARA HEALTH,SENTARA HEALTH,3.10,,,,,,,3.1000,12.0000,percent of total billed charges,25.81% of $12.00 in Billed Charges for Rev 270 = $3.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH DRAIN 2 3/4"" EA 3804",270,RC,27000144,CDM,,,,,,both,,,12.0000,1.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12.00,,,,,,,3.1000,12.0000,percent of total billed charges,100% of $12.00 in Billed Charges for Rev 270 = $12.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH DRAIN 2 3/4"" EA 3804",270,RC,27000144,CDM,,,,,,both,,,12.0000,1.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6.00,,,,,,,3.1000,12.0000,percent of total billed charges,Rev 270 $12.00 in Billed Charges at 50% = $6.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH DRAIN 2 3/4"" EA 3804",270,RC,27000144,CDM,,,,,,both,,,12.0000,1.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3.88,,,,,,,3.1000,12.0000,other,32.3% of $12.00 in Billed Charges for Rev 270 = $3.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
"HC POUCH DRAIN 2 3/4"" EA 3804",270,RC,27000144,CDM,,,,,,both,,,12.0000,1.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3.68,,,,,,,3.1000,12.0000,other,30.7% of $12.00 in Billed Charges for Rev 270 = $3.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
"HC POUCH DRAIN 2 3/4"" EA 3804",270,RC,27000144,CDM,,,,,,both,,,12.0000,1.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,3.88,,,,,,,3.1000,12.0000,percent of total billed charges,32.3% of $12.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH DRAIN 2 3/4"" EA 3804",270,RC,27000144,CDM,,,,,,both,,,12.0000,1.8000,WELLCARE,WELLCARE MEDICAID,12.00,,,,,,,3.1000,12.0000,percent of total billed charges,100% of $12.00 in Billed Charges for Rev 270 = $12.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 1/4"" 401508",270,RC,27000049,CDM,,,,,,both,,,16.0000,2.4000,AETNA,AETNA,6.83,,,,,,,4.1300,16.0000,percent of total billed charges,42.7% of $16.00 in Billed Charges for Rev 270 = $6.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 1/4"" 401508",270,RC,27000049,CDM,,,,,,both,,,16.0000,2.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11.20,,,,,,,4.1300,16.0000,percent of total billed charges,Rev 270 $16.00 in Billed Charges at 70% = $11.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 1/4"" 401508",270,RC,27000049,CDM,,,,,,both,,,16.0000,2.4000,CIGNA HEALTHCARE,CIGNA HMO,6.67,,,,,,,4.1300,16.0000,percent of total billed charges,41.7% of $16.00 in Billed Charges for Rev 270 = $6.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 1/4"" 401508",270,RC,27000049,CDM,,,,,,both,,,16.0000,2.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7.42,,,,,,,4.1300,16.0000,percent of total billed charges,46.4% of $16.00 in Billed Charges for Rev 270 = $7.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 1/4"" 401508",270,RC,27000049,CDM,,,,,,both,,,16.0000,2.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6.67,,,,,,,4.1300,16.0000,percent of total billed charges,41.7% of $16.00 in Billed Charges for Rev 270 = $6.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 1/4"" 401508",270,RC,27000049,CDM,,,,,,both,,,16.0000,2.4000,CIGNA HEALTHCARE,CIGNA PPO,6.67,,,,,,,4.1300,16.0000,percent of total billed charges,41.7% of $16.00 in Billed Charges for Rev 270 = $6.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 1/4"" 401508",270,RC,27000049,CDM,,,,,,both,,,16.0000,2.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,14.40,,,,,,,4.1300,16.0000,percent of total billed charges,90% of $16.00 in Billed Charges for Rev 270 = $14.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 1/4"" 401508",270,RC,27000049,CDM,,,,,,both,,,16.0000,2.4000,MEDCOST,MEDCOST VHN,7.61,,,,,,,4.1300,16.0000,percent of total billed charges,47.59% of $16.00 in Billed Charges for Rev 270 = $7.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 1/4"" 401508",270,RC,27000049,CDM,,,,,,both,,,16.0000,2.4000,SENTARA HEALTH,SENTARA HEALTH,4.13,,,,,,,4.1300,16.0000,percent of total billed charges,25.81% of $16.00 in Billed Charges for Rev 270 = $4.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 1/4"" 401508",270,RC,27000049,CDM,,,,,,both,,,16.0000,2.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",16.00,,,,,,,4.1300,16.0000,percent of total billed charges,100% of $16.00 in Billed Charges for Rev 270 = $16.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 1/4"" 401508",270,RC,27000049,CDM,,,,,,both,,,16.0000,2.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.00,,,,,,,4.1300,16.0000,percent of total billed charges,Rev 270 $16.00 in Billed Charges at 50% = $8.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 1/4"" 401508",270,RC,27000049,CDM,,,,,,both,,,16.0000,2.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5.17,,,,,,,4.1300,16.0000,other,32.3% of $16.00 in Billed Charges for Rev 270 = $5.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
"HC POUCH STOMACH 2 1/4"" 401508",270,RC,27000049,CDM,,,,,,both,,,16.0000,2.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,4.91,,,,,,,4.1300,16.0000,other,30.7% of $16.00 in Billed Charges for Rev 270 = $4.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
"HC POUCH STOMACH 2 1/4"" 401508",270,RC,27000049,CDM,,,,,,both,,,16.0000,2.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,5.17,,,,,,,4.1300,16.0000,percent of total billed charges,32.3% of $16.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 1/4"" 401508",270,RC,27000049,CDM,,,,,,both,,,16.0000,2.4000,WELLCARE,WELLCARE MEDICAID,16.00,,,,,,,4.1300,16.0000,percent of total billed charges,100% of $16.00 in Billed Charges for Rev 270 = $16.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PRISMA PRE DILUTION SET,272,RC,27201009,CDM,,,,,,both,,,799.0000,119.8500,AETNA,AETNA,341.17,,,,,,,206.2200,799.0000,percent of total billed charges,42.7% of $799.00 in Billed Charges for Rev 272 = $341.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PRISMA PRE DILUTION SET,272,RC,27201009,CDM,,,,,,both,,,799.0000,119.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,559.30,,,,,,,206.2200,799.0000,percent of total billed charges,Rev 272 $799.00 in Billed Charges at 70% = $559.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PRISMA PRE DILUTION SET,272,RC,27201009,CDM,,,,,,both,,,799.0000,119.8500,CIGNA HEALTHCARE,CIGNA HMO,333.18,,,,,,,206.2200,799.0000,percent of total billed charges,41.7% of $799.00 in Billed Charges for Rev 272 = $333.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PRISMA PRE DILUTION SET,272,RC,27201009,CDM,,,,,,both,,,799.0000,119.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,370.74,,,,,,,206.2200,799.0000,percent of total billed charges,46.4% of $799.00 in Billed Charges for Rev 272 = $370.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PRISMA PRE DILUTION SET,272,RC,27201009,CDM,,,,,,both,,,799.0000,119.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,333.18,,,,,,,206.2200,799.0000,percent of total billed charges,41.7% of $799.00 in Billed Charges for Rev 272 = $333.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PRISMA PRE DILUTION SET,272,RC,27201009,CDM,,,,,,both,,,799.0000,119.8500,CIGNA HEALTHCARE,CIGNA PPO,333.18,,,,,,,206.2200,799.0000,percent of total billed charges,41.7% of $799.00 in Billed Charges for Rev 272 = $333.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PRISMA PRE DILUTION SET,272,RC,27201009,CDM,,,,,,both,,,799.0000,119.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,719.10,,,,,,,206.2200,799.0000,percent of total billed charges,90% of $799.00 in Billed Charges for Rev 272 = $719.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PRISMA PRE DILUTION SET,272,RC,27201009,CDM,,,,,,both,,,799.0000,119.8500,MEDCOST,MEDCOST VHN,380.24,,,,,,,206.2200,799.0000,percent of total billed charges,47.59% of $799.00 in Billed Charges for Rev 272 = $380.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PRISMA PRE DILUTION SET,272,RC,27201009,CDM,,,,,,both,,,799.0000,119.8500,SENTARA HEALTH,SENTARA HEALTH,206.22,,,,,,,206.2200,799.0000,percent of total billed charges,25.81% of $799.00 in Billed Charges for Rev 272 = $206.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PRISMA PRE DILUTION SET,272,RC,27201009,CDM,,,,,,both,,,799.0000,119.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",799.00,,,,,,,206.2200,799.0000,percent of total billed charges,100% of $799.00 in Billed Charges for Rev 272 = $799.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PRISMA PRE DILUTION SET,272,RC,27201009,CDM,,,,,,both,,,799.0000,119.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,399.50,,,,,,,206.2200,799.0000,percent of total billed charges,Rev 272 $799.00 in Billed Charges at 50% = $399.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PRISMA PRE DILUTION SET,272,RC,27201009,CDM,,,,,,both,,,799.0000,119.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,258.08,,,,,,,206.2200,799.0000,other,32.3% of $799.00 in Billed Charges for Rev 272 = $258.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRISMA PRE DILUTION SET,272,RC,27201009,CDM,,,,,,both,,,799.0000,119.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,245.29,,,,,,,206.2200,799.0000,other,30.7% of $799.00 in Billed Charges for Rev 272 = $245.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PRISMA PRE DILUTION SET,272,RC,27201009,CDM,,,,,,both,,,799.0000,119.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,258.08,,,,,,,206.2200,799.0000,percent of total billed charges,32.3% of $799.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PRISMA PRE DILUTION SET,272,RC,27201009,CDM,,,,,,both,,,799.0000,119.8500,WELLCARE,WELLCARE MEDICAID,799.00,,,,,,,206.2200,799.0000,percent of total billed charges,100% of $799.00 in Billed Charges for Rev 272 = $799.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROBE 13GA MAMMOTOME ELITE,272,RC,27201011,CDM,,,,,,both,,,925.0000,138.7500,AETNA,AETNA,394.98,,,,,,,238.7400,925.0000,percent of total billed charges,42.7% of $925.00 in Billed Charges for Rev 272 = $394.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROBE 13GA MAMMOTOME ELITE,272,RC,27201011,CDM,,,,,,both,,,925.0000,138.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,647.50,,,,,,,238.7400,925.0000,percent of total billed charges,Rev 272 $925.00 in Billed Charges at 70% = $647.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROBE 13GA MAMMOTOME ELITE,272,RC,27201011,CDM,,,,,,both,,,925.0000,138.7500,CIGNA HEALTHCARE,CIGNA HMO,385.73,,,,,,,238.7400,925.0000,percent of total billed charges,41.7% of $925.00 in Billed Charges for Rev 272 = $385.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROBE 13GA MAMMOTOME ELITE,272,RC,27201011,CDM,,,,,,both,,,925.0000,138.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,429.20,,,,,,,238.7400,925.0000,percent of total billed charges,46.4% of $925.00 in Billed Charges for Rev 272 = $429.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROBE 13GA MAMMOTOME ELITE,272,RC,27201011,CDM,,,,,,both,,,925.0000,138.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,385.73,,,,,,,238.7400,925.0000,percent of total billed charges,41.7% of $925.00 in Billed Charges for Rev 272 = $385.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROBE 13GA MAMMOTOME ELITE,272,RC,27201011,CDM,,,,,,both,,,925.0000,138.7500,CIGNA HEALTHCARE,CIGNA PPO,385.73,,,,,,,238.7400,925.0000,percent of total billed charges,41.7% of $925.00 in Billed Charges for Rev 272 = $385.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROBE 13GA MAMMOTOME ELITE,272,RC,27201011,CDM,,,,,,both,,,925.0000,138.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,832.50,,,,,,,238.7400,925.0000,percent of total billed charges,90% of $925.00 in Billed Charges for Rev 272 = $832.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROBE 13GA MAMMOTOME ELITE,272,RC,27201011,CDM,,,,,,both,,,925.0000,138.7500,MEDCOST,MEDCOST VHN,440.21,,,,,,,238.7400,925.0000,percent of total billed charges,47.59% of $925.00 in Billed Charges for Rev 272 = $440.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROBE 13GA MAMMOTOME ELITE,272,RC,27201011,CDM,,,,,,both,,,925.0000,138.7500,SENTARA HEALTH,SENTARA HEALTH,238.74,,,,,,,238.7400,925.0000,percent of total billed charges,25.81% of $925.00 in Billed Charges for Rev 272 = $238.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROBE 13GA MAMMOTOME ELITE,272,RC,27201011,CDM,,,,,,both,,,925.0000,138.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",925.00,,,,,,,238.7400,925.0000,percent of total billed charges,100% of $925.00 in Billed Charges for Rev 272 = $925.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROBE 13GA MAMMOTOME ELITE,272,RC,27201011,CDM,,,,,,both,,,925.0000,138.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,462.50,,,,,,,238.7400,925.0000,percent of total billed charges,Rev 272 $925.00 in Billed Charges at 50% = $462.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROBE 13GA MAMMOTOME ELITE,272,RC,27201011,CDM,,,,,,both,,,925.0000,138.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,298.78,,,,,,,238.7400,925.0000,other,32.3% of $925.00 in Billed Charges for Rev 272 = $298.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROBE 13GA MAMMOTOME ELITE,272,RC,27201011,CDM,,,,,,both,,,925.0000,138.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,283.98,,,,,,,238.7400,925.0000,other,30.7% of $925.00 in Billed Charges for Rev 272 = $283.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROBE 13GA MAMMOTOME ELITE,272,RC,27201011,CDM,,,,,,both,,,925.0000,138.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,298.78,,,,,,,238.7400,925.0000,percent of total billed charges,32.3% of $925.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROBE 13GA MAMMOTOME ELITE,272,RC,27201011,CDM,,,,,,both,,,925.0000,138.7500,WELLCARE,WELLCARE MEDICAID,925.00,,,,,,,238.7400,925.0000,percent of total billed charges,100% of $925.00 in Billed Charges for Rev 272 = $925.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROXIMATE SET FOR PROLAPS PPH03,272,RC,27201015,CDM,,,,,,both,,,1445.0000,216.7500,AETNA,AETNA,617.02,,,,,,,372.9500,1445.0000,percent of total billed charges,"42.7% of $1,445.00 in Billed Charges for Rev 272 = $617.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROXIMATE SET FOR PROLAPS PPH03,272,RC,27201015,CDM,,,,,,both,,,1445.0000,216.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1011.50,,,,,,,372.9500,1445.0000,percent of total billed charges,"Rev 272 $1,445.00 in Billed Charges at 70% = $1,011.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROXIMATE SET FOR PROLAPS PPH03,272,RC,27201015,CDM,,,,,,both,,,1445.0000,216.7500,CIGNA HEALTHCARE,CIGNA HMO,602.57,,,,,,,372.9500,1445.0000,percent of total billed charges,"41.7% of $1,445.00 in Billed Charges for Rev 272 = $602.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROXIMATE SET FOR PROLAPS PPH03,272,RC,27201015,CDM,,,,,,both,,,1445.0000,216.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,670.48,,,,,,,372.9500,1445.0000,percent of total billed charges,"46.4% of $1,445.00 in Billed Charges for Rev 272 = $670.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROXIMATE SET FOR PROLAPS PPH03,272,RC,27201015,CDM,,,,,,both,,,1445.0000,216.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,602.57,,,,,,,372.9500,1445.0000,percent of total billed charges,"41.7% of $1,445.00 in Billed Charges for Rev 272 = $602.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROXIMATE SET FOR PROLAPS PPH03,272,RC,27201015,CDM,,,,,,both,,,1445.0000,216.7500,CIGNA HEALTHCARE,CIGNA PPO,602.57,,,,,,,372.9500,1445.0000,percent of total billed charges,"41.7% of $1,445.00 in Billed Charges for Rev 272 = $602.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROXIMATE SET FOR PROLAPS PPH03,272,RC,27201015,CDM,,,,,,both,,,1445.0000,216.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1300.50,,,,,,,372.9500,1445.0000,percent of total billed charges,"90% of $1,445.00 in Billed Charges for Rev 272 = $1,300.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROXIMATE SET FOR PROLAPS PPH03,272,RC,27201015,CDM,,,,,,both,,,1445.0000,216.7500,MEDCOST,MEDCOST VHN,687.68,,,,,,,372.9500,1445.0000,percent of total billed charges,"47.59% of $1,445.00 in Billed Charges for Rev 272 = $687.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROXIMATE SET FOR PROLAPS PPH03,272,RC,27201015,CDM,,,,,,both,,,1445.0000,216.7500,SENTARA HEALTH,SENTARA HEALTH,372.95,,,,,,,372.9500,1445.0000,percent of total billed charges,"25.81% of $1,445.00 in Billed Charges for Rev 272 = $372.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROXIMATE SET FOR PROLAPS PPH03,272,RC,27201015,CDM,,,,,,both,,,1445.0000,216.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1445.00,,,,,,,372.9500,1445.0000,percent of total billed charges,"100% of $1,445.00 in Billed Charges for Rev 272 = $1,445.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROXIMATE SET FOR PROLAPS PPH03,272,RC,27201015,CDM,,,,,,both,,,1445.0000,216.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,722.50,,,,,,,372.9500,1445.0000,percent of total billed charges,"Rev 272 $1,445.00 in Billed Charges at 50% = $722.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROXIMATE SET FOR PROLAPS PPH03,272,RC,27201015,CDM,,,,,,both,,,1445.0000,216.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,466.74,,,,,,,372.9500,1445.0000,other,"32.3% of $1,445.00 in Billed Charges for Rev 272 = $466.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PROXIMATE SET FOR PROLAPS PPH03,272,RC,27201015,CDM,,,,,,both,,,1445.0000,216.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,443.62,,,,,,,372.9500,1445.0000,other,"30.7% of $1,445.00 in Billed Charges for Rev 272 = $443.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PROXIMATE SET FOR PROLAPS PPH03,272,RC,27201015,CDM,,,,,,both,,,1445.0000,216.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,466.74,,,,,,,372.9500,1445.0000,percent of total billed charges,"32.3% of $1,445.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROXIMATE SET FOR PROLAPS PPH03,272,RC,27201015,CDM,,,,,,both,,,1445.0000,216.7500,WELLCARE,WELLCARE MEDICAID,1445.00,,,,,,,372.9500,1445.0000,percent of total billed charges,"100% of $1,445.00 in Billed Charges for Rev 272 = $1,445.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LESION,76979,CPT,402,RC,40200079,CDM,,,,both,,,970.0000,145.5000,AETNA,AETNA,414.19,,,,,,,153.6200,970.0000,percent of total billed charges,42.7% of $970.00 in Billed Charges for Rev 402 Proc 76979 = $414.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LESION,76979,CPT,402,RC,40200079,CDM,,,,both,,,970.0000,145.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,236.48,,,,,,,153.6200,970.0000,fee schedule,APG 00289 Proc 76979 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 104% = $236.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LESION,76979,CPT,402,RC,40200079,CDM,,,,both,,,970.0000,145.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,234.21,,,,,,,153.6200,970.0000,fee schedule,APG 00289 Proc 76979 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 103% = $234.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LESION,76979,CPT,402,RC,40200079,CDM,,,,both,,,970.0000,145.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,679.00,,,,,,,153.6200,970.0000,percent of total billed charges,Rev 402 Proc 76979 $970.00 in Billed Charges at 70% = $679.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LESION,76979,CPT,402,RC,40200079,CDM,,,,both,,,970.0000,145.5000,BLUE CROSS,BLUE CROSS E NETWORK,521.63,,,,,,,153.6200,970.0000,fee schedule,$163.01 from Fee Schedule BCFSC for Rev 402 Proc 76979 * Qty 1 = $163.01 at 320% = $521.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LESION,76979,CPT,402,RC,40200079,CDM,,,,both,,,970.0000,145.5000,BLUE CROSS,BLUE CROSS P NETWORK,533.04,,,,,,,153.6200,970.0000,fee schedule,$163.01 from Fee Schedule BCFSC for Rev 402 Proc 76979 * Qty 1 = $163.01 at 327% = $533.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LESION,76979,CPT,402,RC,40200079,CDM,,,,both,,,970.0000,145.5000,BLUE CROSS,BLUE CROSS S NETWORK,533.04,,,,,,,153.6200,970.0000,fee schedule,$163.01 from Fee Schedule BCFSC for Rev 402 Proc 76979 * Qty 1 = $163.01 at 327% = $533.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LESION,76979,CPT,402,RC,40200079,CDM,,,,both,,,970.0000,145.5000,BLUE CROSS,TENNCARE BLUE CARE,153.62,,,,,,,153.6200,970.0000,fee schedule,$132.43 from Fee Schedule TC_24 for Rev 402 Proc 76979 * Qty 1 = $132.43 at 116% = $153.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LESION,76979,CPT,402,RC,40200079,CDM,,,,both,,,970.0000,145.5000,BLUE CROSS,TENNCARE BLUE SELECT,153.62,,,,,,,153.6200,970.0000,fee schedule,$132.43 from Fee Schedule TC_24 for Rev 402 Proc 76979 * Qty 1 = $132.43 at 116% = $153.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LESION,76979,CPT,402,RC,40200079,CDM,,,,both,,,970.0000,145.5000,CIGNA HEALTHCARE,CIGNA HMO,404.49,,,,,,,153.6200,970.0000,percent of total billed charges,Rev 402 Proc 76979 $970.00 in Billed Charges at 41.7% = $404.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LESION,76979,CPT,402,RC,40200079,CDM,,,,both,,,970.0000,145.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,404.49,,,,,,,153.6200,970.0000,percent of total billed charges,Rev 402 Proc 76979 $970.00 in Billed Charges at 41.7% = $404.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LESION,76979,CPT,402,RC,40200079,CDM,,,,both,,,970.0000,145.5000,CIGNA HEALTHCARE,CIGNA PPO,404.49,,,,,,,153.6200,970.0000,percent of total billed charges,Rev 402 Proc 76979 $970.00 in Billed Charges at 41.7% = $404.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LESION,76979,CPT,402,RC,40200079,CDM,,,,both,,,970.0000,145.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,873.00,,,,,,,153.6200,970.0000,percent of total billed charges,90% of $970.00 in Billed Charges for Rev 402 Proc 76979 = $873.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LESION,76979,CPT,402,RC,40200079,CDM,,,,both,,,970.0000,145.5000,MEDCOST,MEDCOST VHN,461.62,,,,,,,153.6200,970.0000,percent of total billed charges,47.59% of $970.00 in Billed Charges for Rev 402 Proc 76979 = $461.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LESION,76979,CPT,402,RC,40200079,CDM,,,,both,,,970.0000,145.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,238.76,,,,,,,153.6200,970.0000,fee schedule,APG 00289 Proc 76979 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 100% = $227.39... $227.39 at 105% = $238.76 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LESION,76979,CPT,402,RC,40200079,CDM,,,,both,,,970.0000,145.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,234.44,,,,,,,153.6200,970.0000,fee schedule,APG 00289 Proc 76979 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 100% = $227.39... $227.39 at 103.1% = $234.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LESION,76979,CPT,402,RC,40200079,CDM,,,,both,,,970.0000,145.5000,SENTARA HEALTH,SENTARA HEALTH,250.36,,,,,,,153.6200,970.0000,percent of total billed charges,25.81% of $970.00 in Billed Charges for Rev 402 Proc 76979 = $250.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LESION,76979,CPT,402,RC,40200079,CDM,,,,both,,,970.0000,145.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",970.00,,,,,,,153.6200,970.0000,percent of total billed charges,100% of $970.00 in Billed Charges for Rev 402 Proc 76979 = $970.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LESION,76979,CPT,402,RC,40200079,CDM,,,,both,,,970.0000,145.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,153.6200,970.0000,other,Rev 402 Proc 76979 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LESION,76979,CPT,402,RC,40200079,CDM,,,,both,,,970.0000,145.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,153.6200,970.0000,other,Rev 402 Proc 76979 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LESION,76979,CPT,402,RC,40200079,CDM,,,,both,,,970.0000,145.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,687.00,,,,,,,153.6200,970.0000,other,Rev 402 Proc 76979 1 Visit at $687.00 per Visit = $687.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LESION,76979,CPT,402,RC,40200079,CDM,,,,both,,,970.0000,145.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,234.21,,,,,,,153.6200,970.0000,fee schedule,APG 00289 Proc 76979 at $836.60 (Base Rate) * 0.2718 (Relative Weight) = $227.39 (Total Line Payment) at 103% = $234.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US TRGT DYNAMIC MICROBUBBLE EA ADDL LESION,76979,CPT,402,RC,40200079,CDM,,,,both,,,970.0000,145.5000,WELLCARE,WELLCARE MEDICAID,970.00,,,,,,,153.6200,970.0000,percent of total billed charges,100% of $970.00 in Billed Charges for Rev 402 Proc 76979 = $970.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,AETNA,AETNA,267.30,,,,,,,31.4600,626.0000,percent of total billed charges,42.7% of $626.00 in Billed Charges for Rev 402 Proc 76999 = $267.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,156.09,,,,,,,31.4600,626.0000,fee schedule,APG 00288 Proc 76999 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 104% = $156.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,31.4600,626.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,31.4600,626.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,31.4600,626.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,AMBETTER,AMBETTER,172.12,,,,,,,31.4600,626.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,31.4600,626.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,31.4600,626.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,154.59,,,,,,,31.4600,626.0000,fee schedule,APG 00288 Proc 76999 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 103% = $154.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,31.4600,626.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,31.4600,626.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,31.4600,626.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,31.4600,626.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,CIGNA HEALTHCARE,CIGNA HMO,238.14,,,,,,,31.4600,626.0000,fee schedule,$238.14 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76999 * Qty 1 = $238.14 at 100% = $238.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,153.62,,,,,,,31.4600,626.0000,fee schedule,$153.62 from Fee Schedule CGIFP_25LR for Rev 402 Proc 76999 * Qty 1 = $153.62 at 100% = $153.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,31.4600,626.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,238.14,,,,,,,31.4600,626.0000,fee schedule,$238.14 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76999 * Qty 1 = $238.14 at 100% = $238.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,CIGNA HEALTHCARE,CIGNA PPO,238.14,,,,,,,31.4600,626.0000,fee schedule,$238.14 from Fee Schedule CIGWHS_23 for Rev 402 Proc 76999 * Qty 1 = $238.14 at 100% = $238.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,31.4600,626.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,563.40,,,,,,,31.4600,626.0000,percent of total billed charges,90% of $626.00 in Billed Charges for Rev 402 Proc 76999 = $563.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,HUMANA,HUMANA MEDICARE,78.96,,,,,,,31.4600,626.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,31.4600,626.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,MEDCOST,MEDCOST VHN,297.91,,,,,,,31.4600,626.0000,percent of total billed charges,47.59% of $626.00 in Billed Charges for Rev 402 Proc 76999 = $297.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,157.59,,,,,,,31.4600,626.0000,fee schedule,APG 00288 Proc 76999 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 100% = $150.09... $150.09 at 105% = $157.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,31.4600,626.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,31.4600,626.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,31.4600,626.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,154.74,,,,,,,31.4600,626.0000,fee schedule,APG 00288 Proc 76999 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 100% = $150.09... $150.09 at 103.1% = $154.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,SENTARA HEALTH,SENTARA HEALTH,161.57,,,,,,,31.4600,626.0000,percent of total billed charges,25.81% of $626.00 in Billed Charges for Rev 402 Proc 76999 = $161.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,31.4600,626.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",626.00,,,,,,,31.4600,626.0000,percent of total billed charges,100% of $626.00 in Billed Charges for Rev 402 Proc 76999 = $626.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,31.46,,,,,,,31.4600,626.0000,fee schedule,$62.92 from Fee Schedule TCUHC24 for Rev 402 Proc 76999 * Qty 1 = $62.92 at 50% = $31.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,31.4600,626.0000,other,Rev 402 Proc 76999 1 Visit at $435.00 per Visit = $435.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.00,,,,,,,31.4600,626.0000,other,Rev 402 Proc 76999 1 Visit at $417.00 per Visit = $417.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,626.00,,,,,,,31.4600,626.0000,other,"Rev 402 Proc 76999 1 Visit at $687.00 per Visit = $687.00 (Service Line reduced to $626.00, claim capped at $626.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,154.59,,,,,,,31.4600,626.0000,fee schedule,APG 00288 Proc 76999 at $836.60 (Base Rate) * 0.1794 (Relative Weight) = $150.09 (Total Line Payment) at 103% = $154.59. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,31.4600,626.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,31.4600,626.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,WELLCARE,WELLCARE MEDICAID,626.00,,,,,,,31.4600,626.0000,percent of total billed charges,100% of $626.00 in Billed Charges for Rev 402 Proc 76999 = $626.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US UNLISTED SURGICAL SPECIMEN PX,76999,CPT,402,RC,40200062,CDM,,,,both,,,626.0000,93.9000,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,31.4600,626.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDE NEEDLE PLCMT,77002,CPT,320,RC,32000245,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,40.5800,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 77002 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLUORO GUIDE NEEDLE PLCMT,77002,CPT,320,RC,32000245,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,292.78,,,,,,,40.5800,462.0000,fee schedule,APG 00474 Proc 77002 at $836.60 (Base Rate) * 0.3365 (Relative Weight) = $281.52 (Total Line Payment) at 104% = $292.78. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDE NEEDLE PLCMT,77002,CPT,320,RC,32000245,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,289.96,,,,,,,40.5800,462.0000,fee schedule,APG 00474 Proc 77002 at $836.60 (Base Rate) * 0.3365 (Relative Weight) = $281.52 (Total Line Payment) at 103% = $289.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDE NEEDLE PLCMT,77002,CPT,320,RC,32000245,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,43.05,,,,,,,40.5800,462.0000,fee schedule,$43.05 from Fee Schedule BLDTM_23 for Rev 320 Proc 77002 * Qty 1 = $43.05 at 100% = $43.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDE NEEDLE PLCMT,77002,CPT,320,RC,32000245,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,214.72,,,,,,,40.5800,462.0000,fee schedule,$67.10 from Fee Schedule BCFSC for Rev 320 Proc 77002 * Qty 1 = $67.10 at 320% = $214.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDE NEEDLE PLCMT,77002,CPT,320,RC,32000245,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,219.42,,,,,,,40.5800,462.0000,fee schedule,$67.10 from Fee Schedule BCFSC for Rev 320 Proc 77002 * Qty 1 = $67.10 at 327% = $219.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDE NEEDLE PLCMT,77002,CPT,320,RC,32000245,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,219.42,,,,,,,40.5800,462.0000,fee schedule,$67.10 from Fee Schedule BCFSC for Rev 320 Proc 77002 * Qty 1 = $67.10 at 327% = $219.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDE NEEDLE PLCMT,77002,CPT,320,RC,32000245,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,40.58,,,,,,,40.5800,462.0000,fee schedule,$34.98 from Fee Schedule TC_24 for Rev 320 Proc 77002 * Qty 1 = $34.98 at 116% = $40.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDE NEEDLE PLCMT,77002,CPT,320,RC,32000245,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,40.58,,,,,,,40.5800,462.0000,fee schedule,$34.98 from Fee Schedule TC_24 for Rev 320 Proc 77002 * Qty 1 = $34.98 at 116% = $40.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDE NEEDLE PLCMT,77002,CPT,320,RC,32000245,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,192.65,,,,,,,40.5800,462.0000,percent of total billed charges,Rev 320 Proc 77002 $462.00 in Billed Charges at 41.7% = $192.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLUORO GUIDE NEEDLE PLCMT,77002,CPT,320,RC,32000245,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,192.65,,,,,,,40.5800,462.0000,percent of total billed charges,Rev 320 Proc 77002 $462.00 in Billed Charges at 41.7% = $192.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLUORO GUIDE NEEDLE PLCMT,77002,CPT,320,RC,32000245,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,192.65,,,,,,,40.5800,462.0000,percent of total billed charges,Rev 320 Proc 77002 $462.00 in Billed Charges at 41.7% = $192.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLUORO GUIDE NEEDLE PLCMT,77002,CPT,320,RC,32000245,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,40.5800,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 77002 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLUORO GUIDE NEEDLE PLCMT,77002,CPT,320,RC,32000245,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,40.5800,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 77002 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLUORO GUIDE NEEDLE PLCMT,77002,CPT,320,RC,32000245,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,295.60,,,,,,,40.5800,462.0000,fee schedule,APG 00474 Proc 77002 at $836.60 (Base Rate) * 0.3365 (Relative Weight) = $281.52 (Total Line Payment) at 100% = $281.52... $281.52 at 105% = $295.60 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDE NEEDLE PLCMT,77002,CPT,320,RC,32000245,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,290.25,,,,,,,40.5800,462.0000,fee schedule,APG 00474 Proc 77002 at $836.60 (Base Rate) * 0.3365 (Relative Weight) = $281.52 (Total Line Payment) at 100% = $281.52... $281.52 at 103.1% = $290.25 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDE NEEDLE PLCMT,77002,CPT,320,RC,32000245,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,40.5800,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 77002 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLUORO GUIDE NEEDLE PLCMT,77002,CPT,320,RC,32000245,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,40.5800,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 77002 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLUORO GUIDE NEEDLE PLCMT,77002,CPT,320,RC,32000245,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,40.5800,462.0000,other,Rev 320 Proc 77002 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDE NEEDLE PLCMT,77002,CPT,320,RC,32000245,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,40.5800,462.0000,other,Rev 320 Proc 77002 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDE NEEDLE PLCMT,77002,CPT,320,RC,32000245,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,40.5800,462.0000,other,Rev 320 Proc 77002 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDE NEEDLE PLCMT,77002,CPT,320,RC,32000245,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,289.96,,,,,,,40.5800,462.0000,fee schedule,APG 00474 Proc 77002 at $836.60 (Base Rate) * 0.3365 (Relative Weight) = $281.52 (Total Line Payment) at 103% = $289.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLUORO GUIDE NEEDLE PLCMT,77002,CPT,320,RC,32000245,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,40.5800,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 77002 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NM PET BRAIN IMAGE PERFUSION,78609,CPT,404,RC,40400004,CDM,,,,both,,,11618.0000,1742.7000,AETNA,AETNA,4960.89,,,,,,,37.6100,11618.0000,percent of total billed charges,"42.7% of $11,618.00 in Billed Charges for Rev 404 Proc 78609 = $4,960.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET BRAIN IMAGE PERFUSION,78609,CPT,404,RC,40400004,CDM,,,,both,,,11618.0000,1742.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1998.10,,,,,,,37.6100,11618.0000,fee schedule,"APG 00290 Proc 78609 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 104% = $1,998.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAGE PERFUSION,78609,CPT,404,RC,40400004,CDM,,,,both,,,11618.0000,1742.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1978.89,,,,,,,37.6100,11618.0000,fee schedule,"APG 00290 Proc 78609 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 103% = $1,978.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAGE PERFUSION,78609,CPT,404,RC,40400004,CDM,,,,both,,,11618.0000,1742.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,367.92,,,,,,,37.6100,11618.0000,fee schedule,$367.92 from Fee Schedule BLDTM_23 for Rev 404 Proc 78609 * Qty 1 = $367.92 at 100% = $367.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAGE PERFUSION,78609,CPT,404,RC,40400004,CDM,,,,both,,,11618.0000,1742.7000,BLUE CROSS,BLUE CROSS E NETWORK,237.66,,,,,,,37.6100,11618.0000,fee schedule,$74.27 from Fee Schedule BCFSC for Rev 404 Proc 78609 * Qty 1 = $74.27 at 320% = $237.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAGE PERFUSION,78609,CPT,404,RC,40400004,CDM,,,,both,,,11618.0000,1742.7000,BLUE CROSS,BLUE CROSS P NETWORK,242.86,,,,,,,37.6100,11618.0000,fee schedule,$74.27 from Fee Schedule BCFSC for Rev 404 Proc 78609 * Qty 1 = $74.27 at 327% = $242.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAGE PERFUSION,78609,CPT,404,RC,40400004,CDM,,,,both,,,11618.0000,1742.7000,BLUE CROSS,BLUE CROSS S NETWORK,242.86,,,,,,,37.6100,11618.0000,fee schedule,$74.27 from Fee Schedule BCFSC for Rev 404 Proc 78609 * Qty 1 = $74.27 at 327% = $242.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAGE PERFUSION,78609,CPT,404,RC,40400004,CDM,,,,both,,,11618.0000,1742.7000,BLUE CROSS,TENNCARE BLUE CARE,69.41,,,,,,,37.6100,11618.0000,fee schedule,$59.84 from Fee Schedule TC_24 for Rev 404 Proc 78609 * Qty 1 = $59.84 at 116% = $69.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAGE PERFUSION,78609,CPT,404,RC,40400004,CDM,,,,both,,,11618.0000,1742.7000,BLUE CROSS,TENNCARE BLUE SELECT,69.41,,,,,,,37.6100,11618.0000,fee schedule,$59.84 from Fee Schedule TC_24 for Rev 404 Proc 78609 * Qty 1 = $59.84 at 116% = $69.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAGE PERFUSION,78609,CPT,404,RC,40400004,CDM,,,,both,,,11618.0000,1742.7000,CIGNA HEALTHCARE,CIGNA HMO,312.37,,,,,,,37.6100,11618.0000,fee schedule,$312.37 from Fee Schedule CIGWHS_23 for Rev 404 Proc 78609 * Qty 1 = $312.37 at 100% = $312.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAGE PERFUSION,78609,CPT,404,RC,40400004,CDM,,,,both,,,11618.0000,1742.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,312.37,,,,,,,37.6100,11618.0000,fee schedule,$312.37 from Fee Schedule CIGWHS_23 for Rev 404 Proc 78609 * Qty 1 = $312.37 at 100% = $312.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAGE PERFUSION,78609,CPT,404,RC,40400004,CDM,,,,both,,,11618.0000,1742.7000,CIGNA HEALTHCARE,CIGNA PPO,312.37,,,,,,,37.6100,11618.0000,fee schedule,$312.37 from Fee Schedule CIGWHS_23 for Rev 404 Proc 78609 * Qty 1 = $312.37 at 100% = $312.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAGE PERFUSION,78609,CPT,404,RC,40400004,CDM,,,,both,,,11618.0000,1742.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10456.20,,,,,,,37.6100,11618.0000,percent of total billed charges,"90% of $11,618.00 in Billed Charges for Rev 404 Proc 78609 = $10,456.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET BRAIN IMAGE PERFUSION,78609,CPT,404,RC,40400004,CDM,,,,both,,,11618.0000,1742.7000,MEDCOST,MEDCOST VHN,5529.01,,,,,,,37.6100,11618.0000,percent of total billed charges,"47.59% of $11,618.00 in Billed Charges for Rev 404 Proc 78609 = $5,529.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET BRAIN IMAGE PERFUSION,78609,CPT,404,RC,40400004,CDM,,,,both,,,11618.0000,1742.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2017.31,,,,,,,37.6100,11618.0000,fee schedule,"APG 00290 Proc 78609 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 100% = $1,921.25... $1,921.25 at 105% = $2,017.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAGE PERFUSION,78609,CPT,404,RC,40400004,CDM,,,,both,,,11618.0000,1742.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1980.81,,,,,,,37.6100,11618.0000,fee schedule,"APG 00290 Proc 78609 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 100% = $1,921.25... $1,921.25 at 103.1% = $1,980.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAGE PERFUSION,78609,CPT,404,RC,40400004,CDM,,,,both,,,11618.0000,1742.7000,SENTARA HEALTH,SENTARA HEALTH,2998.61,,,,,,,37.6100,11618.0000,percent of total billed charges,"25.81% of $11,618.00 in Billed Charges for Rev 404 Proc 78609 = $2,998.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET BRAIN IMAGE PERFUSION,78609,CPT,404,RC,40400004,CDM,,,,both,,,11618.0000,1742.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11618.00,,,,,,,37.6100,11618.0000,percent of total billed charges,"100% of $11,618.00 in Billed Charges for Rev 404 Proc 78609 = $11,618.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET BRAIN IMAGE PERFUSION,78609,CPT,404,RC,40400004,CDM,,,,both,,,11618.0000,1742.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,37.61,,,,,,,37.6100,11618.0000,fee schedule,$75.22 from Fee Schedule TCUHC24 for Rev 404 Proc 78609 * Qty 1 = $75.22 at 50% = $37.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET BRAIN IMAGE PERFUSION,78609,CPT,404,RC,40400004,CDM,,,,both,,,11618.0000,1742.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4136.00,,,,,,,37.6100,11618.0000,other,"Rev 404 Proc 78609 1 Visit at $4,136.00 per Visit = $4,136.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAGE PERFUSION,78609,CPT,404,RC,40400004,CDM,,,,both,,,11618.0000,1742.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3957.00,,,,,,,37.6100,11618.0000,other,"Rev 404 Proc 78609 1 Visit at $3,957.00 per Visit = $3,957.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAGE PERFUSION,78609,CPT,404,RC,40400004,CDM,,,,both,,,11618.0000,1742.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,6522.00,,,,,,,37.6100,11618.0000,other,"Rev 404 Proc 78609 1 Visit at $6,522.00 per Visit = $6,522.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAGE PERFUSION,78609,CPT,404,RC,40400004,CDM,,,,both,,,11618.0000,1742.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1978.89,,,,,,,37.6100,11618.0000,fee schedule,"APG 00290 Proc 78609 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 103% = $1,978.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET BRAIN IMAGE PERFUSION,78609,CPT,404,RC,40400004,CDM,,,,both,,,11618.0000,1742.7000,WELLCARE,WELLCARE MEDICAID,11618.00,,,,,,,37.6100,11618.0000,percent of total billed charges,"100% of $11,618.00 in Billed Charges for Rev 404 Proc 78609 = $11,618.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA,1287.41,,,,,,,112.7200,3015.0000,percent of total billed charges,"42.7% of $3,015.00 in Billed Charges for Rev 341 Proc 78645 = $1,287.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1302.66,,,,,,,112.7200,3015.0000,fee schedule,"APG 00332 Proc 78645 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 104% = $1,302.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,492.62,,,,,,,112.7200,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA HEALTHCARE MEDICARE,492.62,,,,,,,112.7200,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,492.62,,,,,,,112.7200,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,AMBETTER,AMBETTER,1073.92,,,,,,,112.7200,3015.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,512.33,,,,,,,112.7200,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM EXCHANGE,1212.87,,,,,,,112.7200,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1290.13,,,,,,,112.7200,3015.0000,fee schedule,"APG 00332 Proc 78645 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 103% = $1,290.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HMO,1288.60,,,,,,,112.7200,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,507.40,,,,,,,112.7200,3015.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1515.92,,,,,,,112.7200,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,204.40,,,,,,,112.7200,3015.0000,fee schedule,$204.40 from Fee Schedule BLDTM_23 for Rev 341 Proc 78645 * Qty 1 = $204.40 at 100% = $204.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS E NETWORK,866.50,,,,,,,112.7200,3015.0000,fee schedule,$270.78 from Fee Schedule BCFSC for Rev 341 Proc 78645 * Qty 1 = $270.78 at 320% = $866.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS MEDICARE,512.33,,,,,,,112.7200,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS P NETWORK,885.45,,,,,,,112.7200,3015.0000,fee schedule,$270.78 from Fee Schedule BCFSC for Rev 341 Proc 78645 * Qty 1 = $270.78 at 327% = $885.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS S NETWORK,885.45,,,,,,,112.7200,3015.0000,fee schedule,$270.78 from Fee Schedule BCFSC for Rev 341 Proc 78645 * Qty 1 = $270.78 at 327% = $885.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE CARE,112.72,,,,,,,112.7200,3015.0000,fee schedule,$97.17 from Fee Schedule TC_24 for Rev 341 Proc 78645 * Qty 1 = $97.17 at 116% = $112.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE SELECT,112.72,,,,,,,112.7200,3015.0000,fee schedule,$97.17 from Fee Schedule TC_24 for Rev 341 Proc 78645 * Qty 1 = $97.17 at 116% = $112.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA HMO,910.80,,,,,,,112.7200,3015.0000,fee schedule,$910.80 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78645 * Qty 1 = $910.80 at 100% = $910.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,504.60,,,,,,,112.7200,3015.0000,fee schedule,$504.60 from Fee Schedule CGIFP_25LR for Rev 341 Proc 78645 * Qty 1 = $504.60 at 100% = $504.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,517.25,,,,,,,112.7200,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,910.80,,,,,,,112.7200,3015.0000,fee schedule,$910.80 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78645 * Qty 1 = $910.80 at 100% = $910.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA PPO,910.80,,,,,,,112.7200,3015.0000,fee schedule,$910.80 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78645 * Qty 1 = $910.80 at 100% = $910.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,517.25,,,,,,,112.7200,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2713.50,,,,,,,112.7200,3015.0000,percent of total billed charges,"90% of $3,015.00 in Billed Charges for Rev 341 Proc 78645 = $2,713.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,HUMANA,HUMANA MEDICARE,492.62,,,,,,,112.7200,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,492.62,,,,,,,112.7200,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,MEDCOST,MEDCOST VHN,1434.84,,,,,,,112.7200,3015.0000,percent of total billed charges,"47.59% of $3,015.00 in Billed Charges for Rev 341 Proc 78645 = $1,434.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1315.19,,,,,,,112.7200,3015.0000,fee schedule,"APG 00332 Proc 78645 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 100% = $1,252.56... $1,252.56 at 105% = $1,315.19 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,517.25,,,,,,,112.7200,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,517.25,,,,,,,112.7200,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,NHC ADVANTAGE,NHC ADVANTAGE,517.25,,,,,,,112.7200,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1291.39,,,,,,,112.7200,3015.0000,fee schedule,"APG 00332 Proc 78645 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 100% = $1,252.56... $1,252.56 at 103.1% = $1,291.39 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA HEALTH,778.17,,,,,,,112.7200,3015.0000,percent of total billed charges,"25.81% of $3,015.00 in Billed Charges for Rev 341 Proc 78645 = $778.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA MEDICARE,492.62,,,,,,,112.7200,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3015.00,,,,,,,112.7200,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 341 Proc 78645 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,120.33,,,,,,,112.7200,3015.0000,fee schedule,$240.65 from Fee Schedule TCUHC24 for Rev 341 Proc 78645 * Qty 1 = $240.65 at 50% = $120.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,810.00,,,,,,,112.7200,3015.0000,other,Rev 341 Proc 78645 1 Visit at $810.00 per Visit = $810.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,774.00,,,,,,,112.7200,3015.0000,other,Rev 341 Proc 78645 1 Visit at $774.00 per Visit = $774.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1599.00,,,,,,,112.7200,3015.0000,other,"Rev 341 Proc 78645 1 Visit at $1,599.00 per Visit = $1,599.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1290.13,,,,,,,112.7200,3015.0000,fee schedule,"APG 00332 Proc 78645 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 103% = $1,290.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,492.62,,,,,,,112.7200,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,492.62,,,,,,,112.7200,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICAID,3015.00,,,,,,,112.7200,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 341 Proc 78645 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM CISTERNOGRAM SHUNT,78645,CPT,341,RC,34100051,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICARE,522.18,,,,,,,112.7200,3015.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PSYCH ROOM DLY SEMI,124,RC,12400001,CDM,,,,,,inpatient,,,1544.0000,231.6000,AETNA,AETNA,793.00,,,,,,,121.7600,1544.0000,per diem,$793.00 for 1 day = $793.00 for Rev 124
HC PSYCH ROOM DLY SEMI,124,RC,12400001,CDM,,,,,,inpatient,,,1544.0000,231.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,121.7600,1544.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC PSYCH ROOM DLY SEMI,124,RC,12400001,CDM,,,,,,inpatient,,,1544.0000,231.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1389.60,,,,,,,121.7600,1544.0000,percent of total billed charges,"90% of $1,544.00 in Billed Charges for Rev 124 = $1,389.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PSYCH ROOM DLY SEMI,124,RC,12400001,CDM,,,,,,inpatient,,,1544.0000,231.6000,MEDCOST,MEDCOST VHN,734.79,,,,,,,121.7600,1544.0000,percent of total billed charges,"47.59% of $1,544.00 in Billed Charges for Rev 124 = $734.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PSYCH ROOM DLY SEMI,124,RC,12400001,CDM,,,,,,inpatient,,,1544.0000,231.6000,SENTARA HEALTH,SENTARA HEALTH,575.60,,,,,,,121.7600,1544.0000,percent of total billed charges,"37.28% of $1,544.00 in Billed Charges for Rev 124 = $575.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PSYCH ROOM DLY SEMI,124,RC,12400001,CDM,,,,,,inpatient,,,1544.0000,231.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1544.00,,,,,,,121.7600,1544.0000,percent of total billed charges,"100% of $1,544.00 in Billed Charges for Rev 124 = $1,544.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PT CPM PATIENT KIT,270,RC,27000092,CDM,,,,,,both,,,204.0000,30.6000,AETNA,AETNA,87.11,,,,,,,52.6500,204.0000,percent of total billed charges,42.7% of $204.00 in Billed Charges for Rev 270 = $87.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PT CPM PATIENT KIT,270,RC,27000092,CDM,,,,,,both,,,204.0000,30.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,142.80,,,,,,,52.6500,204.0000,percent of total billed charges,Rev 270 $204.00 in Billed Charges at 70% = $142.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PT CPM PATIENT KIT,270,RC,27000092,CDM,,,,,,both,,,204.0000,30.6000,CIGNA HEALTHCARE,CIGNA HMO,85.07,,,,,,,52.6500,204.0000,percent of total billed charges,41.7% of $204.00 in Billed Charges for Rev 270 = $85.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PT CPM PATIENT KIT,270,RC,27000092,CDM,,,,,,both,,,204.0000,30.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,94.66,,,,,,,52.6500,204.0000,percent of total billed charges,46.4% of $204.00 in Billed Charges for Rev 270 = $94.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PT CPM PATIENT KIT,270,RC,27000092,CDM,,,,,,both,,,204.0000,30.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,85.07,,,,,,,52.6500,204.0000,percent of total billed charges,41.7% of $204.00 in Billed Charges for Rev 270 = $85.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PT CPM PATIENT KIT,270,RC,27000092,CDM,,,,,,both,,,204.0000,30.6000,CIGNA HEALTHCARE,CIGNA PPO,85.07,,,,,,,52.6500,204.0000,percent of total billed charges,41.7% of $204.00 in Billed Charges for Rev 270 = $85.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PT CPM PATIENT KIT,270,RC,27000092,CDM,,,,,,both,,,204.0000,30.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,183.60,,,,,,,52.6500,204.0000,percent of total billed charges,90% of $204.00 in Billed Charges for Rev 270 = $183.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PT CPM PATIENT KIT,270,RC,27000092,CDM,,,,,,both,,,204.0000,30.6000,MEDCOST,MEDCOST VHN,97.08,,,,,,,52.6500,204.0000,percent of total billed charges,47.59% of $204.00 in Billed Charges for Rev 270 = $97.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PT CPM PATIENT KIT,270,RC,27000092,CDM,,,,,,both,,,204.0000,30.6000,SENTARA HEALTH,SENTARA HEALTH,52.65,,,,,,,52.6500,204.0000,percent of total billed charges,25.81% of $204.00 in Billed Charges for Rev 270 = $52.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PT CPM PATIENT KIT,270,RC,27000092,CDM,,,,,,both,,,204.0000,30.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",204.00,,,,,,,52.6500,204.0000,percent of total billed charges,100% of $204.00 in Billed Charges for Rev 270 = $204.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PT CPM PATIENT KIT,270,RC,27000092,CDM,,,,,,both,,,204.0000,30.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,102.00,,,,,,,52.6500,204.0000,percent of total billed charges,Rev 270 $204.00 in Billed Charges at 50% = $102.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PT CPM PATIENT KIT,270,RC,27000092,CDM,,,,,,both,,,204.0000,30.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,65.89,,,,,,,52.6500,204.0000,other,32.3% of $204.00 in Billed Charges for Rev 270 = $65.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PT CPM PATIENT KIT,270,RC,27000092,CDM,,,,,,both,,,204.0000,30.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,62.63,,,,,,,52.6500,204.0000,other,30.7% of $204.00 in Billed Charges for Rev 270 = $62.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PT CPM PATIENT KIT,270,RC,27000092,CDM,,,,,,both,,,204.0000,30.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,65.89,,,,,,,52.6500,204.0000,percent of total billed charges,32.3% of $204.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PT CPM PATIENT KIT,270,RC,27000092,CDM,,,,,,both,,,204.0000,30.6000,WELLCARE,WELLCARE MEDICAID,204.00,,,,,,,52.6500,204.0000,percent of total billed charges,100% of $204.00 in Billed Charges for Rev 270 = $204.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PULMONARY REHAB PHASE III,410,RC,41000018,CDM,,,,,,both,,,3.0000,0.4500,AETNA,AETNA,1.28,,,,,,,0.5000,3.0000,percent of total billed charges,42.7% of $3.00 in Billed Charges for Rev 410 = $1.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PULMONARY REHAB PHASE III,410,RC,41000018,CDM,,,,,,both,,,3.0000,0.4500,BLUE CROSS,ANTHEM EXCHANGE,0.50,,,,,,,0.5000,3.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULMONARY REHAB PHASE III,410,RC,41000018,CDM,,,,,,both,,,3.0000,0.4500,BLUE CROSS,ANTHEM HMO,0.50,,,,,,,0.5000,3.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULMONARY REHAB PHASE III,410,RC,41000018,CDM,,,,,,both,,,3.0000,0.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",0.50,,,,,,,0.5000,3.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULMONARY REHAB PHASE III,410,RC,41000018,CDM,,,,,,both,,,3.0000,0.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2.10,,,,,,,0.5000,3.0000,percent of total billed charges,Rev 410 $3.00 in Billed Charges at 70% = $2.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PULMONARY REHAB PHASE III,410,RC,41000018,CDM,,,,,,both,,,3.0000,0.4500,CIGNA HEALTHCARE,CIGNA HMO,1.25,,,,,,,0.5000,3.0000,percent of total billed charges,41.7% of $3.00 in Billed Charges for Rev 410 = $1.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PULMONARY REHAB PHASE III,410,RC,41000018,CDM,,,,,,both,,,3.0000,0.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1.39,,,,,,,0.5000,3.0000,percent of total billed charges,46.4% of $3.00 in Billed Charges for Rev 410 = $1.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PULMONARY REHAB PHASE III,410,RC,41000018,CDM,,,,,,both,,,3.0000,0.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1.25,,,,,,,0.5000,3.0000,percent of total billed charges,41.7% of $3.00 in Billed Charges for Rev 410 = $1.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PULMONARY REHAB PHASE III,410,RC,41000018,CDM,,,,,,both,,,3.0000,0.4500,CIGNA HEALTHCARE,CIGNA PPO,1.25,,,,,,,0.5000,3.0000,percent of total billed charges,41.7% of $3.00 in Billed Charges for Rev 410 = $1.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PULMONARY REHAB PHASE III,410,RC,41000018,CDM,,,,,,both,,,3.0000,0.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2.70,,,,,,,0.5000,3.0000,percent of total billed charges,90% of $3.00 in Billed Charges for Rev 410 = $2.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PULMONARY REHAB PHASE III,410,RC,41000018,CDM,,,,,,both,,,3.0000,0.4500,MEDCOST,MEDCOST VHN,1.43,,,,,,,0.5000,3.0000,percent of total billed charges,47.59% of $3.00 in Billed Charges for Rev 410 = $1.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PULMONARY REHAB PHASE III,410,RC,41000018,CDM,,,,,,both,,,3.0000,0.4500,SENTARA HEALTH,SENTARA HEALTH,0.77,,,,,,,0.5000,3.0000,percent of total billed charges,25.81% of $3.00 in Billed Charges for Rev 410 = $0.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PULMONARY REHAB PHASE III,410,RC,41000018,CDM,,,,,,both,,,3.0000,0.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3.00,,,,,,,0.5000,3.0000,percent of total billed charges,100% of $3.00 in Billed Charges for Rev 410 = $3.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PULMONARY REHAB PHASE III,410,RC,41000018,CDM,,,,,,both,,,3.0000,0.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1.50,,,,,,,0.5000,3.0000,percent of total billed charges,Rev 410 $3.00 in Billed Charges at 50% = $1.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PULMONARY REHAB PHASE III,410,RC,41000018,CDM,,,,,,both,,,3.0000,0.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3.00,,,,,,,0.5000,3.0000,other,"Rev 410 1 Visit at $112.00 per Visit = $112.00 (Service Line reduced to $3.00, claim capped at $3.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PULMONARY REHAB PHASE III,410,RC,41000018,CDM,,,,,,both,,,3.0000,0.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3.00,,,,,,,0.5000,3.0000,other,"Rev 410 1 Visit at $106.00 per Visit = $106.00 (Service Line reduced to $3.00, claim capped at $3.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PULMONARY REHAB PHASE III,410,RC,41000018,CDM,,,,,,both,,,3.0000,0.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,3.00,,,,,,,0.5000,3.0000,other,"Rev 410 1 Visit at $175.00 per Visit = $175.00 (Service Line reduced to $3.00, claim capped at $3.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PULMONARY REHAB PHASE III,410,RC,41000018,CDM,,,,,,both,,,3.0000,0.4500,WELLCARE,WELLCARE MEDICAID,3.00,,,,,,,0.5000,3.0000,percent of total billed charges,100% of $3.00 in Billed Charges for Rev 410 = $3.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP PAIN SELECT-A-FLOW 400ML 004,370,RC,37000014,CDM,,,,,,both,,,1250.0000,187.5000,AETNA,AETNA,533.75,,,,,,,322.6300,1250.0000,percent of total billed charges,"42.7% of $1,250.00 in Billed Charges for Rev 370 = $533.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PUMP PAIN SELECT-A-FLOW 400ML 004,370,RC,37000014,CDM,,,,,,both,,,1250.0000,187.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,875.00,,,,,,,322.6300,1250.0000,percent of total billed charges,"Rev 370 $1,250.00 in Billed Charges at 70% = $875.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PUMP PAIN SELECT-A-FLOW 400ML 004,370,RC,37000014,CDM,,,,,,both,,,1250.0000,187.5000,CIGNA HEALTHCARE,CIGNA HMO,521.25,,,,,,,322.6300,1250.0000,percent of total billed charges,"41.7% of $1,250.00 in Billed Charges for Rev 370 = $521.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PUMP PAIN SELECT-A-FLOW 400ML 004,370,RC,37000014,CDM,,,,,,both,,,1250.0000,187.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,580.00,,,,,,,322.6300,1250.0000,percent of total billed charges,"46.4% of $1,250.00 in Billed Charges for Rev 370 = $580.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PUMP PAIN SELECT-A-FLOW 400ML 004,370,RC,37000014,CDM,,,,,,both,,,1250.0000,187.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,521.25,,,,,,,322.6300,1250.0000,percent of total billed charges,"41.7% of $1,250.00 in Billed Charges for Rev 370 = $521.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PUMP PAIN SELECT-A-FLOW 400ML 004,370,RC,37000014,CDM,,,,,,both,,,1250.0000,187.5000,CIGNA HEALTHCARE,CIGNA PPO,521.25,,,,,,,322.6300,1250.0000,percent of total billed charges,"41.7% of $1,250.00 in Billed Charges for Rev 370 = $521.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PUMP PAIN SELECT-A-FLOW 400ML 004,370,RC,37000014,CDM,,,,,,both,,,1250.0000,187.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1125.00,,,,,,,322.6300,1250.0000,percent of total billed charges,"90% of $1,250.00 in Billed Charges for Rev 370 = $1,125.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PUMP PAIN SELECT-A-FLOW 400ML 004,370,RC,37000014,CDM,,,,,,both,,,1250.0000,187.5000,MEDCOST,MEDCOST VHN,594.88,,,,,,,322.6300,1250.0000,percent of total billed charges,"47.59% of $1,250.00 in Billed Charges for Rev 370 = $594.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PUMP PAIN SELECT-A-FLOW 400ML 004,370,RC,37000014,CDM,,,,,,both,,,1250.0000,187.5000,SENTARA HEALTH,SENTARA HEALTH,322.63,,,,,,,322.6300,1250.0000,percent of total billed charges,"25.81% of $1,250.00 in Billed Charges for Rev 370 = $322.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PUMP PAIN SELECT-A-FLOW 400ML 004,370,RC,37000014,CDM,,,,,,both,,,1250.0000,187.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1250.00,,,,,,,322.6300,1250.0000,percent of total billed charges,"100% of $1,250.00 in Billed Charges for Rev 370 = $1,250.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PUMP PAIN SELECT-A-FLOW 400ML 004,370,RC,37000014,CDM,,,,,,both,,,1250.0000,187.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,625.00,,,,,,,322.6300,1250.0000,percent of total billed charges,"Rev 370 $1,250.00 in Billed Charges at 50% = $625.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PUMP PAIN SELECT-A-FLOW 400ML 004,370,RC,37000014,CDM,,,,,,both,,,1250.0000,187.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,403.75,,,,,,,322.6300,1250.0000,other,"32.3% of $1,250.00 in Billed Charges for Rev 370 = $403.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PUMP PAIN SELECT-A-FLOW 400ML 004,370,RC,37000014,CDM,,,,,,both,,,1250.0000,187.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,383.75,,,,,,,322.6300,1250.0000,other,"30.7% of $1,250.00 in Billed Charges for Rev 370 = $383.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PUMP PAIN SELECT-A-FLOW 400ML 004,370,RC,37000014,CDM,,,,,,both,,,1250.0000,187.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,403.75,,,,,,,322.6300,1250.0000,percent of total billed charges,"32.3% of $1,250.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PUMP PAIN SELECT-A-FLOW 400ML 004,370,RC,37000014,CDM,,,,,,both,,,1250.0000,187.5000,WELLCARE,WELLCARE MEDICAID,1250.00,,,,,,,322.6300,1250.0000,percent of total billed charges,"100% of $1,250.00 in Billed Charges for Rev 370 = $1,250.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC QUICK CORE BIOPSY NEEDLE SET,272,RC,27202016,CDM,,,,,,both,,,260.0000,39.0000,AETNA,AETNA,111.02,,,,,,,67.1100,260.0000,percent of total billed charges,42.7% of $260.00 in Billed Charges for Rev 272 = $111.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC QUICK CORE BIOPSY NEEDLE SET,272,RC,27202016,CDM,,,,,,both,,,260.0000,39.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,182.00,,,,,,,67.1100,260.0000,percent of total billed charges,Rev 272 $260.00 in Billed Charges at 70% = $182.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC QUICK CORE BIOPSY NEEDLE SET,272,RC,27202016,CDM,,,,,,both,,,260.0000,39.0000,CIGNA HEALTHCARE,CIGNA HMO,108.42,,,,,,,67.1100,260.0000,percent of total billed charges,41.7% of $260.00 in Billed Charges for Rev 272 = $108.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC QUICK CORE BIOPSY NEEDLE SET,272,RC,27202016,CDM,,,,,,both,,,260.0000,39.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,120.64,,,,,,,67.1100,260.0000,percent of total billed charges,46.4% of $260.00 in Billed Charges for Rev 272 = $120.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC QUICK CORE BIOPSY NEEDLE SET,272,RC,27202016,CDM,,,,,,both,,,260.0000,39.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,108.42,,,,,,,67.1100,260.0000,percent of total billed charges,41.7% of $260.00 in Billed Charges for Rev 272 = $108.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC QUICK CORE BIOPSY NEEDLE SET,272,RC,27202016,CDM,,,,,,both,,,260.0000,39.0000,CIGNA HEALTHCARE,CIGNA PPO,108.42,,,,,,,67.1100,260.0000,percent of total billed charges,41.7% of $260.00 in Billed Charges for Rev 272 = $108.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC QUICK CORE BIOPSY NEEDLE SET,272,RC,27202016,CDM,,,,,,both,,,260.0000,39.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,234.00,,,,,,,67.1100,260.0000,percent of total billed charges,90% of $260.00 in Billed Charges for Rev 272 = $234.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC QUICK CORE BIOPSY NEEDLE SET,272,RC,27202016,CDM,,,,,,both,,,260.0000,39.0000,MEDCOST,MEDCOST VHN,123.73,,,,,,,67.1100,260.0000,percent of total billed charges,47.59% of $260.00 in Billed Charges for Rev 272 = $123.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC QUICK CORE BIOPSY NEEDLE SET,272,RC,27202016,CDM,,,,,,both,,,260.0000,39.0000,SENTARA HEALTH,SENTARA HEALTH,67.11,,,,,,,67.1100,260.0000,percent of total billed charges,25.81% of $260.00 in Billed Charges for Rev 272 = $67.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC QUICK CORE BIOPSY NEEDLE SET,272,RC,27202016,CDM,,,,,,both,,,260.0000,39.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",260.00,,,,,,,67.1100,260.0000,percent of total billed charges,100% of $260.00 in Billed Charges for Rev 272 = $260.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC QUICK CORE BIOPSY NEEDLE SET,272,RC,27202016,CDM,,,,,,both,,,260.0000,39.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,130.00,,,,,,,67.1100,260.0000,percent of total billed charges,Rev 272 $260.00 in Billed Charges at 50% = $130.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC QUICK CORE BIOPSY NEEDLE SET,272,RC,27202016,CDM,,,,,,both,,,260.0000,39.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,83.98,,,,,,,67.1100,260.0000,other,32.3% of $260.00 in Billed Charges for Rev 272 = $83.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUICK CORE BIOPSY NEEDLE SET,272,RC,27202016,CDM,,,,,,both,,,260.0000,39.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,79.82,,,,,,,67.1100,260.0000,other,30.7% of $260.00 in Billed Charges for Rev 272 = $79.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC QUICK CORE BIOPSY NEEDLE SET,272,RC,27202016,CDM,,,,,,both,,,260.0000,39.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,83.98,,,,,,,67.1100,260.0000,percent of total billed charges,32.3% of $260.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC QUICK CORE BIOPSY NEEDLE SET,272,RC,27202016,CDM,,,,,,both,,,260.0000,39.0000,WELLCARE,WELLCARE MEDICAID,260.00,,,,,,,67.1100,260.0000,percent of total billed charges,100% of $260.00 in Billed Charges for Rev 272 = $260.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE PROLENE 3-0 8832H,272,RC,27201448,CDM,,,,,,both,,,16.0000,2.4000,AETNA,AETNA,6.83,,,,,,,4.1300,16.0000,percent of total billed charges,42.7% of $16.00 in Billed Charges for Rev 272 = $6.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE PROLENE 3-0 8832H,272,RC,27201448,CDM,,,,,,both,,,16.0000,2.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11.20,,,,,,,4.1300,16.0000,percent of total billed charges,Rev 272 $16.00 in Billed Charges at 70% = $11.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE PROLENE 3-0 8832H,272,RC,27201448,CDM,,,,,,both,,,16.0000,2.4000,CIGNA HEALTHCARE,CIGNA HMO,6.67,,,,,,,4.1300,16.0000,percent of total billed charges,41.7% of $16.00 in Billed Charges for Rev 272 = $6.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE PROLENE 3-0 8832H,272,RC,27201448,CDM,,,,,,both,,,16.0000,2.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7.42,,,,,,,4.1300,16.0000,percent of total billed charges,46.4% of $16.00 in Billed Charges for Rev 272 = $7.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE PROLENE 3-0 8832H,272,RC,27201448,CDM,,,,,,both,,,16.0000,2.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6.67,,,,,,,4.1300,16.0000,percent of total billed charges,41.7% of $16.00 in Billed Charges for Rev 272 = $6.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE PROLENE 3-0 8832H,272,RC,27201448,CDM,,,,,,both,,,16.0000,2.4000,CIGNA HEALTHCARE,CIGNA PPO,6.67,,,,,,,4.1300,16.0000,percent of total billed charges,41.7% of $16.00 in Billed Charges for Rev 272 = $6.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE PROLENE 3-0 8832H,272,RC,27201448,CDM,,,,,,both,,,16.0000,2.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,14.40,,,,,,,4.1300,16.0000,percent of total billed charges,90% of $16.00 in Billed Charges for Rev 272 = $14.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE PROLENE 3-0 8832H,272,RC,27201448,CDM,,,,,,both,,,16.0000,2.4000,MEDCOST,MEDCOST VHN,7.61,,,,,,,4.1300,16.0000,percent of total billed charges,47.59% of $16.00 in Billed Charges for Rev 272 = $7.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE PROLENE 3-0 8832H,272,RC,27201448,CDM,,,,,,both,,,16.0000,2.4000,SENTARA HEALTH,SENTARA HEALTH,4.13,,,,,,,4.1300,16.0000,percent of total billed charges,25.81% of $16.00 in Billed Charges for Rev 272 = $4.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE PROLENE 3-0 8832H,272,RC,27201448,CDM,,,,,,both,,,16.0000,2.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",16.00,,,,,,,4.1300,16.0000,percent of total billed charges,100% of $16.00 in Billed Charges for Rev 272 = $16.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE PROLENE 3-0 8832H,272,RC,27201448,CDM,,,,,,both,,,16.0000,2.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.00,,,,,,,4.1300,16.0000,percent of total billed charges,Rev 272 $16.00 in Billed Charges at 50% = $8.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE PROLENE 3-0 8832H,272,RC,27201448,CDM,,,,,,both,,,16.0000,2.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5.17,,,,,,,4.1300,16.0000,other,32.3% of $16.00 in Billed Charges for Rev 272 = $5.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE PROLENE 3-0 8832H,272,RC,27201448,CDM,,,,,,both,,,16.0000,2.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,4.91,,,,,,,4.1300,16.0000,other,30.7% of $16.00 in Billed Charges for Rev 272 = $4.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE PROLENE 3-0 8832H,272,RC,27201448,CDM,,,,,,both,,,16.0000,2.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,5.17,,,,,,,4.1300,16.0000,percent of total billed charges,32.3% of $16.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE PROLENE 3-0 8832H,272,RC,27201448,CDM,,,,,,both,,,16.0000,2.4000,WELLCARE,WELLCARE MEDICAID,16.00,,,,,,,4.1300,16.0000,percent of total billed charges,100% of $16.00 in Billed Charges for Rev 272 = $16.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 2-0 CUTTER CURVD FS 685H,272,RC,27201659,CDM,,,,,,both,,,57.0000,8.5500,AETNA,AETNA,24.34,,,,,,,14.7100,57.0000,percent of total billed charges,42.7% of $57.00 in Billed Charges for Rev 272 = $24.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 2-0 CUTTER CURVD FS 685H,272,RC,27201659,CDM,,,,,,both,,,57.0000,8.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,39.90,,,,,,,14.7100,57.0000,percent of total billed charges,Rev 272 $57.00 in Billed Charges at 70% = $39.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 2-0 CUTTER CURVD FS 685H,272,RC,27201659,CDM,,,,,,both,,,57.0000,8.5500,CIGNA HEALTHCARE,CIGNA HMO,23.77,,,,,,,14.7100,57.0000,percent of total billed charges,41.7% of $57.00 in Billed Charges for Rev 272 = $23.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 2-0 CUTTER CURVD FS 685H,272,RC,27201659,CDM,,,,,,both,,,57.0000,8.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,26.45,,,,,,,14.7100,57.0000,percent of total billed charges,46.4% of $57.00 in Billed Charges for Rev 272 = $26.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 2-0 CUTTER CURVD FS 685H,272,RC,27201659,CDM,,,,,,both,,,57.0000,8.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,23.77,,,,,,,14.7100,57.0000,percent of total billed charges,41.7% of $57.00 in Billed Charges for Rev 272 = $23.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 2-0 CUTTER CURVD FS 685H,272,RC,27201659,CDM,,,,,,both,,,57.0000,8.5500,CIGNA HEALTHCARE,CIGNA PPO,23.77,,,,,,,14.7100,57.0000,percent of total billed charges,41.7% of $57.00 in Billed Charges for Rev 272 = $23.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 2-0 CUTTER CURVD FS 685H,272,RC,27201659,CDM,,,,,,both,,,57.0000,8.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,51.30,,,,,,,14.7100,57.0000,percent of total billed charges,90% of $57.00 in Billed Charges for Rev 272 = $51.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 2-0 CUTTER CURVD FS 685H,272,RC,27201659,CDM,,,,,,both,,,57.0000,8.5500,MEDCOST,MEDCOST VHN,27.13,,,,,,,14.7100,57.0000,percent of total billed charges,47.59% of $57.00 in Billed Charges for Rev 272 = $27.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 2-0 CUTTER CURVD FS 685H,272,RC,27201659,CDM,,,,,,both,,,57.0000,8.5500,SENTARA HEALTH,SENTARA HEALTH,14.71,,,,,,,14.7100,57.0000,percent of total billed charges,25.81% of $57.00 in Billed Charges for Rev 272 = $14.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 2-0 CUTTER CURVD FS 685H,272,RC,27201659,CDM,,,,,,both,,,57.0000,8.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",57.00,,,,,,,14.7100,57.0000,percent of total billed charges,100% of $57.00 in Billed Charges for Rev 272 = $57.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 2-0 CUTTER CURVD FS 685H,272,RC,27201659,CDM,,,,,,both,,,57.0000,8.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,28.50,,,,,,,14.7100,57.0000,percent of total billed charges,Rev 272 $57.00 in Billed Charges at 50% = $28.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 2-0 CUTTER CURVD FS 685H,272,RC,27201659,CDM,,,,,,both,,,57.0000,8.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,18.41,,,,,,,14.7100,57.0000,other,32.3% of $57.00 in Billed Charges for Rev 272 = $18.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE SILK 2-0 CUTTER CURVD FS 685H,272,RC,27201659,CDM,,,,,,both,,,57.0000,8.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,17.50,,,,,,,14.7100,57.0000,other,30.7% of $57.00 in Billed Charges for Rev 272 = $17.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE SILK 2-0 CUTTER CURVD FS 685H,272,RC,27201659,CDM,,,,,,both,,,57.0000,8.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,18.41,,,,,,,14.7100,57.0000,percent of total billed charges,32.3% of $57.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 2-0 CUTTER CURVD FS 685H,272,RC,27201659,CDM,,,,,,both,,,57.0000,8.5500,WELLCARE,WELLCARE MEDICAID,57.00,,,,,,,14.7100,57.0000,percent of total billed charges,100% of $57.00 in Billed Charges for Rev 272 = $57.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 3-0 CR C013D,272,RC,27201454,CDM,,,,,,both,,,62.0000,9.3000,AETNA,AETNA,26.47,,,,,,,16.0000,62.0000,percent of total billed charges,42.7% of $62.00 in Billed Charges for Rev 272 = $26.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 3-0 CR C013D,272,RC,27201454,CDM,,,,,,both,,,62.0000,9.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,43.40,,,,,,,16.0000,62.0000,percent of total billed charges,Rev 272 $62.00 in Billed Charges at 70% = $43.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 3-0 CR C013D,272,RC,27201454,CDM,,,,,,both,,,62.0000,9.3000,CIGNA HEALTHCARE,CIGNA HMO,25.85,,,,,,,16.0000,62.0000,percent of total billed charges,41.7% of $62.00 in Billed Charges for Rev 272 = $25.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 3-0 CR C013D,272,RC,27201454,CDM,,,,,,both,,,62.0000,9.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,28.77,,,,,,,16.0000,62.0000,percent of total billed charges,46.4% of $62.00 in Billed Charges for Rev 272 = $28.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 3-0 CR C013D,272,RC,27201454,CDM,,,,,,both,,,62.0000,9.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,25.85,,,,,,,16.0000,62.0000,percent of total billed charges,41.7% of $62.00 in Billed Charges for Rev 272 = $25.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 3-0 CR C013D,272,RC,27201454,CDM,,,,,,both,,,62.0000,9.3000,CIGNA HEALTHCARE,CIGNA PPO,25.85,,,,,,,16.0000,62.0000,percent of total billed charges,41.7% of $62.00 in Billed Charges for Rev 272 = $25.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 3-0 CR C013D,272,RC,27201454,CDM,,,,,,both,,,62.0000,9.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,55.80,,,,,,,16.0000,62.0000,percent of total billed charges,90% of $62.00 in Billed Charges for Rev 272 = $55.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 3-0 CR C013D,272,RC,27201454,CDM,,,,,,both,,,62.0000,9.3000,MEDCOST,MEDCOST VHN,29.51,,,,,,,16.0000,62.0000,percent of total billed charges,47.59% of $62.00 in Billed Charges for Rev 272 = $29.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 3-0 CR C013D,272,RC,27201454,CDM,,,,,,both,,,62.0000,9.3000,SENTARA HEALTH,SENTARA HEALTH,16.00,,,,,,,16.0000,62.0000,percent of total billed charges,25.81% of $62.00 in Billed Charges for Rev 272 = $16.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 3-0 CR C013D,272,RC,27201454,CDM,,,,,,both,,,62.0000,9.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",62.00,,,,,,,16.0000,62.0000,percent of total billed charges,100% of $62.00 in Billed Charges for Rev 272 = $62.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 3-0 CR C013D,272,RC,27201454,CDM,,,,,,both,,,62.0000,9.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,31.00,,,,,,,16.0000,62.0000,percent of total billed charges,Rev 272 $62.00 in Billed Charges at 50% = $31.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 3-0 CR C013D,272,RC,27201454,CDM,,,,,,both,,,62.0000,9.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,20.03,,,,,,,16.0000,62.0000,other,32.3% of $62.00 in Billed Charges for Rev 272 = $20.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE SILK 3-0 CR C013D,272,RC,27201454,CDM,,,,,,both,,,62.0000,9.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,19.03,,,,,,,16.0000,62.0000,other,30.7% of $62.00 in Billed Charges for Rev 272 = $19.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE SILK 3-0 CR C013D,272,RC,27201454,CDM,,,,,,both,,,62.0000,9.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,20.03,,,,,,,16.0000,62.0000,percent of total billed charges,32.3% of $62.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 3-0 CR C013D,272,RC,27201454,CDM,,,,,,both,,,62.0000,9.3000,WELLCARE,WELLCARE MEDICAID,62.00,,,,,,,16.0000,62.0000,percent of total billed charges,100% of $62.00 in Billed Charges for Rev 272 = $62.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA,1287.41,,,,,,,146.9700,3015.0000,percent of total billed charges,"42.7% of $3,015.00 in Billed Charges for Rev 341 Proc 78707 = $1,287.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,528.56,,,,,,,146.9700,3015.0000,fee schedule,APG 00331 Proc 78707 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 104% = $528.56. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,492.62,,,,,,,146.9700,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA HEALTHCARE MEDICARE,492.62,,,,,,,146.9700,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,492.62,,,,,,,146.9700,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,AMBETTER,AMBETTER,1073.92,,,,,,,146.9700,3015.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,512.33,,,,,,,146.9700,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM EXCHANGE,1212.87,,,,,,,146.9700,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,523.48,,,,,,,146.9700,3015.0000,fee schedule,APG 00331 Proc 78707 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 103% = $523.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HMO,1288.60,,,,,,,146.9700,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,507.40,,,,,,,146.9700,3015.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1515.92,,,,,,,146.9700,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,262.53,,,,,,,146.9700,3015.0000,fee schedule,$262.53 from Fee Schedule BLDTM_23 for Rev 341 Proc 78707 * Qty 1 = $262.53 at 100% = $262.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS E NETWORK,542.24,,,,,,,146.9700,3015.0000,fee schedule,$169.45 from Fee Schedule BCFSC for Rev 341 Proc 78707 * Qty 1 = $169.45 at 320% = $542.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS MEDICARE,512.33,,,,,,,146.9700,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS P NETWORK,554.10,,,,,,,146.9700,3015.0000,fee schedule,$169.45 from Fee Schedule BCFSC for Rev 341 Proc 78707 * Qty 1 = $169.45 at 327% = $554.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS S NETWORK,554.10,,,,,,,146.9700,3015.0000,fee schedule,$169.45 from Fee Schedule BCFSC for Rev 341 Proc 78707 * Qty 1 = $169.45 at 327% = $554.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE CARE,146.97,,,,,,,146.9700,3015.0000,fee schedule,$126.70 from Fee Schedule TC_24 for Rev 341 Proc 78707 * Qty 1 = $126.70 at 116% = $146.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE SELECT,146.97,,,,,,,146.9700,3015.0000,fee schedule,$126.70 from Fee Schedule TC_24 for Rev 341 Proc 78707 * Qty 1 = $126.70 at 116% = $146.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA HMO,1206.05,,,,,,,146.9700,3015.0000,fee schedule,"$1,206.05 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78707 * Qty 1 = $1,206.05 at 100% = $1,206.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,321.58,,,,,,,146.9700,3015.0000,fee schedule,$321.58 from Fee Schedule CGIFP_25LR for Rev 341 Proc 78707 * Qty 1 = $321.58 at 100% = $321.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,517.25,,,,,,,146.9700,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1206.05,,,,,,,146.9700,3015.0000,fee schedule,"$1,206.05 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78707 * Qty 1 = $1,206.05 at 100% = $1,206.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA PPO,1206.05,,,,,,,146.9700,3015.0000,fee schedule,"$1,206.05 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78707 * Qty 1 = $1,206.05 at 100% = $1,206.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,517.25,,,,,,,146.9700,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2713.50,,,,,,,146.9700,3015.0000,percent of total billed charges,"90% of $3,015.00 in Billed Charges for Rev 341 Proc 78707 = $2,713.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,HUMANA,HUMANA MEDICARE,492.62,,,,,,,146.9700,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,492.62,,,,,,,146.9700,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,MEDCOST,MEDCOST VHN,1434.84,,,,,,,146.9700,3015.0000,percent of total billed charges,"47.59% of $3,015.00 in Billed Charges for Rev 341 Proc 78707 = $1,434.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,533.64,,,,,,,146.9700,3015.0000,fee schedule,APG 00331 Proc 78707 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 100% = $508.23... $508.23 at 105% = $533.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,517.25,,,,,,,146.9700,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,517.25,,,,,,,146.9700,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,NHC ADVANTAGE,NHC ADVANTAGE,517.25,,,,,,,146.9700,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,523.99,,,,,,,146.9700,3015.0000,fee schedule,APG 00331 Proc 78707 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 100% = $508.23... $508.23 at 103.1% = $523.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA HEALTH,778.17,,,,,,,146.9700,3015.0000,percent of total billed charges,"25.81% of $3,015.00 in Billed Charges for Rev 341 Proc 78707 = $778.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA MEDICARE,492.62,,,,,,,146.9700,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3015.00,,,,,,,146.9700,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 341 Proc 78707 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,159.33,,,,,,,146.9700,3015.0000,fee schedule,$318.66 from Fee Schedule TCUHC24 for Rev 341 Proc 78707 * Qty 1 = $318.66 at 50% = $159.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,810.00,,,,,,,146.9700,3015.0000,other,Rev 341 Proc 78707 1 Visit at $810.00 per Visit = $810.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,774.00,,,,,,,146.9700,3015.0000,other,Rev 341 Proc 78707 1 Visit at $774.00 per Visit = $774.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1599.00,,,,,,,146.9700,3015.0000,other,"Rev 341 Proc 78707 1 Visit at $1,599.00 per Visit = $1,599.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,523.48,,,,,,,146.9700,3015.0000,fee schedule,APG 00331 Proc 78707 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 103% = $523.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,492.62,,,,,,,146.9700,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,492.62,,,,,,,146.9700,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICAID,3015.00,,,,,,,146.9700,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 341 Proc 78707 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM RENAL IMAGE FLOW FCT WO MEDS,78707,CPT,341,RC,34100054,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICARE,522.18,,,,,,,146.9700,3015.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA,1287.41,,,,,,,104.9000,3015.0000,percent of total billed charges,"42.7% of $3,015.00 in Billed Charges for Rev 341 Proc 78761 = $1,287.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,528.56,,,,,,,104.9000,3015.0000,fee schedule,APG 00331 Proc 78761 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 104% = $528.56. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,362.70,,,,,,,104.9000,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA HEALTHCARE MEDICARE,362.70,,,,,,,104.9000,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,362.70,,,,,,,104.9000,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,AMBETTER,AMBETTER,790.69,,,,,,,104.9000,3015.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,377.21,,,,,,,104.9000,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM EXCHANGE,893.00,,,,,,,104.9000,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,523.48,,,,,,,104.9000,3015.0000,fee schedule,APG 00331 Proc 78761 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 103% = $523.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HMO,948.76,,,,,,,104.9000,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,373.58,,,,,,,104.9000,3015.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1116.13,,,,,,,104.9000,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,190.43,,,,,,,104.9000,3015.0000,fee schedule,$190.43 from Fee Schedule BLDTM_23 for Rev 341 Proc 78761 * Qty 1 = $190.43 at 100% = $190.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS E NETWORK,512.38,,,,,,,104.9000,3015.0000,fee schedule,$160.12 from Fee Schedule BCFSC for Rev 341 Proc 78761 * Qty 1 = $160.12 at 320% = $512.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS MEDICARE,377.21,,,,,,,104.9000,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS P NETWORK,523.59,,,,,,,104.9000,3015.0000,fee schedule,$160.12 from Fee Schedule BCFSC for Rev 341 Proc 78761 * Qty 1 = $160.12 at 327% = $523.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS S NETWORK,523.59,,,,,,,104.9000,3015.0000,fee schedule,$160.12 from Fee Schedule BCFSC for Rev 341 Proc 78761 * Qty 1 = $160.12 at 327% = $523.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE CARE,104.90,,,,,,,104.9000,3015.0000,fee schedule,$90.43 from Fee Schedule TC_24 for Rev 341 Proc 78761 * Qty 1 = $90.43 at 116% = $104.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE SELECT,104.90,,,,,,,104.9000,3015.0000,fee schedule,$90.43 from Fee Schedule TC_24 for Rev 341 Proc 78761 * Qty 1 = $90.43 at 116% = $104.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA HMO,1206.05,,,,,,,104.9000,3015.0000,fee schedule,"$1,206.05 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78761 * Qty 1 = $1,206.05 at 100% = $1,206.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,306.55,,,,,,,104.9000,3015.0000,fee schedule,$306.55 from Fee Schedule CGIFP_25LR for Rev 341 Proc 78761 * Qty 1 = $306.55 at 100% = $306.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,380.84,,,,,,,104.9000,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1206.05,,,,,,,104.9000,3015.0000,fee schedule,"$1,206.05 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78761 * Qty 1 = $1,206.05 at 100% = $1,206.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA PPO,1206.05,,,,,,,104.9000,3015.0000,fee schedule,"$1,206.05 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78761 * Qty 1 = $1,206.05 at 100% = $1,206.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,380.84,,,,,,,104.9000,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2713.50,,,,,,,104.9000,3015.0000,percent of total billed charges,"90% of $3,015.00 in Billed Charges for Rev 341 Proc 78761 = $2,713.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,HUMANA,HUMANA MEDICARE,362.70,,,,,,,104.9000,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,362.70,,,,,,,104.9000,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,MEDCOST,MEDCOST VHN,1434.84,,,,,,,104.9000,3015.0000,percent of total billed charges,"47.59% of $3,015.00 in Billed Charges for Rev 341 Proc 78761 = $1,434.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,533.64,,,,,,,104.9000,3015.0000,fee schedule,APG 00331 Proc 78761 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 100% = $508.23... $508.23 at 105% = $533.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,380.84,,,,,,,104.9000,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,380.84,,,,,,,104.9000,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,NHC ADVANTAGE,NHC ADVANTAGE,380.84,,,,,,,104.9000,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,523.99,,,,,,,104.9000,3015.0000,fee schedule,APG 00331 Proc 78761 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 100% = $508.23... $508.23 at 103.1% = $523.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA HEALTH,778.17,,,,,,,104.9000,3015.0000,percent of total billed charges,"25.81% of $3,015.00 in Billed Charges for Rev 341 Proc 78761 = $778.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA MEDICARE,362.70,,,,,,,104.9000,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3015.00,,,,,,,104.9000,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 341 Proc 78761 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,159.33,,,,,,,104.9000,3015.0000,fee schedule,$318.66 from Fee Schedule TCUHC24 for Rev 341 Proc 78761 * Qty 1 = $318.66 at 50% = $159.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,810.00,,,,,,,104.9000,3015.0000,other,Rev 341 Proc 78761 1 Visit at $810.00 per Visit = $810.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,774.00,,,,,,,104.9000,3015.0000,other,Rev 341 Proc 78761 1 Visit at $774.00 per Visit = $774.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1599.00,,,,,,,104.9000,3015.0000,other,"Rev 341 Proc 78761 1 Visit at $1,599.00 per Visit = $1,599.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,523.48,,,,,,,104.9000,3015.0000,fee schedule,APG 00331 Proc 78761 at $836.60 (Base Rate) * 0.6075 (Relative Weight) = $508.23 (Total Line Payment) at 103% = $523.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,362.70,,,,,,,104.9000,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,362.70,,,,,,,104.9000,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICAID,3015.00,,,,,,,104.9000,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 341 Proc 78761 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TESTICULAR IMAGING W VAS FLOW,78761,CPT,341,RC,34100058,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICARE,384.46,,,,,,,104.9000,3015.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA,1287.41,,,,,,,111.5800,3015.0000,percent of total billed charges,"42.7% of $3,015.00 in Billed Charges for Rev 341 Proc 78800 = $1,287.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1302.66,,,,,,,111.5800,3015.0000,fee schedule,"APG 00332 Proc 78800 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 104% = $1,302.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,362.70,,,,,,,111.5800,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA HEALTHCARE MEDICARE,362.70,,,,,,,111.5800,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,362.70,,,,,,,111.5800,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,AMBETTER,AMBETTER,790.69,,,,,,,111.5800,3015.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,377.21,,,,,,,111.5800,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM EXCHANGE,893.00,,,,,,,111.5800,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1290.13,,,,,,,111.5800,3015.0000,fee schedule,"APG 00332 Proc 78800 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 103% = $1,290.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HMO,948.76,,,,,,,111.5800,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,373.58,,,,,,,111.5800,3015.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1116.13,,,,,,,111.5800,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,209.70,,,,,,,111.5800,3015.0000,fee schedule,$209.70 from Fee Schedule BLDTM_23 for Rev 341 Proc 78800 * Qty 1 = $209.70 at 100% = $209.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS E NETWORK,460.93,,,,,,,111.5800,3015.0000,fee schedule,$144.04 from Fee Schedule BCFSC for Rev 341 Proc 78800 * Qty 1 = $144.04 at 320% = $460.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS MEDICARE,377.21,,,,,,,111.5800,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS P NETWORK,471.01,,,,,,,111.5800,3015.0000,fee schedule,$144.04 from Fee Schedule BCFSC for Rev 341 Proc 78800 * Qty 1 = $144.04 at 327% = $471.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS S NETWORK,471.01,,,,,,,111.5800,3015.0000,fee schedule,$144.04 from Fee Schedule BCFSC for Rev 341 Proc 78800 * Qty 1 = $144.04 at 327% = $471.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE CARE,111.58,,,,,,,111.5800,3015.0000,fee schedule,$96.19 from Fee Schedule TC_24 for Rev 341 Proc 78800 * Qty 1 = $96.19 at 116% = $111.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE SELECT,111.58,,,,,,,111.5800,3015.0000,fee schedule,$96.19 from Fee Schedule TC_24 for Rev 341 Proc 78800 * Qty 1 = $96.19 at 116% = $111.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA HMO,1060.27,,,,,,,111.5800,3015.0000,fee schedule,"$1,060.27 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78800 * Qty 1 = $1,060.27 at 100% = $1,060.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,378.58,,,,,,,111.5800,3015.0000,fee schedule,$378.58 from Fee Schedule CGIFP_25LR for Rev 341 Proc 78800 * Qty 1 = $378.58 at 100% = $378.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,380.84,,,,,,,111.5800,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1060.27,,,,,,,111.5800,3015.0000,fee schedule,"$1,060.27 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78800 * Qty 1 = $1,060.27 at 100% = $1,060.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA PPO,1060.27,,,,,,,111.5800,3015.0000,fee schedule,"$1,060.27 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78800 * Qty 1 = $1,060.27 at 100% = $1,060.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,380.84,,,,,,,111.5800,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2713.50,,,,,,,111.5800,3015.0000,percent of total billed charges,"90% of $3,015.00 in Billed Charges for Rev 341 Proc 78800 = $2,713.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,HUMANA,HUMANA MEDICARE,362.70,,,,,,,111.5800,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,362.70,,,,,,,111.5800,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,MEDCOST,MEDCOST VHN,1434.84,,,,,,,111.5800,3015.0000,percent of total billed charges,"47.59% of $3,015.00 in Billed Charges for Rev 341 Proc 78800 = $1,434.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1315.19,,,,,,,111.5800,3015.0000,fee schedule,"APG 00332 Proc 78800 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 100% = $1,252.56... $1,252.56 at 105% = $1,315.19 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,380.84,,,,,,,111.5800,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,380.84,,,,,,,111.5800,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,NHC ADVANTAGE,NHC ADVANTAGE,380.84,,,,,,,111.5800,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1291.39,,,,,,,111.5800,3015.0000,fee schedule,"APG 00332 Proc 78800 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 100% = $1,252.56... $1,252.56 at 103.1% = $1,291.39 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA HEALTH,778.17,,,,,,,111.5800,3015.0000,percent of total billed charges,"25.81% of $3,015.00 in Billed Charges for Rev 341 Proc 78800 = $778.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA MEDICARE,362.70,,,,,,,111.5800,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3015.00,,,,,,,111.5800,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 341 Proc 78800 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,140.07,,,,,,,111.5800,3015.0000,fee schedule,$280.14 from Fee Schedule TCUHC24 for Rev 341 Proc 78800 * Qty 1 = $280.14 at 50% = $140.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,810.00,,,,,,,111.5800,3015.0000,other,Rev 341 Proc 78800 1 Visit at $810.00 per Visit = $810.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,774.00,,,,,,,111.5800,3015.0000,other,Rev 341 Proc 78800 1 Visit at $774.00 per Visit = $774.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1599.00,,,,,,,111.5800,3015.0000,other,"Rev 341 Proc 78800 1 Visit at $1,599.00 per Visit = $1,599.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1290.13,,,,,,,111.5800,3015.0000,fee schedule,"APG 00332 Proc 78800 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 103% = $1,290.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,362.70,,,,,,,111.5800,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,362.70,,,,,,,111.5800,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICAID,3015.00,,,,,,,111.5800,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 341 Proc 78800 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR SNGL AREA SNGL DAY,78800,CPT,341,RC,34100059,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICARE,384.46,,,,,,,111.5800,3015.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,AETNA,AETNA,1351.88,,,,,,,138.6500,3166.0000,percent of total billed charges,"42.7% of $3,166.00 in Billed Charges for Rev 341 Proc 78801 = $1,351.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1302.66,,,,,,,138.6500,3166.0000,fee schedule,"APG 00332 Proc 78801 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 104% = $1,302.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,362.70,,,,,,,138.6500,3166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,AETNA,AETNA HEALTHCARE MEDICARE,362.70,,,,,,,138.6500,3166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,362.70,,,,,,,138.6500,3166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,AMBETTER,AMBETTER,790.69,,,,,,,138.6500,3166.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,377.21,,,,,,,138.6500,3166.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,BLUE CROSS,ANTHEM EXCHANGE,893.00,,,,,,,138.6500,3166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1290.13,,,,,,,138.6500,3166.0000,fee schedule,"APG 00332 Proc 78801 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 103% = $1,290.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,BLUE CROSS,ANTHEM HMO,948.76,,,,,,,138.6500,3166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,373.58,,,,,,,138.6500,3166.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1116.13,,,,,,,138.6500,3166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,258.00,,,,,,,138.6500,3166.0000,fee schedule,$258.00 from Fee Schedule BLDTM_23 for Rev 341 Proc 78801 * Qty 1 = $258.00 at 100% = $258.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,BLUE CROSS,BLUE CROSS E NETWORK,619.46,,,,,,,138.6500,3166.0000,fee schedule,$193.58 from Fee Schedule BCFSC for Rev 341 Proc 78801 * Qty 1 = $193.58 at 320% = $619.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,BLUE CROSS,BLUE CROSS MEDICARE,377.21,,,,,,,138.6500,3166.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,BLUE CROSS,BLUE CROSS P NETWORK,633.01,,,,,,,138.6500,3166.0000,fee schedule,$193.58 from Fee Schedule BCFSC for Rev 341 Proc 78801 * Qty 1 = $193.58 at 327% = $633.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,BLUE CROSS,BLUE CROSS S NETWORK,633.01,,,,,,,138.6500,3166.0000,fee schedule,$193.58 from Fee Schedule BCFSC for Rev 341 Proc 78801 * Qty 1 = $193.58 at 327% = $633.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,BLUE CROSS,TENNCARE BLUE CARE,138.65,,,,,,,138.6500,3166.0000,fee schedule,$119.53 from Fee Schedule TC_24 for Rev 341 Proc 78801 * Qty 1 = $119.53 at 116% = $138.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,BLUE CROSS,TENNCARE BLUE SELECT,138.65,,,,,,,138.6500,3166.0000,fee schedule,$119.53 from Fee Schedule TC_24 for Rev 341 Proc 78801 * Qty 1 = $119.53 at 116% = $138.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,CIGNA HEALTHCARE,CIGNA HMO,1863.85,,,,,,,138.6500,3166.0000,fee schedule,"$1,863.85 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78801 * Qty 1 = $1,863.85 at 100% = $1,863.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,404.26,,,,,,,138.6500,3166.0000,fee schedule,$404.26 from Fee Schedule CGIFP_25LR for Rev 341 Proc 78801 * Qty 1 = $404.26 at 100% = $404.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,380.84,,,,,,,138.6500,3166.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1863.85,,,,,,,138.6500,3166.0000,fee schedule,"$1,863.85 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78801 * Qty 1 = $1,863.85 at 100% = $1,863.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,CIGNA HEALTHCARE,CIGNA PPO,1863.85,,,,,,,138.6500,3166.0000,fee schedule,"$1,863.85 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78801 * Qty 1 = $1,863.85 at 100% = $1,863.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,380.84,,,,,,,138.6500,3166.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2849.40,,,,,,,138.6500,3166.0000,percent of total billed charges,"90% of $3,166.00 in Billed Charges for Rev 341 Proc 78801 = $2,849.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,HUMANA,HUMANA MEDICARE,362.70,,,,,,,138.6500,3166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,362.70,,,,,,,138.6500,3166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,MEDCOST,MEDCOST VHN,1506.70,,,,,,,138.6500,3166.0000,percent of total billed charges,"47.59% of $3,166.00 in Billed Charges for Rev 341 Proc 78801 = $1,506.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1315.19,,,,,,,138.6500,3166.0000,fee schedule,"APG 00332 Proc 78801 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 100% = $1,252.56... $1,252.56 at 105% = $1,315.19 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,380.84,,,,,,,138.6500,3166.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,380.84,,,,,,,138.6500,3166.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,NHC ADVANTAGE,NHC ADVANTAGE,380.84,,,,,,,138.6500,3166.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1291.39,,,,,,,138.6500,3166.0000,fee schedule,"APG 00332 Proc 78801 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 100% = $1,252.56... $1,252.56 at 103.1% = $1,291.39 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,SENTARA HEALTH,SENTARA HEALTH,817.14,,,,,,,138.6500,3166.0000,percent of total billed charges,"25.81% of $3,166.00 in Billed Charges for Rev 341 Proc 78801 = $817.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,SENTARA HEALTH,SENTARA MEDICARE,362.70,,,,,,,138.6500,3166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3166.00,,,,,,,138.6500,3166.0000,percent of total billed charges,"100% of $3,166.00 in Billed Charges for Rev 341 Proc 78801 = $3,166.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,246.23,,,,,,,138.6500,3166.0000,fee schedule,$492.46 from Fee Schedule TCUHC24 for Rev 341 Proc 78801 * Qty 1 = $492.46 at 50% = $246.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,810.00,,,,,,,138.6500,3166.0000,other,Rev 341 Proc 78801 1 Visit at $810.00 per Visit = $810.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,774.00,,,,,,,138.6500,3166.0000,other,Rev 341 Proc 78801 1 Visit at $774.00 per Visit = $774.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,1599.00,,,,,,,138.6500,3166.0000,other,"Rev 341 Proc 78801 1 Visit at $1,599.00 per Visit = $1,599.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1290.13,,,,,,,138.6500,3166.0000,fee schedule,"APG 00332 Proc 78801 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 103% = $1,290.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,362.70,,,,,,,138.6500,3166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,362.70,,,,,,,138.6500,3166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,WELLCARE,WELLCARE MEDICAID,3166.00,,,,,,,138.6500,3166.0000,percent of total billed charges,"100% of $3,166.00 in Billed Charges for Rev 341 Proc 78801 = $3,166.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR 2+ AREAS/1+ DAYS IMG OR SNGL AREA OVER 2+ DAYS,78801,CPT,341,RC,34100060,CDM,,,,both,,,3166.0000,474.9000,WELLCARE,WELLCARE MEDICARE,384.46,,,,,,,138.6500,3166.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA,1287.41,,,,,,,215.3200,3015.0000,percent of total billed charges,"42.7% of $3,015.00 in Billed Charges for Rev 341 Proc 78803 = $1,287.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1302.66,,,,,,,215.3200,3015.0000,fee schedule,"APG 00332 Proc 78803 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 104% = $1,302.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,492.62,,,,,,,215.3200,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA HEALTHCARE MEDICARE,492.62,,,,,,,215.3200,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,492.62,,,,,,,215.3200,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,AMBETTER,AMBETTER,1073.92,,,,,,,215.3200,3015.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,512.33,,,,,,,215.3200,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM EXCHANGE,1212.87,,,,,,,215.3200,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1290.13,,,,,,,215.3200,3015.0000,fee schedule,"APG 00332 Proc 78803 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 103% = $1,290.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HMO,1288.60,,,,,,,215.3200,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,507.40,,,,,,,215.3200,3015.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1515.92,,,,,,,215.3200,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,416.50,,,,,,,215.3200,3015.0000,fee schedule,$416.50 from Fee Schedule BLDTM_23 for Rev 341 Proc 78803 * Qty 1 = $416.50 at 100% = $416.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS E NETWORK,843.84,,,,,,,215.3200,3015.0000,fee schedule,$263.70 from Fee Schedule BCFSC for Rev 341 Proc 78803 * Qty 1 = $263.70 at 320% = $843.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS MEDICARE,512.33,,,,,,,215.3200,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS P NETWORK,862.30,,,,,,,215.3200,3015.0000,fee schedule,$263.70 from Fee Schedule BCFSC for Rev 341 Proc 78803 * Qty 1 = $263.70 at 327% = $862.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS S NETWORK,862.30,,,,,,,215.3200,3015.0000,fee schedule,$263.70 from Fee Schedule BCFSC for Rev 341 Proc 78803 * Qty 1 = $263.70 at 327% = $862.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE CARE,215.32,,,,,,,215.3200,3015.0000,fee schedule,$185.62 from Fee Schedule TC_24 for Rev 341 Proc 78803 * Qty 1 = $185.62 at 116% = $215.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE SELECT,215.32,,,,,,,215.3200,3015.0000,fee schedule,$185.62 from Fee Schedule TC_24 for Rev 341 Proc 78803 * Qty 1 = $185.62 at 116% = $215.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA HMO,1863.85,,,,,,,215.3200,3015.0000,fee schedule,"$1,863.85 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78803 * Qty 1 = $1,863.85 at 100% = $1,863.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,558.72,,,,,,,215.3200,3015.0000,fee schedule,$558.72 from Fee Schedule CGIFP_25LR for Rev 341 Proc 78803 * Qty 1 = $558.72 at 100% = $558.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,517.25,,,,,,,215.3200,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1863.85,,,,,,,215.3200,3015.0000,fee schedule,"$1,863.85 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78803 * Qty 1 = $1,863.85 at 100% = $1,863.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA PPO,1863.85,,,,,,,215.3200,3015.0000,fee schedule,"$1,863.85 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78803 * Qty 1 = $1,863.85 at 100% = $1,863.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,517.25,,,,,,,215.3200,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2713.50,,,,,,,215.3200,3015.0000,percent of total billed charges,"90% of $3,015.00 in Billed Charges for Rev 341 Proc 78803 = $2,713.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,HUMANA,HUMANA MEDICARE,492.62,,,,,,,215.3200,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,492.62,,,,,,,215.3200,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,MEDCOST,MEDCOST VHN,1434.84,,,,,,,215.3200,3015.0000,percent of total billed charges,"47.59% of $3,015.00 in Billed Charges for Rev 341 Proc 78803 = $1,434.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1315.19,,,,,,,215.3200,3015.0000,fee schedule,"APG 00332 Proc 78803 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 100% = $1,252.56... $1,252.56 at 105% = $1,315.19 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,517.25,,,,,,,215.3200,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,517.25,,,,,,,215.3200,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,NHC ADVANTAGE,NHC ADVANTAGE,517.25,,,,,,,215.3200,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1291.39,,,,,,,215.3200,3015.0000,fee schedule,"APG 00332 Proc 78803 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 100% = $1,252.56... $1,252.56 at 103.1% = $1,291.39 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA HEALTH,778.17,,,,,,,215.3200,3015.0000,percent of total billed charges,"25.81% of $3,015.00 in Billed Charges for Rev 341 Proc 78803 = $778.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA MEDICARE,492.62,,,,,,,215.3200,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3015.00,,,,,,,215.3200,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 341 Proc 78803 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,246.23,,,,,,,215.3200,3015.0000,fee schedule,$492.46 from Fee Schedule TCUHC24 for Rev 341 Proc 78803 * Qty 1 = $492.46 at 50% = $246.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,810.00,,,,,,,215.3200,3015.0000,other,Rev 341 Proc 78803 1 Visit at $810.00 per Visit = $810.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,774.00,,,,,,,215.3200,3015.0000,other,Rev 341 Proc 78803 1 Visit at $774.00 per Visit = $774.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1599.00,,,,,,,215.3200,3015.0000,other,"Rev 341 Proc 78803 1 Visit at $1,599.00 per Visit = $1,599.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1290.13,,,,,,,215.3200,3015.0000,fee schedule,"APG 00332 Proc 78803 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 103% = $1,290.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,492.62,,,,,,,215.3200,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,492.62,,,,,,,215.3200,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICAID,3015.00,,,,,,,215.3200,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 341 Proc 78803 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT SPECT SNGL AREA SNGL DAY IMG,78803,CPT,341,RC,34100061,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICARE,522.18,,,,,,,215.3200,3015.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE VICRYL 0 J106T,272,RC,27201456,CDM,,,,,,both,,,36.0000,5.4000,AETNA,AETNA,15.37,,,,,,,9.2900,36.0000,percent of total billed charges,42.7% of $36.00 in Billed Charges for Rev 272 = $15.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 0 J106T,272,RC,27201456,CDM,,,,,,both,,,36.0000,5.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,25.20,,,,,,,9.2900,36.0000,percent of total billed charges,Rev 272 $36.00 in Billed Charges at 70% = $25.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 0 J106T,272,RC,27201456,CDM,,,,,,both,,,36.0000,5.4000,CIGNA HEALTHCARE,CIGNA HMO,15.01,,,,,,,9.2900,36.0000,percent of total billed charges,41.7% of $36.00 in Billed Charges for Rev 272 = $15.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 0 J106T,272,RC,27201456,CDM,,,,,,both,,,36.0000,5.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,16.70,,,,,,,9.2900,36.0000,percent of total billed charges,46.4% of $36.00 in Billed Charges for Rev 272 = $16.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 0 J106T,272,RC,27201456,CDM,,,,,,both,,,36.0000,5.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,15.01,,,,,,,9.2900,36.0000,percent of total billed charges,41.7% of $36.00 in Billed Charges for Rev 272 = $15.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 0 J106T,272,RC,27201456,CDM,,,,,,both,,,36.0000,5.4000,CIGNA HEALTHCARE,CIGNA PPO,15.01,,,,,,,9.2900,36.0000,percent of total billed charges,41.7% of $36.00 in Billed Charges for Rev 272 = $15.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 0 J106T,272,RC,27201456,CDM,,,,,,both,,,36.0000,5.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,32.40,,,,,,,9.2900,36.0000,percent of total billed charges,90% of $36.00 in Billed Charges for Rev 272 = $32.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 0 J106T,272,RC,27201456,CDM,,,,,,both,,,36.0000,5.4000,MEDCOST,MEDCOST VHN,17.13,,,,,,,9.2900,36.0000,percent of total billed charges,47.59% of $36.00 in Billed Charges for Rev 272 = $17.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 0 J106T,272,RC,27201456,CDM,,,,,,both,,,36.0000,5.4000,SENTARA HEALTH,SENTARA HEALTH,9.29,,,,,,,9.2900,36.0000,percent of total billed charges,25.81% of $36.00 in Billed Charges for Rev 272 = $9.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 0 J106T,272,RC,27201456,CDM,,,,,,both,,,36.0000,5.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",36.00,,,,,,,9.2900,36.0000,percent of total billed charges,100% of $36.00 in Billed Charges for Rev 272 = $36.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 0 J106T,272,RC,27201456,CDM,,,,,,both,,,36.0000,5.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,18.00,,,,,,,9.2900,36.0000,percent of total billed charges,Rev 272 $36.00 in Billed Charges at 50% = $18.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 0 J106T,272,RC,27201456,CDM,,,,,,both,,,36.0000,5.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,11.63,,,,,,,9.2900,36.0000,other,32.3% of $36.00 in Billed Charges for Rev 272 = $11.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE VICRYL 0 J106T,272,RC,27201456,CDM,,,,,,both,,,36.0000,5.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11.05,,,,,,,9.2900,36.0000,other,30.7% of $36.00 in Billed Charges for Rev 272 = $11.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE VICRYL 0 J106T,272,RC,27201456,CDM,,,,,,both,,,36.0000,5.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,11.63,,,,,,,9.2900,36.0000,percent of total billed charges,32.3% of $36.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 0 J106T,272,RC,27201456,CDM,,,,,,both,,,36.0000,5.4000,WELLCARE,WELLCARE MEDICAID,36.00,,,,,,,9.2900,36.0000,percent of total billed charges,100% of $36.00 in Billed Charges for Rev 272 = $36.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 3-0 J497G,272,RC,27201467,CDM,,,,,,both,,,28.0000,4.2000,AETNA,AETNA,11.96,,,,,,,7.2300,28.0000,percent of total billed charges,42.7% of $28.00 in Billed Charges for Rev 272 = $11.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 3-0 J497G,272,RC,27201467,CDM,,,,,,both,,,28.0000,4.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,19.60,,,,,,,7.2300,28.0000,percent of total billed charges,Rev 272 $28.00 in Billed Charges at 70% = $19.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 3-0 J497G,272,RC,27201467,CDM,,,,,,both,,,28.0000,4.2000,CIGNA HEALTHCARE,CIGNA HMO,11.68,,,,,,,7.2300,28.0000,percent of total billed charges,41.7% of $28.00 in Billed Charges for Rev 272 = $11.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 3-0 J497G,272,RC,27201467,CDM,,,,,,both,,,28.0000,4.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12.99,,,,,,,7.2300,28.0000,percent of total billed charges,46.4% of $28.00 in Billed Charges for Rev 272 = $12.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 3-0 J497G,272,RC,27201467,CDM,,,,,,both,,,28.0000,4.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11.68,,,,,,,7.2300,28.0000,percent of total billed charges,41.7% of $28.00 in Billed Charges for Rev 272 = $11.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 3-0 J497G,272,RC,27201467,CDM,,,,,,both,,,28.0000,4.2000,CIGNA HEALTHCARE,CIGNA PPO,11.68,,,,,,,7.2300,28.0000,percent of total billed charges,41.7% of $28.00 in Billed Charges for Rev 272 = $11.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 3-0 J497G,272,RC,27201467,CDM,,,,,,both,,,28.0000,4.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,25.20,,,,,,,7.2300,28.0000,percent of total billed charges,90% of $28.00 in Billed Charges for Rev 272 = $25.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 3-0 J497G,272,RC,27201467,CDM,,,,,,both,,,28.0000,4.2000,MEDCOST,MEDCOST VHN,13.33,,,,,,,7.2300,28.0000,percent of total billed charges,47.59% of $28.00 in Billed Charges for Rev 272 = $13.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 3-0 J497G,272,RC,27201467,CDM,,,,,,both,,,28.0000,4.2000,SENTARA HEALTH,SENTARA HEALTH,7.23,,,,,,,7.2300,28.0000,percent of total billed charges,25.81% of $28.00 in Billed Charges for Rev 272 = $7.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 3-0 J497G,272,RC,27201467,CDM,,,,,,both,,,28.0000,4.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",28.00,,,,,,,7.2300,28.0000,percent of total billed charges,100% of $28.00 in Billed Charges for Rev 272 = $28.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 3-0 J497G,272,RC,27201467,CDM,,,,,,both,,,28.0000,4.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14.00,,,,,,,7.2300,28.0000,percent of total billed charges,Rev 272 $28.00 in Billed Charges at 50% = $14.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 3-0 J497G,272,RC,27201467,CDM,,,,,,both,,,28.0000,4.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,9.04,,,,,,,7.2300,28.0000,other,32.3% of $28.00 in Billed Charges for Rev 272 = $9.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE VICRYL 3-0 J497G,272,RC,27201467,CDM,,,,,,both,,,28.0000,4.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,8.60,,,,,,,7.2300,28.0000,other,30.7% of $28.00 in Billed Charges for Rev 272 = $8.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE VICRYL 3-0 J497G,272,RC,27201467,CDM,,,,,,both,,,28.0000,4.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,9.04,,,,,,,7.2300,28.0000,percent of total billed charges,32.3% of $28.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 3-0 J497G,272,RC,27201467,CDM,,,,,,both,,,28.0000,4.2000,WELLCARE,WELLCARE MEDICAID,28.00,,,,,,,7.2300,28.0000,percent of total billed charges,100% of $28.00 in Billed Charges for Rev 272 = $28.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,AETNA,AETNA,1823.29,,,,,,,142.3200,4270.0000,percent of total billed charges,"42.7% of $4,270.00 in Billed Charges for Rev 341 Proc 78804 = $1,823.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1302.66,,,,,,,142.3200,4270.0000,fee schedule,"APG 00332 Proc 78804 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 104% = $1,302.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,492.62,,,,,,,142.3200,4270.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,AETNA,AETNA HEALTHCARE MEDICARE,492.62,,,,,,,142.3200,4270.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,492.62,,,,,,,142.3200,4270.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,AMBETTER,AMBETTER,1073.92,,,,,,,142.3200,4270.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,512.33,,,,,,,142.3200,4270.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,BLUE CROSS,ANTHEM EXCHANGE,1212.87,,,,,,,142.3200,4270.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1290.13,,,,,,,142.3200,4270.0000,fee schedule,"APG 00332 Proc 78804 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 103% = $1,290.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,BLUE CROSS,ANTHEM HMO,1288.60,,,,,,,142.3200,4270.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,507.40,,,,,,,142.3200,4270.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1515.92,,,,,,,142.3200,4270.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,165.19,,,,,,,142.3200,4270.0000,fee schedule,$165.19 from Fee Schedule BLDTM_23 for Rev 341 Proc 78804 * Qty 1 = $165.19 at 100% = $165.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,BLUE CROSS,BLUE CROSS E NETWORK,1511.07,,,,,,,142.3200,4270.0000,fee schedule,"$472.21 from Fee Schedule BCFSC for Rev 341 Proc 78804 * Qty 1 = $472.21 at 320% = $1,511.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,BLUE CROSS,BLUE CROSS MEDICARE,512.33,,,,,,,142.3200,4270.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,BLUE CROSS,BLUE CROSS P NETWORK,1544.13,,,,,,,142.3200,4270.0000,fee schedule,"$472.21 from Fee Schedule BCFSC for Rev 341 Proc 78804 * Qty 1 = $472.21 at 327% = $1,544.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,BLUE CROSS,BLUE CROSS S NETWORK,1544.13,,,,,,,142.3200,4270.0000,fee schedule,"$472.21 from Fee Schedule BCFSC for Rev 341 Proc 78804 * Qty 1 = $472.21 at 327% = $1,544.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,BLUE CROSS,TENNCARE BLUE CARE,142.32,,,,,,,142.3200,4270.0000,fee schedule,$122.69 from Fee Schedule TC_24 for Rev 341 Proc 78804 * Qty 1 = $122.69 at 116% = $142.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,BLUE CROSS,TENNCARE BLUE SELECT,142.32,,,,,,,142.3200,4270.0000,fee schedule,$122.69 from Fee Schedule TC_24 for Rev 341 Proc 78804 * Qty 1 = $122.69 at 116% = $142.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,CIGNA HEALTHCARE,CIGNA HMO,3725.39,,,,,,,142.3200,4270.0000,fee schedule,"$3,725.39 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78804 * Qty 1 = $3,725.39 at 100% = $3,725.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1012.45,,,,,,,142.3200,4270.0000,fee schedule,"$1,012.45 from Fee Schedule CGIFP_25LR for Rev 341 Proc 78804 * Qty 1 = $1,012.45 at 100% = $1,012.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,517.25,,,,,,,142.3200,4270.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3725.39,,,,,,,142.3200,4270.0000,fee schedule,"$3,725.39 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78804 * Qty 1 = $3,725.39 at 100% = $3,725.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,CIGNA HEALTHCARE,CIGNA PPO,3725.39,,,,,,,142.3200,4270.0000,fee schedule,"$3,725.39 from Fee Schedule CIGWHS_23 for Rev 341 Proc 78804 * Qty 1 = $3,725.39 at 100% = $3,725.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,517.25,,,,,,,142.3200,4270.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3843.00,,,,,,,142.3200,4270.0000,percent of total billed charges,"90% of $4,270.00 in Billed Charges for Rev 341 Proc 78804 = $3,843.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,HUMANA,HUMANA MEDICARE,492.62,,,,,,,142.3200,4270.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,492.62,,,,,,,142.3200,4270.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,MEDCOST,MEDCOST VHN,2032.09,,,,,,,142.3200,4270.0000,percent of total billed charges,"47.59% of $4,270.00 in Billed Charges for Rev 341 Proc 78804 = $2,032.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1315.19,,,,,,,142.3200,4270.0000,fee schedule,"APG 00332 Proc 78804 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 100% = $1,252.56... $1,252.56 at 105% = $1,315.19 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,517.25,,,,,,,142.3200,4270.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,517.25,,,,,,,142.3200,4270.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,NHC ADVANTAGE,NHC ADVANTAGE,517.25,,,,,,,142.3200,4270.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1291.39,,,,,,,142.3200,4270.0000,fee schedule,"APG 00332 Proc 78804 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 100% = $1,252.56... $1,252.56 at 103.1% = $1,291.39 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,SENTARA HEALTH,SENTARA HEALTH,1102.09,,,,,,,142.3200,4270.0000,percent of total billed charges,"25.81% of $4,270.00 in Billed Charges for Rev 341 Proc 78804 = $1,102.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,SENTARA HEALTH,SENTARA MEDICARE,492.62,,,,,,,142.3200,4270.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4270.00,,,,,,,142.3200,4270.0000,percent of total billed charges,"100% of $4,270.00 in Billed Charges for Rev 341 Proc 78804 = $4,270.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,492.16,,,,,,,142.3200,4270.0000,fee schedule,$984.31 from Fee Schedule TCUHC24 for Rev 341 Proc 78804 * Qty 1 = $984.31 at 50% = $492.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,810.00,,,,,,,142.3200,4270.0000,other,Rev 341 Proc 78804 1 Visit at $810.00 per Visit = $810.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,774.00,,,,,,,142.3200,4270.0000,other,Rev 341 Proc 78804 1 Visit at $774.00 per Visit = $774.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,1599.00,,,,,,,142.3200,4270.0000,other,"Rev 341 Proc 78804 1 Visit at $1,599.00 per Visit = $1,599.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1290.13,,,,,,,142.3200,4270.0000,fee schedule,"APG 00332 Proc 78804 at $836.60 (Base Rate) * 1.4972 (Relative Weight) = $1,252.56 (Total Line Payment) at 103% = $1,290.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,492.62,,,,,,,142.3200,4270.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,492.62,,,,,,,142.3200,4270.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,WELLCARE,WELLCARE MEDICAID,4270.00,,,,,,,142.3200,4270.0000,percent of total billed charges,"100% of $4,270.00 in Billed Charges for Rev 341 Proc 78804 = $4,270.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM TUMOR LOC/INFLAMM PROC/DIST RADIOPHARM AGENT PLNR WHOLE BODY 2+ DAYS IMG,78804,CPT,341,RC,34100063,CDM,,,,both,,,4270.0000,640.5000,WELLCARE,WELLCARE MEDICARE,522.18,,,,,,,142.3200,4270.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA,1287.41,,,,,,,37.4600,3015.0000,percent of total billed charges,"42.7% of $3,015.00 in Billed Charges for Rev 342 Proc 78808 = $1,287.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,495.24,,,,,,,37.4600,3015.0000,fee schedule,APG 00278 Proc 78808 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 104% = $495.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,362.70,,,,,,,37.4600,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,AETNA,AETNA HEALTHCARE MEDICARE,362.70,,,,,,,37.4600,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,362.70,,,,,,,37.4600,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,AMBETTER,AMBETTER,790.69,,,,,,,37.4600,3015.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,377.21,,,,,,,37.4600,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM EXCHANGE,893.00,,,,,,,37.4600,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,490.48,,,,,,,37.4600,3015.0000,fee schedule,APG 00278 Proc 78808 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 103% = $490.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM HMO,948.76,,,,,,,37.4600,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,373.58,,,,,,,37.4600,3015.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1116.13,,,,,,,37.4600,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,39.75,,,,,,,37.4600,3015.0000,fee schedule,$39.75 from Fee Schedule BLDTM_23 for Rev 342 Proc 78808 * Qty 1 = $39.75 at 100% = $39.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS E NETWORK,136.70,,,,,,,37.4600,3015.0000,fee schedule,$42.72 from Fee Schedule BCFSC for Rev 342 Proc 78808 * Qty 1 = $42.72 at 320% = $136.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS MEDICARE,377.21,,,,,,,37.4600,3015.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS P NETWORK,139.69,,,,,,,37.4600,3015.0000,fee schedule,$42.72 from Fee Schedule BCFSC for Rev 342 Proc 78808 * Qty 1 = $42.72 at 327% = $139.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,BLUE CROSS S NETWORK,139.69,,,,,,,37.4600,3015.0000,fee schedule,$42.72 from Fee Schedule BCFSC for Rev 342 Proc 78808 * Qty 1 = $42.72 at 327% = $139.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE CARE,37.46,,,,,,,37.4600,3015.0000,fee schedule,$32.29 from Fee Schedule TC_24 for Rev 342 Proc 78808 * Qty 1 = $32.29 at 116% = $37.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,BLUE CROSS,TENNCARE BLUE SELECT,37.46,,,,,,,37.4600,3015.0000,fee schedule,$32.29 from Fee Schedule TC_24 for Rev 342 Proc 78808 * Qty 1 = $32.29 at 116% = $37.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA HMO,605.98,,,,,,,37.4600,3015.0000,fee schedule,$605.98 from Fee Schedule CIGWHS_23 for Rev 342 Proc 78808 * Qty 1 = $605.98 at 100% = $605.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,697.24,,,,,,,37.4600,3015.0000,fee schedule,$697.24 from Fee Schedule CGIFP_25LR for Rev 342 Proc 78808 * Qty 1 = $697.24 at 100% = $697.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,380.84,,,,,,,37.4600,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,605.98,,,,,,,37.4600,3015.0000,fee schedule,$605.98 from Fee Schedule CIGWHS_23 for Rev 342 Proc 78808 * Qty 1 = $605.98 at 100% = $605.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,CIGNA HEALTHCARE,CIGNA PPO,605.98,,,,,,,37.4600,3015.0000,fee schedule,$605.98 from Fee Schedule CIGWHS_23 for Rev 342 Proc 78808 * Qty 1 = $605.98 at 100% = $605.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,380.84,,,,,,,37.4600,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2713.50,,,,,,,37.4600,3015.0000,percent of total billed charges,"90% of $3,015.00 in Billed Charges for Rev 342 Proc 78808 = $2,713.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,HUMANA,HUMANA MEDICARE,362.70,,,,,,,37.4600,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,362.70,,,,,,,37.4600,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,MEDCOST,MEDCOST VHN,1434.84,,,,,,,37.4600,3015.0000,percent of total billed charges,"47.59% of $3,015.00 in Billed Charges for Rev 342 Proc 78808 = $1,434.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,500.00,,,,,,,37.4600,3015.0000,fee schedule,APG 00278 Proc 78808 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 100% = $476.19... $476.19 at 105% = $500.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,380.84,,,,,,,37.4600,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,380.84,,,,,,,37.4600,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,NHC ADVANTAGE,NHC ADVANTAGE,380.84,,,,,,,37.4600,3015.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,490.95,,,,,,,37.4600,3015.0000,fee schedule,APG 00278 Proc 78808 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 100% = $476.19... $476.19 at 103.1% = $490.95 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA HEALTH,778.17,,,,,,,37.4600,3015.0000,percent of total billed charges,"25.81% of $3,015.00 in Billed Charges for Rev 342 Proc 78808 = $778.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,SENTARA HEALTH,SENTARA MEDICARE,362.70,,,,,,,37.4600,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3015.00,,,,,,,37.4600,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 342 Proc 78808 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,80.06,,,,,,,37.4600,3015.0000,fee schedule,$160.11 from Fee Schedule TCUHC24 for Rev 342 Proc 78808 * Qty 1 = $160.11 at 50% = $80.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,810.00,,,,,,,37.4600,3015.0000,other,Rev 342 Proc 78808 1 Visit at $810.00 per Visit = $810.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,774.00,,,,,,,37.4600,3015.0000,other,Rev 342 Proc 78808 1 Visit at $774.00 per Visit = $774.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1599.00,,,,,,,37.4600,3015.0000,other,"Rev 342 Proc 78808 1 Visit at $1,599.00 per Visit = $1,599.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,490.48,,,,,,,37.4600,3015.0000,fee schedule,APG 00278 Proc 78808 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 103% = $490.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,362.70,,,,,,,37.4600,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,362.70,,,,,,,37.4600,3015.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICAID,3015.00,,,,,,,37.4600,3015.0000,percent of total billed charges,"100% of $3,015.00 in Billed Charges for Rev 342 Proc 78808 = $3,015.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PARATHYROID INJ,78808,CPT,342,RC,34200002,CDM,,,,both,,,3015.0000,452.2500,WELLCARE,WELLCARE MEDICARE,384.46,,,,,,,37.4600,3015.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,AETNA,AETNA,4558.23,,,,,,,518.4800,10675.0000,percent of total billed charges,"42.7% of $10,675.00 in Billed Charges for Rev 404 Proc 78811 = $4,558.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1998.10,,,,,,,518.4800,10675.0000,fee schedule,"APG 00290 Proc 78811 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 104% = $1,998.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1174.60,,,,,,,518.4800,10675.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,AETNA,AETNA HEALTHCARE MEDICARE,1174.60,,,,,,,518.4800,10675.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,1174.60,,,,,,,518.4800,10675.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,AMBETTER,AMBETTER,2560.63,,,,,,,518.4800,10675.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1221.59,,,,,,,518.4800,10675.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,BLUE CROSS,ANTHEM EXCHANGE,2891.94,,,,,,,518.4800,10675.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1978.89,,,,,,,518.4800,10675.0000,fee schedule,"APG 00290 Proc 78811 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 103% = $1,978.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,BLUE CROSS,ANTHEM HMO,3072.51,,,,,,,518.4800,10675.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1209.84,,,,,,,518.4800,10675.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3614.53,,,,,,,518.4800,10675.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1839.01,,,,,,,518.4800,10675.0000,fee schedule,"$1,839.01 from Fee Schedule BLDTM_23 for Rev 404 Proc 78811 * Qty 1 = $1,839.01 at 100% = $1,839.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,BLUE CROSS,BLUE CROSS E NETWORK,3263.36,,,,,,,518.4800,10675.0000,fee schedule,"$1,019.80 from Fee Schedule BCFSC for Rev 404 Proc 78811 * Qty 1 = $1,019.80 at 320% = $3,263.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,BLUE CROSS,BLUE CROSS MEDICARE,1221.59,,,,,,,518.4800,10675.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,BLUE CROSS,BLUE CROSS P NETWORK,3334.75,,,,,,,518.4800,10675.0000,fee schedule,"$1,019.80 from Fee Schedule BCFSC for Rev 404 Proc 78811 * Qty 1 = $1,019.80 at 327% = $3,334.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,BLUE CROSS,BLUE CROSS S NETWORK,3334.75,,,,,,,518.4800,10675.0000,fee schedule,"$1,019.80 from Fee Schedule BCFSC for Rev 404 Proc 78811 * Qty 1 = $1,019.80 at 327% = $3,334.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,BLUE CROSS,TENNCARE BLUE CARE,877.32,,,,,,,518.4800,10675.0000,fee schedule,$756.31 from Fee Schedule TC_24 for Rev 404 Proc 78811 * Qty 1 = $756.31 at 116% = $877.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,BLUE CROSS,TENNCARE BLUE SELECT,877.32,,,,,,,518.4800,10675.0000,fee schedule,$756.31 from Fee Schedule TC_24 for Rev 404 Proc 78811 * Qty 1 = $756.31 at 116% = $877.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,CIGNA HEALTHCARE,CIGNA HMO,3924.62,,,,,,,518.4800,10675.0000,fee schedule,"$3,924.62 from Fee Schedule CIGWHS_23 for Rev 404 Proc 78811 * Qty 1 = $3,924.62 at 100% = $3,924.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,941.23,,,,,,,518.4800,10675.0000,fee schedule,$941.23 from Fee Schedule CGIFP_25LR for Rev 404 Proc 78811 * Qty 1 = $941.23 at 100% = $941.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,1233.33,,,,,,,518.4800,10675.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3924.62,,,,,,,518.4800,10675.0000,fee schedule,"$3,924.62 from Fee Schedule CIGWHS_23 for Rev 404 Proc 78811 * Qty 1 = $3,924.62 at 100% = $3,924.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,CIGNA HEALTHCARE,CIGNA PPO,3924.62,,,,,,,518.4800,10675.0000,fee schedule,"$3,924.62 from Fee Schedule CIGWHS_23 for Rev 404 Proc 78811 * Qty 1 = $3,924.62 at 100% = $3,924.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1233.33,,,,,,,518.4800,10675.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9607.50,,,,,,,518.4800,10675.0000,percent of total billed charges,"90% of $10,675.00 in Billed Charges for Rev 404 Proc 78811 = $9,607.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,HUMANA,HUMANA MEDICARE,1174.60,,,,,,,518.4800,10675.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1174.60,,,,,,,518.4800,10675.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,MEDCOST,MEDCOST VHN,5080.23,,,,,,,518.4800,10675.0000,percent of total billed charges,"47.59% of $10,675.00 in Billed Charges for Rev 404 Proc 78811 = $5,080.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2017.31,,,,,,,518.4800,10675.0000,fee schedule,"APG 00290 Proc 78811 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 100% = $1,921.25... $1,921.25 at 105% = $2,017.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1233.33,,,,,,,518.4800,10675.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1233.33,,,,,,,518.4800,10675.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,NHC ADVANTAGE,NHC ADVANTAGE,1233.33,,,,,,,518.4800,10675.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1980.81,,,,,,,518.4800,10675.0000,fee schedule,"APG 00290 Proc 78811 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 100% = $1,921.25... $1,921.25 at 103.1% = $1,980.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,SENTARA HEALTH,SENTARA HEALTH,2755.22,,,,,,,518.4800,10675.0000,percent of total billed charges,"25.81% of $10,675.00 in Billed Charges for Rev 404 Proc 78811 = $2,755.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,SENTARA HEALTH,SENTARA MEDICARE,1174.60,,,,,,,518.4800,10675.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10675.00,,,,,,,518.4800,10675.0000,percent of total billed charges,"100% of $10,675.00 in Billed Charges for Rev 404 Proc 78811 = $10,675.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,518.48,,,,,,,518.4800,10675.0000,fee schedule,"$1,036.95 from Fee Schedule TCUHC24 for Rev 404 Proc 78811 * Qty 1 = $1,036.95 at 50% = $518.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4136.00,,,,,,,518.4800,10675.0000,other,"Rev 404 Proc 78811 1 Visit at $4,136.00 per Visit = $4,136.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3957.00,,,,,,,518.4800,10675.0000,other,"Rev 404 Proc 78811 1 Visit at $3,957.00 per Visit = $3,957.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,6522.00,,,,,,,518.4800,10675.0000,other,"Rev 404 Proc 78811 1 Visit at $6,522.00 per Visit = $6,522.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1978.89,,,,,,,518.4800,10675.0000,fee schedule,"APG 00290 Proc 78811 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 103% = $1,978.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1174.60,,,,,,,518.4800,10675.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1174.60,,,,,,,518.4800,10675.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,WELLCARE,WELLCARE MEDICAID,10675.00,,,,,,,518.4800,10675.0000,percent of total billed charges,"100% of $10,675.00 in Billed Charges for Rev 404 Proc 78811 = $10,675.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET LTD AREA CHEST HEAD NECK,78811,CPT,404,RC,40400005,CDM,,,,both,,,10675.0000,1601.2500,WELLCARE,WELLCARE MEDICARE,1245.08,,,,,,,518.4800,10675.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,AETNA,AETNA,5014.26,,,,,,,518.4800,11743.0000,percent of total billed charges,"42.7% of $11,743.00 in Billed Charges for Rev 404 Proc 78812 = $5,014.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1998.10,,,,,,,518.4800,11743.0000,fee schedule,"APG 00290 Proc 78812 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 104% = $1,998.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1297.36,,,,,,,518.4800,11743.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,AETNA,AETNA HEALTHCARE MEDICARE,1297.36,,,,,,,518.4800,11743.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,1297.36,,,,,,,518.4800,11743.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,AMBETTER,AMBETTER,2828.23,,,,,,,518.4800,11743.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1349.25,,,,,,,518.4800,11743.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,BLUE CROSS,ANTHEM EXCHANGE,3194.16,,,,,,,518.4800,11743.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1978.89,,,,,,,518.4800,11743.0000,fee schedule,"APG 00290 Proc 78812 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 103% = $1,978.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,BLUE CROSS,ANTHEM HMO,3393.61,,,,,,,518.4800,11743.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1336.28,,,,,,,518.4800,11743.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3992.26,,,,,,,518.4800,11743.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1824.23,,,,,,,518.4800,11743.0000,fee schedule,"$1,824.23 from Fee Schedule BLDTM_23 for Rev 404 Proc 78812 * Qty 1 = $1,824.23 at 100% = $1,824.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,BLUE CROSS,BLUE CROSS E NETWORK,4895.07,,,,,,,518.4800,11743.0000,fee schedule,"$1,529.71 from Fee Schedule BCFSC for Rev 404 Proc 78812 * Qty 1 = $1,529.71 at 320% = $4,895.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,BLUE CROSS,BLUE CROSS MEDICARE,1349.25,,,,,,,518.4800,11743.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,BLUE CROSS,BLUE CROSS P NETWORK,5002.15,,,,,,,518.4800,11743.0000,fee schedule,"$1,529.71 from Fee Schedule BCFSC for Rev 404 Proc 78812 * Qty 1 = $1,529.71 at 327% = $5,002.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,BLUE CROSS,BLUE CROSS S NETWORK,5002.15,,,,,,,518.4800,11743.0000,fee schedule,"$1,529.71 from Fee Schedule BCFSC for Rev 404 Proc 78812 * Qty 1 = $1,529.71 at 327% = $5,002.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,BLUE CROSS,TENNCARE BLUE CARE,877.32,,,,,,,518.4800,11743.0000,fee schedule,$756.31 from Fee Schedule TC_24 for Rev 404 Proc 78812 * Qty 1 = $756.31 at 116% = $877.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,BLUE CROSS,TENNCARE BLUE SELECT,877.32,,,,,,,518.4800,11743.0000,fee schedule,$756.31 from Fee Schedule TC_24 for Rev 404 Proc 78812 * Qty 1 = $756.31 at 116% = $877.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,CIGNA HEALTHCARE,CIGNA HMO,3924.62,,,,,,,518.4800,11743.0000,fee schedule,"$3,924.62 from Fee Schedule CIGWHS_23 for Rev 404 Proc 78812 * Qty 1 = $3,924.62 at 100% = $3,924.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1188.72,,,,,,,518.4800,11743.0000,fee schedule,"$1,188.72 from Fee Schedule CGIFP_25LR for Rev 404 Proc 78812 * Qty 1 = $1,188.72 at 100% = $1,188.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,1362.22,,,,,,,518.4800,11743.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3924.62,,,,,,,518.4800,11743.0000,fee schedule,"$3,924.62 from Fee Schedule CIGWHS_23 for Rev 404 Proc 78812 * Qty 1 = $3,924.62 at 100% = $3,924.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,CIGNA HEALTHCARE,CIGNA PPO,3924.62,,,,,,,518.4800,11743.0000,fee schedule,"$3,924.62 from Fee Schedule CIGWHS_23 for Rev 404 Proc 78812 * Qty 1 = $3,924.62 at 100% = $3,924.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1362.22,,,,,,,518.4800,11743.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10568.70,,,,,,,518.4800,11743.0000,percent of total billed charges,"90% of $11,743.00 in Billed Charges for Rev 404 Proc 78812 = $10,568.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,HUMANA,HUMANA MEDICARE,1297.36,,,,,,,518.4800,11743.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1297.36,,,,,,,518.4800,11743.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,MEDCOST,MEDCOST VHN,5588.49,,,,,,,518.4800,11743.0000,percent of total billed charges,"47.59% of $11,743.00 in Billed Charges for Rev 404 Proc 78812 = $5,588.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2017.31,,,,,,,518.4800,11743.0000,fee schedule,"APG 00290 Proc 78812 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 100% = $1,921.25... $1,921.25 at 105% = $2,017.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1362.22,,,,,,,518.4800,11743.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1362.22,,,,,,,518.4800,11743.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,NHC ADVANTAGE,NHC ADVANTAGE,1362.22,,,,,,,518.4800,11743.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1980.81,,,,,,,518.4800,11743.0000,fee schedule,"APG 00290 Proc 78812 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 100% = $1,921.25... $1,921.25 at 103.1% = $1,980.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,SENTARA HEALTH,SENTARA HEALTH,3030.87,,,,,,,518.4800,11743.0000,percent of total billed charges,"25.81% of $11,743.00 in Billed Charges for Rev 404 Proc 78812 = $3,030.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,SENTARA HEALTH,SENTARA MEDICARE,1297.36,,,,,,,518.4800,11743.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11743.00,,,,,,,518.4800,11743.0000,percent of total billed charges,"100% of $11,743.00 in Billed Charges for Rev 404 Proc 78812 = $11,743.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,518.48,,,,,,,518.4800,11743.0000,fee schedule,"$1,036.95 from Fee Schedule TCUHC24 for Rev 404 Proc 78812 * Qty 1 = $1,036.95 at 50% = $518.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4136.00,,,,,,,518.4800,11743.0000,other,"Rev 404 Proc 78812 1 Visit at $4,136.00 per Visit = $4,136.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3957.00,,,,,,,518.4800,11743.0000,other,"Rev 404 Proc 78812 1 Visit at $3,957.00 per Visit = $3,957.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,6522.00,,,,,,,518.4800,11743.0000,other,"Rev 404 Proc 78812 1 Visit at $6,522.00 per Visit = $6,522.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1978.89,,,,,,,518.4800,11743.0000,fee schedule,"APG 00290 Proc 78812 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 103% = $1,978.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1297.36,,,,,,,518.4800,11743.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1297.36,,,,,,,518.4800,11743.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,WELLCARE,WELLCARE MEDICAID,11743.00,,,,,,,518.4800,11743.0000,percent of total billed charges,"100% of $11,743.00 in Billed Charges for Rev 404 Proc 78812 = $11,743.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET SKULL BASE TO MID THIGH,78812,CPT,404,RC,40400006,CDM,,,,both,,,11743.0000,1761.4500,WELLCARE,WELLCARE MEDICARE,1375.20,,,,,,,518.4800,11743.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,AETNA,AETNA,4000.99,,,,,,,518.4800,9370.0000,percent of total billed charges,"42.7% of $9,370.00 in Billed Charges for Rev 404 Proc 78814 = $4,000.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1998.10,,,,,,,518.4800,9370.0000,fee schedule,"APG 00290 Proc 78814 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 104% = $1,998.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1297.36,,,,,,,518.4800,9370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,AETNA,AETNA HEALTHCARE MEDICARE,1297.36,,,,,,,518.4800,9370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,1297.36,,,,,,,518.4800,9370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,AMBETTER,AMBETTER,2828.23,,,,,,,518.4800,9370.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1349.25,,,,,,,518.4800,9370.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,BLUE CROSS,ANTHEM EXCHANGE,3194.16,,,,,,,518.4800,9370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1978.89,,,,,,,518.4800,9370.0000,fee schedule,"APG 00290 Proc 78814 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 103% = $1,978.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,BLUE CROSS,ANTHEM HMO,3393.61,,,,,,,518.4800,9370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1336.28,,,,,,,518.4800,9370.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3992.26,,,,,,,518.4800,9370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1814.00,,,,,,,518.4800,9370.0000,fee schedule,"$1,814.00 from Fee Schedule BLDTM_23 for Rev 404 Proc 78814 * Qty 1 = $1,814.00 at 100% = $1,814.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,BLUE CROSS,BLUE CROSS E NETWORK,3263.36,,,,,,,518.4800,9370.0000,fee schedule,"$1,019.80 from Fee Schedule BCFSC for Rev 404 Proc 78814 * Qty 1 = $1,019.80 at 320% = $3,263.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,BLUE CROSS,BLUE CROSS MEDICARE,1349.25,,,,,,,518.4800,9370.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,BLUE CROSS,BLUE CROSS P NETWORK,3334.75,,,,,,,518.4800,9370.0000,fee schedule,"$1,019.80 from Fee Schedule BCFSC for Rev 404 Proc 78814 * Qty 1 = $1,019.80 at 327% = $3,334.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,BLUE CROSS,BLUE CROSS S NETWORK,3334.75,,,,,,,518.4800,9370.0000,fee schedule,"$1,019.80 from Fee Schedule BCFSC for Rev 404 Proc 78814 * Qty 1 = $1,019.80 at 327% = $3,334.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,BLUE CROSS,TENNCARE BLUE CARE,877.32,,,,,,,518.4800,9370.0000,fee schedule,$756.31 from Fee Schedule TC_24 for Rev 404 Proc 78814 * Qty 1 = $756.31 at 116% = $877.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,BLUE CROSS,TENNCARE BLUE SELECT,877.32,,,,,,,518.4800,9370.0000,fee schedule,$756.31 from Fee Schedule TC_24 for Rev 404 Proc 78814 * Qty 1 = $756.31 at 116% = $877.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,CIGNA HEALTHCARE,CIGNA HMO,3924.62,,,,,,,518.4800,9370.0000,fee schedule,"$3,924.62 from Fee Schedule CIGWHS_23 for Rev 404 Proc 78814 * Qty 1 = $3,924.62 at 100% = $3,924.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1346.49,,,,,,,518.4800,9370.0000,fee schedule,"$1,346.49 from Fee Schedule CGIFP_25LR for Rev 404 Proc 78814 * Qty 1 = $1,346.49 at 100% = $1,346.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,1362.22,,,,,,,518.4800,9370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3924.62,,,,,,,518.4800,9370.0000,fee schedule,"$3,924.62 from Fee Schedule CIGWHS_23 for Rev 404 Proc 78814 * Qty 1 = $3,924.62 at 100% = $3,924.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,CIGNA HEALTHCARE,CIGNA PPO,3924.62,,,,,,,518.4800,9370.0000,fee schedule,"$3,924.62 from Fee Schedule CIGWHS_23 for Rev 404 Proc 78814 * Qty 1 = $3,924.62 at 100% = $3,924.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1362.22,,,,,,,518.4800,9370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8433.00,,,,,,,518.4800,9370.0000,percent of total billed charges,"90% of $9,370.00 in Billed Charges for Rev 404 Proc 78814 = $8,433.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,HUMANA,HUMANA MEDICARE,1297.36,,,,,,,518.4800,9370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1297.36,,,,,,,518.4800,9370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,MEDCOST,MEDCOST VHN,4459.18,,,,,,,518.4800,9370.0000,percent of total billed charges,"47.59% of $9,370.00 in Billed Charges for Rev 404 Proc 78814 = $4,459.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2017.31,,,,,,,518.4800,9370.0000,fee schedule,"APG 00290 Proc 78814 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 100% = $1,921.25... $1,921.25 at 105% = $2,017.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1362.22,,,,,,,518.4800,9370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1362.22,,,,,,,518.4800,9370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,NHC ADVANTAGE,NHC ADVANTAGE,1362.22,,,,,,,518.4800,9370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1980.81,,,,,,,518.4800,9370.0000,fee schedule,"APG 00290 Proc 78814 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 100% = $1,921.25... $1,921.25 at 103.1% = $1,980.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,SENTARA HEALTH,SENTARA HEALTH,2418.40,,,,,,,518.4800,9370.0000,percent of total billed charges,"25.81% of $9,370.00 in Billed Charges for Rev 404 Proc 78814 = $2,418.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,SENTARA HEALTH,SENTARA MEDICARE,1297.36,,,,,,,518.4800,9370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9370.00,,,,,,,518.4800,9370.0000,percent of total billed charges,"100% of $9,370.00 in Billed Charges for Rev 404 Proc 78814 = $9,370.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,518.48,,,,,,,518.4800,9370.0000,fee schedule,"$1,036.95 from Fee Schedule TCUHC24 for Rev 404 Proc 78814 * Qty 1 = $1,036.95 at 50% = $518.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4136.00,,,,,,,518.4800,9370.0000,other,"Rev 404 Proc 78814 1 Visit at $4,136.00 per Visit = $4,136.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3957.00,,,,,,,518.4800,9370.0000,other,"Rev 404 Proc 78814 1 Visit at $3,957.00 per Visit = $3,957.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,6522.00,,,,,,,518.4800,9370.0000,other,"Rev 404 Proc 78814 1 Visit at $6,522.00 per Visit = $6,522.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1978.89,,,,,,,518.4800,9370.0000,fee schedule,"APG 00290 Proc 78814 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 103% = $1,978.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1297.36,,,,,,,518.4800,9370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1297.36,,,,,,,518.4800,9370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,WELLCARE,WELLCARE MEDICAID,9370.00,,,,,,,518.4800,9370.0000,percent of total billed charges,"100% of $9,370.00 in Billed Charges for Rev 404 Proc 78814 = $9,370.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET CT LIMITED,78814,CPT,404,RC,40400008,CDM,,,,both,,,9370.0000,1405.5000,WELLCARE,WELLCARE MEDICARE,1375.20,,,,,,,518.4800,9370.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,AETNA,AETNA,4594.52,,,,,,,518.4800,10760.0000,percent of total billed charges,"42.7% of $10,760.00 in Billed Charges for Rev 404 Proc 78816 = $4,594.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1998.10,,,,,,,518.4800,10760.0000,fee schedule,"APG 00290 Proc 78816 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 104% = $1,998.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1297.36,,,,,,,518.4800,10760.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,AETNA,AETNA HEALTHCARE MEDICARE,1297.36,,,,,,,518.4800,10760.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,ALLCARE MEDICARE,ALLCARE MEDICARE,1297.36,,,,,,,518.4800,10760.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,AMBETTER,AMBETTER,2828.23,,,,,,,518.4800,10760.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1349.25,,,,,,,518.4800,10760.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,BLUE CROSS,ANTHEM EXCHANGE,3194.16,,,,,,,518.4800,10760.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1978.89,,,,,,,518.4800,10760.0000,fee schedule,"APG 00290 Proc 78816 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 103% = $1,978.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,BLUE CROSS,ANTHEM HMO,3393.61,,,,,,,518.4800,10760.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1336.28,,,,,,,518.4800,10760.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3992.26,,,,,,,518.4800,10760.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1802.63,,,,,,,518.4800,10760.0000,fee schedule,"$1,802.63 from Fee Schedule BLDTM_23 for Rev 404 Proc 78816 * Qty 1 = $1,802.63 at 100% = $1,802.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,BLUE CROSS,BLUE CROSS E NETWORK,6526.78,,,,,,,518.4800,10760.0000,fee schedule,"$2,039.62 from Fee Schedule BCFSC for Rev 404 Proc 78816 * Qty 1 = $2,039.62 at 320% = $6,526.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,BLUE CROSS,BLUE CROSS MEDICARE,1349.25,,,,,,,518.4800,10760.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,BLUE CROSS,BLUE CROSS P NETWORK,6669.56,,,,,,,518.4800,10760.0000,fee schedule,"$2,039.62 from Fee Schedule BCFSC for Rev 404 Proc 78816 * Qty 1 = $2,039.62 at 327% = $6,669.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,BLUE CROSS,BLUE CROSS S NETWORK,6669.56,,,,,,,518.4800,10760.0000,fee schedule,"$2,039.62 from Fee Schedule BCFSC for Rev 404 Proc 78816 * Qty 1 = $2,039.62 at 327% = $6,669.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,BLUE CROSS,TENNCARE BLUE CARE,877.32,,,,,,,518.4800,10760.0000,fee schedule,$756.31 from Fee Schedule TC_24 for Rev 404 Proc 78816 * Qty 1 = $756.31 at 116% = $877.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,BLUE CROSS,TENNCARE BLUE SELECT,877.32,,,,,,,518.4800,10760.0000,fee schedule,$756.31 from Fee Schedule TC_24 for Rev 404 Proc 78816 * Qty 1 = $756.31 at 116% = $877.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,CIGNA HEALTHCARE,CIGNA HMO,3924.62,,,,,,,518.4800,10760.0000,fee schedule,"$3,924.62 from Fee Schedule CIGWHS_23 for Rev 404 Proc 78816 * Qty 1 = $3,924.62 at 100% = $3,924.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1513.03,,,,,,,518.4800,10760.0000,fee schedule,"$1,513.03 from Fee Schedule CGIFP_25LR for Rev 404 Proc 78816 * Qty 1 = $1,513.03 at 100% = $1,513.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,CIGNA HEALTHCARE,CIGNA MEDICARE,1362.22,,,,,,,518.4800,10760.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3924.62,,,,,,,518.4800,10760.0000,fee schedule,"$3,924.62 from Fee Schedule CIGWHS_23 for Rev 404 Proc 78816 * Qty 1 = $3,924.62 at 100% = $3,924.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,CIGNA HEALTHCARE,CIGNA PPO,3924.62,,,,,,,518.4800,10760.0000,fee schedule,"$3,924.62 from Fee Schedule CIGWHS_23 for Rev 404 Proc 78816 * Qty 1 = $3,924.62 at 100% = $3,924.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1362.22,,,,,,,518.4800,10760.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9684.00,,,,,,,518.4800,10760.0000,percent of total billed charges,"90% of $10,760.00 in Billed Charges for Rev 404 Proc 78816 = $9,684.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,HUMANA,HUMANA MEDICARE,1297.36,,,,,,,518.4800,10760.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1297.36,,,,,,,518.4800,10760.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,MEDCOST,MEDCOST VHN,5120.68,,,,,,,518.4800,10760.0000,percent of total billed charges,"47.59% of $10,760.00 in Billed Charges for Rev 404 Proc 78816 = $5,120.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2017.31,,,,,,,518.4800,10760.0000,fee schedule,"APG 00290 Proc 78816 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 100% = $1,921.25... $1,921.25 at 105% = $2,017.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1362.22,,,,,,,518.4800,10760.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1362.22,,,,,,,518.4800,10760.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,NHC ADVANTAGE,NHC ADVANTAGE,1362.22,,,,,,,518.4800,10760.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1980.81,,,,,,,518.4800,10760.0000,fee schedule,"APG 00290 Proc 78816 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 100% = $1,921.25... $1,921.25 at 103.1% = $1,980.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,SENTARA HEALTH,SENTARA HEALTH,2777.16,,,,,,,518.4800,10760.0000,percent of total billed charges,"25.81% of $10,760.00 in Billed Charges for Rev 404 Proc 78816 = $2,777.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,SENTARA HEALTH,SENTARA MEDICARE,1297.36,,,,,,,518.4800,10760.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10760.00,,,,,,,518.4800,10760.0000,percent of total billed charges,"100% of $10,760.00 in Billed Charges for Rev 404 Proc 78816 = $10,760.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,518.48,,,,,,,518.4800,10760.0000,fee schedule,"$1,036.95 from Fee Schedule TCUHC24 for Rev 404 Proc 78816 * Qty 1 = $1,036.95 at 50% = $518.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4136.00,,,,,,,518.4800,10760.0000,other,"Rev 404 Proc 78816 1 Visit at $4,136.00 per Visit = $4,136.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3957.00,,,,,,,518.4800,10760.0000,other,"Rev 404 Proc 78816 1 Visit at $3,957.00 per Visit = $3,957.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,6522.00,,,,,,,518.4800,10760.0000,other,"Rev 404 Proc 78816 1 Visit at $6,522.00 per Visit = $6,522.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1978.89,,,,,,,518.4800,10760.0000,fee schedule,"APG 00290 Proc 78816 at $836.60 (Base Rate) * 2.2965 (Relative Weight) = $1,921.25 (Total Line Payment) at 103% = $1,978.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1297.36,,,,,,,518.4800,10760.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1297.36,,,,,,,518.4800,10760.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,WELLCARE,WELLCARE MEDICAID,10760.00,,,,,,,518.4800,10760.0000,percent of total billed charges,"100% of $10,760.00 in Billed Charges for Rev 404 Proc 78816 = $10,760.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NM PET CT WHOLE BODY,78816,CPT,404,RC,40400010,CDM,,,,both,,,10760.0000,1614.0000,WELLCARE,WELLCARE MEDICARE,1375.20,,,,,,,518.4800,10760.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEROIN METABOLITE,80356,CPT,301,RC,30100393,CDM,,,,both,,,180.0000,27.0000,AETNA,AETNA,76.86,,,,,,,16.2000,180.0000,percent of total billed charges,42.7% of $180.00 in Billed Charges for Rev 301 Proc 80356 = $76.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEROIN METABOLITE,80356,CPT,301,RC,30100393,CDM,,,,both,,,180.0000,27.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,16.36,,,,,,,16.2000,180.0000,fee schedule,APG 02040 Proc 80356 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 104% = $16.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEROIN METABOLITE,80356,CPT,301,RC,30100393,CDM,,,,both,,,180.0000,27.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,16.20,,,,,,,16.2000,180.0000,fee schedule,APG 02040 Proc 80356 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEROIN METABOLITE,80356,CPT,301,RC,30100393,CDM,,,,both,,,180.0000,27.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,126.00,,,,,,,16.2000,180.0000,percent of total billed charges,Rev 301 Proc 80356 $180.00 in Billed Charges at 70% = $126.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEROIN METABOLITE,80356,CPT,301,RC,30100393,CDM,,,,both,,,180.0000,27.0000,CIGNA HEALTHCARE,CIGNA HMO,75.06,,,,,,,16.2000,180.0000,percent of total billed charges,Rev 301 Proc 80356 $180.00 in Billed Charges at 41.7% = $75.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEROIN METABOLITE,80356,CPT,301,RC,30100393,CDM,,,,both,,,180.0000,27.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,77.04,,,,,,,16.2000,180.0000,percent of total billed charges,Rev 301 Proc 80356 $180.00 in Billed Charges at 42.8% = $77.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEROIN METABOLITE,80356,CPT,301,RC,30100393,CDM,,,,both,,,180.0000,27.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,75.06,,,,,,,16.2000,180.0000,percent of total billed charges,Rev 301 Proc 80356 $180.00 in Billed Charges at 41.7% = $75.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEROIN METABOLITE,80356,CPT,301,RC,30100393,CDM,,,,both,,,180.0000,27.0000,CIGNA HEALTHCARE,CIGNA PPO,75.06,,,,,,,16.2000,180.0000,percent of total billed charges,Rev 301 Proc 80356 $180.00 in Billed Charges at 41.7% = $75.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEROIN METABOLITE,80356,CPT,301,RC,30100393,CDM,,,,both,,,180.0000,27.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,162.00,,,,,,,16.2000,180.0000,percent of total billed charges,90% of $180.00 in Billed Charges for Rev 301 Proc 80356 = $162.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEROIN METABOLITE,80356,CPT,301,RC,30100393,CDM,,,,both,,,180.0000,27.0000,MEDCOST,MEDCOST VHN,85.66,,,,,,,16.2000,180.0000,percent of total billed charges,47.59% of $180.00 in Billed Charges for Rev 301 Proc 80356 = $85.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEROIN METABOLITE,80356,CPT,301,RC,30100393,CDM,,,,both,,,180.0000,27.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,16.52,,,,,,,16.2000,180.0000,fee schedule,APG 02040 Proc 80356 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 105% = $16.52 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEROIN METABOLITE,80356,CPT,301,RC,30100393,CDM,,,,both,,,180.0000,27.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,16.22,,,,,,,16.2000,180.0000,fee schedule,APG 02040 Proc 80356 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 103.1% = $16.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEROIN METABOLITE,80356,CPT,301,RC,30100393,CDM,,,,both,,,180.0000,27.0000,SENTARA HEALTH,SENTARA HEALTH,46.46,,,,,,,16.2000,180.0000,percent of total billed charges,25.81% of $180.00 in Billed Charges for Rev 301 Proc 80356 = $46.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEROIN METABOLITE,80356,CPT,301,RC,30100393,CDM,,,,both,,,180.0000,27.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",180.00,,,,,,,16.2000,180.0000,percent of total billed charges,100% of $180.00 in Billed Charges for Rev 301 Proc 80356 = $180.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEROIN METABOLITE,80356,CPT,301,RC,30100393,CDM,,,,both,,,180.0000,27.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,16.20,,,,,,,16.2000,180.0000,fee schedule,APG 02040 Proc 80356 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEROIN METABOLITE,80356,CPT,301,RC,30100393,CDM,,,,both,,,180.0000,27.0000,WELLCARE,WELLCARE MEDICAID,180.00,,,,,,,16.2000,180.0000,percent of total billed charges,100% of $180.00 in Billed Charges for Rev 301 Proc 80356 = $180.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KETAMINE AND NORKETAMINE,80357,CPT,301,RC,30100394,CDM,,,,both,,,135.0000,20.2500,AETNA,AETNA,57.65,,,,,,,16.2000,135.0000,percent of total billed charges,42.7% of $135.00 in Billed Charges for Rev 301 Proc 80357 = $57.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KETAMINE AND NORKETAMINE,80357,CPT,301,RC,30100394,CDM,,,,both,,,135.0000,20.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,16.36,,,,,,,16.2000,135.0000,fee schedule,APG 02040 Proc 80357 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 104% = $16.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KETAMINE AND NORKETAMINE,80357,CPT,301,RC,30100394,CDM,,,,both,,,135.0000,20.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,16.20,,,,,,,16.2000,135.0000,fee schedule,APG 02040 Proc 80357 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KETAMINE AND NORKETAMINE,80357,CPT,301,RC,30100394,CDM,,,,both,,,135.0000,20.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,94.50,,,,,,,16.2000,135.0000,percent of total billed charges,Rev 301 Proc 80357 $135.00 in Billed Charges at 70% = $94.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KETAMINE AND NORKETAMINE,80357,CPT,301,RC,30100394,CDM,,,,both,,,135.0000,20.2500,CIGNA HEALTHCARE,CIGNA HMO,56.30,,,,,,,16.2000,135.0000,percent of total billed charges,Rev 301 Proc 80357 $135.00 in Billed Charges at 41.7% = $56.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KETAMINE AND NORKETAMINE,80357,CPT,301,RC,30100394,CDM,,,,both,,,135.0000,20.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,57.78,,,,,,,16.2000,135.0000,percent of total billed charges,Rev 301 Proc 80357 $135.00 in Billed Charges at 42.8% = $57.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KETAMINE AND NORKETAMINE,80357,CPT,301,RC,30100394,CDM,,,,both,,,135.0000,20.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,56.30,,,,,,,16.2000,135.0000,percent of total billed charges,Rev 301 Proc 80357 $135.00 in Billed Charges at 41.7% = $56.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KETAMINE AND NORKETAMINE,80357,CPT,301,RC,30100394,CDM,,,,both,,,135.0000,20.2500,CIGNA HEALTHCARE,CIGNA PPO,56.30,,,,,,,16.2000,135.0000,percent of total billed charges,Rev 301 Proc 80357 $135.00 in Billed Charges at 41.7% = $56.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KETAMINE AND NORKETAMINE,80357,CPT,301,RC,30100394,CDM,,,,both,,,135.0000,20.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,121.50,,,,,,,16.2000,135.0000,percent of total billed charges,90% of $135.00 in Billed Charges for Rev 301 Proc 80357 = $121.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KETAMINE AND NORKETAMINE,80357,CPT,301,RC,30100394,CDM,,,,both,,,135.0000,20.2500,MEDCOST,MEDCOST VHN,64.25,,,,,,,16.2000,135.0000,percent of total billed charges,47.59% of $135.00 in Billed Charges for Rev 301 Proc 80357 = $64.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KETAMINE AND NORKETAMINE,80357,CPT,301,RC,30100394,CDM,,,,both,,,135.0000,20.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,16.52,,,,,,,16.2000,135.0000,fee schedule,APG 02040 Proc 80357 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 105% = $16.52 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KETAMINE AND NORKETAMINE,80357,CPT,301,RC,30100394,CDM,,,,both,,,135.0000,20.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,16.22,,,,,,,16.2000,135.0000,fee schedule,APG 02040 Proc 80357 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 103.1% = $16.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KETAMINE AND NORKETAMINE,80357,CPT,301,RC,30100394,CDM,,,,both,,,135.0000,20.2500,SENTARA HEALTH,SENTARA HEALTH,34.84,,,,,,,16.2000,135.0000,percent of total billed charges,25.81% of $135.00 in Billed Charges for Rev 301 Proc 80357 = $34.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KETAMINE AND NORKETAMINE,80357,CPT,301,RC,30100394,CDM,,,,both,,,135.0000,20.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",135.00,,,,,,,16.2000,135.0000,percent of total billed charges,100% of $135.00 in Billed Charges for Rev 301 Proc 80357 = $135.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KETAMINE AND NORKETAMINE,80357,CPT,301,RC,30100394,CDM,,,,both,,,135.0000,20.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,16.20,,,,,,,16.2000,135.0000,fee schedule,APG 02040 Proc 80357 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KETAMINE AND NORKETAMINE,80357,CPT,301,RC,30100394,CDM,,,,both,,,135.0000,20.2500,WELLCARE,WELLCARE MEDICAID,135.00,,,,,,,16.2000,135.0000,percent of total billed charges,100% of $135.00 in Billed Charges for Rev 301 Proc 80357 = $135.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHADONE,80358,CPT,301,RC,30100395,CDM,,,,both,,,82.0000,12.3000,AETNA,AETNA,35.01,,,,,,,16.2000,82.0000,percent of total billed charges,42.7% of $82.00 in Billed Charges for Rev 301 Proc 80358 = $35.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHADONE,80358,CPT,301,RC,30100395,CDM,,,,both,,,82.0000,12.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,16.36,,,,,,,16.2000,82.0000,fee schedule,APG 02040 Proc 80358 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 104% = $16.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHADONE,80358,CPT,301,RC,30100395,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,16.20,,,,,,,16.2000,82.0000,fee schedule,APG 02040 Proc 80358 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHADONE,80358,CPT,301,RC,30100395,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,57.40,,,,,,,16.2000,82.0000,percent of total billed charges,Rev 301 Proc 80358 $82.00 in Billed Charges at 70% = $57.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHADONE,80358,CPT,301,RC,30100395,CDM,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA HMO,34.19,,,,,,,16.2000,82.0000,percent of total billed charges,Rev 301 Proc 80358 $82.00 in Billed Charges at 41.7% = $34.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHADONE,80358,CPT,301,RC,30100395,CDM,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,35.10,,,,,,,16.2000,82.0000,percent of total billed charges,Rev 301 Proc 80358 $82.00 in Billed Charges at 42.8% = $35.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHADONE,80358,CPT,301,RC,30100395,CDM,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,34.19,,,,,,,16.2000,82.0000,percent of total billed charges,Rev 301 Proc 80358 $82.00 in Billed Charges at 41.7% = $34.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHADONE,80358,CPT,301,RC,30100395,CDM,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA PPO,34.19,,,,,,,16.2000,82.0000,percent of total billed charges,Rev 301 Proc 80358 $82.00 in Billed Charges at 41.7% = $34.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHADONE,80358,CPT,301,RC,30100395,CDM,,,,both,,,82.0000,12.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,73.80,,,,,,,16.2000,82.0000,percent of total billed charges,90% of $82.00 in Billed Charges for Rev 301 Proc 80358 = $73.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHADONE,80358,CPT,301,RC,30100395,CDM,,,,both,,,82.0000,12.3000,MEDCOST,MEDCOST VHN,39.02,,,,,,,16.2000,82.0000,percent of total billed charges,47.59% of $82.00 in Billed Charges for Rev 301 Proc 80358 = $39.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHADONE,80358,CPT,301,RC,30100395,CDM,,,,both,,,82.0000,12.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,16.52,,,,,,,16.2000,82.0000,fee schedule,APG 02040 Proc 80358 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 105% = $16.52 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHADONE,80358,CPT,301,RC,30100395,CDM,,,,both,,,82.0000,12.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,16.22,,,,,,,16.2000,82.0000,fee schedule,APG 02040 Proc 80358 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 103.1% = $16.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHADONE,80358,CPT,301,RC,30100395,CDM,,,,both,,,82.0000,12.3000,SENTARA HEALTH,SENTARA HEALTH,21.16,,,,,,,16.2000,82.0000,percent of total billed charges,25.81% of $82.00 in Billed Charges for Rev 301 Proc 80358 = $21.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHADONE,80358,CPT,301,RC,30100395,CDM,,,,both,,,82.0000,12.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",82.00,,,,,,,16.2000,82.0000,percent of total billed charges,100% of $82.00 in Billed Charges for Rev 301 Proc 80358 = $82.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHADONE,80358,CPT,301,RC,30100395,CDM,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,16.20,,,,,,,16.2000,82.0000,fee schedule,APG 02040 Proc 80358 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHADONE,80358,CPT,301,RC,30100395,CDM,,,,both,,,82.0000,12.3000,WELLCARE,WELLCARE MEDICAID,82.00,,,,,,,16.2000,82.0000,percent of total billed charges,100% of $82.00 in Billed Charges for Rev 301 Proc 80358 = $82.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VASC CLOSURE VASCADE 5FR 700-500DX-05U TO 6/7FR 700-5801-05U,272,RC,27201841,CDM,,,,,,both,,,814.0000,122.1000,AETNA,AETNA,347.58,,,,,,,210.0900,814.0000,percent of total billed charges,42.7% of $814.00 in Billed Charges for Rev 272 = $347.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VASC CLOSURE VASCADE 5FR 700-500DX-05U TO 6/7FR 700-5801-05U,272,RC,27201841,CDM,,,,,,both,,,814.0000,122.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,569.80,,,,,,,210.0900,814.0000,percent of total billed charges,Rev 272 $814.00 in Billed Charges at 70% = $569.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VASC CLOSURE VASCADE 5FR 700-500DX-05U TO 6/7FR 700-5801-05U,272,RC,27201841,CDM,,,,,,both,,,814.0000,122.1000,CIGNA HEALTHCARE,CIGNA HMO,339.44,,,,,,,210.0900,814.0000,percent of total billed charges,41.7% of $814.00 in Billed Charges for Rev 272 = $339.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VASC CLOSURE VASCADE 5FR 700-500DX-05U TO 6/7FR 700-5801-05U,272,RC,27201841,CDM,,,,,,both,,,814.0000,122.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,377.70,,,,,,,210.0900,814.0000,percent of total billed charges,46.4% of $814.00 in Billed Charges for Rev 272 = $377.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VASC CLOSURE VASCADE 5FR 700-500DX-05U TO 6/7FR 700-5801-05U,272,RC,27201841,CDM,,,,,,both,,,814.0000,122.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,339.44,,,,,,,210.0900,814.0000,percent of total billed charges,41.7% of $814.00 in Billed Charges for Rev 272 = $339.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VASC CLOSURE VASCADE 5FR 700-500DX-05U TO 6/7FR 700-5801-05U,272,RC,27201841,CDM,,,,,,both,,,814.0000,122.1000,CIGNA HEALTHCARE,CIGNA PPO,339.44,,,,,,,210.0900,814.0000,percent of total billed charges,41.7% of $814.00 in Billed Charges for Rev 272 = $339.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VASC CLOSURE VASCADE 5FR 700-500DX-05U TO 6/7FR 700-5801-05U,272,RC,27201841,CDM,,,,,,both,,,814.0000,122.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,732.60,,,,,,,210.0900,814.0000,percent of total billed charges,90% of $814.00 in Billed Charges for Rev 272 = $732.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VASC CLOSURE VASCADE 5FR 700-500DX-05U TO 6/7FR 700-5801-05U,272,RC,27201841,CDM,,,,,,both,,,814.0000,122.1000,MEDCOST,MEDCOST VHN,387.38,,,,,,,210.0900,814.0000,percent of total billed charges,47.59% of $814.00 in Billed Charges for Rev 272 = $387.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VASC CLOSURE VASCADE 5FR 700-500DX-05U TO 6/7FR 700-5801-05U,272,RC,27201841,CDM,,,,,,both,,,814.0000,122.1000,SENTARA HEALTH,SENTARA HEALTH,210.09,,,,,,,210.0900,814.0000,percent of total billed charges,25.81% of $814.00 in Billed Charges for Rev 272 = $210.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VASC CLOSURE VASCADE 5FR 700-500DX-05U TO 6/7FR 700-5801-05U,272,RC,27201841,CDM,,,,,,both,,,814.0000,122.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",814.00,,,,,,,210.0900,814.0000,percent of total billed charges,100% of $814.00 in Billed Charges for Rev 272 = $814.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VASC CLOSURE VASCADE 5FR 700-500DX-05U TO 6/7FR 700-5801-05U,272,RC,27201841,CDM,,,,,,both,,,814.0000,122.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,407.00,,,,,,,210.0900,814.0000,percent of total billed charges,Rev 272 $814.00 in Billed Charges at 50% = $407.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VASC CLOSURE VASCADE 5FR 700-500DX-05U TO 6/7FR 700-5801-05U,272,RC,27201841,CDM,,,,,,both,,,814.0000,122.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,262.92,,,,,,,210.0900,814.0000,other,32.3% of $814.00 in Billed Charges for Rev 272 = $262.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SYSTEM VASC CLOSURE VASCADE 5FR 700-500DX-05U TO 6/7FR 700-5801-05U,272,RC,27201841,CDM,,,,,,both,,,814.0000,122.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,249.90,,,,,,,210.0900,814.0000,other,30.7% of $814.00 in Billed Charges for Rev 272 = $249.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SYSTEM VASC CLOSURE VASCADE 5FR 700-500DX-05U TO 6/7FR 700-5801-05U,272,RC,27201841,CDM,,,,,,both,,,814.0000,122.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,262.92,,,,,,,210.0900,814.0000,percent of total billed charges,32.3% of $814.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VASC CLOSURE VASCADE 5FR 700-500DX-05U TO 6/7FR 700-5801-05U,272,RC,27201841,CDM,,,,,,both,,,814.0000,122.1000,WELLCARE,WELLCARE MEDICAID,814.00,,,,,,,210.0900,814.0000,percent of total billed charges,100% of $814.00 in Billed Charges for Rev 272 = $814.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TIGHT RAIL MINI 9FR 540-009 TO 11FR 540-011,272,RC,27201766,CDM,,,,,,both,,,3968.0000,595.2000,AETNA,AETNA,1694.34,,,,,,,1024.1400,3968.0000,percent of total billed charges,"42.7% of $3,968.00 in Billed Charges for Rev 272 = $1,694.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL MINI 9FR 540-009 TO 11FR 540-011,272,RC,27201766,CDM,,,,,,both,,,3968.0000,595.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2777.60,,,,,,,1024.1400,3968.0000,percent of total billed charges,"Rev 272 $3,968.00 in Billed Charges at 70% = $2,777.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL MINI 9FR 540-009 TO 11FR 540-011,272,RC,27201766,CDM,,,,,,both,,,3968.0000,595.2000,CIGNA HEALTHCARE,CIGNA HMO,1654.66,,,,,,,1024.1400,3968.0000,percent of total billed charges,"41.7% of $3,968.00 in Billed Charges for Rev 272 = $1,654.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL MINI 9FR 540-009 TO 11FR 540-011,272,RC,27201766,CDM,,,,,,both,,,3968.0000,595.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1841.15,,,,,,,1024.1400,3968.0000,percent of total billed charges,"46.4% of $3,968.00 in Billed Charges for Rev 272 = $1,841.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL MINI 9FR 540-009 TO 11FR 540-011,272,RC,27201766,CDM,,,,,,both,,,3968.0000,595.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1654.66,,,,,,,1024.1400,3968.0000,percent of total billed charges,"41.7% of $3,968.00 in Billed Charges for Rev 272 = $1,654.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL MINI 9FR 540-009 TO 11FR 540-011,272,RC,27201766,CDM,,,,,,both,,,3968.0000,595.2000,CIGNA HEALTHCARE,CIGNA PPO,1654.66,,,,,,,1024.1400,3968.0000,percent of total billed charges,"41.7% of $3,968.00 in Billed Charges for Rev 272 = $1,654.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL MINI 9FR 540-009 TO 11FR 540-011,272,RC,27201766,CDM,,,,,,both,,,3968.0000,595.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3571.20,,,,,,,1024.1400,3968.0000,percent of total billed charges,"90% of $3,968.00 in Billed Charges for Rev 272 = $3,571.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL MINI 9FR 540-009 TO 11FR 540-011,272,RC,27201766,CDM,,,,,,both,,,3968.0000,595.2000,MEDCOST,MEDCOST VHN,1888.37,,,,,,,1024.1400,3968.0000,percent of total billed charges,"47.59% of $3,968.00 in Billed Charges for Rev 272 = $1,888.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL MINI 9FR 540-009 TO 11FR 540-011,272,RC,27201766,CDM,,,,,,both,,,3968.0000,595.2000,SENTARA HEALTH,SENTARA HEALTH,1024.14,,,,,,,1024.1400,3968.0000,percent of total billed charges,"25.81% of $3,968.00 in Billed Charges for Rev 272 = $1,024.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL MINI 9FR 540-009 TO 11FR 540-011,272,RC,27201766,CDM,,,,,,both,,,3968.0000,595.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3968.00,,,,,,,1024.1400,3968.0000,percent of total billed charges,"100% of $3,968.00 in Billed Charges for Rev 272 = $3,968.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL MINI 9FR 540-009 TO 11FR 540-011,272,RC,27201766,CDM,,,,,,both,,,3968.0000,595.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1984.00,,,,,,,1024.1400,3968.0000,percent of total billed charges,"Rev 272 $3,968.00 in Billed Charges at 50% = $1,984.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL MINI 9FR 540-009 TO 11FR 540-011,272,RC,27201766,CDM,,,,,,both,,,3968.0000,595.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1281.66,,,,,,,1024.1400,3968.0000,other,"32.3% of $3,968.00 in Billed Charges for Rev 272 = $1,281.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TIGHT RAIL MINI 9FR 540-009 TO 11FR 540-011,272,RC,27201766,CDM,,,,,,both,,,3968.0000,595.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1218.18,,,,,,,1024.1400,3968.0000,other,"30.7% of $3,968.00 in Billed Charges for Rev 272 = $1,218.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TIGHT RAIL MINI 9FR 540-009 TO 11FR 540-011,272,RC,27201766,CDM,,,,,,both,,,3968.0000,595.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,1281.66,,,,,,,1024.1400,3968.0000,percent of total billed charges,"32.3% of $3,968.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL MINI 9FR 540-009 TO 11FR 540-011,272,RC,27201766,CDM,,,,,,both,,,3968.0000,595.2000,WELLCARE,WELLCARE MEDICAID,3968.00,,,,,,,1024.1400,3968.0000,percent of total billed charges,"100% of $3,968.00 in Billed Charges for Rev 272 = $3,968.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRACH TUBE SHILEY #8 PROX,272,RC,27202290,CDM,,,,,,both,,,551.0000,82.6500,AETNA,AETNA,235.28,,,,,,,142.2100,551.0000,percent of total billed charges,42.7% of $551.00 in Billed Charges for Rev 272 = $235.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACH TUBE SHILEY #8 PROX,272,RC,27202290,CDM,,,,,,both,,,551.0000,82.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,385.70,,,,,,,142.2100,551.0000,percent of total billed charges,Rev 272 $551.00 in Billed Charges at 70% = $385.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACH TUBE SHILEY #8 PROX,272,RC,27202290,CDM,,,,,,both,,,551.0000,82.6500,CIGNA HEALTHCARE,CIGNA HMO,229.77,,,,,,,142.2100,551.0000,percent of total billed charges,41.7% of $551.00 in Billed Charges for Rev 272 = $229.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACH TUBE SHILEY #8 PROX,272,RC,27202290,CDM,,,,,,both,,,551.0000,82.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,255.66,,,,,,,142.2100,551.0000,percent of total billed charges,46.4% of $551.00 in Billed Charges for Rev 272 = $255.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACH TUBE SHILEY #8 PROX,272,RC,27202290,CDM,,,,,,both,,,551.0000,82.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,229.77,,,,,,,142.2100,551.0000,percent of total billed charges,41.7% of $551.00 in Billed Charges for Rev 272 = $229.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACH TUBE SHILEY #8 PROX,272,RC,27202290,CDM,,,,,,both,,,551.0000,82.6500,CIGNA HEALTHCARE,CIGNA PPO,229.77,,,,,,,142.2100,551.0000,percent of total billed charges,41.7% of $551.00 in Billed Charges for Rev 272 = $229.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACH TUBE SHILEY #8 PROX,272,RC,27202290,CDM,,,,,,both,,,551.0000,82.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,495.90,,,,,,,142.2100,551.0000,percent of total billed charges,90% of $551.00 in Billed Charges for Rev 272 = $495.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACH TUBE SHILEY #8 PROX,272,RC,27202290,CDM,,,,,,both,,,551.0000,82.6500,MEDCOST,MEDCOST VHN,262.22,,,,,,,142.2100,551.0000,percent of total billed charges,47.59% of $551.00 in Billed Charges for Rev 272 = $262.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACH TUBE SHILEY #8 PROX,272,RC,27202290,CDM,,,,,,both,,,551.0000,82.6500,SENTARA HEALTH,SENTARA HEALTH,142.21,,,,,,,142.2100,551.0000,percent of total billed charges,25.81% of $551.00 in Billed Charges for Rev 272 = $142.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACH TUBE SHILEY #8 PROX,272,RC,27202290,CDM,,,,,,both,,,551.0000,82.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",551.00,,,,,,,142.2100,551.0000,percent of total billed charges,100% of $551.00 in Billed Charges for Rev 272 = $551.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACH TUBE SHILEY #8 PROX,272,RC,27202290,CDM,,,,,,both,,,551.0000,82.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,275.50,,,,,,,142.2100,551.0000,percent of total billed charges,Rev 272 $551.00 in Billed Charges at 50% = $275.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACH TUBE SHILEY #8 PROX,272,RC,27202290,CDM,,,,,,both,,,551.0000,82.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,177.97,,,,,,,142.2100,551.0000,other,32.3% of $551.00 in Billed Charges for Rev 272 = $177.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE SHILEY #8 PROX,272,RC,27202290,CDM,,,,,,both,,,551.0000,82.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,169.16,,,,,,,142.2100,551.0000,other,30.7% of $551.00 in Billed Charges for Rev 272 = $169.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE SHILEY #8 PROX,272,RC,27202290,CDM,,,,,,both,,,551.0000,82.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,177.97,,,,,,,142.2100,551.0000,percent of total billed charges,32.3% of $551.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACH TUBE SHILEY #8 PROX,272,RC,27202290,CDM,,,,,,both,,,551.0000,82.6500,WELLCARE,WELLCARE MEDICAID,551.00,,,,,,,142.2100,551.0000,percent of total billed charges,100% of $551.00 in Billed Charges for Rev 272 = $551.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACK BACK II DEVICE 91003,272,RC,27201167,CDM,,,,,,both,,,603.0000,90.4500,AETNA,AETNA,257.48,,,,,,,155.6300,603.0000,percent of total billed charges,42.7% of $603.00 in Billed Charges for Rev 272 = $257.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACK BACK II DEVICE 91003,272,RC,27201167,CDM,,,,,,both,,,603.0000,90.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,422.10,,,,,,,155.6300,603.0000,percent of total billed charges,Rev 272 $603.00 in Billed Charges at 70% = $422.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACK BACK II DEVICE 91003,272,RC,27201167,CDM,,,,,,both,,,603.0000,90.4500,CIGNA HEALTHCARE,CIGNA HMO,251.45,,,,,,,155.6300,603.0000,percent of total billed charges,41.7% of $603.00 in Billed Charges for Rev 272 = $251.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACK BACK II DEVICE 91003,272,RC,27201167,CDM,,,,,,both,,,603.0000,90.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,279.79,,,,,,,155.6300,603.0000,percent of total billed charges,46.4% of $603.00 in Billed Charges for Rev 272 = $279.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACK BACK II DEVICE 91003,272,RC,27201167,CDM,,,,,,both,,,603.0000,90.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,251.45,,,,,,,155.6300,603.0000,percent of total billed charges,41.7% of $603.00 in Billed Charges for Rev 272 = $251.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACK BACK II DEVICE 91003,272,RC,27201167,CDM,,,,,,both,,,603.0000,90.4500,CIGNA HEALTHCARE,CIGNA PPO,251.45,,,,,,,155.6300,603.0000,percent of total billed charges,41.7% of $603.00 in Billed Charges for Rev 272 = $251.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACK BACK II DEVICE 91003,272,RC,27201167,CDM,,,,,,both,,,603.0000,90.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,542.70,,,,,,,155.6300,603.0000,percent of total billed charges,90% of $603.00 in Billed Charges for Rev 272 = $542.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACK BACK II DEVICE 91003,272,RC,27201167,CDM,,,,,,both,,,603.0000,90.4500,MEDCOST,MEDCOST VHN,286.97,,,,,,,155.6300,603.0000,percent of total billed charges,47.59% of $603.00 in Billed Charges for Rev 272 = $286.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACK BACK II DEVICE 91003,272,RC,27201167,CDM,,,,,,both,,,603.0000,90.4500,SENTARA HEALTH,SENTARA HEALTH,155.63,,,,,,,155.6300,603.0000,percent of total billed charges,25.81% of $603.00 in Billed Charges for Rev 272 = $155.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACK BACK II DEVICE 91003,272,RC,27201167,CDM,,,,,,both,,,603.0000,90.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",603.00,,,,,,,155.6300,603.0000,percent of total billed charges,100% of $603.00 in Billed Charges for Rev 272 = $603.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACK BACK II DEVICE 91003,272,RC,27201167,CDM,,,,,,both,,,603.0000,90.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,301.50,,,,,,,155.6300,603.0000,percent of total billed charges,Rev 272 $603.00 in Billed Charges at 50% = $301.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACK BACK II DEVICE 91003,272,RC,27201167,CDM,,,,,,both,,,603.0000,90.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,194.77,,,,,,,155.6300,603.0000,other,32.3% of $603.00 in Billed Charges for Rev 272 = $194.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACK BACK II DEVICE 91003,272,RC,27201167,CDM,,,,,,both,,,603.0000,90.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,185.12,,,,,,,155.6300,603.0000,other,30.7% of $603.00 in Billed Charges for Rev 272 = $185.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACK BACK II DEVICE 91003,272,RC,27201167,CDM,,,,,,both,,,603.0000,90.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,194.77,,,,,,,155.6300,603.0000,percent of total billed charges,32.3% of $603.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRACK BACK II DEVICE 91003,272,RC,27201167,CDM,,,,,,both,,,603.0000,90.4500,WELLCARE,WELLCARE MEDICAID,603.00,,,,,,,155.6300,603.0000,percent of total billed charges,100% of $603.00 in Billed Charges for Rev 272 = $603.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHYLPHENIDATE,80360,CPT,301,RC,30100397,CDM,,,,both,,,78.0000,11.7000,AETNA,AETNA,33.31,,,,,,,16.2000,78.0000,percent of total billed charges,42.7% of $78.00 in Billed Charges for Rev 301 Proc 80360 = $33.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHYLPHENIDATE,80360,CPT,301,RC,30100397,CDM,,,,both,,,78.0000,11.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,16.36,,,,,,,16.2000,78.0000,fee schedule,APG 02040 Proc 80360 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 104% = $16.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHYLPHENIDATE,80360,CPT,301,RC,30100397,CDM,,,,both,,,78.0000,11.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,16.20,,,,,,,16.2000,78.0000,fee schedule,APG 02040 Proc 80360 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHYLPHENIDATE,80360,CPT,301,RC,30100397,CDM,,,,both,,,78.0000,11.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,54.60,,,,,,,16.2000,78.0000,percent of total billed charges,Rev 301 Proc 80360 $78.00 in Billed Charges at 70% = $54.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHYLPHENIDATE,80360,CPT,301,RC,30100397,CDM,,,,both,,,78.0000,11.7000,CIGNA HEALTHCARE,CIGNA HMO,32.53,,,,,,,16.2000,78.0000,percent of total billed charges,Rev 301 Proc 80360 $78.00 in Billed Charges at 41.7% = $32.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHYLPHENIDATE,80360,CPT,301,RC,30100397,CDM,,,,both,,,78.0000,11.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,33.38,,,,,,,16.2000,78.0000,percent of total billed charges,Rev 301 Proc 80360 $78.00 in Billed Charges at 42.8% = $33.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHYLPHENIDATE,80360,CPT,301,RC,30100397,CDM,,,,both,,,78.0000,11.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,32.53,,,,,,,16.2000,78.0000,percent of total billed charges,Rev 301 Proc 80360 $78.00 in Billed Charges at 41.7% = $32.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHYLPHENIDATE,80360,CPT,301,RC,30100397,CDM,,,,both,,,78.0000,11.7000,CIGNA HEALTHCARE,CIGNA PPO,32.53,,,,,,,16.2000,78.0000,percent of total billed charges,Rev 301 Proc 80360 $78.00 in Billed Charges at 41.7% = $32.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHYLPHENIDATE,80360,CPT,301,RC,30100397,CDM,,,,both,,,78.0000,11.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,70.20,,,,,,,16.2000,78.0000,percent of total billed charges,90% of $78.00 in Billed Charges for Rev 301 Proc 80360 = $70.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHYLPHENIDATE,80360,CPT,301,RC,30100397,CDM,,,,both,,,78.0000,11.7000,MEDCOST,MEDCOST VHN,37.12,,,,,,,16.2000,78.0000,percent of total billed charges,47.59% of $78.00 in Billed Charges for Rev 301 Proc 80360 = $37.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHYLPHENIDATE,80360,CPT,301,RC,30100397,CDM,,,,both,,,78.0000,11.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,16.52,,,,,,,16.2000,78.0000,fee schedule,APG 02040 Proc 80360 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 105% = $16.52 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHYLPHENIDATE,80360,CPT,301,RC,30100397,CDM,,,,both,,,78.0000,11.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,16.22,,,,,,,16.2000,78.0000,fee schedule,APG 02040 Proc 80360 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 103.1% = $16.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHYLPHENIDATE,80360,CPT,301,RC,30100397,CDM,,,,both,,,78.0000,11.7000,SENTARA HEALTH,SENTARA HEALTH,20.13,,,,,,,16.2000,78.0000,percent of total billed charges,25.81% of $78.00 in Billed Charges for Rev 301 Proc 80360 = $20.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHYLPHENIDATE,80360,CPT,301,RC,30100397,CDM,,,,both,,,78.0000,11.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",78.00,,,,,,,16.2000,78.0000,percent of total billed charges,100% of $78.00 in Billed Charges for Rev 301 Proc 80360 = $78.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHYLPHENIDATE,80360,CPT,301,RC,30100397,CDM,,,,both,,,78.0000,11.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,16.20,,,,,,,16.2000,78.0000,fee schedule,APG 02040 Proc 80360 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHYLPHENIDATE,80360,CPT,301,RC,30100397,CDM,,,,both,,,78.0000,11.7000,WELLCARE,WELLCARE MEDICAID,78.00,,,,,,,16.2000,78.0000,percent of total billed charges,100% of $78.00 in Billed Charges for Rev 301 Proc 80360 = $78.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOIDS & OPIATE ANALOGS 1 OR 2,80362,CPT,301,RC,30100399,CDM,,,,both,,,89.0000,13.3500,AETNA,AETNA,38.00,,,,,,,16.2000,89.0000,percent of total billed charges,42.7% of $89.00 in Billed Charges for Rev 301 Proc 80362 = $38.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOIDS & OPIATE ANALOGS 1 OR 2,80362,CPT,301,RC,30100399,CDM,,,,both,,,89.0000,13.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,16.36,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80362 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 104% = $16.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPIOIDS & OPIATE ANALOGS 1 OR 2,80362,CPT,301,RC,30100399,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,16.20,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80362 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPIOIDS & OPIATE ANALOGS 1 OR 2,80362,CPT,301,RC,30100399,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,62.30,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80362 $89.00 in Billed Charges at 70% = $62.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOIDS & OPIATE ANALOGS 1 OR 2,80362,CPT,301,RC,30100399,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA HMO,37.11,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80362 $89.00 in Billed Charges at 41.7% = $37.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOIDS & OPIATE ANALOGS 1 OR 2,80362,CPT,301,RC,30100399,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,38.09,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80362 $89.00 in Billed Charges at 42.8% = $38.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOIDS & OPIATE ANALOGS 1 OR 2,80362,CPT,301,RC,30100399,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,37.11,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80362 $89.00 in Billed Charges at 41.7% = $37.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOIDS & OPIATE ANALOGS 1 OR 2,80362,CPT,301,RC,30100399,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA PPO,37.11,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80362 $89.00 in Billed Charges at 41.7% = $37.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOIDS & OPIATE ANALOGS 1 OR 2,80362,CPT,301,RC,30100399,CDM,,,,both,,,89.0000,13.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,80.10,,,,,,,16.2000,89.0000,percent of total billed charges,90% of $89.00 in Billed Charges for Rev 301 Proc 80362 = $80.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOIDS & OPIATE ANALOGS 1 OR 2,80362,CPT,301,RC,30100399,CDM,,,,both,,,89.0000,13.3500,MEDCOST,MEDCOST VHN,42.36,,,,,,,16.2000,89.0000,percent of total billed charges,47.59% of $89.00 in Billed Charges for Rev 301 Proc 80362 = $42.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOIDS & OPIATE ANALOGS 1 OR 2,80362,CPT,301,RC,30100399,CDM,,,,both,,,89.0000,13.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,16.52,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80362 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 105% = $16.52 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPIOIDS & OPIATE ANALOGS 1 OR 2,80362,CPT,301,RC,30100399,CDM,,,,both,,,89.0000,13.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,16.22,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80362 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 103.1% = $16.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPIOIDS & OPIATE ANALOGS 1 OR 2,80362,CPT,301,RC,30100399,CDM,,,,both,,,89.0000,13.3500,SENTARA HEALTH,SENTARA HEALTH,22.97,,,,,,,16.2000,89.0000,percent of total billed charges,25.81% of $89.00 in Billed Charges for Rev 301 Proc 80362 = $22.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOIDS & OPIATE ANALOGS 1 OR 2,80362,CPT,301,RC,30100399,CDM,,,,both,,,89.0000,13.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",89.00,,,,,,,16.2000,89.0000,percent of total billed charges,100% of $89.00 in Billed Charges for Rev 301 Proc 80362 = $89.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOIDS & OPIATE ANALOGS 1 OR 2,80362,CPT,301,RC,30100399,CDM,,,,both,,,89.0000,13.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,16.20,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80362 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPIOIDS & OPIATE ANALOGS 1 OR 2,80362,CPT,301,RC,30100399,CDM,,,,both,,,89.0000,13.3500,WELLCARE,WELLCARE MEDICAID,89.00,,,,,,,16.2000,89.0000,percent of total billed charges,100% of $89.00 in Billed Charges for Rev 301 Proc 80362 = $89.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOIDS & OPIATE ANALOGS 3 OR 4,80363,CPT,301,RC,30100400,CDM,,,,both,,,197.0000,29.5500,AETNA,AETNA,84.12,,,,,,,16.2000,197.0000,percent of total billed charges,42.7% of $197.00 in Billed Charges for Rev 301 Proc 80363 = $84.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOIDS & OPIATE ANALOGS 3 OR 4,80363,CPT,301,RC,30100400,CDM,,,,both,,,197.0000,29.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,16.36,,,,,,,16.2000,197.0000,fee schedule,APG 02040 Proc 80363 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 104% = $16.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPIOIDS & OPIATE ANALOGS 3 OR 4,80363,CPT,301,RC,30100400,CDM,,,,both,,,197.0000,29.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,16.20,,,,,,,16.2000,197.0000,fee schedule,APG 02040 Proc 80363 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPIOIDS & OPIATE ANALOGS 3 OR 4,80363,CPT,301,RC,30100400,CDM,,,,both,,,197.0000,29.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,137.90,,,,,,,16.2000,197.0000,percent of total billed charges,Rev 301 Proc 80363 $197.00 in Billed Charges at 70% = $137.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOIDS & OPIATE ANALOGS 3 OR 4,80363,CPT,301,RC,30100400,CDM,,,,both,,,197.0000,29.5500,CIGNA HEALTHCARE,CIGNA HMO,82.15,,,,,,,16.2000,197.0000,percent of total billed charges,Rev 301 Proc 80363 $197.00 in Billed Charges at 41.7% = $82.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOIDS & OPIATE ANALOGS 3 OR 4,80363,CPT,301,RC,30100400,CDM,,,,both,,,197.0000,29.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,84.32,,,,,,,16.2000,197.0000,percent of total billed charges,Rev 301 Proc 80363 $197.00 in Billed Charges at 42.8% = $84.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOIDS & OPIATE ANALOGS 3 OR 4,80363,CPT,301,RC,30100400,CDM,,,,both,,,197.0000,29.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,82.15,,,,,,,16.2000,197.0000,percent of total billed charges,Rev 301 Proc 80363 $197.00 in Billed Charges at 41.7% = $82.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOIDS & OPIATE ANALOGS 3 OR 4,80363,CPT,301,RC,30100400,CDM,,,,both,,,197.0000,29.5500,CIGNA HEALTHCARE,CIGNA PPO,82.15,,,,,,,16.2000,197.0000,percent of total billed charges,Rev 301 Proc 80363 $197.00 in Billed Charges at 41.7% = $82.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOIDS & OPIATE ANALOGS 3 OR 4,80363,CPT,301,RC,30100400,CDM,,,,both,,,197.0000,29.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,177.30,,,,,,,16.2000,197.0000,percent of total billed charges,90% of $197.00 in Billed Charges for Rev 301 Proc 80363 = $177.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOIDS & OPIATE ANALOGS 3 OR 4,80363,CPT,301,RC,30100400,CDM,,,,both,,,197.0000,29.5500,MEDCOST,MEDCOST VHN,93.75,,,,,,,16.2000,197.0000,percent of total billed charges,47.59% of $197.00 in Billed Charges for Rev 301 Proc 80363 = $93.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOIDS & OPIATE ANALOGS 3 OR 4,80363,CPT,301,RC,30100400,CDM,,,,both,,,197.0000,29.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,16.52,,,,,,,16.2000,197.0000,fee schedule,APG 02040 Proc 80363 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 105% = $16.52 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPIOIDS & OPIATE ANALOGS 3 OR 4,80363,CPT,301,RC,30100400,CDM,,,,both,,,197.0000,29.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,16.22,,,,,,,16.2000,197.0000,fee schedule,APG 02040 Proc 80363 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 103.1% = $16.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPIOIDS & OPIATE ANALOGS 3 OR 4,80363,CPT,301,RC,30100400,CDM,,,,both,,,197.0000,29.5500,SENTARA HEALTH,SENTARA HEALTH,50.85,,,,,,,16.2000,197.0000,percent of total billed charges,25.81% of $197.00 in Billed Charges for Rev 301 Proc 80363 = $50.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOIDS & OPIATE ANALOGS 3 OR 4,80363,CPT,301,RC,30100400,CDM,,,,both,,,197.0000,29.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",197.00,,,,,,,16.2000,197.0000,percent of total billed charges,100% of $197.00 in Billed Charges for Rev 301 Proc 80363 = $197.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPIOIDS & OPIATE ANALOGS 3 OR 4,80363,CPT,301,RC,30100400,CDM,,,,both,,,197.0000,29.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,16.20,,,,,,,16.2000,197.0000,fee schedule,APG 02040 Proc 80363 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPIOIDS & OPIATE ANALOGS 3 OR 4,80363,CPT,301,RC,30100400,CDM,,,,both,,,197.0000,29.5500,WELLCARE,WELLCARE MEDICAID,197.00,,,,,,,16.2000,197.0000,percent of total billed charges,100% of $197.00 in Billed Charges for Rev 301 Proc 80363 = $197.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREGABALIN,80366,CPT,301,RC,30100403,CDM,,,,both,,,128.0000,19.2000,AETNA,AETNA,54.66,,,,,,,16.2000,128.0000,percent of total billed charges,42.7% of $128.00 in Billed Charges for Rev 301 Proc 80366 = $54.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREGABALIN,80366,CPT,301,RC,30100403,CDM,,,,both,,,128.0000,19.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,16.36,,,,,,,16.2000,128.0000,fee schedule,APG 02040 Proc 80366 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 104% = $16.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREGABALIN,80366,CPT,301,RC,30100403,CDM,,,,both,,,128.0000,19.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,16.20,,,,,,,16.2000,128.0000,fee schedule,APG 02040 Proc 80366 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREGABALIN,80366,CPT,301,RC,30100403,CDM,,,,both,,,128.0000,19.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,89.60,,,,,,,16.2000,128.0000,percent of total billed charges,Rev 301 Proc 80366 $128.00 in Billed Charges at 70% = $89.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREGABALIN,80366,CPT,301,RC,30100403,CDM,,,,both,,,128.0000,19.2000,CIGNA HEALTHCARE,CIGNA HMO,53.38,,,,,,,16.2000,128.0000,percent of total billed charges,Rev 301 Proc 80366 $128.00 in Billed Charges at 41.7% = $53.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREGABALIN,80366,CPT,301,RC,30100403,CDM,,,,both,,,128.0000,19.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,54.78,,,,,,,16.2000,128.0000,percent of total billed charges,Rev 301 Proc 80366 $128.00 in Billed Charges at 42.8% = $54.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREGABALIN,80366,CPT,301,RC,30100403,CDM,,,,both,,,128.0000,19.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,53.38,,,,,,,16.2000,128.0000,percent of total billed charges,Rev 301 Proc 80366 $128.00 in Billed Charges at 41.7% = $53.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREGABALIN,80366,CPT,301,RC,30100403,CDM,,,,both,,,128.0000,19.2000,CIGNA HEALTHCARE,CIGNA PPO,53.38,,,,,,,16.2000,128.0000,percent of total billed charges,Rev 301 Proc 80366 $128.00 in Billed Charges at 41.7% = $53.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREGABALIN,80366,CPT,301,RC,30100403,CDM,,,,both,,,128.0000,19.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,115.20,,,,,,,16.2000,128.0000,percent of total billed charges,90% of $128.00 in Billed Charges for Rev 301 Proc 80366 = $115.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREGABALIN,80366,CPT,301,RC,30100403,CDM,,,,both,,,128.0000,19.2000,MEDCOST,MEDCOST VHN,60.92,,,,,,,16.2000,128.0000,percent of total billed charges,47.59% of $128.00 in Billed Charges for Rev 301 Proc 80366 = $60.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREGABALIN,80366,CPT,301,RC,30100403,CDM,,,,both,,,128.0000,19.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,16.52,,,,,,,16.2000,128.0000,fee schedule,APG 02040 Proc 80366 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 105% = $16.52 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREGABALIN,80366,CPT,301,RC,30100403,CDM,,,,both,,,128.0000,19.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,16.22,,,,,,,16.2000,128.0000,fee schedule,APG 02040 Proc 80366 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 103.1% = $16.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREGABALIN,80366,CPT,301,RC,30100403,CDM,,,,both,,,128.0000,19.2000,SENTARA HEALTH,SENTARA HEALTH,33.04,,,,,,,16.2000,128.0000,percent of total billed charges,25.81% of $128.00 in Billed Charges for Rev 301 Proc 80366 = $33.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREGABALIN,80366,CPT,301,RC,30100403,CDM,,,,both,,,128.0000,19.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",128.00,,,,,,,16.2000,128.0000,percent of total billed charges,100% of $128.00 in Billed Charges for Rev 301 Proc 80366 = $128.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREGABALIN,80366,CPT,301,RC,30100403,CDM,,,,both,,,128.0000,19.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,16.20,,,,,,,16.2000,128.0000,fee schedule,APG 02040 Proc 80366 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREGABALIN,80366,CPT,301,RC,30100403,CDM,,,,both,,,128.0000,19.2000,WELLCARE,WELLCARE MEDICAID,128.00,,,,,,,16.2000,128.0000,percent of total billed charges,100% of $128.00 in Billed Charges for Rev 301 Proc 80366 = $128.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROPOXYPHENE,80367,CPT,301,RC,30100404,CDM,,,,both,,,89.0000,13.3500,AETNA,AETNA,38.00,,,,,,,16.2000,89.0000,percent of total billed charges,42.7% of $89.00 in Billed Charges for Rev 301 Proc 80367 = $38.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROPOXYPHENE,80367,CPT,301,RC,30100404,CDM,,,,both,,,89.0000,13.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,16.36,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80367 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 104% = $16.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROPOXYPHENE,80367,CPT,301,RC,30100404,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,16.20,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80367 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROPOXYPHENE,80367,CPT,301,RC,30100404,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,62.30,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80367 $89.00 in Billed Charges at 70% = $62.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROPOXYPHENE,80367,CPT,301,RC,30100404,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA HMO,37.11,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80367 $89.00 in Billed Charges at 41.7% = $37.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROPOXYPHENE,80367,CPT,301,RC,30100404,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,38.09,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80367 $89.00 in Billed Charges at 42.8% = $38.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROPOXYPHENE,80367,CPT,301,RC,30100404,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,37.11,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80367 $89.00 in Billed Charges at 41.7% = $37.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROPOXYPHENE,80367,CPT,301,RC,30100404,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA PPO,37.11,,,,,,,16.2000,89.0000,percent of total billed charges,Rev 301 Proc 80367 $89.00 in Billed Charges at 41.7% = $37.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROPOXYPHENE,80367,CPT,301,RC,30100404,CDM,,,,both,,,89.0000,13.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,80.10,,,,,,,16.2000,89.0000,percent of total billed charges,90% of $89.00 in Billed Charges for Rev 301 Proc 80367 = $80.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROPOXYPHENE,80367,CPT,301,RC,30100404,CDM,,,,both,,,89.0000,13.3500,MEDCOST,MEDCOST VHN,42.36,,,,,,,16.2000,89.0000,percent of total billed charges,47.59% of $89.00 in Billed Charges for Rev 301 Proc 80367 = $42.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROPOXYPHENE,80367,CPT,301,RC,30100404,CDM,,,,both,,,89.0000,13.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,16.52,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80367 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 105% = $16.52 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROPOXYPHENE,80367,CPT,301,RC,30100404,CDM,,,,both,,,89.0000,13.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,16.22,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80367 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 103.1% = $16.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROPOXYPHENE,80367,CPT,301,RC,30100404,CDM,,,,both,,,89.0000,13.3500,SENTARA HEALTH,SENTARA HEALTH,22.97,,,,,,,16.2000,89.0000,percent of total billed charges,25.81% of $89.00 in Billed Charges for Rev 301 Proc 80367 = $22.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROPOXYPHENE,80367,CPT,301,RC,30100404,CDM,,,,both,,,89.0000,13.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",89.00,,,,,,,16.2000,89.0000,percent of total billed charges,100% of $89.00 in Billed Charges for Rev 301 Proc 80367 = $89.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PROPOXYPHENE,80367,CPT,301,RC,30100404,CDM,,,,both,,,89.0000,13.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,16.20,,,,,,,16.2000,89.0000,fee schedule,APG 02040 Proc 80367 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PROPOXYPHENE,80367,CPT,301,RC,30100404,CDM,,,,both,,,89.0000,13.3500,WELLCARE,WELLCARE MEDICAID,89.00,,,,,,,16.2000,89.0000,percent of total billed charges,100% of $89.00 in Billed Charges for Rev 301 Proc 80367 = $89.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEDATIVE HYPNOTICS,80368,CPT,301,RC,30100405,CDM,,,,both,,,92.0000,13.8000,AETNA,AETNA,39.28,,,,,,,16.2000,92.0000,percent of total billed charges,42.7% of $92.00 in Billed Charges for Rev 301 Proc 80368 = $39.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEDATIVE HYPNOTICS,80368,CPT,301,RC,30100405,CDM,,,,both,,,92.0000,13.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,16.36,,,,,,,16.2000,92.0000,fee schedule,APG 02040 Proc 80368 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 104% = $16.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEDATIVE HYPNOTICS,80368,CPT,301,RC,30100405,CDM,,,,both,,,92.0000,13.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,16.20,,,,,,,16.2000,92.0000,fee schedule,APG 02040 Proc 80368 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEDATIVE HYPNOTICS,80368,CPT,301,RC,30100405,CDM,,,,both,,,92.0000,13.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,64.40,,,,,,,16.2000,92.0000,percent of total billed charges,Rev 301 Proc 80368 $92.00 in Billed Charges at 70% = $64.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEDATIVE HYPNOTICS,80368,CPT,301,RC,30100405,CDM,,,,both,,,92.0000,13.8000,CIGNA HEALTHCARE,CIGNA HMO,38.36,,,,,,,16.2000,92.0000,percent of total billed charges,Rev 301 Proc 80368 $92.00 in Billed Charges at 41.7% = $38.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEDATIVE HYPNOTICS,80368,CPT,301,RC,30100405,CDM,,,,both,,,92.0000,13.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,39.38,,,,,,,16.2000,92.0000,percent of total billed charges,Rev 301 Proc 80368 $92.00 in Billed Charges at 42.8% = $39.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEDATIVE HYPNOTICS,80368,CPT,301,RC,30100405,CDM,,,,both,,,92.0000,13.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,38.36,,,,,,,16.2000,92.0000,percent of total billed charges,Rev 301 Proc 80368 $92.00 in Billed Charges at 41.7% = $38.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEDATIVE HYPNOTICS,80368,CPT,301,RC,30100405,CDM,,,,both,,,92.0000,13.8000,CIGNA HEALTHCARE,CIGNA PPO,38.36,,,,,,,16.2000,92.0000,percent of total billed charges,Rev 301 Proc 80368 $92.00 in Billed Charges at 41.7% = $38.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEDATIVE HYPNOTICS,80368,CPT,301,RC,30100405,CDM,,,,both,,,92.0000,13.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,82.80,,,,,,,16.2000,92.0000,percent of total billed charges,90% of $92.00 in Billed Charges for Rev 301 Proc 80368 = $82.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEDATIVE HYPNOTICS,80368,CPT,301,RC,30100405,CDM,,,,both,,,92.0000,13.8000,MEDCOST,MEDCOST VHN,43.78,,,,,,,16.2000,92.0000,percent of total billed charges,47.59% of $92.00 in Billed Charges for Rev 301 Proc 80368 = $43.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEDATIVE HYPNOTICS,80368,CPT,301,RC,30100405,CDM,,,,both,,,92.0000,13.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,16.52,,,,,,,16.2000,92.0000,fee schedule,APG 02040 Proc 80368 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 105% = $16.52 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEDATIVE HYPNOTICS,80368,CPT,301,RC,30100405,CDM,,,,both,,,92.0000,13.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,16.22,,,,,,,16.2000,92.0000,fee schedule,APG 02040 Proc 80368 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 103.1% = $16.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEDATIVE HYPNOTICS,80368,CPT,301,RC,30100405,CDM,,,,both,,,92.0000,13.8000,SENTARA HEALTH,SENTARA HEALTH,23.75,,,,,,,16.2000,92.0000,percent of total billed charges,25.81% of $92.00 in Billed Charges for Rev 301 Proc 80368 = $23.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEDATIVE HYPNOTICS,80368,CPT,301,RC,30100405,CDM,,,,both,,,92.0000,13.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",92.00,,,,,,,16.2000,92.0000,percent of total billed charges,100% of $92.00 in Billed Charges for Rev 301 Proc 80368 = $92.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEDATIVE HYPNOTICS,80368,CPT,301,RC,30100405,CDM,,,,both,,,92.0000,13.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,16.20,,,,,,,16.2000,92.0000,fee schedule,APG 02040 Proc 80368 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEDATIVE HYPNOTICS,80368,CPT,301,RC,30100405,CDM,,,,both,,,92.0000,13.8000,WELLCARE,WELLCARE MEDICAID,92.00,,,,,,,16.2000,92.0000,percent of total billed charges,100% of $92.00 in Billed Charges for Rev 301 Proc 80368 = $92.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BUR HIGH SPEED TAPERED DIAMOND CHOANAL ATRESIA,272,RC,,,,,,,,both,,,2796.6400,419.5000,AETNA,AETNA,1194.17,,,,,,,721.8100,2796.6400,percent of total billed charges,"42.7% of $2,796.64 in Billed Charges for Rev 272 = $1,194.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BUR HIGH SPEED TAPERED DIAMOND CHOANAL ATRESIA,272,RC,,,,,,,,both,,,2796.6400,419.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1957.65,,,,,,,721.8100,2796.6400,percent of total billed charges,"Rev 272 $2,796.64 in Billed Charges at 70% = $1,957.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BUR HIGH SPEED TAPERED DIAMOND CHOANAL ATRESIA,272,RC,,,,,,,,both,,,2796.6400,419.5000,CIGNA HEALTHCARE,CIGNA HMO,1166.20,,,,,,,721.8100,2796.6400,percent of total billed charges,"41.7% of $2,796.64 in Billed Charges for Rev 272 = $1,166.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BUR HIGH SPEED TAPERED DIAMOND CHOANAL ATRESIA,272,RC,,,,,,,,both,,,2796.6400,419.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1297.64,,,,,,,721.8100,2796.6400,percent of total billed charges,"46.4% of $2,796.64 in Billed Charges for Rev 272 = $1,297.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BUR HIGH SPEED TAPERED DIAMOND CHOANAL ATRESIA,272,RC,,,,,,,,both,,,2796.6400,419.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1166.20,,,,,,,721.8100,2796.6400,percent of total billed charges,"41.7% of $2,796.64 in Billed Charges for Rev 272 = $1,166.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BUR HIGH SPEED TAPERED DIAMOND CHOANAL ATRESIA,272,RC,,,,,,,,both,,,2796.6400,419.5000,CIGNA HEALTHCARE,CIGNA PPO,1166.20,,,,,,,721.8100,2796.6400,percent of total billed charges,"41.7% of $2,796.64 in Billed Charges for Rev 272 = $1,166.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BUR HIGH SPEED TAPERED DIAMOND CHOANAL ATRESIA,272,RC,,,,,,,,both,,,2796.6400,419.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2516.98,,,,,,,721.8100,2796.6400,percent of total billed charges,"90% of $2,796.64 in Billed Charges for Rev 272 = $2,516.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BUR HIGH SPEED TAPERED DIAMOND CHOANAL ATRESIA,272,RC,,,,,,,,both,,,2796.6400,419.5000,MEDCOST,MEDCOST VHN,1330.92,,,,,,,721.8100,2796.6400,percent of total billed charges,"47.59% of $2,796.64 in Billed Charges for Rev 272 = $1,330.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BUR HIGH SPEED TAPERED DIAMOND CHOANAL ATRESIA,272,RC,,,,,,,,both,,,2796.6400,419.5000,SENTARA HEALTH,SENTARA HEALTH,721.81,,,,,,,721.8100,2796.6400,percent of total billed charges,"25.81% of $2,796.64 in Billed Charges for Rev 272 = $721.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BUR HIGH SPEED TAPERED DIAMOND CHOANAL ATRESIA,272,RC,,,,,,,,both,,,2796.6400,419.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2796.64,,,,,,,721.8100,2796.6400,percent of total billed charges,"100% of $2,796.64 in Billed Charges for Rev 272 = $2,796.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BUR HIGH SPEED TAPERED DIAMOND CHOANAL ATRESIA,272,RC,,,,,,,,both,,,2796.6400,419.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1398.32,,,,,,,721.8100,2796.6400,percent of total billed charges,"Rev 272 $2,796.64 in Billed Charges at 50% = $1,398.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BUR HIGH SPEED TAPERED DIAMOND CHOANAL ATRESIA,272,RC,,,,,,,,both,,,2796.6400,419.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,903.31,,,,,,,721.8100,2796.6400,other,"32.3% of $2,796.64 in Billed Charges for Rev 272 = $903.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A BUR HIGH SPEED TAPERED DIAMOND CHOANAL ATRESIA,272,RC,,,,,,,,both,,,2796.6400,419.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,858.57,,,,,,,721.8100,2796.6400,other,"30.7% of $2,796.64 in Billed Charges for Rev 272 = $858.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A BUR HIGH SPEED TAPERED DIAMOND CHOANAL ATRESIA,272,RC,,,,,,,,both,,,2796.6400,419.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,903.31,,,,,,,721.8100,2796.6400,percent of total billed charges,"32.3% of $2,796.64 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BUR HIGH SPEED TAPERED DIAMOND CHOANAL ATRESIA,272,RC,,,,,,,,both,,,2796.6400,419.5000,WELLCARE,WELLCARE MEDICAID,2796.64,,,,,,,721.8100,2796.6400,percent of total billed charges,"100% of $2,796.64 in Billed Charges for Rev 272 = $2,796.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BURR MATCHHEAD 3.0MM,272,RC,,,,,,,,both,,,1910.7500,286.6100,AETNA,AETNA,815.89,,,,,,,493.1600,1910.7500,percent of total billed charges,"42.7% of $1,910.75 in Billed Charges for Rev 272 = $815.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BURR MATCHHEAD 3.0MM,272,RC,,,,,,,,both,,,1910.7500,286.6100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1337.53,,,,,,,493.1600,1910.7500,percent of total billed charges,"Rev 272 $1,910.75 in Billed Charges at 70% = $1,337.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BURR MATCHHEAD 3.0MM,272,RC,,,,,,,,both,,,1910.7500,286.6100,CIGNA HEALTHCARE,CIGNA HMO,796.78,,,,,,,493.1600,1910.7500,percent of total billed charges,"41.7% of $1,910.75 in Billed Charges for Rev 272 = $796.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BURR MATCHHEAD 3.0MM,272,RC,,,,,,,,both,,,1910.7500,286.6100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,886.59,,,,,,,493.1600,1910.7500,percent of total billed charges,"46.4% of $1,910.75 in Billed Charges for Rev 272 = $886.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BURR MATCHHEAD 3.0MM,272,RC,,,,,,,,both,,,1910.7500,286.6100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,796.78,,,,,,,493.1600,1910.7500,percent of total billed charges,"41.7% of $1,910.75 in Billed Charges for Rev 272 = $796.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BURR MATCHHEAD 3.0MM,272,RC,,,,,,,,both,,,1910.7500,286.6100,CIGNA HEALTHCARE,CIGNA PPO,796.78,,,,,,,493.1600,1910.7500,percent of total billed charges,"41.7% of $1,910.75 in Billed Charges for Rev 272 = $796.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BURR MATCHHEAD 3.0MM,272,RC,,,,,,,,both,,,1910.7500,286.6100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1719.68,,,,,,,493.1600,1910.7500,percent of total billed charges,"90% of $1,910.75 in Billed Charges for Rev 272 = $1,719.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BURR MATCHHEAD 3.0MM,272,RC,,,,,,,,both,,,1910.7500,286.6100,MEDCOST,MEDCOST VHN,909.33,,,,,,,493.1600,1910.7500,percent of total billed charges,"47.59% of $1,910.75 in Billed Charges for Rev 272 = $909.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BURR MATCHHEAD 3.0MM,272,RC,,,,,,,,both,,,1910.7500,286.6100,SENTARA HEALTH,SENTARA HEALTH,493.16,,,,,,,493.1600,1910.7500,percent of total billed charges,"25.81% of $1,910.75 in Billed Charges for Rev 272 = $493.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BURR MATCHHEAD 3.0MM,272,RC,,,,,,,,both,,,1910.7500,286.6100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1910.75,,,,,,,493.1600,1910.7500,percent of total billed charges,"100% of $1,910.75 in Billed Charges for Rev 272 = $1,910.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BURR MATCHHEAD 3.0MM,272,RC,,,,,,,,both,,,1910.7500,286.6100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,955.38,,,,,,,493.1600,1910.7500,percent of total billed charges,"Rev 272 $1,910.75 in Billed Charges at 50% = $955.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BURR MATCHHEAD 3.0MM,272,RC,,,,,,,,both,,,1910.7500,286.6100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,617.17,,,,,,,493.1600,1910.7500,other,"32.3% of $1,910.75 in Billed Charges for Rev 272 = $617.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A BURR MATCHHEAD 3.0MM,272,RC,,,,,,,,both,,,1910.7500,286.6100,UNITED HEALTHCARE,UHC HERITAGE SELECT,586.60,,,,,,,493.1600,1910.7500,other,"30.7% of $1,910.75 in Billed Charges for Rev 272 = $586.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A BURR MATCHHEAD 3.0MM,272,RC,,,,,,,,both,,,1910.7500,286.6100,UNITED HEALTHCARE,UNITED HEALTHCARE,617.17,,,,,,,493.1600,1910.7500,percent of total billed charges,"32.3% of $1,910.75 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BURR MATCHHEAD 3.0MM,272,RC,,,,,,,,both,,,1910.7500,286.6100,WELLCARE,WELLCARE MEDICAID,1910.75,,,,,,,493.1600,1910.7500,percent of total billed charges,"100% of $1,910.75 in Billed Charges for Rev 272 = $1,910.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CLINCH SUTURE OVERSTITCH MFR D/C,272,RC,27200002,CDM,,,,,,both,,,3373.8900,506.0800,AETNA,AETNA,1440.65,,,,,,,870.8000,3373.8900,percent of total billed charges,"42.7% of $3,373.89 in Billed Charges for Rev 272 = $1,440.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CLINCH SUTURE OVERSTITCH MFR D/C,272,RC,27200002,CDM,,,,,,both,,,3373.8900,506.0800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2361.72,,,,,,,870.8000,3373.8900,percent of total billed charges,"Rev 272 $3,373.89 in Billed Charges at 70% = $2,361.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CLINCH SUTURE OVERSTITCH MFR D/C,272,RC,27200002,CDM,,,,,,both,,,3373.8900,506.0800,CIGNA HEALTHCARE,CIGNA HMO,1406.91,,,,,,,870.8000,3373.8900,percent of total billed charges,"41.7% of $3,373.89 in Billed Charges for Rev 272 = $1,406.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CLINCH SUTURE OVERSTITCH MFR D/C,272,RC,27200002,CDM,,,,,,both,,,3373.8900,506.0800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1565.49,,,,,,,870.8000,3373.8900,percent of total billed charges,"46.4% of $3,373.89 in Billed Charges for Rev 272 = $1,565.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CLINCH SUTURE OVERSTITCH MFR D/C,272,RC,27200002,CDM,,,,,,both,,,3373.8900,506.0800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1406.91,,,,,,,870.8000,3373.8900,percent of total billed charges,"41.7% of $3,373.89 in Billed Charges for Rev 272 = $1,406.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CLINCH SUTURE OVERSTITCH MFR D/C,272,RC,27200002,CDM,,,,,,both,,,3373.8900,506.0800,CIGNA HEALTHCARE,CIGNA PPO,1406.91,,,,,,,870.8000,3373.8900,percent of total billed charges,"41.7% of $3,373.89 in Billed Charges for Rev 272 = $1,406.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CLINCH SUTURE OVERSTITCH MFR D/C,272,RC,27200002,CDM,,,,,,both,,,3373.8900,506.0800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3036.50,,,,,,,870.8000,3373.8900,percent of total billed charges,"90% of $3,373.89 in Billed Charges for Rev 272 = $3,036.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CLINCH SUTURE OVERSTITCH MFR D/C,272,RC,27200002,CDM,,,,,,both,,,3373.8900,506.0800,MEDCOST,MEDCOST VHN,1605.63,,,,,,,870.8000,3373.8900,percent of total billed charges,"47.59% of $3,373.89 in Billed Charges for Rev 272 = $1,605.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CLINCH SUTURE OVERSTITCH MFR D/C,272,RC,27200002,CDM,,,,,,both,,,3373.8900,506.0800,SENTARA HEALTH,SENTARA HEALTH,870.80,,,,,,,870.8000,3373.8900,percent of total billed charges,"25.81% of $3,373.89 in Billed Charges for Rev 272 = $870.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CLINCH SUTURE OVERSTITCH MFR D/C,272,RC,27200002,CDM,,,,,,both,,,3373.8900,506.0800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3373.89,,,,,,,870.8000,3373.8900,percent of total billed charges,"100% of $3,373.89 in Billed Charges for Rev 272 = $3,373.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CLINCH SUTURE OVERSTITCH MFR D/C,272,RC,27200002,CDM,,,,,,both,,,3373.8900,506.0800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1686.95,,,,,,,870.8000,3373.8900,percent of total billed charges,"Rev 272 $3,373.89 in Billed Charges at 50% = $1,686.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CLINCH SUTURE OVERSTITCH MFR D/C,272,RC,27200002,CDM,,,,,,both,,,3373.8900,506.0800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1089.77,,,,,,,870.8000,3373.8900,other,"32.3% of $3,373.89 in Billed Charges for Rev 272 = $1,089.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A CLINCH SUTURE OVERSTITCH MFR D/C,272,RC,27200002,CDM,,,,,,both,,,3373.8900,506.0800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1035.78,,,,,,,870.8000,3373.8900,other,"30.7% of $3,373.89 in Billed Charges for Rev 272 = $1,035.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A CLINCH SUTURE OVERSTITCH MFR D/C,272,RC,27200002,CDM,,,,,,both,,,3373.8900,506.0800,UNITED HEALTHCARE,UNITED HEALTHCARE,1089.77,,,,,,,870.8000,3373.8900,percent of total billed charges,"32.3% of $3,373.89 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CLINCH SUTURE OVERSTITCH MFR D/C,272,RC,27200002,CDM,,,,,,both,,,3373.8900,506.0800,WELLCARE,WELLCARE MEDICAID,3373.89,,,,,,,870.8000,3373.8900,percent of total billed charges,"100% of $3,373.89 in Billed Charges for Rev 272 = $3,373.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CRAWFORD LACRIMAL INTUBATION S,272,RC,,,,,,,,both,,,871.1600,130.6700,AETNA,AETNA,371.99,,,,,,,224.8500,871.1600,percent of total billed charges,42.7% of $871.16 in Billed Charges for Rev 272 = $371.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A CRAWFORD LACRIMAL INTUBATION S,272,RC,,,,,,,,both,,,871.1600,130.6700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,609.81,,,,,,,224.8500,871.1600,percent of total billed charges,Rev 272 $871.16 in Billed Charges at 70% = $609.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A CRAWFORD LACRIMAL INTUBATION S,272,RC,,,,,,,,both,,,871.1600,130.6700,CIGNA HEALTHCARE,CIGNA HMO,363.27,,,,,,,224.8500,871.1600,percent of total billed charges,41.7% of $871.16 in Billed Charges for Rev 272 = $363.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A CRAWFORD LACRIMAL INTUBATION S,272,RC,,,,,,,,both,,,871.1600,130.6700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,404.22,,,,,,,224.8500,871.1600,percent of total billed charges,46.4% of $871.16 in Billed Charges for Rev 272 = $404.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A CRAWFORD LACRIMAL INTUBATION S,272,RC,,,,,,,,both,,,871.1600,130.6700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,363.27,,,,,,,224.8500,871.1600,percent of total billed charges,41.7% of $871.16 in Billed Charges for Rev 272 = $363.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A CRAWFORD LACRIMAL INTUBATION S,272,RC,,,,,,,,both,,,871.1600,130.6700,CIGNA HEALTHCARE,CIGNA PPO,363.27,,,,,,,224.8500,871.1600,percent of total billed charges,41.7% of $871.16 in Billed Charges for Rev 272 = $363.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A CRAWFORD LACRIMAL INTUBATION S,272,RC,,,,,,,,both,,,871.1600,130.6700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,784.04,,,,,,,224.8500,871.1600,percent of total billed charges,90% of $871.16 in Billed Charges for Rev 272 = $784.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A CRAWFORD LACRIMAL INTUBATION S,272,RC,,,,,,,,both,,,871.1600,130.6700,MEDCOST,MEDCOST VHN,414.59,,,,,,,224.8500,871.1600,percent of total billed charges,47.59% of $871.16 in Billed Charges for Rev 272 = $414.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A CRAWFORD LACRIMAL INTUBATION S,272,RC,,,,,,,,both,,,871.1600,130.6700,SENTARA HEALTH,SENTARA HEALTH,224.85,,,,,,,224.8500,871.1600,percent of total billed charges,25.81% of $871.16 in Billed Charges for Rev 272 = $224.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A CRAWFORD LACRIMAL INTUBATION S,272,RC,,,,,,,,both,,,871.1600,130.6700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",871.16,,,,,,,224.8500,871.1600,percent of total billed charges,100% of $871.16 in Billed Charges for Rev 272 = $871.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A CRAWFORD LACRIMAL INTUBATION S,272,RC,,,,,,,,both,,,871.1600,130.6700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,435.58,,,,,,,224.8500,871.1600,percent of total billed charges,Rev 272 $871.16 in Billed Charges at 50% = $435.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A CRAWFORD LACRIMAL INTUBATION S,272,RC,,,,,,,,both,,,871.1600,130.6700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,281.38,,,,,,,224.8500,871.1600,other,32.3% of $871.16 in Billed Charges for Rev 272 = $281.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
I/A CRAWFORD LACRIMAL INTUBATION S,272,RC,,,,,,,,both,,,871.1600,130.6700,UNITED HEALTHCARE,UHC HERITAGE SELECT,267.45,,,,,,,224.8500,871.1600,other,30.7% of $871.16 in Billed Charges for Rev 272 = $267.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
I/A CRAWFORD LACRIMAL INTUBATION S,272,RC,,,,,,,,both,,,871.1600,130.6700,UNITED HEALTHCARE,UNITED HEALTHCARE,281.38,,,,,,,224.8500,871.1600,percent of total billed charges,32.3% of $871.16 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A CRAWFORD LACRIMAL INTUBATION S,272,RC,,,,,,,,both,,,871.1600,130.6700,WELLCARE,WELLCARE MEDICAID,871.16,,,,,,,224.8500,871.1600,percent of total billed charges,100% of $871.16 in Billed Charges for Rev 272 = $871.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A DISSECTOR SONICISION CURV 39CM USE LN 180548,272,RC,,,,,,,,both,,,5075.1500,761.2700,AETNA,AETNA,2167.09,,,,,,,1309.9000,5075.1500,percent of total billed charges,"42.7% of $5,075.15 in Billed Charges for Rev 272 = $2,167.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DISSECTOR SONICISION CURV 39CM USE LN 180548,272,RC,,,,,,,,both,,,5075.1500,761.2700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3552.61,,,,,,,1309.9000,5075.1500,percent of total billed charges,"Rev 272 $5,075.15 in Billed Charges at 70% = $3,552.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DISSECTOR SONICISION CURV 39CM USE LN 180548,272,RC,,,,,,,,both,,,5075.1500,761.2700,CIGNA HEALTHCARE,CIGNA HMO,2116.34,,,,,,,1309.9000,5075.1500,percent of total billed charges,"41.7% of $5,075.15 in Billed Charges for Rev 272 = $2,116.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DISSECTOR SONICISION CURV 39CM USE LN 180548,272,RC,,,,,,,,both,,,5075.1500,761.2700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2354.87,,,,,,,1309.9000,5075.1500,percent of total billed charges,"46.4% of $5,075.15 in Billed Charges for Rev 272 = $2,354.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DISSECTOR SONICISION CURV 39CM USE LN 180548,272,RC,,,,,,,,both,,,5075.1500,761.2700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2116.34,,,,,,,1309.9000,5075.1500,percent of total billed charges,"41.7% of $5,075.15 in Billed Charges for Rev 272 = $2,116.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DISSECTOR SONICISION CURV 39CM USE LN 180548,272,RC,,,,,,,,both,,,5075.1500,761.2700,CIGNA HEALTHCARE,CIGNA PPO,2116.34,,,,,,,1309.9000,5075.1500,percent of total billed charges,"41.7% of $5,075.15 in Billed Charges for Rev 272 = $2,116.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DISSECTOR SONICISION CURV 39CM USE LN 180548,272,RC,,,,,,,,both,,,5075.1500,761.2700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4567.64,,,,,,,1309.9000,5075.1500,percent of total billed charges,"90% of $5,075.15 in Billed Charges for Rev 272 = $4,567.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DISSECTOR SONICISION CURV 39CM USE LN 180548,272,RC,,,,,,,,both,,,5075.1500,761.2700,MEDCOST,MEDCOST VHN,2415.26,,,,,,,1309.9000,5075.1500,percent of total billed charges,"47.59% of $5,075.15 in Billed Charges for Rev 272 = $2,415.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DISSECTOR SONICISION CURV 39CM USE LN 180548,272,RC,,,,,,,,both,,,5075.1500,761.2700,SENTARA HEALTH,SENTARA HEALTH,1309.90,,,,,,,1309.9000,5075.1500,percent of total billed charges,"25.81% of $5,075.15 in Billed Charges for Rev 272 = $1,309.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DISSECTOR SONICISION CURV 39CM USE LN 180548,272,RC,,,,,,,,both,,,5075.1500,761.2700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5075.15,,,,,,,1309.9000,5075.1500,percent of total billed charges,"100% of $5,075.15 in Billed Charges for Rev 272 = $5,075.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DISSECTOR SONICISION CURV 39CM USE LN 180548,272,RC,,,,,,,,both,,,5075.1500,761.2700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2537.58,,,,,,,1309.9000,5075.1500,percent of total billed charges,"Rev 272 $5,075.15 in Billed Charges at 50% = $2,537.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DISSECTOR SONICISION CURV 39CM USE LN 180548,272,RC,,,,,,,,both,,,5075.1500,761.2700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1639.27,,,,,,,1309.9000,5075.1500,other,"32.3% of $5,075.15 in Billed Charges for Rev 272 = $1,639.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A DISSECTOR SONICISION CURV 39CM USE LN 180548,272,RC,,,,,,,,both,,,5075.1500,761.2700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1558.07,,,,,,,1309.9000,5075.1500,other,"30.7% of $5,075.15 in Billed Charges for Rev 272 = $1,558.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A DISSECTOR SONICISION CURV 39CM USE LN 180548,272,RC,,,,,,,,both,,,5075.1500,761.2700,UNITED HEALTHCARE,UNITED HEALTHCARE,1639.27,,,,,,,1309.9000,5075.1500,percent of total billed charges,"32.3% of $5,075.15 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DISSECTOR SONICISION CURV 39CM USE LN 180548,272,RC,,,,,,,,both,,,5075.1500,761.2700,WELLCARE,WELLCARE MEDICAID,5075.15,,,,,,,1309.9000,5075.1500,percent of total billed charges,"100% of $5,075.15 in Billed Charges for Rev 272 = $5,075.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STIMULANTS SYNTHETIC,80371,CPT,301,RC,30100408,CDM,,,,both,,,144.0000,21.6000,AETNA,AETNA,61.49,,,,,,,16.2000,144.0000,percent of total billed charges,42.7% of $144.00 in Billed Charges for Rev 301 Proc 80371 = $61.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STIMULANTS SYNTHETIC,80371,CPT,301,RC,30100408,CDM,,,,both,,,144.0000,21.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,16.36,,,,,,,16.2000,144.0000,fee schedule,APG 02040 Proc 80371 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 104% = $16.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STIMULANTS SYNTHETIC,80371,CPT,301,RC,30100408,CDM,,,,both,,,144.0000,21.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,16.20,,,,,,,16.2000,144.0000,fee schedule,APG 02040 Proc 80371 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STIMULANTS SYNTHETIC,80371,CPT,301,RC,30100408,CDM,,,,both,,,144.0000,21.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,100.80,,,,,,,16.2000,144.0000,percent of total billed charges,Rev 301 Proc 80371 $144.00 in Billed Charges at 70% = $100.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STIMULANTS SYNTHETIC,80371,CPT,301,RC,30100408,CDM,,,,both,,,144.0000,21.6000,CIGNA HEALTHCARE,CIGNA HMO,60.05,,,,,,,16.2000,144.0000,percent of total billed charges,Rev 301 Proc 80371 $144.00 in Billed Charges at 41.7% = $60.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STIMULANTS SYNTHETIC,80371,CPT,301,RC,30100408,CDM,,,,both,,,144.0000,21.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,61.63,,,,,,,16.2000,144.0000,percent of total billed charges,Rev 301 Proc 80371 $144.00 in Billed Charges at 42.8% = $61.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STIMULANTS SYNTHETIC,80371,CPT,301,RC,30100408,CDM,,,,both,,,144.0000,21.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,60.05,,,,,,,16.2000,144.0000,percent of total billed charges,Rev 301 Proc 80371 $144.00 in Billed Charges at 41.7% = $60.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STIMULANTS SYNTHETIC,80371,CPT,301,RC,30100408,CDM,,,,both,,,144.0000,21.6000,CIGNA HEALTHCARE,CIGNA PPO,60.05,,,,,,,16.2000,144.0000,percent of total billed charges,Rev 301 Proc 80371 $144.00 in Billed Charges at 41.7% = $60.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STIMULANTS SYNTHETIC,80371,CPT,301,RC,30100408,CDM,,,,both,,,144.0000,21.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,129.60,,,,,,,16.2000,144.0000,percent of total billed charges,90% of $144.00 in Billed Charges for Rev 301 Proc 80371 = $129.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STIMULANTS SYNTHETIC,80371,CPT,301,RC,30100408,CDM,,,,both,,,144.0000,21.6000,MEDCOST,MEDCOST VHN,68.53,,,,,,,16.2000,144.0000,percent of total billed charges,47.59% of $144.00 in Billed Charges for Rev 301 Proc 80371 = $68.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STIMULANTS SYNTHETIC,80371,CPT,301,RC,30100408,CDM,,,,both,,,144.0000,21.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,16.52,,,,,,,16.2000,144.0000,fee schedule,APG 02040 Proc 80371 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 105% = $16.52 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STIMULANTS SYNTHETIC,80371,CPT,301,RC,30100408,CDM,,,,both,,,144.0000,21.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,16.22,,,,,,,16.2000,144.0000,fee schedule,APG 02040 Proc 80371 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 100% = $15.73... $15.73 at 103.1% = $16.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STIMULANTS SYNTHETIC,80371,CPT,301,RC,30100408,CDM,,,,both,,,144.0000,21.6000,SENTARA HEALTH,SENTARA HEALTH,37.17,,,,,,,16.2000,144.0000,percent of total billed charges,25.81% of $144.00 in Billed Charges for Rev 301 Proc 80371 = $37.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STIMULANTS SYNTHETIC,80371,CPT,301,RC,30100408,CDM,,,,both,,,144.0000,21.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",144.00,,,,,,,16.2000,144.0000,percent of total billed charges,100% of $144.00 in Billed Charges for Rev 301 Proc 80371 = $144.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STIMULANTS SYNTHETIC,80371,CPT,301,RC,30100408,CDM,,,,both,,,144.0000,21.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,16.20,,,,,,,16.2000,144.0000,fee schedule,APG 02040 Proc 80371 at $836.60 (Base Rate) * 0.0188 (Relative Weight) = $15.73 (Total Line Payment) at 103% = $16.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STIMULANTS SYNTHETIC,80371,CPT,301,RC,30100408,CDM,,,,both,,,144.0000,21.6000,WELLCARE,WELLCARE MEDICAID,144.00,,,,,,,16.2000,144.0000,percent of total billed charges,100% of $144.00 in Billed Charges for Rev 301 Proc 80371 = $144.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,AETNA,AETNA,718.21,,,,,,,145.6800,1682.0000,percent of total billed charges,"42.7% of $1,682.00 in Billed Charges for Rev 310 Proc 81306 = $718.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,189.06,,,,,,,145.6800,1682.0000,fee schedule,APG 00386 Proc 81306 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 104% = $189.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,291.36,,,,,,,145.6800,1682.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,AETNA,AETNA HEALTHCARE MEDICARE,291.36,,,,,,,145.6800,1682.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,291.36,,,,,,,145.6800,1682.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,AMBETTER,AMBETTER,635.16,,,,,,,145.6800,1682.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,AMERIGROUP,AMERIGROUP,145.68,,,,,,,145.6800,1682.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,303.01,,,,,,,145.6800,1682.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,BLUE CROSS,ANTHEM EXCHANGE,291.36,,,,,,,145.6800,1682.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,187.25,,,,,,,145.6800,1682.0000,fee schedule,APG 00386 Proc 81306 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,BLUE CROSS,ANTHEM HMO,291.36,,,,,,,145.6800,1682.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,300.10,,,,,,,145.6800,1682.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.36,,,,,,,145.6800,1682.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1177.40,,,,,,,145.6800,1682.0000,percent of total billed charges,"Rev 310 Proc 81306 $1,682.00 in Billed Charges at 70% = $1,177.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,BLUE CROSS,BLUE CROSS E NETWORK,932.35,,,,,,,145.6800,1682.0000,fee schedule,$291.36 from Fee Schedule BCFSB for Rev 310 Proc 81306 * Qty 1 = $291.36 at 320% = $932.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,BLUE CROSS,BLUE CROSS MEDICARE,303.01,,,,,,,145.6800,1682.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,BLUE CROSS,BLUE CROSS P NETWORK,952.75,,,,,,,145.6800,1682.0000,fee schedule,$291.36 from Fee Schedule BCFSB for Rev 310 Proc 81306 * Qty 1 = $291.36 at 327% = $952.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,BLUE CROSS,BLUE CROSS S NETWORK,952.75,,,,,,,145.6800,1682.0000,fee schedule,$291.36 from Fee Schedule BCFSB for Rev 310 Proc 81306 * Qty 1 = $291.36 at 327% = $952.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,BLUE CROSS,TENNCARE BLUE CARE,274.60,,,,,,,145.6800,1682.0000,fee schedule,$236.72 from Fee Schedule TC_24 for Rev 310 Proc 81306 * Qty 1 = $236.72 at 116% = $274.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,BLUE CROSS,TENNCARE BLUE SELECT,274.60,,,,,,,145.6800,1682.0000,fee schedule,$236.72 from Fee Schedule TC_24 for Rev 310 Proc 81306 * Qty 1 = $236.72 at 116% = $274.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,CIGNA HEALTHCARE,CIGNA HMO,701.39,,,,,,,145.6800,1682.0000,percent of total billed charges,"Rev 310 Proc 81306 $1,682.00 in Billed Charges at 41.7% = $701.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,642.38,,,,,,,145.6800,1682.0000,fee schedule,$642.38 from Fee Schedule CGIFP_25LR for Rev 310 Proc 81306 * Qty 1 = $642.38 at 100% = $642.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,305.93,,,,,,,145.6800,1682.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,701.39,,,,,,,145.6800,1682.0000,percent of total billed charges,"Rev 310 Proc 81306 $1,682.00 in Billed Charges at 41.7% = $701.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,CIGNA HEALTHCARE,CIGNA PPO,701.39,,,,,,,145.6800,1682.0000,percent of total billed charges,"Rev 310 Proc 81306 $1,682.00 in Billed Charges at 41.7% = $701.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,305.93,,,,,,,145.6800,1682.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1513.80,,,,,,,145.6800,1682.0000,percent of total billed charges,"90% of $1,682.00 in Billed Charges for Rev 310 Proc 81306 = $1,513.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,HUMANA,HUMANA MEDICARE,291.36,,,,,,,145.6800,1682.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,291.36,,,,,,,145.6800,1682.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,MEDCOST,MEDCOST VHN,800.46,,,,,,,145.6800,1682.0000,percent of total billed charges,"47.59% of $1,682.00 in Billed Charges for Rev 310 Proc 81306 = $800.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,190.88,,,,,,,145.6800,1682.0000,fee schedule,APG 00386 Proc 81306 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 105% = $190.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,305.93,,,,,,,145.6800,1682.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,305.93,,,,,,,145.6800,1682.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,NHC ADVANTAGE,NHC ADVANTAGE,305.93,,,,,,,145.6800,1682.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,187.43,,,,,,,145.6800,1682.0000,fee schedule,APG 00386 Proc 81306 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 103.1% = $187.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,SENTARA HEALTH,SENTARA HEALTH,434.12,,,,,,,145.6800,1682.0000,percent of total billed charges,"25.81% of $1,682.00 in Billed Charges for Rev 310 Proc 81306 = $434.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,SENTARA HEALTH,SENTARA MEDICARE,291.36,,,,,,,145.6800,1682.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1682.00,,,,,,,145.6800,1682.0000,percent of total billed charges,"100% of $1,682.00 in Billed Charges for Rev 310 Proc 81306 = $1,682.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,145.68,,,,,,,145.6800,1682.0000,fee schedule,$291.36 from Fee Schedule TCUHC24 for Rev 310 Proc 81306 * Qty 1 = $291.36 at 50% = $145.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,303.01,,,,,,,145.6800,1682.0000,fee schedule,$291.36 from Fee Schedule UHC_31910 for Rev 310 Proc 81306 * Qty 1 = $291.36 at 104% = $303.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,291.36,,,,,,,145.6800,1682.0000,fee schedule,$291.36 from Fee Schedule UHC_31910 for Rev 310 Proc 81306 * Qty 1 = $291.36 at 100% = $291.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,291.36,,,,,,,145.6800,1682.0000,fee schedule,$291.36 from Fee Schedule UHC_31910 for Rev 310 Proc 81306 * Qty 1 = $291.36 at 100% = $291.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,187.25,,,,,,,145.6800,1682.0000,fee schedule,APG 00386 Proc 81306 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,291.36,,,,,,,145.6800,1682.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,291.36,,,,,,,145.6800,1682.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,WELLCARE,WELLCARE MEDICAID,1682.00,,,,,,,145.6800,1682.0000,percent of total billed charges,"100% of $1,682.00 in Billed Charges for Rev 310 Proc 81306 = $1,682.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NUDT15 GENE ANALYSIS COMMON VARIANTS,81306,CPT,310,RC,31000057,CDM,,,,both,,,1682.0000,252.3000,WELLCARE,WELLCARE MEDICARE,308.84,,,,,,,145.6800,1682.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,AETNA,AETNA,632.81,,,,,,,141.4400,1482.0000,percent of total billed charges,"42.7% of $1,482.00 in Billed Charges for Rev 310 Proc 81307 = $632.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,771.31,,,,,,,141.4400,1482.0000,fee schedule,APG 02044 Proc 81307 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 104% = $771.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,676.50,,,,,,,141.4400,1482.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,AETNA,AETNA HEALTHCARE MEDICARE,676.50,,,,,,,141.4400,1482.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,676.50,,,,,,,141.4400,1482.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,AMBETTER,AMBETTER,1474.77,,,,,,,141.4400,1482.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,AMERIGROUP,AMERIGROUP,338.25,,,,,,,141.4400,1482.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,703.56,,,,,,,141.4400,1482.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,BLUE CROSS,ANTHEM EXCHANGE,676.50,,,,,,,141.4400,1482.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,763.90,,,,,,,141.4400,1482.0000,fee schedule,APG 02044 Proc 81307 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 103% = $763.90. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,BLUE CROSS,ANTHEM HMO,676.50,,,,,,,141.4400,1482.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,696.80,,,,,,,141.4400,1482.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",676.50,,,,,,,141.4400,1482.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1037.40,,,,,,,141.4400,1482.0000,percent of total billed charges,"Rev 310 Proc 81307 $1,482.00 in Billed Charges at 70% = $1,037.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,BLUE CROSS,BLUE CROSS E NETWORK,905.22,,,,,,,141.4400,1482.0000,fee schedule,$282.88 from Fee Schedule BCFSB for Rev 310 Proc 81307 * Qty 1 = $282.88 at 320% = $905.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,BLUE CROSS,BLUE CROSS MEDICARE,703.56,,,,,,,141.4400,1482.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,BLUE CROSS,BLUE CROSS P NETWORK,925.02,,,,,,,141.4400,1482.0000,fee schedule,$282.88 from Fee Schedule BCFSB for Rev 310 Proc 81307 * Qty 1 = $282.88 at 327% = $925.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,BLUE CROSS,BLUE CROSS S NETWORK,925.02,,,,,,,141.4400,1482.0000,fee schedule,$282.88 from Fee Schedule BCFSB for Rev 310 Proc 81307 * Qty 1 = $282.88 at 327% = $925.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,BLUE CROSS,TENNCARE BLUE CARE,266.59,,,,,,,141.4400,1482.0000,fee schedule,$229.82 from Fee Schedule TC_24 for Rev 310 Proc 81307 * Qty 1 = $229.82 at 116% = $266.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,BLUE CROSS,TENNCARE BLUE SELECT,266.59,,,,,,,141.4400,1482.0000,fee schedule,$229.82 from Fee Schedule TC_24 for Rev 310 Proc 81307 * Qty 1 = $229.82 at 116% = $266.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,CIGNA HEALTHCARE,CIGNA HMO,617.99,,,,,,,141.4400,1482.0000,percent of total billed charges,"Rev 310 Proc 81307 $1,482.00 in Billed Charges at 41.7% = $617.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1482.00,,,,,,,141.4400,1482.0000,fee schedule,"$1,491.20 from Fee Schedule CGIFP_25LR for Rev 310 Proc 81307 * Qty 1 = $1,491.20 at 100% = $1,491.20 (Limited to $1,482.00 in Billed Charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,710.33,,,,,,,141.4400,1482.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,617.99,,,,,,,141.4400,1482.0000,percent of total billed charges,"Rev 310 Proc 81307 $1,482.00 in Billed Charges at 41.7% = $617.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,CIGNA HEALTHCARE,CIGNA PPO,617.99,,,,,,,141.4400,1482.0000,percent of total billed charges,"Rev 310 Proc 81307 $1,482.00 in Billed Charges at 41.7% = $617.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,710.33,,,,,,,141.4400,1482.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1333.80,,,,,,,141.4400,1482.0000,percent of total billed charges,"90% of $1,482.00 in Billed Charges for Rev 310 Proc 81307 = $1,333.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,HUMANA,HUMANA MEDICARE,676.50,,,,,,,141.4400,1482.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,676.50,,,,,,,141.4400,1482.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,MEDCOST,MEDCOST VHN,705.28,,,,,,,141.4400,1482.0000,percent of total billed charges,"47.59% of $1,482.00 in Billed Charges for Rev 310 Proc 81307 = $705.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,778.73,,,,,,,141.4400,1482.0000,fee schedule,APG 02044 Proc 81307 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 100% = $741.65... $741.65 at 105% = $778.73 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,710.33,,,,,,,141.4400,1482.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,710.33,,,,,,,141.4400,1482.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,NHC ADVANTAGE,NHC ADVANTAGE,710.33,,,,,,,141.4400,1482.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,764.64,,,,,,,141.4400,1482.0000,fee schedule,APG 02044 Proc 81307 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 100% = $741.65... $741.65 at 103.1% = $764.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,SENTARA HEALTH,SENTARA HEALTH,382.50,,,,,,,141.4400,1482.0000,percent of total billed charges,"25.81% of $1,482.00 in Billed Charges for Rev 310 Proc 81307 = $382.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,SENTARA HEALTH,SENTARA MEDICARE,676.50,,,,,,,141.4400,1482.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1482.00,,,,,,,141.4400,1482.0000,percent of total billed charges,"100% of $1,482.00 in Billed Charges for Rev 310 Proc 81307 = $1,482.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,141.44,,,,,,,141.4400,1482.0000,fee schedule,$282.88 from Fee Schedule TCUHC24 for Rev 310 Proc 81307 * Qty 1 = $282.88 at 50% = $141.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,294.20,,,,,,,141.4400,1482.0000,fee schedule,$282.88 from Fee Schedule UHC_31910 for Rev 310 Proc 81307 * Qty 1 = $282.88 at 104% = $294.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,282.88,,,,,,,141.4400,1482.0000,fee schedule,$282.88 from Fee Schedule UHC_31910 for Rev 310 Proc 81307 * Qty 1 = $282.88 at 100% = $282.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,282.88,,,,,,,141.4400,1482.0000,fee schedule,$282.88 from Fee Schedule UHC_31910 for Rev 310 Proc 81307 * Qty 1 = $282.88 at 100% = $282.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,763.90,,,,,,,141.4400,1482.0000,fee schedule,APG 02044 Proc 81307 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 103% = $763.90. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,676.50,,,,,,,141.4400,1482.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,676.50,,,,,,,141.4400,1482.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,WELLCARE,WELLCARE MEDICAID,1482.00,,,,,,,141.4400,1482.0000,percent of total billed charges,"100% of $1,482.00 in Billed Charges for Rev 310 Proc 81307 = $1,482.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PALB2 GENE ANALYSIS FULL GENE SEQUENCE,81307,CPT,310,RC,31000091,CDM,,,,both,,,1482.0000,222.3000,WELLCARE,WELLCARE MEDICARE,717.09,,,,,,,141.4400,1482.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,AETNA,AETNA,903.11,,,,,,,47.1200,2115.0000,percent of total billed charges,"42.7% of $2,115.00 in Billed Charges for Rev 300 Proc 81310 = $903.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,189.06,,,,,,,47.1200,2115.0000,fee schedule,APG 00386 Proc 81310 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 104% = $189.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,246.52,,,,,,,47.1200,2115.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,AETNA,AETNA HEALTHCARE MEDICARE,246.52,,,,,,,47.1200,2115.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,246.52,,,,,,,47.1200,2115.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,AMBETTER,AMBETTER,537.41,,,,,,,47.1200,2115.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,AMERIGROUP,AMERIGROUP,123.26,,,,,,,47.1200,2115.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,256.38,,,,,,,47.1200,2115.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,BLUE CROSS,ANTHEM EXCHANGE,246.52,,,,,,,47.1200,2115.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,187.25,,,,,,,47.1200,2115.0000,fee schedule,APG 00386 Proc 81310 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,BLUE CROSS,ANTHEM HMO,246.52,,,,,,,47.1200,2115.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,253.92,,,,,,,47.1200,2115.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",246.52,,,,,,,47.1200,2115.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1480.50,,,,,,,47.1200,2115.0000,percent of total billed charges,"Rev 300 Proc 81310 $2,115.00 in Billed Charges at 70% = $1,480.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,BLUE CROSS,BLUE CROSS E NETWORK,790.85,,,,,,,47.1200,2115.0000,fee schedule,$247.14 from Fee Schedule BCFSB for Rev 300 Proc 81310 * Qty 1 = $247.14 at 320% = $790.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,BLUE CROSS,BLUE CROSS MEDICARE,256.38,,,,,,,47.1200,2115.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,BLUE CROSS,BLUE CROSS P NETWORK,808.15,,,,,,,47.1200,2115.0000,fee schedule,$247.14 from Fee Schedule BCFSB for Rev 300 Proc 81310 * Qty 1 = $247.14 at 327% = $808.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,BLUE CROSS,BLUE CROSS S NETWORK,808.15,,,,,,,47.1200,2115.0000,fee schedule,$247.14 from Fee Schedule BCFSB for Rev 300 Proc 81310 * Qty 1 = $247.14 at 327% = $808.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,BLUE CROSS,TENNCARE BLUE CARE,47.12,,,,,,,47.1200,2115.0000,fee schedule,$40.62 from Fee Schedule TC_24 for Rev 300 Proc 81310 * Qty 1 = $40.62 at 116% = $47.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,BLUE CROSS,TENNCARE BLUE SELECT,47.12,,,,,,,47.1200,2115.0000,fee schedule,$40.62 from Fee Schedule TC_24 for Rev 300 Proc 81310 * Qty 1 = $40.62 at 116% = $47.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,CIGNA HEALTHCARE,CIGNA HMO,881.96,,,,,,,47.1200,2115.0000,percent of total billed charges,"Rev 300 Proc 81310 $2,115.00 in Billed Charges at 41.7% = $881.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,543.50,,,,,,,47.1200,2115.0000,fee schedule,$543.50 from Fee Schedule CGIFP_25LR for Rev 300 Proc 81310 * Qty 1 = $543.50 at 100% = $543.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,258.85,,,,,,,47.1200,2115.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,881.96,,,,,,,47.1200,2115.0000,percent of total billed charges,"Rev 300 Proc 81310 $2,115.00 in Billed Charges at 41.7% = $881.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,CIGNA HEALTHCARE,CIGNA PPO,881.96,,,,,,,47.1200,2115.0000,percent of total billed charges,"Rev 300 Proc 81310 $2,115.00 in Billed Charges at 41.7% = $881.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,258.85,,,,,,,47.1200,2115.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1903.50,,,,,,,47.1200,2115.0000,percent of total billed charges,"90% of $2,115.00 in Billed Charges for Rev 300 Proc 81310 = $1,903.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,HUMANA,HUMANA MEDICARE,246.52,,,,,,,47.1200,2115.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,246.52,,,,,,,47.1200,2115.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,MEDCOST,MEDCOST VHN,1006.53,,,,,,,47.1200,2115.0000,percent of total billed charges,"47.59% of $2,115.00 in Billed Charges for Rev 300 Proc 81310 = $1,006.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,190.88,,,,,,,47.1200,2115.0000,fee schedule,APG 00386 Proc 81310 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 105% = $190.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,258.85,,,,,,,47.1200,2115.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,258.85,,,,,,,47.1200,2115.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,NHC ADVANTAGE,NHC ADVANTAGE,258.85,,,,,,,47.1200,2115.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,187.43,,,,,,,47.1200,2115.0000,fee schedule,APG 00386 Proc 81310 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 103.1% = $187.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,SENTARA HEALTH,SENTARA HEALTH,545.88,,,,,,,47.1200,2115.0000,percent of total billed charges,"25.81% of $2,115.00 in Billed Charges for Rev 300 Proc 81310 = $545.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,SENTARA HEALTH,SENTARA MEDICARE,246.52,,,,,,,47.1200,2115.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2115.00,,,,,,,47.1200,2115.0000,percent of total billed charges,"100% of $2,115.00 in Billed Charges for Rev 300 Proc 81310 = $2,115.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,123.57,,,,,,,47.1200,2115.0000,fee schedule,$247.14 from Fee Schedule TCUHC24 for Rev 300 Proc 81310 * Qty 1 = $247.14 at 50% = $123.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,256.38,,,,,,,47.1200,2115.0000,fee schedule,$246.52 from Fee Schedule UHC_31910 for Rev 300 Proc 81310 * Qty 1 = $246.52 at 104% = $256.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,246.52,,,,,,,47.1200,2115.0000,fee schedule,$246.52 from Fee Schedule UHC_31910 for Rev 300 Proc 81310 * Qty 1 = $246.52 at 100% = $246.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,246.52,,,,,,,47.1200,2115.0000,fee schedule,$246.52 from Fee Schedule UHC_31910 for Rev 300 Proc 81310 * Qty 1 = $246.52 at 100% = $246.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,187.25,,,,,,,47.1200,2115.0000,fee schedule,APG 00386 Proc 81310 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,246.52,,,,,,,47.1200,2115.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,246.52,,,,,,,47.1200,2115.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,WELLCARE,WELLCARE MEDICAID,2115.00,,,,,,,47.1200,2115.0000,percent of total billed charges,"100% of $2,115.00 in Billed Charges for Rev 300 Proc 81310 = $2,115.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANLYS GENE NPM1 EXON 12 VARIANTS,81310,CPT,300,RC,30000064,CDM,,,,both,,,2115.0000,317.2500,WELLCARE,WELLCARE MEDICARE,261.31,,,,,,,47.1200,2115.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,AETNA,AETNA,950.93,,,,,,,100.0800,2227.0000,percent of total billed charges,"42.7% of $2,227.00 in Billed Charges for Rev 300 Proc 81313 = $950.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,189.06,,,,,,,100.0800,2227.0000,fee schedule,APG 00386 Proc 81313 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 104% = $189.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,255.05,,,,,,,100.0800,2227.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,AETNA,AETNA HEALTHCARE MEDICARE,255.05,,,,,,,100.0800,2227.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,255.05,,,,,,,100.0800,2227.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,AMBETTER,AMBETTER,556.01,,,,,,,100.0800,2227.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,AMERIGROUP,AMERIGROUP,127.53,,,,,,,100.0800,2227.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,265.25,,,,,,,100.0800,2227.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,BLUE CROSS,ANTHEM EXCHANGE,255.05,,,,,,,100.0800,2227.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,187.25,,,,,,,100.0800,2227.0000,fee schedule,APG 00386 Proc 81313 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,BLUE CROSS,ANTHEM HMO,255.05,,,,,,,100.0800,2227.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,262.70,,,,,,,100.0800,2227.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",255.05,,,,,,,100.0800,2227.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1558.90,,,,,,,100.0800,2227.0000,percent of total billed charges,"Rev 300 Proc 81313 $2,227.00 in Billed Charges at 70% = $1,558.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,BLUE CROSS,BLUE CROSS E NETWORK,832.83,,,,,,,100.0800,2227.0000,fee schedule,$260.26 from Fee Schedule BCFSB for Rev 300 Proc 81313 * Qty 1 = $260.26 at 320% = $832.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,BLUE CROSS,BLUE CROSS MEDICARE,265.25,,,,,,,100.0800,2227.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,BLUE CROSS,BLUE CROSS P NETWORK,851.05,,,,,,,100.0800,2227.0000,fee schedule,$260.26 from Fee Schedule BCFSB for Rev 300 Proc 81313 * Qty 1 = $260.26 at 327% = $851.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,BLUE CROSS,BLUE CROSS S NETWORK,851.05,,,,,,,100.0800,2227.0000,fee schedule,$260.26 from Fee Schedule BCFSB for Rev 300 Proc 81313 * Qty 1 = $260.26 at 327% = $851.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,BLUE CROSS,TENNCARE BLUE CARE,240.36,,,,,,,100.0800,2227.0000,fee schedule,$207.21 from Fee Schedule TC_24 for Rev 300 Proc 81313 * Qty 1 = $207.21 at 116% = $240.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,BLUE CROSS,TENNCARE BLUE SELECT,240.36,,,,,,,100.0800,2227.0000,fee schedule,$207.21 from Fee Schedule TC_24 for Rev 300 Proc 81313 * Qty 1 = $207.21 at 116% = $240.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,CIGNA HEALTHCARE,CIGNA HMO,928.66,,,,,,,100.0800,2227.0000,percent of total billed charges,"Rev 300 Proc 81313 $2,227.00 in Billed Charges at 41.7% = $928.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,562.27,,,,,,,100.0800,2227.0000,fee schedule,$562.27 from Fee Schedule CGIFP_25LR for Rev 300 Proc 81313 * Qty 1 = $562.27 at 100% = $562.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,267.80,,,,,,,100.0800,2227.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,928.66,,,,,,,100.0800,2227.0000,percent of total billed charges,"Rev 300 Proc 81313 $2,227.00 in Billed Charges at 41.7% = $928.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,CIGNA HEALTHCARE,CIGNA PPO,928.66,,,,,,,100.0800,2227.0000,percent of total billed charges,"Rev 300 Proc 81313 $2,227.00 in Billed Charges at 41.7% = $928.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,267.80,,,,,,,100.0800,2227.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2004.30,,,,,,,100.0800,2227.0000,percent of total billed charges,"90% of $2,227.00 in Billed Charges for Rev 300 Proc 81313 = $2,004.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,HUMANA,HUMANA MEDICARE,255.05,,,,,,,100.0800,2227.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,255.05,,,,,,,100.0800,2227.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,MEDCOST,MEDCOST VHN,1059.83,,,,,,,100.0800,2227.0000,percent of total billed charges,"47.59% of $2,227.00 in Billed Charges for Rev 300 Proc 81313 = $1,059.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,190.88,,,,,,,100.0800,2227.0000,fee schedule,APG 00386 Proc 81313 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 105% = $190.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,267.80,,,,,,,100.0800,2227.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,267.80,,,,,,,100.0800,2227.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,NHC ADVANTAGE,NHC ADVANTAGE,267.80,,,,,,,100.0800,2227.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,187.43,,,,,,,100.0800,2227.0000,fee schedule,APG 00386 Proc 81313 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 103.1% = $187.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,SENTARA HEALTH,SENTARA HEALTH,574.79,,,,,,,100.0800,2227.0000,percent of total billed charges,"25.81% of $2,227.00 in Billed Charges for Rev 300 Proc 81313 = $574.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,SENTARA HEALTH,SENTARA MEDICARE,255.05,,,,,,,100.0800,2227.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2227.00,,,,,,,100.0800,2227.0000,percent of total billed charges,"100% of $2,227.00 in Billed Charges for Rev 300 Proc 81313 = $2,227.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,100.08,,,,,,,100.0800,2227.0000,fee schedule,$200.15 from Fee Schedule TCUHC24 for Rev 300 Proc 81313 * Qty 1 = $200.15 at 50% = $100.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,265.25,,,,,,,100.0800,2227.0000,fee schedule,$255.05 from Fee Schedule UHC_31910 for Rev 300 Proc 81313 * Qty 1 = $255.05 at 104% = $265.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,255.05,,,,,,,100.0800,2227.0000,fee schedule,$255.05 from Fee Schedule UHC_31910 for Rev 300 Proc 81313 * Qty 1 = $255.05 at 100% = $255.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,255.05,,,,,,,100.0800,2227.0000,fee schedule,$255.05 from Fee Schedule UHC_31910 for Rev 300 Proc 81313 * Qty 1 = $255.05 at 100% = $255.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,187.25,,,,,,,100.0800,2227.0000,fee schedule,APG 00386 Proc 81313 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,255.05,,,,,,,100.0800,2227.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,255.05,,,,,,,100.0800,2227.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,WELLCARE,WELLCARE MEDICAID,2227.00,,,,,,,100.0800,2227.0000,percent of total billed charges,"100% of $2,227.00 in Billed Charges for Rev 300 Proc 81313 = $2,227.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCA3/KLK3 ANTIGEN RATIO,81313,CPT,300,RC,30000129,CDM,,,,both,,,2227.0000,334.0500,WELLCARE,WELLCARE MEDICARE,270.35,,,,,,,100.0800,2227.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
I/A FLIPCUTTER  SHORT 9.5 MM AR-1204AS-95,272,RC,,,,,,,,both,,,4822.5200,723.3800,AETNA,AETNA,2059.22,,,,,,,1244.6900,4822.5200,percent of total billed charges,"42.7% of $4,822.52 in Billed Charges for Rev 272 = $2,059.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A FLIPCUTTER  SHORT 9.5 MM AR-1204AS-95,272,RC,,,,,,,,both,,,4822.5200,723.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3375.76,,,,,,,1244.6900,4822.5200,percent of total billed charges,"Rev 272 $4,822.52 in Billed Charges at 70% = $3,375.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A FLIPCUTTER  SHORT 9.5 MM AR-1204AS-95,272,RC,,,,,,,,both,,,4822.5200,723.3800,CIGNA HEALTHCARE,CIGNA HMO,2010.99,,,,,,,1244.6900,4822.5200,percent of total billed charges,"41.7% of $4,822.52 in Billed Charges for Rev 272 = $2,010.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A FLIPCUTTER  SHORT 9.5 MM AR-1204AS-95,272,RC,,,,,,,,both,,,4822.5200,723.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2237.65,,,,,,,1244.6900,4822.5200,percent of total billed charges,"46.4% of $4,822.52 in Billed Charges for Rev 272 = $2,237.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A FLIPCUTTER  SHORT 9.5 MM AR-1204AS-95,272,RC,,,,,,,,both,,,4822.5200,723.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2010.99,,,,,,,1244.6900,4822.5200,percent of total billed charges,"41.7% of $4,822.52 in Billed Charges for Rev 272 = $2,010.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A FLIPCUTTER  SHORT 9.5 MM AR-1204AS-95,272,RC,,,,,,,,both,,,4822.5200,723.3800,CIGNA HEALTHCARE,CIGNA PPO,2010.99,,,,,,,1244.6900,4822.5200,percent of total billed charges,"41.7% of $4,822.52 in Billed Charges for Rev 272 = $2,010.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A FLIPCUTTER  SHORT 9.5 MM AR-1204AS-95,272,RC,,,,,,,,both,,,4822.5200,723.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4340.27,,,,,,,1244.6900,4822.5200,percent of total billed charges,"90% of $4,822.52 in Billed Charges for Rev 272 = $4,340.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A FLIPCUTTER  SHORT 9.5 MM AR-1204AS-95,272,RC,,,,,,,,both,,,4822.5200,723.3800,MEDCOST,MEDCOST VHN,2295.04,,,,,,,1244.6900,4822.5200,percent of total billed charges,"47.59% of $4,822.52 in Billed Charges for Rev 272 = $2,295.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A FLIPCUTTER  SHORT 9.5 MM AR-1204AS-95,272,RC,,,,,,,,both,,,4822.5200,723.3800,SENTARA HEALTH,SENTARA HEALTH,1244.69,,,,,,,1244.6900,4822.5200,percent of total billed charges,"25.81% of $4,822.52 in Billed Charges for Rev 272 = $1,244.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A FLIPCUTTER  SHORT 9.5 MM AR-1204AS-95,272,RC,,,,,,,,both,,,4822.5200,723.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4822.52,,,,,,,1244.6900,4822.5200,percent of total billed charges,"100% of $4,822.52 in Billed Charges for Rev 272 = $4,822.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A FLIPCUTTER  SHORT 9.5 MM AR-1204AS-95,272,RC,,,,,,,,both,,,4822.5200,723.3800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2411.26,,,,,,,1244.6900,4822.5200,percent of total billed charges,"Rev 272 $4,822.52 in Billed Charges at 50% = $2,411.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A FLIPCUTTER  SHORT 9.5 MM AR-1204AS-95,272,RC,,,,,,,,both,,,4822.5200,723.3800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1557.67,,,,,,,1244.6900,4822.5200,other,"32.3% of $4,822.52 in Billed Charges for Rev 272 = $1,557.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A FLIPCUTTER  SHORT 9.5 MM AR-1204AS-95,272,RC,,,,,,,,both,,,4822.5200,723.3800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1480.51,,,,,,,1244.6900,4822.5200,other,"30.7% of $4,822.52 in Billed Charges for Rev 272 = $1,480.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A FLIPCUTTER  SHORT 9.5 MM AR-1204AS-95,272,RC,,,,,,,,both,,,4822.5200,723.3800,UNITED HEALTHCARE,UNITED HEALTHCARE,1557.67,,,,,,,1244.6900,4822.5200,percent of total billed charges,"32.3% of $4,822.52 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A FLIPCUTTER  SHORT 9.5 MM AR-1204AS-95,272,RC,,,,,,,,both,,,4822.5200,723.3800,WELLCARE,WELLCARE MEDICAID,4822.52,,,,,,,1244.6900,4822.5200,percent of total billed charges,"100% of $4,822.52 in Billed Charges for Rev 272 = $4,822.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A HEMOCONCENTRATOR SET HC1400 MAXI LACK OF USE,272,RC,,,,,,,,both,,,1851.2200,277.6800,AETNA,AETNA,790.47,,,,,,,477.8000,1851.2200,percent of total billed charges,"42.7% of $1,851.22 in Billed Charges for Rev 272 = $790.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A HEMOCONCENTRATOR SET HC1400 MAXI LACK OF USE,272,RC,,,,,,,,both,,,1851.2200,277.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1295.85,,,,,,,477.8000,1851.2200,percent of total billed charges,"Rev 272 $1,851.22 in Billed Charges at 70% = $1,295.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A HEMOCONCENTRATOR SET HC1400 MAXI LACK OF USE,272,RC,,,,,,,,both,,,1851.2200,277.6800,CIGNA HEALTHCARE,CIGNA HMO,771.96,,,,,,,477.8000,1851.2200,percent of total billed charges,"41.7% of $1,851.22 in Billed Charges for Rev 272 = $771.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A HEMOCONCENTRATOR SET HC1400 MAXI LACK OF USE,272,RC,,,,,,,,both,,,1851.2200,277.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,858.97,,,,,,,477.8000,1851.2200,percent of total billed charges,"46.4% of $1,851.22 in Billed Charges for Rev 272 = $858.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A HEMOCONCENTRATOR SET HC1400 MAXI LACK OF USE,272,RC,,,,,,,,both,,,1851.2200,277.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,771.96,,,,,,,477.8000,1851.2200,percent of total billed charges,"41.7% of $1,851.22 in Billed Charges for Rev 272 = $771.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A HEMOCONCENTRATOR SET HC1400 MAXI LACK OF USE,272,RC,,,,,,,,both,,,1851.2200,277.6800,CIGNA HEALTHCARE,CIGNA PPO,771.96,,,,,,,477.8000,1851.2200,percent of total billed charges,"41.7% of $1,851.22 in Billed Charges for Rev 272 = $771.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A HEMOCONCENTRATOR SET HC1400 MAXI LACK OF USE,272,RC,,,,,,,,both,,,1851.2200,277.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1666.10,,,,,,,477.8000,1851.2200,percent of total billed charges,"90% of $1,851.22 in Billed Charges for Rev 272 = $1,666.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A HEMOCONCENTRATOR SET HC1400 MAXI LACK OF USE,272,RC,,,,,,,,both,,,1851.2200,277.6800,MEDCOST,MEDCOST VHN,881.00,,,,,,,477.8000,1851.2200,percent of total billed charges,"47.59% of $1,851.22 in Billed Charges for Rev 272 = $881.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A HEMOCONCENTRATOR SET HC1400 MAXI LACK OF USE,272,RC,,,,,,,,both,,,1851.2200,277.6800,SENTARA HEALTH,SENTARA HEALTH,477.80,,,,,,,477.8000,1851.2200,percent of total billed charges,"25.81% of $1,851.22 in Billed Charges for Rev 272 = $477.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A HEMOCONCENTRATOR SET HC1400 MAXI LACK OF USE,272,RC,,,,,,,,both,,,1851.2200,277.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1851.22,,,,,,,477.8000,1851.2200,percent of total billed charges,"100% of $1,851.22 in Billed Charges for Rev 272 = $1,851.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A HEMOCONCENTRATOR SET HC1400 MAXI LACK OF USE,272,RC,,,,,,,,both,,,1851.2200,277.6800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,925.61,,,,,,,477.8000,1851.2200,percent of total billed charges,"Rev 272 $1,851.22 in Billed Charges at 50% = $925.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A HEMOCONCENTRATOR SET HC1400 MAXI LACK OF USE,272,RC,,,,,,,,both,,,1851.2200,277.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,597.94,,,,,,,477.8000,1851.2200,other,"32.3% of $1,851.22 in Billed Charges for Rev 272 = $597.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A HEMOCONCENTRATOR SET HC1400 MAXI LACK OF USE,272,RC,,,,,,,,both,,,1851.2200,277.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,568.32,,,,,,,477.8000,1851.2200,other,"30.7% of $1,851.22 in Billed Charges for Rev 272 = $568.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A HEMOCONCENTRATOR SET HC1400 MAXI LACK OF USE,272,RC,,,,,,,,both,,,1851.2200,277.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,597.94,,,,,,,477.8000,1851.2200,percent of total billed charges,"32.3% of $1,851.22 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A HEMOCONCENTRATOR SET HC1400 MAXI LACK OF USE,272,RC,,,,,,,,both,,,1851.2200,277.6800,WELLCARE,WELLCARE MEDICAID,1851.22,,,,,,,477.8000,1851.2200,percent of total billed charges,"100% of $1,851.22 in Billed Charges for Rev 272 = $1,851.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,AETNA,AETNA,2854.07,,,,,,,338.2500,6684.0000,percent of total billed charges,"42.7% of $6,684.00 in Billed Charges for Rev 300 Proc 81317 = $2,854.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,771.31,,,,,,,338.2500,6684.0000,fee schedule,APG 02044 Proc 81317 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 104% = $771.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,676.50,,,,,,,338.2500,6684.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,AETNA,AETNA HEALTHCARE MEDICARE,676.50,,,,,,,338.2500,6684.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,676.50,,,,,,,338.2500,6684.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,AMBETTER,AMBETTER,1474.77,,,,,,,338.2500,6684.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,AMERIGROUP,AMERIGROUP,338.25,,,,,,,338.2500,6684.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,703.56,,,,,,,338.2500,6684.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,BLUE CROSS,ANTHEM EXCHANGE,676.50,,,,,,,338.2500,6684.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,763.90,,,,,,,338.2500,6684.0000,fee schedule,APG 02044 Proc 81317 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 103% = $763.90. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,BLUE CROSS,ANTHEM HMO,676.50,,,,,,,338.2500,6684.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,696.80,,,,,,,338.2500,6684.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",676.50,,,,,,,338.2500,6684.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4678.80,,,,,,,338.2500,6684.0000,percent of total billed charges,"Rev 300 Proc 81317 $6,684.00 in Billed Charges at 70% = $4,678.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,BLUE CROSS,BLUE CROSS E NETWORK,2500.13,,,,,,,338.2500,6684.0000,fee schedule,"$781.29 from Fee Schedule BCFSB for Rev 300 Proc 81317 * Qty 1 = $781.29 at 320% = $2,500.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,BLUE CROSS,BLUE CROSS MEDICARE,703.56,,,,,,,338.2500,6684.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,BLUE CROSS,BLUE CROSS P NETWORK,2554.82,,,,,,,338.2500,6684.0000,fee schedule,"$781.29 from Fee Schedule BCFSB for Rev 300 Proc 81317 * Qty 1 = $781.29 at 327% = $2,554.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,BLUE CROSS,BLUE CROSS S NETWORK,2554.82,,,,,,,338.2500,6684.0000,fee schedule,"$781.29 from Fee Schedule BCFSB for Rev 300 Proc 81317 * Qty 1 = $781.29 at 327% = $2,554.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,BLUE CROSS,TENNCARE BLUE CARE,1130.92,,,,,,,338.2500,6684.0000,fee schedule,"$974.93 from Fee Schedule TC_24 for Rev 300 Proc 81317 * Qty 1 = $974.93 at 116% = $1,130.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,BLUE CROSS,TENNCARE BLUE SELECT,1130.92,,,,,,,338.2500,6684.0000,fee schedule,"$974.93 from Fee Schedule TC_24 for Rev 300 Proc 81317 * Qty 1 = $974.93 at 116% = $1,130.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,CIGNA HEALTHCARE,CIGNA HMO,2787.23,,,,,,,338.2500,6684.0000,percent of total billed charges,"Rev 300 Proc 81317 $6,684.00 in Billed Charges at 41.7% = $2,787.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1491.20,,,,,,,338.2500,6684.0000,fee schedule,"$1,491.20 from Fee Schedule CGIFP_25LR for Rev 300 Proc 81317 * Qty 1 = $1,491.20 at 100% = $1,491.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,710.33,,,,,,,338.2500,6684.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2787.23,,,,,,,338.2500,6684.0000,percent of total billed charges,"Rev 300 Proc 81317 $6,684.00 in Billed Charges at 41.7% = $2,787.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,CIGNA HEALTHCARE,CIGNA PPO,2787.23,,,,,,,338.2500,6684.0000,percent of total billed charges,"Rev 300 Proc 81317 $6,684.00 in Billed Charges at 41.7% = $2,787.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,710.33,,,,,,,338.2500,6684.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6015.60,,,,,,,338.2500,6684.0000,percent of total billed charges,"90% of $6,684.00 in Billed Charges for Rev 300 Proc 81317 = $6,015.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,HUMANA,HUMANA MEDICARE,676.50,,,,,,,338.2500,6684.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,676.50,,,,,,,338.2500,6684.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,MEDCOST,MEDCOST VHN,3180.92,,,,,,,338.2500,6684.0000,percent of total billed charges,"47.59% of $6,684.00 in Billed Charges for Rev 300 Proc 81317 = $3,180.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,778.73,,,,,,,338.2500,6684.0000,fee schedule,APG 02044 Proc 81317 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 100% = $741.65... $741.65 at 105% = $778.73 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,710.33,,,,,,,338.2500,6684.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,710.33,,,,,,,338.2500,6684.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,NHC ADVANTAGE,NHC ADVANTAGE,710.33,,,,,,,338.2500,6684.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,764.64,,,,,,,338.2500,6684.0000,fee schedule,APG 02044 Proc 81317 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 100% = $741.65... $741.65 at 103.1% = $764.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,SENTARA HEALTH,SENTARA HEALTH,1725.14,,,,,,,338.2500,6684.0000,percent of total billed charges,"25.81% of $6,684.00 in Billed Charges for Rev 300 Proc 81317 = $1,725.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,SENTARA HEALTH,SENTARA MEDICARE,676.50,,,,,,,338.2500,6684.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6684.00,,,,,,,338.2500,6684.0000,percent of total billed charges,"100% of $6,684.00 in Billed Charges for Rev 300 Proc 81317 = $6,684.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,390.65,,,,,,,338.2500,6684.0000,fee schedule,$781.29 from Fee Schedule TCUHC24 for Rev 300 Proc 81317 * Qty 1 = $781.29 at 50% = $390.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,703.56,,,,,,,338.2500,6684.0000,fee schedule,$676.50 from Fee Schedule UHC_31910 for Rev 300 Proc 81317 * Qty 1 = $676.50 at 104% = $703.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,676.50,,,,,,,338.2500,6684.0000,fee schedule,$676.50 from Fee Schedule UHC_31910 for Rev 300 Proc 81317 * Qty 1 = $676.50 at 100% = $676.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,676.50,,,,,,,338.2500,6684.0000,fee schedule,$676.50 from Fee Schedule UHC_31910 for Rev 300 Proc 81317 * Qty 1 = $676.50 at 100% = $676.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,763.90,,,,,,,338.2500,6684.0000,fee schedule,APG 02044 Proc 81317 at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 103% = $763.90. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,676.50,,,,,,,338.2500,6684.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,676.50,,,,,,,338.2500,6684.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,WELLCARE,WELLCARE MEDICAID,6684.00,,,,,,,338.2500,6684.0000,percent of total billed charges,"100% of $6,684.00 in Billed Charges for Rev 300 Proc 81317 = $6,684.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PMS2 GENE ANALYSIS FULL SEQUENCE,81317,CPT,300,RC,30000183,CDM,,,,both,,,6684.0000,1002.6000,WELLCARE,WELLCARE MEDICARE,717.09,,,,,,,338.2500,6684.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,AETNA,AETNA,195.99,,,,,,,43.8000,654.0000,percent of total billed charges,42.7% of $459.00 in Billed Charges for Rev 310 Proc 81323 = $195.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,189.06,,,,,,,43.8000,654.0000,fee schedule,APG 00386 Proc 81323 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 104% = $189.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,300.00,,,,,,,43.8000,654.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,AETNA,AETNA HEALTHCARE MEDICARE,300.00,,,,,,,43.8000,654.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,300.00,,,,,,,43.8000,654.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,AMBETTER,AMBETTER,654.00,,,,,,,43.8000,654.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,AMERIGROUP,AMERIGROUP,150.00,,,,,,,43.8000,654.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,312.00,,,,,,,43.8000,654.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,BLUE CROSS,ANTHEM EXCHANGE,300.00,,,,,,,43.8000,654.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,187.25,,,,,,,43.8000,654.0000,fee schedule,APG 00386 Proc 81323 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,BLUE CROSS,ANTHEM HMO,300.00,,,,,,,43.8000,654.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,309.00,,,,,,,43.8000,654.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",300.00,,,,,,,43.8000,654.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,321.30,,,,,,,43.8000,654.0000,percent of total billed charges,Rev 310 Proc 81323 $459.00 in Billed Charges at 70% = $321.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,BLUE CROSS,BLUE CROSS E NETWORK,280.32,,,,,,,43.8000,654.0000,fee schedule,$87.60 from Fee Schedule BCFSB for Rev 310 Proc 81323 * Qty 1 = $87.60 at 320% = $280.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,BLUE CROSS,BLUE CROSS MEDICARE,312.00,,,,,,,43.8000,654.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,BLUE CROSS,BLUE CROSS P NETWORK,286.45,,,,,,,43.8000,654.0000,fee schedule,$87.60 from Fee Schedule BCFSB for Rev 310 Proc 81323 * Qty 1 = $87.60 at 327% = $286.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,BLUE CROSS,BLUE CROSS S NETWORK,286.45,,,,,,,43.8000,654.0000,fee schedule,$87.60 from Fee Schedule BCFSB for Rev 310 Proc 81323 * Qty 1 = $87.60 at 327% = $286.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,BLUE CROSS,TENNCARE BLUE CARE,115.92,,,,,,,43.8000,654.0000,fee schedule,$99.93 from Fee Schedule TC_24 for Rev 310 Proc 81323 * Qty 1 = $99.93 at 116% = $115.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,BLUE CROSS,TENNCARE BLUE SELECT,115.92,,,,,,,43.8000,654.0000,fee schedule,$99.93 from Fee Schedule TC_24 for Rev 310 Proc 81323 * Qty 1 = $99.93 at 116% = $115.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,CIGNA HEALTHCARE,CIGNA HMO,191.40,,,,,,,43.8000,654.0000,percent of total billed charges,Rev 310 Proc 81323 $459.00 in Billed Charges at 41.7% = $191.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,459.00,,,,,,,43.8000,654.0000,fee schedule,$661.15 from Fee Schedule CGIFP_25LR for Rev 310 Proc 81323 * Qty 1 = $661.15 at 100% = $661.15 (Limited to $459.00 in Billed Charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,315.00,,,,,,,43.8000,654.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,191.40,,,,,,,43.8000,654.0000,percent of total billed charges,Rev 310 Proc 81323 $459.00 in Billed Charges at 41.7% = $191.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,CIGNA HEALTHCARE,CIGNA PPO,191.40,,,,,,,43.8000,654.0000,percent of total billed charges,Rev 310 Proc 81323 $459.00 in Billed Charges at 41.7% = $191.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,315.00,,,,,,,43.8000,654.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,413.10,,,,,,,43.8000,654.0000,percent of total billed charges,90% of $459.00 in Billed Charges for Rev 310 Proc 81323 = $413.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,HUMANA,HUMANA MEDICARE,300.00,,,,,,,43.8000,654.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,300.00,,,,,,,43.8000,654.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,MEDCOST,MEDCOST VHN,218.44,,,,,,,43.8000,654.0000,percent of total billed charges,47.59% of $459.00 in Billed Charges for Rev 310 Proc 81323 = $218.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,190.88,,,,,,,43.8000,654.0000,fee schedule,APG 00386 Proc 81323 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 105% = $190.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,315.00,,,,,,,43.8000,654.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,315.00,,,,,,,43.8000,654.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,NHC ADVANTAGE,NHC ADVANTAGE,315.00,,,,,,,43.8000,654.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,187.43,,,,,,,43.8000,654.0000,fee schedule,APG 00386 Proc 81323 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 103.1% = $187.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,SENTARA HEALTH,SENTARA HEALTH,118.47,,,,,,,43.8000,654.0000,percent of total billed charges,25.81% of $459.00 in Billed Charges for Rev 310 Proc 81323 = $118.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,SENTARA HEALTH,SENTARA MEDICARE,300.00,,,,,,,43.8000,654.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",459.00,,,,,,,43.8000,654.0000,percent of total billed charges,100% of $459.00 in Billed Charges for Rev 310 Proc 81323 = $459.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,43.80,,,,,,,43.8000,654.0000,fee schedule,$87.60 from Fee Schedule TCUHC24 for Rev 310 Proc 81323 * Qty 1 = $87.60 at 50% = $43.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,312.00,,,,,,,43.8000,654.0000,fee schedule,$300.00 from Fee Schedule UHC_31910 for Rev 310 Proc 81323 * Qty 1 = $300.00 at 104% = $312.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,300.00,,,,,,,43.8000,654.0000,fee schedule,$300.00 from Fee Schedule UHC_31910 for Rev 310 Proc 81323 * Qty 1 = $300.00 at 100% = $300.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,300.00,,,,,,,43.8000,654.0000,fee schedule,$300.00 from Fee Schedule UHC_31910 for Rev 310 Proc 81323 * Qty 1 = $300.00 at 100% = $300.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,187.25,,,,,,,43.8000,654.0000,fee schedule,APG 00386 Proc 81323 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,300.00,,,,,,,43.8000,654.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,300.00,,,,,,,43.8000,654.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,WELLCARE,WELLCARE MEDICAID,459.00,,,,,,,43.8000,654.0000,percent of total billed charges,100% of $459.00 in Billed Charges for Rev 310 Proc 81323 = $459.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT,81323,CPT,310,RC,31000094,CDM,,,,both,,,459.0000,68.8500,WELLCARE,WELLCARE MEDICARE,318.00,,,,,,,43.8000,654.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,AETNA,AETNA,500.44,,,,,,,68.5000,1172.0000,percent of total billed charges,"42.7% of $1,172.00 in Billed Charges for Rev 310 Proc 81329 = $500.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,189.06,,,,,,,68.5000,1172.0000,fee schedule,APG 00386 Proc 81329 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 104% = $189.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,137.00,,,,,,,68.5000,1172.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,AETNA,AETNA HEALTHCARE MEDICARE,137.00,,,,,,,68.5000,1172.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,137.00,,,,,,,68.5000,1172.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,AMBETTER,AMBETTER,298.66,,,,,,,68.5000,1172.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,AMERIGROUP,AMERIGROUP,68.50,,,,,,,68.5000,1172.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,142.48,,,,,,,68.5000,1172.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,BLUE CROSS,ANTHEM EXCHANGE,137.00,,,,,,,68.5000,1172.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,187.25,,,,,,,68.5000,1172.0000,fee schedule,APG 00386 Proc 81329 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,BLUE CROSS,ANTHEM HMO,137.00,,,,,,,68.5000,1172.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,141.11,,,,,,,68.5000,1172.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",137.00,,,,,,,68.5000,1172.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,820.40,,,,,,,68.5000,1172.0000,percent of total billed charges,"Rev 310 Proc 81329 $1,172.00 in Billed Charges at 70% = $820.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,BLUE CROSS,BLUE CROSS E NETWORK,438.40,,,,,,,68.5000,1172.0000,fee schedule,$137.00 from Fee Schedule BCFSB for Rev 310 Proc 81329 * Qty 1 = $137.00 at 320% = $438.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,BLUE CROSS,BLUE CROSS MEDICARE,142.48,,,,,,,68.5000,1172.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,BLUE CROSS,BLUE CROSS P NETWORK,447.99,,,,,,,68.5000,1172.0000,fee schedule,$137.00 from Fee Schedule BCFSB for Rev 310 Proc 81329 * Qty 1 = $137.00 at 327% = $447.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,BLUE CROSS,BLUE CROSS S NETWORK,447.99,,,,,,,68.5000,1172.0000,fee schedule,$137.00 from Fee Schedule BCFSB for Rev 310 Proc 81329 * Qty 1 = $137.00 at 327% = $447.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,BLUE CROSS,TENNCARE BLUE CARE,129.11,,,,,,,68.5000,1172.0000,fee schedule,$111.30 from Fee Schedule TC_24 for Rev 310 Proc 81329 * Qty 1 = $111.30 at 116% = $129.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,BLUE CROSS,TENNCARE BLUE SELECT,129.11,,,,,,,68.5000,1172.0000,fee schedule,$111.30 from Fee Schedule TC_24 for Rev 310 Proc 81329 * Qty 1 = $111.30 at 116% = $129.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,CIGNA HEALTHCARE,CIGNA HMO,488.72,,,,,,,68.5000,1172.0000,percent of total billed charges,"Rev 310 Proc 81329 $1,172.00 in Billed Charges at 41.7% = $488.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,301.70,,,,,,,68.5000,1172.0000,fee schedule,$301.70 from Fee Schedule CGIFP_25LR for Rev 310 Proc 81329 * Qty 1 = $301.70 at 100% = $301.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,143.85,,,,,,,68.5000,1172.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,488.72,,,,,,,68.5000,1172.0000,percent of total billed charges,"Rev 310 Proc 81329 $1,172.00 in Billed Charges at 41.7% = $488.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,CIGNA HEALTHCARE,CIGNA PPO,488.72,,,,,,,68.5000,1172.0000,percent of total billed charges,"Rev 310 Proc 81329 $1,172.00 in Billed Charges at 41.7% = $488.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,143.85,,,,,,,68.5000,1172.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1054.80,,,,,,,68.5000,1172.0000,percent of total billed charges,"90% of $1,172.00 in Billed Charges for Rev 310 Proc 81329 = $1,054.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,HUMANA,HUMANA MEDICARE,137.00,,,,,,,68.5000,1172.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,137.00,,,,,,,68.5000,1172.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,MEDCOST,MEDCOST VHN,557.75,,,,,,,68.5000,1172.0000,percent of total billed charges,"47.59% of $1,172.00 in Billed Charges for Rev 310 Proc 81329 = $557.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,190.88,,,,,,,68.5000,1172.0000,fee schedule,APG 00386 Proc 81329 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 105% = $190.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,143.85,,,,,,,68.5000,1172.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,143.85,,,,,,,68.5000,1172.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,NHC ADVANTAGE,NHC ADVANTAGE,143.85,,,,,,,68.5000,1172.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,187.43,,,,,,,68.5000,1172.0000,fee schedule,APG 00386 Proc 81329 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 103.1% = $187.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,SENTARA HEALTH,SENTARA HEALTH,302.49,,,,,,,68.5000,1172.0000,percent of total billed charges,"25.81% of $1,172.00 in Billed Charges for Rev 310 Proc 81329 = $302.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,SENTARA HEALTH,SENTARA MEDICARE,137.00,,,,,,,68.5000,1172.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1172.00,,,,,,,68.5000,1172.0000,percent of total billed charges,"100% of $1,172.00 in Billed Charges for Rev 310 Proc 81329 = $1,172.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,68.50,,,,,,,68.5000,1172.0000,fee schedule,$137.00 from Fee Schedule TCUHC24 for Rev 310 Proc 81329 * Qty 1 = $137.00 at 50% = $68.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,142.48,,,,,,,68.5000,1172.0000,fee schedule,$137.00 from Fee Schedule UHC_31910 for Rev 310 Proc 81329 * Qty 1 = $137.00 at 104% = $142.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,137.00,,,,,,,68.5000,1172.0000,fee schedule,$137.00 from Fee Schedule UHC_31910 for Rev 310 Proc 81329 * Qty 1 = $137.00 at 100% = $137.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,137.00,,,,,,,68.5000,1172.0000,fee schedule,$137.00 from Fee Schedule UHC_31910 for Rev 310 Proc 81329 * Qty 1 = $137.00 at 100% = $137.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,187.25,,,,,,,68.5000,1172.0000,fee schedule,APG 00386 Proc 81329 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,137.00,,,,,,,68.5000,1172.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,137.00,,,,,,,68.5000,1172.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,WELLCARE,WELLCARE MEDICAID,1172.00,,,,,,,68.5000,1172.0000,percent of total billed charges,"100% of $1,172.00 in Billed Charges for Rev 310 Proc 81329 = $1,172.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS,81329,CPT,310,RC,31000032,CDM,,,,both,,,1172.0000,175.8000,WELLCARE,WELLCARE MEDICARE,145.22,,,,,,,68.5000,1172.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1881.9200,282.2900,AETNA,AETNA,803.58,,,,,,,485.7200,1881.9200,percent of total billed charges,"42.7% of $1,881.92 in Billed Charges for Rev 272 = $803.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1881.9200,282.2900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1317.34,,,,,,,485.7200,1881.9200,percent of total billed charges,"Rev 272 $1,881.92 in Billed Charges at 70% = $1,317.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1881.9200,282.2900,CIGNA HEALTHCARE,CIGNA HMO,784.76,,,,,,,485.7200,1881.9200,percent of total billed charges,"41.7% of $1,881.92 in Billed Charges for Rev 272 = $784.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1881.9200,282.2900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,873.21,,,,,,,485.7200,1881.9200,percent of total billed charges,"46.4% of $1,881.92 in Billed Charges for Rev 272 = $873.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1881.9200,282.2900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,784.76,,,,,,,485.7200,1881.9200,percent of total billed charges,"41.7% of $1,881.92 in Billed Charges for Rev 272 = $784.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1881.9200,282.2900,CIGNA HEALTHCARE,CIGNA PPO,784.76,,,,,,,485.7200,1881.9200,percent of total billed charges,"41.7% of $1,881.92 in Billed Charges for Rev 272 = $784.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1881.9200,282.2900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1693.73,,,,,,,485.7200,1881.9200,percent of total billed charges,"90% of $1,881.92 in Billed Charges for Rev 272 = $1,693.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1881.9200,282.2900,MEDCOST,MEDCOST VHN,895.61,,,,,,,485.7200,1881.9200,percent of total billed charges,"47.59% of $1,881.92 in Billed Charges for Rev 272 = $895.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1881.9200,282.2900,SENTARA HEALTH,SENTARA HEALTH,485.72,,,,,,,485.7200,1881.9200,percent of total billed charges,"25.81% of $1,881.92 in Billed Charges for Rev 272 = $485.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1881.9200,282.2900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1881.92,,,,,,,485.7200,1881.9200,percent of total billed charges,"100% of $1,881.92 in Billed Charges for Rev 272 = $1,881.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1881.9200,282.2900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,940.96,,,,,,,485.7200,1881.9200,percent of total billed charges,"Rev 272 $1,881.92 in Billed Charges at 50% = $940.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1881.9200,282.2900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,607.86,,,,,,,485.7200,1881.9200,other,"32.3% of $1,881.92 in Billed Charges for Rev 272 = $607.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1881.9200,282.2900,UNITED HEALTHCARE,UHC HERITAGE SELECT,577.75,,,,,,,485.7200,1881.9200,other,"30.7% of $1,881.92 in Billed Charges for Rev 272 = $577.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1881.9200,282.2900,UNITED HEALTHCARE,UNITED HEALTHCARE,607.86,,,,,,,485.7200,1881.9200,percent of total billed charges,"32.3% of $1,881.92 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1881.9200,282.2900,WELLCARE,WELLCARE MEDICAID,1881.92,,,,,,,485.7200,1881.9200,percent of total billed charges,"100% of $1,881.92 in Billed Charges for Rev 272 = $1,881.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRESSING VERAFLO MEDIUM,272,RC,27200002,CDM,,,,,,both,,,1144.3600,171.6500,AETNA,AETNA,488.64,,,,,,,295.3600,1144.3600,percent of total billed charges,"42.7% of $1,144.36 in Billed Charges for Rev 272 = $488.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRESSING VERAFLO MEDIUM,272,RC,27200002,CDM,,,,,,both,,,1144.3600,171.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,801.05,,,,,,,295.3600,1144.3600,percent of total billed charges,"Rev 272 $1,144.36 in Billed Charges at 70% = $801.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRESSING VERAFLO MEDIUM,272,RC,27200002,CDM,,,,,,both,,,1144.3600,171.6500,CIGNA HEALTHCARE,CIGNA HMO,477.20,,,,,,,295.3600,1144.3600,percent of total billed charges,"41.7% of $1,144.36 in Billed Charges for Rev 272 = $477.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRESSING VERAFLO MEDIUM,272,RC,27200002,CDM,,,,,,both,,,1144.3600,171.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,530.98,,,,,,,295.3600,1144.3600,percent of total billed charges,"46.4% of $1,144.36 in Billed Charges for Rev 272 = $530.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRESSING VERAFLO MEDIUM,272,RC,27200002,CDM,,,,,,both,,,1144.3600,171.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,477.20,,,,,,,295.3600,1144.3600,percent of total billed charges,"41.7% of $1,144.36 in Billed Charges for Rev 272 = $477.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRESSING VERAFLO MEDIUM,272,RC,27200002,CDM,,,,,,both,,,1144.3600,171.6500,CIGNA HEALTHCARE,CIGNA PPO,477.20,,,,,,,295.3600,1144.3600,percent of total billed charges,"41.7% of $1,144.36 in Billed Charges for Rev 272 = $477.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRESSING VERAFLO MEDIUM,272,RC,27200002,CDM,,,,,,both,,,1144.3600,171.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1029.92,,,,,,,295.3600,1144.3600,percent of total billed charges,"90% of $1,144.36 in Billed Charges for Rev 272 = $1,029.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRESSING VERAFLO MEDIUM,272,RC,27200002,CDM,,,,,,both,,,1144.3600,171.6500,MEDCOST,MEDCOST VHN,544.60,,,,,,,295.3600,1144.3600,percent of total billed charges,"47.59% of $1,144.36 in Billed Charges for Rev 272 = $544.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRESSING VERAFLO MEDIUM,272,RC,27200002,CDM,,,,,,both,,,1144.3600,171.6500,SENTARA HEALTH,SENTARA HEALTH,295.36,,,,,,,295.3600,1144.3600,percent of total billed charges,"25.81% of $1,144.36 in Billed Charges for Rev 272 = $295.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRESSING VERAFLO MEDIUM,272,RC,27200002,CDM,,,,,,both,,,1144.3600,171.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1144.36,,,,,,,295.3600,1144.3600,percent of total billed charges,"100% of $1,144.36 in Billed Charges for Rev 272 = $1,144.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRESSING VERAFLO MEDIUM,272,RC,27200002,CDM,,,,,,both,,,1144.3600,171.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,572.18,,,,,,,295.3600,1144.3600,percent of total billed charges,"Rev 272 $1,144.36 in Billed Charges at 50% = $572.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRESSING VERAFLO MEDIUM,272,RC,27200002,CDM,,,,,,both,,,1144.3600,171.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,369.63,,,,,,,295.3600,1144.3600,other,"32.3% of $1,144.36 in Billed Charges for Rev 272 = $369.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT DRESSING VERAFLO MEDIUM,272,RC,27200002,CDM,,,,,,both,,,1144.3600,171.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,351.32,,,,,,,295.3600,1144.3600,other,"30.7% of $1,144.36 in Billed Charges for Rev 272 = $351.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT DRESSING VERAFLO MEDIUM,272,RC,27200002,CDM,,,,,,both,,,1144.3600,171.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,369.63,,,,,,,295.3600,1144.3600,percent of total billed charges,"32.3% of $1,144.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRESSING VERAFLO MEDIUM,272,RC,27200002,CDM,,,,,,both,,,1144.3600,171.6500,WELLCARE,WELLCARE MEDICAID,1144.36,,,,,,,295.3600,1144.3600,percent of total billed charges,"100% of $1,144.36 in Billed Charges for Rev 272 = $1,144.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,AETNA,AETNA,1203.71,,,,,,,164.7600,2819.0000,percent of total billed charges,"42.7% of $2,819.00 in Billed Charges for Rev 300 Proc 81334 = $1,203.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,189.06,,,,,,,164.7600,2819.0000,fee schedule,APG 00386 Proc 81334 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 104% = $189.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,329.51,,,,,,,164.7600,2819.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,AETNA,AETNA HEALTHCARE MEDICARE,329.51,,,,,,,164.7600,2819.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,329.51,,,,,,,164.7600,2819.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,AMBETTER,AMBETTER,718.33,,,,,,,164.7600,2819.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,AMERIGROUP,AMERIGROUP,164.76,,,,,,,164.7600,2819.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,342.69,,,,,,,164.7600,2819.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,BLUE CROSS,ANTHEM EXCHANGE,329.51,,,,,,,164.7600,2819.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,187.25,,,,,,,164.7600,2819.0000,fee schedule,APG 00386 Proc 81334 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,BLUE CROSS,ANTHEM HMO,329.51,,,,,,,164.7600,2819.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,339.40,,,,,,,164.7600,2819.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",329.51,,,,,,,164.7600,2819.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1973.30,,,,,,,164.7600,2819.0000,percent of total billed charges,"Rev 300 Proc 81334 $2,819.00 in Billed Charges at 70% = $1,973.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,BLUE CROSS,BLUE CROSS E NETWORK,1054.43,,,,,,,164.7600,2819.0000,fee schedule,"$329.51 from Fee Schedule BCFSB for Rev 300 Proc 81334 * Qty 1 = $329.51 at 320% = $1,054.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,BLUE CROSS,BLUE CROSS MEDICARE,342.69,,,,,,,164.7600,2819.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,BLUE CROSS,BLUE CROSS P NETWORK,1077.50,,,,,,,164.7600,2819.0000,fee schedule,"$329.51 from Fee Schedule BCFSB for Rev 300 Proc 81334 * Qty 1 = $329.51 at 327% = $1,077.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,BLUE CROSS,BLUE CROSS S NETWORK,1077.50,,,,,,,164.7600,2819.0000,fee schedule,"$329.51 from Fee Schedule BCFSB for Rev 300 Proc 81334 * Qty 1 = $329.51 at 327% = $1,077.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,BLUE CROSS,TENNCARE BLUE CARE,310.54,,,,,,,164.7600,2819.0000,fee schedule,$267.71 from Fee Schedule TC_24 for Rev 300 Proc 81334 * Qty 1 = $267.71 at 116% = $310.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,BLUE CROSS,TENNCARE BLUE SELECT,310.54,,,,,,,164.7600,2819.0000,fee schedule,$267.71 from Fee Schedule TC_24 for Rev 300 Proc 81334 * Qty 1 = $267.71 at 116% = $310.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,CIGNA HEALTHCARE,CIGNA HMO,1175.52,,,,,,,164.7600,2819.0000,percent of total billed charges,"Rev 300 Proc 81334 $2,819.00 in Billed Charges at 41.7% = $1,175.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,726.11,,,,,,,164.7600,2819.0000,fee schedule,$726.11 from Fee Schedule CGIFP_25LR for Rev 300 Proc 81334 * Qty 1 = $726.11 at 100% = $726.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,345.99,,,,,,,164.7600,2819.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1175.52,,,,,,,164.7600,2819.0000,percent of total billed charges,"Rev 300 Proc 81334 $2,819.00 in Billed Charges at 41.7% = $1,175.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,CIGNA HEALTHCARE,CIGNA PPO,1175.52,,,,,,,164.7600,2819.0000,percent of total billed charges,"Rev 300 Proc 81334 $2,819.00 in Billed Charges at 41.7% = $1,175.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,345.99,,,,,,,164.7600,2819.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2537.10,,,,,,,164.7600,2819.0000,percent of total billed charges,"90% of $2,819.00 in Billed Charges for Rev 300 Proc 81334 = $2,537.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,HUMANA,HUMANA MEDICARE,329.51,,,,,,,164.7600,2819.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,329.51,,,,,,,164.7600,2819.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,MEDCOST,MEDCOST VHN,1341.56,,,,,,,164.7600,2819.0000,percent of total billed charges,"47.59% of $2,819.00 in Billed Charges for Rev 300 Proc 81334 = $1,341.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,190.88,,,,,,,164.7600,2819.0000,fee schedule,APG 00386 Proc 81334 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 105% = $190.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,345.99,,,,,,,164.7600,2819.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,345.99,,,,,,,164.7600,2819.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,NHC ADVANTAGE,NHC ADVANTAGE,345.99,,,,,,,164.7600,2819.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,187.43,,,,,,,164.7600,2819.0000,fee schedule,APG 00386 Proc 81334 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 103.1% = $187.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,SENTARA HEALTH,SENTARA HEALTH,727.58,,,,,,,164.7600,2819.0000,percent of total billed charges,"25.81% of $2,819.00 in Billed Charges for Rev 300 Proc 81334 = $727.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,SENTARA HEALTH,SENTARA MEDICARE,329.51,,,,,,,164.7600,2819.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2819.00,,,,,,,164.7600,2819.0000,percent of total billed charges,"100% of $2,819.00 in Billed Charges for Rev 300 Proc 81334 = $2,819.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,164.76,,,,,,,164.7600,2819.0000,fee schedule,$329.51 from Fee Schedule TCUHC24 for Rev 300 Proc 81334 * Qty 1 = $329.51 at 50% = $164.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,342.69,,,,,,,164.7600,2819.0000,fee schedule,$329.51 from Fee Schedule UHC_31910 for Rev 300 Proc 81334 * Qty 1 = $329.51 at 104% = $342.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,329.51,,,,,,,164.7600,2819.0000,fee schedule,$329.51 from Fee Schedule UHC_31910 for Rev 300 Proc 81334 * Qty 1 = $329.51 at 100% = $329.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,329.51,,,,,,,164.7600,2819.0000,fee schedule,$329.51 from Fee Schedule UHC_31910 for Rev 300 Proc 81334 * Qty 1 = $329.51 at 100% = $329.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,187.25,,,,,,,164.7600,2819.0000,fee schedule,APG 00386 Proc 81334 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,329.51,,,,,,,164.7600,2819.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,329.51,,,,,,,164.7600,2819.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,WELLCARE,WELLCARE MEDICAID,2819.00,,,,,,,164.7600,2819.0000,percent of total billed charges,"100% of $2,819.00 in Billed Charges for Rev 300 Proc 81334 = $2,819.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS,81334,CPT,300,RC,30000184,CDM,,,,both,,,2819.0000,422.8500,WELLCARE,WELLCARE MEDICARE,349.28,,,,,,,164.7600,2819.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,AETNA,AETNA,638.79,,,,,,,87.4100,1496.0000,percent of total billed charges,"42.7% of $1,496.00 in Billed Charges for Rev 310 Proc 81335 = $638.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,189.06,,,,,,,87.4100,1496.0000,fee schedule,APG 00386 Proc 81335 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 104% = $189.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,174.81,,,,,,,87.4100,1496.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,AETNA,AETNA HEALTHCARE MEDICARE,174.81,,,,,,,87.4100,1496.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,174.81,,,,,,,87.4100,1496.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,AMBETTER,AMBETTER,381.09,,,,,,,87.4100,1496.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,AMERIGROUP,AMERIGROUP,87.41,,,,,,,87.4100,1496.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,181.80,,,,,,,87.4100,1496.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,BLUE CROSS,ANTHEM EXCHANGE,174.81,,,,,,,87.4100,1496.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,187.25,,,,,,,87.4100,1496.0000,fee schedule,APG 00386 Proc 81335 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,BLUE CROSS,ANTHEM HMO,174.81,,,,,,,87.4100,1496.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,180.05,,,,,,,87.4100,1496.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",174.81,,,,,,,87.4100,1496.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1047.20,,,,,,,87.4100,1496.0000,percent of total billed charges,"Rev 310 Proc 81335 $1,496.00 in Billed Charges at 70% = $1,047.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,BLUE CROSS,BLUE CROSS E NETWORK,559.39,,,,,,,87.4100,1496.0000,fee schedule,$174.81 from Fee Schedule BCFSB for Rev 310 Proc 81335 * Qty 1 = $174.81 at 320% = $559.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,BLUE CROSS,BLUE CROSS MEDICARE,181.80,,,,,,,87.4100,1496.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,BLUE CROSS,BLUE CROSS P NETWORK,571.63,,,,,,,87.4100,1496.0000,fee schedule,$174.81 from Fee Schedule BCFSB for Rev 310 Proc 81335 * Qty 1 = $174.81 at 327% = $571.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,BLUE CROSS,BLUE CROSS S NETWORK,571.63,,,,,,,87.4100,1496.0000,fee schedule,$174.81 from Fee Schedule BCFSB for Rev 310 Proc 81335 * Qty 1 = $174.81 at 327% = $571.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,BLUE CROSS,TENNCARE BLUE CARE,164.74,,,,,,,87.4100,1496.0000,fee schedule,$142.02 from Fee Schedule TC_24 for Rev 310 Proc 81335 * Qty 1 = $142.02 at 116% = $164.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,BLUE CROSS,TENNCARE BLUE SELECT,164.74,,,,,,,87.4100,1496.0000,fee schedule,$142.02 from Fee Schedule TC_24 for Rev 310 Proc 81335 * Qty 1 = $142.02 at 116% = $164.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,CIGNA HEALTHCARE,CIGNA HMO,623.83,,,,,,,87.4100,1496.0000,percent of total billed charges,"Rev 310 Proc 81335 $1,496.00 in Billed Charges at 41.7% = $623.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,385.43,,,,,,,87.4100,1496.0000,fee schedule,$385.43 from Fee Schedule CGIFP_25LR for Rev 310 Proc 81335 * Qty 1 = $385.43 at 100% = $385.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,183.55,,,,,,,87.4100,1496.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,623.83,,,,,,,87.4100,1496.0000,percent of total billed charges,"Rev 310 Proc 81335 $1,496.00 in Billed Charges at 41.7% = $623.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,CIGNA HEALTHCARE,CIGNA PPO,623.83,,,,,,,87.4100,1496.0000,percent of total billed charges,"Rev 310 Proc 81335 $1,496.00 in Billed Charges at 41.7% = $623.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,183.55,,,,,,,87.4100,1496.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1346.40,,,,,,,87.4100,1496.0000,percent of total billed charges,"90% of $1,496.00 in Billed Charges for Rev 310 Proc 81335 = $1,346.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,HUMANA,HUMANA MEDICARE,174.81,,,,,,,87.4100,1496.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,174.81,,,,,,,87.4100,1496.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,MEDCOST,MEDCOST VHN,711.95,,,,,,,87.4100,1496.0000,percent of total billed charges,"47.59% of $1,496.00 in Billed Charges for Rev 310 Proc 81335 = $711.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,190.88,,,,,,,87.4100,1496.0000,fee schedule,APG 00386 Proc 81335 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 105% = $190.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,183.55,,,,,,,87.4100,1496.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,183.55,,,,,,,87.4100,1496.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,NHC ADVANTAGE,NHC ADVANTAGE,183.55,,,,,,,87.4100,1496.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,187.43,,,,,,,87.4100,1496.0000,fee schedule,APG 00386 Proc 81335 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 103.1% = $187.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,SENTARA HEALTH,SENTARA HEALTH,386.12,,,,,,,87.4100,1496.0000,percent of total billed charges,"25.81% of $1,496.00 in Billed Charges for Rev 310 Proc 81335 = $386.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,SENTARA HEALTH,SENTARA MEDICARE,174.81,,,,,,,87.4100,1496.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1496.00,,,,,,,87.4100,1496.0000,percent of total billed charges,"100% of $1,496.00 in Billed Charges for Rev 310 Proc 81335 = $1,496.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,87.41,,,,,,,87.4100,1496.0000,fee schedule,$174.81 from Fee Schedule TCUHC24 for Rev 310 Proc 81335 * Qty 1 = $174.81 at 50% = $87.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,181.80,,,,,,,87.4100,1496.0000,fee schedule,$174.81 from Fee Schedule UHC_31910 for Rev 310 Proc 81335 * Qty 1 = $174.81 at 104% = $181.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,174.81,,,,,,,87.4100,1496.0000,fee schedule,$174.81 from Fee Schedule UHC_31910 for Rev 310 Proc 81335 * Qty 1 = $174.81 at 100% = $174.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,174.81,,,,,,,87.4100,1496.0000,fee schedule,$174.81 from Fee Schedule UHC_31910 for Rev 310 Proc 81335 * Qty 1 = $174.81 at 100% = $174.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,187.25,,,,,,,87.4100,1496.0000,fee schedule,APG 00386 Proc 81335 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,174.81,,,,,,,87.4100,1496.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,174.81,,,,,,,87.4100,1496.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,WELLCARE,WELLCARE MEDICAID,1496.00,,,,,,,87.4100,1496.0000,percent of total billed charges,"100% of $1,496.00 in Billed Charges for Rev 310 Proc 81335 = $1,496.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TMPT GENE ANALYSIS COMMON VARIANTS,81335,CPT,310,RC,31000035,CDM,,,,both,,,1496.0000,224.4000,WELLCARE,WELLCARE MEDICARE,185.30,,,,,,,87.4100,1496.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,AETNA,AETNA,673.81,,,,,,,150.6800,1578.0000,percent of total billed charges,"42.7% of $1,578.00 in Billed Charges for Rev 310 Proc 81336 = $673.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,189.06,,,,,,,150.6800,1578.0000,fee schedule,APG 00386 Proc 81336 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 104% = $189.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,301.35,,,,,,,150.6800,1578.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,AETNA,AETNA HEALTHCARE MEDICARE,301.35,,,,,,,150.6800,1578.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,301.35,,,,,,,150.6800,1578.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,AMBETTER,AMBETTER,656.94,,,,,,,150.6800,1578.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,AMERIGROUP,AMERIGROUP,150.68,,,,,,,150.6800,1578.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,313.40,,,,,,,150.6800,1578.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,BLUE CROSS,ANTHEM EXCHANGE,301.35,,,,,,,150.6800,1578.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,187.25,,,,,,,150.6800,1578.0000,fee schedule,APG 00386 Proc 81336 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,BLUE CROSS,ANTHEM HMO,301.35,,,,,,,150.6800,1578.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,310.39,,,,,,,150.6800,1578.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",301.35,,,,,,,150.6800,1578.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1104.60,,,,,,,150.6800,1578.0000,percent of total billed charges,"Rev 310 Proc 81336 $1,578.00 in Billed Charges at 70% = $1,104.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,BLUE CROSS,BLUE CROSS E NETWORK,964.32,,,,,,,150.6800,1578.0000,fee schedule,$301.35 from Fee Schedule BCFSB for Rev 310 Proc 81336 * Qty 1 = $301.35 at 320% = $964.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,BLUE CROSS,BLUE CROSS MEDICARE,313.40,,,,,,,150.6800,1578.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,BLUE CROSS,BLUE CROSS P NETWORK,985.41,,,,,,,150.6800,1578.0000,fee schedule,$301.35 from Fee Schedule BCFSB for Rev 310 Proc 81336 * Qty 1 = $301.35 at 327% = $985.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,BLUE CROSS,BLUE CROSS S NETWORK,985.41,,,,,,,150.6800,1578.0000,fee schedule,$301.35 from Fee Schedule BCFSB for Rev 310 Proc 81336 * Qty 1 = $301.35 at 327% = $985.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,BLUE CROSS,TENNCARE BLUE CARE,284.00,,,,,,,150.6800,1578.0000,fee schedule,$244.83 from Fee Schedule TC_24 for Rev 310 Proc 81336 * Qty 1 = $244.83 at 116% = $284.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,BLUE CROSS,TENNCARE BLUE SELECT,284.00,,,,,,,150.6800,1578.0000,fee schedule,$244.83 from Fee Schedule TC_24 for Rev 310 Proc 81336 * Qty 1 = $244.83 at 116% = $284.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,CIGNA HEALTHCARE,CIGNA HMO,658.03,,,,,,,150.6800,1578.0000,percent of total billed charges,"Rev 310 Proc 81336 $1,578.00 in Billed Charges at 41.7% = $658.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,664.04,,,,,,,150.6800,1578.0000,fee schedule,$664.04 from Fee Schedule CGIFP_25LR for Rev 310 Proc 81336 * Qty 1 = $664.04 at 100% = $664.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,316.42,,,,,,,150.6800,1578.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,658.03,,,,,,,150.6800,1578.0000,percent of total billed charges,"Rev 310 Proc 81336 $1,578.00 in Billed Charges at 41.7% = $658.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,CIGNA HEALTHCARE,CIGNA PPO,658.03,,,,,,,150.6800,1578.0000,percent of total billed charges,"Rev 310 Proc 81336 $1,578.00 in Billed Charges at 41.7% = $658.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,316.42,,,,,,,150.6800,1578.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1420.20,,,,,,,150.6800,1578.0000,percent of total billed charges,"90% of $1,578.00 in Billed Charges for Rev 310 Proc 81336 = $1,420.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,HUMANA,HUMANA MEDICARE,301.35,,,,,,,150.6800,1578.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,301.35,,,,,,,150.6800,1578.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,MEDCOST,MEDCOST VHN,750.97,,,,,,,150.6800,1578.0000,percent of total billed charges,"47.59% of $1,578.00 in Billed Charges for Rev 310 Proc 81336 = $750.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,190.88,,,,,,,150.6800,1578.0000,fee schedule,APG 00386 Proc 81336 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 105% = $190.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,316.42,,,,,,,150.6800,1578.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,316.42,,,,,,,150.6800,1578.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,NHC ADVANTAGE,NHC ADVANTAGE,316.42,,,,,,,150.6800,1578.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,187.43,,,,,,,150.6800,1578.0000,fee schedule,APG 00386 Proc 81336 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 103.1% = $187.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,SENTARA HEALTH,SENTARA HEALTH,407.28,,,,,,,150.6800,1578.0000,percent of total billed charges,"25.81% of $1,578.00 in Billed Charges for Rev 310 Proc 81336 = $407.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,SENTARA HEALTH,SENTARA MEDICARE,301.35,,,,,,,150.6800,1578.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1578.00,,,,,,,150.6800,1578.0000,percent of total billed charges,"100% of $1,578.00 in Billed Charges for Rev 310 Proc 81336 = $1,578.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,150.68,,,,,,,150.6800,1578.0000,fee schedule,$301.35 from Fee Schedule TCUHC24 for Rev 310 Proc 81336 * Qty 1 = $301.35 at 50% = $150.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,313.40,,,,,,,150.6800,1578.0000,fee schedule,$301.35 from Fee Schedule UHC_31910 for Rev 310 Proc 81336 * Qty 1 = $301.35 at 104% = $313.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,301.35,,,,,,,150.6800,1578.0000,fee schedule,$301.35 from Fee Schedule UHC_31910 for Rev 310 Proc 81336 * Qty 1 = $301.35 at 100% = $301.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,301.35,,,,,,,150.6800,1578.0000,fee schedule,$301.35 from Fee Schedule UHC_31910 for Rev 310 Proc 81336 * Qty 1 = $301.35 at 100% = $301.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,187.25,,,,,,,150.6800,1578.0000,fee schedule,APG 00386 Proc 81336 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,301.35,,,,,,,150.6800,1578.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,301.35,,,,,,,150.6800,1578.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,WELLCARE,WELLCARE MEDICAID,1578.00,,,,,,,150.6800,1578.0000,percent of total billed charges,"100% of $1,578.00 in Billed Charges for Rev 310 Proc 81336 = $1,578.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMN1 GENE ANALYSIS FULL GENE SEQUENCE,81336,CPT,310,RC,31000097,CDM,,,,both,,,1578.0000,236.7000,WELLCARE,WELLCARE MEDICARE,319.43,,,,,,,150.6800,1578.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,AETNA,AETNA,49.53,,,,,,,4.9500,116.0000,percent of total billed charges,42.7% of $116.00 in Billed Charges for Rev 301 Proc 82180 = $49.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,6.44,,,,,,,4.9500,116.0000,fee schedule,APG 00402 Proc 82180 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 104% = $6.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,9.89,,,,,,,4.9500,116.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,AETNA,AETNA HEALTHCARE MEDICARE,9.89,,,,,,,4.9500,116.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,9.89,,,,,,,4.9500,116.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,AMBETTER,AMBETTER,21.56,,,,,,,4.9500,116.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,AMERIGROUP,AMERIGROUP,4.95,,,,,,,4.9500,116.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,10.29,,,,,,,4.9500,116.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,BLUE CROSS,ANTHEM EXCHANGE,9.89,,,,,,,4.9500,116.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,6.38,,,,,,,4.9500,116.0000,fee schedule,APG 00402 Proc 82180 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,BLUE CROSS,ANTHEM HMO,9.89,,,,,,,4.9500,116.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,10.19,,,,,,,4.9500,116.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9.89,,,,,,,4.9500,116.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,31.80,,,,,,,4.9500,116.0000,fee schedule,$31.80 from Fee Schedule BLDTM_23 for Rev 301 Proc 82180 * Qty 1 = $31.80 at 100% = $31.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,BLUE CROSS,BLUE CROSS E NETWORK,43.14,,,,,,,4.9500,116.0000,fee schedule,$13.48 from Fee Schedule BCFSB for Rev 301 Proc 82180 * Qty 1 = $13.48 at 320% = $43.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,BLUE CROSS,BLUE CROSS MEDICARE,10.29,,,,,,,4.9500,116.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,BLUE CROSS,BLUE CROSS P NETWORK,44.08,,,,,,,4.9500,116.0000,fee schedule,$13.48 from Fee Schedule BCFSB for Rev 301 Proc 82180 * Qty 1 = $13.48 at 327% = $44.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,BLUE CROSS,BLUE CROSS S NETWORK,44.08,,,,,,,4.9500,116.0000,fee schedule,$13.48 from Fee Schedule BCFSB for Rev 301 Proc 82180 * Qty 1 = $13.48 at 327% = $44.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,BLUE CROSS,TENNCARE BLUE CARE,22.09,,,,,,,4.9500,116.0000,fee schedule,$19.04 from Fee Schedule TC_24 for Rev 301 Proc 82180 * Qty 1 = $19.04 at 116% = $22.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,BLUE CROSS,TENNCARE BLUE SELECT,22.09,,,,,,,4.9500,116.0000,fee schedule,$19.04 from Fee Schedule TC_24 for Rev 301 Proc 82180 * Qty 1 = $19.04 at 116% = $22.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,CIGNA HEALTHCARE,CIGNA HMO,39.77,,,,,,,4.9500,116.0000,fee schedule,$39.77 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82180 * Qty 1 = $39.77 at 100% = $39.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,21.65,,,,,,,4.9500,116.0000,fee schedule,$21.65 from Fee Schedule CGIFP_25LR for Rev 301 Proc 82180 * Qty 1 = $21.65 at 100% = $21.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,10.38,,,,,,,4.9500,116.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,39.77,,,,,,,4.9500,116.0000,fee schedule,$39.77 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82180 * Qty 1 = $39.77 at 100% = $39.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,CIGNA HEALTHCARE,CIGNA PPO,39.77,,,,,,,4.9500,116.0000,fee schedule,$39.77 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82180 * Qty 1 = $39.77 at 100% = $39.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,10.38,,,,,,,4.9500,116.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,104.40,,,,,,,4.9500,116.0000,percent of total billed charges,90% of $116.00 in Billed Charges for Rev 301 Proc 82180 = $104.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,HUMANA,HUMANA MEDICARE,9.89,,,,,,,4.9500,116.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,9.89,,,,,,,4.9500,116.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,MEDCOST,MEDCOST VHN,55.20,,,,,,,4.9500,116.0000,percent of total billed charges,47.59% of $116.00 in Billed Charges for Rev 301 Proc 82180 = $55.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,6.50,,,,,,,4.9500,116.0000,fee schedule,APG 00402 Proc 82180 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 105% = $6.50 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,10.38,,,,,,,4.9500,116.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,10.38,,,,,,,4.9500,116.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,NHC ADVANTAGE,NHC ADVANTAGE,10.38,,,,,,,4.9500,116.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,6.38,,,,,,,4.9500,116.0000,fee schedule,APG 00402 Proc 82180 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 103.1% = $6.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,SENTARA HEALTH,SENTARA HEALTH,29.94,,,,,,,4.9500,116.0000,percent of total billed charges,25.81% of $116.00 in Billed Charges for Rev 301 Proc 82180 = $29.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,SENTARA HEALTH,SENTARA MEDICARE,9.89,,,,,,,4.9500,116.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",116.00,,,,,,,4.9500,116.0000,percent of total billed charges,100% of $116.00 in Billed Charges for Rev 301 Proc 82180 = $116.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7.00,,,,,,,4.9500,116.0000,fee schedule,$14.00 from Fee Schedule TCUHC24 for Rev 301 Proc 82180 * Qty 1 = $14.00 at 50% = $7.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,10.29,,,,,,,4.9500,116.0000,fee schedule,$9.89 from Fee Schedule UHC_31910 for Rev 301 Proc 82180 * Qty 1 = $9.89 at 104% = $10.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,9.89,,,,,,,4.9500,116.0000,fee schedule,$9.89 from Fee Schedule UHC_31910 for Rev 301 Proc 82180 * Qty 1 = $9.89 at 100% = $9.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,9.89,,,,,,,4.9500,116.0000,fee schedule,$9.89 from Fee Schedule UHC_31910 for Rev 301 Proc 82180 * Qty 1 = $9.89 at 100% = $9.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,6.38,,,,,,,4.9500,116.0000,fee schedule,APG 00402 Proc 82180 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,9.89,,,,,,,4.9500,116.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,9.89,,,,,,,4.9500,116.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,WELLCARE,WELLCARE MEDICAID,116.00,,,,,,,4.9500,116.0000,percent of total billed charges,100% of $116.00 in Billed Charges for Rev 301 Proc 82180 = $116.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASCORBIC ACID VITAMIN C,82180,CPT,301,RC,30100060,CDM,,,,both,,,116.0000,17.4000,WELLCARE,WELLCARE MEDICARE,10.48,,,,,,,4.9500,116.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,362.9900,54.4500,AETNA,AETNA,155.00,,,,,,,93.6900,362.9900,percent of total billed charges,42.7% of $362.99 in Billed Charges for Rev 272 = $155.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,362.9900,54.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,254.09,,,,,,,93.6900,362.9900,percent of total billed charges,Rev 272 $362.99 in Billed Charges at 70% = $254.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,362.9900,54.4500,CIGNA HEALTHCARE,CIGNA HMO,151.37,,,,,,,93.6900,362.9900,percent of total billed charges,41.7% of $362.99 in Billed Charges for Rev 272 = $151.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,362.9900,54.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,168.43,,,,,,,93.6900,362.9900,percent of total billed charges,46.4% of $362.99 in Billed Charges for Rev 272 = $168.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,362.9900,54.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,151.37,,,,,,,93.6900,362.9900,percent of total billed charges,41.7% of $362.99 in Billed Charges for Rev 272 = $151.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,362.9900,54.4500,CIGNA HEALTHCARE,CIGNA PPO,151.37,,,,,,,93.6900,362.9900,percent of total billed charges,41.7% of $362.99 in Billed Charges for Rev 272 = $151.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,362.9900,54.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,326.69,,,,,,,93.6900,362.9900,percent of total billed charges,90% of $362.99 in Billed Charges for Rev 272 = $326.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,362.9900,54.4500,MEDCOST,MEDCOST VHN,172.75,,,,,,,93.6900,362.9900,percent of total billed charges,47.59% of $362.99 in Billed Charges for Rev 272 = $172.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,362.9900,54.4500,SENTARA HEALTH,SENTARA HEALTH,93.69,,,,,,,93.6900,362.9900,percent of total billed charges,25.81% of $362.99 in Billed Charges for Rev 272 = $93.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,362.9900,54.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",362.99,,,,,,,93.6900,362.9900,percent of total billed charges,100% of $362.99 in Billed Charges for Rev 272 = $362.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,362.9900,54.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,181.50,,,,,,,93.6900,362.9900,percent of total billed charges,Rev 272 $362.99 in Billed Charges at 50% = $181.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,362.9900,54.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,117.25,,,,,,,93.6900,362.9900,other,32.3% of $362.99 in Billed Charges for Rev 272 = $117.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,362.9900,54.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,111.44,,,,,,,93.6900,362.9900,other,30.7% of $362.99 in Billed Charges for Rev 272 = $111.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,362.9900,54.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,117.25,,,,,,,93.6900,362.9900,percent of total billed charges,32.3% of $362.99 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,362.9900,54.4500,WELLCARE,WELLCARE MEDICAID,362.99,,,,,,,93.6900,362.9900,percent of total billed charges,100% of $362.99 in Billed Charges for Rev 272 = $362.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENDOEX EXTRA,272,RC,27200002,CDM,,,,,,both,,,3951.3500,592.7000,AETNA,AETNA,1687.23,,,,,,,1019.8400,3951.3500,percent of total billed charges,"42.7% of $3,951.35 in Billed Charges for Rev 272 = $1,687.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOEX EXTRA,272,RC,27200002,CDM,,,,,,both,,,3951.3500,592.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2765.95,,,,,,,1019.8400,3951.3500,percent of total billed charges,"Rev 272 $3,951.35 in Billed Charges at 70% = $2,765.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOEX EXTRA,272,RC,27200002,CDM,,,,,,both,,,3951.3500,592.7000,CIGNA HEALTHCARE,CIGNA HMO,1647.71,,,,,,,1019.8400,3951.3500,percent of total billed charges,"41.7% of $3,951.35 in Billed Charges for Rev 272 = $1,647.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOEX EXTRA,272,RC,27200002,CDM,,,,,,both,,,3951.3500,592.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1833.43,,,,,,,1019.8400,3951.3500,percent of total billed charges,"46.4% of $3,951.35 in Billed Charges for Rev 272 = $1,833.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOEX EXTRA,272,RC,27200002,CDM,,,,,,both,,,3951.3500,592.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1647.71,,,,,,,1019.8400,3951.3500,percent of total billed charges,"41.7% of $3,951.35 in Billed Charges for Rev 272 = $1,647.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOEX EXTRA,272,RC,27200002,CDM,,,,,,both,,,3951.3500,592.7000,CIGNA HEALTHCARE,CIGNA PPO,1647.71,,,,,,,1019.8400,3951.3500,percent of total billed charges,"41.7% of $3,951.35 in Billed Charges for Rev 272 = $1,647.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOEX EXTRA,272,RC,27200002,CDM,,,,,,both,,,3951.3500,592.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3556.22,,,,,,,1019.8400,3951.3500,percent of total billed charges,"90% of $3,951.35 in Billed Charges for Rev 272 = $3,556.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOEX EXTRA,272,RC,27200002,CDM,,,,,,both,,,3951.3500,592.7000,MEDCOST,MEDCOST VHN,1880.45,,,,,,,1019.8400,3951.3500,percent of total billed charges,"47.59% of $3,951.35 in Billed Charges for Rev 272 = $1,880.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOEX EXTRA,272,RC,27200002,CDM,,,,,,both,,,3951.3500,592.7000,SENTARA HEALTH,SENTARA HEALTH,1019.84,,,,,,,1019.8400,3951.3500,percent of total billed charges,"25.81% of $3,951.35 in Billed Charges for Rev 272 = $1,019.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOEX EXTRA,272,RC,27200002,CDM,,,,,,both,,,3951.3500,592.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3951.35,,,,,,,1019.8400,3951.3500,percent of total billed charges,"100% of $3,951.35 in Billed Charges for Rev 272 = $3,951.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOEX EXTRA,272,RC,27200002,CDM,,,,,,both,,,3951.3500,592.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1975.68,,,,,,,1019.8400,3951.3500,percent of total billed charges,"Rev 272 $3,951.35 in Billed Charges at 50% = $1,975.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOEX EXTRA,272,RC,27200002,CDM,,,,,,both,,,3951.3500,592.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1276.29,,,,,,,1019.8400,3951.3500,other,"32.3% of $3,951.35 in Billed Charges for Rev 272 = $1,276.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ENDOEX EXTRA,272,RC,27200002,CDM,,,,,,both,,,3951.3500,592.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1213.06,,,,,,,1019.8400,3951.3500,other,"30.7% of $3,951.35 in Billed Charges for Rev 272 = $1,213.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ENDOEX EXTRA,272,RC,27200002,CDM,,,,,,both,,,3951.3500,592.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,1276.29,,,,,,,1019.8400,3951.3500,percent of total billed charges,"32.3% of $3,951.35 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOEX EXTRA,272,RC,27200002,CDM,,,,,,both,,,3951.3500,592.7000,WELLCARE,WELLCARE MEDICAID,3951.35,,,,,,,1019.8400,3951.3500,percent of total billed charges,"100% of $3,951.35 in Billed Charges for Rev 272 = $3,951.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT EXTRACTION ACCESSORY,272,RC,27200002,CDM,,,,,,both,,,1223.7800,183.5700,AETNA,AETNA,522.55,,,,,,,315.8600,1223.7800,percent of total billed charges,"42.7% of $1,223.78 in Billed Charges for Rev 272 = $522.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT EXTRACTION ACCESSORY,272,RC,27200002,CDM,,,,,,both,,,1223.7800,183.5700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,856.65,,,,,,,315.8600,1223.7800,percent of total billed charges,"Rev 272 $1,223.78 in Billed Charges at 70% = $856.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT EXTRACTION ACCESSORY,272,RC,27200002,CDM,,,,,,both,,,1223.7800,183.5700,CIGNA HEALTHCARE,CIGNA HMO,510.32,,,,,,,315.8600,1223.7800,percent of total billed charges,"41.7% of $1,223.78 in Billed Charges for Rev 272 = $510.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT EXTRACTION ACCESSORY,272,RC,27200002,CDM,,,,,,both,,,1223.7800,183.5700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,567.83,,,,,,,315.8600,1223.7800,percent of total billed charges,"46.4% of $1,223.78 in Billed Charges for Rev 272 = $567.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT EXTRACTION ACCESSORY,272,RC,27200002,CDM,,,,,,both,,,1223.7800,183.5700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,510.32,,,,,,,315.8600,1223.7800,percent of total billed charges,"41.7% of $1,223.78 in Billed Charges for Rev 272 = $510.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT EXTRACTION ACCESSORY,272,RC,27200002,CDM,,,,,,both,,,1223.7800,183.5700,CIGNA HEALTHCARE,CIGNA PPO,510.32,,,,,,,315.8600,1223.7800,percent of total billed charges,"41.7% of $1,223.78 in Billed Charges for Rev 272 = $510.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT EXTRACTION ACCESSORY,272,RC,27200002,CDM,,,,,,both,,,1223.7800,183.5700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1101.40,,,,,,,315.8600,1223.7800,percent of total billed charges,"90% of $1,223.78 in Billed Charges for Rev 272 = $1,101.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT EXTRACTION ACCESSORY,272,RC,27200002,CDM,,,,,,both,,,1223.7800,183.5700,MEDCOST,MEDCOST VHN,582.40,,,,,,,315.8600,1223.7800,percent of total billed charges,"47.59% of $1,223.78 in Billed Charges for Rev 272 = $582.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT EXTRACTION ACCESSORY,272,RC,27200002,CDM,,,,,,both,,,1223.7800,183.5700,SENTARA HEALTH,SENTARA HEALTH,315.86,,,,,,,315.8600,1223.7800,percent of total billed charges,"25.81% of $1,223.78 in Billed Charges for Rev 272 = $315.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT EXTRACTION ACCESSORY,272,RC,27200002,CDM,,,,,,both,,,1223.7800,183.5700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1223.78,,,,,,,315.8600,1223.7800,percent of total billed charges,"100% of $1,223.78 in Billed Charges for Rev 272 = $1,223.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT EXTRACTION ACCESSORY,272,RC,27200002,CDM,,,,,,both,,,1223.7800,183.5700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,611.89,,,,,,,315.8600,1223.7800,percent of total billed charges,"Rev 272 $1,223.78 in Billed Charges at 50% = $611.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT EXTRACTION ACCESSORY,272,RC,27200002,CDM,,,,,,both,,,1223.7800,183.5700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,395.28,,,,,,,315.8600,1223.7800,other,"32.3% of $1,223.78 in Billed Charges for Rev 272 = $395.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT EXTRACTION ACCESSORY,272,RC,27200002,CDM,,,,,,both,,,1223.7800,183.5700,UNITED HEALTHCARE,UHC HERITAGE SELECT,375.70,,,,,,,315.8600,1223.7800,other,"30.7% of $1,223.78 in Billed Charges for Rev 272 = $375.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT EXTRACTION ACCESSORY,272,RC,27200002,CDM,,,,,,both,,,1223.7800,183.5700,UNITED HEALTHCARE,UNITED HEALTHCARE,395.28,,,,,,,315.8600,1223.7800,percent of total billed charges,"32.3% of $1,223.78 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT EXTRACTION ACCESSORY,272,RC,27200002,CDM,,,,,,both,,,1223.7800,183.5700,WELLCARE,WELLCARE MEDICAID,1223.78,,,,,,,315.8600,1223.7800,percent of total billed charges,"100% of $1,223.78 in Billed Charges for Rev 272 = $1,223.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,AETNA,AETNA,94.79,,,,,,,13.2900,222.0000,percent of total billed charges,42.7% of $222.00 in Billed Charges for Rev 301 Proc 82240 = $94.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,33.15,,,,,,,13.2900,222.0000,fee schedule,APG 00401 Proc 82240 at $836.60 (Base Rate) * 0.0381 (Relative Weight) = $31.87 (Total Line Payment) at 104% = $33.15. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,26.58,,,,,,,13.2900,222.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,AETNA,AETNA HEALTHCARE MEDICARE,26.58,,,,,,,13.2900,222.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,26.58,,,,,,,13.2900,222.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,AMBETTER,AMBETTER,57.94,,,,,,,13.2900,222.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,AMERIGROUP,AMERIGROUP,13.29,,,,,,,13.2900,222.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,27.64,,,,,,,13.2900,222.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,BLUE CROSS,ANTHEM EXCHANGE,26.58,,,,,,,13.2900,222.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,32.83,,,,,,,13.2900,222.0000,fee schedule,APG 00401 Proc 82240 at $836.60 (Base Rate) * 0.0381 (Relative Weight) = $31.87 (Total Line Payment) at 103% = $32.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,BLUE CROSS,ANTHEM HMO,26.58,,,,,,,13.2900,222.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,27.38,,,,,,,13.2900,222.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",26.58,,,,,,,13.2900,222.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,86.47,,,,,,,13.2900,222.0000,fee schedule,$86.47 from Fee Schedule BLDTM_23 for Rev 301 Proc 82240 * Qty 1 = $86.47 at 100% = $86.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,BLUE CROSS,BLUE CROSS E NETWORK,72.32,,,,,,,13.2900,222.0000,fee schedule,$22.60 from Fee Schedule BCFSB for Rev 301 Proc 82240 * Qty 1 = $22.60 at 320% = $72.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,BLUE CROSS,BLUE CROSS MEDICARE,27.64,,,,,,,13.2900,222.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,BLUE CROSS,BLUE CROSS P NETWORK,73.90,,,,,,,13.2900,222.0000,fee schedule,$22.60 from Fee Schedule BCFSB for Rev 301 Proc 82240 * Qty 1 = $22.60 at 327% = $73.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,BLUE CROSS,BLUE CROSS S NETWORK,73.90,,,,,,,13.2900,222.0000,fee schedule,$22.60 from Fee Schedule BCFSB for Rev 301 Proc 82240 * Qty 1 = $22.60 at 327% = $73.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,BLUE CROSS,TENNCARE BLUE CARE,31.75,,,,,,,13.2900,222.0000,fee schedule,$27.37 from Fee Schedule TC_24 for Rev 301 Proc 82240 * Qty 1 = $27.37 at 116% = $31.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,BLUE CROSS,TENNCARE BLUE SELECT,31.75,,,,,,,13.2900,222.0000,fee schedule,$27.37 from Fee Schedule TC_24 for Rev 301 Proc 82240 * Qty 1 = $27.37 at 116% = $31.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,CIGNA HEALTHCARE,CIGNA HMO,106.93,,,,,,,13.2900,222.0000,fee schedule,$106.93 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82240 * Qty 1 = $106.93 at 100% = $106.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,58.46,,,,,,,13.2900,222.0000,fee schedule,$58.46 from Fee Schedule CGIFP_25LR for Rev 301 Proc 82240 * Qty 1 = $58.46 at 100% = $58.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,27.91,,,,,,,13.2900,222.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,106.93,,,,,,,13.2900,222.0000,fee schedule,$106.93 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82240 * Qty 1 = $106.93 at 100% = $106.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,CIGNA HEALTHCARE,CIGNA PPO,106.93,,,,,,,13.2900,222.0000,fee schedule,$106.93 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82240 * Qty 1 = $106.93 at 100% = $106.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,27.91,,,,,,,13.2900,222.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,199.80,,,,,,,13.2900,222.0000,percent of total billed charges,90% of $222.00 in Billed Charges for Rev 301 Proc 82240 = $199.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,HUMANA,HUMANA MEDICARE,26.58,,,,,,,13.2900,222.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,26.58,,,,,,,13.2900,222.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,MEDCOST,MEDCOST VHN,105.65,,,,,,,13.2900,222.0000,percent of total billed charges,47.59% of $222.00 in Billed Charges for Rev 301 Proc 82240 = $105.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,33.46,,,,,,,13.2900,222.0000,fee schedule,APG 00401 Proc 82240 at $836.60 (Base Rate) * 0.0381 (Relative Weight) = $31.87 (Total Line Payment) at 100% = $31.87... $31.87 at 105% = $33.46 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,27.91,,,,,,,13.2900,222.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,27.91,,,,,,,13.2900,222.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,NHC ADVANTAGE,NHC ADVANTAGE,27.91,,,,,,,13.2900,222.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,32.86,,,,,,,13.2900,222.0000,fee schedule,APG 00401 Proc 82240 at $836.60 (Base Rate) * 0.0381 (Relative Weight) = $31.87 (Total Line Payment) at 100% = $31.87... $31.87 at 103.1% = $32.86 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,SENTARA HEALTH,SENTARA HEALTH,57.30,,,,,,,13.2900,222.0000,percent of total billed charges,25.81% of $222.00 in Billed Charges for Rev 301 Proc 82240 = $57.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,SENTARA HEALTH,SENTARA MEDICARE,26.58,,,,,,,13.2900,222.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",222.00,,,,,,,13.2900,222.0000,percent of total billed charges,100% of $222.00 in Billed Charges for Rev 301 Proc 82240 = $222.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,18.82,,,,,,,13.2900,222.0000,fee schedule,$37.64 from Fee Schedule TCUHC24 for Rev 301 Proc 82240 * Qty 1 = $37.64 at 50% = $18.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,27.64,,,,,,,13.2900,222.0000,fee schedule,$26.58 from Fee Schedule UHC_31910 for Rev 301 Proc 82240 * Qty 1 = $26.58 at 104% = $27.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,26.58,,,,,,,13.2900,222.0000,fee schedule,$26.58 from Fee Schedule UHC_31910 for Rev 301 Proc 82240 * Qty 1 = $26.58 at 100% = $26.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,26.58,,,,,,,13.2900,222.0000,fee schedule,$26.58 from Fee Schedule UHC_31910 for Rev 301 Proc 82240 * Qty 1 = $26.58 at 100% = $26.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,32.83,,,,,,,13.2900,222.0000,fee schedule,APG 00401 Proc 82240 at $836.60 (Base Rate) * 0.0381 (Relative Weight) = $31.87 (Total Line Payment) at 103% = $32.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,26.58,,,,,,,13.2900,222.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,26.58,,,,,,,13.2900,222.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,WELLCARE,WELLCARE MEDICAID,222.00,,,,,,,13.2900,222.0000,percent of total billed charges,100% of $222.00 in Billed Charges for Rev 301 Proc 82240 = $222.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BILE ACID CHOLYLGLYCINE,82240,CPT,301,RC,30100301,CDM,,,,both,,,222.0000,33.3000,WELLCARE,WELLCARE MEDICARE,28.17,,,,,,,13.2900,222.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,AETNA,AETNA,25.19,,,,,,,2.5100,59.0000,percent of total billed charges,42.7% of $59.00 in Billed Charges for Rev 301 Proc 82248 = $25.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,6.44,,,,,,,2.5100,59.0000,fee schedule,APG 00402 Proc 82248 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 104% = $6.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5.02,,,,,,,2.5100,59.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,AETNA,AETNA HEALTHCARE MEDICARE,5.02,,,,,,,2.5100,59.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,5.02,,,,,,,2.5100,59.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,AMBETTER,AMBETTER,10.94,,,,,,,2.5100,59.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,AMERIGROUP,AMERIGROUP,2.51,,,,,,,2.5100,59.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,5.22,,,,,,,2.5100,59.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,BLUE CROSS,ANTHEM EXCHANGE,5.02,,,,,,,2.5100,59.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,6.38,,,,,,,2.5100,59.0000,fee schedule,APG 00402 Proc 82248 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,BLUE CROSS,ANTHEM HMO,5.02,,,,,,,2.5100,59.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5.17,,,,,,,2.5100,59.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5.02,,,,,,,2.5100,59.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,16.31,,,,,,,2.5100,59.0000,fee schedule,$16.31 from Fee Schedule BLDTM_23 for Rev 301 Proc 82248 * Qty 1 = $16.31 at 100% = $16.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,BLUE CROSS,BLUE CROSS E NETWORK,21.89,,,,,,,2.5100,59.0000,fee schedule,$6.84 from Fee Schedule BCFSB for Rev 301 Proc 82248 * Qty 1 = $6.84 at 320% = $21.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,BLUE CROSS,BLUE CROSS MEDICARE,5.22,,,,,,,2.5100,59.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,BLUE CROSS,BLUE CROSS P NETWORK,22.37,,,,,,,2.5100,59.0000,fee schedule,$6.84 from Fee Schedule BCFSB for Rev 301 Proc 82248 * Qty 1 = $6.84 at 327% = $22.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,BLUE CROSS,BLUE CROSS S NETWORK,22.37,,,,,,,2.5100,59.0000,fee schedule,$6.84 from Fee Schedule BCFSB for Rev 301 Proc 82248 * Qty 1 = $6.84 at 327% = $22.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,BLUE CROSS,TENNCARE BLUE CARE,10.16,,,,,,,2.5100,59.0000,fee schedule,$8.76 from Fee Schedule TC_24 for Rev 301 Proc 82248 * Qty 1 = $8.76 at 116% = $10.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,BLUE CROSS,TENNCARE BLUE SELECT,10.16,,,,,,,2.5100,59.0000,fee schedule,$8.76 from Fee Schedule TC_24 for Rev 301 Proc 82248 * Qty 1 = $8.76 at 116% = $10.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,CIGNA HEALTHCARE,CIGNA HMO,20.19,,,,,,,2.5100,59.0000,fee schedule,$20.19 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82248 * Qty 1 = $20.19 at 100% = $20.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10.83,,,,,,,2.5100,59.0000,fee schedule,$10.83 from Fee Schedule CGIFP_25LR for Rev 301 Proc 82248 * Qty 1 = $10.83 at 100% = $10.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,5.27,,,,,,,2.5100,59.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,20.19,,,,,,,2.5100,59.0000,fee schedule,$20.19 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82248 * Qty 1 = $20.19 at 100% = $20.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,CIGNA HEALTHCARE,CIGNA PPO,20.19,,,,,,,2.5100,59.0000,fee schedule,$20.19 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82248 * Qty 1 = $20.19 at 100% = $20.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,5.27,,,,,,,2.5100,59.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,53.10,,,,,,,2.5100,59.0000,percent of total billed charges,90% of $59.00 in Billed Charges for Rev 301 Proc 82248 = $53.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,HUMANA,HUMANA MEDICARE,5.02,,,,,,,2.5100,59.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5.02,,,,,,,2.5100,59.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,MEDCOST,MEDCOST VHN,28.08,,,,,,,2.5100,59.0000,percent of total billed charges,47.59% of $59.00 in Billed Charges for Rev 301 Proc 82248 = $28.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,6.50,,,,,,,2.5100,59.0000,fee schedule,APG 00402 Proc 82248 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 105% = $6.50 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,5.27,,,,,,,2.5100,59.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,5.27,,,,,,,2.5100,59.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,NHC ADVANTAGE,NHC ADVANTAGE,5.27,,,,,,,2.5100,59.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,6.38,,,,,,,2.5100,59.0000,fee schedule,APG 00402 Proc 82248 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 103.1% = $6.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,SENTARA HEALTH,SENTARA HEALTH,15.23,,,,,,,2.5100,59.0000,percent of total billed charges,25.81% of $59.00 in Billed Charges for Rev 301 Proc 82248 = $15.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,SENTARA HEALTH,SENTARA MEDICARE,5.02,,,,,,,2.5100,59.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",59.00,,,,,,,2.5100,59.0000,percent of total billed charges,100% of $59.00 in Billed Charges for Rev 301 Proc 82248 = $59.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3.55,,,,,,,2.5100,59.0000,fee schedule,$7.10 from Fee Schedule TCUHC24 for Rev 301 Proc 82248 * Qty 1 = $7.10 at 50% = $3.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5.22,,,,,,,2.5100,59.0000,fee schedule,$5.02 from Fee Schedule UHC_31910 for Rev 301 Proc 82248 * Qty 1 = $5.02 at 104% = $5.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,5.02,,,,,,,2.5100,59.0000,fee schedule,$5.02 from Fee Schedule UHC_31910 for Rev 301 Proc 82248 * Qty 1 = $5.02 at 100% = $5.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,5.02,,,,,,,2.5100,59.0000,fee schedule,$5.02 from Fee Schedule UHC_31910 for Rev 301 Proc 82248 * Qty 1 = $5.02 at 100% = $5.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,6.38,,,,,,,2.5100,59.0000,fee schedule,APG 00402 Proc 82248 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5.02,,,,,,,2.5100,59.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5.02,,,,,,,2.5100,59.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,WELLCARE,WELLCARE MEDICAID,59.00,,,,,,,2.5100,59.0000,percent of total billed charges,100% of $59.00 in Billed Charges for Rev 301 Proc 82248 = $59.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BILIRUBIN DIRECT,82248,CPT,301,RC,30100065,CDM,,,,both,,,59.0000,8.8500,WELLCARE,WELLCARE MEDICARE,5.32,,,,,,,2.5100,59.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,AETNA,AETNA,81.13,,,,,,,8.4400,190.0000,percent of total billed charges,42.7% of $190.00 in Billed Charges for Rev 301 Proc 82261 = $81.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,14.27,,,,,,,8.4400,190.0000,fee schedule,APG 00400 Proc 82261 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 104% = $14.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,16.87,,,,,,,8.4400,190.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,AETNA,AETNA HEALTHCARE MEDICARE,16.87,,,,,,,8.4400,190.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,16.87,,,,,,,8.4400,190.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,AMBETTER,AMBETTER,36.78,,,,,,,8.4400,190.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,AMERIGROUP,AMERIGROUP,8.44,,,,,,,8.4400,190.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,17.54,,,,,,,8.4400,190.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,ANTHEM EXCHANGE,16.87,,,,,,,8.4400,190.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,14.13,,,,,,,8.4400,190.0000,fee schedule,APG 00400 Proc 82261 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,ANTHEM HMO,16.87,,,,,,,8.4400,190.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,17.38,,,,,,,8.4400,190.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",16.87,,,,,,,8.4400,190.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,54.65,,,,,,,8.4400,190.0000,fee schedule,$54.65 from Fee Schedule BLDTM_23 for Rev 301 Proc 82261 * Qty 1 = $54.65 at 100% = $54.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,BLUE CROSS E NETWORK,25.60,,,,,,,8.4400,190.0000,fee schedule,$8.00 from Fee Schedule BCFSB for Rev 301 Proc 82261 * Qty 1 = $8.00 at 320% = $25.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,BLUE CROSS MEDICARE,17.54,,,,,,,8.4400,190.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,BLUE CROSS P NETWORK,26.16,,,,,,,8.4400,190.0000,fee schedule,$8.00 from Fee Schedule BCFSB for Rev 301 Proc 82261 * Qty 1 = $8.00 at 327% = $26.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,BLUE CROSS S NETWORK,26.16,,,,,,,8.4400,190.0000,fee schedule,$8.00 from Fee Schedule BCFSB for Rev 301 Proc 82261 * Qty 1 = $8.00 at 327% = $26.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,TENNCARE BLUE CARE,11.87,,,,,,,8.4400,190.0000,fee schedule,$10.23 from Fee Schedule TC_24 for Rev 301 Proc 82261 * Qty 1 = $10.23 at 116% = $11.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,TENNCARE BLUE SELECT,11.87,,,,,,,8.4400,190.0000,fee schedule,$10.23 from Fee Schedule TC_24 for Rev 301 Proc 82261 * Qty 1 = $10.23 at 116% = $11.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,CIGNA HEALTHCARE,CIGNA HMO,67.87,,,,,,,8.4400,190.0000,fee schedule,$67.87 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82261 * Qty 1 = $67.87 at 100% = $67.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,37.53,,,,,,,8.4400,190.0000,fee schedule,$37.53 from Fee Schedule CGIFP_25LR for Rev 301 Proc 82261 * Qty 1 = $37.53 at 100% = $37.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,17.71,,,,,,,8.4400,190.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,67.87,,,,,,,8.4400,190.0000,fee schedule,$67.87 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82261 * Qty 1 = $67.87 at 100% = $67.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,CIGNA HEALTHCARE,CIGNA PPO,67.87,,,,,,,8.4400,190.0000,fee schedule,$67.87 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82261 * Qty 1 = $67.87 at 100% = $67.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,17.71,,,,,,,8.4400,190.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,171.00,,,,,,,8.4400,190.0000,percent of total billed charges,90% of $190.00 in Billed Charges for Rev 301 Proc 82261 = $171.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,HUMANA,HUMANA MEDICARE,16.87,,,,,,,8.4400,190.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,16.87,,,,,,,8.4400,190.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,MEDCOST,MEDCOST VHN,90.42,,,,,,,8.4400,190.0000,percent of total billed charges,47.59% of $190.00 in Billed Charges for Rev 301 Proc 82261 = $90.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,14.41,,,,,,,8.4400,190.0000,fee schedule,APG 00400 Proc 82261 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 105% = $14.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,17.71,,,,,,,8.4400,190.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,17.71,,,,,,,8.4400,190.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,NHC ADVANTAGE,NHC ADVANTAGE,17.71,,,,,,,8.4400,190.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,14.15,,,,,,,8.4400,190.0000,fee schedule,APG 00400 Proc 82261 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 103.1% = $14.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,SENTARA HEALTH,SENTARA HEALTH,49.04,,,,,,,8.4400,190.0000,percent of total billed charges,25.81% of $190.00 in Billed Charges for Rev 301 Proc 82261 = $49.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,SENTARA HEALTH,SENTARA MEDICARE,16.87,,,,,,,8.4400,190.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",190.00,,,,,,,8.4400,190.0000,percent of total billed charges,100% of $190.00 in Billed Charges for Rev 301 Proc 82261 = $190.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11.95,,,,,,,8.4400,190.0000,fee schedule,$23.89 from Fee Schedule TCUHC24 for Rev 301 Proc 82261 * Qty 1 = $23.89 at 50% = $11.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,17.54,,,,,,,8.4400,190.0000,fee schedule,$16.87 from Fee Schedule UHC_31910 for Rev 301 Proc 82261 * Qty 1 = $16.87 at 104% = $17.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,16.87,,,,,,,8.4400,190.0000,fee schedule,$16.87 from Fee Schedule UHC_31910 for Rev 301 Proc 82261 * Qty 1 = $16.87 at 100% = $16.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,16.87,,,,,,,8.4400,190.0000,fee schedule,$16.87 from Fee Schedule UHC_31910 for Rev 301 Proc 82261 * Qty 1 = $16.87 at 100% = $16.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,14.13,,,,,,,8.4400,190.0000,fee schedule,APG 00400 Proc 82261 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,16.87,,,,,,,8.4400,190.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,16.87,,,,,,,8.4400,190.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,WELLCARE,WELLCARE MEDICAID,190.00,,,,,,,8.4400,190.0000,percent of total billed charges,100% of $190.00 in Billed Charges for Rev 301 Proc 82261 = $190.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BIOTINIDASE,82261,CPT,301,RC,30100066,CDM,,,,both,,,190.0000,28.5000,WELLCARE,WELLCARE MEDICARE,17.88,,,,,,,8.4400,190.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,AETNA,AETNA,16.23,,,,,,,2.3100,38.0000,percent of total billed charges,42.7% of $38.00 in Billed Charges for Rev 301 Proc 82271 = $16.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,6.44,,,,,,,2.3100,38.0000,fee schedule,APG 00402 Proc 82271 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 104% = $6.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5.32,,,,,,,2.3100,38.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,AETNA,AETNA HEALTHCARE MEDICARE,5.32,,,,,,,2.3100,38.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,5.32,,,,,,,2.3100,38.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,AMBETTER,AMBETTER,11.60,,,,,,,2.3100,38.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,AMERIGROUP,AMERIGROUP,2.66,,,,,,,2.3100,38.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,5.53,,,,,,,2.3100,38.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,BLUE CROSS,ANTHEM EXCHANGE,5.32,,,,,,,2.3100,38.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,6.38,,,,,,,2.3100,38.0000,fee schedule,APG 00402 Proc 82271 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,BLUE CROSS,ANTHEM HMO,5.32,,,,,,,2.3100,38.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5.48,,,,,,,2.3100,38.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5.32,,,,,,,2.3100,38.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4.49,,,,,,,2.3100,38.0000,fee schedule,$4.49 from Fee Schedule BLDTM_23 for Rev 301 Proc 82271 * Qty 1 = $4.49 at 100% = $4.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,BLUE CROSS,BLUE CROSS E NETWORK,14.05,,,,,,,2.3100,38.0000,fee schedule,$4.39 from Fee Schedule BCFSB for Rev 301 Proc 82271 * Qty 1 = $4.39 at 320% = $14.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,BLUE CROSS,BLUE CROSS MEDICARE,5.53,,,,,,,2.3100,38.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,BLUE CROSS,BLUE CROSS P NETWORK,14.36,,,,,,,2.3100,38.0000,fee schedule,$4.39 from Fee Schedule BCFSB for Rev 301 Proc 82271 * Qty 1 = $4.39 at 327% = $14.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,BLUE CROSS,BLUE CROSS S NETWORK,14.36,,,,,,,2.3100,38.0000,fee schedule,$4.39 from Fee Schedule BCFSB for Rev 301 Proc 82271 * Qty 1 = $4.39 at 327% = $14.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,BLUE CROSS,TENNCARE BLUE CARE,4.25,,,,,,,2.3100,38.0000,fee schedule,$3.66 from Fee Schedule TC_24 for Rev 301 Proc 82271 * Qty 1 = $3.66 at 116% = $4.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,BLUE CROSS,TENNCARE BLUE SELECT,4.25,,,,,,,2.3100,38.0000,fee schedule,$3.66 from Fee Schedule TC_24 for Rev 301 Proc 82271 * Qty 1 = $3.66 at 116% = $4.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,CIGNA HEALTHCARE,CIGNA HMO,13.11,,,,,,,2.3100,38.0000,fee schedule,$13.11 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82271 * Qty 1 = $13.11 at 100% = $13.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11.55,,,,,,,2.3100,38.0000,fee schedule,$11.55 from Fee Schedule CGIFP_25LR for Rev 301 Proc 82271 * Qty 1 = $11.55 at 100% = $11.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,5.59,,,,,,,2.3100,38.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,13.11,,,,,,,2.3100,38.0000,fee schedule,$13.11 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82271 * Qty 1 = $13.11 at 100% = $13.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,CIGNA HEALTHCARE,CIGNA PPO,13.11,,,,,,,2.3100,38.0000,fee schedule,$13.11 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82271 * Qty 1 = $13.11 at 100% = $13.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,5.59,,,,,,,2.3100,38.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,34.20,,,,,,,2.3100,38.0000,percent of total billed charges,90% of $38.00 in Billed Charges for Rev 301 Proc 82271 = $34.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,HUMANA,HUMANA MEDICARE,5.32,,,,,,,2.3100,38.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5.32,,,,,,,2.3100,38.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,MEDCOST,MEDCOST VHN,18.08,,,,,,,2.3100,38.0000,percent of total billed charges,47.59% of $38.00 in Billed Charges for Rev 301 Proc 82271 = $18.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,6.50,,,,,,,2.3100,38.0000,fee schedule,APG 00402 Proc 82271 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 105% = $6.50 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,5.59,,,,,,,2.3100,38.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,5.59,,,,,,,2.3100,38.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,NHC ADVANTAGE,NHC ADVANTAGE,5.59,,,,,,,2.3100,38.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,6.38,,,,,,,2.3100,38.0000,fee schedule,APG 00402 Proc 82271 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 103.1% = $6.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,SENTARA HEALTH,SENTARA HEALTH,9.81,,,,,,,2.3100,38.0000,percent of total billed charges,25.81% of $38.00 in Billed Charges for Rev 301 Proc 82271 = $9.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,SENTARA HEALTH,SENTARA MEDICARE,5.32,,,,,,,2.3100,38.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",38.00,,,,,,,2.3100,38.0000,percent of total billed charges,100% of $38.00 in Billed Charges for Rev 301 Proc 82271 = $38.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2.31,,,,,,,2.3100,38.0000,fee schedule,$4.61 from Fee Schedule TCUHC24 for Rev 301 Proc 82271 * Qty 1 = $4.61 at 50% = $2.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5.53,,,,,,,2.3100,38.0000,fee schedule,$5.32 from Fee Schedule UHC_31910 for Rev 301 Proc 82271 * Qty 1 = $5.32 at 104% = $5.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,5.32,,,,,,,2.3100,38.0000,fee schedule,$5.32 from Fee Schedule UHC_31910 for Rev 301 Proc 82271 * Qty 1 = $5.32 at 100% = $5.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,5.32,,,,,,,2.3100,38.0000,fee schedule,$5.32 from Fee Schedule UHC_31910 for Rev 301 Proc 82271 * Qty 1 = $5.32 at 100% = $5.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,6.38,,,,,,,2.3100,38.0000,fee schedule,APG 00402 Proc 82271 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5.32,,,,,,,2.3100,38.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5.32,,,,,,,2.3100,38.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,WELLCARE,WELLCARE MEDICAID,38.00,,,,,,,2.3100,38.0000,percent of total billed charges,100% of $38.00 in Billed Charges for Rev 301 Proc 82271 = $38.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OCCULT BLOOD OTHER SOURCE,82271,CPT,301,RC,30100068,CDM,,,,both,,,38.0000,5.7000,WELLCARE,WELLCARE MEDICARE,5.64,,,,,,,2.3100,38.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT FLUID MANAGEMENT SYSTEM SYMPHION,272,RC,27200002,CDM,,,,,,both,,,3100.9300,465.1400,AETNA,AETNA,1324.10,,,,,,,800.3500,3100.9300,percent of total billed charges,"42.7% of $3,100.93 in Billed Charges for Rev 272 = $1,324.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FLUID MANAGEMENT SYSTEM SYMPHION,272,RC,27200002,CDM,,,,,,both,,,3100.9300,465.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2170.65,,,,,,,800.3500,3100.9300,percent of total billed charges,"Rev 272 $3,100.93 in Billed Charges at 70% = $2,170.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FLUID MANAGEMENT SYSTEM SYMPHION,272,RC,27200002,CDM,,,,,,both,,,3100.9300,465.1400,CIGNA HEALTHCARE,CIGNA HMO,1293.09,,,,,,,800.3500,3100.9300,percent of total billed charges,"41.7% of $3,100.93 in Billed Charges for Rev 272 = $1,293.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FLUID MANAGEMENT SYSTEM SYMPHION,272,RC,27200002,CDM,,,,,,both,,,3100.9300,465.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1438.83,,,,,,,800.3500,3100.9300,percent of total billed charges,"46.4% of $3,100.93 in Billed Charges for Rev 272 = $1,438.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FLUID MANAGEMENT SYSTEM SYMPHION,272,RC,27200002,CDM,,,,,,both,,,3100.9300,465.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1293.09,,,,,,,800.3500,3100.9300,percent of total billed charges,"41.7% of $3,100.93 in Billed Charges for Rev 272 = $1,293.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FLUID MANAGEMENT SYSTEM SYMPHION,272,RC,27200002,CDM,,,,,,both,,,3100.9300,465.1400,CIGNA HEALTHCARE,CIGNA PPO,1293.09,,,,,,,800.3500,3100.9300,percent of total billed charges,"41.7% of $3,100.93 in Billed Charges for Rev 272 = $1,293.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FLUID MANAGEMENT SYSTEM SYMPHION,272,RC,27200002,CDM,,,,,,both,,,3100.9300,465.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2790.84,,,,,,,800.3500,3100.9300,percent of total billed charges,"90% of $3,100.93 in Billed Charges for Rev 272 = $2,790.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FLUID MANAGEMENT SYSTEM SYMPHION,272,RC,27200002,CDM,,,,,,both,,,3100.9300,465.1400,MEDCOST,MEDCOST VHN,1475.73,,,,,,,800.3500,3100.9300,percent of total billed charges,"47.59% of $3,100.93 in Billed Charges for Rev 272 = $1,475.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FLUID MANAGEMENT SYSTEM SYMPHION,272,RC,27200002,CDM,,,,,,both,,,3100.9300,465.1400,SENTARA HEALTH,SENTARA HEALTH,800.35,,,,,,,800.3500,3100.9300,percent of total billed charges,"25.81% of $3,100.93 in Billed Charges for Rev 272 = $800.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FLUID MANAGEMENT SYSTEM SYMPHION,272,RC,27200002,CDM,,,,,,both,,,3100.9300,465.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3100.93,,,,,,,800.3500,3100.9300,percent of total billed charges,"100% of $3,100.93 in Billed Charges for Rev 272 = $3,100.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FLUID MANAGEMENT SYSTEM SYMPHION,272,RC,27200002,CDM,,,,,,both,,,3100.9300,465.1400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1550.47,,,,,,,800.3500,3100.9300,percent of total billed charges,"Rev 272 $3,100.93 in Billed Charges at 50% = $1,550.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FLUID MANAGEMENT SYSTEM SYMPHION,272,RC,27200002,CDM,,,,,,both,,,3100.9300,465.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1001.60,,,,,,,800.3500,3100.9300,other,"32.3% of $3,100.93 in Billed Charges for Rev 272 = $1,001.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT FLUID MANAGEMENT SYSTEM SYMPHION,272,RC,27200002,CDM,,,,,,both,,,3100.9300,465.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,951.99,,,,,,,800.3500,3100.9300,other,"30.7% of $3,100.93 in Billed Charges for Rev 272 = $951.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT FLUID MANAGEMENT SYSTEM SYMPHION,272,RC,27200002,CDM,,,,,,both,,,3100.9300,465.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,1001.60,,,,,,,800.3500,3100.9300,percent of total billed charges,"32.3% of $3,100.93 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FLUID MANAGEMENT SYSTEM SYMPHION,272,RC,27200002,CDM,,,,,,both,,,3100.9300,465.1400,WELLCARE,WELLCARE MEDICAID,3100.93,,,,,,,800.3500,3100.9300,percent of total billed charges,"100% of $3,100.93 in Billed Charges for Rev 272 = $3,100.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TUBE FEEDING JEJUNAL 16FR DIA MIC-KEY SILICONE LF ST DISP,272,RC,27200002,CDM,,,,,,both,,,2293.5500,344.0300,AETNA,AETNA,979.35,,,,,,,591.9700,2293.5500,percent of total billed charges,"42.7% of $2,293.55 in Billed Charges for Rev 272 = $979.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TUBE FEEDING JEJUNAL 16FR DIA MIC-KEY SILICONE LF ST DISP,272,RC,27200002,CDM,,,,,,both,,,2293.5500,344.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1605.49,,,,,,,591.9700,2293.5500,percent of total billed charges,"Rev 272 $2,293.55 in Billed Charges at 70% = $1,605.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TUBE FEEDING JEJUNAL 16FR DIA MIC-KEY SILICONE LF ST DISP,272,RC,27200002,CDM,,,,,,both,,,2293.5500,344.0300,CIGNA HEALTHCARE,CIGNA HMO,956.41,,,,,,,591.9700,2293.5500,percent of total billed charges,"41.7% of $2,293.55 in Billed Charges for Rev 272 = $956.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TUBE FEEDING JEJUNAL 16FR DIA MIC-KEY SILICONE LF ST DISP,272,RC,27200002,CDM,,,,,,both,,,2293.5500,344.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1064.21,,,,,,,591.9700,2293.5500,percent of total billed charges,"46.4% of $2,293.55 in Billed Charges for Rev 272 = $1,064.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TUBE FEEDING JEJUNAL 16FR DIA MIC-KEY SILICONE LF ST DISP,272,RC,27200002,CDM,,,,,,both,,,2293.5500,344.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,956.41,,,,,,,591.9700,2293.5500,percent of total billed charges,"41.7% of $2,293.55 in Billed Charges for Rev 272 = $956.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TUBE FEEDING JEJUNAL 16FR DIA MIC-KEY SILICONE LF ST DISP,272,RC,27200002,CDM,,,,,,both,,,2293.5500,344.0300,CIGNA HEALTHCARE,CIGNA PPO,956.41,,,,,,,591.9700,2293.5500,percent of total billed charges,"41.7% of $2,293.55 in Billed Charges for Rev 272 = $956.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TUBE FEEDING JEJUNAL 16FR DIA MIC-KEY SILICONE LF ST DISP,272,RC,27200002,CDM,,,,,,both,,,2293.5500,344.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2064.20,,,,,,,591.9700,2293.5500,percent of total billed charges,"90% of $2,293.55 in Billed Charges for Rev 272 = $2,064.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TUBE FEEDING JEJUNAL 16FR DIA MIC-KEY SILICONE LF ST DISP,272,RC,27200002,CDM,,,,,,both,,,2293.5500,344.0300,MEDCOST,MEDCOST VHN,1091.50,,,,,,,591.9700,2293.5500,percent of total billed charges,"47.59% of $2,293.55 in Billed Charges for Rev 272 = $1,091.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TUBE FEEDING JEJUNAL 16FR DIA MIC-KEY SILICONE LF ST DISP,272,RC,27200002,CDM,,,,,,both,,,2293.5500,344.0300,SENTARA HEALTH,SENTARA HEALTH,591.97,,,,,,,591.9700,2293.5500,percent of total billed charges,"25.81% of $2,293.55 in Billed Charges for Rev 272 = $591.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TUBE FEEDING JEJUNAL 16FR DIA MIC-KEY SILICONE LF ST DISP,272,RC,27200002,CDM,,,,,,both,,,2293.5500,344.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2293.55,,,,,,,591.9700,2293.5500,percent of total billed charges,"100% of $2,293.55 in Billed Charges for Rev 272 = $2,293.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TUBE FEEDING JEJUNAL 16FR DIA MIC-KEY SILICONE LF ST DISP,272,RC,27200002,CDM,,,,,,both,,,2293.5500,344.0300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1146.78,,,,,,,591.9700,2293.5500,percent of total billed charges,"Rev 272 $2,293.55 in Billed Charges at 50% = $1,146.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TUBE FEEDING JEJUNAL 16FR DIA MIC-KEY SILICONE LF ST DISP,272,RC,27200002,CDM,,,,,,both,,,2293.5500,344.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,740.82,,,,,,,591.9700,2293.5500,other,"32.3% of $2,293.55 in Billed Charges for Rev 272 = $740.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT TUBE FEEDING JEJUNAL 16FR DIA MIC-KEY SILICONE LF ST DISP,272,RC,27200002,CDM,,,,,,both,,,2293.5500,344.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,704.12,,,,,,,591.9700,2293.5500,other,"30.7% of $2,293.55 in Billed Charges for Rev 272 = $704.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT TUBE FEEDING JEJUNAL 16FR DIA MIC-KEY SILICONE LF ST DISP,272,RC,27200002,CDM,,,,,,both,,,2293.5500,344.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,740.82,,,,,,,591.9700,2293.5500,percent of total billed charges,"32.3% of $2,293.55 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TUBE FEEDING JEJUNAL 16FR DIA MIC-KEY SILICONE LF ST DISP,272,RC,27200002,CDM,,,,,,both,,,2293.5500,344.0300,WELLCARE,WELLCARE MEDICAID,2293.55,,,,,,,591.9700,2293.5500,percent of total billed charges,"100% of $2,293.55 in Billed Charges for Rev 272 = $2,293.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TUBE PEG CORFLO MAX SAFETY,272,RC,27202162,CDM,,,,,,both,,,810.1300,121.5200,AETNA,AETNA,345.93,,,,,,,209.0900,810.1300,percent of total billed charges,42.7% of $810.13 in Billed Charges for Rev 272 = $345.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUBE PEG CORFLO MAX SAFETY,272,RC,27202162,CDM,,,,,,both,,,810.1300,121.5200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,567.09,,,,,,,209.0900,810.1300,percent of total billed charges,Rev 272 $810.13 in Billed Charges at 70% = $567.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUBE PEG CORFLO MAX SAFETY,272,RC,27202162,CDM,,,,,,both,,,810.1300,121.5200,CIGNA HEALTHCARE,CIGNA HMO,337.82,,,,,,,209.0900,810.1300,percent of total billed charges,41.7% of $810.13 in Billed Charges for Rev 272 = $337.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUBE PEG CORFLO MAX SAFETY,272,RC,27202162,CDM,,,,,,both,,,810.1300,121.5200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,375.90,,,,,,,209.0900,810.1300,percent of total billed charges,46.4% of $810.13 in Billed Charges for Rev 272 = $375.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUBE PEG CORFLO MAX SAFETY,272,RC,27202162,CDM,,,,,,both,,,810.1300,121.5200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,337.82,,,,,,,209.0900,810.1300,percent of total billed charges,41.7% of $810.13 in Billed Charges for Rev 272 = $337.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUBE PEG CORFLO MAX SAFETY,272,RC,27202162,CDM,,,,,,both,,,810.1300,121.5200,CIGNA HEALTHCARE,CIGNA PPO,337.82,,,,,,,209.0900,810.1300,percent of total billed charges,41.7% of $810.13 in Billed Charges for Rev 272 = $337.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUBE PEG CORFLO MAX SAFETY,272,RC,27202162,CDM,,,,,,both,,,810.1300,121.5200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,729.12,,,,,,,209.0900,810.1300,percent of total billed charges,90% of $810.13 in Billed Charges for Rev 272 = $729.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUBE PEG CORFLO MAX SAFETY,272,RC,27202162,CDM,,,,,,both,,,810.1300,121.5200,MEDCOST,MEDCOST VHN,385.54,,,,,,,209.0900,810.1300,percent of total billed charges,47.59% of $810.13 in Billed Charges for Rev 272 = $385.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUBE PEG CORFLO MAX SAFETY,272,RC,27202162,CDM,,,,,,both,,,810.1300,121.5200,SENTARA HEALTH,SENTARA HEALTH,209.09,,,,,,,209.0900,810.1300,percent of total billed charges,25.81% of $810.13 in Billed Charges for Rev 272 = $209.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUBE PEG CORFLO MAX SAFETY,272,RC,27202162,CDM,,,,,,both,,,810.1300,121.5200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",810.13,,,,,,,209.0900,810.1300,percent of total billed charges,100% of $810.13 in Billed Charges for Rev 272 = $810.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUBE PEG CORFLO MAX SAFETY,272,RC,27202162,CDM,,,,,,both,,,810.1300,121.5200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,405.07,,,,,,,209.0900,810.1300,percent of total billed charges,Rev 272 $810.13 in Billed Charges at 50% = $405.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUBE PEG CORFLO MAX SAFETY,272,RC,27202162,CDM,,,,,,both,,,810.1300,121.5200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,261.67,,,,,,,209.0900,810.1300,other,32.3% of $810.13 in Billed Charges for Rev 272 = $261.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT TUBE PEG CORFLO MAX SAFETY,272,RC,27202162,CDM,,,,,,both,,,810.1300,121.5200,UNITED HEALTHCARE,UHC HERITAGE SELECT,248.71,,,,,,,209.0900,810.1300,other,30.7% of $810.13 in Billed Charges for Rev 272 = $248.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT TUBE PEG CORFLO MAX SAFETY,272,RC,27202162,CDM,,,,,,both,,,810.1300,121.5200,UNITED HEALTHCARE,UNITED HEALTHCARE,261.67,,,,,,,209.0900,810.1300,percent of total billed charges,32.3% of $810.13 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUBE PEG CORFLO MAX SAFETY,272,RC,27202162,CDM,,,,,,both,,,810.1300,121.5200,WELLCARE,WELLCARE MEDICAID,810.13,,,,,,,209.0900,810.1300,percent of total billed charges,100% of $810.13 in Billed Charges for Rev 272 = $810.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUNNELING TOOL 35CM,272,RC,27200002,CDM,,,,,,both,,,943.7600,141.5600,AETNA,AETNA,402.99,,,,,,,243.5800,943.7600,percent of total billed charges,42.7% of $943.76 in Billed Charges for Rev 272 = $402.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUNNELING TOOL 35CM,272,RC,27200002,CDM,,,,,,both,,,943.7600,141.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,660.63,,,,,,,243.5800,943.7600,percent of total billed charges,Rev 272 $943.76 in Billed Charges at 70% = $660.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUNNELING TOOL 35CM,272,RC,27200002,CDM,,,,,,both,,,943.7600,141.5600,CIGNA HEALTHCARE,CIGNA HMO,393.55,,,,,,,243.5800,943.7600,percent of total billed charges,41.7% of $943.76 in Billed Charges for Rev 272 = $393.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUNNELING TOOL 35CM,272,RC,27200002,CDM,,,,,,both,,,943.7600,141.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,437.90,,,,,,,243.5800,943.7600,percent of total billed charges,46.4% of $943.76 in Billed Charges for Rev 272 = $437.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUNNELING TOOL 35CM,272,RC,27200002,CDM,,,,,,both,,,943.7600,141.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,393.55,,,,,,,243.5800,943.7600,percent of total billed charges,41.7% of $943.76 in Billed Charges for Rev 272 = $393.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUNNELING TOOL 35CM,272,RC,27200002,CDM,,,,,,both,,,943.7600,141.5600,CIGNA HEALTHCARE,CIGNA PPO,393.55,,,,,,,243.5800,943.7600,percent of total billed charges,41.7% of $943.76 in Billed Charges for Rev 272 = $393.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUNNELING TOOL 35CM,272,RC,27200002,CDM,,,,,,both,,,943.7600,141.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,849.38,,,,,,,243.5800,943.7600,percent of total billed charges,90% of $943.76 in Billed Charges for Rev 272 = $849.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUNNELING TOOL 35CM,272,RC,27200002,CDM,,,,,,both,,,943.7600,141.5600,MEDCOST,MEDCOST VHN,449.14,,,,,,,243.5800,943.7600,percent of total billed charges,47.59% of $943.76 in Billed Charges for Rev 272 = $449.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUNNELING TOOL 35CM,272,RC,27200002,CDM,,,,,,both,,,943.7600,141.5600,SENTARA HEALTH,SENTARA HEALTH,243.58,,,,,,,243.5800,943.7600,percent of total billed charges,25.81% of $943.76 in Billed Charges for Rev 272 = $243.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUNNELING TOOL 35CM,272,RC,27200002,CDM,,,,,,both,,,943.7600,141.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",943.76,,,,,,,243.5800,943.7600,percent of total billed charges,100% of $943.76 in Billed Charges for Rev 272 = $943.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUNNELING TOOL 35CM,272,RC,27200002,CDM,,,,,,both,,,943.7600,141.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,471.88,,,,,,,243.5800,943.7600,percent of total billed charges,Rev 272 $943.76 in Billed Charges at 50% = $471.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUNNELING TOOL 35CM,272,RC,27200002,CDM,,,,,,both,,,943.7600,141.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,304.83,,,,,,,243.5800,943.7600,other,32.3% of $943.76 in Billed Charges for Rev 272 = $304.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT TUNNELING TOOL 35CM,272,RC,27200002,CDM,,,,,,both,,,943.7600,141.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,289.73,,,,,,,243.5800,943.7600,other,30.7% of $943.76 in Billed Charges for Rev 272 = $289.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT TUNNELING TOOL 35CM,272,RC,27200002,CDM,,,,,,both,,,943.7600,141.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,304.83,,,,,,,243.5800,943.7600,percent of total billed charges,32.3% of $943.76 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT TUNNELING TOOL 35CM,272,RC,27200002,CDM,,,,,,both,,,943.7600,141.5600,WELLCARE,WELLCARE MEDICAID,943.76,,,,,,,243.5800,943.7600,percent of total billed charges,100% of $943.76 in Billed Charges for Rev 272 = $943.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,AETNA,AETNA,79.00,,,,,,,7.9600,185.0000,percent of total billed charges,42.7% of $185.00 in Billed Charges for Rev 301 Proc 82274 = $79.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,14.27,,,,,,,7.9600,185.0000,fee schedule,APG 00400 Proc 82274 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 104% = $14.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,15.92,,,,,,,7.9600,185.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,AETNA,AETNA HEALTHCARE MEDICARE,15.92,,,,,,,7.9600,185.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,15.92,,,,,,,7.9600,185.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,AMBETTER,AMBETTER,34.71,,,,,,,7.9600,185.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,AMERIGROUP,AMERIGROUP,7.96,,,,,,,7.9600,185.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,16.56,,,,,,,7.9600,185.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,BLUE CROSS,ANTHEM EXCHANGE,15.92,,,,,,,7.9600,185.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,14.13,,,,,,,7.9600,185.0000,fee schedule,APG 00400 Proc 82274 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,BLUE CROSS,ANTHEM HMO,15.92,,,,,,,7.9600,185.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,16.40,,,,,,,7.9600,185.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",15.92,,,,,,,7.9600,185.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,10.76,,,,,,,7.9600,185.0000,fee schedule,$10.76 from Fee Schedule BLDTM_23 for Rev 301 Proc 82274 * Qty 1 = $10.76 at 100% = $10.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,BLUE CROSS,BLUE CROSS E NETWORK,69.44,,,,,,,7.9600,185.0000,fee schedule,$21.70 from Fee Schedule BCFSB for Rev 301 Proc 82274 * Qty 1 = $21.70 at 320% = $69.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,BLUE CROSS,BLUE CROSS MEDICARE,16.56,,,,,,,7.9600,185.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,BLUE CROSS,BLUE CROSS P NETWORK,70.96,,,,,,,7.9600,185.0000,fee schedule,$21.70 from Fee Schedule BCFSB for Rev 301 Proc 82274 * Qty 1 = $21.70 at 327% = $70.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,BLUE CROSS,BLUE CROSS S NETWORK,70.96,,,,,,,7.9600,185.0000,fee schedule,$21.70 from Fee Schedule BCFSB for Rev 301 Proc 82274 * Qty 1 = $21.70 at 327% = $70.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,BLUE CROSS,TENNCARE BLUE CARE,22.41,,,,,,,7.9600,185.0000,fee schedule,$19.32 from Fee Schedule TC_24 for Rev 301 Proc 82274 * Qty 1 = $19.32 at 116% = $22.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,BLUE CROSS,TENNCARE BLUE SELECT,22.41,,,,,,,7.9600,185.0000,fee schedule,$19.32 from Fee Schedule TC_24 for Rev 301 Proc 82274 * Qty 1 = $19.32 at 116% = $22.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,CIGNA HEALTHCARE,CIGNA HMO,63.98,,,,,,,7.9600,185.0000,fee schedule,$63.98 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82274 * Qty 1 = $63.98 at 100% = $63.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,35.37,,,,,,,7.9600,185.0000,fee schedule,$35.37 from Fee Schedule CGIFP_25LR for Rev 301 Proc 82274 * Qty 1 = $35.37 at 100% = $35.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,16.72,,,,,,,7.9600,185.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,63.98,,,,,,,7.9600,185.0000,fee schedule,$63.98 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82274 * Qty 1 = $63.98 at 100% = $63.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,CIGNA HEALTHCARE,CIGNA PPO,63.98,,,,,,,7.9600,185.0000,fee schedule,$63.98 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82274 * Qty 1 = $63.98 at 100% = $63.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,16.72,,,,,,,7.9600,185.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,166.50,,,,,,,7.9600,185.0000,percent of total billed charges,90% of $185.00 in Billed Charges for Rev 301 Proc 82274 = $166.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,HUMANA,HUMANA MEDICARE,15.92,,,,,,,7.9600,185.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,15.92,,,,,,,7.9600,185.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,MEDCOST,MEDCOST VHN,88.04,,,,,,,7.9600,185.0000,percent of total billed charges,47.59% of $185.00 in Billed Charges for Rev 301 Proc 82274 = $88.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,14.41,,,,,,,7.9600,185.0000,fee schedule,APG 00400 Proc 82274 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 105% = $14.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,16.72,,,,,,,7.9600,185.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,16.72,,,,,,,7.9600,185.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,NHC ADVANTAGE,NHC ADVANTAGE,16.72,,,,,,,7.9600,185.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,14.15,,,,,,,7.9600,185.0000,fee schedule,APG 00400 Proc 82274 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 103.1% = $14.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,SENTARA HEALTH,SENTARA HEALTH,47.75,,,,,,,7.9600,185.0000,percent of total billed charges,25.81% of $185.00 in Billed Charges for Rev 301 Proc 82274 = $47.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,SENTARA HEALTH,SENTARA MEDICARE,15.92,,,,,,,7.9600,185.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",185.00,,,,,,,7.9600,185.0000,percent of total billed charges,100% of $185.00 in Billed Charges for Rev 301 Proc 82274 = $185.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11.27,,,,,,,7.9600,185.0000,fee schedule,$22.53 from Fee Schedule TCUHC24 for Rev 301 Proc 82274 * Qty 1 = $22.53 at 50% = $11.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,16.56,,,,,,,7.9600,185.0000,fee schedule,$15.92 from Fee Schedule UHC_31910 for Rev 301 Proc 82274 * Qty 1 = $15.92 at 104% = $16.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,15.92,,,,,,,7.9600,185.0000,fee schedule,$15.92 from Fee Schedule UHC_31910 for Rev 301 Proc 82274 * Qty 1 = $15.92 at 100% = $15.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,15.92,,,,,,,7.9600,185.0000,fee schedule,$15.92 from Fee Schedule UHC_31910 for Rev 301 Proc 82274 * Qty 1 = $15.92 at 100% = $15.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,14.13,,,,,,,7.9600,185.0000,fee schedule,APG 00400 Proc 82274 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,15.92,,,,,,,7.9600,185.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,15.92,,,,,,,7.9600,185.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,WELLCARE,WELLCARE MEDICAID,185.00,,,,,,,7.9600,185.0000,percent of total billed charges,100% of $185.00 in Billed Charges for Rev 301 Proc 82274 = $185.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY TEST FOR BLOOD FECAL,82274,CPT,301,RC,30100468,CDM,,,,both,,,185.0000,27.7500,WELLCARE,WELLCARE MEDICARE,16.88,,,,,,,7.9600,185.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,AETNA,AETNA,114.44,,,,,,,11.8200,268.0000,percent of total billed charges,42.7% of $268.00 in Billed Charges for Rev 301 Proc 82300 = $114.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,14.36,,,,,,,11.8200,268.0000,fee schedule,APG 00404 Proc 82300 at $836.60 (Base Rate) * 0.0165 (Relative Weight) = $13.80 (Total Line Payment) at 104% = $14.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,23.64,,,,,,,11.8200,268.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,AETNA,AETNA HEALTHCARE MEDICARE,23.64,,,,,,,11.8200,268.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,23.64,,,,,,,11.8200,268.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,AMBETTER,AMBETTER,51.54,,,,,,,11.8200,268.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,AMERIGROUP,AMERIGROUP,11.82,,,,,,,11.8200,268.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,24.59,,,,,,,11.8200,268.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,BLUE CROSS,ANTHEM EXCHANGE,23.64,,,,,,,11.8200,268.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,14.22,,,,,,,11.8200,268.0000,fee schedule,APG 00404 Proc 82300 at $836.60 (Base Rate) * 0.0165 (Relative Weight) = $13.80 (Total Line Payment) at 103% = $14.22. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,BLUE CROSS,ANTHEM HMO,23.64,,,,,,,11.8200,268.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,24.35,,,,,,,11.8200,268.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",23.64,,,,,,,11.8200,268.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,79.54,,,,,,,11.8200,268.0000,fee schedule,$79.54 from Fee Schedule BLDTM_23 for Rev 301 Proc 82300 * Qty 1 = $79.54 at 100% = $79.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,BLUE CROSS,BLUE CROSS E NETWORK,100.26,,,,,,,11.8200,268.0000,fee schedule,$31.33 from Fee Schedule BCFSB for Rev 301 Proc 82300 * Qty 1 = $31.33 at 320% = $100.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,BLUE CROSS,BLUE CROSS MEDICARE,24.59,,,,,,,11.8200,268.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,BLUE CROSS,BLUE CROSS P NETWORK,102.45,,,,,,,11.8200,268.0000,fee schedule,$31.33 from Fee Schedule BCFSB for Rev 301 Proc 82300 * Qty 1 = $31.33 at 327% = $102.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,BLUE CROSS,BLUE CROSS S NETWORK,102.45,,,,,,,11.8200,268.0000,fee schedule,$31.33 from Fee Schedule BCFSB for Rev 301 Proc 82300 * Qty 1 = $31.33 at 327% = $102.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,BLUE CROSS,TENNCARE BLUE CARE,44.02,,,,,,,11.8200,268.0000,fee schedule,$37.95 from Fee Schedule TC_24 for Rev 301 Proc 82300 * Qty 1 = $37.95 at 116% = $44.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,BLUE CROSS,TENNCARE BLUE SELECT,44.02,,,,,,,11.8200,268.0000,fee schedule,$37.95 from Fee Schedule TC_24 for Rev 301 Proc 82300 * Qty 1 = $37.95 at 116% = $44.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,CIGNA HEALTHCARE,CIGNA HMO,93.12,,,,,,,11.8200,268.0000,fee schedule,$93.12 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82300 * Qty 1 = $93.12 at 100% = $93.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,51.97,,,,,,,11.8200,268.0000,fee schedule,$51.97 from Fee Schedule CGIFP_25LR for Rev 301 Proc 82300 * Qty 1 = $51.97 at 100% = $51.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,24.82,,,,,,,11.8200,268.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,93.12,,,,,,,11.8200,268.0000,fee schedule,$93.12 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82300 * Qty 1 = $93.12 at 100% = $93.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,CIGNA HEALTHCARE,CIGNA PPO,93.12,,,,,,,11.8200,268.0000,fee schedule,$93.12 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82300 * Qty 1 = $93.12 at 100% = $93.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,24.82,,,,,,,11.8200,268.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,241.20,,,,,,,11.8200,268.0000,percent of total billed charges,90% of $268.00 in Billed Charges for Rev 301 Proc 82300 = $241.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,HUMANA,HUMANA MEDICARE,23.64,,,,,,,11.8200,268.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,23.64,,,,,,,11.8200,268.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,MEDCOST,MEDCOST VHN,127.54,,,,,,,11.8200,268.0000,percent of total billed charges,47.59% of $268.00 in Billed Charges for Rev 301 Proc 82300 = $127.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,14.49,,,,,,,11.8200,268.0000,fee schedule,APG 00404 Proc 82300 at $836.60 (Base Rate) * 0.0165 (Relative Weight) = $13.80 (Total Line Payment) at 100% = $13.80... $13.80 at 105% = $14.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,24.82,,,,,,,11.8200,268.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,24.82,,,,,,,11.8200,268.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,NHC ADVANTAGE,NHC ADVANTAGE,24.82,,,,,,,11.8200,268.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,14.23,,,,,,,11.8200,268.0000,fee schedule,APG 00404 Proc 82300 at $836.60 (Base Rate) * 0.0165 (Relative Weight) = $13.80 (Total Line Payment) at 100% = $13.80... $13.80 at 103.1% = $14.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,SENTARA HEALTH,SENTARA HEALTH,69.17,,,,,,,11.8200,268.0000,percent of total billed charges,25.81% of $268.00 in Billed Charges for Rev 301 Proc 82300 = $69.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,SENTARA HEALTH,SENTARA MEDICARE,23.64,,,,,,,11.8200,268.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",268.00,,,,,,,11.8200,268.0000,percent of total billed charges,100% of $268.00 in Billed Charges for Rev 301 Proc 82300 = $268.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,16.39,,,,,,,11.8200,268.0000,fee schedule,$32.78 from Fee Schedule TCUHC24 for Rev 301 Proc 82300 * Qty 1 = $32.78 at 50% = $16.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,24.59,,,,,,,11.8200,268.0000,fee schedule,$23.64 from Fee Schedule UHC_31910 for Rev 301 Proc 82300 * Qty 1 = $23.64 at 104% = $24.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,23.64,,,,,,,11.8200,268.0000,fee schedule,$23.64 from Fee Schedule UHC_31910 for Rev 301 Proc 82300 * Qty 1 = $23.64 at 100% = $23.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,23.64,,,,,,,11.8200,268.0000,fee schedule,$23.64 from Fee Schedule UHC_31910 for Rev 301 Proc 82300 * Qty 1 = $23.64 at 100% = $23.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,14.22,,,,,,,11.8200,268.0000,fee schedule,APG 00404 Proc 82300 at $836.60 (Base Rate) * 0.0165 (Relative Weight) = $13.80 (Total Line Payment) at 103% = $14.22. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,23.64,,,,,,,11.8200,268.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,23.64,,,,,,,11.8200,268.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,WELLCARE,WELLCARE MEDICAID,268.00,,,,,,,11.8200,268.0000,percent of total billed charges,100% of $268.00 in Billed Charges for Rev 301 Proc 82300 = $268.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CADMIUM,82300,CPT,301,RC,30100302,CDM,,,,both,,,268.0000,40.2000,WELLCARE,WELLCARE MEDICARE,25.06,,,,,,,11.8200,268.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,AETNA,AETNA,128.53,,,,,,,13.4000,301.0000,percent of total billed charges,42.7% of $301.00 in Billed Charges for Rev 301 Proc 82308 = $128.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15.66,,,,,,,13.4000,301.0000,fee schedule,APG 00398 Proc 82308 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 104% = $15.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,26.79,,,,,,,13.4000,301.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,AETNA,AETNA HEALTHCARE MEDICARE,26.79,,,,,,,13.4000,301.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,26.79,,,,,,,13.4000,301.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,AMBETTER,AMBETTER,58.40,,,,,,,13.4000,301.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,AMERIGROUP,AMERIGROUP,13.40,,,,,,,13.4000,301.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,27.86,,,,,,,13.4000,301.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,BLUE CROSS,ANTHEM EXCHANGE,26.79,,,,,,,13.4000,301.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15.51,,,,,,,13.4000,301.0000,fee schedule,APG 00398 Proc 82308 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,BLUE CROSS,ANTHEM HMO,26.79,,,,,,,13.4000,301.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,27.59,,,,,,,13.4000,301.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",26.79,,,,,,,13.4000,301.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,87.30,,,,,,,13.4000,301.0000,fee schedule,$87.30 from Fee Schedule BLDTM_23 for Rev 301 Proc 82308 * Qty 1 = $87.30 at 100% = $87.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,BLUE CROSS,BLUE CROSS E NETWORK,75.94,,,,,,,13.4000,301.0000,fee schedule,$23.73 from Fee Schedule BCFSB for Rev 301 Proc 82308 * Qty 1 = $23.73 at 320% = $75.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,BLUE CROSS,BLUE CROSS MEDICARE,27.86,,,,,,,13.4000,301.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,BLUE CROSS,BLUE CROSS P NETWORK,77.60,,,,,,,13.4000,301.0000,fee schedule,$23.73 from Fee Schedule BCFSB for Rev 301 Proc 82308 * Qty 1 = $23.73 at 327% = $77.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,BLUE CROSS,BLUE CROSS S NETWORK,77.60,,,,,,,13.4000,301.0000,fee schedule,$23.73 from Fee Schedule BCFSB for Rev 301 Proc 82308 * Qty 1 = $23.73 at 327% = $77.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,BLUE CROSS,TENNCARE BLUE CARE,33.34,,,,,,,13.4000,301.0000,fee schedule,$28.74 from Fee Schedule TC_24 for Rev 301 Proc 82308 * Qty 1 = $28.74 at 116% = $33.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,BLUE CROSS,TENNCARE BLUE SELECT,33.34,,,,,,,13.4000,301.0000,fee schedule,$28.74 from Fee Schedule TC_24 for Rev 301 Proc 82308 * Qty 1 = $28.74 at 116% = $33.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,CIGNA HEALTHCARE,CIGNA HMO,107.72,,,,,,,13.4000,301.0000,fee schedule,$107.72 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82308 * Qty 1 = $107.72 at 100% = $107.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,59.19,,,,,,,13.4000,301.0000,fee schedule,$59.19 from Fee Schedule CGIFP_25LR for Rev 301 Proc 82308 * Qty 1 = $59.19 at 100% = $59.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,28.13,,,,,,,13.4000,301.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,107.72,,,,,,,13.4000,301.0000,fee schedule,$107.72 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82308 * Qty 1 = $107.72 at 100% = $107.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,CIGNA HEALTHCARE,CIGNA PPO,107.72,,,,,,,13.4000,301.0000,fee schedule,$107.72 from Fee Schedule CIGWHS_23 for Rev 301 Proc 82308 * Qty 1 = $107.72 at 100% = $107.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,28.13,,,,,,,13.4000,301.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,270.90,,,,,,,13.4000,301.0000,percent of total billed charges,90% of $301.00 in Billed Charges for Rev 301 Proc 82308 = $270.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,HUMANA,HUMANA MEDICARE,26.79,,,,,,,13.4000,301.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,26.79,,,,,,,13.4000,301.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,MEDCOST,MEDCOST VHN,143.25,,,,,,,13.4000,301.0000,percent of total billed charges,47.59% of $301.00 in Billed Charges for Rev 301 Proc 82308 = $143.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15.81,,,,,,,13.4000,301.0000,fee schedule,APG 00398 Proc 82308 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 105% = $15.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,28.13,,,,,,,13.4000,301.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,28.13,,,,,,,13.4000,301.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,NHC ADVANTAGE,NHC ADVANTAGE,28.13,,,,,,,13.4000,301.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15.53,,,,,,,13.4000,301.0000,fee schedule,APG 00398 Proc 82308 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 103.1% = $15.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,SENTARA HEALTH,SENTARA HEALTH,77.69,,,,,,,13.4000,301.0000,percent of total billed charges,25.81% of $301.00 in Billed Charges for Rev 301 Proc 82308 = $77.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,SENTARA HEALTH,SENTARA MEDICARE,26.79,,,,,,,13.4000,301.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",301.00,,,,,,,13.4000,301.0000,percent of total billed charges,100% of $301.00 in Billed Charges for Rev 301 Proc 82308 = $301.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,18.97,,,,,,,13.4000,301.0000,fee schedule,$37.93 from Fee Schedule TCUHC24 for Rev 301 Proc 82308 * Qty 1 = $37.93 at 50% = $18.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,27.86,,,,,,,13.4000,301.0000,fee schedule,$26.79 from Fee Schedule UHC_31910 for Rev 301 Proc 82308 * Qty 1 = $26.79 at 104% = $27.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,26.79,,,,,,,13.4000,301.0000,fee schedule,$26.79 from Fee Schedule UHC_31910 for Rev 301 Proc 82308 * Qty 1 = $26.79 at 100% = $26.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,26.79,,,,,,,13.4000,301.0000,fee schedule,$26.79 from Fee Schedule UHC_31910 for Rev 301 Proc 82308 * Qty 1 = $26.79 at 100% = $26.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15.51,,,,,,,13.4000,301.0000,fee schedule,APG 00398 Proc 82308 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,26.79,,,,,,,13.4000,301.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,26.79,,,,,,,13.4000,301.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,WELLCARE,WELLCARE MEDICAID,301.00,,,,,,,13.4000,301.0000,percent of total billed charges,100% of $301.00 in Billed Charges for Rev 301 Proc 82308 = $301.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CALCITONIN,82308,CPT,301,RC,30100071,CDM,,,,both,,,301.0000,45.1500,WELLCARE,WELLCARE MEDICARE,28.40,,,,,,,13.4000,301.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CCL  ADVANTAGE INDEFLATORS,272,RC,27200892,CDM,,,,,,both,,,270.0000,40.5000,AETNA,AETNA,115.29,,,,,,,69.6900,270.0000,percent of total billed charges,42.7% of $270.00 in Billed Charges for Rev 272 = $115.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL  ADVANTAGE INDEFLATORS,272,RC,27200892,CDM,,,,,,both,,,270.0000,40.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,189.00,,,,,,,69.6900,270.0000,percent of total billed charges,Rev 272 $270.00 in Billed Charges at 70% = $189.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL  ADVANTAGE INDEFLATORS,272,RC,27200892,CDM,,,,,,both,,,270.0000,40.5000,CIGNA HEALTHCARE,CIGNA HMO,112.59,,,,,,,69.6900,270.0000,percent of total billed charges,41.7% of $270.00 in Billed Charges for Rev 272 = $112.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL  ADVANTAGE INDEFLATORS,272,RC,27200892,CDM,,,,,,both,,,270.0000,40.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,125.28,,,,,,,69.6900,270.0000,percent of total billed charges,46.4% of $270.00 in Billed Charges for Rev 272 = $125.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL  ADVANTAGE INDEFLATORS,272,RC,27200892,CDM,,,,,,both,,,270.0000,40.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,112.59,,,,,,,69.6900,270.0000,percent of total billed charges,41.7% of $270.00 in Billed Charges for Rev 272 = $112.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL  ADVANTAGE INDEFLATORS,272,RC,27200892,CDM,,,,,,both,,,270.0000,40.5000,CIGNA HEALTHCARE,CIGNA PPO,112.59,,,,,,,69.6900,270.0000,percent of total billed charges,41.7% of $270.00 in Billed Charges for Rev 272 = $112.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL  ADVANTAGE INDEFLATORS,272,RC,27200892,CDM,,,,,,both,,,270.0000,40.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,243.00,,,,,,,69.6900,270.0000,percent of total billed charges,90% of $270.00 in Billed Charges for Rev 272 = $243.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL  ADVANTAGE INDEFLATORS,272,RC,27200892,CDM,,,,,,both,,,270.0000,40.5000,MEDCOST,MEDCOST VHN,128.49,,,,,,,69.6900,270.0000,percent of total billed charges,47.59% of $270.00 in Billed Charges for Rev 272 = $128.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL  ADVANTAGE INDEFLATORS,272,RC,27200892,CDM,,,,,,both,,,270.0000,40.5000,SENTARA HEALTH,SENTARA HEALTH,69.69,,,,,,,69.6900,270.0000,percent of total billed charges,25.81% of $270.00 in Billed Charges for Rev 272 = $69.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL  ADVANTAGE INDEFLATORS,272,RC,27200892,CDM,,,,,,both,,,270.0000,40.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",270.00,,,,,,,69.6900,270.0000,percent of total billed charges,100% of $270.00 in Billed Charges for Rev 272 = $270.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL  ADVANTAGE INDEFLATORS,272,RC,27200892,CDM,,,,,,both,,,270.0000,40.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,135.00,,,,,,,69.6900,270.0000,percent of total billed charges,Rev 272 $270.00 in Billed Charges at 50% = $135.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL  ADVANTAGE INDEFLATORS,272,RC,27200892,CDM,,,,,,both,,,270.0000,40.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,87.21,,,,,,,69.6900,270.0000,other,32.3% of $270.00 in Billed Charges for Rev 272 = $87.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CCL  ADVANTAGE INDEFLATORS,272,RC,27200892,CDM,,,,,,both,,,270.0000,40.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,82.89,,,,,,,69.6900,270.0000,other,30.7% of $270.00 in Billed Charges for Rev 272 = $82.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CCL  ADVANTAGE INDEFLATORS,272,RC,27200892,CDM,,,,,,both,,,270.0000,40.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,87.21,,,,,,,69.6900,270.0000,percent of total billed charges,32.3% of $270.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL  ADVANTAGE INDEFLATORS,272,RC,27200892,CDM,,,,,,both,,,270.0000,40.5000,WELLCARE,WELLCARE MEDICAID,270.00,,,,,,,69.6900,270.0000,percent of total billed charges,100% of $270.00 in Billed Charges for Rev 272 = $270.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL END CAP,272,RC,27200895,CDM,,,,,,both,,,164.0000,24.6000,AETNA,AETNA,70.03,,,,,,,42.3300,164.0000,percent of total billed charges,42.7% of $164.00 in Billed Charges for Rev 272 = $70.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL END CAP,272,RC,27200895,CDM,,,,,,both,,,164.0000,24.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,114.80,,,,,,,42.3300,164.0000,percent of total billed charges,Rev 272 $164.00 in Billed Charges at 70% = $114.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL END CAP,272,RC,27200895,CDM,,,,,,both,,,164.0000,24.6000,CIGNA HEALTHCARE,CIGNA HMO,68.39,,,,,,,42.3300,164.0000,percent of total billed charges,41.7% of $164.00 in Billed Charges for Rev 272 = $68.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL END CAP,272,RC,27200895,CDM,,,,,,both,,,164.0000,24.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,76.10,,,,,,,42.3300,164.0000,percent of total billed charges,46.4% of $164.00 in Billed Charges for Rev 272 = $76.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL END CAP,272,RC,27200895,CDM,,,,,,both,,,164.0000,24.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,68.39,,,,,,,42.3300,164.0000,percent of total billed charges,41.7% of $164.00 in Billed Charges for Rev 272 = $68.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL END CAP,272,RC,27200895,CDM,,,,,,both,,,164.0000,24.6000,CIGNA HEALTHCARE,CIGNA PPO,68.39,,,,,,,42.3300,164.0000,percent of total billed charges,41.7% of $164.00 in Billed Charges for Rev 272 = $68.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL END CAP,272,RC,27200895,CDM,,,,,,both,,,164.0000,24.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,147.60,,,,,,,42.3300,164.0000,percent of total billed charges,90% of $164.00 in Billed Charges for Rev 272 = $147.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL END CAP,272,RC,27200895,CDM,,,,,,both,,,164.0000,24.6000,MEDCOST,MEDCOST VHN,78.05,,,,,,,42.3300,164.0000,percent of total billed charges,47.59% of $164.00 in Billed Charges for Rev 272 = $78.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL END CAP,272,RC,27200895,CDM,,,,,,both,,,164.0000,24.6000,SENTARA HEALTH,SENTARA HEALTH,42.33,,,,,,,42.3300,164.0000,percent of total billed charges,25.81% of $164.00 in Billed Charges for Rev 272 = $42.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL END CAP,272,RC,27200895,CDM,,,,,,both,,,164.0000,24.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",164.00,,,,,,,42.3300,164.0000,percent of total billed charges,100% of $164.00 in Billed Charges for Rev 272 = $164.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL END CAP,272,RC,27200895,CDM,,,,,,both,,,164.0000,24.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,82.00,,,,,,,42.3300,164.0000,percent of total billed charges,Rev 272 $164.00 in Billed Charges at 50% = $82.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL END CAP,272,RC,27200895,CDM,,,,,,both,,,164.0000,24.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,52.97,,,,,,,42.3300,164.0000,other,32.3% of $164.00 in Billed Charges for Rev 272 = $52.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CCL END CAP,272,RC,27200895,CDM,,,,,,both,,,164.0000,24.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,50.35,,,,,,,42.3300,164.0000,other,30.7% of $164.00 in Billed Charges for Rev 272 = $50.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CCL END CAP,272,RC,27200895,CDM,,,,,,both,,,164.0000,24.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,52.97,,,,,,,42.3300,164.0000,percent of total billed charges,32.3% of $164.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCL END CAP,272,RC,27200895,CDM,,,,,,both,,,164.0000,24.6000,WELLCARE,WELLCARE MEDICAID,164.00,,,,,,,42.3300,164.0000,percent of total billed charges,100% of $164.00 in Billed Charges for Rev 272 = $164.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT VALULOTOME,272,RC,27200002,CDM,,,,,,both,,,31102.6300,4665.3900,AETNA,AETNA,13280.82,,,,,,,8027.5900,31102.6300,percent of total billed charges,"42.7% of $31,102.63 in Billed Charges for Rev 272 = $13,280.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VALULOTOME,272,RC,27200002,CDM,,,,,,both,,,31102.6300,4665.3900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,21771.84,,,,,,,8027.5900,31102.6300,percent of total billed charges,"Rev 272 $31,102.63 in Billed Charges at 70% = $21,771.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VALULOTOME,272,RC,27200002,CDM,,,,,,both,,,31102.6300,4665.3900,CIGNA HEALTHCARE,CIGNA HMO,12969.80,,,,,,,8027.5900,31102.6300,percent of total billed charges,"41.7% of $31,102.63 in Billed Charges for Rev 272 = $12,969.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VALULOTOME,272,RC,27200002,CDM,,,,,,both,,,31102.6300,4665.3900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,14431.62,,,,,,,8027.5900,31102.6300,percent of total billed charges,"46.4% of $31,102.63 in Billed Charges for Rev 272 = $14,431.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VALULOTOME,272,RC,27200002,CDM,,,,,,both,,,31102.6300,4665.3900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,12969.80,,,,,,,8027.5900,31102.6300,percent of total billed charges,"41.7% of $31,102.63 in Billed Charges for Rev 272 = $12,969.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VALULOTOME,272,RC,27200002,CDM,,,,,,both,,,31102.6300,4665.3900,CIGNA HEALTHCARE,CIGNA PPO,12969.80,,,,,,,8027.5900,31102.6300,percent of total billed charges,"41.7% of $31,102.63 in Billed Charges for Rev 272 = $12,969.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VALULOTOME,272,RC,27200002,CDM,,,,,,both,,,31102.6300,4665.3900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,27992.37,,,,,,,8027.5900,31102.6300,percent of total billed charges,"90% of $31,102.63 in Billed Charges for Rev 272 = $27,992.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VALULOTOME,272,RC,27200002,CDM,,,,,,both,,,31102.6300,4665.3900,MEDCOST,MEDCOST VHN,14801.74,,,,,,,8027.5900,31102.6300,percent of total billed charges,"47.59% of $31,102.63 in Billed Charges for Rev 272 = $14,801.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VALULOTOME,272,RC,27200002,CDM,,,,,,both,,,31102.6300,4665.3900,SENTARA HEALTH,SENTARA HEALTH,8027.59,,,,,,,8027.5900,31102.6300,percent of total billed charges,"25.81% of $31,102.63 in Billed Charges for Rev 272 = $8,027.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VALULOTOME,272,RC,27200002,CDM,,,,,,both,,,31102.6300,4665.3900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",31102.63,,,,,,,8027.5900,31102.6300,percent of total billed charges,"100% of $31,102.63 in Billed Charges for Rev 272 = $31,102.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VALULOTOME,272,RC,27200002,CDM,,,,,,both,,,31102.6300,4665.3900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,15551.32,,,,,,,8027.5900,31102.6300,percent of total billed charges,"Rev 272 $31,102.63 in Billed Charges at 50% = $15,551.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VALULOTOME,272,RC,27200002,CDM,,,,,,both,,,31102.6300,4665.3900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,10046.15,,,,,,,8027.5900,31102.6300,other,"32.3% of $31,102.63 in Billed Charges for Rev 272 = $10,046.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT VALULOTOME,272,RC,27200002,CDM,,,,,,both,,,31102.6300,4665.3900,UNITED HEALTHCARE,UHC HERITAGE SELECT,9548.51,,,,,,,8027.5900,31102.6300,other,"30.7% of $31,102.63 in Billed Charges for Rev 272 = $9,548.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT VALULOTOME,272,RC,27200002,CDM,,,,,,both,,,31102.6300,4665.3900,UNITED HEALTHCARE,UNITED HEALTHCARE,10046.15,,,,,,,8027.5900,31102.6300,percent of total billed charges,"32.3% of $31,102.63 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VALULOTOME,272,RC,27200002,CDM,,,,,,both,,,31102.6300,4665.3900,WELLCARE,WELLCARE MEDICAID,31102.63,,,,,,,8027.5900,31102.6300,percent of total billed charges,"100% of $31,102.63 in Billed Charges for Rev 272 = $31,102.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ANNULOTOMY RETRACTABLE,272,RC,27200002,CDM,,,,,,both,,,4355.8200,653.3700,AETNA,AETNA,1859.94,,,,,,,1124.2400,4355.8200,percent of total billed charges,"42.7% of $4,355.82 in Billed Charges for Rev 272 = $1,859.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ANNULOTOMY RETRACTABLE,272,RC,27200002,CDM,,,,,,both,,,4355.8200,653.3700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3049.07,,,,,,,1124.2400,4355.8200,percent of total billed charges,"Rev 272 $4,355.82 in Billed Charges at 70% = $3,049.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ANNULOTOMY RETRACTABLE,272,RC,27200002,CDM,,,,,,both,,,4355.8200,653.3700,CIGNA HEALTHCARE,CIGNA HMO,1816.38,,,,,,,1124.2400,4355.8200,percent of total billed charges,"41.7% of $4,355.82 in Billed Charges for Rev 272 = $1,816.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ANNULOTOMY RETRACTABLE,272,RC,27200002,CDM,,,,,,both,,,4355.8200,653.3700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2021.10,,,,,,,1124.2400,4355.8200,percent of total billed charges,"46.4% of $4,355.82 in Billed Charges for Rev 272 = $2,021.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ANNULOTOMY RETRACTABLE,272,RC,27200002,CDM,,,,,,both,,,4355.8200,653.3700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1816.38,,,,,,,1124.2400,4355.8200,percent of total billed charges,"41.7% of $4,355.82 in Billed Charges for Rev 272 = $1,816.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ANNULOTOMY RETRACTABLE,272,RC,27200002,CDM,,,,,,both,,,4355.8200,653.3700,CIGNA HEALTHCARE,CIGNA PPO,1816.38,,,,,,,1124.2400,4355.8200,percent of total billed charges,"41.7% of $4,355.82 in Billed Charges for Rev 272 = $1,816.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ANNULOTOMY RETRACTABLE,272,RC,27200002,CDM,,,,,,both,,,4355.8200,653.3700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3920.24,,,,,,,1124.2400,4355.8200,percent of total billed charges,"90% of $4,355.82 in Billed Charges for Rev 272 = $3,920.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ANNULOTOMY RETRACTABLE,272,RC,27200002,CDM,,,,,,both,,,4355.8200,653.3700,MEDCOST,MEDCOST VHN,2072.93,,,,,,,1124.2400,4355.8200,percent of total billed charges,"47.59% of $4,355.82 in Billed Charges for Rev 272 = $2,072.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ANNULOTOMY RETRACTABLE,272,RC,27200002,CDM,,,,,,both,,,4355.8200,653.3700,SENTARA HEALTH,SENTARA HEALTH,1124.24,,,,,,,1124.2400,4355.8200,percent of total billed charges,"25.81% of $4,355.82 in Billed Charges for Rev 272 = $1,124.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ANNULOTOMY RETRACTABLE,272,RC,27200002,CDM,,,,,,both,,,4355.8200,653.3700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4355.82,,,,,,,1124.2400,4355.8200,percent of total billed charges,"100% of $4,355.82 in Billed Charges for Rev 272 = $4,355.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ANNULOTOMY RETRACTABLE,272,RC,27200002,CDM,,,,,,both,,,4355.8200,653.3700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2177.91,,,,,,,1124.2400,4355.8200,percent of total billed charges,"Rev 272 $4,355.82 in Billed Charges at 50% = $2,177.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ANNULOTOMY RETRACTABLE,272,RC,27200002,CDM,,,,,,both,,,4355.8200,653.3700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1406.93,,,,,,,1124.2400,4355.8200,other,"32.3% of $4,355.82 in Billed Charges for Rev 272 = $1,406.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KNIFE ANNULOTOMY RETRACTABLE,272,RC,27200002,CDM,,,,,,both,,,4355.8200,653.3700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1337.24,,,,,,,1124.2400,4355.8200,other,"30.7% of $4,355.82 in Billed Charges for Rev 272 = $1,337.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KNIFE ANNULOTOMY RETRACTABLE,272,RC,27200002,CDM,,,,,,both,,,4355.8200,653.3700,UNITED HEALTHCARE,UNITED HEALTHCARE,1406.93,,,,,,,1124.2400,4355.8200,percent of total billed charges,"32.3% of $4,355.82 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ANNULOTOMY RETRACTABLE,272,RC,27200002,CDM,,,,,,both,,,4355.8200,653.3700,WELLCARE,WELLCARE MEDICAID,4355.82,,,,,,,1124.2400,4355.8200,percent of total billed charges,"100% of $4,355.82 in Billed Charges for Rev 272 = $4,355.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CCM MALE TO MALE ADAPTER,272,RC,27200536,CDM,,,,,,both,,,6.0000,0.9000,AETNA,AETNA,2.56,,,,,,,1.5500,6.0000,percent of total billed charges,42.7% of $6.00 in Billed Charges for Rev 272 = $2.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCM MALE TO MALE ADAPTER,272,RC,27200536,CDM,,,,,,both,,,6.0000,0.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4.20,,,,,,,1.5500,6.0000,percent of total billed charges,Rev 272 $6.00 in Billed Charges at 70% = $4.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCM MALE TO MALE ADAPTER,272,RC,27200536,CDM,,,,,,both,,,6.0000,0.9000,CIGNA HEALTHCARE,CIGNA HMO,2.50,,,,,,,1.5500,6.0000,percent of total billed charges,41.7% of $6.00 in Billed Charges for Rev 272 = $2.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCM MALE TO MALE ADAPTER,272,RC,27200536,CDM,,,,,,both,,,6.0000,0.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2.78,,,,,,,1.5500,6.0000,percent of total billed charges,46.4% of $6.00 in Billed Charges for Rev 272 = $2.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCM MALE TO MALE ADAPTER,272,RC,27200536,CDM,,,,,,both,,,6.0000,0.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2.50,,,,,,,1.5500,6.0000,percent of total billed charges,41.7% of $6.00 in Billed Charges for Rev 272 = $2.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCM MALE TO MALE ADAPTER,272,RC,27200536,CDM,,,,,,both,,,6.0000,0.9000,CIGNA HEALTHCARE,CIGNA PPO,2.50,,,,,,,1.5500,6.0000,percent of total billed charges,41.7% of $6.00 in Billed Charges for Rev 272 = $2.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCM MALE TO MALE ADAPTER,272,RC,27200536,CDM,,,,,,both,,,6.0000,0.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5.40,,,,,,,1.5500,6.0000,percent of total billed charges,90% of $6.00 in Billed Charges for Rev 272 = $5.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCM MALE TO MALE ADAPTER,272,RC,27200536,CDM,,,,,,both,,,6.0000,0.9000,MEDCOST,MEDCOST VHN,2.86,,,,,,,1.5500,6.0000,percent of total billed charges,47.59% of $6.00 in Billed Charges for Rev 272 = $2.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCM MALE TO MALE ADAPTER,272,RC,27200536,CDM,,,,,,both,,,6.0000,0.9000,SENTARA HEALTH,SENTARA HEALTH,1.55,,,,,,,1.5500,6.0000,percent of total billed charges,25.81% of $6.00 in Billed Charges for Rev 272 = $1.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCM MALE TO MALE ADAPTER,272,RC,27200536,CDM,,,,,,both,,,6.0000,0.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6.00,,,,,,,1.5500,6.0000,percent of total billed charges,100% of $6.00 in Billed Charges for Rev 272 = $6.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCM MALE TO MALE ADAPTER,272,RC,27200536,CDM,,,,,,both,,,6.0000,0.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3.00,,,,,,,1.5500,6.0000,percent of total billed charges,Rev 272 $6.00 in Billed Charges at 50% = $3.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCM MALE TO MALE ADAPTER,272,RC,27200536,CDM,,,,,,both,,,6.0000,0.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1.94,,,,,,,1.5500,6.0000,other,32.3% of $6.00 in Billed Charges for Rev 272 = $1.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CCM MALE TO MALE ADAPTER,272,RC,27200536,CDM,,,,,,both,,,6.0000,0.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1.84,,,,,,,1.5500,6.0000,other,30.7% of $6.00 in Billed Charges for Rev 272 = $1.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CCM MALE TO MALE ADAPTER,272,RC,27200536,CDM,,,,,,both,,,6.0000,0.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,1.94,,,,,,,1.5500,6.0000,percent of total billed charges,32.3% of $6.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CCM MALE TO MALE ADAPTER,272,RC,27200536,CDM,,,,,,both,,,6.0000,0.9000,WELLCARE,WELLCARE MEDICAID,6.00,,,,,,,1.5500,6.0000,percent of total billed charges,100% of $6.00 in Billed Charges for Rev 272 = $6.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CEMENT RADIOPAQUE 61911010,272,RC,27200538,CDM,,,,,,both,,,443.0000,66.4500,AETNA,AETNA,189.16,,,,,,,114.3400,443.0000,percent of total billed charges,42.7% of $443.00 in Billed Charges for Rev 272 = $189.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CEMENT RADIOPAQUE 61911010,272,RC,27200538,CDM,,,,,,both,,,443.0000,66.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,310.10,,,,,,,114.3400,443.0000,percent of total billed charges,Rev 272 $443.00 in Billed Charges at 70% = $310.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CEMENT RADIOPAQUE 61911010,272,RC,27200538,CDM,,,,,,both,,,443.0000,66.4500,CIGNA HEALTHCARE,CIGNA HMO,184.73,,,,,,,114.3400,443.0000,percent of total billed charges,41.7% of $443.00 in Billed Charges for Rev 272 = $184.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CEMENT RADIOPAQUE 61911010,272,RC,27200538,CDM,,,,,,both,,,443.0000,66.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,205.55,,,,,,,114.3400,443.0000,percent of total billed charges,46.4% of $443.00 in Billed Charges for Rev 272 = $205.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CEMENT RADIOPAQUE 61911010,272,RC,27200538,CDM,,,,,,both,,,443.0000,66.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,184.73,,,,,,,114.3400,443.0000,percent of total billed charges,41.7% of $443.00 in Billed Charges for Rev 272 = $184.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CEMENT RADIOPAQUE 61911010,272,RC,27200538,CDM,,,,,,both,,,443.0000,66.4500,CIGNA HEALTHCARE,CIGNA PPO,184.73,,,,,,,114.3400,443.0000,percent of total billed charges,41.7% of $443.00 in Billed Charges for Rev 272 = $184.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CEMENT RADIOPAQUE 61911010,272,RC,27200538,CDM,,,,,,both,,,443.0000,66.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,398.70,,,,,,,114.3400,443.0000,percent of total billed charges,90% of $443.00 in Billed Charges for Rev 272 = $398.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CEMENT RADIOPAQUE 61911010,272,RC,27200538,CDM,,,,,,both,,,443.0000,66.4500,MEDCOST,MEDCOST VHN,210.82,,,,,,,114.3400,443.0000,percent of total billed charges,47.59% of $443.00 in Billed Charges for Rev 272 = $210.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CEMENT RADIOPAQUE 61911010,272,RC,27200538,CDM,,,,,,both,,,443.0000,66.4500,SENTARA HEALTH,SENTARA HEALTH,114.34,,,,,,,114.3400,443.0000,percent of total billed charges,25.81% of $443.00 in Billed Charges for Rev 272 = $114.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CEMENT RADIOPAQUE 61911010,272,RC,27200538,CDM,,,,,,both,,,443.0000,66.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",443.00,,,,,,,114.3400,443.0000,percent of total billed charges,100% of $443.00 in Billed Charges for Rev 272 = $443.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CEMENT RADIOPAQUE 61911010,272,RC,27200538,CDM,,,,,,both,,,443.0000,66.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,221.50,,,,,,,114.3400,443.0000,percent of total billed charges,Rev 272 $443.00 in Billed Charges at 50% = $221.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CEMENT RADIOPAQUE 61911010,272,RC,27200538,CDM,,,,,,both,,,443.0000,66.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,143.09,,,,,,,114.3400,443.0000,other,32.3% of $443.00 in Billed Charges for Rev 272 = $143.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CEMENT RADIOPAQUE 61911010,272,RC,27200538,CDM,,,,,,both,,,443.0000,66.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,136.00,,,,,,,114.3400,443.0000,other,30.7% of $443.00 in Billed Charges for Rev 272 = $136.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CEMENT RADIOPAQUE 61911010,272,RC,27200538,CDM,,,,,,both,,,443.0000,66.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,143.09,,,,,,,114.3400,443.0000,percent of total billed charges,32.3% of $443.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CEMENT RADIOPAQUE 61911010,272,RC,27200538,CDM,,,,,,both,,,443.0000,66.4500,WELLCARE,WELLCARE MEDICAID,443.00,,,,,,,114.3400,443.0000,percent of total billed charges,100% of $443.00 in Billed Charges for Rev 272 = $443.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP LIGATURE,272,RC,27201681,CDM,,,,,,both,,,273.0000,40.9500,AETNA,AETNA,116.57,,,,,,,70.4600,273.0000,percent of total billed charges,42.7% of $273.00 in Billed Charges for Rev 272 = $116.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP LIGATURE,272,RC,27201681,CDM,,,,,,both,,,273.0000,40.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,191.10,,,,,,,70.4600,273.0000,percent of total billed charges,Rev 272 $273.00 in Billed Charges at 70% = $191.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP LIGATURE,272,RC,27201681,CDM,,,,,,both,,,273.0000,40.9500,CIGNA HEALTHCARE,CIGNA HMO,113.84,,,,,,,70.4600,273.0000,percent of total billed charges,41.7% of $273.00 in Billed Charges for Rev 272 = $113.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP LIGATURE,272,RC,27201681,CDM,,,,,,both,,,273.0000,40.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,126.67,,,,,,,70.4600,273.0000,percent of total billed charges,46.4% of $273.00 in Billed Charges for Rev 272 = $126.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP LIGATURE,272,RC,27201681,CDM,,,,,,both,,,273.0000,40.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,113.84,,,,,,,70.4600,273.0000,percent of total billed charges,41.7% of $273.00 in Billed Charges for Rev 272 = $113.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP LIGATURE,272,RC,27201681,CDM,,,,,,both,,,273.0000,40.9500,CIGNA HEALTHCARE,CIGNA PPO,113.84,,,,,,,70.4600,273.0000,percent of total billed charges,41.7% of $273.00 in Billed Charges for Rev 272 = $113.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP LIGATURE,272,RC,27201681,CDM,,,,,,both,,,273.0000,40.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,245.70,,,,,,,70.4600,273.0000,percent of total billed charges,90% of $273.00 in Billed Charges for Rev 272 = $245.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP LIGATURE,272,RC,27201681,CDM,,,,,,both,,,273.0000,40.9500,MEDCOST,MEDCOST VHN,129.92,,,,,,,70.4600,273.0000,percent of total billed charges,47.59% of $273.00 in Billed Charges for Rev 272 = $129.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP LIGATURE,272,RC,27201681,CDM,,,,,,both,,,273.0000,40.9500,SENTARA HEALTH,SENTARA HEALTH,70.46,,,,,,,70.4600,273.0000,percent of total billed charges,25.81% of $273.00 in Billed Charges for Rev 272 = $70.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP LIGATURE,272,RC,27201681,CDM,,,,,,both,,,273.0000,40.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",273.00,,,,,,,70.4600,273.0000,percent of total billed charges,100% of $273.00 in Billed Charges for Rev 272 = $273.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP LIGATURE,272,RC,27201681,CDM,,,,,,both,,,273.0000,40.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,136.50,,,,,,,70.4600,273.0000,percent of total billed charges,Rev 272 $273.00 in Billed Charges at 50% = $136.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP LIGATURE,272,RC,27201681,CDM,,,,,,both,,,273.0000,40.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,88.18,,,,,,,70.4600,273.0000,other,32.3% of $273.00 in Billed Charges for Rev 272 = $88.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLIP LIGATURE,272,RC,27201681,CDM,,,,,,both,,,273.0000,40.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,83.81,,,,,,,70.4600,273.0000,other,30.7% of $273.00 in Billed Charges for Rev 272 = $83.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLIP LIGATURE,272,RC,27201681,CDM,,,,,,both,,,273.0000,40.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,88.18,,,,,,,70.4600,273.0000,percent of total billed charges,32.3% of $273.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP LIGATURE,272,RC,27201681,CDM,,,,,,both,,,273.0000,40.9500,WELLCARE,WELLCARE MEDICAID,273.00,,,,,,,70.4600,273.0000,percent of total billed charges,100% of $273.00 in Billed Charges for Rev 272 = $273.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP MARKER MAMMOMARK 8GA,272,RC,27200014,CDM,,,,,,both,,,390.0000,58.5000,AETNA,AETNA,166.53,,,,,,,100.6600,390.0000,percent of total billed charges,42.7% of $390.00 in Billed Charges for Rev 272 = $166.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP MARKER MAMMOMARK 8GA,272,RC,27200014,CDM,,,,,,both,,,390.0000,58.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,273.00,,,,,,,100.6600,390.0000,percent of total billed charges,Rev 272 $390.00 in Billed Charges at 70% = $273.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP MARKER MAMMOMARK 8GA,272,RC,27200014,CDM,,,,,,both,,,390.0000,58.5000,CIGNA HEALTHCARE,CIGNA HMO,162.63,,,,,,,100.6600,390.0000,percent of total billed charges,41.7% of $390.00 in Billed Charges for Rev 272 = $162.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP MARKER MAMMOMARK 8GA,272,RC,27200014,CDM,,,,,,both,,,390.0000,58.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,180.96,,,,,,,100.6600,390.0000,percent of total billed charges,46.4% of $390.00 in Billed Charges for Rev 272 = $180.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP MARKER MAMMOMARK 8GA,272,RC,27200014,CDM,,,,,,both,,,390.0000,58.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,162.63,,,,,,,100.6600,390.0000,percent of total billed charges,41.7% of $390.00 in Billed Charges for Rev 272 = $162.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP MARKER MAMMOMARK 8GA,272,RC,27200014,CDM,,,,,,both,,,390.0000,58.5000,CIGNA HEALTHCARE,CIGNA PPO,162.63,,,,,,,100.6600,390.0000,percent of total billed charges,41.7% of $390.00 in Billed Charges for Rev 272 = $162.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP MARKER MAMMOMARK 8GA,272,RC,27200014,CDM,,,,,,both,,,390.0000,58.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,351.00,,,,,,,100.6600,390.0000,percent of total billed charges,90% of $390.00 in Billed Charges for Rev 272 = $351.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP MARKER MAMMOMARK 8GA,272,RC,27200014,CDM,,,,,,both,,,390.0000,58.5000,MEDCOST,MEDCOST VHN,185.60,,,,,,,100.6600,390.0000,percent of total billed charges,47.59% of $390.00 in Billed Charges for Rev 272 = $185.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP MARKER MAMMOMARK 8GA,272,RC,27200014,CDM,,,,,,both,,,390.0000,58.5000,SENTARA HEALTH,SENTARA HEALTH,100.66,,,,,,,100.6600,390.0000,percent of total billed charges,25.81% of $390.00 in Billed Charges for Rev 272 = $100.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP MARKER MAMMOMARK 8GA,272,RC,27200014,CDM,,,,,,both,,,390.0000,58.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",390.00,,,,,,,100.6600,390.0000,percent of total billed charges,100% of $390.00 in Billed Charges for Rev 272 = $390.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP MARKER MAMMOMARK 8GA,272,RC,27200014,CDM,,,,,,both,,,390.0000,58.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,195.00,,,,,,,100.6600,390.0000,percent of total billed charges,Rev 272 $390.00 in Billed Charges at 50% = $195.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP MARKER MAMMOMARK 8GA,272,RC,27200014,CDM,,,,,,both,,,390.0000,58.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,125.97,,,,,,,100.6600,390.0000,other,32.3% of $390.00 in Billed Charges for Rev 272 = $125.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLIP MARKER MAMMOMARK 8GA,272,RC,27200014,CDM,,,,,,both,,,390.0000,58.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,119.73,,,,,,,100.6600,390.0000,other,30.7% of $390.00 in Billed Charges for Rev 272 = $119.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLIP MARKER MAMMOMARK 8GA,272,RC,27200014,CDM,,,,,,both,,,390.0000,58.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,125.97,,,,,,,100.6600,390.0000,percent of total billed charges,32.3% of $390.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLIP MARKER MAMMOMARK 8GA,272,RC,27200014,CDM,,,,,,both,,,390.0000,58.5000,WELLCARE,WELLCARE MEDICAID,390.00,,,,,,,100.6600,390.0000,percent of total billed charges,100% of $390.00 in Billed Charges for Rev 272 = $390.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL AZUR 018 CX DETACH 4X13 TO 20X40,278,RC,27800514,CDM,,,,,,both,,,2578.0000,386.7000,AETNA,AETNA,1237.44,,,,,,,665.3800,2578.0000,percent of total billed charges,"48% of $2,578.00 in Billed Charges for Rev 278 = $1,237.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 CX DETACH 4X13 TO 20X40,278,RC,27800514,CDM,,,,,,both,,,2578.0000,386.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1289.00,,,,,,,665.3800,2578.0000,percent of total billed charges,"50% of $2,578.00 in Billed Charges for Rev 278 = $1,289.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 CX DETACH 4X13 TO 20X40,278,RC,27800514,CDM,,,,,,both,,,2578.0000,386.7000,CIGNA HEALTHCARE,CIGNA HMO,1075.03,,,,,,,665.3800,2578.0000,percent of total billed charges,"41.7% of $2,578.00 in Billed Charges for Rev 278 = $1,075.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 CX DETACH 4X13 TO 20X40,278,RC,27800514,CDM,,,,,,both,,,2578.0000,386.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1031.20,,,,,,,665.3800,2578.0000,percent of total billed charges,"40% of $2,578.00 in Billed Charges for Rev 278 = $1,031.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 CX DETACH 4X13 TO 20X40,278,RC,27800514,CDM,,,,,,both,,,2578.0000,386.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1075.03,,,,,,,665.3800,2578.0000,percent of total billed charges,"41.7% of $2,578.00 in Billed Charges for Rev 278 = $1,075.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 CX DETACH 4X13 TO 20X40,278,RC,27800514,CDM,,,,,,both,,,2578.0000,386.7000,CIGNA HEALTHCARE,CIGNA PPO,1075.03,,,,,,,665.3800,2578.0000,percent of total billed charges,"41.7% of $2,578.00 in Billed Charges for Rev 278 = $1,075.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 CX DETACH 4X13 TO 20X40,278,RC,27800514,CDM,,,,,,both,,,2578.0000,386.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2320.20,,,,,,,665.3800,2578.0000,percent of total billed charges,"90% of $2,578.00 in Billed Charges for Rev 278 = $2,320.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 CX DETACH 4X13 TO 20X40,278,RC,27800514,CDM,,,,,,both,,,2578.0000,386.7000,MEDCOST,MEDCOST VHN,1226.87,,,,,,,665.3800,2578.0000,percent of total billed charges,"47.59% of $2,578.00 in Billed Charges for Rev 278 = $1,226.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 CX DETACH 4X13 TO 20X40,278,RC,27800514,CDM,,,,,,both,,,2578.0000,386.7000,SENTARA HEALTH,SENTARA HEALTH,665.38,,,,,,,665.3800,2578.0000,percent of total billed charges,"25.81% of $2,578.00 in Billed Charges for Rev 278 = $665.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 CX DETACH 4X13 TO 20X40,278,RC,27800514,CDM,,,,,,both,,,2578.0000,386.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2578.00,,,,,,,665.3800,2578.0000,percent of total billed charges,"100% of $2,578.00 in Billed Charges for Rev 278 = $2,578.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 CX DETACH 4X13 TO 20X40,278,RC,27800514,CDM,,,,,,both,,,2578.0000,386.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1289.00,,,,,,,665.3800,2578.0000,percent of total billed charges,"Rev 278 $2,578.00 in Billed Charges at 50% = $1,289.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 018 CX DETACH 4X13 TO 20X40,278,RC,27800514,CDM,,,,,,both,,,2578.0000,386.7000,WELLCARE,WELLCARE MEDICAID,2578.00,,,,,,,665.3800,2578.0000,percent of total billed charges,"100% of $2,578.00 in Billed Charges for Rev 278 = $2,578.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X10 AND  6X10,278,RC,27800500,CDM,,,,,,both,,,2933.0000,439.9500,AETNA,AETNA,1407.84,,,,,,,757.0100,2933.0000,percent of total billed charges,"48% of $2,933.00 in Billed Charges for Rev 278 = $1,407.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X10 AND  6X10,278,RC,27800500,CDM,,,,,,both,,,2933.0000,439.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1466.50,,,,,,,757.0100,2933.0000,percent of total billed charges,"50% of $2,933.00 in Billed Charges for Rev 278 = $1,466.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X10 AND  6X10,278,RC,27800500,CDM,,,,,,both,,,2933.0000,439.9500,CIGNA HEALTHCARE,CIGNA HMO,1223.06,,,,,,,757.0100,2933.0000,percent of total billed charges,"41.7% of $2,933.00 in Billed Charges for Rev 278 = $1,223.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X10 AND  6X10,278,RC,27800500,CDM,,,,,,both,,,2933.0000,439.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1173.20,,,,,,,757.0100,2933.0000,percent of total billed charges,"40% of $2,933.00 in Billed Charges for Rev 278 = $1,173.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X10 AND  6X10,278,RC,27800500,CDM,,,,,,both,,,2933.0000,439.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1223.06,,,,,,,757.0100,2933.0000,percent of total billed charges,"41.7% of $2,933.00 in Billed Charges for Rev 278 = $1,223.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X10 AND  6X10,278,RC,27800500,CDM,,,,,,both,,,2933.0000,439.9500,CIGNA HEALTHCARE,CIGNA PPO,1223.06,,,,,,,757.0100,2933.0000,percent of total billed charges,"41.7% of $2,933.00 in Billed Charges for Rev 278 = $1,223.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X10 AND  6X10,278,RC,27800500,CDM,,,,,,both,,,2933.0000,439.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2639.70,,,,,,,757.0100,2933.0000,percent of total billed charges,"90% of $2,933.00 in Billed Charges for Rev 278 = $2,639.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X10 AND  6X10,278,RC,27800500,CDM,,,,,,both,,,2933.0000,439.9500,MEDCOST,MEDCOST VHN,1395.81,,,,,,,757.0100,2933.0000,percent of total billed charges,"47.59% of $2,933.00 in Billed Charges for Rev 278 = $1,395.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X10 AND  6X10,278,RC,27800500,CDM,,,,,,both,,,2933.0000,439.9500,SENTARA HEALTH,SENTARA HEALTH,757.01,,,,,,,757.0100,2933.0000,percent of total billed charges,"25.81% of $2,933.00 in Billed Charges for Rev 278 = $757.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X10 AND  6X10,278,RC,27800500,CDM,,,,,,both,,,2933.0000,439.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2933.00,,,,,,,757.0100,2933.0000,percent of total billed charges,"100% of $2,933.00 in Billed Charges for Rev 278 = $2,933.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X10 AND  6X10,278,RC,27800500,CDM,,,,,,both,,,2933.0000,439.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1466.50,,,,,,,757.0100,2933.0000,percent of total billed charges,"Rev 278 $2,933.00 in Billed Charges at 50% = $1,466.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X10 AND  6X10,278,RC,27800500,CDM,,,,,,both,,,2933.0000,439.9500,WELLCARE,WELLCARE MEDICAID,2933.00,,,,,,,757.0100,2933.0000,percent of total billed charges,"100% of $2,933.00 in Billed Charges for Rev 278 = $2,933.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X15 6X15 8X15 10X15 12X15,278,RC,27800501,CDM,,,,,,both,,,3157.0000,473.5500,AETNA,AETNA,1515.36,,,,,,,814.8200,3157.0000,percent of total billed charges,"48% of $3,157.00 in Billed Charges for Rev 278 = $1,515.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X15 6X15 8X15 10X15 12X15,278,RC,27800501,CDM,,,,,,both,,,3157.0000,473.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1578.50,,,,,,,814.8200,3157.0000,percent of total billed charges,"50% of $3,157.00 in Billed Charges for Rev 278 = $1,578.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X15 6X15 8X15 10X15 12X15,278,RC,27800501,CDM,,,,,,both,,,3157.0000,473.5500,CIGNA HEALTHCARE,CIGNA HMO,1316.47,,,,,,,814.8200,3157.0000,percent of total billed charges,"41.7% of $3,157.00 in Billed Charges for Rev 278 = $1,316.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X15 6X15 8X15 10X15 12X15,278,RC,27800501,CDM,,,,,,both,,,3157.0000,473.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1262.80,,,,,,,814.8200,3157.0000,percent of total billed charges,"40% of $3,157.00 in Billed Charges for Rev 278 = $1,262.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X15 6X15 8X15 10X15 12X15,278,RC,27800501,CDM,,,,,,both,,,3157.0000,473.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1316.47,,,,,,,814.8200,3157.0000,percent of total billed charges,"41.7% of $3,157.00 in Billed Charges for Rev 278 = $1,316.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X15 6X15 8X15 10X15 12X15,278,RC,27800501,CDM,,,,,,both,,,3157.0000,473.5500,CIGNA HEALTHCARE,CIGNA PPO,1316.47,,,,,,,814.8200,3157.0000,percent of total billed charges,"41.7% of $3,157.00 in Billed Charges for Rev 278 = $1,316.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X15 6X15 8X15 10X15 12X15,278,RC,27800501,CDM,,,,,,both,,,3157.0000,473.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2841.30,,,,,,,814.8200,3157.0000,percent of total billed charges,"90% of $3,157.00 in Billed Charges for Rev 278 = $2,841.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X15 6X15 8X15 10X15 12X15,278,RC,27800501,CDM,,,,,,both,,,3157.0000,473.5500,MEDCOST,MEDCOST VHN,1502.42,,,,,,,814.8200,3157.0000,percent of total billed charges,"47.59% of $3,157.00 in Billed Charges for Rev 278 = $1,502.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X15 6X15 8X15 10X15 12X15,278,RC,27800501,CDM,,,,,,both,,,3157.0000,473.5500,SENTARA HEALTH,SENTARA HEALTH,814.82,,,,,,,814.8200,3157.0000,percent of total billed charges,"25.81% of $3,157.00 in Billed Charges for Rev 278 = $814.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X15 6X15 8X15 10X15 12X15,278,RC,27800501,CDM,,,,,,both,,,3157.0000,473.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3157.00,,,,,,,814.8200,3157.0000,percent of total billed charges,"100% of $3,157.00 in Billed Charges for Rev 278 = $3,157.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X15 6X15 8X15 10X15 12X15,278,RC,27800501,CDM,,,,,,both,,,3157.0000,473.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1578.50,,,,,,,814.8200,3157.0000,percent of total billed charges,"Rev 278 $3,157.00 in Billed Charges at 50% = $1,578.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X15 6X15 8X15 10X15 12X15,278,RC,27800501,CDM,,,,,,both,,,3157.0000,473.5500,WELLCARE,WELLCARE MEDICAID,3157.00,,,,,,,814.8200,3157.0000,percent of total billed charges,"100% of $3,157.00 in Billed Charges for Rev 278 = $3,157.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X5,278,RC,27800499,CDM,,,,,,both,,,2708.0000,406.2000,AETNA,AETNA,1299.84,,,,,,,698.9300,2708.0000,percent of total billed charges,"48% of $2,708.00 in Billed Charges for Rev 278 = $1,299.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X5,278,RC,27800499,CDM,,,,,,both,,,2708.0000,406.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1354.00,,,,,,,698.9300,2708.0000,percent of total billed charges,"50% of $2,708.00 in Billed Charges for Rev 278 = $1,354.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X5,278,RC,27800499,CDM,,,,,,both,,,2708.0000,406.2000,CIGNA HEALTHCARE,CIGNA HMO,1129.24,,,,,,,698.9300,2708.0000,percent of total billed charges,"41.7% of $2,708.00 in Billed Charges for Rev 278 = $1,129.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X5,278,RC,27800499,CDM,,,,,,both,,,2708.0000,406.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1083.20,,,,,,,698.9300,2708.0000,percent of total billed charges,"40% of $2,708.00 in Billed Charges for Rev 278 = $1,083.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X5,278,RC,27800499,CDM,,,,,,both,,,2708.0000,406.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1129.24,,,,,,,698.9300,2708.0000,percent of total billed charges,"41.7% of $2,708.00 in Billed Charges for Rev 278 = $1,129.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X5,278,RC,27800499,CDM,,,,,,both,,,2708.0000,406.2000,CIGNA HEALTHCARE,CIGNA PPO,1129.24,,,,,,,698.9300,2708.0000,percent of total billed charges,"41.7% of $2,708.00 in Billed Charges for Rev 278 = $1,129.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X5,278,RC,27800499,CDM,,,,,,both,,,2708.0000,406.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2437.20,,,,,,,698.9300,2708.0000,percent of total billed charges,"90% of $2,708.00 in Billed Charges for Rev 278 = $2,437.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X5,278,RC,27800499,CDM,,,,,,both,,,2708.0000,406.2000,MEDCOST,MEDCOST VHN,1288.74,,,,,,,698.9300,2708.0000,percent of total billed charges,"47.59% of $2,708.00 in Billed Charges for Rev 278 = $1,288.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X5,278,RC,27800499,CDM,,,,,,both,,,2708.0000,406.2000,SENTARA HEALTH,SENTARA HEALTH,698.93,,,,,,,698.9300,2708.0000,percent of total billed charges,"25.81% of $2,708.00 in Billed Charges for Rev 278 = $698.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X5,278,RC,27800499,CDM,,,,,,both,,,2708.0000,406.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2708.00,,,,,,,698.9300,2708.0000,percent of total billed charges,"100% of $2,708.00 in Billed Charges for Rev 278 = $2,708.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X5,278,RC,27800499,CDM,,,,,,both,,,2708.0000,406.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1354.00,,,,,,,698.9300,2708.0000,percent of total billed charges,"Rev 278 $2,708.00 in Billed Charges at 50% = $1,354.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL AZUR 035 DETACH 4X5,278,RC,27800499,CDM,,,,,,both,,,2708.0000,406.2000,WELLCARE,WELLCARE MEDICAID,2708.00,,,,,,,698.9300,2708.0000,percent of total billed charges,"100% of $2,708.00 in Billed Charges for Rev 278 = $2,708.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL COOK FLIPPER 10X8,272,RC,27200555,CDM,,,,,,both,,,502.0000,75.3000,AETNA,AETNA,214.35,,,,,,,129.5700,502.0000,percent of total billed charges,42.7% of $502.00 in Billed Charges for Rev 272 = $214.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL COOK FLIPPER 10X8,272,RC,27200555,CDM,,,,,,both,,,502.0000,75.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,351.40,,,,,,,129.5700,502.0000,percent of total billed charges,Rev 272 $502.00 in Billed Charges at 70% = $351.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL COOK FLIPPER 10X8,272,RC,27200555,CDM,,,,,,both,,,502.0000,75.3000,CIGNA HEALTHCARE,CIGNA HMO,209.33,,,,,,,129.5700,502.0000,percent of total billed charges,41.7% of $502.00 in Billed Charges for Rev 272 = $209.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL COOK FLIPPER 10X8,272,RC,27200555,CDM,,,,,,both,,,502.0000,75.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,232.93,,,,,,,129.5700,502.0000,percent of total billed charges,46.4% of $502.00 in Billed Charges for Rev 272 = $232.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL COOK FLIPPER 10X8,272,RC,27200555,CDM,,,,,,both,,,502.0000,75.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,209.33,,,,,,,129.5700,502.0000,percent of total billed charges,41.7% of $502.00 in Billed Charges for Rev 272 = $209.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL COOK FLIPPER 10X8,272,RC,27200555,CDM,,,,,,both,,,502.0000,75.3000,CIGNA HEALTHCARE,CIGNA PPO,209.33,,,,,,,129.5700,502.0000,percent of total billed charges,41.7% of $502.00 in Billed Charges for Rev 272 = $209.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL COOK FLIPPER 10X8,272,RC,27200555,CDM,,,,,,both,,,502.0000,75.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,451.80,,,,,,,129.5700,502.0000,percent of total billed charges,90% of $502.00 in Billed Charges for Rev 272 = $451.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL COOK FLIPPER 10X8,272,RC,27200555,CDM,,,,,,both,,,502.0000,75.3000,MEDCOST,MEDCOST VHN,238.90,,,,,,,129.5700,502.0000,percent of total billed charges,47.59% of $502.00 in Billed Charges for Rev 272 = $238.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL COOK FLIPPER 10X8,272,RC,27200555,CDM,,,,,,both,,,502.0000,75.3000,SENTARA HEALTH,SENTARA HEALTH,129.57,,,,,,,129.5700,502.0000,percent of total billed charges,25.81% of $502.00 in Billed Charges for Rev 272 = $129.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL COOK FLIPPER 10X8,272,RC,27200555,CDM,,,,,,both,,,502.0000,75.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",502.00,,,,,,,129.5700,502.0000,percent of total billed charges,100% of $502.00 in Billed Charges for Rev 272 = $502.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL COOK FLIPPER 10X8,272,RC,27200555,CDM,,,,,,both,,,502.0000,75.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,251.00,,,,,,,129.5700,502.0000,percent of total billed charges,Rev 272 $502.00 in Billed Charges at 50% = $251.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL COOK FLIPPER 10X8,272,RC,27200555,CDM,,,,,,both,,,502.0000,75.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,162.15,,,,,,,129.5700,502.0000,other,32.3% of $502.00 in Billed Charges for Rev 272 = $162.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COIL COOK FLIPPER 10X8,272,RC,27200555,CDM,,,,,,both,,,502.0000,75.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,154.11,,,,,,,129.5700,502.0000,other,30.7% of $502.00 in Billed Charges for Rev 272 = $154.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COIL COOK FLIPPER 10X8,272,RC,27200555,CDM,,,,,,both,,,502.0000,75.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,162.15,,,,,,,129.5700,502.0000,percent of total billed charges,32.3% of $502.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL COOK FLIPPER 10X8,272,RC,27200555,CDM,,,,,,both,,,502.0000,75.3000,WELLCARE,WELLCARE MEDICAID,502.00,,,,,,,129.5700,502.0000,percent of total billed charges,100% of $502.00 in Billed Charges for Rev 272 = $502.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL EMBOL NESTER ALL SIZES,272,RC,27200557,CDM,,,,,,both,,,532.0000,79.8000,AETNA,AETNA,227.16,,,,,,,137.3100,532.0000,percent of total billed charges,42.7% of $532.00 in Billed Charges for Rev 272 = $227.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL EMBOL NESTER ALL SIZES,272,RC,27200557,CDM,,,,,,both,,,532.0000,79.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,372.40,,,,,,,137.3100,532.0000,percent of total billed charges,Rev 272 $532.00 in Billed Charges at 70% = $372.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL EMBOL NESTER ALL SIZES,272,RC,27200557,CDM,,,,,,both,,,532.0000,79.8000,CIGNA HEALTHCARE,CIGNA HMO,221.84,,,,,,,137.3100,532.0000,percent of total billed charges,41.7% of $532.00 in Billed Charges for Rev 272 = $221.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL EMBOL NESTER ALL SIZES,272,RC,27200557,CDM,,,,,,both,,,532.0000,79.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,246.85,,,,,,,137.3100,532.0000,percent of total billed charges,46.4% of $532.00 in Billed Charges for Rev 272 = $246.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL EMBOL NESTER ALL SIZES,272,RC,27200557,CDM,,,,,,both,,,532.0000,79.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,221.84,,,,,,,137.3100,532.0000,percent of total billed charges,41.7% of $532.00 in Billed Charges for Rev 272 = $221.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL EMBOL NESTER ALL SIZES,272,RC,27200557,CDM,,,,,,both,,,532.0000,79.8000,CIGNA HEALTHCARE,CIGNA PPO,221.84,,,,,,,137.3100,532.0000,percent of total billed charges,41.7% of $532.00 in Billed Charges for Rev 272 = $221.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL EMBOL NESTER ALL SIZES,272,RC,27200557,CDM,,,,,,both,,,532.0000,79.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,478.80,,,,,,,137.3100,532.0000,percent of total billed charges,90% of $532.00 in Billed Charges for Rev 272 = $478.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL EMBOL NESTER ALL SIZES,272,RC,27200557,CDM,,,,,,both,,,532.0000,79.8000,MEDCOST,MEDCOST VHN,253.18,,,,,,,137.3100,532.0000,percent of total billed charges,47.59% of $532.00 in Billed Charges for Rev 272 = $253.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL EMBOL NESTER ALL SIZES,272,RC,27200557,CDM,,,,,,both,,,532.0000,79.8000,SENTARA HEALTH,SENTARA HEALTH,137.31,,,,,,,137.3100,532.0000,percent of total billed charges,25.81% of $532.00 in Billed Charges for Rev 272 = $137.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL EMBOL NESTER ALL SIZES,272,RC,27200557,CDM,,,,,,both,,,532.0000,79.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",532.00,,,,,,,137.3100,532.0000,percent of total billed charges,100% of $532.00 in Billed Charges for Rev 272 = $532.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL EMBOL NESTER ALL SIZES,272,RC,27200557,CDM,,,,,,both,,,532.0000,79.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,266.00,,,,,,,137.3100,532.0000,percent of total billed charges,Rev 272 $532.00 in Billed Charges at 50% = $266.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL EMBOL NESTER ALL SIZES,272,RC,27200557,CDM,,,,,,both,,,532.0000,79.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,171.84,,,,,,,137.3100,532.0000,other,32.3% of $532.00 in Billed Charges for Rev 272 = $171.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COIL EMBOL NESTER ALL SIZES,272,RC,27200557,CDM,,,,,,both,,,532.0000,79.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,163.32,,,,,,,137.3100,532.0000,other,30.7% of $532.00 in Billed Charges for Rev 272 = $163.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COIL EMBOL NESTER ALL SIZES,272,RC,27200557,CDM,,,,,,both,,,532.0000,79.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,171.84,,,,,,,137.3100,532.0000,percent of total billed charges,32.3% of $532.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL EMBOL NESTER ALL SIZES,272,RC,27200557,CDM,,,,,,both,,,532.0000,79.8000,WELLCARE,WELLCARE MEDICAID,532.00,,,,,,,137.3100,532.0000,percent of total billed charges,100% of $532.00 in Billed Charges for Rev 272 = $532.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL NESTER 4MM 7CM\14CM AND 6MM 7CM,278,RC,27800647,CDM,,,,,,both,,,478.0000,71.7000,AETNA,AETNA,229.44,,,,,,,123.3700,478.0000,percent of total billed charges,48% of $478.00 in Billed Charges for Rev 278 = $229.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL NESTER 4MM 7CM\14CM AND 6MM 7CM,278,RC,27800647,CDM,,,,,,both,,,478.0000,71.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,239.00,,,,,,,123.3700,478.0000,percent of total billed charges,50% of $478.00 in Billed Charges for Rev 278 = $239.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL NESTER 4MM 7CM\14CM AND 6MM 7CM,278,RC,27800647,CDM,,,,,,both,,,478.0000,71.7000,CIGNA HEALTHCARE,CIGNA HMO,199.33,,,,,,,123.3700,478.0000,percent of total billed charges,41.7% of $478.00 in Billed Charges for Rev 278 = $199.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL NESTER 4MM 7CM\14CM AND 6MM 7CM,278,RC,27800647,CDM,,,,,,both,,,478.0000,71.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,191.20,,,,,,,123.3700,478.0000,percent of total billed charges,40% of $478.00 in Billed Charges for Rev 278 = $191.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL NESTER 4MM 7CM\14CM AND 6MM 7CM,278,RC,27800647,CDM,,,,,,both,,,478.0000,71.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,199.33,,,,,,,123.3700,478.0000,percent of total billed charges,41.7% of $478.00 in Billed Charges for Rev 278 = $199.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL NESTER 4MM 7CM\14CM AND 6MM 7CM,278,RC,27800647,CDM,,,,,,both,,,478.0000,71.7000,CIGNA HEALTHCARE,CIGNA PPO,199.33,,,,,,,123.3700,478.0000,percent of total billed charges,41.7% of $478.00 in Billed Charges for Rev 278 = $199.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL NESTER 4MM 7CM\14CM AND 6MM 7CM,278,RC,27800647,CDM,,,,,,both,,,478.0000,71.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,430.20,,,,,,,123.3700,478.0000,percent of total billed charges,90% of $478.00 in Billed Charges for Rev 278 = $430.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL NESTER 4MM 7CM\14CM AND 6MM 7CM,278,RC,27800647,CDM,,,,,,both,,,478.0000,71.7000,MEDCOST,MEDCOST VHN,227.48,,,,,,,123.3700,478.0000,percent of total billed charges,47.59% of $478.00 in Billed Charges for Rev 278 = $227.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL NESTER 4MM 7CM\14CM AND 6MM 7CM,278,RC,27800647,CDM,,,,,,both,,,478.0000,71.7000,SENTARA HEALTH,SENTARA HEALTH,123.37,,,,,,,123.3700,478.0000,percent of total billed charges,25.81% of $478.00 in Billed Charges for Rev 278 = $123.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL NESTER 4MM 7CM\14CM AND 6MM 7CM,278,RC,27800647,CDM,,,,,,both,,,478.0000,71.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",478.00,,,,,,,123.3700,478.0000,percent of total billed charges,100% of $478.00 in Billed Charges for Rev 278 = $478.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL NESTER 4MM 7CM\14CM AND 6MM 7CM,278,RC,27800647,CDM,,,,,,both,,,478.0000,71.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,239.00,,,,,,,123.3700,478.0000,percent of total billed charges,Rev 278 $478.00 in Billed Charges at 50% = $239.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL NESTER 4MM 7CM\14CM AND 6MM 7CM,278,RC,27800647,CDM,,,,,,both,,,478.0000,71.7000,WELLCARE,WELLCARE MEDICAID,478.00,,,,,,,123.3700,478.0000,percent of total billed charges,100% of $478.00 in Billed Charges for Rev 278 = $478.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COIL RUBY 3MM X 5CM STANDARD,278,RC,27800625,CDM,,,,,,both,,,2397.0000,359.5500,AETNA,AETNA,1150.56,,,,,,,618.6700,2397.0000,percent of total billed charges,"48% of $2,397.00 in Billed Charges for Rev 278 = $1,150.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 3MM X 5CM STANDARD,278,RC,27800625,CDM,,,,,,both,,,2397.0000,359.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1198.50,,,,,,,618.6700,2397.0000,percent of total billed charges,"50% of $2,397.00 in Billed Charges for Rev 278 = $1,198.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 3MM X 5CM STANDARD,278,RC,27800625,CDM,,,,,,both,,,2397.0000,359.5500,CIGNA HEALTHCARE,CIGNA HMO,999.55,,,,,,,618.6700,2397.0000,percent of total billed charges,"41.7% of $2,397.00 in Billed Charges for Rev 278 = $999.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 3MM X 5CM STANDARD,278,RC,27800625,CDM,,,,,,both,,,2397.0000,359.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,958.80,,,,,,,618.6700,2397.0000,percent of total billed charges,"40% of $2,397.00 in Billed Charges for Rev 278 = $958.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 3MM X 5CM STANDARD,278,RC,27800625,CDM,,,,,,both,,,2397.0000,359.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,999.55,,,,,,,618.6700,2397.0000,percent of total billed charges,"41.7% of $2,397.00 in Billed Charges for Rev 278 = $999.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 3MM X 5CM STANDARD,278,RC,27800625,CDM,,,,,,both,,,2397.0000,359.5500,CIGNA HEALTHCARE,CIGNA PPO,999.55,,,,,,,618.6700,2397.0000,percent of total billed charges,"41.7% of $2,397.00 in Billed Charges for Rev 278 = $999.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 3MM X 5CM STANDARD,278,RC,27800625,CDM,,,,,,both,,,2397.0000,359.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2157.30,,,,,,,618.6700,2397.0000,percent of total billed charges,"90% of $2,397.00 in Billed Charges for Rev 278 = $2,157.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 3MM X 5CM STANDARD,278,RC,27800625,CDM,,,,,,both,,,2397.0000,359.5500,MEDCOST,MEDCOST VHN,1140.73,,,,,,,618.6700,2397.0000,percent of total billed charges,"47.59% of $2,397.00 in Billed Charges for Rev 278 = $1,140.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 3MM X 5CM STANDARD,278,RC,27800625,CDM,,,,,,both,,,2397.0000,359.5500,SENTARA HEALTH,SENTARA HEALTH,618.67,,,,,,,618.6700,2397.0000,percent of total billed charges,"25.81% of $2,397.00 in Billed Charges for Rev 278 = $618.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 3MM X 5CM STANDARD,278,RC,27800625,CDM,,,,,,both,,,2397.0000,359.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2397.00,,,,,,,618.6700,2397.0000,percent of total billed charges,"100% of $2,397.00 in Billed Charges for Rev 278 = $2,397.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 3MM X 5CM STANDARD,278,RC,27800625,CDM,,,,,,both,,,2397.0000,359.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1198.50,,,,,,,618.6700,2397.0000,percent of total billed charges,"Rev 278 $2,397.00 in Billed Charges at 50% = $1,198.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 3MM X 5CM STANDARD,278,RC,27800625,CDM,,,,,,both,,,2397.0000,359.5500,WELLCARE,WELLCARE MEDICAID,2397.00,,,,,,,618.6700,2397.0000,percent of total billed charges,"100% of $2,397.00 in Billed Charges for Rev 278 = $2,397.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 4 TO 32MM X 35 TO 60 CM,278,RC,27800675,CDM,,,,,,both,,,3423.0000,513.4500,AETNA,AETNA,1643.04,,,,,,,883.4800,3423.0000,percent of total billed charges,"48% of $3,423.00 in Billed Charges for Rev 278 = $1,643.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 4 TO 32MM X 35 TO 60 CM,278,RC,27800675,CDM,,,,,,both,,,3423.0000,513.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1711.50,,,,,,,883.4800,3423.0000,percent of total billed charges,"50% of $3,423.00 in Billed Charges for Rev 278 = $1,711.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 4 TO 32MM X 35 TO 60 CM,278,RC,27800675,CDM,,,,,,both,,,3423.0000,513.4500,CIGNA HEALTHCARE,CIGNA HMO,1427.39,,,,,,,883.4800,3423.0000,percent of total billed charges,"41.7% of $3,423.00 in Billed Charges for Rev 278 = $1,427.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 4 TO 32MM X 35 TO 60 CM,278,RC,27800675,CDM,,,,,,both,,,3423.0000,513.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1369.20,,,,,,,883.4800,3423.0000,percent of total billed charges,"40% of $3,423.00 in Billed Charges for Rev 278 = $1,369.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 4 TO 32MM X 35 TO 60 CM,278,RC,27800675,CDM,,,,,,both,,,3423.0000,513.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1427.39,,,,,,,883.4800,3423.0000,percent of total billed charges,"41.7% of $3,423.00 in Billed Charges for Rev 278 = $1,427.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 4 TO 32MM X 35 TO 60 CM,278,RC,27800675,CDM,,,,,,both,,,3423.0000,513.4500,CIGNA HEALTHCARE,CIGNA PPO,1427.39,,,,,,,883.4800,3423.0000,percent of total billed charges,"41.7% of $3,423.00 in Billed Charges for Rev 278 = $1,427.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 4 TO 32MM X 35 TO 60 CM,278,RC,27800675,CDM,,,,,,both,,,3423.0000,513.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3080.70,,,,,,,883.4800,3423.0000,percent of total billed charges,"90% of $3,423.00 in Billed Charges for Rev 278 = $3,080.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 4 TO 32MM X 35 TO 60 CM,278,RC,27800675,CDM,,,,,,both,,,3423.0000,513.4500,MEDCOST,MEDCOST VHN,1629.01,,,,,,,883.4800,3423.0000,percent of total billed charges,"47.59% of $3,423.00 in Billed Charges for Rev 278 = $1,629.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 4 TO 32MM X 35 TO 60 CM,278,RC,27800675,CDM,,,,,,both,,,3423.0000,513.4500,SENTARA HEALTH,SENTARA HEALTH,883.48,,,,,,,883.4800,3423.0000,percent of total billed charges,"25.81% of $3,423.00 in Billed Charges for Rev 278 = $883.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 4 TO 32MM X 35 TO 60 CM,278,RC,27800675,CDM,,,,,,both,,,3423.0000,513.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3423.00,,,,,,,883.4800,3423.0000,percent of total billed charges,"100% of $3,423.00 in Billed Charges for Rev 278 = $3,423.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 4 TO 32MM X 35 TO 60 CM,278,RC,27800675,CDM,,,,,,both,,,3423.0000,513.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1711.50,,,,,,,883.4800,3423.0000,percent of total billed charges,"Rev 278 $3,423.00 in Billed Charges at 50% = $1,711.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY 4 TO 32MM X 35 TO 60 CM,278,RC,27800675,CDM,,,,,,both,,,3423.0000,513.4500,WELLCARE,WELLCARE MEDICAID,3423.00,,,,,,,883.4800,3423.0000,percent of total billed charges,"100% of $3,423.00 in Billed Charges for Rev 278 = $3,423.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY SOFT,278,RC,27800626,CDM,,,,,,both,,,3002.0000,450.3000,AETNA,AETNA,1440.96,,,,,,,774.8200,3002.0000,percent of total billed charges,"48% of $3,002.00 in Billed Charges for Rev 278 = $1,440.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY SOFT,278,RC,27800626,CDM,,,,,,both,,,3002.0000,450.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1501.00,,,,,,,774.8200,3002.0000,percent of total billed charges,"50% of $3,002.00 in Billed Charges for Rev 278 = $1,501.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY SOFT,278,RC,27800626,CDM,,,,,,both,,,3002.0000,450.3000,CIGNA HEALTHCARE,CIGNA HMO,1251.83,,,,,,,774.8200,3002.0000,percent of total billed charges,"41.7% of $3,002.00 in Billed Charges for Rev 278 = $1,251.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY SOFT,278,RC,27800626,CDM,,,,,,both,,,3002.0000,450.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1200.80,,,,,,,774.8200,3002.0000,percent of total billed charges,"40% of $3,002.00 in Billed Charges for Rev 278 = $1,200.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY SOFT,278,RC,27800626,CDM,,,,,,both,,,3002.0000,450.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1251.83,,,,,,,774.8200,3002.0000,percent of total billed charges,"41.7% of $3,002.00 in Billed Charges for Rev 278 = $1,251.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY SOFT,278,RC,27800626,CDM,,,,,,both,,,3002.0000,450.3000,CIGNA HEALTHCARE,CIGNA PPO,1251.83,,,,,,,774.8200,3002.0000,percent of total billed charges,"41.7% of $3,002.00 in Billed Charges for Rev 278 = $1,251.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY SOFT,278,RC,27800626,CDM,,,,,,both,,,3002.0000,450.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2701.80,,,,,,,774.8200,3002.0000,percent of total billed charges,"90% of $3,002.00 in Billed Charges for Rev 278 = $2,701.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY SOFT,278,RC,27800626,CDM,,,,,,both,,,3002.0000,450.3000,MEDCOST,MEDCOST VHN,1428.65,,,,,,,774.8200,3002.0000,percent of total billed charges,"47.59% of $3,002.00 in Billed Charges for Rev 278 = $1,428.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY SOFT,278,RC,27800626,CDM,,,,,,both,,,3002.0000,450.3000,SENTARA HEALTH,SENTARA HEALTH,774.82,,,,,,,774.8200,3002.0000,percent of total billed charges,"25.81% of $3,002.00 in Billed Charges for Rev 278 = $774.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY SOFT,278,RC,27800626,CDM,,,,,,both,,,3002.0000,450.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3002.00,,,,,,,774.8200,3002.0000,percent of total billed charges,"100% of $3,002.00 in Billed Charges for Rev 278 = $3,002.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY SOFT,278,RC,27800626,CDM,,,,,,both,,,3002.0000,450.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1501.00,,,,,,,774.8200,3002.0000,percent of total billed charges,"Rev 278 $3,002.00 in Billed Charges at 50% = $1,501.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COIL RUBY SOFT,278,RC,27800626,CDM,,,,,,both,,,3002.0000,450.3000,WELLCARE,WELLCARE MEDICAID,3002.00,,,,,,,774.8200,3002.0000,percent of total billed charges,"100% of $3,002.00 in Billed Charges for Rev 278 = $3,002.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COLLAR PHIL SML 10821/3,270,RC,27000193,CDM,,,,,,both,,,90.0000,13.5000,AETNA,AETNA,38.43,,,,,,,23.2300,90.0000,percent of total billed charges,42.7% of $90.00 in Billed Charges for Rev 270 = $38.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR PHIL SML 10821/3,270,RC,27000193,CDM,,,,,,both,,,90.0000,13.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,63.00,,,,,,,23.2300,90.0000,percent of total billed charges,Rev 270 $90.00 in Billed Charges at 70% = $63.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR PHIL SML 10821/3,270,RC,27000193,CDM,,,,,,both,,,90.0000,13.5000,CIGNA HEALTHCARE,CIGNA HMO,37.53,,,,,,,23.2300,90.0000,percent of total billed charges,41.7% of $90.00 in Billed Charges for Rev 270 = $37.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR PHIL SML 10821/3,270,RC,27000193,CDM,,,,,,both,,,90.0000,13.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,41.76,,,,,,,23.2300,90.0000,percent of total billed charges,46.4% of $90.00 in Billed Charges for Rev 270 = $41.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR PHIL SML 10821/3,270,RC,27000193,CDM,,,,,,both,,,90.0000,13.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,37.53,,,,,,,23.2300,90.0000,percent of total billed charges,41.7% of $90.00 in Billed Charges for Rev 270 = $37.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR PHIL SML 10821/3,270,RC,27000193,CDM,,,,,,both,,,90.0000,13.5000,CIGNA HEALTHCARE,CIGNA PPO,37.53,,,,,,,23.2300,90.0000,percent of total billed charges,41.7% of $90.00 in Billed Charges for Rev 270 = $37.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR PHIL SML 10821/3,270,RC,27000193,CDM,,,,,,both,,,90.0000,13.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,81.00,,,,,,,23.2300,90.0000,percent of total billed charges,90% of $90.00 in Billed Charges for Rev 270 = $81.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR PHIL SML 10821/3,270,RC,27000193,CDM,,,,,,both,,,90.0000,13.5000,MEDCOST,MEDCOST VHN,42.83,,,,,,,23.2300,90.0000,percent of total billed charges,47.59% of $90.00 in Billed Charges for Rev 270 = $42.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR PHIL SML 10821/3,270,RC,27000193,CDM,,,,,,both,,,90.0000,13.5000,SENTARA HEALTH,SENTARA HEALTH,23.23,,,,,,,23.2300,90.0000,percent of total billed charges,25.81% of $90.00 in Billed Charges for Rev 270 = $23.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR PHIL SML 10821/3,270,RC,27000193,CDM,,,,,,both,,,90.0000,13.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",90.00,,,,,,,23.2300,90.0000,percent of total billed charges,100% of $90.00 in Billed Charges for Rev 270 = $90.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR PHIL SML 10821/3,270,RC,27000193,CDM,,,,,,both,,,90.0000,13.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,45.00,,,,,,,23.2300,90.0000,percent of total billed charges,Rev 270 $90.00 in Billed Charges at 50% = $45.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR PHIL SML 10821/3,270,RC,27000193,CDM,,,,,,both,,,90.0000,13.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,29.07,,,,,,,23.2300,90.0000,other,32.3% of $90.00 in Billed Charges for Rev 270 = $29.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COLLAR PHIL SML 10821/3,270,RC,27000193,CDM,,,,,,both,,,90.0000,13.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,27.63,,,,,,,23.2300,90.0000,other,30.7% of $90.00 in Billed Charges for Rev 270 = $27.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COLLAR PHIL SML 10821/3,270,RC,27000193,CDM,,,,,,both,,,90.0000,13.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,29.07,,,,,,,23.2300,90.0000,percent of total billed charges,32.3% of $90.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COLLAR PHIL SML 10821/3,270,RC,27000193,CDM,,,,,,both,,,90.0000,13.5000,WELLCARE,WELLCARE MEDICAID,90.00,,,,,,,23.2300,90.0000,percent of total billed charges,100% of $90.00 in Billed Charges for Rev 270 = $90.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COMPRESSION LOADING COREVALVE,272,RC,27201697,CDM,,,,,,both,,,1380.0000,207.0000,AETNA,AETNA,589.26,,,,,,,356.1800,1380.0000,percent of total billed charges,"42.7% of $1,380.00 in Billed Charges for Rev 272 = $589.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPRESSION LOADING COREVALVE,272,RC,27201697,CDM,,,,,,both,,,1380.0000,207.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,966.00,,,,,,,356.1800,1380.0000,percent of total billed charges,"Rev 272 $1,380.00 in Billed Charges at 70% = $966.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPRESSION LOADING COREVALVE,272,RC,27201697,CDM,,,,,,both,,,1380.0000,207.0000,CIGNA HEALTHCARE,CIGNA HMO,575.46,,,,,,,356.1800,1380.0000,percent of total billed charges,"41.7% of $1,380.00 in Billed Charges for Rev 272 = $575.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPRESSION LOADING COREVALVE,272,RC,27201697,CDM,,,,,,both,,,1380.0000,207.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,640.32,,,,,,,356.1800,1380.0000,percent of total billed charges,"46.4% of $1,380.00 in Billed Charges for Rev 272 = $640.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPRESSION LOADING COREVALVE,272,RC,27201697,CDM,,,,,,both,,,1380.0000,207.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,575.46,,,,,,,356.1800,1380.0000,percent of total billed charges,"41.7% of $1,380.00 in Billed Charges for Rev 272 = $575.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPRESSION LOADING COREVALVE,272,RC,27201697,CDM,,,,,,both,,,1380.0000,207.0000,CIGNA HEALTHCARE,CIGNA PPO,575.46,,,,,,,356.1800,1380.0000,percent of total billed charges,"41.7% of $1,380.00 in Billed Charges for Rev 272 = $575.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPRESSION LOADING COREVALVE,272,RC,27201697,CDM,,,,,,both,,,1380.0000,207.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1242.00,,,,,,,356.1800,1380.0000,percent of total billed charges,"90% of $1,380.00 in Billed Charges for Rev 272 = $1,242.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPRESSION LOADING COREVALVE,272,RC,27201697,CDM,,,,,,both,,,1380.0000,207.0000,MEDCOST,MEDCOST VHN,656.74,,,,,,,356.1800,1380.0000,percent of total billed charges,"47.59% of $1,380.00 in Billed Charges for Rev 272 = $656.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPRESSION LOADING COREVALVE,272,RC,27201697,CDM,,,,,,both,,,1380.0000,207.0000,SENTARA HEALTH,SENTARA HEALTH,356.18,,,,,,,356.1800,1380.0000,percent of total billed charges,"25.81% of $1,380.00 in Billed Charges for Rev 272 = $356.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPRESSION LOADING COREVALVE,272,RC,27201697,CDM,,,,,,both,,,1380.0000,207.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1380.00,,,,,,,356.1800,1380.0000,percent of total billed charges,"100% of $1,380.00 in Billed Charges for Rev 272 = $1,380.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPRESSION LOADING COREVALVE,272,RC,27201697,CDM,,,,,,both,,,1380.0000,207.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,690.00,,,,,,,356.1800,1380.0000,percent of total billed charges,"Rev 272 $1,380.00 in Billed Charges at 50% = $690.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPRESSION LOADING COREVALVE,272,RC,27201697,CDM,,,,,,both,,,1380.0000,207.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,445.74,,,,,,,356.1800,1380.0000,other,"32.3% of $1,380.00 in Billed Charges for Rev 272 = $445.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC COMPRESSION LOADING COREVALVE,272,RC,27201697,CDM,,,,,,both,,,1380.0000,207.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,423.66,,,,,,,356.1800,1380.0000,other,"30.7% of $1,380.00 in Billed Charges for Rev 272 = $423.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC COMPRESSION LOADING COREVALVE,272,RC,27201697,CDM,,,,,,both,,,1380.0000,207.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,445.74,,,,,,,356.1800,1380.0000,percent of total billed charges,"32.3% of $1,380.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPRESSION LOADING COREVALVE,272,RC,27201697,CDM,,,,,,both,,,1380.0000,207.0000,WELLCARE,WELLCARE MEDICAID,1380.00,,,,,,,356.1800,1380.0000,percent of total billed charges,"100% of $1,380.00 in Billed Charges for Rev 272 = $1,380.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONCERTO HELIX COIL 2MM X 4CM TO 20MM X 50CM,278,RC,27801481,CDM,,,,,,both,,,1821.0000,273.1500,AETNA,AETNA,874.08,,,,,,,470.0000,1821.0000,percent of total billed charges,"48% of $1,821.00 in Billed Charges for Rev 278 = $874.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONCERTO HELIX COIL 2MM X 4CM TO 20MM X 50CM,278,RC,27801481,CDM,,,,,,both,,,1821.0000,273.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,910.50,,,,,,,470.0000,1821.0000,percent of total billed charges,"50% of $1,821.00 in Billed Charges for Rev 278 = $910.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONCERTO HELIX COIL 2MM X 4CM TO 20MM X 50CM,278,RC,27801481,CDM,,,,,,both,,,1821.0000,273.1500,CIGNA HEALTHCARE,CIGNA HMO,759.36,,,,,,,470.0000,1821.0000,percent of total billed charges,"41.7% of $1,821.00 in Billed Charges for Rev 278 = $759.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONCERTO HELIX COIL 2MM X 4CM TO 20MM X 50CM,278,RC,27801481,CDM,,,,,,both,,,1821.0000,273.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,728.40,,,,,,,470.0000,1821.0000,percent of total billed charges,"40% of $1,821.00 in Billed Charges for Rev 278 = $728.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONCERTO HELIX COIL 2MM X 4CM TO 20MM X 50CM,278,RC,27801481,CDM,,,,,,both,,,1821.0000,273.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,759.36,,,,,,,470.0000,1821.0000,percent of total billed charges,"41.7% of $1,821.00 in Billed Charges for Rev 278 = $759.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONCERTO HELIX COIL 2MM X 4CM TO 20MM X 50CM,278,RC,27801481,CDM,,,,,,both,,,1821.0000,273.1500,CIGNA HEALTHCARE,CIGNA PPO,759.36,,,,,,,470.0000,1821.0000,percent of total billed charges,"41.7% of $1,821.00 in Billed Charges for Rev 278 = $759.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONCERTO HELIX COIL 2MM X 4CM TO 20MM X 50CM,278,RC,27801481,CDM,,,,,,both,,,1821.0000,273.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1638.90,,,,,,,470.0000,1821.0000,percent of total billed charges,"90% of $1,821.00 in Billed Charges for Rev 278 = $1,638.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONCERTO HELIX COIL 2MM X 4CM TO 20MM X 50CM,278,RC,27801481,CDM,,,,,,both,,,1821.0000,273.1500,MEDCOST,MEDCOST VHN,866.61,,,,,,,470.0000,1821.0000,percent of total billed charges,"47.59% of $1,821.00 in Billed Charges for Rev 278 = $866.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONCERTO HELIX COIL 2MM X 4CM TO 20MM X 50CM,278,RC,27801481,CDM,,,,,,both,,,1821.0000,273.1500,SENTARA HEALTH,SENTARA HEALTH,470.00,,,,,,,470.0000,1821.0000,percent of total billed charges,"25.81% of $1,821.00 in Billed Charges for Rev 278 = $470.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONCERTO HELIX COIL 2MM X 4CM TO 20MM X 50CM,278,RC,27801481,CDM,,,,,,both,,,1821.0000,273.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1821.00,,,,,,,470.0000,1821.0000,percent of total billed charges,"100% of $1,821.00 in Billed Charges for Rev 278 = $1,821.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONCERTO HELIX COIL 2MM X 4CM TO 20MM X 50CM,278,RC,27801481,CDM,,,,,,both,,,1821.0000,273.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,910.50,,,,,,,470.0000,1821.0000,percent of total billed charges,"Rev 278 $1,821.00 in Billed Charges at 50% = $910.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONCERTO HELIX COIL 2MM X 4CM TO 20MM X 50CM,278,RC,27801481,CDM,,,,,,both,,,1821.0000,273.1500,WELLCARE,WELLCARE MEDICAID,1821.00,,,,,,,470.0000,1821.0000,percent of total billed charges,"100% of $1,821.00 in Billed Charges for Rev 278 = $1,821.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONT GLUCOSE MONITOR WITH INSULIN PUMP,920,RC,92000008,CDM,,,,,,both,,,176.0000,26.4000,AETNA,AETNA,75.15,,,,,,,29.0400,176.0000,percent of total billed charges,42.7% of $176.00 in Billed Charges for Rev 920 = $75.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONT GLUCOSE MONITOR WITH INSULIN PUMP,920,RC,92000008,CDM,,,,,,both,,,176.0000,26.4000,BLUE CROSS,ANTHEM EXCHANGE,29.04,,,,,,,29.0400,176.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONT GLUCOSE MONITOR WITH INSULIN PUMP,920,RC,92000008,CDM,,,,,,both,,,176.0000,26.4000,BLUE CROSS,ANTHEM HMO,29.04,,,,,,,29.0400,176.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONT GLUCOSE MONITOR WITH INSULIN PUMP,920,RC,92000008,CDM,,,,,,both,,,176.0000,26.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",29.04,,,,,,,29.0400,176.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONT GLUCOSE MONITOR WITH INSULIN PUMP,920,RC,92000008,CDM,,,,,,both,,,176.0000,26.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,123.20,,,,,,,29.0400,176.0000,percent of total billed charges,Rev 920 $176.00 in Billed Charges at 70% = $123.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONT GLUCOSE MONITOR WITH INSULIN PUMP,920,RC,92000008,CDM,,,,,,both,,,176.0000,26.4000,CIGNA HEALTHCARE,CIGNA HMO,73.39,,,,,,,29.0400,176.0000,percent of total billed charges,41.7% of $176.00 in Billed Charges for Rev 920 = $73.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONT GLUCOSE MONITOR WITH INSULIN PUMP,920,RC,92000008,CDM,,,,,,both,,,176.0000,26.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,81.66,,,,,,,29.0400,176.0000,percent of total billed charges,46.4% of $176.00 in Billed Charges for Rev 920 = $81.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONT GLUCOSE MONITOR WITH INSULIN PUMP,920,RC,92000008,CDM,,,,,,both,,,176.0000,26.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,73.39,,,,,,,29.0400,176.0000,percent of total billed charges,41.7% of $176.00 in Billed Charges for Rev 920 = $73.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONT GLUCOSE MONITOR WITH INSULIN PUMP,920,RC,92000008,CDM,,,,,,both,,,176.0000,26.4000,CIGNA HEALTHCARE,CIGNA PPO,73.39,,,,,,,29.0400,176.0000,percent of total billed charges,41.7% of $176.00 in Billed Charges for Rev 920 = $73.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONT GLUCOSE MONITOR WITH INSULIN PUMP,920,RC,92000008,CDM,,,,,,both,,,176.0000,26.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,158.40,,,,,,,29.0400,176.0000,percent of total billed charges,90% of $176.00 in Billed Charges for Rev 920 = $158.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONT GLUCOSE MONITOR WITH INSULIN PUMP,920,RC,92000008,CDM,,,,,,both,,,176.0000,26.4000,MEDCOST,MEDCOST VHN,83.76,,,,,,,29.0400,176.0000,percent of total billed charges,47.59% of $176.00 in Billed Charges for Rev 920 = $83.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONT GLUCOSE MONITOR WITH INSULIN PUMP,920,RC,92000008,CDM,,,,,,both,,,176.0000,26.4000,SENTARA HEALTH,SENTARA HEALTH,45.43,,,,,,,29.0400,176.0000,percent of total billed charges,25.81% of $176.00 in Billed Charges for Rev 920 = $45.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONT GLUCOSE MONITOR WITH INSULIN PUMP,920,RC,92000008,CDM,,,,,,both,,,176.0000,26.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",176.00,,,,,,,29.0400,176.0000,percent of total billed charges,100% of $176.00 in Billed Charges for Rev 920 = $176.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONT GLUCOSE MONITOR WITH INSULIN PUMP,920,RC,92000008,CDM,,,,,,both,,,176.0000,26.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,88.00,,,,,,,29.0400,176.0000,percent of total billed charges,Rev 920 $176.00 in Billed Charges at 50% = $88.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONT GLUCOSE MONITOR WITH INSULIN PUMP,920,RC,92000008,CDM,,,,,,both,,,176.0000,26.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,176.00,,,,,,,29.0400,176.0000,other,"Rev 920 1 Visit at $423.00 per Visit = $423.00 (Service Line reduced to $176.00, claim capped at $176.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONT GLUCOSE MONITOR WITH INSULIN PUMP,920,RC,92000008,CDM,,,,,,both,,,176.0000,26.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,176.00,,,,,,,29.0400,176.0000,other,"Rev 920 1 Visit at $405.00 per Visit = $405.00 (Service Line reduced to $176.00, claim capped at $176.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONT GLUCOSE MONITOR WITH INSULIN PUMP,920,RC,92000008,CDM,,,,,,both,,,176.0000,26.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,176.00,,,,,,,29.0400,176.0000,other,"Rev 920 1 Visit at $667.00 per Visit = $667.00 (Service Line reduced to $176.00, claim capped at $176.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONT GLUCOSE MONITOR WITH INSULIN PUMP,920,RC,92000008,CDM,,,,,,both,,,176.0000,26.4000,WELLCARE,WELLCARE MEDICAID,176.00,,,,,,,29.0400,176.0000,percent of total billed charges,100% of $176.00 in Billed Charges for Rev 920 = $176.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC COREVALVE 23-31MM DELIVERY SYSTEM,272,RC,27201696,CDM,,,,,,both,,,5600.0000,840.0000,AETNA,AETNA,2391.20,,,,,,,1445.3600,5600.0000,percent of total billed charges,"42.7% of $5,600.00 in Billed Charges for Rev 272 = $2,391.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM DELIVERY SYSTEM,272,RC,27201696,CDM,,,,,,both,,,5600.0000,840.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3920.00,,,,,,,1445.3600,5600.0000,percent of total billed charges,"Rev 272 $5,600.00 in Billed Charges at 70% = $3,920.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM DELIVERY SYSTEM,272,RC,27201696,CDM,,,,,,both,,,5600.0000,840.0000,CIGNA HEALTHCARE,CIGNA HMO,2335.20,,,,,,,1445.3600,5600.0000,percent of total billed charges,"41.7% of $5,600.00 in Billed Charges for Rev 272 = $2,335.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM DELIVERY SYSTEM,272,RC,27201696,CDM,,,,,,both,,,5600.0000,840.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2598.40,,,,,,,1445.3600,5600.0000,percent of total billed charges,"46.4% of $5,600.00 in Billed Charges for Rev 272 = $2,598.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM DELIVERY SYSTEM,272,RC,27201696,CDM,,,,,,both,,,5600.0000,840.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2335.20,,,,,,,1445.3600,5600.0000,percent of total billed charges,"41.7% of $5,600.00 in Billed Charges for Rev 272 = $2,335.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM DELIVERY SYSTEM,272,RC,27201696,CDM,,,,,,both,,,5600.0000,840.0000,CIGNA HEALTHCARE,CIGNA PPO,2335.20,,,,,,,1445.3600,5600.0000,percent of total billed charges,"41.7% of $5,600.00 in Billed Charges for Rev 272 = $2,335.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM DELIVERY SYSTEM,272,RC,27201696,CDM,,,,,,both,,,5600.0000,840.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5040.00,,,,,,,1445.3600,5600.0000,percent of total billed charges,"90% of $5,600.00 in Billed Charges for Rev 272 = $5,040.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM DELIVERY SYSTEM,272,RC,27201696,CDM,,,,,,both,,,5600.0000,840.0000,MEDCOST,MEDCOST VHN,2665.04,,,,,,,1445.3600,5600.0000,percent of total billed charges,"47.59% of $5,600.00 in Billed Charges for Rev 272 = $2,665.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM DELIVERY SYSTEM,272,RC,27201696,CDM,,,,,,both,,,5600.0000,840.0000,SENTARA HEALTH,SENTARA HEALTH,1445.36,,,,,,,1445.3600,5600.0000,percent of total billed charges,"25.81% of $5,600.00 in Billed Charges for Rev 272 = $1,445.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM DELIVERY SYSTEM,272,RC,27201696,CDM,,,,,,both,,,5600.0000,840.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5600.00,,,,,,,1445.3600,5600.0000,percent of total billed charges,"100% of $5,600.00 in Billed Charges for Rev 272 = $5,600.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM DELIVERY SYSTEM,272,RC,27201696,CDM,,,,,,both,,,5600.0000,840.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2800.00,,,,,,,1445.3600,5600.0000,percent of total billed charges,"Rev 272 $5,600.00 in Billed Charges at 50% = $2,800.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM DELIVERY SYSTEM,272,RC,27201696,CDM,,,,,,both,,,5600.0000,840.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1808.80,,,,,,,1445.3600,5600.0000,other,"32.3% of $5,600.00 in Billed Charges for Rev 272 = $1,808.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC COREVALVE 23-31MM DELIVERY SYSTEM,272,RC,27201696,CDM,,,,,,both,,,5600.0000,840.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1719.20,,,,,,,1445.3600,5600.0000,other,"30.7% of $5,600.00 in Billed Charges for Rev 272 = $1,719.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC COREVALVE 23-31MM DELIVERY SYSTEM,272,RC,27201696,CDM,,,,,,both,,,5600.0000,840.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,1808.80,,,,,,,1445.3600,5600.0000,percent of total billed charges,"32.3% of $5,600.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COREVALVE 23-31MM DELIVERY SYSTEM,272,RC,27201696,CDM,,,,,,both,,,5600.0000,840.0000,WELLCARE,WELLCARE MEDICAID,5600.00,,,,,,,1445.3600,5600.0000,percent of total billed charges,"100% of $5,600.00 in Billed Charges for Rev 272 = $5,600.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ICU ROOM DLY,210,RC,21000001,CDM,,,,,,inpatient,,,5305.0000,795.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,121.7600,5305.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC CORONARY ICU ROOM DLY,210,RC,21000001,CDM,,,,,,inpatient,,,5305.0000,795.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4774.50,,,,,,,121.7600,5305.0000,percent of total billed charges,"90% of $5,305.00 in Billed Charges for Rev 210 = $4,774.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ICU ROOM DLY,210,RC,21000001,CDM,,,,,,inpatient,,,5305.0000,795.7500,MEDCOST,MEDCOST VHN,2524.65,,,,,,,121.7600,5305.0000,percent of total billed charges,"47.59% of $5,305.00 in Billed Charges for Rev 210 = $2,524.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ICU ROOM DLY,210,RC,21000001,CDM,,,,,,inpatient,,,5305.0000,795.7500,SENTARA HEALTH,SENTARA HEALTH,1977.70,,,,,,,121.7600,5305.0000,percent of total billed charges,"37.28% of $5,305.00 in Billed Charges for Rev 210 = $1,977.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ICU ROOM DLY,210,RC,21000001,CDM,,,,,,inpatient,,,5305.0000,795.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5305.00,,,,,,,121.7600,5305.0000,percent of total billed charges,"100% of $5,305.00 in Billed Charges for Rev 210 = $5,305.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL PACKING XEROGEL XG-108,272,RC,,,,,,,,both,,,1855.7600,278.3600,AETNA,AETNA,792.41,,,,,,,478.9700,1855.7600,percent of total billed charges,"42.7% of $1,855.76 in Billed Charges for Rev 272 = $792.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL PACKING XEROGEL XG-108,272,RC,,,,,,,,both,,,1855.7600,278.3600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1299.03,,,,,,,478.9700,1855.7600,percent of total billed charges,"Rev 272 $1,855.76 in Billed Charges at 70% = $1,299.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL PACKING XEROGEL XG-108,272,RC,,,,,,,,both,,,1855.7600,278.3600,CIGNA HEALTHCARE,CIGNA HMO,773.85,,,,,,,478.9700,1855.7600,percent of total billed charges,"41.7% of $1,855.76 in Billed Charges for Rev 272 = $773.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL PACKING XEROGEL XG-108,272,RC,,,,,,,,both,,,1855.7600,278.3600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,861.07,,,,,,,478.9700,1855.7600,percent of total billed charges,"46.4% of $1,855.76 in Billed Charges for Rev 272 = $861.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL PACKING XEROGEL XG-108,272,RC,,,,,,,,both,,,1855.7600,278.3600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,773.85,,,,,,,478.9700,1855.7600,percent of total billed charges,"41.7% of $1,855.76 in Billed Charges for Rev 272 = $773.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL PACKING XEROGEL XG-108,272,RC,,,,,,,,both,,,1855.7600,278.3600,CIGNA HEALTHCARE,CIGNA PPO,773.85,,,,,,,478.9700,1855.7600,percent of total billed charges,"41.7% of $1,855.76 in Billed Charges for Rev 272 = $773.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL PACKING XEROGEL XG-108,272,RC,,,,,,,,both,,,1855.7600,278.3600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1670.18,,,,,,,478.9700,1855.7600,percent of total billed charges,"90% of $1,855.76 in Billed Charges for Rev 272 = $1,670.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL PACKING XEROGEL XG-108,272,RC,,,,,,,,both,,,1855.7600,278.3600,MEDCOST,MEDCOST VHN,883.16,,,,,,,478.9700,1855.7600,percent of total billed charges,"47.59% of $1,855.76 in Billed Charges for Rev 272 = $883.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL PACKING XEROGEL XG-108,272,RC,,,,,,,,both,,,1855.7600,278.3600,SENTARA HEALTH,SENTARA HEALTH,478.97,,,,,,,478.9700,1855.7600,percent of total billed charges,"25.81% of $1,855.76 in Billed Charges for Rev 272 = $478.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL PACKING XEROGEL XG-108,272,RC,,,,,,,,both,,,1855.7600,278.3600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1855.76,,,,,,,478.9700,1855.7600,percent of total billed charges,"100% of $1,855.76 in Billed Charges for Rev 272 = $1,855.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL PACKING XEROGEL XG-108,272,RC,,,,,,,,both,,,1855.7600,278.3600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,927.88,,,,,,,478.9700,1855.7600,percent of total billed charges,"Rev 272 $1,855.76 in Billed Charges at 50% = $927.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL PACKING XEROGEL XG-108,272,RC,,,,,,,,both,,,1855.7600,278.3600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,599.41,,,,,,,478.9700,1855.7600,other,"32.3% of $1,855.76 in Billed Charges for Rev 272 = $599.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NASAL PACKING XEROGEL XG-108,272,RC,,,,,,,,both,,,1855.7600,278.3600,UNITED HEALTHCARE,UHC HERITAGE SELECT,569.72,,,,,,,478.9700,1855.7600,other,"30.7% of $1,855.76 in Billed Charges for Rev 272 = $569.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NASAL PACKING XEROGEL XG-108,272,RC,,,,,,,,both,,,1855.7600,278.3600,UNITED HEALTHCARE,UNITED HEALTHCARE,599.41,,,,,,,478.9700,1855.7600,percent of total billed charges,"32.3% of $1,855.76 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL PACKING XEROGEL XG-108,272,RC,,,,,,,,both,,,1855.7600,278.3600,WELLCARE,WELLCARE MEDICAID,1855.76,,,,,,,478.9700,1855.7600,percent of total billed charges,"100% of $1,855.76 in Billed Charges for Rev 272 = $1,855.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL 5CM,272,RC,,,,,,,,both,,,1099.3300,164.9000,AETNA,AETNA,469.41,,,,,,,283.7400,1099.3300,percent of total billed charges,"42.7% of $1,099.33 in Billed Charges for Rev 272 = $469.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL 5CM,272,RC,,,,,,,,both,,,1099.3300,164.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,769.53,,,,,,,283.7400,1099.3300,percent of total billed charges,"Rev 272 $1,099.33 in Billed Charges at 70% = $769.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL 5CM,272,RC,,,,,,,,both,,,1099.3300,164.9000,CIGNA HEALTHCARE,CIGNA HMO,458.42,,,,,,,283.7400,1099.3300,percent of total billed charges,"41.7% of $1,099.33 in Billed Charges for Rev 272 = $458.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL 5CM,272,RC,,,,,,,,both,,,1099.3300,164.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,510.09,,,,,,,283.7400,1099.3300,percent of total billed charges,"46.4% of $1,099.33 in Billed Charges for Rev 272 = $510.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL 5CM,272,RC,,,,,,,,both,,,1099.3300,164.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,458.42,,,,,,,283.7400,1099.3300,percent of total billed charges,"41.7% of $1,099.33 in Billed Charges for Rev 272 = $458.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL 5CM,272,RC,,,,,,,,both,,,1099.3300,164.9000,CIGNA HEALTHCARE,CIGNA PPO,458.42,,,,,,,283.7400,1099.3300,percent of total billed charges,"41.7% of $1,099.33 in Billed Charges for Rev 272 = $458.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL 5CM,272,RC,,,,,,,,both,,,1099.3300,164.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,989.40,,,,,,,283.7400,1099.3300,percent of total billed charges,"90% of $1,099.33 in Billed Charges for Rev 272 = $989.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL 5CM,272,RC,,,,,,,,both,,,1099.3300,164.9000,MEDCOST,MEDCOST VHN,523.17,,,,,,,283.7400,1099.3300,percent of total billed charges,"47.59% of $1,099.33 in Billed Charges for Rev 272 = $523.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL 5CM,272,RC,,,,,,,,both,,,1099.3300,164.9000,SENTARA HEALTH,SENTARA HEALTH,283.74,,,,,,,283.7400,1099.3300,percent of total billed charges,"25.81% of $1,099.33 in Billed Charges for Rev 272 = $283.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL 5CM,272,RC,,,,,,,,both,,,1099.3300,164.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1099.33,,,,,,,283.7400,1099.3300,percent of total billed charges,"100% of $1,099.33 in Billed Charges for Rev 272 = $1,099.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL 5CM,272,RC,,,,,,,,both,,,1099.3300,164.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,549.67,,,,,,,283.7400,1099.3300,percent of total billed charges,"Rev 272 $1,099.33 in Billed Charges at 50% = $549.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL 5CM,272,RC,,,,,,,,both,,,1099.3300,164.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,355.08,,,,,,,283.7400,1099.3300,other,"32.3% of $1,099.33 in Billed Charges for Rev 272 = $355.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NASAL SEPTAL 5CM,272,RC,,,,,,,,both,,,1099.3300,164.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,337.49,,,,,,,283.7400,1099.3300,other,"30.7% of $1,099.33 in Billed Charges for Rev 272 = $337.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NASAL SEPTAL 5CM,272,RC,,,,,,,,both,,,1099.3300,164.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,355.08,,,,,,,283.7400,1099.3300,percent of total billed charges,"32.3% of $1,099.33 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL 5CM,272,RC,,,,,,,,both,,,1099.3300,164.9000,WELLCARE,WELLCARE MEDICAID,1099.33,,,,,,,283.7400,1099.3300,percent of total billed charges,"100% of $1,099.33 in Billed Charges for Rev 272 = $1,099.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE 18GA ACCESS 700-123,272,RC,,,,,,,,both,,,539.2900,80.8900,AETNA,AETNA,230.28,,,,,,,139.1900,539.2900,percent of total billed charges,42.7% of $539.29 in Billed Charges for Rev 272 = $230.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE 18GA ACCESS 700-123,272,RC,,,,,,,,both,,,539.2900,80.8900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,377.50,,,,,,,139.1900,539.2900,percent of total billed charges,Rev 272 $539.29 in Billed Charges at 70% = $377.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE 18GA ACCESS 700-123,272,RC,,,,,,,,both,,,539.2900,80.8900,CIGNA HEALTHCARE,CIGNA HMO,224.88,,,,,,,139.1900,539.2900,percent of total billed charges,41.7% of $539.29 in Billed Charges for Rev 272 = $224.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE 18GA ACCESS 700-123,272,RC,,,,,,,,both,,,539.2900,80.8900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,250.23,,,,,,,139.1900,539.2900,percent of total billed charges,46.4% of $539.29 in Billed Charges for Rev 272 = $250.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE 18GA ACCESS 700-123,272,RC,,,,,,,,both,,,539.2900,80.8900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,224.88,,,,,,,139.1900,539.2900,percent of total billed charges,41.7% of $539.29 in Billed Charges for Rev 272 = $224.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE 18GA ACCESS 700-123,272,RC,,,,,,,,both,,,539.2900,80.8900,CIGNA HEALTHCARE,CIGNA PPO,224.88,,,,,,,139.1900,539.2900,percent of total billed charges,41.7% of $539.29 in Billed Charges for Rev 272 = $224.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE 18GA ACCESS 700-123,272,RC,,,,,,,,both,,,539.2900,80.8900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,485.36,,,,,,,139.1900,539.2900,percent of total billed charges,90% of $539.29 in Billed Charges for Rev 272 = $485.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE 18GA ACCESS 700-123,272,RC,,,,,,,,both,,,539.2900,80.8900,MEDCOST,MEDCOST VHN,256.65,,,,,,,139.1900,539.2900,percent of total billed charges,47.59% of $539.29 in Billed Charges for Rev 272 = $256.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE 18GA ACCESS 700-123,272,RC,,,,,,,,both,,,539.2900,80.8900,SENTARA HEALTH,SENTARA HEALTH,139.19,,,,,,,139.1900,539.2900,percent of total billed charges,25.81% of $539.29 in Billed Charges for Rev 272 = $139.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE 18GA ACCESS 700-123,272,RC,,,,,,,,both,,,539.2900,80.8900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",539.29,,,,,,,139.1900,539.2900,percent of total billed charges,100% of $539.29 in Billed Charges for Rev 272 = $539.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE 18GA ACCESS 700-123,272,RC,,,,,,,,both,,,539.2900,80.8900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,269.65,,,,,,,139.1900,539.2900,percent of total billed charges,Rev 272 $539.29 in Billed Charges at 50% = $269.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE 18GA ACCESS 700-123,272,RC,,,,,,,,both,,,539.2900,80.8900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,174.19,,,,,,,139.1900,539.2900,other,32.3% of $539.29 in Billed Charges for Rev 272 = $174.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE 18GA ACCESS 700-123,272,RC,,,,,,,,both,,,539.2900,80.8900,UNITED HEALTHCARE,UHC HERITAGE SELECT,165.56,,,,,,,139.1900,539.2900,other,30.7% of $539.29 in Billed Charges for Rev 272 = $165.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE 18GA ACCESS 700-123,272,RC,,,,,,,,both,,,539.2900,80.8900,UNITED HEALTHCARE,UNITED HEALTHCARE,174.19,,,,,,,139.1900,539.2900,percent of total billed charges,32.3% of $539.29 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE 18GA ACCESS 700-123,272,RC,,,,,,,,both,,,539.2900,80.8900,WELLCARE,WELLCARE MEDICAID,539.29,,,,,,,139.1900,539.2900,percent of total billed charges,100% of $539.29 in Billed Charges for Rev 272 = $539.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-1.2/TUBE FEEDING 14FR ENFIT,272,RC,27202189,CDM,,,,,,both,,,895.0000,134.2500,AETNA,AETNA,382.17,,,,,,,231.0000,895.0000,percent of total billed charges,42.7% of $895.00 in Billed Charges for Rev 272 = $382.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-1.2/TUBE FEEDING 14FR ENFIT,272,RC,27202189,CDM,,,,,,both,,,895.0000,134.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,626.50,,,,,,,231.0000,895.0000,percent of total billed charges,Rev 272 $895.00 in Billed Charges at 70% = $626.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-1.2/TUBE FEEDING 14FR ENFIT,272,RC,27202189,CDM,,,,,,both,,,895.0000,134.2500,CIGNA HEALTHCARE,CIGNA HMO,373.22,,,,,,,231.0000,895.0000,percent of total billed charges,41.7% of $895.00 in Billed Charges for Rev 272 = $373.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-1.2/TUBE FEEDING 14FR ENFIT,272,RC,27202189,CDM,,,,,,both,,,895.0000,134.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,415.28,,,,,,,231.0000,895.0000,percent of total billed charges,46.4% of $895.00 in Billed Charges for Rev 272 = $415.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-1.2/TUBE FEEDING 14FR ENFIT,272,RC,27202189,CDM,,,,,,both,,,895.0000,134.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,373.22,,,,,,,231.0000,895.0000,percent of total billed charges,41.7% of $895.00 in Billed Charges for Rev 272 = $373.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-1.2/TUBE FEEDING 14FR ENFIT,272,RC,27202189,CDM,,,,,,both,,,895.0000,134.2500,CIGNA HEALTHCARE,CIGNA PPO,373.22,,,,,,,231.0000,895.0000,percent of total billed charges,41.7% of $895.00 in Billed Charges for Rev 272 = $373.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-1.2/TUBE FEEDING 14FR ENFIT,272,RC,27202189,CDM,,,,,,both,,,895.0000,134.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,805.50,,,,,,,231.0000,895.0000,percent of total billed charges,90% of $895.00 in Billed Charges for Rev 272 = $805.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-1.2/TUBE FEEDING 14FR ENFIT,272,RC,27202189,CDM,,,,,,both,,,895.0000,134.2500,MEDCOST,MEDCOST VHN,425.93,,,,,,,231.0000,895.0000,percent of total billed charges,47.59% of $895.00 in Billed Charges for Rev 272 = $425.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-1.2/TUBE FEEDING 14FR ENFIT,272,RC,27202189,CDM,,,,,,both,,,895.0000,134.2500,SENTARA HEALTH,SENTARA HEALTH,231.00,,,,,,,231.0000,895.0000,percent of total billed charges,25.81% of $895.00 in Billed Charges for Rev 272 = $231.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-1.2/TUBE FEEDING 14FR ENFIT,272,RC,27202189,CDM,,,,,,both,,,895.0000,134.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",895.00,,,,,,,231.0000,895.0000,percent of total billed charges,100% of $895.00 in Billed Charges for Rev 272 = $895.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-1.2/TUBE FEEDING 14FR ENFIT,272,RC,27202189,CDM,,,,,,both,,,895.0000,134.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,447.50,,,,,,,231.0000,895.0000,percent of total billed charges,Rev 272 $895.00 in Billed Charges at 50% = $447.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-1.2/TUBE FEEDING 14FR ENFIT,272,RC,27202189,CDM,,,,,,both,,,895.0000,134.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.09,,,,,,,231.0000,895.0000,other,32.3% of $895.00 in Billed Charges for Rev 272 = $289.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIT MIC KEY 14-1.2/TUBE FEEDING 14FR ENFIT,272,RC,27202189,CDM,,,,,,both,,,895.0000,134.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,274.77,,,,,,,231.0000,895.0000,other,30.7% of $895.00 in Billed Charges for Rev 272 = $274.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIT MIC KEY 14-1.2/TUBE FEEDING 14FR ENFIT,272,RC,27202189,CDM,,,,,,both,,,895.0000,134.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,289.09,,,,,,,231.0000,895.0000,percent of total billed charges,32.3% of $895.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT MIC KEY 14-1.2/TUBE FEEDING 14FR ENFIT,272,RC,27202189,CDM,,,,,,both,,,895.0000,134.2500,WELLCARE,WELLCARE MEDICAID,895.00,,,,,,,231.0000,895.0000,percent of total billed charges,100% of $895.00 in Billed Charges for Rev 272 = $895.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT PREVENA PLUS INCISION MGMT,272,RC,27202260,CDM,,,,,,both,,,6106.0000,915.9000,AETNA,AETNA,2607.26,,,,,,,1575.9600,6106.0000,percent of total billed charges,"42.7% of $6,106.00 in Billed Charges for Rev 272 = $2,607.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA PLUS INCISION MGMT,272,RC,27202260,CDM,,,,,,both,,,6106.0000,915.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4274.20,,,,,,,1575.9600,6106.0000,percent of total billed charges,"Rev 272 $6,106.00 in Billed Charges at 70% = $4,274.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA PLUS INCISION MGMT,272,RC,27202260,CDM,,,,,,both,,,6106.0000,915.9000,CIGNA HEALTHCARE,CIGNA HMO,2546.20,,,,,,,1575.9600,6106.0000,percent of total billed charges,"41.7% of $6,106.00 in Billed Charges for Rev 272 = $2,546.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA PLUS INCISION MGMT,272,RC,27202260,CDM,,,,,,both,,,6106.0000,915.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2833.18,,,,,,,1575.9600,6106.0000,percent of total billed charges,"46.4% of $6,106.00 in Billed Charges for Rev 272 = $2,833.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA PLUS INCISION MGMT,272,RC,27202260,CDM,,,,,,both,,,6106.0000,915.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2546.20,,,,,,,1575.9600,6106.0000,percent of total billed charges,"41.7% of $6,106.00 in Billed Charges for Rev 272 = $2,546.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA PLUS INCISION MGMT,272,RC,27202260,CDM,,,,,,both,,,6106.0000,915.9000,CIGNA HEALTHCARE,CIGNA PPO,2546.20,,,,,,,1575.9600,6106.0000,percent of total billed charges,"41.7% of $6,106.00 in Billed Charges for Rev 272 = $2,546.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA PLUS INCISION MGMT,272,RC,27202260,CDM,,,,,,both,,,6106.0000,915.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5495.40,,,,,,,1575.9600,6106.0000,percent of total billed charges,"90% of $6,106.00 in Billed Charges for Rev 272 = $5,495.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA PLUS INCISION MGMT,272,RC,27202260,CDM,,,,,,both,,,6106.0000,915.9000,MEDCOST,MEDCOST VHN,2905.85,,,,,,,1575.9600,6106.0000,percent of total billed charges,"47.59% of $6,106.00 in Billed Charges for Rev 272 = $2,905.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA PLUS INCISION MGMT,272,RC,27202260,CDM,,,,,,both,,,6106.0000,915.9000,SENTARA HEALTH,SENTARA HEALTH,1575.96,,,,,,,1575.9600,6106.0000,percent of total billed charges,"25.81% of $6,106.00 in Billed Charges for Rev 272 = $1,575.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA PLUS INCISION MGMT,272,RC,27202260,CDM,,,,,,both,,,6106.0000,915.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6106.00,,,,,,,1575.9600,6106.0000,percent of total billed charges,"100% of $6,106.00 in Billed Charges for Rev 272 = $6,106.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA PLUS INCISION MGMT,272,RC,27202260,CDM,,,,,,both,,,6106.0000,915.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3053.00,,,,,,,1575.9600,6106.0000,percent of total billed charges,"Rev 272 $6,106.00 in Billed Charges at 50% = $3,053.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA PLUS INCISION MGMT,272,RC,27202260,CDM,,,,,,both,,,6106.0000,915.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1972.24,,,,,,,1575.9600,6106.0000,other,"32.3% of $6,106.00 in Billed Charges for Rev 272 = $1,972.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIT PREVENA PLUS INCISION MGMT,272,RC,27202260,CDM,,,,,,both,,,6106.0000,915.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1874.54,,,,,,,1575.9600,6106.0000,other,"30.7% of $6,106.00 in Billed Charges for Rev 272 = $1,874.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIT PREVENA PLUS INCISION MGMT,272,RC,27202260,CDM,,,,,,both,,,6106.0000,915.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,1972.24,,,,,,,1575.9600,6106.0000,percent of total billed charges,"32.3% of $6,106.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT PREVENA PLUS INCISION MGMT,272,RC,27202260,CDM,,,,,,both,,,6106.0000,915.9000,WELLCARE,WELLCARE MEDICAID,6106.00,,,,,,,1575.9600,6106.0000,percent of total billed charges,"100% of $6,106.00 in Billed Charges for Rev 272 = $6,106.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE 25GX35CM INJETAK CYSTOS,272,RC,27200002,CDM,,,,,,both,,,720.7800,108.1200,AETNA,AETNA,307.77,,,,,,,186.0300,720.7800,percent of total billed charges,42.7% of $720.78 in Billed Charges for Rev 272 = $307.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE 25GX35CM INJETAK CYSTOS,272,RC,27200002,CDM,,,,,,both,,,720.7800,108.1200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,504.55,,,,,,,186.0300,720.7800,percent of total billed charges,Rev 272 $720.78 in Billed Charges at 70% = $504.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE 25GX35CM INJETAK CYSTOS,272,RC,27200002,CDM,,,,,,both,,,720.7800,108.1200,CIGNA HEALTHCARE,CIGNA HMO,300.57,,,,,,,186.0300,720.7800,percent of total billed charges,41.7% of $720.78 in Billed Charges for Rev 272 = $300.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE 25GX35CM INJETAK CYSTOS,272,RC,27200002,CDM,,,,,,both,,,720.7800,108.1200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,334.44,,,,,,,186.0300,720.7800,percent of total billed charges,46.4% of $720.78 in Billed Charges for Rev 272 = $334.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE 25GX35CM INJETAK CYSTOS,272,RC,27200002,CDM,,,,,,both,,,720.7800,108.1200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,300.57,,,,,,,186.0300,720.7800,percent of total billed charges,41.7% of $720.78 in Billed Charges for Rev 272 = $300.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE 25GX35CM INJETAK CYSTOS,272,RC,27200002,CDM,,,,,,both,,,720.7800,108.1200,CIGNA HEALTHCARE,CIGNA PPO,300.57,,,,,,,186.0300,720.7800,percent of total billed charges,41.7% of $720.78 in Billed Charges for Rev 272 = $300.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE 25GX35CM INJETAK CYSTOS,272,RC,27200002,CDM,,,,,,both,,,720.7800,108.1200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,648.70,,,,,,,186.0300,720.7800,percent of total billed charges,90% of $720.78 in Billed Charges for Rev 272 = $648.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE 25GX35CM INJETAK CYSTOS,272,RC,27200002,CDM,,,,,,both,,,720.7800,108.1200,MEDCOST,MEDCOST VHN,343.02,,,,,,,186.0300,720.7800,percent of total billed charges,47.59% of $720.78 in Billed Charges for Rev 272 = $343.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE 25GX35CM INJETAK CYSTOS,272,RC,27200002,CDM,,,,,,both,,,720.7800,108.1200,SENTARA HEALTH,SENTARA HEALTH,186.03,,,,,,,186.0300,720.7800,percent of total billed charges,25.81% of $720.78 in Billed Charges for Rev 272 = $186.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE 25GX35CM INJETAK CYSTOS,272,RC,27200002,CDM,,,,,,both,,,720.7800,108.1200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",720.78,,,,,,,186.0300,720.7800,percent of total billed charges,100% of $720.78 in Billed Charges for Rev 272 = $720.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE 25GX35CM INJETAK CYSTOS,272,RC,27200002,CDM,,,,,,both,,,720.7800,108.1200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,360.39,,,,,,,186.0300,720.7800,percent of total billed charges,Rev 272 $720.78 in Billed Charges at 50% = $360.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE 25GX35CM INJETAK CYSTOS,272,RC,27200002,CDM,,,,,,both,,,720.7800,108.1200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,232.81,,,,,,,186.0300,720.7800,other,32.3% of $720.78 in Billed Charges for Rev 272 = $232.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE 25GX35CM INJETAK CYSTOS,272,RC,27200002,CDM,,,,,,both,,,720.7800,108.1200,UNITED HEALTHCARE,UHC HERITAGE SELECT,221.28,,,,,,,186.0300,720.7800,other,30.7% of $720.78 in Billed Charges for Rev 272 = $221.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE 25GX35CM INJETAK CYSTOS,272,RC,27200002,CDM,,,,,,both,,,720.7800,108.1200,UNITED HEALTHCARE,UNITED HEALTHCARE,232.81,,,,,,,186.0300,720.7800,percent of total billed charges,32.3% of $720.78 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE 25GX35CM INJETAK CYSTOS,272,RC,27200002,CDM,,,,,,both,,,720.7800,108.1200,WELLCARE,WELLCARE MEDICAID,720.78,,,,,,,186.0300,720.7800,percent of total billed charges,100% of $720.78 in Billed Charges for Rev 272 = $720.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE AQUIRE 19GA,272,RC,,,,,,,,both,,,8614.6700,1292.2000,AETNA,AETNA,3678.46,,,,,,,2223.4500,8614.6700,percent of total billed charges,"42.7% of $8,614.67 in Billed Charges for Rev 272 = $3,678.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE AQUIRE 19GA,272,RC,,,,,,,,both,,,8614.6700,1292.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6030.27,,,,,,,2223.4500,8614.6700,percent of total billed charges,"Rev 272 $8,614.67 in Billed Charges at 70% = $6,030.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE AQUIRE 19GA,272,RC,,,,,,,,both,,,8614.6700,1292.2000,CIGNA HEALTHCARE,CIGNA HMO,3592.32,,,,,,,2223.4500,8614.6700,percent of total billed charges,"41.7% of $8,614.67 in Billed Charges for Rev 272 = $3,592.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE AQUIRE 19GA,272,RC,,,,,,,,both,,,8614.6700,1292.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3997.21,,,,,,,2223.4500,8614.6700,percent of total billed charges,"46.4% of $8,614.67 in Billed Charges for Rev 272 = $3,997.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE AQUIRE 19GA,272,RC,,,,,,,,both,,,8614.6700,1292.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3592.32,,,,,,,2223.4500,8614.6700,percent of total billed charges,"41.7% of $8,614.67 in Billed Charges for Rev 272 = $3,592.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE AQUIRE 19GA,272,RC,,,,,,,,both,,,8614.6700,1292.2000,CIGNA HEALTHCARE,CIGNA PPO,3592.32,,,,,,,2223.4500,8614.6700,percent of total billed charges,"41.7% of $8,614.67 in Billed Charges for Rev 272 = $3,592.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE AQUIRE 19GA,272,RC,,,,,,,,both,,,8614.6700,1292.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7753.20,,,,,,,2223.4500,8614.6700,percent of total billed charges,"90% of $8,614.67 in Billed Charges for Rev 272 = $7,753.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE AQUIRE 19GA,272,RC,,,,,,,,both,,,8614.6700,1292.2000,MEDCOST,MEDCOST VHN,4099.72,,,,,,,2223.4500,8614.6700,percent of total billed charges,"47.59% of $8,614.67 in Billed Charges for Rev 272 = $4,099.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE AQUIRE 19GA,272,RC,,,,,,,,both,,,8614.6700,1292.2000,SENTARA HEALTH,SENTARA HEALTH,2223.45,,,,,,,2223.4500,8614.6700,percent of total billed charges,"25.81% of $8,614.67 in Billed Charges for Rev 272 = $2,223.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE AQUIRE 19GA,272,RC,,,,,,,,both,,,8614.6700,1292.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8614.67,,,,,,,2223.4500,8614.6700,percent of total billed charges,"100% of $8,614.67 in Billed Charges for Rev 272 = $8,614.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE AQUIRE 19GA,272,RC,,,,,,,,both,,,8614.6700,1292.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4307.34,,,,,,,2223.4500,8614.6700,percent of total billed charges,"Rev 272 $8,614.67 in Billed Charges at 50% = $4,307.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE AQUIRE 19GA,272,RC,,,,,,,,both,,,8614.6700,1292.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2782.54,,,,,,,2223.4500,8614.6700,other,"32.3% of $8,614.67 in Billed Charges for Rev 272 = $2,782.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE AQUIRE 19GA,272,RC,,,,,,,,both,,,8614.6700,1292.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2644.70,,,,,,,2223.4500,8614.6700,other,"30.7% of $8,614.67 in Billed Charges for Rev 272 = $2,644.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE AQUIRE 19GA,272,RC,,,,,,,,both,,,8614.6700,1292.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,2782.54,,,,,,,2223.4500,8614.6700,percent of total billed charges,"32.3% of $8,614.67 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE AQUIRE 19GA,272,RC,,,,,,,,both,,,8614.6700,1292.2000,WELLCARE,WELLCARE MEDICAID,8614.67,,,,,,,2223.4500,8614.6700,percent of total billed charges,"100% of $8,614.67 in Billed Charges for Rev 272 = $8,614.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ARCUS STIMULATING TARGETING BEVEL TIP STER,272,RC,27200002,CDM,,,,,,both,,,6352.2400,952.8400,AETNA,AETNA,2712.41,,,,,,,1639.5100,6352.2400,percent of total billed charges,"42.7% of $6,352.24 in Billed Charges for Rev 272 = $2,712.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ARCUS STIMULATING TARGETING BEVEL TIP STER,272,RC,27200002,CDM,,,,,,both,,,6352.2400,952.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4446.57,,,,,,,1639.5100,6352.2400,percent of total billed charges,"Rev 272 $6,352.24 in Billed Charges at 70% = $4,446.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ARCUS STIMULATING TARGETING BEVEL TIP STER,272,RC,27200002,CDM,,,,,,both,,,6352.2400,952.8400,CIGNA HEALTHCARE,CIGNA HMO,2648.88,,,,,,,1639.5100,6352.2400,percent of total billed charges,"41.7% of $6,352.24 in Billed Charges for Rev 272 = $2,648.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ARCUS STIMULATING TARGETING BEVEL TIP STER,272,RC,27200002,CDM,,,,,,both,,,6352.2400,952.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2947.44,,,,,,,1639.5100,6352.2400,percent of total billed charges,"46.4% of $6,352.24 in Billed Charges for Rev 272 = $2,947.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ARCUS STIMULATING TARGETING BEVEL TIP STER,272,RC,27200002,CDM,,,,,,both,,,6352.2400,952.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2648.88,,,,,,,1639.5100,6352.2400,percent of total billed charges,"41.7% of $6,352.24 in Billed Charges for Rev 272 = $2,648.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ARCUS STIMULATING TARGETING BEVEL TIP STER,272,RC,27200002,CDM,,,,,,both,,,6352.2400,952.8400,CIGNA HEALTHCARE,CIGNA PPO,2648.88,,,,,,,1639.5100,6352.2400,percent of total billed charges,"41.7% of $6,352.24 in Billed Charges for Rev 272 = $2,648.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ARCUS STIMULATING TARGETING BEVEL TIP STER,272,RC,27200002,CDM,,,,,,both,,,6352.2400,952.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5717.02,,,,,,,1639.5100,6352.2400,percent of total billed charges,"90% of $6,352.24 in Billed Charges for Rev 272 = $5,717.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ARCUS STIMULATING TARGETING BEVEL TIP STER,272,RC,27200002,CDM,,,,,,both,,,6352.2400,952.8400,MEDCOST,MEDCOST VHN,3023.03,,,,,,,1639.5100,6352.2400,percent of total billed charges,"47.59% of $6,352.24 in Billed Charges for Rev 272 = $3,023.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ARCUS STIMULATING TARGETING BEVEL TIP STER,272,RC,27200002,CDM,,,,,,both,,,6352.2400,952.8400,SENTARA HEALTH,SENTARA HEALTH,1639.51,,,,,,,1639.5100,6352.2400,percent of total billed charges,"25.81% of $6,352.24 in Billed Charges for Rev 272 = $1,639.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ARCUS STIMULATING TARGETING BEVEL TIP STER,272,RC,27200002,CDM,,,,,,both,,,6352.2400,952.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6352.24,,,,,,,1639.5100,6352.2400,percent of total billed charges,"100% of $6,352.24 in Billed Charges for Rev 272 = $6,352.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ARCUS STIMULATING TARGETING BEVEL TIP STER,272,RC,27200002,CDM,,,,,,both,,,6352.2400,952.8400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3176.12,,,,,,,1639.5100,6352.2400,percent of total billed charges,"Rev 272 $6,352.24 in Billed Charges at 50% = $3,176.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ARCUS STIMULATING TARGETING BEVEL TIP STER,272,RC,27200002,CDM,,,,,,both,,,6352.2400,952.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2051.77,,,,,,,1639.5100,6352.2400,other,"32.3% of $6,352.24 in Billed Charges for Rev 272 = $2,051.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE ARCUS STIMULATING TARGETING BEVEL TIP STER,272,RC,27200002,CDM,,,,,,both,,,6352.2400,952.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1950.14,,,,,,,1639.5100,6352.2400,other,"30.7% of $6,352.24 in Billed Charges for Rev 272 = $1,950.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE ARCUS STIMULATING TARGETING BEVEL TIP STER,272,RC,27200002,CDM,,,,,,both,,,6352.2400,952.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,2051.77,,,,,,,1639.5100,6352.2400,percent of total billed charges,"32.3% of $6,352.24 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ARCUS STIMULATING TARGETING BEVEL TIP STER,272,RC,27200002,CDM,,,,,,both,,,6352.2400,952.8400,WELLCARE,WELLCARE MEDICAID,6352.24,,,,,,,1639.5100,6352.2400,percent of total billed charges,"100% of $6,352.24 in Billed Charges for Rev 272 = $6,352.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT SUCT CATH&GLV 14FR 22 INCHES,270,RC,27000033,CDM,,,,,,both,,,9.0000,1.3500,AETNA,AETNA,3.84,,,,,,,2.3200,9.0000,percent of total billed charges,42.7% of $9.00 in Billed Charges for Rev 270 = $3.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT SUCT CATH&GLV 14FR 22 INCHES,270,RC,27000033,CDM,,,,,,both,,,9.0000,1.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6.30,,,,,,,2.3200,9.0000,percent of total billed charges,Rev 270 $9.00 in Billed Charges at 70% = $6.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT SUCT CATH&GLV 14FR 22 INCHES,270,RC,27000033,CDM,,,,,,both,,,9.0000,1.3500,CIGNA HEALTHCARE,CIGNA HMO,3.75,,,,,,,2.3200,9.0000,percent of total billed charges,41.7% of $9.00 in Billed Charges for Rev 270 = $3.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT SUCT CATH&GLV 14FR 22 INCHES,270,RC,27000033,CDM,,,,,,both,,,9.0000,1.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4.18,,,,,,,2.3200,9.0000,percent of total billed charges,46.4% of $9.00 in Billed Charges for Rev 270 = $4.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT SUCT CATH&GLV 14FR 22 INCHES,270,RC,27000033,CDM,,,,,,both,,,9.0000,1.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3.75,,,,,,,2.3200,9.0000,percent of total billed charges,41.7% of $9.00 in Billed Charges for Rev 270 = $3.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT SUCT CATH&GLV 14FR 22 INCHES,270,RC,27000033,CDM,,,,,,both,,,9.0000,1.3500,CIGNA HEALTHCARE,CIGNA PPO,3.75,,,,,,,2.3200,9.0000,percent of total billed charges,41.7% of $9.00 in Billed Charges for Rev 270 = $3.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT SUCT CATH&GLV 14FR 22 INCHES,270,RC,27000033,CDM,,,,,,both,,,9.0000,1.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8.10,,,,,,,2.3200,9.0000,percent of total billed charges,90% of $9.00 in Billed Charges for Rev 270 = $8.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT SUCT CATH&GLV 14FR 22 INCHES,270,RC,27000033,CDM,,,,,,both,,,9.0000,1.3500,MEDCOST,MEDCOST VHN,4.28,,,,,,,2.3200,9.0000,percent of total billed charges,47.59% of $9.00 in Billed Charges for Rev 270 = $4.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT SUCT CATH&GLV 14FR 22 INCHES,270,RC,27000033,CDM,,,,,,both,,,9.0000,1.3500,SENTARA HEALTH,SENTARA HEALTH,2.32,,,,,,,2.3200,9.0000,percent of total billed charges,25.81% of $9.00 in Billed Charges for Rev 270 = $2.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT SUCT CATH&GLV 14FR 22 INCHES,270,RC,27000033,CDM,,,,,,both,,,9.0000,1.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9.00,,,,,,,2.3200,9.0000,percent of total billed charges,100% of $9.00 in Billed Charges for Rev 270 = $9.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT SUCT CATH&GLV 14FR 22 INCHES,270,RC,27000033,CDM,,,,,,both,,,9.0000,1.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4.50,,,,,,,2.3200,9.0000,percent of total billed charges,Rev 270 $9.00 in Billed Charges at 50% = $4.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT SUCT CATH&GLV 14FR 22 INCHES,270,RC,27000033,CDM,,,,,,both,,,9.0000,1.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2.91,,,,,,,2.3200,9.0000,other,32.3% of $9.00 in Billed Charges for Rev 270 = $2.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIT SUCT CATH&GLV 14FR 22 INCHES,270,RC,27000033,CDM,,,,,,both,,,9.0000,1.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2.76,,,,,,,2.3200,9.0000,other,30.7% of $9.00 in Billed Charges for Rev 270 = $2.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIT SUCT CATH&GLV 14FR 22 INCHES,270,RC,27000033,CDM,,,,,,both,,,9.0000,1.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,2.91,,,,,,,2.3200,9.0000,percent of total billed charges,32.3% of $9.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT SUCT CATH&GLV 14FR 22 INCHES,270,RC,27000033,CDM,,,,,,both,,,9.0000,1.3500,WELLCARE,WELLCARE MEDICAID,9.00,,,,,,,2.3200,9.0000,percent of total billed charges,100% of $9.00 in Billed Charges for Rev 270 = $9.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT VASCULAR ACCESS,272,RC,27202215,CDM,,,,,,both,,,6615.0000,992.2500,AETNA,AETNA,2824.61,,,,,,,1707.3300,6615.0000,percent of total billed charges,"42.7% of $6,615.00 in Billed Charges for Rev 272 = $2,824.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VASCULAR ACCESS,272,RC,27202215,CDM,,,,,,both,,,6615.0000,992.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4630.50,,,,,,,1707.3300,6615.0000,percent of total billed charges,"Rev 272 $6,615.00 in Billed Charges at 70% = $4,630.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VASCULAR ACCESS,272,RC,27202215,CDM,,,,,,both,,,6615.0000,992.2500,CIGNA HEALTHCARE,CIGNA HMO,2758.46,,,,,,,1707.3300,6615.0000,percent of total billed charges,"41.7% of $6,615.00 in Billed Charges for Rev 272 = $2,758.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VASCULAR ACCESS,272,RC,27202215,CDM,,,,,,both,,,6615.0000,992.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3069.36,,,,,,,1707.3300,6615.0000,percent of total billed charges,"46.4% of $6,615.00 in Billed Charges for Rev 272 = $3,069.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VASCULAR ACCESS,272,RC,27202215,CDM,,,,,,both,,,6615.0000,992.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2758.46,,,,,,,1707.3300,6615.0000,percent of total billed charges,"41.7% of $6,615.00 in Billed Charges for Rev 272 = $2,758.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VASCULAR ACCESS,272,RC,27202215,CDM,,,,,,both,,,6615.0000,992.2500,CIGNA HEALTHCARE,CIGNA PPO,2758.46,,,,,,,1707.3300,6615.0000,percent of total billed charges,"41.7% of $6,615.00 in Billed Charges for Rev 272 = $2,758.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VASCULAR ACCESS,272,RC,27202215,CDM,,,,,,both,,,6615.0000,992.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5953.50,,,,,,,1707.3300,6615.0000,percent of total billed charges,"90% of $6,615.00 in Billed Charges for Rev 272 = $5,953.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VASCULAR ACCESS,272,RC,27202215,CDM,,,,,,both,,,6615.0000,992.2500,MEDCOST,MEDCOST VHN,3148.08,,,,,,,1707.3300,6615.0000,percent of total billed charges,"47.59% of $6,615.00 in Billed Charges for Rev 272 = $3,148.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VASCULAR ACCESS,272,RC,27202215,CDM,,,,,,both,,,6615.0000,992.2500,SENTARA HEALTH,SENTARA HEALTH,1707.33,,,,,,,1707.3300,6615.0000,percent of total billed charges,"25.81% of $6,615.00 in Billed Charges for Rev 272 = $1,707.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VASCULAR ACCESS,272,RC,27202215,CDM,,,,,,both,,,6615.0000,992.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6615.00,,,,,,,1707.3300,6615.0000,percent of total billed charges,"100% of $6,615.00 in Billed Charges for Rev 272 = $6,615.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VASCULAR ACCESS,272,RC,27202215,CDM,,,,,,both,,,6615.0000,992.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3307.50,,,,,,,1707.3300,6615.0000,percent of total billed charges,"Rev 272 $6,615.00 in Billed Charges at 50% = $3,307.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VASCULAR ACCESS,272,RC,27202215,CDM,,,,,,both,,,6615.0000,992.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2136.65,,,,,,,1707.3300,6615.0000,other,"32.3% of $6,615.00 in Billed Charges for Rev 272 = $2,136.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIT VASCULAR ACCESS,272,RC,27202215,CDM,,,,,,both,,,6615.0000,992.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2030.81,,,,,,,1707.3300,6615.0000,other,"30.7% of $6,615.00 in Billed Charges for Rev 272 = $2,030.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIT VASCULAR ACCESS,272,RC,27202215,CDM,,,,,,both,,,6615.0000,992.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,2136.65,,,,,,,1707.3300,6615.0000,percent of total billed charges,"32.3% of $6,615.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VASCULAR ACCESS,272,RC,27202215,CDM,,,,,,both,,,6615.0000,992.2500,WELLCARE,WELLCARE MEDICAID,6615.00,,,,,,,1707.3300,6615.0000,percent of total billed charges,"100% of $6,615.00 in Billed Charges for Rev 272 = $6,615.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VENTRICULOSTOMY,270,RC,27000099,CDM,,,,,,both,,,1005.0000,150.7500,AETNA,AETNA,429.14,,,,,,,259.3900,1005.0000,percent of total billed charges,"42.7% of $1,005.00 in Billed Charges for Rev 270 = $429.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VENTRICULOSTOMY,270,RC,27000099,CDM,,,,,,both,,,1005.0000,150.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,703.50,,,,,,,259.3900,1005.0000,percent of total billed charges,"Rev 270 $1,005.00 in Billed Charges at 70% = $703.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VENTRICULOSTOMY,270,RC,27000099,CDM,,,,,,both,,,1005.0000,150.7500,CIGNA HEALTHCARE,CIGNA HMO,419.09,,,,,,,259.3900,1005.0000,percent of total billed charges,"41.7% of $1,005.00 in Billed Charges for Rev 270 = $419.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VENTRICULOSTOMY,270,RC,27000099,CDM,,,,,,both,,,1005.0000,150.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,466.32,,,,,,,259.3900,1005.0000,percent of total billed charges,"46.4% of $1,005.00 in Billed Charges for Rev 270 = $466.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VENTRICULOSTOMY,270,RC,27000099,CDM,,,,,,both,,,1005.0000,150.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,419.09,,,,,,,259.3900,1005.0000,percent of total billed charges,"41.7% of $1,005.00 in Billed Charges for Rev 270 = $419.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VENTRICULOSTOMY,270,RC,27000099,CDM,,,,,,both,,,1005.0000,150.7500,CIGNA HEALTHCARE,CIGNA PPO,419.09,,,,,,,259.3900,1005.0000,percent of total billed charges,"41.7% of $1,005.00 in Billed Charges for Rev 270 = $419.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VENTRICULOSTOMY,270,RC,27000099,CDM,,,,,,both,,,1005.0000,150.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,904.50,,,,,,,259.3900,1005.0000,percent of total billed charges,"90% of $1,005.00 in Billed Charges for Rev 270 = $904.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VENTRICULOSTOMY,270,RC,27000099,CDM,,,,,,both,,,1005.0000,150.7500,MEDCOST,MEDCOST VHN,478.28,,,,,,,259.3900,1005.0000,percent of total billed charges,"47.59% of $1,005.00 in Billed Charges for Rev 270 = $478.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VENTRICULOSTOMY,270,RC,27000099,CDM,,,,,,both,,,1005.0000,150.7500,SENTARA HEALTH,SENTARA HEALTH,259.39,,,,,,,259.3900,1005.0000,percent of total billed charges,"25.81% of $1,005.00 in Billed Charges for Rev 270 = $259.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VENTRICULOSTOMY,270,RC,27000099,CDM,,,,,,both,,,1005.0000,150.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1005.00,,,,,,,259.3900,1005.0000,percent of total billed charges,"100% of $1,005.00 in Billed Charges for Rev 270 = $1,005.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VENTRICULOSTOMY,270,RC,27000099,CDM,,,,,,both,,,1005.0000,150.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,502.50,,,,,,,259.3900,1005.0000,percent of total billed charges,"Rev 270 $1,005.00 in Billed Charges at 50% = $502.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VENTRICULOSTOMY,270,RC,27000099,CDM,,,,,,both,,,1005.0000,150.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,324.62,,,,,,,259.3900,1005.0000,other,"32.3% of $1,005.00 in Billed Charges for Rev 270 = $324.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIT VENTRICULOSTOMY,270,RC,27000099,CDM,,,,,,both,,,1005.0000,150.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,308.54,,,,,,,259.3900,1005.0000,other,"30.7% of $1,005.00 in Billed Charges for Rev 270 = $308.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIT VENTRICULOSTOMY,270,RC,27000099,CDM,,,,,,both,,,1005.0000,150.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,324.62,,,,,,,259.3900,1005.0000,percent of total billed charges,"32.3% of $1,005.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT VENTRICULOSTOMY,270,RC,27000099,CDM,,,,,,both,,,1005.0000,150.7500,WELLCARE,WELLCARE MEDICAID,1005.00,,,,,,,259.3900,1005.0000,percent of total billed charges,"100% of $1,005.00 in Billed Charges for Rev 270 = $1,005.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LABOR SERVICE,724,RC,72400001,CDM,,,,,,both,,,3308.0000,496.2000,AETNA,AETNA,1412.52,,,,,,,46.0000,3308.0000,percent of total billed charges,"42.7% of $3,308.00 in Billed Charges for Rev 724 = $1,412.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LABOR SERVICE,724,RC,72400001,CDM,,,,,,both,,,3308.0000,496.2000,BLUE CROSS,ANTHEM EXCHANGE,545.82,,,,,,,46.0000,3308.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LABOR SERVICE,724,RC,72400001,CDM,,,,,,both,,,3308.0000,496.2000,BLUE CROSS,ANTHEM HMO,545.82,,,,,,,46.0000,3308.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LABOR SERVICE,724,RC,72400001,CDM,,,,,,both,,,3308.0000,496.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",545.82,,,,,,,46.0000,3308.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LABOR SERVICE,724,RC,72400001,CDM,,,,,,both,,,3308.0000,496.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2315.60,,,,,,,46.0000,3308.0000,percent of total billed charges,"Rev 724 $3,308.00 in Billed Charges at 70% = $2,315.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LABOR SERVICE,724,RC,72400001,CDM,,,,,,both,,,3308.0000,496.2000,BLUE CROSS,BLUE CROSS E NETWORK,46.00,,,,,,,46.0000,3308.0000,other,Rev 724 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LABOR SERVICE,724,RC,72400001,CDM,,,,,,both,,,3308.0000,496.2000,BLUE CROSS,BLUE CROSS P NETWORK,46.00,,,,,,,46.0000,3308.0000,other,Rev 724 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LABOR SERVICE,724,RC,72400001,CDM,,,,,,both,,,3308.0000,496.2000,BLUE CROSS,BLUE CROSS S NETWORK,46.00,,,,,,,46.0000,3308.0000,other,Rev 724 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LABOR SERVICE,724,RC,72400001,CDM,,,,,,both,,,3308.0000,496.2000,CIGNA HEALTHCARE,CIGNA HMO,1379.44,,,,,,,46.0000,3308.0000,percent of total billed charges,"41.7% of $3,308.00 in Billed Charges for Rev 724 = $1,379.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LABOR SERVICE,724,RC,72400001,CDM,,,,,,both,,,3308.0000,496.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1534.91,,,,,,,46.0000,3308.0000,percent of total billed charges,"46.4% of $3,308.00 in Billed Charges for Rev 724 = $1,534.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LABOR SERVICE,724,RC,72400001,CDM,,,,,,both,,,3308.0000,496.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1379.44,,,,,,,46.0000,3308.0000,percent of total billed charges,"41.7% of $3,308.00 in Billed Charges for Rev 724 = $1,379.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LABOR SERVICE,724,RC,72400001,CDM,,,,,,both,,,3308.0000,496.2000,CIGNA HEALTHCARE,CIGNA PPO,1379.44,,,,,,,46.0000,3308.0000,percent of total billed charges,"41.7% of $3,308.00 in Billed Charges for Rev 724 = $1,379.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LABOR SERVICE,724,RC,72400001,CDM,,,,,,both,,,3308.0000,496.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2977.20,,,,,,,46.0000,3308.0000,percent of total billed charges,"90% of $3,308.00 in Billed Charges for Rev 724 = $2,977.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LABOR SERVICE,724,RC,72400001,CDM,,,,,,both,,,3308.0000,496.2000,MEDCOST,MEDCOST VHN,1574.28,,,,,,,46.0000,3308.0000,percent of total billed charges,"47.59% of $3,308.00 in Billed Charges for Rev 724 = $1,574.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LABOR SERVICE,724,RC,72400001,CDM,,,,,,both,,,3308.0000,496.2000,SENTARA HEALTH,SENTARA HEALTH,853.79,,,,,,,46.0000,3308.0000,percent of total billed charges,"25.81% of $3,308.00 in Billed Charges for Rev 724 = $853.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LABOR SERVICE,724,RC,72400001,CDM,,,,,,both,,,3308.0000,496.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3308.00,,,,,,,46.0000,3308.0000,percent of total billed charges,"100% of $3,308.00 in Billed Charges for Rev 724 = $3,308.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LABOR SERVICE,724,RC,72400001,CDM,,,,,,both,,,3308.0000,496.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1654.00,,,,,,,46.0000,3308.0000,percent of total billed charges,"Rev 724 $3,308.00 in Billed Charges at 50% = $1,654.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LABOR SERVICE,724,RC,72400001,CDM,,,,,,both,,,3308.0000,496.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,259.00,,,,,,,46.0000,3308.0000,other,Rev 724 1 Visit at $259.00 per Visit = $259.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LABOR SERVICE,724,RC,72400001,CDM,,,,,,both,,,3308.0000,496.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,247.00,,,,,,,46.0000,3308.0000,other,Rev 724 1 Visit at $247.00 per Visit = $247.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LABOR SERVICE,724,RC,72400001,CDM,,,,,,both,,,3308.0000,496.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,408.00,,,,,,,46.0000,3308.0000,other,Rev 724 1 Visit at $408.00 per Visit = $408.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LABOR SERVICE,724,RC,72400001,CDM,,,,,,both,,,3308.0000,496.2000,WELLCARE,WELLCARE MEDICAID,3308.00,,,,,,,46.0000,3308.0000,percent of total billed charges,"100% of $3,308.00 in Billed Charges for Rev 724 = $3,308.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LASER EYE TREATMENT,361,RC,36100019,CDM,,,,,,both,,,1450.0000,217.5000,AETNA,AETNA,619.15,,,,,,,175.0000,1450.0000,percent of total billed charges,"42.7% of $1,450.00 in Billed Charges for Rev 361 = $619.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LASER EYE TREATMENT,361,RC,36100019,CDM,,,,,,both,,,1450.0000,217.5000,BLUE CROSS,ANTHEM EXCHANGE,239.25,,,,,,,175.0000,1450.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LASER EYE TREATMENT,361,RC,36100019,CDM,,,,,,both,,,1450.0000,217.5000,BLUE CROSS,ANTHEM HMO,239.25,,,,,,,175.0000,1450.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LASER EYE TREATMENT,361,RC,36100019,CDM,,,,,,both,,,1450.0000,217.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",239.25,,,,,,,175.0000,1450.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LASER EYE TREATMENT,361,RC,36100019,CDM,,,,,,both,,,1450.0000,217.5000,CIGNA HEALTHCARE,CIGNA HMO,228.00,,,,,,,175.0000,1450.0000,case rate,Rev 361 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LASER EYE TREATMENT,361,RC,36100019,CDM,,,,,,both,,,1450.0000,217.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.00,,,,,,,175.0000,1450.0000,case rate,Rev 361 ASG Rate of $175.00 at 100% of $175.00 = $175.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LASER EYE TREATMENT,361,RC,36100019,CDM,,,,,,both,,,1450.0000,217.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.00,,,,,,,175.0000,1450.0000,case rate,Rev 361 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LASER EYE TREATMENT,361,RC,36100019,CDM,,,,,,both,,,1450.0000,217.5000,CIGNA HEALTHCARE,CIGNA PPO,228.00,,,,,,,175.0000,1450.0000,case rate,Rev 361 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LASER EYE TREATMENT,361,RC,36100019,CDM,,,,,,both,,,1450.0000,217.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1305.00,,,,,,,175.0000,1450.0000,percent of total billed charges,"90% of $1,450.00 in Billed Charges for Rev 361 = $1,305.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LASER EYE TREATMENT,361,RC,36100019,CDM,,,,,,both,,,1450.0000,217.5000,MEDCOST,MEDCOST VHN,690.06,,,,,,,175.0000,1450.0000,percent of total billed charges,"47.59% of $1,450.00 in Billed Charges for Rev 361 = $690.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LASER EYE TREATMENT,361,RC,36100019,CDM,,,,,,both,,,1450.0000,217.5000,SENTARA HEALTH,SENTARA HEALTH,374.25,,,,,,,175.0000,1450.0000,percent of total billed charges,"25.81% of $1,450.00 in Billed Charges for Rev 361 = $374.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LASER EYE TREATMENT,361,RC,36100019,CDM,,,,,,both,,,1450.0000,217.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1450.00,,,,,,,175.0000,1450.0000,percent of total billed charges,"100% of $1,450.00 in Billed Charges for Rev 361 = $1,450.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LASER EYE TREATMENT,361,RC,36100019,CDM,,,,,,both,,,1450.0000,217.5000,WELLCARE,WELLCARE MEDICAID,1450.00,,,,,,,175.0000,1450.0000,percent of total billed charges,"100% of $1,450.00 in Billed Charges for Rev 361 = $1,450.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATING 21G PREMARK,272,RC,27200002,CDM,,,,,,both,,,1657.2900,248.5900,AETNA,AETNA,707.66,,,,,,,427.7500,1657.2900,percent of total billed charges,"42.7% of $1,657.29 in Billed Charges for Rev 272 = $707.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATING 21G PREMARK,272,RC,27200002,CDM,,,,,,both,,,1657.2900,248.5900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1160.10,,,,,,,427.7500,1657.2900,percent of total billed charges,"Rev 272 $1,657.29 in Billed Charges at 70% = $1,160.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATING 21G PREMARK,272,RC,27200002,CDM,,,,,,both,,,1657.2900,248.5900,CIGNA HEALTHCARE,CIGNA HMO,691.09,,,,,,,427.7500,1657.2900,percent of total billed charges,"41.7% of $1,657.29 in Billed Charges for Rev 272 = $691.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATING 21G PREMARK,272,RC,27200002,CDM,,,,,,both,,,1657.2900,248.5900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,768.98,,,,,,,427.7500,1657.2900,percent of total billed charges,"46.4% of $1,657.29 in Billed Charges for Rev 272 = $768.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATING 21G PREMARK,272,RC,27200002,CDM,,,,,,both,,,1657.2900,248.5900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,691.09,,,,,,,427.7500,1657.2900,percent of total billed charges,"41.7% of $1,657.29 in Billed Charges for Rev 272 = $691.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATING 21G PREMARK,272,RC,27200002,CDM,,,,,,both,,,1657.2900,248.5900,CIGNA HEALTHCARE,CIGNA PPO,691.09,,,,,,,427.7500,1657.2900,percent of total billed charges,"41.7% of $1,657.29 in Billed Charges for Rev 272 = $691.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATING 21G PREMARK,272,RC,27200002,CDM,,,,,,both,,,1657.2900,248.5900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1491.56,,,,,,,427.7500,1657.2900,percent of total billed charges,"90% of $1,657.29 in Billed Charges for Rev 272 = $1,491.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATING 21G PREMARK,272,RC,27200002,CDM,,,,,,both,,,1657.2900,248.5900,MEDCOST,MEDCOST VHN,788.70,,,,,,,427.7500,1657.2900,percent of total billed charges,"47.59% of $1,657.29 in Billed Charges for Rev 272 = $788.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATING 21G PREMARK,272,RC,27200002,CDM,,,,,,both,,,1657.2900,248.5900,SENTARA HEALTH,SENTARA HEALTH,427.75,,,,,,,427.7500,1657.2900,percent of total billed charges,"25.81% of $1,657.29 in Billed Charges for Rev 272 = $427.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATING 21G PREMARK,272,RC,27200002,CDM,,,,,,both,,,1657.2900,248.5900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1657.29,,,,,,,427.7500,1657.2900,percent of total billed charges,"100% of $1,657.29 in Billed Charges for Rev 272 = $1,657.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATING 21G PREMARK,272,RC,27200002,CDM,,,,,,both,,,1657.2900,248.5900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,828.65,,,,,,,427.7500,1657.2900,percent of total billed charges,"Rev 272 $1,657.29 in Billed Charges at 50% = $828.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATING 21G PREMARK,272,RC,27200002,CDM,,,,,,both,,,1657.2900,248.5900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,535.30,,,,,,,427.7500,1657.2900,other,"32.3% of $1,657.29 in Billed Charges for Rev 272 = $535.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE ASPIRATING 21G PREMARK,272,RC,27200002,CDM,,,,,,both,,,1657.2900,248.5900,UNITED HEALTHCARE,UHC HERITAGE SELECT,508.79,,,,,,,427.7500,1657.2900,other,"30.7% of $1,657.29 in Billed Charges for Rev 272 = $508.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE ASPIRATING 21G PREMARK,272,RC,27200002,CDM,,,,,,both,,,1657.2900,248.5900,UNITED HEALTHCARE,UNITED HEALTHCARE,535.30,,,,,,,427.7500,1657.2900,percent of total billed charges,"32.3% of $1,657.29 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATING 21G PREMARK,272,RC,27200002,CDM,,,,,,both,,,1657.2900,248.5900,WELLCARE,WELLCARE MEDICAID,1657.29,,,,,,,427.7500,1657.2900,percent of total billed charges,"100% of $1,657.29 in Billed Charges for Rev 272 = $1,657.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATION 22GA AQUIRE,272,RC,27200002,CDM,,,,,,both,,,6415.9200,962.3900,AETNA,AETNA,2739.60,,,,,,,1655.9500,6415.9200,percent of total billed charges,"42.7% of $6,415.92 in Billed Charges for Rev 272 = $2,739.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATION 22GA AQUIRE,272,RC,27200002,CDM,,,,,,both,,,6415.9200,962.3900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4491.14,,,,,,,1655.9500,6415.9200,percent of total billed charges,"Rev 272 $6,415.92 in Billed Charges at 70% = $4,491.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATION 22GA AQUIRE,272,RC,27200002,CDM,,,,,,both,,,6415.9200,962.3900,CIGNA HEALTHCARE,CIGNA HMO,2675.44,,,,,,,1655.9500,6415.9200,percent of total billed charges,"41.7% of $6,415.92 in Billed Charges for Rev 272 = $2,675.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATION 22GA AQUIRE,272,RC,27200002,CDM,,,,,,both,,,6415.9200,962.3900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2976.99,,,,,,,1655.9500,6415.9200,percent of total billed charges,"46.4% of $6,415.92 in Billed Charges for Rev 272 = $2,976.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATION 22GA AQUIRE,272,RC,27200002,CDM,,,,,,both,,,6415.9200,962.3900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2675.44,,,,,,,1655.9500,6415.9200,percent of total billed charges,"41.7% of $6,415.92 in Billed Charges for Rev 272 = $2,675.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATION 22GA AQUIRE,272,RC,27200002,CDM,,,,,,both,,,6415.9200,962.3900,CIGNA HEALTHCARE,CIGNA PPO,2675.44,,,,,,,1655.9500,6415.9200,percent of total billed charges,"41.7% of $6,415.92 in Billed Charges for Rev 272 = $2,675.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATION 22GA AQUIRE,272,RC,27200002,CDM,,,,,,both,,,6415.9200,962.3900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5774.33,,,,,,,1655.9500,6415.9200,percent of total billed charges,"90% of $6,415.92 in Billed Charges for Rev 272 = $5,774.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATION 22GA AQUIRE,272,RC,27200002,CDM,,,,,,both,,,6415.9200,962.3900,MEDCOST,MEDCOST VHN,3053.34,,,,,,,1655.9500,6415.9200,percent of total billed charges,"47.59% of $6,415.92 in Billed Charges for Rev 272 = $3,053.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATION 22GA AQUIRE,272,RC,27200002,CDM,,,,,,both,,,6415.9200,962.3900,SENTARA HEALTH,SENTARA HEALTH,1655.95,,,,,,,1655.9500,6415.9200,percent of total billed charges,"25.81% of $6,415.92 in Billed Charges for Rev 272 = $1,655.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATION 22GA AQUIRE,272,RC,27200002,CDM,,,,,,both,,,6415.9200,962.3900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6415.92,,,,,,,1655.9500,6415.9200,percent of total billed charges,"100% of $6,415.92 in Billed Charges for Rev 272 = $6,415.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATION 22GA AQUIRE,272,RC,27200002,CDM,,,,,,both,,,6415.9200,962.3900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3207.96,,,,,,,1655.9500,6415.9200,percent of total billed charges,"Rev 272 $6,415.92 in Billed Charges at 50% = $3,207.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATION 22GA AQUIRE,272,RC,27200002,CDM,,,,,,both,,,6415.9200,962.3900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2072.34,,,,,,,1655.9500,6415.9200,other,"32.3% of $6,415.92 in Billed Charges for Rev 272 = $2,072.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE ASPIRATION 22GA AQUIRE,272,RC,27200002,CDM,,,,,,both,,,6415.9200,962.3900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1969.69,,,,,,,1655.9500,6415.9200,other,"30.7% of $6,415.92 in Billed Charges for Rev 272 = $1,969.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE ASPIRATION 22GA AQUIRE,272,RC,27200002,CDM,,,,,,both,,,6415.9200,962.3900,UNITED HEALTHCARE,UNITED HEALTHCARE,2072.34,,,,,,,1655.9500,6415.9200,percent of total billed charges,"32.3% of $6,415.92 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATION 22GA AQUIRE,272,RC,27200002,CDM,,,,,,both,,,6415.9200,962.3900,WELLCARE,WELLCARE MEDICAID,6415.92,,,,,,,1655.9500,6415.9200,percent of total billed charges,"100% of $6,415.92 in Billed Charges for Rev 272 = $6,415.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE ASPIRATION AND SYRINGE VIZISHOT 22G NA-201SX-4022-A,272,RC,27200002,CDM,,,,,,both,,,738.1000,110.7200,AETNA,AETNA,315.17,,,,,,,190.5000,738.1000,percent of total billed charges,42.7% of $738.10 in Billed Charges for Rev 272 = $315.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE ASPIRATION AND SYRINGE VIZISHOT 22G NA-201SX-4022-A,272,RC,27200002,CDM,,,,,,both,,,738.1000,110.7200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,516.67,,,,,,,190.5000,738.1000,percent of total billed charges,Rev 272 $738.10 in Billed Charges at 70% = $516.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE ASPIRATION AND SYRINGE VIZISHOT 22G NA-201SX-4022-A,272,RC,27200002,CDM,,,,,,both,,,738.1000,110.7200,CIGNA HEALTHCARE,CIGNA HMO,307.79,,,,,,,190.5000,738.1000,percent of total billed charges,41.7% of $738.10 in Billed Charges for Rev 272 = $307.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE ASPIRATION AND SYRINGE VIZISHOT 22G NA-201SX-4022-A,272,RC,27200002,CDM,,,,,,both,,,738.1000,110.7200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,342.48,,,,,,,190.5000,738.1000,percent of total billed charges,46.4% of $738.10 in Billed Charges for Rev 272 = $342.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE ASPIRATION AND SYRINGE VIZISHOT 22G NA-201SX-4022-A,272,RC,27200002,CDM,,,,,,both,,,738.1000,110.7200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,307.79,,,,,,,190.5000,738.1000,percent of total billed charges,41.7% of $738.10 in Billed Charges for Rev 272 = $307.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE ASPIRATION AND SYRINGE VIZISHOT 22G NA-201SX-4022-A,272,RC,27200002,CDM,,,,,,both,,,738.1000,110.7200,CIGNA HEALTHCARE,CIGNA PPO,307.79,,,,,,,190.5000,738.1000,percent of total billed charges,41.7% of $738.10 in Billed Charges for Rev 272 = $307.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE ASPIRATION AND SYRINGE VIZISHOT 22G NA-201SX-4022-A,272,RC,27200002,CDM,,,,,,both,,,738.1000,110.7200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,664.29,,,,,,,190.5000,738.1000,percent of total billed charges,90% of $738.10 in Billed Charges for Rev 272 = $664.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE ASPIRATION AND SYRINGE VIZISHOT 22G NA-201SX-4022-A,272,RC,27200002,CDM,,,,,,both,,,738.1000,110.7200,MEDCOST,MEDCOST VHN,351.26,,,,,,,190.5000,738.1000,percent of total billed charges,47.59% of $738.10 in Billed Charges for Rev 272 = $351.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE ASPIRATION AND SYRINGE VIZISHOT 22G NA-201SX-4022-A,272,RC,27200002,CDM,,,,,,both,,,738.1000,110.7200,SENTARA HEALTH,SENTARA HEALTH,190.50,,,,,,,190.5000,738.1000,percent of total billed charges,25.81% of $738.10 in Billed Charges for Rev 272 = $190.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE ASPIRATION AND SYRINGE VIZISHOT 22G NA-201SX-4022-A,272,RC,27200002,CDM,,,,,,both,,,738.1000,110.7200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",738.10,,,,,,,190.5000,738.1000,percent of total billed charges,100% of $738.10 in Billed Charges for Rev 272 = $738.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE ASPIRATION AND SYRINGE VIZISHOT 22G NA-201SX-4022-A,272,RC,27200002,CDM,,,,,,both,,,738.1000,110.7200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,369.05,,,,,,,190.5000,738.1000,percent of total billed charges,Rev 272 $738.10 in Billed Charges at 50% = $369.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE ASPIRATION AND SYRINGE VIZISHOT 22G NA-201SX-4022-A,272,RC,27200002,CDM,,,,,,both,,,738.1000,110.7200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,238.41,,,,,,,190.5000,738.1000,other,32.3% of $738.10 in Billed Charges for Rev 272 = $238.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE ASPIRATION AND SYRINGE VIZISHOT 22G NA-201SX-4022-A,272,RC,27200002,CDM,,,,,,both,,,738.1000,110.7200,UNITED HEALTHCARE,UHC HERITAGE SELECT,226.60,,,,,,,190.5000,738.1000,other,30.7% of $738.10 in Billed Charges for Rev 272 = $226.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE ASPIRATION AND SYRINGE VIZISHOT 22G NA-201SX-4022-A,272,RC,27200002,CDM,,,,,,both,,,738.1000,110.7200,UNITED HEALTHCARE,UNITED HEALTHCARE,238.41,,,,,,,190.5000,738.1000,percent of total billed charges,32.3% of $738.10 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE ASPIRATION AND SYRINGE VIZISHOT 22G NA-201SX-4022-A,272,RC,27200002,CDM,,,,,,both,,,738.1000,110.7200,WELLCARE,WELLCARE MEDICAID,738.10,,,,,,,190.5000,738.1000,percent of total billed charges,100% of $738.10 in Billed Charges for Rev 272 = $738.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH JUGULAR DUAL LUMEN CRESENT 28FR,272,RC,27202212,CDM,,,,,,both,,,20148.0000,3022.2000,AETNA,AETNA,8603.20,,,,,,,5200.2000,20148.0000,percent of total billed charges,"42.7% of $20,148.00 in Billed Charges for Rev 272 = $8,603.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH JUGULAR DUAL LUMEN CRESENT 28FR,272,RC,27202212,CDM,,,,,,both,,,20148.0000,3022.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,14103.60,,,,,,,5200.2000,20148.0000,percent of total billed charges,"Rev 272 $20,148.00 in Billed Charges at 70% = $14,103.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH JUGULAR DUAL LUMEN CRESENT 28FR,272,RC,27202212,CDM,,,,,,both,,,20148.0000,3022.2000,CIGNA HEALTHCARE,CIGNA HMO,8401.72,,,,,,,5200.2000,20148.0000,percent of total billed charges,"41.7% of $20,148.00 in Billed Charges for Rev 272 = $8,401.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH JUGULAR DUAL LUMEN CRESENT 28FR,272,RC,27202212,CDM,,,,,,both,,,20148.0000,3022.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,9348.67,,,,,,,5200.2000,20148.0000,percent of total billed charges,"46.4% of $20,148.00 in Billed Charges for Rev 272 = $9,348.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH JUGULAR DUAL LUMEN CRESENT 28FR,272,RC,27202212,CDM,,,,,,both,,,20148.0000,3022.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8401.72,,,,,,,5200.2000,20148.0000,percent of total billed charges,"41.7% of $20,148.00 in Billed Charges for Rev 272 = $8,401.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH JUGULAR DUAL LUMEN CRESENT 28FR,272,RC,27202212,CDM,,,,,,both,,,20148.0000,3022.2000,CIGNA HEALTHCARE,CIGNA PPO,8401.72,,,,,,,5200.2000,20148.0000,percent of total billed charges,"41.7% of $20,148.00 in Billed Charges for Rev 272 = $8,401.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH JUGULAR DUAL LUMEN CRESENT 28FR,272,RC,27202212,CDM,,,,,,both,,,20148.0000,3022.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,18133.20,,,,,,,5200.2000,20148.0000,percent of total billed charges,"90% of $20,148.00 in Billed Charges for Rev 272 = $18,133.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH JUGULAR DUAL LUMEN CRESENT 28FR,272,RC,27202212,CDM,,,,,,both,,,20148.0000,3022.2000,MEDCOST,MEDCOST VHN,9588.43,,,,,,,5200.2000,20148.0000,percent of total billed charges,"47.59% of $20,148.00 in Billed Charges for Rev 272 = $9,588.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH JUGULAR DUAL LUMEN CRESENT 28FR,272,RC,27202212,CDM,,,,,,both,,,20148.0000,3022.2000,SENTARA HEALTH,SENTARA HEALTH,5200.20,,,,,,,5200.2000,20148.0000,percent of total billed charges,"25.81% of $20,148.00 in Billed Charges for Rev 272 = $5,200.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH JUGULAR DUAL LUMEN CRESENT 28FR,272,RC,27202212,CDM,,,,,,both,,,20148.0000,3022.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",20148.00,,,,,,,5200.2000,20148.0000,percent of total billed charges,"100% of $20,148.00 in Billed Charges for Rev 272 = $20,148.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH JUGULAR DUAL LUMEN CRESENT 28FR,272,RC,27202212,CDM,,,,,,both,,,20148.0000,3022.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,10074.00,,,,,,,5200.2000,20148.0000,percent of total billed charges,"Rev 272 $20,148.00 in Billed Charges at 50% = $10,074.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH JUGULAR DUAL LUMEN CRESENT 28FR,272,RC,27202212,CDM,,,,,,both,,,20148.0000,3022.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,6507.80,,,,,,,5200.2000,20148.0000,other,"32.3% of $20,148.00 in Billed Charges for Rev 272 = $6,507.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH JUGULAR DUAL LUMEN CRESENT 28FR,272,RC,27202212,CDM,,,,,,both,,,20148.0000,3022.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,6185.44,,,,,,,5200.2000,20148.0000,other,"30.7% of $20,148.00 in Billed Charges for Rev 272 = $6,185.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH JUGULAR DUAL LUMEN CRESENT 28FR,272,RC,27202212,CDM,,,,,,both,,,20148.0000,3022.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,6507.80,,,,,,,5200.2000,20148.0000,percent of total billed charges,"32.3% of $20,148.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH JUGULAR DUAL LUMEN CRESENT 28FR,272,RC,27202212,CDM,,,,,,both,,,20148.0000,3022.2000,WELLCARE,WELLCARE MEDICAID,20148.00,,,,,,,5200.2000,20148.0000,percent of total billed charges,"100% of $20,148.00 in Billed Charges for Rev 272 = $20,148.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LD CATH INTRAUTERINE PRESSURE,272,RC,27200914,CDM,,,,,,both,,,186.0000,27.9000,AETNA,AETNA,79.42,,,,,,,48.0100,186.0000,percent of total billed charges,42.7% of $186.00 in Billed Charges for Rev 272 = $79.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD CATH INTRAUTERINE PRESSURE,272,RC,27200914,CDM,,,,,,both,,,186.0000,27.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,130.20,,,,,,,48.0100,186.0000,percent of total billed charges,Rev 272 $186.00 in Billed Charges at 70% = $130.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD CATH INTRAUTERINE PRESSURE,272,RC,27200914,CDM,,,,,,both,,,186.0000,27.9000,CIGNA HEALTHCARE,CIGNA HMO,77.56,,,,,,,48.0100,186.0000,percent of total billed charges,41.7% of $186.00 in Billed Charges for Rev 272 = $77.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD CATH INTRAUTERINE PRESSURE,272,RC,27200914,CDM,,,,,,both,,,186.0000,27.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,86.30,,,,,,,48.0100,186.0000,percent of total billed charges,46.4% of $186.00 in Billed Charges for Rev 272 = $86.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD CATH INTRAUTERINE PRESSURE,272,RC,27200914,CDM,,,,,,both,,,186.0000,27.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,77.56,,,,,,,48.0100,186.0000,percent of total billed charges,41.7% of $186.00 in Billed Charges for Rev 272 = $77.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD CATH INTRAUTERINE PRESSURE,272,RC,27200914,CDM,,,,,,both,,,186.0000,27.9000,CIGNA HEALTHCARE,CIGNA PPO,77.56,,,,,,,48.0100,186.0000,percent of total billed charges,41.7% of $186.00 in Billed Charges for Rev 272 = $77.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD CATH INTRAUTERINE PRESSURE,272,RC,27200914,CDM,,,,,,both,,,186.0000,27.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,167.40,,,,,,,48.0100,186.0000,percent of total billed charges,90% of $186.00 in Billed Charges for Rev 272 = $167.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD CATH INTRAUTERINE PRESSURE,272,RC,27200914,CDM,,,,,,both,,,186.0000,27.9000,MEDCOST,MEDCOST VHN,88.52,,,,,,,48.0100,186.0000,percent of total billed charges,47.59% of $186.00 in Billed Charges for Rev 272 = $88.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD CATH INTRAUTERINE PRESSURE,272,RC,27200914,CDM,,,,,,both,,,186.0000,27.9000,SENTARA HEALTH,SENTARA HEALTH,48.01,,,,,,,48.0100,186.0000,percent of total billed charges,25.81% of $186.00 in Billed Charges for Rev 272 = $48.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD CATH INTRAUTERINE PRESSURE,272,RC,27200914,CDM,,,,,,both,,,186.0000,27.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",186.00,,,,,,,48.0100,186.0000,percent of total billed charges,100% of $186.00 in Billed Charges for Rev 272 = $186.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD CATH INTRAUTERINE PRESSURE,272,RC,27200914,CDM,,,,,,both,,,186.0000,27.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,93.00,,,,,,,48.0100,186.0000,percent of total billed charges,Rev 272 $186.00 in Billed Charges at 50% = $93.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD CATH INTRAUTERINE PRESSURE,272,RC,27200914,CDM,,,,,,both,,,186.0000,27.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,60.08,,,,,,,48.0100,186.0000,other,32.3% of $186.00 in Billed Charges for Rev 272 = $60.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD CATH INTRAUTERINE PRESSURE,272,RC,27200914,CDM,,,,,,both,,,186.0000,27.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,57.10,,,,,,,48.0100,186.0000,other,30.7% of $186.00 in Billed Charges for Rev 272 = $57.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD CATH INTRAUTERINE PRESSURE,272,RC,27200914,CDM,,,,,,both,,,186.0000,27.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,60.08,,,,,,,48.0100,186.0000,percent of total billed charges,32.3% of $186.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD CATH INTRAUTERINE PRESSURE,272,RC,27200914,CDM,,,,,,both,,,186.0000,27.9000,WELLCARE,WELLCARE MEDICAID,186.00,,,,,,,48.0100,186.0000,percent of total billed charges,100% of $186.00 in Billed Charges for Rev 272 = $186.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD MASK BILI DISP,270,RC,27000222,CDM,,,,,,both,,,28.0000,4.2000,AETNA,AETNA,11.96,,,,,,,7.2300,28.0000,percent of total billed charges,42.7% of $28.00 in Billed Charges for Rev 270 = $11.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD MASK BILI DISP,270,RC,27000222,CDM,,,,,,both,,,28.0000,4.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,19.60,,,,,,,7.2300,28.0000,percent of total billed charges,Rev 270 $28.00 in Billed Charges at 70% = $19.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD MASK BILI DISP,270,RC,27000222,CDM,,,,,,both,,,28.0000,4.2000,CIGNA HEALTHCARE,CIGNA HMO,11.68,,,,,,,7.2300,28.0000,percent of total billed charges,41.7% of $28.00 in Billed Charges for Rev 270 = $11.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD MASK BILI DISP,270,RC,27000222,CDM,,,,,,both,,,28.0000,4.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12.99,,,,,,,7.2300,28.0000,percent of total billed charges,46.4% of $28.00 in Billed Charges for Rev 270 = $12.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD MASK BILI DISP,270,RC,27000222,CDM,,,,,,both,,,28.0000,4.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11.68,,,,,,,7.2300,28.0000,percent of total billed charges,41.7% of $28.00 in Billed Charges for Rev 270 = $11.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD MASK BILI DISP,270,RC,27000222,CDM,,,,,,both,,,28.0000,4.2000,CIGNA HEALTHCARE,CIGNA PPO,11.68,,,,,,,7.2300,28.0000,percent of total billed charges,41.7% of $28.00 in Billed Charges for Rev 270 = $11.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD MASK BILI DISP,270,RC,27000222,CDM,,,,,,both,,,28.0000,4.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,25.20,,,,,,,7.2300,28.0000,percent of total billed charges,90% of $28.00 in Billed Charges for Rev 270 = $25.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD MASK BILI DISP,270,RC,27000222,CDM,,,,,,both,,,28.0000,4.2000,MEDCOST,MEDCOST VHN,13.33,,,,,,,7.2300,28.0000,percent of total billed charges,47.59% of $28.00 in Billed Charges for Rev 270 = $13.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD MASK BILI DISP,270,RC,27000222,CDM,,,,,,both,,,28.0000,4.2000,SENTARA HEALTH,SENTARA HEALTH,7.23,,,,,,,7.2300,28.0000,percent of total billed charges,25.81% of $28.00 in Billed Charges for Rev 270 = $7.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD MASK BILI DISP,270,RC,27000222,CDM,,,,,,both,,,28.0000,4.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",28.00,,,,,,,7.2300,28.0000,percent of total billed charges,100% of $28.00 in Billed Charges for Rev 270 = $28.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD MASK BILI DISP,270,RC,27000222,CDM,,,,,,both,,,28.0000,4.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14.00,,,,,,,7.2300,28.0000,percent of total billed charges,Rev 270 $28.00 in Billed Charges at 50% = $14.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD MASK BILI DISP,270,RC,27000222,CDM,,,,,,both,,,28.0000,4.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,9.04,,,,,,,7.2300,28.0000,other,32.3% of $28.00 in Billed Charges for Rev 270 = $9.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD MASK BILI DISP,270,RC,27000222,CDM,,,,,,both,,,28.0000,4.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,8.60,,,,,,,7.2300,28.0000,other,30.7% of $28.00 in Billed Charges for Rev 270 = $8.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LD MASK BILI DISP,270,RC,27000222,CDM,,,,,,both,,,28.0000,4.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,9.04,,,,,,,7.2300,28.0000,percent of total billed charges,32.3% of $28.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LD MASK BILI DISP,270,RC,27000222,CDM,,,,,,both,,,28.0000,4.2000,WELLCARE,WELLCARE MEDICAID,28.00,,,,,,,7.2300,28.0000,percent of total billed charges,100% of $28.00 in Billed Charges for Rev 270 = $28.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD MEDTRONIC ANCHOR SLEEVE,272,RC,27200919,CDM,,,,,,both,,,158.0000,23.7000,AETNA,AETNA,67.47,,,,,,,40.7800,158.0000,percent of total billed charges,42.7% of $158.00 in Billed Charges for Rev 272 = $67.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD MEDTRONIC ANCHOR SLEEVE,272,RC,27200919,CDM,,,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,110.60,,,,,,,40.7800,158.0000,percent of total billed charges,Rev 272 $158.00 in Billed Charges at 70% = $110.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD MEDTRONIC ANCHOR SLEEVE,272,RC,27200919,CDM,,,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA HMO,65.89,,,,,,,40.7800,158.0000,percent of total billed charges,41.7% of $158.00 in Billed Charges for Rev 272 = $65.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD MEDTRONIC ANCHOR SLEEVE,272,RC,27200919,CDM,,,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,73.31,,,,,,,40.7800,158.0000,percent of total billed charges,46.4% of $158.00 in Billed Charges for Rev 272 = $73.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD MEDTRONIC ANCHOR SLEEVE,272,RC,27200919,CDM,,,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,65.89,,,,,,,40.7800,158.0000,percent of total billed charges,41.7% of $158.00 in Billed Charges for Rev 272 = $65.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD MEDTRONIC ANCHOR SLEEVE,272,RC,27200919,CDM,,,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA PPO,65.89,,,,,,,40.7800,158.0000,percent of total billed charges,41.7% of $158.00 in Billed Charges for Rev 272 = $65.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD MEDTRONIC ANCHOR SLEEVE,272,RC,27200919,CDM,,,,,,both,,,158.0000,23.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,142.20,,,,,,,40.7800,158.0000,percent of total billed charges,90% of $158.00 in Billed Charges for Rev 272 = $142.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD MEDTRONIC ANCHOR SLEEVE,272,RC,27200919,CDM,,,,,,both,,,158.0000,23.7000,MEDCOST,MEDCOST VHN,75.19,,,,,,,40.7800,158.0000,percent of total billed charges,47.59% of $158.00 in Billed Charges for Rev 272 = $75.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD MEDTRONIC ANCHOR SLEEVE,272,RC,27200919,CDM,,,,,,both,,,158.0000,23.7000,SENTARA HEALTH,SENTARA HEALTH,40.78,,,,,,,40.7800,158.0000,percent of total billed charges,25.81% of $158.00 in Billed Charges for Rev 272 = $40.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD MEDTRONIC ANCHOR SLEEVE,272,RC,27200919,CDM,,,,,,both,,,158.0000,23.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",158.00,,,,,,,40.7800,158.0000,percent of total billed charges,100% of $158.00 in Billed Charges for Rev 272 = $158.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD MEDTRONIC ANCHOR SLEEVE,272,RC,27200919,CDM,,,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,79.00,,,,,,,40.7800,158.0000,percent of total billed charges,Rev 272 $158.00 in Billed Charges at 50% = $79.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD MEDTRONIC ANCHOR SLEEVE,272,RC,27200919,CDM,,,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,51.03,,,,,,,40.7800,158.0000,other,32.3% of $158.00 in Billed Charges for Rev 272 = $51.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEAD MEDTRONIC ANCHOR SLEEVE,272,RC,27200919,CDM,,,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,48.51,,,,,,,40.7800,158.0000,other,30.7% of $158.00 in Billed Charges for Rev 272 = $48.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEAD MEDTRONIC ANCHOR SLEEVE,272,RC,27200919,CDM,,,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,51.03,,,,,,,40.7800,158.0000,percent of total billed charges,32.3% of $158.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD MEDTRONIC ANCHOR SLEEVE,272,RC,27200919,CDM,,,,,,both,,,158.0000,23.7000,WELLCARE,WELLCARE MEDICAID,158.00,,,,,,,40.7800,158.0000,percent of total billed charges,100% of $158.00 in Billed Charges for Rev 272 = $158.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD PACING 5FR 8556,272,RC,27200920,CDM,,,,,,both,,,659.0000,98.8500,AETNA,AETNA,281.39,,,,,,,170.0900,659.0000,percent of total billed charges,42.7% of $659.00 in Billed Charges for Rev 272 = $281.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD PACING 5FR 8556,272,RC,27200920,CDM,,,,,,both,,,659.0000,98.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,461.30,,,,,,,170.0900,659.0000,percent of total billed charges,Rev 272 $659.00 in Billed Charges at 70% = $461.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD PACING 5FR 8556,272,RC,27200920,CDM,,,,,,both,,,659.0000,98.8500,CIGNA HEALTHCARE,CIGNA HMO,274.80,,,,,,,170.0900,659.0000,percent of total billed charges,41.7% of $659.00 in Billed Charges for Rev 272 = $274.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD PACING 5FR 8556,272,RC,27200920,CDM,,,,,,both,,,659.0000,98.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,305.78,,,,,,,170.0900,659.0000,percent of total billed charges,46.4% of $659.00 in Billed Charges for Rev 272 = $305.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD PACING 5FR 8556,272,RC,27200920,CDM,,,,,,both,,,659.0000,98.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,274.80,,,,,,,170.0900,659.0000,percent of total billed charges,41.7% of $659.00 in Billed Charges for Rev 272 = $274.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD PACING 5FR 8556,272,RC,27200920,CDM,,,,,,both,,,659.0000,98.8500,CIGNA HEALTHCARE,CIGNA PPO,274.80,,,,,,,170.0900,659.0000,percent of total billed charges,41.7% of $659.00 in Billed Charges for Rev 272 = $274.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD PACING 5FR 8556,272,RC,27200920,CDM,,,,,,both,,,659.0000,98.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,593.10,,,,,,,170.0900,659.0000,percent of total billed charges,90% of $659.00 in Billed Charges for Rev 272 = $593.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD PACING 5FR 8556,272,RC,27200920,CDM,,,,,,both,,,659.0000,98.8500,MEDCOST,MEDCOST VHN,313.62,,,,,,,170.0900,659.0000,percent of total billed charges,47.59% of $659.00 in Billed Charges for Rev 272 = $313.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD PACING 5FR 8556,272,RC,27200920,CDM,,,,,,both,,,659.0000,98.8500,SENTARA HEALTH,SENTARA HEALTH,170.09,,,,,,,170.0900,659.0000,percent of total billed charges,25.81% of $659.00 in Billed Charges for Rev 272 = $170.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD PACING 5FR 8556,272,RC,27200920,CDM,,,,,,both,,,659.0000,98.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",659.00,,,,,,,170.0900,659.0000,percent of total billed charges,100% of $659.00 in Billed Charges for Rev 272 = $659.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD PACING 5FR 8556,272,RC,27200920,CDM,,,,,,both,,,659.0000,98.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,329.50,,,,,,,170.0900,659.0000,percent of total billed charges,Rev 272 $659.00 in Billed Charges at 50% = $329.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD PACING 5FR 8556,272,RC,27200920,CDM,,,,,,both,,,659.0000,98.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,212.86,,,,,,,170.0900,659.0000,other,32.3% of $659.00 in Billed Charges for Rev 272 = $212.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEAD PACING 5FR 8556,272,RC,27200920,CDM,,,,,,both,,,659.0000,98.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,202.31,,,,,,,170.0900,659.0000,other,30.7% of $659.00 in Billed Charges for Rev 272 = $202.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEAD PACING 5FR 8556,272,RC,27200920,CDM,,,,,,both,,,659.0000,98.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,212.86,,,,,,,170.0900,659.0000,percent of total billed charges,32.3% of $659.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEAD PACING 5FR 8556,272,RC,27200920,CDM,,,,,,both,,,659.0000,98.8500,WELLCARE,WELLCARE MEDICAID,659.00,,,,,,,170.0900,659.0000,percent of total billed charges,100% of $659.00 in Billed Charges for Rev 272 = $659.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PENUMBRA 088 NEURON DEL CATH,272,RC,27200992,CDM,,,,,,both,,,1337.0000,200.5500,AETNA,AETNA,570.90,,,,,,,345.0800,1337.0000,percent of total billed charges,"42.7% of $1,337.00 in Billed Charges for Rev 272 = $570.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 088 NEURON DEL CATH,272,RC,27200992,CDM,,,,,,both,,,1337.0000,200.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,935.90,,,,,,,345.0800,1337.0000,percent of total billed charges,"Rev 272 $1,337.00 in Billed Charges at 70% = $935.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 088 NEURON DEL CATH,272,RC,27200992,CDM,,,,,,both,,,1337.0000,200.5500,CIGNA HEALTHCARE,CIGNA HMO,557.53,,,,,,,345.0800,1337.0000,percent of total billed charges,"41.7% of $1,337.00 in Billed Charges for Rev 272 = $557.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 088 NEURON DEL CATH,272,RC,27200992,CDM,,,,,,both,,,1337.0000,200.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,620.37,,,,,,,345.0800,1337.0000,percent of total billed charges,"46.4% of $1,337.00 in Billed Charges for Rev 272 = $620.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 088 NEURON DEL CATH,272,RC,27200992,CDM,,,,,,both,,,1337.0000,200.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,557.53,,,,,,,345.0800,1337.0000,percent of total billed charges,"41.7% of $1,337.00 in Billed Charges for Rev 272 = $557.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 088 NEURON DEL CATH,272,RC,27200992,CDM,,,,,,both,,,1337.0000,200.5500,CIGNA HEALTHCARE,CIGNA PPO,557.53,,,,,,,345.0800,1337.0000,percent of total billed charges,"41.7% of $1,337.00 in Billed Charges for Rev 272 = $557.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 088 NEURON DEL CATH,272,RC,27200992,CDM,,,,,,both,,,1337.0000,200.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1203.30,,,,,,,345.0800,1337.0000,percent of total billed charges,"90% of $1,337.00 in Billed Charges for Rev 272 = $1,203.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 088 NEURON DEL CATH,272,RC,27200992,CDM,,,,,,both,,,1337.0000,200.5500,MEDCOST,MEDCOST VHN,636.28,,,,,,,345.0800,1337.0000,percent of total billed charges,"47.59% of $1,337.00 in Billed Charges for Rev 272 = $636.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 088 NEURON DEL CATH,272,RC,27200992,CDM,,,,,,both,,,1337.0000,200.5500,SENTARA HEALTH,SENTARA HEALTH,345.08,,,,,,,345.0800,1337.0000,percent of total billed charges,"25.81% of $1,337.00 in Billed Charges for Rev 272 = $345.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 088 NEURON DEL CATH,272,RC,27200992,CDM,,,,,,both,,,1337.0000,200.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1337.00,,,,,,,345.0800,1337.0000,percent of total billed charges,"100% of $1,337.00 in Billed Charges for Rev 272 = $1,337.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 088 NEURON DEL CATH,272,RC,27200992,CDM,,,,,,both,,,1337.0000,200.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,668.50,,,,,,,345.0800,1337.0000,percent of total billed charges,"Rev 272 $1,337.00 in Billed Charges at 50% = $668.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 088 NEURON DEL CATH,272,RC,27200992,CDM,,,,,,both,,,1337.0000,200.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,431.85,,,,,,,345.0800,1337.0000,other,"32.3% of $1,337.00 in Billed Charges for Rev 272 = $431.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PENUMBRA 088 NEURON DEL CATH,272,RC,27200992,CDM,,,,,,both,,,1337.0000,200.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,410.46,,,,,,,345.0800,1337.0000,other,"30.7% of $1,337.00 in Billed Charges for Rev 272 = $410.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PENUMBRA 088 NEURON DEL CATH,272,RC,27200992,CDM,,,,,,both,,,1337.0000,200.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,431.85,,,,,,,345.0800,1337.0000,percent of total billed charges,"32.3% of $1,337.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PENUMBRA 088 NEURON DEL CATH,272,RC,27200992,CDM,,,,,,both,,,1337.0000,200.5500,WELLCARE,WELLCARE MEDICAID,1337.00,,,,,,,345.0800,1337.0000,percent of total billed charges,"100% of $1,337.00 in Billed Charges for Rev 272 = $1,337.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PHASE II RECOVERY,710,RC,71000203,CDM,,,,,,both,,,1704.0000,255.6000,AETNA,AETNA,727.61,,,,,,,439.8000,1704.0000,percent of total billed charges,"42.7% of $1,704.00 in Billed Charges for Rev 710 = $727.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PHASE II RECOVERY,710,RC,71000203,CDM,,,,,,both,,,1704.0000,255.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1192.80,,,,,,,439.8000,1704.0000,percent of total billed charges,"Rev 710 $1,704.00 in Billed Charges at 70% = $1,192.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PHASE II RECOVERY,710,RC,71000203,CDM,,,,,,both,,,1704.0000,255.6000,CIGNA HEALTHCARE,CIGNA HMO,710.57,,,,,,,439.8000,1704.0000,percent of total billed charges,"41.7% of $1,704.00 in Billed Charges for Rev 710 = $710.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PHASE II RECOVERY,710,RC,71000203,CDM,,,,,,both,,,1704.0000,255.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,790.66,,,,,,,439.8000,1704.0000,percent of total billed charges,"46.4% of $1,704.00 in Billed Charges for Rev 710 = $790.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PHASE II RECOVERY,710,RC,71000203,CDM,,,,,,both,,,1704.0000,255.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,710.57,,,,,,,439.8000,1704.0000,percent of total billed charges,"41.7% of $1,704.00 in Billed Charges for Rev 710 = $710.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PHASE II RECOVERY,710,RC,71000203,CDM,,,,,,both,,,1704.0000,255.6000,CIGNA HEALTHCARE,CIGNA PPO,710.57,,,,,,,439.8000,1704.0000,percent of total billed charges,"41.7% of $1,704.00 in Billed Charges for Rev 710 = $710.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PHASE II RECOVERY,710,RC,71000203,CDM,,,,,,both,,,1704.0000,255.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1533.60,,,,,,,439.8000,1704.0000,percent of total billed charges,"90% of $1,704.00 in Billed Charges for Rev 710 = $1,533.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PHASE II RECOVERY,710,RC,71000203,CDM,,,,,,both,,,1704.0000,255.6000,MEDCOST,MEDCOST VHN,810.93,,,,,,,439.8000,1704.0000,percent of total billed charges,"47.59% of $1,704.00 in Billed Charges for Rev 710 = $810.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PHASE II RECOVERY,710,RC,71000203,CDM,,,,,,both,,,1704.0000,255.6000,SENTARA HEALTH,SENTARA HEALTH,439.80,,,,,,,439.8000,1704.0000,percent of total billed charges,"25.81% of $1,704.00 in Billed Charges for Rev 710 = $439.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PHASE II RECOVERY,710,RC,71000203,CDM,,,,,,both,,,1704.0000,255.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1704.00,,,,,,,439.8000,1704.0000,percent of total billed charges,"100% of $1,704.00 in Billed Charges for Rev 710 = $1,704.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PHASE II RECOVERY,710,RC,71000203,CDM,,,,,,both,,,1704.0000,255.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,852.00,,,,,,,439.8000,1704.0000,percent of total billed charges,"Rev 710 $1,704.00 in Billed Charges at 50% = $852.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PHASE II RECOVERY,710,RC,71000203,CDM,,,,,,both,,,1704.0000,255.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,550.39,,,,,,,439.8000,1704.0000,other,"32.3% of $1,704.00 in Billed Charges for Rev 710 = $550.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PHASE II RECOVERY,710,RC,71000203,CDM,,,,,,both,,,1704.0000,255.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,523.13,,,,,,,439.8000,1704.0000,other,"30.7% of $1,704.00 in Billed Charges for Rev 710 = $523.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PHASE II RECOVERY,710,RC,71000203,CDM,,,,,,both,,,1704.0000,255.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,550.39,,,,,,,439.8000,1704.0000,percent of total billed charges,"32.3% of $1,704.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PHASE II RECOVERY,710,RC,71000203,CDM,,,,,,both,,,1704.0000,255.6000,WELLCARE,WELLCARE MEDICAID,1704.00,,,,,,,439.8000,1704.0000,percent of total billed charges,"100% of $1,704.00 in Billed Charges for Rev 710 = $1,704.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLASMA BLADE PEAK 4.0,272,RC,27200799,CDM,,,,,,both,,,1275.0000,191.2500,AETNA,AETNA,544.43,,,,,,,329.0800,1275.0000,percent of total billed charges,"42.7% of $1,275.00 in Billed Charges for Rev 272 = $544.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLASMA BLADE PEAK 4.0,272,RC,27200799,CDM,,,,,,both,,,1275.0000,191.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,892.50,,,,,,,329.0800,1275.0000,percent of total billed charges,"Rev 272 $1,275.00 in Billed Charges at 70% = $892.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLASMA BLADE PEAK 4.0,272,RC,27200799,CDM,,,,,,both,,,1275.0000,191.2500,CIGNA HEALTHCARE,CIGNA HMO,531.68,,,,,,,329.0800,1275.0000,percent of total billed charges,"41.7% of $1,275.00 in Billed Charges for Rev 272 = $531.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLASMA BLADE PEAK 4.0,272,RC,27200799,CDM,,,,,,both,,,1275.0000,191.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,591.60,,,,,,,329.0800,1275.0000,percent of total billed charges,"46.4% of $1,275.00 in Billed Charges for Rev 272 = $591.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLASMA BLADE PEAK 4.0,272,RC,27200799,CDM,,,,,,both,,,1275.0000,191.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,531.68,,,,,,,329.0800,1275.0000,percent of total billed charges,"41.7% of $1,275.00 in Billed Charges for Rev 272 = $531.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLASMA BLADE PEAK 4.0,272,RC,27200799,CDM,,,,,,both,,,1275.0000,191.2500,CIGNA HEALTHCARE,CIGNA PPO,531.68,,,,,,,329.0800,1275.0000,percent of total billed charges,"41.7% of $1,275.00 in Billed Charges for Rev 272 = $531.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLASMA BLADE PEAK 4.0,272,RC,27200799,CDM,,,,,,both,,,1275.0000,191.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1147.50,,,,,,,329.0800,1275.0000,percent of total billed charges,"90% of $1,275.00 in Billed Charges for Rev 272 = $1,147.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLASMA BLADE PEAK 4.0,272,RC,27200799,CDM,,,,,,both,,,1275.0000,191.2500,MEDCOST,MEDCOST VHN,606.77,,,,,,,329.0800,1275.0000,percent of total billed charges,"47.59% of $1,275.00 in Billed Charges for Rev 272 = $606.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLASMA BLADE PEAK 4.0,272,RC,27200799,CDM,,,,,,both,,,1275.0000,191.2500,SENTARA HEALTH,SENTARA HEALTH,329.08,,,,,,,329.0800,1275.0000,percent of total billed charges,"25.81% of $1,275.00 in Billed Charges for Rev 272 = $329.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLASMA BLADE PEAK 4.0,272,RC,27200799,CDM,,,,,,both,,,1275.0000,191.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1275.00,,,,,,,329.0800,1275.0000,percent of total billed charges,"100% of $1,275.00 in Billed Charges for Rev 272 = $1,275.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLASMA BLADE PEAK 4.0,272,RC,27200799,CDM,,,,,,both,,,1275.0000,191.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,637.50,,,,,,,329.0800,1275.0000,percent of total billed charges,"Rev 272 $1,275.00 in Billed Charges at 50% = $637.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLASMA BLADE PEAK 4.0,272,RC,27200799,CDM,,,,,,both,,,1275.0000,191.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,411.83,,,,,,,329.0800,1275.0000,other,"32.3% of $1,275.00 in Billed Charges for Rev 272 = $411.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLASMA BLADE PEAK 4.0,272,RC,27200799,CDM,,,,,,both,,,1275.0000,191.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,391.43,,,,,,,329.0800,1275.0000,other,"30.7% of $1,275.00 in Billed Charges for Rev 272 = $391.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLASMA BLADE PEAK 4.0,272,RC,27200799,CDM,,,,,,both,,,1275.0000,191.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,411.83,,,,,,,329.0800,1275.0000,percent of total billed charges,"32.3% of $1,275.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLASMA BLADE PEAK 4.0,272,RC,27200799,CDM,,,,,,both,,,1275.0000,191.2500,WELLCARE,WELLCARE MEDICAID,1275.00,,,,,,,329.0800,1275.0000,percent of total billed charges,"100% of $1,275.00 in Billed Charges for Rev 272 = $1,275.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH NEURON 070 6F MP 108/8,272,RC,27201661,CDM,,,,,,both,,,1363.0000,204.4500,AETNA,AETNA,582.00,,,,,,,351.7900,1363.0000,percent of total billed charges,"42.7% of $1,363.00 in Billed Charges for Rev 272 = $582.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH NEURON 070 6F MP 108/8,272,RC,27201661,CDM,,,,,,both,,,1363.0000,204.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,954.10,,,,,,,351.7900,1363.0000,percent of total billed charges,"Rev 272 $1,363.00 in Billed Charges at 70% = $954.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH NEURON 070 6F MP 108/8,272,RC,27201661,CDM,,,,,,both,,,1363.0000,204.4500,CIGNA HEALTHCARE,CIGNA HMO,568.37,,,,,,,351.7900,1363.0000,percent of total billed charges,"41.7% of $1,363.00 in Billed Charges for Rev 272 = $568.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH NEURON 070 6F MP 108/8,272,RC,27201661,CDM,,,,,,both,,,1363.0000,204.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,632.43,,,,,,,351.7900,1363.0000,percent of total billed charges,"46.4% of $1,363.00 in Billed Charges for Rev 272 = $632.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH NEURON 070 6F MP 108/8,272,RC,27201661,CDM,,,,,,both,,,1363.0000,204.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,568.37,,,,,,,351.7900,1363.0000,percent of total billed charges,"41.7% of $1,363.00 in Billed Charges for Rev 272 = $568.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH NEURON 070 6F MP 108/8,272,RC,27201661,CDM,,,,,,both,,,1363.0000,204.4500,CIGNA HEALTHCARE,CIGNA PPO,568.37,,,,,,,351.7900,1363.0000,percent of total billed charges,"41.7% of $1,363.00 in Billed Charges for Rev 272 = $568.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH NEURON 070 6F MP 108/8,272,RC,27201661,CDM,,,,,,both,,,1363.0000,204.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1226.70,,,,,,,351.7900,1363.0000,percent of total billed charges,"90% of $1,363.00 in Billed Charges for Rev 272 = $1,226.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH NEURON 070 6F MP 108/8,272,RC,27201661,CDM,,,,,,both,,,1363.0000,204.4500,MEDCOST,MEDCOST VHN,648.65,,,,,,,351.7900,1363.0000,percent of total billed charges,"47.59% of $1,363.00 in Billed Charges for Rev 272 = $648.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH NEURON 070 6F MP 108/8,272,RC,27201661,CDM,,,,,,both,,,1363.0000,204.4500,SENTARA HEALTH,SENTARA HEALTH,351.79,,,,,,,351.7900,1363.0000,percent of total billed charges,"25.81% of $1,363.00 in Billed Charges for Rev 272 = $351.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH NEURON 070 6F MP 108/8,272,RC,27201661,CDM,,,,,,both,,,1363.0000,204.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1363.00,,,,,,,351.7900,1363.0000,percent of total billed charges,"100% of $1,363.00 in Billed Charges for Rev 272 = $1,363.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH NEURON 070 6F MP 108/8,272,RC,27201661,CDM,,,,,,both,,,1363.0000,204.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,681.50,,,,,,,351.7900,1363.0000,percent of total billed charges,"Rev 272 $1,363.00 in Billed Charges at 50% = $681.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH NEURON 070 6F MP 108/8,272,RC,27201661,CDM,,,,,,both,,,1363.0000,204.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,440.25,,,,,,,351.7900,1363.0000,other,"32.3% of $1,363.00 in Billed Charges for Rev 272 = $440.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH NEURON 070 6F MP 108/8,272,RC,27201661,CDM,,,,,,both,,,1363.0000,204.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,418.44,,,,,,,351.7900,1363.0000,other,"30.7% of $1,363.00 in Billed Charges for Rev 272 = $418.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH NEURON 070 6F MP 108/8,272,RC,27201661,CDM,,,,,,both,,,1363.0000,204.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,440.25,,,,,,,351.7900,1363.0000,percent of total billed charges,"32.3% of $1,363.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH NEURON 070 6F MP 108/8,272,RC,27201661,CDM,,,,,,both,,,1363.0000,204.4500,WELLCARE,WELLCARE MEDICAID,1363.00,,,,,,,351.7900,1363.0000,percent of total billed charges,"100% of $1,363.00 in Billed Charges for Rev 272 = $1,363.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OPTI-Q 8FR J-TIP,272,RC,27200236,CDM,,,,,,both,,,744.0000,111.6000,AETNA,AETNA,317.69,,,,,,,192.0300,744.0000,percent of total billed charges,42.7% of $744.00 in Billed Charges for Rev 272 = $317.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTI-Q 8FR J-TIP,272,RC,27200236,CDM,,,,,,both,,,744.0000,111.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,520.80,,,,,,,192.0300,744.0000,percent of total billed charges,Rev 272 $744.00 in Billed Charges at 70% = $520.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTI-Q 8FR J-TIP,272,RC,27200236,CDM,,,,,,both,,,744.0000,111.6000,CIGNA HEALTHCARE,CIGNA HMO,310.25,,,,,,,192.0300,744.0000,percent of total billed charges,41.7% of $744.00 in Billed Charges for Rev 272 = $310.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTI-Q 8FR J-TIP,272,RC,27200236,CDM,,,,,,both,,,744.0000,111.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,345.22,,,,,,,192.0300,744.0000,percent of total billed charges,46.4% of $744.00 in Billed Charges for Rev 272 = $345.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTI-Q 8FR J-TIP,272,RC,27200236,CDM,,,,,,both,,,744.0000,111.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,310.25,,,,,,,192.0300,744.0000,percent of total billed charges,41.7% of $744.00 in Billed Charges for Rev 272 = $310.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTI-Q 8FR J-TIP,272,RC,27200236,CDM,,,,,,both,,,744.0000,111.6000,CIGNA HEALTHCARE,CIGNA PPO,310.25,,,,,,,192.0300,744.0000,percent of total billed charges,41.7% of $744.00 in Billed Charges for Rev 272 = $310.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTI-Q 8FR J-TIP,272,RC,27200236,CDM,,,,,,both,,,744.0000,111.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,669.60,,,,,,,192.0300,744.0000,percent of total billed charges,90% of $744.00 in Billed Charges for Rev 272 = $669.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTI-Q 8FR J-TIP,272,RC,27200236,CDM,,,,,,both,,,744.0000,111.6000,MEDCOST,MEDCOST VHN,354.07,,,,,,,192.0300,744.0000,percent of total billed charges,47.59% of $744.00 in Billed Charges for Rev 272 = $354.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTI-Q 8FR J-TIP,272,RC,27200236,CDM,,,,,,both,,,744.0000,111.6000,SENTARA HEALTH,SENTARA HEALTH,192.03,,,,,,,192.0300,744.0000,percent of total billed charges,25.81% of $744.00 in Billed Charges for Rev 272 = $192.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTI-Q 8FR J-TIP,272,RC,27200236,CDM,,,,,,both,,,744.0000,111.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",744.00,,,,,,,192.0300,744.0000,percent of total billed charges,100% of $744.00 in Billed Charges for Rev 272 = $744.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTI-Q 8FR J-TIP,272,RC,27200236,CDM,,,,,,both,,,744.0000,111.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,372.00,,,,,,,192.0300,744.0000,percent of total billed charges,Rev 272 $744.00 in Billed Charges at 50% = $372.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTI-Q 8FR J-TIP,272,RC,27200236,CDM,,,,,,both,,,744.0000,111.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,240.31,,,,,,,192.0300,744.0000,other,32.3% of $744.00 in Billed Charges for Rev 272 = $240.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH OPTI-Q 8FR J-TIP,272,RC,27200236,CDM,,,,,,both,,,744.0000,111.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,228.41,,,,,,,192.0300,744.0000,other,30.7% of $744.00 in Billed Charges for Rev 272 = $228.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH OPTI-Q 8FR J-TIP,272,RC,27200236,CDM,,,,,,both,,,744.0000,111.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,240.31,,,,,,,192.0300,744.0000,percent of total billed charges,32.3% of $744.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTI-Q 8FR J-TIP,272,RC,27200236,CDM,,,,,,both,,,744.0000,111.6000,WELLCARE,WELLCARE MEDICAID,744.00,,,,,,,192.0300,744.0000,percent of total billed charges,100% of $744.00 in Billed Charges for Rev 272 = $744.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTICATH ABBOTT,272,RC,27200235,CDM,,,,,,both,,,774.0000,116.1000,AETNA,AETNA,330.50,,,,,,,199.7700,774.0000,percent of total billed charges,42.7% of $774.00 in Billed Charges for Rev 272 = $330.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTICATH ABBOTT,272,RC,27200235,CDM,,,,,,both,,,774.0000,116.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,541.80,,,,,,,199.7700,774.0000,percent of total billed charges,Rev 272 $774.00 in Billed Charges at 70% = $541.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTICATH ABBOTT,272,RC,27200235,CDM,,,,,,both,,,774.0000,116.1000,CIGNA HEALTHCARE,CIGNA HMO,322.76,,,,,,,199.7700,774.0000,percent of total billed charges,41.7% of $774.00 in Billed Charges for Rev 272 = $322.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTICATH ABBOTT,272,RC,27200235,CDM,,,,,,both,,,774.0000,116.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,359.14,,,,,,,199.7700,774.0000,percent of total billed charges,46.4% of $774.00 in Billed Charges for Rev 272 = $359.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTICATH ABBOTT,272,RC,27200235,CDM,,,,,,both,,,774.0000,116.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,322.76,,,,,,,199.7700,774.0000,percent of total billed charges,41.7% of $774.00 in Billed Charges for Rev 272 = $322.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTICATH ABBOTT,272,RC,27200235,CDM,,,,,,both,,,774.0000,116.1000,CIGNA HEALTHCARE,CIGNA PPO,322.76,,,,,,,199.7700,774.0000,percent of total billed charges,41.7% of $774.00 in Billed Charges for Rev 272 = $322.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTICATH ABBOTT,272,RC,27200235,CDM,,,,,,both,,,774.0000,116.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,696.60,,,,,,,199.7700,774.0000,percent of total billed charges,90% of $774.00 in Billed Charges for Rev 272 = $696.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTICATH ABBOTT,272,RC,27200235,CDM,,,,,,both,,,774.0000,116.1000,MEDCOST,MEDCOST VHN,368.35,,,,,,,199.7700,774.0000,percent of total billed charges,47.59% of $774.00 in Billed Charges for Rev 272 = $368.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTICATH ABBOTT,272,RC,27200235,CDM,,,,,,both,,,774.0000,116.1000,SENTARA HEALTH,SENTARA HEALTH,199.77,,,,,,,199.7700,774.0000,percent of total billed charges,25.81% of $774.00 in Billed Charges for Rev 272 = $199.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTICATH ABBOTT,272,RC,27200235,CDM,,,,,,both,,,774.0000,116.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",774.00,,,,,,,199.7700,774.0000,percent of total billed charges,100% of $774.00 in Billed Charges for Rev 272 = $774.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTICATH ABBOTT,272,RC,27200235,CDM,,,,,,both,,,774.0000,116.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,387.00,,,,,,,199.7700,774.0000,percent of total billed charges,Rev 272 $774.00 in Billed Charges at 50% = $387.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTICATH ABBOTT,272,RC,27200235,CDM,,,,,,both,,,774.0000,116.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,250.00,,,,,,,199.7700,774.0000,other,32.3% of $774.00 in Billed Charges for Rev 272 = $250.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH OPTICATH ABBOTT,272,RC,27200235,CDM,,,,,,both,,,774.0000,116.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,237.62,,,,,,,199.7700,774.0000,other,30.7% of $774.00 in Billed Charges for Rev 272 = $237.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH OPTICATH ABBOTT,272,RC,27200235,CDM,,,,,,both,,,774.0000,116.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,250.00,,,,,,,199.7700,774.0000,percent of total billed charges,32.3% of $774.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTICATH ABBOTT,272,RC,27200235,CDM,,,,,,both,,,774.0000,116.1000,WELLCARE,WELLCARE MEDICAID,774.00,,,,,,,199.7700,774.0000,percent of total billed charges,100% of $774.00 in Billed Charges for Rev 272 = $774.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OPTIMA 81683,272,RC,27201311,CDM,,,,,,both,,,5210.0000,781.5000,AETNA,AETNA,2224.67,,,,,,,1344.7000,5210.0000,percent of total billed charges,"42.7% of $5,210.00 in Billed Charges for Rev 272 = $2,224.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OPTIMA 81683,272,RC,27201311,CDM,,,,,,both,,,5210.0000,781.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3647.00,,,,,,,1344.7000,5210.0000,percent of total billed charges,"Rev 272 $5,210.00 in Billed Charges at 70% = $3,647.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OPTIMA 81683,272,RC,27201311,CDM,,,,,,both,,,5210.0000,781.5000,CIGNA HEALTHCARE,CIGNA HMO,2172.57,,,,,,,1344.7000,5210.0000,percent of total billed charges,"41.7% of $5,210.00 in Billed Charges for Rev 272 = $2,172.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OPTIMA 81683,272,RC,27201311,CDM,,,,,,both,,,5210.0000,781.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2417.44,,,,,,,1344.7000,5210.0000,percent of total billed charges,"46.4% of $5,210.00 in Billed Charges for Rev 272 = $2,417.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OPTIMA 81683,272,RC,27201311,CDM,,,,,,both,,,5210.0000,781.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2172.57,,,,,,,1344.7000,5210.0000,percent of total billed charges,"41.7% of $5,210.00 in Billed Charges for Rev 272 = $2,172.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OPTIMA 81683,272,RC,27201311,CDM,,,,,,both,,,5210.0000,781.5000,CIGNA HEALTHCARE,CIGNA PPO,2172.57,,,,,,,1344.7000,5210.0000,percent of total billed charges,"41.7% of $5,210.00 in Billed Charges for Rev 272 = $2,172.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OPTIMA 81683,272,RC,27201311,CDM,,,,,,both,,,5210.0000,781.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4689.00,,,,,,,1344.7000,5210.0000,percent of total billed charges,"90% of $5,210.00 in Billed Charges for Rev 272 = $4,689.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OPTIMA 81683,272,RC,27201311,CDM,,,,,,both,,,5210.0000,781.5000,MEDCOST,MEDCOST VHN,2479.44,,,,,,,1344.7000,5210.0000,percent of total billed charges,"47.59% of $5,210.00 in Billed Charges for Rev 272 = $2,479.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OPTIMA 81683,272,RC,27201311,CDM,,,,,,both,,,5210.0000,781.5000,SENTARA HEALTH,SENTARA HEALTH,1344.70,,,,,,,1344.7000,5210.0000,percent of total billed charges,"25.81% of $5,210.00 in Billed Charges for Rev 272 = $1,344.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OPTIMA 81683,272,RC,27201311,CDM,,,,,,both,,,5210.0000,781.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5210.00,,,,,,,1344.7000,5210.0000,percent of total billed charges,"100% of $5,210.00 in Billed Charges for Rev 272 = $5,210.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OPTIMA 81683,272,RC,27201311,CDM,,,,,,both,,,5210.0000,781.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2605.00,,,,,,,1344.7000,5210.0000,percent of total billed charges,"Rev 272 $5,210.00 in Billed Charges at 50% = $2,605.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OPTIMA 81683,272,RC,27201311,CDM,,,,,,both,,,5210.0000,781.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1682.83,,,,,,,1344.7000,5210.0000,other,"32.3% of $5,210.00 in Billed Charges for Rev 272 = $1,682.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH OPTIMA 81683,272,RC,27201311,CDM,,,,,,both,,,5210.0000,781.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1599.47,,,,,,,1344.7000,5210.0000,other,"30.7% of $5,210.00 in Billed Charges for Rev 272 = $1,599.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH OPTIMA 81683,272,RC,27201311,CDM,,,,,,both,,,5210.0000,781.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,1682.83,,,,,,,1344.7000,5210.0000,percent of total billed charges,"32.3% of $5,210.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OPTIMA 81683,272,RC,27201311,CDM,,,,,,both,,,5210.0000,781.5000,WELLCARE,WELLCARE MEDICAID,5210.00,,,,,,,1344.7000,5210.0000,percent of total billed charges,"100% of $5,210.00 in Billed Charges for Rev 272 = $5,210.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK LTD RE-ENTRY,272,RC,27201312,CDM,,,,,,both,,,5656.0000,848.4000,AETNA,AETNA,2415.11,,,,,,,1459.8100,5656.0000,percent of total billed charges,"42.7% of $5,656.00 in Billed Charges for Rev 272 = $2,415.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK LTD RE-ENTRY,272,RC,27201312,CDM,,,,,,both,,,5656.0000,848.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3959.20,,,,,,,1459.8100,5656.0000,percent of total billed charges,"Rev 272 $5,656.00 in Billed Charges at 70% = $3,959.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK LTD RE-ENTRY,272,RC,27201312,CDM,,,,,,both,,,5656.0000,848.4000,CIGNA HEALTHCARE,CIGNA HMO,2358.55,,,,,,,1459.8100,5656.0000,percent of total billed charges,"41.7% of $5,656.00 in Billed Charges for Rev 272 = $2,358.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK LTD RE-ENTRY,272,RC,27201312,CDM,,,,,,both,,,5656.0000,848.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2624.38,,,,,,,1459.8100,5656.0000,percent of total billed charges,"46.4% of $5,656.00 in Billed Charges for Rev 272 = $2,624.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK LTD RE-ENTRY,272,RC,27201312,CDM,,,,,,both,,,5656.0000,848.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2358.55,,,,,,,1459.8100,5656.0000,percent of total billed charges,"41.7% of $5,656.00 in Billed Charges for Rev 272 = $2,358.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK LTD RE-ENTRY,272,RC,27201312,CDM,,,,,,both,,,5656.0000,848.4000,CIGNA HEALTHCARE,CIGNA PPO,2358.55,,,,,,,1459.8100,5656.0000,percent of total billed charges,"41.7% of $5,656.00 in Billed Charges for Rev 272 = $2,358.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK LTD RE-ENTRY,272,RC,27201312,CDM,,,,,,both,,,5656.0000,848.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5090.40,,,,,,,1459.8100,5656.0000,percent of total billed charges,"90% of $5,656.00 in Billed Charges for Rev 272 = $5,090.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK LTD RE-ENTRY,272,RC,27201312,CDM,,,,,,both,,,5656.0000,848.4000,MEDCOST,MEDCOST VHN,2691.69,,,,,,,1459.8100,5656.0000,percent of total billed charges,"47.59% of $5,656.00 in Billed Charges for Rev 272 = $2,691.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK LTD RE-ENTRY,272,RC,27201312,CDM,,,,,,both,,,5656.0000,848.4000,SENTARA HEALTH,SENTARA HEALTH,1459.81,,,,,,,1459.8100,5656.0000,percent of total billed charges,"25.81% of $5,656.00 in Billed Charges for Rev 272 = $1,459.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK LTD RE-ENTRY,272,RC,27201312,CDM,,,,,,both,,,5656.0000,848.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5656.00,,,,,,,1459.8100,5656.0000,percent of total billed charges,"100% of $5,656.00 in Billed Charges for Rev 272 = $5,656.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK LTD RE-ENTRY,272,RC,27201312,CDM,,,,,,both,,,5656.0000,848.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2828.00,,,,,,,1459.8100,5656.0000,percent of total billed charges,"Rev 272 $5,656.00 in Billed Charges at 50% = $2,828.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK LTD RE-ENTRY,272,RC,27201312,CDM,,,,,,both,,,5656.0000,848.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1826.89,,,,,,,1459.8100,5656.0000,other,"32.3% of $5,656.00 in Billed Charges for Rev 272 = $1,826.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH OUTBACK LTD RE-ENTRY,272,RC,27201312,CDM,,,,,,both,,,5656.0000,848.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1736.39,,,,,,,1459.8100,5656.0000,other,"30.7% of $5,656.00 in Billed Charges for Rev 272 = $1,736.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH OUTBACK LTD RE-ENTRY,272,RC,27201312,CDM,,,,,,both,,,5656.0000,848.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,1826.89,,,,,,,1459.8100,5656.0000,percent of total billed charges,"32.3% of $5,656.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK LTD RE-ENTRY,272,RC,27201312,CDM,,,,,,both,,,5656.0000,848.4000,WELLCARE,WELLCARE MEDICAID,5656.00,,,,,,,1459.8100,5656.0000,percent of total billed charges,"100% of $5,656.00 in Billed Charges for Rev 272 = $5,656.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH SIZING,272,RC,27200523,CDM,,,,,,both,,,160.0000,24.0000,AETNA,AETNA,68.32,,,,,,,41.3000,160.0000,percent of total billed charges,42.7% of $160.00 in Billed Charges for Rev 272 = $68.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SIZING,272,RC,27200523,CDM,,,,,,both,,,160.0000,24.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,112.00,,,,,,,41.3000,160.0000,percent of total billed charges,Rev 272 $160.00 in Billed Charges at 70% = $112.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SIZING,272,RC,27200523,CDM,,,,,,both,,,160.0000,24.0000,CIGNA HEALTHCARE,CIGNA HMO,66.72,,,,,,,41.3000,160.0000,percent of total billed charges,41.7% of $160.00 in Billed Charges for Rev 272 = $66.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SIZING,272,RC,27200523,CDM,,,,,,both,,,160.0000,24.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,74.24,,,,,,,41.3000,160.0000,percent of total billed charges,46.4% of $160.00 in Billed Charges for Rev 272 = $74.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SIZING,272,RC,27200523,CDM,,,,,,both,,,160.0000,24.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,66.72,,,,,,,41.3000,160.0000,percent of total billed charges,41.7% of $160.00 in Billed Charges for Rev 272 = $66.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SIZING,272,RC,27200523,CDM,,,,,,both,,,160.0000,24.0000,CIGNA HEALTHCARE,CIGNA PPO,66.72,,,,,,,41.3000,160.0000,percent of total billed charges,41.7% of $160.00 in Billed Charges for Rev 272 = $66.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SIZING,272,RC,27200523,CDM,,,,,,both,,,160.0000,24.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,144.00,,,,,,,41.3000,160.0000,percent of total billed charges,90% of $160.00 in Billed Charges for Rev 272 = $144.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SIZING,272,RC,27200523,CDM,,,,,,both,,,160.0000,24.0000,MEDCOST,MEDCOST VHN,76.14,,,,,,,41.3000,160.0000,percent of total billed charges,47.59% of $160.00 in Billed Charges for Rev 272 = $76.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SIZING,272,RC,27200523,CDM,,,,,,both,,,160.0000,24.0000,SENTARA HEALTH,SENTARA HEALTH,41.30,,,,,,,41.3000,160.0000,percent of total billed charges,25.81% of $160.00 in Billed Charges for Rev 272 = $41.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SIZING,272,RC,27200523,CDM,,,,,,both,,,160.0000,24.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",160.00,,,,,,,41.3000,160.0000,percent of total billed charges,100% of $160.00 in Billed Charges for Rev 272 = $160.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SIZING,272,RC,27200523,CDM,,,,,,both,,,160.0000,24.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,80.00,,,,,,,41.3000,160.0000,percent of total billed charges,Rev 272 $160.00 in Billed Charges at 50% = $80.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SIZING,272,RC,27200523,CDM,,,,,,both,,,160.0000,24.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,51.68,,,,,,,41.3000,160.0000,other,32.3% of $160.00 in Billed Charges for Rev 272 = $51.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH SIZING,272,RC,27200523,CDM,,,,,,both,,,160.0000,24.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,49.12,,,,,,,41.3000,160.0000,other,30.7% of $160.00 in Billed Charges for Rev 272 = $49.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH SIZING,272,RC,27200523,CDM,,,,,,both,,,160.0000,24.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,51.68,,,,,,,41.3000,160.0000,percent of total billed charges,32.3% of $160.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SIZING,272,RC,27200523,CDM,,,,,,both,,,160.0000,24.0000,WELLCARE,WELLCARE MEDICAID,160.00,,,,,,,41.3000,160.0000,percent of total billed charges,100% of $160.00 in Billed Charges for Rev 272 = $160.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUREVAC SGL AU TRANS,270,RC,27000194,CDM,,,,,,both,,,170.0000,25.5000,AETNA,AETNA,72.59,,,,,,,43.8800,170.0000,percent of total billed charges,42.7% of $170.00 in Billed Charges for Rev 270 = $72.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUREVAC SGL AU TRANS,270,RC,27000194,CDM,,,,,,both,,,170.0000,25.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,119.00,,,,,,,43.8800,170.0000,percent of total billed charges,Rev 270 $170.00 in Billed Charges at 70% = $119.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUREVAC SGL AU TRANS,270,RC,27000194,CDM,,,,,,both,,,170.0000,25.5000,CIGNA HEALTHCARE,CIGNA HMO,70.89,,,,,,,43.8800,170.0000,percent of total billed charges,41.7% of $170.00 in Billed Charges for Rev 270 = $70.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUREVAC SGL AU TRANS,270,RC,27000194,CDM,,,,,,both,,,170.0000,25.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,78.88,,,,,,,43.8800,170.0000,percent of total billed charges,46.4% of $170.00 in Billed Charges for Rev 270 = $78.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUREVAC SGL AU TRANS,270,RC,27000194,CDM,,,,,,both,,,170.0000,25.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,70.89,,,,,,,43.8800,170.0000,percent of total billed charges,41.7% of $170.00 in Billed Charges for Rev 270 = $70.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUREVAC SGL AU TRANS,270,RC,27000194,CDM,,,,,,both,,,170.0000,25.5000,CIGNA HEALTHCARE,CIGNA PPO,70.89,,,,,,,43.8800,170.0000,percent of total billed charges,41.7% of $170.00 in Billed Charges for Rev 270 = $70.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUREVAC SGL AU TRANS,270,RC,27000194,CDM,,,,,,both,,,170.0000,25.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,153.00,,,,,,,43.8800,170.0000,percent of total billed charges,90% of $170.00 in Billed Charges for Rev 270 = $153.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUREVAC SGL AU TRANS,270,RC,27000194,CDM,,,,,,both,,,170.0000,25.5000,MEDCOST,MEDCOST VHN,80.90,,,,,,,43.8800,170.0000,percent of total billed charges,47.59% of $170.00 in Billed Charges for Rev 270 = $80.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUREVAC SGL AU TRANS,270,RC,27000194,CDM,,,,,,both,,,170.0000,25.5000,SENTARA HEALTH,SENTARA HEALTH,43.88,,,,,,,43.8800,170.0000,percent of total billed charges,25.81% of $170.00 in Billed Charges for Rev 270 = $43.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUREVAC SGL AU TRANS,270,RC,27000194,CDM,,,,,,both,,,170.0000,25.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",170.00,,,,,,,43.8800,170.0000,percent of total billed charges,100% of $170.00 in Billed Charges for Rev 270 = $170.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUREVAC SGL AU TRANS,270,RC,27000194,CDM,,,,,,both,,,170.0000,25.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,85.00,,,,,,,43.8800,170.0000,percent of total billed charges,Rev 270 $170.00 in Billed Charges at 50% = $85.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUREVAC SGL AU TRANS,270,RC,27000194,CDM,,,,,,both,,,170.0000,25.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,54.91,,,,,,,43.8800,170.0000,other,32.3% of $170.00 in Billed Charges for Rev 270 = $54.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEUREVAC SGL AU TRANS,270,RC,27000194,CDM,,,,,,both,,,170.0000,25.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,52.19,,,,,,,43.8800,170.0000,other,30.7% of $170.00 in Billed Charges for Rev 270 = $52.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEUREVAC SGL AU TRANS,270,RC,27000194,CDM,,,,,,both,,,170.0000,25.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,54.91,,,,,,,43.8800,170.0000,percent of total billed charges,32.3% of $170.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLEUREVAC SGL AU TRANS,270,RC,27000194,CDM,,,,,,both,,,170.0000,25.5000,WELLCARE,WELLCARE MEDICAID,170.00,,,,,,,43.8800,170.0000,percent of total billed charges,100% of $170.00 in Billed Charges for Rev 270 = $170.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLUG MVP MICROVASCULAR,278,RC,27800597,CDM,,,,,,both,,,4765.0000,714.7500,AETNA,AETNA,2287.20,,,,,,,1229.8500,4765.0000,percent of total billed charges,"48% of $4,765.00 in Billed Charges for Rev 278 = $2,287.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLUG MVP MICROVASCULAR,278,RC,27800597,CDM,,,,,,both,,,4765.0000,714.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2382.50,,,,,,,1229.8500,4765.0000,percent of total billed charges,"50% of $4,765.00 in Billed Charges for Rev 278 = $2,382.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLUG MVP MICROVASCULAR,278,RC,27800597,CDM,,,,,,both,,,4765.0000,714.7500,CIGNA HEALTHCARE,CIGNA HMO,1987.01,,,,,,,1229.8500,4765.0000,percent of total billed charges,"41.7% of $4,765.00 in Billed Charges for Rev 278 = $1,987.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLUG MVP MICROVASCULAR,278,RC,27800597,CDM,,,,,,both,,,4765.0000,714.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1906.00,,,,,,,1229.8500,4765.0000,percent of total billed charges,"40% of $4,765.00 in Billed Charges for Rev 278 = $1,906.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLUG MVP MICROVASCULAR,278,RC,27800597,CDM,,,,,,both,,,4765.0000,714.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1987.01,,,,,,,1229.8500,4765.0000,percent of total billed charges,"41.7% of $4,765.00 in Billed Charges for Rev 278 = $1,987.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLUG MVP MICROVASCULAR,278,RC,27800597,CDM,,,,,,both,,,4765.0000,714.7500,CIGNA HEALTHCARE,CIGNA PPO,1987.01,,,,,,,1229.8500,4765.0000,percent of total billed charges,"41.7% of $4,765.00 in Billed Charges for Rev 278 = $1,987.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLUG MVP MICROVASCULAR,278,RC,27800597,CDM,,,,,,both,,,4765.0000,714.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4288.50,,,,,,,1229.8500,4765.0000,percent of total billed charges,"90% of $4,765.00 in Billed Charges for Rev 278 = $4,288.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLUG MVP MICROVASCULAR,278,RC,27800597,CDM,,,,,,both,,,4765.0000,714.7500,MEDCOST,MEDCOST VHN,2267.66,,,,,,,1229.8500,4765.0000,percent of total billed charges,"47.59% of $4,765.00 in Billed Charges for Rev 278 = $2,267.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLUG MVP MICROVASCULAR,278,RC,27800597,CDM,,,,,,both,,,4765.0000,714.7500,SENTARA HEALTH,SENTARA HEALTH,1229.85,,,,,,,1229.8500,4765.0000,percent of total billed charges,"25.81% of $4,765.00 in Billed Charges for Rev 278 = $1,229.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLUG MVP MICROVASCULAR,278,RC,27800597,CDM,,,,,,both,,,4765.0000,714.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4765.00,,,,,,,1229.8500,4765.0000,percent of total billed charges,"100% of $4,765.00 in Billed Charges for Rev 278 = $4,765.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLUG MVP MICROVASCULAR,278,RC,27800597,CDM,,,,,,both,,,4765.0000,714.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2382.50,,,,,,,1229.8500,4765.0000,percent of total billed charges,"Rev 278 $4,765.00 in Billed Charges at 50% = $2,382.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLUG MVP MICROVASCULAR,278,RC,27800597,CDM,,,,,,both,,,4765.0000,714.7500,WELLCARE,WELLCARE MEDICAID,4765.00,,,,,,,1229.8500,4765.0000,percent of total billed charges,"100% of $4,765.00 in Billed Charges for Rev 278 = $4,765.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLUG NSP VASCULAR 4MM X 100CM TO 22MM X 100CM,278,RC,27800540,CDM,,,,,,both,,,2523.0000,378.4500,AETNA,AETNA,1211.04,,,,,,,651.1900,2523.0000,percent of total billed charges,"48% of $2,523.00 in Billed Charges for Rev 278 = $1,211.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLUG NSP VASCULAR 4MM X 100CM TO 22MM X 100CM,278,RC,27800540,CDM,,,,,,both,,,2523.0000,378.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1261.50,,,,,,,651.1900,2523.0000,percent of total billed charges,"50% of $2,523.00 in Billed Charges for Rev 278 = $1,261.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLUG NSP VASCULAR 4MM X 100CM TO 22MM X 100CM,278,RC,27800540,CDM,,,,,,both,,,2523.0000,378.4500,CIGNA HEALTHCARE,CIGNA HMO,1052.09,,,,,,,651.1900,2523.0000,percent of total billed charges,"41.7% of $2,523.00 in Billed Charges for Rev 278 = $1,052.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLUG NSP VASCULAR 4MM X 100CM TO 22MM X 100CM,278,RC,27800540,CDM,,,,,,both,,,2523.0000,378.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1009.20,,,,,,,651.1900,2523.0000,percent of total billed charges,"40% of $2,523.00 in Billed Charges for Rev 278 = $1,009.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLUG NSP VASCULAR 4MM X 100CM TO 22MM X 100CM,278,RC,27800540,CDM,,,,,,both,,,2523.0000,378.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1052.09,,,,,,,651.1900,2523.0000,percent of total billed charges,"41.7% of $2,523.00 in Billed Charges for Rev 278 = $1,052.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLUG NSP VASCULAR 4MM X 100CM TO 22MM X 100CM,278,RC,27800540,CDM,,,,,,both,,,2523.0000,378.4500,CIGNA HEALTHCARE,CIGNA PPO,1052.09,,,,,,,651.1900,2523.0000,percent of total billed charges,"41.7% of $2,523.00 in Billed Charges for Rev 278 = $1,052.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLUG NSP VASCULAR 4MM X 100CM TO 22MM X 100CM,278,RC,27800540,CDM,,,,,,both,,,2523.0000,378.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2270.70,,,,,,,651.1900,2523.0000,percent of total billed charges,"90% of $2,523.00 in Billed Charges for Rev 278 = $2,270.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLUG NSP VASCULAR 4MM X 100CM TO 22MM X 100CM,278,RC,27800540,CDM,,,,,,both,,,2523.0000,378.4500,MEDCOST,MEDCOST VHN,1200.70,,,,,,,651.1900,2523.0000,percent of total billed charges,"47.59% of $2,523.00 in Billed Charges for Rev 278 = $1,200.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLUG NSP VASCULAR 4MM X 100CM TO 22MM X 100CM,278,RC,27800540,CDM,,,,,,both,,,2523.0000,378.4500,SENTARA HEALTH,SENTARA HEALTH,651.19,,,,,,,651.1900,2523.0000,percent of total billed charges,"25.81% of $2,523.00 in Billed Charges for Rev 278 = $651.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLUG NSP VASCULAR 4MM X 100CM TO 22MM X 100CM,278,RC,27800540,CDM,,,,,,both,,,2523.0000,378.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2523.00,,,,,,,651.1900,2523.0000,percent of total billed charges,"100% of $2,523.00 in Billed Charges for Rev 278 = $2,523.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLUG NSP VASCULAR 4MM X 100CM TO 22MM X 100CM,278,RC,27800540,CDM,,,,,,both,,,2523.0000,378.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1261.50,,,,,,,651.1900,2523.0000,percent of total billed charges,"Rev 278 $2,523.00 in Billed Charges at 50% = $1,261.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLUG NSP VASCULAR 4MM X 100CM TO 22MM X 100CM,278,RC,27800540,CDM,,,,,,both,,,2523.0000,378.4500,WELLCARE,WELLCARE MEDICAID,2523.00,,,,,,,651.1900,2523.0000,percent of total billed charges,"100% of $2,523.00 in Billed Charges for Rev 278 = $2,523.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PNEUMOTHORAX HEIMLICH,272,RC,27201005,CDM,,,,,,both,,,345.0000,51.7500,AETNA,AETNA,147.32,,,,,,,89.0400,345.0000,percent of total billed charges,42.7% of $345.00 in Billed Charges for Rev 272 = $147.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PNEUMOTHORAX HEIMLICH,272,RC,27201005,CDM,,,,,,both,,,345.0000,51.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,241.50,,,,,,,89.0400,345.0000,percent of total billed charges,Rev 272 $345.00 in Billed Charges at 70% = $241.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PNEUMOTHORAX HEIMLICH,272,RC,27201005,CDM,,,,,,both,,,345.0000,51.7500,CIGNA HEALTHCARE,CIGNA HMO,143.87,,,,,,,89.0400,345.0000,percent of total billed charges,41.7% of $345.00 in Billed Charges for Rev 272 = $143.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PNEUMOTHORAX HEIMLICH,272,RC,27201005,CDM,,,,,,both,,,345.0000,51.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,160.08,,,,,,,89.0400,345.0000,percent of total billed charges,46.4% of $345.00 in Billed Charges for Rev 272 = $160.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PNEUMOTHORAX HEIMLICH,272,RC,27201005,CDM,,,,,,both,,,345.0000,51.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,143.87,,,,,,,89.0400,345.0000,percent of total billed charges,41.7% of $345.00 in Billed Charges for Rev 272 = $143.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PNEUMOTHORAX HEIMLICH,272,RC,27201005,CDM,,,,,,both,,,345.0000,51.7500,CIGNA HEALTHCARE,CIGNA PPO,143.87,,,,,,,89.0400,345.0000,percent of total billed charges,41.7% of $345.00 in Billed Charges for Rev 272 = $143.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PNEUMOTHORAX HEIMLICH,272,RC,27201005,CDM,,,,,,both,,,345.0000,51.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,310.50,,,,,,,89.0400,345.0000,percent of total billed charges,90% of $345.00 in Billed Charges for Rev 272 = $310.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PNEUMOTHORAX HEIMLICH,272,RC,27201005,CDM,,,,,,both,,,345.0000,51.7500,MEDCOST,MEDCOST VHN,164.19,,,,,,,89.0400,345.0000,percent of total billed charges,47.59% of $345.00 in Billed Charges for Rev 272 = $164.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PNEUMOTHORAX HEIMLICH,272,RC,27201005,CDM,,,,,,both,,,345.0000,51.7500,SENTARA HEALTH,SENTARA HEALTH,89.04,,,,,,,89.0400,345.0000,percent of total billed charges,25.81% of $345.00 in Billed Charges for Rev 272 = $89.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PNEUMOTHORAX HEIMLICH,272,RC,27201005,CDM,,,,,,both,,,345.0000,51.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",345.00,,,,,,,89.0400,345.0000,percent of total billed charges,100% of $345.00 in Billed Charges for Rev 272 = $345.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PNEUMOTHORAX HEIMLICH,272,RC,27201005,CDM,,,,,,both,,,345.0000,51.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,172.50,,,,,,,89.0400,345.0000,percent of total billed charges,Rev 272 $345.00 in Billed Charges at 50% = $172.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PNEUMOTHORAX HEIMLICH,272,RC,27201005,CDM,,,,,,both,,,345.0000,51.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,111.44,,,,,,,89.0400,345.0000,other,32.3% of $345.00 in Billed Charges for Rev 272 = $111.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PNEUMOTHORAX HEIMLICH,272,RC,27201005,CDM,,,,,,both,,,345.0000,51.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,105.92,,,,,,,89.0400,345.0000,other,30.7% of $345.00 in Billed Charges for Rev 272 = $105.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PNEUMOTHORAX HEIMLICH,272,RC,27201005,CDM,,,,,,both,,,345.0000,51.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,111.44,,,,,,,89.0400,345.0000,percent of total billed charges,32.3% of $345.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PNEUMOTHORAX HEIMLICH,272,RC,27201005,CDM,,,,,,both,,,345.0000,51.7500,WELLCARE,WELLCARE MEDICAID,345.00,,,,,,,89.0400,345.0000,percent of total billed charges,100% of $345.00 in Billed Charges for Rev 272 = $345.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POUCH DRAINAGE WOUND EAKIN FISTULA 11.4 X 5.1 IN,272,RC,27202008,CDM,,,,,,both,,,134.0000,20.1000,AETNA,AETNA,57.22,,,,,,,34.5900,134.0000,percent of total billed charges,42.7% of $134.00 in Billed Charges for Rev 272 = $57.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POUCH DRAINAGE WOUND EAKIN FISTULA 11.4 X 5.1 IN,272,RC,27202008,CDM,,,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,93.80,,,,,,,34.5900,134.0000,percent of total billed charges,Rev 272 $134.00 in Billed Charges at 70% = $93.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POUCH DRAINAGE WOUND EAKIN FISTULA 11.4 X 5.1 IN,272,RC,27202008,CDM,,,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA HMO,55.88,,,,,,,34.5900,134.0000,percent of total billed charges,41.7% of $134.00 in Billed Charges for Rev 272 = $55.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POUCH DRAINAGE WOUND EAKIN FISTULA 11.4 X 5.1 IN,272,RC,27202008,CDM,,,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,62.18,,,,,,,34.5900,134.0000,percent of total billed charges,46.4% of $134.00 in Billed Charges for Rev 272 = $62.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POUCH DRAINAGE WOUND EAKIN FISTULA 11.4 X 5.1 IN,272,RC,27202008,CDM,,,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,55.88,,,,,,,34.5900,134.0000,percent of total billed charges,41.7% of $134.00 in Billed Charges for Rev 272 = $55.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POUCH DRAINAGE WOUND EAKIN FISTULA 11.4 X 5.1 IN,272,RC,27202008,CDM,,,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA PPO,55.88,,,,,,,34.5900,134.0000,percent of total billed charges,41.7% of $134.00 in Billed Charges for Rev 272 = $55.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POUCH DRAINAGE WOUND EAKIN FISTULA 11.4 X 5.1 IN,272,RC,27202008,CDM,,,,,,both,,,134.0000,20.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,120.60,,,,,,,34.5900,134.0000,percent of total billed charges,90% of $134.00 in Billed Charges for Rev 272 = $120.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POUCH DRAINAGE WOUND EAKIN FISTULA 11.4 X 5.1 IN,272,RC,27202008,CDM,,,,,,both,,,134.0000,20.1000,MEDCOST,MEDCOST VHN,63.77,,,,,,,34.5900,134.0000,percent of total billed charges,47.59% of $134.00 in Billed Charges for Rev 272 = $63.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POUCH DRAINAGE WOUND EAKIN FISTULA 11.4 X 5.1 IN,272,RC,27202008,CDM,,,,,,both,,,134.0000,20.1000,SENTARA HEALTH,SENTARA HEALTH,34.59,,,,,,,34.5900,134.0000,percent of total billed charges,25.81% of $134.00 in Billed Charges for Rev 272 = $34.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POUCH DRAINAGE WOUND EAKIN FISTULA 11.4 X 5.1 IN,272,RC,27202008,CDM,,,,,,both,,,134.0000,20.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",134.00,,,,,,,34.5900,134.0000,percent of total billed charges,100% of $134.00 in Billed Charges for Rev 272 = $134.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POUCH DRAINAGE WOUND EAKIN FISTULA 11.4 X 5.1 IN,272,RC,27202008,CDM,,,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,67.00,,,,,,,34.5900,134.0000,percent of total billed charges,Rev 272 $134.00 in Billed Charges at 50% = $67.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POUCH DRAINAGE WOUND EAKIN FISTULA 11.4 X 5.1 IN,272,RC,27202008,CDM,,,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,43.28,,,,,,,34.5900,134.0000,other,32.3% of $134.00 in Billed Charges for Rev 272 = $43.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POUCH DRAINAGE WOUND EAKIN FISTULA 11.4 X 5.1 IN,272,RC,27202008,CDM,,,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,41.14,,,,,,,34.5900,134.0000,other,30.7% of $134.00 in Billed Charges for Rev 272 = $41.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POUCH DRAINAGE WOUND EAKIN FISTULA 11.4 X 5.1 IN,272,RC,27202008,CDM,,,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,43.28,,,,,,,34.5900,134.0000,percent of total billed charges,32.3% of $134.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC POUCH DRAINAGE WOUND EAKIN FISTULA 11.4 X 5.1 IN,272,RC,27202008,CDM,,,,,,both,,,134.0000,20.1000,WELLCARE,WELLCARE MEDICAID,134.00,,,,,,,34.5900,134.0000,percent of total billed charges,100% of $134.00 in Billed Charges for Rev 272 = $134.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 3/4"" 401514",270,RC,27000050,CDM,,,,,,both,,,8.0000,1.2000,AETNA,AETNA,3.42,,,,,,,2.0600,8.0000,percent of total billed charges,42.7% of $8.00 in Billed Charges for Rev 270 = $3.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 3/4"" 401514",270,RC,27000050,CDM,,,,,,both,,,8.0000,1.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5.60,,,,,,,2.0600,8.0000,percent of total billed charges,Rev 270 $8.00 in Billed Charges at 70% = $5.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 3/4"" 401514",270,RC,27000050,CDM,,,,,,both,,,8.0000,1.2000,CIGNA HEALTHCARE,CIGNA HMO,3.34,,,,,,,2.0600,8.0000,percent of total billed charges,41.7% of $8.00 in Billed Charges for Rev 270 = $3.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 3/4"" 401514",270,RC,27000050,CDM,,,,,,both,,,8.0000,1.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3.71,,,,,,,2.0600,8.0000,percent of total billed charges,46.4% of $8.00 in Billed Charges for Rev 270 = $3.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 3/4"" 401514",270,RC,27000050,CDM,,,,,,both,,,8.0000,1.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3.34,,,,,,,2.0600,8.0000,percent of total billed charges,41.7% of $8.00 in Billed Charges for Rev 270 = $3.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 3/4"" 401514",270,RC,27000050,CDM,,,,,,both,,,8.0000,1.2000,CIGNA HEALTHCARE,CIGNA PPO,3.34,,,,,,,2.0600,8.0000,percent of total billed charges,41.7% of $8.00 in Billed Charges for Rev 270 = $3.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 3/4"" 401514",270,RC,27000050,CDM,,,,,,both,,,8.0000,1.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7.20,,,,,,,2.0600,8.0000,percent of total billed charges,90% of $8.00 in Billed Charges for Rev 270 = $7.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 3/4"" 401514",270,RC,27000050,CDM,,,,,,both,,,8.0000,1.2000,MEDCOST,MEDCOST VHN,3.81,,,,,,,2.0600,8.0000,percent of total billed charges,47.59% of $8.00 in Billed Charges for Rev 270 = $3.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 3/4"" 401514",270,RC,27000050,CDM,,,,,,both,,,8.0000,1.2000,SENTARA HEALTH,SENTARA HEALTH,2.06,,,,,,,2.0600,8.0000,percent of total billed charges,25.81% of $8.00 in Billed Charges for Rev 270 = $2.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 3/4"" 401514",270,RC,27000050,CDM,,,,,,both,,,8.0000,1.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8.00,,,,,,,2.0600,8.0000,percent of total billed charges,100% of $8.00 in Billed Charges for Rev 270 = $8.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 3/4"" 401514",270,RC,27000050,CDM,,,,,,both,,,8.0000,1.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4.00,,,,,,,2.0600,8.0000,percent of total billed charges,Rev 270 $8.00 in Billed Charges at 50% = $4.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 3/4"" 401514",270,RC,27000050,CDM,,,,,,both,,,8.0000,1.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2.58,,,,,,,2.0600,8.0000,other,32.3% of $8.00 in Billed Charges for Rev 270 = $2.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
"HC POUCH STOMACH 2 3/4"" 401514",270,RC,27000050,CDM,,,,,,both,,,8.0000,1.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2.46,,,,,,,2.0600,8.0000,other,30.7% of $8.00 in Billed Charges for Rev 270 = $2.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
"HC POUCH STOMACH 2 3/4"" 401514",270,RC,27000050,CDM,,,,,,both,,,8.0000,1.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,2.58,,,,,,,2.0600,8.0000,percent of total billed charges,32.3% of $8.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC POUCH STOMACH 2 3/4"" 401514",270,RC,27000050,CDM,,,,,,both,,,8.0000,1.2000,WELLCARE,WELLCARE MEDICAID,8.00,,,,,,,2.0600,8.0000,percent of total billed charges,100% of $8.00 in Billed Charges for Rev 270 = $8.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATHETER OCCLUSION 7FR ER-REBOA,272,RC,27202239,CDM,,,,,,both,,,35329.0000,5299.3500,AETNA,AETNA,15085.48,,,,,,,9118.4100,35329.0000,percent of total billed charges,"42.7% of $35,329.00 in Billed Charges for Rev 272 = $15,085.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATHETER OCCLUSION 7FR ER-REBOA,272,RC,27202239,CDM,,,,,,both,,,35329.0000,5299.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,24730.30,,,,,,,9118.4100,35329.0000,percent of total billed charges,"Rev 272 $35,329.00 in Billed Charges at 70% = $24,730.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATHETER OCCLUSION 7FR ER-REBOA,272,RC,27202239,CDM,,,,,,both,,,35329.0000,5299.3500,CIGNA HEALTHCARE,CIGNA HMO,14732.19,,,,,,,9118.4100,35329.0000,percent of total billed charges,"41.7% of $35,329.00 in Billed Charges for Rev 272 = $14,732.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATHETER OCCLUSION 7FR ER-REBOA,272,RC,27202239,CDM,,,,,,both,,,35329.0000,5299.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,16392.66,,,,,,,9118.4100,35329.0000,percent of total billed charges,"46.4% of $35,329.00 in Billed Charges for Rev 272 = $16,392.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATHETER OCCLUSION 7FR ER-REBOA,272,RC,27202239,CDM,,,,,,both,,,35329.0000,5299.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,14732.19,,,,,,,9118.4100,35329.0000,percent of total billed charges,"41.7% of $35,329.00 in Billed Charges for Rev 272 = $14,732.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATHETER OCCLUSION 7FR ER-REBOA,272,RC,27202239,CDM,,,,,,both,,,35329.0000,5299.3500,CIGNA HEALTHCARE,CIGNA PPO,14732.19,,,,,,,9118.4100,35329.0000,percent of total billed charges,"41.7% of $35,329.00 in Billed Charges for Rev 272 = $14,732.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATHETER OCCLUSION 7FR ER-REBOA,272,RC,27202239,CDM,,,,,,both,,,35329.0000,5299.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,31796.10,,,,,,,9118.4100,35329.0000,percent of total billed charges,"90% of $35,329.00 in Billed Charges for Rev 272 = $31,796.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATHETER OCCLUSION 7FR ER-REBOA,272,RC,27202239,CDM,,,,,,both,,,35329.0000,5299.3500,MEDCOST,MEDCOST VHN,16813.07,,,,,,,9118.4100,35329.0000,percent of total billed charges,"47.59% of $35,329.00 in Billed Charges for Rev 272 = $16,813.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATHETER OCCLUSION 7FR ER-REBOA,272,RC,27202239,CDM,,,,,,both,,,35329.0000,5299.3500,SENTARA HEALTH,SENTARA HEALTH,9118.41,,,,,,,9118.4100,35329.0000,percent of total billed charges,"25.81% of $35,329.00 in Billed Charges for Rev 272 = $9,118.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATHETER OCCLUSION 7FR ER-REBOA,272,RC,27202239,CDM,,,,,,both,,,35329.0000,5299.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",35329.00,,,,,,,9118.4100,35329.0000,percent of total billed charges,"100% of $35,329.00 in Billed Charges for Rev 272 = $35,329.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATHETER OCCLUSION 7FR ER-REBOA,272,RC,27202239,CDM,,,,,,both,,,35329.0000,5299.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,17664.50,,,,,,,9118.4100,35329.0000,percent of total billed charges,"Rev 272 $35,329.00 in Billed Charges at 50% = $17,664.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATHETER OCCLUSION 7FR ER-REBOA,272,RC,27202239,CDM,,,,,,both,,,35329.0000,5299.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,11411.27,,,,,,,9118.4100,35329.0000,other,"32.3% of $35,329.00 in Billed Charges for Rev 272 = $11,411.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATHETER OCCLUSION 7FR ER-REBOA,272,RC,27202239,CDM,,,,,,both,,,35329.0000,5299.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,10846.00,,,,,,,9118.4100,35329.0000,other,"30.7% of $35,329.00 in Billed Charges for Rev 272 = $10,846.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATHETER OCCLUSION 7FR ER-REBOA,272,RC,27202239,CDM,,,,,,both,,,35329.0000,5299.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,11411.27,,,,,,,9118.4100,35329.0000,percent of total billed charges,"32.3% of $35,329.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATHETER OCCLUSION 7FR ER-REBOA,272,RC,27202239,CDM,,,,,,both,,,35329.0000,5299.3500,WELLCARE,WELLCARE MEDICAID,35329.00,,,,,,,9118.4100,35329.0000,percent of total billed charges,"100% of $35,329.00 in Billed Charges for Rev 272 = $35,329.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATHETER TRUE FLOW VALVUOPLASTY PERFUSION,278,RC,27800604,CDM,,,,,,both,,,3317.0000,497.5500,AETNA,AETNA,1592.16,,,,,,,856.1200,3317.0000,percent of total billed charges,"48% of $3,317.00 in Billed Charges for Rev 278 = $1,592.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATHETER TRUE FLOW VALVUOPLASTY PERFUSION,278,RC,27800604,CDM,,,,,,both,,,3317.0000,497.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1658.50,,,,,,,856.1200,3317.0000,percent of total billed charges,"50% of $3,317.00 in Billed Charges for Rev 278 = $1,658.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATHETER TRUE FLOW VALVUOPLASTY PERFUSION,278,RC,27800604,CDM,,,,,,both,,,3317.0000,497.5500,CIGNA HEALTHCARE,CIGNA HMO,1383.19,,,,,,,856.1200,3317.0000,percent of total billed charges,"41.7% of $3,317.00 in Billed Charges for Rev 278 = $1,383.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATHETER TRUE FLOW VALVUOPLASTY PERFUSION,278,RC,27800604,CDM,,,,,,both,,,3317.0000,497.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1326.80,,,,,,,856.1200,3317.0000,percent of total billed charges,"40% of $3,317.00 in Billed Charges for Rev 278 = $1,326.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATHETER TRUE FLOW VALVUOPLASTY PERFUSION,278,RC,27800604,CDM,,,,,,both,,,3317.0000,497.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1383.19,,,,,,,856.1200,3317.0000,percent of total billed charges,"41.7% of $3,317.00 in Billed Charges for Rev 278 = $1,383.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATHETER TRUE FLOW VALVUOPLASTY PERFUSION,278,RC,27800604,CDM,,,,,,both,,,3317.0000,497.5500,CIGNA HEALTHCARE,CIGNA PPO,1383.19,,,,,,,856.1200,3317.0000,percent of total billed charges,"41.7% of $3,317.00 in Billed Charges for Rev 278 = $1,383.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATHETER TRUE FLOW VALVUOPLASTY PERFUSION,278,RC,27800604,CDM,,,,,,both,,,3317.0000,497.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2985.30,,,,,,,856.1200,3317.0000,percent of total billed charges,"90% of $3,317.00 in Billed Charges for Rev 278 = $2,985.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATHETER TRUE FLOW VALVUOPLASTY PERFUSION,278,RC,27800604,CDM,,,,,,both,,,3317.0000,497.5500,MEDCOST,MEDCOST VHN,1578.56,,,,,,,856.1200,3317.0000,percent of total billed charges,"47.59% of $3,317.00 in Billed Charges for Rev 278 = $1,578.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATHETER TRUE FLOW VALVUOPLASTY PERFUSION,278,RC,27800604,CDM,,,,,,both,,,3317.0000,497.5500,SENTARA HEALTH,SENTARA HEALTH,856.12,,,,,,,856.1200,3317.0000,percent of total billed charges,"25.81% of $3,317.00 in Billed Charges for Rev 278 = $856.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATHETER TRUE FLOW VALVUOPLASTY PERFUSION,278,RC,27800604,CDM,,,,,,both,,,3317.0000,497.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3317.00,,,,,,,856.1200,3317.0000,percent of total billed charges,"100% of $3,317.00 in Billed Charges for Rev 278 = $3,317.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATHETER TRUE FLOW VALVUOPLASTY PERFUSION,278,RC,27800604,CDM,,,,,,both,,,3317.0000,497.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1658.50,,,,,,,856.1200,3317.0000,percent of total billed charges,"Rev 278 $3,317.00 in Billed Charges at 50% = $1,658.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATHETER TRUE FLOW VALVUOPLASTY PERFUSION,278,RC,27800604,CDM,,,,,,both,,,3317.0000,497.5500,WELLCARE,WELLCARE MEDICAID,3317.00,,,,,,,856.1200,3317.0000,percent of total billed charges,"100% of $3,317.00 in Billed Charges for Rev 278 = $3,317.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEMOVAC 400ML WITH NEEDLE,270,RC,27000180,CDM,,,,,,both,,,68.0000,10.2000,AETNA,AETNA,29.04,,,,,,,17.5500,68.0000,percent of total billed charges,42.7% of $68.00 in Billed Charges for Rev 270 = $29.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOVAC 400ML WITH NEEDLE,270,RC,27000180,CDM,,,,,,both,,,68.0000,10.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,47.60,,,,,,,17.5500,68.0000,percent of total billed charges,Rev 270 $68.00 in Billed Charges at 70% = $47.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOVAC 400ML WITH NEEDLE,270,RC,27000180,CDM,,,,,,both,,,68.0000,10.2000,CIGNA HEALTHCARE,CIGNA HMO,28.36,,,,,,,17.5500,68.0000,percent of total billed charges,41.7% of $68.00 in Billed Charges for Rev 270 = $28.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOVAC 400ML WITH NEEDLE,270,RC,27000180,CDM,,,,,,both,,,68.0000,10.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,31.55,,,,,,,17.5500,68.0000,percent of total billed charges,46.4% of $68.00 in Billed Charges for Rev 270 = $31.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOVAC 400ML WITH NEEDLE,270,RC,27000180,CDM,,,,,,both,,,68.0000,10.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,28.36,,,,,,,17.5500,68.0000,percent of total billed charges,41.7% of $68.00 in Billed Charges for Rev 270 = $28.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOVAC 400ML WITH NEEDLE,270,RC,27000180,CDM,,,,,,both,,,68.0000,10.2000,CIGNA HEALTHCARE,CIGNA PPO,28.36,,,,,,,17.5500,68.0000,percent of total billed charges,41.7% of $68.00 in Billed Charges for Rev 270 = $28.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOVAC 400ML WITH NEEDLE,270,RC,27000180,CDM,,,,,,both,,,68.0000,10.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,61.20,,,,,,,17.5500,68.0000,percent of total billed charges,90% of $68.00 in Billed Charges for Rev 270 = $61.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOVAC 400ML WITH NEEDLE,270,RC,27000180,CDM,,,,,,both,,,68.0000,10.2000,MEDCOST,MEDCOST VHN,32.36,,,,,,,17.5500,68.0000,percent of total billed charges,47.59% of $68.00 in Billed Charges for Rev 270 = $32.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOVAC 400ML WITH NEEDLE,270,RC,27000180,CDM,,,,,,both,,,68.0000,10.2000,SENTARA HEALTH,SENTARA HEALTH,17.55,,,,,,,17.5500,68.0000,percent of total billed charges,25.81% of $68.00 in Billed Charges for Rev 270 = $17.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOVAC 400ML WITH NEEDLE,270,RC,27000180,CDM,,,,,,both,,,68.0000,10.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",68.00,,,,,,,17.5500,68.0000,percent of total billed charges,100% of $68.00 in Billed Charges for Rev 270 = $68.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOVAC 400ML WITH NEEDLE,270,RC,27000180,CDM,,,,,,both,,,68.0000,10.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,34.00,,,,,,,17.5500,68.0000,percent of total billed charges,Rev 270 $68.00 in Billed Charges at 50% = $34.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOVAC 400ML WITH NEEDLE,270,RC,27000180,CDM,,,,,,both,,,68.0000,10.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,21.96,,,,,,,17.5500,68.0000,other,32.3% of $68.00 in Billed Charges for Rev 270 = $21.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOVAC 400ML WITH NEEDLE,270,RC,27000180,CDM,,,,,,both,,,68.0000,10.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,20.88,,,,,,,17.5500,68.0000,other,30.7% of $68.00 in Billed Charges for Rev 270 = $20.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOVAC 400ML WITH NEEDLE,270,RC,27000180,CDM,,,,,,both,,,68.0000,10.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,21.96,,,,,,,17.5500,68.0000,percent of total billed charges,32.3% of $68.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOVAC 400ML WITH NEEDLE,270,RC,27000180,CDM,,,,,,both,,,68.0000,10.2000,WELLCARE,WELLCARE MEDICAID,68.00,,,,,,,17.5500,68.0000,percent of total billed charges,100% of $68.00 in Billed Charges for Rev 270 = $68.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIGH PRESSURE CONTRAST TUBING,272,RC,27200853,CDM,,,,,,both,,,56.0000,8.4000,AETNA,AETNA,23.91,,,,,,,14.4500,56.0000,percent of total billed charges,42.7% of $56.00 in Billed Charges for Rev 272 = $23.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIGH PRESSURE CONTRAST TUBING,272,RC,27200853,CDM,,,,,,both,,,56.0000,8.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,39.20,,,,,,,14.4500,56.0000,percent of total billed charges,Rev 272 $56.00 in Billed Charges at 70% = $39.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIGH PRESSURE CONTRAST TUBING,272,RC,27200853,CDM,,,,,,both,,,56.0000,8.4000,CIGNA HEALTHCARE,CIGNA HMO,23.35,,,,,,,14.4500,56.0000,percent of total billed charges,41.7% of $56.00 in Billed Charges for Rev 272 = $23.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIGH PRESSURE CONTRAST TUBING,272,RC,27200853,CDM,,,,,,both,,,56.0000,8.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,25.98,,,,,,,14.4500,56.0000,percent of total billed charges,46.4% of $56.00 in Billed Charges for Rev 272 = $25.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIGH PRESSURE CONTRAST TUBING,272,RC,27200853,CDM,,,,,,both,,,56.0000,8.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,23.35,,,,,,,14.4500,56.0000,percent of total billed charges,41.7% of $56.00 in Billed Charges for Rev 272 = $23.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIGH PRESSURE CONTRAST TUBING,272,RC,27200853,CDM,,,,,,both,,,56.0000,8.4000,CIGNA HEALTHCARE,CIGNA PPO,23.35,,,,,,,14.4500,56.0000,percent of total billed charges,41.7% of $56.00 in Billed Charges for Rev 272 = $23.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIGH PRESSURE CONTRAST TUBING,272,RC,27200853,CDM,,,,,,both,,,56.0000,8.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,50.40,,,,,,,14.4500,56.0000,percent of total billed charges,90% of $56.00 in Billed Charges for Rev 272 = $50.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIGH PRESSURE CONTRAST TUBING,272,RC,27200853,CDM,,,,,,both,,,56.0000,8.4000,MEDCOST,MEDCOST VHN,26.65,,,,,,,14.4500,56.0000,percent of total billed charges,47.59% of $56.00 in Billed Charges for Rev 272 = $26.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIGH PRESSURE CONTRAST TUBING,272,RC,27200853,CDM,,,,,,both,,,56.0000,8.4000,SENTARA HEALTH,SENTARA HEALTH,14.45,,,,,,,14.4500,56.0000,percent of total billed charges,25.81% of $56.00 in Billed Charges for Rev 272 = $14.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIGH PRESSURE CONTRAST TUBING,272,RC,27200853,CDM,,,,,,both,,,56.0000,8.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",56.00,,,,,,,14.4500,56.0000,percent of total billed charges,100% of $56.00 in Billed Charges for Rev 272 = $56.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIGH PRESSURE CONTRAST TUBING,272,RC,27200853,CDM,,,,,,both,,,56.0000,8.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,28.00,,,,,,,14.4500,56.0000,percent of total billed charges,Rev 272 $56.00 in Billed Charges at 50% = $28.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIGH PRESSURE CONTRAST TUBING,272,RC,27200853,CDM,,,,,,both,,,56.0000,8.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,18.09,,,,,,,14.4500,56.0000,other,32.3% of $56.00 in Billed Charges for Rev 272 = $18.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIGH PRESSURE CONTRAST TUBING,272,RC,27200853,CDM,,,,,,both,,,56.0000,8.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,17.19,,,,,,,14.4500,56.0000,other,30.7% of $56.00 in Billed Charges for Rev 272 = $17.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIGH PRESSURE CONTRAST TUBING,272,RC,27200853,CDM,,,,,,both,,,56.0000,8.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,18.09,,,,,,,14.4500,56.0000,percent of total billed charges,32.3% of $56.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIGH PRESSURE CONTRAST TUBING,272,RC,27200853,CDM,,,,,,both,,,56.0000,8.4000,WELLCARE,WELLCARE MEDICAID,56.00,,,,,,,14.4500,56.0000,percent of total billed charges,100% of $56.00 in Billed Charges for Rev 272 = $56.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ICU PED ROOM DLY,203,RC,20300001,CDM,,,,,,inpatient,,,5305.0000,795.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,121.7600,5305.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC ICU PED ROOM DLY,203,RC,20300001,CDM,,,,,,inpatient,,,5305.0000,795.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4774.50,,,,,,,121.7600,5305.0000,percent of total billed charges,"90% of $5,305.00 in Billed Charges for Rev 203 = $4,774.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ICU PED ROOM DLY,203,RC,20300001,CDM,,,,,,inpatient,,,5305.0000,795.7500,MEDCOST,MEDCOST VHN,2524.65,,,,,,,121.7600,5305.0000,percent of total billed charges,"47.59% of $5,305.00 in Billed Charges for Rev 203 = $2,524.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ICU PED ROOM DLY,203,RC,20300001,CDM,,,,,,inpatient,,,5305.0000,795.7500,SENTARA HEALTH,SENTARA HEALTH,1977.70,,,,,,,121.7600,5305.0000,percent of total billed charges,"37.28% of $5,305.00 in Billed Charges for Rev 203 = $1,977.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ICU PED ROOM DLY,203,RC,20300001,CDM,,,,,,inpatient,,,5305.0000,795.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5305.00,,,,,,,121.7600,5305.0000,percent of total billed charges,"100% of $5,305.00 in Billed Charges for Rev 203 = $5,305.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE 8GA MAMMOTOME,272,RC,27201012,CDM,,,,,,both,,,1054.0000,158.1000,AETNA,AETNA,450.06,,,,,,,272.0400,1054.0000,percent of total billed charges,"42.7% of $1,054.00 in Billed Charges for Rev 272 = $450.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE 8GA MAMMOTOME,272,RC,27201012,CDM,,,,,,both,,,1054.0000,158.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,737.80,,,,,,,272.0400,1054.0000,percent of total billed charges,"Rev 272 $1,054.00 in Billed Charges at 70% = $737.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE 8GA MAMMOTOME,272,RC,27201012,CDM,,,,,,both,,,1054.0000,158.1000,CIGNA HEALTHCARE,CIGNA HMO,439.52,,,,,,,272.0400,1054.0000,percent of total billed charges,"41.7% of $1,054.00 in Billed Charges for Rev 272 = $439.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE 8GA MAMMOTOME,272,RC,27201012,CDM,,,,,,both,,,1054.0000,158.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,489.06,,,,,,,272.0400,1054.0000,percent of total billed charges,"46.4% of $1,054.00 in Billed Charges for Rev 272 = $489.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE 8GA MAMMOTOME,272,RC,27201012,CDM,,,,,,both,,,1054.0000,158.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,439.52,,,,,,,272.0400,1054.0000,percent of total billed charges,"41.7% of $1,054.00 in Billed Charges for Rev 272 = $439.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE 8GA MAMMOTOME,272,RC,27201012,CDM,,,,,,both,,,1054.0000,158.1000,CIGNA HEALTHCARE,CIGNA PPO,439.52,,,,,,,272.0400,1054.0000,percent of total billed charges,"41.7% of $1,054.00 in Billed Charges for Rev 272 = $439.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE 8GA MAMMOTOME,272,RC,27201012,CDM,,,,,,both,,,1054.0000,158.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,948.60,,,,,,,272.0400,1054.0000,percent of total billed charges,"90% of $1,054.00 in Billed Charges for Rev 272 = $948.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE 8GA MAMMOTOME,272,RC,27201012,CDM,,,,,,both,,,1054.0000,158.1000,MEDCOST,MEDCOST VHN,501.60,,,,,,,272.0400,1054.0000,percent of total billed charges,"47.59% of $1,054.00 in Billed Charges for Rev 272 = $501.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE 8GA MAMMOTOME,272,RC,27201012,CDM,,,,,,both,,,1054.0000,158.1000,SENTARA HEALTH,SENTARA HEALTH,272.04,,,,,,,272.0400,1054.0000,percent of total billed charges,"25.81% of $1,054.00 in Billed Charges for Rev 272 = $272.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE 8GA MAMMOTOME,272,RC,27201012,CDM,,,,,,both,,,1054.0000,158.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1054.00,,,,,,,272.0400,1054.0000,percent of total billed charges,"100% of $1,054.00 in Billed Charges for Rev 272 = $1,054.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE 8GA MAMMOTOME,272,RC,27201012,CDM,,,,,,both,,,1054.0000,158.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,527.00,,,,,,,272.0400,1054.0000,percent of total billed charges,"Rev 272 $1,054.00 in Billed Charges at 50% = $527.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE 8GA MAMMOTOME,272,RC,27201012,CDM,,,,,,both,,,1054.0000,158.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,340.44,,,,,,,272.0400,1054.0000,other,"32.3% of $1,054.00 in Billed Charges for Rev 272 = $340.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PROBE 8GA MAMMOTOME,272,RC,27201012,CDM,,,,,,both,,,1054.0000,158.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,323.58,,,,,,,272.0400,1054.0000,other,"30.7% of $1,054.00 in Billed Charges for Rev 272 = $323.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PROBE 8GA MAMMOTOME,272,RC,27201012,CDM,,,,,,both,,,1054.0000,158.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,340.44,,,,,,,272.0400,1054.0000,percent of total billed charges,"32.3% of $1,054.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE 8GA MAMMOTOME,272,RC,27201012,CDM,,,,,,both,,,1054.0000,158.1000,WELLCARE,WELLCARE MEDICAID,1054.00,,,,,,,272.0400,1054.0000,percent of total billed charges,"100% of $1,054.00 in Billed Charges for Rev 272 = $1,054.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE RITA 4.0 700-102845,272,RC,27201014,CDM,,,,,,both,,,6396.0000,959.4000,AETNA,AETNA,2731.09,,,,,,,1650.8100,6396.0000,percent of total billed charges,"42.7% of $6,396.00 in Billed Charges for Rev 272 = $2,731.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE RITA 4.0 700-102845,272,RC,27201014,CDM,,,,,,both,,,6396.0000,959.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4477.20,,,,,,,1650.8100,6396.0000,percent of total billed charges,"Rev 272 $6,396.00 in Billed Charges at 70% = $4,477.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE RITA 4.0 700-102845,272,RC,27201014,CDM,,,,,,both,,,6396.0000,959.4000,CIGNA HEALTHCARE,CIGNA HMO,2667.13,,,,,,,1650.8100,6396.0000,percent of total billed charges,"41.7% of $6,396.00 in Billed Charges for Rev 272 = $2,667.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE RITA 4.0 700-102845,272,RC,27201014,CDM,,,,,,both,,,6396.0000,959.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2967.74,,,,,,,1650.8100,6396.0000,percent of total billed charges,"46.4% of $6,396.00 in Billed Charges for Rev 272 = $2,967.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE RITA 4.0 700-102845,272,RC,27201014,CDM,,,,,,both,,,6396.0000,959.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2667.13,,,,,,,1650.8100,6396.0000,percent of total billed charges,"41.7% of $6,396.00 in Billed Charges for Rev 272 = $2,667.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE RITA 4.0 700-102845,272,RC,27201014,CDM,,,,,,both,,,6396.0000,959.4000,CIGNA HEALTHCARE,CIGNA PPO,2667.13,,,,,,,1650.8100,6396.0000,percent of total billed charges,"41.7% of $6,396.00 in Billed Charges for Rev 272 = $2,667.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE RITA 4.0 700-102845,272,RC,27201014,CDM,,,,,,both,,,6396.0000,959.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5756.40,,,,,,,1650.8100,6396.0000,percent of total billed charges,"90% of $6,396.00 in Billed Charges for Rev 272 = $5,756.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE RITA 4.0 700-102845,272,RC,27201014,CDM,,,,,,both,,,6396.0000,959.4000,MEDCOST,MEDCOST VHN,3043.86,,,,,,,1650.8100,6396.0000,percent of total billed charges,"47.59% of $6,396.00 in Billed Charges for Rev 272 = $3,043.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE RITA 4.0 700-102845,272,RC,27201014,CDM,,,,,,both,,,6396.0000,959.4000,SENTARA HEALTH,SENTARA HEALTH,1650.81,,,,,,,1650.8100,6396.0000,percent of total billed charges,"25.81% of $6,396.00 in Billed Charges for Rev 272 = $1,650.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE RITA 4.0 700-102845,272,RC,27201014,CDM,,,,,,both,,,6396.0000,959.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6396.00,,,,,,,1650.8100,6396.0000,percent of total billed charges,"100% of $6,396.00 in Billed Charges for Rev 272 = $6,396.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE RITA 4.0 700-102845,272,RC,27201014,CDM,,,,,,both,,,6396.0000,959.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3198.00,,,,,,,1650.8100,6396.0000,percent of total billed charges,"Rev 272 $6,396.00 in Billed Charges at 50% = $3,198.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE RITA 4.0 700-102845,272,RC,27201014,CDM,,,,,,both,,,6396.0000,959.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2065.91,,,,,,,1650.8100,6396.0000,other,"32.3% of $6,396.00 in Billed Charges for Rev 272 = $2,065.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PROBE RITA 4.0 700-102845,272,RC,27201014,CDM,,,,,,both,,,6396.0000,959.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1963.57,,,,,,,1650.8100,6396.0000,other,"30.7% of $6,396.00 in Billed Charges for Rev 272 = $1,963.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PROBE RITA 4.0 700-102845,272,RC,27201014,CDM,,,,,,both,,,6396.0000,959.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,2065.91,,,,,,,1650.8100,6396.0000,percent of total billed charges,"32.3% of $6,396.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PROBE RITA 4.0 700-102845,272,RC,27201014,CDM,,,,,,both,,,6396.0000,959.4000,WELLCARE,WELLCARE MEDICAID,6396.00,,,,,,,1650.8100,6396.0000,percent of total billed charges,"100% of $6,396.00 in Billed Charges for Rev 272 = $6,396.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PSYCH ROOM DLY PRV,114,RC,11400001,CDM,,,,,,inpatient,,,1544.0000,231.6000,AETNA,AETNA,793.00,,,,,,,121.7600,1544.0000,per diem,$793.00 for 1 day = $793.00 for Rev 114
HC PSYCH ROOM DLY PRV,114,RC,11400001,CDM,,,,,,inpatient,,,1544.0000,231.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,121.7600,1544.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC PSYCH ROOM DLY PRV,114,RC,11400001,CDM,,,,,,inpatient,,,1544.0000,231.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1389.60,,,,,,,121.7600,1544.0000,percent of total billed charges,"90% of $1,544.00 in Billed Charges for Rev 114 = $1,389.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PSYCH ROOM DLY PRV,114,RC,11400001,CDM,,,,,,inpatient,,,1544.0000,231.6000,MEDCOST,MEDCOST VHN,734.79,,,,,,,121.7600,1544.0000,percent of total billed charges,"47.59% of $1,544.00 in Billed Charges for Rev 114 = $734.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PSYCH ROOM DLY PRV,114,RC,11400001,CDM,,,,,,inpatient,,,1544.0000,231.6000,SENTARA HEALTH,SENTARA HEALTH,575.60,,,,,,,121.7600,1544.0000,percent of total billed charges,"37.28% of $1,544.00 in Billed Charges for Rev 114 = $575.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PSYCH ROOM DLY PRV,114,RC,11400001,CDM,,,,,,inpatient,,,1544.0000,231.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1544.00,,,,,,,121.7600,1544.0000,percent of total billed charges,"100% of $1,544.00 in Billed Charges for Rev 114 = $1,544.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PUMP COLD THERAPY T305 DISP,270,RC,27000123,CDM,,,,,,both,,,497.0000,74.5500,AETNA,AETNA,212.22,,,,,,,128.2800,497.0000,percent of total billed charges,42.7% of $497.00 in Billed Charges for Rev 270 = $212.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP COLD THERAPY T305 DISP,270,RC,27000123,CDM,,,,,,both,,,497.0000,74.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,347.90,,,,,,,128.2800,497.0000,percent of total billed charges,Rev 270 $497.00 in Billed Charges at 70% = $347.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP COLD THERAPY T305 DISP,270,RC,27000123,CDM,,,,,,both,,,497.0000,74.5500,CIGNA HEALTHCARE,CIGNA HMO,207.25,,,,,,,128.2800,497.0000,percent of total billed charges,41.7% of $497.00 in Billed Charges for Rev 270 = $207.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP COLD THERAPY T305 DISP,270,RC,27000123,CDM,,,,,,both,,,497.0000,74.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,230.61,,,,,,,128.2800,497.0000,percent of total billed charges,46.4% of $497.00 in Billed Charges for Rev 270 = $230.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP COLD THERAPY T305 DISP,270,RC,27000123,CDM,,,,,,both,,,497.0000,74.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,207.25,,,,,,,128.2800,497.0000,percent of total billed charges,41.7% of $497.00 in Billed Charges for Rev 270 = $207.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP COLD THERAPY T305 DISP,270,RC,27000123,CDM,,,,,,both,,,497.0000,74.5500,CIGNA HEALTHCARE,CIGNA PPO,207.25,,,,,,,128.2800,497.0000,percent of total billed charges,41.7% of $497.00 in Billed Charges for Rev 270 = $207.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP COLD THERAPY T305 DISP,270,RC,27000123,CDM,,,,,,both,,,497.0000,74.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,447.30,,,,,,,128.2800,497.0000,percent of total billed charges,90% of $497.00 in Billed Charges for Rev 270 = $447.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP COLD THERAPY T305 DISP,270,RC,27000123,CDM,,,,,,both,,,497.0000,74.5500,MEDCOST,MEDCOST VHN,236.52,,,,,,,128.2800,497.0000,percent of total billed charges,47.59% of $497.00 in Billed Charges for Rev 270 = $236.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP COLD THERAPY T305 DISP,270,RC,27000123,CDM,,,,,,both,,,497.0000,74.5500,SENTARA HEALTH,SENTARA HEALTH,128.28,,,,,,,128.2800,497.0000,percent of total billed charges,25.81% of $497.00 in Billed Charges for Rev 270 = $128.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP COLD THERAPY T305 DISP,270,RC,27000123,CDM,,,,,,both,,,497.0000,74.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",497.00,,,,,,,128.2800,497.0000,percent of total billed charges,100% of $497.00 in Billed Charges for Rev 270 = $497.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP COLD THERAPY T305 DISP,270,RC,27000123,CDM,,,,,,both,,,497.0000,74.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,248.50,,,,,,,128.2800,497.0000,percent of total billed charges,Rev 270 $497.00 in Billed Charges at 50% = $248.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP COLD THERAPY T305 DISP,270,RC,27000123,CDM,,,,,,both,,,497.0000,74.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,160.53,,,,,,,128.2800,497.0000,other,32.3% of $497.00 in Billed Charges for Rev 270 = $160.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUMP COLD THERAPY T305 DISP,270,RC,27000123,CDM,,,,,,both,,,497.0000,74.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,152.58,,,,,,,128.2800,497.0000,other,30.7% of $497.00 in Billed Charges for Rev 270 = $152.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUMP COLD THERAPY T305 DISP,270,RC,27000123,CDM,,,,,,both,,,497.0000,74.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,160.53,,,,,,,128.2800,497.0000,percent of total billed charges,32.3% of $497.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP COLD THERAPY T305 DISP,270,RC,27000123,CDM,,,,,,both,,,497.0000,74.5500,WELLCARE,WELLCARE MEDICAID,497.00,,,,,,,128.2800,497.0000,percent of total billed charges,100% of $497.00 in Billed Charges for Rev 270 = $497.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP PENUMBRA NS SUPPLIES,271,RC,27100001,CDM,,,,,,both,,,877.0000,131.5500,AETNA,AETNA,374.48,,,,,,,226.3500,877.0000,percent of total billed charges,42.7% of $877.00 in Billed Charges for Rev 271 = $374.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP PENUMBRA NS SUPPLIES,271,RC,27100001,CDM,,,,,,both,,,877.0000,131.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,613.90,,,,,,,226.3500,877.0000,percent of total billed charges,Rev 271 $877.00 in Billed Charges at 70% = $613.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP PENUMBRA NS SUPPLIES,271,RC,27100001,CDM,,,,,,both,,,877.0000,131.5500,CIGNA HEALTHCARE,CIGNA HMO,365.71,,,,,,,226.3500,877.0000,percent of total billed charges,41.7% of $877.00 in Billed Charges for Rev 271 = $365.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP PENUMBRA NS SUPPLIES,271,RC,27100001,CDM,,,,,,both,,,877.0000,131.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,406.93,,,,,,,226.3500,877.0000,percent of total billed charges,46.4% of $877.00 in Billed Charges for Rev 271 = $406.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP PENUMBRA NS SUPPLIES,271,RC,27100001,CDM,,,,,,both,,,877.0000,131.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,365.71,,,,,,,226.3500,877.0000,percent of total billed charges,41.7% of $877.00 in Billed Charges for Rev 271 = $365.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP PENUMBRA NS SUPPLIES,271,RC,27100001,CDM,,,,,,both,,,877.0000,131.5500,CIGNA HEALTHCARE,CIGNA PPO,365.71,,,,,,,226.3500,877.0000,percent of total billed charges,41.7% of $877.00 in Billed Charges for Rev 271 = $365.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP PENUMBRA NS SUPPLIES,271,RC,27100001,CDM,,,,,,both,,,877.0000,131.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,789.30,,,,,,,226.3500,877.0000,percent of total billed charges,90% of $877.00 in Billed Charges for Rev 271 = $789.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP PENUMBRA NS SUPPLIES,271,RC,27100001,CDM,,,,,,both,,,877.0000,131.5500,MEDCOST,MEDCOST VHN,417.36,,,,,,,226.3500,877.0000,percent of total billed charges,47.59% of $877.00 in Billed Charges for Rev 271 = $417.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP PENUMBRA NS SUPPLIES,271,RC,27100001,CDM,,,,,,both,,,877.0000,131.5500,SENTARA HEALTH,SENTARA HEALTH,226.35,,,,,,,226.3500,877.0000,percent of total billed charges,25.81% of $877.00 in Billed Charges for Rev 271 = $226.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP PENUMBRA NS SUPPLIES,271,RC,27100001,CDM,,,,,,both,,,877.0000,131.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",877.00,,,,,,,226.3500,877.0000,percent of total billed charges,100% of $877.00 in Billed Charges for Rev 271 = $877.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP PENUMBRA NS SUPPLIES,271,RC,27100001,CDM,,,,,,both,,,877.0000,131.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,438.50,,,,,,,226.3500,877.0000,percent of total billed charges,Rev 271 $877.00 in Billed Charges at 50% = $438.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP PENUMBRA NS SUPPLIES,271,RC,27100001,CDM,,,,,,both,,,877.0000,131.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,283.27,,,,,,,226.3500,877.0000,other,32.3% of $877.00 in Billed Charges for Rev 271 = $283.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUMP PENUMBRA NS SUPPLIES,271,RC,27100001,CDM,,,,,,both,,,877.0000,131.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,269.24,,,,,,,226.3500,877.0000,other,30.7% of $877.00 in Billed Charges for Rev 271 = $269.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUMP PENUMBRA NS SUPPLIES,271,RC,27100001,CDM,,,,,,both,,,877.0000,131.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,283.27,,,,,,,226.3500,877.0000,percent of total billed charges,32.3% of $877.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP PENUMBRA NS SUPPLIES,271,RC,27100001,CDM,,,,,,both,,,877.0000,131.5500,WELLCARE,WELLCARE MEDICAID,877.00,,,,,,,226.3500,877.0000,percent of total billed charges,100% of $877.00 in Billed Charges for Rev 271 = $877.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP POLAR CARE COLD THRPY DISP,270,RC,27000195,CDM,,,,,,both,,,573.0000,85.9500,AETNA,AETNA,244.67,,,,,,,147.8900,573.0000,percent of total billed charges,42.7% of $573.00 in Billed Charges for Rev 270 = $244.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP POLAR CARE COLD THRPY DISP,270,RC,27000195,CDM,,,,,,both,,,573.0000,85.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,401.10,,,,,,,147.8900,573.0000,percent of total billed charges,Rev 270 $573.00 in Billed Charges at 70% = $401.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP POLAR CARE COLD THRPY DISP,270,RC,27000195,CDM,,,,,,both,,,573.0000,85.9500,CIGNA HEALTHCARE,CIGNA HMO,238.94,,,,,,,147.8900,573.0000,percent of total billed charges,41.7% of $573.00 in Billed Charges for Rev 270 = $238.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP POLAR CARE COLD THRPY DISP,270,RC,27000195,CDM,,,,,,both,,,573.0000,85.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,265.87,,,,,,,147.8900,573.0000,percent of total billed charges,46.4% of $573.00 in Billed Charges for Rev 270 = $265.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP POLAR CARE COLD THRPY DISP,270,RC,27000195,CDM,,,,,,both,,,573.0000,85.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,238.94,,,,,,,147.8900,573.0000,percent of total billed charges,41.7% of $573.00 in Billed Charges for Rev 270 = $238.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP POLAR CARE COLD THRPY DISP,270,RC,27000195,CDM,,,,,,both,,,573.0000,85.9500,CIGNA HEALTHCARE,CIGNA PPO,238.94,,,,,,,147.8900,573.0000,percent of total billed charges,41.7% of $573.00 in Billed Charges for Rev 270 = $238.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP POLAR CARE COLD THRPY DISP,270,RC,27000195,CDM,,,,,,both,,,573.0000,85.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,515.70,,,,,,,147.8900,573.0000,percent of total billed charges,90% of $573.00 in Billed Charges for Rev 270 = $515.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP POLAR CARE COLD THRPY DISP,270,RC,27000195,CDM,,,,,,both,,,573.0000,85.9500,MEDCOST,MEDCOST VHN,272.69,,,,,,,147.8900,573.0000,percent of total billed charges,47.59% of $573.00 in Billed Charges for Rev 270 = $272.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP POLAR CARE COLD THRPY DISP,270,RC,27000195,CDM,,,,,,both,,,573.0000,85.9500,SENTARA HEALTH,SENTARA HEALTH,147.89,,,,,,,147.8900,573.0000,percent of total billed charges,25.81% of $573.00 in Billed Charges for Rev 270 = $147.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP POLAR CARE COLD THRPY DISP,270,RC,27000195,CDM,,,,,,both,,,573.0000,85.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",573.00,,,,,,,147.8900,573.0000,percent of total billed charges,100% of $573.00 in Billed Charges for Rev 270 = $573.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP POLAR CARE COLD THRPY DISP,270,RC,27000195,CDM,,,,,,both,,,573.0000,85.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,286.50,,,,,,,147.8900,573.0000,percent of total billed charges,Rev 270 $573.00 in Billed Charges at 50% = $286.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP POLAR CARE COLD THRPY DISP,270,RC,27000195,CDM,,,,,,both,,,573.0000,85.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,185.08,,,,,,,147.8900,573.0000,other,32.3% of $573.00 in Billed Charges for Rev 270 = $185.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUMP POLAR CARE COLD THRPY DISP,270,RC,27000195,CDM,,,,,,both,,,573.0000,85.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,175.91,,,,,,,147.8900,573.0000,other,30.7% of $573.00 in Billed Charges for Rev 270 = $175.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUMP POLAR CARE COLD THRPY DISP,270,RC,27000195,CDM,,,,,,both,,,573.0000,85.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,185.08,,,,,,,147.8900,573.0000,percent of total billed charges,32.3% of $573.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUMP POLAR CARE COLD THRPY DISP,270,RC,27000195,CDM,,,,,,both,,,573.0000,85.9500,WELLCARE,WELLCARE MEDICAID,573.00,,,,,,,147.8900,573.0000,percent of total billed charges,100% of $573.00 in Billed Charges for Rev 270 = $573.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 0 SA86G ETHICON,272,RC,27201451,CDM,,,,,,both,,,15.0000,2.2500,AETNA,AETNA,6.41,,,,,,,3.8700,15.0000,percent of total billed charges,42.7% of $15.00 in Billed Charges for Rev 272 = $6.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 0 SA86G ETHICON,272,RC,27201451,CDM,,,,,,both,,,15.0000,2.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,10.50,,,,,,,3.8700,15.0000,percent of total billed charges,Rev 272 $15.00 in Billed Charges at 70% = $10.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 0 SA86G ETHICON,272,RC,27201451,CDM,,,,,,both,,,15.0000,2.2500,CIGNA HEALTHCARE,CIGNA HMO,6.26,,,,,,,3.8700,15.0000,percent of total billed charges,41.7% of $15.00 in Billed Charges for Rev 272 = $6.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 0 SA86G ETHICON,272,RC,27201451,CDM,,,,,,both,,,15.0000,2.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6.96,,,,,,,3.8700,15.0000,percent of total billed charges,46.4% of $15.00 in Billed Charges for Rev 272 = $6.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 0 SA86G ETHICON,272,RC,27201451,CDM,,,,,,both,,,15.0000,2.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6.26,,,,,,,3.8700,15.0000,percent of total billed charges,41.7% of $15.00 in Billed Charges for Rev 272 = $6.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 0 SA86G ETHICON,272,RC,27201451,CDM,,,,,,both,,,15.0000,2.2500,CIGNA HEALTHCARE,CIGNA PPO,6.26,,,,,,,3.8700,15.0000,percent of total billed charges,41.7% of $15.00 in Billed Charges for Rev 272 = $6.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 0 SA86G ETHICON,272,RC,27201451,CDM,,,,,,both,,,15.0000,2.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13.50,,,,,,,3.8700,15.0000,percent of total billed charges,90% of $15.00 in Billed Charges for Rev 272 = $13.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 0 SA86G ETHICON,272,RC,27201451,CDM,,,,,,both,,,15.0000,2.2500,MEDCOST,MEDCOST VHN,7.14,,,,,,,3.8700,15.0000,percent of total billed charges,47.59% of $15.00 in Billed Charges for Rev 272 = $7.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 0 SA86G ETHICON,272,RC,27201451,CDM,,,,,,both,,,15.0000,2.2500,SENTARA HEALTH,SENTARA HEALTH,3.87,,,,,,,3.8700,15.0000,percent of total billed charges,25.81% of $15.00 in Billed Charges for Rev 272 = $3.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 0 SA86G ETHICON,272,RC,27201451,CDM,,,,,,both,,,15.0000,2.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15.00,,,,,,,3.8700,15.0000,percent of total billed charges,100% of $15.00 in Billed Charges for Rev 272 = $15.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 0 SA86G ETHICON,272,RC,27201451,CDM,,,,,,both,,,15.0000,2.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7.50,,,,,,,3.8700,15.0000,percent of total billed charges,Rev 272 $15.00 in Billed Charges at 50% = $7.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 0 SA86G ETHICON,272,RC,27201451,CDM,,,,,,both,,,15.0000,2.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4.85,,,,,,,3.8700,15.0000,other,32.3% of $15.00 in Billed Charges for Rev 272 = $4.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE SILK 0 SA86G ETHICON,272,RC,27201451,CDM,,,,,,both,,,15.0000,2.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,4.61,,,,,,,3.8700,15.0000,other,30.7% of $15.00 in Billed Charges for Rev 272 = $4.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE SILK 0 SA86G ETHICON,272,RC,27201451,CDM,,,,,,both,,,15.0000,2.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,4.85,,,,,,,3.8700,15.0000,percent of total billed charges,32.3% of $15.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE SILK 0 SA86G ETHICON,272,RC,27201451,CDM,,,,,,both,,,15.0000,2.2500,WELLCARE,WELLCARE MEDICAID,15.00,,,,,,,3.8700,15.0000,percent of total billed charges,100% of $15.00 in Billed Charges for Rev 272 = $15.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ICU ROOM DLY,200,RC,20000001,CDM,,,,,,inpatient,,,5305.0000,795.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,121.7600,5305.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC ICU ROOM DLY,200,RC,20000001,CDM,,,,,,inpatient,,,5305.0000,795.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4774.50,,,,,,,121.7600,5305.0000,percent of total billed charges,"90% of $5,305.00 in Billed Charges for Rev 200 = $4,774.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ICU ROOM DLY,200,RC,20000001,CDM,,,,,,inpatient,,,5305.0000,795.7500,MEDCOST,MEDCOST VHN,2524.65,,,,,,,121.7600,5305.0000,percent of total billed charges,"47.59% of $5,305.00 in Billed Charges for Rev 200 = $2,524.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ICU ROOM DLY,200,RC,20000001,CDM,,,,,,inpatient,,,5305.0000,795.7500,SENTARA HEALTH,SENTARA HEALTH,1977.70,,,,,,,121.7600,5305.0000,percent of total billed charges,"37.28% of $5,305.00 in Billed Charges for Rev 200 = $1,977.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ICU ROOM DLY,200,RC,20000001,CDM,,,,,,inpatient,,,5305.0000,795.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5305.00,,,,,,,121.7600,5305.0000,percent of total billed charges,"100% of $5,305.00 in Billed Charges for Rev 200 = $5,305.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA 2.5 SET INTRACARDIAC PUMP - LV ASSIST,278,RC,27800545,CDM,,,,,,both,,,53076.0000,7961.4000,AETNA,AETNA,25476.48,,,,,,,3768.4000,53076.0000,percent of total billed charges,"48% of $53,076.00 in Billed Charges for Rev 278 = $25,476.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA 2.5 SET INTRACARDIAC PUMP - LV ASSIST,278,RC,27800545,CDM,,,,,,both,,,53076.0000,7961.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,26538.00,,,,,,,3768.4000,53076.0000,percent of total billed charges,"50% of $53,076.00 in Billed Charges for Rev 278 = $26,538.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA 2.5 SET INTRACARDIAC PUMP - LV ASSIST,278,RC,27800545,CDM,,,,,,both,,,53076.0000,7961.4000,CIGNA HEALTHCARE,CIGNA HMO,22132.69,,,,,,,3768.4000,53076.0000,percent of total billed charges,"41.7% of $53,076.00 in Billed Charges for Rev 278 = $22,132.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA 2.5 SET INTRACARDIAC PUMP - LV ASSIST,278,RC,27800545,CDM,,,,,,both,,,53076.0000,7961.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,21230.40,,,,,,,3768.4000,53076.0000,percent of total billed charges,"40% of $53,076.00 in Billed Charges for Rev 278 = $21,230.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA 2.5 SET INTRACARDIAC PUMP - LV ASSIST,278,RC,27800545,CDM,,,,,,both,,,53076.0000,7961.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,22132.69,,,,,,,3768.4000,53076.0000,percent of total billed charges,"41.7% of $53,076.00 in Billed Charges for Rev 278 = $22,132.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA 2.5 SET INTRACARDIAC PUMP - LV ASSIST,278,RC,27800545,CDM,,,,,,both,,,53076.0000,7961.4000,CIGNA HEALTHCARE,CIGNA PPO,22132.69,,,,,,,3768.4000,53076.0000,percent of total billed charges,"41.7% of $53,076.00 in Billed Charges for Rev 278 = $22,132.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA 2.5 SET INTRACARDIAC PUMP - LV ASSIST,278,RC,27800545,CDM,,,,,,both,,,53076.0000,7961.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,47768.40,,,,,,,3768.4000,53076.0000,percent of total billed charges,"90% of $53,076.00 in Billed Charges for Rev 278 = $47,768.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA 2.5 SET INTRACARDIAC PUMP - LV ASSIST,278,RC,27800545,CDM,,,,,,both,,,53076.0000,7961.4000,MEDCOST,MEDCOST VHN,25258.87,,,,,,,3768.4000,53076.0000,percent of total billed charges,"47.59% of $53,076.00 in Billed Charges for Rev 278 = $25,258.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA 2.5 SET INTRACARDIAC PUMP - LV ASSIST,278,RC,27800545,CDM,,,,,,both,,,53076.0000,7961.4000,SENTARA HEALTH,SENTARA HEALTH,13698.92,,,,,,,3768.4000,53076.0000,percent of total billed charges,"25.81% of $53,076.00 in Billed Charges for Rev 278 = $13,698.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA 2.5 SET INTRACARDIAC PUMP - LV ASSIST,278,RC,27800545,CDM,,,,,,both,,,53076.0000,7961.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",53076.00,,,,,,,3768.4000,53076.0000,percent of total billed charges,"100% of $53,076.00 in Billed Charges for Rev 278 = $53,076.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA 2.5 SET INTRACARDIAC PUMP - LV ASSIST,278,RC,27800545,CDM,,,,,,both,,,53076.0000,7961.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,26538.00,,,,,,,3768.4000,53076.0000,percent of total billed charges,"Rev 278 $53,076.00 in Billed Charges at 50% = $26,538.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA 2.5 SET INTRACARDIAC PUMP - LV ASSIST,278,RC,27800545,CDM,,,,,,both,,,53076.0000,7961.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3980.70,,,,,,,3768.4000,53076.0000,percent of total billed charges,"7.5% of $53,076.00 in Billed Charges for Rev 278 = $3,980.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA 2.5 SET INTRACARDIAC PUMP - LV ASSIST,278,RC,27800545,CDM,,,,,,both,,,53076.0000,7961.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3768.40,,,,,,,3768.4000,53076.0000,percent of total billed charges,"7.1% of $53,076.00 in Billed Charges for Rev 278 = $3,768.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA 2.5 SET INTRACARDIAC PUMP - LV ASSIST,278,RC,27800545,CDM,,,,,,both,,,53076.0000,7961.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,3768.40,,,,,,,3768.4000,53076.0000,percent of total billed charges,"7.1% of $53,076.00 in Billed Charges for Rev 278 = $3,768.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA 2.5 SET INTRACARDIAC PUMP - LV ASSIST,278,RC,27800545,CDM,,,,,,both,,,53076.0000,7961.4000,WELLCARE,WELLCARE MEDICAID,53076.00,,,,,,,3768.4000,53076.0000,percent of total billed charges,"100% of $53,076.00 in Billed Charges for Rev 278 = $53,076.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA CP SET INTRACADIAC PUMP - LV ASSIST,278,RC,27800544,CDM,,,,,,both,,,200055.0000,30008.2500,AETNA,AETNA,96026.40,,,,,,,14203.9100,200055.0000,percent of total billed charges,"48% of $200,055.00 in Billed Charges for Rev 278 = $96,026.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA CP SET INTRACADIAC PUMP - LV ASSIST,278,RC,27800544,CDM,,,,,,both,,,200055.0000,30008.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,100027.50,,,,,,,14203.9100,200055.0000,percent of total billed charges,"50% of $200,055.00 in Billed Charges for Rev 278 = $100,027.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA CP SET INTRACADIAC PUMP - LV ASSIST,278,RC,27800544,CDM,,,,,,both,,,200055.0000,30008.2500,CIGNA HEALTHCARE,CIGNA HMO,83422.94,,,,,,,14203.9100,200055.0000,percent of total billed charges,"41.7% of $200,055.00 in Billed Charges for Rev 278 = $83,422.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA CP SET INTRACADIAC PUMP - LV ASSIST,278,RC,27800544,CDM,,,,,,both,,,200055.0000,30008.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,80022.00,,,,,,,14203.9100,200055.0000,percent of total billed charges,"40% of $200,055.00 in Billed Charges for Rev 278 = $80,022.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA CP SET INTRACADIAC PUMP - LV ASSIST,278,RC,27800544,CDM,,,,,,both,,,200055.0000,30008.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,83422.94,,,,,,,14203.9100,200055.0000,percent of total billed charges,"41.7% of $200,055.00 in Billed Charges for Rev 278 = $83,422.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA CP SET INTRACADIAC PUMP - LV ASSIST,278,RC,27800544,CDM,,,,,,both,,,200055.0000,30008.2500,CIGNA HEALTHCARE,CIGNA PPO,83422.94,,,,,,,14203.9100,200055.0000,percent of total billed charges,"41.7% of $200,055.00 in Billed Charges for Rev 278 = $83,422.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA CP SET INTRACADIAC PUMP - LV ASSIST,278,RC,27800544,CDM,,,,,,both,,,200055.0000,30008.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,180049.50,,,,,,,14203.9100,200055.0000,percent of total billed charges,"90% of $200,055.00 in Billed Charges for Rev 278 = $180,049.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA CP SET INTRACADIAC PUMP - LV ASSIST,278,RC,27800544,CDM,,,,,,both,,,200055.0000,30008.2500,MEDCOST,MEDCOST VHN,95206.17,,,,,,,14203.9100,200055.0000,percent of total billed charges,"47.59% of $200,055.00 in Billed Charges for Rev 278 = $95,206.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA CP SET INTRACADIAC PUMP - LV ASSIST,278,RC,27800544,CDM,,,,,,both,,,200055.0000,30008.2500,SENTARA HEALTH,SENTARA HEALTH,51634.20,,,,,,,14203.9100,200055.0000,percent of total billed charges,"25.81% of $200,055.00 in Billed Charges for Rev 278 = $51,634.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA CP SET INTRACADIAC PUMP - LV ASSIST,278,RC,27800544,CDM,,,,,,both,,,200055.0000,30008.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",200055.00,,,,,,,14203.9100,200055.0000,percent of total billed charges,"100% of $200,055.00 in Billed Charges for Rev 278 = $200,055.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA CP SET INTRACADIAC PUMP - LV ASSIST,278,RC,27800544,CDM,,,,,,both,,,200055.0000,30008.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,100027.50,,,,,,,14203.9100,200055.0000,percent of total billed charges,"Rev 278 $200,055.00 in Billed Charges at 50% = $100,027.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA CP SET INTRACADIAC PUMP - LV ASSIST,278,RC,27800544,CDM,,,,,,both,,,200055.0000,30008.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,15004.13,,,,,,,14203.9100,200055.0000,percent of total billed charges,"7.5% of $200,055.00 in Billed Charges for Rev 278 = $15,004.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA CP SET INTRACADIAC PUMP - LV ASSIST,278,RC,27800544,CDM,,,,,,both,,,200055.0000,30008.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,14203.91,,,,,,,14203.9100,200055.0000,percent of total billed charges,"7.1% of $200,055.00 in Billed Charges for Rev 278 = $14,203.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA CP SET INTRACADIAC PUMP - LV ASSIST,278,RC,27800544,CDM,,,,,,both,,,200055.0000,30008.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,14203.91,,,,,,,14203.9100,200055.0000,percent of total billed charges,"7.1% of $200,055.00 in Billed Charges for Rev 278 = $14,203.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA CP SET INTRACADIAC PUMP - LV ASSIST,278,RC,27800544,CDM,,,,,,both,,,200055.0000,30008.2500,WELLCARE,WELLCARE MEDICAID,200055.00,,,,,,,14203.9100,200055.0000,percent of total billed charges,"100% of $200,055.00 in Billed Charges for Rev 278 = $200,055.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPLANT IMAGNUM 2 OM1502,272,RC,27200856,CDM,,,,,,both,,,1300.0000,195.0000,AETNA,AETNA,555.10,,,,,,,335.5300,1300.0000,percent of total billed charges,"42.7% of $1,300.00 in Billed Charges for Rev 272 = $555.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPLANT IMAGNUM 2 OM1502,272,RC,27200856,CDM,,,,,,both,,,1300.0000,195.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,910.00,,,,,,,335.5300,1300.0000,percent of total billed charges,"Rev 272 $1,300.00 in Billed Charges at 70% = $910.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPLANT IMAGNUM 2 OM1502,272,RC,27200856,CDM,,,,,,both,,,1300.0000,195.0000,CIGNA HEALTHCARE,CIGNA HMO,542.10,,,,,,,335.5300,1300.0000,percent of total billed charges,"41.7% of $1,300.00 in Billed Charges for Rev 272 = $542.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPLANT IMAGNUM 2 OM1502,272,RC,27200856,CDM,,,,,,both,,,1300.0000,195.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,603.20,,,,,,,335.5300,1300.0000,percent of total billed charges,"46.4% of $1,300.00 in Billed Charges for Rev 272 = $603.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPLANT IMAGNUM 2 OM1502,272,RC,27200856,CDM,,,,,,both,,,1300.0000,195.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,542.10,,,,,,,335.5300,1300.0000,percent of total billed charges,"41.7% of $1,300.00 in Billed Charges for Rev 272 = $542.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPLANT IMAGNUM 2 OM1502,272,RC,27200856,CDM,,,,,,both,,,1300.0000,195.0000,CIGNA HEALTHCARE,CIGNA PPO,542.10,,,,,,,335.5300,1300.0000,percent of total billed charges,"41.7% of $1,300.00 in Billed Charges for Rev 272 = $542.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPLANT IMAGNUM 2 OM1502,272,RC,27200856,CDM,,,,,,both,,,1300.0000,195.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1170.00,,,,,,,335.5300,1300.0000,percent of total billed charges,"90% of $1,300.00 in Billed Charges for Rev 272 = $1,170.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPLANT IMAGNUM 2 OM1502,272,RC,27200856,CDM,,,,,,both,,,1300.0000,195.0000,MEDCOST,MEDCOST VHN,618.67,,,,,,,335.5300,1300.0000,percent of total billed charges,"47.59% of $1,300.00 in Billed Charges for Rev 272 = $618.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPLANT IMAGNUM 2 OM1502,272,RC,27200856,CDM,,,,,,both,,,1300.0000,195.0000,SENTARA HEALTH,SENTARA HEALTH,335.53,,,,,,,335.5300,1300.0000,percent of total billed charges,"25.81% of $1,300.00 in Billed Charges for Rev 272 = $335.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPLANT IMAGNUM 2 OM1502,272,RC,27200856,CDM,,,,,,both,,,1300.0000,195.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1300.00,,,,,,,335.5300,1300.0000,percent of total billed charges,"100% of $1,300.00 in Billed Charges for Rev 272 = $1,300.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPLANT IMAGNUM 2 OM1502,272,RC,27200856,CDM,,,,,,both,,,1300.0000,195.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,650.00,,,,,,,335.5300,1300.0000,percent of total billed charges,"Rev 272 $1,300.00 in Billed Charges at 50% = $650.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPLANT IMAGNUM 2 OM1502,272,RC,27200856,CDM,,,,,,both,,,1300.0000,195.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,419.90,,,,,,,335.5300,1300.0000,other,"32.3% of $1,300.00 in Billed Charges for Rev 272 = $419.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IMPLANT IMAGNUM 2 OM1502,272,RC,27200856,CDM,,,,,,both,,,1300.0000,195.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,399.10,,,,,,,335.5300,1300.0000,other,"30.7% of $1,300.00 in Billed Charges for Rev 272 = $399.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IMPLANT IMAGNUM 2 OM1502,272,RC,27200856,CDM,,,,,,both,,,1300.0000,195.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,419.90,,,,,,,335.5300,1300.0000,percent of total billed charges,"32.3% of $1,300.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPLANT IMAGNUM 2 OM1502,272,RC,27200856,CDM,,,,,,both,,,1300.0000,195.0000,WELLCARE,WELLCARE MEDICAID,1300.00,,,,,,,335.5300,1300.0000,percent of total billed charges,"100% of $1,300.00 in Billed Charges for Rev 272 = $1,300.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INPUT TS INTROD SHTH 23CM ALL SZS,272,RC,27200858,CDM,,,,,,both,,,108.0000,16.2000,AETNA,AETNA,46.12,,,,,,,27.8700,108.0000,percent of total billed charges,42.7% of $108.00 in Billed Charges for Rev 272 = $46.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INPUT TS INTROD SHTH 23CM ALL SZS,272,RC,27200858,CDM,,,,,,both,,,108.0000,16.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,75.60,,,,,,,27.8700,108.0000,percent of total billed charges,Rev 272 $108.00 in Billed Charges at 70% = $75.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INPUT TS INTROD SHTH 23CM ALL SZS,272,RC,27200858,CDM,,,,,,both,,,108.0000,16.2000,CIGNA HEALTHCARE,CIGNA HMO,45.04,,,,,,,27.8700,108.0000,percent of total billed charges,41.7% of $108.00 in Billed Charges for Rev 272 = $45.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INPUT TS INTROD SHTH 23CM ALL SZS,272,RC,27200858,CDM,,,,,,both,,,108.0000,16.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,50.11,,,,,,,27.8700,108.0000,percent of total billed charges,46.4% of $108.00 in Billed Charges for Rev 272 = $50.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INPUT TS INTROD SHTH 23CM ALL SZS,272,RC,27200858,CDM,,,,,,both,,,108.0000,16.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,45.04,,,,,,,27.8700,108.0000,percent of total billed charges,41.7% of $108.00 in Billed Charges for Rev 272 = $45.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INPUT TS INTROD SHTH 23CM ALL SZS,272,RC,27200858,CDM,,,,,,both,,,108.0000,16.2000,CIGNA HEALTHCARE,CIGNA PPO,45.04,,,,,,,27.8700,108.0000,percent of total billed charges,41.7% of $108.00 in Billed Charges for Rev 272 = $45.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INPUT TS INTROD SHTH 23CM ALL SZS,272,RC,27200858,CDM,,,,,,both,,,108.0000,16.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,97.20,,,,,,,27.8700,108.0000,percent of total billed charges,90% of $108.00 in Billed Charges for Rev 272 = $97.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INPUT TS INTROD SHTH 23CM ALL SZS,272,RC,27200858,CDM,,,,,,both,,,108.0000,16.2000,MEDCOST,MEDCOST VHN,51.40,,,,,,,27.8700,108.0000,percent of total billed charges,47.59% of $108.00 in Billed Charges for Rev 272 = $51.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INPUT TS INTROD SHTH 23CM ALL SZS,272,RC,27200858,CDM,,,,,,both,,,108.0000,16.2000,SENTARA HEALTH,SENTARA HEALTH,27.87,,,,,,,27.8700,108.0000,percent of total billed charges,25.81% of $108.00 in Billed Charges for Rev 272 = $27.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INPUT TS INTROD SHTH 23CM ALL SZS,272,RC,27200858,CDM,,,,,,both,,,108.0000,16.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",108.00,,,,,,,27.8700,108.0000,percent of total billed charges,100% of $108.00 in Billed Charges for Rev 272 = $108.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INPUT TS INTROD SHTH 23CM ALL SZS,272,RC,27200858,CDM,,,,,,both,,,108.0000,16.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,54.00,,,,,,,27.8700,108.0000,percent of total billed charges,Rev 272 $108.00 in Billed Charges at 50% = $54.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INPUT TS INTROD SHTH 23CM ALL SZS,272,RC,27200858,CDM,,,,,,both,,,108.0000,16.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,34.88,,,,,,,27.8700,108.0000,other,32.3% of $108.00 in Billed Charges for Rev 272 = $34.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INPUT TS INTROD SHTH 23CM ALL SZS,272,RC,27200858,CDM,,,,,,both,,,108.0000,16.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,33.16,,,,,,,27.8700,108.0000,other,30.7% of $108.00 in Billed Charges for Rev 272 = $33.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INPUT TS INTROD SHTH 23CM ALL SZS,272,RC,27200858,CDM,,,,,,both,,,108.0000,16.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,34.88,,,,,,,27.8700,108.0000,percent of total billed charges,32.3% of $108.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INPUT TS INTROD SHTH 23CM ALL SZS,272,RC,27200858,CDM,,,,,,both,,,108.0000,16.2000,WELLCARE,WELLCARE MEDICAID,108.00,,,,,,,27.8700,108.0000,percent of total billed charges,100% of $108.00 in Billed Charges for Rev 272 = $108.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSERTION TRAY PICC DC-1980,272,RC,27200859,CDM,,,,,,both,,,90.0000,13.5000,AETNA,AETNA,38.43,,,,,,,23.2300,90.0000,percent of total billed charges,42.7% of $90.00 in Billed Charges for Rev 272 = $38.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSERTION TRAY PICC DC-1980,272,RC,27200859,CDM,,,,,,both,,,90.0000,13.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,63.00,,,,,,,23.2300,90.0000,percent of total billed charges,Rev 272 $90.00 in Billed Charges at 70% = $63.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSERTION TRAY PICC DC-1980,272,RC,27200859,CDM,,,,,,both,,,90.0000,13.5000,CIGNA HEALTHCARE,CIGNA HMO,37.53,,,,,,,23.2300,90.0000,percent of total billed charges,41.7% of $90.00 in Billed Charges for Rev 272 = $37.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSERTION TRAY PICC DC-1980,272,RC,27200859,CDM,,,,,,both,,,90.0000,13.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,41.76,,,,,,,23.2300,90.0000,percent of total billed charges,46.4% of $90.00 in Billed Charges for Rev 272 = $41.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSERTION TRAY PICC DC-1980,272,RC,27200859,CDM,,,,,,both,,,90.0000,13.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,37.53,,,,,,,23.2300,90.0000,percent of total billed charges,41.7% of $90.00 in Billed Charges for Rev 272 = $37.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSERTION TRAY PICC DC-1980,272,RC,27200859,CDM,,,,,,both,,,90.0000,13.5000,CIGNA HEALTHCARE,CIGNA PPO,37.53,,,,,,,23.2300,90.0000,percent of total billed charges,41.7% of $90.00 in Billed Charges for Rev 272 = $37.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSERTION TRAY PICC DC-1980,272,RC,27200859,CDM,,,,,,both,,,90.0000,13.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,81.00,,,,,,,23.2300,90.0000,percent of total billed charges,90% of $90.00 in Billed Charges for Rev 272 = $81.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSERTION TRAY PICC DC-1980,272,RC,27200859,CDM,,,,,,both,,,90.0000,13.5000,MEDCOST,MEDCOST VHN,42.83,,,,,,,23.2300,90.0000,percent of total billed charges,47.59% of $90.00 in Billed Charges for Rev 272 = $42.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSERTION TRAY PICC DC-1980,272,RC,27200859,CDM,,,,,,both,,,90.0000,13.5000,SENTARA HEALTH,SENTARA HEALTH,23.23,,,,,,,23.2300,90.0000,percent of total billed charges,25.81% of $90.00 in Billed Charges for Rev 272 = $23.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSERTION TRAY PICC DC-1980,272,RC,27200859,CDM,,,,,,both,,,90.0000,13.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",90.00,,,,,,,23.2300,90.0000,percent of total billed charges,100% of $90.00 in Billed Charges for Rev 272 = $90.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSERTION TRAY PICC DC-1980,272,RC,27200859,CDM,,,,,,both,,,90.0000,13.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,45.00,,,,,,,23.2300,90.0000,percent of total billed charges,Rev 272 $90.00 in Billed Charges at 50% = $45.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSERTION TRAY PICC DC-1980,272,RC,27200859,CDM,,,,,,both,,,90.0000,13.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,29.07,,,,,,,23.2300,90.0000,other,32.3% of $90.00 in Billed Charges for Rev 272 = $29.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION TRAY PICC DC-1980,272,RC,27200859,CDM,,,,,,both,,,90.0000,13.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,27.63,,,,,,,23.2300,90.0000,other,30.7% of $90.00 in Billed Charges for Rev 272 = $27.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION TRAY PICC DC-1980,272,RC,27200859,CDM,,,,,,both,,,90.0000,13.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,29.07,,,,,,,23.2300,90.0000,percent of total billed charges,32.3% of $90.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSERTION TRAY PICC DC-1980,272,RC,27200859,CDM,,,,,,both,,,90.0000,13.5000,WELLCARE,WELLCARE MEDICAID,90.00,,,,,,,23.2300,90.0000,percent of total billed charges,100% of $90.00 in Billed Charges for Rev 272 = $90.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN PUMP TRAINING,942,RC,94200009,CDM,,,,,,both,,,816.0000,122.4000,AETNA,AETNA,348.43,,,,,,,210.6100,816.0000,percent of total billed charges,42.7% of $816.00 in Billed Charges for Rev 942 = $348.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN PUMP TRAINING,942,RC,94200009,CDM,,,,,,both,,,816.0000,122.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,571.20,,,,,,,210.6100,816.0000,percent of total billed charges,Rev 942 $816.00 in Billed Charges at 70% = $571.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN PUMP TRAINING,942,RC,94200009,CDM,,,,,,both,,,816.0000,122.4000,CIGNA HEALTHCARE,CIGNA HMO,340.27,,,,,,,210.6100,816.0000,percent of total billed charges,41.7% of $816.00 in Billed Charges for Rev 942 = $340.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN PUMP TRAINING,942,RC,94200009,CDM,,,,,,both,,,816.0000,122.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,378.62,,,,,,,210.6100,816.0000,percent of total billed charges,46.4% of $816.00 in Billed Charges for Rev 942 = $378.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN PUMP TRAINING,942,RC,94200009,CDM,,,,,,both,,,816.0000,122.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,340.27,,,,,,,210.6100,816.0000,percent of total billed charges,41.7% of $816.00 in Billed Charges for Rev 942 = $340.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN PUMP TRAINING,942,RC,94200009,CDM,,,,,,both,,,816.0000,122.4000,CIGNA HEALTHCARE,CIGNA PPO,340.27,,,,,,,210.6100,816.0000,percent of total billed charges,41.7% of $816.00 in Billed Charges for Rev 942 = $340.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN PUMP TRAINING,942,RC,94200009,CDM,,,,,,both,,,816.0000,122.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,734.40,,,,,,,210.6100,816.0000,percent of total billed charges,90% of $816.00 in Billed Charges for Rev 942 = $734.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN PUMP TRAINING,942,RC,94200009,CDM,,,,,,both,,,816.0000,122.4000,MEDCOST,MEDCOST VHN,388.33,,,,,,,210.6100,816.0000,percent of total billed charges,47.59% of $816.00 in Billed Charges for Rev 942 = $388.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN PUMP TRAINING,942,RC,94200009,CDM,,,,,,both,,,816.0000,122.4000,SENTARA HEALTH,SENTARA HEALTH,210.61,,,,,,,210.6100,816.0000,percent of total billed charges,25.81% of $816.00 in Billed Charges for Rev 942 = $210.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN PUMP TRAINING,942,RC,94200009,CDM,,,,,,both,,,816.0000,122.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",816.00,,,,,,,210.6100,816.0000,percent of total billed charges,100% of $816.00 in Billed Charges for Rev 942 = $816.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN PUMP TRAINING,942,RC,94200009,CDM,,,,,,both,,,816.0000,122.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,408.00,,,,,,,210.6100,816.0000,percent of total billed charges,Rev 942 $816.00 in Billed Charges at 50% = $408.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN PUMP TRAINING,942,RC,94200009,CDM,,,,,,both,,,816.0000,122.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,505.00,,,,,,,210.6100,816.0000,other,Rev 942 1 Visit at $505.00 per Visit = $505.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN PUMP TRAINING,942,RC,94200009,CDM,,,,,,both,,,816.0000,122.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,484.00,,,,,,,210.6100,816.0000,other,Rev 942 1 Visit at $484.00 per Visit = $484.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN PUMP TRAINING,942,RC,94200009,CDM,,,,,,both,,,816.0000,122.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,795.00,,,,,,,210.6100,816.0000,other,Rev 942 1 Visit at $795.00 per Visit = $795.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN PUMP TRAINING,942,RC,94200009,CDM,,,,,,both,,,816.0000,122.4000,WELLCARE,WELLCARE MEDICAID,816.00,,,,,,,210.6100,816.0000,percent of total billed charges,100% of $816.00 in Billed Charges for Rev 942 = $816.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTRAOSSEOUS EZ-IO W/STABILIZER,272,RC,27201684,CDM,,,,,,both,,,1747.0000,262.0500,AETNA,AETNA,745.97,,,,,,,450.9000,1747.0000,percent of total billed charges,"42.7% of $1,747.00 in Billed Charges for Rev 272 = $745.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRAOSSEOUS EZ-IO W/STABILIZER,272,RC,27201684,CDM,,,,,,both,,,1747.0000,262.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1222.90,,,,,,,450.9000,1747.0000,percent of total billed charges,"Rev 272 $1,747.00 in Billed Charges at 70% = $1,222.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRAOSSEOUS EZ-IO W/STABILIZER,272,RC,27201684,CDM,,,,,,both,,,1747.0000,262.0500,CIGNA HEALTHCARE,CIGNA HMO,728.50,,,,,,,450.9000,1747.0000,percent of total billed charges,"41.7% of $1,747.00 in Billed Charges for Rev 272 = $728.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRAOSSEOUS EZ-IO W/STABILIZER,272,RC,27201684,CDM,,,,,,both,,,1747.0000,262.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,810.61,,,,,,,450.9000,1747.0000,percent of total billed charges,"46.4% of $1,747.00 in Billed Charges for Rev 272 = $810.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRAOSSEOUS EZ-IO W/STABILIZER,272,RC,27201684,CDM,,,,,,both,,,1747.0000,262.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,728.50,,,,,,,450.9000,1747.0000,percent of total billed charges,"41.7% of $1,747.00 in Billed Charges for Rev 272 = $728.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRAOSSEOUS EZ-IO W/STABILIZER,272,RC,27201684,CDM,,,,,,both,,,1747.0000,262.0500,CIGNA HEALTHCARE,CIGNA PPO,728.50,,,,,,,450.9000,1747.0000,percent of total billed charges,"41.7% of $1,747.00 in Billed Charges for Rev 272 = $728.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRAOSSEOUS EZ-IO W/STABILIZER,272,RC,27201684,CDM,,,,,,both,,,1747.0000,262.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1572.30,,,,,,,450.9000,1747.0000,percent of total billed charges,"90% of $1,747.00 in Billed Charges for Rev 272 = $1,572.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRAOSSEOUS EZ-IO W/STABILIZER,272,RC,27201684,CDM,,,,,,both,,,1747.0000,262.0500,MEDCOST,MEDCOST VHN,831.40,,,,,,,450.9000,1747.0000,percent of total billed charges,"47.59% of $1,747.00 in Billed Charges for Rev 272 = $831.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRAOSSEOUS EZ-IO W/STABILIZER,272,RC,27201684,CDM,,,,,,both,,,1747.0000,262.0500,SENTARA HEALTH,SENTARA HEALTH,450.90,,,,,,,450.9000,1747.0000,percent of total billed charges,"25.81% of $1,747.00 in Billed Charges for Rev 272 = $450.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRAOSSEOUS EZ-IO W/STABILIZER,272,RC,27201684,CDM,,,,,,both,,,1747.0000,262.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1747.00,,,,,,,450.9000,1747.0000,percent of total billed charges,"100% of $1,747.00 in Billed Charges for Rev 272 = $1,747.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRAOSSEOUS EZ-IO W/STABILIZER,272,RC,27201684,CDM,,,,,,both,,,1747.0000,262.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,873.50,,,,,,,450.9000,1747.0000,percent of total billed charges,"Rev 272 $1,747.00 in Billed Charges at 50% = $873.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRAOSSEOUS EZ-IO W/STABILIZER,272,RC,27201684,CDM,,,,,,both,,,1747.0000,262.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,564.28,,,,,,,450.9000,1747.0000,other,"32.3% of $1,747.00 in Billed Charges for Rev 272 = $564.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRAOSSEOUS EZ-IO W/STABILIZER,272,RC,27201684,CDM,,,,,,both,,,1747.0000,262.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,536.33,,,,,,,450.9000,1747.0000,other,"30.7% of $1,747.00 in Billed Charges for Rev 272 = $536.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTRAOSSEOUS EZ-IO W/STABILIZER,272,RC,27201684,CDM,,,,,,both,,,1747.0000,262.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,564.28,,,,,,,450.9000,1747.0000,percent of total billed charges,"32.3% of $1,747.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTRAOSSEOUS EZ-IO W/STABILIZER,272,RC,27201684,CDM,,,,,,both,,,1747.0000,262.0500,WELLCARE,WELLCARE MEDICAID,1747.00,,,,,,,450.9000,1747.0000,percent of total billed charges,"100% of $1,747.00 in Billed Charges for Rev 272 = $1,747.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IRRIGATION SUCT PULSEVAC 51504750,272,RC,27200888,CDM,,,,,,both,,,203.0000,30.4500,AETNA,AETNA,86.68,,,,,,,52.3900,203.0000,percent of total billed charges,42.7% of $203.00 in Billed Charges for Rev 272 = $86.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IRRIGATION SUCT PULSEVAC 51504750,272,RC,27200888,CDM,,,,,,both,,,203.0000,30.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,142.10,,,,,,,52.3900,203.0000,percent of total billed charges,Rev 272 $203.00 in Billed Charges at 70% = $142.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IRRIGATION SUCT PULSEVAC 51504750,272,RC,27200888,CDM,,,,,,both,,,203.0000,30.4500,CIGNA HEALTHCARE,CIGNA HMO,84.65,,,,,,,52.3900,203.0000,percent of total billed charges,41.7% of $203.00 in Billed Charges for Rev 272 = $84.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IRRIGATION SUCT PULSEVAC 51504750,272,RC,27200888,CDM,,,,,,both,,,203.0000,30.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,94.19,,,,,,,52.3900,203.0000,percent of total billed charges,46.4% of $203.00 in Billed Charges for Rev 272 = $94.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IRRIGATION SUCT PULSEVAC 51504750,272,RC,27200888,CDM,,,,,,both,,,203.0000,30.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,84.65,,,,,,,52.3900,203.0000,percent of total billed charges,41.7% of $203.00 in Billed Charges for Rev 272 = $84.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IRRIGATION SUCT PULSEVAC 51504750,272,RC,27200888,CDM,,,,,,both,,,203.0000,30.4500,CIGNA HEALTHCARE,CIGNA PPO,84.65,,,,,,,52.3900,203.0000,percent of total billed charges,41.7% of $203.00 in Billed Charges for Rev 272 = $84.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IRRIGATION SUCT PULSEVAC 51504750,272,RC,27200888,CDM,,,,,,both,,,203.0000,30.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,182.70,,,,,,,52.3900,203.0000,percent of total billed charges,90% of $203.00 in Billed Charges for Rev 272 = $182.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IRRIGATION SUCT PULSEVAC 51504750,272,RC,27200888,CDM,,,,,,both,,,203.0000,30.4500,MEDCOST,MEDCOST VHN,96.61,,,,,,,52.3900,203.0000,percent of total billed charges,47.59% of $203.00 in Billed Charges for Rev 272 = $96.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IRRIGATION SUCT PULSEVAC 51504750,272,RC,27200888,CDM,,,,,,both,,,203.0000,30.4500,SENTARA HEALTH,SENTARA HEALTH,52.39,,,,,,,52.3900,203.0000,percent of total billed charges,25.81% of $203.00 in Billed Charges for Rev 272 = $52.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IRRIGATION SUCT PULSEVAC 51504750,272,RC,27200888,CDM,,,,,,both,,,203.0000,30.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",203.00,,,,,,,52.3900,203.0000,percent of total billed charges,100% of $203.00 in Billed Charges for Rev 272 = $203.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IRRIGATION SUCT PULSEVAC 51504750,272,RC,27200888,CDM,,,,,,both,,,203.0000,30.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,101.50,,,,,,,52.3900,203.0000,percent of total billed charges,Rev 272 $203.00 in Billed Charges at 50% = $101.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IRRIGATION SUCT PULSEVAC 51504750,272,RC,27200888,CDM,,,,,,both,,,203.0000,30.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,65.57,,,,,,,52.3900,203.0000,other,32.3% of $203.00 in Billed Charges for Rev 272 = $65.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATION SUCT PULSEVAC 51504750,272,RC,27200888,CDM,,,,,,both,,,203.0000,30.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,62.32,,,,,,,52.3900,203.0000,other,30.7% of $203.00 in Billed Charges for Rev 272 = $62.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATION SUCT PULSEVAC 51504750,272,RC,27200888,CDM,,,,,,both,,,203.0000,30.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,65.57,,,,,,,52.3900,203.0000,percent of total billed charges,32.3% of $203.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IRRIGATION SUCT PULSEVAC 51504750,272,RC,27200888,CDM,,,,,,both,,,203.0000,30.4500,WELLCARE,WELLCARE MEDICAID,203.00,,,,,,,52.3900,203.0000,percent of total billed charges,100% of $203.00 in Billed Charges for Rev 272 = $203.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 4-0 J214H,272,RC,27201415,CDM,,,,,,both,,,12.0000,1.8000,AETNA,AETNA,5.12,,,,,,,3.1000,12.0000,percent of total billed charges,42.7% of $12.00 in Billed Charges for Rev 272 = $5.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 4-0 J214H,272,RC,27201415,CDM,,,,,,both,,,12.0000,1.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8.40,,,,,,,3.1000,12.0000,percent of total billed charges,Rev 272 $12.00 in Billed Charges at 70% = $8.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 4-0 J214H,272,RC,27201415,CDM,,,,,,both,,,12.0000,1.8000,CIGNA HEALTHCARE,CIGNA HMO,5.00,,,,,,,3.1000,12.0000,percent of total billed charges,41.7% of $12.00 in Billed Charges for Rev 272 = $5.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 4-0 J214H,272,RC,27201415,CDM,,,,,,both,,,12.0000,1.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5.57,,,,,,,3.1000,12.0000,percent of total billed charges,46.4% of $12.00 in Billed Charges for Rev 272 = $5.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 4-0 J214H,272,RC,27201415,CDM,,,,,,both,,,12.0000,1.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5.00,,,,,,,3.1000,12.0000,percent of total billed charges,41.7% of $12.00 in Billed Charges for Rev 272 = $5.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 4-0 J214H,272,RC,27201415,CDM,,,,,,both,,,12.0000,1.8000,CIGNA HEALTHCARE,CIGNA PPO,5.00,,,,,,,3.1000,12.0000,percent of total billed charges,41.7% of $12.00 in Billed Charges for Rev 272 = $5.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 4-0 J214H,272,RC,27201415,CDM,,,,,,both,,,12.0000,1.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10.80,,,,,,,3.1000,12.0000,percent of total billed charges,90% of $12.00 in Billed Charges for Rev 272 = $10.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 4-0 J214H,272,RC,27201415,CDM,,,,,,both,,,12.0000,1.8000,MEDCOST,MEDCOST VHN,5.71,,,,,,,3.1000,12.0000,percent of total billed charges,47.59% of $12.00 in Billed Charges for Rev 272 = $5.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 4-0 J214H,272,RC,27201415,CDM,,,,,,both,,,12.0000,1.8000,SENTARA HEALTH,SENTARA HEALTH,3.10,,,,,,,3.1000,12.0000,percent of total billed charges,25.81% of $12.00 in Billed Charges for Rev 272 = $3.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 4-0 J214H,272,RC,27201415,CDM,,,,,,both,,,12.0000,1.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12.00,,,,,,,3.1000,12.0000,percent of total billed charges,100% of $12.00 in Billed Charges for Rev 272 = $12.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 4-0 J214H,272,RC,27201415,CDM,,,,,,both,,,12.0000,1.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6.00,,,,,,,3.1000,12.0000,percent of total billed charges,Rev 272 $12.00 in Billed Charges at 50% = $6.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 4-0 J214H,272,RC,27201415,CDM,,,,,,both,,,12.0000,1.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3.88,,,,,,,3.1000,12.0000,other,32.3% of $12.00 in Billed Charges for Rev 272 = $3.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE VICRYL 4-0 J214H,272,RC,27201415,CDM,,,,,,both,,,12.0000,1.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3.68,,,,,,,3.1000,12.0000,other,30.7% of $12.00 in Billed Charges for Rev 272 = $3.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE VICRYL 4-0 J214H,272,RC,27201415,CDM,,,,,,both,,,12.0000,1.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,3.88,,,,,,,3.1000,12.0000,percent of total billed charges,32.3% of $12.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE VICRYL 4-0 J214H,272,RC,27201415,CDM,,,,,,both,,,12.0000,1.8000,WELLCARE,WELLCARE MEDICAID,12.00,,,,,,,3.1000,12.0000,percent of total billed charges,100% of $12.00 in Billed Charges for Rev 272 = $12.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC KIT BLOOD CONSERVATION 3/16"" EA",270,RC,27000084,CDM,,,,,,both,,,580.0000,87.0000,AETNA,AETNA,247.66,,,,,,,149.7000,580.0000,percent of total billed charges,42.7% of $580.00 in Billed Charges for Rev 270 = $247.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC KIT BLOOD CONSERVATION 3/16"" EA",270,RC,27000084,CDM,,,,,,both,,,580.0000,87.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,406.00,,,,,,,149.7000,580.0000,percent of total billed charges,Rev 270 $580.00 in Billed Charges at 70% = $406.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC KIT BLOOD CONSERVATION 3/16"" EA",270,RC,27000084,CDM,,,,,,both,,,580.0000,87.0000,CIGNA HEALTHCARE,CIGNA HMO,241.86,,,,,,,149.7000,580.0000,percent of total billed charges,41.7% of $580.00 in Billed Charges for Rev 270 = $241.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC KIT BLOOD CONSERVATION 3/16"" EA",270,RC,27000084,CDM,,,,,,both,,,580.0000,87.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,269.12,,,,,,,149.7000,580.0000,percent of total billed charges,46.4% of $580.00 in Billed Charges for Rev 270 = $269.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC KIT BLOOD CONSERVATION 3/16"" EA",270,RC,27000084,CDM,,,,,,both,,,580.0000,87.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,241.86,,,,,,,149.7000,580.0000,percent of total billed charges,41.7% of $580.00 in Billed Charges for Rev 270 = $241.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC KIT BLOOD CONSERVATION 3/16"" EA",270,RC,27000084,CDM,,,,,,both,,,580.0000,87.0000,CIGNA HEALTHCARE,CIGNA PPO,241.86,,,,,,,149.7000,580.0000,percent of total billed charges,41.7% of $580.00 in Billed Charges for Rev 270 = $241.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC KIT BLOOD CONSERVATION 3/16"" EA",270,RC,27000084,CDM,,,,,,both,,,580.0000,87.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,522.00,,,,,,,149.7000,580.0000,percent of total billed charges,90% of $580.00 in Billed Charges for Rev 270 = $522.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC KIT BLOOD CONSERVATION 3/16"" EA",270,RC,27000084,CDM,,,,,,both,,,580.0000,87.0000,MEDCOST,MEDCOST VHN,276.02,,,,,,,149.7000,580.0000,percent of total billed charges,47.59% of $580.00 in Billed Charges for Rev 270 = $276.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC KIT BLOOD CONSERVATION 3/16"" EA",270,RC,27000084,CDM,,,,,,both,,,580.0000,87.0000,SENTARA HEALTH,SENTARA HEALTH,149.70,,,,,,,149.7000,580.0000,percent of total billed charges,25.81% of $580.00 in Billed Charges for Rev 270 = $149.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC KIT BLOOD CONSERVATION 3/16"" EA",270,RC,27000084,CDM,,,,,,both,,,580.0000,87.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",580.00,,,,,,,149.7000,580.0000,percent of total billed charges,100% of $580.00 in Billed Charges for Rev 270 = $580.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC KIT BLOOD CONSERVATION 3/16"" EA",270,RC,27000084,CDM,,,,,,both,,,580.0000,87.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,290.00,,,,,,,149.7000,580.0000,percent of total billed charges,Rev 270 $580.00 in Billed Charges at 50% = $290.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC KIT BLOOD CONSERVATION 3/16"" EA",270,RC,27000084,CDM,,,,,,both,,,580.0000,87.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,187.34,,,,,,,149.7000,580.0000,other,32.3% of $580.00 in Billed Charges for Rev 270 = $187.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
"HC KIT BLOOD CONSERVATION 3/16"" EA",270,RC,27000084,CDM,,,,,,both,,,580.0000,87.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,178.06,,,,,,,149.7000,580.0000,other,30.7% of $580.00 in Billed Charges for Rev 270 = $178.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
"HC KIT BLOOD CONSERVATION 3/16"" EA",270,RC,27000084,CDM,,,,,,both,,,580.0000,87.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,187.34,,,,,,,149.7000,580.0000,percent of total billed charges,32.3% of $580.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC KIT BLOOD CONSERVATION 3/16"" EA",270,RC,27000084,CDM,,,,,,both,,,580.0000,87.0000,WELLCARE,WELLCARE MEDICAID,580.00,,,,,,,149.7000,580.0000,percent of total billed charges,100% of $580.00 in Billed Charges for Rev 270 = $580.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT CAMINO 110-4HC EACH,270,RC,27000184,CDM,,,,,,both,,,2466.0000,369.9000,AETNA,AETNA,1052.98,,,,,,,636.4700,2466.0000,percent of total billed charges,"42.7% of $2,466.00 in Billed Charges for Rev 270 = $1,052.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CAMINO 110-4HC EACH,270,RC,27000184,CDM,,,,,,both,,,2466.0000,369.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1726.20,,,,,,,636.4700,2466.0000,percent of total billed charges,"Rev 270 $2,466.00 in Billed Charges at 70% = $1,726.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CAMINO 110-4HC EACH,270,RC,27000184,CDM,,,,,,both,,,2466.0000,369.9000,CIGNA HEALTHCARE,CIGNA HMO,1028.32,,,,,,,636.4700,2466.0000,percent of total billed charges,"41.7% of $2,466.00 in Billed Charges for Rev 270 = $1,028.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CAMINO 110-4HC EACH,270,RC,27000184,CDM,,,,,,both,,,2466.0000,369.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1144.22,,,,,,,636.4700,2466.0000,percent of total billed charges,"46.4% of $2,466.00 in Billed Charges for Rev 270 = $1,144.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CAMINO 110-4HC EACH,270,RC,27000184,CDM,,,,,,both,,,2466.0000,369.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1028.32,,,,,,,636.4700,2466.0000,percent of total billed charges,"41.7% of $2,466.00 in Billed Charges for Rev 270 = $1,028.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CAMINO 110-4HC EACH,270,RC,27000184,CDM,,,,,,both,,,2466.0000,369.9000,CIGNA HEALTHCARE,CIGNA PPO,1028.32,,,,,,,636.4700,2466.0000,percent of total billed charges,"41.7% of $2,466.00 in Billed Charges for Rev 270 = $1,028.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CAMINO 110-4HC EACH,270,RC,27000184,CDM,,,,,,both,,,2466.0000,369.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2219.40,,,,,,,636.4700,2466.0000,percent of total billed charges,"90% of $2,466.00 in Billed Charges for Rev 270 = $2,219.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CAMINO 110-4HC EACH,270,RC,27000184,CDM,,,,,,both,,,2466.0000,369.9000,MEDCOST,MEDCOST VHN,1173.57,,,,,,,636.4700,2466.0000,percent of total billed charges,"47.59% of $2,466.00 in Billed Charges for Rev 270 = $1,173.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CAMINO 110-4HC EACH,270,RC,27000184,CDM,,,,,,both,,,2466.0000,369.9000,SENTARA HEALTH,SENTARA HEALTH,636.47,,,,,,,636.4700,2466.0000,percent of total billed charges,"25.81% of $2,466.00 in Billed Charges for Rev 270 = $636.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CAMINO 110-4HC EACH,270,RC,27000184,CDM,,,,,,both,,,2466.0000,369.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2466.00,,,,,,,636.4700,2466.0000,percent of total billed charges,"100% of $2,466.00 in Billed Charges for Rev 270 = $2,466.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CAMINO 110-4HC EACH,270,RC,27000184,CDM,,,,,,both,,,2466.0000,369.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1233.00,,,,,,,636.4700,2466.0000,percent of total billed charges,"Rev 270 $2,466.00 in Billed Charges at 50% = $1,233.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CAMINO 110-4HC EACH,270,RC,27000184,CDM,,,,,,both,,,2466.0000,369.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,796.52,,,,,,,636.4700,2466.0000,other,"32.3% of $2,466.00 in Billed Charges for Rev 270 = $796.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIT CAMINO 110-4HC EACH,270,RC,27000184,CDM,,,,,,both,,,2466.0000,369.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,757.06,,,,,,,636.4700,2466.0000,other,"30.7% of $2,466.00 in Billed Charges for Rev 270 = $757.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIT CAMINO 110-4HC EACH,270,RC,27000184,CDM,,,,,,both,,,2466.0000,369.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,796.52,,,,,,,636.4700,2466.0000,percent of total billed charges,"32.3% of $2,466.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CAMINO 110-4HC EACH,270,RC,27000184,CDM,,,,,,both,,,2466.0000,369.9000,WELLCARE,WELLCARE MEDICAID,2466.00,,,,,,,636.4700,2466.0000,percent of total billed charges,"100% of $2,466.00 in Billed Charges for Rev 270 = $2,466.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CRANIAL ACCESS,272,RC,27202230,CDM,,,,,,both,,,2828.0000,424.2000,AETNA,AETNA,1207.56,,,,,,,729.9100,2828.0000,percent of total billed charges,"42.7% of $2,828.00 in Billed Charges for Rev 272 = $1,207.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CRANIAL ACCESS,272,RC,27202230,CDM,,,,,,both,,,2828.0000,424.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1979.60,,,,,,,729.9100,2828.0000,percent of total billed charges,"Rev 272 $2,828.00 in Billed Charges at 70% = $1,979.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CRANIAL ACCESS,272,RC,27202230,CDM,,,,,,both,,,2828.0000,424.2000,CIGNA HEALTHCARE,CIGNA HMO,1179.28,,,,,,,729.9100,2828.0000,percent of total billed charges,"41.7% of $2,828.00 in Billed Charges for Rev 272 = $1,179.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CRANIAL ACCESS,272,RC,27202230,CDM,,,,,,both,,,2828.0000,424.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1312.19,,,,,,,729.9100,2828.0000,percent of total billed charges,"46.4% of $2,828.00 in Billed Charges for Rev 272 = $1,312.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CRANIAL ACCESS,272,RC,27202230,CDM,,,,,,both,,,2828.0000,424.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1179.28,,,,,,,729.9100,2828.0000,percent of total billed charges,"41.7% of $2,828.00 in Billed Charges for Rev 272 = $1,179.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CRANIAL ACCESS,272,RC,27202230,CDM,,,,,,both,,,2828.0000,424.2000,CIGNA HEALTHCARE,CIGNA PPO,1179.28,,,,,,,729.9100,2828.0000,percent of total billed charges,"41.7% of $2,828.00 in Billed Charges for Rev 272 = $1,179.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CRANIAL ACCESS,272,RC,27202230,CDM,,,,,,both,,,2828.0000,424.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2545.20,,,,,,,729.9100,2828.0000,percent of total billed charges,"90% of $2,828.00 in Billed Charges for Rev 272 = $2,545.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CRANIAL ACCESS,272,RC,27202230,CDM,,,,,,both,,,2828.0000,424.2000,MEDCOST,MEDCOST VHN,1345.85,,,,,,,729.9100,2828.0000,percent of total billed charges,"47.59% of $2,828.00 in Billed Charges for Rev 272 = $1,345.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CRANIAL ACCESS,272,RC,27202230,CDM,,,,,,both,,,2828.0000,424.2000,SENTARA HEALTH,SENTARA HEALTH,729.91,,,,,,,729.9100,2828.0000,percent of total billed charges,"25.81% of $2,828.00 in Billed Charges for Rev 272 = $729.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CRANIAL ACCESS,272,RC,27202230,CDM,,,,,,both,,,2828.0000,424.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2828.00,,,,,,,729.9100,2828.0000,percent of total billed charges,"100% of $2,828.00 in Billed Charges for Rev 272 = $2,828.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CRANIAL ACCESS,272,RC,27202230,CDM,,,,,,both,,,2828.0000,424.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1414.00,,,,,,,729.9100,2828.0000,percent of total billed charges,"Rev 272 $2,828.00 in Billed Charges at 50% = $1,414.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CRANIAL ACCESS,272,RC,27202230,CDM,,,,,,both,,,2828.0000,424.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,913.44,,,,,,,729.9100,2828.0000,other,"32.3% of $2,828.00 in Billed Charges for Rev 272 = $913.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIT CRANIAL ACCESS,272,RC,27202230,CDM,,,,,,both,,,2828.0000,424.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,868.20,,,,,,,729.9100,2828.0000,other,"30.7% of $2,828.00 in Billed Charges for Rev 272 = $868.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIT CRANIAL ACCESS,272,RC,27202230,CDM,,,,,,both,,,2828.0000,424.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,913.44,,,,,,,729.9100,2828.0000,percent of total billed charges,"32.3% of $2,828.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CRANIAL ACCESS,272,RC,27202230,CDM,,,,,,both,,,2828.0000,424.2000,WELLCARE,WELLCARE MEDICAID,2828.00,,,,,,,729.9100,2828.0000,percent of total billed charges,"100% of $2,828.00 in Billed Charges for Rev 272 = $2,828.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT ENHANCE TRANSCAROTID PERIPHERAL ACCESS,272,RC,27202103,CDM,,,,,,both,,,835.0000,125.2500,AETNA,AETNA,356.55,,,,,,,215.5100,835.0000,percent of total billed charges,42.7% of $835.00 in Billed Charges for Rev 272 = $356.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ENHANCE TRANSCAROTID PERIPHERAL ACCESS,272,RC,27202103,CDM,,,,,,both,,,835.0000,125.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,584.50,,,,,,,215.5100,835.0000,percent of total billed charges,Rev 272 $835.00 in Billed Charges at 70% = $584.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ENHANCE TRANSCAROTID PERIPHERAL ACCESS,272,RC,27202103,CDM,,,,,,both,,,835.0000,125.2500,CIGNA HEALTHCARE,CIGNA HMO,348.20,,,,,,,215.5100,835.0000,percent of total billed charges,41.7% of $835.00 in Billed Charges for Rev 272 = $348.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ENHANCE TRANSCAROTID PERIPHERAL ACCESS,272,RC,27202103,CDM,,,,,,both,,,835.0000,125.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,387.44,,,,,,,215.5100,835.0000,percent of total billed charges,46.4% of $835.00 in Billed Charges for Rev 272 = $387.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ENHANCE TRANSCAROTID PERIPHERAL ACCESS,272,RC,27202103,CDM,,,,,,both,,,835.0000,125.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,348.20,,,,,,,215.5100,835.0000,percent of total billed charges,41.7% of $835.00 in Billed Charges for Rev 272 = $348.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ENHANCE TRANSCAROTID PERIPHERAL ACCESS,272,RC,27202103,CDM,,,,,,both,,,835.0000,125.2500,CIGNA HEALTHCARE,CIGNA PPO,348.20,,,,,,,215.5100,835.0000,percent of total billed charges,41.7% of $835.00 in Billed Charges for Rev 272 = $348.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ENHANCE TRANSCAROTID PERIPHERAL ACCESS,272,RC,27202103,CDM,,,,,,both,,,835.0000,125.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,751.50,,,,,,,215.5100,835.0000,percent of total billed charges,90% of $835.00 in Billed Charges for Rev 272 = $751.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ENHANCE TRANSCAROTID PERIPHERAL ACCESS,272,RC,27202103,CDM,,,,,,both,,,835.0000,125.2500,MEDCOST,MEDCOST VHN,397.38,,,,,,,215.5100,835.0000,percent of total billed charges,47.59% of $835.00 in Billed Charges for Rev 272 = $397.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ENHANCE TRANSCAROTID PERIPHERAL ACCESS,272,RC,27202103,CDM,,,,,,both,,,835.0000,125.2500,SENTARA HEALTH,SENTARA HEALTH,215.51,,,,,,,215.5100,835.0000,percent of total billed charges,25.81% of $835.00 in Billed Charges for Rev 272 = $215.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ENHANCE TRANSCAROTID PERIPHERAL ACCESS,272,RC,27202103,CDM,,,,,,both,,,835.0000,125.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",835.00,,,,,,,215.5100,835.0000,percent of total billed charges,100% of $835.00 in Billed Charges for Rev 272 = $835.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ENHANCE TRANSCAROTID PERIPHERAL ACCESS,272,RC,27202103,CDM,,,,,,both,,,835.0000,125.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,417.50,,,,,,,215.5100,835.0000,percent of total billed charges,Rev 272 $835.00 in Billed Charges at 50% = $417.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ENHANCE TRANSCAROTID PERIPHERAL ACCESS,272,RC,27202103,CDM,,,,,,both,,,835.0000,125.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,269.71,,,,,,,215.5100,835.0000,other,32.3% of $835.00 in Billed Charges for Rev 272 = $269.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIT ENHANCE TRANSCAROTID PERIPHERAL ACCESS,272,RC,27202103,CDM,,,,,,both,,,835.0000,125.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,256.35,,,,,,,215.5100,835.0000,other,30.7% of $835.00 in Billed Charges for Rev 272 = $256.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIT ENHANCE TRANSCAROTID PERIPHERAL ACCESS,272,RC,27202103,CDM,,,,,,both,,,835.0000,125.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,269.71,,,,,,,215.5100,835.0000,percent of total billed charges,32.3% of $835.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ENHANCE TRANSCAROTID PERIPHERAL ACCESS,272,RC,27202103,CDM,,,,,,both,,,835.0000,125.2500,WELLCARE,WELLCARE MEDICAID,835.00,,,,,,,215.5100,835.0000,percent of total billed charges,100% of $835.00 in Billed Charges for Rev 272 = $835.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE-2-0 VICRYL J317,272,RC,27201638,CDM,,,,,,both,,,13.0000,1.9500,AETNA,AETNA,5.55,,,,,,,3.3600,13.0000,percent of total billed charges,42.7% of $13.00 in Billed Charges for Rev 272 = $5.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE-2-0 VICRYL J317,272,RC,27201638,CDM,,,,,,both,,,13.0000,1.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9.10,,,,,,,3.3600,13.0000,percent of total billed charges,Rev 272 $13.00 in Billed Charges at 70% = $9.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE-2-0 VICRYL J317,272,RC,27201638,CDM,,,,,,both,,,13.0000,1.9500,CIGNA HEALTHCARE,CIGNA HMO,5.42,,,,,,,3.3600,13.0000,percent of total billed charges,41.7% of $13.00 in Billed Charges for Rev 272 = $5.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE-2-0 VICRYL J317,272,RC,27201638,CDM,,,,,,both,,,13.0000,1.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6.03,,,,,,,3.3600,13.0000,percent of total billed charges,46.4% of $13.00 in Billed Charges for Rev 272 = $6.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE-2-0 VICRYL J317,272,RC,27201638,CDM,,,,,,both,,,13.0000,1.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5.42,,,,,,,3.3600,13.0000,percent of total billed charges,41.7% of $13.00 in Billed Charges for Rev 272 = $5.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE-2-0 VICRYL J317,272,RC,27201638,CDM,,,,,,both,,,13.0000,1.9500,CIGNA HEALTHCARE,CIGNA PPO,5.42,,,,,,,3.3600,13.0000,percent of total billed charges,41.7% of $13.00 in Billed Charges for Rev 272 = $5.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE-2-0 VICRYL J317,272,RC,27201638,CDM,,,,,,both,,,13.0000,1.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11.70,,,,,,,3.3600,13.0000,percent of total billed charges,90% of $13.00 in Billed Charges for Rev 272 = $11.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE-2-0 VICRYL J317,272,RC,27201638,CDM,,,,,,both,,,13.0000,1.9500,MEDCOST,MEDCOST VHN,6.19,,,,,,,3.3600,13.0000,percent of total billed charges,47.59% of $13.00 in Billed Charges for Rev 272 = $6.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE-2-0 VICRYL J317,272,RC,27201638,CDM,,,,,,both,,,13.0000,1.9500,SENTARA HEALTH,SENTARA HEALTH,3.36,,,,,,,3.3600,13.0000,percent of total billed charges,25.81% of $13.00 in Billed Charges for Rev 272 = $3.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE-2-0 VICRYL J317,272,RC,27201638,CDM,,,,,,both,,,13.0000,1.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13.00,,,,,,,3.3600,13.0000,percent of total billed charges,100% of $13.00 in Billed Charges for Rev 272 = $13.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE-2-0 VICRYL J317,272,RC,27201638,CDM,,,,,,both,,,13.0000,1.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6.50,,,,,,,3.3600,13.0000,percent of total billed charges,Rev 272 $13.00 in Billed Charges at 50% = $6.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE-2-0 VICRYL J317,272,RC,27201638,CDM,,,,,,both,,,13.0000,1.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4.20,,,,,,,3.3600,13.0000,other,32.3% of $13.00 in Billed Charges for Rev 272 = $4.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE-2-0 VICRYL J317,272,RC,27201638,CDM,,,,,,both,,,13.0000,1.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3.99,,,,,,,3.3600,13.0000,other,30.7% of $13.00 in Billed Charges for Rev 272 = $3.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE-2-0 VICRYL J317,272,RC,27201638,CDM,,,,,,both,,,13.0000,1.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,4.20,,,,,,,3.3600,13.0000,percent of total billed charges,32.3% of $13.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE-2-0 VICRYL J317,272,RC,27201638,CDM,,,,,,both,,,13.0000,1.9500,WELLCARE,WELLCARE MEDICAID,13.00,,,,,,,3.3600,13.0000,percent of total billed charges,100% of $13.00 in Billed Charges for Rev 272 = $13.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SWING BED ACUTE CARE DLY,119,RC,11900001,CDM,,,,,,inpatient,,,1348.0000,202.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,121.7600,1348.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC SWING BED ACUTE CARE DLY,119,RC,11900001,CDM,,,,,,inpatient,,,1348.0000,202.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1213.20,,,,,,,121.7600,1348.0000,percent of total billed charges,"90% of $1,348.00 in Billed Charges for Rev 119 = $1,213.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SWING BED ACUTE CARE DLY,119,RC,11900001,CDM,,,,,,inpatient,,,1348.0000,202.2000,MEDCOST,MEDCOST VHN,641.51,,,,,,,121.7600,1348.0000,percent of total billed charges,"47.59% of $1,348.00 in Billed Charges for Rev 119 = $641.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SWING BED ACUTE CARE DLY,119,RC,11900001,CDM,,,,,,inpatient,,,1348.0000,202.2000,SENTARA HEALTH,SENTARA HEALTH,502.53,,,,,,,121.7600,1348.0000,percent of total billed charges,"37.28% of $1,348.00 in Billed Charges for Rev 119 = $502.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SWING BED ACUTE CARE DLY,119,RC,11900001,CDM,,,,,,inpatient,,,1348.0000,202.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1348.00,,,,,,,121.7600,1348.0000,percent of total billed charges,"100% of $1,348.00 in Billed Charges for Rev 119 = $1,348.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SWING BED ROOM DLY SEMI,129,RC,12900001,CDM,,,,,,inpatient,,,1290.0000,193.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,121.7600,1290.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC SWING BED ROOM DLY SEMI,129,RC,12900001,CDM,,,,,,inpatient,,,1290.0000,193.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1161.00,,,,,,,121.7600,1290.0000,percent of total billed charges,"90% of $1,290.00 in Billed Charges for Rev 129 = $1,161.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SWING BED ROOM DLY SEMI,129,RC,12900001,CDM,,,,,,inpatient,,,1290.0000,193.5000,MEDCOST,MEDCOST VHN,613.91,,,,,,,121.7600,1290.0000,percent of total billed charges,"47.59% of $1,290.00 in Billed Charges for Rev 129 = $613.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SWING BED ROOM DLY SEMI,129,RC,12900001,CDM,,,,,,inpatient,,,1290.0000,193.5000,SENTARA HEALTH,SENTARA HEALTH,480.91,,,,,,,121.7600,1290.0000,percent of total billed charges,"37.28% of $1,290.00 in Billed Charges for Rev 129 = $480.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SWING BED ROOM DLY SEMI,129,RC,12900001,CDM,,,,,,inpatient,,,1290.0000,193.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1290.00,,,,,,,121.7600,1290.0000,percent of total billed charges,"100% of $1,290.00 in Billed Charges for Rev 129 = $1,290.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYRINGE RING 10CC CONTRAST,272,RC,27201163,CDM,,,,,,both,,,3.0000,0.4500,AETNA,AETNA,1.28,,,,,,,0.7700,3.0000,percent of total billed charges,42.7% of $3.00 in Billed Charges for Rev 272 = $1.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYRINGE RING 10CC CONTRAST,272,RC,27201163,CDM,,,,,,both,,,3.0000,0.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2.10,,,,,,,0.7700,3.0000,percent of total billed charges,Rev 272 $3.00 in Billed Charges at 70% = $2.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYRINGE RING 10CC CONTRAST,272,RC,27201163,CDM,,,,,,both,,,3.0000,0.4500,CIGNA HEALTHCARE,CIGNA HMO,1.25,,,,,,,0.7700,3.0000,percent of total billed charges,41.7% of $3.00 in Billed Charges for Rev 272 = $1.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYRINGE RING 10CC CONTRAST,272,RC,27201163,CDM,,,,,,both,,,3.0000,0.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1.39,,,,,,,0.7700,3.0000,percent of total billed charges,46.4% of $3.00 in Billed Charges for Rev 272 = $1.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYRINGE RING 10CC CONTRAST,272,RC,27201163,CDM,,,,,,both,,,3.0000,0.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1.25,,,,,,,0.7700,3.0000,percent of total billed charges,41.7% of $3.00 in Billed Charges for Rev 272 = $1.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYRINGE RING 10CC CONTRAST,272,RC,27201163,CDM,,,,,,both,,,3.0000,0.4500,CIGNA HEALTHCARE,CIGNA PPO,1.25,,,,,,,0.7700,3.0000,percent of total billed charges,41.7% of $3.00 in Billed Charges for Rev 272 = $1.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYRINGE RING 10CC CONTRAST,272,RC,27201163,CDM,,,,,,both,,,3.0000,0.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2.70,,,,,,,0.7700,3.0000,percent of total billed charges,90% of $3.00 in Billed Charges for Rev 272 = $2.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYRINGE RING 10CC CONTRAST,272,RC,27201163,CDM,,,,,,both,,,3.0000,0.4500,MEDCOST,MEDCOST VHN,1.43,,,,,,,0.7700,3.0000,percent of total billed charges,47.59% of $3.00 in Billed Charges for Rev 272 = $1.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYRINGE RING 10CC CONTRAST,272,RC,27201163,CDM,,,,,,both,,,3.0000,0.4500,SENTARA HEALTH,SENTARA HEALTH,0.77,,,,,,,0.7700,3.0000,percent of total billed charges,25.81% of $3.00 in Billed Charges for Rev 272 = $0.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYRINGE RING 10CC CONTRAST,272,RC,27201163,CDM,,,,,,both,,,3.0000,0.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3.00,,,,,,,0.7700,3.0000,percent of total billed charges,100% of $3.00 in Billed Charges for Rev 272 = $3.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYRINGE RING 10CC CONTRAST,272,RC,27201163,CDM,,,,,,both,,,3.0000,0.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1.50,,,,,,,0.7700,3.0000,percent of total billed charges,Rev 272 $3.00 in Billed Charges at 50% = $1.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYRINGE RING 10CC CONTRAST,272,RC,27201163,CDM,,,,,,both,,,3.0000,0.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,0.97,,,,,,,0.7700,3.0000,other,32.3% of $3.00 in Billed Charges for Rev 272 = $0.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SYRINGE RING 10CC CONTRAST,272,RC,27201163,CDM,,,,,,both,,,3.0000,0.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,0.92,,,,,,,0.7700,3.0000,other,30.7% of $3.00 in Billed Charges for Rev 272 = $0.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SYRINGE RING 10CC CONTRAST,272,RC,27201163,CDM,,,,,,both,,,3.0000,0.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,0.97,,,,,,,0.7700,3.0000,percent of total billed charges,32.3% of $3.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYRINGE RING 10CC CONTRAST,272,RC,27201163,CDM,,,,,,both,,,3.0000,0.4500,WELLCARE,WELLCARE MEDICAID,3.00,,,,,,,0.7700,3.0000,percent of total billed charges,100% of $3.00 in Billed Charges for Rev 272 = $3.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM DBL PUMP LACTINA,270,RC,27000105,CDM,,,,,,both,,,147.0000,22.0500,AETNA,AETNA,62.77,,,,,,,37.9400,147.0000,percent of total billed charges,42.7% of $147.00 in Billed Charges for Rev 270 = $62.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM DBL PUMP LACTINA,270,RC,27000105,CDM,,,,,,both,,,147.0000,22.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,102.90,,,,,,,37.9400,147.0000,percent of total billed charges,Rev 270 $147.00 in Billed Charges at 70% = $102.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM DBL PUMP LACTINA,270,RC,27000105,CDM,,,,,,both,,,147.0000,22.0500,CIGNA HEALTHCARE,CIGNA HMO,61.30,,,,,,,37.9400,147.0000,percent of total billed charges,41.7% of $147.00 in Billed Charges for Rev 270 = $61.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM DBL PUMP LACTINA,270,RC,27000105,CDM,,,,,,both,,,147.0000,22.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,68.21,,,,,,,37.9400,147.0000,percent of total billed charges,46.4% of $147.00 in Billed Charges for Rev 270 = $68.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM DBL PUMP LACTINA,270,RC,27000105,CDM,,,,,,both,,,147.0000,22.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,61.30,,,,,,,37.9400,147.0000,percent of total billed charges,41.7% of $147.00 in Billed Charges for Rev 270 = $61.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM DBL PUMP LACTINA,270,RC,27000105,CDM,,,,,,both,,,147.0000,22.0500,CIGNA HEALTHCARE,CIGNA PPO,61.30,,,,,,,37.9400,147.0000,percent of total billed charges,41.7% of $147.00 in Billed Charges for Rev 270 = $61.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM DBL PUMP LACTINA,270,RC,27000105,CDM,,,,,,both,,,147.0000,22.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,132.30,,,,,,,37.9400,147.0000,percent of total billed charges,90% of $147.00 in Billed Charges for Rev 270 = $132.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM DBL PUMP LACTINA,270,RC,27000105,CDM,,,,,,both,,,147.0000,22.0500,MEDCOST,MEDCOST VHN,69.96,,,,,,,37.9400,147.0000,percent of total billed charges,47.59% of $147.00 in Billed Charges for Rev 270 = $69.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM DBL PUMP LACTINA,270,RC,27000105,CDM,,,,,,both,,,147.0000,22.0500,SENTARA HEALTH,SENTARA HEALTH,37.94,,,,,,,37.9400,147.0000,percent of total billed charges,25.81% of $147.00 in Billed Charges for Rev 270 = $37.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM DBL PUMP LACTINA,270,RC,27000105,CDM,,,,,,both,,,147.0000,22.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",147.00,,,,,,,37.9400,147.0000,percent of total billed charges,100% of $147.00 in Billed Charges for Rev 270 = $147.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM DBL PUMP LACTINA,270,RC,27000105,CDM,,,,,,both,,,147.0000,22.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.50,,,,,,,37.9400,147.0000,percent of total billed charges,Rev 270 $147.00 in Billed Charges at 50% = $73.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM DBL PUMP LACTINA,270,RC,27000105,CDM,,,,,,both,,,147.0000,22.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,47.48,,,,,,,37.9400,147.0000,other,32.3% of $147.00 in Billed Charges for Rev 270 = $47.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SYSTEM DBL PUMP LACTINA,270,RC,27000105,CDM,,,,,,both,,,147.0000,22.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,45.13,,,,,,,37.9400,147.0000,other,30.7% of $147.00 in Billed Charges for Rev 270 = $45.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SYSTEM DBL PUMP LACTINA,270,RC,27000105,CDM,,,,,,both,,,147.0000,22.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,47.48,,,,,,,37.9400,147.0000,percent of total billed charges,32.3% of $147.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM DBL PUMP LACTINA,270,RC,27000105,CDM,,,,,,both,,,147.0000,22.0500,WELLCARE,WELLCARE MEDICAID,147.00,,,,,,,37.9400,147.0000,percent of total billed charges,100% of $147.00 in Billed Charges for Rev 270 = $147.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM ESI NAVX PATCH,270,RC,27000019,CDM,,,,,,both,,,3204.0000,480.6000,AETNA,AETNA,1368.11,,,,,,,826.9500,3204.0000,percent of total billed charges,"42.7% of $3,204.00 in Billed Charges for Rev 270 = $1,368.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM ESI NAVX PATCH,270,RC,27000019,CDM,,,,,,both,,,3204.0000,480.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2242.80,,,,,,,826.9500,3204.0000,percent of total billed charges,"Rev 270 $3,204.00 in Billed Charges at 70% = $2,242.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM ESI NAVX PATCH,270,RC,27000019,CDM,,,,,,both,,,3204.0000,480.6000,CIGNA HEALTHCARE,CIGNA HMO,1336.07,,,,,,,826.9500,3204.0000,percent of total billed charges,"41.7% of $3,204.00 in Billed Charges for Rev 270 = $1,336.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM ESI NAVX PATCH,270,RC,27000019,CDM,,,,,,both,,,3204.0000,480.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1486.66,,,,,,,826.9500,3204.0000,percent of total billed charges,"46.4% of $3,204.00 in Billed Charges for Rev 270 = $1,486.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM ESI NAVX PATCH,270,RC,27000019,CDM,,,,,,both,,,3204.0000,480.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1336.07,,,,,,,826.9500,3204.0000,percent of total billed charges,"41.7% of $3,204.00 in Billed Charges for Rev 270 = $1,336.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM ESI NAVX PATCH,270,RC,27000019,CDM,,,,,,both,,,3204.0000,480.6000,CIGNA HEALTHCARE,CIGNA PPO,1336.07,,,,,,,826.9500,3204.0000,percent of total billed charges,"41.7% of $3,204.00 in Billed Charges for Rev 270 = $1,336.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM ESI NAVX PATCH,270,RC,27000019,CDM,,,,,,both,,,3204.0000,480.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2883.60,,,,,,,826.9500,3204.0000,percent of total billed charges,"90% of $3,204.00 in Billed Charges for Rev 270 = $2,883.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM ESI NAVX PATCH,270,RC,27000019,CDM,,,,,,both,,,3204.0000,480.6000,MEDCOST,MEDCOST VHN,1524.78,,,,,,,826.9500,3204.0000,percent of total billed charges,"47.59% of $3,204.00 in Billed Charges for Rev 270 = $1,524.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM ESI NAVX PATCH,270,RC,27000019,CDM,,,,,,both,,,3204.0000,480.6000,SENTARA HEALTH,SENTARA HEALTH,826.95,,,,,,,826.9500,3204.0000,percent of total billed charges,"25.81% of $3,204.00 in Billed Charges for Rev 270 = $826.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM ESI NAVX PATCH,270,RC,27000019,CDM,,,,,,both,,,3204.0000,480.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3204.00,,,,,,,826.9500,3204.0000,percent of total billed charges,"100% of $3,204.00 in Billed Charges for Rev 270 = $3,204.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM ESI NAVX PATCH,270,RC,27000019,CDM,,,,,,both,,,3204.0000,480.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1602.00,,,,,,,826.9500,3204.0000,percent of total billed charges,"Rev 270 $3,204.00 in Billed Charges at 50% = $1,602.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM ESI NAVX PATCH,270,RC,27000019,CDM,,,,,,both,,,3204.0000,480.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1034.89,,,,,,,826.9500,3204.0000,other,"32.3% of $3,204.00 in Billed Charges for Rev 270 = $1,034.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SYSTEM ESI NAVX PATCH,270,RC,27000019,CDM,,,,,,both,,,3204.0000,480.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,983.63,,,,,,,826.9500,3204.0000,other,"30.7% of $3,204.00 in Billed Charges for Rev 270 = $983.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SYSTEM ESI NAVX PATCH,270,RC,27000019,CDM,,,,,,both,,,3204.0000,480.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,1034.89,,,,,,,826.9500,3204.0000,percent of total billed charges,"32.3% of $3,204.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM ESI NAVX PATCH,270,RC,27000019,CDM,,,,,,both,,,3204.0000,480.6000,WELLCARE,WELLCARE MEDICAID,3204.00,,,,,,,826.9500,3204.0000,percent of total billed charges,"100% of $3,204.00 in Billed Charges for Rev 270 = $3,204.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27202303,CDM,,,,,,both,,,13073.0000,1960.9500,AETNA,AETNA,5582.17,,,,,,,3374.1400,13073.0000,percent of total billed charges,"42.7% of $13,073.00 in Billed Charges for Rev 272 = $5,582.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27202303,CDM,,,,,,both,,,13073.0000,1960.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9151.10,,,,,,,3374.1400,13073.0000,percent of total billed charges,"Rev 272 $13,073.00 in Billed Charges at 70% = $9,151.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27202303,CDM,,,,,,both,,,13073.0000,1960.9500,CIGNA HEALTHCARE,CIGNA HMO,5451.44,,,,,,,3374.1400,13073.0000,percent of total billed charges,"41.7% of $13,073.00 in Billed Charges for Rev 272 = $5,451.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27202303,CDM,,,,,,both,,,13073.0000,1960.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6065.87,,,,,,,3374.1400,13073.0000,percent of total billed charges,"46.4% of $13,073.00 in Billed Charges for Rev 272 = $6,065.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27202303,CDM,,,,,,both,,,13073.0000,1960.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5451.44,,,,,,,3374.1400,13073.0000,percent of total billed charges,"41.7% of $13,073.00 in Billed Charges for Rev 272 = $5,451.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27202303,CDM,,,,,,both,,,13073.0000,1960.9500,CIGNA HEALTHCARE,CIGNA PPO,5451.44,,,,,,,3374.1400,13073.0000,percent of total billed charges,"41.7% of $13,073.00 in Billed Charges for Rev 272 = $5,451.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27202303,CDM,,,,,,both,,,13073.0000,1960.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11765.70,,,,,,,3374.1400,13073.0000,percent of total billed charges,"90% of $13,073.00 in Billed Charges for Rev 272 = $11,765.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27202303,CDM,,,,,,both,,,13073.0000,1960.9500,MEDCOST,MEDCOST VHN,6221.44,,,,,,,3374.1400,13073.0000,percent of total billed charges,"47.59% of $13,073.00 in Billed Charges for Rev 272 = $6,221.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27202303,CDM,,,,,,both,,,13073.0000,1960.9500,SENTARA HEALTH,SENTARA HEALTH,3374.14,,,,,,,3374.1400,13073.0000,percent of total billed charges,"25.81% of $13,073.00 in Billed Charges for Rev 272 = $3,374.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27202303,CDM,,,,,,both,,,13073.0000,1960.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13073.00,,,,,,,3374.1400,13073.0000,percent of total billed charges,"100% of $13,073.00 in Billed Charges for Rev 272 = $13,073.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27202303,CDM,,,,,,both,,,13073.0000,1960.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6536.50,,,,,,,3374.1400,13073.0000,percent of total billed charges,"Rev 272 $13,073.00 in Billed Charges at 50% = $6,536.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27202303,CDM,,,,,,both,,,13073.0000,1960.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4222.58,,,,,,,3374.1400,13073.0000,other,"32.3% of $13,073.00 in Billed Charges for Rev 272 = $4,222.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27202303,CDM,,,,,,both,,,13073.0000,1960.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,4013.41,,,,,,,3374.1400,13073.0000,other,"30.7% of $13,073.00 in Billed Charges for Rev 272 = $4,013.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27202303,CDM,,,,,,both,,,13073.0000,1960.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,4222.58,,,,,,,3374.1400,13073.0000,percent of total billed charges,"32.3% of $13,073.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27202303,CDM,,,,,,both,,,13073.0000,1960.9500,WELLCARE,WELLCARE MEDICAID,13073.00,,,,,,,3374.1400,13073.0000,percent of total billed charges,"100% of $13,073.00 in Billed Charges for Rev 272 = $13,073.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM PREVENA PEEL&PLACE 13CM,272,RC,27202289,CDM,,,,,,both,,,4639.0000,695.8500,AETNA,AETNA,1980.85,,,,,,,1197.3300,4639.0000,percent of total billed charges,"42.7% of $4,639.00 in Billed Charges for Rev 272 = $1,980.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM PREVENA PEEL&PLACE 13CM,272,RC,27202289,CDM,,,,,,both,,,4639.0000,695.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3247.30,,,,,,,1197.3300,4639.0000,percent of total billed charges,"Rev 272 $4,639.00 in Billed Charges at 70% = $3,247.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM PREVENA PEEL&PLACE 13CM,272,RC,27202289,CDM,,,,,,both,,,4639.0000,695.8500,CIGNA HEALTHCARE,CIGNA HMO,1934.46,,,,,,,1197.3300,4639.0000,percent of total billed charges,"41.7% of $4,639.00 in Billed Charges for Rev 272 = $1,934.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM PREVENA PEEL&PLACE 13CM,272,RC,27202289,CDM,,,,,,both,,,4639.0000,695.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2152.50,,,,,,,1197.3300,4639.0000,percent of total billed charges,"46.4% of $4,639.00 in Billed Charges for Rev 272 = $2,152.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM PREVENA PEEL&PLACE 13CM,272,RC,27202289,CDM,,,,,,both,,,4639.0000,695.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1934.46,,,,,,,1197.3300,4639.0000,percent of total billed charges,"41.7% of $4,639.00 in Billed Charges for Rev 272 = $1,934.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM PREVENA PEEL&PLACE 13CM,272,RC,27202289,CDM,,,,,,both,,,4639.0000,695.8500,CIGNA HEALTHCARE,CIGNA PPO,1934.46,,,,,,,1197.3300,4639.0000,percent of total billed charges,"41.7% of $4,639.00 in Billed Charges for Rev 272 = $1,934.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM PREVENA PEEL&PLACE 13CM,272,RC,27202289,CDM,,,,,,both,,,4639.0000,695.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4175.10,,,,,,,1197.3300,4639.0000,percent of total billed charges,"90% of $4,639.00 in Billed Charges for Rev 272 = $4,175.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM PREVENA PEEL&PLACE 13CM,272,RC,27202289,CDM,,,,,,both,,,4639.0000,695.8500,MEDCOST,MEDCOST VHN,2207.70,,,,,,,1197.3300,4639.0000,percent of total billed charges,"47.59% of $4,639.00 in Billed Charges for Rev 272 = $2,207.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM PREVENA PEEL&PLACE 13CM,272,RC,27202289,CDM,,,,,,both,,,4639.0000,695.8500,SENTARA HEALTH,SENTARA HEALTH,1197.33,,,,,,,1197.3300,4639.0000,percent of total billed charges,"25.81% of $4,639.00 in Billed Charges for Rev 272 = $1,197.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM PREVENA PEEL&PLACE 13CM,272,RC,27202289,CDM,,,,,,both,,,4639.0000,695.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4639.00,,,,,,,1197.3300,4639.0000,percent of total billed charges,"100% of $4,639.00 in Billed Charges for Rev 272 = $4,639.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM PREVENA PEEL&PLACE 13CM,272,RC,27202289,CDM,,,,,,both,,,4639.0000,695.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2319.50,,,,,,,1197.3300,4639.0000,percent of total billed charges,"Rev 272 $4,639.00 in Billed Charges at 50% = $2,319.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM PREVENA PEEL&PLACE 13CM,272,RC,27202289,CDM,,,,,,both,,,4639.0000,695.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1498.40,,,,,,,1197.3300,4639.0000,other,"32.3% of $4,639.00 in Billed Charges for Rev 272 = $1,498.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SYSTEM PREVENA PEEL&PLACE 13CM,272,RC,27202289,CDM,,,,,,both,,,4639.0000,695.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1424.17,,,,,,,1197.3300,4639.0000,other,"30.7% of $4,639.00 in Billed Charges for Rev 272 = $1,424.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SYSTEM PREVENA PEEL&PLACE 13CM,272,RC,27202289,CDM,,,,,,both,,,4639.0000,695.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,1498.40,,,,,,,1197.3300,4639.0000,percent of total billed charges,"32.3% of $4,639.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM PREVENA PEEL&PLACE 13CM,272,RC,27202289,CDM,,,,,,both,,,4639.0000,695.8500,WELLCARE,WELLCARE MEDICAID,4639.00,,,,,,,1197.3300,4639.0000,percent of total billed charges,"100% of $4,639.00 in Billed Charges for Rev 272 = $4,639.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM VACUUM DELIVERY KIWI,270,RC,27000213,CDM,,,,,,both,,,142.0000,21.3000,AETNA,AETNA,60.63,,,,,,,36.6500,142.0000,percent of total billed charges,42.7% of $142.00 in Billed Charges for Rev 270 = $60.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VACUUM DELIVERY KIWI,270,RC,27000213,CDM,,,,,,both,,,142.0000,21.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,99.40,,,,,,,36.6500,142.0000,percent of total billed charges,Rev 270 $142.00 in Billed Charges at 70% = $99.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VACUUM DELIVERY KIWI,270,RC,27000213,CDM,,,,,,both,,,142.0000,21.3000,CIGNA HEALTHCARE,CIGNA HMO,59.21,,,,,,,36.6500,142.0000,percent of total billed charges,41.7% of $142.00 in Billed Charges for Rev 270 = $59.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VACUUM DELIVERY KIWI,270,RC,27000213,CDM,,,,,,both,,,142.0000,21.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,65.89,,,,,,,36.6500,142.0000,percent of total billed charges,46.4% of $142.00 in Billed Charges for Rev 270 = $65.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VACUUM DELIVERY KIWI,270,RC,27000213,CDM,,,,,,both,,,142.0000,21.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,59.21,,,,,,,36.6500,142.0000,percent of total billed charges,41.7% of $142.00 in Billed Charges for Rev 270 = $59.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VACUUM DELIVERY KIWI,270,RC,27000213,CDM,,,,,,both,,,142.0000,21.3000,CIGNA HEALTHCARE,CIGNA PPO,59.21,,,,,,,36.6500,142.0000,percent of total billed charges,41.7% of $142.00 in Billed Charges for Rev 270 = $59.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VACUUM DELIVERY KIWI,270,RC,27000213,CDM,,,,,,both,,,142.0000,21.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,127.80,,,,,,,36.6500,142.0000,percent of total billed charges,90% of $142.00 in Billed Charges for Rev 270 = $127.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VACUUM DELIVERY KIWI,270,RC,27000213,CDM,,,,,,both,,,142.0000,21.3000,MEDCOST,MEDCOST VHN,67.58,,,,,,,36.6500,142.0000,percent of total billed charges,47.59% of $142.00 in Billed Charges for Rev 270 = $67.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VACUUM DELIVERY KIWI,270,RC,27000213,CDM,,,,,,both,,,142.0000,21.3000,SENTARA HEALTH,SENTARA HEALTH,36.65,,,,,,,36.6500,142.0000,percent of total billed charges,25.81% of $142.00 in Billed Charges for Rev 270 = $36.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VACUUM DELIVERY KIWI,270,RC,27000213,CDM,,,,,,both,,,142.0000,21.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",142.00,,,,,,,36.6500,142.0000,percent of total billed charges,100% of $142.00 in Billed Charges for Rev 270 = $142.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VACUUM DELIVERY KIWI,270,RC,27000213,CDM,,,,,,both,,,142.0000,21.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,71.00,,,,,,,36.6500,142.0000,percent of total billed charges,Rev 270 $142.00 in Billed Charges at 50% = $71.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VACUUM DELIVERY KIWI,270,RC,27000213,CDM,,,,,,both,,,142.0000,21.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,45.87,,,,,,,36.6500,142.0000,other,32.3% of $142.00 in Billed Charges for Rev 270 = $45.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SYSTEM VACUUM DELIVERY KIWI,270,RC,27000213,CDM,,,,,,both,,,142.0000,21.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,43.59,,,,,,,36.6500,142.0000,other,30.7% of $142.00 in Billed Charges for Rev 270 = $43.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SYSTEM VACUUM DELIVERY KIWI,270,RC,27000213,CDM,,,,,,both,,,142.0000,21.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,45.87,,,,,,,36.6500,142.0000,percent of total billed charges,32.3% of $142.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VACUUM DELIVERY KIWI,270,RC,27000213,CDM,,,,,,both,,,142.0000,21.3000,WELLCARE,WELLCARE MEDICAID,142.00,,,,,,,36.6500,142.0000,percent of total billed charges,100% of $142.00 in Billed Charges for Rev 270 = $142.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SYSTEM VENASEAL CLOSURE VS-402,272,RC,27202010,CDM,,,,,,both,,,4880.0000,732.0000,AETNA,AETNA,2083.76,,,,,,,1259.5300,4880.0000,percent of total billed charges,"42.7% of $4,880.00 in Billed Charges for Rev 272 = $2,083.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM VENASEAL CLOSURE VS-402,272,RC,27202010,CDM,,,,,,both,,,4880.0000,732.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3416.00,,,,,,,1259.5300,4880.0000,percent of total billed charges,"Rev 272 $4,880.00 in Billed Charges at 70% = $3,416.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM VENASEAL CLOSURE VS-402,272,RC,27202010,CDM,,,,,,both,,,4880.0000,732.0000,CIGNA HEALTHCARE,CIGNA HMO,2034.96,,,,,,,1259.5300,4880.0000,percent of total billed charges,"41.7% of $4,880.00 in Billed Charges for Rev 272 = $2,034.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM VENASEAL CLOSURE VS-402,272,RC,27202010,CDM,,,,,,both,,,4880.0000,732.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2264.32,,,,,,,1259.5300,4880.0000,percent of total billed charges,"46.4% of $4,880.00 in Billed Charges for Rev 272 = $2,264.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM VENASEAL CLOSURE VS-402,272,RC,27202010,CDM,,,,,,both,,,4880.0000,732.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2034.96,,,,,,,1259.5300,4880.0000,percent of total billed charges,"41.7% of $4,880.00 in Billed Charges for Rev 272 = $2,034.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM VENASEAL CLOSURE VS-402,272,RC,27202010,CDM,,,,,,both,,,4880.0000,732.0000,CIGNA HEALTHCARE,CIGNA PPO,2034.96,,,,,,,1259.5300,4880.0000,percent of total billed charges,"41.7% of $4,880.00 in Billed Charges for Rev 272 = $2,034.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM VENASEAL CLOSURE VS-402,272,RC,27202010,CDM,,,,,,both,,,4880.0000,732.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4392.00,,,,,,,1259.5300,4880.0000,percent of total billed charges,"90% of $4,880.00 in Billed Charges for Rev 272 = $4,392.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM VENASEAL CLOSURE VS-402,272,RC,27202010,CDM,,,,,,both,,,4880.0000,732.0000,MEDCOST,MEDCOST VHN,2322.39,,,,,,,1259.5300,4880.0000,percent of total billed charges,"47.59% of $4,880.00 in Billed Charges for Rev 272 = $2,322.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM VENASEAL CLOSURE VS-402,272,RC,27202010,CDM,,,,,,both,,,4880.0000,732.0000,SENTARA HEALTH,SENTARA HEALTH,1259.53,,,,,,,1259.5300,4880.0000,percent of total billed charges,"25.81% of $4,880.00 in Billed Charges for Rev 272 = $1,259.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM VENASEAL CLOSURE VS-402,272,RC,27202010,CDM,,,,,,both,,,4880.0000,732.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4880.00,,,,,,,1259.5300,4880.0000,percent of total billed charges,"100% of $4,880.00 in Billed Charges for Rev 272 = $4,880.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM VENASEAL CLOSURE VS-402,272,RC,27202010,CDM,,,,,,both,,,4880.0000,732.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2440.00,,,,,,,1259.5300,4880.0000,percent of total billed charges,"Rev 272 $4,880.00 in Billed Charges at 50% = $2,440.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM VENASEAL CLOSURE VS-402,272,RC,27202010,CDM,,,,,,both,,,4880.0000,732.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1576.24,,,,,,,1259.5300,4880.0000,other,"32.3% of $4,880.00 in Billed Charges for Rev 272 = $1,576.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SYSTEM VENASEAL CLOSURE VS-402,272,RC,27202010,CDM,,,,,,both,,,4880.0000,732.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1498.16,,,,,,,1259.5300,4880.0000,other,"30.7% of $4,880.00 in Billed Charges for Rev 272 = $1,498.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SYSTEM VENASEAL CLOSURE VS-402,272,RC,27202010,CDM,,,,,,both,,,4880.0000,732.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,1576.24,,,,,,,1259.5300,4880.0000,percent of total billed charges,"32.3% of $4,880.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SYSTEM VENASEAL CLOSURE VS-402,272,RC,27202010,CDM,,,,,,both,,,4880.0000,732.0000,WELLCARE,WELLCARE MEDICAID,4880.00,,,,,,,1259.5300,4880.0000,percent of total billed charges,"100% of $4,880.00 in Billed Charges for Rev 272 = $4,880.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL 9FR 545-509 TO 13FR 545-513,272,RC,27201765,CDM,,,,,,both,,,5030.0000,754.5000,AETNA,AETNA,2147.81,,,,,,,1298.2400,5030.0000,percent of total billed charges,"42.7% of $5,030.00 in Billed Charges for Rev 272 = $2,147.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL 9FR 545-509 TO 13FR 545-513,272,RC,27201765,CDM,,,,,,both,,,5030.0000,754.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3521.00,,,,,,,1298.2400,5030.0000,percent of total billed charges,"Rev 272 $5,030.00 in Billed Charges at 70% = $3,521.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL 9FR 545-509 TO 13FR 545-513,272,RC,27201765,CDM,,,,,,both,,,5030.0000,754.5000,CIGNA HEALTHCARE,CIGNA HMO,2097.51,,,,,,,1298.2400,5030.0000,percent of total billed charges,"41.7% of $5,030.00 in Billed Charges for Rev 272 = $2,097.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL 9FR 545-509 TO 13FR 545-513,272,RC,27201765,CDM,,,,,,both,,,5030.0000,754.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2333.92,,,,,,,1298.2400,5030.0000,percent of total billed charges,"46.4% of $5,030.00 in Billed Charges for Rev 272 = $2,333.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL 9FR 545-509 TO 13FR 545-513,272,RC,27201765,CDM,,,,,,both,,,5030.0000,754.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2097.51,,,,,,,1298.2400,5030.0000,percent of total billed charges,"41.7% of $5,030.00 in Billed Charges for Rev 272 = $2,097.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL 9FR 545-509 TO 13FR 545-513,272,RC,27201765,CDM,,,,,,both,,,5030.0000,754.5000,CIGNA HEALTHCARE,CIGNA PPO,2097.51,,,,,,,1298.2400,5030.0000,percent of total billed charges,"41.7% of $5,030.00 in Billed Charges for Rev 272 = $2,097.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL 9FR 545-509 TO 13FR 545-513,272,RC,27201765,CDM,,,,,,both,,,5030.0000,754.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4527.00,,,,,,,1298.2400,5030.0000,percent of total billed charges,"90% of $5,030.00 in Billed Charges for Rev 272 = $4,527.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL 9FR 545-509 TO 13FR 545-513,272,RC,27201765,CDM,,,,,,both,,,5030.0000,754.5000,MEDCOST,MEDCOST VHN,2393.78,,,,,,,1298.2400,5030.0000,percent of total billed charges,"47.59% of $5,030.00 in Billed Charges for Rev 272 = $2,393.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL 9FR 545-509 TO 13FR 545-513,272,RC,27201765,CDM,,,,,,both,,,5030.0000,754.5000,SENTARA HEALTH,SENTARA HEALTH,1298.24,,,,,,,1298.2400,5030.0000,percent of total billed charges,"25.81% of $5,030.00 in Billed Charges for Rev 272 = $1,298.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL 9FR 545-509 TO 13FR 545-513,272,RC,27201765,CDM,,,,,,both,,,5030.0000,754.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5030.00,,,,,,,1298.2400,5030.0000,percent of total billed charges,"100% of $5,030.00 in Billed Charges for Rev 272 = $5,030.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL 9FR 545-509 TO 13FR 545-513,272,RC,27201765,CDM,,,,,,both,,,5030.0000,754.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2515.00,,,,,,,1298.2400,5030.0000,percent of total billed charges,"Rev 272 $5,030.00 in Billed Charges at 50% = $2,515.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL 9FR 545-509 TO 13FR 545-513,272,RC,27201765,CDM,,,,,,both,,,5030.0000,754.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1624.69,,,,,,,1298.2400,5030.0000,other,"32.3% of $5,030.00 in Billed Charges for Rev 272 = $1,624.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TIGHT RAIL 9FR 545-509 TO 13FR 545-513,272,RC,27201765,CDM,,,,,,both,,,5030.0000,754.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1544.21,,,,,,,1298.2400,5030.0000,other,"30.7% of $5,030.00 in Billed Charges for Rev 272 = $1,544.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TIGHT RAIL 9FR 545-509 TO 13FR 545-513,272,RC,27201765,CDM,,,,,,both,,,5030.0000,754.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,1624.69,,,,,,,1298.2400,5030.0000,percent of total billed charges,"32.3% of $5,030.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TIGHT RAIL 9FR 545-509 TO 13FR 545-513,272,RC,27201765,CDM,,,,,,both,,,5030.0000,754.5000,WELLCARE,WELLCARE MEDICAID,5030.00,,,,,,,1298.2400,5030.0000,percent of total billed charges,"100% of $5,030.00 in Billed Charges for Rev 272 = $5,030.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT FECAL MANAGEMENT SIGNAL,272,RC,27202235,CDM,,,,,,both,,,1003.0000,150.4500,AETNA,AETNA,428.28,,,,,,,258.8700,1003.0000,percent of total billed charges,"42.7% of $1,003.00 in Billed Charges for Rev 272 = $428.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT FECAL MANAGEMENT SIGNAL,272,RC,27202235,CDM,,,,,,both,,,1003.0000,150.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,702.10,,,,,,,258.8700,1003.0000,percent of total billed charges,"Rev 272 $1,003.00 in Billed Charges at 70% = $702.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT FECAL MANAGEMENT SIGNAL,272,RC,27202235,CDM,,,,,,both,,,1003.0000,150.4500,CIGNA HEALTHCARE,CIGNA HMO,418.25,,,,,,,258.8700,1003.0000,percent of total billed charges,"41.7% of $1,003.00 in Billed Charges for Rev 272 = $418.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT FECAL MANAGEMENT SIGNAL,272,RC,27202235,CDM,,,,,,both,,,1003.0000,150.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,465.39,,,,,,,258.8700,1003.0000,percent of total billed charges,"46.4% of $1,003.00 in Billed Charges for Rev 272 = $465.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT FECAL MANAGEMENT SIGNAL,272,RC,27202235,CDM,,,,,,both,,,1003.0000,150.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,418.25,,,,,,,258.8700,1003.0000,percent of total billed charges,"41.7% of $1,003.00 in Billed Charges for Rev 272 = $418.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT FECAL MANAGEMENT SIGNAL,272,RC,27202235,CDM,,,,,,both,,,1003.0000,150.4500,CIGNA HEALTHCARE,CIGNA PPO,418.25,,,,,,,258.8700,1003.0000,percent of total billed charges,"41.7% of $1,003.00 in Billed Charges for Rev 272 = $418.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT FECAL MANAGEMENT SIGNAL,272,RC,27202235,CDM,,,,,,both,,,1003.0000,150.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,902.70,,,,,,,258.8700,1003.0000,percent of total billed charges,"90% of $1,003.00 in Billed Charges for Rev 272 = $902.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT FECAL MANAGEMENT SIGNAL,272,RC,27202235,CDM,,,,,,both,,,1003.0000,150.4500,MEDCOST,MEDCOST VHN,477.33,,,,,,,258.8700,1003.0000,percent of total billed charges,"47.59% of $1,003.00 in Billed Charges for Rev 272 = $477.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT FECAL MANAGEMENT SIGNAL,272,RC,27202235,CDM,,,,,,both,,,1003.0000,150.4500,SENTARA HEALTH,SENTARA HEALTH,258.87,,,,,,,258.8700,1003.0000,percent of total billed charges,"25.81% of $1,003.00 in Billed Charges for Rev 272 = $258.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT FECAL MANAGEMENT SIGNAL,272,RC,27202235,CDM,,,,,,both,,,1003.0000,150.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1003.00,,,,,,,258.8700,1003.0000,percent of total billed charges,"100% of $1,003.00 in Billed Charges for Rev 272 = $1,003.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT FECAL MANAGEMENT SIGNAL,272,RC,27202235,CDM,,,,,,both,,,1003.0000,150.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,501.50,,,,,,,258.8700,1003.0000,percent of total billed charges,"Rev 272 $1,003.00 in Billed Charges at 50% = $501.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT FECAL MANAGEMENT SIGNAL,272,RC,27202235,CDM,,,,,,both,,,1003.0000,150.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,323.97,,,,,,,258.8700,1003.0000,other,"32.3% of $1,003.00 in Billed Charges for Rev 272 = $323.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIT FECAL MANAGEMENT SIGNAL,272,RC,27202235,CDM,,,,,,both,,,1003.0000,150.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,307.92,,,,,,,258.8700,1003.0000,other,"30.7% of $1,003.00 in Billed Charges for Rev 272 = $307.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIT FECAL MANAGEMENT SIGNAL,272,RC,27202235,CDM,,,,,,both,,,1003.0000,150.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,323.97,,,,,,,258.8700,1003.0000,percent of total billed charges,"32.3% of $1,003.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT FECAL MANAGEMENT SIGNAL,272,RC,27202235,CDM,,,,,,both,,,1003.0000,150.4500,WELLCARE,WELLCARE MEDICAID,1003.00,,,,,,,258.8700,1003.0000,percent of total billed charges,"100% of $1,003.00 in Billed Charges for Rev 272 = $1,003.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PAD HEARTSTART ADULT M3718A,270,RC,27000020,CDM,,,,,,both,,,179.0000,26.8500,AETNA,AETNA,76.43,,,,,,,46.2000,179.0000,percent of total billed charges,42.7% of $179.00 in Billed Charges for Rev 270 = $76.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PAD HEARTSTART ADULT M3718A,270,RC,27000020,CDM,,,,,,both,,,179.0000,26.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,125.30,,,,,,,46.2000,179.0000,percent of total billed charges,Rev 270 $179.00 in Billed Charges at 70% = $125.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PAD HEARTSTART ADULT M3718A,270,RC,27000020,CDM,,,,,,both,,,179.0000,26.8500,CIGNA HEALTHCARE,CIGNA HMO,74.64,,,,,,,46.2000,179.0000,percent of total billed charges,41.7% of $179.00 in Billed Charges for Rev 270 = $74.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PAD HEARTSTART ADULT M3718A,270,RC,27000020,CDM,,,,,,both,,,179.0000,26.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,83.06,,,,,,,46.2000,179.0000,percent of total billed charges,46.4% of $179.00 in Billed Charges for Rev 270 = $83.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PAD HEARTSTART ADULT M3718A,270,RC,27000020,CDM,,,,,,both,,,179.0000,26.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,74.64,,,,,,,46.2000,179.0000,percent of total billed charges,41.7% of $179.00 in Billed Charges for Rev 270 = $74.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PAD HEARTSTART ADULT M3718A,270,RC,27000020,CDM,,,,,,both,,,179.0000,26.8500,CIGNA HEALTHCARE,CIGNA PPO,74.64,,,,,,,46.2000,179.0000,percent of total billed charges,41.7% of $179.00 in Billed Charges for Rev 270 = $74.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PAD HEARTSTART ADULT M3718A,270,RC,27000020,CDM,,,,,,both,,,179.0000,26.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,161.10,,,,,,,46.2000,179.0000,percent of total billed charges,90% of $179.00 in Billed Charges for Rev 270 = $161.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PAD HEARTSTART ADULT M3718A,270,RC,27000020,CDM,,,,,,both,,,179.0000,26.8500,MEDCOST,MEDCOST VHN,85.19,,,,,,,46.2000,179.0000,percent of total billed charges,47.59% of $179.00 in Billed Charges for Rev 270 = $85.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PAD HEARTSTART ADULT M3718A,270,RC,27000020,CDM,,,,,,both,,,179.0000,26.8500,SENTARA HEALTH,SENTARA HEALTH,46.20,,,,,,,46.2000,179.0000,percent of total billed charges,25.81% of $179.00 in Billed Charges for Rev 270 = $46.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PAD HEARTSTART ADULT M3718A,270,RC,27000020,CDM,,,,,,both,,,179.0000,26.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",179.00,,,,,,,46.2000,179.0000,percent of total billed charges,100% of $179.00 in Billed Charges for Rev 270 = $179.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PAD HEARTSTART ADULT M3718A,270,RC,27000020,CDM,,,,,,both,,,179.0000,26.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,89.50,,,,,,,46.2000,179.0000,percent of total billed charges,Rev 270 $179.00 in Billed Charges at 50% = $89.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PAD HEARTSTART ADULT M3718A,270,RC,27000020,CDM,,,,,,both,,,179.0000,26.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,57.82,,,,,,,46.2000,179.0000,other,32.3% of $179.00 in Billed Charges for Rev 270 = $57.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PAD HEARTSTART ADULT M3718A,270,RC,27000020,CDM,,,,,,both,,,179.0000,26.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,54.95,,,,,,,46.2000,179.0000,other,30.7% of $179.00 in Billed Charges for Rev 270 = $54.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PAD HEARTSTART ADULT M3718A,270,RC,27000020,CDM,,,,,,both,,,179.0000,26.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,57.82,,,,,,,46.2000,179.0000,percent of total billed charges,32.3% of $179.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PAD HEARTSTART ADULT M3718A,270,RC,27000020,CDM,,,,,,both,,,179.0000,26.8500,WELLCARE,WELLCARE MEDICAID,179.00,,,,,,,46.2000,179.0000,percent of total billed charges,100% of $179.00 in Billed Charges for Rev 270 = $179.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16G CV/BL FLXTP AK04306,272,RC,27201568,CDM,,,,,,both,,,7.0000,1.0500,AETNA,AETNA,2.99,,,,,,,1.8100,7.0000,percent of total billed charges,42.7% of $7.00 in Billed Charges for Rev 272 = $2.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16G CV/BL FLXTP AK04306,272,RC,27201568,CDM,,,,,,both,,,7.0000,1.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4.90,,,,,,,1.8100,7.0000,percent of total billed charges,Rev 272 $7.00 in Billed Charges at 70% = $4.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16G CV/BL FLXTP AK04306,272,RC,27201568,CDM,,,,,,both,,,7.0000,1.0500,CIGNA HEALTHCARE,CIGNA HMO,2.92,,,,,,,1.8100,7.0000,percent of total billed charges,41.7% of $7.00 in Billed Charges for Rev 272 = $2.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16G CV/BL FLXTP AK04306,272,RC,27201568,CDM,,,,,,both,,,7.0000,1.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3.25,,,,,,,1.8100,7.0000,percent of total billed charges,46.4% of $7.00 in Billed Charges for Rev 272 = $3.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16G CV/BL FLXTP AK04306,272,RC,27201568,CDM,,,,,,both,,,7.0000,1.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2.92,,,,,,,1.8100,7.0000,percent of total billed charges,41.7% of $7.00 in Billed Charges for Rev 272 = $2.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16G CV/BL FLXTP AK04306,272,RC,27201568,CDM,,,,,,both,,,7.0000,1.0500,CIGNA HEALTHCARE,CIGNA PPO,2.92,,,,,,,1.8100,7.0000,percent of total billed charges,41.7% of $7.00 in Billed Charges for Rev 272 = $2.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16G CV/BL FLXTP AK04306,272,RC,27201568,CDM,,,,,,both,,,7.0000,1.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6.30,,,,,,,1.8100,7.0000,percent of total billed charges,90% of $7.00 in Billed Charges for Rev 272 = $6.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16G CV/BL FLXTP AK04306,272,RC,27201568,CDM,,,,,,both,,,7.0000,1.0500,MEDCOST,MEDCOST VHN,3.33,,,,,,,1.8100,7.0000,percent of total billed charges,47.59% of $7.00 in Billed Charges for Rev 272 = $3.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16G CV/BL FLXTP AK04306,272,RC,27201568,CDM,,,,,,both,,,7.0000,1.0500,SENTARA HEALTH,SENTARA HEALTH,1.81,,,,,,,1.8100,7.0000,percent of total billed charges,25.81% of $7.00 in Billed Charges for Rev 272 = $1.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16G CV/BL FLXTP AK04306,272,RC,27201568,CDM,,,,,,both,,,7.0000,1.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7.00,,,,,,,1.8100,7.0000,percent of total billed charges,100% of $7.00 in Billed Charges for Rev 272 = $7.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16G CV/BL FLXTP AK04306,272,RC,27201568,CDM,,,,,,both,,,7.0000,1.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3.50,,,,,,,1.8100,7.0000,percent of total billed charges,Rev 272 $7.00 in Billed Charges at 50% = $3.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16G CV/BL FLXTP AK04306,272,RC,27201568,CDM,,,,,,both,,,7.0000,1.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2.26,,,,,,,1.8100,7.0000,other,32.3% of $7.00 in Billed Charges for Rev 272 = $2.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PANEL CATH 16G CV/BL FLXTP AK04306,272,RC,27201568,CDM,,,,,,both,,,7.0000,1.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2.15,,,,,,,1.8100,7.0000,other,30.7% of $7.00 in Billed Charges for Rev 272 = $2.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PANEL CATH 16G CV/BL FLXTP AK04306,272,RC,27201568,CDM,,,,,,both,,,7.0000,1.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,2.26,,,,,,,1.8100,7.0000,percent of total billed charges,32.3% of $7.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16G CV/BL FLXTP AK04306,272,RC,27201568,CDM,,,,,,both,,,7.0000,1.0500,WELLCARE,WELLCARE MEDICAID,7.00,,,,,,,1.8100,7.0000,percent of total billed charges,100% of $7.00 in Billed Charges for Rev 272 = $7.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16GA CV AK04400,270,RC,27201569,CDM,,,,,,both,,,15.0000,2.2500,AETNA,AETNA,6.41,,,,,,,3.8700,15.0000,percent of total billed charges,42.7% of $15.00 in Billed Charges for Rev 270 = $6.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16GA CV AK04400,270,RC,27201569,CDM,,,,,,both,,,15.0000,2.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,10.50,,,,,,,3.8700,15.0000,percent of total billed charges,Rev 270 $15.00 in Billed Charges at 70% = $10.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16GA CV AK04400,270,RC,27201569,CDM,,,,,,both,,,15.0000,2.2500,CIGNA HEALTHCARE,CIGNA HMO,6.26,,,,,,,3.8700,15.0000,percent of total billed charges,41.7% of $15.00 in Billed Charges for Rev 270 = $6.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16GA CV AK04400,270,RC,27201569,CDM,,,,,,both,,,15.0000,2.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6.96,,,,,,,3.8700,15.0000,percent of total billed charges,46.4% of $15.00 in Billed Charges for Rev 270 = $6.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16GA CV AK04400,270,RC,27201569,CDM,,,,,,both,,,15.0000,2.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6.26,,,,,,,3.8700,15.0000,percent of total billed charges,41.7% of $15.00 in Billed Charges for Rev 270 = $6.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16GA CV AK04400,270,RC,27201569,CDM,,,,,,both,,,15.0000,2.2500,CIGNA HEALTHCARE,CIGNA PPO,6.26,,,,,,,3.8700,15.0000,percent of total billed charges,41.7% of $15.00 in Billed Charges for Rev 270 = $6.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16GA CV AK04400,270,RC,27201569,CDM,,,,,,both,,,15.0000,2.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13.50,,,,,,,3.8700,15.0000,percent of total billed charges,90% of $15.00 in Billed Charges for Rev 270 = $13.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16GA CV AK04400,270,RC,27201569,CDM,,,,,,both,,,15.0000,2.2500,MEDCOST,MEDCOST VHN,7.14,,,,,,,3.8700,15.0000,percent of total billed charges,47.59% of $15.00 in Billed Charges for Rev 270 = $7.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16GA CV AK04400,270,RC,27201569,CDM,,,,,,both,,,15.0000,2.2500,SENTARA HEALTH,SENTARA HEALTH,3.87,,,,,,,3.8700,15.0000,percent of total billed charges,25.81% of $15.00 in Billed Charges for Rev 270 = $3.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16GA CV AK04400,270,RC,27201569,CDM,,,,,,both,,,15.0000,2.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15.00,,,,,,,3.8700,15.0000,percent of total billed charges,100% of $15.00 in Billed Charges for Rev 270 = $15.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16GA CV AK04400,270,RC,27201569,CDM,,,,,,both,,,15.0000,2.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7.50,,,,,,,3.8700,15.0000,percent of total billed charges,Rev 270 $15.00 in Billed Charges at 50% = $7.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16GA CV AK04400,270,RC,27201569,CDM,,,,,,both,,,15.0000,2.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4.85,,,,,,,3.8700,15.0000,other,32.3% of $15.00 in Billed Charges for Rev 270 = $4.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PANEL CATH 16GA CV AK04400,270,RC,27201569,CDM,,,,,,both,,,15.0000,2.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,4.61,,,,,,,3.8700,15.0000,other,30.7% of $15.00 in Billed Charges for Rev 270 = $4.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PANEL CATH 16GA CV AK04400,270,RC,27201569,CDM,,,,,,both,,,15.0000,2.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,4.85,,,,,,,3.8700,15.0000,percent of total billed charges,32.3% of $15.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL CATH 16GA CV AK04400,270,RC,27201569,CDM,,,,,,both,,,15.0000,2.2500,WELLCARE,WELLCARE MEDICAID,15.00,,,,,,,3.8700,15.0000,percent of total billed charges,100% of $15.00 in Billed Charges for Rev 270 = $15.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOOL TVI GUIDANT 7600,272,RC,27201165,CDM,,,,,,both,,,82.0000,12.3000,AETNA,AETNA,35.01,,,,,,,21.1600,82.0000,percent of total billed charges,42.7% of $82.00 in Billed Charges for Rev 272 = $35.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOOL TVI GUIDANT 7600,272,RC,27201165,CDM,,,,,,both,,,82.0000,12.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,57.40,,,,,,,21.1600,82.0000,percent of total billed charges,Rev 272 $82.00 in Billed Charges at 70% = $57.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOOL TVI GUIDANT 7600,272,RC,27201165,CDM,,,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA HMO,34.19,,,,,,,21.1600,82.0000,percent of total billed charges,41.7% of $82.00 in Billed Charges for Rev 272 = $34.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOOL TVI GUIDANT 7600,272,RC,27201165,CDM,,,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,38.05,,,,,,,21.1600,82.0000,percent of total billed charges,46.4% of $82.00 in Billed Charges for Rev 272 = $38.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOOL TVI GUIDANT 7600,272,RC,27201165,CDM,,,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,34.19,,,,,,,21.1600,82.0000,percent of total billed charges,41.7% of $82.00 in Billed Charges for Rev 272 = $34.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOOL TVI GUIDANT 7600,272,RC,27201165,CDM,,,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA PPO,34.19,,,,,,,21.1600,82.0000,percent of total billed charges,41.7% of $82.00 in Billed Charges for Rev 272 = $34.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOOL TVI GUIDANT 7600,272,RC,27201165,CDM,,,,,,both,,,82.0000,12.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,73.80,,,,,,,21.1600,82.0000,percent of total billed charges,90% of $82.00 in Billed Charges for Rev 272 = $73.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOOL TVI GUIDANT 7600,272,RC,27201165,CDM,,,,,,both,,,82.0000,12.3000,MEDCOST,MEDCOST VHN,39.02,,,,,,,21.1600,82.0000,percent of total billed charges,47.59% of $82.00 in Billed Charges for Rev 272 = $39.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOOL TVI GUIDANT 7600,272,RC,27201165,CDM,,,,,,both,,,82.0000,12.3000,SENTARA HEALTH,SENTARA HEALTH,21.16,,,,,,,21.1600,82.0000,percent of total billed charges,25.81% of $82.00 in Billed Charges for Rev 272 = $21.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOOL TVI GUIDANT 7600,272,RC,27201165,CDM,,,,,,both,,,82.0000,12.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",82.00,,,,,,,21.1600,82.0000,percent of total billed charges,100% of $82.00 in Billed Charges for Rev 272 = $82.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOOL TVI GUIDANT 7600,272,RC,27201165,CDM,,,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,41.00,,,,,,,21.1600,82.0000,percent of total billed charges,Rev 272 $82.00 in Billed Charges at 50% = $41.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOOL TVI GUIDANT 7600,272,RC,27201165,CDM,,,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,26.49,,,,,,,21.1600,82.0000,other,32.3% of $82.00 in Billed Charges for Rev 272 = $26.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOOL TVI GUIDANT 7600,272,RC,27201165,CDM,,,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,25.17,,,,,,,21.1600,82.0000,other,30.7% of $82.00 in Billed Charges for Rev 272 = $25.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOOL TVI GUIDANT 7600,272,RC,27201165,CDM,,,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,26.49,,,,,,,21.1600,82.0000,percent of total billed charges,32.3% of $82.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOOL TVI GUIDANT 7600,272,RC,27201165,CDM,,,,,,both,,,82.0000,12.3000,WELLCARE,WELLCARE MEDICAID,82.00,,,,,,,21.1600,82.0000,percent of total billed charges,100% of $82.00 in Billed Charges for Rev 272 = $82.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A CASSETTE PURGE IMPELLA EQUIP LACK OF USE,272,RC,27200002,CDM,,,,,,both,,,3028.3300,454.2500,AETNA,AETNA,1293.10,,,,,,,781.6100,3028.3300,percent of total billed charges,"42.7% of $3,028.33 in Billed Charges for Rev 272 = $1,293.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CASSETTE PURGE IMPELLA EQUIP LACK OF USE,272,RC,27200002,CDM,,,,,,both,,,3028.3300,454.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2119.83,,,,,,,781.6100,3028.3300,percent of total billed charges,"Rev 272 $3,028.33 in Billed Charges at 70% = $2,119.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CASSETTE PURGE IMPELLA EQUIP LACK OF USE,272,RC,27200002,CDM,,,,,,both,,,3028.3300,454.2500,CIGNA HEALTHCARE,CIGNA HMO,1262.81,,,,,,,781.6100,3028.3300,percent of total billed charges,"41.7% of $3,028.33 in Billed Charges for Rev 272 = $1,262.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CASSETTE PURGE IMPELLA EQUIP LACK OF USE,272,RC,27200002,CDM,,,,,,both,,,3028.3300,454.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1405.15,,,,,,,781.6100,3028.3300,percent of total billed charges,"46.4% of $3,028.33 in Billed Charges for Rev 272 = $1,405.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CASSETTE PURGE IMPELLA EQUIP LACK OF USE,272,RC,27200002,CDM,,,,,,both,,,3028.3300,454.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1262.81,,,,,,,781.6100,3028.3300,percent of total billed charges,"41.7% of $3,028.33 in Billed Charges for Rev 272 = $1,262.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CASSETTE PURGE IMPELLA EQUIP LACK OF USE,272,RC,27200002,CDM,,,,,,both,,,3028.3300,454.2500,CIGNA HEALTHCARE,CIGNA PPO,1262.81,,,,,,,781.6100,3028.3300,percent of total billed charges,"41.7% of $3,028.33 in Billed Charges for Rev 272 = $1,262.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CASSETTE PURGE IMPELLA EQUIP LACK OF USE,272,RC,27200002,CDM,,,,,,both,,,3028.3300,454.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2725.50,,,,,,,781.6100,3028.3300,percent of total billed charges,"90% of $3,028.33 in Billed Charges for Rev 272 = $2,725.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CASSETTE PURGE IMPELLA EQUIP LACK OF USE,272,RC,27200002,CDM,,,,,,both,,,3028.3300,454.2500,MEDCOST,MEDCOST VHN,1441.18,,,,,,,781.6100,3028.3300,percent of total billed charges,"47.59% of $3,028.33 in Billed Charges for Rev 272 = $1,441.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CASSETTE PURGE IMPELLA EQUIP LACK OF USE,272,RC,27200002,CDM,,,,,,both,,,3028.3300,454.2500,SENTARA HEALTH,SENTARA HEALTH,781.61,,,,,,,781.6100,3028.3300,percent of total billed charges,"25.81% of $3,028.33 in Billed Charges for Rev 272 = $781.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CASSETTE PURGE IMPELLA EQUIP LACK OF USE,272,RC,27200002,CDM,,,,,,both,,,3028.3300,454.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3028.33,,,,,,,781.6100,3028.3300,percent of total billed charges,"100% of $3,028.33 in Billed Charges for Rev 272 = $3,028.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CASSETTE PURGE IMPELLA EQUIP LACK OF USE,272,RC,27200002,CDM,,,,,,both,,,3028.3300,454.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1514.17,,,,,,,781.6100,3028.3300,percent of total billed charges,"Rev 272 $3,028.33 in Billed Charges at 50% = $1,514.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CASSETTE PURGE IMPELLA EQUIP LACK OF USE,272,RC,27200002,CDM,,,,,,both,,,3028.3300,454.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,978.15,,,,,,,781.6100,3028.3300,other,"32.3% of $3,028.33 in Billed Charges for Rev 272 = $978.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A CASSETTE PURGE IMPELLA EQUIP LACK OF USE,272,RC,27200002,CDM,,,,,,both,,,3028.3300,454.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,929.70,,,,,,,781.6100,3028.3300,other,"30.7% of $3,028.33 in Billed Charges for Rev 272 = $929.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A CASSETTE PURGE IMPELLA EQUIP LACK OF USE,272,RC,27200002,CDM,,,,,,both,,,3028.3300,454.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,978.15,,,,,,,781.6100,3028.3300,percent of total billed charges,"32.3% of $3,028.33 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CASSETTE PURGE IMPELLA EQUIP LACK OF USE,272,RC,27200002,CDM,,,,,,both,,,3028.3300,454.2500,WELLCARE,WELLCARE MEDICAID,3028.33,,,,,,,781.6100,3028.3300,percent of total billed charges,"100% of $3,028.33 in Billed Charges for Rev 272 = $3,028.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CATH EDGE 180 DEG EXT WORKING CHANNEL FIRM TIP LACK OF USE,272,RC,,,,,,,,both,,,6440.3900,966.0600,AETNA,AETNA,2750.05,,,,,,,1662.2600,6440.3900,percent of total billed charges,"42.7% of $6,440.39 in Billed Charges for Rev 272 = $2,750.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CATH EDGE 180 DEG EXT WORKING CHANNEL FIRM TIP LACK OF USE,272,RC,,,,,,,,both,,,6440.3900,966.0600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4508.27,,,,,,,1662.2600,6440.3900,percent of total billed charges,"Rev 272 $6,440.39 in Billed Charges at 70% = $4,508.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CATH EDGE 180 DEG EXT WORKING CHANNEL FIRM TIP LACK OF USE,272,RC,,,,,,,,both,,,6440.3900,966.0600,CIGNA HEALTHCARE,CIGNA HMO,2685.64,,,,,,,1662.2600,6440.3900,percent of total billed charges,"41.7% of $6,440.39 in Billed Charges for Rev 272 = $2,685.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CATH EDGE 180 DEG EXT WORKING CHANNEL FIRM TIP LACK OF USE,272,RC,,,,,,,,both,,,6440.3900,966.0600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2988.34,,,,,,,1662.2600,6440.3900,percent of total billed charges,"46.4% of $6,440.39 in Billed Charges for Rev 272 = $2,988.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CATH EDGE 180 DEG EXT WORKING CHANNEL FIRM TIP LACK OF USE,272,RC,,,,,,,,both,,,6440.3900,966.0600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2685.64,,,,,,,1662.2600,6440.3900,percent of total billed charges,"41.7% of $6,440.39 in Billed Charges for Rev 272 = $2,685.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CATH EDGE 180 DEG EXT WORKING CHANNEL FIRM TIP LACK OF USE,272,RC,,,,,,,,both,,,6440.3900,966.0600,CIGNA HEALTHCARE,CIGNA PPO,2685.64,,,,,,,1662.2600,6440.3900,percent of total billed charges,"41.7% of $6,440.39 in Billed Charges for Rev 272 = $2,685.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CATH EDGE 180 DEG EXT WORKING CHANNEL FIRM TIP LACK OF USE,272,RC,,,,,,,,both,,,6440.3900,966.0600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5796.35,,,,,,,1662.2600,6440.3900,percent of total billed charges,"90% of $6,440.39 in Billed Charges for Rev 272 = $5,796.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CATH EDGE 180 DEG EXT WORKING CHANNEL FIRM TIP LACK OF USE,272,RC,,,,,,,,both,,,6440.3900,966.0600,MEDCOST,MEDCOST VHN,3064.98,,,,,,,1662.2600,6440.3900,percent of total billed charges,"47.59% of $6,440.39 in Billed Charges for Rev 272 = $3,064.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CATH EDGE 180 DEG EXT WORKING CHANNEL FIRM TIP LACK OF USE,272,RC,,,,,,,,both,,,6440.3900,966.0600,SENTARA HEALTH,SENTARA HEALTH,1662.26,,,,,,,1662.2600,6440.3900,percent of total billed charges,"25.81% of $6,440.39 in Billed Charges for Rev 272 = $1,662.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CATH EDGE 180 DEG EXT WORKING CHANNEL FIRM TIP LACK OF USE,272,RC,,,,,,,,both,,,6440.3900,966.0600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6440.39,,,,,,,1662.2600,6440.3900,percent of total billed charges,"100% of $6,440.39 in Billed Charges for Rev 272 = $6,440.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CATH EDGE 180 DEG EXT WORKING CHANNEL FIRM TIP LACK OF USE,272,RC,,,,,,,,both,,,6440.3900,966.0600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3220.20,,,,,,,1662.2600,6440.3900,percent of total billed charges,"Rev 272 $6,440.39 in Billed Charges at 50% = $3,220.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CATH EDGE 180 DEG EXT WORKING CHANNEL FIRM TIP LACK OF USE,272,RC,,,,,,,,both,,,6440.3900,966.0600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2080.25,,,,,,,1662.2600,6440.3900,other,"32.3% of $6,440.39 in Billed Charges for Rev 272 = $2,080.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A CATH EDGE 180 DEG EXT WORKING CHANNEL FIRM TIP LACK OF USE,272,RC,,,,,,,,both,,,6440.3900,966.0600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1977.20,,,,,,,1662.2600,6440.3900,other,"30.7% of $6,440.39 in Billed Charges for Rev 272 = $1,977.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A CATH EDGE 180 DEG EXT WORKING CHANNEL FIRM TIP LACK OF USE,272,RC,,,,,,,,both,,,6440.3900,966.0600,UNITED HEALTHCARE,UNITED HEALTHCARE,2080.25,,,,,,,1662.2600,6440.3900,percent of total billed charges,"32.3% of $6,440.39 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A CATH EDGE 180 DEG EXT WORKING CHANNEL FIRM TIP LACK OF USE,272,RC,,,,,,,,both,,,6440.3900,966.0600,WELLCARE,WELLCARE MEDICAID,6440.39,,,,,,,1662.2600,6440.3900,percent of total billed charges,"100% of $6,440.39 in Billed Charges for Rev 272 = $6,440.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL INTRODC 8.5F SHEATH AK098835,272,RC,27200875,CDM,,,,,,both,,,44.0000,6.6000,AETNA,AETNA,18.79,,,,,,,11.3600,44.0000,percent of total billed charges,42.7% of $44.00 in Billed Charges for Rev 272 = $18.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL INTRODC 8.5F SHEATH AK098835,272,RC,27200875,CDM,,,,,,both,,,44.0000,6.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,30.80,,,,,,,11.3600,44.0000,percent of total billed charges,Rev 272 $44.00 in Billed Charges at 70% = $30.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL INTRODC 8.5F SHEATH AK098835,272,RC,27200875,CDM,,,,,,both,,,44.0000,6.6000,CIGNA HEALTHCARE,CIGNA HMO,18.35,,,,,,,11.3600,44.0000,percent of total billed charges,41.7% of $44.00 in Billed Charges for Rev 272 = $18.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL INTRODC 8.5F SHEATH AK098835,272,RC,27200875,CDM,,,,,,both,,,44.0000,6.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,20.42,,,,,,,11.3600,44.0000,percent of total billed charges,46.4% of $44.00 in Billed Charges for Rev 272 = $20.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL INTRODC 8.5F SHEATH AK098835,272,RC,27200875,CDM,,,,,,both,,,44.0000,6.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,18.35,,,,,,,11.3600,44.0000,percent of total billed charges,41.7% of $44.00 in Billed Charges for Rev 272 = $18.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL INTRODC 8.5F SHEATH AK098835,272,RC,27200875,CDM,,,,,,both,,,44.0000,6.6000,CIGNA HEALTHCARE,CIGNA PPO,18.35,,,,,,,11.3600,44.0000,percent of total billed charges,41.7% of $44.00 in Billed Charges for Rev 272 = $18.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL INTRODC 8.5F SHEATH AK098835,272,RC,27200875,CDM,,,,,,both,,,44.0000,6.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,39.60,,,,,,,11.3600,44.0000,percent of total billed charges,90% of $44.00 in Billed Charges for Rev 272 = $39.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL INTRODC 8.5F SHEATH AK098835,272,RC,27200875,CDM,,,,,,both,,,44.0000,6.6000,MEDCOST,MEDCOST VHN,20.94,,,,,,,11.3600,44.0000,percent of total billed charges,47.59% of $44.00 in Billed Charges for Rev 272 = $20.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL INTRODC 8.5F SHEATH AK098835,272,RC,27200875,CDM,,,,,,both,,,44.0000,6.6000,SENTARA HEALTH,SENTARA HEALTH,11.36,,,,,,,11.3600,44.0000,percent of total billed charges,25.81% of $44.00 in Billed Charges for Rev 272 = $11.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL INTRODC 8.5F SHEATH AK098835,272,RC,27200875,CDM,,,,,,both,,,44.0000,6.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",44.00,,,,,,,11.3600,44.0000,percent of total billed charges,100% of $44.00 in Billed Charges for Rev 272 = $44.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL INTRODC 8.5F SHEATH AK098835,272,RC,27200875,CDM,,,,,,both,,,44.0000,6.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.00,,,,,,,11.3600,44.0000,percent of total billed charges,Rev 272 $44.00 in Billed Charges at 50% = $22.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL INTRODC 8.5F SHEATH AK098835,272,RC,27200875,CDM,,,,,,both,,,44.0000,6.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,14.21,,,,,,,11.3600,44.0000,other,32.3% of $44.00 in Billed Charges for Rev 272 = $14.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PANEL INTRODC 8.5F SHEATH AK098835,272,RC,27200875,CDM,,,,,,both,,,44.0000,6.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,13.51,,,,,,,11.3600,44.0000,other,30.7% of $44.00 in Billed Charges for Rev 272 = $13.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PANEL INTRODC 8.5F SHEATH AK098835,272,RC,27200875,CDM,,,,,,both,,,44.0000,6.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,14.21,,,,,,,11.3600,44.0000,percent of total billed charges,32.3% of $44.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL INTRODC 8.5F SHEATH AK098835,272,RC,27200875,CDM,,,,,,both,,,44.0000,6.6000,WELLCARE,WELLCARE MEDICAID,44.00,,,,,,,11.3600,44.0000,percent of total billed charges,100% of $44.00 in Billed Charges for Rev 272 = $44.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL NEEDLE TRANSJUGUL LIVER BIOPS,272,RC,27200969,CDM,,,,,,both,,,1734.0000,260.1000,AETNA,AETNA,740.42,,,,,,,447.5500,1734.0000,percent of total billed charges,"42.7% of $1,734.00 in Billed Charges for Rev 272 = $740.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL NEEDLE TRANSJUGUL LIVER BIOPS,272,RC,27200969,CDM,,,,,,both,,,1734.0000,260.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1213.80,,,,,,,447.5500,1734.0000,percent of total billed charges,"Rev 272 $1,734.00 in Billed Charges at 70% = $1,213.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL NEEDLE TRANSJUGUL LIVER BIOPS,272,RC,27200969,CDM,,,,,,both,,,1734.0000,260.1000,CIGNA HEALTHCARE,CIGNA HMO,723.08,,,,,,,447.5500,1734.0000,percent of total billed charges,"41.7% of $1,734.00 in Billed Charges for Rev 272 = $723.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL NEEDLE TRANSJUGUL LIVER BIOPS,272,RC,27200969,CDM,,,,,,both,,,1734.0000,260.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,804.58,,,,,,,447.5500,1734.0000,percent of total billed charges,"46.4% of $1,734.00 in Billed Charges for Rev 272 = $804.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL NEEDLE TRANSJUGUL LIVER BIOPS,272,RC,27200969,CDM,,,,,,both,,,1734.0000,260.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,723.08,,,,,,,447.5500,1734.0000,percent of total billed charges,"41.7% of $1,734.00 in Billed Charges for Rev 272 = $723.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL NEEDLE TRANSJUGUL LIVER BIOPS,272,RC,27200969,CDM,,,,,,both,,,1734.0000,260.1000,CIGNA HEALTHCARE,CIGNA PPO,723.08,,,,,,,447.5500,1734.0000,percent of total billed charges,"41.7% of $1,734.00 in Billed Charges for Rev 272 = $723.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL NEEDLE TRANSJUGUL LIVER BIOPS,272,RC,27200969,CDM,,,,,,both,,,1734.0000,260.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1560.60,,,,,,,447.5500,1734.0000,percent of total billed charges,"90% of $1,734.00 in Billed Charges for Rev 272 = $1,560.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL NEEDLE TRANSJUGUL LIVER BIOPS,272,RC,27200969,CDM,,,,,,both,,,1734.0000,260.1000,MEDCOST,MEDCOST VHN,825.21,,,,,,,447.5500,1734.0000,percent of total billed charges,"47.59% of $1,734.00 in Billed Charges for Rev 272 = $825.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL NEEDLE TRANSJUGUL LIVER BIOPS,272,RC,27200969,CDM,,,,,,both,,,1734.0000,260.1000,SENTARA HEALTH,SENTARA HEALTH,447.55,,,,,,,447.5500,1734.0000,percent of total billed charges,"25.81% of $1,734.00 in Billed Charges for Rev 272 = $447.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL NEEDLE TRANSJUGUL LIVER BIOPS,272,RC,27200969,CDM,,,,,,both,,,1734.0000,260.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1734.00,,,,,,,447.5500,1734.0000,percent of total billed charges,"100% of $1,734.00 in Billed Charges for Rev 272 = $1,734.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL NEEDLE TRANSJUGUL LIVER BIOPS,272,RC,27200969,CDM,,,,,,both,,,1734.0000,260.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,867.00,,,,,,,447.5500,1734.0000,percent of total billed charges,"Rev 272 $1,734.00 in Billed Charges at 50% = $867.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL NEEDLE TRANSJUGUL LIVER BIOPS,272,RC,27200969,CDM,,,,,,both,,,1734.0000,260.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,560.08,,,,,,,447.5500,1734.0000,other,"32.3% of $1,734.00 in Billed Charges for Rev 272 = $560.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PANEL NEEDLE TRANSJUGUL LIVER BIOPS,272,RC,27200969,CDM,,,,,,both,,,1734.0000,260.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,532.34,,,,,,,447.5500,1734.0000,other,"30.7% of $1,734.00 in Billed Charges for Rev 272 = $532.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PANEL NEEDLE TRANSJUGUL LIVER BIOPS,272,RC,27200969,CDM,,,,,,both,,,1734.0000,260.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,560.08,,,,,,,447.5500,1734.0000,percent of total billed charges,"32.3% of $1,734.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL NEEDLE TRANSJUGUL LIVER BIOPS,272,RC,27200969,CDM,,,,,,both,,,1734.0000,260.1000,WELLCARE,WELLCARE MEDICAID,1734.00,,,,,,,447.5500,1734.0000,percent of total billed charges,"100% of $1,734.00 in Billed Charges for Rev 272 = $1,734.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DRESS NASAL/SINUS 4X4 MEROGEL,272,RC,,,,,,,,both,,,1097.0400,164.5600,AETNA,AETNA,468.44,,,,,,,283.1500,1097.0400,percent of total billed charges,"42.7% of $1,097.04 in Billed Charges for Rev 272 = $468.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DRESS NASAL/SINUS 4X4 MEROGEL,272,RC,,,,,,,,both,,,1097.0400,164.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,767.93,,,,,,,283.1500,1097.0400,percent of total billed charges,"Rev 272 $1,097.04 in Billed Charges at 70% = $767.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DRESS NASAL/SINUS 4X4 MEROGEL,272,RC,,,,,,,,both,,,1097.0400,164.5600,CIGNA HEALTHCARE,CIGNA HMO,457.47,,,,,,,283.1500,1097.0400,percent of total billed charges,"41.7% of $1,097.04 in Billed Charges for Rev 272 = $457.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DRESS NASAL/SINUS 4X4 MEROGEL,272,RC,,,,,,,,both,,,1097.0400,164.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,509.03,,,,,,,283.1500,1097.0400,percent of total billed charges,"46.4% of $1,097.04 in Billed Charges for Rev 272 = $509.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DRESS NASAL/SINUS 4X4 MEROGEL,272,RC,,,,,,,,both,,,1097.0400,164.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,457.47,,,,,,,283.1500,1097.0400,percent of total billed charges,"41.7% of $1,097.04 in Billed Charges for Rev 272 = $457.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DRESS NASAL/SINUS 4X4 MEROGEL,272,RC,,,,,,,,both,,,1097.0400,164.5600,CIGNA HEALTHCARE,CIGNA PPO,457.47,,,,,,,283.1500,1097.0400,percent of total billed charges,"41.7% of $1,097.04 in Billed Charges for Rev 272 = $457.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DRESS NASAL/SINUS 4X4 MEROGEL,272,RC,,,,,,,,both,,,1097.0400,164.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,987.34,,,,,,,283.1500,1097.0400,percent of total billed charges,"90% of $1,097.04 in Billed Charges for Rev 272 = $987.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DRESS NASAL/SINUS 4X4 MEROGEL,272,RC,,,,,,,,both,,,1097.0400,164.5600,MEDCOST,MEDCOST VHN,522.08,,,,,,,283.1500,1097.0400,percent of total billed charges,"47.59% of $1,097.04 in Billed Charges for Rev 272 = $522.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DRESS NASAL/SINUS 4X4 MEROGEL,272,RC,,,,,,,,both,,,1097.0400,164.5600,SENTARA HEALTH,SENTARA HEALTH,283.15,,,,,,,283.1500,1097.0400,percent of total billed charges,"25.81% of $1,097.04 in Billed Charges for Rev 272 = $283.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DRESS NASAL/SINUS 4X4 MEROGEL,272,RC,,,,,,,,both,,,1097.0400,164.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1097.04,,,,,,,283.1500,1097.0400,percent of total billed charges,"100% of $1,097.04 in Billed Charges for Rev 272 = $1,097.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DRESS NASAL/SINUS 4X4 MEROGEL,272,RC,,,,,,,,both,,,1097.0400,164.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,548.52,,,,,,,283.1500,1097.0400,percent of total billed charges,"Rev 272 $1,097.04 in Billed Charges at 50% = $548.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DRESS NASAL/SINUS 4X4 MEROGEL,272,RC,,,,,,,,both,,,1097.0400,164.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,354.34,,,,,,,283.1500,1097.0400,other,"32.3% of $1,097.04 in Billed Charges for Rev 272 = $354.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A DRESS NASAL/SINUS 4X4 MEROGEL,272,RC,,,,,,,,both,,,1097.0400,164.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,336.79,,,,,,,283.1500,1097.0400,other,"30.7% of $1,097.04 in Billed Charges for Rev 272 = $336.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A DRESS NASAL/SINUS 4X4 MEROGEL,272,RC,,,,,,,,both,,,1097.0400,164.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,354.34,,,,,,,283.1500,1097.0400,percent of total billed charges,"32.3% of $1,097.04 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A DRESS NASAL/SINUS 4X4 MEROGEL,272,RC,,,,,,,,both,,,1097.0400,164.5600,WELLCARE,WELLCARE MEDICAID,1097.04,,,,,,,283.1500,1097.0400,percent of total billed charges,"100% of $1,097.04 in Billed Charges for Rev 272 = $1,097.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ELECTRODE SUBDURAL STRIP 1X4 PLATINUM,272,RC,,,,,,,,both,,,4739.5500,710.9300,AETNA,AETNA,2023.79,,,,,,,1223.2800,4739.5500,percent of total billed charges,"42.7% of $4,739.55 in Billed Charges for Rev 272 = $2,023.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ELECTRODE SUBDURAL STRIP 1X4 PLATINUM,272,RC,,,,,,,,both,,,4739.5500,710.9300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3317.69,,,,,,,1223.2800,4739.5500,percent of total billed charges,"Rev 272 $4,739.55 in Billed Charges at 70% = $3,317.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ELECTRODE SUBDURAL STRIP 1X4 PLATINUM,272,RC,,,,,,,,both,,,4739.5500,710.9300,CIGNA HEALTHCARE,CIGNA HMO,1976.39,,,,,,,1223.2800,4739.5500,percent of total billed charges,"41.7% of $4,739.55 in Billed Charges for Rev 272 = $1,976.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ELECTRODE SUBDURAL STRIP 1X4 PLATINUM,272,RC,,,,,,,,both,,,4739.5500,710.9300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2199.15,,,,,,,1223.2800,4739.5500,percent of total billed charges,"46.4% of $4,739.55 in Billed Charges for Rev 272 = $2,199.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ELECTRODE SUBDURAL STRIP 1X4 PLATINUM,272,RC,,,,,,,,both,,,4739.5500,710.9300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1976.39,,,,,,,1223.2800,4739.5500,percent of total billed charges,"41.7% of $4,739.55 in Billed Charges for Rev 272 = $1,976.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ELECTRODE SUBDURAL STRIP 1X4 PLATINUM,272,RC,,,,,,,,both,,,4739.5500,710.9300,CIGNA HEALTHCARE,CIGNA PPO,1976.39,,,,,,,1223.2800,4739.5500,percent of total billed charges,"41.7% of $4,739.55 in Billed Charges for Rev 272 = $1,976.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ELECTRODE SUBDURAL STRIP 1X4 PLATINUM,272,RC,,,,,,,,both,,,4739.5500,710.9300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4265.60,,,,,,,1223.2800,4739.5500,percent of total billed charges,"90% of $4,739.55 in Billed Charges for Rev 272 = $4,265.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ELECTRODE SUBDURAL STRIP 1X4 PLATINUM,272,RC,,,,,,,,both,,,4739.5500,710.9300,MEDCOST,MEDCOST VHN,2255.55,,,,,,,1223.2800,4739.5500,percent of total billed charges,"47.59% of $4,739.55 in Billed Charges for Rev 272 = $2,255.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ELECTRODE SUBDURAL STRIP 1X4 PLATINUM,272,RC,,,,,,,,both,,,4739.5500,710.9300,SENTARA HEALTH,SENTARA HEALTH,1223.28,,,,,,,1223.2800,4739.5500,percent of total billed charges,"25.81% of $4,739.55 in Billed Charges for Rev 272 = $1,223.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ELECTRODE SUBDURAL STRIP 1X4 PLATINUM,272,RC,,,,,,,,both,,,4739.5500,710.9300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4739.55,,,,,,,1223.2800,4739.5500,percent of total billed charges,"100% of $4,739.55 in Billed Charges for Rev 272 = $4,739.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ELECTRODE SUBDURAL STRIP 1X4 PLATINUM,272,RC,,,,,,,,both,,,4739.5500,710.9300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2369.78,,,,,,,1223.2800,4739.5500,percent of total billed charges,"Rev 272 $4,739.55 in Billed Charges at 50% = $2,369.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ELECTRODE SUBDURAL STRIP 1X4 PLATINUM,272,RC,,,,,,,,both,,,4739.5500,710.9300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1530.87,,,,,,,1223.2800,4739.5500,other,"32.3% of $4,739.55 in Billed Charges for Rev 272 = $1,530.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A ELECTRODE SUBDURAL STRIP 1X4 PLATINUM,272,RC,,,,,,,,both,,,4739.5500,710.9300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1455.04,,,,,,,1223.2800,4739.5500,other,"30.7% of $4,739.55 in Billed Charges for Rev 272 = $1,455.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A ELECTRODE SUBDURAL STRIP 1X4 PLATINUM,272,RC,,,,,,,,both,,,4739.5500,710.9300,UNITED HEALTHCARE,UNITED HEALTHCARE,1530.87,,,,,,,1223.2800,4739.5500,percent of total billed charges,"32.3% of $4,739.55 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ELECTRODE SUBDURAL STRIP 1X4 PLATINUM,272,RC,,,,,,,,both,,,4739.5500,710.9300,WELLCARE,WELLCARE MEDICAID,4739.55,,,,,,,1223.2800,4739.5500,percent of total billed charges,"100% of $4,739.55 in Billed Charges for Rev 272 = $4,739.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A GRAFT AAA ENDOPROS 28X14X12CM LACK OF USE,278,RC,,,,,,,,both,,,102496.5900,15374.4900,AETNA,AETNA,49198.36,,,,,,,7277.2600,102496.5900,percent of total billed charges,"48% of $102,496.59 in Billed Charges for Rev 278 = $49,198.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A GRAFT AAA ENDOPROS 28X14X12CM LACK OF USE,278,RC,,,,,,,,both,,,102496.5900,15374.4900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,51248.30,,,,,,,7277.2600,102496.5900,percent of total billed charges,"50% of $102,496.59 in Billed Charges for Rev 278 = $51,248.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A GRAFT AAA ENDOPROS 28X14X12CM LACK OF USE,278,RC,,,,,,,,both,,,102496.5900,15374.4900,CIGNA HEALTHCARE,CIGNA HMO,42741.08,,,,,,,7277.2600,102496.5900,percent of total billed charges,"41.7% of $102,496.59 in Billed Charges for Rev 278 = $42,741.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A GRAFT AAA ENDOPROS 28X14X12CM LACK OF USE,278,RC,,,,,,,,both,,,102496.5900,15374.4900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,40998.64,,,,,,,7277.2600,102496.5900,percent of total billed charges,"40% of $102,496.59 in Billed Charges for Rev 278 = $40,998.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A GRAFT AAA ENDOPROS 28X14X12CM LACK OF USE,278,RC,,,,,,,,both,,,102496.5900,15374.4900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,42741.08,,,,,,,7277.2600,102496.5900,percent of total billed charges,"41.7% of $102,496.59 in Billed Charges for Rev 278 = $42,741.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A GRAFT AAA ENDOPROS 28X14X12CM LACK OF USE,278,RC,,,,,,,,both,,,102496.5900,15374.4900,CIGNA HEALTHCARE,CIGNA PPO,42741.08,,,,,,,7277.2600,102496.5900,percent of total billed charges,"41.7% of $102,496.59 in Billed Charges for Rev 278 = $42,741.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A GRAFT AAA ENDOPROS 28X14X12CM LACK OF USE,278,RC,,,,,,,,both,,,102496.5900,15374.4900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,92246.93,,,,,,,7277.2600,102496.5900,percent of total billed charges,"90% of $102,496.59 in Billed Charges for Rev 278 = $92,246.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A GRAFT AAA ENDOPROS 28X14X12CM LACK OF USE,278,RC,,,,,,,,both,,,102496.5900,15374.4900,MEDCOST,MEDCOST VHN,48778.13,,,,,,,7277.2600,102496.5900,percent of total billed charges,"47.59% of $102,496.59 in Billed Charges for Rev 278 = $48,778.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A GRAFT AAA ENDOPROS 28X14X12CM LACK OF USE,278,RC,,,,,,,,both,,,102496.5900,15374.4900,SENTARA HEALTH,SENTARA HEALTH,26454.37,,,,,,,7277.2600,102496.5900,percent of total billed charges,"25.81% of $102,496.59 in Billed Charges for Rev 278 = $26,454.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A GRAFT AAA ENDOPROS 28X14X12CM LACK OF USE,278,RC,,,,,,,,both,,,102496.5900,15374.4900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",102496.59,,,,,,,7277.2600,102496.5900,percent of total billed charges,"100% of $102,496.59 in Billed Charges for Rev 278 = $102,496.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A GRAFT AAA ENDOPROS 28X14X12CM LACK OF USE,278,RC,,,,,,,,both,,,102496.5900,15374.4900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,51248.30,,,,,,,7277.2600,102496.5900,percent of total billed charges,"Rev 278 $102,496.59 in Billed Charges at 50% = $51,248.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A GRAFT AAA ENDOPROS 28X14X12CM LACK OF USE,278,RC,,,,,,,,both,,,102496.5900,15374.4900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7687.24,,,,,,,7277.2600,102496.5900,percent of total billed charges,"7.5% of $102,496.59 in Billed Charges for Rev 278 = $7,687.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A GRAFT AAA ENDOPROS 28X14X12CM LACK OF USE,278,RC,,,,,,,,both,,,102496.5900,15374.4900,UNITED HEALTHCARE,UHC HERITAGE SELECT,7277.26,,,,,,,7277.2600,102496.5900,percent of total billed charges,"7.1% of $102,496.59 in Billed Charges for Rev 278 = $7,277.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A GRAFT AAA ENDOPROS 28X14X12CM LACK OF USE,278,RC,,,,,,,,both,,,102496.5900,15374.4900,UNITED HEALTHCARE,UNITED HEALTHCARE,7277.26,,,,,,,7277.2600,102496.5900,percent of total billed charges,"7.1% of $102,496.59 in Billed Charges for Rev 278 = $7,277.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A GRAFT AAA ENDOPROS 28X14X12CM LACK OF USE,278,RC,,,,,,,,both,,,102496.5900,15374.4900,WELLCARE,WELLCARE MEDICAID,102496.59,,,,,,,7277.2600,102496.5900,percent of total billed charges,"100% of $102,496.59 in Billed Charges for Rev 278 = $102,496.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A GRID BRACHY DSP.18G FOR B-K,272,RC,,,,,,,,both,,,566.2600,84.9400,AETNA,AETNA,241.79,,,,,,,146.1500,566.2600,percent of total billed charges,42.7% of $566.26 in Billed Charges for Rev 272 = $241.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A GRID BRACHY DSP.18G FOR B-K,272,RC,,,,,,,,both,,,566.2600,84.9400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,396.38,,,,,,,146.1500,566.2600,percent of total billed charges,Rev 272 $566.26 in Billed Charges at 70% = $396.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A GRID BRACHY DSP.18G FOR B-K,272,RC,,,,,,,,both,,,566.2600,84.9400,CIGNA HEALTHCARE,CIGNA HMO,236.13,,,,,,,146.1500,566.2600,percent of total billed charges,41.7% of $566.26 in Billed Charges for Rev 272 = $236.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A GRID BRACHY DSP.18G FOR B-K,272,RC,,,,,,,,both,,,566.2600,84.9400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,262.74,,,,,,,146.1500,566.2600,percent of total billed charges,46.4% of $566.26 in Billed Charges for Rev 272 = $262.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A GRID BRACHY DSP.18G FOR B-K,272,RC,,,,,,,,both,,,566.2600,84.9400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,236.13,,,,,,,146.1500,566.2600,percent of total billed charges,41.7% of $566.26 in Billed Charges for Rev 272 = $236.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A GRID BRACHY DSP.18G FOR B-K,272,RC,,,,,,,,both,,,566.2600,84.9400,CIGNA HEALTHCARE,CIGNA PPO,236.13,,,,,,,146.1500,566.2600,percent of total billed charges,41.7% of $566.26 in Billed Charges for Rev 272 = $236.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A GRID BRACHY DSP.18G FOR B-K,272,RC,,,,,,,,both,,,566.2600,84.9400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,509.63,,,,,,,146.1500,566.2600,percent of total billed charges,90% of $566.26 in Billed Charges for Rev 272 = $509.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A GRID BRACHY DSP.18G FOR B-K,272,RC,,,,,,,,both,,,566.2600,84.9400,MEDCOST,MEDCOST VHN,269.48,,,,,,,146.1500,566.2600,percent of total billed charges,47.59% of $566.26 in Billed Charges for Rev 272 = $269.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A GRID BRACHY DSP.18G FOR B-K,272,RC,,,,,,,,both,,,566.2600,84.9400,SENTARA HEALTH,SENTARA HEALTH,146.15,,,,,,,146.1500,566.2600,percent of total billed charges,25.81% of $566.26 in Billed Charges for Rev 272 = $146.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A GRID BRACHY DSP.18G FOR B-K,272,RC,,,,,,,,both,,,566.2600,84.9400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",566.26,,,,,,,146.1500,566.2600,percent of total billed charges,100% of $566.26 in Billed Charges for Rev 272 = $566.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A GRID BRACHY DSP.18G FOR B-K,272,RC,,,,,,,,both,,,566.2600,84.9400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,283.13,,,,,,,146.1500,566.2600,percent of total billed charges,Rev 272 $566.26 in Billed Charges at 50% = $283.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A GRID BRACHY DSP.18G FOR B-K,272,RC,,,,,,,,both,,,566.2600,84.9400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,182.90,,,,,,,146.1500,566.2600,other,32.3% of $566.26 in Billed Charges for Rev 272 = $182.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
I/A GRID BRACHY DSP.18G FOR B-K,272,RC,,,,,,,,both,,,566.2600,84.9400,UNITED HEALTHCARE,UHC HERITAGE SELECT,173.84,,,,,,,146.1500,566.2600,other,30.7% of $566.26 in Billed Charges for Rev 272 = $173.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
I/A GRID BRACHY DSP.18G FOR B-K,272,RC,,,,,,,,both,,,566.2600,84.9400,UNITED HEALTHCARE,UNITED HEALTHCARE,182.90,,,,,,,146.1500,566.2600,percent of total billed charges,32.3% of $566.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A GRID BRACHY DSP.18G FOR B-K,272,RC,,,,,,,,both,,,566.2600,84.9400,WELLCARE,WELLCARE MEDICAID,566.26,,,,,,,146.1500,566.2600,percent of total billed charges,100% of $566.26 in Billed Charges for Rev 272 = $566.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 14 EA,272,RC,27201152,CDM,,,,,,both,,,152.0000,22.8000,AETNA,AETNA,64.90,,,,,,,39.2300,152.0000,percent of total billed charges,42.7% of $152.00 in Billed Charges for Rev 272 = $64.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 14 EA,272,RC,27201152,CDM,,,,,,both,,,152.0000,22.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,106.40,,,,,,,39.2300,152.0000,percent of total billed charges,Rev 272 $152.00 in Billed Charges at 70% = $106.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 14 EA,272,RC,27201152,CDM,,,,,,both,,,152.0000,22.8000,CIGNA HEALTHCARE,CIGNA HMO,63.38,,,,,,,39.2300,152.0000,percent of total billed charges,41.7% of $152.00 in Billed Charges for Rev 272 = $63.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 14 EA,272,RC,27201152,CDM,,,,,,both,,,152.0000,22.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,70.53,,,,,,,39.2300,152.0000,percent of total billed charges,46.4% of $152.00 in Billed Charges for Rev 272 = $70.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 14 EA,272,RC,27201152,CDM,,,,,,both,,,152.0000,22.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,63.38,,,,,,,39.2300,152.0000,percent of total billed charges,41.7% of $152.00 in Billed Charges for Rev 272 = $63.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 14 EA,272,RC,27201152,CDM,,,,,,both,,,152.0000,22.8000,CIGNA HEALTHCARE,CIGNA PPO,63.38,,,,,,,39.2300,152.0000,percent of total billed charges,41.7% of $152.00 in Billed Charges for Rev 272 = $63.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 14 EA,272,RC,27201152,CDM,,,,,,both,,,152.0000,22.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,136.80,,,,,,,39.2300,152.0000,percent of total billed charges,90% of $152.00 in Billed Charges for Rev 272 = $136.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 14 EA,272,RC,27201152,CDM,,,,,,both,,,152.0000,22.8000,MEDCOST,MEDCOST VHN,72.34,,,,,,,39.2300,152.0000,percent of total billed charges,47.59% of $152.00 in Billed Charges for Rev 272 = $72.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 14 EA,272,RC,27201152,CDM,,,,,,both,,,152.0000,22.8000,SENTARA HEALTH,SENTARA HEALTH,39.23,,,,,,,39.2300,152.0000,percent of total billed charges,25.81% of $152.00 in Billed Charges for Rev 272 = $39.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 14 EA,272,RC,27201152,CDM,,,,,,both,,,152.0000,22.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",152.00,,,,,,,39.2300,152.0000,percent of total billed charges,100% of $152.00 in Billed Charges for Rev 272 = $152.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 14 EA,272,RC,27201152,CDM,,,,,,both,,,152.0000,22.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,76.00,,,,,,,39.2300,152.0000,percent of total billed charges,Rev 272 $152.00 in Billed Charges at 50% = $76.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 14 EA,272,RC,27201152,CDM,,,,,,both,,,152.0000,22.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,49.10,,,,,,,39.2300,152.0000,other,32.3% of $152.00 in Billed Charges for Rev 272 = $49.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SURGICEL 2 X 14 EA,272,RC,27201152,CDM,,,,,,both,,,152.0000,22.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,46.66,,,,,,,39.2300,152.0000,other,30.7% of $152.00 in Billed Charges for Rev 272 = $46.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SURGICEL 2 X 14 EA,272,RC,27201152,CDM,,,,,,both,,,152.0000,22.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,49.10,,,,,,,39.2300,152.0000,percent of total billed charges,32.3% of $152.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 14 EA,272,RC,27201152,CDM,,,,,,both,,,152.0000,22.8000,WELLCARE,WELLCARE MEDICAID,152.00,,,,,,,39.2300,152.0000,percent of total billed charges,100% of $152.00 in Billed Charges for Rev 272 = $152.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 3 EA,272,RC,27201153,CDM,,,,,,both,,,113.0000,16.9500,AETNA,AETNA,48.25,,,,,,,29.1700,113.0000,percent of total billed charges,42.7% of $113.00 in Billed Charges for Rev 272 = $48.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 3 EA,272,RC,27201153,CDM,,,,,,both,,,113.0000,16.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,79.10,,,,,,,29.1700,113.0000,percent of total billed charges,Rev 272 $113.00 in Billed Charges at 70% = $79.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 3 EA,272,RC,27201153,CDM,,,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA HMO,47.12,,,,,,,29.1700,113.0000,percent of total billed charges,41.7% of $113.00 in Billed Charges for Rev 272 = $47.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 3 EA,272,RC,27201153,CDM,,,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,52.43,,,,,,,29.1700,113.0000,percent of total billed charges,46.4% of $113.00 in Billed Charges for Rev 272 = $52.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 3 EA,272,RC,27201153,CDM,,,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,47.12,,,,,,,29.1700,113.0000,percent of total billed charges,41.7% of $113.00 in Billed Charges for Rev 272 = $47.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 3 EA,272,RC,27201153,CDM,,,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA PPO,47.12,,,,,,,29.1700,113.0000,percent of total billed charges,41.7% of $113.00 in Billed Charges for Rev 272 = $47.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 3 EA,272,RC,27201153,CDM,,,,,,both,,,113.0000,16.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,101.70,,,,,,,29.1700,113.0000,percent of total billed charges,90% of $113.00 in Billed Charges for Rev 272 = $101.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 3 EA,272,RC,27201153,CDM,,,,,,both,,,113.0000,16.9500,MEDCOST,MEDCOST VHN,53.78,,,,,,,29.1700,113.0000,percent of total billed charges,47.59% of $113.00 in Billed Charges for Rev 272 = $53.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 3 EA,272,RC,27201153,CDM,,,,,,both,,,113.0000,16.9500,SENTARA HEALTH,SENTARA HEALTH,29.17,,,,,,,29.1700,113.0000,percent of total billed charges,25.81% of $113.00 in Billed Charges for Rev 272 = $29.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 3 EA,272,RC,27201153,CDM,,,,,,both,,,113.0000,16.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",113.00,,,,,,,29.1700,113.0000,percent of total billed charges,100% of $113.00 in Billed Charges for Rev 272 = $113.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 3 EA,272,RC,27201153,CDM,,,,,,both,,,113.0000,16.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,56.50,,,,,,,29.1700,113.0000,percent of total billed charges,Rev 272 $113.00 in Billed Charges at 50% = $56.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 3 EA,272,RC,27201153,CDM,,,,,,both,,,113.0000,16.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,36.50,,,,,,,29.1700,113.0000,other,32.3% of $113.00 in Billed Charges for Rev 272 = $36.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SURGICEL 2 X 3 EA,272,RC,27201153,CDM,,,,,,both,,,113.0000,16.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,34.69,,,,,,,29.1700,113.0000,other,30.7% of $113.00 in Billed Charges for Rev 272 = $34.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SURGICEL 2 X 3 EA,272,RC,27201153,CDM,,,,,,both,,,113.0000,16.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,36.50,,,,,,,29.1700,113.0000,percent of total billed charges,32.3% of $113.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 2 X 3 EA,272,RC,27201153,CDM,,,,,,both,,,113.0000,16.9500,WELLCARE,WELLCARE MEDICAID,113.00,,,,,,,29.1700,113.0000,percent of total billed charges,100% of $113.00 in Billed Charges for Rev 272 = $113.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4X8 GREEN,272,RC,27202160,CDM,,,,,,both,,,582.0000,87.3000,AETNA,AETNA,248.51,,,,,,,150.2100,582.0000,percent of total billed charges,42.7% of $582.00 in Billed Charges for Rev 272 = $248.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4X8 GREEN,272,RC,27202160,CDM,,,,,,both,,,582.0000,87.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,407.40,,,,,,,150.2100,582.0000,percent of total billed charges,Rev 272 $582.00 in Billed Charges at 70% = $407.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4X8 GREEN,272,RC,27202160,CDM,,,,,,both,,,582.0000,87.3000,CIGNA HEALTHCARE,CIGNA HMO,242.69,,,,,,,150.2100,582.0000,percent of total billed charges,41.7% of $582.00 in Billed Charges for Rev 272 = $242.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4X8 GREEN,272,RC,27202160,CDM,,,,,,both,,,582.0000,87.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,270.05,,,,,,,150.2100,582.0000,percent of total billed charges,46.4% of $582.00 in Billed Charges for Rev 272 = $270.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4X8 GREEN,272,RC,27202160,CDM,,,,,,both,,,582.0000,87.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,242.69,,,,,,,150.2100,582.0000,percent of total billed charges,41.7% of $582.00 in Billed Charges for Rev 272 = $242.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4X8 GREEN,272,RC,27202160,CDM,,,,,,both,,,582.0000,87.3000,CIGNA HEALTHCARE,CIGNA PPO,242.69,,,,,,,150.2100,582.0000,percent of total billed charges,41.7% of $582.00 in Billed Charges for Rev 272 = $242.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4X8 GREEN,272,RC,27202160,CDM,,,,,,both,,,582.0000,87.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,523.80,,,,,,,150.2100,582.0000,percent of total billed charges,90% of $582.00 in Billed Charges for Rev 272 = $523.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4X8 GREEN,272,RC,27202160,CDM,,,,,,both,,,582.0000,87.3000,MEDCOST,MEDCOST VHN,276.97,,,,,,,150.2100,582.0000,percent of total billed charges,47.59% of $582.00 in Billed Charges for Rev 272 = $276.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4X8 GREEN,272,RC,27202160,CDM,,,,,,both,,,582.0000,87.3000,SENTARA HEALTH,SENTARA HEALTH,150.21,,,,,,,150.2100,582.0000,percent of total billed charges,25.81% of $582.00 in Billed Charges for Rev 272 = $150.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4X8 GREEN,272,RC,27202160,CDM,,,,,,both,,,582.0000,87.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",582.00,,,,,,,150.2100,582.0000,percent of total billed charges,100% of $582.00 in Billed Charges for Rev 272 = $582.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4X8 GREEN,272,RC,27202160,CDM,,,,,,both,,,582.0000,87.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,291.00,,,,,,,150.2100,582.0000,percent of total billed charges,Rev 272 $582.00 in Billed Charges at 50% = $291.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4X8 GREEN,272,RC,27202160,CDM,,,,,,both,,,582.0000,87.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,187.99,,,,,,,150.2100,582.0000,other,32.3% of $582.00 in Billed Charges for Rev 272 = $187.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SURGICEL 4X8 GREEN,272,RC,27202160,CDM,,,,,,both,,,582.0000,87.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,178.67,,,,,,,150.2100,582.0000,other,30.7% of $582.00 in Billed Charges for Rev 272 = $178.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SURGICEL 4X8 GREEN,272,RC,27202160,CDM,,,,,,both,,,582.0000,87.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,187.99,,,,,,,150.2100,582.0000,percent of total billed charges,32.3% of $582.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4X8 GREEN,272,RC,27202160,CDM,,,,,,both,,,582.0000,87.3000,WELLCARE,WELLCARE MEDICAID,582.00,,,,,,,150.2100,582.0000,percent of total billed charges,100% of $582.00 in Billed Charges for Rev 272 = $582.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1680.3100,252.0500,AETNA,AETNA,717.49,,,,,,,433.6900,1680.3100,percent of total billed charges,"42.7% of $1,680.31 in Billed Charges for Rev 272 = $717.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1680.3100,252.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1176.22,,,,,,,433.6900,1680.3100,percent of total billed charges,"Rev 272 $1,680.31 in Billed Charges at 70% = $1,176.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1680.3100,252.0500,CIGNA HEALTHCARE,CIGNA HMO,700.69,,,,,,,433.6900,1680.3100,percent of total billed charges,"41.7% of $1,680.31 in Billed Charges for Rev 272 = $700.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1680.3100,252.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,779.66,,,,,,,433.6900,1680.3100,percent of total billed charges,"46.4% of $1,680.31 in Billed Charges for Rev 272 = $779.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1680.3100,252.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,700.69,,,,,,,433.6900,1680.3100,percent of total billed charges,"41.7% of $1,680.31 in Billed Charges for Rev 272 = $700.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1680.3100,252.0500,CIGNA HEALTHCARE,CIGNA PPO,700.69,,,,,,,433.6900,1680.3100,percent of total billed charges,"41.7% of $1,680.31 in Billed Charges for Rev 272 = $700.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1680.3100,252.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1512.28,,,,,,,433.6900,1680.3100,percent of total billed charges,"90% of $1,680.31 in Billed Charges for Rev 272 = $1,512.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1680.3100,252.0500,MEDCOST,MEDCOST VHN,799.66,,,,,,,433.6900,1680.3100,percent of total billed charges,"47.59% of $1,680.31 in Billed Charges for Rev 272 = $799.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1680.3100,252.0500,SENTARA HEALTH,SENTARA HEALTH,433.69,,,,,,,433.6900,1680.3100,percent of total billed charges,"25.81% of $1,680.31 in Billed Charges for Rev 272 = $433.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1680.3100,252.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1680.31,,,,,,,433.6900,1680.3100,percent of total billed charges,"100% of $1,680.31 in Billed Charges for Rev 272 = $1,680.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1680.3100,252.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,840.16,,,,,,,433.6900,1680.3100,percent of total billed charges,"Rev 272 $1,680.31 in Billed Charges at 50% = $840.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1680.3100,252.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,542.74,,,,,,,433.6900,1680.3100,other,"32.3% of $1,680.31 in Billed Charges for Rev 272 = $542.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1680.3100,252.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,515.86,,,,,,,433.6900,1680.3100,other,"30.7% of $1,680.31 in Billed Charges for Rev 272 = $515.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1680.3100,252.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,542.74,,,,,,,433.6900,1680.3100,percent of total billed charges,"32.3% of $1,680.31 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A KIT PEG SAFETY PULL 20F ENDOVIVE USE LN 126218,272,RC,27200002,CDM,,,,,,both,,,1680.3100,252.0500,WELLCARE,WELLCARE MEDICAID,1680.31,,,,,,,433.6900,1680.3100,percent of total billed charges,"100% of $1,680.31 in Billed Charges for Rev 272 = $1,680.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A NEEDLE SAFETY 18X1 1/2 MAGELLAN USE LN 104322,270,RC,,,,,,,,both,,,610.3300,91.5500,AETNA,AETNA,260.61,,,,,,,157.5300,610.3300,percent of total billed charges,42.7% of $610.33 in Billed Charges for Rev 270 = $260.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A NEEDLE SAFETY 18X1 1/2 MAGELLAN USE LN 104322,270,RC,,,,,,,,both,,,610.3300,91.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,427.23,,,,,,,157.5300,610.3300,percent of total billed charges,Rev 270 $610.33 in Billed Charges at 70% = $427.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A NEEDLE SAFETY 18X1 1/2 MAGELLAN USE LN 104322,270,RC,,,,,,,,both,,,610.3300,91.5500,CIGNA HEALTHCARE,CIGNA HMO,254.51,,,,,,,157.5300,610.3300,percent of total billed charges,41.7% of $610.33 in Billed Charges for Rev 270 = $254.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A NEEDLE SAFETY 18X1 1/2 MAGELLAN USE LN 104322,270,RC,,,,,,,,both,,,610.3300,91.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,283.19,,,,,,,157.5300,610.3300,percent of total billed charges,46.4% of $610.33 in Billed Charges for Rev 270 = $283.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A NEEDLE SAFETY 18X1 1/2 MAGELLAN USE LN 104322,270,RC,,,,,,,,both,,,610.3300,91.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,254.51,,,,,,,157.5300,610.3300,percent of total billed charges,41.7% of $610.33 in Billed Charges for Rev 270 = $254.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A NEEDLE SAFETY 18X1 1/2 MAGELLAN USE LN 104322,270,RC,,,,,,,,both,,,610.3300,91.5500,CIGNA HEALTHCARE,CIGNA PPO,254.51,,,,,,,157.5300,610.3300,percent of total billed charges,41.7% of $610.33 in Billed Charges for Rev 270 = $254.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A NEEDLE SAFETY 18X1 1/2 MAGELLAN USE LN 104322,270,RC,,,,,,,,both,,,610.3300,91.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,549.30,,,,,,,157.5300,610.3300,percent of total billed charges,90% of $610.33 in Billed Charges for Rev 270 = $549.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A NEEDLE SAFETY 18X1 1/2 MAGELLAN USE LN 104322,270,RC,,,,,,,,both,,,610.3300,91.5500,MEDCOST,MEDCOST VHN,290.46,,,,,,,157.5300,610.3300,percent of total billed charges,47.59% of $610.33 in Billed Charges for Rev 270 = $290.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A NEEDLE SAFETY 18X1 1/2 MAGELLAN USE LN 104322,270,RC,,,,,,,,both,,,610.3300,91.5500,SENTARA HEALTH,SENTARA HEALTH,157.53,,,,,,,157.5300,610.3300,percent of total billed charges,25.81% of $610.33 in Billed Charges for Rev 270 = $157.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A NEEDLE SAFETY 18X1 1/2 MAGELLAN USE LN 104322,270,RC,,,,,,,,both,,,610.3300,91.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",610.33,,,,,,,157.5300,610.3300,percent of total billed charges,100% of $610.33 in Billed Charges for Rev 270 = $610.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A NEEDLE SAFETY 18X1 1/2 MAGELLAN USE LN 104322,270,RC,,,,,,,,both,,,610.3300,91.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,305.17,,,,,,,157.5300,610.3300,percent of total billed charges,Rev 270 $610.33 in Billed Charges at 50% = $305.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A NEEDLE SAFETY 18X1 1/2 MAGELLAN USE LN 104322,270,RC,,,,,,,,both,,,610.3300,91.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,197.14,,,,,,,157.5300,610.3300,other,32.3% of $610.33 in Billed Charges for Rev 270 = $197.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
I/A NEEDLE SAFETY 18X1 1/2 MAGELLAN USE LN 104322,270,RC,,,,,,,,both,,,610.3300,91.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,187.37,,,,,,,157.5300,610.3300,other,30.7% of $610.33 in Billed Charges for Rev 270 = $187.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
I/A NEEDLE SAFETY 18X1 1/2 MAGELLAN USE LN 104322,270,RC,,,,,,,,both,,,610.3300,91.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,197.14,,,,,,,157.5300,610.3300,percent of total billed charges,32.3% of $610.33 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A NEEDLE SAFETY 18X1 1/2 MAGELLAN USE LN 104322,270,RC,,,,,,,,both,,,610.3300,91.5500,WELLCARE,WELLCARE MEDICAID,610.33,,,,,,,157.5300,610.3300,percent of total billed charges,100% of $610.33 in Billed Charges for Rev 270 = $610.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRILL GUIDE,272,RC,,,,,,,,both,,,3557.2500,533.5900,AETNA,AETNA,1518.95,,,,,,,918.1300,3557.2500,percent of total billed charges,"42.7% of $3,557.25 in Billed Charges for Rev 272 = $1,518.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRILL GUIDE,272,RC,,,,,,,,both,,,3557.2500,533.5900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2490.08,,,,,,,918.1300,3557.2500,percent of total billed charges,"Rev 272 $3,557.25 in Billed Charges at 70% = $2,490.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRILL GUIDE,272,RC,,,,,,,,both,,,3557.2500,533.5900,CIGNA HEALTHCARE,CIGNA HMO,1483.37,,,,,,,918.1300,3557.2500,percent of total billed charges,"41.7% of $3,557.25 in Billed Charges for Rev 272 = $1,483.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRILL GUIDE,272,RC,,,,,,,,both,,,3557.2500,533.5900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1650.56,,,,,,,918.1300,3557.2500,percent of total billed charges,"46.4% of $3,557.25 in Billed Charges for Rev 272 = $1,650.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRILL GUIDE,272,RC,,,,,,,,both,,,3557.2500,533.5900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1483.37,,,,,,,918.1300,3557.2500,percent of total billed charges,"41.7% of $3,557.25 in Billed Charges for Rev 272 = $1,483.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRILL GUIDE,272,RC,,,,,,,,both,,,3557.2500,533.5900,CIGNA HEALTHCARE,CIGNA PPO,1483.37,,,,,,,918.1300,3557.2500,percent of total billed charges,"41.7% of $3,557.25 in Billed Charges for Rev 272 = $1,483.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRILL GUIDE,272,RC,,,,,,,,both,,,3557.2500,533.5900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3201.53,,,,,,,918.1300,3557.2500,percent of total billed charges,"90% of $3,557.25 in Billed Charges for Rev 272 = $3,201.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRILL GUIDE,272,RC,,,,,,,,both,,,3557.2500,533.5900,MEDCOST,MEDCOST VHN,1692.90,,,,,,,918.1300,3557.2500,percent of total billed charges,"47.59% of $3,557.25 in Billed Charges for Rev 272 = $1,692.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRILL GUIDE,272,RC,,,,,,,,both,,,3557.2500,533.5900,SENTARA HEALTH,SENTARA HEALTH,918.13,,,,,,,918.1300,3557.2500,percent of total billed charges,"25.81% of $3,557.25 in Billed Charges for Rev 272 = $918.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRILL GUIDE,272,RC,,,,,,,,both,,,3557.2500,533.5900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3557.25,,,,,,,918.1300,3557.2500,percent of total billed charges,"100% of $3,557.25 in Billed Charges for Rev 272 = $3,557.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRILL GUIDE,272,RC,,,,,,,,both,,,3557.2500,533.5900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1778.63,,,,,,,918.1300,3557.2500,percent of total billed charges,"Rev 272 $3,557.25 in Billed Charges at 50% = $1,778.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRILL GUIDE,272,RC,,,,,,,,both,,,3557.2500,533.5900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1148.99,,,,,,,918.1300,3557.2500,other,"32.3% of $3,557.25 in Billed Charges for Rev 272 = $1,148.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT DRILL GUIDE,272,RC,,,,,,,,both,,,3557.2500,533.5900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1092.08,,,,,,,918.1300,3557.2500,other,"30.7% of $3,557.25 in Billed Charges for Rev 272 = $1,092.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT DRILL GUIDE,272,RC,,,,,,,,both,,,3557.2500,533.5900,UNITED HEALTHCARE,UNITED HEALTHCARE,1148.99,,,,,,,918.1300,3557.2500,percent of total billed charges,"32.3% of $3,557.25 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRILL GUIDE,272,RC,,,,,,,,both,,,3557.2500,533.5900,WELLCARE,WELLCARE MEDICAID,3557.25,,,,,,,918.1300,3557.2500,percent of total billed charges,"100% of $3,557.25 in Billed Charges for Rev 272 = $3,557.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SUTURE C SECTION,272,RC,27201474,CDM,,,,,,both,,,174.0000,26.1000,AETNA,AETNA,74.30,,,,,,,44.9100,174.0000,percent of total billed charges,42.7% of $174.00 in Billed Charges for Rev 272 = $74.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE C SECTION,272,RC,27201474,CDM,,,,,,both,,,174.0000,26.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,121.80,,,,,,,44.9100,174.0000,percent of total billed charges,Rev 272 $174.00 in Billed Charges at 70% = $121.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE C SECTION,272,RC,27201474,CDM,,,,,,both,,,174.0000,26.1000,CIGNA HEALTHCARE,CIGNA HMO,72.56,,,,,,,44.9100,174.0000,percent of total billed charges,41.7% of $174.00 in Billed Charges for Rev 272 = $72.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE C SECTION,272,RC,27201474,CDM,,,,,,both,,,174.0000,26.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,80.74,,,,,,,44.9100,174.0000,percent of total billed charges,46.4% of $174.00 in Billed Charges for Rev 272 = $80.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE C SECTION,272,RC,27201474,CDM,,,,,,both,,,174.0000,26.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,72.56,,,,,,,44.9100,174.0000,percent of total billed charges,41.7% of $174.00 in Billed Charges for Rev 272 = $72.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE C SECTION,272,RC,27201474,CDM,,,,,,both,,,174.0000,26.1000,CIGNA HEALTHCARE,CIGNA PPO,72.56,,,,,,,44.9100,174.0000,percent of total billed charges,41.7% of $174.00 in Billed Charges for Rev 272 = $72.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE C SECTION,272,RC,27201474,CDM,,,,,,both,,,174.0000,26.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,156.60,,,,,,,44.9100,174.0000,percent of total billed charges,90% of $174.00 in Billed Charges for Rev 272 = $156.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE C SECTION,272,RC,27201474,CDM,,,,,,both,,,174.0000,26.1000,MEDCOST,MEDCOST VHN,82.81,,,,,,,44.9100,174.0000,percent of total billed charges,47.59% of $174.00 in Billed Charges for Rev 272 = $82.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE C SECTION,272,RC,27201474,CDM,,,,,,both,,,174.0000,26.1000,SENTARA HEALTH,SENTARA HEALTH,44.91,,,,,,,44.9100,174.0000,percent of total billed charges,25.81% of $174.00 in Billed Charges for Rev 272 = $44.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE C SECTION,272,RC,27201474,CDM,,,,,,both,,,174.0000,26.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",174.00,,,,,,,44.9100,174.0000,percent of total billed charges,100% of $174.00 in Billed Charges for Rev 272 = $174.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE C SECTION,272,RC,27201474,CDM,,,,,,both,,,174.0000,26.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,87.00,,,,,,,44.9100,174.0000,percent of total billed charges,Rev 272 $174.00 in Billed Charges at 50% = $87.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE C SECTION,272,RC,27201474,CDM,,,,,,both,,,174.0000,26.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,56.20,,,,,,,44.9100,174.0000,other,32.3% of $174.00 in Billed Charges for Rev 272 = $56.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE C SECTION,272,RC,27201474,CDM,,,,,,both,,,174.0000,26.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,53.42,,,,,,,44.9100,174.0000,other,30.7% of $174.00 in Billed Charges for Rev 272 = $53.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE C SECTION,272,RC,27201474,CDM,,,,,,both,,,174.0000,26.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,56.20,,,,,,,44.9100,174.0000,percent of total billed charges,32.3% of $174.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE C SECTION,272,RC,27201474,CDM,,,,,,both,,,174.0000,26.1000,WELLCARE,WELLCARE MEDICAID,174.00,,,,,,,44.9100,174.0000,percent of total billed charges,100% of $174.00 in Billed Charges for Rev 272 = $174.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON 2-0 MONO PS-2 593H,272,RC,27201428,CDM,,,,,,both,,,24.0000,3.6000,AETNA,AETNA,10.25,,,,,,,6.1900,24.0000,percent of total billed charges,42.7% of $24.00 in Billed Charges for Rev 272 = $10.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON 2-0 MONO PS-2 593H,272,RC,27201428,CDM,,,,,,both,,,24.0000,3.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,16.80,,,,,,,6.1900,24.0000,percent of total billed charges,Rev 272 $24.00 in Billed Charges at 70% = $16.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON 2-0 MONO PS-2 593H,272,RC,27201428,CDM,,,,,,both,,,24.0000,3.6000,CIGNA HEALTHCARE,CIGNA HMO,10.01,,,,,,,6.1900,24.0000,percent of total billed charges,41.7% of $24.00 in Billed Charges for Rev 272 = $10.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON 2-0 MONO PS-2 593H,272,RC,27201428,CDM,,,,,,both,,,24.0000,3.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11.14,,,,,,,6.1900,24.0000,percent of total billed charges,46.4% of $24.00 in Billed Charges for Rev 272 = $11.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON 2-0 MONO PS-2 593H,272,RC,27201428,CDM,,,,,,both,,,24.0000,3.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,10.01,,,,,,,6.1900,24.0000,percent of total billed charges,41.7% of $24.00 in Billed Charges for Rev 272 = $10.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON 2-0 MONO PS-2 593H,272,RC,27201428,CDM,,,,,,both,,,24.0000,3.6000,CIGNA HEALTHCARE,CIGNA PPO,10.01,,,,,,,6.1900,24.0000,percent of total billed charges,41.7% of $24.00 in Billed Charges for Rev 272 = $10.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON 2-0 MONO PS-2 593H,272,RC,27201428,CDM,,,,,,both,,,24.0000,3.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,21.60,,,,,,,6.1900,24.0000,percent of total billed charges,90% of $24.00 in Billed Charges for Rev 272 = $21.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON 2-0 MONO PS-2 593H,272,RC,27201428,CDM,,,,,,both,,,24.0000,3.6000,MEDCOST,MEDCOST VHN,11.42,,,,,,,6.1900,24.0000,percent of total billed charges,47.59% of $24.00 in Billed Charges for Rev 272 = $11.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON 2-0 MONO PS-2 593H,272,RC,27201428,CDM,,,,,,both,,,24.0000,3.6000,SENTARA HEALTH,SENTARA HEALTH,6.19,,,,,,,6.1900,24.0000,percent of total billed charges,25.81% of $24.00 in Billed Charges for Rev 272 = $6.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON 2-0 MONO PS-2 593H,272,RC,27201428,CDM,,,,,,both,,,24.0000,3.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",24.00,,,,,,,6.1900,24.0000,percent of total billed charges,100% of $24.00 in Billed Charges for Rev 272 = $24.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON 2-0 MONO PS-2 593H,272,RC,27201428,CDM,,,,,,both,,,24.0000,3.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,12.00,,,,,,,6.1900,24.0000,percent of total billed charges,Rev 272 $24.00 in Billed Charges at 50% = $12.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON 2-0 MONO PS-2 593H,272,RC,27201428,CDM,,,,,,both,,,24.0000,3.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7.75,,,,,,,6.1900,24.0000,other,32.3% of $24.00 in Billed Charges for Rev 272 = $7.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE ETHILON 2-0 MONO PS-2 593H,272,RC,27201428,CDM,,,,,,both,,,24.0000,3.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,7.37,,,,,,,6.1900,24.0000,other,30.7% of $24.00 in Billed Charges for Rev 272 = $7.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE ETHILON 2-0 MONO PS-2 593H,272,RC,27201428,CDM,,,,,,both,,,24.0000,3.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,7.75,,,,,,,6.1900,24.0000,percent of total billed charges,32.3% of $24.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON 2-0 MONO PS-2 593H,272,RC,27201428,CDM,,,,,,both,,,24.0000,3.6000,WELLCARE,WELLCARE MEDICAID,24.00,,,,,,,6.1900,24.0000,percent of total billed charges,100% of $24.00 in Billed Charges for Rev 272 = $24.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRILL PIN DISPOSABLE 1.5MM AR-4151DS,272,RC,27200002,CDM,,,,,,both,,,18149.2500,2722.3900,AETNA,AETNA,7749.73,,,,,,,4684.3200,18149.2500,percent of total billed charges,"42.7% of $18,149.25 in Billed Charges for Rev 272 = $7,749.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRILL PIN DISPOSABLE 1.5MM AR-4151DS,272,RC,27200002,CDM,,,,,,both,,,18149.2500,2722.3900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,12704.48,,,,,,,4684.3200,18149.2500,percent of total billed charges,"Rev 272 $18,149.25 in Billed Charges at 70% = $12,704.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRILL PIN DISPOSABLE 1.5MM AR-4151DS,272,RC,27200002,CDM,,,,,,both,,,18149.2500,2722.3900,CIGNA HEALTHCARE,CIGNA HMO,7568.24,,,,,,,4684.3200,18149.2500,percent of total billed charges,"41.7% of $18,149.25 in Billed Charges for Rev 272 = $7,568.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRILL PIN DISPOSABLE 1.5MM AR-4151DS,272,RC,27200002,CDM,,,,,,both,,,18149.2500,2722.3900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8421.25,,,,,,,4684.3200,18149.2500,percent of total billed charges,"46.4% of $18,149.25 in Billed Charges for Rev 272 = $8,421.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRILL PIN DISPOSABLE 1.5MM AR-4151DS,272,RC,27200002,CDM,,,,,,both,,,18149.2500,2722.3900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7568.24,,,,,,,4684.3200,18149.2500,percent of total billed charges,"41.7% of $18,149.25 in Billed Charges for Rev 272 = $7,568.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRILL PIN DISPOSABLE 1.5MM AR-4151DS,272,RC,27200002,CDM,,,,,,both,,,18149.2500,2722.3900,CIGNA HEALTHCARE,CIGNA PPO,7568.24,,,,,,,4684.3200,18149.2500,percent of total billed charges,"41.7% of $18,149.25 in Billed Charges for Rev 272 = $7,568.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRILL PIN DISPOSABLE 1.5MM AR-4151DS,272,RC,27200002,CDM,,,,,,both,,,18149.2500,2722.3900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,16334.33,,,,,,,4684.3200,18149.2500,percent of total billed charges,"90% of $18,149.25 in Billed Charges for Rev 272 = $16,334.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRILL PIN DISPOSABLE 1.5MM AR-4151DS,272,RC,27200002,CDM,,,,,,both,,,18149.2500,2722.3900,MEDCOST,MEDCOST VHN,8637.23,,,,,,,4684.3200,18149.2500,percent of total billed charges,"47.59% of $18,149.25 in Billed Charges for Rev 272 = $8,637.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRILL PIN DISPOSABLE 1.5MM AR-4151DS,272,RC,27200002,CDM,,,,,,both,,,18149.2500,2722.3900,SENTARA HEALTH,SENTARA HEALTH,4684.32,,,,,,,4684.3200,18149.2500,percent of total billed charges,"25.81% of $18,149.25 in Billed Charges for Rev 272 = $4,684.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRILL PIN DISPOSABLE 1.5MM AR-4151DS,272,RC,27200002,CDM,,,,,,both,,,18149.2500,2722.3900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",18149.25,,,,,,,4684.3200,18149.2500,percent of total billed charges,"100% of $18,149.25 in Billed Charges for Rev 272 = $18,149.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRILL PIN DISPOSABLE 1.5MM AR-4151DS,272,RC,27200002,CDM,,,,,,both,,,18149.2500,2722.3900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9074.63,,,,,,,4684.3200,18149.2500,percent of total billed charges,"Rev 272 $18,149.25 in Billed Charges at 50% = $9,074.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRILL PIN DISPOSABLE 1.5MM AR-4151DS,272,RC,27200002,CDM,,,,,,both,,,18149.2500,2722.3900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5862.21,,,,,,,4684.3200,18149.2500,other,"32.3% of $18,149.25 in Billed Charges for Rev 272 = $5,862.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT DRILL PIN DISPOSABLE 1.5MM AR-4151DS,272,RC,27200002,CDM,,,,,,both,,,18149.2500,2722.3900,UNITED HEALTHCARE,UHC HERITAGE SELECT,5571.82,,,,,,,4684.3200,18149.2500,other,"30.7% of $18,149.25 in Billed Charges for Rev 272 = $5,571.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT DRILL PIN DISPOSABLE 1.5MM AR-4151DS,272,RC,27200002,CDM,,,,,,both,,,18149.2500,2722.3900,UNITED HEALTHCARE,UNITED HEALTHCARE,5862.21,,,,,,,4684.3200,18149.2500,percent of total billed charges,"32.3% of $18,149.25 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRILL PIN DISPOSABLE 1.5MM AR-4151DS,272,RC,27200002,CDM,,,,,,both,,,18149.2500,2722.3900,WELLCARE,WELLCARE MEDICAID,18149.25,,,,,,,4684.3200,18149.2500,percent of total billed charges,"100% of $18,149.25 in Billed Charges for Rev 272 = $18,149.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,342.2400,51.3400,AETNA,AETNA,146.14,,,,,,,88.3300,342.2400,percent of total billed charges,42.7% of $342.24 in Billed Charges for Rev 272 = $146.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,342.2400,51.3400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,239.57,,,,,,,88.3300,342.2400,percent of total billed charges,Rev 272 $342.24 in Billed Charges at 70% = $239.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,342.2400,51.3400,CIGNA HEALTHCARE,CIGNA HMO,142.71,,,,,,,88.3300,342.2400,percent of total billed charges,41.7% of $342.24 in Billed Charges for Rev 272 = $142.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,342.2400,51.3400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,158.80,,,,,,,88.3300,342.2400,percent of total billed charges,46.4% of $342.24 in Billed Charges for Rev 272 = $158.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,342.2400,51.3400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,142.71,,,,,,,88.3300,342.2400,percent of total billed charges,41.7% of $342.24 in Billed Charges for Rev 272 = $142.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,342.2400,51.3400,CIGNA HEALTHCARE,CIGNA PPO,142.71,,,,,,,88.3300,342.2400,percent of total billed charges,41.7% of $342.24 in Billed Charges for Rev 272 = $142.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,342.2400,51.3400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,308.02,,,,,,,88.3300,342.2400,percent of total billed charges,90% of $342.24 in Billed Charges for Rev 272 = $308.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,342.2400,51.3400,MEDCOST,MEDCOST VHN,162.87,,,,,,,88.3300,342.2400,percent of total billed charges,47.59% of $342.24 in Billed Charges for Rev 272 = $162.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,342.2400,51.3400,SENTARA HEALTH,SENTARA HEALTH,88.33,,,,,,,88.3300,342.2400,percent of total billed charges,25.81% of $342.24 in Billed Charges for Rev 272 = $88.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,342.2400,51.3400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",342.24,,,,,,,88.3300,342.2400,percent of total billed charges,100% of $342.24 in Billed Charges for Rev 272 = $342.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,342.2400,51.3400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,171.12,,,,,,,88.3300,342.2400,percent of total billed charges,Rev 272 $342.24 in Billed Charges at 50% = $171.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,342.2400,51.3400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,110.54,,,,,,,88.3300,342.2400,other,32.3% of $342.24 in Billed Charges for Rev 272 = $110.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,342.2400,51.3400,UNITED HEALTHCARE,UHC HERITAGE SELECT,105.07,,,,,,,88.3300,342.2400,other,30.7% of $342.24 in Billed Charges for Rev 272 = $105.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,342.2400,51.3400,UNITED HEALTHCARE,UNITED HEALTHCARE,110.54,,,,,,,88.3300,342.2400,percent of total billed charges,32.3% of $342.24 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENCORE INFLATION DEVICE,272,RC,27800020,CDM,,,,,,both,,,342.2400,51.3400,WELLCARE,WELLCARE MEDICAID,342.24,,,,,,,88.3300,342.2400,percent of total billed charges,100% of $342.24 in Billed Charges for Rev 272 = $342.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ENDO 2.0MM K-201 GSK,272,RC,27200002,CDM,,,,,,both,,,1292.5400,193.8800,AETNA,AETNA,551.91,,,,,,,333.6000,1292.5400,percent of total billed charges,"42.7% of $1,292.54 in Billed Charges for Rev 272 = $551.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDO 2.0MM K-201 GSK,272,RC,27200002,CDM,,,,,,both,,,1292.5400,193.8800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,904.78,,,,,,,333.6000,1292.5400,percent of total billed charges,"Rev 272 $1,292.54 in Billed Charges at 70% = $904.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDO 2.0MM K-201 GSK,272,RC,27200002,CDM,,,,,,both,,,1292.5400,193.8800,CIGNA HEALTHCARE,CIGNA HMO,538.99,,,,,,,333.6000,1292.5400,percent of total billed charges,"41.7% of $1,292.54 in Billed Charges for Rev 272 = $538.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDO 2.0MM K-201 GSK,272,RC,27200002,CDM,,,,,,both,,,1292.5400,193.8800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,599.74,,,,,,,333.6000,1292.5400,percent of total billed charges,"46.4% of $1,292.54 in Billed Charges for Rev 272 = $599.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDO 2.0MM K-201 GSK,272,RC,27200002,CDM,,,,,,both,,,1292.5400,193.8800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,538.99,,,,,,,333.6000,1292.5400,percent of total billed charges,"41.7% of $1,292.54 in Billed Charges for Rev 272 = $538.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDO 2.0MM K-201 GSK,272,RC,27200002,CDM,,,,,,both,,,1292.5400,193.8800,CIGNA HEALTHCARE,CIGNA PPO,538.99,,,,,,,333.6000,1292.5400,percent of total billed charges,"41.7% of $1,292.54 in Billed Charges for Rev 272 = $538.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDO 2.0MM K-201 GSK,272,RC,27200002,CDM,,,,,,both,,,1292.5400,193.8800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1163.29,,,,,,,333.6000,1292.5400,percent of total billed charges,"90% of $1,292.54 in Billed Charges for Rev 272 = $1,163.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDO 2.0MM K-201 GSK,272,RC,27200002,CDM,,,,,,both,,,1292.5400,193.8800,MEDCOST,MEDCOST VHN,615.12,,,,,,,333.6000,1292.5400,percent of total billed charges,"47.59% of $1,292.54 in Billed Charges for Rev 272 = $615.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDO 2.0MM K-201 GSK,272,RC,27200002,CDM,,,,,,both,,,1292.5400,193.8800,SENTARA HEALTH,SENTARA HEALTH,333.60,,,,,,,333.6000,1292.5400,percent of total billed charges,"25.81% of $1,292.54 in Billed Charges for Rev 272 = $333.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDO 2.0MM K-201 GSK,272,RC,27200002,CDM,,,,,,both,,,1292.5400,193.8800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1292.54,,,,,,,333.6000,1292.5400,percent of total billed charges,"100% of $1,292.54 in Billed Charges for Rev 272 = $1,292.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDO 2.0MM K-201 GSK,272,RC,27200002,CDM,,,,,,both,,,1292.5400,193.8800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,646.27,,,,,,,333.6000,1292.5400,percent of total billed charges,"Rev 272 $1,292.54 in Billed Charges at 50% = $646.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDO 2.0MM K-201 GSK,272,RC,27200002,CDM,,,,,,both,,,1292.5400,193.8800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,417.49,,,,,,,333.6000,1292.5400,other,"32.3% of $1,292.54 in Billed Charges for Rev 272 = $417.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ENDO 2.0MM K-201 GSK,272,RC,27200002,CDM,,,,,,both,,,1292.5400,193.8800,UNITED HEALTHCARE,UHC HERITAGE SELECT,396.81,,,,,,,333.6000,1292.5400,other,"30.7% of $1,292.54 in Billed Charges for Rev 272 = $396.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ENDO 2.0MM K-201 GSK,272,RC,27200002,CDM,,,,,,both,,,1292.5400,193.8800,UNITED HEALTHCARE,UNITED HEALTHCARE,417.49,,,,,,,333.6000,1292.5400,percent of total billed charges,"32.3% of $1,292.54 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDO 2.0MM K-201 GSK,272,RC,27200002,CDM,,,,,,both,,,1292.5400,193.8800,WELLCARE,WELLCARE MEDICAID,1292.54,,,,,,,333.6000,1292.5400,percent of total billed charges,"100% of $1,292.54 in Billed Charges for Rev 272 = $1,292.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOSCOPIC MUCOSAL RESECTION STRAIGHT CAP 9.5-10M,272,RC,,,,,,,,both,,,1822.7000,273.4100,AETNA,AETNA,778.29,,,,,,,470.4400,1822.7000,percent of total billed charges,"42.7% of $1,822.70 in Billed Charges for Rev 272 = $778.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOSCOPIC MUCOSAL RESECTION STRAIGHT CAP 9.5-10M,272,RC,,,,,,,,both,,,1822.7000,273.4100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1275.89,,,,,,,470.4400,1822.7000,percent of total billed charges,"Rev 272 $1,822.70 in Billed Charges at 70% = $1,275.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOSCOPIC MUCOSAL RESECTION STRAIGHT CAP 9.5-10M,272,RC,,,,,,,,both,,,1822.7000,273.4100,CIGNA HEALTHCARE,CIGNA HMO,760.07,,,,,,,470.4400,1822.7000,percent of total billed charges,"41.7% of $1,822.70 in Billed Charges for Rev 272 = $760.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOSCOPIC MUCOSAL RESECTION STRAIGHT CAP 9.5-10M,272,RC,,,,,,,,both,,,1822.7000,273.4100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,845.73,,,,,,,470.4400,1822.7000,percent of total billed charges,"46.4% of $1,822.70 in Billed Charges for Rev 272 = $845.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOSCOPIC MUCOSAL RESECTION STRAIGHT CAP 9.5-10M,272,RC,,,,,,,,both,,,1822.7000,273.4100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,760.07,,,,,,,470.4400,1822.7000,percent of total billed charges,"41.7% of $1,822.70 in Billed Charges for Rev 272 = $760.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOSCOPIC MUCOSAL RESECTION STRAIGHT CAP 9.5-10M,272,RC,,,,,,,,both,,,1822.7000,273.4100,CIGNA HEALTHCARE,CIGNA PPO,760.07,,,,,,,470.4400,1822.7000,percent of total billed charges,"41.7% of $1,822.70 in Billed Charges for Rev 272 = $760.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOSCOPIC MUCOSAL RESECTION STRAIGHT CAP 9.5-10M,272,RC,,,,,,,,both,,,1822.7000,273.4100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1640.43,,,,,,,470.4400,1822.7000,percent of total billed charges,"90% of $1,822.70 in Billed Charges for Rev 272 = $1,640.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOSCOPIC MUCOSAL RESECTION STRAIGHT CAP 9.5-10M,272,RC,,,,,,,,both,,,1822.7000,273.4100,MEDCOST,MEDCOST VHN,867.42,,,,,,,470.4400,1822.7000,percent of total billed charges,"47.59% of $1,822.70 in Billed Charges for Rev 272 = $867.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOSCOPIC MUCOSAL RESECTION STRAIGHT CAP 9.5-10M,272,RC,,,,,,,,both,,,1822.7000,273.4100,SENTARA HEALTH,SENTARA HEALTH,470.44,,,,,,,470.4400,1822.7000,percent of total billed charges,"25.81% of $1,822.70 in Billed Charges for Rev 272 = $470.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOSCOPIC MUCOSAL RESECTION STRAIGHT CAP 9.5-10M,272,RC,,,,,,,,both,,,1822.7000,273.4100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1822.70,,,,,,,470.4400,1822.7000,percent of total billed charges,"100% of $1,822.70 in Billed Charges for Rev 272 = $1,822.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOSCOPIC MUCOSAL RESECTION STRAIGHT CAP 9.5-10M,272,RC,,,,,,,,both,,,1822.7000,273.4100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,911.35,,,,,,,470.4400,1822.7000,percent of total billed charges,"Rev 272 $1,822.70 in Billed Charges at 50% = $911.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOSCOPIC MUCOSAL RESECTION STRAIGHT CAP 9.5-10M,272,RC,,,,,,,,both,,,1822.7000,273.4100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,588.73,,,,,,,470.4400,1822.7000,other,"32.3% of $1,822.70 in Billed Charges for Rev 272 = $588.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ENDOSCOPIC MUCOSAL RESECTION STRAIGHT CAP 9.5-10M,272,RC,,,,,,,,both,,,1822.7000,273.4100,UNITED HEALTHCARE,UHC HERITAGE SELECT,559.57,,,,,,,470.4400,1822.7000,other,"30.7% of $1,822.70 in Billed Charges for Rev 272 = $559.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ENDOSCOPIC MUCOSAL RESECTION STRAIGHT CAP 9.5-10M,272,RC,,,,,,,,both,,,1822.7000,273.4100,UNITED HEALTHCARE,UNITED HEALTHCARE,588.73,,,,,,,470.4400,1822.7000,percent of total billed charges,"32.3% of $1,822.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ENDOSCOPIC MUCOSAL RESECTION STRAIGHT CAP 9.5-10M,272,RC,,,,,,,,both,,,1822.7000,273.4100,WELLCARE,WELLCARE MEDICAID,1822.70,,,,,,,470.4400,1822.7000,percent of total billed charges,"100% of $1,822.70 in Billed Charges for Rev 272 = $1,822.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SUTURE ETHILON CT-2 CX27D,272,RC,27201432,CDM,,,,,,both,,,80.0000,12.0000,AETNA,AETNA,34.16,,,,,,,20.6500,80.0000,percent of total billed charges,42.7% of $80.00 in Billed Charges for Rev 272 = $34.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON CT-2 CX27D,272,RC,27201432,CDM,,,,,,both,,,80.0000,12.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,56.00,,,,,,,20.6500,80.0000,percent of total billed charges,Rev 272 $80.00 in Billed Charges at 70% = $56.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON CT-2 CX27D,272,RC,27201432,CDM,,,,,,both,,,80.0000,12.0000,CIGNA HEALTHCARE,CIGNA HMO,33.36,,,,,,,20.6500,80.0000,percent of total billed charges,41.7% of $80.00 in Billed Charges for Rev 272 = $33.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON CT-2 CX27D,272,RC,27201432,CDM,,,,,,both,,,80.0000,12.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,37.12,,,,,,,20.6500,80.0000,percent of total billed charges,46.4% of $80.00 in Billed Charges for Rev 272 = $37.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON CT-2 CX27D,272,RC,27201432,CDM,,,,,,both,,,80.0000,12.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,33.36,,,,,,,20.6500,80.0000,percent of total billed charges,41.7% of $80.00 in Billed Charges for Rev 272 = $33.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON CT-2 CX27D,272,RC,27201432,CDM,,,,,,both,,,80.0000,12.0000,CIGNA HEALTHCARE,CIGNA PPO,33.36,,,,,,,20.6500,80.0000,percent of total billed charges,41.7% of $80.00 in Billed Charges for Rev 272 = $33.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON CT-2 CX27D,272,RC,27201432,CDM,,,,,,both,,,80.0000,12.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,72.00,,,,,,,20.6500,80.0000,percent of total billed charges,90% of $80.00 in Billed Charges for Rev 272 = $72.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON CT-2 CX27D,272,RC,27201432,CDM,,,,,,both,,,80.0000,12.0000,MEDCOST,MEDCOST VHN,38.07,,,,,,,20.6500,80.0000,percent of total billed charges,47.59% of $80.00 in Billed Charges for Rev 272 = $38.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON CT-2 CX27D,272,RC,27201432,CDM,,,,,,both,,,80.0000,12.0000,SENTARA HEALTH,SENTARA HEALTH,20.65,,,,,,,20.6500,80.0000,percent of total billed charges,25.81% of $80.00 in Billed Charges for Rev 272 = $20.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON CT-2 CX27D,272,RC,27201432,CDM,,,,,,both,,,80.0000,12.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",80.00,,,,,,,20.6500,80.0000,percent of total billed charges,100% of $80.00 in Billed Charges for Rev 272 = $80.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON CT-2 CX27D,272,RC,27201432,CDM,,,,,,both,,,80.0000,12.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,40.00,,,,,,,20.6500,80.0000,percent of total billed charges,Rev 272 $80.00 in Billed Charges at 50% = $40.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON CT-2 CX27D,272,RC,27201432,CDM,,,,,,both,,,80.0000,12.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,25.84,,,,,,,20.6500,80.0000,other,32.3% of $80.00 in Billed Charges for Rev 272 = $25.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE ETHILON CT-2 CX27D,272,RC,27201432,CDM,,,,,,both,,,80.0000,12.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,24.56,,,,,,,20.6500,80.0000,other,30.7% of $80.00 in Billed Charges for Rev 272 = $24.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE ETHILON CT-2 CX27D,272,RC,27201432,CDM,,,,,,both,,,80.0000,12.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,25.84,,,,,,,20.6500,80.0000,percent of total billed charges,32.3% of $80.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE ETHILON CT-2 CX27D,272,RC,27201432,CDM,,,,,,both,,,80.0000,12.0000,WELLCARE,WELLCARE MEDICAID,80.00,,,,,,,20.6500,80.0000,percent of total billed charges,100% of $80.00 in Billed Charges for Rev 272 = $80.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE GROUP,272,RC,27201658,CDM,,,,,,both,,,334.0000,50.1000,AETNA,AETNA,142.62,,,,,,,86.2100,334.0000,percent of total billed charges,42.7% of $334.00 in Billed Charges for Rev 272 = $142.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE GROUP,272,RC,27201658,CDM,,,,,,both,,,334.0000,50.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,233.80,,,,,,,86.2100,334.0000,percent of total billed charges,Rev 272 $334.00 in Billed Charges at 70% = $233.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE GROUP,272,RC,27201658,CDM,,,,,,both,,,334.0000,50.1000,CIGNA HEALTHCARE,CIGNA HMO,139.28,,,,,,,86.2100,334.0000,percent of total billed charges,41.7% of $334.00 in Billed Charges for Rev 272 = $139.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE GROUP,272,RC,27201658,CDM,,,,,,both,,,334.0000,50.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,154.98,,,,,,,86.2100,334.0000,percent of total billed charges,46.4% of $334.00 in Billed Charges for Rev 272 = $154.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE GROUP,272,RC,27201658,CDM,,,,,,both,,,334.0000,50.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,139.28,,,,,,,86.2100,334.0000,percent of total billed charges,41.7% of $334.00 in Billed Charges for Rev 272 = $139.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE GROUP,272,RC,27201658,CDM,,,,,,both,,,334.0000,50.1000,CIGNA HEALTHCARE,CIGNA PPO,139.28,,,,,,,86.2100,334.0000,percent of total billed charges,41.7% of $334.00 in Billed Charges for Rev 272 = $139.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE GROUP,272,RC,27201658,CDM,,,,,,both,,,334.0000,50.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,300.60,,,,,,,86.2100,334.0000,percent of total billed charges,90% of $334.00 in Billed Charges for Rev 272 = $300.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE GROUP,272,RC,27201658,CDM,,,,,,both,,,334.0000,50.1000,MEDCOST,MEDCOST VHN,158.95,,,,,,,86.2100,334.0000,percent of total billed charges,47.59% of $334.00 in Billed Charges for Rev 272 = $158.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE GROUP,272,RC,27201658,CDM,,,,,,both,,,334.0000,50.1000,SENTARA HEALTH,SENTARA HEALTH,86.21,,,,,,,86.2100,334.0000,percent of total billed charges,25.81% of $334.00 in Billed Charges for Rev 272 = $86.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE GROUP,272,RC,27201658,CDM,,,,,,both,,,334.0000,50.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",334.00,,,,,,,86.2100,334.0000,percent of total billed charges,100% of $334.00 in Billed Charges for Rev 272 = $334.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE GROUP,272,RC,27201658,CDM,,,,,,both,,,334.0000,50.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,167.00,,,,,,,86.2100,334.0000,percent of total billed charges,Rev 272 $334.00 in Billed Charges at 50% = $167.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE GROUP,272,RC,27201658,CDM,,,,,,both,,,334.0000,50.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,107.88,,,,,,,86.2100,334.0000,other,32.3% of $334.00 in Billed Charges for Rev 272 = $107.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE GROUP,272,RC,27201658,CDM,,,,,,both,,,334.0000,50.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,102.54,,,,,,,86.2100,334.0000,other,30.7% of $334.00 in Billed Charges for Rev 272 = $102.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUTURE GROUP,272,RC,27201658,CDM,,,,,,both,,,334.0000,50.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,107.88,,,,,,,86.2100,334.0000,percent of total billed charges,32.3% of $334.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUTURE GROUP,272,RC,27201658,CDM,,,,,,both,,,334.0000,50.1000,WELLCARE,WELLCARE MEDICAID,334.00,,,,,,,86.2100,334.0000,percent of total billed charges,100% of $334.00 in Billed Charges for Rev 272 = $334.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HOOK 2MM X 30CM,272,RC,27200002,CDM,,,,,,both,,,4084.1000,612.6200,AETNA,AETNA,1743.91,,,,,,,1054.1100,4084.1000,percent of total billed charges,"42.7% of $4,084.10 in Billed Charges for Rev 272 = $1,743.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOOK 2MM X 30CM,272,RC,27200002,CDM,,,,,,both,,,4084.1000,612.6200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2858.87,,,,,,,1054.1100,4084.1000,percent of total billed charges,"Rev 272 $4,084.10 in Billed Charges at 70% = $2,858.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOOK 2MM X 30CM,272,RC,27200002,CDM,,,,,,both,,,4084.1000,612.6200,CIGNA HEALTHCARE,CIGNA HMO,1703.07,,,,,,,1054.1100,4084.1000,percent of total billed charges,"41.7% of $4,084.10 in Billed Charges for Rev 272 = $1,703.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOOK 2MM X 30CM,272,RC,27200002,CDM,,,,,,both,,,4084.1000,612.6200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1895.02,,,,,,,1054.1100,4084.1000,percent of total billed charges,"46.4% of $4,084.10 in Billed Charges for Rev 272 = $1,895.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOOK 2MM X 30CM,272,RC,27200002,CDM,,,,,,both,,,4084.1000,612.6200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1703.07,,,,,,,1054.1100,4084.1000,percent of total billed charges,"41.7% of $4,084.10 in Billed Charges for Rev 272 = $1,703.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOOK 2MM X 30CM,272,RC,27200002,CDM,,,,,,both,,,4084.1000,612.6200,CIGNA HEALTHCARE,CIGNA PPO,1703.07,,,,,,,1054.1100,4084.1000,percent of total billed charges,"41.7% of $4,084.10 in Billed Charges for Rev 272 = $1,703.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOOK 2MM X 30CM,272,RC,27200002,CDM,,,,,,both,,,4084.1000,612.6200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3675.69,,,,,,,1054.1100,4084.1000,percent of total billed charges,"90% of $4,084.10 in Billed Charges for Rev 272 = $3,675.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOOK 2MM X 30CM,272,RC,27200002,CDM,,,,,,both,,,4084.1000,612.6200,MEDCOST,MEDCOST VHN,1943.62,,,,,,,1054.1100,4084.1000,percent of total billed charges,"47.59% of $4,084.10 in Billed Charges for Rev 272 = $1,943.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOOK 2MM X 30CM,272,RC,27200002,CDM,,,,,,both,,,4084.1000,612.6200,SENTARA HEALTH,SENTARA HEALTH,1054.11,,,,,,,1054.1100,4084.1000,percent of total billed charges,"25.81% of $4,084.10 in Billed Charges for Rev 272 = $1,054.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOOK 2MM X 30CM,272,RC,27200002,CDM,,,,,,both,,,4084.1000,612.6200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4084.10,,,,,,,1054.1100,4084.1000,percent of total billed charges,"100% of $4,084.10 in Billed Charges for Rev 272 = $4,084.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOOK 2MM X 30CM,272,RC,27200002,CDM,,,,,,both,,,4084.1000,612.6200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2042.05,,,,,,,1054.1100,4084.1000,percent of total billed charges,"Rev 272 $4,084.10 in Billed Charges at 50% = $2,042.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOOK 2MM X 30CM,272,RC,27200002,CDM,,,,,,both,,,4084.1000,612.6200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1319.16,,,,,,,1054.1100,4084.1000,other,"32.3% of $4,084.10 in Billed Charges for Rev 272 = $1,319.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HOOK 2MM X 30CM,272,RC,27200002,CDM,,,,,,both,,,4084.1000,612.6200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1253.82,,,,,,,1054.1100,4084.1000,other,"30.7% of $4,084.10 in Billed Charges for Rev 272 = $1,253.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HOOK 2MM X 30CM,272,RC,27200002,CDM,,,,,,both,,,4084.1000,612.6200,UNITED HEALTHCARE,UNITED HEALTHCARE,1319.16,,,,,,,1054.1100,4084.1000,percent of total billed charges,"32.3% of $4,084.10 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOOK 2MM X 30CM,272,RC,27200002,CDM,,,,,,both,,,4084.1000,612.6200,WELLCARE,WELLCARE MEDICAID,4084.10,,,,,,,1054.1100,4084.1000,percent of total billed charges,"100% of $4,084.10 in Billed Charges for Rev 272 = $4,084.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FIRST FRACTURE W/ADVANCED OSTEO INTRODUCER 10/3,272,RC,,,,,,,,both,,,24081.0500,3612.1600,AETNA,AETNA,10282.61,,,,,,,6215.3200,24081.0500,percent of total billed charges,"42.7% of $24,081.05 in Billed Charges for Rev 272 = $10,282.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FIRST FRACTURE W/ADVANCED OSTEO INTRODUCER 10/3,272,RC,,,,,,,,both,,,24081.0500,3612.1600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,16856.74,,,,,,,6215.3200,24081.0500,percent of total billed charges,"Rev 272 $24,081.05 in Billed Charges at 70% = $16,856.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FIRST FRACTURE W/ADVANCED OSTEO INTRODUCER 10/3,272,RC,,,,,,,,both,,,24081.0500,3612.1600,CIGNA HEALTHCARE,CIGNA HMO,10041.80,,,,,,,6215.3200,24081.0500,percent of total billed charges,"41.7% of $24,081.05 in Billed Charges for Rev 272 = $10,041.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FIRST FRACTURE W/ADVANCED OSTEO INTRODUCER 10/3,272,RC,,,,,,,,both,,,24081.0500,3612.1600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11173.61,,,,,,,6215.3200,24081.0500,percent of total billed charges,"46.4% of $24,081.05 in Billed Charges for Rev 272 = $11,173.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FIRST FRACTURE W/ADVANCED OSTEO INTRODUCER 10/3,272,RC,,,,,,,,both,,,24081.0500,3612.1600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,10041.80,,,,,,,6215.3200,24081.0500,percent of total billed charges,"41.7% of $24,081.05 in Billed Charges for Rev 272 = $10,041.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FIRST FRACTURE W/ADVANCED OSTEO INTRODUCER 10/3,272,RC,,,,,,,,both,,,24081.0500,3612.1600,CIGNA HEALTHCARE,CIGNA PPO,10041.80,,,,,,,6215.3200,24081.0500,percent of total billed charges,"41.7% of $24,081.05 in Billed Charges for Rev 272 = $10,041.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FIRST FRACTURE W/ADVANCED OSTEO INTRODUCER 10/3,272,RC,,,,,,,,both,,,24081.0500,3612.1600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,21672.95,,,,,,,6215.3200,24081.0500,percent of total billed charges,"90% of $24,081.05 in Billed Charges for Rev 272 = $21,672.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FIRST FRACTURE W/ADVANCED OSTEO INTRODUCER 10/3,272,RC,,,,,,,,both,,,24081.0500,3612.1600,MEDCOST,MEDCOST VHN,11460.17,,,,,,,6215.3200,24081.0500,percent of total billed charges,"47.59% of $24,081.05 in Billed Charges for Rev 272 = $11,460.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FIRST FRACTURE W/ADVANCED OSTEO INTRODUCER 10/3,272,RC,,,,,,,,both,,,24081.0500,3612.1600,SENTARA HEALTH,SENTARA HEALTH,6215.32,,,,,,,6215.3200,24081.0500,percent of total billed charges,"25.81% of $24,081.05 in Billed Charges for Rev 272 = $6,215.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FIRST FRACTURE W/ADVANCED OSTEO INTRODUCER 10/3,272,RC,,,,,,,,both,,,24081.0500,3612.1600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",24081.05,,,,,,,6215.3200,24081.0500,percent of total billed charges,"100% of $24,081.05 in Billed Charges for Rev 272 = $24,081.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FIRST FRACTURE W/ADVANCED OSTEO INTRODUCER 10/3,272,RC,,,,,,,,both,,,24081.0500,3612.1600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,12040.53,,,,,,,6215.3200,24081.0500,percent of total billed charges,"Rev 272 $24,081.05 in Billed Charges at 50% = $12,040.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FIRST FRACTURE W/ADVANCED OSTEO INTRODUCER 10/3,272,RC,,,,,,,,both,,,24081.0500,3612.1600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7778.18,,,,,,,6215.3200,24081.0500,other,"32.3% of $24,081.05 in Billed Charges for Rev 272 = $7,778.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT FIRST FRACTURE W/ADVANCED OSTEO INTRODUCER 10/3,272,RC,,,,,,,,both,,,24081.0500,3612.1600,UNITED HEALTHCARE,UHC HERITAGE SELECT,7392.88,,,,,,,6215.3200,24081.0500,other,"30.7% of $24,081.05 in Billed Charges for Rev 272 = $7,392.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT FIRST FRACTURE W/ADVANCED OSTEO INTRODUCER 10/3,272,RC,,,,,,,,both,,,24081.0500,3612.1600,UNITED HEALTHCARE,UNITED HEALTHCARE,7778.18,,,,,,,6215.3200,24081.0500,percent of total billed charges,"32.3% of $24,081.05 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FIRST FRACTURE W/ADVANCED OSTEO INTRODUCER 10/3,272,RC,,,,,,,,both,,,24081.0500,3612.1600,WELLCARE,WELLCARE MEDICAID,24081.05,,,,,,,6215.3200,24081.0500,percent of total billed charges,"100% of $24,081.05 in Billed Charges for Rev 272 = $24,081.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FRACTURE FIRST EXPRESS KYPHO KEX152EB,272,RC,27200002,CDM,,,,,,both,,,25927.5000,3889.1300,AETNA,AETNA,11071.04,,,,,,,6691.8900,25927.5000,percent of total billed charges,"42.7% of $25,927.50 in Billed Charges for Rev 272 = $11,071.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FRACTURE FIRST EXPRESS KYPHO KEX152EB,272,RC,27200002,CDM,,,,,,both,,,25927.5000,3889.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,18149.25,,,,,,,6691.8900,25927.5000,percent of total billed charges,"Rev 272 $25,927.50 in Billed Charges at 70% = $18,149.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FRACTURE FIRST EXPRESS KYPHO KEX152EB,272,RC,27200002,CDM,,,,,,both,,,25927.5000,3889.1300,CIGNA HEALTHCARE,CIGNA HMO,10811.77,,,,,,,6691.8900,25927.5000,percent of total billed charges,"41.7% of $25,927.50 in Billed Charges for Rev 272 = $10,811.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FRACTURE FIRST EXPRESS KYPHO KEX152EB,272,RC,27200002,CDM,,,,,,both,,,25927.5000,3889.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12030.36,,,,,,,6691.8900,25927.5000,percent of total billed charges,"46.4% of $25,927.50 in Billed Charges for Rev 272 = $12,030.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FRACTURE FIRST EXPRESS KYPHO KEX152EB,272,RC,27200002,CDM,,,,,,both,,,25927.5000,3889.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,10811.77,,,,,,,6691.8900,25927.5000,percent of total billed charges,"41.7% of $25,927.50 in Billed Charges for Rev 272 = $10,811.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FRACTURE FIRST EXPRESS KYPHO KEX152EB,272,RC,27200002,CDM,,,,,,both,,,25927.5000,3889.1300,CIGNA HEALTHCARE,CIGNA PPO,10811.77,,,,,,,6691.8900,25927.5000,percent of total billed charges,"41.7% of $25,927.50 in Billed Charges for Rev 272 = $10,811.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FRACTURE FIRST EXPRESS KYPHO KEX152EB,272,RC,27200002,CDM,,,,,,both,,,25927.5000,3889.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,23334.75,,,,,,,6691.8900,25927.5000,percent of total billed charges,"90% of $25,927.50 in Billed Charges for Rev 272 = $23,334.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FRACTURE FIRST EXPRESS KYPHO KEX152EB,272,RC,27200002,CDM,,,,,,both,,,25927.5000,3889.1300,MEDCOST,MEDCOST VHN,12338.90,,,,,,,6691.8900,25927.5000,percent of total billed charges,"47.59% of $25,927.50 in Billed Charges for Rev 272 = $12,338.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FRACTURE FIRST EXPRESS KYPHO KEX152EB,272,RC,27200002,CDM,,,,,,both,,,25927.5000,3889.1300,SENTARA HEALTH,SENTARA HEALTH,6691.89,,,,,,,6691.8900,25927.5000,percent of total billed charges,"25.81% of $25,927.50 in Billed Charges for Rev 272 = $6,691.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FRACTURE FIRST EXPRESS KYPHO KEX152EB,272,RC,27200002,CDM,,,,,,both,,,25927.5000,3889.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",25927.50,,,,,,,6691.8900,25927.5000,percent of total billed charges,"100% of $25,927.50 in Billed Charges for Rev 272 = $25,927.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FRACTURE FIRST EXPRESS KYPHO KEX152EB,272,RC,27200002,CDM,,,,,,both,,,25927.5000,3889.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,12963.75,,,,,,,6691.8900,25927.5000,percent of total billed charges,"Rev 272 $25,927.50 in Billed Charges at 50% = $12,963.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FRACTURE FIRST EXPRESS KYPHO KEX152EB,272,RC,27200002,CDM,,,,,,both,,,25927.5000,3889.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,8374.58,,,,,,,6691.8900,25927.5000,other,"32.3% of $25,927.50 in Billed Charges for Rev 272 = $8,374.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT FRACTURE FIRST EXPRESS KYPHO KEX152EB,272,RC,27200002,CDM,,,,,,both,,,25927.5000,3889.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,7959.74,,,,,,,6691.8900,25927.5000,other,"30.7% of $25,927.50 in Billed Charges for Rev 272 = $7,959.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT FRACTURE FIRST EXPRESS KYPHO KEX152EB,272,RC,27200002,CDM,,,,,,both,,,25927.5000,3889.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,8374.58,,,,,,,6691.8900,25927.5000,percent of total billed charges,"32.3% of $25,927.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT FRACTURE FIRST EXPRESS KYPHO KEX152EB,272,RC,27200002,CDM,,,,,,both,,,25927.5000,3889.1300,WELLCARE,WELLCARE MEDICAID,25927.50,,,,,,,6691.8900,25927.5000,percent of total billed charges,"100% of $25,927.50 in Billed Charges for Rev 272 = $25,927.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HYDRATOME WIREGUIDED SINGLE USE PRELOADED,272,RC,27200002,CDM,,,,,,both,,,3689.3800,553.4100,AETNA,AETNA,1575.37,,,,,,,952.2300,3689.3800,percent of total billed charges,"42.7% of $3,689.38 in Billed Charges for Rev 272 = $1,575.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HYDRATOME WIREGUIDED SINGLE USE PRELOADED,272,RC,27200002,CDM,,,,,,both,,,3689.3800,553.4100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2582.57,,,,,,,952.2300,3689.3800,percent of total billed charges,"Rev 272 $3,689.38 in Billed Charges at 70% = $2,582.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HYDRATOME WIREGUIDED SINGLE USE PRELOADED,272,RC,27200002,CDM,,,,,,both,,,3689.3800,553.4100,CIGNA HEALTHCARE,CIGNA HMO,1538.47,,,,,,,952.2300,3689.3800,percent of total billed charges,"41.7% of $3,689.38 in Billed Charges for Rev 272 = $1,538.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HYDRATOME WIREGUIDED SINGLE USE PRELOADED,272,RC,27200002,CDM,,,,,,both,,,3689.3800,553.4100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1711.87,,,,,,,952.2300,3689.3800,percent of total billed charges,"46.4% of $3,689.38 in Billed Charges for Rev 272 = $1,711.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HYDRATOME WIREGUIDED SINGLE USE PRELOADED,272,RC,27200002,CDM,,,,,,both,,,3689.3800,553.4100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1538.47,,,,,,,952.2300,3689.3800,percent of total billed charges,"41.7% of $3,689.38 in Billed Charges for Rev 272 = $1,538.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HYDRATOME WIREGUIDED SINGLE USE PRELOADED,272,RC,27200002,CDM,,,,,,both,,,3689.3800,553.4100,CIGNA HEALTHCARE,CIGNA PPO,1538.47,,,,,,,952.2300,3689.3800,percent of total billed charges,"41.7% of $3,689.38 in Billed Charges for Rev 272 = $1,538.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HYDRATOME WIREGUIDED SINGLE USE PRELOADED,272,RC,27200002,CDM,,,,,,both,,,3689.3800,553.4100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3320.44,,,,,,,952.2300,3689.3800,percent of total billed charges,"90% of $3,689.38 in Billed Charges for Rev 272 = $3,320.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HYDRATOME WIREGUIDED SINGLE USE PRELOADED,272,RC,27200002,CDM,,,,,,both,,,3689.3800,553.4100,MEDCOST,MEDCOST VHN,1755.78,,,,,,,952.2300,3689.3800,percent of total billed charges,"47.59% of $3,689.38 in Billed Charges for Rev 272 = $1,755.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HYDRATOME WIREGUIDED SINGLE USE PRELOADED,272,RC,27200002,CDM,,,,,,both,,,3689.3800,553.4100,SENTARA HEALTH,SENTARA HEALTH,952.23,,,,,,,952.2300,3689.3800,percent of total billed charges,"25.81% of $3,689.38 in Billed Charges for Rev 272 = $952.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HYDRATOME WIREGUIDED SINGLE USE PRELOADED,272,RC,27200002,CDM,,,,,,both,,,3689.3800,553.4100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3689.38,,,,,,,952.2300,3689.3800,percent of total billed charges,"100% of $3,689.38 in Billed Charges for Rev 272 = $3,689.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HYDRATOME WIREGUIDED SINGLE USE PRELOADED,272,RC,27200002,CDM,,,,,,both,,,3689.3800,553.4100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1844.69,,,,,,,952.2300,3689.3800,percent of total billed charges,"Rev 272 $3,689.38 in Billed Charges at 50% = $1,844.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HYDRATOME WIREGUIDED SINGLE USE PRELOADED,272,RC,27200002,CDM,,,,,,both,,,3689.3800,553.4100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1191.67,,,,,,,952.2300,3689.3800,other,"32.3% of $3,689.38 in Billed Charges for Rev 272 = $1,191.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HYDRATOME WIREGUIDED SINGLE USE PRELOADED,272,RC,27200002,CDM,,,,,,both,,,3689.3800,553.4100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1132.64,,,,,,,952.2300,3689.3800,other,"30.7% of $3,689.38 in Billed Charges for Rev 272 = $1,132.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HYDRATOME WIREGUIDED SINGLE USE PRELOADED,272,RC,27200002,CDM,,,,,,both,,,3689.3800,553.4100,UNITED HEALTHCARE,UNITED HEALTHCARE,1191.67,,,,,,,952.2300,3689.3800,percent of total billed charges,"32.3% of $3,689.38 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HYDRATOME WIREGUIDED SINGLE USE PRELOADED,272,RC,27200002,CDM,,,,,,both,,,3689.3800,553.4100,WELLCARE,WELLCARE MEDICAID,3689.38,,,,,,,952.2300,3689.3800,percent of total billed charges,"100% of $3,689.38 in Billed Charges for Rev 272 = $3,689.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BASKET STONE RETRIEVAL GRASPIT 2.6 X 120 320-401,272,RC,,,,,,,,both,,,2338.6600,350.8000,AETNA,AETNA,998.61,,,,,,,603.6100,2338.6600,percent of total billed charges,"42.7% of $2,338.66 in Billed Charges for Rev 272 = $998.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BASKET STONE RETRIEVAL GRASPIT 2.6 X 120 320-401,272,RC,,,,,,,,both,,,2338.6600,350.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1637.06,,,,,,,603.6100,2338.6600,percent of total billed charges,"Rev 272 $2,338.66 in Billed Charges at 70% = $1,637.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BASKET STONE RETRIEVAL GRASPIT 2.6 X 120 320-401,272,RC,,,,,,,,both,,,2338.6600,350.8000,CIGNA HEALTHCARE,CIGNA HMO,975.22,,,,,,,603.6100,2338.6600,percent of total billed charges,"41.7% of $2,338.66 in Billed Charges for Rev 272 = $975.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BASKET STONE RETRIEVAL GRASPIT 2.6 X 120 320-401,272,RC,,,,,,,,both,,,2338.6600,350.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1085.14,,,,,,,603.6100,2338.6600,percent of total billed charges,"46.4% of $2,338.66 in Billed Charges for Rev 272 = $1,085.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BASKET STONE RETRIEVAL GRASPIT 2.6 X 120 320-401,272,RC,,,,,,,,both,,,2338.6600,350.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,975.22,,,,,,,603.6100,2338.6600,percent of total billed charges,"41.7% of $2,338.66 in Billed Charges for Rev 272 = $975.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BASKET STONE RETRIEVAL GRASPIT 2.6 X 120 320-401,272,RC,,,,,,,,both,,,2338.6600,350.8000,CIGNA HEALTHCARE,CIGNA PPO,975.22,,,,,,,603.6100,2338.6600,percent of total billed charges,"41.7% of $2,338.66 in Billed Charges for Rev 272 = $975.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BASKET STONE RETRIEVAL GRASPIT 2.6 X 120 320-401,272,RC,,,,,,,,both,,,2338.6600,350.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2104.79,,,,,,,603.6100,2338.6600,percent of total billed charges,"90% of $2,338.66 in Billed Charges for Rev 272 = $2,104.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BASKET STONE RETRIEVAL GRASPIT 2.6 X 120 320-401,272,RC,,,,,,,,both,,,2338.6600,350.8000,MEDCOST,MEDCOST VHN,1112.97,,,,,,,603.6100,2338.6600,percent of total billed charges,"47.59% of $2,338.66 in Billed Charges for Rev 272 = $1,112.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BASKET STONE RETRIEVAL GRASPIT 2.6 X 120 320-401,272,RC,,,,,,,,both,,,2338.6600,350.8000,SENTARA HEALTH,SENTARA HEALTH,603.61,,,,,,,603.6100,2338.6600,percent of total billed charges,"25.81% of $2,338.66 in Billed Charges for Rev 272 = $603.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BASKET STONE RETRIEVAL GRASPIT 2.6 X 120 320-401,272,RC,,,,,,,,both,,,2338.6600,350.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2338.66,,,,,,,603.6100,2338.6600,percent of total billed charges,"100% of $2,338.66 in Billed Charges for Rev 272 = $2,338.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BASKET STONE RETRIEVAL GRASPIT 2.6 X 120 320-401,272,RC,,,,,,,,both,,,2338.6600,350.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1169.33,,,,,,,603.6100,2338.6600,percent of total billed charges,"Rev 272 $2,338.66 in Billed Charges at 50% = $1,169.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BASKET STONE RETRIEVAL GRASPIT 2.6 X 120 320-401,272,RC,,,,,,,,both,,,2338.6600,350.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,755.39,,,,,,,603.6100,2338.6600,other,"32.3% of $2,338.66 in Billed Charges for Rev 272 = $755.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A BASKET STONE RETRIEVAL GRASPIT 2.6 X 120 320-401,272,RC,,,,,,,,both,,,2338.6600,350.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,717.97,,,,,,,603.6100,2338.6600,other,"30.7% of $2,338.66 in Billed Charges for Rev 272 = $717.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A BASKET STONE RETRIEVAL GRASPIT 2.6 X 120 320-401,272,RC,,,,,,,,both,,,2338.6600,350.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,755.39,,,,,,,603.6100,2338.6600,percent of total billed charges,"32.3% of $2,338.66 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BASKET STONE RETRIEVAL GRASPIT 2.6 X 120 320-401,272,RC,,,,,,,,both,,,2338.6600,350.8000,WELLCARE,WELLCARE MEDICAID,2338.66,,,,,,,603.6100,2338.6600,percent of total billed charges,"100% of $2,338.66 in Billed Charges for Rev 272 = $2,338.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILATING MICRO 12MM 296-031-32,272,RC,,,,,,,,both,,,1161.5500,174.2300,AETNA,AETNA,495.98,,,,,,,299.8000,1161.5500,percent of total billed charges,"42.7% of $1,161.55 in Billed Charges for Rev 272 = $495.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILATING MICRO 12MM 296-031-32,272,RC,,,,,,,,both,,,1161.5500,174.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,813.09,,,,,,,299.8000,1161.5500,percent of total billed charges,"Rev 272 $1,161.55 in Billed Charges at 70% = $813.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILATING MICRO 12MM 296-031-32,272,RC,,,,,,,,both,,,1161.5500,174.2300,CIGNA HEALTHCARE,CIGNA HMO,484.37,,,,,,,299.8000,1161.5500,percent of total billed charges,"41.7% of $1,161.55 in Billed Charges for Rev 272 = $484.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILATING MICRO 12MM 296-031-32,272,RC,,,,,,,,both,,,1161.5500,174.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,538.96,,,,,,,299.8000,1161.5500,percent of total billed charges,"46.4% of $1,161.55 in Billed Charges for Rev 272 = $538.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILATING MICRO 12MM 296-031-32,272,RC,,,,,,,,both,,,1161.5500,174.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,484.37,,,,,,,299.8000,1161.5500,percent of total billed charges,"41.7% of $1,161.55 in Billed Charges for Rev 272 = $484.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILATING MICRO 12MM 296-031-32,272,RC,,,,,,,,both,,,1161.5500,174.2300,CIGNA HEALTHCARE,CIGNA PPO,484.37,,,,,,,299.8000,1161.5500,percent of total billed charges,"41.7% of $1,161.55 in Billed Charges for Rev 272 = $484.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILATING MICRO 12MM 296-031-32,272,RC,,,,,,,,both,,,1161.5500,174.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1045.40,,,,,,,299.8000,1161.5500,percent of total billed charges,"90% of $1,161.55 in Billed Charges for Rev 272 = $1,045.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILATING MICRO 12MM 296-031-32,272,RC,,,,,,,,both,,,1161.5500,174.2300,MEDCOST,MEDCOST VHN,552.78,,,,,,,299.8000,1161.5500,percent of total billed charges,"47.59% of $1,161.55 in Billed Charges for Rev 272 = $552.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILATING MICRO 12MM 296-031-32,272,RC,,,,,,,,both,,,1161.5500,174.2300,SENTARA HEALTH,SENTARA HEALTH,299.80,,,,,,,299.8000,1161.5500,percent of total billed charges,"25.81% of $1,161.55 in Billed Charges for Rev 272 = $299.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILATING MICRO 12MM 296-031-32,272,RC,,,,,,,,both,,,1161.5500,174.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1161.55,,,,,,,299.8000,1161.5500,percent of total billed charges,"100% of $1,161.55 in Billed Charges for Rev 272 = $1,161.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILATING MICRO 12MM 296-031-32,272,RC,,,,,,,,both,,,1161.5500,174.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,580.78,,,,,,,299.8000,1161.5500,percent of total billed charges,"Rev 272 $1,161.55 in Billed Charges at 50% = $580.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILATING MICRO 12MM 296-031-32,272,RC,,,,,,,,both,,,1161.5500,174.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,375.18,,,,,,,299.8000,1161.5500,other,"32.3% of $1,161.55 in Billed Charges for Rev 272 = $375.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A BLADE OSCILATING MICRO 12MM 296-031-32,272,RC,,,,,,,,both,,,1161.5500,174.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,356.60,,,,,,,299.8000,1161.5500,other,"30.7% of $1,161.55 in Billed Charges for Rev 272 = $356.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A BLADE OSCILATING MICRO 12MM 296-031-32,272,RC,,,,,,,,both,,,1161.5500,174.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,375.18,,,,,,,299.8000,1161.5500,percent of total billed charges,"32.3% of $1,161.55 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILATING MICRO 12MM 296-031-32,272,RC,,,,,,,,both,,,1161.5500,174.2300,WELLCARE,WELLCARE MEDICAID,1161.55,,,,,,,299.8000,1161.5500,percent of total billed charges,"100% of $1,161.55 in Billed Charges for Rev 272 = $1,161.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE PEAK PLASMA 3.0 PLUS,272,RC,27200002,CDM,,,,,,both,,,6051.4800,907.7200,AETNA,AETNA,2583.98,,,,,,,1561.8900,6051.4800,percent of total billed charges,"42.7% of $6,051.48 in Billed Charges for Rev 272 = $2,583.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE PEAK PLASMA 3.0 PLUS,272,RC,27200002,CDM,,,,,,both,,,6051.4800,907.7200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4236.04,,,,,,,1561.8900,6051.4800,percent of total billed charges,"Rev 272 $6,051.48 in Billed Charges at 70% = $4,236.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE PEAK PLASMA 3.0 PLUS,272,RC,27200002,CDM,,,,,,both,,,6051.4800,907.7200,CIGNA HEALTHCARE,CIGNA HMO,2523.47,,,,,,,1561.8900,6051.4800,percent of total billed charges,"41.7% of $6,051.48 in Billed Charges for Rev 272 = $2,523.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE PEAK PLASMA 3.0 PLUS,272,RC,27200002,CDM,,,,,,both,,,6051.4800,907.7200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2807.89,,,,,,,1561.8900,6051.4800,percent of total billed charges,"46.4% of $6,051.48 in Billed Charges for Rev 272 = $2,807.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE PEAK PLASMA 3.0 PLUS,272,RC,27200002,CDM,,,,,,both,,,6051.4800,907.7200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2523.47,,,,,,,1561.8900,6051.4800,percent of total billed charges,"41.7% of $6,051.48 in Billed Charges for Rev 272 = $2,523.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE PEAK PLASMA 3.0 PLUS,272,RC,27200002,CDM,,,,,,both,,,6051.4800,907.7200,CIGNA HEALTHCARE,CIGNA PPO,2523.47,,,,,,,1561.8900,6051.4800,percent of total billed charges,"41.7% of $6,051.48 in Billed Charges for Rev 272 = $2,523.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE PEAK PLASMA 3.0 PLUS,272,RC,27200002,CDM,,,,,,both,,,6051.4800,907.7200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5446.33,,,,,,,1561.8900,6051.4800,percent of total billed charges,"90% of $6,051.48 in Billed Charges for Rev 272 = $5,446.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE PEAK PLASMA 3.0 PLUS,272,RC,27200002,CDM,,,,,,both,,,6051.4800,907.7200,MEDCOST,MEDCOST VHN,2879.90,,,,,,,1561.8900,6051.4800,percent of total billed charges,"47.59% of $6,051.48 in Billed Charges for Rev 272 = $2,879.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE PEAK PLASMA 3.0 PLUS,272,RC,27200002,CDM,,,,,,both,,,6051.4800,907.7200,SENTARA HEALTH,SENTARA HEALTH,1561.89,,,,,,,1561.8900,6051.4800,percent of total billed charges,"25.81% of $6,051.48 in Billed Charges for Rev 272 = $1,561.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE PEAK PLASMA 3.0 PLUS,272,RC,27200002,CDM,,,,,,both,,,6051.4800,907.7200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6051.48,,,,,,,1561.8900,6051.4800,percent of total billed charges,"100% of $6,051.48 in Billed Charges for Rev 272 = $6,051.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE PEAK PLASMA 3.0 PLUS,272,RC,27200002,CDM,,,,,,both,,,6051.4800,907.7200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3025.74,,,,,,,1561.8900,6051.4800,percent of total billed charges,"Rev 272 $6,051.48 in Billed Charges at 50% = $3,025.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE PEAK PLASMA 3.0 PLUS,272,RC,27200002,CDM,,,,,,both,,,6051.4800,907.7200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1954.63,,,,,,,1561.8900,6051.4800,other,"32.3% of $6,051.48 in Billed Charges for Rev 272 = $1,954.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A BLADE PEAK PLASMA 3.0 PLUS,272,RC,27200002,CDM,,,,,,both,,,6051.4800,907.7200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1857.80,,,,,,,1561.8900,6051.4800,other,"30.7% of $6,051.48 in Billed Charges for Rev 272 = $1,857.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A BLADE PEAK PLASMA 3.0 PLUS,272,RC,27200002,CDM,,,,,,both,,,6051.4800,907.7200,UNITED HEALTHCARE,UNITED HEALTHCARE,1954.63,,,,,,,1561.8900,6051.4800,percent of total billed charges,"32.3% of $6,051.48 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE PEAK PLASMA 3.0 PLUS,272,RC,27200002,CDM,,,,,,both,,,6051.4800,907.7200,WELLCARE,WELLCARE MEDICAID,6051.48,,,,,,,1561.8900,6051.4800,percent of total billed charges,"100% of $6,051.48 in Billed Charges for Rev 272 = $6,051.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VCF AFFIRM PREMIER 15P,272,RC,27200002,CDM,,,,,,both,,,22868.0600,3430.2100,AETNA,AETNA,9764.66,,,,,,,5902.2500,22868.0600,percent of total billed charges,"42.7% of $22,868.06 in Billed Charges for Rev 272 = $9,764.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VCF AFFIRM PREMIER 15P,272,RC,27200002,CDM,,,,,,both,,,22868.0600,3430.2100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,16007.64,,,,,,,5902.2500,22868.0600,percent of total billed charges,"Rev 272 $22,868.06 in Billed Charges at 70% = $16,007.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VCF AFFIRM PREMIER 15P,272,RC,27200002,CDM,,,,,,both,,,22868.0600,3430.2100,CIGNA HEALTHCARE,CIGNA HMO,9535.98,,,,,,,5902.2500,22868.0600,percent of total billed charges,"41.7% of $22,868.06 in Billed Charges for Rev 272 = $9,535.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VCF AFFIRM PREMIER 15P,272,RC,27200002,CDM,,,,,,both,,,22868.0600,3430.2100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10610.78,,,,,,,5902.2500,22868.0600,percent of total billed charges,"46.4% of $22,868.06 in Billed Charges for Rev 272 = $10,610.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VCF AFFIRM PREMIER 15P,272,RC,27200002,CDM,,,,,,both,,,22868.0600,3430.2100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9535.98,,,,,,,5902.2500,22868.0600,percent of total billed charges,"41.7% of $22,868.06 in Billed Charges for Rev 272 = $9,535.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VCF AFFIRM PREMIER 15P,272,RC,27200002,CDM,,,,,,both,,,22868.0600,3430.2100,CIGNA HEALTHCARE,CIGNA PPO,9535.98,,,,,,,5902.2500,22868.0600,percent of total billed charges,"41.7% of $22,868.06 in Billed Charges for Rev 272 = $9,535.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VCF AFFIRM PREMIER 15P,272,RC,27200002,CDM,,,,,,both,,,22868.0600,3430.2100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,20581.25,,,,,,,5902.2500,22868.0600,percent of total billed charges,"90% of $22,868.06 in Billed Charges for Rev 272 = $20,581.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VCF AFFIRM PREMIER 15P,272,RC,27200002,CDM,,,,,,both,,,22868.0600,3430.2100,MEDCOST,MEDCOST VHN,10882.91,,,,,,,5902.2500,22868.0600,percent of total billed charges,"47.59% of $22,868.06 in Billed Charges for Rev 272 = $10,882.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VCF AFFIRM PREMIER 15P,272,RC,27200002,CDM,,,,,,both,,,22868.0600,3430.2100,SENTARA HEALTH,SENTARA HEALTH,5902.25,,,,,,,5902.2500,22868.0600,percent of total billed charges,"25.81% of $22,868.06 in Billed Charges for Rev 272 = $5,902.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VCF AFFIRM PREMIER 15P,272,RC,27200002,CDM,,,,,,both,,,22868.0600,3430.2100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",22868.06,,,,,,,5902.2500,22868.0600,percent of total billed charges,"100% of $22,868.06 in Billed Charges for Rev 272 = $22,868.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VCF AFFIRM PREMIER 15P,272,RC,27200002,CDM,,,,,,both,,,22868.0600,3430.2100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11434.03,,,,,,,5902.2500,22868.0600,percent of total billed charges,"Rev 272 $22,868.06 in Billed Charges at 50% = $11,434.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VCF AFFIRM PREMIER 15P,272,RC,27200002,CDM,,,,,,both,,,22868.0600,3430.2100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7386.38,,,,,,,5902.2500,22868.0600,other,"32.3% of $22,868.06 in Billed Charges for Rev 272 = $7,386.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT VCF AFFIRM PREMIER 15P,272,RC,27200002,CDM,,,,,,both,,,22868.0600,3430.2100,UNITED HEALTHCARE,UHC HERITAGE SELECT,7020.49,,,,,,,5902.2500,22868.0600,other,"30.7% of $22,868.06 in Billed Charges for Rev 272 = $7,020.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT VCF AFFIRM PREMIER 15P,272,RC,27200002,CDM,,,,,,both,,,22868.0600,3430.2100,UNITED HEALTHCARE,UNITED HEALTHCARE,7386.38,,,,,,,5902.2500,22868.0600,percent of total billed charges,"32.3% of $22,868.06 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT VCF AFFIRM PREMIER 15P,272,RC,27200002,CDM,,,,,,both,,,22868.0600,3430.2100,WELLCARE,WELLCARE MEDICAID,22868.06,,,,,,,5902.2500,22868.0600,percent of total billed charges,"100% of $22,868.06 in Billed Charges for Rev 272 = $22,868.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW CRESCENTIC 29MM,272,RC,,,,,,,,both,,,1344.0800,201.6100,AETNA,AETNA,573.92,,,,,,,346.9100,1344.0800,percent of total billed charges,"42.7% of $1,344.08 in Billed Charges for Rev 272 = $573.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW CRESCENTIC 29MM,272,RC,,,,,,,,both,,,1344.0800,201.6100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,940.86,,,,,,,346.9100,1344.0800,percent of total billed charges,"Rev 272 $1,344.08 in Billed Charges at 70% = $940.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW CRESCENTIC 29MM,272,RC,,,,,,,,both,,,1344.0800,201.6100,CIGNA HEALTHCARE,CIGNA HMO,560.48,,,,,,,346.9100,1344.0800,percent of total billed charges,"41.7% of $1,344.08 in Billed Charges for Rev 272 = $560.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW CRESCENTIC 29MM,272,RC,,,,,,,,both,,,1344.0800,201.6100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,623.65,,,,,,,346.9100,1344.0800,percent of total billed charges,"46.4% of $1,344.08 in Billed Charges for Rev 272 = $623.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW CRESCENTIC 29MM,272,RC,,,,,,,,both,,,1344.0800,201.6100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,560.48,,,,,,,346.9100,1344.0800,percent of total billed charges,"41.7% of $1,344.08 in Billed Charges for Rev 272 = $560.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW CRESCENTIC 29MM,272,RC,,,,,,,,both,,,1344.0800,201.6100,CIGNA HEALTHCARE,CIGNA PPO,560.48,,,,,,,346.9100,1344.0800,percent of total billed charges,"41.7% of $1,344.08 in Billed Charges for Rev 272 = $560.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW CRESCENTIC 29MM,272,RC,,,,,,,,both,,,1344.0800,201.6100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1209.67,,,,,,,346.9100,1344.0800,percent of total billed charges,"90% of $1,344.08 in Billed Charges for Rev 272 = $1,209.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW CRESCENTIC 29MM,272,RC,,,,,,,,both,,,1344.0800,201.6100,MEDCOST,MEDCOST VHN,639.65,,,,,,,346.9100,1344.0800,percent of total billed charges,"47.59% of $1,344.08 in Billed Charges for Rev 272 = $639.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW CRESCENTIC 29MM,272,RC,,,,,,,,both,,,1344.0800,201.6100,SENTARA HEALTH,SENTARA HEALTH,346.91,,,,,,,346.9100,1344.0800,percent of total billed charges,"25.81% of $1,344.08 in Billed Charges for Rev 272 = $346.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW CRESCENTIC 29MM,272,RC,,,,,,,,both,,,1344.0800,201.6100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1344.08,,,,,,,346.9100,1344.0800,percent of total billed charges,"100% of $1,344.08 in Billed Charges for Rev 272 = $1,344.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW CRESCENTIC 29MM,272,RC,,,,,,,,both,,,1344.0800,201.6100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,672.04,,,,,,,346.9100,1344.0800,percent of total billed charges,"Rev 272 $1,344.08 in Billed Charges at 50% = $672.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW CRESCENTIC 29MM,272,RC,,,,,,,,both,,,1344.0800,201.6100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,434.14,,,,,,,346.9100,1344.0800,other,"32.3% of $1,344.08 in Billed Charges for Rev 272 = $434.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A BLADE SAW CRESCENTIC 29MM,272,RC,,,,,,,,both,,,1344.0800,201.6100,UNITED HEALTHCARE,UHC HERITAGE SELECT,412.63,,,,,,,346.9100,1344.0800,other,"30.7% of $1,344.08 in Billed Charges for Rev 272 = $412.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A BLADE SAW CRESCENTIC 29MM,272,RC,,,,,,,,both,,,1344.0800,201.6100,UNITED HEALTHCARE,UNITED HEALTHCARE,434.14,,,,,,,346.9100,1344.0800,percent of total billed charges,"32.3% of $1,344.08 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW CRESCENTIC 29MM,272,RC,,,,,,,,both,,,1344.0800,201.6100,WELLCARE,WELLCARE MEDICAID,1344.08,,,,,,,346.9100,1344.0800,percent of total billed charges,"100% of $1,344.08 in Billed Charges for Rev 272 = $1,344.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW SAGITTAL 6125-097-090,272,RC,27200002,CDM,,,,,,both,,,480.7000,72.1100,AETNA,AETNA,205.26,,,,,,,124.0700,480.7000,percent of total billed charges,42.7% of $480.70 in Billed Charges for Rev 272 = $205.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE SAW SAGITTAL 6125-097-090,272,RC,27200002,CDM,,,,,,both,,,480.7000,72.1100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,336.49,,,,,,,124.0700,480.7000,percent of total billed charges,Rev 272 $480.70 in Billed Charges at 70% = $336.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE SAW SAGITTAL 6125-097-090,272,RC,27200002,CDM,,,,,,both,,,480.7000,72.1100,CIGNA HEALTHCARE,CIGNA HMO,200.45,,,,,,,124.0700,480.7000,percent of total billed charges,41.7% of $480.70 in Billed Charges for Rev 272 = $200.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE SAW SAGITTAL 6125-097-090,272,RC,27200002,CDM,,,,,,both,,,480.7000,72.1100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,223.04,,,,,,,124.0700,480.7000,percent of total billed charges,46.4% of $480.70 in Billed Charges for Rev 272 = $223.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE SAW SAGITTAL 6125-097-090,272,RC,27200002,CDM,,,,,,both,,,480.7000,72.1100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,200.45,,,,,,,124.0700,480.7000,percent of total billed charges,41.7% of $480.70 in Billed Charges for Rev 272 = $200.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE SAW SAGITTAL 6125-097-090,272,RC,27200002,CDM,,,,,,both,,,480.7000,72.1100,CIGNA HEALTHCARE,CIGNA PPO,200.45,,,,,,,124.0700,480.7000,percent of total billed charges,41.7% of $480.70 in Billed Charges for Rev 272 = $200.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE SAW SAGITTAL 6125-097-090,272,RC,27200002,CDM,,,,,,both,,,480.7000,72.1100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,432.63,,,,,,,124.0700,480.7000,percent of total billed charges,90% of $480.70 in Billed Charges for Rev 272 = $432.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE SAW SAGITTAL 6125-097-090,272,RC,27200002,CDM,,,,,,both,,,480.7000,72.1100,MEDCOST,MEDCOST VHN,228.77,,,,,,,124.0700,480.7000,percent of total billed charges,47.59% of $480.70 in Billed Charges for Rev 272 = $228.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE SAW SAGITTAL 6125-097-090,272,RC,27200002,CDM,,,,,,both,,,480.7000,72.1100,SENTARA HEALTH,SENTARA HEALTH,124.07,,,,,,,124.0700,480.7000,percent of total billed charges,25.81% of $480.70 in Billed Charges for Rev 272 = $124.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE SAW SAGITTAL 6125-097-090,272,RC,27200002,CDM,,,,,,both,,,480.7000,72.1100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",480.70,,,,,,,124.0700,480.7000,percent of total billed charges,100% of $480.70 in Billed Charges for Rev 272 = $480.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE SAW SAGITTAL 6125-097-090,272,RC,27200002,CDM,,,,,,both,,,480.7000,72.1100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,240.35,,,,,,,124.0700,480.7000,percent of total billed charges,Rev 272 $480.70 in Billed Charges at 50% = $240.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE SAW SAGITTAL 6125-097-090,272,RC,27200002,CDM,,,,,,both,,,480.7000,72.1100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,155.27,,,,,,,124.0700,480.7000,other,32.3% of $480.70 in Billed Charges for Rev 272 = $155.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
I/A BLADE SAW SAGITTAL 6125-097-090,272,RC,27200002,CDM,,,,,,both,,,480.7000,72.1100,UNITED HEALTHCARE,UHC HERITAGE SELECT,147.57,,,,,,,124.0700,480.7000,other,30.7% of $480.70 in Billed Charges for Rev 272 = $147.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
I/A BLADE SAW SAGITTAL 6125-097-090,272,RC,27200002,CDM,,,,,,both,,,480.7000,72.1100,UNITED HEALTHCARE,UNITED HEALTHCARE,155.27,,,,,,,124.0700,480.7000,percent of total billed charges,32.3% of $480.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE SAW SAGITTAL 6125-097-090,272,RC,27200002,CDM,,,,,,both,,,480.7000,72.1100,WELLCARE,WELLCARE MEDICAID,480.70,,,,,,,124.0700,480.7000,percent of total billed charges,100% of $480.70 in Billed Charges for Rev 272 = $480.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KNIFE BAYONET METRX,272,RC,27200002,CDM,,,,,,both,,,1620.9900,243.1500,AETNA,AETNA,692.16,,,,,,,418.3800,1620.9900,percent of total billed charges,"42.7% of $1,620.99 in Billed Charges for Rev 272 = $692.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE BAYONET METRX,272,RC,27200002,CDM,,,,,,both,,,1620.9900,243.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1134.69,,,,,,,418.3800,1620.9900,percent of total billed charges,"Rev 272 $1,620.99 in Billed Charges at 70% = $1,134.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE BAYONET METRX,272,RC,27200002,CDM,,,,,,both,,,1620.9900,243.1500,CIGNA HEALTHCARE,CIGNA HMO,675.95,,,,,,,418.3800,1620.9900,percent of total billed charges,"41.7% of $1,620.99 in Billed Charges for Rev 272 = $675.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE BAYONET METRX,272,RC,27200002,CDM,,,,,,both,,,1620.9900,243.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,752.14,,,,,,,418.3800,1620.9900,percent of total billed charges,"46.4% of $1,620.99 in Billed Charges for Rev 272 = $752.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE BAYONET METRX,272,RC,27200002,CDM,,,,,,both,,,1620.9900,243.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,675.95,,,,,,,418.3800,1620.9900,percent of total billed charges,"41.7% of $1,620.99 in Billed Charges for Rev 272 = $675.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE BAYONET METRX,272,RC,27200002,CDM,,,,,,both,,,1620.9900,243.1500,CIGNA HEALTHCARE,CIGNA PPO,675.95,,,,,,,418.3800,1620.9900,percent of total billed charges,"41.7% of $1,620.99 in Billed Charges for Rev 272 = $675.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE BAYONET METRX,272,RC,27200002,CDM,,,,,,both,,,1620.9900,243.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1458.89,,,,,,,418.3800,1620.9900,percent of total billed charges,"90% of $1,620.99 in Billed Charges for Rev 272 = $1,458.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE BAYONET METRX,272,RC,27200002,CDM,,,,,,both,,,1620.9900,243.1500,MEDCOST,MEDCOST VHN,771.43,,,,,,,418.3800,1620.9900,percent of total billed charges,"47.59% of $1,620.99 in Billed Charges for Rev 272 = $771.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE BAYONET METRX,272,RC,27200002,CDM,,,,,,both,,,1620.9900,243.1500,SENTARA HEALTH,SENTARA HEALTH,418.38,,,,,,,418.3800,1620.9900,percent of total billed charges,"25.81% of $1,620.99 in Billed Charges for Rev 272 = $418.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE BAYONET METRX,272,RC,27200002,CDM,,,,,,both,,,1620.9900,243.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1620.99,,,,,,,418.3800,1620.9900,percent of total billed charges,"100% of $1,620.99 in Billed Charges for Rev 272 = $1,620.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE BAYONET METRX,272,RC,27200002,CDM,,,,,,both,,,1620.9900,243.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,810.50,,,,,,,418.3800,1620.9900,percent of total billed charges,"Rev 272 $1,620.99 in Billed Charges at 50% = $810.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE BAYONET METRX,272,RC,27200002,CDM,,,,,,both,,,1620.9900,243.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,523.58,,,,,,,418.3800,1620.9900,other,"32.3% of $1,620.99 in Billed Charges for Rev 272 = $523.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KNIFE BAYONET METRX,272,RC,27200002,CDM,,,,,,both,,,1620.9900,243.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,497.64,,,,,,,418.3800,1620.9900,other,"30.7% of $1,620.99 in Billed Charges for Rev 272 = $497.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KNIFE BAYONET METRX,272,RC,27200002,CDM,,,,,,both,,,1620.9900,243.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,523.58,,,,,,,418.3800,1620.9900,percent of total billed charges,"32.3% of $1,620.99 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE BAYONET METRX,272,RC,27200002,CDM,,,,,,both,,,1620.9900,243.1500,WELLCARE,WELLCARE MEDICAID,1620.99,,,,,,,418.3800,1620.9900,percent of total billed charges,"100% of $1,620.99 in Billed Charges for Rev 272 = $1,620.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2195.2100,329.2800,AETNA,AETNA,937.35,,,,,,,566.5800,2195.2100,percent of total billed charges,"42.7% of $2,195.21 in Billed Charges for Rev 272 = $937.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2195.2100,329.2800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1536.65,,,,,,,566.5800,2195.2100,percent of total billed charges,"Rev 272 $2,195.21 in Billed Charges at 70% = $1,536.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2195.2100,329.2800,CIGNA HEALTHCARE,CIGNA HMO,915.40,,,,,,,566.5800,2195.2100,percent of total billed charges,"41.7% of $2,195.21 in Billed Charges for Rev 272 = $915.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2195.2100,329.2800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1018.58,,,,,,,566.5800,2195.2100,percent of total billed charges,"46.4% of $2,195.21 in Billed Charges for Rev 272 = $1,018.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2195.2100,329.2800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,915.40,,,,,,,566.5800,2195.2100,percent of total billed charges,"41.7% of $2,195.21 in Billed Charges for Rev 272 = $915.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2195.2100,329.2800,CIGNA HEALTHCARE,CIGNA PPO,915.40,,,,,,,566.5800,2195.2100,percent of total billed charges,"41.7% of $2,195.21 in Billed Charges for Rev 272 = $915.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2195.2100,329.2800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1975.69,,,,,,,566.5800,2195.2100,percent of total billed charges,"90% of $2,195.21 in Billed Charges for Rev 272 = $1,975.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2195.2100,329.2800,MEDCOST,MEDCOST VHN,1044.70,,,,,,,566.5800,2195.2100,percent of total billed charges,"47.59% of $2,195.21 in Billed Charges for Rev 272 = $1,044.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2195.2100,329.2800,SENTARA HEALTH,SENTARA HEALTH,566.58,,,,,,,566.5800,2195.2100,percent of total billed charges,"25.81% of $2,195.21 in Billed Charges for Rev 272 = $566.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2195.2100,329.2800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2195.21,,,,,,,566.5800,2195.2100,percent of total billed charges,"100% of $2,195.21 in Billed Charges for Rev 272 = $2,195.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2195.2100,329.2800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1097.61,,,,,,,566.5800,2195.2100,percent of total billed charges,"Rev 272 $2,195.21 in Billed Charges at 50% = $1,097.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2195.2100,329.2800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,709.05,,,,,,,566.5800,2195.2100,other,"32.3% of $2,195.21 in Billed Charges for Rev 272 = $709.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2195.2100,329.2800,UNITED HEALTHCARE,UHC HERITAGE SELECT,673.93,,,,,,,566.5800,2195.2100,other,"30.7% of $2,195.21 in Billed Charges for Rev 272 = $673.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2195.2100,329.2800,UNITED HEALTHCARE,UNITED HEALTHCARE,709.05,,,,,,,566.5800,2195.2100,percent of total billed charges,"32.3% of $2,195.21 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2195.2100,329.2800,WELLCARE,WELLCARE MEDICAID,2195.21,,,,,,,566.5800,2195.2100,percent of total billed charges,"100% of $2,195.21 in Billed Charges for Rev 272 = $2,195.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2483.8500,372.5800,AETNA,AETNA,1060.60,,,,,,,641.0800,2483.8500,percent of total billed charges,"42.7% of $2,483.85 in Billed Charges for Rev 272 = $1,060.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2483.8500,372.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1738.70,,,,,,,641.0800,2483.8500,percent of total billed charges,"Rev 272 $2,483.85 in Billed Charges at 70% = $1,738.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2483.8500,372.5800,CIGNA HEALTHCARE,CIGNA HMO,1035.77,,,,,,,641.0800,2483.8500,percent of total billed charges,"41.7% of $2,483.85 in Billed Charges for Rev 272 = $1,035.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2483.8500,372.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1152.51,,,,,,,641.0800,2483.8500,percent of total billed charges,"46.4% of $2,483.85 in Billed Charges for Rev 272 = $1,152.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2483.8500,372.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1035.77,,,,,,,641.0800,2483.8500,percent of total billed charges,"41.7% of $2,483.85 in Billed Charges for Rev 272 = $1,035.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2483.8500,372.5800,CIGNA HEALTHCARE,CIGNA PPO,1035.77,,,,,,,641.0800,2483.8500,percent of total billed charges,"41.7% of $2,483.85 in Billed Charges for Rev 272 = $1,035.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2483.8500,372.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2235.47,,,,,,,641.0800,2483.8500,percent of total billed charges,"90% of $2,483.85 in Billed Charges for Rev 272 = $2,235.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2483.8500,372.5800,MEDCOST,MEDCOST VHN,1182.06,,,,,,,641.0800,2483.8500,percent of total billed charges,"47.59% of $2,483.85 in Billed Charges for Rev 272 = $1,182.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2483.8500,372.5800,SENTARA HEALTH,SENTARA HEALTH,641.08,,,,,,,641.0800,2483.8500,percent of total billed charges,"25.81% of $2,483.85 in Billed Charges for Rev 272 = $641.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2483.8500,372.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2483.85,,,,,,,641.0800,2483.8500,percent of total billed charges,"100% of $2,483.85 in Billed Charges for Rev 272 = $2,483.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2483.8500,372.5800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1241.93,,,,,,,641.0800,2483.8500,percent of total billed charges,"Rev 272 $2,483.85 in Billed Charges at 50% = $1,241.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2483.8500,372.5800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,802.28,,,,,,,641.0800,2483.8500,other,"32.3% of $2,483.85 in Billed Charges for Rev 272 = $802.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2483.8500,372.5800,UNITED HEALTHCARE,UHC HERITAGE SELECT,762.54,,,,,,,641.0800,2483.8500,other,"30.7% of $2,483.85 in Billed Charges for Rev 272 = $762.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2483.8500,372.5800,UNITED HEALTHCARE,UNITED HEALTHCARE,802.28,,,,,,,641.0800,2483.8500,percent of total billed charges,"32.3% of $2,483.85 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE COLD RND BLADE URET,272,RC,27200002,CDM,,,,,,both,,,2483.8500,372.5800,WELLCARE,WELLCARE MEDICAID,2483.85,,,,,,,641.0800,2483.8500,percent of total billed charges,"100% of $2,483.85 in Billed Charges for Rev 272 = $2,483.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE CONTROL SONOPET,272,RC,,,,,,,,both,,,7129.6300,1069.4400,AETNA,AETNA,3044.35,,,,,,,1840.1600,7129.6300,percent of total billed charges,"42.7% of $7,129.63 in Billed Charges for Rev 272 = $3,044.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE CONTROL SONOPET,272,RC,,,,,,,,both,,,7129.6300,1069.4400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4990.74,,,,,,,1840.1600,7129.6300,percent of total billed charges,"Rev 272 $7,129.63 in Billed Charges at 70% = $4,990.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE CONTROL SONOPET,272,RC,,,,,,,,both,,,7129.6300,1069.4400,CIGNA HEALTHCARE,CIGNA HMO,2973.06,,,,,,,1840.1600,7129.6300,percent of total billed charges,"41.7% of $7,129.63 in Billed Charges for Rev 272 = $2,973.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE CONTROL SONOPET,272,RC,,,,,,,,both,,,7129.6300,1069.4400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3308.15,,,,,,,1840.1600,7129.6300,percent of total billed charges,"46.4% of $7,129.63 in Billed Charges for Rev 272 = $3,308.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE CONTROL SONOPET,272,RC,,,,,,,,both,,,7129.6300,1069.4400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2973.06,,,,,,,1840.1600,7129.6300,percent of total billed charges,"41.7% of $7,129.63 in Billed Charges for Rev 272 = $2,973.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE CONTROL SONOPET,272,RC,,,,,,,,both,,,7129.6300,1069.4400,CIGNA HEALTHCARE,CIGNA PPO,2973.06,,,,,,,1840.1600,7129.6300,percent of total billed charges,"41.7% of $7,129.63 in Billed Charges for Rev 272 = $2,973.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE CONTROL SONOPET,272,RC,,,,,,,,both,,,7129.6300,1069.4400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6416.67,,,,,,,1840.1600,7129.6300,percent of total billed charges,"90% of $7,129.63 in Billed Charges for Rev 272 = $6,416.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE CONTROL SONOPET,272,RC,,,,,,,,both,,,7129.6300,1069.4400,MEDCOST,MEDCOST VHN,3392.99,,,,,,,1840.1600,7129.6300,percent of total billed charges,"47.59% of $7,129.63 in Billed Charges for Rev 272 = $3,392.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE CONTROL SONOPET,272,RC,,,,,,,,both,,,7129.6300,1069.4400,SENTARA HEALTH,SENTARA HEALTH,1840.16,,,,,,,1840.1600,7129.6300,percent of total billed charges,"25.81% of $7,129.63 in Billed Charges for Rev 272 = $1,840.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE CONTROL SONOPET,272,RC,,,,,,,,both,,,7129.6300,1069.4400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7129.63,,,,,,,1840.1600,7129.6300,percent of total billed charges,"100% of $7,129.63 in Billed Charges for Rev 272 = $7,129.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE CONTROL SONOPET,272,RC,,,,,,,,both,,,7129.6300,1069.4400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3564.82,,,,,,,1840.1600,7129.6300,percent of total billed charges,"Rev 272 $7,129.63 in Billed Charges at 50% = $3,564.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE CONTROL SONOPET,272,RC,,,,,,,,both,,,7129.6300,1069.4400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2302.87,,,,,,,1840.1600,7129.6300,other,"32.3% of $7,129.63 in Billed Charges for Rev 272 = $2,302.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KNIFE CONTROL SONOPET,272,RC,,,,,,,,both,,,7129.6300,1069.4400,UNITED HEALTHCARE,UHC HERITAGE SELECT,2188.80,,,,,,,1840.1600,7129.6300,other,"30.7% of $7,129.63 in Billed Charges for Rev 272 = $2,188.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KNIFE CONTROL SONOPET,272,RC,,,,,,,,both,,,7129.6300,1069.4400,UNITED HEALTHCARE,UNITED HEALTHCARE,2302.87,,,,,,,1840.1600,7129.6300,percent of total billed charges,"32.3% of $7,129.63 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE CONTROL SONOPET,272,RC,,,,,,,,both,,,7129.6300,1069.4400,WELLCARE,WELLCARE MEDICAID,7129.63,,,,,,,1840.1600,7129.6300,percent of total billed charges,"100% of $7,129.63 in Billed Charges for Rev 272 = $7,129.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUAL 0.3MM X 2.0MM,272,RC,,,,,,,,both,,,5379.9600,806.9900,AETNA,AETNA,2297.24,,,,,,,1388.5700,5379.9600,percent of total billed charges,"42.7% of $5,379.96 in Billed Charges for Rev 272 = $2,297.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUAL 0.3MM X 2.0MM,272,RC,,,,,,,,both,,,5379.9600,806.9900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3765.97,,,,,,,1388.5700,5379.9600,percent of total billed charges,"Rev 272 $5,379.96 in Billed Charges at 70% = $3,765.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUAL 0.3MM X 2.0MM,272,RC,,,,,,,,both,,,5379.9600,806.9900,CIGNA HEALTHCARE,CIGNA HMO,2243.44,,,,,,,1388.5700,5379.9600,percent of total billed charges,"41.7% of $5,379.96 in Billed Charges for Rev 272 = $2,243.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUAL 0.3MM X 2.0MM,272,RC,,,,,,,,both,,,5379.9600,806.9900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2496.30,,,,,,,1388.5700,5379.9600,percent of total billed charges,"46.4% of $5,379.96 in Billed Charges for Rev 272 = $2,496.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUAL 0.3MM X 2.0MM,272,RC,,,,,,,,both,,,5379.9600,806.9900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2243.44,,,,,,,1388.5700,5379.9600,percent of total billed charges,"41.7% of $5,379.96 in Billed Charges for Rev 272 = $2,243.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUAL 0.3MM X 2.0MM,272,RC,,,,,,,,both,,,5379.9600,806.9900,CIGNA HEALTHCARE,CIGNA PPO,2243.44,,,,,,,1388.5700,5379.9600,percent of total billed charges,"41.7% of $5,379.96 in Billed Charges for Rev 272 = $2,243.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUAL 0.3MM X 2.0MM,272,RC,,,,,,,,both,,,5379.9600,806.9900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4841.96,,,,,,,1388.5700,5379.9600,percent of total billed charges,"90% of $5,379.96 in Billed Charges for Rev 272 = $4,841.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUAL 0.3MM X 2.0MM,272,RC,,,,,,,,both,,,5379.9600,806.9900,MEDCOST,MEDCOST VHN,2560.32,,,,,,,1388.5700,5379.9600,percent of total billed charges,"47.59% of $5,379.96 in Billed Charges for Rev 272 = $2,560.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUAL 0.3MM X 2.0MM,272,RC,,,,,,,,both,,,5379.9600,806.9900,SENTARA HEALTH,SENTARA HEALTH,1388.57,,,,,,,1388.5700,5379.9600,percent of total billed charges,"25.81% of $5,379.96 in Billed Charges for Rev 272 = $1,388.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUAL 0.3MM X 2.0MM,272,RC,,,,,,,,both,,,5379.9600,806.9900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5379.96,,,,,,,1388.5700,5379.9600,percent of total billed charges,"100% of $5,379.96 in Billed Charges for Rev 272 = $5,379.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUAL 0.3MM X 2.0MM,272,RC,,,,,,,,both,,,5379.9600,806.9900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2689.98,,,,,,,1388.5700,5379.9600,percent of total billed charges,"Rev 272 $5,379.96 in Billed Charges at 50% = $2,689.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUAL 0.3MM X 2.0MM,272,RC,,,,,,,,both,,,5379.9600,806.9900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1737.73,,,,,,,1388.5700,5379.9600,other,"32.3% of $5,379.96 in Billed Charges for Rev 272 = $1,737.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KNIFE ELECTROSURGICAL DUAL 0.3MM X 2.0MM,272,RC,,,,,,,,both,,,5379.9600,806.9900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1651.65,,,,,,,1388.5700,5379.9600,other,"30.7% of $5,379.96 in Billed Charges for Rev 272 = $1,651.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KNIFE ELECTROSURGICAL DUAL 0.3MM X 2.0MM,272,RC,,,,,,,,both,,,5379.9600,806.9900,UNITED HEALTHCARE,UNITED HEALTHCARE,1737.73,,,,,,,1388.5700,5379.9600,percent of total billed charges,"32.3% of $5,379.96 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUAL 0.3MM X 2.0MM,272,RC,,,,,,,,both,,,5379.9600,806.9900,WELLCARE,WELLCARE MEDICAID,5379.96,,,,,,,1388.5700,5379.9600,percent of total billed charges,"100% of $5,379.96 in Billed Charges for Rev 272 = $5,379.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER BODY REPAIR,272,RC,,,,,,,,both,,,1485.1300,222.7700,AETNA,AETNA,634.15,,,,,,,383.3100,1485.1300,percent of total billed charges,"42.7% of $1,485.13 in Billed Charges for Rev 272 = $634.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER BODY REPAIR,272,RC,,,,,,,,both,,,1485.1300,222.7700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1039.59,,,,,,,383.3100,1485.1300,percent of total billed charges,"Rev 272 $1,485.13 in Billed Charges at 70% = $1,039.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER BODY REPAIR,272,RC,,,,,,,,both,,,1485.1300,222.7700,CIGNA HEALTHCARE,CIGNA HMO,619.30,,,,,,,383.3100,1485.1300,percent of total billed charges,"41.7% of $1,485.13 in Billed Charges for Rev 272 = $619.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER BODY REPAIR,272,RC,,,,,,,,both,,,1485.1300,222.7700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,689.10,,,,,,,383.3100,1485.1300,percent of total billed charges,"46.4% of $1,485.13 in Billed Charges for Rev 272 = $689.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER BODY REPAIR,272,RC,,,,,,,,both,,,1485.1300,222.7700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,619.30,,,,,,,383.3100,1485.1300,percent of total billed charges,"41.7% of $1,485.13 in Billed Charges for Rev 272 = $619.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER BODY REPAIR,272,RC,,,,,,,,both,,,1485.1300,222.7700,CIGNA HEALTHCARE,CIGNA PPO,619.30,,,,,,,383.3100,1485.1300,percent of total billed charges,"41.7% of $1,485.13 in Billed Charges for Rev 272 = $619.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER BODY REPAIR,272,RC,,,,,,,,both,,,1485.1300,222.7700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1336.62,,,,,,,383.3100,1485.1300,percent of total billed charges,"90% of $1,485.13 in Billed Charges for Rev 272 = $1,336.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER BODY REPAIR,272,RC,,,,,,,,both,,,1485.1300,222.7700,MEDCOST,MEDCOST VHN,706.77,,,,,,,383.3100,1485.1300,percent of total billed charges,"47.59% of $1,485.13 in Billed Charges for Rev 272 = $706.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER BODY REPAIR,272,RC,,,,,,,,both,,,1485.1300,222.7700,SENTARA HEALTH,SENTARA HEALTH,383.31,,,,,,,383.3100,1485.1300,percent of total billed charges,"25.81% of $1,485.13 in Billed Charges for Rev 272 = $383.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER BODY REPAIR,272,RC,,,,,,,,both,,,1485.1300,222.7700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1485.13,,,,,,,383.3100,1485.1300,percent of total billed charges,"100% of $1,485.13 in Billed Charges for Rev 272 = $1,485.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER BODY REPAIR,272,RC,,,,,,,,both,,,1485.1300,222.7700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,742.57,,,,,,,383.3100,1485.1300,percent of total billed charges,"Rev 272 $1,485.13 in Billed Charges at 50% = $742.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER BODY REPAIR,272,RC,,,,,,,,both,,,1485.1300,222.7700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,479.70,,,,,,,383.3100,1485.1300,other,"32.3% of $1,485.13 in Billed Charges for Rev 272 = $479.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT CATHETER BODY REPAIR,272,RC,,,,,,,,both,,,1485.1300,222.7700,UNITED HEALTHCARE,UHC HERITAGE SELECT,455.93,,,,,,,383.3100,1485.1300,other,"30.7% of $1,485.13 in Billed Charges for Rev 272 = $455.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT CATHETER BODY REPAIR,272,RC,,,,,,,,both,,,1485.1300,222.7700,UNITED HEALTHCARE,UNITED HEALTHCARE,479.70,,,,,,,383.3100,1485.1300,percent of total billed charges,"32.3% of $1,485.13 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER BODY REPAIR,272,RC,,,,,,,,both,,,1485.1300,222.7700,WELLCARE,WELLCARE MEDICAID,1485.13,,,,,,,383.3100,1485.1300,percent of total billed charges,"100% of $1,485.13 in Billed Charges for Rev 272 = $1,485.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER ICY TEMP MGT,272,RC,,,,,,,,both,,,9903.8900,1485.5800,AETNA,AETNA,4228.96,,,,,,,2556.1900,9903.8900,percent of total billed charges,"42.7% of $9,903.89 in Billed Charges for Rev 272 = $4,228.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER ICY TEMP MGT,272,RC,,,,,,,,both,,,9903.8900,1485.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6932.72,,,,,,,2556.1900,9903.8900,percent of total billed charges,"Rev 272 $9,903.89 in Billed Charges at 70% = $6,932.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER ICY TEMP MGT,272,RC,,,,,,,,both,,,9903.8900,1485.5800,CIGNA HEALTHCARE,CIGNA HMO,4129.92,,,,,,,2556.1900,9903.8900,percent of total billed charges,"41.7% of $9,903.89 in Billed Charges for Rev 272 = $4,129.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER ICY TEMP MGT,272,RC,,,,,,,,both,,,9903.8900,1485.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4595.41,,,,,,,2556.1900,9903.8900,percent of total billed charges,"46.4% of $9,903.89 in Billed Charges for Rev 272 = $4,595.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER ICY TEMP MGT,272,RC,,,,,,,,both,,,9903.8900,1485.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4129.92,,,,,,,2556.1900,9903.8900,percent of total billed charges,"41.7% of $9,903.89 in Billed Charges for Rev 272 = $4,129.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER ICY TEMP MGT,272,RC,,,,,,,,both,,,9903.8900,1485.5800,CIGNA HEALTHCARE,CIGNA PPO,4129.92,,,,,,,2556.1900,9903.8900,percent of total billed charges,"41.7% of $9,903.89 in Billed Charges for Rev 272 = $4,129.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER ICY TEMP MGT,272,RC,,,,,,,,both,,,9903.8900,1485.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8913.50,,,,,,,2556.1900,9903.8900,percent of total billed charges,"90% of $9,903.89 in Billed Charges for Rev 272 = $8,913.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER ICY TEMP MGT,272,RC,,,,,,,,both,,,9903.8900,1485.5800,MEDCOST,MEDCOST VHN,4713.26,,,,,,,2556.1900,9903.8900,percent of total billed charges,"47.59% of $9,903.89 in Billed Charges for Rev 272 = $4,713.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER ICY TEMP MGT,272,RC,,,,,,,,both,,,9903.8900,1485.5800,SENTARA HEALTH,SENTARA HEALTH,2556.19,,,,,,,2556.1900,9903.8900,percent of total billed charges,"25.81% of $9,903.89 in Billed Charges for Rev 272 = $2,556.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER ICY TEMP MGT,272,RC,,,,,,,,both,,,9903.8900,1485.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9903.89,,,,,,,2556.1900,9903.8900,percent of total billed charges,"100% of $9,903.89 in Billed Charges for Rev 272 = $9,903.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER ICY TEMP MGT,272,RC,,,,,,,,both,,,9903.8900,1485.5800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4951.95,,,,,,,2556.1900,9903.8900,percent of total billed charges,"Rev 272 $9,903.89 in Billed Charges at 50% = $4,951.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER ICY TEMP MGT,272,RC,,,,,,,,both,,,9903.8900,1485.5800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3198.96,,,,,,,2556.1900,9903.8900,other,"32.3% of $9,903.89 in Billed Charges for Rev 272 = $3,198.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT CATHETER ICY TEMP MGT,272,RC,,,,,,,,both,,,9903.8900,1485.5800,UNITED HEALTHCARE,UHC HERITAGE SELECT,3040.49,,,,,,,2556.1900,9903.8900,other,"30.7% of $9,903.89 in Billed Charges for Rev 272 = $3,040.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT CATHETER ICY TEMP MGT,272,RC,,,,,,,,both,,,9903.8900,1485.5800,UNITED HEALTHCARE,UNITED HEALTHCARE,3198.96,,,,,,,2556.1900,9903.8900,percent of total billed charges,"32.3% of $9,903.89 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER ICY TEMP MGT,272,RC,,,,,,,,both,,,9903.8900,1485.5800,WELLCARE,WELLCARE MEDICAID,9903.89,,,,,,,2556.1900,9903.8900,percent of total billed charges,"100% of $9,903.89 in Billed Charges for Rev 272 = $9,903.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CONVEINIENCE XENON MASK,270,RC,,,,,,,,both,,,172630.4800,25894.5700,AETNA,AETNA,73713.22,,,,,,,44555.9300,172630.4800,percent of total billed charges,"42.7% of $172,630.48 in Billed Charges for Rev 270 = $73,713.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CONVEINIENCE XENON MASK,270,RC,,,,,,,,both,,,172630.4800,25894.5700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,120841.34,,,,,,,44555.9300,172630.4800,percent of total billed charges,"Rev 270 $172,630.48 in Billed Charges at 70% = $120,841.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CONVEINIENCE XENON MASK,270,RC,,,,,,,,both,,,172630.4800,25894.5700,CIGNA HEALTHCARE,CIGNA HMO,71986.91,,,,,,,44555.9300,172630.4800,percent of total billed charges,"41.7% of $172,630.48 in Billed Charges for Rev 270 = $71,986.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CONVEINIENCE XENON MASK,270,RC,,,,,,,,both,,,172630.4800,25894.5700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,80100.54,,,,,,,44555.9300,172630.4800,percent of total billed charges,"46.4% of $172,630.48 in Billed Charges for Rev 270 = $80,100.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CONVEINIENCE XENON MASK,270,RC,,,,,,,,both,,,172630.4800,25894.5700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,71986.91,,,,,,,44555.9300,172630.4800,percent of total billed charges,"41.7% of $172,630.48 in Billed Charges for Rev 270 = $71,986.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CONVEINIENCE XENON MASK,270,RC,,,,,,,,both,,,172630.4800,25894.5700,CIGNA HEALTHCARE,CIGNA PPO,71986.91,,,,,,,44555.9300,172630.4800,percent of total billed charges,"41.7% of $172,630.48 in Billed Charges for Rev 270 = $71,986.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CONVEINIENCE XENON MASK,270,RC,,,,,,,,both,,,172630.4800,25894.5700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,155367.43,,,,,,,44555.9300,172630.4800,percent of total billed charges,"90% of $172,630.48 in Billed Charges for Rev 270 = $155,367.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CONVEINIENCE XENON MASK,270,RC,,,,,,,,both,,,172630.4800,25894.5700,MEDCOST,MEDCOST VHN,82154.85,,,,,,,44555.9300,172630.4800,percent of total billed charges,"47.59% of $172,630.48 in Billed Charges for Rev 270 = $82,154.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CONVEINIENCE XENON MASK,270,RC,,,,,,,,both,,,172630.4800,25894.5700,SENTARA HEALTH,SENTARA HEALTH,44555.93,,,,,,,44555.9300,172630.4800,percent of total billed charges,"25.81% of $172,630.48 in Billed Charges for Rev 270 = $44,555.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CONVEINIENCE XENON MASK,270,RC,,,,,,,,both,,,172630.4800,25894.5700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",172630.48,,,,,,,44555.9300,172630.4800,percent of total billed charges,"100% of $172,630.48 in Billed Charges for Rev 270 = $172,630.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CONVEINIENCE XENON MASK,270,RC,,,,,,,,both,,,172630.4800,25894.5700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,86315.24,,,,,,,44555.9300,172630.4800,percent of total billed charges,"Rev 270 $172,630.48 in Billed Charges at 50% = $86,315.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CONVEINIENCE XENON MASK,270,RC,,,,,,,,both,,,172630.4800,25894.5700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,55759.65,,,,,,,44555.9300,172630.4800,other,"32.3% of $172,630.48 in Billed Charges for Rev 270 = $55,759.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT CONVEINIENCE XENON MASK,270,RC,,,,,,,,both,,,172630.4800,25894.5700,UNITED HEALTHCARE,UHC HERITAGE SELECT,52997.56,,,,,,,44555.9300,172630.4800,other,"30.7% of $172,630.48 in Billed Charges for Rev 270 = $52,997.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT CONVEINIENCE XENON MASK,270,RC,,,,,,,,both,,,172630.4800,25894.5700,UNITED HEALTHCARE,UNITED HEALTHCARE,55759.65,,,,,,,44555.9300,172630.4800,percent of total billed charges,"32.3% of $172,630.48 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CONVEINIENCE XENON MASK,270,RC,,,,,,,,both,,,172630.4800,25894.5700,WELLCARE,WELLCARE MEDICAID,172630.48,,,,,,,44555.9300,172630.4800,percent of total billed charges,"100% of $172,630.48 in Billed Charges for Rev 270 = $172,630.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 2.70MM,272,RC,,,,,,,,both,,,17957.5900,2693.6400,AETNA,AETNA,7667.89,,,,,,,4634.8500,17957.5900,percent of total billed charges,"42.7% of $17,957.59 in Billed Charges for Rev 272 = $7,667.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 2.70MM,272,RC,,,,,,,,both,,,17957.5900,2693.6400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,12570.31,,,,,,,4634.8500,17957.5900,percent of total billed charges,"Rev 272 $17,957.59 in Billed Charges at 70% = $12,570.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 2.70MM,272,RC,,,,,,,,both,,,17957.5900,2693.6400,CIGNA HEALTHCARE,CIGNA HMO,7488.32,,,,,,,4634.8500,17957.5900,percent of total billed charges,"41.7% of $17,957.59 in Billed Charges for Rev 272 = $7,488.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 2.70MM,272,RC,,,,,,,,both,,,17957.5900,2693.6400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8332.32,,,,,,,4634.8500,17957.5900,percent of total billed charges,"46.4% of $17,957.59 in Billed Charges for Rev 272 = $8,332.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 2.70MM,272,RC,,,,,,,,both,,,17957.5900,2693.6400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7488.32,,,,,,,4634.8500,17957.5900,percent of total billed charges,"41.7% of $17,957.59 in Billed Charges for Rev 272 = $7,488.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 2.70MM,272,RC,,,,,,,,both,,,17957.5900,2693.6400,CIGNA HEALTHCARE,CIGNA PPO,7488.32,,,,,,,4634.8500,17957.5900,percent of total billed charges,"41.7% of $17,957.59 in Billed Charges for Rev 272 = $7,488.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 2.70MM,272,RC,,,,,,,,both,,,17957.5900,2693.6400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,16161.83,,,,,,,4634.8500,17957.5900,percent of total billed charges,"90% of $17,957.59 in Billed Charges for Rev 272 = $16,161.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 2.70MM,272,RC,,,,,,,,both,,,17957.5900,2693.6400,MEDCOST,MEDCOST VHN,8546.02,,,,,,,4634.8500,17957.5900,percent of total billed charges,"47.59% of $17,957.59 in Billed Charges for Rev 272 = $8,546.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 2.70MM,272,RC,,,,,,,,both,,,17957.5900,2693.6400,SENTARA HEALTH,SENTARA HEALTH,4634.85,,,,,,,4634.8500,17957.5900,percent of total billed charges,"25.81% of $17,957.59 in Billed Charges for Rev 272 = $4,634.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 2.70MM,272,RC,,,,,,,,both,,,17957.5900,2693.6400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",17957.59,,,,,,,4634.8500,17957.5900,percent of total billed charges,"100% of $17,957.59 in Billed Charges for Rev 272 = $17,957.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 2.70MM,272,RC,,,,,,,,both,,,17957.5900,2693.6400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8978.80,,,,,,,4634.8500,17957.5900,percent of total billed charges,"Rev 272 $17,957.59 in Billed Charges at 50% = $8,978.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 2.70MM,272,RC,,,,,,,,both,,,17957.5900,2693.6400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5800.30,,,,,,,4634.8500,17957.5900,other,"32.3% of $17,957.59 in Billed Charges for Rev 272 = $5,800.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT CRANIAL ACCESS 2.70MM,272,RC,,,,,,,,both,,,17957.5900,2693.6400,UNITED HEALTHCARE,UHC HERITAGE SELECT,5512.98,,,,,,,4634.8500,17957.5900,other,"30.7% of $17,957.59 in Billed Charges for Rev 272 = $5,512.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT CRANIAL ACCESS 2.70MM,272,RC,,,,,,,,both,,,17957.5900,2693.6400,UNITED HEALTHCARE,UNITED HEALTHCARE,5800.30,,,,,,,4634.8500,17957.5900,percent of total billed charges,"32.3% of $17,957.59 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 2.70MM,272,RC,,,,,,,,both,,,17957.5900,2693.6400,WELLCARE,WELLCARE MEDICAID,17957.59,,,,,,,4634.8500,17957.5900,percent of total billed charges,"100% of $17,957.59 in Billed Charges for Rev 272 = $17,957.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 5-IN1,272,RC,,,,,,,,both,,,4489.4000,673.4100,AETNA,AETNA,1916.97,,,,,,,1158.7100,4489.4000,percent of total billed charges,"42.7% of $4,489.40 in Billed Charges for Rev 272 = $1,916.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 5-IN1,272,RC,,,,,,,,both,,,4489.4000,673.4100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3142.58,,,,,,,1158.7100,4489.4000,percent of total billed charges,"Rev 272 $4,489.40 in Billed Charges at 70% = $3,142.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 5-IN1,272,RC,,,,,,,,both,,,4489.4000,673.4100,CIGNA HEALTHCARE,CIGNA HMO,1872.08,,,,,,,1158.7100,4489.4000,percent of total billed charges,"41.7% of $4,489.40 in Billed Charges for Rev 272 = $1,872.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 5-IN1,272,RC,,,,,,,,both,,,4489.4000,673.4100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2083.08,,,,,,,1158.7100,4489.4000,percent of total billed charges,"46.4% of $4,489.40 in Billed Charges for Rev 272 = $2,083.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 5-IN1,272,RC,,,,,,,,both,,,4489.4000,673.4100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1872.08,,,,,,,1158.7100,4489.4000,percent of total billed charges,"41.7% of $4,489.40 in Billed Charges for Rev 272 = $1,872.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 5-IN1,272,RC,,,,,,,,both,,,4489.4000,673.4100,CIGNA HEALTHCARE,CIGNA PPO,1872.08,,,,,,,1158.7100,4489.4000,percent of total billed charges,"41.7% of $4,489.40 in Billed Charges for Rev 272 = $1,872.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 5-IN1,272,RC,,,,,,,,both,,,4489.4000,673.4100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4040.46,,,,,,,1158.7100,4489.4000,percent of total billed charges,"90% of $4,489.40 in Billed Charges for Rev 272 = $4,040.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 5-IN1,272,RC,,,,,,,,both,,,4489.4000,673.4100,MEDCOST,MEDCOST VHN,2136.51,,,,,,,1158.7100,4489.4000,percent of total billed charges,"47.59% of $4,489.40 in Billed Charges for Rev 272 = $2,136.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 5-IN1,272,RC,,,,,,,,both,,,4489.4000,673.4100,SENTARA HEALTH,SENTARA HEALTH,1158.71,,,,,,,1158.7100,4489.4000,percent of total billed charges,"25.81% of $4,489.40 in Billed Charges for Rev 272 = $1,158.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 5-IN1,272,RC,,,,,,,,both,,,4489.4000,673.4100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4489.40,,,,,,,1158.7100,4489.4000,percent of total billed charges,"100% of $4,489.40 in Billed Charges for Rev 272 = $4,489.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 5-IN1,272,RC,,,,,,,,both,,,4489.4000,673.4100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2244.70,,,,,,,1158.7100,4489.4000,percent of total billed charges,"Rev 272 $4,489.40 in Billed Charges at 50% = $2,244.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 5-IN1,272,RC,,,,,,,,both,,,4489.4000,673.4100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1450.08,,,,,,,1158.7100,4489.4000,other,"32.3% of $4,489.40 in Billed Charges for Rev 272 = $1,450.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT CRANIAL ACCESS 5-IN1,272,RC,,,,,,,,both,,,4489.4000,673.4100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1378.25,,,,,,,1158.7100,4489.4000,other,"30.7% of $4,489.40 in Billed Charges for Rev 272 = $1,378.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT CRANIAL ACCESS 5-IN1,272,RC,,,,,,,,both,,,4489.4000,673.4100,UNITED HEALTHCARE,UNITED HEALTHCARE,1450.08,,,,,,,1158.7100,4489.4000,percent of total billed charges,"32.3% of $4,489.40 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CRANIAL ACCESS 5-IN1,272,RC,,,,,,,,both,,,4489.4000,673.4100,WELLCARE,WELLCARE MEDICAID,4489.40,,,,,,,1158.7100,4489.4000,percent of total billed charges,"100% of $4,489.40 in Billed Charges for Rev 272 = $4,489.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUALKNIFE,272,RC,,,,,,,,both,,,8016.7800,1202.5200,AETNA,AETNA,3423.17,,,,,,,2069.1300,8016.7800,percent of total billed charges,"42.7% of $8,016.78 in Billed Charges for Rev 272 = $3,423.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUALKNIFE,272,RC,,,,,,,,both,,,8016.7800,1202.5200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5611.75,,,,,,,2069.1300,8016.7800,percent of total billed charges,"Rev 272 $8,016.78 in Billed Charges at 70% = $5,611.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUALKNIFE,272,RC,,,,,,,,both,,,8016.7800,1202.5200,CIGNA HEALTHCARE,CIGNA HMO,3343.00,,,,,,,2069.1300,8016.7800,percent of total billed charges,"41.7% of $8,016.78 in Billed Charges for Rev 272 = $3,343.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUALKNIFE,272,RC,,,,,,,,both,,,8016.7800,1202.5200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3719.79,,,,,,,2069.1300,8016.7800,percent of total billed charges,"46.4% of $8,016.78 in Billed Charges for Rev 272 = $3,719.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUALKNIFE,272,RC,,,,,,,,both,,,8016.7800,1202.5200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3343.00,,,,,,,2069.1300,8016.7800,percent of total billed charges,"41.7% of $8,016.78 in Billed Charges for Rev 272 = $3,343.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUALKNIFE,272,RC,,,,,,,,both,,,8016.7800,1202.5200,CIGNA HEALTHCARE,CIGNA PPO,3343.00,,,,,,,2069.1300,8016.7800,percent of total billed charges,"41.7% of $8,016.78 in Billed Charges for Rev 272 = $3,343.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUALKNIFE,272,RC,,,,,,,,both,,,8016.7800,1202.5200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7215.10,,,,,,,2069.1300,8016.7800,percent of total billed charges,"90% of $8,016.78 in Billed Charges for Rev 272 = $7,215.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUALKNIFE,272,RC,,,,,,,,both,,,8016.7800,1202.5200,MEDCOST,MEDCOST VHN,3815.19,,,,,,,2069.1300,8016.7800,percent of total billed charges,"47.59% of $8,016.78 in Billed Charges for Rev 272 = $3,815.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUALKNIFE,272,RC,,,,,,,,both,,,8016.7800,1202.5200,SENTARA HEALTH,SENTARA HEALTH,2069.13,,,,,,,2069.1300,8016.7800,percent of total billed charges,"25.81% of $8,016.78 in Billed Charges for Rev 272 = $2,069.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUALKNIFE,272,RC,,,,,,,,both,,,8016.7800,1202.5200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8016.78,,,,,,,2069.1300,8016.7800,percent of total billed charges,"100% of $8,016.78 in Billed Charges for Rev 272 = $8,016.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUALKNIFE,272,RC,,,,,,,,both,,,8016.7800,1202.5200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4008.39,,,,,,,2069.1300,8016.7800,percent of total billed charges,"Rev 272 $8,016.78 in Billed Charges at 50% = $4,008.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUALKNIFE,272,RC,,,,,,,,both,,,8016.7800,1202.5200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2589.42,,,,,,,2069.1300,8016.7800,other,"32.3% of $8,016.78 in Billed Charges for Rev 272 = $2,589.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KNIFE ELECTROSURGICAL DUALKNIFE,272,RC,,,,,,,,both,,,8016.7800,1202.5200,UNITED HEALTHCARE,UHC HERITAGE SELECT,2461.15,,,,,,,2069.1300,8016.7800,other,"30.7% of $8,016.78 in Billed Charges for Rev 272 = $2,461.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KNIFE ELECTROSURGICAL DUALKNIFE,272,RC,,,,,,,,both,,,8016.7800,1202.5200,UNITED HEALTHCARE,UNITED HEALTHCARE,2589.42,,,,,,,2069.1300,8016.7800,percent of total billed charges,"32.3% of $8,016.78 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KNIFE ELECTROSURGICAL DUALKNIFE,272,RC,,,,,,,,both,,,8016.7800,1202.5200,WELLCARE,WELLCARE MEDICAID,8016.78,,,,,,,2069.1300,8016.7800,percent of total billed charges,"100% of $8,016.78 in Billed Charges for Rev 272 = $8,016.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL EXTRACTOR TIP MALE 6 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3111.3000,466.7000,AETNA,AETNA,1328.53,,,,,,,803.0300,3111.3000,percent of total billed charges,"42.7% of $3,111.30 in Billed Charges for Rev 272 = $1,328.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL EXTRACTOR TIP MALE 6 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3111.3000,466.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2177.91,,,,,,,803.0300,3111.3000,percent of total billed charges,"Rev 272 $3,111.30 in Billed Charges at 70% = $2,177.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL EXTRACTOR TIP MALE 6 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3111.3000,466.7000,CIGNA HEALTHCARE,CIGNA HMO,1297.41,,,,,,,803.0300,3111.3000,percent of total billed charges,"41.7% of $3,111.30 in Billed Charges for Rev 272 = $1,297.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL EXTRACTOR TIP MALE 6 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3111.3000,466.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1443.64,,,,,,,803.0300,3111.3000,percent of total billed charges,"46.4% of $3,111.30 in Billed Charges for Rev 272 = $1,443.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL EXTRACTOR TIP MALE 6 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3111.3000,466.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1297.41,,,,,,,803.0300,3111.3000,percent of total billed charges,"41.7% of $3,111.30 in Billed Charges for Rev 272 = $1,297.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL EXTRACTOR TIP MALE 6 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3111.3000,466.7000,CIGNA HEALTHCARE,CIGNA PPO,1297.41,,,,,,,803.0300,3111.3000,percent of total billed charges,"41.7% of $3,111.30 in Billed Charges for Rev 272 = $1,297.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL EXTRACTOR TIP MALE 6 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3111.3000,466.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2800.17,,,,,,,803.0300,3111.3000,percent of total billed charges,"90% of $3,111.30 in Billed Charges for Rev 272 = $2,800.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL EXTRACTOR TIP MALE 6 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3111.3000,466.7000,MEDCOST,MEDCOST VHN,1480.67,,,,,,,803.0300,3111.3000,percent of total billed charges,"47.59% of $3,111.30 in Billed Charges for Rev 272 = $1,480.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL EXTRACTOR TIP MALE 6 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3111.3000,466.7000,SENTARA HEALTH,SENTARA HEALTH,803.03,,,,,,,803.0300,3111.3000,percent of total billed charges,"25.81% of $3,111.30 in Billed Charges for Rev 272 = $803.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL EXTRACTOR TIP MALE 6 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3111.3000,466.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3111.30,,,,,,,803.0300,3111.3000,percent of total billed charges,"100% of $3,111.30 in Billed Charges for Rev 272 = $3,111.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL EXTRACTOR TIP MALE 6 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3111.3000,466.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1555.65,,,,,,,803.0300,3111.3000,percent of total billed charges,"Rev 272 $3,111.30 in Billed Charges at 50% = $1,555.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL EXTRACTOR TIP MALE 6 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3111.3000,466.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1004.95,,,,,,,803.0300,3111.3000,other,"32.3% of $3,111.30 in Billed Charges for Rev 272 = $1,004.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NAIL EXTRACTOR TIP MALE 6 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3111.3000,466.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,955.17,,,,,,,803.0300,3111.3000,other,"30.7% of $3,111.30 in Billed Charges for Rev 272 = $955.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NAIL EXTRACTOR TIP MALE 6 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3111.3000,466.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,1004.95,,,,,,,803.0300,3111.3000,percent of total billed charges,"32.3% of $3,111.30 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL EXTRACTOR TIP MALE 6 X 1.0,272,RC,27200002,CDM,,,,,,both,,,3111.3000,466.7000,WELLCARE,WELLCARE MEDICAID,3111.30,,,,,,,803.0300,3111.3000,percent of total billed charges,"100% of $3,111.30 in Billed Charges for Rev 272 = $3,111.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL FEMORAL CANNULATED TFNA 9 X 360MM 130DEG NECK RIGHT,272,RC,27200002,CDM,,,,,,both,,,23529.4100,3529.4100,AETNA,AETNA,10047.06,,,,,,,6072.9400,23529.4100,percent of total billed charges,"42.7% of $23,529.41 in Billed Charges for Rev 272 = $10,047.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL FEMORAL CANNULATED TFNA 9 X 360MM 130DEG NECK RIGHT,272,RC,27200002,CDM,,,,,,both,,,23529.4100,3529.4100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,16470.59,,,,,,,6072.9400,23529.4100,percent of total billed charges,"Rev 272 $23,529.41 in Billed Charges at 70% = $16,470.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL FEMORAL CANNULATED TFNA 9 X 360MM 130DEG NECK RIGHT,272,RC,27200002,CDM,,,,,,both,,,23529.4100,3529.4100,CIGNA HEALTHCARE,CIGNA HMO,9811.76,,,,,,,6072.9400,23529.4100,percent of total billed charges,"41.7% of $23,529.41 in Billed Charges for Rev 272 = $9,811.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL FEMORAL CANNULATED TFNA 9 X 360MM 130DEG NECK RIGHT,272,RC,27200002,CDM,,,,,,both,,,23529.4100,3529.4100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10917.65,,,,,,,6072.9400,23529.4100,percent of total billed charges,"46.4% of $23,529.41 in Billed Charges for Rev 272 = $10,917.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL FEMORAL CANNULATED TFNA 9 X 360MM 130DEG NECK RIGHT,272,RC,27200002,CDM,,,,,,both,,,23529.4100,3529.4100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9811.76,,,,,,,6072.9400,23529.4100,percent of total billed charges,"41.7% of $23,529.41 in Billed Charges for Rev 272 = $9,811.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL FEMORAL CANNULATED TFNA 9 X 360MM 130DEG NECK RIGHT,272,RC,27200002,CDM,,,,,,both,,,23529.4100,3529.4100,CIGNA HEALTHCARE,CIGNA PPO,9811.76,,,,,,,6072.9400,23529.4100,percent of total billed charges,"41.7% of $23,529.41 in Billed Charges for Rev 272 = $9,811.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL FEMORAL CANNULATED TFNA 9 X 360MM 130DEG NECK RIGHT,272,RC,27200002,CDM,,,,,,both,,,23529.4100,3529.4100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,21176.47,,,,,,,6072.9400,23529.4100,percent of total billed charges,"90% of $23,529.41 in Billed Charges for Rev 272 = $21,176.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL FEMORAL CANNULATED TFNA 9 X 360MM 130DEG NECK RIGHT,272,RC,27200002,CDM,,,,,,both,,,23529.4100,3529.4100,MEDCOST,MEDCOST VHN,11197.65,,,,,,,6072.9400,23529.4100,percent of total billed charges,"47.59% of $23,529.41 in Billed Charges for Rev 272 = $11,197.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL FEMORAL CANNULATED TFNA 9 X 360MM 130DEG NECK RIGHT,272,RC,27200002,CDM,,,,,,both,,,23529.4100,3529.4100,SENTARA HEALTH,SENTARA HEALTH,6072.94,,,,,,,6072.9400,23529.4100,percent of total billed charges,"25.81% of $23,529.41 in Billed Charges for Rev 272 = $6,072.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL FEMORAL CANNULATED TFNA 9 X 360MM 130DEG NECK RIGHT,272,RC,27200002,CDM,,,,,,both,,,23529.4100,3529.4100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",23529.41,,,,,,,6072.9400,23529.4100,percent of total billed charges,"100% of $23,529.41 in Billed Charges for Rev 272 = $23,529.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL FEMORAL CANNULATED TFNA 9 X 360MM 130DEG NECK RIGHT,272,RC,27200002,CDM,,,,,,both,,,23529.4100,3529.4100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11764.71,,,,,,,6072.9400,23529.4100,percent of total billed charges,"Rev 272 $23,529.41 in Billed Charges at 50% = $11,764.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL FEMORAL CANNULATED TFNA 9 X 360MM 130DEG NECK RIGHT,272,RC,27200002,CDM,,,,,,both,,,23529.4100,3529.4100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7600.00,,,,,,,6072.9400,23529.4100,other,"32.3% of $23,529.41 in Billed Charges for Rev 272 = $7,600.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NAIL FEMORAL CANNULATED TFNA 9 X 360MM 130DEG NECK RIGHT,272,RC,27200002,CDM,,,,,,both,,,23529.4100,3529.4100,UNITED HEALTHCARE,UHC HERITAGE SELECT,7223.53,,,,,,,6072.9400,23529.4100,other,"30.7% of $23,529.41 in Billed Charges for Rev 272 = $7,223.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NAIL FEMORAL CANNULATED TFNA 9 X 360MM 130DEG NECK RIGHT,272,RC,27200002,CDM,,,,,,both,,,23529.4100,3529.4100,UNITED HEALTHCARE,UNITED HEALTHCARE,7600.00,,,,,,,6072.9400,23529.4100,percent of total billed charges,"32.3% of $23,529.41 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL FEMORAL CANNULATED TFNA 9 X 360MM 130DEG NECK RIGHT,272,RC,27200002,CDM,,,,,,both,,,23529.4100,3529.4100,WELLCARE,WELLCARE MEDICAID,23529.41,,,,,,,6072.9400,23529.4100,percent of total billed charges,"100% of $23,529.41 in Billed Charges for Rev 272 = $23,529.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL SPLINT LARGE 00-4W,272,RC,,,,,,,,both,,,547.5900,82.1400,AETNA,AETNA,233.82,,,,,,,141.3300,547.5900,percent of total billed charges,42.7% of $547.59 in Billed Charges for Rev 272 = $233.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NAIL SPLINT LARGE 00-4W,272,RC,,,,,,,,both,,,547.5900,82.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,383.31,,,,,,,141.3300,547.5900,percent of total billed charges,Rev 272 $547.59 in Billed Charges at 70% = $383.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NAIL SPLINT LARGE 00-4W,272,RC,,,,,,,,both,,,547.5900,82.1400,CIGNA HEALTHCARE,CIGNA HMO,228.35,,,,,,,141.3300,547.5900,percent of total billed charges,41.7% of $547.59 in Billed Charges for Rev 272 = $228.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NAIL SPLINT LARGE 00-4W,272,RC,,,,,,,,both,,,547.5900,82.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,254.08,,,,,,,141.3300,547.5900,percent of total billed charges,46.4% of $547.59 in Billed Charges for Rev 272 = $254.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NAIL SPLINT LARGE 00-4W,272,RC,,,,,,,,both,,,547.5900,82.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.35,,,,,,,141.3300,547.5900,percent of total billed charges,41.7% of $547.59 in Billed Charges for Rev 272 = $228.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NAIL SPLINT LARGE 00-4W,272,RC,,,,,,,,both,,,547.5900,82.1400,CIGNA HEALTHCARE,CIGNA PPO,228.35,,,,,,,141.3300,547.5900,percent of total billed charges,41.7% of $547.59 in Billed Charges for Rev 272 = $228.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NAIL SPLINT LARGE 00-4W,272,RC,,,,,,,,both,,,547.5900,82.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,492.83,,,,,,,141.3300,547.5900,percent of total billed charges,90% of $547.59 in Billed Charges for Rev 272 = $492.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NAIL SPLINT LARGE 00-4W,272,RC,,,,,,,,both,,,547.5900,82.1400,MEDCOST,MEDCOST VHN,260.60,,,,,,,141.3300,547.5900,percent of total billed charges,47.59% of $547.59 in Billed Charges for Rev 272 = $260.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NAIL SPLINT LARGE 00-4W,272,RC,,,,,,,,both,,,547.5900,82.1400,SENTARA HEALTH,SENTARA HEALTH,141.33,,,,,,,141.3300,547.5900,percent of total billed charges,25.81% of $547.59 in Billed Charges for Rev 272 = $141.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NAIL SPLINT LARGE 00-4W,272,RC,,,,,,,,both,,,547.5900,82.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",547.59,,,,,,,141.3300,547.5900,percent of total billed charges,100% of $547.59 in Billed Charges for Rev 272 = $547.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NAIL SPLINT LARGE 00-4W,272,RC,,,,,,,,both,,,547.5900,82.1400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,273.80,,,,,,,141.3300,547.5900,percent of total billed charges,Rev 272 $547.59 in Billed Charges at 50% = $273.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NAIL SPLINT LARGE 00-4W,272,RC,,,,,,,,both,,,547.5900,82.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,176.87,,,,,,,141.3300,547.5900,other,32.3% of $547.59 in Billed Charges for Rev 272 = $176.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NAIL SPLINT LARGE 00-4W,272,RC,,,,,,,,both,,,547.5900,82.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,168.11,,,,,,,141.3300,547.5900,other,30.7% of $547.59 in Billed Charges for Rev 272 = $168.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NAIL SPLINT LARGE 00-4W,272,RC,,,,,,,,both,,,547.5900,82.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,176.87,,,,,,,141.3300,547.5900,percent of total billed charges,32.3% of $547.59 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NAIL SPLINT LARGE 00-4W,272,RC,,,,,,,,both,,,547.5900,82.1400,WELLCARE,WELLCARE MEDICAID,547.59,,,,,,,141.3300,547.5900,percent of total billed charges,100% of $547.59 in Billed Charges for Rev 272 = $547.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NAIL VALOR MED 10X200MM RT,272,RC,,,,,,,,both,,,27721.6800,4158.2500,AETNA,AETNA,11837.16,,,,,,,7154.9700,27721.6800,percent of total billed charges,"42.7% of $27,721.68 in Billed Charges for Rev 272 = $11,837.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL VALOR MED 10X200MM RT,272,RC,,,,,,,,both,,,27721.6800,4158.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,19405.18,,,,,,,7154.9700,27721.6800,percent of total billed charges,"Rev 272 $27,721.68 in Billed Charges at 70% = $19,405.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL VALOR MED 10X200MM RT,272,RC,,,,,,,,both,,,27721.6800,4158.2500,CIGNA HEALTHCARE,CIGNA HMO,11559.94,,,,,,,7154.9700,27721.6800,percent of total billed charges,"41.7% of $27,721.68 in Billed Charges for Rev 272 = $11,559.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL VALOR MED 10X200MM RT,272,RC,,,,,,,,both,,,27721.6800,4158.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12862.86,,,,,,,7154.9700,27721.6800,percent of total billed charges,"46.4% of $27,721.68 in Billed Charges for Rev 272 = $12,862.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL VALOR MED 10X200MM RT,272,RC,,,,,,,,both,,,27721.6800,4158.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11559.94,,,,,,,7154.9700,27721.6800,percent of total billed charges,"41.7% of $27,721.68 in Billed Charges for Rev 272 = $11,559.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL VALOR MED 10X200MM RT,272,RC,,,,,,,,both,,,27721.6800,4158.2500,CIGNA HEALTHCARE,CIGNA PPO,11559.94,,,,,,,7154.9700,27721.6800,percent of total billed charges,"41.7% of $27,721.68 in Billed Charges for Rev 272 = $11,559.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL VALOR MED 10X200MM RT,272,RC,,,,,,,,both,,,27721.6800,4158.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,24949.51,,,,,,,7154.9700,27721.6800,percent of total billed charges,"90% of $27,721.68 in Billed Charges for Rev 272 = $24,949.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL VALOR MED 10X200MM RT,272,RC,,,,,,,,both,,,27721.6800,4158.2500,MEDCOST,MEDCOST VHN,13192.75,,,,,,,7154.9700,27721.6800,percent of total billed charges,"47.59% of $27,721.68 in Billed Charges for Rev 272 = $13,192.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL VALOR MED 10X200MM RT,272,RC,,,,,,,,both,,,27721.6800,4158.2500,SENTARA HEALTH,SENTARA HEALTH,7154.97,,,,,,,7154.9700,27721.6800,percent of total billed charges,"25.81% of $27,721.68 in Billed Charges for Rev 272 = $7,154.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL VALOR MED 10X200MM RT,272,RC,,,,,,,,both,,,27721.6800,4158.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",27721.68,,,,,,,7154.9700,27721.6800,percent of total billed charges,"100% of $27,721.68 in Billed Charges for Rev 272 = $27,721.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL VALOR MED 10X200MM RT,272,RC,,,,,,,,both,,,27721.6800,4158.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,13860.84,,,,,,,7154.9700,27721.6800,percent of total billed charges,"Rev 272 $27,721.68 in Billed Charges at 50% = $13,860.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL VALOR MED 10X200MM RT,272,RC,,,,,,,,both,,,27721.6800,4158.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,8954.10,,,,,,,7154.9700,27721.6800,other,"32.3% of $27,721.68 in Billed Charges for Rev 272 = $8,954.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NAIL VALOR MED 10X200MM RT,272,RC,,,,,,,,both,,,27721.6800,4158.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,8510.56,,,,,,,7154.9700,27721.6800,other,"30.7% of $27,721.68 in Billed Charges for Rev 272 = $8,510.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NAIL VALOR MED 10X200MM RT,272,RC,,,,,,,,both,,,27721.6800,4158.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,8954.10,,,,,,,7154.9700,27721.6800,percent of total billed charges,"32.3% of $27,721.68 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NAIL VALOR MED 10X200MM RT,272,RC,,,,,,,,both,,,27721.6800,4158.2500,WELLCARE,WELLCARE MEDICAID,27721.68,,,,,,,7154.9700,27721.6800,percent of total billed charges,"100% of $27,721.68 in Billed Charges for Rev 272 = $27,721.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL BUTTON,272,RC,27200002,CDM,,,,,,both,,,1265.2600,189.7900,AETNA,AETNA,540.27,,,,,,,326.5600,1265.2600,percent of total billed charges,"42.7% of $1,265.26 in Billed Charges for Rev 272 = $540.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL BUTTON,272,RC,27200002,CDM,,,,,,both,,,1265.2600,189.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,885.68,,,,,,,326.5600,1265.2600,percent of total billed charges,"Rev 272 $1,265.26 in Billed Charges at 70% = $885.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL BUTTON,272,RC,27200002,CDM,,,,,,both,,,1265.2600,189.7900,CIGNA HEALTHCARE,CIGNA HMO,527.61,,,,,,,326.5600,1265.2600,percent of total billed charges,"41.7% of $1,265.26 in Billed Charges for Rev 272 = $527.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL BUTTON,272,RC,27200002,CDM,,,,,,both,,,1265.2600,189.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,587.08,,,,,,,326.5600,1265.2600,percent of total billed charges,"46.4% of $1,265.26 in Billed Charges for Rev 272 = $587.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL BUTTON,272,RC,27200002,CDM,,,,,,both,,,1265.2600,189.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,527.61,,,,,,,326.5600,1265.2600,percent of total billed charges,"41.7% of $1,265.26 in Billed Charges for Rev 272 = $527.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL BUTTON,272,RC,27200002,CDM,,,,,,both,,,1265.2600,189.7900,CIGNA HEALTHCARE,CIGNA PPO,527.61,,,,,,,326.5600,1265.2600,percent of total billed charges,"41.7% of $1,265.26 in Billed Charges for Rev 272 = $527.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL BUTTON,272,RC,27200002,CDM,,,,,,both,,,1265.2600,189.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1138.73,,,,,,,326.5600,1265.2600,percent of total billed charges,"90% of $1,265.26 in Billed Charges for Rev 272 = $1,138.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL BUTTON,272,RC,27200002,CDM,,,,,,both,,,1265.2600,189.7900,MEDCOST,MEDCOST VHN,602.14,,,,,,,326.5600,1265.2600,percent of total billed charges,"47.59% of $1,265.26 in Billed Charges for Rev 272 = $602.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL BUTTON,272,RC,27200002,CDM,,,,,,both,,,1265.2600,189.7900,SENTARA HEALTH,SENTARA HEALTH,326.56,,,,,,,326.5600,1265.2600,percent of total billed charges,"25.81% of $1,265.26 in Billed Charges for Rev 272 = $326.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL BUTTON,272,RC,27200002,CDM,,,,,,both,,,1265.2600,189.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1265.26,,,,,,,326.5600,1265.2600,percent of total billed charges,"100% of $1,265.26 in Billed Charges for Rev 272 = $1,265.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL BUTTON,272,RC,27200002,CDM,,,,,,both,,,1265.2600,189.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,632.63,,,,,,,326.5600,1265.2600,percent of total billed charges,"Rev 272 $1,265.26 in Billed Charges at 50% = $632.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL BUTTON,272,RC,27200002,CDM,,,,,,both,,,1265.2600,189.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,408.68,,,,,,,326.5600,1265.2600,other,"32.3% of $1,265.26 in Billed Charges for Rev 272 = $408.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NASAL SEPTAL BUTTON,272,RC,27200002,CDM,,,,,,both,,,1265.2600,189.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,388.43,,,,,,,326.5600,1265.2600,other,"30.7% of $1,265.26 in Billed Charges for Rev 272 = $388.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NASAL SEPTAL BUTTON,272,RC,27200002,CDM,,,,,,both,,,1265.2600,189.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,408.68,,,,,,,326.5600,1265.2600,percent of total billed charges,"32.3% of $1,265.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASAL SEPTAL BUTTON,272,RC,27200002,CDM,,,,,,both,,,1265.2600,189.7900,WELLCARE,WELLCARE MEDICAID,1265.26,,,,,,,326.5600,1265.2600,percent of total billed charges,"100% of $1,265.26 in Billed Charges for Rev 272 = $1,265.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASOPORE DRESSING 4CM STD,272,RC,27200002,CDM,,,,,,both,,,1298.5300,194.7800,AETNA,AETNA,554.47,,,,,,,335.1500,1298.5300,percent of total billed charges,"42.7% of $1,298.53 in Billed Charges for Rev 272 = $554.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASOPORE DRESSING 4CM STD,272,RC,27200002,CDM,,,,,,both,,,1298.5300,194.7800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,908.97,,,,,,,335.1500,1298.5300,percent of total billed charges,"Rev 272 $1,298.53 in Billed Charges at 70% = $908.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASOPORE DRESSING 4CM STD,272,RC,27200002,CDM,,,,,,both,,,1298.5300,194.7800,CIGNA HEALTHCARE,CIGNA HMO,541.49,,,,,,,335.1500,1298.5300,percent of total billed charges,"41.7% of $1,298.53 in Billed Charges for Rev 272 = $541.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASOPORE DRESSING 4CM STD,272,RC,27200002,CDM,,,,,,both,,,1298.5300,194.7800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,602.52,,,,,,,335.1500,1298.5300,percent of total billed charges,"46.4% of $1,298.53 in Billed Charges for Rev 272 = $602.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASOPORE DRESSING 4CM STD,272,RC,27200002,CDM,,,,,,both,,,1298.5300,194.7800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,541.49,,,,,,,335.1500,1298.5300,percent of total billed charges,"41.7% of $1,298.53 in Billed Charges for Rev 272 = $541.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASOPORE DRESSING 4CM STD,272,RC,27200002,CDM,,,,,,both,,,1298.5300,194.7800,CIGNA HEALTHCARE,CIGNA PPO,541.49,,,,,,,335.1500,1298.5300,percent of total billed charges,"41.7% of $1,298.53 in Billed Charges for Rev 272 = $541.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASOPORE DRESSING 4CM STD,272,RC,27200002,CDM,,,,,,both,,,1298.5300,194.7800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1168.68,,,,,,,335.1500,1298.5300,percent of total billed charges,"90% of $1,298.53 in Billed Charges for Rev 272 = $1,168.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASOPORE DRESSING 4CM STD,272,RC,27200002,CDM,,,,,,both,,,1298.5300,194.7800,MEDCOST,MEDCOST VHN,617.97,,,,,,,335.1500,1298.5300,percent of total billed charges,"47.59% of $1,298.53 in Billed Charges for Rev 272 = $617.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASOPORE DRESSING 4CM STD,272,RC,27200002,CDM,,,,,,both,,,1298.5300,194.7800,SENTARA HEALTH,SENTARA HEALTH,335.15,,,,,,,335.1500,1298.5300,percent of total billed charges,"25.81% of $1,298.53 in Billed Charges for Rev 272 = $335.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASOPORE DRESSING 4CM STD,272,RC,27200002,CDM,,,,,,both,,,1298.5300,194.7800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1298.53,,,,,,,335.1500,1298.5300,percent of total billed charges,"100% of $1,298.53 in Billed Charges for Rev 272 = $1,298.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASOPORE DRESSING 4CM STD,272,RC,27200002,CDM,,,,,,both,,,1298.5300,194.7800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,649.27,,,,,,,335.1500,1298.5300,percent of total billed charges,"Rev 272 $1,298.53 in Billed Charges at 50% = $649.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASOPORE DRESSING 4CM STD,272,RC,27200002,CDM,,,,,,both,,,1298.5300,194.7800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,419.43,,,,,,,335.1500,1298.5300,other,"32.3% of $1,298.53 in Billed Charges for Rev 272 = $419.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NASOPORE DRESSING 4CM STD,272,RC,27200002,CDM,,,,,,both,,,1298.5300,194.7800,UNITED HEALTHCARE,UHC HERITAGE SELECT,398.65,,,,,,,335.1500,1298.5300,other,"30.7% of $1,298.53 in Billed Charges for Rev 272 = $398.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NASOPORE DRESSING 4CM STD,272,RC,27200002,CDM,,,,,,both,,,1298.5300,194.7800,UNITED HEALTHCARE,UNITED HEALTHCARE,419.43,,,,,,,335.1500,1298.5300,percent of total billed charges,"32.3% of $1,298.53 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NASOPORE DRESSING 4CM STD,272,RC,27200002,CDM,,,,,,both,,,1298.5300,194.7800,WELLCARE,WELLCARE MEDICAID,1298.53,,,,,,,335.1500,1298.5300,percent of total billed charges,"100% of $1,298.53 in Billed Charges for Rev 272 = $1,298.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DRESSING DRAPE 3M DERMTAC MED,272,RC,27200002,CDM,,,,,,both,,,541.7100,81.2600,AETNA,AETNA,231.31,,,,,,,139.8200,541.7100,percent of total billed charges,42.7% of $541.71 in Billed Charges for Rev 272 = $231.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC MED,272,RC,27200002,CDM,,,,,,both,,,541.7100,81.2600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,379.20,,,,,,,139.8200,541.7100,percent of total billed charges,Rev 272 $541.71 in Billed Charges at 70% = $379.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC MED,272,RC,27200002,CDM,,,,,,both,,,541.7100,81.2600,CIGNA HEALTHCARE,CIGNA HMO,225.89,,,,,,,139.8200,541.7100,percent of total billed charges,41.7% of $541.71 in Billed Charges for Rev 272 = $225.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC MED,272,RC,27200002,CDM,,,,,,both,,,541.7100,81.2600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,251.35,,,,,,,139.8200,541.7100,percent of total billed charges,46.4% of $541.71 in Billed Charges for Rev 272 = $251.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC MED,272,RC,27200002,CDM,,,,,,both,,,541.7100,81.2600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,225.89,,,,,,,139.8200,541.7100,percent of total billed charges,41.7% of $541.71 in Billed Charges for Rev 272 = $225.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC MED,272,RC,27200002,CDM,,,,,,both,,,541.7100,81.2600,CIGNA HEALTHCARE,CIGNA PPO,225.89,,,,,,,139.8200,541.7100,percent of total billed charges,41.7% of $541.71 in Billed Charges for Rev 272 = $225.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC MED,272,RC,27200002,CDM,,,,,,both,,,541.7100,81.2600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,487.54,,,,,,,139.8200,541.7100,percent of total billed charges,90% of $541.71 in Billed Charges for Rev 272 = $487.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC MED,272,RC,27200002,CDM,,,,,,both,,,541.7100,81.2600,MEDCOST,MEDCOST VHN,257.80,,,,,,,139.8200,541.7100,percent of total billed charges,47.59% of $541.71 in Billed Charges for Rev 272 = $257.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC MED,272,RC,27200002,CDM,,,,,,both,,,541.7100,81.2600,SENTARA HEALTH,SENTARA HEALTH,139.82,,,,,,,139.8200,541.7100,percent of total billed charges,25.81% of $541.71 in Billed Charges for Rev 272 = $139.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC MED,272,RC,27200002,CDM,,,,,,both,,,541.7100,81.2600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",541.71,,,,,,,139.8200,541.7100,percent of total billed charges,100% of $541.71 in Billed Charges for Rev 272 = $541.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC MED,272,RC,27200002,CDM,,,,,,both,,,541.7100,81.2600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,270.86,,,,,,,139.8200,541.7100,percent of total billed charges,Rev 272 $541.71 in Billed Charges at 50% = $270.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC MED,272,RC,27200002,CDM,,,,,,both,,,541.7100,81.2600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,174.97,,,,,,,139.8200,541.7100,other,32.3% of $541.71 in Billed Charges for Rev 272 = $174.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT DRESSING DRAPE 3M DERMTAC MED,272,RC,27200002,CDM,,,,,,both,,,541.7100,81.2600,UNITED HEALTHCARE,UHC HERITAGE SELECT,166.31,,,,,,,139.8200,541.7100,other,30.7% of $541.71 in Billed Charges for Rev 272 = $166.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT DRESSING DRAPE 3M DERMTAC MED,272,RC,27200002,CDM,,,,,,both,,,541.7100,81.2600,UNITED HEALTHCARE,UNITED HEALTHCARE,174.97,,,,,,,139.8200,541.7100,percent of total billed charges,32.3% of $541.71 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC MED,272,RC,27200002,CDM,,,,,,both,,,541.7100,81.2600,WELLCARE,WELLCARE MEDICAID,541.71,,,,,,,139.8200,541.7100,percent of total billed charges,100% of $541.71 in Billed Charges for Rev 272 = $541.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC SMALL,272,RC,27200002,CDM,,,,,,both,,,422.6700,63.4000,AETNA,AETNA,180.48,,,,,,,109.0900,422.6700,percent of total billed charges,42.7% of $422.67 in Billed Charges for Rev 272 = $180.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC SMALL,272,RC,27200002,CDM,,,,,,both,,,422.6700,63.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,295.87,,,,,,,109.0900,422.6700,percent of total billed charges,Rev 272 $422.67 in Billed Charges at 70% = $295.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC SMALL,272,RC,27200002,CDM,,,,,,both,,,422.6700,63.4000,CIGNA HEALTHCARE,CIGNA HMO,176.25,,,,,,,109.0900,422.6700,percent of total billed charges,41.7% of $422.67 in Billed Charges for Rev 272 = $176.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC SMALL,272,RC,27200002,CDM,,,,,,both,,,422.6700,63.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,196.12,,,,,,,109.0900,422.6700,percent of total billed charges,46.4% of $422.67 in Billed Charges for Rev 272 = $196.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC SMALL,272,RC,27200002,CDM,,,,,,both,,,422.6700,63.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,176.25,,,,,,,109.0900,422.6700,percent of total billed charges,41.7% of $422.67 in Billed Charges for Rev 272 = $176.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC SMALL,272,RC,27200002,CDM,,,,,,both,,,422.6700,63.4000,CIGNA HEALTHCARE,CIGNA PPO,176.25,,,,,,,109.0900,422.6700,percent of total billed charges,41.7% of $422.67 in Billed Charges for Rev 272 = $176.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC SMALL,272,RC,27200002,CDM,,,,,,both,,,422.6700,63.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,380.40,,,,,,,109.0900,422.6700,percent of total billed charges,90% of $422.67 in Billed Charges for Rev 272 = $380.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC SMALL,272,RC,27200002,CDM,,,,,,both,,,422.6700,63.4000,MEDCOST,MEDCOST VHN,201.15,,,,,,,109.0900,422.6700,percent of total billed charges,47.59% of $422.67 in Billed Charges for Rev 272 = $201.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC SMALL,272,RC,27200002,CDM,,,,,,both,,,422.6700,63.4000,SENTARA HEALTH,SENTARA HEALTH,109.09,,,,,,,109.0900,422.6700,percent of total billed charges,25.81% of $422.67 in Billed Charges for Rev 272 = $109.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC SMALL,272,RC,27200002,CDM,,,,,,both,,,422.6700,63.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",422.67,,,,,,,109.0900,422.6700,percent of total billed charges,100% of $422.67 in Billed Charges for Rev 272 = $422.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC SMALL,272,RC,27200002,CDM,,,,,,both,,,422.6700,63.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,211.34,,,,,,,109.0900,422.6700,percent of total billed charges,Rev 272 $422.67 in Billed Charges at 50% = $211.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC SMALL,272,RC,27200002,CDM,,,,,,both,,,422.6700,63.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,136.52,,,,,,,109.0900,422.6700,other,32.3% of $422.67 in Billed Charges for Rev 272 = $136.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT DRESSING DRAPE 3M DERMTAC SMALL,272,RC,27200002,CDM,,,,,,both,,,422.6700,63.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,129.76,,,,,,,109.0900,422.6700,other,30.7% of $422.67 in Billed Charges for Rev 272 = $129.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT DRESSING DRAPE 3M DERMTAC SMALL,272,RC,27200002,CDM,,,,,,both,,,422.6700,63.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,136.52,,,,,,,109.0900,422.6700,percent of total billed charges,32.3% of $422.67 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMTAC SMALL,272,RC,27200002,CDM,,,,,,both,,,422.6700,63.4000,WELLCARE,WELLCARE MEDICAID,422.67,,,,,,,109.0900,422.6700,percent of total billed charges,100% of $422.67 in Billed Charges for Rev 272 = $422.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SPINE JACK PREP 5.0MM,272,RC,27200002,CDM,,,,,,both,,,13347.3700,2002.1100,AETNA,AETNA,5699.33,,,,,,,3444.9600,13347.3700,percent of total billed charges,"42.7% of $13,347.37 in Billed Charges for Rev 272 = $5,699.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPINE JACK PREP 5.0MM,272,RC,27200002,CDM,,,,,,both,,,13347.3700,2002.1100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9343.16,,,,,,,3444.9600,13347.3700,percent of total billed charges,"Rev 272 $13,347.37 in Billed Charges at 70% = $9,343.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPINE JACK PREP 5.0MM,272,RC,27200002,CDM,,,,,,both,,,13347.3700,2002.1100,CIGNA HEALTHCARE,CIGNA HMO,5565.85,,,,,,,3444.9600,13347.3700,percent of total billed charges,"41.7% of $13,347.37 in Billed Charges for Rev 272 = $5,565.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPINE JACK PREP 5.0MM,272,RC,27200002,CDM,,,,,,both,,,13347.3700,2002.1100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6193.18,,,,,,,3444.9600,13347.3700,percent of total billed charges,"46.4% of $13,347.37 in Billed Charges for Rev 272 = $6,193.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPINE JACK PREP 5.0MM,272,RC,27200002,CDM,,,,,,both,,,13347.3700,2002.1100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5565.85,,,,,,,3444.9600,13347.3700,percent of total billed charges,"41.7% of $13,347.37 in Billed Charges for Rev 272 = $5,565.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPINE JACK PREP 5.0MM,272,RC,27200002,CDM,,,,,,both,,,13347.3700,2002.1100,CIGNA HEALTHCARE,CIGNA PPO,5565.85,,,,,,,3444.9600,13347.3700,percent of total billed charges,"41.7% of $13,347.37 in Billed Charges for Rev 272 = $5,565.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPINE JACK PREP 5.0MM,272,RC,27200002,CDM,,,,,,both,,,13347.3700,2002.1100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12012.63,,,,,,,3444.9600,13347.3700,percent of total billed charges,"90% of $13,347.37 in Billed Charges for Rev 272 = $12,012.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPINE JACK PREP 5.0MM,272,RC,27200002,CDM,,,,,,both,,,13347.3700,2002.1100,MEDCOST,MEDCOST VHN,6352.01,,,,,,,3444.9600,13347.3700,percent of total billed charges,"47.59% of $13,347.37 in Billed Charges for Rev 272 = $6,352.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPINE JACK PREP 5.0MM,272,RC,27200002,CDM,,,,,,both,,,13347.3700,2002.1100,SENTARA HEALTH,SENTARA HEALTH,3444.96,,,,,,,3444.9600,13347.3700,percent of total billed charges,"25.81% of $13,347.37 in Billed Charges for Rev 272 = $3,444.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPINE JACK PREP 5.0MM,272,RC,27200002,CDM,,,,,,both,,,13347.3700,2002.1100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13347.37,,,,,,,3444.9600,13347.3700,percent of total billed charges,"100% of $13,347.37 in Billed Charges for Rev 272 = $13,347.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPINE JACK PREP 5.0MM,272,RC,27200002,CDM,,,,,,both,,,13347.3700,2002.1100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6673.69,,,,,,,3444.9600,13347.3700,percent of total billed charges,"Rev 272 $13,347.37 in Billed Charges at 50% = $6,673.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPINE JACK PREP 5.0MM,272,RC,27200002,CDM,,,,,,both,,,13347.3700,2002.1100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4311.20,,,,,,,3444.9600,13347.3700,other,"32.3% of $13,347.37 in Billed Charges for Rev 272 = $4,311.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT SPINE JACK PREP 5.0MM,272,RC,27200002,CDM,,,,,,both,,,13347.3700,2002.1100,UNITED HEALTHCARE,UHC HERITAGE SELECT,4097.64,,,,,,,3444.9600,13347.3700,other,"30.7% of $13,347.37 in Billed Charges for Rev 272 = $4,097.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT SPINE JACK PREP 5.0MM,272,RC,27200002,CDM,,,,,,both,,,13347.3700,2002.1100,UNITED HEALTHCARE,UNITED HEALTHCARE,4311.20,,,,,,,3444.9600,13347.3700,percent of total billed charges,"32.3% of $13,347.37 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPINE JACK PREP 5.0MM,272,RC,27200002,CDM,,,,,,both,,,13347.3700,2002.1100,WELLCARE,WELLCARE MEDICAID,13347.37,,,,,,,3444.9600,13347.3700,percent of total billed charges,"100% of $13,347.37 in Billed Charges for Rev 272 = $13,347.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPRAY TRUFREEZE RAPID AV BOX OF 5,272,RC,27200002,CDM,,,,,,both,,,87894.2300,13184.1300,AETNA,AETNA,37530.84,,,,,,,22685.5000,87894.2300,percent of total billed charges,"42.7% of $87,894.23 in Billed Charges for Rev 272 = $37,530.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPRAY TRUFREEZE RAPID AV BOX OF 5,272,RC,27200002,CDM,,,,,,both,,,87894.2300,13184.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,61525.96,,,,,,,22685.5000,87894.2300,percent of total billed charges,"Rev 272 $87,894.23 in Billed Charges at 70% = $61,525.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPRAY TRUFREEZE RAPID AV BOX OF 5,272,RC,27200002,CDM,,,,,,both,,,87894.2300,13184.1300,CIGNA HEALTHCARE,CIGNA HMO,36651.89,,,,,,,22685.5000,87894.2300,percent of total billed charges,"41.7% of $87,894.23 in Billed Charges for Rev 272 = $36,651.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPRAY TRUFREEZE RAPID AV BOX OF 5,272,RC,27200002,CDM,,,,,,both,,,87894.2300,13184.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,40782.92,,,,,,,22685.5000,87894.2300,percent of total billed charges,"46.4% of $87,894.23 in Billed Charges for Rev 272 = $40,782.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPRAY TRUFREEZE RAPID AV BOX OF 5,272,RC,27200002,CDM,,,,,,both,,,87894.2300,13184.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,36651.89,,,,,,,22685.5000,87894.2300,percent of total billed charges,"41.7% of $87,894.23 in Billed Charges for Rev 272 = $36,651.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPRAY TRUFREEZE RAPID AV BOX OF 5,272,RC,27200002,CDM,,,,,,both,,,87894.2300,13184.1300,CIGNA HEALTHCARE,CIGNA PPO,36651.89,,,,,,,22685.5000,87894.2300,percent of total billed charges,"41.7% of $87,894.23 in Billed Charges for Rev 272 = $36,651.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPRAY TRUFREEZE RAPID AV BOX OF 5,272,RC,27200002,CDM,,,,,,both,,,87894.2300,13184.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,79104.81,,,,,,,22685.5000,87894.2300,percent of total billed charges,"90% of $87,894.23 in Billed Charges for Rev 272 = $79,104.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPRAY TRUFREEZE RAPID AV BOX OF 5,272,RC,27200002,CDM,,,,,,both,,,87894.2300,13184.1300,MEDCOST,MEDCOST VHN,41828.86,,,,,,,22685.5000,87894.2300,percent of total billed charges,"47.59% of $87,894.23 in Billed Charges for Rev 272 = $41,828.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPRAY TRUFREEZE RAPID AV BOX OF 5,272,RC,27200002,CDM,,,,,,both,,,87894.2300,13184.1300,SENTARA HEALTH,SENTARA HEALTH,22685.50,,,,,,,22685.5000,87894.2300,percent of total billed charges,"25.81% of $87,894.23 in Billed Charges for Rev 272 = $22,685.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPRAY TRUFREEZE RAPID AV BOX OF 5,272,RC,27200002,CDM,,,,,,both,,,87894.2300,13184.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",87894.23,,,,,,,22685.5000,87894.2300,percent of total billed charges,"100% of $87,894.23 in Billed Charges for Rev 272 = $87,894.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPRAY TRUFREEZE RAPID AV BOX OF 5,272,RC,27200002,CDM,,,,,,both,,,87894.2300,13184.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,43947.12,,,,,,,22685.5000,87894.2300,percent of total billed charges,"Rev 272 $87,894.23 in Billed Charges at 50% = $43,947.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPRAY TRUFREEZE RAPID AV BOX OF 5,272,RC,27200002,CDM,,,,,,both,,,87894.2300,13184.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,28389.84,,,,,,,22685.5000,87894.2300,other,"32.3% of $87,894.23 in Billed Charges for Rev 272 = $28,389.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT SPRAY TRUFREEZE RAPID AV BOX OF 5,272,RC,27200002,CDM,,,,,,both,,,87894.2300,13184.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,26983.53,,,,,,,22685.5000,87894.2300,other,"30.7% of $87,894.23 in Billed Charges for Rev 272 = $26,983.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT SPRAY TRUFREEZE RAPID AV BOX OF 5,272,RC,27200002,CDM,,,,,,both,,,87894.2300,13184.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,28389.84,,,,,,,22685.5000,87894.2300,percent of total billed charges,"32.3% of $87,894.23 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPRAY TRUFREEZE RAPID AV BOX OF 5,272,RC,27200002,CDM,,,,,,both,,,87894.2300,13184.1300,WELLCARE,WELLCARE MEDICAID,87894.23,,,,,,,22685.5000,87894.2300,percent of total billed charges,"100% of $87,894.23 in Billed Charges for Rev 272 = $87,894.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT START UP LEVEL ONE STERNAL THORACIC TALON,272,RC,27200002,CDM,,,,,,both,,,4978.0800,746.7100,AETNA,AETNA,2125.64,,,,,,,1284.8400,4978.0800,percent of total billed charges,"42.7% of $4,978.08 in Billed Charges for Rev 272 = $2,125.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT START UP LEVEL ONE STERNAL THORACIC TALON,272,RC,27200002,CDM,,,,,,both,,,4978.0800,746.7100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3484.66,,,,,,,1284.8400,4978.0800,percent of total billed charges,"Rev 272 $4,978.08 in Billed Charges at 70% = $3,484.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT START UP LEVEL ONE STERNAL THORACIC TALON,272,RC,27200002,CDM,,,,,,both,,,4978.0800,746.7100,CIGNA HEALTHCARE,CIGNA HMO,2075.86,,,,,,,1284.8400,4978.0800,percent of total billed charges,"41.7% of $4,978.08 in Billed Charges for Rev 272 = $2,075.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT START UP LEVEL ONE STERNAL THORACIC TALON,272,RC,27200002,CDM,,,,,,both,,,4978.0800,746.7100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2309.83,,,,,,,1284.8400,4978.0800,percent of total billed charges,"46.4% of $4,978.08 in Billed Charges for Rev 272 = $2,309.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT START UP LEVEL ONE STERNAL THORACIC TALON,272,RC,27200002,CDM,,,,,,both,,,4978.0800,746.7100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2075.86,,,,,,,1284.8400,4978.0800,percent of total billed charges,"41.7% of $4,978.08 in Billed Charges for Rev 272 = $2,075.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT START UP LEVEL ONE STERNAL THORACIC TALON,272,RC,27200002,CDM,,,,,,both,,,4978.0800,746.7100,CIGNA HEALTHCARE,CIGNA PPO,2075.86,,,,,,,1284.8400,4978.0800,percent of total billed charges,"41.7% of $4,978.08 in Billed Charges for Rev 272 = $2,075.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT START UP LEVEL ONE STERNAL THORACIC TALON,272,RC,27200002,CDM,,,,,,both,,,4978.0800,746.7100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4480.27,,,,,,,1284.8400,4978.0800,percent of total billed charges,"90% of $4,978.08 in Billed Charges for Rev 272 = $4,480.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT START UP LEVEL ONE STERNAL THORACIC TALON,272,RC,27200002,CDM,,,,,,both,,,4978.0800,746.7100,MEDCOST,MEDCOST VHN,2369.07,,,,,,,1284.8400,4978.0800,percent of total billed charges,"47.59% of $4,978.08 in Billed Charges for Rev 272 = $2,369.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT START UP LEVEL ONE STERNAL THORACIC TALON,272,RC,27200002,CDM,,,,,,both,,,4978.0800,746.7100,SENTARA HEALTH,SENTARA HEALTH,1284.84,,,,,,,1284.8400,4978.0800,percent of total billed charges,"25.81% of $4,978.08 in Billed Charges for Rev 272 = $1,284.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT START UP LEVEL ONE STERNAL THORACIC TALON,272,RC,27200002,CDM,,,,,,both,,,4978.0800,746.7100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4978.08,,,,,,,1284.8400,4978.0800,percent of total billed charges,"100% of $4,978.08 in Billed Charges for Rev 272 = $4,978.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT START UP LEVEL ONE STERNAL THORACIC TALON,272,RC,27200002,CDM,,,,,,both,,,4978.0800,746.7100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2489.04,,,,,,,1284.8400,4978.0800,percent of total billed charges,"Rev 272 $4,978.08 in Billed Charges at 50% = $2,489.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT START UP LEVEL ONE STERNAL THORACIC TALON,272,RC,27200002,CDM,,,,,,both,,,4978.0800,746.7100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1607.92,,,,,,,1284.8400,4978.0800,other,"32.3% of $4,978.08 in Billed Charges for Rev 272 = $1,607.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT START UP LEVEL ONE STERNAL THORACIC TALON,272,RC,27200002,CDM,,,,,,both,,,4978.0800,746.7100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1528.27,,,,,,,1284.8400,4978.0800,other,"30.7% of $4,978.08 in Billed Charges for Rev 272 = $1,528.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT START UP LEVEL ONE STERNAL THORACIC TALON,272,RC,27200002,CDM,,,,,,both,,,4978.0800,746.7100,UNITED HEALTHCARE,UNITED HEALTHCARE,1607.92,,,,,,,1284.8400,4978.0800,percent of total billed charges,"32.3% of $4,978.08 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT START UP LEVEL ONE STERNAL THORACIC TALON,272,RC,27200002,CDM,,,,,,both,,,4978.0800,746.7100,WELLCARE,WELLCARE MEDICAID,4978.08,,,,,,,1284.8400,4978.0800,percent of total billed charges,"100% of $4,978.08 in Billed Charges for Rev 272 = $4,978.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH MICRO MEWI INF CATH 150CM,272,RC,27201308,CDM,,,,,,both,,,867.0000,130.0500,AETNA,AETNA,370.21,,,,,,,223.7700,867.0000,percent of total billed charges,42.7% of $867.00 in Billed Charges for Rev 272 = $370.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH MICRO MEWI INF CATH 150CM,272,RC,27201308,CDM,,,,,,both,,,867.0000,130.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,606.90,,,,,,,223.7700,867.0000,percent of total billed charges,Rev 272 $867.00 in Billed Charges at 70% = $606.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH MICRO MEWI INF CATH 150CM,272,RC,27201308,CDM,,,,,,both,,,867.0000,130.0500,CIGNA HEALTHCARE,CIGNA HMO,361.54,,,,,,,223.7700,867.0000,percent of total billed charges,41.7% of $867.00 in Billed Charges for Rev 272 = $361.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH MICRO MEWI INF CATH 150CM,272,RC,27201308,CDM,,,,,,both,,,867.0000,130.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,402.29,,,,,,,223.7700,867.0000,percent of total billed charges,46.4% of $867.00 in Billed Charges for Rev 272 = $402.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH MICRO MEWI INF CATH 150CM,272,RC,27201308,CDM,,,,,,both,,,867.0000,130.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,361.54,,,,,,,223.7700,867.0000,percent of total billed charges,41.7% of $867.00 in Billed Charges for Rev 272 = $361.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH MICRO MEWI INF CATH 150CM,272,RC,27201308,CDM,,,,,,both,,,867.0000,130.0500,CIGNA HEALTHCARE,CIGNA PPO,361.54,,,,,,,223.7700,867.0000,percent of total billed charges,41.7% of $867.00 in Billed Charges for Rev 272 = $361.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH MICRO MEWI INF CATH 150CM,272,RC,27201308,CDM,,,,,,both,,,867.0000,130.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,780.30,,,,,,,223.7700,867.0000,percent of total billed charges,90% of $867.00 in Billed Charges for Rev 272 = $780.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH MICRO MEWI INF CATH 150CM,272,RC,27201308,CDM,,,,,,both,,,867.0000,130.0500,MEDCOST,MEDCOST VHN,412.61,,,,,,,223.7700,867.0000,percent of total billed charges,47.59% of $867.00 in Billed Charges for Rev 272 = $412.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH MICRO MEWI INF CATH 150CM,272,RC,27201308,CDM,,,,,,both,,,867.0000,130.0500,SENTARA HEALTH,SENTARA HEALTH,223.77,,,,,,,223.7700,867.0000,percent of total billed charges,25.81% of $867.00 in Billed Charges for Rev 272 = $223.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH MICRO MEWI INF CATH 150CM,272,RC,27201308,CDM,,,,,,both,,,867.0000,130.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",867.00,,,,,,,223.7700,867.0000,percent of total billed charges,100% of $867.00 in Billed Charges for Rev 272 = $867.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH MICRO MEWI INF CATH 150CM,272,RC,27201308,CDM,,,,,,both,,,867.0000,130.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,433.50,,,,,,,223.7700,867.0000,percent of total billed charges,Rev 272 $867.00 in Billed Charges at 50% = $433.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH MICRO MEWI INF CATH 150CM,272,RC,27201308,CDM,,,,,,both,,,867.0000,130.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,280.04,,,,,,,223.7700,867.0000,other,32.3% of $867.00 in Billed Charges for Rev 272 = $280.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH MICRO MEWI INF CATH 150CM,272,RC,27201308,CDM,,,,,,both,,,867.0000,130.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,266.17,,,,,,,223.7700,867.0000,other,30.7% of $867.00 in Billed Charges for Rev 272 = $266.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH MICRO MEWI INF CATH 150CM,272,RC,27201308,CDM,,,,,,both,,,867.0000,130.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,280.04,,,,,,,223.7700,867.0000,percent of total billed charges,32.3% of $867.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH MICRO MEWI INF CATH 150CM,272,RC,27201308,CDM,,,,,,both,,,867.0000,130.0500,WELLCARE,WELLCARE MEDICAID,867.00,,,,,,,223.7700,867.0000,percent of total billed charges,100% of $867.00 in Billed Charges for Rev 272 = $867.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH OUTBACK RE-ENTRY,272,RC,27201313,CDM,,,,,,both,,,5503.0000,825.4500,AETNA,AETNA,2349.78,,,,,,,1420.3200,5503.0000,percent of total billed charges,"42.7% of $5,503.00 in Billed Charges for Rev 272 = $2,349.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK RE-ENTRY,272,RC,27201313,CDM,,,,,,both,,,5503.0000,825.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3852.10,,,,,,,1420.3200,5503.0000,percent of total billed charges,"Rev 272 $5,503.00 in Billed Charges at 70% = $3,852.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK RE-ENTRY,272,RC,27201313,CDM,,,,,,both,,,5503.0000,825.4500,CIGNA HEALTHCARE,CIGNA HMO,2294.75,,,,,,,1420.3200,5503.0000,percent of total billed charges,"41.7% of $5,503.00 in Billed Charges for Rev 272 = $2,294.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK RE-ENTRY,272,RC,27201313,CDM,,,,,,both,,,5503.0000,825.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2553.39,,,,,,,1420.3200,5503.0000,percent of total billed charges,"46.4% of $5,503.00 in Billed Charges for Rev 272 = $2,553.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK RE-ENTRY,272,RC,27201313,CDM,,,,,,both,,,5503.0000,825.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2294.75,,,,,,,1420.3200,5503.0000,percent of total billed charges,"41.7% of $5,503.00 in Billed Charges for Rev 272 = $2,294.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK RE-ENTRY,272,RC,27201313,CDM,,,,,,both,,,5503.0000,825.4500,CIGNA HEALTHCARE,CIGNA PPO,2294.75,,,,,,,1420.3200,5503.0000,percent of total billed charges,"41.7% of $5,503.00 in Billed Charges for Rev 272 = $2,294.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK RE-ENTRY,272,RC,27201313,CDM,,,,,,both,,,5503.0000,825.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4952.70,,,,,,,1420.3200,5503.0000,percent of total billed charges,"90% of $5,503.00 in Billed Charges for Rev 272 = $4,952.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK RE-ENTRY,272,RC,27201313,CDM,,,,,,both,,,5503.0000,825.4500,MEDCOST,MEDCOST VHN,2618.88,,,,,,,1420.3200,5503.0000,percent of total billed charges,"47.59% of $5,503.00 in Billed Charges for Rev 272 = $2,618.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK RE-ENTRY,272,RC,27201313,CDM,,,,,,both,,,5503.0000,825.4500,SENTARA HEALTH,SENTARA HEALTH,1420.32,,,,,,,1420.3200,5503.0000,percent of total billed charges,"25.81% of $5,503.00 in Billed Charges for Rev 272 = $1,420.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK RE-ENTRY,272,RC,27201313,CDM,,,,,,both,,,5503.0000,825.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5503.00,,,,,,,1420.3200,5503.0000,percent of total billed charges,"100% of $5,503.00 in Billed Charges for Rev 272 = $5,503.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK RE-ENTRY,272,RC,27201313,CDM,,,,,,both,,,5503.0000,825.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2751.50,,,,,,,1420.3200,5503.0000,percent of total billed charges,"Rev 272 $5,503.00 in Billed Charges at 50% = $2,751.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK RE-ENTRY,272,RC,27201313,CDM,,,,,,both,,,5503.0000,825.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1777.47,,,,,,,1420.3200,5503.0000,other,"32.3% of $5,503.00 in Billed Charges for Rev 272 = $1,777.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH OUTBACK RE-ENTRY,272,RC,27201313,CDM,,,,,,both,,,5503.0000,825.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1689.42,,,,,,,1420.3200,5503.0000,other,"30.7% of $5,503.00 in Billed Charges for Rev 272 = $1,689.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH OUTBACK RE-ENTRY,272,RC,27201313,CDM,,,,,,both,,,5503.0000,825.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,1777.47,,,,,,,1420.3200,5503.0000,percent of total billed charges,"32.3% of $5,503.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH OUTBACK RE-ENTRY,272,RC,27201313,CDM,,,,,,both,,,5503.0000,825.4500,WELLCARE,WELLCARE MEDICAID,5503.00,,,,,,,1420.3200,5503.0000,percent of total billed charges,"100% of $5,503.00 in Billed Charges for Rev 272 = $5,503.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH PREMIE PICC 1FR 1261.2,272,RC,27201316,CDM,,,,,,both,,,295.0000,44.2500,AETNA,AETNA,125.97,,,,,,,76.1400,295.0000,percent of total billed charges,42.7% of $295.00 in Billed Charges for Rev 272 = $125.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH PREMIE PICC 1FR 1261.2,272,RC,27201316,CDM,,,,,,both,,,295.0000,44.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,206.50,,,,,,,76.1400,295.0000,percent of total billed charges,Rev 272 $295.00 in Billed Charges at 70% = $206.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH PREMIE PICC 1FR 1261.2,272,RC,27201316,CDM,,,,,,both,,,295.0000,44.2500,CIGNA HEALTHCARE,CIGNA HMO,123.02,,,,,,,76.1400,295.0000,percent of total billed charges,41.7% of $295.00 in Billed Charges for Rev 272 = $123.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH PREMIE PICC 1FR 1261.2,272,RC,27201316,CDM,,,,,,both,,,295.0000,44.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,136.88,,,,,,,76.1400,295.0000,percent of total billed charges,46.4% of $295.00 in Billed Charges for Rev 272 = $136.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH PREMIE PICC 1FR 1261.2,272,RC,27201316,CDM,,,,,,both,,,295.0000,44.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,123.02,,,,,,,76.1400,295.0000,percent of total billed charges,41.7% of $295.00 in Billed Charges for Rev 272 = $123.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH PREMIE PICC 1FR 1261.2,272,RC,27201316,CDM,,,,,,both,,,295.0000,44.2500,CIGNA HEALTHCARE,CIGNA PPO,123.02,,,,,,,76.1400,295.0000,percent of total billed charges,41.7% of $295.00 in Billed Charges for Rev 272 = $123.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH PREMIE PICC 1FR 1261.2,272,RC,27201316,CDM,,,,,,both,,,295.0000,44.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,265.50,,,,,,,76.1400,295.0000,percent of total billed charges,90% of $295.00 in Billed Charges for Rev 272 = $265.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH PREMIE PICC 1FR 1261.2,272,RC,27201316,CDM,,,,,,both,,,295.0000,44.2500,MEDCOST,MEDCOST VHN,140.39,,,,,,,76.1400,295.0000,percent of total billed charges,47.59% of $295.00 in Billed Charges for Rev 272 = $140.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH PREMIE PICC 1FR 1261.2,272,RC,27201316,CDM,,,,,,both,,,295.0000,44.2500,SENTARA HEALTH,SENTARA HEALTH,76.14,,,,,,,76.1400,295.0000,percent of total billed charges,25.81% of $295.00 in Billed Charges for Rev 272 = $76.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH PREMIE PICC 1FR 1261.2,272,RC,27201316,CDM,,,,,,both,,,295.0000,44.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",295.00,,,,,,,76.1400,295.0000,percent of total billed charges,100% of $295.00 in Billed Charges for Rev 272 = $295.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH PREMIE PICC 1FR 1261.2,272,RC,27201316,CDM,,,,,,both,,,295.0000,44.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,147.50,,,,,,,76.1400,295.0000,percent of total billed charges,Rev 272 $295.00 in Billed Charges at 50% = $147.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH PREMIE PICC 1FR 1261.2,272,RC,27201316,CDM,,,,,,both,,,295.0000,44.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,95.29,,,,,,,76.1400,295.0000,other,32.3% of $295.00 in Billed Charges for Rev 272 = $95.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH PREMIE PICC 1FR 1261.2,272,RC,27201316,CDM,,,,,,both,,,295.0000,44.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,90.57,,,,,,,76.1400,295.0000,other,30.7% of $295.00 in Billed Charges for Rev 272 = $90.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH PREMIE PICC 1FR 1261.2,272,RC,27201316,CDM,,,,,,both,,,295.0000,44.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,95.29,,,,,,,76.1400,295.0000,percent of total billed charges,32.3% of $295.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH PREMIE PICC 1FR 1261.2,272,RC,27201316,CDM,,,,,,both,,,295.0000,44.2500,WELLCARE,WELLCARE MEDICAID,295.00,,,,,,,76.1400,295.0000,percent of total billed charges,100% of $295.00 in Billed Charges for Rev 272 = $295.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH RADIAL ACCESS SAN21RDBIA,272,RC,27201317,CDM,,,,,,both,,,516.0000,77.4000,AETNA,AETNA,220.33,,,,,,,133.1800,516.0000,percent of total billed charges,42.7% of $516.00 in Billed Charges for Rev 272 = $220.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH RADIAL ACCESS SAN21RDBIA,272,RC,27201317,CDM,,,,,,both,,,516.0000,77.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,361.20,,,,,,,133.1800,516.0000,percent of total billed charges,Rev 272 $516.00 in Billed Charges at 70% = $361.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH RADIAL ACCESS SAN21RDBIA,272,RC,27201317,CDM,,,,,,both,,,516.0000,77.4000,CIGNA HEALTHCARE,CIGNA HMO,215.17,,,,,,,133.1800,516.0000,percent of total billed charges,41.7% of $516.00 in Billed Charges for Rev 272 = $215.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH RADIAL ACCESS SAN21RDBIA,272,RC,27201317,CDM,,,,,,both,,,516.0000,77.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,239.42,,,,,,,133.1800,516.0000,percent of total billed charges,46.4% of $516.00 in Billed Charges for Rev 272 = $239.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH RADIAL ACCESS SAN21RDBIA,272,RC,27201317,CDM,,,,,,both,,,516.0000,77.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,215.17,,,,,,,133.1800,516.0000,percent of total billed charges,41.7% of $516.00 in Billed Charges for Rev 272 = $215.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH RADIAL ACCESS SAN21RDBIA,272,RC,27201317,CDM,,,,,,both,,,516.0000,77.4000,CIGNA HEALTHCARE,CIGNA PPO,215.17,,,,,,,133.1800,516.0000,percent of total billed charges,41.7% of $516.00 in Billed Charges for Rev 272 = $215.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH RADIAL ACCESS SAN21RDBIA,272,RC,27201317,CDM,,,,,,both,,,516.0000,77.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,464.40,,,,,,,133.1800,516.0000,percent of total billed charges,90% of $516.00 in Billed Charges for Rev 272 = $464.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH RADIAL ACCESS SAN21RDBIA,272,RC,27201317,CDM,,,,,,both,,,516.0000,77.4000,MEDCOST,MEDCOST VHN,245.56,,,,,,,133.1800,516.0000,percent of total billed charges,47.59% of $516.00 in Billed Charges for Rev 272 = $245.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH RADIAL ACCESS SAN21RDBIA,272,RC,27201317,CDM,,,,,,both,,,516.0000,77.4000,SENTARA HEALTH,SENTARA HEALTH,133.18,,,,,,,133.1800,516.0000,percent of total billed charges,25.81% of $516.00 in Billed Charges for Rev 272 = $133.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH RADIAL ACCESS SAN21RDBIA,272,RC,27201317,CDM,,,,,,both,,,516.0000,77.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",516.00,,,,,,,133.1800,516.0000,percent of total billed charges,100% of $516.00 in Billed Charges for Rev 272 = $516.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH RADIAL ACCESS SAN21RDBIA,272,RC,27201317,CDM,,,,,,both,,,516.0000,77.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,258.00,,,,,,,133.1800,516.0000,percent of total billed charges,Rev 272 $516.00 in Billed Charges at 50% = $258.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH RADIAL ACCESS SAN21RDBIA,272,RC,27201317,CDM,,,,,,both,,,516.0000,77.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,166.67,,,,,,,133.1800,516.0000,other,32.3% of $516.00 in Billed Charges for Rev 272 = $166.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH RADIAL ACCESS SAN21RDBIA,272,RC,27201317,CDM,,,,,,both,,,516.0000,77.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,158.41,,,,,,,133.1800,516.0000,other,30.7% of $516.00 in Billed Charges for Rev 272 = $158.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH RADIAL ACCESS SAN21RDBIA,272,RC,27201317,CDM,,,,,,both,,,516.0000,77.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,166.67,,,,,,,133.1800,516.0000,percent of total billed charges,32.3% of $516.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH RADIAL ACCESS SAN21RDBIA,272,RC,27201317,CDM,,,,,,both,,,516.0000,77.4000,WELLCARE,WELLCARE MEDICAID,516.00,,,,,,,133.1800,516.0000,percent of total billed charges,100% of $516.00 in Billed Charges for Rev 272 = $516.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SWAN GANZ #834HF75,272,RC,27200524,CDM,,,,,,both,,,318.0000,47.7000,AETNA,AETNA,135.79,,,,,,,82.0800,318.0000,percent of total billed charges,42.7% of $318.00 in Billed Charges for Rev 272 = $135.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SWAN GANZ #834HF75,272,RC,27200524,CDM,,,,,,both,,,318.0000,47.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,222.60,,,,,,,82.0800,318.0000,percent of total billed charges,Rev 272 $318.00 in Billed Charges at 70% = $222.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SWAN GANZ #834HF75,272,RC,27200524,CDM,,,,,,both,,,318.0000,47.7000,CIGNA HEALTHCARE,CIGNA HMO,132.61,,,,,,,82.0800,318.0000,percent of total billed charges,41.7% of $318.00 in Billed Charges for Rev 272 = $132.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SWAN GANZ #834HF75,272,RC,27200524,CDM,,,,,,both,,,318.0000,47.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,147.55,,,,,,,82.0800,318.0000,percent of total billed charges,46.4% of $318.00 in Billed Charges for Rev 272 = $147.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SWAN GANZ #834HF75,272,RC,27200524,CDM,,,,,,both,,,318.0000,47.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,132.61,,,,,,,82.0800,318.0000,percent of total billed charges,41.7% of $318.00 in Billed Charges for Rev 272 = $132.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SWAN GANZ #834HF75,272,RC,27200524,CDM,,,,,,both,,,318.0000,47.7000,CIGNA HEALTHCARE,CIGNA PPO,132.61,,,,,,,82.0800,318.0000,percent of total billed charges,41.7% of $318.00 in Billed Charges for Rev 272 = $132.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SWAN GANZ #834HF75,272,RC,27200524,CDM,,,,,,both,,,318.0000,47.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,286.20,,,,,,,82.0800,318.0000,percent of total billed charges,90% of $318.00 in Billed Charges for Rev 272 = $286.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SWAN GANZ #834HF75,272,RC,27200524,CDM,,,,,,both,,,318.0000,47.7000,MEDCOST,MEDCOST VHN,151.34,,,,,,,82.0800,318.0000,percent of total billed charges,47.59% of $318.00 in Billed Charges for Rev 272 = $151.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SWAN GANZ #834HF75,272,RC,27200524,CDM,,,,,,both,,,318.0000,47.7000,SENTARA HEALTH,SENTARA HEALTH,82.08,,,,,,,82.0800,318.0000,percent of total billed charges,25.81% of $318.00 in Billed Charges for Rev 272 = $82.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SWAN GANZ #834HF75,272,RC,27200524,CDM,,,,,,both,,,318.0000,47.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",318.00,,,,,,,82.0800,318.0000,percent of total billed charges,100% of $318.00 in Billed Charges for Rev 272 = $318.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SWAN GANZ #834HF75,272,RC,27200524,CDM,,,,,,both,,,318.0000,47.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,159.00,,,,,,,82.0800,318.0000,percent of total billed charges,Rev 272 $318.00 in Billed Charges at 50% = $159.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SWAN GANZ #834HF75,272,RC,27200524,CDM,,,,,,both,,,318.0000,47.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,102.71,,,,,,,82.0800,318.0000,other,32.3% of $318.00 in Billed Charges for Rev 272 = $102.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH SWAN GANZ #834HF75,272,RC,27200524,CDM,,,,,,both,,,318.0000,47.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,97.63,,,,,,,82.0800,318.0000,other,30.7% of $318.00 in Billed Charges for Rev 272 = $97.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH SWAN GANZ #834HF75,272,RC,27200524,CDM,,,,,,both,,,318.0000,47.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,102.71,,,,,,,82.0800,318.0000,percent of total billed charges,32.3% of $318.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH SWAN GANZ #834HF75,272,RC,27200524,CDM,,,,,,both,,,318.0000,47.7000,WELLCARE,WELLCARE MEDICAID,318.00,,,,,,,82.0800,318.0000,percent of total billed charges,100% of $318.00 in Billed Charges for Rev 272 = $318.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH TWIN PASS 3F 134CM 5200,272,RC,27801472,CDM,,,,,,both,,,1471.0000,220.6500,AETNA,AETNA,628.12,,,,,,,379.6700,1471.0000,percent of total billed charges,"42.7% of $1,471.00 in Billed Charges for Rev 272 = $628.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH TWIN PASS 3F 134CM 5200,272,RC,27801472,CDM,,,,,,both,,,1471.0000,220.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1029.70,,,,,,,379.6700,1471.0000,percent of total billed charges,"Rev 272 $1,471.00 in Billed Charges at 70% = $1,029.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH TWIN PASS 3F 134CM 5200,272,RC,27801472,CDM,,,,,,both,,,1471.0000,220.6500,CIGNA HEALTHCARE,CIGNA HMO,613.41,,,,,,,379.6700,1471.0000,percent of total billed charges,"41.7% of $1,471.00 in Billed Charges for Rev 272 = $613.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH TWIN PASS 3F 134CM 5200,272,RC,27801472,CDM,,,,,,both,,,1471.0000,220.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,682.54,,,,,,,379.6700,1471.0000,percent of total billed charges,"46.4% of $1,471.00 in Billed Charges for Rev 272 = $682.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH TWIN PASS 3F 134CM 5200,272,RC,27801472,CDM,,,,,,both,,,1471.0000,220.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,613.41,,,,,,,379.6700,1471.0000,percent of total billed charges,"41.7% of $1,471.00 in Billed Charges for Rev 272 = $613.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH TWIN PASS 3F 134CM 5200,272,RC,27801472,CDM,,,,,,both,,,1471.0000,220.6500,CIGNA HEALTHCARE,CIGNA PPO,613.41,,,,,,,379.6700,1471.0000,percent of total billed charges,"41.7% of $1,471.00 in Billed Charges for Rev 272 = $613.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH TWIN PASS 3F 134CM 5200,272,RC,27801472,CDM,,,,,,both,,,1471.0000,220.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1323.90,,,,,,,379.6700,1471.0000,percent of total billed charges,"90% of $1,471.00 in Billed Charges for Rev 272 = $1,323.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH TWIN PASS 3F 134CM 5200,272,RC,27801472,CDM,,,,,,both,,,1471.0000,220.6500,MEDCOST,MEDCOST VHN,700.05,,,,,,,379.6700,1471.0000,percent of total billed charges,"47.59% of $1,471.00 in Billed Charges for Rev 272 = $700.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH TWIN PASS 3F 134CM 5200,272,RC,27801472,CDM,,,,,,both,,,1471.0000,220.6500,SENTARA HEALTH,SENTARA HEALTH,379.67,,,,,,,379.6700,1471.0000,percent of total billed charges,"25.81% of $1,471.00 in Billed Charges for Rev 272 = $379.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH TWIN PASS 3F 134CM 5200,272,RC,27801472,CDM,,,,,,both,,,1471.0000,220.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1471.00,,,,,,,379.6700,1471.0000,percent of total billed charges,"100% of $1,471.00 in Billed Charges for Rev 272 = $1,471.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH TWIN PASS 3F 134CM 5200,272,RC,27801472,CDM,,,,,,both,,,1471.0000,220.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,735.50,,,,,,,379.6700,1471.0000,percent of total billed charges,"Rev 272 $1,471.00 in Billed Charges at 50% = $735.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH TWIN PASS 3F 134CM 5200,272,RC,27801472,CDM,,,,,,both,,,1471.0000,220.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,475.13,,,,,,,379.6700,1471.0000,other,"32.3% of $1,471.00 in Billed Charges for Rev 272 = $475.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH TWIN PASS 3F 134CM 5200,272,RC,27801472,CDM,,,,,,both,,,1471.0000,220.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,451.60,,,,,,,379.6700,1471.0000,other,"30.7% of $1,471.00 in Billed Charges for Rev 272 = $451.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH TWIN PASS 3F 134CM 5200,272,RC,27801472,CDM,,,,,,both,,,1471.0000,220.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,475.13,,,,,,,379.6700,1471.0000,percent of total billed charges,"32.3% of $1,471.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH TWIN PASS 3F 134CM 5200,272,RC,27801472,CDM,,,,,,both,,,1471.0000,220.6500,WELLCARE,WELLCARE MEDICAID,1471.00,,,,,,,379.6700,1471.0000,percent of total billed charges,"100% of $1,471.00 in Billed Charges for Rev 272 = $1,471.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SUBDURAL EVACUATING PORT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,18944.1900,2841.6300,AETNA,AETNA,8089.17,,,,,,,4889.5000,18944.1900,percent of total billed charges,"42.7% of $18,944.19 in Billed Charges for Rev 272 = $8,089.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SUBDURAL EVACUATING PORT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,18944.1900,2841.6300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,13260.93,,,,,,,4889.5000,18944.1900,percent of total billed charges,"Rev 272 $18,944.19 in Billed Charges at 70% = $13,260.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SUBDURAL EVACUATING PORT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,18944.1900,2841.6300,CIGNA HEALTHCARE,CIGNA HMO,7899.73,,,,,,,4889.5000,18944.1900,percent of total billed charges,"41.7% of $18,944.19 in Billed Charges for Rev 272 = $7,899.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SUBDURAL EVACUATING PORT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,18944.1900,2841.6300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8790.10,,,,,,,4889.5000,18944.1900,percent of total billed charges,"46.4% of $18,944.19 in Billed Charges for Rev 272 = $8,790.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SUBDURAL EVACUATING PORT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,18944.1900,2841.6300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7899.73,,,,,,,4889.5000,18944.1900,percent of total billed charges,"41.7% of $18,944.19 in Billed Charges for Rev 272 = $7,899.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SUBDURAL EVACUATING PORT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,18944.1900,2841.6300,CIGNA HEALTHCARE,CIGNA PPO,7899.73,,,,,,,4889.5000,18944.1900,percent of total billed charges,"41.7% of $18,944.19 in Billed Charges for Rev 272 = $7,899.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SUBDURAL EVACUATING PORT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,18944.1900,2841.6300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,17049.77,,,,,,,4889.5000,18944.1900,percent of total billed charges,"90% of $18,944.19 in Billed Charges for Rev 272 = $17,049.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SUBDURAL EVACUATING PORT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,18944.1900,2841.6300,MEDCOST,MEDCOST VHN,9015.54,,,,,,,4889.5000,18944.1900,percent of total billed charges,"47.59% of $18,944.19 in Billed Charges for Rev 272 = $9,015.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SUBDURAL EVACUATING PORT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,18944.1900,2841.6300,SENTARA HEALTH,SENTARA HEALTH,4889.50,,,,,,,4889.5000,18944.1900,percent of total billed charges,"25.81% of $18,944.19 in Billed Charges for Rev 272 = $4,889.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SUBDURAL EVACUATING PORT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,18944.1900,2841.6300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",18944.19,,,,,,,4889.5000,18944.1900,percent of total billed charges,"100% of $18,944.19 in Billed Charges for Rev 272 = $18,944.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SUBDURAL EVACUATING PORT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,18944.1900,2841.6300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9472.10,,,,,,,4889.5000,18944.1900,percent of total billed charges,"Rev 272 $18,944.19 in Billed Charges at 50% = $9,472.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SUBDURAL EVACUATING PORT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,18944.1900,2841.6300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,6118.97,,,,,,,4889.5000,18944.1900,other,"32.3% of $18,944.19 in Billed Charges for Rev 272 = $6,118.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT SUBDURAL EVACUATING PORT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,18944.1900,2841.6300,UNITED HEALTHCARE,UHC HERITAGE SELECT,5815.87,,,,,,,4889.5000,18944.1900,other,"30.7% of $18,944.19 in Billed Charges for Rev 272 = $5,815.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT SUBDURAL EVACUATING PORT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,18944.1900,2841.6300,UNITED HEALTHCARE,UNITED HEALTHCARE,6118.97,,,,,,,4889.5000,18944.1900,percent of total billed charges,"32.3% of $18,944.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SUBDURAL EVACUATING PORT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,18944.1900,2841.6300,WELLCARE,WELLCARE MEDICAID,18944.19,,,,,,,4889.5000,18944.1900,percent of total billed charges,"100% of $18,944.19 in Billed Charges for Rev 272 = $18,944.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SUSPENSION SHOULDER PARCUS,272,RC,27200002,CDM,,,,,,both,,,456.3200,68.4500,AETNA,AETNA,194.85,,,,,,,117.7800,456.3200,percent of total billed charges,42.7% of $456.32 in Billed Charges for Rev 272 = $194.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SUSPENSION SHOULDER PARCUS,272,RC,27200002,CDM,,,,,,both,,,456.3200,68.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,319.42,,,,,,,117.7800,456.3200,percent of total billed charges,Rev 272 $456.32 in Billed Charges at 70% = $319.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SUSPENSION SHOULDER PARCUS,272,RC,27200002,CDM,,,,,,both,,,456.3200,68.4500,CIGNA HEALTHCARE,CIGNA HMO,190.29,,,,,,,117.7800,456.3200,percent of total billed charges,41.7% of $456.32 in Billed Charges for Rev 272 = $190.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SUSPENSION SHOULDER PARCUS,272,RC,27200002,CDM,,,,,,both,,,456.3200,68.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,211.73,,,,,,,117.7800,456.3200,percent of total billed charges,46.4% of $456.32 in Billed Charges for Rev 272 = $211.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SUSPENSION SHOULDER PARCUS,272,RC,27200002,CDM,,,,,,both,,,456.3200,68.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,190.29,,,,,,,117.7800,456.3200,percent of total billed charges,41.7% of $456.32 in Billed Charges for Rev 272 = $190.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SUSPENSION SHOULDER PARCUS,272,RC,27200002,CDM,,,,,,both,,,456.3200,68.4500,CIGNA HEALTHCARE,CIGNA PPO,190.29,,,,,,,117.7800,456.3200,percent of total billed charges,41.7% of $456.32 in Billed Charges for Rev 272 = $190.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SUSPENSION SHOULDER PARCUS,272,RC,27200002,CDM,,,,,,both,,,456.3200,68.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,410.69,,,,,,,117.7800,456.3200,percent of total billed charges,90% of $456.32 in Billed Charges for Rev 272 = $410.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SUSPENSION SHOULDER PARCUS,272,RC,27200002,CDM,,,,,,both,,,456.3200,68.4500,MEDCOST,MEDCOST VHN,217.16,,,,,,,117.7800,456.3200,percent of total billed charges,47.59% of $456.32 in Billed Charges for Rev 272 = $217.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SUSPENSION SHOULDER PARCUS,272,RC,27200002,CDM,,,,,,both,,,456.3200,68.4500,SENTARA HEALTH,SENTARA HEALTH,117.78,,,,,,,117.7800,456.3200,percent of total billed charges,25.81% of $456.32 in Billed Charges for Rev 272 = $117.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SUSPENSION SHOULDER PARCUS,272,RC,27200002,CDM,,,,,,both,,,456.3200,68.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",456.32,,,,,,,117.7800,456.3200,percent of total billed charges,100% of $456.32 in Billed Charges for Rev 272 = $456.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SUSPENSION SHOULDER PARCUS,272,RC,27200002,CDM,,,,,,both,,,456.3200,68.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,228.16,,,,,,,117.7800,456.3200,percent of total billed charges,Rev 272 $456.32 in Billed Charges at 50% = $228.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SUSPENSION SHOULDER PARCUS,272,RC,27200002,CDM,,,,,,both,,,456.3200,68.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,147.39,,,,,,,117.7800,456.3200,other,32.3% of $456.32 in Billed Charges for Rev 272 = $147.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT SUSPENSION SHOULDER PARCUS,272,RC,27200002,CDM,,,,,,both,,,456.3200,68.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,140.09,,,,,,,117.7800,456.3200,other,30.7% of $456.32 in Billed Charges for Rev 272 = $140.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT SUSPENSION SHOULDER PARCUS,272,RC,27200002,CDM,,,,,,both,,,456.3200,68.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,147.39,,,,,,,117.7800,456.3200,percent of total billed charges,32.3% of $456.32 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SUSPENSION SHOULDER PARCUS,272,RC,27200002,CDM,,,,,,both,,,456.3200,68.4500,WELLCARE,WELLCARE MEDICAID,456.32,,,,,,,117.7800,456.3200,percent of total billed charges,100% of $456.32 in Billed Charges for Rev 272 = $456.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH TWIN TWO LUMEN 20/22 IV01100,272,RC,27200070,CDM,,,,,,both,,,63.0000,9.4500,AETNA,AETNA,26.90,,,,,,,16.2600,63.0000,percent of total billed charges,42.7% of $63.00 in Billed Charges for Rev 272 = $26.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH TWIN TWO LUMEN 20/22 IV01100,272,RC,27200070,CDM,,,,,,both,,,63.0000,9.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,44.10,,,,,,,16.2600,63.0000,percent of total billed charges,Rev 272 $63.00 in Billed Charges at 70% = $44.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH TWIN TWO LUMEN 20/22 IV01100,272,RC,27200070,CDM,,,,,,both,,,63.0000,9.4500,CIGNA HEALTHCARE,CIGNA HMO,26.27,,,,,,,16.2600,63.0000,percent of total billed charges,41.7% of $63.00 in Billed Charges for Rev 272 = $26.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH TWIN TWO LUMEN 20/22 IV01100,272,RC,27200070,CDM,,,,,,both,,,63.0000,9.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,29.23,,,,,,,16.2600,63.0000,percent of total billed charges,46.4% of $63.00 in Billed Charges for Rev 272 = $29.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH TWIN TWO LUMEN 20/22 IV01100,272,RC,27200070,CDM,,,,,,both,,,63.0000,9.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,26.27,,,,,,,16.2600,63.0000,percent of total billed charges,41.7% of $63.00 in Billed Charges for Rev 272 = $26.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH TWIN TWO LUMEN 20/22 IV01100,272,RC,27200070,CDM,,,,,,both,,,63.0000,9.4500,CIGNA HEALTHCARE,CIGNA PPO,26.27,,,,,,,16.2600,63.0000,percent of total billed charges,41.7% of $63.00 in Billed Charges for Rev 272 = $26.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH TWIN TWO LUMEN 20/22 IV01100,272,RC,27200070,CDM,,,,,,both,,,63.0000,9.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,56.70,,,,,,,16.2600,63.0000,percent of total billed charges,90% of $63.00 in Billed Charges for Rev 272 = $56.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH TWIN TWO LUMEN 20/22 IV01100,272,RC,27200070,CDM,,,,,,both,,,63.0000,9.4500,MEDCOST,MEDCOST VHN,29.98,,,,,,,16.2600,63.0000,percent of total billed charges,47.59% of $63.00 in Billed Charges for Rev 272 = $29.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH TWIN TWO LUMEN 20/22 IV01100,272,RC,27200070,CDM,,,,,,both,,,63.0000,9.4500,SENTARA HEALTH,SENTARA HEALTH,16.26,,,,,,,16.2600,63.0000,percent of total billed charges,25.81% of $63.00 in Billed Charges for Rev 272 = $16.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH TWIN TWO LUMEN 20/22 IV01100,272,RC,27200070,CDM,,,,,,both,,,63.0000,9.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",63.00,,,,,,,16.2600,63.0000,percent of total billed charges,100% of $63.00 in Billed Charges for Rev 272 = $63.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH TWIN TWO LUMEN 20/22 IV01100,272,RC,27200070,CDM,,,,,,both,,,63.0000,9.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,31.50,,,,,,,16.2600,63.0000,percent of total billed charges,Rev 272 $63.00 in Billed Charges at 50% = $31.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH TWIN TWO LUMEN 20/22 IV01100,272,RC,27200070,CDM,,,,,,both,,,63.0000,9.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,20.35,,,,,,,16.2600,63.0000,other,32.3% of $63.00 in Billed Charges for Rev 272 = $20.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH TWIN TWO LUMEN 20/22 IV01100,272,RC,27200070,CDM,,,,,,both,,,63.0000,9.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,19.34,,,,,,,16.2600,63.0000,other,30.7% of $63.00 in Billed Charges for Rev 272 = $19.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH TWIN TWO LUMEN 20/22 IV01100,272,RC,27200070,CDM,,,,,,both,,,63.0000,9.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,20.35,,,,,,,16.2600,63.0000,percent of total billed charges,32.3% of $63.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH TWIN TWO LUMEN 20/22 IV01100,272,RC,27200070,CDM,,,,,,both,,,63.0000,9.4500,WELLCARE,WELLCARE MEDICAID,63.00,,,,,,,16.2600,63.0000,percent of total billed charges,100% of $63.00 in Billed Charges for Rev 272 = $63.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATHETER YUEH,272,RC,27200531,CDM,,,,,,both,,,129.0000,19.3500,AETNA,AETNA,55.08,,,,,,,33.2900,129.0000,percent of total billed charges,42.7% of $129.00 in Billed Charges for Rev 272 = $55.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATHETER YUEH,272,RC,27200531,CDM,,,,,,both,,,129.0000,19.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,90.30,,,,,,,33.2900,129.0000,percent of total billed charges,Rev 272 $129.00 in Billed Charges at 70% = $90.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATHETER YUEH,272,RC,27200531,CDM,,,,,,both,,,129.0000,19.3500,CIGNA HEALTHCARE,CIGNA HMO,53.79,,,,,,,33.2900,129.0000,percent of total billed charges,41.7% of $129.00 in Billed Charges for Rev 272 = $53.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATHETER YUEH,272,RC,27200531,CDM,,,,,,both,,,129.0000,19.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,59.86,,,,,,,33.2900,129.0000,percent of total billed charges,46.4% of $129.00 in Billed Charges for Rev 272 = $59.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATHETER YUEH,272,RC,27200531,CDM,,,,,,both,,,129.0000,19.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,53.79,,,,,,,33.2900,129.0000,percent of total billed charges,41.7% of $129.00 in Billed Charges for Rev 272 = $53.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATHETER YUEH,272,RC,27200531,CDM,,,,,,both,,,129.0000,19.3500,CIGNA HEALTHCARE,CIGNA PPO,53.79,,,,,,,33.2900,129.0000,percent of total billed charges,41.7% of $129.00 in Billed Charges for Rev 272 = $53.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATHETER YUEH,272,RC,27200531,CDM,,,,,,both,,,129.0000,19.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,116.10,,,,,,,33.2900,129.0000,percent of total billed charges,90% of $129.00 in Billed Charges for Rev 272 = $116.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATHETER YUEH,272,RC,27200531,CDM,,,,,,both,,,129.0000,19.3500,MEDCOST,MEDCOST VHN,61.39,,,,,,,33.2900,129.0000,percent of total billed charges,47.59% of $129.00 in Billed Charges for Rev 272 = $61.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATHETER YUEH,272,RC,27200531,CDM,,,,,,both,,,129.0000,19.3500,SENTARA HEALTH,SENTARA HEALTH,33.29,,,,,,,33.2900,129.0000,percent of total billed charges,25.81% of $129.00 in Billed Charges for Rev 272 = $33.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATHETER YUEH,272,RC,27200531,CDM,,,,,,both,,,129.0000,19.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",129.00,,,,,,,33.2900,129.0000,percent of total billed charges,100% of $129.00 in Billed Charges for Rev 272 = $129.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATHETER YUEH,272,RC,27200531,CDM,,,,,,both,,,129.0000,19.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,64.50,,,,,,,33.2900,129.0000,percent of total billed charges,Rev 272 $129.00 in Billed Charges at 50% = $64.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATHETER YUEH,272,RC,27200531,CDM,,,,,,both,,,129.0000,19.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,41.67,,,,,,,33.2900,129.0000,other,32.3% of $129.00 in Billed Charges for Rev 272 = $41.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATHETER YUEH,272,RC,27200531,CDM,,,,,,both,,,129.0000,19.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,39.60,,,,,,,33.2900,129.0000,other,30.7% of $129.00 in Billed Charges for Rev 272 = $39.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATHETER YUEH,272,RC,27200531,CDM,,,,,,both,,,129.0000,19.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,41.67,,,,,,,33.2900,129.0000,percent of total billed charges,32.3% of $129.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATHETER YUEH,272,RC,27200531,CDM,,,,,,both,,,129.0000,19.3500,WELLCARE,WELLCARE MEDICAID,129.00,,,,,,,33.2900,129.0000,percent of total billed charges,100% of $129.00 in Billed Charges for Rev 272 = $129.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CBL 10 PN DUO-DECA(RED)401972,272,RC,27200532,CDM,,,,,,both,,,507.0000,76.0500,AETNA,AETNA,216.49,,,,,,,130.8600,507.0000,percent of total billed charges,42.7% of $507.00 in Billed Charges for Rev 272 = $216.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CBL 10 PN DUO-DECA(RED)401972,272,RC,27200532,CDM,,,,,,both,,,507.0000,76.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,354.90,,,,,,,130.8600,507.0000,percent of total billed charges,Rev 272 $507.00 in Billed Charges at 70% = $354.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CBL 10 PN DUO-DECA(RED)401972,272,RC,27200532,CDM,,,,,,both,,,507.0000,76.0500,CIGNA HEALTHCARE,CIGNA HMO,211.42,,,,,,,130.8600,507.0000,percent of total billed charges,41.7% of $507.00 in Billed Charges for Rev 272 = $211.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CBL 10 PN DUO-DECA(RED)401972,272,RC,27200532,CDM,,,,,,both,,,507.0000,76.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,235.25,,,,,,,130.8600,507.0000,percent of total billed charges,46.4% of $507.00 in Billed Charges for Rev 272 = $235.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CBL 10 PN DUO-DECA(RED)401972,272,RC,27200532,CDM,,,,,,both,,,507.0000,76.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,211.42,,,,,,,130.8600,507.0000,percent of total billed charges,41.7% of $507.00 in Billed Charges for Rev 272 = $211.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CBL 10 PN DUO-DECA(RED)401972,272,RC,27200532,CDM,,,,,,both,,,507.0000,76.0500,CIGNA HEALTHCARE,CIGNA PPO,211.42,,,,,,,130.8600,507.0000,percent of total billed charges,41.7% of $507.00 in Billed Charges for Rev 272 = $211.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CBL 10 PN DUO-DECA(RED)401972,272,RC,27200532,CDM,,,,,,both,,,507.0000,76.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,456.30,,,,,,,130.8600,507.0000,percent of total billed charges,90% of $507.00 in Billed Charges for Rev 272 = $456.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CBL 10 PN DUO-DECA(RED)401972,272,RC,27200532,CDM,,,,,,both,,,507.0000,76.0500,MEDCOST,MEDCOST VHN,241.28,,,,,,,130.8600,507.0000,percent of total billed charges,47.59% of $507.00 in Billed Charges for Rev 272 = $241.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CBL 10 PN DUO-DECA(RED)401972,272,RC,27200532,CDM,,,,,,both,,,507.0000,76.0500,SENTARA HEALTH,SENTARA HEALTH,130.86,,,,,,,130.8600,507.0000,percent of total billed charges,25.81% of $507.00 in Billed Charges for Rev 272 = $130.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CBL 10 PN DUO-DECA(RED)401972,272,RC,27200532,CDM,,,,,,both,,,507.0000,76.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",507.00,,,,,,,130.8600,507.0000,percent of total billed charges,100% of $507.00 in Billed Charges for Rev 272 = $507.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CBL 10 PN DUO-DECA(RED)401972,272,RC,27200532,CDM,,,,,,both,,,507.0000,76.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,253.50,,,,,,,130.8600,507.0000,percent of total billed charges,Rev 272 $507.00 in Billed Charges at 50% = $253.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CBL 10 PN DUO-DECA(RED)401972,272,RC,27200532,CDM,,,,,,both,,,507.0000,76.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,163.76,,,,,,,130.8600,507.0000,other,32.3% of $507.00 in Billed Charges for Rev 272 = $163.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBL 10 PN DUO-DECA(RED)401972,272,RC,27200532,CDM,,,,,,both,,,507.0000,76.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,155.65,,,,,,,130.8600,507.0000,other,30.7% of $507.00 in Billed Charges for Rev 272 = $155.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBL 10 PN DUO-DECA(RED)401972,272,RC,27200532,CDM,,,,,,both,,,507.0000,76.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,163.76,,,,,,,130.8600,507.0000,percent of total billed charges,32.3% of $507.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CBL 10 PN DUO-DECA(RED)401972,272,RC,27200532,CDM,,,,,,both,,,507.0000,76.0500,WELLCARE,WELLCARE MEDICAID,507.00,,,,,,,130.8600,507.0000,percent of total billed charges,100% of $507.00 in Billed Charges for Rev 272 = $507.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ICU TRAUMA ROOM DLY,208,RC,20800001,CDM,,,,,,inpatient,,,5305.0000,795.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,121.7600,5305.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC ICU TRAUMA ROOM DLY,208,RC,20800001,CDM,,,,,,inpatient,,,5305.0000,795.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4774.50,,,,,,,121.7600,5305.0000,percent of total billed charges,"90% of $5,305.00 in Billed Charges for Rev 208 = $4,774.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ICU TRAUMA ROOM DLY,208,RC,20800001,CDM,,,,,,inpatient,,,5305.0000,795.7500,MEDCOST,MEDCOST VHN,2524.65,,,,,,,121.7600,5305.0000,percent of total billed charges,"47.59% of $5,305.00 in Billed Charges for Rev 208 = $2,524.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ICU TRAUMA ROOM DLY,208,RC,20800001,CDM,,,,,,inpatient,,,5305.0000,795.7500,SENTARA HEALTH,SENTARA HEALTH,1977.70,,,,,,,121.7600,5305.0000,percent of total billed charges,"37.28% of $5,305.00 in Billed Charges for Rev 208 = $1,977.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ICU TRAUMA ROOM DLY,208,RC,20800001,CDM,,,,,,inpatient,,,5305.0000,795.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5305.00,,,,,,,121.7600,5305.0000,percent of total billed charges,"100% of $5,305.00 in Billed Charges for Rev 208 = $5,305.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SYRINGE TRAUMACEM V+ 03.702.150S,272,RC,27200002,CDM,,,,,,both,,,1307.4700,196.1200,AETNA,AETNA,558.29,,,,,,,337.4600,1307.4700,percent of total billed charges,"42.7% of $1,307.47 in Billed Charges for Rev 272 = $558.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SYRINGE TRAUMACEM V+ 03.702.150S,272,RC,27200002,CDM,,,,,,both,,,1307.4700,196.1200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,915.23,,,,,,,337.4600,1307.4700,percent of total billed charges,"Rev 272 $1,307.47 in Billed Charges at 70% = $915.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SYRINGE TRAUMACEM V+ 03.702.150S,272,RC,27200002,CDM,,,,,,both,,,1307.4700,196.1200,CIGNA HEALTHCARE,CIGNA HMO,545.22,,,,,,,337.4600,1307.4700,percent of total billed charges,"41.7% of $1,307.47 in Billed Charges for Rev 272 = $545.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SYRINGE TRAUMACEM V+ 03.702.150S,272,RC,27200002,CDM,,,,,,both,,,1307.4700,196.1200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,606.67,,,,,,,337.4600,1307.4700,percent of total billed charges,"46.4% of $1,307.47 in Billed Charges for Rev 272 = $606.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SYRINGE TRAUMACEM V+ 03.702.150S,272,RC,27200002,CDM,,,,,,both,,,1307.4700,196.1200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,545.22,,,,,,,337.4600,1307.4700,percent of total billed charges,"41.7% of $1,307.47 in Billed Charges for Rev 272 = $545.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SYRINGE TRAUMACEM V+ 03.702.150S,272,RC,27200002,CDM,,,,,,both,,,1307.4700,196.1200,CIGNA HEALTHCARE,CIGNA PPO,545.22,,,,,,,337.4600,1307.4700,percent of total billed charges,"41.7% of $1,307.47 in Billed Charges for Rev 272 = $545.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SYRINGE TRAUMACEM V+ 03.702.150S,272,RC,27200002,CDM,,,,,,both,,,1307.4700,196.1200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1176.72,,,,,,,337.4600,1307.4700,percent of total billed charges,"90% of $1,307.47 in Billed Charges for Rev 272 = $1,176.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SYRINGE TRAUMACEM V+ 03.702.150S,272,RC,27200002,CDM,,,,,,both,,,1307.4700,196.1200,MEDCOST,MEDCOST VHN,622.23,,,,,,,337.4600,1307.4700,percent of total billed charges,"47.59% of $1,307.47 in Billed Charges for Rev 272 = $622.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SYRINGE TRAUMACEM V+ 03.702.150S,272,RC,27200002,CDM,,,,,,both,,,1307.4700,196.1200,SENTARA HEALTH,SENTARA HEALTH,337.46,,,,,,,337.4600,1307.4700,percent of total billed charges,"25.81% of $1,307.47 in Billed Charges for Rev 272 = $337.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SYRINGE TRAUMACEM V+ 03.702.150S,272,RC,27200002,CDM,,,,,,both,,,1307.4700,196.1200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1307.47,,,,,,,337.4600,1307.4700,percent of total billed charges,"100% of $1,307.47 in Billed Charges for Rev 272 = $1,307.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SYRINGE TRAUMACEM V+ 03.702.150S,272,RC,27200002,CDM,,,,,,both,,,1307.4700,196.1200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,653.74,,,,,,,337.4600,1307.4700,percent of total billed charges,"Rev 272 $1,307.47 in Billed Charges at 50% = $653.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SYRINGE TRAUMACEM V+ 03.702.150S,272,RC,27200002,CDM,,,,,,both,,,1307.4700,196.1200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,422.31,,,,,,,337.4600,1307.4700,other,"32.3% of $1,307.47 in Billed Charges for Rev 272 = $422.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT SYRINGE TRAUMACEM V+ 03.702.150S,272,RC,27200002,CDM,,,,,,both,,,1307.4700,196.1200,UNITED HEALTHCARE,UHC HERITAGE SELECT,401.39,,,,,,,337.4600,1307.4700,other,"30.7% of $1,307.47 in Billed Charges for Rev 272 = $401.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT SYRINGE TRAUMACEM V+ 03.702.150S,272,RC,27200002,CDM,,,,,,both,,,1307.4700,196.1200,UNITED HEALTHCARE,UNITED HEALTHCARE,422.31,,,,,,,337.4600,1307.4700,percent of total billed charges,"32.3% of $1,307.47 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SYRINGE TRAUMACEM V+ 03.702.150S,272,RC,27200002,CDM,,,,,,both,,,1307.4700,196.1200,WELLCARE,WELLCARE MEDICAID,1307.47,,,,,,,337.4600,1307.4700,percent of total billed charges,"100% of $1,307.47 in Billed Charges for Rev 272 = $1,307.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TITAN SHIFT DRL SZ 65 COMP,272,RC,,,,,,,,both,,,2947.3300,442.1000,AETNA,AETNA,1258.51,,,,,,,760.7100,2947.3300,percent of total billed charges,"42.7% of $2,947.33 in Billed Charges for Rev 272 = $1,258.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TITAN SHIFT DRL SZ 65 COMP,272,RC,,,,,,,,both,,,2947.3300,442.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2063.13,,,,,,,760.7100,2947.3300,percent of total billed charges,"Rev 272 $2,947.33 in Billed Charges at 70% = $2,063.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TITAN SHIFT DRL SZ 65 COMP,272,RC,,,,,,,,both,,,2947.3300,442.1000,CIGNA HEALTHCARE,CIGNA HMO,1229.04,,,,,,,760.7100,2947.3300,percent of total billed charges,"41.7% of $2,947.33 in Billed Charges for Rev 272 = $1,229.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TITAN SHIFT DRL SZ 65 COMP,272,RC,,,,,,,,both,,,2947.3300,442.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1367.56,,,,,,,760.7100,2947.3300,percent of total billed charges,"46.4% of $2,947.33 in Billed Charges for Rev 272 = $1,367.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TITAN SHIFT DRL SZ 65 COMP,272,RC,,,,,,,,both,,,2947.3300,442.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1229.04,,,,,,,760.7100,2947.3300,percent of total billed charges,"41.7% of $2,947.33 in Billed Charges for Rev 272 = $1,229.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TITAN SHIFT DRL SZ 65 COMP,272,RC,,,,,,,,both,,,2947.3300,442.1000,CIGNA HEALTHCARE,CIGNA PPO,1229.04,,,,,,,760.7100,2947.3300,percent of total billed charges,"41.7% of $2,947.33 in Billed Charges for Rev 272 = $1,229.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TITAN SHIFT DRL SZ 65 COMP,272,RC,,,,,,,,both,,,2947.3300,442.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2652.60,,,,,,,760.7100,2947.3300,percent of total billed charges,"90% of $2,947.33 in Billed Charges for Rev 272 = $2,652.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TITAN SHIFT DRL SZ 65 COMP,272,RC,,,,,,,,both,,,2947.3300,442.1000,MEDCOST,MEDCOST VHN,1402.63,,,,,,,760.7100,2947.3300,percent of total billed charges,"47.59% of $2,947.33 in Billed Charges for Rev 272 = $1,402.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TITAN SHIFT DRL SZ 65 COMP,272,RC,,,,,,,,both,,,2947.3300,442.1000,SENTARA HEALTH,SENTARA HEALTH,760.71,,,,,,,760.7100,2947.3300,percent of total billed charges,"25.81% of $2,947.33 in Billed Charges for Rev 272 = $760.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TITAN SHIFT DRL SZ 65 COMP,272,RC,,,,,,,,both,,,2947.3300,442.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2947.33,,,,,,,760.7100,2947.3300,percent of total billed charges,"100% of $2,947.33 in Billed Charges for Rev 272 = $2,947.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TITAN SHIFT DRL SZ 65 COMP,272,RC,,,,,,,,both,,,2947.3300,442.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1473.67,,,,,,,760.7100,2947.3300,percent of total billed charges,"Rev 272 $2,947.33 in Billed Charges at 50% = $1,473.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TITAN SHIFT DRL SZ 65 COMP,272,RC,,,,,,,,both,,,2947.3300,442.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,951.99,,,,,,,760.7100,2947.3300,other,"32.3% of $2,947.33 in Billed Charges for Rev 272 = $951.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT TITAN SHIFT DRL SZ 65 COMP,272,RC,,,,,,,,both,,,2947.3300,442.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,904.83,,,,,,,760.7100,2947.3300,other,"30.7% of $2,947.33 in Billed Charges for Rev 272 = $904.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT TITAN SHIFT DRL SZ 65 COMP,272,RC,,,,,,,,both,,,2947.3300,442.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,951.99,,,,,,,760.7100,2947.3300,percent of total billed charges,"32.3% of $2,947.33 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TITAN SHIFT DRL SZ 65 COMP,272,RC,,,,,,,,both,,,2947.3300,442.1000,WELLCARE,WELLCARE MEDICAID,2947.33,,,,,,,760.7100,2947.3300,percent of total billed charges,"100% of $2,947.33 in Billed Charges for Rev 272 = $2,947.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA RP SET INTRACARDIAC PUMP,278,RC,27800758,CDM,,,,,,both,,,59811.0000,8971.6500,AETNA,AETNA,28709.28,,,,,,,4246.5800,59811.0000,percent of total billed charges,"48% of $59,811.00 in Billed Charges for Rev 278 = $28,709.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA RP SET INTRACARDIAC PUMP,278,RC,27800758,CDM,,,,,,both,,,59811.0000,8971.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,29905.50,,,,,,,4246.5800,59811.0000,percent of total billed charges,"50% of $59,811.00 in Billed Charges for Rev 278 = $29,905.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA RP SET INTRACARDIAC PUMP,278,RC,27800758,CDM,,,,,,both,,,59811.0000,8971.6500,CIGNA HEALTHCARE,CIGNA HMO,24941.19,,,,,,,4246.5800,59811.0000,percent of total billed charges,"41.7% of $59,811.00 in Billed Charges for Rev 278 = $24,941.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA RP SET INTRACARDIAC PUMP,278,RC,27800758,CDM,,,,,,both,,,59811.0000,8971.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,23924.40,,,,,,,4246.5800,59811.0000,percent of total billed charges,"40% of $59,811.00 in Billed Charges for Rev 278 = $23,924.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA RP SET INTRACARDIAC PUMP,278,RC,27800758,CDM,,,,,,both,,,59811.0000,8971.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,24941.19,,,,,,,4246.5800,59811.0000,percent of total billed charges,"41.7% of $59,811.00 in Billed Charges for Rev 278 = $24,941.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA RP SET INTRACARDIAC PUMP,278,RC,27800758,CDM,,,,,,both,,,59811.0000,8971.6500,CIGNA HEALTHCARE,CIGNA PPO,24941.19,,,,,,,4246.5800,59811.0000,percent of total billed charges,"41.7% of $59,811.00 in Billed Charges for Rev 278 = $24,941.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA RP SET INTRACARDIAC PUMP,278,RC,27800758,CDM,,,,,,both,,,59811.0000,8971.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,53829.90,,,,,,,4246.5800,59811.0000,percent of total billed charges,"90% of $59,811.00 in Billed Charges for Rev 278 = $53,829.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA RP SET INTRACARDIAC PUMP,278,RC,27800758,CDM,,,,,,both,,,59811.0000,8971.6500,MEDCOST,MEDCOST VHN,28464.05,,,,,,,4246.5800,59811.0000,percent of total billed charges,"47.59% of $59,811.00 in Billed Charges for Rev 278 = $28,464.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA RP SET INTRACARDIAC PUMP,278,RC,27800758,CDM,,,,,,both,,,59811.0000,8971.6500,SENTARA HEALTH,SENTARA HEALTH,15437.22,,,,,,,4246.5800,59811.0000,percent of total billed charges,"25.81% of $59,811.00 in Billed Charges for Rev 278 = $15,437.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA RP SET INTRACARDIAC PUMP,278,RC,27800758,CDM,,,,,,both,,,59811.0000,8971.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",59811.00,,,,,,,4246.5800,59811.0000,percent of total billed charges,"100% of $59,811.00 in Billed Charges for Rev 278 = $59,811.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA RP SET INTRACARDIAC PUMP,278,RC,27800758,CDM,,,,,,both,,,59811.0000,8971.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,29905.50,,,,,,,4246.5800,59811.0000,percent of total billed charges,"Rev 278 $59,811.00 in Billed Charges at 50% = $29,905.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA RP SET INTRACARDIAC PUMP,278,RC,27800758,CDM,,,,,,both,,,59811.0000,8971.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4485.83,,,,,,,4246.5800,59811.0000,percent of total billed charges,"7.5% of $59,811.00 in Billed Charges for Rev 278 = $4,485.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA RP SET INTRACARDIAC PUMP,278,RC,27800758,CDM,,,,,,both,,,59811.0000,8971.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,4246.58,,,,,,,4246.5800,59811.0000,percent of total billed charges,"7.1% of $59,811.00 in Billed Charges for Rev 278 = $4,246.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA RP SET INTRACARDIAC PUMP,278,RC,27800758,CDM,,,,,,both,,,59811.0000,8971.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,4246.58,,,,,,,4246.5800,59811.0000,percent of total billed charges,"7.1% of $59,811.00 in Billed Charges for Rev 278 = $4,246.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC IMPELLA RP SET INTRACARDIAC PUMP,278,RC,27800758,CDM,,,,,,both,,,59811.0000,8971.6500,WELLCARE,WELLCARE MEDICAID,59811.00,,,,,,,4246.5800,59811.0000,percent of total billed charges,"100% of $59,811.00 in Billed Charges for Rev 278 = $59,811.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSULIN PUMP UPGRADE TRAINING,942,RC,94200012,CDM,,,,,,both,,,432.0000,64.8000,AETNA,AETNA,184.46,,,,,,,111.5000,432.0000,percent of total billed charges,42.7% of $432.00 in Billed Charges for Rev 942 = $184.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN PUMP UPGRADE TRAINING,942,RC,94200012,CDM,,,,,,both,,,432.0000,64.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,302.40,,,,,,,111.5000,432.0000,percent of total billed charges,Rev 942 $432.00 in Billed Charges at 70% = $302.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN PUMP UPGRADE TRAINING,942,RC,94200012,CDM,,,,,,both,,,432.0000,64.8000,CIGNA HEALTHCARE,CIGNA HMO,180.14,,,,,,,111.5000,432.0000,percent of total billed charges,41.7% of $432.00 in Billed Charges for Rev 942 = $180.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN PUMP UPGRADE TRAINING,942,RC,94200012,CDM,,,,,,both,,,432.0000,64.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,200.45,,,,,,,111.5000,432.0000,percent of total billed charges,46.4% of $432.00 in Billed Charges for Rev 942 = $200.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN PUMP UPGRADE TRAINING,942,RC,94200012,CDM,,,,,,both,,,432.0000,64.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,180.14,,,,,,,111.5000,432.0000,percent of total billed charges,41.7% of $432.00 in Billed Charges for Rev 942 = $180.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN PUMP UPGRADE TRAINING,942,RC,94200012,CDM,,,,,,both,,,432.0000,64.8000,CIGNA HEALTHCARE,CIGNA PPO,180.14,,,,,,,111.5000,432.0000,percent of total billed charges,41.7% of $432.00 in Billed Charges for Rev 942 = $180.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN PUMP UPGRADE TRAINING,942,RC,94200012,CDM,,,,,,both,,,432.0000,64.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,388.80,,,,,,,111.5000,432.0000,percent of total billed charges,90% of $432.00 in Billed Charges for Rev 942 = $388.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN PUMP UPGRADE TRAINING,942,RC,94200012,CDM,,,,,,both,,,432.0000,64.8000,MEDCOST,MEDCOST VHN,205.59,,,,,,,111.5000,432.0000,percent of total billed charges,47.59% of $432.00 in Billed Charges for Rev 942 = $205.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN PUMP UPGRADE TRAINING,942,RC,94200012,CDM,,,,,,both,,,432.0000,64.8000,SENTARA HEALTH,SENTARA HEALTH,111.50,,,,,,,111.5000,432.0000,percent of total billed charges,25.81% of $432.00 in Billed Charges for Rev 942 = $111.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN PUMP UPGRADE TRAINING,942,RC,94200012,CDM,,,,,,both,,,432.0000,64.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",432.00,,,,,,,111.5000,432.0000,percent of total billed charges,100% of $432.00 in Billed Charges for Rev 942 = $432.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN PUMP UPGRADE TRAINING,942,RC,94200012,CDM,,,,,,both,,,432.0000,64.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,216.00,,,,,,,111.5000,432.0000,percent of total billed charges,Rev 942 $432.00 in Billed Charges at 50% = $216.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN PUMP UPGRADE TRAINING,942,RC,94200012,CDM,,,,,,both,,,432.0000,64.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,432.00,,,,,,,111.5000,432.0000,other,"Rev 942 1 Visit at $505.00 per Visit = $505.00 (Service Line reduced to $432.00, claim capped at $432.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSULIN PUMP UPGRADE TRAINING,942,RC,94200012,CDM,,,,,,both,,,432.0000,64.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,432.00,,,,,,,111.5000,432.0000,other,"Rev 942 1 Visit at $484.00 per Visit = $484.00 (Service Line reduced to $432.00, claim capped at $432.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSULIN PUMP UPGRADE TRAINING,942,RC,94200012,CDM,,,,,,both,,,432.0000,64.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,432.00,,,,,,,111.5000,432.0000,other,"Rev 942 1 Visit at $795.00 per Visit = $795.00 (Service Line reduced to $432.00, claim capped at $432.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSULIN PUMP UPGRADE TRAINING,942,RC,94200012,CDM,,,,,,both,,,432.0000,64.8000,WELLCARE,WELLCARE MEDICAID,432.00,,,,,,,111.5000,432.0000,percent of total billed charges,100% of $432.00 in Billed Charges for Rev 942 = $432.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTROD NEEDLE BIOPINCE,272,RC,27200867,CDM,,,,,,both,,,93.0000,13.9500,AETNA,AETNA,39.71,,,,,,,24.0000,93.0000,percent of total billed charges,42.7% of $93.00 in Billed Charges for Rev 272 = $39.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTROD NEEDLE BIOPINCE,272,RC,27200867,CDM,,,,,,both,,,93.0000,13.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,65.10,,,,,,,24.0000,93.0000,percent of total billed charges,Rev 272 $93.00 in Billed Charges at 70% = $65.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTROD NEEDLE BIOPINCE,272,RC,27200867,CDM,,,,,,both,,,93.0000,13.9500,CIGNA HEALTHCARE,CIGNA HMO,38.78,,,,,,,24.0000,93.0000,percent of total billed charges,41.7% of $93.00 in Billed Charges for Rev 272 = $38.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTROD NEEDLE BIOPINCE,272,RC,27200867,CDM,,,,,,both,,,93.0000,13.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,43.15,,,,,,,24.0000,93.0000,percent of total billed charges,46.4% of $93.00 in Billed Charges for Rev 272 = $43.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTROD NEEDLE BIOPINCE,272,RC,27200867,CDM,,,,,,both,,,93.0000,13.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,38.78,,,,,,,24.0000,93.0000,percent of total billed charges,41.7% of $93.00 in Billed Charges for Rev 272 = $38.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTROD NEEDLE BIOPINCE,272,RC,27200867,CDM,,,,,,both,,,93.0000,13.9500,CIGNA HEALTHCARE,CIGNA PPO,38.78,,,,,,,24.0000,93.0000,percent of total billed charges,41.7% of $93.00 in Billed Charges for Rev 272 = $38.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTROD NEEDLE BIOPINCE,272,RC,27200867,CDM,,,,,,both,,,93.0000,13.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,83.70,,,,,,,24.0000,93.0000,percent of total billed charges,90% of $93.00 in Billed Charges for Rev 272 = $83.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTROD NEEDLE BIOPINCE,272,RC,27200867,CDM,,,,,,both,,,93.0000,13.9500,MEDCOST,MEDCOST VHN,44.26,,,,,,,24.0000,93.0000,percent of total billed charges,47.59% of $93.00 in Billed Charges for Rev 272 = $44.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTROD NEEDLE BIOPINCE,272,RC,27200867,CDM,,,,,,both,,,93.0000,13.9500,SENTARA HEALTH,SENTARA HEALTH,24.00,,,,,,,24.0000,93.0000,percent of total billed charges,25.81% of $93.00 in Billed Charges for Rev 272 = $24.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTROD NEEDLE BIOPINCE,272,RC,27200867,CDM,,,,,,both,,,93.0000,13.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",93.00,,,,,,,24.0000,93.0000,percent of total billed charges,100% of $93.00 in Billed Charges for Rev 272 = $93.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTROD NEEDLE BIOPINCE,272,RC,27200867,CDM,,,,,,both,,,93.0000,13.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,46.50,,,,,,,24.0000,93.0000,percent of total billed charges,Rev 272 $93.00 in Billed Charges at 50% = $46.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTROD NEEDLE BIOPINCE,272,RC,27200867,CDM,,,,,,both,,,93.0000,13.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,30.04,,,,,,,24.0000,93.0000,other,32.3% of $93.00 in Billed Charges for Rev 272 = $30.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTROD NEEDLE BIOPINCE,272,RC,27200867,CDM,,,,,,both,,,93.0000,13.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,28.55,,,,,,,24.0000,93.0000,other,30.7% of $93.00 in Billed Charges for Rev 272 = $28.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTROD NEEDLE BIOPINCE,272,RC,27200867,CDM,,,,,,both,,,93.0000,13.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,30.04,,,,,,,24.0000,93.0000,percent of total billed charges,32.3% of $93.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTROD NEEDLE BIOPINCE,272,RC,27200867,CDM,,,,,,both,,,93.0000,13.9500,WELLCARE,WELLCARE MEDICAID,93.00,,,,,,,24.0000,93.0000,percent of total billed charges,100% of $93.00 in Billed Charges for Rev 272 = $93.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ADAPTER DOUBLE PUMPING,270,RC,27000167,CDM,,,,,,both,,,126.0000,18.9000,AETNA,AETNA,53.80,,,,,,,32.5200,126.0000,percent of total billed charges,42.7% of $126.00 in Billed Charges for Rev 270 = $53.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ADAPTER DOUBLE PUMPING,270,RC,27000167,CDM,,,,,,both,,,126.0000,18.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,88.20,,,,,,,32.5200,126.0000,percent of total billed charges,Rev 270 $126.00 in Billed Charges at 70% = $88.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ADAPTER DOUBLE PUMPING,270,RC,27000167,CDM,,,,,,both,,,126.0000,18.9000,CIGNA HEALTHCARE,CIGNA HMO,52.54,,,,,,,32.5200,126.0000,percent of total billed charges,41.7% of $126.00 in Billed Charges for Rev 270 = $52.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ADAPTER DOUBLE PUMPING,270,RC,27000167,CDM,,,,,,both,,,126.0000,18.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,58.46,,,,,,,32.5200,126.0000,percent of total billed charges,46.4% of $126.00 in Billed Charges for Rev 270 = $58.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ADAPTER DOUBLE PUMPING,270,RC,27000167,CDM,,,,,,both,,,126.0000,18.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,52.54,,,,,,,32.5200,126.0000,percent of total billed charges,41.7% of $126.00 in Billed Charges for Rev 270 = $52.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ADAPTER DOUBLE PUMPING,270,RC,27000167,CDM,,,,,,both,,,126.0000,18.9000,CIGNA HEALTHCARE,CIGNA PPO,52.54,,,,,,,32.5200,126.0000,percent of total billed charges,41.7% of $126.00 in Billed Charges for Rev 270 = $52.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ADAPTER DOUBLE PUMPING,270,RC,27000167,CDM,,,,,,both,,,126.0000,18.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,113.40,,,,,,,32.5200,126.0000,percent of total billed charges,90% of $126.00 in Billed Charges for Rev 270 = $113.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ADAPTER DOUBLE PUMPING,270,RC,27000167,CDM,,,,,,both,,,126.0000,18.9000,MEDCOST,MEDCOST VHN,59.96,,,,,,,32.5200,126.0000,percent of total billed charges,47.59% of $126.00 in Billed Charges for Rev 270 = $59.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ADAPTER DOUBLE PUMPING,270,RC,27000167,CDM,,,,,,both,,,126.0000,18.9000,SENTARA HEALTH,SENTARA HEALTH,32.52,,,,,,,32.5200,126.0000,percent of total billed charges,25.81% of $126.00 in Billed Charges for Rev 270 = $32.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ADAPTER DOUBLE PUMPING,270,RC,27000167,CDM,,,,,,both,,,126.0000,18.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",126.00,,,,,,,32.5200,126.0000,percent of total billed charges,100% of $126.00 in Billed Charges for Rev 270 = $126.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ADAPTER DOUBLE PUMPING,270,RC,27000167,CDM,,,,,,both,,,126.0000,18.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,63.00,,,,,,,32.5200,126.0000,percent of total billed charges,Rev 270 $126.00 in Billed Charges at 50% = $63.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ADAPTER DOUBLE PUMPING,270,RC,27000167,CDM,,,,,,both,,,126.0000,18.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,40.70,,,,,,,32.5200,126.0000,other,32.3% of $126.00 in Billed Charges for Rev 270 = $40.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIT ADAPTER DOUBLE PUMPING,270,RC,27000167,CDM,,,,,,both,,,126.0000,18.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,38.68,,,,,,,32.5200,126.0000,other,30.7% of $126.00 in Billed Charges for Rev 270 = $38.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIT ADAPTER DOUBLE PUMPING,270,RC,27000167,CDM,,,,,,both,,,126.0000,18.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,40.70,,,,,,,32.5200,126.0000,percent of total billed charges,32.3% of $126.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ADAPTER DOUBLE PUMPING,270,RC,27000167,CDM,,,,,,both,,,126.0000,18.9000,WELLCARE,WELLCARE MEDICAID,126.00,,,,,,,32.5200,126.0000,percent of total billed charges,100% of $126.00 in Billed Charges for Rev 270 = $126.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ADULT ENDO TRACHEAL,272,RC,27202244,CDM,,,,,,both,,,1317.0000,197.5500,AETNA,AETNA,562.36,,,,,,,339.9200,1317.0000,percent of total billed charges,"42.7% of $1,317.00 in Billed Charges for Rev 272 = $562.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT ADULT ENDO TRACHEAL,272,RC,27202244,CDM,,,,,,both,,,1317.0000,197.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,921.90,,,,,,,339.9200,1317.0000,percent of total billed charges,"Rev 272 $1,317.00 in Billed Charges at 70% = $921.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT ADULT ENDO TRACHEAL,272,RC,27202244,CDM,,,,,,both,,,1317.0000,197.5500,CIGNA HEALTHCARE,CIGNA HMO,549.19,,,,,,,339.9200,1317.0000,percent of total billed charges,"41.7% of $1,317.00 in Billed Charges for Rev 272 = $549.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT ADULT ENDO TRACHEAL,272,RC,27202244,CDM,,,,,,both,,,1317.0000,197.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,611.09,,,,,,,339.9200,1317.0000,percent of total billed charges,"46.4% of $1,317.00 in Billed Charges for Rev 272 = $611.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT ADULT ENDO TRACHEAL,272,RC,27202244,CDM,,,,,,both,,,1317.0000,197.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,549.19,,,,,,,339.9200,1317.0000,percent of total billed charges,"41.7% of $1,317.00 in Billed Charges for Rev 272 = $549.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT ADULT ENDO TRACHEAL,272,RC,27202244,CDM,,,,,,both,,,1317.0000,197.5500,CIGNA HEALTHCARE,CIGNA PPO,549.19,,,,,,,339.9200,1317.0000,percent of total billed charges,"41.7% of $1,317.00 in Billed Charges for Rev 272 = $549.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT ADULT ENDO TRACHEAL,272,RC,27202244,CDM,,,,,,both,,,1317.0000,197.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1185.30,,,,,,,339.9200,1317.0000,percent of total billed charges,"90% of $1,317.00 in Billed Charges for Rev 272 = $1,185.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT ADULT ENDO TRACHEAL,272,RC,27202244,CDM,,,,,,both,,,1317.0000,197.5500,MEDCOST,MEDCOST VHN,626.76,,,,,,,339.9200,1317.0000,percent of total billed charges,"47.59% of $1,317.00 in Billed Charges for Rev 272 = $626.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT ADULT ENDO TRACHEAL,272,RC,27202244,CDM,,,,,,both,,,1317.0000,197.5500,SENTARA HEALTH,SENTARA HEALTH,339.92,,,,,,,339.9200,1317.0000,percent of total billed charges,"25.81% of $1,317.00 in Billed Charges for Rev 272 = $339.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT ADULT ENDO TRACHEAL,272,RC,27202244,CDM,,,,,,both,,,1317.0000,197.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1317.00,,,,,,,339.9200,1317.0000,percent of total billed charges,"100% of $1,317.00 in Billed Charges for Rev 272 = $1,317.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT ADULT ENDO TRACHEAL,272,RC,27202244,CDM,,,,,,both,,,1317.0000,197.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,658.50,,,,,,,339.9200,1317.0000,percent of total billed charges,"Rev 272 $1,317.00 in Billed Charges at 50% = $658.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT ADULT ENDO TRACHEAL,272,RC,27202244,CDM,,,,,,both,,,1317.0000,197.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,425.39,,,,,,,339.9200,1317.0000,other,"32.3% of $1,317.00 in Billed Charges for Rev 272 = $425.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIT ADULT ENDO TRACHEAL,272,RC,27202244,CDM,,,,,,both,,,1317.0000,197.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,404.32,,,,,,,339.9200,1317.0000,other,"30.7% of $1,317.00 in Billed Charges for Rev 272 = $404.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIT ADULT ENDO TRACHEAL,272,RC,27202244,CDM,,,,,,both,,,1317.0000,197.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,425.39,,,,,,,339.9200,1317.0000,percent of total billed charges,"32.3% of $1,317.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT ADULT ENDO TRACHEAL,272,RC,27202244,CDM,,,,,,both,,,1317.0000,197.5500,WELLCARE,WELLCARE MEDICAID,1317.00,,,,,,,339.9200,1317.0000,percent of total billed charges,"100% of $1,317.00 in Billed Charges for Rev 272 = $1,317.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL ANATOMICAL MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,41068.0200,6160.2000,AETNA,AETNA,17536.04,,,,,,,10599.6600,41068.0200,percent of total billed charges,"42.7% of $41,068.02 in Billed Charges for Rev 272 = $17,536.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL ANATOMICAL MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,41068.0200,6160.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,28747.61,,,,,,,10599.6600,41068.0200,percent of total billed charges,"Rev 272 $41,068.02 in Billed Charges at 70% = $28,747.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL ANATOMICAL MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,41068.0200,6160.2000,CIGNA HEALTHCARE,CIGNA HMO,17125.36,,,,,,,10599.6600,41068.0200,percent of total billed charges,"41.7% of $41,068.02 in Billed Charges for Rev 272 = $17,125.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL ANATOMICAL MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,41068.0200,6160.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,19055.56,,,,,,,10599.6600,41068.0200,percent of total billed charges,"46.4% of $41,068.02 in Billed Charges for Rev 272 = $19,055.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL ANATOMICAL MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,41068.0200,6160.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,17125.36,,,,,,,10599.6600,41068.0200,percent of total billed charges,"41.7% of $41,068.02 in Billed Charges for Rev 272 = $17,125.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL ANATOMICAL MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,41068.0200,6160.2000,CIGNA HEALTHCARE,CIGNA PPO,17125.36,,,,,,,10599.6600,41068.0200,percent of total billed charges,"41.7% of $41,068.02 in Billed Charges for Rev 272 = $17,125.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL ANATOMICAL MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,41068.0200,6160.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,36961.22,,,,,,,10599.6600,41068.0200,percent of total billed charges,"90% of $41,068.02 in Billed Charges for Rev 272 = $36,961.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL ANATOMICAL MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,41068.0200,6160.2000,MEDCOST,MEDCOST VHN,19544.27,,,,,,,10599.6600,41068.0200,percent of total billed charges,"47.59% of $41,068.02 in Billed Charges for Rev 272 = $19,544.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL ANATOMICAL MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,41068.0200,6160.2000,SENTARA HEALTH,SENTARA HEALTH,10599.66,,,,,,,10599.6600,41068.0200,percent of total billed charges,"25.81% of $41,068.02 in Billed Charges for Rev 272 = $10,599.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL ANATOMICAL MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,41068.0200,6160.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",41068.02,,,,,,,10599.6600,41068.0200,percent of total billed charges,"100% of $41,068.02 in Billed Charges for Rev 272 = $41,068.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL ANATOMICAL MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,41068.0200,6160.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,20534.01,,,,,,,10599.6600,41068.0200,percent of total billed charges,"Rev 272 $41,068.02 in Billed Charges at 50% = $20,534.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL ANATOMICAL MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,41068.0200,6160.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13264.97,,,,,,,10599.6600,41068.0200,other,"32.3% of $41,068.02 in Billed Charges for Rev 272 = $13,264.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODEL ANATOMICAL MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,41068.0200,6160.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,12607.88,,,,,,,10599.6600,41068.0200,other,"30.7% of $41,068.02 in Billed Charges for Rev 272 = $12,607.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODEL ANATOMICAL MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,41068.0200,6160.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,13264.97,,,,,,,10599.6600,41068.0200,percent of total billed charges,"32.3% of $41,068.02 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL ANATOMICAL MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,41068.0200,6160.2000,WELLCARE,WELLCARE MEDICAID,41068.02,,,,,,,10599.6600,41068.0200,percent of total billed charges,"100% of $41,068.02 in Billed Charges for Rev 272 = $41,068.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL GUIDE ANOTOMIC,272,RC,27200002,CDM,,,,,,both,,,35838.9600,5375.8400,AETNA,AETNA,15303.24,,,,,,,9250.0400,35838.9600,percent of total billed charges,"42.7% of $35,838.96 in Billed Charges for Rev 272 = $15,303.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL GUIDE ANOTOMIC,272,RC,27200002,CDM,,,,,,both,,,35838.9600,5375.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,25087.27,,,,,,,9250.0400,35838.9600,percent of total billed charges,"Rev 272 $35,838.96 in Billed Charges at 70% = $25,087.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL GUIDE ANOTOMIC,272,RC,27200002,CDM,,,,,,both,,,35838.9600,5375.8400,CIGNA HEALTHCARE,CIGNA HMO,14944.85,,,,,,,9250.0400,35838.9600,percent of total billed charges,"41.7% of $35,838.96 in Billed Charges for Rev 272 = $14,944.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL GUIDE ANOTOMIC,272,RC,27200002,CDM,,,,,,both,,,35838.9600,5375.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,16629.28,,,,,,,9250.0400,35838.9600,percent of total billed charges,"46.4% of $35,838.96 in Billed Charges for Rev 272 = $16,629.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL GUIDE ANOTOMIC,272,RC,27200002,CDM,,,,,,both,,,35838.9600,5375.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,14944.85,,,,,,,9250.0400,35838.9600,percent of total billed charges,"41.7% of $35,838.96 in Billed Charges for Rev 272 = $14,944.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL GUIDE ANOTOMIC,272,RC,27200002,CDM,,,,,,both,,,35838.9600,5375.8400,CIGNA HEALTHCARE,CIGNA PPO,14944.85,,,,,,,9250.0400,35838.9600,percent of total billed charges,"41.7% of $35,838.96 in Billed Charges for Rev 272 = $14,944.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL GUIDE ANOTOMIC,272,RC,27200002,CDM,,,,,,both,,,35838.9600,5375.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,32255.06,,,,,,,9250.0400,35838.9600,percent of total billed charges,"90% of $35,838.96 in Billed Charges for Rev 272 = $32,255.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL GUIDE ANOTOMIC,272,RC,27200002,CDM,,,,,,both,,,35838.9600,5375.8400,MEDCOST,MEDCOST VHN,17055.76,,,,,,,9250.0400,35838.9600,percent of total billed charges,"47.59% of $35,838.96 in Billed Charges for Rev 272 = $17,055.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL GUIDE ANOTOMIC,272,RC,27200002,CDM,,,,,,both,,,35838.9600,5375.8400,SENTARA HEALTH,SENTARA HEALTH,9250.04,,,,,,,9250.0400,35838.9600,percent of total billed charges,"25.81% of $35,838.96 in Billed Charges for Rev 272 = $9,250.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL GUIDE ANOTOMIC,272,RC,27200002,CDM,,,,,,both,,,35838.9600,5375.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",35838.96,,,,,,,9250.0400,35838.9600,percent of total billed charges,"100% of $35,838.96 in Billed Charges for Rev 272 = $35,838.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL GUIDE ANOTOMIC,272,RC,27200002,CDM,,,,,,both,,,35838.9600,5375.8400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,17919.48,,,,,,,9250.0400,35838.9600,percent of total billed charges,"Rev 272 $35,838.96 in Billed Charges at 50% = $17,919.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL GUIDE ANOTOMIC,272,RC,27200002,CDM,,,,,,both,,,35838.9600,5375.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,11575.98,,,,,,,9250.0400,35838.9600,other,"32.3% of $35,838.96 in Billed Charges for Rev 272 = $11,575.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODEL GUIDE ANOTOMIC,272,RC,27200002,CDM,,,,,,both,,,35838.9600,5375.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,11002.56,,,,,,,9250.0400,35838.9600,other,"30.7% of $35,838.96 in Billed Charges for Rev 272 = $11,002.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODEL GUIDE ANOTOMIC,272,RC,27200002,CDM,,,,,,both,,,35838.9600,5375.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,11575.98,,,,,,,9250.0400,35838.9600,percent of total billed charges,"32.3% of $35,838.96 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL GUIDE ANOTOMIC,272,RC,27200002,CDM,,,,,,both,,,35838.9600,5375.8400,WELLCARE,WELLCARE MEDICAID,35838.96,,,,,,,9250.0400,35838.9600,percent of total billed charges,"100% of $35,838.96 in Billed Charges for Rev 272 = $35,838.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL HALF SUPPLEMENTAL LP,272,RC,27200002,CDM,,,,,,both,,,15629.1000,2344.3700,AETNA,AETNA,6673.63,,,,,,,4033.8700,15629.1000,percent of total billed charges,"42.7% of $15,629.10 in Billed Charges for Rev 272 = $6,673.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL HALF SUPPLEMENTAL LP,272,RC,27200002,CDM,,,,,,both,,,15629.1000,2344.3700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,10940.37,,,,,,,4033.8700,15629.1000,percent of total billed charges,"Rev 272 $15,629.10 in Billed Charges at 70% = $10,940.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL HALF SUPPLEMENTAL LP,272,RC,27200002,CDM,,,,,,both,,,15629.1000,2344.3700,CIGNA HEALTHCARE,CIGNA HMO,6517.33,,,,,,,4033.8700,15629.1000,percent of total billed charges,"41.7% of $15,629.10 in Billed Charges for Rev 272 = $6,517.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL HALF SUPPLEMENTAL LP,272,RC,27200002,CDM,,,,,,both,,,15629.1000,2344.3700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7251.90,,,,,,,4033.8700,15629.1000,percent of total billed charges,"46.4% of $15,629.10 in Billed Charges for Rev 272 = $7,251.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL HALF SUPPLEMENTAL LP,272,RC,27200002,CDM,,,,,,both,,,15629.1000,2344.3700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6517.33,,,,,,,4033.8700,15629.1000,percent of total billed charges,"41.7% of $15,629.10 in Billed Charges for Rev 272 = $6,517.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL HALF SUPPLEMENTAL LP,272,RC,27200002,CDM,,,,,,both,,,15629.1000,2344.3700,CIGNA HEALTHCARE,CIGNA PPO,6517.33,,,,,,,4033.8700,15629.1000,percent of total billed charges,"41.7% of $15,629.10 in Billed Charges for Rev 272 = $6,517.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL HALF SUPPLEMENTAL LP,272,RC,27200002,CDM,,,,,,both,,,15629.1000,2344.3700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,14066.19,,,,,,,4033.8700,15629.1000,percent of total billed charges,"90% of $15,629.10 in Billed Charges for Rev 272 = $14,066.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL HALF SUPPLEMENTAL LP,272,RC,27200002,CDM,,,,,,both,,,15629.1000,2344.3700,MEDCOST,MEDCOST VHN,7437.89,,,,,,,4033.8700,15629.1000,percent of total billed charges,"47.59% of $15,629.10 in Billed Charges for Rev 272 = $7,437.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL HALF SUPPLEMENTAL LP,272,RC,27200002,CDM,,,,,,both,,,15629.1000,2344.3700,SENTARA HEALTH,SENTARA HEALTH,4033.87,,,,,,,4033.8700,15629.1000,percent of total billed charges,"25.81% of $15,629.10 in Billed Charges for Rev 272 = $4,033.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL HALF SUPPLEMENTAL LP,272,RC,27200002,CDM,,,,,,both,,,15629.1000,2344.3700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15629.10,,,,,,,4033.8700,15629.1000,percent of total billed charges,"100% of $15,629.10 in Billed Charges for Rev 272 = $15,629.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL HALF SUPPLEMENTAL LP,272,RC,27200002,CDM,,,,,,both,,,15629.1000,2344.3700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7814.55,,,,,,,4033.8700,15629.1000,percent of total billed charges,"Rev 272 $15,629.10 in Billed Charges at 50% = $7,814.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL HALF SUPPLEMENTAL LP,272,RC,27200002,CDM,,,,,,both,,,15629.1000,2344.3700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5048.20,,,,,,,4033.8700,15629.1000,other,"32.3% of $15,629.10 in Billed Charges for Rev 272 = $5,048.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODEL HALF SUPPLEMENTAL LP,272,RC,27200002,CDM,,,,,,both,,,15629.1000,2344.3700,UNITED HEALTHCARE,UHC HERITAGE SELECT,4798.13,,,,,,,4033.8700,15629.1000,other,"30.7% of $15,629.10 in Billed Charges for Rev 272 = $4,798.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODEL HALF SUPPLEMENTAL LP,272,RC,27200002,CDM,,,,,,both,,,15629.1000,2344.3700,UNITED HEALTHCARE,UNITED HEALTHCARE,5048.20,,,,,,,4033.8700,15629.1000,percent of total billed charges,"32.3% of $15,629.10 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL HALF SUPPLEMENTAL LP,272,RC,27200002,CDM,,,,,,both,,,15629.1000,2344.3700,WELLCARE,WELLCARE MEDICAID,15629.10,,,,,,,4033.8700,15629.1000,percent of total billed charges,"100% of $15,629.10 in Billed Charges for Rev 272 = $15,629.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS CRANIAL PLANNING CLASSIC LP,272,RC,27200002,CDM,,,,,,both,,,38818.6500,5822.8000,AETNA,AETNA,16575.56,,,,,,,10019.0900,38818.6500,percent of total billed charges,"42.7% of $38,818.65 in Billed Charges for Rev 272 = $16,575.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS CRANIAL PLANNING CLASSIC LP,272,RC,27200002,CDM,,,,,,both,,,38818.6500,5822.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,27173.06,,,,,,,10019.0900,38818.6500,percent of total billed charges,"Rev 272 $38,818.65 in Billed Charges at 70% = $27,173.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS CRANIAL PLANNING CLASSIC LP,272,RC,27200002,CDM,,,,,,both,,,38818.6500,5822.8000,CIGNA HEALTHCARE,CIGNA HMO,16187.38,,,,,,,10019.0900,38818.6500,percent of total billed charges,"41.7% of $38,818.65 in Billed Charges for Rev 272 = $16,187.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS CRANIAL PLANNING CLASSIC LP,272,RC,27200002,CDM,,,,,,both,,,38818.6500,5822.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,18011.85,,,,,,,10019.0900,38818.6500,percent of total billed charges,"46.4% of $38,818.65 in Billed Charges for Rev 272 = $18,011.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS CRANIAL PLANNING CLASSIC LP,272,RC,27200002,CDM,,,,,,both,,,38818.6500,5822.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,16187.38,,,,,,,10019.0900,38818.6500,percent of total billed charges,"41.7% of $38,818.65 in Billed Charges for Rev 272 = $16,187.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS CRANIAL PLANNING CLASSIC LP,272,RC,27200002,CDM,,,,,,both,,,38818.6500,5822.8000,CIGNA HEALTHCARE,CIGNA PPO,16187.38,,,,,,,10019.0900,38818.6500,percent of total billed charges,"41.7% of $38,818.65 in Billed Charges for Rev 272 = $16,187.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS CRANIAL PLANNING CLASSIC LP,272,RC,27200002,CDM,,,,,,both,,,38818.6500,5822.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,34936.79,,,,,,,10019.0900,38818.6500,percent of total billed charges,"90% of $38,818.65 in Billed Charges for Rev 272 = $34,936.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS CRANIAL PLANNING CLASSIC LP,272,RC,27200002,CDM,,,,,,both,,,38818.6500,5822.8000,MEDCOST,MEDCOST VHN,18473.80,,,,,,,10019.0900,38818.6500,percent of total billed charges,"47.59% of $38,818.65 in Billed Charges for Rev 272 = $18,473.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS CRANIAL PLANNING CLASSIC LP,272,RC,27200002,CDM,,,,,,both,,,38818.6500,5822.8000,SENTARA HEALTH,SENTARA HEALTH,10019.09,,,,,,,10019.0900,38818.6500,percent of total billed charges,"25.81% of $38,818.65 in Billed Charges for Rev 272 = $10,019.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS CRANIAL PLANNING CLASSIC LP,272,RC,27200002,CDM,,,,,,both,,,38818.6500,5822.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",38818.65,,,,,,,10019.0900,38818.6500,percent of total billed charges,"100% of $38,818.65 in Billed Charges for Rev 272 = $38,818.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS CRANIAL PLANNING CLASSIC LP,272,RC,27200002,CDM,,,,,,both,,,38818.6500,5822.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,19409.33,,,,,,,10019.0900,38818.6500,percent of total billed charges,"Rev 272 $38,818.65 in Billed Charges at 50% = $19,409.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS CRANIAL PLANNING CLASSIC LP,272,RC,27200002,CDM,,,,,,both,,,38818.6500,5822.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12538.42,,,,,,,10019.0900,38818.6500,other,"32.3% of $38,818.65 in Billed Charges for Rev 272 = $12,538.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODEL IPS CRANIAL PLANNING CLASSIC LP,272,RC,27200002,CDM,,,,,,both,,,38818.6500,5822.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11917.33,,,,,,,10019.0900,38818.6500,other,"30.7% of $38,818.65 in Billed Charges for Rev 272 = $11,917.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODEL IPS CRANIAL PLANNING CLASSIC LP,272,RC,27200002,CDM,,,,,,both,,,38818.6500,5822.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,12538.42,,,,,,,10019.0900,38818.6500,percent of total billed charges,"32.3% of $38,818.65 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS CRANIAL PLANNING CLASSIC LP,272,RC,27200002,CDM,,,,,,both,,,38818.6500,5822.8000,WELLCARE,WELLCARE MEDICAID,38818.65,,,,,,,10019.0900,38818.6500,percent of total billed charges,"100% of $38,818.65 in Billed Charges for Rev 272 = $38,818.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CLASSIC LP IPS,272,RC,27200002,CDM,,,,,,both,,,31838.9700,4775.8500,AETNA,AETNA,13595.24,,,,,,,8217.6400,31838.9700,percent of total billed charges,"42.7% of $31,838.97 in Billed Charges for Rev 272 = $13,595.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CLASSIC LP IPS,272,RC,27200002,CDM,,,,,,both,,,31838.9700,4775.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,22287.28,,,,,,,8217.6400,31838.9700,percent of total billed charges,"Rev 272 $31,838.97 in Billed Charges at 70% = $22,287.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CLASSIC LP IPS,272,RC,27200002,CDM,,,,,,both,,,31838.9700,4775.8500,CIGNA HEALTHCARE,CIGNA HMO,13276.85,,,,,,,8217.6400,31838.9700,percent of total billed charges,"41.7% of $31,838.97 in Billed Charges for Rev 272 = $13,276.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CLASSIC LP IPS,272,RC,27200002,CDM,,,,,,both,,,31838.9700,4775.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,14773.28,,,,,,,8217.6400,31838.9700,percent of total billed charges,"46.4% of $31,838.97 in Billed Charges for Rev 272 = $14,773.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CLASSIC LP IPS,272,RC,27200002,CDM,,,,,,both,,,31838.9700,4775.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,13276.85,,,,,,,8217.6400,31838.9700,percent of total billed charges,"41.7% of $31,838.97 in Billed Charges for Rev 272 = $13,276.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CLASSIC LP IPS,272,RC,27200002,CDM,,,,,,both,,,31838.9700,4775.8500,CIGNA HEALTHCARE,CIGNA PPO,13276.85,,,,,,,8217.6400,31838.9700,percent of total billed charges,"41.7% of $31,838.97 in Billed Charges for Rev 272 = $13,276.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CLASSIC LP IPS,272,RC,27200002,CDM,,,,,,both,,,31838.9700,4775.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,28655.07,,,,,,,8217.6400,31838.9700,percent of total billed charges,"90% of $31,838.97 in Billed Charges for Rev 272 = $28,655.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CLASSIC LP IPS,272,RC,27200002,CDM,,,,,,both,,,31838.9700,4775.8500,MEDCOST,MEDCOST VHN,15152.17,,,,,,,8217.6400,31838.9700,percent of total billed charges,"47.59% of $31,838.97 in Billed Charges for Rev 272 = $15,152.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CLASSIC LP IPS,272,RC,27200002,CDM,,,,,,both,,,31838.9700,4775.8500,SENTARA HEALTH,SENTARA HEALTH,8217.64,,,,,,,8217.6400,31838.9700,percent of total billed charges,"25.81% of $31,838.97 in Billed Charges for Rev 272 = $8,217.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CLASSIC LP IPS,272,RC,27200002,CDM,,,,,,both,,,31838.9700,4775.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",31838.97,,,,,,,8217.6400,31838.9700,percent of total billed charges,"100% of $31,838.97 in Billed Charges for Rev 272 = $31,838.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CLASSIC LP IPS,272,RC,27200002,CDM,,,,,,both,,,31838.9700,4775.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,15919.49,,,,,,,8217.6400,31838.9700,percent of total billed charges,"Rev 272 $31,838.97 in Billed Charges at 50% = $15,919.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CLASSIC LP IPS,272,RC,27200002,CDM,,,,,,both,,,31838.9700,4775.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,10283.99,,,,,,,8217.6400,31838.9700,other,"32.3% of $31,838.97 in Billed Charges for Rev 272 = $10,283.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODEL MANDIBLE CLASSIC LP IPS,272,RC,27200002,CDM,,,,,,both,,,31838.9700,4775.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,9774.56,,,,,,,8217.6400,31838.9700,other,"30.7% of $31,838.97 in Billed Charges for Rev 272 = $9,774.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODEL MANDIBLE CLASSIC LP IPS,272,RC,27200002,CDM,,,,,,both,,,31838.9700,4775.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,10283.99,,,,,,,8217.6400,31838.9700,percent of total billed charges,"32.3% of $31,838.97 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CLASSIC LP IPS,272,RC,27200002,CDM,,,,,,both,,,31838.9700,4775.8500,WELLCARE,WELLCARE MEDICAID,31838.97,,,,,,,8217.6400,31838.9700,percent of total billed charges,"100% of $31,838.97 in Billed Charges for Rev 272 = $31,838.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CRYSTAL LP,272,RC,27200002,CDM,,,,,,both,,,34628.7700,5194.3200,AETNA,AETNA,14786.48,,,,,,,8937.6900,34628.7700,percent of total billed charges,"42.7% of $34,628.77 in Billed Charges for Rev 272 = $14,786.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CRYSTAL LP,272,RC,27200002,CDM,,,,,,both,,,34628.7700,5194.3200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,24240.14,,,,,,,8937.6900,34628.7700,percent of total billed charges,"Rev 272 $34,628.77 in Billed Charges at 70% = $24,240.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CRYSTAL LP,272,RC,27200002,CDM,,,,,,both,,,34628.7700,5194.3200,CIGNA HEALTHCARE,CIGNA HMO,14440.20,,,,,,,8937.6900,34628.7700,percent of total billed charges,"41.7% of $34,628.77 in Billed Charges for Rev 272 = $14,440.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CRYSTAL LP,272,RC,27200002,CDM,,,,,,both,,,34628.7700,5194.3200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,16067.75,,,,,,,8937.6900,34628.7700,percent of total billed charges,"46.4% of $34,628.77 in Billed Charges for Rev 272 = $16,067.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CRYSTAL LP,272,RC,27200002,CDM,,,,,,both,,,34628.7700,5194.3200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,14440.20,,,,,,,8937.6900,34628.7700,percent of total billed charges,"41.7% of $34,628.77 in Billed Charges for Rev 272 = $14,440.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CRYSTAL LP,272,RC,27200002,CDM,,,,,,both,,,34628.7700,5194.3200,CIGNA HEALTHCARE,CIGNA PPO,14440.20,,,,,,,8937.6900,34628.7700,percent of total billed charges,"41.7% of $34,628.77 in Billed Charges for Rev 272 = $14,440.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CRYSTAL LP,272,RC,27200002,CDM,,,,,,both,,,34628.7700,5194.3200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,31165.89,,,,,,,8937.6900,34628.7700,percent of total billed charges,"90% of $34,628.77 in Billed Charges for Rev 272 = $31,165.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CRYSTAL LP,272,RC,27200002,CDM,,,,,,both,,,34628.7700,5194.3200,MEDCOST,MEDCOST VHN,16479.83,,,,,,,8937.6900,34628.7700,percent of total billed charges,"47.59% of $34,628.77 in Billed Charges for Rev 272 = $16,479.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CRYSTAL LP,272,RC,27200002,CDM,,,,,,both,,,34628.7700,5194.3200,SENTARA HEALTH,SENTARA HEALTH,8937.69,,,,,,,8937.6900,34628.7700,percent of total billed charges,"25.81% of $34,628.77 in Billed Charges for Rev 272 = $8,937.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CRYSTAL LP,272,RC,27200002,CDM,,,,,,both,,,34628.7700,5194.3200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",34628.77,,,,,,,8937.6900,34628.7700,percent of total billed charges,"100% of $34,628.77 in Billed Charges for Rev 272 = $34,628.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CRYSTAL LP,272,RC,27200002,CDM,,,,,,both,,,34628.7700,5194.3200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,17314.39,,,,,,,8937.6900,34628.7700,percent of total billed charges,"Rev 272 $34,628.77 in Billed Charges at 50% = $17,314.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CRYSTAL LP,272,RC,27200002,CDM,,,,,,both,,,34628.7700,5194.3200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,11185.09,,,,,,,8937.6900,34628.7700,other,"32.3% of $34,628.77 in Billed Charges for Rev 272 = $11,185.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODEL MANDIBLE CRYSTAL LP,272,RC,27200002,CDM,,,,,,both,,,34628.7700,5194.3200,UNITED HEALTHCARE,UHC HERITAGE SELECT,10631.03,,,,,,,8937.6900,34628.7700,other,"30.7% of $34,628.77 in Billed Charges for Rev 272 = $10,631.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODEL MANDIBLE CRYSTAL LP,272,RC,27200002,CDM,,,,,,both,,,34628.7700,5194.3200,UNITED HEALTHCARE,UNITED HEALTHCARE,11185.09,,,,,,,8937.6900,34628.7700,percent of total billed charges,"32.3% of $34,628.77 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL MANDIBLE CRYSTAL LP,272,RC,27200002,CDM,,,,,,both,,,34628.7700,5194.3200,WELLCARE,WELLCARE MEDICAID,34628.77,,,,,,,8937.6900,34628.7700,percent of total billed charges,"100% of $34,628.77 in Billed Charges for Rev 272 = $34,628.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT ASSAULT RAPE,270,RC,27000181,CDM,,,,,,both,,,270.0000,40.5000,AETNA,AETNA,115.29,,,,,,,69.6900,270.0000,percent of total billed charges,42.7% of $270.00 in Billed Charges for Rev 270 = $115.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ASSAULT RAPE,270,RC,27000181,CDM,,,,,,both,,,270.0000,40.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,189.00,,,,,,,69.6900,270.0000,percent of total billed charges,Rev 270 $270.00 in Billed Charges at 70% = $189.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ASSAULT RAPE,270,RC,27000181,CDM,,,,,,both,,,270.0000,40.5000,CIGNA HEALTHCARE,CIGNA HMO,112.59,,,,,,,69.6900,270.0000,percent of total billed charges,41.7% of $270.00 in Billed Charges for Rev 270 = $112.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ASSAULT RAPE,270,RC,27000181,CDM,,,,,,both,,,270.0000,40.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,125.28,,,,,,,69.6900,270.0000,percent of total billed charges,46.4% of $270.00 in Billed Charges for Rev 270 = $125.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ASSAULT RAPE,270,RC,27000181,CDM,,,,,,both,,,270.0000,40.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,112.59,,,,,,,69.6900,270.0000,percent of total billed charges,41.7% of $270.00 in Billed Charges for Rev 270 = $112.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ASSAULT RAPE,270,RC,27000181,CDM,,,,,,both,,,270.0000,40.5000,CIGNA HEALTHCARE,CIGNA PPO,112.59,,,,,,,69.6900,270.0000,percent of total billed charges,41.7% of $270.00 in Billed Charges for Rev 270 = $112.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ASSAULT RAPE,270,RC,27000181,CDM,,,,,,both,,,270.0000,40.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,243.00,,,,,,,69.6900,270.0000,percent of total billed charges,90% of $270.00 in Billed Charges for Rev 270 = $243.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ASSAULT RAPE,270,RC,27000181,CDM,,,,,,both,,,270.0000,40.5000,MEDCOST,MEDCOST VHN,128.49,,,,,,,69.6900,270.0000,percent of total billed charges,47.59% of $270.00 in Billed Charges for Rev 270 = $128.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ASSAULT RAPE,270,RC,27000181,CDM,,,,,,both,,,270.0000,40.5000,SENTARA HEALTH,SENTARA HEALTH,69.69,,,,,,,69.6900,270.0000,percent of total billed charges,25.81% of $270.00 in Billed Charges for Rev 270 = $69.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ASSAULT RAPE,270,RC,27000181,CDM,,,,,,both,,,270.0000,40.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",270.00,,,,,,,69.6900,270.0000,percent of total billed charges,100% of $270.00 in Billed Charges for Rev 270 = $270.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ASSAULT RAPE,270,RC,27000181,CDM,,,,,,both,,,270.0000,40.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,135.00,,,,,,,69.6900,270.0000,percent of total billed charges,Rev 270 $270.00 in Billed Charges at 50% = $135.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ASSAULT RAPE,270,RC,27000181,CDM,,,,,,both,,,270.0000,40.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,87.21,,,,,,,69.6900,270.0000,other,32.3% of $270.00 in Billed Charges for Rev 270 = $87.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIT ASSAULT RAPE,270,RC,27000181,CDM,,,,,,both,,,270.0000,40.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,82.89,,,,,,,69.6900,270.0000,other,30.7% of $270.00 in Billed Charges for Rev 270 = $82.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIT ASSAULT RAPE,270,RC,27000181,CDM,,,,,,both,,,270.0000,40.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,87.21,,,,,,,69.6900,270.0000,percent of total billed charges,32.3% of $270.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT ASSAULT RAPE,270,RC,27000181,CDM,,,,,,both,,,270.0000,40.5000,WELLCARE,WELLCARE MEDICAID,270.00,,,,,,,69.6900,270.0000,percent of total billed charges,100% of $270.00 in Billed Charges for Rev 270 = $270.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT CAMINO 110-4BC EACH,270,RC,27000183,CDM,,,,,,both,,,2122.0000,318.3000,AETNA,AETNA,906.09,,,,,,,547.6900,2122.0000,percent of total billed charges,"42.7% of $2,122.00 in Billed Charges for Rev 270 = $906.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CAMINO 110-4BC EACH,270,RC,27000183,CDM,,,,,,both,,,2122.0000,318.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1485.40,,,,,,,547.6900,2122.0000,percent of total billed charges,"Rev 270 $2,122.00 in Billed Charges at 70% = $1,485.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CAMINO 110-4BC EACH,270,RC,27000183,CDM,,,,,,both,,,2122.0000,318.3000,CIGNA HEALTHCARE,CIGNA HMO,884.87,,,,,,,547.6900,2122.0000,percent of total billed charges,"41.7% of $2,122.00 in Billed Charges for Rev 270 = $884.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CAMINO 110-4BC EACH,270,RC,27000183,CDM,,,,,,both,,,2122.0000,318.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,984.61,,,,,,,547.6900,2122.0000,percent of total billed charges,"46.4% of $2,122.00 in Billed Charges for Rev 270 = $984.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CAMINO 110-4BC EACH,270,RC,27000183,CDM,,,,,,both,,,2122.0000,318.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,884.87,,,,,,,547.6900,2122.0000,percent of total billed charges,"41.7% of $2,122.00 in Billed Charges for Rev 270 = $884.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CAMINO 110-4BC EACH,270,RC,27000183,CDM,,,,,,both,,,2122.0000,318.3000,CIGNA HEALTHCARE,CIGNA PPO,884.87,,,,,,,547.6900,2122.0000,percent of total billed charges,"41.7% of $2,122.00 in Billed Charges for Rev 270 = $884.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CAMINO 110-4BC EACH,270,RC,27000183,CDM,,,,,,both,,,2122.0000,318.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1909.80,,,,,,,547.6900,2122.0000,percent of total billed charges,"90% of $2,122.00 in Billed Charges for Rev 270 = $1,909.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CAMINO 110-4BC EACH,270,RC,27000183,CDM,,,,,,both,,,2122.0000,318.3000,MEDCOST,MEDCOST VHN,1009.86,,,,,,,547.6900,2122.0000,percent of total billed charges,"47.59% of $2,122.00 in Billed Charges for Rev 270 = $1,009.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CAMINO 110-4BC EACH,270,RC,27000183,CDM,,,,,,both,,,2122.0000,318.3000,SENTARA HEALTH,SENTARA HEALTH,547.69,,,,,,,547.6900,2122.0000,percent of total billed charges,"25.81% of $2,122.00 in Billed Charges for Rev 270 = $547.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CAMINO 110-4BC EACH,270,RC,27000183,CDM,,,,,,both,,,2122.0000,318.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2122.00,,,,,,,547.6900,2122.0000,percent of total billed charges,"100% of $2,122.00 in Billed Charges for Rev 270 = $2,122.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CAMINO 110-4BC EACH,270,RC,27000183,CDM,,,,,,both,,,2122.0000,318.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1061.00,,,,,,,547.6900,2122.0000,percent of total billed charges,"Rev 270 $2,122.00 in Billed Charges at 50% = $1,061.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CAMINO 110-4BC EACH,270,RC,27000183,CDM,,,,,,both,,,2122.0000,318.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,685.41,,,,,,,547.6900,2122.0000,other,"32.3% of $2,122.00 in Billed Charges for Rev 270 = $685.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIT CAMINO 110-4BC EACH,270,RC,27000183,CDM,,,,,,both,,,2122.0000,318.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,651.45,,,,,,,547.6900,2122.0000,other,"30.7% of $2,122.00 in Billed Charges for Rev 270 = $651.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIT CAMINO 110-4BC EACH,270,RC,27000183,CDM,,,,,,both,,,2122.0000,318.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,685.41,,,,,,,547.6900,2122.0000,percent of total billed charges,"32.3% of $2,122.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CAMINO 110-4BC EACH,270,RC,27000183,CDM,,,,,,both,,,2122.0000,318.3000,WELLCARE,WELLCARE MEDICAID,2122.00,,,,,,,547.6900,2122.0000,percent of total billed charges,"100% of $2,122.00 in Billed Charges for Rev 270 = $2,122.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CATH FEMALE,270,RC,27000034,CDM,,,,,,both,,,26.0000,3.9000,AETNA,AETNA,11.10,,,,,,,6.7100,26.0000,percent of total billed charges,42.7% of $26.00 in Billed Charges for Rev 270 = $11.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT CATH FEMALE,270,RC,27000034,CDM,,,,,,both,,,26.0000,3.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,18.20,,,,,,,6.7100,26.0000,percent of total billed charges,Rev 270 $26.00 in Billed Charges at 70% = $18.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT CATH FEMALE,270,RC,27000034,CDM,,,,,,both,,,26.0000,3.9000,CIGNA HEALTHCARE,CIGNA HMO,10.84,,,,,,,6.7100,26.0000,percent of total billed charges,41.7% of $26.00 in Billed Charges for Rev 270 = $10.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT CATH FEMALE,270,RC,27000034,CDM,,,,,,both,,,26.0000,3.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12.06,,,,,,,6.7100,26.0000,percent of total billed charges,46.4% of $26.00 in Billed Charges for Rev 270 = $12.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT CATH FEMALE,270,RC,27000034,CDM,,,,,,both,,,26.0000,3.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,10.84,,,,,,,6.7100,26.0000,percent of total billed charges,41.7% of $26.00 in Billed Charges for Rev 270 = $10.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT CATH FEMALE,270,RC,27000034,CDM,,,,,,both,,,26.0000,3.9000,CIGNA HEALTHCARE,CIGNA PPO,10.84,,,,,,,6.7100,26.0000,percent of total billed charges,41.7% of $26.00 in Billed Charges for Rev 270 = $10.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT CATH FEMALE,270,RC,27000034,CDM,,,,,,both,,,26.0000,3.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,23.40,,,,,,,6.7100,26.0000,percent of total billed charges,90% of $26.00 in Billed Charges for Rev 270 = $23.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT CATH FEMALE,270,RC,27000034,CDM,,,,,,both,,,26.0000,3.9000,MEDCOST,MEDCOST VHN,12.37,,,,,,,6.7100,26.0000,percent of total billed charges,47.59% of $26.00 in Billed Charges for Rev 270 = $12.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT CATH FEMALE,270,RC,27000034,CDM,,,,,,both,,,26.0000,3.9000,SENTARA HEALTH,SENTARA HEALTH,6.71,,,,,,,6.7100,26.0000,percent of total billed charges,25.81% of $26.00 in Billed Charges for Rev 270 = $6.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT CATH FEMALE,270,RC,27000034,CDM,,,,,,both,,,26.0000,3.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",26.00,,,,,,,6.7100,26.0000,percent of total billed charges,100% of $26.00 in Billed Charges for Rev 270 = $26.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT CATH FEMALE,270,RC,27000034,CDM,,,,,,both,,,26.0000,3.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,13.00,,,,,,,6.7100,26.0000,percent of total billed charges,Rev 270 $26.00 in Billed Charges at 50% = $13.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT CATH FEMALE,270,RC,27000034,CDM,,,,,,both,,,26.0000,3.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,8.40,,,,,,,6.7100,26.0000,other,32.3% of $26.00 in Billed Charges for Rev 270 = $8.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIT CATH FEMALE,270,RC,27000034,CDM,,,,,,both,,,26.0000,3.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,7.98,,,,,,,6.7100,26.0000,other,30.7% of $26.00 in Billed Charges for Rev 270 = $7.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KIT CATH FEMALE,270,RC,27000034,CDM,,,,,,both,,,26.0000,3.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,8.40,,,,,,,6.7100,26.0000,percent of total billed charges,32.3% of $26.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT CATH FEMALE,270,RC,27000034,CDM,,,,,,both,,,26.0000,3.9000,WELLCARE,WELLCARE MEDICAID,26.00,,,,,,,6.7100,26.0000,percent of total billed charges,100% of $26.00 in Billed Charges for Rev 270 = $26.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KIT CATHETER CENTRAL VENOUS SOLEX 7,272,RC,27202315,CDM,,,,,,both,,,1109.0000,166.3500,AETNA,AETNA,473.54,,,,,,,286.2300,1109.0000,percent of total billed charges,"42.7% of $1,109.00 in Billed Charges for Rev 272 = $473.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CATHETER CENTRAL VENOUS SOLEX 7,272,RC,27202315,CDM,,,,,,both,,,1109.0000,166.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,776.30,,,,,,,286.2300,1109.0000,percent of total billed charges,"Rev 272 $1,109.00 in Billed Charges at 70% = $776.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CATHETER CENTRAL VENOUS SOLEX 7,272,RC,27202315,CDM,,,,,,both,,,1109.0000,166.3500,CIGNA HEALTHCARE,CIGNA HMO,462.45,,,,,,,286.2300,1109.0000,percent of total billed charges,"41.7% of $1,109.00 in Billed Charges for Rev 272 = $462.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CATHETER CENTRAL VENOUS SOLEX 7,272,RC,27202315,CDM,,,,,,both,,,1109.0000,166.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,514.58,,,,,,,286.2300,1109.0000,percent of total billed charges,"46.4% of $1,109.00 in Billed Charges for Rev 272 = $514.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CATHETER CENTRAL VENOUS SOLEX 7,272,RC,27202315,CDM,,,,,,both,,,1109.0000,166.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,462.45,,,,,,,286.2300,1109.0000,percent of total billed charges,"41.7% of $1,109.00 in Billed Charges for Rev 272 = $462.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CATHETER CENTRAL VENOUS SOLEX 7,272,RC,27202315,CDM,,,,,,both,,,1109.0000,166.3500,CIGNA HEALTHCARE,CIGNA PPO,462.45,,,,,,,286.2300,1109.0000,percent of total billed charges,"41.7% of $1,109.00 in Billed Charges for Rev 272 = $462.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CATHETER CENTRAL VENOUS SOLEX 7,272,RC,27202315,CDM,,,,,,both,,,1109.0000,166.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,998.10,,,,,,,286.2300,1109.0000,percent of total billed charges,"90% of $1,109.00 in Billed Charges for Rev 272 = $998.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CATHETER CENTRAL VENOUS SOLEX 7,272,RC,27202315,CDM,,,,,,both,,,1109.0000,166.3500,MEDCOST,MEDCOST VHN,527.77,,,,,,,286.2300,1109.0000,percent of total billed charges,"47.59% of $1,109.00 in Billed Charges for Rev 272 = $527.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CATHETER CENTRAL VENOUS SOLEX 7,272,RC,27202315,CDM,,,,,,both,,,1109.0000,166.3500,SENTARA HEALTH,SENTARA HEALTH,286.23,,,,,,,286.2300,1109.0000,percent of total billed charges,"25.81% of $1,109.00 in Billed Charges for Rev 272 = $286.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CATHETER CENTRAL VENOUS SOLEX 7,272,RC,27202315,CDM,,,,,,both,,,1109.0000,166.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1109.00,,,,,,,286.2300,1109.0000,percent of total billed charges,"100% of $1,109.00 in Billed Charges for Rev 272 = $1,109.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CATHETER CENTRAL VENOUS SOLEX 7,272,RC,27202315,CDM,,,,,,both,,,1109.0000,166.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,554.50,,,,,,,286.2300,1109.0000,percent of total billed charges,"Rev 272 $1,109.00 in Billed Charges at 50% = $554.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CATHETER CENTRAL VENOUS SOLEX 7,272,RC,27202315,CDM,,,,,,both,,,1109.0000,166.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,358.21,,,,,,,286.2300,1109.0000,other,"32.3% of $1,109.00 in Billed Charges for Rev 272 = $358.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIT CATHETER CENTRAL VENOUS SOLEX 7,272,RC,27202315,CDM,,,,,,both,,,1109.0000,166.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,340.46,,,,,,,286.2300,1109.0000,other,"30.7% of $1,109.00 in Billed Charges for Rev 272 = $340.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KIT CATHETER CENTRAL VENOUS SOLEX 7,272,RC,27202315,CDM,,,,,,both,,,1109.0000,166.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,358.21,,,,,,,286.2300,1109.0000,percent of total billed charges,"32.3% of $1,109.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KIT CATHETER CENTRAL VENOUS SOLEX 7,272,RC,27202315,CDM,,,,,,both,,,1109.0000,166.3500,WELLCARE,WELLCARE MEDICAID,1109.00,,,,,,,286.2300,1109.0000,percent of total billed charges,"100% of $1,109.00 in Billed Charges for Rev 272 = $1,109.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL THORACIC HEMI CLASSIC LP,272,RC,,,,,,,,both,,,63304.5800,9495.6900,AETNA,AETNA,27031.06,,,,,,,16338.9100,63304.5800,percent of total billed charges,"42.7% of $63,304.58 in Billed Charges for Rev 272 = $27,031.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL THORACIC HEMI CLASSIC LP,272,RC,,,,,,,,both,,,63304.5800,9495.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,44313.21,,,,,,,16338.9100,63304.5800,percent of total billed charges,"Rev 272 $63,304.58 in Billed Charges at 70% = $44,313.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL THORACIC HEMI CLASSIC LP,272,RC,,,,,,,,both,,,63304.5800,9495.6900,CIGNA HEALTHCARE,CIGNA HMO,26398.01,,,,,,,16338.9100,63304.5800,percent of total billed charges,"41.7% of $63,304.58 in Billed Charges for Rev 272 = $26,398.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL THORACIC HEMI CLASSIC LP,272,RC,,,,,,,,both,,,63304.5800,9495.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,29373.33,,,,,,,16338.9100,63304.5800,percent of total billed charges,"46.4% of $63,304.58 in Billed Charges for Rev 272 = $29,373.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL THORACIC HEMI CLASSIC LP,272,RC,,,,,,,,both,,,63304.5800,9495.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,26398.01,,,,,,,16338.9100,63304.5800,percent of total billed charges,"41.7% of $63,304.58 in Billed Charges for Rev 272 = $26,398.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL THORACIC HEMI CLASSIC LP,272,RC,,,,,,,,both,,,63304.5800,9495.6900,CIGNA HEALTHCARE,CIGNA PPO,26398.01,,,,,,,16338.9100,63304.5800,percent of total billed charges,"41.7% of $63,304.58 in Billed Charges for Rev 272 = $26,398.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL THORACIC HEMI CLASSIC LP,272,RC,,,,,,,,both,,,63304.5800,9495.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,56974.12,,,,,,,16338.9100,63304.5800,percent of total billed charges,"90% of $63,304.58 in Billed Charges for Rev 272 = $56,974.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL THORACIC HEMI CLASSIC LP,272,RC,,,,,,,,both,,,63304.5800,9495.6900,MEDCOST,MEDCOST VHN,30126.65,,,,,,,16338.9100,63304.5800,percent of total billed charges,"47.59% of $63,304.58 in Billed Charges for Rev 272 = $30,126.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL THORACIC HEMI CLASSIC LP,272,RC,,,,,,,,both,,,63304.5800,9495.6900,SENTARA HEALTH,SENTARA HEALTH,16338.91,,,,,,,16338.9100,63304.5800,percent of total billed charges,"25.81% of $63,304.58 in Billed Charges for Rev 272 = $16,338.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL THORACIC HEMI CLASSIC LP,272,RC,,,,,,,,both,,,63304.5800,9495.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",63304.58,,,,,,,16338.9100,63304.5800,percent of total billed charges,"100% of $63,304.58 in Billed Charges for Rev 272 = $63,304.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL THORACIC HEMI CLASSIC LP,272,RC,,,,,,,,both,,,63304.5800,9495.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,31652.29,,,,,,,16338.9100,63304.5800,percent of total billed charges,"Rev 272 $63,304.58 in Billed Charges at 50% = $31,652.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL THORACIC HEMI CLASSIC LP,272,RC,,,,,,,,both,,,63304.5800,9495.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,20447.38,,,,,,,16338.9100,63304.5800,other,"32.3% of $63,304.58 in Billed Charges for Rev 272 = $20,447.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODEL THORACIC HEMI CLASSIC LP,272,RC,,,,,,,,both,,,63304.5800,9495.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,19434.51,,,,,,,16338.9100,63304.5800,other,"30.7% of $63,304.58 in Billed Charges for Rev 272 = $19,434.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODEL THORACIC HEMI CLASSIC LP,272,RC,,,,,,,,both,,,63304.5800,9495.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,20447.38,,,,,,,16338.9100,63304.5800,percent of total billed charges,"32.3% of $63,304.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL THORACIC HEMI CLASSIC LP,272,RC,,,,,,,,both,,,63304.5800,9495.6900,WELLCARE,WELLCARE MEDICAID,63304.58,,,,,,,16338.9100,63304.5800,percent of total billed charges,"100% of $63,304.58 in Billed Charges for Rev 272 = $63,304.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE LATERAL PATIENT POSITIONING,272,RC,,,,,,,,both,,,10967.3300,1645.1000,AETNA,AETNA,4683.05,,,,,,,2830.6700,10967.3300,percent of total billed charges,"42.7% of $10,967.33 in Billed Charges for Rev 272 = $4,683.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE LATERAL PATIENT POSITIONING,272,RC,,,,,,,,both,,,10967.3300,1645.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7677.13,,,,,,,2830.6700,10967.3300,percent of total billed charges,"Rev 272 $10,967.33 in Billed Charges at 70% = $7,677.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE LATERAL PATIENT POSITIONING,272,RC,,,,,,,,both,,,10967.3300,1645.1000,CIGNA HEALTHCARE,CIGNA HMO,4573.38,,,,,,,2830.6700,10967.3300,percent of total billed charges,"41.7% of $10,967.33 in Billed Charges for Rev 272 = $4,573.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE LATERAL PATIENT POSITIONING,272,RC,,,,,,,,both,,,10967.3300,1645.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5088.84,,,,,,,2830.6700,10967.3300,percent of total billed charges,"46.4% of $10,967.33 in Billed Charges for Rev 272 = $5,088.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE LATERAL PATIENT POSITIONING,272,RC,,,,,,,,both,,,10967.3300,1645.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4573.38,,,,,,,2830.6700,10967.3300,percent of total billed charges,"41.7% of $10,967.33 in Billed Charges for Rev 272 = $4,573.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE LATERAL PATIENT POSITIONING,272,RC,,,,,,,,both,,,10967.3300,1645.1000,CIGNA HEALTHCARE,CIGNA PPO,4573.38,,,,,,,2830.6700,10967.3300,percent of total billed charges,"41.7% of $10,967.33 in Billed Charges for Rev 272 = $4,573.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE LATERAL PATIENT POSITIONING,272,RC,,,,,,,,both,,,10967.3300,1645.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9870.60,,,,,,,2830.6700,10967.3300,percent of total billed charges,"90% of $10,967.33 in Billed Charges for Rev 272 = $9,870.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE LATERAL PATIENT POSITIONING,272,RC,,,,,,,,both,,,10967.3300,1645.1000,MEDCOST,MEDCOST VHN,5219.35,,,,,,,2830.6700,10967.3300,percent of total billed charges,"47.59% of $10,967.33 in Billed Charges for Rev 272 = $5,219.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE LATERAL PATIENT POSITIONING,272,RC,,,,,,,,both,,,10967.3300,1645.1000,SENTARA HEALTH,SENTARA HEALTH,2830.67,,,,,,,2830.6700,10967.3300,percent of total billed charges,"25.81% of $10,967.33 in Billed Charges for Rev 272 = $2,830.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE LATERAL PATIENT POSITIONING,272,RC,,,,,,,,both,,,10967.3300,1645.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10967.33,,,,,,,2830.6700,10967.3300,percent of total billed charges,"100% of $10,967.33 in Billed Charges for Rev 272 = $10,967.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE LATERAL PATIENT POSITIONING,272,RC,,,,,,,,both,,,10967.3300,1645.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5483.67,,,,,,,2830.6700,10967.3300,percent of total billed charges,"Rev 272 $10,967.33 in Billed Charges at 50% = $5,483.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE LATERAL PATIENT POSITIONING,272,RC,,,,,,,,both,,,10967.3300,1645.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3542.45,,,,,,,2830.6700,10967.3300,other,"32.3% of $10,967.33 in Billed Charges for Rev 272 = $3,542.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODULE LATERAL PATIENT POSITIONING,272,RC,,,,,,,,both,,,10967.3300,1645.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3366.97,,,,,,,2830.6700,10967.3300,other,"30.7% of $10,967.33 in Billed Charges for Rev 272 = $3,366.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODULE LATERAL PATIENT POSITIONING,272,RC,,,,,,,,both,,,10967.3300,1645.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,3542.45,,,,,,,2830.6700,10967.3300,percent of total billed charges,"32.3% of $10,967.33 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE LATERAL PATIENT POSITIONING,272,RC,,,,,,,,both,,,10967.3300,1645.1000,WELLCARE,WELLCARE MEDICAID,10967.33,,,,,,,2830.6700,10967.3300,percent of total billed charges,"100% of $10,967.33 in Billed Charges for Rev 272 = $10,967.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CLOSUREFAST 6FR X 12CM,272,RC,27202011,CDM,,,,,,both,,,1821.0000,273.1500,AETNA,AETNA,777.57,,,,,,,470.0000,1821.0000,percent of total billed charges,"42.7% of $1,821.00 in Billed Charges for Rev 272 = $777.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CLOSUREFAST 6FR X 12CM,272,RC,27202011,CDM,,,,,,both,,,1821.0000,273.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1274.70,,,,,,,470.0000,1821.0000,percent of total billed charges,"Rev 272 $1,821.00 in Billed Charges at 70% = $1,274.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CLOSUREFAST 6FR X 12CM,272,RC,27202011,CDM,,,,,,both,,,1821.0000,273.1500,CIGNA HEALTHCARE,CIGNA HMO,759.36,,,,,,,470.0000,1821.0000,percent of total billed charges,"41.7% of $1,821.00 in Billed Charges for Rev 272 = $759.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CLOSUREFAST 6FR X 12CM,272,RC,27202011,CDM,,,,,,both,,,1821.0000,273.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,844.94,,,,,,,470.0000,1821.0000,percent of total billed charges,"46.4% of $1,821.00 in Billed Charges for Rev 272 = $844.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CLOSUREFAST 6FR X 12CM,272,RC,27202011,CDM,,,,,,both,,,1821.0000,273.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,759.36,,,,,,,470.0000,1821.0000,percent of total billed charges,"41.7% of $1,821.00 in Billed Charges for Rev 272 = $759.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CLOSUREFAST 6FR X 12CM,272,RC,27202011,CDM,,,,,,both,,,1821.0000,273.1500,CIGNA HEALTHCARE,CIGNA PPO,759.36,,,,,,,470.0000,1821.0000,percent of total billed charges,"41.7% of $1,821.00 in Billed Charges for Rev 272 = $759.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CLOSUREFAST 6FR X 12CM,272,RC,27202011,CDM,,,,,,both,,,1821.0000,273.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1638.90,,,,,,,470.0000,1821.0000,percent of total billed charges,"90% of $1,821.00 in Billed Charges for Rev 272 = $1,638.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CLOSUREFAST 6FR X 12CM,272,RC,27202011,CDM,,,,,,both,,,1821.0000,273.1500,MEDCOST,MEDCOST VHN,866.61,,,,,,,470.0000,1821.0000,percent of total billed charges,"47.59% of $1,821.00 in Billed Charges for Rev 272 = $866.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CLOSUREFAST 6FR X 12CM,272,RC,27202011,CDM,,,,,,both,,,1821.0000,273.1500,SENTARA HEALTH,SENTARA HEALTH,470.00,,,,,,,470.0000,1821.0000,percent of total billed charges,"25.81% of $1,821.00 in Billed Charges for Rev 272 = $470.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CLOSUREFAST 6FR X 12CM,272,RC,27202011,CDM,,,,,,both,,,1821.0000,273.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1821.00,,,,,,,470.0000,1821.0000,percent of total billed charges,"100% of $1,821.00 in Billed Charges for Rev 272 = $1,821.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CLOSUREFAST 6FR X 12CM,272,RC,27202011,CDM,,,,,,both,,,1821.0000,273.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,910.50,,,,,,,470.0000,1821.0000,percent of total billed charges,"Rev 272 $1,821.00 in Billed Charges at 50% = $910.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CLOSUREFAST 6FR X 12CM,272,RC,27202011,CDM,,,,,,both,,,1821.0000,273.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,588.18,,,,,,,470.0000,1821.0000,other,"32.3% of $1,821.00 in Billed Charges for Rev 272 = $588.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH CLOSUREFAST 6FR X 12CM,272,RC,27202011,CDM,,,,,,both,,,1821.0000,273.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,559.05,,,,,,,470.0000,1821.0000,other,"30.7% of $1,821.00 in Billed Charges for Rev 272 = $559.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH CLOSUREFAST 6FR X 12CM,272,RC,27202011,CDM,,,,,,both,,,1821.0000,273.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,588.18,,,,,,,470.0000,1821.0000,percent of total billed charges,"32.3% of $1,821.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CLOSUREFAST 6FR X 12CM,272,RC,27202011,CDM,,,,,,both,,,1821.0000,273.1500,WELLCARE,WELLCARE MEDICAID,1821.00,,,,,,,470.0000,1821.0000,percent of total billed charges,"100% of $1,821.00 in Billed Charges for Rev 272 = $1,821.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL DIOMED EVLT KIT,272,RC,27201528,CDM,,,,,,both,,,124.0000,18.6000,AETNA,AETNA,52.95,,,,,,,32.0000,124.0000,percent of total billed charges,42.7% of $124.00 in Billed Charges for Rev 272 = $52.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL DIOMED EVLT KIT,272,RC,27201528,CDM,,,,,,both,,,124.0000,18.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,86.80,,,,,,,32.0000,124.0000,percent of total billed charges,Rev 272 $124.00 in Billed Charges at 70% = $86.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL DIOMED EVLT KIT,272,RC,27201528,CDM,,,,,,both,,,124.0000,18.6000,CIGNA HEALTHCARE,CIGNA HMO,51.71,,,,,,,32.0000,124.0000,percent of total billed charges,41.7% of $124.00 in Billed Charges for Rev 272 = $51.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL DIOMED EVLT KIT,272,RC,27201528,CDM,,,,,,both,,,124.0000,18.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,57.54,,,,,,,32.0000,124.0000,percent of total billed charges,46.4% of $124.00 in Billed Charges for Rev 272 = $57.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL DIOMED EVLT KIT,272,RC,27201528,CDM,,,,,,both,,,124.0000,18.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,51.71,,,,,,,32.0000,124.0000,percent of total billed charges,41.7% of $124.00 in Billed Charges for Rev 272 = $51.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL DIOMED EVLT KIT,272,RC,27201528,CDM,,,,,,both,,,124.0000,18.6000,CIGNA HEALTHCARE,CIGNA PPO,51.71,,,,,,,32.0000,124.0000,percent of total billed charges,41.7% of $124.00 in Billed Charges for Rev 272 = $51.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL DIOMED EVLT KIT,272,RC,27201528,CDM,,,,,,both,,,124.0000,18.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,111.60,,,,,,,32.0000,124.0000,percent of total billed charges,90% of $124.00 in Billed Charges for Rev 272 = $111.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL DIOMED EVLT KIT,272,RC,27201528,CDM,,,,,,both,,,124.0000,18.6000,MEDCOST,MEDCOST VHN,59.01,,,,,,,32.0000,124.0000,percent of total billed charges,47.59% of $124.00 in Billed Charges for Rev 272 = $59.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL DIOMED EVLT KIT,272,RC,27201528,CDM,,,,,,both,,,124.0000,18.6000,SENTARA HEALTH,SENTARA HEALTH,32.00,,,,,,,32.0000,124.0000,percent of total billed charges,25.81% of $124.00 in Billed Charges for Rev 272 = $32.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL DIOMED EVLT KIT,272,RC,27201528,CDM,,,,,,both,,,124.0000,18.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",124.00,,,,,,,32.0000,124.0000,percent of total billed charges,100% of $124.00 in Billed Charges for Rev 272 = $124.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL DIOMED EVLT KIT,272,RC,27201528,CDM,,,,,,both,,,124.0000,18.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,62.00,,,,,,,32.0000,124.0000,percent of total billed charges,Rev 272 $124.00 in Billed Charges at 50% = $62.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL DIOMED EVLT KIT,272,RC,27201528,CDM,,,,,,both,,,124.0000,18.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,40.05,,,,,,,32.0000,124.0000,other,32.3% of $124.00 in Billed Charges for Rev 272 = $40.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PANEL DIOMED EVLT KIT,272,RC,27201528,CDM,,,,,,both,,,124.0000,18.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,38.07,,,,,,,32.0000,124.0000,other,30.7% of $124.00 in Billed Charges for Rev 272 = $38.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PANEL DIOMED EVLT KIT,272,RC,27201528,CDM,,,,,,both,,,124.0000,18.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,40.05,,,,,,,32.0000,124.0000,percent of total billed charges,32.3% of $124.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL DIOMED EVLT KIT,272,RC,27201528,CDM,,,,,,both,,,124.0000,18.6000,WELLCARE,WELLCARE MEDICAID,124.00,,,,,,,32.0000,124.0000,percent of total billed charges,100% of $124.00 in Billed Charges for Rev 272 = $124.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL GI GASTRIC-JEJUN,272,RC,27201515,CDM,,,,,,both,,,72.0000,10.8000,AETNA,AETNA,30.74,,,,,,,18.5800,72.0000,percent of total billed charges,42.7% of $72.00 in Billed Charges for Rev 272 = $30.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL GI GASTRIC-JEJUN,272,RC,27201515,CDM,,,,,,both,,,72.0000,10.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,50.40,,,,,,,18.5800,72.0000,percent of total billed charges,Rev 272 $72.00 in Billed Charges at 70% = $50.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL GI GASTRIC-JEJUN,272,RC,27201515,CDM,,,,,,both,,,72.0000,10.8000,CIGNA HEALTHCARE,CIGNA HMO,30.02,,,,,,,18.5800,72.0000,percent of total billed charges,41.7% of $72.00 in Billed Charges for Rev 272 = $30.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL GI GASTRIC-JEJUN,272,RC,27201515,CDM,,,,,,both,,,72.0000,10.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,33.41,,,,,,,18.5800,72.0000,percent of total billed charges,46.4% of $72.00 in Billed Charges for Rev 272 = $33.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL GI GASTRIC-JEJUN,272,RC,27201515,CDM,,,,,,both,,,72.0000,10.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,30.02,,,,,,,18.5800,72.0000,percent of total billed charges,41.7% of $72.00 in Billed Charges for Rev 272 = $30.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL GI GASTRIC-JEJUN,272,RC,27201515,CDM,,,,,,both,,,72.0000,10.8000,CIGNA HEALTHCARE,CIGNA PPO,30.02,,,,,,,18.5800,72.0000,percent of total billed charges,41.7% of $72.00 in Billed Charges for Rev 272 = $30.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL GI GASTRIC-JEJUN,272,RC,27201515,CDM,,,,,,both,,,72.0000,10.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,64.80,,,,,,,18.5800,72.0000,percent of total billed charges,90% of $72.00 in Billed Charges for Rev 272 = $64.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL GI GASTRIC-JEJUN,272,RC,27201515,CDM,,,,,,both,,,72.0000,10.8000,MEDCOST,MEDCOST VHN,34.26,,,,,,,18.5800,72.0000,percent of total billed charges,47.59% of $72.00 in Billed Charges for Rev 272 = $34.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL GI GASTRIC-JEJUN,272,RC,27201515,CDM,,,,,,both,,,72.0000,10.8000,SENTARA HEALTH,SENTARA HEALTH,18.58,,,,,,,18.5800,72.0000,percent of total billed charges,25.81% of $72.00 in Billed Charges for Rev 272 = $18.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL GI GASTRIC-JEJUN,272,RC,27201515,CDM,,,,,,both,,,72.0000,10.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",72.00,,,,,,,18.5800,72.0000,percent of total billed charges,100% of $72.00 in Billed Charges for Rev 272 = $72.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL GI GASTRIC-JEJUN,272,RC,27201515,CDM,,,,,,both,,,72.0000,10.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,36.00,,,,,,,18.5800,72.0000,percent of total billed charges,Rev 272 $72.00 in Billed Charges at 50% = $36.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL GI GASTRIC-JEJUN,272,RC,27201515,CDM,,,,,,both,,,72.0000,10.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,23.26,,,,,,,18.5800,72.0000,other,32.3% of $72.00 in Billed Charges for Rev 272 = $23.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PANEL GI GASTRIC-JEJUN,272,RC,27201515,CDM,,,,,,both,,,72.0000,10.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,22.10,,,,,,,18.5800,72.0000,other,30.7% of $72.00 in Billed Charges for Rev 272 = $22.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PANEL GI GASTRIC-JEJUN,272,RC,27201515,CDM,,,,,,both,,,72.0000,10.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,23.26,,,,,,,18.5800,72.0000,percent of total billed charges,32.3% of $72.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL GI GASTRIC-JEJUN,272,RC,27201515,CDM,,,,,,both,,,72.0000,10.8000,WELLCARE,WELLCARE MEDICAID,72.00,,,,,,,18.5800,72.0000,percent of total billed charges,100% of $72.00 in Billed Charges for Rev 272 = $72.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL NEEDLE TRANSJUGUL LIVER ACCES,272,RC,27201590,CDM,,,,,,both,,,1567.0000,235.0500,AETNA,AETNA,669.11,,,,,,,404.4400,1567.0000,percent of total billed charges,"42.7% of $1,567.00 in Billed Charges for Rev 272 = $669.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL NEEDLE TRANSJUGUL LIVER ACCES,272,RC,27201590,CDM,,,,,,both,,,1567.0000,235.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1096.90,,,,,,,404.4400,1567.0000,percent of total billed charges,"Rev 272 $1,567.00 in Billed Charges at 70% = $1,096.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL NEEDLE TRANSJUGUL LIVER ACCES,272,RC,27201590,CDM,,,,,,both,,,1567.0000,235.0500,CIGNA HEALTHCARE,CIGNA HMO,653.44,,,,,,,404.4400,1567.0000,percent of total billed charges,"41.7% of $1,567.00 in Billed Charges for Rev 272 = $653.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL NEEDLE TRANSJUGUL LIVER ACCES,272,RC,27201590,CDM,,,,,,both,,,1567.0000,235.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,727.09,,,,,,,404.4400,1567.0000,percent of total billed charges,"46.4% of $1,567.00 in Billed Charges for Rev 272 = $727.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL NEEDLE TRANSJUGUL LIVER ACCES,272,RC,27201590,CDM,,,,,,both,,,1567.0000,235.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,653.44,,,,,,,404.4400,1567.0000,percent of total billed charges,"41.7% of $1,567.00 in Billed Charges for Rev 272 = $653.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL NEEDLE TRANSJUGUL LIVER ACCES,272,RC,27201590,CDM,,,,,,both,,,1567.0000,235.0500,CIGNA HEALTHCARE,CIGNA PPO,653.44,,,,,,,404.4400,1567.0000,percent of total billed charges,"41.7% of $1,567.00 in Billed Charges for Rev 272 = $653.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL NEEDLE TRANSJUGUL LIVER ACCES,272,RC,27201590,CDM,,,,,,both,,,1567.0000,235.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1410.30,,,,,,,404.4400,1567.0000,percent of total billed charges,"90% of $1,567.00 in Billed Charges for Rev 272 = $1,410.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL NEEDLE TRANSJUGUL LIVER ACCES,272,RC,27201590,CDM,,,,,,both,,,1567.0000,235.0500,MEDCOST,MEDCOST VHN,745.74,,,,,,,404.4400,1567.0000,percent of total billed charges,"47.59% of $1,567.00 in Billed Charges for Rev 272 = $745.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL NEEDLE TRANSJUGUL LIVER ACCES,272,RC,27201590,CDM,,,,,,both,,,1567.0000,235.0500,SENTARA HEALTH,SENTARA HEALTH,404.44,,,,,,,404.4400,1567.0000,percent of total billed charges,"25.81% of $1,567.00 in Billed Charges for Rev 272 = $404.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL NEEDLE TRANSJUGUL LIVER ACCES,272,RC,27201590,CDM,,,,,,both,,,1567.0000,235.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1567.00,,,,,,,404.4400,1567.0000,percent of total billed charges,"100% of $1,567.00 in Billed Charges for Rev 272 = $1,567.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL NEEDLE TRANSJUGUL LIVER ACCES,272,RC,27201590,CDM,,,,,,both,,,1567.0000,235.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,783.50,,,,,,,404.4400,1567.0000,percent of total billed charges,"Rev 272 $1,567.00 in Billed Charges at 50% = $783.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL NEEDLE TRANSJUGUL LIVER ACCES,272,RC,27201590,CDM,,,,,,both,,,1567.0000,235.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,506.14,,,,,,,404.4400,1567.0000,other,"32.3% of $1,567.00 in Billed Charges for Rev 272 = $506.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PANEL NEEDLE TRANSJUGUL LIVER ACCES,272,RC,27201590,CDM,,,,,,both,,,1567.0000,235.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,481.07,,,,,,,404.4400,1567.0000,other,"30.7% of $1,567.00 in Billed Charges for Rev 272 = $481.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PANEL NEEDLE TRANSJUGUL LIVER ACCES,272,RC,27201590,CDM,,,,,,both,,,1567.0000,235.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,506.14,,,,,,,404.4400,1567.0000,percent of total billed charges,"32.3% of $1,567.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL NEEDLE TRANSJUGUL LIVER ACCES,272,RC,27201590,CDM,,,,,,both,,,1567.0000,235.0500,WELLCARE,WELLCARE MEDICAID,1567.00,,,,,,,404.4400,1567.0000,percent of total billed charges,"100% of $1,567.00 in Billed Charges for Rev 272 = $1,567.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH COUDE 12FR 5CC,272,RC,27200180,CDM,,,,,,both,,,65.0000,9.7500,AETNA,AETNA,27.76,,,,,,,16.7800,65.0000,percent of total billed charges,42.7% of $65.00 in Billed Charges for Rev 272 = $27.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH COUDE 12FR 5CC,272,RC,27200180,CDM,,,,,,both,,,65.0000,9.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,45.50,,,,,,,16.7800,65.0000,percent of total billed charges,Rev 272 $65.00 in Billed Charges at 70% = $45.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH COUDE 12FR 5CC,272,RC,27200180,CDM,,,,,,both,,,65.0000,9.7500,CIGNA HEALTHCARE,CIGNA HMO,27.11,,,,,,,16.7800,65.0000,percent of total billed charges,41.7% of $65.00 in Billed Charges for Rev 272 = $27.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH COUDE 12FR 5CC,272,RC,27200180,CDM,,,,,,both,,,65.0000,9.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,30.16,,,,,,,16.7800,65.0000,percent of total billed charges,46.4% of $65.00 in Billed Charges for Rev 272 = $30.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH COUDE 12FR 5CC,272,RC,27200180,CDM,,,,,,both,,,65.0000,9.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,27.11,,,,,,,16.7800,65.0000,percent of total billed charges,41.7% of $65.00 in Billed Charges for Rev 272 = $27.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH COUDE 12FR 5CC,272,RC,27200180,CDM,,,,,,both,,,65.0000,9.7500,CIGNA HEALTHCARE,CIGNA PPO,27.11,,,,,,,16.7800,65.0000,percent of total billed charges,41.7% of $65.00 in Billed Charges for Rev 272 = $27.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH COUDE 12FR 5CC,272,RC,27200180,CDM,,,,,,both,,,65.0000,9.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,58.50,,,,,,,16.7800,65.0000,percent of total billed charges,90% of $65.00 in Billed Charges for Rev 272 = $58.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH COUDE 12FR 5CC,272,RC,27200180,CDM,,,,,,both,,,65.0000,9.7500,MEDCOST,MEDCOST VHN,30.93,,,,,,,16.7800,65.0000,percent of total billed charges,47.59% of $65.00 in Billed Charges for Rev 272 = $30.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH COUDE 12FR 5CC,272,RC,27200180,CDM,,,,,,both,,,65.0000,9.7500,SENTARA HEALTH,SENTARA HEALTH,16.78,,,,,,,16.7800,65.0000,percent of total billed charges,25.81% of $65.00 in Billed Charges for Rev 272 = $16.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH COUDE 12FR 5CC,272,RC,27200180,CDM,,,,,,both,,,65.0000,9.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",65.00,,,,,,,16.7800,65.0000,percent of total billed charges,100% of $65.00 in Billed Charges for Rev 272 = $65.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH COUDE 12FR 5CC,272,RC,27200180,CDM,,,,,,both,,,65.0000,9.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,32.50,,,,,,,16.7800,65.0000,percent of total billed charges,Rev 272 $65.00 in Billed Charges at 50% = $32.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH COUDE 12FR 5CC,272,RC,27200180,CDM,,,,,,both,,,65.0000,9.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,21.00,,,,,,,16.7800,65.0000,other,32.3% of $65.00 in Billed Charges for Rev 272 = $21.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH COUDE 12FR 5CC,272,RC,27200180,CDM,,,,,,both,,,65.0000,9.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,19.96,,,,,,,16.7800,65.0000,other,30.7% of $65.00 in Billed Charges for Rev 272 = $19.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH COUDE 12FR 5CC,272,RC,27200180,CDM,,,,,,both,,,65.0000,9.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,21.00,,,,,,,16.7800,65.0000,percent of total billed charges,32.3% of $65.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH COUDE 12FR 5CC,272,RC,27200180,CDM,,,,,,both,,,65.0000,9.7500,WELLCARE,WELLCARE MEDICAID,65.00,,,,,,,16.7800,65.0000,percent of total billed charges,100% of $65.00 in Billed Charges for Rev 272 = $65.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FEMALE SELF CATH 14 FR,272,RC,27200196,CDM,,,,,,both,,,2.0000,0.3000,AETNA,AETNA,0.85,,,,,,,0.5200,2.0000,percent of total billed charges,42.7% of $2.00 in Billed Charges for Rev 272 = $0.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FEMALE SELF CATH 14 FR,272,RC,27200196,CDM,,,,,,both,,,2.0000,0.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1.40,,,,,,,0.5200,2.0000,percent of total billed charges,Rev 272 $2.00 in Billed Charges at 70% = $1.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FEMALE SELF CATH 14 FR,272,RC,27200196,CDM,,,,,,both,,,2.0000,0.3000,CIGNA HEALTHCARE,CIGNA HMO,0.83,,,,,,,0.5200,2.0000,percent of total billed charges,41.7% of $2.00 in Billed Charges for Rev 272 = $0.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FEMALE SELF CATH 14 FR,272,RC,27200196,CDM,,,,,,both,,,2.0000,0.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,0.93,,,,,,,0.5200,2.0000,percent of total billed charges,46.4% of $2.00 in Billed Charges for Rev 272 = $0.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FEMALE SELF CATH 14 FR,272,RC,27200196,CDM,,,,,,both,,,2.0000,0.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,0.83,,,,,,,0.5200,2.0000,percent of total billed charges,41.7% of $2.00 in Billed Charges for Rev 272 = $0.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FEMALE SELF CATH 14 FR,272,RC,27200196,CDM,,,,,,both,,,2.0000,0.3000,CIGNA HEALTHCARE,CIGNA PPO,0.83,,,,,,,0.5200,2.0000,percent of total billed charges,41.7% of $2.00 in Billed Charges for Rev 272 = $0.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FEMALE SELF CATH 14 FR,272,RC,27200196,CDM,,,,,,both,,,2.0000,0.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1.80,,,,,,,0.5200,2.0000,percent of total billed charges,90% of $2.00 in Billed Charges for Rev 272 = $1.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FEMALE SELF CATH 14 FR,272,RC,27200196,CDM,,,,,,both,,,2.0000,0.3000,MEDCOST,MEDCOST VHN,0.95,,,,,,,0.5200,2.0000,percent of total billed charges,47.59% of $2.00 in Billed Charges for Rev 272 = $0.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FEMALE SELF CATH 14 FR,272,RC,27200196,CDM,,,,,,both,,,2.0000,0.3000,SENTARA HEALTH,SENTARA HEALTH,0.52,,,,,,,0.5200,2.0000,percent of total billed charges,25.81% of $2.00 in Billed Charges for Rev 272 = $0.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FEMALE SELF CATH 14 FR,272,RC,27200196,CDM,,,,,,both,,,2.0000,0.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2.00,,,,,,,0.5200,2.0000,percent of total billed charges,100% of $2.00 in Billed Charges for Rev 272 = $2.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FEMALE SELF CATH 14 FR,272,RC,27200196,CDM,,,,,,both,,,2.0000,0.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1.00,,,,,,,0.5200,2.0000,percent of total billed charges,Rev 272 $2.00 in Billed Charges at 50% = $1.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FEMALE SELF CATH 14 FR,272,RC,27200196,CDM,,,,,,both,,,2.0000,0.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,0.65,,,,,,,0.5200,2.0000,other,32.3% of $2.00 in Billed Charges for Rev 272 = $0.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH FEMALE SELF CATH 14 FR,272,RC,27200196,CDM,,,,,,both,,,2.0000,0.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,0.61,,,,,,,0.5200,2.0000,other,30.7% of $2.00 in Billed Charges for Rev 272 = $0.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH FEMALE SELF CATH 14 FR,272,RC,27200196,CDM,,,,,,both,,,2.0000,0.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,0.65,,,,,,,0.5200,2.0000,percent of total billed charges,32.3% of $2.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FEMALE SELF CATH 14 FR,272,RC,27200196,CDM,,,,,,both,,,2.0000,0.3000,WELLCARE,WELLCARE MEDICAID,2.00,,,,,,,0.5200,2.0000,percent of total billed charges,100% of $2.00 in Billed Charges for Rev 272 = $2.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FIDELITY IAB 8FR 40CC,278,RC,27801450,CDM,,,,,,both,,,51352.0000,7702.8000,AETNA,AETNA,24648.96,,,,,,,3645.9900,51352.0000,percent of total billed charges,"48% of $51,352.00 in Billed Charges for Rev 278 = $24,648.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR 40CC,278,RC,27801450,CDM,,,,,,both,,,51352.0000,7702.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,25676.00,,,,,,,3645.9900,51352.0000,percent of total billed charges,"50% of $51,352.00 in Billed Charges for Rev 278 = $25,676.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR 40CC,278,RC,27801450,CDM,,,,,,both,,,51352.0000,7702.8000,CIGNA HEALTHCARE,CIGNA HMO,21413.78,,,,,,,3645.9900,51352.0000,percent of total billed charges,"41.7% of $51,352.00 in Billed Charges for Rev 278 = $21,413.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR 40CC,278,RC,27801450,CDM,,,,,,both,,,51352.0000,7702.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,20540.80,,,,,,,3645.9900,51352.0000,percent of total billed charges,"40% of $51,352.00 in Billed Charges for Rev 278 = $20,540.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR 40CC,278,RC,27801450,CDM,,,,,,both,,,51352.0000,7702.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,21413.78,,,,,,,3645.9900,51352.0000,percent of total billed charges,"41.7% of $51,352.00 in Billed Charges for Rev 278 = $21,413.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR 40CC,278,RC,27801450,CDM,,,,,,both,,,51352.0000,7702.8000,CIGNA HEALTHCARE,CIGNA PPO,21413.78,,,,,,,3645.9900,51352.0000,percent of total billed charges,"41.7% of $51,352.00 in Billed Charges for Rev 278 = $21,413.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR 40CC,278,RC,27801450,CDM,,,,,,both,,,51352.0000,7702.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,46216.80,,,,,,,3645.9900,51352.0000,percent of total billed charges,"90% of $51,352.00 in Billed Charges for Rev 278 = $46,216.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR 40CC,278,RC,27801450,CDM,,,,,,both,,,51352.0000,7702.8000,MEDCOST,MEDCOST VHN,24438.42,,,,,,,3645.9900,51352.0000,percent of total billed charges,"47.59% of $51,352.00 in Billed Charges for Rev 278 = $24,438.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR 40CC,278,RC,27801450,CDM,,,,,,both,,,51352.0000,7702.8000,SENTARA HEALTH,SENTARA HEALTH,13253.95,,,,,,,3645.9900,51352.0000,percent of total billed charges,"25.81% of $51,352.00 in Billed Charges for Rev 278 = $13,253.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR 40CC,278,RC,27801450,CDM,,,,,,both,,,51352.0000,7702.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",51352.00,,,,,,,3645.9900,51352.0000,percent of total billed charges,"100% of $51,352.00 in Billed Charges for Rev 278 = $51,352.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR 40CC,278,RC,27801450,CDM,,,,,,both,,,51352.0000,7702.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,25676.00,,,,,,,3645.9900,51352.0000,percent of total billed charges,"Rev 278 $51,352.00 in Billed Charges at 50% = $25,676.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR 40CC,278,RC,27801450,CDM,,,,,,both,,,51352.0000,7702.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3851.40,,,,,,,3645.9900,51352.0000,percent of total billed charges,"7.5% of $51,352.00 in Billed Charges for Rev 278 = $3,851.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR 40CC,278,RC,27801450,CDM,,,,,,both,,,51352.0000,7702.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3645.99,,,,,,,3645.9900,51352.0000,percent of total billed charges,"7.1% of $51,352.00 in Billed Charges for Rev 278 = $3,645.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR 40CC,278,RC,27801450,CDM,,,,,,both,,,51352.0000,7702.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,3645.99,,,,,,,3645.9900,51352.0000,percent of total billed charges,"7.1% of $51,352.00 in Billed Charges for Rev 278 = $3,645.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR 40CC,278,RC,27801450,CDM,,,,,,both,,,51352.0000,7702.8000,WELLCARE,WELLCARE MEDICAID,51352.00,,,,,,,3645.9900,51352.0000,percent of total billed charges,"100% of $51,352.00 in Billed Charges for Rev 278 = $51,352.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PANEL PICC CATH 4 FR SINGLE VAXCELL,272,RC,27200995,CDM,,,,,,both,,,122.0000,18.3000,AETNA,AETNA,52.09,,,,,,,31.4900,122.0000,percent of total billed charges,42.7% of $122.00 in Billed Charges for Rev 272 = $52.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL PICC CATH 4 FR SINGLE VAXCELL,272,RC,27200995,CDM,,,,,,both,,,122.0000,18.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,85.40,,,,,,,31.4900,122.0000,percent of total billed charges,Rev 272 $122.00 in Billed Charges at 70% = $85.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL PICC CATH 4 FR SINGLE VAXCELL,272,RC,27200995,CDM,,,,,,both,,,122.0000,18.3000,CIGNA HEALTHCARE,CIGNA HMO,50.87,,,,,,,31.4900,122.0000,percent of total billed charges,41.7% of $122.00 in Billed Charges for Rev 272 = $50.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL PICC CATH 4 FR SINGLE VAXCELL,272,RC,27200995,CDM,,,,,,both,,,122.0000,18.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,56.61,,,,,,,31.4900,122.0000,percent of total billed charges,46.4% of $122.00 in Billed Charges for Rev 272 = $56.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL PICC CATH 4 FR SINGLE VAXCELL,272,RC,27200995,CDM,,,,,,both,,,122.0000,18.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,50.87,,,,,,,31.4900,122.0000,percent of total billed charges,41.7% of $122.00 in Billed Charges for Rev 272 = $50.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL PICC CATH 4 FR SINGLE VAXCELL,272,RC,27200995,CDM,,,,,,both,,,122.0000,18.3000,CIGNA HEALTHCARE,CIGNA PPO,50.87,,,,,,,31.4900,122.0000,percent of total billed charges,41.7% of $122.00 in Billed Charges for Rev 272 = $50.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL PICC CATH 4 FR SINGLE VAXCELL,272,RC,27200995,CDM,,,,,,both,,,122.0000,18.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,109.80,,,,,,,31.4900,122.0000,percent of total billed charges,90% of $122.00 in Billed Charges for Rev 272 = $109.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL PICC CATH 4 FR SINGLE VAXCELL,272,RC,27200995,CDM,,,,,,both,,,122.0000,18.3000,MEDCOST,MEDCOST VHN,58.06,,,,,,,31.4900,122.0000,percent of total billed charges,47.59% of $122.00 in Billed Charges for Rev 272 = $58.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL PICC CATH 4 FR SINGLE VAXCELL,272,RC,27200995,CDM,,,,,,both,,,122.0000,18.3000,SENTARA HEALTH,SENTARA HEALTH,31.49,,,,,,,31.4900,122.0000,percent of total billed charges,25.81% of $122.00 in Billed Charges for Rev 272 = $31.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL PICC CATH 4 FR SINGLE VAXCELL,272,RC,27200995,CDM,,,,,,both,,,122.0000,18.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",122.00,,,,,,,31.4900,122.0000,percent of total billed charges,100% of $122.00 in Billed Charges for Rev 272 = $122.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL PICC CATH 4 FR SINGLE VAXCELL,272,RC,27200995,CDM,,,,,,both,,,122.0000,18.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,61.00,,,,,,,31.4900,122.0000,percent of total billed charges,Rev 272 $122.00 in Billed Charges at 50% = $61.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL PICC CATH 4 FR SINGLE VAXCELL,272,RC,27200995,CDM,,,,,,both,,,122.0000,18.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,39.41,,,,,,,31.4900,122.0000,other,32.3% of $122.00 in Billed Charges for Rev 272 = $39.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PANEL PICC CATH 4 FR SINGLE VAXCELL,272,RC,27200995,CDM,,,,,,both,,,122.0000,18.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,37.45,,,,,,,31.4900,122.0000,other,30.7% of $122.00 in Billed Charges for Rev 272 = $37.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PANEL PICC CATH 4 FR SINGLE VAXCELL,272,RC,27200995,CDM,,,,,,both,,,122.0000,18.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,39.41,,,,,,,31.4900,122.0000,percent of total billed charges,32.3% of $122.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL PICC CATH 4 FR SINGLE VAXCELL,272,RC,27200995,CDM,,,,,,both,,,122.0000,18.3000,WELLCARE,WELLCARE MEDICAID,122.00,,,,,,,31.4900,122.0000,percent of total billed charges,100% of $122.00 in Billed Charges for Rev 272 = $122.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRACH PASSY MUIR NON PMV2001,274,RC,27400040,CDM,,,,,,both,,,29.0000,4.3500,AETNA,AETNA,13.92,,,,,,,4.7900,29.0000,percent of total billed charges,48% of $29.00 in Billed Charges for Rev 274 = $13.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRACH PASSY MUIR NON PMV2001,274,RC,27400040,CDM,,,,,,both,,,29.0000,4.3500,BLUE CROSS,ANTHEM EXCHANGE,4.79,,,,,,,4.7900,29.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PANEL TRACH PASSY MUIR NON PMV2001,274,RC,27400040,CDM,,,,,,both,,,29.0000,4.3500,BLUE CROSS,ANTHEM HMO,4.79,,,,,,,4.7900,29.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PANEL TRACH PASSY MUIR NON PMV2001,274,RC,27400040,CDM,,,,,,both,,,29.0000,4.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4.79,,,,,,,4.7900,29.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PANEL TRACH PASSY MUIR NON PMV2001,274,RC,27400040,CDM,,,,,,both,,,29.0000,4.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,14.50,,,,,,,4.7900,29.0000,percent of total billed charges,50% of $29.00 in Billed Charges for Rev 274 = $14.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRACH PASSY MUIR NON PMV2001,274,RC,27400040,CDM,,,,,,both,,,29.0000,4.3500,CIGNA HEALTHCARE,CIGNA HMO,12.09,,,,,,,4.7900,29.0000,percent of total billed charges,41.7% of $29.00 in Billed Charges for Rev 274 = $12.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRACH PASSY MUIR NON PMV2001,274,RC,27400040,CDM,,,,,,both,,,29.0000,4.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11.60,,,,,,,4.7900,29.0000,percent of total billed charges,40% of $29.00 in Billed Charges for Rev 274 = $11.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRACH PASSY MUIR NON PMV2001,274,RC,27400040,CDM,,,,,,both,,,29.0000,4.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,12.09,,,,,,,4.7900,29.0000,percent of total billed charges,41.7% of $29.00 in Billed Charges for Rev 274 = $12.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRACH PASSY MUIR NON PMV2001,274,RC,27400040,CDM,,,,,,both,,,29.0000,4.3500,CIGNA HEALTHCARE,CIGNA PPO,12.09,,,,,,,4.7900,29.0000,percent of total billed charges,41.7% of $29.00 in Billed Charges for Rev 274 = $12.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRACH PASSY MUIR NON PMV2001,274,RC,27400040,CDM,,,,,,both,,,29.0000,4.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,26.10,,,,,,,4.7900,29.0000,percent of total billed charges,90% of $29.00 in Billed Charges for Rev 274 = $26.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRACH PASSY MUIR NON PMV2001,274,RC,27400040,CDM,,,,,,both,,,29.0000,4.3500,MEDCOST,MEDCOST VHN,13.80,,,,,,,4.7900,29.0000,percent of total billed charges,47.59% of $29.00 in Billed Charges for Rev 274 = $13.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRACH PASSY MUIR NON PMV2001,274,RC,27400040,CDM,,,,,,both,,,29.0000,4.3500,SENTARA HEALTH,SENTARA HEALTH,7.48,,,,,,,4.7900,29.0000,percent of total billed charges,25.81% of $29.00 in Billed Charges for Rev 274 = $7.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRACH PASSY MUIR NON PMV2001,274,RC,27400040,CDM,,,,,,both,,,29.0000,4.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",29.00,,,,,,,4.7900,29.0000,percent of total billed charges,100% of $29.00 in Billed Charges for Rev 274 = $29.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRACH PASSY MUIR NON PMV2001,274,RC,27400040,CDM,,,,,,both,,,29.0000,4.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14.50,,,,,,,4.7900,29.0000,percent of total billed charges,Rev 274 $29.00 in Billed Charges at 50% = $14.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRACH PASSY MUIR NON PMV2001,274,RC,27400040,CDM,,,,,,both,,,29.0000,4.3500,WELLCARE,WELLCARE MEDICAID,29.00,,,,,,,4.7900,29.0000,percent of total billed charges,100% of $29.00 in Billed Charges for Rev 274 = $29.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRAY PARACENTESIS,272,RC,27201194,CDM,,,,,,both,,,32.0000,4.8000,AETNA,AETNA,13.66,,,,,,,8.2600,32.0000,percent of total billed charges,42.7% of $32.00 in Billed Charges for Rev 272 = $13.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRAY PARACENTESIS,272,RC,27201194,CDM,,,,,,both,,,32.0000,4.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,22.40,,,,,,,8.2600,32.0000,percent of total billed charges,Rev 272 $32.00 in Billed Charges at 70% = $22.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRAY PARACENTESIS,272,RC,27201194,CDM,,,,,,both,,,32.0000,4.8000,CIGNA HEALTHCARE,CIGNA HMO,13.34,,,,,,,8.2600,32.0000,percent of total billed charges,41.7% of $32.00 in Billed Charges for Rev 272 = $13.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRAY PARACENTESIS,272,RC,27201194,CDM,,,,,,both,,,32.0000,4.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,14.85,,,,,,,8.2600,32.0000,percent of total billed charges,46.4% of $32.00 in Billed Charges for Rev 272 = $14.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRAY PARACENTESIS,272,RC,27201194,CDM,,,,,,both,,,32.0000,4.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,13.34,,,,,,,8.2600,32.0000,percent of total billed charges,41.7% of $32.00 in Billed Charges for Rev 272 = $13.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRAY PARACENTESIS,272,RC,27201194,CDM,,,,,,both,,,32.0000,4.8000,CIGNA HEALTHCARE,CIGNA PPO,13.34,,,,,,,8.2600,32.0000,percent of total billed charges,41.7% of $32.00 in Billed Charges for Rev 272 = $13.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRAY PARACENTESIS,272,RC,27201194,CDM,,,,,,both,,,32.0000,4.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,28.80,,,,,,,8.2600,32.0000,percent of total billed charges,90% of $32.00 in Billed Charges for Rev 272 = $28.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRAY PARACENTESIS,272,RC,27201194,CDM,,,,,,both,,,32.0000,4.8000,MEDCOST,MEDCOST VHN,15.23,,,,,,,8.2600,32.0000,percent of total billed charges,47.59% of $32.00 in Billed Charges for Rev 272 = $15.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRAY PARACENTESIS,272,RC,27201194,CDM,,,,,,both,,,32.0000,4.8000,SENTARA HEALTH,SENTARA HEALTH,8.26,,,,,,,8.2600,32.0000,percent of total billed charges,25.81% of $32.00 in Billed Charges for Rev 272 = $8.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRAY PARACENTESIS,272,RC,27201194,CDM,,,,,,both,,,32.0000,4.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",32.00,,,,,,,8.2600,32.0000,percent of total billed charges,100% of $32.00 in Billed Charges for Rev 272 = $32.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRAY PARACENTESIS,272,RC,27201194,CDM,,,,,,both,,,32.0000,4.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,16.00,,,,,,,8.2600,32.0000,percent of total billed charges,Rev 272 $32.00 in Billed Charges at 50% = $16.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRAY PARACENTESIS,272,RC,27201194,CDM,,,,,,both,,,32.0000,4.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,10.34,,,,,,,8.2600,32.0000,other,32.3% of $32.00 in Billed Charges for Rev 272 = $10.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PANEL TRAY PARACENTESIS,272,RC,27201194,CDM,,,,,,both,,,32.0000,4.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,9.82,,,,,,,8.2600,32.0000,other,30.7% of $32.00 in Billed Charges for Rev 272 = $9.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PANEL TRAY PARACENTESIS,272,RC,27201194,CDM,,,,,,both,,,32.0000,4.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,10.34,,,,,,,8.2600,32.0000,percent of total billed charges,32.3% of $32.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANEL TRAY PARACENTESIS,272,RC,27201194,CDM,,,,,,both,,,32.0000,4.8000,WELLCARE,WELLCARE MEDICAID,32.00,,,,,,,8.2600,32.0000,percent of total billed charges,100% of $32.00 in Billed Charges for Rev 272 = $32.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANNICULOUS RETRACTOR REGULAR,272,RC,27202312,CDM,,,,,,both,,,140.0000,21.0000,AETNA,AETNA,59.78,,,,,,,36.1300,140.0000,percent of total billed charges,42.7% of $140.00 in Billed Charges for Rev 272 = $59.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANNICULOUS RETRACTOR REGULAR,272,RC,27202312,CDM,,,,,,both,,,140.0000,21.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,98.00,,,,,,,36.1300,140.0000,percent of total billed charges,Rev 272 $140.00 in Billed Charges at 70% = $98.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANNICULOUS RETRACTOR REGULAR,272,RC,27202312,CDM,,,,,,both,,,140.0000,21.0000,CIGNA HEALTHCARE,CIGNA HMO,58.38,,,,,,,36.1300,140.0000,percent of total billed charges,41.7% of $140.00 in Billed Charges for Rev 272 = $58.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANNICULOUS RETRACTOR REGULAR,272,RC,27202312,CDM,,,,,,both,,,140.0000,21.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,64.96,,,,,,,36.1300,140.0000,percent of total billed charges,46.4% of $140.00 in Billed Charges for Rev 272 = $64.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANNICULOUS RETRACTOR REGULAR,272,RC,27202312,CDM,,,,,,both,,,140.0000,21.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,58.38,,,,,,,36.1300,140.0000,percent of total billed charges,41.7% of $140.00 in Billed Charges for Rev 272 = $58.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANNICULOUS RETRACTOR REGULAR,272,RC,27202312,CDM,,,,,,both,,,140.0000,21.0000,CIGNA HEALTHCARE,CIGNA PPO,58.38,,,,,,,36.1300,140.0000,percent of total billed charges,41.7% of $140.00 in Billed Charges for Rev 272 = $58.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANNICULOUS RETRACTOR REGULAR,272,RC,27202312,CDM,,,,,,both,,,140.0000,21.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,126.00,,,,,,,36.1300,140.0000,percent of total billed charges,90% of $140.00 in Billed Charges for Rev 272 = $126.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANNICULOUS RETRACTOR REGULAR,272,RC,27202312,CDM,,,,,,both,,,140.0000,21.0000,MEDCOST,MEDCOST VHN,66.63,,,,,,,36.1300,140.0000,percent of total billed charges,47.59% of $140.00 in Billed Charges for Rev 272 = $66.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANNICULOUS RETRACTOR REGULAR,272,RC,27202312,CDM,,,,,,both,,,140.0000,21.0000,SENTARA HEALTH,SENTARA HEALTH,36.13,,,,,,,36.1300,140.0000,percent of total billed charges,25.81% of $140.00 in Billed Charges for Rev 272 = $36.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANNICULOUS RETRACTOR REGULAR,272,RC,27202312,CDM,,,,,,both,,,140.0000,21.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",140.00,,,,,,,36.1300,140.0000,percent of total billed charges,100% of $140.00 in Billed Charges for Rev 272 = $140.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANNICULOUS RETRACTOR REGULAR,272,RC,27202312,CDM,,,,,,both,,,140.0000,21.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,70.00,,,,,,,36.1300,140.0000,percent of total billed charges,Rev 272 $140.00 in Billed Charges at 50% = $70.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANNICULOUS RETRACTOR REGULAR,272,RC,27202312,CDM,,,,,,both,,,140.0000,21.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,45.22,,,,,,,36.1300,140.0000,other,32.3% of $140.00 in Billed Charges for Rev 272 = $45.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PANNICULOUS RETRACTOR REGULAR,272,RC,27202312,CDM,,,,,,both,,,140.0000,21.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,42.98,,,,,,,36.1300,140.0000,other,30.7% of $140.00 in Billed Charges for Rev 272 = $42.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PANNICULOUS RETRACTOR REGULAR,272,RC,27202312,CDM,,,,,,both,,,140.0000,21.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,45.22,,,,,,,36.1300,140.0000,percent of total billed charges,32.3% of $140.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PANNICULOUS RETRACTOR REGULAR,272,RC,27202312,CDM,,,,,,both,,,140.0000,21.0000,WELLCARE,WELLCARE MEDICAID,140.00,,,,,,,36.1300,140.0000,percent of total billed charges,100% of $140.00 in Billed Charges for Rev 272 = $140.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FIDELITY IAB 8FR34C068400430,272,RC,27200199,CDM,,,,,,both,,,2603.0000,390.4500,AETNA,AETNA,1111.48,,,,,,,671.8300,2603.0000,percent of total billed charges,"42.7% of $2,603.00 in Billed Charges for Rev 272 = $1,111.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR34C068400430,272,RC,27200199,CDM,,,,,,both,,,2603.0000,390.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1822.10,,,,,,,671.8300,2603.0000,percent of total billed charges,"Rev 272 $2,603.00 in Billed Charges at 70% = $1,822.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR34C068400430,272,RC,27200199,CDM,,,,,,both,,,2603.0000,390.4500,CIGNA HEALTHCARE,CIGNA HMO,1085.45,,,,,,,671.8300,2603.0000,percent of total billed charges,"41.7% of $2,603.00 in Billed Charges for Rev 272 = $1,085.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR34C068400430,272,RC,27200199,CDM,,,,,,both,,,2603.0000,390.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1207.79,,,,,,,671.8300,2603.0000,percent of total billed charges,"46.4% of $2,603.00 in Billed Charges for Rev 272 = $1,207.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR34C068400430,272,RC,27200199,CDM,,,,,,both,,,2603.0000,390.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1085.45,,,,,,,671.8300,2603.0000,percent of total billed charges,"41.7% of $2,603.00 in Billed Charges for Rev 272 = $1,085.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR34C068400430,272,RC,27200199,CDM,,,,,,both,,,2603.0000,390.4500,CIGNA HEALTHCARE,CIGNA PPO,1085.45,,,,,,,671.8300,2603.0000,percent of total billed charges,"41.7% of $2,603.00 in Billed Charges for Rev 272 = $1,085.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR34C068400430,272,RC,27200199,CDM,,,,,,both,,,2603.0000,390.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2342.70,,,,,,,671.8300,2603.0000,percent of total billed charges,"90% of $2,603.00 in Billed Charges for Rev 272 = $2,342.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR34C068400430,272,RC,27200199,CDM,,,,,,both,,,2603.0000,390.4500,MEDCOST,MEDCOST VHN,1238.77,,,,,,,671.8300,2603.0000,percent of total billed charges,"47.59% of $2,603.00 in Billed Charges for Rev 272 = $1,238.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR34C068400430,272,RC,27200199,CDM,,,,,,both,,,2603.0000,390.4500,SENTARA HEALTH,SENTARA HEALTH,671.83,,,,,,,671.8300,2603.0000,percent of total billed charges,"25.81% of $2,603.00 in Billed Charges for Rev 272 = $671.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR34C068400430,272,RC,27200199,CDM,,,,,,both,,,2603.0000,390.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2603.00,,,,,,,671.8300,2603.0000,percent of total billed charges,"100% of $2,603.00 in Billed Charges for Rev 272 = $2,603.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR34C068400430,272,RC,27200199,CDM,,,,,,both,,,2603.0000,390.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1301.50,,,,,,,671.8300,2603.0000,percent of total billed charges,"Rev 272 $2,603.00 in Billed Charges at 50% = $1,301.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR34C068400430,272,RC,27200199,CDM,,,,,,both,,,2603.0000,390.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,840.77,,,,,,,671.8300,2603.0000,other,"32.3% of $2,603.00 in Billed Charges for Rev 272 = $840.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH FIDELITY IAB 8FR34C068400430,272,RC,27200199,CDM,,,,,,both,,,2603.0000,390.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,799.12,,,,,,,671.8300,2603.0000,other,"30.7% of $2,603.00 in Billed Charges for Rev 272 = $799.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH FIDELITY IAB 8FR34C068400430,272,RC,27200199,CDM,,,,,,both,,,2603.0000,390.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,840.77,,,,,,,671.8300,2603.0000,percent of total billed charges,"32.3% of $2,603.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FIDELITY IAB 8FR34C068400430,272,RC,27200199,CDM,,,,,,both,,,2603.0000,390.4500,WELLCARE,WELLCARE MEDICAID,2603.00,,,,,,,671.8300,2603.0000,percent of total billed charges,"100% of $2,603.00 in Billed Charges for Rev 272 = $2,603.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH FOLEY 3WAY,272,RC,27200214,CDM,,,,,,both,,,114.0000,17.1000,AETNA,AETNA,48.68,,,,,,,29.4200,114.0000,percent of total billed charges,42.7% of $114.00 in Billed Charges for Rev 272 = $48.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY 3WAY,272,RC,27200214,CDM,,,,,,both,,,114.0000,17.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,79.80,,,,,,,29.4200,114.0000,percent of total billed charges,Rev 272 $114.00 in Billed Charges at 70% = $79.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY 3WAY,272,RC,27200214,CDM,,,,,,both,,,114.0000,17.1000,CIGNA HEALTHCARE,CIGNA HMO,47.54,,,,,,,29.4200,114.0000,percent of total billed charges,41.7% of $114.00 in Billed Charges for Rev 272 = $47.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY 3WAY,272,RC,27200214,CDM,,,,,,both,,,114.0000,17.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,52.90,,,,,,,29.4200,114.0000,percent of total billed charges,46.4% of $114.00 in Billed Charges for Rev 272 = $52.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY 3WAY,272,RC,27200214,CDM,,,,,,both,,,114.0000,17.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,47.54,,,,,,,29.4200,114.0000,percent of total billed charges,41.7% of $114.00 in Billed Charges for Rev 272 = $47.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY 3WAY,272,RC,27200214,CDM,,,,,,both,,,114.0000,17.1000,CIGNA HEALTHCARE,CIGNA PPO,47.54,,,,,,,29.4200,114.0000,percent of total billed charges,41.7% of $114.00 in Billed Charges for Rev 272 = $47.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY 3WAY,272,RC,27200214,CDM,,,,,,both,,,114.0000,17.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,102.60,,,,,,,29.4200,114.0000,percent of total billed charges,90% of $114.00 in Billed Charges for Rev 272 = $102.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY 3WAY,272,RC,27200214,CDM,,,,,,both,,,114.0000,17.1000,MEDCOST,MEDCOST VHN,54.25,,,,,,,29.4200,114.0000,percent of total billed charges,47.59% of $114.00 in Billed Charges for Rev 272 = $54.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY 3WAY,272,RC,27200214,CDM,,,,,,both,,,114.0000,17.1000,SENTARA HEALTH,SENTARA HEALTH,29.42,,,,,,,29.4200,114.0000,percent of total billed charges,25.81% of $114.00 in Billed Charges for Rev 272 = $29.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY 3WAY,272,RC,27200214,CDM,,,,,,both,,,114.0000,17.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",114.00,,,,,,,29.4200,114.0000,percent of total billed charges,100% of $114.00 in Billed Charges for Rev 272 = $114.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY 3WAY,272,RC,27200214,CDM,,,,,,both,,,114.0000,17.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,57.00,,,,,,,29.4200,114.0000,percent of total billed charges,Rev 272 $114.00 in Billed Charges at 50% = $57.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY 3WAY,272,RC,27200214,CDM,,,,,,both,,,114.0000,17.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,36.82,,,,,,,29.4200,114.0000,other,32.3% of $114.00 in Billed Charges for Rev 272 = $36.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH FOLEY 3WAY,272,RC,27200214,CDM,,,,,,both,,,114.0000,17.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,35.00,,,,,,,29.4200,114.0000,other,30.7% of $114.00 in Billed Charges for Rev 272 = $35.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH FOLEY 3WAY,272,RC,27200214,CDM,,,,,,both,,,114.0000,17.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,36.82,,,,,,,29.4200,114.0000,percent of total billed charges,32.3% of $114.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY 3WAY,272,RC,27200214,CDM,,,,,,both,,,114.0000,17.1000,WELLCARE,WELLCARE MEDICAID,114.00,,,,,,,29.4200,114.0000,percent of total billed charges,100% of $114.00 in Billed Charges for Rev 272 = $114.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY PED,272,RC,27200219,CDM,,,,,,both,,,58.0000,8.7000,AETNA,AETNA,24.77,,,,,,,14.9700,58.0000,percent of total billed charges,42.7% of $58.00 in Billed Charges for Rev 272 = $24.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY PED,272,RC,27200219,CDM,,,,,,both,,,58.0000,8.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,40.60,,,,,,,14.9700,58.0000,percent of total billed charges,Rev 272 $58.00 in Billed Charges at 70% = $40.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY PED,272,RC,27200219,CDM,,,,,,both,,,58.0000,8.7000,CIGNA HEALTHCARE,CIGNA HMO,24.19,,,,,,,14.9700,58.0000,percent of total billed charges,41.7% of $58.00 in Billed Charges for Rev 272 = $24.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY PED,272,RC,27200219,CDM,,,,,,both,,,58.0000,8.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,26.91,,,,,,,14.9700,58.0000,percent of total billed charges,46.4% of $58.00 in Billed Charges for Rev 272 = $26.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY PED,272,RC,27200219,CDM,,,,,,both,,,58.0000,8.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,24.19,,,,,,,14.9700,58.0000,percent of total billed charges,41.7% of $58.00 in Billed Charges for Rev 272 = $24.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY PED,272,RC,27200219,CDM,,,,,,both,,,58.0000,8.7000,CIGNA HEALTHCARE,CIGNA PPO,24.19,,,,,,,14.9700,58.0000,percent of total billed charges,41.7% of $58.00 in Billed Charges for Rev 272 = $24.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY PED,272,RC,27200219,CDM,,,,,,both,,,58.0000,8.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,52.20,,,,,,,14.9700,58.0000,percent of total billed charges,90% of $58.00 in Billed Charges for Rev 272 = $52.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY PED,272,RC,27200219,CDM,,,,,,both,,,58.0000,8.7000,MEDCOST,MEDCOST VHN,27.60,,,,,,,14.9700,58.0000,percent of total billed charges,47.59% of $58.00 in Billed Charges for Rev 272 = $27.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY PED,272,RC,27200219,CDM,,,,,,both,,,58.0000,8.7000,SENTARA HEALTH,SENTARA HEALTH,14.97,,,,,,,14.9700,58.0000,percent of total billed charges,25.81% of $58.00 in Billed Charges for Rev 272 = $14.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY PED,272,RC,27200219,CDM,,,,,,both,,,58.0000,8.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",58.00,,,,,,,14.9700,58.0000,percent of total billed charges,100% of $58.00 in Billed Charges for Rev 272 = $58.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY PED,272,RC,27200219,CDM,,,,,,both,,,58.0000,8.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,29.00,,,,,,,14.9700,58.0000,percent of total billed charges,Rev 272 $58.00 in Billed Charges at 50% = $29.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY PED,272,RC,27200219,CDM,,,,,,both,,,58.0000,8.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,18.73,,,,,,,14.9700,58.0000,other,32.3% of $58.00 in Billed Charges for Rev 272 = $18.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH FOLEY PED,272,RC,27200219,CDM,,,,,,both,,,58.0000,8.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,17.81,,,,,,,14.9700,58.0000,other,30.7% of $58.00 in Billed Charges for Rev 272 = $17.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH FOLEY PED,272,RC,27200219,CDM,,,,,,both,,,58.0000,8.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,18.73,,,,,,,14.9700,58.0000,percent of total billed charges,32.3% of $58.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH FOLEY PED,272,RC,27200219,CDM,,,,,,both,,,58.0000,8.7000,WELLCARE,WELLCARE MEDICAID,58.00,,,,,,,14.9700,58.0000,percent of total billed charges,100% of $58.00 in Billed Charges for Rev 272 = $58.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GROLLMAN 7 100CM G05576,272,RC,27201330,CDM,,,,,,both,,,100.0000,15.0000,AETNA,AETNA,42.70,,,,,,,25.8100,100.0000,percent of total billed charges,42.7% of $100.00 in Billed Charges for Rev 272 = $42.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GROLLMAN 7 100CM G05576,272,RC,27201330,CDM,,,,,,both,,,100.0000,15.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,70.00,,,,,,,25.8100,100.0000,percent of total billed charges,Rev 272 $100.00 in Billed Charges at 70% = $70.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GROLLMAN 7 100CM G05576,272,RC,27201330,CDM,,,,,,both,,,100.0000,15.0000,CIGNA HEALTHCARE,CIGNA HMO,41.70,,,,,,,25.8100,100.0000,percent of total billed charges,41.7% of $100.00 in Billed Charges for Rev 272 = $41.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GROLLMAN 7 100CM G05576,272,RC,27201330,CDM,,,,,,both,,,100.0000,15.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,46.40,,,,,,,25.8100,100.0000,percent of total billed charges,46.4% of $100.00 in Billed Charges for Rev 272 = $46.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GROLLMAN 7 100CM G05576,272,RC,27201330,CDM,,,,,,both,,,100.0000,15.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,41.70,,,,,,,25.8100,100.0000,percent of total billed charges,41.7% of $100.00 in Billed Charges for Rev 272 = $41.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GROLLMAN 7 100CM G05576,272,RC,27201330,CDM,,,,,,both,,,100.0000,15.0000,CIGNA HEALTHCARE,CIGNA PPO,41.70,,,,,,,25.8100,100.0000,percent of total billed charges,41.7% of $100.00 in Billed Charges for Rev 272 = $41.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GROLLMAN 7 100CM G05576,272,RC,27201330,CDM,,,,,,both,,,100.0000,15.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,90.00,,,,,,,25.8100,100.0000,percent of total billed charges,90% of $100.00 in Billed Charges for Rev 272 = $90.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GROLLMAN 7 100CM G05576,272,RC,27201330,CDM,,,,,,both,,,100.0000,15.0000,MEDCOST,MEDCOST VHN,47.59,,,,,,,25.8100,100.0000,percent of total billed charges,47.59% of $100.00 in Billed Charges for Rev 272 = $47.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GROLLMAN 7 100CM G05576,272,RC,27201330,CDM,,,,,,both,,,100.0000,15.0000,SENTARA HEALTH,SENTARA HEALTH,25.81,,,,,,,25.8100,100.0000,percent of total billed charges,25.81% of $100.00 in Billed Charges for Rev 272 = $25.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GROLLMAN 7 100CM G05576,272,RC,27201330,CDM,,,,,,both,,,100.0000,15.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",100.00,,,,,,,25.8100,100.0000,percent of total billed charges,100% of $100.00 in Billed Charges for Rev 272 = $100.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GROLLMAN 7 100CM G05576,272,RC,27201330,CDM,,,,,,both,,,100.0000,15.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,50.00,,,,,,,25.8100,100.0000,percent of total billed charges,Rev 272 $100.00 in Billed Charges at 50% = $50.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GROLLMAN 7 100CM G05576,272,RC,27201330,CDM,,,,,,both,,,100.0000,15.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,32.30,,,,,,,25.8100,100.0000,other,32.3% of $100.00 in Billed Charges for Rev 272 = $32.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH GROLLMAN 7 100CM G05576,272,RC,27201330,CDM,,,,,,both,,,100.0000,15.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,30.70,,,,,,,25.8100,100.0000,other,30.7% of $100.00 in Billed Charges for Rev 272 = $30.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH GROLLMAN 7 100CM G05576,272,RC,27201330,CDM,,,,,,both,,,100.0000,15.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,32.30,,,,,,,25.8100,100.0000,percent of total billed charges,32.3% of $100.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GROLLMAN 7 100CM G05576,272,RC,27201330,CDM,,,,,,both,,,100.0000,15.0000,WELLCARE,WELLCARE MEDICAID,100.00,,,,,,,25.8100,100.0000,percent of total billed charges,100% of $100.00 in Billed Charges for Rev 272 = $100.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PARSONNET POUCH,272,RC,27201782,CDM,,,,,,both,,,647.0000,97.0500,AETNA,AETNA,276.27,,,,,,,166.9900,647.0000,percent of total billed charges,42.7% of $647.00 in Billed Charges for Rev 272 = $276.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PARSONNET POUCH,272,RC,27201782,CDM,,,,,,both,,,647.0000,97.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,452.90,,,,,,,166.9900,647.0000,percent of total billed charges,Rev 272 $647.00 in Billed Charges at 70% = $452.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PARSONNET POUCH,272,RC,27201782,CDM,,,,,,both,,,647.0000,97.0500,CIGNA HEALTHCARE,CIGNA HMO,269.80,,,,,,,166.9900,647.0000,percent of total billed charges,41.7% of $647.00 in Billed Charges for Rev 272 = $269.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PARSONNET POUCH,272,RC,27201782,CDM,,,,,,both,,,647.0000,97.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,300.21,,,,,,,166.9900,647.0000,percent of total billed charges,46.4% of $647.00 in Billed Charges for Rev 272 = $300.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PARSONNET POUCH,272,RC,27201782,CDM,,,,,,both,,,647.0000,97.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,269.80,,,,,,,166.9900,647.0000,percent of total billed charges,41.7% of $647.00 in Billed Charges for Rev 272 = $269.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PARSONNET POUCH,272,RC,27201782,CDM,,,,,,both,,,647.0000,97.0500,CIGNA HEALTHCARE,CIGNA PPO,269.80,,,,,,,166.9900,647.0000,percent of total billed charges,41.7% of $647.00 in Billed Charges for Rev 272 = $269.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PARSONNET POUCH,272,RC,27201782,CDM,,,,,,both,,,647.0000,97.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,582.30,,,,,,,166.9900,647.0000,percent of total billed charges,90% of $647.00 in Billed Charges for Rev 272 = $582.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PARSONNET POUCH,272,RC,27201782,CDM,,,,,,both,,,647.0000,97.0500,MEDCOST,MEDCOST VHN,307.91,,,,,,,166.9900,647.0000,percent of total billed charges,47.59% of $647.00 in Billed Charges for Rev 272 = $307.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PARSONNET POUCH,272,RC,27201782,CDM,,,,,,both,,,647.0000,97.0500,SENTARA HEALTH,SENTARA HEALTH,166.99,,,,,,,166.9900,647.0000,percent of total billed charges,25.81% of $647.00 in Billed Charges for Rev 272 = $166.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PARSONNET POUCH,272,RC,27201782,CDM,,,,,,both,,,647.0000,97.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",647.00,,,,,,,166.9900,647.0000,percent of total billed charges,100% of $647.00 in Billed Charges for Rev 272 = $647.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PARSONNET POUCH,272,RC,27201782,CDM,,,,,,both,,,647.0000,97.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,323.50,,,,,,,166.9900,647.0000,percent of total billed charges,Rev 272 $647.00 in Billed Charges at 50% = $323.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PARSONNET POUCH,272,RC,27201782,CDM,,,,,,both,,,647.0000,97.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,208.98,,,,,,,166.9900,647.0000,other,32.3% of $647.00 in Billed Charges for Rev 272 = $208.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARSONNET POUCH,272,RC,27201782,CDM,,,,,,both,,,647.0000,97.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,198.63,,,,,,,166.9900,647.0000,other,30.7% of $647.00 in Billed Charges for Rev 272 = $198.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARSONNET POUCH,272,RC,27201782,CDM,,,,,,both,,,647.0000,97.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,208.98,,,,,,,166.9900,647.0000,percent of total billed charges,32.3% of $647.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PARSONNET POUCH,272,RC,27201782,CDM,,,,,,both,,,647.0000,97.0500,WELLCARE,WELLCARE MEDICAID,647.00,,,,,,,166.9900,647.0000,percent of total billed charges,100% of $647.00 in Billed Charges for Rev 272 = $647.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PATCH EXTERNAL REFER CARTO 3 SYS,272,RC,27201320,CDM,,,,,,both,,,1434.0000,215.1000,AETNA,AETNA,612.32,,,,,,,370.1200,1434.0000,percent of total billed charges,"42.7% of $1,434.00 in Billed Charges for Rev 272 = $612.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PATCH EXTERNAL REFER CARTO 3 SYS,272,RC,27201320,CDM,,,,,,both,,,1434.0000,215.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1003.80,,,,,,,370.1200,1434.0000,percent of total billed charges,"Rev 272 $1,434.00 in Billed Charges at 70% = $1,003.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PATCH EXTERNAL REFER CARTO 3 SYS,272,RC,27201320,CDM,,,,,,both,,,1434.0000,215.1000,CIGNA HEALTHCARE,CIGNA HMO,597.98,,,,,,,370.1200,1434.0000,percent of total billed charges,"41.7% of $1,434.00 in Billed Charges for Rev 272 = $597.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PATCH EXTERNAL REFER CARTO 3 SYS,272,RC,27201320,CDM,,,,,,both,,,1434.0000,215.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,665.38,,,,,,,370.1200,1434.0000,percent of total billed charges,"46.4% of $1,434.00 in Billed Charges for Rev 272 = $665.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PATCH EXTERNAL REFER CARTO 3 SYS,272,RC,27201320,CDM,,,,,,both,,,1434.0000,215.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,597.98,,,,,,,370.1200,1434.0000,percent of total billed charges,"41.7% of $1,434.00 in Billed Charges for Rev 272 = $597.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PATCH EXTERNAL REFER CARTO 3 SYS,272,RC,27201320,CDM,,,,,,both,,,1434.0000,215.1000,CIGNA HEALTHCARE,CIGNA PPO,597.98,,,,,,,370.1200,1434.0000,percent of total billed charges,"41.7% of $1,434.00 in Billed Charges for Rev 272 = $597.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PATCH EXTERNAL REFER CARTO 3 SYS,272,RC,27201320,CDM,,,,,,both,,,1434.0000,215.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1290.60,,,,,,,370.1200,1434.0000,percent of total billed charges,"90% of $1,434.00 in Billed Charges for Rev 272 = $1,290.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PATCH EXTERNAL REFER CARTO 3 SYS,272,RC,27201320,CDM,,,,,,both,,,1434.0000,215.1000,MEDCOST,MEDCOST VHN,682.44,,,,,,,370.1200,1434.0000,percent of total billed charges,"47.59% of $1,434.00 in Billed Charges for Rev 272 = $682.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PATCH EXTERNAL REFER CARTO 3 SYS,272,RC,27201320,CDM,,,,,,both,,,1434.0000,215.1000,SENTARA HEALTH,SENTARA HEALTH,370.12,,,,,,,370.1200,1434.0000,percent of total billed charges,"25.81% of $1,434.00 in Billed Charges for Rev 272 = $370.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PATCH EXTERNAL REFER CARTO 3 SYS,272,RC,27201320,CDM,,,,,,both,,,1434.0000,215.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1434.00,,,,,,,370.1200,1434.0000,percent of total billed charges,"100% of $1,434.00 in Billed Charges for Rev 272 = $1,434.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PATCH EXTERNAL REFER CARTO 3 SYS,272,RC,27201320,CDM,,,,,,both,,,1434.0000,215.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,717.00,,,,,,,370.1200,1434.0000,percent of total billed charges,"Rev 272 $1,434.00 in Billed Charges at 50% = $717.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PATCH EXTERNAL REFER CARTO 3 SYS,272,RC,27201320,CDM,,,,,,both,,,1434.0000,215.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,463.18,,,,,,,370.1200,1434.0000,other,"32.3% of $1,434.00 in Billed Charges for Rev 272 = $463.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PATCH EXTERNAL REFER CARTO 3 SYS,272,RC,27201320,CDM,,,,,,both,,,1434.0000,215.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,440.24,,,,,,,370.1200,1434.0000,other,"30.7% of $1,434.00 in Billed Charges for Rev 272 = $440.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PATCH EXTERNAL REFER CARTO 3 SYS,272,RC,27201320,CDM,,,,,,both,,,1434.0000,215.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,463.18,,,,,,,370.1200,1434.0000,percent of total billed charges,"32.3% of $1,434.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PATCH EXTERNAL REFER CARTO 3 SYS,272,RC,27201320,CDM,,,,,,both,,,1434.0000,215.1000,WELLCARE,WELLCARE MEDICAID,1434.00,,,,,,,370.1200,1434.0000,percent of total billed charges,"100% of $1,434.00 in Billed Charges for Rev 272 = $1,434.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SURGICEL 4 X 8 EA,272,RC,27201154,CDM,,,,,,both,,,355.0000,53.2500,AETNA,AETNA,151.59,,,,,,,91.6300,355.0000,percent of total billed charges,42.7% of $355.00 in Billed Charges for Rev 272 = $151.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA,272,RC,27201154,CDM,,,,,,both,,,355.0000,53.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,248.50,,,,,,,91.6300,355.0000,percent of total billed charges,Rev 272 $355.00 in Billed Charges at 70% = $248.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA,272,RC,27201154,CDM,,,,,,both,,,355.0000,53.2500,CIGNA HEALTHCARE,CIGNA HMO,148.04,,,,,,,91.6300,355.0000,percent of total billed charges,41.7% of $355.00 in Billed Charges for Rev 272 = $148.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA,272,RC,27201154,CDM,,,,,,both,,,355.0000,53.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,164.72,,,,,,,91.6300,355.0000,percent of total billed charges,46.4% of $355.00 in Billed Charges for Rev 272 = $164.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA,272,RC,27201154,CDM,,,,,,both,,,355.0000,53.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,148.04,,,,,,,91.6300,355.0000,percent of total billed charges,41.7% of $355.00 in Billed Charges for Rev 272 = $148.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA,272,RC,27201154,CDM,,,,,,both,,,355.0000,53.2500,CIGNA HEALTHCARE,CIGNA PPO,148.04,,,,,,,91.6300,355.0000,percent of total billed charges,41.7% of $355.00 in Billed Charges for Rev 272 = $148.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA,272,RC,27201154,CDM,,,,,,both,,,355.0000,53.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,319.50,,,,,,,91.6300,355.0000,percent of total billed charges,90% of $355.00 in Billed Charges for Rev 272 = $319.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA,272,RC,27201154,CDM,,,,,,both,,,355.0000,53.2500,MEDCOST,MEDCOST VHN,168.94,,,,,,,91.6300,355.0000,percent of total billed charges,47.59% of $355.00 in Billed Charges for Rev 272 = $168.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA,272,RC,27201154,CDM,,,,,,both,,,355.0000,53.2500,SENTARA HEALTH,SENTARA HEALTH,91.63,,,,,,,91.6300,355.0000,percent of total billed charges,25.81% of $355.00 in Billed Charges for Rev 272 = $91.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA,272,RC,27201154,CDM,,,,,,both,,,355.0000,53.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",355.00,,,,,,,91.6300,355.0000,percent of total billed charges,100% of $355.00 in Billed Charges for Rev 272 = $355.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA,272,RC,27201154,CDM,,,,,,both,,,355.0000,53.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,177.50,,,,,,,91.6300,355.0000,percent of total billed charges,Rev 272 $355.00 in Billed Charges at 50% = $177.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA,272,RC,27201154,CDM,,,,,,both,,,355.0000,53.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,114.67,,,,,,,91.6300,355.0000,other,32.3% of $355.00 in Billed Charges for Rev 272 = $114.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SURGICEL 4 X 8 EA,272,RC,27201154,CDM,,,,,,both,,,355.0000,53.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,108.99,,,,,,,91.6300,355.0000,other,30.7% of $355.00 in Billed Charges for Rev 272 = $108.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SURGICEL 4 X 8 EA,272,RC,27201154,CDM,,,,,,both,,,355.0000,53.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,114.67,,,,,,,91.6300,355.0000,percent of total billed charges,32.3% of $355.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA,272,RC,27201154,CDM,,,,,,both,,,355.0000,53.2500,WELLCARE,WELLCARE MEDICAID,355.00,,,,,,,91.6300,355.0000,percent of total billed charges,100% of $355.00 in Billed Charges for Rev 272 = $355.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA GREEN,272,RC,27202083,CDM,,,,,,both,,,497.0000,74.5500,AETNA,AETNA,212.22,,,,,,,128.2800,497.0000,percent of total billed charges,42.7% of $497.00 in Billed Charges for Rev 272 = $212.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA GREEN,272,RC,27202083,CDM,,,,,,both,,,497.0000,74.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,347.90,,,,,,,128.2800,497.0000,percent of total billed charges,Rev 272 $497.00 in Billed Charges at 70% = $347.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA GREEN,272,RC,27202083,CDM,,,,,,both,,,497.0000,74.5500,CIGNA HEALTHCARE,CIGNA HMO,207.25,,,,,,,128.2800,497.0000,percent of total billed charges,41.7% of $497.00 in Billed Charges for Rev 272 = $207.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA GREEN,272,RC,27202083,CDM,,,,,,both,,,497.0000,74.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,230.61,,,,,,,128.2800,497.0000,percent of total billed charges,46.4% of $497.00 in Billed Charges for Rev 272 = $230.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA GREEN,272,RC,27202083,CDM,,,,,,both,,,497.0000,74.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,207.25,,,,,,,128.2800,497.0000,percent of total billed charges,41.7% of $497.00 in Billed Charges for Rev 272 = $207.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA GREEN,272,RC,27202083,CDM,,,,,,both,,,497.0000,74.5500,CIGNA HEALTHCARE,CIGNA PPO,207.25,,,,,,,128.2800,497.0000,percent of total billed charges,41.7% of $497.00 in Billed Charges for Rev 272 = $207.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA GREEN,272,RC,27202083,CDM,,,,,,both,,,497.0000,74.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,447.30,,,,,,,128.2800,497.0000,percent of total billed charges,90% of $497.00 in Billed Charges for Rev 272 = $447.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA GREEN,272,RC,27202083,CDM,,,,,,both,,,497.0000,74.5500,MEDCOST,MEDCOST VHN,236.52,,,,,,,128.2800,497.0000,percent of total billed charges,47.59% of $497.00 in Billed Charges for Rev 272 = $236.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA GREEN,272,RC,27202083,CDM,,,,,,both,,,497.0000,74.5500,SENTARA HEALTH,SENTARA HEALTH,128.28,,,,,,,128.2800,497.0000,percent of total billed charges,25.81% of $497.00 in Billed Charges for Rev 272 = $128.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA GREEN,272,RC,27202083,CDM,,,,,,both,,,497.0000,74.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",497.00,,,,,,,128.2800,497.0000,percent of total billed charges,100% of $497.00 in Billed Charges for Rev 272 = $497.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA GREEN,272,RC,27202083,CDM,,,,,,both,,,497.0000,74.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,248.50,,,,,,,128.2800,497.0000,percent of total billed charges,Rev 272 $497.00 in Billed Charges at 50% = $248.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA GREEN,272,RC,27202083,CDM,,,,,,both,,,497.0000,74.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,160.53,,,,,,,128.2800,497.0000,other,32.3% of $497.00 in Billed Charges for Rev 272 = $160.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SURGICEL 4 X 8 EA GREEN,272,RC,27202083,CDM,,,,,,both,,,497.0000,74.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,152.58,,,,,,,128.2800,497.0000,other,30.7% of $497.00 in Billed Charges for Rev 272 = $152.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SURGICEL 4 X 8 EA GREEN,272,RC,27202083,CDM,,,,,,both,,,497.0000,74.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,160.53,,,,,,,128.2800,497.0000,percent of total billed charges,32.3% of $497.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SURGICEL 4 X 8 EA GREEN,272,RC,27202083,CDM,,,,,,both,,,497.0000,74.5500,WELLCARE,WELLCARE MEDICAID,497.00,,,,,,,128.2800,497.0000,percent of total billed charges,100% of $497.00 in Billed Charges for Rev 272 = $497.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI SPHINCTEROTOME RX #M00545150,272,RC,27200754,CDM,,,,,,both,,,1001.0000,150.1500,AETNA,AETNA,427.43,,,,,,,258.3600,1001.0000,percent of total billed charges,"42.7% of $1,001.00 in Billed Charges for Rev 272 = $427.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI SPHINCTEROTOME RX #M00545150,272,RC,27200754,CDM,,,,,,both,,,1001.0000,150.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,700.70,,,,,,,258.3600,1001.0000,percent of total billed charges,"Rev 272 $1,001.00 in Billed Charges at 70% = $700.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI SPHINCTEROTOME RX #M00545150,272,RC,27200754,CDM,,,,,,both,,,1001.0000,150.1500,CIGNA HEALTHCARE,CIGNA HMO,417.42,,,,,,,258.3600,1001.0000,percent of total billed charges,"41.7% of $1,001.00 in Billed Charges for Rev 272 = $417.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI SPHINCTEROTOME RX #M00545150,272,RC,27200754,CDM,,,,,,both,,,1001.0000,150.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,464.46,,,,,,,258.3600,1001.0000,percent of total billed charges,"46.4% of $1,001.00 in Billed Charges for Rev 272 = $464.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI SPHINCTEROTOME RX #M00545150,272,RC,27200754,CDM,,,,,,both,,,1001.0000,150.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,417.42,,,,,,,258.3600,1001.0000,percent of total billed charges,"41.7% of $1,001.00 in Billed Charges for Rev 272 = $417.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI SPHINCTEROTOME RX #M00545150,272,RC,27200754,CDM,,,,,,both,,,1001.0000,150.1500,CIGNA HEALTHCARE,CIGNA PPO,417.42,,,,,,,258.3600,1001.0000,percent of total billed charges,"41.7% of $1,001.00 in Billed Charges for Rev 272 = $417.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI SPHINCTEROTOME RX #M00545150,272,RC,27200754,CDM,,,,,,both,,,1001.0000,150.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,900.90,,,,,,,258.3600,1001.0000,percent of total billed charges,"90% of $1,001.00 in Billed Charges for Rev 272 = $900.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI SPHINCTEROTOME RX #M00545150,272,RC,27200754,CDM,,,,,,both,,,1001.0000,150.1500,MEDCOST,MEDCOST VHN,476.38,,,,,,,258.3600,1001.0000,percent of total billed charges,"47.59% of $1,001.00 in Billed Charges for Rev 272 = $476.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI SPHINCTEROTOME RX #M00545150,272,RC,27200754,CDM,,,,,,both,,,1001.0000,150.1500,SENTARA HEALTH,SENTARA HEALTH,258.36,,,,,,,258.3600,1001.0000,percent of total billed charges,"25.81% of $1,001.00 in Billed Charges for Rev 272 = $258.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI SPHINCTEROTOME RX #M00545150,272,RC,27200754,CDM,,,,,,both,,,1001.0000,150.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1001.00,,,,,,,258.3600,1001.0000,percent of total billed charges,"100% of $1,001.00 in Billed Charges for Rev 272 = $1,001.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI SPHINCTEROTOME RX #M00545150,272,RC,27200754,CDM,,,,,,both,,,1001.0000,150.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,500.50,,,,,,,258.3600,1001.0000,percent of total billed charges,"Rev 272 $1,001.00 in Billed Charges at 50% = $500.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI SPHINCTEROTOME RX #M00545150,272,RC,27200754,CDM,,,,,,both,,,1001.0000,150.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,323.32,,,,,,,258.3600,1001.0000,other,"32.3% of $1,001.00 in Billed Charges for Rev 272 = $323.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC GI SPHINCTEROTOME RX #M00545150,272,RC,27200754,CDM,,,,,,both,,,1001.0000,150.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,307.31,,,,,,,258.3600,1001.0000,other,"30.7% of $1,001.00 in Billed Charges for Rev 272 = $307.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC GI SPHINCTEROTOME RX #M00545150,272,RC,27200754,CDM,,,,,,both,,,1001.0000,150.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,323.32,,,,,,,258.3600,1001.0000,percent of total billed charges,"32.3% of $1,001.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI SPHINCTEROTOME RX #M00545150,272,RC,27200754,CDM,,,,,,both,,,1001.0000,150.1500,WELLCARE,WELLCARE MEDICAID,1001.00,,,,,,,258.3600,1001.0000,percent of total billed charges,"100% of $1,001.00 in Billed Charges for Rev 272 = $1,001.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI STENT RAPID EXCH 8.5FRX10CM,272,RC,27200755,CDM,,,,,,both,,,538.0000,80.7000,AETNA,AETNA,229.73,,,,,,,138.8600,538.0000,percent of total billed charges,42.7% of $538.00 in Billed Charges for Rev 272 = $229.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCH 8.5FRX10CM,272,RC,27200755,CDM,,,,,,both,,,538.0000,80.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,376.60,,,,,,,138.8600,538.0000,percent of total billed charges,Rev 272 $538.00 in Billed Charges at 70% = $376.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCH 8.5FRX10CM,272,RC,27200755,CDM,,,,,,both,,,538.0000,80.7000,CIGNA HEALTHCARE,CIGNA HMO,224.35,,,,,,,138.8600,538.0000,percent of total billed charges,41.7% of $538.00 in Billed Charges for Rev 272 = $224.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCH 8.5FRX10CM,272,RC,27200755,CDM,,,,,,both,,,538.0000,80.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,249.63,,,,,,,138.8600,538.0000,percent of total billed charges,46.4% of $538.00 in Billed Charges for Rev 272 = $249.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCH 8.5FRX10CM,272,RC,27200755,CDM,,,,,,both,,,538.0000,80.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,224.35,,,,,,,138.8600,538.0000,percent of total billed charges,41.7% of $538.00 in Billed Charges for Rev 272 = $224.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCH 8.5FRX10CM,272,RC,27200755,CDM,,,,,,both,,,538.0000,80.7000,CIGNA HEALTHCARE,CIGNA PPO,224.35,,,,,,,138.8600,538.0000,percent of total billed charges,41.7% of $538.00 in Billed Charges for Rev 272 = $224.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCH 8.5FRX10CM,272,RC,27200755,CDM,,,,,,both,,,538.0000,80.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,484.20,,,,,,,138.8600,538.0000,percent of total billed charges,90% of $538.00 in Billed Charges for Rev 272 = $484.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCH 8.5FRX10CM,272,RC,27200755,CDM,,,,,,both,,,538.0000,80.7000,MEDCOST,MEDCOST VHN,256.03,,,,,,,138.8600,538.0000,percent of total billed charges,47.59% of $538.00 in Billed Charges for Rev 272 = $256.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCH 8.5FRX10CM,272,RC,27200755,CDM,,,,,,both,,,538.0000,80.7000,SENTARA HEALTH,SENTARA HEALTH,138.86,,,,,,,138.8600,538.0000,percent of total billed charges,25.81% of $538.00 in Billed Charges for Rev 272 = $138.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCH 8.5FRX10CM,272,RC,27200755,CDM,,,,,,both,,,538.0000,80.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",538.00,,,,,,,138.8600,538.0000,percent of total billed charges,100% of $538.00 in Billed Charges for Rev 272 = $538.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCH 8.5FRX10CM,272,RC,27200755,CDM,,,,,,both,,,538.0000,80.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,269.00,,,,,,,138.8600,538.0000,percent of total billed charges,Rev 272 $538.00 in Billed Charges at 50% = $269.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCH 8.5FRX10CM,272,RC,27200755,CDM,,,,,,both,,,538.0000,80.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,173.77,,,,,,,138.8600,538.0000,other,32.3% of $538.00 in Billed Charges for Rev 272 = $173.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI STENT RAPID EXCH 8.5FRX10CM,272,RC,27200755,CDM,,,,,,both,,,538.0000,80.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,165.17,,,,,,,138.8600,538.0000,other,30.7% of $538.00 in Billed Charges for Rev 272 = $165.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI STENT RAPID EXCH 8.5FRX10CM,272,RC,27200755,CDM,,,,,,both,,,538.0000,80.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,173.77,,,,,,,138.8600,538.0000,percent of total billed charges,32.3% of $538.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCH 8.5FRX10CM,272,RC,27200755,CDM,,,,,,both,,,538.0000,80.7000,WELLCARE,WELLCARE MEDICAID,538.00,,,,,,,138.8600,538.0000,percent of total billed charges,100% of $538.00 in Billed Charges for Rev 272 = $538.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCHANGE 10FRX12CM,272,RC,27200758,CDM,,,,,,both,,,481.0000,72.1500,AETNA,AETNA,205.39,,,,,,,124.1500,481.0000,percent of total billed charges,42.7% of $481.00 in Billed Charges for Rev 272 = $205.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCHANGE 10FRX12CM,272,RC,27200758,CDM,,,,,,both,,,481.0000,72.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,336.70,,,,,,,124.1500,481.0000,percent of total billed charges,Rev 272 $481.00 in Billed Charges at 70% = $336.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCHANGE 10FRX12CM,272,RC,27200758,CDM,,,,,,both,,,481.0000,72.1500,CIGNA HEALTHCARE,CIGNA HMO,200.58,,,,,,,124.1500,481.0000,percent of total billed charges,41.7% of $481.00 in Billed Charges for Rev 272 = $200.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCHANGE 10FRX12CM,272,RC,27200758,CDM,,,,,,both,,,481.0000,72.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,223.18,,,,,,,124.1500,481.0000,percent of total billed charges,46.4% of $481.00 in Billed Charges for Rev 272 = $223.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCHANGE 10FRX12CM,272,RC,27200758,CDM,,,,,,both,,,481.0000,72.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,200.58,,,,,,,124.1500,481.0000,percent of total billed charges,41.7% of $481.00 in Billed Charges for Rev 272 = $200.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCHANGE 10FRX12CM,272,RC,27200758,CDM,,,,,,both,,,481.0000,72.1500,CIGNA HEALTHCARE,CIGNA PPO,200.58,,,,,,,124.1500,481.0000,percent of total billed charges,41.7% of $481.00 in Billed Charges for Rev 272 = $200.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCHANGE 10FRX12CM,272,RC,27200758,CDM,,,,,,both,,,481.0000,72.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,432.90,,,,,,,124.1500,481.0000,percent of total billed charges,90% of $481.00 in Billed Charges for Rev 272 = $432.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCHANGE 10FRX12CM,272,RC,27200758,CDM,,,,,,both,,,481.0000,72.1500,MEDCOST,MEDCOST VHN,228.91,,,,,,,124.1500,481.0000,percent of total billed charges,47.59% of $481.00 in Billed Charges for Rev 272 = $228.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCHANGE 10FRX12CM,272,RC,27200758,CDM,,,,,,both,,,481.0000,72.1500,SENTARA HEALTH,SENTARA HEALTH,124.15,,,,,,,124.1500,481.0000,percent of total billed charges,25.81% of $481.00 in Billed Charges for Rev 272 = $124.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCHANGE 10FRX12CM,272,RC,27200758,CDM,,,,,,both,,,481.0000,72.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",481.00,,,,,,,124.1500,481.0000,percent of total billed charges,100% of $481.00 in Billed Charges for Rev 272 = $481.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCHANGE 10FRX12CM,272,RC,27200758,CDM,,,,,,both,,,481.0000,72.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,240.50,,,,,,,124.1500,481.0000,percent of total billed charges,Rev 272 $481.00 in Billed Charges at 50% = $240.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCHANGE 10FRX12CM,272,RC,27200758,CDM,,,,,,both,,,481.0000,72.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,155.36,,,,,,,124.1500,481.0000,other,32.3% of $481.00 in Billed Charges for Rev 272 = $155.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI STENT RAPID EXCHANGE 10FRX12CM,272,RC,27200758,CDM,,,,,,both,,,481.0000,72.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,147.67,,,,,,,124.1500,481.0000,other,30.7% of $481.00 in Billed Charges for Rev 272 = $147.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI STENT RAPID EXCHANGE 10FRX12CM,272,RC,27200758,CDM,,,,,,both,,,481.0000,72.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,155.36,,,,,,,124.1500,481.0000,percent of total billed charges,32.3% of $481.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI STENT RAPID EXCHANGE 10FRX12CM,272,RC,27200758,CDM,,,,,,both,,,481.0000,72.1500,WELLCARE,WELLCARE MEDICAID,481.00,,,,,,,124.1500,481.0000,percent of total billed charges,100% of $481.00 in Billed Charges for Rev 272 = $481.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE MAGNAPORT FEEDING,272,RC,27200768,CDM,,,,,,both,,,104.0000,15.6000,AETNA,AETNA,44.41,,,,,,,26.8400,104.0000,percent of total billed charges,42.7% of $104.00 in Billed Charges for Rev 272 = $44.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE MAGNAPORT FEEDING,272,RC,27200768,CDM,,,,,,both,,,104.0000,15.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,72.80,,,,,,,26.8400,104.0000,percent of total billed charges,Rev 272 $104.00 in Billed Charges at 70% = $72.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE MAGNAPORT FEEDING,272,RC,27200768,CDM,,,,,,both,,,104.0000,15.6000,CIGNA HEALTHCARE,CIGNA HMO,43.37,,,,,,,26.8400,104.0000,percent of total billed charges,41.7% of $104.00 in Billed Charges for Rev 272 = $43.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE MAGNAPORT FEEDING,272,RC,27200768,CDM,,,,,,both,,,104.0000,15.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,48.26,,,,,,,26.8400,104.0000,percent of total billed charges,46.4% of $104.00 in Billed Charges for Rev 272 = $48.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE MAGNAPORT FEEDING,272,RC,27200768,CDM,,,,,,both,,,104.0000,15.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,43.37,,,,,,,26.8400,104.0000,percent of total billed charges,41.7% of $104.00 in Billed Charges for Rev 272 = $43.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE MAGNAPORT FEEDING,272,RC,27200768,CDM,,,,,,both,,,104.0000,15.6000,CIGNA HEALTHCARE,CIGNA PPO,43.37,,,,,,,26.8400,104.0000,percent of total billed charges,41.7% of $104.00 in Billed Charges for Rev 272 = $43.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE MAGNAPORT FEEDING,272,RC,27200768,CDM,,,,,,both,,,104.0000,15.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,93.60,,,,,,,26.8400,104.0000,percent of total billed charges,90% of $104.00 in Billed Charges for Rev 272 = $93.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE MAGNAPORT FEEDING,272,RC,27200768,CDM,,,,,,both,,,104.0000,15.6000,MEDCOST,MEDCOST VHN,49.49,,,,,,,26.8400,104.0000,percent of total billed charges,47.59% of $104.00 in Billed Charges for Rev 272 = $49.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE MAGNAPORT FEEDING,272,RC,27200768,CDM,,,,,,both,,,104.0000,15.6000,SENTARA HEALTH,SENTARA HEALTH,26.84,,,,,,,26.8400,104.0000,percent of total billed charges,25.81% of $104.00 in Billed Charges for Rev 272 = $26.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE MAGNAPORT FEEDING,272,RC,27200768,CDM,,,,,,both,,,104.0000,15.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",104.00,,,,,,,26.8400,104.0000,percent of total billed charges,100% of $104.00 in Billed Charges for Rev 272 = $104.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE MAGNAPORT FEEDING,272,RC,27200768,CDM,,,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,52.00,,,,,,,26.8400,104.0000,percent of total billed charges,Rev 272 $104.00 in Billed Charges at 50% = $52.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE MAGNAPORT FEEDING,272,RC,27200768,CDM,,,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,33.59,,,,,,,26.8400,104.0000,other,32.3% of $104.00 in Billed Charges for Rev 272 = $33.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI TUBE MAGNAPORT FEEDING,272,RC,27200768,CDM,,,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,31.93,,,,,,,26.8400,104.0000,other,30.7% of $104.00 in Billed Charges for Rev 272 = $31.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI TUBE MAGNAPORT FEEDING,272,RC,27200768,CDM,,,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,33.59,,,,,,,26.8400,104.0000,percent of total billed charges,32.3% of $104.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE MAGNAPORT FEEDING,272,RC,27200768,CDM,,,,,,both,,,104.0000,15.6000,WELLCARE,WELLCARE MEDICAID,104.00,,,,,,,26.8400,104.0000,percent of total billed charges,100% of $104.00 in Billed Charges for Rev 272 = $104.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GORE EXCLUDER AAA ENDOPROSTHESIS CONTRALATERAL LIMB PLC141400,278,RC,27800700,CDM,,,,,,both,,,10911.0000,1636.6500,AETNA,AETNA,5237.28,,,,,,,2816.1300,10911.0000,percent of total billed charges,"48% of $10,911.00 in Billed Charges for Rev 278 = $5,237.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS CONTRALATERAL LIMB PLC141400,278,RC,27800700,CDM,,,,,,both,,,10911.0000,1636.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5455.50,,,,,,,2816.1300,10911.0000,percent of total billed charges,"50% of $10,911.00 in Billed Charges for Rev 278 = $5,455.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS CONTRALATERAL LIMB PLC141400,278,RC,27800700,CDM,,,,,,both,,,10911.0000,1636.6500,CIGNA HEALTHCARE,CIGNA HMO,4549.89,,,,,,,2816.1300,10911.0000,percent of total billed charges,"41.7% of $10,911.00 in Billed Charges for Rev 278 = $4,549.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS CONTRALATERAL LIMB PLC141400,278,RC,27800700,CDM,,,,,,both,,,10911.0000,1636.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4364.40,,,,,,,2816.1300,10911.0000,percent of total billed charges,"40% of $10,911.00 in Billed Charges for Rev 278 = $4,364.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS CONTRALATERAL LIMB PLC141400,278,RC,27800700,CDM,,,,,,both,,,10911.0000,1636.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4549.89,,,,,,,2816.1300,10911.0000,percent of total billed charges,"41.7% of $10,911.00 in Billed Charges for Rev 278 = $4,549.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS CONTRALATERAL LIMB PLC141400,278,RC,27800700,CDM,,,,,,both,,,10911.0000,1636.6500,CIGNA HEALTHCARE,CIGNA PPO,4549.89,,,,,,,2816.1300,10911.0000,percent of total billed charges,"41.7% of $10,911.00 in Billed Charges for Rev 278 = $4,549.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS CONTRALATERAL LIMB PLC141400,278,RC,27800700,CDM,,,,,,both,,,10911.0000,1636.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9819.90,,,,,,,2816.1300,10911.0000,percent of total billed charges,"90% of $10,911.00 in Billed Charges for Rev 278 = $9,819.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS CONTRALATERAL LIMB PLC141400,278,RC,27800700,CDM,,,,,,both,,,10911.0000,1636.6500,MEDCOST,MEDCOST VHN,5192.54,,,,,,,2816.1300,10911.0000,percent of total billed charges,"47.59% of $10,911.00 in Billed Charges for Rev 278 = $5,192.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS CONTRALATERAL LIMB PLC141400,278,RC,27800700,CDM,,,,,,both,,,10911.0000,1636.6500,SENTARA HEALTH,SENTARA HEALTH,2816.13,,,,,,,2816.1300,10911.0000,percent of total billed charges,"25.81% of $10,911.00 in Billed Charges for Rev 278 = $2,816.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS CONTRALATERAL LIMB PLC141400,278,RC,27800700,CDM,,,,,,both,,,10911.0000,1636.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10911.00,,,,,,,2816.1300,10911.0000,percent of total billed charges,"100% of $10,911.00 in Billed Charges for Rev 278 = $10,911.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS CONTRALATERAL LIMB PLC141400,278,RC,27800700,CDM,,,,,,both,,,10911.0000,1636.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5455.50,,,,,,,2816.1300,10911.0000,percent of total billed charges,"Rev 278 $10,911.00 in Billed Charges at 50% = $5,455.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS CONTRALATERAL LIMB PLC141400,278,RC,27800700,CDM,,,,,,both,,,10911.0000,1636.6500,WELLCARE,WELLCARE MEDICAID,10911.00,,,,,,,2816.1300,10911.0000,percent of total billed charges,"100% of $10,911.00 in Billed Charges for Rev 278 = $10,911.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA 3 PIECE ENDO CAP CODE,278,RC,27800576,CDM,,,,,,both,,,51750.0000,7762.5000,AETNA,AETNA,24840.00,,,,,,,3674.2500,51750.0000,percent of total billed charges,"48% of $51,750.00 in Billed Charges for Rev 278 = $24,840.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA 3 PIECE ENDO CAP CODE,278,RC,27800576,CDM,,,,,,both,,,51750.0000,7762.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,25875.00,,,,,,,3674.2500,51750.0000,percent of total billed charges,"50% of $51,750.00 in Billed Charges for Rev 278 = $25,875.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA 3 PIECE ENDO CAP CODE,278,RC,27800576,CDM,,,,,,both,,,51750.0000,7762.5000,CIGNA HEALTHCARE,CIGNA HMO,21579.75,,,,,,,3674.2500,51750.0000,percent of total billed charges,"41.7% of $51,750.00 in Billed Charges for Rev 278 = $21,579.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA 3 PIECE ENDO CAP CODE,278,RC,27800576,CDM,,,,,,both,,,51750.0000,7762.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,20700.00,,,,,,,3674.2500,51750.0000,percent of total billed charges,"40% of $51,750.00 in Billed Charges for Rev 278 = $20,700.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA 3 PIECE ENDO CAP CODE,278,RC,27800576,CDM,,,,,,both,,,51750.0000,7762.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,21579.75,,,,,,,3674.2500,51750.0000,percent of total billed charges,"41.7% of $51,750.00 in Billed Charges for Rev 278 = $21,579.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA 3 PIECE ENDO CAP CODE,278,RC,27800576,CDM,,,,,,both,,,51750.0000,7762.5000,CIGNA HEALTHCARE,CIGNA PPO,21579.75,,,,,,,3674.2500,51750.0000,percent of total billed charges,"41.7% of $51,750.00 in Billed Charges for Rev 278 = $21,579.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA 3 PIECE ENDO CAP CODE,278,RC,27800576,CDM,,,,,,both,,,51750.0000,7762.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,46575.00,,,,,,,3674.2500,51750.0000,percent of total billed charges,"90% of $51,750.00 in Billed Charges for Rev 278 = $46,575.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA 3 PIECE ENDO CAP CODE,278,RC,27800576,CDM,,,,,,both,,,51750.0000,7762.5000,MEDCOST,MEDCOST VHN,24627.83,,,,,,,3674.2500,51750.0000,percent of total billed charges,"47.59% of $51,750.00 in Billed Charges for Rev 278 = $24,627.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA 3 PIECE ENDO CAP CODE,278,RC,27800576,CDM,,,,,,both,,,51750.0000,7762.5000,SENTARA HEALTH,SENTARA HEALTH,13356.68,,,,,,,3674.2500,51750.0000,percent of total billed charges,"25.81% of $51,750.00 in Billed Charges for Rev 278 = $13,356.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA 3 PIECE ENDO CAP CODE,278,RC,27800576,CDM,,,,,,both,,,51750.0000,7762.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",51750.00,,,,,,,3674.2500,51750.0000,percent of total billed charges,"100% of $51,750.00 in Billed Charges for Rev 278 = $51,750.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA 3 PIECE ENDO CAP CODE,278,RC,27800576,CDM,,,,,,both,,,51750.0000,7762.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,25875.00,,,,,,,3674.2500,51750.0000,percent of total billed charges,"Rev 278 $51,750.00 in Billed Charges at 50% = $25,875.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA 3 PIECE ENDO CAP CODE,278,RC,27800576,CDM,,,,,,both,,,51750.0000,7762.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3881.25,,,,,,,3674.2500,51750.0000,percent of total billed charges,"7.5% of $51,750.00 in Billed Charges for Rev 278 = $3,881.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA 3 PIECE ENDO CAP CODE,278,RC,27800576,CDM,,,,,,both,,,51750.0000,7762.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3674.25,,,,,,,3674.2500,51750.0000,percent of total billed charges,"7.1% of $51,750.00 in Billed Charges for Rev 278 = $3,674.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA 3 PIECE ENDO CAP CODE,278,RC,27800576,CDM,,,,,,both,,,51750.0000,7762.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,3674.25,,,,,,,3674.2500,51750.0000,percent of total billed charges,"7.1% of $51,750.00 in Billed Charges for Rev 278 = $3,674.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA 3 PIECE ENDO CAP CODE,278,RC,27800576,CDM,,,,,,both,,,51750.0000,7762.5000,WELLCARE,WELLCARE MEDICAID,51750.00,,,,,,,3674.2500,51750.0000,percent of total billed charges,"100% of $51,750.00 in Billed Charges for Rev 278 = $51,750.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE OVATION IX 3 PIECE,278,RC,27800593,CDM,,,,,,both,,,41135.0000,6170.2500,AETNA,AETNA,19744.80,,,,,,,2920.5900,41135.0000,percent of total billed charges,"48% of $41,135.00 in Billed Charges for Rev 278 = $19,744.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE OVATION IX 3 PIECE,278,RC,27800593,CDM,,,,,,both,,,41135.0000,6170.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,20567.50,,,,,,,2920.5900,41135.0000,percent of total billed charges,"50% of $41,135.00 in Billed Charges for Rev 278 = $20,567.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE OVATION IX 3 PIECE,278,RC,27800593,CDM,,,,,,both,,,41135.0000,6170.2500,CIGNA HEALTHCARE,CIGNA HMO,17153.30,,,,,,,2920.5900,41135.0000,percent of total billed charges,"41.7% of $41,135.00 in Billed Charges for Rev 278 = $17,153.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE OVATION IX 3 PIECE,278,RC,27800593,CDM,,,,,,both,,,41135.0000,6170.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,16454.00,,,,,,,2920.5900,41135.0000,percent of total billed charges,"40% of $41,135.00 in Billed Charges for Rev 278 = $16,454.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE OVATION IX 3 PIECE,278,RC,27800593,CDM,,,,,,both,,,41135.0000,6170.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,17153.30,,,,,,,2920.5900,41135.0000,percent of total billed charges,"41.7% of $41,135.00 in Billed Charges for Rev 278 = $17,153.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE OVATION IX 3 PIECE,278,RC,27800593,CDM,,,,,,both,,,41135.0000,6170.2500,CIGNA HEALTHCARE,CIGNA PPO,17153.30,,,,,,,2920.5900,41135.0000,percent of total billed charges,"41.7% of $41,135.00 in Billed Charges for Rev 278 = $17,153.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE OVATION IX 3 PIECE,278,RC,27800593,CDM,,,,,,both,,,41135.0000,6170.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,37021.50,,,,,,,2920.5900,41135.0000,percent of total billed charges,"90% of $41,135.00 in Billed Charges for Rev 278 = $37,021.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE OVATION IX 3 PIECE,278,RC,27800593,CDM,,,,,,both,,,41135.0000,6170.2500,MEDCOST,MEDCOST VHN,19576.15,,,,,,,2920.5900,41135.0000,percent of total billed charges,"47.59% of $41,135.00 in Billed Charges for Rev 278 = $19,576.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE OVATION IX 3 PIECE,278,RC,27800593,CDM,,,,,,both,,,41135.0000,6170.2500,SENTARA HEALTH,SENTARA HEALTH,10616.94,,,,,,,2920.5900,41135.0000,percent of total billed charges,"25.81% of $41,135.00 in Billed Charges for Rev 278 = $10,616.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE OVATION IX 3 PIECE,278,RC,27800593,CDM,,,,,,both,,,41135.0000,6170.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",41135.00,,,,,,,2920.5900,41135.0000,percent of total billed charges,"100% of $41,135.00 in Billed Charges for Rev 278 = $41,135.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE OVATION IX 3 PIECE,278,RC,27800593,CDM,,,,,,both,,,41135.0000,6170.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,20567.50,,,,,,,2920.5900,41135.0000,percent of total billed charges,"Rev 278 $41,135.00 in Billed Charges at 50% = $20,567.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE OVATION IX 3 PIECE,278,RC,27800593,CDM,,,,,,both,,,41135.0000,6170.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3085.13,,,,,,,2920.5900,41135.0000,percent of total billed charges,"7.5% of $41,135.00 in Billed Charges for Rev 278 = $3,085.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE OVATION IX 3 PIECE,278,RC,27800593,CDM,,,,,,both,,,41135.0000,6170.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2920.59,,,,,,,2920.5900,41135.0000,percent of total billed charges,"7.1% of $41,135.00 in Billed Charges for Rev 278 = $2,920.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE OVATION IX 3 PIECE,278,RC,27800593,CDM,,,,,,both,,,41135.0000,6170.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,2920.59,,,,,,,2920.5900,41135.0000,percent of total billed charges,"7.1% of $41,135.00 in Billed Charges for Rev 278 = $2,920.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE OVATION IX 3 PIECE,278,RC,27800593,CDM,,,,,,both,,,41135.0000,6170.2500,WELLCARE,WELLCARE MEDICAID,41135.00,,,,,,,2920.5900,41135.0000,percent of total billed charges,"100% of $41,135.00 in Billed Charges for Rev 278 = $41,135.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA SG HBB 24-126-63-12-A12-22,278,RC,27801453,CDM,,,,,,both,,,1800.0000,270.0000,AETNA,AETNA,864.00,,,,,,,464.5800,1800.0000,percent of total billed charges,"48% of $1,800.00 in Billed Charges for Rev 278 = $864.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA SG HBB 24-126-63-12-A12-22,278,RC,27801453,CDM,,,,,,both,,,1800.0000,270.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,900.00,,,,,,,464.5800,1800.0000,percent of total billed charges,"50% of $1,800.00 in Billed Charges for Rev 278 = $900.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA SG HBB 24-126-63-12-A12-22,278,RC,27801453,CDM,,,,,,both,,,1800.0000,270.0000,CIGNA HEALTHCARE,CIGNA HMO,750.60,,,,,,,464.5800,1800.0000,percent of total billed charges,"41.7% of $1,800.00 in Billed Charges for Rev 278 = $750.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA SG HBB 24-126-63-12-A12-22,278,RC,27801453,CDM,,,,,,both,,,1800.0000,270.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,720.00,,,,,,,464.5800,1800.0000,percent of total billed charges,"40% of $1,800.00 in Billed Charges for Rev 278 = $720.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA SG HBB 24-126-63-12-A12-22,278,RC,27801453,CDM,,,,,,both,,,1800.0000,270.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,750.60,,,,,,,464.5800,1800.0000,percent of total billed charges,"41.7% of $1,800.00 in Billed Charges for Rev 278 = $750.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA SG HBB 24-126-63-12-A12-22,278,RC,27801453,CDM,,,,,,both,,,1800.0000,270.0000,CIGNA HEALTHCARE,CIGNA PPO,750.60,,,,,,,464.5800,1800.0000,percent of total billed charges,"41.7% of $1,800.00 in Billed Charges for Rev 278 = $750.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA SG HBB 24-126-63-12-A12-22,278,RC,27801453,CDM,,,,,,both,,,1800.0000,270.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1620.00,,,,,,,464.5800,1800.0000,percent of total billed charges,"90% of $1,800.00 in Billed Charges for Rev 278 = $1,620.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA SG HBB 24-126-63-12-A12-22,278,RC,27801453,CDM,,,,,,both,,,1800.0000,270.0000,MEDCOST,MEDCOST VHN,856.62,,,,,,,464.5800,1800.0000,percent of total billed charges,"47.59% of $1,800.00 in Billed Charges for Rev 278 = $856.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA SG HBB 24-126-63-12-A12-22,278,RC,27801453,CDM,,,,,,both,,,1800.0000,270.0000,SENTARA HEALTH,SENTARA HEALTH,464.58,,,,,,,464.5800,1800.0000,percent of total billed charges,"25.81% of $1,800.00 in Billed Charges for Rev 278 = $464.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA SG HBB 24-126-63-12-A12-22,278,RC,27801453,CDM,,,,,,both,,,1800.0000,270.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1800.00,,,,,,,464.5800,1800.0000,percent of total billed charges,"100% of $1,800.00 in Billed Charges for Rev 278 = $1,800.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA SG HBB 24-126-63-12-A12-22,278,RC,27801453,CDM,,,,,,both,,,1800.0000,270.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,900.00,,,,,,,464.5800,1800.0000,percent of total billed charges,"Rev 278 $1,800.00 in Billed Charges at 50% = $900.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA SG HBB 24-126-63-12-A12-22,278,RC,27801453,CDM,,,,,,both,,,1800.0000,270.0000,WELLCARE,WELLCARE MEDICAID,1800.00,,,,,,,464.5800,1800.0000,percent of total billed charges,"100% of $1,800.00 in Billed Charges for Rev 278 = $1,800.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC EXT 14X14X45 OVATION IX,278,RC,27800664,CDM,,,,,,both,,,11941.0000,1791.1500,AETNA,AETNA,5731.68,,,,,,,3081.9700,11941.0000,percent of total billed charges,"48% of $11,941.00 in Billed Charges for Rev 278 = $5,731.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC EXT 14X14X45 OVATION IX,278,RC,27800664,CDM,,,,,,both,,,11941.0000,1791.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5970.50,,,,,,,3081.9700,11941.0000,percent of total billed charges,"50% of $11,941.00 in Billed Charges for Rev 278 = $5,970.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC EXT 14X14X45 OVATION IX,278,RC,27800664,CDM,,,,,,both,,,11941.0000,1791.1500,CIGNA HEALTHCARE,CIGNA HMO,4979.40,,,,,,,3081.9700,11941.0000,percent of total billed charges,"41.7% of $11,941.00 in Billed Charges for Rev 278 = $4,979.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC EXT 14X14X45 OVATION IX,278,RC,27800664,CDM,,,,,,both,,,11941.0000,1791.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4776.40,,,,,,,3081.9700,11941.0000,percent of total billed charges,"40% of $11,941.00 in Billed Charges for Rev 278 = $4,776.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC EXT 14X14X45 OVATION IX,278,RC,27800664,CDM,,,,,,both,,,11941.0000,1791.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4979.40,,,,,,,3081.9700,11941.0000,percent of total billed charges,"41.7% of $11,941.00 in Billed Charges for Rev 278 = $4,979.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC EXT 14X14X45 OVATION IX,278,RC,27800664,CDM,,,,,,both,,,11941.0000,1791.1500,CIGNA HEALTHCARE,CIGNA PPO,4979.40,,,,,,,3081.9700,11941.0000,percent of total billed charges,"41.7% of $11,941.00 in Billed Charges for Rev 278 = $4,979.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC EXT 14X14X45 OVATION IX,278,RC,27800664,CDM,,,,,,both,,,11941.0000,1791.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10746.90,,,,,,,3081.9700,11941.0000,percent of total billed charges,"90% of $11,941.00 in Billed Charges for Rev 278 = $10,746.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC EXT 14X14X45 OVATION IX,278,RC,27800664,CDM,,,,,,both,,,11941.0000,1791.1500,MEDCOST,MEDCOST VHN,5682.72,,,,,,,3081.9700,11941.0000,percent of total billed charges,"47.59% of $11,941.00 in Billed Charges for Rev 278 = $5,682.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC EXT 14X14X45 OVATION IX,278,RC,27800664,CDM,,,,,,both,,,11941.0000,1791.1500,SENTARA HEALTH,SENTARA HEALTH,3081.97,,,,,,,3081.9700,11941.0000,percent of total billed charges,"25.81% of $11,941.00 in Billed Charges for Rev 278 = $3,081.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC EXT 14X14X45 OVATION IX,278,RC,27800664,CDM,,,,,,both,,,11941.0000,1791.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11941.00,,,,,,,3081.9700,11941.0000,percent of total billed charges,"100% of $11,941.00 in Billed Charges for Rev 278 = $11,941.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC EXT 14X14X45 OVATION IX,278,RC,27800664,CDM,,,,,,both,,,11941.0000,1791.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5970.50,,,,,,,3081.9700,11941.0000,percent of total billed charges,"Rev 278 $11,941.00 in Billed Charges at 50% = $5,970.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC EXT 14X14X45 OVATION IX,278,RC,27800664,CDM,,,,,,both,,,11941.0000,1791.1500,WELLCARE,WELLCARE MEDICAID,11941.00,,,,,,,3081.9700,11941.0000,percent of total billed charges,"100% of $11,941.00 in Billed Charges for Rev 278 = $11,941.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC LIMB 10X100MM OVATION KIT -SINGLE ITEM,278,RC,27800614,CDM,,,,,,both,,,10614.0000,1592.1000,AETNA,AETNA,5094.72,,,,,,,2739.4700,10614.0000,percent of total billed charges,"48% of $10,614.00 in Billed Charges for Rev 278 = $5,094.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC LIMB 10X100MM OVATION KIT -SINGLE ITEM,278,RC,27800614,CDM,,,,,,both,,,10614.0000,1592.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5307.00,,,,,,,2739.4700,10614.0000,percent of total billed charges,"50% of $10,614.00 in Billed Charges for Rev 278 = $5,307.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC LIMB 10X100MM OVATION KIT -SINGLE ITEM,278,RC,27800614,CDM,,,,,,both,,,10614.0000,1592.1000,CIGNA HEALTHCARE,CIGNA HMO,4426.04,,,,,,,2739.4700,10614.0000,percent of total billed charges,"41.7% of $10,614.00 in Billed Charges for Rev 278 = $4,426.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC LIMB 10X100MM OVATION KIT -SINGLE ITEM,278,RC,27800614,CDM,,,,,,both,,,10614.0000,1592.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4245.60,,,,,,,2739.4700,10614.0000,percent of total billed charges,"40% of $10,614.00 in Billed Charges for Rev 278 = $4,245.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC LIMB 10X100MM OVATION KIT -SINGLE ITEM,278,RC,27800614,CDM,,,,,,both,,,10614.0000,1592.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4426.04,,,,,,,2739.4700,10614.0000,percent of total billed charges,"41.7% of $10,614.00 in Billed Charges for Rev 278 = $4,426.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC LIMB 10X100MM OVATION KIT -SINGLE ITEM,278,RC,27800614,CDM,,,,,,both,,,10614.0000,1592.1000,CIGNA HEALTHCARE,CIGNA PPO,4426.04,,,,,,,2739.4700,10614.0000,percent of total billed charges,"41.7% of $10,614.00 in Billed Charges for Rev 278 = $4,426.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC LIMB 10X100MM OVATION KIT -SINGLE ITEM,278,RC,27800614,CDM,,,,,,both,,,10614.0000,1592.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9552.60,,,,,,,2739.4700,10614.0000,percent of total billed charges,"90% of $10,614.00 in Billed Charges for Rev 278 = $9,552.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC LIMB 10X100MM OVATION KIT -SINGLE ITEM,278,RC,27800614,CDM,,,,,,both,,,10614.0000,1592.1000,MEDCOST,MEDCOST VHN,5051.20,,,,,,,2739.4700,10614.0000,percent of total billed charges,"47.59% of $10,614.00 in Billed Charges for Rev 278 = $5,051.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC LIMB 10X100MM OVATION KIT -SINGLE ITEM,278,RC,27800614,CDM,,,,,,both,,,10614.0000,1592.1000,SENTARA HEALTH,SENTARA HEALTH,2739.47,,,,,,,2739.4700,10614.0000,percent of total billed charges,"25.81% of $10,614.00 in Billed Charges for Rev 278 = $2,739.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC LIMB 10X100MM OVATION KIT -SINGLE ITEM,278,RC,27800614,CDM,,,,,,both,,,10614.0000,1592.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10614.00,,,,,,,2739.4700,10614.0000,percent of total billed charges,"100% of $10,614.00 in Billed Charges for Rev 278 = $10,614.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC LIMB 10X100MM OVATION KIT -SINGLE ITEM,278,RC,27800614,CDM,,,,,,both,,,10614.0000,1592.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5307.00,,,,,,,2739.4700,10614.0000,percent of total billed charges,"Rev 278 $10,614.00 in Billed Charges at 50% = $5,307.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC LIMB 10X100MM OVATION KIT -SINGLE ITEM,278,RC,27800614,CDM,,,,,,both,,,10614.0000,1592.1000,WELLCARE,WELLCARE MEDICAID,10614.00,,,,,,,2739.4700,10614.0000,percent of total billed charges,"100% of $10,614.00 in Billed Charges for Rev 278 = $10,614.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC LIMB 14X14X100 OVATION IX,278,RC,27800676,CDM,,,,,,both,,,13267.0000,1990.0500,AETNA,AETNA,6368.16,,,,,,,3424.2100,13267.0000,percent of total billed charges,"48% of $13,267.00 in Billed Charges for Rev 278 = $6,368.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC LIMB 14X14X100 OVATION IX,278,RC,27800676,CDM,,,,,,both,,,13267.0000,1990.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6633.50,,,,,,,3424.2100,13267.0000,percent of total billed charges,"50% of $13,267.00 in Billed Charges for Rev 278 = $6,633.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC LIMB 14X14X100 OVATION IX,278,RC,27800676,CDM,,,,,,both,,,13267.0000,1990.0500,CIGNA HEALTHCARE,CIGNA HMO,5532.34,,,,,,,3424.2100,13267.0000,percent of total billed charges,"41.7% of $13,267.00 in Billed Charges for Rev 278 = $5,532.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC LIMB 14X14X100 OVATION IX,278,RC,27800676,CDM,,,,,,both,,,13267.0000,1990.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5306.80,,,,,,,3424.2100,13267.0000,percent of total billed charges,"40% of $13,267.00 in Billed Charges for Rev 278 = $5,306.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC LIMB 14X14X100 OVATION IX,278,RC,27800676,CDM,,,,,,both,,,13267.0000,1990.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5532.34,,,,,,,3424.2100,13267.0000,percent of total billed charges,"41.7% of $13,267.00 in Billed Charges for Rev 278 = $5,532.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC LIMB 14X14X100 OVATION IX,278,RC,27800676,CDM,,,,,,both,,,13267.0000,1990.0500,CIGNA HEALTHCARE,CIGNA PPO,5532.34,,,,,,,3424.2100,13267.0000,percent of total billed charges,"41.7% of $13,267.00 in Billed Charges for Rev 278 = $5,532.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC LIMB 14X14X100 OVATION IX,278,RC,27800676,CDM,,,,,,both,,,13267.0000,1990.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11940.30,,,,,,,3424.2100,13267.0000,percent of total billed charges,"90% of $13,267.00 in Billed Charges for Rev 278 = $11,940.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC LIMB 14X14X100 OVATION IX,278,RC,27800676,CDM,,,,,,both,,,13267.0000,1990.0500,MEDCOST,MEDCOST VHN,6313.77,,,,,,,3424.2100,13267.0000,percent of total billed charges,"47.59% of $13,267.00 in Billed Charges for Rev 278 = $6,313.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC LIMB 14X14X100 OVATION IX,278,RC,27800676,CDM,,,,,,both,,,13267.0000,1990.0500,SENTARA HEALTH,SENTARA HEALTH,3424.21,,,,,,,3424.2100,13267.0000,percent of total billed charges,"25.81% of $13,267.00 in Billed Charges for Rev 278 = $3,424.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC LIMB 14X14X100 OVATION IX,278,RC,27800676,CDM,,,,,,both,,,13267.0000,1990.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13267.00,,,,,,,3424.2100,13267.0000,percent of total billed charges,"100% of $13,267.00 in Billed Charges for Rev 278 = $13,267.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC LIMB 14X14X100 OVATION IX,278,RC,27800676,CDM,,,,,,both,,,13267.0000,1990.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6633.50,,,,,,,3424.2100,13267.0000,percent of total billed charges,"Rev 278 $13,267.00 in Billed Charges at 50% = $6,633.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT ILIAC LIMB 14X14X100 OVATION IX,278,RC,27800676,CDM,,,,,,both,,,13267.0000,1990.0500,WELLCARE,WELLCARE MEDICAID,13267.00,,,,,,,3424.2100,13267.0000,percent of total billed charges,"100% of $13,267.00 in Billed Charges for Rev 278 = $13,267.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT AAA BIF 22 X 40 X 13 X 40 TO 28 X 70 X 20 X 30,278,RC,27801479,CDM,,,,,,both,,,29975.0000,4496.2500,AETNA,AETNA,14388.00,,,,,,,2128.2300,29975.0000,percent of total billed charges,"48% of $29,975.00 in Billed Charges for Rev 278 = $14,388.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT AAA BIF 22 X 40 X 13 X 40 TO 28 X 70 X 20 X 30,278,RC,27801479,CDM,,,,,,both,,,29975.0000,4496.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,14987.50,,,,,,,2128.2300,29975.0000,percent of total billed charges,"50% of $29,975.00 in Billed Charges for Rev 278 = $14,987.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT AAA BIF 22 X 40 X 13 X 40 TO 28 X 70 X 20 X 30,278,RC,27801479,CDM,,,,,,both,,,29975.0000,4496.2500,CIGNA HEALTHCARE,CIGNA HMO,12499.58,,,,,,,2128.2300,29975.0000,percent of total billed charges,"41.7% of $29,975.00 in Billed Charges for Rev 278 = $12,499.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT AAA BIF 22 X 40 X 13 X 40 TO 28 X 70 X 20 X 30,278,RC,27801479,CDM,,,,,,both,,,29975.0000,4496.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11990.00,,,,,,,2128.2300,29975.0000,percent of total billed charges,"40% of $29,975.00 in Billed Charges for Rev 278 = $11,990.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT AAA BIF 22 X 40 X 13 X 40 TO 28 X 70 X 20 X 30,278,RC,27801479,CDM,,,,,,both,,,29975.0000,4496.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,12499.58,,,,,,,2128.2300,29975.0000,percent of total billed charges,"41.7% of $29,975.00 in Billed Charges for Rev 278 = $12,499.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT AAA BIF 22 X 40 X 13 X 40 TO 28 X 70 X 20 X 30,278,RC,27801479,CDM,,,,,,both,,,29975.0000,4496.2500,CIGNA HEALTHCARE,CIGNA PPO,12499.58,,,,,,,2128.2300,29975.0000,percent of total billed charges,"41.7% of $29,975.00 in Billed Charges for Rev 278 = $12,499.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT AAA BIF 22 X 40 X 13 X 40 TO 28 X 70 X 20 X 30,278,RC,27801479,CDM,,,,,,both,,,29975.0000,4496.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,26977.50,,,,,,,2128.2300,29975.0000,percent of total billed charges,"90% of $29,975.00 in Billed Charges for Rev 278 = $26,977.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT AAA BIF 22 X 40 X 13 X 40 TO 28 X 70 X 20 X 30,278,RC,27801479,CDM,,,,,,both,,,29975.0000,4496.2500,MEDCOST,MEDCOST VHN,14265.10,,,,,,,2128.2300,29975.0000,percent of total billed charges,"47.59% of $29,975.00 in Billed Charges for Rev 278 = $14,265.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT AAA BIF 22 X 40 X 13 X 40 TO 28 X 70 X 20 X 30,278,RC,27801479,CDM,,,,,,both,,,29975.0000,4496.2500,SENTARA HEALTH,SENTARA HEALTH,7736.55,,,,,,,2128.2300,29975.0000,percent of total billed charges,"25.81% of $29,975.00 in Billed Charges for Rev 278 = $7,736.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT AAA BIF 22 X 40 X 13 X 40 TO 28 X 70 X 20 X 30,278,RC,27801479,CDM,,,,,,both,,,29975.0000,4496.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",29975.00,,,,,,,2128.2300,29975.0000,percent of total billed charges,"100% of $29,975.00 in Billed Charges for Rev 278 = $29,975.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT AAA BIF 22 X 40 X 13 X 40 TO 28 X 70 X 20 X 30,278,RC,27801479,CDM,,,,,,both,,,29975.0000,4496.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14987.50,,,,,,,2128.2300,29975.0000,percent of total billed charges,"Rev 278 $29,975.00 in Billed Charges at 50% = $14,987.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT AAA BIF 22 X 40 X 13 X 40 TO 28 X 70 X 20 X 30,278,RC,27801479,CDM,,,,,,both,,,29975.0000,4496.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2248.13,,,,,,,2128.2300,29975.0000,percent of total billed charges,"7.5% of $29,975.00 in Billed Charges for Rev 278 = $2,248.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT AAA BIF 22 X 40 X 13 X 40 TO 28 X 70 X 20 X 30,278,RC,27801479,CDM,,,,,,both,,,29975.0000,4496.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2128.23,,,,,,,2128.2300,29975.0000,percent of total billed charges,"7.1% of $29,975.00 in Billed Charges for Rev 278 = $2,128.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT AAA BIF 22 X 40 X 13 X 40 TO 28 X 70 X 20 X 30,278,RC,27801479,CDM,,,,,,both,,,29975.0000,4496.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,2128.23,,,,,,,2128.2300,29975.0000,percent of total billed charges,"7.1% of $29,975.00 in Billed Charges for Rev 278 = $2,128.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT AAA BIF 22 X 40 X 13 X 40 TO 28 X 70 X 20 X 30,278,RC,27801479,CDM,,,,,,both,,,29975.0000,4496.2500,WELLCARE,WELLCARE MEDICAID,29975.00,,,,,,,2128.2300,29975.0000,percent of total billed charges,"100% of $29,975.00 in Billed Charges for Rev 278 = $29,975.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT LIMB EXTENSION 20 X 25 X 65,278,RC,27801480,CDM,,,,,,both,,,8745.0000,1311.7500,AETNA,AETNA,4197.60,,,,,,,2257.0800,8745.0000,percent of total billed charges,"48% of $8,745.00 in Billed Charges for Rev 278 = $4,197.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT LIMB EXTENSION 20 X 25 X 65,278,RC,27801480,CDM,,,,,,both,,,8745.0000,1311.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4372.50,,,,,,,2257.0800,8745.0000,percent of total billed charges,"50% of $8,745.00 in Billed Charges for Rev 278 = $4,372.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT LIMB EXTENSION 20 X 25 X 65,278,RC,27801480,CDM,,,,,,both,,,8745.0000,1311.7500,CIGNA HEALTHCARE,CIGNA HMO,3646.67,,,,,,,2257.0800,8745.0000,percent of total billed charges,"41.7% of $8,745.00 in Billed Charges for Rev 278 = $3,646.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT LIMB EXTENSION 20 X 25 X 65,278,RC,27801480,CDM,,,,,,both,,,8745.0000,1311.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3498.00,,,,,,,2257.0800,8745.0000,percent of total billed charges,"40% of $8,745.00 in Billed Charges for Rev 278 = $3,498.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT LIMB EXTENSION 20 X 25 X 65,278,RC,27801480,CDM,,,,,,both,,,8745.0000,1311.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3646.67,,,,,,,2257.0800,8745.0000,percent of total billed charges,"41.7% of $8,745.00 in Billed Charges for Rev 278 = $3,646.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT LIMB EXTENSION 20 X 25 X 65,278,RC,27801480,CDM,,,,,,both,,,8745.0000,1311.7500,CIGNA HEALTHCARE,CIGNA PPO,3646.67,,,,,,,2257.0800,8745.0000,percent of total billed charges,"41.7% of $8,745.00 in Billed Charges for Rev 278 = $3,646.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT LIMB EXTENSION 20 X 25 X 65,278,RC,27801480,CDM,,,,,,both,,,8745.0000,1311.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7870.50,,,,,,,2257.0800,8745.0000,percent of total billed charges,"90% of $8,745.00 in Billed Charges for Rev 278 = $7,870.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT LIMB EXTENSION 20 X 25 X 65,278,RC,27801480,CDM,,,,,,both,,,8745.0000,1311.7500,MEDCOST,MEDCOST VHN,4161.75,,,,,,,2257.0800,8745.0000,percent of total billed charges,"47.59% of $8,745.00 in Billed Charges for Rev 278 = $4,161.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT LIMB EXTENSION 20 X 25 X 65,278,RC,27801480,CDM,,,,,,both,,,8745.0000,1311.7500,SENTARA HEALTH,SENTARA HEALTH,2257.08,,,,,,,2257.0800,8745.0000,percent of total billed charges,"25.81% of $8,745.00 in Billed Charges for Rev 278 = $2,257.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT LIMB EXTENSION 20 X 25 X 65,278,RC,27801480,CDM,,,,,,both,,,8745.0000,1311.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8745.00,,,,,,,2257.0800,8745.0000,percent of total billed charges,"100% of $8,745.00 in Billed Charges for Rev 278 = $8,745.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT LIMB EXTENSION 20 X 25 X 65,278,RC,27801480,CDM,,,,,,both,,,8745.0000,1311.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4372.50,,,,,,,2257.0800,8745.0000,percent of total billed charges,"Rev 278 $8,745.00 in Billed Charges at 50% = $4,372.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT LIMB EXTENSION 20 X 25 X 65,278,RC,27801480,CDM,,,,,,both,,,8745.0000,1311.7500,WELLCARE,WELLCARE MEDICAID,8745.00,,,,,,,2257.0800,8745.0000,percent of total billed charges,"100% of $8,745.00 in Billed Charges for Rev 278 = $8,745.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRFT STNT PWRFT AOR EXT3434100RL,278,RC,27800231,CDM,,,,,,both,,,12525.0000,1878.7500,AETNA,AETNA,6012.00,,,,,,,3232.7000,12525.0000,percent of total billed charges,"48% of $12,525.00 in Billed Charges for Rev 278 = $6,012.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRFT STNT PWRFT AOR EXT3434100RL,278,RC,27800231,CDM,,,,,,both,,,12525.0000,1878.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6262.50,,,,,,,3232.7000,12525.0000,percent of total billed charges,"50% of $12,525.00 in Billed Charges for Rev 278 = $6,262.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRFT STNT PWRFT AOR EXT3434100RL,278,RC,27800231,CDM,,,,,,both,,,12525.0000,1878.7500,CIGNA HEALTHCARE,CIGNA HMO,5222.93,,,,,,,3232.7000,12525.0000,percent of total billed charges,"41.7% of $12,525.00 in Billed Charges for Rev 278 = $5,222.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRFT STNT PWRFT AOR EXT3434100RL,278,RC,27800231,CDM,,,,,,both,,,12525.0000,1878.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5010.00,,,,,,,3232.7000,12525.0000,percent of total billed charges,"40% of $12,525.00 in Billed Charges for Rev 278 = $5,010.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRFT STNT PWRFT AOR EXT3434100RL,278,RC,27800231,CDM,,,,,,both,,,12525.0000,1878.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5222.93,,,,,,,3232.7000,12525.0000,percent of total billed charges,"41.7% of $12,525.00 in Billed Charges for Rev 278 = $5,222.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRFT STNT PWRFT AOR EXT3434100RL,278,RC,27800231,CDM,,,,,,both,,,12525.0000,1878.7500,CIGNA HEALTHCARE,CIGNA PPO,5222.93,,,,,,,3232.7000,12525.0000,percent of total billed charges,"41.7% of $12,525.00 in Billed Charges for Rev 278 = $5,222.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRFT STNT PWRFT AOR EXT3434100RL,278,RC,27800231,CDM,,,,,,both,,,12525.0000,1878.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11272.50,,,,,,,3232.7000,12525.0000,percent of total billed charges,"90% of $12,525.00 in Billed Charges for Rev 278 = $11,272.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRFT STNT PWRFT AOR EXT3434100RL,278,RC,27800231,CDM,,,,,,both,,,12525.0000,1878.7500,MEDCOST,MEDCOST VHN,5960.65,,,,,,,3232.7000,12525.0000,percent of total billed charges,"47.59% of $12,525.00 in Billed Charges for Rev 278 = $5,960.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRFT STNT PWRFT AOR EXT3434100RL,278,RC,27800231,CDM,,,,,,both,,,12525.0000,1878.7500,SENTARA HEALTH,SENTARA HEALTH,3232.70,,,,,,,3232.7000,12525.0000,percent of total billed charges,"25.81% of $12,525.00 in Billed Charges for Rev 278 = $3,232.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRFT STNT PWRFT AOR EXT3434100RL,278,RC,27800231,CDM,,,,,,both,,,12525.0000,1878.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12525.00,,,,,,,3232.7000,12525.0000,percent of total billed charges,"100% of $12,525.00 in Billed Charges for Rev 278 = $12,525.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRFT STNT PWRFT AOR EXT3434100RL,278,RC,27800231,CDM,,,,,,both,,,12525.0000,1878.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6262.50,,,,,,,3232.7000,12525.0000,percent of total billed charges,"Rev 278 $12,525.00 in Billed Charges at 50% = $6,262.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRFT STNT PWRFT AOR EXT3434100RL,278,RC,27800231,CDM,,,,,,both,,,12525.0000,1878.7500,WELLCARE,WELLCARE MEDICAID,12525.00,,,,,,,3232.7000,12525.0000,percent of total billed charges,"100% of $12,525.00 in Billed Charges for Rev 278 = $12,525.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HC PACK C SECTION,272,RC,27201653,CDM,,,,,,both,,,696.0000,104.4000,AETNA,AETNA,297.19,,,,,,,179.6400,696.0000,percent of total billed charges,42.7% of $696.00 in Billed Charges for Rev 272 = $297.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HC PACK C SECTION,272,RC,27201653,CDM,,,,,,both,,,696.0000,104.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,487.20,,,,,,,179.6400,696.0000,percent of total billed charges,Rev 272 $696.00 in Billed Charges at 70% = $487.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HC PACK C SECTION,272,RC,27201653,CDM,,,,,,both,,,696.0000,104.4000,CIGNA HEALTHCARE,CIGNA HMO,290.23,,,,,,,179.6400,696.0000,percent of total billed charges,41.7% of $696.00 in Billed Charges for Rev 272 = $290.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HC PACK C SECTION,272,RC,27201653,CDM,,,,,,both,,,696.0000,104.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,322.94,,,,,,,179.6400,696.0000,percent of total billed charges,46.4% of $696.00 in Billed Charges for Rev 272 = $322.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HC PACK C SECTION,272,RC,27201653,CDM,,,,,,both,,,696.0000,104.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,290.23,,,,,,,179.6400,696.0000,percent of total billed charges,41.7% of $696.00 in Billed Charges for Rev 272 = $290.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HC PACK C SECTION,272,RC,27201653,CDM,,,,,,both,,,696.0000,104.4000,CIGNA HEALTHCARE,CIGNA PPO,290.23,,,,,,,179.6400,696.0000,percent of total billed charges,41.7% of $696.00 in Billed Charges for Rev 272 = $290.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HC PACK C SECTION,272,RC,27201653,CDM,,,,,,both,,,696.0000,104.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,626.40,,,,,,,179.6400,696.0000,percent of total billed charges,90% of $696.00 in Billed Charges for Rev 272 = $626.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HC PACK C SECTION,272,RC,27201653,CDM,,,,,,both,,,696.0000,104.4000,MEDCOST,MEDCOST VHN,331.23,,,,,,,179.6400,696.0000,percent of total billed charges,47.59% of $696.00 in Billed Charges for Rev 272 = $331.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HC PACK C SECTION,272,RC,27201653,CDM,,,,,,both,,,696.0000,104.4000,SENTARA HEALTH,SENTARA HEALTH,179.64,,,,,,,179.6400,696.0000,percent of total billed charges,25.81% of $696.00 in Billed Charges for Rev 272 = $179.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HC PACK C SECTION,272,RC,27201653,CDM,,,,,,both,,,696.0000,104.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",696.00,,,,,,,179.6400,696.0000,percent of total billed charges,100% of $696.00 in Billed Charges for Rev 272 = $696.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HC PACK C SECTION,272,RC,27201653,CDM,,,,,,both,,,696.0000,104.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,348.00,,,,,,,179.6400,696.0000,percent of total billed charges,Rev 272 $696.00 in Billed Charges at 50% = $348.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HC PACK C SECTION,272,RC,27201653,CDM,,,,,,both,,,696.0000,104.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,224.81,,,,,,,179.6400,696.0000,other,32.3% of $696.00 in Billed Charges for Rev 272 = $224.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HC PACK C SECTION,272,RC,27201653,CDM,,,,,,both,,,696.0000,104.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,213.67,,,,,,,179.6400,696.0000,other,30.7% of $696.00 in Billed Charges for Rev 272 = $213.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HC PACK C SECTION,272,RC,27201653,CDM,,,,,,both,,,696.0000,104.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,224.81,,,,,,,179.6400,696.0000,percent of total billed charges,32.3% of $696.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HC PACK C SECTION,272,RC,27201653,CDM,,,,,,both,,,696.0000,104.4000,WELLCARE,WELLCARE MEDICAID,696.00,,,,,,,179.6400,696.0000,percent of total billed charges,100% of $696.00 in Billed Charges for Rev 272 = $696.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT ABSRBL ARISTA 3GM SM0002,272,RC,27201703,CDM,,,,,,both,,,853.0000,127.9500,AETNA,AETNA,364.23,,,,,,,220.1600,853.0000,percent of total billed charges,42.7% of $853.00 in Billed Charges for Rev 272 = $364.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT ABSRBL ARISTA 3GM SM0002,272,RC,27201703,CDM,,,,,,both,,,853.0000,127.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,597.10,,,,,,,220.1600,853.0000,percent of total billed charges,Rev 272 $853.00 in Billed Charges at 70% = $597.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT ABSRBL ARISTA 3GM SM0002,272,RC,27201703,CDM,,,,,,both,,,853.0000,127.9500,CIGNA HEALTHCARE,CIGNA HMO,355.70,,,,,,,220.1600,853.0000,percent of total billed charges,41.7% of $853.00 in Billed Charges for Rev 272 = $355.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT ABSRBL ARISTA 3GM SM0002,272,RC,27201703,CDM,,,,,,both,,,853.0000,127.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,395.79,,,,,,,220.1600,853.0000,percent of total billed charges,46.4% of $853.00 in Billed Charges for Rev 272 = $395.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT ABSRBL ARISTA 3GM SM0002,272,RC,27201703,CDM,,,,,,both,,,853.0000,127.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,355.70,,,,,,,220.1600,853.0000,percent of total billed charges,41.7% of $853.00 in Billed Charges for Rev 272 = $355.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT ABSRBL ARISTA 3GM SM0002,272,RC,27201703,CDM,,,,,,both,,,853.0000,127.9500,CIGNA HEALTHCARE,CIGNA PPO,355.70,,,,,,,220.1600,853.0000,percent of total billed charges,41.7% of $853.00 in Billed Charges for Rev 272 = $355.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT ABSRBL ARISTA 3GM SM0002,272,RC,27201703,CDM,,,,,,both,,,853.0000,127.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,767.70,,,,,,,220.1600,853.0000,percent of total billed charges,90% of $853.00 in Billed Charges for Rev 272 = $767.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT ABSRBL ARISTA 3GM SM0002,272,RC,27201703,CDM,,,,,,both,,,853.0000,127.9500,MEDCOST,MEDCOST VHN,405.94,,,,,,,220.1600,853.0000,percent of total billed charges,47.59% of $853.00 in Billed Charges for Rev 272 = $405.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT ABSRBL ARISTA 3GM SM0002,272,RC,27201703,CDM,,,,,,both,,,853.0000,127.9500,SENTARA HEALTH,SENTARA HEALTH,220.16,,,,,,,220.1600,853.0000,percent of total billed charges,25.81% of $853.00 in Billed Charges for Rev 272 = $220.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT ABSRBL ARISTA 3GM SM0002,272,RC,27201703,CDM,,,,,,both,,,853.0000,127.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",853.00,,,,,,,220.1600,853.0000,percent of total billed charges,100% of $853.00 in Billed Charges for Rev 272 = $853.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT ABSRBL ARISTA 3GM SM0002,272,RC,27201703,CDM,,,,,,both,,,853.0000,127.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,426.50,,,,,,,220.1600,853.0000,percent of total billed charges,Rev 272 $853.00 in Billed Charges at 50% = $426.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT ABSRBL ARISTA 3GM SM0002,272,RC,27201703,CDM,,,,,,both,,,853.0000,127.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,275.52,,,,,,,220.1600,853.0000,other,32.3% of $853.00 in Billed Charges for Rev 272 = $275.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSTAT ABSRBL ARISTA 3GM SM0002,272,RC,27201703,CDM,,,,,,both,,,853.0000,127.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,261.87,,,,,,,220.1600,853.0000,other,30.7% of $853.00 in Billed Charges for Rev 272 = $261.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSTAT ABSRBL ARISTA 3GM SM0002,272,RC,27201703,CDM,,,,,,both,,,853.0000,127.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,275.52,,,,,,,220.1600,853.0000,percent of total billed charges,32.3% of $853.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT ABSRBL ARISTA 3GM SM0002,272,RC,27201703,CDM,,,,,,both,,,853.0000,127.9500,WELLCARE,WELLCARE MEDICAID,853.00,,,,,,,220.1600,853.0000,percent of total billed charges,100% of $853.00 in Billed Charges for Rev 272 = $853.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX CORE MD TECH,272,RC,27201733,CDM,,,,,,both,,,229.0000,34.3500,AETNA,AETNA,97.78,,,,,,,59.1000,229.0000,percent of total billed charges,42.7% of $229.00 in Billed Charges for Rev 272 = $97.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX CORE MD TECH,272,RC,27201733,CDM,,,,,,both,,,229.0000,34.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,160.30,,,,,,,59.1000,229.0000,percent of total billed charges,Rev 272 $229.00 in Billed Charges at 70% = $160.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX CORE MD TECH,272,RC,27201733,CDM,,,,,,both,,,229.0000,34.3500,CIGNA HEALTHCARE,CIGNA HMO,95.49,,,,,,,59.1000,229.0000,percent of total billed charges,41.7% of $229.00 in Billed Charges for Rev 272 = $95.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX CORE MD TECH,272,RC,27201733,CDM,,,,,,both,,,229.0000,34.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,106.26,,,,,,,59.1000,229.0000,percent of total billed charges,46.4% of $229.00 in Billed Charges for Rev 272 = $106.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX CORE MD TECH,272,RC,27201733,CDM,,,,,,both,,,229.0000,34.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,95.49,,,,,,,59.1000,229.0000,percent of total billed charges,41.7% of $229.00 in Billed Charges for Rev 272 = $95.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX CORE MD TECH,272,RC,27201733,CDM,,,,,,both,,,229.0000,34.3500,CIGNA HEALTHCARE,CIGNA PPO,95.49,,,,,,,59.1000,229.0000,percent of total billed charges,41.7% of $229.00 in Billed Charges for Rev 272 = $95.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX CORE MD TECH,272,RC,27201733,CDM,,,,,,both,,,229.0000,34.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,206.10,,,,,,,59.1000,229.0000,percent of total billed charges,90% of $229.00 in Billed Charges for Rev 272 = $206.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX CORE MD TECH,272,RC,27201733,CDM,,,,,,both,,,229.0000,34.3500,MEDCOST,MEDCOST VHN,108.98,,,,,,,59.1000,229.0000,percent of total billed charges,47.59% of $229.00 in Billed Charges for Rev 272 = $108.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX CORE MD TECH,272,RC,27201733,CDM,,,,,,both,,,229.0000,34.3500,SENTARA HEALTH,SENTARA HEALTH,59.10,,,,,,,59.1000,229.0000,percent of total billed charges,25.81% of $229.00 in Billed Charges for Rev 272 = $59.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX CORE MD TECH,272,RC,27201733,CDM,,,,,,both,,,229.0000,34.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",229.00,,,,,,,59.1000,229.0000,percent of total billed charges,100% of $229.00 in Billed Charges for Rev 272 = $229.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX CORE MD TECH,272,RC,27201733,CDM,,,,,,both,,,229.0000,34.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,114.50,,,,,,,59.1000,229.0000,percent of total billed charges,Rev 272 $229.00 in Billed Charges at 50% = $114.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX CORE MD TECH,272,RC,27201733,CDM,,,,,,both,,,229.0000,34.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,73.97,,,,,,,59.1000,229.0000,other,32.3% of $229.00 in Billed Charges for Rev 272 = $73.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUS NDL BX CORE MD TECH,272,RC,27201733,CDM,,,,,,both,,,229.0000,34.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,70.30,,,,,,,59.1000,229.0000,other,30.7% of $229.00 in Billed Charges for Rev 272 = $70.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUS NDL BX CORE MD TECH,272,RC,27201733,CDM,,,,,,both,,,229.0000,34.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,73.97,,,,,,,59.1000,229.0000,percent of total billed charges,32.3% of $229.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX CORE MD TECH,272,RC,27201733,CDM,,,,,,both,,,229.0000,34.3500,WELLCARE,WELLCARE MEDICAID,229.00,,,,,,,59.1000,229.0000,percent of total billed charges,100% of $229.00 in Billed Charges for Rev 272 = $229.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX MEDITECH ASAP,272,RC,27201734,CDM,,,,,,both,,,266.0000,39.9000,AETNA,AETNA,113.58,,,,,,,68.6500,266.0000,percent of total billed charges,42.7% of $266.00 in Billed Charges for Rev 272 = $113.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX MEDITECH ASAP,272,RC,27201734,CDM,,,,,,both,,,266.0000,39.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,186.20,,,,,,,68.6500,266.0000,percent of total billed charges,Rev 272 $266.00 in Billed Charges at 70% = $186.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX MEDITECH ASAP,272,RC,27201734,CDM,,,,,,both,,,266.0000,39.9000,CIGNA HEALTHCARE,CIGNA HMO,110.92,,,,,,,68.6500,266.0000,percent of total billed charges,41.7% of $266.00 in Billed Charges for Rev 272 = $110.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX MEDITECH ASAP,272,RC,27201734,CDM,,,,,,both,,,266.0000,39.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,123.42,,,,,,,68.6500,266.0000,percent of total billed charges,46.4% of $266.00 in Billed Charges for Rev 272 = $123.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX MEDITECH ASAP,272,RC,27201734,CDM,,,,,,both,,,266.0000,39.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,110.92,,,,,,,68.6500,266.0000,percent of total billed charges,41.7% of $266.00 in Billed Charges for Rev 272 = $110.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX MEDITECH ASAP,272,RC,27201734,CDM,,,,,,both,,,266.0000,39.9000,CIGNA HEALTHCARE,CIGNA PPO,110.92,,,,,,,68.6500,266.0000,percent of total billed charges,41.7% of $266.00 in Billed Charges for Rev 272 = $110.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX MEDITECH ASAP,272,RC,27201734,CDM,,,,,,both,,,266.0000,39.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,239.40,,,,,,,68.6500,266.0000,percent of total billed charges,90% of $266.00 in Billed Charges for Rev 272 = $239.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX MEDITECH ASAP,272,RC,27201734,CDM,,,,,,both,,,266.0000,39.9000,MEDCOST,MEDCOST VHN,126.59,,,,,,,68.6500,266.0000,percent of total billed charges,47.59% of $266.00 in Billed Charges for Rev 272 = $126.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX MEDITECH ASAP,272,RC,27201734,CDM,,,,,,both,,,266.0000,39.9000,SENTARA HEALTH,SENTARA HEALTH,68.65,,,,,,,68.6500,266.0000,percent of total billed charges,25.81% of $266.00 in Billed Charges for Rev 272 = $68.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX MEDITECH ASAP,272,RC,27201734,CDM,,,,,,both,,,266.0000,39.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",266.00,,,,,,,68.6500,266.0000,percent of total billed charges,100% of $266.00 in Billed Charges for Rev 272 = $266.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX MEDITECH ASAP,272,RC,27201734,CDM,,,,,,both,,,266.0000,39.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,133.00,,,,,,,68.6500,266.0000,percent of total billed charges,Rev 272 $266.00 in Billed Charges at 50% = $133.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX MEDITECH ASAP,272,RC,27201734,CDM,,,,,,both,,,266.0000,39.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,85.92,,,,,,,68.6500,266.0000,other,32.3% of $266.00 in Billed Charges for Rev 272 = $85.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUS NDL BX MEDITECH ASAP,272,RC,27201734,CDM,,,,,,both,,,266.0000,39.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,81.66,,,,,,,68.6500,266.0000,other,30.7% of $266.00 in Billed Charges for Rev 272 = $81.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NUS NDL BX MEDITECH ASAP,272,RC,27201734,CDM,,,,,,both,,,266.0000,39.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,85.92,,,,,,,68.6500,266.0000,percent of total billed charges,32.3% of $266.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NUS NDL BX MEDITECH ASAP,272,RC,27201734,CDM,,,,,,both,,,266.0000,39.9000,WELLCARE,WELLCARE MEDICAID,266.00,,,,,,,68.6500,266.0000,percent of total billed charges,100% of $266.00 in Billed Charges for Rev 272 = $266.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OB ROOM DLY PRV,112,RC,11200001,CDM,,,,,,inpatient,,,2354.0000,353.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,121.76,,,,,,,121.7600,2354.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate
HC OB ROOM DLY PRV,112,RC,11200001,CDM,,,,,,inpatient,,,2354.0000,353.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2118.60,,,,,,,121.7600,2354.0000,percent of total billed charges,"90% of $2,354.00 in Billed Charges for Rev 112 = $2,118.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OB ROOM DLY PRV,112,RC,11200001,CDM,,,,,,inpatient,,,2354.0000,353.1000,MEDCOST,MEDCOST VHN,1120.27,,,,,,,121.7600,2354.0000,percent of total billed charges,"47.59% of $2,354.00 in Billed Charges for Rev 112 = $1,120.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OB ROOM DLY PRV,112,RC,11200001,CDM,,,,,,inpatient,,,2354.0000,353.1000,SENTARA HEALTH,SENTARA HEALTH,877.57,,,,,,,121.7600,2354.0000,percent of total billed charges,"37.28% of $2,354.00 in Billed Charges for Rev 112 = $877.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OB ROOM DLY PRV,112,RC,11200001,CDM,,,,,,inpatient,,,2354.0000,353.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2354.00,,,,,,,121.7600,2354.0000,percent of total billed charges,"100% of $2,354.00 in Billed Charges for Rev 112 = $2,354.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC CONNECTOR W OBT NUCLETRON9011,272,RC,27201371,CDM,,,,,,both,,,1022.0000,153.3000,AETNA,AETNA,436.39,,,,,,,263.7800,1022.0000,percent of total billed charges,"42.7% of $1,022.00 in Billed Charges for Rev 272 = $436.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC CONNECTOR W OBT NUCLETRON9011,272,RC,27201371,CDM,,,,,,both,,,1022.0000,153.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,715.40,,,,,,,263.7800,1022.0000,percent of total billed charges,"Rev 272 $1,022.00 in Billed Charges at 70% = $715.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC CONNECTOR W OBT NUCLETRON9011,272,RC,27201371,CDM,,,,,,both,,,1022.0000,153.3000,CIGNA HEALTHCARE,CIGNA HMO,426.17,,,,,,,263.7800,1022.0000,percent of total billed charges,"41.7% of $1,022.00 in Billed Charges for Rev 272 = $426.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC CONNECTOR W OBT NUCLETRON9011,272,RC,27201371,CDM,,,,,,both,,,1022.0000,153.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,474.21,,,,,,,263.7800,1022.0000,percent of total billed charges,"46.4% of $1,022.00 in Billed Charges for Rev 272 = $474.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC CONNECTOR W OBT NUCLETRON9011,272,RC,27201371,CDM,,,,,,both,,,1022.0000,153.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,426.17,,,,,,,263.7800,1022.0000,percent of total billed charges,"41.7% of $1,022.00 in Billed Charges for Rev 272 = $426.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC CONNECTOR W OBT NUCLETRON9011,272,RC,27201371,CDM,,,,,,both,,,1022.0000,153.3000,CIGNA HEALTHCARE,CIGNA PPO,426.17,,,,,,,263.7800,1022.0000,percent of total billed charges,"41.7% of $1,022.00 in Billed Charges for Rev 272 = $426.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC CONNECTOR W OBT NUCLETRON9011,272,RC,27201371,CDM,,,,,,both,,,1022.0000,153.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,919.80,,,,,,,263.7800,1022.0000,percent of total billed charges,"90% of $1,022.00 in Billed Charges for Rev 272 = $919.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC CONNECTOR W OBT NUCLETRON9011,272,RC,27201371,CDM,,,,,,both,,,1022.0000,153.3000,MEDCOST,MEDCOST VHN,486.37,,,,,,,263.7800,1022.0000,percent of total billed charges,"47.59% of $1,022.00 in Billed Charges for Rev 272 = $486.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC CONNECTOR W OBT NUCLETRON9011,272,RC,27201371,CDM,,,,,,both,,,1022.0000,153.3000,SENTARA HEALTH,SENTARA HEALTH,263.78,,,,,,,263.7800,1022.0000,percent of total billed charges,"25.81% of $1,022.00 in Billed Charges for Rev 272 = $263.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC CONNECTOR W OBT NUCLETRON9011,272,RC,27201371,CDM,,,,,,both,,,1022.0000,153.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1022.00,,,,,,,263.7800,1022.0000,percent of total billed charges,"100% of $1,022.00 in Billed Charges for Rev 272 = $1,022.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC CONNECTOR W OBT NUCLETRON9011,272,RC,27201371,CDM,,,,,,both,,,1022.0000,153.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,511.00,,,,,,,263.7800,1022.0000,percent of total billed charges,"Rev 272 $1,022.00 in Billed Charges at 50% = $511.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC CONNECTOR W OBT NUCLETRON9011,272,RC,27201371,CDM,,,,,,both,,,1022.0000,153.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,330.11,,,,,,,263.7800,1022.0000,other,"32.3% of $1,022.00 in Billed Charges for Rev 272 = $330.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC CONNECTOR W OBT NUCLETRON9011,272,RC,27201371,CDM,,,,,,both,,,1022.0000,153.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,313.75,,,,,,,263.7800,1022.0000,other,"30.7% of $1,022.00 in Billed Charges for Rev 272 = $313.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC CONNECTOR W OBT NUCLETRON9011,272,RC,27201371,CDM,,,,,,both,,,1022.0000,153.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,330.11,,,,,,,263.7800,1022.0000,percent of total billed charges,"32.3% of $1,022.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC CONNECTOR W OBT NUCLETRON9011,272,RC,27201371,CDM,,,,,,both,,,1022.0000,153.3000,WELLCARE,WELLCARE MEDICAID,1022.00,,,,,,,263.7800,1022.0000,percent of total billed charges,"100% of $1,022.00 in Billed Charges for Rev 272 = $1,022.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC RAD DILATOR VAGINAL LARGE,272,RC,27201366,CDM,,,,,,both,,,46.0000,6.9000,AETNA,AETNA,19.64,,,,,,,11.8700,46.0000,percent of total billed charges,42.7% of $46.00 in Billed Charges for Rev 272 = $19.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL LARGE,272,RC,27201366,CDM,,,,,,both,,,46.0000,6.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,32.20,,,,,,,11.8700,46.0000,percent of total billed charges,Rev 272 $46.00 in Billed Charges at 70% = $32.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL LARGE,272,RC,27201366,CDM,,,,,,both,,,46.0000,6.9000,CIGNA HEALTHCARE,CIGNA HMO,19.18,,,,,,,11.8700,46.0000,percent of total billed charges,41.7% of $46.00 in Billed Charges for Rev 272 = $19.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL LARGE,272,RC,27201366,CDM,,,,,,both,,,46.0000,6.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,21.34,,,,,,,11.8700,46.0000,percent of total billed charges,46.4% of $46.00 in Billed Charges for Rev 272 = $21.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL LARGE,272,RC,27201366,CDM,,,,,,both,,,46.0000,6.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,19.18,,,,,,,11.8700,46.0000,percent of total billed charges,41.7% of $46.00 in Billed Charges for Rev 272 = $19.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL LARGE,272,RC,27201366,CDM,,,,,,both,,,46.0000,6.9000,CIGNA HEALTHCARE,CIGNA PPO,19.18,,,,,,,11.8700,46.0000,percent of total billed charges,41.7% of $46.00 in Billed Charges for Rev 272 = $19.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL LARGE,272,RC,27201366,CDM,,,,,,both,,,46.0000,6.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,41.40,,,,,,,11.8700,46.0000,percent of total billed charges,90% of $46.00 in Billed Charges for Rev 272 = $41.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL LARGE,272,RC,27201366,CDM,,,,,,both,,,46.0000,6.9000,MEDCOST,MEDCOST VHN,21.89,,,,,,,11.8700,46.0000,percent of total billed charges,47.59% of $46.00 in Billed Charges for Rev 272 = $21.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL LARGE,272,RC,27201366,CDM,,,,,,both,,,46.0000,6.9000,SENTARA HEALTH,SENTARA HEALTH,11.87,,,,,,,11.8700,46.0000,percent of total billed charges,25.81% of $46.00 in Billed Charges for Rev 272 = $11.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL LARGE,272,RC,27201366,CDM,,,,,,both,,,46.0000,6.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",46.00,,,,,,,11.8700,46.0000,percent of total billed charges,100% of $46.00 in Billed Charges for Rev 272 = $46.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL LARGE,272,RC,27201366,CDM,,,,,,both,,,46.0000,6.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,23.00,,,,,,,11.8700,46.0000,percent of total billed charges,Rev 272 $46.00 in Billed Charges at 50% = $23.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL LARGE,272,RC,27201366,CDM,,,,,,both,,,46.0000,6.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,14.86,,,,,,,11.8700,46.0000,other,32.3% of $46.00 in Billed Charges for Rev 272 = $14.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC RAD DILATOR VAGINAL LARGE,272,RC,27201366,CDM,,,,,,both,,,46.0000,6.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,14.12,,,,,,,11.8700,46.0000,other,30.7% of $46.00 in Billed Charges for Rev 272 = $14.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC RAD DILATOR VAGINAL LARGE,272,RC,27201366,CDM,,,,,,both,,,46.0000,6.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,14.86,,,,,,,11.8700,46.0000,percent of total billed charges,32.3% of $46.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL LARGE,272,RC,27201366,CDM,,,,,,both,,,46.0000,6.9000,WELLCARE,WELLCARE MEDICAID,46.00,,,,,,,11.8700,46.0000,percent of total billed charges,100% of $46.00 in Billed Charges for Rev 272 = $46.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL MED,272,RC,27201367,CDM,,,,,,both,,,38.0000,5.7000,AETNA,AETNA,16.23,,,,,,,9.8100,38.0000,percent of total billed charges,42.7% of $38.00 in Billed Charges for Rev 272 = $16.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL MED,272,RC,27201367,CDM,,,,,,both,,,38.0000,5.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,26.60,,,,,,,9.8100,38.0000,percent of total billed charges,Rev 272 $38.00 in Billed Charges at 70% = $26.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL MED,272,RC,27201367,CDM,,,,,,both,,,38.0000,5.7000,CIGNA HEALTHCARE,CIGNA HMO,15.85,,,,,,,9.8100,38.0000,percent of total billed charges,41.7% of $38.00 in Billed Charges for Rev 272 = $15.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL MED,272,RC,27201367,CDM,,,,,,both,,,38.0000,5.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,17.63,,,,,,,9.8100,38.0000,percent of total billed charges,46.4% of $38.00 in Billed Charges for Rev 272 = $17.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL MED,272,RC,27201367,CDM,,,,,,both,,,38.0000,5.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,15.85,,,,,,,9.8100,38.0000,percent of total billed charges,41.7% of $38.00 in Billed Charges for Rev 272 = $15.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL MED,272,RC,27201367,CDM,,,,,,both,,,38.0000,5.7000,CIGNA HEALTHCARE,CIGNA PPO,15.85,,,,,,,9.8100,38.0000,percent of total billed charges,41.7% of $38.00 in Billed Charges for Rev 272 = $15.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL MED,272,RC,27201367,CDM,,,,,,both,,,38.0000,5.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,34.20,,,,,,,9.8100,38.0000,percent of total billed charges,90% of $38.00 in Billed Charges for Rev 272 = $34.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL MED,272,RC,27201367,CDM,,,,,,both,,,38.0000,5.7000,MEDCOST,MEDCOST VHN,18.08,,,,,,,9.8100,38.0000,percent of total billed charges,47.59% of $38.00 in Billed Charges for Rev 272 = $18.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL MED,272,RC,27201367,CDM,,,,,,both,,,38.0000,5.7000,SENTARA HEALTH,SENTARA HEALTH,9.81,,,,,,,9.8100,38.0000,percent of total billed charges,25.81% of $38.00 in Billed Charges for Rev 272 = $9.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL MED,272,RC,27201367,CDM,,,,,,both,,,38.0000,5.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",38.00,,,,,,,9.8100,38.0000,percent of total billed charges,100% of $38.00 in Billed Charges for Rev 272 = $38.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL MED,272,RC,27201367,CDM,,,,,,both,,,38.0000,5.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,19.00,,,,,,,9.8100,38.0000,percent of total billed charges,Rev 272 $38.00 in Billed Charges at 50% = $19.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL MED,272,RC,27201367,CDM,,,,,,both,,,38.0000,5.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12.27,,,,,,,9.8100,38.0000,other,32.3% of $38.00 in Billed Charges for Rev 272 = $12.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC RAD DILATOR VAGINAL MED,272,RC,27201367,CDM,,,,,,both,,,38.0000,5.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11.67,,,,,,,9.8100,38.0000,other,30.7% of $38.00 in Billed Charges for Rev 272 = $11.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC RAD DILATOR VAGINAL MED,272,RC,27201367,CDM,,,,,,both,,,38.0000,5.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,12.27,,,,,,,9.8100,38.0000,percent of total billed charges,32.3% of $38.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC RAD DILATOR VAGINAL MED,272,RC,27201367,CDM,,,,,,both,,,38.0000,5.7000,WELLCARE,WELLCARE MEDICAID,38.00,,,,,,,9.8100,38.0000,percent of total billed charges,100% of $38.00 in Billed Charges for Rev 272 = $38.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HOOK DISSECTING 5MM HARMONIC,272,RC,27200002,CDM,,,,,,both,,,1909.7900,286.4700,AETNA,AETNA,815.48,,,,,,,492.9200,1909.7900,percent of total billed charges,"42.7% of $1,909.79 in Billed Charges for Rev 272 = $815.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOOK DISSECTING 5MM HARMONIC,272,RC,27200002,CDM,,,,,,both,,,1909.7900,286.4700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1336.85,,,,,,,492.9200,1909.7900,percent of total billed charges,"Rev 272 $1,909.79 in Billed Charges at 70% = $1,336.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOOK DISSECTING 5MM HARMONIC,272,RC,27200002,CDM,,,,,,both,,,1909.7900,286.4700,CIGNA HEALTHCARE,CIGNA HMO,796.38,,,,,,,492.9200,1909.7900,percent of total billed charges,"41.7% of $1,909.79 in Billed Charges for Rev 272 = $796.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOOK DISSECTING 5MM HARMONIC,272,RC,27200002,CDM,,,,,,both,,,1909.7900,286.4700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,886.14,,,,,,,492.9200,1909.7900,percent of total billed charges,"46.4% of $1,909.79 in Billed Charges for Rev 272 = $886.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOOK DISSECTING 5MM HARMONIC,272,RC,27200002,CDM,,,,,,both,,,1909.7900,286.4700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,796.38,,,,,,,492.9200,1909.7900,percent of total billed charges,"41.7% of $1,909.79 in Billed Charges for Rev 272 = $796.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOOK DISSECTING 5MM HARMONIC,272,RC,27200002,CDM,,,,,,both,,,1909.7900,286.4700,CIGNA HEALTHCARE,CIGNA PPO,796.38,,,,,,,492.9200,1909.7900,percent of total billed charges,"41.7% of $1,909.79 in Billed Charges for Rev 272 = $796.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOOK DISSECTING 5MM HARMONIC,272,RC,27200002,CDM,,,,,,both,,,1909.7900,286.4700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1718.81,,,,,,,492.9200,1909.7900,percent of total billed charges,"90% of $1,909.79 in Billed Charges for Rev 272 = $1,718.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOOK DISSECTING 5MM HARMONIC,272,RC,27200002,CDM,,,,,,both,,,1909.7900,286.4700,MEDCOST,MEDCOST VHN,908.87,,,,,,,492.9200,1909.7900,percent of total billed charges,"47.59% of $1,909.79 in Billed Charges for Rev 272 = $908.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOOK DISSECTING 5MM HARMONIC,272,RC,27200002,CDM,,,,,,both,,,1909.7900,286.4700,SENTARA HEALTH,SENTARA HEALTH,492.92,,,,,,,492.9200,1909.7900,percent of total billed charges,"25.81% of $1,909.79 in Billed Charges for Rev 272 = $492.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOOK DISSECTING 5MM HARMONIC,272,RC,27200002,CDM,,,,,,both,,,1909.7900,286.4700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1909.79,,,,,,,492.9200,1909.7900,percent of total billed charges,"100% of $1,909.79 in Billed Charges for Rev 272 = $1,909.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOOK DISSECTING 5MM HARMONIC,272,RC,27200002,CDM,,,,,,both,,,1909.7900,286.4700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,954.90,,,,,,,492.9200,1909.7900,percent of total billed charges,"Rev 272 $1,909.79 in Billed Charges at 50% = $954.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOOK DISSECTING 5MM HARMONIC,272,RC,27200002,CDM,,,,,,both,,,1909.7900,286.4700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,616.86,,,,,,,492.9200,1909.7900,other,"32.3% of $1,909.79 in Billed Charges for Rev 272 = $616.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HOOK DISSECTING 5MM HARMONIC,272,RC,27200002,CDM,,,,,,both,,,1909.7900,286.4700,UNITED HEALTHCARE,UHC HERITAGE SELECT,586.31,,,,,,,492.9200,1909.7900,other,"30.7% of $1,909.79 in Billed Charges for Rev 272 = $586.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HOOK DISSECTING 5MM HARMONIC,272,RC,27200002,CDM,,,,,,both,,,1909.7900,286.4700,UNITED HEALTHCARE,UNITED HEALTHCARE,616.86,,,,,,,492.9200,1909.7900,percent of total billed charges,"32.3% of $1,909.79 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOOK DISSECTING 5MM HARMONIC,272,RC,27200002,CDM,,,,,,both,,,1909.7900,286.4700,WELLCARE,WELLCARE MEDICAID,1909.79,,,,,,,492.9200,1909.7900,percent of total billed charges,"100% of $1,909.79 in Billed Charges for Rev 272 = $1,909.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOVERMATT SPLIT LEG 34IN,272,RC,27200002,CDM,,,,,,both,,,791.3100,118.7000,AETNA,AETNA,337.89,,,,,,,204.2400,791.3100,percent of total billed charges,42.7% of $791.31 in Billed Charges for Rev 272 = $337.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HOVERMATT SPLIT LEG 34IN,272,RC,27200002,CDM,,,,,,both,,,791.3100,118.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,553.92,,,,,,,204.2400,791.3100,percent of total billed charges,Rev 272 $791.31 in Billed Charges at 70% = $553.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HOVERMATT SPLIT LEG 34IN,272,RC,27200002,CDM,,,,,,both,,,791.3100,118.7000,CIGNA HEALTHCARE,CIGNA HMO,329.98,,,,,,,204.2400,791.3100,percent of total billed charges,41.7% of $791.31 in Billed Charges for Rev 272 = $329.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HOVERMATT SPLIT LEG 34IN,272,RC,27200002,CDM,,,,,,both,,,791.3100,118.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,367.17,,,,,,,204.2400,791.3100,percent of total billed charges,46.4% of $791.31 in Billed Charges for Rev 272 = $367.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HOVERMATT SPLIT LEG 34IN,272,RC,27200002,CDM,,,,,,both,,,791.3100,118.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,329.98,,,,,,,204.2400,791.3100,percent of total billed charges,41.7% of $791.31 in Billed Charges for Rev 272 = $329.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HOVERMATT SPLIT LEG 34IN,272,RC,27200002,CDM,,,,,,both,,,791.3100,118.7000,CIGNA HEALTHCARE,CIGNA PPO,329.98,,,,,,,204.2400,791.3100,percent of total billed charges,41.7% of $791.31 in Billed Charges for Rev 272 = $329.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HOVERMATT SPLIT LEG 34IN,272,RC,27200002,CDM,,,,,,both,,,791.3100,118.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,712.18,,,,,,,204.2400,791.3100,percent of total billed charges,90% of $791.31 in Billed Charges for Rev 272 = $712.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HOVERMATT SPLIT LEG 34IN,272,RC,27200002,CDM,,,,,,both,,,791.3100,118.7000,MEDCOST,MEDCOST VHN,376.58,,,,,,,204.2400,791.3100,percent of total billed charges,47.59% of $791.31 in Billed Charges for Rev 272 = $376.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HOVERMATT SPLIT LEG 34IN,272,RC,27200002,CDM,,,,,,both,,,791.3100,118.7000,SENTARA HEALTH,SENTARA HEALTH,204.24,,,,,,,204.2400,791.3100,percent of total billed charges,25.81% of $791.31 in Billed Charges for Rev 272 = $204.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HOVERMATT SPLIT LEG 34IN,272,RC,27200002,CDM,,,,,,both,,,791.3100,118.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",791.31,,,,,,,204.2400,791.3100,percent of total billed charges,100% of $791.31 in Billed Charges for Rev 272 = $791.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HOVERMATT SPLIT LEG 34IN,272,RC,27200002,CDM,,,,,,both,,,791.3100,118.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,395.66,,,,,,,204.2400,791.3100,percent of total billed charges,Rev 272 $791.31 in Billed Charges at 50% = $395.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HOVERMATT SPLIT LEG 34IN,272,RC,27200002,CDM,,,,,,both,,,791.3100,118.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,255.59,,,,,,,204.2400,791.3100,other,32.3% of $791.31 in Billed Charges for Rev 272 = $255.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HOVERMATT SPLIT LEG 34IN,272,RC,27200002,CDM,,,,,,both,,,791.3100,118.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,242.93,,,,,,,204.2400,791.3100,other,30.7% of $791.31 in Billed Charges for Rev 272 = $242.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HOVERMATT SPLIT LEG 34IN,272,RC,27200002,CDM,,,,,,both,,,791.3100,118.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,255.59,,,,,,,204.2400,791.3100,percent of total billed charges,32.3% of $791.31 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HOVERMATT SPLIT LEG 34IN,272,RC,27200002,CDM,,,,,,both,,,791.3100,118.7000,WELLCARE,WELLCARE MEDICAID,791.31,,,,,,,204.2400,791.3100,percent of total billed charges,100% of $791.31 in Billed Charges for Rev 272 = $791.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A ASMBLY DRAINAGE,272,RC,,,,,,,,both,,,1981.2800,297.1900,AETNA,AETNA,846.01,,,,,,,511.3700,1981.2800,percent of total billed charges,"42.7% of $1,981.28 in Billed Charges for Rev 272 = $846.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ASMBLY DRAINAGE,272,RC,,,,,,,,both,,,1981.2800,297.1900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1386.90,,,,,,,511.3700,1981.2800,percent of total billed charges,"Rev 272 $1,981.28 in Billed Charges at 70% = $1,386.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ASMBLY DRAINAGE,272,RC,,,,,,,,both,,,1981.2800,297.1900,CIGNA HEALTHCARE,CIGNA HMO,826.19,,,,,,,511.3700,1981.2800,percent of total billed charges,"41.7% of $1,981.28 in Billed Charges for Rev 272 = $826.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ASMBLY DRAINAGE,272,RC,,,,,,,,both,,,1981.2800,297.1900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,919.31,,,,,,,511.3700,1981.2800,percent of total billed charges,"46.4% of $1,981.28 in Billed Charges for Rev 272 = $919.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ASMBLY DRAINAGE,272,RC,,,,,,,,both,,,1981.2800,297.1900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,826.19,,,,,,,511.3700,1981.2800,percent of total billed charges,"41.7% of $1,981.28 in Billed Charges for Rev 272 = $826.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ASMBLY DRAINAGE,272,RC,,,,,,,,both,,,1981.2800,297.1900,CIGNA HEALTHCARE,CIGNA PPO,826.19,,,,,,,511.3700,1981.2800,percent of total billed charges,"41.7% of $1,981.28 in Billed Charges for Rev 272 = $826.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ASMBLY DRAINAGE,272,RC,,,,,,,,both,,,1981.2800,297.1900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1783.15,,,,,,,511.3700,1981.2800,percent of total billed charges,"90% of $1,981.28 in Billed Charges for Rev 272 = $1,783.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ASMBLY DRAINAGE,272,RC,,,,,,,,both,,,1981.2800,297.1900,MEDCOST,MEDCOST VHN,942.89,,,,,,,511.3700,1981.2800,percent of total billed charges,"47.59% of $1,981.28 in Billed Charges for Rev 272 = $942.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ASMBLY DRAINAGE,272,RC,,,,,,,,both,,,1981.2800,297.1900,SENTARA HEALTH,SENTARA HEALTH,511.37,,,,,,,511.3700,1981.2800,percent of total billed charges,"25.81% of $1,981.28 in Billed Charges for Rev 272 = $511.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ASMBLY DRAINAGE,272,RC,,,,,,,,both,,,1981.2800,297.1900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1981.28,,,,,,,511.3700,1981.2800,percent of total billed charges,"100% of $1,981.28 in Billed Charges for Rev 272 = $1,981.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ASMBLY DRAINAGE,272,RC,,,,,,,,both,,,1981.2800,297.1900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,990.64,,,,,,,511.3700,1981.2800,percent of total billed charges,"Rev 272 $1,981.28 in Billed Charges at 50% = $990.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ASMBLY DRAINAGE,272,RC,,,,,,,,both,,,1981.2800,297.1900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,639.95,,,,,,,511.3700,1981.2800,other,"32.3% of $1,981.28 in Billed Charges for Rev 272 = $639.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A ASMBLY DRAINAGE,272,RC,,,,,,,,both,,,1981.2800,297.1900,UNITED HEALTHCARE,UHC HERITAGE SELECT,608.25,,,,,,,511.3700,1981.2800,other,"30.7% of $1,981.28 in Billed Charges for Rev 272 = $608.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A ASMBLY DRAINAGE,272,RC,,,,,,,,both,,,1981.2800,297.1900,UNITED HEALTHCARE,UNITED HEALTHCARE,639.95,,,,,,,511.3700,1981.2800,percent of total billed charges,"32.3% of $1,981.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A ASMBLY DRAINAGE,272,RC,,,,,,,,both,,,1981.2800,297.1900,WELLCARE,WELLCARE MEDICAID,1981.28,,,,,,,511.3700,1981.2800,percent of total billed charges,"100% of $1,981.28 in Billed Charges for Rev 272 = $1,981.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILLATING ENT 12MM 2296-31-34,272,RC,,,,,,,,both,,,1063.8600,159.5800,AETNA,AETNA,454.27,,,,,,,274.5800,1063.8600,percent of total billed charges,"42.7% of $1,063.86 in Billed Charges for Rev 272 = $454.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILLATING ENT 12MM 2296-31-34,272,RC,,,,,,,,both,,,1063.8600,159.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,744.70,,,,,,,274.5800,1063.8600,percent of total billed charges,"Rev 272 $1,063.86 in Billed Charges at 70% = $744.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILLATING ENT 12MM 2296-31-34,272,RC,,,,,,,,both,,,1063.8600,159.5800,CIGNA HEALTHCARE,CIGNA HMO,443.63,,,,,,,274.5800,1063.8600,percent of total billed charges,"41.7% of $1,063.86 in Billed Charges for Rev 272 = $443.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILLATING ENT 12MM 2296-31-34,272,RC,,,,,,,,both,,,1063.8600,159.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,493.63,,,,,,,274.5800,1063.8600,percent of total billed charges,"46.4% of $1,063.86 in Billed Charges for Rev 272 = $493.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILLATING ENT 12MM 2296-31-34,272,RC,,,,,,,,both,,,1063.8600,159.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,443.63,,,,,,,274.5800,1063.8600,percent of total billed charges,"41.7% of $1,063.86 in Billed Charges for Rev 272 = $443.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILLATING ENT 12MM 2296-31-34,272,RC,,,,,,,,both,,,1063.8600,159.5800,CIGNA HEALTHCARE,CIGNA PPO,443.63,,,,,,,274.5800,1063.8600,percent of total billed charges,"41.7% of $1,063.86 in Billed Charges for Rev 272 = $443.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILLATING ENT 12MM 2296-31-34,272,RC,,,,,,,,both,,,1063.8600,159.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,957.47,,,,,,,274.5800,1063.8600,percent of total billed charges,"90% of $1,063.86 in Billed Charges for Rev 272 = $957.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILLATING ENT 12MM 2296-31-34,272,RC,,,,,,,,both,,,1063.8600,159.5800,MEDCOST,MEDCOST VHN,506.29,,,,,,,274.5800,1063.8600,percent of total billed charges,"47.59% of $1,063.86 in Billed Charges for Rev 272 = $506.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILLATING ENT 12MM 2296-31-34,272,RC,,,,,,,,both,,,1063.8600,159.5800,SENTARA HEALTH,SENTARA HEALTH,274.58,,,,,,,274.5800,1063.8600,percent of total billed charges,"25.81% of $1,063.86 in Billed Charges for Rev 272 = $274.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILLATING ENT 12MM 2296-31-34,272,RC,,,,,,,,both,,,1063.8600,159.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1063.86,,,,,,,274.5800,1063.8600,percent of total billed charges,"100% of $1,063.86 in Billed Charges for Rev 272 = $1,063.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILLATING ENT 12MM 2296-31-34,272,RC,,,,,,,,both,,,1063.8600,159.5800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,531.93,,,,,,,274.5800,1063.8600,percent of total billed charges,"Rev 272 $1,063.86 in Billed Charges at 50% = $531.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILLATING ENT 12MM 2296-31-34,272,RC,,,,,,,,both,,,1063.8600,159.5800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,343.63,,,,,,,274.5800,1063.8600,other,"32.3% of $1,063.86 in Billed Charges for Rev 272 = $343.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A BLADE OSCILLATING ENT 12MM 2296-31-34,272,RC,,,,,,,,both,,,1063.8600,159.5800,UNITED HEALTHCARE,UHC HERITAGE SELECT,326.61,,,,,,,274.5800,1063.8600,other,"30.7% of $1,063.86 in Billed Charges for Rev 272 = $326.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A BLADE OSCILLATING ENT 12MM 2296-31-34,272,RC,,,,,,,,both,,,1063.8600,159.5800,UNITED HEALTHCARE,UNITED HEALTHCARE,343.63,,,,,,,274.5800,1063.8600,percent of total billed charges,"32.3% of $1,063.86 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE OSCILLATING ENT 12MM 2296-31-34,272,RC,,,,,,,,both,,,1063.8600,159.5800,WELLCARE,WELLCARE MEDICAID,1063.86,,,,,,,274.5800,1063.8600,percent of total billed charges,"100% of $1,063.86 in Billed Charges for Rev 272 = $1,063.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC UNIFRAME MASK 9X10,272,RC,27201370,CDM,,,,,,both,,,163.0000,24.4500,AETNA,AETNA,69.60,,,,,,,42.0700,163.0000,percent of total billed charges,42.7% of $163.00 in Billed Charges for Rev 272 = $69.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X10,272,RC,27201370,CDM,,,,,,both,,,163.0000,24.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,114.10,,,,,,,42.0700,163.0000,percent of total billed charges,Rev 272 $163.00 in Billed Charges at 70% = $114.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X10,272,RC,27201370,CDM,,,,,,both,,,163.0000,24.4500,CIGNA HEALTHCARE,CIGNA HMO,67.97,,,,,,,42.0700,163.0000,percent of total billed charges,41.7% of $163.00 in Billed Charges for Rev 272 = $67.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X10,272,RC,27201370,CDM,,,,,,both,,,163.0000,24.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,75.63,,,,,,,42.0700,163.0000,percent of total billed charges,46.4% of $163.00 in Billed Charges for Rev 272 = $75.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X10,272,RC,27201370,CDM,,,,,,both,,,163.0000,24.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,67.97,,,,,,,42.0700,163.0000,percent of total billed charges,41.7% of $163.00 in Billed Charges for Rev 272 = $67.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X10,272,RC,27201370,CDM,,,,,,both,,,163.0000,24.4500,CIGNA HEALTHCARE,CIGNA PPO,67.97,,,,,,,42.0700,163.0000,percent of total billed charges,41.7% of $163.00 in Billed Charges for Rev 272 = $67.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X10,272,RC,27201370,CDM,,,,,,both,,,163.0000,24.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,146.70,,,,,,,42.0700,163.0000,percent of total billed charges,90% of $163.00 in Billed Charges for Rev 272 = $146.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X10,272,RC,27201370,CDM,,,,,,both,,,163.0000,24.4500,MEDCOST,MEDCOST VHN,77.57,,,,,,,42.0700,163.0000,percent of total billed charges,47.59% of $163.00 in Billed Charges for Rev 272 = $77.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X10,272,RC,27201370,CDM,,,,,,both,,,163.0000,24.4500,SENTARA HEALTH,SENTARA HEALTH,42.07,,,,,,,42.0700,163.0000,percent of total billed charges,25.81% of $163.00 in Billed Charges for Rev 272 = $42.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X10,272,RC,27201370,CDM,,,,,,both,,,163.0000,24.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",163.00,,,,,,,42.0700,163.0000,percent of total billed charges,100% of $163.00 in Billed Charges for Rev 272 = $163.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X10,272,RC,27201370,CDM,,,,,,both,,,163.0000,24.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,81.50,,,,,,,42.0700,163.0000,percent of total billed charges,Rev 272 $163.00 in Billed Charges at 50% = $81.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X10,272,RC,27201370,CDM,,,,,,both,,,163.0000,24.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,52.65,,,,,,,42.0700,163.0000,other,32.3% of $163.00 in Billed Charges for Rev 272 = $52.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC UNIFRAME MASK 9X10,272,RC,27201370,CDM,,,,,,both,,,163.0000,24.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,50.04,,,,,,,42.0700,163.0000,other,30.7% of $163.00 in Billed Charges for Rev 272 = $50.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC UNIFRAME MASK 9X10,272,RC,27201370,CDM,,,,,,both,,,163.0000,24.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,52.65,,,,,,,42.0700,163.0000,percent of total billed charges,32.3% of $163.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X10,272,RC,27201370,CDM,,,,,,both,,,163.0000,24.4500,WELLCARE,WELLCARE MEDICAID,163.00,,,,,,,42.0700,163.0000,percent of total billed charges,100% of $163.00 in Billed Charges for Rev 272 = $163.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X12,272,RC,27201365,CDM,,,,,,both,,,176.0000,26.4000,AETNA,AETNA,75.15,,,,,,,45.4300,176.0000,percent of total billed charges,42.7% of $176.00 in Billed Charges for Rev 272 = $75.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X12,272,RC,27201365,CDM,,,,,,both,,,176.0000,26.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,123.20,,,,,,,45.4300,176.0000,percent of total billed charges,Rev 272 $176.00 in Billed Charges at 70% = $123.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X12,272,RC,27201365,CDM,,,,,,both,,,176.0000,26.4000,CIGNA HEALTHCARE,CIGNA HMO,73.39,,,,,,,45.4300,176.0000,percent of total billed charges,41.7% of $176.00 in Billed Charges for Rev 272 = $73.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X12,272,RC,27201365,CDM,,,,,,both,,,176.0000,26.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,81.66,,,,,,,45.4300,176.0000,percent of total billed charges,46.4% of $176.00 in Billed Charges for Rev 272 = $81.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X12,272,RC,27201365,CDM,,,,,,both,,,176.0000,26.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,73.39,,,,,,,45.4300,176.0000,percent of total billed charges,41.7% of $176.00 in Billed Charges for Rev 272 = $73.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X12,272,RC,27201365,CDM,,,,,,both,,,176.0000,26.4000,CIGNA HEALTHCARE,CIGNA PPO,73.39,,,,,,,45.4300,176.0000,percent of total billed charges,41.7% of $176.00 in Billed Charges for Rev 272 = $73.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X12,272,RC,27201365,CDM,,,,,,both,,,176.0000,26.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,158.40,,,,,,,45.4300,176.0000,percent of total billed charges,90% of $176.00 in Billed Charges for Rev 272 = $158.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X12,272,RC,27201365,CDM,,,,,,both,,,176.0000,26.4000,MEDCOST,MEDCOST VHN,83.76,,,,,,,45.4300,176.0000,percent of total billed charges,47.59% of $176.00 in Billed Charges for Rev 272 = $83.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X12,272,RC,27201365,CDM,,,,,,both,,,176.0000,26.4000,SENTARA HEALTH,SENTARA HEALTH,45.43,,,,,,,45.4300,176.0000,percent of total billed charges,25.81% of $176.00 in Billed Charges for Rev 272 = $45.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X12,272,RC,27201365,CDM,,,,,,both,,,176.0000,26.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",176.00,,,,,,,45.4300,176.0000,percent of total billed charges,100% of $176.00 in Billed Charges for Rev 272 = $176.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X12,272,RC,27201365,CDM,,,,,,both,,,176.0000,26.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,88.00,,,,,,,45.4300,176.0000,percent of total billed charges,Rev 272 $176.00 in Billed Charges at 50% = $88.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X12,272,RC,27201365,CDM,,,,,,both,,,176.0000,26.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,56.85,,,,,,,45.4300,176.0000,other,32.3% of $176.00 in Billed Charges for Rev 272 = $56.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC UNIFRAME MASK 9X12,272,RC,27201365,CDM,,,,,,both,,,176.0000,26.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,54.03,,,,,,,45.4300,176.0000,other,30.7% of $176.00 in Billed Charges for Rev 272 = $54.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC UNIFRAME MASK 9X12,272,RC,27201365,CDM,,,,,,both,,,176.0000,26.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,56.85,,,,,,,45.4300,176.0000,percent of total billed charges,32.3% of $176.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC UNIFRAME MASK 9X12,272,RC,27201365,CDM,,,,,,both,,,176.0000,26.4000,WELLCARE,WELLCARE MEDICAID,176.00,,,,,,,45.4300,176.0000,percent of total billed charges,100% of $176.00 in Billed Charges for Rev 272 = $176.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT KNEE IMMOB 8781 SER,270,RC,27000188,CDM,,,,,,both,,,159.0000,23.8500,AETNA,AETNA,67.89,,,,,,,41.0400,159.0000,percent of total billed charges,42.7% of $159.00 in Billed Charges for Rev 270 = $67.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT KNEE IMMOB 8781 SER,270,RC,27000188,CDM,,,,,,both,,,159.0000,23.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,111.30,,,,,,,41.0400,159.0000,percent of total billed charges,Rev 270 $159.00 in Billed Charges at 70% = $111.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT KNEE IMMOB 8781 SER,270,RC,27000188,CDM,,,,,,both,,,159.0000,23.8500,CIGNA HEALTHCARE,CIGNA HMO,66.30,,,,,,,41.0400,159.0000,percent of total billed charges,41.7% of $159.00 in Billed Charges for Rev 270 = $66.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT KNEE IMMOB 8781 SER,270,RC,27000188,CDM,,,,,,both,,,159.0000,23.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,73.78,,,,,,,41.0400,159.0000,percent of total billed charges,46.4% of $159.00 in Billed Charges for Rev 270 = $73.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT KNEE IMMOB 8781 SER,270,RC,27000188,CDM,,,,,,both,,,159.0000,23.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,66.30,,,,,,,41.0400,159.0000,percent of total billed charges,41.7% of $159.00 in Billed Charges for Rev 270 = $66.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT KNEE IMMOB 8781 SER,270,RC,27000188,CDM,,,,,,both,,,159.0000,23.8500,CIGNA HEALTHCARE,CIGNA PPO,66.30,,,,,,,41.0400,159.0000,percent of total billed charges,41.7% of $159.00 in Billed Charges for Rev 270 = $66.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT KNEE IMMOB 8781 SER,270,RC,27000188,CDM,,,,,,both,,,159.0000,23.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,143.10,,,,,,,41.0400,159.0000,percent of total billed charges,90% of $159.00 in Billed Charges for Rev 270 = $143.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT KNEE IMMOB 8781 SER,270,RC,27000188,CDM,,,,,,both,,,159.0000,23.8500,MEDCOST,MEDCOST VHN,75.67,,,,,,,41.0400,159.0000,percent of total billed charges,47.59% of $159.00 in Billed Charges for Rev 270 = $75.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT KNEE IMMOB 8781 SER,270,RC,27000188,CDM,,,,,,both,,,159.0000,23.8500,SENTARA HEALTH,SENTARA HEALTH,41.04,,,,,,,41.0400,159.0000,percent of total billed charges,25.81% of $159.00 in Billed Charges for Rev 270 = $41.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT KNEE IMMOB 8781 SER,270,RC,27000188,CDM,,,,,,both,,,159.0000,23.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",159.00,,,,,,,41.0400,159.0000,percent of total billed charges,100% of $159.00 in Billed Charges for Rev 270 = $159.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT KNEE IMMOB 8781 SER,270,RC,27000188,CDM,,,,,,both,,,159.0000,23.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,79.50,,,,,,,41.0400,159.0000,percent of total billed charges,Rev 270 $159.00 in Billed Charges at 50% = $79.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT KNEE IMMOB 8781 SER,270,RC,27000188,CDM,,,,,,both,,,159.0000,23.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,51.36,,,,,,,41.0400,159.0000,other,32.3% of $159.00 in Billed Charges for Rev 270 = $51.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ORTH SOFT KNEE IMMOB 8781 SER,270,RC,27000188,CDM,,,,,,both,,,159.0000,23.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,48.81,,,,,,,41.0400,159.0000,other,30.7% of $159.00 in Billed Charges for Rev 270 = $48.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ORTH SOFT KNEE IMMOB 8781 SER,270,RC,27000188,CDM,,,,,,both,,,159.0000,23.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,51.36,,,,,,,41.0400,159.0000,percent of total billed charges,32.3% of $159.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT KNEE IMMOB 8781 SER,270,RC,27000188,CDM,,,,,,both,,,159.0000,23.8500,WELLCARE,WELLCARE MEDICAID,159.00,,,,,,,41.0400,159.0000,percent of total billed charges,100% of $159.00 in Billed Charges for Rev 270 = $159.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT LEGGINGS FOR TRACT,270,RC,27000189,CDM,,,,,,both,,,145.0000,21.7500,AETNA,AETNA,61.92,,,,,,,37.4200,145.0000,percent of total billed charges,42.7% of $145.00 in Billed Charges for Rev 270 = $61.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT LEGGINGS FOR TRACT,270,RC,27000189,CDM,,,,,,both,,,145.0000,21.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,101.50,,,,,,,37.4200,145.0000,percent of total billed charges,Rev 270 $145.00 in Billed Charges at 70% = $101.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT LEGGINGS FOR TRACT,270,RC,27000189,CDM,,,,,,both,,,145.0000,21.7500,CIGNA HEALTHCARE,CIGNA HMO,60.47,,,,,,,37.4200,145.0000,percent of total billed charges,41.7% of $145.00 in Billed Charges for Rev 270 = $60.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT LEGGINGS FOR TRACT,270,RC,27000189,CDM,,,,,,both,,,145.0000,21.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,67.28,,,,,,,37.4200,145.0000,percent of total billed charges,46.4% of $145.00 in Billed Charges for Rev 270 = $67.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT LEGGINGS FOR TRACT,270,RC,27000189,CDM,,,,,,both,,,145.0000,21.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,60.47,,,,,,,37.4200,145.0000,percent of total billed charges,41.7% of $145.00 in Billed Charges for Rev 270 = $60.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT LEGGINGS FOR TRACT,270,RC,27000189,CDM,,,,,,both,,,145.0000,21.7500,CIGNA HEALTHCARE,CIGNA PPO,60.47,,,,,,,37.4200,145.0000,percent of total billed charges,41.7% of $145.00 in Billed Charges for Rev 270 = $60.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT LEGGINGS FOR TRACT,270,RC,27000189,CDM,,,,,,both,,,145.0000,21.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,130.50,,,,,,,37.4200,145.0000,percent of total billed charges,90% of $145.00 in Billed Charges for Rev 270 = $130.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT LEGGINGS FOR TRACT,270,RC,27000189,CDM,,,,,,both,,,145.0000,21.7500,MEDCOST,MEDCOST VHN,69.01,,,,,,,37.4200,145.0000,percent of total billed charges,47.59% of $145.00 in Billed Charges for Rev 270 = $69.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT LEGGINGS FOR TRACT,270,RC,27000189,CDM,,,,,,both,,,145.0000,21.7500,SENTARA HEALTH,SENTARA HEALTH,37.42,,,,,,,37.4200,145.0000,percent of total billed charges,25.81% of $145.00 in Billed Charges for Rev 270 = $37.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT LEGGINGS FOR TRACT,270,RC,27000189,CDM,,,,,,both,,,145.0000,21.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",145.00,,,,,,,37.4200,145.0000,percent of total billed charges,100% of $145.00 in Billed Charges for Rev 270 = $145.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT LEGGINGS FOR TRACT,270,RC,27000189,CDM,,,,,,both,,,145.0000,21.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,72.50,,,,,,,37.4200,145.0000,percent of total billed charges,Rev 270 $145.00 in Billed Charges at 50% = $72.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT LEGGINGS FOR TRACT,270,RC,27000189,CDM,,,,,,both,,,145.0000,21.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,46.84,,,,,,,37.4200,145.0000,other,32.3% of $145.00 in Billed Charges for Rev 270 = $46.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ORTH SOFT LEGGINGS FOR TRACT,270,RC,27000189,CDM,,,,,,both,,,145.0000,21.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,44.52,,,,,,,37.4200,145.0000,other,30.7% of $145.00 in Billed Charges for Rev 270 = $44.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ORTH SOFT LEGGINGS FOR TRACT,270,RC,27000189,CDM,,,,,,both,,,145.0000,21.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,46.84,,,,,,,37.4200,145.0000,percent of total billed charges,32.3% of $145.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT LEGGINGS FOR TRACT,270,RC,27000189,CDM,,,,,,both,,,145.0000,21.7500,WELLCARE,WELLCARE MEDICAID,145.00,,,,,,,37.4200,145.0000,percent of total billed charges,100% of $145.00 in Billed Charges for Rev 270 = $145.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OSTOMY SPRAY HOLLISTER #7730,270,RC,27000199,CDM,,,,,,both,,,108.0000,16.2000,AETNA,AETNA,46.12,,,,,,,27.8700,108.0000,percent of total billed charges,42.7% of $108.00 in Billed Charges for Rev 270 = $46.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OSTOMY SPRAY HOLLISTER #7730,270,RC,27000199,CDM,,,,,,both,,,108.0000,16.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,75.60,,,,,,,27.8700,108.0000,percent of total billed charges,Rev 270 $108.00 in Billed Charges at 70% = $75.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OSTOMY SPRAY HOLLISTER #7730,270,RC,27000199,CDM,,,,,,both,,,108.0000,16.2000,CIGNA HEALTHCARE,CIGNA HMO,45.04,,,,,,,27.8700,108.0000,percent of total billed charges,41.7% of $108.00 in Billed Charges for Rev 270 = $45.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OSTOMY SPRAY HOLLISTER #7730,270,RC,27000199,CDM,,,,,,both,,,108.0000,16.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,50.11,,,,,,,27.8700,108.0000,percent of total billed charges,46.4% of $108.00 in Billed Charges for Rev 270 = $50.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OSTOMY SPRAY HOLLISTER #7730,270,RC,27000199,CDM,,,,,,both,,,108.0000,16.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,45.04,,,,,,,27.8700,108.0000,percent of total billed charges,41.7% of $108.00 in Billed Charges for Rev 270 = $45.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OSTOMY SPRAY HOLLISTER #7730,270,RC,27000199,CDM,,,,,,both,,,108.0000,16.2000,CIGNA HEALTHCARE,CIGNA PPO,45.04,,,,,,,27.8700,108.0000,percent of total billed charges,41.7% of $108.00 in Billed Charges for Rev 270 = $45.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OSTOMY SPRAY HOLLISTER #7730,270,RC,27000199,CDM,,,,,,both,,,108.0000,16.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,97.20,,,,,,,27.8700,108.0000,percent of total billed charges,90% of $108.00 in Billed Charges for Rev 270 = $97.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OSTOMY SPRAY HOLLISTER #7730,270,RC,27000199,CDM,,,,,,both,,,108.0000,16.2000,MEDCOST,MEDCOST VHN,51.40,,,,,,,27.8700,108.0000,percent of total billed charges,47.59% of $108.00 in Billed Charges for Rev 270 = $51.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OSTOMY SPRAY HOLLISTER #7730,270,RC,27000199,CDM,,,,,,both,,,108.0000,16.2000,SENTARA HEALTH,SENTARA HEALTH,27.87,,,,,,,27.8700,108.0000,percent of total billed charges,25.81% of $108.00 in Billed Charges for Rev 270 = $27.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OSTOMY SPRAY HOLLISTER #7730,270,RC,27000199,CDM,,,,,,both,,,108.0000,16.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",108.00,,,,,,,27.8700,108.0000,percent of total billed charges,100% of $108.00 in Billed Charges for Rev 270 = $108.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OSTOMY SPRAY HOLLISTER #7730,270,RC,27000199,CDM,,,,,,both,,,108.0000,16.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,54.00,,,,,,,27.8700,108.0000,percent of total billed charges,Rev 270 $108.00 in Billed Charges at 50% = $54.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OSTOMY SPRAY HOLLISTER #7730,270,RC,27000199,CDM,,,,,,both,,,108.0000,16.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,34.88,,,,,,,27.8700,108.0000,other,32.3% of $108.00 in Billed Charges for Rev 270 = $34.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OSTOMY SPRAY HOLLISTER #7730,270,RC,27000199,CDM,,,,,,both,,,108.0000,16.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,33.16,,,,,,,27.8700,108.0000,other,30.7% of $108.00 in Billed Charges for Rev 270 = $33.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OSTOMY SPRAY HOLLISTER #7730,270,RC,27000199,CDM,,,,,,both,,,108.0000,16.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,34.88,,,,,,,27.8700,108.0000,percent of total billed charges,32.3% of $108.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OSTOMY SPRAY HOLLISTER #7730,270,RC,27000199,CDM,,,,,,both,,,108.0000,16.2000,WELLCARE,WELLCARE MEDICAID,108.00,,,,,,,27.8700,108.0000,percent of total billed charges,100% of $108.00 in Billed Charges for Rev 270 = $108.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A SHOELACES TYLASTIC,270,RC,27000232,CDM,,,,,,both,,,7.0000,1.0500,AETNA,AETNA,2.99,,,,,,,1.8100,7.0000,percent of total billed charges,42.7% of $7.00 in Billed Charges for Rev 270 = $2.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A SHOELACES TYLASTIC,270,RC,27000232,CDM,,,,,,both,,,7.0000,1.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4.90,,,,,,,1.8100,7.0000,percent of total billed charges,Rev 270 $7.00 in Billed Charges at 70% = $4.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A SHOELACES TYLASTIC,270,RC,27000232,CDM,,,,,,both,,,7.0000,1.0500,CIGNA HEALTHCARE,CIGNA HMO,2.92,,,,,,,1.8100,7.0000,percent of total billed charges,41.7% of $7.00 in Billed Charges for Rev 270 = $2.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A SHOELACES TYLASTIC,270,RC,27000232,CDM,,,,,,both,,,7.0000,1.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3.25,,,,,,,1.8100,7.0000,percent of total billed charges,46.4% of $7.00 in Billed Charges for Rev 270 = $3.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A SHOELACES TYLASTIC,270,RC,27000232,CDM,,,,,,both,,,7.0000,1.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2.92,,,,,,,1.8100,7.0000,percent of total billed charges,41.7% of $7.00 in Billed Charges for Rev 270 = $2.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A SHOELACES TYLASTIC,270,RC,27000232,CDM,,,,,,both,,,7.0000,1.0500,CIGNA HEALTHCARE,CIGNA PPO,2.92,,,,,,,1.8100,7.0000,percent of total billed charges,41.7% of $7.00 in Billed Charges for Rev 270 = $2.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A SHOELACES TYLASTIC,270,RC,27000232,CDM,,,,,,both,,,7.0000,1.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6.30,,,,,,,1.8100,7.0000,percent of total billed charges,90% of $7.00 in Billed Charges for Rev 270 = $6.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A SHOELACES TYLASTIC,270,RC,27000232,CDM,,,,,,both,,,7.0000,1.0500,MEDCOST,MEDCOST VHN,3.33,,,,,,,1.8100,7.0000,percent of total billed charges,47.59% of $7.00 in Billed Charges for Rev 270 = $3.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A SHOELACES TYLASTIC,270,RC,27000232,CDM,,,,,,both,,,7.0000,1.0500,SENTARA HEALTH,SENTARA HEALTH,1.81,,,,,,,1.8100,7.0000,percent of total billed charges,25.81% of $7.00 in Billed Charges for Rev 270 = $1.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A SHOELACES TYLASTIC,270,RC,27000232,CDM,,,,,,both,,,7.0000,1.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7.00,,,,,,,1.8100,7.0000,percent of total billed charges,100% of $7.00 in Billed Charges for Rev 270 = $7.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A SHOELACES TYLASTIC,270,RC,27000232,CDM,,,,,,both,,,7.0000,1.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3.50,,,,,,,1.8100,7.0000,percent of total billed charges,Rev 270 $7.00 in Billed Charges at 50% = $3.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A SHOELACES TYLASTIC,270,RC,27000232,CDM,,,,,,both,,,7.0000,1.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2.26,,,,,,,1.8100,7.0000,other,32.3% of $7.00 in Billed Charges for Rev 270 = $2.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OT A SHOELACES TYLASTIC,270,RC,27000232,CDM,,,,,,both,,,7.0000,1.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2.15,,,,,,,1.8100,7.0000,other,30.7% of $7.00 in Billed Charges for Rev 270 = $2.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OT A SHOELACES TYLASTIC,270,RC,27000232,CDM,,,,,,both,,,7.0000,1.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,2.26,,,,,,,1.8100,7.0000,percent of total billed charges,32.3% of $7.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A SHOELACES TYLASTIC,270,RC,27000232,CDM,,,,,,both,,,7.0000,1.0500,WELLCARE,WELLCARE MEDICAID,7.00,,,,,,,1.8100,7.0000,percent of total billed charges,100% of $7.00 in Billed Charges for Rev 270 = $7.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT E HAND HELPER,270,RC,27000238,CDM,,,,,,both,,,18.0000,2.7000,AETNA,AETNA,7.69,,,,,,,4.6500,18.0000,percent of total billed charges,42.7% of $18.00 in Billed Charges for Rev 270 = $7.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT E HAND HELPER,270,RC,27000238,CDM,,,,,,both,,,18.0000,2.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,12.60,,,,,,,4.6500,18.0000,percent of total billed charges,Rev 270 $18.00 in Billed Charges at 70% = $12.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT E HAND HELPER,270,RC,27000238,CDM,,,,,,both,,,18.0000,2.7000,CIGNA HEALTHCARE,CIGNA HMO,7.51,,,,,,,4.6500,18.0000,percent of total billed charges,41.7% of $18.00 in Billed Charges for Rev 270 = $7.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT E HAND HELPER,270,RC,27000238,CDM,,,,,,both,,,18.0000,2.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8.35,,,,,,,4.6500,18.0000,percent of total billed charges,46.4% of $18.00 in Billed Charges for Rev 270 = $8.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT E HAND HELPER,270,RC,27000238,CDM,,,,,,both,,,18.0000,2.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7.51,,,,,,,4.6500,18.0000,percent of total billed charges,41.7% of $18.00 in Billed Charges for Rev 270 = $7.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT E HAND HELPER,270,RC,27000238,CDM,,,,,,both,,,18.0000,2.7000,CIGNA HEALTHCARE,CIGNA PPO,7.51,,,,,,,4.6500,18.0000,percent of total billed charges,41.7% of $18.00 in Billed Charges for Rev 270 = $7.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT E HAND HELPER,270,RC,27000238,CDM,,,,,,both,,,18.0000,2.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,16.20,,,,,,,4.6500,18.0000,percent of total billed charges,90% of $18.00 in Billed Charges for Rev 270 = $16.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT E HAND HELPER,270,RC,27000238,CDM,,,,,,both,,,18.0000,2.7000,MEDCOST,MEDCOST VHN,8.57,,,,,,,4.6500,18.0000,percent of total billed charges,47.59% of $18.00 in Billed Charges for Rev 270 = $8.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT E HAND HELPER,270,RC,27000238,CDM,,,,,,both,,,18.0000,2.7000,SENTARA HEALTH,SENTARA HEALTH,4.65,,,,,,,4.6500,18.0000,percent of total billed charges,25.81% of $18.00 in Billed Charges for Rev 270 = $4.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT E HAND HELPER,270,RC,27000238,CDM,,,,,,both,,,18.0000,2.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",18.00,,,,,,,4.6500,18.0000,percent of total billed charges,100% of $18.00 in Billed Charges for Rev 270 = $18.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT E HAND HELPER,270,RC,27000238,CDM,,,,,,both,,,18.0000,2.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9.00,,,,,,,4.6500,18.0000,percent of total billed charges,Rev 270 $18.00 in Billed Charges at 50% = $9.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT E HAND HELPER,270,RC,27000238,CDM,,,,,,both,,,18.0000,2.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5.81,,,,,,,4.6500,18.0000,other,32.3% of $18.00 in Billed Charges for Rev 270 = $5.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OT E HAND HELPER,270,RC,27000238,CDM,,,,,,both,,,18.0000,2.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,5.53,,,,,,,4.6500,18.0000,other,30.7% of $18.00 in Billed Charges for Rev 270 = $5.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OT E HAND HELPER,270,RC,27000238,CDM,,,,,,both,,,18.0000,2.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,5.81,,,,,,,4.6500,18.0000,percent of total billed charges,32.3% of $18.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT E HAND HELPER,270,RC,27000238,CDM,,,,,,both,,,18.0000,2.7000,WELLCARE,WELLCARE MEDICAID,18.00,,,,,,,4.6500,18.0000,percent of total billed charges,100% of $18.00 in Billed Charges for Rev 270 = $18.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S D-RING WRIST BRACE,270,RC,27000241,CDM,,,,,,both,,,48.0000,7.2000,AETNA,AETNA,20.50,,,,,,,12.3900,48.0000,percent of total billed charges,42.7% of $48.00 in Billed Charges for Rev 270 = $20.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S D-RING WRIST BRACE,270,RC,27000241,CDM,,,,,,both,,,48.0000,7.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,33.60,,,,,,,12.3900,48.0000,percent of total billed charges,Rev 270 $48.00 in Billed Charges at 70% = $33.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S D-RING WRIST BRACE,270,RC,27000241,CDM,,,,,,both,,,48.0000,7.2000,CIGNA HEALTHCARE,CIGNA HMO,20.02,,,,,,,12.3900,48.0000,percent of total billed charges,41.7% of $48.00 in Billed Charges for Rev 270 = $20.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S D-RING WRIST BRACE,270,RC,27000241,CDM,,,,,,both,,,48.0000,7.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,22.27,,,,,,,12.3900,48.0000,percent of total billed charges,46.4% of $48.00 in Billed Charges for Rev 270 = $22.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S D-RING WRIST BRACE,270,RC,27000241,CDM,,,,,,both,,,48.0000,7.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,20.02,,,,,,,12.3900,48.0000,percent of total billed charges,41.7% of $48.00 in Billed Charges for Rev 270 = $20.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S D-RING WRIST BRACE,270,RC,27000241,CDM,,,,,,both,,,48.0000,7.2000,CIGNA HEALTHCARE,CIGNA PPO,20.02,,,,,,,12.3900,48.0000,percent of total billed charges,41.7% of $48.00 in Billed Charges for Rev 270 = $20.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S D-RING WRIST BRACE,270,RC,27000241,CDM,,,,,,both,,,48.0000,7.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,43.20,,,,,,,12.3900,48.0000,percent of total billed charges,90% of $48.00 in Billed Charges for Rev 270 = $43.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S D-RING WRIST BRACE,270,RC,27000241,CDM,,,,,,both,,,48.0000,7.2000,MEDCOST,MEDCOST VHN,22.84,,,,,,,12.3900,48.0000,percent of total billed charges,47.59% of $48.00 in Billed Charges for Rev 270 = $22.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S D-RING WRIST BRACE,270,RC,27000241,CDM,,,,,,both,,,48.0000,7.2000,SENTARA HEALTH,SENTARA HEALTH,12.39,,,,,,,12.3900,48.0000,percent of total billed charges,25.81% of $48.00 in Billed Charges for Rev 270 = $12.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S D-RING WRIST BRACE,270,RC,27000241,CDM,,,,,,both,,,48.0000,7.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",48.00,,,,,,,12.3900,48.0000,percent of total billed charges,100% of $48.00 in Billed Charges for Rev 270 = $48.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S D-RING WRIST BRACE,270,RC,27000241,CDM,,,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,24.00,,,,,,,12.3900,48.0000,percent of total billed charges,Rev 270 $48.00 in Billed Charges at 50% = $24.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S D-RING WRIST BRACE,270,RC,27000241,CDM,,,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,15.50,,,,,,,12.3900,48.0000,other,32.3% of $48.00 in Billed Charges for Rev 270 = $15.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OT S D-RING WRIST BRACE,270,RC,27000241,CDM,,,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,14.74,,,,,,,12.3900,48.0000,other,30.7% of $48.00 in Billed Charges for Rev 270 = $14.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OT S D-RING WRIST BRACE,270,RC,27000241,CDM,,,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,15.50,,,,,,,12.3900,48.0000,percent of total billed charges,32.3% of $48.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S D-RING WRIST BRACE,270,RC,27000241,CDM,,,,,,both,,,48.0000,7.2000,WELLCARE,WELLCARE MEDICAID,48.00,,,,,,,12.3900,48.0000,percent of total billed charges,100% of $48.00 in Billed Charges for Rev 270 = $48.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE RECIPROCATING SAW 5100-37-011,272,RC,,,,,,,,both,,,789.4400,118.4200,AETNA,AETNA,337.09,,,,,,,203.7500,789.4400,percent of total billed charges,42.7% of $789.44 in Billed Charges for Rev 272 = $337.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE RECIPROCATING SAW 5100-37-011,272,RC,,,,,,,,both,,,789.4400,118.4200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,552.61,,,,,,,203.7500,789.4400,percent of total billed charges,Rev 272 $789.44 in Billed Charges at 70% = $552.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE RECIPROCATING SAW 5100-37-011,272,RC,,,,,,,,both,,,789.4400,118.4200,CIGNA HEALTHCARE,CIGNA HMO,329.20,,,,,,,203.7500,789.4400,percent of total billed charges,41.7% of $789.44 in Billed Charges for Rev 272 = $329.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE RECIPROCATING SAW 5100-37-011,272,RC,,,,,,,,both,,,789.4400,118.4200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,366.30,,,,,,,203.7500,789.4400,percent of total billed charges,46.4% of $789.44 in Billed Charges for Rev 272 = $366.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE RECIPROCATING SAW 5100-37-011,272,RC,,,,,,,,both,,,789.4400,118.4200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,329.20,,,,,,,203.7500,789.4400,percent of total billed charges,41.7% of $789.44 in Billed Charges for Rev 272 = $329.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE RECIPROCATING SAW 5100-37-011,272,RC,,,,,,,,both,,,789.4400,118.4200,CIGNA HEALTHCARE,CIGNA PPO,329.20,,,,,,,203.7500,789.4400,percent of total billed charges,41.7% of $789.44 in Billed Charges for Rev 272 = $329.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE RECIPROCATING SAW 5100-37-011,272,RC,,,,,,,,both,,,789.4400,118.4200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,710.50,,,,,,,203.7500,789.4400,percent of total billed charges,90% of $789.44 in Billed Charges for Rev 272 = $710.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE RECIPROCATING SAW 5100-37-011,272,RC,,,,,,,,both,,,789.4400,118.4200,MEDCOST,MEDCOST VHN,375.69,,,,,,,203.7500,789.4400,percent of total billed charges,47.59% of $789.44 in Billed Charges for Rev 272 = $375.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE RECIPROCATING SAW 5100-37-011,272,RC,,,,,,,,both,,,789.4400,118.4200,SENTARA HEALTH,SENTARA HEALTH,203.75,,,,,,,203.7500,789.4400,percent of total billed charges,25.81% of $789.44 in Billed Charges for Rev 272 = $203.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE RECIPROCATING SAW 5100-37-011,272,RC,,,,,,,,both,,,789.4400,118.4200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",789.44,,,,,,,203.7500,789.4400,percent of total billed charges,100% of $789.44 in Billed Charges for Rev 272 = $789.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE RECIPROCATING SAW 5100-37-011,272,RC,,,,,,,,both,,,789.4400,118.4200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,394.72,,,,,,,203.7500,789.4400,percent of total billed charges,Rev 272 $789.44 in Billed Charges at 50% = $394.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE RECIPROCATING SAW 5100-37-011,272,RC,,,,,,,,both,,,789.4400,118.4200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,254.99,,,,,,,203.7500,789.4400,other,32.3% of $789.44 in Billed Charges for Rev 272 = $254.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
I/A BLADE RECIPROCATING SAW 5100-37-011,272,RC,,,,,,,,both,,,789.4400,118.4200,UNITED HEALTHCARE,UHC HERITAGE SELECT,242.36,,,,,,,203.7500,789.4400,other,30.7% of $789.44 in Billed Charges for Rev 272 = $242.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
I/A BLADE RECIPROCATING SAW 5100-37-011,272,RC,,,,,,,,both,,,789.4400,118.4200,UNITED HEALTHCARE,UNITED HEALTHCARE,254.99,,,,,,,203.7500,789.4400,percent of total billed charges,32.3% of $789.44 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE RECIPROCATING SAW 5100-37-011,272,RC,,,,,,,,both,,,789.4400,118.4200,WELLCARE,WELLCARE MEDICAID,789.44,,,,,,,203.7500,789.4400,percent of total billed charges,100% of $789.44 in Billed Charges for Rev 272 = $789.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
I/A BLADE RIOFDAN RASP SMALL 5100-27-127,272,RC,,,,,,,,both,,,1994.2400,299.1400,AETNA,AETNA,851.54,,,,,,,514.7100,1994.2400,percent of total billed charges,"42.7% of $1,994.24 in Billed Charges for Rev 272 = $851.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE RIOFDAN RASP SMALL 5100-27-127,272,RC,,,,,,,,both,,,1994.2400,299.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1395.97,,,,,,,514.7100,1994.2400,percent of total billed charges,"Rev 272 $1,994.24 in Billed Charges at 70% = $1,395.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE RIOFDAN RASP SMALL 5100-27-127,272,RC,,,,,,,,both,,,1994.2400,299.1400,CIGNA HEALTHCARE,CIGNA HMO,831.60,,,,,,,514.7100,1994.2400,percent of total billed charges,"41.7% of $1,994.24 in Billed Charges for Rev 272 = $831.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE RIOFDAN RASP SMALL 5100-27-127,272,RC,,,,,,,,both,,,1994.2400,299.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,925.33,,,,,,,514.7100,1994.2400,percent of total billed charges,"46.4% of $1,994.24 in Billed Charges for Rev 272 = $925.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE RIOFDAN RASP SMALL 5100-27-127,272,RC,,,,,,,,both,,,1994.2400,299.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,831.60,,,,,,,514.7100,1994.2400,percent of total billed charges,"41.7% of $1,994.24 in Billed Charges for Rev 272 = $831.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE RIOFDAN RASP SMALL 5100-27-127,272,RC,,,,,,,,both,,,1994.2400,299.1400,CIGNA HEALTHCARE,CIGNA PPO,831.60,,,,,,,514.7100,1994.2400,percent of total billed charges,"41.7% of $1,994.24 in Billed Charges for Rev 272 = $831.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE RIOFDAN RASP SMALL 5100-27-127,272,RC,,,,,,,,both,,,1994.2400,299.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1794.82,,,,,,,514.7100,1994.2400,percent of total billed charges,"90% of $1,994.24 in Billed Charges for Rev 272 = $1,794.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE RIOFDAN RASP SMALL 5100-27-127,272,RC,,,,,,,,both,,,1994.2400,299.1400,MEDCOST,MEDCOST VHN,949.06,,,,,,,514.7100,1994.2400,percent of total billed charges,"47.59% of $1,994.24 in Billed Charges for Rev 272 = $949.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE RIOFDAN RASP SMALL 5100-27-127,272,RC,,,,,,,,both,,,1994.2400,299.1400,SENTARA HEALTH,SENTARA HEALTH,514.71,,,,,,,514.7100,1994.2400,percent of total billed charges,"25.81% of $1,994.24 in Billed Charges for Rev 272 = $514.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE RIOFDAN RASP SMALL 5100-27-127,272,RC,,,,,,,,both,,,1994.2400,299.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1994.24,,,,,,,514.7100,1994.2400,percent of total billed charges,"100% of $1,994.24 in Billed Charges for Rev 272 = $1,994.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE RIOFDAN RASP SMALL 5100-27-127,272,RC,,,,,,,,both,,,1994.2400,299.1400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,997.12,,,,,,,514.7100,1994.2400,percent of total billed charges,"Rev 272 $1,994.24 in Billed Charges at 50% = $997.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE RIOFDAN RASP SMALL 5100-27-127,272,RC,,,,,,,,both,,,1994.2400,299.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,644.14,,,,,,,514.7100,1994.2400,other,"32.3% of $1,994.24 in Billed Charges for Rev 272 = $644.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A BLADE RIOFDAN RASP SMALL 5100-27-127,272,RC,,,,,,,,both,,,1994.2400,299.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,612.23,,,,,,,514.7100,1994.2400,other,"30.7% of $1,994.24 in Billed Charges for Rev 272 = $612.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A BLADE RIOFDAN RASP SMALL 5100-27-127,272,RC,,,,,,,,both,,,1994.2400,299.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,644.14,,,,,,,514.7100,1994.2400,percent of total billed charges,"32.3% of $1,994.24 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE RIOFDAN RASP SMALL 5100-27-127,272,RC,,,,,,,,both,,,1994.2400,299.1400,WELLCARE,WELLCARE MEDICAID,1994.24,,,,,,,514.7100,1994.2400,percent of total billed charges,"100% of $1,994.24 in Billed Charges for Rev 272 = $1,994.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW RECIP 8.0 X 0.98 X 43MM,272,RC,27200002,CDM,,,,,,both,,,23302.0800,3495.3100,AETNA,AETNA,9949.99,,,,,,,6014.2700,23302.0800,percent of total billed charges,"42.7% of $23,302.08 in Billed Charges for Rev 272 = $9,949.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW RECIP 8.0 X 0.98 X 43MM,272,RC,27200002,CDM,,,,,,both,,,23302.0800,3495.3100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,16311.46,,,,,,,6014.2700,23302.0800,percent of total billed charges,"Rev 272 $23,302.08 in Billed Charges at 70% = $16,311.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW RECIP 8.0 X 0.98 X 43MM,272,RC,27200002,CDM,,,,,,both,,,23302.0800,3495.3100,CIGNA HEALTHCARE,CIGNA HMO,9716.97,,,,,,,6014.2700,23302.0800,percent of total billed charges,"41.7% of $23,302.08 in Billed Charges for Rev 272 = $9,716.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW RECIP 8.0 X 0.98 X 43MM,272,RC,27200002,CDM,,,,,,both,,,23302.0800,3495.3100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10812.17,,,,,,,6014.2700,23302.0800,percent of total billed charges,"46.4% of $23,302.08 in Billed Charges for Rev 272 = $10,812.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW RECIP 8.0 X 0.98 X 43MM,272,RC,27200002,CDM,,,,,,both,,,23302.0800,3495.3100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9716.97,,,,,,,6014.2700,23302.0800,percent of total billed charges,"41.7% of $23,302.08 in Billed Charges for Rev 272 = $9,716.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW RECIP 8.0 X 0.98 X 43MM,272,RC,27200002,CDM,,,,,,both,,,23302.0800,3495.3100,CIGNA HEALTHCARE,CIGNA PPO,9716.97,,,,,,,6014.2700,23302.0800,percent of total billed charges,"41.7% of $23,302.08 in Billed Charges for Rev 272 = $9,716.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW RECIP 8.0 X 0.98 X 43MM,272,RC,27200002,CDM,,,,,,both,,,23302.0800,3495.3100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,20971.87,,,,,,,6014.2700,23302.0800,percent of total billed charges,"90% of $23,302.08 in Billed Charges for Rev 272 = $20,971.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW RECIP 8.0 X 0.98 X 43MM,272,RC,27200002,CDM,,,,,,both,,,23302.0800,3495.3100,MEDCOST,MEDCOST VHN,11089.46,,,,,,,6014.2700,23302.0800,percent of total billed charges,"47.59% of $23,302.08 in Billed Charges for Rev 272 = $11,089.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW RECIP 8.0 X 0.98 X 43MM,272,RC,27200002,CDM,,,,,,both,,,23302.0800,3495.3100,SENTARA HEALTH,SENTARA HEALTH,6014.27,,,,,,,6014.2700,23302.0800,percent of total billed charges,"25.81% of $23,302.08 in Billed Charges for Rev 272 = $6,014.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW RECIP 8.0 X 0.98 X 43MM,272,RC,27200002,CDM,,,,,,both,,,23302.0800,3495.3100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",23302.08,,,,,,,6014.2700,23302.0800,percent of total billed charges,"100% of $23,302.08 in Billed Charges for Rev 272 = $23,302.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW RECIP 8.0 X 0.98 X 43MM,272,RC,27200002,CDM,,,,,,both,,,23302.0800,3495.3100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11651.04,,,,,,,6014.2700,23302.0800,percent of total billed charges,"Rev 272 $23,302.08 in Billed Charges at 50% = $11,651.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW RECIP 8.0 X 0.98 X 43MM,272,RC,27200002,CDM,,,,,,both,,,23302.0800,3495.3100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7526.57,,,,,,,6014.2700,23302.0800,other,"32.3% of $23,302.08 in Billed Charges for Rev 272 = $7,526.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A BLADE SAW RECIP 8.0 X 0.98 X 43MM,272,RC,27200002,CDM,,,,,,both,,,23302.0800,3495.3100,UNITED HEALTHCARE,UHC HERITAGE SELECT,7153.74,,,,,,,6014.2700,23302.0800,other,"30.7% of $23,302.08 in Billed Charges for Rev 272 = $7,153.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
I/A BLADE SAW RECIP 8.0 X 0.98 X 43MM,272,RC,27200002,CDM,,,,,,both,,,23302.0800,3495.3100,UNITED HEALTHCARE,UNITED HEALTHCARE,7526.57,,,,,,,6014.2700,23302.0800,percent of total billed charges,"32.3% of $23,302.08 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
I/A BLADE SAW RECIP 8.0 X 0.98 X 43MM,272,RC,27200002,CDM,,,,,,both,,,23302.0800,3495.3100,WELLCARE,WELLCARE MEDICAID,23302.08,,,,,,,6014.2700,23302.0800,percent of total billed charges,"100% of $23,302.08 in Billed Charges for Rev 272 = $23,302.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OVR 20WK FETAL DEMISE LAB DEL REC,720,RC,72000004,CDM,,,,,,both,,,1496.0000,224.4000,AETNA,AETNA,638.79,,,,,,,12.0000,1496.0000,percent of total billed charges,"42.7% of $1,496.00 in Billed Charges for Rev 720 = $638.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OVR 20WK FETAL DEMISE LAB DEL REC,720,RC,72000004,CDM,,,,,,both,,,1496.0000,224.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1047.20,,,,,,,12.0000,1496.0000,percent of total billed charges,"Rev 720 $1,496.00 in Billed Charges at 70% = $1,047.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OVR 20WK FETAL DEMISE LAB DEL REC,720,RC,72000004,CDM,,,,,,both,,,1496.0000,224.4000,BLUE CROSS,BLUE CROSS E NETWORK,46.00,,,,,,,12.0000,1496.0000,other,Rev 720 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OVR 20WK FETAL DEMISE LAB DEL REC,720,RC,72000004,CDM,,,,,,both,,,1496.0000,224.4000,BLUE CROSS,BLUE CROSS P NETWORK,46.00,,,,,,,12.0000,1496.0000,other,Rev 720 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OVR 20WK FETAL DEMISE LAB DEL REC,720,RC,72000004,CDM,,,,,,both,,,1496.0000,224.4000,BLUE CROSS,BLUE CROSS S NETWORK,46.00,,,,,,,12.0000,1496.0000,other,Rev 720 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OVR 20WK FETAL DEMISE LAB DEL REC,720,RC,72000004,CDM,,,,,,both,,,1496.0000,224.4000,BLUE CROSS,TENNCARE BLUE CARE,12.00,,,,,,,12.0000,1496.0000,other,Rev 720 Qty 1 * $12.00 = $12.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OVR 20WK FETAL DEMISE LAB DEL REC,720,RC,72000004,CDM,,,,,,both,,,1496.0000,224.4000,BLUE CROSS,TENNCARE BLUE SELECT,12.00,,,,,,,12.0000,1496.0000,other,Rev 720 Qty 1 * $12.00 = $12.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OVR 20WK FETAL DEMISE LAB DEL REC,720,RC,72000004,CDM,,,,,,both,,,1496.0000,224.4000,CIGNA HEALTHCARE,CIGNA HMO,623.83,,,,,,,12.0000,1496.0000,percent of total billed charges,"41.7% of $1,496.00 in Billed Charges for Rev 720 = $623.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OVR 20WK FETAL DEMISE LAB DEL REC,720,RC,72000004,CDM,,,,,,both,,,1496.0000,224.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,694.14,,,,,,,12.0000,1496.0000,percent of total billed charges,"46.4% of $1,496.00 in Billed Charges for Rev 720 = $694.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OVR 20WK FETAL DEMISE LAB DEL REC,720,RC,72000004,CDM,,,,,,both,,,1496.0000,224.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,623.83,,,,,,,12.0000,1496.0000,percent of total billed charges,"41.7% of $1,496.00 in Billed Charges for Rev 720 = $623.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OVR 20WK FETAL DEMISE LAB DEL REC,720,RC,72000004,CDM,,,,,,both,,,1496.0000,224.4000,CIGNA HEALTHCARE,CIGNA PPO,623.83,,,,,,,12.0000,1496.0000,percent of total billed charges,"41.7% of $1,496.00 in Billed Charges for Rev 720 = $623.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OVR 20WK FETAL DEMISE LAB DEL REC,720,RC,72000004,CDM,,,,,,both,,,1496.0000,224.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1346.40,,,,,,,12.0000,1496.0000,percent of total billed charges,"90% of $1,496.00 in Billed Charges for Rev 720 = $1,346.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OVR 20WK FETAL DEMISE LAB DEL REC,720,RC,72000004,CDM,,,,,,both,,,1496.0000,224.4000,MEDCOST,MEDCOST VHN,711.95,,,,,,,12.0000,1496.0000,percent of total billed charges,"47.59% of $1,496.00 in Billed Charges for Rev 720 = $711.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OVR 20WK FETAL DEMISE LAB DEL REC,720,RC,72000004,CDM,,,,,,both,,,1496.0000,224.4000,SENTARA HEALTH,SENTARA HEALTH,386.12,,,,,,,12.0000,1496.0000,percent of total billed charges,"25.81% of $1,496.00 in Billed Charges for Rev 720 = $386.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OVR 20WK FETAL DEMISE LAB DEL REC,720,RC,72000004,CDM,,,,,,both,,,1496.0000,224.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1496.00,,,,,,,12.0000,1496.0000,percent of total billed charges,"100% of $1,496.00 in Billed Charges for Rev 720 = $1,496.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OVR 20WK FETAL DEMISE LAB DEL REC,720,RC,72000004,CDM,,,,,,both,,,1496.0000,224.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,748.00,,,,,,,12.0000,1496.0000,percent of total billed charges,"Rev 720 $1,496.00 in Billed Charges at 50% = $748.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OVR 20WK FETAL DEMISE LAB DEL REC,720,RC,72000004,CDM,,,,,,both,,,1496.0000,224.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,259.00,,,,,,,12.0000,1496.0000,other,Rev 720 1 Visit at $259.00 per Visit = $259.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OVR 20WK FETAL DEMISE LAB DEL REC,720,RC,72000004,CDM,,,,,,both,,,1496.0000,224.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,247.00,,,,,,,12.0000,1496.0000,other,Rev 720 1 Visit at $247.00 per Visit = $247.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OVR 20WK FETAL DEMISE LAB DEL REC,720,RC,72000004,CDM,,,,,,both,,,1496.0000,224.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,408.00,,,,,,,12.0000,1496.0000,other,Rev 720 1 Visit at $408.00 per Visit = $408.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OVR 20WK FETAL DEMISE LAB DEL REC,720,RC,72000004,CDM,,,,,,both,,,1496.0000,224.4000,WELLCARE,WELLCARE MEDICAID,1496.00,,,,,,,12.0000,1496.0000,percent of total billed charges,"100% of $1,496.00 in Billed Charges for Rev 720 = $1,496.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OXYGEN/AEROSOL INITIAL DAY,270,RC,27000006,CDM,,,,,,both,,,449.0000,67.3500,AETNA,AETNA,191.72,,,,,,,115.8900,449.0000,percent of total billed charges,42.7% of $449.00 in Billed Charges for Rev 270 = $191.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OXYGEN/AEROSOL INITIAL DAY,270,RC,27000006,CDM,,,,,,both,,,449.0000,67.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,314.30,,,,,,,115.8900,449.0000,percent of total billed charges,Rev 270 $449.00 in Billed Charges at 70% = $314.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OXYGEN/AEROSOL INITIAL DAY,270,RC,27000006,CDM,,,,,,both,,,449.0000,67.3500,CIGNA HEALTHCARE,CIGNA HMO,187.23,,,,,,,115.8900,449.0000,percent of total billed charges,41.7% of $449.00 in Billed Charges for Rev 270 = $187.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OXYGEN/AEROSOL INITIAL DAY,270,RC,27000006,CDM,,,,,,both,,,449.0000,67.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,208.34,,,,,,,115.8900,449.0000,percent of total billed charges,46.4% of $449.00 in Billed Charges for Rev 270 = $208.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OXYGEN/AEROSOL INITIAL DAY,270,RC,27000006,CDM,,,,,,both,,,449.0000,67.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,187.23,,,,,,,115.8900,449.0000,percent of total billed charges,41.7% of $449.00 in Billed Charges for Rev 270 = $187.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OXYGEN/AEROSOL INITIAL DAY,270,RC,27000006,CDM,,,,,,both,,,449.0000,67.3500,CIGNA HEALTHCARE,CIGNA PPO,187.23,,,,,,,115.8900,449.0000,percent of total billed charges,41.7% of $449.00 in Billed Charges for Rev 270 = $187.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OXYGEN/AEROSOL INITIAL DAY,270,RC,27000006,CDM,,,,,,both,,,449.0000,67.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,404.10,,,,,,,115.8900,449.0000,percent of total billed charges,90% of $449.00 in Billed Charges for Rev 270 = $404.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OXYGEN/AEROSOL INITIAL DAY,270,RC,27000006,CDM,,,,,,both,,,449.0000,67.3500,MEDCOST,MEDCOST VHN,213.68,,,,,,,115.8900,449.0000,percent of total billed charges,47.59% of $449.00 in Billed Charges for Rev 270 = $213.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OXYGEN/AEROSOL INITIAL DAY,270,RC,27000006,CDM,,,,,,both,,,449.0000,67.3500,SENTARA HEALTH,SENTARA HEALTH,115.89,,,,,,,115.8900,449.0000,percent of total billed charges,25.81% of $449.00 in Billed Charges for Rev 270 = $115.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OXYGEN/AEROSOL INITIAL DAY,270,RC,27000006,CDM,,,,,,both,,,449.0000,67.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",449.00,,,,,,,115.8900,449.0000,percent of total billed charges,100% of $449.00 in Billed Charges for Rev 270 = $449.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OXYGEN/AEROSOL INITIAL DAY,270,RC,27000006,CDM,,,,,,both,,,449.0000,67.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,224.50,,,,,,,115.8900,449.0000,percent of total billed charges,Rev 270 $449.00 in Billed Charges at 50% = $224.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OXYGEN/AEROSOL INITIAL DAY,270,RC,27000006,CDM,,,,,,both,,,449.0000,67.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,145.03,,,,,,,115.8900,449.0000,other,32.3% of $449.00 in Billed Charges for Rev 270 = $145.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYGEN/AEROSOL INITIAL DAY,270,RC,27000006,CDM,,,,,,both,,,449.0000,67.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,137.84,,,,,,,115.8900,449.0000,other,30.7% of $449.00 in Billed Charges for Rev 270 = $137.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OXYGEN/AEROSOL INITIAL DAY,270,RC,27000006,CDM,,,,,,both,,,449.0000,67.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,145.03,,,,,,,115.8900,449.0000,percent of total billed charges,32.3% of $449.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OXYGEN/AEROSOL INITIAL DAY,270,RC,27000006,CDM,,,,,,both,,,449.0000,67.3500,WELLCARE,WELLCARE MEDICAID,449.00,,,,,,,115.8900,449.0000,percent of total billed charges,100% of $449.00 in Billed Charges for Rev 270 = $449.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK ANGIO PIGGYBACK,272,RC,27201666,CDM,,,,,,both,,,300.0000,45.0000,AETNA,AETNA,128.10,,,,,,,77.4300,300.0000,percent of total billed charges,42.7% of $300.00 in Billed Charges for Rev 272 = $128.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK ANGIO PIGGYBACK,272,RC,27201666,CDM,,,,,,both,,,300.0000,45.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,210.00,,,,,,,77.4300,300.0000,percent of total billed charges,Rev 272 $300.00 in Billed Charges at 70% = $210.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK ANGIO PIGGYBACK,272,RC,27201666,CDM,,,,,,both,,,300.0000,45.0000,CIGNA HEALTHCARE,CIGNA HMO,125.10,,,,,,,77.4300,300.0000,percent of total billed charges,41.7% of $300.00 in Billed Charges for Rev 272 = $125.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK ANGIO PIGGYBACK,272,RC,27201666,CDM,,,,,,both,,,300.0000,45.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,139.20,,,,,,,77.4300,300.0000,percent of total billed charges,46.4% of $300.00 in Billed Charges for Rev 272 = $139.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK ANGIO PIGGYBACK,272,RC,27201666,CDM,,,,,,both,,,300.0000,45.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,125.10,,,,,,,77.4300,300.0000,percent of total billed charges,41.7% of $300.00 in Billed Charges for Rev 272 = $125.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK ANGIO PIGGYBACK,272,RC,27201666,CDM,,,,,,both,,,300.0000,45.0000,CIGNA HEALTHCARE,CIGNA PPO,125.10,,,,,,,77.4300,300.0000,percent of total billed charges,41.7% of $300.00 in Billed Charges for Rev 272 = $125.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK ANGIO PIGGYBACK,272,RC,27201666,CDM,,,,,,both,,,300.0000,45.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,270.00,,,,,,,77.4300,300.0000,percent of total billed charges,90% of $300.00 in Billed Charges for Rev 272 = $270.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK ANGIO PIGGYBACK,272,RC,27201666,CDM,,,,,,both,,,300.0000,45.0000,MEDCOST,MEDCOST VHN,142.77,,,,,,,77.4300,300.0000,percent of total billed charges,47.59% of $300.00 in Billed Charges for Rev 272 = $142.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK ANGIO PIGGYBACK,272,RC,27201666,CDM,,,,,,both,,,300.0000,45.0000,SENTARA HEALTH,SENTARA HEALTH,77.43,,,,,,,77.4300,300.0000,percent of total billed charges,25.81% of $300.00 in Billed Charges for Rev 272 = $77.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK ANGIO PIGGYBACK,272,RC,27201666,CDM,,,,,,both,,,300.0000,45.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",300.00,,,,,,,77.4300,300.0000,percent of total billed charges,100% of $300.00 in Billed Charges for Rev 272 = $300.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK ANGIO PIGGYBACK,272,RC,27201666,CDM,,,,,,both,,,300.0000,45.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,150.00,,,,,,,77.4300,300.0000,percent of total billed charges,Rev 272 $300.00 in Billed Charges at 50% = $150.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK ANGIO PIGGYBACK,272,RC,27201666,CDM,,,,,,both,,,300.0000,45.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,96.90,,,,,,,77.4300,300.0000,other,32.3% of $300.00 in Billed Charges for Rev 272 = $96.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PACK ANGIO PIGGYBACK,272,RC,27201666,CDM,,,,,,both,,,300.0000,45.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,92.10,,,,,,,77.4300,300.0000,other,30.7% of $300.00 in Billed Charges for Rev 272 = $92.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PACK ANGIO PIGGYBACK,272,RC,27201666,CDM,,,,,,both,,,300.0000,45.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,96.90,,,,,,,77.4300,300.0000,percent of total billed charges,32.3% of $300.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK ANGIO PIGGYBACK,272,RC,27201666,CDM,,,,,,both,,,300.0000,45.0000,WELLCARE,WELLCARE MEDICAID,300.00,,,,,,,77.4300,300.0000,percent of total billed charges,100% of $300.00 in Billed Charges for Rev 272 = $300.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK HIP SOPHPHVL,272,RC,27200977,CDM,,,,,,both,,,433.0000,64.9500,AETNA,AETNA,184.89,,,,,,,111.7600,433.0000,percent of total billed charges,42.7% of $433.00 in Billed Charges for Rev 272 = $184.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK HIP SOPHPHVL,272,RC,27200977,CDM,,,,,,both,,,433.0000,64.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,303.10,,,,,,,111.7600,433.0000,percent of total billed charges,Rev 272 $433.00 in Billed Charges at 70% = $303.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK HIP SOPHPHVL,272,RC,27200977,CDM,,,,,,both,,,433.0000,64.9500,CIGNA HEALTHCARE,CIGNA HMO,180.56,,,,,,,111.7600,433.0000,percent of total billed charges,41.7% of $433.00 in Billed Charges for Rev 272 = $180.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK HIP SOPHPHVL,272,RC,27200977,CDM,,,,,,both,,,433.0000,64.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,200.91,,,,,,,111.7600,433.0000,percent of total billed charges,46.4% of $433.00 in Billed Charges for Rev 272 = $200.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK HIP SOPHPHVL,272,RC,27200977,CDM,,,,,,both,,,433.0000,64.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,180.56,,,,,,,111.7600,433.0000,percent of total billed charges,41.7% of $433.00 in Billed Charges for Rev 272 = $180.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK HIP SOPHPHVL,272,RC,27200977,CDM,,,,,,both,,,433.0000,64.9500,CIGNA HEALTHCARE,CIGNA PPO,180.56,,,,,,,111.7600,433.0000,percent of total billed charges,41.7% of $433.00 in Billed Charges for Rev 272 = $180.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK HIP SOPHPHVL,272,RC,27200977,CDM,,,,,,both,,,433.0000,64.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,389.70,,,,,,,111.7600,433.0000,percent of total billed charges,90% of $433.00 in Billed Charges for Rev 272 = $389.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK HIP SOPHPHVL,272,RC,27200977,CDM,,,,,,both,,,433.0000,64.9500,MEDCOST,MEDCOST VHN,206.06,,,,,,,111.7600,433.0000,percent of total billed charges,47.59% of $433.00 in Billed Charges for Rev 272 = $206.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK HIP SOPHPHVL,272,RC,27200977,CDM,,,,,,both,,,433.0000,64.9500,SENTARA HEALTH,SENTARA HEALTH,111.76,,,,,,,111.7600,433.0000,percent of total billed charges,25.81% of $433.00 in Billed Charges for Rev 272 = $111.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK HIP SOPHPHVL,272,RC,27200977,CDM,,,,,,both,,,433.0000,64.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",433.00,,,,,,,111.7600,433.0000,percent of total billed charges,100% of $433.00 in Billed Charges for Rev 272 = $433.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK HIP SOPHPHVL,272,RC,27200977,CDM,,,,,,both,,,433.0000,64.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,216.50,,,,,,,111.7600,433.0000,percent of total billed charges,Rev 272 $433.00 in Billed Charges at 50% = $216.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK HIP SOPHPHVL,272,RC,27200977,CDM,,,,,,both,,,433.0000,64.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,139.86,,,,,,,111.7600,433.0000,other,32.3% of $433.00 in Billed Charges for Rev 272 = $139.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PACK HIP SOPHPHVL,272,RC,27200977,CDM,,,,,,both,,,433.0000,64.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,132.93,,,,,,,111.7600,433.0000,other,30.7% of $433.00 in Billed Charges for Rev 272 = $132.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PACK HIP SOPHPHVL,272,RC,27200977,CDM,,,,,,both,,,433.0000,64.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,139.86,,,,,,,111.7600,433.0000,percent of total billed charges,32.3% of $433.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK HIP SOPHPHVL,272,RC,27200977,CDM,,,,,,both,,,433.0000,64.9500,WELLCARE,WELLCARE MEDICAID,433.00,,,,,,,111.7600,433.0000,percent of total billed charges,100% of $433.00 in Billed Charges for Rev 272 = $433.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK PBDS PACEMAKER,272,RC,27201665,CDM,,,,,,both,,,487.0000,73.0500,AETNA,AETNA,207.95,,,,,,,125.6900,487.0000,percent of total billed charges,42.7% of $487.00 in Billed Charges for Rev 272 = $207.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK PBDS PACEMAKER,272,RC,27201665,CDM,,,,,,both,,,487.0000,73.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,340.90,,,,,,,125.6900,487.0000,percent of total billed charges,Rev 272 $487.00 in Billed Charges at 70% = $340.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK PBDS PACEMAKER,272,RC,27201665,CDM,,,,,,both,,,487.0000,73.0500,CIGNA HEALTHCARE,CIGNA HMO,203.08,,,,,,,125.6900,487.0000,percent of total billed charges,41.7% of $487.00 in Billed Charges for Rev 272 = $203.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK PBDS PACEMAKER,272,RC,27201665,CDM,,,,,,both,,,487.0000,73.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,225.97,,,,,,,125.6900,487.0000,percent of total billed charges,46.4% of $487.00 in Billed Charges for Rev 272 = $225.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK PBDS PACEMAKER,272,RC,27201665,CDM,,,,,,both,,,487.0000,73.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,203.08,,,,,,,125.6900,487.0000,percent of total billed charges,41.7% of $487.00 in Billed Charges for Rev 272 = $203.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK PBDS PACEMAKER,272,RC,27201665,CDM,,,,,,both,,,487.0000,73.0500,CIGNA HEALTHCARE,CIGNA PPO,203.08,,,,,,,125.6900,487.0000,percent of total billed charges,41.7% of $487.00 in Billed Charges for Rev 272 = $203.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK PBDS PACEMAKER,272,RC,27201665,CDM,,,,,,both,,,487.0000,73.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,438.30,,,,,,,125.6900,487.0000,percent of total billed charges,90% of $487.00 in Billed Charges for Rev 272 = $438.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK PBDS PACEMAKER,272,RC,27201665,CDM,,,,,,both,,,487.0000,73.0500,MEDCOST,MEDCOST VHN,231.76,,,,,,,125.6900,487.0000,percent of total billed charges,47.59% of $487.00 in Billed Charges for Rev 272 = $231.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK PBDS PACEMAKER,272,RC,27201665,CDM,,,,,,both,,,487.0000,73.0500,SENTARA HEALTH,SENTARA HEALTH,125.69,,,,,,,125.6900,487.0000,percent of total billed charges,25.81% of $487.00 in Billed Charges for Rev 272 = $125.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK PBDS PACEMAKER,272,RC,27201665,CDM,,,,,,both,,,487.0000,73.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",487.00,,,,,,,125.6900,487.0000,percent of total billed charges,100% of $487.00 in Billed Charges for Rev 272 = $487.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK PBDS PACEMAKER,272,RC,27201665,CDM,,,,,,both,,,487.0000,73.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,243.50,,,,,,,125.6900,487.0000,percent of total billed charges,Rev 272 $487.00 in Billed Charges at 50% = $243.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK PBDS PACEMAKER,272,RC,27201665,CDM,,,,,,both,,,487.0000,73.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,157.30,,,,,,,125.6900,487.0000,other,32.3% of $487.00 in Billed Charges for Rev 272 = $157.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PACK PBDS PACEMAKER,272,RC,27201665,CDM,,,,,,both,,,487.0000,73.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,149.51,,,,,,,125.6900,487.0000,other,30.7% of $487.00 in Billed Charges for Rev 272 = $149.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PACK PBDS PACEMAKER,272,RC,27201665,CDM,,,,,,both,,,487.0000,73.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,157.30,,,,,,,125.6900,487.0000,percent of total billed charges,32.3% of $487.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK PBDS PACEMAKER,272,RC,27201665,CDM,,,,,,both,,,487.0000,73.0500,WELLCARE,WELLCARE MEDICAID,487.00,,,,,,,125.6900,487.0000,percent of total billed charges,100% of $487.00 in Billed Charges for Rev 272 = $487.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACU PROCEDURE,361,RC,36100017,CDM,,,,,,both,,,1038.0000,155.7000,AETNA,AETNA,443.23,,,,,,,171.2700,1038.0000,percent of total billed charges,"42.7% of $1,038.00 in Billed Charges for Rev 361 = $443.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PACU PROCEDURE,361,RC,36100017,CDM,,,,,,both,,,1038.0000,155.7000,BLUE CROSS,ANTHEM EXCHANGE,171.27,,,,,,,171.2700,1038.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PACU PROCEDURE,361,RC,36100017,CDM,,,,,,both,,,1038.0000,155.7000,BLUE CROSS,ANTHEM HMO,171.27,,,,,,,171.2700,1038.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PACU PROCEDURE,361,RC,36100017,CDM,,,,,,both,,,1038.0000,155.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",171.27,,,,,,,171.2700,1038.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PACU PROCEDURE,361,RC,36100017,CDM,,,,,,both,,,1038.0000,155.7000,CIGNA HEALTHCARE,CIGNA HMO,228.00,,,,,,,171.2700,1038.0000,case rate,Rev 361 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PACU PROCEDURE,361,RC,36100017,CDM,,,,,,both,,,1038.0000,155.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.00,,,,,,,171.2700,1038.0000,case rate,Rev 361 ASG Rate of $175.00 at 100% of $175.00 = $175.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PACU PROCEDURE,361,RC,36100017,CDM,,,,,,both,,,1038.0000,155.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.00,,,,,,,171.2700,1038.0000,case rate,Rev 361 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PACU PROCEDURE,361,RC,36100017,CDM,,,,,,both,,,1038.0000,155.7000,CIGNA HEALTHCARE,CIGNA PPO,228.00,,,,,,,171.2700,1038.0000,case rate,Rev 361 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PACU PROCEDURE,361,RC,36100017,CDM,,,,,,both,,,1038.0000,155.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,934.20,,,,,,,171.2700,1038.0000,percent of total billed charges,"90% of $1,038.00 in Billed Charges for Rev 361 = $934.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PACU PROCEDURE,361,RC,36100017,CDM,,,,,,both,,,1038.0000,155.7000,MEDCOST,MEDCOST VHN,493.98,,,,,,,171.2700,1038.0000,percent of total billed charges,"47.59% of $1,038.00 in Billed Charges for Rev 361 = $493.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PACU PROCEDURE,361,RC,36100017,CDM,,,,,,both,,,1038.0000,155.7000,SENTARA HEALTH,SENTARA HEALTH,267.91,,,,,,,171.2700,1038.0000,percent of total billed charges,"25.81% of $1,038.00 in Billed Charges for Rev 361 = $267.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PACU PROCEDURE,361,RC,36100017,CDM,,,,,,both,,,1038.0000,155.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1038.00,,,,,,,171.2700,1038.0000,percent of total billed charges,"100% of $1,038.00 in Billed Charges for Rev 361 = $1,038.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PACU PROCEDURE,361,RC,36100017,CDM,,,,,,both,,,1038.0000,155.7000,WELLCARE,WELLCARE MEDICAID,1038.00,,,,,,,171.2700,1038.0000,percent of total billed charges,"100% of $1,038.00 in Billed Charges for Rev 361 = $1,038.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATHETER REPAIR GROSH CV  7740000,272,RC,27200002,CDM,,,,,,both,,,397.0000,59.5500,AETNA,AETNA,169.52,,,,,,,102.4700,397.0000,percent of total billed charges,42.7% of $397.00 in Billed Charges for Rev 272 = $169.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CATHETER REPAIR GROSH CV  7740000,272,RC,27200002,CDM,,,,,,both,,,397.0000,59.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,277.90,,,,,,,102.4700,397.0000,percent of total billed charges,Rev 272 $397.00 in Billed Charges at 70% = $277.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CATHETER REPAIR GROSH CV  7740000,272,RC,27200002,CDM,,,,,,both,,,397.0000,59.5500,CIGNA HEALTHCARE,CIGNA HMO,165.55,,,,,,,102.4700,397.0000,percent of total billed charges,41.7% of $397.00 in Billed Charges for Rev 272 = $165.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CATHETER REPAIR GROSH CV  7740000,272,RC,27200002,CDM,,,,,,both,,,397.0000,59.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,184.21,,,,,,,102.4700,397.0000,percent of total billed charges,46.4% of $397.00 in Billed Charges for Rev 272 = $184.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CATHETER REPAIR GROSH CV  7740000,272,RC,27200002,CDM,,,,,,both,,,397.0000,59.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,165.55,,,,,,,102.4700,397.0000,percent of total billed charges,41.7% of $397.00 in Billed Charges for Rev 272 = $165.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CATHETER REPAIR GROSH CV  7740000,272,RC,27200002,CDM,,,,,,both,,,397.0000,59.5500,CIGNA HEALTHCARE,CIGNA PPO,165.55,,,,,,,102.4700,397.0000,percent of total billed charges,41.7% of $397.00 in Billed Charges for Rev 272 = $165.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CATHETER REPAIR GROSH CV  7740000,272,RC,27200002,CDM,,,,,,both,,,397.0000,59.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,357.30,,,,,,,102.4700,397.0000,percent of total billed charges,90% of $397.00 in Billed Charges for Rev 272 = $357.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CATHETER REPAIR GROSH CV  7740000,272,RC,27200002,CDM,,,,,,both,,,397.0000,59.5500,MEDCOST,MEDCOST VHN,188.93,,,,,,,102.4700,397.0000,percent of total billed charges,47.59% of $397.00 in Billed Charges for Rev 272 = $188.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CATHETER REPAIR GROSH CV  7740000,272,RC,27200002,CDM,,,,,,both,,,397.0000,59.5500,SENTARA HEALTH,SENTARA HEALTH,102.47,,,,,,,102.4700,397.0000,percent of total billed charges,25.81% of $397.00 in Billed Charges for Rev 272 = $102.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CATHETER REPAIR GROSH CV  7740000,272,RC,27200002,CDM,,,,,,both,,,397.0000,59.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",397.00,,,,,,,102.4700,397.0000,percent of total billed charges,100% of $397.00 in Billed Charges for Rev 272 = $397.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CATHETER REPAIR GROSH CV  7740000,272,RC,27200002,CDM,,,,,,both,,,397.0000,59.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,198.50,,,,,,,102.4700,397.0000,percent of total billed charges,Rev 272 $397.00 in Billed Charges at 50% = $198.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CATHETER REPAIR GROSH CV  7740000,272,RC,27200002,CDM,,,,,,both,,,397.0000,59.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,128.23,,,,,,,102.4700,397.0000,other,32.3% of $397.00 in Billed Charges for Rev 272 = $128.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT CATHETER REPAIR GROSH CV  7740000,272,RC,27200002,CDM,,,,,,both,,,397.0000,59.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,121.88,,,,,,,102.4700,397.0000,other,30.7% of $397.00 in Billed Charges for Rev 272 = $121.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT CATHETER REPAIR GROSH CV  7740000,272,RC,27200002,CDM,,,,,,both,,,397.0000,59.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,128.23,,,,,,,102.4700,397.0000,percent of total billed charges,32.3% of $397.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CATHETER REPAIR GROSH CV  7740000,272,RC,27200002,CDM,,,,,,both,,,397.0000,59.5500,WELLCARE,WELLCARE MEDICAID,397.00,,,,,,,102.4700,397.0000,percent of total billed charges,100% of $397.00 in Billed Charges for Rev 272 = $397.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPINAL TAP PROCEDURE,361,RC,36100018,CDM,,,,,,both,,,181.0000,27.1500,AETNA,AETNA,77.29,,,,,,,29.8700,181.0000,percent of total billed charges,42.7% of $181.00 in Billed Charges for Rev 361 = $77.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPINAL TAP PROCEDURE,361,RC,36100018,CDM,,,,,,both,,,181.0000,27.1500,BLUE CROSS,ANTHEM EXCHANGE,29.87,,,,,,,29.8700,181.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPINAL TAP PROCEDURE,361,RC,36100018,CDM,,,,,,both,,,181.0000,27.1500,BLUE CROSS,ANTHEM HMO,29.87,,,,,,,29.8700,181.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPINAL TAP PROCEDURE,361,RC,36100018,CDM,,,,,,both,,,181.0000,27.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",29.87,,,,,,,29.8700,181.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPINAL TAP PROCEDURE,361,RC,36100018,CDM,,,,,,both,,,181.0000,27.1500,CIGNA HEALTHCARE,CIGNA HMO,181.00,,,,,,,29.8700,181.0000,case rate,Rev 361 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total (Limited to $181.00 in Billed Charges - $0.00 in ASG Allowed Amount = $181.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPINAL TAP PROCEDURE,361,RC,36100018,CDM,,,,,,both,,,181.0000,27.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.00,,,,,,,29.8700,181.0000,case rate,Rev 361 ASG Rate of $175.00 at 100% of $175.00 = $175.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPINAL TAP PROCEDURE,361,RC,36100018,CDM,,,,,,both,,,181.0000,27.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,181.00,,,,,,,29.8700,181.0000,case rate,Rev 361 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total (Limited to $181.00 in Billed Charges - $0.00 in ASG Allowed Amount = $181.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPINAL TAP PROCEDURE,361,RC,36100018,CDM,,,,,,both,,,181.0000,27.1500,CIGNA HEALTHCARE,CIGNA PPO,181.00,,,,,,,29.8700,181.0000,case rate,Rev 361 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total (Limited to $181.00 in Billed Charges - $0.00 in ASG Allowed Amount = $181.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPINAL TAP PROCEDURE,361,RC,36100018,CDM,,,,,,both,,,181.0000,27.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,162.90,,,,,,,29.8700,181.0000,percent of total billed charges,90% of $181.00 in Billed Charges for Rev 361 = $162.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPINAL TAP PROCEDURE,361,RC,36100018,CDM,,,,,,both,,,181.0000,27.1500,MEDCOST,MEDCOST VHN,86.14,,,,,,,29.8700,181.0000,percent of total billed charges,47.59% of $181.00 in Billed Charges for Rev 361 = $86.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPINAL TAP PROCEDURE,361,RC,36100018,CDM,,,,,,both,,,181.0000,27.1500,SENTARA HEALTH,SENTARA HEALTH,46.72,,,,,,,29.8700,181.0000,percent of total billed charges,25.81% of $181.00 in Billed Charges for Rev 361 = $46.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPINAL TAP PROCEDURE,361,RC,36100018,CDM,,,,,,both,,,181.0000,27.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",181.00,,,,,,,29.8700,181.0000,percent of total billed charges,100% of $181.00 in Billed Charges for Rev 361 = $181.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPINAL TAP PROCEDURE,361,RC,36100018,CDM,,,,,,both,,,181.0000,27.1500,WELLCARE,WELLCARE MEDICAID,181.00,,,,,,,29.8700,181.0000,percent of total billed charges,100% of $181.00 in Billed Charges for Rev 361 = $181.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT DISP FEMORAL TRACTION,270,RC,27000131,CDM,,,,,,both,,,337.0000,50.5500,AETNA,AETNA,143.90,,,,,,,86.9800,337.0000,percent of total billed charges,42.7% of $337.00 in Billed Charges for Rev 270 = $143.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT DISP FEMORAL TRACTION,270,RC,27000131,CDM,,,,,,both,,,337.0000,50.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,235.90,,,,,,,86.9800,337.0000,percent of total billed charges,Rev 270 $337.00 in Billed Charges at 70% = $235.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT DISP FEMORAL TRACTION,270,RC,27000131,CDM,,,,,,both,,,337.0000,50.5500,CIGNA HEALTHCARE,CIGNA HMO,140.53,,,,,,,86.9800,337.0000,percent of total billed charges,41.7% of $337.00 in Billed Charges for Rev 270 = $140.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT DISP FEMORAL TRACTION,270,RC,27000131,CDM,,,,,,both,,,337.0000,50.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,156.37,,,,,,,86.9800,337.0000,percent of total billed charges,46.4% of $337.00 in Billed Charges for Rev 270 = $156.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT DISP FEMORAL TRACTION,270,RC,27000131,CDM,,,,,,both,,,337.0000,50.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,140.53,,,,,,,86.9800,337.0000,percent of total billed charges,41.7% of $337.00 in Billed Charges for Rev 270 = $140.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT DISP FEMORAL TRACTION,270,RC,27000131,CDM,,,,,,both,,,337.0000,50.5500,CIGNA HEALTHCARE,CIGNA PPO,140.53,,,,,,,86.9800,337.0000,percent of total billed charges,41.7% of $337.00 in Billed Charges for Rev 270 = $140.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT DISP FEMORAL TRACTION,270,RC,27000131,CDM,,,,,,both,,,337.0000,50.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,303.30,,,,,,,86.9800,337.0000,percent of total billed charges,90% of $337.00 in Billed Charges for Rev 270 = $303.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT DISP FEMORAL TRACTION,270,RC,27000131,CDM,,,,,,both,,,337.0000,50.5500,MEDCOST,MEDCOST VHN,160.38,,,,,,,86.9800,337.0000,percent of total billed charges,47.59% of $337.00 in Billed Charges for Rev 270 = $160.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT DISP FEMORAL TRACTION,270,RC,27000131,CDM,,,,,,both,,,337.0000,50.5500,SENTARA HEALTH,SENTARA HEALTH,86.98,,,,,,,86.9800,337.0000,percent of total billed charges,25.81% of $337.00 in Billed Charges for Rev 270 = $86.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT DISP FEMORAL TRACTION,270,RC,27000131,CDM,,,,,,both,,,337.0000,50.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",337.00,,,,,,,86.9800,337.0000,percent of total billed charges,100% of $337.00 in Billed Charges for Rev 270 = $337.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT DISP FEMORAL TRACTION,270,RC,27000131,CDM,,,,,,both,,,337.0000,50.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,168.50,,,,,,,86.9800,337.0000,percent of total billed charges,Rev 270 $337.00 in Billed Charges at 50% = $168.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT DISP FEMORAL TRACTION,270,RC,27000131,CDM,,,,,,both,,,337.0000,50.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,108.85,,,,,,,86.9800,337.0000,other,32.3% of $337.00 in Billed Charges for Rev 270 = $108.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPLINT DISP FEMORAL TRACTION,270,RC,27000131,CDM,,,,,,both,,,337.0000,50.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,103.46,,,,,,,86.9800,337.0000,other,30.7% of $337.00 in Billed Charges for Rev 270 = $103.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPLINT DISP FEMORAL TRACTION,270,RC,27000131,CDM,,,,,,both,,,337.0000,50.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,108.85,,,,,,,86.9800,337.0000,percent of total billed charges,32.3% of $337.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT DISP FEMORAL TRACTION,270,RC,27000131,CDM,,,,,,both,,,337.0000,50.5500,WELLCARE,WELLCARE MEDICAID,337.00,,,,,,,86.9800,337.0000,percent of total billed charges,100% of $337.00 in Billed Charges for Rev 270 = $337.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 5IN,272,RC,27202281,CDM,,,,,,both,,,610.0000,91.5000,AETNA,AETNA,260.47,,,,,,,157.4400,610.0000,percent of total billed charges,42.7% of $610.00 in Billed Charges for Rev 272 = $260.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 5IN,272,RC,27202281,CDM,,,,,,both,,,610.0000,91.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,427.00,,,,,,,157.4400,610.0000,percent of total billed charges,Rev 272 $610.00 in Billed Charges at 70% = $427.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 5IN,272,RC,27202281,CDM,,,,,,both,,,610.0000,91.5000,CIGNA HEALTHCARE,CIGNA HMO,254.37,,,,,,,157.4400,610.0000,percent of total billed charges,41.7% of $610.00 in Billed Charges for Rev 272 = $254.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 5IN,272,RC,27202281,CDM,,,,,,both,,,610.0000,91.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,283.04,,,,,,,157.4400,610.0000,percent of total billed charges,46.4% of $610.00 in Billed Charges for Rev 272 = $283.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 5IN,272,RC,27202281,CDM,,,,,,both,,,610.0000,91.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,254.37,,,,,,,157.4400,610.0000,percent of total billed charges,41.7% of $610.00 in Billed Charges for Rev 272 = $254.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 5IN,272,RC,27202281,CDM,,,,,,both,,,610.0000,91.5000,CIGNA HEALTHCARE,CIGNA PPO,254.37,,,,,,,157.4400,610.0000,percent of total billed charges,41.7% of $610.00 in Billed Charges for Rev 272 = $254.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 5IN,272,RC,27202281,CDM,,,,,,both,,,610.0000,91.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,549.00,,,,,,,157.4400,610.0000,percent of total billed charges,90% of $610.00 in Billed Charges for Rev 272 = $549.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 5IN,272,RC,27202281,CDM,,,,,,both,,,610.0000,91.5000,MEDCOST,MEDCOST VHN,290.30,,,,,,,157.4400,610.0000,percent of total billed charges,47.59% of $610.00 in Billed Charges for Rev 272 = $290.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 5IN,272,RC,27202281,CDM,,,,,,both,,,610.0000,91.5000,SENTARA HEALTH,SENTARA HEALTH,157.44,,,,,,,157.4400,610.0000,percent of total billed charges,25.81% of $610.00 in Billed Charges for Rev 272 = $157.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 5IN,272,RC,27202281,CDM,,,,,,both,,,610.0000,91.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",610.00,,,,,,,157.4400,610.0000,percent of total billed charges,100% of $610.00 in Billed Charges for Rev 272 = $610.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 5IN,272,RC,27202281,CDM,,,,,,both,,,610.0000,91.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,305.00,,,,,,,157.4400,610.0000,percent of total billed charges,Rev 272 $610.00 in Billed Charges at 50% = $305.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 5IN,272,RC,27202281,CDM,,,,,,both,,,610.0000,91.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,197.03,,,,,,,157.4400,610.0000,other,32.3% of $610.00 in Billed Charges for Rev 272 = $197.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPLINT OCL PLASTER 5IN,272,RC,27202281,CDM,,,,,,both,,,610.0000,91.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,187.27,,,,,,,157.4400,610.0000,other,30.7% of $610.00 in Billed Charges for Rev 272 = $187.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPLINT OCL PLASTER 5IN,272,RC,27202281,CDM,,,,,,both,,,610.0000,91.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,197.03,,,,,,,157.4400,610.0000,percent of total billed charges,32.3% of $610.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 5IN,272,RC,27202281,CDM,,,,,,both,,,610.0000,91.5000,WELLCARE,WELLCARE MEDICAID,610.00,,,,,,,157.4400,610.0000,percent of total billed charges,100% of $610.00 in Billed Charges for Rev 272 = $610.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 6IN,272,RC,27202282,CDM,,,,,,both,,,698.0000,104.7000,AETNA,AETNA,298.05,,,,,,,180.1500,698.0000,percent of total billed charges,42.7% of $698.00 in Billed Charges for Rev 272 = $298.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 6IN,272,RC,27202282,CDM,,,,,,both,,,698.0000,104.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,488.60,,,,,,,180.1500,698.0000,percent of total billed charges,Rev 272 $698.00 in Billed Charges at 70% = $488.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 6IN,272,RC,27202282,CDM,,,,,,both,,,698.0000,104.7000,CIGNA HEALTHCARE,CIGNA HMO,291.07,,,,,,,180.1500,698.0000,percent of total billed charges,41.7% of $698.00 in Billed Charges for Rev 272 = $291.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 6IN,272,RC,27202282,CDM,,,,,,both,,,698.0000,104.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,323.87,,,,,,,180.1500,698.0000,percent of total billed charges,46.4% of $698.00 in Billed Charges for Rev 272 = $323.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 6IN,272,RC,27202282,CDM,,,,,,both,,,698.0000,104.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,291.07,,,,,,,180.1500,698.0000,percent of total billed charges,41.7% of $698.00 in Billed Charges for Rev 272 = $291.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 6IN,272,RC,27202282,CDM,,,,,,both,,,698.0000,104.7000,CIGNA HEALTHCARE,CIGNA PPO,291.07,,,,,,,180.1500,698.0000,percent of total billed charges,41.7% of $698.00 in Billed Charges for Rev 272 = $291.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 6IN,272,RC,27202282,CDM,,,,,,both,,,698.0000,104.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,628.20,,,,,,,180.1500,698.0000,percent of total billed charges,90% of $698.00 in Billed Charges for Rev 272 = $628.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 6IN,272,RC,27202282,CDM,,,,,,both,,,698.0000,104.7000,MEDCOST,MEDCOST VHN,332.18,,,,,,,180.1500,698.0000,percent of total billed charges,47.59% of $698.00 in Billed Charges for Rev 272 = $332.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 6IN,272,RC,27202282,CDM,,,,,,both,,,698.0000,104.7000,SENTARA HEALTH,SENTARA HEALTH,180.15,,,,,,,180.1500,698.0000,percent of total billed charges,25.81% of $698.00 in Billed Charges for Rev 272 = $180.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 6IN,272,RC,27202282,CDM,,,,,,both,,,698.0000,104.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",698.00,,,,,,,180.1500,698.0000,percent of total billed charges,100% of $698.00 in Billed Charges for Rev 272 = $698.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 6IN,272,RC,27202282,CDM,,,,,,both,,,698.0000,104.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,349.00,,,,,,,180.1500,698.0000,percent of total billed charges,Rev 272 $698.00 in Billed Charges at 50% = $349.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 6IN,272,RC,27202282,CDM,,,,,,both,,,698.0000,104.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,225.45,,,,,,,180.1500,698.0000,other,32.3% of $698.00 in Billed Charges for Rev 272 = $225.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPLINT OCL PLASTER 6IN,272,RC,27202282,CDM,,,,,,both,,,698.0000,104.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,214.29,,,,,,,180.1500,698.0000,other,30.7% of $698.00 in Billed Charges for Rev 272 = $214.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPLINT OCL PLASTER 6IN,272,RC,27202282,CDM,,,,,,both,,,698.0000,104.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,225.45,,,,,,,180.1500,698.0000,percent of total billed charges,32.3% of $698.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT OCL PLASTER 6IN,272,RC,27202282,CDM,,,,,,both,,,698.0000,104.7000,WELLCARE,WELLCARE MEDICAID,698.00,,,,,,,180.1500,698.0000,percent of total billed charges,100% of $698.00 in Billed Charges for Rev 272 = $698.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CUTTING OCA OBLONG,272,RC,,,,,,,,both,,,10827.3200,1624.1000,AETNA,AETNA,4623.27,,,,,,,2794.5300,10827.3200,percent of total billed charges,"42.7% of $10,827.32 in Billed Charges for Rev 272 = $4,623.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CUTTING OCA OBLONG,272,RC,,,,,,,,both,,,10827.3200,1624.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7579.12,,,,,,,2794.5300,10827.3200,percent of total billed charges,"Rev 272 $10,827.32 in Billed Charges at 70% = $7,579.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CUTTING OCA OBLONG,272,RC,,,,,,,,both,,,10827.3200,1624.1000,CIGNA HEALTHCARE,CIGNA HMO,4514.99,,,,,,,2794.5300,10827.3200,percent of total billed charges,"41.7% of $10,827.32 in Billed Charges for Rev 272 = $4,514.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CUTTING OCA OBLONG,272,RC,,,,,,,,both,,,10827.3200,1624.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5023.88,,,,,,,2794.5300,10827.3200,percent of total billed charges,"46.4% of $10,827.32 in Billed Charges for Rev 272 = $5,023.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CUTTING OCA OBLONG,272,RC,,,,,,,,both,,,10827.3200,1624.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4514.99,,,,,,,2794.5300,10827.3200,percent of total billed charges,"41.7% of $10,827.32 in Billed Charges for Rev 272 = $4,514.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CUTTING OCA OBLONG,272,RC,,,,,,,,both,,,10827.3200,1624.1000,CIGNA HEALTHCARE,CIGNA PPO,4514.99,,,,,,,2794.5300,10827.3200,percent of total billed charges,"41.7% of $10,827.32 in Billed Charges for Rev 272 = $4,514.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CUTTING OCA OBLONG,272,RC,,,,,,,,both,,,10827.3200,1624.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9744.59,,,,,,,2794.5300,10827.3200,percent of total billed charges,"90% of $10,827.32 in Billed Charges for Rev 272 = $9,744.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CUTTING OCA OBLONG,272,RC,,,,,,,,both,,,10827.3200,1624.1000,MEDCOST,MEDCOST VHN,5152.72,,,,,,,2794.5300,10827.3200,percent of total billed charges,"47.59% of $10,827.32 in Billed Charges for Rev 272 = $5,152.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CUTTING OCA OBLONG,272,RC,,,,,,,,both,,,10827.3200,1624.1000,SENTARA HEALTH,SENTARA HEALTH,2794.53,,,,,,,2794.5300,10827.3200,percent of total billed charges,"25.81% of $10,827.32 in Billed Charges for Rev 272 = $2,794.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CUTTING OCA OBLONG,272,RC,,,,,,,,both,,,10827.3200,1624.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10827.32,,,,,,,2794.5300,10827.3200,percent of total billed charges,"100% of $10,827.32 in Billed Charges for Rev 272 = $10,827.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CUTTING OCA OBLONG,272,RC,,,,,,,,both,,,10827.3200,1624.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5413.66,,,,,,,2794.5300,10827.3200,percent of total billed charges,"Rev 272 $10,827.32 in Billed Charges at 50% = $5,413.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CUTTING OCA OBLONG,272,RC,,,,,,,,both,,,10827.3200,1624.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3497.22,,,,,,,2794.5300,10827.3200,other,"32.3% of $10,827.32 in Billed Charges for Rev 272 = $3,497.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT CUTTING OCA OBLONG,272,RC,,,,,,,,both,,,10827.3200,1624.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3323.99,,,,,,,2794.5300,10827.3200,other,"30.7% of $10,827.32 in Billed Charges for Rev 272 = $3,323.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT CUTTING OCA OBLONG,272,RC,,,,,,,,both,,,10827.3200,1624.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,3497.22,,,,,,,2794.5300,10827.3200,percent of total billed charges,"32.3% of $10,827.32 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CUTTING OCA OBLONG,272,RC,,,,,,,,both,,,10827.3200,1624.1000,WELLCARE,WELLCARE MEDICAID,10827.32,,,,,,,2794.5300,10827.3200,percent of total billed charges,"100% of $10,827.32 in Billed Charges for Rev 272 = $10,827.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DILATOR SO3,272,RC,27200002,CDM,,,,,,both,,,11343.2800,1701.4900,AETNA,AETNA,4843.58,,,,,,,2927.7000,11343.2800,percent of total billed charges,"42.7% of $11,343.28 in Billed Charges for Rev 272 = $4,843.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DILATOR SO3,272,RC,27200002,CDM,,,,,,both,,,11343.2800,1701.4900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7940.30,,,,,,,2927.7000,11343.2800,percent of total billed charges,"Rev 272 $11,343.28 in Billed Charges at 70% = $7,940.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DILATOR SO3,272,RC,27200002,CDM,,,,,,both,,,11343.2800,1701.4900,CIGNA HEALTHCARE,CIGNA HMO,4730.15,,,,,,,2927.7000,11343.2800,percent of total billed charges,"41.7% of $11,343.28 in Billed Charges for Rev 272 = $4,730.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DILATOR SO3,272,RC,27200002,CDM,,,,,,both,,,11343.2800,1701.4900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5263.28,,,,,,,2927.7000,11343.2800,percent of total billed charges,"46.4% of $11,343.28 in Billed Charges for Rev 272 = $5,263.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DILATOR SO3,272,RC,27200002,CDM,,,,,,both,,,11343.2800,1701.4900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4730.15,,,,,,,2927.7000,11343.2800,percent of total billed charges,"41.7% of $11,343.28 in Billed Charges for Rev 272 = $4,730.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DILATOR SO3,272,RC,27200002,CDM,,,,,,both,,,11343.2800,1701.4900,CIGNA HEALTHCARE,CIGNA PPO,4730.15,,,,,,,2927.7000,11343.2800,percent of total billed charges,"41.7% of $11,343.28 in Billed Charges for Rev 272 = $4,730.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DILATOR SO3,272,RC,27200002,CDM,,,,,,both,,,11343.2800,1701.4900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10208.95,,,,,,,2927.7000,11343.2800,percent of total billed charges,"90% of $11,343.28 in Billed Charges for Rev 272 = $10,208.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DILATOR SO3,272,RC,27200002,CDM,,,,,,both,,,11343.2800,1701.4900,MEDCOST,MEDCOST VHN,5398.27,,,,,,,2927.7000,11343.2800,percent of total billed charges,"47.59% of $11,343.28 in Billed Charges for Rev 272 = $5,398.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DILATOR SO3,272,RC,27200002,CDM,,,,,,both,,,11343.2800,1701.4900,SENTARA HEALTH,SENTARA HEALTH,2927.70,,,,,,,2927.7000,11343.2800,percent of total billed charges,"25.81% of $11,343.28 in Billed Charges for Rev 272 = $2,927.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DILATOR SO3,272,RC,27200002,CDM,,,,,,both,,,11343.2800,1701.4900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11343.28,,,,,,,2927.7000,11343.2800,percent of total billed charges,"100% of $11,343.28 in Billed Charges for Rev 272 = $11,343.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DILATOR SO3,272,RC,27200002,CDM,,,,,,both,,,11343.2800,1701.4900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5671.64,,,,,,,2927.7000,11343.2800,percent of total billed charges,"Rev 272 $11,343.28 in Billed Charges at 50% = $5,671.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DILATOR SO3,272,RC,27200002,CDM,,,,,,both,,,11343.2800,1701.4900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3663.88,,,,,,,2927.7000,11343.2800,other,"32.3% of $11,343.28 in Billed Charges for Rev 272 = $3,663.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT DILATOR SO3,272,RC,27200002,CDM,,,,,,both,,,11343.2800,1701.4900,UNITED HEALTHCARE,UHC HERITAGE SELECT,3482.39,,,,,,,2927.7000,11343.2800,other,"30.7% of $11,343.28 in Billed Charges for Rev 272 = $3,482.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT DILATOR SO3,272,RC,27200002,CDM,,,,,,both,,,11343.2800,1701.4900,UNITED HEALTHCARE,UNITED HEALTHCARE,3663.88,,,,,,,2927.7000,11343.2800,percent of total billed charges,"32.3% of $11,343.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT DILATOR SO3,272,RC,27200002,CDM,,,,,,both,,,11343.2800,1701.4900,WELLCARE,WELLCARE MEDICAID,11343.28,,,,,,,2927.7000,11343.2800,percent of total billed charges,"100% of $11,343.28 in Billed Charges for Rev 272 = $11,343.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLE RELOAD BLUE 6R45B,272,RC,27201100,CDM,,,,,,both,,,559.0000,83.8500,AETNA,AETNA,238.69,,,,,,,144.2800,559.0000,percent of total billed charges,42.7% of $559.00 in Billed Charges for Rev 272 = $238.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD BLUE 6R45B,272,RC,27201100,CDM,,,,,,both,,,559.0000,83.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,391.30,,,,,,,144.2800,559.0000,percent of total billed charges,Rev 272 $559.00 in Billed Charges at 70% = $391.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD BLUE 6R45B,272,RC,27201100,CDM,,,,,,both,,,559.0000,83.8500,CIGNA HEALTHCARE,CIGNA HMO,233.10,,,,,,,144.2800,559.0000,percent of total billed charges,41.7% of $559.00 in Billed Charges for Rev 272 = $233.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD BLUE 6R45B,272,RC,27201100,CDM,,,,,,both,,,559.0000,83.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,259.38,,,,,,,144.2800,559.0000,percent of total billed charges,46.4% of $559.00 in Billed Charges for Rev 272 = $259.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD BLUE 6R45B,272,RC,27201100,CDM,,,,,,both,,,559.0000,83.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,233.10,,,,,,,144.2800,559.0000,percent of total billed charges,41.7% of $559.00 in Billed Charges for Rev 272 = $233.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD BLUE 6R45B,272,RC,27201100,CDM,,,,,,both,,,559.0000,83.8500,CIGNA HEALTHCARE,CIGNA PPO,233.10,,,,,,,144.2800,559.0000,percent of total billed charges,41.7% of $559.00 in Billed Charges for Rev 272 = $233.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD BLUE 6R45B,272,RC,27201100,CDM,,,,,,both,,,559.0000,83.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,503.10,,,,,,,144.2800,559.0000,percent of total billed charges,90% of $559.00 in Billed Charges for Rev 272 = $503.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD BLUE 6R45B,272,RC,27201100,CDM,,,,,,both,,,559.0000,83.8500,MEDCOST,MEDCOST VHN,266.03,,,,,,,144.2800,559.0000,percent of total billed charges,47.59% of $559.00 in Billed Charges for Rev 272 = $266.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD BLUE 6R45B,272,RC,27201100,CDM,,,,,,both,,,559.0000,83.8500,SENTARA HEALTH,SENTARA HEALTH,144.28,,,,,,,144.2800,559.0000,percent of total billed charges,25.81% of $559.00 in Billed Charges for Rev 272 = $144.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD BLUE 6R45B,272,RC,27201100,CDM,,,,,,both,,,559.0000,83.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",559.00,,,,,,,144.2800,559.0000,percent of total billed charges,100% of $559.00 in Billed Charges for Rev 272 = $559.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD BLUE 6R45B,272,RC,27201100,CDM,,,,,,both,,,559.0000,83.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,279.50,,,,,,,144.2800,559.0000,percent of total billed charges,Rev 272 $559.00 in Billed Charges at 50% = $279.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD BLUE 6R45B,272,RC,27201100,CDM,,,,,,both,,,559.0000,83.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,180.56,,,,,,,144.2800,559.0000,other,32.3% of $559.00 in Billed Charges for Rev 272 = $180.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STAPLE RELOAD BLUE 6R45B,272,RC,27201100,CDM,,,,,,both,,,559.0000,83.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,171.61,,,,,,,144.2800,559.0000,other,30.7% of $559.00 in Billed Charges for Rev 272 = $171.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STAPLE RELOAD BLUE 6R45B,272,RC,27201100,CDM,,,,,,both,,,559.0000,83.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,180.56,,,,,,,144.2800,559.0000,percent of total billed charges,32.3% of $559.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD BLUE 6R45B,272,RC,27201100,CDM,,,,,,both,,,559.0000,83.8500,WELLCARE,WELLCARE MEDICAID,559.00,,,,,,,144.2800,559.0000,percent of total billed charges,100% of $559.00 in Billed Charges for Rev 272 = $559.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD GRAY 6R45M,272,RC,27201101,CDM,,,,,,both,,,1084.0000,162.6000,AETNA,AETNA,462.87,,,,,,,279.7800,1084.0000,percent of total billed charges,"42.7% of $1,084.00 in Billed Charges for Rev 272 = $462.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLE RELOAD GRAY 6R45M,272,RC,27201101,CDM,,,,,,both,,,1084.0000,162.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,758.80,,,,,,,279.7800,1084.0000,percent of total billed charges,"Rev 272 $1,084.00 in Billed Charges at 70% = $758.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLE RELOAD GRAY 6R45M,272,RC,27201101,CDM,,,,,,both,,,1084.0000,162.6000,CIGNA HEALTHCARE,CIGNA HMO,452.03,,,,,,,279.7800,1084.0000,percent of total billed charges,"41.7% of $1,084.00 in Billed Charges for Rev 272 = $452.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLE RELOAD GRAY 6R45M,272,RC,27201101,CDM,,,,,,both,,,1084.0000,162.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,502.98,,,,,,,279.7800,1084.0000,percent of total billed charges,"46.4% of $1,084.00 in Billed Charges for Rev 272 = $502.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLE RELOAD GRAY 6R45M,272,RC,27201101,CDM,,,,,,both,,,1084.0000,162.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,452.03,,,,,,,279.7800,1084.0000,percent of total billed charges,"41.7% of $1,084.00 in Billed Charges for Rev 272 = $452.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLE RELOAD GRAY 6R45M,272,RC,27201101,CDM,,,,,,both,,,1084.0000,162.6000,CIGNA HEALTHCARE,CIGNA PPO,452.03,,,,,,,279.7800,1084.0000,percent of total billed charges,"41.7% of $1,084.00 in Billed Charges for Rev 272 = $452.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLE RELOAD GRAY 6R45M,272,RC,27201101,CDM,,,,,,both,,,1084.0000,162.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,975.60,,,,,,,279.7800,1084.0000,percent of total billed charges,"90% of $1,084.00 in Billed Charges for Rev 272 = $975.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLE RELOAD GRAY 6R45M,272,RC,27201101,CDM,,,,,,both,,,1084.0000,162.6000,MEDCOST,MEDCOST VHN,515.88,,,,,,,279.7800,1084.0000,percent of total billed charges,"47.59% of $1,084.00 in Billed Charges for Rev 272 = $515.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLE RELOAD GRAY 6R45M,272,RC,27201101,CDM,,,,,,both,,,1084.0000,162.6000,SENTARA HEALTH,SENTARA HEALTH,279.78,,,,,,,279.7800,1084.0000,percent of total billed charges,"25.81% of $1,084.00 in Billed Charges for Rev 272 = $279.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLE RELOAD GRAY 6R45M,272,RC,27201101,CDM,,,,,,both,,,1084.0000,162.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1084.00,,,,,,,279.7800,1084.0000,percent of total billed charges,"100% of $1,084.00 in Billed Charges for Rev 272 = $1,084.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLE RELOAD GRAY 6R45M,272,RC,27201101,CDM,,,,,,both,,,1084.0000,162.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,542.00,,,,,,,279.7800,1084.0000,percent of total billed charges,"Rev 272 $1,084.00 in Billed Charges at 50% = $542.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLE RELOAD GRAY 6R45M,272,RC,27201101,CDM,,,,,,both,,,1084.0000,162.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,350.13,,,,,,,279.7800,1084.0000,other,"32.3% of $1,084.00 in Billed Charges for Rev 272 = $350.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STAPLE RELOAD GRAY 6R45M,272,RC,27201101,CDM,,,,,,both,,,1084.0000,162.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,332.79,,,,,,,279.7800,1084.0000,other,"30.7% of $1,084.00 in Billed Charges for Rev 272 = $332.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STAPLE RELOAD GRAY 6R45M,272,RC,27201101,CDM,,,,,,both,,,1084.0000,162.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,350.13,,,,,,,279.7800,1084.0000,percent of total billed charges,"32.3% of $1,084.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLE RELOAD GRAY 6R45M,272,RC,27201101,CDM,,,,,,both,,,1084.0000,162.6000,WELLCARE,WELLCARE MEDICAID,1084.00,,,,,,,279.7800,1084.0000,percent of total billed charges,"100% of $1,084.00 in Billed Charges for Rev 272 = $1,084.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLE RELOAD WHITE TR45W,272,RC,27201102,CDM,,,,,,both,,,495.0000,74.2500,AETNA,AETNA,211.37,,,,,,,127.7600,495.0000,percent of total billed charges,42.7% of $495.00 in Billed Charges for Rev 272 = $211.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD WHITE TR45W,272,RC,27201102,CDM,,,,,,both,,,495.0000,74.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,346.50,,,,,,,127.7600,495.0000,percent of total billed charges,Rev 272 $495.00 in Billed Charges at 70% = $346.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD WHITE TR45W,272,RC,27201102,CDM,,,,,,both,,,495.0000,74.2500,CIGNA HEALTHCARE,CIGNA HMO,206.42,,,,,,,127.7600,495.0000,percent of total billed charges,41.7% of $495.00 in Billed Charges for Rev 272 = $206.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD WHITE TR45W,272,RC,27201102,CDM,,,,,,both,,,495.0000,74.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,229.68,,,,,,,127.7600,495.0000,percent of total billed charges,46.4% of $495.00 in Billed Charges for Rev 272 = $229.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD WHITE TR45W,272,RC,27201102,CDM,,,,,,both,,,495.0000,74.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,206.42,,,,,,,127.7600,495.0000,percent of total billed charges,41.7% of $495.00 in Billed Charges for Rev 272 = $206.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD WHITE TR45W,272,RC,27201102,CDM,,,,,,both,,,495.0000,74.2500,CIGNA HEALTHCARE,CIGNA PPO,206.42,,,,,,,127.7600,495.0000,percent of total billed charges,41.7% of $495.00 in Billed Charges for Rev 272 = $206.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD WHITE TR45W,272,RC,27201102,CDM,,,,,,both,,,495.0000,74.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,445.50,,,,,,,127.7600,495.0000,percent of total billed charges,90% of $495.00 in Billed Charges for Rev 272 = $445.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD WHITE TR45W,272,RC,27201102,CDM,,,,,,both,,,495.0000,74.2500,MEDCOST,MEDCOST VHN,235.57,,,,,,,127.7600,495.0000,percent of total billed charges,47.59% of $495.00 in Billed Charges for Rev 272 = $235.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD WHITE TR45W,272,RC,27201102,CDM,,,,,,both,,,495.0000,74.2500,SENTARA HEALTH,SENTARA HEALTH,127.76,,,,,,,127.7600,495.0000,percent of total billed charges,25.81% of $495.00 in Billed Charges for Rev 272 = $127.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD WHITE TR45W,272,RC,27201102,CDM,,,,,,both,,,495.0000,74.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",495.00,,,,,,,127.7600,495.0000,percent of total billed charges,100% of $495.00 in Billed Charges for Rev 272 = $495.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD WHITE TR45W,272,RC,27201102,CDM,,,,,,both,,,495.0000,74.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,247.50,,,,,,,127.7600,495.0000,percent of total billed charges,Rev 272 $495.00 in Billed Charges at 50% = $247.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD WHITE TR45W,272,RC,27201102,CDM,,,,,,both,,,495.0000,74.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,159.89,,,,,,,127.7600,495.0000,other,32.3% of $495.00 in Billed Charges for Rev 272 = $159.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STAPLE RELOAD WHITE TR45W,272,RC,27201102,CDM,,,,,,both,,,495.0000,74.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,151.97,,,,,,,127.7600,495.0000,other,30.7% of $495.00 in Billed Charges for Rev 272 = $151.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STAPLE RELOAD WHITE TR45W,272,RC,27201102,CDM,,,,,,both,,,495.0000,74.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,159.89,,,,,,,127.7600,495.0000,percent of total billed charges,32.3% of $495.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLE RELOAD WHITE TR45W,272,RC,27201102,CDM,,,,,,both,,,495.0000,74.2500,WELLCARE,WELLCARE MEDICAID,495.00,,,,,,,127.7600,495.0000,percent of total billed charges,100% of $495.00 in Billed Charges for Rev 272 = $495.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER ARTICULATING AX55G,272,RC,27201103,CDM,,,,,,both,,,903.0000,135.4500,AETNA,AETNA,385.58,,,,,,,233.0600,903.0000,percent of total billed charges,42.7% of $903.00 in Billed Charges for Rev 272 = $385.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER ARTICULATING AX55G,272,RC,27201103,CDM,,,,,,both,,,903.0000,135.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,632.10,,,,,,,233.0600,903.0000,percent of total billed charges,Rev 272 $903.00 in Billed Charges at 70% = $632.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER ARTICULATING AX55G,272,RC,27201103,CDM,,,,,,both,,,903.0000,135.4500,CIGNA HEALTHCARE,CIGNA HMO,376.55,,,,,,,233.0600,903.0000,percent of total billed charges,41.7% of $903.00 in Billed Charges for Rev 272 = $376.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER ARTICULATING AX55G,272,RC,27201103,CDM,,,,,,both,,,903.0000,135.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,418.99,,,,,,,233.0600,903.0000,percent of total billed charges,46.4% of $903.00 in Billed Charges for Rev 272 = $418.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER ARTICULATING AX55G,272,RC,27201103,CDM,,,,,,both,,,903.0000,135.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,376.55,,,,,,,233.0600,903.0000,percent of total billed charges,41.7% of $903.00 in Billed Charges for Rev 272 = $376.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER ARTICULATING AX55G,272,RC,27201103,CDM,,,,,,both,,,903.0000,135.4500,CIGNA HEALTHCARE,CIGNA PPO,376.55,,,,,,,233.0600,903.0000,percent of total billed charges,41.7% of $903.00 in Billed Charges for Rev 272 = $376.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER ARTICULATING AX55G,272,RC,27201103,CDM,,,,,,both,,,903.0000,135.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,812.70,,,,,,,233.0600,903.0000,percent of total billed charges,90% of $903.00 in Billed Charges for Rev 272 = $812.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER ARTICULATING AX55G,272,RC,27201103,CDM,,,,,,both,,,903.0000,135.4500,MEDCOST,MEDCOST VHN,429.74,,,,,,,233.0600,903.0000,percent of total billed charges,47.59% of $903.00 in Billed Charges for Rev 272 = $429.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER ARTICULATING AX55G,272,RC,27201103,CDM,,,,,,both,,,903.0000,135.4500,SENTARA HEALTH,SENTARA HEALTH,233.06,,,,,,,233.0600,903.0000,percent of total billed charges,25.81% of $903.00 in Billed Charges for Rev 272 = $233.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER ARTICULATING AX55G,272,RC,27201103,CDM,,,,,,both,,,903.0000,135.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",903.00,,,,,,,233.0600,903.0000,percent of total billed charges,100% of $903.00 in Billed Charges for Rev 272 = $903.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER ARTICULATING AX55G,272,RC,27201103,CDM,,,,,,both,,,903.0000,135.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,451.50,,,,,,,233.0600,903.0000,percent of total billed charges,Rev 272 $903.00 in Billed Charges at 50% = $451.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER ARTICULATING AX55G,272,RC,27201103,CDM,,,,,,both,,,903.0000,135.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,291.67,,,,,,,233.0600,903.0000,other,32.3% of $903.00 in Billed Charges for Rev 272 = $291.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STAPLER ARTICULATING AX55G,272,RC,27201103,CDM,,,,,,both,,,903.0000,135.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.22,,,,,,,233.0600,903.0000,other,30.7% of $903.00 in Billed Charges for Rev 272 = $277.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STAPLER ARTICULATING AX55G,272,RC,27201103,CDM,,,,,,both,,,903.0000,135.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,291.67,,,,,,,233.0600,903.0000,percent of total billed charges,32.3% of $903.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER ARTICULATING AX55G,272,RC,27201103,CDM,,,,,,both,,,903.0000,135.4500,WELLCARE,WELLCARE MEDICAID,903.00,,,,,,,233.0600,903.0000,percent of total billed charges,100% of $903.00 in Billed Charges for Rev 272 = $903.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER CLIP APPLIER 5M EL5ML,272,RC,27201104,CDM,,,,,,both,,,714.0000,107.1000,AETNA,AETNA,304.88,,,,,,,184.2800,714.0000,percent of total billed charges,42.7% of $714.00 in Billed Charges for Rev 272 = $304.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER CLIP APPLIER 5M EL5ML,272,RC,27201104,CDM,,,,,,both,,,714.0000,107.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,499.80,,,,,,,184.2800,714.0000,percent of total billed charges,Rev 272 $714.00 in Billed Charges at 70% = $499.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER CLIP APPLIER 5M EL5ML,272,RC,27201104,CDM,,,,,,both,,,714.0000,107.1000,CIGNA HEALTHCARE,CIGNA HMO,297.74,,,,,,,184.2800,714.0000,percent of total billed charges,41.7% of $714.00 in Billed Charges for Rev 272 = $297.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER CLIP APPLIER 5M EL5ML,272,RC,27201104,CDM,,,,,,both,,,714.0000,107.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,331.30,,,,,,,184.2800,714.0000,percent of total billed charges,46.4% of $714.00 in Billed Charges for Rev 272 = $331.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER CLIP APPLIER 5M EL5ML,272,RC,27201104,CDM,,,,,,both,,,714.0000,107.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,297.74,,,,,,,184.2800,714.0000,percent of total billed charges,41.7% of $714.00 in Billed Charges for Rev 272 = $297.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER CLIP APPLIER 5M EL5ML,272,RC,27201104,CDM,,,,,,both,,,714.0000,107.1000,CIGNA HEALTHCARE,CIGNA PPO,297.74,,,,,,,184.2800,714.0000,percent of total billed charges,41.7% of $714.00 in Billed Charges for Rev 272 = $297.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER CLIP APPLIER 5M EL5ML,272,RC,27201104,CDM,,,,,,both,,,714.0000,107.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,642.60,,,,,,,184.2800,714.0000,percent of total billed charges,90% of $714.00 in Billed Charges for Rev 272 = $642.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER CLIP APPLIER 5M EL5ML,272,RC,27201104,CDM,,,,,,both,,,714.0000,107.1000,MEDCOST,MEDCOST VHN,339.79,,,,,,,184.2800,714.0000,percent of total billed charges,47.59% of $714.00 in Billed Charges for Rev 272 = $339.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER CLIP APPLIER 5M EL5ML,272,RC,27201104,CDM,,,,,,both,,,714.0000,107.1000,SENTARA HEALTH,SENTARA HEALTH,184.28,,,,,,,184.2800,714.0000,percent of total billed charges,25.81% of $714.00 in Billed Charges for Rev 272 = $184.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER CLIP APPLIER 5M EL5ML,272,RC,27201104,CDM,,,,,,both,,,714.0000,107.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",714.00,,,,,,,184.2800,714.0000,percent of total billed charges,100% of $714.00 in Billed Charges for Rev 272 = $714.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER CLIP APPLIER 5M EL5ML,272,RC,27201104,CDM,,,,,,both,,,714.0000,107.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,357.00,,,,,,,184.2800,714.0000,percent of total billed charges,Rev 272 $714.00 in Billed Charges at 50% = $357.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER CLIP APPLIER 5M EL5ML,272,RC,27201104,CDM,,,,,,both,,,714.0000,107.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,230.62,,,,,,,184.2800,714.0000,other,32.3% of $714.00 in Billed Charges for Rev 272 = $230.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STAPLER CLIP APPLIER 5M EL5ML,272,RC,27201104,CDM,,,,,,both,,,714.0000,107.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,219.20,,,,,,,184.2800,714.0000,other,30.7% of $714.00 in Billed Charges for Rev 272 = $219.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STAPLER CLIP APPLIER 5M EL5ML,272,RC,27201104,CDM,,,,,,both,,,714.0000,107.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,230.62,,,,,,,184.2800,714.0000,percent of total billed charges,32.3% of $714.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER CLIP APPLIER 5M EL5ML,272,RC,27201104,CDM,,,,,,both,,,714.0000,107.1000,WELLCARE,WELLCARE MEDICAID,714.00,,,,,,,184.2800,714.0000,percent of total billed charges,100% of $714.00 in Billed Charges for Rev 272 = $714.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER LINEAR CUTTER 75MM TLC75,272,RC,27201106,CDM,,,,,,both,,,687.0000,103.0500,AETNA,AETNA,293.35,,,,,,,177.3100,687.0000,percent of total billed charges,42.7% of $687.00 in Billed Charges for Rev 272 = $293.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER LINEAR CUTTER 75MM TLC75,272,RC,27201106,CDM,,,,,,both,,,687.0000,103.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,480.90,,,,,,,177.3100,687.0000,percent of total billed charges,Rev 272 $687.00 in Billed Charges at 70% = $480.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER LINEAR CUTTER 75MM TLC75,272,RC,27201106,CDM,,,,,,both,,,687.0000,103.0500,CIGNA HEALTHCARE,CIGNA HMO,286.48,,,,,,,177.3100,687.0000,percent of total billed charges,41.7% of $687.00 in Billed Charges for Rev 272 = $286.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER LINEAR CUTTER 75MM TLC75,272,RC,27201106,CDM,,,,,,both,,,687.0000,103.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,318.77,,,,,,,177.3100,687.0000,percent of total billed charges,46.4% of $687.00 in Billed Charges for Rev 272 = $318.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER LINEAR CUTTER 75MM TLC75,272,RC,27201106,CDM,,,,,,both,,,687.0000,103.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,286.48,,,,,,,177.3100,687.0000,percent of total billed charges,41.7% of $687.00 in Billed Charges for Rev 272 = $286.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER LINEAR CUTTER 75MM TLC75,272,RC,27201106,CDM,,,,,,both,,,687.0000,103.0500,CIGNA HEALTHCARE,CIGNA PPO,286.48,,,,,,,177.3100,687.0000,percent of total billed charges,41.7% of $687.00 in Billed Charges for Rev 272 = $286.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER LINEAR CUTTER 75MM TLC75,272,RC,27201106,CDM,,,,,,both,,,687.0000,103.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,618.30,,,,,,,177.3100,687.0000,percent of total billed charges,90% of $687.00 in Billed Charges for Rev 272 = $618.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER LINEAR CUTTER 75MM TLC75,272,RC,27201106,CDM,,,,,,both,,,687.0000,103.0500,MEDCOST,MEDCOST VHN,326.94,,,,,,,177.3100,687.0000,percent of total billed charges,47.59% of $687.00 in Billed Charges for Rev 272 = $326.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER LINEAR CUTTER 75MM TLC75,272,RC,27201106,CDM,,,,,,both,,,687.0000,103.0500,SENTARA HEALTH,SENTARA HEALTH,177.31,,,,,,,177.3100,687.0000,percent of total billed charges,25.81% of $687.00 in Billed Charges for Rev 272 = $177.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER LINEAR CUTTER 75MM TLC75,272,RC,27201106,CDM,,,,,,both,,,687.0000,103.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",687.00,,,,,,,177.3100,687.0000,percent of total billed charges,100% of $687.00 in Billed Charges for Rev 272 = $687.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER LINEAR CUTTER 75MM TLC75,272,RC,27201106,CDM,,,,,,both,,,687.0000,103.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,343.50,,,,,,,177.3100,687.0000,percent of total billed charges,Rev 272 $687.00 in Billed Charges at 50% = $343.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER LINEAR CUTTER 75MM TLC75,272,RC,27201106,CDM,,,,,,both,,,687.0000,103.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,221.90,,,,,,,177.3100,687.0000,other,32.3% of $687.00 in Billed Charges for Rev 272 = $221.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STAPLER LINEAR CUTTER 75MM TLC75,272,RC,27201106,CDM,,,,,,both,,,687.0000,103.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,210.91,,,,,,,177.3100,687.0000,other,30.7% of $687.00 in Billed Charges for Rev 272 = $210.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STAPLER LINEAR CUTTER 75MM TLC75,272,RC,27201106,CDM,,,,,,both,,,687.0000,103.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,221.90,,,,,,,177.3100,687.0000,percent of total billed charges,32.3% of $687.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER LINEAR CUTTER 75MM TLC75,272,RC,27201106,CDM,,,,,,both,,,687.0000,103.0500,WELLCARE,WELLCARE MEDICAID,687.00,,,,,,,177.3100,687.0000,percent of total billed charges,100% of $687.00 in Billed Charges for Rev 272 = $687.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER RELOAD TR35W,272,RC,27201109,CDM,,,,,,both,,,436.0000,65.4000,AETNA,AETNA,186.17,,,,,,,112.5300,436.0000,percent of total billed charges,42.7% of $436.00 in Billed Charges for Rev 272 = $186.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER RELOAD TR35W,272,RC,27201109,CDM,,,,,,both,,,436.0000,65.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,305.20,,,,,,,112.5300,436.0000,percent of total billed charges,Rev 272 $436.00 in Billed Charges at 70% = $305.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER RELOAD TR35W,272,RC,27201109,CDM,,,,,,both,,,436.0000,65.4000,CIGNA HEALTHCARE,CIGNA HMO,181.81,,,,,,,112.5300,436.0000,percent of total billed charges,41.7% of $436.00 in Billed Charges for Rev 272 = $181.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER RELOAD TR35W,272,RC,27201109,CDM,,,,,,both,,,436.0000,65.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,202.30,,,,,,,112.5300,436.0000,percent of total billed charges,46.4% of $436.00 in Billed Charges for Rev 272 = $202.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER RELOAD TR35W,272,RC,27201109,CDM,,,,,,both,,,436.0000,65.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,181.81,,,,,,,112.5300,436.0000,percent of total billed charges,41.7% of $436.00 in Billed Charges for Rev 272 = $181.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER RELOAD TR35W,272,RC,27201109,CDM,,,,,,both,,,436.0000,65.4000,CIGNA HEALTHCARE,CIGNA PPO,181.81,,,,,,,112.5300,436.0000,percent of total billed charges,41.7% of $436.00 in Billed Charges for Rev 272 = $181.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER RELOAD TR35W,272,RC,27201109,CDM,,,,,,both,,,436.0000,65.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,392.40,,,,,,,112.5300,436.0000,percent of total billed charges,90% of $436.00 in Billed Charges for Rev 272 = $392.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER RELOAD TR35W,272,RC,27201109,CDM,,,,,,both,,,436.0000,65.4000,MEDCOST,MEDCOST VHN,207.49,,,,,,,112.5300,436.0000,percent of total billed charges,47.59% of $436.00 in Billed Charges for Rev 272 = $207.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER RELOAD TR35W,272,RC,27201109,CDM,,,,,,both,,,436.0000,65.4000,SENTARA HEALTH,SENTARA HEALTH,112.53,,,,,,,112.5300,436.0000,percent of total billed charges,25.81% of $436.00 in Billed Charges for Rev 272 = $112.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER RELOAD TR35W,272,RC,27201109,CDM,,,,,,both,,,436.0000,65.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",436.00,,,,,,,112.5300,436.0000,percent of total billed charges,100% of $436.00 in Billed Charges for Rev 272 = $436.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER RELOAD TR35W,272,RC,27201109,CDM,,,,,,both,,,436.0000,65.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,218.00,,,,,,,112.5300,436.0000,percent of total billed charges,Rev 272 $436.00 in Billed Charges at 50% = $218.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER RELOAD TR35W,272,RC,27201109,CDM,,,,,,both,,,436.0000,65.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,140.83,,,,,,,112.5300,436.0000,other,32.3% of $436.00 in Billed Charges for Rev 272 = $140.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STAPLER RELOAD TR35W,272,RC,27201109,CDM,,,,,,both,,,436.0000,65.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,133.85,,,,,,,112.5300,436.0000,other,30.7% of $436.00 in Billed Charges for Rev 272 = $133.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STAPLER RELOAD TR35W,272,RC,27201109,CDM,,,,,,both,,,436.0000,65.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,140.83,,,,,,,112.5300,436.0000,percent of total billed charges,32.3% of $436.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER RELOAD TR35W,272,RC,27201109,CDM,,,,,,both,,,436.0000,65.4000,WELLCARE,WELLCARE MEDICAID,436.00,,,,,,,112.5300,436.0000,percent of total billed charges,100% of $436.00 in Billed Charges for Rev 272 = $436.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STEALTH CROWN CLASSIC & SOLID,272,RC,27201644,CDM,,,,,,both,,,9011.0000,1351.6500,AETNA,AETNA,3847.70,,,,,,,2325.7400,9011.0000,percent of total billed charges,"42.7% of $9,011.00 in Billed Charges for Rev 272 = $3,847.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STEALTH CROWN CLASSIC & SOLID,272,RC,27201644,CDM,,,,,,both,,,9011.0000,1351.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6307.70,,,,,,,2325.7400,9011.0000,percent of total billed charges,"Rev 272 $9,011.00 in Billed Charges at 70% = $6,307.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STEALTH CROWN CLASSIC & SOLID,272,RC,27201644,CDM,,,,,,both,,,9011.0000,1351.6500,CIGNA HEALTHCARE,CIGNA HMO,3757.59,,,,,,,2325.7400,9011.0000,percent of total billed charges,"41.7% of $9,011.00 in Billed Charges for Rev 272 = $3,757.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STEALTH CROWN CLASSIC & SOLID,272,RC,27201644,CDM,,,,,,both,,,9011.0000,1351.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4181.10,,,,,,,2325.7400,9011.0000,percent of total billed charges,"46.4% of $9,011.00 in Billed Charges for Rev 272 = $4,181.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STEALTH CROWN CLASSIC & SOLID,272,RC,27201644,CDM,,,,,,both,,,9011.0000,1351.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3757.59,,,,,,,2325.7400,9011.0000,percent of total billed charges,"41.7% of $9,011.00 in Billed Charges for Rev 272 = $3,757.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STEALTH CROWN CLASSIC & SOLID,272,RC,27201644,CDM,,,,,,both,,,9011.0000,1351.6500,CIGNA HEALTHCARE,CIGNA PPO,3757.59,,,,,,,2325.7400,9011.0000,percent of total billed charges,"41.7% of $9,011.00 in Billed Charges for Rev 272 = $3,757.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STEALTH CROWN CLASSIC & SOLID,272,RC,27201644,CDM,,,,,,both,,,9011.0000,1351.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8109.90,,,,,,,2325.7400,9011.0000,percent of total billed charges,"90% of $9,011.00 in Billed Charges for Rev 272 = $8,109.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STEALTH CROWN CLASSIC & SOLID,272,RC,27201644,CDM,,,,,,both,,,9011.0000,1351.6500,MEDCOST,MEDCOST VHN,4288.33,,,,,,,2325.7400,9011.0000,percent of total billed charges,"47.59% of $9,011.00 in Billed Charges for Rev 272 = $4,288.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STEALTH CROWN CLASSIC & SOLID,272,RC,27201644,CDM,,,,,,both,,,9011.0000,1351.6500,SENTARA HEALTH,SENTARA HEALTH,2325.74,,,,,,,2325.7400,9011.0000,percent of total billed charges,"25.81% of $9,011.00 in Billed Charges for Rev 272 = $2,325.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STEALTH CROWN CLASSIC & SOLID,272,RC,27201644,CDM,,,,,,both,,,9011.0000,1351.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9011.00,,,,,,,2325.7400,9011.0000,percent of total billed charges,"100% of $9,011.00 in Billed Charges for Rev 272 = $9,011.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STEALTH CROWN CLASSIC & SOLID,272,RC,27201644,CDM,,,,,,both,,,9011.0000,1351.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4505.50,,,,,,,2325.7400,9011.0000,percent of total billed charges,"Rev 272 $9,011.00 in Billed Charges at 50% = $4,505.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STEALTH CROWN CLASSIC & SOLID,272,RC,27201644,CDM,,,,,,both,,,9011.0000,1351.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2910.55,,,,,,,2325.7400,9011.0000,other,"32.3% of $9,011.00 in Billed Charges for Rev 272 = $2,910.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STEALTH CROWN CLASSIC & SOLID,272,RC,27201644,CDM,,,,,,both,,,9011.0000,1351.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2766.38,,,,,,,2325.7400,9011.0000,other,"30.7% of $9,011.00 in Billed Charges for Rev 272 = $2,766.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STEALTH CROWN CLASSIC & SOLID,272,RC,27201644,CDM,,,,,,both,,,9011.0000,1351.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,2910.55,,,,,,,2325.7400,9011.0000,percent of total billed charges,"32.3% of $9,011.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STEALTH CROWN CLASSIC & SOLID,272,RC,27201644,CDM,,,,,,both,,,9011.0000,1351.6500,WELLCARE,WELLCARE MEDICAID,9011.00,,,,,,,2325.7400,9011.0000,percent of total billed charges,"100% of $9,011.00 in Billed Charges for Rev 272 = $9,011.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT SCAFFOLD CAROTID 6-8X30MM TO 8-10X30MM  TAPER,278,RC,27801530,CDM,,,,,,both,,,5906.0000,885.9000,AETNA,AETNA,2834.88,,,,,,,1524.3400,5906.0000,percent of total billed charges,"48% of $5,906.00 in Billed Charges for Rev 278 = $2,834.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT SCAFFOLD CAROTID 6-8X30MM TO 8-10X30MM  TAPER,278,RC,27801530,CDM,,,,,,both,,,5906.0000,885.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2953.00,,,,,,,1524.3400,5906.0000,percent of total billed charges,"50% of $5,906.00 in Billed Charges for Rev 278 = $2,953.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT SCAFFOLD CAROTID 6-8X30MM TO 8-10X30MM  TAPER,278,RC,27801530,CDM,,,,,,both,,,5906.0000,885.9000,CIGNA HEALTHCARE,CIGNA HMO,2462.80,,,,,,,1524.3400,5906.0000,percent of total billed charges,"41.7% of $5,906.00 in Billed Charges for Rev 278 = $2,462.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT SCAFFOLD CAROTID 6-8X30MM TO 8-10X30MM  TAPER,278,RC,27801530,CDM,,,,,,both,,,5906.0000,885.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2362.40,,,,,,,1524.3400,5906.0000,percent of total billed charges,"40% of $5,906.00 in Billed Charges for Rev 278 = $2,362.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT SCAFFOLD CAROTID 6-8X30MM TO 8-10X30MM  TAPER,278,RC,27801530,CDM,,,,,,both,,,5906.0000,885.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2462.80,,,,,,,1524.3400,5906.0000,percent of total billed charges,"41.7% of $5,906.00 in Billed Charges for Rev 278 = $2,462.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT SCAFFOLD CAROTID 6-8X30MM TO 8-10X30MM  TAPER,278,RC,27801530,CDM,,,,,,both,,,5906.0000,885.9000,CIGNA HEALTHCARE,CIGNA PPO,2462.80,,,,,,,1524.3400,5906.0000,percent of total billed charges,"41.7% of $5,906.00 in Billed Charges for Rev 278 = $2,462.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT SCAFFOLD CAROTID 6-8X30MM TO 8-10X30MM  TAPER,278,RC,27801530,CDM,,,,,,both,,,5906.0000,885.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5315.40,,,,,,,1524.3400,5906.0000,percent of total billed charges,"90% of $5,906.00 in Billed Charges for Rev 278 = $5,315.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT SCAFFOLD CAROTID 6-8X30MM TO 8-10X30MM  TAPER,278,RC,27801530,CDM,,,,,,both,,,5906.0000,885.9000,MEDCOST,MEDCOST VHN,2810.67,,,,,,,1524.3400,5906.0000,percent of total billed charges,"47.59% of $5,906.00 in Billed Charges for Rev 278 = $2,810.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT SCAFFOLD CAROTID 6-8X30MM TO 8-10X30MM  TAPER,278,RC,27801530,CDM,,,,,,both,,,5906.0000,885.9000,SENTARA HEALTH,SENTARA HEALTH,1524.34,,,,,,,1524.3400,5906.0000,percent of total billed charges,"25.81% of $5,906.00 in Billed Charges for Rev 278 = $1,524.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT SCAFFOLD CAROTID 6-8X30MM TO 8-10X30MM  TAPER,278,RC,27801530,CDM,,,,,,both,,,5906.0000,885.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5906.00,,,,,,,1524.3400,5906.0000,percent of total billed charges,"100% of $5,906.00 in Billed Charges for Rev 278 = $5,906.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT SCAFFOLD CAROTID 6-8X30MM TO 8-10X30MM  TAPER,278,RC,27801530,CDM,,,,,,both,,,5906.0000,885.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2953.00,,,,,,,1524.3400,5906.0000,percent of total billed charges,"Rev 278 $5,906.00 in Billed Charges at 50% = $2,953.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT SCAFFOLD CAROTID 6-8X30MM TO 8-10X30MM  TAPER,278,RC,27801530,CDM,,,,,,both,,,5906.0000,885.9000,WELLCARE,WELLCARE MEDICAID,5906.00,,,,,,,1524.3400,5906.0000,percent of total billed charges,"100% of $5,906.00 in Billed Charges for Rev 278 = $5,906.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STERILE C-ARM DRAPE E9100AH,272,RC,27201118,CDM,,,,,,both,,,109.0000,16.3500,AETNA,AETNA,46.54,,,,,,,28.1300,109.0000,percent of total billed charges,42.7% of $109.00 in Billed Charges for Rev 272 = $46.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STERILE C-ARM DRAPE E9100AH,272,RC,27201118,CDM,,,,,,both,,,109.0000,16.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,76.30,,,,,,,28.1300,109.0000,percent of total billed charges,Rev 272 $109.00 in Billed Charges at 70% = $76.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STERILE C-ARM DRAPE E9100AH,272,RC,27201118,CDM,,,,,,both,,,109.0000,16.3500,CIGNA HEALTHCARE,CIGNA HMO,45.45,,,,,,,28.1300,109.0000,percent of total billed charges,41.7% of $109.00 in Billed Charges for Rev 272 = $45.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STERILE C-ARM DRAPE E9100AH,272,RC,27201118,CDM,,,,,,both,,,109.0000,16.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,50.58,,,,,,,28.1300,109.0000,percent of total billed charges,46.4% of $109.00 in Billed Charges for Rev 272 = $50.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STERILE C-ARM DRAPE E9100AH,272,RC,27201118,CDM,,,,,,both,,,109.0000,16.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,45.45,,,,,,,28.1300,109.0000,percent of total billed charges,41.7% of $109.00 in Billed Charges for Rev 272 = $45.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STERILE C-ARM DRAPE E9100AH,272,RC,27201118,CDM,,,,,,both,,,109.0000,16.3500,CIGNA HEALTHCARE,CIGNA PPO,45.45,,,,,,,28.1300,109.0000,percent of total billed charges,41.7% of $109.00 in Billed Charges for Rev 272 = $45.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STERILE C-ARM DRAPE E9100AH,272,RC,27201118,CDM,,,,,,both,,,109.0000,16.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,98.10,,,,,,,28.1300,109.0000,percent of total billed charges,90% of $109.00 in Billed Charges for Rev 272 = $98.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STERILE C-ARM DRAPE E9100AH,272,RC,27201118,CDM,,,,,,both,,,109.0000,16.3500,MEDCOST,MEDCOST VHN,51.87,,,,,,,28.1300,109.0000,percent of total billed charges,47.59% of $109.00 in Billed Charges for Rev 272 = $51.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STERILE C-ARM DRAPE E9100AH,272,RC,27201118,CDM,,,,,,both,,,109.0000,16.3500,SENTARA HEALTH,SENTARA HEALTH,28.13,,,,,,,28.1300,109.0000,percent of total billed charges,25.81% of $109.00 in Billed Charges for Rev 272 = $28.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STERILE C-ARM DRAPE E9100AH,272,RC,27201118,CDM,,,,,,both,,,109.0000,16.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",109.00,,,,,,,28.1300,109.0000,percent of total billed charges,100% of $109.00 in Billed Charges for Rev 272 = $109.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STERILE C-ARM DRAPE E9100AH,272,RC,27201118,CDM,,,,,,both,,,109.0000,16.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,54.50,,,,,,,28.1300,109.0000,percent of total billed charges,Rev 272 $109.00 in Billed Charges at 50% = $54.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STERILE C-ARM DRAPE E9100AH,272,RC,27201118,CDM,,,,,,both,,,109.0000,16.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,35.21,,,,,,,28.1300,109.0000,other,32.3% of $109.00 in Billed Charges for Rev 272 = $35.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERILE C-ARM DRAPE E9100AH,272,RC,27201118,CDM,,,,,,both,,,109.0000,16.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,33.46,,,,,,,28.1300,109.0000,other,30.7% of $109.00 in Billed Charges for Rev 272 = $33.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STERILE C-ARM DRAPE E9100AH,272,RC,27201118,CDM,,,,,,both,,,109.0000,16.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,35.21,,,,,,,28.1300,109.0000,percent of total billed charges,32.3% of $109.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STERILE C-ARM DRAPE E9100AH,272,RC,27201118,CDM,,,,,,both,,,109.0000,16.3500,WELLCARE,WELLCARE MEDICAID,109.00,,,,,,,28.1300,109.0000,percent of total billed charges,100% of $109.00 in Billed Charges for Rev 272 = $109.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMATC LARGE,272,RC,27200002,CDM,,,,,,both,,,663.0400,99.4600,AETNA,AETNA,283.12,,,,,,,171.1300,663.0400,percent of total billed charges,42.7% of $663.04 in Billed Charges for Rev 272 = $283.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMATC LARGE,272,RC,27200002,CDM,,,,,,both,,,663.0400,99.4600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,464.13,,,,,,,171.1300,663.0400,percent of total billed charges,Rev 272 $663.04 in Billed Charges at 70% = $464.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMATC LARGE,272,RC,27200002,CDM,,,,,,both,,,663.0400,99.4600,CIGNA HEALTHCARE,CIGNA HMO,276.49,,,,,,,171.1300,663.0400,percent of total billed charges,41.7% of $663.04 in Billed Charges for Rev 272 = $276.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMATC LARGE,272,RC,27200002,CDM,,,,,,both,,,663.0400,99.4600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,307.65,,,,,,,171.1300,663.0400,percent of total billed charges,46.4% of $663.04 in Billed Charges for Rev 272 = $307.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMATC LARGE,272,RC,27200002,CDM,,,,,,both,,,663.0400,99.4600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,276.49,,,,,,,171.1300,663.0400,percent of total billed charges,41.7% of $663.04 in Billed Charges for Rev 272 = $276.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMATC LARGE,272,RC,27200002,CDM,,,,,,both,,,663.0400,99.4600,CIGNA HEALTHCARE,CIGNA PPO,276.49,,,,,,,171.1300,663.0400,percent of total billed charges,41.7% of $663.04 in Billed Charges for Rev 272 = $276.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMATC LARGE,272,RC,27200002,CDM,,,,,,both,,,663.0400,99.4600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,596.74,,,,,,,171.1300,663.0400,percent of total billed charges,90% of $663.04 in Billed Charges for Rev 272 = $596.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMATC LARGE,272,RC,27200002,CDM,,,,,,both,,,663.0400,99.4600,MEDCOST,MEDCOST VHN,315.54,,,,,,,171.1300,663.0400,percent of total billed charges,47.59% of $663.04 in Billed Charges for Rev 272 = $315.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMATC LARGE,272,RC,27200002,CDM,,,,,,both,,,663.0400,99.4600,SENTARA HEALTH,SENTARA HEALTH,171.13,,,,,,,171.1300,663.0400,percent of total billed charges,25.81% of $663.04 in Billed Charges for Rev 272 = $171.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMATC LARGE,272,RC,27200002,CDM,,,,,,both,,,663.0400,99.4600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",663.04,,,,,,,171.1300,663.0400,percent of total billed charges,100% of $663.04 in Billed Charges for Rev 272 = $663.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMATC LARGE,272,RC,27200002,CDM,,,,,,both,,,663.0400,99.4600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,331.52,,,,,,,171.1300,663.0400,percent of total billed charges,Rev 272 $663.04 in Billed Charges at 50% = $331.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMATC LARGE,272,RC,27200002,CDM,,,,,,both,,,663.0400,99.4600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,214.16,,,,,,,171.1300,663.0400,other,32.3% of $663.04 in Billed Charges for Rev 272 = $214.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT DRESSING DRAPE 3M DERMATC LARGE,272,RC,27200002,CDM,,,,,,both,,,663.0400,99.4600,UNITED HEALTHCARE,UHC HERITAGE SELECT,203.55,,,,,,,171.1300,663.0400,other,30.7% of $663.04 in Billed Charges for Rev 272 = $203.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT DRESSING DRAPE 3M DERMATC LARGE,272,RC,27200002,CDM,,,,,,both,,,663.0400,99.4600,UNITED HEALTHCARE,UNITED HEALTHCARE,214.16,,,,,,,171.1300,663.0400,percent of total billed charges,32.3% of $663.04 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT DRESSING DRAPE 3M DERMATC LARGE,272,RC,27200002,CDM,,,,,,both,,,663.0400,99.4600,WELLCARE,WELLCARE MEDICAID,663.04,,,,,,,171.1300,663.0400,percent of total billed charges,100% of $663.04 in Billed Charges for Rev 272 = $663.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SPINEJACK TO INCLUDE PREP KIT AND 2 EXPANSION KITS,272,RC,,,,,,,,both,,,40171.5500,6025.7300,AETNA,AETNA,17153.25,,,,,,,10368.2800,40171.5500,percent of total billed charges,"42.7% of $40,171.55 in Billed Charges for Rev 272 = $17,153.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPINEJACK TO INCLUDE PREP KIT AND 2 EXPANSION KITS,272,RC,,,,,,,,both,,,40171.5500,6025.7300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,28120.09,,,,,,,10368.2800,40171.5500,percent of total billed charges,"Rev 272 $40,171.55 in Billed Charges at 70% = $28,120.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPINEJACK TO INCLUDE PREP KIT AND 2 EXPANSION KITS,272,RC,,,,,,,,both,,,40171.5500,6025.7300,CIGNA HEALTHCARE,CIGNA HMO,16751.54,,,,,,,10368.2800,40171.5500,percent of total billed charges,"41.7% of $40,171.55 in Billed Charges for Rev 272 = $16,751.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPINEJACK TO INCLUDE PREP KIT AND 2 EXPANSION KITS,272,RC,,,,,,,,both,,,40171.5500,6025.7300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,18639.60,,,,,,,10368.2800,40171.5500,percent of total billed charges,"46.4% of $40,171.55 in Billed Charges for Rev 272 = $18,639.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPINEJACK TO INCLUDE PREP KIT AND 2 EXPANSION KITS,272,RC,,,,,,,,both,,,40171.5500,6025.7300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,16751.54,,,,,,,10368.2800,40171.5500,percent of total billed charges,"41.7% of $40,171.55 in Billed Charges for Rev 272 = $16,751.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPINEJACK TO INCLUDE PREP KIT AND 2 EXPANSION KITS,272,RC,,,,,,,,both,,,40171.5500,6025.7300,CIGNA HEALTHCARE,CIGNA PPO,16751.54,,,,,,,10368.2800,40171.5500,percent of total billed charges,"41.7% of $40,171.55 in Billed Charges for Rev 272 = $16,751.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPINEJACK TO INCLUDE PREP KIT AND 2 EXPANSION KITS,272,RC,,,,,,,,both,,,40171.5500,6025.7300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,36154.40,,,,,,,10368.2800,40171.5500,percent of total billed charges,"90% of $40,171.55 in Billed Charges for Rev 272 = $36,154.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPINEJACK TO INCLUDE PREP KIT AND 2 EXPANSION KITS,272,RC,,,,,,,,both,,,40171.5500,6025.7300,MEDCOST,MEDCOST VHN,19117.64,,,,,,,10368.2800,40171.5500,percent of total billed charges,"47.59% of $40,171.55 in Billed Charges for Rev 272 = $19,117.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPINEJACK TO INCLUDE PREP KIT AND 2 EXPANSION KITS,272,RC,,,,,,,,both,,,40171.5500,6025.7300,SENTARA HEALTH,SENTARA HEALTH,10368.28,,,,,,,10368.2800,40171.5500,percent of total billed charges,"25.81% of $40,171.55 in Billed Charges for Rev 272 = $10,368.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPINEJACK TO INCLUDE PREP KIT AND 2 EXPANSION KITS,272,RC,,,,,,,,both,,,40171.5500,6025.7300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",40171.55,,,,,,,10368.2800,40171.5500,percent of total billed charges,"100% of $40,171.55 in Billed Charges for Rev 272 = $40,171.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPINEJACK TO INCLUDE PREP KIT AND 2 EXPANSION KITS,272,RC,,,,,,,,both,,,40171.5500,6025.7300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,20085.78,,,,,,,10368.2800,40171.5500,percent of total billed charges,"Rev 272 $40,171.55 in Billed Charges at 50% = $20,085.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPINEJACK TO INCLUDE PREP KIT AND 2 EXPANSION KITS,272,RC,,,,,,,,both,,,40171.5500,6025.7300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12975.41,,,,,,,10368.2800,40171.5500,other,"32.3% of $40,171.55 in Billed Charges for Rev 272 = $12,975.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT SPINEJACK TO INCLUDE PREP KIT AND 2 EXPANSION KITS,272,RC,,,,,,,,both,,,40171.5500,6025.7300,UNITED HEALTHCARE,UHC HERITAGE SELECT,12332.67,,,,,,,10368.2800,40171.5500,other,"30.7% of $40,171.55 in Billed Charges for Rev 272 = $12,332.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT SPINEJACK TO INCLUDE PREP KIT AND 2 EXPANSION KITS,272,RC,,,,,,,,both,,,40171.5500,6025.7300,UNITED HEALTHCARE,UNITED HEALTHCARE,12975.41,,,,,,,10368.2800,40171.5500,percent of total billed charges,"32.3% of $40,171.55 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SPINEJACK TO INCLUDE PREP KIT AND 2 EXPANSION KITS,272,RC,,,,,,,,both,,,40171.5500,6025.7300,WELLCARE,WELLCARE MEDICAID,40171.55,,,,,,,10368.2800,40171.5500,percent of total billed charges,"100% of $40,171.55 in Billed Charges for Rev 272 = $40,171.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT STAPLE PLATE SHARPS,272,RC,27200002,CDM,,,,,,both,,,7825.2300,1173.7800,AETNA,AETNA,3341.37,,,,,,,2019.6900,7825.2300,percent of total billed charges,"42.7% of $7,825.23 in Billed Charges for Rev 272 = $3,341.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT STAPLE PLATE SHARPS,272,RC,27200002,CDM,,,,,,both,,,7825.2300,1173.7800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5477.66,,,,,,,2019.6900,7825.2300,percent of total billed charges,"Rev 272 $7,825.23 in Billed Charges at 70% = $5,477.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT STAPLE PLATE SHARPS,272,RC,27200002,CDM,,,,,,both,,,7825.2300,1173.7800,CIGNA HEALTHCARE,CIGNA HMO,3263.12,,,,,,,2019.6900,7825.2300,percent of total billed charges,"41.7% of $7,825.23 in Billed Charges for Rev 272 = $3,263.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT STAPLE PLATE SHARPS,272,RC,27200002,CDM,,,,,,both,,,7825.2300,1173.7800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3630.91,,,,,,,2019.6900,7825.2300,percent of total billed charges,"46.4% of $7,825.23 in Billed Charges for Rev 272 = $3,630.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT STAPLE PLATE SHARPS,272,RC,27200002,CDM,,,,,,both,,,7825.2300,1173.7800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3263.12,,,,,,,2019.6900,7825.2300,percent of total billed charges,"41.7% of $7,825.23 in Billed Charges for Rev 272 = $3,263.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT STAPLE PLATE SHARPS,272,RC,27200002,CDM,,,,,,both,,,7825.2300,1173.7800,CIGNA HEALTHCARE,CIGNA PPO,3263.12,,,,,,,2019.6900,7825.2300,percent of total billed charges,"41.7% of $7,825.23 in Billed Charges for Rev 272 = $3,263.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT STAPLE PLATE SHARPS,272,RC,27200002,CDM,,,,,,both,,,7825.2300,1173.7800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7042.71,,,,,,,2019.6900,7825.2300,percent of total billed charges,"90% of $7,825.23 in Billed Charges for Rev 272 = $7,042.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT STAPLE PLATE SHARPS,272,RC,27200002,CDM,,,,,,both,,,7825.2300,1173.7800,MEDCOST,MEDCOST VHN,3724.03,,,,,,,2019.6900,7825.2300,percent of total billed charges,"47.59% of $7,825.23 in Billed Charges for Rev 272 = $3,724.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT STAPLE PLATE SHARPS,272,RC,27200002,CDM,,,,,,both,,,7825.2300,1173.7800,SENTARA HEALTH,SENTARA HEALTH,2019.69,,,,,,,2019.6900,7825.2300,percent of total billed charges,"25.81% of $7,825.23 in Billed Charges for Rev 272 = $2,019.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT STAPLE PLATE SHARPS,272,RC,27200002,CDM,,,,,,both,,,7825.2300,1173.7800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7825.23,,,,,,,2019.6900,7825.2300,percent of total billed charges,"100% of $7,825.23 in Billed Charges for Rev 272 = $7,825.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT STAPLE PLATE SHARPS,272,RC,27200002,CDM,,,,,,both,,,7825.2300,1173.7800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3912.62,,,,,,,2019.6900,7825.2300,percent of total billed charges,"Rev 272 $7,825.23 in Billed Charges at 50% = $3,912.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT STAPLE PLATE SHARPS,272,RC,27200002,CDM,,,,,,both,,,7825.2300,1173.7800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2527.55,,,,,,,2019.6900,7825.2300,other,"32.3% of $7,825.23 in Billed Charges for Rev 272 = $2,527.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT STAPLE PLATE SHARPS,272,RC,27200002,CDM,,,,,,both,,,7825.2300,1173.7800,UNITED HEALTHCARE,UHC HERITAGE SELECT,2402.35,,,,,,,2019.6900,7825.2300,other,"30.7% of $7,825.23 in Billed Charges for Rev 272 = $2,402.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT STAPLE PLATE SHARPS,272,RC,27200002,CDM,,,,,,both,,,7825.2300,1173.7800,UNITED HEALTHCARE,UNITED HEALTHCARE,2527.55,,,,,,,2019.6900,7825.2300,percent of total billed charges,"32.3% of $7,825.23 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT STAPLE PLATE SHARPS,272,RC,27200002,CDM,,,,,,both,,,7825.2300,1173.7800,WELLCARE,WELLCARE MEDICAID,7825.23,,,,,,,2019.6900,7825.2300,percent of total billed charges,"100% of $7,825.23 in Billed Charges for Rev 272 = $7,825.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VIPERTRACK RADIOPAQUE TAPE,272,RC,27201647,CDM,,,,,,both,,,195.0000,29.2500,AETNA,AETNA,83.27,,,,,,,50.3300,195.0000,percent of total billed charges,42.7% of $195.00 in Billed Charges for Rev 272 = $83.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERTRACK RADIOPAQUE TAPE,272,RC,27201647,CDM,,,,,,both,,,195.0000,29.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,136.50,,,,,,,50.3300,195.0000,percent of total billed charges,Rev 272 $195.00 in Billed Charges at 70% = $136.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERTRACK RADIOPAQUE TAPE,272,RC,27201647,CDM,,,,,,both,,,195.0000,29.2500,CIGNA HEALTHCARE,CIGNA HMO,81.32,,,,,,,50.3300,195.0000,percent of total billed charges,41.7% of $195.00 in Billed Charges for Rev 272 = $81.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERTRACK RADIOPAQUE TAPE,272,RC,27201647,CDM,,,,,,both,,,195.0000,29.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,90.48,,,,,,,50.3300,195.0000,percent of total billed charges,46.4% of $195.00 in Billed Charges for Rev 272 = $90.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERTRACK RADIOPAQUE TAPE,272,RC,27201647,CDM,,,,,,both,,,195.0000,29.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,81.32,,,,,,,50.3300,195.0000,percent of total billed charges,41.7% of $195.00 in Billed Charges for Rev 272 = $81.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERTRACK RADIOPAQUE TAPE,272,RC,27201647,CDM,,,,,,both,,,195.0000,29.2500,CIGNA HEALTHCARE,CIGNA PPO,81.32,,,,,,,50.3300,195.0000,percent of total billed charges,41.7% of $195.00 in Billed Charges for Rev 272 = $81.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERTRACK RADIOPAQUE TAPE,272,RC,27201647,CDM,,,,,,both,,,195.0000,29.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,175.50,,,,,,,50.3300,195.0000,percent of total billed charges,90% of $195.00 in Billed Charges for Rev 272 = $175.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERTRACK RADIOPAQUE TAPE,272,RC,27201647,CDM,,,,,,both,,,195.0000,29.2500,MEDCOST,MEDCOST VHN,92.80,,,,,,,50.3300,195.0000,percent of total billed charges,47.59% of $195.00 in Billed Charges for Rev 272 = $92.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERTRACK RADIOPAQUE TAPE,272,RC,27201647,CDM,,,,,,both,,,195.0000,29.2500,SENTARA HEALTH,SENTARA HEALTH,50.33,,,,,,,50.3300,195.0000,percent of total billed charges,25.81% of $195.00 in Billed Charges for Rev 272 = $50.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERTRACK RADIOPAQUE TAPE,272,RC,27201647,CDM,,,,,,both,,,195.0000,29.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",195.00,,,,,,,50.3300,195.0000,percent of total billed charges,100% of $195.00 in Billed Charges for Rev 272 = $195.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERTRACK RADIOPAQUE TAPE,272,RC,27201647,CDM,,,,,,both,,,195.0000,29.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,97.50,,,,,,,50.3300,195.0000,percent of total billed charges,Rev 272 $195.00 in Billed Charges at 50% = $97.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERTRACK RADIOPAQUE TAPE,272,RC,27201647,CDM,,,,,,both,,,195.0000,29.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,62.99,,,,,,,50.3300,195.0000,other,32.3% of $195.00 in Billed Charges for Rev 272 = $62.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIPERTRACK RADIOPAQUE TAPE,272,RC,27201647,CDM,,,,,,both,,,195.0000,29.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,59.87,,,,,,,50.3300,195.0000,other,30.7% of $195.00 in Billed Charges for Rev 272 = $59.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIPERTRACK RADIOPAQUE TAPE,272,RC,27201647,CDM,,,,,,both,,,195.0000,29.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,62.99,,,,,,,50.3300,195.0000,percent of total billed charges,32.3% of $195.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERTRACK RADIOPAQUE TAPE,272,RC,27201647,CDM,,,,,,both,,,195.0000,29.2500,WELLCARE,WELLCARE MEDICAID,195.00,,,,,,,50.3300,195.0000,percent of total billed charges,100% of $195.00 in Billed Charges for Rev 272 = $195.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERWIRE ADVANCED,272,RC,27201645,CDM,,,,,,both,,,625.0000,93.7500,AETNA,AETNA,266.88,,,,,,,161.3100,625.0000,percent of total billed charges,42.7% of $625.00 in Billed Charges for Rev 272 = $266.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERWIRE ADVANCED,272,RC,27201645,CDM,,,,,,both,,,625.0000,93.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,437.50,,,,,,,161.3100,625.0000,percent of total billed charges,Rev 272 $625.00 in Billed Charges at 70% = $437.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERWIRE ADVANCED,272,RC,27201645,CDM,,,,,,both,,,625.0000,93.7500,CIGNA HEALTHCARE,CIGNA HMO,260.63,,,,,,,161.3100,625.0000,percent of total billed charges,41.7% of $625.00 in Billed Charges for Rev 272 = $260.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERWIRE ADVANCED,272,RC,27201645,CDM,,,,,,both,,,625.0000,93.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,290.00,,,,,,,161.3100,625.0000,percent of total billed charges,46.4% of $625.00 in Billed Charges for Rev 272 = $290.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERWIRE ADVANCED,272,RC,27201645,CDM,,,,,,both,,,625.0000,93.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,260.63,,,,,,,161.3100,625.0000,percent of total billed charges,41.7% of $625.00 in Billed Charges for Rev 272 = $260.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERWIRE ADVANCED,272,RC,27201645,CDM,,,,,,both,,,625.0000,93.7500,CIGNA HEALTHCARE,CIGNA PPO,260.63,,,,,,,161.3100,625.0000,percent of total billed charges,41.7% of $625.00 in Billed Charges for Rev 272 = $260.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERWIRE ADVANCED,272,RC,27201645,CDM,,,,,,both,,,625.0000,93.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,562.50,,,,,,,161.3100,625.0000,percent of total billed charges,90% of $625.00 in Billed Charges for Rev 272 = $562.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERWIRE ADVANCED,272,RC,27201645,CDM,,,,,,both,,,625.0000,93.7500,MEDCOST,MEDCOST VHN,297.44,,,,,,,161.3100,625.0000,percent of total billed charges,47.59% of $625.00 in Billed Charges for Rev 272 = $297.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERWIRE ADVANCED,272,RC,27201645,CDM,,,,,,both,,,625.0000,93.7500,SENTARA HEALTH,SENTARA HEALTH,161.31,,,,,,,161.3100,625.0000,percent of total billed charges,25.81% of $625.00 in Billed Charges for Rev 272 = $161.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERWIRE ADVANCED,272,RC,27201645,CDM,,,,,,both,,,625.0000,93.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",625.00,,,,,,,161.3100,625.0000,percent of total billed charges,100% of $625.00 in Billed Charges for Rev 272 = $625.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERWIRE ADVANCED,272,RC,27201645,CDM,,,,,,both,,,625.0000,93.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,312.50,,,,,,,161.3100,625.0000,percent of total billed charges,Rev 272 $625.00 in Billed Charges at 50% = $312.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERWIRE ADVANCED,272,RC,27201645,CDM,,,,,,both,,,625.0000,93.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,201.88,,,,,,,161.3100,625.0000,other,32.3% of $625.00 in Billed Charges for Rev 272 = $201.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIPERWIRE ADVANCED,272,RC,27201645,CDM,,,,,,both,,,625.0000,93.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,191.88,,,,,,,161.3100,625.0000,other,30.7% of $625.00 in Billed Charges for Rev 272 = $191.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIPERWIRE ADVANCED,272,RC,27201645,CDM,,,,,,both,,,625.0000,93.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,201.88,,,,,,,161.3100,625.0000,percent of total billed charges,32.3% of $625.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIPERWIRE ADVANCED,272,RC,27201645,CDM,,,,,,both,,,625.0000,93.7500,WELLCARE,WELLCARE MEDICAID,625.00,,,,,,,161.3100,625.0000,percent of total billed charges,100% of $625.00 in Billed Charges for Rev 272 = $625.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAFER SKIN BARRIER 4X4 21712,270,RC,27000048,CDM,,,,,,both,,,25.0000,3.7500,AETNA,AETNA,10.68,,,,,,,6.4500,25.0000,percent of total billed charges,42.7% of $25.00 in Billed Charges for Rev 270 = $10.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAFER SKIN BARRIER 4X4 21712,270,RC,27000048,CDM,,,,,,both,,,25.0000,3.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,17.50,,,,,,,6.4500,25.0000,percent of total billed charges,Rev 270 $25.00 in Billed Charges at 70% = $17.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAFER SKIN BARRIER 4X4 21712,270,RC,27000048,CDM,,,,,,both,,,25.0000,3.7500,CIGNA HEALTHCARE,CIGNA HMO,10.43,,,,,,,6.4500,25.0000,percent of total billed charges,41.7% of $25.00 in Billed Charges for Rev 270 = $10.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAFER SKIN BARRIER 4X4 21712,270,RC,27000048,CDM,,,,,,both,,,25.0000,3.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11.60,,,,,,,6.4500,25.0000,percent of total billed charges,46.4% of $25.00 in Billed Charges for Rev 270 = $11.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAFER SKIN BARRIER 4X4 21712,270,RC,27000048,CDM,,,,,,both,,,25.0000,3.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,10.43,,,,,,,6.4500,25.0000,percent of total billed charges,41.7% of $25.00 in Billed Charges for Rev 270 = $10.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAFER SKIN BARRIER 4X4 21712,270,RC,27000048,CDM,,,,,,both,,,25.0000,3.7500,CIGNA HEALTHCARE,CIGNA PPO,10.43,,,,,,,6.4500,25.0000,percent of total billed charges,41.7% of $25.00 in Billed Charges for Rev 270 = $10.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAFER SKIN BARRIER 4X4 21712,270,RC,27000048,CDM,,,,,,both,,,25.0000,3.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,22.50,,,,,,,6.4500,25.0000,percent of total billed charges,90% of $25.00 in Billed Charges for Rev 270 = $22.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAFER SKIN BARRIER 4X4 21712,270,RC,27000048,CDM,,,,,,both,,,25.0000,3.7500,MEDCOST,MEDCOST VHN,11.90,,,,,,,6.4500,25.0000,percent of total billed charges,47.59% of $25.00 in Billed Charges for Rev 270 = $11.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAFER SKIN BARRIER 4X4 21712,270,RC,27000048,CDM,,,,,,both,,,25.0000,3.7500,SENTARA HEALTH,SENTARA HEALTH,6.45,,,,,,,6.4500,25.0000,percent of total billed charges,25.81% of $25.00 in Billed Charges for Rev 270 = $6.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAFER SKIN BARRIER 4X4 21712,270,RC,27000048,CDM,,,,,,both,,,25.0000,3.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",25.00,,,,,,,6.4500,25.0000,percent of total billed charges,100% of $25.00 in Billed Charges for Rev 270 = $25.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAFER SKIN BARRIER 4X4 21712,270,RC,27000048,CDM,,,,,,both,,,25.0000,3.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,12.50,,,,,,,6.4500,25.0000,percent of total billed charges,Rev 270 $25.00 in Billed Charges at 50% = $12.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAFER SKIN BARRIER 4X4 21712,270,RC,27000048,CDM,,,,,,both,,,25.0000,3.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,8.08,,,,,,,6.4500,25.0000,other,32.3% of $25.00 in Billed Charges for Rev 270 = $8.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WAFER SKIN BARRIER 4X4 21712,270,RC,27000048,CDM,,,,,,both,,,25.0000,3.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7.68,,,,,,,6.4500,25.0000,other,30.7% of $25.00 in Billed Charges for Rev 270 = $7.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WAFER SKIN BARRIER 4X4 21712,270,RC,27000048,CDM,,,,,,both,,,25.0000,3.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,8.08,,,,,,,6.4500,25.0000,percent of total billed charges,32.3% of $25.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAFER SKIN BARRIER 4X4 21712,270,RC,27000048,CDM,,,,,,both,,,25.0000,3.7500,WELLCARE,WELLCARE MEDICAID,25.00,,,,,,,6.4500,25.0000,percent of total billed charges,100% of $25.00 in Billed Charges for Rev 270 = $25.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC WAFER SURFIT 4"" 401905",270,RC,27000052,CDM,,,,,,both,,,62.0000,9.3000,AETNA,AETNA,26.47,,,,,,,16.0000,62.0000,percent of total billed charges,42.7% of $62.00 in Billed Charges for Rev 270 = $26.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC WAFER SURFIT 4"" 401905",270,RC,27000052,CDM,,,,,,both,,,62.0000,9.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,43.40,,,,,,,16.0000,62.0000,percent of total billed charges,Rev 270 $62.00 in Billed Charges at 70% = $43.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC WAFER SURFIT 4"" 401905",270,RC,27000052,CDM,,,,,,both,,,62.0000,9.3000,CIGNA HEALTHCARE,CIGNA HMO,25.85,,,,,,,16.0000,62.0000,percent of total billed charges,41.7% of $62.00 in Billed Charges for Rev 270 = $25.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC WAFER SURFIT 4"" 401905",270,RC,27000052,CDM,,,,,,both,,,62.0000,9.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,28.77,,,,,,,16.0000,62.0000,percent of total billed charges,46.4% of $62.00 in Billed Charges for Rev 270 = $28.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC WAFER SURFIT 4"" 401905",270,RC,27000052,CDM,,,,,,both,,,62.0000,9.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,25.85,,,,,,,16.0000,62.0000,percent of total billed charges,41.7% of $62.00 in Billed Charges for Rev 270 = $25.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC WAFER SURFIT 4"" 401905",270,RC,27000052,CDM,,,,,,both,,,62.0000,9.3000,CIGNA HEALTHCARE,CIGNA PPO,25.85,,,,,,,16.0000,62.0000,percent of total billed charges,41.7% of $62.00 in Billed Charges for Rev 270 = $25.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC WAFER SURFIT 4"" 401905",270,RC,27000052,CDM,,,,,,both,,,62.0000,9.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,55.80,,,,,,,16.0000,62.0000,percent of total billed charges,90% of $62.00 in Billed Charges for Rev 270 = $55.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC WAFER SURFIT 4"" 401905",270,RC,27000052,CDM,,,,,,both,,,62.0000,9.3000,MEDCOST,MEDCOST VHN,29.51,,,,,,,16.0000,62.0000,percent of total billed charges,47.59% of $62.00 in Billed Charges for Rev 270 = $29.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC WAFER SURFIT 4"" 401905",270,RC,27000052,CDM,,,,,,both,,,62.0000,9.3000,SENTARA HEALTH,SENTARA HEALTH,16.00,,,,,,,16.0000,62.0000,percent of total billed charges,25.81% of $62.00 in Billed Charges for Rev 270 = $16.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC WAFER SURFIT 4"" 401905",270,RC,27000052,CDM,,,,,,both,,,62.0000,9.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",62.00,,,,,,,16.0000,62.0000,percent of total billed charges,100% of $62.00 in Billed Charges for Rev 270 = $62.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC WAFER SURFIT 4"" 401905",270,RC,27000052,CDM,,,,,,both,,,62.0000,9.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,31.00,,,,,,,16.0000,62.0000,percent of total billed charges,Rev 270 $62.00 in Billed Charges at 50% = $31.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC WAFER SURFIT 4"" 401905",270,RC,27000052,CDM,,,,,,both,,,62.0000,9.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,20.03,,,,,,,16.0000,62.0000,other,32.3% of $62.00 in Billed Charges for Rev 270 = $20.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
"HC WAFER SURFIT 4"" 401905",270,RC,27000052,CDM,,,,,,both,,,62.0000,9.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,19.03,,,,,,,16.0000,62.0000,other,30.7% of $62.00 in Billed Charges for Rev 270 = $19.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
"HC WAFER SURFIT 4"" 401905",270,RC,27000052,CDM,,,,,,both,,,62.0000,9.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,20.03,,,,,,,16.0000,62.0000,percent of total billed charges,32.3% of $62.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"HC WAFER SURFIT 4"" 401905",270,RC,27000052,CDM,,,,,,both,,,62.0000,9.3000,WELLCARE,WELLCARE MEDICAID,62.00,,,,,,,16.0000,62.0000,percent of total billed charges,100% of $62.00 in Billed Charges for Rev 270 = $62.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND TONSIL/ADENOID EVAC 70,272,RC,27201265,CDM,,,,,,both,,,827.0000,124.0500,AETNA,AETNA,353.13,,,,,,,213.4500,827.0000,percent of total billed charges,42.7% of $827.00 in Billed Charges for Rev 272 = $353.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND TONSIL/ADENOID EVAC 70,272,RC,27201265,CDM,,,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,578.90,,,,,,,213.4500,827.0000,percent of total billed charges,Rev 272 $827.00 in Billed Charges at 70% = $578.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND TONSIL/ADENOID EVAC 70,272,RC,27201265,CDM,,,,,,both,,,827.0000,124.0500,CIGNA HEALTHCARE,CIGNA HMO,344.86,,,,,,,213.4500,827.0000,percent of total billed charges,41.7% of $827.00 in Billed Charges for Rev 272 = $344.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND TONSIL/ADENOID EVAC 70,272,RC,27201265,CDM,,,,,,both,,,827.0000,124.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,383.73,,,,,,,213.4500,827.0000,percent of total billed charges,46.4% of $827.00 in Billed Charges for Rev 272 = $383.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND TONSIL/ADENOID EVAC 70,272,RC,27201265,CDM,,,,,,both,,,827.0000,124.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,344.86,,,,,,,213.4500,827.0000,percent of total billed charges,41.7% of $827.00 in Billed Charges for Rev 272 = $344.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND TONSIL/ADENOID EVAC 70,272,RC,27201265,CDM,,,,,,both,,,827.0000,124.0500,CIGNA HEALTHCARE,CIGNA PPO,344.86,,,,,,,213.4500,827.0000,percent of total billed charges,41.7% of $827.00 in Billed Charges for Rev 272 = $344.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND TONSIL/ADENOID EVAC 70,272,RC,27201265,CDM,,,,,,both,,,827.0000,124.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,744.30,,,,,,,213.4500,827.0000,percent of total billed charges,90% of $827.00 in Billed Charges for Rev 272 = $744.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND TONSIL/ADENOID EVAC 70,272,RC,27201265,CDM,,,,,,both,,,827.0000,124.0500,MEDCOST,MEDCOST VHN,393.57,,,,,,,213.4500,827.0000,percent of total billed charges,47.59% of $827.00 in Billed Charges for Rev 272 = $393.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND TONSIL/ADENOID EVAC 70,272,RC,27201265,CDM,,,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA HEALTH,213.45,,,,,,,213.4500,827.0000,percent of total billed charges,25.81% of $827.00 in Billed Charges for Rev 272 = $213.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND TONSIL/ADENOID EVAC 70,272,RC,27201265,CDM,,,,,,both,,,827.0000,124.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",827.00,,,,,,,213.4500,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 272 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND TONSIL/ADENOID EVAC 70,272,RC,27201265,CDM,,,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,413.50,,,,,,,213.4500,827.0000,percent of total billed charges,Rev 272 $827.00 in Billed Charges at 50% = $413.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND TONSIL/ADENOID EVAC 70,272,RC,27201265,CDM,,,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,267.12,,,,,,,213.4500,827.0000,other,32.3% of $827.00 in Billed Charges for Rev 272 = $267.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WAND TONSIL/ADENOID EVAC 70,272,RC,27201265,CDM,,,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,253.89,,,,,,,213.4500,827.0000,other,30.7% of $827.00 in Billed Charges for Rev 272 = $253.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WAND TONSIL/ADENOID EVAC 70,272,RC,27201265,CDM,,,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,267.12,,,,,,,213.4500,827.0000,percent of total billed charges,32.3% of $827.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND TONSIL/ADENOID EVAC 70,272,RC,27201265,CDM,,,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICAID,827.00,,,,,,,213.4500,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 272 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WATCHMAN CLOSURE DEVICE LAA,278,RC,27800744,CDM,,,,,,both,,,28470.0000,4270.5000,AETNA,AETNA,13665.60,,,,,,,2021.3700,28470.0000,percent of total billed charges,"48% of $28,470.00 in Billed Charges for Rev 278 = $13,665.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN CLOSURE DEVICE LAA,278,RC,27800744,CDM,,,,,,both,,,28470.0000,4270.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,14235.00,,,,,,,2021.3700,28470.0000,percent of total billed charges,"50% of $28,470.00 in Billed Charges for Rev 278 = $14,235.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN CLOSURE DEVICE LAA,278,RC,27800744,CDM,,,,,,both,,,28470.0000,4270.5000,CIGNA HEALTHCARE,CIGNA HMO,11871.99,,,,,,,2021.3700,28470.0000,percent of total billed charges,"41.7% of $28,470.00 in Billed Charges for Rev 278 = $11,871.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN CLOSURE DEVICE LAA,278,RC,27800744,CDM,,,,,,both,,,28470.0000,4270.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11388.00,,,,,,,2021.3700,28470.0000,percent of total billed charges,"40% of $28,470.00 in Billed Charges for Rev 278 = $11,388.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN CLOSURE DEVICE LAA,278,RC,27800744,CDM,,,,,,both,,,28470.0000,4270.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11871.99,,,,,,,2021.3700,28470.0000,percent of total billed charges,"41.7% of $28,470.00 in Billed Charges for Rev 278 = $11,871.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN CLOSURE DEVICE LAA,278,RC,27800744,CDM,,,,,,both,,,28470.0000,4270.5000,CIGNA HEALTHCARE,CIGNA PPO,11871.99,,,,,,,2021.3700,28470.0000,percent of total billed charges,"41.7% of $28,470.00 in Billed Charges for Rev 278 = $11,871.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN CLOSURE DEVICE LAA,278,RC,27800744,CDM,,,,,,both,,,28470.0000,4270.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,25623.00,,,,,,,2021.3700,28470.0000,percent of total billed charges,"90% of $28,470.00 in Billed Charges for Rev 278 = $25,623.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN CLOSURE DEVICE LAA,278,RC,27800744,CDM,,,,,,both,,,28470.0000,4270.5000,MEDCOST,MEDCOST VHN,13548.87,,,,,,,2021.3700,28470.0000,percent of total billed charges,"47.59% of $28,470.00 in Billed Charges for Rev 278 = $13,548.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN CLOSURE DEVICE LAA,278,RC,27800744,CDM,,,,,,both,,,28470.0000,4270.5000,SENTARA HEALTH,SENTARA HEALTH,7348.11,,,,,,,2021.3700,28470.0000,percent of total billed charges,"25.81% of $28,470.00 in Billed Charges for Rev 278 = $7,348.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN CLOSURE DEVICE LAA,278,RC,27800744,CDM,,,,,,both,,,28470.0000,4270.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",28470.00,,,,,,,2021.3700,28470.0000,percent of total billed charges,"100% of $28,470.00 in Billed Charges for Rev 278 = $28,470.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN CLOSURE DEVICE LAA,278,RC,27800744,CDM,,,,,,both,,,28470.0000,4270.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14235.00,,,,,,,2021.3700,28470.0000,percent of total billed charges,"Rev 278 $28,470.00 in Billed Charges at 50% = $14,235.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN CLOSURE DEVICE LAA,278,RC,27800744,CDM,,,,,,both,,,28470.0000,4270.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2135.25,,,,,,,2021.3700,28470.0000,percent of total billed charges,"7.5% of $28,470.00 in Billed Charges for Rev 278 = $2,135.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN CLOSURE DEVICE LAA,278,RC,27800744,CDM,,,,,,both,,,28470.0000,4270.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2021.37,,,,,,,2021.3700,28470.0000,percent of total billed charges,"7.1% of $28,470.00 in Billed Charges for Rev 278 = $2,021.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN CLOSURE DEVICE LAA,278,RC,27800744,CDM,,,,,,both,,,28470.0000,4270.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,2021.37,,,,,,,2021.3700,28470.0000,percent of total billed charges,"7.1% of $28,470.00 in Billed Charges for Rev 278 = $2,021.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN CLOSURE DEVICE LAA,278,RC,27800744,CDM,,,,,,both,,,28470.0000,4270.5000,WELLCARE,WELLCARE MEDICAID,28470.00,,,,,,,2021.3700,28470.0000,percent of total billed charges,"100% of $28,470.00 in Billed Charges for Rev 278 = $28,470.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX WITH SPIRAL Z TECH AAA ENDOVASCULAR GRAFT ILIAC LEG,278,RC,27800596,CDM,,,,,,both,,,8435.0000,1265.2500,AETNA,AETNA,4048.80,,,,,,,2177.0700,8435.0000,percent of total billed charges,"48% of $8,435.00 in Billed Charges for Rev 278 = $4,048.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX WITH SPIRAL Z TECH AAA ENDOVASCULAR GRAFT ILIAC LEG,278,RC,27800596,CDM,,,,,,both,,,8435.0000,1265.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4217.50,,,,,,,2177.0700,8435.0000,percent of total billed charges,"50% of $8,435.00 in Billed Charges for Rev 278 = $4,217.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX WITH SPIRAL Z TECH AAA ENDOVASCULAR GRAFT ILIAC LEG,278,RC,27800596,CDM,,,,,,both,,,8435.0000,1265.2500,CIGNA HEALTHCARE,CIGNA HMO,3517.40,,,,,,,2177.0700,8435.0000,percent of total billed charges,"41.7% of $8,435.00 in Billed Charges for Rev 278 = $3,517.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX WITH SPIRAL Z TECH AAA ENDOVASCULAR GRAFT ILIAC LEG,278,RC,27800596,CDM,,,,,,both,,,8435.0000,1265.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3374.00,,,,,,,2177.0700,8435.0000,percent of total billed charges,"40% of $8,435.00 in Billed Charges for Rev 278 = $3,374.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX WITH SPIRAL Z TECH AAA ENDOVASCULAR GRAFT ILIAC LEG,278,RC,27800596,CDM,,,,,,both,,,8435.0000,1265.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3517.40,,,,,,,2177.0700,8435.0000,percent of total billed charges,"41.7% of $8,435.00 in Billed Charges for Rev 278 = $3,517.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX WITH SPIRAL Z TECH AAA ENDOVASCULAR GRAFT ILIAC LEG,278,RC,27800596,CDM,,,,,,both,,,8435.0000,1265.2500,CIGNA HEALTHCARE,CIGNA PPO,3517.40,,,,,,,2177.0700,8435.0000,percent of total billed charges,"41.7% of $8,435.00 in Billed Charges for Rev 278 = $3,517.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX WITH SPIRAL Z TECH AAA ENDOVASCULAR GRAFT ILIAC LEG,278,RC,27800596,CDM,,,,,,both,,,8435.0000,1265.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7591.50,,,,,,,2177.0700,8435.0000,percent of total billed charges,"90% of $8,435.00 in Billed Charges for Rev 278 = $7,591.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX WITH SPIRAL Z TECH AAA ENDOVASCULAR GRAFT ILIAC LEG,278,RC,27800596,CDM,,,,,,both,,,8435.0000,1265.2500,MEDCOST,MEDCOST VHN,4014.22,,,,,,,2177.0700,8435.0000,percent of total billed charges,"47.59% of $8,435.00 in Billed Charges for Rev 278 = $4,014.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX WITH SPIRAL Z TECH AAA ENDOVASCULAR GRAFT ILIAC LEG,278,RC,27800596,CDM,,,,,,both,,,8435.0000,1265.2500,SENTARA HEALTH,SENTARA HEALTH,2177.07,,,,,,,2177.0700,8435.0000,percent of total billed charges,"25.81% of $8,435.00 in Billed Charges for Rev 278 = $2,177.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX WITH SPIRAL Z TECH AAA ENDOVASCULAR GRAFT ILIAC LEG,278,RC,27800596,CDM,,,,,,both,,,8435.0000,1265.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8435.00,,,,,,,2177.0700,8435.0000,percent of total billed charges,"100% of $8,435.00 in Billed Charges for Rev 278 = $8,435.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX WITH SPIRAL Z TECH AAA ENDOVASCULAR GRAFT ILIAC LEG,278,RC,27800596,CDM,,,,,,both,,,8435.0000,1265.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4217.50,,,,,,,2177.0700,8435.0000,percent of total billed charges,"Rev 278 $8,435.00 in Billed Charges at 50% = $4,217.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX WITH SPIRAL Z TECH AAA ENDOVASCULAR GRAFT ILIAC LEG,278,RC,27800596,CDM,,,,,,both,,,8435.0000,1265.2500,WELLCARE,WELLCARE MEDICAID,8435.00,,,,,,,2177.0700,8435.0000,percent of total billed charges,"100% of $8,435.00 in Billed Charges for Rev 278 = $8,435.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT STYLET LEAD 58 ATRIAL J SHAPED,272,RC,27200002,CDM,,,,,,both,,,614.7900,92.2200,AETNA,AETNA,262.52,,,,,,,158.6800,614.7900,percent of total billed charges,42.7% of $614.79 in Billed Charges for Rev 272 = $262.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT STYLET LEAD 58 ATRIAL J SHAPED,272,RC,27200002,CDM,,,,,,both,,,614.7900,92.2200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,430.35,,,,,,,158.6800,614.7900,percent of total billed charges,Rev 272 $614.79 in Billed Charges at 70% = $430.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT STYLET LEAD 58 ATRIAL J SHAPED,272,RC,27200002,CDM,,,,,,both,,,614.7900,92.2200,CIGNA HEALTHCARE,CIGNA HMO,256.37,,,,,,,158.6800,614.7900,percent of total billed charges,41.7% of $614.79 in Billed Charges for Rev 272 = $256.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT STYLET LEAD 58 ATRIAL J SHAPED,272,RC,27200002,CDM,,,,,,both,,,614.7900,92.2200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,285.26,,,,,,,158.6800,614.7900,percent of total billed charges,46.4% of $614.79 in Billed Charges for Rev 272 = $285.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT STYLET LEAD 58 ATRIAL J SHAPED,272,RC,27200002,CDM,,,,,,both,,,614.7900,92.2200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,256.37,,,,,,,158.6800,614.7900,percent of total billed charges,41.7% of $614.79 in Billed Charges for Rev 272 = $256.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT STYLET LEAD 58 ATRIAL J SHAPED,272,RC,27200002,CDM,,,,,,both,,,614.7900,92.2200,CIGNA HEALTHCARE,CIGNA PPO,256.37,,,,,,,158.6800,614.7900,percent of total billed charges,41.7% of $614.79 in Billed Charges for Rev 272 = $256.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT STYLET LEAD 58 ATRIAL J SHAPED,272,RC,27200002,CDM,,,,,,both,,,614.7900,92.2200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,553.31,,,,,,,158.6800,614.7900,percent of total billed charges,90% of $614.79 in Billed Charges for Rev 272 = $553.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT STYLET LEAD 58 ATRIAL J SHAPED,272,RC,27200002,CDM,,,,,,both,,,614.7900,92.2200,MEDCOST,MEDCOST VHN,292.58,,,,,,,158.6800,614.7900,percent of total billed charges,47.59% of $614.79 in Billed Charges for Rev 272 = $292.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT STYLET LEAD 58 ATRIAL J SHAPED,272,RC,27200002,CDM,,,,,,both,,,614.7900,92.2200,SENTARA HEALTH,SENTARA HEALTH,158.68,,,,,,,158.6800,614.7900,percent of total billed charges,25.81% of $614.79 in Billed Charges for Rev 272 = $158.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT STYLET LEAD 58 ATRIAL J SHAPED,272,RC,27200002,CDM,,,,,,both,,,614.7900,92.2200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",614.79,,,,,,,158.6800,614.7900,percent of total billed charges,100% of $614.79 in Billed Charges for Rev 272 = $614.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT STYLET LEAD 58 ATRIAL J SHAPED,272,RC,27200002,CDM,,,,,,both,,,614.7900,92.2200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,307.40,,,,,,,158.6800,614.7900,percent of total billed charges,Rev 272 $614.79 in Billed Charges at 50% = $307.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT STYLET LEAD 58 ATRIAL J SHAPED,272,RC,27200002,CDM,,,,,,both,,,614.7900,92.2200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,198.58,,,,,,,158.6800,614.7900,other,32.3% of $614.79 in Billed Charges for Rev 272 = $198.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT STYLET LEAD 58 ATRIAL J SHAPED,272,RC,27200002,CDM,,,,,,both,,,614.7900,92.2200,UNITED HEALTHCARE,UHC HERITAGE SELECT,188.74,,,,,,,158.6800,614.7900,other,30.7% of $614.79 in Billed Charges for Rev 272 = $188.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT STYLET LEAD 58 ATRIAL J SHAPED,272,RC,27200002,CDM,,,,,,both,,,614.7900,92.2200,UNITED HEALTHCARE,UNITED HEALTHCARE,198.58,,,,,,,158.6800,614.7900,percent of total billed charges,32.3% of $614.79 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT STYLET LEAD 58 ATRIAL J SHAPED,272,RC,27200002,CDM,,,,,,both,,,614.7900,92.2200,WELLCARE,WELLCARE MEDICAID,614.79,,,,,,,158.6800,614.7900,percent of total billed charges,100% of $614.79 in Billed Charges for Rev 272 = $614.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SURFACE ELECTRODE SAFEOP EMG & SSEP,272,RC,27200002,CDM,,,,,,both,,,14156.4200,2123.4600,AETNA,AETNA,6044.79,,,,,,,3653.7700,14156.4200,percent of total billed charges,"42.7% of $14,156.42 in Billed Charges for Rev 272 = $6,044.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SURFACE ELECTRODE SAFEOP EMG & SSEP,272,RC,27200002,CDM,,,,,,both,,,14156.4200,2123.4600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9909.49,,,,,,,3653.7700,14156.4200,percent of total billed charges,"Rev 272 $14,156.42 in Billed Charges at 70% = $9,909.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SURFACE ELECTRODE SAFEOP EMG & SSEP,272,RC,27200002,CDM,,,,,,both,,,14156.4200,2123.4600,CIGNA HEALTHCARE,CIGNA HMO,5903.23,,,,,,,3653.7700,14156.4200,percent of total billed charges,"41.7% of $14,156.42 in Billed Charges for Rev 272 = $5,903.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SURFACE ELECTRODE SAFEOP EMG & SSEP,272,RC,27200002,CDM,,,,,,both,,,14156.4200,2123.4600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6568.58,,,,,,,3653.7700,14156.4200,percent of total billed charges,"46.4% of $14,156.42 in Billed Charges for Rev 272 = $6,568.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SURFACE ELECTRODE SAFEOP EMG & SSEP,272,RC,27200002,CDM,,,,,,both,,,14156.4200,2123.4600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5903.23,,,,,,,3653.7700,14156.4200,percent of total billed charges,"41.7% of $14,156.42 in Billed Charges for Rev 272 = $5,903.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SURFACE ELECTRODE SAFEOP EMG & SSEP,272,RC,27200002,CDM,,,,,,both,,,14156.4200,2123.4600,CIGNA HEALTHCARE,CIGNA PPO,5903.23,,,,,,,3653.7700,14156.4200,percent of total billed charges,"41.7% of $14,156.42 in Billed Charges for Rev 272 = $5,903.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SURFACE ELECTRODE SAFEOP EMG & SSEP,272,RC,27200002,CDM,,,,,,both,,,14156.4200,2123.4600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12740.78,,,,,,,3653.7700,14156.4200,percent of total billed charges,"90% of $14,156.42 in Billed Charges for Rev 272 = $12,740.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SURFACE ELECTRODE SAFEOP EMG & SSEP,272,RC,27200002,CDM,,,,,,both,,,14156.4200,2123.4600,MEDCOST,MEDCOST VHN,6737.04,,,,,,,3653.7700,14156.4200,percent of total billed charges,"47.59% of $14,156.42 in Billed Charges for Rev 272 = $6,737.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SURFACE ELECTRODE SAFEOP EMG & SSEP,272,RC,27200002,CDM,,,,,,both,,,14156.4200,2123.4600,SENTARA HEALTH,SENTARA HEALTH,3653.77,,,,,,,3653.7700,14156.4200,percent of total billed charges,"25.81% of $14,156.42 in Billed Charges for Rev 272 = $3,653.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SURFACE ELECTRODE SAFEOP EMG & SSEP,272,RC,27200002,CDM,,,,,,both,,,14156.4200,2123.4600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",14156.42,,,,,,,3653.7700,14156.4200,percent of total billed charges,"100% of $14,156.42 in Billed Charges for Rev 272 = $14,156.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SURFACE ELECTRODE SAFEOP EMG & SSEP,272,RC,27200002,CDM,,,,,,both,,,14156.4200,2123.4600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7078.21,,,,,,,3653.7700,14156.4200,percent of total billed charges,"Rev 272 $14,156.42 in Billed Charges at 50% = $7,078.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SURFACE ELECTRODE SAFEOP EMG & SSEP,272,RC,27200002,CDM,,,,,,both,,,14156.4200,2123.4600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4572.52,,,,,,,3653.7700,14156.4200,other,"32.3% of $14,156.42 in Billed Charges for Rev 272 = $4,572.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT SURFACE ELECTRODE SAFEOP EMG & SSEP,272,RC,27200002,CDM,,,,,,both,,,14156.4200,2123.4600,UNITED HEALTHCARE,UHC HERITAGE SELECT,4346.02,,,,,,,3653.7700,14156.4200,other,"30.7% of $14,156.42 in Billed Charges for Rev 272 = $4,346.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT SURFACE ELECTRODE SAFEOP EMG & SSEP,272,RC,27200002,CDM,,,,,,both,,,14156.4200,2123.4600,UNITED HEALTHCARE,UNITED HEALTHCARE,4572.52,,,,,,,3653.7700,14156.4200,percent of total billed charges,"32.3% of $14,156.42 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SURFACE ELECTRODE SAFEOP EMG & SSEP,272,RC,27200002,CDM,,,,,,both,,,14156.4200,2123.4600,WELLCARE,WELLCARE MEDICAID,14156.42,,,,,,,3653.7700,14156.4200,percent of total billed charges,"100% of $14,156.42 in Billed Charges for Rev 272 = $14,156.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SWIVELOCK CANNULATED DISPOSABLE 4.75MM,272,RC,27200002,CDM,,,,,,both,,,6481.8800,972.2800,AETNA,AETNA,2767.76,,,,,,,1672.9700,6481.8800,percent of total billed charges,"42.7% of $6,481.88 in Billed Charges for Rev 272 = $2,767.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SWIVELOCK CANNULATED DISPOSABLE 4.75MM,272,RC,27200002,CDM,,,,,,both,,,6481.8800,972.2800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4537.32,,,,,,,1672.9700,6481.8800,percent of total billed charges,"Rev 272 $6,481.88 in Billed Charges at 70% = $4,537.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SWIVELOCK CANNULATED DISPOSABLE 4.75MM,272,RC,27200002,CDM,,,,,,both,,,6481.8800,972.2800,CIGNA HEALTHCARE,CIGNA HMO,2702.94,,,,,,,1672.9700,6481.8800,percent of total billed charges,"41.7% of $6,481.88 in Billed Charges for Rev 272 = $2,702.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SWIVELOCK CANNULATED DISPOSABLE 4.75MM,272,RC,27200002,CDM,,,,,,both,,,6481.8800,972.2800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3007.59,,,,,,,1672.9700,6481.8800,percent of total billed charges,"46.4% of $6,481.88 in Billed Charges for Rev 272 = $3,007.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SWIVELOCK CANNULATED DISPOSABLE 4.75MM,272,RC,27200002,CDM,,,,,,both,,,6481.8800,972.2800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2702.94,,,,,,,1672.9700,6481.8800,percent of total billed charges,"41.7% of $6,481.88 in Billed Charges for Rev 272 = $2,702.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SWIVELOCK CANNULATED DISPOSABLE 4.75MM,272,RC,27200002,CDM,,,,,,both,,,6481.8800,972.2800,CIGNA HEALTHCARE,CIGNA PPO,2702.94,,,,,,,1672.9700,6481.8800,percent of total billed charges,"41.7% of $6,481.88 in Billed Charges for Rev 272 = $2,702.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SWIVELOCK CANNULATED DISPOSABLE 4.75MM,272,RC,27200002,CDM,,,,,,both,,,6481.8800,972.2800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5833.69,,,,,,,1672.9700,6481.8800,percent of total billed charges,"90% of $6,481.88 in Billed Charges for Rev 272 = $5,833.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SWIVELOCK CANNULATED DISPOSABLE 4.75MM,272,RC,27200002,CDM,,,,,,both,,,6481.8800,972.2800,MEDCOST,MEDCOST VHN,3084.73,,,,,,,1672.9700,6481.8800,percent of total billed charges,"47.59% of $6,481.88 in Billed Charges for Rev 272 = $3,084.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SWIVELOCK CANNULATED DISPOSABLE 4.75MM,272,RC,27200002,CDM,,,,,,both,,,6481.8800,972.2800,SENTARA HEALTH,SENTARA HEALTH,1672.97,,,,,,,1672.9700,6481.8800,percent of total billed charges,"25.81% of $6,481.88 in Billed Charges for Rev 272 = $1,672.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SWIVELOCK CANNULATED DISPOSABLE 4.75MM,272,RC,27200002,CDM,,,,,,both,,,6481.8800,972.2800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6481.88,,,,,,,1672.9700,6481.8800,percent of total billed charges,"100% of $6,481.88 in Billed Charges for Rev 272 = $6,481.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SWIVELOCK CANNULATED DISPOSABLE 4.75MM,272,RC,27200002,CDM,,,,,,both,,,6481.8800,972.2800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3240.94,,,,,,,1672.9700,6481.8800,percent of total billed charges,"Rev 272 $6,481.88 in Billed Charges at 50% = $3,240.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SWIVELOCK CANNULATED DISPOSABLE 4.75MM,272,RC,27200002,CDM,,,,,,both,,,6481.8800,972.2800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2093.65,,,,,,,1672.9700,6481.8800,other,"32.3% of $6,481.88 in Billed Charges for Rev 272 = $2,093.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT SWIVELOCK CANNULATED DISPOSABLE 4.75MM,272,RC,27200002,CDM,,,,,,both,,,6481.8800,972.2800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1989.94,,,,,,,1672.9700,6481.8800,other,"30.7% of $6,481.88 in Billed Charges for Rev 272 = $1,989.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT SWIVELOCK CANNULATED DISPOSABLE 4.75MM,272,RC,27200002,CDM,,,,,,both,,,6481.8800,972.2800,UNITED HEALTHCARE,UNITED HEALTHCARE,2093.65,,,,,,,1672.9700,6481.8800,percent of total billed charges,"32.3% of $6,481.88 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SWIVELOCK CANNULATED DISPOSABLE 4.75MM,272,RC,27200002,CDM,,,,,,both,,,6481.8800,972.2800,WELLCARE,WELLCARE MEDICAID,6481.88,,,,,,,1672.9700,6481.8800,percent of total billed charges,"100% of $6,481.88 in Billed Charges for Rev 272 = $6,481.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEARTSTRING III,272,RC,27200002,CDM,,,,,,both,,,5466.0400,819.9100,AETNA,AETNA,2334.00,,,,,,,1410.7800,5466.0400,percent of total billed charges,"42.7% of $5,466.04 in Billed Charges for Rev 272 = $2,334.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEARTSTRING III,272,RC,27200002,CDM,,,,,,both,,,5466.0400,819.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3826.23,,,,,,,1410.7800,5466.0400,percent of total billed charges,"Rev 272 $5,466.04 in Billed Charges at 70% = $3,826.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEARTSTRING III,272,RC,27200002,CDM,,,,,,both,,,5466.0400,819.9100,CIGNA HEALTHCARE,CIGNA HMO,2279.34,,,,,,,1410.7800,5466.0400,percent of total billed charges,"41.7% of $5,466.04 in Billed Charges for Rev 272 = $2,279.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEARTSTRING III,272,RC,27200002,CDM,,,,,,both,,,5466.0400,819.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2536.24,,,,,,,1410.7800,5466.0400,percent of total billed charges,"46.4% of $5,466.04 in Billed Charges for Rev 272 = $2,536.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEARTSTRING III,272,RC,27200002,CDM,,,,,,both,,,5466.0400,819.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2279.34,,,,,,,1410.7800,5466.0400,percent of total billed charges,"41.7% of $5,466.04 in Billed Charges for Rev 272 = $2,279.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEARTSTRING III,272,RC,27200002,CDM,,,,,,both,,,5466.0400,819.9100,CIGNA HEALTHCARE,CIGNA PPO,2279.34,,,,,,,1410.7800,5466.0400,percent of total billed charges,"41.7% of $5,466.04 in Billed Charges for Rev 272 = $2,279.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEARTSTRING III,272,RC,27200002,CDM,,,,,,both,,,5466.0400,819.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4919.44,,,,,,,1410.7800,5466.0400,percent of total billed charges,"90% of $5,466.04 in Billed Charges for Rev 272 = $4,919.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEARTSTRING III,272,RC,27200002,CDM,,,,,,both,,,5466.0400,819.9100,MEDCOST,MEDCOST VHN,2601.29,,,,,,,1410.7800,5466.0400,percent of total billed charges,"47.59% of $5,466.04 in Billed Charges for Rev 272 = $2,601.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEARTSTRING III,272,RC,27200002,CDM,,,,,,both,,,5466.0400,819.9100,SENTARA HEALTH,SENTARA HEALTH,1410.78,,,,,,,1410.7800,5466.0400,percent of total billed charges,"25.81% of $5,466.04 in Billed Charges for Rev 272 = $1,410.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEARTSTRING III,272,RC,27200002,CDM,,,,,,both,,,5466.0400,819.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5466.04,,,,,,,1410.7800,5466.0400,percent of total billed charges,"100% of $5,466.04 in Billed Charges for Rev 272 = $5,466.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEARTSTRING III,272,RC,27200002,CDM,,,,,,both,,,5466.0400,819.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2733.02,,,,,,,1410.7800,5466.0400,percent of total billed charges,"Rev 272 $5,466.04 in Billed Charges at 50% = $2,733.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEARTSTRING III,272,RC,27200002,CDM,,,,,,both,,,5466.0400,819.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1765.53,,,,,,,1410.7800,5466.0400,other,"32.3% of $5,466.04 in Billed Charges for Rev 272 = $1,765.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HEARTSTRING III,272,RC,27200002,CDM,,,,,,both,,,5466.0400,819.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1678.07,,,,,,,1410.7800,5466.0400,other,"30.7% of $5,466.04 in Billed Charges for Rev 272 = $1,678.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HEARTSTRING III,272,RC,27200002,CDM,,,,,,both,,,5466.0400,819.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,1765.53,,,,,,,1410.7800,5466.0400,percent of total billed charges,"32.3% of $5,466.04 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEARTSTRING III,272,RC,27200002,CDM,,,,,,both,,,5466.0400,819.9100,WELLCARE,WELLCARE MEDICAID,5466.04,,,,,,,1410.7800,5466.0400,percent of total billed charges,"100% of $5,466.04 in Billed Charges for Rev 272 = $5,466.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TRANSDUCER PRESSURE MONITOR TRUWAVE 3-60IN 3ML,272,RC,,,,,,,,both,,,2479.1900,371.8800,AETNA,AETNA,1058.61,,,,,,,639.8800,2479.1900,percent of total billed charges,"42.7% of $2,479.19 in Billed Charges for Rev 272 = $1,058.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TRANSDUCER PRESSURE MONITOR TRUWAVE 3-60IN 3ML,272,RC,,,,,,,,both,,,2479.1900,371.8800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1735.43,,,,,,,639.8800,2479.1900,percent of total billed charges,"Rev 272 $2,479.19 in Billed Charges at 70% = $1,735.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TRANSDUCER PRESSURE MONITOR TRUWAVE 3-60IN 3ML,272,RC,,,,,,,,both,,,2479.1900,371.8800,CIGNA HEALTHCARE,CIGNA HMO,1033.82,,,,,,,639.8800,2479.1900,percent of total billed charges,"41.7% of $2,479.19 in Billed Charges for Rev 272 = $1,033.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TRANSDUCER PRESSURE MONITOR TRUWAVE 3-60IN 3ML,272,RC,,,,,,,,both,,,2479.1900,371.8800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1150.34,,,,,,,639.8800,2479.1900,percent of total billed charges,"46.4% of $2,479.19 in Billed Charges for Rev 272 = $1,150.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TRANSDUCER PRESSURE MONITOR TRUWAVE 3-60IN 3ML,272,RC,,,,,,,,both,,,2479.1900,371.8800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1033.82,,,,,,,639.8800,2479.1900,percent of total billed charges,"41.7% of $2,479.19 in Billed Charges for Rev 272 = $1,033.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TRANSDUCER PRESSURE MONITOR TRUWAVE 3-60IN 3ML,272,RC,,,,,,,,both,,,2479.1900,371.8800,CIGNA HEALTHCARE,CIGNA PPO,1033.82,,,,,,,639.8800,2479.1900,percent of total billed charges,"41.7% of $2,479.19 in Billed Charges for Rev 272 = $1,033.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TRANSDUCER PRESSURE MONITOR TRUWAVE 3-60IN 3ML,272,RC,,,,,,,,both,,,2479.1900,371.8800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2231.27,,,,,,,639.8800,2479.1900,percent of total billed charges,"90% of $2,479.19 in Billed Charges for Rev 272 = $2,231.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TRANSDUCER PRESSURE MONITOR TRUWAVE 3-60IN 3ML,272,RC,,,,,,,,both,,,2479.1900,371.8800,MEDCOST,MEDCOST VHN,1179.85,,,,,,,639.8800,2479.1900,percent of total billed charges,"47.59% of $2,479.19 in Billed Charges for Rev 272 = $1,179.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TRANSDUCER PRESSURE MONITOR TRUWAVE 3-60IN 3ML,272,RC,,,,,,,,both,,,2479.1900,371.8800,SENTARA HEALTH,SENTARA HEALTH,639.88,,,,,,,639.8800,2479.1900,percent of total billed charges,"25.81% of $2,479.19 in Billed Charges for Rev 272 = $639.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TRANSDUCER PRESSURE MONITOR TRUWAVE 3-60IN 3ML,272,RC,,,,,,,,both,,,2479.1900,371.8800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2479.19,,,,,,,639.8800,2479.1900,percent of total billed charges,"100% of $2,479.19 in Billed Charges for Rev 272 = $2,479.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TRANSDUCER PRESSURE MONITOR TRUWAVE 3-60IN 3ML,272,RC,,,,,,,,both,,,2479.1900,371.8800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1239.60,,,,,,,639.8800,2479.1900,percent of total billed charges,"Rev 272 $2,479.19 in Billed Charges at 50% = $1,239.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TRANSDUCER PRESSURE MONITOR TRUWAVE 3-60IN 3ML,272,RC,,,,,,,,both,,,2479.1900,371.8800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,800.78,,,,,,,639.8800,2479.1900,other,"32.3% of $2,479.19 in Billed Charges for Rev 272 = $800.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT TRANSDUCER PRESSURE MONITOR TRUWAVE 3-60IN 3ML,272,RC,,,,,,,,both,,,2479.1900,371.8800,UNITED HEALTHCARE,UHC HERITAGE SELECT,761.11,,,,,,,639.8800,2479.1900,other,"30.7% of $2,479.19 in Billed Charges for Rev 272 = $761.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT TRANSDUCER PRESSURE MONITOR TRUWAVE 3-60IN 3ML,272,RC,,,,,,,,both,,,2479.1900,371.8800,UNITED HEALTHCARE,UNITED HEALTHCARE,800.78,,,,,,,639.8800,2479.1900,percent of total billed charges,"32.3% of $2,479.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT TRANSDUCER PRESSURE MONITOR TRUWAVE 3-60IN 3ML,272,RC,,,,,,,,both,,,2479.1900,371.8800,WELLCARE,WELLCARE MEDICAID,2479.19,,,,,,,639.8800,2479.1900,percent of total billed charges,"100% of $2,479.19 in Billed Charges for Rev 272 = $2,479.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MIS BLADE ILLUMINATOR 698.605S,272,RC,,,,,,,,both,,,18014.4300,2702.1600,AETNA,AETNA,7692.16,,,,,,,4649.5200,18014.4300,percent of total billed charges,"42.7% of $18,014.43 in Billed Charges for Rev 272 = $7,692.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MIS BLADE ILLUMINATOR 698.605S,272,RC,,,,,,,,both,,,18014.4300,2702.1600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,12610.10,,,,,,,4649.5200,18014.4300,percent of total billed charges,"Rev 272 $18,014.43 in Billed Charges at 70% = $12,610.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MIS BLADE ILLUMINATOR 698.605S,272,RC,,,,,,,,both,,,18014.4300,2702.1600,CIGNA HEALTHCARE,CIGNA HMO,7512.02,,,,,,,4649.5200,18014.4300,percent of total billed charges,"41.7% of $18,014.43 in Billed Charges for Rev 272 = $7,512.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MIS BLADE ILLUMINATOR 698.605S,272,RC,,,,,,,,both,,,18014.4300,2702.1600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8358.70,,,,,,,4649.5200,18014.4300,percent of total billed charges,"46.4% of $18,014.43 in Billed Charges for Rev 272 = $8,358.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MIS BLADE ILLUMINATOR 698.605S,272,RC,,,,,,,,both,,,18014.4300,2702.1600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7512.02,,,,,,,4649.5200,18014.4300,percent of total billed charges,"41.7% of $18,014.43 in Billed Charges for Rev 272 = $7,512.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MIS BLADE ILLUMINATOR 698.605S,272,RC,,,,,,,,both,,,18014.4300,2702.1600,CIGNA HEALTHCARE,CIGNA PPO,7512.02,,,,,,,4649.5200,18014.4300,percent of total billed charges,"41.7% of $18,014.43 in Billed Charges for Rev 272 = $7,512.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MIS BLADE ILLUMINATOR 698.605S,272,RC,,,,,,,,both,,,18014.4300,2702.1600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,16212.99,,,,,,,4649.5200,18014.4300,percent of total billed charges,"90% of $18,014.43 in Billed Charges for Rev 272 = $16,212.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MIS BLADE ILLUMINATOR 698.605S,272,RC,,,,,,,,both,,,18014.4300,2702.1600,MEDCOST,MEDCOST VHN,8573.07,,,,,,,4649.5200,18014.4300,percent of total billed charges,"47.59% of $18,014.43 in Billed Charges for Rev 272 = $8,573.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MIS BLADE ILLUMINATOR 698.605S,272,RC,,,,,,,,both,,,18014.4300,2702.1600,SENTARA HEALTH,SENTARA HEALTH,4649.52,,,,,,,4649.5200,18014.4300,percent of total billed charges,"25.81% of $18,014.43 in Billed Charges for Rev 272 = $4,649.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MIS BLADE ILLUMINATOR 698.605S,272,RC,,,,,,,,both,,,18014.4300,2702.1600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",18014.43,,,,,,,4649.5200,18014.4300,percent of total billed charges,"100% of $18,014.43 in Billed Charges for Rev 272 = $18,014.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MIS BLADE ILLUMINATOR 698.605S,272,RC,,,,,,,,both,,,18014.4300,2702.1600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9007.22,,,,,,,4649.5200,18014.4300,percent of total billed charges,"Rev 272 $18,014.43 in Billed Charges at 50% = $9,007.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MIS BLADE ILLUMINATOR 698.605S,272,RC,,,,,,,,both,,,18014.4300,2702.1600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5818.66,,,,,,,4649.5200,18014.4300,other,"32.3% of $18,014.43 in Billed Charges for Rev 272 = $5,818.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MIS BLADE ILLUMINATOR 698.605S,272,RC,,,,,,,,both,,,18014.4300,2702.1600,UNITED HEALTHCARE,UHC HERITAGE SELECT,5530.43,,,,,,,4649.5200,18014.4300,other,"30.7% of $18,014.43 in Billed Charges for Rev 272 = $5,530.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MIS BLADE ILLUMINATOR 698.605S,272,RC,,,,,,,,both,,,18014.4300,2702.1600,UNITED HEALTHCARE,UNITED HEALTHCARE,5818.66,,,,,,,4649.5200,18014.4300,percent of total billed charges,"32.3% of $18,014.43 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MIS BLADE ILLUMINATOR 698.605S,272,RC,,,,,,,,both,,,18014.4300,2702.1600,WELLCARE,WELLCARE MEDICAID,18014.43,,,,,,,4649.5200,18014.4300,percent of total billed charges,"100% of $18,014.43 in Billed Charges for Rev 272 = $18,014.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOLDER PRESSURE MONITOR TRUCLIP 2.75 X 8IN X 2.5,272,RC,,,,,,,,both,,,1691.8200,253.7700,AETNA,AETNA,722.41,,,,,,,436.6600,1691.8200,percent of total billed charges,"42.7% of $1,691.82 in Billed Charges for Rev 272 = $722.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOLDER PRESSURE MONITOR TRUCLIP 2.75 X 8IN X 2.5,272,RC,,,,,,,,both,,,1691.8200,253.7700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1184.27,,,,,,,436.6600,1691.8200,percent of total billed charges,"Rev 272 $1,691.82 in Billed Charges at 70% = $1,184.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOLDER PRESSURE MONITOR TRUCLIP 2.75 X 8IN X 2.5,272,RC,,,,,,,,both,,,1691.8200,253.7700,CIGNA HEALTHCARE,CIGNA HMO,705.49,,,,,,,436.6600,1691.8200,percent of total billed charges,"41.7% of $1,691.82 in Billed Charges for Rev 272 = $705.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOLDER PRESSURE MONITOR TRUCLIP 2.75 X 8IN X 2.5,272,RC,,,,,,,,both,,,1691.8200,253.7700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,785.00,,,,,,,436.6600,1691.8200,percent of total billed charges,"46.4% of $1,691.82 in Billed Charges for Rev 272 = $785.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOLDER PRESSURE MONITOR TRUCLIP 2.75 X 8IN X 2.5,272,RC,,,,,,,,both,,,1691.8200,253.7700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,705.49,,,,,,,436.6600,1691.8200,percent of total billed charges,"41.7% of $1,691.82 in Billed Charges for Rev 272 = $705.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOLDER PRESSURE MONITOR TRUCLIP 2.75 X 8IN X 2.5,272,RC,,,,,,,,both,,,1691.8200,253.7700,CIGNA HEALTHCARE,CIGNA PPO,705.49,,,,,,,436.6600,1691.8200,percent of total billed charges,"41.7% of $1,691.82 in Billed Charges for Rev 272 = $705.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOLDER PRESSURE MONITOR TRUCLIP 2.75 X 8IN X 2.5,272,RC,,,,,,,,both,,,1691.8200,253.7700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1522.64,,,,,,,436.6600,1691.8200,percent of total billed charges,"90% of $1,691.82 in Billed Charges for Rev 272 = $1,522.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOLDER PRESSURE MONITOR TRUCLIP 2.75 X 8IN X 2.5,272,RC,,,,,,,,both,,,1691.8200,253.7700,MEDCOST,MEDCOST VHN,805.14,,,,,,,436.6600,1691.8200,percent of total billed charges,"47.59% of $1,691.82 in Billed Charges for Rev 272 = $805.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOLDER PRESSURE MONITOR TRUCLIP 2.75 X 8IN X 2.5,272,RC,,,,,,,,both,,,1691.8200,253.7700,SENTARA HEALTH,SENTARA HEALTH,436.66,,,,,,,436.6600,1691.8200,percent of total billed charges,"25.81% of $1,691.82 in Billed Charges for Rev 272 = $436.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOLDER PRESSURE MONITOR TRUCLIP 2.75 X 8IN X 2.5,272,RC,,,,,,,,both,,,1691.8200,253.7700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1691.82,,,,,,,436.6600,1691.8200,percent of total billed charges,"100% of $1,691.82 in Billed Charges for Rev 272 = $1,691.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOLDER PRESSURE MONITOR TRUCLIP 2.75 X 8IN X 2.5,272,RC,,,,,,,,both,,,1691.8200,253.7700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,845.91,,,,,,,436.6600,1691.8200,percent of total billed charges,"Rev 272 $1,691.82 in Billed Charges at 50% = $845.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOLDER PRESSURE MONITOR TRUCLIP 2.75 X 8IN X 2.5,272,RC,,,,,,,,both,,,1691.8200,253.7700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,546.46,,,,,,,436.6600,1691.8200,other,"32.3% of $1,691.82 in Billed Charges for Rev 272 = $546.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HOLDER PRESSURE MONITOR TRUCLIP 2.75 X 8IN X 2.5,272,RC,,,,,,,,both,,,1691.8200,253.7700,UNITED HEALTHCARE,UHC HERITAGE SELECT,519.39,,,,,,,436.6600,1691.8200,other,"30.7% of $1,691.82 in Billed Charges for Rev 272 = $519.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HOLDER PRESSURE MONITOR TRUCLIP 2.75 X 8IN X 2.5,272,RC,,,,,,,,both,,,1691.8200,253.7700,UNITED HEALTHCARE,UNITED HEALTHCARE,546.46,,,,,,,436.6600,1691.8200,percent of total billed charges,"32.3% of $1,691.82 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HOLDER PRESSURE MONITOR TRUCLIP 2.75 X 8IN X 2.5,272,RC,,,,,,,,both,,,1691.8200,253.7700,WELLCARE,WELLCARE MEDICAID,1691.82,,,,,,,436.6600,1691.8200,percent of total billed charges,"100% of $1,691.82 in Billed Charges for Rev 272 = $1,691.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS HALF SUP IPS,272,RC,27200002,CDM,,,,,,both,,,14623.1100,2193.4700,AETNA,AETNA,6244.07,,,,,,,3774.2200,14623.1100,percent of total billed charges,"42.7% of $14,623.11 in Billed Charges for Rev 272 = $6,244.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS HALF SUP IPS,272,RC,27200002,CDM,,,,,,both,,,14623.1100,2193.4700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,10236.18,,,,,,,3774.2200,14623.1100,percent of total billed charges,"Rev 272 $14,623.11 in Billed Charges at 70% = $10,236.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS HALF SUP IPS,272,RC,27200002,CDM,,,,,,both,,,14623.1100,2193.4700,CIGNA HEALTHCARE,CIGNA HMO,6097.84,,,,,,,3774.2200,14623.1100,percent of total billed charges,"41.7% of $14,623.11 in Billed Charges for Rev 272 = $6,097.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS HALF SUP IPS,272,RC,27200002,CDM,,,,,,both,,,14623.1100,2193.4700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6785.12,,,,,,,3774.2200,14623.1100,percent of total billed charges,"46.4% of $14,623.11 in Billed Charges for Rev 272 = $6,785.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS HALF SUP IPS,272,RC,27200002,CDM,,,,,,both,,,14623.1100,2193.4700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6097.84,,,,,,,3774.2200,14623.1100,percent of total billed charges,"41.7% of $14,623.11 in Billed Charges for Rev 272 = $6,097.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS HALF SUP IPS,272,RC,27200002,CDM,,,,,,both,,,14623.1100,2193.4700,CIGNA HEALTHCARE,CIGNA PPO,6097.84,,,,,,,3774.2200,14623.1100,percent of total billed charges,"41.7% of $14,623.11 in Billed Charges for Rev 272 = $6,097.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS HALF SUP IPS,272,RC,27200002,CDM,,,,,,both,,,14623.1100,2193.4700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13160.80,,,,,,,3774.2200,14623.1100,percent of total billed charges,"90% of $14,623.11 in Billed Charges for Rev 272 = $13,160.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS HALF SUP IPS,272,RC,27200002,CDM,,,,,,both,,,14623.1100,2193.4700,MEDCOST,MEDCOST VHN,6959.14,,,,,,,3774.2200,14623.1100,percent of total billed charges,"47.59% of $14,623.11 in Billed Charges for Rev 272 = $6,959.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS HALF SUP IPS,272,RC,27200002,CDM,,,,,,both,,,14623.1100,2193.4700,SENTARA HEALTH,SENTARA HEALTH,3774.22,,,,,,,3774.2200,14623.1100,percent of total billed charges,"25.81% of $14,623.11 in Billed Charges for Rev 272 = $3,774.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS HALF SUP IPS,272,RC,27200002,CDM,,,,,,both,,,14623.1100,2193.4700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",14623.11,,,,,,,3774.2200,14623.1100,percent of total billed charges,"100% of $14,623.11 in Billed Charges for Rev 272 = $14,623.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS HALF SUP IPS,272,RC,27200002,CDM,,,,,,both,,,14623.1100,2193.4700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7311.56,,,,,,,3774.2200,14623.1100,percent of total billed charges,"Rev 272 $14,623.11 in Billed Charges at 50% = $7,311.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS HALF SUP IPS,272,RC,27200002,CDM,,,,,,both,,,14623.1100,2193.4700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4723.26,,,,,,,3774.2200,14623.1100,other,"32.3% of $14,623.11 in Billed Charges for Rev 272 = $4,723.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODEL IPS HALF SUP IPS,272,RC,27200002,CDM,,,,,,both,,,14623.1100,2193.4700,UNITED HEALTHCARE,UHC HERITAGE SELECT,4489.29,,,,,,,3774.2200,14623.1100,other,"30.7% of $14,623.11 in Billed Charges for Rev 272 = $4,489.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODEL IPS HALF SUP IPS,272,RC,27200002,CDM,,,,,,both,,,14623.1100,2193.4700,UNITED HEALTHCARE,UNITED HEALTHCARE,4723.26,,,,,,,3774.2200,14623.1100,percent of total billed charges,"32.3% of $14,623.11 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS HALF SUP IPS,272,RC,27200002,CDM,,,,,,both,,,14623.1100,2193.4700,WELLCARE,WELLCARE MEDICAID,14623.11,,,,,,,3774.2200,14623.1100,percent of total billed charges,"100% of $14,623.11 in Billed Charges for Rev 272 = $14,623.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS MAXIOLLA AND CRANIUM CLASSIC,272,RC,27200002,CDM,,,,,,both,,,64435.0200,9665.2500,AETNA,AETNA,27513.75,,,,,,,16630.6800,64435.0200,percent of total billed charges,"42.7% of $64,435.02 in Billed Charges for Rev 272 = $27,513.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS MAXIOLLA AND CRANIUM CLASSIC,272,RC,27200002,CDM,,,,,,both,,,64435.0200,9665.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,45104.51,,,,,,,16630.6800,64435.0200,percent of total billed charges,"Rev 272 $64,435.02 in Billed Charges at 70% = $45,104.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS MAXIOLLA AND CRANIUM CLASSIC,272,RC,27200002,CDM,,,,,,both,,,64435.0200,9665.2500,CIGNA HEALTHCARE,CIGNA HMO,26869.40,,,,,,,16630.6800,64435.0200,percent of total billed charges,"41.7% of $64,435.02 in Billed Charges for Rev 272 = $26,869.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS MAXIOLLA AND CRANIUM CLASSIC,272,RC,27200002,CDM,,,,,,both,,,64435.0200,9665.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,29897.85,,,,,,,16630.6800,64435.0200,percent of total billed charges,"46.4% of $64,435.02 in Billed Charges for Rev 272 = $29,897.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS MAXIOLLA AND CRANIUM CLASSIC,272,RC,27200002,CDM,,,,,,both,,,64435.0200,9665.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,26869.40,,,,,,,16630.6800,64435.0200,percent of total billed charges,"41.7% of $64,435.02 in Billed Charges for Rev 272 = $26,869.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS MAXIOLLA AND CRANIUM CLASSIC,272,RC,27200002,CDM,,,,,,both,,,64435.0200,9665.2500,CIGNA HEALTHCARE,CIGNA PPO,26869.40,,,,,,,16630.6800,64435.0200,percent of total billed charges,"41.7% of $64,435.02 in Billed Charges for Rev 272 = $26,869.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS MAXIOLLA AND CRANIUM CLASSIC,272,RC,27200002,CDM,,,,,,both,,,64435.0200,9665.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,57991.52,,,,,,,16630.6800,64435.0200,percent of total billed charges,"90% of $64,435.02 in Billed Charges for Rev 272 = $57,991.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS MAXIOLLA AND CRANIUM CLASSIC,272,RC,27200002,CDM,,,,,,both,,,64435.0200,9665.2500,MEDCOST,MEDCOST VHN,30664.63,,,,,,,16630.6800,64435.0200,percent of total billed charges,"47.59% of $64,435.02 in Billed Charges for Rev 272 = $30,664.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS MAXIOLLA AND CRANIUM CLASSIC,272,RC,27200002,CDM,,,,,,both,,,64435.0200,9665.2500,SENTARA HEALTH,SENTARA HEALTH,16630.68,,,,,,,16630.6800,64435.0200,percent of total billed charges,"25.81% of $64,435.02 in Billed Charges for Rev 272 = $16,630.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS MAXIOLLA AND CRANIUM CLASSIC,272,RC,27200002,CDM,,,,,,both,,,64435.0200,9665.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",64435.02,,,,,,,16630.6800,64435.0200,percent of total billed charges,"100% of $64,435.02 in Billed Charges for Rev 272 = $64,435.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS MAXIOLLA AND CRANIUM CLASSIC,272,RC,27200002,CDM,,,,,,both,,,64435.0200,9665.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,32217.51,,,,,,,16630.6800,64435.0200,percent of total billed charges,"Rev 272 $64,435.02 in Billed Charges at 50% = $32,217.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS MAXIOLLA AND CRANIUM CLASSIC,272,RC,27200002,CDM,,,,,,both,,,64435.0200,9665.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,20812.51,,,,,,,16630.6800,64435.0200,other,"32.3% of $64,435.02 in Billed Charges for Rev 272 = $20,812.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODEL IPS MAXIOLLA AND CRANIUM CLASSIC,272,RC,27200002,CDM,,,,,,both,,,64435.0200,9665.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,19781.55,,,,,,,16630.6800,64435.0200,other,"30.7% of $64,435.02 in Billed Charges for Rev 272 = $19,781.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODEL IPS MAXIOLLA AND CRANIUM CLASSIC,272,RC,27200002,CDM,,,,,,both,,,64435.0200,9665.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,20812.51,,,,,,,16630.6800,64435.0200,percent of total billed charges,"32.3% of $64,435.02 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL IPS MAXIOLLA AND CRANIUM CLASSIC,272,RC,27200002,CDM,,,,,,both,,,64435.0200,9665.2500,WELLCARE,WELLCARE MEDICAID,64435.02,,,,,,,16630.6800,64435.0200,percent of total billed charges,"100% of $64,435.02 in Billed Charges for Rev 272 = $64,435.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ANGIO VAC CANNULA AND DILATOR 180 DEGREE,272,RC,27200002,CDM,,,,,,both,,,134823.0000,20223.4500,AETNA,AETNA,57569.42,,,,,,,34797.8200,134823.0000,percent of total billed charges,"42.7% of $134,823.00 in Billed Charges for Rev 272 = $57,569.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ANGIO VAC CANNULA AND DILATOR 180 DEGREE,272,RC,27200002,CDM,,,,,,both,,,134823.0000,20223.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,94376.10,,,,,,,34797.8200,134823.0000,percent of total billed charges,"Rev 272 $134,823.00 in Billed Charges at 70% = $94,376.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ANGIO VAC CANNULA AND DILATOR 180 DEGREE,272,RC,27200002,CDM,,,,,,both,,,134823.0000,20223.4500,CIGNA HEALTHCARE,CIGNA HMO,56221.19,,,,,,,34797.8200,134823.0000,percent of total billed charges,"41.7% of $134,823.00 in Billed Charges for Rev 272 = $56,221.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ANGIO VAC CANNULA AND DILATOR 180 DEGREE,272,RC,27200002,CDM,,,,,,both,,,134823.0000,20223.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,62557.87,,,,,,,34797.8200,134823.0000,percent of total billed charges,"46.4% of $134,823.00 in Billed Charges for Rev 272 = $62,557.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ANGIO VAC CANNULA AND DILATOR 180 DEGREE,272,RC,27200002,CDM,,,,,,both,,,134823.0000,20223.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,56221.19,,,,,,,34797.8200,134823.0000,percent of total billed charges,"41.7% of $134,823.00 in Billed Charges for Rev 272 = $56,221.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ANGIO VAC CANNULA AND DILATOR 180 DEGREE,272,RC,27200002,CDM,,,,,,both,,,134823.0000,20223.4500,CIGNA HEALTHCARE,CIGNA PPO,56221.19,,,,,,,34797.8200,134823.0000,percent of total billed charges,"41.7% of $134,823.00 in Billed Charges for Rev 272 = $56,221.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ANGIO VAC CANNULA AND DILATOR 180 DEGREE,272,RC,27200002,CDM,,,,,,both,,,134823.0000,20223.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,121340.70,,,,,,,34797.8200,134823.0000,percent of total billed charges,"90% of $134,823.00 in Billed Charges for Rev 272 = $121,340.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ANGIO VAC CANNULA AND DILATOR 180 DEGREE,272,RC,27200002,CDM,,,,,,both,,,134823.0000,20223.4500,MEDCOST,MEDCOST VHN,64162.27,,,,,,,34797.8200,134823.0000,percent of total billed charges,"47.59% of $134,823.00 in Billed Charges for Rev 272 = $64,162.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ANGIO VAC CANNULA AND DILATOR 180 DEGREE,272,RC,27200002,CDM,,,,,,both,,,134823.0000,20223.4500,SENTARA HEALTH,SENTARA HEALTH,34797.82,,,,,,,34797.8200,134823.0000,percent of total billed charges,"25.81% of $134,823.00 in Billed Charges for Rev 272 = $34,797.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ANGIO VAC CANNULA AND DILATOR 180 DEGREE,272,RC,27200002,CDM,,,,,,both,,,134823.0000,20223.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",134823.00,,,,,,,34797.8200,134823.0000,percent of total billed charges,"100% of $134,823.00 in Billed Charges for Rev 272 = $134,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ANGIO VAC CANNULA AND DILATOR 180 DEGREE,272,RC,27200002,CDM,,,,,,both,,,134823.0000,20223.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,67411.50,,,,,,,34797.8200,134823.0000,percent of total billed charges,"Rev 272 $134,823.00 in Billed Charges at 50% = $67,411.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ANGIO VAC CANNULA AND DILATOR 180 DEGREE,272,RC,27200002,CDM,,,,,,both,,,134823.0000,20223.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,43547.83,,,,,,,34797.8200,134823.0000,other,"32.3% of $134,823.00 in Billed Charges for Rev 272 = $43,547.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ANGIO VAC CANNULA AND DILATOR 180 DEGREE,272,RC,27200002,CDM,,,,,,both,,,134823.0000,20223.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,41390.66,,,,,,,34797.8200,134823.0000,other,"30.7% of $134,823.00 in Billed Charges for Rev 272 = $41,390.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ANGIO VAC CANNULA AND DILATOR 180 DEGREE,272,RC,27200002,CDM,,,,,,both,,,134823.0000,20223.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,43547.83,,,,,,,34797.8200,134823.0000,percent of total billed charges,"32.3% of $134,823.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ANGIO VAC CANNULA AND DILATOR 180 DEGREE,272,RC,27200002,CDM,,,,,,both,,,134823.0000,20223.4500,WELLCARE,WELLCARE MEDICAID,134823.00,,,,,,,34797.8200,134823.0000,percent of total billed charges,"100% of $134,823.00 in Billed Charges for Rev 272 = $134,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BIOPSY 10G STERILE,272,RC,,,,,,,,both,,,771.6000,115.7400,AETNA,AETNA,329.47,,,,,,,199.1500,771.6000,percent of total billed charges,42.7% of $771.60 in Billed Charges for Rev 272 = $329.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BIOPSY 10G STERILE,272,RC,,,,,,,,both,,,771.6000,115.7400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,540.12,,,,,,,199.1500,771.6000,percent of total billed charges,Rev 272 $771.60 in Billed Charges at 70% = $540.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BIOPSY 10G STERILE,272,RC,,,,,,,,both,,,771.6000,115.7400,CIGNA HEALTHCARE,CIGNA HMO,321.76,,,,,,,199.1500,771.6000,percent of total billed charges,41.7% of $771.60 in Billed Charges for Rev 272 = $321.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BIOPSY 10G STERILE,272,RC,,,,,,,,both,,,771.6000,115.7400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,358.02,,,,,,,199.1500,771.6000,percent of total billed charges,46.4% of $771.60 in Billed Charges for Rev 272 = $358.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BIOPSY 10G STERILE,272,RC,,,,,,,,both,,,771.6000,115.7400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,321.76,,,,,,,199.1500,771.6000,percent of total billed charges,41.7% of $771.60 in Billed Charges for Rev 272 = $321.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BIOPSY 10G STERILE,272,RC,,,,,,,,both,,,771.6000,115.7400,CIGNA HEALTHCARE,CIGNA PPO,321.76,,,,,,,199.1500,771.6000,percent of total billed charges,41.7% of $771.60 in Billed Charges for Rev 272 = $321.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BIOPSY 10G STERILE,272,RC,,,,,,,,both,,,771.6000,115.7400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,694.44,,,,,,,199.1500,771.6000,percent of total billed charges,90% of $771.60 in Billed Charges for Rev 272 = $694.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BIOPSY 10G STERILE,272,RC,,,,,,,,both,,,771.6000,115.7400,MEDCOST,MEDCOST VHN,367.20,,,,,,,199.1500,771.6000,percent of total billed charges,47.59% of $771.60 in Billed Charges for Rev 272 = $367.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BIOPSY 10G STERILE,272,RC,,,,,,,,both,,,771.6000,115.7400,SENTARA HEALTH,SENTARA HEALTH,199.15,,,,,,,199.1500,771.6000,percent of total billed charges,25.81% of $771.60 in Billed Charges for Rev 272 = $199.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BIOPSY 10G STERILE,272,RC,,,,,,,,both,,,771.6000,115.7400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",771.60,,,,,,,199.1500,771.6000,percent of total billed charges,100% of $771.60 in Billed Charges for Rev 272 = $771.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BIOPSY 10G STERILE,272,RC,,,,,,,,both,,,771.6000,115.7400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,385.80,,,,,,,199.1500,771.6000,percent of total billed charges,Rev 272 $771.60 in Billed Charges at 50% = $385.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BIOPSY 10G STERILE,272,RC,,,,,,,,both,,,771.6000,115.7400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,249.23,,,,,,,199.1500,771.6000,other,32.3% of $771.60 in Billed Charges for Rev 272 = $249.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT BIOPSY 10G STERILE,272,RC,,,,,,,,both,,,771.6000,115.7400,UNITED HEALTHCARE,UHC HERITAGE SELECT,236.88,,,,,,,199.1500,771.6000,other,30.7% of $771.60 in Billed Charges for Rev 272 = $236.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT BIOPSY 10G STERILE,272,RC,,,,,,,,both,,,771.6000,115.7400,UNITED HEALTHCARE,UNITED HEALTHCARE,249.23,,,,,,,199.1500,771.6000,percent of total billed charges,32.3% of $771.60 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BIOPSY 10G STERILE,272,RC,,,,,,,,both,,,771.6000,115.7400,WELLCARE,WELLCARE MEDICAID,771.60,,,,,,,199.1500,771.6000,percent of total billed charges,100% of $771.60 in Billed Charges for Rev 272 = $771.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE BIOPSY 13GA,272,RC,27200002,CDM,,,,,,both,,,855.4200,128.3100,AETNA,AETNA,365.26,,,,,,,220.7800,855.4200,percent of total billed charges,42.7% of $855.42 in Billed Charges for Rev 272 = $365.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE BIOPSY 13GA,272,RC,27200002,CDM,,,,,,both,,,855.4200,128.3100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,598.79,,,,,,,220.7800,855.4200,percent of total billed charges,Rev 272 $855.42 in Billed Charges at 70% = $598.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE BIOPSY 13GA,272,RC,27200002,CDM,,,,,,both,,,855.4200,128.3100,CIGNA HEALTHCARE,CIGNA HMO,356.71,,,,,,,220.7800,855.4200,percent of total billed charges,41.7% of $855.42 in Billed Charges for Rev 272 = $356.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE BIOPSY 13GA,272,RC,27200002,CDM,,,,,,both,,,855.4200,128.3100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,396.91,,,,,,,220.7800,855.4200,percent of total billed charges,46.4% of $855.42 in Billed Charges for Rev 272 = $396.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE BIOPSY 13GA,272,RC,27200002,CDM,,,,,,both,,,855.4200,128.3100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,356.71,,,,,,,220.7800,855.4200,percent of total billed charges,41.7% of $855.42 in Billed Charges for Rev 272 = $356.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE BIOPSY 13GA,272,RC,27200002,CDM,,,,,,both,,,855.4200,128.3100,CIGNA HEALTHCARE,CIGNA PPO,356.71,,,,,,,220.7800,855.4200,percent of total billed charges,41.7% of $855.42 in Billed Charges for Rev 272 = $356.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE BIOPSY 13GA,272,RC,27200002,CDM,,,,,,both,,,855.4200,128.3100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,769.88,,,,,,,220.7800,855.4200,percent of total billed charges,90% of $855.42 in Billed Charges for Rev 272 = $769.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE BIOPSY 13GA,272,RC,27200002,CDM,,,,,,both,,,855.4200,128.3100,MEDCOST,MEDCOST VHN,407.09,,,,,,,220.7800,855.4200,percent of total billed charges,47.59% of $855.42 in Billed Charges for Rev 272 = $407.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE BIOPSY 13GA,272,RC,27200002,CDM,,,,,,both,,,855.4200,128.3100,SENTARA HEALTH,SENTARA HEALTH,220.78,,,,,,,220.7800,855.4200,percent of total billed charges,25.81% of $855.42 in Billed Charges for Rev 272 = $220.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE BIOPSY 13GA,272,RC,27200002,CDM,,,,,,both,,,855.4200,128.3100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",855.42,,,,,,,220.7800,855.4200,percent of total billed charges,100% of $855.42 in Billed Charges for Rev 272 = $855.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE BIOPSY 13GA,272,RC,27200002,CDM,,,,,,both,,,855.4200,128.3100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,427.71,,,,,,,220.7800,855.4200,percent of total billed charges,Rev 272 $855.42 in Billed Charges at 50% = $427.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE BIOPSY 13GA,272,RC,27200002,CDM,,,,,,both,,,855.4200,128.3100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,276.30,,,,,,,220.7800,855.4200,other,32.3% of $855.42 in Billed Charges for Rev 272 = $276.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT BONE BIOPSY 13GA,272,RC,27200002,CDM,,,,,,both,,,855.4200,128.3100,UNITED HEALTHCARE,UHC HERITAGE SELECT,262.61,,,,,,,220.7800,855.4200,other,30.7% of $855.42 in Billed Charges for Rev 272 = $262.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT BONE BIOPSY 13GA,272,RC,27200002,CDM,,,,,,both,,,855.4200,128.3100,UNITED HEALTHCARE,UNITED HEALTHCARE,276.30,,,,,,,220.7800,855.4200,percent of total billed charges,32.3% of $855.42 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE BIOPSY 13GA,272,RC,27200002,CDM,,,,,,both,,,855.4200,128.3100,WELLCARE,WELLCARE MEDICAID,855.42,,,,,,,220.7800,855.4200,percent of total billed charges,100% of $855.42 in Billed Charges for Rev 272 = $855.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE DOWEL REVISION 16MM,272,RC,,,,,,,,both,,,6616.7000,992.5100,AETNA,AETNA,2825.33,,,,,,,1707.7700,6616.7000,percent of total billed charges,"42.7% of $6,616.70 in Billed Charges for Rev 272 = $2,825.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE DOWEL REVISION 16MM,272,RC,,,,,,,,both,,,6616.7000,992.5100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4631.69,,,,,,,1707.7700,6616.7000,percent of total billed charges,"Rev 272 $6,616.70 in Billed Charges at 70% = $4,631.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE DOWEL REVISION 16MM,272,RC,,,,,,,,both,,,6616.7000,992.5100,CIGNA HEALTHCARE,CIGNA HMO,2759.16,,,,,,,1707.7700,6616.7000,percent of total billed charges,"41.7% of $6,616.70 in Billed Charges for Rev 272 = $2,759.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE DOWEL REVISION 16MM,272,RC,,,,,,,,both,,,6616.7000,992.5100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3070.15,,,,,,,1707.7700,6616.7000,percent of total billed charges,"46.4% of $6,616.70 in Billed Charges for Rev 272 = $3,070.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE DOWEL REVISION 16MM,272,RC,,,,,,,,both,,,6616.7000,992.5100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2759.16,,,,,,,1707.7700,6616.7000,percent of total billed charges,"41.7% of $6,616.70 in Billed Charges for Rev 272 = $2,759.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE DOWEL REVISION 16MM,272,RC,,,,,,,,both,,,6616.7000,992.5100,CIGNA HEALTHCARE,CIGNA PPO,2759.16,,,,,,,1707.7700,6616.7000,percent of total billed charges,"41.7% of $6,616.70 in Billed Charges for Rev 272 = $2,759.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE DOWEL REVISION 16MM,272,RC,,,,,,,,both,,,6616.7000,992.5100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5955.03,,,,,,,1707.7700,6616.7000,percent of total billed charges,"90% of $6,616.70 in Billed Charges for Rev 272 = $5,955.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE DOWEL REVISION 16MM,272,RC,,,,,,,,both,,,6616.7000,992.5100,MEDCOST,MEDCOST VHN,3148.89,,,,,,,1707.7700,6616.7000,percent of total billed charges,"47.59% of $6,616.70 in Billed Charges for Rev 272 = $3,148.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE DOWEL REVISION 16MM,272,RC,,,,,,,,both,,,6616.7000,992.5100,SENTARA HEALTH,SENTARA HEALTH,1707.77,,,,,,,1707.7700,6616.7000,percent of total billed charges,"25.81% of $6,616.70 in Billed Charges for Rev 272 = $1,707.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE DOWEL REVISION 16MM,272,RC,,,,,,,,both,,,6616.7000,992.5100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6616.70,,,,,,,1707.7700,6616.7000,percent of total billed charges,"100% of $6,616.70 in Billed Charges for Rev 272 = $6,616.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE DOWEL REVISION 16MM,272,RC,,,,,,,,both,,,6616.7000,992.5100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3308.35,,,,,,,1707.7700,6616.7000,percent of total billed charges,"Rev 272 $6,616.70 in Billed Charges at 50% = $3,308.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE DOWEL REVISION 16MM,272,RC,,,,,,,,both,,,6616.7000,992.5100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2137.19,,,,,,,1707.7700,6616.7000,other,"32.3% of $6,616.70 in Billed Charges for Rev 272 = $2,137.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT BONE DOWEL REVISION 16MM,272,RC,,,,,,,,both,,,6616.7000,992.5100,UNITED HEALTHCARE,UHC HERITAGE SELECT,2031.33,,,,,,,1707.7700,6616.7000,other,"30.7% of $6,616.70 in Billed Charges for Rev 272 = $2,031.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT BONE DOWEL REVISION 16MM,272,RC,,,,,,,,both,,,6616.7000,992.5100,UNITED HEALTHCARE,UNITED HEALTHCARE,2137.19,,,,,,,1707.7700,6616.7000,percent of total billed charges,"32.3% of $6,616.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE DOWEL REVISION 16MM,272,RC,,,,,,,,both,,,6616.7000,992.5100,WELLCARE,WELLCARE MEDICAID,6616.70,,,,,,,1707.7700,6616.7000,percent of total billed charges,"100% of $6,616.70 in Billed Charges for Rev 272 = $6,616.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL PLANNED MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,33633.7800,5045.0700,AETNA,AETNA,14361.62,,,,,,,8680.8800,33633.7800,percent of total billed charges,"42.7% of $33,633.78 in Billed Charges for Rev 272 = $14,361.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL PLANNED MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,33633.7800,5045.0700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,23543.65,,,,,,,8680.8800,33633.7800,percent of total billed charges,"Rev 272 $33,633.78 in Billed Charges at 70% = $23,543.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL PLANNED MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,33633.7800,5045.0700,CIGNA HEALTHCARE,CIGNA HMO,14025.29,,,,,,,8680.8800,33633.7800,percent of total billed charges,"41.7% of $33,633.78 in Billed Charges for Rev 272 = $14,025.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL PLANNED MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,33633.7800,5045.0700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,15606.07,,,,,,,8680.8800,33633.7800,percent of total billed charges,"46.4% of $33,633.78 in Billed Charges for Rev 272 = $15,606.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL PLANNED MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,33633.7800,5045.0700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,14025.29,,,,,,,8680.8800,33633.7800,percent of total billed charges,"41.7% of $33,633.78 in Billed Charges for Rev 272 = $14,025.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL PLANNED MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,33633.7800,5045.0700,CIGNA HEALTHCARE,CIGNA PPO,14025.29,,,,,,,8680.8800,33633.7800,percent of total billed charges,"41.7% of $33,633.78 in Billed Charges for Rev 272 = $14,025.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL PLANNED MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,33633.7800,5045.0700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,30270.40,,,,,,,8680.8800,33633.7800,percent of total billed charges,"90% of $33,633.78 in Billed Charges for Rev 272 = $30,270.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL PLANNED MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,33633.7800,5045.0700,MEDCOST,MEDCOST VHN,16006.32,,,,,,,8680.8800,33633.7800,percent of total billed charges,"47.59% of $33,633.78 in Billed Charges for Rev 272 = $16,006.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL PLANNED MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,33633.7800,5045.0700,SENTARA HEALTH,SENTARA HEALTH,8680.88,,,,,,,8680.8800,33633.7800,percent of total billed charges,"25.81% of $33,633.78 in Billed Charges for Rev 272 = $8,680.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL PLANNED MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,33633.7800,5045.0700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",33633.78,,,,,,,8680.8800,33633.7800,percent of total billed charges,"100% of $33,633.78 in Billed Charges for Rev 272 = $33,633.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL PLANNED MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,33633.7800,5045.0700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,16816.89,,,,,,,8680.8800,33633.7800,percent of total billed charges,"Rev 272 $33,633.78 in Billed Charges at 50% = $16,816.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL PLANNED MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,33633.7800,5045.0700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,10863.71,,,,,,,8680.8800,33633.7800,other,"32.3% of $33,633.78 in Billed Charges for Rev 272 = $10,863.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODEL PLANNED MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,33633.7800,5045.0700,UNITED HEALTHCARE,UHC HERITAGE SELECT,10325.57,,,,,,,8680.8800,33633.7800,other,"30.7% of $33,633.78 in Billed Charges for Rev 272 = $10,325.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODEL PLANNED MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,33633.7800,5045.0700,UNITED HEALTHCARE,UNITED HEALTHCARE,10863.71,,,,,,,8680.8800,33633.7800,percent of total billed charges,"32.3% of $33,633.78 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODEL PLANNED MAXILLA CRANIUM,272,RC,27200002,CDM,,,,,,both,,,33633.7800,5045.0700,WELLCARE,WELLCARE MEDICAID,33633.78,,,,,,,8680.8800,33633.7800,percent of total billed charges,"100% of $33,633.78 in Billed Charges for Rev 272 = $33,633.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE INTUBATION PURPLE,270,RC,,,,,,,,both,,,1037.1000,155.5700,AETNA,AETNA,442.84,,,,,,,267.6800,1037.1000,percent of total billed charges,"42.7% of $1,037.10 in Billed Charges for Rev 270 = $442.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE INTUBATION PURPLE,270,RC,,,,,,,,both,,,1037.1000,155.5700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,725.97,,,,,,,267.6800,1037.1000,percent of total billed charges,"Rev 270 $1,037.10 in Billed Charges at 70% = $725.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE INTUBATION PURPLE,270,RC,,,,,,,,both,,,1037.1000,155.5700,CIGNA HEALTHCARE,CIGNA HMO,432.47,,,,,,,267.6800,1037.1000,percent of total billed charges,"41.7% of $1,037.10 in Billed Charges for Rev 270 = $432.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE INTUBATION PURPLE,270,RC,,,,,,,,both,,,1037.1000,155.5700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,481.21,,,,,,,267.6800,1037.1000,percent of total billed charges,"46.4% of $1,037.10 in Billed Charges for Rev 270 = $481.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE INTUBATION PURPLE,270,RC,,,,,,,,both,,,1037.1000,155.5700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,432.47,,,,,,,267.6800,1037.1000,percent of total billed charges,"41.7% of $1,037.10 in Billed Charges for Rev 270 = $432.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE INTUBATION PURPLE,270,RC,,,,,,,,both,,,1037.1000,155.5700,CIGNA HEALTHCARE,CIGNA PPO,432.47,,,,,,,267.6800,1037.1000,percent of total billed charges,"41.7% of $1,037.10 in Billed Charges for Rev 270 = $432.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE INTUBATION PURPLE,270,RC,,,,,,,,both,,,1037.1000,155.5700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,933.39,,,,,,,267.6800,1037.1000,percent of total billed charges,"90% of $1,037.10 in Billed Charges for Rev 270 = $933.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE INTUBATION PURPLE,270,RC,,,,,,,,both,,,1037.1000,155.5700,MEDCOST,MEDCOST VHN,493.56,,,,,,,267.6800,1037.1000,percent of total billed charges,"47.59% of $1,037.10 in Billed Charges for Rev 270 = $493.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE INTUBATION PURPLE,270,RC,,,,,,,,both,,,1037.1000,155.5700,SENTARA HEALTH,SENTARA HEALTH,267.68,,,,,,,267.6800,1037.1000,percent of total billed charges,"25.81% of $1,037.10 in Billed Charges for Rev 270 = $267.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE INTUBATION PURPLE,270,RC,,,,,,,,both,,,1037.1000,155.5700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1037.10,,,,,,,267.6800,1037.1000,percent of total billed charges,"100% of $1,037.10 in Billed Charges for Rev 270 = $1,037.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE INTUBATION PURPLE,270,RC,,,,,,,,both,,,1037.1000,155.5700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,518.55,,,,,,,267.6800,1037.1000,percent of total billed charges,"Rev 270 $1,037.10 in Billed Charges at 50% = $518.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE INTUBATION PURPLE,270,RC,,,,,,,,both,,,1037.1000,155.5700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,334.98,,,,,,,267.6800,1037.1000,other,"32.3% of $1,037.10 in Billed Charges for Rev 270 = $334.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODULE INTUBATION PURPLE,270,RC,,,,,,,,both,,,1037.1000,155.5700,UNITED HEALTHCARE,UHC HERITAGE SELECT,318.39,,,,,,,267.6800,1037.1000,other,"30.7% of $1,037.10 in Billed Charges for Rev 270 = $318.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODULE INTUBATION PURPLE,270,RC,,,,,,,,both,,,1037.1000,155.5700,UNITED HEALTHCARE,UNITED HEALTHCARE,334.98,,,,,,,267.6800,1037.1000,percent of total billed charges,"32.3% of $1,037.10 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE INTUBATION PURPLE,270,RC,,,,,,,,both,,,1037.1000,155.5700,WELLCARE,WELLCARE MEDICAID,1037.10,,,,,,,267.6800,1037.1000,percent of total billed charges,"100% of $1,037.10 in Billed Charges for Rev 270 = $1,037.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE OXYGEN DEL YELLOW,270,RC,,,,,,,,both,,,2512.4800,376.8700,AETNA,AETNA,1072.83,,,,,,,648.4700,2512.4800,percent of total billed charges,"42.7% of $2,512.48 in Billed Charges for Rev 270 = $1,072.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE OXYGEN DEL YELLOW,270,RC,,,,,,,,both,,,2512.4800,376.8700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1758.74,,,,,,,648.4700,2512.4800,percent of total billed charges,"Rev 270 $2,512.48 in Billed Charges at 70% = $1,758.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE OXYGEN DEL YELLOW,270,RC,,,,,,,,both,,,2512.4800,376.8700,CIGNA HEALTHCARE,CIGNA HMO,1047.70,,,,,,,648.4700,2512.4800,percent of total billed charges,"41.7% of $2,512.48 in Billed Charges for Rev 270 = $1,047.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE OXYGEN DEL YELLOW,270,RC,,,,,,,,both,,,2512.4800,376.8700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1165.79,,,,,,,648.4700,2512.4800,percent of total billed charges,"46.4% of $2,512.48 in Billed Charges for Rev 270 = $1,165.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE OXYGEN DEL YELLOW,270,RC,,,,,,,,both,,,2512.4800,376.8700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1047.70,,,,,,,648.4700,2512.4800,percent of total billed charges,"41.7% of $2,512.48 in Billed Charges for Rev 270 = $1,047.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE OXYGEN DEL YELLOW,270,RC,,,,,,,,both,,,2512.4800,376.8700,CIGNA HEALTHCARE,CIGNA PPO,1047.70,,,,,,,648.4700,2512.4800,percent of total billed charges,"41.7% of $2,512.48 in Billed Charges for Rev 270 = $1,047.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE OXYGEN DEL YELLOW,270,RC,,,,,,,,both,,,2512.4800,376.8700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2261.23,,,,,,,648.4700,2512.4800,percent of total billed charges,"90% of $2,512.48 in Billed Charges for Rev 270 = $2,261.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE OXYGEN DEL YELLOW,270,RC,,,,,,,,both,,,2512.4800,376.8700,MEDCOST,MEDCOST VHN,1195.69,,,,,,,648.4700,2512.4800,percent of total billed charges,"47.59% of $2,512.48 in Billed Charges for Rev 270 = $1,195.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE OXYGEN DEL YELLOW,270,RC,,,,,,,,both,,,2512.4800,376.8700,SENTARA HEALTH,SENTARA HEALTH,648.47,,,,,,,648.4700,2512.4800,percent of total billed charges,"25.81% of $2,512.48 in Billed Charges for Rev 270 = $648.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE OXYGEN DEL YELLOW,270,RC,,,,,,,,both,,,2512.4800,376.8700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2512.48,,,,,,,648.4700,2512.4800,percent of total billed charges,"100% of $2,512.48 in Billed Charges for Rev 270 = $2,512.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE OXYGEN DEL YELLOW,270,RC,,,,,,,,both,,,2512.4800,376.8700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1256.24,,,,,,,648.4700,2512.4800,percent of total billed charges,"Rev 270 $2,512.48 in Billed Charges at 50% = $1,256.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE OXYGEN DEL YELLOW,270,RC,,,,,,,,both,,,2512.4800,376.8700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,811.53,,,,,,,648.4700,2512.4800,other,"32.3% of $2,512.48 in Billed Charges for Rev 270 = $811.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODULE OXYGEN DEL YELLOW,270,RC,,,,,,,,both,,,2512.4800,376.8700,UNITED HEALTHCARE,UHC HERITAGE SELECT,771.33,,,,,,,648.4700,2512.4800,other,"30.7% of $2,512.48 in Billed Charges for Rev 270 = $771.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MODULE OXYGEN DEL YELLOW,270,RC,,,,,,,,both,,,2512.4800,376.8700,UNITED HEALTHCARE,UNITED HEALTHCARE,811.53,,,,,,,648.4700,2512.4800,percent of total billed charges,"32.3% of $2,512.48 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MODULE OXYGEN DEL YELLOW,270,RC,,,,,,,,both,,,2512.4800,376.8700,WELLCARE,WELLCARE MEDICAID,2512.48,,,,,,,648.4700,2512.4800,percent of total billed charges,"100% of $2,512.48 in Billed Charges for Rev 270 = $2,512.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MOXY FGI REG A GREENLIGHT,272,RC,27200002,CDM,,,,,,both,,,13897.1400,2084.5700,AETNA,AETNA,5934.08,,,,,,,3586.8500,13897.1400,percent of total billed charges,"42.7% of $13,897.14 in Billed Charges for Rev 272 = $5,934.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MOXY FGI REG A GREENLIGHT,272,RC,27200002,CDM,,,,,,both,,,13897.1400,2084.5700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9728.00,,,,,,,3586.8500,13897.1400,percent of total billed charges,"Rev 272 $13,897.14 in Billed Charges at 70% = $9,728.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MOXY FGI REG A GREENLIGHT,272,RC,27200002,CDM,,,,,,both,,,13897.1400,2084.5700,CIGNA HEALTHCARE,CIGNA HMO,5795.11,,,,,,,3586.8500,13897.1400,percent of total billed charges,"41.7% of $13,897.14 in Billed Charges for Rev 272 = $5,795.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MOXY FGI REG A GREENLIGHT,272,RC,27200002,CDM,,,,,,both,,,13897.1400,2084.5700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6448.27,,,,,,,3586.8500,13897.1400,percent of total billed charges,"46.4% of $13,897.14 in Billed Charges for Rev 272 = $6,448.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MOXY FGI REG A GREENLIGHT,272,RC,27200002,CDM,,,,,,both,,,13897.1400,2084.5700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5795.11,,,,,,,3586.8500,13897.1400,percent of total billed charges,"41.7% of $13,897.14 in Billed Charges for Rev 272 = $5,795.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MOXY FGI REG A GREENLIGHT,272,RC,27200002,CDM,,,,,,both,,,13897.1400,2084.5700,CIGNA HEALTHCARE,CIGNA PPO,5795.11,,,,,,,3586.8500,13897.1400,percent of total billed charges,"41.7% of $13,897.14 in Billed Charges for Rev 272 = $5,795.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MOXY FGI REG A GREENLIGHT,272,RC,27200002,CDM,,,,,,both,,,13897.1400,2084.5700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12507.43,,,,,,,3586.8500,13897.1400,percent of total billed charges,"90% of $13,897.14 in Billed Charges for Rev 272 = $12,507.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MOXY FGI REG A GREENLIGHT,272,RC,27200002,CDM,,,,,,both,,,13897.1400,2084.5700,MEDCOST,MEDCOST VHN,6613.65,,,,,,,3586.8500,13897.1400,percent of total billed charges,"47.59% of $13,897.14 in Billed Charges for Rev 272 = $6,613.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MOXY FGI REG A GREENLIGHT,272,RC,27200002,CDM,,,,,,both,,,13897.1400,2084.5700,SENTARA HEALTH,SENTARA HEALTH,3586.85,,,,,,,3586.8500,13897.1400,percent of total billed charges,"25.81% of $13,897.14 in Billed Charges for Rev 272 = $3,586.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MOXY FGI REG A GREENLIGHT,272,RC,27200002,CDM,,,,,,both,,,13897.1400,2084.5700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13897.14,,,,,,,3586.8500,13897.1400,percent of total billed charges,"100% of $13,897.14 in Billed Charges for Rev 272 = $13,897.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MOXY FGI REG A GREENLIGHT,272,RC,27200002,CDM,,,,,,both,,,13897.1400,2084.5700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6948.57,,,,,,,3586.8500,13897.1400,percent of total billed charges,"Rev 272 $13,897.14 in Billed Charges at 50% = $6,948.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MOXY FGI REG A GREENLIGHT,272,RC,27200002,CDM,,,,,,both,,,13897.1400,2084.5700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4488.78,,,,,,,3586.8500,13897.1400,other,"32.3% of $13,897.14 in Billed Charges for Rev 272 = $4,488.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MOXY FGI REG A GREENLIGHT,272,RC,27200002,CDM,,,,,,both,,,13897.1400,2084.5700,UNITED HEALTHCARE,UHC HERITAGE SELECT,4266.42,,,,,,,3586.8500,13897.1400,other,"30.7% of $13,897.14 in Billed Charges for Rev 272 = $4,266.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MOXY FGI REG A GREENLIGHT,272,RC,27200002,CDM,,,,,,both,,,13897.1400,2084.5700,UNITED HEALTHCARE,UNITED HEALTHCARE,4488.78,,,,,,,3586.8500,13897.1400,percent of total billed charges,"32.3% of $13,897.14 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MOXY FGI REG A GREENLIGHT,272,RC,27200002,CDM,,,,,,both,,,13897.1400,2084.5700,WELLCARE,WELLCARE MEDICAID,13897.14,,,,,,,3586.8500,13897.1400,percent of total billed charges,"100% of $13,897.14 in Billed Charges for Rev 272 = $13,897.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,981.9300,147.2900,AETNA,AETNA,419.28,,,,,,,253.4400,981.9300,percent of total billed charges,42.7% of $981.93 in Billed Charges for Rev 272 = $419.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,981.9300,147.2900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,687.35,,,,,,,253.4400,981.9300,percent of total billed charges,Rev 272 $981.93 in Billed Charges at 70% = $687.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,981.9300,147.2900,CIGNA HEALTHCARE,CIGNA HMO,409.46,,,,,,,253.4400,981.9300,percent of total billed charges,41.7% of $981.93 in Billed Charges for Rev 272 = $409.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,981.9300,147.2900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,455.62,,,,,,,253.4400,981.9300,percent of total billed charges,46.4% of $981.93 in Billed Charges for Rev 272 = $455.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,981.9300,147.2900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,409.46,,,,,,,253.4400,981.9300,percent of total billed charges,41.7% of $981.93 in Billed Charges for Rev 272 = $409.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,981.9300,147.2900,CIGNA HEALTHCARE,CIGNA PPO,409.46,,,,,,,253.4400,981.9300,percent of total billed charges,41.7% of $981.93 in Billed Charges for Rev 272 = $409.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,981.9300,147.2900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,883.74,,,,,,,253.4400,981.9300,percent of total billed charges,90% of $981.93 in Billed Charges for Rev 272 = $883.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,981.9300,147.2900,MEDCOST,MEDCOST VHN,467.30,,,,,,,253.4400,981.9300,percent of total billed charges,47.59% of $981.93 in Billed Charges for Rev 272 = $467.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,981.9300,147.2900,SENTARA HEALTH,SENTARA HEALTH,253.44,,,,,,,253.4400,981.9300,percent of total billed charges,25.81% of $981.93 in Billed Charges for Rev 272 = $253.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,981.9300,147.2900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",981.93,,,,,,,253.4400,981.9300,percent of total billed charges,100% of $981.93 in Billed Charges for Rev 272 = $981.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,981.9300,147.2900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,490.97,,,,,,,253.4400,981.9300,percent of total billed charges,Rev 272 $981.93 in Billed Charges at 50% = $490.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,981.9300,147.2900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,317.16,,,,,,,253.4400,981.9300,other,32.3% of $981.93 in Billed Charges for Rev 272 = $317.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,981.9300,147.2900,UNITED HEALTHCARE,UHC HERITAGE SELECT,301.45,,,,,,,253.4400,981.9300,other,30.7% of $981.93 in Billed Charges for Rev 272 = $301.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,981.9300,147.2900,UNITED HEALTHCARE,UNITED HEALTHCARE,317.16,,,,,,,253.4400,981.9300,percent of total billed charges,32.3% of $981.93 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,981.9300,147.2900,WELLCARE,WELLCARE MEDICAID,981.93,,,,,,,253.4400,981.9300,percent of total billed charges,100% of $981.93 in Billed Charges for Rev 272 = $981.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PROCEDURE EDGE 180 FT,272,RC,27200002,CDM,,,,,,both,,,18501.8600,2775.2800,AETNA,AETNA,7900.29,,,,,,,4775.3300,18501.8600,percent of total billed charges,"42.7% of $18,501.86 in Billed Charges for Rev 272 = $7,900.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE EDGE 180 FT,272,RC,27200002,CDM,,,,,,both,,,18501.8600,2775.2800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,12951.30,,,,,,,4775.3300,18501.8600,percent of total billed charges,"Rev 272 $18,501.86 in Billed Charges at 70% = $12,951.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE EDGE 180 FT,272,RC,27200002,CDM,,,,,,both,,,18501.8600,2775.2800,CIGNA HEALTHCARE,CIGNA HMO,7715.28,,,,,,,4775.3300,18501.8600,percent of total billed charges,"41.7% of $18,501.86 in Billed Charges for Rev 272 = $7,715.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE EDGE 180 FT,272,RC,27200002,CDM,,,,,,both,,,18501.8600,2775.2800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8584.86,,,,,,,4775.3300,18501.8600,percent of total billed charges,"46.4% of $18,501.86 in Billed Charges for Rev 272 = $8,584.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE EDGE 180 FT,272,RC,27200002,CDM,,,,,,both,,,18501.8600,2775.2800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7715.28,,,,,,,4775.3300,18501.8600,percent of total billed charges,"41.7% of $18,501.86 in Billed Charges for Rev 272 = $7,715.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE EDGE 180 FT,272,RC,27200002,CDM,,,,,,both,,,18501.8600,2775.2800,CIGNA HEALTHCARE,CIGNA PPO,7715.28,,,,,,,4775.3300,18501.8600,percent of total billed charges,"41.7% of $18,501.86 in Billed Charges for Rev 272 = $7,715.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE EDGE 180 FT,272,RC,27200002,CDM,,,,,,both,,,18501.8600,2775.2800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,16651.67,,,,,,,4775.3300,18501.8600,percent of total billed charges,"90% of $18,501.86 in Billed Charges for Rev 272 = $16,651.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE EDGE 180 FT,272,RC,27200002,CDM,,,,,,both,,,18501.8600,2775.2800,MEDCOST,MEDCOST VHN,8805.04,,,,,,,4775.3300,18501.8600,percent of total billed charges,"47.59% of $18,501.86 in Billed Charges for Rev 272 = $8,805.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE EDGE 180 FT,272,RC,27200002,CDM,,,,,,both,,,18501.8600,2775.2800,SENTARA HEALTH,SENTARA HEALTH,4775.33,,,,,,,4775.3300,18501.8600,percent of total billed charges,"25.81% of $18,501.86 in Billed Charges for Rev 272 = $4,775.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE EDGE 180 FT,272,RC,27200002,CDM,,,,,,both,,,18501.8600,2775.2800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",18501.86,,,,,,,4775.3300,18501.8600,percent of total billed charges,"100% of $18,501.86 in Billed Charges for Rev 272 = $18,501.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE EDGE 180 FT,272,RC,27200002,CDM,,,,,,both,,,18501.8600,2775.2800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9250.93,,,,,,,4775.3300,18501.8600,percent of total billed charges,"Rev 272 $18,501.86 in Billed Charges at 50% = $9,250.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE EDGE 180 FT,272,RC,27200002,CDM,,,,,,both,,,18501.8600,2775.2800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5976.10,,,,,,,4775.3300,18501.8600,other,"32.3% of $18,501.86 in Billed Charges for Rev 272 = $5,976.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PROCEDURE EDGE 180 FT,272,RC,27200002,CDM,,,,,,both,,,18501.8600,2775.2800,UNITED HEALTHCARE,UHC HERITAGE SELECT,5680.07,,,,,,,4775.3300,18501.8600,other,"30.7% of $18,501.86 in Billed Charges for Rev 272 = $5,680.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PROCEDURE EDGE 180 FT,272,RC,27200002,CDM,,,,,,both,,,18501.8600,2775.2800,UNITED HEALTHCARE,UNITED HEALTHCARE,5976.10,,,,,,,4775.3300,18501.8600,percent of total billed charges,"32.3% of $18,501.86 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE EDGE 180 FT,272,RC,27200002,CDM,,,,,,both,,,18501.8600,2775.2800,WELLCARE,WELLCARE MEDICAID,18501.86,,,,,,,4775.3300,18501.8600,percent of total billed charges,"100% of $18,501.86 in Billed Charges for Rev 272 = $18,501.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH COOL LN 9.3FR 22CM TRP L,272,RC,27200500,CDM,,,,,,both,,,1365.0000,204.7500,AETNA,AETNA,582.86,,,,,,,352.3100,1365.0000,percent of total billed charges,"42.7% of $1,365.00 in Billed Charges for Rev 272 = $582.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH COOL LN 9.3FR 22CM TRP L,272,RC,27200500,CDM,,,,,,both,,,1365.0000,204.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,955.50,,,,,,,352.3100,1365.0000,percent of total billed charges,"Rev 272 $1,365.00 in Billed Charges at 70% = $955.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH COOL LN 9.3FR 22CM TRP L,272,RC,27200500,CDM,,,,,,both,,,1365.0000,204.7500,CIGNA HEALTHCARE,CIGNA HMO,569.21,,,,,,,352.3100,1365.0000,percent of total billed charges,"41.7% of $1,365.00 in Billed Charges for Rev 272 = $569.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH COOL LN 9.3FR 22CM TRP L,272,RC,27200500,CDM,,,,,,both,,,1365.0000,204.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,633.36,,,,,,,352.3100,1365.0000,percent of total billed charges,"46.4% of $1,365.00 in Billed Charges for Rev 272 = $633.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH COOL LN 9.3FR 22CM TRP L,272,RC,27200500,CDM,,,,,,both,,,1365.0000,204.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,569.21,,,,,,,352.3100,1365.0000,percent of total billed charges,"41.7% of $1,365.00 in Billed Charges for Rev 272 = $569.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH COOL LN 9.3FR 22CM TRP L,272,RC,27200500,CDM,,,,,,both,,,1365.0000,204.7500,CIGNA HEALTHCARE,CIGNA PPO,569.21,,,,,,,352.3100,1365.0000,percent of total billed charges,"41.7% of $1,365.00 in Billed Charges for Rev 272 = $569.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH COOL LN 9.3FR 22CM TRP L,272,RC,27200500,CDM,,,,,,both,,,1365.0000,204.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1228.50,,,,,,,352.3100,1365.0000,percent of total billed charges,"90% of $1,365.00 in Billed Charges for Rev 272 = $1,228.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH COOL LN 9.3FR 22CM TRP L,272,RC,27200500,CDM,,,,,,both,,,1365.0000,204.7500,MEDCOST,MEDCOST VHN,649.60,,,,,,,352.3100,1365.0000,percent of total billed charges,"47.59% of $1,365.00 in Billed Charges for Rev 272 = $649.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH COOL LN 9.3FR 22CM TRP L,272,RC,27200500,CDM,,,,,,both,,,1365.0000,204.7500,SENTARA HEALTH,SENTARA HEALTH,352.31,,,,,,,352.3100,1365.0000,percent of total billed charges,"25.81% of $1,365.00 in Billed Charges for Rev 272 = $352.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH COOL LN 9.3FR 22CM TRP L,272,RC,27200500,CDM,,,,,,both,,,1365.0000,204.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1365.00,,,,,,,352.3100,1365.0000,percent of total billed charges,"100% of $1,365.00 in Billed Charges for Rev 272 = $1,365.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH COOL LN 9.3FR 22CM TRP L,272,RC,27200500,CDM,,,,,,both,,,1365.0000,204.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,682.50,,,,,,,352.3100,1365.0000,percent of total billed charges,"Rev 272 $1,365.00 in Billed Charges at 50% = $682.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH COOL LN 9.3FR 22CM TRP L,272,RC,27200500,CDM,,,,,,both,,,1365.0000,204.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,440.90,,,,,,,352.3100,1365.0000,other,"32.3% of $1,365.00 in Billed Charges for Rev 272 = $440.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH COOL LN 9.3FR 22CM TRP L,272,RC,27200500,CDM,,,,,,both,,,1365.0000,204.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,419.06,,,,,,,352.3100,1365.0000,other,"30.7% of $1,365.00 in Billed Charges for Rev 272 = $419.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH COOL LN 9.3FR 22CM TRP L,272,RC,27200500,CDM,,,,,,both,,,1365.0000,204.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,440.90,,,,,,,352.3100,1365.0000,percent of total billed charges,"32.3% of $1,365.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH COOL LN 9.3FR 22CM TRP L,272,RC,27200500,CDM,,,,,,both,,,1365.0000,204.7500,WELLCARE,WELLCARE MEDICAID,1365.00,,,,,,,352.3100,1365.0000,percent of total billed charges,"100% of $1,365.00 in Billed Charges for Rev 272 = $1,365.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CTO CROSS IMG GUIDE OCELOT MVRX W/WEDGE TIP 6FRX.014INCHX110CM,272,RC,27201886,CDM,,,,,,both,,,10603.0000,1590.4500,AETNA,AETNA,4527.48,,,,,,,2736.6300,10603.0000,percent of total billed charges,"42.7% of $10,603.00 in Billed Charges for Rev 272 = $4,527.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CTO CROSS IMG GUIDE OCELOT MVRX W/WEDGE TIP 6FRX.014INCHX110CM,272,RC,27201886,CDM,,,,,,both,,,10603.0000,1590.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7422.10,,,,,,,2736.6300,10603.0000,percent of total billed charges,"Rev 272 $10,603.00 in Billed Charges at 70% = $7,422.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CTO CROSS IMG GUIDE OCELOT MVRX W/WEDGE TIP 6FRX.014INCHX110CM,272,RC,27201886,CDM,,,,,,both,,,10603.0000,1590.4500,CIGNA HEALTHCARE,CIGNA HMO,4421.45,,,,,,,2736.6300,10603.0000,percent of total billed charges,"41.7% of $10,603.00 in Billed Charges for Rev 272 = $4,421.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CTO CROSS IMG GUIDE OCELOT MVRX W/WEDGE TIP 6FRX.014INCHX110CM,272,RC,27201886,CDM,,,,,,both,,,10603.0000,1590.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4919.79,,,,,,,2736.6300,10603.0000,percent of total billed charges,"46.4% of $10,603.00 in Billed Charges for Rev 272 = $4,919.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CTO CROSS IMG GUIDE OCELOT MVRX W/WEDGE TIP 6FRX.014INCHX110CM,272,RC,27201886,CDM,,,,,,both,,,10603.0000,1590.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4421.45,,,,,,,2736.6300,10603.0000,percent of total billed charges,"41.7% of $10,603.00 in Billed Charges for Rev 272 = $4,421.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CTO CROSS IMG GUIDE OCELOT MVRX W/WEDGE TIP 6FRX.014INCHX110CM,272,RC,27201886,CDM,,,,,,both,,,10603.0000,1590.4500,CIGNA HEALTHCARE,CIGNA PPO,4421.45,,,,,,,2736.6300,10603.0000,percent of total billed charges,"41.7% of $10,603.00 in Billed Charges for Rev 272 = $4,421.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CTO CROSS IMG GUIDE OCELOT MVRX W/WEDGE TIP 6FRX.014INCHX110CM,272,RC,27201886,CDM,,,,,,both,,,10603.0000,1590.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9542.70,,,,,,,2736.6300,10603.0000,percent of total billed charges,"90% of $10,603.00 in Billed Charges for Rev 272 = $9,542.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CTO CROSS IMG GUIDE OCELOT MVRX W/WEDGE TIP 6FRX.014INCHX110CM,272,RC,27201886,CDM,,,,,,both,,,10603.0000,1590.4500,MEDCOST,MEDCOST VHN,5045.97,,,,,,,2736.6300,10603.0000,percent of total billed charges,"47.59% of $10,603.00 in Billed Charges for Rev 272 = $5,045.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CTO CROSS IMG GUIDE OCELOT MVRX W/WEDGE TIP 6FRX.014INCHX110CM,272,RC,27201886,CDM,,,,,,both,,,10603.0000,1590.4500,SENTARA HEALTH,SENTARA HEALTH,2736.63,,,,,,,2736.6300,10603.0000,percent of total billed charges,"25.81% of $10,603.00 in Billed Charges for Rev 272 = $2,736.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CTO CROSS IMG GUIDE OCELOT MVRX W/WEDGE TIP 6FRX.014INCHX110CM,272,RC,27201886,CDM,,,,,,both,,,10603.0000,1590.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10603.00,,,,,,,2736.6300,10603.0000,percent of total billed charges,"100% of $10,603.00 in Billed Charges for Rev 272 = $10,603.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CTO CROSS IMG GUIDE OCELOT MVRX W/WEDGE TIP 6FRX.014INCHX110CM,272,RC,27201886,CDM,,,,,,both,,,10603.0000,1590.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5301.50,,,,,,,2736.6300,10603.0000,percent of total billed charges,"Rev 272 $10,603.00 in Billed Charges at 50% = $5,301.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CTO CROSS IMG GUIDE OCELOT MVRX W/WEDGE TIP 6FRX.014INCHX110CM,272,RC,27201886,CDM,,,,,,both,,,10603.0000,1590.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3424.77,,,,,,,2736.6300,10603.0000,other,"32.3% of $10,603.00 in Billed Charges for Rev 272 = $3,424.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH CTO CROSS IMG GUIDE OCELOT MVRX W/WEDGE TIP 6FRX.014INCHX110CM,272,RC,27201886,CDM,,,,,,both,,,10603.0000,1590.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3255.12,,,,,,,2736.6300,10603.0000,other,"30.7% of $10,603.00 in Billed Charges for Rev 272 = $3,255.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH CTO CROSS IMG GUIDE OCELOT MVRX W/WEDGE TIP 6FRX.014INCHX110CM,272,RC,27201886,CDM,,,,,,both,,,10603.0000,1590.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,3424.77,,,,,,,2736.6300,10603.0000,percent of total billed charges,"32.3% of $10,603.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH CTO CROSS IMG GUIDE OCELOT MVRX W/WEDGE TIP 6FRX.014INCHX110CM,272,RC,27201886,CDM,,,,,,both,,,10603.0000,1590.4500,WELLCARE,WELLCARE MEDICAID,10603.00,,,,,,,2736.6300,10603.0000,percent of total billed charges,"100% of $10,603.00 in Billed Charges for Rev 272 = $10,603.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ELITECROSS EXTRA SUPPORT STRAIGHT/ANGLED,272,RC,27201933,CDM,,,,,,both,,,2748.0000,412.2000,AETNA,AETNA,1173.40,,,,,,,709.2600,2748.0000,percent of total billed charges,"42.7% of $2,748.00 in Billed Charges for Rev 272 = $1,173.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ELITECROSS EXTRA SUPPORT STRAIGHT/ANGLED,272,RC,27201933,CDM,,,,,,both,,,2748.0000,412.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1923.60,,,,,,,709.2600,2748.0000,percent of total billed charges,"Rev 272 $2,748.00 in Billed Charges at 70% = $1,923.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ELITECROSS EXTRA SUPPORT STRAIGHT/ANGLED,272,RC,27201933,CDM,,,,,,both,,,2748.0000,412.2000,CIGNA HEALTHCARE,CIGNA HMO,1145.92,,,,,,,709.2600,2748.0000,percent of total billed charges,"41.7% of $2,748.00 in Billed Charges for Rev 272 = $1,145.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ELITECROSS EXTRA SUPPORT STRAIGHT/ANGLED,272,RC,27201933,CDM,,,,,,both,,,2748.0000,412.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1275.07,,,,,,,709.2600,2748.0000,percent of total billed charges,"46.4% of $2,748.00 in Billed Charges for Rev 272 = $1,275.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ELITECROSS EXTRA SUPPORT STRAIGHT/ANGLED,272,RC,27201933,CDM,,,,,,both,,,2748.0000,412.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1145.92,,,,,,,709.2600,2748.0000,percent of total billed charges,"41.7% of $2,748.00 in Billed Charges for Rev 272 = $1,145.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ELITECROSS EXTRA SUPPORT STRAIGHT/ANGLED,272,RC,27201933,CDM,,,,,,both,,,2748.0000,412.2000,CIGNA HEALTHCARE,CIGNA PPO,1145.92,,,,,,,709.2600,2748.0000,percent of total billed charges,"41.7% of $2,748.00 in Billed Charges for Rev 272 = $1,145.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ELITECROSS EXTRA SUPPORT STRAIGHT/ANGLED,272,RC,27201933,CDM,,,,,,both,,,2748.0000,412.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2473.20,,,,,,,709.2600,2748.0000,percent of total billed charges,"90% of $2,748.00 in Billed Charges for Rev 272 = $2,473.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ELITECROSS EXTRA SUPPORT STRAIGHT/ANGLED,272,RC,27201933,CDM,,,,,,both,,,2748.0000,412.2000,MEDCOST,MEDCOST VHN,1307.77,,,,,,,709.2600,2748.0000,percent of total billed charges,"47.59% of $2,748.00 in Billed Charges for Rev 272 = $1,307.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ELITECROSS EXTRA SUPPORT STRAIGHT/ANGLED,272,RC,27201933,CDM,,,,,,both,,,2748.0000,412.2000,SENTARA HEALTH,SENTARA HEALTH,709.26,,,,,,,709.2600,2748.0000,percent of total billed charges,"25.81% of $2,748.00 in Billed Charges for Rev 272 = $709.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ELITECROSS EXTRA SUPPORT STRAIGHT/ANGLED,272,RC,27201933,CDM,,,,,,both,,,2748.0000,412.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2748.00,,,,,,,709.2600,2748.0000,percent of total billed charges,"100% of $2,748.00 in Billed Charges for Rev 272 = $2,748.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ELITECROSS EXTRA SUPPORT STRAIGHT/ANGLED,272,RC,27201933,CDM,,,,,,both,,,2748.0000,412.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1374.00,,,,,,,709.2600,2748.0000,percent of total billed charges,"Rev 272 $2,748.00 in Billed Charges at 50% = $1,374.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ELITECROSS EXTRA SUPPORT STRAIGHT/ANGLED,272,RC,27201933,CDM,,,,,,both,,,2748.0000,412.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,887.60,,,,,,,709.2600,2748.0000,other,"32.3% of $2,748.00 in Billed Charges for Rev 272 = $887.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH ELITECROSS EXTRA SUPPORT STRAIGHT/ANGLED,272,RC,27201933,CDM,,,,,,both,,,2748.0000,412.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,843.64,,,,,,,709.2600,2748.0000,other,"30.7% of $2,748.00 in Billed Charges for Rev 272 = $843.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH ELITECROSS EXTRA SUPPORT STRAIGHT/ANGLED,272,RC,27201933,CDM,,,,,,both,,,2748.0000,412.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,887.60,,,,,,,709.2600,2748.0000,percent of total billed charges,"32.3% of $2,748.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ELITECROSS EXTRA SUPPORT STRAIGHT/ANGLED,272,RC,27201933,CDM,,,,,,both,,,2748.0000,412.2000,WELLCARE,WELLCARE MEDICAID,2748.00,,,,,,,709.2600,2748.0000,percent of total billed charges,"100% of $2,748.00 in Billed Charges for Rev 272 = $2,748.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 45 CATHETER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,16531.3700,2479.7100,AETNA,AETNA,7058.90,,,,,,,4266.7500,16531.3700,percent of total billed charges,"42.7% of $16,531.37 in Billed Charges for Rev 272 = $7,058.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 45 CATHETER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,16531.3700,2479.7100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11571.96,,,,,,,4266.7500,16531.3700,percent of total billed charges,"Rev 272 $16,531.37 in Billed Charges at 70% = $11,571.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 45 CATHETER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,16531.3700,2479.7100,CIGNA HEALTHCARE,CIGNA HMO,6893.58,,,,,,,4266.7500,16531.3700,percent of total billed charges,"41.7% of $16,531.37 in Billed Charges for Rev 272 = $6,893.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 45 CATHETER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,16531.3700,2479.7100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7670.56,,,,,,,4266.7500,16531.3700,percent of total billed charges,"46.4% of $16,531.37 in Billed Charges for Rev 272 = $7,670.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 45 CATHETER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,16531.3700,2479.7100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6893.58,,,,,,,4266.7500,16531.3700,percent of total billed charges,"41.7% of $16,531.37 in Billed Charges for Rev 272 = $6,893.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 45 CATHETER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,16531.3700,2479.7100,CIGNA HEALTHCARE,CIGNA PPO,6893.58,,,,,,,4266.7500,16531.3700,percent of total billed charges,"41.7% of $16,531.37 in Billed Charges for Rev 272 = $6,893.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 45 CATHETER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,16531.3700,2479.7100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,14878.23,,,,,,,4266.7500,16531.3700,percent of total billed charges,"90% of $16,531.37 in Billed Charges for Rev 272 = $14,878.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 45 CATHETER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,16531.3700,2479.7100,MEDCOST,MEDCOST VHN,7867.28,,,,,,,4266.7500,16531.3700,percent of total billed charges,"47.59% of $16,531.37 in Billed Charges for Rev 272 = $7,867.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 45 CATHETER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,16531.3700,2479.7100,SENTARA HEALTH,SENTARA HEALTH,4266.75,,,,,,,4266.7500,16531.3700,percent of total billed charges,"25.81% of $16,531.37 in Billed Charges for Rev 272 = $4,266.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 45 CATHETER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,16531.3700,2479.7100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",16531.37,,,,,,,4266.7500,16531.3700,percent of total billed charges,"100% of $16,531.37 in Billed Charges for Rev 272 = $16,531.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 45 CATHETER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,16531.3700,2479.7100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8265.69,,,,,,,4266.7500,16531.3700,percent of total billed charges,"Rev 272 $16,531.37 in Billed Charges at 50% = $8,265.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 45 CATHETER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,16531.3700,2479.7100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5339.63,,,,,,,4266.7500,16531.3700,other,"32.3% of $16,531.37 in Billed Charges for Rev 272 = $5,339.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PROCEDURE ENDOBRONCH 45 CATHETER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,16531.3700,2479.7100,UNITED HEALTHCARE,UHC HERITAGE SELECT,5075.13,,,,,,,4266.7500,16531.3700,other,"30.7% of $16,531.37 in Billed Charges for Rev 272 = $5,075.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PROCEDURE ENDOBRONCH 45 CATHETER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,16531.3700,2479.7100,UNITED HEALTHCARE,UNITED HEALTHCARE,5339.63,,,,,,,4266.7500,16531.3700,percent of total billed charges,"32.3% of $16,531.37 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 45 CATHETER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,16531.3700,2479.7100,WELLCARE,WELLCARE MEDICAID,16531.37,,,,,,,4266.7500,16531.3700,percent of total billed charges,"100% of $16,531.37 in Billed Charges for Rev 272 = $16,531.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCESSING BMC ANGEL ABS-10062T,272,RC,27200002,CDM,,,,,,both,,,16946.2100,2541.9300,AETNA,AETNA,7236.03,,,,,,,4373.8200,16946.2100,percent of total billed charges,"42.7% of $16,946.21 in Billed Charges for Rev 272 = $7,236.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCESSING BMC ANGEL ABS-10062T,272,RC,27200002,CDM,,,,,,both,,,16946.2100,2541.9300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11862.35,,,,,,,4373.8200,16946.2100,percent of total billed charges,"Rev 272 $16,946.21 in Billed Charges at 70% = $11,862.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCESSING BMC ANGEL ABS-10062T,272,RC,27200002,CDM,,,,,,both,,,16946.2100,2541.9300,CIGNA HEALTHCARE,CIGNA HMO,7066.57,,,,,,,4373.8200,16946.2100,percent of total billed charges,"41.7% of $16,946.21 in Billed Charges for Rev 272 = $7,066.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCESSING BMC ANGEL ABS-10062T,272,RC,27200002,CDM,,,,,,both,,,16946.2100,2541.9300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7863.04,,,,,,,4373.8200,16946.2100,percent of total billed charges,"46.4% of $16,946.21 in Billed Charges for Rev 272 = $7,863.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCESSING BMC ANGEL ABS-10062T,272,RC,27200002,CDM,,,,,,both,,,16946.2100,2541.9300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7066.57,,,,,,,4373.8200,16946.2100,percent of total billed charges,"41.7% of $16,946.21 in Billed Charges for Rev 272 = $7,066.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCESSING BMC ANGEL ABS-10062T,272,RC,27200002,CDM,,,,,,both,,,16946.2100,2541.9300,CIGNA HEALTHCARE,CIGNA PPO,7066.57,,,,,,,4373.8200,16946.2100,percent of total billed charges,"41.7% of $16,946.21 in Billed Charges for Rev 272 = $7,066.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCESSING BMC ANGEL ABS-10062T,272,RC,27200002,CDM,,,,,,both,,,16946.2100,2541.9300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,15251.59,,,,,,,4373.8200,16946.2100,percent of total billed charges,"90% of $16,946.21 in Billed Charges for Rev 272 = $15,251.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCESSING BMC ANGEL ABS-10062T,272,RC,27200002,CDM,,,,,,both,,,16946.2100,2541.9300,MEDCOST,MEDCOST VHN,8064.70,,,,,,,4373.8200,16946.2100,percent of total billed charges,"47.59% of $16,946.21 in Billed Charges for Rev 272 = $8,064.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCESSING BMC ANGEL ABS-10062T,272,RC,27200002,CDM,,,,,,both,,,16946.2100,2541.9300,SENTARA HEALTH,SENTARA HEALTH,4373.82,,,,,,,4373.8200,16946.2100,percent of total billed charges,"25.81% of $16,946.21 in Billed Charges for Rev 272 = $4,373.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCESSING BMC ANGEL ABS-10062T,272,RC,27200002,CDM,,,,,,both,,,16946.2100,2541.9300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",16946.21,,,,,,,4373.8200,16946.2100,percent of total billed charges,"100% of $16,946.21 in Billed Charges for Rev 272 = $16,946.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCESSING BMC ANGEL ABS-10062T,272,RC,27200002,CDM,,,,,,both,,,16946.2100,2541.9300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8473.11,,,,,,,4373.8200,16946.2100,percent of total billed charges,"Rev 272 $16,946.21 in Billed Charges at 50% = $8,473.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCESSING BMC ANGEL ABS-10062T,272,RC,27200002,CDM,,,,,,both,,,16946.2100,2541.9300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5473.63,,,,,,,4373.8200,16946.2100,other,"32.3% of $16,946.21 in Billed Charges for Rev 272 = $5,473.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PROCESSING BMC ANGEL ABS-10062T,272,RC,27200002,CDM,,,,,,both,,,16946.2100,2541.9300,UNITED HEALTHCARE,UHC HERITAGE SELECT,5202.49,,,,,,,4373.8200,16946.2100,other,"30.7% of $16,946.21 in Billed Charges for Rev 272 = $5,202.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PROCESSING BMC ANGEL ABS-10062T,272,RC,27200002,CDM,,,,,,both,,,16946.2100,2541.9300,UNITED HEALTHCARE,UNITED HEALTHCARE,5473.63,,,,,,,4373.8200,16946.2100,percent of total billed charges,"32.3% of $16,946.21 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCESSING BMC ANGEL ABS-10062T,272,RC,27200002,CDM,,,,,,both,,,16946.2100,2541.9300,WELLCARE,WELLCARE MEDICAID,16946.21,,,,,,,4373.8200,16946.2100,percent of total billed charges,"100% of $16,946.21 in Billed Charges for Rev 272 = $16,946.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PSI 9FR MAX BARRIER,272,RC,,,,,,,,both,,,927.1700,139.0800,AETNA,AETNA,395.90,,,,,,,239.3000,927.1700,percent of total billed charges,42.7% of $927.17 in Billed Charges for Rev 272 = $395.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PSI 9FR MAX BARRIER,272,RC,,,,,,,,both,,,927.1700,139.0800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,649.02,,,,,,,239.3000,927.1700,percent of total billed charges,Rev 272 $927.17 in Billed Charges at 70% = $649.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PSI 9FR MAX BARRIER,272,RC,,,,,,,,both,,,927.1700,139.0800,CIGNA HEALTHCARE,CIGNA HMO,386.63,,,,,,,239.3000,927.1700,percent of total billed charges,41.7% of $927.17 in Billed Charges for Rev 272 = $386.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PSI 9FR MAX BARRIER,272,RC,,,,,,,,both,,,927.1700,139.0800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,430.21,,,,,,,239.3000,927.1700,percent of total billed charges,46.4% of $927.17 in Billed Charges for Rev 272 = $430.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PSI 9FR MAX BARRIER,272,RC,,,,,,,,both,,,927.1700,139.0800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,386.63,,,,,,,239.3000,927.1700,percent of total billed charges,41.7% of $927.17 in Billed Charges for Rev 272 = $386.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PSI 9FR MAX BARRIER,272,RC,,,,,,,,both,,,927.1700,139.0800,CIGNA HEALTHCARE,CIGNA PPO,386.63,,,,,,,239.3000,927.1700,percent of total billed charges,41.7% of $927.17 in Billed Charges for Rev 272 = $386.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PSI 9FR MAX BARRIER,272,RC,,,,,,,,both,,,927.1700,139.0800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,834.45,,,,,,,239.3000,927.1700,percent of total billed charges,90% of $927.17 in Billed Charges for Rev 272 = $834.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PSI 9FR MAX BARRIER,272,RC,,,,,,,,both,,,927.1700,139.0800,MEDCOST,MEDCOST VHN,441.24,,,,,,,239.3000,927.1700,percent of total billed charges,47.59% of $927.17 in Billed Charges for Rev 272 = $441.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PSI 9FR MAX BARRIER,272,RC,,,,,,,,both,,,927.1700,139.0800,SENTARA HEALTH,SENTARA HEALTH,239.30,,,,,,,239.3000,927.1700,percent of total billed charges,25.81% of $927.17 in Billed Charges for Rev 272 = $239.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PSI 9FR MAX BARRIER,272,RC,,,,,,,,both,,,927.1700,139.0800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",927.17,,,,,,,239.3000,927.1700,percent of total billed charges,100% of $927.17 in Billed Charges for Rev 272 = $927.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PSI 9FR MAX BARRIER,272,RC,,,,,,,,both,,,927.1700,139.0800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,463.59,,,,,,,239.3000,927.1700,percent of total billed charges,Rev 272 $927.17 in Billed Charges at 50% = $463.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PSI 9FR MAX BARRIER,272,RC,,,,,,,,both,,,927.1700,139.0800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,299.48,,,,,,,239.3000,927.1700,other,32.3% of $927.17 in Billed Charges for Rev 272 = $299.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT PSI 9FR MAX BARRIER,272,RC,,,,,,,,both,,,927.1700,139.0800,UNITED HEALTHCARE,UHC HERITAGE SELECT,284.64,,,,,,,239.3000,927.1700,other,30.7% of $927.17 in Billed Charges for Rev 272 = $284.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT PSI 9FR MAX BARRIER,272,RC,,,,,,,,both,,,927.1700,139.0800,UNITED HEALTHCARE,UNITED HEALTHCARE,299.48,,,,,,,239.3000,927.1700,percent of total billed charges,32.3% of $927.17 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT PSI 9FR MAX BARRIER,272,RC,,,,,,,,both,,,927.1700,139.0800,WELLCARE,WELLCARE MEDICAID,927.17,,,,,,,239.3000,927.1700,percent of total billed charges,100% of $927.17 in Billed Charges for Rev 272 = $927.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH EXCH AIRWAY YELLOW 14FR,272,RC,27202238,CDM,,,,,,both,,,674.0000,101.1000,AETNA,AETNA,287.80,,,,,,,173.9600,674.0000,percent of total billed charges,42.7% of $674.00 in Billed Charges for Rev 272 = $287.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH EXCH AIRWAY YELLOW 14FR,272,RC,27202238,CDM,,,,,,both,,,674.0000,101.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,471.80,,,,,,,173.9600,674.0000,percent of total billed charges,Rev 272 $674.00 in Billed Charges at 70% = $471.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH EXCH AIRWAY YELLOW 14FR,272,RC,27202238,CDM,,,,,,both,,,674.0000,101.1000,CIGNA HEALTHCARE,CIGNA HMO,281.06,,,,,,,173.9600,674.0000,percent of total billed charges,41.7% of $674.00 in Billed Charges for Rev 272 = $281.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH EXCH AIRWAY YELLOW 14FR,272,RC,27202238,CDM,,,,,,both,,,674.0000,101.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,312.74,,,,,,,173.9600,674.0000,percent of total billed charges,46.4% of $674.00 in Billed Charges for Rev 272 = $312.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH EXCH AIRWAY YELLOW 14FR,272,RC,27202238,CDM,,,,,,both,,,674.0000,101.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,281.06,,,,,,,173.9600,674.0000,percent of total billed charges,41.7% of $674.00 in Billed Charges for Rev 272 = $281.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH EXCH AIRWAY YELLOW 14FR,272,RC,27202238,CDM,,,,,,both,,,674.0000,101.1000,CIGNA HEALTHCARE,CIGNA PPO,281.06,,,,,,,173.9600,674.0000,percent of total billed charges,41.7% of $674.00 in Billed Charges for Rev 272 = $281.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH EXCH AIRWAY YELLOW 14FR,272,RC,27202238,CDM,,,,,,both,,,674.0000,101.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,606.60,,,,,,,173.9600,674.0000,percent of total billed charges,90% of $674.00 in Billed Charges for Rev 272 = $606.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH EXCH AIRWAY YELLOW 14FR,272,RC,27202238,CDM,,,,,,both,,,674.0000,101.1000,MEDCOST,MEDCOST VHN,320.76,,,,,,,173.9600,674.0000,percent of total billed charges,47.59% of $674.00 in Billed Charges for Rev 272 = $320.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH EXCH AIRWAY YELLOW 14FR,272,RC,27202238,CDM,,,,,,both,,,674.0000,101.1000,SENTARA HEALTH,SENTARA HEALTH,173.96,,,,,,,173.9600,674.0000,percent of total billed charges,25.81% of $674.00 in Billed Charges for Rev 272 = $173.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH EXCH AIRWAY YELLOW 14FR,272,RC,27202238,CDM,,,,,,both,,,674.0000,101.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",674.00,,,,,,,173.9600,674.0000,percent of total billed charges,100% of $674.00 in Billed Charges for Rev 272 = $674.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH EXCH AIRWAY YELLOW 14FR,272,RC,27202238,CDM,,,,,,both,,,674.0000,101.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,337.00,,,,,,,173.9600,674.0000,percent of total billed charges,Rev 272 $674.00 in Billed Charges at 50% = $337.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH EXCH AIRWAY YELLOW 14FR,272,RC,27202238,CDM,,,,,,both,,,674.0000,101.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,217.70,,,,,,,173.9600,674.0000,other,32.3% of $674.00 in Billed Charges for Rev 272 = $217.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH EXCH AIRWAY YELLOW 14FR,272,RC,27202238,CDM,,,,,,both,,,674.0000,101.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,206.92,,,,,,,173.9600,674.0000,other,30.7% of $674.00 in Billed Charges for Rev 272 = $206.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH EXCH AIRWAY YELLOW 14FR,272,RC,27202238,CDM,,,,,,both,,,674.0000,101.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,217.70,,,,,,,173.9600,674.0000,percent of total billed charges,32.3% of $674.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH EXCH AIRWAY YELLOW 14FR,272,RC,27202238,CDM,,,,,,both,,,674.0000,101.1000,WELLCARE,WELLCARE MEDICAID,674.00,,,,,,,173.9600,674.0000,percent of total billed charges,100% of $674.00 in Billed Charges for Rev 272 = $674.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT REPAIR BROVIAC 2.7FR,272,RC,,,,,,,,both,,,449.5800,67.4400,AETNA,AETNA,191.97,,,,,,,116.0400,449.5800,percent of total billed charges,42.7% of $449.58 in Billed Charges for Rev 272 = $191.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT REPAIR BROVIAC 2.7FR,272,RC,,,,,,,,both,,,449.5800,67.4400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,314.71,,,,,,,116.0400,449.5800,percent of total billed charges,Rev 272 $449.58 in Billed Charges at 70% = $314.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT REPAIR BROVIAC 2.7FR,272,RC,,,,,,,,both,,,449.5800,67.4400,CIGNA HEALTHCARE,CIGNA HMO,187.47,,,,,,,116.0400,449.5800,percent of total billed charges,41.7% of $449.58 in Billed Charges for Rev 272 = $187.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT REPAIR BROVIAC 2.7FR,272,RC,,,,,,,,both,,,449.5800,67.4400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,208.61,,,,,,,116.0400,449.5800,percent of total billed charges,46.4% of $449.58 in Billed Charges for Rev 272 = $208.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT REPAIR BROVIAC 2.7FR,272,RC,,,,,,,,both,,,449.5800,67.4400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,187.47,,,,,,,116.0400,449.5800,percent of total billed charges,41.7% of $449.58 in Billed Charges for Rev 272 = $187.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT REPAIR BROVIAC 2.7FR,272,RC,,,,,,,,both,,,449.5800,67.4400,CIGNA HEALTHCARE,CIGNA PPO,187.47,,,,,,,116.0400,449.5800,percent of total billed charges,41.7% of $449.58 in Billed Charges for Rev 272 = $187.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT REPAIR BROVIAC 2.7FR,272,RC,,,,,,,,both,,,449.5800,67.4400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,404.62,,,,,,,116.0400,449.5800,percent of total billed charges,90% of $449.58 in Billed Charges for Rev 272 = $404.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT REPAIR BROVIAC 2.7FR,272,RC,,,,,,,,both,,,449.5800,67.4400,MEDCOST,MEDCOST VHN,213.96,,,,,,,116.0400,449.5800,percent of total billed charges,47.59% of $449.58 in Billed Charges for Rev 272 = $213.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT REPAIR BROVIAC 2.7FR,272,RC,,,,,,,,both,,,449.5800,67.4400,SENTARA HEALTH,SENTARA HEALTH,116.04,,,,,,,116.0400,449.5800,percent of total billed charges,25.81% of $449.58 in Billed Charges for Rev 272 = $116.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT REPAIR BROVIAC 2.7FR,272,RC,,,,,,,,both,,,449.5800,67.4400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",449.58,,,,,,,116.0400,449.5800,percent of total billed charges,100% of $449.58 in Billed Charges for Rev 272 = $449.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT REPAIR BROVIAC 2.7FR,272,RC,,,,,,,,both,,,449.5800,67.4400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,224.79,,,,,,,116.0400,449.5800,percent of total billed charges,Rev 272 $449.58 in Billed Charges at 50% = $224.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT REPAIR BROVIAC 2.7FR,272,RC,,,,,,,,both,,,449.5800,67.4400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,145.21,,,,,,,116.0400,449.5800,other,32.3% of $449.58 in Billed Charges for Rev 272 = $145.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT REPAIR BROVIAC 2.7FR,272,RC,,,,,,,,both,,,449.5800,67.4400,UNITED HEALTHCARE,UHC HERITAGE SELECT,138.02,,,,,,,116.0400,449.5800,other,30.7% of $449.58 in Billed Charges for Rev 272 = $138.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT REPAIR BROVIAC 2.7FR,272,RC,,,,,,,,both,,,449.5800,67.4400,UNITED HEALTHCARE,UNITED HEALTHCARE,145.21,,,,,,,116.0400,449.5800,percent of total billed charges,32.3% of $449.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT REPAIR BROVIAC 2.7FR,272,RC,,,,,,,,both,,,449.5800,67.4400,WELLCARE,WELLCARE MEDICAID,449.58,,,,,,,116.0400,449.5800,percent of total billed charges,100% of $449.58 in Billed Charges for Rev 272 = $449.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT REPAIR SINGLE HICKMAN CATHETER,272,RC,,,,,,,,both,,,4469.9000,670.4900,AETNA,AETNA,1908.65,,,,,,,1153.6800,4469.9000,percent of total billed charges,"42.7% of $4,469.90 in Billed Charges for Rev 272 = $1,908.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REPAIR SINGLE HICKMAN CATHETER,272,RC,,,,,,,,both,,,4469.9000,670.4900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3128.93,,,,,,,1153.6800,4469.9000,percent of total billed charges,"Rev 272 $4,469.90 in Billed Charges at 70% = $3,128.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REPAIR SINGLE HICKMAN CATHETER,272,RC,,,,,,,,both,,,4469.9000,670.4900,CIGNA HEALTHCARE,CIGNA HMO,1863.95,,,,,,,1153.6800,4469.9000,percent of total billed charges,"41.7% of $4,469.90 in Billed Charges for Rev 272 = $1,863.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REPAIR SINGLE HICKMAN CATHETER,272,RC,,,,,,,,both,,,4469.9000,670.4900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2074.03,,,,,,,1153.6800,4469.9000,percent of total billed charges,"46.4% of $4,469.90 in Billed Charges for Rev 272 = $2,074.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REPAIR SINGLE HICKMAN CATHETER,272,RC,,,,,,,,both,,,4469.9000,670.4900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1863.95,,,,,,,1153.6800,4469.9000,percent of total billed charges,"41.7% of $4,469.90 in Billed Charges for Rev 272 = $1,863.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REPAIR SINGLE HICKMAN CATHETER,272,RC,,,,,,,,both,,,4469.9000,670.4900,CIGNA HEALTHCARE,CIGNA PPO,1863.95,,,,,,,1153.6800,4469.9000,percent of total billed charges,"41.7% of $4,469.90 in Billed Charges for Rev 272 = $1,863.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REPAIR SINGLE HICKMAN CATHETER,272,RC,,,,,,,,both,,,4469.9000,670.4900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4022.91,,,,,,,1153.6800,4469.9000,percent of total billed charges,"90% of $4,469.90 in Billed Charges for Rev 272 = $4,022.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REPAIR SINGLE HICKMAN CATHETER,272,RC,,,,,,,,both,,,4469.9000,670.4900,MEDCOST,MEDCOST VHN,2127.23,,,,,,,1153.6800,4469.9000,percent of total billed charges,"47.59% of $4,469.90 in Billed Charges for Rev 272 = $2,127.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REPAIR SINGLE HICKMAN CATHETER,272,RC,,,,,,,,both,,,4469.9000,670.4900,SENTARA HEALTH,SENTARA HEALTH,1153.68,,,,,,,1153.6800,4469.9000,percent of total billed charges,"25.81% of $4,469.90 in Billed Charges for Rev 272 = $1,153.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REPAIR SINGLE HICKMAN CATHETER,272,RC,,,,,,,,both,,,4469.9000,670.4900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4469.90,,,,,,,1153.6800,4469.9000,percent of total billed charges,"100% of $4,469.90 in Billed Charges for Rev 272 = $4,469.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REPAIR SINGLE HICKMAN CATHETER,272,RC,,,,,,,,both,,,4469.9000,670.4900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2234.95,,,,,,,1153.6800,4469.9000,percent of total billed charges,"Rev 272 $4,469.90 in Billed Charges at 50% = $2,234.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REPAIR SINGLE HICKMAN CATHETER,272,RC,,,,,,,,both,,,4469.9000,670.4900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1443.78,,,,,,,1153.6800,4469.9000,other,"32.3% of $4,469.90 in Billed Charges for Rev 272 = $1,443.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT REPAIR SINGLE HICKMAN CATHETER,272,RC,,,,,,,,both,,,4469.9000,670.4900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1372.26,,,,,,,1153.6800,4469.9000,other,"30.7% of $4,469.90 in Billed Charges for Rev 272 = $1,372.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT REPAIR SINGLE HICKMAN CATHETER,272,RC,,,,,,,,both,,,4469.9000,670.4900,UNITED HEALTHCARE,UNITED HEALTHCARE,1443.78,,,,,,,1153.6800,4469.9000,percent of total billed charges,"32.3% of $4,469.90 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REPAIR SINGLE HICKMAN CATHETER,272,RC,,,,,,,,both,,,4469.9000,670.4900,WELLCARE,WELLCARE MEDICAID,4469.90,,,,,,,1153.6800,4469.9000,percent of total billed charges,"100% of $4,469.90 in Billed Charges for Rev 272 = $4,469.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT RIGIDLOOP ADJUSTABLE,272,RC,,,,,,,,both,,,9761.3900,1464.2100,AETNA,AETNA,4168.11,,,,,,,2519.4100,9761.3900,percent of total billed charges,"42.7% of $9,761.39 in Billed Charges for Rev 272 = $4,168.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT RIGIDLOOP ADJUSTABLE,272,RC,,,,,,,,both,,,9761.3900,1464.2100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6832.97,,,,,,,2519.4100,9761.3900,percent of total billed charges,"Rev 272 $9,761.39 in Billed Charges at 70% = $6,832.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT RIGIDLOOP ADJUSTABLE,272,RC,,,,,,,,both,,,9761.3900,1464.2100,CIGNA HEALTHCARE,CIGNA HMO,4070.50,,,,,,,2519.4100,9761.3900,percent of total billed charges,"41.7% of $9,761.39 in Billed Charges for Rev 272 = $4,070.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT RIGIDLOOP ADJUSTABLE,272,RC,,,,,,,,both,,,9761.3900,1464.2100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4529.29,,,,,,,2519.4100,9761.3900,percent of total billed charges,"46.4% of $9,761.39 in Billed Charges for Rev 272 = $4,529.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT RIGIDLOOP ADJUSTABLE,272,RC,,,,,,,,both,,,9761.3900,1464.2100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4070.50,,,,,,,2519.4100,9761.3900,percent of total billed charges,"41.7% of $9,761.39 in Billed Charges for Rev 272 = $4,070.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT RIGIDLOOP ADJUSTABLE,272,RC,,,,,,,,both,,,9761.3900,1464.2100,CIGNA HEALTHCARE,CIGNA PPO,4070.50,,,,,,,2519.4100,9761.3900,percent of total billed charges,"41.7% of $9,761.39 in Billed Charges for Rev 272 = $4,070.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT RIGIDLOOP ADJUSTABLE,272,RC,,,,,,,,both,,,9761.3900,1464.2100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8785.25,,,,,,,2519.4100,9761.3900,percent of total billed charges,"90% of $9,761.39 in Billed Charges for Rev 272 = $8,785.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT RIGIDLOOP ADJUSTABLE,272,RC,,,,,,,,both,,,9761.3900,1464.2100,MEDCOST,MEDCOST VHN,4645.45,,,,,,,2519.4100,9761.3900,percent of total billed charges,"47.59% of $9,761.39 in Billed Charges for Rev 272 = $4,645.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT RIGIDLOOP ADJUSTABLE,272,RC,,,,,,,,both,,,9761.3900,1464.2100,SENTARA HEALTH,SENTARA HEALTH,2519.41,,,,,,,2519.4100,9761.3900,percent of total billed charges,"25.81% of $9,761.39 in Billed Charges for Rev 272 = $2,519.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT RIGIDLOOP ADJUSTABLE,272,RC,,,,,,,,both,,,9761.3900,1464.2100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9761.39,,,,,,,2519.4100,9761.3900,percent of total billed charges,"100% of $9,761.39 in Billed Charges for Rev 272 = $9,761.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT RIGIDLOOP ADJUSTABLE,272,RC,,,,,,,,both,,,9761.3900,1464.2100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4880.70,,,,,,,2519.4100,9761.3900,percent of total billed charges,"Rev 272 $9,761.39 in Billed Charges at 50% = $4,880.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT RIGIDLOOP ADJUSTABLE,272,RC,,,,,,,,both,,,9761.3900,1464.2100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3152.93,,,,,,,2519.4100,9761.3900,other,"32.3% of $9,761.39 in Billed Charges for Rev 272 = $3,152.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT RIGIDLOOP ADJUSTABLE,272,RC,,,,,,,,both,,,9761.3900,1464.2100,UNITED HEALTHCARE,UHC HERITAGE SELECT,2996.75,,,,,,,2519.4100,9761.3900,other,"30.7% of $9,761.39 in Billed Charges for Rev 272 = $2,996.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT RIGIDLOOP ADJUSTABLE,272,RC,,,,,,,,both,,,9761.3900,1464.2100,UNITED HEALTHCARE,UNITED HEALTHCARE,3152.93,,,,,,,2519.4100,9761.3900,percent of total billed charges,"32.3% of $9,761.39 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT RIGIDLOOP ADJUSTABLE,272,RC,,,,,,,,both,,,9761.3900,1464.2100,WELLCARE,WELLCARE MEDICAID,9761.39,,,,,,,2519.4100,9761.3900,percent of total billed charges,"100% of $9,761.39 in Billed Charges for Rev 272 = $9,761.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT SHOULDER SUSPENSION,272,RC,27200002,CDM,,,,,,both,,,967.8200,145.1700,AETNA,AETNA,413.26,,,,,,,249.7900,967.8200,percent of total billed charges,42.7% of $967.82 in Billed Charges for Rev 272 = $413.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SHOULDER SUSPENSION,272,RC,27200002,CDM,,,,,,both,,,967.8200,145.1700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,677.47,,,,,,,249.7900,967.8200,percent of total billed charges,Rev 272 $967.82 in Billed Charges at 70% = $677.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SHOULDER SUSPENSION,272,RC,27200002,CDM,,,,,,both,,,967.8200,145.1700,CIGNA HEALTHCARE,CIGNA HMO,403.58,,,,,,,249.7900,967.8200,percent of total billed charges,41.7% of $967.82 in Billed Charges for Rev 272 = $403.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SHOULDER SUSPENSION,272,RC,27200002,CDM,,,,,,both,,,967.8200,145.1700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,449.07,,,,,,,249.7900,967.8200,percent of total billed charges,46.4% of $967.82 in Billed Charges for Rev 272 = $449.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SHOULDER SUSPENSION,272,RC,27200002,CDM,,,,,,both,,,967.8200,145.1700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,403.58,,,,,,,249.7900,967.8200,percent of total billed charges,41.7% of $967.82 in Billed Charges for Rev 272 = $403.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SHOULDER SUSPENSION,272,RC,27200002,CDM,,,,,,both,,,967.8200,145.1700,CIGNA HEALTHCARE,CIGNA PPO,403.58,,,,,,,249.7900,967.8200,percent of total billed charges,41.7% of $967.82 in Billed Charges for Rev 272 = $403.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SHOULDER SUSPENSION,272,RC,27200002,CDM,,,,,,both,,,967.8200,145.1700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,871.04,,,,,,,249.7900,967.8200,percent of total billed charges,90% of $967.82 in Billed Charges for Rev 272 = $871.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SHOULDER SUSPENSION,272,RC,27200002,CDM,,,,,,both,,,967.8200,145.1700,MEDCOST,MEDCOST VHN,460.59,,,,,,,249.7900,967.8200,percent of total billed charges,47.59% of $967.82 in Billed Charges for Rev 272 = $460.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SHOULDER SUSPENSION,272,RC,27200002,CDM,,,,,,both,,,967.8200,145.1700,SENTARA HEALTH,SENTARA HEALTH,249.79,,,,,,,249.7900,967.8200,percent of total billed charges,25.81% of $967.82 in Billed Charges for Rev 272 = $249.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SHOULDER SUSPENSION,272,RC,27200002,CDM,,,,,,both,,,967.8200,145.1700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",967.82,,,,,,,249.7900,967.8200,percent of total billed charges,100% of $967.82 in Billed Charges for Rev 272 = $967.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SHOULDER SUSPENSION,272,RC,27200002,CDM,,,,,,both,,,967.8200,145.1700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,483.91,,,,,,,249.7900,967.8200,percent of total billed charges,Rev 272 $967.82 in Billed Charges at 50% = $483.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SHOULDER SUSPENSION,272,RC,27200002,CDM,,,,,,both,,,967.8200,145.1700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,312.61,,,,,,,249.7900,967.8200,other,32.3% of $967.82 in Billed Charges for Rev 272 = $312.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT SHOULDER SUSPENSION,272,RC,27200002,CDM,,,,,,both,,,967.8200,145.1700,UNITED HEALTHCARE,UHC HERITAGE SELECT,297.12,,,,,,,249.7900,967.8200,other,30.7% of $967.82 in Billed Charges for Rev 272 = $297.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT SHOULDER SUSPENSION,272,RC,27200002,CDM,,,,,,both,,,967.8200,145.1700,UNITED HEALTHCARE,UNITED HEALTHCARE,312.61,,,,,,,249.7900,967.8200,percent of total billed charges,32.3% of $967.82 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT SHOULDER SUSPENSION,272,RC,27200002,CDM,,,,,,both,,,967.8200,145.1700,WELLCARE,WELLCARE MEDICAID,967.82,,,,,,,249.7900,967.8200,percent of total billed charges,100% of $967.82 in Billed Charges for Rev 272 = $967.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GLIDE 5F TAPER 100CM,272,RC,27200521,CDM,,,,,,both,,,353.0000,52.9500,AETNA,AETNA,150.73,,,,,,,91.1100,353.0000,percent of total billed charges,42.7% of $353.00 in Billed Charges for Rev 272 = $150.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GLIDE 5F TAPER 100CM,272,RC,27200521,CDM,,,,,,both,,,353.0000,52.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,247.10,,,,,,,91.1100,353.0000,percent of total billed charges,Rev 272 $353.00 in Billed Charges at 70% = $247.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GLIDE 5F TAPER 100CM,272,RC,27200521,CDM,,,,,,both,,,353.0000,52.9500,CIGNA HEALTHCARE,CIGNA HMO,147.20,,,,,,,91.1100,353.0000,percent of total billed charges,41.7% of $353.00 in Billed Charges for Rev 272 = $147.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GLIDE 5F TAPER 100CM,272,RC,27200521,CDM,,,,,,both,,,353.0000,52.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,163.79,,,,,,,91.1100,353.0000,percent of total billed charges,46.4% of $353.00 in Billed Charges for Rev 272 = $163.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GLIDE 5F TAPER 100CM,272,RC,27200521,CDM,,,,,,both,,,353.0000,52.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,147.20,,,,,,,91.1100,353.0000,percent of total billed charges,41.7% of $353.00 in Billed Charges for Rev 272 = $147.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GLIDE 5F TAPER 100CM,272,RC,27200521,CDM,,,,,,both,,,353.0000,52.9500,CIGNA HEALTHCARE,CIGNA PPO,147.20,,,,,,,91.1100,353.0000,percent of total billed charges,41.7% of $353.00 in Billed Charges for Rev 272 = $147.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GLIDE 5F TAPER 100CM,272,RC,27200521,CDM,,,,,,both,,,353.0000,52.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,317.70,,,,,,,91.1100,353.0000,percent of total billed charges,90% of $353.00 in Billed Charges for Rev 272 = $317.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GLIDE 5F TAPER 100CM,272,RC,27200521,CDM,,,,,,both,,,353.0000,52.9500,MEDCOST,MEDCOST VHN,167.99,,,,,,,91.1100,353.0000,percent of total billed charges,47.59% of $353.00 in Billed Charges for Rev 272 = $167.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GLIDE 5F TAPER 100CM,272,RC,27200521,CDM,,,,,,both,,,353.0000,52.9500,SENTARA HEALTH,SENTARA HEALTH,91.11,,,,,,,91.1100,353.0000,percent of total billed charges,25.81% of $353.00 in Billed Charges for Rev 272 = $91.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GLIDE 5F TAPER 100CM,272,RC,27200521,CDM,,,,,,both,,,353.0000,52.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",353.00,,,,,,,91.1100,353.0000,percent of total billed charges,100% of $353.00 in Billed Charges for Rev 272 = $353.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GLIDE 5F TAPER 100CM,272,RC,27200521,CDM,,,,,,both,,,353.0000,52.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,176.50,,,,,,,91.1100,353.0000,percent of total billed charges,Rev 272 $353.00 in Billed Charges at 50% = $176.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GLIDE 5F TAPER 100CM,272,RC,27200521,CDM,,,,,,both,,,353.0000,52.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,114.02,,,,,,,91.1100,353.0000,other,32.3% of $353.00 in Billed Charges for Rev 272 = $114.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH GLIDE 5F TAPER 100CM,272,RC,27200521,CDM,,,,,,both,,,353.0000,52.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,108.37,,,,,,,91.1100,353.0000,other,30.7% of $353.00 in Billed Charges for Rev 272 = $108.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH GLIDE 5F TAPER 100CM,272,RC,27200521,CDM,,,,,,both,,,353.0000,52.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,114.02,,,,,,,91.1100,353.0000,percent of total billed charges,32.3% of $353.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH GLIDE 5F TAPER 100CM,272,RC,27200521,CDM,,,,,,both,,,353.0000,52.9500,WELLCARE,WELLCARE MEDICAID,353.00,,,,,,,91.1100,353.0000,percent of total billed charges,100% of $353.00 in Billed Charges for Rev 272 = $353.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH HEMODIALYSIS REPAIR KIT,272,RC,27200511,CDM,,,,,,both,,,498.0000,74.7000,AETNA,AETNA,212.65,,,,,,,128.5300,498.0000,percent of total billed charges,42.7% of $498.00 in Billed Charges for Rev 272 = $212.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH HEMODIALYSIS REPAIR KIT,272,RC,27200511,CDM,,,,,,both,,,498.0000,74.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,348.60,,,,,,,128.5300,498.0000,percent of total billed charges,Rev 272 $498.00 in Billed Charges at 70% = $348.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH HEMODIALYSIS REPAIR KIT,272,RC,27200511,CDM,,,,,,both,,,498.0000,74.7000,CIGNA HEALTHCARE,CIGNA HMO,207.67,,,,,,,128.5300,498.0000,percent of total billed charges,41.7% of $498.00 in Billed Charges for Rev 272 = $207.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH HEMODIALYSIS REPAIR KIT,272,RC,27200511,CDM,,,,,,both,,,498.0000,74.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,231.07,,,,,,,128.5300,498.0000,percent of total billed charges,46.4% of $498.00 in Billed Charges for Rev 272 = $231.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH HEMODIALYSIS REPAIR KIT,272,RC,27200511,CDM,,,,,,both,,,498.0000,74.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,207.67,,,,,,,128.5300,498.0000,percent of total billed charges,41.7% of $498.00 in Billed Charges for Rev 272 = $207.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH HEMODIALYSIS REPAIR KIT,272,RC,27200511,CDM,,,,,,both,,,498.0000,74.7000,CIGNA HEALTHCARE,CIGNA PPO,207.67,,,,,,,128.5300,498.0000,percent of total billed charges,41.7% of $498.00 in Billed Charges for Rev 272 = $207.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH HEMODIALYSIS REPAIR KIT,272,RC,27200511,CDM,,,,,,both,,,498.0000,74.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,448.20,,,,,,,128.5300,498.0000,percent of total billed charges,90% of $498.00 in Billed Charges for Rev 272 = $448.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH HEMODIALYSIS REPAIR KIT,272,RC,27200511,CDM,,,,,,both,,,498.0000,74.7000,MEDCOST,MEDCOST VHN,237.00,,,,,,,128.5300,498.0000,percent of total billed charges,47.59% of $498.00 in Billed Charges for Rev 272 = $237.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH HEMODIALYSIS REPAIR KIT,272,RC,27200511,CDM,,,,,,both,,,498.0000,74.7000,SENTARA HEALTH,SENTARA HEALTH,128.53,,,,,,,128.5300,498.0000,percent of total billed charges,25.81% of $498.00 in Billed Charges for Rev 272 = $128.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH HEMODIALYSIS REPAIR KIT,272,RC,27200511,CDM,,,,,,both,,,498.0000,74.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",498.00,,,,,,,128.5300,498.0000,percent of total billed charges,100% of $498.00 in Billed Charges for Rev 272 = $498.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH HEMODIALYSIS REPAIR KIT,272,RC,27200511,CDM,,,,,,both,,,498.0000,74.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,249.00,,,,,,,128.5300,498.0000,percent of total billed charges,Rev 272 $498.00 in Billed Charges at 50% = $249.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH HEMODIALYSIS REPAIR KIT,272,RC,27200511,CDM,,,,,,both,,,498.0000,74.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,160.85,,,,,,,128.5300,498.0000,other,32.3% of $498.00 in Billed Charges for Rev 272 = $160.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH HEMODIALYSIS REPAIR KIT,272,RC,27200511,CDM,,,,,,both,,,498.0000,74.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,152.89,,,,,,,128.5300,498.0000,other,30.7% of $498.00 in Billed Charges for Rev 272 = $152.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH HEMODIALYSIS REPAIR KIT,272,RC,27200511,CDM,,,,,,both,,,498.0000,74.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,160.85,,,,,,,128.5300,498.0000,percent of total billed charges,32.3% of $498.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH HEMODIALYSIS REPAIR KIT,272,RC,27200511,CDM,,,,,,both,,,498.0000,74.7000,WELLCARE,WELLCARE MEDICAID,498.00,,,,,,,128.5300,498.0000,percent of total billed charges,100% of $498.00 in Billed Charges for Rev 272 = $498.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ICY 9.3FR 38CM TRP LUMEN,272,RC,27200512,CDM,,,,,,both,,,2041.0000,306.1500,AETNA,AETNA,871.51,,,,,,,526.7800,2041.0000,percent of total billed charges,"42.7% of $2,041.00 in Billed Charges for Rev 272 = $871.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ICY 9.3FR 38CM TRP LUMEN,272,RC,27200512,CDM,,,,,,both,,,2041.0000,306.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1428.70,,,,,,,526.7800,2041.0000,percent of total billed charges,"Rev 272 $2,041.00 in Billed Charges at 70% = $1,428.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ICY 9.3FR 38CM TRP LUMEN,272,RC,27200512,CDM,,,,,,both,,,2041.0000,306.1500,CIGNA HEALTHCARE,CIGNA HMO,851.10,,,,,,,526.7800,2041.0000,percent of total billed charges,"41.7% of $2,041.00 in Billed Charges for Rev 272 = $851.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ICY 9.3FR 38CM TRP LUMEN,272,RC,27200512,CDM,,,,,,both,,,2041.0000,306.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,947.02,,,,,,,526.7800,2041.0000,percent of total billed charges,"46.4% of $2,041.00 in Billed Charges for Rev 272 = $947.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ICY 9.3FR 38CM TRP LUMEN,272,RC,27200512,CDM,,,,,,both,,,2041.0000,306.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,851.10,,,,,,,526.7800,2041.0000,percent of total billed charges,"41.7% of $2,041.00 in Billed Charges for Rev 272 = $851.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ICY 9.3FR 38CM TRP LUMEN,272,RC,27200512,CDM,,,,,,both,,,2041.0000,306.1500,CIGNA HEALTHCARE,CIGNA PPO,851.10,,,,,,,526.7800,2041.0000,percent of total billed charges,"41.7% of $2,041.00 in Billed Charges for Rev 272 = $851.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ICY 9.3FR 38CM TRP LUMEN,272,RC,27200512,CDM,,,,,,both,,,2041.0000,306.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1836.90,,,,,,,526.7800,2041.0000,percent of total billed charges,"90% of $2,041.00 in Billed Charges for Rev 272 = $1,836.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ICY 9.3FR 38CM TRP LUMEN,272,RC,27200512,CDM,,,,,,both,,,2041.0000,306.1500,MEDCOST,MEDCOST VHN,971.31,,,,,,,526.7800,2041.0000,percent of total billed charges,"47.59% of $2,041.00 in Billed Charges for Rev 272 = $971.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ICY 9.3FR 38CM TRP LUMEN,272,RC,27200512,CDM,,,,,,both,,,2041.0000,306.1500,SENTARA HEALTH,SENTARA HEALTH,526.78,,,,,,,526.7800,2041.0000,percent of total billed charges,"25.81% of $2,041.00 in Billed Charges for Rev 272 = $526.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ICY 9.3FR 38CM TRP LUMEN,272,RC,27200512,CDM,,,,,,both,,,2041.0000,306.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2041.00,,,,,,,526.7800,2041.0000,percent of total billed charges,"100% of $2,041.00 in Billed Charges for Rev 272 = $2,041.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ICY 9.3FR 38CM TRP LUMEN,272,RC,27200512,CDM,,,,,,both,,,2041.0000,306.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1020.50,,,,,,,526.7800,2041.0000,percent of total billed charges,"Rev 272 $2,041.00 in Billed Charges at 50% = $1,020.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ICY 9.3FR 38CM TRP LUMEN,272,RC,27200512,CDM,,,,,,both,,,2041.0000,306.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,659.24,,,,,,,526.7800,2041.0000,other,"32.3% of $2,041.00 in Billed Charges for Rev 272 = $659.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH ICY 9.3FR 38CM TRP LUMEN,272,RC,27200512,CDM,,,,,,both,,,2041.0000,306.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,626.59,,,,,,,526.7800,2041.0000,other,"30.7% of $2,041.00 in Billed Charges for Rev 272 = $626.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH ICY 9.3FR 38CM TRP LUMEN,272,RC,27200512,CDM,,,,,,both,,,2041.0000,306.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,659.24,,,,,,,526.7800,2041.0000,percent of total billed charges,"32.3% of $2,041.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CATH ICY 9.3FR 38CM TRP LUMEN,272,RC,27200512,CDM,,,,,,both,,,2041.0000,306.1500,WELLCARE,WELLCARE MEDICAID,2041.00,,,,,,,526.7800,2041.0000,percent of total billed charges,"100% of $2,041.00 in Billed Charges for Rev 272 = $2,041.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI TATTOOING SPOT,272,RC,27200763,CDM,,,,,,both,,,112.0000,16.8000,AETNA,AETNA,47.82,,,,,,,28.9100,112.0000,percent of total billed charges,42.7% of $112.00 in Billed Charges for Rev 272 = $47.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TATTOOING SPOT,272,RC,27200763,CDM,,,,,,both,,,112.0000,16.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,78.40,,,,,,,28.9100,112.0000,percent of total billed charges,Rev 272 $112.00 in Billed Charges at 70% = $78.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TATTOOING SPOT,272,RC,27200763,CDM,,,,,,both,,,112.0000,16.8000,CIGNA HEALTHCARE,CIGNA HMO,46.70,,,,,,,28.9100,112.0000,percent of total billed charges,41.7% of $112.00 in Billed Charges for Rev 272 = $46.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TATTOOING SPOT,272,RC,27200763,CDM,,,,,,both,,,112.0000,16.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,51.97,,,,,,,28.9100,112.0000,percent of total billed charges,46.4% of $112.00 in Billed Charges for Rev 272 = $51.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TATTOOING SPOT,272,RC,27200763,CDM,,,,,,both,,,112.0000,16.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,46.70,,,,,,,28.9100,112.0000,percent of total billed charges,41.7% of $112.00 in Billed Charges for Rev 272 = $46.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TATTOOING SPOT,272,RC,27200763,CDM,,,,,,both,,,112.0000,16.8000,CIGNA HEALTHCARE,CIGNA PPO,46.70,,,,,,,28.9100,112.0000,percent of total billed charges,41.7% of $112.00 in Billed Charges for Rev 272 = $46.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TATTOOING SPOT,272,RC,27200763,CDM,,,,,,both,,,112.0000,16.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,100.80,,,,,,,28.9100,112.0000,percent of total billed charges,90% of $112.00 in Billed Charges for Rev 272 = $100.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TATTOOING SPOT,272,RC,27200763,CDM,,,,,,both,,,112.0000,16.8000,MEDCOST,MEDCOST VHN,53.30,,,,,,,28.9100,112.0000,percent of total billed charges,47.59% of $112.00 in Billed Charges for Rev 272 = $53.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TATTOOING SPOT,272,RC,27200763,CDM,,,,,,both,,,112.0000,16.8000,SENTARA HEALTH,SENTARA HEALTH,28.91,,,,,,,28.9100,112.0000,percent of total billed charges,25.81% of $112.00 in Billed Charges for Rev 272 = $28.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TATTOOING SPOT,272,RC,27200763,CDM,,,,,,both,,,112.0000,16.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",112.00,,,,,,,28.9100,112.0000,percent of total billed charges,100% of $112.00 in Billed Charges for Rev 272 = $112.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TATTOOING SPOT,272,RC,27200763,CDM,,,,,,both,,,112.0000,16.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,56.00,,,,,,,28.9100,112.0000,percent of total billed charges,Rev 272 $112.00 in Billed Charges at 50% = $56.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TATTOOING SPOT,272,RC,27200763,CDM,,,,,,both,,,112.0000,16.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,36.18,,,,,,,28.9100,112.0000,other,32.3% of $112.00 in Billed Charges for Rev 272 = $36.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI TATTOOING SPOT,272,RC,27200763,CDM,,,,,,both,,,112.0000,16.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,34.38,,,,,,,28.9100,112.0000,other,30.7% of $112.00 in Billed Charges for Rev 272 = $34.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI TATTOOING SPOT,272,RC,27200763,CDM,,,,,,both,,,112.0000,16.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,36.18,,,,,,,28.9100,112.0000,percent of total billed charges,32.3% of $112.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TATTOOING SPOT,272,RC,27200763,CDM,,,,,,both,,,112.0000,16.8000,WELLCARE,WELLCARE MEDICAID,112.00,,,,,,,28.9100,112.0000,percent of total billed charges,100% of $112.00 in Billed Charges for Rev 272 = $112.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MARKER DELIVERY KIT,272,RC,27200002,CDM,,,,,,both,,,1381.4200,207.2100,AETNA,AETNA,589.87,,,,,,,356.5400,1381.4200,percent of total billed charges,"42.7% of $1,381.42 in Billed Charges for Rev 272 = $589.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKER DELIVERY KIT,272,RC,27200002,CDM,,,,,,both,,,1381.4200,207.2100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,966.99,,,,,,,356.5400,1381.4200,percent of total billed charges,"Rev 272 $1,381.42 in Billed Charges at 70% = $966.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKER DELIVERY KIT,272,RC,27200002,CDM,,,,,,both,,,1381.4200,207.2100,CIGNA HEALTHCARE,CIGNA HMO,576.05,,,,,,,356.5400,1381.4200,percent of total billed charges,"41.7% of $1,381.42 in Billed Charges for Rev 272 = $576.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKER DELIVERY KIT,272,RC,27200002,CDM,,,,,,both,,,1381.4200,207.2100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,640.98,,,,,,,356.5400,1381.4200,percent of total billed charges,"46.4% of $1,381.42 in Billed Charges for Rev 272 = $640.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKER DELIVERY KIT,272,RC,27200002,CDM,,,,,,both,,,1381.4200,207.2100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,576.05,,,,,,,356.5400,1381.4200,percent of total billed charges,"41.7% of $1,381.42 in Billed Charges for Rev 272 = $576.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKER DELIVERY KIT,272,RC,27200002,CDM,,,,,,both,,,1381.4200,207.2100,CIGNA HEALTHCARE,CIGNA PPO,576.05,,,,,,,356.5400,1381.4200,percent of total billed charges,"41.7% of $1,381.42 in Billed Charges for Rev 272 = $576.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKER DELIVERY KIT,272,RC,27200002,CDM,,,,,,both,,,1381.4200,207.2100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1243.28,,,,,,,356.5400,1381.4200,percent of total billed charges,"90% of $1,381.42 in Billed Charges for Rev 272 = $1,243.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKER DELIVERY KIT,272,RC,27200002,CDM,,,,,,both,,,1381.4200,207.2100,MEDCOST,MEDCOST VHN,657.42,,,,,,,356.5400,1381.4200,percent of total billed charges,"47.59% of $1,381.42 in Billed Charges for Rev 272 = $657.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKER DELIVERY KIT,272,RC,27200002,CDM,,,,,,both,,,1381.4200,207.2100,SENTARA HEALTH,SENTARA HEALTH,356.54,,,,,,,356.5400,1381.4200,percent of total billed charges,"25.81% of $1,381.42 in Billed Charges for Rev 272 = $356.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKER DELIVERY KIT,272,RC,27200002,CDM,,,,,,both,,,1381.4200,207.2100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1381.42,,,,,,,356.5400,1381.4200,percent of total billed charges,"100% of $1,381.42 in Billed Charges for Rev 272 = $1,381.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKER DELIVERY KIT,272,RC,27200002,CDM,,,,,,both,,,1381.4200,207.2100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,690.71,,,,,,,356.5400,1381.4200,percent of total billed charges,"Rev 272 $1,381.42 in Billed Charges at 50% = $690.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKER DELIVERY KIT,272,RC,27200002,CDM,,,,,,both,,,1381.4200,207.2100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,446.20,,,,,,,356.5400,1381.4200,other,"32.3% of $1,381.42 in Billed Charges for Rev 272 = $446.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MARKER DELIVERY KIT,272,RC,27200002,CDM,,,,,,both,,,1381.4200,207.2100,UNITED HEALTHCARE,UHC HERITAGE SELECT,424.10,,,,,,,356.5400,1381.4200,other,"30.7% of $1,381.42 in Billed Charges for Rev 272 = $424.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MARKER DELIVERY KIT,272,RC,27200002,CDM,,,,,,both,,,1381.4200,207.2100,UNITED HEALTHCARE,UNITED HEALTHCARE,446.20,,,,,,,356.5400,1381.4200,percent of total billed charges,"32.3% of $1,381.42 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKER DELIVERY KIT,272,RC,27200002,CDM,,,,,,both,,,1381.4200,207.2100,WELLCARE,WELLCARE MEDICAID,1381.42,,,,,,,356.5400,1381.4200,percent of total billed charges,"100% of $1,381.42 in Billed Charges for Rev 272 = $1,381.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GI TUBE GASTROSTOMY REPLACE 20FR,272,RC,27200765,CDM,,,,,,both,,,224.0000,33.6000,AETNA,AETNA,95.65,,,,,,,57.8100,224.0000,percent of total billed charges,42.7% of $224.00 in Billed Charges for Rev 272 = $95.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE GASTROSTOMY REPLACE 20FR,272,RC,27200765,CDM,,,,,,both,,,224.0000,33.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,156.80,,,,,,,57.8100,224.0000,percent of total billed charges,Rev 272 $224.00 in Billed Charges at 70% = $156.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE GASTROSTOMY REPLACE 20FR,272,RC,27200765,CDM,,,,,,both,,,224.0000,33.6000,CIGNA HEALTHCARE,CIGNA HMO,93.41,,,,,,,57.8100,224.0000,percent of total billed charges,41.7% of $224.00 in Billed Charges for Rev 272 = $93.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE GASTROSTOMY REPLACE 20FR,272,RC,27200765,CDM,,,,,,both,,,224.0000,33.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,103.94,,,,,,,57.8100,224.0000,percent of total billed charges,46.4% of $224.00 in Billed Charges for Rev 272 = $103.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE GASTROSTOMY REPLACE 20FR,272,RC,27200765,CDM,,,,,,both,,,224.0000,33.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,93.41,,,,,,,57.8100,224.0000,percent of total billed charges,41.7% of $224.00 in Billed Charges for Rev 272 = $93.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE GASTROSTOMY REPLACE 20FR,272,RC,27200765,CDM,,,,,,both,,,224.0000,33.6000,CIGNA HEALTHCARE,CIGNA PPO,93.41,,,,,,,57.8100,224.0000,percent of total billed charges,41.7% of $224.00 in Billed Charges for Rev 272 = $93.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE GASTROSTOMY REPLACE 20FR,272,RC,27200765,CDM,,,,,,both,,,224.0000,33.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,201.60,,,,,,,57.8100,224.0000,percent of total billed charges,90% of $224.00 in Billed Charges for Rev 272 = $201.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE GASTROSTOMY REPLACE 20FR,272,RC,27200765,CDM,,,,,,both,,,224.0000,33.6000,MEDCOST,MEDCOST VHN,106.60,,,,,,,57.8100,224.0000,percent of total billed charges,47.59% of $224.00 in Billed Charges for Rev 272 = $106.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE GASTROSTOMY REPLACE 20FR,272,RC,27200765,CDM,,,,,,both,,,224.0000,33.6000,SENTARA HEALTH,SENTARA HEALTH,57.81,,,,,,,57.8100,224.0000,percent of total billed charges,25.81% of $224.00 in Billed Charges for Rev 272 = $57.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE GASTROSTOMY REPLACE 20FR,272,RC,27200765,CDM,,,,,,both,,,224.0000,33.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",224.00,,,,,,,57.8100,224.0000,percent of total billed charges,100% of $224.00 in Billed Charges for Rev 272 = $224.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE GASTROSTOMY REPLACE 20FR,272,RC,27200765,CDM,,,,,,both,,,224.0000,33.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,112.00,,,,,,,57.8100,224.0000,percent of total billed charges,Rev 272 $224.00 in Billed Charges at 50% = $112.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE GASTROSTOMY REPLACE 20FR,272,RC,27200765,CDM,,,,,,both,,,224.0000,33.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,72.35,,,,,,,57.8100,224.0000,other,32.3% of $224.00 in Billed Charges for Rev 272 = $72.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI TUBE GASTROSTOMY REPLACE 20FR,272,RC,27200765,CDM,,,,,,both,,,224.0000,33.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,68.77,,,,,,,57.8100,224.0000,other,30.7% of $224.00 in Billed Charges for Rev 272 = $68.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GI TUBE GASTROSTOMY REPLACE 20FR,272,RC,27200765,CDM,,,,,,both,,,224.0000,33.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,72.35,,,,,,,57.8100,224.0000,percent of total billed charges,32.3% of $224.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GI TUBE GASTROSTOMY REPLACE 20FR,272,RC,27200765,CDM,,,,,,both,,,224.0000,33.6000,WELLCARE,WELLCARE MEDICAID,224.00,,,,,,,57.8100,224.0000,percent of total billed charges,100% of $224.00 in Billed Charges for Rev 272 = $224.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GORE EXCLUDER AAA ENDOPROSTHESIS IPSILATERAL TRUNK RLT281218,278,RC,27800699,CDM,,,,,,both,,,26249.0000,3937.3500,AETNA,AETNA,12599.52,,,,,,,1863.6800,26249.0000,percent of total billed charges,"48% of $26,249.00 in Billed Charges for Rev 278 = $12,599.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS IPSILATERAL TRUNK RLT281218,278,RC,27800699,CDM,,,,,,both,,,26249.0000,3937.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,13124.50,,,,,,,1863.6800,26249.0000,percent of total billed charges,"50% of $26,249.00 in Billed Charges for Rev 278 = $13,124.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS IPSILATERAL TRUNK RLT281218,278,RC,27800699,CDM,,,,,,both,,,26249.0000,3937.3500,CIGNA HEALTHCARE,CIGNA HMO,10945.83,,,,,,,1863.6800,26249.0000,percent of total billed charges,"41.7% of $26,249.00 in Billed Charges for Rev 278 = $10,945.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS IPSILATERAL TRUNK RLT281218,278,RC,27800699,CDM,,,,,,both,,,26249.0000,3937.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10499.60,,,,,,,1863.6800,26249.0000,percent of total billed charges,"40% of $26,249.00 in Billed Charges for Rev 278 = $10,499.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS IPSILATERAL TRUNK RLT281218,278,RC,27800699,CDM,,,,,,both,,,26249.0000,3937.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,10945.83,,,,,,,1863.6800,26249.0000,percent of total billed charges,"41.7% of $26,249.00 in Billed Charges for Rev 278 = $10,945.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS IPSILATERAL TRUNK RLT281218,278,RC,27800699,CDM,,,,,,both,,,26249.0000,3937.3500,CIGNA HEALTHCARE,CIGNA PPO,10945.83,,,,,,,1863.6800,26249.0000,percent of total billed charges,"41.7% of $26,249.00 in Billed Charges for Rev 278 = $10,945.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS IPSILATERAL TRUNK RLT281218,278,RC,27800699,CDM,,,,,,both,,,26249.0000,3937.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,23624.10,,,,,,,1863.6800,26249.0000,percent of total billed charges,"90% of $26,249.00 in Billed Charges for Rev 278 = $23,624.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS IPSILATERAL TRUNK RLT281218,278,RC,27800699,CDM,,,,,,both,,,26249.0000,3937.3500,MEDCOST,MEDCOST VHN,12491.90,,,,,,,1863.6800,26249.0000,percent of total billed charges,"47.59% of $26,249.00 in Billed Charges for Rev 278 = $12,491.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS IPSILATERAL TRUNK RLT281218,278,RC,27800699,CDM,,,,,,both,,,26249.0000,3937.3500,SENTARA HEALTH,SENTARA HEALTH,6774.87,,,,,,,1863.6800,26249.0000,percent of total billed charges,"25.81% of $26,249.00 in Billed Charges for Rev 278 = $6,774.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS IPSILATERAL TRUNK RLT281218,278,RC,27800699,CDM,,,,,,both,,,26249.0000,3937.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",26249.00,,,,,,,1863.6800,26249.0000,percent of total billed charges,"100% of $26,249.00 in Billed Charges for Rev 278 = $26,249.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS IPSILATERAL TRUNK RLT281218,278,RC,27800699,CDM,,,,,,both,,,26249.0000,3937.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,13124.50,,,,,,,1863.6800,26249.0000,percent of total billed charges,"Rev 278 $26,249.00 in Billed Charges at 50% = $13,124.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS IPSILATERAL TRUNK RLT281218,278,RC,27800699,CDM,,,,,,both,,,26249.0000,3937.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1968.68,,,,,,,1863.6800,26249.0000,percent of total billed charges,"7.5% of $26,249.00 in Billed Charges for Rev 278 = $1,968.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS IPSILATERAL TRUNK RLT281218,278,RC,27800699,CDM,,,,,,both,,,26249.0000,3937.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1863.68,,,,,,,1863.6800,26249.0000,percent of total billed charges,"7.1% of $26,249.00 in Billed Charges for Rev 278 = $1,863.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS IPSILATERAL TRUNK RLT281218,278,RC,27800699,CDM,,,,,,both,,,26249.0000,3937.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,1863.68,,,,,,,1863.6800,26249.0000,percent of total billed charges,"7.1% of $26,249.00 in Billed Charges for Rev 278 = $1,863.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GORE EXCLUDER AAA ENDOPROSTHESIS IPSILATERAL TRUNK RLT281218,278,RC,27800699,CDM,,,,,,both,,,26249.0000,3937.3500,WELLCARE,WELLCARE MEDICAID,26249.00,,,,,,,1863.6800,26249.0000,percent of total billed charges,"100% of $26,249.00 in Billed Charges for Rev 278 = $26,249.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE AFX/AFX2 2 PIECE,278,RC,27800592,CDM,,,,,,both,,,39808.0000,5971.2000,AETNA,AETNA,19107.84,,,,,,,2826.3700,39808.0000,percent of total billed charges,"48% of $39,808.00 in Billed Charges for Rev 278 = $19,107.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE AFX/AFX2 2 PIECE,278,RC,27800592,CDM,,,,,,both,,,39808.0000,5971.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,19904.00,,,,,,,2826.3700,39808.0000,percent of total billed charges,"50% of $39,808.00 in Billed Charges for Rev 278 = $19,904.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE AFX/AFX2 2 PIECE,278,RC,27800592,CDM,,,,,,both,,,39808.0000,5971.2000,CIGNA HEALTHCARE,CIGNA HMO,16599.94,,,,,,,2826.3700,39808.0000,percent of total billed charges,"41.7% of $39,808.00 in Billed Charges for Rev 278 = $16,599.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE AFX/AFX2 2 PIECE,278,RC,27800592,CDM,,,,,,both,,,39808.0000,5971.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,15923.20,,,,,,,2826.3700,39808.0000,percent of total billed charges,"40% of $39,808.00 in Billed Charges for Rev 278 = $15,923.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE AFX/AFX2 2 PIECE,278,RC,27800592,CDM,,,,,,both,,,39808.0000,5971.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,16599.94,,,,,,,2826.3700,39808.0000,percent of total billed charges,"41.7% of $39,808.00 in Billed Charges for Rev 278 = $16,599.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE AFX/AFX2 2 PIECE,278,RC,27800592,CDM,,,,,,both,,,39808.0000,5971.2000,CIGNA HEALTHCARE,CIGNA PPO,16599.94,,,,,,,2826.3700,39808.0000,percent of total billed charges,"41.7% of $39,808.00 in Billed Charges for Rev 278 = $16,599.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE AFX/AFX2 2 PIECE,278,RC,27800592,CDM,,,,,,both,,,39808.0000,5971.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,35827.20,,,,,,,2826.3700,39808.0000,percent of total billed charges,"90% of $39,808.00 in Billed Charges for Rev 278 = $35,827.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE AFX/AFX2 2 PIECE,278,RC,27800592,CDM,,,,,,both,,,39808.0000,5971.2000,MEDCOST,MEDCOST VHN,18944.63,,,,,,,2826.3700,39808.0000,percent of total billed charges,"47.59% of $39,808.00 in Billed Charges for Rev 278 = $18,944.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE AFX/AFX2 2 PIECE,278,RC,27800592,CDM,,,,,,both,,,39808.0000,5971.2000,SENTARA HEALTH,SENTARA HEALTH,10274.44,,,,,,,2826.3700,39808.0000,percent of total billed charges,"25.81% of $39,808.00 in Billed Charges for Rev 278 = $10,274.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE AFX/AFX2 2 PIECE,278,RC,27800592,CDM,,,,,,both,,,39808.0000,5971.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",39808.00,,,,,,,2826.3700,39808.0000,percent of total billed charges,"100% of $39,808.00 in Billed Charges for Rev 278 = $39,808.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE AFX/AFX2 2 PIECE,278,RC,27800592,CDM,,,,,,both,,,39808.0000,5971.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,19904.00,,,,,,,2826.3700,39808.0000,percent of total billed charges,"Rev 278 $39,808.00 in Billed Charges at 50% = $19,904.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE AFX/AFX2 2 PIECE,278,RC,27800592,CDM,,,,,,both,,,39808.0000,5971.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2985.60,,,,,,,2826.3700,39808.0000,percent of total billed charges,"7.5% of $39,808.00 in Billed Charges for Rev 278 = $2,985.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE AFX/AFX2 2 PIECE,278,RC,27800592,CDM,,,,,,both,,,39808.0000,5971.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2826.37,,,,,,,2826.3700,39808.0000,percent of total billed charges,"7.1% of $39,808.00 in Billed Charges for Rev 278 = $2,826.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE AFX/AFX2 2 PIECE,278,RC,27800592,CDM,,,,,,both,,,39808.0000,5971.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,2826.37,,,,,,,2826.3700,39808.0000,percent of total billed charges,"7.1% of $39,808.00 in Billed Charges for Rev 278 = $2,826.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOLOGIX CAP CODE AFX/AFX2 2 PIECE,278,RC,27800592,CDM,,,,,,both,,,39808.0000,5971.2000,WELLCARE,WELLCARE MEDICAID,39808.00,,,,,,,2826.3700,39808.0000,percent of total billed charges,"100% of $39,808.00 in Billed Charges for Rev 278 = $39,808.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOPROSTHESIS TRUNK 28 X 14 X 18 RLT281418,278,RC,27800577,CDM,,,,,,both,,,27189.0000,4078.3500,AETNA,AETNA,13050.72,,,,,,,1930.4200,27189.0000,percent of total billed charges,"48% of $27,189.00 in Billed Charges for Rev 278 = $13,050.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOPROSTHESIS TRUNK 28 X 14 X 18 RLT281418,278,RC,27800577,CDM,,,,,,both,,,27189.0000,4078.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,13594.50,,,,,,,1930.4200,27189.0000,percent of total billed charges,"50% of $27,189.00 in Billed Charges for Rev 278 = $13,594.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOPROSTHESIS TRUNK 28 X 14 X 18 RLT281418,278,RC,27800577,CDM,,,,,,both,,,27189.0000,4078.3500,CIGNA HEALTHCARE,CIGNA HMO,11337.81,,,,,,,1930.4200,27189.0000,percent of total billed charges,"41.7% of $27,189.00 in Billed Charges for Rev 278 = $11,337.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOPROSTHESIS TRUNK 28 X 14 X 18 RLT281418,278,RC,27800577,CDM,,,,,,both,,,27189.0000,4078.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10875.60,,,,,,,1930.4200,27189.0000,percent of total billed charges,"40% of $27,189.00 in Billed Charges for Rev 278 = $10,875.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOPROSTHESIS TRUNK 28 X 14 X 18 RLT281418,278,RC,27800577,CDM,,,,,,both,,,27189.0000,4078.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11337.81,,,,,,,1930.4200,27189.0000,percent of total billed charges,"41.7% of $27,189.00 in Billed Charges for Rev 278 = $11,337.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOPROSTHESIS TRUNK 28 X 14 X 18 RLT281418,278,RC,27800577,CDM,,,,,,both,,,27189.0000,4078.3500,CIGNA HEALTHCARE,CIGNA PPO,11337.81,,,,,,,1930.4200,27189.0000,percent of total billed charges,"41.7% of $27,189.00 in Billed Charges for Rev 278 = $11,337.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOPROSTHESIS TRUNK 28 X 14 X 18 RLT281418,278,RC,27800577,CDM,,,,,,both,,,27189.0000,4078.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,24470.10,,,,,,,1930.4200,27189.0000,percent of total billed charges,"90% of $27,189.00 in Billed Charges for Rev 278 = $24,470.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOPROSTHESIS TRUNK 28 X 14 X 18 RLT281418,278,RC,27800577,CDM,,,,,,both,,,27189.0000,4078.3500,MEDCOST,MEDCOST VHN,12939.25,,,,,,,1930.4200,27189.0000,percent of total billed charges,"47.59% of $27,189.00 in Billed Charges for Rev 278 = $12,939.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOPROSTHESIS TRUNK 28 X 14 X 18 RLT281418,278,RC,27800577,CDM,,,,,,both,,,27189.0000,4078.3500,SENTARA HEALTH,SENTARA HEALTH,7017.48,,,,,,,1930.4200,27189.0000,percent of total billed charges,"25.81% of $27,189.00 in Billed Charges for Rev 278 = $7,017.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOPROSTHESIS TRUNK 28 X 14 X 18 RLT281418,278,RC,27800577,CDM,,,,,,both,,,27189.0000,4078.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",27189.00,,,,,,,1930.4200,27189.0000,percent of total billed charges,"100% of $27,189.00 in Billed Charges for Rev 278 = $27,189.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOPROSTHESIS TRUNK 28 X 14 X 18 RLT281418,278,RC,27800577,CDM,,,,,,both,,,27189.0000,4078.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,13594.50,,,,,,,1930.4200,27189.0000,percent of total billed charges,"Rev 278 $27,189.00 in Billed Charges at 50% = $13,594.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOPROSTHESIS TRUNK 28 X 14 X 18 RLT281418,278,RC,27800577,CDM,,,,,,both,,,27189.0000,4078.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2039.18,,,,,,,1930.4200,27189.0000,percent of total billed charges,"7.5% of $27,189.00 in Billed Charges for Rev 278 = $2,039.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOPROSTHESIS TRUNK 28 X 14 X 18 RLT281418,278,RC,27800577,CDM,,,,,,both,,,27189.0000,4078.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1930.42,,,,,,,1930.4200,27189.0000,percent of total billed charges,"7.1% of $27,189.00 in Billed Charges for Rev 278 = $1,930.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOPROSTHESIS TRUNK 28 X 14 X 18 RLT281418,278,RC,27800577,CDM,,,,,,both,,,27189.0000,4078.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,1930.42,,,,,,,1930.4200,27189.0000,percent of total billed charges,"7.1% of $27,189.00 in Billed Charges for Rev 278 = $1,930.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA ENDOPROSTHESIS TRUNK 28 X 14 X 18 RLT281418,278,RC,27800577,CDM,,,,,,both,,,27189.0000,4078.3500,WELLCARE,WELLCARE MEDICAID,27189.00,,,,,,,1930.4200,27189.0000,percent of total billed charges,"100% of $27,189.00 in Billed Charges for Rev 278 = $27,189.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER BELL BOTTOM LIMB,278,RC,27800586,CDM,,,,,,both,,,11147.0000,1672.0500,AETNA,AETNA,5350.56,,,,,,,2877.0400,11147.0000,percent of total billed charges,"48% of $11,147.00 in Billed Charges for Rev 278 = $5,350.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER BELL BOTTOM LIMB,278,RC,27800586,CDM,,,,,,both,,,11147.0000,1672.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5573.50,,,,,,,2877.0400,11147.0000,percent of total billed charges,"50% of $11,147.00 in Billed Charges for Rev 278 = $5,573.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER BELL BOTTOM LIMB,278,RC,27800586,CDM,,,,,,both,,,11147.0000,1672.0500,CIGNA HEALTHCARE,CIGNA HMO,4648.30,,,,,,,2877.0400,11147.0000,percent of total billed charges,"41.7% of $11,147.00 in Billed Charges for Rev 278 = $4,648.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER BELL BOTTOM LIMB,278,RC,27800586,CDM,,,,,,both,,,11147.0000,1672.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4458.80,,,,,,,2877.0400,11147.0000,percent of total billed charges,"40% of $11,147.00 in Billed Charges for Rev 278 = $4,458.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER BELL BOTTOM LIMB,278,RC,27800586,CDM,,,,,,both,,,11147.0000,1672.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4648.30,,,,,,,2877.0400,11147.0000,percent of total billed charges,"41.7% of $11,147.00 in Billed Charges for Rev 278 = $4,648.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER BELL BOTTOM LIMB,278,RC,27800586,CDM,,,,,,both,,,11147.0000,1672.0500,CIGNA HEALTHCARE,CIGNA PPO,4648.30,,,,,,,2877.0400,11147.0000,percent of total billed charges,"41.7% of $11,147.00 in Billed Charges for Rev 278 = $4,648.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER BELL BOTTOM LIMB,278,RC,27800586,CDM,,,,,,both,,,11147.0000,1672.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10032.30,,,,,,,2877.0400,11147.0000,percent of total billed charges,"90% of $11,147.00 in Billed Charges for Rev 278 = $10,032.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER BELL BOTTOM LIMB,278,RC,27800586,CDM,,,,,,both,,,11147.0000,1672.0500,MEDCOST,MEDCOST VHN,5304.86,,,,,,,2877.0400,11147.0000,percent of total billed charges,"47.59% of $11,147.00 in Billed Charges for Rev 278 = $5,304.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER BELL BOTTOM LIMB,278,RC,27800586,CDM,,,,,,both,,,11147.0000,1672.0500,SENTARA HEALTH,SENTARA HEALTH,2877.04,,,,,,,2877.0400,11147.0000,percent of total billed charges,"25.81% of $11,147.00 in Billed Charges for Rev 278 = $2,877.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER BELL BOTTOM LIMB,278,RC,27800586,CDM,,,,,,both,,,11147.0000,1672.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11147.00,,,,,,,2877.0400,11147.0000,percent of total billed charges,"100% of $11,147.00 in Billed Charges for Rev 278 = $11,147.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER BELL BOTTOM LIMB,278,RC,27800586,CDM,,,,,,both,,,11147.0000,1672.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5573.50,,,,,,,2877.0400,11147.0000,percent of total billed charges,"Rev 278 $11,147.00 in Billed Charges at 50% = $5,573.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER BELL BOTTOM LIMB,278,RC,27800586,CDM,,,,,,both,,,11147.0000,1672.0500,WELLCARE,WELLCARE MEDICAID,11147.00,,,,,,,2877.0400,11147.0000,percent of total billed charges,"100% of $11,147.00 in Billed Charges for Rev 278 = $11,147.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER IBE MAIN BODY CEB231010A 23MMX10MMX100MM,278,RC,27800712,CDM,,,,,,both,,,27125.0000,4068.7500,AETNA,AETNA,13020.00,,,,,,,1925.8800,27125.0000,percent of total billed charges,"48% of $27,125.00 in Billed Charges for Rev 278 = $13,020.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER IBE MAIN BODY CEB231010A 23MMX10MMX100MM,278,RC,27800712,CDM,,,,,,both,,,27125.0000,4068.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,13562.50,,,,,,,1925.8800,27125.0000,percent of total billed charges,"50% of $27,125.00 in Billed Charges for Rev 278 = $13,562.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER IBE MAIN BODY CEB231010A 23MMX10MMX100MM,278,RC,27800712,CDM,,,,,,both,,,27125.0000,4068.7500,CIGNA HEALTHCARE,CIGNA HMO,11311.13,,,,,,,1925.8800,27125.0000,percent of total billed charges,"41.7% of $27,125.00 in Billed Charges for Rev 278 = $11,311.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER IBE MAIN BODY CEB231010A 23MMX10MMX100MM,278,RC,27800712,CDM,,,,,,both,,,27125.0000,4068.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10850.00,,,,,,,1925.8800,27125.0000,percent of total billed charges,"40% of $27,125.00 in Billed Charges for Rev 278 = $10,850.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER IBE MAIN BODY CEB231010A 23MMX10MMX100MM,278,RC,27800712,CDM,,,,,,both,,,27125.0000,4068.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11311.13,,,,,,,1925.8800,27125.0000,percent of total billed charges,"41.7% of $27,125.00 in Billed Charges for Rev 278 = $11,311.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER IBE MAIN BODY CEB231010A 23MMX10MMX100MM,278,RC,27800712,CDM,,,,,,both,,,27125.0000,4068.7500,CIGNA HEALTHCARE,CIGNA PPO,11311.13,,,,,,,1925.8800,27125.0000,percent of total billed charges,"41.7% of $27,125.00 in Billed Charges for Rev 278 = $11,311.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER IBE MAIN BODY CEB231010A 23MMX10MMX100MM,278,RC,27800712,CDM,,,,,,both,,,27125.0000,4068.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,24412.50,,,,,,,1925.8800,27125.0000,percent of total billed charges,"90% of $27,125.00 in Billed Charges for Rev 278 = $24,412.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER IBE MAIN BODY CEB231010A 23MMX10MMX100MM,278,RC,27800712,CDM,,,,,,both,,,27125.0000,4068.7500,MEDCOST,MEDCOST VHN,12908.79,,,,,,,1925.8800,27125.0000,percent of total billed charges,"47.59% of $27,125.00 in Billed Charges for Rev 278 = $12,908.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER IBE MAIN BODY CEB231010A 23MMX10MMX100MM,278,RC,27800712,CDM,,,,,,both,,,27125.0000,4068.7500,SENTARA HEALTH,SENTARA HEALTH,7000.96,,,,,,,1925.8800,27125.0000,percent of total billed charges,"25.81% of $27,125.00 in Billed Charges for Rev 278 = $7,000.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER IBE MAIN BODY CEB231010A 23MMX10MMX100MM,278,RC,27800712,CDM,,,,,,both,,,27125.0000,4068.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",27125.00,,,,,,,1925.8800,27125.0000,percent of total billed charges,"100% of $27,125.00 in Billed Charges for Rev 278 = $27,125.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER IBE MAIN BODY CEB231010A 23MMX10MMX100MM,278,RC,27800712,CDM,,,,,,both,,,27125.0000,4068.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,13562.50,,,,,,,1925.8800,27125.0000,percent of total billed charges,"Rev 278 $27,125.00 in Billed Charges at 50% = $13,562.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER IBE MAIN BODY CEB231010A 23MMX10MMX100MM,278,RC,27800712,CDM,,,,,,both,,,27125.0000,4068.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2034.38,,,,,,,1925.8800,27125.0000,percent of total billed charges,"7.5% of $27,125.00 in Billed Charges for Rev 278 = $2,034.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER IBE MAIN BODY CEB231010A 23MMX10MMX100MM,278,RC,27800712,CDM,,,,,,both,,,27125.0000,4068.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1925.88,,,,,,,1925.8800,27125.0000,percent of total billed charges,"7.1% of $27,125.00 in Billed Charges for Rev 278 = $1,925.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER IBE MAIN BODY CEB231010A 23MMX10MMX100MM,278,RC,27800712,CDM,,,,,,both,,,27125.0000,4068.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,1925.88,,,,,,,1925.8800,27125.0000,percent of total billed charges,"7.1% of $27,125.00 in Billed Charges for Rev 278 = $1,925.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER IBE MAIN BODY CEB231010A 23MMX10MMX100MM,278,RC,27800712,CDM,,,,,,both,,,27125.0000,4068.7500,WELLCARE,WELLCARE MEDICAID,27125.00,,,,,,,1925.8800,27125.0000,percent of total billed charges,"100% of $27,125.00 in Billed Charges for Rev 278 = $27,125.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER LIMB PXC121000 12MMX100MM,278,RC,27800713,CDM,,,,,,both,,,12900.0000,1935.0000,AETNA,AETNA,6192.00,,,,,,,3329.4900,12900.0000,percent of total billed charges,"48% of $12,900.00 in Billed Charges for Rev 278 = $6,192.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER LIMB PXC121000 12MMX100MM,278,RC,27800713,CDM,,,,,,both,,,12900.0000,1935.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6450.00,,,,,,,3329.4900,12900.0000,percent of total billed charges,"50% of $12,900.00 in Billed Charges for Rev 278 = $6,450.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER LIMB PXC121000 12MMX100MM,278,RC,27800713,CDM,,,,,,both,,,12900.0000,1935.0000,CIGNA HEALTHCARE,CIGNA HMO,5379.30,,,,,,,3329.4900,12900.0000,percent of total billed charges,"41.7% of $12,900.00 in Billed Charges for Rev 278 = $5,379.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER LIMB PXC121000 12MMX100MM,278,RC,27800713,CDM,,,,,,both,,,12900.0000,1935.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5160.00,,,,,,,3329.4900,12900.0000,percent of total billed charges,"40% of $12,900.00 in Billed Charges for Rev 278 = $5,160.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER LIMB PXC121000 12MMX100MM,278,RC,27800713,CDM,,,,,,both,,,12900.0000,1935.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5379.30,,,,,,,3329.4900,12900.0000,percent of total billed charges,"41.7% of $12,900.00 in Billed Charges for Rev 278 = $5,379.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER LIMB PXC121000 12MMX100MM,278,RC,27800713,CDM,,,,,,both,,,12900.0000,1935.0000,CIGNA HEALTHCARE,CIGNA PPO,5379.30,,,,,,,3329.4900,12900.0000,percent of total billed charges,"41.7% of $12,900.00 in Billed Charges for Rev 278 = $5,379.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER LIMB PXC121000 12MMX100MM,278,RC,27800713,CDM,,,,,,both,,,12900.0000,1935.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11610.00,,,,,,,3329.4900,12900.0000,percent of total billed charges,"90% of $12,900.00 in Billed Charges for Rev 278 = $11,610.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER LIMB PXC121000 12MMX100MM,278,RC,27800713,CDM,,,,,,both,,,12900.0000,1935.0000,MEDCOST,MEDCOST VHN,6139.11,,,,,,,3329.4900,12900.0000,percent of total billed charges,"47.59% of $12,900.00 in Billed Charges for Rev 278 = $6,139.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER LIMB PXC121000 12MMX100MM,278,RC,27800713,CDM,,,,,,both,,,12900.0000,1935.0000,SENTARA HEALTH,SENTARA HEALTH,3329.49,,,,,,,3329.4900,12900.0000,percent of total billed charges,"25.81% of $12,900.00 in Billed Charges for Rev 278 = $3,329.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER LIMB PXC121000 12MMX100MM,278,RC,27800713,CDM,,,,,,both,,,12900.0000,1935.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12900.00,,,,,,,3329.4900,12900.0000,percent of total billed charges,"100% of $12,900.00 in Billed Charges for Rev 278 = $12,900.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER LIMB PXC121000 12MMX100MM,278,RC,27800713,CDM,,,,,,both,,,12900.0000,1935.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6450.00,,,,,,,3329.4900,12900.0000,percent of total billed charges,"Rev 278 $12,900.00 in Billed Charges at 50% = $6,450.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT AAA EXCLUDER LIMB PXC121000 12MMX100MM,278,RC,27800713,CDM,,,,,,both,,,12900.0000,1935.0000,WELLCARE,WELLCARE MEDICAID,12900.00,,,,,,,3329.4900,12900.0000,percent of total billed charges,"100% of $12,900.00 in Billed Charges for Rev 278 = $12,900.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT LIMB EXTENSION 20 X13X88MM TO 20X25X55MM,278,RC,27800569,CDM,,,,,,both,,,9286.0000,1392.9000,AETNA,AETNA,4457.28,,,,,,,2396.7200,9286.0000,percent of total billed charges,"48% of $9,286.00 in Billed Charges for Rev 278 = $4,457.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT LIMB EXTENSION 20 X13X88MM TO 20X25X55MM,278,RC,27800569,CDM,,,,,,both,,,9286.0000,1392.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4643.00,,,,,,,2396.7200,9286.0000,percent of total billed charges,"50% of $9,286.00 in Billed Charges for Rev 278 = $4,643.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT LIMB EXTENSION 20 X13X88MM TO 20X25X55MM,278,RC,27800569,CDM,,,,,,both,,,9286.0000,1392.9000,CIGNA HEALTHCARE,CIGNA HMO,3872.26,,,,,,,2396.7200,9286.0000,percent of total billed charges,"41.7% of $9,286.00 in Billed Charges for Rev 278 = $3,872.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT LIMB EXTENSION 20 X13X88MM TO 20X25X55MM,278,RC,27800569,CDM,,,,,,both,,,9286.0000,1392.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3714.40,,,,,,,2396.7200,9286.0000,percent of total billed charges,"40% of $9,286.00 in Billed Charges for Rev 278 = $3,714.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT LIMB EXTENSION 20 X13X88MM TO 20X25X55MM,278,RC,27800569,CDM,,,,,,both,,,9286.0000,1392.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3872.26,,,,,,,2396.7200,9286.0000,percent of total billed charges,"41.7% of $9,286.00 in Billed Charges for Rev 278 = $3,872.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT LIMB EXTENSION 20 X13X88MM TO 20X25X55MM,278,RC,27800569,CDM,,,,,,both,,,9286.0000,1392.9000,CIGNA HEALTHCARE,CIGNA PPO,3872.26,,,,,,,2396.7200,9286.0000,percent of total billed charges,"41.7% of $9,286.00 in Billed Charges for Rev 278 = $3,872.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT LIMB EXTENSION 20 X13X88MM TO 20X25X55MM,278,RC,27800569,CDM,,,,,,both,,,9286.0000,1392.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8357.40,,,,,,,2396.7200,9286.0000,percent of total billed charges,"90% of $9,286.00 in Billed Charges for Rev 278 = $8,357.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT LIMB EXTENSION 20 X13X88MM TO 20X25X55MM,278,RC,27800569,CDM,,,,,,both,,,9286.0000,1392.9000,MEDCOST,MEDCOST VHN,4419.21,,,,,,,2396.7200,9286.0000,percent of total billed charges,"47.59% of $9,286.00 in Billed Charges for Rev 278 = $4,419.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT LIMB EXTENSION 20 X13X88MM TO 20X25X55MM,278,RC,27800569,CDM,,,,,,both,,,9286.0000,1392.9000,SENTARA HEALTH,SENTARA HEALTH,2396.72,,,,,,,2396.7200,9286.0000,percent of total billed charges,"25.81% of $9,286.00 in Billed Charges for Rev 278 = $2,396.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT LIMB EXTENSION 20 X13X88MM TO 20X25X55MM,278,RC,27800569,CDM,,,,,,both,,,9286.0000,1392.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9286.00,,,,,,,2396.7200,9286.0000,percent of total billed charges,"100% of $9,286.00 in Billed Charges for Rev 278 = $9,286.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT LIMB EXTENSION 20 X13X88MM TO 20X25X55MM,278,RC,27800569,CDM,,,,,,both,,,9286.0000,1392.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4643.00,,,,,,,2396.7200,9286.0000,percent of total billed charges,"Rev 278 $9,286.00 in Billed Charges at 50% = $4,643.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GRAFT STENT LIMB EXTENSION 20 X13X88MM TO 20X25X55MM,278,RC,27800569,CDM,,,,,,both,,,9286.0000,1392.9000,WELLCARE,WELLCARE MEDICAID,9286.00,,,,,,,2396.7200,9286.0000,percent of total billed charges,"100% of $9,286.00 in Billed Charges for Rev 278 = $9,286.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,23137.7000,3470.6600,AETNA,AETNA,9879.80,,,,,,,5971.8400,23137.7000,percent of total billed charges,"42.7% of $23,137.70 in Billed Charges for Rev 272 = $9,879.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,23137.7000,3470.6600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,16196.39,,,,,,,5971.8400,23137.7000,percent of total billed charges,"Rev 272 $23,137.70 in Billed Charges at 70% = $16,196.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,23137.7000,3470.6600,CIGNA HEALTHCARE,CIGNA HMO,9648.42,,,,,,,5971.8400,23137.7000,percent of total billed charges,"41.7% of $23,137.70 in Billed Charges for Rev 272 = $9,648.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,23137.7000,3470.6600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10735.89,,,,,,,5971.8400,23137.7000,percent of total billed charges,"46.4% of $23,137.70 in Billed Charges for Rev 272 = $10,735.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,23137.7000,3470.6600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9648.42,,,,,,,5971.8400,23137.7000,percent of total billed charges,"41.7% of $23,137.70 in Billed Charges for Rev 272 = $9,648.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,23137.7000,3470.6600,CIGNA HEALTHCARE,CIGNA PPO,9648.42,,,,,,,5971.8400,23137.7000,percent of total billed charges,"41.7% of $23,137.70 in Billed Charges for Rev 272 = $9,648.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,23137.7000,3470.6600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,20823.93,,,,,,,5971.8400,23137.7000,percent of total billed charges,"90% of $23,137.70 in Billed Charges for Rev 272 = $20,823.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,23137.7000,3470.6600,MEDCOST,MEDCOST VHN,11011.23,,,,,,,5971.8400,23137.7000,percent of total billed charges,"47.59% of $23,137.70 in Billed Charges for Rev 272 = $11,011.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,23137.7000,3470.6600,SENTARA HEALTH,SENTARA HEALTH,5971.84,,,,,,,5971.8400,23137.7000,percent of total billed charges,"25.81% of $23,137.70 in Billed Charges for Rev 272 = $5,971.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,23137.7000,3470.6600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",23137.70,,,,,,,5971.8400,23137.7000,percent of total billed charges,"100% of $23,137.70 in Billed Charges for Rev 272 = $23,137.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,23137.7000,3470.6600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11568.85,,,,,,,5971.8400,23137.7000,percent of total billed charges,"Rev 272 $23,137.70 in Billed Charges at 50% = $11,568.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,23137.7000,3470.6600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7473.48,,,,,,,5971.8400,23137.7000,other,"32.3% of $23,137.70 in Billed Charges for Rev 272 = $7,473.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MARKING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,23137.7000,3470.6600,UNITED HEALTHCARE,UHC HERITAGE SELECT,7103.27,,,,,,,5971.8400,23137.7000,other,"30.7% of $23,137.70 in Billed Charges for Rev 272 = $7,103.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MARKING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,23137.7000,3470.6600,UNITED HEALTHCARE,UNITED HEALTHCARE,7473.48,,,,,,,5971.8400,23137.7000,percent of total billed charges,"32.3% of $23,137.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE IPS CRANIAL SUPPLEMENTAL,272,RC,27200002,CDM,,,,,,both,,,23137.7000,3470.6600,WELLCARE,WELLCARE MEDICAID,23137.70,,,,,,,5971.8400,23137.7000,percent of total billed charges,"100% of $23,137.70 in Billed Charges for Rev 272 = $23,137.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE RECON COMPLEX,272,RC,27200002,CDM,,,,,,both,,,63957.9600,9593.6900,AETNA,AETNA,27310.05,,,,,,,16507.5500,63957.9600,percent of total billed charges,"42.7% of $63,957.96 in Billed Charges for Rev 272 = $27,310.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE RECON COMPLEX,272,RC,27200002,CDM,,,,,,both,,,63957.9600,9593.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,44770.57,,,,,,,16507.5500,63957.9600,percent of total billed charges,"Rev 272 $63,957.96 in Billed Charges at 70% = $44,770.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE RECON COMPLEX,272,RC,27200002,CDM,,,,,,both,,,63957.9600,9593.6900,CIGNA HEALTHCARE,CIGNA HMO,26670.47,,,,,,,16507.5500,63957.9600,percent of total billed charges,"41.7% of $63,957.96 in Billed Charges for Rev 272 = $26,670.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE RECON COMPLEX,272,RC,27200002,CDM,,,,,,both,,,63957.9600,9593.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,29676.49,,,,,,,16507.5500,63957.9600,percent of total billed charges,"46.4% of $63,957.96 in Billed Charges for Rev 272 = $29,676.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE RECON COMPLEX,272,RC,27200002,CDM,,,,,,both,,,63957.9600,9593.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,26670.47,,,,,,,16507.5500,63957.9600,percent of total billed charges,"41.7% of $63,957.96 in Billed Charges for Rev 272 = $26,670.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE RECON COMPLEX,272,RC,27200002,CDM,,,,,,both,,,63957.9600,9593.6900,CIGNA HEALTHCARE,CIGNA PPO,26670.47,,,,,,,16507.5500,63957.9600,percent of total billed charges,"41.7% of $63,957.96 in Billed Charges for Rev 272 = $26,670.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE RECON COMPLEX,272,RC,27200002,CDM,,,,,,both,,,63957.9600,9593.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,57562.16,,,,,,,16507.5500,63957.9600,percent of total billed charges,"90% of $63,957.96 in Billed Charges for Rev 272 = $57,562.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE RECON COMPLEX,272,RC,27200002,CDM,,,,,,both,,,63957.9600,9593.6900,MEDCOST,MEDCOST VHN,30437.59,,,,,,,16507.5500,63957.9600,percent of total billed charges,"47.59% of $63,957.96 in Billed Charges for Rev 272 = $30,437.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE RECON COMPLEX,272,RC,27200002,CDM,,,,,,both,,,63957.9600,9593.6900,SENTARA HEALTH,SENTARA HEALTH,16507.55,,,,,,,16507.5500,63957.9600,percent of total billed charges,"25.81% of $63,957.96 in Billed Charges for Rev 272 = $16,507.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE RECON COMPLEX,272,RC,27200002,CDM,,,,,,both,,,63957.9600,9593.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",63957.96,,,,,,,16507.5500,63957.9600,percent of total billed charges,"100% of $63,957.96 in Billed Charges for Rev 272 = $63,957.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE RECON COMPLEX,272,RC,27200002,CDM,,,,,,both,,,63957.9600,9593.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,31978.98,,,,,,,16507.5500,63957.9600,percent of total billed charges,"Rev 272 $63,957.96 in Billed Charges at 50% = $31,978.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE RECON COMPLEX,272,RC,27200002,CDM,,,,,,both,,,63957.9600,9593.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,20658.42,,,,,,,16507.5500,63957.9600,other,"32.3% of $63,957.96 in Billed Charges for Rev 272 = $20,658.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MARKING GUIDE RECON COMPLEX,272,RC,27200002,CDM,,,,,,both,,,63957.9600,9593.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,19635.09,,,,,,,16507.5500,63957.9600,other,"30.7% of $63,957.96 in Billed Charges for Rev 272 = $19,635.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
MARKING GUIDE RECON COMPLEX,272,RC,27200002,CDM,,,,,,both,,,63957.9600,9593.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,20658.42,,,,,,,16507.5500,63957.9600,percent of total billed charges,"32.3% of $63,957.96 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MARKING GUIDE RECON COMPLEX,272,RC,27200002,CDM,,,,,,both,,,63957.9600,9593.6900,WELLCARE,WELLCARE MEDICAID,63957.96,,,,,,,16507.5500,63957.9600,percent of total billed charges,"100% of $63,957.96 in Billed Charges for Rev 272 = $63,957.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MAT SINGLE PATIENT 39 X 45 HOVERMATT,272,RC,27200002,CDM,,,,,,both,,,687.6000,103.1400,AETNA,AETNA,293.61,,,,,,,177.4700,687.6000,percent of total billed charges,42.7% of $687.60 in Billed Charges for Rev 272 = $293.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MAT SINGLE PATIENT 39 X 45 HOVERMATT,272,RC,27200002,CDM,,,,,,both,,,687.6000,103.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,481.32,,,,,,,177.4700,687.6000,percent of total billed charges,Rev 272 $687.60 in Billed Charges at 70% = $481.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MAT SINGLE PATIENT 39 X 45 HOVERMATT,272,RC,27200002,CDM,,,,,,both,,,687.6000,103.1400,CIGNA HEALTHCARE,CIGNA HMO,286.73,,,,,,,177.4700,687.6000,percent of total billed charges,41.7% of $687.60 in Billed Charges for Rev 272 = $286.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MAT SINGLE PATIENT 39 X 45 HOVERMATT,272,RC,27200002,CDM,,,,,,both,,,687.6000,103.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,319.05,,,,,,,177.4700,687.6000,percent of total billed charges,46.4% of $687.60 in Billed Charges for Rev 272 = $319.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MAT SINGLE PATIENT 39 X 45 HOVERMATT,272,RC,27200002,CDM,,,,,,both,,,687.6000,103.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,286.73,,,,,,,177.4700,687.6000,percent of total billed charges,41.7% of $687.60 in Billed Charges for Rev 272 = $286.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MAT SINGLE PATIENT 39 X 45 HOVERMATT,272,RC,27200002,CDM,,,,,,both,,,687.6000,103.1400,CIGNA HEALTHCARE,CIGNA PPO,286.73,,,,,,,177.4700,687.6000,percent of total billed charges,41.7% of $687.60 in Billed Charges for Rev 272 = $286.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MAT SINGLE PATIENT 39 X 45 HOVERMATT,272,RC,27200002,CDM,,,,,,both,,,687.6000,103.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,618.84,,,,,,,177.4700,687.6000,percent of total billed charges,90% of $687.60 in Billed Charges for Rev 272 = $618.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MAT SINGLE PATIENT 39 X 45 HOVERMATT,272,RC,27200002,CDM,,,,,,both,,,687.6000,103.1400,MEDCOST,MEDCOST VHN,327.23,,,,,,,177.4700,687.6000,percent of total billed charges,47.59% of $687.60 in Billed Charges for Rev 272 = $327.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MAT SINGLE PATIENT 39 X 45 HOVERMATT,272,RC,27200002,CDM,,,,,,both,,,687.6000,103.1400,SENTARA HEALTH,SENTARA HEALTH,177.47,,,,,,,177.4700,687.6000,percent of total billed charges,25.81% of $687.60 in Billed Charges for Rev 272 = $177.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MAT SINGLE PATIENT 39 X 45 HOVERMATT,272,RC,27200002,CDM,,,,,,both,,,687.6000,103.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",687.60,,,,,,,177.4700,687.6000,percent of total billed charges,100% of $687.60 in Billed Charges for Rev 272 = $687.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MAT SINGLE PATIENT 39 X 45 HOVERMATT,272,RC,27200002,CDM,,,,,,both,,,687.6000,103.1400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,343.80,,,,,,,177.4700,687.6000,percent of total billed charges,Rev 272 $687.60 in Billed Charges at 50% = $343.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MAT SINGLE PATIENT 39 X 45 HOVERMATT,272,RC,27200002,CDM,,,,,,both,,,687.6000,103.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,222.09,,,,,,,177.4700,687.6000,other,32.3% of $687.60 in Billed Charges for Rev 272 = $222.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
MAT SINGLE PATIENT 39 X 45 HOVERMATT,272,RC,27200002,CDM,,,,,,both,,,687.6000,103.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,211.09,,,,,,,177.4700,687.6000,other,30.7% of $687.60 in Billed Charges for Rev 272 = $211.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
MAT SINGLE PATIENT 39 X 45 HOVERMATT,272,RC,27200002,CDM,,,,,,both,,,687.6000,103.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,222.09,,,,,,,177.4700,687.6000,percent of total billed charges,32.3% of $687.60 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MAT SINGLE PATIENT 39 X 45 HOVERMATT,272,RC,27200002,CDM,,,,,,both,,,687.6000,103.1400,WELLCARE,WELLCARE MEDICAID,687.60,,,,,,,177.4700,687.6000,percent of total billed charges,100% of $687.60 in Billed Charges for Rev 272 = $687.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 34,272,RC,27200002,CDM,,,,,,both,,,710.4100,106.5600,AETNA,AETNA,303.35,,,,,,,183.3600,710.4100,percent of total billed charges,42.7% of $710.41 in Billed Charges for Rev 272 = $303.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 34,272,RC,27200002,CDM,,,,,,both,,,710.4100,106.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,497.29,,,,,,,183.3600,710.4100,percent of total billed charges,Rev 272 $710.41 in Billed Charges at 70% = $497.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 34,272,RC,27200002,CDM,,,,,,both,,,710.4100,106.5600,CIGNA HEALTHCARE,CIGNA HMO,296.24,,,,,,,183.3600,710.4100,percent of total billed charges,41.7% of $710.41 in Billed Charges for Rev 272 = $296.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 34,272,RC,27200002,CDM,,,,,,both,,,710.4100,106.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,329.63,,,,,,,183.3600,710.4100,percent of total billed charges,46.4% of $710.41 in Billed Charges for Rev 272 = $329.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 34,272,RC,27200002,CDM,,,,,,both,,,710.4100,106.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,296.24,,,,,,,183.3600,710.4100,percent of total billed charges,41.7% of $710.41 in Billed Charges for Rev 272 = $296.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 34,272,RC,27200002,CDM,,,,,,both,,,710.4100,106.5600,CIGNA HEALTHCARE,CIGNA PPO,296.24,,,,,,,183.3600,710.4100,percent of total billed charges,41.7% of $710.41 in Billed Charges for Rev 272 = $296.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 34,272,RC,27200002,CDM,,,,,,both,,,710.4100,106.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,639.37,,,,,,,183.3600,710.4100,percent of total billed charges,90% of $710.41 in Billed Charges for Rev 272 = $639.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 34,272,RC,27200002,CDM,,,,,,both,,,710.4100,106.5600,MEDCOST,MEDCOST VHN,338.08,,,,,,,183.3600,710.4100,percent of total billed charges,47.59% of $710.41 in Billed Charges for Rev 272 = $338.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 34,272,RC,27200002,CDM,,,,,,both,,,710.4100,106.5600,SENTARA HEALTH,SENTARA HEALTH,183.36,,,,,,,183.3600,710.4100,percent of total billed charges,25.81% of $710.41 in Billed Charges for Rev 272 = $183.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 34,272,RC,27200002,CDM,,,,,,both,,,710.4100,106.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",710.41,,,,,,,183.3600,710.4100,percent of total billed charges,100% of $710.41 in Billed Charges for Rev 272 = $710.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 34,272,RC,27200002,CDM,,,,,,both,,,710.4100,106.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,355.21,,,,,,,183.3600,710.4100,percent of total billed charges,Rev 272 $710.41 in Billed Charges at 50% = $355.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 34,272,RC,27200002,CDM,,,,,,both,,,710.4100,106.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,229.46,,,,,,,183.3600,710.4100,other,32.3% of $710.41 in Billed Charges for Rev 272 = $229.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
MATT HOVER SINGLE USE 34,272,RC,27200002,CDM,,,,,,both,,,710.4100,106.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,218.10,,,,,,,183.3600,710.4100,other,30.7% of $710.41 in Billed Charges for Rev 272 = $218.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
MATT HOVER SINGLE USE 34,272,RC,27200002,CDM,,,,,,both,,,710.4100,106.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,229.46,,,,,,,183.3600,710.4100,percent of total billed charges,32.3% of $710.41 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 34,272,RC,27200002,CDM,,,,,,both,,,710.4100,106.5600,WELLCARE,WELLCARE MEDICAID,710.41,,,,,,,183.3600,710.4100,percent of total billed charges,100% of $710.41 in Billed Charges for Rev 272 = $710.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 39,272,RC,27200002,CDM,,,,,,both,,,803.7500,120.5600,AETNA,AETNA,343.20,,,,,,,207.4500,803.7500,percent of total billed charges,42.7% of $803.75 in Billed Charges for Rev 272 = $343.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 39,272,RC,27200002,CDM,,,,,,both,,,803.7500,120.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,562.63,,,,,,,207.4500,803.7500,percent of total billed charges,Rev 272 $803.75 in Billed Charges at 70% = $562.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 39,272,RC,27200002,CDM,,,,,,both,,,803.7500,120.5600,CIGNA HEALTHCARE,CIGNA HMO,335.16,,,,,,,207.4500,803.7500,percent of total billed charges,41.7% of $803.75 in Billed Charges for Rev 272 = $335.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 39,272,RC,27200002,CDM,,,,,,both,,,803.7500,120.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,372.94,,,,,,,207.4500,803.7500,percent of total billed charges,46.4% of $803.75 in Billed Charges for Rev 272 = $372.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 39,272,RC,27200002,CDM,,,,,,both,,,803.7500,120.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,335.16,,,,,,,207.4500,803.7500,percent of total billed charges,41.7% of $803.75 in Billed Charges for Rev 272 = $335.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 39,272,RC,27200002,CDM,,,,,,both,,,803.7500,120.5600,CIGNA HEALTHCARE,CIGNA PPO,335.16,,,,,,,207.4500,803.7500,percent of total billed charges,41.7% of $803.75 in Billed Charges for Rev 272 = $335.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 39,272,RC,27200002,CDM,,,,,,both,,,803.7500,120.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,723.38,,,,,,,207.4500,803.7500,percent of total billed charges,90% of $803.75 in Billed Charges for Rev 272 = $723.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 39,272,RC,27200002,CDM,,,,,,both,,,803.7500,120.5600,MEDCOST,MEDCOST VHN,382.50,,,,,,,207.4500,803.7500,percent of total billed charges,47.59% of $803.75 in Billed Charges for Rev 272 = $382.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 39,272,RC,27200002,CDM,,,,,,both,,,803.7500,120.5600,SENTARA HEALTH,SENTARA HEALTH,207.45,,,,,,,207.4500,803.7500,percent of total billed charges,25.81% of $803.75 in Billed Charges for Rev 272 = $207.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 39,272,RC,27200002,CDM,,,,,,both,,,803.7500,120.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",803.75,,,,,,,207.4500,803.7500,percent of total billed charges,100% of $803.75 in Billed Charges for Rev 272 = $803.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 39,272,RC,27200002,CDM,,,,,,both,,,803.7500,120.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,401.88,,,,,,,207.4500,803.7500,percent of total billed charges,Rev 272 $803.75 in Billed Charges at 50% = $401.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 39,272,RC,27200002,CDM,,,,,,both,,,803.7500,120.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,259.61,,,,,,,207.4500,803.7500,other,32.3% of $803.75 in Billed Charges for Rev 272 = $259.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
MATT HOVER SINGLE USE 39,272,RC,27200002,CDM,,,,,,both,,,803.7500,120.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,246.75,,,,,,,207.4500,803.7500,other,30.7% of $803.75 in Billed Charges for Rev 272 = $246.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
MATT HOVER SINGLE USE 39,272,RC,27200002,CDM,,,,,,both,,,803.7500,120.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,259.61,,,,,,,207.4500,803.7500,percent of total billed charges,32.3% of $803.75 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 39,272,RC,27200002,CDM,,,,,,both,,,803.7500,120.5600,WELLCARE,WELLCARE MEDICAID,803.75,,,,,,,207.4500,803.7500,percent of total billed charges,100% of $803.75 in Billed Charges for Rev 272 = $803.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GUIDEWIRE STEELCORE LT .018 190CM,272,RC,27200805,CDM,,,,,,both,,,466.0000,69.9000,AETNA,AETNA,198.98,,,,,,,120.2700,466.0000,percent of total billed charges,42.7% of $466.00 in Billed Charges for Rev 272 = $198.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GUIDEWIRE STEELCORE LT .018 190CM,272,RC,27200805,CDM,,,,,,both,,,466.0000,69.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,326.20,,,,,,,120.2700,466.0000,percent of total billed charges,Rev 272 $466.00 in Billed Charges at 70% = $326.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GUIDEWIRE STEELCORE LT .018 190CM,272,RC,27200805,CDM,,,,,,both,,,466.0000,69.9000,CIGNA HEALTHCARE,CIGNA HMO,194.32,,,,,,,120.2700,466.0000,percent of total billed charges,41.7% of $466.00 in Billed Charges for Rev 272 = $194.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GUIDEWIRE STEELCORE LT .018 190CM,272,RC,27200805,CDM,,,,,,both,,,466.0000,69.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,216.22,,,,,,,120.2700,466.0000,percent of total billed charges,46.4% of $466.00 in Billed Charges for Rev 272 = $216.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GUIDEWIRE STEELCORE LT .018 190CM,272,RC,27200805,CDM,,,,,,both,,,466.0000,69.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,194.32,,,,,,,120.2700,466.0000,percent of total billed charges,41.7% of $466.00 in Billed Charges for Rev 272 = $194.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GUIDEWIRE STEELCORE LT .018 190CM,272,RC,27200805,CDM,,,,,,both,,,466.0000,69.9000,CIGNA HEALTHCARE,CIGNA PPO,194.32,,,,,,,120.2700,466.0000,percent of total billed charges,41.7% of $466.00 in Billed Charges for Rev 272 = $194.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GUIDEWIRE STEELCORE LT .018 190CM,272,RC,27200805,CDM,,,,,,both,,,466.0000,69.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,419.40,,,,,,,120.2700,466.0000,percent of total billed charges,90% of $466.00 in Billed Charges for Rev 272 = $419.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GUIDEWIRE STEELCORE LT .018 190CM,272,RC,27200805,CDM,,,,,,both,,,466.0000,69.9000,MEDCOST,MEDCOST VHN,221.77,,,,,,,120.2700,466.0000,percent of total billed charges,47.59% of $466.00 in Billed Charges for Rev 272 = $221.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GUIDEWIRE STEELCORE LT .018 190CM,272,RC,27200805,CDM,,,,,,both,,,466.0000,69.9000,SENTARA HEALTH,SENTARA HEALTH,120.27,,,,,,,120.2700,466.0000,percent of total billed charges,25.81% of $466.00 in Billed Charges for Rev 272 = $120.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GUIDEWIRE STEELCORE LT .018 190CM,272,RC,27200805,CDM,,,,,,both,,,466.0000,69.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",466.00,,,,,,,120.2700,466.0000,percent of total billed charges,100% of $466.00 in Billed Charges for Rev 272 = $466.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GUIDEWIRE STEELCORE LT .018 190CM,272,RC,27200805,CDM,,,,,,both,,,466.0000,69.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,233.00,,,,,,,120.2700,466.0000,percent of total billed charges,Rev 272 $466.00 in Billed Charges at 50% = $233.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GUIDEWIRE STEELCORE LT .018 190CM,272,RC,27200805,CDM,,,,,,both,,,466.0000,69.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,150.52,,,,,,,120.2700,466.0000,other,32.3% of $466.00 in Billed Charges for Rev 272 = $150.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GUIDEWIRE STEELCORE LT .018 190CM,272,RC,27200805,CDM,,,,,,both,,,466.0000,69.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,143.06,,,,,,,120.2700,466.0000,other,30.7% of $466.00 in Billed Charges for Rev 272 = $143.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GUIDEWIRE STEELCORE LT .018 190CM,272,RC,27200805,CDM,,,,,,both,,,466.0000,69.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,150.52,,,,,,,120.2700,466.0000,percent of total billed charges,32.3% of $466.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GUIDEWIRE STEELCORE LT .018 190CM,272,RC,27200805,CDM,,,,,,both,,,466.0000,69.9000,WELLCARE,WELLCARE MEDICAID,466.00,,,,,,,120.2700,466.0000,percent of total billed charges,100% of $466.00 in Billed Charges for Rev 272 = $466.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HD DIALYSIS SET CATHETERIZATION,270,RC,27000097,CDM,,,,,,both,,,469.0000,70.3500,AETNA,AETNA,200.26,,,,,,,121.0500,469.0000,percent of total billed charges,42.7% of $469.00 in Billed Charges for Rev 270 = $200.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HD DIALYSIS SET CATHETERIZATION,270,RC,27000097,CDM,,,,,,both,,,469.0000,70.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,328.30,,,,,,,121.0500,469.0000,percent of total billed charges,Rev 270 $469.00 in Billed Charges at 70% = $328.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HD DIALYSIS SET CATHETERIZATION,270,RC,27000097,CDM,,,,,,both,,,469.0000,70.3500,CIGNA HEALTHCARE,CIGNA HMO,195.57,,,,,,,121.0500,469.0000,percent of total billed charges,41.7% of $469.00 in Billed Charges for Rev 270 = $195.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HD DIALYSIS SET CATHETERIZATION,270,RC,27000097,CDM,,,,,,both,,,469.0000,70.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,217.62,,,,,,,121.0500,469.0000,percent of total billed charges,46.4% of $469.00 in Billed Charges for Rev 270 = $217.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HD DIALYSIS SET CATHETERIZATION,270,RC,27000097,CDM,,,,,,both,,,469.0000,70.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,195.57,,,,,,,121.0500,469.0000,percent of total billed charges,41.7% of $469.00 in Billed Charges for Rev 270 = $195.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HD DIALYSIS SET CATHETERIZATION,270,RC,27000097,CDM,,,,,,both,,,469.0000,70.3500,CIGNA HEALTHCARE,CIGNA PPO,195.57,,,,,,,121.0500,469.0000,percent of total billed charges,41.7% of $469.00 in Billed Charges for Rev 270 = $195.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HD DIALYSIS SET CATHETERIZATION,270,RC,27000097,CDM,,,,,,both,,,469.0000,70.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,422.10,,,,,,,121.0500,469.0000,percent of total billed charges,90% of $469.00 in Billed Charges for Rev 270 = $422.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HD DIALYSIS SET CATHETERIZATION,270,RC,27000097,CDM,,,,,,both,,,469.0000,70.3500,MEDCOST,MEDCOST VHN,223.20,,,,,,,121.0500,469.0000,percent of total billed charges,47.59% of $469.00 in Billed Charges for Rev 270 = $223.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HD DIALYSIS SET CATHETERIZATION,270,RC,27000097,CDM,,,,,,both,,,469.0000,70.3500,SENTARA HEALTH,SENTARA HEALTH,121.05,,,,,,,121.0500,469.0000,percent of total billed charges,25.81% of $469.00 in Billed Charges for Rev 270 = $121.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HD DIALYSIS SET CATHETERIZATION,270,RC,27000097,CDM,,,,,,both,,,469.0000,70.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",469.00,,,,,,,121.0500,469.0000,percent of total billed charges,100% of $469.00 in Billed Charges for Rev 270 = $469.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HD DIALYSIS SET CATHETERIZATION,270,RC,27000097,CDM,,,,,,both,,,469.0000,70.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,234.50,,,,,,,121.0500,469.0000,percent of total billed charges,Rev 270 $469.00 in Billed Charges at 50% = $234.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HD DIALYSIS SET CATHETERIZATION,270,RC,27000097,CDM,,,,,,both,,,469.0000,70.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,151.49,,,,,,,121.0500,469.0000,other,32.3% of $469.00 in Billed Charges for Rev 270 = $151.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HD DIALYSIS SET CATHETERIZATION,270,RC,27000097,CDM,,,,,,both,,,469.0000,70.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,143.98,,,,,,,121.0500,469.0000,other,30.7% of $469.00 in Billed Charges for Rev 270 = $143.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HD DIALYSIS SET CATHETERIZATION,270,RC,27000097,CDM,,,,,,both,,,469.0000,70.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,151.49,,,,,,,121.0500,469.0000,percent of total billed charges,32.3% of $469.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HD DIALYSIS SET CATHETERIZATION,270,RC,27000097,CDM,,,,,,both,,,469.0000,70.3500,WELLCARE,WELLCARE MEDICAID,469.00,,,,,,,121.0500,469.0000,percent of total billed charges,100% of $469.00 in Billed Charges for Rev 270 = $469.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMODIALYSIS,801,RC,80100001,CDM,,,,,,both,,,1877.0000,281.5500,AETNA,AETNA,801.48,,,,,,,484.4500,1877.0000,percent of total billed charges,"42.7% of $1,877.00 in Billed Charges for Rev 801 = $801.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEMODIALYSIS,801,RC,80100001,CDM,,,,,,both,,,1877.0000,281.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1313.90,,,,,,,484.4500,1877.0000,percent of total billed charges,"Rev 801 $1,877.00 in Billed Charges at 70% = $1,313.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEMODIALYSIS,801,RC,80100001,CDM,,,,,,both,,,1877.0000,281.5500,CIGNA HEALTHCARE,CIGNA HMO,782.71,,,,,,,484.4500,1877.0000,percent of total billed charges,"41.7% of $1,877.00 in Billed Charges for Rev 801 = $782.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEMODIALYSIS,801,RC,80100001,CDM,,,,,,both,,,1877.0000,281.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,870.93,,,,,,,484.4500,1877.0000,percent of total billed charges,"46.4% of $1,877.00 in Billed Charges for Rev 801 = $870.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEMODIALYSIS,801,RC,80100001,CDM,,,,,,both,,,1877.0000,281.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,782.71,,,,,,,484.4500,1877.0000,percent of total billed charges,"41.7% of $1,877.00 in Billed Charges for Rev 801 = $782.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEMODIALYSIS,801,RC,80100001,CDM,,,,,,both,,,1877.0000,281.5500,CIGNA HEALTHCARE,CIGNA PPO,782.71,,,,,,,484.4500,1877.0000,percent of total billed charges,"41.7% of $1,877.00 in Billed Charges for Rev 801 = $782.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEMODIALYSIS,801,RC,80100001,CDM,,,,,,both,,,1877.0000,281.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1689.30,,,,,,,484.4500,1877.0000,percent of total billed charges,"90% of $1,877.00 in Billed Charges for Rev 801 = $1,689.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEMODIALYSIS,801,RC,80100001,CDM,,,,,,both,,,1877.0000,281.5500,MEDCOST,MEDCOST VHN,893.26,,,,,,,484.4500,1877.0000,percent of total billed charges,"47.59% of $1,877.00 in Billed Charges for Rev 801 = $893.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEMODIALYSIS,801,RC,80100001,CDM,,,,,,both,,,1877.0000,281.5500,SENTARA HEALTH,SENTARA HEALTH,484.45,,,,,,,484.4500,1877.0000,percent of total billed charges,"25.81% of $1,877.00 in Billed Charges for Rev 801 = $484.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEMODIALYSIS,801,RC,80100001,CDM,,,,,,both,,,1877.0000,281.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1877.00,,,,,,,484.4500,1877.0000,percent of total billed charges,"100% of $1,877.00 in Billed Charges for Rev 801 = $1,877.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEMODIALYSIS,801,RC,80100001,CDM,,,,,,both,,,1877.0000,281.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,938.50,,,,,,,484.4500,1877.0000,percent of total billed charges,"Rev 801 $1,877.00 in Billed Charges at 50% = $938.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEMODIALYSIS,801,RC,80100001,CDM,,,,,,both,,,1877.0000,281.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,606.27,,,,,,,484.4500,1877.0000,other,"32.3% of $1,877.00 in Billed Charges for Rev 801 = $606.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC HEMODIALYSIS,801,RC,80100001,CDM,,,,,,both,,,1877.0000,281.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,576.24,,,,,,,484.4500,1877.0000,other,"30.7% of $1,877.00 in Billed Charges for Rev 801 = $576.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC HEMODIALYSIS,801,RC,80100001,CDM,,,,,,both,,,1877.0000,281.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,606.27,,,,,,,484.4500,1877.0000,percent of total billed charges,"32.3% of $1,877.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEMODIALYSIS,801,RC,80100001,CDM,,,,,,both,,,1877.0000,281.5500,WELLCARE,WELLCARE MEDICAID,1877.00,,,,,,,484.4500,1877.0000,percent of total billed charges,"100% of $1,877.00 in Billed Charges for Rev 801 = $1,877.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEMOSTAT FLOWABLE D-STAT,272,RC,27201967,CDM,,,,,,both,,,491.0000,73.6500,AETNA,AETNA,209.66,,,,,,,126.7300,491.0000,percent of total billed charges,42.7% of $491.00 in Billed Charges for Rev 272 = $209.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT FLOWABLE D-STAT,272,RC,27201967,CDM,,,,,,both,,,491.0000,73.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,343.70,,,,,,,126.7300,491.0000,percent of total billed charges,Rev 272 $491.00 in Billed Charges at 70% = $343.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT FLOWABLE D-STAT,272,RC,27201967,CDM,,,,,,both,,,491.0000,73.6500,CIGNA HEALTHCARE,CIGNA HMO,204.75,,,,,,,126.7300,491.0000,percent of total billed charges,41.7% of $491.00 in Billed Charges for Rev 272 = $204.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT FLOWABLE D-STAT,272,RC,27201967,CDM,,,,,,both,,,491.0000,73.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,227.82,,,,,,,126.7300,491.0000,percent of total billed charges,46.4% of $491.00 in Billed Charges for Rev 272 = $227.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT FLOWABLE D-STAT,272,RC,27201967,CDM,,,,,,both,,,491.0000,73.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,204.75,,,,,,,126.7300,491.0000,percent of total billed charges,41.7% of $491.00 in Billed Charges for Rev 272 = $204.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT FLOWABLE D-STAT,272,RC,27201967,CDM,,,,,,both,,,491.0000,73.6500,CIGNA HEALTHCARE,CIGNA PPO,204.75,,,,,,,126.7300,491.0000,percent of total billed charges,41.7% of $491.00 in Billed Charges for Rev 272 = $204.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT FLOWABLE D-STAT,272,RC,27201967,CDM,,,,,,both,,,491.0000,73.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,441.90,,,,,,,126.7300,491.0000,percent of total billed charges,90% of $491.00 in Billed Charges for Rev 272 = $441.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT FLOWABLE D-STAT,272,RC,27201967,CDM,,,,,,both,,,491.0000,73.6500,MEDCOST,MEDCOST VHN,233.67,,,,,,,126.7300,491.0000,percent of total billed charges,47.59% of $491.00 in Billed Charges for Rev 272 = $233.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT FLOWABLE D-STAT,272,RC,27201967,CDM,,,,,,both,,,491.0000,73.6500,SENTARA HEALTH,SENTARA HEALTH,126.73,,,,,,,126.7300,491.0000,percent of total billed charges,25.81% of $491.00 in Billed Charges for Rev 272 = $126.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT FLOWABLE D-STAT,272,RC,27201967,CDM,,,,,,both,,,491.0000,73.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",491.00,,,,,,,126.7300,491.0000,percent of total billed charges,100% of $491.00 in Billed Charges for Rev 272 = $491.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT FLOWABLE D-STAT,272,RC,27201967,CDM,,,,,,both,,,491.0000,73.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,245.50,,,,,,,126.7300,491.0000,percent of total billed charges,Rev 272 $491.00 in Billed Charges at 50% = $245.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT FLOWABLE D-STAT,272,RC,27201967,CDM,,,,,,both,,,491.0000,73.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,158.59,,,,,,,126.7300,491.0000,other,32.3% of $491.00 in Billed Charges for Rev 272 = $158.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSTAT FLOWABLE D-STAT,272,RC,27201967,CDM,,,,,,both,,,491.0000,73.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,150.74,,,,,,,126.7300,491.0000,other,30.7% of $491.00 in Billed Charges for Rev 272 = $150.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSTAT FLOWABLE D-STAT,272,RC,27201967,CDM,,,,,,both,,,491.0000,73.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,158.59,,,,,,,126.7300,491.0000,percent of total billed charges,32.3% of $491.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT FLOWABLE D-STAT,272,RC,27201967,CDM,,,,,,both,,,491.0000,73.6500,WELLCARE,WELLCARE MEDICAID,491.00,,,,,,,126.7300,491.0000,percent of total billed charges,100% of $491.00 in Billed Charges for Rev 272 = $491.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27202243,CDM,,,,,,both,,,592.0000,88.8000,AETNA,AETNA,252.78,,,,,,,152.8000,592.0000,percent of total billed charges,42.7% of $592.00 in Billed Charges for Rev 272 = $252.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27202243,CDM,,,,,,both,,,592.0000,88.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,414.40,,,,,,,152.8000,592.0000,percent of total billed charges,Rev 272 $592.00 in Billed Charges at 70% = $414.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27202243,CDM,,,,,,both,,,592.0000,88.8000,CIGNA HEALTHCARE,CIGNA HMO,246.86,,,,,,,152.8000,592.0000,percent of total billed charges,41.7% of $592.00 in Billed Charges for Rev 272 = $246.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27202243,CDM,,,,,,both,,,592.0000,88.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,274.69,,,,,,,152.8000,592.0000,percent of total billed charges,46.4% of $592.00 in Billed Charges for Rev 272 = $274.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27202243,CDM,,,,,,both,,,592.0000,88.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,246.86,,,,,,,152.8000,592.0000,percent of total billed charges,41.7% of $592.00 in Billed Charges for Rev 272 = $246.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27202243,CDM,,,,,,both,,,592.0000,88.8000,CIGNA HEALTHCARE,CIGNA PPO,246.86,,,,,,,152.8000,592.0000,percent of total billed charges,41.7% of $592.00 in Billed Charges for Rev 272 = $246.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27202243,CDM,,,,,,both,,,592.0000,88.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,532.80,,,,,,,152.8000,592.0000,percent of total billed charges,90% of $592.00 in Billed Charges for Rev 272 = $532.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27202243,CDM,,,,,,both,,,592.0000,88.8000,MEDCOST,MEDCOST VHN,281.73,,,,,,,152.8000,592.0000,percent of total billed charges,47.59% of $592.00 in Billed Charges for Rev 272 = $281.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27202243,CDM,,,,,,both,,,592.0000,88.8000,SENTARA HEALTH,SENTARA HEALTH,152.80,,,,,,,152.8000,592.0000,percent of total billed charges,25.81% of $592.00 in Billed Charges for Rev 272 = $152.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27202243,CDM,,,,,,both,,,592.0000,88.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",592.00,,,,,,,152.8000,592.0000,percent of total billed charges,100% of $592.00 in Billed Charges for Rev 272 = $592.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27202243,CDM,,,,,,both,,,592.0000,88.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,296.00,,,,,,,152.8000,592.0000,percent of total billed charges,Rev 272 $592.00 in Billed Charges at 50% = $296.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27202243,CDM,,,,,,both,,,592.0000,88.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,191.22,,,,,,,152.8000,592.0000,other,32.3% of $592.00 in Billed Charges for Rev 272 = $191.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27202243,CDM,,,,,,both,,,592.0000,88.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,181.74,,,,,,,152.8000,592.0000,other,30.7% of $592.00 in Billed Charges for Rev 272 = $181.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27202243,CDM,,,,,,both,,,592.0000,88.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,191.22,,,,,,,152.8000,592.0000,percent of total billed charges,32.3% of $592.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27202243,CDM,,,,,,both,,,592.0000,88.8000,WELLCARE,WELLCARE MEDICAID,592.00,,,,,,,152.8000,592.0000,percent of total billed charges,100% of $592.00 in Billed Charges for Rev 272 = $592.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OBTURATOR EXCH,270,RC,27201389,CDM,,,,,,both,,,192.0000,28.8000,AETNA,AETNA,81.98,,,,,,,49.5600,192.0000,percent of total billed charges,42.7% of $192.00 in Billed Charges for Rev 270 = $81.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OBTURATOR EXCH,270,RC,27201389,CDM,,,,,,both,,,192.0000,28.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,134.40,,,,,,,49.5600,192.0000,percent of total billed charges,Rev 270 $192.00 in Billed Charges at 70% = $134.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OBTURATOR EXCH,270,RC,27201389,CDM,,,,,,both,,,192.0000,28.8000,CIGNA HEALTHCARE,CIGNA HMO,80.06,,,,,,,49.5600,192.0000,percent of total billed charges,41.7% of $192.00 in Billed Charges for Rev 270 = $80.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OBTURATOR EXCH,270,RC,27201389,CDM,,,,,,both,,,192.0000,28.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,89.09,,,,,,,49.5600,192.0000,percent of total billed charges,46.4% of $192.00 in Billed Charges for Rev 270 = $89.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OBTURATOR EXCH,270,RC,27201389,CDM,,,,,,both,,,192.0000,28.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,80.06,,,,,,,49.5600,192.0000,percent of total billed charges,41.7% of $192.00 in Billed Charges for Rev 270 = $80.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OBTURATOR EXCH,270,RC,27201389,CDM,,,,,,both,,,192.0000,28.8000,CIGNA HEALTHCARE,CIGNA PPO,80.06,,,,,,,49.5600,192.0000,percent of total billed charges,41.7% of $192.00 in Billed Charges for Rev 270 = $80.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OBTURATOR EXCH,270,RC,27201389,CDM,,,,,,both,,,192.0000,28.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,172.80,,,,,,,49.5600,192.0000,percent of total billed charges,90% of $192.00 in Billed Charges for Rev 270 = $172.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OBTURATOR EXCH,270,RC,27201389,CDM,,,,,,both,,,192.0000,28.8000,MEDCOST,MEDCOST VHN,91.37,,,,,,,49.5600,192.0000,percent of total billed charges,47.59% of $192.00 in Billed Charges for Rev 270 = $91.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OBTURATOR EXCH,270,RC,27201389,CDM,,,,,,both,,,192.0000,28.8000,SENTARA HEALTH,SENTARA HEALTH,49.56,,,,,,,49.5600,192.0000,percent of total billed charges,25.81% of $192.00 in Billed Charges for Rev 270 = $49.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OBTURATOR EXCH,270,RC,27201389,CDM,,,,,,both,,,192.0000,28.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",192.00,,,,,,,49.5600,192.0000,percent of total billed charges,100% of $192.00 in Billed Charges for Rev 270 = $192.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OBTURATOR EXCH,270,RC,27201389,CDM,,,,,,both,,,192.0000,28.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,96.00,,,,,,,49.5600,192.0000,percent of total billed charges,Rev 270 $192.00 in Billed Charges at 50% = $96.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OBTURATOR EXCH,270,RC,27201389,CDM,,,,,,both,,,192.0000,28.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,62.02,,,,,,,49.5600,192.0000,other,32.3% of $192.00 in Billed Charges for Rev 270 = $62.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OBTURATOR EXCH,270,RC,27201389,CDM,,,,,,both,,,192.0000,28.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,58.94,,,,,,,49.5600,192.0000,other,30.7% of $192.00 in Billed Charges for Rev 270 = $58.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OBTURATOR EXCH,270,RC,27201389,CDM,,,,,,both,,,192.0000,28.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,62.02,,,,,,,49.5600,192.0000,percent of total billed charges,32.3% of $192.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OBTURATOR EXCH,270,RC,27201389,CDM,,,,,,both,,,192.0000,28.8000,WELLCARE,WELLCARE MEDICAID,192.00,,,,,,,49.5600,192.0000,percent of total billed charges,100% of $192.00 in Billed Charges for Rev 270 = $192.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT BOOT EZ WALK CAST,270,RC,27000186,CDM,,,,,,both,,,89.0000,13.3500,AETNA,AETNA,38.00,,,,,,,22.9700,89.0000,percent of total billed charges,42.7% of $89.00 in Billed Charges for Rev 270 = $38.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT BOOT EZ WALK CAST,270,RC,27000186,CDM,,,,,,both,,,89.0000,13.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,62.30,,,,,,,22.9700,89.0000,percent of total billed charges,Rev 270 $89.00 in Billed Charges at 70% = $62.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT BOOT EZ WALK CAST,270,RC,27000186,CDM,,,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA HMO,37.11,,,,,,,22.9700,89.0000,percent of total billed charges,41.7% of $89.00 in Billed Charges for Rev 270 = $37.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT BOOT EZ WALK CAST,270,RC,27000186,CDM,,,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,41.30,,,,,,,22.9700,89.0000,percent of total billed charges,46.4% of $89.00 in Billed Charges for Rev 270 = $41.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT BOOT EZ WALK CAST,270,RC,27000186,CDM,,,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,37.11,,,,,,,22.9700,89.0000,percent of total billed charges,41.7% of $89.00 in Billed Charges for Rev 270 = $37.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT BOOT EZ WALK CAST,270,RC,27000186,CDM,,,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA PPO,37.11,,,,,,,22.9700,89.0000,percent of total billed charges,41.7% of $89.00 in Billed Charges for Rev 270 = $37.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT BOOT EZ WALK CAST,270,RC,27000186,CDM,,,,,,both,,,89.0000,13.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,80.10,,,,,,,22.9700,89.0000,percent of total billed charges,90% of $89.00 in Billed Charges for Rev 270 = $80.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT BOOT EZ WALK CAST,270,RC,27000186,CDM,,,,,,both,,,89.0000,13.3500,MEDCOST,MEDCOST VHN,42.36,,,,,,,22.9700,89.0000,percent of total billed charges,47.59% of $89.00 in Billed Charges for Rev 270 = $42.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT BOOT EZ WALK CAST,270,RC,27000186,CDM,,,,,,both,,,89.0000,13.3500,SENTARA HEALTH,SENTARA HEALTH,22.97,,,,,,,22.9700,89.0000,percent of total billed charges,25.81% of $89.00 in Billed Charges for Rev 270 = $22.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT BOOT EZ WALK CAST,270,RC,27000186,CDM,,,,,,both,,,89.0000,13.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",89.00,,,,,,,22.9700,89.0000,percent of total billed charges,100% of $89.00 in Billed Charges for Rev 270 = $89.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT BOOT EZ WALK CAST,270,RC,27000186,CDM,,,,,,both,,,89.0000,13.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,44.50,,,,,,,22.9700,89.0000,percent of total billed charges,Rev 270 $89.00 in Billed Charges at 50% = $44.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT BOOT EZ WALK CAST,270,RC,27000186,CDM,,,,,,both,,,89.0000,13.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,28.75,,,,,,,22.9700,89.0000,other,32.3% of $89.00 in Billed Charges for Rev 270 = $28.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ORTH SOFT BOOT EZ WALK CAST,270,RC,27000186,CDM,,,,,,both,,,89.0000,13.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,27.32,,,,,,,22.9700,89.0000,other,30.7% of $89.00 in Billed Charges for Rev 270 = $27.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ORTH SOFT BOOT EZ WALK CAST,270,RC,27000186,CDM,,,,,,both,,,89.0000,13.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,28.75,,,,,,,22.9700,89.0000,percent of total billed charges,32.3% of $89.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ORTH SOFT BOOT EZ WALK CAST,270,RC,27000186,CDM,,,,,,both,,,89.0000,13.3500,WELLCARE,WELLCARE MEDICAID,89.00,,,,,,,22.9700,89.0000,percent of total billed charges,100% of $89.00 in Billed Charges for Rev 270 = $89.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A DYCEM ROLL 8X8,270,RC,27000041,CDM,,,,,,both,,,4.0000,0.6000,AETNA,AETNA,1.71,,,,,,,1.0300,4.0000,percent of total billed charges,42.7% of $4.00 in Billed Charges for Rev 270 = $1.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A DYCEM ROLL 8X8,270,RC,27000041,CDM,,,,,,both,,,4.0000,0.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2.80,,,,,,,1.0300,4.0000,percent of total billed charges,Rev 270 $4.00 in Billed Charges at 70% = $2.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A DYCEM ROLL 8X8,270,RC,27000041,CDM,,,,,,both,,,4.0000,0.6000,CIGNA HEALTHCARE,CIGNA HMO,1.67,,,,,,,1.0300,4.0000,percent of total billed charges,41.7% of $4.00 in Billed Charges for Rev 270 = $1.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A DYCEM ROLL 8X8,270,RC,27000041,CDM,,,,,,both,,,4.0000,0.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1.86,,,,,,,1.0300,4.0000,percent of total billed charges,46.4% of $4.00 in Billed Charges for Rev 270 = $1.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A DYCEM ROLL 8X8,270,RC,27000041,CDM,,,,,,both,,,4.0000,0.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1.67,,,,,,,1.0300,4.0000,percent of total billed charges,41.7% of $4.00 in Billed Charges for Rev 270 = $1.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A DYCEM ROLL 8X8,270,RC,27000041,CDM,,,,,,both,,,4.0000,0.6000,CIGNA HEALTHCARE,CIGNA PPO,1.67,,,,,,,1.0300,4.0000,percent of total billed charges,41.7% of $4.00 in Billed Charges for Rev 270 = $1.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A DYCEM ROLL 8X8,270,RC,27000041,CDM,,,,,,both,,,4.0000,0.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3.60,,,,,,,1.0300,4.0000,percent of total billed charges,90% of $4.00 in Billed Charges for Rev 270 = $3.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A DYCEM ROLL 8X8,270,RC,27000041,CDM,,,,,,both,,,4.0000,0.6000,MEDCOST,MEDCOST VHN,1.90,,,,,,,1.0300,4.0000,percent of total billed charges,47.59% of $4.00 in Billed Charges for Rev 270 = $1.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A DYCEM ROLL 8X8,270,RC,27000041,CDM,,,,,,both,,,4.0000,0.6000,SENTARA HEALTH,SENTARA HEALTH,1.03,,,,,,,1.0300,4.0000,percent of total billed charges,25.81% of $4.00 in Billed Charges for Rev 270 = $1.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A DYCEM ROLL 8X8,270,RC,27000041,CDM,,,,,,both,,,4.0000,0.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4.00,,,,,,,1.0300,4.0000,percent of total billed charges,100% of $4.00 in Billed Charges for Rev 270 = $4.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A DYCEM ROLL 8X8,270,RC,27000041,CDM,,,,,,both,,,4.0000,0.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2.00,,,,,,,1.0300,4.0000,percent of total billed charges,Rev 270 $4.00 in Billed Charges at 50% = $2.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A DYCEM ROLL 8X8,270,RC,27000041,CDM,,,,,,both,,,4.0000,0.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1.29,,,,,,,1.0300,4.0000,other,32.3% of $4.00 in Billed Charges for Rev 270 = $1.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OT A DYCEM ROLL 8X8,270,RC,27000041,CDM,,,,,,both,,,4.0000,0.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1.23,,,,,,,1.0300,4.0000,other,30.7% of $4.00 in Billed Charges for Rev 270 = $1.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OT A DYCEM ROLL 8X8,270,RC,27000041,CDM,,,,,,both,,,4.0000,0.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,1.29,,,,,,,1.0300,4.0000,percent of total billed charges,32.3% of $4.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A DYCEM ROLL 8X8,270,RC,27000041,CDM,,,,,,both,,,4.0000,0.6000,WELLCARE,WELLCARE MEDICAID,4.00,,,,,,,1.0300,4.0000,percent of total billed charges,100% of $4.00 in Billed Charges for Rev 270 = $4.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A REACHER ECONOMY,270,RC,27000203,CDM,,,,,,both,,,32.0000,4.8000,AETNA,AETNA,13.66,,,,,,,8.2600,32.0000,percent of total billed charges,42.7% of $32.00 in Billed Charges for Rev 270 = $13.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A REACHER ECONOMY,270,RC,27000203,CDM,,,,,,both,,,32.0000,4.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,22.40,,,,,,,8.2600,32.0000,percent of total billed charges,Rev 270 $32.00 in Billed Charges at 70% = $22.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A REACHER ECONOMY,270,RC,27000203,CDM,,,,,,both,,,32.0000,4.8000,CIGNA HEALTHCARE,CIGNA HMO,13.34,,,,,,,8.2600,32.0000,percent of total billed charges,41.7% of $32.00 in Billed Charges for Rev 270 = $13.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A REACHER ECONOMY,270,RC,27000203,CDM,,,,,,both,,,32.0000,4.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,14.85,,,,,,,8.2600,32.0000,percent of total billed charges,46.4% of $32.00 in Billed Charges for Rev 270 = $14.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A REACHER ECONOMY,270,RC,27000203,CDM,,,,,,both,,,32.0000,4.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,13.34,,,,,,,8.2600,32.0000,percent of total billed charges,41.7% of $32.00 in Billed Charges for Rev 270 = $13.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A REACHER ECONOMY,270,RC,27000203,CDM,,,,,,both,,,32.0000,4.8000,CIGNA HEALTHCARE,CIGNA PPO,13.34,,,,,,,8.2600,32.0000,percent of total billed charges,41.7% of $32.00 in Billed Charges for Rev 270 = $13.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A REACHER ECONOMY,270,RC,27000203,CDM,,,,,,both,,,32.0000,4.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,28.80,,,,,,,8.2600,32.0000,percent of total billed charges,90% of $32.00 in Billed Charges for Rev 270 = $28.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A REACHER ECONOMY,270,RC,27000203,CDM,,,,,,both,,,32.0000,4.8000,MEDCOST,MEDCOST VHN,15.23,,,,,,,8.2600,32.0000,percent of total billed charges,47.59% of $32.00 in Billed Charges for Rev 270 = $15.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A REACHER ECONOMY,270,RC,27000203,CDM,,,,,,both,,,32.0000,4.8000,SENTARA HEALTH,SENTARA HEALTH,8.26,,,,,,,8.2600,32.0000,percent of total billed charges,25.81% of $32.00 in Billed Charges for Rev 270 = $8.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A REACHER ECONOMY,270,RC,27000203,CDM,,,,,,both,,,32.0000,4.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",32.00,,,,,,,8.2600,32.0000,percent of total billed charges,100% of $32.00 in Billed Charges for Rev 270 = $32.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A REACHER ECONOMY,270,RC,27000203,CDM,,,,,,both,,,32.0000,4.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,16.00,,,,,,,8.2600,32.0000,percent of total billed charges,Rev 270 $32.00 in Billed Charges at 50% = $16.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A REACHER ECONOMY,270,RC,27000203,CDM,,,,,,both,,,32.0000,4.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,10.34,,,,,,,8.2600,32.0000,other,32.3% of $32.00 in Billed Charges for Rev 270 = $10.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OT A REACHER ECONOMY,270,RC,27000203,CDM,,,,,,both,,,32.0000,4.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,9.82,,,,,,,8.2600,32.0000,other,30.7% of $32.00 in Billed Charges for Rev 270 = $9.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OT A REACHER ECONOMY,270,RC,27000203,CDM,,,,,,both,,,32.0000,4.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,10.34,,,,,,,8.2600,32.0000,percent of total billed charges,32.3% of $32.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT A REACHER ECONOMY,270,RC,27000203,CDM,,,,,,both,,,32.0000,4.8000,WELLCARE,WELLCARE MEDICAID,32.00,,,,,,,8.2600,32.0000,percent of total billed charges,100% of $32.00 in Billed Charges for Rev 270 = $32.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 50,272,RC,27200002,CDM,,,,,,both,,,976.9500,146.5400,AETNA,AETNA,417.16,,,,,,,252.1500,976.9500,percent of total billed charges,42.7% of $976.95 in Billed Charges for Rev 272 = $417.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 50,272,RC,27200002,CDM,,,,,,both,,,976.9500,146.5400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,683.87,,,,,,,252.1500,976.9500,percent of total billed charges,Rev 272 $976.95 in Billed Charges at 70% = $683.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 50,272,RC,27200002,CDM,,,,,,both,,,976.9500,146.5400,CIGNA HEALTHCARE,CIGNA HMO,407.39,,,,,,,252.1500,976.9500,percent of total billed charges,41.7% of $976.95 in Billed Charges for Rev 272 = $407.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 50,272,RC,27200002,CDM,,,,,,both,,,976.9500,146.5400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,453.30,,,,,,,252.1500,976.9500,percent of total billed charges,46.4% of $976.95 in Billed Charges for Rev 272 = $453.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 50,272,RC,27200002,CDM,,,,,,both,,,976.9500,146.5400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,407.39,,,,,,,252.1500,976.9500,percent of total billed charges,41.7% of $976.95 in Billed Charges for Rev 272 = $407.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 50,272,RC,27200002,CDM,,,,,,both,,,976.9500,146.5400,CIGNA HEALTHCARE,CIGNA PPO,407.39,,,,,,,252.1500,976.9500,percent of total billed charges,41.7% of $976.95 in Billed Charges for Rev 272 = $407.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 50,272,RC,27200002,CDM,,,,,,both,,,976.9500,146.5400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,879.26,,,,,,,252.1500,976.9500,percent of total billed charges,90% of $976.95 in Billed Charges for Rev 272 = $879.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 50,272,RC,27200002,CDM,,,,,,both,,,976.9500,146.5400,MEDCOST,MEDCOST VHN,464.93,,,,,,,252.1500,976.9500,percent of total billed charges,47.59% of $976.95 in Billed Charges for Rev 272 = $464.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 50,272,RC,27200002,CDM,,,,,,both,,,976.9500,146.5400,SENTARA HEALTH,SENTARA HEALTH,252.15,,,,,,,252.1500,976.9500,percent of total billed charges,25.81% of $976.95 in Billed Charges for Rev 272 = $252.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 50,272,RC,27200002,CDM,,,,,,both,,,976.9500,146.5400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",976.95,,,,,,,252.1500,976.9500,percent of total billed charges,100% of $976.95 in Billed Charges for Rev 272 = $976.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 50,272,RC,27200002,CDM,,,,,,both,,,976.9500,146.5400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,488.48,,,,,,,252.1500,976.9500,percent of total billed charges,Rev 272 $976.95 in Billed Charges at 50% = $488.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 50,272,RC,27200002,CDM,,,,,,both,,,976.9500,146.5400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,315.55,,,,,,,252.1500,976.9500,other,32.3% of $976.95 in Billed Charges for Rev 272 = $315.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
MATT HOVER SINGLE USE 50,272,RC,27200002,CDM,,,,,,both,,,976.9500,146.5400,UNITED HEALTHCARE,UHC HERITAGE SELECT,299.92,,,,,,,252.1500,976.9500,other,30.7% of $976.95 in Billed Charges for Rev 272 = $299.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
MATT HOVER SINGLE USE 50,272,RC,27200002,CDM,,,,,,both,,,976.9500,146.5400,UNITED HEALTHCARE,UNITED HEALTHCARE,315.55,,,,,,,252.1500,976.9500,percent of total billed charges,32.3% of $976.95 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
MATT HOVER SINGLE USE 50,272,RC,27200002,CDM,,,,,,both,,,976.9500,146.5400,WELLCARE,WELLCARE MEDICAID,976.95,,,,,,,252.1500,976.9500,percent of total billed charges,100% of $976.95 in Billed Charges for Rev 272 = $976.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INJECT FOR COAPTITE 21GX37CM,272,RC,27200002,CDM,,,,,,both,,,688.7400,103.3100,AETNA,AETNA,294.09,,,,,,,177.7600,688.7400,percent of total billed charges,42.7% of $688.74 in Billed Charges for Rev 272 = $294.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INJECT FOR COAPTITE 21GX37CM,272,RC,27200002,CDM,,,,,,both,,,688.7400,103.3100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,482.12,,,,,,,177.7600,688.7400,percent of total billed charges,Rev 272 $688.74 in Billed Charges at 70% = $482.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INJECT FOR COAPTITE 21GX37CM,272,RC,27200002,CDM,,,,,,both,,,688.7400,103.3100,CIGNA HEALTHCARE,CIGNA HMO,287.20,,,,,,,177.7600,688.7400,percent of total billed charges,41.7% of $688.74 in Billed Charges for Rev 272 = $287.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INJECT FOR COAPTITE 21GX37CM,272,RC,27200002,CDM,,,,,,both,,,688.7400,103.3100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,319.58,,,,,,,177.7600,688.7400,percent of total billed charges,46.4% of $688.74 in Billed Charges for Rev 272 = $319.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INJECT FOR COAPTITE 21GX37CM,272,RC,27200002,CDM,,,,,,both,,,688.7400,103.3100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,287.20,,,,,,,177.7600,688.7400,percent of total billed charges,41.7% of $688.74 in Billed Charges for Rev 272 = $287.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INJECT FOR COAPTITE 21GX37CM,272,RC,27200002,CDM,,,,,,both,,,688.7400,103.3100,CIGNA HEALTHCARE,CIGNA PPO,287.20,,,,,,,177.7600,688.7400,percent of total billed charges,41.7% of $688.74 in Billed Charges for Rev 272 = $287.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INJECT FOR COAPTITE 21GX37CM,272,RC,27200002,CDM,,,,,,both,,,688.7400,103.3100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,619.87,,,,,,,177.7600,688.7400,percent of total billed charges,90% of $688.74 in Billed Charges for Rev 272 = $619.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INJECT FOR COAPTITE 21GX37CM,272,RC,27200002,CDM,,,,,,both,,,688.7400,103.3100,MEDCOST,MEDCOST VHN,327.77,,,,,,,177.7600,688.7400,percent of total billed charges,47.59% of $688.74 in Billed Charges for Rev 272 = $327.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INJECT FOR COAPTITE 21GX37CM,272,RC,27200002,CDM,,,,,,both,,,688.7400,103.3100,SENTARA HEALTH,SENTARA HEALTH,177.76,,,,,,,177.7600,688.7400,percent of total billed charges,25.81% of $688.74 in Billed Charges for Rev 272 = $177.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INJECT FOR COAPTITE 21GX37CM,272,RC,27200002,CDM,,,,,,both,,,688.7400,103.3100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",688.74,,,,,,,177.7600,688.7400,percent of total billed charges,100% of $688.74 in Billed Charges for Rev 272 = $688.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INJECT FOR COAPTITE 21GX37CM,272,RC,27200002,CDM,,,,,,both,,,688.7400,103.3100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,344.37,,,,,,,177.7600,688.7400,percent of total billed charges,Rev 272 $688.74 in Billed Charges at 50% = $344.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INJECT FOR COAPTITE 21GX37CM,272,RC,27200002,CDM,,,,,,both,,,688.7400,103.3100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,222.46,,,,,,,177.7600,688.7400,other,32.3% of $688.74 in Billed Charges for Rev 272 = $222.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE INJECT FOR COAPTITE 21GX37CM,272,RC,27200002,CDM,,,,,,both,,,688.7400,103.3100,UNITED HEALTHCARE,UHC HERITAGE SELECT,211.44,,,,,,,177.7600,688.7400,other,30.7% of $688.74 in Billed Charges for Rev 272 = $211.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE INJECT FOR COAPTITE 21GX37CM,272,RC,27200002,CDM,,,,,,both,,,688.7400,103.3100,UNITED HEALTHCARE,UNITED HEALTHCARE,222.46,,,,,,,177.7600,688.7400,percent of total billed charges,32.3% of $688.74 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INJECT FOR COAPTITE 21GX37CM,272,RC,27200002,CDM,,,,,,both,,,688.7400,103.3100,WELLCARE,WELLCARE MEDICAID,688.74,,,,,,,177.7600,688.7400,percent of total billed charges,100% of $688.74 in Billed Charges for Rev 272 = $688.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S PALM PROTECTOR SPLINT,270,RC,27000243,CDM,,,,,,both,,,23.0000,3.4500,AETNA,AETNA,9.82,,,,,,,5.9400,23.0000,percent of total billed charges,42.7% of $23.00 in Billed Charges for Rev 270 = $9.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S PALM PROTECTOR SPLINT,270,RC,27000243,CDM,,,,,,both,,,23.0000,3.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,16.10,,,,,,,5.9400,23.0000,percent of total billed charges,Rev 270 $23.00 in Billed Charges at 70% = $16.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S PALM PROTECTOR SPLINT,270,RC,27000243,CDM,,,,,,both,,,23.0000,3.4500,CIGNA HEALTHCARE,CIGNA HMO,9.59,,,,,,,5.9400,23.0000,percent of total billed charges,41.7% of $23.00 in Billed Charges for Rev 270 = $9.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S PALM PROTECTOR SPLINT,270,RC,27000243,CDM,,,,,,both,,,23.0000,3.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10.67,,,,,,,5.9400,23.0000,percent of total billed charges,46.4% of $23.00 in Billed Charges for Rev 270 = $10.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S PALM PROTECTOR SPLINT,270,RC,27000243,CDM,,,,,,both,,,23.0000,3.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9.59,,,,,,,5.9400,23.0000,percent of total billed charges,41.7% of $23.00 in Billed Charges for Rev 270 = $9.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S PALM PROTECTOR SPLINT,270,RC,27000243,CDM,,,,,,both,,,23.0000,3.4500,CIGNA HEALTHCARE,CIGNA PPO,9.59,,,,,,,5.9400,23.0000,percent of total billed charges,41.7% of $23.00 in Billed Charges for Rev 270 = $9.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S PALM PROTECTOR SPLINT,270,RC,27000243,CDM,,,,,,both,,,23.0000,3.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,20.70,,,,,,,5.9400,23.0000,percent of total billed charges,90% of $23.00 in Billed Charges for Rev 270 = $20.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S PALM PROTECTOR SPLINT,270,RC,27000243,CDM,,,,,,both,,,23.0000,3.4500,MEDCOST,MEDCOST VHN,10.95,,,,,,,5.9400,23.0000,percent of total billed charges,47.59% of $23.00 in Billed Charges for Rev 270 = $10.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S PALM PROTECTOR SPLINT,270,RC,27000243,CDM,,,,,,both,,,23.0000,3.4500,SENTARA HEALTH,SENTARA HEALTH,5.94,,,,,,,5.9400,23.0000,percent of total billed charges,25.81% of $23.00 in Billed Charges for Rev 270 = $5.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S PALM PROTECTOR SPLINT,270,RC,27000243,CDM,,,,,,both,,,23.0000,3.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",23.00,,,,,,,5.9400,23.0000,percent of total billed charges,100% of $23.00 in Billed Charges for Rev 270 = $23.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S PALM PROTECTOR SPLINT,270,RC,27000243,CDM,,,,,,both,,,23.0000,3.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11.50,,,,,,,5.9400,23.0000,percent of total billed charges,Rev 270 $23.00 in Billed Charges at 50% = $11.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S PALM PROTECTOR SPLINT,270,RC,27000243,CDM,,,,,,both,,,23.0000,3.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7.43,,,,,,,5.9400,23.0000,other,32.3% of $23.00 in Billed Charges for Rev 270 = $7.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OT S PALM PROTECTOR SPLINT,270,RC,27000243,CDM,,,,,,both,,,23.0000,3.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7.06,,,,,,,5.9400,23.0000,other,30.7% of $23.00 in Billed Charges for Rev 270 = $7.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OT S PALM PROTECTOR SPLINT,270,RC,27000243,CDM,,,,,,both,,,23.0000,3.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,7.43,,,,,,,5.9400,23.0000,percent of total billed charges,32.3% of $23.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OT S PALM PROTECTOR SPLINT,270,RC,27000243,CDM,,,,,,both,,,23.0000,3.4500,WELLCARE,WELLCARE MEDICAID,23.00,,,,,,,5.9400,23.0000,percent of total billed charges,100% of $23.00 in Billed Charges for Rev 270 = $23.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC,270,RC,27000038,CDM,,,,,,both,,,70.0000,10.5000,AETNA,AETNA,29.89,,,,,,,18.0700,70.0000,percent of total billed charges,42.7% of $70.00 in Billed Charges for Rev 270 = $29.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC,270,RC,27000038,CDM,,,,,,both,,,70.0000,10.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,49.00,,,,,,,18.0700,70.0000,percent of total billed charges,Rev 270 $70.00 in Billed Charges at 70% = $49.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC,270,RC,27000038,CDM,,,,,,both,,,70.0000,10.5000,CIGNA HEALTHCARE,CIGNA HMO,29.19,,,,,,,18.0700,70.0000,percent of total billed charges,41.7% of $70.00 in Billed Charges for Rev 270 = $29.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC,270,RC,27000038,CDM,,,,,,both,,,70.0000,10.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,32.48,,,,,,,18.0700,70.0000,percent of total billed charges,46.4% of $70.00 in Billed Charges for Rev 270 = $32.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC,270,RC,27000038,CDM,,,,,,both,,,70.0000,10.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,29.19,,,,,,,18.0700,70.0000,percent of total billed charges,41.7% of $70.00 in Billed Charges for Rev 270 = $29.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC,270,RC,27000038,CDM,,,,,,both,,,70.0000,10.5000,CIGNA HEALTHCARE,CIGNA PPO,29.19,,,,,,,18.0700,70.0000,percent of total billed charges,41.7% of $70.00 in Billed Charges for Rev 270 = $29.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC,270,RC,27000038,CDM,,,,,,both,,,70.0000,10.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,63.00,,,,,,,18.0700,70.0000,percent of total billed charges,90% of $70.00 in Billed Charges for Rev 270 = $63.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC,270,RC,27000038,CDM,,,,,,both,,,70.0000,10.5000,MEDCOST,MEDCOST VHN,33.31,,,,,,,18.0700,70.0000,percent of total billed charges,47.59% of $70.00 in Billed Charges for Rev 270 = $33.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC,270,RC,27000038,CDM,,,,,,both,,,70.0000,10.5000,SENTARA HEALTH,SENTARA HEALTH,18.07,,,,,,,18.0700,70.0000,percent of total billed charges,25.81% of $70.00 in Billed Charges for Rev 270 = $18.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC,270,RC,27000038,CDM,,,,,,both,,,70.0000,10.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",70.00,,,,,,,18.0700,70.0000,percent of total billed charges,100% of $70.00 in Billed Charges for Rev 270 = $70.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC,270,RC,27000038,CDM,,,,,,both,,,70.0000,10.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,35.00,,,,,,,18.0700,70.0000,percent of total billed charges,Rev 270 $70.00 in Billed Charges at 50% = $35.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC,270,RC,27000038,CDM,,,,,,both,,,70.0000,10.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,22.61,,,,,,,18.0700,70.0000,other,32.3% of $70.00 in Billed Charges for Rev 270 = $22.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PACK BASIC,270,RC,27000038,CDM,,,,,,both,,,70.0000,10.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,21.49,,,,,,,18.0700,70.0000,other,30.7% of $70.00 in Billed Charges for Rev 270 = $21.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PACK BASIC,270,RC,27000038,CDM,,,,,,both,,,70.0000,10.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,22.61,,,,,,,18.0700,70.0000,percent of total billed charges,32.3% of $70.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC,270,RC,27000038,CDM,,,,,,both,,,70.0000,10.5000,WELLCARE,WELLCARE MEDICAID,70.00,,,,,,,18.0700,70.0000,percent of total billed charges,100% of $70.00 in Billed Charges for Rev 270 = $70.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC CARDIAC CATH.,272,RC,27200441,CDM,,,,,,both,,,365.0000,54.7500,AETNA,AETNA,155.86,,,,,,,94.2100,365.0000,percent of total billed charges,42.7% of $365.00 in Billed Charges for Rev 272 = $155.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC CARDIAC CATH.,272,RC,27200441,CDM,,,,,,both,,,365.0000,54.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,255.50,,,,,,,94.2100,365.0000,percent of total billed charges,Rev 272 $365.00 in Billed Charges at 70% = $255.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC CARDIAC CATH.,272,RC,27200441,CDM,,,,,,both,,,365.0000,54.7500,CIGNA HEALTHCARE,CIGNA HMO,152.21,,,,,,,94.2100,365.0000,percent of total billed charges,41.7% of $365.00 in Billed Charges for Rev 272 = $152.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC CARDIAC CATH.,272,RC,27200441,CDM,,,,,,both,,,365.0000,54.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,169.36,,,,,,,94.2100,365.0000,percent of total billed charges,46.4% of $365.00 in Billed Charges for Rev 272 = $169.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC CARDIAC CATH.,272,RC,27200441,CDM,,,,,,both,,,365.0000,54.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,152.21,,,,,,,94.2100,365.0000,percent of total billed charges,41.7% of $365.00 in Billed Charges for Rev 272 = $152.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC CARDIAC CATH.,272,RC,27200441,CDM,,,,,,both,,,365.0000,54.7500,CIGNA HEALTHCARE,CIGNA PPO,152.21,,,,,,,94.2100,365.0000,percent of total billed charges,41.7% of $365.00 in Billed Charges for Rev 272 = $152.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC CARDIAC CATH.,272,RC,27200441,CDM,,,,,,both,,,365.0000,54.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,328.50,,,,,,,94.2100,365.0000,percent of total billed charges,90% of $365.00 in Billed Charges for Rev 272 = $328.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC CARDIAC CATH.,272,RC,27200441,CDM,,,,,,both,,,365.0000,54.7500,MEDCOST,MEDCOST VHN,173.70,,,,,,,94.2100,365.0000,percent of total billed charges,47.59% of $365.00 in Billed Charges for Rev 272 = $173.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC CARDIAC CATH.,272,RC,27200441,CDM,,,,,,both,,,365.0000,54.7500,SENTARA HEALTH,SENTARA HEALTH,94.21,,,,,,,94.2100,365.0000,percent of total billed charges,25.81% of $365.00 in Billed Charges for Rev 272 = $94.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC CARDIAC CATH.,272,RC,27200441,CDM,,,,,,both,,,365.0000,54.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",365.00,,,,,,,94.2100,365.0000,percent of total billed charges,100% of $365.00 in Billed Charges for Rev 272 = $365.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC CARDIAC CATH.,272,RC,27200441,CDM,,,,,,both,,,365.0000,54.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,182.50,,,,,,,94.2100,365.0000,percent of total billed charges,Rev 272 $365.00 in Billed Charges at 50% = $182.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC CARDIAC CATH.,272,RC,27200441,CDM,,,,,,both,,,365.0000,54.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,117.90,,,,,,,94.2100,365.0000,other,32.3% of $365.00 in Billed Charges for Rev 272 = $117.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PACK BASIC CARDIAC CATH.,272,RC,27200441,CDM,,,,,,both,,,365.0000,54.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,112.06,,,,,,,94.2100,365.0000,other,30.7% of $365.00 in Billed Charges for Rev 272 = $112.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PACK BASIC CARDIAC CATH.,272,RC,27200441,CDM,,,,,,both,,,365.0000,54.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,117.90,,,,,,,94.2100,365.0000,percent of total billed charges,32.3% of $365.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK BASIC CARDIAC CATH.,272,RC,27200441,CDM,,,,,,both,,,365.0000,54.7500,WELLCARE,WELLCARE MEDICAID,365.00,,,,,,,94.2100,365.0000,percent of total billed charges,100% of $365.00 in Billed Charges for Rev 272 = $365.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 BEVEL TIP,272,RC,27200002,CDM,,,,,,both,,,805.8300,120.8700,AETNA,AETNA,344.09,,,,,,,207.9800,805.8300,percent of total billed charges,42.7% of $805.83 in Billed Charges for Rev 272 = $344.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 BEVEL TIP,272,RC,27200002,CDM,,,,,,both,,,805.8300,120.8700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,564.08,,,,,,,207.9800,805.8300,percent of total billed charges,Rev 272 $805.83 in Billed Charges at 70% = $564.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 BEVEL TIP,272,RC,27200002,CDM,,,,,,both,,,805.8300,120.8700,CIGNA HEALTHCARE,CIGNA HMO,336.03,,,,,,,207.9800,805.8300,percent of total billed charges,41.7% of $805.83 in Billed Charges for Rev 272 = $336.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 BEVEL TIP,272,RC,27200002,CDM,,,,,,both,,,805.8300,120.8700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,373.91,,,,,,,207.9800,805.8300,percent of total billed charges,46.4% of $805.83 in Billed Charges for Rev 272 = $373.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 BEVEL TIP,272,RC,27200002,CDM,,,,,,both,,,805.8300,120.8700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,336.03,,,,,,,207.9800,805.8300,percent of total billed charges,41.7% of $805.83 in Billed Charges for Rev 272 = $336.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 BEVEL TIP,272,RC,27200002,CDM,,,,,,both,,,805.8300,120.8700,CIGNA HEALTHCARE,CIGNA PPO,336.03,,,,,,,207.9800,805.8300,percent of total billed charges,41.7% of $805.83 in Billed Charges for Rev 272 = $336.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 BEVEL TIP,272,RC,27200002,CDM,,,,,,both,,,805.8300,120.8700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,725.25,,,,,,,207.9800,805.8300,percent of total billed charges,90% of $805.83 in Billed Charges for Rev 272 = $725.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 BEVEL TIP,272,RC,27200002,CDM,,,,,,both,,,805.8300,120.8700,MEDCOST,MEDCOST VHN,383.49,,,,,,,207.9800,805.8300,percent of total billed charges,47.59% of $805.83 in Billed Charges for Rev 272 = $383.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 BEVEL TIP,272,RC,27200002,CDM,,,,,,both,,,805.8300,120.8700,SENTARA HEALTH,SENTARA HEALTH,207.98,,,,,,,207.9800,805.8300,percent of total billed charges,25.81% of $805.83 in Billed Charges for Rev 272 = $207.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 BEVEL TIP,272,RC,27200002,CDM,,,,,,both,,,805.8300,120.8700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",805.83,,,,,,,207.9800,805.8300,percent of total billed charges,100% of $805.83 in Billed Charges for Rev 272 = $805.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 BEVEL TIP,272,RC,27200002,CDM,,,,,,both,,,805.8300,120.8700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,402.92,,,,,,,207.9800,805.8300,percent of total billed charges,Rev 272 $805.83 in Billed Charges at 50% = $402.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 BEVEL TIP,272,RC,27200002,CDM,,,,,,both,,,805.8300,120.8700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,260.28,,,,,,,207.9800,805.8300,other,32.3% of $805.83 in Billed Charges for Rev 272 = $260.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE PAK 2 BEVEL TIP,272,RC,27200002,CDM,,,,,,both,,,805.8300,120.8700,UNITED HEALTHCARE,UHC HERITAGE SELECT,247.39,,,,,,,207.9800,805.8300,other,30.7% of $805.83 in Billed Charges for Rev 272 = $247.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE PAK 2 BEVEL TIP,272,RC,27200002,CDM,,,,,,both,,,805.8300,120.8700,UNITED HEALTHCARE,UNITED HEALTHCARE,260.28,,,,,,,207.9800,805.8300,percent of total billed charges,32.3% of $805.83 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 BEVEL TIP,272,RC,27200002,CDM,,,,,,both,,,805.8300,120.8700,WELLCARE,WELLCARE MEDICAID,805.83,,,,,,,207.9800,805.8300,percent of total billed charges,100% of $805.83 in Billed Charges for Rev 272 = $805.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK EXTREMITY LATEX FREE,272,RC,27200976,CDM,,,,,,both,,,393.0000,58.9500,AETNA,AETNA,167.81,,,,,,,101.4300,393.0000,percent of total billed charges,42.7% of $393.00 in Billed Charges for Rev 272 = $167.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK EXTREMITY LATEX FREE,272,RC,27200976,CDM,,,,,,both,,,393.0000,58.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,275.10,,,,,,,101.4300,393.0000,percent of total billed charges,Rev 272 $393.00 in Billed Charges at 70% = $275.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK EXTREMITY LATEX FREE,272,RC,27200976,CDM,,,,,,both,,,393.0000,58.9500,CIGNA HEALTHCARE,CIGNA HMO,163.88,,,,,,,101.4300,393.0000,percent of total billed charges,41.7% of $393.00 in Billed Charges for Rev 272 = $163.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK EXTREMITY LATEX FREE,272,RC,27200976,CDM,,,,,,both,,,393.0000,58.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,182.35,,,,,,,101.4300,393.0000,percent of total billed charges,46.4% of $393.00 in Billed Charges for Rev 272 = $182.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK EXTREMITY LATEX FREE,272,RC,27200976,CDM,,,,,,both,,,393.0000,58.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,163.88,,,,,,,101.4300,393.0000,percent of total billed charges,41.7% of $393.00 in Billed Charges for Rev 272 = $163.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK EXTREMITY LATEX FREE,272,RC,27200976,CDM,,,,,,both,,,393.0000,58.9500,CIGNA HEALTHCARE,CIGNA PPO,163.88,,,,,,,101.4300,393.0000,percent of total billed charges,41.7% of $393.00 in Billed Charges for Rev 272 = $163.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK EXTREMITY LATEX FREE,272,RC,27200976,CDM,,,,,,both,,,393.0000,58.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,353.70,,,,,,,101.4300,393.0000,percent of total billed charges,90% of $393.00 in Billed Charges for Rev 272 = $353.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK EXTREMITY LATEX FREE,272,RC,27200976,CDM,,,,,,both,,,393.0000,58.9500,MEDCOST,MEDCOST VHN,187.03,,,,,,,101.4300,393.0000,percent of total billed charges,47.59% of $393.00 in Billed Charges for Rev 272 = $187.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK EXTREMITY LATEX FREE,272,RC,27200976,CDM,,,,,,both,,,393.0000,58.9500,SENTARA HEALTH,SENTARA HEALTH,101.43,,,,,,,101.4300,393.0000,percent of total billed charges,25.81% of $393.00 in Billed Charges for Rev 272 = $101.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK EXTREMITY LATEX FREE,272,RC,27200976,CDM,,,,,,both,,,393.0000,58.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",393.00,,,,,,,101.4300,393.0000,percent of total billed charges,100% of $393.00 in Billed Charges for Rev 272 = $393.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK EXTREMITY LATEX FREE,272,RC,27200976,CDM,,,,,,both,,,393.0000,58.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,196.50,,,,,,,101.4300,393.0000,percent of total billed charges,Rev 272 $393.00 in Billed Charges at 50% = $196.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK EXTREMITY LATEX FREE,272,RC,27200976,CDM,,,,,,both,,,393.0000,58.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,126.94,,,,,,,101.4300,393.0000,other,32.3% of $393.00 in Billed Charges for Rev 272 = $126.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PACK EXTREMITY LATEX FREE,272,RC,27200976,CDM,,,,,,both,,,393.0000,58.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,120.65,,,,,,,101.4300,393.0000,other,30.7% of $393.00 in Billed Charges for Rev 272 = $120.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PACK EXTREMITY LATEX FREE,272,RC,27200976,CDM,,,,,,both,,,393.0000,58.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,126.94,,,,,,,101.4300,393.0000,percent of total billed charges,32.3% of $393.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK EXTREMITY LATEX FREE,272,RC,27200976,CDM,,,,,,both,,,393.0000,58.9500,WELLCARE,WELLCARE MEDICAID,393.00,,,,,,,101.4300,393.0000,percent of total billed charges,100% of $393.00 in Billed Charges for Rev 272 = $393.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK LAPAROTOMY MAJOR,272,RC,27200978,CDM,,,,,,both,,,371.0000,55.6500,AETNA,AETNA,158.42,,,,,,,95.7600,371.0000,percent of total billed charges,42.7% of $371.00 in Billed Charges for Rev 272 = $158.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK LAPAROTOMY MAJOR,272,RC,27200978,CDM,,,,,,both,,,371.0000,55.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,259.70,,,,,,,95.7600,371.0000,percent of total billed charges,Rev 272 $371.00 in Billed Charges at 70% = $259.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK LAPAROTOMY MAJOR,272,RC,27200978,CDM,,,,,,both,,,371.0000,55.6500,CIGNA HEALTHCARE,CIGNA HMO,154.71,,,,,,,95.7600,371.0000,percent of total billed charges,41.7% of $371.00 in Billed Charges for Rev 272 = $154.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK LAPAROTOMY MAJOR,272,RC,27200978,CDM,,,,,,both,,,371.0000,55.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,172.14,,,,,,,95.7600,371.0000,percent of total billed charges,46.4% of $371.00 in Billed Charges for Rev 272 = $172.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK LAPAROTOMY MAJOR,272,RC,27200978,CDM,,,,,,both,,,371.0000,55.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,154.71,,,,,,,95.7600,371.0000,percent of total billed charges,41.7% of $371.00 in Billed Charges for Rev 272 = $154.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK LAPAROTOMY MAJOR,272,RC,27200978,CDM,,,,,,both,,,371.0000,55.6500,CIGNA HEALTHCARE,CIGNA PPO,154.71,,,,,,,95.7600,371.0000,percent of total billed charges,41.7% of $371.00 in Billed Charges for Rev 272 = $154.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK LAPAROTOMY MAJOR,272,RC,27200978,CDM,,,,,,both,,,371.0000,55.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,333.90,,,,,,,95.7600,371.0000,percent of total billed charges,90% of $371.00 in Billed Charges for Rev 272 = $333.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK LAPAROTOMY MAJOR,272,RC,27200978,CDM,,,,,,both,,,371.0000,55.6500,MEDCOST,MEDCOST VHN,176.56,,,,,,,95.7600,371.0000,percent of total billed charges,47.59% of $371.00 in Billed Charges for Rev 272 = $176.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK LAPAROTOMY MAJOR,272,RC,27200978,CDM,,,,,,both,,,371.0000,55.6500,SENTARA HEALTH,SENTARA HEALTH,95.76,,,,,,,95.7600,371.0000,percent of total billed charges,25.81% of $371.00 in Billed Charges for Rev 272 = $95.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK LAPAROTOMY MAJOR,272,RC,27200978,CDM,,,,,,both,,,371.0000,55.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",371.00,,,,,,,95.7600,371.0000,percent of total billed charges,100% of $371.00 in Billed Charges for Rev 272 = $371.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK LAPAROTOMY MAJOR,272,RC,27200978,CDM,,,,,,both,,,371.0000,55.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,185.50,,,,,,,95.7600,371.0000,percent of total billed charges,Rev 272 $371.00 in Billed Charges at 50% = $185.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK LAPAROTOMY MAJOR,272,RC,27200978,CDM,,,,,,both,,,371.0000,55.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,119.83,,,,,,,95.7600,371.0000,other,32.3% of $371.00 in Billed Charges for Rev 272 = $119.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PACK LAPAROTOMY MAJOR,272,RC,27200978,CDM,,,,,,both,,,371.0000,55.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,113.90,,,,,,,95.7600,371.0000,other,30.7% of $371.00 in Billed Charges for Rev 272 = $113.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PACK LAPAROTOMY MAJOR,272,RC,27200978,CDM,,,,,,both,,,371.0000,55.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,119.83,,,,,,,95.7600,371.0000,percent of total billed charges,32.3% of $371.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK LAPAROTOMY MAJOR,272,RC,27200978,CDM,,,,,,both,,,371.0000,55.6500,WELLCARE,WELLCARE MEDICAID,371.00,,,,,,,95.7600,371.0000,percent of total billed charges,100% of $371.00 in Billed Charges for Rev 272 = $371.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK MAJOR ABDOMINAL DYNJ24048A,272,RC,27200979,CDM,,,,,,both,,,342.0000,51.3000,AETNA,AETNA,146.03,,,,,,,88.2700,342.0000,percent of total billed charges,42.7% of $342.00 in Billed Charges for Rev 272 = $146.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK MAJOR ABDOMINAL DYNJ24048A,272,RC,27200979,CDM,,,,,,both,,,342.0000,51.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,239.40,,,,,,,88.2700,342.0000,percent of total billed charges,Rev 272 $342.00 in Billed Charges at 70% = $239.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK MAJOR ABDOMINAL DYNJ24048A,272,RC,27200979,CDM,,,,,,both,,,342.0000,51.3000,CIGNA HEALTHCARE,CIGNA HMO,142.61,,,,,,,88.2700,342.0000,percent of total billed charges,41.7% of $342.00 in Billed Charges for Rev 272 = $142.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK MAJOR ABDOMINAL DYNJ24048A,272,RC,27200979,CDM,,,,,,both,,,342.0000,51.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,158.69,,,,,,,88.2700,342.0000,percent of total billed charges,46.4% of $342.00 in Billed Charges for Rev 272 = $158.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK MAJOR ABDOMINAL DYNJ24048A,272,RC,27200979,CDM,,,,,,both,,,342.0000,51.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,142.61,,,,,,,88.2700,342.0000,percent of total billed charges,41.7% of $342.00 in Billed Charges for Rev 272 = $142.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK MAJOR ABDOMINAL DYNJ24048A,272,RC,27200979,CDM,,,,,,both,,,342.0000,51.3000,CIGNA HEALTHCARE,CIGNA PPO,142.61,,,,,,,88.2700,342.0000,percent of total billed charges,41.7% of $342.00 in Billed Charges for Rev 272 = $142.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK MAJOR ABDOMINAL DYNJ24048A,272,RC,27200979,CDM,,,,,,both,,,342.0000,51.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,307.80,,,,,,,88.2700,342.0000,percent of total billed charges,90% of $342.00 in Billed Charges for Rev 272 = $307.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK MAJOR ABDOMINAL DYNJ24048A,272,RC,27200979,CDM,,,,,,both,,,342.0000,51.3000,MEDCOST,MEDCOST VHN,162.76,,,,,,,88.2700,342.0000,percent of total billed charges,47.59% of $342.00 in Billed Charges for Rev 272 = $162.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK MAJOR ABDOMINAL DYNJ24048A,272,RC,27200979,CDM,,,,,,both,,,342.0000,51.3000,SENTARA HEALTH,SENTARA HEALTH,88.27,,,,,,,88.2700,342.0000,percent of total billed charges,25.81% of $342.00 in Billed Charges for Rev 272 = $88.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK MAJOR ABDOMINAL DYNJ24048A,272,RC,27200979,CDM,,,,,,both,,,342.0000,51.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",342.00,,,,,,,88.2700,342.0000,percent of total billed charges,100% of $342.00 in Billed Charges for Rev 272 = $342.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK MAJOR ABDOMINAL DYNJ24048A,272,RC,27200979,CDM,,,,,,both,,,342.0000,51.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,171.00,,,,,,,88.2700,342.0000,percent of total billed charges,Rev 272 $342.00 in Billed Charges at 50% = $171.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK MAJOR ABDOMINAL DYNJ24048A,272,RC,27200979,CDM,,,,,,both,,,342.0000,51.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,110.47,,,,,,,88.2700,342.0000,other,32.3% of $342.00 in Billed Charges for Rev 272 = $110.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PACK MAJOR ABDOMINAL DYNJ24048A,272,RC,27200979,CDM,,,,,,both,,,342.0000,51.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,104.99,,,,,,,88.2700,342.0000,other,30.7% of $342.00 in Billed Charges for Rev 272 = $104.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PACK MAJOR ABDOMINAL DYNJ24048A,272,RC,27200979,CDM,,,,,,both,,,342.0000,51.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,110.47,,,,,,,88.2700,342.0000,percent of total billed charges,32.3% of $342.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PACK MAJOR ABDOMINAL DYNJ24048A,272,RC,27200979,CDM,,,,,,both,,,342.0000,51.3000,WELLCARE,WELLCARE MEDICAID,342.00,,,,,,,88.2700,342.0000,percent of total billed charges,100% of $342.00 in Billed Charges for Rev 272 = $342.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPACER VERTEBRAL 50 X 18X  7MM 38-1850-7,278,RC,27801485,CDM,,,,,,both,,,14596.0000,2189.4000,AETNA,AETNA,7006.08,,,,,,,1036.3200,14596.0000,percent of total billed charges,"48% of $14,596.00 in Billed Charges for Rev 278 = $7,006.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SPACER VERTEBRAL 50 X 18X  7MM 38-1850-7,278,RC,27801485,CDM,,,,,,both,,,14596.0000,2189.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7298.00,,,,,,,1036.3200,14596.0000,percent of total billed charges,"50% of $14,596.00 in Billed Charges for Rev 278 = $7,298.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SPACER VERTEBRAL 50 X 18X  7MM 38-1850-7,278,RC,27801485,CDM,,,,,,both,,,14596.0000,2189.4000,CIGNA HEALTHCARE,CIGNA HMO,6086.53,,,,,,,1036.3200,14596.0000,percent of total billed charges,"41.7% of $14,596.00 in Billed Charges for Rev 278 = $6,086.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SPACER VERTEBRAL 50 X 18X  7MM 38-1850-7,278,RC,27801485,CDM,,,,,,both,,,14596.0000,2189.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5838.40,,,,,,,1036.3200,14596.0000,percent of total billed charges,"40% of $14,596.00 in Billed Charges for Rev 278 = $5,838.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SPACER VERTEBRAL 50 X 18X  7MM 38-1850-7,278,RC,27801485,CDM,,,,,,both,,,14596.0000,2189.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6086.53,,,,,,,1036.3200,14596.0000,percent of total billed charges,"41.7% of $14,596.00 in Billed Charges for Rev 278 = $6,086.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SPACER VERTEBRAL 50 X 18X  7MM 38-1850-7,278,RC,27801485,CDM,,,,,,both,,,14596.0000,2189.4000,CIGNA HEALTHCARE,CIGNA PPO,6086.53,,,,,,,1036.3200,14596.0000,percent of total billed charges,"41.7% of $14,596.00 in Billed Charges for Rev 278 = $6,086.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SPACER VERTEBRAL 50 X 18X  7MM 38-1850-7,278,RC,27801485,CDM,,,,,,both,,,14596.0000,2189.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13136.40,,,,,,,1036.3200,14596.0000,percent of total billed charges,"90% of $14,596.00 in Billed Charges for Rev 278 = $13,136.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SPACER VERTEBRAL 50 X 18X  7MM 38-1850-7,278,RC,27801485,CDM,,,,,,both,,,14596.0000,2189.4000,MEDCOST,MEDCOST VHN,6946.24,,,,,,,1036.3200,14596.0000,percent of total billed charges,"47.59% of $14,596.00 in Billed Charges for Rev 278 = $6,946.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SPACER VERTEBRAL 50 X 18X  7MM 38-1850-7,278,RC,27801485,CDM,,,,,,both,,,14596.0000,2189.4000,SENTARA HEALTH,SENTARA HEALTH,3767.23,,,,,,,1036.3200,14596.0000,percent of total billed charges,"25.81% of $14,596.00 in Billed Charges for Rev 278 = $3,767.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SPACER VERTEBRAL 50 X 18X  7MM 38-1850-7,278,RC,27801485,CDM,,,,,,both,,,14596.0000,2189.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",14596.00,,,,,,,1036.3200,14596.0000,percent of total billed charges,"100% of $14,596.00 in Billed Charges for Rev 278 = $14,596.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SPACER VERTEBRAL 50 X 18X  7MM 38-1850-7,278,RC,27801485,CDM,,,,,,both,,,14596.0000,2189.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7298.00,,,,,,,1036.3200,14596.0000,percent of total billed charges,"Rev 278 $14,596.00 in Billed Charges at 50% = $7,298.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SPACER VERTEBRAL 50 X 18X  7MM 38-1850-7,278,RC,27801485,CDM,,,,,,both,,,14596.0000,2189.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1094.70,,,,,,,1036.3200,14596.0000,percent of total billed charges,"7.5% of $14,596.00 in Billed Charges for Rev 278 = $1,094.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SPACER VERTEBRAL 50 X 18X  7MM 38-1850-7,278,RC,27801485,CDM,,,,,,both,,,14596.0000,2189.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1036.32,,,,,,,1036.3200,14596.0000,percent of total billed charges,"7.1% of $14,596.00 in Billed Charges for Rev 278 = $1,036.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SPACER VERTEBRAL 50 X 18X  7MM 38-1850-7,278,RC,27801485,CDM,,,,,,both,,,14596.0000,2189.4000,WELLCARE,WELLCARE MEDICAID,14596.00,,,,,,,1036.3200,14596.0000,percent of total billed charges,"100% of $14,596.00 in Billed Charges for Rev 278 = $14,596.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE PAK 2 TROCAR TIP,272,RC,,,,,,,,both,,,940.1300,141.0200,AETNA,AETNA,401.44,,,,,,,242.6500,940.1300,percent of total billed charges,42.7% of $940.13 in Billed Charges for Rev 272 = $401.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 TROCAR TIP,272,RC,,,,,,,,both,,,940.1300,141.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,658.09,,,,,,,242.6500,940.1300,percent of total billed charges,Rev 272 $940.13 in Billed Charges at 70% = $658.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 TROCAR TIP,272,RC,,,,,,,,both,,,940.1300,141.0200,CIGNA HEALTHCARE,CIGNA HMO,392.03,,,,,,,242.6500,940.1300,percent of total billed charges,41.7% of $940.13 in Billed Charges for Rev 272 = $392.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 TROCAR TIP,272,RC,,,,,,,,both,,,940.1300,141.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,436.22,,,,,,,242.6500,940.1300,percent of total billed charges,46.4% of $940.13 in Billed Charges for Rev 272 = $436.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 TROCAR TIP,272,RC,,,,,,,,both,,,940.1300,141.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,392.03,,,,,,,242.6500,940.1300,percent of total billed charges,41.7% of $940.13 in Billed Charges for Rev 272 = $392.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 TROCAR TIP,272,RC,,,,,,,,both,,,940.1300,141.0200,CIGNA HEALTHCARE,CIGNA PPO,392.03,,,,,,,242.6500,940.1300,percent of total billed charges,41.7% of $940.13 in Billed Charges for Rev 272 = $392.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 TROCAR TIP,272,RC,,,,,,,,both,,,940.1300,141.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,846.12,,,,,,,242.6500,940.1300,percent of total billed charges,90% of $940.13 in Billed Charges for Rev 272 = $846.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 TROCAR TIP,272,RC,,,,,,,,both,,,940.1300,141.0200,MEDCOST,MEDCOST VHN,447.41,,,,,,,242.6500,940.1300,percent of total billed charges,47.59% of $940.13 in Billed Charges for Rev 272 = $447.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 TROCAR TIP,272,RC,,,,,,,,both,,,940.1300,141.0200,SENTARA HEALTH,SENTARA HEALTH,242.65,,,,,,,242.6500,940.1300,percent of total billed charges,25.81% of $940.13 in Billed Charges for Rev 272 = $242.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 TROCAR TIP,272,RC,,,,,,,,both,,,940.1300,141.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",940.13,,,,,,,242.6500,940.1300,percent of total billed charges,100% of $940.13 in Billed Charges for Rev 272 = $940.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 TROCAR TIP,272,RC,,,,,,,,both,,,940.1300,141.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,470.07,,,,,,,242.6500,940.1300,percent of total billed charges,Rev 272 $940.13 in Billed Charges at 50% = $470.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 TROCAR TIP,272,RC,,,,,,,,both,,,940.1300,141.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,303.66,,,,,,,242.6500,940.1300,other,32.3% of $940.13 in Billed Charges for Rev 272 = $303.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE PAK 2 TROCAR TIP,272,RC,,,,,,,,both,,,940.1300,141.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,288.62,,,,,,,242.6500,940.1300,other,30.7% of $940.13 in Billed Charges for Rev 272 = $288.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE PAK 2 TROCAR TIP,272,RC,,,,,,,,both,,,940.1300,141.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,303.66,,,,,,,242.6500,940.1300,percent of total billed charges,32.3% of $940.13 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE PAK 2 TROCAR TIP,272,RC,,,,,,,,both,,,940.1300,141.0200,WELLCARE,WELLCARE MEDICAID,940.13,,,,,,,242.6500,940.1300,percent of total billed charges,100% of $940.13 in Billed Charges for Rev 272 = $940.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SAFETY HYPODERMIC 21GA X 1 1/2IN GREEN MONOJECT,270,RC,,,,,,,,both,,,1591.2200,238.6800,AETNA,AETNA,679.45,,,,,,,410.6900,1591.2200,percent of total billed charges,"42.7% of $1,591.22 in Billed Charges for Rev 270 = $679.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SAFETY HYPODERMIC 21GA X 1 1/2IN GREEN MONOJECT,270,RC,,,,,,,,both,,,1591.2200,238.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1113.85,,,,,,,410.6900,1591.2200,percent of total billed charges,"Rev 270 $1,591.22 in Billed Charges at 70% = $1,113.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SAFETY HYPODERMIC 21GA X 1 1/2IN GREEN MONOJECT,270,RC,,,,,,,,both,,,1591.2200,238.6800,CIGNA HEALTHCARE,CIGNA HMO,663.54,,,,,,,410.6900,1591.2200,percent of total billed charges,"41.7% of $1,591.22 in Billed Charges for Rev 270 = $663.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SAFETY HYPODERMIC 21GA X 1 1/2IN GREEN MONOJECT,270,RC,,,,,,,,both,,,1591.2200,238.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,738.33,,,,,,,410.6900,1591.2200,percent of total billed charges,"46.4% of $1,591.22 in Billed Charges for Rev 270 = $738.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SAFETY HYPODERMIC 21GA X 1 1/2IN GREEN MONOJECT,270,RC,,,,,,,,both,,,1591.2200,238.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,663.54,,,,,,,410.6900,1591.2200,percent of total billed charges,"41.7% of $1,591.22 in Billed Charges for Rev 270 = $663.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SAFETY HYPODERMIC 21GA X 1 1/2IN GREEN MONOJECT,270,RC,,,,,,,,both,,,1591.2200,238.6800,CIGNA HEALTHCARE,CIGNA PPO,663.54,,,,,,,410.6900,1591.2200,percent of total billed charges,"41.7% of $1,591.22 in Billed Charges for Rev 270 = $663.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SAFETY HYPODERMIC 21GA X 1 1/2IN GREEN MONOJECT,270,RC,,,,,,,,both,,,1591.2200,238.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1432.10,,,,,,,410.6900,1591.2200,percent of total billed charges,"90% of $1,591.22 in Billed Charges for Rev 270 = $1,432.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SAFETY HYPODERMIC 21GA X 1 1/2IN GREEN MONOJECT,270,RC,,,,,,,,both,,,1591.2200,238.6800,MEDCOST,MEDCOST VHN,757.26,,,,,,,410.6900,1591.2200,percent of total billed charges,"47.59% of $1,591.22 in Billed Charges for Rev 270 = $757.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SAFETY HYPODERMIC 21GA X 1 1/2IN GREEN MONOJECT,270,RC,,,,,,,,both,,,1591.2200,238.6800,SENTARA HEALTH,SENTARA HEALTH,410.69,,,,,,,410.6900,1591.2200,percent of total billed charges,"25.81% of $1,591.22 in Billed Charges for Rev 270 = $410.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SAFETY HYPODERMIC 21GA X 1 1/2IN GREEN MONOJECT,270,RC,,,,,,,,both,,,1591.2200,238.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1591.22,,,,,,,410.6900,1591.2200,percent of total billed charges,"100% of $1,591.22 in Billed Charges for Rev 270 = $1,591.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SAFETY HYPODERMIC 21GA X 1 1/2IN GREEN MONOJECT,270,RC,,,,,,,,both,,,1591.2200,238.6800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,795.61,,,,,,,410.6900,1591.2200,percent of total billed charges,"Rev 270 $1,591.22 in Billed Charges at 50% = $795.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SAFETY HYPODERMIC 21GA X 1 1/2IN GREEN MONOJECT,270,RC,,,,,,,,both,,,1591.2200,238.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,513.96,,,,,,,410.6900,1591.2200,other,"32.3% of $1,591.22 in Billed Charges for Rev 270 = $513.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE SAFETY HYPODERMIC 21GA X 1 1/2IN GREEN MONOJECT,270,RC,,,,,,,,both,,,1591.2200,238.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,488.50,,,,,,,410.6900,1591.2200,other,"30.7% of $1,591.22 in Billed Charges for Rev 270 = $488.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE SAFETY HYPODERMIC 21GA X 1 1/2IN GREEN MONOJECT,270,RC,,,,,,,,both,,,1591.2200,238.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,513.96,,,,,,,410.6900,1591.2200,percent of total billed charges,"32.3% of $1,591.22 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SAFETY HYPODERMIC 21GA X 1 1/2IN GREEN MONOJECT,270,RC,,,,,,,,both,,,1591.2200,238.6800,WELLCARE,WELLCARE MEDICAID,1591.22,,,,,,,410.6900,1591.2200,percent of total billed charges,"100% of $1,591.22 in Billed Charges for Rev 270 = $1,591.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH EXTERNAL REFERENCE CARTO 3 SYSTEM,272,RC,27200002,CDM,,,,,,both,,,4034.3200,605.1500,AETNA,AETNA,1722.65,,,,,,,1041.2600,4034.3200,percent of total billed charges,"42.7% of $4,034.32 in Billed Charges for Rev 272 = $1,722.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH EXTERNAL REFERENCE CARTO 3 SYSTEM,272,RC,27200002,CDM,,,,,,both,,,4034.3200,605.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2824.02,,,,,,,1041.2600,4034.3200,percent of total billed charges,"Rev 272 $4,034.32 in Billed Charges at 70% = $2,824.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH EXTERNAL REFERENCE CARTO 3 SYSTEM,272,RC,27200002,CDM,,,,,,both,,,4034.3200,605.1500,CIGNA HEALTHCARE,CIGNA HMO,1682.31,,,,,,,1041.2600,4034.3200,percent of total billed charges,"41.7% of $4,034.32 in Billed Charges for Rev 272 = $1,682.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH EXTERNAL REFERENCE CARTO 3 SYSTEM,272,RC,27200002,CDM,,,,,,both,,,4034.3200,605.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1871.92,,,,,,,1041.2600,4034.3200,percent of total billed charges,"46.4% of $4,034.32 in Billed Charges for Rev 272 = $1,871.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH EXTERNAL REFERENCE CARTO 3 SYSTEM,272,RC,27200002,CDM,,,,,,both,,,4034.3200,605.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1682.31,,,,,,,1041.2600,4034.3200,percent of total billed charges,"41.7% of $4,034.32 in Billed Charges for Rev 272 = $1,682.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH EXTERNAL REFERENCE CARTO 3 SYSTEM,272,RC,27200002,CDM,,,,,,both,,,4034.3200,605.1500,CIGNA HEALTHCARE,CIGNA PPO,1682.31,,,,,,,1041.2600,4034.3200,percent of total billed charges,"41.7% of $4,034.32 in Billed Charges for Rev 272 = $1,682.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH EXTERNAL REFERENCE CARTO 3 SYSTEM,272,RC,27200002,CDM,,,,,,both,,,4034.3200,605.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3630.89,,,,,,,1041.2600,4034.3200,percent of total billed charges,"90% of $4,034.32 in Billed Charges for Rev 272 = $3,630.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH EXTERNAL REFERENCE CARTO 3 SYSTEM,272,RC,27200002,CDM,,,,,,both,,,4034.3200,605.1500,MEDCOST,MEDCOST VHN,1919.93,,,,,,,1041.2600,4034.3200,percent of total billed charges,"47.59% of $4,034.32 in Billed Charges for Rev 272 = $1,919.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH EXTERNAL REFERENCE CARTO 3 SYSTEM,272,RC,27200002,CDM,,,,,,both,,,4034.3200,605.1500,SENTARA HEALTH,SENTARA HEALTH,1041.26,,,,,,,1041.2600,4034.3200,percent of total billed charges,"25.81% of $4,034.32 in Billed Charges for Rev 272 = $1,041.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH EXTERNAL REFERENCE CARTO 3 SYSTEM,272,RC,27200002,CDM,,,,,,both,,,4034.3200,605.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4034.32,,,,,,,1041.2600,4034.3200,percent of total billed charges,"100% of $4,034.32 in Billed Charges for Rev 272 = $4,034.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH EXTERNAL REFERENCE CARTO 3 SYSTEM,272,RC,27200002,CDM,,,,,,both,,,4034.3200,605.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2017.16,,,,,,,1041.2600,4034.3200,percent of total billed charges,"Rev 272 $4,034.32 in Billed Charges at 50% = $2,017.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH EXTERNAL REFERENCE CARTO 3 SYSTEM,272,RC,27200002,CDM,,,,,,both,,,4034.3200,605.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1303.09,,,,,,,1041.2600,4034.3200,other,"32.3% of $4,034.32 in Billed Charges for Rev 272 = $1,303.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PATCH EXTERNAL REFERENCE CARTO 3 SYSTEM,272,RC,27200002,CDM,,,,,,both,,,4034.3200,605.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1238.54,,,,,,,1041.2600,4034.3200,other,"30.7% of $4,034.32 in Billed Charges for Rev 272 = $1,238.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PATCH EXTERNAL REFERENCE CARTO 3 SYSTEM,272,RC,27200002,CDM,,,,,,both,,,4034.3200,605.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,1303.09,,,,,,,1041.2600,4034.3200,percent of total billed charges,"32.3% of $4,034.32 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH EXTERNAL REFERENCE CARTO 3 SYSTEM,272,RC,27200002,CDM,,,,,,both,,,4034.3200,605.1500,WELLCARE,WELLCARE MEDICAID,4034.32,,,,,,,1041.2600,4034.3200,percent of total billed charges,"100% of $4,034.32 in Billed Charges for Rev 272 = $4,034.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SPLINT ORTHO GLASS 5INX15FT,272,RC,27202284,CDM,,,,,,both,,,669.0000,100.3500,AETNA,AETNA,285.66,,,,,,,172.6700,669.0000,percent of total billed charges,42.7% of $669.00 in Billed Charges for Rev 272 = $285.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT ORTHO GLASS 5INX15FT,272,RC,27202284,CDM,,,,,,both,,,669.0000,100.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,468.30,,,,,,,172.6700,669.0000,percent of total billed charges,Rev 272 $669.00 in Billed Charges at 70% = $468.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT ORTHO GLASS 5INX15FT,272,RC,27202284,CDM,,,,,,both,,,669.0000,100.3500,CIGNA HEALTHCARE,CIGNA HMO,278.97,,,,,,,172.6700,669.0000,percent of total billed charges,41.7% of $669.00 in Billed Charges for Rev 272 = $278.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT ORTHO GLASS 5INX15FT,272,RC,27202284,CDM,,,,,,both,,,669.0000,100.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,310.42,,,,,,,172.6700,669.0000,percent of total billed charges,46.4% of $669.00 in Billed Charges for Rev 272 = $310.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT ORTHO GLASS 5INX15FT,272,RC,27202284,CDM,,,,,,both,,,669.0000,100.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,278.97,,,,,,,172.6700,669.0000,percent of total billed charges,41.7% of $669.00 in Billed Charges for Rev 272 = $278.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT ORTHO GLASS 5INX15FT,272,RC,27202284,CDM,,,,,,both,,,669.0000,100.3500,CIGNA HEALTHCARE,CIGNA PPO,278.97,,,,,,,172.6700,669.0000,percent of total billed charges,41.7% of $669.00 in Billed Charges for Rev 272 = $278.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT ORTHO GLASS 5INX15FT,272,RC,27202284,CDM,,,,,,both,,,669.0000,100.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,602.10,,,,,,,172.6700,669.0000,percent of total billed charges,90% of $669.00 in Billed Charges for Rev 272 = $602.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT ORTHO GLASS 5INX15FT,272,RC,27202284,CDM,,,,,,both,,,669.0000,100.3500,MEDCOST,MEDCOST VHN,318.38,,,,,,,172.6700,669.0000,percent of total billed charges,47.59% of $669.00 in Billed Charges for Rev 272 = $318.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT ORTHO GLASS 5INX15FT,272,RC,27202284,CDM,,,,,,both,,,669.0000,100.3500,SENTARA HEALTH,SENTARA HEALTH,172.67,,,,,,,172.6700,669.0000,percent of total billed charges,25.81% of $669.00 in Billed Charges for Rev 272 = $172.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT ORTHO GLASS 5INX15FT,272,RC,27202284,CDM,,,,,,both,,,669.0000,100.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",669.00,,,,,,,172.6700,669.0000,percent of total billed charges,100% of $669.00 in Billed Charges for Rev 272 = $669.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT ORTHO GLASS 5INX15FT,272,RC,27202284,CDM,,,,,,both,,,669.0000,100.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,334.50,,,,,,,172.6700,669.0000,percent of total billed charges,Rev 272 $669.00 in Billed Charges at 50% = $334.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT ORTHO GLASS 5INX15FT,272,RC,27202284,CDM,,,,,,both,,,669.0000,100.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,216.09,,,,,,,172.6700,669.0000,other,32.3% of $669.00 in Billed Charges for Rev 272 = $216.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPLINT ORTHO GLASS 5INX15FT,272,RC,27202284,CDM,,,,,,both,,,669.0000,100.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,205.38,,,,,,,172.6700,669.0000,other,30.7% of $669.00 in Billed Charges for Rev 272 = $205.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPLINT ORTHO GLASS 5INX15FT,272,RC,27202284,CDM,,,,,,both,,,669.0000,100.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,216.09,,,,,,,172.6700,669.0000,percent of total billed charges,32.3% of $669.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPLINT ORTHO GLASS 5INX15FT,272,RC,27202284,CDM,,,,,,both,,,669.0000,100.3500,WELLCARE,WELLCARE MEDICAID,669.00,,,,,,,172.6700,669.0000,percent of total billed charges,100% of $669.00 in Billed Charges for Rev 272 = $669.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER CUTTER CONTOUR CURVED,272,RC,27201105,CDM,,,,,,both,,,1385.0000,207.7500,AETNA,AETNA,591.40,,,,,,,357.4700,1385.0000,percent of total billed charges,"42.7% of $1,385.00 in Billed Charges for Rev 272 = $591.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLER CUTTER CONTOUR CURVED,272,RC,27201105,CDM,,,,,,both,,,1385.0000,207.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,969.50,,,,,,,357.4700,1385.0000,percent of total billed charges,"Rev 272 $1,385.00 in Billed Charges at 70% = $969.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLER CUTTER CONTOUR CURVED,272,RC,27201105,CDM,,,,,,both,,,1385.0000,207.7500,CIGNA HEALTHCARE,CIGNA HMO,577.55,,,,,,,357.4700,1385.0000,percent of total billed charges,"41.7% of $1,385.00 in Billed Charges for Rev 272 = $577.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLER CUTTER CONTOUR CURVED,272,RC,27201105,CDM,,,,,,both,,,1385.0000,207.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,642.64,,,,,,,357.4700,1385.0000,percent of total billed charges,"46.4% of $1,385.00 in Billed Charges for Rev 272 = $642.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLER CUTTER CONTOUR CURVED,272,RC,27201105,CDM,,,,,,both,,,1385.0000,207.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,577.55,,,,,,,357.4700,1385.0000,percent of total billed charges,"41.7% of $1,385.00 in Billed Charges for Rev 272 = $577.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLER CUTTER CONTOUR CURVED,272,RC,27201105,CDM,,,,,,both,,,1385.0000,207.7500,CIGNA HEALTHCARE,CIGNA PPO,577.55,,,,,,,357.4700,1385.0000,percent of total billed charges,"41.7% of $1,385.00 in Billed Charges for Rev 272 = $577.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLER CUTTER CONTOUR CURVED,272,RC,27201105,CDM,,,,,,both,,,1385.0000,207.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1246.50,,,,,,,357.4700,1385.0000,percent of total billed charges,"90% of $1,385.00 in Billed Charges for Rev 272 = $1,246.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLER CUTTER CONTOUR CURVED,272,RC,27201105,CDM,,,,,,both,,,1385.0000,207.7500,MEDCOST,MEDCOST VHN,659.12,,,,,,,357.4700,1385.0000,percent of total billed charges,"47.59% of $1,385.00 in Billed Charges for Rev 272 = $659.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLER CUTTER CONTOUR CURVED,272,RC,27201105,CDM,,,,,,both,,,1385.0000,207.7500,SENTARA HEALTH,SENTARA HEALTH,357.47,,,,,,,357.4700,1385.0000,percent of total billed charges,"25.81% of $1,385.00 in Billed Charges for Rev 272 = $357.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLER CUTTER CONTOUR CURVED,272,RC,27201105,CDM,,,,,,both,,,1385.0000,207.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1385.00,,,,,,,357.4700,1385.0000,percent of total billed charges,"100% of $1,385.00 in Billed Charges for Rev 272 = $1,385.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLER CUTTER CONTOUR CURVED,272,RC,27201105,CDM,,,,,,both,,,1385.0000,207.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,692.50,,,,,,,357.4700,1385.0000,percent of total billed charges,"Rev 272 $1,385.00 in Billed Charges at 50% = $692.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLER CUTTER CONTOUR CURVED,272,RC,27201105,CDM,,,,,,both,,,1385.0000,207.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,447.36,,,,,,,357.4700,1385.0000,other,"32.3% of $1,385.00 in Billed Charges for Rev 272 = $447.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STAPLER CUTTER CONTOUR CURVED,272,RC,27201105,CDM,,,,,,both,,,1385.0000,207.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,425.20,,,,,,,357.4700,1385.0000,other,"30.7% of $1,385.00 in Billed Charges for Rev 272 = $425.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STAPLER CUTTER CONTOUR CURVED,272,RC,27201105,CDM,,,,,,both,,,1385.0000,207.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,447.36,,,,,,,357.4700,1385.0000,percent of total billed charges,"32.3% of $1,385.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLER CUTTER CONTOUR CURVED,272,RC,27201105,CDM,,,,,,both,,,1385.0000,207.7500,WELLCARE,WELLCARE MEDICAID,1385.00,,,,,,,357.4700,1385.0000,percent of total billed charges,"100% of $1,385.00 in Billed Charges for Rev 272 = $1,385.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEG SAFETY DOBBHOFF 20F ENFIT,272,RC,27200002,CDM,,,,,,both,,,1308.6100,196.2900,AETNA,AETNA,558.78,,,,,,,337.7500,1308.6100,percent of total billed charges,"42.7% of $1,308.61 in Billed Charges for Rev 272 = $558.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEG SAFETY DOBBHOFF 20F ENFIT,272,RC,27200002,CDM,,,,,,both,,,1308.6100,196.2900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,916.03,,,,,,,337.7500,1308.6100,percent of total billed charges,"Rev 272 $1,308.61 in Billed Charges at 70% = $916.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEG SAFETY DOBBHOFF 20F ENFIT,272,RC,27200002,CDM,,,,,,both,,,1308.6100,196.2900,CIGNA HEALTHCARE,CIGNA HMO,545.69,,,,,,,337.7500,1308.6100,percent of total billed charges,"41.7% of $1,308.61 in Billed Charges for Rev 272 = $545.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEG SAFETY DOBBHOFF 20F ENFIT,272,RC,27200002,CDM,,,,,,both,,,1308.6100,196.2900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,607.20,,,,,,,337.7500,1308.6100,percent of total billed charges,"46.4% of $1,308.61 in Billed Charges for Rev 272 = $607.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEG SAFETY DOBBHOFF 20F ENFIT,272,RC,27200002,CDM,,,,,,both,,,1308.6100,196.2900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,545.69,,,,,,,337.7500,1308.6100,percent of total billed charges,"41.7% of $1,308.61 in Billed Charges for Rev 272 = $545.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEG SAFETY DOBBHOFF 20F ENFIT,272,RC,27200002,CDM,,,,,,both,,,1308.6100,196.2900,CIGNA HEALTHCARE,CIGNA PPO,545.69,,,,,,,337.7500,1308.6100,percent of total billed charges,"41.7% of $1,308.61 in Billed Charges for Rev 272 = $545.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEG SAFETY DOBBHOFF 20F ENFIT,272,RC,27200002,CDM,,,,,,both,,,1308.6100,196.2900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1177.75,,,,,,,337.7500,1308.6100,percent of total billed charges,"90% of $1,308.61 in Billed Charges for Rev 272 = $1,177.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEG SAFETY DOBBHOFF 20F ENFIT,272,RC,27200002,CDM,,,,,,both,,,1308.6100,196.2900,MEDCOST,MEDCOST VHN,622.77,,,,,,,337.7500,1308.6100,percent of total billed charges,"47.59% of $1,308.61 in Billed Charges for Rev 272 = $622.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEG SAFETY DOBBHOFF 20F ENFIT,272,RC,27200002,CDM,,,,,,both,,,1308.6100,196.2900,SENTARA HEALTH,SENTARA HEALTH,337.75,,,,,,,337.7500,1308.6100,percent of total billed charges,"25.81% of $1,308.61 in Billed Charges for Rev 272 = $337.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEG SAFETY DOBBHOFF 20F ENFIT,272,RC,27200002,CDM,,,,,,both,,,1308.6100,196.2900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1308.61,,,,,,,337.7500,1308.6100,percent of total billed charges,"100% of $1,308.61 in Billed Charges for Rev 272 = $1,308.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEG SAFETY DOBBHOFF 20F ENFIT,272,RC,27200002,CDM,,,,,,both,,,1308.6100,196.2900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,654.31,,,,,,,337.7500,1308.6100,percent of total billed charges,"Rev 272 $1,308.61 in Billed Charges at 50% = $654.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEG SAFETY DOBBHOFF 20F ENFIT,272,RC,27200002,CDM,,,,,,both,,,1308.6100,196.2900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,422.68,,,,,,,337.7500,1308.6100,other,"32.3% of $1,308.61 in Billed Charges for Rev 272 = $422.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PEG SAFETY DOBBHOFF 20F ENFIT,272,RC,27200002,CDM,,,,,,both,,,1308.6100,196.2900,UNITED HEALTHCARE,UHC HERITAGE SELECT,401.74,,,,,,,337.7500,1308.6100,other,"30.7% of $1,308.61 in Billed Charges for Rev 272 = $401.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PEG SAFETY DOBBHOFF 20F ENFIT,272,RC,27200002,CDM,,,,,,both,,,1308.6100,196.2900,UNITED HEALTHCARE,UNITED HEALTHCARE,422.68,,,,,,,337.7500,1308.6100,percent of total billed charges,"32.3% of $1,308.61 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEG SAFETY DOBBHOFF 20F ENFIT,272,RC,27200002,CDM,,,,,,both,,,1308.6100,196.2900,WELLCARE,WELLCARE MEDICAID,1308.61,,,,,,,337.7500,1308.6100,percent of total billed charges,"100% of $1,308.61 in Billed Charges for Rev 272 = $1,308.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN BIPOLAR MAX1,272,RC,,,,,,,,both,,,23199.9300,3479.9900,AETNA,AETNA,9906.37,,,,,,,5987.9000,23199.9300,percent of total billed charges,"42.7% of $23,199.93 in Billed Charges for Rev 272 = $9,906.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN BIPOLAR MAX1,272,RC,,,,,,,,both,,,23199.9300,3479.9900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,16239.95,,,,,,,5987.9000,23199.9300,percent of total billed charges,"Rev 272 $23,199.93 in Billed Charges at 70% = $16,239.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN BIPOLAR MAX1,272,RC,,,,,,,,both,,,23199.9300,3479.9900,CIGNA HEALTHCARE,CIGNA HMO,9674.37,,,,,,,5987.9000,23199.9300,percent of total billed charges,"41.7% of $23,199.93 in Billed Charges for Rev 272 = $9,674.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN BIPOLAR MAX1,272,RC,,,,,,,,both,,,23199.9300,3479.9900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10764.77,,,,,,,5987.9000,23199.9300,percent of total billed charges,"46.4% of $23,199.93 in Billed Charges for Rev 272 = $10,764.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN BIPOLAR MAX1,272,RC,,,,,,,,both,,,23199.9300,3479.9900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9674.37,,,,,,,5987.9000,23199.9300,percent of total billed charges,"41.7% of $23,199.93 in Billed Charges for Rev 272 = $9,674.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN BIPOLAR MAX1,272,RC,,,,,,,,both,,,23199.9300,3479.9900,CIGNA HEALTHCARE,CIGNA PPO,9674.37,,,,,,,5987.9000,23199.9300,percent of total billed charges,"41.7% of $23,199.93 in Billed Charges for Rev 272 = $9,674.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN BIPOLAR MAX1,272,RC,,,,,,,,both,,,23199.9300,3479.9900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,20879.94,,,,,,,5987.9000,23199.9300,percent of total billed charges,"90% of $23,199.93 in Billed Charges for Rev 272 = $20,879.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN BIPOLAR MAX1,272,RC,,,,,,,,both,,,23199.9300,3479.9900,MEDCOST,MEDCOST VHN,11040.85,,,,,,,5987.9000,23199.9300,percent of total billed charges,"47.59% of $23,199.93 in Billed Charges for Rev 272 = $11,040.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN BIPOLAR MAX1,272,RC,,,,,,,,both,,,23199.9300,3479.9900,SENTARA HEALTH,SENTARA HEALTH,5987.90,,,,,,,5987.9000,23199.9300,percent of total billed charges,"25.81% of $23,199.93 in Billed Charges for Rev 272 = $5,987.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN BIPOLAR MAX1,272,RC,,,,,,,,both,,,23199.9300,3479.9900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",23199.93,,,,,,,5987.9000,23199.9300,percent of total billed charges,"100% of $23,199.93 in Billed Charges for Rev 272 = $23,199.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN BIPOLAR MAX1,272,RC,,,,,,,,both,,,23199.9300,3479.9900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11599.97,,,,,,,5987.9000,23199.9300,percent of total billed charges,"Rev 272 $23,199.93 in Billed Charges at 50% = $11,599.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN BIPOLAR MAX1,272,RC,,,,,,,,both,,,23199.9300,3479.9900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7493.58,,,,,,,5987.9000,23199.9300,other,"32.3% of $23,199.93 in Billed Charges for Rev 272 = $7,493.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PEN BIPOLAR MAX1,272,RC,,,,,,,,both,,,23199.9300,3479.9900,UNITED HEALTHCARE,UHC HERITAGE SELECT,7122.38,,,,,,,5987.9000,23199.9300,other,"30.7% of $23,199.93 in Billed Charges for Rev 272 = $7,122.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PEN BIPOLAR MAX1,272,RC,,,,,,,,both,,,23199.9300,3479.9900,UNITED HEALTHCARE,UNITED HEALTHCARE,7493.58,,,,,,,5987.9000,23199.9300,percent of total billed charges,"32.3% of $23,199.93 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN BIPOLAR MAX1,272,RC,,,,,,,,both,,,23199.9300,3479.9900,WELLCARE,WELLCARE MEDICAID,23199.93,,,,,,,5987.9000,23199.9300,percent of total billed charges,"100% of $23,199.93 in Billed Charges for Rev 272 = $23,199.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STAPLER PRECISE SKIN SHOT,270,RC,27000255,CDM,,,,,,both,,,38.0000,5.7000,AETNA,AETNA,16.23,,,,,,,9.8100,38.0000,percent of total billed charges,42.7% of $38.00 in Billed Charges for Rev 270 = $16.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER PRECISE SKIN SHOT,270,RC,27000255,CDM,,,,,,both,,,38.0000,5.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,26.60,,,,,,,9.8100,38.0000,percent of total billed charges,Rev 270 $38.00 in Billed Charges at 70% = $26.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER PRECISE SKIN SHOT,270,RC,27000255,CDM,,,,,,both,,,38.0000,5.7000,CIGNA HEALTHCARE,CIGNA HMO,15.85,,,,,,,9.8100,38.0000,percent of total billed charges,41.7% of $38.00 in Billed Charges for Rev 270 = $15.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER PRECISE SKIN SHOT,270,RC,27000255,CDM,,,,,,both,,,38.0000,5.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,17.63,,,,,,,9.8100,38.0000,percent of total billed charges,46.4% of $38.00 in Billed Charges for Rev 270 = $17.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER PRECISE SKIN SHOT,270,RC,27000255,CDM,,,,,,both,,,38.0000,5.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,15.85,,,,,,,9.8100,38.0000,percent of total billed charges,41.7% of $38.00 in Billed Charges for Rev 270 = $15.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER PRECISE SKIN SHOT,270,RC,27000255,CDM,,,,,,both,,,38.0000,5.7000,CIGNA HEALTHCARE,CIGNA PPO,15.85,,,,,,,9.8100,38.0000,percent of total billed charges,41.7% of $38.00 in Billed Charges for Rev 270 = $15.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER PRECISE SKIN SHOT,270,RC,27000255,CDM,,,,,,both,,,38.0000,5.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,34.20,,,,,,,9.8100,38.0000,percent of total billed charges,90% of $38.00 in Billed Charges for Rev 270 = $34.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER PRECISE SKIN SHOT,270,RC,27000255,CDM,,,,,,both,,,38.0000,5.7000,MEDCOST,MEDCOST VHN,18.08,,,,,,,9.8100,38.0000,percent of total billed charges,47.59% of $38.00 in Billed Charges for Rev 270 = $18.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER PRECISE SKIN SHOT,270,RC,27000255,CDM,,,,,,both,,,38.0000,5.7000,SENTARA HEALTH,SENTARA HEALTH,9.81,,,,,,,9.8100,38.0000,percent of total billed charges,25.81% of $38.00 in Billed Charges for Rev 270 = $9.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER PRECISE SKIN SHOT,270,RC,27000255,CDM,,,,,,both,,,38.0000,5.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",38.00,,,,,,,9.8100,38.0000,percent of total billed charges,100% of $38.00 in Billed Charges for Rev 270 = $38.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER PRECISE SKIN SHOT,270,RC,27000255,CDM,,,,,,both,,,38.0000,5.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,19.00,,,,,,,9.8100,38.0000,percent of total billed charges,Rev 270 $38.00 in Billed Charges at 50% = $19.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER PRECISE SKIN SHOT,270,RC,27000255,CDM,,,,,,both,,,38.0000,5.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12.27,,,,,,,9.8100,38.0000,other,32.3% of $38.00 in Billed Charges for Rev 270 = $12.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STAPLER PRECISE SKIN SHOT,270,RC,27000255,CDM,,,,,,both,,,38.0000,5.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11.67,,,,,,,9.8100,38.0000,other,30.7% of $38.00 in Billed Charges for Rev 270 = $11.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STAPLER PRECISE SKIN SHOT,270,RC,27000255,CDM,,,,,,both,,,38.0000,5.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,12.27,,,,,,,9.8100,38.0000,percent of total billed charges,32.3% of $38.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER PRECISE SKIN SHOT,270,RC,27000255,CDM,,,,,,both,,,38.0000,5.7000,WELLCARE,WELLCARE MEDICAID,38.00,,,,,,,9.8100,38.0000,percent of total billed charges,100% of $38.00 in Billed Charges for Rev 270 = $38.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER SKIN 15 SHOT,270,RC,27000256,CDM,,,,,,both,,,43.0000,6.4500,AETNA,AETNA,18.36,,,,,,,11.1000,43.0000,percent of total billed charges,42.7% of $43.00 in Billed Charges for Rev 270 = $18.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER SKIN 15 SHOT,270,RC,27000256,CDM,,,,,,both,,,43.0000,6.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,30.10,,,,,,,11.1000,43.0000,percent of total billed charges,Rev 270 $43.00 in Billed Charges at 70% = $30.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER SKIN 15 SHOT,270,RC,27000256,CDM,,,,,,both,,,43.0000,6.4500,CIGNA HEALTHCARE,CIGNA HMO,17.93,,,,,,,11.1000,43.0000,percent of total billed charges,41.7% of $43.00 in Billed Charges for Rev 270 = $17.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER SKIN 15 SHOT,270,RC,27000256,CDM,,,,,,both,,,43.0000,6.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,19.95,,,,,,,11.1000,43.0000,percent of total billed charges,46.4% of $43.00 in Billed Charges for Rev 270 = $19.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER SKIN 15 SHOT,270,RC,27000256,CDM,,,,,,both,,,43.0000,6.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,17.93,,,,,,,11.1000,43.0000,percent of total billed charges,41.7% of $43.00 in Billed Charges for Rev 270 = $17.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER SKIN 15 SHOT,270,RC,27000256,CDM,,,,,,both,,,43.0000,6.4500,CIGNA HEALTHCARE,CIGNA PPO,17.93,,,,,,,11.1000,43.0000,percent of total billed charges,41.7% of $43.00 in Billed Charges for Rev 270 = $17.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER SKIN 15 SHOT,270,RC,27000256,CDM,,,,,,both,,,43.0000,6.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,38.70,,,,,,,11.1000,43.0000,percent of total billed charges,90% of $43.00 in Billed Charges for Rev 270 = $38.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER SKIN 15 SHOT,270,RC,27000256,CDM,,,,,,both,,,43.0000,6.4500,MEDCOST,MEDCOST VHN,20.46,,,,,,,11.1000,43.0000,percent of total billed charges,47.59% of $43.00 in Billed Charges for Rev 270 = $20.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER SKIN 15 SHOT,270,RC,27000256,CDM,,,,,,both,,,43.0000,6.4500,SENTARA HEALTH,SENTARA HEALTH,11.10,,,,,,,11.1000,43.0000,percent of total billed charges,25.81% of $43.00 in Billed Charges for Rev 270 = $11.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER SKIN 15 SHOT,270,RC,27000256,CDM,,,,,,both,,,43.0000,6.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",43.00,,,,,,,11.1000,43.0000,percent of total billed charges,100% of $43.00 in Billed Charges for Rev 270 = $43.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER SKIN 15 SHOT,270,RC,27000256,CDM,,,,,,both,,,43.0000,6.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,21.50,,,,,,,11.1000,43.0000,percent of total billed charges,Rev 270 $43.00 in Billed Charges at 50% = $21.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER SKIN 15 SHOT,270,RC,27000256,CDM,,,,,,both,,,43.0000,6.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13.89,,,,,,,11.1000,43.0000,other,32.3% of $43.00 in Billed Charges for Rev 270 = $13.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STAPLER SKIN 15 SHOT,270,RC,27000256,CDM,,,,,,both,,,43.0000,6.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,13.20,,,,,,,11.1000,43.0000,other,30.7% of $43.00 in Billed Charges for Rev 270 = $13.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STAPLER SKIN 15 SHOT,270,RC,27000256,CDM,,,,,,both,,,43.0000,6.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,13.89,,,,,,,11.1000,43.0000,percent of total billed charges,32.3% of $43.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STAPLER SKIN 15 SHOT,270,RC,27000256,CDM,,,,,,both,,,43.0000,6.4500,WELLCARE,WELLCARE MEDICAID,43.00,,,,,,,11.1000,43.0000,percent of total billed charges,100% of $43.00 in Billed Charges for Rev 270 = $43.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STARTUP TUBG W/AIR TRAP & COIL,272,RC,27201112,CDM,,,,,,both,,,975.0000,146.2500,AETNA,AETNA,416.33,,,,,,,251.6500,975.0000,percent of total billed charges,42.7% of $975.00 in Billed Charges for Rev 272 = $416.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STARTUP TUBG W/AIR TRAP & COIL,272,RC,27201112,CDM,,,,,,both,,,975.0000,146.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,682.50,,,,,,,251.6500,975.0000,percent of total billed charges,Rev 272 $975.00 in Billed Charges at 70% = $682.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STARTUP TUBG W/AIR TRAP & COIL,272,RC,27201112,CDM,,,,,,both,,,975.0000,146.2500,CIGNA HEALTHCARE,CIGNA HMO,406.58,,,,,,,251.6500,975.0000,percent of total billed charges,41.7% of $975.00 in Billed Charges for Rev 272 = $406.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STARTUP TUBG W/AIR TRAP & COIL,272,RC,27201112,CDM,,,,,,both,,,975.0000,146.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,452.40,,,,,,,251.6500,975.0000,percent of total billed charges,46.4% of $975.00 in Billed Charges for Rev 272 = $452.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STARTUP TUBG W/AIR TRAP & COIL,272,RC,27201112,CDM,,,,,,both,,,975.0000,146.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,406.58,,,,,,,251.6500,975.0000,percent of total billed charges,41.7% of $975.00 in Billed Charges for Rev 272 = $406.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STARTUP TUBG W/AIR TRAP & COIL,272,RC,27201112,CDM,,,,,,both,,,975.0000,146.2500,CIGNA HEALTHCARE,CIGNA PPO,406.58,,,,,,,251.6500,975.0000,percent of total billed charges,41.7% of $975.00 in Billed Charges for Rev 272 = $406.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STARTUP TUBG W/AIR TRAP & COIL,272,RC,27201112,CDM,,,,,,both,,,975.0000,146.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,877.50,,,,,,,251.6500,975.0000,percent of total billed charges,90% of $975.00 in Billed Charges for Rev 272 = $877.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STARTUP TUBG W/AIR TRAP & COIL,272,RC,27201112,CDM,,,,,,both,,,975.0000,146.2500,MEDCOST,MEDCOST VHN,464.00,,,,,,,251.6500,975.0000,percent of total billed charges,47.59% of $975.00 in Billed Charges for Rev 272 = $464.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STARTUP TUBG W/AIR TRAP & COIL,272,RC,27201112,CDM,,,,,,both,,,975.0000,146.2500,SENTARA HEALTH,SENTARA HEALTH,251.65,,,,,,,251.6500,975.0000,percent of total billed charges,25.81% of $975.00 in Billed Charges for Rev 272 = $251.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STARTUP TUBG W/AIR TRAP & COIL,272,RC,27201112,CDM,,,,,,both,,,975.0000,146.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",975.00,,,,,,,251.6500,975.0000,percent of total billed charges,100% of $975.00 in Billed Charges for Rev 272 = $975.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STARTUP TUBG W/AIR TRAP & COIL,272,RC,27201112,CDM,,,,,,both,,,975.0000,146.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,487.50,,,,,,,251.6500,975.0000,percent of total billed charges,Rev 272 $975.00 in Billed Charges at 50% = $487.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STARTUP TUBG W/AIR TRAP & COIL,272,RC,27201112,CDM,,,,,,both,,,975.0000,146.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,314.93,,,,,,,251.6500,975.0000,other,32.3% of $975.00 in Billed Charges for Rev 272 = $314.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STARTUP TUBG W/AIR TRAP & COIL,272,RC,27201112,CDM,,,,,,both,,,975.0000,146.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,299.33,,,,,,,251.6500,975.0000,other,30.7% of $975.00 in Billed Charges for Rev 272 = $299.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STARTUP TUBG W/AIR TRAP & COIL,272,RC,27201112,CDM,,,,,,both,,,975.0000,146.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,314.93,,,,,,,251.6500,975.0000,percent of total billed charges,32.3% of $975.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STARTUP TUBG W/AIR TRAP & COIL,272,RC,27201112,CDM,,,,,,both,,,975.0000,146.2500,WELLCARE,WELLCARE MEDICAID,975.00,,,,,,,251.6500,975.0000,percent of total billed charges,100% of $975.00 in Billed Charges for Rev 272 = $975.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STENT SCAFFOLD CAROTID 10X40MM,278,RC,27801533,CDM,,,,,,both,,,6171.0000,925.6500,AETNA,AETNA,2962.08,,,,,,,1592.7400,6171.0000,percent of total billed charges,"48% of $6,171.00 in Billed Charges for Rev 278 = $2,962.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT SCAFFOLD CAROTID 10X40MM,278,RC,27801533,CDM,,,,,,both,,,6171.0000,925.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3085.50,,,,,,,1592.7400,6171.0000,percent of total billed charges,"50% of $6,171.00 in Billed Charges for Rev 278 = $3,085.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT SCAFFOLD CAROTID 10X40MM,278,RC,27801533,CDM,,,,,,both,,,6171.0000,925.6500,CIGNA HEALTHCARE,CIGNA HMO,2573.31,,,,,,,1592.7400,6171.0000,percent of total billed charges,"41.7% of $6,171.00 in Billed Charges for Rev 278 = $2,573.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT SCAFFOLD CAROTID 10X40MM,278,RC,27801533,CDM,,,,,,both,,,6171.0000,925.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2468.40,,,,,,,1592.7400,6171.0000,percent of total billed charges,"40% of $6,171.00 in Billed Charges for Rev 278 = $2,468.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT SCAFFOLD CAROTID 10X40MM,278,RC,27801533,CDM,,,,,,both,,,6171.0000,925.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2573.31,,,,,,,1592.7400,6171.0000,percent of total billed charges,"41.7% of $6,171.00 in Billed Charges for Rev 278 = $2,573.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT SCAFFOLD CAROTID 10X40MM,278,RC,27801533,CDM,,,,,,both,,,6171.0000,925.6500,CIGNA HEALTHCARE,CIGNA PPO,2573.31,,,,,,,1592.7400,6171.0000,percent of total billed charges,"41.7% of $6,171.00 in Billed Charges for Rev 278 = $2,573.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT SCAFFOLD CAROTID 10X40MM,278,RC,27801533,CDM,,,,,,both,,,6171.0000,925.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5553.90,,,,,,,1592.7400,6171.0000,percent of total billed charges,"90% of $6,171.00 in Billed Charges for Rev 278 = $5,553.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT SCAFFOLD CAROTID 10X40MM,278,RC,27801533,CDM,,,,,,both,,,6171.0000,925.6500,MEDCOST,MEDCOST VHN,2936.78,,,,,,,1592.7400,6171.0000,percent of total billed charges,"47.59% of $6,171.00 in Billed Charges for Rev 278 = $2,936.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT SCAFFOLD CAROTID 10X40MM,278,RC,27801533,CDM,,,,,,both,,,6171.0000,925.6500,SENTARA HEALTH,SENTARA HEALTH,1592.74,,,,,,,1592.7400,6171.0000,percent of total billed charges,"25.81% of $6,171.00 in Billed Charges for Rev 278 = $1,592.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT SCAFFOLD CAROTID 10X40MM,278,RC,27801533,CDM,,,,,,both,,,6171.0000,925.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6171.00,,,,,,,1592.7400,6171.0000,percent of total billed charges,"100% of $6,171.00 in Billed Charges for Rev 278 = $6,171.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT SCAFFOLD CAROTID 10X40MM,278,RC,27801533,CDM,,,,,,both,,,6171.0000,925.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3085.50,,,,,,,1592.7400,6171.0000,percent of total billed charges,"Rev 278 $6,171.00 in Billed Charges at 50% = $3,085.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT SCAFFOLD CAROTID 10X40MM,278,RC,27801533,CDM,,,,,,both,,,6171.0000,925.6500,WELLCARE,WELLCARE MEDICAID,6171.00,,,,,,,1592.7400,6171.0000,percent of total billed charges,"100% of $6,171.00 in Billed Charges for Rev 278 = $6,171.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFORATOR ADULT LARGE,272,RC,27200002,CDM,,,,,,both,,,2063.9300,309.5900,AETNA,AETNA,881.30,,,,,,,532.7000,2063.9300,percent of total billed charges,"42.7% of $2,063.93 in Billed Charges for Rev 272 = $881.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFORATOR ADULT LARGE,272,RC,27200002,CDM,,,,,,both,,,2063.9300,309.5900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1444.75,,,,,,,532.7000,2063.9300,percent of total billed charges,"Rev 272 $2,063.93 in Billed Charges at 70% = $1,444.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFORATOR ADULT LARGE,272,RC,27200002,CDM,,,,,,both,,,2063.9300,309.5900,CIGNA HEALTHCARE,CIGNA HMO,860.66,,,,,,,532.7000,2063.9300,percent of total billed charges,"41.7% of $2,063.93 in Billed Charges for Rev 272 = $860.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFORATOR ADULT LARGE,272,RC,27200002,CDM,,,,,,both,,,2063.9300,309.5900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,957.66,,,,,,,532.7000,2063.9300,percent of total billed charges,"46.4% of $2,063.93 in Billed Charges for Rev 272 = $957.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFORATOR ADULT LARGE,272,RC,27200002,CDM,,,,,,both,,,2063.9300,309.5900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,860.66,,,,,,,532.7000,2063.9300,percent of total billed charges,"41.7% of $2,063.93 in Billed Charges for Rev 272 = $860.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFORATOR ADULT LARGE,272,RC,27200002,CDM,,,,,,both,,,2063.9300,309.5900,CIGNA HEALTHCARE,CIGNA PPO,860.66,,,,,,,532.7000,2063.9300,percent of total billed charges,"41.7% of $2,063.93 in Billed Charges for Rev 272 = $860.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFORATOR ADULT LARGE,272,RC,27200002,CDM,,,,,,both,,,2063.9300,309.5900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1857.54,,,,,,,532.7000,2063.9300,percent of total billed charges,"90% of $2,063.93 in Billed Charges for Rev 272 = $1,857.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFORATOR ADULT LARGE,272,RC,27200002,CDM,,,,,,both,,,2063.9300,309.5900,MEDCOST,MEDCOST VHN,982.22,,,,,,,532.7000,2063.9300,percent of total billed charges,"47.59% of $2,063.93 in Billed Charges for Rev 272 = $982.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFORATOR ADULT LARGE,272,RC,27200002,CDM,,,,,,both,,,2063.9300,309.5900,SENTARA HEALTH,SENTARA HEALTH,532.70,,,,,,,532.7000,2063.9300,percent of total billed charges,"25.81% of $2,063.93 in Billed Charges for Rev 272 = $532.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFORATOR ADULT LARGE,272,RC,27200002,CDM,,,,,,both,,,2063.9300,309.5900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2063.93,,,,,,,532.7000,2063.9300,percent of total billed charges,"100% of $2,063.93 in Billed Charges for Rev 272 = $2,063.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFORATOR ADULT LARGE,272,RC,27200002,CDM,,,,,,both,,,2063.9300,309.5900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1031.97,,,,,,,532.7000,2063.9300,percent of total billed charges,"Rev 272 $2,063.93 in Billed Charges at 50% = $1,031.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFORATOR ADULT LARGE,272,RC,27200002,CDM,,,,,,both,,,2063.9300,309.5900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,666.65,,,,,,,532.7000,2063.9300,other,"32.3% of $2,063.93 in Billed Charges for Rev 272 = $666.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PERFORATOR ADULT LARGE,272,RC,27200002,CDM,,,,,,both,,,2063.9300,309.5900,UNITED HEALTHCARE,UHC HERITAGE SELECT,633.63,,,,,,,532.7000,2063.9300,other,"30.7% of $2,063.93 in Billed Charges for Rev 272 = $633.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PERFORATOR ADULT LARGE,272,RC,27200002,CDM,,,,,,both,,,2063.9300,309.5900,UNITED HEALTHCARE,UNITED HEALTHCARE,666.65,,,,,,,532.7000,2063.9300,percent of total billed charges,"32.3% of $2,063.93 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFORATOR ADULT LARGE,272,RC,27200002,CDM,,,,,,both,,,2063.9300,309.5900,WELLCARE,WELLCARE MEDICAID,2063.93,,,,,,,532.7000,2063.9300,percent of total billed charges,"100% of $2,063.93 in Billed Charges for Rev 272 = $2,063.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERIVIEW FLEX TBNA NDL 21G,272,RC,27200002,CDM,,,,,,both,,,2144.7200,321.7100,AETNA,AETNA,915.80,,,,,,,553.5500,2144.7200,percent of total billed charges,"42.7% of $2,144.72 in Billed Charges for Rev 272 = $915.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERIVIEW FLEX TBNA NDL 21G,272,RC,27200002,CDM,,,,,,both,,,2144.7200,321.7100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1501.30,,,,,,,553.5500,2144.7200,percent of total billed charges,"Rev 272 $2,144.72 in Billed Charges at 70% = $1,501.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERIVIEW FLEX TBNA NDL 21G,272,RC,27200002,CDM,,,,,,both,,,2144.7200,321.7100,CIGNA HEALTHCARE,CIGNA HMO,894.35,,,,,,,553.5500,2144.7200,percent of total billed charges,"41.7% of $2,144.72 in Billed Charges for Rev 272 = $894.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERIVIEW FLEX TBNA NDL 21G,272,RC,27200002,CDM,,,,,,both,,,2144.7200,321.7100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,995.15,,,,,,,553.5500,2144.7200,percent of total billed charges,"46.4% of $2,144.72 in Billed Charges for Rev 272 = $995.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERIVIEW FLEX TBNA NDL 21G,272,RC,27200002,CDM,,,,,,both,,,2144.7200,321.7100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,894.35,,,,,,,553.5500,2144.7200,percent of total billed charges,"41.7% of $2,144.72 in Billed Charges for Rev 272 = $894.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERIVIEW FLEX TBNA NDL 21G,272,RC,27200002,CDM,,,,,,both,,,2144.7200,321.7100,CIGNA HEALTHCARE,CIGNA PPO,894.35,,,,,,,553.5500,2144.7200,percent of total billed charges,"41.7% of $2,144.72 in Billed Charges for Rev 272 = $894.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERIVIEW FLEX TBNA NDL 21G,272,RC,27200002,CDM,,,,,,both,,,2144.7200,321.7100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1930.25,,,,,,,553.5500,2144.7200,percent of total billed charges,"90% of $2,144.72 in Billed Charges for Rev 272 = $1,930.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERIVIEW FLEX TBNA NDL 21G,272,RC,27200002,CDM,,,,,,both,,,2144.7200,321.7100,MEDCOST,MEDCOST VHN,1020.67,,,,,,,553.5500,2144.7200,percent of total billed charges,"47.59% of $2,144.72 in Billed Charges for Rev 272 = $1,020.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERIVIEW FLEX TBNA NDL 21G,272,RC,27200002,CDM,,,,,,both,,,2144.7200,321.7100,SENTARA HEALTH,SENTARA HEALTH,553.55,,,,,,,553.5500,2144.7200,percent of total billed charges,"25.81% of $2,144.72 in Billed Charges for Rev 272 = $553.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERIVIEW FLEX TBNA NDL 21G,272,RC,27200002,CDM,,,,,,both,,,2144.7200,321.7100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2144.72,,,,,,,553.5500,2144.7200,percent of total billed charges,"100% of $2,144.72 in Billed Charges for Rev 272 = $2,144.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERIVIEW FLEX TBNA NDL 21G,272,RC,27200002,CDM,,,,,,both,,,2144.7200,321.7100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1072.36,,,,,,,553.5500,2144.7200,percent of total billed charges,"Rev 272 $2,144.72 in Billed Charges at 50% = $1,072.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERIVIEW FLEX TBNA NDL 21G,272,RC,27200002,CDM,,,,,,both,,,2144.7200,321.7100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,692.74,,,,,,,553.5500,2144.7200,other,"32.3% of $2,144.72 in Billed Charges for Rev 272 = $692.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PERIVIEW FLEX TBNA NDL 21G,272,RC,27200002,CDM,,,,,,both,,,2144.7200,321.7100,UNITED HEALTHCARE,UHC HERITAGE SELECT,658.43,,,,,,,553.5500,2144.7200,other,"30.7% of $2,144.72 in Billed Charges for Rev 272 = $658.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PERIVIEW FLEX TBNA NDL 21G,272,RC,27200002,CDM,,,,,,both,,,2144.7200,321.7100,UNITED HEALTHCARE,UNITED HEALTHCARE,692.74,,,,,,,553.5500,2144.7200,percent of total billed charges,"32.3% of $2,144.72 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERIVIEW FLEX TBNA NDL 21G,272,RC,27200002,CDM,,,,,,both,,,2144.7200,321.7100,WELLCARE,WELLCARE MEDICAID,2144.72,,,,,,,553.5500,2144.7200,percent of total billed charges,"100% of $2,144.72 in Billed Charges for Rev 272 = $2,144.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SUPP FEE/CASE EVAL/CLARIFY OP,519,RC,51900003,CDM,,,,,,both,,,781.0000,117.1500,AETNA,AETNA,333.49,,,,,,,128.8700,781.0000,percent of total billed charges,42.7% of $781.00 in Billed Charges for Rev 519 = $333.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUPP FEE/CASE EVAL/CLARIFY OP,519,RC,51900003,CDM,,,,,,both,,,781.0000,117.1500,BLUE CROSS,ANTHEM EXCHANGE,128.87,,,,,,,128.8700,781.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPP FEE/CASE EVAL/CLARIFY OP,519,RC,51900003,CDM,,,,,,both,,,781.0000,117.1500,BLUE CROSS,ANTHEM HMO,128.87,,,,,,,128.8700,781.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPP FEE/CASE EVAL/CLARIFY OP,519,RC,51900003,CDM,,,,,,both,,,781.0000,117.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",128.87,,,,,,,128.8700,781.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPP FEE/CASE EVAL/CLARIFY OP,519,RC,51900003,CDM,,,,,,both,,,781.0000,117.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,546.70,,,,,,,128.8700,781.0000,percent of total billed charges,Rev 519 $781.00 in Billed Charges at 70% = $546.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUPP FEE/CASE EVAL/CLARIFY OP,519,RC,51900003,CDM,,,,,,both,,,781.0000,117.1500,CIGNA HEALTHCARE,CIGNA HMO,325.68,,,,,,,128.8700,781.0000,percent of total billed charges,41.7% of $781.00 in Billed Charges for Rev 519 = $325.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUPP FEE/CASE EVAL/CLARIFY OP,519,RC,51900003,CDM,,,,,,both,,,781.0000,117.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,362.38,,,,,,,128.8700,781.0000,percent of total billed charges,46.4% of $781.00 in Billed Charges for Rev 519 = $362.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUPP FEE/CASE EVAL/CLARIFY OP,519,RC,51900003,CDM,,,,,,both,,,781.0000,117.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,325.68,,,,,,,128.8700,781.0000,percent of total billed charges,41.7% of $781.00 in Billed Charges for Rev 519 = $325.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUPP FEE/CASE EVAL/CLARIFY OP,519,RC,51900003,CDM,,,,,,both,,,781.0000,117.1500,CIGNA HEALTHCARE,CIGNA PPO,325.68,,,,,,,128.8700,781.0000,percent of total billed charges,41.7% of $781.00 in Billed Charges for Rev 519 = $325.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUPP FEE/CASE EVAL/CLARIFY OP,519,RC,51900003,CDM,,,,,,both,,,781.0000,117.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,702.90,,,,,,,128.8700,781.0000,percent of total billed charges,90% of $781.00 in Billed Charges for Rev 519 = $702.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUPP FEE/CASE EVAL/CLARIFY OP,519,RC,51900003,CDM,,,,,,both,,,781.0000,117.1500,MEDCOST,MEDCOST VHN,371.68,,,,,,,128.8700,781.0000,percent of total billed charges,47.59% of $781.00 in Billed Charges for Rev 519 = $371.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUPP FEE/CASE EVAL/CLARIFY OP,519,RC,51900003,CDM,,,,,,both,,,781.0000,117.1500,SENTARA HEALTH,SENTARA HEALTH,201.58,,,,,,,128.8700,781.0000,percent of total billed charges,25.81% of $781.00 in Billed Charges for Rev 519 = $201.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUPP FEE/CASE EVAL/CLARIFY OP,519,RC,51900003,CDM,,,,,,both,,,781.0000,117.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",781.00,,,,,,,128.8700,781.0000,percent of total billed charges,100% of $781.00 in Billed Charges for Rev 519 = $781.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUPP FEE/CASE EVAL/CLARIFY OP,519,RC,51900003,CDM,,,,,,both,,,781.0000,117.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,390.50,,,,,,,128.8700,781.0000,percent of total billed charges,Rev 519 $781.00 in Billed Charges at 50% = $390.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUPP FEE/CASE EVAL/CLARIFY OP,519,RC,51900003,CDM,,,,,,both,,,781.0000,117.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,252.26,,,,,,,128.8700,781.0000,other,32.3% of $781.00 in Billed Charges for Rev 519 = $252.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPP FEE/CASE EVAL/CLARIFY OP,519,RC,51900003,CDM,,,,,,both,,,781.0000,117.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,239.77,,,,,,,128.8700,781.0000,other,30.7% of $781.00 in Billed Charges for Rev 519 = $239.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPP FEE/CASE EVAL/CLARIFY OP,519,RC,51900003,CDM,,,,,,both,,,781.0000,117.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,252.26,,,,,,,128.8700,781.0000,percent of total billed charges,32.3% of $781.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUPP FEE/CASE EVAL/CLARIFY OP,519,RC,51900003,CDM,,,,,,both,,,781.0000,117.1500,WELLCARE,WELLCARE MEDICAID,781.00,,,,,,,128.8700,781.0000,percent of total billed charges,100% of $781.00 in Billed Charges for Rev 519 = $781.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND ABLATION SUPER MULTIVAC 50,272,RC,27201264,CDM,,,,,,both,,,741.0000,111.1500,AETNA,AETNA,316.41,,,,,,,191.2500,741.0000,percent of total billed charges,42.7% of $741.00 in Billed Charges for Rev 272 = $316.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND ABLATION SUPER MULTIVAC 50,272,RC,27201264,CDM,,,,,,both,,,741.0000,111.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,518.70,,,,,,,191.2500,741.0000,percent of total billed charges,Rev 272 $741.00 in Billed Charges at 70% = $518.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND ABLATION SUPER MULTIVAC 50,272,RC,27201264,CDM,,,,,,both,,,741.0000,111.1500,CIGNA HEALTHCARE,CIGNA HMO,309.00,,,,,,,191.2500,741.0000,percent of total billed charges,41.7% of $741.00 in Billed Charges for Rev 272 = $309.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND ABLATION SUPER MULTIVAC 50,272,RC,27201264,CDM,,,,,,both,,,741.0000,111.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,343.82,,,,,,,191.2500,741.0000,percent of total billed charges,46.4% of $741.00 in Billed Charges for Rev 272 = $343.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND ABLATION SUPER MULTIVAC 50,272,RC,27201264,CDM,,,,,,both,,,741.0000,111.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,309.00,,,,,,,191.2500,741.0000,percent of total billed charges,41.7% of $741.00 in Billed Charges for Rev 272 = $309.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND ABLATION SUPER MULTIVAC 50,272,RC,27201264,CDM,,,,,,both,,,741.0000,111.1500,CIGNA HEALTHCARE,CIGNA PPO,309.00,,,,,,,191.2500,741.0000,percent of total billed charges,41.7% of $741.00 in Billed Charges for Rev 272 = $309.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND ABLATION SUPER MULTIVAC 50,272,RC,27201264,CDM,,,,,,both,,,741.0000,111.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,666.90,,,,,,,191.2500,741.0000,percent of total billed charges,90% of $741.00 in Billed Charges for Rev 272 = $666.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND ABLATION SUPER MULTIVAC 50,272,RC,27201264,CDM,,,,,,both,,,741.0000,111.1500,MEDCOST,MEDCOST VHN,352.64,,,,,,,191.2500,741.0000,percent of total billed charges,47.59% of $741.00 in Billed Charges for Rev 272 = $352.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND ABLATION SUPER MULTIVAC 50,272,RC,27201264,CDM,,,,,,both,,,741.0000,111.1500,SENTARA HEALTH,SENTARA HEALTH,191.25,,,,,,,191.2500,741.0000,percent of total billed charges,25.81% of $741.00 in Billed Charges for Rev 272 = $191.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND ABLATION SUPER MULTIVAC 50,272,RC,27201264,CDM,,,,,,both,,,741.0000,111.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",741.00,,,,,,,191.2500,741.0000,percent of total billed charges,100% of $741.00 in Billed Charges for Rev 272 = $741.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND ABLATION SUPER MULTIVAC 50,272,RC,27201264,CDM,,,,,,both,,,741.0000,111.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,370.50,,,,,,,191.2500,741.0000,percent of total billed charges,Rev 272 $741.00 in Billed Charges at 50% = $370.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND ABLATION SUPER MULTIVAC 50,272,RC,27201264,CDM,,,,,,both,,,741.0000,111.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,239.34,,,,,,,191.2500,741.0000,other,32.3% of $741.00 in Billed Charges for Rev 272 = $239.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WAND ABLATION SUPER MULTIVAC 50,272,RC,27201264,CDM,,,,,,both,,,741.0000,111.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,227.49,,,,,,,191.2500,741.0000,other,30.7% of $741.00 in Billed Charges for Rev 272 = $227.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WAND ABLATION SUPER MULTIVAC 50,272,RC,27201264,CDM,,,,,,both,,,741.0000,111.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,239.34,,,,,,,191.2500,741.0000,percent of total billed charges,32.3% of $741.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WAND ABLATION SUPER MULTIVAC 50,272,RC,27201264,CDM,,,,,,both,,,741.0000,111.1500,WELLCARE,WELLCARE MEDICAID,741.00,,,,,,,191.2500,741.0000,percent of total billed charges,100% of $741.00 in Billed Charges for Rev 272 = $741.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WATCHMAN ACCESS SYSTEM,272,RC,27202111,CDM,,,,,,both,,,2734.0000,410.1000,AETNA,AETNA,1167.42,,,,,,,705.6500,2734.0000,percent of total billed charges,"42.7% of $2,734.00 in Billed Charges for Rev 272 = $1,167.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN ACCESS SYSTEM,272,RC,27202111,CDM,,,,,,both,,,2734.0000,410.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1913.80,,,,,,,705.6500,2734.0000,percent of total billed charges,"Rev 272 $2,734.00 in Billed Charges at 70% = $1,913.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN ACCESS SYSTEM,272,RC,27202111,CDM,,,,,,both,,,2734.0000,410.1000,CIGNA HEALTHCARE,CIGNA HMO,1140.08,,,,,,,705.6500,2734.0000,percent of total billed charges,"41.7% of $2,734.00 in Billed Charges for Rev 272 = $1,140.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN ACCESS SYSTEM,272,RC,27202111,CDM,,,,,,both,,,2734.0000,410.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1268.58,,,,,,,705.6500,2734.0000,percent of total billed charges,"46.4% of $2,734.00 in Billed Charges for Rev 272 = $1,268.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN ACCESS SYSTEM,272,RC,27202111,CDM,,,,,,both,,,2734.0000,410.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1140.08,,,,,,,705.6500,2734.0000,percent of total billed charges,"41.7% of $2,734.00 in Billed Charges for Rev 272 = $1,140.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN ACCESS SYSTEM,272,RC,27202111,CDM,,,,,,both,,,2734.0000,410.1000,CIGNA HEALTHCARE,CIGNA PPO,1140.08,,,,,,,705.6500,2734.0000,percent of total billed charges,"41.7% of $2,734.00 in Billed Charges for Rev 272 = $1,140.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN ACCESS SYSTEM,272,RC,27202111,CDM,,,,,,both,,,2734.0000,410.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2460.60,,,,,,,705.6500,2734.0000,percent of total billed charges,"90% of $2,734.00 in Billed Charges for Rev 272 = $2,460.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN ACCESS SYSTEM,272,RC,27202111,CDM,,,,,,both,,,2734.0000,410.1000,MEDCOST,MEDCOST VHN,1301.11,,,,,,,705.6500,2734.0000,percent of total billed charges,"47.59% of $2,734.00 in Billed Charges for Rev 272 = $1,301.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN ACCESS SYSTEM,272,RC,27202111,CDM,,,,,,both,,,2734.0000,410.1000,SENTARA HEALTH,SENTARA HEALTH,705.65,,,,,,,705.6500,2734.0000,percent of total billed charges,"25.81% of $2,734.00 in Billed Charges for Rev 272 = $705.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN ACCESS SYSTEM,272,RC,27202111,CDM,,,,,,both,,,2734.0000,410.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2734.00,,,,,,,705.6500,2734.0000,percent of total billed charges,"100% of $2,734.00 in Billed Charges for Rev 272 = $2,734.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN ACCESS SYSTEM,272,RC,27202111,CDM,,,,,,both,,,2734.0000,410.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1367.00,,,,,,,705.6500,2734.0000,percent of total billed charges,"Rev 272 $2,734.00 in Billed Charges at 50% = $1,367.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN ACCESS SYSTEM,272,RC,27202111,CDM,,,,,,both,,,2734.0000,410.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,883.08,,,,,,,705.6500,2734.0000,other,"32.3% of $2,734.00 in Billed Charges for Rev 272 = $883.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WATCHMAN ACCESS SYSTEM,272,RC,27202111,CDM,,,,,,both,,,2734.0000,410.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,839.34,,,,,,,705.6500,2734.0000,other,"30.7% of $2,734.00 in Billed Charges for Rev 272 = $839.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WATCHMAN ACCESS SYSTEM,272,RC,27202111,CDM,,,,,,both,,,2734.0000,410.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,883.08,,,,,,,705.6500,2734.0000,percent of total billed charges,"32.3% of $2,734.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WATCHMAN ACCESS SYSTEM,272,RC,27202111,CDM,,,,,,both,,,2734.0000,410.1000,WELLCARE,WELLCARE MEDICAID,2734.00,,,,,,,705.6500,2734.0000,percent of total billed charges,"100% of $2,734.00 in Billed Charges for Rev 272 = $2,734.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WRAP KENDALL FOOT PR,270,RC,27000198,CDM,,,,,,both,,,326.0000,48.9000,AETNA,AETNA,139.20,,,,,,,84.1400,326.0000,percent of total billed charges,42.7% of $326.00 in Billed Charges for Rev 270 = $139.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WRAP KENDALL FOOT PR,270,RC,27000198,CDM,,,,,,both,,,326.0000,48.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,228.20,,,,,,,84.1400,326.0000,percent of total billed charges,Rev 270 $326.00 in Billed Charges at 70% = $228.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WRAP KENDALL FOOT PR,270,RC,27000198,CDM,,,,,,both,,,326.0000,48.9000,CIGNA HEALTHCARE,CIGNA HMO,135.94,,,,,,,84.1400,326.0000,percent of total billed charges,41.7% of $326.00 in Billed Charges for Rev 270 = $135.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WRAP KENDALL FOOT PR,270,RC,27000198,CDM,,,,,,both,,,326.0000,48.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,151.26,,,,,,,84.1400,326.0000,percent of total billed charges,46.4% of $326.00 in Billed Charges for Rev 270 = $151.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WRAP KENDALL FOOT PR,270,RC,27000198,CDM,,,,,,both,,,326.0000,48.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,135.94,,,,,,,84.1400,326.0000,percent of total billed charges,41.7% of $326.00 in Billed Charges for Rev 270 = $135.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WRAP KENDALL FOOT PR,270,RC,27000198,CDM,,,,,,both,,,326.0000,48.9000,CIGNA HEALTHCARE,CIGNA PPO,135.94,,,,,,,84.1400,326.0000,percent of total billed charges,41.7% of $326.00 in Billed Charges for Rev 270 = $135.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WRAP KENDALL FOOT PR,270,RC,27000198,CDM,,,,,,both,,,326.0000,48.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,293.40,,,,,,,84.1400,326.0000,percent of total billed charges,90% of $326.00 in Billed Charges for Rev 270 = $293.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WRAP KENDALL FOOT PR,270,RC,27000198,CDM,,,,,,both,,,326.0000,48.9000,MEDCOST,MEDCOST VHN,155.14,,,,,,,84.1400,326.0000,percent of total billed charges,47.59% of $326.00 in Billed Charges for Rev 270 = $155.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WRAP KENDALL FOOT PR,270,RC,27000198,CDM,,,,,,both,,,326.0000,48.9000,SENTARA HEALTH,SENTARA HEALTH,84.14,,,,,,,84.1400,326.0000,percent of total billed charges,25.81% of $326.00 in Billed Charges for Rev 270 = $84.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WRAP KENDALL FOOT PR,270,RC,27000198,CDM,,,,,,both,,,326.0000,48.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",326.00,,,,,,,84.1400,326.0000,percent of total billed charges,100% of $326.00 in Billed Charges for Rev 270 = $326.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WRAP KENDALL FOOT PR,270,RC,27000198,CDM,,,,,,both,,,326.0000,48.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,163.00,,,,,,,84.1400,326.0000,percent of total billed charges,Rev 270 $326.00 in Billed Charges at 50% = $163.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WRAP KENDALL FOOT PR,270,RC,27000198,CDM,,,,,,both,,,326.0000,48.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,105.30,,,,,,,84.1400,326.0000,other,32.3% of $326.00 in Billed Charges for Rev 270 = $105.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WRAP KENDALL FOOT PR,270,RC,27000198,CDM,,,,,,both,,,326.0000,48.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,100.08,,,,,,,84.1400,326.0000,other,30.7% of $326.00 in Billed Charges for Rev 270 = $100.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WRAP KENDALL FOOT PR,270,RC,27000198,CDM,,,,,,both,,,326.0000,48.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,105.30,,,,,,,84.1400,326.0000,percent of total billed charges,32.3% of $326.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WRAP KENDALL FOOT PR,270,RC,27000198,CDM,,,,,,both,,,326.0000,48.9000,WELLCARE,WELLCARE MEDICAID,326.00,,,,,,,84.1400,326.0000,percent of total billed charges,100% of $326.00 in Billed Charges for Rev 270 = $326.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ZENITH FLEX AAA ENDOVASCULAR GRAFT BIFURCATED MAIN BODY,278,RC,27800595,CDM,,,,,,both,,,23121.0000,3468.1500,AETNA,AETNA,11098.08,,,,,,,1641.5900,23121.0000,percent of total billed charges,"48% of $23,121.00 in Billed Charges for Rev 278 = $11,098.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX AAA ENDOVASCULAR GRAFT BIFURCATED MAIN BODY,278,RC,27800595,CDM,,,,,,both,,,23121.0000,3468.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11560.50,,,,,,,1641.5900,23121.0000,percent of total billed charges,"50% of $23,121.00 in Billed Charges for Rev 278 = $11,560.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX AAA ENDOVASCULAR GRAFT BIFURCATED MAIN BODY,278,RC,27800595,CDM,,,,,,both,,,23121.0000,3468.1500,CIGNA HEALTHCARE,CIGNA HMO,9641.46,,,,,,,1641.5900,23121.0000,percent of total billed charges,"41.7% of $23,121.00 in Billed Charges for Rev 278 = $9,641.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX AAA ENDOVASCULAR GRAFT BIFURCATED MAIN BODY,278,RC,27800595,CDM,,,,,,both,,,23121.0000,3468.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,9248.40,,,,,,,1641.5900,23121.0000,percent of total billed charges,"40% of $23,121.00 in Billed Charges for Rev 278 = $9,248.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX AAA ENDOVASCULAR GRAFT BIFURCATED MAIN BODY,278,RC,27800595,CDM,,,,,,both,,,23121.0000,3468.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9641.46,,,,,,,1641.5900,23121.0000,percent of total billed charges,"41.7% of $23,121.00 in Billed Charges for Rev 278 = $9,641.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX AAA ENDOVASCULAR GRAFT BIFURCATED MAIN BODY,278,RC,27800595,CDM,,,,,,both,,,23121.0000,3468.1500,CIGNA HEALTHCARE,CIGNA PPO,9641.46,,,,,,,1641.5900,23121.0000,percent of total billed charges,"41.7% of $23,121.00 in Billed Charges for Rev 278 = $9,641.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX AAA ENDOVASCULAR GRAFT BIFURCATED MAIN BODY,278,RC,27800595,CDM,,,,,,both,,,23121.0000,3468.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,20808.90,,,,,,,1641.5900,23121.0000,percent of total billed charges,"90% of $23,121.00 in Billed Charges for Rev 278 = $20,808.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX AAA ENDOVASCULAR GRAFT BIFURCATED MAIN BODY,278,RC,27800595,CDM,,,,,,both,,,23121.0000,3468.1500,MEDCOST,MEDCOST VHN,11003.28,,,,,,,1641.5900,23121.0000,percent of total billed charges,"47.59% of $23,121.00 in Billed Charges for Rev 278 = $11,003.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX AAA ENDOVASCULAR GRAFT BIFURCATED MAIN BODY,278,RC,27800595,CDM,,,,,,both,,,23121.0000,3468.1500,SENTARA HEALTH,SENTARA HEALTH,5967.53,,,,,,,1641.5900,23121.0000,percent of total billed charges,"25.81% of $23,121.00 in Billed Charges for Rev 278 = $5,967.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX AAA ENDOVASCULAR GRAFT BIFURCATED MAIN BODY,278,RC,27800595,CDM,,,,,,both,,,23121.0000,3468.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",23121.00,,,,,,,1641.5900,23121.0000,percent of total billed charges,"100% of $23,121.00 in Billed Charges for Rev 278 = $23,121.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX AAA ENDOVASCULAR GRAFT BIFURCATED MAIN BODY,278,RC,27800595,CDM,,,,,,both,,,23121.0000,3468.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11560.50,,,,,,,1641.5900,23121.0000,percent of total billed charges,"Rev 278 $23,121.00 in Billed Charges at 50% = $11,560.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX AAA ENDOVASCULAR GRAFT BIFURCATED MAIN BODY,278,RC,27800595,CDM,,,,,,both,,,23121.0000,3468.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1734.08,,,,,,,1641.5900,23121.0000,percent of total billed charges,"7.5% of $23,121.00 in Billed Charges for Rev 278 = $1,734.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX AAA ENDOVASCULAR GRAFT BIFURCATED MAIN BODY,278,RC,27800595,CDM,,,,,,both,,,23121.0000,3468.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1641.59,,,,,,,1641.5900,23121.0000,percent of total billed charges,"7.1% of $23,121.00 in Billed Charges for Rev 278 = $1,641.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX AAA ENDOVASCULAR GRAFT BIFURCATED MAIN BODY,278,RC,27800595,CDM,,,,,,both,,,23121.0000,3468.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,1641.59,,,,,,,1641.5900,23121.0000,percent of total billed charges,"7.1% of $23,121.00 in Billed Charges for Rev 278 = $1,641.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ZENITH FLEX AAA ENDOVASCULAR GRAFT BIFURCATED MAIN BODY,278,RC,27800595,CDM,,,,,,both,,,23121.0000,3468.1500,WELLCARE,WELLCARE MEDICAID,23121.00,,,,,,,1641.5900,23121.0000,percent of total billed charges,"100% of $23,121.00 in Billed Charges for Rev 278 = $23,121.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN 3.0MM X355MM,272,RC,,,,,,,,both,,,1093.9300,164.0900,AETNA,AETNA,467.11,,,,,,,282.3400,1093.9300,percent of total billed charges,"42.7% of $1,093.93 in Billed Charges for Rev 272 = $467.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN 3.0MM X355MM,272,RC,,,,,,,,both,,,1093.9300,164.0900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,765.75,,,,,,,282.3400,1093.9300,percent of total billed charges,"Rev 272 $1,093.93 in Billed Charges at 70% = $765.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN 3.0MM X355MM,272,RC,,,,,,,,both,,,1093.9300,164.0900,CIGNA HEALTHCARE,CIGNA HMO,456.17,,,,,,,282.3400,1093.9300,percent of total billed charges,"41.7% of $1,093.93 in Billed Charges for Rev 272 = $456.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN 3.0MM X355MM,272,RC,,,,,,,,both,,,1093.9300,164.0900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,507.58,,,,,,,282.3400,1093.9300,percent of total billed charges,"46.4% of $1,093.93 in Billed Charges for Rev 272 = $507.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN 3.0MM X355MM,272,RC,,,,,,,,both,,,1093.9300,164.0900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,456.17,,,,,,,282.3400,1093.9300,percent of total billed charges,"41.7% of $1,093.93 in Billed Charges for Rev 272 = $456.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN 3.0MM X355MM,272,RC,,,,,,,,both,,,1093.9300,164.0900,CIGNA HEALTHCARE,CIGNA PPO,456.17,,,,,,,282.3400,1093.9300,percent of total billed charges,"41.7% of $1,093.93 in Billed Charges for Rev 272 = $456.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN 3.0MM X355MM,272,RC,,,,,,,,both,,,1093.9300,164.0900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,984.54,,,,,,,282.3400,1093.9300,percent of total billed charges,"90% of $1,093.93 in Billed Charges for Rev 272 = $984.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN 3.0MM X355MM,272,RC,,,,,,,,both,,,1093.9300,164.0900,MEDCOST,MEDCOST VHN,520.60,,,,,,,282.3400,1093.9300,percent of total billed charges,"47.59% of $1,093.93 in Billed Charges for Rev 272 = $520.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN 3.0MM X355MM,272,RC,,,,,,,,both,,,1093.9300,164.0900,SENTARA HEALTH,SENTARA HEALTH,282.34,,,,,,,282.3400,1093.9300,percent of total billed charges,"25.81% of $1,093.93 in Billed Charges for Rev 272 = $282.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN 3.0MM X355MM,272,RC,,,,,,,,both,,,1093.9300,164.0900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1093.93,,,,,,,282.3400,1093.9300,percent of total billed charges,"100% of $1,093.93 in Billed Charges for Rev 272 = $1,093.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN 3.0MM X355MM,272,RC,,,,,,,,both,,,1093.9300,164.0900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,546.97,,,,,,,282.3400,1093.9300,percent of total billed charges,"Rev 272 $1,093.93 in Billed Charges at 50% = $546.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN 3.0MM X355MM,272,RC,,,,,,,,both,,,1093.9300,164.0900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,353.34,,,,,,,282.3400,1093.9300,other,"32.3% of $1,093.93 in Billed Charges for Rev 272 = $353.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PIN 3.0MM X355MM,272,RC,,,,,,,,both,,,1093.9300,164.0900,UNITED HEALTHCARE,UHC HERITAGE SELECT,335.84,,,,,,,282.3400,1093.9300,other,"30.7% of $1,093.93 in Billed Charges for Rev 272 = $335.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PIN 3.0MM X355MM,272,RC,,,,,,,,both,,,1093.9300,164.0900,UNITED HEALTHCARE,UNITED HEALTHCARE,353.34,,,,,,,282.3400,1093.9300,percent of total billed charges,"32.3% of $1,093.93 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN 3.0MM X355MM,272,RC,,,,,,,,both,,,1093.9300,164.0900,WELLCARE,WELLCARE MEDICAID,1093.93,,,,,,,282.3400,1093.9300,percent of total billed charges,"100% of $1,093.93 in Billed Charges for Rev 272 = $1,093.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PUMP BLOOD CENTRIFUGAL PC COATED,270,RC,,,,,,,,both,,,4690.8200,703.6200,AETNA,AETNA,2002.98,,,,,,,1210.7000,4690.8200,percent of total billed charges,"42.7% of $4,690.82 in Billed Charges for Rev 270 = $2,002.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PUMP BLOOD CENTRIFUGAL PC COATED,270,RC,,,,,,,,both,,,4690.8200,703.6200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3283.57,,,,,,,1210.7000,4690.8200,percent of total billed charges,"Rev 270 $4,690.82 in Billed Charges at 70% = $3,283.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PUMP BLOOD CENTRIFUGAL PC COATED,270,RC,,,,,,,,both,,,4690.8200,703.6200,CIGNA HEALTHCARE,CIGNA HMO,1956.07,,,,,,,1210.7000,4690.8200,percent of total billed charges,"41.7% of $4,690.82 in Billed Charges for Rev 270 = $1,956.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PUMP BLOOD CENTRIFUGAL PC COATED,270,RC,,,,,,,,both,,,4690.8200,703.6200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2176.54,,,,,,,1210.7000,4690.8200,percent of total billed charges,"46.4% of $4,690.82 in Billed Charges for Rev 270 = $2,176.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PUMP BLOOD CENTRIFUGAL PC COATED,270,RC,,,,,,,,both,,,4690.8200,703.6200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1956.07,,,,,,,1210.7000,4690.8200,percent of total billed charges,"41.7% of $4,690.82 in Billed Charges for Rev 270 = $1,956.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PUMP BLOOD CENTRIFUGAL PC COATED,270,RC,,,,,,,,both,,,4690.8200,703.6200,CIGNA HEALTHCARE,CIGNA PPO,1956.07,,,,,,,1210.7000,4690.8200,percent of total billed charges,"41.7% of $4,690.82 in Billed Charges for Rev 270 = $1,956.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PUMP BLOOD CENTRIFUGAL PC COATED,270,RC,,,,,,,,both,,,4690.8200,703.6200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4221.74,,,,,,,1210.7000,4690.8200,percent of total billed charges,"90% of $4,690.82 in Billed Charges for Rev 270 = $4,221.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PUMP BLOOD CENTRIFUGAL PC COATED,270,RC,,,,,,,,both,,,4690.8200,703.6200,MEDCOST,MEDCOST VHN,2232.36,,,,,,,1210.7000,4690.8200,percent of total billed charges,"47.59% of $4,690.82 in Billed Charges for Rev 270 = $2,232.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PUMP BLOOD CENTRIFUGAL PC COATED,270,RC,,,,,,,,both,,,4690.8200,703.6200,SENTARA HEALTH,SENTARA HEALTH,1210.70,,,,,,,1210.7000,4690.8200,percent of total billed charges,"25.81% of $4,690.82 in Billed Charges for Rev 270 = $1,210.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PUMP BLOOD CENTRIFUGAL PC COATED,270,RC,,,,,,,,both,,,4690.8200,703.6200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4690.82,,,,,,,1210.7000,4690.8200,percent of total billed charges,"100% of $4,690.82 in Billed Charges for Rev 270 = $4,690.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PUMP BLOOD CENTRIFUGAL PC COATED,270,RC,,,,,,,,both,,,4690.8200,703.6200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2345.41,,,,,,,1210.7000,4690.8200,percent of total billed charges,"Rev 270 $4,690.82 in Billed Charges at 50% = $2,345.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PUMP BLOOD CENTRIFUGAL PC COATED,270,RC,,,,,,,,both,,,4690.8200,703.6200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1515.13,,,,,,,1210.7000,4690.8200,other,"32.3% of $4,690.82 in Billed Charges for Rev 270 = $1,515.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PUMP BLOOD CENTRIFUGAL PC COATED,270,RC,,,,,,,,both,,,4690.8200,703.6200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1440.08,,,,,,,1210.7000,4690.8200,other,"30.7% of $4,690.82 in Billed Charges for Rev 270 = $1,440.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PUMP BLOOD CENTRIFUGAL PC COATED,270,RC,,,,,,,,both,,,4690.8200,703.6200,UNITED HEALTHCARE,UNITED HEALTHCARE,1515.13,,,,,,,1210.7000,4690.8200,percent of total billed charges,"32.3% of $4,690.82 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PUMP BLOOD CENTRIFUGAL PC COATED,270,RC,,,,,,,,both,,,4690.8200,703.6200,WELLCARE,WELLCARE MEDICAID,4690.82,,,,,,,1210.7000,4690.8200,percent of total billed charges,"100% of $4,690.82 in Billed Charges for Rev 270 = $4,690.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,733.6300,110.0400,AETNA,AETNA,313.26,,,,,,,189.3500,733.6300,percent of total billed charges,42.7% of $733.63 in Billed Charges for Rev 272 = $313.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,733.6300,110.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,513.54,,,,,,,189.3500,733.6300,percent of total billed charges,Rev 272 $733.63 in Billed Charges at 70% = $513.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,733.6300,110.0400,CIGNA HEALTHCARE,CIGNA HMO,305.92,,,,,,,189.3500,733.6300,percent of total billed charges,41.7% of $733.63 in Billed Charges for Rev 272 = $305.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,733.6300,110.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,340.40,,,,,,,189.3500,733.6300,percent of total billed charges,46.4% of $733.63 in Billed Charges for Rev 272 = $340.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,733.6300,110.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,305.92,,,,,,,189.3500,733.6300,percent of total billed charges,41.7% of $733.63 in Billed Charges for Rev 272 = $305.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,733.6300,110.0400,CIGNA HEALTHCARE,CIGNA PPO,305.92,,,,,,,189.3500,733.6300,percent of total billed charges,41.7% of $733.63 in Billed Charges for Rev 272 = $305.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,733.6300,110.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,660.27,,,,,,,189.3500,733.6300,percent of total billed charges,90% of $733.63 in Billed Charges for Rev 272 = $660.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,733.6300,110.0400,MEDCOST,MEDCOST VHN,349.13,,,,,,,189.3500,733.6300,percent of total billed charges,47.59% of $733.63 in Billed Charges for Rev 272 = $349.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,733.6300,110.0400,SENTARA HEALTH,SENTARA HEALTH,189.35,,,,,,,189.3500,733.6300,percent of total billed charges,25.81% of $733.63 in Billed Charges for Rev 272 = $189.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,733.6300,110.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",733.63,,,,,,,189.3500,733.6300,percent of total billed charges,100% of $733.63 in Billed Charges for Rev 272 = $733.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,733.6300,110.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,366.82,,,,,,,189.3500,733.6300,percent of total billed charges,Rev 272 $733.63 in Billed Charges at 50% = $366.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,733.6300,110.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,236.96,,,,,,,189.3500,733.6300,other,32.3% of $733.63 in Billed Charges for Rev 272 = $236.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,733.6300,110.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,225.22,,,,,,,189.3500,733.6300,other,30.7% of $733.63 in Billed Charges for Rev 272 = $225.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,733.6300,110.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,236.96,,,,,,,189.3500,733.6300,percent of total billed charges,32.3% of $733.63 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,733.6300,110.0400,WELLCARE,WELLCARE MEDICAID,733.63,,,,,,,189.3500,733.6300,percent of total billed charges,100% of $733.63 in Billed Charges for Rev 272 = $733.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,3240.9400,486.1400,AETNA,AETNA,1383.88,,,,,,,836.4900,3240.9400,percent of total billed charges,"42.7% of $3,240.94 in Billed Charges for Rev 272 = $1,383.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,3240.9400,486.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2268.66,,,,,,,836.4900,3240.9400,percent of total billed charges,"Rev 272 $3,240.94 in Billed Charges at 70% = $2,268.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,3240.9400,486.1400,CIGNA HEALTHCARE,CIGNA HMO,1351.47,,,,,,,836.4900,3240.9400,percent of total billed charges,"41.7% of $3,240.94 in Billed Charges for Rev 272 = $1,351.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,3240.9400,486.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1503.80,,,,,,,836.4900,3240.9400,percent of total billed charges,"46.4% of $3,240.94 in Billed Charges for Rev 272 = $1,503.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,3240.9400,486.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1351.47,,,,,,,836.4900,3240.9400,percent of total billed charges,"41.7% of $3,240.94 in Billed Charges for Rev 272 = $1,351.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,3240.9400,486.1400,CIGNA HEALTHCARE,CIGNA PPO,1351.47,,,,,,,836.4900,3240.9400,percent of total billed charges,"41.7% of $3,240.94 in Billed Charges for Rev 272 = $1,351.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,3240.9400,486.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2916.85,,,,,,,836.4900,3240.9400,percent of total billed charges,"90% of $3,240.94 in Billed Charges for Rev 272 = $2,916.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,3240.9400,486.1400,MEDCOST,MEDCOST VHN,1542.36,,,,,,,836.4900,3240.9400,percent of total billed charges,"47.59% of $3,240.94 in Billed Charges for Rev 272 = $1,542.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,3240.9400,486.1400,SENTARA HEALTH,SENTARA HEALTH,836.49,,,,,,,836.4900,3240.9400,percent of total billed charges,"25.81% of $3,240.94 in Billed Charges for Rev 272 = $836.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,3240.9400,486.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3240.94,,,,,,,836.4900,3240.9400,percent of total billed charges,"100% of $3,240.94 in Billed Charges for Rev 272 = $3,240.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,3240.9400,486.1400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1620.47,,,,,,,836.4900,3240.9400,percent of total billed charges,"Rev 272 $3,240.94 in Billed Charges at 50% = $1,620.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,3240.9400,486.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1046.82,,,,,,,836.4900,3240.9400,other,"32.3% of $3,240.94 in Billed Charges for Rev 272 = $1,046.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,3240.9400,486.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,994.97,,,,,,,836.4900,3240.9400,other,"30.7% of $3,240.94 in Billed Charges for Rev 272 = $994.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,3240.9400,486.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,1046.82,,,,,,,836.4900,3240.9400,percent of total billed charges,"32.3% of $3,240.94 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEART SUPPORT JANKE-BARRON,272,RC,27200002,CDM,,,,,,both,,,3240.9400,486.1400,WELLCARE,WELLCARE MEDICAID,3240.94,,,,,,,836.4900,3240.9400,percent of total billed charges,"100% of $3,240.94 in Billed Charges for Rev 272 = $3,240.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT NU KNIT ABSORB,272,RC,27200002,CDM,,,,,,both,,,1272.7600,190.9100,AETNA,AETNA,543.47,,,,,,,328.5000,1272.7600,percent of total billed charges,"42.7% of $1,272.76 in Billed Charges for Rev 272 = $543.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT NU KNIT ABSORB,272,RC,27200002,CDM,,,,,,both,,,1272.7600,190.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,890.93,,,,,,,328.5000,1272.7600,percent of total billed charges,"Rev 272 $1,272.76 in Billed Charges at 70% = $890.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT NU KNIT ABSORB,272,RC,27200002,CDM,,,,,,both,,,1272.7600,190.9100,CIGNA HEALTHCARE,CIGNA HMO,530.74,,,,,,,328.5000,1272.7600,percent of total billed charges,"41.7% of $1,272.76 in Billed Charges for Rev 272 = $530.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT NU KNIT ABSORB,272,RC,27200002,CDM,,,,,,both,,,1272.7600,190.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,590.56,,,,,,,328.5000,1272.7600,percent of total billed charges,"46.4% of $1,272.76 in Billed Charges for Rev 272 = $590.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT NU KNIT ABSORB,272,RC,27200002,CDM,,,,,,both,,,1272.7600,190.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,530.74,,,,,,,328.5000,1272.7600,percent of total billed charges,"41.7% of $1,272.76 in Billed Charges for Rev 272 = $530.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT NU KNIT ABSORB,272,RC,27200002,CDM,,,,,,both,,,1272.7600,190.9100,CIGNA HEALTHCARE,CIGNA PPO,530.74,,,,,,,328.5000,1272.7600,percent of total billed charges,"41.7% of $1,272.76 in Billed Charges for Rev 272 = $530.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT NU KNIT ABSORB,272,RC,27200002,CDM,,,,,,both,,,1272.7600,190.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1145.48,,,,,,,328.5000,1272.7600,percent of total billed charges,"90% of $1,272.76 in Billed Charges for Rev 272 = $1,145.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT NU KNIT ABSORB,272,RC,27200002,CDM,,,,,,both,,,1272.7600,190.9100,MEDCOST,MEDCOST VHN,605.71,,,,,,,328.5000,1272.7600,percent of total billed charges,"47.59% of $1,272.76 in Billed Charges for Rev 272 = $605.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT NU KNIT ABSORB,272,RC,27200002,CDM,,,,,,both,,,1272.7600,190.9100,SENTARA HEALTH,SENTARA HEALTH,328.50,,,,,,,328.5000,1272.7600,percent of total billed charges,"25.81% of $1,272.76 in Billed Charges for Rev 272 = $328.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT NU KNIT ABSORB,272,RC,27200002,CDM,,,,,,both,,,1272.7600,190.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1272.76,,,,,,,328.5000,1272.7600,percent of total billed charges,"100% of $1,272.76 in Billed Charges for Rev 272 = $1,272.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT NU KNIT ABSORB,272,RC,27200002,CDM,,,,,,both,,,1272.7600,190.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,636.38,,,,,,,328.5000,1272.7600,percent of total billed charges,"Rev 272 $1,272.76 in Billed Charges at 50% = $636.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT NU KNIT ABSORB,272,RC,27200002,CDM,,,,,,both,,,1272.7600,190.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,411.10,,,,,,,328.5000,1272.7600,other,"32.3% of $1,272.76 in Billed Charges for Rev 272 = $411.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HEMOSTAT NU KNIT ABSORB,272,RC,27200002,CDM,,,,,,both,,,1272.7600,190.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,390.74,,,,,,,328.5000,1272.7600,other,"30.7% of $1,272.76 in Billed Charges for Rev 272 = $390.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HEMOSTAT NU KNIT ABSORB,272,RC,27200002,CDM,,,,,,both,,,1272.7600,190.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,411.10,,,,,,,328.5000,1272.7600,percent of total billed charges,"32.3% of $1,272.76 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT NU KNIT ABSORB,272,RC,27200002,CDM,,,,,,both,,,1272.7600,190.9100,WELLCARE,WELLCARE MEDICAID,1272.76,,,,,,,328.5000,1272.7600,percent of total billed charges,"100% of $1,272.76 in Billed Charges for Rev 272 = $1,272.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27200002,CDM,,,,,,both,,,663.4600,99.5200,AETNA,AETNA,283.30,,,,,,,171.2400,663.4600,percent of total billed charges,42.7% of $663.46 in Billed Charges for Rev 272 = $283.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27200002,CDM,,,,,,both,,,663.4600,99.5200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,464.42,,,,,,,171.2400,663.4600,percent of total billed charges,Rev 272 $663.46 in Billed Charges at 70% = $464.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27200002,CDM,,,,,,both,,,663.4600,99.5200,CIGNA HEALTHCARE,CIGNA HMO,276.66,,,,,,,171.2400,663.4600,percent of total billed charges,41.7% of $663.46 in Billed Charges for Rev 272 = $276.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27200002,CDM,,,,,,both,,,663.4600,99.5200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,307.85,,,,,,,171.2400,663.4600,percent of total billed charges,46.4% of $663.46 in Billed Charges for Rev 272 = $307.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27200002,CDM,,,,,,both,,,663.4600,99.5200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,276.66,,,,,,,171.2400,663.4600,percent of total billed charges,41.7% of $663.46 in Billed Charges for Rev 272 = $276.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27200002,CDM,,,,,,both,,,663.4600,99.5200,CIGNA HEALTHCARE,CIGNA PPO,276.66,,,,,,,171.2400,663.4600,percent of total billed charges,41.7% of $663.46 in Billed Charges for Rev 272 = $276.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27200002,CDM,,,,,,both,,,663.4600,99.5200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,597.11,,,,,,,171.2400,663.4600,percent of total billed charges,90% of $663.46 in Billed Charges for Rev 272 = $597.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27200002,CDM,,,,,,both,,,663.4600,99.5200,MEDCOST,MEDCOST VHN,315.74,,,,,,,171.2400,663.4600,percent of total billed charges,47.59% of $663.46 in Billed Charges for Rev 272 = $315.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27200002,CDM,,,,,,both,,,663.4600,99.5200,SENTARA HEALTH,SENTARA HEALTH,171.24,,,,,,,171.2400,663.4600,percent of total billed charges,25.81% of $663.46 in Billed Charges for Rev 272 = $171.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27200002,CDM,,,,,,both,,,663.4600,99.5200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",663.46,,,,,,,171.2400,663.4600,percent of total billed charges,100% of $663.46 in Billed Charges for Rev 272 = $663.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27200002,CDM,,,,,,both,,,663.4600,99.5200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,331.73,,,,,,,171.2400,663.4600,percent of total billed charges,Rev 272 $663.46 in Billed Charges at 50% = $331.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27200002,CDM,,,,,,both,,,663.4600,99.5200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,214.30,,,,,,,171.2400,663.4600,other,32.3% of $663.46 in Billed Charges for Rev 272 = $214.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27200002,CDM,,,,,,both,,,663.4600,99.5200,UNITED HEALTHCARE,UHC HERITAGE SELECT,203.68,,,,,,,171.2400,663.4600,other,30.7% of $663.46 in Billed Charges for Rev 272 = $203.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27200002,CDM,,,,,,both,,,663.4600,99.5200,UNITED HEALTHCARE,UNITED HEALTHCARE,214.30,,,,,,,171.2400,663.4600,percent of total billed charges,32.3% of $663.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL ABSORB 4X8 1952,272,RC,27200002,CDM,,,,,,both,,,663.4600,99.5200,WELLCARE,WELLCARE MEDICAID,663.46,,,,,,,171.2400,663.4600,percent of total billed charges,100% of $663.46 in Billed Charges for Rev 272 = $663.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL POWDER 3G,272,RC,27200002,CDM,,,,,,both,,,1679.4400,251.9200,AETNA,AETNA,717.12,,,,,,,433.4600,1679.4400,percent of total billed charges,"42.7% of $1,679.44 in Billed Charges for Rev 272 = $717.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT SURGICEL POWDER 3G,272,RC,27200002,CDM,,,,,,both,,,1679.4400,251.9200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1175.61,,,,,,,433.4600,1679.4400,percent of total billed charges,"Rev 272 $1,679.44 in Billed Charges at 70% = $1,175.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT SURGICEL POWDER 3G,272,RC,27200002,CDM,,,,,,both,,,1679.4400,251.9200,CIGNA HEALTHCARE,CIGNA HMO,700.33,,,,,,,433.4600,1679.4400,percent of total billed charges,"41.7% of $1,679.44 in Billed Charges for Rev 272 = $700.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT SURGICEL POWDER 3G,272,RC,27200002,CDM,,,,,,both,,,1679.4400,251.9200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,779.26,,,,,,,433.4600,1679.4400,percent of total billed charges,"46.4% of $1,679.44 in Billed Charges for Rev 272 = $779.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT SURGICEL POWDER 3G,272,RC,27200002,CDM,,,,,,both,,,1679.4400,251.9200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,700.33,,,,,,,433.4600,1679.4400,percent of total billed charges,"41.7% of $1,679.44 in Billed Charges for Rev 272 = $700.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT SURGICEL POWDER 3G,272,RC,27200002,CDM,,,,,,both,,,1679.4400,251.9200,CIGNA HEALTHCARE,CIGNA PPO,700.33,,,,,,,433.4600,1679.4400,percent of total billed charges,"41.7% of $1,679.44 in Billed Charges for Rev 272 = $700.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT SURGICEL POWDER 3G,272,RC,27200002,CDM,,,,,,both,,,1679.4400,251.9200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1511.50,,,,,,,433.4600,1679.4400,percent of total billed charges,"90% of $1,679.44 in Billed Charges for Rev 272 = $1,511.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT SURGICEL POWDER 3G,272,RC,27200002,CDM,,,,,,both,,,1679.4400,251.9200,MEDCOST,MEDCOST VHN,799.25,,,,,,,433.4600,1679.4400,percent of total billed charges,"47.59% of $1,679.44 in Billed Charges for Rev 272 = $799.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT SURGICEL POWDER 3G,272,RC,27200002,CDM,,,,,,both,,,1679.4400,251.9200,SENTARA HEALTH,SENTARA HEALTH,433.46,,,,,,,433.4600,1679.4400,percent of total billed charges,"25.81% of $1,679.44 in Billed Charges for Rev 272 = $433.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT SURGICEL POWDER 3G,272,RC,27200002,CDM,,,,,,both,,,1679.4400,251.9200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1679.44,,,,,,,433.4600,1679.4400,percent of total billed charges,"100% of $1,679.44 in Billed Charges for Rev 272 = $1,679.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT SURGICEL POWDER 3G,272,RC,27200002,CDM,,,,,,both,,,1679.4400,251.9200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,839.72,,,,,,,433.4600,1679.4400,percent of total billed charges,"Rev 272 $1,679.44 in Billed Charges at 50% = $839.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT SURGICEL POWDER 3G,272,RC,27200002,CDM,,,,,,both,,,1679.4400,251.9200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,542.46,,,,,,,433.4600,1679.4400,other,"32.3% of $1,679.44 in Billed Charges for Rev 272 = $542.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HEMOSTAT SURGICEL POWDER 3G,272,RC,27200002,CDM,,,,,,both,,,1679.4400,251.9200,UNITED HEALTHCARE,UHC HERITAGE SELECT,515.59,,,,,,,433.4600,1679.4400,other,"30.7% of $1,679.44 in Billed Charges for Rev 272 = $515.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HEMOSTAT SURGICEL POWDER 3G,272,RC,27200002,CDM,,,,,,both,,,1679.4400,251.9200,UNITED HEALTHCARE,UNITED HEALTHCARE,542.46,,,,,,,433.4600,1679.4400,percent of total billed charges,"32.3% of $1,679.44 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT SURGICEL POWDER 3G,272,RC,27200002,CDM,,,,,,both,,,1679.4400,251.9200,WELLCARE,WELLCARE MEDICAID,1679.44,,,,,,,433.4600,1679.4400,percent of total billed charges,"100% of $1,679.44 in Billed Charges for Rev 272 = $1,679.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
QUICKTRACH SZ 2MM,272,RC,,,,,,,,both,,,1783.2900,267.4900,AETNA,AETNA,761.46,,,,,,,460.2700,1783.2900,percent of total billed charges,"42.7% of $1,783.29 in Billed Charges for Rev 272 = $761.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
QUICKTRACH SZ 2MM,272,RC,,,,,,,,both,,,1783.2900,267.4900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1248.30,,,,,,,460.2700,1783.2900,percent of total billed charges,"Rev 272 $1,783.29 in Billed Charges at 70% = $1,248.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
QUICKTRACH SZ 2MM,272,RC,,,,,,,,both,,,1783.2900,267.4900,CIGNA HEALTHCARE,CIGNA HMO,743.63,,,,,,,460.2700,1783.2900,percent of total billed charges,"41.7% of $1,783.29 in Billed Charges for Rev 272 = $743.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
QUICKTRACH SZ 2MM,272,RC,,,,,,,,both,,,1783.2900,267.4900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,827.45,,,,,,,460.2700,1783.2900,percent of total billed charges,"46.4% of $1,783.29 in Billed Charges for Rev 272 = $827.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
QUICKTRACH SZ 2MM,272,RC,,,,,,,,both,,,1783.2900,267.4900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,743.63,,,,,,,460.2700,1783.2900,percent of total billed charges,"41.7% of $1,783.29 in Billed Charges for Rev 272 = $743.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
QUICKTRACH SZ 2MM,272,RC,,,,,,,,both,,,1783.2900,267.4900,CIGNA HEALTHCARE,CIGNA PPO,743.63,,,,,,,460.2700,1783.2900,percent of total billed charges,"41.7% of $1,783.29 in Billed Charges for Rev 272 = $743.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
QUICKTRACH SZ 2MM,272,RC,,,,,,,,both,,,1783.2900,267.4900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1604.96,,,,,,,460.2700,1783.2900,percent of total billed charges,"90% of $1,783.29 in Billed Charges for Rev 272 = $1,604.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
QUICKTRACH SZ 2MM,272,RC,,,,,,,,both,,,1783.2900,267.4900,MEDCOST,MEDCOST VHN,848.67,,,,,,,460.2700,1783.2900,percent of total billed charges,"47.59% of $1,783.29 in Billed Charges for Rev 272 = $848.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
QUICKTRACH SZ 2MM,272,RC,,,,,,,,both,,,1783.2900,267.4900,SENTARA HEALTH,SENTARA HEALTH,460.27,,,,,,,460.2700,1783.2900,percent of total billed charges,"25.81% of $1,783.29 in Billed Charges for Rev 272 = $460.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
QUICKTRACH SZ 2MM,272,RC,,,,,,,,both,,,1783.2900,267.4900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1783.29,,,,,,,460.2700,1783.2900,percent of total billed charges,"100% of $1,783.29 in Billed Charges for Rev 272 = $1,783.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
QUICKTRACH SZ 2MM,272,RC,,,,,,,,both,,,1783.2900,267.4900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,891.65,,,,,,,460.2700,1783.2900,percent of total billed charges,"Rev 272 $1,783.29 in Billed Charges at 50% = $891.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
QUICKTRACH SZ 2MM,272,RC,,,,,,,,both,,,1783.2900,267.4900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,576.00,,,,,,,460.2700,1783.2900,other,"32.3% of $1,783.29 in Billed Charges for Rev 272 = $576.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
QUICKTRACH SZ 2MM,272,RC,,,,,,,,both,,,1783.2900,267.4900,UNITED HEALTHCARE,UHC HERITAGE SELECT,547.47,,,,,,,460.2700,1783.2900,other,"30.7% of $1,783.29 in Billed Charges for Rev 272 = $547.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
QUICKTRACH SZ 2MM,272,RC,,,,,,,,both,,,1783.2900,267.4900,UNITED HEALTHCARE,UNITED HEALTHCARE,576.00,,,,,,,460.2700,1783.2900,percent of total billed charges,"32.3% of $1,783.29 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
QUICKTRACH SZ 2MM,272,RC,,,,,,,,both,,,1783.2900,267.4900,WELLCARE,WELLCARE MEDICAID,1783.29,,,,,,,460.2700,1783.2900,percent of total billed charges,"100% of $1,783.29 in Billed Charges for Rev 272 = $1,783.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCODIAL METAL CUTTING 3.2X18.3MM,272,RC,27200002,CDM,,,,,,both,,,1314.8400,197.2300,AETNA,AETNA,561.44,,,,,,,339.3600,1314.8400,percent of total billed charges,"42.7% of $1,314.84 in Billed Charges for Rev 272 = $561.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCODIAL METAL CUTTING 3.2X18.3MM,272,RC,27200002,CDM,,,,,,both,,,1314.8400,197.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,920.39,,,,,,,339.3600,1314.8400,percent of total billed charges,"Rev 272 $1,314.84 in Billed Charges at 70% = $920.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCODIAL METAL CUTTING 3.2X18.3MM,272,RC,27200002,CDM,,,,,,both,,,1314.8400,197.2300,CIGNA HEALTHCARE,CIGNA HMO,548.29,,,,,,,339.3600,1314.8400,percent of total billed charges,"41.7% of $1,314.84 in Billed Charges for Rev 272 = $548.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCODIAL METAL CUTTING 3.2X18.3MM,272,RC,27200002,CDM,,,,,,both,,,1314.8400,197.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,610.09,,,,,,,339.3600,1314.8400,percent of total billed charges,"46.4% of $1,314.84 in Billed Charges for Rev 272 = $610.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCODIAL METAL CUTTING 3.2X18.3MM,272,RC,27200002,CDM,,,,,,both,,,1314.8400,197.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,548.29,,,,,,,339.3600,1314.8400,percent of total billed charges,"41.7% of $1,314.84 in Billed Charges for Rev 272 = $548.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCODIAL METAL CUTTING 3.2X18.3MM,272,RC,27200002,CDM,,,,,,both,,,1314.8400,197.2300,CIGNA HEALTHCARE,CIGNA PPO,548.29,,,,,,,339.3600,1314.8400,percent of total billed charges,"41.7% of $1,314.84 in Billed Charges for Rev 272 = $548.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCODIAL METAL CUTTING 3.2X18.3MM,272,RC,27200002,CDM,,,,,,both,,,1314.8400,197.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1183.36,,,,,,,339.3600,1314.8400,percent of total billed charges,"90% of $1,314.84 in Billed Charges for Rev 272 = $1,183.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCODIAL METAL CUTTING 3.2X18.3MM,272,RC,27200002,CDM,,,,,,both,,,1314.8400,197.2300,MEDCOST,MEDCOST VHN,625.73,,,,,,,339.3600,1314.8400,percent of total billed charges,"47.59% of $1,314.84 in Billed Charges for Rev 272 = $625.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCODIAL METAL CUTTING 3.2X18.3MM,272,RC,27200002,CDM,,,,,,both,,,1314.8400,197.2300,SENTARA HEALTH,SENTARA HEALTH,339.36,,,,,,,339.3600,1314.8400,percent of total billed charges,"25.81% of $1,314.84 in Billed Charges for Rev 272 = $339.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCODIAL METAL CUTTING 3.2X18.3MM,272,RC,27200002,CDM,,,,,,both,,,1314.8400,197.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1314.84,,,,,,,339.3600,1314.8400,percent of total billed charges,"100% of $1,314.84 in Billed Charges for Rev 272 = $1,314.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCODIAL METAL CUTTING 3.2X18.3MM,272,RC,27200002,CDM,,,,,,both,,,1314.8400,197.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,657.42,,,,,,,339.3600,1314.8400,percent of total billed charges,"Rev 272 $1,314.84 in Billed Charges at 50% = $657.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCODIAL METAL CUTTING 3.2X18.3MM,272,RC,27200002,CDM,,,,,,both,,,1314.8400,197.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,424.69,,,,,,,339.3600,1314.8400,other,"32.3% of $1,314.84 in Billed Charges for Rev 272 = $424.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RASP HELIOCODIAL METAL CUTTING 3.2X18.3MM,272,RC,27200002,CDM,,,,,,both,,,1314.8400,197.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,403.66,,,,,,,339.3600,1314.8400,other,"30.7% of $1,314.84 in Billed Charges for Rev 272 = $403.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RASP HELIOCODIAL METAL CUTTING 3.2X18.3MM,272,RC,27200002,CDM,,,,,,both,,,1314.8400,197.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,424.69,,,,,,,339.3600,1314.8400,percent of total billed charges,"32.3% of $1,314.84 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCODIAL METAL CUTTING 3.2X18.3MM,272,RC,27200002,CDM,,,,,,both,,,1314.8400,197.2300,WELLCARE,WELLCARE MEDICAID,1314.84,,,,,,,339.3600,1314.8400,percent of total billed charges,"100% of $1,314.84 in Billed Charges for Rev 272 = $1,314.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HEMOSTAT SURGICEL SNOW 2X4,272,RC,27200002,CDM,,,,,,both,,,862.1100,129.3200,AETNA,AETNA,368.12,,,,,,,222.5100,862.1100,percent of total billed charges,42.7% of $862.11 in Billed Charges for Rev 272 = $368.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL SNOW 2X4,272,RC,27200002,CDM,,,,,,both,,,862.1100,129.3200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,603.48,,,,,,,222.5100,862.1100,percent of total billed charges,Rev 272 $862.11 in Billed Charges at 70% = $603.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL SNOW 2X4,272,RC,27200002,CDM,,,,,,both,,,862.1100,129.3200,CIGNA HEALTHCARE,CIGNA HMO,359.50,,,,,,,222.5100,862.1100,percent of total billed charges,41.7% of $862.11 in Billed Charges for Rev 272 = $359.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL SNOW 2X4,272,RC,27200002,CDM,,,,,,both,,,862.1100,129.3200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,400.02,,,,,,,222.5100,862.1100,percent of total billed charges,46.4% of $862.11 in Billed Charges for Rev 272 = $400.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL SNOW 2X4,272,RC,27200002,CDM,,,,,,both,,,862.1100,129.3200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,359.50,,,,,,,222.5100,862.1100,percent of total billed charges,41.7% of $862.11 in Billed Charges for Rev 272 = $359.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL SNOW 2X4,272,RC,27200002,CDM,,,,,,both,,,862.1100,129.3200,CIGNA HEALTHCARE,CIGNA PPO,359.50,,,,,,,222.5100,862.1100,percent of total billed charges,41.7% of $862.11 in Billed Charges for Rev 272 = $359.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL SNOW 2X4,272,RC,27200002,CDM,,,,,,both,,,862.1100,129.3200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,775.90,,,,,,,222.5100,862.1100,percent of total billed charges,90% of $862.11 in Billed Charges for Rev 272 = $775.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL SNOW 2X4,272,RC,27200002,CDM,,,,,,both,,,862.1100,129.3200,MEDCOST,MEDCOST VHN,410.28,,,,,,,222.5100,862.1100,percent of total billed charges,47.59% of $862.11 in Billed Charges for Rev 272 = $410.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL SNOW 2X4,272,RC,27200002,CDM,,,,,,both,,,862.1100,129.3200,SENTARA HEALTH,SENTARA HEALTH,222.51,,,,,,,222.5100,862.1100,percent of total billed charges,25.81% of $862.11 in Billed Charges for Rev 272 = $222.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL SNOW 2X4,272,RC,27200002,CDM,,,,,,both,,,862.1100,129.3200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",862.11,,,,,,,222.5100,862.1100,percent of total billed charges,100% of $862.11 in Billed Charges for Rev 272 = $862.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL SNOW 2X4,272,RC,27200002,CDM,,,,,,both,,,862.1100,129.3200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,431.06,,,,,,,222.5100,862.1100,percent of total billed charges,Rev 272 $862.11 in Billed Charges at 50% = $431.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL SNOW 2X4,272,RC,27200002,CDM,,,,,,both,,,862.1100,129.3200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,278.46,,,,,,,222.5100,862.1100,other,32.3% of $862.11 in Billed Charges for Rev 272 = $278.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HEMOSTAT SURGICEL SNOW 2X4,272,RC,27200002,CDM,,,,,,both,,,862.1100,129.3200,UNITED HEALTHCARE,UHC HERITAGE SELECT,264.67,,,,,,,222.5100,862.1100,other,30.7% of $862.11 in Billed Charges for Rev 272 = $264.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HEMOSTAT SURGICEL SNOW 2X4,272,RC,27200002,CDM,,,,,,both,,,862.1100,129.3200,UNITED HEALTHCARE,UNITED HEALTHCARE,278.46,,,,,,,222.5100,862.1100,percent of total billed charges,32.3% of $862.11 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HEMOSTAT SURGICEL SNOW 2X4,272,RC,27200002,CDM,,,,,,both,,,862.1100,129.3200,WELLCARE,WELLCARE MEDICAID,862.11,,,,,,,222.5100,862.1100,percent of total billed charges,100% of $862.11 in Billed Charges for Rev 272 = $862.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT ALLOGRAFT OATS DISPOSABLES 20MM,272,RC,27200002,CDM,,,,,,both,,,20742.0000,3111.3000,AETNA,AETNA,8856.83,,,,,,,5353.5100,20742.0000,percent of total billed charges,"42.7% of $20,742.00 in Billed Charges for Rev 272 = $8,856.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ALLOGRAFT OATS DISPOSABLES 20MM,272,RC,27200002,CDM,,,,,,both,,,20742.0000,3111.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,14519.40,,,,,,,5353.5100,20742.0000,percent of total billed charges,"Rev 272 $20,742.00 in Billed Charges at 70% = $14,519.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ALLOGRAFT OATS DISPOSABLES 20MM,272,RC,27200002,CDM,,,,,,both,,,20742.0000,3111.3000,CIGNA HEALTHCARE,CIGNA HMO,8649.41,,,,,,,5353.5100,20742.0000,percent of total billed charges,"41.7% of $20,742.00 in Billed Charges for Rev 272 = $8,649.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ALLOGRAFT OATS DISPOSABLES 20MM,272,RC,27200002,CDM,,,,,,both,,,20742.0000,3111.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,9624.29,,,,,,,5353.5100,20742.0000,percent of total billed charges,"46.4% of $20,742.00 in Billed Charges for Rev 272 = $9,624.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ALLOGRAFT OATS DISPOSABLES 20MM,272,RC,27200002,CDM,,,,,,both,,,20742.0000,3111.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8649.41,,,,,,,5353.5100,20742.0000,percent of total billed charges,"41.7% of $20,742.00 in Billed Charges for Rev 272 = $8,649.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ALLOGRAFT OATS DISPOSABLES 20MM,272,RC,27200002,CDM,,,,,,both,,,20742.0000,3111.3000,CIGNA HEALTHCARE,CIGNA PPO,8649.41,,,,,,,5353.5100,20742.0000,percent of total billed charges,"41.7% of $20,742.00 in Billed Charges for Rev 272 = $8,649.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ALLOGRAFT OATS DISPOSABLES 20MM,272,RC,27200002,CDM,,,,,,both,,,20742.0000,3111.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,18667.80,,,,,,,5353.5100,20742.0000,percent of total billed charges,"90% of $20,742.00 in Billed Charges for Rev 272 = $18,667.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ALLOGRAFT OATS DISPOSABLES 20MM,272,RC,27200002,CDM,,,,,,both,,,20742.0000,3111.3000,MEDCOST,MEDCOST VHN,9871.12,,,,,,,5353.5100,20742.0000,percent of total billed charges,"47.59% of $20,742.00 in Billed Charges for Rev 272 = $9,871.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ALLOGRAFT OATS DISPOSABLES 20MM,272,RC,27200002,CDM,,,,,,both,,,20742.0000,3111.3000,SENTARA HEALTH,SENTARA HEALTH,5353.51,,,,,,,5353.5100,20742.0000,percent of total billed charges,"25.81% of $20,742.00 in Billed Charges for Rev 272 = $5,353.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ALLOGRAFT OATS DISPOSABLES 20MM,272,RC,27200002,CDM,,,,,,both,,,20742.0000,3111.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",20742.00,,,,,,,5353.5100,20742.0000,percent of total billed charges,"100% of $20,742.00 in Billed Charges for Rev 272 = $20,742.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ALLOGRAFT OATS DISPOSABLES 20MM,272,RC,27200002,CDM,,,,,,both,,,20742.0000,3111.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,10371.00,,,,,,,5353.5100,20742.0000,percent of total billed charges,"Rev 272 $20,742.00 in Billed Charges at 50% = $10,371.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ALLOGRAFT OATS DISPOSABLES 20MM,272,RC,27200002,CDM,,,,,,both,,,20742.0000,3111.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,6699.67,,,,,,,5353.5100,20742.0000,other,"32.3% of $20,742.00 in Billed Charges for Rev 272 = $6,699.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ALLOGRAFT OATS DISPOSABLES 20MM,272,RC,27200002,CDM,,,,,,both,,,20742.0000,3111.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,6367.79,,,,,,,5353.5100,20742.0000,other,"30.7% of $20,742.00 in Billed Charges for Rev 272 = $6,367.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT ALLOGRAFT OATS DISPOSABLES 20MM,272,RC,27200002,CDM,,,,,,both,,,20742.0000,3111.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,6699.67,,,,,,,5353.5100,20742.0000,percent of total billed charges,"32.3% of $20,742.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT ALLOGRAFT OATS DISPOSABLES 20MM,272,RC,27200002,CDM,,,,,,both,,,20742.0000,3111.3000,WELLCARE,WELLCARE MEDICAID,20742.00,,,,,,,5353.5100,20742.0000,percent of total billed charges,"100% of $20,742.00 in Billed Charges for Rev 272 = $20,742.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCOIDAL 3.2X18.33,272,RC,27200002,CDM,,,,,,both,,,1184.1600,177.6200,AETNA,AETNA,505.64,,,,,,,305.6300,1184.1600,percent of total billed charges,"42.7% of $1,184.16 in Billed Charges for Rev 272 = $505.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCOIDAL 3.2X18.33,272,RC,27200002,CDM,,,,,,both,,,1184.1600,177.6200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,828.91,,,,,,,305.6300,1184.1600,percent of total billed charges,"Rev 272 $1,184.16 in Billed Charges at 70% = $828.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCOIDAL 3.2X18.33,272,RC,27200002,CDM,,,,,,both,,,1184.1600,177.6200,CIGNA HEALTHCARE,CIGNA HMO,493.79,,,,,,,305.6300,1184.1600,percent of total billed charges,"41.7% of $1,184.16 in Billed Charges for Rev 272 = $493.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCOIDAL 3.2X18.33,272,RC,27200002,CDM,,,,,,both,,,1184.1600,177.6200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,549.45,,,,,,,305.6300,1184.1600,percent of total billed charges,"46.4% of $1,184.16 in Billed Charges for Rev 272 = $549.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCOIDAL 3.2X18.33,272,RC,27200002,CDM,,,,,,both,,,1184.1600,177.6200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,493.79,,,,,,,305.6300,1184.1600,percent of total billed charges,"41.7% of $1,184.16 in Billed Charges for Rev 272 = $493.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCOIDAL 3.2X18.33,272,RC,27200002,CDM,,,,,,both,,,1184.1600,177.6200,CIGNA HEALTHCARE,CIGNA PPO,493.79,,,,,,,305.6300,1184.1600,percent of total billed charges,"41.7% of $1,184.16 in Billed Charges for Rev 272 = $493.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCOIDAL 3.2X18.33,272,RC,27200002,CDM,,,,,,both,,,1184.1600,177.6200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1065.74,,,,,,,305.6300,1184.1600,percent of total billed charges,"90% of $1,184.16 in Billed Charges for Rev 272 = $1,065.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCOIDAL 3.2X18.33,272,RC,27200002,CDM,,,,,,both,,,1184.1600,177.6200,MEDCOST,MEDCOST VHN,563.54,,,,,,,305.6300,1184.1600,percent of total billed charges,"47.59% of $1,184.16 in Billed Charges for Rev 272 = $563.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCOIDAL 3.2X18.33,272,RC,27200002,CDM,,,,,,both,,,1184.1600,177.6200,SENTARA HEALTH,SENTARA HEALTH,305.63,,,,,,,305.6300,1184.1600,percent of total billed charges,"25.81% of $1,184.16 in Billed Charges for Rev 272 = $305.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCOIDAL 3.2X18.33,272,RC,27200002,CDM,,,,,,both,,,1184.1600,177.6200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1184.16,,,,,,,305.6300,1184.1600,percent of total billed charges,"100% of $1,184.16 in Billed Charges for Rev 272 = $1,184.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCOIDAL 3.2X18.33,272,RC,27200002,CDM,,,,,,both,,,1184.1600,177.6200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,592.08,,,,,,,305.6300,1184.1600,percent of total billed charges,"Rev 272 $1,184.16 in Billed Charges at 50% = $592.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCOIDAL 3.2X18.33,272,RC,27200002,CDM,,,,,,both,,,1184.1600,177.6200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,382.48,,,,,,,305.6300,1184.1600,other,"32.3% of $1,184.16 in Billed Charges for Rev 272 = $382.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RASP HELIOCOIDAL 3.2X18.33,272,RC,27200002,CDM,,,,,,both,,,1184.1600,177.6200,UNITED HEALTHCARE,UHC HERITAGE SELECT,363.54,,,,,,,305.6300,1184.1600,other,"30.7% of $1,184.16 in Billed Charges for Rev 272 = $363.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RASP HELIOCOIDAL 3.2X18.33,272,RC,27200002,CDM,,,,,,both,,,1184.1600,177.6200,UNITED HEALTHCARE,UNITED HEALTHCARE,382.48,,,,,,,305.6300,1184.1600,percent of total billed charges,"32.3% of $1,184.16 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP HELIOCOIDAL 3.2X18.33,272,RC,27200002,CDM,,,,,,both,,,1184.1600,177.6200,WELLCARE,WELLCARE MEDICAID,1184.16,,,,,,,305.6300,1184.1600,percent of total billed charges,"100% of $1,184.16 in Billed Charges for Rev 272 = $1,184.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,1046.1200,156.9200,AETNA,AETNA,446.69,,,,,,,270.0000,1046.1200,percent of total billed charges,"42.7% of $1,046.12 in Billed Charges for Rev 272 = $446.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,1046.1200,156.9200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,732.28,,,,,,,270.0000,1046.1200,percent of total billed charges,"Rev 272 $1,046.12 in Billed Charges at 70% = $732.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,1046.1200,156.9200,CIGNA HEALTHCARE,CIGNA HMO,436.23,,,,,,,270.0000,1046.1200,percent of total billed charges,"41.7% of $1,046.12 in Billed Charges for Rev 272 = $436.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,1046.1200,156.9200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,485.40,,,,,,,270.0000,1046.1200,percent of total billed charges,"46.4% of $1,046.12 in Billed Charges for Rev 272 = $485.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,1046.1200,156.9200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,436.23,,,,,,,270.0000,1046.1200,percent of total billed charges,"41.7% of $1,046.12 in Billed Charges for Rev 272 = $436.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,1046.1200,156.9200,CIGNA HEALTHCARE,CIGNA PPO,436.23,,,,,,,270.0000,1046.1200,percent of total billed charges,"41.7% of $1,046.12 in Billed Charges for Rev 272 = $436.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,1046.1200,156.9200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,941.51,,,,,,,270.0000,1046.1200,percent of total billed charges,"90% of $1,046.12 in Billed Charges for Rev 272 = $941.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,1046.1200,156.9200,MEDCOST,MEDCOST VHN,497.85,,,,,,,270.0000,1046.1200,percent of total billed charges,"47.59% of $1,046.12 in Billed Charges for Rev 272 = $497.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,1046.1200,156.9200,SENTARA HEALTH,SENTARA HEALTH,270.00,,,,,,,270.0000,1046.1200,percent of total billed charges,"25.81% of $1,046.12 in Billed Charges for Rev 272 = $270.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,1046.1200,156.9200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1046.12,,,,,,,270.0000,1046.1200,percent of total billed charges,"100% of $1,046.12 in Billed Charges for Rev 272 = $1,046.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,1046.1200,156.9200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,523.06,,,,,,,270.0000,1046.1200,percent of total billed charges,"Rev 272 $1,046.12 in Billed Charges at 50% = $523.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,1046.1200,156.9200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,337.90,,,,,,,270.0000,1046.1200,other,"32.3% of $1,046.12 in Billed Charges for Rev 272 = $337.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,1046.1200,156.9200,UNITED HEALTHCARE,UHC HERITAGE SELECT,321.16,,,,,,,270.0000,1046.1200,other,"30.7% of $1,046.12 in Billed Charges for Rev 272 = $321.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,1046.1200,156.9200,UNITED HEALTHCARE,UNITED HEALTHCARE,337.90,,,,,,,270.0000,1046.1200,percent of total billed charges,"32.3% of $1,046.12 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,1046.1200,156.9200,WELLCARE,WELLCARE MEDICAID,1046.12,,,,,,,270.0000,1046.1200,percent of total billed charges,"100% of $1,046.12 in Billed Charges for Rev 272 = $1,046.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 30 2.0 GRAY 48630M,272,RC,27200002,CDM,,,,,,both,,,1860.7300,279.1100,AETNA,AETNA,794.53,,,,,,,480.2500,1860.7300,percent of total billed charges,"42.7% of $1,860.73 in Billed Charges for Rev 272 = $794.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 30 2.0 GRAY 48630M,272,RC,27200002,CDM,,,,,,both,,,1860.7300,279.1100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1302.51,,,,,,,480.2500,1860.7300,percent of total billed charges,"Rev 272 $1,860.73 in Billed Charges at 70% = $1,302.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 30 2.0 GRAY 48630M,272,RC,27200002,CDM,,,,,,both,,,1860.7300,279.1100,CIGNA HEALTHCARE,CIGNA HMO,775.92,,,,,,,480.2500,1860.7300,percent of total billed charges,"41.7% of $1,860.73 in Billed Charges for Rev 272 = $775.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 30 2.0 GRAY 48630M,272,RC,27200002,CDM,,,,,,both,,,1860.7300,279.1100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,863.38,,,,,,,480.2500,1860.7300,percent of total billed charges,"46.4% of $1,860.73 in Billed Charges for Rev 272 = $863.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 30 2.0 GRAY 48630M,272,RC,27200002,CDM,,,,,,both,,,1860.7300,279.1100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,775.92,,,,,,,480.2500,1860.7300,percent of total billed charges,"41.7% of $1,860.73 in Billed Charges for Rev 272 = $775.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 30 2.0 GRAY 48630M,272,RC,27200002,CDM,,,,,,both,,,1860.7300,279.1100,CIGNA HEALTHCARE,CIGNA PPO,775.92,,,,,,,480.2500,1860.7300,percent of total billed charges,"41.7% of $1,860.73 in Billed Charges for Rev 272 = $775.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 30 2.0 GRAY 48630M,272,RC,27200002,CDM,,,,,,both,,,1860.7300,279.1100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1674.66,,,,,,,480.2500,1860.7300,percent of total billed charges,"90% of $1,860.73 in Billed Charges for Rev 272 = $1,674.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 30 2.0 GRAY 48630M,272,RC,27200002,CDM,,,,,,both,,,1860.7300,279.1100,MEDCOST,MEDCOST VHN,885.52,,,,,,,480.2500,1860.7300,percent of total billed charges,"47.59% of $1,860.73 in Billed Charges for Rev 272 = $885.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 30 2.0 GRAY 48630M,272,RC,27200002,CDM,,,,,,both,,,1860.7300,279.1100,SENTARA HEALTH,SENTARA HEALTH,480.25,,,,,,,480.2500,1860.7300,percent of total billed charges,"25.81% of $1,860.73 in Billed Charges for Rev 272 = $480.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 30 2.0 GRAY 48630M,272,RC,27200002,CDM,,,,,,both,,,1860.7300,279.1100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1860.73,,,,,,,480.2500,1860.7300,percent of total billed charges,"100% of $1,860.73 in Billed Charges for Rev 272 = $1,860.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 30 2.0 GRAY 48630M,272,RC,27200002,CDM,,,,,,both,,,1860.7300,279.1100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,930.37,,,,,,,480.2500,1860.7300,percent of total billed charges,"Rev 272 $1,860.73 in Billed Charges at 50% = $930.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 30 2.0 GRAY 48630M,272,RC,27200002,CDM,,,,,,both,,,1860.7300,279.1100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,601.02,,,,,,,480.2500,1860.7300,other,"32.3% of $1,860.73 in Billed Charges for Rev 272 = $601.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD SUREFORM 30 2.0 GRAY 48630M,272,RC,27200002,CDM,,,,,,both,,,1860.7300,279.1100,UNITED HEALTHCARE,UHC HERITAGE SELECT,571.24,,,,,,,480.2500,1860.7300,other,"30.7% of $1,860.73 in Billed Charges for Rev 272 = $571.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD SUREFORM 30 2.0 GRAY 48630M,272,RC,27200002,CDM,,,,,,both,,,1860.7300,279.1100,UNITED HEALTHCARE,UNITED HEALTHCARE,601.02,,,,,,,480.2500,1860.7300,percent of total billed charges,"32.3% of $1,860.73 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 30 2.0 GRAY 48630M,272,RC,27200002,CDM,,,,,,both,,,1860.7300,279.1100,WELLCARE,WELLCARE MEDICAID,1860.73,,,,,,,480.2500,1860.7300,percent of total billed charges,"100% of $1,860.73 in Billed Charges for Rev 272 = $1,860.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE HARVESTING FOR RIA2,272,RC,27200002,CDM,,,,,,both,,,30123.6100,4518.5400,AETNA,AETNA,12862.78,,,,,,,7774.9000,30123.6100,percent of total billed charges,"42.7% of $30,123.61 in Billed Charges for Rev 272 = $12,862.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE HARVESTING FOR RIA2,272,RC,27200002,CDM,,,,,,both,,,30123.6100,4518.5400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,21086.53,,,,,,,7774.9000,30123.6100,percent of total billed charges,"Rev 272 $30,123.61 in Billed Charges at 70% = $21,086.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE HARVESTING FOR RIA2,272,RC,27200002,CDM,,,,,,both,,,30123.6100,4518.5400,CIGNA HEALTHCARE,CIGNA HMO,12561.55,,,,,,,7774.9000,30123.6100,percent of total billed charges,"41.7% of $30,123.61 in Billed Charges for Rev 272 = $12,561.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE HARVESTING FOR RIA2,272,RC,27200002,CDM,,,,,,both,,,30123.6100,4518.5400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,13977.36,,,,,,,7774.9000,30123.6100,percent of total billed charges,"46.4% of $30,123.61 in Billed Charges for Rev 272 = $13,977.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE HARVESTING FOR RIA2,272,RC,27200002,CDM,,,,,,both,,,30123.6100,4518.5400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,12561.55,,,,,,,7774.9000,30123.6100,percent of total billed charges,"41.7% of $30,123.61 in Billed Charges for Rev 272 = $12,561.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE HARVESTING FOR RIA2,272,RC,27200002,CDM,,,,,,both,,,30123.6100,4518.5400,CIGNA HEALTHCARE,CIGNA PPO,12561.55,,,,,,,7774.9000,30123.6100,percent of total billed charges,"41.7% of $30,123.61 in Billed Charges for Rev 272 = $12,561.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE HARVESTING FOR RIA2,272,RC,27200002,CDM,,,,,,both,,,30123.6100,4518.5400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,27111.25,,,,,,,7774.9000,30123.6100,percent of total billed charges,"90% of $30,123.61 in Billed Charges for Rev 272 = $27,111.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE HARVESTING FOR RIA2,272,RC,27200002,CDM,,,,,,both,,,30123.6100,4518.5400,MEDCOST,MEDCOST VHN,14335.83,,,,,,,7774.9000,30123.6100,percent of total billed charges,"47.59% of $30,123.61 in Billed Charges for Rev 272 = $14,335.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE HARVESTING FOR RIA2,272,RC,27200002,CDM,,,,,,both,,,30123.6100,4518.5400,SENTARA HEALTH,SENTARA HEALTH,7774.90,,,,,,,7774.9000,30123.6100,percent of total billed charges,"25.81% of $30,123.61 in Billed Charges for Rev 272 = $7,774.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE HARVESTING FOR RIA2,272,RC,27200002,CDM,,,,,,both,,,30123.6100,4518.5400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",30123.61,,,,,,,7774.9000,30123.6100,percent of total billed charges,"100% of $30,123.61 in Billed Charges for Rev 272 = $30,123.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE HARVESTING FOR RIA2,272,RC,27200002,CDM,,,,,,both,,,30123.6100,4518.5400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,15061.81,,,,,,,7774.9000,30123.6100,percent of total billed charges,"Rev 272 $30,123.61 in Billed Charges at 50% = $15,061.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE HARVESTING FOR RIA2,272,RC,27200002,CDM,,,,,,both,,,30123.6100,4518.5400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,9729.93,,,,,,,7774.9000,30123.6100,other,"32.3% of $30,123.61 in Billed Charges for Rev 272 = $9,729.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT BONE HARVESTING FOR RIA2,272,RC,27200002,CDM,,,,,,both,,,30123.6100,4518.5400,UNITED HEALTHCARE,UHC HERITAGE SELECT,9247.95,,,,,,,7774.9000,30123.6100,other,"30.7% of $30,123.61 in Billed Charges for Rev 272 = $9,247.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT BONE HARVESTING FOR RIA2,272,RC,27200002,CDM,,,,,,both,,,30123.6100,4518.5400,UNITED HEALTHCARE,UNITED HEALTHCARE,9729.93,,,,,,,7774.9000,30123.6100,percent of total billed charges,"32.3% of $30,123.61 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE HARVESTING FOR RIA2,272,RC,27200002,CDM,,,,,,both,,,30123.6100,4518.5400,WELLCARE,WELLCARE MEDICAID,30123.61,,,,,,,7774.9000,30123.6100,percent of total billed charges,"100% of $30,123.61 in Billed Charges for Rev 272 = $30,123.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TRI STAPLE 60MM JCMC OPEN HEART ONLY,272,RC,27200002,CDM,,,,,,both,,,9392.5200,1408.8800,AETNA,AETNA,4010.61,,,,,,,2424.2100,9392.5200,percent of total billed charges,"42.7% of $9,392.52 in Billed Charges for Rev 272 = $4,010.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TRI STAPLE 60MM JCMC OPEN HEART ONLY,272,RC,27200002,CDM,,,,,,both,,,9392.5200,1408.8800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6574.76,,,,,,,2424.2100,9392.5200,percent of total billed charges,"Rev 272 $9,392.52 in Billed Charges at 70% = $6,574.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TRI STAPLE 60MM JCMC OPEN HEART ONLY,272,RC,27200002,CDM,,,,,,both,,,9392.5200,1408.8800,CIGNA HEALTHCARE,CIGNA HMO,3916.68,,,,,,,2424.2100,9392.5200,percent of total billed charges,"41.7% of $9,392.52 in Billed Charges for Rev 272 = $3,916.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TRI STAPLE 60MM JCMC OPEN HEART ONLY,272,RC,27200002,CDM,,,,,,both,,,9392.5200,1408.8800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4358.13,,,,,,,2424.2100,9392.5200,percent of total billed charges,"46.4% of $9,392.52 in Billed Charges for Rev 272 = $4,358.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TRI STAPLE 60MM JCMC OPEN HEART ONLY,272,RC,27200002,CDM,,,,,,both,,,9392.5200,1408.8800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3916.68,,,,,,,2424.2100,9392.5200,percent of total billed charges,"41.7% of $9,392.52 in Billed Charges for Rev 272 = $3,916.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TRI STAPLE 60MM JCMC OPEN HEART ONLY,272,RC,27200002,CDM,,,,,,both,,,9392.5200,1408.8800,CIGNA HEALTHCARE,CIGNA PPO,3916.68,,,,,,,2424.2100,9392.5200,percent of total billed charges,"41.7% of $9,392.52 in Billed Charges for Rev 272 = $3,916.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TRI STAPLE 60MM JCMC OPEN HEART ONLY,272,RC,27200002,CDM,,,,,,both,,,9392.5200,1408.8800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8453.27,,,,,,,2424.2100,9392.5200,percent of total billed charges,"90% of $9,392.52 in Billed Charges for Rev 272 = $8,453.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TRI STAPLE 60MM JCMC OPEN HEART ONLY,272,RC,27200002,CDM,,,,,,both,,,9392.5200,1408.8800,MEDCOST,MEDCOST VHN,4469.90,,,,,,,2424.2100,9392.5200,percent of total billed charges,"47.59% of $9,392.52 in Billed Charges for Rev 272 = $4,469.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TRI STAPLE 60MM JCMC OPEN HEART ONLY,272,RC,27200002,CDM,,,,,,both,,,9392.5200,1408.8800,SENTARA HEALTH,SENTARA HEALTH,2424.21,,,,,,,2424.2100,9392.5200,percent of total billed charges,"25.81% of $9,392.52 in Billed Charges for Rev 272 = $2,424.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TRI STAPLE 60MM JCMC OPEN HEART ONLY,272,RC,27200002,CDM,,,,,,both,,,9392.5200,1408.8800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9392.52,,,,,,,2424.2100,9392.5200,percent of total billed charges,"100% of $9,392.52 in Billed Charges for Rev 272 = $9,392.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TRI STAPLE 60MM JCMC OPEN HEART ONLY,272,RC,27200002,CDM,,,,,,both,,,9392.5200,1408.8800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4696.26,,,,,,,2424.2100,9392.5200,percent of total billed charges,"Rev 272 $9,392.52 in Billed Charges at 50% = $4,696.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TRI STAPLE 60MM JCMC OPEN HEART ONLY,272,RC,27200002,CDM,,,,,,both,,,9392.5200,1408.8800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3033.78,,,,,,,2424.2100,9392.5200,other,"32.3% of $9,392.52 in Billed Charges for Rev 272 = $3,033.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD TRI STAPLE 60MM JCMC OPEN HEART ONLY,272,RC,27200002,CDM,,,,,,both,,,9392.5200,1408.8800,UNITED HEALTHCARE,UHC HERITAGE SELECT,2883.50,,,,,,,2424.2100,9392.5200,other,"30.7% of $9,392.52 in Billed Charges for Rev 272 = $2,883.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD TRI STAPLE 60MM JCMC OPEN HEART ONLY,272,RC,27200002,CDM,,,,,,both,,,9392.5200,1408.8800,UNITED HEALTHCARE,UNITED HEALTHCARE,3033.78,,,,,,,2424.2100,9392.5200,percent of total billed charges,"32.3% of $9,392.52 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TRI STAPLE 60MM JCMC OPEN HEART ONLY,272,RC,27200002,CDM,,,,,,both,,,9392.5200,1408.8800,WELLCARE,WELLCARE MEDICAID,9392.52,,,,,,,2424.2100,9392.5200,percent of total billed charges,"100% of $9,392.52 in Billed Charges for Rev 272 = $9,392.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,1018.2800,152.7400,AETNA,AETNA,434.81,,,,,,,262.8200,1018.2800,percent of total billed charges,"42.7% of $1,018.28 in Billed Charges for Rev 272 = $434.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,1018.2800,152.7400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,712.80,,,,,,,262.8200,1018.2800,percent of total billed charges,"Rev 272 $1,018.28 in Billed Charges at 70% = $712.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,1018.2800,152.7400,CIGNA HEALTHCARE,CIGNA HMO,424.62,,,,,,,262.8200,1018.2800,percent of total billed charges,"41.7% of $1,018.28 in Billed Charges for Rev 272 = $424.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,1018.2800,152.7400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,472.48,,,,,,,262.8200,1018.2800,percent of total billed charges,"46.4% of $1,018.28 in Billed Charges for Rev 272 = $472.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,1018.2800,152.7400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,424.62,,,,,,,262.8200,1018.2800,percent of total billed charges,"41.7% of $1,018.28 in Billed Charges for Rev 272 = $424.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,1018.2800,152.7400,CIGNA HEALTHCARE,CIGNA PPO,424.62,,,,,,,262.8200,1018.2800,percent of total billed charges,"41.7% of $1,018.28 in Billed Charges for Rev 272 = $424.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,1018.2800,152.7400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,916.45,,,,,,,262.8200,1018.2800,percent of total billed charges,"90% of $1,018.28 in Billed Charges for Rev 272 = $916.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,1018.2800,152.7400,MEDCOST,MEDCOST VHN,484.60,,,,,,,262.8200,1018.2800,percent of total billed charges,"47.59% of $1,018.28 in Billed Charges for Rev 272 = $484.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,1018.2800,152.7400,SENTARA HEALTH,SENTARA HEALTH,262.82,,,,,,,262.8200,1018.2800,percent of total billed charges,"25.81% of $1,018.28 in Billed Charges for Rev 272 = $262.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,1018.2800,152.7400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1018.28,,,,,,,262.8200,1018.2800,percent of total billed charges,"100% of $1,018.28 in Billed Charges for Rev 272 = $1,018.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,1018.2800,152.7400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,509.14,,,,,,,262.8200,1018.2800,percent of total billed charges,"Rev 272 $1,018.28 in Billed Charges at 50% = $509.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,1018.2800,152.7400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,328.90,,,,,,,262.8200,1018.2800,other,"32.3% of $1,018.28 in Billed Charges for Rev 272 = $328.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,1018.2800,152.7400,UNITED HEALTHCARE,UHC HERITAGE SELECT,312.61,,,,,,,262.8200,1018.2800,other,"30.7% of $1,018.28 in Billed Charges for Rev 272 = $312.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,1018.2800,152.7400,UNITED HEALTHCARE,UNITED HEALTHCARE,328.90,,,,,,,262.8200,1018.2800,percent of total billed charges,"32.3% of $1,018.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT BONE PREP STRYKER 206-710,272,RC,27200002,CDM,,,,,,both,,,1018.2800,152.7400,WELLCARE,WELLCARE MEDICAID,1018.28,,,,,,,262.8200,1018.2800,percent of total billed charges,"100% of $1,018.28 in Billed Charges for Rev 272 = $1,018.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC 2.7FR,272,RC,27201600,CDM,,,,,,both,,,2373.5100,356.0300,AETNA,AETNA,1013.49,,,,,,,612.6000,2373.5100,percent of total billed charges,"42.7% of $2,373.51 in Billed Charges for Rev 272 = $1,013.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC 2.7FR,272,RC,27201600,CDM,,,,,,both,,,2373.5100,356.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1661.46,,,,,,,612.6000,2373.5100,percent of total billed charges,"Rev 272 $2,373.51 in Billed Charges at 70% = $1,661.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC 2.7FR,272,RC,27201600,CDM,,,,,,both,,,2373.5100,356.0300,CIGNA HEALTHCARE,CIGNA HMO,989.75,,,,,,,612.6000,2373.5100,percent of total billed charges,"41.7% of $2,373.51 in Billed Charges for Rev 272 = $989.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC 2.7FR,272,RC,27201600,CDM,,,,,,both,,,2373.5100,356.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1101.31,,,,,,,612.6000,2373.5100,percent of total billed charges,"46.4% of $2,373.51 in Billed Charges for Rev 272 = $1,101.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC 2.7FR,272,RC,27201600,CDM,,,,,,both,,,2373.5100,356.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,989.75,,,,,,,612.6000,2373.5100,percent of total billed charges,"41.7% of $2,373.51 in Billed Charges for Rev 272 = $989.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC 2.7FR,272,RC,27201600,CDM,,,,,,both,,,2373.5100,356.0300,CIGNA HEALTHCARE,CIGNA PPO,989.75,,,,,,,612.6000,2373.5100,percent of total billed charges,"41.7% of $2,373.51 in Billed Charges for Rev 272 = $989.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC 2.7FR,272,RC,27201600,CDM,,,,,,both,,,2373.5100,356.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2136.16,,,,,,,612.6000,2373.5100,percent of total billed charges,"90% of $2,373.51 in Billed Charges for Rev 272 = $2,136.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC 2.7FR,272,RC,27201600,CDM,,,,,,both,,,2373.5100,356.0300,MEDCOST,MEDCOST VHN,1129.55,,,,,,,612.6000,2373.5100,percent of total billed charges,"47.59% of $2,373.51 in Billed Charges for Rev 272 = $1,129.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC 2.7FR,272,RC,27201600,CDM,,,,,,both,,,2373.5100,356.0300,SENTARA HEALTH,SENTARA HEALTH,612.60,,,,,,,612.6000,2373.5100,percent of total billed charges,"25.81% of $2,373.51 in Billed Charges for Rev 272 = $612.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC 2.7FR,272,RC,27201600,CDM,,,,,,both,,,2373.5100,356.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2373.51,,,,,,,612.6000,2373.5100,percent of total billed charges,"100% of $2,373.51 in Billed Charges for Rev 272 = $2,373.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC 2.7FR,272,RC,27201600,CDM,,,,,,both,,,2373.5100,356.0300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1186.76,,,,,,,612.6000,2373.5100,percent of total billed charges,"Rev 272 $2,373.51 in Billed Charges at 50% = $1,186.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC 2.7FR,272,RC,27201600,CDM,,,,,,both,,,2373.5100,356.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,766.64,,,,,,,612.6000,2373.5100,other,"32.3% of $2,373.51 in Billed Charges for Rev 272 = $766.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT CATH BROVIAC 2.7FR,272,RC,27201600,CDM,,,,,,both,,,2373.5100,356.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,728.67,,,,,,,612.6000,2373.5100,other,"30.7% of $2,373.51 in Billed Charges for Rev 272 = $728.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT CATH BROVIAC 2.7FR,272,RC,27201600,CDM,,,,,,both,,,2373.5100,356.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,766.64,,,,,,,612.6000,2373.5100,percent of total billed charges,"32.3% of $2,373.51 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC 2.7FR,272,RC,27201600,CDM,,,,,,both,,,2373.5100,356.0300,WELLCARE,WELLCARE MEDICAID,2373.51,,,,,,,612.6000,2373.5100,percent of total billed charges,"100% of $2,373.51 in Billed Charges for Rev 272 = $2,373.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC R ARTERIAL,272,RC,27200002,CDM,,,,,,both,,,3132.1500,469.8200,AETNA,AETNA,1337.43,,,,,,,808.4100,3132.1500,percent of total billed charges,"42.7% of $3,132.15 in Billed Charges for Rev 272 = $1,337.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC R ARTERIAL,272,RC,27200002,CDM,,,,,,both,,,3132.1500,469.8200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2192.51,,,,,,,808.4100,3132.1500,percent of total billed charges,"Rev 272 $3,132.15 in Billed Charges at 70% = $2,192.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC R ARTERIAL,272,RC,27200002,CDM,,,,,,both,,,3132.1500,469.8200,CIGNA HEALTHCARE,CIGNA HMO,1306.11,,,,,,,808.4100,3132.1500,percent of total billed charges,"41.7% of $3,132.15 in Billed Charges for Rev 272 = $1,306.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC R ARTERIAL,272,RC,27200002,CDM,,,,,,both,,,3132.1500,469.8200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1453.32,,,,,,,808.4100,3132.1500,percent of total billed charges,"46.4% of $3,132.15 in Billed Charges for Rev 272 = $1,453.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC R ARTERIAL,272,RC,27200002,CDM,,,,,,both,,,3132.1500,469.8200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1306.11,,,,,,,808.4100,3132.1500,percent of total billed charges,"41.7% of $3,132.15 in Billed Charges for Rev 272 = $1,306.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC R ARTERIAL,272,RC,27200002,CDM,,,,,,both,,,3132.1500,469.8200,CIGNA HEALTHCARE,CIGNA PPO,1306.11,,,,,,,808.4100,3132.1500,percent of total billed charges,"41.7% of $3,132.15 in Billed Charges for Rev 272 = $1,306.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC R ARTERIAL,272,RC,27200002,CDM,,,,,,both,,,3132.1500,469.8200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2818.94,,,,,,,808.4100,3132.1500,percent of total billed charges,"90% of $3,132.15 in Billed Charges for Rev 272 = $2,818.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC R ARTERIAL,272,RC,27200002,CDM,,,,,,both,,,3132.1500,469.8200,MEDCOST,MEDCOST VHN,1490.59,,,,,,,808.4100,3132.1500,percent of total billed charges,"47.59% of $3,132.15 in Billed Charges for Rev 272 = $1,490.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC R ARTERIAL,272,RC,27200002,CDM,,,,,,both,,,3132.1500,469.8200,SENTARA HEALTH,SENTARA HEALTH,808.41,,,,,,,808.4100,3132.1500,percent of total billed charges,"25.81% of $3,132.15 in Billed Charges for Rev 272 = $808.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC R ARTERIAL,272,RC,27200002,CDM,,,,,,both,,,3132.1500,469.8200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3132.15,,,,,,,808.4100,3132.1500,percent of total billed charges,"100% of $3,132.15 in Billed Charges for Rev 272 = $3,132.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC R ARTERIAL,272,RC,27200002,CDM,,,,,,both,,,3132.1500,469.8200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1566.08,,,,,,,808.4100,3132.1500,percent of total billed charges,"Rev 272 $3,132.15 in Billed Charges at 50% = $1,566.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC R ARTERIAL,272,RC,27200002,CDM,,,,,,both,,,3132.1500,469.8200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1011.68,,,,,,,808.4100,3132.1500,other,"32.3% of $3,132.15 in Billed Charges for Rev 272 = $1,011.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT CATH BROVIAC R ARTERIAL,272,RC,27200002,CDM,,,,,,both,,,3132.1500,469.8200,UNITED HEALTHCARE,UHC HERITAGE SELECT,961.57,,,,,,,808.4100,3132.1500,other,"30.7% of $3,132.15 in Billed Charges for Rev 272 = $961.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT CATH BROVIAC R ARTERIAL,272,RC,27200002,CDM,,,,,,both,,,3132.1500,469.8200,UNITED HEALTHCARE,UNITED HEALTHCARE,1011.68,,,,,,,808.4100,3132.1500,percent of total billed charges,"32.3% of $3,132.15 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH BROVIAC R ARTERIAL,272,RC,27200002,CDM,,,,,,both,,,3132.1500,469.8200,WELLCARE,WELLCARE MEDICAID,3132.15,,,,,,,808.4100,3132.1500,percent of total billed charges,"100% of $3,132.15 in Billed Charges for Rev 272 = $3,132.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT CATH CENTRAL VEIN 5FR AK-25502,272,RC,,,,,,,,both,,,742.5600,111.3800,AETNA,AETNA,317.07,,,,,,,191.6500,742.5600,percent of total billed charges,42.7% of $742.56 in Billed Charges for Rev 272 = $317.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CATH CENTRAL VEIN 5FR AK-25502,272,RC,,,,,,,,both,,,742.5600,111.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,519.79,,,,,,,191.6500,742.5600,percent of total billed charges,Rev 272 $742.56 in Billed Charges at 70% = $519.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CATH CENTRAL VEIN 5FR AK-25502,272,RC,,,,,,,,both,,,742.5600,111.3800,CIGNA HEALTHCARE,CIGNA HMO,309.65,,,,,,,191.6500,742.5600,percent of total billed charges,41.7% of $742.56 in Billed Charges for Rev 272 = $309.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CATH CENTRAL VEIN 5FR AK-25502,272,RC,,,,,,,,both,,,742.5600,111.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,344.55,,,,,,,191.6500,742.5600,percent of total billed charges,46.4% of $742.56 in Billed Charges for Rev 272 = $344.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CATH CENTRAL VEIN 5FR AK-25502,272,RC,,,,,,,,both,,,742.5600,111.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,309.65,,,,,,,191.6500,742.5600,percent of total billed charges,41.7% of $742.56 in Billed Charges for Rev 272 = $309.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CATH CENTRAL VEIN 5FR AK-25502,272,RC,,,,,,,,both,,,742.5600,111.3800,CIGNA HEALTHCARE,CIGNA PPO,309.65,,,,,,,191.6500,742.5600,percent of total billed charges,41.7% of $742.56 in Billed Charges for Rev 272 = $309.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CATH CENTRAL VEIN 5FR AK-25502,272,RC,,,,,,,,both,,,742.5600,111.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,668.30,,,,,,,191.6500,742.5600,percent of total billed charges,90% of $742.56 in Billed Charges for Rev 272 = $668.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CATH CENTRAL VEIN 5FR AK-25502,272,RC,,,,,,,,both,,,742.5600,111.3800,MEDCOST,MEDCOST VHN,353.38,,,,,,,191.6500,742.5600,percent of total billed charges,47.59% of $742.56 in Billed Charges for Rev 272 = $353.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CATH CENTRAL VEIN 5FR AK-25502,272,RC,,,,,,,,both,,,742.5600,111.3800,SENTARA HEALTH,SENTARA HEALTH,191.65,,,,,,,191.6500,742.5600,percent of total billed charges,25.81% of $742.56 in Billed Charges for Rev 272 = $191.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CATH CENTRAL VEIN 5FR AK-25502,272,RC,,,,,,,,both,,,742.5600,111.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",742.56,,,,,,,191.6500,742.5600,percent of total billed charges,100% of $742.56 in Billed Charges for Rev 272 = $742.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CATH CENTRAL VEIN 5FR AK-25502,272,RC,,,,,,,,both,,,742.5600,111.3800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,371.28,,,,,,,191.6500,742.5600,percent of total billed charges,Rev 272 $742.56 in Billed Charges at 50% = $371.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CATH CENTRAL VEIN 5FR AK-25502,272,RC,,,,,,,,both,,,742.5600,111.3800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,239.85,,,,,,,191.6500,742.5600,other,32.3% of $742.56 in Billed Charges for Rev 272 = $239.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT CATH CENTRAL VEIN 5FR AK-25502,272,RC,,,,,,,,both,,,742.5600,111.3800,UNITED HEALTHCARE,UHC HERITAGE SELECT,227.97,,,,,,,191.6500,742.5600,other,30.7% of $742.56 in Billed Charges for Rev 272 = $227.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
KIT CATH CENTRAL VEIN 5FR AK-25502,272,RC,,,,,,,,both,,,742.5600,111.3800,UNITED HEALTHCARE,UNITED HEALTHCARE,239.85,,,,,,,191.6500,742.5600,percent of total billed charges,32.3% of $742.56 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
KIT CATH CENTRAL VEIN 5FR AK-25502,272,RC,,,,,,,,both,,,742.5600,111.3800,WELLCARE,WELLCARE MEDICAID,742.56,,,,,,,191.6500,742.5600,percent of total billed charges,100% of $742.56 in Billed Charges for Rev 272 = $742.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RET KIT SCREW REDDICK,272,RC,27200002,CDM,,,,,,both,,,3305.1100,495.7700,AETNA,AETNA,1411.28,,,,,,,853.0500,3305.1100,percent of total billed charges,"42.7% of $3,305.11 in Billed Charges for Rev 272 = $1,411.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RET KIT SCREW REDDICK,272,RC,27200002,CDM,,,,,,both,,,3305.1100,495.7700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2313.58,,,,,,,853.0500,3305.1100,percent of total billed charges,"Rev 272 $3,305.11 in Billed Charges at 70% = $2,313.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RET KIT SCREW REDDICK,272,RC,27200002,CDM,,,,,,both,,,3305.1100,495.7700,CIGNA HEALTHCARE,CIGNA HMO,1378.23,,,,,,,853.0500,3305.1100,percent of total billed charges,"41.7% of $3,305.11 in Billed Charges for Rev 272 = $1,378.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RET KIT SCREW REDDICK,272,RC,27200002,CDM,,,,,,both,,,3305.1100,495.7700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1533.57,,,,,,,853.0500,3305.1100,percent of total billed charges,"46.4% of $3,305.11 in Billed Charges for Rev 272 = $1,533.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RET KIT SCREW REDDICK,272,RC,27200002,CDM,,,,,,both,,,3305.1100,495.7700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1378.23,,,,,,,853.0500,3305.1100,percent of total billed charges,"41.7% of $3,305.11 in Billed Charges for Rev 272 = $1,378.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RET KIT SCREW REDDICK,272,RC,27200002,CDM,,,,,,both,,,3305.1100,495.7700,CIGNA HEALTHCARE,CIGNA PPO,1378.23,,,,,,,853.0500,3305.1100,percent of total billed charges,"41.7% of $3,305.11 in Billed Charges for Rev 272 = $1,378.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RET KIT SCREW REDDICK,272,RC,27200002,CDM,,,,,,both,,,3305.1100,495.7700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2974.60,,,,,,,853.0500,3305.1100,percent of total billed charges,"90% of $3,305.11 in Billed Charges for Rev 272 = $2,974.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RET KIT SCREW REDDICK,272,RC,27200002,CDM,,,,,,both,,,3305.1100,495.7700,MEDCOST,MEDCOST VHN,1572.90,,,,,,,853.0500,3305.1100,percent of total billed charges,"47.59% of $3,305.11 in Billed Charges for Rev 272 = $1,572.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RET KIT SCREW REDDICK,272,RC,27200002,CDM,,,,,,both,,,3305.1100,495.7700,SENTARA HEALTH,SENTARA HEALTH,853.05,,,,,,,853.0500,3305.1100,percent of total billed charges,"25.81% of $3,305.11 in Billed Charges for Rev 272 = $853.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RET KIT SCREW REDDICK,272,RC,27200002,CDM,,,,,,both,,,3305.1100,495.7700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3305.11,,,,,,,853.0500,3305.1100,percent of total billed charges,"100% of $3,305.11 in Billed Charges for Rev 272 = $3,305.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RET KIT SCREW REDDICK,272,RC,27200002,CDM,,,,,,both,,,3305.1100,495.7700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1652.56,,,,,,,853.0500,3305.1100,percent of total billed charges,"Rev 272 $3,305.11 in Billed Charges at 50% = $1,652.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RET KIT SCREW REDDICK,272,RC,27200002,CDM,,,,,,both,,,3305.1100,495.7700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1067.55,,,,,,,853.0500,3305.1100,other,"32.3% of $3,305.11 in Billed Charges for Rev 272 = $1,067.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RET KIT SCREW REDDICK,272,RC,27200002,CDM,,,,,,both,,,3305.1100,495.7700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1014.67,,,,,,,853.0500,3305.1100,other,"30.7% of $3,305.11 in Billed Charges for Rev 272 = $1,014.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RET KIT SCREW REDDICK,272,RC,27200002,CDM,,,,,,both,,,3305.1100,495.7700,UNITED HEALTHCARE,UNITED HEALTHCARE,1067.55,,,,,,,853.0500,3305.1100,percent of total billed charges,"32.3% of $3,305.11 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RET KIT SCREW REDDICK,272,RC,27200002,CDM,,,,,,both,,,3305.1100,495.7700,WELLCARE,WELLCARE MEDICAID,3305.11,,,,,,,853.0500,3305.1100,percent of total billed charges,"100% of $3,305.11 in Billed Charges for Rev 272 = $3,305.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 180 CATHETHER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,17879.6000,2681.9400,AETNA,AETNA,7634.59,,,,,,,4614.7200,17879.6000,percent of total billed charges,"42.7% of $17,879.60 in Billed Charges for Rev 272 = $7,634.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 180 CATHETHER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,17879.6000,2681.9400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,12515.72,,,,,,,4614.7200,17879.6000,percent of total billed charges,"Rev 272 $17,879.60 in Billed Charges at 70% = $12,515.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 180 CATHETHER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,17879.6000,2681.9400,CIGNA HEALTHCARE,CIGNA HMO,7455.79,,,,,,,4614.7200,17879.6000,percent of total billed charges,"41.7% of $17,879.60 in Billed Charges for Rev 272 = $7,455.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 180 CATHETHER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,17879.6000,2681.9400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8296.13,,,,,,,4614.7200,17879.6000,percent of total billed charges,"46.4% of $17,879.60 in Billed Charges for Rev 272 = $8,296.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 180 CATHETHER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,17879.6000,2681.9400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7455.79,,,,,,,4614.7200,17879.6000,percent of total billed charges,"41.7% of $17,879.60 in Billed Charges for Rev 272 = $7,455.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 180 CATHETHER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,17879.6000,2681.9400,CIGNA HEALTHCARE,CIGNA PPO,7455.79,,,,,,,4614.7200,17879.6000,percent of total billed charges,"41.7% of $17,879.60 in Billed Charges for Rev 272 = $7,455.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 180 CATHETHER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,17879.6000,2681.9400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,16091.64,,,,,,,4614.7200,17879.6000,percent of total billed charges,"90% of $17,879.60 in Billed Charges for Rev 272 = $16,091.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 180 CATHETHER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,17879.6000,2681.9400,MEDCOST,MEDCOST VHN,8508.90,,,,,,,4614.7200,17879.6000,percent of total billed charges,"47.59% of $17,879.60 in Billed Charges for Rev 272 = $8,508.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 180 CATHETHER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,17879.6000,2681.9400,SENTARA HEALTH,SENTARA HEALTH,4614.72,,,,,,,4614.7200,17879.6000,percent of total billed charges,"25.81% of $17,879.60 in Billed Charges for Rev 272 = $4,614.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 180 CATHETHER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,17879.6000,2681.9400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",17879.60,,,,,,,4614.7200,17879.6000,percent of total billed charges,"100% of $17,879.60 in Billed Charges for Rev 272 = $17,879.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 180 CATHETHER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,17879.6000,2681.9400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8939.80,,,,,,,4614.7200,17879.6000,percent of total billed charges,"Rev 272 $17,879.60 in Billed Charges at 50% = $8,939.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 180 CATHETHER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,17879.6000,2681.9400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5775.11,,,,,,,4614.7200,17879.6000,other,"32.3% of $17,879.60 in Billed Charges for Rev 272 = $5,775.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PROCEDURE ENDOBRONCH 180 CATHETHER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,17879.6000,2681.9400,UNITED HEALTHCARE,UHC HERITAGE SELECT,5489.04,,,,,,,4614.7200,17879.6000,other,"30.7% of $17,879.60 in Billed Charges for Rev 272 = $5,489.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PROCEDURE ENDOBRONCH 180 CATHETHER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,17879.6000,2681.9400,UNITED HEALTHCARE,UNITED HEALTHCARE,5775.11,,,,,,,4614.7200,17879.6000,percent of total billed charges,"32.3% of $17,879.60 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE ENDOBRONCH 180 CATHETHER ILLUMISITE,272,RC,27200002,CDM,,,,,,both,,,17879.6000,2681.9400,WELLCARE,WELLCARE MEDICAID,17879.60,,,,,,,4614.7200,17879.6000,percent of total billed charges,"100% of $17,879.60 in Billed Charges for Rev 272 = $17,879.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT FLUID MANAGEMENT SYSTEM HOLOGIC,272,RC,27200002,CDM,,,,,,both,,,2686.0900,402.9100,AETNA,AETNA,1146.96,,,,,,,693.2800,2686.0900,percent of total billed charges,"42.7% of $2,686.09 in Billed Charges for Rev 272 = $1,146.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT FLUID MANAGEMENT SYSTEM HOLOGIC,272,RC,27200002,CDM,,,,,,both,,,2686.0900,402.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1880.26,,,,,,,693.2800,2686.0900,percent of total billed charges,"Rev 272 $2,686.09 in Billed Charges at 70% = $1,880.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT FLUID MANAGEMENT SYSTEM HOLOGIC,272,RC,27200002,CDM,,,,,,both,,,2686.0900,402.9100,CIGNA HEALTHCARE,CIGNA HMO,1120.10,,,,,,,693.2800,2686.0900,percent of total billed charges,"41.7% of $2,686.09 in Billed Charges for Rev 272 = $1,120.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT FLUID MANAGEMENT SYSTEM HOLOGIC,272,RC,27200002,CDM,,,,,,both,,,2686.0900,402.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1246.35,,,,,,,693.2800,2686.0900,percent of total billed charges,"46.4% of $2,686.09 in Billed Charges for Rev 272 = $1,246.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT FLUID MANAGEMENT SYSTEM HOLOGIC,272,RC,27200002,CDM,,,,,,both,,,2686.0900,402.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1120.10,,,,,,,693.2800,2686.0900,percent of total billed charges,"41.7% of $2,686.09 in Billed Charges for Rev 272 = $1,120.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT FLUID MANAGEMENT SYSTEM HOLOGIC,272,RC,27200002,CDM,,,,,,both,,,2686.0900,402.9100,CIGNA HEALTHCARE,CIGNA PPO,1120.10,,,,,,,693.2800,2686.0900,percent of total billed charges,"41.7% of $2,686.09 in Billed Charges for Rev 272 = $1,120.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT FLUID MANAGEMENT SYSTEM HOLOGIC,272,RC,27200002,CDM,,,,,,both,,,2686.0900,402.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2417.48,,,,,,,693.2800,2686.0900,percent of total billed charges,"90% of $2,686.09 in Billed Charges for Rev 272 = $2,417.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT FLUID MANAGEMENT SYSTEM HOLOGIC,272,RC,27200002,CDM,,,,,,both,,,2686.0900,402.9100,MEDCOST,MEDCOST VHN,1278.31,,,,,,,693.2800,2686.0900,percent of total billed charges,"47.59% of $2,686.09 in Billed Charges for Rev 272 = $1,278.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT FLUID MANAGEMENT SYSTEM HOLOGIC,272,RC,27200002,CDM,,,,,,both,,,2686.0900,402.9100,SENTARA HEALTH,SENTARA HEALTH,693.28,,,,,,,693.2800,2686.0900,percent of total billed charges,"25.81% of $2,686.09 in Billed Charges for Rev 272 = $693.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT FLUID MANAGEMENT SYSTEM HOLOGIC,272,RC,27200002,CDM,,,,,,both,,,2686.0900,402.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2686.09,,,,,,,693.2800,2686.0900,percent of total billed charges,"100% of $2,686.09 in Billed Charges for Rev 272 = $2,686.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT FLUID MANAGEMENT SYSTEM HOLOGIC,272,RC,27200002,CDM,,,,,,both,,,2686.0900,402.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1343.05,,,,,,,693.2800,2686.0900,percent of total billed charges,"Rev 272 $2,686.09 in Billed Charges at 50% = $1,343.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT FLUID MANAGEMENT SYSTEM HOLOGIC,272,RC,27200002,CDM,,,,,,both,,,2686.0900,402.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,867.61,,,,,,,693.2800,2686.0900,other,"32.3% of $2,686.09 in Billed Charges for Rev 272 = $867.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PROCEDURE FLUENT FLUID MANAGEMENT SYSTEM HOLOGIC,272,RC,27200002,CDM,,,,,,both,,,2686.0900,402.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,824.63,,,,,,,693.2800,2686.0900,other,"30.7% of $2,686.09 in Billed Charges for Rev 272 = $824.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PROCEDURE FLUENT FLUID MANAGEMENT SYSTEM HOLOGIC,272,RC,27200002,CDM,,,,,,both,,,2686.0900,402.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,867.61,,,,,,,693.2800,2686.0900,percent of total billed charges,"32.3% of $2,686.09 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT FLUID MANAGEMENT SYSTEM HOLOGIC,272,RC,27200002,CDM,,,,,,both,,,2686.0900,402.9100,WELLCARE,WELLCARE MEDICAID,2686.09,,,,,,,693.2800,2686.0900,percent of total billed charges,"100% of $2,686.09 in Billed Charges for Rev 272 = $2,686.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT PRO FLUID MANAGEMENT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,2954.7000,443.2100,AETNA,AETNA,1261.66,,,,,,,762.6100,2954.7000,percent of total billed charges,"42.7% of $2,954.70 in Billed Charges for Rev 272 = $1,261.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT PRO FLUID MANAGEMENT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,2954.7000,443.2100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2068.29,,,,,,,762.6100,2954.7000,percent of total billed charges,"Rev 272 $2,954.70 in Billed Charges at 70% = $2,068.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT PRO FLUID MANAGEMENT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,2954.7000,443.2100,CIGNA HEALTHCARE,CIGNA HMO,1232.11,,,,,,,762.6100,2954.7000,percent of total billed charges,"41.7% of $2,954.70 in Billed Charges for Rev 272 = $1,232.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT PRO FLUID MANAGEMENT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,2954.7000,443.2100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1370.98,,,,,,,762.6100,2954.7000,percent of total billed charges,"46.4% of $2,954.70 in Billed Charges for Rev 272 = $1,370.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT PRO FLUID MANAGEMENT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,2954.7000,443.2100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1232.11,,,,,,,762.6100,2954.7000,percent of total billed charges,"41.7% of $2,954.70 in Billed Charges for Rev 272 = $1,232.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT PRO FLUID MANAGEMENT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,2954.7000,443.2100,CIGNA HEALTHCARE,CIGNA PPO,1232.11,,,,,,,762.6100,2954.7000,percent of total billed charges,"41.7% of $2,954.70 in Billed Charges for Rev 272 = $1,232.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT PRO FLUID MANAGEMENT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,2954.7000,443.2100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2659.23,,,,,,,762.6100,2954.7000,percent of total billed charges,"90% of $2,954.70 in Billed Charges for Rev 272 = $2,659.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT PRO FLUID MANAGEMENT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,2954.7000,443.2100,MEDCOST,MEDCOST VHN,1406.14,,,,,,,762.6100,2954.7000,percent of total billed charges,"47.59% of $2,954.70 in Billed Charges for Rev 272 = $1,406.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT PRO FLUID MANAGEMENT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,2954.7000,443.2100,SENTARA HEALTH,SENTARA HEALTH,762.61,,,,,,,762.6100,2954.7000,percent of total billed charges,"25.81% of $2,954.70 in Billed Charges for Rev 272 = $762.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT PRO FLUID MANAGEMENT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,2954.7000,443.2100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2954.70,,,,,,,762.6100,2954.7000,percent of total billed charges,"100% of $2,954.70 in Billed Charges for Rev 272 = $2,954.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT PRO FLUID MANAGEMENT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,2954.7000,443.2100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1477.35,,,,,,,762.6100,2954.7000,percent of total billed charges,"Rev 272 $2,954.70 in Billed Charges at 50% = $1,477.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT PRO FLUID MANAGEMENT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,2954.7000,443.2100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,954.37,,,,,,,762.6100,2954.7000,other,"32.3% of $2,954.70 in Billed Charges for Rev 272 = $954.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PROCEDURE FLUENT PRO FLUID MANAGEMENT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,2954.7000,443.2100,UNITED HEALTHCARE,UHC HERITAGE SELECT,907.09,,,,,,,762.6100,2954.7000,other,"30.7% of $2,954.70 in Billed Charges for Rev 272 = $907.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT PROCEDURE FLUENT PRO FLUID MANAGEMENT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,2954.7000,443.2100,UNITED HEALTHCARE,UNITED HEALTHCARE,954.37,,,,,,,762.6100,2954.7000,percent of total billed charges,"32.3% of $2,954.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT PROCEDURE FLUENT PRO FLUID MANAGEMENT SYSTEM,272,RC,27200002,CDM,,,,,,both,,,2954.7000,443.2100,WELLCARE,WELLCARE MEDICAID,2954.70,,,,,,,762.6100,2954.7000,percent of total billed charges,"100% of $2,954.70 in Billed Charges for Rev 272 = $2,954.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REMOVAL FIBULINK,272,RC,27200002,CDM,,,,,,both,,,7036.8300,1055.5200,AETNA,AETNA,3004.73,,,,,,,1816.2100,7036.8300,percent of total billed charges,"42.7% of $7,036.83 in Billed Charges for Rev 272 = $3,004.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REMOVAL FIBULINK,272,RC,27200002,CDM,,,,,,both,,,7036.8300,1055.5200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4925.78,,,,,,,1816.2100,7036.8300,percent of total billed charges,"Rev 272 $7,036.83 in Billed Charges at 70% = $4,925.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REMOVAL FIBULINK,272,RC,27200002,CDM,,,,,,both,,,7036.8300,1055.5200,CIGNA HEALTHCARE,CIGNA HMO,2934.36,,,,,,,1816.2100,7036.8300,percent of total billed charges,"41.7% of $7,036.83 in Billed Charges for Rev 272 = $2,934.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REMOVAL FIBULINK,272,RC,27200002,CDM,,,,,,both,,,7036.8300,1055.5200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3265.09,,,,,,,1816.2100,7036.8300,percent of total billed charges,"46.4% of $7,036.83 in Billed Charges for Rev 272 = $3,265.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REMOVAL FIBULINK,272,RC,27200002,CDM,,,,,,both,,,7036.8300,1055.5200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2934.36,,,,,,,1816.2100,7036.8300,percent of total billed charges,"41.7% of $7,036.83 in Billed Charges for Rev 272 = $2,934.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REMOVAL FIBULINK,272,RC,27200002,CDM,,,,,,both,,,7036.8300,1055.5200,CIGNA HEALTHCARE,CIGNA PPO,2934.36,,,,,,,1816.2100,7036.8300,percent of total billed charges,"41.7% of $7,036.83 in Billed Charges for Rev 272 = $2,934.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REMOVAL FIBULINK,272,RC,27200002,CDM,,,,,,both,,,7036.8300,1055.5200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6333.15,,,,,,,1816.2100,7036.8300,percent of total billed charges,"90% of $7,036.83 in Billed Charges for Rev 272 = $6,333.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REMOVAL FIBULINK,272,RC,27200002,CDM,,,,,,both,,,7036.8300,1055.5200,MEDCOST,MEDCOST VHN,3348.83,,,,,,,1816.2100,7036.8300,percent of total billed charges,"47.59% of $7,036.83 in Billed Charges for Rev 272 = $3,348.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REMOVAL FIBULINK,272,RC,27200002,CDM,,,,,,both,,,7036.8300,1055.5200,SENTARA HEALTH,SENTARA HEALTH,1816.21,,,,,,,1816.2100,7036.8300,percent of total billed charges,"25.81% of $7,036.83 in Billed Charges for Rev 272 = $1,816.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REMOVAL FIBULINK,272,RC,27200002,CDM,,,,,,both,,,7036.8300,1055.5200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7036.83,,,,,,,1816.2100,7036.8300,percent of total billed charges,"100% of $7,036.83 in Billed Charges for Rev 272 = $7,036.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REMOVAL FIBULINK,272,RC,27200002,CDM,,,,,,both,,,7036.8300,1055.5200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3518.42,,,,,,,1816.2100,7036.8300,percent of total billed charges,"Rev 272 $7,036.83 in Billed Charges at 50% = $3,518.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REMOVAL FIBULINK,272,RC,27200002,CDM,,,,,,both,,,7036.8300,1055.5200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2272.90,,,,,,,1816.2100,7036.8300,other,"32.3% of $7,036.83 in Billed Charges for Rev 272 = $2,272.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT REMOVAL FIBULINK,272,RC,27200002,CDM,,,,,,both,,,7036.8300,1055.5200,UNITED HEALTHCARE,UHC HERITAGE SELECT,2160.31,,,,,,,1816.2100,7036.8300,other,"30.7% of $7,036.83 in Billed Charges for Rev 272 = $2,160.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
KIT REMOVAL FIBULINK,272,RC,27200002,CDM,,,,,,both,,,7036.8300,1055.5200,UNITED HEALTHCARE,UNITED HEALTHCARE,2272.90,,,,,,,1816.2100,7036.8300,percent of total billed charges,"32.3% of $7,036.83 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
KIT REMOVAL FIBULINK,272,RC,27200002,CDM,,,,,,both,,,7036.8300,1055.5200,WELLCARE,WELLCARE MEDICAID,7036.83,,,,,,,1816.2100,7036.8300,percent of total billed charges,"100% of $7,036.83 in Billed Charges for Rev 272 = $7,036.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT HEMOSTATIC COSEAL 4ML,272,RC,27200002,CDM,,,,,,both,,,7890.6700,1183.6000,AETNA,AETNA,3369.32,,,,,,,2036.5800,7890.6700,percent of total billed charges,"42.7% of $7,890.67 in Billed Charges for Rev 272 = $3,369.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT HEMOSTATIC COSEAL 4ML,272,RC,27200002,CDM,,,,,,both,,,7890.6700,1183.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5523.47,,,,,,,2036.5800,7890.6700,percent of total billed charges,"Rev 272 $7,890.67 in Billed Charges at 70% = $5,523.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT HEMOSTATIC COSEAL 4ML,272,RC,27200002,CDM,,,,,,both,,,7890.6700,1183.6000,CIGNA HEALTHCARE,CIGNA HMO,3290.41,,,,,,,2036.5800,7890.6700,percent of total billed charges,"41.7% of $7,890.67 in Billed Charges for Rev 272 = $3,290.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT HEMOSTATIC COSEAL 4ML,272,RC,27200002,CDM,,,,,,both,,,7890.6700,1183.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3661.27,,,,,,,2036.5800,7890.6700,percent of total billed charges,"46.4% of $7,890.67 in Billed Charges for Rev 272 = $3,661.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT HEMOSTATIC COSEAL 4ML,272,RC,27200002,CDM,,,,,,both,,,7890.6700,1183.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3290.41,,,,,,,2036.5800,7890.6700,percent of total billed charges,"41.7% of $7,890.67 in Billed Charges for Rev 272 = $3,290.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT HEMOSTATIC COSEAL 4ML,272,RC,27200002,CDM,,,,,,both,,,7890.6700,1183.6000,CIGNA HEALTHCARE,CIGNA PPO,3290.41,,,,,,,2036.5800,7890.6700,percent of total billed charges,"41.7% of $7,890.67 in Billed Charges for Rev 272 = $3,290.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT HEMOSTATIC COSEAL 4ML,272,RC,27200002,CDM,,,,,,both,,,7890.6700,1183.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7101.60,,,,,,,2036.5800,7890.6700,percent of total billed charges,"90% of $7,890.67 in Billed Charges for Rev 272 = $7,101.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT HEMOSTATIC COSEAL 4ML,272,RC,27200002,CDM,,,,,,both,,,7890.6700,1183.6000,MEDCOST,MEDCOST VHN,3755.17,,,,,,,2036.5800,7890.6700,percent of total billed charges,"47.59% of $7,890.67 in Billed Charges for Rev 272 = $3,755.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT HEMOSTATIC COSEAL 4ML,272,RC,27200002,CDM,,,,,,both,,,7890.6700,1183.6000,SENTARA HEALTH,SENTARA HEALTH,2036.58,,,,,,,2036.5800,7890.6700,percent of total billed charges,"25.81% of $7,890.67 in Billed Charges for Rev 272 = $2,036.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT HEMOSTATIC COSEAL 4ML,272,RC,27200002,CDM,,,,,,both,,,7890.6700,1183.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7890.67,,,,,,,2036.5800,7890.6700,percent of total billed charges,"100% of $7,890.67 in Billed Charges for Rev 272 = $7,890.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT HEMOSTATIC COSEAL 4ML,272,RC,27200002,CDM,,,,,,both,,,7890.6700,1183.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3945.34,,,,,,,2036.5800,7890.6700,percent of total billed charges,"Rev 272 $7,890.67 in Billed Charges at 50% = $3,945.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT HEMOSTATIC COSEAL 4ML,272,RC,27200002,CDM,,,,,,both,,,7890.6700,1183.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2548.69,,,,,,,2036.5800,7890.6700,other,"32.3% of $7,890.67 in Billed Charges for Rev 272 = $2,548.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALANT HEMOSTATIC COSEAL 4ML,272,RC,27200002,CDM,,,,,,both,,,7890.6700,1183.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2422.44,,,,,,,2036.5800,7890.6700,other,"30.7% of $7,890.67 in Billed Charges for Rev 272 = $2,422.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALANT HEMOSTATIC COSEAL 4ML,272,RC,27200002,CDM,,,,,,both,,,7890.6700,1183.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,2548.69,,,,,,,2036.5800,7890.6700,percent of total billed charges,"32.3% of $7,890.67 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT HEMOSTATIC COSEAL 4ML,272,RC,27200002,CDM,,,,,,both,,,7890.6700,1183.6000,WELLCARE,WELLCARE MEDICAID,7890.67,,,,,,,2036.5800,7890.6700,percent of total billed charges,"100% of $7,890.67 in Billed Charges for Rev 272 = $7,890.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER LIGASURE 37MM LF1837,272,RC,27200002,CDM,,,,,,both,,,5997.9600,899.6900,AETNA,AETNA,2561.13,,,,,,,1548.0700,5997.9600,percent of total billed charges,"42.7% of $5,997.96 in Billed Charges for Rev 272 = $2,561.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER LIGASURE 37MM LF1837,272,RC,27200002,CDM,,,,,,both,,,5997.9600,899.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4198.57,,,,,,,1548.0700,5997.9600,percent of total billed charges,"Rev 272 $5,997.96 in Billed Charges at 70% = $4,198.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER LIGASURE 37MM LF1837,272,RC,27200002,CDM,,,,,,both,,,5997.9600,899.6900,CIGNA HEALTHCARE,CIGNA HMO,2501.15,,,,,,,1548.0700,5997.9600,percent of total billed charges,"41.7% of $5,997.96 in Billed Charges for Rev 272 = $2,501.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER LIGASURE 37MM LF1837,272,RC,27200002,CDM,,,,,,both,,,5997.9600,899.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2783.05,,,,,,,1548.0700,5997.9600,percent of total billed charges,"46.4% of $5,997.96 in Billed Charges for Rev 272 = $2,783.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER LIGASURE 37MM LF1837,272,RC,27200002,CDM,,,,,,both,,,5997.9600,899.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2501.15,,,,,,,1548.0700,5997.9600,percent of total billed charges,"41.7% of $5,997.96 in Billed Charges for Rev 272 = $2,501.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER LIGASURE 37MM LF1837,272,RC,27200002,CDM,,,,,,both,,,5997.9600,899.6900,CIGNA HEALTHCARE,CIGNA PPO,2501.15,,,,,,,1548.0700,5997.9600,percent of total billed charges,"41.7% of $5,997.96 in Billed Charges for Rev 272 = $2,501.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER LIGASURE 37MM LF1837,272,RC,27200002,CDM,,,,,,both,,,5997.9600,899.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5398.16,,,,,,,1548.0700,5997.9600,percent of total billed charges,"90% of $5,997.96 in Billed Charges for Rev 272 = $5,398.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER LIGASURE 37MM LF1837,272,RC,27200002,CDM,,,,,,both,,,5997.9600,899.6900,MEDCOST,MEDCOST VHN,2854.43,,,,,,,1548.0700,5997.9600,percent of total billed charges,"47.59% of $5,997.96 in Billed Charges for Rev 272 = $2,854.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER LIGASURE 37MM LF1837,272,RC,27200002,CDM,,,,,,both,,,5997.9600,899.6900,SENTARA HEALTH,SENTARA HEALTH,1548.07,,,,,,,1548.0700,5997.9600,percent of total billed charges,"25.81% of $5,997.96 in Billed Charges for Rev 272 = $1,548.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER LIGASURE 37MM LF1837,272,RC,27200002,CDM,,,,,,both,,,5997.9600,899.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5997.96,,,,,,,1548.0700,5997.9600,percent of total billed charges,"100% of $5,997.96 in Billed Charges for Rev 272 = $5,997.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER LIGASURE 37MM LF1837,272,RC,27200002,CDM,,,,,,both,,,5997.9600,899.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2998.98,,,,,,,1548.0700,5997.9600,percent of total billed charges,"Rev 272 $5,997.96 in Billed Charges at 50% = $2,998.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER LIGASURE 37MM LF1837,272,RC,27200002,CDM,,,,,,both,,,5997.9600,899.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1937.34,,,,,,,1548.0700,5997.9600,other,"32.3% of $5,997.96 in Billed Charges for Rev 272 = $1,937.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALER LIGASURE 37MM LF1837,272,RC,27200002,CDM,,,,,,both,,,5997.9600,899.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1841.37,,,,,,,1548.0700,5997.9600,other,"30.7% of $5,997.96 in Billed Charges for Rev 272 = $1,841.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALER LIGASURE 37MM LF1837,272,RC,27200002,CDM,,,,,,both,,,5997.9600,899.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,1937.34,,,,,,,1548.0700,5997.9600,percent of total billed charges,"32.3% of $5,997.96 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER LIGASURE 37MM LF1837,272,RC,27200002,CDM,,,,,,both,,,5997.9600,899.6900,WELLCARE,WELLCARE MEDICAID,5997.96,,,,,,,1548.0700,5997.9600,percent of total billed charges,"100% of $5,997.96 in Billed Charges for Rev 272 = $5,997.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,4448.3300,667.2500,AETNA,AETNA,1899.44,,,,,,,1148.1100,4448.3300,percent of total billed charges,"42.7% of $4,448.33 in Billed Charges for Rev 272 = $1,899.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,4448.3300,667.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3113.83,,,,,,,1148.1100,4448.3300,percent of total billed charges,"Rev 272 $4,448.33 in Billed Charges at 70% = $3,113.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,4448.3300,667.2500,CIGNA HEALTHCARE,CIGNA HMO,1854.95,,,,,,,1148.1100,4448.3300,percent of total billed charges,"41.7% of $4,448.33 in Billed Charges for Rev 272 = $1,854.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,4448.3300,667.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2064.03,,,,,,,1148.1100,4448.3300,percent of total billed charges,"46.4% of $4,448.33 in Billed Charges for Rev 272 = $2,064.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,4448.3300,667.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1854.95,,,,,,,1148.1100,4448.3300,percent of total billed charges,"41.7% of $4,448.33 in Billed Charges for Rev 272 = $1,854.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,4448.3300,667.2500,CIGNA HEALTHCARE,CIGNA PPO,1854.95,,,,,,,1148.1100,4448.3300,percent of total billed charges,"41.7% of $4,448.33 in Billed Charges for Rev 272 = $1,854.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,4448.3300,667.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4003.50,,,,,,,1148.1100,4448.3300,percent of total billed charges,"90% of $4,448.33 in Billed Charges for Rev 272 = $4,003.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,4448.3300,667.2500,MEDCOST,MEDCOST VHN,2116.96,,,,,,,1148.1100,4448.3300,percent of total billed charges,"47.59% of $4,448.33 in Billed Charges for Rev 272 = $2,116.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,4448.3300,667.2500,SENTARA HEALTH,SENTARA HEALTH,1148.11,,,,,,,1148.1100,4448.3300,percent of total billed charges,"25.81% of $4,448.33 in Billed Charges for Rev 272 = $1,148.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,4448.3300,667.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4448.33,,,,,,,1148.1100,4448.3300,percent of total billed charges,"100% of $4,448.33 in Billed Charges for Rev 272 = $4,448.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,4448.3300,667.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2224.17,,,,,,,1148.1100,4448.3300,percent of total billed charges,"Rev 272 $4,448.33 in Billed Charges at 50% = $2,224.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,4448.3300,667.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1436.81,,,,,,,1148.1100,4448.3300,other,"32.3% of $4,448.33 in Billed Charges for Rev 272 = $1,436.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,4448.3300,667.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1365.64,,,,,,,1148.1100,4448.3300,other,"30.7% of $4,448.33 in Billed Charges for Rev 272 = $1,365.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,4448.3300,667.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1436.81,,,,,,,1148.1100,4448.3300,percent of total billed charges,"32.3% of $4,448.33 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,4448.3300,667.2500,WELLCARE,WELLCARE MEDICAID,4448.33,,,,,,,1148.1100,4448.3300,percent of total billed charges,"100% of $4,448.33 in Billed Charges for Rev 272 = $4,448.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4126.9100,619.0400,AETNA,AETNA,1762.19,,,,,,,1065.1600,4126.9100,percent of total billed charges,"42.7% of $4,126.91 in Billed Charges for Rev 272 = $1,762.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4126.9100,619.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2888.84,,,,,,,1065.1600,4126.9100,percent of total billed charges,"Rev 272 $4,126.91 in Billed Charges at 70% = $2,888.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4126.9100,619.0400,CIGNA HEALTHCARE,CIGNA HMO,1720.92,,,,,,,1065.1600,4126.9100,percent of total billed charges,"41.7% of $4,126.91 in Billed Charges for Rev 272 = $1,720.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4126.9100,619.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1914.89,,,,,,,1065.1600,4126.9100,percent of total billed charges,"46.4% of $4,126.91 in Billed Charges for Rev 272 = $1,914.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4126.9100,619.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1720.92,,,,,,,1065.1600,4126.9100,percent of total billed charges,"41.7% of $4,126.91 in Billed Charges for Rev 272 = $1,720.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4126.9100,619.0400,CIGNA HEALTHCARE,CIGNA PPO,1720.92,,,,,,,1065.1600,4126.9100,percent of total billed charges,"41.7% of $4,126.91 in Billed Charges for Rev 272 = $1,720.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4126.9100,619.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3714.22,,,,,,,1065.1600,4126.9100,percent of total billed charges,"90% of $4,126.91 in Billed Charges for Rev 272 = $3,714.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4126.9100,619.0400,MEDCOST,MEDCOST VHN,1964.00,,,,,,,1065.1600,4126.9100,percent of total billed charges,"47.59% of $4,126.91 in Billed Charges for Rev 272 = $1,964.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4126.9100,619.0400,SENTARA HEALTH,SENTARA HEALTH,1065.16,,,,,,,1065.1600,4126.9100,percent of total billed charges,"25.81% of $4,126.91 in Billed Charges for Rev 272 = $1,065.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4126.9100,619.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4126.91,,,,,,,1065.1600,4126.9100,percent of total billed charges,"100% of $4,126.91 in Billed Charges for Rev 272 = $4,126.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4126.9100,619.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2063.46,,,,,,,1065.1600,4126.9100,percent of total billed charges,"Rev 272 $4,126.91 in Billed Charges at 50% = $2,063.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4126.9100,619.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1332.99,,,,,,,1065.1600,4126.9100,other,"32.3% of $4,126.91 in Billed Charges for Rev 272 = $1,332.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4126.9100,619.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1266.96,,,,,,,1065.1600,4126.9100,other,"30.7% of $4,126.91 in Billed Charges for Rev 272 = $1,266.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4126.9100,619.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,1332.99,,,,,,,1065.1600,4126.9100,percent of total billed charges,"32.3% of $4,126.91 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4126.9100,619.0400,WELLCARE,WELLCARE MEDICAID,4126.91,,,,,,,1065.1600,4126.9100,percent of total billed charges,"100% of $4,126.91 in Billed Charges for Rev 272 = $4,126.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,21693.9500,3254.0900,AETNA,AETNA,9263.32,,,,,,,5599.2100,21693.9500,percent of total billed charges,"42.7% of $21,693.95 in Billed Charges for Rev 272 = $9,263.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,21693.9500,3254.0900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,15185.77,,,,,,,5599.2100,21693.9500,percent of total billed charges,"Rev 272 $21,693.95 in Billed Charges at 70% = $15,185.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,21693.9500,3254.0900,CIGNA HEALTHCARE,CIGNA HMO,9046.38,,,,,,,5599.2100,21693.9500,percent of total billed charges,"41.7% of $21,693.95 in Billed Charges for Rev 272 = $9,046.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,21693.9500,3254.0900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10065.99,,,,,,,5599.2100,21693.9500,percent of total billed charges,"46.4% of $21,693.95 in Billed Charges for Rev 272 = $10,065.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,21693.9500,3254.0900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9046.38,,,,,,,5599.2100,21693.9500,percent of total billed charges,"41.7% of $21,693.95 in Billed Charges for Rev 272 = $9,046.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,21693.9500,3254.0900,CIGNA HEALTHCARE,CIGNA PPO,9046.38,,,,,,,5599.2100,21693.9500,percent of total billed charges,"41.7% of $21,693.95 in Billed Charges for Rev 272 = $9,046.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,21693.9500,3254.0900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,19524.56,,,,,,,5599.2100,21693.9500,percent of total billed charges,"90% of $21,693.95 in Billed Charges for Rev 272 = $19,524.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,21693.9500,3254.0900,MEDCOST,MEDCOST VHN,10324.15,,,,,,,5599.2100,21693.9500,percent of total billed charges,"47.59% of $21,693.95 in Billed Charges for Rev 272 = $10,324.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,21693.9500,3254.0900,SENTARA HEALTH,SENTARA HEALTH,5599.21,,,,,,,5599.2100,21693.9500,percent of total billed charges,"25.81% of $21,693.95 in Billed Charges for Rev 272 = $5,599.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,21693.9500,3254.0900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",21693.95,,,,,,,5599.2100,21693.9500,percent of total billed charges,"100% of $21,693.95 in Billed Charges for Rev 272 = $21,693.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,21693.9500,3254.0900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,10846.98,,,,,,,5599.2100,21693.9500,percent of total billed charges,"Rev 272 $21,693.95 in Billed Charges at 50% = $10,846.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,21693.9500,3254.0900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7007.15,,,,,,,5599.2100,21693.9500,other,"32.3% of $21,693.95 in Billed Charges for Rev 272 = $7,007.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,21693.9500,3254.0900,UNITED HEALTHCARE,UHC HERITAGE SELECT,6660.04,,,,,,,5599.2100,21693.9500,other,"30.7% of $21,693.95 in Billed Charges for Rev 272 = $6,660.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,21693.9500,3254.0900,UNITED HEALTHCARE,UNITED HEALTHCARE,7007.15,,,,,,,5599.2100,21693.9500,percent of total billed charges,"32.3% of $21,693.95 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 25CM CURVED,272,RC,27200002,CDM,,,,,,both,,,21693.9500,3254.0900,WELLCARE,WELLCARE MEDICAID,21693.95,,,,,,,5599.2100,21693.9500,percent of total billed charges,"100% of $21,693.95 in Billed Charges for Rev 272 = $21,693.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SENSOR ADULT OXIMETRY,272,RC,,,,,,,,both,,,968.4600,145.2700,AETNA,AETNA,413.53,,,,,,,249.9600,968.4600,percent of total billed charges,42.7% of $968.46 in Billed Charges for Rev 272 = $413.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SENSOR ADULT OXIMETRY,272,RC,,,,,,,,both,,,968.4600,145.2700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,677.92,,,,,,,249.9600,968.4600,percent of total billed charges,Rev 272 $968.46 in Billed Charges at 70% = $677.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SENSOR ADULT OXIMETRY,272,RC,,,,,,,,both,,,968.4600,145.2700,CIGNA HEALTHCARE,CIGNA HMO,403.85,,,,,,,249.9600,968.4600,percent of total billed charges,41.7% of $968.46 in Billed Charges for Rev 272 = $403.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SENSOR ADULT OXIMETRY,272,RC,,,,,,,,both,,,968.4600,145.2700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,449.37,,,,,,,249.9600,968.4600,percent of total billed charges,46.4% of $968.46 in Billed Charges for Rev 272 = $449.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SENSOR ADULT OXIMETRY,272,RC,,,,,,,,both,,,968.4600,145.2700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,403.85,,,,,,,249.9600,968.4600,percent of total billed charges,41.7% of $968.46 in Billed Charges for Rev 272 = $403.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SENSOR ADULT OXIMETRY,272,RC,,,,,,,,both,,,968.4600,145.2700,CIGNA HEALTHCARE,CIGNA PPO,403.85,,,,,,,249.9600,968.4600,percent of total billed charges,41.7% of $968.46 in Billed Charges for Rev 272 = $403.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SENSOR ADULT OXIMETRY,272,RC,,,,,,,,both,,,968.4600,145.2700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,871.61,,,,,,,249.9600,968.4600,percent of total billed charges,90% of $968.46 in Billed Charges for Rev 272 = $871.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SENSOR ADULT OXIMETRY,272,RC,,,,,,,,both,,,968.4600,145.2700,MEDCOST,MEDCOST VHN,460.89,,,,,,,249.9600,968.4600,percent of total billed charges,47.59% of $968.46 in Billed Charges for Rev 272 = $460.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SENSOR ADULT OXIMETRY,272,RC,,,,,,,,both,,,968.4600,145.2700,SENTARA HEALTH,SENTARA HEALTH,249.96,,,,,,,249.9600,968.4600,percent of total billed charges,25.81% of $968.46 in Billed Charges for Rev 272 = $249.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SENSOR ADULT OXIMETRY,272,RC,,,,,,,,both,,,968.4600,145.2700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",968.46,,,,,,,249.9600,968.4600,percent of total billed charges,100% of $968.46 in Billed Charges for Rev 272 = $968.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SENSOR ADULT OXIMETRY,272,RC,,,,,,,,both,,,968.4600,145.2700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,484.23,,,,,,,249.9600,968.4600,percent of total billed charges,Rev 272 $968.46 in Billed Charges at 50% = $484.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SENSOR ADULT OXIMETRY,272,RC,,,,,,,,both,,,968.4600,145.2700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,312.81,,,,,,,249.9600,968.4600,other,32.3% of $968.46 in Billed Charges for Rev 272 = $312.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SENSOR ADULT OXIMETRY,272,RC,,,,,,,,both,,,968.4600,145.2700,UNITED HEALTHCARE,UHC HERITAGE SELECT,297.32,,,,,,,249.9600,968.4600,other,30.7% of $968.46 in Billed Charges for Rev 272 = $297.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SENSOR ADULT OXIMETRY,272,RC,,,,,,,,both,,,968.4600,145.2700,UNITED HEALTHCARE,UNITED HEALTHCARE,312.81,,,,,,,249.9600,968.4600,percent of total billed charges,32.3% of $968.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SENSOR ADULT OXIMETRY,272,RC,,,,,,,,both,,,968.4600,145.2700,WELLCARE,WELLCARE MEDICAID,968.46,,,,,,,249.9600,968.4600,percent of total billed charges,100% of $968.46 in Billed Charges for Rev 272 = $968.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SENSOR ADULT RS02,272,RC,,,,,,,,both,,,1084.1300,162.6200,AETNA,AETNA,462.92,,,,,,,279.8100,1084.1300,percent of total billed charges,"42.7% of $1,084.13 in Billed Charges for Rev 272 = $462.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SENSOR ADULT RS02,272,RC,,,,,,,,both,,,1084.1300,162.6200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,758.89,,,,,,,279.8100,1084.1300,percent of total billed charges,"Rev 272 $1,084.13 in Billed Charges at 70% = $758.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SENSOR ADULT RS02,272,RC,,,,,,,,both,,,1084.1300,162.6200,CIGNA HEALTHCARE,CIGNA HMO,452.08,,,,,,,279.8100,1084.1300,percent of total billed charges,"41.7% of $1,084.13 in Billed Charges for Rev 272 = $452.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SENSOR ADULT RS02,272,RC,,,,,,,,both,,,1084.1300,162.6200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,503.04,,,,,,,279.8100,1084.1300,percent of total billed charges,"46.4% of $1,084.13 in Billed Charges for Rev 272 = $503.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SENSOR ADULT RS02,272,RC,,,,,,,,both,,,1084.1300,162.6200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,452.08,,,,,,,279.8100,1084.1300,percent of total billed charges,"41.7% of $1,084.13 in Billed Charges for Rev 272 = $452.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SENSOR ADULT RS02,272,RC,,,,,,,,both,,,1084.1300,162.6200,CIGNA HEALTHCARE,CIGNA PPO,452.08,,,,,,,279.8100,1084.1300,percent of total billed charges,"41.7% of $1,084.13 in Billed Charges for Rev 272 = $452.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SENSOR ADULT RS02,272,RC,,,,,,,,both,,,1084.1300,162.6200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,975.72,,,,,,,279.8100,1084.1300,percent of total billed charges,"90% of $1,084.13 in Billed Charges for Rev 272 = $975.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SENSOR ADULT RS02,272,RC,,,,,,,,both,,,1084.1300,162.6200,MEDCOST,MEDCOST VHN,515.94,,,,,,,279.8100,1084.1300,percent of total billed charges,"47.59% of $1,084.13 in Billed Charges for Rev 272 = $515.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SENSOR ADULT RS02,272,RC,,,,,,,,both,,,1084.1300,162.6200,SENTARA HEALTH,SENTARA HEALTH,279.81,,,,,,,279.8100,1084.1300,percent of total billed charges,"25.81% of $1,084.13 in Billed Charges for Rev 272 = $279.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SENSOR ADULT RS02,272,RC,,,,,,,,both,,,1084.1300,162.6200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1084.13,,,,,,,279.8100,1084.1300,percent of total billed charges,"100% of $1,084.13 in Billed Charges for Rev 272 = $1,084.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SENSOR ADULT RS02,272,RC,,,,,,,,both,,,1084.1300,162.6200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,542.07,,,,,,,279.8100,1084.1300,percent of total billed charges,"Rev 272 $1,084.13 in Billed Charges at 50% = $542.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SENSOR ADULT RS02,272,RC,,,,,,,,both,,,1084.1300,162.6200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,350.17,,,,,,,279.8100,1084.1300,other,"32.3% of $1,084.13 in Billed Charges for Rev 272 = $350.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SENSOR ADULT RS02,272,RC,,,,,,,,both,,,1084.1300,162.6200,UNITED HEALTHCARE,UHC HERITAGE SELECT,332.83,,,,,,,279.8100,1084.1300,other,"30.7% of $1,084.13 in Billed Charges for Rev 272 = $332.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SENSOR ADULT RS02,272,RC,,,,,,,,both,,,1084.1300,162.6200,UNITED HEALTHCARE,UNITED HEALTHCARE,350.17,,,,,,,279.8100,1084.1300,percent of total billed charges,"32.3% of $1,084.13 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SENSOR ADULT RS02,272,RC,,,,,,,,both,,,1084.1300,162.6200,WELLCARE,WELLCARE MEDICAID,1084.13,,,,,,,279.8100,1084.1300,percent of total billed charges,"100% of $1,084.13 in Billed Charges for Rev 272 = $1,084.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND HIGH PLUS EXTRA PROFILE GEL 535CC,272,RC,27200002,CDM,,,,,,both,,,2489.4300,373.4100,AETNA,AETNA,1062.99,,,,,,,642.5200,2489.4300,percent of total billed charges,"42.7% of $2,489.43 in Billed Charges for Rev 272 = $1,062.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND HIGH PLUS EXTRA PROFILE GEL 535CC,272,RC,27200002,CDM,,,,,,both,,,2489.4300,373.4100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1742.60,,,,,,,642.5200,2489.4300,percent of total billed charges,"Rev 272 $2,489.43 in Billed Charges at 70% = $1,742.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND HIGH PLUS EXTRA PROFILE GEL 535CC,272,RC,27200002,CDM,,,,,,both,,,2489.4300,373.4100,CIGNA HEALTHCARE,CIGNA HMO,1038.09,,,,,,,642.5200,2489.4300,percent of total billed charges,"41.7% of $2,489.43 in Billed Charges for Rev 272 = $1,038.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND HIGH PLUS EXTRA PROFILE GEL 535CC,272,RC,27200002,CDM,,,,,,both,,,2489.4300,373.4100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1155.10,,,,,,,642.5200,2489.4300,percent of total billed charges,"46.4% of $2,489.43 in Billed Charges for Rev 272 = $1,155.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND HIGH PLUS EXTRA PROFILE GEL 535CC,272,RC,27200002,CDM,,,,,,both,,,2489.4300,373.4100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1038.09,,,,,,,642.5200,2489.4300,percent of total billed charges,"41.7% of $2,489.43 in Billed Charges for Rev 272 = $1,038.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND HIGH PLUS EXTRA PROFILE GEL 535CC,272,RC,27200002,CDM,,,,,,both,,,2489.4300,373.4100,CIGNA HEALTHCARE,CIGNA PPO,1038.09,,,,,,,642.5200,2489.4300,percent of total billed charges,"41.7% of $2,489.43 in Billed Charges for Rev 272 = $1,038.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND HIGH PLUS EXTRA PROFILE GEL 535CC,272,RC,27200002,CDM,,,,,,both,,,2489.4300,373.4100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2240.49,,,,,,,642.5200,2489.4300,percent of total billed charges,"90% of $2,489.43 in Billed Charges for Rev 272 = $2,240.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND HIGH PLUS EXTRA PROFILE GEL 535CC,272,RC,27200002,CDM,,,,,,both,,,2489.4300,373.4100,MEDCOST,MEDCOST VHN,1184.72,,,,,,,642.5200,2489.4300,percent of total billed charges,"47.59% of $2,489.43 in Billed Charges for Rev 272 = $1,184.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND HIGH PLUS EXTRA PROFILE GEL 535CC,272,RC,27200002,CDM,,,,,,both,,,2489.4300,373.4100,SENTARA HEALTH,SENTARA HEALTH,642.52,,,,,,,642.5200,2489.4300,percent of total billed charges,"25.81% of $2,489.43 in Billed Charges for Rev 272 = $642.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND HIGH PLUS EXTRA PROFILE GEL 535CC,272,RC,27200002,CDM,,,,,,both,,,2489.4300,373.4100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2489.43,,,,,,,642.5200,2489.4300,percent of total billed charges,"100% of $2,489.43 in Billed Charges for Rev 272 = $2,489.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND HIGH PLUS EXTRA PROFILE GEL 535CC,272,RC,27200002,CDM,,,,,,both,,,2489.4300,373.4100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1244.72,,,,,,,642.5200,2489.4300,percent of total billed charges,"Rev 272 $2,489.43 in Billed Charges at 50% = $1,244.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND HIGH PLUS EXTRA PROFILE GEL 535CC,272,RC,27200002,CDM,,,,,,both,,,2489.4300,373.4100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,804.09,,,,,,,642.5200,2489.4300,other,"32.3% of $2,489.43 in Billed Charges for Rev 272 = $804.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SIZER ROUND HIGH PLUS EXTRA PROFILE GEL 535CC,272,RC,27200002,CDM,,,,,,both,,,2489.4300,373.4100,UNITED HEALTHCARE,UHC HERITAGE SELECT,764.26,,,,,,,642.5200,2489.4300,other,"30.7% of $2,489.43 in Billed Charges for Rev 272 = $764.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SIZER ROUND HIGH PLUS EXTRA PROFILE GEL 535CC,272,RC,27200002,CDM,,,,,,both,,,2489.4300,373.4100,UNITED HEALTHCARE,UNITED HEALTHCARE,804.09,,,,,,,642.5200,2489.4300,percent of total billed charges,"32.3% of $2,489.43 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND HIGH PLUS EXTRA PROFILE GEL 535CC,272,RC,27200002,CDM,,,,,,both,,,2489.4300,373.4100,WELLCARE,WELLCARE MEDICAID,2489.43,,,,,,,642.5200,2489.4300,percent of total billed charges,"100% of $2,489.43 in Billed Charges for Rev 272 = $2,489.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MEMBRANE SOFT TISSUE AVIVE 3 X 4CM,278,RC,,,,,,,,both,,,31631.5500,4744.7300,AETNA,AETNA,15183.14,,,,,,,2245.8400,31631.5500,percent of total billed charges,"48% of $31,631.55 in Billed Charges for Rev 278 = $15,183.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MEMBRANE SOFT TISSUE AVIVE 3 X 4CM,278,RC,,,,,,,,both,,,31631.5500,4744.7300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,15815.78,,,,,,,2245.8400,31631.5500,percent of total billed charges,"50% of $31,631.55 in Billed Charges for Rev 278 = $15,815.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MEMBRANE SOFT TISSUE AVIVE 3 X 4CM,278,RC,,,,,,,,both,,,31631.5500,4744.7300,CIGNA HEALTHCARE,CIGNA HMO,13190.36,,,,,,,2245.8400,31631.5500,percent of total billed charges,"41.7% of $31,631.55 in Billed Charges for Rev 278 = $13,190.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MEMBRANE SOFT TISSUE AVIVE 3 X 4CM,278,RC,,,,,,,,both,,,31631.5500,4744.7300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12652.62,,,,,,,2245.8400,31631.5500,percent of total billed charges,"40% of $31,631.55 in Billed Charges for Rev 278 = $12,652.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MEMBRANE SOFT TISSUE AVIVE 3 X 4CM,278,RC,,,,,,,,both,,,31631.5500,4744.7300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,13190.36,,,,,,,2245.8400,31631.5500,percent of total billed charges,"41.7% of $31,631.55 in Billed Charges for Rev 278 = $13,190.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MEMBRANE SOFT TISSUE AVIVE 3 X 4CM,278,RC,,,,,,,,both,,,31631.5500,4744.7300,CIGNA HEALTHCARE,CIGNA PPO,13190.36,,,,,,,2245.8400,31631.5500,percent of total billed charges,"41.7% of $31,631.55 in Billed Charges for Rev 278 = $13,190.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MEMBRANE SOFT TISSUE AVIVE 3 X 4CM,278,RC,,,,,,,,both,,,31631.5500,4744.7300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,28468.40,,,,,,,2245.8400,31631.5500,percent of total billed charges,"90% of $31,631.55 in Billed Charges for Rev 278 = $28,468.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MEMBRANE SOFT TISSUE AVIVE 3 X 4CM,278,RC,,,,,,,,both,,,31631.5500,4744.7300,MEDCOST,MEDCOST VHN,15053.45,,,,,,,2245.8400,31631.5500,percent of total billed charges,"47.59% of $31,631.55 in Billed Charges for Rev 278 = $15,053.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MEMBRANE SOFT TISSUE AVIVE 3 X 4CM,278,RC,,,,,,,,both,,,31631.5500,4744.7300,SENTARA HEALTH,SENTARA HEALTH,8164.10,,,,,,,2245.8400,31631.5500,percent of total billed charges,"25.81% of $31,631.55 in Billed Charges for Rev 278 = $8,164.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MEMBRANE SOFT TISSUE AVIVE 3 X 4CM,278,RC,,,,,,,,both,,,31631.5500,4744.7300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",31631.55,,,,,,,2245.8400,31631.5500,percent of total billed charges,"100% of $31,631.55 in Billed Charges for Rev 278 = $31,631.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MEMBRANE SOFT TISSUE AVIVE 3 X 4CM,278,RC,,,,,,,,both,,,31631.5500,4744.7300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,15815.78,,,,,,,2245.8400,31631.5500,percent of total billed charges,"Rev 278 $31,631.55 in Billed Charges at 50% = $15,815.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MEMBRANE SOFT TISSUE AVIVE 3 X 4CM,278,RC,,,,,,,,both,,,31631.5500,4744.7300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2372.37,,,,,,,2245.8400,31631.5500,percent of total billed charges,"7.5% of $31,631.55 in Billed Charges for Rev 278 = $2,372.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MEMBRANE SOFT TISSUE AVIVE 3 X 4CM,278,RC,,,,,,,,both,,,31631.5500,4744.7300,UNITED HEALTHCARE,UHC HERITAGE SELECT,2245.84,,,,,,,2245.8400,31631.5500,percent of total billed charges,"7.1% of $31,631.55 in Billed Charges for Rev 278 = $2,245.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MEMBRANE SOFT TISSUE AVIVE 3 X 4CM,278,RC,,,,,,,,both,,,31631.5500,4744.7300,UNITED HEALTHCARE,UNITED HEALTHCARE,2245.84,,,,,,,2245.8400,31631.5500,percent of total billed charges,"7.1% of $31,631.55 in Billed Charges for Rev 278 = $2,245.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
MEMBRANE SOFT TISSUE AVIVE 3 X 4CM,278,RC,,,,,,,,both,,,31631.5500,4744.7300,WELLCARE,WELLCARE MEDICAID,31631.55,,,,,,,2245.8400,31631.5500,percent of total billed charges,"100% of $31,631.55 in Billed Charges for Rev 278 = $31,631.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE INTERSTIM 5IN 20G FORAMEN,272,RC,27200002,CDM,,,,,,both,,,672.9700,100.9500,AETNA,AETNA,287.36,,,,,,,173.6900,672.9700,percent of total billed charges,42.7% of $672.97 in Billed Charges for Rev 272 = $287.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INTERSTIM 5IN 20G FORAMEN,272,RC,27200002,CDM,,,,,,both,,,672.9700,100.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,471.08,,,,,,,173.6900,672.9700,percent of total billed charges,Rev 272 $672.97 in Billed Charges at 70% = $471.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INTERSTIM 5IN 20G FORAMEN,272,RC,27200002,CDM,,,,,,both,,,672.9700,100.9500,CIGNA HEALTHCARE,CIGNA HMO,280.63,,,,,,,173.6900,672.9700,percent of total billed charges,41.7% of $672.97 in Billed Charges for Rev 272 = $280.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INTERSTIM 5IN 20G FORAMEN,272,RC,27200002,CDM,,,,,,both,,,672.9700,100.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,312.26,,,,,,,173.6900,672.9700,percent of total billed charges,46.4% of $672.97 in Billed Charges for Rev 272 = $312.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INTERSTIM 5IN 20G FORAMEN,272,RC,27200002,CDM,,,,,,both,,,672.9700,100.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,280.63,,,,,,,173.6900,672.9700,percent of total billed charges,41.7% of $672.97 in Billed Charges for Rev 272 = $280.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INTERSTIM 5IN 20G FORAMEN,272,RC,27200002,CDM,,,,,,both,,,672.9700,100.9500,CIGNA HEALTHCARE,CIGNA PPO,280.63,,,,,,,173.6900,672.9700,percent of total billed charges,41.7% of $672.97 in Billed Charges for Rev 272 = $280.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INTERSTIM 5IN 20G FORAMEN,272,RC,27200002,CDM,,,,,,both,,,672.9700,100.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,605.67,,,,,,,173.6900,672.9700,percent of total billed charges,90% of $672.97 in Billed Charges for Rev 272 = $605.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INTERSTIM 5IN 20G FORAMEN,272,RC,27200002,CDM,,,,,,both,,,672.9700,100.9500,MEDCOST,MEDCOST VHN,320.27,,,,,,,173.6900,672.9700,percent of total billed charges,47.59% of $672.97 in Billed Charges for Rev 272 = $320.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INTERSTIM 5IN 20G FORAMEN,272,RC,27200002,CDM,,,,,,both,,,672.9700,100.9500,SENTARA HEALTH,SENTARA HEALTH,173.69,,,,,,,173.6900,672.9700,percent of total billed charges,25.81% of $672.97 in Billed Charges for Rev 272 = $173.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INTERSTIM 5IN 20G FORAMEN,272,RC,27200002,CDM,,,,,,both,,,672.9700,100.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",672.97,,,,,,,173.6900,672.9700,percent of total billed charges,100% of $672.97 in Billed Charges for Rev 272 = $672.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INTERSTIM 5IN 20G FORAMEN,272,RC,27200002,CDM,,,,,,both,,,672.9700,100.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,336.49,,,,,,,173.6900,672.9700,percent of total billed charges,Rev 272 $672.97 in Billed Charges at 50% = $336.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INTERSTIM 5IN 20G FORAMEN,272,RC,27200002,CDM,,,,,,both,,,672.9700,100.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,217.37,,,,,,,173.6900,672.9700,other,32.3% of $672.97 in Billed Charges for Rev 272 = $217.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE INTERSTIM 5IN 20G FORAMEN,272,RC,27200002,CDM,,,,,,both,,,672.9700,100.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,206.60,,,,,,,173.6900,672.9700,other,30.7% of $672.97 in Billed Charges for Rev 272 = $206.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE INTERSTIM 5IN 20G FORAMEN,272,RC,27200002,CDM,,,,,,both,,,672.9700,100.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,217.37,,,,,,,173.6900,672.9700,percent of total billed charges,32.3% of $672.97 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE INTERSTIM 5IN 20G FORAMEN,272,RC,27200002,CDM,,,,,,both,,,672.9700,100.9500,WELLCARE,WELLCARE MEDICAID,672.97,,,,,,,173.6900,672.9700,percent of total billed charges,100% of $672.97 in Billed Charges for Rev 272 = $672.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE KNIFE CUT3V WITH COATING,272,RC,27200002,CDM,,,,,,both,,,1485.7500,222.8600,AETNA,AETNA,634.42,,,,,,,383.4700,1485.7500,percent of total billed charges,"42.7% of $1,485.75 in Billed Charges for Rev 272 = $634.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE KNIFE CUT3V WITH COATING,272,RC,27200002,CDM,,,,,,both,,,1485.7500,222.8600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1040.03,,,,,,,383.4700,1485.7500,percent of total billed charges,"Rev 272 $1,485.75 in Billed Charges at 70% = $1,040.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE KNIFE CUT3V WITH COATING,272,RC,27200002,CDM,,,,,,both,,,1485.7500,222.8600,CIGNA HEALTHCARE,CIGNA HMO,619.56,,,,,,,383.4700,1485.7500,percent of total billed charges,"41.7% of $1,485.75 in Billed Charges for Rev 272 = $619.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE KNIFE CUT3V WITH COATING,272,RC,27200002,CDM,,,,,,both,,,1485.7500,222.8600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,689.39,,,,,,,383.4700,1485.7500,percent of total billed charges,"46.4% of $1,485.75 in Billed Charges for Rev 272 = $689.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE KNIFE CUT3V WITH COATING,272,RC,27200002,CDM,,,,,,both,,,1485.7500,222.8600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,619.56,,,,,,,383.4700,1485.7500,percent of total billed charges,"41.7% of $1,485.75 in Billed Charges for Rev 272 = $619.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE KNIFE CUT3V WITH COATING,272,RC,27200002,CDM,,,,,,both,,,1485.7500,222.8600,CIGNA HEALTHCARE,CIGNA PPO,619.56,,,,,,,383.4700,1485.7500,percent of total billed charges,"41.7% of $1,485.75 in Billed Charges for Rev 272 = $619.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE KNIFE CUT3V WITH COATING,272,RC,27200002,CDM,,,,,,both,,,1485.7500,222.8600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1337.18,,,,,,,383.4700,1485.7500,percent of total billed charges,"90% of $1,485.75 in Billed Charges for Rev 272 = $1,337.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE KNIFE CUT3V WITH COATING,272,RC,27200002,CDM,,,,,,both,,,1485.7500,222.8600,MEDCOST,MEDCOST VHN,707.07,,,,,,,383.4700,1485.7500,percent of total billed charges,"47.59% of $1,485.75 in Billed Charges for Rev 272 = $707.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE KNIFE CUT3V WITH COATING,272,RC,27200002,CDM,,,,,,both,,,1485.7500,222.8600,SENTARA HEALTH,SENTARA HEALTH,383.47,,,,,,,383.4700,1485.7500,percent of total billed charges,"25.81% of $1,485.75 in Billed Charges for Rev 272 = $383.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE KNIFE CUT3V WITH COATING,272,RC,27200002,CDM,,,,,,both,,,1485.7500,222.8600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1485.75,,,,,,,383.4700,1485.7500,percent of total billed charges,"100% of $1,485.75 in Billed Charges for Rev 272 = $1,485.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE KNIFE CUT3V WITH COATING,272,RC,27200002,CDM,,,,,,both,,,1485.7500,222.8600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,742.88,,,,,,,383.4700,1485.7500,percent of total billed charges,"Rev 272 $1,485.75 in Billed Charges at 50% = $742.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE KNIFE CUT3V WITH COATING,272,RC,27200002,CDM,,,,,,both,,,1485.7500,222.8600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,479.90,,,,,,,383.4700,1485.7500,other,"32.3% of $1,485.75 in Billed Charges for Rev 272 = $479.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE KNIFE CUT3V WITH COATING,272,RC,27200002,CDM,,,,,,both,,,1485.7500,222.8600,UNITED HEALTHCARE,UHC HERITAGE SELECT,456.13,,,,,,,383.4700,1485.7500,other,"30.7% of $1,485.75 in Billed Charges for Rev 272 = $456.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE KNIFE CUT3V WITH COATING,272,RC,27200002,CDM,,,,,,both,,,1485.7500,222.8600,UNITED HEALTHCARE,UNITED HEALTHCARE,479.90,,,,,,,383.4700,1485.7500,percent of total billed charges,"32.3% of $1,485.75 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE KNIFE CUT3V WITH COATING,272,RC,27200002,CDM,,,,,,both,,,1485.7500,222.8600,WELLCARE,WELLCARE MEDICAID,1485.75,,,,,,,383.4700,1485.7500,percent of total billed charges,"100% of $1,485.75 in Billed Charges for Rev 272 = $1,485.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE LUNG BIOPSY VISISHOT2 19G VFLEX NEEDLE,272,RC,27200002,CDM,,,,,,both,,,2675.7200,401.3600,AETNA,AETNA,1142.53,,,,,,,690.6000,2675.7200,percent of total billed charges,"42.7% of $2,675.72 in Billed Charges for Rev 272 = $1,142.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE LUNG BIOPSY VISISHOT2 19G VFLEX NEEDLE,272,RC,27200002,CDM,,,,,,both,,,2675.7200,401.3600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1873.00,,,,,,,690.6000,2675.7200,percent of total billed charges,"Rev 272 $2,675.72 in Billed Charges at 70% = $1,873.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE LUNG BIOPSY VISISHOT2 19G VFLEX NEEDLE,272,RC,27200002,CDM,,,,,,both,,,2675.7200,401.3600,CIGNA HEALTHCARE,CIGNA HMO,1115.78,,,,,,,690.6000,2675.7200,percent of total billed charges,"41.7% of $2,675.72 in Billed Charges for Rev 272 = $1,115.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE LUNG BIOPSY VISISHOT2 19G VFLEX NEEDLE,272,RC,27200002,CDM,,,,,,both,,,2675.7200,401.3600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1241.53,,,,,,,690.6000,2675.7200,percent of total billed charges,"46.4% of $2,675.72 in Billed Charges for Rev 272 = $1,241.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE LUNG BIOPSY VISISHOT2 19G VFLEX NEEDLE,272,RC,27200002,CDM,,,,,,both,,,2675.7200,401.3600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1115.78,,,,,,,690.6000,2675.7200,percent of total billed charges,"41.7% of $2,675.72 in Billed Charges for Rev 272 = $1,115.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE LUNG BIOPSY VISISHOT2 19G VFLEX NEEDLE,272,RC,27200002,CDM,,,,,,both,,,2675.7200,401.3600,CIGNA HEALTHCARE,CIGNA PPO,1115.78,,,,,,,690.6000,2675.7200,percent of total billed charges,"41.7% of $2,675.72 in Billed Charges for Rev 272 = $1,115.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE LUNG BIOPSY VISISHOT2 19G VFLEX NEEDLE,272,RC,27200002,CDM,,,,,,both,,,2675.7200,401.3600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2408.15,,,,,,,690.6000,2675.7200,percent of total billed charges,"90% of $2,675.72 in Billed Charges for Rev 272 = $2,408.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE LUNG BIOPSY VISISHOT2 19G VFLEX NEEDLE,272,RC,27200002,CDM,,,,,,both,,,2675.7200,401.3600,MEDCOST,MEDCOST VHN,1273.38,,,,,,,690.6000,2675.7200,percent of total billed charges,"47.59% of $2,675.72 in Billed Charges for Rev 272 = $1,273.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE LUNG BIOPSY VISISHOT2 19G VFLEX NEEDLE,272,RC,27200002,CDM,,,,,,both,,,2675.7200,401.3600,SENTARA HEALTH,SENTARA HEALTH,690.60,,,,,,,690.6000,2675.7200,percent of total billed charges,"25.81% of $2,675.72 in Billed Charges for Rev 272 = $690.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE LUNG BIOPSY VISISHOT2 19G VFLEX NEEDLE,272,RC,27200002,CDM,,,,,,both,,,2675.7200,401.3600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2675.72,,,,,,,690.6000,2675.7200,percent of total billed charges,"100% of $2,675.72 in Billed Charges for Rev 272 = $2,675.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE LUNG BIOPSY VISISHOT2 19G VFLEX NEEDLE,272,RC,27200002,CDM,,,,,,both,,,2675.7200,401.3600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1337.86,,,,,,,690.6000,2675.7200,percent of total billed charges,"Rev 272 $2,675.72 in Billed Charges at 50% = $1,337.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE LUNG BIOPSY VISISHOT2 19G VFLEX NEEDLE,272,RC,27200002,CDM,,,,,,both,,,2675.7200,401.3600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,864.26,,,,,,,690.6000,2675.7200,other,"32.3% of $2,675.72 in Billed Charges for Rev 272 = $864.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE LUNG BIOPSY VISISHOT2 19G VFLEX NEEDLE,272,RC,27200002,CDM,,,,,,both,,,2675.7200,401.3600,UNITED HEALTHCARE,UHC HERITAGE SELECT,821.45,,,,,,,690.6000,2675.7200,other,"30.7% of $2,675.72 in Billed Charges for Rev 272 = $821.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE LUNG BIOPSY VISISHOT2 19G VFLEX NEEDLE,272,RC,27200002,CDM,,,,,,both,,,2675.7200,401.3600,UNITED HEALTHCARE,UNITED HEALTHCARE,864.26,,,,,,,690.6000,2675.7200,percent of total billed charges,"32.3% of $2,675.72 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE LUNG BIOPSY VISISHOT2 19G VFLEX NEEDLE,272,RC,27200002,CDM,,,,,,both,,,2675.7200,401.3600,WELLCARE,WELLCARE MEDICAID,2675.72,,,,,,,690.6000,2675.7200,percent of total billed charges,"100% of $2,675.72 in Billed Charges for Rev 272 = $2,675.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND HIGH PROFILE GEL 500CC,272,RC,27200002,CDM,,,,,,both,,,233.2800,34.9900,AETNA,AETNA,99.61,,,,,,,60.2100,233.2800,percent of total billed charges,42.7% of $233.28 in Billed Charges for Rev 272 = $99.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER ROUND HIGH PROFILE GEL 500CC,272,RC,27200002,CDM,,,,,,both,,,233.2800,34.9900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,163.30,,,,,,,60.2100,233.2800,percent of total billed charges,Rev 272 $233.28 in Billed Charges at 70% = $163.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER ROUND HIGH PROFILE GEL 500CC,272,RC,27200002,CDM,,,,,,both,,,233.2800,34.9900,CIGNA HEALTHCARE,CIGNA HMO,97.28,,,,,,,60.2100,233.2800,percent of total billed charges,41.7% of $233.28 in Billed Charges for Rev 272 = $97.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER ROUND HIGH PROFILE GEL 500CC,272,RC,27200002,CDM,,,,,,both,,,233.2800,34.9900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,108.24,,,,,,,60.2100,233.2800,percent of total billed charges,46.4% of $233.28 in Billed Charges for Rev 272 = $108.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER ROUND HIGH PROFILE GEL 500CC,272,RC,27200002,CDM,,,,,,both,,,233.2800,34.9900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,97.28,,,,,,,60.2100,233.2800,percent of total billed charges,41.7% of $233.28 in Billed Charges for Rev 272 = $97.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER ROUND HIGH PROFILE GEL 500CC,272,RC,27200002,CDM,,,,,,both,,,233.2800,34.9900,CIGNA HEALTHCARE,CIGNA PPO,97.28,,,,,,,60.2100,233.2800,percent of total billed charges,41.7% of $233.28 in Billed Charges for Rev 272 = $97.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER ROUND HIGH PROFILE GEL 500CC,272,RC,27200002,CDM,,,,,,both,,,233.2800,34.9900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,209.95,,,,,,,60.2100,233.2800,percent of total billed charges,90% of $233.28 in Billed Charges for Rev 272 = $209.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER ROUND HIGH PROFILE GEL 500CC,272,RC,27200002,CDM,,,,,,both,,,233.2800,34.9900,MEDCOST,MEDCOST VHN,111.02,,,,,,,60.2100,233.2800,percent of total billed charges,47.59% of $233.28 in Billed Charges for Rev 272 = $111.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER ROUND HIGH PROFILE GEL 500CC,272,RC,27200002,CDM,,,,,,both,,,233.2800,34.9900,SENTARA HEALTH,SENTARA HEALTH,60.21,,,,,,,60.2100,233.2800,percent of total billed charges,25.81% of $233.28 in Billed Charges for Rev 272 = $60.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER ROUND HIGH PROFILE GEL 500CC,272,RC,27200002,CDM,,,,,,both,,,233.2800,34.9900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",233.28,,,,,,,60.2100,233.2800,percent of total billed charges,100% of $233.28 in Billed Charges for Rev 272 = $233.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER ROUND HIGH PROFILE GEL 500CC,272,RC,27200002,CDM,,,,,,both,,,233.2800,34.9900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,116.64,,,,,,,60.2100,233.2800,percent of total billed charges,Rev 272 $233.28 in Billed Charges at 50% = $116.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER ROUND HIGH PROFILE GEL 500CC,272,RC,27200002,CDM,,,,,,both,,,233.2800,34.9900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,75.35,,,,,,,60.2100,233.2800,other,32.3% of $233.28 in Billed Charges for Rev 272 = $75.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SIZER ROUND HIGH PROFILE GEL 500CC,272,RC,27200002,CDM,,,,,,both,,,233.2800,34.9900,UNITED HEALTHCARE,UHC HERITAGE SELECT,71.62,,,,,,,60.2100,233.2800,other,30.7% of $233.28 in Billed Charges for Rev 272 = $71.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SIZER ROUND HIGH PROFILE GEL 500CC,272,RC,27200002,CDM,,,,,,both,,,233.2800,34.9900,UNITED HEALTHCARE,UNITED HEALTHCARE,75.35,,,,,,,60.2100,233.2800,percent of total billed charges,32.3% of $233.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER ROUND HIGH PROFILE GEL 500CC,272,RC,27200002,CDM,,,,,,both,,,233.2800,34.9900,WELLCARE,WELLCARE MEDICAID,233.28,,,,,,,60.2100,233.2800,percent of total billed charges,100% of $233.28 in Billed Charges for Rev 272 = $233.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE DRILL THREADED SHORT 6.0/5.0MM,272,RC,,,,,,,,both,,,2038.4200,305.7600,AETNA,AETNA,870.41,,,,,,,526.1200,2038.4200,percent of total billed charges,"42.7% of $2,038.42 in Billed Charges for Rev 272 = $870.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE DRILL THREADED SHORT 6.0/5.0MM,272,RC,,,,,,,,both,,,2038.4200,305.7600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1426.89,,,,,,,526.1200,2038.4200,percent of total billed charges,"Rev 272 $2,038.42 in Billed Charges at 70% = $1,426.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE DRILL THREADED SHORT 6.0/5.0MM,272,RC,,,,,,,,both,,,2038.4200,305.7600,CIGNA HEALTHCARE,CIGNA HMO,850.02,,,,,,,526.1200,2038.4200,percent of total billed charges,"41.7% of $2,038.42 in Billed Charges for Rev 272 = $850.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE DRILL THREADED SHORT 6.0/5.0MM,272,RC,,,,,,,,both,,,2038.4200,305.7600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,945.83,,,,,,,526.1200,2038.4200,percent of total billed charges,"46.4% of $2,038.42 in Billed Charges for Rev 272 = $945.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE DRILL THREADED SHORT 6.0/5.0MM,272,RC,,,,,,,,both,,,2038.4200,305.7600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,850.02,,,,,,,526.1200,2038.4200,percent of total billed charges,"41.7% of $2,038.42 in Billed Charges for Rev 272 = $850.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE DRILL THREADED SHORT 6.0/5.0MM,272,RC,,,,,,,,both,,,2038.4200,305.7600,CIGNA HEALTHCARE,CIGNA PPO,850.02,,,,,,,526.1200,2038.4200,percent of total billed charges,"41.7% of $2,038.42 in Billed Charges for Rev 272 = $850.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE DRILL THREADED SHORT 6.0/5.0MM,272,RC,,,,,,,,both,,,2038.4200,305.7600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1834.58,,,,,,,526.1200,2038.4200,percent of total billed charges,"90% of $2,038.42 in Billed Charges for Rev 272 = $1,834.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE DRILL THREADED SHORT 6.0/5.0MM,272,RC,,,,,,,,both,,,2038.4200,305.7600,MEDCOST,MEDCOST VHN,970.08,,,,,,,526.1200,2038.4200,percent of total billed charges,"47.59% of $2,038.42 in Billed Charges for Rev 272 = $970.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE DRILL THREADED SHORT 6.0/5.0MM,272,RC,,,,,,,,both,,,2038.4200,305.7600,SENTARA HEALTH,SENTARA HEALTH,526.12,,,,,,,526.1200,2038.4200,percent of total billed charges,"25.81% of $2,038.42 in Billed Charges for Rev 272 = $526.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE DRILL THREADED SHORT 6.0/5.0MM,272,RC,,,,,,,,both,,,2038.4200,305.7600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2038.42,,,,,,,526.1200,2038.4200,percent of total billed charges,"100% of $2,038.42 in Billed Charges for Rev 272 = $2,038.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE DRILL THREADED SHORT 6.0/5.0MM,272,RC,,,,,,,,both,,,2038.4200,305.7600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1019.21,,,,,,,526.1200,2038.4200,percent of total billed charges,"Rev 272 $2,038.42 in Billed Charges at 50% = $1,019.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE DRILL THREADED SHORT 6.0/5.0MM,272,RC,,,,,,,,both,,,2038.4200,305.7600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,658.41,,,,,,,526.1200,2038.4200,other,"32.3% of $2,038.42 in Billed Charges for Rev 272 = $658.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SLEEVE DRILL THREADED SHORT 6.0/5.0MM,272,RC,,,,,,,,both,,,2038.4200,305.7600,UNITED HEALTHCARE,UHC HERITAGE SELECT,625.79,,,,,,,526.1200,2038.4200,other,"30.7% of $2,038.42 in Billed Charges for Rev 272 = $625.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SLEEVE DRILL THREADED SHORT 6.0/5.0MM,272,RC,,,,,,,,both,,,2038.4200,305.7600,UNITED HEALTHCARE,UNITED HEALTHCARE,658.41,,,,,,,526.1200,2038.4200,percent of total billed charges,"32.3% of $2,038.42 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE DRILL THREADED SHORT 6.0/5.0MM,272,RC,,,,,,,,both,,,2038.4200,305.7600,WELLCARE,WELLCARE MEDICAID,2038.42,,,,,,,526.1200,2038.4200,percent of total billed charges,"100% of $2,038.42 in Billed Charges for Rev 272 = $2,038.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,652.3400,97.8500,AETNA,AETNA,278.55,,,,,,,168.3700,652.3400,percent of total billed charges,42.7% of $652.34 in Billed Charges for Rev 272 = $278.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,652.3400,97.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,456.64,,,,,,,168.3700,652.3400,percent of total billed charges,Rev 272 $652.34 in Billed Charges at 70% = $456.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,652.3400,97.8500,CIGNA HEALTHCARE,CIGNA HMO,272.03,,,,,,,168.3700,652.3400,percent of total billed charges,41.7% of $652.34 in Billed Charges for Rev 272 = $272.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,652.3400,97.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,302.69,,,,,,,168.3700,652.3400,percent of total billed charges,46.4% of $652.34 in Billed Charges for Rev 272 = $302.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,652.3400,97.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,272.03,,,,,,,168.3700,652.3400,percent of total billed charges,41.7% of $652.34 in Billed Charges for Rev 272 = $272.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,652.3400,97.8500,CIGNA HEALTHCARE,CIGNA PPO,272.03,,,,,,,168.3700,652.3400,percent of total billed charges,41.7% of $652.34 in Billed Charges for Rev 272 = $272.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,652.3400,97.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,587.11,,,,,,,168.3700,652.3400,percent of total billed charges,90% of $652.34 in Billed Charges for Rev 272 = $587.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,652.3400,97.8500,MEDCOST,MEDCOST VHN,310.45,,,,,,,168.3700,652.3400,percent of total billed charges,47.59% of $652.34 in Billed Charges for Rev 272 = $310.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,652.3400,97.8500,SENTARA HEALTH,SENTARA HEALTH,168.37,,,,,,,168.3700,652.3400,percent of total billed charges,25.81% of $652.34 in Billed Charges for Rev 272 = $168.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,652.3400,97.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",652.34,,,,,,,168.3700,652.3400,percent of total billed charges,100% of $652.34 in Billed Charges for Rev 272 = $652.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,652.3400,97.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,326.17,,,,,,,168.3700,652.3400,percent of total billed charges,Rev 272 $652.34 in Billed Charges at 50% = $326.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,652.3400,97.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,210.71,,,,,,,168.3700,652.3400,other,32.3% of $652.34 in Billed Charges for Rev 272 = $210.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,652.3400,97.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,200.27,,,,,,,168.3700,652.3400,other,30.7% of $652.34 in Billed Charges for Rev 272 = $200.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,652.3400,97.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,210.71,,,,,,,168.3700,652.3400,percent of total billed charges,32.3% of $652.34 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,652.3400,97.8500,WELLCARE,WELLCARE MEDICAID,652.34,,,,,,,168.3700,652.3400,percent of total billed charges,100% of $652.34 in Billed Charges for Rev 272 = $652.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,844.6100,126.6900,AETNA,AETNA,360.65,,,,,,,217.9900,844.6100,percent of total billed charges,42.7% of $844.61 in Billed Charges for Rev 272 = $360.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,844.6100,126.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,591.23,,,,,,,217.9900,844.6100,percent of total billed charges,Rev 272 $844.61 in Billed Charges at 70% = $591.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,844.6100,126.6900,CIGNA HEALTHCARE,CIGNA HMO,352.20,,,,,,,217.9900,844.6100,percent of total billed charges,41.7% of $844.61 in Billed Charges for Rev 272 = $352.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,844.6100,126.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,391.90,,,,,,,217.9900,844.6100,percent of total billed charges,46.4% of $844.61 in Billed Charges for Rev 272 = $391.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,844.6100,126.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,352.20,,,,,,,217.9900,844.6100,percent of total billed charges,41.7% of $844.61 in Billed Charges for Rev 272 = $352.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,844.6100,126.6900,CIGNA HEALTHCARE,CIGNA PPO,352.20,,,,,,,217.9900,844.6100,percent of total billed charges,41.7% of $844.61 in Billed Charges for Rev 272 = $352.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,844.6100,126.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,760.15,,,,,,,217.9900,844.6100,percent of total billed charges,90% of $844.61 in Billed Charges for Rev 272 = $760.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,844.6100,126.6900,MEDCOST,MEDCOST VHN,401.95,,,,,,,217.9900,844.6100,percent of total billed charges,47.59% of $844.61 in Billed Charges for Rev 272 = $401.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,844.6100,126.6900,SENTARA HEALTH,SENTARA HEALTH,217.99,,,,,,,217.9900,844.6100,percent of total billed charges,25.81% of $844.61 in Billed Charges for Rev 272 = $217.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,844.6100,126.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",844.61,,,,,,,217.9900,844.6100,percent of total billed charges,100% of $844.61 in Billed Charges for Rev 272 = $844.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,844.6100,126.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,422.31,,,,,,,217.9900,844.6100,percent of total billed charges,Rev 272 $844.61 in Billed Charges at 50% = $422.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,844.6100,126.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,272.81,,,,,,,217.9900,844.6100,other,32.3% of $844.61 in Billed Charges for Rev 272 = $272.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,844.6100,126.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,259.30,,,,,,,217.9900,844.6100,other,30.7% of $844.61 in Billed Charges for Rev 272 = $259.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,844.6100,126.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,272.81,,,,,,,217.9900,844.6100,percent of total billed charges,32.3% of $844.61 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,844.6100,126.6900,WELLCARE,WELLCARE MEDICAID,844.61,,,,,,,217.9900,844.6100,percent of total billed charges,100% of $844.61 in Billed Charges for Rev 272 = $844.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PEAK PLASMABLADE 4.0,272,RC,27200002,CDM,,,,,,both,,,3481.9600,522.2900,AETNA,AETNA,1486.80,,,,,,,898.6900,3481.9600,percent of total billed charges,"42.7% of $3,481.96 in Billed Charges for Rev 272 = $1,486.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEAK PLASMABLADE 4.0,272,RC,27200002,CDM,,,,,,both,,,3481.9600,522.2900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2437.37,,,,,,,898.6900,3481.9600,percent of total billed charges,"Rev 272 $3,481.96 in Billed Charges at 70% = $2,437.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEAK PLASMABLADE 4.0,272,RC,27200002,CDM,,,,,,both,,,3481.9600,522.2900,CIGNA HEALTHCARE,CIGNA HMO,1451.98,,,,,,,898.6900,3481.9600,percent of total billed charges,"41.7% of $3,481.96 in Billed Charges for Rev 272 = $1,451.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEAK PLASMABLADE 4.0,272,RC,27200002,CDM,,,,,,both,,,3481.9600,522.2900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1615.63,,,,,,,898.6900,3481.9600,percent of total billed charges,"46.4% of $3,481.96 in Billed Charges for Rev 272 = $1,615.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEAK PLASMABLADE 4.0,272,RC,27200002,CDM,,,,,,both,,,3481.9600,522.2900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1451.98,,,,,,,898.6900,3481.9600,percent of total billed charges,"41.7% of $3,481.96 in Billed Charges for Rev 272 = $1,451.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEAK PLASMABLADE 4.0,272,RC,27200002,CDM,,,,,,both,,,3481.9600,522.2900,CIGNA HEALTHCARE,CIGNA PPO,1451.98,,,,,,,898.6900,3481.9600,percent of total billed charges,"41.7% of $3,481.96 in Billed Charges for Rev 272 = $1,451.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEAK PLASMABLADE 4.0,272,RC,27200002,CDM,,,,,,both,,,3481.9600,522.2900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3133.76,,,,,,,898.6900,3481.9600,percent of total billed charges,"90% of $3,481.96 in Billed Charges for Rev 272 = $3,133.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEAK PLASMABLADE 4.0,272,RC,27200002,CDM,,,,,,both,,,3481.9600,522.2900,MEDCOST,MEDCOST VHN,1657.06,,,,,,,898.6900,3481.9600,percent of total billed charges,"47.59% of $3,481.96 in Billed Charges for Rev 272 = $1,657.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEAK PLASMABLADE 4.0,272,RC,27200002,CDM,,,,,,both,,,3481.9600,522.2900,SENTARA HEALTH,SENTARA HEALTH,898.69,,,,,,,898.6900,3481.9600,percent of total billed charges,"25.81% of $3,481.96 in Billed Charges for Rev 272 = $898.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEAK PLASMABLADE 4.0,272,RC,27200002,CDM,,,,,,both,,,3481.9600,522.2900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3481.96,,,,,,,898.6900,3481.9600,percent of total billed charges,"100% of $3,481.96 in Billed Charges for Rev 272 = $3,481.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEAK PLASMABLADE 4.0,272,RC,27200002,CDM,,,,,,both,,,3481.9600,522.2900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1740.98,,,,,,,898.6900,3481.9600,percent of total billed charges,"Rev 272 $3,481.96 in Billed Charges at 50% = $1,740.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEAK PLASMABLADE 4.0,272,RC,27200002,CDM,,,,,,both,,,3481.9600,522.2900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1124.67,,,,,,,898.6900,3481.9600,other,"32.3% of $3,481.96 in Billed Charges for Rev 272 = $1,124.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PEAK PLASMABLADE 4.0,272,RC,27200002,CDM,,,,,,both,,,3481.9600,522.2900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1068.96,,,,,,,898.6900,3481.9600,other,"30.7% of $3,481.96 in Billed Charges for Rev 272 = $1,068.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PEAK PLASMABLADE 4.0,272,RC,27200002,CDM,,,,,,both,,,3481.9600,522.2900,UNITED HEALTHCARE,UNITED HEALTHCARE,1124.67,,,,,,,898.6900,3481.9600,percent of total billed charges,"32.3% of $3,481.96 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEAK PLASMABLADE 4.0,272,RC,27200002,CDM,,,,,,both,,,3481.9600,522.2900,WELLCARE,WELLCARE MEDICAID,3481.96,,,,,,,898.6900,3481.9600,percent of total billed charges,"100% of $3,481.96 in Billed Charges for Rev 272 = $3,481.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN LINEAR,272,RC,,,,,,,,both,,,25284.5000,3792.6800,AETNA,AETNA,10796.48,,,,,,,6525.9300,25284.5000,percent of total billed charges,"42.7% of $25,284.50 in Billed Charges for Rev 272 = $10,796.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN LINEAR,272,RC,,,,,,,,both,,,25284.5000,3792.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,17699.15,,,,,,,6525.9300,25284.5000,percent of total billed charges,"Rev 272 $25,284.50 in Billed Charges at 70% = $17,699.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN LINEAR,272,RC,,,,,,,,both,,,25284.5000,3792.6800,CIGNA HEALTHCARE,CIGNA HMO,10543.64,,,,,,,6525.9300,25284.5000,percent of total billed charges,"41.7% of $25,284.50 in Billed Charges for Rev 272 = $10,543.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN LINEAR,272,RC,,,,,,,,both,,,25284.5000,3792.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11732.01,,,,,,,6525.9300,25284.5000,percent of total billed charges,"46.4% of $25,284.50 in Billed Charges for Rev 272 = $11,732.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN LINEAR,272,RC,,,,,,,,both,,,25284.5000,3792.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,10543.64,,,,,,,6525.9300,25284.5000,percent of total billed charges,"41.7% of $25,284.50 in Billed Charges for Rev 272 = $10,543.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN LINEAR,272,RC,,,,,,,,both,,,25284.5000,3792.6800,CIGNA HEALTHCARE,CIGNA PPO,10543.64,,,,,,,6525.9300,25284.5000,percent of total billed charges,"41.7% of $25,284.50 in Billed Charges for Rev 272 = $10,543.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN LINEAR,272,RC,,,,,,,,both,,,25284.5000,3792.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,22756.05,,,,,,,6525.9300,25284.5000,percent of total billed charges,"90% of $25,284.50 in Billed Charges for Rev 272 = $22,756.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN LINEAR,272,RC,,,,,,,,both,,,25284.5000,3792.6800,MEDCOST,MEDCOST VHN,12032.89,,,,,,,6525.9300,25284.5000,percent of total billed charges,"47.59% of $25,284.50 in Billed Charges for Rev 272 = $12,032.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN LINEAR,272,RC,,,,,,,,both,,,25284.5000,3792.6800,SENTARA HEALTH,SENTARA HEALTH,6525.93,,,,,,,6525.9300,25284.5000,percent of total billed charges,"25.81% of $25,284.50 in Billed Charges for Rev 272 = $6,525.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN LINEAR,272,RC,,,,,,,,both,,,25284.5000,3792.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",25284.50,,,,,,,6525.9300,25284.5000,percent of total billed charges,"100% of $25,284.50 in Billed Charges for Rev 272 = $25,284.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN LINEAR,272,RC,,,,,,,,both,,,25284.5000,3792.6800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,12642.25,,,,,,,6525.9300,25284.5000,percent of total billed charges,"Rev 272 $25,284.50 in Billed Charges at 50% = $12,642.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN LINEAR,272,RC,,,,,,,,both,,,25284.5000,3792.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,8166.89,,,,,,,6525.9300,25284.5000,other,"32.3% of $25,284.50 in Billed Charges for Rev 272 = $8,166.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PEN LINEAR,272,RC,,,,,,,,both,,,25284.5000,3792.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,7762.34,,,,,,,6525.9300,25284.5000,other,"30.7% of $25,284.50 in Billed Charges for Rev 272 = $7,762.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PEN LINEAR,272,RC,,,,,,,,both,,,25284.5000,3792.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,8166.89,,,,,,,6525.9300,25284.5000,percent of total billed charges,"32.3% of $25,284.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN LINEAR,272,RC,,,,,,,,both,,,25284.5000,3792.6800,WELLCARE,WELLCARE MEDICAID,25284.50,,,,,,,6525.9300,25284.5000,percent of total billed charges,"100% of $25,284.50 in Billed Charges for Rev 272 = $25,284.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN RF BIPOLAR LONG,272,RC,,,,,,,,both,,,28333.5700,4250.0400,AETNA,AETNA,12098.43,,,,,,,7312.8900,28333.5700,percent of total billed charges,"42.7% of $28,333.57 in Billed Charges for Rev 272 = $12,098.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN RF BIPOLAR LONG,272,RC,,,,,,,,both,,,28333.5700,4250.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,19833.50,,,,,,,7312.8900,28333.5700,percent of total billed charges,"Rev 272 $28,333.57 in Billed Charges at 70% = $19,833.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN RF BIPOLAR LONG,272,RC,,,,,,,,both,,,28333.5700,4250.0400,CIGNA HEALTHCARE,CIGNA HMO,11815.10,,,,,,,7312.8900,28333.5700,percent of total billed charges,"41.7% of $28,333.57 in Billed Charges for Rev 272 = $11,815.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN RF BIPOLAR LONG,272,RC,,,,,,,,both,,,28333.5700,4250.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,13146.78,,,,,,,7312.8900,28333.5700,percent of total billed charges,"46.4% of $28,333.57 in Billed Charges for Rev 272 = $13,146.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN RF BIPOLAR LONG,272,RC,,,,,,,,both,,,28333.5700,4250.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11815.10,,,,,,,7312.8900,28333.5700,percent of total billed charges,"41.7% of $28,333.57 in Billed Charges for Rev 272 = $11,815.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN RF BIPOLAR LONG,272,RC,,,,,,,,both,,,28333.5700,4250.0400,CIGNA HEALTHCARE,CIGNA PPO,11815.10,,,,,,,7312.8900,28333.5700,percent of total billed charges,"41.7% of $28,333.57 in Billed Charges for Rev 272 = $11,815.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN RF BIPOLAR LONG,272,RC,,,,,,,,both,,,28333.5700,4250.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,25500.21,,,,,,,7312.8900,28333.5700,percent of total billed charges,"90% of $28,333.57 in Billed Charges for Rev 272 = $25,500.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN RF BIPOLAR LONG,272,RC,,,,,,,,both,,,28333.5700,4250.0400,MEDCOST,MEDCOST VHN,13483.95,,,,,,,7312.8900,28333.5700,percent of total billed charges,"47.59% of $28,333.57 in Billed Charges for Rev 272 = $13,483.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN RF BIPOLAR LONG,272,RC,,,,,,,,both,,,28333.5700,4250.0400,SENTARA HEALTH,SENTARA HEALTH,7312.89,,,,,,,7312.8900,28333.5700,percent of total billed charges,"25.81% of $28,333.57 in Billed Charges for Rev 272 = $7,312.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN RF BIPOLAR LONG,272,RC,,,,,,,,both,,,28333.5700,4250.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",28333.57,,,,,,,7312.8900,28333.5700,percent of total billed charges,"100% of $28,333.57 in Billed Charges for Rev 272 = $28,333.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN RF BIPOLAR LONG,272,RC,,,,,,,,both,,,28333.5700,4250.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14166.79,,,,,,,7312.8900,28333.5700,percent of total billed charges,"Rev 272 $28,333.57 in Billed Charges at 50% = $14,166.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN RF BIPOLAR LONG,272,RC,,,,,,,,both,,,28333.5700,4250.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,9151.74,,,,,,,7312.8900,28333.5700,other,"32.3% of $28,333.57 in Billed Charges for Rev 272 = $9,151.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PEN RF BIPOLAR LONG,272,RC,,,,,,,,both,,,28333.5700,4250.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,8698.41,,,,,,,7312.8900,28333.5700,other,"30.7% of $28,333.57 in Billed Charges for Rev 272 = $8,698.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PEN RF BIPOLAR LONG,272,RC,,,,,,,,both,,,28333.5700,4250.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,9151.74,,,,,,,7312.8900,28333.5700,percent of total billed charges,"32.3% of $28,333.57 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PEN RF BIPOLAR LONG,272,RC,,,,,,,,both,,,28333.5700,4250.0400,WELLCARE,WELLCARE MEDICAID,28333.57,,,,,,,7312.8900,28333.5700,percent of total billed charges,"100% of $28,333.57 in Billed Charges for Rev 272 = $28,333.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFECT SCALPEL EVEREST SPINE,272,RC,,,,,,,,both,,,2286.8100,343.0200,AETNA,AETNA,976.47,,,,,,,590.2300,2286.8100,percent of total billed charges,"42.7% of $2,286.81 in Billed Charges for Rev 272 = $976.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFECT SCALPEL EVEREST SPINE,272,RC,,,,,,,,both,,,2286.8100,343.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1600.77,,,,,,,590.2300,2286.8100,percent of total billed charges,"Rev 272 $2,286.81 in Billed Charges at 70% = $1,600.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFECT SCALPEL EVEREST SPINE,272,RC,,,,,,,,both,,,2286.8100,343.0200,CIGNA HEALTHCARE,CIGNA HMO,953.60,,,,,,,590.2300,2286.8100,percent of total billed charges,"41.7% of $2,286.81 in Billed Charges for Rev 272 = $953.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFECT SCALPEL EVEREST SPINE,272,RC,,,,,,,,both,,,2286.8100,343.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1061.08,,,,,,,590.2300,2286.8100,percent of total billed charges,"46.4% of $2,286.81 in Billed Charges for Rev 272 = $1,061.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFECT SCALPEL EVEREST SPINE,272,RC,,,,,,,,both,,,2286.8100,343.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,953.60,,,,,,,590.2300,2286.8100,percent of total billed charges,"41.7% of $2,286.81 in Billed Charges for Rev 272 = $953.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFECT SCALPEL EVEREST SPINE,272,RC,,,,,,,,both,,,2286.8100,343.0200,CIGNA HEALTHCARE,CIGNA PPO,953.60,,,,,,,590.2300,2286.8100,percent of total billed charges,"41.7% of $2,286.81 in Billed Charges for Rev 272 = $953.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFECT SCALPEL EVEREST SPINE,272,RC,,,,,,,,both,,,2286.8100,343.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2058.13,,,,,,,590.2300,2286.8100,percent of total billed charges,"90% of $2,286.81 in Billed Charges for Rev 272 = $2,058.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFECT SCALPEL EVEREST SPINE,272,RC,,,,,,,,both,,,2286.8100,343.0200,MEDCOST,MEDCOST VHN,1088.29,,,,,,,590.2300,2286.8100,percent of total billed charges,"47.59% of $2,286.81 in Billed Charges for Rev 272 = $1,088.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFECT SCALPEL EVEREST SPINE,272,RC,,,,,,,,both,,,2286.8100,343.0200,SENTARA HEALTH,SENTARA HEALTH,590.23,,,,,,,590.2300,2286.8100,percent of total billed charges,"25.81% of $2,286.81 in Billed Charges for Rev 272 = $590.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFECT SCALPEL EVEREST SPINE,272,RC,,,,,,,,both,,,2286.8100,343.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2286.81,,,,,,,590.2300,2286.8100,percent of total billed charges,"100% of $2,286.81 in Billed Charges for Rev 272 = $2,286.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFECT SCALPEL EVEREST SPINE,272,RC,,,,,,,,both,,,2286.8100,343.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1143.41,,,,,,,590.2300,2286.8100,percent of total billed charges,"Rev 272 $2,286.81 in Billed Charges at 50% = $1,143.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFECT SCALPEL EVEREST SPINE,272,RC,,,,,,,,both,,,2286.8100,343.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,738.64,,,,,,,590.2300,2286.8100,other,"32.3% of $2,286.81 in Billed Charges for Rev 272 = $738.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PERFECT SCALPEL EVEREST SPINE,272,RC,,,,,,,,both,,,2286.8100,343.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,702.05,,,,,,,590.2300,2286.8100,other,"30.7% of $2,286.81 in Billed Charges for Rev 272 = $702.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PERFECT SCALPEL EVEREST SPINE,272,RC,,,,,,,,both,,,2286.8100,343.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,738.64,,,,,,,590.2300,2286.8100,percent of total billed charges,"32.3% of $2,286.81 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERFECT SCALPEL EVEREST SPINE,272,RC,,,,,,,,both,,,2286.8100,343.0200,WELLCARE,WELLCARE MEDICAID,2286.81,,,,,,,590.2300,2286.8100,percent of total billed charges,"100% of $2,286.81 in Billed Charges for Rev 272 = $2,286.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE KIT RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,4402.0700,660.3100,AETNA,AETNA,1879.68,,,,,,,1136.1700,4402.0700,percent of total billed charges,"42.7% of $4,402.07 in Billed Charges for Rev 272 = $1,879.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE KIT RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,4402.0700,660.3100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3081.45,,,,,,,1136.1700,4402.0700,percent of total billed charges,"Rev 272 $4,402.07 in Billed Charges at 70% = $3,081.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE KIT RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,4402.0700,660.3100,CIGNA HEALTHCARE,CIGNA HMO,1835.66,,,,,,,1136.1700,4402.0700,percent of total billed charges,"41.7% of $4,402.07 in Billed Charges for Rev 272 = $1,835.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE KIT RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,4402.0700,660.3100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2042.56,,,,,,,1136.1700,4402.0700,percent of total billed charges,"46.4% of $4,402.07 in Billed Charges for Rev 272 = $2,042.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE KIT RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,4402.0700,660.3100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1835.66,,,,,,,1136.1700,4402.0700,percent of total billed charges,"41.7% of $4,402.07 in Billed Charges for Rev 272 = $1,835.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE KIT RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,4402.0700,660.3100,CIGNA HEALTHCARE,CIGNA PPO,1835.66,,,,,,,1136.1700,4402.0700,percent of total billed charges,"41.7% of $4,402.07 in Billed Charges for Rev 272 = $1,835.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE KIT RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,4402.0700,660.3100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3961.86,,,,,,,1136.1700,4402.0700,percent of total billed charges,"90% of $4,402.07 in Billed Charges for Rev 272 = $3,961.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE KIT RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,4402.0700,660.3100,MEDCOST,MEDCOST VHN,2094.95,,,,,,,1136.1700,4402.0700,percent of total billed charges,"47.59% of $4,402.07 in Billed Charges for Rev 272 = $2,094.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE KIT RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,4402.0700,660.3100,SENTARA HEALTH,SENTARA HEALTH,1136.17,,,,,,,1136.1700,4402.0700,percent of total billed charges,"25.81% of $4,402.07 in Billed Charges for Rev 272 = $1,136.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE KIT RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,4402.0700,660.3100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4402.07,,,,,,,1136.1700,4402.0700,percent of total billed charges,"100% of $4,402.07 in Billed Charges for Rev 272 = $4,402.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE KIT RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,4402.0700,660.3100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2201.04,,,,,,,1136.1700,4402.0700,percent of total billed charges,"Rev 272 $4,402.07 in Billed Charges at 50% = $2,201.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE KIT RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,4402.0700,660.3100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1421.87,,,,,,,1136.1700,4402.0700,other,"32.3% of $4,402.07 in Billed Charges for Rev 272 = $1,421.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SNARE KIT RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,4402.0700,660.3100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1351.44,,,,,,,1136.1700,4402.0700,other,"30.7% of $4,402.07 in Billed Charges for Rev 272 = $1,351.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SNARE KIT RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,4402.0700,660.3100,UNITED HEALTHCARE,UNITED HEALTHCARE,1421.87,,,,,,,1136.1700,4402.0700,percent of total billed charges,"32.3% of $4,402.07 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE KIT RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,4402.0700,660.3100,WELLCARE,WELLCARE MEDICAID,4402.07,,,,,,,1136.1700,4402.0700,percent of total billed charges,"100% of $4,402.07 in Billed Charges for Rev 272 = $4,402.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERMATAPE 1.3MM,272,RC,27200002,CDM,,,,,,both,,,1191.3200,178.7000,AETNA,AETNA,508.69,,,,,,,307.4800,1191.3200,percent of total billed charges,"42.7% of $1,191.32 in Billed Charges for Rev 272 = $508.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERMATAPE 1.3MM,272,RC,27200002,CDM,,,,,,both,,,1191.3200,178.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,833.92,,,,,,,307.4800,1191.3200,percent of total billed charges,"Rev 272 $1,191.32 in Billed Charges at 70% = $833.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERMATAPE 1.3MM,272,RC,27200002,CDM,,,,,,both,,,1191.3200,178.7000,CIGNA HEALTHCARE,CIGNA HMO,496.78,,,,,,,307.4800,1191.3200,percent of total billed charges,"41.7% of $1,191.32 in Billed Charges for Rev 272 = $496.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERMATAPE 1.3MM,272,RC,27200002,CDM,,,,,,both,,,1191.3200,178.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,552.77,,,,,,,307.4800,1191.3200,percent of total billed charges,"46.4% of $1,191.32 in Billed Charges for Rev 272 = $552.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERMATAPE 1.3MM,272,RC,27200002,CDM,,,,,,both,,,1191.3200,178.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,496.78,,,,,,,307.4800,1191.3200,percent of total billed charges,"41.7% of $1,191.32 in Billed Charges for Rev 272 = $496.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERMATAPE 1.3MM,272,RC,27200002,CDM,,,,,,both,,,1191.3200,178.7000,CIGNA HEALTHCARE,CIGNA PPO,496.78,,,,,,,307.4800,1191.3200,percent of total billed charges,"41.7% of $1,191.32 in Billed Charges for Rev 272 = $496.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERMATAPE 1.3MM,272,RC,27200002,CDM,,,,,,both,,,1191.3200,178.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1072.19,,,,,,,307.4800,1191.3200,percent of total billed charges,"90% of $1,191.32 in Billed Charges for Rev 272 = $1,072.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERMATAPE 1.3MM,272,RC,27200002,CDM,,,,,,both,,,1191.3200,178.7000,MEDCOST,MEDCOST VHN,566.95,,,,,,,307.4800,1191.3200,percent of total billed charges,"47.59% of $1,191.32 in Billed Charges for Rev 272 = $566.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERMATAPE 1.3MM,272,RC,27200002,CDM,,,,,,both,,,1191.3200,178.7000,SENTARA HEALTH,SENTARA HEALTH,307.48,,,,,,,307.4800,1191.3200,percent of total billed charges,"25.81% of $1,191.32 in Billed Charges for Rev 272 = $307.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERMATAPE 1.3MM,272,RC,27200002,CDM,,,,,,both,,,1191.3200,178.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1191.32,,,,,,,307.4800,1191.3200,percent of total billed charges,"100% of $1,191.32 in Billed Charges for Rev 272 = $1,191.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERMATAPE 1.3MM,272,RC,27200002,CDM,,,,,,both,,,1191.3200,178.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,595.66,,,,,,,307.4800,1191.3200,percent of total billed charges,"Rev 272 $1,191.32 in Billed Charges at 50% = $595.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERMATAPE 1.3MM,272,RC,27200002,CDM,,,,,,both,,,1191.3200,178.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,384.80,,,,,,,307.4800,1191.3200,other,"32.3% of $1,191.32 in Billed Charges for Rev 272 = $384.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PERMATAPE 1.3MM,272,RC,27200002,CDM,,,,,,both,,,1191.3200,178.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,365.74,,,,,,,307.4800,1191.3200,other,"30.7% of $1,191.32 in Billed Charges for Rev 272 = $365.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PERMATAPE 1.3MM,272,RC,27200002,CDM,,,,,,both,,,1191.3200,178.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,384.80,,,,,,,307.4800,1191.3200,percent of total billed charges,"32.3% of $1,191.32 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PERMATAPE 1.3MM,272,RC,27200002,CDM,,,,,,both,,,1191.3200,178.7000,WELLCARE,WELLCARE MEDICAID,1191.32,,,,,,,307.4800,1191.3200,percent of total billed charges,"100% of $1,191.32 in Billed Charges for Rev 272 = $1,191.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PHACO TIP KELMIN .9 MM,272,RC,,,,,,,,both,,,628.8700,94.3300,AETNA,AETNA,268.53,,,,,,,162.3100,628.8700,percent of total billed charges,42.7% of $628.87 in Billed Charges for Rev 272 = $268.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PHACO TIP KELMIN .9 MM,272,RC,,,,,,,,both,,,628.8700,94.3300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,440.21,,,,,,,162.3100,628.8700,percent of total billed charges,Rev 272 $628.87 in Billed Charges at 70% = $440.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PHACO TIP KELMIN .9 MM,272,RC,,,,,,,,both,,,628.8700,94.3300,CIGNA HEALTHCARE,CIGNA HMO,262.24,,,,,,,162.3100,628.8700,percent of total billed charges,41.7% of $628.87 in Billed Charges for Rev 272 = $262.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PHACO TIP KELMIN .9 MM,272,RC,,,,,,,,both,,,628.8700,94.3300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,291.80,,,,,,,162.3100,628.8700,percent of total billed charges,46.4% of $628.87 in Billed Charges for Rev 272 = $291.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PHACO TIP KELMIN .9 MM,272,RC,,,,,,,,both,,,628.8700,94.3300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,262.24,,,,,,,162.3100,628.8700,percent of total billed charges,41.7% of $628.87 in Billed Charges for Rev 272 = $262.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PHACO TIP KELMIN .9 MM,272,RC,,,,,,,,both,,,628.8700,94.3300,CIGNA HEALTHCARE,CIGNA PPO,262.24,,,,,,,162.3100,628.8700,percent of total billed charges,41.7% of $628.87 in Billed Charges for Rev 272 = $262.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PHACO TIP KELMIN .9 MM,272,RC,,,,,,,,both,,,628.8700,94.3300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,565.98,,,,,,,162.3100,628.8700,percent of total billed charges,90% of $628.87 in Billed Charges for Rev 272 = $565.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PHACO TIP KELMIN .9 MM,272,RC,,,,,,,,both,,,628.8700,94.3300,MEDCOST,MEDCOST VHN,299.28,,,,,,,162.3100,628.8700,percent of total billed charges,47.59% of $628.87 in Billed Charges for Rev 272 = $299.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PHACO TIP KELMIN .9 MM,272,RC,,,,,,,,both,,,628.8700,94.3300,SENTARA HEALTH,SENTARA HEALTH,162.31,,,,,,,162.3100,628.8700,percent of total billed charges,25.81% of $628.87 in Billed Charges for Rev 272 = $162.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PHACO TIP KELMIN .9 MM,272,RC,,,,,,,,both,,,628.8700,94.3300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",628.87,,,,,,,162.3100,628.8700,percent of total billed charges,100% of $628.87 in Billed Charges for Rev 272 = $628.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PHACO TIP KELMIN .9 MM,272,RC,,,,,,,,both,,,628.8700,94.3300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,314.44,,,,,,,162.3100,628.8700,percent of total billed charges,Rev 272 $628.87 in Billed Charges at 50% = $314.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PHACO TIP KELMIN .9 MM,272,RC,,,,,,,,both,,,628.8700,94.3300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,203.13,,,,,,,162.3100,628.8700,other,32.3% of $628.87 in Billed Charges for Rev 272 = $203.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PHACO TIP KELMIN .9 MM,272,RC,,,,,,,,both,,,628.8700,94.3300,UNITED HEALTHCARE,UHC HERITAGE SELECT,193.06,,,,,,,162.3100,628.8700,other,30.7% of $628.87 in Billed Charges for Rev 272 = $193.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PHACO TIP KELMIN .9 MM,272,RC,,,,,,,,both,,,628.8700,94.3300,UNITED HEALTHCARE,UNITED HEALTHCARE,203.13,,,,,,,162.3100,628.8700,percent of total billed charges,32.3% of $628.87 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PHACO TIP KELMIN .9 MM,272,RC,,,,,,,,both,,,628.8700,94.3300,WELLCARE,WELLCARE MEDICAID,628.87,,,,,,,162.3100,628.8700,percent of total billed charges,100% of $628.87 in Billed Charges for Rev 272 = $628.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PIN ALIGNMENT LARGE,272,RC,,,,,,,,both,,,1151.1800,172.6800,AETNA,AETNA,491.55,,,,,,,297.1200,1151.1800,percent of total billed charges,"42.7% of $1,151.18 in Billed Charges for Rev 272 = $491.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN ALIGNMENT LARGE,272,RC,,,,,,,,both,,,1151.1800,172.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,805.83,,,,,,,297.1200,1151.1800,percent of total billed charges,"Rev 272 $1,151.18 in Billed Charges at 70% = $805.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN ALIGNMENT LARGE,272,RC,,,,,,,,both,,,1151.1800,172.6800,CIGNA HEALTHCARE,CIGNA HMO,480.04,,,,,,,297.1200,1151.1800,percent of total billed charges,"41.7% of $1,151.18 in Billed Charges for Rev 272 = $480.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN ALIGNMENT LARGE,272,RC,,,,,,,,both,,,1151.1800,172.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,534.15,,,,,,,297.1200,1151.1800,percent of total billed charges,"46.4% of $1,151.18 in Billed Charges for Rev 272 = $534.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN ALIGNMENT LARGE,272,RC,,,,,,,,both,,,1151.1800,172.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,480.04,,,,,,,297.1200,1151.1800,percent of total billed charges,"41.7% of $1,151.18 in Billed Charges for Rev 272 = $480.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN ALIGNMENT LARGE,272,RC,,,,,,,,both,,,1151.1800,172.6800,CIGNA HEALTHCARE,CIGNA PPO,480.04,,,,,,,297.1200,1151.1800,percent of total billed charges,"41.7% of $1,151.18 in Billed Charges for Rev 272 = $480.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN ALIGNMENT LARGE,272,RC,,,,,,,,both,,,1151.1800,172.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1036.06,,,,,,,297.1200,1151.1800,percent of total billed charges,"90% of $1,151.18 in Billed Charges for Rev 272 = $1,036.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN ALIGNMENT LARGE,272,RC,,,,,,,,both,,,1151.1800,172.6800,MEDCOST,MEDCOST VHN,547.85,,,,,,,297.1200,1151.1800,percent of total billed charges,"47.59% of $1,151.18 in Billed Charges for Rev 272 = $547.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN ALIGNMENT LARGE,272,RC,,,,,,,,both,,,1151.1800,172.6800,SENTARA HEALTH,SENTARA HEALTH,297.12,,,,,,,297.1200,1151.1800,percent of total billed charges,"25.81% of $1,151.18 in Billed Charges for Rev 272 = $297.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN ALIGNMENT LARGE,272,RC,,,,,,,,both,,,1151.1800,172.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1151.18,,,,,,,297.1200,1151.1800,percent of total billed charges,"100% of $1,151.18 in Billed Charges for Rev 272 = $1,151.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN ALIGNMENT LARGE,272,RC,,,,,,,,both,,,1151.1800,172.6800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,575.59,,,,,,,297.1200,1151.1800,percent of total billed charges,"Rev 272 $1,151.18 in Billed Charges at 50% = $575.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN ALIGNMENT LARGE,272,RC,,,,,,,,both,,,1151.1800,172.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,371.83,,,,,,,297.1200,1151.1800,other,"32.3% of $1,151.18 in Billed Charges for Rev 272 = $371.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PIN ALIGNMENT LARGE,272,RC,,,,,,,,both,,,1151.1800,172.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,353.41,,,,,,,297.1200,1151.1800,other,"30.7% of $1,151.18 in Billed Charges for Rev 272 = $353.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PIN ALIGNMENT LARGE,272,RC,,,,,,,,both,,,1151.1800,172.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,371.83,,,,,,,297.1200,1151.1800,percent of total billed charges,"32.3% of $1,151.18 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN ALIGNMENT LARGE,272,RC,,,,,,,,both,,,1151.1800,172.6800,WELLCARE,WELLCARE MEDICAID,1151.18,,,,,,,297.1200,1151.1800,percent of total billed charges,"100% of $1,151.18 in Billed Charges for Rev 272 = $1,151.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR VASC 30MM,272,RC,,,,,,,,both,,,761.9900,114.3000,AETNA,AETNA,325.37,,,,,,,196.6700,761.9900,percent of total billed charges,42.7% of $761.99 in Billed Charges for Rev 272 = $325.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR VASC 30MM,272,RC,,,,,,,,both,,,761.9900,114.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,533.39,,,,,,,196.6700,761.9900,percent of total billed charges,Rev 272 $761.99 in Billed Charges at 70% = $533.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR VASC 30MM,272,RC,,,,,,,,both,,,761.9900,114.3000,CIGNA HEALTHCARE,CIGNA HMO,317.75,,,,,,,196.6700,761.9900,percent of total billed charges,41.7% of $761.99 in Billed Charges for Rev 272 = $317.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR VASC 30MM,272,RC,,,,,,,,both,,,761.9900,114.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,353.56,,,,,,,196.6700,761.9900,percent of total billed charges,46.4% of $761.99 in Billed Charges for Rev 272 = $353.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR VASC 30MM,272,RC,,,,,,,,both,,,761.9900,114.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,317.75,,,,,,,196.6700,761.9900,percent of total billed charges,41.7% of $761.99 in Billed Charges for Rev 272 = $317.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR VASC 30MM,272,RC,,,,,,,,both,,,761.9900,114.3000,CIGNA HEALTHCARE,CIGNA PPO,317.75,,,,,,,196.6700,761.9900,percent of total billed charges,41.7% of $761.99 in Billed Charges for Rev 272 = $317.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR VASC 30MM,272,RC,,,,,,,,both,,,761.9900,114.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,685.79,,,,,,,196.6700,761.9900,percent of total billed charges,90% of $761.99 in Billed Charges for Rev 272 = $685.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR VASC 30MM,272,RC,,,,,,,,both,,,761.9900,114.3000,MEDCOST,MEDCOST VHN,362.63,,,,,,,196.6700,761.9900,percent of total billed charges,47.59% of $761.99 in Billed Charges for Rev 272 = $362.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR VASC 30MM,272,RC,,,,,,,,both,,,761.9900,114.3000,SENTARA HEALTH,SENTARA HEALTH,196.67,,,,,,,196.6700,761.9900,percent of total billed charges,25.81% of $761.99 in Billed Charges for Rev 272 = $196.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR VASC 30MM,272,RC,,,,,,,,both,,,761.9900,114.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",761.99,,,,,,,196.6700,761.9900,percent of total billed charges,100% of $761.99 in Billed Charges for Rev 272 = $761.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR VASC 30MM,272,RC,,,,,,,,both,,,761.9900,114.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,381.00,,,,,,,196.6700,761.9900,percent of total billed charges,Rev 272 $761.99 in Billed Charges at 50% = $381.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR VASC 30MM,272,RC,,,,,,,,both,,,761.9900,114.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,246.12,,,,,,,196.6700,761.9900,other,32.3% of $761.99 in Billed Charges for Rev 272 = $246.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER LINEAR VASC 30MM,272,RC,,,,,,,,both,,,761.9900,114.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,233.93,,,,,,,196.6700,761.9900,other,30.7% of $761.99 in Billed Charges for Rev 272 = $233.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER LINEAR VASC 30MM,272,RC,,,,,,,,both,,,761.9900,114.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,246.12,,,,,,,196.6700,761.9900,percent of total billed charges,32.3% of $761.99 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR VASC 30MM,272,RC,,,,,,,,both,,,761.9900,114.3000,WELLCARE,WELLCARE MEDICAID,761.99,,,,,,,196.6700,761.9900,percent of total billed charges,100% of $761.99 in Billed Charges for Rev 272 = $761.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER POWERED ECHELON 29MM CDH29P,272,RC,27200002,CDM,,,,,,both,,,3496.4100,524.4600,AETNA,AETNA,1492.97,,,,,,,902.4200,3496.4100,percent of total billed charges,"42.7% of $3,496.41 in Billed Charges for Rev 272 = $1,492.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 29MM CDH29P,272,RC,27200002,CDM,,,,,,both,,,3496.4100,524.4600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2447.49,,,,,,,902.4200,3496.4100,percent of total billed charges,"Rev 272 $3,496.41 in Billed Charges at 70% = $2,447.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 29MM CDH29P,272,RC,27200002,CDM,,,,,,both,,,3496.4100,524.4600,CIGNA HEALTHCARE,CIGNA HMO,1458.00,,,,,,,902.4200,3496.4100,percent of total billed charges,"41.7% of $3,496.41 in Billed Charges for Rev 272 = $1,458.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 29MM CDH29P,272,RC,27200002,CDM,,,,,,both,,,3496.4100,524.4600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1622.33,,,,,,,902.4200,3496.4100,percent of total billed charges,"46.4% of $3,496.41 in Billed Charges for Rev 272 = $1,622.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 29MM CDH29P,272,RC,27200002,CDM,,,,,,both,,,3496.4100,524.4600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1458.00,,,,,,,902.4200,3496.4100,percent of total billed charges,"41.7% of $3,496.41 in Billed Charges for Rev 272 = $1,458.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 29MM CDH29P,272,RC,27200002,CDM,,,,,,both,,,3496.4100,524.4600,CIGNA HEALTHCARE,CIGNA PPO,1458.00,,,,,,,902.4200,3496.4100,percent of total billed charges,"41.7% of $3,496.41 in Billed Charges for Rev 272 = $1,458.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 29MM CDH29P,272,RC,27200002,CDM,,,,,,both,,,3496.4100,524.4600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3146.77,,,,,,,902.4200,3496.4100,percent of total billed charges,"90% of $3,496.41 in Billed Charges for Rev 272 = $3,146.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 29MM CDH29P,272,RC,27200002,CDM,,,,,,both,,,3496.4100,524.4600,MEDCOST,MEDCOST VHN,1663.94,,,,,,,902.4200,3496.4100,percent of total billed charges,"47.59% of $3,496.41 in Billed Charges for Rev 272 = $1,663.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 29MM CDH29P,272,RC,27200002,CDM,,,,,,both,,,3496.4100,524.4600,SENTARA HEALTH,SENTARA HEALTH,902.42,,,,,,,902.4200,3496.4100,percent of total billed charges,"25.81% of $3,496.41 in Billed Charges for Rev 272 = $902.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 29MM CDH29P,272,RC,27200002,CDM,,,,,,both,,,3496.4100,524.4600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3496.41,,,,,,,902.4200,3496.4100,percent of total billed charges,"100% of $3,496.41 in Billed Charges for Rev 272 = $3,496.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 29MM CDH29P,272,RC,27200002,CDM,,,,,,both,,,3496.4100,524.4600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1748.21,,,,,,,902.4200,3496.4100,percent of total billed charges,"Rev 272 $3,496.41 in Billed Charges at 50% = $1,748.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 29MM CDH29P,272,RC,27200002,CDM,,,,,,both,,,3496.4100,524.4600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1129.34,,,,,,,902.4200,3496.4100,other,"32.3% of $3,496.41 in Billed Charges for Rev 272 = $1,129.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER POWERED ECHELON 29MM CDH29P,272,RC,27200002,CDM,,,,,,both,,,3496.4100,524.4600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1073.40,,,,,,,902.4200,3496.4100,other,"30.7% of $3,496.41 in Billed Charges for Rev 272 = $1,073.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER POWERED ECHELON 29MM CDH29P,272,RC,27200002,CDM,,,,,,both,,,3496.4100,524.4600,UNITED HEALTHCARE,UNITED HEALTHCARE,1129.34,,,,,,,902.4200,3496.4100,percent of total billed charges,"32.3% of $3,496.41 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 29MM CDH29P,272,RC,27200002,CDM,,,,,,both,,,3496.4100,524.4600,WELLCARE,WELLCARE MEDICAID,3496.41,,,,,,,902.4200,3496.4100,percent of total billed charges,"100% of $3,496.41 in Billed Charges for Rev 272 = $3,496.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 45 LONG SHAFT 440MM,272,RC,27200002,CDM,,,,,,both,,,2678.0700,401.7100,AETNA,AETNA,1143.54,,,,,,,691.2100,2678.0700,percent of total billed charges,"42.7% of $2,678.07 in Billed Charges for Rev 272 = $1,143.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 45 LONG SHAFT 440MM,272,RC,27200002,CDM,,,,,,both,,,2678.0700,401.7100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1874.65,,,,,,,691.2100,2678.0700,percent of total billed charges,"Rev 272 $2,678.07 in Billed Charges at 70% = $1,874.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 45 LONG SHAFT 440MM,272,RC,27200002,CDM,,,,,,both,,,2678.0700,401.7100,CIGNA HEALTHCARE,CIGNA HMO,1116.76,,,,,,,691.2100,2678.0700,percent of total billed charges,"41.7% of $2,678.07 in Billed Charges for Rev 272 = $1,116.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 45 LONG SHAFT 440MM,272,RC,27200002,CDM,,,,,,both,,,2678.0700,401.7100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1242.62,,,,,,,691.2100,2678.0700,percent of total billed charges,"46.4% of $2,678.07 in Billed Charges for Rev 272 = $1,242.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 45 LONG SHAFT 440MM,272,RC,27200002,CDM,,,,,,both,,,2678.0700,401.7100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1116.76,,,,,,,691.2100,2678.0700,percent of total billed charges,"41.7% of $2,678.07 in Billed Charges for Rev 272 = $1,116.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 45 LONG SHAFT 440MM,272,RC,27200002,CDM,,,,,,both,,,2678.0700,401.7100,CIGNA HEALTHCARE,CIGNA PPO,1116.76,,,,,,,691.2100,2678.0700,percent of total billed charges,"41.7% of $2,678.07 in Billed Charges for Rev 272 = $1,116.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 45 LONG SHAFT 440MM,272,RC,27200002,CDM,,,,,,both,,,2678.0700,401.7100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2410.26,,,,,,,691.2100,2678.0700,percent of total billed charges,"90% of $2,678.07 in Billed Charges for Rev 272 = $2,410.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 45 LONG SHAFT 440MM,272,RC,27200002,CDM,,,,,,both,,,2678.0700,401.7100,MEDCOST,MEDCOST VHN,1274.49,,,,,,,691.2100,2678.0700,percent of total billed charges,"47.59% of $2,678.07 in Billed Charges for Rev 272 = $1,274.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 45 LONG SHAFT 440MM,272,RC,27200002,CDM,,,,,,both,,,2678.0700,401.7100,SENTARA HEALTH,SENTARA HEALTH,691.21,,,,,,,691.2100,2678.0700,percent of total billed charges,"25.81% of $2,678.07 in Billed Charges for Rev 272 = $691.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 45 LONG SHAFT 440MM,272,RC,27200002,CDM,,,,,,both,,,2678.0700,401.7100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2678.07,,,,,,,691.2100,2678.0700,percent of total billed charges,"100% of $2,678.07 in Billed Charges for Rev 272 = $2,678.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 45 LONG SHAFT 440MM,272,RC,27200002,CDM,,,,,,both,,,2678.0700,401.7100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1339.04,,,,,,,691.2100,2678.0700,percent of total billed charges,"Rev 272 $2,678.07 in Billed Charges at 50% = $1,339.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 45 LONG SHAFT 440MM,272,RC,27200002,CDM,,,,,,both,,,2678.0700,401.7100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,865.02,,,,,,,691.2100,2678.0700,other,"32.3% of $2,678.07 in Billed Charges for Rev 272 = $865.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER POWERED ECHELON 45 LONG SHAFT 440MM,272,RC,27200002,CDM,,,,,,both,,,2678.0700,401.7100,UNITED HEALTHCARE,UHC HERITAGE SELECT,822.17,,,,,,,691.2100,2678.0700,other,"30.7% of $2,678.07 in Billed Charges for Rev 272 = $822.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER POWERED ECHELON 45 LONG SHAFT 440MM,272,RC,27200002,CDM,,,,,,both,,,2678.0700,401.7100,UNITED HEALTHCARE,UNITED HEALTHCARE,865.02,,,,,,,691.2100,2678.0700,percent of total billed charges,"32.3% of $2,678.07 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON 45 LONG SHAFT 440MM,272,RC,27200002,CDM,,,,,,both,,,2678.0700,401.7100,WELLCARE,WELLCARE MEDICAID,2678.07,,,,,,,691.2100,2678.0700,percent of total billed charges,"100% of $2,678.07 in Billed Charges for Rev 272 = $2,678.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROXIMATE FOR PROLAPS PPH03,272,RC,27200002,CDM,,,,,,both,,,4122.4700,618.3700,AETNA,AETNA,1760.29,,,,,,,1064.0100,4122.4700,percent of total billed charges,"42.7% of $4,122.47 in Billed Charges for Rev 272 = $1,760.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROXIMATE FOR PROLAPS PPH03,272,RC,27200002,CDM,,,,,,both,,,4122.4700,618.3700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2885.73,,,,,,,1064.0100,4122.4700,percent of total billed charges,"Rev 272 $4,122.47 in Billed Charges at 70% = $2,885.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROXIMATE FOR PROLAPS PPH03,272,RC,27200002,CDM,,,,,,both,,,4122.4700,618.3700,CIGNA HEALTHCARE,CIGNA HMO,1719.07,,,,,,,1064.0100,4122.4700,percent of total billed charges,"41.7% of $4,122.47 in Billed Charges for Rev 272 = $1,719.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROXIMATE FOR PROLAPS PPH03,272,RC,27200002,CDM,,,,,,both,,,4122.4700,618.3700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1912.83,,,,,,,1064.0100,4122.4700,percent of total billed charges,"46.4% of $4,122.47 in Billed Charges for Rev 272 = $1,912.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROXIMATE FOR PROLAPS PPH03,272,RC,27200002,CDM,,,,,,both,,,4122.4700,618.3700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1719.07,,,,,,,1064.0100,4122.4700,percent of total billed charges,"41.7% of $4,122.47 in Billed Charges for Rev 272 = $1,719.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROXIMATE FOR PROLAPS PPH03,272,RC,27200002,CDM,,,,,,both,,,4122.4700,618.3700,CIGNA HEALTHCARE,CIGNA PPO,1719.07,,,,,,,1064.0100,4122.4700,percent of total billed charges,"41.7% of $4,122.47 in Billed Charges for Rev 272 = $1,719.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROXIMATE FOR PROLAPS PPH03,272,RC,27200002,CDM,,,,,,both,,,4122.4700,618.3700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3710.22,,,,,,,1064.0100,4122.4700,percent of total billed charges,"90% of $4,122.47 in Billed Charges for Rev 272 = $3,710.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROXIMATE FOR PROLAPS PPH03,272,RC,27200002,CDM,,,,,,both,,,4122.4700,618.3700,MEDCOST,MEDCOST VHN,1961.88,,,,,,,1064.0100,4122.4700,percent of total billed charges,"47.59% of $4,122.47 in Billed Charges for Rev 272 = $1,961.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROXIMATE FOR PROLAPS PPH03,272,RC,27200002,CDM,,,,,,both,,,4122.4700,618.3700,SENTARA HEALTH,SENTARA HEALTH,1064.01,,,,,,,1064.0100,4122.4700,percent of total billed charges,"25.81% of $4,122.47 in Billed Charges for Rev 272 = $1,064.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROXIMATE FOR PROLAPS PPH03,272,RC,27200002,CDM,,,,,,both,,,4122.4700,618.3700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4122.47,,,,,,,1064.0100,4122.4700,percent of total billed charges,"100% of $4,122.47 in Billed Charges for Rev 272 = $4,122.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROXIMATE FOR PROLAPS PPH03,272,RC,27200002,CDM,,,,,,both,,,4122.4700,618.3700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2061.24,,,,,,,1064.0100,4122.4700,percent of total billed charges,"Rev 272 $4,122.47 in Billed Charges at 50% = $2,061.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROXIMATE FOR PROLAPS PPH03,272,RC,27200002,CDM,,,,,,both,,,4122.4700,618.3700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1331.56,,,,,,,1064.0100,4122.4700,other,"32.3% of $4,122.47 in Billed Charges for Rev 272 = $1,331.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROXIMATE FOR PROLAPS PPH03,272,RC,27200002,CDM,,,,,,both,,,4122.4700,618.3700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1265.60,,,,,,,1064.0100,4122.4700,other,"30.7% of $4,122.47 in Billed Charges for Rev 272 = $1,265.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROXIMATE FOR PROLAPS PPH03,272,RC,27200002,CDM,,,,,,both,,,4122.4700,618.3700,UNITED HEALTHCARE,UNITED HEALTHCARE,1331.56,,,,,,,1064.0100,4122.4700,percent of total billed charges,"32.3% of $4,122.47 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROXIMATE FOR PROLAPS PPH03,272,RC,27200002,CDM,,,,,,both,,,4122.4700,618.3700,WELLCARE,WELLCARE MEDICAID,4122.47,,,,,,,1064.0100,4122.4700,percent of total billed charges,"100% of $4,122.47 in Billed Charges for Rev 272 = $4,122.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON FLEX 60MM COMPACT,272,RC,,,,,,,,both,,,3213.6600,482.0500,AETNA,AETNA,1372.23,,,,,,,829.4500,3213.6600,percent of total billed charges,"42.7% of $3,213.66 in Billed Charges for Rev 272 = $1,372.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON FLEX 60MM COMPACT,272,RC,,,,,,,,both,,,3213.6600,482.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2249.56,,,,,,,829.4500,3213.6600,percent of total billed charges,"Rev 272 $3,213.66 in Billed Charges at 70% = $2,249.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON FLEX 60MM COMPACT,272,RC,,,,,,,,both,,,3213.6600,482.0500,CIGNA HEALTHCARE,CIGNA HMO,1340.10,,,,,,,829.4500,3213.6600,percent of total billed charges,"41.7% of $3,213.66 in Billed Charges for Rev 272 = $1,340.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON FLEX 60MM COMPACT,272,RC,,,,,,,,both,,,3213.6600,482.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1491.14,,,,,,,829.4500,3213.6600,percent of total billed charges,"46.4% of $3,213.66 in Billed Charges for Rev 272 = $1,491.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON FLEX 60MM COMPACT,272,RC,,,,,,,,both,,,3213.6600,482.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1340.10,,,,,,,829.4500,3213.6600,percent of total billed charges,"41.7% of $3,213.66 in Billed Charges for Rev 272 = $1,340.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON FLEX 60MM COMPACT,272,RC,,,,,,,,both,,,3213.6600,482.0500,CIGNA HEALTHCARE,CIGNA PPO,1340.10,,,,,,,829.4500,3213.6600,percent of total billed charges,"41.7% of $3,213.66 in Billed Charges for Rev 272 = $1,340.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON FLEX 60MM COMPACT,272,RC,,,,,,,,both,,,3213.6600,482.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2892.29,,,,,,,829.4500,3213.6600,percent of total billed charges,"90% of $3,213.66 in Billed Charges for Rev 272 = $2,892.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON FLEX 60MM COMPACT,272,RC,,,,,,,,both,,,3213.6600,482.0500,MEDCOST,MEDCOST VHN,1529.38,,,,,,,829.4500,3213.6600,percent of total billed charges,"47.59% of $3,213.66 in Billed Charges for Rev 272 = $1,529.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON FLEX 60MM COMPACT,272,RC,,,,,,,,both,,,3213.6600,482.0500,SENTARA HEALTH,SENTARA HEALTH,829.45,,,,,,,829.4500,3213.6600,percent of total billed charges,"25.81% of $3,213.66 in Billed Charges for Rev 272 = $829.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON FLEX 60MM COMPACT,272,RC,,,,,,,,both,,,3213.6600,482.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3213.66,,,,,,,829.4500,3213.6600,percent of total billed charges,"100% of $3,213.66 in Billed Charges for Rev 272 = $3,213.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON FLEX 60MM COMPACT,272,RC,,,,,,,,both,,,3213.6600,482.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1606.83,,,,,,,829.4500,3213.6600,percent of total billed charges,"Rev 272 $3,213.66 in Billed Charges at 50% = $1,606.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON FLEX 60MM COMPACT,272,RC,,,,,,,,both,,,3213.6600,482.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1038.01,,,,,,,829.4500,3213.6600,other,"32.3% of $3,213.66 in Billed Charges for Rev 272 = $1,038.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER POWERED ECHELON FLEX 60MM COMPACT,272,RC,,,,,,,,both,,,3213.6600,482.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,986.59,,,,,,,829.4500,3213.6600,other,"30.7% of $3,213.66 in Billed Charges for Rev 272 = $986.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER POWERED ECHELON FLEX 60MM COMPACT,272,RC,,,,,,,,both,,,3213.6600,482.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,1038.01,,,,,,,829.4500,3213.6600,percent of total billed charges,"32.3% of $3,213.66 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER POWERED ECHELON FLEX 60MM COMPACT,272,RC,,,,,,,,both,,,3213.6600,482.0500,WELLCARE,WELLCARE MEDICAID,3213.66,,,,,,,829.4500,3213.6600,percent of total billed charges,"100% of $3,213.66 in Billed Charges for Rev 272 = $3,213.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,7966.6200,1194.9900,AETNA,AETNA,3401.75,,,,,,,2056.1800,7966.6200,percent of total billed charges,"42.7% of $7,966.62 in Billed Charges for Rev 272 = $3,401.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,7966.6200,1194.9900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5576.63,,,,,,,2056.1800,7966.6200,percent of total billed charges,"Rev 272 $7,966.62 in Billed Charges at 70% = $5,576.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,7966.6200,1194.9900,CIGNA HEALTHCARE,CIGNA HMO,3322.08,,,,,,,2056.1800,7966.6200,percent of total billed charges,"41.7% of $7,966.62 in Billed Charges for Rev 272 = $3,322.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,7966.6200,1194.9900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3696.51,,,,,,,2056.1800,7966.6200,percent of total billed charges,"46.4% of $7,966.62 in Billed Charges for Rev 272 = $3,696.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,7966.6200,1194.9900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3322.08,,,,,,,2056.1800,7966.6200,percent of total billed charges,"41.7% of $7,966.62 in Billed Charges for Rev 272 = $3,322.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,7966.6200,1194.9900,CIGNA HEALTHCARE,CIGNA PPO,3322.08,,,,,,,2056.1800,7966.6200,percent of total billed charges,"41.7% of $7,966.62 in Billed Charges for Rev 272 = $3,322.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,7966.6200,1194.9900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7169.96,,,,,,,2056.1800,7966.6200,percent of total billed charges,"90% of $7,966.62 in Billed Charges for Rev 272 = $7,169.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,7966.6200,1194.9900,MEDCOST,MEDCOST VHN,3791.31,,,,,,,2056.1800,7966.6200,percent of total billed charges,"47.59% of $7,966.62 in Billed Charges for Rev 272 = $3,791.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,7966.6200,1194.9900,SENTARA HEALTH,SENTARA HEALTH,2056.18,,,,,,,2056.1800,7966.6200,percent of total billed charges,"25.81% of $7,966.62 in Billed Charges for Rev 272 = $2,056.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,7966.6200,1194.9900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7966.62,,,,,,,2056.1800,7966.6200,percent of total billed charges,"100% of $7,966.62 in Billed Charges for Rev 272 = $7,966.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,7966.6200,1194.9900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3983.31,,,,,,,2056.1800,7966.6200,percent of total billed charges,"Rev 272 $7,966.62 in Billed Charges at 50% = $3,983.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,7966.6200,1194.9900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2573.22,,,,,,,2056.1800,7966.6200,other,"32.3% of $7,966.62 in Billed Charges for Rev 272 = $2,573.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,7966.6200,1194.9900,UNITED HEALTHCARE,UHC HERITAGE SELECT,2445.75,,,,,,,2056.1800,7966.6200,other,"30.7% of $7,966.62 in Billed Charges for Rev 272 = $2,445.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,7966.6200,1194.9900,UNITED HEALTHCARE,UNITED HEALTHCARE,2573.22,,,,,,,2056.1800,7966.6200,percent of total billed charges,"32.3% of $7,966.62 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,7966.6200,1194.9900,WELLCARE,WELLCARE MEDICAID,7966.62,,,,,,,2056.1800,7966.6200,percent of total billed charges,"100% of $7,966.62 in Billed Charges for Rev 272 = $7,966.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSE STRING INST. 020242,272,RC,27200002,CDM,,,,,,both,,,2590.0200,388.5000,AETNA,AETNA,1105.94,,,,,,,668.4800,2590.0200,percent of total billed charges,"42.7% of $2,590.02 in Billed Charges for Rev 272 = $1,105.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSE STRING INST. 020242,272,RC,27200002,CDM,,,,,,both,,,2590.0200,388.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1813.01,,,,,,,668.4800,2590.0200,percent of total billed charges,"Rev 272 $2,590.02 in Billed Charges at 70% = $1,813.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSE STRING INST. 020242,272,RC,27200002,CDM,,,,,,both,,,2590.0200,388.5000,CIGNA HEALTHCARE,CIGNA HMO,1080.04,,,,,,,668.4800,2590.0200,percent of total billed charges,"41.7% of $2,590.02 in Billed Charges for Rev 272 = $1,080.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSE STRING INST. 020242,272,RC,27200002,CDM,,,,,,both,,,2590.0200,388.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1201.77,,,,,,,668.4800,2590.0200,percent of total billed charges,"46.4% of $2,590.02 in Billed Charges for Rev 272 = $1,201.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSE STRING INST. 020242,272,RC,27200002,CDM,,,,,,both,,,2590.0200,388.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1080.04,,,,,,,668.4800,2590.0200,percent of total billed charges,"41.7% of $2,590.02 in Billed Charges for Rev 272 = $1,080.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSE STRING INST. 020242,272,RC,27200002,CDM,,,,,,both,,,2590.0200,388.5000,CIGNA HEALTHCARE,CIGNA PPO,1080.04,,,,,,,668.4800,2590.0200,percent of total billed charges,"41.7% of $2,590.02 in Billed Charges for Rev 272 = $1,080.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSE STRING INST. 020242,272,RC,27200002,CDM,,,,,,both,,,2590.0200,388.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2331.02,,,,,,,668.4800,2590.0200,percent of total billed charges,"90% of $2,590.02 in Billed Charges for Rev 272 = $2,331.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSE STRING INST. 020242,272,RC,27200002,CDM,,,,,,both,,,2590.0200,388.5000,MEDCOST,MEDCOST VHN,1232.59,,,,,,,668.4800,2590.0200,percent of total billed charges,"47.59% of $2,590.02 in Billed Charges for Rev 272 = $1,232.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSE STRING INST. 020242,272,RC,27200002,CDM,,,,,,both,,,2590.0200,388.5000,SENTARA HEALTH,SENTARA HEALTH,668.48,,,,,,,668.4800,2590.0200,percent of total billed charges,"25.81% of $2,590.02 in Billed Charges for Rev 272 = $668.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSE STRING INST. 020242,272,RC,27200002,CDM,,,,,,both,,,2590.0200,388.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2590.02,,,,,,,668.4800,2590.0200,percent of total billed charges,"100% of $2,590.02 in Billed Charges for Rev 272 = $2,590.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSE STRING INST. 020242,272,RC,27200002,CDM,,,,,,both,,,2590.0200,388.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1295.01,,,,,,,668.4800,2590.0200,percent of total billed charges,"Rev 272 $2,590.02 in Billed Charges at 50% = $1,295.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSE STRING INST. 020242,272,RC,27200002,CDM,,,,,,both,,,2590.0200,388.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,836.58,,,,,,,668.4800,2590.0200,other,"32.3% of $2,590.02 in Billed Charges for Rev 272 = $836.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER PURSE STRING INST. 020242,272,RC,27200002,CDM,,,,,,both,,,2590.0200,388.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,795.14,,,,,,,668.4800,2590.0200,other,"30.7% of $2,590.02 in Billed Charges for Rev 272 = $795.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER PURSE STRING INST. 020242,272,RC,27200002,CDM,,,,,,both,,,2590.0200,388.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,836.58,,,,,,,668.4800,2590.0200,percent of total billed charges,"32.3% of $2,590.02 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSE STRING INST. 020242,272,RC,27200002,CDM,,,,,,both,,,2590.0200,388.5000,WELLCARE,WELLCARE MEDICAID,2590.02,,,,,,,668.4800,2590.0200,percent of total billed charges,"100% of $2,590.02 in Billed Charges for Rev 272 = $2,590.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 5100-037-113,272,RC,27200002,CDM,,,,,,both,,,1135.8300,170.3700,AETNA,AETNA,485.00,,,,,,,293.1600,1135.8300,percent of total billed charges,"42.7% of $1,135.83 in Billed Charges for Rev 272 = $485.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 5100-037-113,272,RC,27200002,CDM,,,,,,both,,,1135.8300,170.3700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,795.08,,,,,,,293.1600,1135.8300,percent of total billed charges,"Rev 272 $1,135.83 in Billed Charges at 70% = $795.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 5100-037-113,272,RC,27200002,CDM,,,,,,both,,,1135.8300,170.3700,CIGNA HEALTHCARE,CIGNA HMO,473.64,,,,,,,293.1600,1135.8300,percent of total billed charges,"41.7% of $1,135.83 in Billed Charges for Rev 272 = $473.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 5100-037-113,272,RC,27200002,CDM,,,,,,both,,,1135.8300,170.3700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,527.03,,,,,,,293.1600,1135.8300,percent of total billed charges,"46.4% of $1,135.83 in Billed Charges for Rev 272 = $527.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 5100-037-113,272,RC,27200002,CDM,,,,,,both,,,1135.8300,170.3700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,473.64,,,,,,,293.1600,1135.8300,percent of total billed charges,"41.7% of $1,135.83 in Billed Charges for Rev 272 = $473.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 5100-037-113,272,RC,27200002,CDM,,,,,,both,,,1135.8300,170.3700,CIGNA HEALTHCARE,CIGNA PPO,473.64,,,,,,,293.1600,1135.8300,percent of total billed charges,"41.7% of $1,135.83 in Billed Charges for Rev 272 = $473.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 5100-037-113,272,RC,27200002,CDM,,,,,,both,,,1135.8300,170.3700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1022.25,,,,,,,293.1600,1135.8300,percent of total billed charges,"90% of $1,135.83 in Billed Charges for Rev 272 = $1,022.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 5100-037-113,272,RC,27200002,CDM,,,,,,both,,,1135.8300,170.3700,MEDCOST,MEDCOST VHN,540.54,,,,,,,293.1600,1135.8300,percent of total billed charges,"47.59% of $1,135.83 in Billed Charges for Rev 272 = $540.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 5100-037-113,272,RC,27200002,CDM,,,,,,both,,,1135.8300,170.3700,SENTARA HEALTH,SENTARA HEALTH,293.16,,,,,,,293.1600,1135.8300,percent of total billed charges,"25.81% of $1,135.83 in Billed Charges for Rev 272 = $293.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 5100-037-113,272,RC,27200002,CDM,,,,,,both,,,1135.8300,170.3700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1135.83,,,,,,,293.1600,1135.8300,percent of total billed charges,"100% of $1,135.83 in Billed Charges for Rev 272 = $1,135.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 5100-037-113,272,RC,27200002,CDM,,,,,,both,,,1135.8300,170.3700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,567.92,,,,,,,293.1600,1135.8300,percent of total billed charges,"Rev 272 $1,135.83 in Billed Charges at 50% = $567.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 5100-037-113,272,RC,27200002,CDM,,,,,,both,,,1135.8300,170.3700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,366.87,,,,,,,293.1600,1135.8300,other,"32.3% of $1,135.83 in Billed Charges for Rev 272 = $366.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RASP 5100-037-113,272,RC,27200002,CDM,,,,,,both,,,1135.8300,170.3700,UNITED HEALTHCARE,UHC HERITAGE SELECT,348.70,,,,,,,293.1600,1135.8300,other,"30.7% of $1,135.83 in Billed Charges for Rev 272 = $348.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RASP 5100-037-113,272,RC,27200002,CDM,,,,,,both,,,1135.8300,170.3700,UNITED HEALTHCARE,UNITED HEALTHCARE,366.87,,,,,,,293.1600,1135.8300,percent of total billed charges,"32.3% of $1,135.83 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 5100-037-113,272,RC,27200002,CDM,,,,,,both,,,1135.8300,170.3700,WELLCARE,WELLCARE MEDICAID,1135.83,,,,,,,293.1600,1135.8300,percent of total billed charges,"100% of $1,135.83 in Billed Charges for Rev 272 = $1,135.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 510037114,272,RC,,,,,,,,both,,,1100.2600,165.0400,AETNA,AETNA,469.81,,,,,,,283.9800,1100.2600,percent of total billed charges,"42.7% of $1,100.26 in Billed Charges for Rev 272 = $469.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 510037114,272,RC,,,,,,,,both,,,1100.2600,165.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,770.18,,,,,,,283.9800,1100.2600,percent of total billed charges,"Rev 272 $1,100.26 in Billed Charges at 70% = $770.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 510037114,272,RC,,,,,,,,both,,,1100.2600,165.0400,CIGNA HEALTHCARE,CIGNA HMO,458.81,,,,,,,283.9800,1100.2600,percent of total billed charges,"41.7% of $1,100.26 in Billed Charges for Rev 272 = $458.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 510037114,272,RC,,,,,,,,both,,,1100.2600,165.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,510.52,,,,,,,283.9800,1100.2600,percent of total billed charges,"46.4% of $1,100.26 in Billed Charges for Rev 272 = $510.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 510037114,272,RC,,,,,,,,both,,,1100.2600,165.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,458.81,,,,,,,283.9800,1100.2600,percent of total billed charges,"41.7% of $1,100.26 in Billed Charges for Rev 272 = $458.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 510037114,272,RC,,,,,,,,both,,,1100.2600,165.0400,CIGNA HEALTHCARE,CIGNA PPO,458.81,,,,,,,283.9800,1100.2600,percent of total billed charges,"41.7% of $1,100.26 in Billed Charges for Rev 272 = $458.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 510037114,272,RC,,,,,,,,both,,,1100.2600,165.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,990.23,,,,,,,283.9800,1100.2600,percent of total billed charges,"90% of $1,100.26 in Billed Charges for Rev 272 = $990.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 510037114,272,RC,,,,,,,,both,,,1100.2600,165.0400,MEDCOST,MEDCOST VHN,523.61,,,,,,,283.9800,1100.2600,percent of total billed charges,"47.59% of $1,100.26 in Billed Charges for Rev 272 = $523.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 510037114,272,RC,,,,,,,,both,,,1100.2600,165.0400,SENTARA HEALTH,SENTARA HEALTH,283.98,,,,,,,283.9800,1100.2600,percent of total billed charges,"25.81% of $1,100.26 in Billed Charges for Rev 272 = $283.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 510037114,272,RC,,,,,,,,both,,,1100.2600,165.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1100.26,,,,,,,283.9800,1100.2600,percent of total billed charges,"100% of $1,100.26 in Billed Charges for Rev 272 = $1,100.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 510037114,272,RC,,,,,,,,both,,,1100.2600,165.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,550.13,,,,,,,283.9800,1100.2600,percent of total billed charges,"Rev 272 $1,100.26 in Billed Charges at 50% = $550.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 510037114,272,RC,,,,,,,,both,,,1100.2600,165.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,355.38,,,,,,,283.9800,1100.2600,other,"32.3% of $1,100.26 in Billed Charges for Rev 272 = $355.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RASP 510037114,272,RC,,,,,,,,both,,,1100.2600,165.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,337.78,,,,,,,283.9800,1100.2600,other,"30.7% of $1,100.26 in Billed Charges for Rev 272 = $337.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RASP 510037114,272,RC,,,,,,,,both,,,1100.2600,165.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,355.38,,,,,,,283.9800,1100.2600,percent of total billed charges,"32.3% of $1,100.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP 510037114,272,RC,,,,,,,,both,,,1100.2600,165.0400,WELLCARE,WELLCARE MEDICAID,1100.26,,,,,,,283.9800,1100.2600,percent of total billed charges,"100% of $1,100.26 in Billed Charges for Rev 272 = $1,100.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP POWER 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2509.7800,376.4700,AETNA,AETNA,1071.68,,,,,,,647.7700,2509.7800,percent of total billed charges,"42.7% of $2,509.78 in Billed Charges for Rev 272 = $1,071.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP POWER 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2509.7800,376.4700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1756.85,,,,,,,647.7700,2509.7800,percent of total billed charges,"Rev 272 $2,509.78 in Billed Charges at 70% = $1,756.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP POWER 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2509.7800,376.4700,CIGNA HEALTHCARE,CIGNA HMO,1046.58,,,,,,,647.7700,2509.7800,percent of total billed charges,"41.7% of $2,509.78 in Billed Charges for Rev 272 = $1,046.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP POWER 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2509.7800,376.4700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1164.54,,,,,,,647.7700,2509.7800,percent of total billed charges,"46.4% of $2,509.78 in Billed Charges for Rev 272 = $1,164.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP POWER 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2509.7800,376.4700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1046.58,,,,,,,647.7700,2509.7800,percent of total billed charges,"41.7% of $2,509.78 in Billed Charges for Rev 272 = $1,046.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP POWER 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2509.7800,376.4700,CIGNA HEALTHCARE,CIGNA PPO,1046.58,,,,,,,647.7700,2509.7800,percent of total billed charges,"41.7% of $2,509.78 in Billed Charges for Rev 272 = $1,046.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP POWER 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2509.7800,376.4700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2258.80,,,,,,,647.7700,2509.7800,percent of total billed charges,"90% of $2,509.78 in Billed Charges for Rev 272 = $2,258.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP POWER 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2509.7800,376.4700,MEDCOST,MEDCOST VHN,1194.40,,,,,,,647.7700,2509.7800,percent of total billed charges,"47.59% of $2,509.78 in Billed Charges for Rev 272 = $1,194.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP POWER 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2509.7800,376.4700,SENTARA HEALTH,SENTARA HEALTH,647.77,,,,,,,647.7700,2509.7800,percent of total billed charges,"25.81% of $2,509.78 in Billed Charges for Rev 272 = $647.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP POWER 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2509.7800,376.4700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2509.78,,,,,,,647.7700,2509.7800,percent of total billed charges,"100% of $2,509.78 in Billed Charges for Rev 272 = $2,509.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP POWER 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2509.7800,376.4700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1254.89,,,,,,,647.7700,2509.7800,percent of total billed charges,"Rev 272 $2,509.78 in Billed Charges at 50% = $1,254.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP POWER 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2509.7800,376.4700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,810.66,,,,,,,647.7700,2509.7800,other,"32.3% of $2,509.78 in Billed Charges for Rev 272 = $810.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RASP POWER 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2509.7800,376.4700,UNITED HEALTHCARE,UHC HERITAGE SELECT,770.50,,,,,,,647.7700,2509.7800,other,"30.7% of $2,509.78 in Billed Charges for Rev 272 = $770.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RASP POWER 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2509.7800,376.4700,UNITED HEALTHCARE,UNITED HEALTHCARE,810.66,,,,,,,647.7700,2509.7800,percent of total billed charges,"32.3% of $2,509.78 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RASP POWER 3.5MM,272,RC,27200002,CDM,,,,,,both,,,2509.7800,376.4700,WELLCARE,WELLCARE MEDICAID,2509.78,,,,,,,647.7700,2509.7800,percent of total billed charges,"100% of $2,509.78 in Billed Charges for Rev 272 = $2,509.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BONE MARROW ASPIRATION CLOSED TIP,272,RC,27200002,CDM,,,,,,both,,,4221.0000,633.1500,AETNA,AETNA,1802.37,,,,,,,1089.4400,4221.0000,percent of total billed charges,"42.7% of $4,221.00 in Billed Charges for Rev 272 = $1,802.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BONE MARROW ASPIRATION CLOSED TIP,272,RC,27200002,CDM,,,,,,both,,,4221.0000,633.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2954.70,,,,,,,1089.4400,4221.0000,percent of total billed charges,"Rev 272 $4,221.00 in Billed Charges at 70% = $2,954.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BONE MARROW ASPIRATION CLOSED TIP,272,RC,27200002,CDM,,,,,,both,,,4221.0000,633.1500,CIGNA HEALTHCARE,CIGNA HMO,1760.16,,,,,,,1089.4400,4221.0000,percent of total billed charges,"41.7% of $4,221.00 in Billed Charges for Rev 272 = $1,760.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BONE MARROW ASPIRATION CLOSED TIP,272,RC,27200002,CDM,,,,,,both,,,4221.0000,633.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1958.54,,,,,,,1089.4400,4221.0000,percent of total billed charges,"46.4% of $4,221.00 in Billed Charges for Rev 272 = $1,958.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BONE MARROW ASPIRATION CLOSED TIP,272,RC,27200002,CDM,,,,,,both,,,4221.0000,633.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1760.16,,,,,,,1089.4400,4221.0000,percent of total billed charges,"41.7% of $4,221.00 in Billed Charges for Rev 272 = $1,760.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BONE MARROW ASPIRATION CLOSED TIP,272,RC,27200002,CDM,,,,,,both,,,4221.0000,633.1500,CIGNA HEALTHCARE,CIGNA PPO,1760.16,,,,,,,1089.4400,4221.0000,percent of total billed charges,"41.7% of $4,221.00 in Billed Charges for Rev 272 = $1,760.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BONE MARROW ASPIRATION CLOSED TIP,272,RC,27200002,CDM,,,,,,both,,,4221.0000,633.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3798.90,,,,,,,1089.4400,4221.0000,percent of total billed charges,"90% of $4,221.00 in Billed Charges for Rev 272 = $3,798.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BONE MARROW ASPIRATION CLOSED TIP,272,RC,27200002,CDM,,,,,,both,,,4221.0000,633.1500,MEDCOST,MEDCOST VHN,2008.77,,,,,,,1089.4400,4221.0000,percent of total billed charges,"47.59% of $4,221.00 in Billed Charges for Rev 272 = $2,008.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BONE MARROW ASPIRATION CLOSED TIP,272,RC,27200002,CDM,,,,,,both,,,4221.0000,633.1500,SENTARA HEALTH,SENTARA HEALTH,1089.44,,,,,,,1089.4400,4221.0000,percent of total billed charges,"25.81% of $4,221.00 in Billed Charges for Rev 272 = $1,089.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BONE MARROW ASPIRATION CLOSED TIP,272,RC,27200002,CDM,,,,,,both,,,4221.0000,633.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4221.00,,,,,,,1089.4400,4221.0000,percent of total billed charges,"100% of $4,221.00 in Billed Charges for Rev 272 = $4,221.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BONE MARROW ASPIRATION CLOSED TIP,272,RC,27200002,CDM,,,,,,both,,,4221.0000,633.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2110.50,,,,,,,1089.4400,4221.0000,percent of total billed charges,"Rev 272 $4,221.00 in Billed Charges at 50% = $2,110.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BONE MARROW ASPIRATION CLOSED TIP,272,RC,27200002,CDM,,,,,,both,,,4221.0000,633.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1363.38,,,,,,,1089.4400,4221.0000,other,"32.3% of $4,221.00 in Billed Charges for Rev 272 = $1,363.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE BONE MARROW ASPIRATION CLOSED TIP,272,RC,27200002,CDM,,,,,,both,,,4221.0000,633.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1295.85,,,,,,,1089.4400,4221.0000,other,"30.7% of $4,221.00 in Billed Charges for Rev 272 = $1,295.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE BONE MARROW ASPIRATION CLOSED TIP,272,RC,27200002,CDM,,,,,,both,,,4221.0000,633.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,1363.38,,,,,,,1089.4400,4221.0000,percent of total billed charges,"32.3% of $4,221.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BONE MARROW ASPIRATION CLOSED TIP,272,RC,27200002,CDM,,,,,,both,,,4221.0000,633.1500,WELLCARE,WELLCARE MEDICAID,4221.00,,,,,,,1089.4400,4221.0000,percent of total billed charges,"100% of $4,221.00 in Billed Charges for Rev 272 = $4,221.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BX KIT PASSIVE,272,RC,27200002,CDM,,,,,,both,,,8794.6100,1319.1900,AETNA,AETNA,3755.30,,,,,,,2269.8900,8794.6100,percent of total billed charges,"42.7% of $8,794.61 in Billed Charges for Rev 272 = $3,755.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BX KIT PASSIVE,272,RC,27200002,CDM,,,,,,both,,,8794.6100,1319.1900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6156.23,,,,,,,2269.8900,8794.6100,percent of total billed charges,"Rev 272 $8,794.61 in Billed Charges at 70% = $6,156.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BX KIT PASSIVE,272,RC,27200002,CDM,,,,,,both,,,8794.6100,1319.1900,CIGNA HEALTHCARE,CIGNA HMO,3667.35,,,,,,,2269.8900,8794.6100,percent of total billed charges,"41.7% of $8,794.61 in Billed Charges for Rev 272 = $3,667.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BX KIT PASSIVE,272,RC,27200002,CDM,,,,,,both,,,8794.6100,1319.1900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4080.70,,,,,,,2269.8900,8794.6100,percent of total billed charges,"46.4% of $8,794.61 in Billed Charges for Rev 272 = $4,080.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BX KIT PASSIVE,272,RC,27200002,CDM,,,,,,both,,,8794.6100,1319.1900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3667.35,,,,,,,2269.8900,8794.6100,percent of total billed charges,"41.7% of $8,794.61 in Billed Charges for Rev 272 = $3,667.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BX KIT PASSIVE,272,RC,27200002,CDM,,,,,,both,,,8794.6100,1319.1900,CIGNA HEALTHCARE,CIGNA PPO,3667.35,,,,,,,2269.8900,8794.6100,percent of total billed charges,"41.7% of $8,794.61 in Billed Charges for Rev 272 = $3,667.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BX KIT PASSIVE,272,RC,27200002,CDM,,,,,,both,,,8794.6100,1319.1900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7915.15,,,,,,,2269.8900,8794.6100,percent of total billed charges,"90% of $8,794.61 in Billed Charges for Rev 272 = $7,915.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BX KIT PASSIVE,272,RC,27200002,CDM,,,,,,both,,,8794.6100,1319.1900,MEDCOST,MEDCOST VHN,4185.35,,,,,,,2269.8900,8794.6100,percent of total billed charges,"47.59% of $8,794.61 in Billed Charges for Rev 272 = $4,185.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BX KIT PASSIVE,272,RC,27200002,CDM,,,,,,both,,,8794.6100,1319.1900,SENTARA HEALTH,SENTARA HEALTH,2269.89,,,,,,,2269.8900,8794.6100,percent of total billed charges,"25.81% of $8,794.61 in Billed Charges for Rev 272 = $2,269.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BX KIT PASSIVE,272,RC,27200002,CDM,,,,,,both,,,8794.6100,1319.1900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8794.61,,,,,,,2269.8900,8794.6100,percent of total billed charges,"100% of $8,794.61 in Billed Charges for Rev 272 = $8,794.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BX KIT PASSIVE,272,RC,27200002,CDM,,,,,,both,,,8794.6100,1319.1900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4397.31,,,,,,,2269.8900,8794.6100,percent of total billed charges,"Rev 272 $8,794.61 in Billed Charges at 50% = $4,397.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BX KIT PASSIVE,272,RC,27200002,CDM,,,,,,both,,,8794.6100,1319.1900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2840.66,,,,,,,2269.8900,8794.6100,other,"32.3% of $8,794.61 in Billed Charges for Rev 272 = $2,840.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE BX KIT PASSIVE,272,RC,27200002,CDM,,,,,,both,,,8794.6100,1319.1900,UNITED HEALTHCARE,UHC HERITAGE SELECT,2699.95,,,,,,,2269.8900,8794.6100,other,"30.7% of $8,794.61 in Billed Charges for Rev 272 = $2,699.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE BX KIT PASSIVE,272,RC,27200002,CDM,,,,,,both,,,8794.6100,1319.1900,UNITED HEALTHCARE,UNITED HEALTHCARE,2840.66,,,,,,,2269.8900,8794.6100,percent of total billed charges,"32.3% of $8,794.61 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BX KIT PASSIVE,272,RC,27200002,CDM,,,,,,both,,,8794.6100,1319.1900,WELLCARE,WELLCARE MEDICAID,8794.61,,,,,,,2269.8900,8794.6100,percent of total billed charges,"100% of $8,794.61 in Billed Charges for Rev 272 = $8,794.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE COLORADO 6 INCH EXTENDED TIP,272,RC,,,,,,,,both,,,587.1000,88.0700,AETNA,AETNA,250.69,,,,,,,151.5300,587.1000,percent of total billed charges,42.7% of $587.10 in Billed Charges for Rev 272 = $250.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE COLORADO 6 INCH EXTENDED TIP,272,RC,,,,,,,,both,,,587.1000,88.0700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,410.97,,,,,,,151.5300,587.1000,percent of total billed charges,Rev 272 $587.10 in Billed Charges at 70% = $410.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE COLORADO 6 INCH EXTENDED TIP,272,RC,,,,,,,,both,,,587.1000,88.0700,CIGNA HEALTHCARE,CIGNA HMO,244.82,,,,,,,151.5300,587.1000,percent of total billed charges,41.7% of $587.10 in Billed Charges for Rev 272 = $244.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE COLORADO 6 INCH EXTENDED TIP,272,RC,,,,,,,,both,,,587.1000,88.0700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,272.41,,,,,,,151.5300,587.1000,percent of total billed charges,46.4% of $587.10 in Billed Charges for Rev 272 = $272.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE COLORADO 6 INCH EXTENDED TIP,272,RC,,,,,,,,both,,,587.1000,88.0700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,244.82,,,,,,,151.5300,587.1000,percent of total billed charges,41.7% of $587.10 in Billed Charges for Rev 272 = $244.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE COLORADO 6 INCH EXTENDED TIP,272,RC,,,,,,,,both,,,587.1000,88.0700,CIGNA HEALTHCARE,CIGNA PPO,244.82,,,,,,,151.5300,587.1000,percent of total billed charges,41.7% of $587.10 in Billed Charges for Rev 272 = $244.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE COLORADO 6 INCH EXTENDED TIP,272,RC,,,,,,,,both,,,587.1000,88.0700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,528.39,,,,,,,151.5300,587.1000,percent of total billed charges,90% of $587.10 in Billed Charges for Rev 272 = $528.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE COLORADO 6 INCH EXTENDED TIP,272,RC,,,,,,,,both,,,587.1000,88.0700,MEDCOST,MEDCOST VHN,279.40,,,,,,,151.5300,587.1000,percent of total billed charges,47.59% of $587.10 in Billed Charges for Rev 272 = $279.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE COLORADO 6 INCH EXTENDED TIP,272,RC,,,,,,,,both,,,587.1000,88.0700,SENTARA HEALTH,SENTARA HEALTH,151.53,,,,,,,151.5300,587.1000,percent of total billed charges,25.81% of $587.10 in Billed Charges for Rev 272 = $151.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE COLORADO 6 INCH EXTENDED TIP,272,RC,,,,,,,,both,,,587.1000,88.0700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",587.10,,,,,,,151.5300,587.1000,percent of total billed charges,100% of $587.10 in Billed Charges for Rev 272 = $587.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE COLORADO 6 INCH EXTENDED TIP,272,RC,,,,,,,,both,,,587.1000,88.0700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,293.55,,,,,,,151.5300,587.1000,percent of total billed charges,Rev 272 $587.10 in Billed Charges at 50% = $293.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE COLORADO 6 INCH EXTENDED TIP,272,RC,,,,,,,,both,,,587.1000,88.0700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,189.63,,,,,,,151.5300,587.1000,other,32.3% of $587.10 in Billed Charges for Rev 272 = $189.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE COLORADO 6 INCH EXTENDED TIP,272,RC,,,,,,,,both,,,587.1000,88.0700,UNITED HEALTHCARE,UHC HERITAGE SELECT,180.24,,,,,,,151.5300,587.1000,other,30.7% of $587.10 in Billed Charges for Rev 272 = $180.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE COLORADO 6 INCH EXTENDED TIP,272,RC,,,,,,,,both,,,587.1000,88.0700,UNITED HEALTHCARE,UNITED HEALTHCARE,189.63,,,,,,,151.5300,587.1000,percent of total billed charges,32.3% of $587.10 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE COLORADO 6 INCH EXTENDED TIP,272,RC,,,,,,,,both,,,587.1000,88.0700,WELLCARE,WELLCARE MEDICAID,587.10,,,,,,,151.5300,587.1000,percent of total billed charges,100% of $587.10 in Billed Charges for Rev 272 = $587.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
REACH NANO PASS 45 DEG LEFT CAT01355,272,RC,,,,,,,,both,,,3576.7500,536.5100,AETNA,AETNA,1527.27,,,,,,,923.1600,3576.7500,percent of total billed charges,"42.7% of $3,576.75 in Billed Charges for Rev 272 = $1,527.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REACH NANO PASS 45 DEG LEFT CAT01355,272,RC,,,,,,,,both,,,3576.7500,536.5100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2503.73,,,,,,,923.1600,3576.7500,percent of total billed charges,"Rev 272 $3,576.75 in Billed Charges at 70% = $2,503.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REACH NANO PASS 45 DEG LEFT CAT01355,272,RC,,,,,,,,both,,,3576.7500,536.5100,CIGNA HEALTHCARE,CIGNA HMO,1491.50,,,,,,,923.1600,3576.7500,percent of total billed charges,"41.7% of $3,576.75 in Billed Charges for Rev 272 = $1,491.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REACH NANO PASS 45 DEG LEFT CAT01355,272,RC,,,,,,,,both,,,3576.7500,536.5100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1659.61,,,,,,,923.1600,3576.7500,percent of total billed charges,"46.4% of $3,576.75 in Billed Charges for Rev 272 = $1,659.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REACH NANO PASS 45 DEG LEFT CAT01355,272,RC,,,,,,,,both,,,3576.7500,536.5100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1491.50,,,,,,,923.1600,3576.7500,percent of total billed charges,"41.7% of $3,576.75 in Billed Charges for Rev 272 = $1,491.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REACH NANO PASS 45 DEG LEFT CAT01355,272,RC,,,,,,,,both,,,3576.7500,536.5100,CIGNA HEALTHCARE,CIGNA PPO,1491.50,,,,,,,923.1600,3576.7500,percent of total billed charges,"41.7% of $3,576.75 in Billed Charges for Rev 272 = $1,491.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REACH NANO PASS 45 DEG LEFT CAT01355,272,RC,,,,,,,,both,,,3576.7500,536.5100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3219.08,,,,,,,923.1600,3576.7500,percent of total billed charges,"90% of $3,576.75 in Billed Charges for Rev 272 = $3,219.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REACH NANO PASS 45 DEG LEFT CAT01355,272,RC,,,,,,,,both,,,3576.7500,536.5100,MEDCOST,MEDCOST VHN,1702.18,,,,,,,923.1600,3576.7500,percent of total billed charges,"47.59% of $3,576.75 in Billed Charges for Rev 272 = $1,702.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REACH NANO PASS 45 DEG LEFT CAT01355,272,RC,,,,,,,,both,,,3576.7500,536.5100,SENTARA HEALTH,SENTARA HEALTH,923.16,,,,,,,923.1600,3576.7500,percent of total billed charges,"25.81% of $3,576.75 in Billed Charges for Rev 272 = $923.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REACH NANO PASS 45 DEG LEFT CAT01355,272,RC,,,,,,,,both,,,3576.7500,536.5100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3576.75,,,,,,,923.1600,3576.7500,percent of total billed charges,"100% of $3,576.75 in Billed Charges for Rev 272 = $3,576.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REACH NANO PASS 45 DEG LEFT CAT01355,272,RC,,,,,,,,both,,,3576.7500,536.5100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1788.38,,,,,,,923.1600,3576.7500,percent of total billed charges,"Rev 272 $3,576.75 in Billed Charges at 50% = $1,788.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REACH NANO PASS 45 DEG LEFT CAT01355,272,RC,,,,,,,,both,,,3576.7500,536.5100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1155.29,,,,,,,923.1600,3576.7500,other,"32.3% of $3,576.75 in Billed Charges for Rev 272 = $1,155.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
REACH NANO PASS 45 DEG LEFT CAT01355,272,RC,,,,,,,,both,,,3576.7500,536.5100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1098.06,,,,,,,923.1600,3576.7500,other,"30.7% of $3,576.75 in Billed Charges for Rev 272 = $1,098.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
REACH NANO PASS 45 DEG LEFT CAT01355,272,RC,,,,,,,,both,,,3576.7500,536.5100,UNITED HEALTHCARE,UNITED HEALTHCARE,1155.29,,,,,,,923.1600,3576.7500,percent of total billed charges,"32.3% of $3,576.75 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REACH NANO PASS 45 DEG LEFT CAT01355,272,RC,,,,,,,,both,,,3576.7500,536.5100,WELLCARE,WELLCARE MEDICAID,3576.75,,,,,,,923.1600,3576.7500,percent of total billed charges,"100% of $3,576.75 in Billed Charges for Rev 272 = $3,576.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,3744.7600,561.7100,AETNA,AETNA,1599.01,,,,,,,966.5200,3744.7600,percent of total billed charges,"42.7% of $3,744.76 in Billed Charges for Rev 272 = $1,599.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,3744.7600,561.7100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2621.33,,,,,,,966.5200,3744.7600,percent of total billed charges,"Rev 272 $3,744.76 in Billed Charges at 70% = $2,621.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,3744.7600,561.7100,CIGNA HEALTHCARE,CIGNA HMO,1561.56,,,,,,,966.5200,3744.7600,percent of total billed charges,"41.7% of $3,744.76 in Billed Charges for Rev 272 = $1,561.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,3744.7600,561.7100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1737.57,,,,,,,966.5200,3744.7600,percent of total billed charges,"46.4% of $3,744.76 in Billed Charges for Rev 272 = $1,737.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,3744.7600,561.7100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1561.56,,,,,,,966.5200,3744.7600,percent of total billed charges,"41.7% of $3,744.76 in Billed Charges for Rev 272 = $1,561.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,3744.7600,561.7100,CIGNA HEALTHCARE,CIGNA PPO,1561.56,,,,,,,966.5200,3744.7600,percent of total billed charges,"41.7% of $3,744.76 in Billed Charges for Rev 272 = $1,561.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,3744.7600,561.7100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3370.28,,,,,,,966.5200,3744.7600,percent of total billed charges,"90% of $3,744.76 in Billed Charges for Rev 272 = $3,370.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,3744.7600,561.7100,MEDCOST,MEDCOST VHN,1782.13,,,,,,,966.5200,3744.7600,percent of total billed charges,"47.59% of $3,744.76 in Billed Charges for Rev 272 = $1,782.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,3744.7600,561.7100,SENTARA HEALTH,SENTARA HEALTH,966.52,,,,,,,966.5200,3744.7600,percent of total billed charges,"25.81% of $3,744.76 in Billed Charges for Rev 272 = $966.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,3744.7600,561.7100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3744.76,,,,,,,966.5200,3744.7600,percent of total billed charges,"100% of $3,744.76 in Billed Charges for Rev 272 = $3,744.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,3744.7600,561.7100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1872.38,,,,,,,966.5200,3744.7600,percent of total billed charges,"Rev 272 $3,744.76 in Billed Charges at 50% = $1,872.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,3744.7600,561.7100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1209.56,,,,,,,966.5200,3744.7600,other,"32.3% of $3,744.76 in Billed Charges for Rev 272 = $1,209.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
REAMER 2.7,272,RC,,,,,,,,both,,,3744.7600,561.7100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1149.64,,,,,,,966.5200,3744.7600,other,"30.7% of $3,744.76 in Billed Charges for Rev 272 = $1,149.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
REAMER 2.7,272,RC,,,,,,,,both,,,3744.7600,561.7100,UNITED HEALTHCARE,UNITED HEALTHCARE,1209.56,,,,,,,966.5200,3744.7600,percent of total billed charges,"32.3% of $3,744.76 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,3744.7600,561.7100,WELLCARE,WELLCARE MEDICAID,3744.76,,,,,,,966.5200,3744.7600,percent of total billed charges,"100% of $3,744.76 in Billed Charges for Rev 272 = $3,744.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE DISSECTION COLORADO MIC,272,RC,27200002,CDM,,,,,,both,,,559.5200,83.9300,AETNA,AETNA,238.92,,,,,,,144.4100,559.5200,percent of total billed charges,42.7% of $559.52 in Billed Charges for Rev 272 = $238.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE DISSECTION COLORADO MIC,272,RC,27200002,CDM,,,,,,both,,,559.5200,83.9300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,391.66,,,,,,,144.4100,559.5200,percent of total billed charges,Rev 272 $559.52 in Billed Charges at 70% = $391.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE DISSECTION COLORADO MIC,272,RC,27200002,CDM,,,,,,both,,,559.5200,83.9300,CIGNA HEALTHCARE,CIGNA HMO,233.32,,,,,,,144.4100,559.5200,percent of total billed charges,41.7% of $559.52 in Billed Charges for Rev 272 = $233.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE DISSECTION COLORADO MIC,272,RC,27200002,CDM,,,,,,both,,,559.5200,83.9300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,259.62,,,,,,,144.4100,559.5200,percent of total billed charges,46.4% of $559.52 in Billed Charges for Rev 272 = $259.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE DISSECTION COLORADO MIC,272,RC,27200002,CDM,,,,,,both,,,559.5200,83.9300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,233.32,,,,,,,144.4100,559.5200,percent of total billed charges,41.7% of $559.52 in Billed Charges for Rev 272 = $233.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE DISSECTION COLORADO MIC,272,RC,27200002,CDM,,,,,,both,,,559.5200,83.9300,CIGNA HEALTHCARE,CIGNA PPO,233.32,,,,,,,144.4100,559.5200,percent of total billed charges,41.7% of $559.52 in Billed Charges for Rev 272 = $233.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE DISSECTION COLORADO MIC,272,RC,27200002,CDM,,,,,,both,,,559.5200,83.9300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,503.57,,,,,,,144.4100,559.5200,percent of total billed charges,90% of $559.52 in Billed Charges for Rev 272 = $503.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE DISSECTION COLORADO MIC,272,RC,27200002,CDM,,,,,,both,,,559.5200,83.9300,MEDCOST,MEDCOST VHN,266.28,,,,,,,144.4100,559.5200,percent of total billed charges,47.59% of $559.52 in Billed Charges for Rev 272 = $266.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE DISSECTION COLORADO MIC,272,RC,27200002,CDM,,,,,,both,,,559.5200,83.9300,SENTARA HEALTH,SENTARA HEALTH,144.41,,,,,,,144.4100,559.5200,percent of total billed charges,25.81% of $559.52 in Billed Charges for Rev 272 = $144.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE DISSECTION COLORADO MIC,272,RC,27200002,CDM,,,,,,both,,,559.5200,83.9300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",559.52,,,,,,,144.4100,559.5200,percent of total billed charges,100% of $559.52 in Billed Charges for Rev 272 = $559.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE DISSECTION COLORADO MIC,272,RC,27200002,CDM,,,,,,both,,,559.5200,83.9300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,279.76,,,,,,,144.4100,559.5200,percent of total billed charges,Rev 272 $559.52 in Billed Charges at 50% = $279.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE DISSECTION COLORADO MIC,272,RC,27200002,CDM,,,,,,both,,,559.5200,83.9300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,180.73,,,,,,,144.4100,559.5200,other,32.3% of $559.52 in Billed Charges for Rev 272 = $180.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE DISSECTION COLORADO MIC,272,RC,27200002,CDM,,,,,,both,,,559.5200,83.9300,UNITED HEALTHCARE,UHC HERITAGE SELECT,171.77,,,,,,,144.4100,559.5200,other,30.7% of $559.52 in Billed Charges for Rev 272 = $171.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE DISSECTION COLORADO MIC,272,RC,27200002,CDM,,,,,,both,,,559.5200,83.9300,UNITED HEALTHCARE,UNITED HEALTHCARE,180.73,,,,,,,144.4100,559.5200,percent of total billed charges,32.3% of $559.52 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE DISSECTION COLORADO MIC,272,RC,27200002,CDM,,,,,,both,,,559.5200,83.9300,WELLCARE,WELLCARE MEDICAID,559.52,,,,,,,144.4100,559.5200,percent of total billed charges,100% of $559.52 in Billed Charges for Rev 272 = $559.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD SUREFORM 60 2.5 WHITE 48360W,272,RC,27200002,CDM,,,,,,both,,,2504.6000,375.6900,AETNA,AETNA,1069.46,,,,,,,646.4400,2504.6000,percent of total billed charges,"42.7% of $2,504.60 in Billed Charges for Rev 272 = $1,069.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 60 2.5 WHITE 48360W,272,RC,27200002,CDM,,,,,,both,,,2504.6000,375.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1753.22,,,,,,,646.4400,2504.6000,percent of total billed charges,"Rev 272 $2,504.60 in Billed Charges at 70% = $1,753.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 60 2.5 WHITE 48360W,272,RC,27200002,CDM,,,,,,both,,,2504.6000,375.6900,CIGNA HEALTHCARE,CIGNA HMO,1044.42,,,,,,,646.4400,2504.6000,percent of total billed charges,"41.7% of $2,504.60 in Billed Charges for Rev 272 = $1,044.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 60 2.5 WHITE 48360W,272,RC,27200002,CDM,,,,,,both,,,2504.6000,375.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1162.13,,,,,,,646.4400,2504.6000,percent of total billed charges,"46.4% of $2,504.60 in Billed Charges for Rev 272 = $1,162.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 60 2.5 WHITE 48360W,272,RC,27200002,CDM,,,,,,both,,,2504.6000,375.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1044.42,,,,,,,646.4400,2504.6000,percent of total billed charges,"41.7% of $2,504.60 in Billed Charges for Rev 272 = $1,044.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 60 2.5 WHITE 48360W,272,RC,27200002,CDM,,,,,,both,,,2504.6000,375.6900,CIGNA HEALTHCARE,CIGNA PPO,1044.42,,,,,,,646.4400,2504.6000,percent of total billed charges,"41.7% of $2,504.60 in Billed Charges for Rev 272 = $1,044.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 60 2.5 WHITE 48360W,272,RC,27200002,CDM,,,,,,both,,,2504.6000,375.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2254.14,,,,,,,646.4400,2504.6000,percent of total billed charges,"90% of $2,504.60 in Billed Charges for Rev 272 = $2,254.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 60 2.5 WHITE 48360W,272,RC,27200002,CDM,,,,,,both,,,2504.6000,375.6900,MEDCOST,MEDCOST VHN,1191.94,,,,,,,646.4400,2504.6000,percent of total billed charges,"47.59% of $2,504.60 in Billed Charges for Rev 272 = $1,191.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 60 2.5 WHITE 48360W,272,RC,27200002,CDM,,,,,,both,,,2504.6000,375.6900,SENTARA HEALTH,SENTARA HEALTH,646.44,,,,,,,646.4400,2504.6000,percent of total billed charges,"25.81% of $2,504.60 in Billed Charges for Rev 272 = $646.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 60 2.5 WHITE 48360W,272,RC,27200002,CDM,,,,,,both,,,2504.6000,375.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2504.60,,,,,,,646.4400,2504.6000,percent of total billed charges,"100% of $2,504.60 in Billed Charges for Rev 272 = $2,504.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 60 2.5 WHITE 48360W,272,RC,27200002,CDM,,,,,,both,,,2504.6000,375.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1252.30,,,,,,,646.4400,2504.6000,percent of total billed charges,"Rev 272 $2,504.60 in Billed Charges at 50% = $1,252.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 60 2.5 WHITE 48360W,272,RC,27200002,CDM,,,,,,both,,,2504.6000,375.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,808.99,,,,,,,646.4400,2504.6000,other,"32.3% of $2,504.60 in Billed Charges for Rev 272 = $808.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD SUREFORM 60 2.5 WHITE 48360W,272,RC,27200002,CDM,,,,,,both,,,2504.6000,375.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,768.91,,,,,,,646.4400,2504.6000,other,"30.7% of $2,504.60 in Billed Charges for Rev 272 = $768.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD SUREFORM 60 2.5 WHITE 48360W,272,RC,27200002,CDM,,,,,,both,,,2504.6000,375.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,808.99,,,,,,,646.4400,2504.6000,percent of total billed charges,"32.3% of $2,504.60 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD SUREFORM 60 2.5 WHITE 48360W,272,RC,27200002,CDM,,,,,,both,,,2504.6000,375.6900,WELLCARE,WELLCARE MEDICAID,2504.60,,,,,,,646.4400,2504.6000,percent of total billed charges,"100% of $2,504.60 in Billed Charges for Rev 272 = $2,504.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TA 45-3.5 TA4535L SURPASS SEE LN 120315,272,RC,,,,,,,,both,,,2068.4400,310.2700,AETNA,AETNA,883.22,,,,,,,533.8600,2068.4400,percent of total billed charges,"42.7% of $2,068.44 in Billed Charges for Rev 272 = $883.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TA 45-3.5 TA4535L SURPASS SEE LN 120315,272,RC,,,,,,,,both,,,2068.4400,310.2700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1447.91,,,,,,,533.8600,2068.4400,percent of total billed charges,"Rev 272 $2,068.44 in Billed Charges at 70% = $1,447.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TA 45-3.5 TA4535L SURPASS SEE LN 120315,272,RC,,,,,,,,both,,,2068.4400,310.2700,CIGNA HEALTHCARE,CIGNA HMO,862.54,,,,,,,533.8600,2068.4400,percent of total billed charges,"41.7% of $2,068.44 in Billed Charges for Rev 272 = $862.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TA 45-3.5 TA4535L SURPASS SEE LN 120315,272,RC,,,,,,,,both,,,2068.4400,310.2700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,959.76,,,,,,,533.8600,2068.4400,percent of total billed charges,"46.4% of $2,068.44 in Billed Charges for Rev 272 = $959.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TA 45-3.5 TA4535L SURPASS SEE LN 120315,272,RC,,,,,,,,both,,,2068.4400,310.2700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,862.54,,,,,,,533.8600,2068.4400,percent of total billed charges,"41.7% of $2,068.44 in Billed Charges for Rev 272 = $862.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TA 45-3.5 TA4535L SURPASS SEE LN 120315,272,RC,,,,,,,,both,,,2068.4400,310.2700,CIGNA HEALTHCARE,CIGNA PPO,862.54,,,,,,,533.8600,2068.4400,percent of total billed charges,"41.7% of $2,068.44 in Billed Charges for Rev 272 = $862.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TA 45-3.5 TA4535L SURPASS SEE LN 120315,272,RC,,,,,,,,both,,,2068.4400,310.2700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1861.60,,,,,,,533.8600,2068.4400,percent of total billed charges,"90% of $2,068.44 in Billed Charges for Rev 272 = $1,861.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TA 45-3.5 TA4535L SURPASS SEE LN 120315,272,RC,,,,,,,,both,,,2068.4400,310.2700,MEDCOST,MEDCOST VHN,984.37,,,,,,,533.8600,2068.4400,percent of total billed charges,"47.59% of $2,068.44 in Billed Charges for Rev 272 = $984.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TA 45-3.5 TA4535L SURPASS SEE LN 120315,272,RC,,,,,,,,both,,,2068.4400,310.2700,SENTARA HEALTH,SENTARA HEALTH,533.86,,,,,,,533.8600,2068.4400,percent of total billed charges,"25.81% of $2,068.44 in Billed Charges for Rev 272 = $533.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TA 45-3.5 TA4535L SURPASS SEE LN 120315,272,RC,,,,,,,,both,,,2068.4400,310.2700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2068.44,,,,,,,533.8600,2068.4400,percent of total billed charges,"100% of $2,068.44 in Billed Charges for Rev 272 = $2,068.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TA 45-3.5 TA4535L SURPASS SEE LN 120315,272,RC,,,,,,,,both,,,2068.4400,310.2700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1034.22,,,,,,,533.8600,2068.4400,percent of total billed charges,"Rev 272 $2,068.44 in Billed Charges at 50% = $1,034.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TA 45-3.5 TA4535L SURPASS SEE LN 120315,272,RC,,,,,,,,both,,,2068.4400,310.2700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,668.11,,,,,,,533.8600,2068.4400,other,"32.3% of $2,068.44 in Billed Charges for Rev 272 = $668.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD TA 45-3.5 TA4535L SURPASS SEE LN 120315,272,RC,,,,,,,,both,,,2068.4400,310.2700,UNITED HEALTHCARE,UHC HERITAGE SELECT,635.01,,,,,,,533.8600,2068.4400,other,"30.7% of $2,068.44 in Billed Charges for Rev 272 = $635.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD TA 45-3.5 TA4535L SURPASS SEE LN 120315,272,RC,,,,,,,,both,,,2068.4400,310.2700,UNITED HEALTHCARE,UNITED HEALTHCARE,668.11,,,,,,,533.8600,2068.4400,percent of total billed charges,"32.3% of $2,068.44 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD TA 45-3.5 TA4535L SURPASS SEE LN 120315,272,RC,,,,,,,,both,,,2068.4400,310.2700,WELLCARE,WELLCARE MEDICAID,2068.44,,,,,,,533.8600,2068.4400,percent of total billed charges,"100% of $2,068.44 in Billed Charges for Rev 272 = $2,068.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE FLEXIBLE FOR RP 360 SUTURE PASSER,272,RC,,,,,,,,both,,,2307.1300,346.0700,AETNA,AETNA,985.14,,,,,,,595.4700,2307.1300,percent of total billed charges,"42.7% of $2,307.13 in Billed Charges for Rev 272 = $985.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE FLEXIBLE FOR RP 360 SUTURE PASSER,272,RC,,,,,,,,both,,,2307.1300,346.0700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1614.99,,,,,,,595.4700,2307.1300,percent of total billed charges,"Rev 272 $2,307.13 in Billed Charges at 70% = $1,614.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE FLEXIBLE FOR RP 360 SUTURE PASSER,272,RC,,,,,,,,both,,,2307.1300,346.0700,CIGNA HEALTHCARE,CIGNA HMO,962.07,,,,,,,595.4700,2307.1300,percent of total billed charges,"41.7% of $2,307.13 in Billed Charges for Rev 272 = $962.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE FLEXIBLE FOR RP 360 SUTURE PASSER,272,RC,,,,,,,,both,,,2307.1300,346.0700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1070.51,,,,,,,595.4700,2307.1300,percent of total billed charges,"46.4% of $2,307.13 in Billed Charges for Rev 272 = $1,070.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE FLEXIBLE FOR RP 360 SUTURE PASSER,272,RC,,,,,,,,both,,,2307.1300,346.0700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,962.07,,,,,,,595.4700,2307.1300,percent of total billed charges,"41.7% of $2,307.13 in Billed Charges for Rev 272 = $962.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE FLEXIBLE FOR RP 360 SUTURE PASSER,272,RC,,,,,,,,both,,,2307.1300,346.0700,CIGNA HEALTHCARE,CIGNA PPO,962.07,,,,,,,595.4700,2307.1300,percent of total billed charges,"41.7% of $2,307.13 in Billed Charges for Rev 272 = $962.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE FLEXIBLE FOR RP 360 SUTURE PASSER,272,RC,,,,,,,,both,,,2307.1300,346.0700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2076.42,,,,,,,595.4700,2307.1300,percent of total billed charges,"90% of $2,307.13 in Billed Charges for Rev 272 = $2,076.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE FLEXIBLE FOR RP 360 SUTURE PASSER,272,RC,,,,,,,,both,,,2307.1300,346.0700,MEDCOST,MEDCOST VHN,1097.96,,,,,,,595.4700,2307.1300,percent of total billed charges,"47.59% of $2,307.13 in Billed Charges for Rev 272 = $1,097.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE FLEXIBLE FOR RP 360 SUTURE PASSER,272,RC,,,,,,,,both,,,2307.1300,346.0700,SENTARA HEALTH,SENTARA HEALTH,595.47,,,,,,,595.4700,2307.1300,percent of total billed charges,"25.81% of $2,307.13 in Billed Charges for Rev 272 = $595.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE FLEXIBLE FOR RP 360 SUTURE PASSER,272,RC,,,,,,,,both,,,2307.1300,346.0700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2307.13,,,,,,,595.4700,2307.1300,percent of total billed charges,"100% of $2,307.13 in Billed Charges for Rev 272 = $2,307.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE FLEXIBLE FOR RP 360 SUTURE PASSER,272,RC,,,,,,,,both,,,2307.1300,346.0700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1153.57,,,,,,,595.4700,2307.1300,percent of total billed charges,"Rev 272 $2,307.13 in Billed Charges at 50% = $1,153.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE FLEXIBLE FOR RP 360 SUTURE PASSER,272,RC,,,,,,,,both,,,2307.1300,346.0700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,745.20,,,,,,,595.4700,2307.1300,other,"32.3% of $2,307.13 in Billed Charges for Rev 272 = $745.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE FLEXIBLE FOR RP 360 SUTURE PASSER,272,RC,,,,,,,,both,,,2307.1300,346.0700,UNITED HEALTHCARE,UHC HERITAGE SELECT,708.29,,,,,,,595.4700,2307.1300,other,"30.7% of $2,307.13 in Billed Charges for Rev 272 = $708.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE FLEXIBLE FOR RP 360 SUTURE PASSER,272,RC,,,,,,,,both,,,2307.1300,346.0700,UNITED HEALTHCARE,UNITED HEALTHCARE,745.20,,,,,,,595.4700,2307.1300,percent of total billed charges,"32.3% of $2,307.13 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE FLEXIBLE FOR RP 360 SUTURE PASSER,272,RC,,,,,,,,both,,,2307.1300,346.0700,WELLCARE,WELLCARE MEDICAID,2307.13,,,,,,,595.4700,2307.1300,percent of total billed charges,"100% of $2,307.13 in Billed Charges for Rev 272 = $2,307.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE HOLDER 7IN MAYO HEGAR,272,RC,,,,,,,,both,,,802.7200,120.4100,AETNA,AETNA,342.76,,,,,,,207.1800,802.7200,percent of total billed charges,42.7% of $802.72 in Billed Charges for Rev 272 = $342.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE HOLDER 7IN MAYO HEGAR,272,RC,,,,,,,,both,,,802.7200,120.4100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,561.90,,,,,,,207.1800,802.7200,percent of total billed charges,Rev 272 $802.72 in Billed Charges at 70% = $561.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE HOLDER 7IN MAYO HEGAR,272,RC,,,,,,,,both,,,802.7200,120.4100,CIGNA HEALTHCARE,CIGNA HMO,334.73,,,,,,,207.1800,802.7200,percent of total billed charges,41.7% of $802.72 in Billed Charges for Rev 272 = $334.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE HOLDER 7IN MAYO HEGAR,272,RC,,,,,,,,both,,,802.7200,120.4100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,372.46,,,,,,,207.1800,802.7200,percent of total billed charges,46.4% of $802.72 in Billed Charges for Rev 272 = $372.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE HOLDER 7IN MAYO HEGAR,272,RC,,,,,,,,both,,,802.7200,120.4100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,334.73,,,,,,,207.1800,802.7200,percent of total billed charges,41.7% of $802.72 in Billed Charges for Rev 272 = $334.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE HOLDER 7IN MAYO HEGAR,272,RC,,,,,,,,both,,,802.7200,120.4100,CIGNA HEALTHCARE,CIGNA PPO,334.73,,,,,,,207.1800,802.7200,percent of total billed charges,41.7% of $802.72 in Billed Charges for Rev 272 = $334.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE HOLDER 7IN MAYO HEGAR,272,RC,,,,,,,,both,,,802.7200,120.4100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,722.45,,,,,,,207.1800,802.7200,percent of total billed charges,90% of $802.72 in Billed Charges for Rev 272 = $722.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE HOLDER 7IN MAYO HEGAR,272,RC,,,,,,,,both,,,802.7200,120.4100,MEDCOST,MEDCOST VHN,382.01,,,,,,,207.1800,802.7200,percent of total billed charges,47.59% of $802.72 in Billed Charges for Rev 272 = $382.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE HOLDER 7IN MAYO HEGAR,272,RC,,,,,,,,both,,,802.7200,120.4100,SENTARA HEALTH,SENTARA HEALTH,207.18,,,,,,,207.1800,802.7200,percent of total billed charges,25.81% of $802.72 in Billed Charges for Rev 272 = $207.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE HOLDER 7IN MAYO HEGAR,272,RC,,,,,,,,both,,,802.7200,120.4100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",802.72,,,,,,,207.1800,802.7200,percent of total billed charges,100% of $802.72 in Billed Charges for Rev 272 = $802.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE HOLDER 7IN MAYO HEGAR,272,RC,,,,,,,,both,,,802.7200,120.4100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,401.36,,,,,,,207.1800,802.7200,percent of total billed charges,Rev 272 $802.72 in Billed Charges at 50% = $401.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE HOLDER 7IN MAYO HEGAR,272,RC,,,,,,,,both,,,802.7200,120.4100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,259.28,,,,,,,207.1800,802.7200,other,32.3% of $802.72 in Billed Charges for Rev 272 = $259.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE HOLDER 7IN MAYO HEGAR,272,RC,,,,,,,,both,,,802.7200,120.4100,UNITED HEALTHCARE,UHC HERITAGE SELECT,246.44,,,,,,,207.1800,802.7200,other,30.7% of $802.72 in Billed Charges for Rev 272 = $246.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE HOLDER 7IN MAYO HEGAR,272,RC,,,,,,,,both,,,802.7200,120.4100,UNITED HEALTHCARE,UNITED HEALTHCARE,259.28,,,,,,,207.1800,802.7200,percent of total billed charges,32.3% of $802.72 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE HOLDER 7IN MAYO HEGAR,272,RC,,,,,,,,both,,,802.7200,120.4100,WELLCARE,WELLCARE MEDICAID,802.72,,,,,,,207.1800,802.7200,percent of total billed charges,100% of $802.72 in Billed Charges for Rev 272 = $802.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE HOLDER ENDOPATH 5MM,272,RC,,,,,,,,both,,,4718.9100,707.8400,AETNA,AETNA,2014.97,,,,,,,1217.9500,4718.9100,percent of total billed charges,"42.7% of $4,718.91 in Billed Charges for Rev 272 = $2,014.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE HOLDER ENDOPATH 5MM,272,RC,,,,,,,,both,,,4718.9100,707.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3303.24,,,,,,,1217.9500,4718.9100,percent of total billed charges,"Rev 272 $4,718.91 in Billed Charges at 70% = $3,303.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE HOLDER ENDOPATH 5MM,272,RC,,,,,,,,both,,,4718.9100,707.8400,CIGNA HEALTHCARE,CIGNA HMO,1967.79,,,,,,,1217.9500,4718.9100,percent of total billed charges,"41.7% of $4,718.91 in Billed Charges for Rev 272 = $1,967.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE HOLDER ENDOPATH 5MM,272,RC,,,,,,,,both,,,4718.9100,707.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2189.57,,,,,,,1217.9500,4718.9100,percent of total billed charges,"46.4% of $4,718.91 in Billed Charges for Rev 272 = $2,189.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE HOLDER ENDOPATH 5MM,272,RC,,,,,,,,both,,,4718.9100,707.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1967.79,,,,,,,1217.9500,4718.9100,percent of total billed charges,"41.7% of $4,718.91 in Billed Charges for Rev 272 = $1,967.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE HOLDER ENDOPATH 5MM,272,RC,,,,,,,,both,,,4718.9100,707.8400,CIGNA HEALTHCARE,CIGNA PPO,1967.79,,,,,,,1217.9500,4718.9100,percent of total billed charges,"41.7% of $4,718.91 in Billed Charges for Rev 272 = $1,967.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE HOLDER ENDOPATH 5MM,272,RC,,,,,,,,both,,,4718.9100,707.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4247.02,,,,,,,1217.9500,4718.9100,percent of total billed charges,"90% of $4,718.91 in Billed Charges for Rev 272 = $4,247.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE HOLDER ENDOPATH 5MM,272,RC,,,,,,,,both,,,4718.9100,707.8400,MEDCOST,MEDCOST VHN,2245.73,,,,,,,1217.9500,4718.9100,percent of total billed charges,"47.59% of $4,718.91 in Billed Charges for Rev 272 = $2,245.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE HOLDER ENDOPATH 5MM,272,RC,,,,,,,,both,,,4718.9100,707.8400,SENTARA HEALTH,SENTARA HEALTH,1217.95,,,,,,,1217.9500,4718.9100,percent of total billed charges,"25.81% of $4,718.91 in Billed Charges for Rev 272 = $1,217.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE HOLDER ENDOPATH 5MM,272,RC,,,,,,,,both,,,4718.9100,707.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4718.91,,,,,,,1217.9500,4718.9100,percent of total billed charges,"100% of $4,718.91 in Billed Charges for Rev 272 = $4,718.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE HOLDER ENDOPATH 5MM,272,RC,,,,,,,,both,,,4718.9100,707.8400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2359.46,,,,,,,1217.9500,4718.9100,percent of total billed charges,"Rev 272 $4,718.91 in Billed Charges at 50% = $2,359.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE HOLDER ENDOPATH 5MM,272,RC,,,,,,,,both,,,4718.9100,707.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1524.21,,,,,,,1217.9500,4718.9100,other,"32.3% of $4,718.91 in Billed Charges for Rev 272 = $1,524.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE HOLDER ENDOPATH 5MM,272,RC,,,,,,,,both,,,4718.9100,707.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1448.71,,,,,,,1217.9500,4718.9100,other,"30.7% of $4,718.91 in Billed Charges for Rev 272 = $1,448.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE HOLDER ENDOPATH 5MM,272,RC,,,,,,,,both,,,4718.9100,707.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,1524.21,,,,,,,1217.9500,4718.9100,percent of total billed charges,"32.3% of $4,718.91 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE HOLDER ENDOPATH 5MM,272,RC,,,,,,,,both,,,4718.9100,707.8400,WELLCARE,WELLCARE MEDICAID,4718.91,,,,,,,1217.9500,4718.9100,percent of total billed charges,"100% of $4,718.91 in Billed Charges for Rev 272 = $4,718.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK STARTER SINGLE USE IOP DISP10,272,RC,,,,,,,,both,,,12006.8200,1801.0200,AETNA,AETNA,5126.91,,,,,,,3098.9600,12006.8200,percent of total billed charges,"42.7% of $12,006.82 in Billed Charges for Rev 272 = $5,126.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK STARTER SINGLE USE IOP DISP10,272,RC,,,,,,,,both,,,12006.8200,1801.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8404.77,,,,,,,3098.9600,12006.8200,percent of total billed charges,"Rev 272 $12,006.82 in Billed Charges at 70% = $8,404.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK STARTER SINGLE USE IOP DISP10,272,RC,,,,,,,,both,,,12006.8200,1801.0200,CIGNA HEALTHCARE,CIGNA HMO,5006.84,,,,,,,3098.9600,12006.8200,percent of total billed charges,"41.7% of $12,006.82 in Billed Charges for Rev 272 = $5,006.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK STARTER SINGLE USE IOP DISP10,272,RC,,,,,,,,both,,,12006.8200,1801.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5571.16,,,,,,,3098.9600,12006.8200,percent of total billed charges,"46.4% of $12,006.82 in Billed Charges for Rev 272 = $5,571.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK STARTER SINGLE USE IOP DISP10,272,RC,,,,,,,,both,,,12006.8200,1801.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5006.84,,,,,,,3098.9600,12006.8200,percent of total billed charges,"41.7% of $12,006.82 in Billed Charges for Rev 272 = $5,006.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK STARTER SINGLE USE IOP DISP10,272,RC,,,,,,,,both,,,12006.8200,1801.0200,CIGNA HEALTHCARE,CIGNA PPO,5006.84,,,,,,,3098.9600,12006.8200,percent of total billed charges,"41.7% of $12,006.82 in Billed Charges for Rev 272 = $5,006.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK STARTER SINGLE USE IOP DISP10,272,RC,,,,,,,,both,,,12006.8200,1801.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10806.14,,,,,,,3098.9600,12006.8200,percent of total billed charges,"90% of $12,006.82 in Billed Charges for Rev 272 = $10,806.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK STARTER SINGLE USE IOP DISP10,272,RC,,,,,,,,both,,,12006.8200,1801.0200,MEDCOST,MEDCOST VHN,5714.05,,,,,,,3098.9600,12006.8200,percent of total billed charges,"47.59% of $12,006.82 in Billed Charges for Rev 272 = $5,714.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK STARTER SINGLE USE IOP DISP10,272,RC,,,,,,,,both,,,12006.8200,1801.0200,SENTARA HEALTH,SENTARA HEALTH,3098.96,,,,,,,3098.9600,12006.8200,percent of total billed charges,"25.81% of $12,006.82 in Billed Charges for Rev 272 = $3,098.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK STARTER SINGLE USE IOP DISP10,272,RC,,,,,,,,both,,,12006.8200,1801.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12006.82,,,,,,,3098.9600,12006.8200,percent of total billed charges,"100% of $12,006.82 in Billed Charges for Rev 272 = $12,006.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK STARTER SINGLE USE IOP DISP10,272,RC,,,,,,,,both,,,12006.8200,1801.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6003.41,,,,,,,3098.9600,12006.8200,percent of total billed charges,"Rev 272 $12,006.82 in Billed Charges at 50% = $6,003.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK STARTER SINGLE USE IOP DISP10,272,RC,,,,,,,,both,,,12006.8200,1801.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3878.20,,,,,,,3098.9600,12006.8200,other,"32.3% of $12,006.82 in Billed Charges for Rev 272 = $3,878.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK STARTER SINGLE USE IOP DISP10,272,RC,,,,,,,,both,,,12006.8200,1801.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,3686.09,,,,,,,3098.9600,12006.8200,other,"30.7% of $12,006.82 in Billed Charges for Rev 272 = $3,686.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK STARTER SINGLE USE IOP DISP10,272,RC,,,,,,,,both,,,12006.8200,1801.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,3878.20,,,,,,,3098.9600,12006.8200,percent of total billed charges,"32.3% of $12,006.82 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK STARTER SINGLE USE IOP DISP10,272,RC,,,,,,,,both,,,12006.8200,1801.0200,WELLCARE,WELLCARE MEDICAID,12006.82,,,,,,,3098.9600,12006.8200,percent of total billed charges,"100% of $12,006.82 in Billed Charges for Rev 272 = $12,006.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETAINING SYSTEM NASAL TUBE10FR TEAL,272,RC,27200002,CDM,,,,,,both,,,1080.6600,162.1000,AETNA,AETNA,461.44,,,,,,,278.9200,1080.6600,percent of total billed charges,"42.7% of $1,080.66 in Billed Charges for Rev 272 = $461.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETAINING SYSTEM NASAL TUBE10FR TEAL,272,RC,27200002,CDM,,,,,,both,,,1080.6600,162.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,756.46,,,,,,,278.9200,1080.6600,percent of total billed charges,"Rev 272 $1,080.66 in Billed Charges at 70% = $756.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETAINING SYSTEM NASAL TUBE10FR TEAL,272,RC,27200002,CDM,,,,,,both,,,1080.6600,162.1000,CIGNA HEALTHCARE,CIGNA HMO,450.64,,,,,,,278.9200,1080.6600,percent of total billed charges,"41.7% of $1,080.66 in Billed Charges for Rev 272 = $450.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETAINING SYSTEM NASAL TUBE10FR TEAL,272,RC,27200002,CDM,,,,,,both,,,1080.6600,162.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,501.43,,,,,,,278.9200,1080.6600,percent of total billed charges,"46.4% of $1,080.66 in Billed Charges for Rev 272 = $501.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETAINING SYSTEM NASAL TUBE10FR TEAL,272,RC,27200002,CDM,,,,,,both,,,1080.6600,162.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,450.64,,,,,,,278.9200,1080.6600,percent of total billed charges,"41.7% of $1,080.66 in Billed Charges for Rev 272 = $450.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETAINING SYSTEM NASAL TUBE10FR TEAL,272,RC,27200002,CDM,,,,,,both,,,1080.6600,162.1000,CIGNA HEALTHCARE,CIGNA PPO,450.64,,,,,,,278.9200,1080.6600,percent of total billed charges,"41.7% of $1,080.66 in Billed Charges for Rev 272 = $450.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETAINING SYSTEM NASAL TUBE10FR TEAL,272,RC,27200002,CDM,,,,,,both,,,1080.6600,162.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,972.59,,,,,,,278.9200,1080.6600,percent of total billed charges,"90% of $1,080.66 in Billed Charges for Rev 272 = $972.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETAINING SYSTEM NASAL TUBE10FR TEAL,272,RC,27200002,CDM,,,,,,both,,,1080.6600,162.1000,MEDCOST,MEDCOST VHN,514.29,,,,,,,278.9200,1080.6600,percent of total billed charges,"47.59% of $1,080.66 in Billed Charges for Rev 272 = $514.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETAINING SYSTEM NASAL TUBE10FR TEAL,272,RC,27200002,CDM,,,,,,both,,,1080.6600,162.1000,SENTARA HEALTH,SENTARA HEALTH,278.92,,,,,,,278.9200,1080.6600,percent of total billed charges,"25.81% of $1,080.66 in Billed Charges for Rev 272 = $278.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETAINING SYSTEM NASAL TUBE10FR TEAL,272,RC,27200002,CDM,,,,,,both,,,1080.6600,162.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1080.66,,,,,,,278.9200,1080.6600,percent of total billed charges,"100% of $1,080.66 in Billed Charges for Rev 272 = $1,080.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETAINING SYSTEM NASAL TUBE10FR TEAL,272,RC,27200002,CDM,,,,,,both,,,1080.6600,162.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,540.33,,,,,,,278.9200,1080.6600,percent of total billed charges,"Rev 272 $1,080.66 in Billed Charges at 50% = $540.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETAINING SYSTEM NASAL TUBE10FR TEAL,272,RC,27200002,CDM,,,,,,both,,,1080.6600,162.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,349.05,,,,,,,278.9200,1080.6600,other,"32.3% of $1,080.66 in Billed Charges for Rev 272 = $349.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RETAINING SYSTEM NASAL TUBE10FR TEAL,272,RC,27200002,CDM,,,,,,both,,,1080.6600,162.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,331.76,,,,,,,278.9200,1080.6600,other,"30.7% of $1,080.66 in Billed Charges for Rev 272 = $331.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RETAINING SYSTEM NASAL TUBE10FR TEAL,272,RC,27200002,CDM,,,,,,both,,,1080.6600,162.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,349.05,,,,,,,278.9200,1080.6600,percent of total billed charges,"32.3% of $1,080.66 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETAINING SYSTEM NASAL TUBE10FR TEAL,272,RC,27200002,CDM,,,,,,both,,,1080.6600,162.1000,WELLCARE,WELLCARE MEDICAID,1080.66,,,,,,,278.9200,1080.6600,percent of total billed charges,"100% of $1,080.66 in Billed Charges for Rev 272 = $1,080.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT FIBRIN EVICEL 1ML,272,RC,,,,,,,,both,,,1133.3400,170.0000,AETNA,AETNA,483.94,,,,,,,292.5200,1133.3400,percent of total billed charges,"42.7% of $1,133.34 in Billed Charges for Rev 272 = $483.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT FIBRIN EVICEL 1ML,272,RC,,,,,,,,both,,,1133.3400,170.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,793.34,,,,,,,292.5200,1133.3400,percent of total billed charges,"Rev 272 $1,133.34 in Billed Charges at 70% = $793.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT FIBRIN EVICEL 1ML,272,RC,,,,,,,,both,,,1133.3400,170.0000,CIGNA HEALTHCARE,CIGNA HMO,472.60,,,,,,,292.5200,1133.3400,percent of total billed charges,"41.7% of $1,133.34 in Billed Charges for Rev 272 = $472.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT FIBRIN EVICEL 1ML,272,RC,,,,,,,,both,,,1133.3400,170.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,525.87,,,,,,,292.5200,1133.3400,percent of total billed charges,"46.4% of $1,133.34 in Billed Charges for Rev 272 = $525.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT FIBRIN EVICEL 1ML,272,RC,,,,,,,,both,,,1133.3400,170.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,472.60,,,,,,,292.5200,1133.3400,percent of total billed charges,"41.7% of $1,133.34 in Billed Charges for Rev 272 = $472.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT FIBRIN EVICEL 1ML,272,RC,,,,,,,,both,,,1133.3400,170.0000,CIGNA HEALTHCARE,CIGNA PPO,472.60,,,,,,,292.5200,1133.3400,percent of total billed charges,"41.7% of $1,133.34 in Billed Charges for Rev 272 = $472.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT FIBRIN EVICEL 1ML,272,RC,,,,,,,,both,,,1133.3400,170.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1020.01,,,,,,,292.5200,1133.3400,percent of total billed charges,"90% of $1,133.34 in Billed Charges for Rev 272 = $1,020.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT FIBRIN EVICEL 1ML,272,RC,,,,,,,,both,,,1133.3400,170.0000,MEDCOST,MEDCOST VHN,539.36,,,,,,,292.5200,1133.3400,percent of total billed charges,"47.59% of $1,133.34 in Billed Charges for Rev 272 = $539.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT FIBRIN EVICEL 1ML,272,RC,,,,,,,,both,,,1133.3400,170.0000,SENTARA HEALTH,SENTARA HEALTH,292.52,,,,,,,292.5200,1133.3400,percent of total billed charges,"25.81% of $1,133.34 in Billed Charges for Rev 272 = $292.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT FIBRIN EVICEL 1ML,272,RC,,,,,,,,both,,,1133.3400,170.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1133.34,,,,,,,292.5200,1133.3400,percent of total billed charges,"100% of $1,133.34 in Billed Charges for Rev 272 = $1,133.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT FIBRIN EVICEL 1ML,272,RC,,,,,,,,both,,,1133.3400,170.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,566.67,,,,,,,292.5200,1133.3400,percent of total billed charges,"Rev 272 $1,133.34 in Billed Charges at 50% = $566.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT FIBRIN EVICEL 1ML,272,RC,,,,,,,,both,,,1133.3400,170.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,366.07,,,,,,,292.5200,1133.3400,other,"32.3% of $1,133.34 in Billed Charges for Rev 272 = $366.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALANT FIBRIN EVICEL 1ML,272,RC,,,,,,,,both,,,1133.3400,170.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,347.94,,,,,,,292.5200,1133.3400,other,"30.7% of $1,133.34 in Billed Charges for Rev 272 = $347.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALANT FIBRIN EVICEL 1ML,272,RC,,,,,,,,both,,,1133.3400,170.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,366.07,,,,,,,292.5200,1133.3400,percent of total billed charges,"32.3% of $1,133.34 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT FIBRIN EVICEL 1ML,272,RC,,,,,,,,both,,,1133.3400,170.0000,WELLCARE,WELLCARE MEDICAID,1133.34,,,,,,,292.5200,1133.3400,percent of total billed charges,"100% of $1,133.34 in Billed Charges for Rev 272 = $1,133.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT SPINE DURASEAL 5ML,272,RC,27200002,CDM,,,,,,both,,,14193.0000,2128.9500,AETNA,AETNA,6060.41,,,,,,,3663.2100,14193.0000,percent of total billed charges,"42.7% of $14,193.00 in Billed Charges for Rev 272 = $6,060.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT SPINE DURASEAL 5ML,272,RC,27200002,CDM,,,,,,both,,,14193.0000,2128.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9935.10,,,,,,,3663.2100,14193.0000,percent of total billed charges,"Rev 272 $14,193.00 in Billed Charges at 70% = $9,935.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT SPINE DURASEAL 5ML,272,RC,27200002,CDM,,,,,,both,,,14193.0000,2128.9500,CIGNA HEALTHCARE,CIGNA HMO,5918.48,,,,,,,3663.2100,14193.0000,percent of total billed charges,"41.7% of $14,193.00 in Billed Charges for Rev 272 = $5,918.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT SPINE DURASEAL 5ML,272,RC,27200002,CDM,,,,,,both,,,14193.0000,2128.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6585.55,,,,,,,3663.2100,14193.0000,percent of total billed charges,"46.4% of $14,193.00 in Billed Charges for Rev 272 = $6,585.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT SPINE DURASEAL 5ML,272,RC,27200002,CDM,,,,,,both,,,14193.0000,2128.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5918.48,,,,,,,3663.2100,14193.0000,percent of total billed charges,"41.7% of $14,193.00 in Billed Charges for Rev 272 = $5,918.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT SPINE DURASEAL 5ML,272,RC,27200002,CDM,,,,,,both,,,14193.0000,2128.9500,CIGNA HEALTHCARE,CIGNA PPO,5918.48,,,,,,,3663.2100,14193.0000,percent of total billed charges,"41.7% of $14,193.00 in Billed Charges for Rev 272 = $5,918.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT SPINE DURASEAL 5ML,272,RC,27200002,CDM,,,,,,both,,,14193.0000,2128.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12773.70,,,,,,,3663.2100,14193.0000,percent of total billed charges,"90% of $14,193.00 in Billed Charges for Rev 272 = $12,773.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT SPINE DURASEAL 5ML,272,RC,27200002,CDM,,,,,,both,,,14193.0000,2128.9500,MEDCOST,MEDCOST VHN,6754.45,,,,,,,3663.2100,14193.0000,percent of total billed charges,"47.59% of $14,193.00 in Billed Charges for Rev 272 = $6,754.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT SPINE DURASEAL 5ML,272,RC,27200002,CDM,,,,,,both,,,14193.0000,2128.9500,SENTARA HEALTH,SENTARA HEALTH,3663.21,,,,,,,3663.2100,14193.0000,percent of total billed charges,"25.81% of $14,193.00 in Billed Charges for Rev 272 = $3,663.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT SPINE DURASEAL 5ML,272,RC,27200002,CDM,,,,,,both,,,14193.0000,2128.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",14193.00,,,,,,,3663.2100,14193.0000,percent of total billed charges,"100% of $14,193.00 in Billed Charges for Rev 272 = $14,193.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT SPINE DURASEAL 5ML,272,RC,27200002,CDM,,,,,,both,,,14193.0000,2128.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7096.50,,,,,,,3663.2100,14193.0000,percent of total billed charges,"Rev 272 $14,193.00 in Billed Charges at 50% = $7,096.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT SPINE DURASEAL 5ML,272,RC,27200002,CDM,,,,,,both,,,14193.0000,2128.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4584.34,,,,,,,3663.2100,14193.0000,other,"32.3% of $14,193.00 in Billed Charges for Rev 272 = $4,584.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALANT SPINE DURASEAL 5ML,272,RC,27200002,CDM,,,,,,both,,,14193.0000,2128.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,4357.25,,,,,,,3663.2100,14193.0000,other,"30.7% of $14,193.00 in Billed Charges for Rev 272 = $4,357.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALANT SPINE DURASEAL 5ML,272,RC,27200002,CDM,,,,,,both,,,14193.0000,2128.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,4584.34,,,,,,,3663.2100,14193.0000,percent of total billed charges,"32.3% of $14,193.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT SPINE DURASEAL 5ML,272,RC,27200002,CDM,,,,,,both,,,14193.0000,2128.9500,WELLCARE,WELLCARE MEDICAID,14193.00,,,,,,,3663.2100,14193.0000,percent of total billed charges,"100% of $14,193.00 in Billed Charges for Rev 272 = $14,193.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK TOWEL BARRIER PT READY,272,RC,27200002,CDM,,,,,,both,,,4.1900,0.6300,AETNA,AETNA,1.79,,,,,,,1.0800,4.1900,percent of total billed charges,42.7% of $4.19 in Billed Charges for Rev 272 = $1.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK TOWEL BARRIER PT READY,272,RC,27200002,CDM,,,,,,both,,,4.1900,0.6300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2.93,,,,,,,1.0800,4.1900,percent of total billed charges,Rev 272 $4.19 in Billed Charges at 70% = $2.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK TOWEL BARRIER PT READY,272,RC,27200002,CDM,,,,,,both,,,4.1900,0.6300,CIGNA HEALTHCARE,CIGNA HMO,1.75,,,,,,,1.0800,4.1900,percent of total billed charges,41.7% of $4.19 in Billed Charges for Rev 272 = $1.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK TOWEL BARRIER PT READY,272,RC,27200002,CDM,,,,,,both,,,4.1900,0.6300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1.94,,,,,,,1.0800,4.1900,percent of total billed charges,46.4% of $4.19 in Billed Charges for Rev 272 = $1.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK TOWEL BARRIER PT READY,272,RC,27200002,CDM,,,,,,both,,,4.1900,0.6300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1.75,,,,,,,1.0800,4.1900,percent of total billed charges,41.7% of $4.19 in Billed Charges for Rev 272 = $1.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK TOWEL BARRIER PT READY,272,RC,27200002,CDM,,,,,,both,,,4.1900,0.6300,CIGNA HEALTHCARE,CIGNA PPO,1.75,,,,,,,1.0800,4.1900,percent of total billed charges,41.7% of $4.19 in Billed Charges for Rev 272 = $1.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK TOWEL BARRIER PT READY,272,RC,27200002,CDM,,,,,,both,,,4.1900,0.6300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3.77,,,,,,,1.0800,4.1900,percent of total billed charges,90% of $4.19 in Billed Charges for Rev 272 = $3.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK TOWEL BARRIER PT READY,272,RC,27200002,CDM,,,,,,both,,,4.1900,0.6300,MEDCOST,MEDCOST VHN,1.99,,,,,,,1.0800,4.1900,percent of total billed charges,47.59% of $4.19 in Billed Charges for Rev 272 = $1.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK TOWEL BARRIER PT READY,272,RC,27200002,CDM,,,,,,both,,,4.1900,0.6300,SENTARA HEALTH,SENTARA HEALTH,1.08,,,,,,,1.0800,4.1900,percent of total billed charges,25.81% of $4.19 in Billed Charges for Rev 272 = $1.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK TOWEL BARRIER PT READY,272,RC,27200002,CDM,,,,,,both,,,4.1900,0.6300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4.19,,,,,,,1.0800,4.1900,percent of total billed charges,100% of $4.19 in Billed Charges for Rev 272 = $4.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK TOWEL BARRIER PT READY,272,RC,27200002,CDM,,,,,,both,,,4.1900,0.6300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2.10,,,,,,,1.0800,4.1900,percent of total billed charges,Rev 272 $4.19 in Billed Charges at 50% = $2.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK TOWEL BARRIER PT READY,272,RC,27200002,CDM,,,,,,both,,,4.1900,0.6300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1.35,,,,,,,1.0800,4.1900,other,32.3% of $4.19 in Billed Charges for Rev 272 = $1.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK TOWEL BARRIER PT READY,272,RC,27200002,CDM,,,,,,both,,,4.1900,0.6300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1.29,,,,,,,1.0800,4.1900,other,30.7% of $4.19 in Billed Charges for Rev 272 = $1.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK TOWEL BARRIER PT READY,272,RC,27200002,CDM,,,,,,both,,,4.1900,0.6300,UNITED HEALTHCARE,UNITED HEALTHCARE,1.35,,,,,,,1.0800,4.1900,percent of total billed charges,32.3% of $4.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK TOWEL BARRIER PT READY,272,RC,27200002,CDM,,,,,,both,,,4.1900,0.6300,WELLCARE,WELLCARE MEDICAID,4.19,,,,,,,1.0800,4.1900,percent of total billed charges,100% of $4.19 in Billed Charges for Rev 272 = $4.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK URO ROBOT HVMC,272,RC,,,,,,,,both,,,2265.1300,339.7700,AETNA,AETNA,967.21,,,,,,,584.6300,2265.1300,percent of total billed charges,"42.7% of $2,265.13 in Billed Charges for Rev 272 = $967.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK URO ROBOT HVMC,272,RC,,,,,,,,both,,,2265.1300,339.7700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1585.59,,,,,,,584.6300,2265.1300,percent of total billed charges,"Rev 272 $2,265.13 in Billed Charges at 70% = $1,585.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK URO ROBOT HVMC,272,RC,,,,,,,,both,,,2265.1300,339.7700,CIGNA HEALTHCARE,CIGNA HMO,944.56,,,,,,,584.6300,2265.1300,percent of total billed charges,"41.7% of $2,265.13 in Billed Charges for Rev 272 = $944.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK URO ROBOT HVMC,272,RC,,,,,,,,both,,,2265.1300,339.7700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1051.02,,,,,,,584.6300,2265.1300,percent of total billed charges,"46.4% of $2,265.13 in Billed Charges for Rev 272 = $1,051.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK URO ROBOT HVMC,272,RC,,,,,,,,both,,,2265.1300,339.7700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,944.56,,,,,,,584.6300,2265.1300,percent of total billed charges,"41.7% of $2,265.13 in Billed Charges for Rev 272 = $944.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK URO ROBOT HVMC,272,RC,,,,,,,,both,,,2265.1300,339.7700,CIGNA HEALTHCARE,CIGNA PPO,944.56,,,,,,,584.6300,2265.1300,percent of total billed charges,"41.7% of $2,265.13 in Billed Charges for Rev 272 = $944.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK URO ROBOT HVMC,272,RC,,,,,,,,both,,,2265.1300,339.7700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2038.62,,,,,,,584.6300,2265.1300,percent of total billed charges,"90% of $2,265.13 in Billed Charges for Rev 272 = $2,038.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK URO ROBOT HVMC,272,RC,,,,,,,,both,,,2265.1300,339.7700,MEDCOST,MEDCOST VHN,1077.98,,,,,,,584.6300,2265.1300,percent of total billed charges,"47.59% of $2,265.13 in Billed Charges for Rev 272 = $1,077.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK URO ROBOT HVMC,272,RC,,,,,,,,both,,,2265.1300,339.7700,SENTARA HEALTH,SENTARA HEALTH,584.63,,,,,,,584.6300,2265.1300,percent of total billed charges,"25.81% of $2,265.13 in Billed Charges for Rev 272 = $584.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK URO ROBOT HVMC,272,RC,,,,,,,,both,,,2265.1300,339.7700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2265.13,,,,,,,584.6300,2265.1300,percent of total billed charges,"100% of $2,265.13 in Billed Charges for Rev 272 = $2,265.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK URO ROBOT HVMC,272,RC,,,,,,,,both,,,2265.1300,339.7700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1132.57,,,,,,,584.6300,2265.1300,percent of total billed charges,"Rev 272 $2,265.13 in Billed Charges at 50% = $1,132.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK URO ROBOT HVMC,272,RC,,,,,,,,both,,,2265.1300,339.7700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,731.64,,,,,,,584.6300,2265.1300,other,"32.3% of $2,265.13 in Billed Charges for Rev 272 = $731.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK URO ROBOT HVMC,272,RC,,,,,,,,both,,,2265.1300,339.7700,UNITED HEALTHCARE,UHC HERITAGE SELECT,695.39,,,,,,,584.6300,2265.1300,other,"30.7% of $2,265.13 in Billed Charges for Rev 272 = $695.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK URO ROBOT HVMC,272,RC,,,,,,,,both,,,2265.1300,339.7700,UNITED HEALTHCARE,UNITED HEALTHCARE,731.64,,,,,,,584.6300,2265.1300,percent of total billed charges,"32.3% of $2,265.13 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK URO ROBOT HVMC,272,RC,,,,,,,,both,,,2265.1300,339.7700,WELLCARE,WELLCARE MEDICAID,2265.13,,,,,,,584.6300,2265.1300,percent of total billed charges,"100% of $2,265.13 in Billed Charges for Rev 272 = $2,265.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK UROLOGICAL JMH CUSTOM,272,RC,27200002,CDM,,,,,,both,,,448.8300,67.3200,AETNA,AETNA,191.65,,,,,,,115.8400,448.8300,percent of total billed charges,42.7% of $448.83 in Billed Charges for Rev 272 = $191.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK UROLOGICAL JMH CUSTOM,272,RC,27200002,CDM,,,,,,both,,,448.8300,67.3200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,314.18,,,,,,,115.8400,448.8300,percent of total billed charges,Rev 272 $448.83 in Billed Charges at 70% = $314.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK UROLOGICAL JMH CUSTOM,272,RC,27200002,CDM,,,,,,both,,,448.8300,67.3200,CIGNA HEALTHCARE,CIGNA HMO,187.16,,,,,,,115.8400,448.8300,percent of total billed charges,41.7% of $448.83 in Billed Charges for Rev 272 = $187.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK UROLOGICAL JMH CUSTOM,272,RC,27200002,CDM,,,,,,both,,,448.8300,67.3200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,208.26,,,,,,,115.8400,448.8300,percent of total billed charges,46.4% of $448.83 in Billed Charges for Rev 272 = $208.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK UROLOGICAL JMH CUSTOM,272,RC,27200002,CDM,,,,,,both,,,448.8300,67.3200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,187.16,,,,,,,115.8400,448.8300,percent of total billed charges,41.7% of $448.83 in Billed Charges for Rev 272 = $187.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK UROLOGICAL JMH CUSTOM,272,RC,27200002,CDM,,,,,,both,,,448.8300,67.3200,CIGNA HEALTHCARE,CIGNA PPO,187.16,,,,,,,115.8400,448.8300,percent of total billed charges,41.7% of $448.83 in Billed Charges for Rev 272 = $187.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK UROLOGICAL JMH CUSTOM,272,RC,27200002,CDM,,,,,,both,,,448.8300,67.3200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,403.95,,,,,,,115.8400,448.8300,percent of total billed charges,90% of $448.83 in Billed Charges for Rev 272 = $403.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK UROLOGICAL JMH CUSTOM,272,RC,27200002,CDM,,,,,,both,,,448.8300,67.3200,MEDCOST,MEDCOST VHN,213.60,,,,,,,115.8400,448.8300,percent of total billed charges,47.59% of $448.83 in Billed Charges for Rev 272 = $213.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK UROLOGICAL JMH CUSTOM,272,RC,27200002,CDM,,,,,,both,,,448.8300,67.3200,SENTARA HEALTH,SENTARA HEALTH,115.84,,,,,,,115.8400,448.8300,percent of total billed charges,25.81% of $448.83 in Billed Charges for Rev 272 = $115.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK UROLOGICAL JMH CUSTOM,272,RC,27200002,CDM,,,,,,both,,,448.8300,67.3200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",448.83,,,,,,,115.8400,448.8300,percent of total billed charges,100% of $448.83 in Billed Charges for Rev 272 = $448.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK UROLOGICAL JMH CUSTOM,272,RC,27200002,CDM,,,,,,both,,,448.8300,67.3200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,224.42,,,,,,,115.8400,448.8300,percent of total billed charges,Rev 272 $448.83 in Billed Charges at 50% = $224.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK UROLOGICAL JMH CUSTOM,272,RC,27200002,CDM,,,,,,both,,,448.8300,67.3200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,144.97,,,,,,,115.8400,448.8300,other,32.3% of $448.83 in Billed Charges for Rev 272 = $144.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK UROLOGICAL JMH CUSTOM,272,RC,27200002,CDM,,,,,,both,,,448.8300,67.3200,UNITED HEALTHCARE,UHC HERITAGE SELECT,137.79,,,,,,,115.8400,448.8300,other,30.7% of $448.83 in Billed Charges for Rev 272 = $137.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK UROLOGICAL JMH CUSTOM,272,RC,27200002,CDM,,,,,,both,,,448.8300,67.3200,UNITED HEALTHCARE,UNITED HEALTHCARE,144.97,,,,,,,115.8400,448.8300,percent of total billed charges,32.3% of $448.83 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK UROLOGICAL JMH CUSTOM,272,RC,27200002,CDM,,,,,,both,,,448.8300,67.3200,WELLCARE,WELLCARE MEDICAID,448.83,,,,,,,115.8400,448.8300,percent of total billed charges,100% of $448.83 in Billed Charges for Rev 272 = $448.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SEALER AQUAMANTIS BIPOLAR 6.0,272,RC,27200002,CDM,,,,,,both,,,4490.6400,673.6000,AETNA,AETNA,1917.50,,,,,,,1159.0300,4490.6400,percent of total billed charges,"42.7% of $4,490.64 in Billed Charges for Rev 272 = $1,917.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTIS BIPOLAR 6.0,272,RC,27200002,CDM,,,,,,both,,,4490.6400,673.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3143.45,,,,,,,1159.0300,4490.6400,percent of total billed charges,"Rev 272 $4,490.64 in Billed Charges at 70% = $3,143.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTIS BIPOLAR 6.0,272,RC,27200002,CDM,,,,,,both,,,4490.6400,673.6000,CIGNA HEALTHCARE,CIGNA HMO,1872.60,,,,,,,1159.0300,4490.6400,percent of total billed charges,"41.7% of $4,490.64 in Billed Charges for Rev 272 = $1,872.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTIS BIPOLAR 6.0,272,RC,27200002,CDM,,,,,,both,,,4490.6400,673.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2083.66,,,,,,,1159.0300,4490.6400,percent of total billed charges,"46.4% of $4,490.64 in Billed Charges for Rev 272 = $2,083.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTIS BIPOLAR 6.0,272,RC,27200002,CDM,,,,,,both,,,4490.6400,673.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1872.60,,,,,,,1159.0300,4490.6400,percent of total billed charges,"41.7% of $4,490.64 in Billed Charges for Rev 272 = $1,872.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTIS BIPOLAR 6.0,272,RC,27200002,CDM,,,,,,both,,,4490.6400,673.6000,CIGNA HEALTHCARE,CIGNA PPO,1872.60,,,,,,,1159.0300,4490.6400,percent of total billed charges,"41.7% of $4,490.64 in Billed Charges for Rev 272 = $1,872.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTIS BIPOLAR 6.0,272,RC,27200002,CDM,,,,,,both,,,4490.6400,673.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4041.58,,,,,,,1159.0300,4490.6400,percent of total billed charges,"90% of $4,490.64 in Billed Charges for Rev 272 = $4,041.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTIS BIPOLAR 6.0,272,RC,27200002,CDM,,,,,,both,,,4490.6400,673.6000,MEDCOST,MEDCOST VHN,2137.10,,,,,,,1159.0300,4490.6400,percent of total billed charges,"47.59% of $4,490.64 in Billed Charges for Rev 272 = $2,137.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTIS BIPOLAR 6.0,272,RC,27200002,CDM,,,,,,both,,,4490.6400,673.6000,SENTARA HEALTH,SENTARA HEALTH,1159.03,,,,,,,1159.0300,4490.6400,percent of total billed charges,"25.81% of $4,490.64 in Billed Charges for Rev 272 = $1,159.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTIS BIPOLAR 6.0,272,RC,27200002,CDM,,,,,,both,,,4490.6400,673.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4490.64,,,,,,,1159.0300,4490.6400,percent of total billed charges,"100% of $4,490.64 in Billed Charges for Rev 272 = $4,490.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTIS BIPOLAR 6.0,272,RC,27200002,CDM,,,,,,both,,,4490.6400,673.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2245.32,,,,,,,1159.0300,4490.6400,percent of total billed charges,"Rev 272 $4,490.64 in Billed Charges at 50% = $2,245.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTIS BIPOLAR 6.0,272,RC,27200002,CDM,,,,,,both,,,4490.6400,673.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1450.48,,,,,,,1159.0300,4490.6400,other,"32.3% of $4,490.64 in Billed Charges for Rev 272 = $1,450.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALER AQUAMANTIS BIPOLAR 6.0,272,RC,27200002,CDM,,,,,,both,,,4490.6400,673.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1378.63,,,,,,,1159.0300,4490.6400,other,"30.7% of $4,490.64 in Billed Charges for Rev 272 = $1,378.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALER AQUAMANTIS BIPOLAR 6.0,272,RC,27200002,CDM,,,,,,both,,,4490.6400,673.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,1450.48,,,,,,,1159.0300,4490.6400,percent of total billed charges,"32.3% of $4,490.64 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTIS BIPOLAR 6.0,272,RC,27200002,CDM,,,,,,both,,,4490.6400,673.6000,WELLCARE,WELLCARE MEDICAID,4490.64,,,,,,,1159.0300,4490.6400,percent of total billed charges,"100% of $4,490.64 in Billed Charges for Rev 272 = $4,490.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTYS BIPOLAR SBS 5.0 SHEATHED,272,RC,,,,,,,,both,,,6876.6000,1031.4900,AETNA,AETNA,2936.31,,,,,,,1774.8500,6876.6000,percent of total billed charges,"42.7% of $6,876.60 in Billed Charges for Rev 272 = $2,936.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTYS BIPOLAR SBS 5.0 SHEATHED,272,RC,,,,,,,,both,,,6876.6000,1031.4900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4813.62,,,,,,,1774.8500,6876.6000,percent of total billed charges,"Rev 272 $6,876.60 in Billed Charges at 70% = $4,813.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTYS BIPOLAR SBS 5.0 SHEATHED,272,RC,,,,,,,,both,,,6876.6000,1031.4900,CIGNA HEALTHCARE,CIGNA HMO,2867.54,,,,,,,1774.8500,6876.6000,percent of total billed charges,"41.7% of $6,876.60 in Billed Charges for Rev 272 = $2,867.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTYS BIPOLAR SBS 5.0 SHEATHED,272,RC,,,,,,,,both,,,6876.6000,1031.4900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3190.74,,,,,,,1774.8500,6876.6000,percent of total billed charges,"46.4% of $6,876.60 in Billed Charges for Rev 272 = $3,190.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTYS BIPOLAR SBS 5.0 SHEATHED,272,RC,,,,,,,,both,,,6876.6000,1031.4900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2867.54,,,,,,,1774.8500,6876.6000,percent of total billed charges,"41.7% of $6,876.60 in Billed Charges for Rev 272 = $2,867.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTYS BIPOLAR SBS 5.0 SHEATHED,272,RC,,,,,,,,both,,,6876.6000,1031.4900,CIGNA HEALTHCARE,CIGNA PPO,2867.54,,,,,,,1774.8500,6876.6000,percent of total billed charges,"41.7% of $6,876.60 in Billed Charges for Rev 272 = $2,867.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTYS BIPOLAR SBS 5.0 SHEATHED,272,RC,,,,,,,,both,,,6876.6000,1031.4900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6188.94,,,,,,,1774.8500,6876.6000,percent of total billed charges,"90% of $6,876.60 in Billed Charges for Rev 272 = $6,188.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTYS BIPOLAR SBS 5.0 SHEATHED,272,RC,,,,,,,,both,,,6876.6000,1031.4900,MEDCOST,MEDCOST VHN,3272.57,,,,,,,1774.8500,6876.6000,percent of total billed charges,"47.59% of $6,876.60 in Billed Charges for Rev 272 = $3,272.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTYS BIPOLAR SBS 5.0 SHEATHED,272,RC,,,,,,,,both,,,6876.6000,1031.4900,SENTARA HEALTH,SENTARA HEALTH,1774.85,,,,,,,1774.8500,6876.6000,percent of total billed charges,"25.81% of $6,876.60 in Billed Charges for Rev 272 = $1,774.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTYS BIPOLAR SBS 5.0 SHEATHED,272,RC,,,,,,,,both,,,6876.6000,1031.4900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6876.60,,,,,,,1774.8500,6876.6000,percent of total billed charges,"100% of $6,876.60 in Billed Charges for Rev 272 = $6,876.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTYS BIPOLAR SBS 5.0 SHEATHED,272,RC,,,,,,,,both,,,6876.6000,1031.4900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3438.30,,,,,,,1774.8500,6876.6000,percent of total billed charges,"Rev 272 $6,876.60 in Billed Charges at 50% = $3,438.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTYS BIPOLAR SBS 5.0 SHEATHED,272,RC,,,,,,,,both,,,6876.6000,1031.4900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2221.14,,,,,,,1774.8500,6876.6000,other,"32.3% of $6,876.60 in Billed Charges for Rev 272 = $2,221.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALER AQUAMANTYS BIPOLAR SBS 5.0 SHEATHED,272,RC,,,,,,,,both,,,6876.6000,1031.4900,UNITED HEALTHCARE,UHC HERITAGE SELECT,2111.12,,,,,,,1774.8500,6876.6000,other,"30.7% of $6,876.60 in Billed Charges for Rev 272 = $2,111.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALER AQUAMANTYS BIPOLAR SBS 5.0 SHEATHED,272,RC,,,,,,,,both,,,6876.6000,1031.4900,UNITED HEALTHCARE,UNITED HEALTHCARE,2221.14,,,,,,,1774.8500,6876.6000,percent of total billed charges,"32.3% of $6,876.60 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER AQUAMANTYS BIPOLAR SBS 5.0 SHEATHED,272,RC,,,,,,,,both,,,6876.6000,1031.4900,WELLCARE,WELLCARE MEDICAID,6876.60,,,,,,,1774.8500,6876.6000,percent of total billed charges,"100% of $6,876.60 in Billed Charges for Rev 272 = $6,876.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,5276.9400,791.5400,AETNA,AETNA,2253.25,,,,,,,1361.9800,5276.9400,percent of total billed charges,"42.7% of $5,276.94 in Billed Charges for Rev 272 = $2,253.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,5276.9400,791.5400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3693.86,,,,,,,1361.9800,5276.9400,percent of total billed charges,"Rev 272 $5,276.94 in Billed Charges at 70% = $3,693.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,5276.9400,791.5400,CIGNA HEALTHCARE,CIGNA HMO,2200.48,,,,,,,1361.9800,5276.9400,percent of total billed charges,"41.7% of $5,276.94 in Billed Charges for Rev 272 = $2,200.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,5276.9400,791.5400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2448.50,,,,,,,1361.9800,5276.9400,percent of total billed charges,"46.4% of $5,276.94 in Billed Charges for Rev 272 = $2,448.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,5276.9400,791.5400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2200.48,,,,,,,1361.9800,5276.9400,percent of total billed charges,"41.7% of $5,276.94 in Billed Charges for Rev 272 = $2,200.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,5276.9400,791.5400,CIGNA HEALTHCARE,CIGNA PPO,2200.48,,,,,,,1361.9800,5276.9400,percent of total billed charges,"41.7% of $5,276.94 in Billed Charges for Rev 272 = $2,200.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,5276.9400,791.5400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4749.25,,,,,,,1361.9800,5276.9400,percent of total billed charges,"90% of $5,276.94 in Billed Charges for Rev 272 = $4,749.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,5276.9400,791.5400,MEDCOST,MEDCOST VHN,2511.30,,,,,,,1361.9800,5276.9400,percent of total billed charges,"47.59% of $5,276.94 in Billed Charges for Rev 272 = $2,511.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,5276.9400,791.5400,SENTARA HEALTH,SENTARA HEALTH,1361.98,,,,,,,1361.9800,5276.9400,percent of total billed charges,"25.81% of $5,276.94 in Billed Charges for Rev 272 = $1,361.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,5276.9400,791.5400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5276.94,,,,,,,1361.9800,5276.9400,percent of total billed charges,"100% of $5,276.94 in Billed Charges for Rev 272 = $5,276.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,5276.9400,791.5400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2638.47,,,,,,,1361.9800,5276.9400,percent of total billed charges,"Rev 272 $5,276.94 in Billed Charges at 50% = $2,638.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,5276.9400,791.5400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1704.45,,,,,,,1361.9800,5276.9400,other,"32.3% of $5,276.94 in Billed Charges for Rev 272 = $1,704.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,5276.9400,791.5400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1620.02,,,,,,,1361.9800,5276.9400,other,"30.7% of $5,276.94 in Billed Charges for Rev 272 = $1,620.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,5276.9400,791.5400,UNITED HEALTHCARE,UNITED HEALTHCARE,1704.45,,,,,,,1361.9800,5276.9400,percent of total billed charges,"32.3% of $5,276.94 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL 5MMX35CM,272,RC,27200002,CDM,,,,,,both,,,5276.9400,791.5400,WELLCARE,WELLCARE MEDICAID,5276.94,,,,,,,1361.9800,5276.9400,percent of total billed charges,"100% of $5,276.94 in Billed Charges for Rev 272 = $5,276.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAD ABTHERA W/SENSATRAC ULTA,272,RC,27200002,CDM,,,,,,both,,,4910.8800,736.6300,AETNA,AETNA,2096.95,,,,,,,1267.5000,4910.8800,percent of total billed charges,"42.7% of $4,910.88 in Billed Charges for Rev 272 = $2,096.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAD ABTHERA W/SENSATRAC ULTA,272,RC,27200002,CDM,,,,,,both,,,4910.8800,736.6300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3437.62,,,,,,,1267.5000,4910.8800,percent of total billed charges,"Rev 272 $4,910.88 in Billed Charges at 70% = $3,437.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAD ABTHERA W/SENSATRAC ULTA,272,RC,27200002,CDM,,,,,,both,,,4910.8800,736.6300,CIGNA HEALTHCARE,CIGNA HMO,2047.84,,,,,,,1267.5000,4910.8800,percent of total billed charges,"41.7% of $4,910.88 in Billed Charges for Rev 272 = $2,047.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAD ABTHERA W/SENSATRAC ULTA,272,RC,27200002,CDM,,,,,,both,,,4910.8800,736.6300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2278.65,,,,,,,1267.5000,4910.8800,percent of total billed charges,"46.4% of $4,910.88 in Billed Charges for Rev 272 = $2,278.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAD ABTHERA W/SENSATRAC ULTA,272,RC,27200002,CDM,,,,,,both,,,4910.8800,736.6300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2047.84,,,,,,,1267.5000,4910.8800,percent of total billed charges,"41.7% of $4,910.88 in Billed Charges for Rev 272 = $2,047.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAD ABTHERA W/SENSATRAC ULTA,272,RC,27200002,CDM,,,,,,both,,,4910.8800,736.6300,CIGNA HEALTHCARE,CIGNA PPO,2047.84,,,,,,,1267.5000,4910.8800,percent of total billed charges,"41.7% of $4,910.88 in Billed Charges for Rev 272 = $2,047.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAD ABTHERA W/SENSATRAC ULTA,272,RC,27200002,CDM,,,,,,both,,,4910.8800,736.6300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4419.79,,,,,,,1267.5000,4910.8800,percent of total billed charges,"90% of $4,910.88 in Billed Charges for Rev 272 = $4,419.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAD ABTHERA W/SENSATRAC ULTA,272,RC,27200002,CDM,,,,,,both,,,4910.8800,736.6300,MEDCOST,MEDCOST VHN,2337.09,,,,,,,1267.5000,4910.8800,percent of total billed charges,"47.59% of $4,910.88 in Billed Charges for Rev 272 = $2,337.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAD ABTHERA W/SENSATRAC ULTA,272,RC,27200002,CDM,,,,,,both,,,4910.8800,736.6300,SENTARA HEALTH,SENTARA HEALTH,1267.50,,,,,,,1267.5000,4910.8800,percent of total billed charges,"25.81% of $4,910.88 in Billed Charges for Rev 272 = $1,267.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAD ABTHERA W/SENSATRAC ULTA,272,RC,27200002,CDM,,,,,,both,,,4910.8800,736.6300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4910.88,,,,,,,1267.5000,4910.8800,percent of total billed charges,"100% of $4,910.88 in Billed Charges for Rev 272 = $4,910.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAD ABTHERA W/SENSATRAC ULTA,272,RC,27200002,CDM,,,,,,both,,,4910.8800,736.6300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2455.44,,,,,,,1267.5000,4910.8800,percent of total billed charges,"Rev 272 $4,910.88 in Billed Charges at 50% = $2,455.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAD ABTHERA W/SENSATRAC ULTA,272,RC,27200002,CDM,,,,,,both,,,4910.8800,736.6300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1586.21,,,,,,,1267.5000,4910.8800,other,"32.3% of $4,910.88 in Billed Charges for Rev 272 = $1,586.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PAD ABTHERA W/SENSATRAC ULTA,272,RC,27200002,CDM,,,,,,both,,,4910.8800,736.6300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1507.64,,,,,,,1267.5000,4910.8800,other,"30.7% of $4,910.88 in Billed Charges for Rev 272 = $1,507.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PAD ABTHERA W/SENSATRAC ULTA,272,RC,27200002,CDM,,,,,,both,,,4910.8800,736.6300,UNITED HEALTHCARE,UNITED HEALTHCARE,1586.21,,,,,,,1267.5000,4910.8800,percent of total billed charges,"32.3% of $4,910.88 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAD ABTHERA W/SENSATRAC ULTA,272,RC,27200002,CDM,,,,,,both,,,4910.8800,736.6300,WELLCARE,WELLCARE MEDICAID,4910.88,,,,,,,1267.5000,4910.8800,percent of total billed charges,"100% of $4,910.88 in Billed Charges for Rev 272 = $4,910.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAD GEL DISTRACTOR W/ WRAP STL,272,RC,27200002,CDM,,,,,,both,,,620.1900,93.0300,AETNA,AETNA,264.82,,,,,,,160.0700,620.1900,percent of total billed charges,42.7% of $620.19 in Billed Charges for Rev 272 = $264.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD GEL DISTRACTOR W/ WRAP STL,272,RC,27200002,CDM,,,,,,both,,,620.1900,93.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,434.13,,,,,,,160.0700,620.1900,percent of total billed charges,Rev 272 $620.19 in Billed Charges at 70% = $434.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD GEL DISTRACTOR W/ WRAP STL,272,RC,27200002,CDM,,,,,,both,,,620.1900,93.0300,CIGNA HEALTHCARE,CIGNA HMO,258.62,,,,,,,160.0700,620.1900,percent of total billed charges,41.7% of $620.19 in Billed Charges for Rev 272 = $258.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD GEL DISTRACTOR W/ WRAP STL,272,RC,27200002,CDM,,,,,,both,,,620.1900,93.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,287.77,,,,,,,160.0700,620.1900,percent of total billed charges,46.4% of $620.19 in Billed Charges for Rev 272 = $287.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD GEL DISTRACTOR W/ WRAP STL,272,RC,27200002,CDM,,,,,,both,,,620.1900,93.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,258.62,,,,,,,160.0700,620.1900,percent of total billed charges,41.7% of $620.19 in Billed Charges for Rev 272 = $258.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD GEL DISTRACTOR W/ WRAP STL,272,RC,27200002,CDM,,,,,,both,,,620.1900,93.0300,CIGNA HEALTHCARE,CIGNA PPO,258.62,,,,,,,160.0700,620.1900,percent of total billed charges,41.7% of $620.19 in Billed Charges for Rev 272 = $258.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD GEL DISTRACTOR W/ WRAP STL,272,RC,27200002,CDM,,,,,,both,,,620.1900,93.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,558.17,,,,,,,160.0700,620.1900,percent of total billed charges,90% of $620.19 in Billed Charges for Rev 272 = $558.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD GEL DISTRACTOR W/ WRAP STL,272,RC,27200002,CDM,,,,,,both,,,620.1900,93.0300,MEDCOST,MEDCOST VHN,295.15,,,,,,,160.0700,620.1900,percent of total billed charges,47.59% of $620.19 in Billed Charges for Rev 272 = $295.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD GEL DISTRACTOR W/ WRAP STL,272,RC,27200002,CDM,,,,,,both,,,620.1900,93.0300,SENTARA HEALTH,SENTARA HEALTH,160.07,,,,,,,160.0700,620.1900,percent of total billed charges,25.81% of $620.19 in Billed Charges for Rev 272 = $160.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD GEL DISTRACTOR W/ WRAP STL,272,RC,27200002,CDM,,,,,,both,,,620.1900,93.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",620.19,,,,,,,160.0700,620.1900,percent of total billed charges,100% of $620.19 in Billed Charges for Rev 272 = $620.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD GEL DISTRACTOR W/ WRAP STL,272,RC,27200002,CDM,,,,,,both,,,620.1900,93.0300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,310.10,,,,,,,160.0700,620.1900,percent of total billed charges,Rev 272 $620.19 in Billed Charges at 50% = $310.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD GEL DISTRACTOR W/ WRAP STL,272,RC,27200002,CDM,,,,,,both,,,620.1900,93.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,200.32,,,,,,,160.0700,620.1900,other,32.3% of $620.19 in Billed Charges for Rev 272 = $200.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PAD GEL DISTRACTOR W/ WRAP STL,272,RC,27200002,CDM,,,,,,both,,,620.1900,93.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,190.40,,,,,,,160.0700,620.1900,other,30.7% of $620.19 in Billed Charges for Rev 272 = $190.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PAD GEL DISTRACTOR W/ WRAP STL,272,RC,27200002,CDM,,,,,,both,,,620.1900,93.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,200.32,,,,,,,160.0700,620.1900,percent of total billed charges,32.3% of $620.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD GEL DISTRACTOR W/ WRAP STL,272,RC,27200002,CDM,,,,,,both,,,620.1900,93.0300,WELLCARE,WELLCARE MEDICAID,620.19,,,,,,,160.0700,620.1900,percent of total billed charges,100% of $620.19 in Billed Charges for Rev 272 = $620.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD TRAC VAC,270,RC,,,,,,,,both,,,933.3900,140.0100,AETNA,AETNA,398.56,,,,,,,240.9100,933.3900,percent of total billed charges,42.7% of $933.39 in Billed Charges for Rev 270 = $398.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD TRAC VAC,270,RC,,,,,,,,both,,,933.3900,140.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,653.37,,,,,,,240.9100,933.3900,percent of total billed charges,Rev 270 $933.39 in Billed Charges at 70% = $653.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD TRAC VAC,270,RC,,,,,,,,both,,,933.3900,140.0100,CIGNA HEALTHCARE,CIGNA HMO,389.22,,,,,,,240.9100,933.3900,percent of total billed charges,41.7% of $933.39 in Billed Charges for Rev 270 = $389.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD TRAC VAC,270,RC,,,,,,,,both,,,933.3900,140.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,433.09,,,,,,,240.9100,933.3900,percent of total billed charges,46.4% of $933.39 in Billed Charges for Rev 270 = $433.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD TRAC VAC,270,RC,,,,,,,,both,,,933.3900,140.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,389.22,,,,,,,240.9100,933.3900,percent of total billed charges,41.7% of $933.39 in Billed Charges for Rev 270 = $389.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD TRAC VAC,270,RC,,,,,,,,both,,,933.3900,140.0100,CIGNA HEALTHCARE,CIGNA PPO,389.22,,,,,,,240.9100,933.3900,percent of total billed charges,41.7% of $933.39 in Billed Charges for Rev 270 = $389.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD TRAC VAC,270,RC,,,,,,,,both,,,933.3900,140.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,840.05,,,,,,,240.9100,933.3900,percent of total billed charges,90% of $933.39 in Billed Charges for Rev 270 = $840.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD TRAC VAC,270,RC,,,,,,,,both,,,933.3900,140.0100,MEDCOST,MEDCOST VHN,444.20,,,,,,,240.9100,933.3900,percent of total billed charges,47.59% of $933.39 in Billed Charges for Rev 270 = $444.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD TRAC VAC,270,RC,,,,,,,,both,,,933.3900,140.0100,SENTARA HEALTH,SENTARA HEALTH,240.91,,,,,,,240.9100,933.3900,percent of total billed charges,25.81% of $933.39 in Billed Charges for Rev 270 = $240.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD TRAC VAC,270,RC,,,,,,,,both,,,933.3900,140.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",933.39,,,,,,,240.9100,933.3900,percent of total billed charges,100% of $933.39 in Billed Charges for Rev 270 = $933.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD TRAC VAC,270,RC,,,,,,,,both,,,933.3900,140.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,466.70,,,,,,,240.9100,933.3900,percent of total billed charges,Rev 270 $933.39 in Billed Charges at 50% = $466.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD TRAC VAC,270,RC,,,,,,,,both,,,933.3900,140.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,301.49,,,,,,,240.9100,933.3900,other,32.3% of $933.39 in Billed Charges for Rev 270 = $301.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PAD TRAC VAC,270,RC,,,,,,,,both,,,933.3900,140.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,286.55,,,,,,,240.9100,933.3900,other,30.7% of $933.39 in Billed Charges for Rev 270 = $286.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PAD TRAC VAC,270,RC,,,,,,,,both,,,933.3900,140.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,301.49,,,,,,,240.9100,933.3900,percent of total billed charges,32.3% of $933.39 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAD TRAC VAC,270,RC,,,,,,,,both,,,933.3900,140.0100,WELLCARE,WELLCARE MEDICAID,933.39,,,,,,,240.9100,933.3900,percent of total billed charges,100% of $933.39 in Billed Charges for Rev 270 = $933.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SEALER TISSUE ENSEAL G2 14CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4323.4300,648.5100,AETNA,AETNA,1846.10,,,,,,,1115.8800,4323.4300,percent of total billed charges,"42.7% of $4,323.43 in Billed Charges for Rev 272 = $1,846.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 14CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4323.4300,648.5100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3026.40,,,,,,,1115.8800,4323.4300,percent of total billed charges,"Rev 272 $4,323.43 in Billed Charges at 70% = $3,026.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 14CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4323.4300,648.5100,CIGNA HEALTHCARE,CIGNA HMO,1802.87,,,,,,,1115.8800,4323.4300,percent of total billed charges,"41.7% of $4,323.43 in Billed Charges for Rev 272 = $1,802.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 14CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4323.4300,648.5100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2006.07,,,,,,,1115.8800,4323.4300,percent of total billed charges,"46.4% of $4,323.43 in Billed Charges for Rev 272 = $2,006.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 14CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4323.4300,648.5100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1802.87,,,,,,,1115.8800,4323.4300,percent of total billed charges,"41.7% of $4,323.43 in Billed Charges for Rev 272 = $1,802.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 14CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4323.4300,648.5100,CIGNA HEALTHCARE,CIGNA PPO,1802.87,,,,,,,1115.8800,4323.4300,percent of total billed charges,"41.7% of $4,323.43 in Billed Charges for Rev 272 = $1,802.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 14CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4323.4300,648.5100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3891.09,,,,,,,1115.8800,4323.4300,percent of total billed charges,"90% of $4,323.43 in Billed Charges for Rev 272 = $3,891.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 14CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4323.4300,648.5100,MEDCOST,MEDCOST VHN,2057.52,,,,,,,1115.8800,4323.4300,percent of total billed charges,"47.59% of $4,323.43 in Billed Charges for Rev 272 = $2,057.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 14CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4323.4300,648.5100,SENTARA HEALTH,SENTARA HEALTH,1115.88,,,,,,,1115.8800,4323.4300,percent of total billed charges,"25.81% of $4,323.43 in Billed Charges for Rev 272 = $1,115.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 14CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4323.4300,648.5100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4323.43,,,,,,,1115.8800,4323.4300,percent of total billed charges,"100% of $4,323.43 in Billed Charges for Rev 272 = $4,323.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 14CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4323.4300,648.5100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2161.72,,,,,,,1115.8800,4323.4300,percent of total billed charges,"Rev 272 $4,323.43 in Billed Charges at 50% = $2,161.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 14CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4323.4300,648.5100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1396.47,,,,,,,1115.8800,4323.4300,other,"32.3% of $4,323.43 in Billed Charges for Rev 272 = $1,396.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALER TISSUE ENSEAL G2 14CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4323.4300,648.5100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1327.29,,,,,,,1115.8800,4323.4300,other,"30.7% of $4,323.43 in Billed Charges for Rev 272 = $1,327.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALER TISSUE ENSEAL G2 14CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4323.4300,648.5100,UNITED HEALTHCARE,UNITED HEALTHCARE,1396.47,,,,,,,1115.8800,4323.4300,percent of total billed charges,"32.3% of $4,323.43 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER TISSUE ENSEAL G2 14CM CURVED,272,RC,27200002,CDM,,,,,,both,,,4323.4300,648.5100,WELLCARE,WELLCARE MEDICAID,4323.43,,,,,,,1115.8800,4323.4300,percent of total billed charges,"100% of $4,323.43 in Billed Charges for Rev 272 = $4,323.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER VESSEL ENDOWRIST,272,RC,27200002,CDM,,,,,,both,,,6480.1500,972.0200,AETNA,AETNA,2767.02,,,,,,,1672.5300,6480.1500,percent of total billed charges,"42.7% of $6,480.15 in Billed Charges for Rev 272 = $2,767.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER VESSEL ENDOWRIST,272,RC,27200002,CDM,,,,,,both,,,6480.1500,972.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4536.11,,,,,,,1672.5300,6480.1500,percent of total billed charges,"Rev 272 $6,480.15 in Billed Charges at 70% = $4,536.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER VESSEL ENDOWRIST,272,RC,27200002,CDM,,,,,,both,,,6480.1500,972.0200,CIGNA HEALTHCARE,CIGNA HMO,2702.22,,,,,,,1672.5300,6480.1500,percent of total billed charges,"41.7% of $6,480.15 in Billed Charges for Rev 272 = $2,702.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER VESSEL ENDOWRIST,272,RC,27200002,CDM,,,,,,both,,,6480.1500,972.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3006.79,,,,,,,1672.5300,6480.1500,percent of total billed charges,"46.4% of $6,480.15 in Billed Charges for Rev 272 = $3,006.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER VESSEL ENDOWRIST,272,RC,27200002,CDM,,,,,,both,,,6480.1500,972.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2702.22,,,,,,,1672.5300,6480.1500,percent of total billed charges,"41.7% of $6,480.15 in Billed Charges for Rev 272 = $2,702.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER VESSEL ENDOWRIST,272,RC,27200002,CDM,,,,,,both,,,6480.1500,972.0200,CIGNA HEALTHCARE,CIGNA PPO,2702.22,,,,,,,1672.5300,6480.1500,percent of total billed charges,"41.7% of $6,480.15 in Billed Charges for Rev 272 = $2,702.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER VESSEL ENDOWRIST,272,RC,27200002,CDM,,,,,,both,,,6480.1500,972.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5832.14,,,,,,,1672.5300,6480.1500,percent of total billed charges,"90% of $6,480.15 in Billed Charges for Rev 272 = $5,832.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER VESSEL ENDOWRIST,272,RC,27200002,CDM,,,,,,both,,,6480.1500,972.0200,MEDCOST,MEDCOST VHN,3083.90,,,,,,,1672.5300,6480.1500,percent of total billed charges,"47.59% of $6,480.15 in Billed Charges for Rev 272 = $3,083.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER VESSEL ENDOWRIST,272,RC,27200002,CDM,,,,,,both,,,6480.1500,972.0200,SENTARA HEALTH,SENTARA HEALTH,1672.53,,,,,,,1672.5300,6480.1500,percent of total billed charges,"25.81% of $6,480.15 in Billed Charges for Rev 272 = $1,672.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER VESSEL ENDOWRIST,272,RC,27200002,CDM,,,,,,both,,,6480.1500,972.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6480.15,,,,,,,1672.5300,6480.1500,percent of total billed charges,"100% of $6,480.15 in Billed Charges for Rev 272 = $6,480.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER VESSEL ENDOWRIST,272,RC,27200002,CDM,,,,,,both,,,6480.1500,972.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3240.08,,,,,,,1672.5300,6480.1500,percent of total billed charges,"Rev 272 $6,480.15 in Billed Charges at 50% = $3,240.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER VESSEL ENDOWRIST,272,RC,27200002,CDM,,,,,,both,,,6480.1500,972.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2093.09,,,,,,,1672.5300,6480.1500,other,"32.3% of $6,480.15 in Billed Charges for Rev 272 = $2,093.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALER VESSEL ENDOWRIST,272,RC,27200002,CDM,,,,,,both,,,6480.1500,972.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1989.41,,,,,,,1672.5300,6480.1500,other,"30.7% of $6,480.15 in Billed Charges for Rev 272 = $1,989.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALER VESSEL ENDOWRIST,272,RC,27200002,CDM,,,,,,both,,,6480.1500,972.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,2093.09,,,,,,,1672.5300,6480.1500,percent of total billed charges,"32.3% of $6,480.15 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER VESSEL ENDOWRIST,272,RC,27200002,CDM,,,,,,both,,,6480.1500,972.0200,WELLCARE,WELLCARE MEDICAID,6480.15,,,,,,,1672.5300,6480.1500,percent of total billed charges,"100% of $6,480.15 in Billed Charges for Rev 272 = $6,480.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER XI VESSEL EXTEND,272,RC,27200002,CDM,,,,,,both,,,6806.8300,1021.0200,AETNA,AETNA,2906.52,,,,,,,1756.8400,6806.8300,percent of total billed charges,"42.7% of $6,806.83 in Billed Charges for Rev 272 = $2,906.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER XI VESSEL EXTEND,272,RC,27200002,CDM,,,,,,both,,,6806.8300,1021.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4764.78,,,,,,,1756.8400,6806.8300,percent of total billed charges,"Rev 272 $6,806.83 in Billed Charges at 70% = $4,764.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER XI VESSEL EXTEND,272,RC,27200002,CDM,,,,,,both,,,6806.8300,1021.0200,CIGNA HEALTHCARE,CIGNA HMO,2838.45,,,,,,,1756.8400,6806.8300,percent of total billed charges,"41.7% of $6,806.83 in Billed Charges for Rev 272 = $2,838.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER XI VESSEL EXTEND,272,RC,27200002,CDM,,,,,,both,,,6806.8300,1021.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3158.37,,,,,,,1756.8400,6806.8300,percent of total billed charges,"46.4% of $6,806.83 in Billed Charges for Rev 272 = $3,158.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER XI VESSEL EXTEND,272,RC,27200002,CDM,,,,,,both,,,6806.8300,1021.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2838.45,,,,,,,1756.8400,6806.8300,percent of total billed charges,"41.7% of $6,806.83 in Billed Charges for Rev 272 = $2,838.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER XI VESSEL EXTEND,272,RC,27200002,CDM,,,,,,both,,,6806.8300,1021.0200,CIGNA HEALTHCARE,CIGNA PPO,2838.45,,,,,,,1756.8400,6806.8300,percent of total billed charges,"41.7% of $6,806.83 in Billed Charges for Rev 272 = $2,838.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER XI VESSEL EXTEND,272,RC,27200002,CDM,,,,,,both,,,6806.8300,1021.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6126.15,,,,,,,1756.8400,6806.8300,percent of total billed charges,"90% of $6,806.83 in Billed Charges for Rev 272 = $6,126.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER XI VESSEL EXTEND,272,RC,27200002,CDM,,,,,,both,,,6806.8300,1021.0200,MEDCOST,MEDCOST VHN,3239.37,,,,,,,1756.8400,6806.8300,percent of total billed charges,"47.59% of $6,806.83 in Billed Charges for Rev 272 = $3,239.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER XI VESSEL EXTEND,272,RC,27200002,CDM,,,,,,both,,,6806.8300,1021.0200,SENTARA HEALTH,SENTARA HEALTH,1756.84,,,,,,,1756.8400,6806.8300,percent of total billed charges,"25.81% of $6,806.83 in Billed Charges for Rev 272 = $1,756.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER XI VESSEL EXTEND,272,RC,27200002,CDM,,,,,,both,,,6806.8300,1021.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6806.83,,,,,,,1756.8400,6806.8300,percent of total billed charges,"100% of $6,806.83 in Billed Charges for Rev 272 = $6,806.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER XI VESSEL EXTEND,272,RC,27200002,CDM,,,,,,both,,,6806.8300,1021.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3403.42,,,,,,,1756.8400,6806.8300,percent of total billed charges,"Rev 272 $6,806.83 in Billed Charges at 50% = $3,403.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER XI VESSEL EXTEND,272,RC,27200002,CDM,,,,,,both,,,6806.8300,1021.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2198.61,,,,,,,1756.8400,6806.8300,other,"32.3% of $6,806.83 in Billed Charges for Rev 272 = $2,198.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALER XI VESSEL EXTEND,272,RC,27200002,CDM,,,,,,both,,,6806.8300,1021.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,2089.70,,,,,,,1756.8400,6806.8300,other,"30.7% of $6,806.83 in Billed Charges for Rev 272 = $2,089.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALER XI VESSEL EXTEND,272,RC,27200002,CDM,,,,,,both,,,6806.8300,1021.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,2198.61,,,,,,,1756.8400,6806.8300,percent of total billed charges,"32.3% of $6,806.83 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALER XI VESSEL EXTEND,272,RC,27200002,CDM,,,,,,both,,,6806.8300,1021.0200,WELLCARE,WELLCARE MEDICAID,6806.83,,,,,,,1756.8400,6806.8300,percent of total billed charges,"100% of $6,806.83 in Billed Charges for Rev 272 = $6,806.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MAMMOTOME ST 8 GA,272,RC,27200002,CDM,,,,,,both,,,3474.1200,521.1200,AETNA,AETNA,1483.45,,,,,,,896.6700,3474.1200,percent of total billed charges,"42.7% of $3,474.12 in Billed Charges for Rev 272 = $1,483.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MAMMOTOME ST 8 GA,272,RC,27200002,CDM,,,,,,both,,,3474.1200,521.1200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2431.88,,,,,,,896.6700,3474.1200,percent of total billed charges,"Rev 272 $3,474.12 in Billed Charges at 70% = $2,431.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MAMMOTOME ST 8 GA,272,RC,27200002,CDM,,,,,,both,,,3474.1200,521.1200,CIGNA HEALTHCARE,CIGNA HMO,1448.71,,,,,,,896.6700,3474.1200,percent of total billed charges,"41.7% of $3,474.12 in Billed Charges for Rev 272 = $1,448.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MAMMOTOME ST 8 GA,272,RC,27200002,CDM,,,,,,both,,,3474.1200,521.1200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1611.99,,,,,,,896.6700,3474.1200,percent of total billed charges,"46.4% of $3,474.12 in Billed Charges for Rev 272 = $1,611.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MAMMOTOME ST 8 GA,272,RC,27200002,CDM,,,,,,both,,,3474.1200,521.1200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1448.71,,,,,,,896.6700,3474.1200,percent of total billed charges,"41.7% of $3,474.12 in Billed Charges for Rev 272 = $1,448.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MAMMOTOME ST 8 GA,272,RC,27200002,CDM,,,,,,both,,,3474.1200,521.1200,CIGNA HEALTHCARE,CIGNA PPO,1448.71,,,,,,,896.6700,3474.1200,percent of total billed charges,"41.7% of $3,474.12 in Billed Charges for Rev 272 = $1,448.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MAMMOTOME ST 8 GA,272,RC,27200002,CDM,,,,,,both,,,3474.1200,521.1200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3126.71,,,,,,,896.6700,3474.1200,percent of total billed charges,"90% of $3,474.12 in Billed Charges for Rev 272 = $3,126.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MAMMOTOME ST 8 GA,272,RC,27200002,CDM,,,,,,both,,,3474.1200,521.1200,MEDCOST,MEDCOST VHN,1653.33,,,,,,,896.6700,3474.1200,percent of total billed charges,"47.59% of $3,474.12 in Billed Charges for Rev 272 = $1,653.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MAMMOTOME ST 8 GA,272,RC,27200002,CDM,,,,,,both,,,3474.1200,521.1200,SENTARA HEALTH,SENTARA HEALTH,896.67,,,,,,,896.6700,3474.1200,percent of total billed charges,"25.81% of $3,474.12 in Billed Charges for Rev 272 = $896.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MAMMOTOME ST 8 GA,272,RC,27200002,CDM,,,,,,both,,,3474.1200,521.1200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3474.12,,,,,,,896.6700,3474.1200,percent of total billed charges,"100% of $3,474.12 in Billed Charges for Rev 272 = $3,474.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MAMMOTOME ST 8 GA,272,RC,27200002,CDM,,,,,,both,,,3474.1200,521.1200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1737.06,,,,,,,896.6700,3474.1200,percent of total billed charges,"Rev 272 $3,474.12 in Billed Charges at 50% = $1,737.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MAMMOTOME ST 8 GA,272,RC,27200002,CDM,,,,,,both,,,3474.1200,521.1200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1122.14,,,,,,,896.6700,3474.1200,other,"32.3% of $3,474.12 in Billed Charges for Rev 272 = $1,122.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE MAMMOTOME ST 8 GA,272,RC,27200002,CDM,,,,,,both,,,3474.1200,521.1200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1066.55,,,,,,,896.6700,3474.1200,other,"30.7% of $3,474.12 in Billed Charges for Rev 272 = $1,066.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE MAMMOTOME ST 8 GA,272,RC,27200002,CDM,,,,,,both,,,3474.1200,521.1200,UNITED HEALTHCARE,UNITED HEALTHCARE,1122.14,,,,,,,896.6700,3474.1200,percent of total billed charges,"32.3% of $3,474.12 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MAMMOTOME ST 8 GA,272,RC,27200002,CDM,,,,,,both,,,3474.1200,521.1200,WELLCARE,WELLCARE MEDICAID,3474.12,,,,,,,896.6700,3474.1200,percent of total billed charges,"100% of $3,474.12 in Billed Charges for Rev 272 = $3,474.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MATOME STEROTACTIC 11GA,272,RC,,,,,,,,both,,,2732.5500,409.8800,AETNA,AETNA,1166.80,,,,,,,705.2700,2732.5500,percent of total billed charges,"42.7% of $2,732.55 in Billed Charges for Rev 272 = $1,166.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MATOME STEROTACTIC 11GA,272,RC,,,,,,,,both,,,2732.5500,409.8800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1912.79,,,,,,,705.2700,2732.5500,percent of total billed charges,"Rev 272 $2,732.55 in Billed Charges at 70% = $1,912.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MATOME STEROTACTIC 11GA,272,RC,,,,,,,,both,,,2732.5500,409.8800,CIGNA HEALTHCARE,CIGNA HMO,1139.47,,,,,,,705.2700,2732.5500,percent of total billed charges,"41.7% of $2,732.55 in Billed Charges for Rev 272 = $1,139.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MATOME STEROTACTIC 11GA,272,RC,,,,,,,,both,,,2732.5500,409.8800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1267.90,,,,,,,705.2700,2732.5500,percent of total billed charges,"46.4% of $2,732.55 in Billed Charges for Rev 272 = $1,267.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MATOME STEROTACTIC 11GA,272,RC,,,,,,,,both,,,2732.5500,409.8800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1139.47,,,,,,,705.2700,2732.5500,percent of total billed charges,"41.7% of $2,732.55 in Billed Charges for Rev 272 = $1,139.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MATOME STEROTACTIC 11GA,272,RC,,,,,,,,both,,,2732.5500,409.8800,CIGNA HEALTHCARE,CIGNA PPO,1139.47,,,,,,,705.2700,2732.5500,percent of total billed charges,"41.7% of $2,732.55 in Billed Charges for Rev 272 = $1,139.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MATOME STEROTACTIC 11GA,272,RC,,,,,,,,both,,,2732.5500,409.8800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2459.30,,,,,,,705.2700,2732.5500,percent of total billed charges,"90% of $2,732.55 in Billed Charges for Rev 272 = $2,459.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MATOME STEROTACTIC 11GA,272,RC,,,,,,,,both,,,2732.5500,409.8800,MEDCOST,MEDCOST VHN,1300.42,,,,,,,705.2700,2732.5500,percent of total billed charges,"47.59% of $2,732.55 in Billed Charges for Rev 272 = $1,300.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MATOME STEROTACTIC 11GA,272,RC,,,,,,,,both,,,2732.5500,409.8800,SENTARA HEALTH,SENTARA HEALTH,705.27,,,,,,,705.2700,2732.5500,percent of total billed charges,"25.81% of $2,732.55 in Billed Charges for Rev 272 = $705.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MATOME STEROTACTIC 11GA,272,RC,,,,,,,,both,,,2732.5500,409.8800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2732.55,,,,,,,705.2700,2732.5500,percent of total billed charges,"100% of $2,732.55 in Billed Charges for Rev 272 = $2,732.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MATOME STEROTACTIC 11GA,272,RC,,,,,,,,both,,,2732.5500,409.8800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1366.28,,,,,,,705.2700,2732.5500,percent of total billed charges,"Rev 272 $2,732.55 in Billed Charges at 50% = $1,366.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MATOME STEROTACTIC 11GA,272,RC,,,,,,,,both,,,2732.5500,409.8800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,882.61,,,,,,,705.2700,2732.5500,other,"32.3% of $2,732.55 in Billed Charges for Rev 272 = $882.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE MATOME STEROTACTIC 11GA,272,RC,,,,,,,,both,,,2732.5500,409.8800,UNITED HEALTHCARE,UHC HERITAGE SELECT,838.89,,,,,,,705.2700,2732.5500,other,"30.7% of $2,732.55 in Billed Charges for Rev 272 = $838.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE MATOME STEROTACTIC 11GA,272,RC,,,,,,,,both,,,2732.5500,409.8800,UNITED HEALTHCARE,UNITED HEALTHCARE,882.61,,,,,,,705.2700,2732.5500,percent of total billed charges,"32.3% of $2,732.55 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE MATOME STEROTACTIC 11GA,272,RC,,,,,,,,both,,,2732.5500,409.8800,WELLCARE,WELLCARE MEDICAID,2732.55,,,,,,,705.2700,2732.5500,percent of total billed charges,"100% of $2,732.55 in Billed Charges for Rev 272 = $2,732.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE PLUS II HOOK 5MM X 34CM,272,RC,,,,,,,,both,,,164.2100,24.6300,AETNA,AETNA,70.12,,,,,,,42.3800,164.2100,percent of total billed charges,42.7% of $164.21 in Billed Charges for Rev 272 = $70.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE PLUS II HOOK 5MM X 34CM,272,RC,,,,,,,,both,,,164.2100,24.6300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,114.95,,,,,,,42.3800,164.2100,percent of total billed charges,Rev 272 $164.21 in Billed Charges at 70% = $114.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE PLUS II HOOK 5MM X 34CM,272,RC,,,,,,,,both,,,164.2100,24.6300,CIGNA HEALTHCARE,CIGNA HMO,68.48,,,,,,,42.3800,164.2100,percent of total billed charges,41.7% of $164.21 in Billed Charges for Rev 272 = $68.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE PLUS II HOOK 5MM X 34CM,272,RC,,,,,,,,both,,,164.2100,24.6300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,76.19,,,,,,,42.3800,164.2100,percent of total billed charges,46.4% of $164.21 in Billed Charges for Rev 272 = $76.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE PLUS II HOOK 5MM X 34CM,272,RC,,,,,,,,both,,,164.2100,24.6300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,68.48,,,,,,,42.3800,164.2100,percent of total billed charges,41.7% of $164.21 in Billed Charges for Rev 272 = $68.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE PLUS II HOOK 5MM X 34CM,272,RC,,,,,,,,both,,,164.2100,24.6300,CIGNA HEALTHCARE,CIGNA PPO,68.48,,,,,,,42.3800,164.2100,percent of total billed charges,41.7% of $164.21 in Billed Charges for Rev 272 = $68.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE PLUS II HOOK 5MM X 34CM,272,RC,,,,,,,,both,,,164.2100,24.6300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,147.79,,,,,,,42.3800,164.2100,percent of total billed charges,90% of $164.21 in Billed Charges for Rev 272 = $147.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE PLUS II HOOK 5MM X 34CM,272,RC,,,,,,,,both,,,164.2100,24.6300,MEDCOST,MEDCOST VHN,78.15,,,,,,,42.3800,164.2100,percent of total billed charges,47.59% of $164.21 in Billed Charges for Rev 272 = $78.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE PLUS II HOOK 5MM X 34CM,272,RC,,,,,,,,both,,,164.2100,24.6300,SENTARA HEALTH,SENTARA HEALTH,42.38,,,,,,,42.3800,164.2100,percent of total billed charges,25.81% of $164.21 in Billed Charges for Rev 272 = $42.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE PLUS II HOOK 5MM X 34CM,272,RC,,,,,,,,both,,,164.2100,24.6300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",164.21,,,,,,,42.3800,164.2100,percent of total billed charges,100% of $164.21 in Billed Charges for Rev 272 = $164.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE PLUS II HOOK 5MM X 34CM,272,RC,,,,,,,,both,,,164.2100,24.6300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,82.11,,,,,,,42.3800,164.2100,percent of total billed charges,Rev 272 $164.21 in Billed Charges at 50% = $82.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE PLUS II HOOK 5MM X 34CM,272,RC,,,,,,,,both,,,164.2100,24.6300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,53.04,,,,,,,42.3800,164.2100,other,32.3% of $164.21 in Billed Charges for Rev 272 = $53.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PROBE PLUS II HOOK 5MM X 34CM,272,RC,,,,,,,,both,,,164.2100,24.6300,UNITED HEALTHCARE,UHC HERITAGE SELECT,50.41,,,,,,,42.3800,164.2100,other,30.7% of $164.21 in Billed Charges for Rev 272 = $50.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PROBE PLUS II HOOK 5MM X 34CM,272,RC,,,,,,,,both,,,164.2100,24.6300,UNITED HEALTHCARE,UNITED HEALTHCARE,53.04,,,,,,,42.3800,164.2100,percent of total billed charges,32.3% of $164.21 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE PLUS II HOOK 5MM X 34CM,272,RC,,,,,,,,both,,,164.2100,24.6300,WELLCARE,WELLCARE MEDICAID,164.21,,,,,,,42.3800,164.2100,percent of total billed charges,100% of $164.21 in Billed Charges for Rev 272 = $164.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE XL 50-S 0279-351-253,272,RC,,,,,,,,both,,,2461.3500,369.2000,AETNA,AETNA,1051.00,,,,,,,635.2700,2461.3500,percent of total billed charges,"42.7% of $2,461.35 in Billed Charges for Rev 272 = $1,051.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 50-S 0279-351-253,272,RC,,,,,,,,both,,,2461.3500,369.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1722.95,,,,,,,635.2700,2461.3500,percent of total billed charges,"Rev 272 $2,461.35 in Billed Charges at 70% = $1,722.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 50-S 0279-351-253,272,RC,,,,,,,,both,,,2461.3500,369.2000,CIGNA HEALTHCARE,CIGNA HMO,1026.38,,,,,,,635.2700,2461.3500,percent of total billed charges,"41.7% of $2,461.35 in Billed Charges for Rev 272 = $1,026.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 50-S 0279-351-253,272,RC,,,,,,,,both,,,2461.3500,369.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1142.07,,,,,,,635.2700,2461.3500,percent of total billed charges,"46.4% of $2,461.35 in Billed Charges for Rev 272 = $1,142.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 50-S 0279-351-253,272,RC,,,,,,,,both,,,2461.3500,369.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1026.38,,,,,,,635.2700,2461.3500,percent of total billed charges,"41.7% of $2,461.35 in Billed Charges for Rev 272 = $1,026.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 50-S 0279-351-253,272,RC,,,,,,,,both,,,2461.3500,369.2000,CIGNA HEALTHCARE,CIGNA PPO,1026.38,,,,,,,635.2700,2461.3500,percent of total billed charges,"41.7% of $2,461.35 in Billed Charges for Rev 272 = $1,026.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 50-S 0279-351-253,272,RC,,,,,,,,both,,,2461.3500,369.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2215.22,,,,,,,635.2700,2461.3500,percent of total billed charges,"90% of $2,461.35 in Billed Charges for Rev 272 = $2,215.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 50-S 0279-351-253,272,RC,,,,,,,,both,,,2461.3500,369.2000,MEDCOST,MEDCOST VHN,1171.36,,,,,,,635.2700,2461.3500,percent of total billed charges,"47.59% of $2,461.35 in Billed Charges for Rev 272 = $1,171.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 50-S 0279-351-253,272,RC,,,,,,,,both,,,2461.3500,369.2000,SENTARA HEALTH,SENTARA HEALTH,635.27,,,,,,,635.2700,2461.3500,percent of total billed charges,"25.81% of $2,461.35 in Billed Charges for Rev 272 = $635.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 50-S 0279-351-253,272,RC,,,,,,,,both,,,2461.3500,369.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2461.35,,,,,,,635.2700,2461.3500,percent of total billed charges,"100% of $2,461.35 in Billed Charges for Rev 272 = $2,461.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 50-S 0279-351-253,272,RC,,,,,,,,both,,,2461.3500,369.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1230.68,,,,,,,635.2700,2461.3500,percent of total billed charges,"Rev 272 $2,461.35 in Billed Charges at 50% = $1,230.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 50-S 0279-351-253,272,RC,,,,,,,,both,,,2461.3500,369.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,795.02,,,,,,,635.2700,2461.3500,other,"32.3% of $2,461.35 in Billed Charges for Rev 272 = $795.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE XL 50-S 0279-351-253,272,RC,,,,,,,,both,,,2461.3500,369.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,755.63,,,,,,,635.2700,2461.3500,other,"30.7% of $2,461.35 in Billed Charges for Rev 272 = $755.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE XL 50-S 0279-351-253,272,RC,,,,,,,,both,,,2461.3500,369.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,795.02,,,,,,,635.2700,2461.3500,percent of total billed charges,"32.3% of $2,461.35 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 50-S 0279-351-253,272,RC,,,,,,,,both,,,2461.3500,369.2000,WELLCARE,WELLCARE MEDICAID,2461.35,,,,,,,635.2700,2461.3500,percent of total billed charges,"100% of $2,461.35 in Billed Charges for Rev 272 = $2,461.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROGRAMMER PATIENT,272,RC,,,,,,,,both,,,18812.9900,2821.9500,AETNA,AETNA,8033.15,,,,,,,4855.6300,18812.9900,percent of total billed charges,"42.7% of $18,812.99 in Billed Charges for Rev 272 = $8,033.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROGRAMMER PATIENT,272,RC,,,,,,,,both,,,18812.9900,2821.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,13169.09,,,,,,,4855.6300,18812.9900,percent of total billed charges,"Rev 272 $18,812.99 in Billed Charges at 70% = $13,169.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROGRAMMER PATIENT,272,RC,,,,,,,,both,,,18812.9900,2821.9500,CIGNA HEALTHCARE,CIGNA HMO,7845.02,,,,,,,4855.6300,18812.9900,percent of total billed charges,"41.7% of $18,812.99 in Billed Charges for Rev 272 = $7,845.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROGRAMMER PATIENT,272,RC,,,,,,,,both,,,18812.9900,2821.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8729.23,,,,,,,4855.6300,18812.9900,percent of total billed charges,"46.4% of $18,812.99 in Billed Charges for Rev 272 = $8,729.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROGRAMMER PATIENT,272,RC,,,,,,,,both,,,18812.9900,2821.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7845.02,,,,,,,4855.6300,18812.9900,percent of total billed charges,"41.7% of $18,812.99 in Billed Charges for Rev 272 = $7,845.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROGRAMMER PATIENT,272,RC,,,,,,,,both,,,18812.9900,2821.9500,CIGNA HEALTHCARE,CIGNA PPO,7845.02,,,,,,,4855.6300,18812.9900,percent of total billed charges,"41.7% of $18,812.99 in Billed Charges for Rev 272 = $7,845.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROGRAMMER PATIENT,272,RC,,,,,,,,both,,,18812.9900,2821.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,16931.69,,,,,,,4855.6300,18812.9900,percent of total billed charges,"90% of $18,812.99 in Billed Charges for Rev 272 = $16,931.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROGRAMMER PATIENT,272,RC,,,,,,,,both,,,18812.9900,2821.9500,MEDCOST,MEDCOST VHN,8953.10,,,,,,,4855.6300,18812.9900,percent of total billed charges,"47.59% of $18,812.99 in Billed Charges for Rev 272 = $8,953.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROGRAMMER PATIENT,272,RC,,,,,,,,both,,,18812.9900,2821.9500,SENTARA HEALTH,SENTARA HEALTH,4855.63,,,,,,,4855.6300,18812.9900,percent of total billed charges,"25.81% of $18,812.99 in Billed Charges for Rev 272 = $4,855.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROGRAMMER PATIENT,272,RC,,,,,,,,both,,,18812.9900,2821.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",18812.99,,,,,,,4855.6300,18812.9900,percent of total billed charges,"100% of $18,812.99 in Billed Charges for Rev 272 = $18,812.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROGRAMMER PATIENT,272,RC,,,,,,,,both,,,18812.9900,2821.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9406.50,,,,,,,4855.6300,18812.9900,percent of total billed charges,"Rev 272 $18,812.99 in Billed Charges at 50% = $9,406.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROGRAMMER PATIENT,272,RC,,,,,,,,both,,,18812.9900,2821.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,6076.60,,,,,,,4855.6300,18812.9900,other,"32.3% of $18,812.99 in Billed Charges for Rev 272 = $6,076.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROGRAMMER PATIENT,272,RC,,,,,,,,both,,,18812.9900,2821.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,5775.59,,,,,,,4855.6300,18812.9900,other,"30.7% of $18,812.99 in Billed Charges for Rev 272 = $5,775.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROGRAMMER PATIENT,272,RC,,,,,,,,both,,,18812.9900,2821.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,6076.60,,,,,,,4855.6300,18812.9900,percent of total billed charges,"32.3% of $18,812.99 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROGRAMMER PATIENT,272,RC,,,,,,,,both,,,18812.9900,2821.9500,WELLCARE,WELLCARE MEDICAID,18812.99,,,,,,,4855.6300,18812.9900,percent of total billed charges,"100% of $18,812.99 in Billed Charges for Rev 272 = $18,812.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRONG GRASPER DISP,272,RC,,,,,,,,both,,,2219.2900,332.8900,AETNA,AETNA,947.64,,,,,,,572.8000,2219.2900,percent of total billed charges,"42.7% of $2,219.29 in Billed Charges for Rev 272 = $947.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRONG GRASPER DISP,272,RC,,,,,,,,both,,,2219.2900,332.8900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1553.50,,,,,,,572.8000,2219.2900,percent of total billed charges,"Rev 272 $2,219.29 in Billed Charges at 70% = $1,553.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRONG GRASPER DISP,272,RC,,,,,,,,both,,,2219.2900,332.8900,CIGNA HEALTHCARE,CIGNA HMO,925.44,,,,,,,572.8000,2219.2900,percent of total billed charges,"41.7% of $2,219.29 in Billed Charges for Rev 272 = $925.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRONG GRASPER DISP,272,RC,,,,,,,,both,,,2219.2900,332.8900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1029.75,,,,,,,572.8000,2219.2900,percent of total billed charges,"46.4% of $2,219.29 in Billed Charges for Rev 272 = $1,029.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRONG GRASPER DISP,272,RC,,,,,,,,both,,,2219.2900,332.8900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,925.44,,,,,,,572.8000,2219.2900,percent of total billed charges,"41.7% of $2,219.29 in Billed Charges for Rev 272 = $925.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRONG GRASPER DISP,272,RC,,,,,,,,both,,,2219.2900,332.8900,CIGNA HEALTHCARE,CIGNA PPO,925.44,,,,,,,572.8000,2219.2900,percent of total billed charges,"41.7% of $2,219.29 in Billed Charges for Rev 272 = $925.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRONG GRASPER DISP,272,RC,,,,,,,,both,,,2219.2900,332.8900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1997.36,,,,,,,572.8000,2219.2900,percent of total billed charges,"90% of $2,219.29 in Billed Charges for Rev 272 = $1,997.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRONG GRASPER DISP,272,RC,,,,,,,,both,,,2219.2900,332.8900,MEDCOST,MEDCOST VHN,1056.16,,,,,,,572.8000,2219.2900,percent of total billed charges,"47.59% of $2,219.29 in Billed Charges for Rev 272 = $1,056.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRONG GRASPER DISP,272,RC,,,,,,,,both,,,2219.2900,332.8900,SENTARA HEALTH,SENTARA HEALTH,572.80,,,,,,,572.8000,2219.2900,percent of total billed charges,"25.81% of $2,219.29 in Billed Charges for Rev 272 = $572.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRONG GRASPER DISP,272,RC,,,,,,,,both,,,2219.2900,332.8900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2219.29,,,,,,,572.8000,2219.2900,percent of total billed charges,"100% of $2,219.29 in Billed Charges for Rev 272 = $2,219.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRONG GRASPER DISP,272,RC,,,,,,,,both,,,2219.2900,332.8900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1109.65,,,,,,,572.8000,2219.2900,percent of total billed charges,"Rev 272 $2,219.29 in Billed Charges at 50% = $1,109.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRONG GRASPER DISP,272,RC,,,,,,,,both,,,2219.2900,332.8900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,716.83,,,,,,,572.8000,2219.2900,other,"32.3% of $2,219.29 in Billed Charges for Rev 272 = $716.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PRONG GRASPER DISP,272,RC,,,,,,,,both,,,2219.2900,332.8900,UNITED HEALTHCARE,UHC HERITAGE SELECT,681.32,,,,,,,572.8000,2219.2900,other,"30.7% of $2,219.29 in Billed Charges for Rev 272 = $681.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PRONG GRASPER DISP,272,RC,,,,,,,,both,,,2219.2900,332.8900,UNITED HEALTHCARE,UNITED HEALTHCARE,716.83,,,,,,,572.8000,2219.2900,percent of total billed charges,"32.3% of $2,219.29 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRONG GRASPER DISP,272,RC,,,,,,,,both,,,2219.2900,332.8900,WELLCARE,WELLCARE MEDICAID,2219.29,,,,,,,572.8000,2219.2900,percent of total billed charges,"100% of $2,219.29 in Billed Charges for Rev 272 = $2,219.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE ECHELON LINEAR CUTTERS 80MM GREEN RELOAD,272,RC,,,,,,,,both,,,858.5500,128.7800,AETNA,AETNA,366.60,,,,,,,221.5900,858.5500,percent of total billed charges,42.7% of $858.55 in Billed Charges for Rev 272 = $366.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLE ECHELON LINEAR CUTTERS 80MM GREEN RELOAD,272,RC,,,,,,,,both,,,858.5500,128.7800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,600.99,,,,,,,221.5900,858.5500,percent of total billed charges,Rev 272 $858.55 in Billed Charges at 70% = $600.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLE ECHELON LINEAR CUTTERS 80MM GREEN RELOAD,272,RC,,,,,,,,both,,,858.5500,128.7800,CIGNA HEALTHCARE,CIGNA HMO,358.02,,,,,,,221.5900,858.5500,percent of total billed charges,41.7% of $858.55 in Billed Charges for Rev 272 = $358.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLE ECHELON LINEAR CUTTERS 80MM GREEN RELOAD,272,RC,,,,,,,,both,,,858.5500,128.7800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,398.37,,,,,,,221.5900,858.5500,percent of total billed charges,46.4% of $858.55 in Billed Charges for Rev 272 = $398.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLE ECHELON LINEAR CUTTERS 80MM GREEN RELOAD,272,RC,,,,,,,,both,,,858.5500,128.7800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,358.02,,,,,,,221.5900,858.5500,percent of total billed charges,41.7% of $858.55 in Billed Charges for Rev 272 = $358.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLE ECHELON LINEAR CUTTERS 80MM GREEN RELOAD,272,RC,,,,,,,,both,,,858.5500,128.7800,CIGNA HEALTHCARE,CIGNA PPO,358.02,,,,,,,221.5900,858.5500,percent of total billed charges,41.7% of $858.55 in Billed Charges for Rev 272 = $358.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLE ECHELON LINEAR CUTTERS 80MM GREEN RELOAD,272,RC,,,,,,,,both,,,858.5500,128.7800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,772.70,,,,,,,221.5900,858.5500,percent of total billed charges,90% of $858.55 in Billed Charges for Rev 272 = $772.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLE ECHELON LINEAR CUTTERS 80MM GREEN RELOAD,272,RC,,,,,,,,both,,,858.5500,128.7800,MEDCOST,MEDCOST VHN,408.58,,,,,,,221.5900,858.5500,percent of total billed charges,47.59% of $858.55 in Billed Charges for Rev 272 = $408.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLE ECHELON LINEAR CUTTERS 80MM GREEN RELOAD,272,RC,,,,,,,,both,,,858.5500,128.7800,SENTARA HEALTH,SENTARA HEALTH,221.59,,,,,,,221.5900,858.5500,percent of total billed charges,25.81% of $858.55 in Billed Charges for Rev 272 = $221.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLE ECHELON LINEAR CUTTERS 80MM GREEN RELOAD,272,RC,,,,,,,,both,,,858.5500,128.7800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",858.55,,,,,,,221.5900,858.5500,percent of total billed charges,100% of $858.55 in Billed Charges for Rev 272 = $858.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLE ECHELON LINEAR CUTTERS 80MM GREEN RELOAD,272,RC,,,,,,,,both,,,858.5500,128.7800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,429.28,,,,,,,221.5900,858.5500,percent of total billed charges,Rev 272 $858.55 in Billed Charges at 50% = $429.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLE ECHELON LINEAR CUTTERS 80MM GREEN RELOAD,272,RC,,,,,,,,both,,,858.5500,128.7800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,277.31,,,,,,,221.5900,858.5500,other,32.3% of $858.55 in Billed Charges for Rev 272 = $277.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
RELOAD STAPLE ECHELON LINEAR CUTTERS 80MM GREEN RELOAD,272,RC,,,,,,,,both,,,858.5500,128.7800,UNITED HEALTHCARE,UHC HERITAGE SELECT,263.57,,,,,,,221.5900,858.5500,other,30.7% of $858.55 in Billed Charges for Rev 272 = $263.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
RELOAD STAPLE ECHELON LINEAR CUTTERS 80MM GREEN RELOAD,272,RC,,,,,,,,both,,,858.5500,128.7800,UNITED HEALTHCARE,UNITED HEALTHCARE,277.31,,,,,,,221.5900,858.5500,percent of total billed charges,32.3% of $858.55 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLE ECHELON LINEAR CUTTERS 80MM GREEN RELOAD,272,RC,,,,,,,,both,,,858.5500,128.7800,WELLCARE,WELLCARE MEDICAID,858.55,,,,,,,221.5900,858.5500,percent of total billed charges,100% of $858.55 in Billed Charges for Rev 272 = $858.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE DRILL BIT SHORT 5.0/3.5MM,272,RC,,,,,,,,both,,,1766.0800,264.9100,AETNA,AETNA,754.12,,,,,,,455.8300,1766.0800,percent of total billed charges,"42.7% of $1,766.08 in Billed Charges for Rev 272 = $754.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE DRILL BIT SHORT 5.0/3.5MM,272,RC,,,,,,,,both,,,1766.0800,264.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1236.26,,,,,,,455.8300,1766.0800,percent of total billed charges,"Rev 272 $1,766.08 in Billed Charges at 70% = $1,236.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE DRILL BIT SHORT 5.0/3.5MM,272,RC,,,,,,,,both,,,1766.0800,264.9100,CIGNA HEALTHCARE,CIGNA HMO,736.46,,,,,,,455.8300,1766.0800,percent of total billed charges,"41.7% of $1,766.08 in Billed Charges for Rev 272 = $736.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE DRILL BIT SHORT 5.0/3.5MM,272,RC,,,,,,,,both,,,1766.0800,264.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,819.46,,,,,,,455.8300,1766.0800,percent of total billed charges,"46.4% of $1,766.08 in Billed Charges for Rev 272 = $819.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE DRILL BIT SHORT 5.0/3.5MM,272,RC,,,,,,,,both,,,1766.0800,264.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,736.46,,,,,,,455.8300,1766.0800,percent of total billed charges,"41.7% of $1,766.08 in Billed Charges for Rev 272 = $736.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE DRILL BIT SHORT 5.0/3.5MM,272,RC,,,,,,,,both,,,1766.0800,264.9100,CIGNA HEALTHCARE,CIGNA PPO,736.46,,,,,,,455.8300,1766.0800,percent of total billed charges,"41.7% of $1,766.08 in Billed Charges for Rev 272 = $736.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE DRILL BIT SHORT 5.0/3.5MM,272,RC,,,,,,,,both,,,1766.0800,264.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1589.47,,,,,,,455.8300,1766.0800,percent of total billed charges,"90% of $1,766.08 in Billed Charges for Rev 272 = $1,589.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE DRILL BIT SHORT 5.0/3.5MM,272,RC,,,,,,,,both,,,1766.0800,264.9100,MEDCOST,MEDCOST VHN,840.48,,,,,,,455.8300,1766.0800,percent of total billed charges,"47.59% of $1,766.08 in Billed Charges for Rev 272 = $840.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE DRILL BIT SHORT 5.0/3.5MM,272,RC,,,,,,,,both,,,1766.0800,264.9100,SENTARA HEALTH,SENTARA HEALTH,455.83,,,,,,,455.8300,1766.0800,percent of total billed charges,"25.81% of $1,766.08 in Billed Charges for Rev 272 = $455.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE DRILL BIT SHORT 5.0/3.5MM,272,RC,,,,,,,,both,,,1766.0800,264.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1766.08,,,,,,,455.8300,1766.0800,percent of total billed charges,"100% of $1,766.08 in Billed Charges for Rev 272 = $1,766.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE DRILL BIT SHORT 5.0/3.5MM,272,RC,,,,,,,,both,,,1766.0800,264.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,883.04,,,,,,,455.8300,1766.0800,percent of total billed charges,"Rev 272 $1,766.08 in Billed Charges at 50% = $883.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE DRILL BIT SHORT 5.0/3.5MM,272,RC,,,,,,,,both,,,1766.0800,264.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,570.44,,,,,,,455.8300,1766.0800,other,"32.3% of $1,766.08 in Billed Charges for Rev 272 = $570.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SLEEVE DRILL BIT SHORT 5.0/3.5MM,272,RC,,,,,,,,both,,,1766.0800,264.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,542.19,,,,,,,455.8300,1766.0800,other,"30.7% of $1,766.08 in Billed Charges for Rev 272 = $542.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SLEEVE DRILL BIT SHORT 5.0/3.5MM,272,RC,,,,,,,,both,,,1766.0800,264.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,570.44,,,,,,,455.8300,1766.0800,percent of total billed charges,"32.3% of $1,766.08 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE DRILL BIT SHORT 5.0/3.5MM,272,RC,,,,,,,,both,,,1766.0800,264.9100,WELLCARE,WELLCARE MEDICAID,1766.08,,,,,,,455.8300,1766.0800,percent of total billed charges,"100% of $1,766.08 in Billed Charges for Rev 272 = $1,766.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FIXATION DRILLL STOP 60MM,272,RC,,,,,,,,both,,,5447.8900,817.1800,AETNA,AETNA,2326.25,,,,,,,1406.1000,5447.8900,percent of total billed charges,"42.7% of $5,447.89 in Billed Charges for Rev 272 = $2,326.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FIXATION DRILLL STOP 60MM,272,RC,,,,,,,,both,,,5447.8900,817.1800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3813.52,,,,,,,1406.1000,5447.8900,percent of total billed charges,"Rev 272 $5,447.89 in Billed Charges at 70% = $3,813.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FIXATION DRILLL STOP 60MM,272,RC,,,,,,,,both,,,5447.8900,817.1800,CIGNA HEALTHCARE,CIGNA HMO,2271.77,,,,,,,1406.1000,5447.8900,percent of total billed charges,"41.7% of $5,447.89 in Billed Charges for Rev 272 = $2,271.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FIXATION DRILLL STOP 60MM,272,RC,,,,,,,,both,,,5447.8900,817.1800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2527.82,,,,,,,1406.1000,5447.8900,percent of total billed charges,"46.4% of $5,447.89 in Billed Charges for Rev 272 = $2,527.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FIXATION DRILLL STOP 60MM,272,RC,,,,,,,,both,,,5447.8900,817.1800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2271.77,,,,,,,1406.1000,5447.8900,percent of total billed charges,"41.7% of $5,447.89 in Billed Charges for Rev 272 = $2,271.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FIXATION DRILLL STOP 60MM,272,RC,,,,,,,,both,,,5447.8900,817.1800,CIGNA HEALTHCARE,CIGNA PPO,2271.77,,,,,,,1406.1000,5447.8900,percent of total billed charges,"41.7% of $5,447.89 in Billed Charges for Rev 272 = $2,271.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FIXATION DRILLL STOP 60MM,272,RC,,,,,,,,both,,,5447.8900,817.1800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4903.10,,,,,,,1406.1000,5447.8900,percent of total billed charges,"90% of $5,447.89 in Billed Charges for Rev 272 = $4,903.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FIXATION DRILLL STOP 60MM,272,RC,,,,,,,,both,,,5447.8900,817.1800,MEDCOST,MEDCOST VHN,2592.65,,,,,,,1406.1000,5447.8900,percent of total billed charges,"47.59% of $5,447.89 in Billed Charges for Rev 272 = $2,592.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FIXATION DRILLL STOP 60MM,272,RC,,,,,,,,both,,,5447.8900,817.1800,SENTARA HEALTH,SENTARA HEALTH,1406.10,,,,,,,1406.1000,5447.8900,percent of total billed charges,"25.81% of $5,447.89 in Billed Charges for Rev 272 = $1,406.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FIXATION DRILLL STOP 60MM,272,RC,,,,,,,,both,,,5447.8900,817.1800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5447.89,,,,,,,1406.1000,5447.8900,percent of total billed charges,"100% of $5,447.89 in Billed Charges for Rev 272 = $5,447.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FIXATION DRILLL STOP 60MM,272,RC,,,,,,,,both,,,5447.8900,817.1800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2723.95,,,,,,,1406.1000,5447.8900,percent of total billed charges,"Rev 272 $5,447.89 in Billed Charges at 50% = $2,723.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FIXATION DRILLL STOP 60MM,272,RC,,,,,,,,both,,,5447.8900,817.1800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1759.67,,,,,,,1406.1000,5447.8900,other,"32.3% of $5,447.89 in Billed Charges for Rev 272 = $1,759.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SLEEVE FIXATION DRILLL STOP 60MM,272,RC,,,,,,,,both,,,5447.8900,817.1800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1672.50,,,,,,,1406.1000,5447.8900,other,"30.7% of $5,447.89 in Billed Charges for Rev 272 = $1,672.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SLEEVE FIXATION DRILLL STOP 60MM,272,RC,,,,,,,,both,,,5447.8900,817.1800,UNITED HEALTHCARE,UNITED HEALTHCARE,1759.67,,,,,,,1406.1000,5447.8900,percent of total billed charges,"32.3% of $5,447.89 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FIXATION DRILLL STOP 60MM,272,RC,,,,,,,,both,,,5447.8900,817.1800,WELLCARE,WELLCARE MEDICAID,5447.89,,,,,,,1406.1000,5447.8900,percent of total billed charges,"100% of $5,447.89 in Billed Charges for Rev 272 = $5,447.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FOR ECHELON STAPLER 60,272,RC,27200002,CDM,,,,,,both,,,1676.6500,251.5000,AETNA,AETNA,715.93,,,,,,,432.7400,1676.6500,percent of total billed charges,"42.7% of $1,676.65 in Billed Charges for Rev 272 = $715.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FOR ECHELON STAPLER 60,272,RC,27200002,CDM,,,,,,both,,,1676.6500,251.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1173.66,,,,,,,432.7400,1676.6500,percent of total billed charges,"Rev 272 $1,676.65 in Billed Charges at 70% = $1,173.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FOR ECHELON STAPLER 60,272,RC,27200002,CDM,,,,,,both,,,1676.6500,251.5000,CIGNA HEALTHCARE,CIGNA HMO,699.16,,,,,,,432.7400,1676.6500,percent of total billed charges,"41.7% of $1,676.65 in Billed Charges for Rev 272 = $699.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FOR ECHELON STAPLER 60,272,RC,27200002,CDM,,,,,,both,,,1676.6500,251.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,777.97,,,,,,,432.7400,1676.6500,percent of total billed charges,"46.4% of $1,676.65 in Billed Charges for Rev 272 = $777.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FOR ECHELON STAPLER 60,272,RC,27200002,CDM,,,,,,both,,,1676.6500,251.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,699.16,,,,,,,432.7400,1676.6500,percent of total billed charges,"41.7% of $1,676.65 in Billed Charges for Rev 272 = $699.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FOR ECHELON STAPLER 60,272,RC,27200002,CDM,,,,,,both,,,1676.6500,251.5000,CIGNA HEALTHCARE,CIGNA PPO,699.16,,,,,,,432.7400,1676.6500,percent of total billed charges,"41.7% of $1,676.65 in Billed Charges for Rev 272 = $699.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FOR ECHELON STAPLER 60,272,RC,27200002,CDM,,,,,,both,,,1676.6500,251.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1508.99,,,,,,,432.7400,1676.6500,percent of total billed charges,"90% of $1,676.65 in Billed Charges for Rev 272 = $1,508.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FOR ECHELON STAPLER 60,272,RC,27200002,CDM,,,,,,both,,,1676.6500,251.5000,MEDCOST,MEDCOST VHN,797.92,,,,,,,432.7400,1676.6500,percent of total billed charges,"47.59% of $1,676.65 in Billed Charges for Rev 272 = $797.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FOR ECHELON STAPLER 60,272,RC,27200002,CDM,,,,,,both,,,1676.6500,251.5000,SENTARA HEALTH,SENTARA HEALTH,432.74,,,,,,,432.7400,1676.6500,percent of total billed charges,"25.81% of $1,676.65 in Billed Charges for Rev 272 = $432.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FOR ECHELON STAPLER 60,272,RC,27200002,CDM,,,,,,both,,,1676.6500,251.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1676.65,,,,,,,432.7400,1676.6500,percent of total billed charges,"100% of $1,676.65 in Billed Charges for Rev 272 = $1,676.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FOR ECHELON STAPLER 60,272,RC,27200002,CDM,,,,,,both,,,1676.6500,251.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,838.33,,,,,,,432.7400,1676.6500,percent of total billed charges,"Rev 272 $1,676.65 in Billed Charges at 50% = $838.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FOR ECHELON STAPLER 60,272,RC,27200002,CDM,,,,,,both,,,1676.6500,251.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,541.56,,,,,,,432.7400,1676.6500,other,"32.3% of $1,676.65 in Billed Charges for Rev 272 = $541.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SLEEVE FOR ECHELON STAPLER 60,272,RC,27200002,CDM,,,,,,both,,,1676.6500,251.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,514.73,,,,,,,432.7400,1676.6500,other,"30.7% of $1,676.65 in Billed Charges for Rev 272 = $514.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SLEEVE FOR ECHELON STAPLER 60,272,RC,27200002,CDM,,,,,,both,,,1676.6500,251.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,541.56,,,,,,,432.7400,1676.6500,percent of total billed charges,"32.3% of $1,676.65 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE FOR ECHELON STAPLER 60,272,RC,27200002,CDM,,,,,,both,,,1676.6500,251.5000,WELLCARE,WELLCARE MEDICAID,1676.65,,,,,,,432.7400,1676.6500,percent of total billed charges,"100% of $1,676.65 in Billed Charges for Rev 272 = $1,676.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE IRRIGATION ELITE 12.0CM,272,RC,27200002,CDM,,,,,,both,,,716.5100,107.4800,AETNA,AETNA,305.95,,,,,,,184.9300,716.5100,percent of total billed charges,42.7% of $716.51 in Billed Charges for Rev 272 = $305.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE IRRIGATION ELITE 12.0CM,272,RC,27200002,CDM,,,,,,both,,,716.5100,107.4800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,501.56,,,,,,,184.9300,716.5100,percent of total billed charges,Rev 272 $716.51 in Billed Charges at 70% = $501.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE IRRIGATION ELITE 12.0CM,272,RC,27200002,CDM,,,,,,both,,,716.5100,107.4800,CIGNA HEALTHCARE,CIGNA HMO,298.78,,,,,,,184.9300,716.5100,percent of total billed charges,41.7% of $716.51 in Billed Charges for Rev 272 = $298.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE IRRIGATION ELITE 12.0CM,272,RC,27200002,CDM,,,,,,both,,,716.5100,107.4800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,332.46,,,,,,,184.9300,716.5100,percent of total billed charges,46.4% of $716.51 in Billed Charges for Rev 272 = $332.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE IRRIGATION ELITE 12.0CM,272,RC,27200002,CDM,,,,,,both,,,716.5100,107.4800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,298.78,,,,,,,184.9300,716.5100,percent of total billed charges,41.7% of $716.51 in Billed Charges for Rev 272 = $298.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE IRRIGATION ELITE 12.0CM,272,RC,27200002,CDM,,,,,,both,,,716.5100,107.4800,CIGNA HEALTHCARE,CIGNA PPO,298.78,,,,,,,184.9300,716.5100,percent of total billed charges,41.7% of $716.51 in Billed Charges for Rev 272 = $298.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE IRRIGATION ELITE 12.0CM,272,RC,27200002,CDM,,,,,,both,,,716.5100,107.4800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,644.86,,,,,,,184.9300,716.5100,percent of total billed charges,90% of $716.51 in Billed Charges for Rev 272 = $644.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE IRRIGATION ELITE 12.0CM,272,RC,27200002,CDM,,,,,,both,,,716.5100,107.4800,MEDCOST,MEDCOST VHN,340.99,,,,,,,184.9300,716.5100,percent of total billed charges,47.59% of $716.51 in Billed Charges for Rev 272 = $340.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE IRRIGATION ELITE 12.0CM,272,RC,27200002,CDM,,,,,,both,,,716.5100,107.4800,SENTARA HEALTH,SENTARA HEALTH,184.93,,,,,,,184.9300,716.5100,percent of total billed charges,25.81% of $716.51 in Billed Charges for Rev 272 = $184.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE IRRIGATION ELITE 12.0CM,272,RC,27200002,CDM,,,,,,both,,,716.5100,107.4800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",716.51,,,,,,,184.9300,716.5100,percent of total billed charges,100% of $716.51 in Billed Charges for Rev 272 = $716.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE IRRIGATION ELITE 12.0CM,272,RC,27200002,CDM,,,,,,both,,,716.5100,107.4800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,358.26,,,,,,,184.9300,716.5100,percent of total billed charges,Rev 272 $716.51 in Billed Charges at 50% = $358.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE IRRIGATION ELITE 12.0CM,272,RC,27200002,CDM,,,,,,both,,,716.5100,107.4800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,231.43,,,,,,,184.9300,716.5100,other,32.3% of $716.51 in Billed Charges for Rev 272 = $231.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SLEEVE IRRIGATION ELITE 12.0CM,272,RC,27200002,CDM,,,,,,both,,,716.5100,107.4800,UNITED HEALTHCARE,UHC HERITAGE SELECT,219.97,,,,,,,184.9300,716.5100,other,30.7% of $716.51 in Billed Charges for Rev 272 = $219.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SLEEVE IRRIGATION ELITE 12.0CM,272,RC,27200002,CDM,,,,,,both,,,716.5100,107.4800,UNITED HEALTHCARE,UNITED HEALTHCARE,231.43,,,,,,,184.9300,716.5100,percent of total billed charges,32.3% of $716.51 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE IRRIGATION ELITE 12.0CM,272,RC,27200002,CDM,,,,,,both,,,716.5100,107.4800,WELLCARE,WELLCARE MEDICAID,716.51,,,,,,,184.9300,716.5100,percent of total billed charges,100% of $716.51 in Billed Charges for Rev 272 = $716.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE PROTECTION F_NAILS 08-11MM LONG STER,272,RC,27200002,CDM,,,,,,both,,,2439.1600,365.8700,AETNA,AETNA,1041.52,,,,,,,629.5500,2439.1600,percent of total billed charges,"42.7% of $2,439.16 in Billed Charges for Rev 272 = $1,041.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION F_NAILS 08-11MM LONG STER,272,RC,27200002,CDM,,,,,,both,,,2439.1600,365.8700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1707.41,,,,,,,629.5500,2439.1600,percent of total billed charges,"Rev 272 $2,439.16 in Billed Charges at 70% = $1,707.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION F_NAILS 08-11MM LONG STER,272,RC,27200002,CDM,,,,,,both,,,2439.1600,365.8700,CIGNA HEALTHCARE,CIGNA HMO,1017.13,,,,,,,629.5500,2439.1600,percent of total billed charges,"41.7% of $2,439.16 in Billed Charges for Rev 272 = $1,017.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION F_NAILS 08-11MM LONG STER,272,RC,27200002,CDM,,,,,,both,,,2439.1600,365.8700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1131.77,,,,,,,629.5500,2439.1600,percent of total billed charges,"46.4% of $2,439.16 in Billed Charges for Rev 272 = $1,131.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION F_NAILS 08-11MM LONG STER,272,RC,27200002,CDM,,,,,,both,,,2439.1600,365.8700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1017.13,,,,,,,629.5500,2439.1600,percent of total billed charges,"41.7% of $2,439.16 in Billed Charges for Rev 272 = $1,017.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION F_NAILS 08-11MM LONG STER,272,RC,27200002,CDM,,,,,,both,,,2439.1600,365.8700,CIGNA HEALTHCARE,CIGNA PPO,1017.13,,,,,,,629.5500,2439.1600,percent of total billed charges,"41.7% of $2,439.16 in Billed Charges for Rev 272 = $1,017.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION F_NAILS 08-11MM LONG STER,272,RC,27200002,CDM,,,,,,both,,,2439.1600,365.8700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2195.24,,,,,,,629.5500,2439.1600,percent of total billed charges,"90% of $2,439.16 in Billed Charges for Rev 272 = $2,195.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION F_NAILS 08-11MM LONG STER,272,RC,27200002,CDM,,,,,,both,,,2439.1600,365.8700,MEDCOST,MEDCOST VHN,1160.80,,,,,,,629.5500,2439.1600,percent of total billed charges,"47.59% of $2,439.16 in Billed Charges for Rev 272 = $1,160.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION F_NAILS 08-11MM LONG STER,272,RC,27200002,CDM,,,,,,both,,,2439.1600,365.8700,SENTARA HEALTH,SENTARA HEALTH,629.55,,,,,,,629.5500,2439.1600,percent of total billed charges,"25.81% of $2,439.16 in Billed Charges for Rev 272 = $629.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION F_NAILS 08-11MM LONG STER,272,RC,27200002,CDM,,,,,,both,,,2439.1600,365.8700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2439.16,,,,,,,629.5500,2439.1600,percent of total billed charges,"100% of $2,439.16 in Billed Charges for Rev 272 = $2,439.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION F_NAILS 08-11MM LONG STER,272,RC,27200002,CDM,,,,,,both,,,2439.1600,365.8700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1219.58,,,,,,,629.5500,2439.1600,percent of total billed charges,"Rev 272 $2,439.16 in Billed Charges at 50% = $1,219.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION F_NAILS 08-11MM LONG STER,272,RC,27200002,CDM,,,,,,both,,,2439.1600,365.8700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,787.85,,,,,,,629.5500,2439.1600,other,"32.3% of $2,439.16 in Billed Charges for Rev 272 = $787.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SLEEVE PROTECTION F_NAILS 08-11MM LONG STER,272,RC,27200002,CDM,,,,,,both,,,2439.1600,365.8700,UNITED HEALTHCARE,UHC HERITAGE SELECT,748.82,,,,,,,629.5500,2439.1600,other,"30.7% of $2,439.16 in Billed Charges for Rev 272 = $748.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SLEEVE PROTECTION F_NAILS 08-11MM LONG STER,272,RC,27200002,CDM,,,,,,both,,,2439.1600,365.8700,UNITED HEALTHCARE,UNITED HEALTHCARE,787.85,,,,,,,629.5500,2439.1600,percent of total billed charges,"32.3% of $2,439.16 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION F_NAILS 08-11MM LONG STER,272,RC,27200002,CDM,,,,,,both,,,2439.1600,365.8700,WELLCARE,WELLCARE MEDICAID,2439.16,,,,,,,629.5500,2439.1600,percent of total billed charges,"100% of $2,439.16 in Billed Charges for Rev 272 = $2,439.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE VASC THIN 8MM SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,8840.8600,1326.1300,AETNA,AETNA,3775.05,,,,,,,2281.8300,8840.8600,percent of total billed charges,"42.7% of $8,840.86 in Billed Charges for Rev 272 = $3,775.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE VASC THIN 8MM SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,8840.8600,1326.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6188.60,,,,,,,2281.8300,8840.8600,percent of total billed charges,"Rev 272 $8,840.86 in Billed Charges at 70% = $6,188.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE VASC THIN 8MM SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,8840.8600,1326.1300,CIGNA HEALTHCARE,CIGNA HMO,3686.64,,,,,,,2281.8300,8840.8600,percent of total billed charges,"41.7% of $8,840.86 in Billed Charges for Rev 272 = $3,686.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE VASC THIN 8MM SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,8840.8600,1326.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4102.16,,,,,,,2281.8300,8840.8600,percent of total billed charges,"46.4% of $8,840.86 in Billed Charges for Rev 272 = $4,102.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE VASC THIN 8MM SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,8840.8600,1326.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3686.64,,,,,,,2281.8300,8840.8600,percent of total billed charges,"41.7% of $8,840.86 in Billed Charges for Rev 272 = $3,686.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE VASC THIN 8MM SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,8840.8600,1326.1300,CIGNA HEALTHCARE,CIGNA PPO,3686.64,,,,,,,2281.8300,8840.8600,percent of total billed charges,"41.7% of $8,840.86 in Billed Charges for Rev 272 = $3,686.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE VASC THIN 8MM SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,8840.8600,1326.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7956.77,,,,,,,2281.8300,8840.8600,percent of total billed charges,"90% of $8,840.86 in Billed Charges for Rev 272 = $7,956.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE VASC THIN 8MM SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,8840.8600,1326.1300,MEDCOST,MEDCOST VHN,4207.37,,,,,,,2281.8300,8840.8600,percent of total billed charges,"47.59% of $8,840.86 in Billed Charges for Rev 272 = $4,207.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE VASC THIN 8MM SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,8840.8600,1326.1300,SENTARA HEALTH,SENTARA HEALTH,2281.83,,,,,,,2281.8300,8840.8600,percent of total billed charges,"25.81% of $8,840.86 in Billed Charges for Rev 272 = $2,281.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE VASC THIN 8MM SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,8840.8600,1326.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8840.86,,,,,,,2281.8300,8840.8600,percent of total billed charges,"100% of $8,840.86 in Billed Charges for Rev 272 = $8,840.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE VASC THIN 8MM SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,8840.8600,1326.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4420.43,,,,,,,2281.8300,8840.8600,percent of total billed charges,"Rev 272 $8,840.86 in Billed Charges at 50% = $4,420.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE VASC THIN 8MM SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,8840.8600,1326.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2855.60,,,,,,,2281.8300,8840.8600,other,"32.3% of $8,840.86 in Billed Charges for Rev 272 = $2,855.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD STAPLE VASC THIN 8MM SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,8840.8600,1326.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,2714.14,,,,,,,2281.8300,8840.8600,other,"30.7% of $8,840.86 in Billed Charges for Rev 272 = $2,714.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD STAPLE VASC THIN 8MM SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,8840.8600,1326.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,2855.60,,,,,,,2281.8300,8840.8600,percent of total billed charges,"32.3% of $8,840.86 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE VASC THIN 8MM SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,8840.8600,1326.1300,WELLCARE,WELLCARE MEDICAID,8840.86,,,,,,,2281.8300,8840.8600,percent of total billed charges,"100% of $8,840.86 in Billed Charges for Rev 272 = $8,840.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER 100MM GIA10038S SURPASS SEE LN 36015,272,RC,,,,,,,,both,,,8649.8600,1297.4800,AETNA,AETNA,3693.49,,,,,,,2232.5300,8649.8600,percent of total billed charges,"42.7% of $8,649.86 in Billed Charges for Rev 272 = $3,693.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER 100MM GIA10038S SURPASS SEE LN 36015,272,RC,,,,,,,,both,,,8649.8600,1297.4800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6054.90,,,,,,,2232.5300,8649.8600,percent of total billed charges,"Rev 272 $8,649.86 in Billed Charges at 70% = $6,054.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER 100MM GIA10038S SURPASS SEE LN 36015,272,RC,,,,,,,,both,,,8649.8600,1297.4800,CIGNA HEALTHCARE,CIGNA HMO,3606.99,,,,,,,2232.5300,8649.8600,percent of total billed charges,"41.7% of $8,649.86 in Billed Charges for Rev 272 = $3,606.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER 100MM GIA10038S SURPASS SEE LN 36015,272,RC,,,,,,,,both,,,8649.8600,1297.4800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4013.54,,,,,,,2232.5300,8649.8600,percent of total billed charges,"46.4% of $8,649.86 in Billed Charges for Rev 272 = $4,013.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER 100MM GIA10038S SURPASS SEE LN 36015,272,RC,,,,,,,,both,,,8649.8600,1297.4800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3606.99,,,,,,,2232.5300,8649.8600,percent of total billed charges,"41.7% of $8,649.86 in Billed Charges for Rev 272 = $3,606.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER 100MM GIA10038S SURPASS SEE LN 36015,272,RC,,,,,,,,both,,,8649.8600,1297.4800,CIGNA HEALTHCARE,CIGNA PPO,3606.99,,,,,,,2232.5300,8649.8600,percent of total billed charges,"41.7% of $8,649.86 in Billed Charges for Rev 272 = $3,606.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER 100MM GIA10038S SURPASS SEE LN 36015,272,RC,,,,,,,,both,,,8649.8600,1297.4800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7784.87,,,,,,,2232.5300,8649.8600,percent of total billed charges,"90% of $8,649.86 in Billed Charges for Rev 272 = $7,784.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER 100MM GIA10038S SURPASS SEE LN 36015,272,RC,,,,,,,,both,,,8649.8600,1297.4800,MEDCOST,MEDCOST VHN,4116.47,,,,,,,2232.5300,8649.8600,percent of total billed charges,"47.59% of $8,649.86 in Billed Charges for Rev 272 = $4,116.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER 100MM GIA10038S SURPASS SEE LN 36015,272,RC,,,,,,,,both,,,8649.8600,1297.4800,SENTARA HEALTH,SENTARA HEALTH,2232.53,,,,,,,2232.5300,8649.8600,percent of total billed charges,"25.81% of $8,649.86 in Billed Charges for Rev 272 = $2,232.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER 100MM GIA10038S SURPASS SEE LN 36015,272,RC,,,,,,,,both,,,8649.8600,1297.4800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8649.86,,,,,,,2232.5300,8649.8600,percent of total billed charges,"100% of $8,649.86 in Billed Charges for Rev 272 = $8,649.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER 100MM GIA10038S SURPASS SEE LN 36015,272,RC,,,,,,,,both,,,8649.8600,1297.4800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4324.93,,,,,,,2232.5300,8649.8600,percent of total billed charges,"Rev 272 $8,649.86 in Billed Charges at 50% = $4,324.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER 100MM GIA10038S SURPASS SEE LN 36015,272,RC,,,,,,,,both,,,8649.8600,1297.4800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2793.90,,,,,,,2232.5300,8649.8600,other,"32.3% of $8,649.86 in Billed Charges for Rev 272 = $2,793.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD STAPLER 100MM GIA10038S SURPASS SEE LN 36015,272,RC,,,,,,,,both,,,8649.8600,1297.4800,UNITED HEALTHCARE,UHC HERITAGE SELECT,2655.51,,,,,,,2232.5300,8649.8600,other,"30.7% of $8,649.86 in Billed Charges for Rev 272 = $2,655.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD STAPLER 100MM GIA10038S SURPASS SEE LN 36015,272,RC,,,,,,,,both,,,8649.8600,1297.4800,UNITED HEALTHCARE,UNITED HEALTHCARE,2793.90,,,,,,,2232.5300,8649.8600,percent of total billed charges,"32.3% of $8,649.86 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER 100MM GIA10038S SURPASS SEE LN 36015,272,RC,,,,,,,,both,,,8649.8600,1297.4800,WELLCARE,WELLCARE MEDICAID,8649.86,,,,,,,2232.5300,8649.8600,percent of total billed charges,"100% of $8,649.86 in Billed Charges for Rev 272 = $8,649.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1535.6300,230.3400,AETNA,AETNA,655.71,,,,,,,396.3500,1535.6300,percent of total billed charges,"42.7% of $1,535.63 in Billed Charges for Rev 272 = $655.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1535.6300,230.3400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1074.94,,,,,,,396.3500,1535.6300,percent of total billed charges,"Rev 272 $1,535.63 in Billed Charges at 70% = $1,074.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1535.6300,230.3400,CIGNA HEALTHCARE,CIGNA HMO,640.36,,,,,,,396.3500,1535.6300,percent of total billed charges,"41.7% of $1,535.63 in Billed Charges for Rev 272 = $640.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1535.6300,230.3400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,712.53,,,,,,,396.3500,1535.6300,percent of total billed charges,"46.4% of $1,535.63 in Billed Charges for Rev 272 = $712.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1535.6300,230.3400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,640.36,,,,,,,396.3500,1535.6300,percent of total billed charges,"41.7% of $1,535.63 in Billed Charges for Rev 272 = $640.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1535.6300,230.3400,CIGNA HEALTHCARE,CIGNA PPO,640.36,,,,,,,396.3500,1535.6300,percent of total billed charges,"41.7% of $1,535.63 in Billed Charges for Rev 272 = $640.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1535.6300,230.3400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1382.07,,,,,,,396.3500,1535.6300,percent of total billed charges,"90% of $1,535.63 in Billed Charges for Rev 272 = $1,382.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1535.6300,230.3400,MEDCOST,MEDCOST VHN,730.81,,,,,,,396.3500,1535.6300,percent of total billed charges,"47.59% of $1,535.63 in Billed Charges for Rev 272 = $730.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1535.6300,230.3400,SENTARA HEALTH,SENTARA HEALTH,396.35,,,,,,,396.3500,1535.6300,percent of total billed charges,"25.81% of $1,535.63 in Billed Charges for Rev 272 = $396.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1535.6300,230.3400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1535.63,,,,,,,396.3500,1535.6300,percent of total billed charges,"100% of $1,535.63 in Billed Charges for Rev 272 = $1,535.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1535.6300,230.3400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,767.82,,,,,,,396.3500,1535.6300,percent of total billed charges,"Rev 272 $1,535.63 in Billed Charges at 50% = $767.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1535.6300,230.3400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,496.01,,,,,,,396.3500,1535.6300,other,"32.3% of $1,535.63 in Billed Charges for Rev 272 = $496.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1535.6300,230.3400,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.44,,,,,,,396.3500,1535.6300,other,"30.7% of $1,535.63 in Billed Charges for Rev 272 = $471.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1535.6300,230.3400,UNITED HEALTHCARE,UNITED HEALTHCARE,496.01,,,,,,,396.3500,1535.6300,percent of total billed charges,"32.3% of $1,535.63 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1535.6300,230.3400,WELLCARE,WELLCARE MEDICAID,1535.63,,,,,,,396.3500,1535.6300,percent of total billed charges,"100% of $1,535.63 in Billed Charges for Rev 272 = $1,535.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION FOR NAILS 8-11MM RIGID/STREILE,272,RC,27200002,CDM,,,,,,both,,,3276.6100,491.4900,AETNA,AETNA,1399.11,,,,,,,845.6900,3276.6100,percent of total billed charges,"42.7% of $3,276.61 in Billed Charges for Rev 272 = $1,399.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION FOR NAILS 8-11MM RIGID/STREILE,272,RC,27200002,CDM,,,,,,both,,,3276.6100,491.4900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2293.63,,,,,,,845.6900,3276.6100,percent of total billed charges,"Rev 272 $3,276.61 in Billed Charges at 70% = $2,293.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION FOR NAILS 8-11MM RIGID/STREILE,272,RC,27200002,CDM,,,,,,both,,,3276.6100,491.4900,CIGNA HEALTHCARE,CIGNA HMO,1366.35,,,,,,,845.6900,3276.6100,percent of total billed charges,"41.7% of $3,276.61 in Billed Charges for Rev 272 = $1,366.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION FOR NAILS 8-11MM RIGID/STREILE,272,RC,27200002,CDM,,,,,,both,,,3276.6100,491.4900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1520.35,,,,,,,845.6900,3276.6100,percent of total billed charges,"46.4% of $3,276.61 in Billed Charges for Rev 272 = $1,520.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION FOR NAILS 8-11MM RIGID/STREILE,272,RC,27200002,CDM,,,,,,both,,,3276.6100,491.4900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1366.35,,,,,,,845.6900,3276.6100,percent of total billed charges,"41.7% of $3,276.61 in Billed Charges for Rev 272 = $1,366.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION FOR NAILS 8-11MM RIGID/STREILE,272,RC,27200002,CDM,,,,,,both,,,3276.6100,491.4900,CIGNA HEALTHCARE,CIGNA PPO,1366.35,,,,,,,845.6900,3276.6100,percent of total billed charges,"41.7% of $3,276.61 in Billed Charges for Rev 272 = $1,366.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION FOR NAILS 8-11MM RIGID/STREILE,272,RC,27200002,CDM,,,,,,both,,,3276.6100,491.4900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2948.95,,,,,,,845.6900,3276.6100,percent of total billed charges,"90% of $3,276.61 in Billed Charges for Rev 272 = $2,948.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION FOR NAILS 8-11MM RIGID/STREILE,272,RC,27200002,CDM,,,,,,both,,,3276.6100,491.4900,MEDCOST,MEDCOST VHN,1559.34,,,,,,,845.6900,3276.6100,percent of total billed charges,"47.59% of $3,276.61 in Billed Charges for Rev 272 = $1,559.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION FOR NAILS 8-11MM RIGID/STREILE,272,RC,27200002,CDM,,,,,,both,,,3276.6100,491.4900,SENTARA HEALTH,SENTARA HEALTH,845.69,,,,,,,845.6900,3276.6100,percent of total billed charges,"25.81% of $3,276.61 in Billed Charges for Rev 272 = $845.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION FOR NAILS 8-11MM RIGID/STREILE,272,RC,27200002,CDM,,,,,,both,,,3276.6100,491.4900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3276.61,,,,,,,845.6900,3276.6100,percent of total billed charges,"100% of $3,276.61 in Billed Charges for Rev 272 = $3,276.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION FOR NAILS 8-11MM RIGID/STREILE,272,RC,27200002,CDM,,,,,,both,,,3276.6100,491.4900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1638.31,,,,,,,845.6900,3276.6100,percent of total billed charges,"Rev 272 $3,276.61 in Billed Charges at 50% = $1,638.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION FOR NAILS 8-11MM RIGID/STREILE,272,RC,27200002,CDM,,,,,,both,,,3276.6100,491.4900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1058.35,,,,,,,845.6900,3276.6100,other,"32.3% of $3,276.61 in Billed Charges for Rev 272 = $1,058.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SLEEVE PROTECTION FOR NAILS 8-11MM RIGID/STREILE,272,RC,27200002,CDM,,,,,,both,,,3276.6100,491.4900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1005.92,,,,,,,845.6900,3276.6100,other,"30.7% of $3,276.61 in Billed Charges for Rev 272 = $1,005.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SLEEVE PROTECTION FOR NAILS 8-11MM RIGID/STREILE,272,RC,27200002,CDM,,,,,,both,,,3276.6100,491.4900,UNITED HEALTHCARE,UNITED HEALTHCARE,1058.35,,,,,,,845.6900,3276.6100,percent of total billed charges,"32.3% of $3,276.61 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE PROTECTION FOR NAILS 8-11MM RIGID/STREILE,272,RC,27200002,CDM,,,,,,both,,,3276.6100,491.4900,WELLCARE,WELLCARE MEDICAID,3276.61,,,,,,,845.6900,3276.6100,percent of total billed charges,"100% of $3,276.61 in Billed Charges for Rev 272 = $3,276.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SMART CAP ENDO # 10014,270,RC,,,,,,,,both,,,829.6800,124.4500,AETNA,AETNA,354.27,,,,,,,214.1400,829.6800,percent of total billed charges,42.7% of $829.68 in Billed Charges for Rev 270 = $354.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SMART CAP ENDO # 10014,270,RC,,,,,,,,both,,,829.6800,124.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,580.78,,,,,,,214.1400,829.6800,percent of total billed charges,Rev 270 $829.68 in Billed Charges at 70% = $580.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SMART CAP ENDO # 10014,270,RC,,,,,,,,both,,,829.6800,124.4500,CIGNA HEALTHCARE,CIGNA HMO,345.98,,,,,,,214.1400,829.6800,percent of total billed charges,41.7% of $829.68 in Billed Charges for Rev 270 = $345.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SMART CAP ENDO # 10014,270,RC,,,,,,,,both,,,829.6800,124.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,384.97,,,,,,,214.1400,829.6800,percent of total billed charges,46.4% of $829.68 in Billed Charges for Rev 270 = $384.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SMART CAP ENDO # 10014,270,RC,,,,,,,,both,,,829.6800,124.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,345.98,,,,,,,214.1400,829.6800,percent of total billed charges,41.7% of $829.68 in Billed Charges for Rev 270 = $345.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SMART CAP ENDO # 10014,270,RC,,,,,,,,both,,,829.6800,124.4500,CIGNA HEALTHCARE,CIGNA PPO,345.98,,,,,,,214.1400,829.6800,percent of total billed charges,41.7% of $829.68 in Billed Charges for Rev 270 = $345.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SMART CAP ENDO # 10014,270,RC,,,,,,,,both,,,829.6800,124.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,746.71,,,,,,,214.1400,829.6800,percent of total billed charges,90% of $829.68 in Billed Charges for Rev 270 = $746.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SMART CAP ENDO # 10014,270,RC,,,,,,,,both,,,829.6800,124.4500,MEDCOST,MEDCOST VHN,394.84,,,,,,,214.1400,829.6800,percent of total billed charges,47.59% of $829.68 in Billed Charges for Rev 270 = $394.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SMART CAP ENDO # 10014,270,RC,,,,,,,,both,,,829.6800,124.4500,SENTARA HEALTH,SENTARA HEALTH,214.14,,,,,,,214.1400,829.6800,percent of total billed charges,25.81% of $829.68 in Billed Charges for Rev 270 = $214.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SMART CAP ENDO # 10014,270,RC,,,,,,,,both,,,829.6800,124.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",829.68,,,,,,,214.1400,829.6800,percent of total billed charges,100% of $829.68 in Billed Charges for Rev 270 = $829.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SMART CAP ENDO # 10014,270,RC,,,,,,,,both,,,829.6800,124.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,414.84,,,,,,,214.1400,829.6800,percent of total billed charges,Rev 270 $829.68 in Billed Charges at 50% = $414.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SMART CAP ENDO # 10014,270,RC,,,,,,,,both,,,829.6800,124.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,267.99,,,,,,,214.1400,829.6800,other,32.3% of $829.68 in Billed Charges for Rev 270 = $267.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SMART CAP ENDO # 10014,270,RC,,,,,,,,both,,,829.6800,124.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,254.71,,,,,,,214.1400,829.6800,other,30.7% of $829.68 in Billed Charges for Rev 270 = $254.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SMART CAP ENDO # 10014,270,RC,,,,,,,,both,,,829.6800,124.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,267.99,,,,,,,214.1400,829.6800,percent of total billed charges,32.3% of $829.68 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SMART CAP ENDO # 10014,270,RC,,,,,,,,both,,,829.6800,124.4500,WELLCARE,WELLCARE MEDICAID,829.68,,,,,,,214.1400,829.6800,percent of total billed charges,100% of $829.68 in Billed Charges for Rev 270 = $829.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLER ECHELON 60MM WHITE GST60W,272,RC,27200002,CDM,,,,,,both,,,19247.7500,2887.1600,AETNA,AETNA,8218.79,,,,,,,4967.8400,19247.7500,percent of total billed charges,"42.7% of $19,247.75 in Billed Charges for Rev 272 = $8,218.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM WHITE GST60W,272,RC,27200002,CDM,,,,,,both,,,19247.7500,2887.1600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,13473.43,,,,,,,4967.8400,19247.7500,percent of total billed charges,"Rev 272 $19,247.75 in Billed Charges at 70% = $13,473.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM WHITE GST60W,272,RC,27200002,CDM,,,,,,both,,,19247.7500,2887.1600,CIGNA HEALTHCARE,CIGNA HMO,8026.31,,,,,,,4967.8400,19247.7500,percent of total billed charges,"41.7% of $19,247.75 in Billed Charges for Rev 272 = $8,026.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM WHITE GST60W,272,RC,27200002,CDM,,,,,,both,,,19247.7500,2887.1600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8930.96,,,,,,,4967.8400,19247.7500,percent of total billed charges,"46.4% of $19,247.75 in Billed Charges for Rev 272 = $8,930.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM WHITE GST60W,272,RC,27200002,CDM,,,,,,both,,,19247.7500,2887.1600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8026.31,,,,,,,4967.8400,19247.7500,percent of total billed charges,"41.7% of $19,247.75 in Billed Charges for Rev 272 = $8,026.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM WHITE GST60W,272,RC,27200002,CDM,,,,,,both,,,19247.7500,2887.1600,CIGNA HEALTHCARE,CIGNA PPO,8026.31,,,,,,,4967.8400,19247.7500,percent of total billed charges,"41.7% of $19,247.75 in Billed Charges for Rev 272 = $8,026.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM WHITE GST60W,272,RC,27200002,CDM,,,,,,both,,,19247.7500,2887.1600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,17322.98,,,,,,,4967.8400,19247.7500,percent of total billed charges,"90% of $19,247.75 in Billed Charges for Rev 272 = $17,322.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM WHITE GST60W,272,RC,27200002,CDM,,,,,,both,,,19247.7500,2887.1600,MEDCOST,MEDCOST VHN,9160.00,,,,,,,4967.8400,19247.7500,percent of total billed charges,"47.59% of $19,247.75 in Billed Charges for Rev 272 = $9,160.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM WHITE GST60W,272,RC,27200002,CDM,,,,,,both,,,19247.7500,2887.1600,SENTARA HEALTH,SENTARA HEALTH,4967.84,,,,,,,4967.8400,19247.7500,percent of total billed charges,"25.81% of $19,247.75 in Billed Charges for Rev 272 = $4,967.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM WHITE GST60W,272,RC,27200002,CDM,,,,,,both,,,19247.7500,2887.1600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",19247.75,,,,,,,4967.8400,19247.7500,percent of total billed charges,"100% of $19,247.75 in Billed Charges for Rev 272 = $19,247.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM WHITE GST60W,272,RC,27200002,CDM,,,,,,both,,,19247.7500,2887.1600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9623.88,,,,,,,4967.8400,19247.7500,percent of total billed charges,"Rev 272 $19,247.75 in Billed Charges at 50% = $9,623.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM WHITE GST60W,272,RC,27200002,CDM,,,,,,both,,,19247.7500,2887.1600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,6217.02,,,,,,,4967.8400,19247.7500,other,"32.3% of $19,247.75 in Billed Charges for Rev 272 = $6,217.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD STAPLER ECHELON 60MM WHITE GST60W,272,RC,27200002,CDM,,,,,,both,,,19247.7500,2887.1600,UNITED HEALTHCARE,UHC HERITAGE SELECT,5909.06,,,,,,,4967.8400,19247.7500,other,"30.7% of $19,247.75 in Billed Charges for Rev 272 = $5,909.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD STAPLER ECHELON 60MM WHITE GST60W,272,RC,27200002,CDM,,,,,,both,,,19247.7500,2887.1600,UNITED HEALTHCARE,UNITED HEALTHCARE,6217.02,,,,,,,4967.8400,19247.7500,percent of total billed charges,"32.3% of $19,247.75 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM WHITE GST60W,272,RC,27200002,CDM,,,,,,both,,,19247.7500,2887.1600,WELLCARE,WELLCARE MEDICAID,19247.75,,,,,,,4967.8400,19247.7500,percent of total billed charges,"100% of $19,247.75 in Billed Charges for Rev 272 = $19,247.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON CONTOUR  GST  (BLUE),272,RC,27200002,CDM,,,,,,both,,,2939.9500,440.9900,AETNA,AETNA,1255.36,,,,,,,758.8000,2939.9500,percent of total billed charges,"42.7% of $2,939.95 in Billed Charges for Rev 272 = $1,255.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON CONTOUR  GST  (BLUE),272,RC,27200002,CDM,,,,,,both,,,2939.9500,440.9900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2057.97,,,,,,,758.8000,2939.9500,percent of total billed charges,"Rev 272 $2,939.95 in Billed Charges at 70% = $2,057.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON CONTOUR  GST  (BLUE),272,RC,27200002,CDM,,,,,,both,,,2939.9500,440.9900,CIGNA HEALTHCARE,CIGNA HMO,1225.96,,,,,,,758.8000,2939.9500,percent of total billed charges,"41.7% of $2,939.95 in Billed Charges for Rev 272 = $1,225.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON CONTOUR  GST  (BLUE),272,RC,27200002,CDM,,,,,,both,,,2939.9500,440.9900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1364.14,,,,,,,758.8000,2939.9500,percent of total billed charges,"46.4% of $2,939.95 in Billed Charges for Rev 272 = $1,364.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON CONTOUR  GST  (BLUE),272,RC,27200002,CDM,,,,,,both,,,2939.9500,440.9900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1225.96,,,,,,,758.8000,2939.9500,percent of total billed charges,"41.7% of $2,939.95 in Billed Charges for Rev 272 = $1,225.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON CONTOUR  GST  (BLUE),272,RC,27200002,CDM,,,,,,both,,,2939.9500,440.9900,CIGNA HEALTHCARE,CIGNA PPO,1225.96,,,,,,,758.8000,2939.9500,percent of total billed charges,"41.7% of $2,939.95 in Billed Charges for Rev 272 = $1,225.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON CONTOUR  GST  (BLUE),272,RC,27200002,CDM,,,,,,both,,,2939.9500,440.9900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2645.96,,,,,,,758.8000,2939.9500,percent of total billed charges,"90% of $2,939.95 in Billed Charges for Rev 272 = $2,645.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON CONTOUR  GST  (BLUE),272,RC,27200002,CDM,,,,,,both,,,2939.9500,440.9900,MEDCOST,MEDCOST VHN,1399.12,,,,,,,758.8000,2939.9500,percent of total billed charges,"47.59% of $2,939.95 in Billed Charges for Rev 272 = $1,399.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON CONTOUR  GST  (BLUE),272,RC,27200002,CDM,,,,,,both,,,2939.9500,440.9900,SENTARA HEALTH,SENTARA HEALTH,758.80,,,,,,,758.8000,2939.9500,percent of total billed charges,"25.81% of $2,939.95 in Billed Charges for Rev 272 = $758.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON CONTOUR  GST  (BLUE),272,RC,27200002,CDM,,,,,,both,,,2939.9500,440.9900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2939.95,,,,,,,758.8000,2939.9500,percent of total billed charges,"100% of $2,939.95 in Billed Charges for Rev 272 = $2,939.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON CONTOUR  GST  (BLUE),272,RC,27200002,CDM,,,,,,both,,,2939.9500,440.9900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1469.98,,,,,,,758.8000,2939.9500,percent of total billed charges,"Rev 272 $2,939.95 in Billed Charges at 50% = $1,469.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON CONTOUR  GST  (BLUE),272,RC,27200002,CDM,,,,,,both,,,2939.9500,440.9900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,949.60,,,,,,,758.8000,2939.9500,other,"32.3% of $2,939.95 in Billed Charges for Rev 272 = $949.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD STAPLER ECHELON CONTOUR  GST  (BLUE),272,RC,27200002,CDM,,,,,,both,,,2939.9500,440.9900,UNITED HEALTHCARE,UHC HERITAGE SELECT,902.56,,,,,,,758.8000,2939.9500,other,"30.7% of $2,939.95 in Billed Charges for Rev 272 = $902.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD STAPLER ECHELON CONTOUR  GST  (BLUE),272,RC,27200002,CDM,,,,,,both,,,2939.9500,440.9900,UNITED HEALTHCARE,UNITED HEALTHCARE,949.60,,,,,,,758.8000,2939.9500,percent of total billed charges,"32.3% of $2,939.95 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON CONTOUR  GST  (BLUE),272,RC,27200002,CDM,,,,,,both,,,2939.9500,440.9900,WELLCARE,WELLCARE MEDICAID,2939.95,,,,,,,758.8000,2939.9500,percent of total billed charges,"100% of $2,939.95 in Billed Charges for Rev 272 = $2,939.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,856.8300,128.5200,AETNA,AETNA,365.87,,,,,,,221.1500,856.8300,percent of total billed charges,42.7% of $856.83 in Billed Charges for Rev 272 = $365.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,856.8300,128.5200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,599.78,,,,,,,221.1500,856.8300,percent of total billed charges,Rev 272 $856.83 in Billed Charges at 70% = $599.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,856.8300,128.5200,CIGNA HEALTHCARE,CIGNA HMO,357.30,,,,,,,221.1500,856.8300,percent of total billed charges,41.7% of $856.83 in Billed Charges for Rev 272 = $357.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,856.8300,128.5200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,397.57,,,,,,,221.1500,856.8300,percent of total billed charges,46.4% of $856.83 in Billed Charges for Rev 272 = $397.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,856.8300,128.5200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,357.30,,,,,,,221.1500,856.8300,percent of total billed charges,41.7% of $856.83 in Billed Charges for Rev 272 = $357.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,856.8300,128.5200,CIGNA HEALTHCARE,CIGNA PPO,357.30,,,,,,,221.1500,856.8300,percent of total billed charges,41.7% of $856.83 in Billed Charges for Rev 272 = $357.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,856.8300,128.5200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,771.15,,,,,,,221.1500,856.8300,percent of total billed charges,90% of $856.83 in Billed Charges for Rev 272 = $771.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,856.8300,128.5200,MEDCOST,MEDCOST VHN,407.77,,,,,,,221.1500,856.8300,percent of total billed charges,47.59% of $856.83 in Billed Charges for Rev 272 = $407.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,856.8300,128.5200,SENTARA HEALTH,SENTARA HEALTH,221.15,,,,,,,221.1500,856.8300,percent of total billed charges,25.81% of $856.83 in Billed Charges for Rev 272 = $221.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,856.8300,128.5200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",856.83,,,,,,,221.1500,856.8300,percent of total billed charges,100% of $856.83 in Billed Charges for Rev 272 = $856.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,856.8300,128.5200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,428.42,,,,,,,221.1500,856.8300,percent of total billed charges,Rev 272 $856.83 in Billed Charges at 50% = $428.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,856.8300,128.5200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,276.76,,,,,,,221.1500,856.8300,other,32.3% of $856.83 in Billed Charges for Rev 272 = $276.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,856.8300,128.5200,UNITED HEALTHCARE,UHC HERITAGE SELECT,263.05,,,,,,,221.1500,856.8300,other,30.7% of $856.83 in Billed Charges for Rev 272 = $263.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,856.8300,128.5200,UNITED HEALTHCARE,UNITED HEALTHCARE,276.76,,,,,,,221.1500,856.8300,percent of total billed charges,32.3% of $856.83 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RELOAD STAPLER PROX 100 GRN,272,RC,27200002,CDM,,,,,,both,,,856.8300,128.5200,WELLCARE,WELLCARE MEDICAID,856.83,,,,,,,221.1500,856.8300,percent of total billed charges,100% of $856.83 in Billed Charges for Rev 272 = $856.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCREW DRIVER PEG DRVR-S20,272,RC,,,,,,,,both,,,1078.5800,161.7900,AETNA,AETNA,460.55,,,,,,,278.3800,1078.5800,percent of total billed charges,"42.7% of $1,078.58 in Billed Charges for Rev 272 = $460.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER PEG DRVR-S20,272,RC,,,,,,,,both,,,1078.5800,161.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,755.01,,,,,,,278.3800,1078.5800,percent of total billed charges,"Rev 272 $1,078.58 in Billed Charges at 70% = $755.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER PEG DRVR-S20,272,RC,,,,,,,,both,,,1078.5800,161.7900,CIGNA HEALTHCARE,CIGNA HMO,449.77,,,,,,,278.3800,1078.5800,percent of total billed charges,"41.7% of $1,078.58 in Billed Charges for Rev 272 = $449.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER PEG DRVR-S20,272,RC,,,,,,,,both,,,1078.5800,161.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,500.46,,,,,,,278.3800,1078.5800,percent of total billed charges,"46.4% of $1,078.58 in Billed Charges for Rev 272 = $500.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER PEG DRVR-S20,272,RC,,,,,,,,both,,,1078.5800,161.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,449.77,,,,,,,278.3800,1078.5800,percent of total billed charges,"41.7% of $1,078.58 in Billed Charges for Rev 272 = $449.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER PEG DRVR-S20,272,RC,,,,,,,,both,,,1078.5800,161.7900,CIGNA HEALTHCARE,CIGNA PPO,449.77,,,,,,,278.3800,1078.5800,percent of total billed charges,"41.7% of $1,078.58 in Billed Charges for Rev 272 = $449.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER PEG DRVR-S20,272,RC,,,,,,,,both,,,1078.5800,161.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,970.72,,,,,,,278.3800,1078.5800,percent of total billed charges,"90% of $1,078.58 in Billed Charges for Rev 272 = $970.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER PEG DRVR-S20,272,RC,,,,,,,,both,,,1078.5800,161.7900,MEDCOST,MEDCOST VHN,513.30,,,,,,,278.3800,1078.5800,percent of total billed charges,"47.59% of $1,078.58 in Billed Charges for Rev 272 = $513.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER PEG DRVR-S20,272,RC,,,,,,,,both,,,1078.5800,161.7900,SENTARA HEALTH,SENTARA HEALTH,278.38,,,,,,,278.3800,1078.5800,percent of total billed charges,"25.81% of $1,078.58 in Billed Charges for Rev 272 = $278.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER PEG DRVR-S20,272,RC,,,,,,,,both,,,1078.5800,161.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1078.58,,,,,,,278.3800,1078.5800,percent of total billed charges,"100% of $1,078.58 in Billed Charges for Rev 272 = $1,078.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER PEG DRVR-S20,272,RC,,,,,,,,both,,,1078.5800,161.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,539.29,,,,,,,278.3800,1078.5800,percent of total billed charges,"Rev 272 $1,078.58 in Billed Charges at 50% = $539.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER PEG DRVR-S20,272,RC,,,,,,,,both,,,1078.5800,161.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,348.38,,,,,,,278.3800,1078.5800,other,"32.3% of $1,078.58 in Billed Charges for Rev 272 = $348.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCREW DRIVER PEG DRVR-S20,272,RC,,,,,,,,both,,,1078.5800,161.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,331.12,,,,,,,278.3800,1078.5800,other,"30.7% of $1,078.58 in Billed Charges for Rev 272 = $331.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCREW DRIVER PEG DRVR-S20,272,RC,,,,,,,,both,,,1078.5800,161.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,348.38,,,,,,,278.3800,1078.5800,percent of total billed charges,"32.3% of $1,078.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER PEG DRVR-S20,272,RC,,,,,,,,both,,,1078.5800,161.7900,WELLCARE,WELLCARE MEDICAID,1078.58,,,,,,,278.3800,1078.5800,percent of total billed charges,"100% of $1,078.58 in Billed Charges for Rev 272 = $1,078.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE 9 15MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3230.2600,484.5400,AETNA,AETNA,1379.32,,,,,,,833.7300,3230.2600,percent of total billed charges,"42.7% of $3,230.26 in Billed Charges for Rev 272 = $1,379.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE 9 15MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3230.2600,484.5400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2261.18,,,,,,,833.7300,3230.2600,percent of total billed charges,"Rev 272 $3,230.26 in Billed Charges at 70% = $2,261.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE 9 15MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3230.2600,484.5400,CIGNA HEALTHCARE,CIGNA HMO,1347.02,,,,,,,833.7300,3230.2600,percent of total billed charges,"41.7% of $3,230.26 in Billed Charges for Rev 272 = $1,347.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE 9 15MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3230.2600,484.5400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1498.84,,,,,,,833.7300,3230.2600,percent of total billed charges,"46.4% of $3,230.26 in Billed Charges for Rev 272 = $1,498.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE 9 15MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3230.2600,484.5400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1347.02,,,,,,,833.7300,3230.2600,percent of total billed charges,"41.7% of $3,230.26 in Billed Charges for Rev 272 = $1,347.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE 9 15MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3230.2600,484.5400,CIGNA HEALTHCARE,CIGNA PPO,1347.02,,,,,,,833.7300,3230.2600,percent of total billed charges,"41.7% of $3,230.26 in Billed Charges for Rev 272 = $1,347.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE 9 15MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3230.2600,484.5400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2907.23,,,,,,,833.7300,3230.2600,percent of total billed charges,"90% of $3,230.26 in Billed Charges for Rev 272 = $2,907.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE 9 15MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3230.2600,484.5400,MEDCOST,MEDCOST VHN,1537.28,,,,,,,833.7300,3230.2600,percent of total billed charges,"47.59% of $3,230.26 in Billed Charges for Rev 272 = $1,537.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE 9 15MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3230.2600,484.5400,SENTARA HEALTH,SENTARA HEALTH,833.73,,,,,,,833.7300,3230.2600,percent of total billed charges,"25.81% of $3,230.26 in Billed Charges for Rev 272 = $833.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE 9 15MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3230.2600,484.5400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3230.26,,,,,,,833.7300,3230.2600,percent of total billed charges,"100% of $3,230.26 in Billed Charges for Rev 272 = $3,230.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE 9 15MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3230.2600,484.5400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1615.13,,,,,,,833.7300,3230.2600,percent of total billed charges,"Rev 272 $3,230.26 in Billed Charges at 50% = $1,615.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE 9 15MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3230.2600,484.5400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1043.37,,,,,,,833.7300,3230.2600,other,"32.3% of $3,230.26 in Billed Charges for Rev 272 = $1,043.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SNARE 9 15MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3230.2600,484.5400,UNITED HEALTHCARE,UHC HERITAGE SELECT,991.69,,,,,,,833.7300,3230.2600,other,"30.7% of $3,230.26 in Billed Charges for Rev 272 = $991.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SNARE 9 15MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3230.2600,484.5400,UNITED HEALTHCARE,UNITED HEALTHCARE,1043.37,,,,,,,833.7300,3230.2600,percent of total billed charges,"32.3% of $3,230.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SNARE 9 15MM X 120CM,272,RC,27200002,CDM,,,,,,both,,,3230.2600,484.5400,WELLCARE,WELLCARE MEDICAID,3230.26,,,,,,,833.7300,3230.2600,percent of total billed charges,"100% of $3,230.26 in Billed Charges for Rev 272 = $3,230.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SOLUTION PRONTOSAN W/PULSE LAVAGE ADAPTER WOUNND IRRG,272,RC,27200002,CDM,,,,,,both,,,1130.4400,169.5700,AETNA,AETNA,482.70,,,,,,,291.7700,1130.4400,percent of total billed charges,"42.7% of $1,130.44 in Billed Charges for Rev 272 = $482.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SOLUTION PRONTOSAN W/PULSE LAVAGE ADAPTER WOUNND IRRG,272,RC,27200002,CDM,,,,,,both,,,1130.4400,169.5700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,791.31,,,,,,,291.7700,1130.4400,percent of total billed charges,"Rev 272 $1,130.44 in Billed Charges at 70% = $791.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SOLUTION PRONTOSAN W/PULSE LAVAGE ADAPTER WOUNND IRRG,272,RC,27200002,CDM,,,,,,both,,,1130.4400,169.5700,CIGNA HEALTHCARE,CIGNA HMO,471.39,,,,,,,291.7700,1130.4400,percent of total billed charges,"41.7% of $1,130.44 in Billed Charges for Rev 272 = $471.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SOLUTION PRONTOSAN W/PULSE LAVAGE ADAPTER WOUNND IRRG,272,RC,27200002,CDM,,,,,,both,,,1130.4400,169.5700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,524.52,,,,,,,291.7700,1130.4400,percent of total billed charges,"46.4% of $1,130.44 in Billed Charges for Rev 272 = $524.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SOLUTION PRONTOSAN W/PULSE LAVAGE ADAPTER WOUNND IRRG,272,RC,27200002,CDM,,,,,,both,,,1130.4400,169.5700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,471.39,,,,,,,291.7700,1130.4400,percent of total billed charges,"41.7% of $1,130.44 in Billed Charges for Rev 272 = $471.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SOLUTION PRONTOSAN W/PULSE LAVAGE ADAPTER WOUNND IRRG,272,RC,27200002,CDM,,,,,,both,,,1130.4400,169.5700,CIGNA HEALTHCARE,CIGNA PPO,471.39,,,,,,,291.7700,1130.4400,percent of total billed charges,"41.7% of $1,130.44 in Billed Charges for Rev 272 = $471.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SOLUTION PRONTOSAN W/PULSE LAVAGE ADAPTER WOUNND IRRG,272,RC,27200002,CDM,,,,,,both,,,1130.4400,169.5700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1017.40,,,,,,,291.7700,1130.4400,percent of total billed charges,"90% of $1,130.44 in Billed Charges for Rev 272 = $1,017.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SOLUTION PRONTOSAN W/PULSE LAVAGE ADAPTER WOUNND IRRG,272,RC,27200002,CDM,,,,,,both,,,1130.4400,169.5700,MEDCOST,MEDCOST VHN,537.98,,,,,,,291.7700,1130.4400,percent of total billed charges,"47.59% of $1,130.44 in Billed Charges for Rev 272 = $537.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SOLUTION PRONTOSAN W/PULSE LAVAGE ADAPTER WOUNND IRRG,272,RC,27200002,CDM,,,,,,both,,,1130.4400,169.5700,SENTARA HEALTH,SENTARA HEALTH,291.77,,,,,,,291.7700,1130.4400,percent of total billed charges,"25.81% of $1,130.44 in Billed Charges for Rev 272 = $291.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SOLUTION PRONTOSAN W/PULSE LAVAGE ADAPTER WOUNND IRRG,272,RC,27200002,CDM,,,,,,both,,,1130.4400,169.5700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1130.44,,,,,,,291.7700,1130.4400,percent of total billed charges,"100% of $1,130.44 in Billed Charges for Rev 272 = $1,130.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SOLUTION PRONTOSAN W/PULSE LAVAGE ADAPTER WOUNND IRRG,272,RC,27200002,CDM,,,,,,both,,,1130.4400,169.5700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,565.22,,,,,,,291.7700,1130.4400,percent of total billed charges,"Rev 272 $1,130.44 in Billed Charges at 50% = $565.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SOLUTION PRONTOSAN W/PULSE LAVAGE ADAPTER WOUNND IRRG,272,RC,27200002,CDM,,,,,,both,,,1130.4400,169.5700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,365.13,,,,,,,291.7700,1130.4400,other,"32.3% of $1,130.44 in Billed Charges for Rev 272 = $365.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SOLUTION PRONTOSAN W/PULSE LAVAGE ADAPTER WOUNND IRRG,272,RC,27200002,CDM,,,,,,both,,,1130.4400,169.5700,UNITED HEALTHCARE,UHC HERITAGE SELECT,347.05,,,,,,,291.7700,1130.4400,other,"30.7% of $1,130.44 in Billed Charges for Rev 272 = $347.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SOLUTION PRONTOSAN W/PULSE LAVAGE ADAPTER WOUNND IRRG,272,RC,27200002,CDM,,,,,,both,,,1130.4400,169.5700,UNITED HEALTHCARE,UNITED HEALTHCARE,365.13,,,,,,,291.7700,1130.4400,percent of total billed charges,"32.3% of $1,130.44 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SOLUTION PRONTOSAN W/PULSE LAVAGE ADAPTER WOUNND IRRG,272,RC,27200002,CDM,,,,,,both,,,1130.4400,169.5700,WELLCARE,WELLCARE MEDICAID,1130.44,,,,,,,291.7700,1130.4400,percent of total billed charges,"100% of $1,130.44 in Billed Charges for Rev 272 = $1,130.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SONICPIN RX SONOTRODE II STANDARD STRAIGHT 1.6X7MM,272,RC,,,,,,,,both,,,2376.3100,356.4500,AETNA,AETNA,1014.68,,,,,,,613.3300,2376.3100,percent of total billed charges,"42.7% of $2,376.31 in Billed Charges for Rev 272 = $1,014.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SONICPIN RX SONOTRODE II STANDARD STRAIGHT 1.6X7MM,272,RC,,,,,,,,both,,,2376.3100,356.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1663.42,,,,,,,613.3300,2376.3100,percent of total billed charges,"Rev 272 $2,376.31 in Billed Charges at 70% = $1,663.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SONICPIN RX SONOTRODE II STANDARD STRAIGHT 1.6X7MM,272,RC,,,,,,,,both,,,2376.3100,356.4500,CIGNA HEALTHCARE,CIGNA HMO,990.92,,,,,,,613.3300,2376.3100,percent of total billed charges,"41.7% of $2,376.31 in Billed Charges for Rev 272 = $990.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SONICPIN RX SONOTRODE II STANDARD STRAIGHT 1.6X7MM,272,RC,,,,,,,,both,,,2376.3100,356.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1102.61,,,,,,,613.3300,2376.3100,percent of total billed charges,"46.4% of $2,376.31 in Billed Charges for Rev 272 = $1,102.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SONICPIN RX SONOTRODE II STANDARD STRAIGHT 1.6X7MM,272,RC,,,,,,,,both,,,2376.3100,356.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,990.92,,,,,,,613.3300,2376.3100,percent of total billed charges,"41.7% of $2,376.31 in Billed Charges for Rev 272 = $990.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SONICPIN RX SONOTRODE II STANDARD STRAIGHT 1.6X7MM,272,RC,,,,,,,,both,,,2376.3100,356.4500,CIGNA HEALTHCARE,CIGNA PPO,990.92,,,,,,,613.3300,2376.3100,percent of total billed charges,"41.7% of $2,376.31 in Billed Charges for Rev 272 = $990.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SONICPIN RX SONOTRODE II STANDARD STRAIGHT 1.6X7MM,272,RC,,,,,,,,both,,,2376.3100,356.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2138.68,,,,,,,613.3300,2376.3100,percent of total billed charges,"90% of $2,376.31 in Billed Charges for Rev 272 = $2,138.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SONICPIN RX SONOTRODE II STANDARD STRAIGHT 1.6X7MM,272,RC,,,,,,,,both,,,2376.3100,356.4500,MEDCOST,MEDCOST VHN,1130.89,,,,,,,613.3300,2376.3100,percent of total billed charges,"47.59% of $2,376.31 in Billed Charges for Rev 272 = $1,130.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SONICPIN RX SONOTRODE II STANDARD STRAIGHT 1.6X7MM,272,RC,,,,,,,,both,,,2376.3100,356.4500,SENTARA HEALTH,SENTARA HEALTH,613.33,,,,,,,613.3300,2376.3100,percent of total billed charges,"25.81% of $2,376.31 in Billed Charges for Rev 272 = $613.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SONICPIN RX SONOTRODE II STANDARD STRAIGHT 1.6X7MM,272,RC,,,,,,,,both,,,2376.3100,356.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2376.31,,,,,,,613.3300,2376.3100,percent of total billed charges,"100% of $2,376.31 in Billed Charges for Rev 272 = $2,376.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SONICPIN RX SONOTRODE II STANDARD STRAIGHT 1.6X7MM,272,RC,,,,,,,,both,,,2376.3100,356.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1188.16,,,,,,,613.3300,2376.3100,percent of total billed charges,"Rev 272 $2,376.31 in Billed Charges at 50% = $1,188.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SONICPIN RX SONOTRODE II STANDARD STRAIGHT 1.6X7MM,272,RC,,,,,,,,both,,,2376.3100,356.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,767.55,,,,,,,613.3300,2376.3100,other,"32.3% of $2,376.31 in Billed Charges for Rev 272 = $767.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SONICPIN RX SONOTRODE II STANDARD STRAIGHT 1.6X7MM,272,RC,,,,,,,,both,,,2376.3100,356.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,729.53,,,,,,,613.3300,2376.3100,other,"30.7% of $2,376.31 in Billed Charges for Rev 272 = $729.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SONICPIN RX SONOTRODE II STANDARD STRAIGHT 1.6X7MM,272,RC,,,,,,,,both,,,2376.3100,356.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,767.55,,,,,,,613.3300,2376.3100,percent of total billed charges,"32.3% of $2,376.31 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SONICPIN RX SONOTRODE II STANDARD STRAIGHT 1.6X7MM,272,RC,,,,,,,,both,,,2376.3100,356.4500,WELLCARE,WELLCARE MEDICAID,2376.31,,,,,,,613.3300,2376.3100,percent of total billed charges,"100% of $2,376.31 in Billed Charges for Rev 272 = $2,376.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,706.0200,105.9000,AETNA,AETNA,301.47,,,,,,,182.2200,706.0200,percent of total billed charges,42.7% of $706.02 in Billed Charges for Rev 272 = $301.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,706.0200,105.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,494.21,,,,,,,182.2200,706.0200,percent of total billed charges,Rev 272 $706.02 in Billed Charges at 70% = $494.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,706.0200,105.9000,CIGNA HEALTHCARE,CIGNA HMO,294.41,,,,,,,182.2200,706.0200,percent of total billed charges,41.7% of $706.02 in Billed Charges for Rev 272 = $294.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,706.0200,105.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,327.59,,,,,,,182.2200,706.0200,percent of total billed charges,46.4% of $706.02 in Billed Charges for Rev 272 = $327.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,706.0200,105.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,294.41,,,,,,,182.2200,706.0200,percent of total billed charges,41.7% of $706.02 in Billed Charges for Rev 272 = $294.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,706.0200,105.9000,CIGNA HEALTHCARE,CIGNA PPO,294.41,,,,,,,182.2200,706.0200,percent of total billed charges,41.7% of $706.02 in Billed Charges for Rev 272 = $294.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,706.0200,105.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,635.42,,,,,,,182.2200,706.0200,percent of total billed charges,90% of $706.02 in Billed Charges for Rev 272 = $635.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,706.0200,105.9000,MEDCOST,MEDCOST VHN,335.99,,,,,,,182.2200,706.0200,percent of total billed charges,47.59% of $706.02 in Billed Charges for Rev 272 = $335.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,706.0200,105.9000,SENTARA HEALTH,SENTARA HEALTH,182.22,,,,,,,182.2200,706.0200,percent of total billed charges,25.81% of $706.02 in Billed Charges for Rev 272 = $182.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,706.0200,105.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",706.02,,,,,,,182.2200,706.0200,percent of total billed charges,100% of $706.02 in Billed Charges for Rev 272 = $706.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,706.0200,105.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,353.01,,,,,,,182.2200,706.0200,percent of total billed charges,Rev 272 $706.02 in Billed Charges at 50% = $353.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,706.0200,105.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,228.04,,,,,,,182.2200,706.0200,other,32.3% of $706.02 in Billed Charges for Rev 272 = $228.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,706.0200,105.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,216.75,,,,,,,182.2200,706.0200,other,30.7% of $706.02 in Billed Charges for Rev 272 = $216.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,706.0200,105.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,228.04,,,,,,,182.2200,706.0200,percent of total billed charges,32.3% of $706.02 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,706.0200,105.9000,WELLCARE,WELLCARE MEDICAID,706.02,,,,,,,182.2200,706.0200,percent of total billed charges,100% of $706.02 in Billed Charges for Rev 272 = $706.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,2172.6200,325.8900,AETNA,AETNA,927.71,,,,,,,560.7500,2172.6200,percent of total billed charges,"42.7% of $2,172.62 in Billed Charges for Rev 272 = $927.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,2172.6200,325.8900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1520.83,,,,,,,560.7500,2172.6200,percent of total billed charges,"Rev 272 $2,172.62 in Billed Charges at 70% = $1,520.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,2172.6200,325.8900,CIGNA HEALTHCARE,CIGNA HMO,905.98,,,,,,,560.7500,2172.6200,percent of total billed charges,"41.7% of $2,172.62 in Billed Charges for Rev 272 = $905.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,2172.6200,325.8900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1008.10,,,,,,,560.7500,2172.6200,percent of total billed charges,"46.4% of $2,172.62 in Billed Charges for Rev 272 = $1,008.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,2172.6200,325.8900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,905.98,,,,,,,560.7500,2172.6200,percent of total billed charges,"41.7% of $2,172.62 in Billed Charges for Rev 272 = $905.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,2172.6200,325.8900,CIGNA HEALTHCARE,CIGNA PPO,905.98,,,,,,,560.7500,2172.6200,percent of total billed charges,"41.7% of $2,172.62 in Billed Charges for Rev 272 = $905.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,2172.6200,325.8900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1955.36,,,,,,,560.7500,2172.6200,percent of total billed charges,"90% of $2,172.62 in Billed Charges for Rev 272 = $1,955.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,2172.6200,325.8900,MEDCOST,MEDCOST VHN,1033.95,,,,,,,560.7500,2172.6200,percent of total billed charges,"47.59% of $2,172.62 in Billed Charges for Rev 272 = $1,033.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,2172.6200,325.8900,SENTARA HEALTH,SENTARA HEALTH,560.75,,,,,,,560.7500,2172.6200,percent of total billed charges,"25.81% of $2,172.62 in Billed Charges for Rev 272 = $560.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,2172.6200,325.8900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2172.62,,,,,,,560.7500,2172.6200,percent of total billed charges,"100% of $2,172.62 in Billed Charges for Rev 272 = $2,172.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,2172.6200,325.8900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1086.31,,,,,,,560.7500,2172.6200,percent of total billed charges,"Rev 272 $2,172.62 in Billed Charges at 50% = $1,086.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,2172.6200,325.8900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,701.76,,,,,,,560.7500,2172.6200,other,"32.3% of $2,172.62 in Billed Charges for Rev 272 = $701.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,2172.6200,325.8900,UNITED HEALTHCARE,UHC HERITAGE SELECT,666.99,,,,,,,560.7500,2172.6200,other,"30.7% of $2,172.62 in Billed Charges for Rev 272 = $666.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,2172.6200,325.8900,UNITED HEALTHCARE,UNITED HEALTHCARE,701.76,,,,,,,560.7500,2172.6200,percent of total billed charges,"32.3% of $2,172.62 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR TX 60B,272,RC,27200002,CDM,,,,,,both,,,2172.6200,325.8900,WELLCARE,WELLCARE MEDICAID,2172.62,,,,,,,560.7500,2172.6200,percent of total billed charges,"100% of $2,172.62 in Billed Charges for Rev 272 = $2,172.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER UNIVERSAL,272,RC,,,,,,,,both,,,4825.6300,723.8400,AETNA,AETNA,2060.54,,,,,,,1245.5000,4825.6300,percent of total billed charges,"42.7% of $4,825.63 in Billed Charges for Rev 272 = $2,060.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER UNIVERSAL,272,RC,,,,,,,,both,,,4825.6300,723.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3377.94,,,,,,,1245.5000,4825.6300,percent of total billed charges,"Rev 272 $4,825.63 in Billed Charges at 70% = $3,377.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER UNIVERSAL,272,RC,,,,,,,,both,,,4825.6300,723.8400,CIGNA HEALTHCARE,CIGNA HMO,2012.29,,,,,,,1245.5000,4825.6300,percent of total billed charges,"41.7% of $4,825.63 in Billed Charges for Rev 272 = $2,012.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER UNIVERSAL,272,RC,,,,,,,,both,,,4825.6300,723.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2239.09,,,,,,,1245.5000,4825.6300,percent of total billed charges,"46.4% of $4,825.63 in Billed Charges for Rev 272 = $2,239.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER UNIVERSAL,272,RC,,,,,,,,both,,,4825.6300,723.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2012.29,,,,,,,1245.5000,4825.6300,percent of total billed charges,"41.7% of $4,825.63 in Billed Charges for Rev 272 = $2,012.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER UNIVERSAL,272,RC,,,,,,,,both,,,4825.6300,723.8400,CIGNA HEALTHCARE,CIGNA PPO,2012.29,,,,,,,1245.5000,4825.6300,percent of total billed charges,"41.7% of $4,825.63 in Billed Charges for Rev 272 = $2,012.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER UNIVERSAL,272,RC,,,,,,,,both,,,4825.6300,723.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4343.07,,,,,,,1245.5000,4825.6300,percent of total billed charges,"90% of $4,825.63 in Billed Charges for Rev 272 = $4,343.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER UNIVERSAL,272,RC,,,,,,,,both,,,4825.6300,723.8400,MEDCOST,MEDCOST VHN,2296.52,,,,,,,1245.5000,4825.6300,percent of total billed charges,"47.59% of $4,825.63 in Billed Charges for Rev 272 = $2,296.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER UNIVERSAL,272,RC,,,,,,,,both,,,4825.6300,723.8400,SENTARA HEALTH,SENTARA HEALTH,1245.50,,,,,,,1245.5000,4825.6300,percent of total billed charges,"25.81% of $4,825.63 in Billed Charges for Rev 272 = $1,245.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER UNIVERSAL,272,RC,,,,,,,,both,,,4825.6300,723.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4825.63,,,,,,,1245.5000,4825.6300,percent of total billed charges,"100% of $4,825.63 in Billed Charges for Rev 272 = $4,825.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER UNIVERSAL,272,RC,,,,,,,,both,,,4825.6300,723.8400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2412.82,,,,,,,1245.5000,4825.6300,percent of total billed charges,"Rev 272 $4,825.63 in Billed Charges at 50% = $2,412.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER UNIVERSAL,272,RC,,,,,,,,both,,,4825.6300,723.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1558.68,,,,,,,1245.5000,4825.6300,other,"32.3% of $4,825.63 in Billed Charges for Rev 272 = $1,558.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCREW DRIVER UNIVERSAL,272,RC,,,,,,,,both,,,4825.6300,723.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1481.47,,,,,,,1245.5000,4825.6300,other,"30.7% of $4,825.63 in Billed Charges for Rev 272 = $1,481.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCREW DRIVER UNIVERSAL,272,RC,,,,,,,,both,,,4825.6300,723.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,1558.68,,,,,,,1245.5000,4825.6300,percent of total billed charges,"32.3% of $4,825.63 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW DRIVER UNIVERSAL,272,RC,,,,,,,,both,,,4825.6300,723.8400,WELLCARE,WELLCARE MEDICAID,4825.63,,,,,,,1245.5000,4825.6300,percent of total billed charges,"100% of $4,825.63 in Billed Charges for Rev 272 = $4,825.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW TAP SPINE 5.0MM  CT  GI7,272,RC,,,,,,,,both,,,5672.9400,850.9400,AETNA,AETNA,2422.35,,,,,,,1464.1900,5672.9400,percent of total billed charges,"42.7% of $5,672.94 in Billed Charges for Rev 272 = $2,422.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW TAP SPINE 5.0MM  CT  GI7,272,RC,,,,,,,,both,,,5672.9400,850.9400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3971.06,,,,,,,1464.1900,5672.9400,percent of total billed charges,"Rev 272 $5,672.94 in Billed Charges at 70% = $3,971.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW TAP SPINE 5.0MM  CT  GI7,272,RC,,,,,,,,both,,,5672.9400,850.9400,CIGNA HEALTHCARE,CIGNA HMO,2365.62,,,,,,,1464.1900,5672.9400,percent of total billed charges,"41.7% of $5,672.94 in Billed Charges for Rev 272 = $2,365.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW TAP SPINE 5.0MM  CT  GI7,272,RC,,,,,,,,both,,,5672.9400,850.9400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2632.24,,,,,,,1464.1900,5672.9400,percent of total billed charges,"46.4% of $5,672.94 in Billed Charges for Rev 272 = $2,632.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW TAP SPINE 5.0MM  CT  GI7,272,RC,,,,,,,,both,,,5672.9400,850.9400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2365.62,,,,,,,1464.1900,5672.9400,percent of total billed charges,"41.7% of $5,672.94 in Billed Charges for Rev 272 = $2,365.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW TAP SPINE 5.0MM  CT  GI7,272,RC,,,,,,,,both,,,5672.9400,850.9400,CIGNA HEALTHCARE,CIGNA PPO,2365.62,,,,,,,1464.1900,5672.9400,percent of total billed charges,"41.7% of $5,672.94 in Billed Charges for Rev 272 = $2,365.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW TAP SPINE 5.0MM  CT  GI7,272,RC,,,,,,,,both,,,5672.9400,850.9400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5105.65,,,,,,,1464.1900,5672.9400,percent of total billed charges,"90% of $5,672.94 in Billed Charges for Rev 272 = $5,105.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW TAP SPINE 5.0MM  CT  GI7,272,RC,,,,,,,,both,,,5672.9400,850.9400,MEDCOST,MEDCOST VHN,2699.75,,,,,,,1464.1900,5672.9400,percent of total billed charges,"47.59% of $5,672.94 in Billed Charges for Rev 272 = $2,699.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW TAP SPINE 5.0MM  CT  GI7,272,RC,,,,,,,,both,,,5672.9400,850.9400,SENTARA HEALTH,SENTARA HEALTH,1464.19,,,,,,,1464.1900,5672.9400,percent of total billed charges,"25.81% of $5,672.94 in Billed Charges for Rev 272 = $1,464.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW TAP SPINE 5.0MM  CT  GI7,272,RC,,,,,,,,both,,,5672.9400,850.9400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5672.94,,,,,,,1464.1900,5672.9400,percent of total billed charges,"100% of $5,672.94 in Billed Charges for Rev 272 = $5,672.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW TAP SPINE 5.0MM  CT  GI7,272,RC,,,,,,,,both,,,5672.9400,850.9400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2836.47,,,,,,,1464.1900,5672.9400,percent of total billed charges,"Rev 272 $5,672.94 in Billed Charges at 50% = $2,836.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW TAP SPINE 5.0MM  CT  GI7,272,RC,,,,,,,,both,,,5672.9400,850.9400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1832.36,,,,,,,1464.1900,5672.9400,other,"32.3% of $5,672.94 in Billed Charges for Rev 272 = $1,832.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCREW TAP SPINE 5.0MM  CT  GI7,272,RC,,,,,,,,both,,,5672.9400,850.9400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1741.59,,,,,,,1464.1900,5672.9400,other,"30.7% of $5,672.94 in Billed Charges for Rev 272 = $1,741.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCREW TAP SPINE 5.0MM  CT  GI7,272,RC,,,,,,,,both,,,5672.9400,850.9400,UNITED HEALTHCARE,UNITED HEALTHCARE,1832.36,,,,,,,1464.1900,5672.9400,percent of total billed charges,"32.3% of $5,672.94 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW TAP SPINE 5.0MM  CT  GI7,272,RC,,,,,,,,both,,,5672.9400,850.9400,WELLCARE,WELLCARE MEDICAID,5672.94,,,,,,,1464.1900,5672.9400,percent of total billed charges,"100% of $5,672.94 in Billed Charges for Rev 272 = $5,672.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE T10,272,RC,,,,,,,,both,,,2030.5900,304.5900,AETNA,AETNA,867.06,,,,,,,524.1000,2030.5900,percent of total billed charges,"42.7% of $2,030.59 in Billed Charges for Rev 272 = $867.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE T10,272,RC,,,,,,,,both,,,2030.5900,304.5900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1421.41,,,,,,,524.1000,2030.5900,percent of total billed charges,"Rev 272 $2,030.59 in Billed Charges at 70% = $1,421.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE T10,272,RC,,,,,,,,both,,,2030.5900,304.5900,CIGNA HEALTHCARE,CIGNA HMO,846.76,,,,,,,524.1000,2030.5900,percent of total billed charges,"41.7% of $2,030.59 in Billed Charges for Rev 272 = $846.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE T10,272,RC,,,,,,,,both,,,2030.5900,304.5900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,942.19,,,,,,,524.1000,2030.5900,percent of total billed charges,"46.4% of $2,030.59 in Billed Charges for Rev 272 = $942.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE T10,272,RC,,,,,,,,both,,,2030.5900,304.5900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,846.76,,,,,,,524.1000,2030.5900,percent of total billed charges,"41.7% of $2,030.59 in Billed Charges for Rev 272 = $846.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE T10,272,RC,,,,,,,,both,,,2030.5900,304.5900,CIGNA HEALTHCARE,CIGNA PPO,846.76,,,,,,,524.1000,2030.5900,percent of total billed charges,"41.7% of $2,030.59 in Billed Charges for Rev 272 = $846.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE T10,272,RC,,,,,,,,both,,,2030.5900,304.5900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1827.53,,,,,,,524.1000,2030.5900,percent of total billed charges,"90% of $2,030.59 in Billed Charges for Rev 272 = $1,827.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE T10,272,RC,,,,,,,,both,,,2030.5900,304.5900,MEDCOST,MEDCOST VHN,966.36,,,,,,,524.1000,2030.5900,percent of total billed charges,"47.59% of $2,030.59 in Billed Charges for Rev 272 = $966.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE T10,272,RC,,,,,,,,both,,,2030.5900,304.5900,SENTARA HEALTH,SENTARA HEALTH,524.10,,,,,,,524.1000,2030.5900,percent of total billed charges,"25.81% of $2,030.59 in Billed Charges for Rev 272 = $524.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE T10,272,RC,,,,,,,,both,,,2030.5900,304.5900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2030.59,,,,,,,524.1000,2030.5900,percent of total billed charges,"100% of $2,030.59 in Billed Charges for Rev 272 = $2,030.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE T10,272,RC,,,,,,,,both,,,2030.5900,304.5900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1015.30,,,,,,,524.1000,2030.5900,percent of total billed charges,"Rev 272 $2,030.59 in Billed Charges at 50% = $1,015.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE T10,272,RC,,,,,,,,both,,,2030.5900,304.5900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,655.88,,,,,,,524.1000,2030.5900,other,"32.3% of $2,030.59 in Billed Charges for Rev 272 = $655.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCREWDRIVER BLADE T10,272,RC,,,,,,,,both,,,2030.5900,304.5900,UNITED HEALTHCARE,UHC HERITAGE SELECT,623.39,,,,,,,524.1000,2030.5900,other,"30.7% of $2,030.59 in Billed Charges for Rev 272 = $623.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCREWDRIVER BLADE T10,272,RC,,,,,,,,both,,,2030.5900,304.5900,UNITED HEALTHCARE,UNITED HEALTHCARE,655.88,,,,,,,524.1000,2030.5900,percent of total billed charges,"32.3% of $2,030.59 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE T10,272,RC,,,,,,,,both,,,2030.5900,304.5900,WELLCARE,WELLCARE MEDICAID,2030.59,,,,,,,524.1000,2030.5900,percent of total billed charges,"100% of $2,030.59 in Billed Charges for Rev 272 = $2,030.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLING 2MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1569.5000,235.4300,AETNA,AETNA,670.18,,,,,,,405.0900,1569.5000,percent of total billed charges,"42.7% of $1,569.50 in Billed Charges for Rev 272 = $670.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLING 2MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1569.5000,235.4300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1098.65,,,,,,,405.0900,1569.5000,percent of total billed charges,"Rev 272 $1,569.50 in Billed Charges at 70% = $1,098.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLING 2MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1569.5000,235.4300,CIGNA HEALTHCARE,CIGNA HMO,654.48,,,,,,,405.0900,1569.5000,percent of total billed charges,"41.7% of $1,569.50 in Billed Charges for Rev 272 = $654.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLING 2MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1569.5000,235.4300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,728.25,,,,,,,405.0900,1569.5000,percent of total billed charges,"46.4% of $1,569.50 in Billed Charges for Rev 272 = $728.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLING 2MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1569.5000,235.4300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,654.48,,,,,,,405.0900,1569.5000,percent of total billed charges,"41.7% of $1,569.50 in Billed Charges for Rev 272 = $654.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLING 2MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1569.5000,235.4300,CIGNA HEALTHCARE,CIGNA PPO,654.48,,,,,,,405.0900,1569.5000,percent of total billed charges,"41.7% of $1,569.50 in Billed Charges for Rev 272 = $654.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLING 2MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1569.5000,235.4300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1412.55,,,,,,,405.0900,1569.5000,percent of total billed charges,"90% of $1,569.50 in Billed Charges for Rev 272 = $1,412.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLING 2MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1569.5000,235.4300,MEDCOST,MEDCOST VHN,746.93,,,,,,,405.0900,1569.5000,percent of total billed charges,"47.59% of $1,569.50 in Billed Charges for Rev 272 = $746.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLING 2MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1569.5000,235.4300,SENTARA HEALTH,SENTARA HEALTH,405.09,,,,,,,405.0900,1569.5000,percent of total billed charges,"25.81% of $1,569.50 in Billed Charges for Rev 272 = $405.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLING 2MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1569.5000,235.4300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1569.50,,,,,,,405.0900,1569.5000,percent of total billed charges,"100% of $1,569.50 in Billed Charges for Rev 272 = $1,569.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLING 2MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1569.5000,235.4300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,784.75,,,,,,,405.0900,1569.5000,percent of total billed charges,"Rev 272 $1,569.50 in Billed Charges at 50% = $784.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLING 2MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1569.5000,235.4300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,506.95,,,,,,,405.0900,1569.5000,other,"32.3% of $1,569.50 in Billed Charges for Rev 272 = $506.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCREWDRIVER CANNULATED AO COUPLING 2MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1569.5000,235.4300,UNITED HEALTHCARE,UHC HERITAGE SELECT,481.84,,,,,,,405.0900,1569.5000,other,"30.7% of $1,569.50 in Billed Charges for Rev 272 = $481.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCREWDRIVER CANNULATED AO COUPLING 2MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1569.5000,235.4300,UNITED HEALTHCARE,UNITED HEALTHCARE,506.95,,,,,,,405.0900,1569.5000,percent of total billed charges,"32.3% of $1,569.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLING 2MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1569.5000,235.4300,WELLCARE,WELLCARE MEDICAID,1569.50,,,,,,,405.0900,1569.5000,percent of total billed charges,"100% of $1,569.50 in Billed Charges for Rev 272 = $1,569.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLLING 3MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1551.7600,232.7600,AETNA,AETNA,662.60,,,,,,,400.5100,1551.7600,percent of total billed charges,"42.7% of $1,551.76 in Billed Charges for Rev 272 = $662.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLLING 3MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1551.7600,232.7600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1086.23,,,,,,,400.5100,1551.7600,percent of total billed charges,"Rev 272 $1,551.76 in Billed Charges at 70% = $1,086.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLLING 3MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1551.7600,232.7600,CIGNA HEALTHCARE,CIGNA HMO,647.08,,,,,,,400.5100,1551.7600,percent of total billed charges,"41.7% of $1,551.76 in Billed Charges for Rev 272 = $647.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLLING 3MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1551.7600,232.7600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,720.02,,,,,,,400.5100,1551.7600,percent of total billed charges,"46.4% of $1,551.76 in Billed Charges for Rev 272 = $720.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLLING 3MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1551.7600,232.7600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,647.08,,,,,,,400.5100,1551.7600,percent of total billed charges,"41.7% of $1,551.76 in Billed Charges for Rev 272 = $647.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLLING 3MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1551.7600,232.7600,CIGNA HEALTHCARE,CIGNA PPO,647.08,,,,,,,400.5100,1551.7600,percent of total billed charges,"41.7% of $1,551.76 in Billed Charges for Rev 272 = $647.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLLING 3MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1551.7600,232.7600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1396.58,,,,,,,400.5100,1551.7600,percent of total billed charges,"90% of $1,551.76 in Billed Charges for Rev 272 = $1,396.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLLING 3MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1551.7600,232.7600,MEDCOST,MEDCOST VHN,738.48,,,,,,,400.5100,1551.7600,percent of total billed charges,"47.59% of $1,551.76 in Billed Charges for Rev 272 = $738.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLLING 3MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1551.7600,232.7600,SENTARA HEALTH,SENTARA HEALTH,400.51,,,,,,,400.5100,1551.7600,percent of total billed charges,"25.81% of $1,551.76 in Billed Charges for Rev 272 = $400.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLLING 3MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1551.7600,232.7600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1551.76,,,,,,,400.5100,1551.7600,percent of total billed charges,"100% of $1,551.76 in Billed Charges for Rev 272 = $1,551.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLLING 3MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1551.7600,232.7600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,775.88,,,,,,,400.5100,1551.7600,percent of total billed charges,"Rev 272 $1,551.76 in Billed Charges at 50% = $775.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLLING 3MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1551.7600,232.7600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,501.22,,,,,,,400.5100,1551.7600,other,"32.3% of $1,551.76 in Billed Charges for Rev 272 = $501.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCREWDRIVER CANNULATED AO COUPLLING 3MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1551.7600,232.7600,UNITED HEALTHCARE,UHC HERITAGE SELECT,476.39,,,,,,,400.5100,1551.7600,other,"30.7% of $1,551.76 in Billed Charges for Rev 272 = $476.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCREWDRIVER CANNULATED AO COUPLLING 3MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1551.7600,232.7600,UNITED HEALTHCARE,UNITED HEALTHCARE,501.22,,,,,,,400.5100,1551.7600,percent of total billed charges,"32.3% of $1,551.76 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER CANNULATED AO COUPLLING 3MM STERILE DISPOSABLE,272,RC,,,,,,,,both,,,1551.7600,232.7600,WELLCARE,WELLCARE MEDICAID,1551.76,,,,,,,400.5100,1551.7600,percent of total billed charges,"100% of $1,551.76 in Billed Charges for Rev 272 = $1,551.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER MED/THICK 60 RELOAD SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,8068.7500,1210.3100,AETNA,AETNA,3445.36,,,,,,,2082.5400,8068.7500,percent of total billed charges,"42.7% of $8,068.75 in Billed Charges for Rev 272 = $3,445.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER MED/THICK 60 RELOAD SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,8068.7500,1210.3100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5648.13,,,,,,,2082.5400,8068.7500,percent of total billed charges,"Rev 272 $8,068.75 in Billed Charges at 70% = $5,648.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER MED/THICK 60 RELOAD SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,8068.7500,1210.3100,CIGNA HEALTHCARE,CIGNA HMO,3364.67,,,,,,,2082.5400,8068.7500,percent of total billed charges,"41.7% of $8,068.75 in Billed Charges for Rev 272 = $3,364.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER MED/THICK 60 RELOAD SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,8068.7500,1210.3100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3743.90,,,,,,,2082.5400,8068.7500,percent of total billed charges,"46.4% of $8,068.75 in Billed Charges for Rev 272 = $3,743.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER MED/THICK 60 RELOAD SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,8068.7500,1210.3100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3364.67,,,,,,,2082.5400,8068.7500,percent of total billed charges,"41.7% of $8,068.75 in Billed Charges for Rev 272 = $3,364.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER MED/THICK 60 RELOAD SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,8068.7500,1210.3100,CIGNA HEALTHCARE,CIGNA PPO,3364.67,,,,,,,2082.5400,8068.7500,percent of total billed charges,"41.7% of $8,068.75 in Billed Charges for Rev 272 = $3,364.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER MED/THICK 60 RELOAD SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,8068.7500,1210.3100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7261.88,,,,,,,2082.5400,8068.7500,percent of total billed charges,"90% of $8,068.75 in Billed Charges for Rev 272 = $7,261.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER MED/THICK 60 RELOAD SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,8068.7500,1210.3100,MEDCOST,MEDCOST VHN,3839.92,,,,,,,2082.5400,8068.7500,percent of total billed charges,"47.59% of $8,068.75 in Billed Charges for Rev 272 = $3,839.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER MED/THICK 60 RELOAD SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,8068.7500,1210.3100,SENTARA HEALTH,SENTARA HEALTH,2082.54,,,,,,,2082.5400,8068.7500,percent of total billed charges,"25.81% of $8,068.75 in Billed Charges for Rev 272 = $2,082.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER MED/THICK 60 RELOAD SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,8068.7500,1210.3100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8068.75,,,,,,,2082.5400,8068.7500,percent of total billed charges,"100% of $8,068.75 in Billed Charges for Rev 272 = $8,068.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER MED/THICK 60 RELOAD SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,8068.7500,1210.3100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4034.38,,,,,,,2082.5400,8068.7500,percent of total billed charges,"Rev 272 $8,068.75 in Billed Charges at 50% = $4,034.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER MED/THICK 60 RELOAD SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,8068.7500,1210.3100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2606.21,,,,,,,2082.5400,8068.7500,other,"32.3% of $8,068.75 in Billed Charges for Rev 272 = $2,606.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER MED/THICK 60 RELOAD SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,8068.7500,1210.3100,UNITED HEALTHCARE,UHC HERITAGE SELECT,2477.11,,,,,,,2082.5400,8068.7500,other,"30.7% of $8,068.75 in Billed Charges for Rev 272 = $2,477.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER MED/THICK 60 RELOAD SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,8068.7500,1210.3100,UNITED HEALTHCARE,UNITED HEALTHCARE,2606.21,,,,,,,2082.5400,8068.7500,percent of total billed charges,"32.3% of $8,068.75 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER MED/THICK 60 RELOAD SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,8068.7500,1210.3100,WELLCARE,WELLCARE MEDICAID,8068.75,,,,,,,2082.5400,8068.7500,percent of total billed charges,"100% of $8,068.75 in Billed Charges for Rev 272 = $8,068.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCULPS CEMENT DISPOSABLE,272,RC,,,,,,,,both,,,172.5200,25.8800,AETNA,AETNA,73.67,,,,,,,44.5300,172.5200,percent of total billed charges,42.7% of $172.52 in Billed Charges for Rev 272 = $73.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCULPS CEMENT DISPOSABLE,272,RC,,,,,,,,both,,,172.5200,25.8800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,120.76,,,,,,,44.5300,172.5200,percent of total billed charges,Rev 272 $172.52 in Billed Charges at 70% = $120.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCULPS CEMENT DISPOSABLE,272,RC,,,,,,,,both,,,172.5200,25.8800,CIGNA HEALTHCARE,CIGNA HMO,71.94,,,,,,,44.5300,172.5200,percent of total billed charges,41.7% of $172.52 in Billed Charges for Rev 272 = $71.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCULPS CEMENT DISPOSABLE,272,RC,,,,,,,,both,,,172.5200,25.8800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,80.05,,,,,,,44.5300,172.5200,percent of total billed charges,46.4% of $172.52 in Billed Charges for Rev 272 = $80.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCULPS CEMENT DISPOSABLE,272,RC,,,,,,,,both,,,172.5200,25.8800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,71.94,,,,,,,44.5300,172.5200,percent of total billed charges,41.7% of $172.52 in Billed Charges for Rev 272 = $71.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCULPS CEMENT DISPOSABLE,272,RC,,,,,,,,both,,,172.5200,25.8800,CIGNA HEALTHCARE,CIGNA PPO,71.94,,,,,,,44.5300,172.5200,percent of total billed charges,41.7% of $172.52 in Billed Charges for Rev 272 = $71.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCULPS CEMENT DISPOSABLE,272,RC,,,,,,,,both,,,172.5200,25.8800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,155.27,,,,,,,44.5300,172.5200,percent of total billed charges,90% of $172.52 in Billed Charges for Rev 272 = $155.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCULPS CEMENT DISPOSABLE,272,RC,,,,,,,,both,,,172.5200,25.8800,MEDCOST,MEDCOST VHN,82.10,,,,,,,44.5300,172.5200,percent of total billed charges,47.59% of $172.52 in Billed Charges for Rev 272 = $82.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCULPS CEMENT DISPOSABLE,272,RC,,,,,,,,both,,,172.5200,25.8800,SENTARA HEALTH,SENTARA HEALTH,44.53,,,,,,,44.5300,172.5200,percent of total billed charges,25.81% of $172.52 in Billed Charges for Rev 272 = $44.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCULPS CEMENT DISPOSABLE,272,RC,,,,,,,,both,,,172.5200,25.8800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",172.52,,,,,,,44.5300,172.5200,percent of total billed charges,100% of $172.52 in Billed Charges for Rev 272 = $172.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCULPS CEMENT DISPOSABLE,272,RC,,,,,,,,both,,,172.5200,25.8800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,86.26,,,,,,,44.5300,172.5200,percent of total billed charges,Rev 272 $172.52 in Billed Charges at 50% = $86.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCULPS CEMENT DISPOSABLE,272,RC,,,,,,,,both,,,172.5200,25.8800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,55.72,,,,,,,44.5300,172.5200,other,32.3% of $172.52 in Billed Charges for Rev 272 = $55.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SCULPS CEMENT DISPOSABLE,272,RC,,,,,,,,both,,,172.5200,25.8800,UNITED HEALTHCARE,UHC HERITAGE SELECT,52.96,,,,,,,44.5300,172.5200,other,30.7% of $172.52 in Billed Charges for Rev 272 = $52.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SCULPS CEMENT DISPOSABLE,272,RC,,,,,,,,both,,,172.5200,25.8800,UNITED HEALTHCARE,UNITED HEALTHCARE,55.72,,,,,,,44.5300,172.5200,percent of total billed charges,32.3% of $172.52 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SCULPS CEMENT DISPOSABLE,272,RC,,,,,,,,both,,,172.5200,25.8800,WELLCARE,WELLCARE MEDICAID,172.52,,,,,,,44.5300,172.5200,percent of total billed charges,100% of $172.52 in Billed Charges for Rev 272 = $172.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,4908.0800,736.2100,AETNA,AETNA,2095.75,,,,,,,1266.7800,4908.0800,percent of total billed charges,"42.7% of $4,908.08 in Billed Charges for Rev 272 = $2,095.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,4908.0800,736.2100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3435.66,,,,,,,1266.7800,4908.0800,percent of total billed charges,"Rev 272 $4,908.08 in Billed Charges at 70% = $3,435.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,4908.0800,736.2100,CIGNA HEALTHCARE,CIGNA HMO,2046.67,,,,,,,1266.7800,4908.0800,percent of total billed charges,"41.7% of $4,908.08 in Billed Charges for Rev 272 = $2,046.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,4908.0800,736.2100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2277.35,,,,,,,1266.7800,4908.0800,percent of total billed charges,"46.4% of $4,908.08 in Billed Charges for Rev 272 = $2,277.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,4908.0800,736.2100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2046.67,,,,,,,1266.7800,4908.0800,percent of total billed charges,"41.7% of $4,908.08 in Billed Charges for Rev 272 = $2,046.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,4908.0800,736.2100,CIGNA HEALTHCARE,CIGNA PPO,2046.67,,,,,,,1266.7800,4908.0800,percent of total billed charges,"41.7% of $4,908.08 in Billed Charges for Rev 272 = $2,046.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,4908.0800,736.2100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4417.27,,,,,,,1266.7800,4908.0800,percent of total billed charges,"90% of $4,908.08 in Billed Charges for Rev 272 = $4,417.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,4908.0800,736.2100,MEDCOST,MEDCOST VHN,2335.76,,,,,,,1266.7800,4908.0800,percent of total billed charges,"47.59% of $4,908.08 in Billed Charges for Rev 272 = $2,335.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,4908.0800,736.2100,SENTARA HEALTH,SENTARA HEALTH,1266.78,,,,,,,1266.7800,4908.0800,percent of total billed charges,"25.81% of $4,908.08 in Billed Charges for Rev 272 = $1,266.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,4908.0800,736.2100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4908.08,,,,,,,1266.7800,4908.0800,percent of total billed charges,"100% of $4,908.08 in Billed Charges for Rev 272 = $4,908.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,4908.0800,736.2100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2454.04,,,,,,,1266.7800,4908.0800,percent of total billed charges,"Rev 272 $4,908.08 in Billed Charges at 50% = $2,454.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,4908.0800,736.2100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1585.31,,,,,,,1266.7800,4908.0800,other,"32.3% of $4,908.08 in Billed Charges for Rev 272 = $1,585.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,4908.0800,736.2100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1506.78,,,,,,,1266.7800,4908.0800,other,"30.7% of $4,908.08 in Billed Charges for Rev 272 = $1,506.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,4908.0800,736.2100,UNITED HEALTHCARE,UNITED HEALTHCARE,1585.31,,,,,,,1266.7800,4908.0800,percent of total billed charges,"32.3% of $4,908.08 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,4908.0800,736.2100,WELLCARE,WELLCARE MEDICAID,4908.08,,,,,,,1266.7800,4908.0800,percent of total billed charges,"100% of $4,908.08 in Billed Charges for Rev 272 = $4,908.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL SYNCROSEAL 8MM IS400 DAVINCI,272,RC,27200002,CDM,,,,,,both,,,7513.7900,1127.0700,AETNA,AETNA,3208.39,,,,,,,1939.3100,7513.7900,percent of total billed charges,"42.7% of $7,513.79 in Billed Charges for Rev 272 = $3,208.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL SYNCROSEAL 8MM IS400 DAVINCI,272,RC,27200002,CDM,,,,,,both,,,7513.7900,1127.0700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5259.65,,,,,,,1939.3100,7513.7900,percent of total billed charges,"Rev 272 $7,513.79 in Billed Charges at 70% = $5,259.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL SYNCROSEAL 8MM IS400 DAVINCI,272,RC,27200002,CDM,,,,,,both,,,7513.7900,1127.0700,CIGNA HEALTHCARE,CIGNA HMO,3133.25,,,,,,,1939.3100,7513.7900,percent of total billed charges,"41.7% of $7,513.79 in Billed Charges for Rev 272 = $3,133.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL SYNCROSEAL 8MM IS400 DAVINCI,272,RC,27200002,CDM,,,,,,both,,,7513.7900,1127.0700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3486.40,,,,,,,1939.3100,7513.7900,percent of total billed charges,"46.4% of $7,513.79 in Billed Charges for Rev 272 = $3,486.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL SYNCROSEAL 8MM IS400 DAVINCI,272,RC,27200002,CDM,,,,,,both,,,7513.7900,1127.0700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3133.25,,,,,,,1939.3100,7513.7900,percent of total billed charges,"41.7% of $7,513.79 in Billed Charges for Rev 272 = $3,133.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL SYNCROSEAL 8MM IS400 DAVINCI,272,RC,27200002,CDM,,,,,,both,,,7513.7900,1127.0700,CIGNA HEALTHCARE,CIGNA PPO,3133.25,,,,,,,1939.3100,7513.7900,percent of total billed charges,"41.7% of $7,513.79 in Billed Charges for Rev 272 = $3,133.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL SYNCROSEAL 8MM IS400 DAVINCI,272,RC,27200002,CDM,,,,,,both,,,7513.7900,1127.0700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6762.41,,,,,,,1939.3100,7513.7900,percent of total billed charges,"90% of $7,513.79 in Billed Charges for Rev 272 = $6,762.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL SYNCROSEAL 8MM IS400 DAVINCI,272,RC,27200002,CDM,,,,,,both,,,7513.7900,1127.0700,MEDCOST,MEDCOST VHN,3575.81,,,,,,,1939.3100,7513.7900,percent of total billed charges,"47.59% of $7,513.79 in Billed Charges for Rev 272 = $3,575.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL SYNCROSEAL 8MM IS400 DAVINCI,272,RC,27200002,CDM,,,,,,both,,,7513.7900,1127.0700,SENTARA HEALTH,SENTARA HEALTH,1939.31,,,,,,,1939.3100,7513.7900,percent of total billed charges,"25.81% of $7,513.79 in Billed Charges for Rev 272 = $1,939.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL SYNCROSEAL 8MM IS400 DAVINCI,272,RC,27200002,CDM,,,,,,both,,,7513.7900,1127.0700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7513.79,,,,,,,1939.3100,7513.7900,percent of total billed charges,"100% of $7,513.79 in Billed Charges for Rev 272 = $7,513.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL SYNCROSEAL 8MM IS400 DAVINCI,272,RC,27200002,CDM,,,,,,both,,,7513.7900,1127.0700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3756.90,,,,,,,1939.3100,7513.7900,percent of total billed charges,"Rev 272 $7,513.79 in Billed Charges at 50% = $3,756.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL SYNCROSEAL 8MM IS400 DAVINCI,272,RC,27200002,CDM,,,,,,both,,,7513.7900,1127.0700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2426.95,,,,,,,1939.3100,7513.7900,other,"32.3% of $7,513.79 in Billed Charges for Rev 272 = $2,426.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEAL SYNCROSEAL 8MM IS400 DAVINCI,272,RC,27200002,CDM,,,,,,both,,,7513.7900,1127.0700,UNITED HEALTHCARE,UHC HERITAGE SELECT,2306.73,,,,,,,1939.3100,7513.7900,other,"30.7% of $7,513.79 in Billed Charges for Rev 272 = $2,306.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEAL SYNCROSEAL 8MM IS400 DAVINCI,272,RC,27200002,CDM,,,,,,both,,,7513.7900,1127.0700,UNITED HEALTHCARE,UNITED HEALTHCARE,2426.95,,,,,,,1939.3100,7513.7900,percent of total billed charges,"32.3% of $7,513.79 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL SYNCROSEAL 8MM IS400 DAVINCI,272,RC,27200002,CDM,,,,,,both,,,7513.7900,1127.0700,WELLCARE,WELLCARE MEDICAID,7513.79,,,,,,,1939.3100,7513.7900,percent of total billed charges,"100% of $7,513.79 in Billed Charges for Rev 272 = $7,513.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PREM PLUS EEA 28MM SURPASS SEE LN 187376,272,RC,27200002,CDM,,,,,,both,,,10229.8200,1534.4700,AETNA,AETNA,4368.13,,,,,,,2640.3200,10229.8200,percent of total billed charges,"42.7% of $10,229.82 in Billed Charges for Rev 272 = $4,368.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PREM PLUS EEA 28MM SURPASS SEE LN 187376,272,RC,27200002,CDM,,,,,,both,,,10229.8200,1534.4700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7160.87,,,,,,,2640.3200,10229.8200,percent of total billed charges,"Rev 272 $10,229.82 in Billed Charges at 70% = $7,160.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PREM PLUS EEA 28MM SURPASS SEE LN 187376,272,RC,27200002,CDM,,,,,,both,,,10229.8200,1534.4700,CIGNA HEALTHCARE,CIGNA HMO,4265.83,,,,,,,2640.3200,10229.8200,percent of total billed charges,"41.7% of $10,229.82 in Billed Charges for Rev 272 = $4,265.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PREM PLUS EEA 28MM SURPASS SEE LN 187376,272,RC,27200002,CDM,,,,,,both,,,10229.8200,1534.4700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4746.64,,,,,,,2640.3200,10229.8200,percent of total billed charges,"46.4% of $10,229.82 in Billed Charges for Rev 272 = $4,746.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PREM PLUS EEA 28MM SURPASS SEE LN 187376,272,RC,27200002,CDM,,,,,,both,,,10229.8200,1534.4700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4265.83,,,,,,,2640.3200,10229.8200,percent of total billed charges,"41.7% of $10,229.82 in Billed Charges for Rev 272 = $4,265.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PREM PLUS EEA 28MM SURPASS SEE LN 187376,272,RC,27200002,CDM,,,,,,both,,,10229.8200,1534.4700,CIGNA HEALTHCARE,CIGNA PPO,4265.83,,,,,,,2640.3200,10229.8200,percent of total billed charges,"41.7% of $10,229.82 in Billed Charges for Rev 272 = $4,265.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PREM PLUS EEA 28MM SURPASS SEE LN 187376,272,RC,27200002,CDM,,,,,,both,,,10229.8200,1534.4700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9206.84,,,,,,,2640.3200,10229.8200,percent of total billed charges,"90% of $10,229.82 in Billed Charges for Rev 272 = $9,206.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PREM PLUS EEA 28MM SURPASS SEE LN 187376,272,RC,27200002,CDM,,,,,,both,,,10229.8200,1534.4700,MEDCOST,MEDCOST VHN,4868.37,,,,,,,2640.3200,10229.8200,percent of total billed charges,"47.59% of $10,229.82 in Billed Charges for Rev 272 = $4,868.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PREM PLUS EEA 28MM SURPASS SEE LN 187376,272,RC,27200002,CDM,,,,,,both,,,10229.8200,1534.4700,SENTARA HEALTH,SENTARA HEALTH,2640.32,,,,,,,2640.3200,10229.8200,percent of total billed charges,"25.81% of $10,229.82 in Billed Charges for Rev 272 = $2,640.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PREM PLUS EEA 28MM SURPASS SEE LN 187376,272,RC,27200002,CDM,,,,,,both,,,10229.8200,1534.4700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10229.82,,,,,,,2640.3200,10229.8200,percent of total billed charges,"100% of $10,229.82 in Billed Charges for Rev 272 = $10,229.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PREM PLUS EEA 28MM SURPASS SEE LN 187376,272,RC,27200002,CDM,,,,,,both,,,10229.8200,1534.4700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5114.91,,,,,,,2640.3200,10229.8200,percent of total billed charges,"Rev 272 $10,229.82 in Billed Charges at 50% = $5,114.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PREM PLUS EEA 28MM SURPASS SEE LN 187376,272,RC,27200002,CDM,,,,,,both,,,10229.8200,1534.4700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3304.23,,,,,,,2640.3200,10229.8200,other,"32.3% of $10,229.82 in Billed Charges for Rev 272 = $3,304.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER PREM PLUS EEA 28MM SURPASS SEE LN 187376,272,RC,27200002,CDM,,,,,,both,,,10229.8200,1534.4700,UNITED HEALTHCARE,UHC HERITAGE SELECT,3140.55,,,,,,,2640.3200,10229.8200,other,"30.7% of $10,229.82 in Billed Charges for Rev 272 = $3,140.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER PREM PLUS EEA 28MM SURPASS SEE LN 187376,272,RC,27200002,CDM,,,,,,both,,,10229.8200,1534.4700,UNITED HEALTHCARE,UNITED HEALTHCARE,3304.23,,,,,,,2640.3200,10229.8200,percent of total billed charges,"32.3% of $10,229.82 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PREM PLUS EEA 28MM SURPASS SEE LN 187376,272,RC,27200002,CDM,,,,,,both,,,10229.8200,1534.4700,WELLCARE,WELLCARE MEDICAID,10229.82,,,,,,,2640.3200,10229.8200,percent of total billed charges,"100% of $10,229.82 in Billed Charges for Rev 272 = $10,229.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,42946.6200,6441.9900,AETNA,AETNA,18338.21,,,,,,,11084.5200,42946.6200,percent of total billed charges,"42.7% of $42,946.62 in Billed Charges for Rev 272 = $18,338.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,42946.6200,6441.9900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,30062.63,,,,,,,11084.5200,42946.6200,percent of total billed charges,"Rev 272 $42,946.62 in Billed Charges at 70% = $30,062.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,42946.6200,6441.9900,CIGNA HEALTHCARE,CIGNA HMO,17908.74,,,,,,,11084.5200,42946.6200,percent of total billed charges,"41.7% of $42,946.62 in Billed Charges for Rev 272 = $17,908.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,42946.6200,6441.9900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,19927.23,,,,,,,11084.5200,42946.6200,percent of total billed charges,"46.4% of $42,946.62 in Billed Charges for Rev 272 = $19,927.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,42946.6200,6441.9900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,17908.74,,,,,,,11084.5200,42946.6200,percent of total billed charges,"41.7% of $42,946.62 in Billed Charges for Rev 272 = $17,908.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,42946.6200,6441.9900,CIGNA HEALTHCARE,CIGNA PPO,17908.74,,,,,,,11084.5200,42946.6200,percent of total billed charges,"41.7% of $42,946.62 in Billed Charges for Rev 272 = $17,908.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,42946.6200,6441.9900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,38651.96,,,,,,,11084.5200,42946.6200,percent of total billed charges,"90% of $42,946.62 in Billed Charges for Rev 272 = $38,651.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,42946.6200,6441.9900,MEDCOST,MEDCOST VHN,20438.30,,,,,,,11084.5200,42946.6200,percent of total billed charges,"47.59% of $42,946.62 in Billed Charges for Rev 272 = $20,438.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,42946.6200,6441.9900,SENTARA HEALTH,SENTARA HEALTH,11084.52,,,,,,,11084.5200,42946.6200,percent of total billed charges,"25.81% of $42,946.62 in Billed Charges for Rev 272 = $11,084.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,42946.6200,6441.9900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",42946.62,,,,,,,11084.5200,42946.6200,percent of total billed charges,"100% of $42,946.62 in Billed Charges for Rev 272 = $42,946.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,42946.6200,6441.9900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,21473.31,,,,,,,11084.5200,42946.6200,percent of total billed charges,"Rev 272 $42,946.62 in Billed Charges at 50% = $21,473.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,42946.6200,6441.9900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13871.76,,,,,,,11084.5200,42946.6200,other,"32.3% of $42,946.62 in Billed Charges for Rev 272 = $13,871.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,42946.6200,6441.9900,UNITED HEALTHCARE,UHC HERITAGE SELECT,13184.61,,,,,,,11084.5200,42946.6200,other,"30.7% of $42,946.62 in Billed Charges for Rev 272 = $13,184.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,42946.6200,6441.9900,UNITED HEALTHCARE,UNITED HEALTHCARE,13871.76,,,,,,,11084.5200,42946.6200,percent of total billed charges,"32.3% of $42,946.62 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PROTACK 5MM ENDOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,42946.6200,6441.9900,WELLCARE,WELLCARE MEDICAID,42946.62,,,,,,,11084.5200,42946.6200,percent of total billed charges,"100% of $42,946.62 in Billed Charges for Rev 272 = $42,946.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSTRING 45IN 2-0 SUTURE,272,RC,,,,,,,,both,,,2504.1600,375.6200,AETNA,AETNA,1069.28,,,,,,,646.3200,2504.1600,percent of total billed charges,"42.7% of $2,504.16 in Billed Charges for Rev 272 = $1,069.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSTRING 45IN 2-0 SUTURE,272,RC,,,,,,,,both,,,2504.1600,375.6200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1752.91,,,,,,,646.3200,2504.1600,percent of total billed charges,"Rev 272 $2,504.16 in Billed Charges at 70% = $1,752.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSTRING 45IN 2-0 SUTURE,272,RC,,,,,,,,both,,,2504.1600,375.6200,CIGNA HEALTHCARE,CIGNA HMO,1044.23,,,,,,,646.3200,2504.1600,percent of total billed charges,"41.7% of $2,504.16 in Billed Charges for Rev 272 = $1,044.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSTRING 45IN 2-0 SUTURE,272,RC,,,,,,,,both,,,2504.1600,375.6200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1161.93,,,,,,,646.3200,2504.1600,percent of total billed charges,"46.4% of $2,504.16 in Billed Charges for Rev 272 = $1,161.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSTRING 45IN 2-0 SUTURE,272,RC,,,,,,,,both,,,2504.1600,375.6200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1044.23,,,,,,,646.3200,2504.1600,percent of total billed charges,"41.7% of $2,504.16 in Billed Charges for Rev 272 = $1,044.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSTRING 45IN 2-0 SUTURE,272,RC,,,,,,,,both,,,2504.1600,375.6200,CIGNA HEALTHCARE,CIGNA PPO,1044.23,,,,,,,646.3200,2504.1600,percent of total billed charges,"41.7% of $2,504.16 in Billed Charges for Rev 272 = $1,044.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSTRING 45IN 2-0 SUTURE,272,RC,,,,,,,,both,,,2504.1600,375.6200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2253.74,,,,,,,646.3200,2504.1600,percent of total billed charges,"90% of $2,504.16 in Billed Charges for Rev 272 = $2,253.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSTRING 45IN 2-0 SUTURE,272,RC,,,,,,,,both,,,2504.1600,375.6200,MEDCOST,MEDCOST VHN,1191.73,,,,,,,646.3200,2504.1600,percent of total billed charges,"47.59% of $2,504.16 in Billed Charges for Rev 272 = $1,191.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSTRING 45IN 2-0 SUTURE,272,RC,,,,,,,,both,,,2504.1600,375.6200,SENTARA HEALTH,SENTARA HEALTH,646.32,,,,,,,646.3200,2504.1600,percent of total billed charges,"25.81% of $2,504.16 in Billed Charges for Rev 272 = $646.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSTRING 45IN 2-0 SUTURE,272,RC,,,,,,,,both,,,2504.1600,375.6200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2504.16,,,,,,,646.3200,2504.1600,percent of total billed charges,"100% of $2,504.16 in Billed Charges for Rev 272 = $2,504.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSTRING 45IN 2-0 SUTURE,272,RC,,,,,,,,both,,,2504.1600,375.6200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1252.08,,,,,,,646.3200,2504.1600,percent of total billed charges,"Rev 272 $2,504.16 in Billed Charges at 50% = $1,252.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSTRING 45IN 2-0 SUTURE,272,RC,,,,,,,,both,,,2504.1600,375.6200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,808.84,,,,,,,646.3200,2504.1600,other,"32.3% of $2,504.16 in Billed Charges for Rev 272 = $808.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER PURSTRING 45IN 2-0 SUTURE,272,RC,,,,,,,,both,,,2504.1600,375.6200,UNITED HEALTHCARE,UHC HERITAGE SELECT,768.78,,,,,,,646.3200,2504.1600,other,"30.7% of $2,504.16 in Billed Charges for Rev 272 = $768.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER PURSTRING 45IN 2-0 SUTURE,272,RC,,,,,,,,both,,,2504.1600,375.6200,UNITED HEALTHCARE,UNITED HEALTHCARE,808.84,,,,,,,646.3200,2504.1600,percent of total billed charges,"32.3% of $2,504.16 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER PURSTRING 45IN 2-0 SUTURE,272,RC,,,,,,,,both,,,2504.1600,375.6200,WELLCARE,WELLCARE MEDICAID,2504.16,,,,,,,646.3200,2504.1600,percent of total billed charges,"100% of $2,504.16 in Billed Charges for Rev 272 = $2,504.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE BOVIE TIP COLORADO 4CM,272,RC,27200002,CDM,,,,,,both,,,509.5300,76.4300,AETNA,AETNA,217.57,,,,,,,131.5100,509.5300,percent of total billed charges,42.7% of $509.53 in Billed Charges for Rev 272 = $217.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE BOVIE TIP COLORADO 4CM,272,RC,27200002,CDM,,,,,,both,,,509.5300,76.4300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,356.67,,,,,,,131.5100,509.5300,percent of total billed charges,Rev 272 $509.53 in Billed Charges at 70% = $356.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE BOVIE TIP COLORADO 4CM,272,RC,27200002,CDM,,,,,,both,,,509.5300,76.4300,CIGNA HEALTHCARE,CIGNA HMO,212.47,,,,,,,131.5100,509.5300,percent of total billed charges,41.7% of $509.53 in Billed Charges for Rev 272 = $212.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE BOVIE TIP COLORADO 4CM,272,RC,27200002,CDM,,,,,,both,,,509.5300,76.4300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,236.42,,,,,,,131.5100,509.5300,percent of total billed charges,46.4% of $509.53 in Billed Charges for Rev 272 = $236.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE BOVIE TIP COLORADO 4CM,272,RC,27200002,CDM,,,,,,both,,,509.5300,76.4300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,212.47,,,,,,,131.5100,509.5300,percent of total billed charges,41.7% of $509.53 in Billed Charges for Rev 272 = $212.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE BOVIE TIP COLORADO 4CM,272,RC,27200002,CDM,,,,,,both,,,509.5300,76.4300,CIGNA HEALTHCARE,CIGNA PPO,212.47,,,,,,,131.5100,509.5300,percent of total billed charges,41.7% of $509.53 in Billed Charges for Rev 272 = $212.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE BOVIE TIP COLORADO 4CM,272,RC,27200002,CDM,,,,,,both,,,509.5300,76.4300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,458.58,,,,,,,131.5100,509.5300,percent of total billed charges,90% of $509.53 in Billed Charges for Rev 272 = $458.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE BOVIE TIP COLORADO 4CM,272,RC,27200002,CDM,,,,,,both,,,509.5300,76.4300,MEDCOST,MEDCOST VHN,242.49,,,,,,,131.5100,509.5300,percent of total billed charges,47.59% of $509.53 in Billed Charges for Rev 272 = $242.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE BOVIE TIP COLORADO 4CM,272,RC,27200002,CDM,,,,,,both,,,509.5300,76.4300,SENTARA HEALTH,SENTARA HEALTH,131.51,,,,,,,131.5100,509.5300,percent of total billed charges,25.81% of $509.53 in Billed Charges for Rev 272 = $131.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE BOVIE TIP COLORADO 4CM,272,RC,27200002,CDM,,,,,,both,,,509.5300,76.4300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",509.53,,,,,,,131.5100,509.5300,percent of total billed charges,100% of $509.53 in Billed Charges for Rev 272 = $509.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE BOVIE TIP COLORADO 4CM,272,RC,27200002,CDM,,,,,,both,,,509.5300,76.4300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,254.77,,,,,,,131.5100,509.5300,percent of total billed charges,Rev 272 $509.53 in Billed Charges at 50% = $254.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE BOVIE TIP COLORADO 4CM,272,RC,27200002,CDM,,,,,,both,,,509.5300,76.4300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,164.58,,,,,,,131.5100,509.5300,other,32.3% of $509.53 in Billed Charges for Rev 272 = $164.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE BOVIE TIP COLORADO 4CM,272,RC,27200002,CDM,,,,,,both,,,509.5300,76.4300,UNITED HEALTHCARE,UHC HERITAGE SELECT,156.43,,,,,,,131.5100,509.5300,other,30.7% of $509.53 in Billed Charges for Rev 272 = $156.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE BOVIE TIP COLORADO 4CM,272,RC,27200002,CDM,,,,,,both,,,509.5300,76.4300,UNITED HEALTHCARE,UNITED HEALTHCARE,164.58,,,,,,,131.5100,509.5300,percent of total billed charges,32.3% of $509.53 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE BOVIE TIP COLORADO 4CM,272,RC,27200002,CDM,,,,,,both,,,509.5300,76.4300,WELLCARE,WELLCARE MEDICAID,509.53,,,,,,,131.5100,509.5300,percent of total billed charges,100% of $509.53 in Billed Charges for Rev 272 = $509.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SEALANT EVARREST,272,RC,27200002,CDM,,,,,,both,,,8640.4900,1296.0700,AETNA,AETNA,3689.49,,,,,,,2230.1100,8640.4900,percent of total billed charges,"42.7% of $8,640.49 in Billed Charges for Rev 272 = $3,689.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT EVARREST,272,RC,27200002,CDM,,,,,,both,,,8640.4900,1296.0700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6048.34,,,,,,,2230.1100,8640.4900,percent of total billed charges,"Rev 272 $8,640.49 in Billed Charges at 70% = $6,048.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT EVARREST,272,RC,27200002,CDM,,,,,,both,,,8640.4900,1296.0700,CIGNA HEALTHCARE,CIGNA HMO,3603.08,,,,,,,2230.1100,8640.4900,percent of total billed charges,"41.7% of $8,640.49 in Billed Charges for Rev 272 = $3,603.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT EVARREST,272,RC,27200002,CDM,,,,,,both,,,8640.4900,1296.0700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4009.19,,,,,,,2230.1100,8640.4900,percent of total billed charges,"46.4% of $8,640.49 in Billed Charges for Rev 272 = $4,009.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT EVARREST,272,RC,27200002,CDM,,,,,,both,,,8640.4900,1296.0700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3603.08,,,,,,,2230.1100,8640.4900,percent of total billed charges,"41.7% of $8,640.49 in Billed Charges for Rev 272 = $3,603.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT EVARREST,272,RC,27200002,CDM,,,,,,both,,,8640.4900,1296.0700,CIGNA HEALTHCARE,CIGNA PPO,3603.08,,,,,,,2230.1100,8640.4900,percent of total billed charges,"41.7% of $8,640.49 in Billed Charges for Rev 272 = $3,603.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT EVARREST,272,RC,27200002,CDM,,,,,,both,,,8640.4900,1296.0700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7776.44,,,,,,,2230.1100,8640.4900,percent of total billed charges,"90% of $8,640.49 in Billed Charges for Rev 272 = $7,776.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT EVARREST,272,RC,27200002,CDM,,,,,,both,,,8640.4900,1296.0700,MEDCOST,MEDCOST VHN,4112.01,,,,,,,2230.1100,8640.4900,percent of total billed charges,"47.59% of $8,640.49 in Billed Charges for Rev 272 = $4,112.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT EVARREST,272,RC,27200002,CDM,,,,,,both,,,8640.4900,1296.0700,SENTARA HEALTH,SENTARA HEALTH,2230.11,,,,,,,2230.1100,8640.4900,percent of total billed charges,"25.81% of $8,640.49 in Billed Charges for Rev 272 = $2,230.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT EVARREST,272,RC,27200002,CDM,,,,,,both,,,8640.4900,1296.0700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8640.49,,,,,,,2230.1100,8640.4900,percent of total billed charges,"100% of $8,640.49 in Billed Charges for Rev 272 = $8,640.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT EVARREST,272,RC,27200002,CDM,,,,,,both,,,8640.4900,1296.0700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4320.25,,,,,,,2230.1100,8640.4900,percent of total billed charges,"Rev 272 $8,640.49 in Billed Charges at 50% = $4,320.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT EVARREST,272,RC,27200002,CDM,,,,,,both,,,8640.4900,1296.0700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2790.88,,,,,,,2230.1100,8640.4900,other,"32.3% of $8,640.49 in Billed Charges for Rev 272 = $2,790.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALANT EVARREST,272,RC,27200002,CDM,,,,,,both,,,8640.4900,1296.0700,UNITED HEALTHCARE,UHC HERITAGE SELECT,2652.63,,,,,,,2230.1100,8640.4900,other,"30.7% of $8,640.49 in Billed Charges for Rev 272 = $2,652.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALANT EVARREST,272,RC,27200002,CDM,,,,,,both,,,8640.4900,1296.0700,UNITED HEALTHCARE,UNITED HEALTHCARE,2790.88,,,,,,,2230.1100,8640.4900,percent of total billed charges,"32.3% of $8,640.49 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT EVARREST,272,RC,27200002,CDM,,,,,,both,,,8640.4900,1296.0700,WELLCARE,WELLCARE MEDICAID,8640.49,,,,,,,2230.1100,8640.4900,percent of total billed charges,"100% of $8,640.49 in Billed Charges for Rev 272 = $8,640.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE CURVED AVAFLEX 1025-011-500,272,RC,27200002,CDM,,,,,,both,,,3883.9400,582.5900,AETNA,AETNA,1658.44,,,,,,,1002.4400,3883.9400,percent of total billed charges,"42.7% of $3,883.94 in Billed Charges for Rev 272 = $1,658.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE CURVED AVAFLEX 1025-011-500,272,RC,27200002,CDM,,,,,,both,,,3883.9400,582.5900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2718.76,,,,,,,1002.4400,3883.9400,percent of total billed charges,"Rev 272 $3,883.94 in Billed Charges at 70% = $2,718.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE CURVED AVAFLEX 1025-011-500,272,RC,27200002,CDM,,,,,,both,,,3883.9400,582.5900,CIGNA HEALTHCARE,CIGNA HMO,1619.60,,,,,,,1002.4400,3883.9400,percent of total billed charges,"41.7% of $3,883.94 in Billed Charges for Rev 272 = $1,619.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE CURVED AVAFLEX 1025-011-500,272,RC,27200002,CDM,,,,,,both,,,3883.9400,582.5900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1802.15,,,,,,,1002.4400,3883.9400,percent of total billed charges,"46.4% of $3,883.94 in Billed Charges for Rev 272 = $1,802.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE CURVED AVAFLEX 1025-011-500,272,RC,27200002,CDM,,,,,,both,,,3883.9400,582.5900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1619.60,,,,,,,1002.4400,3883.9400,percent of total billed charges,"41.7% of $3,883.94 in Billed Charges for Rev 272 = $1,619.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE CURVED AVAFLEX 1025-011-500,272,RC,27200002,CDM,,,,,,both,,,3883.9400,582.5900,CIGNA HEALTHCARE,CIGNA PPO,1619.60,,,,,,,1002.4400,3883.9400,percent of total billed charges,"41.7% of $3,883.94 in Billed Charges for Rev 272 = $1,619.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE CURVED AVAFLEX 1025-011-500,272,RC,27200002,CDM,,,,,,both,,,3883.9400,582.5900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3495.55,,,,,,,1002.4400,3883.9400,percent of total billed charges,"90% of $3,883.94 in Billed Charges for Rev 272 = $3,495.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE CURVED AVAFLEX 1025-011-500,272,RC,27200002,CDM,,,,,,both,,,3883.9400,582.5900,MEDCOST,MEDCOST VHN,1848.37,,,,,,,1002.4400,3883.9400,percent of total billed charges,"47.59% of $3,883.94 in Billed Charges for Rev 272 = $1,848.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE CURVED AVAFLEX 1025-011-500,272,RC,27200002,CDM,,,,,,both,,,3883.9400,582.5900,SENTARA HEALTH,SENTARA HEALTH,1002.44,,,,,,,1002.4400,3883.9400,percent of total billed charges,"25.81% of $3,883.94 in Billed Charges for Rev 272 = $1,002.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE CURVED AVAFLEX 1025-011-500,272,RC,27200002,CDM,,,,,,both,,,3883.9400,582.5900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3883.94,,,,,,,1002.4400,3883.9400,percent of total billed charges,"100% of $3,883.94 in Billed Charges for Rev 272 = $3,883.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE CURVED AVAFLEX 1025-011-500,272,RC,27200002,CDM,,,,,,both,,,3883.9400,582.5900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1941.97,,,,,,,1002.4400,3883.9400,percent of total billed charges,"Rev 272 $3,883.94 in Billed Charges at 50% = $1,941.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE CURVED AVAFLEX 1025-011-500,272,RC,27200002,CDM,,,,,,both,,,3883.9400,582.5900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1254.51,,,,,,,1002.4400,3883.9400,other,"32.3% of $3,883.94 in Billed Charges for Rev 272 = $1,254.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE CURVED AVAFLEX 1025-011-500,272,RC,27200002,CDM,,,,,,both,,,3883.9400,582.5900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1192.37,,,,,,,1002.4400,3883.9400,other,"30.7% of $3,883.94 in Billed Charges for Rev 272 = $1,192.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE CURVED AVAFLEX 1025-011-500,272,RC,27200002,CDM,,,,,,both,,,3883.9400,582.5900,UNITED HEALTHCARE,UNITED HEALTHCARE,1254.51,,,,,,,1002.4400,3883.9400,percent of total billed charges,"32.3% of $3,883.94 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE CURVED AVAFLEX 1025-011-500,272,RC,27200002,CDM,,,,,,both,,,3883.9400,582.5900,WELLCARE,WELLCARE MEDICAID,3883.94,,,,,,,1002.4400,3883.9400,percent of total billed charges,"100% of $3,883.94 in Billed Charges for Rev 272 = $3,883.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE EZ SHOT 3 PLUS 19 GA ASP FNA NA-U200H-8019,272,RC,27200002,CDM,,,,,,both,,,2988.0900,448.2100,AETNA,AETNA,1275.91,,,,,,,771.2300,2988.0900,percent of total billed charges,"42.7% of $2,988.09 in Billed Charges for Rev 272 = $1,275.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE EZ SHOT 3 PLUS 19 GA ASP FNA NA-U200H-8019,272,RC,27200002,CDM,,,,,,both,,,2988.0900,448.2100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2091.66,,,,,,,771.2300,2988.0900,percent of total billed charges,"Rev 272 $2,988.09 in Billed Charges at 70% = $2,091.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE EZ SHOT 3 PLUS 19 GA ASP FNA NA-U200H-8019,272,RC,27200002,CDM,,,,,,both,,,2988.0900,448.2100,CIGNA HEALTHCARE,CIGNA HMO,1246.03,,,,,,,771.2300,2988.0900,percent of total billed charges,"41.7% of $2,988.09 in Billed Charges for Rev 272 = $1,246.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE EZ SHOT 3 PLUS 19 GA ASP FNA NA-U200H-8019,272,RC,27200002,CDM,,,,,,both,,,2988.0900,448.2100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1386.47,,,,,,,771.2300,2988.0900,percent of total billed charges,"46.4% of $2,988.09 in Billed Charges for Rev 272 = $1,386.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE EZ SHOT 3 PLUS 19 GA ASP FNA NA-U200H-8019,272,RC,27200002,CDM,,,,,,both,,,2988.0900,448.2100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1246.03,,,,,,,771.2300,2988.0900,percent of total billed charges,"41.7% of $2,988.09 in Billed Charges for Rev 272 = $1,246.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE EZ SHOT 3 PLUS 19 GA ASP FNA NA-U200H-8019,272,RC,27200002,CDM,,,,,,both,,,2988.0900,448.2100,CIGNA HEALTHCARE,CIGNA PPO,1246.03,,,,,,,771.2300,2988.0900,percent of total billed charges,"41.7% of $2,988.09 in Billed Charges for Rev 272 = $1,246.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE EZ SHOT 3 PLUS 19 GA ASP FNA NA-U200H-8019,272,RC,27200002,CDM,,,,,,both,,,2988.0900,448.2100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2689.28,,,,,,,771.2300,2988.0900,percent of total billed charges,"90% of $2,988.09 in Billed Charges for Rev 272 = $2,689.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE EZ SHOT 3 PLUS 19 GA ASP FNA NA-U200H-8019,272,RC,27200002,CDM,,,,,,both,,,2988.0900,448.2100,MEDCOST,MEDCOST VHN,1422.03,,,,,,,771.2300,2988.0900,percent of total billed charges,"47.59% of $2,988.09 in Billed Charges for Rev 272 = $1,422.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE EZ SHOT 3 PLUS 19 GA ASP FNA NA-U200H-8019,272,RC,27200002,CDM,,,,,,both,,,2988.0900,448.2100,SENTARA HEALTH,SENTARA HEALTH,771.23,,,,,,,771.2300,2988.0900,percent of total billed charges,"25.81% of $2,988.09 in Billed Charges for Rev 272 = $771.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE EZ SHOT 3 PLUS 19 GA ASP FNA NA-U200H-8019,272,RC,27200002,CDM,,,,,,both,,,2988.0900,448.2100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2988.09,,,,,,,771.2300,2988.0900,percent of total billed charges,"100% of $2,988.09 in Billed Charges for Rev 272 = $2,988.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE EZ SHOT 3 PLUS 19 GA ASP FNA NA-U200H-8019,272,RC,27200002,CDM,,,,,,both,,,2988.0900,448.2100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1494.05,,,,,,,771.2300,2988.0900,percent of total billed charges,"Rev 272 $2,988.09 in Billed Charges at 50% = $1,494.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE EZ SHOT 3 PLUS 19 GA ASP FNA NA-U200H-8019,272,RC,27200002,CDM,,,,,,both,,,2988.0900,448.2100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,965.15,,,,,,,771.2300,2988.0900,other,"32.3% of $2,988.09 in Billed Charges for Rev 272 = $965.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE EZ SHOT 3 PLUS 19 GA ASP FNA NA-U200H-8019,272,RC,27200002,CDM,,,,,,both,,,2988.0900,448.2100,UNITED HEALTHCARE,UHC HERITAGE SELECT,917.34,,,,,,,771.2300,2988.0900,other,"30.7% of $2,988.09 in Billed Charges for Rev 272 = $917.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE EZ SHOT 3 PLUS 19 GA ASP FNA NA-U200H-8019,272,RC,27200002,CDM,,,,,,both,,,2988.0900,448.2100,UNITED HEALTHCARE,UNITED HEALTHCARE,965.15,,,,,,,771.2300,2988.0900,percent of total billed charges,"32.3% of $2,988.09 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE EZ SHOT 3 PLUS 19 GA ASP FNA NA-U200H-8019,272,RC,27200002,CDM,,,,,,both,,,2988.0900,448.2100,WELLCARE,WELLCARE MEDICAID,2988.09,,,,,,,771.2300,2988.0900,percent of total billed charges,"100% of $2,988.09 in Billed Charges for Rev 272 = $2,988.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE FORAMEN LONG,272,RC,27200002,CDM,,,,,,both,,,795.1100,119.2700,AETNA,AETNA,339.51,,,,,,,205.2200,795.1100,percent of total billed charges,42.7% of $795.11 in Billed Charges for Rev 272 = $339.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE FORAMEN LONG,272,RC,27200002,CDM,,,,,,both,,,795.1100,119.2700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,556.58,,,,,,,205.2200,795.1100,percent of total billed charges,Rev 272 $795.11 in Billed Charges at 70% = $556.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE FORAMEN LONG,272,RC,27200002,CDM,,,,,,both,,,795.1100,119.2700,CIGNA HEALTHCARE,CIGNA HMO,331.56,,,,,,,205.2200,795.1100,percent of total billed charges,41.7% of $795.11 in Billed Charges for Rev 272 = $331.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE FORAMEN LONG,272,RC,27200002,CDM,,,,,,both,,,795.1100,119.2700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,368.93,,,,,,,205.2200,795.1100,percent of total billed charges,46.4% of $795.11 in Billed Charges for Rev 272 = $368.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE FORAMEN LONG,272,RC,27200002,CDM,,,,,,both,,,795.1100,119.2700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,331.56,,,,,,,205.2200,795.1100,percent of total billed charges,41.7% of $795.11 in Billed Charges for Rev 272 = $331.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE FORAMEN LONG,272,RC,27200002,CDM,,,,,,both,,,795.1100,119.2700,CIGNA HEALTHCARE,CIGNA PPO,331.56,,,,,,,205.2200,795.1100,percent of total billed charges,41.7% of $795.11 in Billed Charges for Rev 272 = $331.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE FORAMEN LONG,272,RC,27200002,CDM,,,,,,both,,,795.1100,119.2700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,715.60,,,,,,,205.2200,795.1100,percent of total billed charges,90% of $795.11 in Billed Charges for Rev 272 = $715.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE FORAMEN LONG,272,RC,27200002,CDM,,,,,,both,,,795.1100,119.2700,MEDCOST,MEDCOST VHN,378.39,,,,,,,205.2200,795.1100,percent of total billed charges,47.59% of $795.11 in Billed Charges for Rev 272 = $378.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE FORAMEN LONG,272,RC,27200002,CDM,,,,,,both,,,795.1100,119.2700,SENTARA HEALTH,SENTARA HEALTH,205.22,,,,,,,205.2200,795.1100,percent of total billed charges,25.81% of $795.11 in Billed Charges for Rev 272 = $205.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE FORAMEN LONG,272,RC,27200002,CDM,,,,,,both,,,795.1100,119.2700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",795.11,,,,,,,205.2200,795.1100,percent of total billed charges,100% of $795.11 in Billed Charges for Rev 272 = $795.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE FORAMEN LONG,272,RC,27200002,CDM,,,,,,both,,,795.1100,119.2700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,397.56,,,,,,,205.2200,795.1100,percent of total billed charges,Rev 272 $795.11 in Billed Charges at 50% = $397.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE FORAMEN LONG,272,RC,27200002,CDM,,,,,,both,,,795.1100,119.2700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,256.82,,,,,,,205.2200,795.1100,other,32.3% of $795.11 in Billed Charges for Rev 272 = $256.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE FORAMEN LONG,272,RC,27200002,CDM,,,,,,both,,,795.1100,119.2700,UNITED HEALTHCARE,UHC HERITAGE SELECT,244.10,,,,,,,205.2200,795.1100,other,30.7% of $795.11 in Billed Charges for Rev 272 = $244.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE FORAMEN LONG,272,RC,27200002,CDM,,,,,,both,,,795.1100,119.2700,UNITED HEALTHCARE,UNITED HEALTHCARE,256.82,,,,,,,205.2200,795.1100,percent of total billed charges,32.3% of $795.11 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE FORAMEN LONG,272,RC,27200002,CDM,,,,,,both,,,795.1100,119.2700,WELLCARE,WELLCARE MEDICAID,795.11,,,,,,,205.2200,795.1100,percent of total billed charges,100% of $795.11 in Billed Charges for Rev 272 = $795.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG BASIC SET UP PACK,272,RC,27200002,CDM,,,,,,both,,,28.5100,4.2800,AETNA,AETNA,12.17,,,,,,,7.3600,28.5100,percent of total billed charges,42.7% of $28.51 in Billed Charges for Rev 272 = $12.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG BASIC SET UP PACK,272,RC,27200002,CDM,,,,,,both,,,28.5100,4.2800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,19.96,,,,,,,7.3600,28.5100,percent of total billed charges,Rev 272 $28.51 in Billed Charges at 70% = $19.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG BASIC SET UP PACK,272,RC,27200002,CDM,,,,,,both,,,28.5100,4.2800,CIGNA HEALTHCARE,CIGNA HMO,11.89,,,,,,,7.3600,28.5100,percent of total billed charges,41.7% of $28.51 in Billed Charges for Rev 272 = $11.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG BASIC SET UP PACK,272,RC,27200002,CDM,,,,,,both,,,28.5100,4.2800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,13.23,,,,,,,7.3600,28.5100,percent of total billed charges,46.4% of $28.51 in Billed Charges for Rev 272 = $13.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG BASIC SET UP PACK,272,RC,27200002,CDM,,,,,,both,,,28.5100,4.2800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11.89,,,,,,,7.3600,28.5100,percent of total billed charges,41.7% of $28.51 in Billed Charges for Rev 272 = $11.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG BASIC SET UP PACK,272,RC,27200002,CDM,,,,,,both,,,28.5100,4.2800,CIGNA HEALTHCARE,CIGNA PPO,11.89,,,,,,,7.3600,28.5100,percent of total billed charges,41.7% of $28.51 in Billed Charges for Rev 272 = $11.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG BASIC SET UP PACK,272,RC,27200002,CDM,,,,,,both,,,28.5100,4.2800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,25.66,,,,,,,7.3600,28.5100,percent of total billed charges,90% of $28.51 in Billed Charges for Rev 272 = $25.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG BASIC SET UP PACK,272,RC,27200002,CDM,,,,,,both,,,28.5100,4.2800,MEDCOST,MEDCOST VHN,13.57,,,,,,,7.3600,28.5100,percent of total billed charges,47.59% of $28.51 in Billed Charges for Rev 272 = $13.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG BASIC SET UP PACK,272,RC,27200002,CDM,,,,,,both,,,28.5100,4.2800,SENTARA HEALTH,SENTARA HEALTH,7.36,,,,,,,7.3600,28.5100,percent of total billed charges,25.81% of $28.51 in Billed Charges for Rev 272 = $7.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG BASIC SET UP PACK,272,RC,27200002,CDM,,,,,,both,,,28.5100,4.2800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",28.51,,,,,,,7.3600,28.5100,percent of total billed charges,100% of $28.51 in Billed Charges for Rev 272 = $28.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG BASIC SET UP PACK,272,RC,27200002,CDM,,,,,,both,,,28.5100,4.2800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14.26,,,,,,,7.3600,28.5100,percent of total billed charges,Rev 272 $28.51 in Billed Charges at 50% = $14.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG BASIC SET UP PACK,272,RC,27200002,CDM,,,,,,both,,,28.5100,4.2800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,9.21,,,,,,,7.3600,28.5100,other,32.3% of $28.51 in Billed Charges for Rev 272 = $9.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK SURG BASIC SET UP PACK,272,RC,27200002,CDM,,,,,,both,,,28.5100,4.2800,UNITED HEALTHCARE,UHC HERITAGE SELECT,8.75,,,,,,,7.3600,28.5100,other,30.7% of $28.51 in Billed Charges for Rev 272 = $8.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK SURG BASIC SET UP PACK,272,RC,27200002,CDM,,,,,,both,,,28.5100,4.2800,UNITED HEALTHCARE,UNITED HEALTHCARE,9.21,,,,,,,7.3600,28.5100,percent of total billed charges,32.3% of $28.51 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG BASIC SET UP PACK,272,RC,27200002,CDM,,,,,,both,,,28.5100,4.2800,WELLCARE,WELLCARE MEDICAID,28.51,,,,,,,7.3600,28.5100,percent of total billed charges,100% of $28.51 in Billed Charges for Rev 272 = $28.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG CYSTO II,272,RC,27200002,CDM,,,,,,both,,,106.8700,16.0300,AETNA,AETNA,45.63,,,,,,,27.5800,106.8700,percent of total billed charges,42.7% of $106.87 in Billed Charges for Rev 272 = $45.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG CYSTO II,272,RC,27200002,CDM,,,,,,both,,,106.8700,16.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,74.81,,,,,,,27.5800,106.8700,percent of total billed charges,Rev 272 $106.87 in Billed Charges at 70% = $74.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG CYSTO II,272,RC,27200002,CDM,,,,,,both,,,106.8700,16.0300,CIGNA HEALTHCARE,CIGNA HMO,44.56,,,,,,,27.5800,106.8700,percent of total billed charges,41.7% of $106.87 in Billed Charges for Rev 272 = $44.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG CYSTO II,272,RC,27200002,CDM,,,,,,both,,,106.8700,16.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,49.59,,,,,,,27.5800,106.8700,percent of total billed charges,46.4% of $106.87 in Billed Charges for Rev 272 = $49.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG CYSTO II,272,RC,27200002,CDM,,,,,,both,,,106.8700,16.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,44.56,,,,,,,27.5800,106.8700,percent of total billed charges,41.7% of $106.87 in Billed Charges for Rev 272 = $44.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG CYSTO II,272,RC,27200002,CDM,,,,,,both,,,106.8700,16.0300,CIGNA HEALTHCARE,CIGNA PPO,44.56,,,,,,,27.5800,106.8700,percent of total billed charges,41.7% of $106.87 in Billed Charges for Rev 272 = $44.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG CYSTO II,272,RC,27200002,CDM,,,,,,both,,,106.8700,16.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,96.18,,,,,,,27.5800,106.8700,percent of total billed charges,90% of $106.87 in Billed Charges for Rev 272 = $96.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG CYSTO II,272,RC,27200002,CDM,,,,,,both,,,106.8700,16.0300,MEDCOST,MEDCOST VHN,50.86,,,,,,,27.5800,106.8700,percent of total billed charges,47.59% of $106.87 in Billed Charges for Rev 272 = $50.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG CYSTO II,272,RC,27200002,CDM,,,,,,both,,,106.8700,16.0300,SENTARA HEALTH,SENTARA HEALTH,27.58,,,,,,,27.5800,106.8700,percent of total billed charges,25.81% of $106.87 in Billed Charges for Rev 272 = $27.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG CYSTO II,272,RC,27200002,CDM,,,,,,both,,,106.8700,16.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",106.87,,,,,,,27.5800,106.8700,percent of total billed charges,100% of $106.87 in Billed Charges for Rev 272 = $106.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG CYSTO II,272,RC,27200002,CDM,,,,,,both,,,106.8700,16.0300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,53.44,,,,,,,27.5800,106.8700,percent of total billed charges,Rev 272 $106.87 in Billed Charges at 50% = $53.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG CYSTO II,272,RC,27200002,CDM,,,,,,both,,,106.8700,16.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,34.52,,,,,,,27.5800,106.8700,other,32.3% of $106.87 in Billed Charges for Rev 272 = $34.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK SURG CYSTO II,272,RC,27200002,CDM,,,,,,both,,,106.8700,16.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,32.81,,,,,,,27.5800,106.8700,other,30.7% of $106.87 in Billed Charges for Rev 272 = $32.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK SURG CYSTO II,272,RC,27200002,CDM,,,,,,both,,,106.8700,16.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,34.52,,,,,,,27.5800,106.8700,percent of total billed charges,32.3% of $106.87 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURG CYSTO II,272,RC,27200002,CDM,,,,,,both,,,106.8700,16.0300,WELLCARE,WELLCARE MEDICAID,106.87,,,,,,,27.5800,106.8700,percent of total billed charges,100% of $106.87 in Billed Charges for Rev 272 = $106.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURGERY SET UP,272,RC,27200002,CDM,,,,,,both,,,990.5900,148.5900,AETNA,AETNA,422.98,,,,,,,255.6700,990.5900,percent of total billed charges,42.7% of $990.59 in Billed Charges for Rev 272 = $422.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURGERY SET UP,272,RC,27200002,CDM,,,,,,both,,,990.5900,148.5900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,693.41,,,,,,,255.6700,990.5900,percent of total billed charges,Rev 272 $990.59 in Billed Charges at 70% = $693.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURGERY SET UP,272,RC,27200002,CDM,,,,,,both,,,990.5900,148.5900,CIGNA HEALTHCARE,CIGNA HMO,413.08,,,,,,,255.6700,990.5900,percent of total billed charges,41.7% of $990.59 in Billed Charges for Rev 272 = $413.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURGERY SET UP,272,RC,27200002,CDM,,,,,,both,,,990.5900,148.5900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,459.63,,,,,,,255.6700,990.5900,percent of total billed charges,46.4% of $990.59 in Billed Charges for Rev 272 = $459.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURGERY SET UP,272,RC,27200002,CDM,,,,,,both,,,990.5900,148.5900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,413.08,,,,,,,255.6700,990.5900,percent of total billed charges,41.7% of $990.59 in Billed Charges for Rev 272 = $413.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURGERY SET UP,272,RC,27200002,CDM,,,,,,both,,,990.5900,148.5900,CIGNA HEALTHCARE,CIGNA PPO,413.08,,,,,,,255.6700,990.5900,percent of total billed charges,41.7% of $990.59 in Billed Charges for Rev 272 = $413.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURGERY SET UP,272,RC,27200002,CDM,,,,,,both,,,990.5900,148.5900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,891.53,,,,,,,255.6700,990.5900,percent of total billed charges,90% of $990.59 in Billed Charges for Rev 272 = $891.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURGERY SET UP,272,RC,27200002,CDM,,,,,,both,,,990.5900,148.5900,MEDCOST,MEDCOST VHN,471.42,,,,,,,255.6700,990.5900,percent of total billed charges,47.59% of $990.59 in Billed Charges for Rev 272 = $471.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURGERY SET UP,272,RC,27200002,CDM,,,,,,both,,,990.5900,148.5900,SENTARA HEALTH,SENTARA HEALTH,255.67,,,,,,,255.6700,990.5900,percent of total billed charges,25.81% of $990.59 in Billed Charges for Rev 272 = $255.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURGERY SET UP,272,RC,27200002,CDM,,,,,,both,,,990.5900,148.5900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",990.59,,,,,,,255.6700,990.5900,percent of total billed charges,100% of $990.59 in Billed Charges for Rev 272 = $990.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURGERY SET UP,272,RC,27200002,CDM,,,,,,both,,,990.5900,148.5900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,495.30,,,,,,,255.6700,990.5900,percent of total billed charges,Rev 272 $990.59 in Billed Charges at 50% = $495.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURGERY SET UP,272,RC,27200002,CDM,,,,,,both,,,990.5900,148.5900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,319.96,,,,,,,255.6700,990.5900,other,32.3% of $990.59 in Billed Charges for Rev 272 = $319.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK SURGERY SET UP,272,RC,27200002,CDM,,,,,,both,,,990.5900,148.5900,UNITED HEALTHCARE,UHC HERITAGE SELECT,304.11,,,,,,,255.6700,990.5900,other,30.7% of $990.59 in Billed Charges for Rev 272 = $304.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK SURGERY SET UP,272,RC,27200002,CDM,,,,,,both,,,990.5900,148.5900,UNITED HEALTHCARE,UNITED HEALTHCARE,319.96,,,,,,,255.6700,990.5900,percent of total billed charges,32.3% of $990.59 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK SURGERY SET UP,272,RC,27200002,CDM,,,,,,both,,,990.5900,148.5900,WELLCARE,WELLCARE MEDICAID,990.59,,,,,,,255.6700,990.5900,percent of total billed charges,100% of $990.59 in Billed Charges for Rev 272 = $990.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK TRENGUARD 450 CLASSIC,270,RC,27000002,CDM,,,,,,both,,,1051.9300,157.7900,AETNA,AETNA,449.17,,,,,,,271.5000,1051.9300,percent of total billed charges,"42.7% of $1,051.93 in Billed Charges for Rev 270 = $449.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK TRENGUARD 450 CLASSIC,270,RC,27000002,CDM,,,,,,both,,,1051.9300,157.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,736.35,,,,,,,271.5000,1051.9300,percent of total billed charges,"Rev 270 $1,051.93 in Billed Charges at 70% = $736.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK TRENGUARD 450 CLASSIC,270,RC,27000002,CDM,,,,,,both,,,1051.9300,157.7900,CIGNA HEALTHCARE,CIGNA HMO,438.65,,,,,,,271.5000,1051.9300,percent of total billed charges,"41.7% of $1,051.93 in Billed Charges for Rev 270 = $438.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK TRENGUARD 450 CLASSIC,270,RC,27000002,CDM,,,,,,both,,,1051.9300,157.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,488.10,,,,,,,271.5000,1051.9300,percent of total billed charges,"46.4% of $1,051.93 in Billed Charges for Rev 270 = $488.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK TRENGUARD 450 CLASSIC,270,RC,27000002,CDM,,,,,,both,,,1051.9300,157.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,438.65,,,,,,,271.5000,1051.9300,percent of total billed charges,"41.7% of $1,051.93 in Billed Charges for Rev 270 = $438.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK TRENGUARD 450 CLASSIC,270,RC,27000002,CDM,,,,,,both,,,1051.9300,157.7900,CIGNA HEALTHCARE,CIGNA PPO,438.65,,,,,,,271.5000,1051.9300,percent of total billed charges,"41.7% of $1,051.93 in Billed Charges for Rev 270 = $438.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK TRENGUARD 450 CLASSIC,270,RC,27000002,CDM,,,,,,both,,,1051.9300,157.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,946.74,,,,,,,271.5000,1051.9300,percent of total billed charges,"90% of $1,051.93 in Billed Charges for Rev 270 = $946.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK TRENGUARD 450 CLASSIC,270,RC,27000002,CDM,,,,,,both,,,1051.9300,157.7900,MEDCOST,MEDCOST VHN,500.61,,,,,,,271.5000,1051.9300,percent of total billed charges,"47.59% of $1,051.93 in Billed Charges for Rev 270 = $500.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK TRENGUARD 450 CLASSIC,270,RC,27000002,CDM,,,,,,both,,,1051.9300,157.7900,SENTARA HEALTH,SENTARA HEALTH,271.50,,,,,,,271.5000,1051.9300,percent of total billed charges,"25.81% of $1,051.93 in Billed Charges for Rev 270 = $271.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK TRENGUARD 450 CLASSIC,270,RC,27000002,CDM,,,,,,both,,,1051.9300,157.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1051.93,,,,,,,271.5000,1051.9300,percent of total billed charges,"100% of $1,051.93 in Billed Charges for Rev 270 = $1,051.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK TRENGUARD 450 CLASSIC,270,RC,27000002,CDM,,,,,,both,,,1051.9300,157.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,525.97,,,,,,,271.5000,1051.9300,percent of total billed charges,"Rev 270 $1,051.93 in Billed Charges at 50% = $525.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK TRENGUARD 450 CLASSIC,270,RC,27000002,CDM,,,,,,both,,,1051.9300,157.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,339.77,,,,,,,271.5000,1051.9300,other,"32.3% of $1,051.93 in Billed Charges for Rev 270 = $339.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK TRENGUARD 450 CLASSIC,270,RC,27000002,CDM,,,,,,both,,,1051.9300,157.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,322.94,,,,,,,271.5000,1051.9300,other,"30.7% of $1,051.93 in Billed Charges for Rev 270 = $322.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK TRENGUARD 450 CLASSIC,270,RC,27000002,CDM,,,,,,both,,,1051.9300,157.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,339.77,,,,,,,271.5000,1051.9300,percent of total billed charges,"32.3% of $1,051.93 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK TRENGUARD 450 CLASSIC,270,RC,27000002,CDM,,,,,,both,,,1051.9300,157.7900,WELLCARE,WELLCARE MEDICAID,1051.93,,,,,,,271.5000,1051.9300,percent of total billed charges,"100% of $1,051.93 in Billed Charges for Rev 270 = $1,051.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK U-BAR III CHEST,272,RC,27200002,CDM,,,,,,both,,,1330.2900,199.5400,AETNA,AETNA,568.03,,,,,,,343.3500,1330.2900,percent of total billed charges,"42.7% of $1,330.29 in Billed Charges for Rev 272 = $568.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK U-BAR III CHEST,272,RC,27200002,CDM,,,,,,both,,,1330.2900,199.5400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,931.20,,,,,,,343.3500,1330.2900,percent of total billed charges,"Rev 272 $1,330.29 in Billed Charges at 70% = $931.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK U-BAR III CHEST,272,RC,27200002,CDM,,,,,,both,,,1330.2900,199.5400,CIGNA HEALTHCARE,CIGNA HMO,554.73,,,,,,,343.3500,1330.2900,percent of total billed charges,"41.7% of $1,330.29 in Billed Charges for Rev 272 = $554.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK U-BAR III CHEST,272,RC,27200002,CDM,,,,,,both,,,1330.2900,199.5400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,617.25,,,,,,,343.3500,1330.2900,percent of total billed charges,"46.4% of $1,330.29 in Billed Charges for Rev 272 = $617.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK U-BAR III CHEST,272,RC,27200002,CDM,,,,,,both,,,1330.2900,199.5400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,554.73,,,,,,,343.3500,1330.2900,percent of total billed charges,"41.7% of $1,330.29 in Billed Charges for Rev 272 = $554.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK U-BAR III CHEST,272,RC,27200002,CDM,,,,,,both,,,1330.2900,199.5400,CIGNA HEALTHCARE,CIGNA PPO,554.73,,,,,,,343.3500,1330.2900,percent of total billed charges,"41.7% of $1,330.29 in Billed Charges for Rev 272 = $554.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK U-BAR III CHEST,272,RC,27200002,CDM,,,,,,both,,,1330.2900,199.5400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1197.26,,,,,,,343.3500,1330.2900,percent of total billed charges,"90% of $1,330.29 in Billed Charges for Rev 272 = $1,197.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK U-BAR III CHEST,272,RC,27200002,CDM,,,,,,both,,,1330.2900,199.5400,MEDCOST,MEDCOST VHN,633.09,,,,,,,343.3500,1330.2900,percent of total billed charges,"47.59% of $1,330.29 in Billed Charges for Rev 272 = $633.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK U-BAR III CHEST,272,RC,27200002,CDM,,,,,,both,,,1330.2900,199.5400,SENTARA HEALTH,SENTARA HEALTH,343.35,,,,,,,343.3500,1330.2900,percent of total billed charges,"25.81% of $1,330.29 in Billed Charges for Rev 272 = $343.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK U-BAR III CHEST,272,RC,27200002,CDM,,,,,,both,,,1330.2900,199.5400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1330.29,,,,,,,343.3500,1330.2900,percent of total billed charges,"100% of $1,330.29 in Billed Charges for Rev 272 = $1,330.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK U-BAR III CHEST,272,RC,27200002,CDM,,,,,,both,,,1330.2900,199.5400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,665.15,,,,,,,343.3500,1330.2900,percent of total billed charges,"Rev 272 $1,330.29 in Billed Charges at 50% = $665.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK U-BAR III CHEST,272,RC,27200002,CDM,,,,,,both,,,1330.2900,199.5400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,429.68,,,,,,,343.3500,1330.2900,other,"32.3% of $1,330.29 in Billed Charges for Rev 272 = $429.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK U-BAR III CHEST,272,RC,27200002,CDM,,,,,,both,,,1330.2900,199.5400,UNITED HEALTHCARE,UHC HERITAGE SELECT,408.40,,,,,,,343.3500,1330.2900,other,"30.7% of $1,330.29 in Billed Charges for Rev 272 = $408.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK U-BAR III CHEST,272,RC,27200002,CDM,,,,,,both,,,1330.2900,199.5400,UNITED HEALTHCARE,UNITED HEALTHCARE,429.68,,,,,,,343.3500,1330.2900,percent of total billed charges,"32.3% of $1,330.29 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK U-BAR III CHEST,272,RC,27200002,CDM,,,,,,both,,,1330.2900,199.5400,WELLCARE,WELLCARE MEDICAID,1330.29,,,,,,,343.3500,1330.2900,percent of total billed charges,"100% of $1,330.29 in Billed Charges for Rev 272 = $1,330.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK VAGINAL CUSTOM,272,RC,27200002,CDM,,,,,,both,,,518.5000,77.7800,AETNA,AETNA,221.40,,,,,,,133.8200,518.5000,percent of total billed charges,42.7% of $518.50 in Billed Charges for Rev 272 = $221.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK VAGINAL CUSTOM,272,RC,27200002,CDM,,,,,,both,,,518.5000,77.7800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,362.95,,,,,,,133.8200,518.5000,percent of total billed charges,Rev 272 $518.50 in Billed Charges at 70% = $362.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK VAGINAL CUSTOM,272,RC,27200002,CDM,,,,,,both,,,518.5000,77.7800,CIGNA HEALTHCARE,CIGNA HMO,216.21,,,,,,,133.8200,518.5000,percent of total billed charges,41.7% of $518.50 in Billed Charges for Rev 272 = $216.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK VAGINAL CUSTOM,272,RC,27200002,CDM,,,,,,both,,,518.5000,77.7800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,240.58,,,,,,,133.8200,518.5000,percent of total billed charges,46.4% of $518.50 in Billed Charges for Rev 272 = $240.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK VAGINAL CUSTOM,272,RC,27200002,CDM,,,,,,both,,,518.5000,77.7800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,216.21,,,,,,,133.8200,518.5000,percent of total billed charges,41.7% of $518.50 in Billed Charges for Rev 272 = $216.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK VAGINAL CUSTOM,272,RC,27200002,CDM,,,,,,both,,,518.5000,77.7800,CIGNA HEALTHCARE,CIGNA PPO,216.21,,,,,,,133.8200,518.5000,percent of total billed charges,41.7% of $518.50 in Billed Charges for Rev 272 = $216.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK VAGINAL CUSTOM,272,RC,27200002,CDM,,,,,,both,,,518.5000,77.7800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,466.65,,,,,,,133.8200,518.5000,percent of total billed charges,90% of $518.50 in Billed Charges for Rev 272 = $466.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK VAGINAL CUSTOM,272,RC,27200002,CDM,,,,,,both,,,518.5000,77.7800,MEDCOST,MEDCOST VHN,246.75,,,,,,,133.8200,518.5000,percent of total billed charges,47.59% of $518.50 in Billed Charges for Rev 272 = $246.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK VAGINAL CUSTOM,272,RC,27200002,CDM,,,,,,both,,,518.5000,77.7800,SENTARA HEALTH,SENTARA HEALTH,133.82,,,,,,,133.8200,518.5000,percent of total billed charges,25.81% of $518.50 in Billed Charges for Rev 272 = $133.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK VAGINAL CUSTOM,272,RC,27200002,CDM,,,,,,both,,,518.5000,77.7800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",518.50,,,,,,,133.8200,518.5000,percent of total billed charges,100% of $518.50 in Billed Charges for Rev 272 = $518.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK VAGINAL CUSTOM,272,RC,27200002,CDM,,,,,,both,,,518.5000,77.7800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,259.25,,,,,,,133.8200,518.5000,percent of total billed charges,Rev 272 $518.50 in Billed Charges at 50% = $259.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK VAGINAL CUSTOM,272,RC,27200002,CDM,,,,,,both,,,518.5000,77.7800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,167.48,,,,,,,133.8200,518.5000,other,32.3% of $518.50 in Billed Charges for Rev 272 = $167.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK VAGINAL CUSTOM,272,RC,27200002,CDM,,,,,,both,,,518.5000,77.7800,UNITED HEALTHCARE,UHC HERITAGE SELECT,159.18,,,,,,,133.8200,518.5000,other,30.7% of $518.50 in Billed Charges for Rev 272 = $159.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK VAGINAL CUSTOM,272,RC,27200002,CDM,,,,,,both,,,518.5000,77.7800,UNITED HEALTHCARE,UNITED HEALTHCARE,167.48,,,,,,,133.8200,518.5000,percent of total billed charges,32.3% of $518.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK VAGINAL CUSTOM,272,RC,27200002,CDM,,,,,,both,,,518.5000,77.7800,WELLCARE,WELLCARE MEDICAID,518.50,,,,,,,133.8200,518.5000,percent of total billed charges,100% of $518.50 in Billed Charges for Rev 272 = $518.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER SMOOTH ROUND MODERATE HIGH PROFILE EXTRA GEL 470CC,272,RC,27200002,CDM,,,,,,both,,,2489.0400,373.3600,AETNA,AETNA,1062.82,,,,,,,642.4200,2489.0400,percent of total billed charges,"42.7% of $2,489.04 in Billed Charges for Rev 272 = $1,062.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE EXTRA GEL 470CC,272,RC,27200002,CDM,,,,,,both,,,2489.0400,373.3600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1742.33,,,,,,,642.4200,2489.0400,percent of total billed charges,"Rev 272 $2,489.04 in Billed Charges at 70% = $1,742.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE EXTRA GEL 470CC,272,RC,27200002,CDM,,,,,,both,,,2489.0400,373.3600,CIGNA HEALTHCARE,CIGNA HMO,1037.93,,,,,,,642.4200,2489.0400,percent of total billed charges,"41.7% of $2,489.04 in Billed Charges for Rev 272 = $1,037.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE EXTRA GEL 470CC,272,RC,27200002,CDM,,,,,,both,,,2489.0400,373.3600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1154.91,,,,,,,642.4200,2489.0400,percent of total billed charges,"46.4% of $2,489.04 in Billed Charges for Rev 272 = $1,154.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE EXTRA GEL 470CC,272,RC,27200002,CDM,,,,,,both,,,2489.0400,373.3600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1037.93,,,,,,,642.4200,2489.0400,percent of total billed charges,"41.7% of $2,489.04 in Billed Charges for Rev 272 = $1,037.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE EXTRA GEL 470CC,272,RC,27200002,CDM,,,,,,both,,,2489.0400,373.3600,CIGNA HEALTHCARE,CIGNA PPO,1037.93,,,,,,,642.4200,2489.0400,percent of total billed charges,"41.7% of $2,489.04 in Billed Charges for Rev 272 = $1,037.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE EXTRA GEL 470CC,272,RC,27200002,CDM,,,,,,both,,,2489.0400,373.3600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2240.14,,,,,,,642.4200,2489.0400,percent of total billed charges,"90% of $2,489.04 in Billed Charges for Rev 272 = $2,240.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE EXTRA GEL 470CC,272,RC,27200002,CDM,,,,,,both,,,2489.0400,373.3600,MEDCOST,MEDCOST VHN,1184.53,,,,,,,642.4200,2489.0400,percent of total billed charges,"47.59% of $2,489.04 in Billed Charges for Rev 272 = $1,184.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE EXTRA GEL 470CC,272,RC,27200002,CDM,,,,,,both,,,2489.0400,373.3600,SENTARA HEALTH,SENTARA HEALTH,642.42,,,,,,,642.4200,2489.0400,percent of total billed charges,"25.81% of $2,489.04 in Billed Charges for Rev 272 = $642.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE EXTRA GEL 470CC,272,RC,27200002,CDM,,,,,,both,,,2489.0400,373.3600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2489.04,,,,,,,642.4200,2489.0400,percent of total billed charges,"100% of $2,489.04 in Billed Charges for Rev 272 = $2,489.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE EXTRA GEL 470CC,272,RC,27200002,CDM,,,,,,both,,,2489.0400,373.3600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1244.52,,,,,,,642.4200,2489.0400,percent of total billed charges,"Rev 272 $2,489.04 in Billed Charges at 50% = $1,244.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE EXTRA GEL 470CC,272,RC,27200002,CDM,,,,,,both,,,2489.0400,373.3600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,803.96,,,,,,,642.4200,2489.0400,other,"32.3% of $2,489.04 in Billed Charges for Rev 272 = $803.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE EXTRA GEL 470CC,272,RC,27200002,CDM,,,,,,both,,,2489.0400,373.3600,UNITED HEALTHCARE,UHC HERITAGE SELECT,764.14,,,,,,,642.4200,2489.0400,other,"30.7% of $2,489.04 in Billed Charges for Rev 272 = $764.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE EXTRA GEL 470CC,272,RC,27200002,CDM,,,,,,both,,,2489.0400,373.3600,UNITED HEALTHCARE,UNITED HEALTHCARE,803.96,,,,,,,642.4200,2489.0400,percent of total billed charges,"32.3% of $2,489.04 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER SMOOTH ROUND MODERATE HIGH PROFILE EXTRA GEL 470CC,272,RC,27200002,CDM,,,,,,both,,,2489.0400,373.3600,WELLCARE,WELLCARE MEDICAID,2489.04,,,,,,,642.4200,2489.0400,percent of total billed charges,"100% of $2,489.04 in Billed Charges for Rev 272 = $2,489.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK VAGINAL MAJOR,272,RC,27200002,CDM,,,,,,both,,,373.4600,56.0200,AETNA,AETNA,159.47,,,,,,,96.3900,373.4600,percent of total billed charges,42.7% of $373.46 in Billed Charges for Rev 272 = $159.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK VAGINAL MAJOR,272,RC,27200002,CDM,,,,,,both,,,373.4600,56.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,261.42,,,,,,,96.3900,373.4600,percent of total billed charges,Rev 272 $373.46 in Billed Charges at 70% = $261.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK VAGINAL MAJOR,272,RC,27200002,CDM,,,,,,both,,,373.4600,56.0200,CIGNA HEALTHCARE,CIGNA HMO,155.73,,,,,,,96.3900,373.4600,percent of total billed charges,41.7% of $373.46 in Billed Charges for Rev 272 = $155.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK VAGINAL MAJOR,272,RC,27200002,CDM,,,,,,both,,,373.4600,56.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,173.29,,,,,,,96.3900,373.4600,percent of total billed charges,46.4% of $373.46 in Billed Charges for Rev 272 = $173.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK VAGINAL MAJOR,272,RC,27200002,CDM,,,,,,both,,,373.4600,56.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,155.73,,,,,,,96.3900,373.4600,percent of total billed charges,41.7% of $373.46 in Billed Charges for Rev 272 = $155.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK VAGINAL MAJOR,272,RC,27200002,CDM,,,,,,both,,,373.4600,56.0200,CIGNA HEALTHCARE,CIGNA PPO,155.73,,,,,,,96.3900,373.4600,percent of total billed charges,41.7% of $373.46 in Billed Charges for Rev 272 = $155.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK VAGINAL MAJOR,272,RC,27200002,CDM,,,,,,both,,,373.4600,56.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,336.11,,,,,,,96.3900,373.4600,percent of total billed charges,90% of $373.46 in Billed Charges for Rev 272 = $336.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK VAGINAL MAJOR,272,RC,27200002,CDM,,,,,,both,,,373.4600,56.0200,MEDCOST,MEDCOST VHN,177.73,,,,,,,96.3900,373.4600,percent of total billed charges,47.59% of $373.46 in Billed Charges for Rev 272 = $177.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK VAGINAL MAJOR,272,RC,27200002,CDM,,,,,,both,,,373.4600,56.0200,SENTARA HEALTH,SENTARA HEALTH,96.39,,,,,,,96.3900,373.4600,percent of total billed charges,25.81% of $373.46 in Billed Charges for Rev 272 = $96.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK VAGINAL MAJOR,272,RC,27200002,CDM,,,,,,both,,,373.4600,56.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",373.46,,,,,,,96.3900,373.4600,percent of total billed charges,100% of $373.46 in Billed Charges for Rev 272 = $373.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK VAGINAL MAJOR,272,RC,27200002,CDM,,,,,,both,,,373.4600,56.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,186.73,,,,,,,96.3900,373.4600,percent of total billed charges,Rev 272 $373.46 in Billed Charges at 50% = $186.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK VAGINAL MAJOR,272,RC,27200002,CDM,,,,,,both,,,373.4600,56.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,120.63,,,,,,,96.3900,373.4600,other,32.3% of $373.46 in Billed Charges for Rev 272 = $120.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK VAGINAL MAJOR,272,RC,27200002,CDM,,,,,,both,,,373.4600,56.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,114.65,,,,,,,96.3900,373.4600,other,30.7% of $373.46 in Billed Charges for Rev 272 = $114.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK VAGINAL MAJOR,272,RC,27200002,CDM,,,,,,both,,,373.4600,56.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,120.63,,,,,,,96.3900,373.4600,percent of total billed charges,32.3% of $373.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK VAGINAL MAJOR,272,RC,27200002,CDM,,,,,,both,,,373.4600,56.0200,WELLCARE,WELLCARE MEDICAID,373.46,,,,,,,96.3900,373.4600,percent of total billed charges,100% of $373.46 in Billed Charges for Rev 272 = $373.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PAK PROC COMB 23G,272,RC,27200002,CDM,,,,,,both,,,7993.3400,1199.0000,AETNA,AETNA,3413.16,,,,,,,2063.0800,7993.3400,percent of total billed charges,"42.7% of $7,993.34 in Billed Charges for Rev 272 = $3,413.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAK PROC COMB 23G,272,RC,27200002,CDM,,,,,,both,,,7993.3400,1199.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5595.34,,,,,,,2063.0800,7993.3400,percent of total billed charges,"Rev 272 $7,993.34 in Billed Charges at 70% = $5,595.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAK PROC COMB 23G,272,RC,27200002,CDM,,,,,,both,,,7993.3400,1199.0000,CIGNA HEALTHCARE,CIGNA HMO,3333.22,,,,,,,2063.0800,7993.3400,percent of total billed charges,"41.7% of $7,993.34 in Billed Charges for Rev 272 = $3,333.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAK PROC COMB 23G,272,RC,27200002,CDM,,,,,,both,,,7993.3400,1199.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3708.91,,,,,,,2063.0800,7993.3400,percent of total billed charges,"46.4% of $7,993.34 in Billed Charges for Rev 272 = $3,708.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAK PROC COMB 23G,272,RC,27200002,CDM,,,,,,both,,,7993.3400,1199.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3333.22,,,,,,,2063.0800,7993.3400,percent of total billed charges,"41.7% of $7,993.34 in Billed Charges for Rev 272 = $3,333.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAK PROC COMB 23G,272,RC,27200002,CDM,,,,,,both,,,7993.3400,1199.0000,CIGNA HEALTHCARE,CIGNA PPO,3333.22,,,,,,,2063.0800,7993.3400,percent of total billed charges,"41.7% of $7,993.34 in Billed Charges for Rev 272 = $3,333.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAK PROC COMB 23G,272,RC,27200002,CDM,,,,,,both,,,7993.3400,1199.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7194.01,,,,,,,2063.0800,7993.3400,percent of total billed charges,"90% of $7,993.34 in Billed Charges for Rev 272 = $7,194.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAK PROC COMB 23G,272,RC,27200002,CDM,,,,,,both,,,7993.3400,1199.0000,MEDCOST,MEDCOST VHN,3804.03,,,,,,,2063.0800,7993.3400,percent of total billed charges,"47.59% of $7,993.34 in Billed Charges for Rev 272 = $3,804.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAK PROC COMB 23G,272,RC,27200002,CDM,,,,,,both,,,7993.3400,1199.0000,SENTARA HEALTH,SENTARA HEALTH,2063.08,,,,,,,2063.0800,7993.3400,percent of total billed charges,"25.81% of $7,993.34 in Billed Charges for Rev 272 = $2,063.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAK PROC COMB 23G,272,RC,27200002,CDM,,,,,,both,,,7993.3400,1199.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7993.34,,,,,,,2063.0800,7993.3400,percent of total billed charges,"100% of $7,993.34 in Billed Charges for Rev 272 = $7,993.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAK PROC COMB 23G,272,RC,27200002,CDM,,,,,,both,,,7993.3400,1199.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3996.67,,,,,,,2063.0800,7993.3400,percent of total billed charges,"Rev 272 $7,993.34 in Billed Charges at 50% = $3,996.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAK PROC COMB 23G,272,RC,27200002,CDM,,,,,,both,,,7993.3400,1199.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2581.85,,,,,,,2063.0800,7993.3400,other,"32.3% of $7,993.34 in Billed Charges for Rev 272 = $2,581.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PAK PROC COMB 23G,272,RC,27200002,CDM,,,,,,both,,,7993.3400,1199.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2453.96,,,,,,,2063.0800,7993.3400,other,"30.7% of $7,993.34 in Billed Charges for Rev 272 = $2,453.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PAK PROC COMB 23G,272,RC,27200002,CDM,,,,,,both,,,7993.3400,1199.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,2581.85,,,,,,,2063.0800,7993.3400,percent of total billed charges,"32.3% of $7,993.34 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PAK PROC COMB 23G,272,RC,27200002,CDM,,,,,,both,,,7993.3400,1199.0000,WELLCARE,WELLCARE MEDICAID,7993.34,,,,,,,2063.0800,7993.3400,percent of total billed charges,"100% of $7,993.34 in Billed Charges for Rev 272 = $7,993.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIN CLOSURE DERMABOND PRINEO 42CM,272,RC,27200002,CDM,,,,,,both,,,957.0400,143.5600,AETNA,AETNA,408.66,,,,,,,247.0100,957.0400,percent of total billed charges,42.7% of $957.04 in Billed Charges for Rev 272 = $408.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SKIN CLOSURE DERMABOND PRINEO 42CM,272,RC,27200002,CDM,,,,,,both,,,957.0400,143.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,669.93,,,,,,,247.0100,957.0400,percent of total billed charges,Rev 272 $957.04 in Billed Charges at 70% = $669.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SKIN CLOSURE DERMABOND PRINEO 42CM,272,RC,27200002,CDM,,,,,,both,,,957.0400,143.5600,CIGNA HEALTHCARE,CIGNA HMO,399.09,,,,,,,247.0100,957.0400,percent of total billed charges,41.7% of $957.04 in Billed Charges for Rev 272 = $399.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SKIN CLOSURE DERMABOND PRINEO 42CM,272,RC,27200002,CDM,,,,,,both,,,957.0400,143.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,444.07,,,,,,,247.0100,957.0400,percent of total billed charges,46.4% of $957.04 in Billed Charges for Rev 272 = $444.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SKIN CLOSURE DERMABOND PRINEO 42CM,272,RC,27200002,CDM,,,,,,both,,,957.0400,143.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,399.09,,,,,,,247.0100,957.0400,percent of total billed charges,41.7% of $957.04 in Billed Charges for Rev 272 = $399.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SKIN CLOSURE DERMABOND PRINEO 42CM,272,RC,27200002,CDM,,,,,,both,,,957.0400,143.5600,CIGNA HEALTHCARE,CIGNA PPO,399.09,,,,,,,247.0100,957.0400,percent of total billed charges,41.7% of $957.04 in Billed Charges for Rev 272 = $399.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SKIN CLOSURE DERMABOND PRINEO 42CM,272,RC,27200002,CDM,,,,,,both,,,957.0400,143.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,861.34,,,,,,,247.0100,957.0400,percent of total billed charges,90% of $957.04 in Billed Charges for Rev 272 = $861.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SKIN CLOSURE DERMABOND PRINEO 42CM,272,RC,27200002,CDM,,,,,,both,,,957.0400,143.5600,MEDCOST,MEDCOST VHN,455.46,,,,,,,247.0100,957.0400,percent of total billed charges,47.59% of $957.04 in Billed Charges for Rev 272 = $455.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SKIN CLOSURE DERMABOND PRINEO 42CM,272,RC,27200002,CDM,,,,,,both,,,957.0400,143.5600,SENTARA HEALTH,SENTARA HEALTH,247.01,,,,,,,247.0100,957.0400,percent of total billed charges,25.81% of $957.04 in Billed Charges for Rev 272 = $247.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SKIN CLOSURE DERMABOND PRINEO 42CM,272,RC,27200002,CDM,,,,,,both,,,957.0400,143.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",957.04,,,,,,,247.0100,957.0400,percent of total billed charges,100% of $957.04 in Billed Charges for Rev 272 = $957.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SKIN CLOSURE DERMABOND PRINEO 42CM,272,RC,27200002,CDM,,,,,,both,,,957.0400,143.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,478.52,,,,,,,247.0100,957.0400,percent of total billed charges,Rev 272 $957.04 in Billed Charges at 50% = $478.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SKIN CLOSURE DERMABOND PRINEO 42CM,272,RC,27200002,CDM,,,,,,both,,,957.0400,143.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,309.12,,,,,,,247.0100,957.0400,other,32.3% of $957.04 in Billed Charges for Rev 272 = $309.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SKIN CLOSURE DERMABOND PRINEO 42CM,272,RC,27200002,CDM,,,,,,both,,,957.0400,143.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,293.81,,,,,,,247.0100,957.0400,other,30.7% of $957.04 in Billed Charges for Rev 272 = $293.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SKIN CLOSURE DERMABOND PRINEO 42CM,272,RC,27200002,CDM,,,,,,both,,,957.0400,143.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,309.12,,,,,,,247.0100,957.0400,percent of total billed charges,32.3% of $957.04 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SKIN CLOSURE DERMABOND PRINEO 42CM,272,RC,27200002,CDM,,,,,,both,,,957.0400,143.5600,WELLCARE,WELLCARE MEDICAID,957.04,,,,,,,247.0100,957.0400,percent of total billed charges,100% of $957.04 in Billed Charges for Rev 272 = $957.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE ADAPTER NEUTRAL 3.5MM FOR 3.5MM NON LOCKING DRILL GUIDE,272,RC,,,,,,,,both,,,1720.6500,258.1000,AETNA,AETNA,734.72,,,,,,,444.1000,1720.6500,percent of total billed charges,"42.7% of $1,720.65 in Billed Charges for Rev 272 = $734.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE ADAPTER NEUTRAL 3.5MM FOR 3.5MM NON LOCKING DRILL GUIDE,272,RC,,,,,,,,both,,,1720.6500,258.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1204.46,,,,,,,444.1000,1720.6500,percent of total billed charges,"Rev 272 $1,720.65 in Billed Charges at 70% = $1,204.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE ADAPTER NEUTRAL 3.5MM FOR 3.5MM NON LOCKING DRILL GUIDE,272,RC,,,,,,,,both,,,1720.6500,258.1000,CIGNA HEALTHCARE,CIGNA HMO,717.51,,,,,,,444.1000,1720.6500,percent of total billed charges,"41.7% of $1,720.65 in Billed Charges for Rev 272 = $717.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE ADAPTER NEUTRAL 3.5MM FOR 3.5MM NON LOCKING DRILL GUIDE,272,RC,,,,,,,,both,,,1720.6500,258.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,798.38,,,,,,,444.1000,1720.6500,percent of total billed charges,"46.4% of $1,720.65 in Billed Charges for Rev 272 = $798.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE ADAPTER NEUTRAL 3.5MM FOR 3.5MM NON LOCKING DRILL GUIDE,272,RC,,,,,,,,both,,,1720.6500,258.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,717.51,,,,,,,444.1000,1720.6500,percent of total billed charges,"41.7% of $1,720.65 in Billed Charges for Rev 272 = $717.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE ADAPTER NEUTRAL 3.5MM FOR 3.5MM NON LOCKING DRILL GUIDE,272,RC,,,,,,,,both,,,1720.6500,258.1000,CIGNA HEALTHCARE,CIGNA PPO,717.51,,,,,,,444.1000,1720.6500,percent of total billed charges,"41.7% of $1,720.65 in Billed Charges for Rev 272 = $717.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE ADAPTER NEUTRAL 3.5MM FOR 3.5MM NON LOCKING DRILL GUIDE,272,RC,,,,,,,,both,,,1720.6500,258.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1548.59,,,,,,,444.1000,1720.6500,percent of total billed charges,"90% of $1,720.65 in Billed Charges for Rev 272 = $1,548.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE ADAPTER NEUTRAL 3.5MM FOR 3.5MM NON LOCKING DRILL GUIDE,272,RC,,,,,,,,both,,,1720.6500,258.1000,MEDCOST,MEDCOST VHN,818.86,,,,,,,444.1000,1720.6500,percent of total billed charges,"47.59% of $1,720.65 in Billed Charges for Rev 272 = $818.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE ADAPTER NEUTRAL 3.5MM FOR 3.5MM NON LOCKING DRILL GUIDE,272,RC,,,,,,,,both,,,1720.6500,258.1000,SENTARA HEALTH,SENTARA HEALTH,444.10,,,,,,,444.1000,1720.6500,percent of total billed charges,"25.81% of $1,720.65 in Billed Charges for Rev 272 = $444.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE ADAPTER NEUTRAL 3.5MM FOR 3.5MM NON LOCKING DRILL GUIDE,272,RC,,,,,,,,both,,,1720.6500,258.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1720.65,,,,,,,444.1000,1720.6500,percent of total billed charges,"100% of $1,720.65 in Billed Charges for Rev 272 = $1,720.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE ADAPTER NEUTRAL 3.5MM FOR 3.5MM NON LOCKING DRILL GUIDE,272,RC,,,,,,,,both,,,1720.6500,258.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,860.33,,,,,,,444.1000,1720.6500,percent of total billed charges,"Rev 272 $1,720.65 in Billed Charges at 50% = $860.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE ADAPTER NEUTRAL 3.5MM FOR 3.5MM NON LOCKING DRILL GUIDE,272,RC,,,,,,,,both,,,1720.6500,258.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,555.77,,,,,,,444.1000,1720.6500,other,"32.3% of $1,720.65 in Billed Charges for Rev 272 = $555.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SLEEVE ADAPTER NEUTRAL 3.5MM FOR 3.5MM NON LOCKING DRILL GUIDE,272,RC,,,,,,,,both,,,1720.6500,258.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,528.24,,,,,,,444.1000,1720.6500,other,"30.7% of $1,720.65 in Billed Charges for Rev 272 = $528.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SLEEVE ADAPTER NEUTRAL 3.5MM FOR 3.5MM NON LOCKING DRILL GUIDE,272,RC,,,,,,,,both,,,1720.6500,258.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,555.77,,,,,,,444.1000,1720.6500,percent of total billed charges,"32.3% of $1,720.65 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SLEEVE ADAPTER NEUTRAL 3.5MM FOR 3.5MM NON LOCKING DRILL GUIDE,272,RC,,,,,,,,both,,,1720.6500,258.1000,WELLCARE,WELLCARE MEDICAID,1720.65,,,,,,,444.1000,1720.6500,percent of total billed charges,"100% of $1,720.65 in Billed Charges for Rev 272 = $1,720.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH ENSITE PRECISION,272,RC,27200002,CDM,,,,,,both,,,12497.0600,1874.5600,AETNA,AETNA,5336.24,,,,,,,3225.4900,12497.0600,percent of total billed charges,"42.7% of $12,497.06 in Billed Charges for Rev 272 = $5,336.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH ENSITE PRECISION,272,RC,27200002,CDM,,,,,,both,,,12497.0600,1874.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8747.94,,,,,,,3225.4900,12497.0600,percent of total billed charges,"Rev 272 $12,497.06 in Billed Charges at 70% = $8,747.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH ENSITE PRECISION,272,RC,27200002,CDM,,,,,,both,,,12497.0600,1874.5600,CIGNA HEALTHCARE,CIGNA HMO,5211.27,,,,,,,3225.4900,12497.0600,percent of total billed charges,"41.7% of $12,497.06 in Billed Charges for Rev 272 = $5,211.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH ENSITE PRECISION,272,RC,27200002,CDM,,,,,,both,,,12497.0600,1874.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5798.64,,,,,,,3225.4900,12497.0600,percent of total billed charges,"46.4% of $12,497.06 in Billed Charges for Rev 272 = $5,798.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH ENSITE PRECISION,272,RC,27200002,CDM,,,,,,both,,,12497.0600,1874.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5211.27,,,,,,,3225.4900,12497.0600,percent of total billed charges,"41.7% of $12,497.06 in Billed Charges for Rev 272 = $5,211.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH ENSITE PRECISION,272,RC,27200002,CDM,,,,,,both,,,12497.0600,1874.5600,CIGNA HEALTHCARE,CIGNA PPO,5211.27,,,,,,,3225.4900,12497.0600,percent of total billed charges,"41.7% of $12,497.06 in Billed Charges for Rev 272 = $5,211.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH ENSITE PRECISION,272,RC,27200002,CDM,,,,,,both,,,12497.0600,1874.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11247.35,,,,,,,3225.4900,12497.0600,percent of total billed charges,"90% of $12,497.06 in Billed Charges for Rev 272 = $11,247.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH ENSITE PRECISION,272,RC,27200002,CDM,,,,,,both,,,12497.0600,1874.5600,MEDCOST,MEDCOST VHN,5947.35,,,,,,,3225.4900,12497.0600,percent of total billed charges,"47.59% of $12,497.06 in Billed Charges for Rev 272 = $5,947.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH ENSITE PRECISION,272,RC,27200002,CDM,,,,,,both,,,12497.0600,1874.5600,SENTARA HEALTH,SENTARA HEALTH,3225.49,,,,,,,3225.4900,12497.0600,percent of total billed charges,"25.81% of $12,497.06 in Billed Charges for Rev 272 = $3,225.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH ENSITE PRECISION,272,RC,27200002,CDM,,,,,,both,,,12497.0600,1874.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12497.06,,,,,,,3225.4900,12497.0600,percent of total billed charges,"100% of $12,497.06 in Billed Charges for Rev 272 = $12,497.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH ENSITE PRECISION,272,RC,27200002,CDM,,,,,,both,,,12497.0600,1874.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6248.53,,,,,,,3225.4900,12497.0600,percent of total billed charges,"Rev 272 $12,497.06 in Billed Charges at 50% = $6,248.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH ENSITE PRECISION,272,RC,27200002,CDM,,,,,,both,,,12497.0600,1874.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4036.55,,,,,,,3225.4900,12497.0600,other,"32.3% of $12,497.06 in Billed Charges for Rev 272 = $4,036.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PATCH ENSITE PRECISION,272,RC,27200002,CDM,,,,,,both,,,12497.0600,1874.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,3836.60,,,,,,,3225.4900,12497.0600,other,"30.7% of $12,497.06 in Billed Charges for Rev 272 = $3,836.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PATCH ENSITE PRECISION,272,RC,27200002,CDM,,,,,,both,,,12497.0600,1874.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,4036.55,,,,,,,3225.4900,12497.0600,percent of total billed charges,"32.3% of $12,497.06 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PATCH ENSITE PRECISION,272,RC,27200002,CDM,,,,,,both,,,12497.0600,1874.5600,WELLCARE,WELLCARE MEDICAID,12497.06,,,,,,,3225.4900,12497.0600,percent of total billed charges,"100% of $12,497.06 in Billed Charges for Rev 272 = $12,497.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE NERVE BLOCK,272,RC,27200002,CDM,,,,,,both,,,29038.8000,4355.8200,AETNA,AETNA,12399.57,,,,,,,7494.9100,29038.8000,percent of total billed charges,"42.7% of $29,038.80 in Billed Charges for Rev 272 = $12,399.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE NERVE BLOCK,272,RC,27200002,CDM,,,,,,both,,,29038.8000,4355.8200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,20327.16,,,,,,,7494.9100,29038.8000,percent of total billed charges,"Rev 272 $29,038.80 in Billed Charges at 70% = $20,327.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE NERVE BLOCK,272,RC,27200002,CDM,,,,,,both,,,29038.8000,4355.8200,CIGNA HEALTHCARE,CIGNA HMO,12109.18,,,,,,,7494.9100,29038.8000,percent of total billed charges,"41.7% of $29,038.80 in Billed Charges for Rev 272 = $12,109.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE NERVE BLOCK,272,RC,27200002,CDM,,,,,,both,,,29038.8000,4355.8200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,13474.00,,,,,,,7494.9100,29038.8000,percent of total billed charges,"46.4% of $29,038.80 in Billed Charges for Rev 272 = $13,474.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE NERVE BLOCK,272,RC,27200002,CDM,,,,,,both,,,29038.8000,4355.8200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,12109.18,,,,,,,7494.9100,29038.8000,percent of total billed charges,"41.7% of $29,038.80 in Billed Charges for Rev 272 = $12,109.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE NERVE BLOCK,272,RC,27200002,CDM,,,,,,both,,,29038.8000,4355.8200,CIGNA HEALTHCARE,CIGNA PPO,12109.18,,,,,,,7494.9100,29038.8000,percent of total billed charges,"41.7% of $29,038.80 in Billed Charges for Rev 272 = $12,109.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE NERVE BLOCK,272,RC,27200002,CDM,,,,,,both,,,29038.8000,4355.8200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,26134.92,,,,,,,7494.9100,29038.8000,percent of total billed charges,"90% of $29,038.80 in Billed Charges for Rev 272 = $26,134.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE NERVE BLOCK,272,RC,27200002,CDM,,,,,,both,,,29038.8000,4355.8200,MEDCOST,MEDCOST VHN,13819.56,,,,,,,7494.9100,29038.8000,percent of total billed charges,"47.59% of $29,038.80 in Billed Charges for Rev 272 = $13,819.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE NERVE BLOCK,272,RC,27200002,CDM,,,,,,both,,,29038.8000,4355.8200,SENTARA HEALTH,SENTARA HEALTH,7494.91,,,,,,,7494.9100,29038.8000,percent of total billed charges,"25.81% of $29,038.80 in Billed Charges for Rev 272 = $7,494.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE NERVE BLOCK,272,RC,27200002,CDM,,,,,,both,,,29038.8000,4355.8200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",29038.80,,,,,,,7494.9100,29038.8000,percent of total billed charges,"100% of $29,038.80 in Billed Charges for Rev 272 = $29,038.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE NERVE BLOCK,272,RC,27200002,CDM,,,,,,both,,,29038.8000,4355.8200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14519.40,,,,,,,7494.9100,29038.8000,percent of total billed charges,"Rev 272 $29,038.80 in Billed Charges at 50% = $14,519.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE NERVE BLOCK,272,RC,27200002,CDM,,,,,,both,,,29038.8000,4355.8200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,9379.53,,,,,,,7494.9100,29038.8000,other,"32.3% of $29,038.80 in Billed Charges for Rev 272 = $9,379.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE NERVE BLOCK,272,RC,27200002,CDM,,,,,,both,,,29038.8000,4355.8200,UNITED HEALTHCARE,UHC HERITAGE SELECT,8914.91,,,,,,,7494.9100,29038.8000,other,"30.7% of $29,038.80 in Billed Charges for Rev 272 = $8,914.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE NERVE BLOCK,272,RC,27200002,CDM,,,,,,both,,,29038.8000,4355.8200,UNITED HEALTHCARE,UNITED HEALTHCARE,9379.53,,,,,,,7494.9100,29038.8000,percent of total billed charges,"32.3% of $29,038.80 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE NERVE BLOCK,272,RC,27200002,CDM,,,,,,both,,,29038.8000,4355.8200,WELLCARE,WELLCARE MEDICAID,29038.80,,,,,,,7494.9100,29038.8000,percent of total billed charges,"100% of $29,038.80 in Billed Charges for Rev 272 = $29,038.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE POINTER NAVIGATION 9735319,272,RC,27200002,CDM,,,,,,both,,,6243.3400,936.5000,AETNA,AETNA,2665.91,,,,,,,1611.4100,6243.3400,percent of total billed charges,"42.7% of $6,243.34 in Billed Charges for Rev 272 = $2,665.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE POINTER NAVIGATION 9735319,272,RC,27200002,CDM,,,,,,both,,,6243.3400,936.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4370.34,,,,,,,1611.4100,6243.3400,percent of total billed charges,"Rev 272 $6,243.34 in Billed Charges at 70% = $4,370.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE POINTER NAVIGATION 9735319,272,RC,27200002,CDM,,,,,,both,,,6243.3400,936.5000,CIGNA HEALTHCARE,CIGNA HMO,2603.47,,,,,,,1611.4100,6243.3400,percent of total billed charges,"41.7% of $6,243.34 in Billed Charges for Rev 272 = $2,603.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE POINTER NAVIGATION 9735319,272,RC,27200002,CDM,,,,,,both,,,6243.3400,936.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2896.91,,,,,,,1611.4100,6243.3400,percent of total billed charges,"46.4% of $6,243.34 in Billed Charges for Rev 272 = $2,896.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE POINTER NAVIGATION 9735319,272,RC,27200002,CDM,,,,,,both,,,6243.3400,936.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2603.47,,,,,,,1611.4100,6243.3400,percent of total billed charges,"41.7% of $6,243.34 in Billed Charges for Rev 272 = $2,603.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE POINTER NAVIGATION 9735319,272,RC,27200002,CDM,,,,,,both,,,6243.3400,936.5000,CIGNA HEALTHCARE,CIGNA PPO,2603.47,,,,,,,1611.4100,6243.3400,percent of total billed charges,"41.7% of $6,243.34 in Billed Charges for Rev 272 = $2,603.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE POINTER NAVIGATION 9735319,272,RC,27200002,CDM,,,,,,both,,,6243.3400,936.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5619.01,,,,,,,1611.4100,6243.3400,percent of total billed charges,"90% of $6,243.34 in Billed Charges for Rev 272 = $5,619.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE POINTER NAVIGATION 9735319,272,RC,27200002,CDM,,,,,,both,,,6243.3400,936.5000,MEDCOST,MEDCOST VHN,2971.21,,,,,,,1611.4100,6243.3400,percent of total billed charges,"47.59% of $6,243.34 in Billed Charges for Rev 272 = $2,971.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE POINTER NAVIGATION 9735319,272,RC,27200002,CDM,,,,,,both,,,6243.3400,936.5000,SENTARA HEALTH,SENTARA HEALTH,1611.41,,,,,,,1611.4100,6243.3400,percent of total billed charges,"25.81% of $6,243.34 in Billed Charges for Rev 272 = $1,611.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE POINTER NAVIGATION 9735319,272,RC,27200002,CDM,,,,,,both,,,6243.3400,936.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6243.34,,,,,,,1611.4100,6243.3400,percent of total billed charges,"100% of $6,243.34 in Billed Charges for Rev 272 = $6,243.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE POINTER NAVIGATION 9735319,272,RC,27200002,CDM,,,,,,both,,,6243.3400,936.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3121.67,,,,,,,1611.4100,6243.3400,percent of total billed charges,"Rev 272 $6,243.34 in Billed Charges at 50% = $3,121.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE POINTER NAVIGATION 9735319,272,RC,27200002,CDM,,,,,,both,,,6243.3400,936.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2016.60,,,,,,,1611.4100,6243.3400,other,"32.3% of $6,243.34 in Billed Charges for Rev 272 = $2,016.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE POINTER NAVIGATION 9735319,272,RC,27200002,CDM,,,,,,both,,,6243.3400,936.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1916.71,,,,,,,1611.4100,6243.3400,other,"30.7% of $6,243.34 in Billed Charges for Rev 272 = $1,916.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE POINTER NAVIGATION 9735319,272,RC,27200002,CDM,,,,,,both,,,6243.3400,936.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,2016.60,,,,,,,1611.4100,6243.3400,percent of total billed charges,"32.3% of $6,243.34 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE POINTER NAVIGATION 9735319,272,RC,27200002,CDM,,,,,,both,,,6243.3400,936.5000,WELLCARE,WELLCARE MEDICAID,6243.34,,,,,,,1611.4100,6243.3400,percent of total billed charges,"100% of $6,243.34 in Billed Charges for Rev 272 = $6,243.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE STIMULATOR 8225101,272,RC,27200002,CDM,,,,,,both,,,1366.3800,204.9600,AETNA,AETNA,583.44,,,,,,,352.6600,1366.3800,percent of total billed charges,"42.7% of $1,366.38 in Billed Charges for Rev 272 = $583.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE STIMULATOR 8225101,272,RC,27200002,CDM,,,,,,both,,,1366.3800,204.9600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,956.47,,,,,,,352.6600,1366.3800,percent of total billed charges,"Rev 272 $1,366.38 in Billed Charges at 70% = $956.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE STIMULATOR 8225101,272,RC,27200002,CDM,,,,,,both,,,1366.3800,204.9600,CIGNA HEALTHCARE,CIGNA HMO,569.78,,,,,,,352.6600,1366.3800,percent of total billed charges,"41.7% of $1,366.38 in Billed Charges for Rev 272 = $569.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE STIMULATOR 8225101,272,RC,27200002,CDM,,,,,,both,,,1366.3800,204.9600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,634.00,,,,,,,352.6600,1366.3800,percent of total billed charges,"46.4% of $1,366.38 in Billed Charges for Rev 272 = $634.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE STIMULATOR 8225101,272,RC,27200002,CDM,,,,,,both,,,1366.3800,204.9600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,569.78,,,,,,,352.6600,1366.3800,percent of total billed charges,"41.7% of $1,366.38 in Billed Charges for Rev 272 = $569.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE STIMULATOR 8225101,272,RC,27200002,CDM,,,,,,both,,,1366.3800,204.9600,CIGNA HEALTHCARE,CIGNA PPO,569.78,,,,,,,352.6600,1366.3800,percent of total billed charges,"41.7% of $1,366.38 in Billed Charges for Rev 272 = $569.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE STIMULATOR 8225101,272,RC,27200002,CDM,,,,,,both,,,1366.3800,204.9600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1229.74,,,,,,,352.6600,1366.3800,percent of total billed charges,"90% of $1,366.38 in Billed Charges for Rev 272 = $1,229.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE STIMULATOR 8225101,272,RC,27200002,CDM,,,,,,both,,,1366.3800,204.9600,MEDCOST,MEDCOST VHN,650.26,,,,,,,352.6600,1366.3800,percent of total billed charges,"47.59% of $1,366.38 in Billed Charges for Rev 272 = $650.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE STIMULATOR 8225101,272,RC,27200002,CDM,,,,,,both,,,1366.3800,204.9600,SENTARA HEALTH,SENTARA HEALTH,352.66,,,,,,,352.6600,1366.3800,percent of total billed charges,"25.81% of $1,366.38 in Billed Charges for Rev 272 = $352.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE STIMULATOR 8225101,272,RC,27200002,CDM,,,,,,both,,,1366.3800,204.9600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1366.38,,,,,,,352.6600,1366.3800,percent of total billed charges,"100% of $1,366.38 in Billed Charges for Rev 272 = $1,366.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE STIMULATOR 8225101,272,RC,27200002,CDM,,,,,,both,,,1366.3800,204.9600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,683.19,,,,,,,352.6600,1366.3800,percent of total billed charges,"Rev 272 $1,366.38 in Billed Charges at 50% = $683.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE STIMULATOR 8225101,272,RC,27200002,CDM,,,,,,both,,,1366.3800,204.9600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,441.34,,,,,,,352.6600,1366.3800,other,"32.3% of $1,366.38 in Billed Charges for Rev 272 = $441.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE STIMULATOR 8225101,272,RC,27200002,CDM,,,,,,both,,,1366.3800,204.9600,UNITED HEALTHCARE,UHC HERITAGE SELECT,419.48,,,,,,,352.6600,1366.3800,other,"30.7% of $1,366.38 in Billed Charges for Rev 272 = $419.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE STIMULATOR 8225101,272,RC,27200002,CDM,,,,,,both,,,1366.3800,204.9600,UNITED HEALTHCARE,UNITED HEALTHCARE,441.34,,,,,,,352.6600,1366.3800,percent of total billed charges,"32.3% of $1,366.38 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE STIMULATOR 8225101,272,RC,27200002,CDM,,,,,,both,,,1366.3800,204.9600,WELLCARE,WELLCARE MEDICAID,1366.38,,,,,,,352.6600,1366.3800,percent of total billed charges,"100% of $1,366.38 in Billed Charges for Rev 272 = $1,366.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER HERNIA VERSATAK,272,RC,,,,,,,,both,,,3429.2200,514.3800,AETNA,AETNA,1464.28,,,,,,,885.0800,3429.2200,percent of total billed charges,"42.7% of $3,429.22 in Billed Charges for Rev 272 = $1,464.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER HERNIA VERSATAK,272,RC,,,,,,,,both,,,3429.2200,514.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2400.45,,,,,,,885.0800,3429.2200,percent of total billed charges,"Rev 272 $3,429.22 in Billed Charges at 70% = $2,400.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER HERNIA VERSATAK,272,RC,,,,,,,,both,,,3429.2200,514.3800,CIGNA HEALTHCARE,CIGNA HMO,1429.98,,,,,,,885.0800,3429.2200,percent of total billed charges,"41.7% of $3,429.22 in Billed Charges for Rev 272 = $1,429.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER HERNIA VERSATAK,272,RC,,,,,,,,both,,,3429.2200,514.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1591.16,,,,,,,885.0800,3429.2200,percent of total billed charges,"46.4% of $3,429.22 in Billed Charges for Rev 272 = $1,591.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER HERNIA VERSATAK,272,RC,,,,,,,,both,,,3429.2200,514.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1429.98,,,,,,,885.0800,3429.2200,percent of total billed charges,"41.7% of $3,429.22 in Billed Charges for Rev 272 = $1,429.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER HERNIA VERSATAK,272,RC,,,,,,,,both,,,3429.2200,514.3800,CIGNA HEALTHCARE,CIGNA PPO,1429.98,,,,,,,885.0800,3429.2200,percent of total billed charges,"41.7% of $3,429.22 in Billed Charges for Rev 272 = $1,429.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER HERNIA VERSATAK,272,RC,,,,,,,,both,,,3429.2200,514.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3086.30,,,,,,,885.0800,3429.2200,percent of total billed charges,"90% of $3,429.22 in Billed Charges for Rev 272 = $3,086.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER HERNIA VERSATAK,272,RC,,,,,,,,both,,,3429.2200,514.3800,MEDCOST,MEDCOST VHN,1631.97,,,,,,,885.0800,3429.2200,percent of total billed charges,"47.59% of $3,429.22 in Billed Charges for Rev 272 = $1,631.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER HERNIA VERSATAK,272,RC,,,,,,,,both,,,3429.2200,514.3800,SENTARA HEALTH,SENTARA HEALTH,885.08,,,,,,,885.0800,3429.2200,percent of total billed charges,"25.81% of $3,429.22 in Billed Charges for Rev 272 = $885.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER HERNIA VERSATAK,272,RC,,,,,,,,both,,,3429.2200,514.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3429.22,,,,,,,885.0800,3429.2200,percent of total billed charges,"100% of $3,429.22 in Billed Charges for Rev 272 = $3,429.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER HERNIA VERSATAK,272,RC,,,,,,,,both,,,3429.2200,514.3800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1714.61,,,,,,,885.0800,3429.2200,percent of total billed charges,"Rev 272 $3,429.22 in Billed Charges at 50% = $1,714.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER HERNIA VERSATAK,272,RC,,,,,,,,both,,,3429.2200,514.3800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1107.64,,,,,,,885.0800,3429.2200,other,"32.3% of $3,429.22 in Billed Charges for Rev 272 = $1,107.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER HERNIA VERSATAK,272,RC,,,,,,,,both,,,3429.2200,514.3800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1052.77,,,,,,,885.0800,3429.2200,other,"30.7% of $3,429.22 in Billed Charges for Rev 272 = $1,052.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER HERNIA VERSATAK,272,RC,,,,,,,,both,,,3429.2200,514.3800,UNITED HEALTHCARE,UNITED HEALTHCARE,1107.64,,,,,,,885.0800,3429.2200,percent of total billed charges,"32.3% of $3,429.22 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER HERNIA VERSATAK,272,RC,,,,,,,,both,,,3429.2200,514.3800,WELLCARE,WELLCARE MEDICAID,3429.22,,,,,,,885.0800,3429.2200,percent of total billed charges,"100% of $3,429.22 in Billed Charges for Rev 272 = $3,429.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER INTERNAL ECHELON LINEAR CUTTER 100MM HAND-HELD 3D SQUEEZE HANDLE STERILE,272,RC,,,,,,,,both,,,976.5000,146.4800,AETNA,AETNA,416.97,,,,,,,252.0300,976.5000,percent of total billed charges,42.7% of $976.50 in Billed Charges for Rev 272 = $416.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER INTERNAL ECHELON LINEAR CUTTER 100MM HAND-HELD 3D SQUEEZE HANDLE STERILE,272,RC,,,,,,,,both,,,976.5000,146.4800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,683.55,,,,,,,252.0300,976.5000,percent of total billed charges,Rev 272 $976.50 in Billed Charges at 70% = $683.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER INTERNAL ECHELON LINEAR CUTTER 100MM HAND-HELD 3D SQUEEZE HANDLE STERILE,272,RC,,,,,,,,both,,,976.5000,146.4800,CIGNA HEALTHCARE,CIGNA HMO,407.20,,,,,,,252.0300,976.5000,percent of total billed charges,41.7% of $976.50 in Billed Charges for Rev 272 = $407.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER INTERNAL ECHELON LINEAR CUTTER 100MM HAND-HELD 3D SQUEEZE HANDLE STERILE,272,RC,,,,,,,,both,,,976.5000,146.4800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,453.10,,,,,,,252.0300,976.5000,percent of total billed charges,46.4% of $976.50 in Billed Charges for Rev 272 = $453.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER INTERNAL ECHELON LINEAR CUTTER 100MM HAND-HELD 3D SQUEEZE HANDLE STERILE,272,RC,,,,,,,,both,,,976.5000,146.4800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,407.20,,,,,,,252.0300,976.5000,percent of total billed charges,41.7% of $976.50 in Billed Charges for Rev 272 = $407.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER INTERNAL ECHELON LINEAR CUTTER 100MM HAND-HELD 3D SQUEEZE HANDLE STERILE,272,RC,,,,,,,,both,,,976.5000,146.4800,CIGNA HEALTHCARE,CIGNA PPO,407.20,,,,,,,252.0300,976.5000,percent of total billed charges,41.7% of $976.50 in Billed Charges for Rev 272 = $407.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER INTERNAL ECHELON LINEAR CUTTER 100MM HAND-HELD 3D SQUEEZE HANDLE STERILE,272,RC,,,,,,,,both,,,976.5000,146.4800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,878.85,,,,,,,252.0300,976.5000,percent of total billed charges,90% of $976.50 in Billed Charges for Rev 272 = $878.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER INTERNAL ECHELON LINEAR CUTTER 100MM HAND-HELD 3D SQUEEZE HANDLE STERILE,272,RC,,,,,,,,both,,,976.5000,146.4800,MEDCOST,MEDCOST VHN,464.72,,,,,,,252.0300,976.5000,percent of total billed charges,47.59% of $976.50 in Billed Charges for Rev 272 = $464.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER INTERNAL ECHELON LINEAR CUTTER 100MM HAND-HELD 3D SQUEEZE HANDLE STERILE,272,RC,,,,,,,,both,,,976.5000,146.4800,SENTARA HEALTH,SENTARA HEALTH,252.03,,,,,,,252.0300,976.5000,percent of total billed charges,25.81% of $976.50 in Billed Charges for Rev 272 = $252.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER INTERNAL ECHELON LINEAR CUTTER 100MM HAND-HELD 3D SQUEEZE HANDLE STERILE,272,RC,,,,,,,,both,,,976.5000,146.4800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",976.50,,,,,,,252.0300,976.5000,percent of total billed charges,100% of $976.50 in Billed Charges for Rev 272 = $976.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER INTERNAL ECHELON LINEAR CUTTER 100MM HAND-HELD 3D SQUEEZE HANDLE STERILE,272,RC,,,,,,,,both,,,976.5000,146.4800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,488.25,,,,,,,252.0300,976.5000,percent of total billed charges,Rev 272 $976.50 in Billed Charges at 50% = $488.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER INTERNAL ECHELON LINEAR CUTTER 100MM HAND-HELD 3D SQUEEZE HANDLE STERILE,272,RC,,,,,,,,both,,,976.5000,146.4800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,315.41,,,,,,,252.0300,976.5000,other,32.3% of $976.50 in Billed Charges for Rev 272 = $315.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER INTERNAL ECHELON LINEAR CUTTER 100MM HAND-HELD 3D SQUEEZE HANDLE STERILE,272,RC,,,,,,,,both,,,976.5000,146.4800,UNITED HEALTHCARE,UHC HERITAGE SELECT,299.79,,,,,,,252.0300,976.5000,other,30.7% of $976.50 in Billed Charges for Rev 272 = $299.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER INTERNAL ECHELON LINEAR CUTTER 100MM HAND-HELD 3D SQUEEZE HANDLE STERILE,272,RC,,,,,,,,both,,,976.5000,146.4800,UNITED HEALTHCARE,UNITED HEALTHCARE,315.41,,,,,,,252.0300,976.5000,percent of total billed charges,32.3% of $976.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER INTERNAL ECHELON LINEAR CUTTER 100MM HAND-HELD 3D SQUEEZE HANDLE STERILE,272,RC,,,,,,,,both,,,976.5000,146.4800,WELLCARE,WELLCARE MEDICAID,976.50,,,,,,,252.0300,976.5000,percent of total billed charges,100% of $976.50 in Billed Charges for Rev 272 = $976.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1066.1400,159.9200,AETNA,AETNA,455.24,,,,,,,275.1700,1066.1400,percent of total billed charges,"42.7% of $1,066.14 in Billed Charges for Rev 272 = $455.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1066.1400,159.9200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,746.30,,,,,,,275.1700,1066.1400,percent of total billed charges,"Rev 272 $1,066.14 in Billed Charges at 70% = $746.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1066.1400,159.9200,CIGNA HEALTHCARE,CIGNA HMO,444.58,,,,,,,275.1700,1066.1400,percent of total billed charges,"41.7% of $1,066.14 in Billed Charges for Rev 272 = $444.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1066.1400,159.9200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,494.69,,,,,,,275.1700,1066.1400,percent of total billed charges,"46.4% of $1,066.14 in Billed Charges for Rev 272 = $494.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1066.1400,159.9200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,444.58,,,,,,,275.1700,1066.1400,percent of total billed charges,"41.7% of $1,066.14 in Billed Charges for Rev 272 = $444.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1066.1400,159.9200,CIGNA HEALTHCARE,CIGNA PPO,444.58,,,,,,,275.1700,1066.1400,percent of total billed charges,"41.7% of $1,066.14 in Billed Charges for Rev 272 = $444.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1066.1400,159.9200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,959.53,,,,,,,275.1700,1066.1400,percent of total billed charges,"90% of $1,066.14 in Billed Charges for Rev 272 = $959.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1066.1400,159.9200,MEDCOST,MEDCOST VHN,507.38,,,,,,,275.1700,1066.1400,percent of total billed charges,"47.59% of $1,066.14 in Billed Charges for Rev 272 = $507.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1066.1400,159.9200,SENTARA HEALTH,SENTARA HEALTH,275.17,,,,,,,275.1700,1066.1400,percent of total billed charges,"25.81% of $1,066.14 in Billed Charges for Rev 272 = $275.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1066.1400,159.9200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1066.14,,,,,,,275.1700,1066.1400,percent of total billed charges,"100% of $1,066.14 in Billed Charges for Rev 272 = $1,066.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1066.1400,159.9200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,533.07,,,,,,,275.1700,1066.1400,percent of total billed charges,"Rev 272 $1,066.14 in Billed Charges at 50% = $533.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1066.1400,159.9200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,344.36,,,,,,,275.1700,1066.1400,other,"32.3% of $1,066.14 in Billed Charges for Rev 272 = $344.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1066.1400,159.9200,UNITED HEALTHCARE,UHC HERITAGE SELECT,327.31,,,,,,,275.1700,1066.1400,other,"30.7% of $1,066.14 in Billed Charges for Rev 272 = $327.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1066.1400,159.9200,UNITED HEALTHCARE,UNITED HEALTHCARE,344.36,,,,,,,275.1700,1066.1400,percent of total billed charges,"32.3% of $1,066.14 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1066.1400,159.9200,WELLCARE,WELLCARE MEDICAID,1066.14,,,,,,,275.1700,1066.1400,percent of total billed charges,"100% of $1,066.14 in Billed Charges for Rev 272 = $1,066.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION 90-S CRUISE 4.0,272,RC,27200002,CDM,,,,,,both,,,2041.2200,306.1800,AETNA,AETNA,871.60,,,,,,,526.8400,2041.2200,percent of total billed charges,"42.7% of $2,041.22 in Billed Charges for Rev 272 = $871.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION 90-S CRUISE 4.0,272,RC,27200002,CDM,,,,,,both,,,2041.2200,306.1800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1428.85,,,,,,,526.8400,2041.2200,percent of total billed charges,"Rev 272 $2,041.22 in Billed Charges at 70% = $1,428.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION 90-S CRUISE 4.0,272,RC,27200002,CDM,,,,,,both,,,2041.2200,306.1800,CIGNA HEALTHCARE,CIGNA HMO,851.19,,,,,,,526.8400,2041.2200,percent of total billed charges,"41.7% of $2,041.22 in Billed Charges for Rev 272 = $851.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION 90-S CRUISE 4.0,272,RC,27200002,CDM,,,,,,both,,,2041.2200,306.1800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,947.13,,,,,,,526.8400,2041.2200,percent of total billed charges,"46.4% of $2,041.22 in Billed Charges for Rev 272 = $947.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION 90-S CRUISE 4.0,272,RC,27200002,CDM,,,,,,both,,,2041.2200,306.1800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,851.19,,,,,,,526.8400,2041.2200,percent of total billed charges,"41.7% of $2,041.22 in Billed Charges for Rev 272 = $851.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION 90-S CRUISE 4.0,272,RC,27200002,CDM,,,,,,both,,,2041.2200,306.1800,CIGNA HEALTHCARE,CIGNA PPO,851.19,,,,,,,526.8400,2041.2200,percent of total billed charges,"41.7% of $2,041.22 in Billed Charges for Rev 272 = $851.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION 90-S CRUISE 4.0,272,RC,27200002,CDM,,,,,,both,,,2041.2200,306.1800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1837.10,,,,,,,526.8400,2041.2200,percent of total billed charges,"90% of $2,041.22 in Billed Charges for Rev 272 = $1,837.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION 90-S CRUISE 4.0,272,RC,27200002,CDM,,,,,,both,,,2041.2200,306.1800,MEDCOST,MEDCOST VHN,971.42,,,,,,,526.8400,2041.2200,percent of total billed charges,"47.59% of $2,041.22 in Billed Charges for Rev 272 = $971.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION 90-S CRUISE 4.0,272,RC,27200002,CDM,,,,,,both,,,2041.2200,306.1800,SENTARA HEALTH,SENTARA HEALTH,526.84,,,,,,,526.8400,2041.2200,percent of total billed charges,"25.81% of $2,041.22 in Billed Charges for Rev 272 = $526.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION 90-S CRUISE 4.0,272,RC,27200002,CDM,,,,,,both,,,2041.2200,306.1800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2041.22,,,,,,,526.8400,2041.2200,percent of total billed charges,"100% of $2,041.22 in Billed Charges for Rev 272 = $2,041.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION 90-S CRUISE 4.0,272,RC,27200002,CDM,,,,,,both,,,2041.2200,306.1800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1020.61,,,,,,,526.8400,2041.2200,percent of total billed charges,"Rev 272 $2,041.22 in Billed Charges at 50% = $1,020.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION 90-S CRUISE 4.0,272,RC,27200002,CDM,,,,,,both,,,2041.2200,306.1800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,659.31,,,,,,,526.8400,2041.2200,other,"32.3% of $2,041.22 in Billed Charges for Rev 272 = $659.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE SUCTION 90-S CRUISE 4.0,272,RC,27200002,CDM,,,,,,both,,,2041.2200,306.1800,UNITED HEALTHCARE,UHC HERITAGE SELECT,626.65,,,,,,,526.8400,2041.2200,other,"30.7% of $2,041.22 in Billed Charges for Rev 272 = $626.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE SUCTION 90-S CRUISE 4.0,272,RC,27200002,CDM,,,,,,both,,,2041.2200,306.1800,UNITED HEALTHCARE,UNITED HEALTHCARE,659.31,,,,,,,526.8400,2041.2200,percent of total billed charges,"32.3% of $2,041.22 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION 90-S CRUISE 4.0,272,RC,27200002,CDM,,,,,,both,,,2041.2200,306.1800,WELLCARE,WELLCARE MEDICAID,2041.22,,,,,,,526.8400,2041.2200,percent of total billed charges,"100% of $2,041.22 in Billed Charges for Rev 272 = $2,041.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION SERFAS 90-S MAX,272,RC,27200002,CDM,,,,,,both,,,1783.0900,267.4600,AETNA,AETNA,761.38,,,,,,,460.2200,1783.0900,percent of total billed charges,"42.7% of $1,783.09 in Billed Charges for Rev 272 = $761.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION SERFAS 90-S MAX,272,RC,27200002,CDM,,,,,,both,,,1783.0900,267.4600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1248.16,,,,,,,460.2200,1783.0900,percent of total billed charges,"Rev 272 $1,783.09 in Billed Charges at 70% = $1,248.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION SERFAS 90-S MAX,272,RC,27200002,CDM,,,,,,both,,,1783.0900,267.4600,CIGNA HEALTHCARE,CIGNA HMO,743.55,,,,,,,460.2200,1783.0900,percent of total billed charges,"41.7% of $1,783.09 in Billed Charges for Rev 272 = $743.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION SERFAS 90-S MAX,272,RC,27200002,CDM,,,,,,both,,,1783.0900,267.4600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,827.35,,,,,,,460.2200,1783.0900,percent of total billed charges,"46.4% of $1,783.09 in Billed Charges for Rev 272 = $827.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION SERFAS 90-S MAX,272,RC,27200002,CDM,,,,,,both,,,1783.0900,267.4600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,743.55,,,,,,,460.2200,1783.0900,percent of total billed charges,"41.7% of $1,783.09 in Billed Charges for Rev 272 = $743.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION SERFAS 90-S MAX,272,RC,27200002,CDM,,,,,,both,,,1783.0900,267.4600,CIGNA HEALTHCARE,CIGNA PPO,743.55,,,,,,,460.2200,1783.0900,percent of total billed charges,"41.7% of $1,783.09 in Billed Charges for Rev 272 = $743.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION SERFAS 90-S MAX,272,RC,27200002,CDM,,,,,,both,,,1783.0900,267.4600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1604.78,,,,,,,460.2200,1783.0900,percent of total billed charges,"90% of $1,783.09 in Billed Charges for Rev 272 = $1,604.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION SERFAS 90-S MAX,272,RC,27200002,CDM,,,,,,both,,,1783.0900,267.4600,MEDCOST,MEDCOST VHN,848.57,,,,,,,460.2200,1783.0900,percent of total billed charges,"47.59% of $1,783.09 in Billed Charges for Rev 272 = $848.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION SERFAS 90-S MAX,272,RC,27200002,CDM,,,,,,both,,,1783.0900,267.4600,SENTARA HEALTH,SENTARA HEALTH,460.22,,,,,,,460.2200,1783.0900,percent of total billed charges,"25.81% of $1,783.09 in Billed Charges for Rev 272 = $460.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION SERFAS 90-S MAX,272,RC,27200002,CDM,,,,,,both,,,1783.0900,267.4600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1783.09,,,,,,,460.2200,1783.0900,percent of total billed charges,"100% of $1,783.09 in Billed Charges for Rev 272 = $1,783.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION SERFAS 90-S MAX,272,RC,27200002,CDM,,,,,,both,,,1783.0900,267.4600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,891.55,,,,,,,460.2200,1783.0900,percent of total billed charges,"Rev 272 $1,783.09 in Billed Charges at 50% = $891.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION SERFAS 90-S MAX,272,RC,27200002,CDM,,,,,,both,,,1783.0900,267.4600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,575.94,,,,,,,460.2200,1783.0900,other,"32.3% of $1,783.09 in Billed Charges for Rev 272 = $575.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE SUCTION SERFAS 90-S MAX,272,RC,27200002,CDM,,,,,,both,,,1783.0900,267.4600,UNITED HEALTHCARE,UHC HERITAGE SELECT,547.41,,,,,,,460.2200,1783.0900,other,"30.7% of $1,783.09 in Billed Charges for Rev 272 = $547.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE SUCTION SERFAS 90-S MAX,272,RC,27200002,CDM,,,,,,both,,,1783.0900,267.4600,UNITED HEALTHCARE,UNITED HEALTHCARE,575.94,,,,,,,460.2200,1783.0900,percent of total billed charges,"32.3% of $1,783.09 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE SUCTION SERFAS 90-S MAX,272,RC,27200002,CDM,,,,,,both,,,1783.0900,267.4600,WELLCARE,WELLCARE MEDICAID,1783.09,,,,,,,460.2200,1783.0900,percent of total billed charges,"100% of $1,783.09 in Billed Charges for Rev 272 = $1,783.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE VENTRICULAR PACING 2.4FR X 135CM 98-100H,272,RC,,,,,,,,both,,,1175.0300,176.2500,AETNA,AETNA,501.74,,,,,,,303.2800,1175.0300,percent of total billed charges,"42.7% of $1,175.03 in Billed Charges for Rev 272 = $501.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE VENTRICULAR PACING 2.4FR X 135CM 98-100H,272,RC,,,,,,,,both,,,1175.0300,176.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,822.52,,,,,,,303.2800,1175.0300,percent of total billed charges,"Rev 272 $1,175.03 in Billed Charges at 70% = $822.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE VENTRICULAR PACING 2.4FR X 135CM 98-100H,272,RC,,,,,,,,both,,,1175.0300,176.2500,CIGNA HEALTHCARE,CIGNA HMO,489.99,,,,,,,303.2800,1175.0300,percent of total billed charges,"41.7% of $1,175.03 in Billed Charges for Rev 272 = $489.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE VENTRICULAR PACING 2.4FR X 135CM 98-100H,272,RC,,,,,,,,both,,,1175.0300,176.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,545.21,,,,,,,303.2800,1175.0300,percent of total billed charges,"46.4% of $1,175.03 in Billed Charges for Rev 272 = $545.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE VENTRICULAR PACING 2.4FR X 135CM 98-100H,272,RC,,,,,,,,both,,,1175.0300,176.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,489.99,,,,,,,303.2800,1175.0300,percent of total billed charges,"41.7% of $1,175.03 in Billed Charges for Rev 272 = $489.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE VENTRICULAR PACING 2.4FR X 135CM 98-100H,272,RC,,,,,,,,both,,,1175.0300,176.2500,CIGNA HEALTHCARE,CIGNA PPO,489.99,,,,,,,303.2800,1175.0300,percent of total billed charges,"41.7% of $1,175.03 in Billed Charges for Rev 272 = $489.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE VENTRICULAR PACING 2.4FR X 135CM 98-100H,272,RC,,,,,,,,both,,,1175.0300,176.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1057.53,,,,,,,303.2800,1175.0300,percent of total billed charges,"90% of $1,175.03 in Billed Charges for Rev 272 = $1,057.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE VENTRICULAR PACING 2.4FR X 135CM 98-100H,272,RC,,,,,,,,both,,,1175.0300,176.2500,MEDCOST,MEDCOST VHN,559.20,,,,,,,303.2800,1175.0300,percent of total billed charges,"47.59% of $1,175.03 in Billed Charges for Rev 272 = $559.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE VENTRICULAR PACING 2.4FR X 135CM 98-100H,272,RC,,,,,,,,both,,,1175.0300,176.2500,SENTARA HEALTH,SENTARA HEALTH,303.28,,,,,,,303.2800,1175.0300,percent of total billed charges,"25.81% of $1,175.03 in Billed Charges for Rev 272 = $303.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE VENTRICULAR PACING 2.4FR X 135CM 98-100H,272,RC,,,,,,,,both,,,1175.0300,176.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1175.03,,,,,,,303.2800,1175.0300,percent of total billed charges,"100% of $1,175.03 in Billed Charges for Rev 272 = $1,175.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE VENTRICULAR PACING 2.4FR X 135CM 98-100H,272,RC,,,,,,,,both,,,1175.0300,176.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,587.52,,,,,,,303.2800,1175.0300,percent of total billed charges,"Rev 272 $1,175.03 in Billed Charges at 50% = $587.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE VENTRICULAR PACING 2.4FR X 135CM 98-100H,272,RC,,,,,,,,both,,,1175.0300,176.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,379.53,,,,,,,303.2800,1175.0300,other,"32.3% of $1,175.03 in Billed Charges for Rev 272 = $379.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE VENTRICULAR PACING 2.4FR X 135CM 98-100H,272,RC,,,,,,,,both,,,1175.0300,176.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,360.73,,,,,,,303.2800,1175.0300,other,"30.7% of $1,175.03 in Billed Charges for Rev 272 = $360.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE VENTRICULAR PACING 2.4FR X 135CM 98-100H,272,RC,,,,,,,,both,,,1175.0300,176.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,379.53,,,,,,,303.2800,1175.0300,percent of total billed charges,"32.3% of $1,175.03 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE VENTRICULAR PACING 2.4FR X 135CM 98-100H,272,RC,,,,,,,,both,,,1175.0300,176.2500,WELLCARE,WELLCARE MEDICAID,1175.03,,,,,,,303.2800,1175.0300,percent of total billed charges,"100% of $1,175.03 in Billed Charges for Rev 272 = $1,175.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE W/ FILTER,272,RC,27200002,CDM,,,,,,both,,,2565.7900,384.8700,AETNA,AETNA,1095.59,,,,,,,662.2300,2565.7900,percent of total billed charges,"42.7% of $2,565.79 in Billed Charges for Rev 272 = $1,095.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE W/ FILTER,272,RC,27200002,CDM,,,,,,both,,,2565.7900,384.8700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1796.05,,,,,,,662.2300,2565.7900,percent of total billed charges,"Rev 272 $2,565.79 in Billed Charges at 70% = $1,796.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE W/ FILTER,272,RC,27200002,CDM,,,,,,both,,,2565.7900,384.8700,CIGNA HEALTHCARE,CIGNA HMO,1069.93,,,,,,,662.2300,2565.7900,percent of total billed charges,"41.7% of $2,565.79 in Billed Charges for Rev 272 = $1,069.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE W/ FILTER,272,RC,27200002,CDM,,,,,,both,,,2565.7900,384.8700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1190.53,,,,,,,662.2300,2565.7900,percent of total billed charges,"46.4% of $2,565.79 in Billed Charges for Rev 272 = $1,190.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE W/ FILTER,272,RC,27200002,CDM,,,,,,both,,,2565.7900,384.8700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1069.93,,,,,,,662.2300,2565.7900,percent of total billed charges,"41.7% of $2,565.79 in Billed Charges for Rev 272 = $1,069.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE W/ FILTER,272,RC,27200002,CDM,,,,,,both,,,2565.7900,384.8700,CIGNA HEALTHCARE,CIGNA PPO,1069.93,,,,,,,662.2300,2565.7900,percent of total billed charges,"41.7% of $2,565.79 in Billed Charges for Rev 272 = $1,069.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE W/ FILTER,272,RC,27200002,CDM,,,,,,both,,,2565.7900,384.8700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2309.21,,,,,,,662.2300,2565.7900,percent of total billed charges,"90% of $2,565.79 in Billed Charges for Rev 272 = $2,309.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE W/ FILTER,272,RC,27200002,CDM,,,,,,both,,,2565.7900,384.8700,MEDCOST,MEDCOST VHN,1221.06,,,,,,,662.2300,2565.7900,percent of total billed charges,"47.59% of $2,565.79 in Billed Charges for Rev 272 = $1,221.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE W/ FILTER,272,RC,27200002,CDM,,,,,,both,,,2565.7900,384.8700,SENTARA HEALTH,SENTARA HEALTH,662.23,,,,,,,662.2300,2565.7900,percent of total billed charges,"25.81% of $2,565.79 in Billed Charges for Rev 272 = $662.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE W/ FILTER,272,RC,27200002,CDM,,,,,,both,,,2565.7900,384.8700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2565.79,,,,,,,662.2300,2565.7900,percent of total billed charges,"100% of $2,565.79 in Billed Charges for Rev 272 = $2,565.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE W/ FILTER,272,RC,27200002,CDM,,,,,,both,,,2565.7900,384.8700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1282.90,,,,,,,662.2300,2565.7900,percent of total billed charges,"Rev 272 $2,565.79 in Billed Charges at 50% = $1,282.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE W/ FILTER,272,RC,27200002,CDM,,,,,,both,,,2565.7900,384.8700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,828.75,,,,,,,662.2300,2565.7900,other,"32.3% of $2,565.79 in Billed Charges for Rev 272 = $828.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE W/ FILTER,272,RC,27200002,CDM,,,,,,both,,,2565.7900,384.8700,UNITED HEALTHCARE,UHC HERITAGE SELECT,787.70,,,,,,,662.2300,2565.7900,other,"30.7% of $2,565.79 in Billed Charges for Rev 272 = $787.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE W/ FILTER,272,RC,27200002,CDM,,,,,,both,,,2565.7900,384.8700,UNITED HEALTHCARE,UNITED HEALTHCARE,828.75,,,,,,,662.2300,2565.7900,percent of total billed charges,"32.3% of $2,565.79 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE W/ FILTER,272,RC,27200002,CDM,,,,,,both,,,2565.7900,384.8700,WELLCARE,WELLCARE MEDICAID,2565.79,,,,,,,662.2300,2565.7900,percent of total billed charges,"100% of $2,565.79 in Billed Charges for Rev 272 = $2,565.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,2358.7800,353.8200,AETNA,AETNA,1007.20,,,,,,,608.8000,2358.7800,percent of total billed charges,"42.7% of $2,358.78 in Billed Charges for Rev 272 = $1,007.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,2358.7800,353.8200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1651.15,,,,,,,608.8000,2358.7800,percent of total billed charges,"Rev 272 $2,358.78 in Billed Charges at 70% = $1,651.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,2358.7800,353.8200,CIGNA HEALTHCARE,CIGNA HMO,983.61,,,,,,,608.8000,2358.7800,percent of total billed charges,"41.7% of $2,358.78 in Billed Charges for Rev 272 = $983.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,2358.7800,353.8200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1094.47,,,,,,,608.8000,2358.7800,percent of total billed charges,"46.4% of $2,358.78 in Billed Charges for Rev 272 = $1,094.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,2358.7800,353.8200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,983.61,,,,,,,608.8000,2358.7800,percent of total billed charges,"41.7% of $2,358.78 in Billed Charges for Rev 272 = $983.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,2358.7800,353.8200,CIGNA HEALTHCARE,CIGNA PPO,983.61,,,,,,,608.8000,2358.7800,percent of total billed charges,"41.7% of $2,358.78 in Billed Charges for Rev 272 = $983.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,2358.7800,353.8200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2122.90,,,,,,,608.8000,2358.7800,percent of total billed charges,"90% of $2,358.78 in Billed Charges for Rev 272 = $2,122.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,2358.7800,353.8200,MEDCOST,MEDCOST VHN,1122.54,,,,,,,608.8000,2358.7800,percent of total billed charges,"47.59% of $2,358.78 in Billed Charges for Rev 272 = $1,122.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,2358.7800,353.8200,SENTARA HEALTH,SENTARA HEALTH,608.80,,,,,,,608.8000,2358.7800,percent of total billed charges,"25.81% of $2,358.78 in Billed Charges for Rev 272 = $608.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,2358.7800,353.8200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2358.78,,,,,,,608.8000,2358.7800,percent of total billed charges,"100% of $2,358.78 in Billed Charges for Rev 272 = $2,358.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,2358.7800,353.8200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1179.39,,,,,,,608.8000,2358.7800,percent of total billed charges,"Rev 272 $2,358.78 in Billed Charges at 50% = $1,179.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,2358.7800,353.8200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,761.89,,,,,,,608.8000,2358.7800,other,"32.3% of $2,358.78 in Billed Charges for Rev 272 = $761.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,2358.7800,353.8200,UNITED HEALTHCARE,UHC HERITAGE SELECT,724.15,,,,,,,608.8000,2358.7800,other,"30.7% of $2,358.78 in Billed Charges for Rev 272 = $724.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,2358.7800,353.8200,UNITED HEALTHCARE,UNITED HEALTHCARE,761.89,,,,,,,608.8000,2358.7800,percent of total billed charges,"32.3% of $2,358.78 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,2358.7800,353.8200,WELLCARE,WELLCARE MEDICAID,2358.78,,,,,,,608.8000,2358.7800,percent of total billed charges,"100% of $2,358.78 in Billed Charges for Rev 272 = $2,358.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,6336.6800,950.5000,AETNA,AETNA,2705.76,,,,,,,1635.5000,6336.6800,percent of total billed charges,"42.7% of $6,336.68 in Billed Charges for Rev 272 = $2,705.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,6336.6800,950.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4435.68,,,,,,,1635.5000,6336.6800,percent of total billed charges,"Rev 272 $6,336.68 in Billed Charges at 70% = $4,435.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,6336.6800,950.5000,CIGNA HEALTHCARE,CIGNA HMO,2642.40,,,,,,,1635.5000,6336.6800,percent of total billed charges,"41.7% of $6,336.68 in Billed Charges for Rev 272 = $2,642.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,6336.6800,950.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2940.22,,,,,,,1635.5000,6336.6800,percent of total billed charges,"46.4% of $6,336.68 in Billed Charges for Rev 272 = $2,940.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,6336.6800,950.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2642.40,,,,,,,1635.5000,6336.6800,percent of total billed charges,"41.7% of $6,336.68 in Billed Charges for Rev 272 = $2,642.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,6336.6800,950.5000,CIGNA HEALTHCARE,CIGNA PPO,2642.40,,,,,,,1635.5000,6336.6800,percent of total billed charges,"41.7% of $6,336.68 in Billed Charges for Rev 272 = $2,642.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,6336.6800,950.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5703.01,,,,,,,1635.5000,6336.6800,percent of total billed charges,"90% of $6,336.68 in Billed Charges for Rev 272 = $5,703.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,6336.6800,950.5000,MEDCOST,MEDCOST VHN,3015.63,,,,,,,1635.5000,6336.6800,percent of total billed charges,"47.59% of $6,336.68 in Billed Charges for Rev 272 = $3,015.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,6336.6800,950.5000,SENTARA HEALTH,SENTARA HEALTH,1635.50,,,,,,,1635.5000,6336.6800,percent of total billed charges,"25.81% of $6,336.68 in Billed Charges for Rev 272 = $1,635.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,6336.6800,950.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6336.68,,,,,,,1635.5000,6336.6800,percent of total billed charges,"100% of $6,336.68 in Billed Charges for Rev 272 = $6,336.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,6336.6800,950.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3168.34,,,,,,,1635.5000,6336.6800,percent of total billed charges,"Rev 272 $6,336.68 in Billed Charges at 50% = $3,168.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,6336.6800,950.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2046.75,,,,,,,1635.5000,6336.6800,other,"32.3% of $6,336.68 in Billed Charges for Rev 272 = $2,046.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,6336.6800,950.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1945.36,,,,,,,1635.5000,6336.6800,other,"30.7% of $6,336.68 in Billed Charges for Rev 272 = $1,945.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,6336.6800,950.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,2046.75,,,,,,,1635.5000,6336.6800,percent of total billed charges,"32.3% of $6,336.68 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE XL 90-S 0279-351-103,272,RC,27200002,CDM,,,,,,both,,,6336.6800,950.5000,WELLCARE,WELLCARE MEDICAID,6336.68,,,,,,,1635.5000,6336.6800,percent of total billed charges,"100% of $6,336.68 in Billed Charges for Rev 272 = $6,336.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUTTER TX 30B,272,RC,27200002,CDM,,,,,,both,,,702.5700,105.3900,AETNA,AETNA,300.00,,,,,,,181.3300,702.5700,percent of total billed charges,42.7% of $702.57 in Billed Charges for Rev 272 = $300.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER TX 30B,272,RC,27200002,CDM,,,,,,both,,,702.5700,105.3900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,491.80,,,,,,,181.3300,702.5700,percent of total billed charges,Rev 272 $702.57 in Billed Charges at 70% = $491.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER TX 30B,272,RC,27200002,CDM,,,,,,both,,,702.5700,105.3900,CIGNA HEALTHCARE,CIGNA HMO,292.97,,,,,,,181.3300,702.5700,percent of total billed charges,41.7% of $702.57 in Billed Charges for Rev 272 = $292.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER TX 30B,272,RC,27200002,CDM,,,,,,both,,,702.5700,105.3900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,325.99,,,,,,,181.3300,702.5700,percent of total billed charges,46.4% of $702.57 in Billed Charges for Rev 272 = $325.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER TX 30B,272,RC,27200002,CDM,,,,,,both,,,702.5700,105.3900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,292.97,,,,,,,181.3300,702.5700,percent of total billed charges,41.7% of $702.57 in Billed Charges for Rev 272 = $292.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER TX 30B,272,RC,27200002,CDM,,,,,,both,,,702.5700,105.3900,CIGNA HEALTHCARE,CIGNA PPO,292.97,,,,,,,181.3300,702.5700,percent of total billed charges,41.7% of $702.57 in Billed Charges for Rev 272 = $292.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER TX 30B,272,RC,27200002,CDM,,,,,,both,,,702.5700,105.3900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,632.31,,,,,,,181.3300,702.5700,percent of total billed charges,90% of $702.57 in Billed Charges for Rev 272 = $632.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER TX 30B,272,RC,27200002,CDM,,,,,,both,,,702.5700,105.3900,MEDCOST,MEDCOST VHN,334.35,,,,,,,181.3300,702.5700,percent of total billed charges,47.59% of $702.57 in Billed Charges for Rev 272 = $334.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER TX 30B,272,RC,27200002,CDM,,,,,,both,,,702.5700,105.3900,SENTARA HEALTH,SENTARA HEALTH,181.33,,,,,,,181.3300,702.5700,percent of total billed charges,25.81% of $702.57 in Billed Charges for Rev 272 = $181.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER TX 30B,272,RC,27200002,CDM,,,,,,both,,,702.5700,105.3900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",702.57,,,,,,,181.3300,702.5700,percent of total billed charges,100% of $702.57 in Billed Charges for Rev 272 = $702.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER TX 30B,272,RC,27200002,CDM,,,,,,both,,,702.5700,105.3900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,351.29,,,,,,,181.3300,702.5700,percent of total billed charges,Rev 272 $702.57 in Billed Charges at 50% = $351.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER TX 30B,272,RC,27200002,CDM,,,,,,both,,,702.5700,105.3900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,226.93,,,,,,,181.3300,702.5700,other,32.3% of $702.57 in Billed Charges for Rev 272 = $226.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER LINEAR CUTTER TX 30B,272,RC,27200002,CDM,,,,,,both,,,702.5700,105.3900,UNITED HEALTHCARE,UHC HERITAGE SELECT,215.69,,,,,,,181.3300,702.5700,other,30.7% of $702.57 in Billed Charges for Rev 272 = $215.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER LINEAR CUTTER TX 30B,272,RC,27200002,CDM,,,,,,both,,,702.5700,105.3900,UNITED HEALTHCARE,UNITED HEALTHCARE,226.93,,,,,,,181.3300,702.5700,percent of total billed charges,32.3% of $702.57 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER TX 30B,272,RC,27200002,CDM,,,,,,both,,,702.5700,105.3900,WELLCARE,WELLCARE MEDICAID,702.57,,,,,,,181.3300,702.5700,percent of total billed charges,100% of $702.57 in Billed Charges for Rev 272 = $702.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR HEAVY 60-4.8 TX60G,272,RC,27200002,CDM,,,,,,both,,,712.7000,106.9100,AETNA,AETNA,304.32,,,,,,,183.9500,712.7000,percent of total billed charges,42.7% of $712.70 in Billed Charges for Rev 272 = $304.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR HEAVY 60-4.8 TX60G,272,RC,27200002,CDM,,,,,,both,,,712.7000,106.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,498.89,,,,,,,183.9500,712.7000,percent of total billed charges,Rev 272 $712.70 in Billed Charges at 70% = $498.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR HEAVY 60-4.8 TX60G,272,RC,27200002,CDM,,,,,,both,,,712.7000,106.9100,CIGNA HEALTHCARE,CIGNA HMO,297.20,,,,,,,183.9500,712.7000,percent of total billed charges,41.7% of $712.70 in Billed Charges for Rev 272 = $297.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR HEAVY 60-4.8 TX60G,272,RC,27200002,CDM,,,,,,both,,,712.7000,106.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,330.69,,,,,,,183.9500,712.7000,percent of total billed charges,46.4% of $712.70 in Billed Charges for Rev 272 = $330.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR HEAVY 60-4.8 TX60G,272,RC,27200002,CDM,,,,,,both,,,712.7000,106.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,297.20,,,,,,,183.9500,712.7000,percent of total billed charges,41.7% of $712.70 in Billed Charges for Rev 272 = $297.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR HEAVY 60-4.8 TX60G,272,RC,27200002,CDM,,,,,,both,,,712.7000,106.9100,CIGNA HEALTHCARE,CIGNA PPO,297.20,,,,,,,183.9500,712.7000,percent of total billed charges,41.7% of $712.70 in Billed Charges for Rev 272 = $297.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR HEAVY 60-4.8 TX60G,272,RC,27200002,CDM,,,,,,both,,,712.7000,106.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,641.43,,,,,,,183.9500,712.7000,percent of total billed charges,90% of $712.70 in Billed Charges for Rev 272 = $641.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR HEAVY 60-4.8 TX60G,272,RC,27200002,CDM,,,,,,both,,,712.7000,106.9100,MEDCOST,MEDCOST VHN,339.17,,,,,,,183.9500,712.7000,percent of total billed charges,47.59% of $712.70 in Billed Charges for Rev 272 = $339.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR HEAVY 60-4.8 TX60G,272,RC,27200002,CDM,,,,,,both,,,712.7000,106.9100,SENTARA HEALTH,SENTARA HEALTH,183.95,,,,,,,183.9500,712.7000,percent of total billed charges,25.81% of $712.70 in Billed Charges for Rev 272 = $183.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR HEAVY 60-4.8 TX60G,272,RC,27200002,CDM,,,,,,both,,,712.7000,106.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",712.70,,,,,,,183.9500,712.7000,percent of total billed charges,100% of $712.70 in Billed Charges for Rev 272 = $712.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR HEAVY 60-4.8 TX60G,272,RC,27200002,CDM,,,,,,both,,,712.7000,106.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,356.35,,,,,,,183.9500,712.7000,percent of total billed charges,Rev 272 $712.70 in Billed Charges at 50% = $356.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR HEAVY 60-4.8 TX60G,272,RC,27200002,CDM,,,,,,both,,,712.7000,106.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,230.20,,,,,,,183.9500,712.7000,other,32.3% of $712.70 in Billed Charges for Rev 272 = $230.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER LINEAR HEAVY 60-4.8 TX60G,272,RC,27200002,CDM,,,,,,both,,,712.7000,106.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,218.80,,,,,,,183.9500,712.7000,other,30.7% of $712.70 in Billed Charges for Rev 272 = $218.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER LINEAR HEAVY 60-4.8 TX60G,272,RC,27200002,CDM,,,,,,both,,,712.7000,106.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,230.20,,,,,,,183.9500,712.7000,percent of total billed charges,32.3% of $712.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR HEAVY 60-4.8 TX60G,272,RC,27200002,CDM,,,,,,both,,,712.7000,106.9100,WELLCARE,WELLCARE MEDICAID,712.70,,,,,,,183.9500,712.7000,percent of total billed charges,100% of $712.70 in Billed Charges for Rev 272 = $712.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,AETNA,AETNA,90.10,,,,,,,6.9800,211.0000,percent of total billed charges,42.7% of $211.00 in Billed Charges for Rev 301 Proc 83021 = $90.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,7.05,,,,,,,6.9800,211.0000,fee schedule,APG 00408 Proc 83021 at $836.60 (Base Rate) * 0.0081 (Relative Weight) = $6.78 (Total Line Payment) at 104% = $7.05. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,18.06,,,,,,,6.9800,211.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,AETNA,AETNA HEALTHCARE MEDICARE,18.06,,,,,,,6.9800,211.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,18.06,,,,,,,6.9800,211.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,AMBETTER,AMBETTER,39.37,,,,,,,6.9800,211.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,AMERIGROUP,AMERIGROUP,9.03,,,,,,,6.9800,211.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,18.78,,,,,,,6.9800,211.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,BLUE CROSS,ANTHEM EXCHANGE,18.06,,,,,,,6.9800,211.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,6.98,,,,,,,6.9800,211.0000,fee schedule,APG 00408 Proc 83021 at $836.60 (Base Rate) * 0.0081 (Relative Weight) = $6.78 (Total Line Payment) at 103% = $6.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,BLUE CROSS,ANTHEM HMO,18.06,,,,,,,6.9800,211.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,18.60,,,,,,,6.9800,211.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",18.06,,,,,,,6.9800,211.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,58.75,,,,,,,6.9800,211.0000,fee schedule,$58.75 from Fee Schedule BLDTM_23 for Rev 301 Proc 83021 * Qty 1 = $58.75 at 100% = $58.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,BLUE CROSS,BLUE CROSS E NETWORK,78.82,,,,,,,6.9800,211.0000,fee schedule,$24.63 from Fee Schedule BCFSB for Rev 301 Proc 83021 * Qty 1 = $24.63 at 320% = $78.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,BLUE CROSS,BLUE CROSS MEDICARE,18.78,,,,,,,6.9800,211.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,BLUE CROSS,BLUE CROSS P NETWORK,80.54,,,,,,,6.9800,211.0000,fee schedule,$24.63 from Fee Schedule BCFSB for Rev 301 Proc 83021 * Qty 1 = $24.63 at 327% = $80.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,BLUE CROSS,BLUE CROSS S NETWORK,80.54,,,,,,,6.9800,211.0000,fee schedule,$24.63 from Fee Schedule BCFSB for Rev 301 Proc 83021 * Qty 1 = $24.63 at 327% = $80.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,BLUE CROSS,TENNCARE BLUE CARE,36.53,,,,,,,6.9800,211.0000,fee schedule,$31.49 from Fee Schedule TC_24 for Rev 301 Proc 83021 * Qty 1 = $31.49 at 116% = $36.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,BLUE CROSS,TENNCARE BLUE SELECT,36.53,,,,,,,6.9800,211.0000,fee schedule,$31.49 from Fee Schedule TC_24 for Rev 301 Proc 83021 * Qty 1 = $31.49 at 116% = $36.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,CIGNA HEALTHCARE,CIGNA HMO,72.63,,,,,,,6.9800,211.0000,fee schedule,$72.63 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83021 * Qty 1 = $72.63 at 100% = $72.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,39.70,,,,,,,6.9800,211.0000,fee schedule,$39.70 from Fee Schedule CGIFP_25LR for Rev 301 Proc 83021 * Qty 1 = $39.70 at 100% = $39.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,18.96,,,,,,,6.9800,211.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,72.63,,,,,,,6.9800,211.0000,fee schedule,$72.63 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83021 * Qty 1 = $72.63 at 100% = $72.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,CIGNA HEALTHCARE,CIGNA PPO,72.63,,,,,,,6.9800,211.0000,fee schedule,$72.63 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83021 * Qty 1 = $72.63 at 100% = $72.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,18.96,,,,,,,6.9800,211.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,189.90,,,,,,,6.9800,211.0000,percent of total billed charges,90% of $211.00 in Billed Charges for Rev 301 Proc 83021 = $189.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,HUMANA,HUMANA MEDICARE,18.06,,,,,,,6.9800,211.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,18.06,,,,,,,6.9800,211.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,MEDCOST,MEDCOST VHN,100.41,,,,,,,6.9800,211.0000,percent of total billed charges,47.59% of $211.00 in Billed Charges for Rev 301 Proc 83021 = $100.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,7.12,,,,,,,6.9800,211.0000,fee schedule,APG 00408 Proc 83021 at $836.60 (Base Rate) * 0.0081 (Relative Weight) = $6.78 (Total Line Payment) at 100% = $6.78... $6.78 at 105% = $7.12 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,18.96,,,,,,,6.9800,211.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,18.96,,,,,,,6.9800,211.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,NHC ADVANTAGE,NHC ADVANTAGE,18.96,,,,,,,6.9800,211.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,6.99,,,,,,,6.9800,211.0000,fee schedule,APG 00408 Proc 83021 at $836.60 (Base Rate) * 0.0081 (Relative Weight) = $6.78 (Total Line Payment) at 100% = $6.78... $6.78 at 103.1% = $6.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,SENTARA HEALTH,SENTARA HEALTH,54.46,,,,,,,6.9800,211.0000,percent of total billed charges,25.81% of $211.00 in Billed Charges for Rev 301 Proc 83021 = $54.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,SENTARA HEALTH,SENTARA MEDICARE,18.06,,,,,,,6.9800,211.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",211.00,,,,,,,6.9800,211.0000,percent of total billed charges,100% of $211.00 in Billed Charges for Rev 301 Proc 83021 = $211.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,12.79,,,,,,,6.9800,211.0000,fee schedule,$25.57 from Fee Schedule TCUHC24 for Rev 301 Proc 83021 * Qty 1 = $25.57 at 50% = $12.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,18.78,,,,,,,6.9800,211.0000,fee schedule,$18.06 from Fee Schedule UHC_31910 for Rev 301 Proc 83021 * Qty 1 = $18.06 at 104% = $18.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,18.06,,,,,,,6.9800,211.0000,fee schedule,$18.06 from Fee Schedule UHC_31910 for Rev 301 Proc 83021 * Qty 1 = $18.06 at 100% = $18.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,18.06,,,,,,,6.9800,211.0000,fee schedule,$18.06 from Fee Schedule UHC_31910 for Rev 301 Proc 83021 * Qty 1 = $18.06 at 100% = $18.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,6.98,,,,,,,6.9800,211.0000,fee schedule,APG 00408 Proc 83021 at $836.60 (Base Rate) * 0.0081 (Relative Weight) = $6.78 (Total Line Payment) at 103% = $6.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,18.06,,,,,,,6.9800,211.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,18.06,,,,,,,6.9800,211.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,WELLCARE,WELLCARE MEDICAID,211.00,,,,,,,6.9800,211.0000,percent of total billed charges,100% of $211.00 in Billed Charges for Rev 301 Proc 83021 = $211.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOGLOBIN QUANT CHROMATOGRAPHY,83021,CPT,301,RC,30100148,CDM,,,,both,,,211.0000,31.6500,WELLCARE,WELLCARE MEDICARE,19.14,,,,,,,6.9800,211.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,AETNA,AETNA,29.46,,,,,,,4.0000,69.0000,percent of total billed charges,42.7% of $69.00 in Billed Charges for Rev 301 Proc 83033 = $29.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,6.44,,,,,,,4.0000,69.0000,fee schedule,APG 00402 Proc 83033 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 104% = $6.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,8.00,,,,,,,4.0000,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,AETNA,AETNA HEALTHCARE MEDICARE,8.00,,,,,,,4.0000,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,8.00,,,,,,,4.0000,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,AMBETTER,AMBETTER,17.44,,,,,,,4.0000,69.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,AMERIGROUP,AMERIGROUP,4.00,,,,,,,4.0000,69.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,8.32,,,,,,,4.0000,69.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,ANTHEM EXCHANGE,8.00,,,,,,,4.0000,69.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,6.38,,,,,,,4.0000,69.0000,fee schedule,APG 00402 Proc 83033 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,ANTHEM HMO,8.00,,,,,,,4.0000,69.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,8.24,,,,,,,4.0000,69.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8.00,,,,,,,4.0000,69.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,19.59,,,,,,,4.0000,69.0000,fee schedule,$19.59 from Fee Schedule BLDTM_23 for Rev 301 Proc 83033 * Qty 1 = $19.59 at 100% = $19.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS E NETWORK,26.02,,,,,,,4.0000,69.0000,fee schedule,$8.13 from Fee Schedule BCFSB for Rev 301 Proc 83033 * Qty 1 = $8.13 at 320% = $26.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS MEDICARE,8.32,,,,,,,4.0000,69.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS P NETWORK,26.59,,,,,,,4.0000,69.0000,fee schedule,$8.13 from Fee Schedule BCFSB for Rev 301 Proc 83033 * Qty 1 = $8.13 at 327% = $26.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS S NETWORK,26.59,,,,,,,4.0000,69.0000,fee schedule,$8.13 from Fee Schedule BCFSB for Rev 301 Proc 83033 * Qty 1 = $8.13 at 327% = $26.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,TENNCARE BLUE CARE,13.11,,,,,,,4.0000,69.0000,fee schedule,$11.30 from Fee Schedule TC_24 for Rev 301 Proc 83033 * Qty 1 = $11.30 at 116% = $13.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,TENNCARE BLUE SELECT,13.11,,,,,,,4.0000,69.0000,fee schedule,$11.30 from Fee Schedule TC_24 for Rev 301 Proc 83033 * Qty 1 = $11.30 at 116% = $13.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA HMO,23.99,,,,,,,4.0000,69.0000,fee schedule,$23.99 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83033 * Qty 1 = $23.99 at 100% = $23.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,17.32,,,,,,,4.0000,69.0000,fee schedule,$17.32 from Fee Schedule CGIFP_25LR for Rev 301 Proc 83033 * Qty 1 = $17.32 at 100% = $17.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,8.40,,,,,,,4.0000,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,23.99,,,,,,,4.0000,69.0000,fee schedule,$23.99 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83033 * Qty 1 = $23.99 at 100% = $23.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA PPO,23.99,,,,,,,4.0000,69.0000,fee schedule,$23.99 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83033 * Qty 1 = $23.99 at 100% = $23.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,8.40,,,,,,,4.0000,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,62.10,,,,,,,4.0000,69.0000,percent of total billed charges,90% of $69.00 in Billed Charges for Rev 301 Proc 83033 = $62.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,HUMANA,HUMANA MEDICARE,8.00,,,,,,,4.0000,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,8.00,,,,,,,4.0000,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,MEDCOST,MEDCOST VHN,32.84,,,,,,,4.0000,69.0000,percent of total billed charges,47.59% of $69.00 in Billed Charges for Rev 301 Proc 83033 = $32.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,6.50,,,,,,,4.0000,69.0000,fee schedule,APG 00402 Proc 83033 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 105% = $6.50 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,8.40,,,,,,,4.0000,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,8.40,,,,,,,4.0000,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,NHC ADVANTAGE,NHC ADVANTAGE,8.40,,,,,,,4.0000,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,6.38,,,,,,,4.0000,69.0000,fee schedule,APG 00402 Proc 83033 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 103.1% = $6.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,SENTARA HEALTH,SENTARA HEALTH,17.81,,,,,,,4.0000,69.0000,percent of total billed charges,25.81% of $69.00 in Billed Charges for Rev 301 Proc 83033 = $17.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,SENTARA HEALTH,SENTARA MEDICARE,8.00,,,,,,,4.0000,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",69.00,,,,,,,4.0000,69.0000,percent of total billed charges,100% of $69.00 in Billed Charges for Rev 301 Proc 83033 = $69.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4.22,,,,,,,4.0000,69.0000,fee schedule,$8.44 from Fee Schedule TCUHC24 for Rev 301 Proc 83033 * Qty 1 = $8.44 at 50% = $4.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,8.32,,,,,,,4.0000,69.0000,fee schedule,$8.00 from Fee Schedule UHC_31910 for Rev 301 Proc 83033 * Qty 1 = $8.00 at 104% = $8.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,8.00,,,,,,,4.0000,69.0000,fee schedule,$8.00 from Fee Schedule UHC_31910 for Rev 301 Proc 83033 * Qty 1 = $8.00 at 100% = $8.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,8.00,,,,,,,4.0000,69.0000,fee schedule,$8.00 from Fee Schedule UHC_31910 for Rev 301 Proc 83033 * Qty 1 = $8.00 at 100% = $8.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,6.38,,,,,,,4.0000,69.0000,fee schedule,APG 00402 Proc 83033 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,8.00,,,,,,,4.0000,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,8.00,,,,,,,4.0000,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,WELLCARE,WELLCARE MEDICAID,69.00,,,,,,,4.0000,69.0000,percent of total billed charges,100% of $69.00 in Billed Charges for Rev 301 Proc 83033 = $69.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOGLOBIN FETAL QUALITATIVE,83033,CPT,301,RC,30100313,CDM,,,,both,,,69.0000,10.3500,WELLCARE,WELLCARE MEDICARE,8.48,,,,,,,4.0000,69.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,AETNA,AETNA,48.25,,,,,,,4.8600,113.0000,percent of total billed charges,42.7% of $113.00 in Billed Charges for Rev 301 Proc 83036 Mod QW = $48.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,6.44,,,,,,,4.8600,113.0000,fee schedule,APG 00402 Proc 83036 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 104% = $6.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,9.71,,,,,,,4.8600,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,AETNA,AETNA HEALTHCARE MEDICARE,9.71,,,,,,,4.8600,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,9.71,,,,,,,4.8600,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,AMBETTER,AMBETTER,21.17,,,,,,,4.8600,113.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,AMERIGROUP,AMERIGROUP,4.86,,,,,,,4.8600,113.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,10.10,,,,,,,4.8600,113.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,BLUE CROSS,ANTHEM EXCHANGE,9.71,,,,,,,4.8600,113.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,6.38,,,,,,,4.8600,113.0000,fee schedule,APG 00402 Proc 83036 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,BLUE CROSS,ANTHEM HMO,9.71,,,,,,,4.8600,113.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,10.00,,,,,,,4.8600,113.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9.71,,,,,,,4.8600,113.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,18.29,,,,,,,4.8600,113.0000,fee schedule,$18.29 from Fee Schedule BLDTM_23 for Rev 301 Proc 83036 Mod QW * Qty 1 = $18.29 at 100% = $18.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,BLUE CROSS,BLUE CROSS E NETWORK,42.37,,,,,,,4.8600,113.0000,fee schedule,$13.24 from Fee Schedule BCFSB for Rev 301 Proc 83036 Mod QW * Qty 1 = $13.24 at 320% = $42.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,BLUE CROSS,BLUE CROSS MEDICARE,10.10,,,,,,,4.8600,113.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,BLUE CROSS,BLUE CROSS P NETWORK,43.29,,,,,,,4.8600,113.0000,fee schedule,$13.24 from Fee Schedule BCFSB for Rev 301 Proc 83036 Mod QW * Qty 1 = $13.24 at 327% = $43.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,BLUE CROSS,BLUE CROSS S NETWORK,43.29,,,,,,,4.8600,113.0000,fee schedule,$13.24 from Fee Schedule BCFSB for Rev 301 Proc 83036 Mod QW * Qty 1 = $13.24 at 327% = $43.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,BLUE CROSS,TENNCARE BLUE CARE,21.56,,,,,,,4.8600,113.0000,fee schedule,$18.59 from Fee Schedule TC_24 for Rev 301 Proc 83036 Mod QW * Qty 1 = $18.59 at 116% = $21.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,BLUE CROSS,TENNCARE BLUE SELECT,21.56,,,,,,,4.8600,113.0000,fee schedule,$18.59 from Fee Schedule TC_24 for Rev 301 Proc 83036 Mod QW * Qty 1 = $18.59 at 116% = $21.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA HMO,39.07,,,,,,,4.8600,113.0000,fee schedule,$39.07 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83036 Mod QW * Qty 1 = $39.07 at 100% = $39.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,21.65,,,,,,,4.8600,113.0000,fee schedule,$21.65 from Fee Schedule CGIFP_25LR for Rev 301 Proc 83036 Mod QW * Qty 1 = $21.65 at 100% = $21.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,10.20,,,,,,,4.8600,113.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,39.07,,,,,,,4.8600,113.0000,fee schedule,$39.07 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83036 Mod QW * Qty 1 = $39.07 at 100% = $39.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA PPO,39.07,,,,,,,4.8600,113.0000,fee schedule,$39.07 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83036 Mod QW * Qty 1 = $39.07 at 100% = $39.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,10.20,,,,,,,4.8600,113.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,101.70,,,,,,,4.8600,113.0000,percent of total billed charges,90% of $113.00 in Billed Charges for Rev 301 Proc 83036 Mod QW = $101.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,HUMANA,HUMANA MEDICARE,9.71,,,,,,,4.8600,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,9.71,,,,,,,4.8600,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,MEDCOST,MEDCOST VHN,53.78,,,,,,,4.8600,113.0000,percent of total billed charges,47.59% of $113.00 in Billed Charges for Rev 301 Proc 83036 Mod QW = $53.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,6.50,,,,,,,4.8600,113.0000,fee schedule,APG 00402 Proc 83036 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 105% = $6.50 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,10.20,,,,,,,4.8600,113.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,10.20,,,,,,,4.8600,113.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,NHC ADVANTAGE,NHC ADVANTAGE,10.20,,,,,,,4.8600,113.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,6.38,,,,,,,4.8600,113.0000,fee schedule,APG 00402 Proc 83036 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 103.1% = $6.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,SENTARA HEALTH,SENTARA HEALTH,29.17,,,,,,,4.8600,113.0000,percent of total billed charges,25.81% of $113.00 in Billed Charges for Rev 301 Proc 83036 Mod QW = $29.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,SENTARA HEALTH,SENTARA MEDICARE,9.71,,,,,,,4.8600,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",113.00,,,,,,,4.8600,113.0000,percent of total billed charges,100% of $113.00 in Billed Charges for Rev 301 Proc 83036 Mod QW = $113.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6.88,,,,,,,4.8600,113.0000,fee schedule,$13.75 from Fee Schedule TCUHC24 for Rev 301 Proc 83036 Mod QW * Qty 1 = $13.75 at 50% = $6.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,10.10,,,,,,,4.8600,113.0000,fee schedule,$9.71 from Fee Schedule UHC_31910 for Rev 301 Proc 83036 Mod QW * Qty 1 = $9.71 at 104% = $10.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,9.71,,,,,,,4.8600,113.0000,fee schedule,$9.71 from Fee Schedule UHC_31910 for Rev 301 Proc 83036 Mod QW * Qty 1 = $9.71 at 100% = $9.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,9.71,,,,,,,4.8600,113.0000,fee schedule,$9.71 from Fee Schedule UHC_31910 for Rev 301 Proc 83036 Mod QW * Qty 1 = $9.71 at 100% = $9.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,6.38,,,,,,,4.8600,113.0000,fee schedule,APG 00402 Proc 83036 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,9.71,,,,,,,4.8600,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,9.71,,,,,,,4.8600,113.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,WELLCARE,WELLCARE MEDICAID,113.00,,,,,,,4.8600,113.0000,percent of total billed charges,100% of $113.00 in Billed Charges for Rev 301 Proc 83036 Mod QW = $113.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HGB A1C HEMOGLOBIN GLYCATED,83036,CPT,301,RC,30100149,CDM,,,QW,both,,,113.0000,16.9500,WELLCARE,WELLCARE MEDICARE,10.29,,,,,,,4.8600,113.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
RELOAD STAPLE ETHICON 3D BLACK,272,RC,,,,,,,,both,,,1798.5800,269.7900,AETNA,AETNA,767.99,,,,,,,464.2100,1798.5800,percent of total billed charges,"42.7% of $1,798.58 in Billed Charges for Rev 272 = $767.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE ETHICON 3D BLACK,272,RC,,,,,,,,both,,,1798.5800,269.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1259.01,,,,,,,464.2100,1798.5800,percent of total billed charges,"Rev 272 $1,798.58 in Billed Charges at 70% = $1,259.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE ETHICON 3D BLACK,272,RC,,,,,,,,both,,,1798.5800,269.7900,CIGNA HEALTHCARE,CIGNA HMO,750.01,,,,,,,464.2100,1798.5800,percent of total billed charges,"41.7% of $1,798.58 in Billed Charges for Rev 272 = $750.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE ETHICON 3D BLACK,272,RC,,,,,,,,both,,,1798.5800,269.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,834.54,,,,,,,464.2100,1798.5800,percent of total billed charges,"46.4% of $1,798.58 in Billed Charges for Rev 272 = $834.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE ETHICON 3D BLACK,272,RC,,,,,,,,both,,,1798.5800,269.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,750.01,,,,,,,464.2100,1798.5800,percent of total billed charges,"41.7% of $1,798.58 in Billed Charges for Rev 272 = $750.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE ETHICON 3D BLACK,272,RC,,,,,,,,both,,,1798.5800,269.7900,CIGNA HEALTHCARE,CIGNA PPO,750.01,,,,,,,464.2100,1798.5800,percent of total billed charges,"41.7% of $1,798.58 in Billed Charges for Rev 272 = $750.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE ETHICON 3D BLACK,272,RC,,,,,,,,both,,,1798.5800,269.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1618.72,,,,,,,464.2100,1798.5800,percent of total billed charges,"90% of $1,798.58 in Billed Charges for Rev 272 = $1,618.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE ETHICON 3D BLACK,272,RC,,,,,,,,both,,,1798.5800,269.7900,MEDCOST,MEDCOST VHN,855.94,,,,,,,464.2100,1798.5800,percent of total billed charges,"47.59% of $1,798.58 in Billed Charges for Rev 272 = $855.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE ETHICON 3D BLACK,272,RC,,,,,,,,both,,,1798.5800,269.7900,SENTARA HEALTH,SENTARA HEALTH,464.21,,,,,,,464.2100,1798.5800,percent of total billed charges,"25.81% of $1,798.58 in Billed Charges for Rev 272 = $464.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE ETHICON 3D BLACK,272,RC,,,,,,,,both,,,1798.5800,269.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1798.58,,,,,,,464.2100,1798.5800,percent of total billed charges,"100% of $1,798.58 in Billed Charges for Rev 272 = $1,798.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE ETHICON 3D BLACK,272,RC,,,,,,,,both,,,1798.5800,269.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,899.29,,,,,,,464.2100,1798.5800,percent of total billed charges,"Rev 272 $1,798.58 in Billed Charges at 50% = $899.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE ETHICON 3D BLACK,272,RC,,,,,,,,both,,,1798.5800,269.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,580.94,,,,,,,464.2100,1798.5800,other,"32.3% of $1,798.58 in Billed Charges for Rev 272 = $580.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD STAPLE ETHICON 3D BLACK,272,RC,,,,,,,,both,,,1798.5800,269.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,552.16,,,,,,,464.2100,1798.5800,other,"30.7% of $1,798.58 in Billed Charges for Rev 272 = $552.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD STAPLE ETHICON 3D BLACK,272,RC,,,,,,,,both,,,1798.5800,269.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,580.94,,,,,,,464.2100,1798.5800,percent of total billed charges,"32.3% of $1,798.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLE ETHICON 3D BLACK,272,RC,,,,,,,,both,,,1798.5800,269.7900,WELLCARE,WELLCARE MEDICAID,1798.58,,,,,,,464.2100,1798.5800,percent of total billed charges,"100% of $1,798.58 in Billed Charges for Rev 272 = $1,798.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,AETNA,AETNA,35.01,,,,,,,4.1000,82.0000,percent of total billed charges,42.7% of $82.00 in Billed Charges for Rev 300 Proc 83050 = $35.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,6.44,,,,,,,4.1000,82.0000,fee schedule,APG 00402 Proc 83050 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 104% = $6.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,8.20,,,,,,,4.1000,82.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,AETNA,AETNA HEALTHCARE MEDICARE,8.20,,,,,,,4.1000,82.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,8.20,,,,,,,4.1000,82.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,AMBETTER,AMBETTER,17.88,,,,,,,4.1000,82.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,AMERIGROUP,AMERIGROUP,4.10,,,,,,,4.1000,82.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,8.53,,,,,,,4.1000,82.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,ANTHEM EXCHANGE,8.20,,,,,,,4.1000,82.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,6.38,,,,,,,4.1000,82.0000,fee schedule,APG 00402 Proc 83050 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,ANTHEM HMO,8.20,,,,,,,4.1000,82.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,8.45,,,,,,,4.1000,82.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8.20,,,,,,,4.1000,82.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,23.66,,,,,,,4.1000,82.0000,fee schedule,$23.66 from Fee Schedule BLDTM_23 for Rev 300 Proc 83050 * Qty 1 = $23.66 at 100% = $23.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,BLUE CROSS E NETWORK,12.80,,,,,,,4.1000,82.0000,fee schedule,$4.00 from Fee Schedule BCFSB for Rev 300 Proc 83050 * Qty 1 = $4.00 at 320% = $12.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,BLUE CROSS MEDICARE,8.53,,,,,,,4.1000,82.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,BLUE CROSS P NETWORK,13.08,,,,,,,4.1000,82.0000,fee schedule,$4.00 from Fee Schedule BCFSB for Rev 300 Proc 83050 * Qty 1 = $4.00 at 327% = $13.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,BLUE CROSS S NETWORK,13.08,,,,,,,4.1000,82.0000,fee schedule,$4.00 from Fee Schedule BCFSB for Rev 300 Proc 83050 * Qty 1 = $4.00 at 327% = $13.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,TENNCARE BLUE CARE,5.52,,,,,,,4.1000,82.0000,fee schedule,$4.76 from Fee Schedule TC_24 for Rev 300 Proc 83050 * Qty 1 = $4.76 at 116% = $5.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,TENNCARE BLUE SELECT,5.52,,,,,,,4.1000,82.0000,fee schedule,$4.76 from Fee Schedule TC_24 for Rev 300 Proc 83050 * Qty 1 = $4.76 at 116% = $5.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA HMO,29.45,,,,,,,4.1000,82.0000,fee schedule,$29.45 from Fee Schedule CIGWHS_23 for Rev 300 Proc 83050 * Qty 1 = $29.45 at 100% = $29.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,18.04,,,,,,,4.1000,82.0000,fee schedule,$18.04 from Fee Schedule CGIFP_25LR for Rev 300 Proc 83050 * Qty 1 = $18.04 at 100% = $18.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,8.61,,,,,,,4.1000,82.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,29.45,,,,,,,4.1000,82.0000,fee schedule,$29.45 from Fee Schedule CIGWHS_23 for Rev 300 Proc 83050 * Qty 1 = $29.45 at 100% = $29.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA PPO,29.45,,,,,,,4.1000,82.0000,fee schedule,$29.45 from Fee Schedule CIGWHS_23 for Rev 300 Proc 83050 * Qty 1 = $29.45 at 100% = $29.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,8.61,,,,,,,4.1000,82.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,73.80,,,,,,,4.1000,82.0000,percent of total billed charges,90% of $82.00 in Billed Charges for Rev 300 Proc 83050 = $73.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,HUMANA,HUMANA MEDICARE,8.20,,,,,,,4.1000,82.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,8.20,,,,,,,4.1000,82.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,MEDCOST,MEDCOST VHN,39.02,,,,,,,4.1000,82.0000,percent of total billed charges,47.59% of $82.00 in Billed Charges for Rev 300 Proc 83050 = $39.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,6.50,,,,,,,4.1000,82.0000,fee schedule,APG 00402 Proc 83050 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 105% = $6.50 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,8.61,,,,,,,4.1000,82.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,8.61,,,,,,,4.1000,82.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,NHC ADVANTAGE,NHC ADVANTAGE,8.61,,,,,,,4.1000,82.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,6.38,,,,,,,4.1000,82.0000,fee schedule,APG 00402 Proc 83050 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 103.1% = $6.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,SENTARA HEALTH,SENTARA HEALTH,21.16,,,,,,,4.1000,82.0000,percent of total billed charges,25.81% of $82.00 in Billed Charges for Rev 300 Proc 83050 = $21.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,SENTARA HEALTH,SENTARA MEDICARE,8.20,,,,,,,4.1000,82.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",82.00,,,,,,,4.1000,82.0000,percent of total billed charges,100% of $82.00 in Billed Charges for Rev 300 Proc 83050 = $82.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5.19,,,,,,,4.1000,82.0000,fee schedule,$10.37 from Fee Schedule TCUHC24 for Rev 300 Proc 83050 * Qty 1 = $10.37 at 50% = $5.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,8.53,,,,,,,4.1000,82.0000,fee schedule,$8.20 from Fee Schedule UHC_31910 for Rev 300 Proc 83050 * Qty 1 = $8.20 at 104% = $8.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,8.20,,,,,,,4.1000,82.0000,fee schedule,$8.20 from Fee Schedule UHC_31910 for Rev 300 Proc 83050 * Qty 1 = $8.20 at 100% = $8.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,8.20,,,,,,,4.1000,82.0000,fee schedule,$8.20 from Fee Schedule UHC_31910 for Rev 300 Proc 83050 * Qty 1 = $8.20 at 100% = $8.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,6.38,,,,,,,4.1000,82.0000,fee schedule,APG 00402 Proc 83050 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,8.20,,,,,,,4.1000,82.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,8.20,,,,,,,4.1000,82.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,WELLCARE,WELLCARE MEDICAID,82.00,,,,,,,4.1000,82.0000,percent of total billed charges,100% of $82.00 in Billed Charges for Rev 300 Proc 83050 = $82.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC METHEMOGLOBIN QUANT,83050,CPT,300,RC,30000109,CDM,,,,both,,,82.0000,12.3000,WELLCARE,WELLCARE MEDICARE,8.69,,,,,,,4.1000,82.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,AETNA,AETNA,36.30,,,,,,,3.6600,85.0000,percent of total billed charges,42.7% of $85.00 in Billed Charges for Rev 301 Proc 83051 = $36.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,6.44,,,,,,,3.6600,85.0000,fee schedule,APG 00402 Proc 83051 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 104% = $6.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,7.31,,,,,,,3.6600,85.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,AETNA,AETNA HEALTHCARE MEDICARE,7.31,,,,,,,3.6600,85.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,7.31,,,,,,,3.6600,85.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,AMBETTER,AMBETTER,15.94,,,,,,,3.6600,85.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,AMERIGROUP,AMERIGROUP,3.66,,,,,,,3.6600,85.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,7.60,,,,,,,3.6600,85.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,BLUE CROSS,ANTHEM EXCHANGE,7.31,,,,,,,3.6600,85.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,6.38,,,,,,,3.6600,85.0000,fee schedule,APG 00402 Proc 83051 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,BLUE CROSS,ANTHEM HMO,7.31,,,,,,,3.6600,85.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,7.53,,,,,,,3.6600,85.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",7.31,,,,,,,3.6600,85.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,20.60,,,,,,,3.6600,85.0000,fee schedule,$20.60 from Fee Schedule BLDTM_23 for Rev 301 Proc 83051 * Qty 1 = $20.60 at 100% = $20.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,BLUE CROSS,BLUE CROSS E NETWORK,31.94,,,,,,,3.6600,85.0000,fee schedule,$9.98 from Fee Schedule BCFSB for Rev 301 Proc 83051 * Qty 1 = $9.98 at 320% = $31.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,BLUE CROSS,BLUE CROSS MEDICARE,7.60,,,,,,,3.6600,85.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,BLUE CROSS,BLUE CROSS P NETWORK,32.63,,,,,,,3.6600,85.0000,fee schedule,$9.98 from Fee Schedule BCFSB for Rev 301 Proc 83051 * Qty 1 = $9.98 at 327% = $32.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,BLUE CROSS,BLUE CROSS S NETWORK,32.63,,,,,,,3.6600,85.0000,fee schedule,$9.98 from Fee Schedule BCFSB for Rev 301 Proc 83051 * Qty 1 = $9.98 at 327% = $32.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,BLUE CROSS,TENNCARE BLUE CARE,16.63,,,,,,,3.6600,85.0000,fee schedule,$14.34 from Fee Schedule TC_24 for Rev 301 Proc 83051 * Qty 1 = $14.34 at 116% = $16.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,BLUE CROSS,TENNCARE BLUE SELECT,16.63,,,,,,,3.6600,85.0000,fee schedule,$14.34 from Fee Schedule TC_24 for Rev 301 Proc 83051 * Qty 1 = $14.34 at 116% = $16.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,CIGNA HEALTHCARE,CIGNA HMO,29.41,,,,,,,3.6600,85.0000,fee schedule,$29.41 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83051 * Qty 1 = $29.41 at 100% = $29.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,15.88,,,,,,,3.6600,85.0000,fee schedule,$15.88 from Fee Schedule CGIFP_25LR for Rev 301 Proc 83051 * Qty 1 = $15.88 at 100% = $15.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,7.68,,,,,,,3.6600,85.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,29.41,,,,,,,3.6600,85.0000,fee schedule,$29.41 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83051 * Qty 1 = $29.41 at 100% = $29.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,CIGNA HEALTHCARE,CIGNA PPO,29.41,,,,,,,3.6600,85.0000,fee schedule,$29.41 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83051 * Qty 1 = $29.41 at 100% = $29.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,7.68,,,,,,,3.6600,85.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,76.50,,,,,,,3.6600,85.0000,percent of total billed charges,90% of $85.00 in Billed Charges for Rev 301 Proc 83051 = $76.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,HUMANA,HUMANA MEDICARE,7.31,,,,,,,3.6600,85.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,7.31,,,,,,,3.6600,85.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,MEDCOST,MEDCOST VHN,40.45,,,,,,,3.6600,85.0000,percent of total billed charges,47.59% of $85.00 in Billed Charges for Rev 301 Proc 83051 = $40.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,6.50,,,,,,,3.6600,85.0000,fee schedule,APG 00402 Proc 83051 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 105% = $6.50 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,7.68,,,,,,,3.6600,85.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,7.68,,,,,,,3.6600,85.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,NHC ADVANTAGE,NHC ADVANTAGE,7.68,,,,,,,3.6600,85.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,6.38,,,,,,,3.6600,85.0000,fee schedule,APG 00402 Proc 83051 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 103.1% = $6.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,SENTARA HEALTH,SENTARA HEALTH,21.94,,,,,,,3.6600,85.0000,percent of total billed charges,25.81% of $85.00 in Billed Charges for Rev 301 Proc 83051 = $21.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,SENTARA HEALTH,SENTARA MEDICARE,7.31,,,,,,,3.6600,85.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",85.00,,,,,,,3.6600,85.0000,percent of total billed charges,100% of $85.00 in Billed Charges for Rev 301 Proc 83051 = $85.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5.18,,,,,,,3.6600,85.0000,fee schedule,$10.35 from Fee Schedule TCUHC24 for Rev 301 Proc 83051 * Qty 1 = $10.35 at 50% = $5.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7.60,,,,,,,3.6600,85.0000,fee schedule,$7.31 from Fee Schedule UHC_31910 for Rev 301 Proc 83051 * Qty 1 = $7.31 at 104% = $7.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7.31,,,,,,,3.6600,85.0000,fee schedule,$7.31 from Fee Schedule UHC_31910 for Rev 301 Proc 83051 * Qty 1 = $7.31 at 100% = $7.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,7.31,,,,,,,3.6600,85.0000,fee schedule,$7.31 from Fee Schedule UHC_31910 for Rev 301 Proc 83051 * Qty 1 = $7.31 at 100% = $7.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,6.38,,,,,,,3.6600,85.0000,fee schedule,APG 00402 Proc 83051 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,7.31,,,,,,,3.6600,85.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,7.31,,,,,,,3.6600,85.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,WELLCARE,WELLCARE MEDICAID,85.00,,,,,,,3.6600,85.0000,percent of total billed charges,100% of $85.00 in Billed Charges for Rev 301 Proc 83051 = $85.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HGB HEMOGLOBIN PLASMA,83051,CPT,301,RC,30100151,CDM,,,,both,,,85.0000,12.7500,WELLCARE,WELLCARE MEDICARE,7.75,,,,,,,3.6600,85.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,AETNA,AETNA,81.13,,,,,,,8.4400,190.0000,percent of total billed charges,42.7% of $190.00 in Billed Charges for Rev 301 Proc 83080 = $81.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,14.27,,,,,,,8.4400,190.0000,fee schedule,APG 00400 Proc 83080 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 104% = $14.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,16.87,,,,,,,8.4400,190.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,AETNA,AETNA HEALTHCARE MEDICARE,16.87,,,,,,,8.4400,190.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,16.87,,,,,,,8.4400,190.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,AMBETTER,AMBETTER,36.78,,,,,,,8.4400,190.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,AMERIGROUP,AMERIGROUP,8.44,,,,,,,8.4400,190.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,17.54,,,,,,,8.4400,190.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,ANTHEM EXCHANGE,16.87,,,,,,,8.4400,190.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,14.13,,,,,,,8.4400,190.0000,fee schedule,APG 00400 Proc 83080 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,ANTHEM HMO,16.87,,,,,,,8.4400,190.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,17.38,,,,,,,8.4400,190.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",16.87,,,,,,,8.4400,190.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,54.65,,,,,,,8.4400,190.0000,fee schedule,$54.65 from Fee Schedule BLDTM_23 for Rev 301 Proc 83080 * Qty 1 = $54.65 at 100% = $54.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,BLUE CROSS E NETWORK,25.60,,,,,,,8.4400,190.0000,fee schedule,$8.00 from Fee Schedule BCFSB for Rev 301 Proc 83080 * Qty 1 = $8.00 at 320% = $25.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,BLUE CROSS MEDICARE,17.54,,,,,,,8.4400,190.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,BLUE CROSS P NETWORK,26.16,,,,,,,8.4400,190.0000,fee schedule,$8.00 from Fee Schedule BCFSB for Rev 301 Proc 83080 * Qty 1 = $8.00 at 327% = $26.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,BLUE CROSS S NETWORK,26.16,,,,,,,8.4400,190.0000,fee schedule,$8.00 from Fee Schedule BCFSB for Rev 301 Proc 83080 * Qty 1 = $8.00 at 327% = $26.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,TENNCARE BLUE CARE,11.87,,,,,,,8.4400,190.0000,fee schedule,$10.23 from Fee Schedule TC_24 for Rev 301 Proc 83080 * Qty 1 = $10.23 at 116% = $11.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,TENNCARE BLUE SELECT,11.87,,,,,,,8.4400,190.0000,fee schedule,$10.23 from Fee Schedule TC_24 for Rev 301 Proc 83080 * Qty 1 = $10.23 at 116% = $11.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,CIGNA HEALTHCARE,CIGNA HMO,67.87,,,,,,,8.4400,190.0000,fee schedule,$67.87 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83080 * Qty 1 = $67.87 at 100% = $67.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,37.53,,,,,,,8.4400,190.0000,fee schedule,$37.53 from Fee Schedule CGIFP_25LR for Rev 301 Proc 83080 * Qty 1 = $37.53 at 100% = $37.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,17.71,,,,,,,8.4400,190.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,67.87,,,,,,,8.4400,190.0000,fee schedule,$67.87 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83080 * Qty 1 = $67.87 at 100% = $67.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,CIGNA HEALTHCARE,CIGNA PPO,67.87,,,,,,,8.4400,190.0000,fee schedule,$67.87 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83080 * Qty 1 = $67.87 at 100% = $67.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,17.71,,,,,,,8.4400,190.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,171.00,,,,,,,8.4400,190.0000,percent of total billed charges,90% of $190.00 in Billed Charges for Rev 301 Proc 83080 = $171.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,HUMANA,HUMANA MEDICARE,16.87,,,,,,,8.4400,190.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,16.87,,,,,,,8.4400,190.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,MEDCOST,MEDCOST VHN,90.42,,,,,,,8.4400,190.0000,percent of total billed charges,47.59% of $190.00 in Billed Charges for Rev 301 Proc 83080 = $90.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,14.41,,,,,,,8.4400,190.0000,fee schedule,APG 00400 Proc 83080 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 105% = $14.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,17.71,,,,,,,8.4400,190.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,17.71,,,,,,,8.4400,190.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,NHC ADVANTAGE,NHC ADVANTAGE,17.71,,,,,,,8.4400,190.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,14.15,,,,,,,8.4400,190.0000,fee schedule,APG 00400 Proc 83080 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 103.1% = $14.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,SENTARA HEALTH,SENTARA HEALTH,49.04,,,,,,,8.4400,190.0000,percent of total billed charges,25.81% of $190.00 in Billed Charges for Rev 301 Proc 83080 = $49.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,SENTARA HEALTH,SENTARA MEDICARE,16.87,,,,,,,8.4400,190.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",190.00,,,,,,,8.4400,190.0000,percent of total billed charges,100% of $190.00 in Billed Charges for Rev 301 Proc 83080 = $190.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11.95,,,,,,,8.4400,190.0000,fee schedule,$23.89 from Fee Schedule TCUHC24 for Rev 301 Proc 83080 * Qty 1 = $23.89 at 50% = $11.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,17.54,,,,,,,8.4400,190.0000,fee schedule,$16.87 from Fee Schedule UHC_31910 for Rev 301 Proc 83080 * Qty 1 = $16.87 at 104% = $17.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,16.87,,,,,,,8.4400,190.0000,fee schedule,$16.87 from Fee Schedule UHC_31910 for Rev 301 Proc 83080 * Qty 1 = $16.87 at 100% = $16.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,16.87,,,,,,,8.4400,190.0000,fee schedule,$16.87 from Fee Schedule UHC_31910 for Rev 301 Proc 83080 * Qty 1 = $16.87 at 100% = $16.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,14.13,,,,,,,8.4400,190.0000,fee schedule,APG 00400 Proc 83080 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,16.87,,,,,,,8.4400,190.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,16.87,,,,,,,8.4400,190.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,WELLCARE,WELLCARE MEDICAID,190.00,,,,,,,8.4400,190.0000,percent of total billed charges,100% of $190.00 in Billed Charges for Rev 301 Proc 83080 = $190.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY OF B HEXOSAMINIDASE EACH ASSAY,83080,CPT,301,RC,30100522,CDM,,,,both,,,190.0000,28.5000,WELLCARE,WELLCARE MEDICARE,17.88,,,,,,,8.4400,190.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,AETNA,AETNA,147.32,,,,,,,14.7700,345.0000,percent of total billed charges,42.7% of $345.00 in Billed Charges for Rev 301 Proc 83088 = $147.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,33.15,,,,,,,14.7700,345.0000,fee schedule,APG 00401 Proc 83088 at $836.60 (Base Rate) * 0.0381 (Relative Weight) = $31.87 (Total Line Payment) at 104% = $33.15. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,29.53,,,,,,,14.7700,345.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,AETNA,AETNA HEALTHCARE MEDICARE,29.53,,,,,,,14.7700,345.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,29.53,,,,,,,14.7700,345.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,AMBETTER,AMBETTER,64.38,,,,,,,14.7700,345.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,AMERIGROUP,AMERIGROUP,14.77,,,,,,,14.7700,345.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,30.71,,,,,,,14.7700,345.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,BLUE CROSS,ANTHEM EXCHANGE,29.53,,,,,,,14.7700,345.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,32.83,,,,,,,14.7700,345.0000,fee schedule,APG 00401 Proc 83088 at $836.60 (Base Rate) * 0.0381 (Relative Weight) = $31.87 (Total Line Payment) at 103% = $32.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,BLUE CROSS,ANTHEM HMO,29.53,,,,,,,14.7700,345.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,30.42,,,,,,,14.7700,345.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",29.53,,,,,,,14.7700,345.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,96.25,,,,,,,14.7700,345.0000,fee schedule,$96.25 from Fee Schedule BLDTM_23 for Rev 301 Proc 83088 * Qty 1 = $96.25 at 100% = $96.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,BLUE CROSS,BLUE CROSS E NETWORK,128.93,,,,,,,14.7700,345.0000,fee schedule,$40.29 from Fee Schedule BCFSB for Rev 301 Proc 83088 * Qty 1 = $40.29 at 320% = $128.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,BLUE CROSS,BLUE CROSS MEDICARE,30.71,,,,,,,14.7700,345.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,BLUE CROSS,BLUE CROSS P NETWORK,131.75,,,,,,,14.7700,345.0000,fee schedule,$40.29 from Fee Schedule BCFSB for Rev 301 Proc 83088 * Qty 1 = $40.29 at 327% = $131.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,BLUE CROSS,BLUE CROSS S NETWORK,131.75,,,,,,,14.7700,345.0000,fee schedule,$40.29 from Fee Schedule BCFSB for Rev 301 Proc 83088 * Qty 1 = $40.29 at 327% = $131.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,BLUE CROSS,TENNCARE BLUE CARE,63.67,,,,,,,14.7700,345.0000,fee schedule,$54.89 from Fee Schedule TC_24 for Rev 301 Proc 83088 * Qty 1 = $54.89 at 116% = $63.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,BLUE CROSS,TENNCARE BLUE SELECT,63.67,,,,,,,14.7700,345.0000,fee schedule,$54.89 from Fee Schedule TC_24 for Rev 301 Proc 83088 * Qty 1 = $54.89 at 116% = $63.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,CIGNA HEALTHCARE,CIGNA HMO,118.82,,,,,,,14.7700,345.0000,fee schedule,$118.82 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83088 * Qty 1 = $118.82 at 100% = $118.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,64.96,,,,,,,14.7700,345.0000,fee schedule,$64.96 from Fee Schedule CGIFP_25LR for Rev 301 Proc 83088 * Qty 1 = $64.96 at 100% = $64.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,31.01,,,,,,,14.7700,345.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,118.82,,,,,,,14.7700,345.0000,fee schedule,$118.82 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83088 * Qty 1 = $118.82 at 100% = $118.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,CIGNA HEALTHCARE,CIGNA PPO,118.82,,,,,,,14.7700,345.0000,fee schedule,$118.82 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83088 * Qty 1 = $118.82 at 100% = $118.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,31.01,,,,,,,14.7700,345.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,310.50,,,,,,,14.7700,345.0000,percent of total billed charges,90% of $345.00 in Billed Charges for Rev 301 Proc 83088 = $310.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,HUMANA,HUMANA MEDICARE,29.53,,,,,,,14.7700,345.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,29.53,,,,,,,14.7700,345.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,MEDCOST,MEDCOST VHN,164.19,,,,,,,14.7700,345.0000,percent of total billed charges,47.59% of $345.00 in Billed Charges for Rev 301 Proc 83088 = $164.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,33.46,,,,,,,14.7700,345.0000,fee schedule,APG 00401 Proc 83088 at $836.60 (Base Rate) * 0.0381 (Relative Weight) = $31.87 (Total Line Payment) at 100% = $31.87... $31.87 at 105% = $33.46 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,31.01,,,,,,,14.7700,345.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,31.01,,,,,,,14.7700,345.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,NHC ADVANTAGE,NHC ADVANTAGE,31.01,,,,,,,14.7700,345.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,32.86,,,,,,,14.7700,345.0000,fee schedule,APG 00401 Proc 83088 at $836.60 (Base Rate) * 0.0381 (Relative Weight) = $31.87 (Total Line Payment) at 100% = $31.87... $31.87 at 103.1% = $32.86 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,SENTARA HEALTH,SENTARA HEALTH,89.04,,,,,,,14.7700,345.0000,percent of total billed charges,25.81% of $345.00 in Billed Charges for Rev 301 Proc 83088 = $89.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,SENTARA HEALTH,SENTARA MEDICARE,29.53,,,,,,,14.7700,345.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",345.00,,,,,,,14.7700,345.0000,percent of total billed charges,100% of $345.00 in Billed Charges for Rev 301 Proc 83088 = $345.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,20.92,,,,,,,14.7700,345.0000,fee schedule,$41.83 from Fee Schedule TCUHC24 for Rev 301 Proc 83088 * Qty 1 = $41.83 at 50% = $20.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,30.71,,,,,,,14.7700,345.0000,fee schedule,$29.53 from Fee Schedule UHC_31910 for Rev 301 Proc 83088 * Qty 1 = $29.53 at 104% = $30.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,29.53,,,,,,,14.7700,345.0000,fee schedule,$29.53 from Fee Schedule UHC_31910 for Rev 301 Proc 83088 * Qty 1 = $29.53 at 100% = $29.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,29.53,,,,,,,14.7700,345.0000,fee schedule,$29.53 from Fee Schedule UHC_31910 for Rev 301 Proc 83088 * Qty 1 = $29.53 at 100% = $29.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,32.83,,,,,,,14.7700,345.0000,fee schedule,APG 00401 Proc 83088 at $836.60 (Base Rate) * 0.0381 (Relative Weight) = $31.87 (Total Line Payment) at 103% = $32.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,29.53,,,,,,,14.7700,345.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,29.53,,,,,,,14.7700,345.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,WELLCARE,WELLCARE MEDICAID,345.00,,,,,,,14.7700,345.0000,percent of total billed charges,100% of $345.00 in Billed Charges for Rev 301 Proc 83088 = $345.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HISTAMINE,83088,CPT,301,RC,30100153,CDM,,,,both,,,345.0000,51.7500,WELLCARE,WELLCARE MEDICARE,31.30,,,,,,,14.7700,345.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,AETNA,AETNA,84.12,,,,,,,7.6300,197.0000,percent of total billed charges,42.7% of $197.00 in Billed Charges for Rev 301 Proc 83090 = $84.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15.66,,,,,,,7.6300,197.0000,fee schedule,APG 00398 Proc 83090 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 104% = $15.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,17.92,,,,,,,7.6300,197.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,AETNA,AETNA HEALTHCARE MEDICARE,17.92,,,,,,,7.6300,197.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,17.92,,,,,,,7.6300,197.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,AMBETTER,AMBETTER,39.07,,,,,,,7.6300,197.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,AMERIGROUP,AMERIGROUP,8.96,,,,,,,7.6300,197.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,18.64,,,,,,,7.6300,197.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,BLUE CROSS,ANTHEM EXCHANGE,17.92,,,,,,,7.6300,197.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15.51,,,,,,,7.6300,197.0000,fee schedule,APG 00398 Proc 83090 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,BLUE CROSS,ANTHEM HMO,17.92,,,,,,,7.6300,197.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,18.46,,,,,,,7.6300,197.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",17.92,,,,,,,7.6300,197.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,21.56,,,,,,,7.6300,197.0000,fee schedule,$21.56 from Fee Schedule BLDTM_23 for Rev 301 Proc 83090 * Qty 1 = $21.56 at 100% = $21.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,BLUE CROSS,BLUE CROSS E NETWORK,73.63,,,,,,,7.6300,197.0000,fee schedule,$23.01 from Fee Schedule BCFSB for Rev 301 Proc 83090 * Qty 1 = $23.01 at 320% = $73.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,BLUE CROSS,BLUE CROSS MEDICARE,18.64,,,,,,,7.6300,197.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,BLUE CROSS,BLUE CROSS P NETWORK,75.24,,,,,,,7.6300,197.0000,fee schedule,$23.01 from Fee Schedule BCFSB for Rev 301 Proc 83090 * Qty 1 = $23.01 at 327% = $75.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,BLUE CROSS,BLUE CROSS S NETWORK,75.24,,,,,,,7.6300,197.0000,fee schedule,$23.01 from Fee Schedule BCFSB for Rev 301 Proc 83090 * Qty 1 = $23.01 at 327% = $75.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,BLUE CROSS,TENNCARE BLUE CARE,7.63,,,,,,,7.6300,197.0000,fee schedule,$6.58 from Fee Schedule TC_24 for Rev 301 Proc 83090 * Qty 1 = $6.58 at 116% = $7.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,BLUE CROSS,TENNCARE BLUE SELECT,7.63,,,,,,,7.6300,197.0000,fee schedule,$6.58 from Fee Schedule TC_24 for Rev 301 Proc 83090 * Qty 1 = $6.58 at 116% = $7.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,CIGNA HEALTHCARE,CIGNA HMO,67.87,,,,,,,7.6300,197.0000,fee schedule,$67.87 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83090 * Qty 1 = $67.87 at 100% = $67.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,39.70,,,,,,,7.6300,197.0000,fee schedule,$39.70 from Fee Schedule CGIFP_25LR for Rev 301 Proc 83090 * Qty 1 = $39.70 at 100% = $39.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,18.82,,,,,,,7.6300,197.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,67.87,,,,,,,7.6300,197.0000,fee schedule,$67.87 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83090 * Qty 1 = $67.87 at 100% = $67.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,CIGNA HEALTHCARE,CIGNA PPO,67.87,,,,,,,7.6300,197.0000,fee schedule,$67.87 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83090 * Qty 1 = $67.87 at 100% = $67.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,18.82,,,,,,,7.6300,197.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,177.30,,,,,,,7.6300,197.0000,percent of total billed charges,90% of $197.00 in Billed Charges for Rev 301 Proc 83090 = $177.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,HUMANA,HUMANA MEDICARE,17.92,,,,,,,7.6300,197.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,17.92,,,,,,,7.6300,197.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,MEDCOST,MEDCOST VHN,93.75,,,,,,,7.6300,197.0000,percent of total billed charges,47.59% of $197.00 in Billed Charges for Rev 301 Proc 83090 = $93.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15.81,,,,,,,7.6300,197.0000,fee schedule,APG 00398 Proc 83090 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 105% = $15.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,18.82,,,,,,,7.6300,197.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,18.82,,,,,,,7.6300,197.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,NHC ADVANTAGE,NHC ADVANTAGE,18.82,,,,,,,7.6300,197.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15.53,,,,,,,7.6300,197.0000,fee schedule,APG 00398 Proc 83090 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 103.1% = $15.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,SENTARA HEALTH,SENTARA HEALTH,50.85,,,,,,,7.6300,197.0000,percent of total billed charges,25.81% of $197.00 in Billed Charges for Rev 301 Proc 83090 = $50.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,SENTARA HEALTH,SENTARA MEDICARE,17.92,,,,,,,7.6300,197.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",197.00,,,,,,,7.6300,197.0000,percent of total billed charges,100% of $197.00 in Billed Charges for Rev 301 Proc 83090 = $197.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11.95,,,,,,,7.6300,197.0000,fee schedule,$23.89 from Fee Schedule TCUHC24 for Rev 301 Proc 83090 * Qty 1 = $23.89 at 50% = $11.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,18.64,,,,,,,7.6300,197.0000,fee schedule,$17.92 from Fee Schedule UHC_31910 for Rev 301 Proc 83090 * Qty 1 = $17.92 at 104% = $18.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,17.92,,,,,,,7.6300,197.0000,fee schedule,$17.92 from Fee Schedule UHC_31910 for Rev 301 Proc 83090 * Qty 1 = $17.92 at 100% = $17.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,17.92,,,,,,,7.6300,197.0000,fee schedule,$17.92 from Fee Schedule UHC_31910 for Rev 301 Proc 83090 * Qty 1 = $17.92 at 100% = $17.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15.51,,,,,,,7.6300,197.0000,fee schedule,APG 00398 Proc 83090 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,17.92,,,,,,,7.6300,197.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,17.92,,,,,,,7.6300,197.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,WELLCARE,WELLCARE MEDICAID,197.00,,,,,,,7.6300,197.0000,percent of total billed charges,100% of $197.00 in Billed Charges for Rev 301 Proc 83090 = $197.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HOMOCYSTEINE,83090,CPT,301,RC,30100154,CDM,,,,both,,,197.0000,29.5500,WELLCARE,WELLCARE MEDICARE,19.00,,,,,,,7.6300,197.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,AETNA,AETNA,96.50,,,,,,,11.2100,226.0000,percent of total billed charges,42.7% of $226.00 in Billed Charges for Rev 301 Proc 83150 = $96.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15.66,,,,,,,11.2100,226.0000,fee schedule,APG 00398 Proc 83150 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 104% = $15.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,22.41,,,,,,,11.2100,226.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,AETNA,AETNA HEALTHCARE MEDICARE,22.41,,,,,,,11.2100,226.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,22.41,,,,,,,11.2100,226.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,AMBETTER,AMBETTER,48.85,,,,,,,11.2100,226.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,AMERIGROUP,AMERIGROUP,11.21,,,,,,,11.2100,226.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,23.31,,,,,,,11.2100,226.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,ANTHEM EXCHANGE,22.41,,,,,,,11.2100,226.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15.51,,,,,,,11.2100,226.0000,fee schedule,APG 00398 Proc 83150 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,ANTHEM HMO,22.41,,,,,,,11.2100,226.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,23.08,,,,,,,11.2100,226.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",22.41,,,,,,,11.2100,226.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,62.81,,,,,,,11.2100,226.0000,fee schedule,$62.81 from Fee Schedule BLDTM_23 for Rev 301 Proc 83150 * Qty 1 = $62.81 at 100% = $62.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,BLUE CROSS E NETWORK,84.48,,,,,,,11.2100,226.0000,fee schedule,$26.40 from Fee Schedule BCFSB for Rev 301 Proc 83150 * Qty 1 = $26.40 at 320% = $84.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,BLUE CROSS MEDICARE,23.31,,,,,,,11.2100,226.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,BLUE CROSS P NETWORK,86.33,,,,,,,11.2100,226.0000,fee schedule,$26.40 from Fee Schedule BCFSB for Rev 301 Proc 83150 * Qty 1 = $26.40 at 327% = $86.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,BLUE CROSS S NETWORK,86.33,,,,,,,11.2100,226.0000,fee schedule,$26.40 from Fee Schedule BCFSB for Rev 301 Proc 83150 * Qty 1 = $26.40 at 327% = $86.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,TENNCARE BLUE CARE,44.06,,,,,,,11.2100,226.0000,fee schedule,$37.98 from Fee Schedule TC_24 for Rev 301 Proc 83150 * Qty 1 = $37.98 at 116% = $44.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,TENNCARE BLUE SELECT,44.06,,,,,,,11.2100,226.0000,fee schedule,$37.98 from Fee Schedule TC_24 for Rev 301 Proc 83150 * Qty 1 = $37.98 at 116% = $44.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,CIGNA HEALTHCARE,CIGNA HMO,77.83,,,,,,,11.2100,226.0000,fee schedule,$77.83 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83150 * Qty 1 = $77.83 at 100% = $77.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,49.08,,,,,,,11.2100,226.0000,fee schedule,$49.08 from Fee Schedule CGIFP_25LR for Rev 301 Proc 83150 * Qty 1 = $49.08 at 100% = $49.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,23.53,,,,,,,11.2100,226.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,77.83,,,,,,,11.2100,226.0000,fee schedule,$77.83 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83150 * Qty 1 = $77.83 at 100% = $77.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,CIGNA HEALTHCARE,CIGNA PPO,77.83,,,,,,,11.2100,226.0000,fee schedule,$77.83 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83150 * Qty 1 = $77.83 at 100% = $77.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,23.53,,,,,,,11.2100,226.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,203.40,,,,,,,11.2100,226.0000,percent of total billed charges,90% of $226.00 in Billed Charges for Rev 301 Proc 83150 = $203.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,HUMANA,HUMANA MEDICARE,22.41,,,,,,,11.2100,226.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,22.41,,,,,,,11.2100,226.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,MEDCOST,MEDCOST VHN,107.55,,,,,,,11.2100,226.0000,percent of total billed charges,47.59% of $226.00 in Billed Charges for Rev 301 Proc 83150 = $107.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15.81,,,,,,,11.2100,226.0000,fee schedule,APG 00398 Proc 83150 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 105% = $15.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,23.53,,,,,,,11.2100,226.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,23.53,,,,,,,11.2100,226.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,NHC ADVANTAGE,NHC ADVANTAGE,23.53,,,,,,,11.2100,226.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15.53,,,,,,,11.2100,226.0000,fee schedule,APG 00398 Proc 83150 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 103.1% = $15.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,SENTARA HEALTH,SENTARA HEALTH,58.33,,,,,,,11.2100,226.0000,percent of total billed charges,25.81% of $226.00 in Billed Charges for Rev 301 Proc 83150 = $58.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,SENTARA HEALTH,SENTARA MEDICARE,22.41,,,,,,,11.2100,226.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",226.00,,,,,,,11.2100,226.0000,percent of total billed charges,100% of $226.00 in Billed Charges for Rev 301 Proc 83150 = $226.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,13.70,,,,,,,11.2100,226.0000,fee schedule,$27.40 from Fee Schedule TCUHC24 for Rev 301 Proc 83150 * Qty 1 = $27.40 at 50% = $13.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,23.31,,,,,,,11.2100,226.0000,fee schedule,$22.41 from Fee Schedule UHC_31910 for Rev 301 Proc 83150 * Qty 1 = $22.41 at 104% = $23.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,22.41,,,,,,,11.2100,226.0000,fee schedule,$22.41 from Fee Schedule UHC_31910 for Rev 301 Proc 83150 * Qty 1 = $22.41 at 100% = $22.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,22.41,,,,,,,11.2100,226.0000,fee schedule,$22.41 from Fee Schedule UHC_31910 for Rev 301 Proc 83150 * Qty 1 = $22.41 at 100% = $22.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15.51,,,,,,,11.2100,226.0000,fee schedule,APG 00398 Proc 83150 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,22.41,,,,,,,11.2100,226.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,22.41,,,,,,,11.2100,226.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,WELLCARE,WELLCARE MEDICAID,226.00,,,,,,,11.2100,226.0000,percent of total billed charges,100% of $226.00 in Billed Charges for Rev 301 Proc 83150 = $226.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HOMOVANILLIC ACID HVA,83150,CPT,301,RC,30100155,CDM,,,,both,,,226.0000,33.9000,WELLCARE,WELLCARE MEDICARE,23.75,,,,,,,11.2100,226.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
RELOAD STAPLER ECHELON 45MM GOLD GST45D,272,RC,27200002,CDM,,,,,,both,,,1474.5900,221.1900,AETNA,AETNA,629.65,,,,,,,380.5900,1474.5900,percent of total billed charges,"42.7% of $1,474.59 in Billed Charges for Rev 272 = $629.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GOLD GST45D,272,RC,27200002,CDM,,,,,,both,,,1474.5900,221.1900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1032.21,,,,,,,380.5900,1474.5900,percent of total billed charges,"Rev 272 $1,474.59 in Billed Charges at 70% = $1,032.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GOLD GST45D,272,RC,27200002,CDM,,,,,,both,,,1474.5900,221.1900,CIGNA HEALTHCARE,CIGNA HMO,614.90,,,,,,,380.5900,1474.5900,percent of total billed charges,"41.7% of $1,474.59 in Billed Charges for Rev 272 = $614.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GOLD GST45D,272,RC,27200002,CDM,,,,,,both,,,1474.5900,221.1900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,684.21,,,,,,,380.5900,1474.5900,percent of total billed charges,"46.4% of $1,474.59 in Billed Charges for Rev 272 = $684.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GOLD GST45D,272,RC,27200002,CDM,,,,,,both,,,1474.5900,221.1900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,614.90,,,,,,,380.5900,1474.5900,percent of total billed charges,"41.7% of $1,474.59 in Billed Charges for Rev 272 = $614.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GOLD GST45D,272,RC,27200002,CDM,,,,,,both,,,1474.5900,221.1900,CIGNA HEALTHCARE,CIGNA PPO,614.90,,,,,,,380.5900,1474.5900,percent of total billed charges,"41.7% of $1,474.59 in Billed Charges for Rev 272 = $614.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GOLD GST45D,272,RC,27200002,CDM,,,,,,both,,,1474.5900,221.1900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1327.13,,,,,,,380.5900,1474.5900,percent of total billed charges,"90% of $1,474.59 in Billed Charges for Rev 272 = $1,327.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GOLD GST45D,272,RC,27200002,CDM,,,,,,both,,,1474.5900,221.1900,MEDCOST,MEDCOST VHN,701.76,,,,,,,380.5900,1474.5900,percent of total billed charges,"47.59% of $1,474.59 in Billed Charges for Rev 272 = $701.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GOLD GST45D,272,RC,27200002,CDM,,,,,,both,,,1474.5900,221.1900,SENTARA HEALTH,SENTARA HEALTH,380.59,,,,,,,380.5900,1474.5900,percent of total billed charges,"25.81% of $1,474.59 in Billed Charges for Rev 272 = $380.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GOLD GST45D,272,RC,27200002,CDM,,,,,,both,,,1474.5900,221.1900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1474.59,,,,,,,380.5900,1474.5900,percent of total billed charges,"100% of $1,474.59 in Billed Charges for Rev 272 = $1,474.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GOLD GST45D,272,RC,27200002,CDM,,,,,,both,,,1474.5900,221.1900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,737.30,,,,,,,380.5900,1474.5900,percent of total billed charges,"Rev 272 $1,474.59 in Billed Charges at 50% = $737.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GOLD GST45D,272,RC,27200002,CDM,,,,,,both,,,1474.5900,221.1900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,476.29,,,,,,,380.5900,1474.5900,other,"32.3% of $1,474.59 in Billed Charges for Rev 272 = $476.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD STAPLER ECHELON 45MM GOLD GST45D,272,RC,27200002,CDM,,,,,,both,,,1474.5900,221.1900,UNITED HEALTHCARE,UHC HERITAGE SELECT,452.70,,,,,,,380.5900,1474.5900,other,"30.7% of $1,474.59 in Billed Charges for Rev 272 = $452.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD STAPLER ECHELON 45MM GOLD GST45D,272,RC,27200002,CDM,,,,,,both,,,1474.5900,221.1900,UNITED HEALTHCARE,UNITED HEALTHCARE,476.29,,,,,,,380.5900,1474.5900,percent of total billed charges,"32.3% of $1,474.59 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GOLD GST45D,272,RC,27200002,CDM,,,,,,both,,,1474.5900,221.1900,WELLCARE,WELLCARE MEDICAID,1474.59,,,,,,,380.5900,1474.5900,percent of total billed charges,"100% of $1,474.59 in Billed Charges for Rev 272 = $1,474.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GRAY ECR45M,272,RC,27200002,CDM,,,,,,both,,,1446.3900,216.9600,AETNA,AETNA,617.61,,,,,,,373.3100,1446.3900,percent of total billed charges,"42.7% of $1,446.39 in Billed Charges for Rev 272 = $617.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GRAY ECR45M,272,RC,27200002,CDM,,,,,,both,,,1446.3900,216.9600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1012.47,,,,,,,373.3100,1446.3900,percent of total billed charges,"Rev 272 $1,446.39 in Billed Charges at 70% = $1,012.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GRAY ECR45M,272,RC,27200002,CDM,,,,,,both,,,1446.3900,216.9600,CIGNA HEALTHCARE,CIGNA HMO,603.14,,,,,,,373.3100,1446.3900,percent of total billed charges,"41.7% of $1,446.39 in Billed Charges for Rev 272 = $603.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GRAY ECR45M,272,RC,27200002,CDM,,,,,,both,,,1446.3900,216.9600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,671.13,,,,,,,373.3100,1446.3900,percent of total billed charges,"46.4% of $1,446.39 in Billed Charges for Rev 272 = $671.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GRAY ECR45M,272,RC,27200002,CDM,,,,,,both,,,1446.3900,216.9600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,603.14,,,,,,,373.3100,1446.3900,percent of total billed charges,"41.7% of $1,446.39 in Billed Charges for Rev 272 = $603.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GRAY ECR45M,272,RC,27200002,CDM,,,,,,both,,,1446.3900,216.9600,CIGNA HEALTHCARE,CIGNA PPO,603.14,,,,,,,373.3100,1446.3900,percent of total billed charges,"41.7% of $1,446.39 in Billed Charges for Rev 272 = $603.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GRAY ECR45M,272,RC,27200002,CDM,,,,,,both,,,1446.3900,216.9600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1301.75,,,,,,,373.3100,1446.3900,percent of total billed charges,"90% of $1,446.39 in Billed Charges for Rev 272 = $1,301.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GRAY ECR45M,272,RC,27200002,CDM,,,,,,both,,,1446.3900,216.9600,MEDCOST,MEDCOST VHN,688.34,,,,,,,373.3100,1446.3900,percent of total billed charges,"47.59% of $1,446.39 in Billed Charges for Rev 272 = $688.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GRAY ECR45M,272,RC,27200002,CDM,,,,,,both,,,1446.3900,216.9600,SENTARA HEALTH,SENTARA HEALTH,373.31,,,,,,,373.3100,1446.3900,percent of total billed charges,"25.81% of $1,446.39 in Billed Charges for Rev 272 = $373.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GRAY ECR45M,272,RC,27200002,CDM,,,,,,both,,,1446.3900,216.9600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1446.39,,,,,,,373.3100,1446.3900,percent of total billed charges,"100% of $1,446.39 in Billed Charges for Rev 272 = $1,446.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GRAY ECR45M,272,RC,27200002,CDM,,,,,,both,,,1446.3900,216.9600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,723.20,,,,,,,373.3100,1446.3900,percent of total billed charges,"Rev 272 $1,446.39 in Billed Charges at 50% = $723.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GRAY ECR45M,272,RC,27200002,CDM,,,,,,both,,,1446.3900,216.9600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,467.18,,,,,,,373.3100,1446.3900,other,"32.3% of $1,446.39 in Billed Charges for Rev 272 = $467.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD STAPLER ECHELON 45MM GRAY ECR45M,272,RC,27200002,CDM,,,,,,both,,,1446.3900,216.9600,UNITED HEALTHCARE,UHC HERITAGE SELECT,444.04,,,,,,,373.3100,1446.3900,other,"30.7% of $1,446.39 in Billed Charges for Rev 272 = $444.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD STAPLER ECHELON 45MM GRAY ECR45M,272,RC,27200002,CDM,,,,,,both,,,1446.3900,216.9600,UNITED HEALTHCARE,UNITED HEALTHCARE,467.18,,,,,,,373.3100,1446.3900,percent of total billed charges,"32.3% of $1,446.39 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 45MM GRAY ECR45M,272,RC,27200002,CDM,,,,,,both,,,1446.3900,216.9600,WELLCARE,WELLCARE MEDICAID,1446.39,,,,,,,373.3100,1446.3900,percent of total billed charges,"100% of $1,446.39 in Billed Charges for Rev 272 = $1,446.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM,272,RC,27200002,CDM,,,,,,both,,,1923.7000,288.5600,AETNA,AETNA,821.42,,,,,,,496.5100,1923.7000,percent of total billed charges,"42.7% of $1,923.70 in Billed Charges for Rev 272 = $821.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM,272,RC,27200002,CDM,,,,,,both,,,1923.7000,288.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1346.59,,,,,,,496.5100,1923.7000,percent of total billed charges,"Rev 272 $1,923.70 in Billed Charges at 70% = $1,346.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM,272,RC,27200002,CDM,,,,,,both,,,1923.7000,288.5600,CIGNA HEALTHCARE,CIGNA HMO,802.18,,,,,,,496.5100,1923.7000,percent of total billed charges,"41.7% of $1,923.70 in Billed Charges for Rev 272 = $802.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM,272,RC,27200002,CDM,,,,,,both,,,1923.7000,288.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,892.60,,,,,,,496.5100,1923.7000,percent of total billed charges,"46.4% of $1,923.70 in Billed Charges for Rev 272 = $892.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM,272,RC,27200002,CDM,,,,,,both,,,1923.7000,288.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,802.18,,,,,,,496.5100,1923.7000,percent of total billed charges,"41.7% of $1,923.70 in Billed Charges for Rev 272 = $802.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM,272,RC,27200002,CDM,,,,,,both,,,1923.7000,288.5600,CIGNA HEALTHCARE,CIGNA PPO,802.18,,,,,,,496.5100,1923.7000,percent of total billed charges,"41.7% of $1,923.70 in Billed Charges for Rev 272 = $802.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM,272,RC,27200002,CDM,,,,,,both,,,1923.7000,288.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1731.33,,,,,,,496.5100,1923.7000,percent of total billed charges,"90% of $1,923.70 in Billed Charges for Rev 272 = $1,731.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM,272,RC,27200002,CDM,,,,,,both,,,1923.7000,288.5600,MEDCOST,MEDCOST VHN,915.49,,,,,,,496.5100,1923.7000,percent of total billed charges,"47.59% of $1,923.70 in Billed Charges for Rev 272 = $915.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM,272,RC,27200002,CDM,,,,,,both,,,1923.7000,288.5600,SENTARA HEALTH,SENTARA HEALTH,496.51,,,,,,,496.5100,1923.7000,percent of total billed charges,"25.81% of $1,923.70 in Billed Charges for Rev 272 = $496.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM,272,RC,27200002,CDM,,,,,,both,,,1923.7000,288.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1923.70,,,,,,,496.5100,1923.7000,percent of total billed charges,"100% of $1,923.70 in Billed Charges for Rev 272 = $1,923.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM,272,RC,27200002,CDM,,,,,,both,,,1923.7000,288.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,961.85,,,,,,,496.5100,1923.7000,percent of total billed charges,"Rev 272 $1,923.70 in Billed Charges at 50% = $961.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM,272,RC,27200002,CDM,,,,,,both,,,1923.7000,288.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,621.36,,,,,,,496.5100,1923.7000,other,"32.3% of $1,923.70 in Billed Charges for Rev 272 = $621.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD STAPLER ECHELON 60MM,272,RC,27200002,CDM,,,,,,both,,,1923.7000,288.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,590.58,,,,,,,496.5100,1923.7000,other,"30.7% of $1,923.70 in Billed Charges for Rev 272 = $590.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD STAPLER ECHELON 60MM,272,RC,27200002,CDM,,,,,,both,,,1923.7000,288.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,621.36,,,,,,,496.5100,1923.7000,percent of total billed charges,"32.3% of $1,923.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM,272,RC,27200002,CDM,,,,,,both,,,1923.7000,288.5600,WELLCARE,WELLCARE MEDICAID,1923.70,,,,,,,496.5100,1923.7000,percent of total billed charges,"100% of $1,923.70 in Billed Charges for Rev 272 = $1,923.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1563.9900,234.6000,AETNA,AETNA,667.82,,,,,,,403.6700,1563.9900,percent of total billed charges,"42.7% of $1,563.99 in Billed Charges for Rev 272 = $667.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1563.9900,234.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1094.79,,,,,,,403.6700,1563.9900,percent of total billed charges,"Rev 272 $1,563.99 in Billed Charges at 70% = $1,094.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1563.9900,234.6000,CIGNA HEALTHCARE,CIGNA HMO,652.18,,,,,,,403.6700,1563.9900,percent of total billed charges,"41.7% of $1,563.99 in Billed Charges for Rev 272 = $652.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1563.9900,234.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,725.69,,,,,,,403.6700,1563.9900,percent of total billed charges,"46.4% of $1,563.99 in Billed Charges for Rev 272 = $725.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1563.9900,234.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,652.18,,,,,,,403.6700,1563.9900,percent of total billed charges,"41.7% of $1,563.99 in Billed Charges for Rev 272 = $652.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1563.9900,234.6000,CIGNA HEALTHCARE,CIGNA PPO,652.18,,,,,,,403.6700,1563.9900,percent of total billed charges,"41.7% of $1,563.99 in Billed Charges for Rev 272 = $652.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1563.9900,234.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1407.59,,,,,,,403.6700,1563.9900,percent of total billed charges,"90% of $1,563.99 in Billed Charges for Rev 272 = $1,407.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1563.9900,234.6000,MEDCOST,MEDCOST VHN,744.30,,,,,,,403.6700,1563.9900,percent of total billed charges,"47.59% of $1,563.99 in Billed Charges for Rev 272 = $744.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1563.9900,234.6000,SENTARA HEALTH,SENTARA HEALTH,403.67,,,,,,,403.6700,1563.9900,percent of total billed charges,"25.81% of $1,563.99 in Billed Charges for Rev 272 = $403.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1563.9900,234.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1563.99,,,,,,,403.6700,1563.9900,percent of total billed charges,"100% of $1,563.99 in Billed Charges for Rev 272 = $1,563.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1563.9900,234.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,782.00,,,,,,,403.6700,1563.9900,percent of total billed charges,"Rev 272 $1,563.99 in Billed Charges at 50% = $782.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1563.9900,234.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,505.17,,,,,,,403.6700,1563.9900,other,"32.3% of $1,563.99 in Billed Charges for Rev 272 = $505.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1563.9900,234.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,480.14,,,,,,,403.6700,1563.9900,other,"30.7% of $1,563.99 in Billed Charges for Rev 272 = $480.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1563.9900,234.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,505.17,,,,,,,403.6700,1563.9900,percent of total billed charges,"32.3% of $1,563.99 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM BLUE GST60B,272,RC,27200002,CDM,,,,,,both,,,1563.9900,234.6000,WELLCARE,WELLCARE MEDICAID,1563.99,,,,,,,403.6700,1563.9900,percent of total billed charges,"100% of $1,563.99 in Billed Charges for Rev 272 = $1,563.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,AETNA,AETNA,87.11,,,,,,,8.9500,204.0000,percent of total billed charges,42.7% of $204.00 in Billed Charges for Rev 301 Proc 83491 = $87.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15.66,,,,,,,8.9500,204.0000,fee schedule,APG 00398 Proc 83491 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 104% = $15.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,17.90,,,,,,,8.9500,204.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,AETNA,AETNA HEALTHCARE MEDICARE,17.90,,,,,,,8.9500,204.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,17.90,,,,,,,8.9500,204.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,AMBETTER,AMBETTER,39.02,,,,,,,8.9500,204.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,AMERIGROUP,AMERIGROUP,8.95,,,,,,,8.9500,204.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,18.62,,,,,,,8.9500,204.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,BLUE CROSS,ANTHEM EXCHANGE,17.90,,,,,,,8.9500,204.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15.51,,,,,,,8.9500,204.0000,fee schedule,APG 00398 Proc 83491 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,BLUE CROSS,ANTHEM HMO,17.90,,,,,,,8.9500,204.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,18.44,,,,,,,8.9500,204.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",17.90,,,,,,,8.9500,204.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,57.10,,,,,,,8.9500,204.0000,fee schedule,$57.10 from Fee Schedule BLDTM_23 for Rev 301 Proc 83491 * Qty 1 = $57.10 at 100% = $57.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,BLUE CROSS,BLUE CROSS E NETWORK,76.48,,,,,,,8.9500,204.0000,fee schedule,$23.90 from Fee Schedule BCFSB for Rev 301 Proc 83491 * Qty 1 = $23.90 at 320% = $76.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,BLUE CROSS,BLUE CROSS MEDICARE,18.62,,,,,,,8.9500,204.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,BLUE CROSS,BLUE CROSS P NETWORK,78.15,,,,,,,8.9500,204.0000,fee schedule,$23.90 from Fee Schedule BCFSB for Rev 301 Proc 83491 * Qty 1 = $23.90 at 327% = $78.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,BLUE CROSS,BLUE CROSS S NETWORK,78.15,,,,,,,8.9500,204.0000,fee schedule,$23.90 from Fee Schedule BCFSB for Rev 301 Proc 83491 * Qty 1 = $23.90 at 327% = $78.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,BLUE CROSS,TENNCARE BLUE CARE,38.91,,,,,,,8.9500,204.0000,fee schedule,$33.54 from Fee Schedule TC_24 for Rev 301 Proc 83491 * Qty 1 = $33.54 at 116% = $38.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,BLUE CROSS,TENNCARE BLUE SELECT,38.91,,,,,,,8.9500,204.0000,fee schedule,$33.54 from Fee Schedule TC_24 for Rev 301 Proc 83491 * Qty 1 = $33.54 at 116% = $38.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,CIGNA HEALTHCARE,CIGNA HMO,70.49,,,,,,,8.9500,204.0000,fee schedule,$70.49 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83491 * Qty 1 = $70.49 at 100% = $70.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,39.70,,,,,,,8.9500,204.0000,fee schedule,$39.70 from Fee Schedule CGIFP_25LR for Rev 301 Proc 83491 * Qty 1 = $39.70 at 100% = $39.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,18.80,,,,,,,8.9500,204.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,70.49,,,,,,,8.9500,204.0000,fee schedule,$70.49 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83491 * Qty 1 = $70.49 at 100% = $70.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,CIGNA HEALTHCARE,CIGNA PPO,70.49,,,,,,,8.9500,204.0000,fee schedule,$70.49 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83491 * Qty 1 = $70.49 at 100% = $70.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,18.80,,,,,,,8.9500,204.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,183.60,,,,,,,8.9500,204.0000,percent of total billed charges,90% of $204.00 in Billed Charges for Rev 301 Proc 83491 = $183.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,HUMANA,HUMANA MEDICARE,17.90,,,,,,,8.9500,204.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,17.90,,,,,,,8.9500,204.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,MEDCOST,MEDCOST VHN,97.08,,,,,,,8.9500,204.0000,percent of total billed charges,47.59% of $204.00 in Billed Charges for Rev 301 Proc 83491 = $97.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15.81,,,,,,,8.9500,204.0000,fee schedule,APG 00398 Proc 83491 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 105% = $15.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,18.80,,,,,,,8.9500,204.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,18.80,,,,,,,8.9500,204.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,NHC ADVANTAGE,NHC ADVANTAGE,18.80,,,,,,,8.9500,204.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15.53,,,,,,,8.9500,204.0000,fee schedule,APG 00398 Proc 83491 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 103.1% = $15.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,SENTARA HEALTH,SENTARA HEALTH,52.65,,,,,,,8.9500,204.0000,percent of total billed charges,25.81% of $204.00 in Billed Charges for Rev 301 Proc 83491 = $52.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,SENTARA HEALTH,SENTARA MEDICARE,17.90,,,,,,,8.9500,204.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",204.00,,,,,,,8.9500,204.0000,percent of total billed charges,100% of $204.00 in Billed Charges for Rev 301 Proc 83491 = $204.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,12.41,,,,,,,8.9500,204.0000,fee schedule,$24.81 from Fee Schedule TCUHC24 for Rev 301 Proc 83491 * Qty 1 = $24.81 at 50% = $12.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,18.62,,,,,,,8.9500,204.0000,fee schedule,$17.90 from Fee Schedule UHC_31910 for Rev 301 Proc 83491 * Qty 1 = $17.90 at 104% = $18.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,17.90,,,,,,,8.9500,204.0000,fee schedule,$17.90 from Fee Schedule UHC_31910 for Rev 301 Proc 83491 * Qty 1 = $17.90 at 100% = $17.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,17.90,,,,,,,8.9500,204.0000,fee schedule,$17.90 from Fee Schedule UHC_31910 for Rev 301 Proc 83491 * Qty 1 = $17.90 at 100% = $17.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15.51,,,,,,,8.9500,204.0000,fee schedule,APG 00398 Proc 83491 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,17.90,,,,,,,8.9500,204.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,17.90,,,,,,,8.9500,204.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,WELLCARE,WELLCARE MEDICAID,204.00,,,,,,,8.9500,204.0000,percent of total billed charges,100% of $204.00 in Billed Charges for Rev 301 Proc 83491 = $204.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC 17 HYDROXY CORTICOSTEROIDS,83491,CPT,301,RC,30100156,CDM,,,,both,,,204.0000,30.6000,WELLCARE,WELLCARE MEDICARE,18.97,,,,,,,8.9500,204.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,AETNA,AETNA,64.48,,,,,,,6.4500,151.0000,percent of total billed charges,42.7% of $151.00 in Billed Charges for Rev 301 Proc 83497 = $64.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15.66,,,,,,,6.4500,151.0000,fee schedule,APG 00398 Proc 83497 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 104% = $15.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,12.90,,,,,,,6.4500,151.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,AETNA,AETNA HEALTHCARE MEDICARE,12.90,,,,,,,6.4500,151.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,12.90,,,,,,,6.4500,151.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,AMBETTER,AMBETTER,28.12,,,,,,,6.4500,151.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,AMERIGROUP,AMERIGROUP,6.45,,,,,,,6.4500,151.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,13.42,,,,,,,6.4500,151.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,BLUE CROSS,ANTHEM EXCHANGE,12.90,,,,,,,6.4500,151.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15.51,,,,,,,6.4500,151.0000,fee schedule,APG 00398 Proc 83497 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,BLUE CROSS,ANTHEM HMO,12.90,,,,,,,6.4500,151.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,13.29,,,,,,,6.4500,151.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",12.90,,,,,,,6.4500,151.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,44.10,,,,,,,6.4500,151.0000,fee schedule,$44.10 from Fee Schedule BLDTM_23 for Rev 301 Proc 83497 * Qty 1 = $44.10 at 100% = $44.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,BLUE CROSS,BLUE CROSS E NETWORK,56.29,,,,,,,6.4500,151.0000,fee schedule,$17.59 from Fee Schedule BCFSB for Rev 301 Proc 83497 * Qty 1 = $17.59 at 320% = $56.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,BLUE CROSS,BLUE CROSS MEDICARE,13.42,,,,,,,6.4500,151.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,BLUE CROSS,BLUE CROSS P NETWORK,57.52,,,,,,,6.4500,151.0000,fee schedule,$17.59 from Fee Schedule BCFSB for Rev 301 Proc 83497 * Qty 1 = $17.59 at 327% = $57.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,BLUE CROSS,BLUE CROSS S NETWORK,57.52,,,,,,,6.4500,151.0000,fee schedule,$17.59 from Fee Schedule BCFSB for Rev 301 Proc 83497 * Qty 1 = $17.59 at 327% = $57.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,BLUE CROSS,TENNCARE BLUE CARE,27.81,,,,,,,6.4500,151.0000,fee schedule,$23.97 from Fee Schedule TC_24 for Rev 301 Proc 83497 * Qty 1 = $23.97 at 116% = $27.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,BLUE CROSS,TENNCARE BLUE SELECT,27.81,,,,,,,6.4500,151.0000,fee schedule,$23.97 from Fee Schedule TC_24 for Rev 301 Proc 83497 * Qty 1 = $23.97 at 116% = $27.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,CIGNA HEALTHCARE,CIGNA HMO,51.87,,,,,,,6.4500,151.0000,fee schedule,$51.87 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83497 * Qty 1 = $51.87 at 100% = $51.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,28.15,,,,,,,6.4500,151.0000,fee schedule,$28.15 from Fee Schedule CGIFP_25LR for Rev 301 Proc 83497 * Qty 1 = $28.15 at 100% = $28.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,13.55,,,,,,,6.4500,151.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,51.87,,,,,,,6.4500,151.0000,fee schedule,$51.87 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83497 * Qty 1 = $51.87 at 100% = $51.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,CIGNA HEALTHCARE,CIGNA PPO,51.87,,,,,,,6.4500,151.0000,fee schedule,$51.87 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83497 * Qty 1 = $51.87 at 100% = $51.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,13.55,,,,,,,6.4500,151.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,135.90,,,,,,,6.4500,151.0000,percent of total billed charges,90% of $151.00 in Billed Charges for Rev 301 Proc 83497 = $135.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,HUMANA,HUMANA MEDICARE,12.90,,,,,,,6.4500,151.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,12.90,,,,,,,6.4500,151.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,MEDCOST,MEDCOST VHN,71.86,,,,,,,6.4500,151.0000,percent of total billed charges,47.59% of $151.00 in Billed Charges for Rev 301 Proc 83497 = $71.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15.81,,,,,,,6.4500,151.0000,fee schedule,APG 00398 Proc 83497 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 105% = $15.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,13.55,,,,,,,6.4500,151.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,13.55,,,,,,,6.4500,151.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,NHC ADVANTAGE,NHC ADVANTAGE,13.55,,,,,,,6.4500,151.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15.53,,,,,,,6.4500,151.0000,fee schedule,APG 00398 Proc 83497 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 103.1% = $15.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,SENTARA HEALTH,SENTARA HEALTH,38.97,,,,,,,6.4500,151.0000,percent of total billed charges,25.81% of $151.00 in Billed Charges for Rev 301 Proc 83497 = $38.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,SENTARA HEALTH,SENTARA MEDICARE,12.90,,,,,,,6.4500,151.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",151.00,,,,,,,6.4500,151.0000,percent of total billed charges,100% of $151.00 in Billed Charges for Rev 301 Proc 83497 = $151.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9.13,,,,,,,6.4500,151.0000,fee schedule,$18.26 from Fee Schedule TCUHC24 for Rev 301 Proc 83497 * Qty 1 = $18.26 at 50% = $9.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13.42,,,,,,,6.4500,151.0000,fee schedule,$12.90 from Fee Schedule UHC_31910 for Rev 301 Proc 83497 * Qty 1 = $12.90 at 104% = $13.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,12.90,,,,,,,6.4500,151.0000,fee schedule,$12.90 from Fee Schedule UHC_31910 for Rev 301 Proc 83497 * Qty 1 = $12.90 at 100% = $12.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,12.90,,,,,,,6.4500,151.0000,fee schedule,$12.90 from Fee Schedule UHC_31910 for Rev 301 Proc 83497 * Qty 1 = $12.90 at 100% = $12.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15.51,,,,,,,6.4500,151.0000,fee schedule,APG 00398 Proc 83497 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,12.90,,,,,,,6.4500,151.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,12.90,,,,,,,6.4500,151.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,WELLCARE,WELLCARE MEDICAID,151.00,,,,,,,6.4500,151.0000,percent of total billed charges,100% of $151.00 in Billed Charges for Rev 301 Proc 83497 = $151.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HYDROXYINDOLACETIC ACID 5 HIAA,83497,CPT,301,RC,30100157,CDM,,,,both,,,151.0000,22.6500,WELLCARE,WELLCARE MEDICARE,13.67,,,,,,,6.4500,151.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,AETNA,AETNA,121.27,,,,,,,12.1500,284.0000,percent of total billed charges,42.7% of $284.00 in Billed Charges for Rev 301 Proc 83505 = $121.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15.66,,,,,,,12.1500,284.0000,fee schedule,APG 00398 Proc 83505 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 104% = $15.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,24.30,,,,,,,12.1500,284.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,AETNA,AETNA HEALTHCARE MEDICARE,24.30,,,,,,,12.1500,284.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,24.30,,,,,,,12.1500,284.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,AMBETTER,AMBETTER,52.97,,,,,,,12.1500,284.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,AMERIGROUP,AMERIGROUP,12.15,,,,,,,12.1500,284.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,25.27,,,,,,,12.1500,284.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,BLUE CROSS,ANTHEM EXCHANGE,24.30,,,,,,,12.1500,284.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15.51,,,,,,,12.1500,284.0000,fee schedule,APG 00398 Proc 83505 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,BLUE CROSS,ANTHEM HMO,24.30,,,,,,,12.1500,284.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,25.03,,,,,,,12.1500,284.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",24.30,,,,,,,12.1500,284.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,79.12,,,,,,,12.1500,284.0000,fee schedule,$79.12 from Fee Schedule BLDTM_23 for Rev 301 Proc 83505 * Qty 1 = $79.12 at 100% = $79.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,BLUE CROSS,BLUE CROSS E NETWORK,106.14,,,,,,,12.1500,284.0000,fee schedule,$33.17 from Fee Schedule BCFSB for Rev 301 Proc 83505 * Qty 1 = $33.17 at 320% = $106.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,BLUE CROSS,BLUE CROSS MEDICARE,25.27,,,,,,,12.1500,284.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,BLUE CROSS,BLUE CROSS P NETWORK,108.47,,,,,,,12.1500,284.0000,fee schedule,$33.17 from Fee Schedule BCFSB for Rev 301 Proc 83505 * Qty 1 = $33.17 at 327% = $108.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,BLUE CROSS,BLUE CROSS S NETWORK,108.47,,,,,,,12.1500,284.0000,fee schedule,$33.17 from Fee Schedule BCFSB for Rev 301 Proc 83505 * Qty 1 = $33.17 at 327% = $108.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,BLUE CROSS,TENNCARE BLUE CARE,63.67,,,,,,,12.1500,284.0000,fee schedule,$54.89 from Fee Schedule TC_24 for Rev 301 Proc 83505 * Qty 1 = $54.89 at 116% = $63.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,BLUE CROSS,TENNCARE BLUE SELECT,63.67,,,,,,,12.1500,284.0000,fee schedule,$54.89 from Fee Schedule TC_24 for Rev 301 Proc 83505 * Qty 1 = $54.89 at 116% = $63.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,CIGNA HEALTHCARE,CIGNA HMO,97.80,,,,,,,12.1500,284.0000,fee schedule,$97.80 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83505 * Qty 1 = $97.80 at 100% = $97.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,53.41,,,,,,,12.1500,284.0000,fee schedule,$53.41 from Fee Schedule CGIFP_25LR for Rev 301 Proc 83505 * Qty 1 = $53.41 at 100% = $53.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,25.52,,,,,,,12.1500,284.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,97.80,,,,,,,12.1500,284.0000,fee schedule,$97.80 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83505 * Qty 1 = $97.80 at 100% = $97.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,CIGNA HEALTHCARE,CIGNA PPO,97.80,,,,,,,12.1500,284.0000,fee schedule,$97.80 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83505 * Qty 1 = $97.80 at 100% = $97.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,25.52,,,,,,,12.1500,284.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,255.60,,,,,,,12.1500,284.0000,percent of total billed charges,90% of $284.00 in Billed Charges for Rev 301 Proc 83505 = $255.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,HUMANA,HUMANA MEDICARE,24.30,,,,,,,12.1500,284.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,24.30,,,,,,,12.1500,284.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,MEDCOST,MEDCOST VHN,135.16,,,,,,,12.1500,284.0000,percent of total billed charges,47.59% of $284.00 in Billed Charges for Rev 301 Proc 83505 = $135.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15.81,,,,,,,12.1500,284.0000,fee schedule,APG 00398 Proc 83505 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 105% = $15.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,25.52,,,,,,,12.1500,284.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,25.52,,,,,,,12.1500,284.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,NHC ADVANTAGE,NHC ADVANTAGE,25.52,,,,,,,12.1500,284.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15.53,,,,,,,12.1500,284.0000,fee schedule,APG 00398 Proc 83505 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 103.1% = $15.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,SENTARA HEALTH,SENTARA HEALTH,73.30,,,,,,,12.1500,284.0000,percent of total billed charges,25.81% of $284.00 in Billed Charges for Rev 301 Proc 83505 = $73.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,SENTARA HEALTH,SENTARA MEDICARE,24.30,,,,,,,12.1500,284.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",284.00,,,,,,,12.1500,284.0000,percent of total billed charges,100% of $284.00 in Billed Charges for Rev 301 Proc 83505 = $284.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,17.22,,,,,,,12.1500,284.0000,fee schedule,$34.43 from Fee Schedule TCUHC24 for Rev 301 Proc 83505 * Qty 1 = $34.43 at 50% = $17.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,25.27,,,,,,,12.1500,284.0000,fee schedule,$24.30 from Fee Schedule UHC_31910 for Rev 301 Proc 83505 * Qty 1 = $24.30 at 104% = $25.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,24.30,,,,,,,12.1500,284.0000,fee schedule,$24.30 from Fee Schedule UHC_31910 for Rev 301 Proc 83505 * Qty 1 = $24.30 at 100% = $24.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,24.30,,,,,,,12.1500,284.0000,fee schedule,$24.30 from Fee Schedule UHC_31910 for Rev 301 Proc 83505 * Qty 1 = $24.30 at 100% = $24.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15.51,,,,,,,12.1500,284.0000,fee schedule,APG 00398 Proc 83505 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,24.30,,,,,,,12.1500,284.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,24.30,,,,,,,12.1500,284.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,WELLCARE,WELLCARE MEDICAID,284.00,,,,,,,12.1500,284.0000,percent of total billed charges,100% of $284.00 in Billed Charges for Rev 301 Proc 83505 = $284.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HYDROXYPROLINE TOTAL,83505,CPT,301,RC,30100316,CDM,,,,both,,,284.0000,42.6000,WELLCARE,WELLCARE MEDICARE,25.76,,,,,,,12.1500,284.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,AETNA,AETNA,109.31,,,,,,,8.6400,256.0000,percent of total billed charges,42.7% of $256.00 in Billed Charges for Rev 300 Proc 83521 = $109.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,14.27,,,,,,,8.6400,256.0000,fee schedule,APG 00400 Proc 83521 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 104% = $14.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,17.27,,,,,,,8.6400,256.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,AETNA,AETNA HEALTHCARE MEDICARE,17.27,,,,,,,8.6400,256.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,17.27,,,,,,,8.6400,256.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,AMBETTER,AMBETTER,37.65,,,,,,,8.6400,256.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,AMERIGROUP,AMERIGROUP,8.64,,,,,,,8.6400,256.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,17.96,,,,,,,8.6400,256.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,BLUE CROSS,ANTHEM EXCHANGE,17.27,,,,,,,8.6400,256.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,14.13,,,,,,,8.6400,256.0000,fee schedule,APG 00400 Proc 83521 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,BLUE CROSS,ANTHEM HMO,17.27,,,,,,,8.6400,256.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,17.79,,,,,,,8.6400,256.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",17.27,,,,,,,8.6400,256.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,179.20,,,,,,,8.6400,256.0000,percent of total billed charges,Rev 300 Proc 83521 $256.00 in Billed Charges at 70% = $179.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,BLUE CROSS,BLUE CROSS E NETWORK,55.26,,,,,,,8.6400,256.0000,fee schedule,$17.27 from Fee Schedule BCFSB for Rev 300 Proc 83521 * Qty 1 = $17.27 at 320% = $55.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,BLUE CROSS,BLUE CROSS MEDICARE,17.96,,,,,,,8.6400,256.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,BLUE CROSS,BLUE CROSS P NETWORK,56.47,,,,,,,8.6400,256.0000,fee schedule,$17.27 from Fee Schedule BCFSB for Rev 300 Proc 83521 * Qty 1 = $17.27 at 327% = $56.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,BLUE CROSS,BLUE CROSS S NETWORK,56.47,,,,,,,8.6400,256.0000,fee schedule,$17.27 from Fee Schedule BCFSB for Rev 300 Proc 83521 * Qty 1 = $17.27 at 327% = $56.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,BLUE CROSS,TENNCARE BLUE CARE,16.27,,,,,,,8.6400,256.0000,fee schedule,$14.03 from Fee Schedule TC_24 for Rev 300 Proc 83521 * Qty 1 = $14.03 at 116% = $16.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,BLUE CROSS,TENNCARE BLUE SELECT,16.27,,,,,,,8.6400,256.0000,fee schedule,$14.03 from Fee Schedule TC_24 for Rev 300 Proc 83521 * Qty 1 = $14.03 at 116% = $16.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,CIGNA HEALTHCARE,CIGNA HMO,106.75,,,,,,,8.6400,256.0000,percent of total billed charges,Rev 300 Proc 83521 $256.00 in Billed Charges at 41.7% = $106.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,38.25,,,,,,,8.6400,256.0000,fee schedule,$38.25 from Fee Schedule CGIFP_25LR for Rev 300 Proc 83521 * Qty 1 = $38.25 at 100% = $38.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,18.13,,,,,,,8.6400,256.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,106.75,,,,,,,8.6400,256.0000,percent of total billed charges,Rev 300 Proc 83521 $256.00 in Billed Charges at 41.7% = $106.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,CIGNA HEALTHCARE,CIGNA PPO,106.75,,,,,,,8.6400,256.0000,percent of total billed charges,Rev 300 Proc 83521 $256.00 in Billed Charges at 41.7% = $106.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,18.13,,,,,,,8.6400,256.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,230.40,,,,,,,8.6400,256.0000,percent of total billed charges,90% of $256.00 in Billed Charges for Rev 300 Proc 83521 = $230.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,HUMANA,HUMANA MEDICARE,17.27,,,,,,,8.6400,256.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,17.27,,,,,,,8.6400,256.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,MEDCOST,MEDCOST VHN,121.83,,,,,,,8.6400,256.0000,percent of total billed charges,47.59% of $256.00 in Billed Charges for Rev 300 Proc 83521 = $121.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,14.41,,,,,,,8.6400,256.0000,fee schedule,APG 00400 Proc 83521 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 105% = $14.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,18.13,,,,,,,8.6400,256.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,18.13,,,,,,,8.6400,256.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,NHC ADVANTAGE,NHC ADVANTAGE,18.13,,,,,,,8.6400,256.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,14.15,,,,,,,8.6400,256.0000,fee schedule,APG 00400 Proc 83521 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 103.1% = $14.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,SENTARA HEALTH,SENTARA HEALTH,66.07,,,,,,,8.6400,256.0000,percent of total billed charges,25.81% of $256.00 in Billed Charges for Rev 300 Proc 83521 = $66.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,SENTARA HEALTH,SENTARA MEDICARE,17.27,,,,,,,8.6400,256.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",256.00,,,,,,,8.6400,256.0000,percent of total billed charges,100% of $256.00 in Billed Charges for Rev 300 Proc 83521 = $256.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.64,,,,,,,8.6400,256.0000,fee schedule,$17.27 from Fee Schedule TCUHC24 for Rev 300 Proc 83521 * Qty 1 = $17.27 at 50% = $8.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,17.96,,,,,,,8.6400,256.0000,fee schedule,$17.27 from Fee Schedule UHC_31910 for Rev 300 Proc 83521 * Qty 1 = $17.27 at 104% = $17.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,17.27,,,,,,,8.6400,256.0000,fee schedule,$17.27 from Fee Schedule UHC_31910 for Rev 300 Proc 83521 * Qty 1 = $17.27 at 100% = $17.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,17.27,,,,,,,8.6400,256.0000,fee schedule,$17.27 from Fee Schedule UHC_31910 for Rev 300 Proc 83521 * Qty 1 = $17.27 at 100% = $17.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,14.13,,,,,,,8.6400,256.0000,fee schedule,APG 00400 Proc 83521 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,17.27,,,,,,,8.6400,256.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,17.27,,,,,,,8.6400,256.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,WELLCARE,WELLCARE MEDICAID,256.00,,,,,,,8.6400,256.0000,percent of total billed charges,100% of $256.00 in Billed Charges for Rev 300 Proc 83521 = $256.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH,83521,CPT,300,RC,30000304,CDM,,,,both,,,256.0000,38.4000,WELLCARE,WELLCARE MEDICARE,18.31,,,,,,,8.6400,256.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,AETNA,AETNA,56.79,,,,,,,5.7200,133.0000,percent of total billed charges,42.7% of $133.00 in Billed Charges for Rev 301 Proc 83525 = $56.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15.66,,,,,,,5.7200,133.0000,fee schedule,APG 00398 Proc 83525 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 104% = $15.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,11.43,,,,,,,5.7200,133.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,AETNA,AETNA HEALTHCARE MEDICARE,11.43,,,,,,,5.7200,133.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,11.43,,,,,,,5.7200,133.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,AMBETTER,AMBETTER,24.92,,,,,,,5.7200,133.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,AMERIGROUP,AMERIGROUP,5.72,,,,,,,5.7200,133.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,11.89,,,,,,,5.7200,133.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,BLUE CROSS,ANTHEM EXCHANGE,11.43,,,,,,,5.7200,133.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15.51,,,,,,,5.7200,133.0000,fee schedule,APG 00398 Proc 83525 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,BLUE CROSS,ANTHEM HMO,11.43,,,,,,,5.7200,133.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,11.77,,,,,,,5.7200,133.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",11.43,,,,,,,5.7200,133.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,39.75,,,,,,,5.7200,133.0000,fee schedule,$39.75 from Fee Schedule BLDTM_23 for Rev 301 Proc 83525 * Qty 1 = $39.75 at 100% = $39.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,BLUE CROSS,BLUE CROSS E NETWORK,49.89,,,,,,,5.7200,133.0000,fee schedule,$15.59 from Fee Schedule BCFSB for Rev 301 Proc 83525 * Qty 1 = $15.59 at 320% = $49.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,BLUE CROSS,BLUE CROSS MEDICARE,11.89,,,,,,,5.7200,133.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,BLUE CROSS,BLUE CROSS P NETWORK,50.98,,,,,,,5.7200,133.0000,fee schedule,$15.59 from Fee Schedule BCFSB for Rev 301 Proc 83525 * Qty 1 = $15.59 at 327% = $50.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,BLUE CROSS,BLUE CROSS S NETWORK,50.98,,,,,,,5.7200,133.0000,fee schedule,$15.59 from Fee Schedule BCFSB for Rev 301 Proc 83525 * Qty 1 = $15.59 at 327% = $50.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,BLUE CROSS,TENNCARE BLUE CARE,25.40,,,,,,,5.7200,133.0000,fee schedule,$21.90 from Fee Schedule TC_24 for Rev 301 Proc 83525 * Qty 1 = $21.90 at 116% = $25.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,BLUE CROSS,TENNCARE BLUE SELECT,25.40,,,,,,,5.7200,133.0000,fee schedule,$21.90 from Fee Schedule TC_24 for Rev 301 Proc 83525 * Qty 1 = $21.90 at 116% = $25.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,CIGNA HEALTHCARE,CIGNA HMO,45.97,,,,,,,5.7200,133.0000,fee schedule,$45.97 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83525 * Qty 1 = $45.97 at 100% = $45.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,25.26,,,,,,,5.7200,133.0000,fee schedule,$25.26 from Fee Schedule CGIFP_25LR for Rev 301 Proc 83525 * Qty 1 = $25.26 at 100% = $25.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,12.00,,,,,,,5.7200,133.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,45.97,,,,,,,5.7200,133.0000,fee schedule,$45.97 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83525 * Qty 1 = $45.97 at 100% = $45.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,CIGNA HEALTHCARE,CIGNA PPO,45.97,,,,,,,5.7200,133.0000,fee schedule,$45.97 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83525 * Qty 1 = $45.97 at 100% = $45.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,12.00,,,,,,,5.7200,133.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,119.70,,,,,,,5.7200,133.0000,percent of total billed charges,90% of $133.00 in Billed Charges for Rev 301 Proc 83525 = $119.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,HUMANA,HUMANA MEDICARE,11.43,,,,,,,5.7200,133.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,11.43,,,,,,,5.7200,133.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,MEDCOST,MEDCOST VHN,63.29,,,,,,,5.7200,133.0000,percent of total billed charges,47.59% of $133.00 in Billed Charges for Rev 301 Proc 83525 = $63.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15.81,,,,,,,5.7200,133.0000,fee schedule,APG 00398 Proc 83525 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 105% = $15.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,12.00,,,,,,,5.7200,133.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,12.00,,,,,,,5.7200,133.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,NHC ADVANTAGE,NHC ADVANTAGE,12.00,,,,,,,5.7200,133.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15.53,,,,,,,5.7200,133.0000,fee schedule,APG 00398 Proc 83525 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 103.1% = $15.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,SENTARA HEALTH,SENTARA HEALTH,34.33,,,,,,,5.7200,133.0000,percent of total billed charges,25.81% of $133.00 in Billed Charges for Rev 301 Proc 83525 = $34.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,SENTARA HEALTH,SENTARA MEDICARE,11.43,,,,,,,5.7200,133.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",133.00,,,,,,,5.7200,133.0000,percent of total billed charges,100% of $133.00 in Billed Charges for Rev 301 Proc 83525 = $133.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.10,,,,,,,5.7200,133.0000,fee schedule,$16.19 from Fee Schedule TCUHC24 for Rev 301 Proc 83525 * Qty 1 = $16.19 at 50% = $8.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,11.89,,,,,,,5.7200,133.0000,fee schedule,$11.43 from Fee Schedule UHC_31910 for Rev 301 Proc 83525 * Qty 1 = $11.43 at 104% = $11.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,11.43,,,,,,,5.7200,133.0000,fee schedule,$11.43 from Fee Schedule UHC_31910 for Rev 301 Proc 83525 * Qty 1 = $11.43 at 100% = $11.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,11.43,,,,,,,5.7200,133.0000,fee schedule,$11.43 from Fee Schedule UHC_31910 for Rev 301 Proc 83525 * Qty 1 = $11.43 at 100% = $11.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15.51,,,,,,,5.7200,133.0000,fee schedule,APG 00398 Proc 83525 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,11.43,,,,,,,5.7200,133.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,11.43,,,,,,,5.7200,133.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,WELLCARE,WELLCARE MEDICAID,133.00,,,,,,,5.7200,133.0000,percent of total billed charges,100% of $133.00 in Billed Charges for Rev 301 Proc 83525 = $133.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSULIN,83525,CPT,301,RC,30100163,CDM,,,,both,,,133.0000,19.9500,WELLCARE,WELLCARE MEDICARE,12.12,,,,,,,5.7200,133.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
RELOAD STAPLER ECHELON 60MM GREEN  GST60G,272,RC,27200002,CDM,,,,,,both,,,1594.4900,239.1700,AETNA,AETNA,680.85,,,,,,,411.5400,1594.4900,percent of total billed charges,"42.7% of $1,594.49 in Billed Charges for Rev 272 = $680.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM GREEN  GST60G,272,RC,27200002,CDM,,,,,,both,,,1594.4900,239.1700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1116.14,,,,,,,411.5400,1594.4900,percent of total billed charges,"Rev 272 $1,594.49 in Billed Charges at 70% = $1,116.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM GREEN  GST60G,272,RC,27200002,CDM,,,,,,both,,,1594.4900,239.1700,CIGNA HEALTHCARE,CIGNA HMO,664.90,,,,,,,411.5400,1594.4900,percent of total billed charges,"41.7% of $1,594.49 in Billed Charges for Rev 272 = $664.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM GREEN  GST60G,272,RC,27200002,CDM,,,,,,both,,,1594.4900,239.1700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,739.84,,,,,,,411.5400,1594.4900,percent of total billed charges,"46.4% of $1,594.49 in Billed Charges for Rev 272 = $739.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM GREEN  GST60G,272,RC,27200002,CDM,,,,,,both,,,1594.4900,239.1700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,664.90,,,,,,,411.5400,1594.4900,percent of total billed charges,"41.7% of $1,594.49 in Billed Charges for Rev 272 = $664.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM GREEN  GST60G,272,RC,27200002,CDM,,,,,,both,,,1594.4900,239.1700,CIGNA HEALTHCARE,CIGNA PPO,664.90,,,,,,,411.5400,1594.4900,percent of total billed charges,"41.7% of $1,594.49 in Billed Charges for Rev 272 = $664.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM GREEN  GST60G,272,RC,27200002,CDM,,,,,,both,,,1594.4900,239.1700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1435.04,,,,,,,411.5400,1594.4900,percent of total billed charges,"90% of $1,594.49 in Billed Charges for Rev 272 = $1,435.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM GREEN  GST60G,272,RC,27200002,CDM,,,,,,both,,,1594.4900,239.1700,MEDCOST,MEDCOST VHN,758.82,,,,,,,411.5400,1594.4900,percent of total billed charges,"47.59% of $1,594.49 in Billed Charges for Rev 272 = $758.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM GREEN  GST60G,272,RC,27200002,CDM,,,,,,both,,,1594.4900,239.1700,SENTARA HEALTH,SENTARA HEALTH,411.54,,,,,,,411.5400,1594.4900,percent of total billed charges,"25.81% of $1,594.49 in Billed Charges for Rev 272 = $411.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM GREEN  GST60G,272,RC,27200002,CDM,,,,,,both,,,1594.4900,239.1700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1594.49,,,,,,,411.5400,1594.4900,percent of total billed charges,"100% of $1,594.49 in Billed Charges for Rev 272 = $1,594.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM GREEN  GST60G,272,RC,27200002,CDM,,,,,,both,,,1594.4900,239.1700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,797.25,,,,,,,411.5400,1594.4900,percent of total billed charges,"Rev 272 $1,594.49 in Billed Charges at 50% = $797.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM GREEN  GST60G,272,RC,27200002,CDM,,,,,,both,,,1594.4900,239.1700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,515.02,,,,,,,411.5400,1594.4900,other,"32.3% of $1,594.49 in Billed Charges for Rev 272 = $515.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD STAPLER ECHELON 60MM GREEN  GST60G,272,RC,27200002,CDM,,,,,,both,,,1594.4900,239.1700,UNITED HEALTHCARE,UHC HERITAGE SELECT,489.51,,,,,,,411.5400,1594.4900,other,"30.7% of $1,594.49 in Billed Charges for Rev 272 = $489.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RELOAD STAPLER ECHELON 60MM GREEN  GST60G,272,RC,27200002,CDM,,,,,,both,,,1594.4900,239.1700,UNITED HEALTHCARE,UNITED HEALTHCARE,515.02,,,,,,,411.5400,1594.4900,percent of total billed charges,"32.3% of $1,594.49 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RELOAD STAPLER ECHELON 60MM GREEN  GST60G,272,RC,27200002,CDM,,,,,,both,,,1594.4900,239.1700,WELLCARE,WELLCARE MEDICAID,1594.49,,,,,,,411.5400,1594.4900,percent of total billed charges,"100% of $1,594.49 in Billed Charges for Rev 272 = $1,594.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW LAG DRILL,272,RC,,,,,,,,both,,,5904.6300,885.6900,AETNA,AETNA,2521.28,,,,,,,1523.9900,5904.6300,percent of total billed charges,"42.7% of $5,904.63 in Billed Charges for Rev 272 = $2,521.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW LAG DRILL,272,RC,,,,,,,,both,,,5904.6300,885.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4133.24,,,,,,,1523.9900,5904.6300,percent of total billed charges,"Rev 272 $5,904.63 in Billed Charges at 70% = $4,133.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW LAG DRILL,272,RC,,,,,,,,both,,,5904.6300,885.6900,CIGNA HEALTHCARE,CIGNA HMO,2462.23,,,,,,,1523.9900,5904.6300,percent of total billed charges,"41.7% of $5,904.63 in Billed Charges for Rev 272 = $2,462.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW LAG DRILL,272,RC,,,,,,,,both,,,5904.6300,885.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2739.75,,,,,,,1523.9900,5904.6300,percent of total billed charges,"46.4% of $5,904.63 in Billed Charges for Rev 272 = $2,739.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW LAG DRILL,272,RC,,,,,,,,both,,,5904.6300,885.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2462.23,,,,,,,1523.9900,5904.6300,percent of total billed charges,"41.7% of $5,904.63 in Billed Charges for Rev 272 = $2,462.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW LAG DRILL,272,RC,,,,,,,,both,,,5904.6300,885.6900,CIGNA HEALTHCARE,CIGNA PPO,2462.23,,,,,,,1523.9900,5904.6300,percent of total billed charges,"41.7% of $5,904.63 in Billed Charges for Rev 272 = $2,462.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW LAG DRILL,272,RC,,,,,,,,both,,,5904.6300,885.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5314.17,,,,,,,1523.9900,5904.6300,percent of total billed charges,"90% of $5,904.63 in Billed Charges for Rev 272 = $5,314.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW LAG DRILL,272,RC,,,,,,,,both,,,5904.6300,885.6900,MEDCOST,MEDCOST VHN,2810.01,,,,,,,1523.9900,5904.6300,percent of total billed charges,"47.59% of $5,904.63 in Billed Charges for Rev 272 = $2,810.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW LAG DRILL,272,RC,,,,,,,,both,,,5904.6300,885.6900,SENTARA HEALTH,SENTARA HEALTH,1523.99,,,,,,,1523.9900,5904.6300,percent of total billed charges,"25.81% of $5,904.63 in Billed Charges for Rev 272 = $1,523.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW LAG DRILL,272,RC,,,,,,,,both,,,5904.6300,885.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5904.63,,,,,,,1523.9900,5904.6300,percent of total billed charges,"100% of $5,904.63 in Billed Charges for Rev 272 = $5,904.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW LAG DRILL,272,RC,,,,,,,,both,,,5904.6300,885.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2952.32,,,,,,,1523.9900,5904.6300,percent of total billed charges,"Rev 272 $5,904.63 in Billed Charges at 50% = $2,952.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW LAG DRILL,272,RC,,,,,,,,both,,,5904.6300,885.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1907.20,,,,,,,1523.9900,5904.6300,other,"32.3% of $5,904.63 in Billed Charges for Rev 272 = $1,907.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCREW LAG DRILL,272,RC,,,,,,,,both,,,5904.6300,885.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1812.72,,,,,,,1523.9900,5904.6300,other,"30.7% of $5,904.63 in Billed Charges for Rev 272 = $1,812.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCREW LAG DRILL,272,RC,,,,,,,,both,,,5904.6300,885.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,1907.20,,,,,,,1523.9900,5904.6300,percent of total billed charges,"32.3% of $5,904.63 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREW LAG DRILL,272,RC,,,,,,,,both,,,5904.6300,885.6900,WELLCARE,WELLCARE MEDICAID,5904.63,,,,,,,1523.9900,5904.6300,percent of total billed charges,"100% of $5,904.63 in Billed Charges for Rev 272 = $5,904.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA,57.22,,,,,,,5.7700,134.0000,percent of total billed charges,42.7% of $134.00 in Billed Charges for Rev 301 Proc 84378 = $57.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,14.27,,,,,,,5.7700,134.0000,fee schedule,APG 00400 Proc 84378 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 104% = $14.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,11.53,,,,,,,5.7700,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA HEALTHCARE MEDICARE,11.53,,,,,,,5.7700,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,11.53,,,,,,,5.7700,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,AMBETTER,AMBETTER,25.14,,,,,,,5.7700,134.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,AMERIGROUP,AMERIGROUP,5.77,,,,,,,5.7700,134.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,11.99,,,,,,,5.7700,134.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM EXCHANGE,11.53,,,,,,,5.7700,134.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,14.13,,,,,,,5.7700,134.0000,fee schedule,APG 00400 Proc 84378 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM HMO,11.53,,,,,,,5.7700,134.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,11.88,,,,,,,5.7700,134.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",11.53,,,,,,,5.7700,134.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,39.81,,,,,,,5.7700,134.0000,fee schedule,$39.81 from Fee Schedule BLDTM_23 for Rev 301 Proc 84378 * Qty 1 = $39.81 at 100% = $39.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS E NETWORK,50.34,,,,,,,5.7700,134.0000,fee schedule,$15.73 from Fee Schedule BCFSB for Rev 301 Proc 84378 * Qty 1 = $15.73 at 320% = $50.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS MEDICARE,11.99,,,,,,,5.7700,134.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS P NETWORK,51.44,,,,,,,5.7700,134.0000,fee schedule,$15.73 from Fee Schedule BCFSB for Rev 301 Proc 84378 * Qty 1 = $15.73 at 327% = $51.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS S NETWORK,51.44,,,,,,,5.7700,134.0000,fee schedule,$15.73 from Fee Schedule BCFSB for Rev 301 Proc 84378 * Qty 1 = $15.73 at 327% = $51.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,TENNCARE BLUE CARE,23.30,,,,,,,5.7700,134.0000,fee schedule,$20.09 from Fee Schedule TC_24 for Rev 301 Proc 84378 * Qty 1 = $20.09 at 116% = $23.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,TENNCARE BLUE SELECT,23.30,,,,,,,5.7700,134.0000,fee schedule,$20.09 from Fee Schedule TC_24 for Rev 301 Proc 84378 * Qty 1 = $20.09 at 116% = $23.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA HMO,46.37,,,,,,,5.7700,134.0000,fee schedule,$46.37 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84378 * Qty 1 = $46.37 at 100% = $46.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,25.26,,,,,,,5.7700,134.0000,fee schedule,$25.26 from Fee Schedule CGIFP_25LR for Rev 301 Proc 84378 * Qty 1 = $25.26 at 100% = $25.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,12.11,,,,,,,5.7700,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,46.37,,,,,,,5.7700,134.0000,fee schedule,$46.37 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84378 * Qty 1 = $46.37 at 100% = $46.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA PPO,46.37,,,,,,,5.7700,134.0000,fee schedule,$46.37 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84378 * Qty 1 = $46.37 at 100% = $46.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,12.11,,,,,,,5.7700,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,120.60,,,,,,,5.7700,134.0000,percent of total billed charges,90% of $134.00 in Billed Charges for Rev 301 Proc 84378 = $120.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,HUMANA,HUMANA MEDICARE,11.53,,,,,,,5.7700,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,11.53,,,,,,,5.7700,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,MEDCOST,MEDCOST VHN,63.77,,,,,,,5.7700,134.0000,percent of total billed charges,47.59% of $134.00 in Billed Charges for Rev 301 Proc 84378 = $63.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,14.41,,,,,,,5.7700,134.0000,fee schedule,APG 00400 Proc 84378 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 105% = $14.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,12.11,,,,,,,5.7700,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,12.11,,,,,,,5.7700,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,NHC ADVANTAGE,NHC ADVANTAGE,12.11,,,,,,,5.7700,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,14.15,,,,,,,5.7700,134.0000,fee schedule,APG 00400 Proc 84378 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 103.1% = $14.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,SENTARA HEALTH,SENTARA HEALTH,34.59,,,,,,,5.7700,134.0000,percent of total billed charges,25.81% of $134.00 in Billed Charges for Rev 301 Proc 84378 = $34.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,SENTARA HEALTH,SENTARA MEDICARE,11.53,,,,,,,5.7700,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",134.00,,,,,,,5.7700,134.0000,percent of total billed charges,100% of $134.00 in Billed Charges for Rev 301 Proc 84378 = $134.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.16,,,,,,,5.7700,134.0000,fee schedule,$16.32 from Fee Schedule TCUHC24 for Rev 301 Proc 84378 * Qty 1 = $16.32 at 50% = $8.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,11.99,,,,,,,5.7700,134.0000,fee schedule,$11.53 from Fee Schedule UHC_31910 for Rev 301 Proc 84378 * Qty 1 = $11.53 at 104% = $11.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11.53,,,,,,,5.7700,134.0000,fee schedule,$11.53 from Fee Schedule UHC_31910 for Rev 301 Proc 84378 * Qty 1 = $11.53 at 100% = $11.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,11.53,,,,,,,5.7700,134.0000,fee schedule,$11.53 from Fee Schedule UHC_31910 for Rev 301 Proc 84378 * Qty 1 = $11.53 at 100% = $11.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,14.13,,,,,,,5.7700,134.0000,fee schedule,APG 00400 Proc 84378 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,11.53,,,,,,,5.7700,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,11.53,,,,,,,5.7700,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,WELLCARE,WELLCARE MEDICAID,134.00,,,,,,,5.7700,134.0000,percent of total billed charges,100% of $134.00 in Billed Charges for Rev 301 Proc 84378 = $134.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUGARS MONO/DI/OLIGOS SNGL QUAN EA SPEC,84378,CPT,301,RC,30100512,CDM,,,,both,,,134.0000,20.1000,WELLCARE,WELLCARE MEDICARE,12.22,,,,,,,5.7700,134.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,AETNA,AETNA,23.91,,,,,,,2.7500,56.0000,percent of total billed charges,42.7% of $56.00 in Billed Charges for Rev 300 Proc 84392 = $23.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3.48,,,,,,,2.7500,56.0000,fee schedule,APG 00410 Proc 84392 at $836.60 (Base Rate) * 0.004 (Relative Weight) = $3.35 (Total Line Payment) at 104% = $3.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5.49,,,,,,,2.7500,56.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,AETNA,AETNA HEALTHCARE MEDICARE,5.49,,,,,,,2.7500,56.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,5.49,,,,,,,2.7500,56.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,AMBETTER,AMBETTER,11.97,,,,,,,2.7500,56.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,AMERIGROUP,AMERIGROUP,2.75,,,,,,,2.7500,56.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,5.71,,,,,,,2.7500,56.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,BLUE CROSS,ANTHEM EXCHANGE,5.49,,,,,,,2.7500,56.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3.45,,,,,,,2.7500,56.0000,fee schedule,APG 00410 Proc 84392 at $836.60 (Base Rate) * 0.004 (Relative Weight) = $3.35 (Total Line Payment) at 103% = $3.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,BLUE CROSS,ANTHEM HMO,5.49,,,,,,,2.7500,56.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5.65,,,,,,,2.7500,56.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5.49,,,,,,,2.7500,56.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,16.44,,,,,,,2.7500,56.0000,fee schedule,$16.44 from Fee Schedule BLDTM_23 for Rev 300 Proc 84392 * Qty 1 = $16.44 at 100% = $16.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,BLUE CROSS,BLUE CROSS E NETWORK,20.74,,,,,,,2.7500,56.0000,fee schedule,$6.48 from Fee Schedule BCFSB for Rev 300 Proc 84392 * Qty 1 = $6.48 at 320% = $20.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,BLUE CROSS,BLUE CROSS MEDICARE,5.71,,,,,,,2.7500,56.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,BLUE CROSS,BLUE CROSS P NETWORK,21.19,,,,,,,2.7500,56.0000,fee schedule,$6.48 from Fee Schedule BCFSB for Rev 300 Proc 84392 * Qty 1 = $6.48 at 327% = $21.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,BLUE CROSS,BLUE CROSS S NETWORK,21.19,,,,,,,2.7500,56.0000,fee schedule,$6.48 from Fee Schedule BCFSB for Rev 300 Proc 84392 * Qty 1 = $6.48 at 327% = $21.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,BLUE CROSS,TENNCARE BLUE CARE,56.00,,,,,,,2.7500,56.0000,fee schedule,"$64.94 from Fee Schedule TC_24 for Rev 300 Proc 84392 * Qty 1 = $64.94 at 116% = $75.33 (Service Line reduced to $56.00, claim capped at $56.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,BLUE CROSS,TENNCARE BLUE SELECT,56.00,,,,,,,2.7500,56.0000,fee schedule,"$64.94 from Fee Schedule TC_24 for Rev 300 Proc 84392 * Qty 1 = $64.94 at 116% = $75.33 (Service Line reduced to $56.00, claim capped at $56.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,CIGNA HEALTHCARE,CIGNA HMO,19.10,,,,,,,2.7500,56.0000,fee schedule,$19.10 from Fee Schedule CIGWHS_23 for Rev 300 Proc 84392 * Qty 1 = $19.10 at 100% = $19.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12.27,,,,,,,2.7500,56.0000,fee schedule,$12.27 from Fee Schedule CGIFP_25LR for Rev 300 Proc 84392 * Qty 1 = $12.27 at 100% = $12.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,5.76,,,,,,,2.7500,56.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,19.10,,,,,,,2.7500,56.0000,fee schedule,$19.10 from Fee Schedule CIGWHS_23 for Rev 300 Proc 84392 * Qty 1 = $19.10 at 100% = $19.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,CIGNA HEALTHCARE,CIGNA PPO,19.10,,,,,,,2.7500,56.0000,fee schedule,$19.10 from Fee Schedule CIGWHS_23 for Rev 300 Proc 84392 * Qty 1 = $19.10 at 100% = $19.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,5.76,,,,,,,2.7500,56.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,50.40,,,,,,,2.7500,56.0000,percent of total billed charges,90% of $56.00 in Billed Charges for Rev 300 Proc 84392 = $50.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,HUMANA,HUMANA MEDICARE,5.49,,,,,,,2.7500,56.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5.49,,,,,,,2.7500,56.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,MEDCOST,MEDCOST VHN,26.65,,,,,,,2.7500,56.0000,percent of total billed charges,47.59% of $56.00 in Billed Charges for Rev 300 Proc 84392 = $26.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3.52,,,,,,,2.7500,56.0000,fee schedule,APG 00410 Proc 84392 at $836.60 (Base Rate) * 0.004 (Relative Weight) = $3.35 (Total Line Payment) at 100% = $3.35... $3.35 at 105% = $3.52 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,5.76,,,,,,,2.7500,56.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,5.76,,,,,,,2.7500,56.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,NHC ADVANTAGE,NHC ADVANTAGE,5.76,,,,,,,2.7500,56.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3.45,,,,,,,2.7500,56.0000,fee schedule,APG 00410 Proc 84392 at $836.60 (Base Rate) * 0.004 (Relative Weight) = $3.35 (Total Line Payment) at 100% = $3.35... $3.35 at 103.1% = $3.45 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,SENTARA HEALTH,SENTARA HEALTH,14.45,,,,,,,2.7500,56.0000,percent of total billed charges,25.81% of $56.00 in Billed Charges for Rev 300 Proc 84392 = $14.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,SENTARA HEALTH,SENTARA MEDICARE,5.49,,,,,,,2.7500,56.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",56.00,,,,,,,2.7500,56.0000,percent of total billed charges,100% of $56.00 in Billed Charges for Rev 300 Proc 84392 = $56.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3.37,,,,,,,2.7500,56.0000,fee schedule,$6.73 from Fee Schedule TCUHC24 for Rev 300 Proc 84392 * Qty 1 = $6.73 at 50% = $3.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5.71,,,,,,,2.7500,56.0000,fee schedule,$5.49 from Fee Schedule UHC_31910 for Rev 300 Proc 84392 * Qty 1 = $5.49 at 104% = $5.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,5.49,,,,,,,2.7500,56.0000,fee schedule,$5.49 from Fee Schedule UHC_31910 for Rev 300 Proc 84392 * Qty 1 = $5.49 at 100% = $5.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,5.49,,,,,,,2.7500,56.0000,fee schedule,$5.49 from Fee Schedule UHC_31910 for Rev 300 Proc 84392 * Qty 1 = $5.49 at 100% = $5.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3.45,,,,,,,2.7500,56.0000,fee schedule,APG 00410 Proc 84392 at $836.60 (Base Rate) * 0.004 (Relative Weight) = $3.35 (Total Line Payment) at 103% = $3.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5.49,,,,,,,2.7500,56.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5.49,,,,,,,2.7500,56.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,WELLCARE,WELLCARE MEDICAID,56.00,,,,,,,2.7500,56.0000,percent of total billed charges,100% of $56.00 in Billed Charges for Rev 300 Proc 84392 = $56.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SULFATE URINE,84392,CPT,300,RC,30000173,CDM,,,,both,,,56.0000,8.4000,WELLCARE,WELLCARE MEDICARE,5.82,,,,,,,2.7500,56.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,AETNA,AETNA,145.61,,,,,,,64.4600,341.0000,percent of total billed charges,42.7% of $341.00 in Billed Charges for Rev 300 Proc 84393 = $145.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,128.92,,,,,,,64.4600,341.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,AETNA,AETNA HEALTHCARE MEDICARE,128.92,,,,,,,64.4600,341.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,128.92,,,,,,,64.4600,341.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,AMBETTER,AMBETTER,281.05,,,,,,,64.4600,341.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,AMERIGROUP,AMERIGROUP,64.46,,,,,,,64.4600,341.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,134.08,,,,,,,64.4600,341.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,BLUE CROSS,ANTHEM EXCHANGE,128.92,,,,,,,64.4600,341.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,BLUE CROSS,ANTHEM HMO,128.92,,,,,,,64.4600,341.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,132.79,,,,,,,64.4600,341.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",128.92,,,,,,,64.4600,341.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,238.70,,,,,,,64.4600,341.0000,percent of total billed charges,Rev 300 Proc 84393 $341.00 in Billed Charges at 70% = $238.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,BLUE CROSS,BLUE CROSS MEDICARE,134.08,,,,,,,64.4600,341.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,CIGNA HEALTHCARE,CIGNA HMO,142.20,,,,,,,64.4600,341.0000,percent of total billed charges,Rev 300 Proc 84393 $341.00 in Billed Charges at 41.7% = $142.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,145.95,,,,,,,64.4600,341.0000,percent of total billed charges,Rev 300 Proc 84393 $341.00 in Billed Charges at 42.8% = $145.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,135.37,,,,,,,64.4600,341.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,142.20,,,,,,,64.4600,341.0000,percent of total billed charges,Rev 300 Proc 84393 $341.00 in Billed Charges at 41.7% = $142.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,CIGNA HEALTHCARE,CIGNA PPO,142.20,,,,,,,64.4600,341.0000,percent of total billed charges,Rev 300 Proc 84393 $341.00 in Billed Charges at 41.7% = $142.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,135.37,,,,,,,64.4600,341.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,306.90,,,,,,,64.4600,341.0000,percent of total billed charges,90% of $341.00 in Billed Charges for Rev 300 Proc 84393 = $306.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,HUMANA,HUMANA MEDICARE,128.92,,,,,,,64.4600,341.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,128.92,,,,,,,64.4600,341.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,MEDCOST,MEDCOST VHN,162.28,,,,,,,64.4600,341.0000,percent of total billed charges,47.59% of $341.00 in Billed Charges for Rev 300 Proc 84393 = $162.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,135.37,,,,,,,64.4600,341.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,135.37,,,,,,,64.4600,341.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,NHC ADVANTAGE,NHC ADVANTAGE,135.37,,,,,,,64.4600,341.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,SENTARA HEALTH,SENTARA HEALTH,88.01,,,,,,,64.4600,341.0000,percent of total billed charges,25.81% of $341.00 in Billed Charges for Rev 300 Proc 84393 = $88.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,SENTARA HEALTH,SENTARA MEDICARE,128.92,,,,,,,64.4600,341.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",341.00,,,,,,,64.4600,341.0000,percent of total billed charges,100% of $341.00 in Billed Charges for Rev 300 Proc 84393 = $341.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,170.50,,,,,,,64.4600,341.0000,percent of total billed charges,Rev 300 Proc 84393 $341.00 in Billed Charges at 50% = $170.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,128.92,,,,,,,64.4600,341.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,128.92,,,,,,,64.4600,341.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,WELLCARE,WELLCARE MEDICAID,341.00,,,,,,,64.4600,341.0000,percent of total billed charges,100% of $341.00 in Billed Charges for Rev 300 Proc 84393 = $341.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TAU PHOSPHORYLATED EACH,84393,CPT,300,RC,30000335,CDM,,,,both,,,341.0000,51.1500,WELLCARE,WELLCARE MEDICARE,136.66,,,,,,,64.4600,341.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,AETNA,AETNA,145.61,,,,,,,64.4600,341.0000,percent of total billed charges,42.7% of $341.00 in Billed Charges for Rev 300 Proc 84394 = $145.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,128.92,,,,,,,64.4600,341.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,AETNA,AETNA HEALTHCARE MEDICARE,128.92,,,,,,,64.4600,341.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,128.92,,,,,,,64.4600,341.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,AMBETTER,AMBETTER,281.05,,,,,,,64.4600,341.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,AMERIGROUP,AMERIGROUP,64.46,,,,,,,64.4600,341.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,134.08,,,,,,,64.4600,341.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,BLUE CROSS,ANTHEM EXCHANGE,128.92,,,,,,,64.4600,341.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,BLUE CROSS,ANTHEM HMO,128.92,,,,,,,64.4600,341.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,132.79,,,,,,,64.4600,341.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",128.92,,,,,,,64.4600,341.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,238.70,,,,,,,64.4600,341.0000,percent of total billed charges,Rev 300 Proc 84394 $341.00 in Billed Charges at 70% = $238.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,BLUE CROSS,BLUE CROSS MEDICARE,134.08,,,,,,,64.4600,341.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,CIGNA HEALTHCARE,CIGNA HMO,142.20,,,,,,,64.4600,341.0000,percent of total billed charges,Rev 300 Proc 84394 $341.00 in Billed Charges at 41.7% = $142.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,145.95,,,,,,,64.4600,341.0000,percent of total billed charges,Rev 300 Proc 84394 $341.00 in Billed Charges at 42.8% = $145.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,135.37,,,,,,,64.4600,341.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,142.20,,,,,,,64.4600,341.0000,percent of total billed charges,Rev 300 Proc 84394 $341.00 in Billed Charges at 41.7% = $142.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,CIGNA HEALTHCARE,CIGNA PPO,142.20,,,,,,,64.4600,341.0000,percent of total billed charges,Rev 300 Proc 84394 $341.00 in Billed Charges at 41.7% = $142.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,135.37,,,,,,,64.4600,341.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,306.90,,,,,,,64.4600,341.0000,percent of total billed charges,90% of $341.00 in Billed Charges for Rev 300 Proc 84394 = $306.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,HUMANA,HUMANA MEDICARE,128.92,,,,,,,64.4600,341.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,128.92,,,,,,,64.4600,341.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,MEDCOST,MEDCOST VHN,162.28,,,,,,,64.4600,341.0000,percent of total billed charges,47.59% of $341.00 in Billed Charges for Rev 300 Proc 84394 = $162.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,135.37,,,,,,,64.4600,341.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,135.37,,,,,,,64.4600,341.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,NHC ADVANTAGE,NHC ADVANTAGE,135.37,,,,,,,64.4600,341.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,SENTARA HEALTH,SENTARA HEALTH,88.01,,,,,,,64.4600,341.0000,percent of total billed charges,25.81% of $341.00 in Billed Charges for Rev 300 Proc 84394 = $88.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,SENTARA HEALTH,SENTARA MEDICARE,128.92,,,,,,,64.4600,341.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",341.00,,,,,,,64.4600,341.0000,percent of total billed charges,100% of $341.00 in Billed Charges for Rev 300 Proc 84394 = $341.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,170.50,,,,,,,64.4600,341.0000,percent of total billed charges,Rev 300 Proc 84394 $341.00 in Billed Charges at 50% = $170.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,128.92,,,,,,,64.4600,341.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,128.92,,,,,,,64.4600,341.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,WELLCARE,WELLCARE MEDICAID,341.00,,,,,,,64.4600,341.0000,percent of total billed charges,100% of $341.00 in Billed Charges for Rev 300 Proc 84394 = $341.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOTAL TAU TTAU,84394,CPT,300,RC,30000336,CDM,,,,both,,,341.0000,51.1500,WELLCARE,WELLCARE MEDICARE,136.66,,,,,,,64.4600,341.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,AETNA,AETNA,128.53,,,,,,,12.9100,301.0000,percent of total billed charges,42.7% of $301.00 in Billed Charges for Rev 301 Proc 84403 = $128.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15.66,,,,,,,12.9100,301.0000,fee schedule,APG 00398 Proc 84403 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 104% = $15.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,25.81,,,,,,,12.9100,301.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,AETNA,AETNA HEALTHCARE MEDICARE,25.81,,,,,,,12.9100,301.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,25.81,,,,,,,12.9100,301.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,AMBETTER,AMBETTER,56.27,,,,,,,12.9100,301.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,AMERIGROUP,AMERIGROUP,12.91,,,,,,,12.9100,301.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,26.84,,,,,,,12.9100,301.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,BLUE CROSS,ANTHEM EXCHANGE,25.81,,,,,,,12.9100,301.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15.51,,,,,,,12.9100,301.0000,fee schedule,APG 00398 Proc 84403 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,BLUE CROSS,ANTHEM HMO,25.81,,,,,,,12.9100,301.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,26.58,,,,,,,12.9100,301.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",25.81,,,,,,,12.9100,301.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,91.63,,,,,,,12.9100,301.0000,fee schedule,$91.63 from Fee Schedule BLDTM_23 for Rev 301 Proc 84403 * Qty 1 = $91.63 at 100% = $91.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,BLUE CROSS,BLUE CROSS E NETWORK,112.70,,,,,,,12.9100,301.0000,fee schedule,$35.22 from Fee Schedule BCFSB for Rev 301 Proc 84403 * Qty 1 = $35.22 at 320% = $112.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,BLUE CROSS,BLUE CROSS MEDICARE,26.84,,,,,,,12.9100,301.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,BLUE CROSS,BLUE CROSS P NETWORK,115.17,,,,,,,12.9100,301.0000,fee schedule,$35.22 from Fee Schedule BCFSB for Rev 301 Proc 84403 * Qty 1 = $35.22 at 327% = $115.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,BLUE CROSS,BLUE CROSS S NETWORK,115.17,,,,,,,12.9100,301.0000,fee schedule,$35.22 from Fee Schedule BCFSB for Rev 301 Proc 84403 * Qty 1 = $35.22 at 327% = $115.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,BLUE CROSS,TENNCARE BLUE CARE,58.66,,,,,,,12.9100,301.0000,fee schedule,$50.57 from Fee Schedule TC_24 for Rev 301 Proc 84403 * Qty 1 = $50.57 at 116% = $58.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,BLUE CROSS,TENNCARE BLUE SELECT,58.66,,,,,,,12.9100,301.0000,fee schedule,$50.57 from Fee Schedule TC_24 for Rev 301 Proc 84403 * Qty 1 = $50.57 at 116% = $58.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,CIGNA HEALTHCARE,CIGNA HMO,103.87,,,,,,,12.9100,301.0000,fee schedule,$103.87 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84403 * Qty 1 = $103.87 at 100% = $103.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,57.02,,,,,,,12.9100,301.0000,fee schedule,$57.02 from Fee Schedule CGIFP_25LR for Rev 301 Proc 84403 * Qty 1 = $57.02 at 100% = $57.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,27.10,,,,,,,12.9100,301.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,103.87,,,,,,,12.9100,301.0000,fee schedule,$103.87 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84403 * Qty 1 = $103.87 at 100% = $103.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,CIGNA HEALTHCARE,CIGNA PPO,103.87,,,,,,,12.9100,301.0000,fee schedule,$103.87 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84403 * Qty 1 = $103.87 at 100% = $103.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,27.10,,,,,,,12.9100,301.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,270.90,,,,,,,12.9100,301.0000,percent of total billed charges,90% of $301.00 in Billed Charges for Rev 301 Proc 84403 = $270.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,HUMANA,HUMANA MEDICARE,25.81,,,,,,,12.9100,301.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,25.81,,,,,,,12.9100,301.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,MEDCOST,MEDCOST VHN,143.25,,,,,,,12.9100,301.0000,percent of total billed charges,47.59% of $301.00 in Billed Charges for Rev 301 Proc 84403 = $143.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15.81,,,,,,,12.9100,301.0000,fee schedule,APG 00398 Proc 84403 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 105% = $15.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,27.10,,,,,,,12.9100,301.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,27.10,,,,,,,12.9100,301.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,NHC ADVANTAGE,NHC ADVANTAGE,27.10,,,,,,,12.9100,301.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15.53,,,,,,,12.9100,301.0000,fee schedule,APG 00398 Proc 84403 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 103.1% = $15.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,SENTARA HEALTH,SENTARA HEALTH,77.69,,,,,,,12.9100,301.0000,percent of total billed charges,25.81% of $301.00 in Billed Charges for Rev 301 Proc 84403 = $77.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,SENTARA HEALTH,SENTARA MEDICARE,25.81,,,,,,,12.9100,301.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",301.00,,,,,,,12.9100,301.0000,percent of total billed charges,100% of $301.00 in Billed Charges for Rev 301 Proc 84403 = $301.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,18.29,,,,,,,12.9100,301.0000,fee schedule,$36.57 from Fee Schedule TCUHC24 for Rev 301 Proc 84403 * Qty 1 = $36.57 at 50% = $18.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,26.84,,,,,,,12.9100,301.0000,fee schedule,$25.81 from Fee Schedule UHC_31910 for Rev 301 Proc 84403 * Qty 1 = $25.81 at 104% = $26.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,25.81,,,,,,,12.9100,301.0000,fee schedule,$25.81 from Fee Schedule UHC_31910 for Rev 301 Proc 84403 * Qty 1 = $25.81 at 100% = $25.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,25.81,,,,,,,12.9100,301.0000,fee schedule,$25.81 from Fee Schedule UHC_31910 for Rev 301 Proc 84403 * Qty 1 = $25.81 at 100% = $25.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15.51,,,,,,,12.9100,301.0000,fee schedule,APG 00398 Proc 84403 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,25.81,,,,,,,12.9100,301.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,25.81,,,,,,,12.9100,301.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,WELLCARE,WELLCARE MEDICAID,301.00,,,,,,,12.9100,301.0000,percent of total billed charges,100% of $301.00 in Billed Charges for Rev 301 Proc 84403 = $301.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TESTOSTERONE TOTAL,84403,CPT,301,RC,30100255,CDM,,,,both,,,301.0000,45.1500,WELLCARE,WELLCARE MEDICARE,27.36,,,,,,,12.9100,301.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,AETNA,AETNA,131.94,,,,,,,25.6400,309.0000,percent of total billed charges,42.7% of $309.00 in Billed Charges for Rev 301 Proc 84410 = $131.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,41.07,,,,,,,25.6400,309.0000,fee schedule,APG 00399 Proc 84410 at $836.60 (Base Rate) * 0.0472 (Relative Weight) = $39.49 (Total Line Payment) at 104% = $41.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,51.28,,,,,,,25.6400,309.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,AETNA,AETNA HEALTHCARE MEDICARE,51.28,,,,,,,25.6400,309.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,51.28,,,,,,,25.6400,309.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,AMBETTER,AMBETTER,111.79,,,,,,,25.6400,309.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,AMERIGROUP,AMERIGROUP,25.64,,,,,,,25.6400,309.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,53.33,,,,,,,25.6400,309.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,BLUE CROSS,ANTHEM EXCHANGE,51.28,,,,,,,25.6400,309.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,40.67,,,,,,,25.6400,309.0000,fee schedule,APG 00399 Proc 84410 at $836.60 (Base Rate) * 0.0472 (Relative Weight) = $39.49 (Total Line Payment) at 103% = $40.67. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,BLUE CROSS,ANTHEM HMO,51.28,,,,,,,25.6400,309.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,52.82,,,,,,,25.6400,309.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",51.28,,,,,,,25.6400,309.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,216.30,,,,,,,25.6400,309.0000,percent of total billed charges,Rev 301 Proc 84410 $309.00 in Billed Charges at 70% = $216.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,BLUE CROSS,BLUE CROSS E NETWORK,232.16,,,,,,,25.6400,309.0000,fee schedule,$72.55 from Fee Schedule BCFSB for Rev 301 Proc 84410 * Qty 1 = $72.55 at 320% = $232.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,BLUE CROSS,BLUE CROSS MEDICARE,53.33,,,,,,,25.6400,309.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,BLUE CROSS,BLUE CROSS P NETWORK,237.24,,,,,,,25.6400,309.0000,fee schedule,$72.55 from Fee Schedule BCFSB for Rev 301 Proc 84410 * Qty 1 = $72.55 at 327% = $237.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,BLUE CROSS,BLUE CROSS S NETWORK,237.24,,,,,,,25.6400,309.0000,fee schedule,$72.55 from Fee Schedule BCFSB for Rev 301 Proc 84410 * Qty 1 = $72.55 at 327% = $237.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,BLUE CROSS,TENNCARE BLUE CARE,68.37,,,,,,,25.6400,309.0000,fee schedule,$58.94 from Fee Schedule TC_24 for Rev 301 Proc 84410 * Qty 1 = $58.94 at 116% = $68.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,BLUE CROSS,TENNCARE BLUE SELECT,68.37,,,,,,,25.6400,309.0000,fee schedule,$58.94 from Fee Schedule TC_24 for Rev 301 Proc 84410 * Qty 1 = $58.94 at 116% = $68.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,CIGNA HEALTHCARE,CIGNA HMO,128.85,,,,,,,25.6400,309.0000,percent of total billed charges,Rev 301 Proc 84410 $309.00 in Billed Charges at 41.7% = $128.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,113.32,,,,,,,25.6400,309.0000,fee schedule,$113.32 from Fee Schedule CGIFP_25LR for Rev 301 Proc 84410 * Qty 1 = $113.32 at 100% = $113.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,53.84,,,,,,,25.6400,309.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,128.85,,,,,,,25.6400,309.0000,percent of total billed charges,Rev 301 Proc 84410 $309.00 in Billed Charges at 41.7% = $128.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,CIGNA HEALTHCARE,CIGNA PPO,128.85,,,,,,,25.6400,309.0000,percent of total billed charges,Rev 301 Proc 84410 $309.00 in Billed Charges at 41.7% = $128.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,53.84,,,,,,,25.6400,309.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,278.10,,,,,,,25.6400,309.0000,percent of total billed charges,90% of $309.00 in Billed Charges for Rev 301 Proc 84410 = $278.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,HUMANA,HUMANA MEDICARE,51.28,,,,,,,25.6400,309.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,51.28,,,,,,,25.6400,309.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,MEDCOST,MEDCOST VHN,147.05,,,,,,,25.6400,309.0000,percent of total billed charges,47.59% of $309.00 in Billed Charges for Rev 301 Proc 84410 = $147.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,41.46,,,,,,,25.6400,309.0000,fee schedule,APG 00399 Proc 84410 at $836.60 (Base Rate) * 0.0472 (Relative Weight) = $39.49 (Total Line Payment) at 100% = $39.49... $39.49 at 105% = $41.46 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,53.84,,,,,,,25.6400,309.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,53.84,,,,,,,25.6400,309.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,NHC ADVANTAGE,NHC ADVANTAGE,53.84,,,,,,,25.6400,309.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,40.71,,,,,,,25.6400,309.0000,fee schedule,APG 00399 Proc 84410 at $836.60 (Base Rate) * 0.0472 (Relative Weight) = $39.49 (Total Line Payment) at 100% = $39.49... $39.49 at 103.1% = $40.71 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,SENTARA HEALTH,SENTARA HEALTH,79.75,,,,,,,25.6400,309.0000,percent of total billed charges,25.81% of $309.00 in Billed Charges for Rev 301 Proc 84410 = $79.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,SENTARA HEALTH,SENTARA MEDICARE,51.28,,,,,,,25.6400,309.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",309.00,,,,,,,25.6400,309.0000,percent of total billed charges,100% of $309.00 in Billed Charges for Rev 301 Proc 84410 = $309.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,36.28,,,,,,,25.6400,309.0000,fee schedule,$72.55 from Fee Schedule TCUHC24 for Rev 301 Proc 84410 * Qty 1 = $72.55 at 50% = $36.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,53.33,,,,,,,25.6400,309.0000,fee schedule,$51.28 from Fee Schedule UHC_31910 for Rev 301 Proc 84410 * Qty 1 = $51.28 at 104% = $53.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,51.28,,,,,,,25.6400,309.0000,fee schedule,$51.28 from Fee Schedule UHC_31910 for Rev 301 Proc 84410 * Qty 1 = $51.28 at 100% = $51.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,51.28,,,,,,,25.6400,309.0000,fee schedule,$51.28 from Fee Schedule UHC_31910 for Rev 301 Proc 84410 * Qty 1 = $51.28 at 100% = $51.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,40.67,,,,,,,25.6400,309.0000,fee schedule,APG 00399 Proc 84410 at $836.60 (Base Rate) * 0.0472 (Relative Weight) = $39.49 (Total Line Payment) at 103% = $40.67. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,51.28,,,,,,,25.6400,309.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,51.28,,,,,,,25.6400,309.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,WELLCARE,WELLCARE MEDICAID,309.00,,,,,,,25.6400,309.0000,percent of total billed charges,100% of $309.00 in Billed Charges for Rev 301 Proc 84410 = $309.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TESTOSTERONE BIOAVAILABLE,84410,CPT,301,RC,30100463,CDM,,,,both,,,309.0000,46.3500,WELLCARE,WELLCARE MEDICARE,54.36,,,,,,,25.6400,309.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SCREWDRIVER BLADE UNIII AXS LONG,272,RC,,,,,,,,both,,,3041.0900,456.1600,AETNA,AETNA,1298.55,,,,,,,784.9100,3041.0900,percent of total billed charges,"42.7% of $3,041.09 in Billed Charges for Rev 272 = $1,298.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE UNIII AXS LONG,272,RC,,,,,,,,both,,,3041.0900,456.1600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2128.76,,,,,,,784.9100,3041.0900,percent of total billed charges,"Rev 272 $3,041.09 in Billed Charges at 70% = $2,128.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE UNIII AXS LONG,272,RC,,,,,,,,both,,,3041.0900,456.1600,CIGNA HEALTHCARE,CIGNA HMO,1268.13,,,,,,,784.9100,3041.0900,percent of total billed charges,"41.7% of $3,041.09 in Billed Charges for Rev 272 = $1,268.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE UNIII AXS LONG,272,RC,,,,,,,,both,,,3041.0900,456.1600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1411.07,,,,,,,784.9100,3041.0900,percent of total billed charges,"46.4% of $3,041.09 in Billed Charges for Rev 272 = $1,411.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE UNIII AXS LONG,272,RC,,,,,,,,both,,,3041.0900,456.1600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1268.13,,,,,,,784.9100,3041.0900,percent of total billed charges,"41.7% of $3,041.09 in Billed Charges for Rev 272 = $1,268.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE UNIII AXS LONG,272,RC,,,,,,,,both,,,3041.0900,456.1600,CIGNA HEALTHCARE,CIGNA PPO,1268.13,,,,,,,784.9100,3041.0900,percent of total billed charges,"41.7% of $3,041.09 in Billed Charges for Rev 272 = $1,268.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE UNIII AXS LONG,272,RC,,,,,,,,both,,,3041.0900,456.1600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2736.98,,,,,,,784.9100,3041.0900,percent of total billed charges,"90% of $3,041.09 in Billed Charges for Rev 272 = $2,736.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE UNIII AXS LONG,272,RC,,,,,,,,both,,,3041.0900,456.1600,MEDCOST,MEDCOST VHN,1447.25,,,,,,,784.9100,3041.0900,percent of total billed charges,"47.59% of $3,041.09 in Billed Charges for Rev 272 = $1,447.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE UNIII AXS LONG,272,RC,,,,,,,,both,,,3041.0900,456.1600,SENTARA HEALTH,SENTARA HEALTH,784.91,,,,,,,784.9100,3041.0900,percent of total billed charges,"25.81% of $3,041.09 in Billed Charges for Rev 272 = $784.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE UNIII AXS LONG,272,RC,,,,,,,,both,,,3041.0900,456.1600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3041.09,,,,,,,784.9100,3041.0900,percent of total billed charges,"100% of $3,041.09 in Billed Charges for Rev 272 = $3,041.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE UNIII AXS LONG,272,RC,,,,,,,,both,,,3041.0900,456.1600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1520.55,,,,,,,784.9100,3041.0900,percent of total billed charges,"Rev 272 $3,041.09 in Billed Charges at 50% = $1,520.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE UNIII AXS LONG,272,RC,,,,,,,,both,,,3041.0900,456.1600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,982.27,,,,,,,784.9100,3041.0900,other,"32.3% of $3,041.09 in Billed Charges for Rev 272 = $982.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCREWDRIVER BLADE UNIII AXS LONG,272,RC,,,,,,,,both,,,3041.0900,456.1600,UNITED HEALTHCARE,UHC HERITAGE SELECT,933.61,,,,,,,784.9100,3041.0900,other,"30.7% of $3,041.09 in Billed Charges for Rev 272 = $933.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCREWDRIVER BLADE UNIII AXS LONG,272,RC,,,,,,,,both,,,3041.0900,456.1600,UNITED HEALTHCARE,UNITED HEALTHCARE,982.27,,,,,,,784.9100,3041.0900,percent of total billed charges,"32.3% of $3,041.09 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER BLADE UNIII AXS LONG,272,RC,,,,,,,,both,,,3041.0900,456.1600,WELLCARE,WELLCARE MEDICAID,3041.09,,,,,,,784.9100,3041.0900,percent of total billed charges,"100% of $3,041.09 in Billed Charges for Rev 272 = $3,041.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER STARDRIVE T15 3.5 X 365MM,272,RC,27200002,CDM,,,,,,both,,,6333.2600,949.9900,AETNA,AETNA,2704.30,,,,,,,1634.6100,6333.2600,percent of total billed charges,"42.7% of $6,333.26 in Billed Charges for Rev 272 = $2,704.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER STARDRIVE T15 3.5 X 365MM,272,RC,27200002,CDM,,,,,,both,,,6333.2600,949.9900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4433.28,,,,,,,1634.6100,6333.2600,percent of total billed charges,"Rev 272 $6,333.26 in Billed Charges at 70% = $4,433.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER STARDRIVE T15 3.5 X 365MM,272,RC,27200002,CDM,,,,,,both,,,6333.2600,949.9900,CIGNA HEALTHCARE,CIGNA HMO,2640.97,,,,,,,1634.6100,6333.2600,percent of total billed charges,"41.7% of $6,333.26 in Billed Charges for Rev 272 = $2,640.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER STARDRIVE T15 3.5 X 365MM,272,RC,27200002,CDM,,,,,,both,,,6333.2600,949.9900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2938.63,,,,,,,1634.6100,6333.2600,percent of total billed charges,"46.4% of $6,333.26 in Billed Charges for Rev 272 = $2,938.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER STARDRIVE T15 3.5 X 365MM,272,RC,27200002,CDM,,,,,,both,,,6333.2600,949.9900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2640.97,,,,,,,1634.6100,6333.2600,percent of total billed charges,"41.7% of $6,333.26 in Billed Charges for Rev 272 = $2,640.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER STARDRIVE T15 3.5 X 365MM,272,RC,27200002,CDM,,,,,,both,,,6333.2600,949.9900,CIGNA HEALTHCARE,CIGNA PPO,2640.97,,,,,,,1634.6100,6333.2600,percent of total billed charges,"41.7% of $6,333.26 in Billed Charges for Rev 272 = $2,640.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER STARDRIVE T15 3.5 X 365MM,272,RC,27200002,CDM,,,,,,both,,,6333.2600,949.9900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5699.93,,,,,,,1634.6100,6333.2600,percent of total billed charges,"90% of $6,333.26 in Billed Charges for Rev 272 = $5,699.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER STARDRIVE T15 3.5 X 365MM,272,RC,27200002,CDM,,,,,,both,,,6333.2600,949.9900,MEDCOST,MEDCOST VHN,3014.00,,,,,,,1634.6100,6333.2600,percent of total billed charges,"47.59% of $6,333.26 in Billed Charges for Rev 272 = $3,014.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER STARDRIVE T15 3.5 X 365MM,272,RC,27200002,CDM,,,,,,both,,,6333.2600,949.9900,SENTARA HEALTH,SENTARA HEALTH,1634.61,,,,,,,1634.6100,6333.2600,percent of total billed charges,"25.81% of $6,333.26 in Billed Charges for Rev 272 = $1,634.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER STARDRIVE T15 3.5 X 365MM,272,RC,27200002,CDM,,,,,,both,,,6333.2600,949.9900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6333.26,,,,,,,1634.6100,6333.2600,percent of total billed charges,"100% of $6,333.26 in Billed Charges for Rev 272 = $6,333.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER STARDRIVE T15 3.5 X 365MM,272,RC,27200002,CDM,,,,,,both,,,6333.2600,949.9900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3166.63,,,,,,,1634.6100,6333.2600,percent of total billed charges,"Rev 272 $6,333.26 in Billed Charges at 50% = $3,166.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER STARDRIVE T15 3.5 X 365MM,272,RC,27200002,CDM,,,,,,both,,,6333.2600,949.9900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2045.64,,,,,,,1634.6100,6333.2600,other,"32.3% of $6,333.26 in Billed Charges for Rev 272 = $2,045.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCREWDRIVER STARDRIVE T15 3.5 X 365MM,272,RC,27200002,CDM,,,,,,both,,,6333.2600,949.9900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1944.31,,,,,,,1634.6100,6333.2600,other,"30.7% of $6,333.26 in Billed Charges for Rev 272 = $1,944.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SCREWDRIVER STARDRIVE T15 3.5 X 365MM,272,RC,27200002,CDM,,,,,,both,,,6333.2600,949.9900,UNITED HEALTHCARE,UNITED HEALTHCARE,2045.64,,,,,,,1634.6100,6333.2600,percent of total billed charges,"32.3% of $6,333.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SCREWDRIVER STARDRIVE T15 3.5 X 365MM,272,RC,27200002,CDM,,,,,,both,,,6333.2600,949.9900,WELLCARE,WELLCARE MEDICAID,6333.26,,,,,,,1634.6100,6333.2600,percent of total billed charges,"100% of $6,333.26 in Billed Charges for Rev 272 = $6,333.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,AETNA,AETNA,32.03,,,,,,,5.8200,75.0000,percent of total billed charges,42.7% of $75.00 in Billed Charges for Rev 301 Proc 84430 = $32.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,14.36,,,,,,,5.8200,75.0000,fee schedule,APG 00404 Proc 84430 at $836.60 (Base Rate) * 0.0165 (Relative Weight) = $13.80 (Total Line Payment) at 104% = $14.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,11.63,,,,,,,5.8200,75.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,AETNA,AETNA HEALTHCARE MEDICARE,11.63,,,,,,,5.8200,75.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,11.63,,,,,,,5.8200,75.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,AMBETTER,AMBETTER,25.35,,,,,,,5.8200,75.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,AMERIGROUP,AMERIGROUP,5.82,,,,,,,5.8200,75.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,12.10,,,,,,,5.8200,75.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,BLUE CROSS,ANTHEM EXCHANGE,11.63,,,,,,,5.8200,75.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,14.22,,,,,,,5.8200,75.0000,fee schedule,APG 00404 Proc 84430 at $836.60 (Base Rate) * 0.0165 (Relative Weight) = $13.80 (Total Line Payment) at 103% = $14.22. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,BLUE CROSS,ANTHEM HMO,11.63,,,,,,,5.8200,75.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,11.98,,,,,,,5.8200,75.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",11.63,,,,,,,5.8200,75.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,39.81,,,,,,,5.8200,75.0000,fee schedule,$39.81 from Fee Schedule BLDTM_23 for Rev 301 Proc 84430 * Qty 1 = $39.81 at 100% = $39.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,BLUE CROSS,BLUE CROSS E NETWORK,50.78,,,,,,,5.8200,75.0000,fee schedule,$15.87 from Fee Schedule BCFSB for Rev 301 Proc 84430 * Qty 1 = $15.87 at 320% = $50.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,BLUE CROSS,BLUE CROSS MEDICARE,12.10,,,,,,,5.8200,75.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,BLUE CROSS,BLUE CROSS P NETWORK,51.89,,,,,,,5.8200,75.0000,fee schedule,$15.87 from Fee Schedule BCFSB for Rev 301 Proc 84430 * Qty 1 = $15.87 at 327% = $51.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,BLUE CROSS,BLUE CROSS S NETWORK,51.89,,,,,,,5.8200,75.0000,fee schedule,$15.87 from Fee Schedule BCFSB for Rev 301 Proc 84430 * Qty 1 = $15.87 at 327% = $51.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,BLUE CROSS,TENNCARE BLUE CARE,25.51,,,,,,,5.8200,75.0000,fee schedule,$21.99 from Fee Schedule TC_24 for Rev 301 Proc 84430 * Qty 1 = $21.99 at 116% = $25.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,BLUE CROSS,TENNCARE BLUE SELECT,25.51,,,,,,,5.8200,75.0000,fee schedule,$21.99 from Fee Schedule TC_24 for Rev 301 Proc 84430 * Qty 1 = $21.99 at 116% = $25.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,CIGNA HEALTHCARE,CIGNA HMO,46.80,,,,,,,5.8200,75.0000,fee schedule,$46.80 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84430 * Qty 1 = $46.80 at 100% = $46.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,25.98,,,,,,,5.8200,75.0000,fee schedule,$25.98 from Fee Schedule CGIFP_25LR for Rev 301 Proc 84430 * Qty 1 = $25.98 at 100% = $25.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,12.21,,,,,,,5.8200,75.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,46.80,,,,,,,5.8200,75.0000,fee schedule,$46.80 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84430 * Qty 1 = $46.80 at 100% = $46.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,CIGNA HEALTHCARE,CIGNA PPO,46.80,,,,,,,5.8200,75.0000,fee schedule,$46.80 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84430 * Qty 1 = $46.80 at 100% = $46.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,12.21,,,,,,,5.8200,75.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,67.50,,,,,,,5.8200,75.0000,percent of total billed charges,90% of $75.00 in Billed Charges for Rev 301 Proc 84430 = $67.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,HUMANA,HUMANA MEDICARE,11.63,,,,,,,5.8200,75.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,11.63,,,,,,,5.8200,75.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,MEDCOST,MEDCOST VHN,35.69,,,,,,,5.8200,75.0000,percent of total billed charges,47.59% of $75.00 in Billed Charges for Rev 301 Proc 84430 = $35.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,14.49,,,,,,,5.8200,75.0000,fee schedule,APG 00404 Proc 84430 at $836.60 (Base Rate) * 0.0165 (Relative Weight) = $13.80 (Total Line Payment) at 100% = $13.80... $13.80 at 105% = $14.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,12.21,,,,,,,5.8200,75.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,12.21,,,,,,,5.8200,75.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,NHC ADVANTAGE,NHC ADVANTAGE,12.21,,,,,,,5.8200,75.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,14.23,,,,,,,5.8200,75.0000,fee schedule,APG 00404 Proc 84430 at $836.60 (Base Rate) * 0.0165 (Relative Weight) = $13.80 (Total Line Payment) at 100% = $13.80... $13.80 at 103.1% = $14.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,SENTARA HEALTH,SENTARA HEALTH,19.36,,,,,,,5.8200,75.0000,percent of total billed charges,25.81% of $75.00 in Billed Charges for Rev 301 Proc 84430 = $19.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,SENTARA HEALTH,SENTARA MEDICARE,11.63,,,,,,,5.8200,75.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",75.00,,,,,,,5.8200,75.0000,percent of total billed charges,100% of $75.00 in Billed Charges for Rev 301 Proc 84430 = $75.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.24,,,,,,,5.8200,75.0000,fee schedule,$16.48 from Fee Schedule TCUHC24 for Rev 301 Proc 84430 * Qty 1 = $16.48 at 50% = $8.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12.10,,,,,,,5.8200,75.0000,fee schedule,$11.63 from Fee Schedule UHC_31910 for Rev 301 Proc 84430 * Qty 1 = $11.63 at 104% = $12.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,11.63,,,,,,,5.8200,75.0000,fee schedule,$11.63 from Fee Schedule UHC_31910 for Rev 301 Proc 84430 * Qty 1 = $11.63 at 100% = $11.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,11.63,,,,,,,5.8200,75.0000,fee schedule,$11.63 from Fee Schedule UHC_31910 for Rev 301 Proc 84430 * Qty 1 = $11.63 at 100% = $11.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,14.22,,,,,,,5.8200,75.0000,fee schedule,APG 00404 Proc 84430 at $836.60 (Base Rate) * 0.0165 (Relative Weight) = $13.80 (Total Line Payment) at 103% = $14.22. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,11.63,,,,,,,5.8200,75.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,11.63,,,,,,,5.8200,75.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,WELLCARE,WELLCARE MEDICAID,75.00,,,,,,,5.8200,75.0000,percent of total billed charges,100% of $75.00 in Billed Charges for Rev 301 Proc 84430 = $75.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THIOCYANATE,84430,CPT,301,RC,30100258,CDM,,,,both,,,75.0000,11.2500,WELLCARE,WELLCARE MEDICARE,12.33,,,,,,,5.8200,75.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,AETNA,AETNA,34.59,,,,,,,11.0900,81.0000,percent of total billed charges,42.7% of $81.00 in Billed Charges for Rev 301 Proc 84433 = $34.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,14.27,,,,,,,11.0900,81.0000,fee schedule,APG 00400 Proc 84433 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 104% = $14.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,22.17,,,,,,,11.0900,81.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,AETNA,AETNA HEALTHCARE MEDICARE,22.17,,,,,,,11.0900,81.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,22.17,,,,,,,11.0900,81.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,AMBETTER,AMBETTER,48.33,,,,,,,11.0900,81.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,AMERIGROUP,AMERIGROUP,11.09,,,,,,,11.0900,81.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,23.06,,,,,,,11.0900,81.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,ANTHEM EXCHANGE,22.17,,,,,,,11.0900,81.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,14.13,,,,,,,11.0900,81.0000,fee schedule,APG 00400 Proc 84433 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,ANTHEM HMO,22.17,,,,,,,11.0900,81.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,22.84,,,,,,,11.0900,81.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",22.17,,,,,,,11.0900,81.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,56.70,,,,,,,11.0900,81.0000,percent of total billed charges,Rev 301 Proc 84433 $81.00 in Billed Charges at 70% = $56.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,BLUE CROSS E NETWORK,70.94,,,,,,,11.0900,81.0000,fee schedule,$22.17 from Fee Schedule BCFSB for Rev 301 Proc 84433 * Qty 1 = $22.17 at 320% = $70.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,BLUE CROSS MEDICARE,23.06,,,,,,,11.0900,81.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,BLUE CROSS P NETWORK,72.50,,,,,,,11.0900,81.0000,fee schedule,$22.17 from Fee Schedule BCFSB for Rev 301 Proc 84433 * Qty 1 = $22.17 at 327% = $72.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,BLUE CROSS S NETWORK,72.50,,,,,,,11.0900,81.0000,fee schedule,$22.17 from Fee Schedule BCFSB for Rev 301 Proc 84433 * Qty 1 = $22.17 at 327% = $72.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,TENNCARE BLUE CARE,20.90,,,,,,,11.0900,81.0000,fee schedule,$18.02 from Fee Schedule TC_24 for Rev 301 Proc 84433 * Qty 1 = $18.02 at 116% = $20.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,TENNCARE BLUE SELECT,20.90,,,,,,,11.0900,81.0000,fee schedule,$18.02 from Fee Schedule TC_24 for Rev 301 Proc 84433 * Qty 1 = $18.02 at 116% = $20.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,CIGNA HEALTHCARE,CIGNA HMO,33.78,,,,,,,11.0900,81.0000,percent of total billed charges,Rev 301 Proc 84433 $81.00 in Billed Charges at 41.7% = $33.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,49.08,,,,,,,11.0900,81.0000,fee schedule,$49.08 from Fee Schedule CGIFP_25LR for Rev 301 Proc 84433 * Qty 1 = $49.08 at 100% = $49.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,23.28,,,,,,,11.0900,81.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,33.78,,,,,,,11.0900,81.0000,percent of total billed charges,Rev 301 Proc 84433 $81.00 in Billed Charges at 41.7% = $33.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,CIGNA HEALTHCARE,CIGNA PPO,33.78,,,,,,,11.0900,81.0000,percent of total billed charges,Rev 301 Proc 84433 $81.00 in Billed Charges at 41.7% = $33.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,23.28,,,,,,,11.0900,81.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,72.90,,,,,,,11.0900,81.0000,percent of total billed charges,90% of $81.00 in Billed Charges for Rev 301 Proc 84433 = $72.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,HUMANA,HUMANA MEDICARE,22.17,,,,,,,11.0900,81.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,22.17,,,,,,,11.0900,81.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,MEDCOST,MEDCOST VHN,38.55,,,,,,,11.0900,81.0000,percent of total billed charges,47.59% of $81.00 in Billed Charges for Rev 301 Proc 84433 = $38.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,14.41,,,,,,,11.0900,81.0000,fee schedule,APG 00400 Proc 84433 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 105% = $14.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,23.28,,,,,,,11.0900,81.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,23.28,,,,,,,11.0900,81.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,NHC ADVANTAGE,NHC ADVANTAGE,23.28,,,,,,,11.0900,81.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,14.15,,,,,,,11.0900,81.0000,fee schedule,APG 00400 Proc 84433 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 103.1% = $14.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,SENTARA HEALTH,SENTARA HEALTH,20.91,,,,,,,11.0900,81.0000,percent of total billed charges,25.81% of $81.00 in Billed Charges for Rev 301 Proc 84433 = $20.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,SENTARA HEALTH,SENTARA MEDICARE,22.17,,,,,,,11.0900,81.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",81.00,,,,,,,11.0900,81.0000,percent of total billed charges,100% of $81.00 in Billed Charges for Rev 301 Proc 84433 = $81.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11.09,,,,,,,11.0900,81.0000,fee schedule,$22.17 from Fee Schedule TCUHC24 for Rev 301 Proc 84433 * Qty 1 = $22.17 at 50% = $11.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,23.06,,,,,,,11.0900,81.0000,fee schedule,$22.17 from Fee Schedule UHC_31910 for Rev 301 Proc 84433 * Qty 1 = $22.17 at 104% = $23.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,22.17,,,,,,,11.0900,81.0000,fee schedule,$22.17 from Fee Schedule UHC_31910 for Rev 301 Proc 84433 * Qty 1 = $22.17 at 100% = $22.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,22.17,,,,,,,11.0900,81.0000,fee schedule,$22.17 from Fee Schedule UHC_31910 for Rev 301 Proc 84433 * Qty 1 = $22.17 at 100% = $22.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,14.13,,,,,,,11.0900,81.0000,fee schedule,APG 00400 Proc 84433 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,22.17,,,,,,,11.0900,81.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,22.17,,,,,,,11.0900,81.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,WELLCARE,WELLCARE MEDICAID,81.00,,,,,,,11.0900,81.0000,percent of total billed charges,100% of $81.00 in Billed Charges for Rev 301 Proc 84433 = $81.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY THIOPURINE S-METHYLTRANSFERASE,84433,CPT,301,RC,30100526,CDM,,,,both,,,81.0000,12.1500,WELLCARE,WELLCARE MEDICARE,23.50,,,,,,,11.0900,81.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,AETNA,AETNA,83.69,,,,,,,8.4000,196.0000,percent of total billed charges,42.7% of $196.00 in Billed Charges for Rev 301 Proc 84443 = $83.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15.66,,,,,,,8.4000,196.0000,fee schedule,APG 00398 Proc 84443 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 104% = $15.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,16.80,,,,,,,8.4000,196.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,AETNA,AETNA HEALTHCARE MEDICARE,16.80,,,,,,,8.4000,196.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,16.80,,,,,,,8.4000,196.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,AMBETTER,AMBETTER,36.62,,,,,,,8.4000,196.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,AMERIGROUP,AMERIGROUP,8.40,,,,,,,8.4000,196.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,17.47,,,,,,,8.4000,196.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,BLUE CROSS,ANTHEM EXCHANGE,16.80,,,,,,,8.4000,196.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15.51,,,,,,,8.4000,196.0000,fee schedule,APG 00398 Proc 84443 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,BLUE CROSS,ANTHEM HMO,16.80,,,,,,,8.4000,196.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,17.30,,,,,,,8.4000,196.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",16.80,,,,,,,8.4000,196.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,18.48,,,,,,,8.4000,196.0000,fee schedule,$18.48 from Fee Schedule BLDTM_23 for Rev 301 Proc 84443 * Qty 1 = $18.48 at 100% = $18.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,BLUE CROSS,BLUE CROSS E NETWORK,73.38,,,,,,,8.4000,196.0000,fee schedule,$22.93 from Fee Schedule BCFSB for Rev 301 Proc 84443 * Qty 1 = $22.93 at 320% = $73.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,BLUE CROSS,BLUE CROSS MEDICARE,17.47,,,,,,,8.4000,196.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,BLUE CROSS,BLUE CROSS P NETWORK,74.98,,,,,,,8.4000,196.0000,fee schedule,$22.93 from Fee Schedule BCFSB for Rev 301 Proc 84443 * Qty 1 = $22.93 at 327% = $74.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,BLUE CROSS,BLUE CROSS S NETWORK,74.98,,,,,,,8.4000,196.0000,fee schedule,$22.93 from Fee Schedule BCFSB for Rev 301 Proc 84443 * Qty 1 = $22.93 at 327% = $74.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,BLUE CROSS,TENNCARE BLUE CARE,38.27,,,,,,,8.4000,196.0000,fee schedule,$32.99 from Fee Schedule TC_24 for Rev 301 Proc 84443 * Qty 1 = $32.99 at 116% = $38.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,CIGNA HEALTHCARE,CIGNA HMO,67.60,,,,,,,8.4000,196.0000,fee schedule,$67.60 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84443 * Qty 1 = $67.60 at 100% = $67.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,36.81,,,,,,,8.4000,196.0000,fee schedule,$36.81 from Fee Schedule CGIFP_25LR for Rev 301 Proc 84443 * Qty 1 = $36.81 at 100% = $36.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,17.64,,,,,,,8.4000,196.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,67.60,,,,,,,8.4000,196.0000,fee schedule,$67.60 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84443 * Qty 1 = $67.60 at 100% = $67.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,CIGNA HEALTHCARE,CIGNA PPO,67.60,,,,,,,8.4000,196.0000,fee schedule,$67.60 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84443 * Qty 1 = $67.60 at 100% = $67.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,17.64,,,,,,,8.4000,196.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,176.40,,,,,,,8.4000,196.0000,percent of total billed charges,90% of $196.00 in Billed Charges for Rev 301 Proc 84443 = $176.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,HUMANA,HUMANA MEDICARE,16.80,,,,,,,8.4000,196.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,16.80,,,,,,,8.4000,196.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,MEDCOST,MEDCOST VHN,93.28,,,,,,,8.4000,196.0000,percent of total billed charges,47.59% of $196.00 in Billed Charges for Rev 301 Proc 84443 = $93.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15.81,,,,,,,8.4000,196.0000,fee schedule,APG 00398 Proc 84443 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 105% = $15.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,17.64,,,,,,,8.4000,196.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,17.64,,,,,,,8.4000,196.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,NHC ADVANTAGE,NHC ADVANTAGE,17.64,,,,,,,8.4000,196.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15.53,,,,,,,8.4000,196.0000,fee schedule,APG 00398 Proc 84443 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 103.1% = $15.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,SENTARA HEALTH,SENTARA HEALTH,50.59,,,,,,,8.4000,196.0000,percent of total billed charges,25.81% of $196.00 in Billed Charges for Rev 301 Proc 84443 = $50.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,SENTARA HEALTH,SENTARA MEDICARE,16.80,,,,,,,8.4000,196.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",196.00,,,,,,,8.4000,196.0000,percent of total billed charges,100% of $196.00 in Billed Charges for Rev 301 Proc 84443 = $196.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11.90,,,,,,,8.4000,196.0000,fee schedule,$23.80 from Fee Schedule TCUHC24 for Rev 301 Proc 84443 * Qty 1 = $23.80 at 50% = $11.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,17.47,,,,,,,8.4000,196.0000,fee schedule,$16.80 from Fee Schedule UHC_31910 for Rev 301 Proc 84443 * Qty 1 = $16.80 at 104% = $17.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,16.80,,,,,,,8.4000,196.0000,fee schedule,$16.80 from Fee Schedule UHC_31910 for Rev 301 Proc 84443 * Qty 1 = $16.80 at 100% = $16.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,16.80,,,,,,,8.4000,196.0000,fee schedule,$16.80 from Fee Schedule UHC_31910 for Rev 301 Proc 84443 * Qty 1 = $16.80 at 100% = $16.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15.51,,,,,,,8.4000,196.0000,fee schedule,APG 00398 Proc 84443 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,16.80,,,,,,,8.4000,196.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,16.80,,,,,,,8.4000,196.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,WELLCARE,WELLCARE MEDICAID,196.00,,,,,,,8.4000,196.0000,percent of total billed charges,100% of $196.00 in Billed Charges for Rev 301 Proc 84443 = $196.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THYROID STIMULATING HORMONE TSH,84443,CPT,301,RC,30100264,CDM,,,,both,,,196.0000,29.4000,WELLCARE,WELLCARE MEDICARE,17.81,,,,,,,8.4000,196.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,AETNA,AETNA,164.82,,,,,,,25.4300,386.0000,percent of total billed charges,42.7% of $386.00 in Billed Charges for Rev 301 Proc 84445 = $164.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,41.07,,,,,,,25.4300,386.0000,fee schedule,APG 00399 Proc 84445 at $836.60 (Base Rate) * 0.0472 (Relative Weight) = $39.49 (Total Line Payment) at 104% = $41.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,50.86,,,,,,,25.4300,386.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,AETNA,AETNA HEALTHCARE MEDICARE,50.86,,,,,,,25.4300,386.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,50.86,,,,,,,25.4300,386.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,AMBETTER,AMBETTER,110.87,,,,,,,25.4300,386.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,AMERIGROUP,AMERIGROUP,25.43,,,,,,,25.4300,386.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,52.89,,,,,,,25.4300,386.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,BLUE CROSS,ANTHEM EXCHANGE,50.86,,,,,,,25.4300,386.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,40.67,,,,,,,25.4300,386.0000,fee schedule,APG 00399 Proc 84445 at $836.60 (Base Rate) * 0.0472 (Relative Weight) = $39.49 (Total Line Payment) at 103% = $40.67. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,BLUE CROSS,ANTHEM HMO,50.86,,,,,,,25.4300,386.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,52.39,,,,,,,25.4300,386.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",50.86,,,,,,,25.4300,386.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,182.79,,,,,,,25.4300,386.0000,fee schedule,$182.79 from Fee Schedule BLDTM_23 for Rev 301 Proc 84445 * Qty 1 = $182.79 at 100% = $182.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,BLUE CROSS,BLUE CROSS E NETWORK,106.02,,,,,,,25.4300,386.0000,fee schedule,$33.13 from Fee Schedule BCFSB for Rev 301 Proc 84445 * Qty 1 = $33.13 at 320% = $106.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,BLUE CROSS,BLUE CROSS MEDICARE,52.89,,,,,,,25.4300,386.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,BLUE CROSS,BLUE CROSS P NETWORK,108.34,,,,,,,25.4300,386.0000,fee schedule,$33.13 from Fee Schedule BCFSB for Rev 301 Proc 84445 * Qty 1 = $33.13 at 327% = $108.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,BLUE CROSS,BLUE CROSS S NETWORK,108.34,,,,,,,25.4300,386.0000,fee schedule,$33.13 from Fee Schedule BCFSB for Rev 301 Proc 84445 * Qty 1 = $33.13 at 327% = $108.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,BLUE CROSS,TENNCARE BLUE CARE,46.52,,,,,,,25.4300,386.0000,fee schedule,$40.10 from Fee Schedule TC_24 for Rev 301 Proc 84445 * Qty 1 = $40.10 at 116% = $46.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,BLUE CROSS,TENNCARE BLUE SELECT,46.52,,,,,,,25.4300,386.0000,fee schedule,$40.10 from Fee Schedule TC_24 for Rev 301 Proc 84445 * Qty 1 = $40.10 at 116% = $46.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,CIGNA HEALTHCARE,CIGNA HMO,204.56,,,,,,,25.4300,386.0000,fee schedule,$204.56 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84445 * Qty 1 = $204.56 at 100% = $204.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,111.88,,,,,,,25.4300,386.0000,fee schedule,$111.88 from Fee Schedule CGIFP_25LR for Rev 301 Proc 84445 * Qty 1 = $111.88 at 100% = $111.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,53.40,,,,,,,25.4300,386.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,204.56,,,,,,,25.4300,386.0000,fee schedule,$204.56 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84445 * Qty 1 = $204.56 at 100% = $204.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,CIGNA HEALTHCARE,CIGNA PPO,204.56,,,,,,,25.4300,386.0000,fee schedule,$204.56 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84445 * Qty 1 = $204.56 at 100% = $204.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,53.40,,,,,,,25.4300,386.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,347.40,,,,,,,25.4300,386.0000,percent of total billed charges,90% of $386.00 in Billed Charges for Rev 301 Proc 84445 = $347.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,HUMANA,HUMANA MEDICARE,50.86,,,,,,,25.4300,386.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,50.86,,,,,,,25.4300,386.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,MEDCOST,MEDCOST VHN,183.70,,,,,,,25.4300,386.0000,percent of total billed charges,47.59% of $386.00 in Billed Charges for Rev 301 Proc 84445 = $183.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,41.46,,,,,,,25.4300,386.0000,fee schedule,APG 00399 Proc 84445 at $836.60 (Base Rate) * 0.0472 (Relative Weight) = $39.49 (Total Line Payment) at 100% = $39.49... $39.49 at 105% = $41.46 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,53.40,,,,,,,25.4300,386.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,53.40,,,,,,,25.4300,386.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,NHC ADVANTAGE,NHC ADVANTAGE,53.40,,,,,,,25.4300,386.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,40.71,,,,,,,25.4300,386.0000,fee schedule,APG 00399 Proc 84445 at $836.60 (Base Rate) * 0.0472 (Relative Weight) = $39.49 (Total Line Payment) at 100% = $39.49... $39.49 at 103.1% = $40.71 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,SENTARA HEALTH,SENTARA HEALTH,99.63,,,,,,,25.4300,386.0000,percent of total billed charges,25.81% of $386.00 in Billed Charges for Rev 301 Proc 84445 = $99.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,SENTARA HEALTH,SENTARA MEDICARE,50.86,,,,,,,25.4300,386.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",386.00,,,,,,,25.4300,386.0000,percent of total billed charges,100% of $386.00 in Billed Charges for Rev 301 Proc 84445 = $386.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,36.01,,,,,,,25.4300,386.0000,fee schedule,$72.02 from Fee Schedule TCUHC24 for Rev 301 Proc 84445 * Qty 1 = $72.02 at 50% = $36.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,52.89,,,,,,,25.4300,386.0000,fee schedule,$50.86 from Fee Schedule UHC_31910 for Rev 301 Proc 84445 * Qty 1 = $50.86 at 104% = $52.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,50.86,,,,,,,25.4300,386.0000,fee schedule,$50.86 from Fee Schedule UHC_31910 for Rev 301 Proc 84445 * Qty 1 = $50.86 at 100% = $50.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,50.86,,,,,,,25.4300,386.0000,fee schedule,$50.86 from Fee Schedule UHC_31910 for Rev 301 Proc 84445 * Qty 1 = $50.86 at 100% = $50.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,40.67,,,,,,,25.4300,386.0000,fee schedule,APG 00399 Proc 84445 at $836.60 (Base Rate) * 0.0472 (Relative Weight) = $39.49 (Total Line Payment) at 103% = $40.67. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,50.86,,,,,,,25.4300,386.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,50.86,,,,,,,25.4300,386.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,WELLCARE,WELLCARE MEDICAID,386.00,,,,,,,25.4300,386.0000,percent of total billed charges,100% of $386.00 in Billed Charges for Rev 301 Proc 84445 = $386.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THYROID STIMULATING IMMUNOGLOB,84445,CPT,301,RC,30100265,CDM,,,,both,,,386.0000,57.9000,WELLCARE,WELLCARE MEDICARE,53.91,,,,,,,25.4300,386.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,AETNA,AETNA,70.88,,,,,,,7.0900,166.0000,percent of total billed charges,42.7% of $166.00 in Billed Charges for Rev 301 Proc 84446 = $70.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,14.27,,,,,,,7.0900,166.0000,fee schedule,APG 00400 Proc 84446 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 104% = $14.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,14.18,,,,,,,7.0900,166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,AETNA,AETNA HEALTHCARE MEDICARE,14.18,,,,,,,7.0900,166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,14.18,,,,,,,7.0900,166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,AMBETTER,AMBETTER,30.91,,,,,,,7.0900,166.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,AMERIGROUP,AMERIGROUP,7.09,,,,,,,7.0900,166.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,14.75,,,,,,,7.0900,166.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,BLUE CROSS,ANTHEM EXCHANGE,14.18,,,,,,,7.0900,166.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,14.13,,,,,,,7.0900,166.0000,fee schedule,APG 00400 Proc 84446 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,BLUE CROSS,ANTHEM HMO,14.18,,,,,,,7.0900,166.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,14.61,,,,,,,7.0900,166.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",14.18,,,,,,,7.0900,166.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,48.44,,,,,,,7.0900,166.0000,fee schedule,$48.44 from Fee Schedule BLDTM_23 for Rev 301 Proc 84446 * Qty 1 = $48.44 at 100% = $48.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,BLUE CROSS,BLUE CROSS E NETWORK,61.89,,,,,,,7.0900,166.0000,fee schedule,$19.34 from Fee Schedule BCFSB for Rev 301 Proc 84446 * Qty 1 = $19.34 at 320% = $61.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,BLUE CROSS,BLUE CROSS MEDICARE,14.75,,,,,,,7.0900,166.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,BLUE CROSS,BLUE CROSS P NETWORK,63.24,,,,,,,7.0900,166.0000,fee schedule,$19.34 from Fee Schedule BCFSB for Rev 301 Proc 84446 * Qty 1 = $19.34 at 327% = $63.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,BLUE CROSS,BLUE CROSS S NETWORK,63.24,,,,,,,7.0900,166.0000,fee schedule,$19.34 from Fee Schedule BCFSB for Rev 301 Proc 84446 * Qty 1 = $19.34 at 327% = $63.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,BLUE CROSS,TENNCARE BLUE CARE,31.34,,,,,,,7.0900,166.0000,fee schedule,$27.02 from Fee Schedule TC_24 for Rev 301 Proc 84446 * Qty 1 = $27.02 at 116% = $31.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,BLUE CROSS,TENNCARE BLUE SELECT,31.34,,,,,,,7.0900,166.0000,fee schedule,$27.02 from Fee Schedule TC_24 for Rev 301 Proc 84446 * Qty 1 = $27.02 at 116% = $31.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,CIGNA HEALTHCARE,CIGNA HMO,57.03,,,,,,,7.0900,166.0000,fee schedule,$57.03 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84446 * Qty 1 = $57.03 at 100% = $57.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,31.04,,,,,,,7.0900,166.0000,fee schedule,$31.04 from Fee Schedule CGIFP_25LR for Rev 301 Proc 84446 * Qty 1 = $31.04 at 100% = $31.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,14.89,,,,,,,7.0900,166.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,57.03,,,,,,,7.0900,166.0000,fee schedule,$57.03 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84446 * Qty 1 = $57.03 at 100% = $57.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,CIGNA HEALTHCARE,CIGNA PPO,57.03,,,,,,,7.0900,166.0000,fee schedule,$57.03 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84446 * Qty 1 = $57.03 at 100% = $57.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,14.89,,,,,,,7.0900,166.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,149.40,,,,,,,7.0900,166.0000,percent of total billed charges,90% of $166.00 in Billed Charges for Rev 301 Proc 84446 = $149.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,HUMANA,HUMANA MEDICARE,14.18,,,,,,,7.0900,166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,14.18,,,,,,,7.0900,166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,MEDCOST,MEDCOST VHN,79.00,,,,,,,7.0900,166.0000,percent of total billed charges,47.59% of $166.00 in Billed Charges for Rev 301 Proc 84446 = $79.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,14.41,,,,,,,7.0900,166.0000,fee schedule,APG 00400 Proc 84446 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 105% = $14.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,14.89,,,,,,,7.0900,166.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,14.89,,,,,,,7.0900,166.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,NHC ADVANTAGE,NHC ADVANTAGE,14.89,,,,,,,7.0900,166.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,14.15,,,,,,,7.0900,166.0000,fee schedule,APG 00400 Proc 84446 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 103.1% = $14.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,SENTARA HEALTH,SENTARA HEALTH,42.84,,,,,,,7.0900,166.0000,percent of total billed charges,25.81% of $166.00 in Billed Charges for Rev 301 Proc 84446 = $42.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,SENTARA HEALTH,SENTARA MEDICARE,14.18,,,,,,,7.0900,166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",166.00,,,,,,,7.0900,166.0000,percent of total billed charges,100% of $166.00 in Billed Charges for Rev 301 Proc 84446 = $166.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,10.04,,,,,,,7.0900,166.0000,fee schedule,$20.08 from Fee Schedule TCUHC24 for Rev 301 Proc 84446 * Qty 1 = $20.08 at 50% = $10.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,14.75,,,,,,,7.0900,166.0000,fee schedule,$14.18 from Fee Schedule UHC_31910 for Rev 301 Proc 84446 * Qty 1 = $14.18 at 104% = $14.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,14.18,,,,,,,7.0900,166.0000,fee schedule,$14.18 from Fee Schedule UHC_31910 for Rev 301 Proc 84446 * Qty 1 = $14.18 at 100% = $14.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,14.18,,,,,,,7.0900,166.0000,fee schedule,$14.18 from Fee Schedule UHC_31910 for Rev 301 Proc 84446 * Qty 1 = $14.18 at 100% = $14.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,14.13,,,,,,,7.0900,166.0000,fee schedule,APG 00400 Proc 84446 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,14.18,,,,,,,7.0900,166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,14.18,,,,,,,7.0900,166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,WELLCARE,WELLCARE MEDICAID,166.00,,,,,,,7.0900,166.0000,percent of total billed charges,100% of $166.00 in Billed Charges for Rev 301 Proc 84446 = $166.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VITAMIN E TOCOPHEROL,84446,CPT,301,RC,30100266,CDM,,,,both,,,166.0000,24.9000,WELLCARE,WELLCARE MEDICARE,15.03,,,,,,,7.0900,166.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,AETNA,AETNA,58.50,,,,,,,9.0000,137.0000,percent of total billed charges,42.7% of $137.00 in Billed Charges for Rev 301 Proc 84449 = $58.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15.66,,,,,,,9.0000,137.0000,fee schedule,APG 00398 Proc 84449 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 104% = $15.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,18.00,,,,,,,9.0000,137.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,AETNA,AETNA HEALTHCARE MEDICARE,18.00,,,,,,,9.0000,137.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,18.00,,,,,,,9.0000,137.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,AMBETTER,AMBETTER,39.24,,,,,,,9.0000,137.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,AMERIGROUP,AMERIGROUP,9.00,,,,,,,9.0000,137.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,18.72,,,,,,,9.0000,137.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,BLUE CROSS,ANTHEM EXCHANGE,18.00,,,,,,,9.0000,137.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15.51,,,,,,,9.0000,137.0000,fee schedule,APG 00398 Proc 84449 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,BLUE CROSS,ANTHEM HMO,18.00,,,,,,,9.0000,137.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,18.54,,,,,,,9.0000,137.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",18.00,,,,,,,9.0000,137.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,62.28,,,,,,,9.0000,137.0000,fee schedule,$62.28 from Fee Schedule BLDTM_23 for Rev 301 Proc 84449 * Qty 1 = $62.28 at 100% = $62.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,BLUE CROSS,BLUE CROSS E NETWORK,77.79,,,,,,,9.0000,137.0000,fee schedule,$24.31 from Fee Schedule BCFSB for Rev 301 Proc 84449 * Qty 1 = $24.31 at 320% = $77.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,BLUE CROSS,BLUE CROSS MEDICARE,18.72,,,,,,,9.0000,137.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,BLUE CROSS,BLUE CROSS P NETWORK,79.49,,,,,,,9.0000,137.0000,fee schedule,$24.31 from Fee Schedule BCFSB for Rev 301 Proc 84449 * Qty 1 = $24.31 at 327% = $79.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,BLUE CROSS,BLUE CROSS S NETWORK,79.49,,,,,,,9.0000,137.0000,fee schedule,$24.31 from Fee Schedule BCFSB for Rev 301 Proc 84449 * Qty 1 = $24.31 at 327% = $79.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,BLUE CROSS,TENNCARE BLUE CARE,37.38,,,,,,,9.0000,137.0000,fee schedule,$32.22 from Fee Schedule TC_24 for Rev 301 Proc 84449 * Qty 1 = $32.22 at 116% = $37.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,BLUE CROSS,TENNCARE BLUE SELECT,37.38,,,,,,,9.0000,137.0000,fee schedule,$32.22 from Fee Schedule TC_24 for Rev 301 Proc 84449 * Qty 1 = $32.22 at 116% = $37.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,CIGNA HEALTHCARE,CIGNA HMO,72.41,,,,,,,9.0000,137.0000,fee schedule,$72.41 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84449 * Qty 1 = $72.41 at 100% = $72.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,39.70,,,,,,,9.0000,137.0000,fee schedule,$39.70 from Fee Schedule CGIFP_25LR for Rev 301 Proc 84449 * Qty 1 = $39.70 at 100% = $39.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,18.90,,,,,,,9.0000,137.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,72.41,,,,,,,9.0000,137.0000,fee schedule,$72.41 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84449 * Qty 1 = $72.41 at 100% = $72.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,CIGNA HEALTHCARE,CIGNA PPO,72.41,,,,,,,9.0000,137.0000,fee schedule,$72.41 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84449 * Qty 1 = $72.41 at 100% = $72.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,18.90,,,,,,,9.0000,137.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,123.30,,,,,,,9.0000,137.0000,percent of total billed charges,90% of $137.00 in Billed Charges for Rev 301 Proc 84449 = $123.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,HUMANA,HUMANA MEDICARE,18.00,,,,,,,9.0000,137.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,18.00,,,,,,,9.0000,137.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,MEDCOST,MEDCOST VHN,65.20,,,,,,,9.0000,137.0000,percent of total billed charges,47.59% of $137.00 in Billed Charges for Rev 301 Proc 84449 = $65.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15.81,,,,,,,9.0000,137.0000,fee schedule,APG 00398 Proc 84449 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 105% = $15.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,18.90,,,,,,,9.0000,137.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,18.90,,,,,,,9.0000,137.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,NHC ADVANTAGE,NHC ADVANTAGE,18.90,,,,,,,9.0000,137.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15.53,,,,,,,9.0000,137.0000,fee schedule,APG 00398 Proc 84449 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 103.1% = $15.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,SENTARA HEALTH,SENTARA HEALTH,35.36,,,,,,,9.0000,137.0000,percent of total billed charges,25.81% of $137.00 in Billed Charges for Rev 301 Proc 84449 = $35.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,SENTARA HEALTH,SENTARA MEDICARE,18.00,,,,,,,9.0000,137.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",137.00,,,,,,,9.0000,137.0000,percent of total billed charges,100% of $137.00 in Billed Charges for Rev 301 Proc 84449 = $137.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,12.75,,,,,,,9.0000,137.0000,fee schedule,$25.49 from Fee Schedule TCUHC24 for Rev 301 Proc 84449 * Qty 1 = $25.49 at 50% = $12.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,18.72,,,,,,,9.0000,137.0000,fee schedule,$18.00 from Fee Schedule UHC_31910 for Rev 301 Proc 84449 * Qty 1 = $18.00 at 104% = $18.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,18.00,,,,,,,9.0000,137.0000,fee schedule,$18.00 from Fee Schedule UHC_31910 for Rev 301 Proc 84449 * Qty 1 = $18.00 at 100% = $18.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,18.00,,,,,,,9.0000,137.0000,fee schedule,$18.00 from Fee Schedule UHC_31910 for Rev 301 Proc 84449 * Qty 1 = $18.00 at 100% = $18.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15.51,,,,,,,9.0000,137.0000,fee schedule,APG 00398 Proc 84449 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,18.00,,,,,,,9.0000,137.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,18.00,,,,,,,9.0000,137.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,WELLCARE,WELLCARE MEDICAID,137.00,,,,,,,9.0000,137.0000,percent of total billed charges,100% of $137.00 in Billed Charges for Rev 301 Proc 84449 = $137.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY OF TRANSCORTIN,84449,CPT,301,RC,30100524,CDM,,,,both,,,137.0000,20.5500,WELLCARE,WELLCARE MEDICARE,19.08,,,,,,,9.0000,137.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,7606.8900,1141.0300,AETNA,AETNA,3248.14,,,,,,,1963.3400,7606.8900,percent of total billed charges,"42.7% of $7,606.89 in Billed Charges for Rev 272 = $3,248.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,7606.8900,1141.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5324.82,,,,,,,1963.3400,7606.8900,percent of total billed charges,"Rev 272 $7,606.89 in Billed Charges at 70% = $5,324.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,7606.8900,1141.0300,CIGNA HEALTHCARE,CIGNA HMO,3172.07,,,,,,,1963.3400,7606.8900,percent of total billed charges,"41.7% of $7,606.89 in Billed Charges for Rev 272 = $3,172.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,7606.8900,1141.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3529.60,,,,,,,1963.3400,7606.8900,percent of total billed charges,"46.4% of $7,606.89 in Billed Charges for Rev 272 = $3,529.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,7606.8900,1141.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3172.07,,,,,,,1963.3400,7606.8900,percent of total billed charges,"41.7% of $7,606.89 in Billed Charges for Rev 272 = $3,172.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,7606.8900,1141.0300,CIGNA HEALTHCARE,CIGNA PPO,3172.07,,,,,,,1963.3400,7606.8900,percent of total billed charges,"41.7% of $7,606.89 in Billed Charges for Rev 272 = $3,172.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,7606.8900,1141.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6846.20,,,,,,,1963.3400,7606.8900,percent of total billed charges,"90% of $7,606.89 in Billed Charges for Rev 272 = $6,846.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,7606.8900,1141.0300,MEDCOST,MEDCOST VHN,3620.12,,,,,,,1963.3400,7606.8900,percent of total billed charges,"47.59% of $7,606.89 in Billed Charges for Rev 272 = $3,620.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,7606.8900,1141.0300,SENTARA HEALTH,SENTARA HEALTH,1963.34,,,,,,,1963.3400,7606.8900,percent of total billed charges,"25.81% of $7,606.89 in Billed Charges for Rev 272 = $1,963.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,7606.8900,1141.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7606.89,,,,,,,1963.3400,7606.8900,percent of total billed charges,"100% of $7,606.89 in Billed Charges for Rev 272 = $7,606.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,7606.8900,1141.0300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3803.45,,,,,,,1963.3400,7606.8900,percent of total billed charges,"Rev 272 $7,606.89 in Billed Charges at 50% = $3,803.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,7606.8900,1141.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2457.03,,,,,,,1963.3400,7606.8900,other,"32.3% of $7,606.89 in Billed Charges for Rev 272 = $2,457.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,7606.8900,1141.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,2335.32,,,,,,,1963.3400,7606.8900,other,"30.7% of $7,606.89 in Billed Charges for Rev 272 = $2,335.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,7606.8900,1141.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,2457.03,,,,,,,1963.3400,7606.8900,percent of total billed charges,"32.3% of $7,606.89 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEAL CAP ASSEMBLY W/ACCESSORIS,272,RC,27200002,CDM,,,,,,both,,,7606.8900,1141.0300,WELLCARE,WELLCARE MEDICAID,7606.89,,,,,,,1963.3400,7606.8900,percent of total billed charges,"100% of $7,606.89 in Billed Charges for Rev 272 = $7,606.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT ADHERUS AUTOSPRAY ET DURAL,272,RC,27200002,CDM,,,,,,both,,,9942.5500,1491.3800,AETNA,AETNA,4245.47,,,,,,,2566.1700,9942.5500,percent of total billed charges,"42.7% of $9,942.55 in Billed Charges for Rev 272 = $4,245.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT ADHERUS AUTOSPRAY ET DURAL,272,RC,27200002,CDM,,,,,,both,,,9942.5500,1491.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6959.79,,,,,,,2566.1700,9942.5500,percent of total billed charges,"Rev 272 $9,942.55 in Billed Charges at 70% = $6,959.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT ADHERUS AUTOSPRAY ET DURAL,272,RC,27200002,CDM,,,,,,both,,,9942.5500,1491.3800,CIGNA HEALTHCARE,CIGNA HMO,4146.04,,,,,,,2566.1700,9942.5500,percent of total billed charges,"41.7% of $9,942.55 in Billed Charges for Rev 272 = $4,146.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT ADHERUS AUTOSPRAY ET DURAL,272,RC,27200002,CDM,,,,,,both,,,9942.5500,1491.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4613.34,,,,,,,2566.1700,9942.5500,percent of total billed charges,"46.4% of $9,942.55 in Billed Charges for Rev 272 = $4,613.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT ADHERUS AUTOSPRAY ET DURAL,272,RC,27200002,CDM,,,,,,both,,,9942.5500,1491.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4146.04,,,,,,,2566.1700,9942.5500,percent of total billed charges,"41.7% of $9,942.55 in Billed Charges for Rev 272 = $4,146.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT ADHERUS AUTOSPRAY ET DURAL,272,RC,27200002,CDM,,,,,,both,,,9942.5500,1491.3800,CIGNA HEALTHCARE,CIGNA PPO,4146.04,,,,,,,2566.1700,9942.5500,percent of total billed charges,"41.7% of $9,942.55 in Billed Charges for Rev 272 = $4,146.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT ADHERUS AUTOSPRAY ET DURAL,272,RC,27200002,CDM,,,,,,both,,,9942.5500,1491.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8948.30,,,,,,,2566.1700,9942.5500,percent of total billed charges,"90% of $9,942.55 in Billed Charges for Rev 272 = $8,948.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT ADHERUS AUTOSPRAY ET DURAL,272,RC,27200002,CDM,,,,,,both,,,9942.5500,1491.3800,MEDCOST,MEDCOST VHN,4731.66,,,,,,,2566.1700,9942.5500,percent of total billed charges,"47.59% of $9,942.55 in Billed Charges for Rev 272 = $4,731.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT ADHERUS AUTOSPRAY ET DURAL,272,RC,27200002,CDM,,,,,,both,,,9942.5500,1491.3800,SENTARA HEALTH,SENTARA HEALTH,2566.17,,,,,,,2566.1700,9942.5500,percent of total billed charges,"25.81% of $9,942.55 in Billed Charges for Rev 272 = $2,566.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT ADHERUS AUTOSPRAY ET DURAL,272,RC,27200002,CDM,,,,,,both,,,9942.5500,1491.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9942.55,,,,,,,2566.1700,9942.5500,percent of total billed charges,"100% of $9,942.55 in Billed Charges for Rev 272 = $9,942.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT ADHERUS AUTOSPRAY ET DURAL,272,RC,27200002,CDM,,,,,,both,,,9942.5500,1491.3800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4971.28,,,,,,,2566.1700,9942.5500,percent of total billed charges,"Rev 272 $9,942.55 in Billed Charges at 50% = $4,971.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT ADHERUS AUTOSPRAY ET DURAL,272,RC,27200002,CDM,,,,,,both,,,9942.5500,1491.3800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3211.44,,,,,,,2566.1700,9942.5500,other,"32.3% of $9,942.55 in Billed Charges for Rev 272 = $3,211.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALANT ADHERUS AUTOSPRAY ET DURAL,272,RC,27200002,CDM,,,,,,both,,,9942.5500,1491.3800,UNITED HEALTHCARE,UHC HERITAGE SELECT,3052.36,,,,,,,2566.1700,9942.5500,other,"30.7% of $9,942.55 in Billed Charges for Rev 272 = $3,052.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALANT ADHERUS AUTOSPRAY ET DURAL,272,RC,27200002,CDM,,,,,,both,,,9942.5500,1491.3800,UNITED HEALTHCARE,UNITED HEALTHCARE,3211.44,,,,,,,2566.1700,9942.5500,percent of total billed charges,"32.3% of $9,942.55 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT ADHERUS AUTOSPRAY ET DURAL,272,RC,27200002,CDM,,,,,,both,,,9942.5500,1491.3800,WELLCARE,WELLCARE MEDICAID,9942.55,,,,,,,2566.1700,9942.5500,percent of total billed charges,"100% of $9,942.55 in Billed Charges for Rev 272 = $9,942.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT DURAL DURASEAL,272,RC,27200002,CDM,,,,,,both,,,13705.1500,2055.7700,AETNA,AETNA,5852.10,,,,,,,3537.3000,13705.1500,percent of total billed charges,"42.7% of $13,705.15 in Billed Charges for Rev 272 = $5,852.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT DURAL DURASEAL,272,RC,27200002,CDM,,,,,,both,,,13705.1500,2055.7700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9593.61,,,,,,,3537.3000,13705.1500,percent of total billed charges,"Rev 272 $13,705.15 in Billed Charges at 70% = $9,593.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT DURAL DURASEAL,272,RC,27200002,CDM,,,,,,both,,,13705.1500,2055.7700,CIGNA HEALTHCARE,CIGNA HMO,5715.05,,,,,,,3537.3000,13705.1500,percent of total billed charges,"41.7% of $13,705.15 in Billed Charges for Rev 272 = $5,715.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT DURAL DURASEAL,272,RC,27200002,CDM,,,,,,both,,,13705.1500,2055.7700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6359.19,,,,,,,3537.3000,13705.1500,percent of total billed charges,"46.4% of $13,705.15 in Billed Charges for Rev 272 = $6,359.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT DURAL DURASEAL,272,RC,27200002,CDM,,,,,,both,,,13705.1500,2055.7700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5715.05,,,,,,,3537.3000,13705.1500,percent of total billed charges,"41.7% of $13,705.15 in Billed Charges for Rev 272 = $5,715.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT DURAL DURASEAL,272,RC,27200002,CDM,,,,,,both,,,13705.1500,2055.7700,CIGNA HEALTHCARE,CIGNA PPO,5715.05,,,,,,,3537.3000,13705.1500,percent of total billed charges,"41.7% of $13,705.15 in Billed Charges for Rev 272 = $5,715.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT DURAL DURASEAL,272,RC,27200002,CDM,,,,,,both,,,13705.1500,2055.7700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12334.64,,,,,,,3537.3000,13705.1500,percent of total billed charges,"90% of $13,705.15 in Billed Charges for Rev 272 = $12,334.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT DURAL DURASEAL,272,RC,27200002,CDM,,,,,,both,,,13705.1500,2055.7700,MEDCOST,MEDCOST VHN,6522.28,,,,,,,3537.3000,13705.1500,percent of total billed charges,"47.59% of $13,705.15 in Billed Charges for Rev 272 = $6,522.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT DURAL DURASEAL,272,RC,27200002,CDM,,,,,,both,,,13705.1500,2055.7700,SENTARA HEALTH,SENTARA HEALTH,3537.30,,,,,,,3537.3000,13705.1500,percent of total billed charges,"25.81% of $13,705.15 in Billed Charges for Rev 272 = $3,537.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT DURAL DURASEAL,272,RC,27200002,CDM,,,,,,both,,,13705.1500,2055.7700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13705.15,,,,,,,3537.3000,13705.1500,percent of total billed charges,"100% of $13,705.15 in Billed Charges for Rev 272 = $13,705.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT DURAL DURASEAL,272,RC,27200002,CDM,,,,,,both,,,13705.1500,2055.7700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6852.58,,,,,,,3537.3000,13705.1500,percent of total billed charges,"Rev 272 $13,705.15 in Billed Charges at 50% = $6,852.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT DURAL DURASEAL,272,RC,27200002,CDM,,,,,,both,,,13705.1500,2055.7700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4426.76,,,,,,,3537.3000,13705.1500,other,"32.3% of $13,705.15 in Billed Charges for Rev 272 = $4,426.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALANT DURAL DURASEAL,272,RC,27200002,CDM,,,,,,both,,,13705.1500,2055.7700,UNITED HEALTHCARE,UHC HERITAGE SELECT,4207.48,,,,,,,3537.3000,13705.1500,other,"30.7% of $13,705.15 in Billed Charges for Rev 272 = $4,207.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEALANT DURAL DURASEAL,272,RC,27200002,CDM,,,,,,both,,,13705.1500,2055.7700,UNITED HEALTHCARE,UNITED HEALTHCARE,4426.76,,,,,,,3537.3000,13705.1500,percent of total billed charges,"32.3% of $13,705.15 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEALANT DURAL DURASEAL,272,RC,27200002,CDM,,,,,,both,,,13705.1500,2055.7700,WELLCARE,WELLCARE MEDICAID,13705.15,,,,,,,3537.3000,13705.1500,percent of total billed charges,"100% of $13,705.15 in Billed Charges for Rev 272 = $13,705.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,AETNA,AETNA,26.05,,,,,,,2.5900,61.0000,percent of total billed charges,42.7% of $61.00 in Billed Charges for Rev 301 Proc 84450 = $26.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,6.44,,,,,,,2.5900,61.0000,fee schedule,APG 00402 Proc 84450 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 104% = $6.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5.18,,,,,,,2.5900,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,AETNA,AETNA HEALTHCARE MEDICARE,5.18,,,,,,,2.5900,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,5.18,,,,,,,2.5900,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,AMBETTER,AMBETTER,11.29,,,,,,,2.5900,61.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,AMERIGROUP,AMERIGROUP,2.59,,,,,,,2.5900,61.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,5.39,,,,,,,2.5900,61.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,ANTHEM EXCHANGE,5.18,,,,,,,2.5900,61.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,6.38,,,,,,,2.5900,61.0000,fee schedule,APG 00402 Proc 84450 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,ANTHEM HMO,5.18,,,,,,,2.5900,61.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5.34,,,,,,,2.5900,61.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5.18,,,,,,,2.5900,61.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6.93,,,,,,,2.5900,61.0000,fee schedule,$6.93 from Fee Schedule BLDTM_23 for Rev 301 Proc 84450 * Qty 1 = $6.93 at 100% = $6.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS E NETWORK,22.59,,,,,,,2.5900,61.0000,fee schedule,$7.06 from Fee Schedule BCFSB for Rev 301 Proc 84450 * Qty 1 = $7.06 at 320% = $22.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS MEDICARE,5.39,,,,,,,2.5900,61.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS P NETWORK,23.09,,,,,,,2.5900,61.0000,fee schedule,$7.06 from Fee Schedule BCFSB for Rev 301 Proc 84450 * Qty 1 = $7.06 at 327% = $23.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS S NETWORK,23.09,,,,,,,2.5900,61.0000,fee schedule,$7.06 from Fee Schedule BCFSB for Rev 301 Proc 84450 * Qty 1 = $7.06 at 327% = $23.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,TENNCARE BLUE CARE,11.79,,,,,,,2.5900,61.0000,fee schedule,$10.16 from Fee Schedule TC_24 for Rev 301 Proc 84450 * Qty 1 = $10.16 at 116% = $11.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA HMO,20.80,,,,,,,2.5900,61.0000,fee schedule,$20.80 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84450 * Qty 1 = $20.80 at 100% = $20.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11.55,,,,,,,2.5900,61.0000,fee schedule,$11.55 from Fee Schedule CGIFP_25LR for Rev 301 Proc 84450 * Qty 1 = $11.55 at 100% = $11.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,5.44,,,,,,,2.5900,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,20.80,,,,,,,2.5900,61.0000,fee schedule,$20.80 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84450 * Qty 1 = $20.80 at 100% = $20.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA PPO,20.80,,,,,,,2.5900,61.0000,fee schedule,$20.80 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84450 * Qty 1 = $20.80 at 100% = $20.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,5.44,,,,,,,2.5900,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,54.90,,,,,,,2.5900,61.0000,percent of total billed charges,90% of $61.00 in Billed Charges for Rev 301 Proc 84450 = $54.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,HUMANA,HUMANA MEDICARE,5.18,,,,,,,2.5900,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5.18,,,,,,,2.5900,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,MEDCOST,MEDCOST VHN,29.03,,,,,,,2.5900,61.0000,percent of total billed charges,47.59% of $61.00 in Billed Charges for Rev 301 Proc 84450 = $29.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,6.50,,,,,,,2.5900,61.0000,fee schedule,APG 00402 Proc 84450 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 105% = $6.50 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,5.44,,,,,,,2.5900,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,5.44,,,,,,,2.5900,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,NHC ADVANTAGE,NHC ADVANTAGE,5.44,,,,,,,2.5900,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,6.38,,,,,,,2.5900,61.0000,fee schedule,APG 00402 Proc 84450 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 103.1% = $6.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,SENTARA HEALTH,SENTARA HEALTH,15.74,,,,,,,2.5900,61.0000,percent of total billed charges,25.81% of $61.00 in Billed Charges for Rev 301 Proc 84450 = $15.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,SENTARA HEALTH,SENTARA MEDICARE,5.18,,,,,,,2.5900,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",61.00,,,,,,,2.5900,61.0000,percent of total billed charges,100% of $61.00 in Billed Charges for Rev 301 Proc 84450 = $61.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3.67,,,,,,,2.5900,61.0000,fee schedule,$7.33 from Fee Schedule TCUHC24 for Rev 301 Proc 84450 * Qty 1 = $7.33 at 50% = $3.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5.39,,,,,,,2.5900,61.0000,fee schedule,$5.18 from Fee Schedule UHC_31910 for Rev 301 Proc 84450 * Qty 1 = $5.18 at 104% = $5.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,5.18,,,,,,,2.5900,61.0000,fee schedule,$5.18 from Fee Schedule UHC_31910 for Rev 301 Proc 84450 * Qty 1 = $5.18 at 100% = $5.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,5.18,,,,,,,2.5900,61.0000,fee schedule,$5.18 from Fee Schedule UHC_31910 for Rev 301 Proc 84450 * Qty 1 = $5.18 at 100% = $5.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,6.38,,,,,,,2.5900,61.0000,fee schedule,APG 00402 Proc 84450 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5.18,,,,,,,2.5900,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5.18,,,,,,,2.5900,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,WELLCARE,WELLCARE MEDICAID,61.00,,,,,,,2.5900,61.0000,percent of total billed charges,100% of $61.00 in Billed Charges for Rev 301 Proc 84450 = $61.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SGOT AST,84450,CPT,301,RC,30100267,CDM,,,,both,,,61.0000,9.1500,WELLCARE,WELLCARE MEDICARE,5.49,,,,,,,2.5900,61.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,AETNA,AETNA,35.01,,,,,,,3.4900,82.0000,percent of total billed charges,42.7% of $82.00 in Billed Charges for Rev 302 Proc 86000 = $35.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,3.4900,82.0000,fee schedule,APG 00394 Proc 86000 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,6.98,,,,,,,3.4900,82.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,AETNA,AETNA HEALTHCARE MEDICARE,6.98,,,,,,,3.4900,82.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,6.98,,,,,,,3.4900,82.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,AMBETTER,AMBETTER,15.22,,,,,,,3.4900,82.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,AMERIGROUP,AMERIGROUP,3.49,,,,,,,3.4900,82.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,7.26,,,,,,,3.4900,82.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,ANTHEM EXCHANGE,6.98,,,,,,,3.4900,82.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,3.4900,82.0000,fee schedule,APG 00394 Proc 86000 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,ANTHEM HMO,6.98,,,,,,,3.4900,82.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,7.19,,,,,,,3.4900,82.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",6.98,,,,,,,3.4900,82.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,20.06,,,,,,,3.4900,82.0000,fee schedule,$20.06 from Fee Schedule BLDTM_23 for Rev 302 Proc 86000 * Qty 1 = $20.06 at 100% = $20.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,BLUE CROSS E NETWORK,30.46,,,,,,,3.4900,82.0000,fee schedule,$9.52 from Fee Schedule BCFSB for Rev 302 Proc 86000 * Qty 1 = $9.52 at 320% = $30.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,BLUE CROSS MEDICARE,7.26,,,,,,,3.4900,82.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,BLUE CROSS P NETWORK,31.13,,,,,,,3.4900,82.0000,fee schedule,$9.52 from Fee Schedule BCFSB for Rev 302 Proc 86000 * Qty 1 = $9.52 at 327% = $31.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,BLUE CROSS S NETWORK,31.13,,,,,,,3.4900,82.0000,fee schedule,$9.52 from Fee Schedule BCFSB for Rev 302 Proc 86000 * Qty 1 = $9.52 at 327% = $31.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,TENNCARE BLUE CARE,15.67,,,,,,,3.4900,82.0000,fee schedule,$13.51 from Fee Schedule TC_24 for Rev 302 Proc 86000 * Qty 1 = $13.51 at 116% = $15.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,TENNCARE BLUE SELECT,15.67,,,,,,,3.4900,82.0000,fee schedule,$13.51 from Fee Schedule TC_24 for Rev 302 Proc 86000 * Qty 1 = $13.51 at 116% = $15.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA HMO,28.10,,,,,,,3.4900,82.0000,fee schedule,$28.10 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86000 * Qty 1 = $28.10 at 100% = $28.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,15.16,,,,,,,3.4900,82.0000,fee schedule,$15.16 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86000 * Qty 1 = $15.16 at 100% = $15.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,7.33,,,,,,,3.4900,82.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,28.10,,,,,,,3.4900,82.0000,fee schedule,$28.10 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86000 * Qty 1 = $28.10 at 100% = $28.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA PPO,28.10,,,,,,,3.4900,82.0000,fee schedule,$28.10 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86000 * Qty 1 = $28.10 at 100% = $28.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,7.33,,,,,,,3.4900,82.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,73.80,,,,,,,3.4900,82.0000,percent of total billed charges,90% of $82.00 in Billed Charges for Rev 302 Proc 86000 = $73.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,HUMANA,HUMANA MEDICARE,6.98,,,,,,,3.4900,82.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,6.98,,,,,,,3.4900,82.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,MEDCOST,MEDCOST VHN,39.02,,,,,,,3.4900,82.0000,percent of total billed charges,47.59% of $82.00 in Billed Charges for Rev 302 Proc 86000 = $39.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,3.4900,82.0000,fee schedule,APG 00394 Proc 86000 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,7.33,,,,,,,3.4900,82.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,7.33,,,,,,,3.4900,82.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,NHC ADVANTAGE,NHC ADVANTAGE,7.33,,,,,,,3.4900,82.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,3.4900,82.0000,fee schedule,APG 00394 Proc 86000 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,SENTARA HEALTH,SENTARA HEALTH,21.16,,,,,,,3.4900,82.0000,percent of total billed charges,25.81% of $82.00 in Billed Charges for Rev 302 Proc 86000 = $21.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,SENTARA HEALTH,SENTARA MEDICARE,6.98,,,,,,,3.4900,82.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",82.00,,,,,,,3.4900,82.0000,percent of total billed charges,100% of $82.00 in Billed Charges for Rev 302 Proc 86000 = $82.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4.95,,,,,,,3.4900,82.0000,fee schedule,$9.89 from Fee Schedule TCUHC24 for Rev 302 Proc 86000 * Qty 1 = $9.89 at 50% = $4.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7.26,,,,,,,3.4900,82.0000,fee schedule,$6.98 from Fee Schedule UHC_31910 for Rev 302 Proc 86000 * Qty 1 = $6.98 at 104% = $7.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,6.98,,,,,,,3.4900,82.0000,fee schedule,$6.98 from Fee Schedule UHC_31910 for Rev 302 Proc 86000 * Qty 1 = $6.98 at 100% = $6.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,6.98,,,,,,,3.4900,82.0000,fee schedule,$6.98 from Fee Schedule UHC_31910 for Rev 302 Proc 86000 * Qty 1 = $6.98 at 100% = $6.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,3.4900,82.0000,fee schedule,APG 00394 Proc 86000 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,6.98,,,,,,,3.4900,82.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,6.98,,,,,,,3.4900,82.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,WELLCARE,WELLCARE MEDICAID,82.00,,,,,,,3.4900,82.0000,percent of total billed charges,100% of $82.00 in Billed Charges for Rev 302 Proc 86000 = $82.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AGGLUTININS FEBRILE,86000,CPT,302,RC,30200128,CDM,,,,both,,,82.0000,12.3000,WELLCARE,WELLCARE MEDICARE,7.40,,,,,,,3.4900,82.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,AETNA,AETNA,81.13,,,,,,,8.9700,190.0000,percent of total billed charges,42.7% of $190.00 in Billed Charges for Rev 302 Proc 86008 = $81.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,8.9700,190.0000,fee schedule,APG 00394 Proc 86008 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,17.93,,,,,,,8.9700,190.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,AETNA,AETNA HEALTHCARE MEDICARE,17.93,,,,,,,8.9700,190.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,17.93,,,,,,,8.9700,190.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,AMBETTER,AMBETTER,39.09,,,,,,,8.9700,190.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,AMERIGROUP,AMERIGROUP,8.97,,,,,,,8.9700,190.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,18.65,,,,,,,8.9700,190.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,ANTHEM EXCHANGE,17.93,,,,,,,8.9700,190.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,8.9700,190.0000,fee schedule,APG 00394 Proc 86008 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,ANTHEM HMO,17.93,,,,,,,8.9700,190.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,18.47,,,,,,,8.9700,190.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",17.93,,,,,,,8.9700,190.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,133.00,,,,,,,8.9700,190.0000,percent of total billed charges,Rev 302 Proc 86008 $190.00 in Billed Charges at 70% = $133.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,BLUE CROSS E NETWORK,70.85,,,,,,,8.9700,190.0000,fee schedule,$22.14 from Fee Schedule BCFSB for Rev 302 Proc 86008 * Qty 1 = $22.14 at 320% = $70.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,BLUE CROSS MEDICARE,18.65,,,,,,,8.9700,190.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,BLUE CROSS P NETWORK,72.40,,,,,,,8.9700,190.0000,fee schedule,$22.14 from Fee Schedule BCFSB for Rev 302 Proc 86008 * Qty 1 = $22.14 at 327% = $72.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,BLUE CROSS S NETWORK,72.40,,,,,,,8.9700,190.0000,fee schedule,$22.14 from Fee Schedule BCFSB for Rev 302 Proc 86008 * Qty 1 = $22.14 at 327% = $72.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,TENNCARE BLUE CARE,20.87,,,,,,,8.9700,190.0000,fee schedule,$17.99 from Fee Schedule TC_24 for Rev 302 Proc 86008 * Qty 1 = $17.99 at 116% = $20.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,BLUE CROSS,TENNCARE BLUE SELECT,20.87,,,,,,,8.9700,190.0000,fee schedule,$17.99 from Fee Schedule TC_24 for Rev 302 Proc 86008 * Qty 1 = $17.99 at 116% = $20.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,CIGNA HEALTHCARE,CIGNA HMO,79.23,,,,,,,8.9700,190.0000,percent of total billed charges,Rev 302 Proc 86008 $190.00 in Billed Charges at 41.7% = $79.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,39.70,,,,,,,8.9700,190.0000,fee schedule,$39.70 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86008 * Qty 1 = $39.70 at 100% = $39.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,18.83,,,,,,,8.9700,190.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,79.23,,,,,,,8.9700,190.0000,percent of total billed charges,Rev 302 Proc 86008 $190.00 in Billed Charges at 41.7% = $79.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,CIGNA HEALTHCARE,CIGNA PPO,79.23,,,,,,,8.9700,190.0000,percent of total billed charges,Rev 302 Proc 86008 $190.00 in Billed Charges at 41.7% = $79.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,18.83,,,,,,,8.9700,190.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,171.00,,,,,,,8.9700,190.0000,percent of total billed charges,90% of $190.00 in Billed Charges for Rev 302 Proc 86008 = $171.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,HUMANA,HUMANA MEDICARE,17.93,,,,,,,8.9700,190.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,17.93,,,,,,,8.9700,190.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,MEDCOST,MEDCOST VHN,90.42,,,,,,,8.9700,190.0000,percent of total billed charges,47.59% of $190.00 in Billed Charges for Rev 302 Proc 86008 = $90.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,8.9700,190.0000,fee schedule,APG 00394 Proc 86008 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,18.83,,,,,,,8.9700,190.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,18.83,,,,,,,8.9700,190.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,NHC ADVANTAGE,NHC ADVANTAGE,18.83,,,,,,,8.9700,190.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,8.9700,190.0000,fee schedule,APG 00394 Proc 86008 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,SENTARA HEALTH,SENTARA HEALTH,49.04,,,,,,,8.9700,190.0000,percent of total billed charges,25.81% of $190.00 in Billed Charges for Rev 302 Proc 86008 = $49.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,SENTARA HEALTH,SENTARA MEDICARE,17.93,,,,,,,8.9700,190.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",190.00,,,,,,,8.9700,190.0000,percent of total billed charges,100% of $190.00 in Billed Charges for Rev 302 Proc 86008 = $190.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11.07,,,,,,,8.9700,190.0000,fee schedule,$22.14 from Fee Schedule TCUHC24 for Rev 302 Proc 86008 * Qty 1 = $22.14 at 50% = $11.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,18.65,,,,,,,8.9700,190.0000,fee schedule,$17.93 from Fee Schedule UHC_31910 for Rev 302 Proc 86008 * Qty 1 = $17.93 at 104% = $18.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,17.93,,,,,,,8.9700,190.0000,fee schedule,$17.93 from Fee Schedule UHC_31910 for Rev 302 Proc 86008 * Qty 1 = $17.93 at 100% = $17.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,17.93,,,,,,,8.9700,190.0000,fee schedule,$17.93 from Fee Schedule UHC_31910 for Rev 302 Proc 86008 * Qty 1 = $17.93 at 100% = $17.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,8.9700,190.0000,fee schedule,APG 00394 Proc 86008 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,17.93,,,,,,,8.9700,190.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,17.93,,,,,,,8.9700,190.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,WELLCARE,WELLCARE MEDICAID,190.00,,,,,,,8.9700,190.0000,percent of total billed charges,100% of $190.00 in Billed Charges for Rev 302 Proc 86008 = $190.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA,86008,CPT,302,RC,30200138,CDM,,,,both,,,190.0000,28.5000,WELLCARE,WELLCARE MEDICARE,19.01,,,,,,,8.9700,190.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,AETNA,AETNA,72.16,,,,,,,7.5300,169.0000,percent of total billed charges,42.7% of $169.00 in Billed Charges for Rev 302 Proc 86021 = $72.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,7.5300,169.0000,fee schedule,APG 00394 Proc 86021 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,15.05,,,,,,,7.5300,169.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,AETNA,AETNA HEALTHCARE MEDICARE,15.05,,,,,,,7.5300,169.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,15.05,,,,,,,7.5300,169.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,AMBETTER,AMBETTER,32.81,,,,,,,7.5300,169.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,AMERIGROUP,AMERIGROUP,7.53,,,,,,,7.5300,169.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,15.65,,,,,,,7.5300,169.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,BLUE CROSS,ANTHEM EXCHANGE,15.05,,,,,,,7.5300,169.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,7.5300,169.0000,fee schedule,APG 00394 Proc 86021 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,BLUE CROSS,ANTHEM HMO,15.05,,,,,,,7.5300,169.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,15.50,,,,,,,7.5300,169.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",15.05,,,,,,,7.5300,169.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,42.99,,,,,,,7.5300,169.0000,fee schedule,$42.99 from Fee Schedule BLDTM_23 for Rev 302 Proc 86021 * Qty 1 = $42.99 at 100% = $42.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,BLUE CROSS,BLUE CROSS E NETWORK,26.40,,,,,,,7.5300,169.0000,fee schedule,$8.25 from Fee Schedule BCFSB for Rev 302 Proc 86021 * Qty 1 = $8.25 at 320% = $26.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,BLUE CROSS,BLUE CROSS MEDICARE,15.65,,,,,,,7.5300,169.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,BLUE CROSS,BLUE CROSS P NETWORK,26.98,,,,,,,7.5300,169.0000,fee schedule,$8.25 from Fee Schedule BCFSB for Rev 302 Proc 86021 * Qty 1 = $8.25 at 327% = $26.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,BLUE CROSS,BLUE CROSS S NETWORK,26.98,,,,,,,7.5300,169.0000,fee schedule,$8.25 from Fee Schedule BCFSB for Rev 302 Proc 86021 * Qty 1 = $8.25 at 327% = $26.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,BLUE CROSS,TENNCARE BLUE CARE,11.58,,,,,,,7.5300,169.0000,fee schedule,$9.98 from Fee Schedule TC_24 for Rev 302 Proc 86021 * Qty 1 = $9.98 at 116% = $11.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,BLUE CROSS,TENNCARE BLUE SELECT,11.58,,,,,,,7.5300,169.0000,fee schedule,$9.98 from Fee Schedule TC_24 for Rev 302 Proc 86021 * Qty 1 = $9.98 at 116% = $11.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,CIGNA HEALTHCARE,CIGNA HMO,60.57,,,,,,,7.5300,169.0000,fee schedule,$60.57 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86021 * Qty 1 = $60.57 at 100% = $60.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,33.20,,,,,,,7.5300,169.0000,fee schedule,$33.20 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86021 * Qty 1 = $33.20 at 100% = $33.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,15.80,,,,,,,7.5300,169.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,60.57,,,,,,,7.5300,169.0000,fee schedule,$60.57 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86021 * Qty 1 = $60.57 at 100% = $60.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,CIGNA HEALTHCARE,CIGNA PPO,60.57,,,,,,,7.5300,169.0000,fee schedule,$60.57 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86021 * Qty 1 = $60.57 at 100% = $60.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,15.80,,,,,,,7.5300,169.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,152.10,,,,,,,7.5300,169.0000,percent of total billed charges,90% of $169.00 in Billed Charges for Rev 302 Proc 86021 = $152.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,HUMANA,HUMANA MEDICARE,15.05,,,,,,,7.5300,169.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,15.05,,,,,,,7.5300,169.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,MEDCOST,MEDCOST VHN,80.43,,,,,,,7.5300,169.0000,percent of total billed charges,47.59% of $169.00 in Billed Charges for Rev 302 Proc 86021 = $80.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,7.5300,169.0000,fee schedule,APG 00394 Proc 86021 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,15.80,,,,,,,7.5300,169.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,15.80,,,,,,,7.5300,169.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,NHC ADVANTAGE,NHC ADVANTAGE,15.80,,,,,,,7.5300,169.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,7.5300,169.0000,fee schedule,APG 00394 Proc 86021 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,SENTARA HEALTH,SENTARA HEALTH,43.62,,,,,,,7.5300,169.0000,percent of total billed charges,25.81% of $169.00 in Billed Charges for Rev 302 Proc 86021 = $43.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,SENTARA HEALTH,SENTARA MEDICARE,15.05,,,,,,,7.5300,169.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",169.00,,,,,,,7.5300,169.0000,percent of total billed charges,100% of $169.00 in Billed Charges for Rev 302 Proc 86021 = $169.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,10.67,,,,,,,7.5300,169.0000,fee schedule,$21.33 from Fee Schedule TCUHC24 for Rev 302 Proc 86021 * Qty 1 = $21.33 at 50% = $10.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,15.65,,,,,,,7.5300,169.0000,fee schedule,$15.05 from Fee Schedule UHC_31910 for Rev 302 Proc 86021 * Qty 1 = $15.05 at 104% = $15.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,15.05,,,,,,,7.5300,169.0000,fee schedule,$15.05 from Fee Schedule UHC_31910 for Rev 302 Proc 86021 * Qty 1 = $15.05 at 100% = $15.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,15.05,,,,,,,7.5300,169.0000,fee schedule,$15.05 from Fee Schedule UHC_31910 for Rev 302 Proc 86021 * Qty 1 = $15.05 at 100% = $15.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,7.5300,169.0000,fee schedule,APG 00394 Proc 86021 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,15.05,,,,,,,7.5300,169.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,15.05,,,,,,,7.5300,169.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,WELLCARE,WELLCARE MEDICAID,169.00,,,,,,,7.5300,169.0000,percent of total billed charges,100% of $169.00 in Billed Charges for Rev 302 Proc 86021 = $169.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY ID LEUKOCYTE AB,86021,CPT,302,RC,30200034,CDM,,,,both,,,169.0000,25.3500,WELLCARE,WELLCARE MEDICARE,15.95,,,,,,,7.5300,169.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,AETNA,AETNA,88.39,,,,,,,9.1900,207.0000,percent of total billed charges,42.7% of $207.00 in Billed Charges for Rev 302 Proc 86022 = $88.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,9.1900,207.0000,fee schedule,APG 00394 Proc 86022 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,18.37,,,,,,,9.1900,207.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,AETNA,AETNA HEALTHCARE MEDICARE,18.37,,,,,,,9.1900,207.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,18.37,,,,,,,9.1900,207.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,AMBETTER,AMBETTER,40.05,,,,,,,9.1900,207.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,AMERIGROUP,AMERIGROUP,9.19,,,,,,,9.1900,207.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,19.10,,,,,,,9.1900,207.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,BLUE CROSS,ANTHEM EXCHANGE,18.37,,,,,,,9.1900,207.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,9.1900,207.0000,fee schedule,APG 00394 Proc 86022 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,BLUE CROSS,ANTHEM HMO,18.37,,,,,,,9.1900,207.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,18.92,,,,,,,9.1900,207.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",18.37,,,,,,,9.1900,207.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,62.25,,,,,,,9.1900,207.0000,fee schedule,$62.25 from Fee Schedule BLDTM_23 for Rev 302 Proc 86022 * Qty 1 = $62.25 at 100% = $62.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,BLUE CROSS,BLUE CROSS E NETWORK,47.42,,,,,,,9.1900,207.0000,fee schedule,$14.82 from Fee Schedule BCFSB for Rev 302 Proc 86022 * Qty 1 = $14.82 at 320% = $47.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,BLUE CROSS,BLUE CROSS MEDICARE,19.10,,,,,,,9.1900,207.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,BLUE CROSS,BLUE CROSS P NETWORK,48.46,,,,,,,9.1900,207.0000,fee schedule,$14.82 from Fee Schedule BCFSB for Rev 302 Proc 86022 * Qty 1 = $14.82 at 327% = $48.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,BLUE CROSS,BLUE CROSS S NETWORK,48.46,,,,,,,9.1900,207.0000,fee schedule,$14.82 from Fee Schedule BCFSB for Rev 302 Proc 86022 * Qty 1 = $14.82 at 327% = $48.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,BLUE CROSS,TENNCARE BLUE CARE,11.58,,,,,,,9.1900,207.0000,fee schedule,$9.98 from Fee Schedule TC_24 for Rev 302 Proc 86022 * Qty 1 = $9.98 at 116% = $11.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,BLUE CROSS,TENNCARE BLUE SELECT,11.58,,,,,,,9.1900,207.0000,fee schedule,$9.98 from Fee Schedule TC_24 for Rev 302 Proc 86022 * Qty 1 = $9.98 at 116% = $11.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,CIGNA HEALTHCARE,CIGNA HMO,73.90,,,,,,,9.1900,207.0000,fee schedule,$73.90 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86022 * Qty 1 = $73.90 at 100% = $73.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,40.42,,,,,,,9.1900,207.0000,fee schedule,$40.42 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86022 * Qty 1 = $40.42 at 100% = $40.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,19.29,,,,,,,9.1900,207.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,73.90,,,,,,,9.1900,207.0000,fee schedule,$73.90 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86022 * Qty 1 = $73.90 at 100% = $73.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,CIGNA HEALTHCARE,CIGNA PPO,73.90,,,,,,,9.1900,207.0000,fee schedule,$73.90 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86022 * Qty 1 = $73.90 at 100% = $73.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,19.29,,,,,,,9.1900,207.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,186.30,,,,,,,9.1900,207.0000,percent of total billed charges,90% of $207.00 in Billed Charges for Rev 302 Proc 86022 = $186.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,HUMANA,HUMANA MEDICARE,18.37,,,,,,,9.1900,207.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,18.37,,,,,,,9.1900,207.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,MEDCOST,MEDCOST VHN,98.51,,,,,,,9.1900,207.0000,percent of total billed charges,47.59% of $207.00 in Billed Charges for Rev 302 Proc 86022 = $98.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,9.1900,207.0000,fee schedule,APG 00394 Proc 86022 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,19.29,,,,,,,9.1900,207.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,19.29,,,,,,,9.1900,207.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,NHC ADVANTAGE,NHC ADVANTAGE,19.29,,,,,,,9.1900,207.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,9.1900,207.0000,fee schedule,APG 00394 Proc 86022 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,SENTARA HEALTH,SENTARA HEALTH,53.43,,,,,,,9.1900,207.0000,percent of total billed charges,25.81% of $207.00 in Billed Charges for Rev 302 Proc 86022 = $53.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,SENTARA HEALTH,SENTARA MEDICARE,18.37,,,,,,,9.1900,207.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",207.00,,,,,,,9.1900,207.0000,percent of total billed charges,100% of $207.00 in Billed Charges for Rev 302 Proc 86022 = $207.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,13.01,,,,,,,9.1900,207.0000,fee schedule,$26.02 from Fee Schedule TCUHC24 for Rev 302 Proc 86022 * Qty 1 = $26.02 at 50% = $13.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,19.10,,,,,,,9.1900,207.0000,fee schedule,$18.37 from Fee Schedule UHC_31910 for Rev 302 Proc 86022 * Qty 1 = $18.37 at 104% = $19.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,18.37,,,,,,,9.1900,207.0000,fee schedule,$18.37 from Fee Schedule UHC_31910 for Rev 302 Proc 86022 * Qty 1 = $18.37 at 100% = $18.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,18.37,,,,,,,9.1900,207.0000,fee schedule,$18.37 from Fee Schedule UHC_31910 for Rev 302 Proc 86022 * Qty 1 = $18.37 at 100% = $18.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,9.1900,207.0000,fee schedule,APG 00394 Proc 86022 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,18.37,,,,,,,9.1900,207.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,18.37,,,,,,,9.1900,207.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,WELLCARE,WELLCARE MEDICAID,207.00,,,,,,,9.1900,207.0000,percent of total billed charges,100% of $207.00 in Billed Charges for Rev 302 Proc 86022 = $207.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLATELET ANTIBODIES ADDL REF,86022,CPT,302,RC,30200002,CDM,,,,both,,,207.0000,31.0500,WELLCARE,WELLCARE MEDICARE,19.47,,,,,,,9.1900,207.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,AETNA,AETNA,62.34,,,,,,,6.2300,146.0000,percent of total billed charges,42.7% of $146.00 in Billed Charges for Rev 302 Proc 86023 = $62.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,6.2300,146.0000,fee schedule,APG 00394 Proc 86023 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,12.46,,,,,,,6.2300,146.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,AETNA,AETNA HEALTHCARE MEDICARE,12.46,,,,,,,6.2300,146.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,12.46,,,,,,,6.2300,146.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,AMBETTER,AMBETTER,27.16,,,,,,,6.2300,146.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,AMERIGROUP,AMERIGROUP,6.23,,,,,,,6.2300,146.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,12.96,,,,,,,6.2300,146.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,BLUE CROSS,ANTHEM EXCHANGE,12.46,,,,,,,6.2300,146.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,6.2300,146.0000,fee schedule,APG 00394 Proc 86023 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,BLUE CROSS,ANTHEM HMO,12.46,,,,,,,6.2300,146.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,12.83,,,,,,,6.2300,146.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",12.46,,,,,,,6.2300,146.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,35.83,,,,,,,6.2300,146.0000,fee schedule,$35.83 from Fee Schedule BLDTM_23 for Rev 302 Proc 86023 * Qty 1 = $35.83 at 100% = $35.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,BLUE CROSS,BLUE CROSS E NETWORK,54.40,,,,,,,6.2300,146.0000,fee schedule,$17.00 from Fee Schedule BCFSB for Rev 302 Proc 86023 * Qty 1 = $17.00 at 320% = $54.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,BLUE CROSS,BLUE CROSS MEDICARE,12.96,,,,,,,6.2300,146.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,BLUE CROSS,BLUE CROSS P NETWORK,55.59,,,,,,,6.2300,146.0000,fee schedule,$17.00 from Fee Schedule BCFSB for Rev 302 Proc 86023 * Qty 1 = $17.00 at 327% = $55.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,BLUE CROSS,BLUE CROSS S NETWORK,55.59,,,,,,,6.2300,146.0000,fee schedule,$17.00 from Fee Schedule BCFSB for Rev 302 Proc 86023 * Qty 1 = $17.00 at 327% = $55.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,BLUE CROSS,TENNCARE BLUE CARE,24.08,,,,,,,6.2300,146.0000,fee schedule,$20.76 from Fee Schedule TC_24 for Rev 302 Proc 86023 * Qty 1 = $20.76 at 116% = $24.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,BLUE CROSS,TENNCARE BLUE SELECT,24.08,,,,,,,6.2300,146.0000,fee schedule,$20.76 from Fee Schedule TC_24 for Rev 302 Proc 86023 * Qty 1 = $20.76 at 116% = $24.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,CIGNA HEALTHCARE,CIGNA HMO,50.12,,,,,,,6.2300,146.0000,fee schedule,$50.12 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86023 * Qty 1 = $50.12 at 100% = $50.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,27.43,,,,,,,6.2300,146.0000,fee schedule,$27.43 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86023 * Qty 1 = $27.43 at 100% = $27.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,13.08,,,,,,,6.2300,146.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,50.12,,,,,,,6.2300,146.0000,fee schedule,$50.12 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86023 * Qty 1 = $50.12 at 100% = $50.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,CIGNA HEALTHCARE,CIGNA PPO,50.12,,,,,,,6.2300,146.0000,fee schedule,$50.12 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86023 * Qty 1 = $50.12 at 100% = $50.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,13.08,,,,,,,6.2300,146.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,131.40,,,,,,,6.2300,146.0000,percent of total billed charges,90% of $146.00 in Billed Charges for Rev 302 Proc 86023 = $131.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,HUMANA,HUMANA MEDICARE,12.46,,,,,,,6.2300,146.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,12.46,,,,,,,6.2300,146.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,MEDCOST,MEDCOST VHN,69.48,,,,,,,6.2300,146.0000,percent of total billed charges,47.59% of $146.00 in Billed Charges for Rev 302 Proc 86023 = $69.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,6.2300,146.0000,fee schedule,APG 00394 Proc 86023 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,13.08,,,,,,,6.2300,146.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,13.08,,,,,,,6.2300,146.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,NHC ADVANTAGE,NHC ADVANTAGE,13.08,,,,,,,6.2300,146.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,6.2300,146.0000,fee schedule,APG 00394 Proc 86023 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,SENTARA HEALTH,SENTARA HEALTH,37.68,,,,,,,6.2300,146.0000,percent of total billed charges,25.81% of $146.00 in Billed Charges for Rev 302 Proc 86023 = $37.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,SENTARA HEALTH,SENTARA MEDICARE,12.46,,,,,,,6.2300,146.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",146.00,,,,,,,6.2300,146.0000,percent of total billed charges,100% of $146.00 in Billed Charges for Rev 302 Proc 86023 = $146.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.82,,,,,,,6.2300,146.0000,fee schedule,$17.64 from Fee Schedule TCUHC24 for Rev 302 Proc 86023 * Qty 1 = $17.64 at 50% = $8.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12.96,,,,,,,6.2300,146.0000,fee schedule,$12.46 from Fee Schedule UHC_31910 for Rev 302 Proc 86023 * Qty 1 = $12.46 at 104% = $12.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,12.46,,,,,,,6.2300,146.0000,fee schedule,$12.46 from Fee Schedule UHC_31910 for Rev 302 Proc 86023 * Qty 1 = $12.46 at 100% = $12.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,12.46,,,,,,,6.2300,146.0000,fee schedule,$12.46 from Fee Schedule UHC_31910 for Rev 302 Proc 86023 * Qty 1 = $12.46 at 100% = $12.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,6.2300,146.0000,fee schedule,APG 00394 Proc 86023 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,12.46,,,,,,,6.2300,146.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,12.46,,,,,,,6.2300,146.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,WELLCARE,WELLCARE MEDICAID,146.00,,,,,,,6.2300,146.0000,percent of total billed charges,100% of $146.00 in Billed Charges for Rev 302 Proc 86023 = $146.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLATELET ASSOC IMMUNOGLOBULIN,86023,CPT,302,RC,30200017,CDM,,,,both,,,146.0000,21.9000,WELLCARE,WELLCARE MEDICARE,13.21,,,,,,,6.2300,146.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,AETNA,AETNA,80.28,,,,,,,6.0300,188.0000,percent of total billed charges,42.7% of $188.00 in Billed Charges for Rev 300 Proc 86036 = $80.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,6.0300,188.0000,fee schedule,APG 00394 Proc 86036 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,12.05,,,,,,,6.0300,188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,AETNA,AETNA HEALTHCARE MEDICARE,12.05,,,,,,,6.0300,188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,12.05,,,,,,,6.0300,188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,AMBETTER,AMBETTER,26.27,,,,,,,6.0300,188.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,AMERIGROUP,AMERIGROUP,6.03,,,,,,,6.0300,188.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,12.53,,,,,,,6.0300,188.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,ANTHEM EXCHANGE,12.05,,,,,,,6.0300,188.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,6.0300,188.0000,fee schedule,APG 00394 Proc 86036 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,ANTHEM HMO,12.05,,,,,,,6.0300,188.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,12.41,,,,,,,6.0300,188.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",12.05,,,,,,,6.0300,188.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,131.60,,,,,,,6.0300,188.0000,percent of total billed charges,Rev 300 Proc 86036 $188.00 in Billed Charges at 70% = $131.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,BLUE CROSS E NETWORK,38.56,,,,,,,6.0300,188.0000,fee schedule,$12.05 from Fee Schedule BCFSB for Rev 300 Proc 86036 * Qty 1 = $12.05 at 320% = $38.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,BLUE CROSS MEDICARE,12.53,,,,,,,6.0300,188.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,BLUE CROSS P NETWORK,39.40,,,,,,,6.0300,188.0000,fee schedule,$12.05 from Fee Schedule BCFSB for Rev 300 Proc 86036 * Qty 1 = $12.05 at 327% = $39.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,BLUE CROSS S NETWORK,39.40,,,,,,,6.0300,188.0000,fee schedule,$12.05 from Fee Schedule BCFSB for Rev 300 Proc 86036 * Qty 1 = $12.05 at 327% = $39.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,TENNCARE BLUE CARE,11.36,,,,,,,6.0300,188.0000,fee schedule,$9.79 from Fee Schedule TC_24 for Rev 300 Proc 86036 * Qty 1 = $9.79 at 116% = $11.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,TENNCARE BLUE SELECT,11.36,,,,,,,6.0300,188.0000,fee schedule,$9.79 from Fee Schedule TC_24 for Rev 300 Proc 86036 * Qty 1 = $9.79 at 116% = $11.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,CIGNA HEALTHCARE,CIGNA HMO,78.40,,,,,,,6.0300,188.0000,percent of total billed charges,Rev 300 Proc 86036 $188.00 in Billed Charges at 41.7% = $78.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,26.71,,,,,,,6.0300,188.0000,fee schedule,$26.71 from Fee Schedule CGIFP_25LR for Rev 300 Proc 86036 * Qty 1 = $26.71 at 100% = $26.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,12.65,,,,,,,6.0300,188.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,78.40,,,,,,,6.0300,188.0000,percent of total billed charges,Rev 300 Proc 86036 $188.00 in Billed Charges at 41.7% = $78.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,CIGNA HEALTHCARE,CIGNA PPO,78.40,,,,,,,6.0300,188.0000,percent of total billed charges,Rev 300 Proc 86036 $188.00 in Billed Charges at 41.7% = $78.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,12.65,,,,,,,6.0300,188.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,169.20,,,,,,,6.0300,188.0000,percent of total billed charges,90% of $188.00 in Billed Charges for Rev 300 Proc 86036 = $169.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,HUMANA,HUMANA MEDICARE,12.05,,,,,,,6.0300,188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,12.05,,,,,,,6.0300,188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,MEDCOST,MEDCOST VHN,89.47,,,,,,,6.0300,188.0000,percent of total billed charges,47.59% of $188.00 in Billed Charges for Rev 300 Proc 86036 = $89.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,6.0300,188.0000,fee schedule,APG 00394 Proc 86036 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,12.65,,,,,,,6.0300,188.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,12.65,,,,,,,6.0300,188.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,NHC ADVANTAGE,NHC ADVANTAGE,12.65,,,,,,,6.0300,188.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,6.0300,188.0000,fee schedule,APG 00394 Proc 86036 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,SENTARA HEALTH,SENTARA HEALTH,48.52,,,,,,,6.0300,188.0000,percent of total billed charges,25.81% of $188.00 in Billed Charges for Rev 300 Proc 86036 = $48.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,SENTARA HEALTH,SENTARA MEDICARE,12.05,,,,,,,6.0300,188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",188.00,,,,,,,6.0300,188.0000,percent of total billed charges,100% of $188.00 in Billed Charges for Rev 300 Proc 86036 = $188.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6.03,,,,,,,6.0300,188.0000,fee schedule,$12.05 from Fee Schedule TCUHC24 for Rev 300 Proc 86036 * Qty 1 = $12.05 at 50% = $6.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12.53,,,,,,,6.0300,188.0000,fee schedule,$12.05 from Fee Schedule UHC_31910 for Rev 300 Proc 86036 * Qty 1 = $12.05 at 104% = $12.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,12.05,,,,,,,6.0300,188.0000,fee schedule,$12.05 from Fee Schedule UHC_31910 for Rev 300 Proc 86036 * Qty 1 = $12.05 at 100% = $12.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,12.05,,,,,,,6.0300,188.0000,fee schedule,$12.05 from Fee Schedule UHC_31910 for Rev 300 Proc 86036 * Qty 1 = $12.05 at 100% = $12.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,6.0300,188.0000,fee schedule,APG 00394 Proc 86036 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,12.05,,,,,,,6.0300,188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,12.05,,,,,,,6.0300,188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,WELLCARE,WELLCARE MEDICAID,188.00,,,,,,,6.0300,188.0000,percent of total billed charges,100% of $188.00 in Billed Charges for Rev 300 Proc 86036 = $188.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB,86036,CPT,300,RC,30000307,CDM,,,,both,,,188.0000,28.2000,WELLCARE,WELLCARE MEDICARE,12.77,,,,,,,6.0300,188.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,AETNA,AETNA,60.21,,,,,,,6.0500,141.0000,percent of total billed charges,42.7% of $141.00 in Billed Charges for Rev 302 Proc 86038 = $60.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,6.0500,141.0000,fee schedule,APG 00394 Proc 86038 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,12.09,,,,,,,6.0500,141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,AETNA,AETNA HEALTHCARE MEDICARE,12.09,,,,,,,6.0500,141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,12.09,,,,,,,6.0500,141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,AMBETTER,AMBETTER,26.36,,,,,,,6.0500,141.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,AMERIGROUP,AMERIGROUP,6.05,,,,,,,6.0500,141.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,12.57,,,,,,,6.0500,141.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,ANTHEM EXCHANGE,12.09,,,,,,,6.0500,141.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,6.0500,141.0000,fee schedule,APG 00394 Proc 86038 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,ANTHEM HMO,12.09,,,,,,,6.0500,141.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,12.45,,,,,,,6.0500,141.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",12.09,,,,,,,6.0500,141.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,40.93,,,,,,,6.0500,141.0000,fee schedule,$40.93 from Fee Schedule BLDTM_23 for Rev 302 Proc 86038 * Qty 1 = $40.93 at 100% = $40.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,BLUE CROSS E NETWORK,52.77,,,,,,,6.0500,141.0000,fee schedule,$16.49 from Fee Schedule BCFSB for Rev 302 Proc 86038 * Qty 1 = $16.49 at 320% = $52.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,BLUE CROSS MEDICARE,12.57,,,,,,,6.0500,141.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,BLUE CROSS P NETWORK,53.92,,,,,,,6.0500,141.0000,fee schedule,$16.49 from Fee Schedule BCFSB for Rev 302 Proc 86038 * Qty 1 = $16.49 at 327% = $53.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,BLUE CROSS S NETWORK,53.92,,,,,,,6.0500,141.0000,fee schedule,$16.49 from Fee Schedule BCFSB for Rev 302 Proc 86038 * Qty 1 = $16.49 at 327% = $53.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,TENNCARE BLUE CARE,27.47,,,,,,,6.0500,141.0000,fee schedule,$23.68 from Fee Schedule TC_24 for Rev 302 Proc 86038 * Qty 1 = $23.68 at 116% = $27.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,TENNCARE BLUE SELECT,27.47,,,,,,,6.0500,141.0000,fee schedule,$23.68 from Fee Schedule TC_24 for Rev 302 Proc 86038 * Qty 1 = $23.68 at 116% = $27.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,CIGNA HEALTHCARE,CIGNA HMO,48.64,,,,,,,6.0500,141.0000,fee schedule,$48.64 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86038 * Qty 1 = $48.64 at 100% = $48.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,26.71,,,,,,,6.0500,141.0000,fee schedule,$26.71 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86038 * Qty 1 = $26.71 at 100% = $26.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,12.69,,,,,,,6.0500,141.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,48.64,,,,,,,6.0500,141.0000,fee schedule,$48.64 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86038 * Qty 1 = $48.64 at 100% = $48.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,CIGNA HEALTHCARE,CIGNA PPO,48.64,,,,,,,6.0500,141.0000,fee schedule,$48.64 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86038 * Qty 1 = $48.64 at 100% = $48.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,12.69,,,,,,,6.0500,141.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,126.90,,,,,,,6.0500,141.0000,percent of total billed charges,90% of $141.00 in Billed Charges for Rev 302 Proc 86038 = $126.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,HUMANA,HUMANA MEDICARE,12.09,,,,,,,6.0500,141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,12.09,,,,,,,6.0500,141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,MEDCOST,MEDCOST VHN,67.10,,,,,,,6.0500,141.0000,percent of total billed charges,47.59% of $141.00 in Billed Charges for Rev 302 Proc 86038 = $67.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,6.0500,141.0000,fee schedule,APG 00394 Proc 86038 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,12.69,,,,,,,6.0500,141.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,12.69,,,,,,,6.0500,141.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,NHC ADVANTAGE,NHC ADVANTAGE,12.69,,,,,,,6.0500,141.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,6.0500,141.0000,fee schedule,APG 00394 Proc 86038 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,SENTARA HEALTH,SENTARA HEALTH,36.39,,,,,,,6.0500,141.0000,percent of total billed charges,25.81% of $141.00 in Billed Charges for Rev 302 Proc 86038 = $36.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,SENTARA HEALTH,SENTARA MEDICARE,12.09,,,,,,,6.0500,141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",141.00,,,,,,,6.0500,141.0000,percent of total billed charges,100% of $141.00 in Billed Charges for Rev 302 Proc 86038 = $141.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.56,,,,,,,6.0500,141.0000,fee schedule,$17.12 from Fee Schedule TCUHC24 for Rev 302 Proc 86038 * Qty 1 = $17.12 at 50% = $8.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12.57,,,,,,,6.0500,141.0000,fee schedule,$12.09 from Fee Schedule UHC_31910 for Rev 302 Proc 86038 * Qty 1 = $12.09 at 104% = $12.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,12.09,,,,,,,6.0500,141.0000,fee schedule,$12.09 from Fee Schedule UHC_31910 for Rev 302 Proc 86038 * Qty 1 = $12.09 at 100% = $12.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,12.09,,,,,,,6.0500,141.0000,fee schedule,$12.09 from Fee Schedule UHC_31910 for Rev 302 Proc 86038 * Qty 1 = $12.09 at 100% = $12.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,6.0500,141.0000,fee schedule,APG 00394 Proc 86038 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,12.09,,,,,,,6.0500,141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,12.09,,,,,,,6.0500,141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,WELLCARE,WELLCARE MEDICAID,141.00,,,,,,,6.0500,141.0000,percent of total billed charges,100% of $141.00 in Billed Charges for Rev 302 Proc 86038 = $141.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINUCLEAR ANTIBODIES ANA SCREEN,86038,CPT,302,RC,30200003,CDM,,,,both,,,141.0000,21.1500,WELLCARE,WELLCARE MEDICARE,12.82,,,,,,,6.0500,141.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,AETNA,AETNA,55.51,,,,,,,5.5800,130.0000,percent of total billed charges,42.7% of $130.00 in Billed Charges for Rev 302 Proc 86039 = $55.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,5.5800,130.0000,fee schedule,APG 00394 Proc 86039 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,11.16,,,,,,,5.5800,130.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,AETNA,AETNA HEALTHCARE MEDICARE,11.16,,,,,,,5.5800,130.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,11.16,,,,,,,5.5800,130.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,AMBETTER,AMBETTER,24.33,,,,,,,5.5800,130.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,AMERIGROUP,AMERIGROUP,5.58,,,,,,,5.5800,130.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,11.61,,,,,,,5.5800,130.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,BLUE CROSS,ANTHEM EXCHANGE,11.16,,,,,,,5.5800,130.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,5.5800,130.0000,fee schedule,APG 00394 Proc 86039 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,BLUE CROSS,ANTHEM HMO,11.16,,,,,,,5.5800,130.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,11.49,,,,,,,5.5800,130.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",11.16,,,,,,,5.5800,130.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,37.52,,,,,,,5.5800,130.0000,fee schedule,$37.52 from Fee Schedule BLDTM_23 for Rev 302 Proc 86039 * Qty 1 = $37.52 at 100% = $37.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,BLUE CROSS,BLUE CROSS E NETWORK,48.74,,,,,,,5.5800,130.0000,fee schedule,$15.23 from Fee Schedule BCFSB for Rev 302 Proc 86039 * Qty 1 = $15.23 at 320% = $48.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,BLUE CROSS,BLUE CROSS MEDICARE,11.61,,,,,,,5.5800,130.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,BLUE CROSS,BLUE CROSS P NETWORK,49.80,,,,,,,5.5800,130.0000,fee schedule,$15.23 from Fee Schedule BCFSB for Rev 302 Proc 86039 * Qty 1 = $15.23 at 327% = $49.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,BLUE CROSS,BLUE CROSS S NETWORK,49.80,,,,,,,5.5800,130.0000,fee schedule,$15.23 from Fee Schedule BCFSB for Rev 302 Proc 86039 * Qty 1 = $15.23 at 327% = $49.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,BLUE CROSS,TENNCARE BLUE CARE,17.56,,,,,,,5.5800,130.0000,fee schedule,$15.14 from Fee Schedule TC_24 for Rev 302 Proc 86039 * Qty 1 = $15.14 at 116% = $17.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,BLUE CROSS,TENNCARE BLUE SELECT,17.56,,,,,,,5.5800,130.0000,fee schedule,$15.14 from Fee Schedule TC_24 for Rev 302 Proc 86039 * Qty 1 = $15.14 at 116% = $17.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,CIGNA HEALTHCARE,CIGNA HMO,44.92,,,,,,,5.5800,130.0000,fee schedule,$44.92 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86039 * Qty 1 = $44.92 at 100% = $44.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,24.54,,,,,,,5.5800,130.0000,fee schedule,$24.54 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86039 * Qty 1 = $24.54 at 100% = $24.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,11.72,,,,,,,5.5800,130.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,44.92,,,,,,,5.5800,130.0000,fee schedule,$44.92 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86039 * Qty 1 = $44.92 at 100% = $44.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,CIGNA HEALTHCARE,CIGNA PPO,44.92,,,,,,,5.5800,130.0000,fee schedule,$44.92 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86039 * Qty 1 = $44.92 at 100% = $44.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,11.72,,,,,,,5.5800,130.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,117.00,,,,,,,5.5800,130.0000,percent of total billed charges,90% of $130.00 in Billed Charges for Rev 302 Proc 86039 = $117.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,HUMANA,HUMANA MEDICARE,11.16,,,,,,,5.5800,130.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,11.16,,,,,,,5.5800,130.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,MEDCOST,MEDCOST VHN,61.87,,,,,,,5.5800,130.0000,percent of total billed charges,47.59% of $130.00 in Billed Charges for Rev 302 Proc 86039 = $61.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,5.5800,130.0000,fee schedule,APG 00394 Proc 86039 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,11.72,,,,,,,5.5800,130.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,11.72,,,,,,,5.5800,130.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,NHC ADVANTAGE,NHC ADVANTAGE,11.72,,,,,,,5.5800,130.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,5.5800,130.0000,fee schedule,APG 00394 Proc 86039 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,SENTARA HEALTH,SENTARA HEALTH,33.55,,,,,,,5.5800,130.0000,percent of total billed charges,25.81% of $130.00 in Billed Charges for Rev 302 Proc 86039 = $33.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,SENTARA HEALTH,SENTARA MEDICARE,11.16,,,,,,,5.5800,130.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",130.00,,,,,,,5.5800,130.0000,percent of total billed charges,100% of $130.00 in Billed Charges for Rev 302 Proc 86039 = $130.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7.91,,,,,,,5.5800,130.0000,fee schedule,$15.81 from Fee Schedule TCUHC24 for Rev 302 Proc 86039 * Qty 1 = $15.81 at 50% = $7.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,11.61,,,,,,,5.5800,130.0000,fee schedule,$11.16 from Fee Schedule UHC_31910 for Rev 302 Proc 86039 * Qty 1 = $11.16 at 104% = $11.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11.16,,,,,,,5.5800,130.0000,fee schedule,$11.16 from Fee Schedule UHC_31910 for Rev 302 Proc 86039 * Qty 1 = $11.16 at 100% = $11.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,11.16,,,,,,,5.5800,130.0000,fee schedule,$11.16 from Fee Schedule UHC_31910 for Rev 302 Proc 86039 * Qty 1 = $11.16 at 100% = $11.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,5.5800,130.0000,fee schedule,APG 00394 Proc 86039 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,11.16,,,,,,,5.5800,130.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,11.16,,,,,,,5.5800,130.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,WELLCARE,WELLCARE MEDICAID,130.00,,,,,,,5.5800,130.0000,percent of total billed charges,100% of $130.00 in Billed Charges for Rev 302 Proc 86039 = $130.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANA TITER REF,86039,CPT,302,RC,30200004,CDM,,,,both,,,130.0000,19.5000,WELLCARE,WELLCARE MEDICARE,11.83,,,,,,,5.5800,130.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,AETNA,AETNA,67.47,,,,,,,9.2000,158.0000,percent of total billed charges,42.7% of $158.00 in Billed Charges for Rev 300 Proc 86041 = $67.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,9.2000,158.0000,fee schedule,APG 00394 Proc 86041 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,AETNA,AETNA HEALTHCARE MEDICARE,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,AMBETTER,AMBETTER,40.11,,,,,,,9.2000,158.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,AMERIGROUP,AMERIGROUP,9.20,,,,,,,9.2000,158.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,19.14,,,,,,,9.2000,158.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,ANTHEM EXCHANGE,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,9.2000,158.0000,fee schedule,APG 00394 Proc 86041 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,ANTHEM HMO,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,18.95,,,,,,,9.2000,158.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,110.60,,,,,,,9.2000,158.0000,percent of total billed charges,Rev 300 Proc 86041 $158.00 in Billed Charges at 70% = $110.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS E NETWORK,58.88,,,,,,,9.2000,158.0000,fee schedule,$18.40 from Fee Schedule BCFSB for Rev 300 Proc 86041 * Qty 1 = $18.40 at 320% = $58.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS MEDICARE,19.14,,,,,,,9.2000,158.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS P NETWORK,60.17,,,,,,,9.2000,158.0000,fee schedule,$18.40 from Fee Schedule BCFSB for Rev 300 Proc 86041 * Qty 1 = $18.40 at 327% = $60.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS S NETWORK,60.17,,,,,,,9.2000,158.0000,fee schedule,$18.40 from Fee Schedule BCFSB for Rev 300 Proc 86041 * Qty 1 = $18.40 at 327% = $60.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,TENNCARE BLUE CARE,17.34,,,,,,,9.2000,158.0000,fee schedule,$14.95 from Fee Schedule TC_24 for Rev 300 Proc 86041 * Qty 1 = $14.95 at 116% = $17.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,TENNCARE BLUE SELECT,17.34,,,,,,,9.2000,158.0000,fee schedule,$14.95 from Fee Schedule TC_24 for Rev 300 Proc 86041 * Qty 1 = $14.95 at 116% = $17.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA HMO,65.89,,,,,,,9.2000,158.0000,percent of total billed charges,Rev 300 Proc 86041 $158.00 in Billed Charges at 41.7% = $65.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,40.42,,,,,,,9.2000,158.0000,fee schedule,$40.42 from Fee Schedule CGIFP_25LR for Rev 300 Proc 86041 * Qty 1 = $40.42 at 100% = $40.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,19.32,,,,,,,9.2000,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,65.89,,,,,,,9.2000,158.0000,percent of total billed charges,Rev 300 Proc 86041 $158.00 in Billed Charges at 41.7% = $65.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA PPO,65.89,,,,,,,9.2000,158.0000,percent of total billed charges,Rev 300 Proc 86041 $158.00 in Billed Charges at 41.7% = $65.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,19.32,,,,,,,9.2000,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,142.20,,,,,,,9.2000,158.0000,percent of total billed charges,90% of $158.00 in Billed Charges for Rev 300 Proc 86041 = $142.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,HUMANA,HUMANA MEDICARE,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,MEDCOST,MEDCOST VHN,75.19,,,,,,,9.2000,158.0000,percent of total billed charges,47.59% of $158.00 in Billed Charges for Rev 300 Proc 86041 = $75.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,9.2000,158.0000,fee schedule,APG 00394 Proc 86041 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,19.32,,,,,,,9.2000,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,19.32,,,,,,,9.2000,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,NHC ADVANTAGE,NHC ADVANTAGE,19.32,,,,,,,9.2000,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,9.2000,158.0000,fee schedule,APG 00394 Proc 86041 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,SENTARA HEALTH,SENTARA HEALTH,40.78,,,,,,,9.2000,158.0000,percent of total billed charges,25.81% of $158.00 in Billed Charges for Rev 300 Proc 86041 = $40.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,SENTARA HEALTH,SENTARA MEDICARE,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",158.00,,,,,,,9.2000,158.0000,percent of total billed charges,100% of $158.00 in Billed Charges for Rev 300 Proc 86041 = $158.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9.20,,,,,,,9.2000,158.0000,fee schedule,$18.40 from Fee Schedule TCUHC24 for Rev 300 Proc 86041 * Qty 1 = $18.40 at 50% = $9.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,19.14,,,,,,,9.2000,158.0000,fee schedule,$18.40 from Fee Schedule UHC_31910 for Rev 300 Proc 86041 * Qty 1 = $18.40 at 104% = $19.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,18.40,,,,,,,9.2000,158.0000,fee schedule,$18.40 from Fee Schedule UHC_31910 for Rev 300 Proc 86041 * Qty 1 = $18.40 at 100% = $18.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,18.40,,,,,,,9.2000,158.0000,fee schedule,$18.40 from Fee Schedule UHC_31910 for Rev 300 Proc 86041 * Qty 1 = $18.40 at 100% = $18.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,9.2000,158.0000,fee schedule,APG 00394 Proc 86041 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,WELLCARE,WELLCARE MEDICAID,158.00,,,,,,,9.2000,158.0000,percent of total billed charges,100% of $158.00 in Billed Charges for Rev 300 Proc 86041 = $158.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY,86041,CPT,300,RC,30000329,CDM,,,,both,,,158.0000,23.7000,WELLCARE,WELLCARE MEDICARE,19.50,,,,,,,9.2000,158.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,AETNA,AETNA,60.21,,,,,,,6.0300,141.0000,percent of total billed charges,42.7% of $141.00 in Billed Charges for Rev 300 Proc 86043 = $60.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,6.0300,141.0000,fee schedule,APG 00394 Proc 86043 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,12.05,,,,,,,6.0300,141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,AETNA,AETNA HEALTHCARE MEDICARE,12.05,,,,,,,6.0300,141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,12.05,,,,,,,6.0300,141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,AMBETTER,AMBETTER,26.27,,,,,,,6.0300,141.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,AMERIGROUP,AMERIGROUP,6.03,,,,,,,6.0300,141.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,12.53,,,,,,,6.0300,141.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,ANTHEM EXCHANGE,12.05,,,,,,,6.0300,141.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,6.0300,141.0000,fee schedule,APG 00394 Proc 86043 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,ANTHEM HMO,12.05,,,,,,,6.0300,141.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,12.41,,,,,,,6.0300,141.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",12.05,,,,,,,6.0300,141.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,98.70,,,,,,,6.0300,141.0000,percent of total billed charges,Rev 300 Proc 86043 $141.00 in Billed Charges at 70% = $98.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,BLUE CROSS E NETWORK,38.56,,,,,,,6.0300,141.0000,fee schedule,$12.05 from Fee Schedule BCFSB for Rev 300 Proc 86043 * Qty 1 = $12.05 at 320% = $38.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,BLUE CROSS MEDICARE,12.53,,,,,,,6.0300,141.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,BLUE CROSS P NETWORK,39.40,,,,,,,6.0300,141.0000,fee schedule,$12.05 from Fee Schedule BCFSB for Rev 300 Proc 86043 * Qty 1 = $12.05 at 327% = $39.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,BLUE CROSS S NETWORK,39.40,,,,,,,6.0300,141.0000,fee schedule,$12.05 from Fee Schedule BCFSB for Rev 300 Proc 86043 * Qty 1 = $12.05 at 327% = $39.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,TENNCARE BLUE CARE,11.36,,,,,,,6.0300,141.0000,fee schedule,$9.79 from Fee Schedule TC_24 for Rev 300 Proc 86043 * Qty 1 = $9.79 at 116% = $11.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,TENNCARE BLUE SELECT,11.36,,,,,,,6.0300,141.0000,fee schedule,$9.79 from Fee Schedule TC_24 for Rev 300 Proc 86043 * Qty 1 = $9.79 at 116% = $11.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,CIGNA HEALTHCARE,CIGNA HMO,58.80,,,,,,,6.0300,141.0000,percent of total billed charges,Rev 300 Proc 86043 $141.00 in Billed Charges at 41.7% = $58.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,26.71,,,,,,,6.0300,141.0000,fee schedule,$26.71 from Fee Schedule CGIFP_25LR for Rev 300 Proc 86043 * Qty 1 = $26.71 at 100% = $26.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,12.65,,,,,,,6.0300,141.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,58.80,,,,,,,6.0300,141.0000,percent of total billed charges,Rev 300 Proc 86043 $141.00 in Billed Charges at 41.7% = $58.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,CIGNA HEALTHCARE,CIGNA PPO,58.80,,,,,,,6.0300,141.0000,percent of total billed charges,Rev 300 Proc 86043 $141.00 in Billed Charges at 41.7% = $58.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,12.65,,,,,,,6.0300,141.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,126.90,,,,,,,6.0300,141.0000,percent of total billed charges,90% of $141.00 in Billed Charges for Rev 300 Proc 86043 = $126.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,HUMANA,HUMANA MEDICARE,12.05,,,,,,,6.0300,141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,12.05,,,,,,,6.0300,141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,MEDCOST,MEDCOST VHN,67.10,,,,,,,6.0300,141.0000,percent of total billed charges,47.59% of $141.00 in Billed Charges for Rev 300 Proc 86043 = $67.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,6.0300,141.0000,fee schedule,APG 00394 Proc 86043 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,12.65,,,,,,,6.0300,141.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,12.65,,,,,,,6.0300,141.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,NHC ADVANTAGE,NHC ADVANTAGE,12.65,,,,,,,6.0300,141.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,6.0300,141.0000,fee schedule,APG 00394 Proc 86043 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,SENTARA HEALTH,SENTARA HEALTH,36.39,,,,,,,6.0300,141.0000,percent of total billed charges,25.81% of $141.00 in Billed Charges for Rev 300 Proc 86043 = $36.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,SENTARA HEALTH,SENTARA MEDICARE,12.05,,,,,,,6.0300,141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",141.00,,,,,,,6.0300,141.0000,percent of total billed charges,100% of $141.00 in Billed Charges for Rev 300 Proc 86043 = $141.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6.03,,,,,,,6.0300,141.0000,fee schedule,$12.05 from Fee Schedule TCUHC24 for Rev 300 Proc 86043 * Qty 1 = $12.05 at 50% = $6.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12.53,,,,,,,6.0300,141.0000,fee schedule,$12.05 from Fee Schedule UHC_31910 for Rev 300 Proc 86043 * Qty 1 = $12.05 at 104% = $12.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,12.05,,,,,,,6.0300,141.0000,fee schedule,$12.05 from Fee Schedule UHC_31910 for Rev 300 Proc 86043 * Qty 1 = $12.05 at 100% = $12.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,12.05,,,,,,,6.0300,141.0000,fee schedule,$12.05 from Fee Schedule UHC_31910 for Rev 300 Proc 86043 * Qty 1 = $12.05 at 100% = $12.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,6.0300,141.0000,fee schedule,APG 00394 Proc 86043 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,12.05,,,,,,,6.0300,141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,12.05,,,,,,,6.0300,141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,WELLCARE,WELLCARE MEDICAID,141.00,,,,,,,6.0300,141.0000,percent of total billed charges,100% of $141.00 in Billed Charges for Rev 300 Proc 86043 = $141.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY,86043,CPT,300,RC,30000331,CDM,,,,both,,,141.0000,21.1500,WELLCARE,WELLCARE MEDICARE,12.77,,,,,,,6.0300,141.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,AETNA,AETNA,97.36,,,,,,,5.7700,228.0000,percent of total billed charges,42.7% of $228.00 in Billed Charges for Rev 300 Proc 86051 = $97.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,5.7700,228.0000,fee schedule,APG 00394 Proc 86051 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,11.53,,,,,,,5.7700,228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,AETNA,AETNA HEALTHCARE MEDICARE,11.53,,,,,,,5.7700,228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,11.53,,,,,,,5.7700,228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,AMBETTER,AMBETTER,25.14,,,,,,,5.7700,228.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,AMERIGROUP,AMERIGROUP,5.77,,,,,,,5.7700,228.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,11.99,,,,,,,5.7700,228.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,ANTHEM EXCHANGE,11.53,,,,,,,5.7700,228.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,5.7700,228.0000,fee schedule,APG 00394 Proc 86051 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,ANTHEM HMO,11.53,,,,,,,5.7700,228.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,11.88,,,,,,,5.7700,228.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",11.53,,,,,,,5.7700,228.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,159.60,,,,,,,5.7700,228.0000,percent of total billed charges,Rev 300 Proc 86051 $228.00 in Billed Charges at 70% = $159.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,BLUE CROSS E NETWORK,36.90,,,,,,,5.7700,228.0000,fee schedule,$11.53 from Fee Schedule BCFSB for Rev 300 Proc 86051 * Qty 1 = $11.53 at 320% = $36.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,BLUE CROSS MEDICARE,11.99,,,,,,,5.7700,228.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,BLUE CROSS P NETWORK,37.70,,,,,,,5.7700,228.0000,fee schedule,$11.53 from Fee Schedule BCFSB for Rev 300 Proc 86051 * Qty 1 = $11.53 at 327% = $37.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,BLUE CROSS S NETWORK,37.70,,,,,,,5.7700,228.0000,fee schedule,$11.53 from Fee Schedule BCFSB for Rev 300 Proc 86051 * Qty 1 = $11.53 at 327% = $37.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,TENNCARE BLUE CARE,10.87,,,,,,,5.7700,228.0000,fee schedule,$9.37 from Fee Schedule TC_24 for Rev 300 Proc 86051 * Qty 1 = $9.37 at 116% = $10.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,TENNCARE BLUE SELECT,10.87,,,,,,,5.7700,228.0000,fee schedule,$9.37 from Fee Schedule TC_24 for Rev 300 Proc 86051 * Qty 1 = $9.37 at 116% = $10.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,CIGNA HEALTHCARE,CIGNA HMO,95.08,,,,,,,5.7700,228.0000,percent of total billed charges,Rev 300 Proc 86051 $228.00 in Billed Charges at 41.7% = $95.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,25.26,,,,,,,5.7700,228.0000,fee schedule,$25.26 from Fee Schedule CGIFP_25LR for Rev 300 Proc 86051 * Qty 1 = $25.26 at 100% = $25.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,12.11,,,,,,,5.7700,228.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,95.08,,,,,,,5.7700,228.0000,percent of total billed charges,Rev 300 Proc 86051 $228.00 in Billed Charges at 41.7% = $95.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,CIGNA HEALTHCARE,CIGNA PPO,95.08,,,,,,,5.7700,228.0000,percent of total billed charges,Rev 300 Proc 86051 $228.00 in Billed Charges at 41.7% = $95.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,12.11,,,,,,,5.7700,228.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,205.20,,,,,,,5.7700,228.0000,percent of total billed charges,90% of $228.00 in Billed Charges for Rev 300 Proc 86051 = $205.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,HUMANA,HUMANA MEDICARE,11.53,,,,,,,5.7700,228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,11.53,,,,,,,5.7700,228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,MEDCOST,MEDCOST VHN,108.51,,,,,,,5.7700,228.0000,percent of total billed charges,47.59% of $228.00 in Billed Charges for Rev 300 Proc 86051 = $108.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,5.7700,228.0000,fee schedule,APG 00394 Proc 86051 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,12.11,,,,,,,5.7700,228.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,12.11,,,,,,,5.7700,228.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,NHC ADVANTAGE,NHC ADVANTAGE,12.11,,,,,,,5.7700,228.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,5.7700,228.0000,fee schedule,APG 00394 Proc 86051 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,SENTARA HEALTH,SENTARA HEALTH,58.85,,,,,,,5.7700,228.0000,percent of total billed charges,25.81% of $228.00 in Billed Charges for Rev 300 Proc 86051 = $58.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,SENTARA HEALTH,SENTARA MEDICARE,11.53,,,,,,,5.7700,228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",228.00,,,,,,,5.7700,228.0000,percent of total billed charges,100% of $228.00 in Billed Charges for Rev 300 Proc 86051 = $228.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5.77,,,,,,,5.7700,228.0000,fee schedule,$11.53 from Fee Schedule TCUHC24 for Rev 300 Proc 86051 * Qty 1 = $11.53 at 50% = $5.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,11.99,,,,,,,5.7700,228.0000,fee schedule,$11.53 from Fee Schedule UHC_31910 for Rev 300 Proc 86051 * Qty 1 = $11.53 at 104% = $11.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11.53,,,,,,,5.7700,228.0000,fee schedule,$11.53 from Fee Schedule UHC_31910 for Rev 300 Proc 86051 * Qty 1 = $11.53 at 100% = $11.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,11.53,,,,,,,5.7700,228.0000,fee schedule,$11.53 from Fee Schedule UHC_31910 for Rev 300 Proc 86051 * Qty 1 = $11.53 at 100% = $11.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,5.7700,228.0000,fee schedule,APG 00394 Proc 86051 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,11.53,,,,,,,5.7700,228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,11.53,,,,,,,5.7700,228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,WELLCARE,WELLCARE MEDICAID,228.00,,,,,,,5.7700,228.0000,percent of total billed charges,100% of $228.00 in Billed Charges for Rev 300 Proc 86051 = $228.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AQUAPORIN-4 ANTIBODY ELISA,86051,CPT,300,RC,30000309,CDM,,,,both,,,228.0000,34.2000,WELLCARE,WELLCARE MEDICARE,12.22,,,,,,,5.7700,228.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,AETNA,AETNA,76.43,,,,,,,7.9200,179.0000,percent of total billed charges,42.7% of $179.00 in Billed Charges for Rev 302 Proc 86684 = $76.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,7.9200,179.0000,fee schedule,APG 00394 Proc 86684 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,15.84,,,,,,,7.9200,179.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,AETNA,AETNA HEALTHCARE MEDICARE,15.84,,,,,,,7.9200,179.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,15.84,,,,,,,7.9200,179.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,AMBETTER,AMBETTER,34.53,,,,,,,7.9200,179.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,AMERIGROUP,AMERIGROUP,7.92,,,,,,,7.9200,179.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,16.47,,,,,,,7.9200,179.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,BLUE CROSS,ANTHEM EXCHANGE,15.84,,,,,,,7.9200,179.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,7.9200,179.0000,fee schedule,APG 00394 Proc 86684 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,BLUE CROSS,ANTHEM HMO,15.84,,,,,,,7.9200,179.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,16.32,,,,,,,7.9200,179.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",15.84,,,,,,,7.9200,179.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,45.14,,,,,,,7.9200,179.0000,fee schedule,$45.14 from Fee Schedule BLDTM_23 for Rev 302 Proc 86684 * Qty 1 = $45.14 at 100% = $45.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,BLUE CROSS,BLUE CROSS E NETWORK,65.25,,,,,,,7.9200,179.0000,fee schedule,$20.39 from Fee Schedule BCFSB for Rev 302 Proc 86684 * Qty 1 = $20.39 at 320% = $65.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,BLUE CROSS,BLUE CROSS MEDICARE,16.47,,,,,,,7.9200,179.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,BLUE CROSS,BLUE CROSS P NETWORK,66.68,,,,,,,7.9200,179.0000,fee schedule,$20.39 from Fee Schedule BCFSB for Rev 302 Proc 86684 * Qty 1 = $20.39 at 327% = $66.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,BLUE CROSS,BLUE CROSS S NETWORK,66.68,,,,,,,7.9200,179.0000,fee schedule,$20.39 from Fee Schedule BCFSB for Rev 302 Proc 86684 * Qty 1 = $20.39 at 327% = $66.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,BLUE CROSS,TENNCARE BLUE CARE,34.53,,,,,,,7.9200,179.0000,fee schedule,$29.77 from Fee Schedule TC_24 for Rev 302 Proc 86684 * Qty 1 = $29.77 at 116% = $34.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,BLUE CROSS,TENNCARE BLUE SELECT,34.53,,,,,,,7.9200,179.0000,fee schedule,$29.77 from Fee Schedule TC_24 for Rev 302 Proc 86684 * Qty 1 = $29.77 at 116% = $34.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,CIGNA HEALTHCARE,CIGNA HMO,63.76,,,,,,,7.9200,179.0000,fee schedule,$63.76 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86684 * Qty 1 = $63.76 at 100% = $63.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,34.65,,,,,,,7.9200,179.0000,fee schedule,$34.65 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86684 * Qty 1 = $34.65 at 100% = $34.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,16.63,,,,,,,7.9200,179.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,63.76,,,,,,,7.9200,179.0000,fee schedule,$63.76 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86684 * Qty 1 = $63.76 at 100% = $63.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,CIGNA HEALTHCARE,CIGNA PPO,63.76,,,,,,,7.9200,179.0000,fee schedule,$63.76 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86684 * Qty 1 = $63.76 at 100% = $63.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,16.63,,,,,,,7.9200,179.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,161.10,,,,,,,7.9200,179.0000,percent of total billed charges,90% of $179.00 in Billed Charges for Rev 302 Proc 86684 = $161.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,HUMANA,HUMANA MEDICARE,15.84,,,,,,,7.9200,179.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,15.84,,,,,,,7.9200,179.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,MEDCOST,MEDCOST VHN,85.19,,,,,,,7.9200,179.0000,percent of total billed charges,47.59% of $179.00 in Billed Charges for Rev 302 Proc 86684 = $85.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,7.9200,179.0000,fee schedule,APG 00394 Proc 86684 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,16.63,,,,,,,7.9200,179.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,16.63,,,,,,,7.9200,179.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,NHC ADVANTAGE,NHC ADVANTAGE,16.63,,,,,,,7.9200,179.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,7.9200,179.0000,fee schedule,APG 00394 Proc 86684 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,SENTARA HEALTH,SENTARA HEALTH,46.20,,,,,,,7.9200,179.0000,percent of total billed charges,25.81% of $179.00 in Billed Charges for Rev 302 Proc 86684 = $46.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,SENTARA HEALTH,SENTARA MEDICARE,15.84,,,,,,,7.9200,179.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",179.00,,,,,,,7.9200,179.0000,percent of total billed charges,100% of $179.00 in Billed Charges for Rev 302 Proc 86684 = $179.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11.22,,,,,,,7.9200,179.0000,fee schedule,$22.44 from Fee Schedule TCUHC24 for Rev 302 Proc 86684 * Qty 1 = $22.44 at 50% = $11.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,16.47,,,,,,,7.9200,179.0000,fee schedule,$15.84 from Fee Schedule UHC_31910 for Rev 302 Proc 86684 * Qty 1 = $15.84 at 104% = $16.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,15.84,,,,,,,7.9200,179.0000,fee schedule,$15.84 from Fee Schedule UHC_31910 for Rev 302 Proc 86684 * Qty 1 = $15.84 at 100% = $15.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,15.84,,,,,,,7.9200,179.0000,fee schedule,$15.84 from Fee Schedule UHC_31910 for Rev 302 Proc 86684 * Qty 1 = $15.84 at 100% = $15.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,7.9200,179.0000,fee schedule,APG 00394 Proc 86684 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,15.84,,,,,,,7.9200,179.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,15.84,,,,,,,7.9200,179.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,WELLCARE,WELLCARE MEDICAID,179.00,,,,,,,7.9200,179.0000,percent of total billed charges,100% of $179.00 in Billed Charges for Rev 302 Proc 86684 = $179.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY HAEMOPHILUS INFLUENZA,86684,CPT,302,RC,30200137,CDM,,,,both,,,179.0000,26.8500,WELLCARE,WELLCARE MEDICARE,16.79,,,,,,,7.9200,179.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,AETNA,AETNA,44.41,,,,,,,7.0000,104.0000,percent of total billed charges,42.7% of $104.00 in Billed Charges for Rev 302 Proc 86688 = $44.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,7.0000,104.0000,fee schedule,APG 00394 Proc 86688 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,14.00,,,,,,,7.0000,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,AETNA,AETNA HEALTHCARE MEDICARE,14.00,,,,,,,7.0000,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,14.00,,,,,,,7.0000,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,AMBETTER,AMBETTER,30.52,,,,,,,7.0000,104.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,AMERIGROUP,AMERIGROUP,7.00,,,,,,,7.0000,104.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,14.56,,,,,,,7.0000,104.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,ANTHEM EXCHANGE,14.00,,,,,,,7.0000,104.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,7.0000,104.0000,fee schedule,APG 00394 Proc 86688 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,ANTHEM HMO,14.00,,,,,,,7.0000,104.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,14.42,,,,,,,7.0000,104.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",14.00,,,,,,,7.0000,104.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,40.12,,,,,,,7.0000,104.0000,fee schedule,$40.12 from Fee Schedule BLDTM_23 for Rev 302 Proc 86688 * Qty 1 = $40.12 at 100% = $40.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,BLUE CROSS E NETWORK,60.29,,,,,,,7.0000,104.0000,fee schedule,$18.84 from Fee Schedule BCFSB for Rev 302 Proc 86688 * Qty 1 = $18.84 at 320% = $60.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,BLUE CROSS MEDICARE,14.56,,,,,,,7.0000,104.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,BLUE CROSS P NETWORK,61.61,,,,,,,7.0000,104.0000,fee schedule,$18.84 from Fee Schedule BCFSB for Rev 302 Proc 86688 * Qty 1 = $18.84 at 327% = $61.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,BLUE CROSS S NETWORK,61.61,,,,,,,7.0000,104.0000,fee schedule,$18.84 from Fee Schedule BCFSB for Rev 302 Proc 86688 * Qty 1 = $18.84 at 327% = $61.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,TENNCARE BLUE CARE,26.66,,,,,,,7.0000,104.0000,fee schedule,$22.98 from Fee Schedule TC_24 for Rev 302 Proc 86688 * Qty 1 = $22.98 at 116% = $26.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,TENNCARE BLUE SELECT,26.66,,,,,,,7.0000,104.0000,fee schedule,$22.98 from Fee Schedule TC_24 for Rev 302 Proc 86688 * Qty 1 = $22.98 at 116% = $26.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,CIGNA HEALTHCARE,CIGNA HMO,56.37,,,,,,,7.0000,104.0000,fee schedule,$56.37 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86688 * Qty 1 = $56.37 at 100% = $56.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,31.04,,,,,,,7.0000,104.0000,fee schedule,$31.04 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86688 * Qty 1 = $31.04 at 100% = $31.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,14.70,,,,,,,7.0000,104.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,56.37,,,,,,,7.0000,104.0000,fee schedule,$56.37 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86688 * Qty 1 = $56.37 at 100% = $56.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,CIGNA HEALTHCARE,CIGNA PPO,56.37,,,,,,,7.0000,104.0000,fee schedule,$56.37 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86688 * Qty 1 = $56.37 at 100% = $56.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,14.70,,,,,,,7.0000,104.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,93.60,,,,,,,7.0000,104.0000,percent of total billed charges,90% of $104.00 in Billed Charges for Rev 302 Proc 86688 = $93.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,HUMANA,HUMANA MEDICARE,14.00,,,,,,,7.0000,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,14.00,,,,,,,7.0000,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,MEDCOST,MEDCOST VHN,49.49,,,,,,,7.0000,104.0000,percent of total billed charges,47.59% of $104.00 in Billed Charges for Rev 302 Proc 86688 = $49.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,7.0000,104.0000,fee schedule,APG 00394 Proc 86688 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,14.70,,,,,,,7.0000,104.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,14.70,,,,,,,7.0000,104.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,NHC ADVANTAGE,NHC ADVANTAGE,14.70,,,,,,,7.0000,104.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,7.0000,104.0000,fee schedule,APG 00394 Proc 86688 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,SENTARA HEALTH,SENTARA HEALTH,26.84,,,,,,,7.0000,104.0000,percent of total billed charges,25.81% of $104.00 in Billed Charges for Rev 302 Proc 86688 = $26.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,SENTARA HEALTH,SENTARA MEDICARE,14.00,,,,,,,7.0000,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",104.00,,,,,,,7.0000,104.0000,percent of total billed charges,100% of $104.00 in Billed Charges for Rev 302 Proc 86688 = $104.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9.92,,,,,,,7.0000,104.0000,fee schedule,$19.84 from Fee Schedule TCUHC24 for Rev 302 Proc 86688 * Qty 1 = $19.84 at 50% = $9.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,14.56,,,,,,,7.0000,104.0000,fee schedule,$14.00 from Fee Schedule UHC_31910 for Rev 302 Proc 86688 * Qty 1 = $14.00 at 104% = $14.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,14.00,,,,,,,7.0000,104.0000,fee schedule,$14.00 from Fee Schedule UHC_31910 for Rev 302 Proc 86688 * Qty 1 = $14.00 at 100% = $14.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,14.00,,,,,,,7.0000,104.0000,fee schedule,$14.00 from Fee Schedule UHC_31910 for Rev 302 Proc 86688 * Qty 1 = $14.00 at 100% = $14.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,7.0000,104.0000,fee schedule,APG 00394 Proc 86688 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,14.00,,,,,,,7.0000,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,14.00,,,,,,,7.0000,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,WELLCARE,WELLCARE MEDICAID,104.00,,,,,,,7.0000,104.0000,percent of total billed charges,100% of $104.00 in Billed Charges for Rev 302 Proc 86688 = $104.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST,86688,CPT,302,RC,30200160,CDM,,,,both,,,104.0000,15.6000,WELLCARE,WELLCARE MEDICARE,14.84,,,,,,,7.0000,104.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,AETNA,AETNA,96.50,,,,,,,9.6800,226.0000,percent of total billed charges,42.7% of $226.00 in Billed Charges for Rev 302 Proc 86689 = $96.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,9.6800,226.0000,fee schedule,APG 00394 Proc 86689 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,19.35,,,,,,,9.6800,226.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,AETNA,AETNA HEALTHCARE MEDICARE,19.35,,,,,,,9.6800,226.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,19.35,,,,,,,9.6800,226.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,AMBETTER,AMBETTER,42.18,,,,,,,9.6800,226.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,AMERIGROUP,AMERIGROUP,9.68,,,,,,,9.6800,226.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,20.12,,,,,,,9.6800,226.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,ANTHEM EXCHANGE,19.35,,,,,,,9.6800,226.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,9.6800,226.0000,fee schedule,APG 00394 Proc 86689 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,ANTHEM HMO,19.35,,,,,,,9.6800,226.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,19.93,,,,,,,9.6800,226.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",19.35,,,,,,,9.6800,226.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,65.65,,,,,,,9.6800,226.0000,fee schedule,$65.65 from Fee Schedule BLDTM_23 for Rev 302 Proc 86689 * Qty 1 = $65.65 at 100% = $65.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,BLUE CROSS E NETWORK,84.48,,,,,,,9.6800,226.0000,fee schedule,$26.40 from Fee Schedule BCFSB for Rev 302 Proc 86689 * Qty 1 = $26.40 at 320% = $84.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,BLUE CROSS MEDICARE,20.12,,,,,,,9.6800,226.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,BLUE CROSS P NETWORK,86.33,,,,,,,9.6800,226.0000,fee schedule,$26.40 from Fee Schedule BCFSB for Rev 302 Proc 86689 * Qty 1 = $26.40 at 327% = $86.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,BLUE CROSS S NETWORK,86.33,,,,,,,9.6800,226.0000,fee schedule,$26.40 from Fee Schedule BCFSB for Rev 302 Proc 86689 * Qty 1 = $26.40 at 327% = $86.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,TENNCARE BLUE CARE,22.89,,,,,,,9.6800,226.0000,fee schedule,$19.73 from Fee Schedule TC_24 for Rev 302 Proc 86689 * Qty 1 = $19.73 at 116% = $22.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,BLUE CROSS,TENNCARE BLUE SELECT,22.89,,,,,,,9.6800,226.0000,fee schedule,$19.73 from Fee Schedule TC_24 for Rev 302 Proc 86689 * Qty 1 = $19.73 at 116% = $22.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,CIGNA HEALTHCARE,CIGNA HMO,77.87,,,,,,,9.6800,226.0000,fee schedule,$77.87 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86689 * Qty 1 = $77.87 at 100% = $77.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,42.58,,,,,,,9.6800,226.0000,fee schedule,$42.58 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86689 * Qty 1 = $42.58 at 100% = $42.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,20.32,,,,,,,9.6800,226.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,77.87,,,,,,,9.6800,226.0000,fee schedule,$77.87 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86689 * Qty 1 = $77.87 at 100% = $77.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,CIGNA HEALTHCARE,CIGNA PPO,77.87,,,,,,,9.6800,226.0000,fee schedule,$77.87 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86689 * Qty 1 = $77.87 at 100% = $77.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,20.32,,,,,,,9.6800,226.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,203.40,,,,,,,9.6800,226.0000,percent of total billed charges,90% of $226.00 in Billed Charges for Rev 302 Proc 86689 = $203.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,HUMANA,HUMANA MEDICARE,19.35,,,,,,,9.6800,226.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,19.35,,,,,,,9.6800,226.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,MEDCOST,MEDCOST VHN,107.55,,,,,,,9.6800,226.0000,percent of total billed charges,47.59% of $226.00 in Billed Charges for Rev 302 Proc 86689 = $107.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,9.6800,226.0000,fee schedule,APG 00394 Proc 86689 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,20.32,,,,,,,9.6800,226.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,20.32,,,,,,,9.6800,226.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,NHC ADVANTAGE,NHC ADVANTAGE,20.32,,,,,,,9.6800,226.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,9.6800,226.0000,fee schedule,APG 00394 Proc 86689 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,SENTARA HEALTH,SENTARA HEALTH,58.33,,,,,,,9.6800,226.0000,percent of total billed charges,25.81% of $226.00 in Billed Charges for Rev 302 Proc 86689 = $58.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,SENTARA HEALTH,SENTARA MEDICARE,19.35,,,,,,,9.6800,226.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",226.00,,,,,,,9.6800,226.0000,percent of total billed charges,100% of $226.00 in Billed Charges for Rev 302 Proc 86689 = $226.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,13.71,,,,,,,9.6800,226.0000,fee schedule,$27.41 from Fee Schedule TCUHC24 for Rev 302 Proc 86689 * Qty 1 = $27.41 at 50% = $13.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,20.12,,,,,,,9.6800,226.0000,fee schedule,$19.35 from Fee Schedule UHC_31910 for Rev 302 Proc 86689 * Qty 1 = $19.35 at 104% = $20.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,19.35,,,,,,,9.6800,226.0000,fee schedule,$19.35 from Fee Schedule UHC_31910 for Rev 302 Proc 86689 * Qty 1 = $19.35 at 100% = $19.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,19.35,,,,,,,9.6800,226.0000,fee schedule,$19.35 from Fee Schedule UHC_31910 for Rev 302 Proc 86689 * Qty 1 = $19.35 at 100% = $19.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,9.6800,226.0000,fee schedule,APG 00394 Proc 86689 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,19.35,,,,,,,9.6800,226.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,19.35,,,,,,,9.6800,226.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,WELLCARE,WELLCARE MEDICAID,226.00,,,,,,,9.6800,226.0000,percent of total billed charges,100% of $226.00 in Billed Charges for Rev 302 Proc 86689 = $226.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HTLV HIV ANTI CONFIRMATORY TEST,86689,CPT,302,RC,30200081,CDM,,,,both,,,226.0000,33.9000,WELLCARE,WELLCARE MEDICARE,20.51,,,,,,,9.6800,226.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,AETNA,AETNA,39.71,,,,,,,8.5800,93.0000,percent of total billed charges,42.7% of $93.00 in Billed Charges for Rev 302 Proc 86692 = $39.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,8.5800,93.0000,fee schedule,APG 00394 Proc 86692 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,17.16,,,,,,,8.5800,93.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,AETNA,AETNA HEALTHCARE MEDICARE,17.16,,,,,,,8.5800,93.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,17.16,,,,,,,8.5800,93.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,AMBETTER,AMBETTER,37.41,,,,,,,8.5800,93.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,AMERIGROUP,AMERIGROUP,8.58,,,,,,,8.5800,93.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,17.85,,,,,,,8.5800,93.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,BLUE CROSS,ANTHEM EXCHANGE,17.16,,,,,,,8.5800,93.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,8.5800,93.0000,fee schedule,APG 00394 Proc 86692 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,BLUE CROSS,ANTHEM HMO,17.16,,,,,,,8.5800,93.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,17.67,,,,,,,8.5800,93.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",17.16,,,,,,,8.5800,93.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,57.98,,,,,,,8.5800,93.0000,fee schedule,$57.98 from Fee Schedule BLDTM_23 for Rev 302 Proc 86692 * Qty 1 = $57.98 at 100% = $57.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,BLUE CROSS,BLUE CROSS E NETWORK,65.25,,,,,,,8.5800,93.0000,fee schedule,$20.39 from Fee Schedule BCFSB for Rev 302 Proc 86692 * Qty 1 = $20.39 at 320% = $65.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,BLUE CROSS,BLUE CROSS MEDICARE,17.85,,,,,,,8.5800,93.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,BLUE CROSS,BLUE CROSS P NETWORK,66.68,,,,,,,8.5800,93.0000,fee schedule,$20.39 from Fee Schedule BCFSB for Rev 302 Proc 86692 * Qty 1 = $20.39 at 327% = $66.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,BLUE CROSS,BLUE CROSS S NETWORK,66.68,,,,,,,8.5800,93.0000,fee schedule,$20.39 from Fee Schedule BCFSB for Rev 302 Proc 86692 * Qty 1 = $20.39 at 327% = $66.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,BLUE CROSS,TENNCARE BLUE CARE,15.98,,,,,,,8.5800,93.0000,fee schedule,$13.78 from Fee Schedule TC_24 for Rev 302 Proc 86692 * Qty 1 = $13.78 at 116% = $15.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,BLUE CROSS,TENNCARE BLUE SELECT,15.98,,,,,,,8.5800,93.0000,fee schedule,$13.78 from Fee Schedule TC_24 for Rev 302 Proc 86692 * Qty 1 = $13.78 at 116% = $15.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,CIGNA HEALTHCARE,CIGNA HMO,69.05,,,,,,,8.5800,93.0000,fee schedule,$69.05 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86692 * Qty 1 = $69.05 at 100% = $69.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,37.53,,,,,,,8.5800,93.0000,fee schedule,$37.53 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86692 * Qty 1 = $37.53 at 100% = $37.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,18.02,,,,,,,8.5800,93.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,69.05,,,,,,,8.5800,93.0000,fee schedule,$69.05 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86692 * Qty 1 = $69.05 at 100% = $69.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,CIGNA HEALTHCARE,CIGNA PPO,69.05,,,,,,,8.5800,93.0000,fee schedule,$69.05 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86692 * Qty 1 = $69.05 at 100% = $69.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,18.02,,,,,,,8.5800,93.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,83.70,,,,,,,8.5800,93.0000,percent of total billed charges,90% of $93.00 in Billed Charges for Rev 302 Proc 86692 = $83.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,HUMANA,HUMANA MEDICARE,17.16,,,,,,,8.5800,93.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,17.16,,,,,,,8.5800,93.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,MEDCOST,MEDCOST VHN,44.26,,,,,,,8.5800,93.0000,percent of total billed charges,47.59% of $93.00 in Billed Charges for Rev 302 Proc 86692 = $44.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,8.5800,93.0000,fee schedule,APG 00394 Proc 86692 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,18.02,,,,,,,8.5800,93.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,18.02,,,,,,,8.5800,93.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,NHC ADVANTAGE,NHC ADVANTAGE,18.02,,,,,,,8.5800,93.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,8.5800,93.0000,fee schedule,APG 00394 Proc 86692 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,SENTARA HEALTH,SENTARA HEALTH,24.00,,,,,,,8.5800,93.0000,percent of total billed charges,25.81% of $93.00 in Billed Charges for Rev 302 Proc 86692 = $24.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,SENTARA HEALTH,SENTARA MEDICARE,17.16,,,,,,,8.5800,93.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",93.00,,,,,,,8.5800,93.0000,percent of total billed charges,100% of $93.00 in Billed Charges for Rev 302 Proc 86692 = $93.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,12.16,,,,,,,8.5800,93.0000,fee schedule,$24.31 from Fee Schedule TCUHC24 for Rev 302 Proc 86692 * Qty 1 = $24.31 at 50% = $12.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,17.85,,,,,,,8.5800,93.0000,fee schedule,$17.16 from Fee Schedule UHC_31910 for Rev 302 Proc 86692 * Qty 1 = $17.16 at 104% = $17.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,17.16,,,,,,,8.5800,93.0000,fee schedule,$17.16 from Fee Schedule UHC_31910 for Rev 302 Proc 86692 * Qty 1 = $17.16 at 100% = $17.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,17.16,,,,,,,8.5800,93.0000,fee schedule,$17.16 from Fee Schedule UHC_31910 for Rev 302 Proc 86692 * Qty 1 = $17.16 at 100% = $17.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,8.5800,93.0000,fee schedule,APG 00394 Proc 86692 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,17.16,,,,,,,8.5800,93.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,17.16,,,,,,,8.5800,93.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,WELLCARE,WELLCARE MEDICAID,93.00,,,,,,,8.5800,93.0000,percent of total billed charges,100% of $93.00 in Billed Charges for Rev 302 Proc 86692 = $93.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS DELTA AGENT AB,86692,CPT,302,RC,30200082,CDM,,,,both,,,93.0000,13.9500,WELLCARE,WELLCARE MEDICARE,18.19,,,,,,,8.5800,93.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,AETNA,AETNA,65.76,,,,,,,6.6000,154.0000,percent of total billed charges,42.7% of $154.00 in Billed Charges for Rev 302 Proc 86695 = $65.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,6.6000,154.0000,fee schedule,APG 00394 Proc 86695 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,13.19,,,,,,,6.6000,154.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,AETNA,AETNA HEALTHCARE MEDICARE,13.19,,,,,,,6.6000,154.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,13.19,,,,,,,6.6000,154.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,AMBETTER,AMBETTER,28.75,,,,,,,6.6000,154.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,AMERIGROUP,AMERIGROUP,6.60,,,,,,,6.6000,154.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,13.72,,,,,,,6.6000,154.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,BLUE CROSS,ANTHEM EXCHANGE,13.19,,,,,,,6.6000,154.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,6.6000,154.0000,fee schedule,APG 00394 Proc 86695 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,BLUE CROSS,ANTHEM HMO,13.19,,,,,,,6.6000,154.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,13.59,,,,,,,6.6000,154.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",13.19,,,,,,,6.6000,154.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,44.35,,,,,,,6.6000,154.0000,fee schedule,$44.35 from Fee Schedule BLDTM_23 for Rev 302 Proc 86695 * Qty 1 = $44.35 at 100% = $44.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,BLUE CROSS,BLUE CROSS E NETWORK,57.60,,,,,,,6.6000,154.0000,fee schedule,$18.00 from Fee Schedule BCFSB for Rev 302 Proc 86695 * Qty 1 = $18.00 at 320% = $57.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,BLUE CROSS,BLUE CROSS MEDICARE,13.72,,,,,,,6.6000,154.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,BLUE CROSS,BLUE CROSS P NETWORK,58.86,,,,,,,6.6000,154.0000,fee schedule,$18.00 from Fee Schedule BCFSB for Rev 302 Proc 86695 * Qty 1 = $18.00 at 327% = $58.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,BLUE CROSS,BLUE CROSS S NETWORK,58.86,,,,,,,6.6000,154.0000,fee schedule,$18.00 from Fee Schedule BCFSB for Rev 302 Proc 86695 * Qty 1 = $18.00 at 327% = $58.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,BLUE CROSS,TENNCARE BLUE CARE,18.63,,,,,,,6.6000,154.0000,fee schedule,$16.06 from Fee Schedule TC_24 for Rev 302 Proc 86695 * Qty 1 = $16.06 at 116% = $18.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,BLUE CROSS,TENNCARE BLUE SELECT,18.63,,,,,,,6.6000,154.0000,fee schedule,$16.06 from Fee Schedule TC_24 for Rev 302 Proc 86695 * Qty 1 = $16.06 at 116% = $18.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,CIGNA HEALTHCARE,CIGNA HMO,53.05,,,,,,,6.6000,154.0000,fee schedule,$53.05 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86695 * Qty 1 = $53.05 at 100% = $53.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,28.87,,,,,,,6.6000,154.0000,fee schedule,$28.87 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86695 * Qty 1 = $28.87 at 100% = $28.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,13.85,,,,,,,6.6000,154.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,53.05,,,,,,,6.6000,154.0000,fee schedule,$53.05 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86695 * Qty 1 = $53.05 at 100% = $53.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,CIGNA HEALTHCARE,CIGNA PPO,53.05,,,,,,,6.6000,154.0000,fee schedule,$53.05 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86695 * Qty 1 = $53.05 at 100% = $53.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,13.85,,,,,,,6.6000,154.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,138.60,,,,,,,6.6000,154.0000,percent of total billed charges,90% of $154.00 in Billed Charges for Rev 302 Proc 86695 = $138.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,HUMANA,HUMANA MEDICARE,13.19,,,,,,,6.6000,154.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,13.19,,,,,,,6.6000,154.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,MEDCOST,MEDCOST VHN,73.29,,,,,,,6.6000,154.0000,percent of total billed charges,47.59% of $154.00 in Billed Charges for Rev 302 Proc 86695 = $73.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,6.6000,154.0000,fee schedule,APG 00394 Proc 86695 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,13.85,,,,,,,6.6000,154.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,13.85,,,,,,,6.6000,154.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,NHC ADVANTAGE,NHC ADVANTAGE,13.85,,,,,,,6.6000,154.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,6.6000,154.0000,fee schedule,APG 00394 Proc 86695 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,SENTARA HEALTH,SENTARA HEALTH,39.75,,,,,,,6.6000,154.0000,percent of total billed charges,25.81% of $154.00 in Billed Charges for Rev 302 Proc 86695 = $39.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,SENTARA HEALTH,SENTARA MEDICARE,13.19,,,,,,,6.6000,154.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",154.00,,,,,,,6.6000,154.0000,percent of total billed charges,100% of $154.00 in Billed Charges for Rev 302 Proc 86695 = $154.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9.34,,,,,,,6.6000,154.0000,fee schedule,$18.68 from Fee Schedule TCUHC24 for Rev 302 Proc 86695 * Qty 1 = $18.68 at 50% = $9.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13.72,,,,,,,6.6000,154.0000,fee schedule,$13.19 from Fee Schedule UHC_31910 for Rev 302 Proc 86695 * Qty 1 = $13.19 at 104% = $13.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,13.19,,,,,,,6.6000,154.0000,fee schedule,$13.19 from Fee Schedule UHC_31910 for Rev 302 Proc 86695 * Qty 1 = $13.19 at 100% = $13.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,13.19,,,,,,,6.6000,154.0000,fee schedule,$13.19 from Fee Schedule UHC_31910 for Rev 302 Proc 86695 * Qty 1 = $13.19 at 100% = $13.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,6.6000,154.0000,fee schedule,APG 00394 Proc 86695 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,13.19,,,,,,,6.6000,154.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,13.19,,,,,,,6.6000,154.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,WELLCARE,WELLCARE MEDICAID,154.00,,,,,,,6.6000,154.0000,percent of total billed charges,100% of $154.00 in Billed Charges for Rev 302 Proc 86695 = $154.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX AB TYPE 1,86695,CPT,302,RC,30200084,CDM,,,,both,,,154.0000,23.1000,WELLCARE,WELLCARE MEDICARE,13.98,,,,,,,6.6000,154.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,AETNA,AETNA,49.96,,,,,,,9.6800,117.0000,percent of total billed charges,42.7% of $117.00 in Billed Charges for Rev 302 Proc 86696 = $49.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,9.6800,117.0000,fee schedule,APG 00394 Proc 86696 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,19.35,,,,,,,9.6800,117.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,AETNA,AETNA HEALTHCARE MEDICARE,19.35,,,,,,,9.6800,117.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,19.35,,,,,,,9.6800,117.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,AMBETTER,AMBETTER,42.18,,,,,,,9.6800,117.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,AMERIGROUP,AMERIGROUP,9.68,,,,,,,9.6800,117.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,20.12,,,,,,,9.6800,117.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,BLUE CROSS,ANTHEM EXCHANGE,19.35,,,,,,,9.6800,117.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,9.6800,117.0000,fee schedule,APG 00394 Proc 86696 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,BLUE CROSS,ANTHEM HMO,19.35,,,,,,,9.6800,117.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,19.93,,,,,,,9.6800,117.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",19.35,,,,,,,9.6800,117.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,71.05,,,,,,,9.6800,117.0000,fee schedule,$71.05 from Fee Schedule BLDTM_23 for Rev 302 Proc 86696 * Qty 1 = $71.05 at 100% = $71.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,BLUE CROSS,BLUE CROSS E NETWORK,84.48,,,,,,,9.6800,117.0000,fee schedule,$26.40 from Fee Schedule BCFSB for Rev 302 Proc 86696 * Qty 1 = $26.40 at 320% = $84.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,BLUE CROSS,BLUE CROSS MEDICARE,20.12,,,,,,,9.6800,117.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,BLUE CROSS,BLUE CROSS P NETWORK,86.33,,,,,,,9.6800,117.0000,fee schedule,$26.40 from Fee Schedule BCFSB for Rev 302 Proc 86696 * Qty 1 = $26.40 at 327% = $86.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,BLUE CROSS,BLUE CROSS S NETWORK,86.33,,,,,,,9.6800,117.0000,fee schedule,$26.40 from Fee Schedule BCFSB for Rev 302 Proc 86696 * Qty 1 = $26.40 at 327% = $86.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,BLUE CROSS,TENNCARE BLUE CARE,25.22,,,,,,,9.6800,117.0000,fee schedule,$21.74 from Fee Schedule TC_24 for Rev 302 Proc 86696 * Qty 1 = $21.74 at 116% = $25.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,BLUE CROSS,TENNCARE BLUE SELECT,25.22,,,,,,,9.6800,117.0000,fee schedule,$21.74 from Fee Schedule TC_24 for Rev 302 Proc 86696 * Qty 1 = $21.74 at 116% = $25.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,CIGNA HEALTHCARE,CIGNA HMO,77.87,,,,,,,9.6800,117.0000,fee schedule,$77.87 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86696 * Qty 1 = $77.87 at 100% = $77.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,42.58,,,,,,,9.6800,117.0000,fee schedule,$42.58 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86696 * Qty 1 = $42.58 at 100% = $42.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,20.32,,,,,,,9.6800,117.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,77.87,,,,,,,9.6800,117.0000,fee schedule,$77.87 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86696 * Qty 1 = $77.87 at 100% = $77.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,CIGNA HEALTHCARE,CIGNA PPO,77.87,,,,,,,9.6800,117.0000,fee schedule,$77.87 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86696 * Qty 1 = $77.87 at 100% = $77.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,20.32,,,,,,,9.6800,117.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,105.30,,,,,,,9.6800,117.0000,percent of total billed charges,90% of $117.00 in Billed Charges for Rev 302 Proc 86696 = $105.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,HUMANA,HUMANA MEDICARE,19.35,,,,,,,9.6800,117.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,19.35,,,,,,,9.6800,117.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,MEDCOST,MEDCOST VHN,55.68,,,,,,,9.6800,117.0000,percent of total billed charges,47.59% of $117.00 in Billed Charges for Rev 302 Proc 86696 = $55.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,9.6800,117.0000,fee schedule,APG 00394 Proc 86696 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,20.32,,,,,,,9.6800,117.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,20.32,,,,,,,9.6800,117.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,NHC ADVANTAGE,NHC ADVANTAGE,20.32,,,,,,,9.6800,117.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,9.6800,117.0000,fee schedule,APG 00394 Proc 86696 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,SENTARA HEALTH,SENTARA HEALTH,30.20,,,,,,,9.6800,117.0000,percent of total billed charges,25.81% of $117.00 in Billed Charges for Rev 302 Proc 86696 = $30.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,SENTARA HEALTH,SENTARA MEDICARE,19.35,,,,,,,9.6800,117.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",117.00,,,,,,,9.6800,117.0000,percent of total billed charges,100% of $117.00 in Billed Charges for Rev 302 Proc 86696 = $117.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,13.71,,,,,,,9.6800,117.0000,fee schedule,$27.41 from Fee Schedule TCUHC24 for Rev 302 Proc 86696 * Qty 1 = $27.41 at 50% = $13.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,20.12,,,,,,,9.6800,117.0000,fee schedule,$19.35 from Fee Schedule UHC_31910 for Rev 302 Proc 86696 * Qty 1 = $19.35 at 104% = $20.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,19.35,,,,,,,9.6800,117.0000,fee schedule,$19.35 from Fee Schedule UHC_31910 for Rev 302 Proc 86696 * Qty 1 = $19.35 at 100% = $19.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,19.35,,,,,,,9.6800,117.0000,fee schedule,$19.35 from Fee Schedule UHC_31910 for Rev 302 Proc 86696 * Qty 1 = $19.35 at 100% = $19.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,9.6800,117.0000,fee schedule,APG 00394 Proc 86696 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,19.35,,,,,,,9.6800,117.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,19.35,,,,,,,9.6800,117.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,WELLCARE,WELLCARE MEDICAID,117.00,,,,,,,9.6800,117.0000,percent of total billed charges,100% of $117.00 in Billed Charges for Rev 302 Proc 86696 = $117.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX AB TYPE 2,86696,CPT,302,RC,30200085,CDM,,,,both,,,117.0000,17.5500,WELLCARE,WELLCARE MEDICARE,20.51,,,,,,,9.6800,117.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,AETNA,AETNA,62.34,,,,,,,6.9000,146.0000,percent of total billed charges,42.7% of $146.00 in Billed Charges for Rev 302 Proc 86698 = $62.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,6.9000,146.0000,fee schedule,APG 00394 Proc 86698 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,13.79,,,,,,,6.9000,146.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,AETNA,AETNA HEALTHCARE MEDICARE,13.79,,,,,,,6.9000,146.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,13.79,,,,,,,6.9000,146.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,AMBETTER,AMBETTER,30.06,,,,,,,6.9000,146.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,AMERIGROUP,AMERIGROUP,6.90,,,,,,,6.9000,146.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,14.34,,,,,,,6.9000,146.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,BLUE CROSS,ANTHEM EXCHANGE,13.79,,,,,,,6.9000,146.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,6.9000,146.0000,fee schedule,APG 00394 Proc 86698 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,BLUE CROSS,ANTHEM HMO,13.79,,,,,,,6.9000,146.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,14.20,,,,,,,6.9000,146.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",13.79,,,,,,,6.9000,146.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,35.83,,,,,,,6.9000,146.0000,fee schedule,$35.83 from Fee Schedule BLDTM_23 for Rev 302 Proc 86698 * Qty 1 = $35.83 at 100% = $35.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,BLUE CROSS,BLUE CROSS E NETWORK,54.56,,,,,,,6.9000,146.0000,fee schedule,$17.05 from Fee Schedule BCFSB for Rev 302 Proc 86698 * Qty 1 = $17.05 at 320% = $54.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,BLUE CROSS,BLUE CROSS MEDICARE,14.34,,,,,,,6.9000,146.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,BLUE CROSS,BLUE CROSS P NETWORK,55.75,,,,,,,6.9000,146.0000,fee schedule,$17.05 from Fee Schedule BCFSB for Rev 302 Proc 86698 * Qty 1 = $17.05 at 327% = $55.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,BLUE CROSS,BLUE CROSS S NETWORK,55.75,,,,,,,6.9000,146.0000,fee schedule,$17.05 from Fee Schedule BCFSB for Rev 302 Proc 86698 * Qty 1 = $17.05 at 327% = $55.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,BLUE CROSS,TENNCARE BLUE CARE,28.54,,,,,,,6.9000,146.0000,fee schedule,$24.60 from Fee Schedule TC_24 for Rev 302 Proc 86698 * Qty 1 = $24.60 at 116% = $28.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,BLUE CROSS,TENNCARE BLUE SELECT,28.54,,,,,,,6.9000,146.0000,fee schedule,$24.60 from Fee Schedule TC_24 for Rev 302 Proc 86698 * Qty 1 = $24.60 at 116% = $28.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,CIGNA HEALTHCARE,CIGNA HMO,50.30,,,,,,,6.9000,146.0000,fee schedule,$50.30 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86698 * Qty 1 = $50.30 at 100% = $50.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,30.31,,,,,,,6.9000,146.0000,fee schedule,$30.31 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86698 * Qty 1 = $30.31 at 100% = $30.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,14.48,,,,,,,6.9000,146.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,50.30,,,,,,,6.9000,146.0000,fee schedule,$50.30 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86698 * Qty 1 = $50.30 at 100% = $50.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,CIGNA HEALTHCARE,CIGNA PPO,50.30,,,,,,,6.9000,146.0000,fee schedule,$50.30 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86698 * Qty 1 = $50.30 at 100% = $50.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,14.48,,,,,,,6.9000,146.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,131.40,,,,,,,6.9000,146.0000,percent of total billed charges,90% of $146.00 in Billed Charges for Rev 302 Proc 86698 = $131.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,HUMANA,HUMANA MEDICARE,13.79,,,,,,,6.9000,146.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,13.79,,,,,,,6.9000,146.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,MEDCOST,MEDCOST VHN,69.48,,,,,,,6.9000,146.0000,percent of total billed charges,47.59% of $146.00 in Billed Charges for Rev 302 Proc 86698 = $69.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,6.9000,146.0000,fee schedule,APG 00394 Proc 86698 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,14.48,,,,,,,6.9000,146.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,14.48,,,,,,,6.9000,146.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,NHC ADVANTAGE,NHC ADVANTAGE,14.48,,,,,,,6.9000,146.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,6.9000,146.0000,fee schedule,APG 00394 Proc 86698 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,SENTARA HEALTH,SENTARA HEALTH,37.68,,,,,,,6.9000,146.0000,percent of total billed charges,25.81% of $146.00 in Billed Charges for Rev 302 Proc 86698 = $37.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,SENTARA HEALTH,SENTARA MEDICARE,13.79,,,,,,,6.9000,146.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",146.00,,,,,,,6.9000,146.0000,percent of total billed charges,100% of $146.00 in Billed Charges for Rev 302 Proc 86698 = $146.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.86,,,,,,,6.9000,146.0000,fee schedule,$17.71 from Fee Schedule TCUHC24 for Rev 302 Proc 86698 * Qty 1 = $17.71 at 50% = $8.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,14.34,,,,,,,6.9000,146.0000,fee schedule,$13.79 from Fee Schedule UHC_31910 for Rev 302 Proc 86698 * Qty 1 = $13.79 at 104% = $14.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,13.79,,,,,,,6.9000,146.0000,fee schedule,$13.79 from Fee Schedule UHC_31910 for Rev 302 Proc 86698 * Qty 1 = $13.79 at 100% = $13.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,13.79,,,,,,,6.9000,146.0000,fee schedule,$13.79 from Fee Schedule UHC_31910 for Rev 302 Proc 86698 * Qty 1 = $13.79 at 100% = $13.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,6.9000,146.0000,fee schedule,APG 00394 Proc 86698 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,13.79,,,,,,,6.9000,146.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,13.79,,,,,,,6.9000,146.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,WELLCARE,WELLCARE MEDICAID,146.00,,,,,,,6.9000,146.0000,percent of total billed charges,100% of $146.00 in Billed Charges for Rev 302 Proc 86698 = $146.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY HISTOPLASMA,86698,CPT,302,RC,30200086,CDM,,,,both,,,146.0000,21.9000,WELLCARE,WELLCARE MEDICARE,14.62,,,,,,,6.9000,146.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,AETNA,AETNA,58.93,,,,,,,5.8900,138.0000,percent of total billed charges,42.7% of $138.00 in Billed Charges for Rev 302 Proc 86705 = $58.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,5.8900,138.0000,fee schedule,APG 00394 Proc 86705 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,11.77,,,,,,,5.8900,138.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,AETNA,AETNA HEALTHCARE MEDICARE,11.77,,,,,,,5.8900,138.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,11.77,,,,,,,5.8900,138.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,AMBETTER,AMBETTER,25.66,,,,,,,5.8900,138.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,AMERIGROUP,AMERIGROUP,5.89,,,,,,,5.8900,138.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,12.24,,,,,,,5.8900,138.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,BLUE CROSS,ANTHEM EXCHANGE,11.77,,,,,,,5.8900,138.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,5.8900,138.0000,fee schedule,APG 00394 Proc 86705 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,BLUE CROSS,ANTHEM HMO,11.77,,,,,,,5.8900,138.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,12.12,,,,,,,5.8900,138.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",11.77,,,,,,,5.8900,138.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,40.08,,,,,,,5.8900,138.0000,fee schedule,$40.08 from Fee Schedule BLDTM_23 for Rev 302 Proc 86705 * Qty 1 = $40.08 at 100% = $40.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,BLUE CROSS,BLUE CROSS E NETWORK,51.42,,,,,,,5.8900,138.0000,fee schedule,$16.07 from Fee Schedule BCFSB for Rev 302 Proc 86705 * Qty 1 = $16.07 at 320% = $51.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,BLUE CROSS,BLUE CROSS MEDICARE,12.24,,,,,,,5.8900,138.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,BLUE CROSS,BLUE CROSS P NETWORK,52.55,,,,,,,5.8900,138.0000,fee schedule,$16.07 from Fee Schedule BCFSB for Rev 302 Proc 86705 * Qty 1 = $16.07 at 327% = $52.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,BLUE CROSS,BLUE CROSS S NETWORK,52.55,,,,,,,5.8900,138.0000,fee schedule,$16.07 from Fee Schedule BCFSB for Rev 302 Proc 86705 * Qty 1 = $16.07 at 327% = $52.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,BLUE CROSS,TENNCARE BLUE CARE,23.81,,,,,,,5.8900,138.0000,fee schedule,$20.53 from Fee Schedule TC_24 for Rev 302 Proc 86705 * Qty 1 = $20.53 at 116% = $23.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,BLUE CROSS,TENNCARE BLUE SELECT,23.81,,,,,,,5.8900,138.0000,fee schedule,$20.53 from Fee Schedule TC_24 for Rev 302 Proc 86705 * Qty 1 = $20.53 at 116% = $23.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,CIGNA HEALTHCARE,CIGNA HMO,47.37,,,,,,,5.8900,138.0000,fee schedule,$47.37 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86705 * Qty 1 = $47.37 at 100% = $47.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,25.98,,,,,,,5.8900,138.0000,fee schedule,$25.98 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86705 * Qty 1 = $25.98 at 100% = $25.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,12.36,,,,,,,5.8900,138.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,47.37,,,,,,,5.8900,138.0000,fee schedule,$47.37 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86705 * Qty 1 = $47.37 at 100% = $47.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,CIGNA HEALTHCARE,CIGNA PPO,47.37,,,,,,,5.8900,138.0000,fee schedule,$47.37 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86705 * Qty 1 = $47.37 at 100% = $47.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,12.36,,,,,,,5.8900,138.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,124.20,,,,,,,5.8900,138.0000,percent of total billed charges,90% of $138.00 in Billed Charges for Rev 302 Proc 86705 = $124.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,HUMANA,HUMANA MEDICARE,11.77,,,,,,,5.8900,138.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,11.77,,,,,,,5.8900,138.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,MEDCOST,MEDCOST VHN,65.67,,,,,,,5.8900,138.0000,percent of total billed charges,47.59% of $138.00 in Billed Charges for Rev 302 Proc 86705 = $65.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,5.8900,138.0000,fee schedule,APG 00394 Proc 86705 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,12.36,,,,,,,5.8900,138.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,12.36,,,,,,,5.8900,138.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,NHC ADVANTAGE,NHC ADVANTAGE,12.36,,,,,,,5.8900,138.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,5.8900,138.0000,fee schedule,APG 00394 Proc 86705 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,SENTARA HEALTH,SENTARA HEALTH,35.62,,,,,,,5.8900,138.0000,percent of total billed charges,25.81% of $138.00 in Billed Charges for Rev 302 Proc 86705 = $35.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,SENTARA HEALTH,SENTARA MEDICARE,11.77,,,,,,,5.8900,138.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",138.00,,,,,,,5.8900,138.0000,percent of total billed charges,100% of $138.00 in Billed Charges for Rev 302 Proc 86705 = $138.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.34,,,,,,,5.8900,138.0000,fee schedule,$16.67 from Fee Schedule TCUHC24 for Rev 302 Proc 86705 * Qty 1 = $16.67 at 50% = $8.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12.24,,,,,,,5.8900,138.0000,fee schedule,$11.77 from Fee Schedule UHC_31910 for Rev 302 Proc 86705 * Qty 1 = $11.77 at 104% = $12.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11.77,,,,,,,5.8900,138.0000,fee schedule,$11.77 from Fee Schedule UHC_31910 for Rev 302 Proc 86705 * Qty 1 = $11.77 at 100% = $11.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,11.77,,,,,,,5.8900,138.0000,fee schedule,$11.77 from Fee Schedule UHC_31910 for Rev 302 Proc 86705 * Qty 1 = $11.77 at 100% = $11.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,5.8900,138.0000,fee schedule,APG 00394 Proc 86705 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,11.77,,,,,,,5.8900,138.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,11.77,,,,,,,5.8900,138.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,WELLCARE,WELLCARE MEDICAID,138.00,,,,,,,5.8900,138.0000,percent of total billed charges,100% of $138.00 in Billed Charges for Rev 302 Proc 86705 = $138.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS B CORE IGM AB,86705,CPT,302,RC,30200091,CDM,,,,both,,,138.0000,20.7000,WELLCARE,WELLCARE MEDICARE,12.48,,,,,,,5.8900,138.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SKIMMER BLADE DIAMETER 3.5,272,RC,27200002,CDM,,,,,,both,,,6689.3000,1003.4000,AETNA,AETNA,2856.33,,,,,,,1726.5100,6689.3000,percent of total billed charges,"42.7% of $6,689.30 in Billed Charges for Rev 272 = $2,856.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIMMER BLADE DIAMETER 3.5,272,RC,27200002,CDM,,,,,,both,,,6689.3000,1003.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4682.51,,,,,,,1726.5100,6689.3000,percent of total billed charges,"Rev 272 $6,689.30 in Billed Charges at 70% = $4,682.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIMMER BLADE DIAMETER 3.5,272,RC,27200002,CDM,,,,,,both,,,6689.3000,1003.4000,CIGNA HEALTHCARE,CIGNA HMO,2789.44,,,,,,,1726.5100,6689.3000,percent of total billed charges,"41.7% of $6,689.30 in Billed Charges for Rev 272 = $2,789.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIMMER BLADE DIAMETER 3.5,272,RC,27200002,CDM,,,,,,both,,,6689.3000,1003.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3103.84,,,,,,,1726.5100,6689.3000,percent of total billed charges,"46.4% of $6,689.30 in Billed Charges for Rev 272 = $3,103.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIMMER BLADE DIAMETER 3.5,272,RC,27200002,CDM,,,,,,both,,,6689.3000,1003.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2789.44,,,,,,,1726.5100,6689.3000,percent of total billed charges,"41.7% of $6,689.30 in Billed Charges for Rev 272 = $2,789.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIMMER BLADE DIAMETER 3.5,272,RC,27200002,CDM,,,,,,both,,,6689.3000,1003.4000,CIGNA HEALTHCARE,CIGNA PPO,2789.44,,,,,,,1726.5100,6689.3000,percent of total billed charges,"41.7% of $6,689.30 in Billed Charges for Rev 272 = $2,789.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIMMER BLADE DIAMETER 3.5,272,RC,27200002,CDM,,,,,,both,,,6689.3000,1003.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6020.37,,,,,,,1726.5100,6689.3000,percent of total billed charges,"90% of $6,689.30 in Billed Charges for Rev 272 = $6,020.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIMMER BLADE DIAMETER 3.5,272,RC,27200002,CDM,,,,,,both,,,6689.3000,1003.4000,MEDCOST,MEDCOST VHN,3183.44,,,,,,,1726.5100,6689.3000,percent of total billed charges,"47.59% of $6,689.30 in Billed Charges for Rev 272 = $3,183.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIMMER BLADE DIAMETER 3.5,272,RC,27200002,CDM,,,,,,both,,,6689.3000,1003.4000,SENTARA HEALTH,SENTARA HEALTH,1726.51,,,,,,,1726.5100,6689.3000,percent of total billed charges,"25.81% of $6,689.30 in Billed Charges for Rev 272 = $1,726.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIMMER BLADE DIAMETER 3.5,272,RC,27200002,CDM,,,,,,both,,,6689.3000,1003.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6689.30,,,,,,,1726.5100,6689.3000,percent of total billed charges,"100% of $6,689.30 in Billed Charges for Rev 272 = $6,689.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIMMER BLADE DIAMETER 3.5,272,RC,27200002,CDM,,,,,,both,,,6689.3000,1003.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3344.65,,,,,,,1726.5100,6689.3000,percent of total billed charges,"Rev 272 $6,689.30 in Billed Charges at 50% = $3,344.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIMMER BLADE DIAMETER 3.5,272,RC,27200002,CDM,,,,,,both,,,6689.3000,1003.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2160.64,,,,,,,1726.5100,6689.3000,other,"32.3% of $6,689.30 in Billed Charges for Rev 272 = $2,160.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SKIMMER BLADE DIAMETER 3.5,272,RC,27200002,CDM,,,,,,both,,,6689.3000,1003.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2053.62,,,,,,,1726.5100,6689.3000,other,"30.7% of $6,689.30 in Billed Charges for Rev 272 = $2,053.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SKIMMER BLADE DIAMETER 3.5,272,RC,27200002,CDM,,,,,,both,,,6689.3000,1003.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,2160.64,,,,,,,1726.5100,6689.3000,percent of total billed charges,"32.3% of $6,689.30 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIMMER BLADE DIAMETER 3.5,272,RC,27200002,CDM,,,,,,both,,,6689.3000,1003.4000,WELLCARE,WELLCARE MEDICAID,6689.30,,,,,,,1726.5100,6689.3000,percent of total billed charges,"100% of $6,689.30 in Billed Charges for Rev 272 = $6,689.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIN CLOSURE DEVICE ZIP 24,272,RC,27200002,CDM,,,,,,both,,,1186.9600,178.0400,AETNA,AETNA,506.83,,,,,,,306.3500,1186.9600,percent of total billed charges,"42.7% of $1,186.96 in Billed Charges for Rev 272 = $506.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIN CLOSURE DEVICE ZIP 24,272,RC,27200002,CDM,,,,,,both,,,1186.9600,178.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,830.87,,,,,,,306.3500,1186.9600,percent of total billed charges,"Rev 272 $1,186.96 in Billed Charges at 70% = $830.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIN CLOSURE DEVICE ZIP 24,272,RC,27200002,CDM,,,,,,both,,,1186.9600,178.0400,CIGNA HEALTHCARE,CIGNA HMO,494.96,,,,,,,306.3500,1186.9600,percent of total billed charges,"41.7% of $1,186.96 in Billed Charges for Rev 272 = $494.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIN CLOSURE DEVICE ZIP 24,272,RC,27200002,CDM,,,,,,both,,,1186.9600,178.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,550.75,,,,,,,306.3500,1186.9600,percent of total billed charges,"46.4% of $1,186.96 in Billed Charges for Rev 272 = $550.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIN CLOSURE DEVICE ZIP 24,272,RC,27200002,CDM,,,,,,both,,,1186.9600,178.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,494.96,,,,,,,306.3500,1186.9600,percent of total billed charges,"41.7% of $1,186.96 in Billed Charges for Rev 272 = $494.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIN CLOSURE DEVICE ZIP 24,272,RC,27200002,CDM,,,,,,both,,,1186.9600,178.0400,CIGNA HEALTHCARE,CIGNA PPO,494.96,,,,,,,306.3500,1186.9600,percent of total billed charges,"41.7% of $1,186.96 in Billed Charges for Rev 272 = $494.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIN CLOSURE DEVICE ZIP 24,272,RC,27200002,CDM,,,,,,both,,,1186.9600,178.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1068.26,,,,,,,306.3500,1186.9600,percent of total billed charges,"90% of $1,186.96 in Billed Charges for Rev 272 = $1,068.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIN CLOSURE DEVICE ZIP 24,272,RC,27200002,CDM,,,,,,both,,,1186.9600,178.0400,MEDCOST,MEDCOST VHN,564.87,,,,,,,306.3500,1186.9600,percent of total billed charges,"47.59% of $1,186.96 in Billed Charges for Rev 272 = $564.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIN CLOSURE DEVICE ZIP 24,272,RC,27200002,CDM,,,,,,both,,,1186.9600,178.0400,SENTARA HEALTH,SENTARA HEALTH,306.35,,,,,,,306.3500,1186.9600,percent of total billed charges,"25.81% of $1,186.96 in Billed Charges for Rev 272 = $306.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIN CLOSURE DEVICE ZIP 24,272,RC,27200002,CDM,,,,,,both,,,1186.9600,178.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1186.96,,,,,,,306.3500,1186.9600,percent of total billed charges,"100% of $1,186.96 in Billed Charges for Rev 272 = $1,186.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIN CLOSURE DEVICE ZIP 24,272,RC,27200002,CDM,,,,,,both,,,1186.9600,178.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,593.48,,,,,,,306.3500,1186.9600,percent of total billed charges,"Rev 272 $1,186.96 in Billed Charges at 50% = $593.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIN CLOSURE DEVICE ZIP 24,272,RC,27200002,CDM,,,,,,both,,,1186.9600,178.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,383.39,,,,,,,306.3500,1186.9600,other,"32.3% of $1,186.96 in Billed Charges for Rev 272 = $383.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SKIN CLOSURE DEVICE ZIP 24,272,RC,27200002,CDM,,,,,,both,,,1186.9600,178.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,364.40,,,,,,,306.3500,1186.9600,other,"30.7% of $1,186.96 in Billed Charges for Rev 272 = $364.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SKIN CLOSURE DEVICE ZIP 24,272,RC,27200002,CDM,,,,,,both,,,1186.9600,178.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,383.39,,,,,,,306.3500,1186.9600,percent of total billed charges,"32.3% of $1,186.96 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SKIN CLOSURE DEVICE ZIP 24,272,RC,27200002,CDM,,,,,,both,,,1186.9600,178.0400,WELLCARE,WELLCARE MEDICAID,1186.96,,,,,,,306.3500,1186.9600,percent of total billed charges,"100% of $1,186.96 in Billed Charges for Rev 272 = $1,186.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,AETNA,AETNA,67.47,,,,,,,6.7800,158.0000,percent of total billed charges,42.7% of $158.00 in Billed Charges for Rev 302 Proc 86710 = $67.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,6.7800,158.0000,fee schedule,APG 00394 Proc 86710 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,13.55,,,,,,,6.7800,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,AETNA,AETNA HEALTHCARE MEDICARE,13.55,,,,,,,6.7800,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,13.55,,,,,,,6.7800,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,AMBETTER,AMBETTER,29.54,,,,,,,6.7800,158.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,AMERIGROUP,AMERIGROUP,6.78,,,,,,,6.7800,158.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,14.09,,,,,,,6.7800,158.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,ANTHEM EXCHANGE,13.55,,,,,,,6.7800,158.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,6.7800,158.0000,fee schedule,APG 00394 Proc 86710 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,ANTHEM HMO,13.55,,,,,,,6.7800,158.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,13.96,,,,,,,6.7800,158.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",13.55,,,,,,,6.7800,158.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,38.69,,,,,,,6.7800,158.0000,fee schedule,$38.69 from Fee Schedule BLDTM_23 for Rev 302 Proc 86710 * Qty 1 = $38.69 at 100% = $38.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS E NETWORK,59.17,,,,,,,6.7800,158.0000,fee schedule,$18.49 from Fee Schedule BCFSB for Rev 302 Proc 86710 * Qty 1 = $18.49 at 320% = $59.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS MEDICARE,14.09,,,,,,,6.7800,158.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS P NETWORK,60.46,,,,,,,6.7800,158.0000,fee schedule,$18.49 from Fee Schedule BCFSB for Rev 302 Proc 86710 * Qty 1 = $18.49 at 327% = $60.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS S NETWORK,60.46,,,,,,,6.7800,158.0000,fee schedule,$18.49 from Fee Schedule BCFSB for Rev 302 Proc 86710 * Qty 1 = $18.49 at 327% = $60.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,TENNCARE BLUE CARE,40.25,,,,,,,6.7800,158.0000,fee schedule,$34.70 from Fee Schedule TC_24 for Rev 302 Proc 86710 * Qty 1 = $34.70 at 116% = $40.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,TENNCARE BLUE SELECT,40.25,,,,,,,6.7800,158.0000,fee schedule,$34.70 from Fee Schedule TC_24 for Rev 302 Proc 86710 * Qty 1 = $34.70 at 116% = $40.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA HMO,54.54,,,,,,,6.7800,158.0000,fee schedule,$54.54 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86710 * Qty 1 = $54.54 at 100% = $54.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,29.59,,,,,,,6.7800,158.0000,fee schedule,$29.59 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86710 * Qty 1 = $29.59 at 100% = $29.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,14.23,,,,,,,6.7800,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,54.54,,,,,,,6.7800,158.0000,fee schedule,$54.54 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86710 * Qty 1 = $54.54 at 100% = $54.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA PPO,54.54,,,,,,,6.7800,158.0000,fee schedule,$54.54 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86710 * Qty 1 = $54.54 at 100% = $54.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,14.23,,,,,,,6.7800,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,142.20,,,,,,,6.7800,158.0000,percent of total billed charges,90% of $158.00 in Billed Charges for Rev 302 Proc 86710 = $142.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,HUMANA,HUMANA MEDICARE,13.55,,,,,,,6.7800,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,13.55,,,,,,,6.7800,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,MEDCOST,MEDCOST VHN,75.19,,,,,,,6.7800,158.0000,percent of total billed charges,47.59% of $158.00 in Billed Charges for Rev 302 Proc 86710 = $75.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,6.7800,158.0000,fee schedule,APG 00394 Proc 86710 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,14.23,,,,,,,6.7800,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,14.23,,,,,,,6.7800,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,NHC ADVANTAGE,NHC ADVANTAGE,14.23,,,,,,,6.7800,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,6.7800,158.0000,fee schedule,APG 00394 Proc 86710 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,SENTARA HEALTH,SENTARA HEALTH,40.78,,,,,,,6.7800,158.0000,percent of total billed charges,25.81% of $158.00 in Billed Charges for Rev 302 Proc 86710 = $40.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,SENTARA HEALTH,SENTARA MEDICARE,13.55,,,,,,,6.7800,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",158.00,,,,,,,6.7800,158.0000,percent of total billed charges,100% of $158.00 in Billed Charges for Rev 302 Proc 86710 = $158.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9.60,,,,,,,6.7800,158.0000,fee schedule,$19.20 from Fee Schedule TCUHC24 for Rev 302 Proc 86710 * Qty 1 = $19.20 at 50% = $9.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,14.09,,,,,,,6.7800,158.0000,fee schedule,$13.55 from Fee Schedule UHC_31910 for Rev 302 Proc 86710 * Qty 1 = $13.55 at 104% = $14.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,13.55,,,,,,,6.7800,158.0000,fee schedule,$13.55 from Fee Schedule UHC_31910 for Rev 302 Proc 86710 * Qty 1 = $13.55 at 100% = $13.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,13.55,,,,,,,6.7800,158.0000,fee schedule,$13.55 from Fee Schedule UHC_31910 for Rev 302 Proc 86710 * Qty 1 = $13.55 at 100% = $13.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,6.7800,158.0000,fee schedule,APG 00394 Proc 86710 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,13.55,,,,,,,6.7800,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,13.55,,,,,,,6.7800,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,WELLCARE,WELLCARE MEDICAID,158.00,,,,,,,6.7800,158.0000,percent of total billed charges,100% of $158.00 in Billed Charges for Rev 302 Proc 86710 = $158.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY INFLUENZA VIRUS,86710,CPT,302,RC,30200096,CDM,,,,both,,,158.0000,23.7000,WELLCARE,WELLCARE MEDICARE,14.36,,,,,,,6.7800,158.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,AETNA,AETNA,71.74,,,,,,,8.4500,168.0000,percent of total billed charges,42.7% of $168.00 in Billed Charges for Rev 302 Proc 86711 = $71.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,8.4500,168.0000,fee schedule,APG 00394 Proc 86711 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,16.89,,,,,,,8.4500,168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,AETNA,AETNA HEALTHCARE MEDICARE,16.89,,,,,,,8.4500,168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,16.89,,,,,,,8.4500,168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,AMBETTER,AMBETTER,36.82,,,,,,,8.4500,168.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,AMERIGROUP,AMERIGROUP,8.45,,,,,,,8.4500,168.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,17.57,,,,,,,8.4500,168.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,BLUE CROSS,ANTHEM EXCHANGE,16.89,,,,,,,8.4500,168.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,8.4500,168.0000,fee schedule,APG 00394 Proc 86711 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,BLUE CROSS,ANTHEM HMO,16.89,,,,,,,8.4500,168.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,17.40,,,,,,,8.4500,168.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",16.89,,,,,,,8.4500,168.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,117.60,,,,,,,8.4500,168.0000,percent of total billed charges,Rev 302 Proc 86711 $168.00 in Billed Charges at 70% = $117.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,BLUE CROSS,BLUE CROSS E NETWORK,62.85,,,,,,,8.4500,168.0000,fee schedule,$19.64 from Fee Schedule BCFSB for Rev 302 Proc 86711 * Qty 1 = $19.64 at 320% = $62.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,BLUE CROSS,BLUE CROSS MEDICARE,17.57,,,,,,,8.4500,168.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,BLUE CROSS,BLUE CROSS P NETWORK,64.22,,,,,,,8.4500,168.0000,fee schedule,$19.64 from Fee Schedule BCFSB for Rev 302 Proc 86711 * Qty 1 = $19.64 at 327% = $64.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,BLUE CROSS,BLUE CROSS S NETWORK,64.22,,,,,,,8.4500,168.0000,fee schedule,$19.64 from Fee Schedule BCFSB for Rev 302 Proc 86711 * Qty 1 = $19.64 at 327% = $64.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,BLUE CROSS,TENNCARE BLUE CARE,18.65,,,,,,,8.4500,168.0000,fee schedule,$16.08 from Fee Schedule TC_24 for Rev 302 Proc 86711 * Qty 1 = $16.08 at 116% = $18.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,BLUE CROSS,TENNCARE BLUE SELECT,18.65,,,,,,,8.4500,168.0000,fee schedule,$16.08 from Fee Schedule TC_24 for Rev 302 Proc 86711 * Qty 1 = $16.08 at 116% = $18.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,CIGNA HEALTHCARE,CIGNA HMO,70.06,,,,,,,8.4500,168.0000,percent of total billed charges,Rev 302 Proc 86711 $168.00 in Billed Charges at 41.7% = $70.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,37.53,,,,,,,8.4500,168.0000,fee schedule,$37.53 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86711 * Qty 1 = $37.53 at 100% = $37.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,17.73,,,,,,,8.4500,168.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,70.06,,,,,,,8.4500,168.0000,percent of total billed charges,Rev 302 Proc 86711 $168.00 in Billed Charges at 41.7% = $70.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,CIGNA HEALTHCARE,CIGNA PPO,70.06,,,,,,,8.4500,168.0000,percent of total billed charges,Rev 302 Proc 86711 $168.00 in Billed Charges at 41.7% = $70.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,17.73,,,,,,,8.4500,168.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,151.20,,,,,,,8.4500,168.0000,percent of total billed charges,90% of $168.00 in Billed Charges for Rev 302 Proc 86711 = $151.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,HUMANA,HUMANA MEDICARE,16.89,,,,,,,8.4500,168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,16.89,,,,,,,8.4500,168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,MEDCOST,MEDCOST VHN,79.95,,,,,,,8.4500,168.0000,percent of total billed charges,47.59% of $168.00 in Billed Charges for Rev 302 Proc 86711 = $79.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,8.4500,168.0000,fee schedule,APG 00394 Proc 86711 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,17.73,,,,,,,8.4500,168.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,17.73,,,,,,,8.4500,168.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,NHC ADVANTAGE,NHC ADVANTAGE,17.73,,,,,,,8.4500,168.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,8.4500,168.0000,fee schedule,APG 00394 Proc 86711 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,SENTARA HEALTH,SENTARA HEALTH,43.36,,,,,,,8.4500,168.0000,percent of total billed charges,25.81% of $168.00 in Billed Charges for Rev 302 Proc 86711 = $43.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,SENTARA HEALTH,SENTARA MEDICARE,16.89,,,,,,,8.4500,168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",168.00,,,,,,,8.4500,168.0000,percent of total billed charges,100% of $168.00 in Billed Charges for Rev 302 Proc 86711 = $168.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9.90,,,,,,,8.4500,168.0000,fee schedule,$19.79 from Fee Schedule TCUHC24 for Rev 302 Proc 86711 * Qty 1 = $19.79 at 50% = $9.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,17.57,,,,,,,8.4500,168.0000,fee schedule,$16.89 from Fee Schedule UHC_31910 for Rev 302 Proc 86711 * Qty 1 = $16.89 at 104% = $17.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,16.89,,,,,,,8.4500,168.0000,fee schedule,$16.89 from Fee Schedule UHC_31910 for Rev 302 Proc 86711 * Qty 1 = $16.89 at 100% = $16.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,16.89,,,,,,,8.4500,168.0000,fee schedule,$16.89 from Fee Schedule UHC_31910 for Rev 302 Proc 86711 * Qty 1 = $16.89 at 100% = $16.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,8.4500,168.0000,fee schedule,APG 00394 Proc 86711 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,16.89,,,,,,,8.4500,168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,16.89,,,,,,,8.4500,168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,WELLCARE,WELLCARE MEDICAID,168.00,,,,,,,8.4500,168.0000,percent of total billed charges,100% of $168.00 in Billed Charges for Rev 302 Proc 86711 = $168.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTIBODY JOHN CUNNINGHAM VIRUS,86711,CPT,302,RC,30200155,CDM,,,,both,,,168.0000,25.2000,WELLCARE,WELLCARE MEDICARE,17.90,,,,,,,8.4500,168.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,AETNA,AETNA,20.50,,,,,,,3.3200,48.0000,percent of total billed charges,42.7% of $48.00 in Billed Charges for Rev 306 Proc 87188 = $20.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,3.3200,48.0000,fee schedule,APG 00396 Proc 87188 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,6.64,,,,,,,3.3200,48.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,AETNA,AETNA HEALTHCARE MEDICARE,6.64,,,,,,,3.3200,48.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,6.64,,,,,,,3.3200,48.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,AMBETTER,AMBETTER,14.48,,,,,,,3.3200,48.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,AMERIGROUP,AMERIGROUP,3.32,,,,,,,3.3200,48.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,6.91,,,,,,,3.3200,48.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,ANTHEM EXCHANGE,6.64,,,,,,,3.3200,48.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,3.3200,48.0000,fee schedule,APG 00396 Proc 87188 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,ANTHEM HMO,6.64,,,,,,,3.3200,48.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,6.84,,,,,,,3.3200,48.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",6.64,,,,,,,3.3200,48.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,19.27,,,,,,,3.3200,48.0000,fee schedule,$19.27 from Fee Schedule BLDTM_23 for Rev 306 Proc 87188 * Qty 1 = $19.27 at 100% = $19.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,BLUE CROSS E NETWORK,28.99,,,,,,,3.3200,48.0000,fee schedule,$9.06 from Fee Schedule BCFSB for Rev 306 Proc 87188 * Qty 1 = $9.06 at 320% = $28.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,BLUE CROSS MEDICARE,6.91,,,,,,,3.3200,48.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,BLUE CROSS P NETWORK,29.63,,,,,,,3.3200,48.0000,fee schedule,$9.06 from Fee Schedule BCFSB for Rev 306 Proc 87188 * Qty 1 = $9.06 at 327% = $29.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,BLUE CROSS S NETWORK,29.63,,,,,,,3.3200,48.0000,fee schedule,$9.06 from Fee Schedule BCFSB for Rev 306 Proc 87188 * Qty 1 = $9.06 at 327% = $29.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,TENNCARE BLUE CARE,15.10,,,,,,,3.3200,48.0000,fee schedule,$13.02 from Fee Schedule TC_24 for Rev 306 Proc 87188 * Qty 1 = $13.02 at 116% = $15.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,TENNCARE BLUE SELECT,15.10,,,,,,,3.3200,48.0000,fee schedule,$13.02 from Fee Schedule TC_24 for Rev 306 Proc 87188 * Qty 1 = $13.02 at 116% = $15.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,CIGNA HEALTHCARE,CIGNA HMO,26.70,,,,,,,3.3200,48.0000,fee schedule,$26.70 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87188 * Qty 1 = $26.70 at 100% = $26.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,14.44,,,,,,,3.3200,48.0000,fee schedule,$14.44 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87188 * Qty 1 = $14.44 at 100% = $14.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,6.97,,,,,,,3.3200,48.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,26.70,,,,,,,3.3200,48.0000,fee schedule,$26.70 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87188 * Qty 1 = $26.70 at 100% = $26.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,CIGNA HEALTHCARE,CIGNA PPO,26.70,,,,,,,3.3200,48.0000,fee schedule,$26.70 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87188 * Qty 1 = $26.70 at 100% = $26.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,6.97,,,,,,,3.3200,48.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,43.20,,,,,,,3.3200,48.0000,percent of total billed charges,90% of $48.00 in Billed Charges for Rev 306 Proc 87188 = $43.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,HUMANA,HUMANA MEDICARE,6.64,,,,,,,3.3200,48.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,6.64,,,,,,,3.3200,48.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,MEDCOST,MEDCOST VHN,22.84,,,,,,,3.3200,48.0000,percent of total billed charges,47.59% of $48.00 in Billed Charges for Rev 306 Proc 87188 = $22.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,3.3200,48.0000,fee schedule,APG 00396 Proc 87188 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,6.97,,,,,,,3.3200,48.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,6.97,,,,,,,3.3200,48.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,NHC ADVANTAGE,NHC ADVANTAGE,6.97,,,,,,,3.3200,48.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,3.3200,48.0000,fee schedule,APG 00396 Proc 87188 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,SENTARA HEALTH,SENTARA HEALTH,12.39,,,,,,,3.3200,48.0000,percent of total billed charges,25.81% of $48.00 in Billed Charges for Rev 306 Proc 87188 = $12.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,SENTARA HEALTH,SENTARA MEDICARE,6.64,,,,,,,3.3200,48.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",48.00,,,,,,,3.3200,48.0000,percent of total billed charges,100% of $48.00 in Billed Charges for Rev 306 Proc 87188 = $48.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4.70,,,,,,,3.3200,48.0000,fee schedule,$9.40 from Fee Schedule TCUHC24 for Rev 306 Proc 87188 * Qty 1 = $9.40 at 50% = $4.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,6.91,,,,,,,3.3200,48.0000,fee schedule,$6.64 from Fee Schedule UHC_31910 for Rev 306 Proc 87188 * Qty 1 = $6.64 at 104% = $6.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,6.64,,,,,,,3.3200,48.0000,fee schedule,$6.64 from Fee Schedule UHC_31910 for Rev 306 Proc 87188 * Qty 1 = $6.64 at 100% = $6.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,6.64,,,,,,,3.3200,48.0000,fee schedule,$6.64 from Fee Schedule UHC_31910 for Rev 306 Proc 87188 * Qty 1 = $6.64 at 100% = $6.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,3.3200,48.0000,fee schedule,APG 00396 Proc 87188 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,6.64,,,,,,,3.3200,48.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,6.64,,,,,,,3.3200,48.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,WELLCARE,WELLCARE MEDICAID,48.00,,,,,,,3.3200,48.0000,percent of total billed charges,100% of $48.00 in Billed Charges for Rev 306 Proc 87188 = $48.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT,87188,CPT,306,RC,30600206,CDM,,,,both,,,48.0000,7.2000,WELLCARE,WELLCARE MEDICARE,7.04,,,,,,,3.3200,48.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,AETNA,AETNA,26.90,,,,,,,1.4200,63.0000,percent of total billed charges,42.7% of $63.00 in Billed Charges for Rev 306 Proc 87190 = $26.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,1.4200,63.0000,fee schedule,APG 00396 Proc 87190 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,7.31,,,,,,,1.4200,63.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,AETNA,AETNA HEALTHCARE MEDICARE,7.31,,,,,,,1.4200,63.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,7.31,,,,,,,1.4200,63.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,AMBETTER,AMBETTER,15.94,,,,,,,1.4200,63.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,AMERIGROUP,AMERIGROUP,3.66,,,,,,,1.4200,63.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,7.60,,,,,,,1.4200,63.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,BLUE CROSS,ANTHEM EXCHANGE,7.31,,,,,,,1.4200,63.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,1.4200,63.0000,fee schedule,APG 00396 Proc 87190 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,BLUE CROSS,ANTHEM HMO,7.31,,,,,,,1.4200,63.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,7.53,,,,,,,1.4200,63.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",7.31,,,,,,,1.4200,63.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,15.69,,,,,,,1.4200,63.0000,fee schedule,$15.69 from Fee Schedule BLDTM_23 for Rev 306 Proc 87190 * Qty 1 = $15.69 at 100% = $15.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,BLUE CROSS,BLUE CROSS E NETWORK,3.26,,,,,,,1.4200,63.0000,fee schedule,$1.02 from Fee Schedule BCFSB for Rev 306 Proc 87190 * Qty 1 = $1.02 at 320% = $3.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,BLUE CROSS,BLUE CROSS MEDICARE,7.60,,,,,,,1.4200,63.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,BLUE CROSS,BLUE CROSS P NETWORK,3.34,,,,,,,1.4200,63.0000,fee schedule,$1.02 from Fee Schedule BCFSB for Rev 306 Proc 87190 * Qty 1 = $1.02 at 327% = $3.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,BLUE CROSS,BLUE CROSS S NETWORK,3.34,,,,,,,1.4200,63.0000,fee schedule,$1.02 from Fee Schedule BCFSB for Rev 306 Proc 87190 * Qty 1 = $1.02 at 327% = $3.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,BLUE CROSS,TENNCARE BLUE CARE,1.42,,,,,,,1.4200,63.0000,fee schedule,$1.22 from Fee Schedule TC_24 for Rev 306 Proc 87190 * Qty 1 = $1.22 at 116% = $1.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,BLUE CROSS,TENNCARE BLUE SELECT,1.42,,,,,,,1.4200,63.0000,fee schedule,$1.22 from Fee Schedule TC_24 for Rev 306 Proc 87190 * Qty 1 = $1.22 at 116% = $1.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,CIGNA HEALTHCARE,CIGNA HMO,22.77,,,,,,,1.4200,63.0000,fee schedule,$22.77 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87190 * Qty 1 = $22.77 at 100% = $22.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,15.88,,,,,,,1.4200,63.0000,fee schedule,$15.88 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87190 * Qty 1 = $15.88 at 100% = $15.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,7.68,,,,,,,1.4200,63.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,22.77,,,,,,,1.4200,63.0000,fee schedule,$22.77 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87190 * Qty 1 = $22.77 at 100% = $22.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,CIGNA HEALTHCARE,CIGNA PPO,22.77,,,,,,,1.4200,63.0000,fee schedule,$22.77 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87190 * Qty 1 = $22.77 at 100% = $22.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,7.68,,,,,,,1.4200,63.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,56.70,,,,,,,1.4200,63.0000,percent of total billed charges,90% of $63.00 in Billed Charges for Rev 306 Proc 87190 = $56.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,HUMANA,HUMANA MEDICARE,7.31,,,,,,,1.4200,63.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,7.31,,,,,,,1.4200,63.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,MEDCOST,MEDCOST VHN,29.98,,,,,,,1.4200,63.0000,percent of total billed charges,47.59% of $63.00 in Billed Charges for Rev 306 Proc 87190 = $29.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,1.4200,63.0000,fee schedule,APG 00396 Proc 87190 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,7.68,,,,,,,1.4200,63.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,7.68,,,,,,,1.4200,63.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,NHC ADVANTAGE,NHC ADVANTAGE,7.68,,,,,,,1.4200,63.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,1.4200,63.0000,fee schedule,APG 00396 Proc 87190 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,SENTARA HEALTH,SENTARA HEALTH,16.26,,,,,,,1.4200,63.0000,percent of total billed charges,25.81% of $63.00 in Billed Charges for Rev 306 Proc 87190 = $16.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,SENTARA HEALTH,SENTARA MEDICARE,7.31,,,,,,,1.4200,63.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",63.00,,,,,,,1.4200,63.0000,percent of total billed charges,100% of $63.00 in Billed Charges for Rev 306 Proc 87190 = $63.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4.01,,,,,,,1.4200,63.0000,fee schedule,$8.01 from Fee Schedule TCUHC24 for Rev 306 Proc 87190 * Qty 1 = $8.01 at 50% = $4.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7.60,,,,,,,1.4200,63.0000,fee schedule,$7.31 from Fee Schedule UHC_31910 for Rev 306 Proc 87190 * Qty 1 = $7.31 at 104% = $7.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7.31,,,,,,,1.4200,63.0000,fee schedule,$7.31 from Fee Schedule UHC_31910 for Rev 306 Proc 87190 * Qty 1 = $7.31 at 100% = $7.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,7.31,,,,,,,1.4200,63.0000,fee schedule,$7.31 from Fee Schedule UHC_31910 for Rev 306 Proc 87190 * Qty 1 = $7.31 at 100% = $7.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,1.4200,63.0000,fee schedule,APG 00396 Proc 87190 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,7.31,,,,,,,1.4200,63.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,7.31,,,,,,,1.4200,63.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,WELLCARE,WELLCARE MEDICAID,63.00,,,,,,,1.4200,63.0000,percent of total billed charges,100% of $63.00 in Billed Charges for Rev 306 Proc 87190 = $63.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUSCEPTIBILITY STDY ANTMCRB MYCOBACT PROPORTION WTHD EA AG,87190,CPT,306,RC,30600158,CDM,,,,both,,,63.0000,9.4500,WELLCARE,WELLCARE MEDICARE,7.75,,,,,,,1.4200,63.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,AETNA,AETNA,20.92,,,,,,,2.1400,49.0000,percent of total billed charges,42.7% of $49.00 in Billed Charges for Rev 306 Proc 87205 = $20.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,2.1400,49.0000,fee schedule,APG 00396 Proc 87205 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,4.27,,,,,,,2.1400,49.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,AETNA,AETNA HEALTHCARE MEDICARE,4.27,,,,,,,2.1400,49.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,4.27,,,,,,,2.1400,49.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,AMBETTER,AMBETTER,9.31,,,,,,,2.1400,49.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,AMERIGROUP,AMERIGROUP,2.14,,,,,,,2.1400,49.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,4.44,,,,,,,2.1400,49.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,BLUE CROSS,ANTHEM EXCHANGE,4.27,,,,,,,2.1400,49.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,2.1400,49.0000,fee schedule,APG 00396 Proc 87205 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,BLUE CROSS,ANTHEM HMO,4.27,,,,,,,2.1400,49.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,4.40,,,,,,,2.1400,49.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4.27,,,,,,,2.1400,49.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11.55,,,,,,,2.1400,49.0000,fee schedule,$11.55 from Fee Schedule BLDTM_23 for Rev 306 Proc 87205 * Qty 1 = $11.55 at 100% = $11.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,BLUE CROSS,BLUE CROSS E NETWORK,18.62,,,,,,,2.1400,49.0000,fee schedule,$5.82 from Fee Schedule BCFSB for Rev 306 Proc 87205 * Qty 1 = $5.82 at 320% = $18.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,BLUE CROSS,BLUE CROSS MEDICARE,4.44,,,,,,,2.1400,49.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,BLUE CROSS,BLUE CROSS P NETWORK,19.03,,,,,,,2.1400,49.0000,fee schedule,$5.82 from Fee Schedule BCFSB for Rev 306 Proc 87205 * Qty 1 = $5.82 at 327% = $19.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,BLUE CROSS,BLUE CROSS S NETWORK,19.03,,,,,,,2.1400,49.0000,fee schedule,$5.82 from Fee Schedule BCFSB for Rev 306 Proc 87205 * Qty 1 = $5.82 at 327% = $19.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,BLUE CROSS,TENNCARE BLUE CARE,8.91,,,,,,,2.1400,49.0000,fee schedule,$7.68 from Fee Schedule TC_24 for Rev 306 Proc 87205 * Qty 1 = $7.68 at 116% = $8.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,BLUE CROSS,TENNCARE BLUE SELECT,8.91,,,,,,,2.1400,49.0000,fee schedule,$7.68 from Fee Schedule TC_24 for Rev 306 Proc 87205 * Qty 1 = $7.68 at 116% = $8.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,CIGNA HEALTHCARE,CIGNA HMO,17.17,,,,,,,2.1400,49.0000,fee schedule,$17.17 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87205 * Qty 1 = $17.17 at 100% = $17.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,9.38,,,,,,,2.1400,49.0000,fee schedule,$9.38 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87205 * Qty 1 = $9.38 at 100% = $9.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,4.48,,,,,,,2.1400,49.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,17.17,,,,,,,2.1400,49.0000,fee schedule,$17.17 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87205 * Qty 1 = $17.17 at 100% = $17.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,CIGNA HEALTHCARE,CIGNA PPO,17.17,,,,,,,2.1400,49.0000,fee schedule,$17.17 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87205 * Qty 1 = $17.17 at 100% = $17.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,4.48,,,,,,,2.1400,49.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,44.10,,,,,,,2.1400,49.0000,percent of total billed charges,90% of $49.00 in Billed Charges for Rev 306 Proc 87205 = $44.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,HUMANA,HUMANA MEDICARE,4.27,,,,,,,2.1400,49.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,4.27,,,,,,,2.1400,49.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,MEDCOST,MEDCOST VHN,23.32,,,,,,,2.1400,49.0000,percent of total billed charges,47.59% of $49.00 in Billed Charges for Rev 306 Proc 87205 = $23.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,2.1400,49.0000,fee schedule,APG 00396 Proc 87205 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,4.48,,,,,,,2.1400,49.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,4.48,,,,,,,2.1400,49.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,NHC ADVANTAGE,NHC ADVANTAGE,4.48,,,,,,,2.1400,49.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,2.1400,49.0000,fee schedule,APG 00396 Proc 87205 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,SENTARA HEALTH,SENTARA HEALTH,12.65,,,,,,,2.1400,49.0000,percent of total billed charges,25.81% of $49.00 in Billed Charges for Rev 306 Proc 87205 = $12.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,SENTARA HEALTH,SENTARA MEDICARE,4.27,,,,,,,2.1400,49.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",49.00,,,,,,,2.1400,49.0000,percent of total billed charges,100% of $49.00 in Billed Charges for Rev 306 Proc 87205 = $49.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3.03,,,,,,,2.1400,49.0000,fee schedule,$6.05 from Fee Schedule TCUHC24 for Rev 306 Proc 87205 * Qty 1 = $6.05 at 50% = $3.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4.44,,,,,,,2.1400,49.0000,fee schedule,$4.27 from Fee Schedule UHC_31910 for Rev 306 Proc 87205 * Qty 1 = $4.27 at 104% = $4.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,4.27,,,,,,,2.1400,49.0000,fee schedule,$4.27 from Fee Schedule UHC_31910 for Rev 306 Proc 87205 * Qty 1 = $4.27 at 100% = $4.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,4.27,,,,,,,2.1400,49.0000,fee schedule,$4.27 from Fee Schedule UHC_31910 for Rev 306 Proc 87205 * Qty 1 = $4.27 at 100% = $4.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,2.1400,49.0000,fee schedule,APG 00396 Proc 87205 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,4.27,,,,,,,2.1400,49.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,4.27,,,,,,,2.1400,49.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,WELLCARE,WELLCARE MEDICAID,49.00,,,,,,,2.1400,49.0000,percent of total billed charges,100% of $49.00 in Billed Charges for Rev 306 Proc 87205 = $49.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMEAR GRAM OR GIEMSA,87205,CPT,306,RC,30600031,CDM,,,,both,,,49.0000,7.3500,WELLCARE,WELLCARE MEDICARE,4.53,,,,,,,2.1400,49.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,AETNA,AETNA,26.05,,,,,,,2.7000,61.0000,percent of total billed charges,42.7% of $61.00 in Billed Charges for Rev 306 Proc 87206 = $26.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,2.7000,61.0000,fee schedule,APG 00396 Proc 87206 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5.39,,,,,,,2.7000,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,AETNA,AETNA HEALTHCARE MEDICARE,5.39,,,,,,,2.7000,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,5.39,,,,,,,2.7000,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,AMBETTER,AMBETTER,11.75,,,,,,,2.7000,61.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,AMERIGROUP,AMERIGROUP,2.70,,,,,,,2.7000,61.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,5.61,,,,,,,2.7000,61.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,ANTHEM EXCHANGE,5.39,,,,,,,2.7000,61.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,2.7000,61.0000,fee schedule,APG 00396 Proc 87206 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,ANTHEM HMO,5.39,,,,,,,2.7000,61.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5.55,,,,,,,2.7000,61.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5.39,,,,,,,2.7000,61.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,15.57,,,,,,,2.7000,61.0000,fee schedule,$15.57 from Fee Schedule BLDTM_23 for Rev 306 Proc 87206 * Qty 1 = $15.57 at 100% = $15.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS E NETWORK,20.29,,,,,,,2.7000,61.0000,fee schedule,$6.34 from Fee Schedule BCFSB for Rev 306 Proc 87206 * Qty 1 = $6.34 at 320% = $20.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS MEDICARE,5.61,,,,,,,2.7000,61.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS P NETWORK,20.73,,,,,,,2.7000,61.0000,fee schedule,$6.34 from Fee Schedule BCFSB for Rev 306 Proc 87206 * Qty 1 = $6.34 at 327% = $20.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS S NETWORK,20.73,,,,,,,2.7000,61.0000,fee schedule,$6.34 from Fee Schedule BCFSB for Rev 306 Proc 87206 * Qty 1 = $6.34 at 327% = $20.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,TENNCARE BLUE CARE,8.91,,,,,,,2.7000,61.0000,fee schedule,$7.68 from Fee Schedule TC_24 for Rev 306 Proc 87206 * Qty 1 = $7.68 at 116% = $8.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,TENNCARE BLUE SELECT,8.91,,,,,,,2.7000,61.0000,fee schedule,$7.68 from Fee Schedule TC_24 for Rev 306 Proc 87206 * Qty 1 = $7.68 at 116% = $8.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA HMO,21.63,,,,,,,2.7000,61.0000,fee schedule,$21.63 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87206 * Qty 1 = $21.63 at 100% = $21.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11.55,,,,,,,2.7000,61.0000,fee schedule,$11.55 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87206 * Qty 1 = $11.55 at 100% = $11.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,5.66,,,,,,,2.7000,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,21.63,,,,,,,2.7000,61.0000,fee schedule,$21.63 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87206 * Qty 1 = $21.63 at 100% = $21.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA PPO,21.63,,,,,,,2.7000,61.0000,fee schedule,$21.63 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87206 * Qty 1 = $21.63 at 100% = $21.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,5.66,,,,,,,2.7000,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,54.90,,,,,,,2.7000,61.0000,percent of total billed charges,90% of $61.00 in Billed Charges for Rev 306 Proc 87206 = $54.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,HUMANA,HUMANA MEDICARE,5.39,,,,,,,2.7000,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5.39,,,,,,,2.7000,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,MEDCOST,MEDCOST VHN,29.03,,,,,,,2.7000,61.0000,percent of total billed charges,47.59% of $61.00 in Billed Charges for Rev 306 Proc 87206 = $29.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,2.7000,61.0000,fee schedule,APG 00396 Proc 87206 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,5.66,,,,,,,2.7000,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,5.66,,,,,,,2.7000,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,NHC ADVANTAGE,NHC ADVANTAGE,5.66,,,,,,,2.7000,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,2.7000,61.0000,fee schedule,APG 00396 Proc 87206 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,SENTARA HEALTH,SENTARA HEALTH,15.74,,,,,,,2.7000,61.0000,percent of total billed charges,25.81% of $61.00 in Billed Charges for Rev 306 Proc 87206 = $15.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,SENTARA HEALTH,SENTARA MEDICARE,5.39,,,,,,,2.7000,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",61.00,,,,,,,2.7000,61.0000,percent of total billed charges,100% of $61.00 in Billed Charges for Rev 306 Proc 87206 = $61.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3.81,,,,,,,2.7000,61.0000,fee schedule,$7.61 from Fee Schedule TCUHC24 for Rev 306 Proc 87206 * Qty 1 = $7.61 at 50% = $3.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5.61,,,,,,,2.7000,61.0000,fee schedule,$5.39 from Fee Schedule UHC_31910 for Rev 306 Proc 87206 * Qty 1 = $5.39 at 104% = $5.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,5.39,,,,,,,2.7000,61.0000,fee schedule,$5.39 from Fee Schedule UHC_31910 for Rev 306 Proc 87206 * Qty 1 = $5.39 at 100% = $5.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,5.39,,,,,,,2.7000,61.0000,fee schedule,$5.39 from Fee Schedule UHC_31910 for Rev 306 Proc 87206 * Qty 1 = $5.39 at 100% = $5.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,2.7000,61.0000,fee schedule,APG 00396 Proc 87206 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5.39,,,,,,,2.7000,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5.39,,,,,,,2.7000,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,WELLCARE,WELLCARE MEDICAID,61.00,,,,,,,2.7000,61.0000,percent of total billed charges,100% of $61.00 in Billed Charges for Rev 306 Proc 87206 = $61.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMEAR FLUORES AND OR ACID FAST ST,87206,CPT,306,RC,30600032,CDM,,,,both,,,61.0000,9.1500,WELLCARE,WELLCARE MEDICARE,5.71,,,,,,,2.7000,61.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SLEEVE CONNECTOR LEAD IS4/DF4,272,RC,27800530,CDM,,,,,,both,,,907.9800,136.2000,AETNA,AETNA,387.71,,,,,,,234.3500,907.9800,percent of total billed charges,42.7% of $907.98 in Billed Charges for Rev 272 = $387.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE CONNECTOR LEAD IS4/DF4,272,RC,27800530,CDM,,,,,,both,,,907.9800,136.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,635.59,,,,,,,234.3500,907.9800,percent of total billed charges,Rev 272 $907.98 in Billed Charges at 70% = $635.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE CONNECTOR LEAD IS4/DF4,272,RC,27800530,CDM,,,,,,both,,,907.9800,136.2000,CIGNA HEALTHCARE,CIGNA HMO,378.63,,,,,,,234.3500,907.9800,percent of total billed charges,41.7% of $907.98 in Billed Charges for Rev 272 = $378.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE CONNECTOR LEAD IS4/DF4,272,RC,27800530,CDM,,,,,,both,,,907.9800,136.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,421.30,,,,,,,234.3500,907.9800,percent of total billed charges,46.4% of $907.98 in Billed Charges for Rev 272 = $421.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE CONNECTOR LEAD IS4/DF4,272,RC,27800530,CDM,,,,,,both,,,907.9800,136.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,378.63,,,,,,,234.3500,907.9800,percent of total billed charges,41.7% of $907.98 in Billed Charges for Rev 272 = $378.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE CONNECTOR LEAD IS4/DF4,272,RC,27800530,CDM,,,,,,both,,,907.9800,136.2000,CIGNA HEALTHCARE,CIGNA PPO,378.63,,,,,,,234.3500,907.9800,percent of total billed charges,41.7% of $907.98 in Billed Charges for Rev 272 = $378.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE CONNECTOR LEAD IS4/DF4,272,RC,27800530,CDM,,,,,,both,,,907.9800,136.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,817.18,,,,,,,234.3500,907.9800,percent of total billed charges,90% of $907.98 in Billed Charges for Rev 272 = $817.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE CONNECTOR LEAD IS4/DF4,272,RC,27800530,CDM,,,,,,both,,,907.9800,136.2000,MEDCOST,MEDCOST VHN,432.11,,,,,,,234.3500,907.9800,percent of total billed charges,47.59% of $907.98 in Billed Charges for Rev 272 = $432.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE CONNECTOR LEAD IS4/DF4,272,RC,27800530,CDM,,,,,,both,,,907.9800,136.2000,SENTARA HEALTH,SENTARA HEALTH,234.35,,,,,,,234.3500,907.9800,percent of total billed charges,25.81% of $907.98 in Billed Charges for Rev 272 = $234.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE CONNECTOR LEAD IS4/DF4,272,RC,27800530,CDM,,,,,,both,,,907.9800,136.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",907.98,,,,,,,234.3500,907.9800,percent of total billed charges,100% of $907.98 in Billed Charges for Rev 272 = $907.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE CONNECTOR LEAD IS4/DF4,272,RC,27800530,CDM,,,,,,both,,,907.9800,136.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,453.99,,,,,,,234.3500,907.9800,percent of total billed charges,Rev 272 $907.98 in Billed Charges at 50% = $453.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE CONNECTOR LEAD IS4/DF4,272,RC,27800530,CDM,,,,,,both,,,907.9800,136.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,293.28,,,,,,,234.3500,907.9800,other,32.3% of $907.98 in Billed Charges for Rev 272 = $293.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SLEEVE CONNECTOR LEAD IS4/DF4,272,RC,27800530,CDM,,,,,,both,,,907.9800,136.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,278.75,,,,,,,234.3500,907.9800,other,30.7% of $907.98 in Billed Charges for Rev 272 = $278.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SLEEVE CONNECTOR LEAD IS4/DF4,272,RC,27800530,CDM,,,,,,both,,,907.9800,136.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,293.28,,,,,,,234.3500,907.9800,percent of total billed charges,32.3% of $907.98 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SLEEVE CONNECTOR LEAD IS4/DF4,272,RC,27800530,CDM,,,,,,both,,,907.9800,136.2000,WELLCARE,WELLCARE MEDICAID,907.98,,,,,,,234.3500,907.9800,percent of total billed charges,100% of $907.98 in Billed Charges for Rev 272 = $907.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER GIA 80MM MED/THICK PURPLE,272,RC,,,,,,,,both,,,8341.0100,1251.1500,AETNA,AETNA,3561.61,,,,,,,2152.8100,8341.0100,percent of total billed charges,"42.7% of $8,341.01 in Billed Charges for Rev 272 = $3,561.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM MED/THICK PURPLE,272,RC,,,,,,,,both,,,8341.0100,1251.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5838.71,,,,,,,2152.8100,8341.0100,percent of total billed charges,"Rev 272 $8,341.01 in Billed Charges at 70% = $5,838.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM MED/THICK PURPLE,272,RC,,,,,,,,both,,,8341.0100,1251.1500,CIGNA HEALTHCARE,CIGNA HMO,3478.20,,,,,,,2152.8100,8341.0100,percent of total billed charges,"41.7% of $8,341.01 in Billed Charges for Rev 272 = $3,478.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM MED/THICK PURPLE,272,RC,,,,,,,,both,,,8341.0100,1251.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3870.23,,,,,,,2152.8100,8341.0100,percent of total billed charges,"46.4% of $8,341.01 in Billed Charges for Rev 272 = $3,870.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM MED/THICK PURPLE,272,RC,,,,,,,,both,,,8341.0100,1251.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3478.20,,,,,,,2152.8100,8341.0100,percent of total billed charges,"41.7% of $8,341.01 in Billed Charges for Rev 272 = $3,478.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM MED/THICK PURPLE,272,RC,,,,,,,,both,,,8341.0100,1251.1500,CIGNA HEALTHCARE,CIGNA PPO,3478.20,,,,,,,2152.8100,8341.0100,percent of total billed charges,"41.7% of $8,341.01 in Billed Charges for Rev 272 = $3,478.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM MED/THICK PURPLE,272,RC,,,,,,,,both,,,8341.0100,1251.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7506.91,,,,,,,2152.8100,8341.0100,percent of total billed charges,"90% of $8,341.01 in Billed Charges for Rev 272 = $7,506.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM MED/THICK PURPLE,272,RC,,,,,,,,both,,,8341.0100,1251.1500,MEDCOST,MEDCOST VHN,3969.49,,,,,,,2152.8100,8341.0100,percent of total billed charges,"47.59% of $8,341.01 in Billed Charges for Rev 272 = $3,969.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM MED/THICK PURPLE,272,RC,,,,,,,,both,,,8341.0100,1251.1500,SENTARA HEALTH,SENTARA HEALTH,2152.81,,,,,,,2152.8100,8341.0100,percent of total billed charges,"25.81% of $8,341.01 in Billed Charges for Rev 272 = $2,152.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM MED/THICK PURPLE,272,RC,,,,,,,,both,,,8341.0100,1251.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8341.01,,,,,,,2152.8100,8341.0100,percent of total billed charges,"100% of $8,341.01 in Billed Charges for Rev 272 = $8,341.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM MED/THICK PURPLE,272,RC,,,,,,,,both,,,8341.0100,1251.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4170.51,,,,,,,2152.8100,8341.0100,percent of total billed charges,"Rev 272 $8,341.01 in Billed Charges at 50% = $4,170.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM MED/THICK PURPLE,272,RC,,,,,,,,both,,,8341.0100,1251.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2694.15,,,,,,,2152.8100,8341.0100,other,"32.3% of $8,341.01 in Billed Charges for Rev 272 = $2,694.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER GIA 80MM MED/THICK PURPLE,272,RC,,,,,,,,both,,,8341.0100,1251.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2560.69,,,,,,,2152.8100,8341.0100,other,"30.7% of $8,341.01 in Billed Charges for Rev 272 = $2,560.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER GIA 80MM MED/THICK PURPLE,272,RC,,,,,,,,both,,,8341.0100,1251.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,2694.15,,,,,,,2152.8100,8341.0100,percent of total billed charges,"32.3% of $8,341.01 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM MED/THICK PURPLE,272,RC,,,,,,,,both,,,8341.0100,1251.1500,WELLCARE,WELLCARE MEDICAID,8341.01,,,,,,,2152.8100,8341.0100,percent of total billed charges,"100% of $8,341.01 in Billed Charges for Rev 272 = $8,341.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM X THICK BLK,272,RC,,,,,,,,both,,,8480.1600,1272.0200,AETNA,AETNA,3621.03,,,,,,,2188.7300,8480.1600,percent of total billed charges,"42.7% of $8,480.16 in Billed Charges for Rev 272 = $3,621.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM X THICK BLK,272,RC,,,,,,,,both,,,8480.1600,1272.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5936.11,,,,,,,2188.7300,8480.1600,percent of total billed charges,"Rev 272 $8,480.16 in Billed Charges at 70% = $5,936.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM X THICK BLK,272,RC,,,,,,,,both,,,8480.1600,1272.0200,CIGNA HEALTHCARE,CIGNA HMO,3536.23,,,,,,,2188.7300,8480.1600,percent of total billed charges,"41.7% of $8,480.16 in Billed Charges for Rev 272 = $3,536.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM X THICK BLK,272,RC,,,,,,,,both,,,8480.1600,1272.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3934.79,,,,,,,2188.7300,8480.1600,percent of total billed charges,"46.4% of $8,480.16 in Billed Charges for Rev 272 = $3,934.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM X THICK BLK,272,RC,,,,,,,,both,,,8480.1600,1272.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3536.23,,,,,,,2188.7300,8480.1600,percent of total billed charges,"41.7% of $8,480.16 in Billed Charges for Rev 272 = $3,536.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM X THICK BLK,272,RC,,,,,,,,both,,,8480.1600,1272.0200,CIGNA HEALTHCARE,CIGNA PPO,3536.23,,,,,,,2188.7300,8480.1600,percent of total billed charges,"41.7% of $8,480.16 in Billed Charges for Rev 272 = $3,536.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM X THICK BLK,272,RC,,,,,,,,both,,,8480.1600,1272.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7632.14,,,,,,,2188.7300,8480.1600,percent of total billed charges,"90% of $8,480.16 in Billed Charges for Rev 272 = $7,632.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM X THICK BLK,272,RC,,,,,,,,both,,,8480.1600,1272.0200,MEDCOST,MEDCOST VHN,4035.71,,,,,,,2188.7300,8480.1600,percent of total billed charges,"47.59% of $8,480.16 in Billed Charges for Rev 272 = $4,035.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM X THICK BLK,272,RC,,,,,,,,both,,,8480.1600,1272.0200,SENTARA HEALTH,SENTARA HEALTH,2188.73,,,,,,,2188.7300,8480.1600,percent of total billed charges,"25.81% of $8,480.16 in Billed Charges for Rev 272 = $2,188.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM X THICK BLK,272,RC,,,,,,,,both,,,8480.1600,1272.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8480.16,,,,,,,2188.7300,8480.1600,percent of total billed charges,"100% of $8,480.16 in Billed Charges for Rev 272 = $8,480.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM X THICK BLK,272,RC,,,,,,,,both,,,8480.1600,1272.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4240.08,,,,,,,2188.7300,8480.1600,percent of total billed charges,"Rev 272 $8,480.16 in Billed Charges at 50% = $4,240.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM X THICK BLK,272,RC,,,,,,,,both,,,8480.1600,1272.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2739.09,,,,,,,2188.7300,8480.1600,other,"32.3% of $8,480.16 in Billed Charges for Rev 272 = $2,739.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER GIA 80MM X THICK BLK,272,RC,,,,,,,,both,,,8480.1600,1272.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,2603.41,,,,,,,2188.7300,8480.1600,other,"30.7% of $8,480.16 in Billed Charges for Rev 272 = $2,603.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER GIA 80MM X THICK BLK,272,RC,,,,,,,,both,,,8480.1600,1272.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,2739.09,,,,,,,2188.7300,8480.1600,percent of total billed charges,"32.3% of $8,480.16 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER GIA 80MM X THICK BLK,272,RC,,,,,,,,both,,,8480.1600,1272.0200,WELLCARE,WELLCARE MEDICAID,8480.16,,,,,,,2188.7300,8480.1600,percent of total billed charges,"100% of $8,480.16 in Billed Charges for Rev 272 = $8,480.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,AETNA,AETNA,29.46,,,,,,,3.0000,69.0000,percent of total billed charges,42.7% of $69.00 in Billed Charges for Rev 306 Proc 87207 = $29.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,3.0000,69.0000,fee schedule,APG 00396 Proc 87207 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5.99,,,,,,,3.0000,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,AETNA,AETNA HEALTHCARE MEDICARE,5.99,,,,,,,3.0000,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,5.99,,,,,,,3.0000,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,AMBETTER,AMBETTER,13.06,,,,,,,3.0000,69.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,AMERIGROUP,AMERIGROUP,3.00,,,,,,,3.0000,69.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,6.23,,,,,,,3.0000,69.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,ANTHEM EXCHANGE,5.99,,,,,,,3.0000,69.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,3.0000,69.0000,fee schedule,APG 00396 Proc 87207 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,ANTHEM HMO,5.99,,,,,,,3.0000,69.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,6.17,,,,,,,3.0000,69.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5.99,,,,,,,3.0000,69.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,27.45,,,,,,,3.0000,69.0000,fee schedule,$27.45 from Fee Schedule BLDTM_23 for Rev 306 Proc 87207 * Qty 1 = $27.45 at 100% = $27.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS E NETWORK,26.18,,,,,,,3.0000,69.0000,fee schedule,$8.18 from Fee Schedule BCFSB for Rev 306 Proc 87207 * Qty 1 = $8.18 at 320% = $26.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS MEDICARE,6.23,,,,,,,3.0000,69.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS P NETWORK,26.75,,,,,,,3.0000,69.0000,fee schedule,$8.18 from Fee Schedule BCFSB for Rev 306 Proc 87207 * Qty 1 = $8.18 at 327% = $26.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS S NETWORK,26.75,,,,,,,3.0000,69.0000,fee schedule,$8.18 from Fee Schedule BCFSB for Rev 306 Proc 87207 * Qty 1 = $8.18 at 327% = $26.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,TENNCARE BLUE CARE,13.39,,,,,,,3.0000,69.0000,fee schedule,$11.54 from Fee Schedule TC_24 for Rev 306 Proc 87207 * Qty 1 = $11.54 at 116% = $13.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,TENNCARE BLUE SELECT,13.39,,,,,,,3.0000,69.0000,fee schedule,$11.54 from Fee Schedule TC_24 for Rev 306 Proc 87207 * Qty 1 = $11.54 at 116% = $13.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA HMO,24.12,,,,,,,3.0000,69.0000,fee schedule,$24.12 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87207 * Qty 1 = $24.12 at 100% = $24.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12.99,,,,,,,3.0000,69.0000,fee schedule,$12.99 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87207 * Qty 1 = $12.99 at 100% = $12.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,6.29,,,,,,,3.0000,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,24.12,,,,,,,3.0000,69.0000,fee schedule,$24.12 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87207 * Qty 1 = $24.12 at 100% = $24.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA PPO,24.12,,,,,,,3.0000,69.0000,fee schedule,$24.12 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87207 * Qty 1 = $24.12 at 100% = $24.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,6.29,,,,,,,3.0000,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,62.10,,,,,,,3.0000,69.0000,percent of total billed charges,90% of $69.00 in Billed Charges for Rev 306 Proc 87207 = $62.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,HUMANA,HUMANA MEDICARE,5.99,,,,,,,3.0000,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5.99,,,,,,,3.0000,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,MEDCOST,MEDCOST VHN,32.84,,,,,,,3.0000,69.0000,percent of total billed charges,47.59% of $69.00 in Billed Charges for Rev 306 Proc 87207 = $32.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,3.0000,69.0000,fee schedule,APG 00396 Proc 87207 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,6.29,,,,,,,3.0000,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,6.29,,,,,,,3.0000,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,NHC ADVANTAGE,NHC ADVANTAGE,6.29,,,,,,,3.0000,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,3.0000,69.0000,fee schedule,APG 00396 Proc 87207 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,SENTARA HEALTH,SENTARA HEALTH,17.81,,,,,,,3.0000,69.0000,percent of total billed charges,25.81% of $69.00 in Billed Charges for Rev 306 Proc 87207 = $17.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,SENTARA HEALTH,SENTARA MEDICARE,5.99,,,,,,,3.0000,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",69.00,,,,,,,3.0000,69.0000,percent of total billed charges,100% of $69.00 in Billed Charges for Rev 306 Proc 87207 = $69.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4.25,,,,,,,3.0000,69.0000,fee schedule,$8.49 from Fee Schedule TCUHC24 for Rev 306 Proc 87207 * Qty 1 = $8.49 at 50% = $4.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,6.23,,,,,,,3.0000,69.0000,fee schedule,$5.99 from Fee Schedule UHC_31910 for Rev 306 Proc 87207 * Qty 1 = $5.99 at 104% = $6.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,5.99,,,,,,,3.0000,69.0000,fee schedule,$5.99 from Fee Schedule UHC_31910 for Rev 306 Proc 87207 * Qty 1 = $5.99 at 100% = $5.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,5.99,,,,,,,3.0000,69.0000,fee schedule,$5.99 from Fee Schedule UHC_31910 for Rev 306 Proc 87207 * Qty 1 = $5.99 at 100% = $5.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,3.0000,69.0000,fee schedule,APG 00396 Proc 87207 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5.99,,,,,,,3.0000,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5.99,,,,,,,3.0000,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,WELLCARE,WELLCARE MEDICAID,69.00,,,,,,,3.0000,69.0000,percent of total billed charges,100% of $69.00 in Billed Charges for Rev 306 Proc 87207 = $69.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMEAR SPECIAL STAIN,87207,CPT,306,RC,30600033,CDM,,,,both,,,69.0000,10.3500,WELLCARE,WELLCARE MEDICARE,6.35,,,,,,,3.0000,69.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,AETNA,AETNA,89.67,,,,,,,8.9900,210.0000,percent of total billed charges,42.7% of $210.00 in Billed Charges for Rev 306 Proc 87209 = $89.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,8.9900,210.0000,fee schedule,APG 00396 Proc 87209 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,17.98,,,,,,,8.9900,210.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,AETNA,AETNA HEALTHCARE MEDICARE,17.98,,,,,,,8.9900,210.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,17.98,,,,,,,8.9900,210.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,AMBETTER,AMBETTER,39.20,,,,,,,8.9900,210.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,AMERIGROUP,AMERIGROUP,8.99,,,,,,,8.9900,210.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,18.70,,,,,,,8.9900,210.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,BLUE CROSS,ANTHEM EXCHANGE,17.98,,,,,,,8.9900,210.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,8.9900,210.0000,fee schedule,APG 00396 Proc 87209 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,BLUE CROSS,ANTHEM HMO,17.98,,,,,,,8.9900,210.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,18.52,,,,,,,8.9900,210.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",17.98,,,,,,,8.9900,210.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,25.11,,,,,,,8.9900,210.0000,fee schedule,$25.11 from Fee Schedule BLDTM_23 for Rev 306 Proc 87209 * Qty 1 = $25.11 at 100% = $25.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,BLUE CROSS,BLUE CROSS E NETWORK,78.46,,,,,,,8.9900,210.0000,fee schedule,$24.52 from Fee Schedule BCFSB for Rev 306 Proc 87209 * Qty 1 = $24.52 at 320% = $78.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,BLUE CROSS,BLUE CROSS MEDICARE,18.70,,,,,,,8.9900,210.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,BLUE CROSS,BLUE CROSS P NETWORK,80.18,,,,,,,8.9900,210.0000,fee schedule,$24.52 from Fee Schedule BCFSB for Rev 306 Proc 87209 * Qty 1 = $24.52 at 327% = $80.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,BLUE CROSS,BLUE CROSS S NETWORK,80.18,,,,,,,8.9900,210.0000,fee schedule,$24.52 from Fee Schedule BCFSB for Rev 306 Proc 87209 * Qty 1 = $24.52 at 327% = $80.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,BLUE CROSS,TENNCARE BLUE CARE,23.65,,,,,,,8.9900,210.0000,fee schedule,$20.39 from Fee Schedule TC_24 for Rev 306 Proc 87209 * Qty 1 = $20.39 at 116% = $23.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,BLUE CROSS,TENNCARE BLUE SELECT,23.65,,,,,,,8.9900,210.0000,fee schedule,$20.39 from Fee Schedule TC_24 for Rev 306 Proc 87209 * Qty 1 = $20.39 at 116% = $23.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,CIGNA HEALTHCARE,CIGNA HMO,72.32,,,,,,,8.9900,210.0000,fee schedule,$72.32 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87209 * Qty 1 = $72.32 at 100% = $72.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,39.70,,,,,,,8.9900,210.0000,fee schedule,$39.70 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87209 * Qty 1 = $39.70 at 100% = $39.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,18.88,,,,,,,8.9900,210.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,72.32,,,,,,,8.9900,210.0000,fee schedule,$72.32 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87209 * Qty 1 = $72.32 at 100% = $72.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,CIGNA HEALTHCARE,CIGNA PPO,72.32,,,,,,,8.9900,210.0000,fee schedule,$72.32 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87209 * Qty 1 = $72.32 at 100% = $72.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,18.88,,,,,,,8.9900,210.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,189.00,,,,,,,8.9900,210.0000,percent of total billed charges,90% of $210.00 in Billed Charges for Rev 306 Proc 87209 = $189.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,HUMANA,HUMANA MEDICARE,17.98,,,,,,,8.9900,210.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,17.98,,,,,,,8.9900,210.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,MEDCOST,MEDCOST VHN,99.94,,,,,,,8.9900,210.0000,percent of total billed charges,47.59% of $210.00 in Billed Charges for Rev 306 Proc 87209 = $99.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,8.9900,210.0000,fee schedule,APG 00396 Proc 87209 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,18.88,,,,,,,8.9900,210.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,18.88,,,,,,,8.9900,210.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,NHC ADVANTAGE,NHC ADVANTAGE,18.88,,,,,,,8.9900,210.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,8.9900,210.0000,fee schedule,APG 00396 Proc 87209 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,SENTARA HEALTH,SENTARA HEALTH,54.20,,,,,,,8.9900,210.0000,percent of total billed charges,25.81% of $210.00 in Billed Charges for Rev 306 Proc 87209 = $54.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,SENTARA HEALTH,SENTARA MEDICARE,17.98,,,,,,,8.9900,210.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",210.00,,,,,,,8.9900,210.0000,percent of total billed charges,100% of $210.00 in Billed Charges for Rev 306 Proc 87209 = $210.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,12.73,,,,,,,8.9900,210.0000,fee schedule,$25.46 from Fee Schedule TCUHC24 for Rev 306 Proc 87209 * Qty 1 = $25.46 at 50% = $12.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,18.70,,,,,,,8.9900,210.0000,fee schedule,$17.98 from Fee Schedule UHC_31910 for Rev 306 Proc 87209 * Qty 1 = $17.98 at 104% = $18.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,17.98,,,,,,,8.9900,210.0000,fee schedule,$17.98 from Fee Schedule UHC_31910 for Rev 306 Proc 87209 * Qty 1 = $17.98 at 100% = $17.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,17.98,,,,,,,8.9900,210.0000,fee schedule,$17.98 from Fee Schedule UHC_31910 for Rev 306 Proc 87209 * Qty 1 = $17.98 at 100% = $17.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,8.9900,210.0000,fee schedule,APG 00396 Proc 87209 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,17.98,,,,,,,8.9900,210.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,17.98,,,,,,,8.9900,210.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,WELLCARE,WELLCARE MEDICAID,210.00,,,,,,,8.9900,210.0000,percent of total billed charges,100% of $210.00 in Billed Charges for Rev 306 Proc 87209 = $210.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SP STAIN TRICHROME FOR O&P,87209,CPT,306,RC,30600034,CDM,,,,both,,,210.0000,31.5000,WELLCARE,WELLCARE MEDICARE,19.06,,,,,,,8.9900,210.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,AETNA,AETNA,98.21,,,,,,,9.8700,230.0000,percent of total billed charges,42.7% of $230.00 in Billed Charges for Rev 306 Proc 87230 = $98.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,9.8700,230.0000,fee schedule,APG 00396 Proc 87230 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,19.74,,,,,,,9.8700,230.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,AETNA,AETNA HEALTHCARE MEDICARE,19.74,,,,,,,9.8700,230.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,19.74,,,,,,,9.8700,230.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,AMBETTER,AMBETTER,43.03,,,,,,,9.8700,230.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,AMERIGROUP,AMERIGROUP,9.87,,,,,,,9.8700,230.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,20.53,,,,,,,9.8700,230.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,BLUE CROSS,ANTHEM EXCHANGE,19.74,,,,,,,9.8700,230.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,9.8700,230.0000,fee schedule,APG 00396 Proc 87230 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,BLUE CROSS,ANTHEM HMO,19.74,,,,,,,9.8700,230.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,20.33,,,,,,,9.8700,230.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",19.74,,,,,,,9.8700,230.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,58.63,,,,,,,9.8700,230.0000,fee schedule,$58.63 from Fee Schedule BLDTM_23 for Rev 306 Proc 87230 * Qty 1 = $58.63 at 100% = $58.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,BLUE CROSS,BLUE CROSS E NETWORK,86.21,,,,,,,9.8700,230.0000,fee schedule,$26.94 from Fee Schedule BCFSB for Rev 306 Proc 87230 * Qty 1 = $26.94 at 320% = $86.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,BLUE CROSS,BLUE CROSS MEDICARE,20.53,,,,,,,9.8700,230.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,BLUE CROSS,BLUE CROSS P NETWORK,88.09,,,,,,,9.8700,230.0000,fee schedule,$26.94 from Fee Schedule BCFSB for Rev 306 Proc 87230 * Qty 1 = $26.94 at 327% = $88.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,BLUE CROSS,BLUE CROSS S NETWORK,88.09,,,,,,,9.8700,230.0000,fee schedule,$26.94 from Fee Schedule BCFSB for Rev 306 Proc 87230 * Qty 1 = $26.94 at 327% = $88.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,BLUE CROSS,TENNCARE BLUE CARE,38.96,,,,,,,9.8700,230.0000,fee schedule,$33.59 from Fee Schedule TC_24 for Rev 306 Proc 87230 * Qty 1 = $33.59 at 116% = $38.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,BLUE CROSS,TENNCARE BLUE SELECT,38.96,,,,,,,9.8700,230.0000,fee schedule,$33.59 from Fee Schedule TC_24 for Rev 306 Proc 87230 * Qty 1 = $33.59 at 116% = $38.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,CIGNA HEALTHCARE,CIGNA HMO,79.40,,,,,,,9.8700,230.0000,fee schedule,$79.40 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87230 * Qty 1 = $79.40 at 100% = $79.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,43.31,,,,,,,9.8700,230.0000,fee schedule,$43.31 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87230 * Qty 1 = $43.31 at 100% = $43.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,20.73,,,,,,,9.8700,230.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,79.40,,,,,,,9.8700,230.0000,fee schedule,$79.40 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87230 * Qty 1 = $79.40 at 100% = $79.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,CIGNA HEALTHCARE,CIGNA PPO,79.40,,,,,,,9.8700,230.0000,fee schedule,$79.40 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87230 * Qty 1 = $79.40 at 100% = $79.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,20.73,,,,,,,9.8700,230.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,207.00,,,,,,,9.8700,230.0000,percent of total billed charges,90% of $230.00 in Billed Charges for Rev 306 Proc 87230 = $207.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,HUMANA,HUMANA MEDICARE,19.74,,,,,,,9.8700,230.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,19.74,,,,,,,9.8700,230.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,MEDCOST,MEDCOST VHN,109.46,,,,,,,9.8700,230.0000,percent of total billed charges,47.59% of $230.00 in Billed Charges for Rev 306 Proc 87230 = $109.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,9.8700,230.0000,fee schedule,APG 00396 Proc 87230 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,20.73,,,,,,,9.8700,230.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,20.73,,,,,,,9.8700,230.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,NHC ADVANTAGE,NHC ADVANTAGE,20.73,,,,,,,9.8700,230.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,9.8700,230.0000,fee schedule,APG 00396 Proc 87230 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,SENTARA HEALTH,SENTARA HEALTH,59.36,,,,,,,9.8700,230.0000,percent of total billed charges,25.81% of $230.00 in Billed Charges for Rev 306 Proc 87230 = $59.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,SENTARA HEALTH,SENTARA MEDICARE,19.74,,,,,,,9.8700,230.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",230.00,,,,,,,9.8700,230.0000,percent of total billed charges,100% of $230.00 in Billed Charges for Rev 306 Proc 87230 = $230.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,13.98,,,,,,,9.8700,230.0000,fee schedule,$27.96 from Fee Schedule TCUHC24 for Rev 306 Proc 87230 * Qty 1 = $27.96 at 50% = $13.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,20.53,,,,,,,9.8700,230.0000,fee schedule,$19.74 from Fee Schedule UHC_31910 for Rev 306 Proc 87230 * Qty 1 = $19.74 at 104% = $20.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,19.74,,,,,,,9.8700,230.0000,fee schedule,$19.74 from Fee Schedule UHC_31910 for Rev 306 Proc 87230 * Qty 1 = $19.74 at 100% = $19.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,19.74,,,,,,,9.8700,230.0000,fee schedule,$19.74 from Fee Schedule UHC_31910 for Rev 306 Proc 87230 * Qty 1 = $19.74 at 100% = $19.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,9.8700,230.0000,fee schedule,APG 00396 Proc 87230 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,19.74,,,,,,,9.8700,230.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,19.74,,,,,,,9.8700,230.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,WELLCARE,WELLCARE MEDICAID,230.00,,,,,,,9.8700,230.0000,percent of total billed charges,100% of $230.00 in Billed Charges for Rev 306 Proc 87230 = $230.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSAY TOXIN OR ANTITOXIN,87230,CPT,306,RC,30600037,CDM,,,,both,,,230.0000,34.5000,WELLCARE,WELLCARE MEDICARE,20.92,,,,,,,9.8700,230.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,AETNA,AETNA,97.36,,,,,,,10.1000,228.0000,percent of total billed charges,42.7% of $228.00 in Billed Charges for Rev 306 Proc 87253 = $97.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,10.1000,228.0000,fee schedule,APG 00396 Proc 87253 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,20.20,,,,,,,10.1000,228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,AETNA,AETNA HEALTHCARE MEDICARE,20.20,,,,,,,10.1000,228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,20.20,,,,,,,10.1000,228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,AMBETTER,AMBETTER,44.04,,,,,,,10.1000,228.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,AMERIGROUP,AMERIGROUP,10.10,,,,,,,10.1000,228.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,21.01,,,,,,,10.1000,228.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,ANTHEM EXCHANGE,20.20,,,,,,,10.1000,228.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,10.1000,228.0000,fee schedule,APG 00396 Proc 87253 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,ANTHEM HMO,20.20,,,,,,,10.1000,228.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,20.81,,,,,,,10.1000,228.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",20.20,,,,,,,10.1000,228.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,57.02,,,,,,,10.1000,228.0000,fee schedule,$57.02 from Fee Schedule BLDTM_23 for Rev 306 Proc 87253 * Qty 1 = $57.02 at 100% = $57.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,BLUE CROSS E NETWORK,71.10,,,,,,,10.1000,228.0000,fee schedule,$22.22 from Fee Schedule BCFSB for Rev 306 Proc 87253 * Qty 1 = $22.22 at 320% = $71.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,BLUE CROSS MEDICARE,21.01,,,,,,,10.1000,228.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,BLUE CROSS P NETWORK,72.66,,,,,,,10.1000,228.0000,fee schedule,$22.22 from Fee Schedule BCFSB for Rev 306 Proc 87253 * Qty 1 = $22.22 at 327% = $72.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,BLUE CROSS S NETWORK,72.66,,,,,,,10.1000,228.0000,fee schedule,$22.22 from Fee Schedule BCFSB for Rev 306 Proc 87253 * Qty 1 = $22.22 at 327% = $72.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,TENNCARE BLUE CARE,41.25,,,,,,,10.1000,228.0000,fee schedule,$35.56 from Fee Schedule TC_24 for Rev 306 Proc 87253 * Qty 1 = $35.56 at 116% = $41.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,TENNCARE BLUE SELECT,41.25,,,,,,,10.1000,228.0000,fee schedule,$35.56 from Fee Schedule TC_24 for Rev 306 Proc 87253 * Qty 1 = $35.56 at 116% = $41.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,CIGNA HEALTHCARE,CIGNA HMO,81.28,,,,,,,10.1000,228.0000,fee schedule,$81.28 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87253 * Qty 1 = $81.28 at 100% = $81.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,44.75,,,,,,,10.1000,228.0000,fee schedule,$44.75 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87253 * Qty 1 = $44.75 at 100% = $44.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,21.21,,,,,,,10.1000,228.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,81.28,,,,,,,10.1000,228.0000,fee schedule,$81.28 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87253 * Qty 1 = $81.28 at 100% = $81.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,CIGNA HEALTHCARE,CIGNA PPO,81.28,,,,,,,10.1000,228.0000,fee schedule,$81.28 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87253 * Qty 1 = $81.28 at 100% = $81.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,21.21,,,,,,,10.1000,228.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,205.20,,,,,,,10.1000,228.0000,percent of total billed charges,90% of $228.00 in Billed Charges for Rev 306 Proc 87253 = $205.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,HUMANA,HUMANA MEDICARE,20.20,,,,,,,10.1000,228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,20.20,,,,,,,10.1000,228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,MEDCOST,MEDCOST VHN,108.51,,,,,,,10.1000,228.0000,percent of total billed charges,47.59% of $228.00 in Billed Charges for Rev 306 Proc 87253 = $108.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,10.1000,228.0000,fee schedule,APG 00396 Proc 87253 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,21.21,,,,,,,10.1000,228.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,21.21,,,,,,,10.1000,228.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,NHC ADVANTAGE,NHC ADVANTAGE,21.21,,,,,,,10.1000,228.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,10.1000,228.0000,fee schedule,APG 00396 Proc 87253 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,SENTARA HEALTH,SENTARA HEALTH,58.85,,,,,,,10.1000,228.0000,percent of total billed charges,25.81% of $228.00 in Billed Charges for Rev 306 Proc 87253 = $58.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,SENTARA HEALTH,SENTARA MEDICARE,20.20,,,,,,,10.1000,228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",228.00,,,,,,,10.1000,228.0000,percent of total billed charges,100% of $228.00 in Billed Charges for Rev 306 Proc 87253 = $228.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14.31,,,,,,,10.1000,228.0000,fee schedule,$28.61 from Fee Schedule TCUHC24 for Rev 306 Proc 87253 * Qty 1 = $28.61 at 50% = $14.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,21.01,,,,,,,10.1000,228.0000,fee schedule,$20.20 from Fee Schedule UHC_31910 for Rev 306 Proc 87253 * Qty 1 = $20.20 at 104% = $21.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,20.20,,,,,,,10.1000,228.0000,fee schedule,$20.20 from Fee Schedule UHC_31910 for Rev 306 Proc 87253 * Qty 1 = $20.20 at 100% = $20.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,20.20,,,,,,,10.1000,228.0000,fee schedule,$20.20 from Fee Schedule UHC_31910 for Rev 306 Proc 87253 * Qty 1 = $20.20 at 100% = $20.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,10.1000,228.0000,fee schedule,APG 00396 Proc 87253 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,20.20,,,,,,,10.1000,228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,20.20,,,,,,,10.1000,228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,WELLCARE,WELLCARE MEDICAID,228.00,,,,,,,10.1000,228.0000,percent of total billed charges,100% of $228.00 in Billed Charges for Rev 306 Proc 87253 = $228.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRAL ISLTN TISS CULTURE ADDITNAL,87253,CPT,306,RC,30600040,CDM,,,,both,,,228.0000,34.2000,WELLCARE,WELLCARE MEDICARE,21.41,,,,,,,10.1000,228.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER INTERNAL ECHELON LINEAR CUTTER 80MM 3D SQUEEZE HANDLE STERILE,272,RC,27200002,CDM,,,,,,both,,,640.3700,96.0600,AETNA,AETNA,273.44,,,,,,,165.2800,640.3700,percent of total billed charges,42.7% of $640.37 in Billed Charges for Rev 272 = $273.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER INTERNAL ECHELON LINEAR CUTTER 80MM 3D SQUEEZE HANDLE STERILE,272,RC,27200002,CDM,,,,,,both,,,640.3700,96.0600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,448.26,,,,,,,165.2800,640.3700,percent of total billed charges,Rev 272 $640.37 in Billed Charges at 70% = $448.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER INTERNAL ECHELON LINEAR CUTTER 80MM 3D SQUEEZE HANDLE STERILE,272,RC,27200002,CDM,,,,,,both,,,640.3700,96.0600,CIGNA HEALTHCARE,CIGNA HMO,267.03,,,,,,,165.2800,640.3700,percent of total billed charges,41.7% of $640.37 in Billed Charges for Rev 272 = $267.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER INTERNAL ECHELON LINEAR CUTTER 80MM 3D SQUEEZE HANDLE STERILE,272,RC,27200002,CDM,,,,,,both,,,640.3700,96.0600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,297.13,,,,,,,165.2800,640.3700,percent of total billed charges,46.4% of $640.37 in Billed Charges for Rev 272 = $297.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER INTERNAL ECHELON LINEAR CUTTER 80MM 3D SQUEEZE HANDLE STERILE,272,RC,27200002,CDM,,,,,,both,,,640.3700,96.0600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,267.03,,,,,,,165.2800,640.3700,percent of total billed charges,41.7% of $640.37 in Billed Charges for Rev 272 = $267.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER INTERNAL ECHELON LINEAR CUTTER 80MM 3D SQUEEZE HANDLE STERILE,272,RC,27200002,CDM,,,,,,both,,,640.3700,96.0600,CIGNA HEALTHCARE,CIGNA PPO,267.03,,,,,,,165.2800,640.3700,percent of total billed charges,41.7% of $640.37 in Billed Charges for Rev 272 = $267.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER INTERNAL ECHELON LINEAR CUTTER 80MM 3D SQUEEZE HANDLE STERILE,272,RC,27200002,CDM,,,,,,both,,,640.3700,96.0600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,576.33,,,,,,,165.2800,640.3700,percent of total billed charges,90% of $640.37 in Billed Charges for Rev 272 = $576.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER INTERNAL ECHELON LINEAR CUTTER 80MM 3D SQUEEZE HANDLE STERILE,272,RC,27200002,CDM,,,,,,both,,,640.3700,96.0600,MEDCOST,MEDCOST VHN,304.75,,,,,,,165.2800,640.3700,percent of total billed charges,47.59% of $640.37 in Billed Charges for Rev 272 = $304.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER INTERNAL ECHELON LINEAR CUTTER 80MM 3D SQUEEZE HANDLE STERILE,272,RC,27200002,CDM,,,,,,both,,,640.3700,96.0600,SENTARA HEALTH,SENTARA HEALTH,165.28,,,,,,,165.2800,640.3700,percent of total billed charges,25.81% of $640.37 in Billed Charges for Rev 272 = $165.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER INTERNAL ECHELON LINEAR CUTTER 80MM 3D SQUEEZE HANDLE STERILE,272,RC,27200002,CDM,,,,,,both,,,640.3700,96.0600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",640.37,,,,,,,165.2800,640.3700,percent of total billed charges,100% of $640.37 in Billed Charges for Rev 272 = $640.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER INTERNAL ECHELON LINEAR CUTTER 80MM 3D SQUEEZE HANDLE STERILE,272,RC,27200002,CDM,,,,,,both,,,640.3700,96.0600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,320.19,,,,,,,165.2800,640.3700,percent of total billed charges,Rev 272 $640.37 in Billed Charges at 50% = $320.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER INTERNAL ECHELON LINEAR CUTTER 80MM 3D SQUEEZE HANDLE STERILE,272,RC,27200002,CDM,,,,,,both,,,640.3700,96.0600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,206.84,,,,,,,165.2800,640.3700,other,32.3% of $640.37 in Billed Charges for Rev 272 = $206.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER INTERNAL ECHELON LINEAR CUTTER 80MM 3D SQUEEZE HANDLE STERILE,272,RC,27200002,CDM,,,,,,both,,,640.3700,96.0600,UNITED HEALTHCARE,UHC HERITAGE SELECT,196.59,,,,,,,165.2800,640.3700,other,30.7% of $640.37 in Billed Charges for Rev 272 = $196.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER INTERNAL ECHELON LINEAR CUTTER 80MM 3D SQUEEZE HANDLE STERILE,272,RC,27200002,CDM,,,,,,both,,,640.3700,96.0600,UNITED HEALTHCARE,UNITED HEALTHCARE,206.84,,,,,,,165.2800,640.3700,percent of total billed charges,32.3% of $640.37 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER INTERNAL ECHELON LINEAR CUTTER 80MM 3D SQUEEZE HANDLE STERILE,272,RC,27200002,CDM,,,,,,both,,,640.3700,96.0600,WELLCARE,WELLCARE MEDICAID,640.37,,,,,,,165.2800,640.3700,percent of total billed charges,100% of $640.37 in Billed Charges for Rev 272 = $640.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1301.6600,195.2500,AETNA,AETNA,555.81,,,,,,,335.9600,1301.6600,percent of total billed charges,"42.7% of $1,301.66 in Billed Charges for Rev 272 = $555.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1301.6600,195.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,911.16,,,,,,,335.9600,1301.6600,percent of total billed charges,"Rev 272 $1,301.66 in Billed Charges at 70% = $911.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1301.6600,195.2500,CIGNA HEALTHCARE,CIGNA HMO,542.79,,,,,,,335.9600,1301.6600,percent of total billed charges,"41.7% of $1,301.66 in Billed Charges for Rev 272 = $542.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1301.6600,195.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,603.97,,,,,,,335.9600,1301.6600,percent of total billed charges,"46.4% of $1,301.66 in Billed Charges for Rev 272 = $603.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1301.6600,195.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,542.79,,,,,,,335.9600,1301.6600,percent of total billed charges,"41.7% of $1,301.66 in Billed Charges for Rev 272 = $542.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1301.6600,195.2500,CIGNA HEALTHCARE,CIGNA PPO,542.79,,,,,,,335.9600,1301.6600,percent of total billed charges,"41.7% of $1,301.66 in Billed Charges for Rev 272 = $542.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1301.6600,195.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1171.49,,,,,,,335.9600,1301.6600,percent of total billed charges,"90% of $1,301.66 in Billed Charges for Rev 272 = $1,171.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1301.6600,195.2500,MEDCOST,MEDCOST VHN,619.46,,,,,,,335.9600,1301.6600,percent of total billed charges,"47.59% of $1,301.66 in Billed Charges for Rev 272 = $619.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1301.6600,195.2500,SENTARA HEALTH,SENTARA HEALTH,335.96,,,,,,,335.9600,1301.6600,percent of total billed charges,"25.81% of $1,301.66 in Billed Charges for Rev 272 = $335.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1301.6600,195.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1301.66,,,,,,,335.9600,1301.6600,percent of total billed charges,"100% of $1,301.66 in Billed Charges for Rev 272 = $1,301.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1301.6600,195.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,650.83,,,,,,,335.9600,1301.6600,percent of total billed charges,"Rev 272 $1,301.66 in Billed Charges at 50% = $650.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1301.6600,195.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,420.44,,,,,,,335.9600,1301.6600,other,"32.3% of $1,301.66 in Billed Charges for Rev 272 = $420.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1301.6600,195.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,399.61,,,,,,,335.9600,1301.6600,other,"30.7% of $1,301.66 in Billed Charges for Rev 272 = $399.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1301.6600,195.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,420.44,,,,,,,335.9600,1301.6600,percent of total billed charges,"32.3% of $1,301.66 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUT 75MM TLC75,272,RC,27200002,CDM,,,,,,both,,,1301.6600,195.2500,WELLCARE,WELLCARE MEDICAID,1301.66,,,,,,,335.9600,1301.6600,percent of total billed charges,"100% of $1,301.66 in Billed Charges for Rev 272 = $1,301.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUTTER  TRT 75,272,RC,27200002,CDM,,,,,,both,,,579.6700,86.9500,AETNA,AETNA,247.52,,,,,,,149.6100,579.6700,percent of total billed charges,42.7% of $579.67 in Billed Charges for Rev 272 = $247.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER  TRT 75,272,RC,27200002,CDM,,,,,,both,,,579.6700,86.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,405.77,,,,,,,149.6100,579.6700,percent of total billed charges,Rev 272 $579.67 in Billed Charges at 70% = $405.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER  TRT 75,272,RC,27200002,CDM,,,,,,both,,,579.6700,86.9500,CIGNA HEALTHCARE,CIGNA HMO,241.72,,,,,,,149.6100,579.6700,percent of total billed charges,41.7% of $579.67 in Billed Charges for Rev 272 = $241.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER  TRT 75,272,RC,27200002,CDM,,,,,,both,,,579.6700,86.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,268.97,,,,,,,149.6100,579.6700,percent of total billed charges,46.4% of $579.67 in Billed Charges for Rev 272 = $268.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER  TRT 75,272,RC,27200002,CDM,,,,,,both,,,579.6700,86.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,241.72,,,,,,,149.6100,579.6700,percent of total billed charges,41.7% of $579.67 in Billed Charges for Rev 272 = $241.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER  TRT 75,272,RC,27200002,CDM,,,,,,both,,,579.6700,86.9500,CIGNA HEALTHCARE,CIGNA PPO,241.72,,,,,,,149.6100,579.6700,percent of total billed charges,41.7% of $579.67 in Billed Charges for Rev 272 = $241.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER  TRT 75,272,RC,27200002,CDM,,,,,,both,,,579.6700,86.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,521.70,,,,,,,149.6100,579.6700,percent of total billed charges,90% of $579.67 in Billed Charges for Rev 272 = $521.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER  TRT 75,272,RC,27200002,CDM,,,,,,both,,,579.6700,86.9500,MEDCOST,MEDCOST VHN,275.87,,,,,,,149.6100,579.6700,percent of total billed charges,47.59% of $579.67 in Billed Charges for Rev 272 = $275.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER  TRT 75,272,RC,27200002,CDM,,,,,,both,,,579.6700,86.9500,SENTARA HEALTH,SENTARA HEALTH,149.61,,,,,,,149.6100,579.6700,percent of total billed charges,25.81% of $579.67 in Billed Charges for Rev 272 = $149.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER  TRT 75,272,RC,27200002,CDM,,,,,,both,,,579.6700,86.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",579.67,,,,,,,149.6100,579.6700,percent of total billed charges,100% of $579.67 in Billed Charges for Rev 272 = $579.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER  TRT 75,272,RC,27200002,CDM,,,,,,both,,,579.6700,86.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,289.84,,,,,,,149.6100,579.6700,percent of total billed charges,Rev 272 $579.67 in Billed Charges at 50% = $289.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER  TRT 75,272,RC,27200002,CDM,,,,,,both,,,579.6700,86.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,187.23,,,,,,,149.6100,579.6700,other,32.3% of $579.67 in Billed Charges for Rev 272 = $187.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER LINEAR CUTTER  TRT 75,272,RC,27200002,CDM,,,,,,both,,,579.6700,86.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,177.96,,,,,,,149.6100,579.6700,other,30.7% of $579.67 in Billed Charges for Rev 272 = $177.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER LINEAR CUTTER  TRT 75,272,RC,27200002,CDM,,,,,,both,,,579.6700,86.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,187.23,,,,,,,149.6100,579.6700,percent of total billed charges,32.3% of $579.67 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER  TRT 75,272,RC,27200002,CDM,,,,,,both,,,579.6700,86.9500,WELLCARE,WELLCARE MEDICAID,579.67,,,,,,,149.6100,579.6700,percent of total billed charges,100% of $579.67 in Billed Charges for Rev 272 = $579.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,714.4200,107.1600,AETNA,AETNA,305.06,,,,,,,184.3900,714.4200,percent of total billed charges,42.7% of $714.42 in Billed Charges for Rev 272 = $305.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,714.4200,107.1600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,500.09,,,,,,,184.3900,714.4200,percent of total billed charges,Rev 272 $714.42 in Billed Charges at 70% = $500.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,714.4200,107.1600,CIGNA HEALTHCARE,CIGNA HMO,297.91,,,,,,,184.3900,714.4200,percent of total billed charges,41.7% of $714.42 in Billed Charges for Rev 272 = $297.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,714.4200,107.1600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,331.49,,,,,,,184.3900,714.4200,percent of total billed charges,46.4% of $714.42 in Billed Charges for Rev 272 = $331.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,714.4200,107.1600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,297.91,,,,,,,184.3900,714.4200,percent of total billed charges,41.7% of $714.42 in Billed Charges for Rev 272 = $297.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,714.4200,107.1600,CIGNA HEALTHCARE,CIGNA PPO,297.91,,,,,,,184.3900,714.4200,percent of total billed charges,41.7% of $714.42 in Billed Charges for Rev 272 = $297.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,714.4200,107.1600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,642.98,,,,,,,184.3900,714.4200,percent of total billed charges,90% of $714.42 in Billed Charges for Rev 272 = $642.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,714.4200,107.1600,MEDCOST,MEDCOST VHN,339.99,,,,,,,184.3900,714.4200,percent of total billed charges,47.59% of $714.42 in Billed Charges for Rev 272 = $339.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,714.4200,107.1600,SENTARA HEALTH,SENTARA HEALTH,184.39,,,,,,,184.3900,714.4200,percent of total billed charges,25.81% of $714.42 in Billed Charges for Rev 272 = $184.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,714.4200,107.1600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",714.42,,,,,,,184.3900,714.4200,percent of total billed charges,100% of $714.42 in Billed Charges for Rev 272 = $714.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,714.4200,107.1600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,357.21,,,,,,,184.3900,714.4200,percent of total billed charges,Rev 272 $714.42 in Billed Charges at 50% = $357.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,714.4200,107.1600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,230.76,,,,,,,184.3900,714.4200,other,32.3% of $714.42 in Billed Charges for Rev 272 = $230.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,714.4200,107.1600,UNITED HEALTHCARE,UHC HERITAGE SELECT,219.33,,,,,,,184.3900,714.4200,other,30.7% of $714.42 in Billed Charges for Rev 272 = $219.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,714.4200,107.1600,UNITED HEALTHCARE,UNITED HEALTHCARE,230.76,,,,,,,184.3900,714.4200,percent of total billed charges,32.3% of $714.42 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,714.4200,107.1600,WELLCARE,WELLCARE MEDICAID,714.42,,,,,,,184.3900,714.4200,percent of total billed charges,100% of $714.42 in Billed Charges for Rev 272 = $714.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,AETNA,AETNA,31.60,,,,,,,5.9900,74.0000,percent of total billed charges,42.7% of $74.00 in Billed Charges for Rev 306 Proc 87265 = $31.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,5.9900,74.0000,fee schedule,APG 00396 Proc 87265 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,11.98,,,,,,,5.9900,74.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,AETNA,AETNA HEALTHCARE MEDICARE,11.98,,,,,,,5.9900,74.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,11.98,,,,,,,5.9900,74.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,AMBETTER,AMBETTER,26.12,,,,,,,5.9900,74.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,AMERIGROUP,AMERIGROUP,5.99,,,,,,,5.9900,74.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,12.46,,,,,,,5.9900,74.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,BLUE CROSS,ANTHEM EXCHANGE,11.98,,,,,,,5.9900,74.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,5.9900,74.0000,fee schedule,APG 00396 Proc 87265 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,BLUE CROSS,ANTHEM HMO,11.98,,,,,,,5.9900,74.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,12.34,,,,,,,5.9900,74.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",11.98,,,,,,,5.9900,74.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,34.21,,,,,,,5.9900,74.0000,fee schedule,$34.21 from Fee Schedule BLDTM_23 for Rev 306 Proc 87265 * Qty 1 = $34.21 at 100% = $34.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,BLUE CROSS,BLUE CROSS E NETWORK,49.98,,,,,,,5.9900,74.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 306 Proc 87265 * Qty 1 = $15.62 at 320% = $49.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,BLUE CROSS,BLUE CROSS MEDICARE,12.46,,,,,,,5.9900,74.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,BLUE CROSS,BLUE CROSS P NETWORK,51.08,,,,,,,5.9900,74.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 306 Proc 87265 * Qty 1 = $15.62 at 327% = $51.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,BLUE CROSS,BLUE CROSS S NETWORK,51.08,,,,,,,5.9900,74.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 306 Proc 87265 * Qty 1 = $15.62 at 327% = $51.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,BLUE CROSS,TENNCARE BLUE CARE,23.17,,,,,,,5.9900,74.0000,fee schedule,$19.97 from Fee Schedule TC_24 for Rev 306 Proc 87265 * Qty 1 = $19.97 at 116% = $23.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,BLUE CROSS,TENNCARE BLUE SELECT,23.17,,,,,,,5.9900,74.0000,fee schedule,$19.97 from Fee Schedule TC_24 for Rev 306 Proc 87265 * Qty 1 = $19.97 at 116% = $23.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,CIGNA HEALTHCARE,CIGNA HMO,48.24,,,,,,,5.9900,74.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87265 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,26.71,,,,,,,5.9900,74.0000,fee schedule,$26.71 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87265 * Qty 1 = $26.71 at 100% = $26.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,12.58,,,,,,,5.9900,74.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,48.24,,,,,,,5.9900,74.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87265 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,CIGNA HEALTHCARE,CIGNA PPO,48.24,,,,,,,5.9900,74.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87265 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,12.58,,,,,,,5.9900,74.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,66.60,,,,,,,5.9900,74.0000,percent of total billed charges,90% of $74.00 in Billed Charges for Rev 306 Proc 87265 = $66.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,HUMANA,HUMANA MEDICARE,11.98,,,,,,,5.9900,74.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,11.98,,,,,,,5.9900,74.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,MEDCOST,MEDCOST VHN,35.22,,,,,,,5.9900,74.0000,percent of total billed charges,47.59% of $74.00 in Billed Charges for Rev 306 Proc 87265 = $35.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,5.9900,74.0000,fee schedule,APG 00396 Proc 87265 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,12.58,,,,,,,5.9900,74.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,12.58,,,,,,,5.9900,74.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,NHC ADVANTAGE,NHC ADVANTAGE,12.58,,,,,,,5.9900,74.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,5.9900,74.0000,fee schedule,APG 00396 Proc 87265 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,SENTARA HEALTH,SENTARA HEALTH,19.10,,,,,,,5.9900,74.0000,percent of total billed charges,25.81% of $74.00 in Billed Charges for Rev 306 Proc 87265 = $19.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,SENTARA HEALTH,SENTARA MEDICARE,11.98,,,,,,,5.9900,74.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",74.00,,,,,,,5.9900,74.0000,percent of total billed charges,100% of $74.00 in Billed Charges for Rev 306 Proc 87265 = $74.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.50,,,,,,,5.9900,74.0000,fee schedule,$16.99 from Fee Schedule TCUHC24 for Rev 306 Proc 87265 * Qty 1 = $16.99 at 50% = $8.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12.46,,,,,,,5.9900,74.0000,fee schedule,$11.98 from Fee Schedule UHC_31910 for Rev 306 Proc 87265 * Qty 1 = $11.98 at 104% = $12.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11.98,,,,,,,5.9900,74.0000,fee schedule,$11.98 from Fee Schedule UHC_31910 for Rev 306 Proc 87265 * Qty 1 = $11.98 at 100% = $11.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,11.98,,,,,,,5.9900,74.0000,fee schedule,$11.98 from Fee Schedule UHC_31910 for Rev 306 Proc 87265 * Qty 1 = $11.98 at 100% = $11.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,5.9900,74.0000,fee schedule,APG 00396 Proc 87265 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,11.98,,,,,,,5.9900,74.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,11.98,,,,,,,5.9900,74.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,WELLCARE,WELLCARE MEDICAID,74.00,,,,,,,5.9900,74.0000,percent of total billed charges,100% of $74.00 in Billed Charges for Rev 306 Proc 87265 = $74.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PERTUSSIS AG IF,87265,CPT,306,RC,30600044,CDM,,,,both,,,74.0000,11.1000,WELLCARE,WELLCARE MEDICARE,12.70,,,,,,,5.9900,74.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA,57.22,,,,,,,5.9900,134.0000,percent of total billed charges,42.7% of $134.00 in Billed Charges for Rev 306 Proc 87270 = $57.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,5.9900,134.0000,fee schedule,APG 00396 Proc 87270 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA HEALTHCARE MEDICARE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,AMBETTER,AMBETTER,26.12,,,,,,,5.9900,134.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,AMERIGROUP,AMERIGROUP,5.99,,,,,,,5.9900,134.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,12.46,,,,,,,5.9900,134.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM EXCHANGE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,5.9900,134.0000,fee schedule,APG 00396 Proc 87270 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM HMO,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,12.34,,,,,,,5.9900,134.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,34.21,,,,,,,5.9900,134.0000,fee schedule,$34.21 from Fee Schedule BLDTM_23 for Rev 306 Proc 87270 * Qty 1 = $34.21 at 100% = $34.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS E NETWORK,49.98,,,,,,,5.9900,134.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 306 Proc 87270 * Qty 1 = $15.62 at 320% = $49.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS MEDICARE,12.46,,,,,,,5.9900,134.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS P NETWORK,51.08,,,,,,,5.9900,134.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 306 Proc 87270 * Qty 1 = $15.62 at 327% = $51.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS S NETWORK,51.08,,,,,,,5.9900,134.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 306 Proc 87270 * Qty 1 = $15.62 at 327% = $51.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,TENNCARE BLUE CARE,23.17,,,,,,,5.9900,134.0000,fee schedule,$19.97 from Fee Schedule TC_24 for Rev 306 Proc 87270 * Qty 1 = $19.97 at 116% = $23.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,TENNCARE BLUE SELECT,23.17,,,,,,,5.9900,134.0000,fee schedule,$19.97 from Fee Schedule TC_24 for Rev 306 Proc 87270 * Qty 1 = $19.97 at 116% = $23.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA HMO,48.24,,,,,,,5.9900,134.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87270 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,26.71,,,,,,,5.9900,134.0000,fee schedule,$26.71 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87270 * Qty 1 = $26.71 at 100% = $26.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,12.58,,,,,,,5.9900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,48.24,,,,,,,5.9900,134.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87270 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA PPO,48.24,,,,,,,5.9900,134.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87270 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,12.58,,,,,,,5.9900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,120.60,,,,,,,5.9900,134.0000,percent of total billed charges,90% of $134.00 in Billed Charges for Rev 306 Proc 87270 = $120.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,HUMANA,HUMANA MEDICARE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,MEDCOST,MEDCOST VHN,63.77,,,,,,,5.9900,134.0000,percent of total billed charges,47.59% of $134.00 in Billed Charges for Rev 306 Proc 87270 = $63.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,5.9900,134.0000,fee schedule,APG 00396 Proc 87270 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,12.58,,,,,,,5.9900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,12.58,,,,,,,5.9900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,NHC ADVANTAGE,NHC ADVANTAGE,12.58,,,,,,,5.9900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,5.9900,134.0000,fee schedule,APG 00396 Proc 87270 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,SENTARA HEALTH,SENTARA HEALTH,34.59,,,,,,,5.9900,134.0000,percent of total billed charges,25.81% of $134.00 in Billed Charges for Rev 306 Proc 87270 = $34.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,SENTARA HEALTH,SENTARA MEDICARE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",134.00,,,,,,,5.9900,134.0000,percent of total billed charges,100% of $134.00 in Billed Charges for Rev 306 Proc 87270 = $134.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.50,,,,,,,5.9900,134.0000,fee schedule,$16.99 from Fee Schedule TCUHC24 for Rev 306 Proc 87270 * Qty 1 = $16.99 at 50% = $8.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12.46,,,,,,,5.9900,134.0000,fee schedule,$11.98 from Fee Schedule UHC_31910 for Rev 306 Proc 87270 * Qty 1 = $11.98 at 104% = $12.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11.98,,,,,,,5.9900,134.0000,fee schedule,$11.98 from Fee Schedule UHC_31910 for Rev 306 Proc 87270 * Qty 1 = $11.98 at 100% = $11.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,11.98,,,,,,,5.9900,134.0000,fee schedule,$11.98 from Fee Schedule UHC_31910 for Rev 306 Proc 87270 * Qty 1 = $11.98 at 100% = $11.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,5.9900,134.0000,fee schedule,APG 00396 Proc 87270 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,WELLCARE,WELLCARE MEDICAID,134.00,,,,,,,5.9900,134.0000,percent of total billed charges,100% of $134.00 in Billed Charges for Rev 306 Proc 87270 = $134.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHLAMYDIA TRACHOMATIS DFA,87270,CPT,306,RC,30600045,CDM,,,,both,,,134.0000,20.1000,WELLCARE,WELLCARE MEDICARE,12.70,,,,,,,5.9900,134.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA,57.22,,,,,,,5.9900,134.0000,percent of total billed charges,42.7% of $134.00 in Billed Charges for Rev 306 Proc 87272 = $57.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,5.9900,134.0000,fee schedule,APG 00396 Proc 87272 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA HEALTHCARE MEDICARE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,AMBETTER,AMBETTER,26.12,,,,,,,5.9900,134.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,AMERIGROUP,AMERIGROUP,5.99,,,,,,,5.9900,134.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,12.46,,,,,,,5.9900,134.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM EXCHANGE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,5.9900,134.0000,fee schedule,APG 00396 Proc 87272 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM HMO,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,12.34,,,,,,,5.9900,134.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,34.21,,,,,,,5.9900,134.0000,fee schedule,$34.21 from Fee Schedule BLDTM_23 for Rev 306 Proc 87272 * Qty 1 = $34.21 at 100% = $34.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS E NETWORK,49.98,,,,,,,5.9900,134.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 306 Proc 87272 * Qty 1 = $15.62 at 320% = $49.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS MEDICARE,12.46,,,,,,,5.9900,134.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS P NETWORK,51.08,,,,,,,5.9900,134.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 306 Proc 87272 * Qty 1 = $15.62 at 327% = $51.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS S NETWORK,51.08,,,,,,,5.9900,134.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 306 Proc 87272 * Qty 1 = $15.62 at 327% = $51.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,TENNCARE BLUE CARE,23.17,,,,,,,5.9900,134.0000,fee schedule,$19.97 from Fee Schedule TC_24 for Rev 306 Proc 87272 * Qty 1 = $19.97 at 116% = $23.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,TENNCARE BLUE SELECT,23.17,,,,,,,5.9900,134.0000,fee schedule,$19.97 from Fee Schedule TC_24 for Rev 306 Proc 87272 * Qty 1 = $19.97 at 116% = $23.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA HMO,48.24,,,,,,,5.9900,134.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87272 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,26.71,,,,,,,5.9900,134.0000,fee schedule,$26.71 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87272 * Qty 1 = $26.71 at 100% = $26.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,12.58,,,,,,,5.9900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,48.24,,,,,,,5.9900,134.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87272 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA PPO,48.24,,,,,,,5.9900,134.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87272 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,12.58,,,,,,,5.9900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,120.60,,,,,,,5.9900,134.0000,percent of total billed charges,90% of $134.00 in Billed Charges for Rev 306 Proc 87272 = $120.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,HUMANA,HUMANA MEDICARE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,MEDCOST,MEDCOST VHN,63.77,,,,,,,5.9900,134.0000,percent of total billed charges,47.59% of $134.00 in Billed Charges for Rev 306 Proc 87272 = $63.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,5.9900,134.0000,fee schedule,APG 00396 Proc 87272 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,12.58,,,,,,,5.9900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,12.58,,,,,,,5.9900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,NHC ADVANTAGE,NHC ADVANTAGE,12.58,,,,,,,5.9900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,5.9900,134.0000,fee schedule,APG 00396 Proc 87272 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,SENTARA HEALTH,SENTARA HEALTH,34.59,,,,,,,5.9900,134.0000,percent of total billed charges,25.81% of $134.00 in Billed Charges for Rev 306 Proc 87272 = $34.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,SENTARA HEALTH,SENTARA MEDICARE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",134.00,,,,,,,5.9900,134.0000,percent of total billed charges,100% of $134.00 in Billed Charges for Rev 306 Proc 87272 = $134.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.50,,,,,,,5.9900,134.0000,fee schedule,$16.99 from Fee Schedule TCUHC24 for Rev 306 Proc 87272 * Qty 1 = $16.99 at 50% = $8.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12.46,,,,,,,5.9900,134.0000,fee schedule,$11.98 from Fee Schedule UHC_31910 for Rev 306 Proc 87272 * Qty 1 = $11.98 at 104% = $12.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11.98,,,,,,,5.9900,134.0000,fee schedule,$11.98 from Fee Schedule UHC_31910 for Rev 306 Proc 87272 * Qty 1 = $11.98 at 100% = $11.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,11.98,,,,,,,5.9900,134.0000,fee schedule,$11.98 from Fee Schedule UHC_31910 for Rev 306 Proc 87272 * Qty 1 = $11.98 at 100% = $11.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,5.9900,134.0000,fee schedule,APG 00396 Proc 87272 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,WELLCARE,WELLCARE MEDICAID,134.00,,,,,,,5.9900,134.0000,percent of total billed charges,100% of $134.00 in Billed Charges for Rev 306 Proc 87272 = $134.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CRYPTOSPORIDUM AG DFA,87272,CPT,306,RC,30600150,CDM,,,,both,,,134.0000,20.1000,WELLCARE,WELLCARE MEDICARE,12.70,,,,,,,5.9900,134.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA,57.22,,,,,,,5.9900,134.0000,percent of total billed charges,42.7% of $134.00 in Billed Charges for Rev 300 Proc 87273 = $57.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,5.9900,134.0000,fee schedule,APG 00396 Proc 87273 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA HEALTHCARE MEDICARE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,AMBETTER,AMBETTER,26.12,,,,,,,5.9900,134.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,AMERIGROUP,AMERIGROUP,5.99,,,,,,,5.9900,134.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,12.46,,,,,,,5.9900,134.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM EXCHANGE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,5.9900,134.0000,fee schedule,APG 00396 Proc 87273 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM HMO,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,12.34,,,,,,,5.9900,134.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,42.08,,,,,,,5.9900,134.0000,fee schedule,$42.08 from Fee Schedule BLDTM_23 for Rev 300 Proc 87273 * Qty 1 = $42.08 at 100% = $42.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS E NETWORK,49.98,,,,,,,5.9900,134.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 300 Proc 87273 * Qty 1 = $15.62 at 320% = $49.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS MEDICARE,12.46,,,,,,,5.9900,134.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS P NETWORK,51.08,,,,,,,5.9900,134.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 300 Proc 87273 * Qty 1 = $15.62 at 327% = $51.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS S NETWORK,51.08,,,,,,,5.9900,134.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 300 Proc 87273 * Qty 1 = $15.62 at 327% = $51.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,TENNCARE BLUE CARE,14.93,,,,,,,5.9900,134.0000,fee schedule,$12.87 from Fee Schedule TC_24 for Rev 300 Proc 87273 * Qty 1 = $12.87 at 116% = $14.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,TENNCARE BLUE SELECT,14.93,,,,,,,5.9900,134.0000,fee schedule,$12.87 from Fee Schedule TC_24 for Rev 300 Proc 87273 * Qty 1 = $12.87 at 116% = $14.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA HMO,48.24,,,,,,,5.9900,134.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 300 Proc 87273 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,26.71,,,,,,,5.9900,134.0000,fee schedule,$26.71 from Fee Schedule CGIFP_25LR for Rev 300 Proc 87273 * Qty 1 = $26.71 at 100% = $26.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,12.58,,,,,,,5.9900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,48.24,,,,,,,5.9900,134.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 300 Proc 87273 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA PPO,48.24,,,,,,,5.9900,134.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 300 Proc 87273 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,12.58,,,,,,,5.9900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,120.60,,,,,,,5.9900,134.0000,percent of total billed charges,90% of $134.00 in Billed Charges for Rev 300 Proc 87273 = $120.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,HUMANA,HUMANA MEDICARE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,MEDCOST,MEDCOST VHN,63.77,,,,,,,5.9900,134.0000,percent of total billed charges,47.59% of $134.00 in Billed Charges for Rev 300 Proc 87273 = $63.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,5.9900,134.0000,fee schedule,APG 00396 Proc 87273 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,12.58,,,,,,,5.9900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,12.58,,,,,,,5.9900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,NHC ADVANTAGE,NHC ADVANTAGE,12.58,,,,,,,5.9900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,5.9900,134.0000,fee schedule,APG 00396 Proc 87273 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,SENTARA HEALTH,SENTARA HEALTH,34.59,,,,,,,5.9900,134.0000,percent of total billed charges,25.81% of $134.00 in Billed Charges for Rev 300 Proc 87273 = $34.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,SENTARA HEALTH,SENTARA MEDICARE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",134.00,,,,,,,5.9900,134.0000,percent of total billed charges,100% of $134.00 in Billed Charges for Rev 300 Proc 87273 = $134.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.50,,,,,,,5.9900,134.0000,fee schedule,$16.99 from Fee Schedule TCUHC24 for Rev 300 Proc 87273 * Qty 1 = $16.99 at 50% = $8.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12.46,,,,,,,5.9900,134.0000,fee schedule,$11.98 from Fee Schedule UHC_31910 for Rev 300 Proc 87273 * Qty 1 = $11.98 at 104% = $12.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11.98,,,,,,,5.9900,134.0000,fee schedule,$11.98 from Fee Schedule UHC_31910 for Rev 300 Proc 87273 * Qty 1 = $11.98 at 100% = $11.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,11.98,,,,,,,5.9900,134.0000,fee schedule,$11.98 from Fee Schedule UHC_31910 for Rev 300 Proc 87273 * Qty 1 = $11.98 at 100% = $11.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,5.9900,134.0000,fee schedule,APG 00396 Proc 87273 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,WELLCARE,WELLCARE MEDICAID,134.00,,,,,,,5.9900,134.0000,percent of total billed charges,100% of $134.00 in Billed Charges for Rev 300 Proc 87273 = $134.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX 2 AG IF,87273,CPT,300,RC,30000202,CDM,,,,both,,,134.0000,20.1000,WELLCARE,WELLCARE MEDICARE,12.70,,,,,,,5.9900,134.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,AETNA,AETNA,29.46,,,,,,,6.1300,69.0000,percent of total billed charges,42.7% of $69.00 in Billed Charges for Rev 306 Proc 87275 = $29.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,6.1300,69.0000,fee schedule,APG 00396 Proc 87275 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,12.25,,,,,,,6.1300,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,AETNA,AETNA HEALTHCARE MEDICARE,12.25,,,,,,,6.1300,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,12.25,,,,,,,6.1300,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,AMBETTER,AMBETTER,26.71,,,,,,,6.1300,69.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,AMERIGROUP,AMERIGROUP,6.13,,,,,,,6.1300,69.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,12.74,,,,,,,6.1300,69.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,ANTHEM EXCHANGE,12.25,,,,,,,6.1300,69.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,6.1300,69.0000,fee schedule,APG 00396 Proc 87275 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,ANTHEM HMO,12.25,,,,,,,6.1300,69.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,12.62,,,,,,,6.1300,69.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",12.25,,,,,,,6.1300,69.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,42.08,,,,,,,6.1300,69.0000,fee schedule,$42.08 from Fee Schedule BLDTM_23 for Rev 306 Proc 87275 * Qty 1 = $42.08 at 100% = $42.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS E NETWORK,49.98,,,,,,,6.1300,69.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 306 Proc 87275 * Qty 1 = $15.62 at 320% = $49.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS MEDICARE,12.74,,,,,,,6.1300,69.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS P NETWORK,51.08,,,,,,,6.1300,69.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 306 Proc 87275 * Qty 1 = $15.62 at 327% = $51.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS S NETWORK,51.08,,,,,,,6.1300,69.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 306 Proc 87275 * Qty 1 = $15.62 at 327% = $51.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,TENNCARE BLUE CARE,14.93,,,,,,,6.1300,69.0000,fee schedule,$12.87 from Fee Schedule TC_24 for Rev 306 Proc 87275 * Qty 1 = $12.87 at 116% = $14.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,TENNCARE BLUE SELECT,14.93,,,,,,,6.1300,69.0000,fee schedule,$12.87 from Fee Schedule TC_24 for Rev 306 Proc 87275 * Qty 1 = $12.87 at 116% = $14.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA HMO,48.24,,,,,,,6.1300,69.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87275 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,26.71,,,,,,,6.1300,69.0000,fee schedule,$26.71 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87275 * Qty 1 = $26.71 at 100% = $26.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,12.86,,,,,,,6.1300,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,48.24,,,,,,,6.1300,69.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87275 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA PPO,48.24,,,,,,,6.1300,69.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87275 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,12.86,,,,,,,6.1300,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,62.10,,,,,,,6.1300,69.0000,percent of total billed charges,90% of $69.00 in Billed Charges for Rev 306 Proc 87275 = $62.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,HUMANA,HUMANA MEDICARE,12.25,,,,,,,6.1300,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,12.25,,,,,,,6.1300,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,MEDCOST,MEDCOST VHN,32.84,,,,,,,6.1300,69.0000,percent of total billed charges,47.59% of $69.00 in Billed Charges for Rev 306 Proc 87275 = $32.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,6.1300,69.0000,fee schedule,APG 00396 Proc 87275 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,12.86,,,,,,,6.1300,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,12.86,,,,,,,6.1300,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,NHC ADVANTAGE,NHC ADVANTAGE,12.86,,,,,,,6.1300,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,6.1300,69.0000,fee schedule,APG 00396 Proc 87275 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,SENTARA HEALTH,SENTARA HEALTH,17.81,,,,,,,6.1300,69.0000,percent of total billed charges,25.81% of $69.00 in Billed Charges for Rev 306 Proc 87275 = $17.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,SENTARA HEALTH,SENTARA MEDICARE,12.25,,,,,,,6.1300,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",69.00,,,,,,,6.1300,69.0000,percent of total billed charges,100% of $69.00 in Billed Charges for Rev 306 Proc 87275 = $69.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.50,,,,,,,6.1300,69.0000,fee schedule,$16.99 from Fee Schedule TCUHC24 for Rev 306 Proc 87275 * Qty 1 = $16.99 at 50% = $8.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12.74,,,,,,,6.1300,69.0000,fee schedule,$12.25 from Fee Schedule UHC_31910 for Rev 306 Proc 87275 * Qty 1 = $12.25 at 104% = $12.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,12.25,,,,,,,6.1300,69.0000,fee schedule,$12.25 from Fee Schedule UHC_31910 for Rev 306 Proc 87275 * Qty 1 = $12.25 at 100% = $12.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,12.25,,,,,,,6.1300,69.0000,fee schedule,$12.25 from Fee Schedule UHC_31910 for Rev 306 Proc 87275 * Qty 1 = $12.25 at 100% = $12.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,6.1300,69.0000,fee schedule,APG 00396 Proc 87275 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,12.25,,,,,,,6.1300,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,12.25,,,,,,,6.1300,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,WELLCARE,WELLCARE MEDICAID,69.00,,,,,,,6.1300,69.0000,percent of total billed charges,100% of $69.00 in Billed Charges for Rev 306 Proc 87275 = $69.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INFLUENZA B AG IF,87275,CPT,306,RC,30600046,CDM,,,,both,,,69.0000,10.3500,WELLCARE,WELLCARE MEDICARE,12.99,,,,,,,6.1300,69.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,AETNA,AETNA,29.46,,,,,,,8.0400,69.0000,percent of total billed charges,42.7% of $69.00 in Billed Charges for Rev 306 Proc 87276 = $29.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,8.0400,69.0000,fee schedule,APG 00396 Proc 87276 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,16.07,,,,,,,8.0400,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,AETNA,AETNA HEALTHCARE MEDICARE,16.07,,,,,,,8.0400,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,16.07,,,,,,,8.0400,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,AMBETTER,AMBETTER,35.03,,,,,,,8.0400,69.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,AMERIGROUP,AMERIGROUP,8.04,,,,,,,8.0400,69.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,16.71,,,,,,,8.0400,69.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,ANTHEM EXCHANGE,16.07,,,,,,,8.0400,69.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,8.0400,69.0000,fee schedule,APG 00396 Proc 87276 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,ANTHEM HMO,16.07,,,,,,,8.0400,69.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,16.55,,,,,,,8.0400,69.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",16.07,,,,,,,8.0400,69.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,34.21,,,,,,,8.0400,69.0000,fee schedule,$34.21 from Fee Schedule BLDTM_23 for Rev 306 Proc 87276 * Qty 1 = $34.21 at 100% = $34.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS E NETWORK,49.98,,,,,,,8.0400,69.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 306 Proc 87276 * Qty 1 = $15.62 at 320% = $49.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS MEDICARE,16.71,,,,,,,8.0400,69.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS P NETWORK,51.08,,,,,,,8.0400,69.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 306 Proc 87276 * Qty 1 = $15.62 at 327% = $51.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS S NETWORK,51.08,,,,,,,8.0400,69.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 306 Proc 87276 * Qty 1 = $15.62 at 327% = $51.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,TENNCARE BLUE CARE,23.17,,,,,,,8.0400,69.0000,fee schedule,$19.97 from Fee Schedule TC_24 for Rev 306 Proc 87276 * Qty 1 = $19.97 at 116% = $23.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,TENNCARE BLUE SELECT,23.17,,,,,,,8.0400,69.0000,fee schedule,$19.97 from Fee Schedule TC_24 for Rev 306 Proc 87276 * Qty 1 = $19.97 at 116% = $23.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA HMO,48.24,,,,,,,8.0400,69.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87276 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,35.37,,,,,,,8.0400,69.0000,fee schedule,$35.37 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87276 * Qty 1 = $35.37 at 100% = $35.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,16.87,,,,,,,8.0400,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,48.24,,,,,,,8.0400,69.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87276 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA PPO,48.24,,,,,,,8.0400,69.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87276 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,16.87,,,,,,,8.0400,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,62.10,,,,,,,8.0400,69.0000,percent of total billed charges,90% of $69.00 in Billed Charges for Rev 306 Proc 87276 = $62.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,HUMANA,HUMANA MEDICARE,16.07,,,,,,,8.0400,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,16.07,,,,,,,8.0400,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,MEDCOST,MEDCOST VHN,32.84,,,,,,,8.0400,69.0000,percent of total billed charges,47.59% of $69.00 in Billed Charges for Rev 306 Proc 87276 = $32.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,8.0400,69.0000,fee schedule,APG 00396 Proc 87276 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,16.87,,,,,,,8.0400,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,16.87,,,,,,,8.0400,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,NHC ADVANTAGE,NHC ADVANTAGE,16.87,,,,,,,8.0400,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,8.0400,69.0000,fee schedule,APG 00396 Proc 87276 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,SENTARA HEALTH,SENTARA HEALTH,17.81,,,,,,,8.0400,69.0000,percent of total billed charges,25.81% of $69.00 in Billed Charges for Rev 306 Proc 87276 = $17.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,SENTARA HEALTH,SENTARA MEDICARE,16.07,,,,,,,8.0400,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",69.00,,,,,,,8.0400,69.0000,percent of total billed charges,100% of $69.00 in Billed Charges for Rev 306 Proc 87276 = $69.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.50,,,,,,,8.0400,69.0000,fee schedule,$16.99 from Fee Schedule TCUHC24 for Rev 306 Proc 87276 * Qty 1 = $16.99 at 50% = $8.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,16.71,,,,,,,8.0400,69.0000,fee schedule,$16.07 from Fee Schedule UHC_31910 for Rev 306 Proc 87276 * Qty 1 = $16.07 at 104% = $16.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,16.07,,,,,,,8.0400,69.0000,fee schedule,$16.07 from Fee Schedule UHC_31910 for Rev 306 Proc 87276 * Qty 1 = $16.07 at 100% = $16.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,16.07,,,,,,,8.0400,69.0000,fee schedule,$16.07 from Fee Schedule UHC_31910 for Rev 306 Proc 87276 * Qty 1 = $16.07 at 100% = $16.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,8.0400,69.0000,fee schedule,APG 00396 Proc 87276 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,16.07,,,,,,,8.0400,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,16.07,,,,,,,8.0400,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,WELLCARE,WELLCARE MEDICAID,69.00,,,,,,,8.0400,69.0000,percent of total billed charges,100% of $69.00 in Billed Charges for Rev 306 Proc 87276 = $69.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INFLUENZA A AG IF,87276,CPT,306,RC,30600047,CDM,,,,both,,,69.0000,10.3500,WELLCARE,WELLCARE MEDICARE,17.03,,,,,,,8.0400,69.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,AETNA,AETNA,1105.50,,,,,,,128.7300,2589.0000,percent of total billed charges,"42.7% of $2,589.00 in Billed Charges for Rev 306 Proc 87902 = $1,105.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,189.06,,,,,,,128.7300,2589.0000,fee schedule,APG 00386 Proc 87902 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 104% = $189.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,257.45,,,,,,,128.7300,2589.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,AETNA,AETNA HEALTHCARE MEDICARE,257.45,,,,,,,128.7300,2589.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,257.45,,,,,,,128.7300,2589.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,AMBETTER,AMBETTER,561.24,,,,,,,128.7300,2589.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,AMERIGROUP,AMERIGROUP,128.73,,,,,,,128.7300,2589.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,267.75,,,,,,,128.7300,2589.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,ANTHEM EXCHANGE,257.45,,,,,,,128.7300,2589.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,187.25,,,,,,,128.7300,2589.0000,fee schedule,APG 00386 Proc 87902 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,ANTHEM HMO,257.45,,,,,,,128.7300,2589.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,265.17,,,,,,,128.7300,2589.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",257.45,,,,,,,128.7300,2589.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,602.84,,,,,,,128.7300,2589.0000,fee schedule,$602.84 from Fee Schedule BLDTM_23 for Rev 306 Proc 87902 * Qty 1 = $602.84 at 100% = $602.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,BLUE CROSS E NETWORK,785.18,,,,,,,128.7300,2589.0000,fee schedule,$245.37 from Fee Schedule BCFSB for Rev 306 Proc 87902 * Qty 1 = $245.37 at 320% = $785.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,BLUE CROSS MEDICARE,267.75,,,,,,,128.7300,2589.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,BLUE CROSS P NETWORK,802.36,,,,,,,128.7300,2589.0000,fee schedule,$245.37 from Fee Schedule BCFSB for Rev 306 Proc 87902 * Qty 1 = $245.37 at 327% = $802.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,BLUE CROSS S NETWORK,802.36,,,,,,,128.7300,2589.0000,fee schedule,$245.37 from Fee Schedule BCFSB for Rev 306 Proc 87902 * Qty 1 = $245.37 at 327% = $802.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,TENNCARE BLUE CARE,234.23,,,,,,,128.7300,2589.0000,fee schedule,$201.92 from Fee Schedule TC_24 for Rev 306 Proc 87902 * Qty 1 = $201.92 at 116% = $234.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,TENNCARE BLUE SELECT,234.23,,,,,,,128.7300,2589.0000,fee schedule,$201.92 from Fee Schedule TC_24 for Rev 306 Proc 87902 * Qty 1 = $201.92 at 116% = $234.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,CIGNA HEALTHCARE,CIGNA HMO,1035.78,,,,,,,128.7300,2589.0000,fee schedule,"$1,035.78 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87902 * Qty 1 = $1,035.78 at 100% = $1,035.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,567.32,,,,,,,128.7300,2589.0000,fee schedule,$567.32 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87902 * Qty 1 = $567.32 at 100% = $567.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,270.32,,,,,,,128.7300,2589.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1035.78,,,,,,,128.7300,2589.0000,fee schedule,"$1,035.78 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87902 * Qty 1 = $1,035.78 at 100% = $1,035.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,CIGNA HEALTHCARE,CIGNA PPO,1035.78,,,,,,,128.7300,2589.0000,fee schedule,"$1,035.78 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87902 * Qty 1 = $1,035.78 at 100% = $1,035.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,270.32,,,,,,,128.7300,2589.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2330.10,,,,,,,128.7300,2589.0000,percent of total billed charges,"90% of $2,589.00 in Billed Charges for Rev 306 Proc 87902 = $2,330.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,HUMANA,HUMANA MEDICARE,257.45,,,,,,,128.7300,2589.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,257.45,,,,,,,128.7300,2589.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,MEDCOST,MEDCOST VHN,1232.11,,,,,,,128.7300,2589.0000,percent of total billed charges,"47.59% of $2,589.00 in Billed Charges for Rev 306 Proc 87902 = $1,232.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,190.88,,,,,,,128.7300,2589.0000,fee schedule,APG 00386 Proc 87902 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 105% = $190.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,270.32,,,,,,,128.7300,2589.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,270.32,,,,,,,128.7300,2589.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,NHC ADVANTAGE,NHC ADVANTAGE,270.32,,,,,,,128.7300,2589.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,187.43,,,,,,,128.7300,2589.0000,fee schedule,APG 00386 Proc 87902 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 103.1% = $187.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,SENTARA HEALTH,SENTARA HEALTH,668.22,,,,,,,128.7300,2589.0000,percent of total billed charges,"25.81% of $2,589.00 in Billed Charges for Rev 306 Proc 87902 = $668.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,SENTARA HEALTH,SENTARA MEDICARE,257.45,,,,,,,128.7300,2589.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2589.00,,,,,,,128.7300,2589.0000,percent of total billed charges,"100% of $2,589.00 in Billed Charges for Rev 306 Proc 87902 = $2,589.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,182.32,,,,,,,128.7300,2589.0000,fee schedule,$364.64 from Fee Schedule TCUHC24 for Rev 306 Proc 87902 * Qty 1 = $364.64 at 50% = $182.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,267.75,,,,,,,128.7300,2589.0000,fee schedule,$257.45 from Fee Schedule UHC_31910 for Rev 306 Proc 87902 * Qty 1 = $257.45 at 104% = $267.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,257.45,,,,,,,128.7300,2589.0000,fee schedule,$257.45 from Fee Schedule UHC_31910 for Rev 306 Proc 87902 * Qty 1 = $257.45 at 100% = $257.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,257.45,,,,,,,128.7300,2589.0000,fee schedule,$257.45 from Fee Schedule UHC_31910 for Rev 306 Proc 87902 * Qty 1 = $257.45 at 100% = $257.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,187.25,,,,,,,128.7300,2589.0000,fee schedule,APG 00386 Proc 87902 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,257.45,,,,,,,128.7300,2589.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,257.45,,,,,,,128.7300,2589.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,WELLCARE,WELLCARE MEDICAID,2589.00,,,,,,,128.7300,2589.0000,percent of total billed charges,"100% of $2,589.00 in Billed Charges for Rev 306 Proc 87902 = $2,589.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEPATITIS C GENOTYPE,87902,CPT,306,RC,30600095,CDM,,,,both,,,2589.0000,388.3500,WELLCARE,WELLCARE MEDICARE,272.90,,,,,,,128.7300,2589.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,AETNA,AETNA,130.24,,,,,,,13.0400,305.0000,percent of total billed charges,42.7% of $305.00 in Billed Charges for Rev 306 Proc 87904 = $130.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,51.42,,,,,,,13.0400,305.0000,fee schedule,APG 00385 Proc 87904 at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 104% = $51.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,26.07,,,,,,,13.0400,305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,AETNA,AETNA HEALTHCARE MEDICARE,26.07,,,,,,,13.0400,305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,26.07,,,,,,,13.0400,305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,AMBETTER,AMBETTER,56.83,,,,,,,13.0400,305.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,AMERIGROUP,AMERIGROUP,13.04,,,,,,,13.0400,305.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,27.11,,,,,,,13.0400,305.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,ANTHEM EXCHANGE,26.07,,,,,,,13.0400,305.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,50.93,,,,,,,13.0400,305.0000,fee schedule,APG 00385 Proc 87904 at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 103% = $50.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,ANTHEM HMO,26.07,,,,,,,13.0400,305.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,26.85,,,,,,,13.0400,305.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",26.07,,,,,,,13.0400,305.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,95.68,,,,,,,13.0400,305.0000,fee schedule,$95.68 from Fee Schedule BLDTM_23 for Rev 306 Proc 87904 * Qty 1 = $95.68 at 100% = $95.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,BLUE CROSS E NETWORK,113.79,,,,,,,13.0400,305.0000,fee schedule,$35.56 from Fee Schedule BCFSB for Rev 306 Proc 87904 * Qty 1 = $35.56 at 320% = $113.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,BLUE CROSS MEDICARE,27.11,,,,,,,13.0400,305.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,BLUE CROSS P NETWORK,116.28,,,,,,,13.0400,305.0000,fee schedule,$35.56 from Fee Schedule BCFSB for Rev 306 Proc 87904 * Qty 1 = $35.56 at 327% = $116.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,BLUE CROSS S NETWORK,116.28,,,,,,,13.0400,305.0000,fee schedule,$35.56 from Fee Schedule BCFSB for Rev 306 Proc 87904 * Qty 1 = $35.56 at 327% = $116.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,TENNCARE BLUE CARE,33.95,,,,,,,13.0400,305.0000,fee schedule,$29.27 from Fee Schedule TC_24 for Rev 306 Proc 87904 * Qty 1 = $29.27 at 116% = $33.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,TENNCARE BLUE SELECT,33.95,,,,,,,13.0400,305.0000,fee schedule,$29.27 from Fee Schedule TC_24 for Rev 306 Proc 87904 * Qty 1 = $29.27 at 116% = $33.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,CIGNA HEALTHCARE,CIGNA HMO,104.88,,,,,,,13.0400,305.0000,fee schedule,$104.88 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87904 * Qty 1 = $104.88 at 100% = $104.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,57.74,,,,,,,13.0400,305.0000,fee schedule,$57.74 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87904 * Qty 1 = $57.74 at 100% = $57.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,27.37,,,,,,,13.0400,305.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,104.88,,,,,,,13.0400,305.0000,fee schedule,$104.88 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87904 * Qty 1 = $104.88 at 100% = $104.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,CIGNA HEALTHCARE,CIGNA PPO,104.88,,,,,,,13.0400,305.0000,fee schedule,$104.88 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87904 * Qty 1 = $104.88 at 100% = $104.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,27.37,,,,,,,13.0400,305.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,274.50,,,,,,,13.0400,305.0000,percent of total billed charges,90% of $305.00 in Billed Charges for Rev 306 Proc 87904 = $274.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,HUMANA,HUMANA MEDICARE,26.07,,,,,,,13.0400,305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,26.07,,,,,,,13.0400,305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,MEDCOST,MEDCOST VHN,145.15,,,,,,,13.0400,305.0000,percent of total billed charges,47.59% of $305.00 in Billed Charges for Rev 306 Proc 87904 = $145.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,51.91,,,,,,,13.0400,305.0000,fee schedule,APG 00385 Proc 87904 at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 100% = $49.44... $49.44 at 105% = $51.91 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,27.37,,,,,,,13.0400,305.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,27.37,,,,,,,13.0400,305.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,NHC ADVANTAGE,NHC ADVANTAGE,27.37,,,,,,,13.0400,305.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,50.97,,,,,,,13.0400,305.0000,fee schedule,APG 00385 Proc 87904 at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 100% = $49.44... $49.44 at 103.1% = $50.97 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,SENTARA HEALTH,SENTARA HEALTH,78.72,,,,,,,13.0400,305.0000,percent of total billed charges,25.81% of $305.00 in Billed Charges for Rev 306 Proc 87904 = $78.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,SENTARA HEALTH,SENTARA MEDICARE,26.07,,,,,,,13.0400,305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",305.00,,,,,,,13.0400,305.0000,percent of total billed charges,100% of $305.00 in Billed Charges for Rev 306 Proc 87904 = $305.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,18.46,,,,,,,13.0400,305.0000,fee schedule,$36.92 from Fee Schedule TCUHC24 for Rev 306 Proc 87904 * Qty 1 = $36.92 at 50% = $18.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,27.11,,,,,,,13.0400,305.0000,fee schedule,$26.07 from Fee Schedule UHC_31910 for Rev 306 Proc 87904 * Qty 1 = $26.07 at 104% = $27.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,26.07,,,,,,,13.0400,305.0000,fee schedule,$26.07 from Fee Schedule UHC_31910 for Rev 306 Proc 87904 * Qty 1 = $26.07 at 100% = $26.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,26.07,,,,,,,13.0400,305.0000,fee schedule,$26.07 from Fee Schedule UHC_31910 for Rev 306 Proc 87904 * Qty 1 = $26.07 at 100% = $26.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,50.93,,,,,,,13.0400,305.0000,fee schedule,APG 00385 Proc 87904 at $836.60 (Base Rate) * 0.0591 (Relative Weight) = $49.44 (Total Line Payment) at 103% = $50.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,26.07,,,,,,,13.0400,305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,26.07,,,,,,,13.0400,305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,WELLCARE,WELLCARE MEDICAID,305.00,,,,,,,13.0400,305.0000,percent of total billed charges,100% of $305.00 in Billed Charges for Rev 306 Proc 87904 = $305.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INF AGT PHENO DNA RNA HIV1 ADD1-5,87904,CPT,306,RC,30600097,CDM,,,,both,,,305.0000,45.7500,WELLCARE,WELLCARE MEDICARE,27.63,,,,,,,13.0400,305.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,2177.8100,326.6700,AETNA,AETNA,929.92,,,,,,,562.0900,2177.8100,percent of total billed charges,"42.7% of $2,177.81 in Billed Charges for Rev 272 = $929.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,2177.8100,326.6700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1524.47,,,,,,,562.0900,2177.8100,percent of total billed charges,"Rev 272 $2,177.81 in Billed Charges at 70% = $1,524.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,2177.8100,326.6700,CIGNA HEALTHCARE,CIGNA HMO,908.15,,,,,,,562.0900,2177.8100,percent of total billed charges,"41.7% of $2,177.81 in Billed Charges for Rev 272 = $908.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,2177.8100,326.6700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1010.50,,,,,,,562.0900,2177.8100,percent of total billed charges,"46.4% of $2,177.81 in Billed Charges for Rev 272 = $1,010.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,2177.8100,326.6700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,908.15,,,,,,,562.0900,2177.8100,percent of total billed charges,"41.7% of $2,177.81 in Billed Charges for Rev 272 = $908.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,2177.8100,326.6700,CIGNA HEALTHCARE,CIGNA PPO,908.15,,,,,,,562.0900,2177.8100,percent of total billed charges,"41.7% of $2,177.81 in Billed Charges for Rev 272 = $908.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,2177.8100,326.6700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1960.03,,,,,,,562.0900,2177.8100,percent of total billed charges,"90% of $2,177.81 in Billed Charges for Rev 272 = $1,960.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,2177.8100,326.6700,MEDCOST,MEDCOST VHN,1036.42,,,,,,,562.0900,2177.8100,percent of total billed charges,"47.59% of $2,177.81 in Billed Charges for Rev 272 = $1,036.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,2177.8100,326.6700,SENTARA HEALTH,SENTARA HEALTH,562.09,,,,,,,562.0900,2177.8100,percent of total billed charges,"25.81% of $2,177.81 in Billed Charges for Rev 272 = $562.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,2177.8100,326.6700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2177.81,,,,,,,562.0900,2177.8100,percent of total billed charges,"100% of $2,177.81 in Billed Charges for Rev 272 = $2,177.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,2177.8100,326.6700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1088.91,,,,,,,562.0900,2177.8100,percent of total billed charges,"Rev 272 $2,177.81 in Billed Charges at 50% = $1,088.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,2177.8100,326.6700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,703.43,,,,,,,562.0900,2177.8100,other,"32.3% of $2,177.81 in Billed Charges for Rev 272 = $703.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,2177.8100,326.6700,UNITED HEALTHCARE,UHC HERITAGE SELECT,668.59,,,,,,,562.0900,2177.8100,other,"30.7% of $2,177.81 in Billed Charges for Rev 272 = $668.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,2177.8100,326.6700,UNITED HEALTHCARE,UNITED HEALTHCARE,703.43,,,,,,,562.0900,2177.8100,percent of total billed charges,"32.3% of $2,177.81 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR CUTTER 55MM TLC 55,272,RC,27200002,CDM,,,,,,both,,,2177.8100,326.6700,WELLCARE,WELLCARE MEDICAID,2177.81,,,,,,,562.0900,2177.8100,percent of total billed charges,"100% of $2,177.81 in Billed Charges for Rev 272 = $2,177.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER LINEAR TX 30 G,272,RC,27200002,CDM,,,,,,both,,,689.1500,103.3700,AETNA,AETNA,294.27,,,,,,,177.8700,689.1500,percent of total billed charges,42.7% of $689.15 in Billed Charges for Rev 272 = $294.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 30 G,272,RC,27200002,CDM,,,,,,both,,,689.1500,103.3700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,482.41,,,,,,,177.8700,689.1500,percent of total billed charges,Rev 272 $689.15 in Billed Charges at 70% = $482.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 30 G,272,RC,27200002,CDM,,,,,,both,,,689.1500,103.3700,CIGNA HEALTHCARE,CIGNA HMO,287.38,,,,,,,177.8700,689.1500,percent of total billed charges,41.7% of $689.15 in Billed Charges for Rev 272 = $287.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 30 G,272,RC,27200002,CDM,,,,,,both,,,689.1500,103.3700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,319.77,,,,,,,177.8700,689.1500,percent of total billed charges,46.4% of $689.15 in Billed Charges for Rev 272 = $319.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 30 G,272,RC,27200002,CDM,,,,,,both,,,689.1500,103.3700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,287.38,,,,,,,177.8700,689.1500,percent of total billed charges,41.7% of $689.15 in Billed Charges for Rev 272 = $287.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 30 G,272,RC,27200002,CDM,,,,,,both,,,689.1500,103.3700,CIGNA HEALTHCARE,CIGNA PPO,287.38,,,,,,,177.8700,689.1500,percent of total billed charges,41.7% of $689.15 in Billed Charges for Rev 272 = $287.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 30 G,272,RC,27200002,CDM,,,,,,both,,,689.1500,103.3700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,620.24,,,,,,,177.8700,689.1500,percent of total billed charges,90% of $689.15 in Billed Charges for Rev 272 = $620.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 30 G,272,RC,27200002,CDM,,,,,,both,,,689.1500,103.3700,MEDCOST,MEDCOST VHN,327.97,,,,,,,177.8700,689.1500,percent of total billed charges,47.59% of $689.15 in Billed Charges for Rev 272 = $327.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 30 G,272,RC,27200002,CDM,,,,,,both,,,689.1500,103.3700,SENTARA HEALTH,SENTARA HEALTH,177.87,,,,,,,177.8700,689.1500,percent of total billed charges,25.81% of $689.15 in Billed Charges for Rev 272 = $177.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 30 G,272,RC,27200002,CDM,,,,,,both,,,689.1500,103.3700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",689.15,,,,,,,177.8700,689.1500,percent of total billed charges,100% of $689.15 in Billed Charges for Rev 272 = $689.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 30 G,272,RC,27200002,CDM,,,,,,both,,,689.1500,103.3700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,344.58,,,,,,,177.8700,689.1500,percent of total billed charges,Rev 272 $689.15 in Billed Charges at 50% = $344.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 30 G,272,RC,27200002,CDM,,,,,,both,,,689.1500,103.3700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,222.60,,,,,,,177.8700,689.1500,other,32.3% of $689.15 in Billed Charges for Rev 272 = $222.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER LINEAR TX 30 G,272,RC,27200002,CDM,,,,,,both,,,689.1500,103.3700,UNITED HEALTHCARE,UHC HERITAGE SELECT,211.57,,,,,,,177.8700,689.1500,other,30.7% of $689.15 in Billed Charges for Rev 272 = $211.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER LINEAR TX 30 G,272,RC,27200002,CDM,,,,,,both,,,689.1500,103.3700,UNITED HEALTHCARE,UNITED HEALTHCARE,222.60,,,,,,,177.8700,689.1500,percent of total billed charges,32.3% of $689.15 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER LINEAR TX 30 G,272,RC,27200002,CDM,,,,,,both,,,689.1500,103.3700,WELLCARE,WELLCARE MEDICAID,689.15,,,,,,,177.8700,689.1500,percent of total billed charges,100% of $689.15 in Billed Charges for Rev 272 = $689.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,AETNA,AETNA,1106.78,,,,,,,128.7300,2592.0000,percent of total billed charges,"42.7% of $2,592.00 in Billed Charges for Rev 300 Proc 87910 = $1,106.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,212.56,,,,,,,128.7300,2592.0000,fee schedule,APG 00388 Proc 87910 at $836.60 (Base Rate) * 0.2443 (Relative Weight) = $204.38 (Total Line Payment) at 104% = $212.56. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,257.45,,,,,,,128.7300,2592.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,AETNA,AETNA HEALTHCARE MEDICARE,257.45,,,,,,,128.7300,2592.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,257.45,,,,,,,128.7300,2592.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,AMBETTER,AMBETTER,561.24,,,,,,,128.7300,2592.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,AMERIGROUP,AMERIGROUP,128.73,,,,,,,128.7300,2592.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,267.75,,,,,,,128.7300,2592.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,BLUE CROSS,ANTHEM EXCHANGE,257.45,,,,,,,128.7300,2592.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,210.51,,,,,,,128.7300,2592.0000,fee schedule,APG 00388 Proc 87910 at $836.60 (Base Rate) * 0.2443 (Relative Weight) = $204.38 (Total Line Payment) at 103% = $210.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,BLUE CROSS,ANTHEM HMO,257.45,,,,,,,128.7300,2592.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,265.17,,,,,,,128.7300,2592.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",257.45,,,,,,,128.7300,2592.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1814.40,,,,,,,128.7300,2592.0000,percent of total billed charges,"Rev 300 Proc 87910 $2,592.00 in Billed Charges at 70% = $1,814.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,BLUE CROSS,BLUE CROSS E NETWORK,785.18,,,,,,,128.7300,2592.0000,fee schedule,$245.37 from Fee Schedule BCFSB for Rev 300 Proc 87910 * Qty 1 = $245.37 at 320% = $785.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,BLUE CROSS,BLUE CROSS MEDICARE,267.75,,,,,,,128.7300,2592.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,BLUE CROSS,BLUE CROSS P NETWORK,802.36,,,,,,,128.7300,2592.0000,fee schedule,$245.37 from Fee Schedule BCFSB for Rev 300 Proc 87910 * Qty 1 = $245.37 at 327% = $802.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,BLUE CROSS,BLUE CROSS S NETWORK,802.36,,,,,,,128.7300,2592.0000,fee schedule,$245.37 from Fee Schedule BCFSB for Rev 300 Proc 87910 * Qty 1 = $245.37 at 327% = $802.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,BLUE CROSS,TENNCARE BLUE CARE,232.99,,,,,,,128.7300,2592.0000,fee schedule,$200.85 from Fee Schedule TC_24 for Rev 300 Proc 87910 * Qty 1 = $200.85 at 116% = $232.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,BLUE CROSS,TENNCARE BLUE SELECT,232.99,,,,,,,128.7300,2592.0000,fee schedule,$200.85 from Fee Schedule TC_24 for Rev 300 Proc 87910 * Qty 1 = $200.85 at 116% = $232.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,CIGNA HEALTHCARE,CIGNA HMO,1080.86,,,,,,,128.7300,2592.0000,percent of total billed charges,"Rev 300 Proc 87910 $2,592.00 in Billed Charges at 41.7% = $1,080.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,567.32,,,,,,,128.7300,2592.0000,fee schedule,$567.32 from Fee Schedule CGIFP_25LR for Rev 300 Proc 87910 * Qty 1 = $567.32 at 100% = $567.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,270.32,,,,,,,128.7300,2592.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1080.86,,,,,,,128.7300,2592.0000,percent of total billed charges,"Rev 300 Proc 87910 $2,592.00 in Billed Charges at 41.7% = $1,080.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,CIGNA HEALTHCARE,CIGNA PPO,1080.86,,,,,,,128.7300,2592.0000,percent of total billed charges,"Rev 300 Proc 87910 $2,592.00 in Billed Charges at 41.7% = $1,080.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,270.32,,,,,,,128.7300,2592.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2332.80,,,,,,,128.7300,2592.0000,percent of total billed charges,"90% of $2,592.00 in Billed Charges for Rev 300 Proc 87910 = $2,332.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,HUMANA,HUMANA MEDICARE,257.45,,,,,,,128.7300,2592.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,257.45,,,,,,,128.7300,2592.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,MEDCOST,MEDCOST VHN,1233.53,,,,,,,128.7300,2592.0000,percent of total billed charges,"47.59% of $2,592.00 in Billed Charges for Rev 300 Proc 87910 = $1,233.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,214.60,,,,,,,128.7300,2592.0000,fee schedule,APG 00388 Proc 87910 at $836.60 (Base Rate) * 0.2443 (Relative Weight) = $204.38 (Total Line Payment) at 100% = $204.38... $204.38 at 105% = $214.60 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,270.32,,,,,,,128.7300,2592.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,270.32,,,,,,,128.7300,2592.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,NHC ADVANTAGE,NHC ADVANTAGE,270.32,,,,,,,128.7300,2592.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,210.72,,,,,,,128.7300,2592.0000,fee schedule,APG 00388 Proc 87910 at $836.60 (Base Rate) * 0.2443 (Relative Weight) = $204.38 (Total Line Payment) at 100% = $204.38... $204.38 at 103.1% = $210.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,SENTARA HEALTH,SENTARA HEALTH,669.00,,,,,,,128.7300,2592.0000,percent of total billed charges,"25.81% of $2,592.00 in Billed Charges for Rev 300 Proc 87910 = $669.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,SENTARA HEALTH,SENTARA MEDICARE,257.45,,,,,,,128.7300,2592.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2592.00,,,,,,,128.7300,2592.0000,percent of total billed charges,"100% of $2,592.00 in Billed Charges for Rev 300 Proc 87910 = $2,592.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,176.94,,,,,,,128.7300,2592.0000,fee schedule,$353.88 from Fee Schedule TCUHC24 for Rev 300 Proc 87910 * Qty 1 = $353.88 at 50% = $176.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,267.75,,,,,,,128.7300,2592.0000,fee schedule,$257.45 from Fee Schedule UHC_31910 for Rev 300 Proc 87910 * Qty 1 = $257.45 at 104% = $267.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,257.45,,,,,,,128.7300,2592.0000,fee schedule,$257.45 from Fee Schedule UHC_31910 for Rev 300 Proc 87910 * Qty 1 = $257.45 at 100% = $257.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,257.45,,,,,,,128.7300,2592.0000,fee schedule,$257.45 from Fee Schedule UHC_31910 for Rev 300 Proc 87910 * Qty 1 = $257.45 at 100% = $257.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,210.51,,,,,,,128.7300,2592.0000,fee schedule,APG 00388 Proc 87910 at $836.60 (Base Rate) * 0.2443 (Relative Weight) = $204.38 (Total Line Payment) at 103% = $210.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,257.45,,,,,,,128.7300,2592.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,257.45,,,,,,,128.7300,2592.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,WELLCARE,WELLCARE MEDICAID,2592.00,,,,,,,128.7300,2592.0000,percent of total billed charges,"100% of $2,592.00 in Billed Charges for Rev 300 Proc 87910 = $2,592.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NFCT AGT GENOTYPE NUCLEIC ACID CYTOMEGALOVIRUS,87910,CPT,300,RC,30000197,CDM,,,,both,,,2592.0000,388.8000,WELLCARE,WELLCARE MEDICARE,272.90,,,,,,,128.7300,2592.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MICROBIOLOGY PROCEDURE,87999,CPT,306,RC,30600200,CDM,,,,both,,,345.0000,51.7500,AETNA,AETNA,147.32,,,,,,,11.5500,345.0000,percent of total billed charges,42.7% of $345.00 in Billed Charges for Rev 306 Proc 87999 = $147.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED MICROBIOLOGY PROCEDURE,87999,CPT,306,RC,30600200,CDM,,,,both,,,345.0000,51.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,11.5500,345.0000,fee schedule,APG 00396 Proc 87999 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MICROBIOLOGY PROCEDURE,87999,CPT,306,RC,30600200,CDM,,,,both,,,345.0000,51.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,11.5500,345.0000,fee schedule,APG 00396 Proc 87999 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MICROBIOLOGY PROCEDURE,87999,CPT,306,RC,30600200,CDM,,,,both,,,345.0000,51.7500,BLUE CROSS,TENNCARE BLUE CARE,87.81,,,,,,,11.5500,345.0000,fee schedule,$75.70 from Fee Schedule TC_24 for Rev 306 Proc 87999 * Qty 1 = $75.70 at 116% = $87.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MICROBIOLOGY PROCEDURE,87999,CPT,306,RC,30600200,CDM,,,,both,,,345.0000,51.7500,BLUE CROSS,TENNCARE BLUE SELECT,87.81,,,,,,,11.5500,345.0000,fee schedule,$75.70 from Fee Schedule TC_24 for Rev 306 Proc 87999 * Qty 1 = $75.70 at 116% = $87.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MICROBIOLOGY PROCEDURE,87999,CPT,306,RC,30600200,CDM,,,,both,,,345.0000,51.7500,CIGNA HEALTHCARE,CIGNA HMO,16.21,,,,,,,11.5500,345.0000,fee schedule,$16.21 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87999 * Qty 1 = $16.21 at 100% = $16.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MICROBIOLOGY PROCEDURE,87999,CPT,306,RC,30600200,CDM,,,,both,,,345.0000,51.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,36.15,,,,,,,11.5500,345.0000,fee schedule,$36.15 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87999 * Qty 1 = $36.15 at 100% = $36.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MICROBIOLOGY PROCEDURE,87999,CPT,306,RC,30600200,CDM,,,,both,,,345.0000,51.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,16.21,,,,,,,11.5500,345.0000,fee schedule,$16.21 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87999 * Qty 1 = $16.21 at 100% = $16.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MICROBIOLOGY PROCEDURE,87999,CPT,306,RC,30600200,CDM,,,,both,,,345.0000,51.7500,CIGNA HEALTHCARE,CIGNA PPO,16.21,,,,,,,11.5500,345.0000,fee schedule,$16.21 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87999 * Qty 1 = $16.21 at 100% = $16.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MICROBIOLOGY PROCEDURE,87999,CPT,306,RC,30600200,CDM,,,,both,,,345.0000,51.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,310.50,,,,,,,11.5500,345.0000,percent of total billed charges,90% of $345.00 in Billed Charges for Rev 306 Proc 87999 = $310.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED MICROBIOLOGY PROCEDURE,87999,CPT,306,RC,30600200,CDM,,,,both,,,345.0000,51.7500,MEDCOST,MEDCOST VHN,164.19,,,,,,,11.5500,345.0000,percent of total billed charges,47.59% of $345.00 in Billed Charges for Rev 306 Proc 87999 = $164.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED MICROBIOLOGY PROCEDURE,87999,CPT,306,RC,30600200,CDM,,,,both,,,345.0000,51.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,11.5500,345.0000,fee schedule,APG 00396 Proc 87999 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MICROBIOLOGY PROCEDURE,87999,CPT,306,RC,30600200,CDM,,,,both,,,345.0000,51.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,11.5500,345.0000,fee schedule,APG 00396 Proc 87999 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MICROBIOLOGY PROCEDURE,87999,CPT,306,RC,30600200,CDM,,,,both,,,345.0000,51.7500,SENTARA HEALTH,SENTARA HEALTH,89.04,,,,,,,11.5500,345.0000,percent of total billed charges,25.81% of $345.00 in Billed Charges for Rev 306 Proc 87999 = $89.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED MICROBIOLOGY PROCEDURE,87999,CPT,306,RC,30600200,CDM,,,,both,,,345.0000,51.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",345.00,,,,,,,11.5500,345.0000,percent of total billed charges,100% of $345.00 in Billed Charges for Rev 306 Proc 87999 = $345.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED MICROBIOLOGY PROCEDURE,87999,CPT,306,RC,30600200,CDM,,,,both,,,345.0000,51.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,172.50,,,,,,,11.5500,345.0000,percent of total billed charges,Rev 306 Proc 87999 $345.00 in Billed Charges at 50% = $172.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED MICROBIOLOGY PROCEDURE,87999,CPT,306,RC,30600200,CDM,,,,both,,,345.0000,51.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,11.5500,345.0000,fee schedule,APG 00396 Proc 87999 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED MICROBIOLOGY PROCEDURE,87999,CPT,306,RC,30600200,CDM,,,,both,,,345.0000,51.7500,WELLCARE,WELLCARE MEDICAID,345.00,,,,,,,11.5500,345.0000,percent of total billed charges,100% of $345.00 in Billed Charges for Rev 306 Proc 87999 = $345.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,AETNA,AETNA,146.46,,,,,,,7.1700,343.0000,percent of total billed charges,42.7% of $343.00 in Billed Charges for Rev 311 Proc 88104 = $146.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,46.90,,,,,,,7.1700,343.0000,fee schedule,APG 00391 Proc 88104 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 104% = $46.90. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,33.89,,,,,,,7.1700,343.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,AETNA,AETNA HEALTHCARE MEDICARE,33.89,,,,,,,7.1700,343.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,33.89,,,,,,,7.1700,343.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,AMBETTER,AMBETTER,73.87,,,,,,,7.1700,343.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,35.24,,,,,,,7.1700,343.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,BLUE CROSS,ANTHEM EXCHANGE,83.43,,,,,,,7.1700,343.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,46.45,,,,,,,7.1700,343.0000,fee schedule,APG 00391 Proc 88104 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 103% = $46.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,BLUE CROSS,ANTHEM HMO,88.63,,,,,,,7.1700,343.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,34.90,,,,,,,7.1700,343.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",104.27,,,,,,,7.1700,343.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11.80,,,,,,,7.1700,343.0000,fee schedule,$11.80 from Fee Schedule BLDTM_23 for Rev 311 Proc 88104 * Qty 1 = $11.80 at 100% = $11.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,BLUE CROSS,BLUE CROSS E NETWORK,128.26,,,,,,,7.1700,343.0000,fee schedule,$40.08 from Fee Schedule BCFSB for Rev 311 Proc 88104 * Qty 1 = $40.08 at 320% = $128.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,BLUE CROSS,BLUE CROSS MEDICARE,35.24,,,,,,,7.1700,343.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,BLUE CROSS,BLUE CROSS P NETWORK,131.06,,,,,,,7.1700,343.0000,fee schedule,$40.08 from Fee Schedule BCFSB for Rev 311 Proc 88104 * Qty 1 = $40.08 at 327% = $131.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,BLUE CROSS,BLUE CROSS S NETWORK,131.06,,,,,,,7.1700,343.0000,fee schedule,$40.08 from Fee Schedule BCFSB for Rev 311 Proc 88104 * Qty 1 = $40.08 at 327% = $131.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,BLUE CROSS,TENNCARE BLUE CARE,7.17,,,,,,,7.1700,343.0000,fee schedule,$6.18 from Fee Schedule TC_24 for Rev 311 Proc 88104 * Qty 1 = $6.18 at 116% = $7.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,BLUE CROSS,TENNCARE BLUE SELECT,7.17,,,,,,,7.1700,343.0000,fee schedule,$6.18 from Fee Schedule TC_24 for Rev 311 Proc 88104 * Qty 1 = $6.18 at 116% = $7.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,CIGNA HEALTHCARE,CIGNA HMO,115.06,,,,,,,7.1700,343.0000,fee schedule,$115.06 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88104 * Qty 1 = $115.06 at 100% = $115.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,105.53,,,,,,,7.1700,343.0000,fee schedule,$105.53 from Fee Schedule CGIFP_25LR for Rev 311 Proc 88104 * Qty 1 = $105.53 at 100% = $105.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,35.58,,,,,,,7.1700,343.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,115.06,,,,,,,7.1700,343.0000,fee schedule,$115.06 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88104 * Qty 1 = $115.06 at 100% = $115.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,CIGNA HEALTHCARE,CIGNA PPO,115.06,,,,,,,7.1700,343.0000,fee schedule,$115.06 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88104 * Qty 1 = $115.06 at 100% = $115.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,35.58,,,,,,,7.1700,343.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,308.70,,,,,,,7.1700,343.0000,percent of total billed charges,90% of $343.00 in Billed Charges for Rev 311 Proc 88104 = $308.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,HUMANA,HUMANA MEDICARE,33.89,,,,,,,7.1700,343.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,33.89,,,,,,,7.1700,343.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,MEDCOST,MEDCOST VHN,163.23,,,,,,,7.1700,343.0000,percent of total billed charges,47.59% of $343.00 in Billed Charges for Rev 311 Proc 88104 = $163.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,47.34,,,,,,,7.1700,343.0000,fee schedule,APG 00391 Proc 88104 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 100% = $45.09... $45.09 at 105% = $47.34 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,35.58,,,,,,,7.1700,343.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,35.58,,,,,,,7.1700,343.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,NHC ADVANTAGE,NHC ADVANTAGE,35.58,,,,,,,7.1700,343.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,46.49,,,,,,,7.1700,343.0000,fee schedule,APG 00391 Proc 88104 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 100% = $45.09... $45.09 at 103.1% = $46.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,SENTARA HEALTH,SENTARA HEALTH,88.53,,,,,,,7.1700,343.0000,percent of total billed charges,25.81% of $343.00 in Billed Charges for Rev 311 Proc 88104 = $88.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,SENTARA HEALTH,SENTARA MEDICARE,33.89,,,,,,,7.1700,343.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",343.00,,,,,,,7.1700,343.0000,percent of total billed charges,100% of $343.00 in Billed Charges for Rev 311 Proc 88104 = $343.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.54,,,,,,,7.1700,343.0000,fee schedule,$17.08 from Fee Schedule TCUHC24 for Rev 311 Proc 88104 * Qty 1 = $17.08 at 50% = $8.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,34.77,,,,,,,7.1700,343.0000,fee schedule,$33.43 from Fee Schedule UHC_31910 for Rev 311 Proc 88104 * Qty 1 = $33.43 at 104% = $34.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,33.43,,,,,,,7.1700,343.0000,fee schedule,$33.43 from Fee Schedule UHC_31910 for Rev 311 Proc 88104 * Qty 1 = $33.43 at 100% = $33.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,33.43,,,,,,,7.1700,343.0000,fee schedule,$33.43 from Fee Schedule UHC_31910 for Rev 311 Proc 88104 * Qty 1 = $33.43 at 100% = $33.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,46.45,,,,,,,7.1700,343.0000,fee schedule,APG 00391 Proc 88104 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 103% = $46.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,33.89,,,,,,,7.1700,343.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,33.89,,,,,,,7.1700,343.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,WELLCARE,WELLCARE MEDICAID,343.00,,,,,,,7.1700,343.0000,percent of total billed charges,100% of $343.00 in Billed Charges for Rev 311 Proc 88104 = $343.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY FLUIDS NONGYN,88104,CPT,311,RC,31100001,CDM,,,,both,,,343.0000,51.4500,WELLCARE,WELLCARE MEDICARE,35.92,,,,,,,7.1700,343.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,AETNA,AETNA,182.33,,,,,,,7.8100,427.0000,percent of total billed charges,42.7% of $427.00 in Billed Charges for Rev 311 Proc 88108 = $182.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,46.90,,,,,,,7.8100,427.0000,fee schedule,APG 00391 Proc 88108 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 104% = $46.90. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,33.89,,,,,,,7.8100,427.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,AETNA,AETNA HEALTHCARE MEDICARE,33.89,,,,,,,7.8100,427.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,33.89,,,,,,,7.8100,427.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,AMBETTER,AMBETTER,73.87,,,,,,,7.8100,427.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,35.24,,,,,,,7.8100,427.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,BLUE CROSS,ANTHEM EXCHANGE,83.43,,,,,,,7.8100,427.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,46.45,,,,,,,7.8100,427.0000,fee schedule,APG 00391 Proc 88108 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 103% = $46.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,BLUE CROSS,ANTHEM HMO,88.63,,,,,,,7.8100,427.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,34.90,,,,,,,7.8100,427.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",104.27,,,,,,,7.8100,427.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7.83,,,,,,,7.8100,427.0000,fee schedule,$7.83 from Fee Schedule BLDTM_23 for Rev 311 Proc 88108 * Qty 1 = $7.83 at 100% = $7.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,BLUE CROSS,BLUE CROSS E NETWORK,160.16,,,,,,,7.8100,427.0000,fee schedule,$50.05 from Fee Schedule BCFSB for Rev 311 Proc 88108 * Qty 1 = $50.05 at 320% = $160.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,BLUE CROSS,BLUE CROSS MEDICARE,35.24,,,,,,,7.8100,427.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,BLUE CROSS,BLUE CROSS P NETWORK,163.66,,,,,,,7.8100,427.0000,fee schedule,$50.05 from Fee Schedule BCFSB for Rev 311 Proc 88108 * Qty 1 = $50.05 at 327% = $163.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,BLUE CROSS,BLUE CROSS S NETWORK,163.66,,,,,,,7.8100,427.0000,fee schedule,$50.05 from Fee Schedule BCFSB for Rev 311 Proc 88108 * Qty 1 = $50.05 at 327% = $163.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,BLUE CROSS,TENNCARE BLUE CARE,7.81,,,,,,,7.8100,427.0000,fee schedule,$6.73 from Fee Schedule TC_24 for Rev 311 Proc 88108 * Qty 1 = $6.73 at 116% = $7.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,BLUE CROSS,TENNCARE BLUE SELECT,7.81,,,,,,,7.8100,427.0000,fee schedule,$6.73 from Fee Schedule TC_24 for Rev 311 Proc 88108 * Qty 1 = $6.73 at 116% = $7.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,CIGNA HEALTHCARE,CIGNA HMO,140.19,,,,,,,7.8100,427.0000,fee schedule,$140.19 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88108 * Qty 1 = $140.19 at 100% = $140.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,101.49,,,,,,,7.8100,427.0000,fee schedule,$101.49 from Fee Schedule CGIFP_25LR for Rev 311 Proc 88108 * Qty 1 = $101.49 at 100% = $101.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,35.58,,,,,,,7.8100,427.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,140.19,,,,,,,7.8100,427.0000,fee schedule,$140.19 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88108 * Qty 1 = $140.19 at 100% = $140.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,CIGNA HEALTHCARE,CIGNA PPO,140.19,,,,,,,7.8100,427.0000,fee schedule,$140.19 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88108 * Qty 1 = $140.19 at 100% = $140.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,35.58,,,,,,,7.8100,427.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,384.30,,,,,,,7.8100,427.0000,percent of total billed charges,90% of $427.00 in Billed Charges for Rev 311 Proc 88108 = $384.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,HUMANA,HUMANA MEDICARE,33.89,,,,,,,7.8100,427.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,33.89,,,,,,,7.8100,427.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,MEDCOST,MEDCOST VHN,203.21,,,,,,,7.8100,427.0000,percent of total billed charges,47.59% of $427.00 in Billed Charges for Rev 311 Proc 88108 = $203.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,47.34,,,,,,,7.8100,427.0000,fee schedule,APG 00391 Proc 88108 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 100% = $45.09... $45.09 at 105% = $47.34 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,35.58,,,,,,,7.8100,427.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,35.58,,,,,,,7.8100,427.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,NHC ADVANTAGE,NHC ADVANTAGE,35.58,,,,,,,7.8100,427.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,46.49,,,,,,,7.8100,427.0000,fee schedule,APG 00391 Proc 88108 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 100% = $45.09... $45.09 at 103.1% = $46.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,SENTARA HEALTH,SENTARA HEALTH,110.21,,,,,,,7.8100,427.0000,percent of total billed charges,25.81% of $427.00 in Billed Charges for Rev 311 Proc 88108 = $110.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,SENTARA HEALTH,SENTARA MEDICARE,33.89,,,,,,,7.8100,427.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",427.00,,,,,,,7.8100,427.0000,percent of total billed charges,100% of $427.00 in Billed Charges for Rev 311 Proc 88108 = $427.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.54,,,,,,,7.8100,427.0000,fee schedule,$17.08 from Fee Schedule TCUHC24 for Rev 311 Proc 88108 * Qty 1 = $17.08 at 50% = $8.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,34.77,,,,,,,7.8100,427.0000,fee schedule,$33.43 from Fee Schedule UHC_31910 for Rev 311 Proc 88108 * Qty 1 = $33.43 at 104% = $34.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,33.43,,,,,,,7.8100,427.0000,fee schedule,$33.43 from Fee Schedule UHC_31910 for Rev 311 Proc 88108 * Qty 1 = $33.43 at 100% = $33.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,33.43,,,,,,,7.8100,427.0000,fee schedule,$33.43 from Fee Schedule UHC_31910 for Rev 311 Proc 88108 * Qty 1 = $33.43 at 100% = $33.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,46.45,,,,,,,7.8100,427.0000,fee schedule,APG 00391 Proc 88108 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 103% = $46.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,33.89,,,,,,,7.8100,427.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,33.89,,,,,,,7.8100,427.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,WELLCARE,WELLCARE MEDICAID,427.00,,,,,,,7.8100,427.0000,percent of total billed charges,100% of $427.00 in Billed Charges for Rev 311 Proc 88108 = $427.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOLOGY CONCENTRATION TECH,88108,CPT,311,RC,31100003,CDM,,,,both,,,427.0000,64.0500,WELLCARE,WELLCARE MEDICARE,35.92,,,,,,,7.8100,427.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,AETNA,AETNA,220.76,,,,,,,18.4100,517.0000,percent of total billed charges,42.7% of $517.00 in Billed Charges for Rev 311 Proc 88112 = $220.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,46.90,,,,,,,18.4100,517.0000,fee schedule,APG 00391 Proc 88112 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 104% = $46.90. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,47.28,,,,,,,18.4100,517.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,AETNA,AETNA HEALTHCARE MEDICARE,47.28,,,,,,,18.4100,517.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,47.28,,,,,,,18.4100,517.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,AMBETTER,AMBETTER,103.07,,,,,,,18.4100,517.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,49.17,,,,,,,18.4100,517.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,BLUE CROSS,ANTHEM EXCHANGE,116.40,,,,,,,18.4100,517.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,46.45,,,,,,,18.4100,517.0000,fee schedule,APG 00391 Proc 88112 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 103% = $46.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,BLUE CROSS,ANTHEM HMO,123.67,,,,,,,18.4100,517.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,48.70,,,,,,,18.4100,517.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",145.49,,,,,,,18.4100,517.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,57.13,,,,,,,18.4100,517.0000,fee schedule,$57.13 from Fee Schedule BLDTM_23 for Rev 311 Proc 88112 * Qty 1 = $57.13 at 100% = $57.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,BLUE CROSS,BLUE CROSS E NETWORK,99.42,,,,,,,18.4100,517.0000,fee schedule,$31.07 from Fee Schedule BCFSB for Rev 311 Proc 88112 * Qty 1 = $31.07 at 320% = $99.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,BLUE CROSS,BLUE CROSS MEDICARE,49.17,,,,,,,18.4100,517.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,BLUE CROSS,BLUE CROSS P NETWORK,101.60,,,,,,,18.4100,517.0000,fee schedule,$31.07 from Fee Schedule BCFSB for Rev 311 Proc 88112 * Qty 1 = $31.07 at 327% = $101.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,BLUE CROSS,BLUE CROSS S NETWORK,101.60,,,,,,,18.4100,517.0000,fee schedule,$31.07 from Fee Schedule BCFSB for Rev 311 Proc 88112 * Qty 1 = $31.07 at 327% = $101.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,BLUE CROSS,TENNCARE BLUE CARE,46.98,,,,,,,18.4100,517.0000,fee schedule,$40.50 from Fee Schedule TC_24 for Rev 311 Proc 88112 * Qty 1 = $40.50 at 116% = $46.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,BLUE CROSS,TENNCARE BLUE SELECT,46.98,,,,,,,18.4100,517.0000,fee schedule,$40.50 from Fee Schedule TC_24 for Rev 311 Proc 88112 * Qty 1 = $40.50 at 116% = $46.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,CIGNA HEALTHCARE,CIGNA HMO,131.49,,,,,,,18.4100,517.0000,fee schedule,$131.49 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88112 * Qty 1 = $131.49 at 100% = $131.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,89.22,,,,,,,18.4100,517.0000,fee schedule,$89.22 from Fee Schedule CGIFP_25LR for Rev 311 Proc 88112 * Qty 1 = $89.22 at 100% = $89.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,49.64,,,,,,,18.4100,517.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,131.49,,,,,,,18.4100,517.0000,fee schedule,$131.49 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88112 * Qty 1 = $131.49 at 100% = $131.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,CIGNA HEALTHCARE,CIGNA PPO,131.49,,,,,,,18.4100,517.0000,fee schedule,$131.49 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88112 * Qty 1 = $131.49 at 100% = $131.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,49.64,,,,,,,18.4100,517.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,465.30,,,,,,,18.4100,517.0000,percent of total billed charges,90% of $517.00 in Billed Charges for Rev 311 Proc 88112 = $465.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,HUMANA,HUMANA MEDICARE,47.28,,,,,,,18.4100,517.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,47.28,,,,,,,18.4100,517.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,MEDCOST,MEDCOST VHN,246.04,,,,,,,18.4100,517.0000,percent of total billed charges,47.59% of $517.00 in Billed Charges for Rev 311 Proc 88112 = $246.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,47.34,,,,,,,18.4100,517.0000,fee schedule,APG 00391 Proc 88112 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 100% = $45.09... $45.09 at 105% = $47.34 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,49.64,,,,,,,18.4100,517.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,49.64,,,,,,,18.4100,517.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,NHC ADVANTAGE,NHC ADVANTAGE,49.64,,,,,,,18.4100,517.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,46.49,,,,,,,18.4100,517.0000,fee schedule,APG 00391 Proc 88112 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 100% = $45.09... $45.09 at 103.1% = $46.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,SENTARA HEALTH,SENTARA HEALTH,133.44,,,,,,,18.4100,517.0000,percent of total billed charges,25.81% of $517.00 in Billed Charges for Rev 311 Proc 88112 = $133.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,SENTARA HEALTH,SENTARA MEDICARE,47.28,,,,,,,18.4100,517.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",517.00,,,,,,,18.4100,517.0000,percent of total billed charges,100% of $517.00 in Billed Charges for Rev 311 Proc 88112 = $517.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,18.41,,,,,,,18.4100,517.0000,fee schedule,$36.81 from Fee Schedule TCUHC24 for Rev 311 Proc 88112 * Qty 1 = $36.81 at 50% = $18.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,51.45,,,,,,,18.4100,517.0000,fee schedule,$49.47 from Fee Schedule UHC_31910 for Rev 311 Proc 88112 * Qty 1 = $49.47 at 104% = $51.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,49.47,,,,,,,18.4100,517.0000,fee schedule,$49.47 from Fee Schedule UHC_31910 for Rev 311 Proc 88112 * Qty 1 = $49.47 at 100% = $49.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,49.47,,,,,,,18.4100,517.0000,fee schedule,$49.47 from Fee Schedule UHC_31910 for Rev 311 Proc 88112 * Qty 1 = $49.47 at 100% = $49.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,46.45,,,,,,,18.4100,517.0000,fee schedule,APG 00391 Proc 88112 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 103% = $46.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,47.28,,,,,,,18.4100,517.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,47.28,,,,,,,18.4100,517.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,WELLCARE,WELLCARE MEDICAID,517.00,,,,,,,18.4100,517.0000,percent of total billed charges,100% of $517.00 in Billed Charges for Rev 311 Proc 88112 = $517.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATH CELLR ENCHANCE NO CERV,88112,CPT,311,RC,31100004,CDM,,,,both,,,517.0000,77.5500,WELLCARE,WELLCARE MEDICARE,50.12,,,,,,,18.4100,517.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,AETNA,AETNA,40.99,,,,,,,5.7700,96.0000,percent of total billed charges,42.7% of $96.00 in Billed Charges for Rev 311 Proc 88130 = $40.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,5.83,,,,,,,5.7700,96.0000,fee schedule,APG 00390 Proc 88130 at $836.60 (Base Rate) * 0.0067 (Relative Weight) = $5.61 (Total Line Payment) at 104% = $5.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,17.98,,,,,,,5.7700,96.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,AETNA,AETNA HEALTHCARE MEDICARE,17.98,,,,,,,5.7700,96.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,17.98,,,,,,,5.7700,96.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,AMBETTER,AMBETTER,39.20,,,,,,,5.7700,96.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,AMERIGROUP,AMERIGROUP,8.99,,,,,,,5.7700,96.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,18.70,,,,,,,5.7700,96.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,BLUE CROSS,ANTHEM EXCHANGE,17.98,,,,,,,5.7700,96.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,5.77,,,,,,,5.7700,96.0000,fee schedule,APG 00390 Proc 88130 at $836.60 (Base Rate) * 0.0067 (Relative Weight) = $5.61 (Total Line Payment) at 103% = $5.77. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,BLUE CROSS,ANTHEM HMO,17.98,,,,,,,5.7700,96.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,18.52,,,,,,,5.7700,96.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",17.98,,,,,,,5.7700,96.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,60.06,,,,,,,5.7700,96.0000,fee schedule,$60.06 from Fee Schedule BLDTM_23 for Rev 311 Proc 88130 * Qty 1 = $60.06 at 100% = $60.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,BLUE CROSS,BLUE CROSS E NETWORK,65.73,,,,,,,5.7700,96.0000,fee schedule,$20.54 from Fee Schedule BCFSB for Rev 311 Proc 88130 * Qty 1 = $20.54 at 320% = $65.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,BLUE CROSS,BLUE CROSS MEDICARE,18.70,,,,,,,5.7700,96.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,BLUE CROSS,BLUE CROSS P NETWORK,67.17,,,,,,,5.7700,96.0000,fee schedule,$20.54 from Fee Schedule BCFSB for Rev 311 Proc 88130 * Qty 1 = $20.54 at 327% = $67.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,BLUE CROSS,BLUE CROSS S NETWORK,67.17,,,,,,,5.7700,96.0000,fee schedule,$20.54 from Fee Schedule BCFSB for Rev 311 Proc 88130 * Qty 1 = $20.54 at 327% = $67.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,BLUE CROSS,TENNCARE BLUE CARE,13.39,,,,,,,5.7700,96.0000,fee schedule,$11.54 from Fee Schedule TC_24 for Rev 311 Proc 88130 * Qty 1 = $11.54 at 116% = $13.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,BLUE CROSS,TENNCARE BLUE SELECT,13.39,,,,,,,5.7700,96.0000,fee schedule,$11.54 from Fee Schedule TC_24 for Rev 311 Proc 88130 * Qty 1 = $11.54 at 116% = $13.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,CIGNA HEALTHCARE,CIGNA HMO,60.57,,,,,,,5.7700,96.0000,fee schedule,$60.57 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88130 * Qty 1 = $60.57 at 100% = $60.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,39.70,,,,,,,5.7700,96.0000,fee schedule,$39.70 from Fee Schedule CGIFP_25LR for Rev 311 Proc 88130 * Qty 1 = $39.70 at 100% = $39.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,18.88,,,,,,,5.7700,96.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,60.57,,,,,,,5.7700,96.0000,fee schedule,$60.57 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88130 * Qty 1 = $60.57 at 100% = $60.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,CIGNA HEALTHCARE,CIGNA PPO,60.57,,,,,,,5.7700,96.0000,fee schedule,$60.57 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88130 * Qty 1 = $60.57 at 100% = $60.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,18.88,,,,,,,5.7700,96.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,86.40,,,,,,,5.7700,96.0000,percent of total billed charges,90% of $96.00 in Billed Charges for Rev 311 Proc 88130 = $86.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,HUMANA,HUMANA MEDICARE,17.98,,,,,,,5.7700,96.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,17.98,,,,,,,5.7700,96.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,MEDCOST,MEDCOST VHN,45.69,,,,,,,5.7700,96.0000,percent of total billed charges,47.59% of $96.00 in Billed Charges for Rev 311 Proc 88130 = $45.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,5.89,,,,,,,5.7700,96.0000,fee schedule,APG 00390 Proc 88130 at $836.60 (Base Rate) * 0.0067 (Relative Weight) = $5.61 (Total Line Payment) at 100% = $5.61... $5.61 at 105% = $5.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,18.88,,,,,,,5.7700,96.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,18.88,,,,,,,5.7700,96.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,NHC ADVANTAGE,NHC ADVANTAGE,18.88,,,,,,,5.7700,96.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,5.78,,,,,,,5.7700,96.0000,fee schedule,APG 00390 Proc 88130 at $836.60 (Base Rate) * 0.0067 (Relative Weight) = $5.61 (Total Line Payment) at 100% = $5.61... $5.61 at 103.1% = $5.78 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,SENTARA HEALTH,SENTARA HEALTH,24.78,,,,,,,5.7700,96.0000,percent of total billed charges,25.81% of $96.00 in Billed Charges for Rev 311 Proc 88130 = $24.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,SENTARA HEALTH,SENTARA MEDICARE,17.98,,,,,,,5.7700,96.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",96.00,,,,,,,5.7700,96.0000,percent of total billed charges,100% of $96.00 in Billed Charges for Rev 311 Proc 88130 = $96.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,10.66,,,,,,,5.7700,96.0000,fee schedule,$21.32 from Fee Schedule TCUHC24 for Rev 311 Proc 88130 * Qty 1 = $21.32 at 50% = $10.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,18.70,,,,,,,5.7700,96.0000,fee schedule,$17.98 from Fee Schedule UHC_31910 for Rev 311 Proc 88130 * Qty 1 = $17.98 at 104% = $18.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,17.98,,,,,,,5.7700,96.0000,fee schedule,$17.98 from Fee Schedule UHC_31910 for Rev 311 Proc 88130 * Qty 1 = $17.98 at 100% = $17.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,17.98,,,,,,,5.7700,96.0000,fee schedule,$17.98 from Fee Schedule UHC_31910 for Rev 311 Proc 88130 * Qty 1 = $17.98 at 100% = $17.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,5.77,,,,,,,5.7700,96.0000,fee schedule,APG 00390 Proc 88130 at $836.60 (Base Rate) * 0.0067 (Relative Weight) = $5.61 (Total Line Payment) at 103% = $5.77. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,17.98,,,,,,,5.7700,96.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,17.98,,,,,,,5.7700,96.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,WELLCARE,WELLCARE MEDICAID,96.00,,,,,,,5.7700,96.0000,percent of total billed charges,100% of $96.00 in Billed Charges for Rev 311 Proc 88130 = $96.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SEX CHROMATIN ID BARR BODIES,88130,CPT,311,RC,31100005,CDM,,,,both,,,96.0000,14.4000,WELLCARE,WELLCARE MEDICARE,19.06,,,,,,,5.7700,96.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,AETNA,AETNA,29.46,,,,,,,4.2500,69.0000,percent of total billed charges,42.7% of $69.00 in Billed Charges for Rev 311 Proc 88155 = $29.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,24.10,,,,,,,4.2500,69.0000,fee schedule,APG 00392 Proc 88155 at $836.60 (Base Rate) * 0.0277 (Relative Weight) = $23.17 (Total Line Payment) at 104% = $24.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,14.65,,,,,,,4.2500,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,AETNA,AETNA HEALTHCARE MEDICARE,14.65,,,,,,,4.2500,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,14.65,,,,,,,4.2500,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,AMBETTER,AMBETTER,31.94,,,,,,,4.2500,69.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,AMERIGROUP,AMERIGROUP,7.33,,,,,,,4.2500,69.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,15.24,,,,,,,4.2500,69.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,ANTHEM EXCHANGE,14.65,,,,,,,4.2500,69.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,23.87,,,,,,,4.2500,69.0000,fee schedule,APG 00392 Proc 88155 at $836.60 (Base Rate) * 0.0277 (Relative Weight) = $23.17 (Total Line Payment) at 103% = $23.87. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,ANTHEM HMO,14.65,,,,,,,4.2500,69.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,15.09,,,,,,,4.2500,69.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",14.65,,,,,,,4.2500,69.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,26.43,,,,,,,4.2500,69.0000,fee schedule,$26.43 from Fee Schedule BLDTM_23 for Rev 311 Proc 88155 * Qty 1 = $26.43 at 100% = $26.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS E NETWORK,26.18,,,,,,,4.2500,69.0000,fee schedule,$8.18 from Fee Schedule BCFSB for Rev 311 Proc 88155 * Qty 1 = $8.18 at 320% = $26.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS MEDICARE,15.24,,,,,,,4.2500,69.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS P NETWORK,26.75,,,,,,,4.2500,69.0000,fee schedule,$8.18 from Fee Schedule BCFSB for Rev 311 Proc 88155 * Qty 1 = $8.18 at 327% = $26.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS S NETWORK,26.75,,,,,,,4.2500,69.0000,fee schedule,$8.18 from Fee Schedule BCFSB for Rev 311 Proc 88155 * Qty 1 = $8.18 at 327% = $26.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,TENNCARE BLUE CARE,13.64,,,,,,,4.2500,69.0000,fee schedule,$11.76 from Fee Schedule TC_24 for Rev 311 Proc 88155 * Qty 1 = $11.76 at 116% = $13.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,TENNCARE BLUE SELECT,13.64,,,,,,,4.2500,69.0000,fee schedule,$11.76 from Fee Schedule TC_24 for Rev 311 Proc 88155 * Qty 1 = $11.76 at 116% = $13.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA HMO,24.12,,,,,,,4.2500,69.0000,fee schedule,$24.12 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88155 * Qty 1 = $24.12 at 100% = $24.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,32.48,,,,,,,4.2500,69.0000,fee schedule,$32.48 from Fee Schedule CGIFP_25LR for Rev 311 Proc 88155 * Qty 1 = $32.48 at 100% = $32.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,15.38,,,,,,,4.2500,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,24.12,,,,,,,4.2500,69.0000,fee schedule,$24.12 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88155 * Qty 1 = $24.12 at 100% = $24.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA PPO,24.12,,,,,,,4.2500,69.0000,fee schedule,$24.12 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88155 * Qty 1 = $24.12 at 100% = $24.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,15.38,,,,,,,4.2500,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,62.10,,,,,,,4.2500,69.0000,percent of total billed charges,90% of $69.00 in Billed Charges for Rev 311 Proc 88155 = $62.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,HUMANA,HUMANA MEDICARE,14.65,,,,,,,4.2500,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,14.65,,,,,,,4.2500,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,MEDCOST,MEDCOST VHN,32.84,,,,,,,4.2500,69.0000,percent of total billed charges,47.59% of $69.00 in Billed Charges for Rev 311 Proc 88155 = $32.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,24.33,,,,,,,4.2500,69.0000,fee schedule,APG 00392 Proc 88155 at $836.60 (Base Rate) * 0.0277 (Relative Weight) = $23.17 (Total Line Payment) at 100% = $23.17... $23.17 at 105% = $24.33 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,15.38,,,,,,,4.2500,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,15.38,,,,,,,4.2500,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,NHC ADVANTAGE,NHC ADVANTAGE,15.38,,,,,,,4.2500,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,23.89,,,,,,,4.2500,69.0000,fee schedule,APG 00392 Proc 88155 at $836.60 (Base Rate) * 0.0277 (Relative Weight) = $23.17 (Total Line Payment) at 100% = $23.17... $23.17 at 103.1% = $23.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,SENTARA HEALTH,SENTARA HEALTH,17.81,,,,,,,4.2500,69.0000,percent of total billed charges,25.81% of $69.00 in Billed Charges for Rev 311 Proc 88155 = $17.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,SENTARA HEALTH,SENTARA MEDICARE,14.65,,,,,,,4.2500,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",69.00,,,,,,,4.2500,69.0000,percent of total billed charges,100% of $69.00 in Billed Charges for Rev 311 Proc 88155 = $69.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4.25,,,,,,,4.2500,69.0000,fee schedule,$8.49 from Fee Schedule TCUHC24 for Rev 311 Proc 88155 * Qty 1 = $8.49 at 50% = $4.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,15.24,,,,,,,4.2500,69.0000,fee schedule,$14.65 from Fee Schedule UHC_31910 for Rev 311 Proc 88155 * Qty 1 = $14.65 at 104% = $15.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,14.65,,,,,,,4.2500,69.0000,fee schedule,$14.65 from Fee Schedule UHC_31910 for Rev 311 Proc 88155 * Qty 1 = $14.65 at 100% = $14.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,14.65,,,,,,,4.2500,69.0000,fee schedule,$14.65 from Fee Schedule UHC_31910 for Rev 311 Proc 88155 * Qty 1 = $14.65 at 100% = $14.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,23.87,,,,,,,4.2500,69.0000,fee schedule,APG 00392 Proc 88155 at $836.60 (Base Rate) * 0.0277 (Relative Weight) = $23.17 (Total Line Payment) at 103% = $23.87. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,14.65,,,,,,,4.2500,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,14.65,,,,,,,4.2500,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,WELLCARE,WELLCARE MEDICAID,69.00,,,,,,,4.2500,69.0000,percent of total billed charges,100% of $69.00 in Billed Charges for Rev 311 Proc 88155 = $69.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY CV HORMONAL EV,88155,CPT,311,RC,31100006,CDM,,,,both,,,69.0000,10.3500,WELLCARE,WELLCARE MEDICARE,15.53,,,,,,,4.2500,69.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,AETNA,AETNA,40.99,,,,,,,4.6400,96.0000,percent of total billed charges,42.7% of $96.00 in Billed Charges for Rev 301 Proc 83068 = $40.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,6.44,,,,,,,4.6400,96.0000,fee schedule,APG 00402 Proc 83068 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 104% = $6.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,9.47,,,,,,,4.6400,96.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,AETNA,AETNA HEALTHCARE MEDICARE,9.47,,,,,,,4.6400,96.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,9.47,,,,,,,4.6400,96.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,AMBETTER,AMBETTER,20.64,,,,,,,4.6400,96.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,AMERIGROUP,AMERIGROUP,4.74,,,,,,,4.6400,96.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,9.85,,,,,,,4.6400,96.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,BLUE CROSS,ANTHEM EXCHANGE,9.47,,,,,,,4.6400,96.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,6.38,,,,,,,4.6400,96.0000,fee schedule,APG 00402 Proc 83068 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,BLUE CROSS,ANTHEM HMO,9.47,,,,,,,4.6400,96.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,9.75,,,,,,,4.6400,96.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9.47,,,,,,,4.6400,96.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,27.74,,,,,,,4.6400,96.0000,fee schedule,$27.74 from Fee Schedule BLDTM_23 for Rev 301 Proc 83068 * Qty 1 = $27.74 at 100% = $27.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,BLUE CROSS,BLUE CROSS E NETWORK,12.58,,,,,,,4.6400,96.0000,fee schedule,$3.93 from Fee Schedule BCFSB for Rev 301 Proc 83068 * Qty 1 = $3.93 at 320% = $12.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,BLUE CROSS,BLUE CROSS MEDICARE,9.85,,,,,,,4.6400,96.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,BLUE CROSS,BLUE CROSS P NETWORK,12.85,,,,,,,4.6400,96.0000,fee schedule,$3.93 from Fee Schedule BCFSB for Rev 301 Proc 83068 * Qty 1 = $3.93 at 327% = $12.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,BLUE CROSS,BLUE CROSS S NETWORK,12.85,,,,,,,4.6400,96.0000,fee schedule,$3.93 from Fee Schedule BCFSB for Rev 301 Proc 83068 * Qty 1 = $3.93 at 327% = $12.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,BLUE CROSS,TENNCARE BLUE CARE,4.64,,,,,,,4.6400,96.0000,fee schedule,$4.00 from Fee Schedule TC_24 for Rev 301 Proc 83068 * Qty 1 = $4.00 at 116% = $4.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,BLUE CROSS,TENNCARE BLUE SELECT,4.64,,,,,,,4.6400,96.0000,fee schedule,$4.00 from Fee Schedule TC_24 for Rev 301 Proc 83068 * Qty 1 = $4.00 at 116% = $4.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,CIGNA HEALTHCARE,CIGNA HMO,34.04,,,,,,,4.6400,96.0000,fee schedule,$34.04 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83068 * Qty 1 = $34.04 at 100% = $34.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,20.93,,,,,,,4.6400,96.0000,fee schedule,$20.93 from Fee Schedule CGIFP_25LR for Rev 301 Proc 83068 * Qty 1 = $20.93 at 100% = $20.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,9.94,,,,,,,4.6400,96.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,34.04,,,,,,,4.6400,96.0000,fee schedule,$34.04 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83068 * Qty 1 = $34.04 at 100% = $34.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,CIGNA HEALTHCARE,CIGNA PPO,34.04,,,,,,,4.6400,96.0000,fee schedule,$34.04 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83068 * Qty 1 = $34.04 at 100% = $34.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,9.94,,,,,,,4.6400,96.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,86.40,,,,,,,4.6400,96.0000,percent of total billed charges,90% of $96.00 in Billed Charges for Rev 301 Proc 83068 = $86.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,HUMANA,HUMANA MEDICARE,9.47,,,,,,,4.6400,96.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,9.47,,,,,,,4.6400,96.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,MEDCOST,MEDCOST VHN,45.69,,,,,,,4.6400,96.0000,percent of total billed charges,47.59% of $96.00 in Billed Charges for Rev 301 Proc 83068 = $45.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,6.50,,,,,,,4.6400,96.0000,fee schedule,APG 00402 Proc 83068 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 105% = $6.50 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,9.94,,,,,,,4.6400,96.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,9.94,,,,,,,4.6400,96.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,NHC ADVANTAGE,NHC ADVANTAGE,9.94,,,,,,,4.6400,96.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,6.38,,,,,,,4.6400,96.0000,fee schedule,APG 00402 Proc 83068 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 103.1% = $6.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,SENTARA HEALTH,SENTARA HEALTH,24.78,,,,,,,4.6400,96.0000,percent of total billed charges,25.81% of $96.00 in Billed Charges for Rev 301 Proc 83068 = $24.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,SENTARA HEALTH,SENTARA MEDICARE,9.47,,,,,,,4.6400,96.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",96.00,,,,,,,4.6400,96.0000,percent of total billed charges,100% of $96.00 in Billed Charges for Rev 301 Proc 83068 = $96.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6.00,,,,,,,4.6400,96.0000,fee schedule,$11.99 from Fee Schedule TCUHC24 for Rev 301 Proc 83068 * Qty 1 = $11.99 at 50% = $6.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,9.85,,,,,,,4.6400,96.0000,fee schedule,$9.47 from Fee Schedule UHC_31910 for Rev 301 Proc 83068 * Qty 1 = $9.47 at 104% = $9.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,9.47,,,,,,,4.6400,96.0000,fee schedule,$9.47 from Fee Schedule UHC_31910 for Rev 301 Proc 83068 * Qty 1 = $9.47 at 100% = $9.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,9.47,,,,,,,4.6400,96.0000,fee schedule,$9.47 from Fee Schedule UHC_31910 for Rev 301 Proc 83068 * Qty 1 = $9.47 at 100% = $9.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,6.38,,,,,,,4.6400,96.0000,fee schedule,APG 00402 Proc 83068 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,9.47,,,,,,,4.6400,96.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,9.47,,,,,,,4.6400,96.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,WELLCARE,WELLCARE MEDICAID,96.00,,,,,,,4.6400,96.0000,percent of total billed charges,100% of $96.00 in Billed Charges for Rev 301 Proc 83068 = $96.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOGLOBIN UNSTABLE SCREEN,83068,CPT,301,RC,30100496,CDM,,,,both,,,96.0000,14.4000,WELLCARE,WELLCARE MEDICARE,10.04,,,,,,,4.6400,96.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,AETNA,AETNA,23.91,,,,,,,2.3800,56.0000,percent of total billed charges,42.7% of $56.00 in Billed Charges for Rev 301 Proc 83070 = $23.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,6.44,,,,,,,2.3800,56.0000,fee schedule,APG 00402 Proc 83070 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 104% = $6.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,4.75,,,,,,,2.3800,56.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,AETNA,AETNA HEALTHCARE MEDICARE,4.75,,,,,,,2.3800,56.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,4.75,,,,,,,2.3800,56.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,AMBETTER,AMBETTER,10.36,,,,,,,2.3800,56.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,AMERIGROUP,AMERIGROUP,2.38,,,,,,,2.3800,56.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,4.94,,,,,,,2.3800,56.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,BLUE CROSS,ANTHEM EXCHANGE,4.75,,,,,,,2.3800,56.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,6.38,,,,,,,2.3800,56.0000,fee schedule,APG 00402 Proc 83070 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,BLUE CROSS,ANTHEM HMO,4.75,,,,,,,2.3800,56.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,4.89,,,,,,,2.3800,56.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4.75,,,,,,,2.3800,56.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,15.50,,,,,,,2.3800,56.0000,fee schedule,$15.50 from Fee Schedule BLDTM_23 for Rev 301 Proc 83070 * Qty 1 = $15.50 at 100% = $15.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,BLUE CROSS,BLUE CROSS E NETWORK,20.74,,,,,,,2.3800,56.0000,fee schedule,$6.48 from Fee Schedule BCFSB for Rev 301 Proc 83070 * Qty 1 = $6.48 at 320% = $20.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,BLUE CROSS,BLUE CROSS MEDICARE,4.94,,,,,,,2.3800,56.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,BLUE CROSS,BLUE CROSS P NETWORK,21.19,,,,,,,2.3800,56.0000,fee schedule,$6.48 from Fee Schedule BCFSB for Rev 301 Proc 83070 * Qty 1 = $6.48 at 327% = $21.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,BLUE CROSS,BLUE CROSS S NETWORK,21.19,,,,,,,2.3800,56.0000,fee schedule,$6.48 from Fee Schedule BCFSB for Rev 301 Proc 83070 * Qty 1 = $6.48 at 327% = $21.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,BLUE CROSS,TENNCARE BLUE CARE,10.82,,,,,,,2.3800,56.0000,fee schedule,$9.33 from Fee Schedule TC_24 for Rev 301 Proc 83070 * Qty 1 = $9.33 at 116% = $10.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,BLUE CROSS,TENNCARE BLUE SELECT,10.82,,,,,,,2.3800,56.0000,fee schedule,$9.33 from Fee Schedule TC_24 for Rev 301 Proc 83070 * Qty 1 = $9.33 at 116% = $10.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,CIGNA HEALTHCARE,CIGNA HMO,19.10,,,,,,,2.3800,56.0000,fee schedule,$19.10 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83070 * Qty 1 = $19.10 at 100% = $19.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10.83,,,,,,,2.3800,56.0000,fee schedule,$10.83 from Fee Schedule CGIFP_25LR for Rev 301 Proc 83070 * Qty 1 = $10.83 at 100% = $10.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,4.99,,,,,,,2.3800,56.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,19.10,,,,,,,2.3800,56.0000,fee schedule,$19.10 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83070 * Qty 1 = $19.10 at 100% = $19.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,CIGNA HEALTHCARE,CIGNA PPO,19.10,,,,,,,2.3800,56.0000,fee schedule,$19.10 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83070 * Qty 1 = $19.10 at 100% = $19.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,4.99,,,,,,,2.3800,56.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,50.40,,,,,,,2.3800,56.0000,percent of total billed charges,90% of $56.00 in Billed Charges for Rev 301 Proc 83070 = $50.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,HUMANA,HUMANA MEDICARE,4.75,,,,,,,2.3800,56.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,4.75,,,,,,,2.3800,56.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,MEDCOST,MEDCOST VHN,26.65,,,,,,,2.3800,56.0000,percent of total billed charges,47.59% of $56.00 in Billed Charges for Rev 301 Proc 83070 = $26.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,6.50,,,,,,,2.3800,56.0000,fee schedule,APG 00402 Proc 83070 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 105% = $6.50 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,4.99,,,,,,,2.3800,56.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,4.99,,,,,,,2.3800,56.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,NHC ADVANTAGE,NHC ADVANTAGE,4.99,,,,,,,2.3800,56.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,6.38,,,,,,,2.3800,56.0000,fee schedule,APG 00402 Proc 83070 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 103.1% = $6.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,SENTARA HEALTH,SENTARA HEALTH,14.45,,,,,,,2.3800,56.0000,percent of total billed charges,25.81% of $56.00 in Billed Charges for Rev 301 Proc 83070 = $14.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,SENTARA HEALTH,SENTARA MEDICARE,4.75,,,,,,,2.3800,56.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",56.00,,,,,,,2.3800,56.0000,percent of total billed charges,100% of $56.00 in Billed Charges for Rev 301 Proc 83070 = $56.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3.37,,,,,,,2.3800,56.0000,fee schedule,$6.73 from Fee Schedule TCUHC24 for Rev 301 Proc 83070 * Qty 1 = $6.73 at 50% = $3.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4.94,,,,,,,2.3800,56.0000,fee schedule,$4.75 from Fee Schedule UHC_31910 for Rev 301 Proc 83070 * Qty 1 = $4.75 at 104% = $4.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,4.75,,,,,,,2.3800,56.0000,fee schedule,$4.75 from Fee Schedule UHC_31910 for Rev 301 Proc 83070 * Qty 1 = $4.75 at 100% = $4.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,4.75,,,,,,,2.3800,56.0000,fee schedule,$4.75 from Fee Schedule UHC_31910 for Rev 301 Proc 83070 * Qty 1 = $4.75 at 100% = $4.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,6.38,,,,,,,2.3800,56.0000,fee schedule,APG 00402 Proc 83070 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,4.75,,,,,,,2.3800,56.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,4.75,,,,,,,2.3800,56.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,WELLCARE,WELLCARE MEDICAID,56.00,,,,,,,2.3800,56.0000,percent of total billed charges,100% of $56.00 in Billed Charges for Rev 301 Proc 83070 = $56.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEMOSIDERIN QUALITATIVE,83070,CPT,301,RC,30100152,CDM,,,,both,,,56.0000,8.4000,WELLCARE,WELLCARE MEDICARE,5.04,,,,,,,2.3800,56.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,AETNA,AETNA,135.36,,,,,,,13.5900,317.0000,percent of total billed charges,42.7% of $317.00 in Billed Charges for Rev 301 Proc 83498 = $135.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15.66,,,,,,,13.5900,317.0000,fee schedule,APG 00398 Proc 83498 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 104% = $15.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,27.17,,,,,,,13.5900,317.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,AETNA,AETNA HEALTHCARE MEDICARE,27.17,,,,,,,13.5900,317.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,27.17,,,,,,,13.5900,317.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,AMBETTER,AMBETTER,59.23,,,,,,,13.5900,317.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,AMERIGROUP,AMERIGROUP,13.59,,,,,,,13.5900,317.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,28.26,,,,,,,13.5900,317.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,BLUE CROSS,ANTHEM EXCHANGE,27.17,,,,,,,13.5900,317.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15.51,,,,,,,13.5900,317.0000,fee schedule,APG 00398 Proc 83498 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,BLUE CROSS,ANTHEM HMO,27.17,,,,,,,13.5900,317.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,27.99,,,,,,,13.5900,317.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",27.17,,,,,,,13.5900,317.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,88.11,,,,,,,13.5900,317.0000,fee schedule,$88.11 from Fee Schedule BLDTM_23 for Rev 301 Proc 83498 * Qty 1 = $88.11 at 100% = $88.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,BLUE CROSS,BLUE CROSS E NETWORK,118.62,,,,,,,13.5900,317.0000,fee schedule,$37.07 from Fee Schedule BCFSB for Rev 301 Proc 83498 * Qty 1 = $37.07 at 320% = $118.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,BLUE CROSS,BLUE CROSS MEDICARE,28.26,,,,,,,13.5900,317.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,BLUE CROSS,BLUE CROSS P NETWORK,121.22,,,,,,,13.5900,317.0000,fee schedule,$37.07 from Fee Schedule BCFSB for Rev 301 Proc 83498 * Qty 1 = $37.07 at 327% = $121.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,BLUE CROSS,BLUE CROSS S NETWORK,121.22,,,,,,,13.5900,317.0000,fee schedule,$37.07 from Fee Schedule BCFSB for Rev 301 Proc 83498 * Qty 1 = $37.07 at 327% = $121.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,BLUE CROSS,TENNCARE BLUE CARE,61.32,,,,,,,13.5900,317.0000,fee schedule,$52.86 from Fee Schedule TC_24 for Rev 301 Proc 83498 * Qty 1 = $52.86 at 116% = $61.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,BLUE CROSS,TENNCARE BLUE SELECT,61.32,,,,,,,13.5900,317.0000,fee schedule,$52.86 from Fee Schedule TC_24 for Rev 301 Proc 83498 * Qty 1 = $52.86 at 116% = $61.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,CIGNA HEALTHCARE,CIGNA HMO,109.29,,,,,,,13.5900,317.0000,fee schedule,$109.29 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83498 * Qty 1 = $109.29 at 100% = $109.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,59.91,,,,,,,13.5900,317.0000,fee schedule,$59.91 from Fee Schedule CGIFP_25LR for Rev 301 Proc 83498 * Qty 1 = $59.91 at 100% = $59.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,28.53,,,,,,,13.5900,317.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,109.29,,,,,,,13.5900,317.0000,fee schedule,$109.29 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83498 * Qty 1 = $109.29 at 100% = $109.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,CIGNA HEALTHCARE,CIGNA PPO,109.29,,,,,,,13.5900,317.0000,fee schedule,$109.29 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83498 * Qty 1 = $109.29 at 100% = $109.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,28.53,,,,,,,13.5900,317.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,285.30,,,,,,,13.5900,317.0000,percent of total billed charges,90% of $317.00 in Billed Charges for Rev 301 Proc 83498 = $285.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,HUMANA,HUMANA MEDICARE,27.17,,,,,,,13.5900,317.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,27.17,,,,,,,13.5900,317.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,MEDCOST,MEDCOST VHN,150.86,,,,,,,13.5900,317.0000,percent of total billed charges,47.59% of $317.00 in Billed Charges for Rev 301 Proc 83498 = $150.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15.81,,,,,,,13.5900,317.0000,fee schedule,APG 00398 Proc 83498 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 105% = $15.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,28.53,,,,,,,13.5900,317.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,28.53,,,,,,,13.5900,317.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,NHC ADVANTAGE,NHC ADVANTAGE,28.53,,,,,,,13.5900,317.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15.53,,,,,,,13.5900,317.0000,fee schedule,APG 00398 Proc 83498 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 103.1% = $15.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,SENTARA HEALTH,SENTARA HEALTH,81.82,,,,,,,13.5900,317.0000,percent of total billed charges,25.81% of $317.00 in Billed Charges for Rev 301 Proc 83498 = $81.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,SENTARA HEALTH,SENTARA MEDICARE,27.17,,,,,,,13.5900,317.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",317.00,,,,,,,13.5900,317.0000,percent of total billed charges,100% of $317.00 in Billed Charges for Rev 301 Proc 83498 = $317.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,19.24,,,,,,,13.5900,317.0000,fee schedule,$38.48 from Fee Schedule TCUHC24 for Rev 301 Proc 83498 * Qty 1 = $38.48 at 50% = $19.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,28.26,,,,,,,13.5900,317.0000,fee schedule,$27.17 from Fee Schedule UHC_31910 for Rev 301 Proc 83498 * Qty 1 = $27.17 at 104% = $28.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,27.17,,,,,,,13.5900,317.0000,fee schedule,$27.17 from Fee Schedule UHC_31910 for Rev 301 Proc 83498 * Qty 1 = $27.17 at 100% = $27.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,27.17,,,,,,,13.5900,317.0000,fee schedule,$27.17 from Fee Schedule UHC_31910 for Rev 301 Proc 83498 * Qty 1 = $27.17 at 100% = $27.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15.51,,,,,,,13.5900,317.0000,fee schedule,APG 00398 Proc 83498 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,27.17,,,,,,,13.5900,317.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,27.17,,,,,,,13.5900,317.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,WELLCARE,WELLCARE MEDICAID,317.00,,,,,,,13.5900,317.0000,percent of total billed charges,100% of $317.00 in Billed Charges for Rev 301 Proc 83498 = $317.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC 17 HYDROXYPROGESTERONE,83498,CPT,301,RC,30100158,CDM,,,,both,,,317.0000,47.5500,WELLCARE,WELLCARE MEDICARE,28.80,,,,,,,13.5900,317.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,AETNA,AETNA,113.16,,,,,,,11.3300,265.0000,percent of total billed charges,42.7% of $265.00 in Billed Charges for Rev 301 Proc 83500 = $113.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15.66,,,,,,,11.3300,265.0000,fee schedule,APG 00398 Proc 83500 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 104% = $15.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,22.65,,,,,,,11.3300,265.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,AETNA,AETNA HEALTHCARE MEDICARE,22.65,,,,,,,11.3300,265.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,22.65,,,,,,,11.3300,265.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,AMBETTER,AMBETTER,49.38,,,,,,,11.3300,265.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,AMERIGROUP,AMERIGROUP,11.33,,,,,,,11.3300,265.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,23.56,,,,,,,11.3300,265.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,BLUE CROSS,ANTHEM EXCHANGE,22.65,,,,,,,11.3300,265.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15.51,,,,,,,11.3300,265.0000,fee schedule,APG 00398 Proc 83500 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,BLUE CROSS,ANTHEM HMO,22.65,,,,,,,11.3300,265.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,23.33,,,,,,,11.3300,265.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",22.65,,,,,,,11.3300,265.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,73.42,,,,,,,11.3300,265.0000,fee schedule,$73.42 from Fee Schedule BLDTM_23 for Rev 301 Proc 83500 * Qty 1 = $73.42 at 100% = $73.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,BLUE CROSS,BLUE CROSS E NETWORK,98.88,,,,,,,11.3300,265.0000,fee schedule,$30.90 from Fee Schedule BCFSB for Rev 301 Proc 83500 * Qty 1 = $30.90 at 320% = $98.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,BLUE CROSS,BLUE CROSS MEDICARE,23.56,,,,,,,11.3300,265.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,BLUE CROSS,BLUE CROSS P NETWORK,101.04,,,,,,,11.3300,265.0000,fee schedule,$30.90 from Fee Schedule BCFSB for Rev 301 Proc 83500 * Qty 1 = $30.90 at 327% = $101.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,BLUE CROSS,BLUE CROSS S NETWORK,101.04,,,,,,,11.3300,265.0000,fee schedule,$30.90 from Fee Schedule BCFSB for Rev 301 Proc 83500 * Qty 1 = $30.90 at 327% = $101.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,BLUE CROSS,TENNCARE BLUE CARE,55.82,,,,,,,11.3300,265.0000,fee schedule,$48.12 from Fee Schedule TC_24 for Rev 301 Proc 83500 * Qty 1 = $48.12 at 116% = $55.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,BLUE CROSS,TENNCARE BLUE SELECT,55.82,,,,,,,11.3300,265.0000,fee schedule,$48.12 from Fee Schedule TC_24 for Rev 301 Proc 83500 * Qty 1 = $48.12 at 116% = $55.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,CIGNA HEALTHCARE,CIGNA HMO,91.11,,,,,,,11.3300,265.0000,fee schedule,$91.11 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83500 * Qty 1 = $91.11 at 100% = $91.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,49.80,,,,,,,11.3300,265.0000,fee schedule,$49.80 from Fee Schedule CGIFP_25LR for Rev 301 Proc 83500 * Qty 1 = $49.80 at 100% = $49.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,23.78,,,,,,,11.3300,265.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,91.11,,,,,,,11.3300,265.0000,fee schedule,$91.11 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83500 * Qty 1 = $91.11 at 100% = $91.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,CIGNA HEALTHCARE,CIGNA PPO,91.11,,,,,,,11.3300,265.0000,fee schedule,$91.11 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83500 * Qty 1 = $91.11 at 100% = $91.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,23.78,,,,,,,11.3300,265.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,238.50,,,,,,,11.3300,265.0000,percent of total billed charges,90% of $265.00 in Billed Charges for Rev 301 Proc 83500 = $238.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,HUMANA,HUMANA MEDICARE,22.65,,,,,,,11.3300,265.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,22.65,,,,,,,11.3300,265.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,MEDCOST,MEDCOST VHN,126.11,,,,,,,11.3300,265.0000,percent of total billed charges,47.59% of $265.00 in Billed Charges for Rev 301 Proc 83500 = $126.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15.81,,,,,,,11.3300,265.0000,fee schedule,APG 00398 Proc 83500 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 105% = $15.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,23.78,,,,,,,11.3300,265.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,23.78,,,,,,,11.3300,265.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,NHC ADVANTAGE,NHC ADVANTAGE,23.78,,,,,,,11.3300,265.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15.53,,,,,,,11.3300,265.0000,fee schedule,APG 00398 Proc 83500 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 103.1% = $15.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,SENTARA HEALTH,SENTARA HEALTH,68.40,,,,,,,11.3300,265.0000,percent of total billed charges,25.81% of $265.00 in Billed Charges for Rev 301 Proc 83500 = $68.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,SENTARA HEALTH,SENTARA MEDICARE,22.65,,,,,,,11.3300,265.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",265.00,,,,,,,11.3300,265.0000,percent of total billed charges,100% of $265.00 in Billed Charges for Rev 301 Proc 83500 = $265.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,16.04,,,,,,,11.3300,265.0000,fee schedule,$32.08 from Fee Schedule TCUHC24 for Rev 301 Proc 83500 * Qty 1 = $32.08 at 50% = $16.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,23.56,,,,,,,11.3300,265.0000,fee schedule,$22.65 from Fee Schedule UHC_31910 for Rev 301 Proc 83500 * Qty 1 = $22.65 at 104% = $23.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,22.65,,,,,,,11.3300,265.0000,fee schedule,$22.65 from Fee Schedule UHC_31910 for Rev 301 Proc 83500 * Qty 1 = $22.65 at 100% = $22.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,22.65,,,,,,,11.3300,265.0000,fee schedule,$22.65 from Fee Schedule UHC_31910 for Rev 301 Proc 83500 * Qty 1 = $22.65 at 100% = $22.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15.51,,,,,,,11.3300,265.0000,fee schedule,APG 00398 Proc 83500 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,22.65,,,,,,,11.3300,265.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,22.65,,,,,,,11.3300,265.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,WELLCARE,WELLCARE MEDICAID,265.00,,,,,,,11.3300,265.0000,percent of total billed charges,100% of $265.00 in Billed Charges for Rev 301 Proc 83500 = $265.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HYDROXYPROLINE FREE,83500,CPT,301,RC,30100315,CDM,,,,both,,,265.0000,39.7500,WELLCARE,WELLCARE MEDICARE,24.01,,,,,,,11.3300,265.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,AETNA,AETNA,182.33,,,,,,,13.0500,427.0000,percent of total billed charges,42.7% of $427.00 in Billed Charges for Rev 311 Proc 88162 = $182.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,46.90,,,,,,,13.0500,427.0000,fee schedule,APG 00391 Proc 88162 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 104% = $46.90. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,47.28,,,,,,,13.0500,427.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,AETNA,AETNA HEALTHCARE MEDICARE,47.28,,,,,,,13.0500,427.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,47.28,,,,,,,13.0500,427.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,AMBETTER,AMBETTER,103.07,,,,,,,13.0500,427.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,49.17,,,,,,,13.0500,427.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,BLUE CROSS,ANTHEM EXCHANGE,116.40,,,,,,,13.0500,427.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,46.45,,,,,,,13.0500,427.0000,fee schedule,APG 00391 Proc 88162 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 103% = $46.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,BLUE CROSS,ANTHEM HMO,123.67,,,,,,,13.0500,427.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,48.70,,,,,,,13.0500,427.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",145.49,,,,,,,13.0500,427.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,20.70,,,,,,,13.0500,427.0000,fee schedule,$20.70 from Fee Schedule BLDTM_23 for Rev 311 Proc 88162 * Qty 1 = $20.70 at 100% = $20.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,BLUE CROSS,BLUE CROSS E NETWORK,160.16,,,,,,,13.0500,427.0000,fee schedule,$50.05 from Fee Schedule BCFSB for Rev 311 Proc 88162 * Qty 1 = $50.05 at 320% = $160.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,BLUE CROSS,BLUE CROSS MEDICARE,49.17,,,,,,,13.0500,427.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,BLUE CROSS,BLUE CROSS P NETWORK,163.66,,,,,,,13.0500,427.0000,fee schedule,$50.05 from Fee Schedule BCFSB for Rev 311 Proc 88162 * Qty 1 = $50.05 at 327% = $163.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,BLUE CROSS,BLUE CROSS S NETWORK,163.66,,,,,,,13.0500,427.0000,fee schedule,$50.05 from Fee Schedule BCFSB for Rev 311 Proc 88162 * Qty 1 = $50.05 at 327% = $163.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,BLUE CROSS,TENNCARE BLUE CARE,13.05,,,,,,,13.0500,427.0000,fee schedule,$11.25 from Fee Schedule TC_24 for Rev 311 Proc 88162 * Qty 1 = $11.25 at 116% = $13.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,BLUE CROSS,TENNCARE BLUE SELECT,13.05,,,,,,,13.0500,427.0000,fee schedule,$11.25 from Fee Schedule TC_24 for Rev 311 Proc 88162 * Qty 1 = $11.25 at 116% = $13.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,CIGNA HEALTHCARE,CIGNA HMO,136.30,,,,,,,13.0500,427.0000,fee schedule,$136.30 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88162 * Qty 1 = $136.30 at 100% = $136.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,195.47,,,,,,,13.0500,427.0000,fee schedule,$195.47 from Fee Schedule CGIFP_25LR for Rev 311 Proc 88162 * Qty 1 = $195.47 at 100% = $195.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,49.64,,,,,,,13.0500,427.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,136.30,,,,,,,13.0500,427.0000,fee schedule,$136.30 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88162 * Qty 1 = $136.30 at 100% = $136.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,CIGNA HEALTHCARE,CIGNA PPO,136.30,,,,,,,13.0500,427.0000,fee schedule,$136.30 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88162 * Qty 1 = $136.30 at 100% = $136.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,49.64,,,,,,,13.0500,427.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,384.30,,,,,,,13.0500,427.0000,percent of total billed charges,90% of $427.00 in Billed Charges for Rev 311 Proc 88162 = $384.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,HUMANA,HUMANA MEDICARE,47.28,,,,,,,13.0500,427.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,47.28,,,,,,,13.0500,427.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,MEDCOST,MEDCOST VHN,203.21,,,,,,,13.0500,427.0000,percent of total billed charges,47.59% of $427.00 in Billed Charges for Rev 311 Proc 88162 = $203.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,47.34,,,,,,,13.0500,427.0000,fee schedule,APG 00391 Proc 88162 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 100% = $45.09... $45.09 at 105% = $47.34 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,49.64,,,,,,,13.0500,427.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,49.64,,,,,,,13.0500,427.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,NHC ADVANTAGE,NHC ADVANTAGE,49.64,,,,,,,13.0500,427.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,46.49,,,,,,,13.0500,427.0000,fee schedule,APG 00391 Proc 88162 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 100% = $45.09... $45.09 at 103.1% = $46.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,SENTARA HEALTH,SENTARA HEALTH,110.21,,,,,,,13.0500,427.0000,percent of total billed charges,25.81% of $427.00 in Billed Charges for Rev 311 Proc 88162 = $110.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,SENTARA HEALTH,SENTARA MEDICARE,47.28,,,,,,,13.0500,427.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",427.00,,,,,,,13.0500,427.0000,percent of total billed charges,100% of $427.00 in Billed Charges for Rev 311 Proc 88162 = $427.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,18.41,,,,,,,13.0500,427.0000,fee schedule,$36.81 from Fee Schedule TCUHC24 for Rev 311 Proc 88162 * Qty 1 = $36.81 at 50% = $18.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,51.45,,,,,,,13.0500,427.0000,fee schedule,$49.47 from Fee Schedule UHC_31910 for Rev 311 Proc 88162 * Qty 1 = $49.47 at 104% = $51.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,49.47,,,,,,,13.0500,427.0000,fee schedule,$49.47 from Fee Schedule UHC_31910 for Rev 311 Proc 88162 * Qty 1 = $49.47 at 100% = $49.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,49.47,,,,,,,13.0500,427.0000,fee schedule,$49.47 from Fee Schedule UHC_31910 for Rev 311 Proc 88162 * Qty 1 = $49.47 at 100% = $49.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,46.45,,,,,,,13.0500,427.0000,fee schedule,APG 00391 Proc 88162 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 103% = $46.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,47.28,,,,,,,13.0500,427.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,47.28,,,,,,,13.0500,427.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,WELLCARE,WELLCARE MEDICAID,427.00,,,,,,,13.0500,427.0000,percent of total billed charges,100% of $427.00 in Billed Charges for Rev 311 Proc 88162 = $427.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXTENDED STUDY OVER 5 SLIDES,88162,CPT,311,RC,31100016,CDM,,,,both,,,427.0000,64.0500,WELLCARE,WELLCARE MEDICARE,50.12,,,,,,,13.0500,427.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,AETNA,AETNA,134.93,,,,,,,8.5400,336.9700,percent of total billed charges,42.7% of $316.00 in Billed Charges for Rev 311 Proc 88172 = $134.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,238.40,,,,,,,8.5400,336.9700,fee schedule,APG 00308 Proc 88172 at $836.60 (Base Rate) * 0.274 (Relative Weight) = $229.23 (Total Line Payment) at 104% = $238.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,154.57,,,,,,,8.5400,336.9700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,AETNA,AETNA HEALTHCARE MEDICARE,154.57,,,,,,,8.5400,336.9700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,154.57,,,,,,,8.5400,336.9700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,AMBETTER,AMBETTER,336.97,,,,,,,8.5400,336.9700,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,160.76,,,,,,,8.5400,336.9700,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,BLUE CROSS,ANTHEM EXCHANGE,316.00,,,,,,,8.5400,336.9700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,236.11,,,,,,,8.5400,336.9700,fee schedule,APG 00308 Proc 88172 at $836.60 (Base Rate) * 0.274 (Relative Weight) = $229.23 (Total Line Payment) at 103% = $236.11. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,BLUE CROSS,ANTHEM HMO,316.00,,,,,,,8.5400,336.9700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,159.21,,,,,,,8.5400,336.9700,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",316.00,,,,,,,8.5400,336.9700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,14.78,,,,,,,8.5400,336.9700,fee schedule,$14.78 from Fee Schedule BLDTM_23 for Rev 311 Proc 88172 * Qty 1 = $14.78 at 100% = $14.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,BLUE CROSS,BLUE CROSS E NETWORK,52.06,,,,,,,8.5400,336.9700,fee schedule,$16.27 from Fee Schedule BCFSB for Rev 311 Proc 88172 * Qty 1 = $16.27 at 320% = $52.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,BLUE CROSS,BLUE CROSS MEDICARE,160.76,,,,,,,8.5400,336.9700,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,BLUE CROSS,BLUE CROSS P NETWORK,53.20,,,,,,,8.5400,336.9700,fee schedule,$16.27 from Fee Schedule BCFSB for Rev 311 Proc 88172 * Qty 1 = $16.27 at 327% = $53.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,BLUE CROSS,BLUE CROSS S NETWORK,53.20,,,,,,,8.5400,336.9700,fee schedule,$16.27 from Fee Schedule BCFSB for Rev 311 Proc 88172 * Qty 1 = $16.27 at 327% = $53.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,BLUE CROSS,TENNCARE BLUE CARE,11.76,,,,,,,8.5400,336.9700,fee schedule,$10.14 from Fee Schedule TC_24 for Rev 311 Proc 88172 * Qty 1 = $10.14 at 116% = $11.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,BLUE CROSS,TENNCARE BLUE SELECT,11.76,,,,,,,8.5400,336.9700,fee schedule,$10.14 from Fee Schedule TC_24 for Rev 311 Proc 88172 * Qty 1 = $10.14 at 116% = $11.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,CIGNA HEALTHCARE,CIGNA HMO,54.14,,,,,,,8.5400,336.9700,fee schedule,$54.14 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88172 * Qty 1 = $54.14 at 100% = $54.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,46.63,,,,,,,8.5400,336.9700,fee schedule,$46.63 from Fee Schedule CGIFP_25LR for Rev 311 Proc 88172 * Qty 1 = $46.63 at 100% = $46.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,162.30,,,,,,,8.5400,336.9700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,54.14,,,,,,,8.5400,336.9700,fee schedule,$54.14 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88172 * Qty 1 = $54.14 at 100% = $54.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,CIGNA HEALTHCARE,CIGNA PPO,54.14,,,,,,,8.5400,336.9700,fee schedule,$54.14 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88172 * Qty 1 = $54.14 at 100% = $54.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,162.30,,,,,,,8.5400,336.9700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,284.40,,,,,,,8.5400,336.9700,percent of total billed charges,90% of $316.00 in Billed Charges for Rev 311 Proc 88172 = $284.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,HUMANA,HUMANA MEDICARE,154.57,,,,,,,8.5400,336.9700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,154.57,,,,,,,8.5400,336.9700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,MEDCOST,MEDCOST VHN,150.38,,,,,,,8.5400,336.9700,percent of total billed charges,47.59% of $316.00 in Billed Charges for Rev 311 Proc 88172 = $150.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,240.69,,,,,,,8.5400,336.9700,fee schedule,APG 00308 Proc 88172 at $836.60 (Base Rate) * 0.274 (Relative Weight) = $229.23 (Total Line Payment) at 100% = $229.23... $229.23 at 105% = $240.69 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,162.30,,,,,,,8.5400,336.9700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,162.30,,,,,,,8.5400,336.9700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,NHC ADVANTAGE,NHC ADVANTAGE,162.30,,,,,,,8.5400,336.9700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,236.34,,,,,,,8.5400,336.9700,fee schedule,APG 00308 Proc 88172 at $836.60 (Base Rate) * 0.274 (Relative Weight) = $229.23 (Total Line Payment) at 100% = $229.23... $229.23 at 103.1% = $236.34 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,SENTARA HEALTH,SENTARA HEALTH,81.56,,,,,,,8.5400,336.9700,percent of total billed charges,25.81% of $316.00 in Billed Charges for Rev 311 Proc 88172 = $81.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,SENTARA HEALTH,SENTARA MEDICARE,154.57,,,,,,,8.5400,336.9700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",316.00,,,,,,,8.5400,336.9700,percent of total billed charges,100% of $316.00 in Billed Charges for Rev 311 Proc 88172 = $316.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.54,,,,,,,8.5400,336.9700,fee schedule,$17.08 from Fee Schedule TCUHC24 for Rev 311 Proc 88172 * Qty 1 = $17.08 at 50% = $8.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,149.24,,,,,,,8.5400,336.9700,fee schedule,$143.50 from Fee Schedule UHC_31910 for Rev 311 Proc 88172 * Qty 1 = $143.50 at 104% = $149.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,143.50,,,,,,,8.5400,336.9700,fee schedule,$143.50 from Fee Schedule UHC_31910 for Rev 311 Proc 88172 * Qty 1 = $143.50 at 100% = $143.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,143.50,,,,,,,8.5400,336.9700,fee schedule,$143.50 from Fee Schedule UHC_31910 for Rev 311 Proc 88172 * Qty 1 = $143.50 at 100% = $143.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,236.11,,,,,,,8.5400,336.9700,fee schedule,APG 00308 Proc 88172 at $836.60 (Base Rate) * 0.274 (Relative Weight) = $229.23 (Total Line Payment) at 103% = $236.11. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,154.57,,,,,,,8.5400,336.9700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,154.57,,,,,,,8.5400,336.9700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,WELLCARE,WELLCARE MEDICAID,316.00,,,,,,,8.5400,336.9700,percent of total billed charges,100% of $316.00 in Billed Charges for Rev 311 Proc 88172 = $316.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA IMMED STUDY ADEQUACY,88172,CPT,311,RC,31100018,CDM,,,,both,,,316.0000,47.4000,WELLCARE,WELLCARE MEDICARE,163.85,,,,,,,8.5400,336.9700,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,AETNA,AETNA,245.10,,,,,,,14.3600,574.0000,percent of total billed charges,42.7% of $574.00 in Billed Charges for Rev 311 Proc 88173 = $245.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,137.12,,,,,,,14.3600,574.0000,fee schedule,APG 00158 Proc 88173 at $836.60 (Base Rate) * 0.1576 (Relative Weight) = $131.85 (Total Line Payment) at 104% = $137.12. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,47.28,,,,,,,14.3600,574.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,AETNA,AETNA HEALTHCARE MEDICARE,47.28,,,,,,,14.3600,574.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,47.28,,,,,,,14.3600,574.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,AMBETTER,AMBETTER,103.07,,,,,,,14.3600,574.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,49.17,,,,,,,14.3600,574.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,BLUE CROSS,ANTHEM EXCHANGE,116.40,,,,,,,14.3600,574.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,135.80,,,,,,,14.3600,574.0000,fee schedule,APG 00158 Proc 88173 at $836.60 (Base Rate) * 0.1576 (Relative Weight) = $131.85 (Total Line Payment) at 103% = $135.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,BLUE CROSS,ANTHEM HMO,123.67,,,,,,,14.3600,574.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,48.70,,,,,,,14.3600,574.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",145.49,,,,,,,14.3600,574.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,21.83,,,,,,,14.3600,574.0000,fee schedule,$21.83 from Fee Schedule BLDTM_23 for Rev 311 Proc 88173 * Qty 1 = $21.83 at 100% = $21.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,BLUE CROSS,BLUE CROSS E NETWORK,214.72,,,,,,,14.3600,574.0000,fee schedule,$67.10 from Fee Schedule BCFSB for Rev 311 Proc 88173 * Qty 1 = $67.10 at 320% = $214.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,BLUE CROSS,BLUE CROSS MEDICARE,49.17,,,,,,,14.3600,574.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,BLUE CROSS,BLUE CROSS P NETWORK,219.42,,,,,,,14.3600,574.0000,fee schedule,$67.10 from Fee Schedule BCFSB for Rev 311 Proc 88173 * Qty 1 = $67.10 at 327% = $219.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,BLUE CROSS,BLUE CROSS S NETWORK,219.42,,,,,,,14.3600,574.0000,fee schedule,$67.10 from Fee Schedule BCFSB for Rev 311 Proc 88173 * Qty 1 = $67.10 at 327% = $219.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,BLUE CROSS,TENNCARE BLUE CARE,14.36,,,,,,,14.3600,574.0000,fee schedule,$12.38 from Fee Schedule TC_24 for Rev 311 Proc 88173 * Qty 1 = $12.38 at 116% = $14.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,BLUE CROSS,TENNCARE BLUE SELECT,14.36,,,,,,,14.3600,574.0000,fee schedule,$12.38 from Fee Schedule TC_24 for Rev 311 Proc 88173 * Qty 1 = $12.38 at 116% = $14.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,CIGNA HEALTHCARE,CIGNA HMO,202.07,,,,,,,14.3600,574.0000,fee schedule,$202.07 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88173 * Qty 1 = $202.07 at 100% = $202.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,215.68,,,,,,,14.3600,574.0000,fee schedule,$215.68 from Fee Schedule CGIFP_25LR for Rev 311 Proc 88173 * Qty 1 = $215.68 at 100% = $215.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,49.64,,,,,,,14.3600,574.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,202.07,,,,,,,14.3600,574.0000,fee schedule,$202.07 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88173 * Qty 1 = $202.07 at 100% = $202.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,CIGNA HEALTHCARE,CIGNA PPO,202.07,,,,,,,14.3600,574.0000,fee schedule,$202.07 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88173 * Qty 1 = $202.07 at 100% = $202.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,49.64,,,,,,,14.3600,574.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,516.60,,,,,,,14.3600,574.0000,percent of total billed charges,90% of $574.00 in Billed Charges for Rev 311 Proc 88173 = $516.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,HUMANA,HUMANA MEDICARE,47.28,,,,,,,14.3600,574.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,47.28,,,,,,,14.3600,574.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,MEDCOST,MEDCOST VHN,273.17,,,,,,,14.3600,574.0000,percent of total billed charges,47.59% of $574.00 in Billed Charges for Rev 311 Proc 88173 = $273.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,138.44,,,,,,,14.3600,574.0000,fee schedule,APG 00158 Proc 88173 at $836.60 (Base Rate) * 0.1576 (Relative Weight) = $131.85 (Total Line Payment) at 100% = $131.85... $131.85 at 105% = $138.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,49.64,,,,,,,14.3600,574.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,49.64,,,,,,,14.3600,574.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,NHC ADVANTAGE,NHC ADVANTAGE,49.64,,,,,,,14.3600,574.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,135.94,,,,,,,14.3600,574.0000,fee schedule,APG 00158 Proc 88173 at $836.60 (Base Rate) * 0.1576 (Relative Weight) = $131.85 (Total Line Payment) at 100% = $131.85... $131.85 at 103.1% = $135.94 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,SENTARA HEALTH,SENTARA HEALTH,148.15,,,,,,,14.3600,574.0000,percent of total billed charges,25.81% of $574.00 in Billed Charges for Rev 311 Proc 88173 = $148.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,SENTARA HEALTH,SENTARA MEDICARE,47.28,,,,,,,14.3600,574.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",574.00,,,,,,,14.3600,574.0000,percent of total billed charges,100% of $574.00 in Billed Charges for Rev 311 Proc 88173 = $574.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,18.41,,,,,,,14.3600,574.0000,fee schedule,$36.81 from Fee Schedule TCUHC24 for Rev 311 Proc 88173 * Qty 1 = $36.81 at 50% = $18.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,51.45,,,,,,,14.3600,574.0000,fee schedule,$49.47 from Fee Schedule UHC_31910 for Rev 311 Proc 88173 * Qty 1 = $49.47 at 104% = $51.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,49.47,,,,,,,14.3600,574.0000,fee schedule,$49.47 from Fee Schedule UHC_31910 for Rev 311 Proc 88173 * Qty 1 = $49.47 at 100% = $49.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,49.47,,,,,,,14.3600,574.0000,fee schedule,$49.47 from Fee Schedule UHC_31910 for Rev 311 Proc 88173 * Qty 1 = $49.47 at 100% = $49.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,135.80,,,,,,,14.3600,574.0000,fee schedule,APG 00158 Proc 88173 at $836.60 (Base Rate) * 0.1576 (Relative Weight) = $131.85 (Total Line Payment) at 103% = $135.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,47.28,,,,,,,14.3600,574.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,47.28,,,,,,,14.3600,574.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,WELLCARE,WELLCARE MEDICAID,574.00,,,,,,,14.3600,574.0000,percent of total billed charges,100% of $574.00 in Billed Charges for Rev 311 Proc 88173 = $574.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY EVAL FNA REPORT,88173,CPT,311,RC,31100009,CDM,,,,both,,,574.0000,86.1000,WELLCARE,WELLCARE MEDICARE,50.12,,,,,,,14.3600,574.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,AETNA,AETNA,66.61,,,,,,,13.3100,156.0000,percent of total billed charges,42.7% of $156.00 in Billed Charges for Rev 311 Proc 88175 = $66.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,24.10,,,,,,,13.3100,156.0000,fee schedule,APG 00392 Proc 88175 at $836.60 (Base Rate) * 0.0277 (Relative Weight) = $23.17 (Total Line Payment) at 104% = $24.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,26.61,,,,,,,13.3100,156.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,AETNA,AETNA HEALTHCARE MEDICARE,26.61,,,,,,,13.3100,156.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,26.61,,,,,,,13.3100,156.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,AMBETTER,AMBETTER,58.01,,,,,,,13.3100,156.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,AMERIGROUP,AMERIGROUP,13.31,,,,,,,13.3100,156.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,27.67,,,,,,,13.3100,156.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,BLUE CROSS,ANTHEM EXCHANGE,26.61,,,,,,,13.3100,156.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,23.87,,,,,,,13.3100,156.0000,fee schedule,APG 00392 Proc 88175 at $836.60 (Base Rate) * 0.0277 (Relative Weight) = $23.17 (Total Line Payment) at 103% = $23.87. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,BLUE CROSS,ANTHEM HMO,26.61,,,,,,,13.3100,156.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,27.41,,,,,,,13.3100,156.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",26.61,,,,,,,13.3100,156.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,41.94,,,,,,,13.3100,156.0000,fee schedule,$41.94 from Fee Schedule BLDTM_23 for Rev 311 Proc 88175 * Qty 1 = $41.94 at 100% = $41.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,BLUE CROSS,BLUE CROSS E NETWORK,113.44,,,,,,,13.3100,156.0000,fee schedule,$35.45 from Fee Schedule BCFSB for Rev 311 Proc 88175 * Qty 1 = $35.45 at 320% = $113.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,BLUE CROSS,BLUE CROSS MEDICARE,27.67,,,,,,,13.3100,156.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,BLUE CROSS,BLUE CROSS P NETWORK,115.92,,,,,,,13.3100,156.0000,fee schedule,$35.45 from Fee Schedule BCFSB for Rev 311 Proc 88175 * Qty 1 = $35.45 at 327% = $115.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,BLUE CROSS,BLUE CROSS S NETWORK,115.92,,,,,,,13.3100,156.0000,fee schedule,$35.45 from Fee Schedule BCFSB for Rev 311 Proc 88175 * Qty 1 = $35.45 at 327% = $115.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,BLUE CROSS,TENNCARE BLUE CARE,33.38,,,,,,,13.3100,156.0000,fee schedule,$28.78 from Fee Schedule TC_24 for Rev 311 Proc 88175 * Qty 1 = $28.78 at 116% = $33.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,BLUE CROSS,TENNCARE BLUE SELECT,33.38,,,,,,,13.3100,156.0000,fee schedule,$28.78 from Fee Schedule TC_24 for Rev 311 Proc 88175 * Qty 1 = $28.78 at 116% = $33.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,CIGNA HEALTHCARE,CIGNA HMO,106.58,,,,,,,13.3100,156.0000,fee schedule,$106.58 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88175 * Qty 1 = $106.58 at 100% = $106.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,58.46,,,,,,,13.3100,156.0000,fee schedule,$58.46 from Fee Schedule CGIFP_25LR for Rev 311 Proc 88175 * Qty 1 = $58.46 at 100% = $58.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,27.94,,,,,,,13.3100,156.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,106.58,,,,,,,13.3100,156.0000,fee schedule,$106.58 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88175 * Qty 1 = $106.58 at 100% = $106.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,CIGNA HEALTHCARE,CIGNA PPO,106.58,,,,,,,13.3100,156.0000,fee schedule,$106.58 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88175 * Qty 1 = $106.58 at 100% = $106.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,27.94,,,,,,,13.3100,156.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,140.40,,,,,,,13.3100,156.0000,percent of total billed charges,90% of $156.00 in Billed Charges for Rev 311 Proc 88175 = $140.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,HUMANA,HUMANA MEDICARE,26.61,,,,,,,13.3100,156.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,26.61,,,,,,,13.3100,156.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,MEDCOST,MEDCOST VHN,74.24,,,,,,,13.3100,156.0000,percent of total billed charges,47.59% of $156.00 in Billed Charges for Rev 311 Proc 88175 = $74.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,24.33,,,,,,,13.3100,156.0000,fee schedule,APG 00392 Proc 88175 at $836.60 (Base Rate) * 0.0277 (Relative Weight) = $23.17 (Total Line Payment) at 100% = $23.17... $23.17 at 105% = $24.33 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,27.94,,,,,,,13.3100,156.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,27.94,,,,,,,13.3100,156.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,NHC ADVANTAGE,NHC ADVANTAGE,27.94,,,,,,,13.3100,156.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,23.89,,,,,,,13.3100,156.0000,fee schedule,APG 00392 Proc 88175 at $836.60 (Base Rate) * 0.0277 (Relative Weight) = $23.17 (Total Line Payment) at 100% = $23.17... $23.17 at 103.1% = $23.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,SENTARA HEALTH,SENTARA HEALTH,40.26,,,,,,,13.3100,156.0000,percent of total billed charges,25.81% of $156.00 in Billed Charges for Rev 311 Proc 88175 = $40.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,SENTARA HEALTH,SENTARA MEDICARE,26.61,,,,,,,13.3100,156.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",156.00,,,,,,,13.3100,156.0000,percent of total billed charges,100% of $156.00 in Billed Charges for Rev 311 Proc 88175 = $156.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,18.76,,,,,,,13.3100,156.0000,fee schedule,$37.52 from Fee Schedule TCUHC24 for Rev 311 Proc 88175 * Qty 1 = $37.52 at 50% = $18.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,27.67,,,,,,,13.3100,156.0000,fee schedule,$26.61 from Fee Schedule UHC_31910 for Rev 311 Proc 88175 * Qty 1 = $26.61 at 104% = $27.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,26.61,,,,,,,13.3100,156.0000,fee schedule,$26.61 from Fee Schedule UHC_31910 for Rev 311 Proc 88175 * Qty 1 = $26.61 at 100% = $26.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,26.61,,,,,,,13.3100,156.0000,fee schedule,$26.61 from Fee Schedule UHC_31910 for Rev 311 Proc 88175 * Qty 1 = $26.61 at 100% = $26.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,23.87,,,,,,,13.3100,156.0000,fee schedule,APG 00392 Proc 88175 at $836.60 (Base Rate) * 0.0277 (Relative Weight) = $23.17 (Total Line Payment) at 103% = $23.87. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,26.61,,,,,,,13.3100,156.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,26.61,,,,,,,13.3100,156.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,WELLCARE,WELLCARE MEDICAID,156.00,,,,,,,13.3100,156.0000,percent of total billed charges,100% of $156.00 in Billed Charges for Rev 311 Proc 88175 = $156.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY CV THINPREP IMAG,88175,CPT,311,RC,31100010,CDM,,,,both,,,156.0000,23.4000,WELLCARE,WELLCARE MEDICARE,28.21,,,,,,,13.3100,156.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,AETNA,AETNA,27.76,,,,,,,5.5800,65.0000,percent of total billed charges,42.7% of $65.00 in Billed Charges for Rev 311 Proc 88177 = $27.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,46.90,,,,,,,5.5800,65.0000,fee schedule,APG 00391 Proc 88177 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 104% = $46.90. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,46.45,,,,,,,5.5800,65.0000,fee schedule,APG 00391 Proc 88177 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 103% = $46.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5.98,,,,,,,5.5800,65.0000,fee schedule,$5.98 from Fee Schedule BLDTM_23 for Rev 311 Proc 88177 * Qty 1 = $5.98 at 100% = $5.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,BLUE CROSS,BLUE CROSS E NETWORK,21.18,,,,,,,5.5800,65.0000,fee schedule,$6.62 from Fee Schedule BCFSB for Rev 311 Proc 88177 * Qty 1 = $6.62 at 320% = $21.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,BLUE CROSS,BLUE CROSS P NETWORK,21.65,,,,,,,5.5800,65.0000,fee schedule,$6.62 from Fee Schedule BCFSB for Rev 311 Proc 88177 * Qty 1 = $6.62 at 327% = $21.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,BLUE CROSS,BLUE CROSS S NETWORK,21.65,,,,,,,5.5800,65.0000,fee schedule,$6.62 from Fee Schedule BCFSB for Rev 311 Proc 88177 * Qty 1 = $6.62 at 327% = $21.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,BLUE CROSS,TENNCARE BLUE CARE,5.63,,,,,,,5.5800,65.0000,fee schedule,$4.85 from Fee Schedule TC_24 for Rev 311 Proc 88177 * Qty 1 = $4.85 at 116% = $5.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,BLUE CROSS,TENNCARE BLUE SELECT,5.63,,,,,,,5.5800,65.0000,fee schedule,$4.85 from Fee Schedule TC_24 for Rev 311 Proc 88177 * Qty 1 = $4.85 at 116% = $5.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,CIGNA HEALTHCARE,CIGNA HMO,19.36,,,,,,,5.5800,65.0000,fee schedule,$19.36 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88177 * Qty 1 = $19.36 at 100% = $19.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,18.04,,,,,,,5.5800,65.0000,fee schedule,$18.04 from Fee Schedule CGIFP_25LR for Rev 311 Proc 88177 * Qty 1 = $18.04 at 100% = $18.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,19.36,,,,,,,5.5800,65.0000,fee schedule,$19.36 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88177 * Qty 1 = $19.36 at 100% = $19.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,CIGNA HEALTHCARE,CIGNA PPO,19.36,,,,,,,5.5800,65.0000,fee schedule,$19.36 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88177 * Qty 1 = $19.36 at 100% = $19.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,58.50,,,,,,,5.5800,65.0000,percent of total billed charges,90% of $65.00 in Billed Charges for Rev 311 Proc 88177 = $58.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,MEDCOST,MEDCOST VHN,30.93,,,,,,,5.5800,65.0000,percent of total billed charges,47.59% of $65.00 in Billed Charges for Rev 311 Proc 88177 = $30.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,47.34,,,,,,,5.5800,65.0000,fee schedule,APG 00391 Proc 88177 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 100% = $45.09... $45.09 at 105% = $47.34 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,46.49,,,,,,,5.5800,65.0000,fee schedule,APG 00391 Proc 88177 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 100% = $45.09... $45.09 at 103.1% = $46.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,SENTARA HEALTH,SENTARA HEALTH,16.78,,,,,,,5.5800,65.0000,percent of total billed charges,25.81% of $65.00 in Billed Charges for Rev 311 Proc 88177 = $16.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",65.00,,,,,,,5.5800,65.0000,percent of total billed charges,100% of $65.00 in Billed Charges for Rev 311 Proc 88177 = $65.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5.58,,,,,,,5.5800,65.0000,fee schedule,$11.16 from Fee Schedule TCUHC24 for Rev 311 Proc 88177 * Qty 1 = $11.16 at 50% = $5.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7.51,,,,,,,5.5800,65.0000,fee schedule,$7.22 from Fee Schedule UHC_31910 for Rev 311 Proc 88177 * Qty 1 = $7.22 at 104% = $7.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7.22,,,,,,,5.5800,65.0000,fee schedule,$7.22 from Fee Schedule UHC_31910 for Rev 311 Proc 88177 * Qty 1 = $7.22 at 100% = $7.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,7.22,,,,,,,5.5800,65.0000,fee schedule,$7.22 from Fee Schedule UHC_31910 for Rev 311 Proc 88177 * Qty 1 = $7.22 at 100% = $7.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,46.45,,,,,,,5.5800,65.0000,fee schedule,APG 00391 Proc 88177 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 103% = $46.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA IMMEDIATE SCREEN EACH ADDITNL,88177,CPT,311,RC,31100017,CDM,,,,both,,,65.0000,9.7500,WELLCARE,WELLCARE MEDICAID,65.00,,,,,,,5.5800,65.0000,percent of total billed charges,100% of $65.00 in Billed Charges for Rev 311 Proc 88177 = $65.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,AETNA,AETNA,287.80,,,,,,,8.5400,708.9600,percent of total billed charges,42.7% of $674.00 in Billed Charges for Rev 311 Proc 88184 = $287.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,238.40,,,,,,,8.5400,708.9600,fee schedule,APG 00308 Proc 88184 at $836.60 (Base Rate) * 0.274 (Relative Weight) = $229.23 (Total Line Payment) at 104% = $238.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,325.21,,,,,,,8.5400,708.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,AETNA,AETNA HEALTHCARE MEDICARE,325.21,,,,,,,8.5400,708.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,325.21,,,,,,,8.5400,708.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,AMBETTER,AMBETTER,708.96,,,,,,,8.5400,708.9600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,338.22,,,,,,,8.5400,708.9600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,ANTHEM EXCHANGE,674.00,,,,,,,8.5400,708.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,236.11,,,,,,,8.5400,708.9600,fee schedule,APG 00308 Proc 88184 at $836.60 (Base Rate) * 0.274 (Relative Weight) = $229.23 (Total Line Payment) at 103% = $236.11. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,ANTHEM HMO,674.00,,,,,,,8.5400,708.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,334.97,,,,,,,8.5400,708.9600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",674.00,,,,,,,8.5400,708.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,45.00,,,,,,,8.5400,708.9600,fee schedule,$45.00 from Fee Schedule BLDTM_23 for Rev 311 Proc 88184 * Qty 1 = $45.00 at 100% = $45.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,BLUE CROSS E NETWORK,251.78,,,,,,,8.5400,708.9600,fee schedule,$78.68 from Fee Schedule BCFSB for Rev 311 Proc 88184 * Qty 1 = $78.68 at 320% = $251.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,BLUE CROSS MEDICARE,338.22,,,,,,,8.5400,708.9600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,BLUE CROSS P NETWORK,257.28,,,,,,,8.5400,708.9600,fee schedule,$78.68 from Fee Schedule BCFSB for Rev 311 Proc 88184 * Qty 1 = $78.68 at 327% = $257.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,BLUE CROSS S NETWORK,257.28,,,,,,,8.5400,708.9600,fee schedule,$78.68 from Fee Schedule BCFSB for Rev 311 Proc 88184 * Qty 1 = $78.68 at 327% = $257.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,TENNCARE BLUE CARE,42.41,,,,,,,8.5400,708.9600,fee schedule,$36.56 from Fee Schedule TC_24 for Rev 311 Proc 88184 * Qty 1 = $36.56 at 116% = $42.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,TENNCARE BLUE SELECT,42.41,,,,,,,8.5400,708.9600,fee schedule,$36.56 from Fee Schedule TC_24 for Rev 311 Proc 88184 * Qty 1 = $36.56 at 116% = $42.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,CIGNA HEALTHCARE,CIGNA HMO,234.93,,,,,,,8.5400,708.9600,fee schedule,$234.93 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88184 * Qty 1 = $234.93 at 100% = $234.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,168.33,,,,,,,8.5400,708.9600,fee schedule,$168.33 from Fee Schedule CGIFP_25LR for Rev 311 Proc 88184 * Qty 1 = $168.33 at 100% = $168.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,341.47,,,,,,,8.5400,708.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,234.93,,,,,,,8.5400,708.9600,fee schedule,$234.93 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88184 * Qty 1 = $234.93 at 100% = $234.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,CIGNA HEALTHCARE,CIGNA PPO,234.93,,,,,,,8.5400,708.9600,fee schedule,$234.93 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88184 * Qty 1 = $234.93 at 100% = $234.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,341.47,,,,,,,8.5400,708.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,606.60,,,,,,,8.5400,708.9600,percent of total billed charges,90% of $674.00 in Billed Charges for Rev 311 Proc 88184 = $606.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,HUMANA,HUMANA MEDICARE,325.21,,,,,,,8.5400,708.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,325.21,,,,,,,8.5400,708.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,MEDCOST,MEDCOST VHN,320.76,,,,,,,8.5400,708.9600,percent of total billed charges,47.59% of $674.00 in Billed Charges for Rev 311 Proc 88184 = $320.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,240.69,,,,,,,8.5400,708.9600,fee schedule,APG 00308 Proc 88184 at $836.60 (Base Rate) * 0.274 (Relative Weight) = $229.23 (Total Line Payment) at 100% = $229.23... $229.23 at 105% = $240.69 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,341.47,,,,,,,8.5400,708.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,341.47,,,,,,,8.5400,708.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,NHC ADVANTAGE,NHC ADVANTAGE,341.47,,,,,,,8.5400,708.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,236.34,,,,,,,8.5400,708.9600,fee schedule,APG 00308 Proc 88184 at $836.60 (Base Rate) * 0.274 (Relative Weight) = $229.23 (Total Line Payment) at 100% = $229.23... $229.23 at 103.1% = $236.34 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,SENTARA HEALTH,SENTARA HEALTH,173.96,,,,,,,8.5400,708.9600,percent of total billed charges,25.81% of $674.00 in Billed Charges for Rev 311 Proc 88184 = $173.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,SENTARA HEALTH,SENTARA MEDICARE,325.21,,,,,,,8.5400,708.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",674.00,,,,,,,8.5400,708.9600,percent of total billed charges,100% of $674.00 in Billed Charges for Rev 311 Proc 88184 = $674.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.54,,,,,,,8.5400,708.9600,fee schedule,$17.08 from Fee Schedule TCUHC24 for Rev 311 Proc 88184 * Qty 1 = $17.08 at 50% = $8.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,294.75,,,,,,,8.5400,708.9600,fee schedule,$283.41 from Fee Schedule UHC_31910 for Rev 311 Proc 88184 * Qty 1 = $283.41 at 104% = $294.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,283.41,,,,,,,8.5400,708.9600,fee schedule,$283.41 from Fee Schedule UHC_31910 for Rev 311 Proc 88184 * Qty 1 = $283.41 at 100% = $283.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,283.41,,,,,,,8.5400,708.9600,fee schedule,$283.41 from Fee Schedule UHC_31910 for Rev 311 Proc 88184 * Qty 1 = $283.41 at 100% = $283.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,236.11,,,,,,,8.5400,708.9600,fee schedule,APG 00308 Proc 88184 at $836.60 (Base Rate) * 0.274 (Relative Weight) = $229.23 (Total Line Payment) at 103% = $236.11. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,325.21,,,,,,,8.5400,708.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,325.21,,,,,,,8.5400,708.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,WELLCARE,WELLCARE MEDICAID,674.00,,,,,,,8.5400,708.9600,percent of total billed charges,100% of $674.00 in Billed Charges for Rev 311 Proc 88184 = $674.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLOW CYTOMETRY 1ST MARKER,88184,CPT,311,RC,31100011,CDM,,,,both,,,674.0000,101.1000,WELLCARE,WELLCARE MEDICARE,344.72,,,,,,,8.5400,708.9600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,AETNA,AETNA,56.79,,,,,,,5.7700,133.0000,percent of total billed charges,42.7% of $133.00 in Billed Charges for Rev 301 Proc 83516 = $56.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,14.27,,,,,,,5.7700,133.0000,fee schedule,APG 00400 Proc 83516 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 104% = $14.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,11.53,,,,,,,5.7700,133.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,AETNA,AETNA HEALTHCARE MEDICARE,11.53,,,,,,,5.7700,133.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,11.53,,,,,,,5.7700,133.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,AMBETTER,AMBETTER,25.14,,,,,,,5.7700,133.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,AMERIGROUP,AMERIGROUP,5.77,,,,,,,5.7700,133.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,11.99,,,,,,,5.7700,133.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,BLUE CROSS,ANTHEM EXCHANGE,11.53,,,,,,,5.7700,133.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,14.13,,,,,,,5.7700,133.0000,fee schedule,APG 00400 Proc 83516 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,BLUE CROSS,ANTHEM HMO,11.53,,,,,,,5.7700,133.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,11.88,,,,,,,5.7700,133.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",11.53,,,,,,,5.7700,133.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,39.75,,,,,,,5.7700,133.0000,fee schedule,$39.75 from Fee Schedule BLDTM_23 for Rev 301 Proc 83516 * Qty 1 = $39.75 at 100% = $39.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,BLUE CROSS,BLUE CROSS E NETWORK,49.98,,,,,,,5.7700,133.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 301 Proc 83516 * Qty 1 = $15.62 at 320% = $49.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,BLUE CROSS,BLUE CROSS MEDICARE,11.99,,,,,,,5.7700,133.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,BLUE CROSS,BLUE CROSS P NETWORK,51.08,,,,,,,5.7700,133.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 301 Proc 83516 * Qty 1 = $15.62 at 327% = $51.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,BLUE CROSS,BLUE CROSS S NETWORK,51.08,,,,,,,5.7700,133.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 301 Proc 83516 * Qty 1 = $15.62 at 327% = $51.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,BLUE CROSS,TENNCARE BLUE CARE,22.56,,,,,,,5.7700,133.0000,fee schedule,$19.45 from Fee Schedule TC_24 for Rev 301 Proc 83516 * Qty 1 = $19.45 at 116% = $22.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,BLUE CROSS,TENNCARE BLUE SELECT,22.56,,,,,,,5.7700,133.0000,fee schedule,$19.45 from Fee Schedule TC_24 for Rev 301 Proc 83516 * Qty 1 = $19.45 at 116% = $22.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,CIGNA HEALTHCARE,CIGNA HMO,46.41,,,,,,,5.7700,133.0000,fee schedule,$46.41 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83516 * Qty 1 = $46.41 at 100% = $46.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,25.26,,,,,,,5.7700,133.0000,fee schedule,$25.26 from Fee Schedule CGIFP_25LR for Rev 301 Proc 83516 * Qty 1 = $25.26 at 100% = $25.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,12.11,,,,,,,5.7700,133.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,46.41,,,,,,,5.7700,133.0000,fee schedule,$46.41 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83516 * Qty 1 = $46.41 at 100% = $46.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,CIGNA HEALTHCARE,CIGNA PPO,46.41,,,,,,,5.7700,133.0000,fee schedule,$46.41 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83516 * Qty 1 = $46.41 at 100% = $46.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,12.11,,,,,,,5.7700,133.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,119.70,,,,,,,5.7700,133.0000,percent of total billed charges,90% of $133.00 in Billed Charges for Rev 301 Proc 83516 = $119.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,HUMANA,HUMANA MEDICARE,11.53,,,,,,,5.7700,133.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,11.53,,,,,,,5.7700,133.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,MEDCOST,MEDCOST VHN,63.29,,,,,,,5.7700,133.0000,percent of total billed charges,47.59% of $133.00 in Billed Charges for Rev 301 Proc 83516 = $63.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,14.41,,,,,,,5.7700,133.0000,fee schedule,APG 00400 Proc 83516 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 105% = $14.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,12.11,,,,,,,5.7700,133.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,12.11,,,,,,,5.7700,133.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,NHC ADVANTAGE,NHC ADVANTAGE,12.11,,,,,,,5.7700,133.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,14.15,,,,,,,5.7700,133.0000,fee schedule,APG 00400 Proc 83516 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 103.1% = $14.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,SENTARA HEALTH,SENTARA HEALTH,34.33,,,,,,,5.7700,133.0000,percent of total billed charges,25.81% of $133.00 in Billed Charges for Rev 301 Proc 83516 = $34.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,SENTARA HEALTH,SENTARA MEDICARE,11.53,,,,,,,5.7700,133.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",133.00,,,,,,,5.7700,133.0000,percent of total billed charges,100% of $133.00 in Billed Charges for Rev 301 Proc 83516 = $133.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.17,,,,,,,5.7700,133.0000,fee schedule,$16.34 from Fee Schedule TCUHC24 for Rev 301 Proc 83516 * Qty 1 = $16.34 at 50% = $8.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,11.99,,,,,,,5.7700,133.0000,fee schedule,$11.53 from Fee Schedule UHC_31910 for Rev 301 Proc 83516 * Qty 1 = $11.53 at 104% = $11.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,11.53,,,,,,,5.7700,133.0000,fee schedule,$11.53 from Fee Schedule UHC_31910 for Rev 301 Proc 83516 * Qty 1 = $11.53 at 100% = $11.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,11.53,,,,,,,5.7700,133.0000,fee schedule,$11.53 from Fee Schedule UHC_31910 for Rev 301 Proc 83516 * Qty 1 = $11.53 at 100% = $11.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,14.13,,,,,,,5.7700,133.0000,fee schedule,APG 00400 Proc 83516 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,11.53,,,,,,,5.7700,133.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,11.53,,,,,,,5.7700,133.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,WELLCARE,WELLCARE MEDICAID,133.00,,,,,,,5.7700,133.0000,percent of total billed charges,100% of $133.00 in Billed Charges for Rev 301 Proc 83516 = $133.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOASSAY MULTI STEP REF,83516,CPT,301,RC,30100159,CDM,,,,both,,,133.0000,19.9500,WELLCARE,WELLCARE MEDICARE,12.22,,,,,,,5.7700,133.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,AETNA,AETNA,38.00,,,,,,,4.8200,89.0000,percent of total billed charges,42.7% of $89.00 in Billed Charges for Rev 301 Proc 83518 = $38.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,6.44,,,,,,,4.8200,89.0000,fee schedule,APG 00402 Proc 83518 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 104% = $6.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,9.64,,,,,,,4.8200,89.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,AETNA,AETNA HEALTHCARE MEDICARE,9.64,,,,,,,4.8200,89.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,9.64,,,,,,,4.8200,89.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,AMBETTER,AMBETTER,21.02,,,,,,,4.8200,89.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,AMERIGROUP,AMERIGROUP,4.82,,,,,,,4.8200,89.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,10.03,,,,,,,4.8200,89.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,ANTHEM EXCHANGE,9.64,,,,,,,4.8200,89.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,6.38,,,,,,,4.8200,89.0000,fee schedule,APG 00402 Proc 83518 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,ANTHEM HMO,9.64,,,,,,,4.8200,89.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,9.93,,,,,,,4.8200,89.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9.64,,,,,,,4.8200,89.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,29.38,,,,,,,4.8200,89.0000,fee schedule,$29.38 from Fee Schedule BLDTM_23 for Rev 301 Proc 83518 * Qty 1 = $29.38 at 100% = $29.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,BLUE CROSS E NETWORK,33.38,,,,,,,4.8200,89.0000,fee schedule,$10.43 from Fee Schedule BCFSB for Rev 301 Proc 83518 * Qty 1 = $10.43 at 320% = $33.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,BLUE CROSS MEDICARE,10.03,,,,,,,4.8200,89.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,BLUE CROSS P NETWORK,34.11,,,,,,,4.8200,89.0000,fee schedule,$10.43 from Fee Schedule BCFSB for Rev 301 Proc 83518 * Qty 1 = $10.43 at 327% = $34.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,BLUE CROSS S NETWORK,34.11,,,,,,,4.8200,89.0000,fee schedule,$10.43 from Fee Schedule BCFSB for Rev 301 Proc 83518 * Qty 1 = $10.43 at 327% = $34.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,TENNCARE BLUE CARE,15.05,,,,,,,4.8200,89.0000,fee schedule,$12.97 from Fee Schedule TC_24 for Rev 301 Proc 83518 * Qty 1 = $12.97 at 116% = $15.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,BLUE CROSS,TENNCARE BLUE SELECT,15.05,,,,,,,4.8200,89.0000,fee schedule,$12.97 from Fee Schedule TC_24 for Rev 301 Proc 83518 * Qty 1 = $12.97 at 116% = $15.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA HMO,34.09,,,,,,,4.8200,89.0000,fee schedule,$34.09 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83518 * Qty 1 = $34.09 at 100% = $34.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,20.93,,,,,,,4.8200,89.0000,fee schedule,$20.93 from Fee Schedule CGIFP_25LR for Rev 301 Proc 83518 * Qty 1 = $20.93 at 100% = $20.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,10.12,,,,,,,4.8200,89.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,34.09,,,,,,,4.8200,89.0000,fee schedule,$34.09 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83518 * Qty 1 = $34.09 at 100% = $34.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,CIGNA HEALTHCARE,CIGNA PPO,34.09,,,,,,,4.8200,89.0000,fee schedule,$34.09 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83518 * Qty 1 = $34.09 at 100% = $34.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,10.12,,,,,,,4.8200,89.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,80.10,,,,,,,4.8200,89.0000,percent of total billed charges,90% of $89.00 in Billed Charges for Rev 301 Proc 83518 = $80.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,HUMANA,HUMANA MEDICARE,9.64,,,,,,,4.8200,89.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,9.64,,,,,,,4.8200,89.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,MEDCOST,MEDCOST VHN,42.36,,,,,,,4.8200,89.0000,percent of total billed charges,47.59% of $89.00 in Billed Charges for Rev 301 Proc 83518 = $42.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,6.50,,,,,,,4.8200,89.0000,fee schedule,APG 00402 Proc 83518 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 105% = $6.50 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,10.12,,,,,,,4.8200,89.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,10.12,,,,,,,4.8200,89.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,NHC ADVANTAGE,NHC ADVANTAGE,10.12,,,,,,,4.8200,89.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,6.38,,,,,,,4.8200,89.0000,fee schedule,APG 00402 Proc 83518 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 103.1% = $6.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,SENTARA HEALTH,SENTARA HEALTH,22.97,,,,,,,4.8200,89.0000,percent of total billed charges,25.81% of $89.00 in Billed Charges for Rev 301 Proc 83518 = $22.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,SENTARA HEALTH,SENTARA MEDICARE,9.64,,,,,,,4.8200,89.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",89.00,,,,,,,4.8200,89.0000,percent of total billed charges,100% of $89.00 in Billed Charges for Rev 301 Proc 83518 = $89.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6.00,,,,,,,4.8200,89.0000,fee schedule,$12.00 from Fee Schedule TCUHC24 for Rev 301 Proc 83518 * Qty 1 = $12.00 at 50% = $6.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,10.03,,,,,,,4.8200,89.0000,fee schedule,$9.64 from Fee Schedule UHC_31910 for Rev 301 Proc 83518 * Qty 1 = $9.64 at 104% = $10.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,9.64,,,,,,,4.8200,89.0000,fee schedule,$9.64 from Fee Schedule UHC_31910 for Rev 301 Proc 83518 * Qty 1 = $9.64 at 100% = $9.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,9.64,,,,,,,4.8200,89.0000,fee schedule,$9.64 from Fee Schedule UHC_31910 for Rev 301 Proc 83518 * Qty 1 = $9.64 at 100% = $9.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,6.38,,,,,,,4.8200,89.0000,fee schedule,APG 00402 Proc 83518 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,9.64,,,,,,,4.8200,89.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,9.64,,,,,,,4.8200,89.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,WELLCARE,WELLCARE MEDICAID,89.00,,,,,,,4.8200,89.0000,percent of total billed charges,100% of $89.00 in Billed Charges for Rev 301 Proc 83518 = $89.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOASSAY ANALYTE QUAL/EMIZUAL SINGLE STEP,83518,CPT,301,RC,30100497,CDM,,,,both,,,89.0000,13.3500,WELLCARE,WELLCARE MEDICARE,10.22,,,,,,,4.8200,89.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,AETNA,AETNA,67.47,,,,,,,9.2000,158.0000,percent of total billed charges,42.7% of $158.00 in Billed Charges for Rev 301 Proc 83519 = $67.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,14.27,,,,,,,9.2000,158.0000,fee schedule,APG 00400 Proc 83519 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 104% = $14.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,AETNA,AETNA HEALTHCARE MEDICARE,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,AMBETTER,AMBETTER,40.11,,,,,,,9.2000,158.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,AMERIGROUP,AMERIGROUP,9.20,,,,,,,9.2000,158.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,19.14,,,,,,,9.2000,158.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,ANTHEM EXCHANGE,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,14.13,,,,,,,9.2000,158.0000,fee schedule,APG 00400 Proc 83519 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,ANTHEM HMO,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,18.95,,,,,,,9.2000,158.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,46.68,,,,,,,9.2000,158.0000,fee schedule,$46.68 from Fee Schedule BLDTM_23 for Rev 301 Proc 83519 * Qty 1 = $46.68 at 100% = $46.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS E NETWORK,58.98,,,,,,,9.2000,158.0000,fee schedule,$18.43 from Fee Schedule BCFSB for Rev 301 Proc 83519 * Qty 1 = $18.43 at 320% = $58.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS MEDICARE,19.14,,,,,,,9.2000,158.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS P NETWORK,60.27,,,,,,,9.2000,158.0000,fee schedule,$18.43 from Fee Schedule BCFSB for Rev 301 Proc 83519 * Qty 1 = $18.43 at 327% = $60.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS S NETWORK,60.27,,,,,,,9.2000,158.0000,fee schedule,$18.43 from Fee Schedule BCFSB for Rev 301 Proc 83519 * Qty 1 = $18.43 at 327% = $60.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,TENNCARE BLUE CARE,18.55,,,,,,,9.2000,158.0000,fee schedule,$15.99 from Fee Schedule TC_24 for Rev 301 Proc 83519 * Qty 1 = $15.99 at 116% = $18.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,TENNCARE BLUE SELECT,18.55,,,,,,,9.2000,158.0000,fee schedule,$15.99 from Fee Schedule TC_24 for Rev 301 Proc 83519 * Qty 1 = $15.99 at 116% = $18.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA HMO,54.36,,,,,,,9.2000,158.0000,fee schedule,$54.36 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83519 * Qty 1 = $54.36 at 100% = $54.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,40.42,,,,,,,9.2000,158.0000,fee schedule,$40.42 from Fee Schedule CGIFP_25LR for Rev 301 Proc 83519 * Qty 1 = $40.42 at 100% = $40.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,19.32,,,,,,,9.2000,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,54.36,,,,,,,9.2000,158.0000,fee schedule,$54.36 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83519 * Qty 1 = $54.36 at 100% = $54.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA PPO,54.36,,,,,,,9.2000,158.0000,fee schedule,$54.36 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83519 * Qty 1 = $54.36 at 100% = $54.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,19.32,,,,,,,9.2000,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,142.20,,,,,,,9.2000,158.0000,percent of total billed charges,90% of $158.00 in Billed Charges for Rev 301 Proc 83519 = $142.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,HUMANA,HUMANA MEDICARE,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,MEDCOST,MEDCOST VHN,75.19,,,,,,,9.2000,158.0000,percent of total billed charges,47.59% of $158.00 in Billed Charges for Rev 301 Proc 83519 = $75.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,14.41,,,,,,,9.2000,158.0000,fee schedule,APG 00400 Proc 83519 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 105% = $14.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,19.32,,,,,,,9.2000,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,19.32,,,,,,,9.2000,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,NHC ADVANTAGE,NHC ADVANTAGE,19.32,,,,,,,9.2000,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,14.15,,,,,,,9.2000,158.0000,fee schedule,APG 00400 Proc 83519 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 103.1% = $14.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,SENTARA HEALTH,SENTARA HEALTH,40.78,,,,,,,9.2000,158.0000,percent of total billed charges,25.81% of $158.00 in Billed Charges for Rev 301 Proc 83519 = $40.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,SENTARA HEALTH,SENTARA MEDICARE,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",158.00,,,,,,,9.2000,158.0000,percent of total billed charges,100% of $158.00 in Billed Charges for Rev 301 Proc 83519 = $158.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9.57,,,,,,,9.2000,158.0000,fee schedule,$19.14 from Fee Schedule TCUHC24 for Rev 301 Proc 83519 * Qty 1 = $19.14 at 50% = $9.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,19.14,,,,,,,9.2000,158.0000,fee schedule,$18.40 from Fee Schedule UHC_31910 for Rev 301 Proc 83519 * Qty 1 = $18.40 at 104% = $19.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,18.40,,,,,,,9.2000,158.0000,fee schedule,$18.40 from Fee Schedule UHC_31910 for Rev 301 Proc 83519 * Qty 1 = $18.40 at 100% = $18.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,18.40,,,,,,,9.2000,158.0000,fee schedule,$18.40 from Fee Schedule UHC_31910 for Rev 301 Proc 83519 * Qty 1 = $18.40 at 100% = $18.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,14.13,,,,,,,9.2000,158.0000,fee schedule,APG 00400 Proc 83519 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,WELLCARE,WELLCARE MEDICAID,158.00,,,,,,,9.2000,158.0000,percent of total billed charges,100% of $158.00 in Billed Charges for Rev 301 Proc 83519 = $158.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOASSAY QUANT RIA,83519,CPT,301,RC,30100160,CDM,,,,both,,,158.0000,23.7000,WELLCARE,WELLCARE MEDICARE,19.50,,,,,,,9.2000,158.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,AETNA,AETNA,64.48,,,,,,,8.6400,151.0000,percent of total billed charges,42.7% of $151.00 in Billed Charges for Rev 301 Proc 83520 = $64.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,14.27,,,,,,,8.6400,151.0000,fee schedule,APG 00400 Proc 83520 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 104% = $14.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,17.27,,,,,,,8.6400,151.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,AETNA,AETNA HEALTHCARE MEDICARE,17.27,,,,,,,8.6400,151.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,17.27,,,,,,,8.6400,151.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,AMBETTER,AMBETTER,37.65,,,,,,,8.6400,151.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,AMERIGROUP,AMERIGROUP,8.64,,,,,,,8.6400,151.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,17.96,,,,,,,8.6400,151.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,BLUE CROSS,ANTHEM EXCHANGE,17.27,,,,,,,8.6400,151.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,14.13,,,,,,,8.6400,151.0000,fee schedule,APG 00400 Proc 83520 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,BLUE CROSS,ANTHEM HMO,17.27,,,,,,,8.6400,151.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,17.79,,,,,,,8.6400,151.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",17.27,,,,,,,8.6400,151.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,44.95,,,,,,,8.6400,151.0000,fee schedule,$44.95 from Fee Schedule BLDTM_23 for Rev 301 Proc 83520 * Qty 1 = $44.95 at 100% = $44.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,BLUE CROSS,BLUE CROSS E NETWORK,56.51,,,,,,,8.6400,151.0000,fee schedule,$17.66 from Fee Schedule BCFSB for Rev 301 Proc 83520 * Qty 1 = $17.66 at 320% = $56.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,BLUE CROSS,BLUE CROSS MEDICARE,17.96,,,,,,,8.6400,151.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,BLUE CROSS,BLUE CROSS P NETWORK,57.75,,,,,,,8.6400,151.0000,fee schedule,$17.66 from Fee Schedule BCFSB for Rev 301 Proc 83520 * Qty 1 = $17.66 at 327% = $57.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,BLUE CROSS,BLUE CROSS S NETWORK,57.75,,,,,,,8.6400,151.0000,fee schedule,$17.66 from Fee Schedule BCFSB for Rev 301 Proc 83520 * Qty 1 = $17.66 at 327% = $57.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,BLUE CROSS,TENNCARE BLUE CARE,28.14,,,,,,,8.6400,151.0000,fee schedule,$24.26 from Fee Schedule TC_24 for Rev 301 Proc 83520 * Qty 1 = $24.26 at 116% = $28.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,BLUE CROSS,TENNCARE BLUE SELECT,28.14,,,,,,,8.6400,151.0000,fee schedule,$24.26 from Fee Schedule TC_24 for Rev 301 Proc 83520 * Qty 1 = $24.26 at 116% = $28.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,CIGNA HEALTHCARE,CIGNA HMO,52.09,,,,,,,8.6400,151.0000,fee schedule,$52.09 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83520 * Qty 1 = $52.09 at 100% = $52.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,38.25,,,,,,,8.6400,151.0000,fee schedule,$38.25 from Fee Schedule CGIFP_25LR for Rev 301 Proc 83520 * Qty 1 = $38.25 at 100% = $38.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,18.13,,,,,,,8.6400,151.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,52.09,,,,,,,8.6400,151.0000,fee schedule,$52.09 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83520 * Qty 1 = $52.09 at 100% = $52.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,CIGNA HEALTHCARE,CIGNA PPO,52.09,,,,,,,8.6400,151.0000,fee schedule,$52.09 from Fee Schedule CIGWHS_23 for Rev 301 Proc 83520 * Qty 1 = $52.09 at 100% = $52.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,18.13,,,,,,,8.6400,151.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,135.90,,,,,,,8.6400,151.0000,percent of total billed charges,90% of $151.00 in Billed Charges for Rev 301 Proc 83520 = $135.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,HUMANA,HUMANA MEDICARE,17.27,,,,,,,8.6400,151.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,17.27,,,,,,,8.6400,151.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,MEDCOST,MEDCOST VHN,71.86,,,,,,,8.6400,151.0000,percent of total billed charges,47.59% of $151.00 in Billed Charges for Rev 301 Proc 83520 = $71.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,14.41,,,,,,,8.6400,151.0000,fee schedule,APG 00400 Proc 83520 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 105% = $14.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,18.13,,,,,,,8.6400,151.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,18.13,,,,,,,8.6400,151.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,NHC ADVANTAGE,NHC ADVANTAGE,18.13,,,,,,,8.6400,151.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,14.15,,,,,,,8.6400,151.0000,fee schedule,APG 00400 Proc 83520 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 103.1% = $14.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,SENTARA HEALTH,SENTARA HEALTH,38.97,,,,,,,8.6400,151.0000,percent of total billed charges,25.81% of $151.00 in Billed Charges for Rev 301 Proc 83520 = $38.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,SENTARA HEALTH,SENTARA MEDICARE,17.27,,,,,,,8.6400,151.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",151.00,,,,,,,8.6400,151.0000,percent of total billed charges,100% of $151.00 in Billed Charges for Rev 301 Proc 83520 = $151.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9.17,,,,,,,8.6400,151.0000,fee schedule,$18.34 from Fee Schedule TCUHC24 for Rev 301 Proc 83520 * Qty 1 = $18.34 at 50% = $9.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,17.96,,,,,,,8.6400,151.0000,fee schedule,$17.27 from Fee Schedule UHC_31910 for Rev 301 Proc 83520 * Qty 1 = $17.27 at 104% = $17.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,17.27,,,,,,,8.6400,151.0000,fee schedule,$17.27 from Fee Schedule UHC_31910 for Rev 301 Proc 83520 * Qty 1 = $17.27 at 100% = $17.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,17.27,,,,,,,8.6400,151.0000,fee schedule,$17.27 from Fee Schedule UHC_31910 for Rev 301 Proc 83520 * Qty 1 = $17.27 at 100% = $17.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,14.13,,,,,,,8.6400,151.0000,fee schedule,APG 00400 Proc 83520 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,17.27,,,,,,,8.6400,151.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,17.27,,,,,,,8.6400,151.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,WELLCARE,WELLCARE MEDICAID,151.00,,,,,,,8.6400,151.0000,percent of total billed charges,100% of $151.00 in Billed Charges for Rev 301 Proc 83520 = $151.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IMMUNOASSAY QUANT NOS,83520,CPT,301,RC,30100161,CDM,,,,both,,,151.0000,22.6500,WELLCARE,WELLCARE MEDICARE,18.31,,,,,,,8.6400,151.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,AETNA,AETNA,27.33,,,,,,,2.7500,64.0000,percent of total billed charges,42.7% of $64.00 in Billed Charges for Rev 301 Proc 84377 = $27.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,6.44,,,,,,,2.7500,64.0000,fee schedule,APG 00402 Proc 84377 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 104% = $6.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5.50,,,,,,,2.7500,64.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,AETNA,AETNA HEALTHCARE MEDICARE,5.50,,,,,,,2.7500,64.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,5.50,,,,,,,2.7500,64.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,AMBETTER,AMBETTER,11.99,,,,,,,2.7500,64.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,AMERIGROUP,AMERIGROUP,2.75,,,,,,,2.7500,64.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,5.72,,,,,,,2.7500,64.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,BLUE CROSS,ANTHEM EXCHANGE,5.50,,,,,,,2.7500,64.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,6.38,,,,,,,2.7500,64.0000,fee schedule,APG 00402 Proc 84377 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,BLUE CROSS,ANTHEM HMO,5.50,,,,,,,2.7500,64.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5.67,,,,,,,2.7500,64.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5.50,,,,,,,2.7500,64.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,19.04,,,,,,,2.7500,64.0000,fee schedule,$19.04 from Fee Schedule BLDTM_23 for Rev 301 Proc 84377 * Qty 1 = $19.04 at 100% = $19.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,BLUE CROSS,BLUE CROSS E NETWORK,24.00,,,,,,,2.7500,64.0000,fee schedule,$7.50 from Fee Schedule BCFSB for Rev 301 Proc 84377 * Qty 1 = $7.50 at 320% = $24.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,BLUE CROSS,BLUE CROSS MEDICARE,5.72,,,,,,,2.7500,64.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,BLUE CROSS,BLUE CROSS P NETWORK,24.53,,,,,,,2.7500,64.0000,fee schedule,$7.50 from Fee Schedule BCFSB for Rev 301 Proc 84377 * Qty 1 = $7.50 at 327% = $24.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,BLUE CROSS,BLUE CROSS S NETWORK,24.53,,,,,,,2.7500,64.0000,fee schedule,$7.50 from Fee Schedule BCFSB for Rev 301 Proc 84377 * Qty 1 = $7.50 at 327% = $24.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,BLUE CROSS,TENNCARE BLUE CARE,11.14,,,,,,,2.7500,64.0000,fee schedule,$9.60 from Fee Schedule TC_24 for Rev 301 Proc 84377 * Qty 1 = $9.60 at 116% = $11.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,BLUE CROSS,TENNCARE BLUE SELECT,11.14,,,,,,,2.7500,64.0000,fee schedule,$9.60 from Fee Schedule TC_24 for Rev 301 Proc 84377 * Qty 1 = $9.60 at 116% = $11.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,CIGNA HEALTHCARE,CIGNA HMO,22.11,,,,,,,2.7500,64.0000,fee schedule,$22.11 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84377 * Qty 1 = $22.11 at 100% = $22.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12.27,,,,,,,2.7500,64.0000,fee schedule,$12.27 from Fee Schedule CGIFP_25LR for Rev 301 Proc 84377 * Qty 1 = $12.27 at 100% = $12.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,5.78,,,,,,,2.7500,64.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,22.11,,,,,,,2.7500,64.0000,fee schedule,$22.11 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84377 * Qty 1 = $22.11 at 100% = $22.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,CIGNA HEALTHCARE,CIGNA PPO,22.11,,,,,,,2.7500,64.0000,fee schedule,$22.11 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84377 * Qty 1 = $22.11 at 100% = $22.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,5.78,,,,,,,2.7500,64.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,57.60,,,,,,,2.7500,64.0000,percent of total billed charges,90% of $64.00 in Billed Charges for Rev 301 Proc 84377 = $57.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,HUMANA,HUMANA MEDICARE,5.50,,,,,,,2.7500,64.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5.50,,,,,,,2.7500,64.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,MEDCOST,MEDCOST VHN,30.46,,,,,,,2.7500,64.0000,percent of total billed charges,47.59% of $64.00 in Billed Charges for Rev 301 Proc 84377 = $30.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,6.50,,,,,,,2.7500,64.0000,fee schedule,APG 00402 Proc 84377 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 105% = $6.50 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,5.78,,,,,,,2.7500,64.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,5.78,,,,,,,2.7500,64.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,NHC ADVANTAGE,NHC ADVANTAGE,5.78,,,,,,,2.7500,64.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,6.38,,,,,,,2.7500,64.0000,fee schedule,APG 00402 Proc 84377 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 100% = $6.19... $6.19 at 103.1% = $6.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,SENTARA HEALTH,SENTARA HEALTH,16.52,,,,,,,2.7500,64.0000,percent of total billed charges,25.81% of $64.00 in Billed Charges for Rev 301 Proc 84377 = $16.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,SENTARA HEALTH,SENTARA MEDICARE,5.50,,,,,,,2.7500,64.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",64.00,,,,,,,2.7500,64.0000,percent of total billed charges,100% of $64.00 in Billed Charges for Rev 301 Proc 84377 = $64.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3.90,,,,,,,2.7500,64.0000,fee schedule,$7.79 from Fee Schedule TCUHC24 for Rev 301 Proc 84377 * Qty 1 = $7.79 at 50% = $3.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5.72,,,,,,,2.7500,64.0000,fee schedule,$5.50 from Fee Schedule UHC_31910 for Rev 301 Proc 84377 * Qty 1 = $5.50 at 104% = $5.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,5.50,,,,,,,2.7500,64.0000,fee schedule,$5.50 from Fee Schedule UHC_31910 for Rev 301 Proc 84377 * Qty 1 = $5.50 at 100% = $5.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,5.50,,,,,,,2.7500,64.0000,fee schedule,$5.50 from Fee Schedule UHC_31910 for Rev 301 Proc 84377 * Qty 1 = $5.50 at 100% = $5.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,6.38,,,,,,,2.7500,64.0000,fee schedule,APG 00402 Proc 84377 at $836.60 (Base Rate) * 0.0074 (Relative Weight) = $6.19 (Total Line Payment) at 103% = $6.38. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5.50,,,,,,,2.7500,64.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5.50,,,,,,,2.7500,64.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,WELLCARE,WELLCARE MEDICAID,64.00,,,,,,,2.7500,64.0000,percent of total billed charges,100% of $64.00 in Billed Charges for Rev 301 Proc 84377 = $64.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUGARS MULTIPLE QUAL EA SPECIMEN,84377,CPT,301,RC,30100519,CDM,,,,both,,,64.0000,9.6000,WELLCARE,WELLCARE MEDICARE,5.83,,,,,,,2.7500,64.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,AETNA,AETNA,35.01,,,,,,,5.7700,82.0000,percent of total billed charges,42.7% of $82.00 in Billed Charges for Rev 300 Proc 84379 = $35.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,14.27,,,,,,,5.7700,82.0000,fee schedule,APG 00400 Proc 84379 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 104% = $14.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,11.53,,,,,,,5.7700,82.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,AETNA,AETNA HEALTHCARE MEDICARE,11.53,,,,,,,5.7700,82.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,11.53,,,,,,,5.7700,82.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,AMBETTER,AMBETTER,25.14,,,,,,,5.7700,82.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,AMERIGROUP,AMERIGROUP,5.77,,,,,,,5.7700,82.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,11.99,,,,,,,5.7700,82.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,ANTHEM EXCHANGE,11.53,,,,,,,5.7700,82.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,14.13,,,,,,,5.7700,82.0000,fee schedule,APG 00400 Proc 84379 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,ANTHEM HMO,11.53,,,,,,,5.7700,82.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,11.88,,,,,,,5.7700,82.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",11.53,,,,,,,5.7700,82.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,39.81,,,,,,,5.7700,82.0000,fee schedule,$39.81 from Fee Schedule BLDTM_23 for Rev 300 Proc 84379 * Qty 1 = $39.81 at 100% = $39.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,BLUE CROSS E NETWORK,50.34,,,,,,,5.7700,82.0000,fee schedule,$15.73 from Fee Schedule BCFSB for Rev 300 Proc 84379 * Qty 1 = $15.73 at 320% = $50.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,BLUE CROSS MEDICARE,11.99,,,,,,,5.7700,82.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,BLUE CROSS P NETWORK,51.44,,,,,,,5.7700,82.0000,fee schedule,$15.73 from Fee Schedule BCFSB for Rev 300 Proc 84379 * Qty 1 = $15.73 at 327% = $51.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,BLUE CROSS S NETWORK,51.44,,,,,,,5.7700,82.0000,fee schedule,$15.73 from Fee Schedule BCFSB for Rev 300 Proc 84379 * Qty 1 = $15.73 at 327% = $51.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,TENNCARE BLUE CARE,23.30,,,,,,,5.7700,82.0000,fee schedule,$20.09 from Fee Schedule TC_24 for Rev 300 Proc 84379 * Qty 1 = $20.09 at 116% = $23.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,BLUE CROSS,TENNCARE BLUE SELECT,23.30,,,,,,,5.7700,82.0000,fee schedule,$20.09 from Fee Schedule TC_24 for Rev 300 Proc 84379 * Qty 1 = $20.09 at 116% = $23.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA HMO,46.37,,,,,,,5.7700,82.0000,fee schedule,$46.37 from Fee Schedule CIGWHS_23 for Rev 300 Proc 84379 * Qty 1 = $46.37 at 100% = $46.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,25.26,,,,,,,5.7700,82.0000,fee schedule,$25.26 from Fee Schedule CGIFP_25LR for Rev 300 Proc 84379 * Qty 1 = $25.26 at 100% = $25.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,12.11,,,,,,,5.7700,82.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,46.37,,,,,,,5.7700,82.0000,fee schedule,$46.37 from Fee Schedule CIGWHS_23 for Rev 300 Proc 84379 * Qty 1 = $46.37 at 100% = $46.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,CIGNA HEALTHCARE,CIGNA PPO,46.37,,,,,,,5.7700,82.0000,fee schedule,$46.37 from Fee Schedule CIGWHS_23 for Rev 300 Proc 84379 * Qty 1 = $46.37 at 100% = $46.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,12.11,,,,,,,5.7700,82.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,73.80,,,,,,,5.7700,82.0000,percent of total billed charges,90% of $82.00 in Billed Charges for Rev 300 Proc 84379 = $73.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,HUMANA,HUMANA MEDICARE,11.53,,,,,,,5.7700,82.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,11.53,,,,,,,5.7700,82.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,MEDCOST,MEDCOST VHN,39.02,,,,,,,5.7700,82.0000,percent of total billed charges,47.59% of $82.00 in Billed Charges for Rev 300 Proc 84379 = $39.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,14.41,,,,,,,5.7700,82.0000,fee schedule,APG 00400 Proc 84379 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 105% = $14.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,12.11,,,,,,,5.7700,82.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,12.11,,,,,,,5.7700,82.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,NHC ADVANTAGE,NHC ADVANTAGE,12.11,,,,,,,5.7700,82.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,14.15,,,,,,,5.7700,82.0000,fee schedule,APG 00400 Proc 84379 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 103.1% = $14.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,SENTARA HEALTH,SENTARA HEALTH,21.16,,,,,,,5.7700,82.0000,percent of total billed charges,25.81% of $82.00 in Billed Charges for Rev 300 Proc 84379 = $21.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,SENTARA HEALTH,SENTARA MEDICARE,11.53,,,,,,,5.7700,82.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",82.00,,,,,,,5.7700,82.0000,percent of total billed charges,100% of $82.00 in Billed Charges for Rev 300 Proc 84379 = $82.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.16,,,,,,,5.7700,82.0000,fee schedule,$16.32 from Fee Schedule TCUHC24 for Rev 300 Proc 84379 * Qty 1 = $16.32 at 50% = $8.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,11.99,,,,,,,5.7700,82.0000,fee schedule,$11.53 from Fee Schedule UHC_31910 for Rev 300 Proc 84379 * Qty 1 = $11.53 at 104% = $11.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11.53,,,,,,,5.7700,82.0000,fee schedule,$11.53 from Fee Schedule UHC_31910 for Rev 300 Proc 84379 * Qty 1 = $11.53 at 100% = $11.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,11.53,,,,,,,5.7700,82.0000,fee schedule,$11.53 from Fee Schedule UHC_31910 for Rev 300 Proc 84379 * Qty 1 = $11.53 at 100% = $11.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,14.13,,,,,,,5.7700,82.0000,fee schedule,APG 00400 Proc 84379 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,11.53,,,,,,,5.7700,82.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,11.53,,,,,,,5.7700,82.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,WELLCARE,WELLCARE MEDICAID,82.00,,,,,,,5.7700,82.0000,percent of total billed charges,100% of $82.00 in Billed Charges for Rev 300 Proc 84379 = $82.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC,84379,CPT,300,RC,30000338,CDM,,,,both,,,82.0000,12.3000,WELLCARE,WELLCARE MEDICARE,12.22,,,,,,,5.7700,82.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,AETNA,AETNA,145.18,,,,,,,19.2900,405.0500,percent of total billed charges,42.7% of $340.00 in Billed Charges for Rev 440 Proc 92608 = $145.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,401.19,,,,,,,19.2900,405.0500,fee schedule,APG 00272 Proc 92608 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 104% = $401.19. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,45.54,,,,,,,19.2900,405.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,AETNA,AETNA HEALTHCARE MEDICARE,45.54,,,,,,,19.2900,405.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,ALLCARE MEDICARE,ALLCARE MEDICARE,45.54,,,,,,,19.2900,405.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,AMBETTER,AMBETTER,99.28,,,,,,,19.2900,405.0500,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,AMERIGROUP,AMERIGROUP,42.35,,,,,,,19.2900,405.0500,fee schedule,93.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,47.36,,,,,,,19.2900,405.0500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,BLUE CROSS,ANTHEM EXCHANGE,45.54,,,,,,,19.2900,405.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,340.00,,,,,,,19.2900,405.0500,fee schedule,"APG 00272 Proc 92608 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 103% = $397.33 (Service Line reduced to $340.00, claim capped at $340.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,BLUE CROSS,ANTHEM HMO,45.54,,,,,,,19.2900,405.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,46.91,,,,,,,19.2900,405.0500,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",45.54,,,,,,,19.2900,405.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,116.00,,,,,,,19.2900,405.0500,other,Rev 440 Proc 92608 1 Visit at $116.00 per Visit = $116.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,BLUE CROSS,BLUE CROSS E NETWORK,219.22,,,,,,,19.2900,405.0500,fee schedule,$50.28 from Fee Schedule BCFSG for Rev 440 Proc 92608 * Qty 1 = $50.28 at 436% = $219.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,BLUE CROSS,BLUE CROSS MEDICARE,47.36,,,,,,,19.2900,405.0500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,BLUE CROSS,BLUE CROSS P NETWORK,223.75,,,,,,,19.2900,405.0500,fee schedule,$50.28 from Fee Schedule BCFSG for Rev 440 Proc 92608 * Qty 1 = $50.28 at 445% = $223.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,BLUE CROSS,BLUE CROSS S NETWORK,223.75,,,,,,,19.2900,405.0500,fee schedule,$50.28 from Fee Schedule BCFSG for Rev 440 Proc 92608 * Qty 1 = $50.28 at 445% = $223.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,BLUE CROSS,TENNCARE BLUE CARE,19.29,,,,,,,19.2900,405.0500,fee schedule,$16.63 from Fee Schedule TC_24 for Rev 440 Proc 92608 * Qty 1 = $16.63 at 116% = $19.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,BLUE CROSS,TENNCARE BLUE SELECT,19.29,,,,,,,19.2900,405.0500,fee schedule,$16.63 from Fee Schedule TC_24 for Rev 440 Proc 92608 * Qty 1 = $16.63 at 116% = $19.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,CIGNA HEALTHCARE,CIGNA HMO,141.78,,,,,,,19.2900,405.0500,percent of total billed charges,41.7% of $340.00 in Billed Charges for Rev 440 Proc 92608 = $141.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,157.76,,,,,,,19.2900,405.0500,percent of total billed charges,46.4% of $340.00 in Billed Charges for Rev 440 Proc 92608 = $157.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,CIGNA HEALTHCARE,CIGNA MEDICARE,47.82,,,,,,,19.2900,405.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,141.78,,,,,,,19.2900,405.0500,percent of total billed charges,41.7% of $340.00 in Billed Charges for Rev 440 Proc 92608 = $141.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,CIGNA HEALTHCARE,CIGNA PPO,141.78,,,,,,,19.2900,405.0500,percent of total billed charges,41.7% of $340.00 in Billed Charges for Rev 440 Proc 92608 = $141.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,47.82,,,,,,,19.2900,405.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,306.00,,,,,,,19.2900,405.0500,percent of total billed charges,90% of $340.00 in Billed Charges for Rev 440 Proc 92608 = $306.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,HUMANA,HUMANA MEDICARE,45.54,,,,,,,19.2900,405.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,45.54,,,,,,,19.2900,405.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,MEDCOST,MEDCOST VHN,161.81,,,,,,,19.2900,405.0500,percent of total billed charges,47.59% of $340.00 in Billed Charges for Rev 440 Proc 92608 = $161.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,405.05,,,,,,,19.2900,405.0500,fee schedule,APG 00272 Proc 92608 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 100% = $385.76... $385.76 at 105% = $405.05 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,47.82,,,,,,,19.2900,405.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,47.82,,,,,,,19.2900,405.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,NHC ADVANTAGE,NHC ADVANTAGE,47.82,,,,,,,19.2900,405.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,397.72,,,,,,,19.2900,405.0500,fee schedule,APG 00272 Proc 92608 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 100% = $385.76... $385.76 at 103.1% = $397.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,SENTARA HEALTH,SENTARA HEALTH,87.75,,,,,,,19.2900,405.0500,percent of total billed charges,25.81% of $340.00 in Billed Charges for Rev 440 Proc 92608 = $87.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,SENTARA HEALTH,SENTARA MEDICARE,45.54,,,,,,,19.2900,405.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",340.00,,,,,,,19.2900,405.0500,percent of total billed charges,100% of $340.00 in Billed Charges for Rev 440 Proc 92608 = $340.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,43.00,,,,,,,19.2900,405.0500,other,Rev 440 Proc 92608 1 Visit at $43.00 per Visit = $43.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,257.00,,,,,,,19.2900,405.0500,other,Rev 440 Proc 92608 1 Visit at $257.00 per Visit = $257.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,245.00,,,,,,,19.2900,405.0500,other,Rev 440 Proc 92608 1 Visit at $245.00 per Visit = $245.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,340.00,,,,,,,19.2900,405.0500,other,"Rev 440 Proc 92608 1 Visit at $403.00 per Visit = $403.00 (Service Line reduced to $340.00, claim capped at $340.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,397.33,,,,,,,19.2900,405.0500,fee schedule,APG 00272 Proc 92608 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 103% = $397.33. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,45.54,,,,,,,19.2900,405.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,45.54,,,,,,,19.2900,405.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,WELLCARE,WELLCARE MEDICAID,340.00,,,,,,,19.2900,405.0500,percent of total billed charges,100% of $340.00 in Billed Charges for Rev 440 Proc 92608 = $340.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL RX SPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92608,CPT,440,RC,44000037,CDM,,,,both,,,340.0000,51.0000,WELLCARE,WELLCARE MEDICARE,48.27,,,,,,,19.2900,405.0500,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,AETNA,AETNA,304.88,,,,,,,43.0000,714.0000,percent of total billed charges,42.7% of $714.00 in Billed Charges for Rev 440 Proc 92609 = $304.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,50.64,,,,,,,43.0000,714.0000,fee schedule,APG 00269 Proc 92609 at $836.60 (Base Rate) * 0.0582 (Relative Weight) = $48.69 (Total Line Payment) at 104% = $50.64. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,97.64,,,,,,,43.0000,714.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,AETNA,AETNA HEALTHCARE MEDICARE,97.64,,,,,,,43.0000,714.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,97.64,,,,,,,43.0000,714.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,AMBETTER,AMBETTER,212.86,,,,,,,43.0000,714.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,AMERIGROUP,AMERIGROUP,90.81,,,,,,,43.0000,714.0000,fee schedule,93.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,101.55,,,,,,,43.0000,714.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,BLUE CROSS,ANTHEM EXCHANGE,97.64,,,,,,,43.0000,714.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,50.15,,,,,,,43.0000,714.0000,fee schedule,APG 00269 Proc 92609 at $836.60 (Base Rate) * 0.0582 (Relative Weight) = $48.69 (Total Line Payment) at 103% = $50.15. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,BLUE CROSS,ANTHEM HMO,97.64,,,,,,,43.0000,714.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,100.57,,,,,,,43.0000,714.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",97.64,,,,,,,43.0000,714.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,116.00,,,,,,,43.0000,714.0000,other,Rev 440 Proc 92609 1 Visit at $116.00 per Visit = $116.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,BLUE CROSS,BLUE CROSS E NETWORK,460.20,,,,,,,43.0000,714.0000,fee schedule,$105.55 from Fee Schedule BCFSG for Rev 440 Proc 92609 * Qty 1 = $105.55 at 436% = $460.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,BLUE CROSS,BLUE CROSS MEDICARE,101.55,,,,,,,43.0000,714.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,BLUE CROSS,BLUE CROSS P NETWORK,469.70,,,,,,,43.0000,714.0000,fee schedule,$105.55 from Fee Schedule BCFSG for Rev 440 Proc 92609 * Qty 1 = $105.55 at 445% = $469.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,BLUE CROSS,BLUE CROSS S NETWORK,469.70,,,,,,,43.0000,714.0000,fee schedule,$105.55 from Fee Schedule BCFSG for Rev 440 Proc 92609 * Qty 1 = $105.55 at 445% = $469.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,BLUE CROSS,TENNCARE BLUE CARE,53.53,,,,,,,43.0000,714.0000,fee schedule,$46.15 from Fee Schedule TC_24 for Rev 440 Proc 92609 * Qty 1 = $46.15 at 116% = $53.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,BLUE CROSS,TENNCARE BLUE SELECT,53.53,,,,,,,43.0000,714.0000,fee schedule,$46.15 from Fee Schedule TC_24 for Rev 440 Proc 92609 * Qty 1 = $46.15 at 116% = $53.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,CIGNA HEALTHCARE,CIGNA HMO,297.74,,,,,,,43.0000,714.0000,percent of total billed charges,41.7% of $714.00 in Billed Charges for Rev 440 Proc 92609 = $297.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,331.30,,,,,,,43.0000,714.0000,percent of total billed charges,46.4% of $714.00 in Billed Charges for Rev 440 Proc 92609 = $331.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,102.52,,,,,,,43.0000,714.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,297.74,,,,,,,43.0000,714.0000,percent of total billed charges,41.7% of $714.00 in Billed Charges for Rev 440 Proc 92609 = $297.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,CIGNA HEALTHCARE,CIGNA PPO,297.74,,,,,,,43.0000,714.0000,percent of total billed charges,41.7% of $714.00 in Billed Charges for Rev 440 Proc 92609 = $297.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,102.52,,,,,,,43.0000,714.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,642.60,,,,,,,43.0000,714.0000,percent of total billed charges,90% of $714.00 in Billed Charges for Rev 440 Proc 92609 = $642.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,HUMANA,HUMANA MEDICARE,97.64,,,,,,,43.0000,714.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,97.64,,,,,,,43.0000,714.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,MEDCOST,MEDCOST VHN,339.79,,,,,,,43.0000,714.0000,percent of total billed charges,47.59% of $714.00 in Billed Charges for Rev 440 Proc 92609 = $339.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,51.12,,,,,,,43.0000,714.0000,fee schedule,APG 00269 Proc 92609 at $836.60 (Base Rate) * 0.0582 (Relative Weight) = $48.69 (Total Line Payment) at 100% = $48.69... $48.69 at 105% = $51.12 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,102.52,,,,,,,43.0000,714.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,102.52,,,,,,,43.0000,714.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,NHC ADVANTAGE,NHC ADVANTAGE,102.52,,,,,,,43.0000,714.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,50.20,,,,,,,43.0000,714.0000,fee schedule,APG 00269 Proc 92609 at $836.60 (Base Rate) * 0.0582 (Relative Weight) = $48.69 (Total Line Payment) at 100% = $48.69... $48.69 at 103.1% = $50.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,SENTARA HEALTH,SENTARA HEALTH,184.28,,,,,,,43.0000,714.0000,percent of total billed charges,25.81% of $714.00 in Billed Charges for Rev 440 Proc 92609 = $184.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,SENTARA HEALTH,SENTARA MEDICARE,97.64,,,,,,,43.0000,714.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",714.00,,,,,,,43.0000,714.0000,percent of total billed charges,100% of $714.00 in Billed Charges for Rev 440 Proc 92609 = $714.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,43.00,,,,,,,43.0000,714.0000,other,Rev 440 Proc 92609 1 Visit at $43.00 per Visit = $43.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,257.00,,,,,,,43.0000,714.0000,other,Rev 440 Proc 92609 1 Visit at $257.00 per Visit = $257.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,245.00,,,,,,,43.0000,714.0000,other,Rev 440 Proc 92609 1 Visit at $245.00 per Visit = $245.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,403.00,,,,,,,43.0000,714.0000,other,Rev 440 Proc 92609 1 Visit at $403.00 per Visit = $403.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,50.15,,,,,,,43.0000,714.0000,fee schedule,APG 00269 Proc 92609 at $836.60 (Base Rate) * 0.0582 (Relative Weight) = $48.69 (Total Line Payment) at 103% = $50.15. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,97.64,,,,,,,43.0000,714.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,97.64,,,,,,,43.0000,714.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,WELLCARE,WELLCARE MEDICAID,714.00,,,,,,,43.0000,714.0000,percent of total billed charges,100% of $714.00 in Billed Charges for Rev 440 Proc 92609 = $714.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SERVICE FOR USE OF SPEECH DEVICE,92609,CPT,440,RC,44000007,CDM,,,,both,,,714.0000,107.1000,WELLCARE,WELLCARE MEDICARE,103.50,,,,,,,43.0000,714.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,AETNA,AETNA,234.00,,,,,,,37.6800,548.0000,percent of total billed charges,42.7% of $548.00 in Billed Charges for Rev 444 Proc 92610 = $234.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,401.19,,,,,,,37.6800,548.0000,fee schedule,APG 00272 Proc 92610 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 104% = $401.19. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,80.95,,,,,,,37.6800,548.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,AETNA,AETNA HEALTHCARE MEDICARE,80.95,,,,,,,37.6800,548.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,80.95,,,,,,,37.6800,548.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,AMBETTER,AMBETTER,176.47,,,,,,,37.6800,548.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,AMERIGROUP,AMERIGROUP,75.28,,,,,,,37.6800,548.0000,fee schedule,93.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,84.19,,,,,,,37.6800,548.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,BLUE CROSS,ANTHEM EXCHANGE,80.95,,,,,,,37.6800,548.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,397.33,,,,,,,37.6800,548.0000,fee schedule,APG 00272 Proc 92610 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 103% = $397.33. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,BLUE CROSS,ANTHEM HMO,80.95,,,,,,,37.6800,548.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,83.38,,,,,,,37.6800,548.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",80.95,,,,,,,37.6800,548.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,116.00,,,,,,,37.6800,548.0000,other,Rev 444 Proc 92610 1 Visit at $116.00 per Visit = $116.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,BLUE CROSS,BLUE CROSS E NETWORK,353.25,,,,,,,37.6800,548.0000,fee schedule,$81.02 from Fee Schedule BCFSG for Rev 444 Proc 92610 * Qty 1 = $81.02 at 436% = $353.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,BLUE CROSS,BLUE CROSS MEDICARE,84.19,,,,,,,37.6800,548.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,BLUE CROSS,BLUE CROSS P NETWORK,360.54,,,,,,,37.6800,548.0000,fee schedule,$81.02 from Fee Schedule BCFSG for Rev 444 Proc 92610 * Qty 1 = $81.02 at 445% = $360.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,BLUE CROSS,BLUE CROSS S NETWORK,360.54,,,,,,,37.6800,548.0000,fee schedule,$81.02 from Fee Schedule BCFSG for Rev 444 Proc 92610 * Qty 1 = $81.02 at 445% = $360.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,BLUE CROSS,TENNCARE BLUE CARE,37.68,,,,,,,37.6800,548.0000,fee schedule,$32.48 from Fee Schedule TC_24 for Rev 444 Proc 92610 * Qty 1 = $32.48 at 116% = $37.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,BLUE CROSS,TENNCARE BLUE SELECT,37.68,,,,,,,37.6800,548.0000,fee schedule,$32.48 from Fee Schedule TC_24 for Rev 444 Proc 92610 * Qty 1 = $32.48 at 116% = $37.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,CIGNA HEALTHCARE,CIGNA HMO,228.52,,,,,,,37.6800,548.0000,percent of total billed charges,41.7% of $548.00 in Billed Charges for Rev 444 Proc 92610 = $228.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,254.27,,,,,,,37.6800,548.0000,percent of total billed charges,46.4% of $548.00 in Billed Charges for Rev 444 Proc 92610 = $254.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,85.00,,,,,,,37.6800,548.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.52,,,,,,,37.6800,548.0000,percent of total billed charges,41.7% of $548.00 in Billed Charges for Rev 444 Proc 92610 = $228.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,CIGNA HEALTHCARE,CIGNA PPO,228.52,,,,,,,37.6800,548.0000,percent of total billed charges,41.7% of $548.00 in Billed Charges for Rev 444 Proc 92610 = $228.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,85.00,,,,,,,37.6800,548.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,493.20,,,,,,,37.6800,548.0000,percent of total billed charges,90% of $548.00 in Billed Charges for Rev 444 Proc 92610 = $493.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,HUMANA,HUMANA MEDICARE,80.95,,,,,,,37.6800,548.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,80.95,,,,,,,37.6800,548.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,MEDCOST,MEDCOST VHN,260.79,,,,,,,37.6800,548.0000,percent of total billed charges,47.59% of $548.00 in Billed Charges for Rev 444 Proc 92610 = $260.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,405.05,,,,,,,37.6800,548.0000,fee schedule,APG 00272 Proc 92610 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 100% = $385.76... $385.76 at 105% = $405.05 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,85.00,,,,,,,37.6800,548.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,85.00,,,,,,,37.6800,548.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,NHC ADVANTAGE,NHC ADVANTAGE,85.00,,,,,,,37.6800,548.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,397.72,,,,,,,37.6800,548.0000,fee schedule,APG 00272 Proc 92610 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 100% = $385.76... $385.76 at 103.1% = $397.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,SENTARA HEALTH,SENTARA HEALTH,141.44,,,,,,,37.6800,548.0000,percent of total billed charges,25.81% of $548.00 in Billed Charges for Rev 444 Proc 92610 = $141.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,SENTARA HEALTH,SENTARA MEDICARE,80.95,,,,,,,37.6800,548.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",548.00,,,,,,,37.6800,548.0000,percent of total billed charges,100% of $548.00 in Billed Charges for Rev 444 Proc 92610 = $548.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,43.00,,,,,,,37.6800,548.0000,other,Rev 444 Proc 92610 1 Visit at $43.00 per Visit = $43.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,257.00,,,,,,,37.6800,548.0000,other,Rev 444 Proc 92610 1 Visit at $257.00 per Visit = $257.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,245.00,,,,,,,37.6800,548.0000,other,Rev 444 Proc 92610 1 Visit at $245.00 per Visit = $245.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,403.00,,,,,,,37.6800,548.0000,other,Rev 444 Proc 92610 1 Visit at $403.00 per Visit = $403.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,397.33,,,,,,,37.6800,548.0000,fee schedule,APG 00272 Proc 92610 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 103% = $397.33. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,80.95,,,,,,,37.6800,548.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,80.95,,,,,,,37.6800,548.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,WELLCARE,WELLCARE MEDICAID,548.00,,,,,,,37.6800,548.0000,percent of total billed charges,100% of $548.00 in Billed Charges for Rev 444 Proc 92610 = $548.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SWALLOW FUNCTION EVALUATION,92610,CPT,444,RC,44400002,CDM,,,,both,,,548.0000,82.2000,WELLCARE,WELLCARE MEDICARE,85.81,,,,,,,37.6800,548.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,AETNA,AETNA,238.27,,,,,,,41.0200,558.0000,percent of total billed charges,42.7% of $558.00 in Billed Charges for Rev 444 Proc 92611 = $238.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,166.44,,,,,,,41.0200,558.0000,fee schedule,APG 00389 Proc 92611 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 104% = $166.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,86.55,,,,,,,41.0200,558.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,AETNA,AETNA HEALTHCARE MEDICARE,86.55,,,,,,,41.0200,558.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,86.55,,,,,,,41.0200,558.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,AMBETTER,AMBETTER,188.68,,,,,,,41.0200,558.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,AMERIGROUP,AMERIGROUP,80.49,,,,,,,41.0200,558.0000,fee schedule,93.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,90.01,,,,,,,41.0200,558.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,BLUE CROSS,ANTHEM EXCHANGE,86.55,,,,,,,41.0200,558.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,164.84,,,,,,,41.0200,558.0000,fee schedule,APG 00389 Proc 92611 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,BLUE CROSS,ANTHEM HMO,86.55,,,,,,,41.0200,558.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,89.15,,,,,,,41.0200,558.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",86.55,,,,,,,41.0200,558.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,116.00,,,,,,,41.0200,558.0000,other,Rev 444 Proc 92611 1 Visit at $116.00 per Visit = $116.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,BLUE CROSS,BLUE CROSS E NETWORK,377.14,,,,,,,41.0200,558.0000,fee schedule,$86.50 from Fee Schedule BCFSG for Rev 444 Proc 92611 * Qty 1 = $86.50 at 436% = $377.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,BLUE CROSS,BLUE CROSS MEDICARE,90.01,,,,,,,41.0200,558.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,BLUE CROSS,BLUE CROSS P NETWORK,384.93,,,,,,,41.0200,558.0000,fee schedule,$86.50 from Fee Schedule BCFSG for Rev 444 Proc 92611 * Qty 1 = $86.50 at 445% = $384.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,BLUE CROSS,BLUE CROSS S NETWORK,384.93,,,,,,,41.0200,558.0000,fee schedule,$86.50 from Fee Schedule BCFSG for Rev 444 Proc 92611 * Qty 1 = $86.50 at 445% = $384.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,BLUE CROSS,TENNCARE BLUE CARE,41.02,,,,,,,41.0200,558.0000,fee schedule,$35.36 from Fee Schedule TC_24 for Rev 444 Proc 92611 * Qty 1 = $35.36 at 116% = $41.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,BLUE CROSS,TENNCARE BLUE SELECT,41.02,,,,,,,41.0200,558.0000,fee schedule,$35.36 from Fee Schedule TC_24 for Rev 444 Proc 92611 * Qty 1 = $35.36 at 116% = $41.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,CIGNA HEALTHCARE,CIGNA HMO,232.69,,,,,,,41.0200,558.0000,percent of total billed charges,41.7% of $558.00 in Billed Charges for Rev 444 Proc 92611 = $232.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,258.91,,,,,,,41.0200,558.0000,percent of total billed charges,46.4% of $558.00 in Billed Charges for Rev 444 Proc 92611 = $258.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,90.88,,,,,,,41.0200,558.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,232.69,,,,,,,41.0200,558.0000,percent of total billed charges,41.7% of $558.00 in Billed Charges for Rev 444 Proc 92611 = $232.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,CIGNA HEALTHCARE,CIGNA PPO,232.69,,,,,,,41.0200,558.0000,percent of total billed charges,41.7% of $558.00 in Billed Charges for Rev 444 Proc 92611 = $232.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,90.88,,,,,,,41.0200,558.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,502.20,,,,,,,41.0200,558.0000,percent of total billed charges,90% of $558.00 in Billed Charges for Rev 444 Proc 92611 = $502.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,HUMANA,HUMANA MEDICARE,86.55,,,,,,,41.0200,558.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,86.55,,,,,,,41.0200,558.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,MEDCOST,MEDCOST VHN,265.55,,,,,,,41.0200,558.0000,percent of total billed charges,47.59% of $558.00 in Billed Charges for Rev 444 Proc 92611 = $265.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,168.04,,,,,,,41.0200,558.0000,fee schedule,APG 00389 Proc 92611 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 105% = $168.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,90.88,,,,,,,41.0200,558.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,90.88,,,,,,,41.0200,558.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,NHC ADVANTAGE,NHC ADVANTAGE,90.88,,,,,,,41.0200,558.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,165.00,,,,,,,41.0200,558.0000,fee schedule,APG 00389 Proc 92611 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 100% = $160.04... $160.04 at 103.1% = $165.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,SENTARA HEALTH,SENTARA HEALTH,144.02,,,,,,,41.0200,558.0000,percent of total billed charges,25.81% of $558.00 in Billed Charges for Rev 444 Proc 92611 = $144.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,SENTARA HEALTH,SENTARA MEDICARE,86.55,,,,,,,41.0200,558.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",558.00,,,,,,,41.0200,558.0000,percent of total billed charges,100% of $558.00 in Billed Charges for Rev 444 Proc 92611 = $558.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,43.00,,,,,,,41.0200,558.0000,other,Rev 444 Proc 92611 1 Visit at $43.00 per Visit = $43.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,257.00,,,,,,,41.0200,558.0000,other,Rev 444 Proc 92611 1 Visit at $257.00 per Visit = $257.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,245.00,,,,,,,41.0200,558.0000,other,Rev 444 Proc 92611 1 Visit at $245.00 per Visit = $245.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,403.00,,,,,,,41.0200,558.0000,other,Rev 444 Proc 92611 1 Visit at $403.00 per Visit = $403.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,164.84,,,,,,,41.0200,558.0000,fee schedule,APG 00389 Proc 92611 at $836.60 (Base Rate) * 0.1913 (Relative Weight) = $160.04 (Total Line Payment) at 103% = $164.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,86.55,,,,,,,41.0200,558.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,86.55,,,,,,,41.0200,558.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,WELLCARE,WELLCARE MEDICAID,558.00,,,,,,,41.0200,558.0000,percent of total billed charges,100% of $558.00 in Billed Charges for Rev 444 Proc 92611 = $558.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MOTION FLUOROSCOPY SWALLOW EV,92611,CPT,444,RC,44400005,CDM,,,,both,,,558.0000,83.7000,WELLCARE,WELLCARE MEDICARE,91.74,,,,,,,41.0200,558.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,AETNA,AETNA,475.68,,,,,,,43.0000,1114.0000,percent of total billed charges,"42.7% of $1,114.00 in Billed Charges for Rev 440 Proc 92612 = $475.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,265.28,,,,,,,43.0000,1114.0000,fee schedule,APG 00249 Proc 92612 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment) at 104% = $265.28. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,184.71,,,,,,,43.0000,1114.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,AETNA,AETNA HEALTHCARE MEDICARE,184.71,,,,,,,43.0000,1114.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,184.71,,,,,,,43.0000,1114.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,AMBETTER,AMBETTER,402.67,,,,,,,43.0000,1114.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,AMERIGROUP,AMERIGROUP,171.78,,,,,,,43.0000,1114.0000,fee schedule,93.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,192.10,,,,,,,43.0000,1114.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,BLUE CROSS,ANTHEM EXCHANGE,184.71,,,,,,,43.0000,1114.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,262.73,,,,,,,43.0000,1114.0000,fee schedule,APG 00249 Proc 92612 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment) at 103% = $262.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,BLUE CROSS,ANTHEM HMO,184.71,,,,,,,43.0000,1114.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,190.25,,,,,,,43.0000,1114.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",184.71,,,,,,,43.0000,1114.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,116.00,,,,,,,43.0000,1114.0000,other,Rev 440 Proc 92612 1 Visit at $116.00 per Visit = $116.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,BLUE CROSS,BLUE CROSS E NETWORK,717.44,,,,,,,43.0000,1114.0000,fee schedule,$164.55 from Fee Schedule BCFSG for Rev 440 Proc 92612 * Qty 1 = $164.55 at 436% = $717.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,BLUE CROSS,BLUE CROSS MEDICARE,192.10,,,,,,,43.0000,1114.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,BLUE CROSS,BLUE CROSS P NETWORK,732.25,,,,,,,43.0000,1114.0000,fee schedule,$164.55 from Fee Schedule BCFSG for Rev 440 Proc 92612 * Qty 1 = $164.55 at 445% = $732.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,BLUE CROSS,BLUE CROSS S NETWORK,732.25,,,,,,,43.0000,1114.0000,fee schedule,$164.55 from Fee Schedule BCFSG for Rev 440 Proc 92612 * Qty 1 = $164.55 at 445% = $732.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,BLUE CROSS,TENNCARE BLUE CARE,159.99,,,,,,,43.0000,1114.0000,fee schedule,$137.92 from Fee Schedule TC_24 for Rev 440 Proc 92612 * Qty 1 = $137.92 at 116% = $159.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,BLUE CROSS,TENNCARE BLUE SELECT,159.99,,,,,,,43.0000,1114.0000,fee schedule,$137.92 from Fee Schedule TC_24 for Rev 440 Proc 92612 * Qty 1 = $137.92 at 116% = $159.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,CIGNA HEALTHCARE,CIGNA HMO,464.54,,,,,,,43.0000,1114.0000,percent of total billed charges,"41.7% of $1,114.00 in Billed Charges for Rev 440 Proc 92612 = $464.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,516.90,,,,,,,43.0000,1114.0000,percent of total billed charges,"46.4% of $1,114.00 in Billed Charges for Rev 440 Proc 92612 = $516.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,193.95,,,,,,,43.0000,1114.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,464.54,,,,,,,43.0000,1114.0000,percent of total billed charges,"41.7% of $1,114.00 in Billed Charges for Rev 440 Proc 92612 = $464.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,CIGNA HEALTHCARE,CIGNA PPO,464.54,,,,,,,43.0000,1114.0000,percent of total billed charges,"41.7% of $1,114.00 in Billed Charges for Rev 440 Proc 92612 = $464.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,193.95,,,,,,,43.0000,1114.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1002.60,,,,,,,43.0000,1114.0000,percent of total billed charges,"90% of $1,114.00 in Billed Charges for Rev 440 Proc 92612 = $1,002.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,HUMANA,HUMANA MEDICARE,184.71,,,,,,,43.0000,1114.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,184.71,,,,,,,43.0000,1114.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,MEDCOST,MEDCOST VHN,530.15,,,,,,,43.0000,1114.0000,percent of total billed charges,"47.59% of $1,114.00 in Billed Charges for Rev 440 Proc 92612 = $530.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,267.83,,,,,,,43.0000,1114.0000,fee schedule,APG 00249 Proc 92612 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment) at 100% = $255.08... $255.08 at 105% = $267.83 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,193.95,,,,,,,43.0000,1114.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,193.95,,,,,,,43.0000,1114.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,NHC ADVANTAGE,NHC ADVANTAGE,193.95,,,,,,,43.0000,1114.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,262.99,,,,,,,43.0000,1114.0000,fee schedule,APG 00249 Proc 92612 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment) at 100% = $255.08... $255.08 at 103.1% = $262.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,SENTARA HEALTH,SENTARA HEALTH,287.52,,,,,,,43.0000,1114.0000,percent of total billed charges,"25.81% of $1,114.00 in Billed Charges for Rev 440 Proc 92612 = $287.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,SENTARA HEALTH,SENTARA MEDICARE,184.71,,,,,,,43.0000,1114.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1114.00,,,,,,,43.0000,1114.0000,percent of total billed charges,"100% of $1,114.00 in Billed Charges for Rev 440 Proc 92612 = $1,114.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,43.00,,,,,,,43.0000,1114.0000,other,Rev 440 Proc 92612 1 Visit at $43.00 per Visit = $43.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,257.00,,,,,,,43.0000,1114.0000,other,Rev 440 Proc 92612 1 Visit at $257.00 per Visit = $257.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,245.00,,,,,,,43.0000,1114.0000,other,Rev 440 Proc 92612 1 Visit at $245.00 per Visit = $245.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,403.00,,,,,,,43.0000,1114.0000,other,Rev 440 Proc 92612 1 Visit at $403.00 per Visit = $403.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,262.73,,,,,,,43.0000,1114.0000,fee schedule,APG 00249 Proc 92612 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment) at 103% = $262.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,184.71,,,,,,,43.0000,1114.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,184.71,,,,,,,43.0000,1114.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,WELLCARE,WELLCARE MEDICAID,1114.00,,,,,,,43.0000,1114.0000,percent of total billed charges,"100% of $1,114.00 in Billed Charges for Rev 440 Proc 92612 = $1,114.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FEES C/V REC,92612,CPT,440,RC,44000039,CDM,,,,both,,,1114.0000,167.1000,WELLCARE,WELLCARE MEDICARE,195.79,,,,,,,43.0000,1114.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX NONSPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92618,CPT,440,RC,44000036,CDM,,,,both,,,213.0000,31.9500,AETNA,AETNA,90.95,,,,,,,43.0000,405.0500,percent of total billed charges,42.7% of $213.00 in Billed Charges for Rev 440 Proc 92618 = $90.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL RX NONSPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92618,CPT,440,RC,44000036,CDM,,,,both,,,213.0000,31.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,401.19,,,,,,,43.0000,405.0500,fee schedule,APG 00272 Proc 92618 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 104% = $401.19. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX NONSPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92618,CPT,440,RC,44000036,CDM,,,,both,,,213.0000,31.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,213.00,,,,,,,43.0000,405.0500,fee schedule,"APG 00272 Proc 92618 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 103% = $397.33 (Service Line reduced to $213.00, claim capped at $213.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVAL RX NONSPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92618,CPT,440,RC,44000036,CDM,,,,both,,,213.0000,31.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,116.00,,,,,,,43.0000,405.0500,other,Rev 440 Proc 92618 1 Visit at $116.00 per Visit = $116.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX NONSPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92618,CPT,440,RC,44000036,CDM,,,,both,,,213.0000,31.9500,BLUE CROSS,BLUE CROSS E NETWORK,136.77,,,,,,,43.0000,405.0500,fee schedule,$31.37 from Fee Schedule BCFSG for Rev 440 Proc 92618 * Qty 1 = $31.37 at 436% = $136.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX NONSPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92618,CPT,440,RC,44000036,CDM,,,,both,,,213.0000,31.9500,BLUE CROSS,BLUE CROSS P NETWORK,139.60,,,,,,,43.0000,405.0500,fee schedule,$31.37 from Fee Schedule BCFSG for Rev 440 Proc 92618 * Qty 1 = $31.37 at 445% = $139.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX NONSPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92618,CPT,440,RC,44000036,CDM,,,,both,,,213.0000,31.9500,BLUE CROSS,BLUE CROSS S NETWORK,139.60,,,,,,,43.0000,405.0500,fee schedule,$31.37 from Fee Schedule BCFSG for Rev 440 Proc 92618 * Qty 1 = $31.37 at 445% = $139.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX NONSPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92618,CPT,440,RC,44000036,CDM,,,,both,,,213.0000,31.9500,CIGNA HEALTHCARE,CIGNA HMO,88.82,,,,,,,43.0000,405.0500,percent of total billed charges,41.7% of $213.00 in Billed Charges for Rev 440 Proc 92618 = $88.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL RX NONSPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92618,CPT,440,RC,44000036,CDM,,,,both,,,213.0000,31.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,98.83,,,,,,,43.0000,405.0500,percent of total billed charges,46.4% of $213.00 in Billed Charges for Rev 440 Proc 92618 = $98.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL RX NONSPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92618,CPT,440,RC,44000036,CDM,,,,both,,,213.0000,31.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,88.82,,,,,,,43.0000,405.0500,percent of total billed charges,41.7% of $213.00 in Billed Charges for Rev 440 Proc 92618 = $88.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL RX NONSPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92618,CPT,440,RC,44000036,CDM,,,,both,,,213.0000,31.9500,CIGNA HEALTHCARE,CIGNA PPO,88.82,,,,,,,43.0000,405.0500,percent of total billed charges,41.7% of $213.00 in Billed Charges for Rev 440 Proc 92618 = $88.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL RX NONSPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92618,CPT,440,RC,44000036,CDM,,,,both,,,213.0000,31.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,191.70,,,,,,,43.0000,405.0500,percent of total billed charges,90% of $213.00 in Billed Charges for Rev 440 Proc 92618 = $191.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL RX NONSPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92618,CPT,440,RC,44000036,CDM,,,,both,,,213.0000,31.9500,MEDCOST,MEDCOST VHN,101.37,,,,,,,43.0000,405.0500,percent of total billed charges,47.59% of $213.00 in Billed Charges for Rev 440 Proc 92618 = $101.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL RX NONSPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92618,CPT,440,RC,44000036,CDM,,,,both,,,213.0000,31.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,405.05,,,,,,,43.0000,405.0500,fee schedule,APG 00272 Proc 92618 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 100% = $385.76... $385.76 at 105% = $405.05 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX NONSPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92618,CPT,440,RC,44000036,CDM,,,,both,,,213.0000,31.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,397.72,,,,,,,43.0000,405.0500,fee schedule,APG 00272 Proc 92618 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 100% = $385.76... $385.76 at 103.1% = $397.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX NONSPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92618,CPT,440,RC,44000036,CDM,,,,both,,,213.0000,31.9500,SENTARA HEALTH,SENTARA HEALTH,54.98,,,,,,,43.0000,405.0500,percent of total billed charges,25.81% of $213.00 in Billed Charges for Rev 440 Proc 92618 = $54.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL RX NONSPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92618,CPT,440,RC,44000036,CDM,,,,both,,,213.0000,31.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",213.00,,,,,,,43.0000,405.0500,percent of total billed charges,100% of $213.00 in Billed Charges for Rev 440 Proc 92618 = $213.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL RX NONSPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92618,CPT,440,RC,44000036,CDM,,,,both,,,213.0000,31.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,43.00,,,,,,,43.0000,405.0500,other,Rev 440 Proc 92618 1 Visit at $43.00 per Visit = $43.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX NONSPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92618,CPT,440,RC,44000036,CDM,,,,both,,,213.0000,31.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,213.00,,,,,,,43.0000,405.0500,other,"Rev 440 Proc 92618 1 Visit at $257.00 per Visit = $257.00 (Service Line reduced to $213.00, claim capped at $213.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVAL RX NONSPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92618,CPT,440,RC,44000036,CDM,,,,both,,,213.0000,31.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,213.00,,,,,,,43.0000,405.0500,other,"Rev 440 Proc 92618 1 Visit at $245.00 per Visit = $245.00 (Service Line reduced to $213.00, claim capped at $213.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVAL RX NONSPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92618,CPT,440,RC,44000036,CDM,,,,both,,,213.0000,31.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,213.00,,,,,,,43.0000,405.0500,other,"Rev 440 Proc 92618 1 Visit at $403.00 per Visit = $403.00 (Service Line reduced to $213.00, claim capped at $213.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVAL RX NONSPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92618,CPT,440,RC,44000036,CDM,,,,both,,,213.0000,31.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,397.33,,,,,,,43.0000,405.0500,fee schedule,APG 00272 Proc 92618 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 103% = $397.33. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL RX NONSPEECH GEN AUMT ALT COMMUN DEV FTF EA ADDL 30 MIN,92618,CPT,440,RC,44000036,CDM,,,,both,,,213.0000,31.9500,WELLCARE,WELLCARE MEDICAID,213.00,,,,,,,43.0000,405.0500,percent of total billed charges,100% of $213.00 in Billed Charges for Rev 440 Proc 92618 = $213.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,AETNA,AETNA,163.11,,,,,,,39.8900,405.0500,percent of total billed charges,42.7% of $382.00 in Billed Charges for Rev 471 Proc 92620 = $163.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,401.19,,,,,,,39.8900,405.0500,fee schedule,APG 00272 Proc 92620 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 104% = $401.19. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,116.74,,,,,,,39.8900,405.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,AETNA,AETNA HEALTHCARE MEDICARE,116.74,,,,,,,39.8900,405.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,116.74,,,,,,,39.8900,405.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,AMBETTER,AMBETTER,254.50,,,,,,,39.8900,405.0500,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,121.41,,,,,,,39.8900,405.0500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,BLUE CROSS,ANTHEM EXCHANGE,287.43,,,,,,,39.8900,405.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,382.00,,,,,,,39.8900,405.0500,fee schedule,"APG 00272 Proc 92620 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 103% = $397.33 (Service Line reduced to $382.00, claim capped at $382.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,BLUE CROSS,ANTHEM HMO,305.38,,,,,,,39.8900,405.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,120.24,,,,,,,39.8900,405.0500,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",359.25,,,,,,,39.8900,405.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,39.89,,,,,,,39.8900,405.0500,fee schedule,$39.89 from Fee Schedule BLDTM_23 for Rev 471 Proc 92620 * Qty 1 = $39.89 at 100% = $39.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,BLUE CROSS,BLUE CROSS E NETWORK,382.00,,,,,,,39.8900,405.0500,fee schedule,"$89.79 from Fee Schedule BCFSG for Rev 471 Proc 92620 * Qty 1 = $89.79 at 436% = $391.48 (Service Line reduced to $382.00, claim capped at $382.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,BLUE CROSS,BLUE CROSS MEDICARE,121.41,,,,,,,39.8900,405.0500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,BLUE CROSS,BLUE CROSS P NETWORK,382.00,,,,,,,39.8900,405.0500,fee schedule,"$89.79 from Fee Schedule BCFSG for Rev 471 Proc 92620 * Qty 1 = $89.79 at 445% = $399.57 (Service Line reduced to $382.00, claim capped at $382.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,BLUE CROSS,BLUE CROSS S NETWORK,382.00,,,,,,,39.8900,405.0500,fee schedule,"$89.79 from Fee Schedule BCFSG for Rev 471 Proc 92620 * Qty 1 = $89.79 at 445% = $399.57 (Service Line reduced to $382.00, claim capped at $382.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,BLUE CROSS,TENNCARE BLUE CARE,40.31,,,,,,,39.8900,405.0500,fee schedule,$34.75 from Fee Schedule TC_24 for Rev 471 Proc 92620 * Qty 1 = $34.75 at 116% = $40.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,BLUE CROSS,TENNCARE BLUE SELECT,40.31,,,,,,,39.8900,405.0500,fee schedule,$34.75 from Fee Schedule TC_24 for Rev 471 Proc 92620 * Qty 1 = $34.75 at 116% = $40.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,CIGNA HEALTHCARE,CIGNA HMO,159.29,,,,,,,39.8900,405.0500,percent of total billed charges,41.7% of $382.00 in Billed Charges for Rev 471 Proc 92620 = $159.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,177.25,,,,,,,39.8900,405.0500,percent of total billed charges,46.4% of $382.00 in Billed Charges for Rev 471 Proc 92620 = $177.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,122.58,,,,,,,39.8900,405.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,159.29,,,,,,,39.8900,405.0500,percent of total billed charges,41.7% of $382.00 in Billed Charges for Rev 471 Proc 92620 = $159.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,CIGNA HEALTHCARE,CIGNA PPO,159.29,,,,,,,39.8900,405.0500,percent of total billed charges,41.7% of $382.00 in Billed Charges for Rev 471 Proc 92620 = $159.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,122.58,,,,,,,39.8900,405.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,343.80,,,,,,,39.8900,405.0500,percent of total billed charges,90% of $382.00 in Billed Charges for Rev 471 Proc 92620 = $343.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,HUMANA,HUMANA MEDICARE,116.74,,,,,,,39.8900,405.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,116.74,,,,,,,39.8900,405.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,MEDCOST,MEDCOST VHN,181.79,,,,,,,39.8900,405.0500,percent of total billed charges,47.59% of $382.00 in Billed Charges for Rev 471 Proc 92620 = $181.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,405.05,,,,,,,39.8900,405.0500,fee schedule,APG 00272 Proc 92620 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 100% = $385.76... $385.76 at 105% = $405.05 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,122.58,,,,,,,39.8900,405.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,122.58,,,,,,,39.8900,405.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,NHC ADVANTAGE,NHC ADVANTAGE,122.58,,,,,,,39.8900,405.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,397.72,,,,,,,39.8900,405.0500,fee schedule,APG 00272 Proc 92620 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 100% = $385.76... $385.76 at 103.1% = $397.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,SENTARA HEALTH,SENTARA HEALTH,98.59,,,,,,,39.8900,405.0500,percent of total billed charges,25.81% of $382.00 in Billed Charges for Rev 471 Proc 92620 = $98.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,SENTARA HEALTH,SENTARA MEDICARE,116.74,,,,,,,39.8900,405.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",382.00,,,,,,,39.8900,405.0500,percent of total billed charges,100% of $382.00 in Billed Charges for Rev 471 Proc 92620 = $382.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,42.58,,,,,,,39.8900,405.0500,fee schedule,$85.15 from Fee Schedule TCUHC24 for Rev 471 Proc 92620 * Qty 1 = $85.15 at 50% = $42.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,320.00,,,,,,,39.8900,405.0500,other,Rev 471 Proc 92620 1 Visit at $320.00 per Visit = $320.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,305.00,,,,,,,39.8900,405.0500,other,Rev 471 Proc 92620 1 Visit at $305.00 per Visit = $305.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,382.00,,,,,,,39.8900,405.0500,other,"Rev 471 Proc 92620 1 Visit at $502.00 per Visit = $502.00 (Service Line reduced to $382.00, claim capped at $382.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,397.33,,,,,,,39.8900,405.0500,fee schedule,APG 00272 Proc 92620 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 103% = $397.33. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,116.74,,,,,,,39.8900,405.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,116.74,,,,,,,39.8900,405.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,WELLCARE,WELLCARE MEDICAID,382.00,,,,,,,39.8900,405.0500,percent of total billed charges,100% of $382.00 in Billed Charges for Rev 471 Proc 92620 = $382.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CENTRAL AUDITORY FUNCT TEST 1HR,92620,CPT,471,RC,47100012,CDM,,,,both,,,382.0000,57.3000,WELLCARE,WELLCARE MEDICARE,123.75,,,,,,,39.8900,405.0500,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUD FUNCT TEST ADDL 15MIN,92621,CPT,471,RC,47100016,CDM,,,,both,,,32.0000,4.8000,AETNA,AETNA,13.66,,,,,,,8.2600,405.0500,percent of total billed charges,42.7% of $32.00 in Billed Charges for Rev 471 Proc 92621 = $13.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CENTRAL AUD FUNCT TEST ADDL 15MIN,92621,CPT,471,RC,47100016,CDM,,,,both,,,32.0000,4.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,401.19,,,,,,,8.2600,405.0500,fee schedule,APG 00272 Proc 92621 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 104% = $401.19. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUD FUNCT TEST ADDL 15MIN,92621,CPT,471,RC,47100016,CDM,,,,both,,,32.0000,4.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,32.00,,,,,,,8.2600,405.0500,fee schedule,"APG 00272 Proc 92621 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 103% = $397.33 (Service Line reduced to $32.00, claim capped at $32.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CENTRAL AUD FUNCT TEST ADDL 15MIN,92621,CPT,471,RC,47100016,CDM,,,,both,,,32.0000,4.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9.87,,,,,,,8.2600,405.0500,fee schedule,$9.87 from Fee Schedule BLDTM_23 for Rev 471 Proc 92621 * Qty 1 = $9.87 at 100% = $9.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUD FUNCT TEST ADDL 15MIN,92621,CPT,471,RC,47100016,CDM,,,,both,,,32.0000,4.8000,BLUE CROSS,BLUE CROSS E NETWORK,32.00,,,,,,,8.2600,405.0500,fee schedule,"$21.41 from Fee Schedule BCFSG for Rev 471 Proc 92621 * Qty 1 = $21.41 at 436% = $93.35 (Service Line reduced to $32.00, claim capped at $32.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CENTRAL AUD FUNCT TEST ADDL 15MIN,92621,CPT,471,RC,47100016,CDM,,,,both,,,32.0000,4.8000,BLUE CROSS,BLUE CROSS P NETWORK,32.00,,,,,,,8.2600,405.0500,fee schedule,"$21.41 from Fee Schedule BCFSG for Rev 471 Proc 92621 * Qty 1 = $21.41 at 445% = $95.27 (Service Line reduced to $32.00, claim capped at $32.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CENTRAL AUD FUNCT TEST ADDL 15MIN,92621,CPT,471,RC,47100016,CDM,,,,both,,,32.0000,4.8000,BLUE CROSS,BLUE CROSS S NETWORK,32.00,,,,,,,8.2600,405.0500,fee schedule,"$21.41 from Fee Schedule BCFSG for Rev 471 Proc 92621 * Qty 1 = $21.41 at 445% = $95.27 (Service Line reduced to $32.00, claim capped at $32.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CENTRAL AUD FUNCT TEST ADDL 15MIN,92621,CPT,471,RC,47100016,CDM,,,,both,,,32.0000,4.8000,BLUE CROSS,TENNCARE BLUE CARE,9.98,,,,,,,8.2600,405.0500,fee schedule,$8.60 from Fee Schedule TC_24 for Rev 471 Proc 92621 * Qty 1 = $8.60 at 116% = $9.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUD FUNCT TEST ADDL 15MIN,92621,CPT,471,RC,47100016,CDM,,,,both,,,32.0000,4.8000,BLUE CROSS,TENNCARE BLUE SELECT,9.98,,,,,,,8.2600,405.0500,fee schedule,$8.60 from Fee Schedule TC_24 for Rev 471 Proc 92621 * Qty 1 = $8.60 at 116% = $9.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUD FUNCT TEST ADDL 15MIN,92621,CPT,471,RC,47100016,CDM,,,,both,,,32.0000,4.8000,CIGNA HEALTHCARE,CIGNA HMO,13.34,,,,,,,8.2600,405.0500,percent of total billed charges,41.7% of $32.00 in Billed Charges for Rev 471 Proc 92621 = $13.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CENTRAL AUD FUNCT TEST ADDL 15MIN,92621,CPT,471,RC,47100016,CDM,,,,both,,,32.0000,4.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,14.85,,,,,,,8.2600,405.0500,percent of total billed charges,46.4% of $32.00 in Billed Charges for Rev 471 Proc 92621 = $14.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CENTRAL AUD FUNCT TEST ADDL 15MIN,92621,CPT,471,RC,47100016,CDM,,,,both,,,32.0000,4.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,13.34,,,,,,,8.2600,405.0500,percent of total billed charges,41.7% of $32.00 in Billed Charges for Rev 471 Proc 92621 = $13.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CENTRAL AUD FUNCT TEST ADDL 15MIN,92621,CPT,471,RC,47100016,CDM,,,,both,,,32.0000,4.8000,CIGNA HEALTHCARE,CIGNA PPO,13.34,,,,,,,8.2600,405.0500,percent of total billed charges,41.7% of $32.00 in Billed Charges for Rev 471 Proc 92621 = $13.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CENTRAL AUD FUNCT TEST ADDL 15MIN,92621,CPT,471,RC,47100016,CDM,,,,both,,,32.0000,4.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,28.80,,,,,,,8.2600,405.0500,percent of total billed charges,90% of $32.00 in Billed Charges for Rev 471 Proc 92621 = $28.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CENTRAL AUD FUNCT TEST ADDL 15MIN,92621,CPT,471,RC,47100016,CDM,,,,both,,,32.0000,4.8000,MEDCOST,MEDCOST VHN,15.23,,,,,,,8.2600,405.0500,percent of total billed charges,47.59% of $32.00 in Billed Charges for Rev 471 Proc 92621 = $15.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CENTRAL AUD FUNCT TEST ADDL 15MIN,92621,CPT,471,RC,47100016,CDM,,,,both,,,32.0000,4.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,405.05,,,,,,,8.2600,405.0500,fee schedule,APG 00272 Proc 92621 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 100% = $385.76... $385.76 at 105% = $405.05 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUD FUNCT TEST ADDL 15MIN,92621,CPT,471,RC,47100016,CDM,,,,both,,,32.0000,4.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,397.72,,,,,,,8.2600,405.0500,fee schedule,APG 00272 Proc 92621 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 100% = $385.76... $385.76 at 103.1% = $397.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUD FUNCT TEST ADDL 15MIN,92621,CPT,471,RC,47100016,CDM,,,,both,,,32.0000,4.8000,SENTARA HEALTH,SENTARA HEALTH,8.26,,,,,,,8.2600,405.0500,percent of total billed charges,25.81% of $32.00 in Billed Charges for Rev 471 Proc 92621 = $8.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CENTRAL AUD FUNCT TEST ADDL 15MIN,92621,CPT,471,RC,47100016,CDM,,,,both,,,32.0000,4.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",32.00,,,,,,,8.2600,405.0500,percent of total billed charges,100% of $32.00 in Billed Charges for Rev 471 Proc 92621 = $32.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CENTRAL AUD FUNCT TEST ADDL 15MIN,92621,CPT,471,RC,47100016,CDM,,,,both,,,32.0000,4.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,32.00,,,,,,,8.2600,405.0500,other,"Rev 471 Proc 92621 1 Visit at $320.00 per Visit = $320.00 (Service Line reduced to $32.00, claim capped at $32.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CENTRAL AUD FUNCT TEST ADDL 15MIN,92621,CPT,471,RC,47100016,CDM,,,,both,,,32.0000,4.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,32.00,,,,,,,8.2600,405.0500,other,"Rev 471 Proc 92621 1 Visit at $305.00 per Visit = $305.00 (Service Line reduced to $32.00, claim capped at $32.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CENTRAL AUD FUNCT TEST ADDL 15MIN,92621,CPT,471,RC,47100016,CDM,,,,both,,,32.0000,4.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,32.00,,,,,,,8.2600,405.0500,other,"Rev 471 Proc 92621 1 Visit at $502.00 per Visit = $502.00 (Service Line reduced to $32.00, claim capped at $32.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CENTRAL AUD FUNCT TEST ADDL 15MIN,92621,CPT,471,RC,47100016,CDM,,,,both,,,32.0000,4.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,397.33,,,,,,,8.2600,405.0500,fee schedule,APG 00272 Proc 92621 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 103% = $397.33. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CENTRAL AUD FUNCT TEST ADDL 15MIN,92621,CPT,471,RC,47100016,CDM,,,,both,,,32.0000,4.8000,WELLCARE,WELLCARE MEDICAID,32.00,,,,,,,8.2600,405.0500,percent of total billed charges,100% of $32.00 in Billed Charges for Rev 471 Proc 92621 = $32.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,AETNA,AETNA,46.97,,,,,,,28.3900,254.5000,percent of total billed charges,42.7% of $110.00 in Billed Charges for Rev 471 Proc 92625 = $46.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,114.24,,,,,,,28.3900,254.5000,fee schedule,APG 00257 Proc 92625 at $836.60 (Base Rate) * 0.1313 (Relative Weight) = $109.85 (Total Line Payment) at 104% = $114.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,110.00,,,,,,,28.3900,254.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,AETNA,AETNA HEALTHCARE MEDICARE,110.00,,,,,,,28.3900,254.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,110.00,,,,,,,28.3900,254.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,AMBETTER,AMBETTER,254.50,,,,,,,28.3900,254.5000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,110.00,,,,,,,28.3900,254.5000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,BLUE CROSS,ANTHEM EXCHANGE,110.00,,,,,,,28.3900,254.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,110.00,,,,,,,28.3900,254.5000,fee schedule,"APG 00257 Proc 92625 at $836.60 (Base Rate) * 0.1313 (Relative Weight) = $109.85 (Total Line Payment) at 103% = $113.14 (Service Line reduced to $110.00, claim capped at $110.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,BLUE CROSS,ANTHEM HMO,110.00,,,,,,,28.3900,254.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,110.00,,,,,,,28.3900,254.5000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",110.00,,,,,,,28.3900,254.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,39.21,,,,,,,28.3900,254.5000,fee schedule,$39.21 from Fee Schedule BLDTM_23 for Rev 471 Proc 92625 * Qty 1 = $39.21 at 100% = $39.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,BLUE CROSS,BLUE CROSS E NETWORK,110.00,,,,,,,28.3900,254.5000,fee schedule,"$66.90 from Fee Schedule BCFSG for Rev 471 Proc 92625 * Qty 1 = $66.90 at 436% = $291.68 (Service Line reduced to $110.00, claim capped at $110.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,BLUE CROSS,BLUE CROSS MEDICARE,121.41,,,,,,,28.3900,254.5000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,BLUE CROSS,BLUE CROSS P NETWORK,110.00,,,,,,,28.3900,254.5000,fee schedule,"$66.90 from Fee Schedule BCFSG for Rev 471 Proc 92625 * Qty 1 = $66.90 at 445% = $297.71 (Service Line reduced to $110.00, claim capped at $110.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,BLUE CROSS,BLUE CROSS S NETWORK,110.00,,,,,,,28.3900,254.5000,fee schedule,"$66.90 from Fee Schedule BCFSG for Rev 471 Proc 92625 * Qty 1 = $66.90 at 445% = $297.71 (Service Line reduced to $110.00, claim capped at $110.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,BLUE CROSS,TENNCARE BLUE CARE,39.63,,,,,,,28.3900,254.5000,fee schedule,$34.16 from Fee Schedule TC_24 for Rev 471 Proc 92625 * Qty 1 = $34.16 at 116% = $39.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,BLUE CROSS,TENNCARE BLUE SELECT,39.63,,,,,,,28.3900,254.5000,fee schedule,$34.16 from Fee Schedule TC_24 for Rev 471 Proc 92625 * Qty 1 = $34.16 at 116% = $39.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,CIGNA HEALTHCARE,CIGNA HMO,45.87,,,,,,,28.3900,254.5000,percent of total billed charges,41.7% of $110.00 in Billed Charges for Rev 471 Proc 92625 = $45.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,51.04,,,,,,,28.3900,254.5000,percent of total billed charges,46.4% of $110.00 in Billed Charges for Rev 471 Proc 92625 = $51.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,110.00,,,,,,,28.3900,254.5000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,45.87,,,,,,,28.3900,254.5000,percent of total billed charges,41.7% of $110.00 in Billed Charges for Rev 471 Proc 92625 = $45.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,CIGNA HEALTHCARE,CIGNA PPO,45.87,,,,,,,28.3900,254.5000,percent of total billed charges,41.7% of $110.00 in Billed Charges for Rev 471 Proc 92625 = $45.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,110.00,,,,,,,28.3900,254.5000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,99.00,,,,,,,28.3900,254.5000,percent of total billed charges,90% of $110.00 in Billed Charges for Rev 471 Proc 92625 = $99.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,HUMANA,HUMANA MEDICARE,110.00,,,,,,,28.3900,254.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,110.00,,,,,,,28.3900,254.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,MEDCOST,MEDCOST VHN,52.35,,,,,,,28.3900,254.5000,percent of total billed charges,47.59% of $110.00 in Billed Charges for Rev 471 Proc 92625 = $52.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,115.34,,,,,,,28.3900,254.5000,fee schedule,APG 00257 Proc 92625 at $836.60 (Base Rate) * 0.1313 (Relative Weight) = $109.85 (Total Line Payment) at 100% = $109.85... $109.85 at 105% = $115.34 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,110.00,,,,,,,28.3900,254.5000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,110.00,,,,,,,28.3900,254.5000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,NHC ADVANTAGE,NHC ADVANTAGE,110.00,,,,,,,28.3900,254.5000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,113.26,,,,,,,28.3900,254.5000,fee schedule,APG 00257 Proc 92625 at $836.60 (Base Rate) * 0.1313 (Relative Weight) = $109.85 (Total Line Payment) at 100% = $109.85... $109.85 at 103.1% = $113.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,SENTARA HEALTH,SENTARA HEALTH,28.39,,,,,,,28.3900,254.5000,percent of total billed charges,25.81% of $110.00 in Billed Charges for Rev 471 Proc 92625 = $28.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,SENTARA HEALTH,SENTARA MEDICARE,110.00,,,,,,,28.3900,254.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",110.00,,,,,,,28.3900,254.5000,percent of total billed charges,100% of $110.00 in Billed Charges for Rev 471 Proc 92625 = $110.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,42.58,,,,,,,28.3900,254.5000,fee schedule,$85.15 from Fee Schedule TCUHC24 for Rev 471 Proc 92625 * Qty 1 = $85.15 at 50% = $42.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,110.00,,,,,,,28.3900,254.5000,other,"Rev 471 Proc 92625 1 Visit at $320.00 per Visit = $320.00 (Service Line reduced to $110.00, claim capped at $110.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,110.00,,,,,,,28.3900,254.5000,other,"Rev 471 Proc 92625 1 Visit at $305.00 per Visit = $305.00 (Service Line reduced to $110.00, claim capped at $110.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,110.00,,,,,,,28.3900,254.5000,other,"Rev 471 Proc 92625 1 Visit at $502.00 per Visit = $502.00 (Service Line reduced to $110.00, claim capped at $110.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,113.14,,,,,,,28.3900,254.5000,fee schedule,APG 00257 Proc 92625 at $836.60 (Base Rate) * 0.1313 (Relative Weight) = $109.85 (Total Line Payment) at 103% = $113.14. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,110.00,,,,,,,28.3900,254.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,110.00,,,,,,,28.3900,254.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,WELLCARE,WELLCARE MEDICAID,110.00,,,,,,,28.3900,254.5000,percent of total billed charges,100% of $110.00 in Billed Charges for Rev 471 Proc 92625 = $110.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TINNITUS ASSESSMENT,92625,CPT,471,RC,47100017,CDM,,,,both,,,110.0000,16.5000,WELLCARE,WELLCARE MEDICARE,123.75,,,,,,,28.3900,254.5000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,AETNA,AETNA,188.73,,,,,,,69.7800,442.0000,percent of total billed charges,42.7% of $442.00 in Billed Charges for Rev 471 Proc 92651 = $188.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,114.24,,,,,,,69.7800,442.0000,fee schedule,APG 00257 Proc 92651 at $836.60 (Base Rate) * 0.1313 (Relative Weight) = $109.85 (Total Line Payment) at 104% = $114.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,195.90,,,,,,,69.7800,442.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,AETNA,AETNA HEALTHCARE MEDICARE,195.90,,,,,,,69.7800,442.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,195.90,,,,,,,69.7800,442.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,AMBETTER,AMBETTER,427.07,,,,,,,69.7800,442.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,203.74,,,,,,,69.7800,442.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,BLUE CROSS,ANTHEM EXCHANGE,442.00,,,,,,,69.7800,442.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,113.14,,,,,,,69.7800,442.0000,fee schedule,APG 00257 Proc 92651 at $836.60 (Base Rate) * 0.1313 (Relative Weight) = $109.85 (Total Line Payment) at 103% = $113.14. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,BLUE CROSS,ANTHEM HMO,442.00,,,,,,,69.7800,442.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,201.78,,,,,,,69.7800,442.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",442.00,,,,,,,69.7800,442.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,309.40,,,,,,,69.7800,442.0000,percent of total billed charges,Rev 471 Proc 92651 $442.00 in Billed Charges at 70% = $309.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,BLUE CROSS,BLUE CROSS E NETWORK,368.94,,,,,,,69.7800,442.0000,fee schedule,$84.62 from Fee Schedule BCFSG for Rev 471 Proc 92651 * Qty 1 = $84.62 at 436% = $368.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,BLUE CROSS,BLUE CROSS MEDICARE,203.74,,,,,,,69.7800,442.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,BLUE CROSS,BLUE CROSS P NETWORK,376.56,,,,,,,69.7800,442.0000,fee schedule,$84.62 from Fee Schedule BCFSG for Rev 471 Proc 92651 * Qty 1 = $84.62 at 445% = $376.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,BLUE CROSS,BLUE CROSS S NETWORK,376.56,,,,,,,69.7800,442.0000,fee schedule,$84.62 from Fee Schedule BCFSG for Rev 471 Proc 92651 * Qty 1 = $84.62 at 445% = $376.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,BLUE CROSS,TENNCARE BLUE CARE,85.53,,,,,,,69.7800,442.0000,fee schedule,$73.73 from Fee Schedule TC_24 for Rev 471 Proc 92651 * Qty 1 = $73.73 at 116% = $85.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,BLUE CROSS,TENNCARE BLUE SELECT,85.53,,,,,,,69.7800,442.0000,fee schedule,$73.73 from Fee Schedule TC_24 for Rev 471 Proc 92651 * Qty 1 = $73.73 at 116% = $85.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,CIGNA HEALTHCARE,CIGNA HMO,184.31,,,,,,,69.7800,442.0000,percent of total billed charges,41.7% of $442.00 in Billed Charges for Rev 471 Proc 92651 = $184.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,205.09,,,,,,,69.7800,442.0000,percent of total billed charges,46.4% of $442.00 in Billed Charges for Rev 471 Proc 92651 = $205.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,205.70,,,,,,,69.7800,442.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,184.31,,,,,,,69.7800,442.0000,percent of total billed charges,41.7% of $442.00 in Billed Charges for Rev 471 Proc 92651 = $184.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,CIGNA HEALTHCARE,CIGNA PPO,184.31,,,,,,,69.7800,442.0000,percent of total billed charges,41.7% of $442.00 in Billed Charges for Rev 471 Proc 92651 = $184.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,205.70,,,,,,,69.7800,442.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,397.80,,,,,,,69.7800,442.0000,percent of total billed charges,90% of $442.00 in Billed Charges for Rev 471 Proc 92651 = $397.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,HUMANA,HUMANA MEDICARE,195.90,,,,,,,69.7800,442.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,195.90,,,,,,,69.7800,442.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,MEDCOST,MEDCOST VHN,210.35,,,,,,,69.7800,442.0000,percent of total billed charges,47.59% of $442.00 in Billed Charges for Rev 471 Proc 92651 = $210.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,115.34,,,,,,,69.7800,442.0000,fee schedule,APG 00257 Proc 92651 at $836.60 (Base Rate) * 0.1313 (Relative Weight) = $109.85 (Total Line Payment) at 100% = $109.85... $109.85 at 105% = $115.34 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,205.70,,,,,,,69.7800,442.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,205.70,,,,,,,69.7800,442.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,NHC ADVANTAGE,NHC ADVANTAGE,205.70,,,,,,,69.7800,442.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,113.26,,,,,,,69.7800,442.0000,fee schedule,APG 00257 Proc 92651 at $836.60 (Base Rate) * 0.1313 (Relative Weight) = $109.85 (Total Line Payment) at 100% = $109.85... $109.85 at 103.1% = $113.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,SENTARA HEALTH,SENTARA HEALTH,114.08,,,,,,,69.7800,442.0000,percent of total billed charges,25.81% of $442.00 in Billed Charges for Rev 471 Proc 92651 = $114.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,SENTARA HEALTH,SENTARA MEDICARE,195.90,,,,,,,69.7800,442.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",442.00,,,,,,,69.7800,442.0000,percent of total billed charges,100% of $442.00 in Billed Charges for Rev 471 Proc 92651 = $442.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,69.78,,,,,,,69.7800,442.0000,fee schedule,$139.55 from Fee Schedule TCUHC24 for Rev 471 Proc 92651 * Qty 1 = $139.55 at 50% = $69.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,320.00,,,,,,,69.7800,442.0000,other,Rev 471 Proc 92651 1 Visit at $320.00 per Visit = $320.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,305.00,,,,,,,69.7800,442.0000,other,Rev 471 Proc 92651 1 Visit at $305.00 per Visit = $305.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,442.00,,,,,,,69.7800,442.0000,other,"Rev 471 Proc 92651 1 Visit at $502.00 per Visit = $502.00 (Service Line reduced to $442.00, claim capped at $442.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,113.14,,,,,,,69.7800,442.0000,fee schedule,APG 00257 Proc 92651 at $836.60 (Base Rate) * 0.1313 (Relative Weight) = $109.85 (Total Line Payment) at 103% = $113.14. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,195.90,,,,,,,69.7800,442.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,195.90,,,,,,,69.7800,442.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,WELLCARE,WELLCARE MEDICAID,442.00,,,,,,,69.7800,442.0000,percent of total billed charges,100% of $442.00 in Billed Charges for Rev 471 Proc 92651 = $442.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AUDITORY EVOKE POT/CNS SCRN LTD,92651,CPT,471,RC,47100020,CDM,,,,both,,,442.0000,66.3000,WELLCARE,WELLCARE MEDICARE,207.66,,,,,,,69.7800,442.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,AETNA,AETNA,12404.78,,,,,,,510.9100,29051.0000,percent of total billed charges,"42.7% of $29,051.00 in Billed Charges for Rev 481 Proc 92920 = $12,404.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,12234.58,,,,,,,510.9100,29051.0000,fee schedule,"APG 00099 Proc 92920 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 104% = $12,234.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5163.81,,,,,,,510.9100,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,AETNA,AETNA HEALTHCARE MEDICARE,5163.81,,,,,,,510.9100,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,5163.81,,,,,,,510.9100,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,AMBETTER,AMBETTER,11257.11,,,,,,,510.9100,29051.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,5370.36,,,,,,,510.9100,29051.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,ANTHEM EXCHANGE,12713.57,,,,,,,510.9100,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,12116.94,,,,,,,510.9100,29051.0000,fee schedule,"APG 00099 Proc 92920 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,ANTHEM HMO,13507.41,,,,,,,510.9100,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5318.72,,,,,,,510.9100,29051.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",15890.21,,,,,,,510.9100,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,20335.70,,,,,,,510.9100,29051.0000,percent of total billed charges,"Rev 481 Proc 92920 $29,051.00 in Billed Charges at 70% = $20,335.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,BLUE CROSS E NETWORK,21607.00,,,,,,,510.9100,29051.0000,case rate,"Rev 481 Proc 92920 ASG Rate of $21,607.00 at 100% of $21,607.00 = $21,607.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,BLUE CROSS MEDICARE,5370.36,,,,,,,510.9100,29051.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,BLUE CROSS P NETWORK,22094.00,,,,,,,510.9100,29051.0000,case rate,"Rev 481 Proc 92920 ASG Rate of $22,094.00 at 100% of $22,094.00 = $22,094.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,BLUE CROSS S NETWORK,22094.00,,,,,,,510.9100,29051.0000,case rate,"Rev 481 Proc 92920 ASG Rate of $22,094.00 at 100% of $22,094.00 = $22,094.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,TENNCARE BLUE CARE,510.91,,,,,,,510.9100,29051.0000,fee schedule,$440.44 from Fee Schedule TC_24 for Rev 481 Proc 92920 * Qty 1 = $440.44 at 116% = $510.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,TENNCARE BLUE SELECT,510.91,,,,,,,510.9100,29051.0000,fee schedule,$440.44 from Fee Schedule TC_24 for Rev 481 Proc 92920 * Qty 1 = $440.44 at 116% = $510.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,CIGNA HEALTHCARE,CIGNA HMO,12114.27,,,,,,,510.9100,29051.0000,percent of total billed charges,"41.7% of $29,051.00 in Billed Charges for Rev 481 Proc 92920 = $12,114.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,13479.66,,,,,,,510.9100,29051.0000,percent of total billed charges,"46.4% of $29,051.00 in Billed Charges for Rev 481 Proc 92920 = $13,479.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,5422.00,,,,,,,510.9100,29051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,12114.27,,,,,,,510.9100,29051.0000,percent of total billed charges,"41.7% of $29,051.00 in Billed Charges for Rev 481 Proc 92920 = $12,114.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,CIGNA HEALTHCARE,CIGNA PPO,12114.27,,,,,,,510.9100,29051.0000,percent of total billed charges,"41.7% of $29,051.00 in Billed Charges for Rev 481 Proc 92920 = $12,114.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,5422.00,,,,,,,510.9100,29051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,26145.90,,,,,,,510.9100,29051.0000,percent of total billed charges,"90% of $29,051.00 in Billed Charges for Rev 481 Proc 92920 = $26,145.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,HUMANA,HUMANA MEDICARE,5163.81,,,,,,,510.9100,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5163.81,,,,,,,510.9100,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,MEDCOST,MEDCOST VHN,13825.37,,,,,,,510.9100,29051.0000,percent of total billed charges,"47.59% of $29,051.00 in Billed Charges for Rev 481 Proc 92920 = $13,825.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,12352.22,,,,,,,510.9100,29051.0000,fee schedule,"APG 00099 Proc 92920 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 105% = $12,352.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,5422.00,,,,,,,510.9100,29051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,5422.00,,,,,,,510.9100,29051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,NHC ADVANTAGE,NHC ADVANTAGE,5422.00,,,,,,,510.9100,29051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,12128.70,,,,,,,510.9100,29051.0000,fee schedule,"APG 00099 Proc 92920 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 103.1% = $12,128.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,SENTARA HEALTH,SENTARA HEALTH,7498.06,,,,,,,510.9100,29051.0000,percent of total billed charges,"25.81% of $29,051.00 in Billed Charges for Rev 481 Proc 92920 = $7,498.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,SENTARA HEALTH,SENTARA MEDICARE,5163.81,,,,,,,510.9100,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",29051.00,,,,,,,510.9100,29051.0000,percent of total billed charges,"100% of $29,051.00 in Billed Charges for Rev 481 Proc 92920 = $29,051.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,510.9100,29051.0000,case rate,"Rev 481 Proc 92920 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,510.9100,29051.0000,case rate,"Rev 481 Proc 92920 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,510.9100,29051.0000,case rate,"Rev 481 Proc 92920 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,510.9100,29051.0000,case rate,"Rev 481 Proc 92920 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,12116.94,,,,,,,510.9100,29051.0000,fee schedule,"APG 00099 Proc 92920 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5163.81,,,,,,,510.9100,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5163.81,,,,,,,510.9100,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,WELLCARE,WELLCARE MEDICAID,29051.00,,,,,,,510.9100,29051.0000,percent of total billed charges,"100% of $29,051.00 in Billed Charges for Rev 481 Proc 92920 = $29,051.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ANGIOPLASTY PTCA,92920,CPT,481,RC,48100086,CDM,,,,both,,,29051.0000,4357.6500,WELLCARE,WELLCARE MEDICARE,5473.64,,,,,,,510.9100,29051.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,AETNA,AETNA,122.55,,,,,,,12.7400,287.0000,percent of total billed charges,42.7% of $287.00 in Billed Charges for Rev 301 Proc 84402 = $122.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15.66,,,,,,,12.7400,287.0000,fee schedule,APG 00398 Proc 84402 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 104% = $15.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,25.47,,,,,,,12.7400,287.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,AETNA,AETNA HEALTHCARE MEDICARE,25.47,,,,,,,12.7400,287.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,25.47,,,,,,,12.7400,287.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,AMBETTER,AMBETTER,55.52,,,,,,,12.7400,287.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,AMERIGROUP,AMERIGROUP,12.74,,,,,,,12.7400,287.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,26.49,,,,,,,12.7400,287.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,BLUE CROSS,ANTHEM EXCHANGE,25.47,,,,,,,12.7400,287.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15.51,,,,,,,12.7400,287.0000,fee schedule,APG 00398 Proc 84402 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,BLUE CROSS,ANTHEM HMO,25.47,,,,,,,12.7400,287.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,26.23,,,,,,,12.7400,287.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",25.47,,,,,,,12.7400,287.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,91.40,,,,,,,12.7400,287.0000,fee schedule,$91.40 from Fee Schedule BLDTM_23 for Rev 301 Proc 84402 * Qty 1 = $91.40 at 100% = $91.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,BLUE CROSS,BLUE CROSS E NETWORK,91.46,,,,,,,12.7400,287.0000,fee schedule,$28.58 from Fee Schedule BCFSB for Rev 301 Proc 84402 * Qty 1 = $28.58 at 320% = $91.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,BLUE CROSS,BLUE CROSS MEDICARE,26.49,,,,,,,12.7400,287.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,BLUE CROSS,BLUE CROSS P NETWORK,93.46,,,,,,,12.7400,287.0000,fee schedule,$28.58 from Fee Schedule BCFSB for Rev 301 Proc 84402 * Qty 1 = $28.58 at 327% = $93.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,BLUE CROSS,BLUE CROSS S NETWORK,93.46,,,,,,,12.7400,287.0000,fee schedule,$28.58 from Fee Schedule BCFSB for Rev 301 Proc 84402 * Qty 1 = $28.58 at 327% = $93.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,BLUE CROSS,TENNCARE BLUE CARE,75.33,,,,,,,12.7400,287.0000,fee schedule,$64.94 from Fee Schedule TC_24 for Rev 301 Proc 84402 * Qty 1 = $64.94 at 116% = $75.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,BLUE CROSS,TENNCARE BLUE SELECT,75.33,,,,,,,12.7400,287.0000,fee schedule,$64.94 from Fee Schedule TC_24 for Rev 301 Proc 84402 * Qty 1 = $64.94 at 116% = $75.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,CIGNA HEALTHCARE,CIGNA HMO,102.48,,,,,,,12.7400,287.0000,fee schedule,$102.48 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84402 * Qty 1 = $102.48 at 100% = $102.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,56.30,,,,,,,12.7400,287.0000,fee schedule,$56.30 from Fee Schedule CGIFP_25LR for Rev 301 Proc 84402 * Qty 1 = $56.30 at 100% = $56.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,26.74,,,,,,,12.7400,287.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,102.48,,,,,,,12.7400,287.0000,fee schedule,$102.48 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84402 * Qty 1 = $102.48 at 100% = $102.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,CIGNA HEALTHCARE,CIGNA PPO,102.48,,,,,,,12.7400,287.0000,fee schedule,$102.48 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84402 * Qty 1 = $102.48 at 100% = $102.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,26.74,,,,,,,12.7400,287.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,258.30,,,,,,,12.7400,287.0000,percent of total billed charges,90% of $287.00 in Billed Charges for Rev 301 Proc 84402 = $258.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,HUMANA,HUMANA MEDICARE,25.47,,,,,,,12.7400,287.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,25.47,,,,,,,12.7400,287.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,MEDCOST,MEDCOST VHN,136.58,,,,,,,12.7400,287.0000,percent of total billed charges,47.59% of $287.00 in Billed Charges for Rev 301 Proc 84402 = $136.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15.81,,,,,,,12.7400,287.0000,fee schedule,APG 00398 Proc 84402 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 105% = $15.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,26.74,,,,,,,12.7400,287.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,26.74,,,,,,,12.7400,287.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,NHC ADVANTAGE,NHC ADVANTAGE,26.74,,,,,,,12.7400,287.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15.53,,,,,,,12.7400,287.0000,fee schedule,APG 00398 Proc 84402 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 103.1% = $15.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,SENTARA HEALTH,SENTARA HEALTH,74.07,,,,,,,12.7400,287.0000,percent of total billed charges,25.81% of $287.00 in Billed Charges for Rev 301 Proc 84402 = $74.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,SENTARA HEALTH,SENTARA MEDICARE,25.47,,,,,,,12.7400,287.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",287.00,,,,,,,12.7400,287.0000,percent of total billed charges,100% of $287.00 in Billed Charges for Rev 301 Proc 84402 = $287.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,18.04,,,,,,,12.7400,287.0000,fee schedule,$36.07 from Fee Schedule TCUHC24 for Rev 301 Proc 84402 * Qty 1 = $36.07 at 50% = $18.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,26.49,,,,,,,12.7400,287.0000,fee schedule,$25.47 from Fee Schedule UHC_31910 for Rev 301 Proc 84402 * Qty 1 = $25.47 at 104% = $26.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,25.47,,,,,,,12.7400,287.0000,fee schedule,$25.47 from Fee Schedule UHC_31910 for Rev 301 Proc 84402 * Qty 1 = $25.47 at 100% = $25.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,25.47,,,,,,,12.7400,287.0000,fee schedule,$25.47 from Fee Schedule UHC_31910 for Rev 301 Proc 84402 * Qty 1 = $25.47 at 100% = $25.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15.51,,,,,,,12.7400,287.0000,fee schedule,APG 00398 Proc 84402 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,25.47,,,,,,,12.7400,287.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,25.47,,,,,,,12.7400,287.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,WELLCARE,WELLCARE MEDICAID,287.00,,,,,,,12.7400,287.0000,percent of total billed charges,100% of $287.00 in Billed Charges for Rev 301 Proc 84402 = $287.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TESTOSTERONE FREE,84402,CPT,301,RC,30100329,CDM,,,,both,,,287.0000,43.0500,WELLCARE,WELLCARE MEDICARE,27.00,,,,,,,12.7400,287.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,AETNA,AETNA,105.90,,,,,,,10.6200,248.0000,percent of total billed charges,42.7% of $248.00 in Billed Charges for Rev 301 Proc 84425 = $105.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,14.27,,,,,,,10.6200,248.0000,fee schedule,APG 00400 Proc 84425 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 104% = $14.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,21.23,,,,,,,10.6200,248.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,AETNA,AETNA HEALTHCARE MEDICARE,21.23,,,,,,,10.6200,248.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,21.23,,,,,,,10.6200,248.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,AMBETTER,AMBETTER,46.28,,,,,,,10.6200,248.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,AMERIGROUP,AMERIGROUP,10.62,,,,,,,10.6200,248.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,22.08,,,,,,,10.6200,248.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,ANTHEM EXCHANGE,21.23,,,,,,,10.6200,248.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,14.13,,,,,,,10.6200,248.0000,fee schedule,APG 00400 Proc 84425 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,ANTHEM HMO,21.23,,,,,,,10.6200,248.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,21.87,,,,,,,10.6200,248.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",21.23,,,,,,,10.6200,248.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,73.53,,,,,,,10.6200,248.0000,fee schedule,$73.53 from Fee Schedule BLDTM_23 for Rev 301 Proc 84425 * Qty 1 = $73.53 at 100% = $73.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,BLUE CROSS E NETWORK,92.67,,,,,,,10.6200,248.0000,fee schedule,$28.96 from Fee Schedule BCFSB for Rev 301 Proc 84425 * Qty 1 = $28.96 at 320% = $92.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,BLUE CROSS MEDICARE,22.08,,,,,,,10.6200,248.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,BLUE CROSS P NETWORK,94.70,,,,,,,10.6200,248.0000,fee schedule,$28.96 from Fee Schedule BCFSB for Rev 301 Proc 84425 * Qty 1 = $28.96 at 327% = $94.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,BLUE CROSS S NETWORK,94.70,,,,,,,10.6200,248.0000,fee schedule,$28.96 from Fee Schedule BCFSB for Rev 301 Proc 84425 * Qty 1 = $28.96 at 327% = $94.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,TENNCARE BLUE CARE,48.13,,,,,,,10.6200,248.0000,fee schedule,$41.49 from Fee Schedule TC_24 for Rev 301 Proc 84425 * Qty 1 = $41.49 at 116% = $48.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,BLUE CROSS,TENNCARE BLUE SELECT,48.13,,,,,,,10.6200,248.0000,fee schedule,$41.49 from Fee Schedule TC_24 for Rev 301 Proc 84425 * Qty 1 = $41.49 at 116% = $48.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,CIGNA HEALTHCARE,CIGNA HMO,85.43,,,,,,,10.6200,248.0000,fee schedule,$85.43 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84425 * Qty 1 = $85.43 at 100% = $85.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,46.92,,,,,,,10.6200,248.0000,fee schedule,$46.92 from Fee Schedule CGIFP_25LR for Rev 301 Proc 84425 * Qty 1 = $46.92 at 100% = $46.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,22.29,,,,,,,10.6200,248.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,85.43,,,,,,,10.6200,248.0000,fee schedule,$85.43 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84425 * Qty 1 = $85.43 at 100% = $85.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,CIGNA HEALTHCARE,CIGNA PPO,85.43,,,,,,,10.6200,248.0000,fee schedule,$85.43 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84425 * Qty 1 = $85.43 at 100% = $85.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,22.29,,,,,,,10.6200,248.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,223.20,,,,,,,10.6200,248.0000,percent of total billed charges,90% of $248.00 in Billed Charges for Rev 301 Proc 84425 = $223.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,HUMANA,HUMANA MEDICARE,21.23,,,,,,,10.6200,248.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,21.23,,,,,,,10.6200,248.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,MEDCOST,MEDCOST VHN,118.02,,,,,,,10.6200,248.0000,percent of total billed charges,47.59% of $248.00 in Billed Charges for Rev 301 Proc 84425 = $118.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,14.41,,,,,,,10.6200,248.0000,fee schedule,APG 00400 Proc 84425 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 105% = $14.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,22.29,,,,,,,10.6200,248.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,22.29,,,,,,,10.6200,248.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,NHC ADVANTAGE,NHC ADVANTAGE,22.29,,,,,,,10.6200,248.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,14.15,,,,,,,10.6200,248.0000,fee schedule,APG 00400 Proc 84425 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 100% = $13.72... $13.72 at 103.1% = $14.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,SENTARA HEALTH,SENTARA HEALTH,64.01,,,,,,,10.6200,248.0000,percent of total billed charges,25.81% of $248.00 in Billed Charges for Rev 301 Proc 84425 = $64.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,SENTARA HEALTH,SENTARA MEDICARE,21.23,,,,,,,10.6200,248.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",248.00,,,,,,,10.6200,248.0000,percent of total billed charges,100% of $248.00 in Billed Charges for Rev 301 Proc 84425 = $248.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,15.04,,,,,,,10.6200,248.0000,fee schedule,$30.07 from Fee Schedule TCUHC24 for Rev 301 Proc 84425 * Qty 1 = $30.07 at 50% = $15.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,22.08,,,,,,,10.6200,248.0000,fee schedule,$21.23 from Fee Schedule UHC_31910 for Rev 301 Proc 84425 * Qty 1 = $21.23 at 104% = $22.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,21.23,,,,,,,10.6200,248.0000,fee schedule,$21.23 from Fee Schedule UHC_31910 for Rev 301 Proc 84425 * Qty 1 = $21.23 at 100% = $21.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,21.23,,,,,,,10.6200,248.0000,fee schedule,$21.23 from Fee Schedule UHC_31910 for Rev 301 Proc 84425 * Qty 1 = $21.23 at 100% = $21.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,14.13,,,,,,,10.6200,248.0000,fee schedule,APG 00400 Proc 84425 at $836.60 (Base Rate) * 0.0164 (Relative Weight) = $13.72 (Total Line Payment) at 103% = $14.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,21.23,,,,,,,10.6200,248.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,21.23,,,,,,,10.6200,248.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,WELLCARE,WELLCARE MEDICAID,248.00,,,,,,,10.6200,248.0000,percent of total billed charges,100% of $248.00 in Billed Charges for Rev 301 Proc 84425 = $248.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THIAMINE VITAMIN B1,84425,CPT,301,RC,30100257,CDM,,,,both,,,248.0000,37.2000,WELLCARE,WELLCARE MEDICARE,22.50,,,,,,,10.6200,248.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,AETNA,AETNA,77.29,,,,,,,8.0300,181.0000,percent of total billed charges,42.7% of $181.00 in Billed Charges for Rev 301 Proc 84432 = $77.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15.66,,,,,,,8.0300,181.0000,fee schedule,APG 00398 Proc 84432 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 104% = $15.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,16.06,,,,,,,8.0300,181.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,AETNA,AETNA HEALTHCARE MEDICARE,16.06,,,,,,,8.0300,181.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,16.06,,,,,,,8.0300,181.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,AMBETTER,AMBETTER,35.01,,,,,,,8.0300,181.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,AMERIGROUP,AMERIGROUP,8.03,,,,,,,8.0300,181.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,16.70,,,,,,,8.0300,181.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,BLUE CROSS,ANTHEM EXCHANGE,16.06,,,,,,,8.0300,181.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15.51,,,,,,,8.0300,181.0000,fee schedule,APG 00398 Proc 84432 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,BLUE CROSS,ANTHEM HMO,16.06,,,,,,,8.0300,181.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,16.54,,,,,,,8.0300,181.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",16.06,,,,,,,8.0300,181.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,55.37,,,,,,,8.0300,181.0000,fee schedule,$55.37 from Fee Schedule BLDTM_23 for Rev 301 Proc 84432 * Qty 1 = $55.37 at 100% = $55.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,BLUE CROSS,BLUE CROSS E NETWORK,50.82,,,,,,,8.0300,181.0000,fee schedule,$15.88 from Fee Schedule BCFSB for Rev 301 Proc 84432 * Qty 1 = $15.88 at 320% = $50.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,BLUE CROSS,BLUE CROSS MEDICARE,16.70,,,,,,,8.0300,181.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,BLUE CROSS,BLUE CROSS P NETWORK,51.93,,,,,,,8.0300,181.0000,fee schedule,$15.88 from Fee Schedule BCFSB for Rev 301 Proc 84432 * Qty 1 = $15.88 at 327% = $51.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,BLUE CROSS,BLUE CROSS S NETWORK,51.93,,,,,,,8.0300,181.0000,fee schedule,$15.88 from Fee Schedule BCFSB for Rev 301 Proc 84432 * Qty 1 = $15.88 at 327% = $51.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,BLUE CROSS,TENNCARE BLUE CARE,45.23,,,,,,,8.0300,181.0000,fee schedule,$38.99 from Fee Schedule TC_24 for Rev 301 Proc 84432 * Qty 1 = $38.99 at 116% = $45.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,BLUE CROSS,TENNCARE BLUE SELECT,45.23,,,,,,,8.0300,181.0000,fee schedule,$38.99 from Fee Schedule TC_24 for Rev 301 Proc 84432 * Qty 1 = $38.99 at 116% = $45.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,CIGNA HEALTHCARE,CIGNA HMO,64.63,,,,,,,8.0300,181.0000,fee schedule,$64.63 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84432 * Qty 1 = $64.63 at 100% = $64.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,35.37,,,,,,,8.0300,181.0000,fee schedule,$35.37 from Fee Schedule CGIFP_25LR for Rev 301 Proc 84432 * Qty 1 = $35.37 at 100% = $35.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,16.86,,,,,,,8.0300,181.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,64.63,,,,,,,8.0300,181.0000,fee schedule,$64.63 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84432 * Qty 1 = $64.63 at 100% = $64.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,CIGNA HEALTHCARE,CIGNA PPO,64.63,,,,,,,8.0300,181.0000,fee schedule,$64.63 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84432 * Qty 1 = $64.63 at 100% = $64.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,16.86,,,,,,,8.0300,181.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,162.90,,,,,,,8.0300,181.0000,percent of total billed charges,90% of $181.00 in Billed Charges for Rev 301 Proc 84432 = $162.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,HUMANA,HUMANA MEDICARE,16.06,,,,,,,8.0300,181.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,16.06,,,,,,,8.0300,181.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,MEDCOST,MEDCOST VHN,86.14,,,,,,,8.0300,181.0000,percent of total billed charges,47.59% of $181.00 in Billed Charges for Rev 301 Proc 84432 = $86.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15.81,,,,,,,8.0300,181.0000,fee schedule,APG 00398 Proc 84432 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 105% = $15.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,16.86,,,,,,,8.0300,181.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,16.86,,,,,,,8.0300,181.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,NHC ADVANTAGE,NHC ADVANTAGE,16.86,,,,,,,8.0300,181.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15.53,,,,,,,8.0300,181.0000,fee schedule,APG 00398 Proc 84432 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 103.1% = $15.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,SENTARA HEALTH,SENTARA HEALTH,46.72,,,,,,,8.0300,181.0000,percent of total billed charges,25.81% of $181.00 in Billed Charges for Rev 301 Proc 84432 = $46.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,SENTARA HEALTH,SENTARA MEDICARE,16.06,,,,,,,8.0300,181.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",181.00,,,,,,,8.0300,181.0000,percent of total billed charges,100% of $181.00 in Billed Charges for Rev 301 Proc 84432 = $181.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11.38,,,,,,,8.0300,181.0000,fee schedule,$22.76 from Fee Schedule TCUHC24 for Rev 301 Proc 84432 * Qty 1 = $22.76 at 50% = $11.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,16.70,,,,,,,8.0300,181.0000,fee schedule,$16.06 from Fee Schedule UHC_31910 for Rev 301 Proc 84432 * Qty 1 = $16.06 at 104% = $16.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,16.06,,,,,,,8.0300,181.0000,fee schedule,$16.06 from Fee Schedule UHC_31910 for Rev 301 Proc 84432 * Qty 1 = $16.06 at 100% = $16.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,16.06,,,,,,,8.0300,181.0000,fee schedule,$16.06 from Fee Schedule UHC_31910 for Rev 301 Proc 84432 * Qty 1 = $16.06 at 100% = $16.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15.51,,,,,,,8.0300,181.0000,fee schedule,APG 00398 Proc 84432 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,16.06,,,,,,,8.0300,181.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,16.06,,,,,,,8.0300,181.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,WELLCARE,WELLCARE MEDICAID,181.00,,,,,,,8.0300,181.0000,percent of total billed charges,100% of $181.00 in Billed Charges for Rev 301 Proc 84432 = $181.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THYROGLOBULIN,84432,CPT,301,RC,30100259,CDM,,,,both,,,181.0000,27.1500,WELLCARE,WELLCARE MEDICARE,17.02,,,,,,,8.0300,181.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIO PTCA ADDL VESSL,92921,CPT,481,RC,48100087,CDM,,,,both,,,13360.0000,2004.0000,AETNA,AETNA,5704.72,,,,,,,148.0000,13360.0000,percent of total billed charges,"42.7% of $13,360.00 in Billed Charges for Rev 481 Proc 92921 = $5,704.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ANGIO PTCA ADDL VESSL,92921,CPT,481,RC,48100087,CDM,,,,both,,,13360.0000,2004.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,12234.58,,,,,,,148.0000,13360.0000,fee schedule,"APG 00099 Proc 92921 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 104% = $12,234.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORONARY ANGIO PTCA ADDL VESSL,92921,CPT,481,RC,48100087,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,12116.94,,,,,,,148.0000,13360.0000,fee schedule,"APG 00099 Proc 92921 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORONARY ANGIO PTCA ADDL VESSL,92921,CPT,481,RC,48100087,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9352.00,,,,,,,148.0000,13360.0000,percent of total billed charges,"Rev 481 Proc 92921 $13,360.00 in Billed Charges at 70% = $9,352.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ANGIO PTCA ADDL VESSL,92921,CPT,481,RC,48100087,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,13360.0000,case rate,Rev 481 Proc 92921 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIO PTCA ADDL VESSL,92921,CPT,481,RC,48100087,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,13360.0000,case rate,Rev 481 Proc 92921 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIO PTCA ADDL VESSL,92921,CPT,481,RC,48100087,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,13360.0000,case rate,Rev 481 Proc 92921 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORONARY ANGIO PTCA ADDL VESSL,92921,CPT,481,RC,48100087,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA HMO,5571.12,,,,,,,148.0000,13360.0000,percent of total billed charges,"41.7% of $13,360.00 in Billed Charges for Rev 481 Proc 92921 = $5,571.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ANGIO PTCA ADDL VESSL,92921,CPT,481,RC,48100087,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6199.04,,,,,,,148.0000,13360.0000,percent of total billed charges,"46.4% of $13,360.00 in Billed Charges for Rev 481 Proc 92921 = $6,199.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ANGIO PTCA ADDL VESSL,92921,CPT,481,RC,48100087,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5571.12,,,,,,,148.0000,13360.0000,percent of total billed charges,"41.7% of $13,360.00 in Billed Charges for Rev 481 Proc 92921 = $5,571.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ANGIO PTCA ADDL VESSL,92921,CPT,481,RC,48100087,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA PPO,5571.12,,,,,,,148.0000,13360.0000,percent of total billed charges,"41.7% of $13,360.00 in Billed Charges for Rev 481 Proc 92921 = $5,571.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ANGIO PTCA ADDL VESSL,92921,CPT,481,RC,48100087,CDM,,,,both,,,13360.0000,2004.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12024.00,,,,,,,148.0000,13360.0000,percent of total billed charges,"90% of $13,360.00 in Billed Charges for Rev 481 Proc 92921 = $12,024.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ANGIO PTCA ADDL VESSL,92921,CPT,481,RC,48100087,CDM,,,,both,,,13360.0000,2004.0000,MEDCOST,MEDCOST VHN,6358.02,,,,,,,148.0000,13360.0000,percent of total billed charges,"47.59% of $13,360.00 in Billed Charges for Rev 481 Proc 92921 = $6,358.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ANGIO PTCA ADDL VESSL,92921,CPT,481,RC,48100087,CDM,,,,both,,,13360.0000,2004.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,12352.22,,,,,,,148.0000,13360.0000,fee schedule,"APG 00099 Proc 92921 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 105% = $12,352.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORONARY ANGIO PTCA ADDL VESSL,92921,CPT,481,RC,48100087,CDM,,,,both,,,13360.0000,2004.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,12128.70,,,,,,,148.0000,13360.0000,fee schedule,"APG 00099 Proc 92921 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 103.1% = $12,128.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORONARY ANGIO PTCA ADDL VESSL,92921,CPT,481,RC,48100087,CDM,,,,both,,,13360.0000,2004.0000,SENTARA HEALTH,SENTARA HEALTH,3448.22,,,,,,,148.0000,13360.0000,percent of total billed charges,"25.81% of $13,360.00 in Billed Charges for Rev 481 Proc 92921 = $3,448.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ANGIO PTCA ADDL VESSL,92921,CPT,481,RC,48100087,CDM,,,,both,,,13360.0000,2004.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13360.00,,,,,,,148.0000,13360.0000,percent of total billed charges,"100% of $13,360.00 in Billed Charges for Rev 481 Proc 92921 = $13,360.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORONARY ANGIO PTCA ADDL VESSL,92921,CPT,481,RC,48100087,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,148.0000,13360.0000,case rate,"Rev 481 Proc 92921 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORONARY ANGIO PTCA ADDL VESSL,92921,CPT,481,RC,48100087,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,148.0000,13360.0000,case rate,"Rev 481 Proc 92921 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORONARY ANGIO PTCA ADDL VESSL,92921,CPT,481,RC,48100087,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,148.0000,13360.0000,case rate,"Rev 481 Proc 92921 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORONARY ANGIO PTCA ADDL VESSL,92921,CPT,481,RC,48100087,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,148.0000,13360.0000,case rate,"Rev 481 Proc 92921 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORONARY ANGIO PTCA ADDL VESSL,92921,CPT,481,RC,48100087,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,12116.94,,,,,,,148.0000,13360.0000,fee schedule,"APG 00099 Proc 92921 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORONARY ANGIO PTCA ADDL VESSL,92921,CPT,481,RC,48100087,CDM,,,,both,,,13360.0000,2004.0000,WELLCARE,WELLCARE MEDICAID,13360.00,,,,,,,148.0000,13360.0000,percent of total billed charges,"100% of $13,360.00 in Billed Charges for Rev 481 Proc 92921 = $13,360.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,AETNA,AETNA,9507.16,,,,,,,568.3900,22832.7700,percent of total billed charges,"42.7% of $22,265.00 in Billed Charges for Rev 481 Proc 92928 = $9,507.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,12234.58,,,,,,,568.3900,22832.7700,fee schedule,"APG 00099 Proc 92928 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 104% = $12,234.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,10473.75,,,,,,,568.3900,22832.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,AETNA,AETNA HEALTHCARE MEDICARE,10473.75,,,,,,,568.3900,22832.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,10473.75,,,,,,,568.3900,22832.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,AMBETTER,AMBETTER,22832.77,,,,,,,568.3900,22832.7700,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,10892.70,,,,,,,568.3900,22832.7700,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,BLUE CROSS,ANTHEM EXCHANGE,22265.00,,,,,,,568.3900,22832.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,12116.94,,,,,,,568.3900,22832.7700,fee schedule,"APG 00099 Proc 92928 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,BLUE CROSS,ANTHEM HMO,22265.00,,,,,,,568.3900,22832.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,10787.96,,,,,,,568.3900,22832.7700,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",22265.00,,,,,,,568.3900,22832.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,15585.50,,,,,,,568.3900,22832.7700,percent of total billed charges,"Rev 481 Proc 92928 $22,265.00 in Billed Charges at 70% = $15,585.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,BLUE CROSS,BLUE CROSS E NETWORK,21607.00,,,,,,,568.3900,22832.7700,case rate,"Rev 481 Proc 92928 ASG Rate of $21,607.00 at 100% of $21,607.00 = $21,607.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,BLUE CROSS,BLUE CROSS MEDICARE,10892.70,,,,,,,568.3900,22832.7700,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,BLUE CROSS,BLUE CROSS P NETWORK,22094.00,,,,,,,568.3900,22832.7700,case rate,"Rev 481 Proc 92928 ASG Rate of $22,094.00 at 100% of $22,094.00 = $22,094.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,BLUE CROSS,BLUE CROSS S NETWORK,22094.00,,,,,,,568.3900,22832.7700,case rate,"Rev 481 Proc 92928 ASG Rate of $22,094.00 at 100% of $22,094.00 = $22,094.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,BLUE CROSS,TENNCARE BLUE CARE,568.39,,,,,,,568.3900,22832.7700,fee schedule,$489.99 from Fee Schedule TC_24 for Rev 481 Proc 92928 * Qty 1 = $489.99 at 116% = $568.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,BLUE CROSS,TENNCARE BLUE SELECT,568.39,,,,,,,568.3900,22832.7700,fee schedule,$489.99 from Fee Schedule TC_24 for Rev 481 Proc 92928 * Qty 1 = $489.99 at 116% = $568.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,CIGNA HEALTHCARE,CIGNA HMO,9284.51,,,,,,,568.3900,22832.7700,percent of total billed charges,"41.7% of $22,265.00 in Billed Charges for Rev 481 Proc 92928 = $9,284.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10330.96,,,,,,,568.3900,22832.7700,percent of total billed charges,"46.4% of $22,265.00 in Billed Charges for Rev 481 Proc 92928 = $10,330.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,10997.44,,,,,,,568.3900,22832.7700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9284.51,,,,,,,568.3900,22832.7700,percent of total billed charges,"41.7% of $22,265.00 in Billed Charges for Rev 481 Proc 92928 = $9,284.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,CIGNA HEALTHCARE,CIGNA PPO,9284.51,,,,,,,568.3900,22832.7700,percent of total billed charges,"41.7% of $22,265.00 in Billed Charges for Rev 481 Proc 92928 = $9,284.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,10997.44,,,,,,,568.3900,22832.7700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,20038.50,,,,,,,568.3900,22832.7700,percent of total billed charges,"90% of $22,265.00 in Billed Charges for Rev 481 Proc 92928 = $20,038.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,HUMANA,HUMANA MEDICARE,10473.75,,,,,,,568.3900,22832.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,10473.75,,,,,,,568.3900,22832.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,MEDCOST,MEDCOST VHN,10595.91,,,,,,,568.3900,22832.7700,percent of total billed charges,"47.59% of $22,265.00 in Billed Charges for Rev 481 Proc 92928 = $10,595.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,12352.22,,,,,,,568.3900,22832.7700,fee schedule,"APG 00099 Proc 92928 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 105% = $12,352.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,10997.44,,,,,,,568.3900,22832.7700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,10997.44,,,,,,,568.3900,22832.7700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,NHC ADVANTAGE,NHC ADVANTAGE,10997.44,,,,,,,568.3900,22832.7700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,12128.70,,,,,,,568.3900,22832.7700,fee schedule,"APG 00099 Proc 92928 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 103.1% = $12,128.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,SENTARA HEALTH,SENTARA HEALTH,5746.60,,,,,,,568.3900,22832.7700,percent of total billed charges,"25.81% of $22,265.00 in Billed Charges for Rev 481 Proc 92928 = $5,746.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,SENTARA HEALTH,SENTARA MEDICARE,10473.75,,,,,,,568.3900,22832.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",22265.00,,,,,,,568.3900,22832.7700,percent of total billed charges,"100% of $22,265.00 in Billed Charges for Rev 481 Proc 92928 = $22,265.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,568.3900,22832.7700,case rate,"Rev 481 Proc 92928 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,568.3900,22832.7700,case rate,"Rev 481 Proc 92928 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,568.3900,22832.7700,case rate,"Rev 481 Proc 92928 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,568.3900,22832.7700,case rate,"Rev 481 Proc 92928 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,12116.94,,,,,,,568.3900,22832.7700,fee schedule,"APG 00099 Proc 92928 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,10473.75,,,,,,,568.3900,22832.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,10473.75,,,,,,,568.3900,22832.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,WELLCARE,WELLCARE MEDICAID,22265.00,,,,,,,568.3900,22832.7700,percent of total billed charges,"100% of $22,265.00 in Billed Charges for Rev 481 Proc 92928 = $22,265.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ANGIO,92928,CPT,481,RC,48100088,CDM,,,,both,,,22265.0000,3339.7500,WELLCARE,WELLCARE MEDICARE,11102.17,,,,,,,568.3900,22832.7700,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIOPL EA ADDL MAJ COR ART,92929,CPT,481,RC,48100151,CDM,,,,both,,,14575.0000,2186.2500,AETNA,AETNA,6223.53,,,,,,,148.0000,14575.0000,percent of total billed charges,"42.7% of $14,575.00 in Billed Charges for Rev 481 Proc 92929 = $6,223.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ANGIOPL EA ADDL MAJ COR ART,92929,CPT,481,RC,48100151,CDM,,,,both,,,14575.0000,2186.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,12234.58,,,,,,,148.0000,14575.0000,fee schedule,"APG 00099 Proc 92929 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 104% = $12,234.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ANGIOPL EA ADDL MAJ COR ART,92929,CPT,481,RC,48100151,CDM,,,,both,,,14575.0000,2186.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,12116.94,,,,,,,148.0000,14575.0000,fee schedule,"APG 00099 Proc 92929 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ANGIOPL EA ADDL MAJ COR ART,92929,CPT,481,RC,48100151,CDM,,,,both,,,14575.0000,2186.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,10202.50,,,,,,,148.0000,14575.0000,percent of total billed charges,"Rev 481 Proc 92929 $14,575.00 in Billed Charges at 70% = $10,202.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ANGIOPL EA ADDL MAJ COR ART,92929,CPT,481,RC,48100151,CDM,,,,both,,,14575.0000,2186.2500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,14575.0000,case rate,Rev 481 Proc 92929 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIOPL EA ADDL MAJ COR ART,92929,CPT,481,RC,48100151,CDM,,,,both,,,14575.0000,2186.2500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,14575.0000,case rate,Rev 481 Proc 92929 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIOPL EA ADDL MAJ COR ART,92929,CPT,481,RC,48100151,CDM,,,,both,,,14575.0000,2186.2500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,14575.0000,case rate,Rev 481 Proc 92929 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ANGIOPL EA ADDL MAJ COR ART,92929,CPT,481,RC,48100151,CDM,,,,both,,,14575.0000,2186.2500,CIGNA HEALTHCARE,CIGNA HMO,6077.78,,,,,,,148.0000,14575.0000,percent of total billed charges,"41.7% of $14,575.00 in Billed Charges for Rev 481 Proc 92929 = $6,077.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ANGIOPL EA ADDL MAJ COR ART,92929,CPT,481,RC,48100151,CDM,,,,both,,,14575.0000,2186.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6762.80,,,,,,,148.0000,14575.0000,percent of total billed charges,"46.4% of $14,575.00 in Billed Charges for Rev 481 Proc 92929 = $6,762.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ANGIOPL EA ADDL MAJ COR ART,92929,CPT,481,RC,48100151,CDM,,,,both,,,14575.0000,2186.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6077.78,,,,,,,148.0000,14575.0000,percent of total billed charges,"41.7% of $14,575.00 in Billed Charges for Rev 481 Proc 92929 = $6,077.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ANGIOPL EA ADDL MAJ COR ART,92929,CPT,481,RC,48100151,CDM,,,,both,,,14575.0000,2186.2500,CIGNA HEALTHCARE,CIGNA PPO,6077.78,,,,,,,148.0000,14575.0000,percent of total billed charges,"41.7% of $14,575.00 in Billed Charges for Rev 481 Proc 92929 = $6,077.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ANGIOPL EA ADDL MAJ COR ART,92929,CPT,481,RC,48100151,CDM,,,,both,,,14575.0000,2186.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13117.50,,,,,,,148.0000,14575.0000,percent of total billed charges,"90% of $14,575.00 in Billed Charges for Rev 481 Proc 92929 = $13,117.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ANGIOPL EA ADDL MAJ COR ART,92929,CPT,481,RC,48100151,CDM,,,,both,,,14575.0000,2186.2500,MEDCOST,MEDCOST VHN,6936.24,,,,,,,148.0000,14575.0000,percent of total billed charges,"47.59% of $14,575.00 in Billed Charges for Rev 481 Proc 92929 = $6,936.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ANGIOPL EA ADDL MAJ COR ART,92929,CPT,481,RC,48100151,CDM,,,,both,,,14575.0000,2186.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,12352.22,,,,,,,148.0000,14575.0000,fee schedule,"APG 00099 Proc 92929 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 105% = $12,352.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ANGIOPL EA ADDL MAJ COR ART,92929,CPT,481,RC,48100151,CDM,,,,both,,,14575.0000,2186.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,12128.70,,,,,,,148.0000,14575.0000,fee schedule,"APG 00099 Proc 92929 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 103.1% = $12,128.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ANGIOPL EA ADDL MAJ COR ART,92929,CPT,481,RC,48100151,CDM,,,,both,,,14575.0000,2186.2500,SENTARA HEALTH,SENTARA HEALTH,3761.81,,,,,,,148.0000,14575.0000,percent of total billed charges,"25.81% of $14,575.00 in Billed Charges for Rev 481 Proc 92929 = $3,761.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ANGIOPL EA ADDL MAJ COR ART,92929,CPT,481,RC,48100151,CDM,,,,both,,,14575.0000,2186.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",14575.00,,,,,,,148.0000,14575.0000,percent of total billed charges,"100% of $14,575.00 in Billed Charges for Rev 481 Proc 92929 = $14,575.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ANGIOPL EA ADDL MAJ COR ART,92929,CPT,481,RC,48100151,CDM,,,,both,,,14575.0000,2186.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,148.0000,14575.0000,case rate,"Rev 481 Proc 92929 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ANGIOPL EA ADDL MAJ COR ART,92929,CPT,481,RC,48100151,CDM,,,,both,,,14575.0000,2186.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,148.0000,14575.0000,case rate,"Rev 481 Proc 92929 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ANGIOPL EA ADDL MAJ COR ART,92929,CPT,481,RC,48100151,CDM,,,,both,,,14575.0000,2186.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,148.0000,14575.0000,case rate,"Rev 481 Proc 92929 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ANGIOPL EA ADDL MAJ COR ART,92929,CPT,481,RC,48100151,CDM,,,,both,,,14575.0000,2186.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,148.0000,14575.0000,case rate,"Rev 481 Proc 92929 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ANGIOPL EA ADDL MAJ COR ART,92929,CPT,481,RC,48100151,CDM,,,,both,,,14575.0000,2186.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,12116.94,,,,,,,148.0000,14575.0000,fee schedule,"APG 00099 Proc 92929 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ANGIOPL EA ADDL MAJ COR ART,92929,CPT,481,RC,48100151,CDM,,,,both,,,14575.0000,2186.2500,WELLCARE,WELLCARE MEDICAID,14575.00,,,,,,,148.0000,14575.0000,percent of total billed charges,"100% of $14,575.00 in Billed Charges for Rev 481 Proc 92929 = $14,575.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,AETNA,AETNA,9507.16,,,,,,,637.5500,36257.3800,percent of total billed charges,"42.7% of $22,265.00 in Billed Charges for Rev 481 Proc 92933 = $9,507.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,12234.58,,,,,,,637.5500,36257.3800,fee schedule,"APG 00099 Proc 92933 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 104% = $12,234.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,16631.83,,,,,,,637.5500,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,AETNA,AETNA HEALTHCARE MEDICARE,16631.83,,,,,,,637.5500,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,16631.83,,,,,,,637.5500,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,AMBETTER,AMBETTER,36257.38,,,,,,,637.5500,36257.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,17297.10,,,,,,,637.5500,36257.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,BLUE CROSS,ANTHEM EXCHANGE,22265.00,,,,,,,637.5500,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,12116.94,,,,,,,637.5500,36257.3800,fee schedule,"APG 00099 Proc 92933 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,BLUE CROSS,ANTHEM HMO,22265.00,,,,,,,637.5500,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,17130.78,,,,,,,637.5500,36257.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",22265.00,,,,,,,637.5500,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,15585.50,,,,,,,637.5500,36257.3800,percent of total billed charges,"Rev 481 Proc 92933 $22,265.00 in Billed Charges at 70% = $15,585.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,BLUE CROSS,BLUE CROSS E NETWORK,21607.00,,,,,,,637.5500,36257.3800,case rate,"Rev 481 Proc 92933 ASG Rate of $21,607.00 at 100% of $21,607.00 = $21,607.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,BLUE CROSS,BLUE CROSS MEDICARE,17297.10,,,,,,,637.5500,36257.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,BLUE CROSS,BLUE CROSS P NETWORK,22094.00,,,,,,,637.5500,36257.3800,case rate,"Rev 481 Proc 92933 ASG Rate of $22,094.00 at 100% of $22,094.00 = $22,094.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,BLUE CROSS,BLUE CROSS S NETWORK,22094.00,,,,,,,637.5500,36257.3800,case rate,"Rev 481 Proc 92933 ASG Rate of $22,094.00 at 100% of $22,094.00 = $22,094.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,BLUE CROSS,TENNCARE BLUE CARE,637.55,,,,,,,637.5500,36257.3800,fee schedule,$549.61 from Fee Schedule TC_24 for Rev 481 Proc 92933 * Qty 1 = $549.61 at 116% = $637.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,BLUE CROSS,TENNCARE BLUE SELECT,637.55,,,,,,,637.5500,36257.3800,fee schedule,$549.61 from Fee Schedule TC_24 for Rev 481 Proc 92933 * Qty 1 = $549.61 at 116% = $637.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,CIGNA HEALTHCARE,CIGNA HMO,9284.51,,,,,,,637.5500,36257.3800,percent of total billed charges,"41.7% of $22,265.00 in Billed Charges for Rev 481 Proc 92933 = $9,284.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10330.96,,,,,,,637.5500,36257.3800,percent of total billed charges,"46.4% of $22,265.00 in Billed Charges for Rev 481 Proc 92933 = $10,330.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,17463.42,,,,,,,637.5500,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9284.51,,,,,,,637.5500,36257.3800,percent of total billed charges,"41.7% of $22,265.00 in Billed Charges for Rev 481 Proc 92933 = $9,284.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,CIGNA HEALTHCARE,CIGNA PPO,9284.51,,,,,,,637.5500,36257.3800,percent of total billed charges,"41.7% of $22,265.00 in Billed Charges for Rev 481 Proc 92933 = $9,284.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,17463.42,,,,,,,637.5500,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,20038.50,,,,,,,637.5500,36257.3800,percent of total billed charges,"90% of $22,265.00 in Billed Charges for Rev 481 Proc 92933 = $20,038.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,HUMANA,HUMANA MEDICARE,16631.83,,,,,,,637.5500,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,16631.83,,,,,,,637.5500,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,MEDCOST,MEDCOST VHN,10595.91,,,,,,,637.5500,36257.3800,percent of total billed charges,"47.59% of $22,265.00 in Billed Charges for Rev 481 Proc 92933 = $10,595.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,12352.22,,,,,,,637.5500,36257.3800,fee schedule,"APG 00099 Proc 92933 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 105% = $12,352.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,17463.42,,,,,,,637.5500,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,17463.42,,,,,,,637.5500,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,NHC ADVANTAGE,NHC ADVANTAGE,17463.42,,,,,,,637.5500,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,12128.70,,,,,,,637.5500,36257.3800,fee schedule,"APG 00099 Proc 92933 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 103.1% = $12,128.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,SENTARA HEALTH,SENTARA HEALTH,5746.60,,,,,,,637.5500,36257.3800,percent of total billed charges,"25.81% of $22,265.00 in Billed Charges for Rev 481 Proc 92933 = $5,746.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,SENTARA HEALTH,SENTARA MEDICARE,16631.83,,,,,,,637.5500,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",22265.00,,,,,,,637.5500,36257.3800,percent of total billed charges,"100% of $22,265.00 in Billed Charges for Rev 481 Proc 92933 = $22,265.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,637.5500,36257.3800,case rate,"Rev 481 Proc 92933 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,637.5500,36257.3800,case rate,"Rev 481 Proc 92933 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,637.5500,36257.3800,case rate,"Rev 481 Proc 92933 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,637.5500,36257.3800,case rate,"Rev 481 Proc 92933 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,12116.94,,,,,,,637.5500,36257.3800,fee schedule,"APG 00099 Proc 92933 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,16631.83,,,,,,,637.5500,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,16631.83,,,,,,,637.5500,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,WELLCARE,WELLCARE MEDICAID,22265.00,,,,,,,637.5500,36257.3800,percent of total billed charges,"100% of $22,265.00 in Billed Charges for Rev 481 Proc 92933 = $22,265.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLCMNT INTRA W ATHER&ANGIO,92933,CPT,481,RC,48100089,CDM,,,,both,,,22265.0000,3339.7500,WELLCARE,WELLCARE MEDICARE,17629.74,,,,,,,637.5500,36257.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRONIC TOTAL OCCL ADD SGL,92944,CPT,481,RC,48100094,CDM,,,,both,,,13360.0000,2004.0000,AETNA,AETNA,5704.72,,,,,,,148.0000,13360.0000,percent of total billed charges,"42.7% of $13,360.00 in Billed Charges for Rev 481 Proc 92944 = $5,704.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC CHRONIC TOTAL OCCL ADD SGL,92944,CPT,481,RC,48100094,CDM,,,,both,,,13360.0000,2004.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,12234.58,,,,,,,148.0000,13360.0000,fee schedule,"APG 00099 Proc 92944 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 104% = $12,234.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC CHRONIC TOTAL OCCL ADD SGL,92944,CPT,481,RC,48100094,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,12116.94,,,,,,,148.0000,13360.0000,fee schedule,"APG 00099 Proc 92944 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC CHRONIC TOTAL OCCL ADD SGL,92944,CPT,481,RC,48100094,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9352.00,,,,,,,148.0000,13360.0000,percent of total billed charges,"Rev 481 Proc 92944 $13,360.00 in Billed Charges at 70% = $9,352.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC CHRONIC TOTAL OCCL ADD SGL,92944,CPT,481,RC,48100094,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,13360.0000,case rate,Rev 481 Proc 92944 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRONIC TOTAL OCCL ADD SGL,92944,CPT,481,RC,48100094,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,13360.0000,case rate,Rev 481 Proc 92944 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRONIC TOTAL OCCL ADD SGL,92944,CPT,481,RC,48100094,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,13360.0000,case rate,Rev 481 Proc 92944 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRONIC TOTAL OCCL ADD SGL,92944,CPT,481,RC,48100094,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA HMO,5571.12,,,,,,,148.0000,13360.0000,percent of total billed charges,"41.7% of $13,360.00 in Billed Charges for Rev 481 Proc 92944 = $5,571.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC CHRONIC TOTAL OCCL ADD SGL,92944,CPT,481,RC,48100094,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6199.04,,,,,,,148.0000,13360.0000,percent of total billed charges,"46.4% of $13,360.00 in Billed Charges for Rev 481 Proc 92944 = $6,199.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC CHRONIC TOTAL OCCL ADD SGL,92944,CPT,481,RC,48100094,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5571.12,,,,,,,148.0000,13360.0000,percent of total billed charges,"41.7% of $13,360.00 in Billed Charges for Rev 481 Proc 92944 = $5,571.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC CHRONIC TOTAL OCCL ADD SGL,92944,CPT,481,RC,48100094,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA PPO,5571.12,,,,,,,148.0000,13360.0000,percent of total billed charges,"41.7% of $13,360.00 in Billed Charges for Rev 481 Proc 92944 = $5,571.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC CHRONIC TOTAL OCCL ADD SGL,92944,CPT,481,RC,48100094,CDM,,,,both,,,13360.0000,2004.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12024.00,,,,,,,148.0000,13360.0000,percent of total billed charges,"90% of $13,360.00 in Billed Charges for Rev 481 Proc 92944 = $12,024.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC CHRONIC TOTAL OCCL ADD SGL,92944,CPT,481,RC,48100094,CDM,,,,both,,,13360.0000,2004.0000,MEDCOST,MEDCOST VHN,6358.02,,,,,,,148.0000,13360.0000,percent of total billed charges,"47.59% of $13,360.00 in Billed Charges for Rev 481 Proc 92944 = $6,358.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC CHRONIC TOTAL OCCL ADD SGL,92944,CPT,481,RC,48100094,CDM,,,,both,,,13360.0000,2004.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,12352.22,,,,,,,148.0000,13360.0000,fee schedule,"APG 00099 Proc 92944 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 105% = $12,352.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC CHRONIC TOTAL OCCL ADD SGL,92944,CPT,481,RC,48100094,CDM,,,,both,,,13360.0000,2004.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,12128.70,,,,,,,148.0000,13360.0000,fee schedule,"APG 00099 Proc 92944 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 103.1% = $12,128.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC CHRONIC TOTAL OCCL ADD SGL,92944,CPT,481,RC,48100094,CDM,,,,both,,,13360.0000,2004.0000,SENTARA HEALTH,SENTARA HEALTH,3448.22,,,,,,,148.0000,13360.0000,percent of total billed charges,"25.81% of $13,360.00 in Billed Charges for Rev 481 Proc 92944 = $3,448.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC CHRONIC TOTAL OCCL ADD SGL,92944,CPT,481,RC,48100094,CDM,,,,both,,,13360.0000,2004.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13360.00,,,,,,,148.0000,13360.0000,percent of total billed charges,"100% of $13,360.00 in Billed Charges for Rev 481 Proc 92944 = $13,360.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC CHRONIC TOTAL OCCL ADD SGL,92944,CPT,481,RC,48100094,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,148.0000,13360.0000,case rate,"Rev 481 Proc 92944 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC CHRONIC TOTAL OCCL ADD SGL,92944,CPT,481,RC,48100094,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,148.0000,13360.0000,case rate,"Rev 481 Proc 92944 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC CHRONIC TOTAL OCCL ADD SGL,92944,CPT,481,RC,48100094,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,148.0000,13360.0000,case rate,"Rev 481 Proc 92944 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC CHRONIC TOTAL OCCL ADD SGL,92944,CPT,481,RC,48100094,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,148.0000,13360.0000,case rate,"Rev 481 Proc 92944 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC CHRONIC TOTAL OCCL ADD SGL,92944,CPT,481,RC,48100094,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,12116.94,,,,,,,148.0000,13360.0000,fee schedule,"APG 00099 Proc 92944 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC CHRONIC TOTAL OCCL ADD SGL,92944,CPT,481,RC,48100094,CDM,,,,both,,,13360.0000,2004.0000,WELLCARE,WELLCARE MEDICAID,13360.00,,,,,,,148.0000,13360.0000,percent of total billed charges,"100% of $13,360.00 in Billed Charges for Rev 481 Proc 92944 = $13,360.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,AETNA,AETNA,1462.90,,,,,,,78.0400,3426.0000,percent of total billed charges,"42.7% of $3,426.00 in Billed Charges for Rev 480 Proc 92950 = $1,462.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1062.17,,,,,,,78.0400,3426.0000,fee schedule,"APG 00092 Proc 92950 at $836.60 (Base Rate) * 1.2208 (Relative Weight) = $1,021.32 (Total Line Payment) at 104% = $1,062.17. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,195.90,,,,,,,78.0400,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,AETNA,AETNA HEALTHCARE MEDICARE,195.90,,,,,,,78.0400,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,195.90,,,,,,,78.0400,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,AMBETTER,AMBETTER,427.07,,,,,,,78.0400,3426.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,203.74,,,,,,,78.0400,3426.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,ANTHEM EXCHANGE,482.33,,,,,,,78.0400,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1051.96,,,,,,,78.0400,3426.0000,fee schedule,"APG 00092 Proc 92950 at $836.60 (Base Rate) * 1.2208 (Relative Weight) = $1,021.32 (Total Line Payment) at 103% = $1,051.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,ANTHEM HMO,512.44,,,,,,,78.0400,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,201.78,,,,,,,78.0400,3426.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",602.84,,,,,,,78.0400,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,267.32,,,,,,,78.0400,3426.0000,fee schedule,$267.32 from Fee Schedule BLDTM_23 for Rev 480 Proc 92950 * Qty 1 = $267.32 at 100% = $267.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,BLUE CROSS MEDICARE,203.74,,,,,,,78.0400,3426.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,TENNCARE BLUE CARE,232.06,,,,,,,78.0400,3426.0000,fee schedule,$200.05 from Fee Schedule TC_24 for Rev 480 Proc 92950 * Qty 1 = $200.05 at 116% = $232.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,BLUE CROSS,TENNCARE BLUE SELECT,232.06,,,,,,,78.0400,3426.0000,fee schedule,$200.05 from Fee Schedule TC_24 for Rev 480 Proc 92950 * Qty 1 = $200.05 at 116% = $232.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,CIGNA HEALTHCARE,CIGNA HMO,1428.64,,,,,,,78.0400,3426.0000,percent of total billed charges,"41.7% of $3,426.00 in Billed Charges for Rev 480 Proc 92950 = $1,428.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1589.66,,,,,,,78.0400,3426.0000,percent of total billed charges,"46.4% of $3,426.00 in Billed Charges for Rev 480 Proc 92950 = $1,589.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,205.70,,,,,,,78.0400,3426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1428.64,,,,,,,78.0400,3426.0000,percent of total billed charges,"41.7% of $3,426.00 in Billed Charges for Rev 480 Proc 92950 = $1,428.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,CIGNA HEALTHCARE,CIGNA PPO,1428.64,,,,,,,78.0400,3426.0000,percent of total billed charges,"41.7% of $3,426.00 in Billed Charges for Rev 480 Proc 92950 = $1,428.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,205.70,,,,,,,78.0400,3426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3083.40,,,,,,,78.0400,3426.0000,percent of total billed charges,"90% of $3,426.00 in Billed Charges for Rev 480 Proc 92950 = $3,083.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,HUMANA,HUMANA MEDICARE,195.90,,,,,,,78.0400,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,195.90,,,,,,,78.0400,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,MEDCOST,MEDCOST VHN,1630.43,,,,,,,78.0400,3426.0000,percent of total billed charges,"47.59% of $3,426.00 in Billed Charges for Rev 480 Proc 92950 = $1,630.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1072.39,,,,,,,78.0400,3426.0000,fee schedule,"APG 00092 Proc 92950 at $836.60 (Base Rate) * 1.2208 (Relative Weight) = $1,021.32 (Total Line Payment) at 100% = $1,021.32... $1,021.32 at 105% = $1,072.39 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,205.70,,,,,,,78.0400,3426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,205.70,,,,,,,78.0400,3426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,NHC ADVANTAGE,NHC ADVANTAGE,205.70,,,,,,,78.0400,3426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1052.98,,,,,,,78.0400,3426.0000,fee schedule,"APG 00092 Proc 92950 at $836.60 (Base Rate) * 1.2208 (Relative Weight) = $1,021.32 (Total Line Payment) at 100% = $1,021.32... $1,021.32 at 103.1% = $1,052.98 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,SENTARA HEALTH,SENTARA HEALTH,884.25,,,,,,,78.0400,3426.0000,percent of total billed charges,"25.81% of $3,426.00 in Billed Charges for Rev 480 Proc 92950 = $884.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,SENTARA HEALTH,SENTARA MEDICARE,195.90,,,,,,,78.0400,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3426.00,,,,,,,78.0400,3426.0000,percent of total billed charges,"100% of $3,426.00 in Billed Charges for Rev 480 Proc 92950 = $3,426.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,78.04,,,,,,,78.0400,3426.0000,fee schedule,$156.07 from Fee Schedule TCUHC24 for Rev 480 Proc 92950 * Qty 1 = $156.07 at 50% = $78.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1642.00,,,,,,,78.0400,3426.0000,other,"Rev 480 Proc 92950 1 Visit at $1,642.00 per Visit = $1,642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1571.00,,,,,,,78.0400,3426.0000,other,"Rev 480 Proc 92950 1 Visit at $1,571.00 per Visit = $1,571.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,3097.00,,,,,,,78.0400,3426.0000,other,"Rev 480 Proc 92950 1 Visit at $3,097.00 per Visit = $3,097.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1051.96,,,,,,,78.0400,3426.0000,fee schedule,"APG 00092 Proc 92950 at $836.60 (Base Rate) * 1.2208 (Relative Weight) = $1,021.32 (Total Line Payment) at 103% = $1,051.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,195.90,,,,,,,78.0400,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,195.90,,,,,,,78.0400,3426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,WELLCARE,WELLCARE MEDICAID,3426.00,,,,,,,78.0400,3426.0000,percent of total billed charges,"100% of $3,426.00 in Billed Charges for Rev 480 Proc 92950 = $3,426.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CARDIOPULMONARY RESUSCITATION,92950,CPT,480,RC,48000041,CDM,,,,both,,,3426.0000,513.9000,WELLCARE,WELLCARE MEDICARE,207.66,,,,,,,78.0400,3426.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,AETNA,AETNA,34.59,,,,,,,3.4400,81.0000,percent of total billed charges,42.7% of $81.00 in Billed Charges for Rev 301 Proc 84436 = $34.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15.66,,,,,,,3.4400,81.0000,fee schedule,APG 00398 Proc 84436 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 104% = $15.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,6.87,,,,,,,3.4400,81.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,AETNA,AETNA HEALTHCARE MEDICARE,6.87,,,,,,,3.4400,81.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,6.87,,,,,,,3.4400,81.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,AMBETTER,AMBETTER,14.98,,,,,,,3.4400,81.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,AMERIGROUP,AMERIGROUP,3.44,,,,,,,3.4400,81.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,7.14,,,,,,,3.4400,81.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,ANTHEM EXCHANGE,6.87,,,,,,,3.4400,81.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15.51,,,,,,,3.4400,81.0000,fee schedule,APG 00398 Proc 84436 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,ANTHEM HMO,6.87,,,,,,,3.4400,81.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,7.08,,,,,,,3.4400,81.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",6.87,,,,,,,3.4400,81.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9.24,,,,,,,3.4400,81.0000,fee schedule,$9.24 from Fee Schedule BLDTM_23 for Rev 301 Proc 84436 * Qty 1 = $9.24 at 100% = $9.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,BLUE CROSS E NETWORK,29.98,,,,,,,3.4400,81.0000,fee schedule,$9.37 from Fee Schedule BCFSB for Rev 301 Proc 84436 * Qty 1 = $9.37 at 320% = $29.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,BLUE CROSS MEDICARE,7.14,,,,,,,3.4400,81.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,BLUE CROSS P NETWORK,30.64,,,,,,,3.4400,81.0000,fee schedule,$9.37 from Fee Schedule BCFSB for Rev 301 Proc 84436 * Qty 1 = $9.37 at 327% = $30.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,BLUE CROSS S NETWORK,30.64,,,,,,,3.4400,81.0000,fee schedule,$9.37 from Fee Schedule BCFSB for Rev 301 Proc 84436 * Qty 1 = $9.37 at 327% = $30.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,TENNCARE BLUE CARE,13.39,,,,,,,3.4400,81.0000,fee schedule,$11.54 from Fee Schedule TC_24 for Rev 301 Proc 84436 * Qty 1 = $11.54 at 116% = $13.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,TENNCARE BLUE SELECT,13.39,,,,,,,3.4400,81.0000,fee schedule,$11.54 from Fee Schedule TC_24 for Rev 301 Proc 84436 * Qty 1 = $11.54 at 116% = $13.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,CIGNA HEALTHCARE,CIGNA HMO,27.62,,,,,,,3.4400,81.0000,fee schedule,$27.62 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84436 * Qty 1 = $27.62 at 100% = $27.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,15.16,,,,,,,3.4400,81.0000,fee schedule,$15.16 from Fee Schedule CGIFP_25LR for Rev 301 Proc 84436 * Qty 1 = $15.16 at 100% = $15.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,7.21,,,,,,,3.4400,81.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,27.62,,,,,,,3.4400,81.0000,fee schedule,$27.62 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84436 * Qty 1 = $27.62 at 100% = $27.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,CIGNA HEALTHCARE,CIGNA PPO,27.62,,,,,,,3.4400,81.0000,fee schedule,$27.62 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84436 * Qty 1 = $27.62 at 100% = $27.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,7.21,,,,,,,3.4400,81.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,72.90,,,,,,,3.4400,81.0000,percent of total billed charges,90% of $81.00 in Billed Charges for Rev 301 Proc 84436 = $72.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,HUMANA,HUMANA MEDICARE,6.87,,,,,,,3.4400,81.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,6.87,,,,,,,3.4400,81.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,MEDCOST,MEDCOST VHN,38.55,,,,,,,3.4400,81.0000,percent of total billed charges,47.59% of $81.00 in Billed Charges for Rev 301 Proc 84436 = $38.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15.81,,,,,,,3.4400,81.0000,fee schedule,APG 00398 Proc 84436 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 105% = $15.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,7.21,,,,,,,3.4400,81.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,7.21,,,,,,,3.4400,81.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,NHC ADVANTAGE,NHC ADVANTAGE,7.21,,,,,,,3.4400,81.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15.53,,,,,,,3.4400,81.0000,fee schedule,APG 00398 Proc 84436 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 103.1% = $15.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,SENTARA HEALTH,SENTARA HEALTH,20.91,,,,,,,3.4400,81.0000,percent of total billed charges,25.81% of $81.00 in Billed Charges for Rev 301 Proc 84436 = $20.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,SENTARA HEALTH,SENTARA MEDICARE,6.87,,,,,,,3.4400,81.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",81.00,,,,,,,3.4400,81.0000,percent of total billed charges,100% of $81.00 in Billed Charges for Rev 301 Proc 84436 = $81.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4.87,,,,,,,3.4400,81.0000,fee schedule,$9.73 from Fee Schedule TCUHC24 for Rev 301 Proc 84436 * Qty 1 = $9.73 at 50% = $4.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7.14,,,,,,,3.4400,81.0000,fee schedule,$6.87 from Fee Schedule UHC_31910 for Rev 301 Proc 84436 * Qty 1 = $6.87 at 104% = $7.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,6.87,,,,,,,3.4400,81.0000,fee schedule,$6.87 from Fee Schedule UHC_31910 for Rev 301 Proc 84436 * Qty 1 = $6.87 at 100% = $6.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,6.87,,,,,,,3.4400,81.0000,fee schedule,$6.87 from Fee Schedule UHC_31910 for Rev 301 Proc 84436 * Qty 1 = $6.87 at 100% = $6.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15.51,,,,,,,3.4400,81.0000,fee schedule,APG 00398 Proc 84436 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,6.87,,,,,,,3.4400,81.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,6.87,,,,,,,3.4400,81.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,WELLCARE,WELLCARE MEDICAID,81.00,,,,,,,3.4400,81.0000,percent of total billed charges,100% of $81.00 in Billed Charges for Rev 301 Proc 84436 = $81.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC T4 THYROXINE TOTAL,84436,CPT,301,RC,30100260,CDM,,,,both,,,81.0000,12.1500,WELLCARE,WELLCARE MEDICARE,7.28,,,,,,,3.4400,81.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,AETNA,AETNA,44.84,,,,,,,4.5100,105.0000,percent of total billed charges,42.7% of $105.00 in Billed Charges for Rev 301 Proc 84439 = $44.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15.66,,,,,,,4.5100,105.0000,fee schedule,APG 00398 Proc 84439 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 104% = $15.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,9.02,,,,,,,4.5100,105.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,AETNA,AETNA HEALTHCARE MEDICARE,9.02,,,,,,,4.5100,105.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,9.02,,,,,,,4.5100,105.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,AMBETTER,AMBETTER,19.66,,,,,,,4.5100,105.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,AMERIGROUP,AMERIGROUP,4.51,,,,,,,4.5100,105.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,9.38,,,,,,,4.5100,105.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,BLUE CROSS,ANTHEM EXCHANGE,9.02,,,,,,,4.5100,105.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15.51,,,,,,,4.5100,105.0000,fee schedule,APG 00398 Proc 84439 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,BLUE CROSS,ANTHEM HMO,9.02,,,,,,,4.5100,105.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,9.29,,,,,,,4.5100,105.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9.02,,,,,,,4.5100,105.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9.24,,,,,,,4.5100,105.0000,fee schedule,$9.24 from Fee Schedule BLDTM_23 for Rev 301 Proc 84439 * Qty 1 = $9.24 at 100% = $9.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,BLUE CROSS,BLUE CROSS E NETWORK,39.36,,,,,,,4.5100,105.0000,fee schedule,$12.30 from Fee Schedule BCFSB for Rev 301 Proc 84439 * Qty 1 = $12.30 at 320% = $39.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,BLUE CROSS,BLUE CROSS MEDICARE,9.38,,,,,,,4.5100,105.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,BLUE CROSS,BLUE CROSS P NETWORK,40.22,,,,,,,4.5100,105.0000,fee schedule,$12.30 from Fee Schedule BCFSB for Rev 301 Proc 84439 * Qty 1 = $12.30 at 327% = $40.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,BLUE CROSS,BLUE CROSS S NETWORK,40.22,,,,,,,4.5100,105.0000,fee schedule,$12.30 from Fee Schedule BCFSB for Rev 301 Proc 84439 * Qty 1 = $12.30 at 327% = $40.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,BLUE CROSS,TENNCARE BLUE CARE,17.18,,,,,,,4.5100,105.0000,fee schedule,$14.81 from Fee Schedule TC_24 for Rev 301 Proc 84439 * Qty 1 = $14.81 at 116% = $17.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,CIGNA HEALTHCARE,CIGNA HMO,36.27,,,,,,,4.5100,105.0000,fee schedule,$36.27 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84439 * Qty 1 = $36.27 at 100% = $36.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,20.21,,,,,,,4.5100,105.0000,fee schedule,$20.21 from Fee Schedule CGIFP_25LR for Rev 301 Proc 84439 * Qty 1 = $20.21 at 100% = $20.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,9.47,,,,,,,4.5100,105.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,36.27,,,,,,,4.5100,105.0000,fee schedule,$36.27 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84439 * Qty 1 = $36.27 at 100% = $36.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,CIGNA HEALTHCARE,CIGNA PPO,36.27,,,,,,,4.5100,105.0000,fee schedule,$36.27 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84439 * Qty 1 = $36.27 at 100% = $36.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,9.47,,,,,,,4.5100,105.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,94.50,,,,,,,4.5100,105.0000,percent of total billed charges,90% of $105.00 in Billed Charges for Rev 301 Proc 84439 = $94.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,HUMANA,HUMANA MEDICARE,9.02,,,,,,,4.5100,105.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,9.02,,,,,,,4.5100,105.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,MEDCOST,MEDCOST VHN,49.97,,,,,,,4.5100,105.0000,percent of total billed charges,47.59% of $105.00 in Billed Charges for Rev 301 Proc 84439 = $49.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15.81,,,,,,,4.5100,105.0000,fee schedule,APG 00398 Proc 84439 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 105% = $15.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,9.47,,,,,,,4.5100,105.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,9.47,,,,,,,4.5100,105.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,NHC ADVANTAGE,NHC ADVANTAGE,9.47,,,,,,,4.5100,105.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15.53,,,,,,,4.5100,105.0000,fee schedule,APG 00398 Proc 84439 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 103.1% = $15.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,SENTARA HEALTH,SENTARA HEALTH,27.10,,,,,,,4.5100,105.0000,percent of total billed charges,25.81% of $105.00 in Billed Charges for Rev 301 Proc 84439 = $27.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,SENTARA HEALTH,SENTARA MEDICARE,9.02,,,,,,,4.5100,105.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",105.00,,,,,,,4.5100,105.0000,percent of total billed charges,100% of $105.00 in Billed Charges for Rev 301 Proc 84439 = $105.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6.39,,,,,,,4.5100,105.0000,fee schedule,$12.77 from Fee Schedule TCUHC24 for Rev 301 Proc 84439 * Qty 1 = $12.77 at 50% = $6.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,9.38,,,,,,,4.5100,105.0000,fee schedule,$9.02 from Fee Schedule UHC_31910 for Rev 301 Proc 84439 * Qty 1 = $9.02 at 104% = $9.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,9.02,,,,,,,4.5100,105.0000,fee schedule,$9.02 from Fee Schedule UHC_31910 for Rev 301 Proc 84439 * Qty 1 = $9.02 at 100% = $9.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,9.02,,,,,,,4.5100,105.0000,fee schedule,$9.02 from Fee Schedule UHC_31910 for Rev 301 Proc 84439 * Qty 1 = $9.02 at 100% = $9.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15.51,,,,,,,4.5100,105.0000,fee schedule,APG 00398 Proc 84439 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,9.02,,,,,,,4.5100,105.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,9.02,,,,,,,4.5100,105.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,WELLCARE,WELLCARE MEDICAID,105.00,,,,,,,4.5100,105.0000,percent of total billed charges,100% of $105.00 in Billed Charges for Rev 301 Proc 84439 = $105.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FREE T4 THYROXINE,84439,CPT,301,RC,30100261,CDM,,,,both,,,105.0000,15.7500,WELLCARE,WELLCARE MEDICARE,9.56,,,,,,,4.5100,105.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,AETNA,AETNA,71.31,,,,,,,7.3900,167.0000,percent of total billed charges,42.7% of $167.00 in Billed Charges for Rev 301 Proc 84442 = $71.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15.66,,,,,,,7.3900,167.0000,fee schedule,APG 00398 Proc 84442 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 104% = $15.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,14.78,,,,,,,7.3900,167.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,AETNA,AETNA HEALTHCARE MEDICARE,14.78,,,,,,,7.3900,167.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,14.78,,,,,,,7.3900,167.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,AMBETTER,AMBETTER,32.22,,,,,,,7.3900,167.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,AMERIGROUP,AMERIGROUP,7.39,,,,,,,7.3900,167.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,15.37,,,,,,,7.3900,167.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,BLUE CROSS,ANTHEM EXCHANGE,14.78,,,,,,,7.3900,167.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15.51,,,,,,,7.3900,167.0000,fee schedule,APG 00398 Proc 84442 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,BLUE CROSS,ANTHEM HMO,14.78,,,,,,,7.3900,167.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,15.22,,,,,,,7.3900,167.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",14.78,,,,,,,7.3900,167.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,51.05,,,,,,,7.3900,167.0000,fee schedule,$51.05 from Fee Schedule BLDTM_23 for Rev 301 Proc 84442 * Qty 1 = $51.05 at 100% = $51.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,BLUE CROSS,BLUE CROSS E NETWORK,50.82,,,,,,,7.3900,167.0000,fee schedule,$15.88 from Fee Schedule BCFSB for Rev 301 Proc 84442 * Qty 1 = $15.88 at 320% = $50.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,BLUE CROSS,BLUE CROSS MEDICARE,15.37,,,,,,,7.3900,167.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,BLUE CROSS,BLUE CROSS P NETWORK,51.93,,,,,,,7.3900,167.0000,fee schedule,$15.88 from Fee Schedule BCFSB for Rev 301 Proc 84442 * Qty 1 = $15.88 at 327% = $51.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,BLUE CROSS,BLUE CROSS S NETWORK,51.93,,,,,,,7.3900,167.0000,fee schedule,$15.88 from Fee Schedule BCFSB for Rev 301 Proc 84442 * Qty 1 = $15.88 at 327% = $51.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,BLUE CROSS,TENNCARE BLUE CARE,22.28,,,,,,,7.3900,167.0000,fee schedule,$19.21 from Fee Schedule TC_24 for Rev 301 Proc 84442 * Qty 1 = $19.21 at 116% = $22.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,BLUE CROSS,TENNCARE BLUE SELECT,22.28,,,,,,,7.3900,167.0000,fee schedule,$19.21 from Fee Schedule TC_24 for Rev 301 Proc 84442 * Qty 1 = $19.21 at 116% = $22.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,CIGNA HEALTHCARE,CIGNA HMO,59.52,,,,,,,7.3900,167.0000,fee schedule,$59.52 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84442 * Qty 1 = $59.52 at 100% = $59.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,32.48,,,,,,,7.3900,167.0000,fee schedule,$32.48 from Fee Schedule CGIFP_25LR for Rev 301 Proc 84442 * Qty 1 = $32.48 at 100% = $32.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,15.52,,,,,,,7.3900,167.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,59.52,,,,,,,7.3900,167.0000,fee schedule,$59.52 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84442 * Qty 1 = $59.52 at 100% = $59.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,CIGNA HEALTHCARE,CIGNA PPO,59.52,,,,,,,7.3900,167.0000,fee schedule,$59.52 from Fee Schedule CIGWHS_23 for Rev 301 Proc 84442 * Qty 1 = $59.52 at 100% = $59.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,15.52,,,,,,,7.3900,167.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,150.30,,,,,,,7.3900,167.0000,percent of total billed charges,90% of $167.00 in Billed Charges for Rev 301 Proc 84442 = $150.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,HUMANA,HUMANA MEDICARE,14.78,,,,,,,7.3900,167.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,14.78,,,,,,,7.3900,167.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,MEDCOST,MEDCOST VHN,79.48,,,,,,,7.3900,167.0000,percent of total billed charges,47.59% of $167.00 in Billed Charges for Rev 301 Proc 84442 = $79.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15.81,,,,,,,7.3900,167.0000,fee schedule,APG 00398 Proc 84442 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 105% = $15.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,15.52,,,,,,,7.3900,167.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,15.52,,,,,,,7.3900,167.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,NHC ADVANTAGE,NHC ADVANTAGE,15.52,,,,,,,7.3900,167.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15.53,,,,,,,7.3900,167.0000,fee schedule,APG 00398 Proc 84442 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 100% = $15.06... $15.06 at 103.1% = $15.53 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,SENTARA HEALTH,SENTARA HEALTH,43.10,,,,,,,7.3900,167.0000,percent of total billed charges,25.81% of $167.00 in Billed Charges for Rev 301 Proc 84442 = $43.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,SENTARA HEALTH,SENTARA MEDICARE,14.78,,,,,,,7.3900,167.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",167.00,,,,,,,7.3900,167.0000,percent of total billed charges,100% of $167.00 in Billed Charges for Rev 301 Proc 84442 = $167.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,10.48,,,,,,,7.3900,167.0000,fee schedule,$20.95 from Fee Schedule TCUHC24 for Rev 301 Proc 84442 * Qty 1 = $20.95 at 50% = $10.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,15.37,,,,,,,7.3900,167.0000,fee schedule,$14.78 from Fee Schedule UHC_31910 for Rev 301 Proc 84442 * Qty 1 = $14.78 at 104% = $15.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,14.78,,,,,,,7.3900,167.0000,fee schedule,$14.78 from Fee Schedule UHC_31910 for Rev 301 Proc 84442 * Qty 1 = $14.78 at 100% = $14.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,14.78,,,,,,,7.3900,167.0000,fee schedule,$14.78 from Fee Schedule UHC_31910 for Rev 301 Proc 84442 * Qty 1 = $14.78 at 100% = $14.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15.51,,,,,,,7.3900,167.0000,fee schedule,APG 00398 Proc 84442 at $836.60 (Base Rate) * 0.018 (Relative Weight) = $15.06 (Total Line Payment) at 103% = $15.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,14.78,,,,,,,7.3900,167.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,14.78,,,,,,,7.3900,167.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,WELLCARE,WELLCARE MEDICAID,167.00,,,,,,,7.3900,167.0000,percent of total billed charges,100% of $167.00 in Billed Charges for Rev 301 Proc 84442 = $167.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THYROXINE BINDING GLOBULIN TBG,84442,CPT,301,RC,30100262,CDM,,,,both,,,167.0000,25.0500,WELLCARE,WELLCARE MEDICARE,15.67,,,,,,,7.3900,167.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,AETNA,AETNA,1154.61,,,,,,,59.0400,2704.0000,percent of total billed charges,"42.7% of $2,704.00 in Billed Charges for Rev 410 Proc 94003 = $1,154.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1706.89,,,,,,,59.0400,2704.0000,fee schedule,"APG 00067 Proc 94003 at $836.60 (Base Rate) * 1.9618 (Relative Weight) = $1,641.24 (Total Line Payment) at 104% = $1,706.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,560.50,,,,,,,59.0400,2704.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,AETNA,AETNA HEALTHCARE MEDICARE,560.50,,,,,,,59.0400,2704.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,560.50,,,,,,,59.0400,2704.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,AMBETTER,AMBETTER,1221.90,,,,,,,59.0400,2704.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,582.92,,,,,,,59.0400,2704.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,BLUE CROSS,ANTHEM EXCHANGE,1380.00,,,,,,,59.0400,2704.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1690.48,,,,,,,59.0400,2704.0000,fee schedule,"APG 00067 Proc 94003 at $836.60 (Base Rate) * 1.9618 (Relative Weight) = $1,641.24 (Total Line Payment) at 103% = $1,690.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,BLUE CROSS,ANTHEM HMO,1466.17,,,,,,,59.0400,2704.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,577.32,,,,,,,59.0400,2704.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1724.81,,,,,,,59.0400,2704.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,59.04,,,,,,,59.0400,2704.0000,fee schedule,$59.04 from Fee Schedule BLDTM_23 for Rev 410 Proc 94003 * Qty 1 = $59.04 at 100% = $59.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,BLUE CROSS,BLUE CROSS MEDICARE,582.92,,,,,,,59.0400,2704.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,BLUE CROSS,TENNCARE BLUE CARE,59.67,,,,,,,59.0400,2704.0000,fee schedule,$51.44 from Fee Schedule TC_24 for Rev 410 Proc 94003 * Qty 1 = $51.44 at 116% = $59.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,BLUE CROSS,TENNCARE BLUE SELECT,59.67,,,,,,,59.0400,2704.0000,fee schedule,$51.44 from Fee Schedule TC_24 for Rev 410 Proc 94003 * Qty 1 = $51.44 at 116% = $59.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,CIGNA HEALTHCARE,CIGNA HMO,1127.57,,,,,,,59.0400,2704.0000,percent of total billed charges,"41.7% of $2,704.00 in Billed Charges for Rev 410 Proc 94003 = $1,127.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1254.66,,,,,,,59.0400,2704.0000,percent of total billed charges,"46.4% of $2,704.00 in Billed Charges for Rev 410 Proc 94003 = $1,254.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,588.53,,,,,,,59.0400,2704.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1127.57,,,,,,,59.0400,2704.0000,percent of total billed charges,"41.7% of $2,704.00 in Billed Charges for Rev 410 Proc 94003 = $1,127.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,CIGNA HEALTHCARE,CIGNA PPO,1127.57,,,,,,,59.0400,2704.0000,percent of total billed charges,"41.7% of $2,704.00 in Billed Charges for Rev 410 Proc 94003 = $1,127.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,588.53,,,,,,,59.0400,2704.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2433.60,,,,,,,59.0400,2704.0000,percent of total billed charges,"90% of $2,704.00 in Billed Charges for Rev 410 Proc 94003 = $2,433.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,HUMANA,HUMANA MEDICARE,560.50,,,,,,,59.0400,2704.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,560.50,,,,,,,59.0400,2704.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,MEDCOST,MEDCOST VHN,1286.83,,,,,,,59.0400,2704.0000,percent of total billed charges,"47.59% of $2,704.00 in Billed Charges for Rev 410 Proc 94003 = $1,286.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1723.30,,,,,,,59.0400,2704.0000,fee schedule,"APG 00067 Proc 94003 at $836.60 (Base Rate) * 1.9618 (Relative Weight) = $1,641.24 (Total Line Payment) at 100% = $1,641.24... $1,641.24 at 105% = $1,723.30 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,588.53,,,,,,,59.0400,2704.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,588.53,,,,,,,59.0400,2704.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,NHC ADVANTAGE,NHC ADVANTAGE,588.53,,,,,,,59.0400,2704.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1692.12,,,,,,,59.0400,2704.0000,fee schedule,"APG 00067 Proc 94003 at $836.60 (Base Rate) * 1.9618 (Relative Weight) = $1,641.24 (Total Line Payment) at 100% = $1,641.24... $1,641.24 at 103.1% = $1,692.12 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,SENTARA HEALTH,SENTARA HEALTH,697.90,,,,,,,59.0400,2704.0000,percent of total billed charges,"25.81% of $2,704.00 in Billed Charges for Rev 410 Proc 94003 = $697.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,SENTARA HEALTH,SENTARA MEDICARE,560.50,,,,,,,59.0400,2704.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2704.00,,,,,,,59.0400,2704.0000,percent of total billed charges,"100% of $2,704.00 in Billed Charges for Rev 410 Proc 94003 = $2,704.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,107.42,,,,,,,59.0400,2704.0000,fee schedule,$214.83 from Fee Schedule TCUHC24 for Rev 410 Proc 94003 * Qty 1 = $214.83 at 50% = $107.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,112.00,,,,,,,59.0400,2704.0000,other,Rev 410 Proc 94003 1 Visit at $112.00 per Visit = $112.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,106.00,,,,,,,59.0400,2704.0000,other,Rev 410 Proc 94003 1 Visit at $106.00 per Visit = $106.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,175.00,,,,,,,59.0400,2704.0000,other,Rev 410 Proc 94003 1 Visit at $175.00 per Visit = $175.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1690.48,,,,,,,59.0400,2704.0000,fee schedule,"APG 00067 Proc 94003 at $836.60 (Base Rate) * 1.9618 (Relative Weight) = $1,641.24 (Total Line Payment) at 103% = $1,690.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,560.50,,,,,,,59.0400,2704.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,560.50,,,,,,,59.0400,2704.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,WELLCARE,WELLCARE MEDICAID,2704.00,,,,,,,59.0400,2704.0000,percent of total billed charges,"100% of $2,704.00 in Billed Charges for Rev 410 Proc 94003 = $2,704.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SUBS DAY VENTILATION ASSIST & MAN,94003,CPT,410,RC,41000003,CDM,,,,both,,,2704.0000,405.6000,WELLCARE,WELLCARE MEDICARE,594.13,,,,,,,59.0400,2704.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,AETNA,AETNA,553.82,,,,,,,32.8900,1297.0000,percent of total billed charges,"42.7% of $1,297.00 in Billed Charges for Rev 460 Proc 94060 = $553.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,151.57,,,,,,,32.8900,1297.0000,fee schedule,APG 00060 Proc 94060 at $836.60 (Base Rate) * 0.1742 (Relative Weight) = $145.74 (Total Line Payment) at 104% = $151.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,338.56,,,,,,,32.8900,1297.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,AETNA,AETNA HEALTHCARE MEDICARE,338.56,,,,,,,32.8900,1297.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,338.56,,,,,,,32.8900,1297.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,AMBETTER,AMBETTER,738.05,,,,,,,32.8900,1297.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,352.10,,,,,,,32.8900,1297.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,BLUE CROSS,ANTHEM EXCHANGE,833.54,,,,,,,32.8900,1297.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,150.11,,,,,,,32.8900,1297.0000,fee schedule,APG 00060 Proc 94060 at $836.60 (Base Rate) * 0.1742 (Relative Weight) = $145.74 (Total Line Payment) at 103% = $150.11. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,BLUE CROSS,ANTHEM HMO,885.58,,,,,,,32.8900,1297.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,348.71,,,,,,,32.8900,1297.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1041.81,,,,,,,32.8900,1297.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,36.63,,,,,,,32.8900,1297.0000,fee schedule,$36.63 from Fee Schedule BLDTM_23 for Rev 460 Proc 94060 * Qty 1 = $36.63 at 100% = $36.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,BLUE CROSS,BLUE CROSS E NETWORK,185.95,,,,,,,32.8900,1297.0000,fee schedule,$42.65 from Fee Schedule BCFSG for Rev 460 Proc 94060 * Qty 1 = $42.65 at 436% = $185.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,BLUE CROSS,BLUE CROSS MEDICARE,352.10,,,,,,,32.8900,1297.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,BLUE CROSS,BLUE CROSS P NETWORK,189.79,,,,,,,32.8900,1297.0000,fee schedule,$42.65 from Fee Schedule BCFSG for Rev 460 Proc 94060 * Qty 1 = $42.65 at 445% = $189.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,BLUE CROSS,BLUE CROSS S NETWORK,189.79,,,,,,,32.8900,1297.0000,fee schedule,$42.65 from Fee Schedule BCFSG for Rev 460 Proc 94060 * Qty 1 = $42.65 at 445% = $189.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,BLUE CROSS,TENNCARE BLUE CARE,32.89,,,,,,,32.8900,1297.0000,fee schedule,$28.35 from Fee Schedule TC_24 for Rev 460 Proc 94060 * Qty 1 = $28.35 at 116% = $32.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,BLUE CROSS,TENNCARE BLUE SELECT,32.89,,,,,,,32.8900,1297.0000,fee schedule,$28.35 from Fee Schedule TC_24 for Rev 460 Proc 94060 * Qty 1 = $28.35 at 116% = $32.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,CIGNA HEALTHCARE,CIGNA HMO,540.85,,,,,,,32.8900,1297.0000,percent of total billed charges,"41.7% of $1,297.00 in Billed Charges for Rev 460 Proc 94060 = $540.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,601.81,,,,,,,32.8900,1297.0000,percent of total billed charges,"46.4% of $1,297.00 in Billed Charges for Rev 460 Proc 94060 = $601.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,355.48,,,,,,,32.8900,1297.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,540.85,,,,,,,32.8900,1297.0000,percent of total billed charges,"41.7% of $1,297.00 in Billed Charges for Rev 460 Proc 94060 = $540.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,CIGNA HEALTHCARE,CIGNA PPO,540.85,,,,,,,32.8900,1297.0000,percent of total billed charges,"41.7% of $1,297.00 in Billed Charges for Rev 460 Proc 94060 = $540.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,355.48,,,,,,,32.8900,1297.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1167.30,,,,,,,32.8900,1297.0000,percent of total billed charges,"90% of $1,297.00 in Billed Charges for Rev 460 Proc 94060 = $1,167.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,HUMANA,HUMANA MEDICARE,338.56,,,,,,,32.8900,1297.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,338.56,,,,,,,32.8900,1297.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,MEDCOST,MEDCOST VHN,617.24,,,,,,,32.8900,1297.0000,percent of total billed charges,"47.59% of $1,297.00 in Billed Charges for Rev 460 Proc 94060 = $617.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,153.03,,,,,,,32.8900,1297.0000,fee schedule,APG 00060 Proc 94060 at $836.60 (Base Rate) * 0.1742 (Relative Weight) = $145.74 (Total Line Payment) at 100% = $145.74... $145.74 at 105% = $153.03 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,355.48,,,,,,,32.8900,1297.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,355.48,,,,,,,32.8900,1297.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,NHC ADVANTAGE,NHC ADVANTAGE,355.48,,,,,,,32.8900,1297.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,150.26,,,,,,,32.8900,1297.0000,fee schedule,APG 00060 Proc 94060 at $836.60 (Base Rate) * 0.1742 (Relative Weight) = $145.74 (Total Line Payment) at 100% = $145.74... $145.74 at 103.1% = $150.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,SENTARA HEALTH,SENTARA HEALTH,334.76,,,,,,,32.8900,1297.0000,percent of total billed charges,"25.81% of $1,297.00 in Billed Charges for Rev 460 Proc 94060 = $334.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,SENTARA HEALTH,SENTARA MEDICARE,338.56,,,,,,,32.8900,1297.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1297.00,,,,,,,32.8900,1297.0000,percent of total billed charges,"100% of $1,297.00 in Billed Charges for Rev 460 Proc 94060 = $1,297.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,49.40,,,,,,,32.8900,1297.0000,fee schedule,$98.80 from Fee Schedule TCUHC24 for Rev 460 Proc 94060 * Qty 1 = $98.80 at 50% = $49.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,860.00,,,,,,,32.8900,1297.0000,other,Rev 460 Proc 94060 1 Visit at $860.00 per Visit = $860.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,822.00,,,,,,,32.8900,1297.0000,other,Rev 460 Proc 94060 1 Visit at $822.00 per Visit = $822.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,1297.00,,,,,,,32.8900,1297.0000,other,"Rev 460 Proc 94060 1 Visit at $1,353.00 per Visit = $1,353.00 (Service Line reduced to $1,297.00, claim capped at $1,297.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,150.11,,,,,,,32.8900,1297.0000,fee schedule,APG 00060 Proc 94060 at $836.60 (Base Rate) * 0.1742 (Relative Weight) = $145.74 (Total Line Payment) at 103% = $150.11. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,338.56,,,,,,,32.8900,1297.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,338.56,,,,,,,32.8900,1297.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,WELLCARE,WELLCARE MEDICAID,1297.00,,,,,,,32.8900,1297.0000,percent of total billed charges,"100% of $1,297.00 in Billed Charges for Rev 460 Proc 94060 = $1,297.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SPIROMETRY BRONCHOSPASM EVAL,94060,CPT,460,RC,46000002,CDM,,,,both,,,1297.0000,194.5500,WELLCARE,WELLCARE MEDICARE,358.87,,,,,,,32.8900,1297.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,AETNA,AETNA,652.46,,,,,,,51.7700,1528.0000,percent of total billed charges,"42.7% of $1,528.00 in Billed Charges for Rev 460 Proc 94070 = $652.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,151.57,,,,,,,51.7700,1528.0000,fee schedule,APG 00060 Proc 94070 at $836.60 (Base Rate) * 0.1742 (Relative Weight) = $145.74 (Total Line Payment) at 104% = $151.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,338.56,,,,,,,51.7700,1528.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,AETNA,AETNA HEALTHCARE MEDICARE,338.56,,,,,,,51.7700,1528.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,338.56,,,,,,,51.7700,1528.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,AMBETTER,AMBETTER,738.05,,,,,,,51.7700,1528.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,352.10,,,,,,,51.7700,1528.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,BLUE CROSS,ANTHEM EXCHANGE,833.54,,,,,,,51.7700,1528.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,150.11,,,,,,,51.7700,1528.0000,fee schedule,APG 00060 Proc 94070 at $836.60 (Base Rate) * 0.1742 (Relative Weight) = $145.74 (Total Line Payment) at 103% = $150.11. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,BLUE CROSS,ANTHEM HMO,885.58,,,,,,,51.7700,1528.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,348.71,,,,,,,51.7700,1528.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1041.81,,,,,,,51.7700,1528.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,57.06,,,,,,,51.7700,1528.0000,fee schedule,$57.06 from Fee Schedule BLDTM_23 for Rev 460 Proc 94070 * Qty 1 = $57.06 at 100% = $57.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,BLUE CROSS,BLUE CROSS E NETWORK,120.03,,,,,,,51.7700,1528.0000,fee schedule,$27.53 from Fee Schedule BCFSG for Rev 460 Proc 94070 * Qty 1 = $27.53 at 436% = $120.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,BLUE CROSS,BLUE CROSS MEDICARE,352.10,,,,,,,51.7700,1528.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,BLUE CROSS,BLUE CROSS P NETWORK,122.51,,,,,,,51.7700,1528.0000,fee schedule,$27.53 from Fee Schedule BCFSG for Rev 460 Proc 94070 * Qty 1 = $27.53 at 445% = $122.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,BLUE CROSS,BLUE CROSS S NETWORK,122.51,,,,,,,51.7700,1528.0000,fee schedule,$27.53 from Fee Schedule BCFSG for Rev 460 Proc 94070 * Qty 1 = $27.53 at 445% = $122.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,BLUE CROSS,TENNCARE BLUE CARE,51.77,,,,,,,51.7700,1528.0000,fee schedule,$44.63 from Fee Schedule TC_24 for Rev 460 Proc 94070 * Qty 1 = $44.63 at 116% = $51.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,BLUE CROSS,TENNCARE BLUE SELECT,51.77,,,,,,,51.7700,1528.0000,fee schedule,$44.63 from Fee Schedule TC_24 for Rev 460 Proc 94070 * Qty 1 = $44.63 at 116% = $51.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,CIGNA HEALTHCARE,CIGNA HMO,637.18,,,,,,,51.7700,1528.0000,percent of total billed charges,"41.7% of $1,528.00 in Billed Charges for Rev 460 Proc 94070 = $637.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,708.99,,,,,,,51.7700,1528.0000,percent of total billed charges,"46.4% of $1,528.00 in Billed Charges for Rev 460 Proc 94070 = $708.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,355.48,,,,,,,51.7700,1528.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,637.18,,,,,,,51.7700,1528.0000,percent of total billed charges,"41.7% of $1,528.00 in Billed Charges for Rev 460 Proc 94070 = $637.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,CIGNA HEALTHCARE,CIGNA PPO,637.18,,,,,,,51.7700,1528.0000,percent of total billed charges,"41.7% of $1,528.00 in Billed Charges for Rev 460 Proc 94070 = $637.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,355.48,,,,,,,51.7700,1528.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1375.20,,,,,,,51.7700,1528.0000,percent of total billed charges,"90% of $1,528.00 in Billed Charges for Rev 460 Proc 94070 = $1,375.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,HUMANA,HUMANA MEDICARE,338.56,,,,,,,51.7700,1528.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,338.56,,,,,,,51.7700,1528.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,MEDCOST,MEDCOST VHN,727.18,,,,,,,51.7700,1528.0000,percent of total billed charges,"47.59% of $1,528.00 in Billed Charges for Rev 460 Proc 94070 = $727.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,153.03,,,,,,,51.7700,1528.0000,fee schedule,APG 00060 Proc 94070 at $836.60 (Base Rate) * 0.1742 (Relative Weight) = $145.74 (Total Line Payment) at 100% = $145.74... $145.74 at 105% = $153.03 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,355.48,,,,,,,51.7700,1528.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,355.48,,,,,,,51.7700,1528.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,NHC ADVANTAGE,NHC ADVANTAGE,355.48,,,,,,,51.7700,1528.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,150.26,,,,,,,51.7700,1528.0000,fee schedule,APG 00060 Proc 94070 at $836.60 (Base Rate) * 0.1742 (Relative Weight) = $145.74 (Total Line Payment) at 100% = $145.74... $145.74 at 103.1% = $150.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,SENTARA HEALTH,SENTARA HEALTH,394.38,,,,,,,51.7700,1528.0000,percent of total billed charges,"25.81% of $1,528.00 in Billed Charges for Rev 460 Proc 94070 = $394.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,SENTARA HEALTH,SENTARA MEDICARE,338.56,,,,,,,51.7700,1528.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1528.00,,,,,,,51.7700,1528.0000,percent of total billed charges,"100% of $1,528.00 in Billed Charges for Rev 460 Proc 94070 = $1,528.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,94.10,,,,,,,51.7700,1528.0000,fee schedule,$188.20 from Fee Schedule TCUHC24 for Rev 460 Proc 94070 * Qty 1 = $188.20 at 50% = $94.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,860.00,,,,,,,51.7700,1528.0000,other,Rev 460 Proc 94070 1 Visit at $860.00 per Visit = $860.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,822.00,,,,,,,51.7700,1528.0000,other,Rev 460 Proc 94070 1 Visit at $822.00 per Visit = $822.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,1353.00,,,,,,,51.7700,1528.0000,other,"Rev 460 Proc 94070 1 Visit at $1,353.00 per Visit = $1,353.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,150.11,,,,,,,51.7700,1528.0000,fee schedule,APG 00060 Proc 94070 at $836.60 (Base Rate) * 0.1742 (Relative Weight) = $145.74 (Total Line Payment) at 103% = $150.11. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,338.56,,,,,,,51.7700,1528.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,338.56,,,,,,,51.7700,1528.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,WELLCARE,WELLCARE MEDICAID,1528.00,,,,,,,51.7700,1528.0000,percent of total billed charges,"100% of $1,528.00 in Billed Charges for Rev 460 Proc 94070 = $1,528.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC POSTEXPOSURE BRONCHOSPASM TEST,94070,CPT,460,RC,46000003,CDM,,,,both,,,1528.0000,229.2000,WELLCARE,WELLCARE MEDICARE,358.87,,,,,,,51.7700,1528.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,AETNA,AETNA,57.65,,,,,,,5.8400,135.0000,percent of total billed charges,42.7% of $135.00 in Billed Charges for Rev 305 Proc 85810 = $57.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,7.05,,,,,,,5.8400,135.0000,fee schedule,APG 00408 Proc 85810 at $836.60 (Base Rate) * 0.0081 (Relative Weight) = $6.78 (Total Line Payment) at 104% = $7.05. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,11.67,,,,,,,5.8400,135.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,AETNA,AETNA HEALTHCARE MEDICARE,11.67,,,,,,,5.8400,135.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,11.67,,,,,,,5.8400,135.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,AMBETTER,AMBETTER,25.44,,,,,,,5.8400,135.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,AMERIGROUP,AMERIGROUP,5.84,,,,,,,5.8400,135.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,12.14,,,,,,,5.8400,135.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,BLUE CROSS,ANTHEM EXCHANGE,11.67,,,,,,,5.8400,135.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,6.98,,,,,,,5.8400,135.0000,fee schedule,APG 00408 Proc 85810 at $836.60 (Base Rate) * 0.0081 (Relative Weight) = $6.78 (Total Line Payment) at 103% = $6.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,BLUE CROSS,ANTHEM HMO,11.67,,,,,,,5.8400,135.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,12.02,,,,,,,5.8400,135.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",11.67,,,,,,,5.8400,135.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,44.33,,,,,,,5.8400,135.0000,fee schedule,$44.33 from Fee Schedule BLDTM_23 for Rev 305 Proc 85810 * Qty 1 = $44.33 at 100% = $44.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,BLUE CROSS,BLUE CROSS E NETWORK,50.82,,,,,,,5.8400,135.0000,fee schedule,$15.88 from Fee Schedule BCFSB for Rev 305 Proc 85810 * Qty 1 = $15.88 at 320% = $50.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,BLUE CROSS,BLUE CROSS MEDICARE,12.14,,,,,,,5.8400,135.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,BLUE CROSS,BLUE CROSS P NETWORK,51.93,,,,,,,5.8400,135.0000,fee schedule,$15.88 from Fee Schedule BCFSB for Rev 305 Proc 85810 * Qty 1 = $15.88 at 327% = $51.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,BLUE CROSS,BLUE CROSS S NETWORK,51.93,,,,,,,5.8400,135.0000,fee schedule,$15.88 from Fee Schedule BCFSB for Rev 305 Proc 85810 * Qty 1 = $15.88 at 327% = $51.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,BLUE CROSS,TENNCARE BLUE CARE,22.28,,,,,,,5.8400,135.0000,fee schedule,$19.21 from Fee Schedule TC_24 for Rev 305 Proc 85810 * Qty 1 = $19.21 at 116% = $22.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,BLUE CROSS,TENNCARE BLUE SELECT,22.28,,,,,,,5.8400,135.0000,fee schedule,$19.21 from Fee Schedule TC_24 for Rev 305 Proc 85810 * Qty 1 = $19.21 at 116% = $22.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,CIGNA HEALTHCARE,CIGNA HMO,46.93,,,,,,,5.8400,135.0000,fee schedule,$46.93 from Fee Schedule CIGWHS_23 for Rev 305 Proc 85810 * Qty 1 = $46.93 at 100% = $46.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,25.98,,,,,,,5.8400,135.0000,fee schedule,$25.98 from Fee Schedule CGIFP_25LR for Rev 305 Proc 85810 * Qty 1 = $25.98 at 100% = $25.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,12.25,,,,,,,5.8400,135.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,46.93,,,,,,,5.8400,135.0000,fee schedule,$46.93 from Fee Schedule CIGWHS_23 for Rev 305 Proc 85810 * Qty 1 = $46.93 at 100% = $46.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,CIGNA HEALTHCARE,CIGNA PPO,46.93,,,,,,,5.8400,135.0000,fee schedule,$46.93 from Fee Schedule CIGWHS_23 for Rev 305 Proc 85810 * Qty 1 = $46.93 at 100% = $46.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,12.25,,,,,,,5.8400,135.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,121.50,,,,,,,5.8400,135.0000,percent of total billed charges,90% of $135.00 in Billed Charges for Rev 305 Proc 85810 = $121.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,HUMANA,HUMANA MEDICARE,11.67,,,,,,,5.8400,135.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,11.67,,,,,,,5.8400,135.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,MEDCOST,MEDCOST VHN,64.25,,,,,,,5.8400,135.0000,percent of total billed charges,47.59% of $135.00 in Billed Charges for Rev 305 Proc 85810 = $64.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,7.12,,,,,,,5.8400,135.0000,fee schedule,APG 00408 Proc 85810 at $836.60 (Base Rate) * 0.0081 (Relative Weight) = $6.78 (Total Line Payment) at 100% = $6.78... $6.78 at 105% = $7.12 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,12.25,,,,,,,5.8400,135.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,12.25,,,,,,,5.8400,135.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,NHC ADVANTAGE,NHC ADVANTAGE,12.25,,,,,,,5.8400,135.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,6.99,,,,,,,5.8400,135.0000,fee schedule,APG 00408 Proc 85810 at $836.60 (Base Rate) * 0.0081 (Relative Weight) = $6.78 (Total Line Payment) at 100% = $6.78... $6.78 at 103.1% = $6.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,SENTARA HEALTH,SENTARA HEALTH,34.84,,,,,,,5.8400,135.0000,percent of total billed charges,25.81% of $135.00 in Billed Charges for Rev 305 Proc 85810 = $34.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,SENTARA HEALTH,SENTARA MEDICARE,11.67,,,,,,,5.8400,135.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",135.00,,,,,,,5.8400,135.0000,percent of total billed charges,100% of $135.00 in Billed Charges for Rev 305 Proc 85810 = $135.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.27,,,,,,,5.8400,135.0000,fee schedule,$16.53 from Fee Schedule TCUHC24 for Rev 305 Proc 85810 * Qty 1 = $16.53 at 50% = $8.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12.14,,,,,,,5.8400,135.0000,fee schedule,$11.67 from Fee Schedule UHC_31910 for Rev 305 Proc 85810 * Qty 1 = $11.67 at 104% = $12.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,11.67,,,,,,,5.8400,135.0000,fee schedule,$11.67 from Fee Schedule UHC_31910 for Rev 305 Proc 85810 * Qty 1 = $11.67 at 100% = $11.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,11.67,,,,,,,5.8400,135.0000,fee schedule,$11.67 from Fee Schedule UHC_31910 for Rev 305 Proc 85810 * Qty 1 = $11.67 at 100% = $11.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,6.98,,,,,,,5.8400,135.0000,fee schedule,APG 00408 Proc 85810 at $836.60 (Base Rate) * 0.0081 (Relative Weight) = $6.78 (Total Line Payment) at 103% = $6.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,11.67,,,,,,,5.8400,135.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,11.67,,,,,,,5.8400,135.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,WELLCARE,WELLCARE MEDICAID,135.00,,,,,,,5.8400,135.0000,percent of total billed charges,100% of $135.00 in Billed Charges for Rev 305 Proc 85810 = $135.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VISCOSITY BLOOD REF,85810,CPT,305,RC,30500053,CDM,,,,both,,,135.0000,20.2500,WELLCARE,WELLCARE MEDICARE,12.37,,,,,,,5.8400,135.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,AETNA,AETNA,26.05,,,,,,,3.7000,61.0000,percent of total billed charges,42.7% of $61.00 in Billed Charges for Rev 302 Proc 86001 = $26.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,3.7000,61.0000,fee schedule,APG 00394 Proc 86001 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,7.82,,,,,,,3.7000,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,AETNA,AETNA HEALTHCARE MEDICARE,7.82,,,,,,,3.7000,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,7.82,,,,,,,3.7000,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,AMBETTER,AMBETTER,17.05,,,,,,,3.7000,61.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,AMERIGROUP,AMERIGROUP,3.91,,,,,,,3.7000,61.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,8.13,,,,,,,3.7000,61.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,ANTHEM EXCHANGE,7.82,,,,,,,3.7000,61.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,3.7000,61.0000,fee schedule,APG 00394 Proc 86001 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,ANTHEM HMO,7.82,,,,,,,3.7000,61.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,8.05,,,,,,,3.7000,61.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",7.82,,,,,,,3.7000,61.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,19.17,,,,,,,3.7000,61.0000,fee schedule,$19.17 from Fee Schedule BLDTM_23 for Rev 302 Proc 86001 * Qty 1 = $19.17 at 100% = $19.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS E NETWORK,22.78,,,,,,,3.7000,61.0000,fee schedule,$7.12 from Fee Schedule BCFSB for Rev 302 Proc 86001 * Qty 1 = $7.12 at 320% = $22.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS MEDICARE,8.13,,,,,,,3.7000,61.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS P NETWORK,23.28,,,,,,,3.7000,61.0000,fee schedule,$7.12 from Fee Schedule BCFSB for Rev 302 Proc 86001 * Qty 1 = $7.12 at 327% = $23.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS S NETWORK,23.28,,,,,,,3.7000,61.0000,fee schedule,$7.12 from Fee Schedule BCFSB for Rev 302 Proc 86001 * Qty 1 = $7.12 at 327% = $23.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,TENNCARE BLUE CARE,6.81,,,,,,,3.7000,61.0000,fee schedule,$5.87 from Fee Schedule TC_24 for Rev 302 Proc 86001 * Qty 1 = $5.87 at 116% = $6.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,TENNCARE BLUE SELECT,6.81,,,,,,,3.7000,61.0000,fee schedule,$5.87 from Fee Schedule TC_24 for Rev 302 Proc 86001 * Qty 1 = $5.87 at 116% = $6.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA HMO,20.98,,,,,,,3.7000,61.0000,fee schedule,$20.98 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86001 * Qty 1 = $20.98 at 100% = $20.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,17.32,,,,,,,3.7000,61.0000,fee schedule,$17.32 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86001 * Qty 1 = $17.32 at 100% = $17.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,8.21,,,,,,,3.7000,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,20.98,,,,,,,3.7000,61.0000,fee schedule,$20.98 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86001 * Qty 1 = $20.98 at 100% = $20.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA PPO,20.98,,,,,,,3.7000,61.0000,fee schedule,$20.98 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86001 * Qty 1 = $20.98 at 100% = $20.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,8.21,,,,,,,3.7000,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,54.90,,,,,,,3.7000,61.0000,percent of total billed charges,90% of $61.00 in Billed Charges for Rev 302 Proc 86001 = $54.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,HUMANA,HUMANA MEDICARE,7.82,,,,,,,3.7000,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,7.82,,,,,,,3.7000,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,MEDCOST,MEDCOST VHN,29.03,,,,,,,3.7000,61.0000,percent of total billed charges,47.59% of $61.00 in Billed Charges for Rev 302 Proc 86001 = $29.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,3.7000,61.0000,fee schedule,APG 00394 Proc 86001 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,8.21,,,,,,,3.7000,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,8.21,,,,,,,3.7000,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,NHC ADVANTAGE,NHC ADVANTAGE,8.21,,,,,,,3.7000,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,3.7000,61.0000,fee schedule,APG 00394 Proc 86001 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,SENTARA HEALTH,SENTARA HEALTH,15.74,,,,,,,3.7000,61.0000,percent of total billed charges,25.81% of $61.00 in Billed Charges for Rev 302 Proc 86001 = $15.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,SENTARA HEALTH,SENTARA MEDICARE,7.82,,,,,,,3.7000,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",61.00,,,,,,,3.7000,61.0000,percent of total billed charges,100% of $61.00 in Billed Charges for Rev 302 Proc 86001 = $61.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3.70,,,,,,,3.7000,61.0000,fee schedule,$7.39 from Fee Schedule TCUHC24 for Rev 302 Proc 86001 * Qty 1 = $7.39 at 50% = $3.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,8.13,,,,,,,3.7000,61.0000,fee schedule,$7.82 from Fee Schedule UHC_31910 for Rev 302 Proc 86001 * Qty 1 = $7.82 at 104% = $8.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7.82,,,,,,,3.7000,61.0000,fee schedule,$7.82 from Fee Schedule UHC_31910 for Rev 302 Proc 86001 * Qty 1 = $7.82 at 100% = $7.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,7.82,,,,,,,3.7000,61.0000,fee schedule,$7.82 from Fee Schedule UHC_31910 for Rev 302 Proc 86001 * Qty 1 = $7.82 at 100% = $7.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,3.7000,61.0000,fee schedule,APG 00394 Proc 86001 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,7.82,,,,,,,3.7000,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,7.82,,,,,,,3.7000,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,WELLCARE,WELLCARE MEDICAID,61.00,,,,,,,3.7000,61.0000,percent of total billed charges,100% of $61.00 in Billed Charges for Rev 302 Proc 86001 = $61.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN,86001,CPT,302,RC,30200139,CDM,,,,both,,,61.0000,9.1500,WELLCARE,WELLCARE MEDICARE,8.29,,,,,,,3.7000,61.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,AETNA,AETNA,26.05,,,,,,,2.6100,61.0000,percent of total billed charges,42.7% of $61.00 in Billed Charges for Rev 302 Proc 86003 = $26.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,2.6100,61.0000,fee schedule,APG 00394 Proc 86003 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5.22,,,,,,,2.6100,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,AETNA,AETNA HEALTHCARE MEDICARE,5.22,,,,,,,2.6100,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,5.22,,,,,,,2.6100,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,AMBETTER,AMBETTER,11.38,,,,,,,2.6100,61.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,AMERIGROUP,AMERIGROUP,2.61,,,,,,,2.6100,61.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,5.43,,,,,,,2.6100,61.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,ANTHEM EXCHANGE,5.22,,,,,,,2.6100,61.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,2.6100,61.0000,fee schedule,APG 00394 Proc 86003 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,ANTHEM HMO,5.22,,,,,,,2.6100,61.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5.38,,,,,,,2.6100,61.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5.22,,,,,,,2.6100,61.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,17.90,,,,,,,2.6100,61.0000,fee schedule,$17.90 from Fee Schedule BLDTM_23 for Rev 302 Proc 86003 * Qty 1 = $17.90 at 100% = $17.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS E NETWORK,22.78,,,,,,,2.6100,61.0000,fee schedule,$7.12 from Fee Schedule BCFSB for Rev 302 Proc 86003 * Qty 1 = $7.12 at 320% = $22.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS MEDICARE,5.43,,,,,,,2.6100,61.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS P NETWORK,23.28,,,,,,,2.6100,61.0000,fee schedule,$7.12 from Fee Schedule BCFSB for Rev 302 Proc 86003 * Qty 1 = $7.12 at 327% = $23.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,BLUE CROSS S NETWORK,23.28,,,,,,,2.6100,61.0000,fee schedule,$7.12 from Fee Schedule BCFSB for Rev 302 Proc 86003 * Qty 1 = $7.12 at 327% = $23.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,TENNCARE BLUE CARE,25.02,,,,,,,2.6100,61.0000,fee schedule,$21.57 from Fee Schedule TC_24 for Rev 302 Proc 86003 * Qty 1 = $21.57 at 116% = $25.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,BLUE CROSS,TENNCARE BLUE SELECT,25.02,,,,,,,2.6100,61.0000,fee schedule,$21.57 from Fee Schedule TC_24 for Rev 302 Proc 86003 * Qty 1 = $21.57 at 116% = $25.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA HMO,20.98,,,,,,,2.6100,61.0000,fee schedule,$20.98 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86003 * Qty 1 = $20.98 at 100% = $20.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11.55,,,,,,,2.6100,61.0000,fee schedule,$11.55 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86003 * Qty 1 = $11.55 at 100% = $11.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,5.48,,,,,,,2.6100,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,20.98,,,,,,,2.6100,61.0000,fee schedule,$20.98 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86003 * Qty 1 = $20.98 at 100% = $20.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,CIGNA HEALTHCARE,CIGNA PPO,20.98,,,,,,,2.6100,61.0000,fee schedule,$20.98 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86003 * Qty 1 = $20.98 at 100% = $20.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,5.48,,,,,,,2.6100,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,54.90,,,,,,,2.6100,61.0000,percent of total billed charges,90% of $61.00 in Billed Charges for Rev 302 Proc 86003 = $54.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,HUMANA,HUMANA MEDICARE,5.22,,,,,,,2.6100,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5.22,,,,,,,2.6100,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,MEDCOST,MEDCOST VHN,29.03,,,,,,,2.6100,61.0000,percent of total billed charges,47.59% of $61.00 in Billed Charges for Rev 302 Proc 86003 = $29.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,2.6100,61.0000,fee schedule,APG 00394 Proc 86003 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,5.48,,,,,,,2.6100,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,5.48,,,,,,,2.6100,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,NHC ADVANTAGE,NHC ADVANTAGE,5.48,,,,,,,2.6100,61.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,2.6100,61.0000,fee schedule,APG 00394 Proc 86003 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,SENTARA HEALTH,SENTARA HEALTH,15.74,,,,,,,2.6100,61.0000,percent of total billed charges,25.81% of $61.00 in Billed Charges for Rev 302 Proc 86003 = $15.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,SENTARA HEALTH,SENTARA MEDICARE,5.22,,,,,,,2.6100,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",61.00,,,,,,,2.6100,61.0000,percent of total billed charges,100% of $61.00 in Billed Charges for Rev 302 Proc 86003 = $61.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3.70,,,,,,,2.6100,61.0000,fee schedule,$7.39 from Fee Schedule TCUHC24 for Rev 302 Proc 86003 * Qty 1 = $7.39 at 50% = $3.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5.43,,,,,,,2.6100,61.0000,fee schedule,$5.22 from Fee Schedule UHC_31910 for Rev 302 Proc 86003 * Qty 1 = $5.22 at 104% = $5.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,5.22,,,,,,,2.6100,61.0000,fee schedule,$5.22 from Fee Schedule UHC_31910 for Rev 302 Proc 86003 * Qty 1 = $5.22 at 100% = $5.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,5.22,,,,,,,2.6100,61.0000,fee schedule,$5.22 from Fee Schedule UHC_31910 for Rev 302 Proc 86003 * Qty 1 = $5.22 at 100% = $5.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,2.6100,61.0000,fee schedule,APG 00394 Proc 86003 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5.22,,,,,,,2.6100,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5.22,,,,,,,2.6100,61.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,WELLCARE,WELLCARE MEDICAID,61.00,,,,,,,2.6100,61.0000,percent of total billed charges,100% of $61.00 in Billed Charges for Rev 302 Proc 86003 = $61.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPECIFIC IGE,86003,CPT,302,RC,30200001,CDM,,,,both,,,61.0000,9.1500,WELLCARE,WELLCARE MEDICARE,5.53,,,,,,,2.6100,61.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,AETNA,AETNA,39.28,,,,,,,3.9900,92.0000,percent of total billed charges,42.7% of $92.00 in Billed Charges for Rev 302 Proc 86005 = $39.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,3.9900,92.0000,fee schedule,APG 00394 Proc 86005 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,7.97,,,,,,,3.9900,92.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,AETNA,AETNA HEALTHCARE MEDICARE,7.97,,,,,,,3.9900,92.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,7.97,,,,,,,3.9900,92.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,AMBETTER,AMBETTER,17.37,,,,,,,3.9900,92.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,AMERIGROUP,AMERIGROUP,3.99,,,,,,,3.9900,92.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,8.29,,,,,,,3.9900,92.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,BLUE CROSS,ANTHEM EXCHANGE,7.97,,,,,,,3.9900,92.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,3.9900,92.0000,fee schedule,APG 00394 Proc 86005 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,BLUE CROSS,ANTHEM HMO,7.97,,,,,,,3.9900,92.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,8.21,,,,,,,3.9900,92.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",7.97,,,,,,,3.9900,92.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,22.94,,,,,,,3.9900,92.0000,fee schedule,$22.94 from Fee Schedule BLDTM_23 for Rev 302 Proc 86005 * Qty 1 = $22.94 at 100% = $22.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,BLUE CROSS,BLUE CROSS E NETWORK,34.82,,,,,,,3.9900,92.0000,fee schedule,$10.88 from Fee Schedule BCFSB for Rev 302 Proc 86005 * Qty 1 = $10.88 at 320% = $34.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,BLUE CROSS,BLUE CROSS MEDICARE,8.29,,,,,,,3.9900,92.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,BLUE CROSS,BLUE CROSS P NETWORK,35.58,,,,,,,3.9900,92.0000,fee schedule,$10.88 from Fee Schedule BCFSB for Rev 302 Proc 86005 * Qty 1 = $10.88 at 327% = $35.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,BLUE CROSS,BLUE CROSS S NETWORK,35.58,,,,,,,3.9900,92.0000,fee schedule,$10.88 from Fee Schedule BCFSB for Rev 302 Proc 86005 * Qty 1 = $10.88 at 327% = $35.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,BLUE CROSS,TENNCARE BLUE CARE,11.32,,,,,,,3.9900,92.0000,fee schedule,$9.76 from Fee Schedule TC_24 for Rev 302 Proc 86005 * Qty 1 = $9.76 at 116% = $11.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,BLUE CROSS,TENNCARE BLUE SELECT,11.32,,,,,,,3.9900,92.0000,fee schedule,$9.76 from Fee Schedule TC_24 for Rev 302 Proc 86005 * Qty 1 = $9.76 at 116% = $11.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,CIGNA HEALTHCARE,CIGNA HMO,32.08,,,,,,,3.9900,92.0000,fee schedule,$32.08 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86005 * Qty 1 = $32.08 at 100% = $32.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,17.32,,,,,,,3.9900,92.0000,fee schedule,$17.32 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86005 * Qty 1 = $17.32 at 100% = $17.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,8.37,,,,,,,3.9900,92.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,32.08,,,,,,,3.9900,92.0000,fee schedule,$32.08 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86005 * Qty 1 = $32.08 at 100% = $32.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,CIGNA HEALTHCARE,CIGNA PPO,32.08,,,,,,,3.9900,92.0000,fee schedule,$32.08 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86005 * Qty 1 = $32.08 at 100% = $32.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,8.37,,,,,,,3.9900,92.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,82.80,,,,,,,3.9900,92.0000,percent of total billed charges,90% of $92.00 in Billed Charges for Rev 302 Proc 86005 = $82.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,HUMANA,HUMANA MEDICARE,7.97,,,,,,,3.9900,92.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,7.97,,,,,,,3.9900,92.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,MEDCOST,MEDCOST VHN,43.78,,,,,,,3.9900,92.0000,percent of total billed charges,47.59% of $92.00 in Billed Charges for Rev 302 Proc 86005 = $43.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,3.9900,92.0000,fee schedule,APG 00394 Proc 86005 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,8.37,,,,,,,3.9900,92.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,8.37,,,,,,,3.9900,92.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,NHC ADVANTAGE,NHC ADVANTAGE,8.37,,,,,,,3.9900,92.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,3.9900,92.0000,fee schedule,APG 00394 Proc 86005 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,SENTARA HEALTH,SENTARA HEALTH,23.75,,,,,,,3.9900,92.0000,percent of total billed charges,25.81% of $92.00 in Billed Charges for Rev 302 Proc 86005 = $23.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,SENTARA HEALTH,SENTARA MEDICARE,7.97,,,,,,,3.9900,92.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",92.00,,,,,,,3.9900,92.0000,percent of total billed charges,100% of $92.00 in Billed Charges for Rev 302 Proc 86005 = $92.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5.65,,,,,,,3.9900,92.0000,fee schedule,$11.29 from Fee Schedule TCUHC24 for Rev 302 Proc 86005 * Qty 1 = $11.29 at 50% = $5.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,8.29,,,,,,,3.9900,92.0000,fee schedule,$7.97 from Fee Schedule UHC_31910 for Rev 302 Proc 86005 * Qty 1 = $7.97 at 104% = $8.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,7.97,,,,,,,3.9900,92.0000,fee schedule,$7.97 from Fee Schedule UHC_31910 for Rev 302 Proc 86005 * Qty 1 = $7.97 at 100% = $7.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,7.97,,,,,,,3.9900,92.0000,fee schedule,$7.97 from Fee Schedule UHC_31910 for Rev 302 Proc 86005 * Qty 1 = $7.97 at 100% = $7.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,3.9900,92.0000,fee schedule,APG 00394 Proc 86005 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,7.97,,,,,,,3.9900,92.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,7.97,,,,,,,3.9900,92.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,WELLCARE,WELLCARE MEDICAID,92.00,,,,,,,3.9900,92.0000,percent of total billed charges,100% of $92.00 in Billed Charges for Rev 302 Proc 86005 = $92.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN,86005,CPT,302,RC,30200133,CDM,,,,both,,,92.0000,13.8000,WELLCARE,WELLCARE MEDICARE,8.45,,,,,,,3.9900,92.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,AETNA,AETNA,80.28,,,,,,,5.7700,188.0000,percent of total billed charges,42.7% of $188.00 in Billed Charges for Rev 300 Proc 86015 = $80.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,5.7700,188.0000,fee schedule,APG 00394 Proc 86015 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,12.05,,,,,,,5.7700,188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,AETNA,AETNA HEALTHCARE MEDICARE,12.05,,,,,,,5.7700,188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,12.05,,,,,,,5.7700,188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,AMBETTER,AMBETTER,26.27,,,,,,,5.7700,188.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,AMERIGROUP,AMERIGROUP,6.03,,,,,,,5.7700,188.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,12.53,,,,,,,5.7700,188.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,ANTHEM EXCHANGE,12.05,,,,,,,5.7700,188.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,5.7700,188.0000,fee schedule,APG 00394 Proc 86015 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,ANTHEM HMO,12.05,,,,,,,5.7700,188.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,12.41,,,,,,,5.7700,188.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",12.05,,,,,,,5.7700,188.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,131.60,,,,,,,5.7700,188.0000,percent of total billed charges,Rev 300 Proc 86015 $188.00 in Billed Charges at 70% = $131.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,BLUE CROSS E NETWORK,36.90,,,,,,,5.7700,188.0000,fee schedule,$11.53 from Fee Schedule BCFSB for Rev 300 Proc 86015 * Qty 1 = $11.53 at 320% = $36.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,BLUE CROSS MEDICARE,12.53,,,,,,,5.7700,188.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,BLUE CROSS P NETWORK,37.70,,,,,,,5.7700,188.0000,fee schedule,$11.53 from Fee Schedule BCFSB for Rev 300 Proc 86015 * Qty 1 = $11.53 at 327% = $37.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,BLUE CROSS S NETWORK,37.70,,,,,,,5.7700,188.0000,fee schedule,$11.53 from Fee Schedule BCFSB for Rev 300 Proc 86015 * Qty 1 = $11.53 at 327% = $37.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,TENNCARE BLUE CARE,10.87,,,,,,,5.7700,188.0000,fee schedule,$9.37 from Fee Schedule TC_24 for Rev 300 Proc 86015 * Qty 1 = $9.37 at 116% = $10.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,TENNCARE BLUE SELECT,10.87,,,,,,,5.7700,188.0000,fee schedule,$9.37 from Fee Schedule TC_24 for Rev 300 Proc 86015 * Qty 1 = $9.37 at 116% = $10.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,CIGNA HEALTHCARE,CIGNA HMO,78.40,,,,,,,5.7700,188.0000,percent of total billed charges,Rev 300 Proc 86015 $188.00 in Billed Charges at 41.7% = $78.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,26.71,,,,,,,5.7700,188.0000,fee schedule,$26.71 from Fee Schedule CGIFP_25LR for Rev 300 Proc 86015 * Qty 1 = $26.71 at 100% = $26.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,12.65,,,,,,,5.7700,188.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,78.40,,,,,,,5.7700,188.0000,percent of total billed charges,Rev 300 Proc 86015 $188.00 in Billed Charges at 41.7% = $78.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,CIGNA HEALTHCARE,CIGNA PPO,78.40,,,,,,,5.7700,188.0000,percent of total billed charges,Rev 300 Proc 86015 $188.00 in Billed Charges at 41.7% = $78.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,12.65,,,,,,,5.7700,188.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,169.20,,,,,,,5.7700,188.0000,percent of total billed charges,90% of $188.00 in Billed Charges for Rev 300 Proc 86015 = $169.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,HUMANA,HUMANA MEDICARE,12.05,,,,,,,5.7700,188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,12.05,,,,,,,5.7700,188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,MEDCOST,MEDCOST VHN,89.47,,,,,,,5.7700,188.0000,percent of total billed charges,47.59% of $188.00 in Billed Charges for Rev 300 Proc 86015 = $89.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,5.7700,188.0000,fee schedule,APG 00394 Proc 86015 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,12.65,,,,,,,5.7700,188.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,12.65,,,,,,,5.7700,188.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,NHC ADVANTAGE,NHC ADVANTAGE,12.65,,,,,,,5.7700,188.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,5.7700,188.0000,fee schedule,APG 00394 Proc 86015 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,SENTARA HEALTH,SENTARA HEALTH,48.52,,,,,,,5.7700,188.0000,percent of total billed charges,25.81% of $188.00 in Billed Charges for Rev 300 Proc 86015 = $48.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,SENTARA HEALTH,SENTARA MEDICARE,12.05,,,,,,,5.7700,188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",188.00,,,,,,,5.7700,188.0000,percent of total billed charges,100% of $188.00 in Billed Charges for Rev 300 Proc 86015 = $188.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5.77,,,,,,,5.7700,188.0000,fee schedule,$11.53 from Fee Schedule TCUHC24 for Rev 300 Proc 86015 * Qty 1 = $11.53 at 50% = $5.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,11.99,,,,,,,5.7700,188.0000,fee schedule,$11.53 from Fee Schedule UHC_31910 for Rev 300 Proc 86015 * Qty 1 = $11.53 at 104% = $11.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11.53,,,,,,,5.7700,188.0000,fee schedule,$11.53 from Fee Schedule UHC_31910 for Rev 300 Proc 86015 * Qty 1 = $11.53 at 100% = $11.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,11.53,,,,,,,5.7700,188.0000,fee schedule,$11.53 from Fee Schedule UHC_31910 for Rev 300 Proc 86015 * Qty 1 = $11.53 at 100% = $11.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,5.7700,188.0000,fee schedule,APG 00394 Proc 86015 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,12.05,,,,,,,5.7700,188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,12.05,,,,,,,5.7700,188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,WELLCARE,WELLCARE MEDICAID,188.00,,,,,,,5.7700,188.0000,percent of total billed charges,100% of $188.00 in Billed Charges for Rev 300 Proc 86015 = $188.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACTIN SMOOTH MUSCLE ANTIBODY EACH,86015,CPT,300,RC,30000306,CDM,,,,both,,,188.0000,28.2000,WELLCARE,WELLCARE MEDICARE,12.77,,,,,,,5.7700,188.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,AETNA,AETNA,166.96,,,,,,,14.8600,433.1100,percent of total billed charges,42.7% of $391.00 in Billed Charges for Rev 410 Proc 94610 = $166.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,83.09,,,,,,,14.8600,433.1100,fee schedule,APG 00412 Proc 94610 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 104% = $83.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,198.67,,,,,,,14.8600,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,AETNA,AETNA HEALTHCARE MEDICARE,198.67,,,,,,,14.8600,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,198.67,,,,,,,14.8600,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,AMBETTER,AMBETTER,433.11,,,,,,,14.8600,433.1100,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,206.62,,,,,,,14.8600,433.1100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,BLUE CROSS,ANTHEM EXCHANGE,391.00,,,,,,,14.8600,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,82.29,,,,,,,14.8600,433.1100,fee schedule,APG 00412 Proc 94610 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 103% = $82.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,BLUE CROSS,ANTHEM HMO,391.00,,,,,,,14.8600,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,204.63,,,,,,,14.8600,433.1100,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",391.00,,,,,,,14.8600,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,57.22,,,,,,,14.8600,433.1100,fee schedule,$57.22 from Fee Schedule BLDTM_23 for Rev 410 Proc 94610 * Qty 1 = $57.22 at 100% = $57.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,BLUE CROSS,BLUE CROSS E NETWORK,251.44,,,,,,,14.8600,433.1100,fee schedule,$57.67 from Fee Schedule BCFSG for Rev 410 Proc 94610 * Qty 1 = $57.67 at 436% = $251.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,BLUE CROSS,BLUE CROSS MEDICARE,206.62,,,,,,,14.8600,433.1100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,BLUE CROSS,BLUE CROSS P NETWORK,256.63,,,,,,,14.8600,433.1100,fee schedule,$57.67 from Fee Schedule BCFSG for Rev 410 Proc 94610 * Qty 1 = $57.67 at 445% = $256.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,BLUE CROSS,BLUE CROSS S NETWORK,256.63,,,,,,,14.8600,433.1100,fee schedule,$57.67 from Fee Schedule BCFSG for Rev 410 Proc 94610 * Qty 1 = $57.67 at 445% = $256.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,BLUE CROSS,TENNCARE BLUE CARE,57.83,,,,,,,14.8600,433.1100,fee schedule,$49.85 from Fee Schedule TC_24 for Rev 410 Proc 94610 * Qty 1 = $49.85 at 116% = $57.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,BLUE CROSS,TENNCARE BLUE SELECT,57.83,,,,,,,14.8600,433.1100,fee schedule,$49.85 from Fee Schedule TC_24 for Rev 410 Proc 94610 * Qty 1 = $49.85 at 116% = $57.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,CIGNA HEALTHCARE,CIGNA HMO,163.05,,,,,,,14.8600,433.1100,percent of total billed charges,41.7% of $391.00 in Billed Charges for Rev 410 Proc 94610 = $163.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,181.42,,,,,,,14.8600,433.1100,percent of total billed charges,46.4% of $391.00 in Billed Charges for Rev 410 Proc 94610 = $181.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,208.61,,,,,,,14.8600,433.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,163.05,,,,,,,14.8600,433.1100,percent of total billed charges,41.7% of $391.00 in Billed Charges for Rev 410 Proc 94610 = $163.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,CIGNA HEALTHCARE,CIGNA PPO,163.05,,,,,,,14.8600,433.1100,percent of total billed charges,41.7% of $391.00 in Billed Charges for Rev 410 Proc 94610 = $163.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,208.61,,,,,,,14.8600,433.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,351.90,,,,,,,14.8600,433.1100,percent of total billed charges,90% of $391.00 in Billed Charges for Rev 410 Proc 94610 = $351.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,HUMANA,HUMANA MEDICARE,198.67,,,,,,,14.8600,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,198.67,,,,,,,14.8600,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,MEDCOST,MEDCOST VHN,186.08,,,,,,,14.8600,433.1100,percent of total billed charges,47.59% of $391.00 in Billed Charges for Rev 410 Proc 94610 = $186.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,83.90,,,,,,,14.8600,433.1100,fee schedule,APG 00412 Proc 94610 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 100% = $79.90... $79.90 at 105% = $83.90 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,208.61,,,,,,,14.8600,433.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,208.61,,,,,,,14.8600,433.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,NHC ADVANTAGE,NHC ADVANTAGE,208.61,,,,,,,14.8600,433.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,82.38,,,,,,,14.8600,433.1100,fee schedule,APG 00412 Proc 94610 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 100% = $79.90... $79.90 at 103.1% = $82.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,SENTARA HEALTH,SENTARA HEALTH,100.92,,,,,,,14.8600,433.1100,percent of total billed charges,25.81% of $391.00 in Billed Charges for Rev 410 Proc 94610 = $100.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,SENTARA HEALTH,SENTARA MEDICARE,198.67,,,,,,,14.8600,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",391.00,,,,,,,14.8600,433.1100,percent of total billed charges,100% of $391.00 in Billed Charges for Rev 410 Proc 94610 = $391.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14.86,,,,,,,14.8600,433.1100,fee schedule,$29.71 from Fee Schedule TCUHC24 for Rev 410 Proc 94610 * Qty 1 = $29.71 at 50% = $14.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,112.00,,,,,,,14.8600,433.1100,other,Rev 410 Proc 94610 1 Visit at $112.00 per Visit = $112.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,106.00,,,,,,,14.8600,433.1100,other,Rev 410 Proc 94610 1 Visit at $106.00 per Visit = $106.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,175.00,,,,,,,14.8600,433.1100,other,Rev 410 Proc 94610 1 Visit at $175.00 per Visit = $175.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,82.29,,,,,,,14.8600,433.1100,fee schedule,APG 00412 Proc 94610 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 103% = $82.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,198.67,,,,,,,14.8600,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,198.67,,,,,,,14.8600,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,WELLCARE,WELLCARE MEDICAID,391.00,,,,,,,14.8600,433.1100,percent of total billed charges,100% of $391.00 in Billed Charges for Rev 410 Proc 94610 = $391.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INTRAPULMONARY SURFACTANT ADMIN,94610,CPT,410,RC,41000001,CDM,,,,both,,,391.0000,58.6500,WELLCARE,WELLCARE MEDICARE,210.59,,,,,,,14.8600,433.1100,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,AETNA,AETNA,171.23,,,,,,,52.5200,401.0000,percent of total billed charges,42.7% of $401.00 in Billed Charges for Rev 460 Proc 94617 = $171.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,83.09,,,,,,,52.5200,401.0000,fee schedule,APG 00412 Proc 94617 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 104% = $83.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,120.71,,,,,,,52.5200,401.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,AETNA,AETNA HEALTHCARE MEDICARE,120.71,,,,,,,52.5200,401.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,120.71,,,,,,,52.5200,401.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,AMBETTER,AMBETTER,263.15,,,,,,,52.5200,401.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,125.54,,,,,,,52.5200,401.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,BLUE CROSS,ANTHEM EXCHANGE,297.21,,,,,,,52.5200,401.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,82.29,,,,,,,52.5200,401.0000,fee schedule,APG 00412 Proc 94617 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 103% = $82.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,BLUE CROSS,ANTHEM HMO,315.76,,,,,,,52.5200,401.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,124.33,,,,,,,52.5200,401.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",371.47,,,,,,,52.5200,401.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,280.70,,,,,,,52.5200,401.0000,percent of total billed charges,Rev 460 Proc 94617 $401.00 in Billed Charges at 70% = $280.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,BLUE CROSS,BLUE CROSS E NETWORK,246.30,,,,,,,52.5200,401.0000,fee schedule,$56.49 from Fee Schedule BCFSG for Rev 460 Proc 94617 * Qty 1 = $56.49 at 436% = $246.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,BLUE CROSS,BLUE CROSS MEDICARE,125.54,,,,,,,52.5200,401.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,BLUE CROSS,BLUE CROSS P NETWORK,251.38,,,,,,,52.5200,401.0000,fee schedule,$56.49 from Fee Schedule BCFSG for Rev 460 Proc 94617 * Qty 1 = $56.49 at 445% = $251.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,BLUE CROSS,BLUE CROSS S NETWORK,251.38,,,,,,,52.5200,401.0000,fee schedule,$56.49 from Fee Schedule BCFSG for Rev 460 Proc 94617 * Qty 1 = $56.49 at 445% = $251.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,BLUE CROSS,TENNCARE BLUE CARE,57.10,,,,,,,52.5200,401.0000,fee schedule,$49.22 from Fee Schedule TC_24 for Rev 460 Proc 94617 * Qty 1 = $49.22 at 116% = $57.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,BLUE CROSS,TENNCARE BLUE SELECT,57.10,,,,,,,52.5200,401.0000,fee schedule,$49.22 from Fee Schedule TC_24 for Rev 460 Proc 94617 * Qty 1 = $49.22 at 116% = $57.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,CIGNA HEALTHCARE,CIGNA HMO,167.22,,,,,,,52.5200,401.0000,percent of total billed charges,41.7% of $401.00 in Billed Charges for Rev 460 Proc 94617 = $167.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,186.06,,,,,,,52.5200,401.0000,percent of total billed charges,46.4% of $401.00 in Billed Charges for Rev 460 Proc 94617 = $186.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,126.75,,,,,,,52.5200,401.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,167.22,,,,,,,52.5200,401.0000,percent of total billed charges,41.7% of $401.00 in Billed Charges for Rev 460 Proc 94617 = $167.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,CIGNA HEALTHCARE,CIGNA PPO,167.22,,,,,,,52.5200,401.0000,percent of total billed charges,41.7% of $401.00 in Billed Charges for Rev 460 Proc 94617 = $167.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,126.75,,,,,,,52.5200,401.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,360.90,,,,,,,52.5200,401.0000,percent of total billed charges,90% of $401.00 in Billed Charges for Rev 460 Proc 94617 = $360.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,HUMANA,HUMANA MEDICARE,120.71,,,,,,,52.5200,401.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,120.71,,,,,,,52.5200,401.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,MEDCOST,MEDCOST VHN,190.84,,,,,,,52.5200,401.0000,percent of total billed charges,47.59% of $401.00 in Billed Charges for Rev 460 Proc 94617 = $190.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,83.90,,,,,,,52.5200,401.0000,fee schedule,APG 00412 Proc 94617 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 100% = $79.90... $79.90 at 105% = $83.90 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,126.75,,,,,,,52.5200,401.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,126.75,,,,,,,52.5200,401.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,NHC ADVANTAGE,NHC ADVANTAGE,126.75,,,,,,,52.5200,401.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,82.38,,,,,,,52.5200,401.0000,fee schedule,APG 00412 Proc 94617 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 100% = $79.90... $79.90 at 103.1% = $82.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,SENTARA HEALTH,SENTARA HEALTH,103.50,,,,,,,52.5200,401.0000,percent of total billed charges,25.81% of $401.00 in Billed Charges for Rev 460 Proc 94617 = $103.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,SENTARA HEALTH,SENTARA MEDICARE,120.71,,,,,,,52.5200,401.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",401.00,,,,,,,52.5200,401.0000,percent of total billed charges,100% of $401.00 in Billed Charges for Rev 460 Proc 94617 = $401.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,52.52,,,,,,,52.5200,401.0000,fee schedule,$105.04 from Fee Schedule TCUHC24 for Rev 460 Proc 94617 * Qty 1 = $105.04 at 50% = $52.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,401.00,,,,,,,52.5200,401.0000,other,"Rev 460 Proc 94617 1 Visit at $860.00 per Visit = $860.00 (Service Line reduced to $401.00, claim capped at $401.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,401.00,,,,,,,52.5200,401.0000,other,"Rev 460 Proc 94617 1 Visit at $822.00 per Visit = $822.00 (Service Line reduced to $401.00, claim capped at $401.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,401.00,,,,,,,52.5200,401.0000,other,"Rev 460 Proc 94617 1 Visit at $1,353.00 per Visit = $1,353.00 (Service Line reduced to $401.00, claim capped at $401.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,82.29,,,,,,,52.5200,401.0000,fee schedule,APG 00412 Proc 94617 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 103% = $82.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,120.71,,,,,,,52.5200,401.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,120.71,,,,,,,52.5200,401.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,WELLCARE,WELLCARE MEDICAID,401.00,,,,,,,52.5200,401.0000,percent of total billed charges,100% of $401.00 in Billed Charges for Rev 460 Proc 94617 = $401.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXERC TEST FOR BRONCHOSPASM W RECORDINGS,94617,CPT,460,RC,46000018,CDM,,,,both,,,401.0000,60.1500,WELLCARE,WELLCARE MEDICARE,127.95,,,,,,,52.5200,401.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,AETNA,AETNA,704.55,,,,,,,53.4800,1650.0000,percent of total billed charges,"42.7% of $1,650.00 in Billed Charges for Rev 460 Proc 94621 = $704.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,151.57,,,,,,,53.4800,1650.0000,fee schedule,APG 00060 Proc 94621 at $836.60 (Base Rate) * 0.1742 (Relative Weight) = $145.74 (Total Line Payment) at 104% = $151.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,338.56,,,,,,,53.4800,1650.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,AETNA,AETNA HEALTHCARE MEDICARE,338.56,,,,,,,53.4800,1650.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,338.56,,,,,,,53.4800,1650.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,AMBETTER,AMBETTER,738.05,,,,,,,53.4800,1650.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,352.10,,,,,,,53.4800,1650.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,BLUE CROSS,ANTHEM EXCHANGE,833.54,,,,,,,53.4800,1650.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,150.11,,,,,,,53.4800,1650.0000,fee schedule,APG 00060 Proc 94621 at $836.60 (Base Rate) * 0.1742 (Relative Weight) = $145.74 (Total Line Payment) at 103% = $150.11. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,BLUE CROSS,ANTHEM HMO,885.58,,,,,,,53.4800,1650.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,348.71,,,,,,,53.4800,1650.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1041.81,,,,,,,53.4800,1650.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,84.26,,,,,,,53.4800,1650.0000,fee schedule,$84.26 from Fee Schedule BLDTM_23 for Rev 460 Proc 94621 * Qty 1 = $84.26 at 100% = $84.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,BLUE CROSS,BLUE CROSS E NETWORK,369.68,,,,,,,53.4800,1650.0000,fee schedule,$84.79 from Fee Schedule BCFSG for Rev 460 Proc 94621 * Qty 1 = $84.79 at 436% = $369.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,BLUE CROSS,BLUE CROSS MEDICARE,352.10,,,,,,,53.4800,1650.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,BLUE CROSS,BLUE CROSS P NETWORK,377.32,,,,,,,53.4800,1650.0000,fee schedule,$84.79 from Fee Schedule BCFSG for Rev 460 Proc 94621 * Qty 1 = $84.79 at 445% = $377.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,BLUE CROSS,BLUE CROSS S NETWORK,377.32,,,,,,,53.4800,1650.0000,fee schedule,$84.79 from Fee Schedule BCFSG for Rev 460 Proc 94621 * Qty 1 = $84.79 at 445% = $377.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,BLUE CROSS,TENNCARE BLUE CARE,53.48,,,,,,,53.4800,1650.0000,fee schedule,$46.10 from Fee Schedule TC_24 for Rev 460 Proc 94621 * Qty 1 = $46.10 at 116% = $53.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,BLUE CROSS,TENNCARE BLUE SELECT,53.48,,,,,,,53.4800,1650.0000,fee schedule,$46.10 from Fee Schedule TC_24 for Rev 460 Proc 94621 * Qty 1 = $46.10 at 116% = $53.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,CIGNA HEALTHCARE,CIGNA HMO,688.05,,,,,,,53.4800,1650.0000,percent of total billed charges,"41.7% of $1,650.00 in Billed Charges for Rev 460 Proc 94621 = $688.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,765.60,,,,,,,53.4800,1650.0000,percent of total billed charges,"46.4% of $1,650.00 in Billed Charges for Rev 460 Proc 94621 = $765.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,355.48,,,,,,,53.4800,1650.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,688.05,,,,,,,53.4800,1650.0000,percent of total billed charges,"41.7% of $1,650.00 in Billed Charges for Rev 460 Proc 94621 = $688.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,CIGNA HEALTHCARE,CIGNA PPO,688.05,,,,,,,53.4800,1650.0000,percent of total billed charges,"41.7% of $1,650.00 in Billed Charges for Rev 460 Proc 94621 = $688.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,355.48,,,,,,,53.4800,1650.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1485.00,,,,,,,53.4800,1650.0000,percent of total billed charges,"90% of $1,650.00 in Billed Charges for Rev 460 Proc 94621 = $1,485.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,HUMANA,HUMANA MEDICARE,338.56,,,,,,,53.4800,1650.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,338.56,,,,,,,53.4800,1650.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,MEDCOST,MEDCOST VHN,785.24,,,,,,,53.4800,1650.0000,percent of total billed charges,"47.59% of $1,650.00 in Billed Charges for Rev 460 Proc 94621 = $785.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,153.03,,,,,,,53.4800,1650.0000,fee schedule,APG 00060 Proc 94621 at $836.60 (Base Rate) * 0.1742 (Relative Weight) = $145.74 (Total Line Payment) at 100% = $145.74... $145.74 at 105% = $153.03 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,355.48,,,,,,,53.4800,1650.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,355.48,,,,,,,53.4800,1650.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,NHC ADVANTAGE,NHC ADVANTAGE,355.48,,,,,,,53.4800,1650.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,150.26,,,,,,,53.4800,1650.0000,fee schedule,APG 00060 Proc 94621 at $836.60 (Base Rate) * 0.1742 (Relative Weight) = $145.74 (Total Line Payment) at 100% = $145.74... $145.74 at 103.1% = $150.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,SENTARA HEALTH,SENTARA HEALTH,425.87,,,,,,,53.4800,1650.0000,percent of total billed charges,"25.81% of $1,650.00 in Billed Charges for Rev 460 Proc 94621 = $425.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,SENTARA HEALTH,SENTARA MEDICARE,338.56,,,,,,,53.4800,1650.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1650.00,,,,,,,53.4800,1650.0000,percent of total billed charges,"100% of $1,650.00 in Billed Charges for Rev 460 Proc 94621 = $1,650.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,94.10,,,,,,,53.4800,1650.0000,fee schedule,$188.20 from Fee Schedule TCUHC24 for Rev 460 Proc 94621 * Qty 1 = $188.20 at 50% = $94.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,860.00,,,,,,,53.4800,1650.0000,other,Rev 460 Proc 94621 1 Visit at $860.00 per Visit = $860.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,822.00,,,,,,,53.4800,1650.0000,other,Rev 460 Proc 94621 1 Visit at $822.00 per Visit = $822.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,1353.00,,,,,,,53.4800,1650.0000,other,"Rev 460 Proc 94621 1 Visit at $1,353.00 per Visit = $1,353.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,150.11,,,,,,,53.4800,1650.0000,fee schedule,APG 00060 Proc 94621 at $836.60 (Base Rate) * 0.1742 (Relative Weight) = $145.74 (Total Line Payment) at 103% = $150.11. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,338.56,,,,,,,53.4800,1650.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,338.56,,,,,,,53.4800,1650.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,WELLCARE,WELLCARE MEDICAID,1650.00,,,,,,,53.4800,1650.0000,percent of total billed charges,"100% of $1,650.00 in Billed Charges for Rev 460 Proc 94621 = $1,650.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CARDIOPULM EXERC TEST,94621,CPT,460,RC,46000007,CDM,,,,both,,,1650.0000,247.5000,WELLCARE,WELLCARE MEDICARE,358.87,,,,,,,53.4800,1650.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,AETNA,AETNA,102.05,,,,,,,28.4300,239.0000,percent of total billed charges,42.7% of $239.00 in Billed Charges for Rev 948 Proc 94625 = $102.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,49.16,,,,,,,28.4300,239.0000,fee schedule,APG 00066 Proc 94625 at $836.60 (Base Rate) * 0.0565 (Relative Weight) = $47.27 (Total Line Payment) at 104% = $49.16. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,53.52,,,,,,,28.4300,239.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,AETNA,AETNA HEALTHCARE MEDICARE,53.52,,,,,,,28.4300,239.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,53.52,,,,,,,28.4300,239.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,AMBETTER,AMBETTER,116.68,,,,,,,28.4300,239.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,55.66,,,,,,,28.4300,239.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,BLUE CROSS,ANTHEM EXCHANGE,131.77,,,,,,,28.4300,239.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,48.69,,,,,,,28.4300,239.0000,fee schedule,APG 00066 Proc 94625 at $836.60 (Base Rate) * 0.0565 (Relative Weight) = $47.27 (Total Line Payment) at 103% = $48.69. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,BLUE CROSS,ANTHEM HMO,140.00,,,,,,,28.4300,239.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,55.13,,,,,,,28.4300,239.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",164.70,,,,,,,28.4300,239.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,167.30,,,,,,,28.4300,239.0000,percent of total billed charges,Rev 948 Proc 94625 $239.00 in Billed Charges at 70% = $167.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,BLUE CROSS,BLUE CROSS MEDICARE,55.66,,,,,,,28.4300,239.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,BLUE CROSS,TENNCARE BLUE CARE,60.25,,,,,,,28.4300,239.0000,fee schedule,$51.94 from Fee Schedule TC_24 for Rev 948 Proc 94625 * Qty 1 = $51.94 at 116% = $60.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,BLUE CROSS,TENNCARE BLUE SELECT,60.25,,,,,,,28.4300,239.0000,fee schedule,$51.94 from Fee Schedule TC_24 for Rev 948 Proc 94625 * Qty 1 = $51.94 at 116% = $60.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,CIGNA HEALTHCARE,CIGNA HMO,99.66,,,,,,,28.4300,239.0000,percent of total billed charges,41.7% of $239.00 in Billed Charges for Rev 948 Proc 94625 = $99.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,110.90,,,,,,,28.4300,239.0000,percent of total billed charges,46.4% of $239.00 in Billed Charges for Rev 948 Proc 94625 = $110.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,56.20,,,,,,,28.4300,239.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,99.66,,,,,,,28.4300,239.0000,percent of total billed charges,41.7% of $239.00 in Billed Charges for Rev 948 Proc 94625 = $99.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,CIGNA HEALTHCARE,CIGNA PPO,99.66,,,,,,,28.4300,239.0000,percent of total billed charges,41.7% of $239.00 in Billed Charges for Rev 948 Proc 94625 = $99.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,56.20,,,,,,,28.4300,239.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,215.10,,,,,,,28.4300,239.0000,percent of total billed charges,90% of $239.00 in Billed Charges for Rev 948 Proc 94625 = $215.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,HUMANA,HUMANA MEDICARE,53.52,,,,,,,28.4300,239.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,53.52,,,,,,,28.4300,239.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,MEDCOST,MEDCOST VHN,113.74,,,,,,,28.4300,239.0000,percent of total billed charges,47.59% of $239.00 in Billed Charges for Rev 948 Proc 94625 = $113.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,49.63,,,,,,,28.4300,239.0000,fee schedule,APG 00066 Proc 94625 at $836.60 (Base Rate) * 0.0565 (Relative Weight) = $47.27 (Total Line Payment) at 100% = $47.27... $47.27 at 105% = $49.63 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,56.20,,,,,,,28.4300,239.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,56.20,,,,,,,28.4300,239.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,NHC ADVANTAGE,NHC ADVANTAGE,56.20,,,,,,,28.4300,239.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,48.74,,,,,,,28.4300,239.0000,fee schedule,APG 00066 Proc 94625 at $836.60 (Base Rate) * 0.0565 (Relative Weight) = $47.27 (Total Line Payment) at 100% = $47.27... $47.27 at 103.1% = $48.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,SENTARA HEALTH,SENTARA HEALTH,61.69,,,,,,,28.4300,239.0000,percent of total billed charges,25.81% of $239.00 in Billed Charges for Rev 948 Proc 94625 = $61.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,SENTARA HEALTH,SENTARA MEDICARE,53.52,,,,,,,28.4300,239.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",239.00,,,,,,,28.4300,239.0000,percent of total billed charges,100% of $239.00 in Billed Charges for Rev 948 Proc 94625 = $239.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,28.43,,,,,,,28.4300,239.0000,fee schedule,$56.85 from Fee Schedule TCUHC24 for Rev 948 Proc 94625 * Qty 1 = $56.85 at 50% = $28.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,129.00,,,,,,,28.4300,239.0000,other,Rev 948 Proc 94625 1 Visit at $129.00 per Visit = $129.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,123.00,,,,,,,28.4300,239.0000,other,Rev 948 Proc 94625 1 Visit at $123.00 per Visit = $123.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,204.00,,,,,,,28.4300,239.0000,other,Rev 948 Proc 94625 1 Visit at $204.00 per Visit = $204.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,48.69,,,,,,,28.4300,239.0000,fee schedule,APG 00066 Proc 94625 at $836.60 (Base Rate) * 0.0565 (Relative Weight) = $47.27 (Total Line Payment) at 103% = $48.69. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,53.52,,,,,,,28.4300,239.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,53.52,,,,,,,28.4300,239.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,WELLCARE,WELLCARE MEDICAID,239.00,,,,,,,28.4300,239.0000,percent of total billed charges,100% of $239.00 in Billed Charges for Rev 948 Proc 94625 = $239.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR,94625,CPT,948,RC,94800002,CDM,,,,both,,,239.0000,35.8500,WELLCARE,WELLCARE MEDICARE,56.73,,,,,,,28.4300,239.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,AETNA,AETNA,108.46,,,,,,,28.4300,254.0000,percent of total billed charges,42.7% of $254.00 in Billed Charges for Rev 948 Proc 94626 = $108.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,49.16,,,,,,,28.4300,254.0000,fee schedule,APG 00066 Proc 94626 at $836.60 (Base Rate) * 0.0565 (Relative Weight) = $47.27 (Total Line Payment) at 104% = $49.16. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,53.52,,,,,,,28.4300,254.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,AETNA,AETNA HEALTHCARE MEDICARE,53.52,,,,,,,28.4300,254.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,53.52,,,,,,,28.4300,254.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,AMBETTER,AMBETTER,116.68,,,,,,,28.4300,254.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,55.66,,,,,,,28.4300,254.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,BLUE CROSS,ANTHEM EXCHANGE,131.77,,,,,,,28.4300,254.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,48.69,,,,,,,28.4300,254.0000,fee schedule,APG 00066 Proc 94626 at $836.60 (Base Rate) * 0.0565 (Relative Weight) = $47.27 (Total Line Payment) at 103% = $48.69. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,BLUE CROSS,ANTHEM HMO,140.00,,,,,,,28.4300,254.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,55.13,,,,,,,28.4300,254.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",164.70,,,,,,,28.4300,254.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,177.80,,,,,,,28.4300,254.0000,percent of total billed charges,Rev 948 Proc 94626 $254.00 in Billed Charges at 70% = $177.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,BLUE CROSS,BLUE CROSS MEDICARE,55.66,,,,,,,28.4300,254.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,BLUE CROSS,TENNCARE BLUE CARE,69.25,,,,,,,28.4300,254.0000,fee schedule,$59.70 from Fee Schedule TC_24 for Rev 948 Proc 94626 * Qty 1 = $59.70 at 116% = $69.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,BLUE CROSS,TENNCARE BLUE SELECT,69.25,,,,,,,28.4300,254.0000,fee schedule,$59.70 from Fee Schedule TC_24 for Rev 948 Proc 94626 * Qty 1 = $59.70 at 116% = $69.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,CIGNA HEALTHCARE,CIGNA HMO,105.92,,,,,,,28.4300,254.0000,percent of total billed charges,41.7% of $254.00 in Billed Charges for Rev 948 Proc 94626 = $105.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,117.86,,,,,,,28.4300,254.0000,percent of total billed charges,46.4% of $254.00 in Billed Charges for Rev 948 Proc 94626 = $117.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,56.20,,,,,,,28.4300,254.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,105.92,,,,,,,28.4300,254.0000,percent of total billed charges,41.7% of $254.00 in Billed Charges for Rev 948 Proc 94626 = $105.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,CIGNA HEALTHCARE,CIGNA PPO,105.92,,,,,,,28.4300,254.0000,percent of total billed charges,41.7% of $254.00 in Billed Charges for Rev 948 Proc 94626 = $105.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,56.20,,,,,,,28.4300,254.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,228.60,,,,,,,28.4300,254.0000,percent of total billed charges,90% of $254.00 in Billed Charges for Rev 948 Proc 94626 = $228.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,HUMANA,HUMANA MEDICARE,53.52,,,,,,,28.4300,254.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,53.52,,,,,,,28.4300,254.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,MEDCOST,MEDCOST VHN,120.88,,,,,,,28.4300,254.0000,percent of total billed charges,47.59% of $254.00 in Billed Charges for Rev 948 Proc 94626 = $120.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,49.63,,,,,,,28.4300,254.0000,fee schedule,APG 00066 Proc 94626 at $836.60 (Base Rate) * 0.0565 (Relative Weight) = $47.27 (Total Line Payment) at 100% = $47.27... $47.27 at 105% = $49.63 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,56.20,,,,,,,28.4300,254.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,56.20,,,,,,,28.4300,254.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,NHC ADVANTAGE,NHC ADVANTAGE,56.20,,,,,,,28.4300,254.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,48.74,,,,,,,28.4300,254.0000,fee schedule,APG 00066 Proc 94626 at $836.60 (Base Rate) * 0.0565 (Relative Weight) = $47.27 (Total Line Payment) at 100% = $47.27... $47.27 at 103.1% = $48.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,SENTARA HEALTH,SENTARA HEALTH,65.56,,,,,,,28.4300,254.0000,percent of total billed charges,25.81% of $254.00 in Billed Charges for Rev 948 Proc 94626 = $65.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,SENTARA HEALTH,SENTARA MEDICARE,53.52,,,,,,,28.4300,254.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",254.00,,,,,,,28.4300,254.0000,percent of total billed charges,100% of $254.00 in Billed Charges for Rev 948 Proc 94626 = $254.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,28.43,,,,,,,28.4300,254.0000,fee schedule,$56.85 from Fee Schedule TCUHC24 for Rev 948 Proc 94626 * Qty 1 = $56.85 at 50% = $28.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,129.00,,,,,,,28.4300,254.0000,other,Rev 948 Proc 94626 1 Visit at $129.00 per Visit = $129.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,123.00,,,,,,,28.4300,254.0000,other,Rev 948 Proc 94626 1 Visit at $123.00 per Visit = $123.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,204.00,,,,,,,28.4300,254.0000,other,Rev 948 Proc 94626 1 Visit at $204.00 per Visit = $204.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,48.69,,,,,,,28.4300,254.0000,fee schedule,APG 00066 Proc 94626 at $836.60 (Base Rate) * 0.0565 (Relative Weight) = $47.27 (Total Line Payment) at 103% = $48.69. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,53.52,,,,,,,28.4300,254.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,53.52,,,,,,,28.4300,254.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,WELLCARE,WELLCARE MEDICAID,254.00,,,,,,,28.4300,254.0000,percent of total billed charges,100% of $254.00 in Billed Charges for Rev 948 Proc 94626 = $254.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR,94626,CPT,948,RC,94800003,CDM,,,,both,,,254.0000,38.1000,WELLCARE,WELLCARE MEDICARE,56.73,,,,,,,28.4300,254.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,AETNA,AETNA,84.55,,,,,,,6.0300,198.0000,percent of total billed charges,42.7% of $198.00 in Billed Charges for Rev 300 Proc 86037 = $84.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,6.0300,198.0000,fee schedule,APG 00394 Proc 86037 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,12.05,,,,,,,6.0300,198.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,AETNA,AETNA HEALTHCARE MEDICARE,12.05,,,,,,,6.0300,198.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,12.05,,,,,,,6.0300,198.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,AMBETTER,AMBETTER,26.27,,,,,,,6.0300,198.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,AMERIGROUP,AMERIGROUP,6.03,,,,,,,6.0300,198.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,12.53,,,,,,,6.0300,198.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,BLUE CROSS,ANTHEM EXCHANGE,12.05,,,,,,,6.0300,198.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,6.0300,198.0000,fee schedule,APG 00394 Proc 86037 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,BLUE CROSS,ANTHEM HMO,12.05,,,,,,,6.0300,198.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,12.41,,,,,,,6.0300,198.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",12.05,,,,,,,6.0300,198.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,138.60,,,,,,,6.0300,198.0000,percent of total billed charges,Rev 300 Proc 86037 $198.00 in Billed Charges at 70% = $138.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,BLUE CROSS,BLUE CROSS E NETWORK,38.56,,,,,,,6.0300,198.0000,fee schedule,$12.05 from Fee Schedule BCFSB for Rev 300 Proc 86037 * Qty 1 = $12.05 at 320% = $38.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,BLUE CROSS,BLUE CROSS MEDICARE,12.53,,,,,,,6.0300,198.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,BLUE CROSS,BLUE CROSS P NETWORK,39.40,,,,,,,6.0300,198.0000,fee schedule,$12.05 from Fee Schedule BCFSB for Rev 300 Proc 86037 * Qty 1 = $12.05 at 327% = $39.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,BLUE CROSS,BLUE CROSS S NETWORK,39.40,,,,,,,6.0300,198.0000,fee schedule,$12.05 from Fee Schedule BCFSB for Rev 300 Proc 86037 * Qty 1 = $12.05 at 327% = $39.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,BLUE CROSS,TENNCARE BLUE CARE,11.36,,,,,,,6.0300,198.0000,fee schedule,$9.79 from Fee Schedule TC_24 for Rev 300 Proc 86037 * Qty 1 = $9.79 at 116% = $11.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,BLUE CROSS,TENNCARE BLUE SELECT,11.36,,,,,,,6.0300,198.0000,fee schedule,$9.79 from Fee Schedule TC_24 for Rev 300 Proc 86037 * Qty 1 = $9.79 at 116% = $11.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,CIGNA HEALTHCARE,CIGNA HMO,82.57,,,,,,,6.0300,198.0000,percent of total billed charges,Rev 300 Proc 86037 $198.00 in Billed Charges at 41.7% = $82.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,26.71,,,,,,,6.0300,198.0000,fee schedule,$26.71 from Fee Schedule CGIFP_25LR for Rev 300 Proc 86037 * Qty 1 = $26.71 at 100% = $26.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,12.65,,,,,,,6.0300,198.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,82.57,,,,,,,6.0300,198.0000,percent of total billed charges,Rev 300 Proc 86037 $198.00 in Billed Charges at 41.7% = $82.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,CIGNA HEALTHCARE,CIGNA PPO,82.57,,,,,,,6.0300,198.0000,percent of total billed charges,Rev 300 Proc 86037 $198.00 in Billed Charges at 41.7% = $82.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,12.65,,,,,,,6.0300,198.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,178.20,,,,,,,6.0300,198.0000,percent of total billed charges,90% of $198.00 in Billed Charges for Rev 300 Proc 86037 = $178.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,HUMANA,HUMANA MEDICARE,12.05,,,,,,,6.0300,198.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,12.05,,,,,,,6.0300,198.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,MEDCOST,MEDCOST VHN,94.23,,,,,,,6.0300,198.0000,percent of total billed charges,47.59% of $198.00 in Billed Charges for Rev 300 Proc 86037 = $94.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,6.0300,198.0000,fee schedule,APG 00394 Proc 86037 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,12.65,,,,,,,6.0300,198.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,12.65,,,,,,,6.0300,198.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,NHC ADVANTAGE,NHC ADVANTAGE,12.65,,,,,,,6.0300,198.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,6.0300,198.0000,fee schedule,APG 00394 Proc 86037 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,SENTARA HEALTH,SENTARA HEALTH,51.10,,,,,,,6.0300,198.0000,percent of total billed charges,25.81% of $198.00 in Billed Charges for Rev 300 Proc 86037 = $51.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,SENTARA HEALTH,SENTARA MEDICARE,12.05,,,,,,,6.0300,198.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",198.00,,,,,,,6.0300,198.0000,percent of total billed charges,100% of $198.00 in Billed Charges for Rev 300 Proc 86037 = $198.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6.03,,,,,,,6.0300,198.0000,fee schedule,$12.05 from Fee Schedule TCUHC24 for Rev 300 Proc 86037 * Qty 1 = $12.05 at 50% = $6.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12.53,,,,,,,6.0300,198.0000,fee schedule,$12.05 from Fee Schedule UHC_31910 for Rev 300 Proc 86037 * Qty 1 = $12.05 at 104% = $12.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,12.05,,,,,,,6.0300,198.0000,fee schedule,$12.05 from Fee Schedule UHC_31910 for Rev 300 Proc 86037 * Qty 1 = $12.05 at 100% = $12.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,12.05,,,,,,,6.0300,198.0000,fee schedule,$12.05 from Fee Schedule UHC_31910 for Rev 300 Proc 86037 * Qty 1 = $12.05 at 100% = $12.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,6.0300,198.0000,fee schedule,APG 00394 Proc 86037 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,12.05,,,,,,,6.0300,198.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,12.05,,,,,,,6.0300,198.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,WELLCARE,WELLCARE MEDICAID,198.00,,,,,,,6.0300,198.0000,percent of total billed charges,100% of $198.00 in Billed Charges for Rev 300 Proc 86037 = $198.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB,86037,CPT,300,RC,30000308,CDM,,,,both,,,198.0000,29.7000,WELLCARE,WELLCARE MEDICARE,12.77,,,,,,,6.0300,198.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,AETNA,AETNA,67.47,,,,,,,9.2000,158.0000,percent of total billed charges,42.7% of $158.00 in Billed Charges for Rev 300 Proc 86042 = $67.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,9.2000,158.0000,fee schedule,APG 00394 Proc 86042 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,AETNA,AETNA HEALTHCARE MEDICARE,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,AMBETTER,AMBETTER,40.11,,,,,,,9.2000,158.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,AMERIGROUP,AMERIGROUP,9.20,,,,,,,9.2000,158.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,19.14,,,,,,,9.2000,158.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,ANTHEM EXCHANGE,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,9.2000,158.0000,fee schedule,APG 00394 Proc 86042 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,ANTHEM HMO,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,18.95,,,,,,,9.2000,158.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,110.60,,,,,,,9.2000,158.0000,percent of total billed charges,Rev 300 Proc 86042 $158.00 in Billed Charges at 70% = $110.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS E NETWORK,58.88,,,,,,,9.2000,158.0000,fee schedule,$18.40 from Fee Schedule BCFSB for Rev 300 Proc 86042 * Qty 1 = $18.40 at 320% = $58.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS MEDICARE,19.14,,,,,,,9.2000,158.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS P NETWORK,60.17,,,,,,,9.2000,158.0000,fee schedule,$18.40 from Fee Schedule BCFSB for Rev 300 Proc 86042 * Qty 1 = $18.40 at 327% = $60.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS S NETWORK,60.17,,,,,,,9.2000,158.0000,fee schedule,$18.40 from Fee Schedule BCFSB for Rev 300 Proc 86042 * Qty 1 = $18.40 at 327% = $60.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,TENNCARE BLUE CARE,17.34,,,,,,,9.2000,158.0000,fee schedule,$14.95 from Fee Schedule TC_24 for Rev 300 Proc 86042 * Qty 1 = $14.95 at 116% = $17.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,TENNCARE BLUE SELECT,17.34,,,,,,,9.2000,158.0000,fee schedule,$14.95 from Fee Schedule TC_24 for Rev 300 Proc 86042 * Qty 1 = $14.95 at 116% = $17.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA HMO,65.89,,,,,,,9.2000,158.0000,percent of total billed charges,Rev 300 Proc 86042 $158.00 in Billed Charges at 41.7% = $65.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,40.42,,,,,,,9.2000,158.0000,fee schedule,$40.42 from Fee Schedule CGIFP_25LR for Rev 300 Proc 86042 * Qty 1 = $40.42 at 100% = $40.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,19.32,,,,,,,9.2000,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,65.89,,,,,,,9.2000,158.0000,percent of total billed charges,Rev 300 Proc 86042 $158.00 in Billed Charges at 41.7% = $65.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA PPO,65.89,,,,,,,9.2000,158.0000,percent of total billed charges,Rev 300 Proc 86042 $158.00 in Billed Charges at 41.7% = $65.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,19.32,,,,,,,9.2000,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,142.20,,,,,,,9.2000,158.0000,percent of total billed charges,90% of $158.00 in Billed Charges for Rev 300 Proc 86042 = $142.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,HUMANA,HUMANA MEDICARE,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,MEDCOST,MEDCOST VHN,75.19,,,,,,,9.2000,158.0000,percent of total billed charges,47.59% of $158.00 in Billed Charges for Rev 300 Proc 86042 = $75.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,9.2000,158.0000,fee schedule,APG 00394 Proc 86042 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,19.32,,,,,,,9.2000,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,19.32,,,,,,,9.2000,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,NHC ADVANTAGE,NHC ADVANTAGE,19.32,,,,,,,9.2000,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,9.2000,158.0000,fee schedule,APG 00394 Proc 86042 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,SENTARA HEALTH,SENTARA HEALTH,40.78,,,,,,,9.2000,158.0000,percent of total billed charges,25.81% of $158.00 in Billed Charges for Rev 300 Proc 86042 = $40.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,SENTARA HEALTH,SENTARA MEDICARE,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",158.00,,,,,,,9.2000,158.0000,percent of total billed charges,100% of $158.00 in Billed Charges for Rev 300 Proc 86042 = $158.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9.20,,,,,,,9.2000,158.0000,fee schedule,$18.40 from Fee Schedule TCUHC24 for Rev 300 Proc 86042 * Qty 1 = $18.40 at 50% = $9.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,19.14,,,,,,,9.2000,158.0000,fee schedule,$18.40 from Fee Schedule UHC_31910 for Rev 300 Proc 86042 * Qty 1 = $18.40 at 104% = $19.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,18.40,,,,,,,9.2000,158.0000,fee schedule,$18.40 from Fee Schedule UHC_31910 for Rev 300 Proc 86042 * Qty 1 = $18.40 at 100% = $18.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,18.40,,,,,,,9.2000,158.0000,fee schedule,$18.40 from Fee Schedule UHC_31910 for Rev 300 Proc 86042 * Qty 1 = $18.40 at 100% = $18.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,9.2000,158.0000,fee schedule,APG 00394 Proc 86042 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,18.40,,,,,,,9.2000,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,WELLCARE,WELLCARE MEDICAID,158.00,,,,,,,9.2000,158.0000,percent of total billed charges,100% of $158.00 in Billed Charges for Rev 300 Proc 86042 = $158.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY,86042,CPT,300,RC,30000330,CDM,,,,both,,,158.0000,23.7000,WELLCARE,WELLCARE MEDICARE,19.50,,,,,,,9.2000,158.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,AETNA,AETNA,80.28,,,,,,,6.0300,188.0000,percent of total billed charges,42.7% of $188.00 in Billed Charges for Rev 300 Proc 86052 = $80.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,6.0300,188.0000,fee schedule,APG 00394 Proc 86052 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,12.05,,,,,,,6.0300,188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,AETNA,AETNA HEALTHCARE MEDICARE,12.05,,,,,,,6.0300,188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,12.05,,,,,,,6.0300,188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,AMBETTER,AMBETTER,26.27,,,,,,,6.0300,188.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,AMERIGROUP,AMERIGROUP,6.03,,,,,,,6.0300,188.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,12.53,,,,,,,6.0300,188.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,ANTHEM EXCHANGE,12.05,,,,,,,6.0300,188.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,6.0300,188.0000,fee schedule,APG 00394 Proc 86052 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,ANTHEM HMO,12.05,,,,,,,6.0300,188.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,12.41,,,,,,,6.0300,188.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",12.05,,,,,,,6.0300,188.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,131.60,,,,,,,6.0300,188.0000,percent of total billed charges,Rev 300 Proc 86052 $188.00 in Billed Charges at 70% = $131.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,BLUE CROSS E NETWORK,38.56,,,,,,,6.0300,188.0000,fee schedule,$12.05 from Fee Schedule BCFSB for Rev 300 Proc 86052 * Qty 1 = $12.05 at 320% = $38.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,BLUE CROSS MEDICARE,12.53,,,,,,,6.0300,188.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,BLUE CROSS P NETWORK,39.40,,,,,,,6.0300,188.0000,fee schedule,$12.05 from Fee Schedule BCFSB for Rev 300 Proc 86052 * Qty 1 = $12.05 at 327% = $39.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,BLUE CROSS S NETWORK,39.40,,,,,,,6.0300,188.0000,fee schedule,$12.05 from Fee Schedule BCFSB for Rev 300 Proc 86052 * Qty 1 = $12.05 at 327% = $39.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,TENNCARE BLUE CARE,11.36,,,,,,,6.0300,188.0000,fee schedule,$9.79 from Fee Schedule TC_24 for Rev 300 Proc 86052 * Qty 1 = $9.79 at 116% = $11.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,BLUE CROSS,TENNCARE BLUE SELECT,11.36,,,,,,,6.0300,188.0000,fee schedule,$9.79 from Fee Schedule TC_24 for Rev 300 Proc 86052 * Qty 1 = $9.79 at 116% = $11.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,CIGNA HEALTHCARE,CIGNA HMO,78.40,,,,,,,6.0300,188.0000,percent of total billed charges,Rev 300 Proc 86052 $188.00 in Billed Charges at 41.7% = $78.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,26.71,,,,,,,6.0300,188.0000,fee schedule,$26.71 from Fee Schedule CGIFP_25LR for Rev 300 Proc 86052 * Qty 1 = $26.71 at 100% = $26.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,12.65,,,,,,,6.0300,188.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,78.40,,,,,,,6.0300,188.0000,percent of total billed charges,Rev 300 Proc 86052 $188.00 in Billed Charges at 41.7% = $78.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,CIGNA HEALTHCARE,CIGNA PPO,78.40,,,,,,,6.0300,188.0000,percent of total billed charges,Rev 300 Proc 86052 $188.00 in Billed Charges at 41.7% = $78.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,12.65,,,,,,,6.0300,188.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,169.20,,,,,,,6.0300,188.0000,percent of total billed charges,90% of $188.00 in Billed Charges for Rev 300 Proc 86052 = $169.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,HUMANA,HUMANA MEDICARE,12.05,,,,,,,6.0300,188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,12.05,,,,,,,6.0300,188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,MEDCOST,MEDCOST VHN,89.47,,,,,,,6.0300,188.0000,percent of total billed charges,47.59% of $188.00 in Billed Charges for Rev 300 Proc 86052 = $89.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,6.0300,188.0000,fee schedule,APG 00394 Proc 86052 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,12.65,,,,,,,6.0300,188.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,12.65,,,,,,,6.0300,188.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,NHC ADVANTAGE,NHC ADVANTAGE,12.65,,,,,,,6.0300,188.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,6.0300,188.0000,fee schedule,APG 00394 Proc 86052 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,SENTARA HEALTH,SENTARA HEALTH,48.52,,,,,,,6.0300,188.0000,percent of total billed charges,25.81% of $188.00 in Billed Charges for Rev 300 Proc 86052 = $48.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,SENTARA HEALTH,SENTARA MEDICARE,12.05,,,,,,,6.0300,188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",188.00,,,,,,,6.0300,188.0000,percent of total billed charges,100% of $188.00 in Billed Charges for Rev 300 Proc 86052 = $188.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6.03,,,,,,,6.0300,188.0000,fee schedule,$12.05 from Fee Schedule TCUHC24 for Rev 300 Proc 86052 * Qty 1 = $12.05 at 50% = $6.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12.53,,,,,,,6.0300,188.0000,fee schedule,$12.05 from Fee Schedule UHC_31910 for Rev 300 Proc 86052 * Qty 1 = $12.05 at 104% = $12.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,12.05,,,,,,,6.0300,188.0000,fee schedule,$12.05 from Fee Schedule UHC_31910 for Rev 300 Proc 86052 * Qty 1 = $12.05 at 100% = $12.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,12.05,,,,,,,6.0300,188.0000,fee schedule,$12.05 from Fee Schedule UHC_31910 for Rev 300 Proc 86052 * Qty 1 = $12.05 at 100% = $12.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,6.0300,188.0000,fee schedule,APG 00394 Proc 86052 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,12.05,,,,,,,6.0300,188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,12.05,,,,,,,6.0300,188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,WELLCARE,WELLCARE MEDICAID,188.00,,,,,,,6.0300,188.0000,percent of total billed charges,100% of $188.00 in Billed Charges for Rev 300 Proc 86052 = $188.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA,86052,CPT,300,RC,30000310,CDM,,,,both,,,188.0000,28.2000,WELLCARE,WELLCARE MEDICARE,12.77,,,,,,,6.0300,188.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3501.9800,525.3000,AETNA,AETNA,1495.35,,,,,,,903.8600,3501.9800,percent of total billed charges,"42.7% of $3,501.98 in Billed Charges for Rev 272 = $1,495.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3501.9800,525.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2451.39,,,,,,,903.8600,3501.9800,percent of total billed charges,"Rev 272 $3,501.98 in Billed Charges at 70% = $2,451.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3501.9800,525.3000,CIGNA HEALTHCARE,CIGNA HMO,1460.33,,,,,,,903.8600,3501.9800,percent of total billed charges,"41.7% of $3,501.98 in Billed Charges for Rev 272 = $1,460.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3501.9800,525.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1624.92,,,,,,,903.8600,3501.9800,percent of total billed charges,"46.4% of $3,501.98 in Billed Charges for Rev 272 = $1,624.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3501.9800,525.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1460.33,,,,,,,903.8600,3501.9800,percent of total billed charges,"41.7% of $3,501.98 in Billed Charges for Rev 272 = $1,460.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3501.9800,525.3000,CIGNA HEALTHCARE,CIGNA PPO,1460.33,,,,,,,903.8600,3501.9800,percent of total billed charges,"41.7% of $3,501.98 in Billed Charges for Rev 272 = $1,460.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3501.9800,525.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3151.78,,,,,,,903.8600,3501.9800,percent of total billed charges,"90% of $3,501.98 in Billed Charges for Rev 272 = $3,151.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3501.9800,525.3000,MEDCOST,MEDCOST VHN,1666.59,,,,,,,903.8600,3501.9800,percent of total billed charges,"47.59% of $3,501.98 in Billed Charges for Rev 272 = $1,666.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3501.9800,525.3000,SENTARA HEALTH,SENTARA HEALTH,903.86,,,,,,,903.8600,3501.9800,percent of total billed charges,"25.81% of $3,501.98 in Billed Charges for Rev 272 = $903.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3501.9800,525.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3501.98,,,,,,,903.8600,3501.9800,percent of total billed charges,"100% of $3,501.98 in Billed Charges for Rev 272 = $3,501.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3501.9800,525.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1750.99,,,,,,,903.8600,3501.9800,percent of total billed charges,"Rev 272 $3,501.98 in Billed Charges at 50% = $1,750.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3501.9800,525.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1131.14,,,,,,,903.8600,3501.9800,other,"32.3% of $3,501.98 in Billed Charges for Rev 272 = $1,131.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3501.9800,525.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1075.11,,,,,,,903.8600,3501.9800,other,"30.7% of $3,501.98 in Billed Charges for Rev 272 = $1,075.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3501.9800,525.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,1131.14,,,,,,,903.8600,3501.9800,percent of total billed charges,"32.3% of $3,501.98 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3501.9800,525.3000,WELLCARE,WELLCARE MEDICAID,3501.98,,,,,,,903.8600,3501.9800,percent of total billed charges,"100% of $3,501.98 in Billed Charges for Rev 272 = $3,501.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ARTHO 88488,272,RC,27200002,CDM,,,,,,both,,,632.3600,94.8500,AETNA,AETNA,270.02,,,,,,,163.2100,632.3600,percent of total billed charges,42.7% of $632.36 in Billed Charges for Rev 272 = $270.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ARTHO 88488,272,RC,27200002,CDM,,,,,,both,,,632.3600,94.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,442.65,,,,,,,163.2100,632.3600,percent of total billed charges,Rev 272 $632.36 in Billed Charges at 70% = $442.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ARTHO 88488,272,RC,27200002,CDM,,,,,,both,,,632.3600,94.8500,CIGNA HEALTHCARE,CIGNA HMO,263.69,,,,,,,163.2100,632.3600,percent of total billed charges,41.7% of $632.36 in Billed Charges for Rev 272 = $263.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ARTHO 88488,272,RC,27200002,CDM,,,,,,both,,,632.3600,94.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,293.42,,,,,,,163.2100,632.3600,percent of total billed charges,46.4% of $632.36 in Billed Charges for Rev 272 = $293.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ARTHO 88488,272,RC,27200002,CDM,,,,,,both,,,632.3600,94.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,263.69,,,,,,,163.2100,632.3600,percent of total billed charges,41.7% of $632.36 in Billed Charges for Rev 272 = $263.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ARTHO 88488,272,RC,27200002,CDM,,,,,,both,,,632.3600,94.8500,CIGNA HEALTHCARE,CIGNA PPO,263.69,,,,,,,163.2100,632.3600,percent of total billed charges,41.7% of $632.36 in Billed Charges for Rev 272 = $263.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ARTHO 88488,272,RC,27200002,CDM,,,,,,both,,,632.3600,94.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,569.12,,,,,,,163.2100,632.3600,percent of total billed charges,90% of $632.36 in Billed Charges for Rev 272 = $569.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ARTHO 88488,272,RC,27200002,CDM,,,,,,both,,,632.3600,94.8500,MEDCOST,MEDCOST VHN,300.94,,,,,,,163.2100,632.3600,percent of total billed charges,47.59% of $632.36 in Billed Charges for Rev 272 = $300.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ARTHO 88488,272,RC,27200002,CDM,,,,,,both,,,632.3600,94.8500,SENTARA HEALTH,SENTARA HEALTH,163.21,,,,,,,163.2100,632.3600,percent of total billed charges,25.81% of $632.36 in Billed Charges for Rev 272 = $163.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ARTHO 88488,272,RC,27200002,CDM,,,,,,both,,,632.3600,94.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",632.36,,,,,,,163.2100,632.3600,percent of total billed charges,100% of $632.36 in Billed Charges for Rev 272 = $632.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ARTHO 88488,272,RC,27200002,CDM,,,,,,both,,,632.3600,94.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,316.18,,,,,,,163.2100,632.3600,percent of total billed charges,Rev 272 $632.36 in Billed Charges at 50% = $316.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ARTHO 88488,272,RC,27200002,CDM,,,,,,both,,,632.3600,94.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,204.25,,,,,,,163.2100,632.3600,other,32.3% of $632.36 in Billed Charges for Rev 272 = $204.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK ARTHO 88488,272,RC,27200002,CDM,,,,,,both,,,632.3600,94.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,194.13,,,,,,,163.2100,632.3600,other,30.7% of $632.36 in Billed Charges for Rev 272 = $194.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK ARTHO 88488,272,RC,27200002,CDM,,,,,,both,,,632.3600,94.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,204.25,,,,,,,163.2100,632.3600,percent of total billed charges,32.3% of $632.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ARTHO 88488,272,RC,27200002,CDM,,,,,,both,,,632.3600,94.8500,WELLCARE,WELLCARE MEDICAID,632.36,,,,,,,163.2100,632.3600,percent of total billed charges,100% of $632.36 in Billed Charges for Rev 272 = $632.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BATTERY KLS-SD-1000 SCREWDRIVER,272,RC,,,,,,,,both,,,1925.2700,288.7900,AETNA,AETNA,822.09,,,,,,,496.9100,1925.2700,percent of total billed charges,"42.7% of $1,925.27 in Billed Charges for Rev 272 = $822.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BATTERY KLS-SD-1000 SCREWDRIVER,272,RC,,,,,,,,both,,,1925.2700,288.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1347.69,,,,,,,496.9100,1925.2700,percent of total billed charges,"Rev 272 $1,925.27 in Billed Charges at 70% = $1,347.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BATTERY KLS-SD-1000 SCREWDRIVER,272,RC,,,,,,,,both,,,1925.2700,288.7900,CIGNA HEALTHCARE,CIGNA HMO,802.84,,,,,,,496.9100,1925.2700,percent of total billed charges,"41.7% of $1,925.27 in Billed Charges for Rev 272 = $802.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BATTERY KLS-SD-1000 SCREWDRIVER,272,RC,,,,,,,,both,,,1925.2700,288.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,893.33,,,,,,,496.9100,1925.2700,percent of total billed charges,"46.4% of $1,925.27 in Billed Charges for Rev 272 = $893.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BATTERY KLS-SD-1000 SCREWDRIVER,272,RC,,,,,,,,both,,,1925.2700,288.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,802.84,,,,,,,496.9100,1925.2700,percent of total billed charges,"41.7% of $1,925.27 in Billed Charges for Rev 272 = $802.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BATTERY KLS-SD-1000 SCREWDRIVER,272,RC,,,,,,,,both,,,1925.2700,288.7900,CIGNA HEALTHCARE,CIGNA PPO,802.84,,,,,,,496.9100,1925.2700,percent of total billed charges,"41.7% of $1,925.27 in Billed Charges for Rev 272 = $802.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BATTERY KLS-SD-1000 SCREWDRIVER,272,RC,,,,,,,,both,,,1925.2700,288.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1732.74,,,,,,,496.9100,1925.2700,percent of total billed charges,"90% of $1,925.27 in Billed Charges for Rev 272 = $1,732.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BATTERY KLS-SD-1000 SCREWDRIVER,272,RC,,,,,,,,both,,,1925.2700,288.7900,MEDCOST,MEDCOST VHN,916.24,,,,,,,496.9100,1925.2700,percent of total billed charges,"47.59% of $1,925.27 in Billed Charges for Rev 272 = $916.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BATTERY KLS-SD-1000 SCREWDRIVER,272,RC,,,,,,,,both,,,1925.2700,288.7900,SENTARA HEALTH,SENTARA HEALTH,496.91,,,,,,,496.9100,1925.2700,percent of total billed charges,"25.81% of $1,925.27 in Billed Charges for Rev 272 = $496.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BATTERY KLS-SD-1000 SCREWDRIVER,272,RC,,,,,,,,both,,,1925.2700,288.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1925.27,,,,,,,496.9100,1925.2700,percent of total billed charges,"100% of $1,925.27 in Billed Charges for Rev 272 = $1,925.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BATTERY KLS-SD-1000 SCREWDRIVER,272,RC,,,,,,,,both,,,1925.2700,288.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,962.64,,,,,,,496.9100,1925.2700,percent of total billed charges,"Rev 272 $1,925.27 in Billed Charges at 50% = $962.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BATTERY KLS-SD-1000 SCREWDRIVER,272,RC,,,,,,,,both,,,1925.2700,288.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,621.86,,,,,,,496.9100,1925.2700,other,"32.3% of $1,925.27 in Billed Charges for Rev 272 = $621.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK BATTERY KLS-SD-1000 SCREWDRIVER,272,RC,,,,,,,,both,,,1925.2700,288.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,591.06,,,,,,,496.9100,1925.2700,other,"30.7% of $1,925.27 in Billed Charges for Rev 272 = $591.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK BATTERY KLS-SD-1000 SCREWDRIVER,272,RC,,,,,,,,both,,,1925.2700,288.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,621.86,,,,,,,496.9100,1925.2700,percent of total billed charges,"32.3% of $1,925.27 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BATTERY KLS-SD-1000 SCREWDRIVER,272,RC,,,,,,,,both,,,1925.2700,288.7900,WELLCARE,WELLCARE MEDICAID,1925.27,,,,,,,496.9100,1925.2700,percent of total billed charges,"100% of $1,925.27 in Billed Charges for Rev 272 = $1,925.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,AETNA,AETNA,41.85,,,,,,,4.5500,98.0000,percent of total billed charges,42.7% of $98.00 in Billed Charges for Rev 302 Proc 86687 = $41.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,4.5500,98.0000,fee schedule,APG 00394 Proc 86687 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,9.09,,,,,,,4.5500,98.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,AETNA,AETNA HEALTHCARE MEDICARE,9.09,,,,,,,4.5500,98.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,9.09,,,,,,,4.5500,98.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,AMBETTER,AMBETTER,19.82,,,,,,,4.5500,98.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,AMERIGROUP,AMERIGROUP,4.55,,,,,,,4.5500,98.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,9.45,,,,,,,4.5500,98.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,BLUE CROSS,ANTHEM EXCHANGE,9.09,,,,,,,4.5500,98.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,4.5500,98.0000,fee schedule,APG 00394 Proc 86687 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,BLUE CROSS,ANTHEM HMO,9.09,,,,,,,4.5500,98.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,9.36,,,,,,,4.5500,98.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9.09,,,,,,,4.5500,98.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,28.14,,,,,,,4.5500,98.0000,fee schedule,$28.14 from Fee Schedule BLDTM_23 for Rev 302 Proc 86687 * Qty 1 = $28.14 at 100% = $28.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,BLUE CROSS,BLUE CROSS E NETWORK,36.64,,,,,,,4.5500,98.0000,fee schedule,$11.45 from Fee Schedule BCFSB for Rev 302 Proc 86687 * Qty 1 = $11.45 at 320% = $36.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,BLUE CROSS,BLUE CROSS MEDICARE,9.45,,,,,,,4.5500,98.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,BLUE CROSS,BLUE CROSS P NETWORK,37.44,,,,,,,4.5500,98.0000,fee schedule,$11.45 from Fee Schedule BCFSB for Rev 302 Proc 86687 * Qty 1 = $11.45 at 327% = $37.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,BLUE CROSS,BLUE CROSS S NETWORK,37.44,,,,,,,4.5500,98.0000,fee schedule,$11.45 from Fee Schedule BCFSB for Rev 302 Proc 86687 * Qty 1 = $11.45 at 327% = $37.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,BLUE CROSS,TENNCARE BLUE CARE,22.89,,,,,,,4.5500,98.0000,fee schedule,$19.73 from Fee Schedule TC_24 for Rev 302 Proc 86687 * Qty 1 = $19.73 at 116% = $22.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,BLUE CROSS,TENNCARE BLUE SELECT,22.89,,,,,,,4.5500,98.0000,fee schedule,$19.73 from Fee Schedule TC_24 for Rev 302 Proc 86687 * Qty 1 = $19.73 at 116% = $22.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,CIGNA HEALTHCARE,CIGNA HMO,33.74,,,,,,,4.5500,98.0000,fee schedule,$33.74 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86687 * Qty 1 = $33.74 at 100% = $33.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,20.21,,,,,,,4.5500,98.0000,fee schedule,$20.21 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86687 * Qty 1 = $20.21 at 100% = $20.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,9.54,,,,,,,4.5500,98.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,33.74,,,,,,,4.5500,98.0000,fee schedule,$33.74 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86687 * Qty 1 = $33.74 at 100% = $33.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,CIGNA HEALTHCARE,CIGNA PPO,33.74,,,,,,,4.5500,98.0000,fee schedule,$33.74 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86687 * Qty 1 = $33.74 at 100% = $33.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,9.54,,,,,,,4.5500,98.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,88.20,,,,,,,4.5500,98.0000,percent of total billed charges,90% of $98.00 in Billed Charges for Rev 302 Proc 86687 = $88.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,HUMANA,HUMANA MEDICARE,9.09,,,,,,,4.5500,98.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,9.09,,,,,,,4.5500,98.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,MEDCOST,MEDCOST VHN,46.64,,,,,,,4.5500,98.0000,percent of total billed charges,47.59% of $98.00 in Billed Charges for Rev 302 Proc 86687 = $46.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,4.5500,98.0000,fee schedule,APG 00394 Proc 86687 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,9.54,,,,,,,4.5500,98.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,9.54,,,,,,,4.5500,98.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,NHC ADVANTAGE,NHC ADVANTAGE,9.54,,,,,,,4.5500,98.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,4.5500,98.0000,fee schedule,APG 00394 Proc 86687 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,SENTARA HEALTH,SENTARA HEALTH,25.29,,,,,,,4.5500,98.0000,percent of total billed charges,25.81% of $98.00 in Billed Charges for Rev 302 Proc 86687 = $25.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,SENTARA HEALTH,SENTARA MEDICARE,9.09,,,,,,,4.5500,98.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",98.00,,,,,,,4.5500,98.0000,percent of total billed charges,100% of $98.00 in Billed Charges for Rev 302 Proc 86687 = $98.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5.94,,,,,,,4.5500,98.0000,fee schedule,$11.88 from Fee Schedule TCUHC24 for Rev 302 Proc 86687 * Qty 1 = $11.88 at 50% = $5.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,9.45,,,,,,,4.5500,98.0000,fee schedule,$9.09 from Fee Schedule UHC_31910 for Rev 302 Proc 86687 * Qty 1 = $9.09 at 104% = $9.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,9.09,,,,,,,4.5500,98.0000,fee schedule,$9.09 from Fee Schedule UHC_31910 for Rev 302 Proc 86687 * Qty 1 = $9.09 at 100% = $9.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,9.09,,,,,,,4.5500,98.0000,fee schedule,$9.09 from Fee Schedule UHC_31910 for Rev 302 Proc 86687 * Qty 1 = $9.09 at 100% = $9.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,4.5500,98.0000,fee schedule,APG 00394 Proc 86687 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,9.09,,,,,,,4.5500,98.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,9.09,,,,,,,4.5500,98.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,WELLCARE,WELLCARE MEDICAID,98.00,,,,,,,4.5500,98.0000,percent of total billed charges,100% of $98.00 in Billed Charges for Rev 302 Proc 86687 = $98.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HTLV I ANTIBODY,86687,CPT,302,RC,30200080,CDM,,,,both,,,98.0000,14.7000,WELLCARE,WELLCARE MEDICARE,9.64,,,,,,,4.5500,98.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,AETNA,AETNA,71.74,,,,,,,7.2000,168.0000,percent of total billed charges,42.7% of $168.00 in Billed Charges for Rev 302 Proc 86694 = $71.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,7.2000,168.0000,fee schedule,APG 00394 Proc 86694 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,14.39,,,,,,,7.2000,168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,AETNA,AETNA HEALTHCARE MEDICARE,14.39,,,,,,,7.2000,168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,14.39,,,,,,,7.2000,168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,AMBETTER,AMBETTER,31.37,,,,,,,7.2000,168.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,AMERIGROUP,AMERIGROUP,7.20,,,,,,,7.2000,168.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,14.97,,,,,,,7.2000,168.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,BLUE CROSS,ANTHEM EXCHANGE,14.39,,,,,,,7.2000,168.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,7.2000,168.0000,fee schedule,APG 00394 Proc 86694 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,BLUE CROSS,ANTHEM HMO,14.39,,,,,,,7.2000,168.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,14.82,,,,,,,7.2000,168.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",14.39,,,,,,,7.2000,168.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,48.60,,,,,,,7.2000,168.0000,fee schedule,$48.60 from Fee Schedule BLDTM_23 for Rev 302 Proc 86694 * Qty 1 = $48.60 at 100% = $48.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,BLUE CROSS,BLUE CROSS E NETWORK,62.85,,,,,,,7.2000,168.0000,fee schedule,$19.64 from Fee Schedule BCFSB for Rev 302 Proc 86694 * Qty 1 = $19.64 at 320% = $62.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,BLUE CROSS,BLUE CROSS MEDICARE,14.97,,,,,,,7.2000,168.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,BLUE CROSS,BLUE CROSS P NETWORK,64.22,,,,,,,7.2000,168.0000,fee schedule,$19.64 from Fee Schedule BCFSB for Rev 302 Proc 86694 * Qty 1 = $19.64 at 327% = $64.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,BLUE CROSS,BLUE CROSS S NETWORK,64.22,,,,,,,7.2000,168.0000,fee schedule,$19.64 from Fee Schedule BCFSB for Rev 302 Proc 86694 * Qty 1 = $19.64 at 327% = $64.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,BLUE CROSS,TENNCARE BLUE CARE,16.94,,,,,,,7.2000,168.0000,fee schedule,$14.60 from Fee Schedule TC_24 for Rev 302 Proc 86694 * Qty 1 = $14.60 at 116% = $16.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,BLUE CROSS,TENNCARE BLUE SELECT,16.94,,,,,,,7.2000,168.0000,fee schedule,$14.60 from Fee Schedule TC_24 for Rev 302 Proc 86694 * Qty 1 = $14.60 at 116% = $16.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,CIGNA HEALTHCARE,CIGNA HMO,57.90,,,,,,,7.2000,168.0000,fee schedule,$57.90 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86694 * Qty 1 = $57.90 at 100% = $57.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,31.76,,,,,,,7.2000,168.0000,fee schedule,$31.76 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86694 * Qty 1 = $31.76 at 100% = $31.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,15.11,,,,,,,7.2000,168.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,57.90,,,,,,,7.2000,168.0000,fee schedule,$57.90 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86694 * Qty 1 = $57.90 at 100% = $57.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,CIGNA HEALTHCARE,CIGNA PPO,57.90,,,,,,,7.2000,168.0000,fee schedule,$57.90 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86694 * Qty 1 = $57.90 at 100% = $57.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,15.11,,,,,,,7.2000,168.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,151.20,,,,,,,7.2000,168.0000,percent of total billed charges,90% of $168.00 in Billed Charges for Rev 302 Proc 86694 = $151.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,HUMANA,HUMANA MEDICARE,14.39,,,,,,,7.2000,168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,14.39,,,,,,,7.2000,168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,MEDCOST,MEDCOST VHN,79.95,,,,,,,7.2000,168.0000,percent of total billed charges,47.59% of $168.00 in Billed Charges for Rev 302 Proc 86694 = $79.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,7.2000,168.0000,fee schedule,APG 00394 Proc 86694 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,15.11,,,,,,,7.2000,168.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,15.11,,,,,,,7.2000,168.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,NHC ADVANTAGE,NHC ADVANTAGE,15.11,,,,,,,7.2000,168.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,7.2000,168.0000,fee schedule,APG 00394 Proc 86694 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,SENTARA HEALTH,SENTARA HEALTH,43.36,,,,,,,7.2000,168.0000,percent of total billed charges,25.81% of $168.00 in Billed Charges for Rev 302 Proc 86694 = $43.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,SENTARA HEALTH,SENTARA MEDICARE,14.39,,,,,,,7.2000,168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",168.00,,,,,,,7.2000,168.0000,percent of total billed charges,100% of $168.00 in Billed Charges for Rev 302 Proc 86694 = $168.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,10.20,,,,,,,7.2000,168.0000,fee schedule,$20.39 from Fee Schedule TCUHC24 for Rev 302 Proc 86694 * Qty 1 = $20.39 at 50% = $10.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,14.97,,,,,,,7.2000,168.0000,fee schedule,$14.39 from Fee Schedule UHC_31910 for Rev 302 Proc 86694 * Qty 1 = $14.39 at 104% = $14.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,14.39,,,,,,,7.2000,168.0000,fee schedule,$14.39 from Fee Schedule UHC_31910 for Rev 302 Proc 86694 * Qty 1 = $14.39 at 100% = $14.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,14.39,,,,,,,7.2000,168.0000,fee schedule,$14.39 from Fee Schedule UHC_31910 for Rev 302 Proc 86694 * Qty 1 = $14.39 at 100% = $14.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,7.2000,168.0000,fee schedule,APG 00394 Proc 86694 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,14.39,,,,,,,7.2000,168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,14.39,,,,,,,7.2000,168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,WELLCARE,WELLCARE MEDICAID,168.00,,,,,,,7.2000,168.0000,percent of total billed charges,100% of $168.00 in Billed Charges for Rev 302 Proc 86694 = $168.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX AB NONSPEC,86694,CPT,302,RC,30200083,CDM,,,,both,,,168.0000,25.2000,WELLCARE,WELLCARE MEDICARE,15.25,,,,,,,7.2000,168.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,AETNA,AETNA,44.41,,,,,,,4.4500,104.0000,percent of total billed charges,42.7% of $104.00 in Billed Charges for Rev 302 Proc 86701 = $44.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,4.4500,104.0000,fee schedule,APG 00394 Proc 86701 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,8.89,,,,,,,4.4500,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,AETNA,AETNA HEALTHCARE MEDICARE,8.89,,,,,,,4.4500,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,8.89,,,,,,,4.4500,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,AMBETTER,AMBETTER,19.38,,,,,,,4.4500,104.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,AMERIGROUP,AMERIGROUP,4.45,,,,,,,4.4500,104.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,9.25,,,,,,,4.4500,104.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,ANTHEM EXCHANGE,8.89,,,,,,,4.4500,104.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,4.4500,104.0000,fee schedule,APG 00394 Proc 86701 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,ANTHEM HMO,8.89,,,,,,,4.4500,104.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,9.16,,,,,,,4.4500,104.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8.89,,,,,,,4.4500,104.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,23.10,,,,,,,4.4500,104.0000,fee schedule,$23.10 from Fee Schedule BLDTM_23 for Rev 302 Proc 86701 * Qty 1 = $23.10 at 100% = $23.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,BLUE CROSS E NETWORK,38.78,,,,,,,4.4500,104.0000,fee schedule,$12.12 from Fee Schedule BCFSB for Rev 302 Proc 86701 * Qty 1 = $12.12 at 320% = $38.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,BLUE CROSS MEDICARE,9.25,,,,,,,4.4500,104.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,BLUE CROSS P NETWORK,39.63,,,,,,,4.4500,104.0000,fee schedule,$12.12 from Fee Schedule BCFSB for Rev 302 Proc 86701 * Qty 1 = $12.12 at 327% = $39.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,BLUE CROSS S NETWORK,39.63,,,,,,,4.4500,104.0000,fee schedule,$12.12 from Fee Schedule BCFSB for Rev 302 Proc 86701 * Qty 1 = $12.12 at 327% = $39.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,TENNCARE BLUE CARE,20.35,,,,,,,4.4500,104.0000,fee schedule,$17.54 from Fee Schedule TC_24 for Rev 302 Proc 86701 * Qty 1 = $17.54 at 116% = $20.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,BLUE CROSS,TENNCARE BLUE SELECT,20.35,,,,,,,4.4500,104.0000,fee schedule,$17.54 from Fee Schedule TC_24 for Rev 302 Proc 86701 * Qty 1 = $17.54 at 116% = $20.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,CIGNA HEALTHCARE,CIGNA HMO,35.75,,,,,,,4.4500,104.0000,fee schedule,$35.75 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86701 * Qty 1 = $35.75 at 100% = $35.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,19.49,,,,,,,4.4500,104.0000,fee schedule,$19.49 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86701 * Qty 1 = $19.49 at 100% = $19.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,9.33,,,,,,,4.4500,104.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,35.75,,,,,,,4.4500,104.0000,fee schedule,$35.75 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86701 * Qty 1 = $35.75 at 100% = $35.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,CIGNA HEALTHCARE,CIGNA PPO,35.75,,,,,,,4.4500,104.0000,fee schedule,$35.75 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86701 * Qty 1 = $35.75 at 100% = $35.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,9.33,,,,,,,4.4500,104.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,93.60,,,,,,,4.4500,104.0000,percent of total billed charges,90% of $104.00 in Billed Charges for Rev 302 Proc 86701 = $93.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,HUMANA,HUMANA MEDICARE,8.89,,,,,,,4.4500,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,8.89,,,,,,,4.4500,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,MEDCOST,MEDCOST VHN,49.49,,,,,,,4.4500,104.0000,percent of total billed charges,47.59% of $104.00 in Billed Charges for Rev 302 Proc 86701 = $49.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,4.4500,104.0000,fee schedule,APG 00394 Proc 86701 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,9.33,,,,,,,4.4500,104.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,9.33,,,,,,,4.4500,104.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,NHC ADVANTAGE,NHC ADVANTAGE,9.33,,,,,,,4.4500,104.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,4.4500,104.0000,fee schedule,APG 00394 Proc 86701 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,SENTARA HEALTH,SENTARA HEALTH,26.84,,,,,,,4.4500,104.0000,percent of total billed charges,25.81% of $104.00 in Billed Charges for Rev 302 Proc 86701 = $26.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,SENTARA HEALTH,SENTARA MEDICARE,8.89,,,,,,,4.4500,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",104.00,,,,,,,4.4500,104.0000,percent of total billed charges,100% of $104.00 in Billed Charges for Rev 302 Proc 86701 = $104.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6.29,,,,,,,4.4500,104.0000,fee schedule,$12.58 from Fee Schedule TCUHC24 for Rev 302 Proc 86701 * Qty 1 = $12.58 at 50% = $6.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,9.25,,,,,,,4.4500,104.0000,fee schedule,$8.89 from Fee Schedule UHC_31910 for Rev 302 Proc 86701 * Qty 1 = $8.89 at 104% = $9.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,8.89,,,,,,,4.4500,104.0000,fee schedule,$8.89 from Fee Schedule UHC_31910 for Rev 302 Proc 86701 * Qty 1 = $8.89 at 100% = $8.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,8.89,,,,,,,4.4500,104.0000,fee schedule,$8.89 from Fee Schedule UHC_31910 for Rev 302 Proc 86701 * Qty 1 = $8.89 at 100% = $8.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,4.4500,104.0000,fee schedule,APG 00394 Proc 86701 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,8.89,,,,,,,4.4500,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,8.89,,,,,,,4.4500,104.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,WELLCARE,WELLCARE MEDICAID,104.00,,,,,,,4.4500,104.0000,percent of total billed charges,100% of $104.00 in Billed Charges for Rev 302 Proc 86701 = $104.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIV 1 ANTIBODY,86701,CPT,302,RC,30200087,CDM,,,,both,,,104.0000,15.6000,WELLCARE,WELLCARE MEDICARE,9.42,,,,,,,4.4500,104.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,AETNA,AETNA,67.47,,,,,,,6.7600,158.0000,percent of total billed charges,42.7% of $158.00 in Billed Charges for Rev 302 Proc 86702 = $67.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,6.7600,158.0000,fee schedule,APG 00394 Proc 86702 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,13.52,,,,,,,6.7600,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,AETNA,AETNA HEALTHCARE MEDICARE,13.52,,,,,,,6.7600,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,13.52,,,,,,,6.7600,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,AMBETTER,AMBETTER,29.47,,,,,,,6.7600,158.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,AMERIGROUP,AMERIGROUP,6.76,,,,,,,6.7600,158.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,14.06,,,,,,,6.7600,158.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,ANTHEM EXCHANGE,13.52,,,,,,,6.7600,158.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,6.7600,158.0000,fee schedule,APG 00394 Proc 86702 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,ANTHEM HMO,13.52,,,,,,,6.7600,158.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,13.93,,,,,,,6.7600,158.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",13.52,,,,,,,6.7600,158.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,38.69,,,,,,,6.7600,158.0000,fee schedule,$38.69 from Fee Schedule BLDTM_23 for Rev 302 Proc 86702 * Qty 1 = $38.69 at 100% = $38.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS E NETWORK,59.01,,,,,,,6.7600,158.0000,fee schedule,$18.44 from Fee Schedule BCFSB for Rev 302 Proc 86702 * Qty 1 = $18.44 at 320% = $59.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS MEDICARE,14.06,,,,,,,6.7600,158.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS P NETWORK,60.30,,,,,,,6.7600,158.0000,fee schedule,$18.44 from Fee Schedule BCFSB for Rev 302 Proc 86702 * Qty 1 = $18.44 at 327% = $60.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,BLUE CROSS S NETWORK,60.30,,,,,,,6.7600,158.0000,fee schedule,$18.44 from Fee Schedule BCFSB for Rev 302 Proc 86702 * Qty 1 = $18.44 at 327% = $60.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,TENNCARE BLUE CARE,24.81,,,,,,,6.7600,158.0000,fee schedule,$21.39 from Fee Schedule TC_24 for Rev 302 Proc 86702 * Qty 1 = $21.39 at 116% = $24.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,BLUE CROSS,TENNCARE BLUE SELECT,24.81,,,,,,,6.7600,158.0000,fee schedule,$21.39 from Fee Schedule TC_24 for Rev 302 Proc 86702 * Qty 1 = $21.39 at 116% = $24.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA HMO,54.36,,,,,,,6.7600,158.0000,fee schedule,$54.36 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86702 * Qty 1 = $54.36 at 100% = $54.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,29.59,,,,,,,6.7600,158.0000,fee schedule,$29.59 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86702 * Qty 1 = $29.59 at 100% = $29.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,14.20,,,,,,,6.7600,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,54.36,,,,,,,6.7600,158.0000,fee schedule,$54.36 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86702 * Qty 1 = $54.36 at 100% = $54.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,CIGNA HEALTHCARE,CIGNA PPO,54.36,,,,,,,6.7600,158.0000,fee schedule,$54.36 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86702 * Qty 1 = $54.36 at 100% = $54.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,14.20,,,,,,,6.7600,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,142.20,,,,,,,6.7600,158.0000,percent of total billed charges,90% of $158.00 in Billed Charges for Rev 302 Proc 86702 = $142.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,HUMANA,HUMANA MEDICARE,13.52,,,,,,,6.7600,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,13.52,,,,,,,6.7600,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,MEDCOST,MEDCOST VHN,75.19,,,,,,,6.7600,158.0000,percent of total billed charges,47.59% of $158.00 in Billed Charges for Rev 302 Proc 86702 = $75.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,6.7600,158.0000,fee schedule,APG 00394 Proc 86702 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,14.20,,,,,,,6.7600,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,14.20,,,,,,,6.7600,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,NHC ADVANTAGE,NHC ADVANTAGE,14.20,,,,,,,6.7600,158.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,6.7600,158.0000,fee schedule,APG 00394 Proc 86702 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,SENTARA HEALTH,SENTARA HEALTH,40.78,,,,,,,6.7600,158.0000,percent of total billed charges,25.81% of $158.00 in Billed Charges for Rev 302 Proc 86702 = $40.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,SENTARA HEALTH,SENTARA MEDICARE,13.52,,,,,,,6.7600,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",158.00,,,,,,,6.7600,158.0000,percent of total billed charges,100% of $158.00 in Billed Charges for Rev 302 Proc 86702 = $158.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9.57,,,,,,,6.7600,158.0000,fee schedule,$19.14 from Fee Schedule TCUHC24 for Rev 302 Proc 86702 * Qty 1 = $19.14 at 50% = $9.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,14.06,,,,,,,6.7600,158.0000,fee schedule,$13.52 from Fee Schedule UHC_31910 for Rev 302 Proc 86702 * Qty 1 = $13.52 at 104% = $14.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,13.52,,,,,,,6.7600,158.0000,fee schedule,$13.52 from Fee Schedule UHC_31910 for Rev 302 Proc 86702 * Qty 1 = $13.52 at 100% = $13.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,13.52,,,,,,,6.7600,158.0000,fee schedule,$13.52 from Fee Schedule UHC_31910 for Rev 302 Proc 86702 * Qty 1 = $13.52 at 100% = $13.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,6.7600,158.0000,fee schedule,APG 00394 Proc 86702 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,13.52,,,,,,,6.7600,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,13.52,,,,,,,6.7600,158.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,WELLCARE,WELLCARE MEDICAID,158.00,,,,,,,6.7600,158.0000,percent of total billed charges,100% of $158.00 in Billed Charges for Rev 302 Proc 86702 = $158.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIV 2 ANTIBODY,86702,CPT,302,RC,30200088,CDM,,,,both,,,158.0000,23.7000,WELLCARE,WELLCARE MEDICARE,14.33,,,,,,,6.7600,158.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK BRISTOL CAROTID,272,RC,27200002,CDM,,,,,,both,,,802.2000,120.3300,AETNA,AETNA,342.54,,,,,,,207.0500,802.2000,percent of total billed charges,42.7% of $802.20 in Billed Charges for Rev 272 = $342.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL CAROTID,272,RC,27200002,CDM,,,,,,both,,,802.2000,120.3300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,561.54,,,,,,,207.0500,802.2000,percent of total billed charges,Rev 272 $802.20 in Billed Charges at 70% = $561.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL CAROTID,272,RC,27200002,CDM,,,,,,both,,,802.2000,120.3300,CIGNA HEALTHCARE,CIGNA HMO,334.52,,,,,,,207.0500,802.2000,percent of total billed charges,41.7% of $802.20 in Billed Charges for Rev 272 = $334.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL CAROTID,272,RC,27200002,CDM,,,,,,both,,,802.2000,120.3300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,372.22,,,,,,,207.0500,802.2000,percent of total billed charges,46.4% of $802.20 in Billed Charges for Rev 272 = $372.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL CAROTID,272,RC,27200002,CDM,,,,,,both,,,802.2000,120.3300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,334.52,,,,,,,207.0500,802.2000,percent of total billed charges,41.7% of $802.20 in Billed Charges for Rev 272 = $334.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL CAROTID,272,RC,27200002,CDM,,,,,,both,,,802.2000,120.3300,CIGNA HEALTHCARE,CIGNA PPO,334.52,,,,,,,207.0500,802.2000,percent of total billed charges,41.7% of $802.20 in Billed Charges for Rev 272 = $334.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL CAROTID,272,RC,27200002,CDM,,,,,,both,,,802.2000,120.3300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,721.98,,,,,,,207.0500,802.2000,percent of total billed charges,90% of $802.20 in Billed Charges for Rev 272 = $721.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL CAROTID,272,RC,27200002,CDM,,,,,,both,,,802.2000,120.3300,MEDCOST,MEDCOST VHN,381.77,,,,,,,207.0500,802.2000,percent of total billed charges,47.59% of $802.20 in Billed Charges for Rev 272 = $381.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL CAROTID,272,RC,27200002,CDM,,,,,,both,,,802.2000,120.3300,SENTARA HEALTH,SENTARA HEALTH,207.05,,,,,,,207.0500,802.2000,percent of total billed charges,25.81% of $802.20 in Billed Charges for Rev 272 = $207.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL CAROTID,272,RC,27200002,CDM,,,,,,both,,,802.2000,120.3300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",802.20,,,,,,,207.0500,802.2000,percent of total billed charges,100% of $802.20 in Billed Charges for Rev 272 = $802.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL CAROTID,272,RC,27200002,CDM,,,,,,both,,,802.2000,120.3300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,401.10,,,,,,,207.0500,802.2000,percent of total billed charges,Rev 272 $802.20 in Billed Charges at 50% = $401.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL CAROTID,272,RC,27200002,CDM,,,,,,both,,,802.2000,120.3300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,259.11,,,,,,,207.0500,802.2000,other,32.3% of $802.20 in Billed Charges for Rev 272 = $259.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK BRISTOL CAROTID,272,RC,27200002,CDM,,,,,,both,,,802.2000,120.3300,UNITED HEALTHCARE,UHC HERITAGE SELECT,246.28,,,,,,,207.0500,802.2000,other,30.7% of $802.20 in Billed Charges for Rev 272 = $246.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK BRISTOL CAROTID,272,RC,27200002,CDM,,,,,,both,,,802.2000,120.3300,UNITED HEALTHCARE,UNITED HEALTHCARE,259.11,,,,,,,207.0500,802.2000,percent of total billed charges,32.3% of $802.20 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL CAROTID,272,RC,27200002,CDM,,,,,,both,,,802.2000,120.3300,WELLCARE,WELLCARE MEDICAID,802.20,,,,,,,207.0500,802.2000,percent of total billed charges,100% of $802.20 in Billed Charges for Rev 272 = $802.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK C SECTION  INDIAN PATH,270,RC,,,,,,,,both,,,1701.6200,255.2400,AETNA,AETNA,726.59,,,,,,,439.1900,1701.6200,percent of total billed charges,"42.7% of $1,701.62 in Billed Charges for Rev 270 = $726.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK C SECTION  INDIAN PATH,270,RC,,,,,,,,both,,,1701.6200,255.2400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1191.13,,,,,,,439.1900,1701.6200,percent of total billed charges,"Rev 270 $1,701.62 in Billed Charges at 70% = $1,191.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK C SECTION  INDIAN PATH,270,RC,,,,,,,,both,,,1701.6200,255.2400,CIGNA HEALTHCARE,CIGNA HMO,709.58,,,,,,,439.1900,1701.6200,percent of total billed charges,"41.7% of $1,701.62 in Billed Charges for Rev 270 = $709.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK C SECTION  INDIAN PATH,270,RC,,,,,,,,both,,,1701.6200,255.2400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,789.55,,,,,,,439.1900,1701.6200,percent of total billed charges,"46.4% of $1,701.62 in Billed Charges for Rev 270 = $789.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK C SECTION  INDIAN PATH,270,RC,,,,,,,,both,,,1701.6200,255.2400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,709.58,,,,,,,439.1900,1701.6200,percent of total billed charges,"41.7% of $1,701.62 in Billed Charges for Rev 270 = $709.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK C SECTION  INDIAN PATH,270,RC,,,,,,,,both,,,1701.6200,255.2400,CIGNA HEALTHCARE,CIGNA PPO,709.58,,,,,,,439.1900,1701.6200,percent of total billed charges,"41.7% of $1,701.62 in Billed Charges for Rev 270 = $709.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK C SECTION  INDIAN PATH,270,RC,,,,,,,,both,,,1701.6200,255.2400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1531.46,,,,,,,439.1900,1701.6200,percent of total billed charges,"90% of $1,701.62 in Billed Charges for Rev 270 = $1,531.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK C SECTION  INDIAN PATH,270,RC,,,,,,,,both,,,1701.6200,255.2400,MEDCOST,MEDCOST VHN,809.80,,,,,,,439.1900,1701.6200,percent of total billed charges,"47.59% of $1,701.62 in Billed Charges for Rev 270 = $809.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK C SECTION  INDIAN PATH,270,RC,,,,,,,,both,,,1701.6200,255.2400,SENTARA HEALTH,SENTARA HEALTH,439.19,,,,,,,439.1900,1701.6200,percent of total billed charges,"25.81% of $1,701.62 in Billed Charges for Rev 270 = $439.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK C SECTION  INDIAN PATH,270,RC,,,,,,,,both,,,1701.6200,255.2400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1701.62,,,,,,,439.1900,1701.6200,percent of total billed charges,"100% of $1,701.62 in Billed Charges for Rev 270 = $1,701.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK C SECTION  INDIAN PATH,270,RC,,,,,,,,both,,,1701.6200,255.2400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,850.81,,,,,,,439.1900,1701.6200,percent of total billed charges,"Rev 270 $1,701.62 in Billed Charges at 50% = $850.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK C SECTION  INDIAN PATH,270,RC,,,,,,,,both,,,1701.6200,255.2400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,549.62,,,,,,,439.1900,1701.6200,other,"32.3% of $1,701.62 in Billed Charges for Rev 270 = $549.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK C SECTION  INDIAN PATH,270,RC,,,,,,,,both,,,1701.6200,255.2400,UNITED HEALTHCARE,UHC HERITAGE SELECT,522.40,,,,,,,439.1900,1701.6200,other,"30.7% of $1,701.62 in Billed Charges for Rev 270 = $522.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK C SECTION  INDIAN PATH,270,RC,,,,,,,,both,,,1701.6200,255.2400,UNITED HEALTHCARE,UNITED HEALTHCARE,549.62,,,,,,,439.1900,1701.6200,percent of total billed charges,"32.3% of $1,701.62 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK C SECTION  INDIAN PATH,270,RC,,,,,,,,both,,,1701.6200,255.2400,WELLCARE,WELLCARE MEDICAID,1701.62,,,,,,,439.1900,1701.6200,percent of total billed charges,"100% of $1,701.62 in Billed Charges for Rev 270 = $1,701.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM COMBO 23G,272,RC,,,,,,,,both,,,6427.5300,964.1300,AETNA,AETNA,2744.56,,,,,,,1658.9500,6427.5300,percent of total billed charges,"42.7% of $6,427.53 in Billed Charges for Rev 272 = $2,744.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM COMBO 23G,272,RC,,,,,,,,both,,,6427.5300,964.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4499.27,,,,,,,1658.9500,6427.5300,percent of total billed charges,"Rev 272 $6,427.53 in Billed Charges at 70% = $4,499.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM COMBO 23G,272,RC,,,,,,,,both,,,6427.5300,964.1300,CIGNA HEALTHCARE,CIGNA HMO,2680.28,,,,,,,1658.9500,6427.5300,percent of total billed charges,"41.7% of $6,427.53 in Billed Charges for Rev 272 = $2,680.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM COMBO 23G,272,RC,,,,,,,,both,,,6427.5300,964.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2982.37,,,,,,,1658.9500,6427.5300,percent of total billed charges,"46.4% of $6,427.53 in Billed Charges for Rev 272 = $2,982.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM COMBO 23G,272,RC,,,,,,,,both,,,6427.5300,964.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2680.28,,,,,,,1658.9500,6427.5300,percent of total billed charges,"41.7% of $6,427.53 in Billed Charges for Rev 272 = $2,680.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM COMBO 23G,272,RC,,,,,,,,both,,,6427.5300,964.1300,CIGNA HEALTHCARE,CIGNA PPO,2680.28,,,,,,,1658.9500,6427.5300,percent of total billed charges,"41.7% of $6,427.53 in Billed Charges for Rev 272 = $2,680.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM COMBO 23G,272,RC,,,,,,,,both,,,6427.5300,964.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5784.78,,,,,,,1658.9500,6427.5300,percent of total billed charges,"90% of $6,427.53 in Billed Charges for Rev 272 = $5,784.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM COMBO 23G,272,RC,,,,,,,,both,,,6427.5300,964.1300,MEDCOST,MEDCOST VHN,3058.86,,,,,,,1658.9500,6427.5300,percent of total billed charges,"47.59% of $6,427.53 in Billed Charges for Rev 272 = $3,058.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM COMBO 23G,272,RC,,,,,,,,both,,,6427.5300,964.1300,SENTARA HEALTH,SENTARA HEALTH,1658.95,,,,,,,1658.9500,6427.5300,percent of total billed charges,"25.81% of $6,427.53 in Billed Charges for Rev 272 = $1,658.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM COMBO 23G,272,RC,,,,,,,,both,,,6427.5300,964.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6427.53,,,,,,,1658.9500,6427.5300,percent of total billed charges,"100% of $6,427.53 in Billed Charges for Rev 272 = $6,427.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM COMBO 23G,272,RC,,,,,,,,both,,,6427.5300,964.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3213.77,,,,,,,1658.9500,6427.5300,percent of total billed charges,"Rev 272 $6,427.53 in Billed Charges at 50% = $3,213.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM COMBO 23G,272,RC,,,,,,,,both,,,6427.5300,964.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2076.09,,,,,,,1658.9500,6427.5300,other,"32.3% of $6,427.53 in Billed Charges for Rev 272 = $2,076.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK CUSTOM COMBO 23G,272,RC,,,,,,,,both,,,6427.5300,964.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1973.25,,,,,,,1658.9500,6427.5300,other,"30.7% of $6,427.53 in Billed Charges for Rev 272 = $1,973.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK CUSTOM COMBO 23G,272,RC,,,,,,,,both,,,6427.5300,964.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,2076.09,,,,,,,1658.9500,6427.5300,percent of total billed charges,"32.3% of $6,427.53 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM COMBO 23G,272,RC,,,,,,,,both,,,6427.5300,964.1300,WELLCARE,WELLCARE MEDICAID,6427.53,,,,,,,1658.9500,6427.5300,percent of total billed charges,"100% of $6,427.53 in Billed Charges for Rev 272 = $6,427.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,AETNA,AETNA,68.32,,,,,,,6.8600,160.0000,percent of total billed charges,42.7% of $160.00 in Billed Charges for Rev 302 Proc 86703 = $68.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,6.8600,160.0000,fee schedule,APG 00394 Proc 86703 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,13.71,,,,,,,6.8600,160.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,AETNA,AETNA HEALTHCARE MEDICARE,13.71,,,,,,,6.8600,160.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,ALLCARE MEDICARE,ALLCARE MEDICARE,13.71,,,,,,,6.8600,160.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,AMBETTER,AMBETTER,29.89,,,,,,,6.8600,160.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,AMERIGROUP,AMERIGROUP,6.86,,,,,,,6.8600,160.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,14.26,,,,,,,6.8600,160.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,BLUE CROSS,ANTHEM EXCHANGE,13.71,,,,,,,6.8600,160.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,6.8600,160.0000,fee schedule,APG 00394 Proc 86703 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,BLUE CROSS,ANTHEM HMO,13.71,,,,,,,6.8600,160.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,14.12,,,,,,,6.8600,160.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",13.71,,,,,,,6.8600,160.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,23.35,,,,,,,6.8600,160.0000,fee schedule,$23.35 from Fee Schedule BLDTM_23 for Rev 302 Proc 86703 * Qty 1 = $23.35 at 100% = $23.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,BLUE CROSS,BLUE CROSS E NETWORK,59.84,,,,,,,6.8600,160.0000,fee schedule,$18.70 from Fee Schedule BCFSB for Rev 302 Proc 86703 * Qty 1 = $18.70 at 320% = $59.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,BLUE CROSS,BLUE CROSS MEDICARE,14.26,,,,,,,6.8600,160.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,BLUE CROSS,BLUE CROSS P NETWORK,61.15,,,,,,,6.8600,160.0000,fee schedule,$18.70 from Fee Schedule BCFSB for Rev 302 Proc 86703 * Qty 1 = $18.70 at 327% = $61.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,BLUE CROSS,BLUE CROSS S NETWORK,61.15,,,,,,,6.8600,160.0000,fee schedule,$18.70 from Fee Schedule BCFSB for Rev 302 Proc 86703 * Qty 1 = $18.70 at 327% = $61.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,BLUE CROSS,TENNCARE BLUE CARE,36.60,,,,,,,6.8600,160.0000,fee schedule,$31.55 from Fee Schedule TC_24 for Rev 302 Proc 86703 * Qty 1 = $31.55 at 116% = $36.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,BLUE CROSS,TENNCARE BLUE SELECT,36.60,,,,,,,6.8600,160.0000,fee schedule,$31.55 from Fee Schedule TC_24 for Rev 302 Proc 86703 * Qty 1 = $31.55 at 116% = $36.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,CIGNA HEALTHCARE,CIGNA HMO,55.19,,,,,,,6.8600,160.0000,fee schedule,$55.19 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86703 * Qty 1 = $55.19 at 100% = $55.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,30.31,,,,,,,6.8600,160.0000,fee schedule,$30.31 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86703 * Qty 1 = $30.31 at 100% = $30.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,CIGNA HEALTHCARE,CIGNA MEDICARE,14.40,,,,,,,6.8600,160.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,55.19,,,,,,,6.8600,160.0000,fee schedule,$55.19 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86703 * Qty 1 = $55.19 at 100% = $55.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,CIGNA HEALTHCARE,CIGNA PPO,55.19,,,,,,,6.8600,160.0000,fee schedule,$55.19 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86703 * Qty 1 = $55.19 at 100% = $55.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,14.40,,,,,,,6.8600,160.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,144.00,,,,,,,6.8600,160.0000,percent of total billed charges,90% of $160.00 in Billed Charges for Rev 302 Proc 86703 = $144.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,HUMANA,HUMANA MEDICARE,13.71,,,,,,,6.8600,160.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,13.71,,,,,,,6.8600,160.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,MEDCOST,MEDCOST VHN,76.14,,,,,,,6.8600,160.0000,percent of total billed charges,47.59% of $160.00 in Billed Charges for Rev 302 Proc 86703 = $76.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,6.8600,160.0000,fee schedule,APG 00394 Proc 86703 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,14.40,,,,,,,6.8600,160.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,14.40,,,,,,,6.8600,160.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,NHC ADVANTAGE,NHC ADVANTAGE,14.40,,,,,,,6.8600,160.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,6.8600,160.0000,fee schedule,APG 00394 Proc 86703 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,SENTARA HEALTH,SENTARA HEALTH,41.30,,,,,,,6.8600,160.0000,percent of total billed charges,25.81% of $160.00 in Billed Charges for Rev 302 Proc 86703 = $41.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,SENTARA HEALTH,SENTARA MEDICARE,13.71,,,,,,,6.8600,160.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",160.00,,,,,,,6.8600,160.0000,percent of total billed charges,100% of $160.00 in Billed Charges for Rev 302 Proc 86703 = $160.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9.72,,,,,,,6.8600,160.0000,fee schedule,$19.43 from Fee Schedule TCUHC24 for Rev 302 Proc 86703 * Qty 1 = $19.43 at 50% = $9.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,14.26,,,,,,,6.8600,160.0000,fee schedule,$13.71 from Fee Schedule UHC_31910 for Rev 302 Proc 86703 * Qty 1 = $13.71 at 104% = $14.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,13.71,,,,,,,6.8600,160.0000,fee schedule,$13.71 from Fee Schedule UHC_31910 for Rev 302 Proc 86703 * Qty 1 = $13.71 at 100% = $13.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,13.71,,,,,,,6.8600,160.0000,fee schedule,$13.71 from Fee Schedule UHC_31910 for Rev 302 Proc 86703 * Qty 1 = $13.71 at 100% = $13.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,6.8600,160.0000,fee schedule,APG 00394 Proc 86703 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,13.71,,,,,,,6.8600,160.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,13.71,,,,,,,6.8600,160.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,WELLCARE,WELLCARE MEDICAID,160.00,,,,,,,6.8600,160.0000,percent of total billed charges,100% of $160.00 in Billed Charges for Rev 302 Proc 86703 = $160.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HIV1 HIV2 ANTIBODY SINGLE ASSAY,86703,CPT,302,RC,30200089,CDM,,,,both,,,160.0000,24.0000,WELLCARE,WELLCARE MEDICARE,14.53,,,,,,,6.8600,160.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,AETNA,AETNA,60.21,,,,,,,6.0300,141.0000,percent of total billed charges,42.7% of $141.00 in Billed Charges for Rev 302 Proc 86704 = $60.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,6.0300,141.0000,fee schedule,APG 00394 Proc 86704 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,12.05,,,,,,,6.0300,141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,AETNA,AETNA HEALTHCARE MEDICARE,12.05,,,,,,,6.0300,141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,12.05,,,,,,,6.0300,141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,AMBETTER,AMBETTER,26.27,,,,,,,6.0300,141.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,AMERIGROUP,AMERIGROUP,6.03,,,,,,,6.0300,141.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,12.53,,,,,,,6.0300,141.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,ANTHEM EXCHANGE,12.05,,,,,,,6.0300,141.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,6.0300,141.0000,fee schedule,APG 00394 Proc 86704 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,ANTHEM HMO,12.05,,,,,,,6.0300,141.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,12.41,,,,,,,6.0300,141.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",12.05,,,,,,,6.0300,141.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,40.93,,,,,,,6.0300,141.0000,fee schedule,$40.93 from Fee Schedule BLDTM_23 for Rev 302 Proc 86704 * Qty 1 = $40.93 at 100% = $40.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,BLUE CROSS E NETWORK,52.61,,,,,,,6.0300,141.0000,fee schedule,$16.44 from Fee Schedule BCFSB for Rev 302 Proc 86704 * Qty 1 = $16.44 at 320% = $52.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,BLUE CROSS MEDICARE,12.53,,,,,,,6.0300,141.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,BLUE CROSS P NETWORK,53.76,,,,,,,6.0300,141.0000,fee schedule,$16.44 from Fee Schedule BCFSB for Rev 302 Proc 86704 * Qty 1 = $16.44 at 327% = $53.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,BLUE CROSS S NETWORK,53.76,,,,,,,6.0300,141.0000,fee schedule,$16.44 from Fee Schedule BCFSB for Rev 302 Proc 86704 * Qty 1 = $16.44 at 327% = $53.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,TENNCARE BLUE CARE,24.39,,,,,,,6.0300,141.0000,fee schedule,$21.03 from Fee Schedule TC_24 for Rev 302 Proc 86704 * Qty 1 = $21.03 at 116% = $24.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,BLUE CROSS,TENNCARE BLUE SELECT,24.39,,,,,,,6.0300,141.0000,fee schedule,$21.03 from Fee Schedule TC_24 for Rev 302 Proc 86704 * Qty 1 = $21.03 at 116% = $24.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,CIGNA HEALTHCARE,CIGNA HMO,48.51,,,,,,,6.0300,141.0000,fee schedule,$48.51 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86704 * Qty 1 = $48.51 at 100% = $48.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,26.71,,,,,,,6.0300,141.0000,fee schedule,$26.71 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86704 * Qty 1 = $26.71 at 100% = $26.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,12.65,,,,,,,6.0300,141.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,48.51,,,,,,,6.0300,141.0000,fee schedule,$48.51 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86704 * Qty 1 = $48.51 at 100% = $48.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,CIGNA HEALTHCARE,CIGNA PPO,48.51,,,,,,,6.0300,141.0000,fee schedule,$48.51 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86704 * Qty 1 = $48.51 at 100% = $48.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,12.65,,,,,,,6.0300,141.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,126.90,,,,,,,6.0300,141.0000,percent of total billed charges,90% of $141.00 in Billed Charges for Rev 302 Proc 86704 = $126.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,HUMANA,HUMANA MEDICARE,12.05,,,,,,,6.0300,141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,12.05,,,,,,,6.0300,141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,MEDCOST,MEDCOST VHN,67.10,,,,,,,6.0300,141.0000,percent of total billed charges,47.59% of $141.00 in Billed Charges for Rev 302 Proc 86704 = $67.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,6.0300,141.0000,fee schedule,APG 00394 Proc 86704 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,12.65,,,,,,,6.0300,141.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,12.65,,,,,,,6.0300,141.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,NHC ADVANTAGE,NHC ADVANTAGE,12.65,,,,,,,6.0300,141.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,6.0300,141.0000,fee schedule,APG 00394 Proc 86704 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,SENTARA HEALTH,SENTARA HEALTH,36.39,,,,,,,6.0300,141.0000,percent of total billed charges,25.81% of $141.00 in Billed Charges for Rev 302 Proc 86704 = $36.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,SENTARA HEALTH,SENTARA MEDICARE,12.05,,,,,,,6.0300,141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",141.00,,,,,,,6.0300,141.0000,percent of total billed charges,100% of $141.00 in Billed Charges for Rev 302 Proc 86704 = $141.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.54,,,,,,,6.0300,141.0000,fee schedule,$17.07 from Fee Schedule TCUHC24 for Rev 302 Proc 86704 * Qty 1 = $17.07 at 50% = $8.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12.53,,,,,,,6.0300,141.0000,fee schedule,$12.05 from Fee Schedule UHC_31910 for Rev 302 Proc 86704 * Qty 1 = $12.05 at 104% = $12.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,12.05,,,,,,,6.0300,141.0000,fee schedule,$12.05 from Fee Schedule UHC_31910 for Rev 302 Proc 86704 * Qty 1 = $12.05 at 100% = $12.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,12.05,,,,,,,6.0300,141.0000,fee schedule,$12.05 from Fee Schedule UHC_31910 for Rev 302 Proc 86704 * Qty 1 = $12.05 at 100% = $12.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,6.0300,141.0000,fee schedule,APG 00394 Proc 86704 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,12.05,,,,,,,6.0300,141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,12.05,,,,,,,6.0300,141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,WELLCARE,WELLCARE MEDICAID,141.00,,,,,,,6.0300,141.0000,percent of total billed charges,100% of $141.00 in Billed Charges for Rev 302 Proc 86704 = $141.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS B CORE AB TOTAL,86704,CPT,302,RC,30200090,CDM,,,,both,,,141.0000,21.1500,WELLCARE,WELLCARE MEDICARE,12.77,,,,,,,6.0300,141.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,AETNA,AETNA,53.80,,,,,,,5.3700,126.0000,percent of total billed charges,42.7% of $126.00 in Billed Charges for Rev 302 Proc 86706 = $53.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,5.3700,126.0000,fee schedule,APG 00394 Proc 86706 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,10.74,,,,,,,5.3700,126.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,AETNA,AETNA HEALTHCARE MEDICARE,10.74,,,,,,,5.3700,126.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,10.74,,,,,,,5.3700,126.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,AMBETTER,AMBETTER,23.41,,,,,,,5.3700,126.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,AMERIGROUP,AMERIGROUP,5.37,,,,,,,5.3700,126.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,11.17,,,,,,,5.3700,126.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,BLUE CROSS,ANTHEM EXCHANGE,10.74,,,,,,,5.3700,126.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,5.3700,126.0000,fee schedule,APG 00394 Proc 86706 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,BLUE CROSS,ANTHEM HMO,10.74,,,,,,,5.3700,126.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,11.06,,,,,,,5.3700,126.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",10.74,,,,,,,5.3700,126.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,36.66,,,,,,,5.3700,126.0000,fee schedule,$36.66 from Fee Schedule BLDTM_23 for Rev 302 Proc 86706 * Qty 1 = $36.66 at 100% = $36.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,BLUE CROSS,BLUE CROSS E NETWORK,46.88,,,,,,,5.3700,126.0000,fee schedule,$14.65 from Fee Schedule BCFSB for Rev 302 Proc 86706 * Qty 1 = $14.65 at 320% = $46.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,BLUE CROSS,BLUE CROSS MEDICARE,11.17,,,,,,,5.3700,126.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,BLUE CROSS,BLUE CROSS P NETWORK,47.91,,,,,,,5.3700,126.0000,fee schedule,$14.65 from Fee Schedule BCFSB for Rev 302 Proc 86706 * Qty 1 = $14.65 at 327% = $47.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,BLUE CROSS,BLUE CROSS S NETWORK,47.91,,,,,,,5.3700,126.0000,fee schedule,$14.65 from Fee Schedule BCFSB for Rev 302 Proc 86706 * Qty 1 = $14.65 at 327% = $47.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,BLUE CROSS,TENNCARE BLUE CARE,21.72,,,,,,,5.3700,126.0000,fee schedule,$18.72 from Fee Schedule TC_24 for Rev 302 Proc 86706 * Qty 1 = $18.72 at 116% = $21.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,BLUE CROSS,TENNCARE BLUE SELECT,21.72,,,,,,,5.3700,126.0000,fee schedule,$18.72 from Fee Schedule TC_24 for Rev 302 Proc 86706 * Qty 1 = $18.72 at 116% = $21.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,CIGNA HEALTHCARE,CIGNA HMO,43.22,,,,,,,5.3700,126.0000,fee schedule,$43.22 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86706 * Qty 1 = $43.22 at 100% = $43.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,23.82,,,,,,,5.3700,126.0000,fee schedule,$23.82 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86706 * Qty 1 = $23.82 at 100% = $23.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,11.28,,,,,,,5.3700,126.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,43.22,,,,,,,5.3700,126.0000,fee schedule,$43.22 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86706 * Qty 1 = $43.22 at 100% = $43.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,CIGNA HEALTHCARE,CIGNA PPO,43.22,,,,,,,5.3700,126.0000,fee schedule,$43.22 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86706 * Qty 1 = $43.22 at 100% = $43.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,11.28,,,,,,,5.3700,126.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,113.40,,,,,,,5.3700,126.0000,percent of total billed charges,90% of $126.00 in Billed Charges for Rev 302 Proc 86706 = $113.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,HUMANA,HUMANA MEDICARE,10.74,,,,,,,5.3700,126.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,10.74,,,,,,,5.3700,126.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,MEDCOST,MEDCOST VHN,59.96,,,,,,,5.3700,126.0000,percent of total billed charges,47.59% of $126.00 in Billed Charges for Rev 302 Proc 86706 = $59.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,5.3700,126.0000,fee schedule,APG 00394 Proc 86706 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,11.28,,,,,,,5.3700,126.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,11.28,,,,,,,5.3700,126.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,NHC ADVANTAGE,NHC ADVANTAGE,11.28,,,,,,,5.3700,126.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,5.3700,126.0000,fee schedule,APG 00394 Proc 86706 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,SENTARA HEALTH,SENTARA HEALTH,32.52,,,,,,,5.3700,126.0000,percent of total billed charges,25.81% of $126.00 in Billed Charges for Rev 302 Proc 86706 = $32.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,SENTARA HEALTH,SENTARA MEDICARE,10.74,,,,,,,5.3700,126.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",126.00,,,,,,,5.3700,126.0000,percent of total billed charges,100% of $126.00 in Billed Charges for Rev 302 Proc 86706 = $126.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7.61,,,,,,,5.3700,126.0000,fee schedule,$15.21 from Fee Schedule TCUHC24 for Rev 302 Proc 86706 * Qty 1 = $15.21 at 50% = $7.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,11.17,,,,,,,5.3700,126.0000,fee schedule,$10.74 from Fee Schedule UHC_31910 for Rev 302 Proc 86706 * Qty 1 = $10.74 at 104% = $11.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,10.74,,,,,,,5.3700,126.0000,fee schedule,$10.74 from Fee Schedule UHC_31910 for Rev 302 Proc 86706 * Qty 1 = $10.74 at 100% = $10.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,10.74,,,,,,,5.3700,126.0000,fee schedule,$10.74 from Fee Schedule UHC_31910 for Rev 302 Proc 86706 * Qty 1 = $10.74 at 100% = $10.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,5.3700,126.0000,fee schedule,APG 00394 Proc 86706 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,10.74,,,,,,,5.3700,126.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,10.74,,,,,,,5.3700,126.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,WELLCARE,WELLCARE MEDICAID,126.00,,,,,,,5.3700,126.0000,percent of total billed charges,100% of $126.00 in Billed Charges for Rev 302 Proc 86706 = $126.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS B SURFACE AB,86706,CPT,302,RC,30200092,CDM,,,,both,,,126.0000,18.9000,WELLCARE,WELLCARE MEDICARE,11.38,,,,,,,5.3700,126.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA,57.22,,,,,,,5.7900,134.0000,percent of total billed charges,42.7% of $134.00 in Billed Charges for Rev 302 Proc 86707 = $57.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,5.7900,134.0000,fee schedule,APG 00394 Proc 86707 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,11.57,,,,,,,5.7900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA HEALTHCARE MEDICARE,11.57,,,,,,,5.7900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,11.57,,,,,,,5.7900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,AMBETTER,AMBETTER,25.22,,,,,,,5.7900,134.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,AMERIGROUP,AMERIGROUP,5.79,,,,,,,5.7900,134.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,12.03,,,,,,,5.7900,134.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM EXCHANGE,11.57,,,,,,,5.7900,134.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,5.7900,134.0000,fee schedule,APG 00394 Proc 86707 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM HMO,11.57,,,,,,,5.7900,134.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,11.92,,,,,,,5.7900,134.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",11.57,,,,,,,5.7900,134.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,39.23,,,,,,,5.7900,134.0000,fee schedule,$39.23 from Fee Schedule BLDTM_23 for Rev 302 Proc 86707 * Qty 1 = $39.23 at 100% = $39.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS E NETWORK,50.50,,,,,,,5.7900,134.0000,fee schedule,$15.78 from Fee Schedule BCFSB for Rev 302 Proc 86707 * Qty 1 = $15.78 at 320% = $50.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS MEDICARE,12.03,,,,,,,5.7900,134.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS P NETWORK,51.60,,,,,,,5.7900,134.0000,fee schedule,$15.78 from Fee Schedule BCFSB for Rev 302 Proc 86707 * Qty 1 = $15.78 at 327% = $51.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS S NETWORK,51.60,,,,,,,5.7900,134.0000,fee schedule,$15.78 from Fee Schedule BCFSB for Rev 302 Proc 86707 * Qty 1 = $15.78 at 327% = $51.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,TENNCARE BLUE CARE,23.40,,,,,,,5.7900,134.0000,fee schedule,$20.17 from Fee Schedule TC_24 for Rev 302 Proc 86707 * Qty 1 = $20.17 at 116% = $23.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,TENNCARE BLUE SELECT,23.40,,,,,,,5.7900,134.0000,fee schedule,$20.17 from Fee Schedule TC_24 for Rev 302 Proc 86707 * Qty 1 = $20.17 at 116% = $23.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA HMO,46.54,,,,,,,5.7900,134.0000,fee schedule,$46.54 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86707 * Qty 1 = $46.54 at 100% = $46.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,25.26,,,,,,,5.7900,134.0000,fee schedule,$25.26 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86707 * Qty 1 = $25.26 at 100% = $25.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,12.15,,,,,,,5.7900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,46.54,,,,,,,5.7900,134.0000,fee schedule,$46.54 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86707 * Qty 1 = $46.54 at 100% = $46.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA PPO,46.54,,,,,,,5.7900,134.0000,fee schedule,$46.54 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86707 * Qty 1 = $46.54 at 100% = $46.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,12.15,,,,,,,5.7900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,120.60,,,,,,,5.7900,134.0000,percent of total billed charges,90% of $134.00 in Billed Charges for Rev 302 Proc 86707 = $120.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,HUMANA,HUMANA MEDICARE,11.57,,,,,,,5.7900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,11.57,,,,,,,5.7900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,MEDCOST,MEDCOST VHN,63.77,,,,,,,5.7900,134.0000,percent of total billed charges,47.59% of $134.00 in Billed Charges for Rev 302 Proc 86707 = $63.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,5.7900,134.0000,fee schedule,APG 00394 Proc 86707 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,12.15,,,,,,,5.7900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,12.15,,,,,,,5.7900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,NHC ADVANTAGE,NHC ADVANTAGE,12.15,,,,,,,5.7900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,5.7900,134.0000,fee schedule,APG 00394 Proc 86707 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,SENTARA HEALTH,SENTARA HEALTH,34.59,,,,,,,5.7900,134.0000,percent of total billed charges,25.81% of $134.00 in Billed Charges for Rev 302 Proc 86707 = $34.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,SENTARA HEALTH,SENTARA MEDICARE,11.57,,,,,,,5.7900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",134.00,,,,,,,5.7900,134.0000,percent of total billed charges,100% of $134.00 in Billed Charges for Rev 302 Proc 86707 = $134.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.19,,,,,,,5.7900,134.0000,fee schedule,$16.38 from Fee Schedule TCUHC24 for Rev 302 Proc 86707 * Qty 1 = $16.38 at 50% = $8.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12.03,,,,,,,5.7900,134.0000,fee schedule,$11.57 from Fee Schedule UHC_31910 for Rev 302 Proc 86707 * Qty 1 = $11.57 at 104% = $12.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11.57,,,,,,,5.7900,134.0000,fee schedule,$11.57 from Fee Schedule UHC_31910 for Rev 302 Proc 86707 * Qty 1 = $11.57 at 100% = $11.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,11.57,,,,,,,5.7900,134.0000,fee schedule,$11.57 from Fee Schedule UHC_31910 for Rev 302 Proc 86707 * Qty 1 = $11.57 at 100% = $11.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,5.7900,134.0000,fee schedule,APG 00394 Proc 86707 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,11.57,,,,,,,5.7900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,11.57,,,,,,,5.7900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,WELLCARE,WELLCARE MEDICAID,134.00,,,,,,,5.7900,134.0000,percent of total billed charges,100% of $134.00 in Billed Charges for Rev 302 Proc 86707 = $134.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS BE AB,86707,CPT,302,RC,30200093,CDM,,,,both,,,134.0000,20.1000,WELLCARE,WELLCARE MEDICARE,12.26,,,,,,,5.7900,134.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,AETNA,AETNA,58.93,,,,,,,6.2000,138.0000,percent of total billed charges,42.7% of $138.00 in Billed Charges for Rev 302 Proc 86708 = $58.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,6.2000,138.0000,fee schedule,APG 00394 Proc 86708 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,12.39,,,,,,,6.2000,138.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,AETNA,AETNA HEALTHCARE MEDICARE,12.39,,,,,,,6.2000,138.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,12.39,,,,,,,6.2000,138.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,AMBETTER,AMBETTER,27.01,,,,,,,6.2000,138.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,AMERIGROUP,AMERIGROUP,6.20,,,,,,,6.2000,138.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,12.89,,,,,,,6.2000,138.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,BLUE CROSS,ANTHEM EXCHANGE,12.39,,,,,,,6.2000,138.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,6.2000,138.0000,fee schedule,APG 00394 Proc 86708 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,BLUE CROSS,ANTHEM HMO,12.39,,,,,,,6.2000,138.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,12.76,,,,,,,6.2000,138.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",12.39,,,,,,,6.2000,138.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,41.79,,,,,,,6.2000,138.0000,fee schedule,$41.79 from Fee Schedule BLDTM_23 for Rev 302 Proc 86708 * Qty 1 = $41.79 at 100% = $41.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,BLUE CROSS,BLUE CROSS E NETWORK,50.82,,,,,,,6.2000,138.0000,fee schedule,$15.88 from Fee Schedule BCFSB for Rev 302 Proc 86708 * Qty 1 = $15.88 at 320% = $50.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,BLUE CROSS,BLUE CROSS MEDICARE,12.89,,,,,,,6.2000,138.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,BLUE CROSS,BLUE CROSS P NETWORK,51.93,,,,,,,6.2000,138.0000,fee schedule,$15.88 from Fee Schedule BCFSB for Rev 302 Proc 86708 * Qty 1 = $15.88 at 327% = $51.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,BLUE CROSS,BLUE CROSS S NETWORK,51.93,,,,,,,6.2000,138.0000,fee schedule,$15.88 from Fee Schedule BCFSB for Rev 302 Proc 86708 * Qty 1 = $15.88 at 327% = $51.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,BLUE CROSS,TENNCARE BLUE CARE,23.54,,,,,,,6.2000,138.0000,fee schedule,$20.29 from Fee Schedule TC_24 for Rev 302 Proc 86708 * Qty 1 = $20.29 at 116% = $23.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,BLUE CROSS,TENNCARE BLUE SELECT,23.54,,,,,,,6.2000,138.0000,fee schedule,$20.29 from Fee Schedule TC_24 for Rev 302 Proc 86708 * Qty 1 = $20.29 at 116% = $23.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,CIGNA HEALTHCARE,CIGNA HMO,49.86,,,,,,,6.2000,138.0000,fee schedule,$49.86 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86708 * Qty 1 = $49.86 at 100% = $49.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,27.43,,,,,,,6.2000,138.0000,fee schedule,$27.43 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86708 * Qty 1 = $27.43 at 100% = $27.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,13.01,,,,,,,6.2000,138.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,49.86,,,,,,,6.2000,138.0000,fee schedule,$49.86 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86708 * Qty 1 = $49.86 at 100% = $49.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,CIGNA HEALTHCARE,CIGNA PPO,49.86,,,,,,,6.2000,138.0000,fee schedule,$49.86 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86708 * Qty 1 = $49.86 at 100% = $49.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,13.01,,,,,,,6.2000,138.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,124.20,,,,,,,6.2000,138.0000,percent of total billed charges,90% of $138.00 in Billed Charges for Rev 302 Proc 86708 = $124.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,HUMANA,HUMANA MEDICARE,12.39,,,,,,,6.2000,138.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,12.39,,,,,,,6.2000,138.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,MEDCOST,MEDCOST VHN,65.67,,,,,,,6.2000,138.0000,percent of total billed charges,47.59% of $138.00 in Billed Charges for Rev 302 Proc 86708 = $65.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,6.2000,138.0000,fee schedule,APG 00394 Proc 86708 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,13.01,,,,,,,6.2000,138.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,13.01,,,,,,,6.2000,138.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,NHC ADVANTAGE,NHC ADVANTAGE,13.01,,,,,,,6.2000,138.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,6.2000,138.0000,fee schedule,APG 00394 Proc 86708 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,SENTARA HEALTH,SENTARA HEALTH,35.62,,,,,,,6.2000,138.0000,percent of total billed charges,25.81% of $138.00 in Billed Charges for Rev 302 Proc 86708 = $35.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,SENTARA HEALTH,SENTARA MEDICARE,12.39,,,,,,,6.2000,138.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",138.00,,,,,,,6.2000,138.0000,percent of total billed charges,100% of $138.00 in Billed Charges for Rev 302 Proc 86708 = $138.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.78,,,,,,,6.2000,138.0000,fee schedule,$17.55 from Fee Schedule TCUHC24 for Rev 302 Proc 86708 * Qty 1 = $17.55 at 50% = $8.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12.89,,,,,,,6.2000,138.0000,fee schedule,$12.39 from Fee Schedule UHC_31910 for Rev 302 Proc 86708 * Qty 1 = $12.39 at 104% = $12.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,12.39,,,,,,,6.2000,138.0000,fee schedule,$12.39 from Fee Schedule UHC_31910 for Rev 302 Proc 86708 * Qty 1 = $12.39 at 100% = $12.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,12.39,,,,,,,6.2000,138.0000,fee schedule,$12.39 from Fee Schedule UHC_31910 for Rev 302 Proc 86708 * Qty 1 = $12.39 at 100% = $12.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,6.2000,138.0000,fee schedule,APG 00394 Proc 86708 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,12.39,,,,,,,6.2000,138.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,12.39,,,,,,,6.2000,138.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,WELLCARE,WELLCARE MEDICAID,138.00,,,,,,,6.2000,138.0000,percent of total billed charges,100% of $138.00 in Billed Charges for Rev 302 Proc 86708 = $138.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS A AB,86708,CPT,302,RC,30200094,CDM,,,,both,,,138.0000,20.7000,WELLCARE,WELLCARE MEDICARE,13.13,,,,,,,6.2000,138.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,AETNA,AETNA,55.94,,,,,,,5.6300,131.0000,percent of total billed charges,42.7% of $131.00 in Billed Charges for Rev 302 Proc 86709 = $55.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,13.31,,,,,,,5.6300,131.0000,fee schedule,APG 00394 Proc 86709 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 104% = $13.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,11.26,,,,,,,5.6300,131.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,AETNA,AETNA HEALTHCARE MEDICARE,11.26,,,,,,,5.6300,131.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,11.26,,,,,,,5.6300,131.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,AMBETTER,AMBETTER,24.55,,,,,,,5.6300,131.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,AMERIGROUP,AMERIGROUP,5.63,,,,,,,5.6300,131.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,11.71,,,,,,,5.6300,131.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,BLUE CROSS,ANTHEM EXCHANGE,11.26,,,,,,,5.6300,131.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13.18,,,,,,,5.6300,131.0000,fee schedule,APG 00394 Proc 86709 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,BLUE CROSS,ANTHEM HMO,11.26,,,,,,,5.6300,131.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,11.60,,,,,,,5.6300,131.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",11.26,,,,,,,5.6300,131.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,38.37,,,,,,,5.6300,131.0000,fee schedule,$38.37 from Fee Schedule BLDTM_23 for Rev 302 Proc 86709 * Qty 1 = $38.37 at 100% = $38.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,BLUE CROSS,BLUE CROSS E NETWORK,49.15,,,,,,,5.6300,131.0000,fee schedule,$15.36 from Fee Schedule BCFSB for Rev 302 Proc 86709 * Qty 1 = $15.36 at 320% = $49.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,BLUE CROSS,BLUE CROSS MEDICARE,11.71,,,,,,,5.6300,131.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,BLUE CROSS,BLUE CROSS P NETWORK,50.23,,,,,,,5.6300,131.0000,fee schedule,$15.36 from Fee Schedule BCFSB for Rev 302 Proc 86709 * Qty 1 = $15.36 at 327% = $50.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,BLUE CROSS,BLUE CROSS S NETWORK,50.23,,,,,,,5.6300,131.0000,fee schedule,$15.36 from Fee Schedule BCFSB for Rev 302 Proc 86709 * Qty 1 = $15.36 at 327% = $50.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,BLUE CROSS,TENNCARE BLUE CARE,22.76,,,,,,,5.6300,131.0000,fee schedule,$19.62 from Fee Schedule TC_24 for Rev 302 Proc 86709 * Qty 1 = $19.62 at 116% = $22.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,BLUE CROSS,TENNCARE BLUE SELECT,22.76,,,,,,,5.6300,131.0000,fee schedule,$19.62 from Fee Schedule TC_24 for Rev 302 Proc 86709 * Qty 1 = $19.62 at 116% = $22.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,CIGNA HEALTHCARE,CIGNA HMO,45.32,,,,,,,5.6300,131.0000,fee schedule,$45.32 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86709 * Qty 1 = $45.32 at 100% = $45.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,24.54,,,,,,,5.6300,131.0000,fee schedule,$24.54 from Fee Schedule CGIFP_25LR for Rev 302 Proc 86709 * Qty 1 = $24.54 at 100% = $24.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,11.82,,,,,,,5.6300,131.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,45.32,,,,,,,5.6300,131.0000,fee schedule,$45.32 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86709 * Qty 1 = $45.32 at 100% = $45.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,CIGNA HEALTHCARE,CIGNA PPO,45.32,,,,,,,5.6300,131.0000,fee schedule,$45.32 from Fee Schedule CIGWHS_23 for Rev 302 Proc 86709 * Qty 1 = $45.32 at 100% = $45.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,11.82,,,,,,,5.6300,131.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,117.90,,,,,,,5.6300,131.0000,percent of total billed charges,90% of $131.00 in Billed Charges for Rev 302 Proc 86709 = $117.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,HUMANA,HUMANA MEDICARE,11.26,,,,,,,5.6300,131.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,11.26,,,,,,,5.6300,131.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,MEDCOST,MEDCOST VHN,62.34,,,,,,,5.6300,131.0000,percent of total billed charges,47.59% of $131.00 in Billed Charges for Rev 302 Proc 86709 = $62.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,13.44,,,,,,,5.6300,131.0000,fee schedule,APG 00394 Proc 86709 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 105% = $13.44 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,11.82,,,,,,,5.6300,131.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,11.82,,,,,,,5.6300,131.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,NHC ADVANTAGE,NHC ADVANTAGE,11.82,,,,,,,5.6300,131.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,13.20,,,,,,,5.6300,131.0000,fee schedule,APG 00394 Proc 86709 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 100% = $12.80... $12.80 at 103.1% = $13.20 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,SENTARA HEALTH,SENTARA HEALTH,33.81,,,,,,,5.6300,131.0000,percent of total billed charges,25.81% of $131.00 in Billed Charges for Rev 302 Proc 86709 = $33.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,SENTARA HEALTH,SENTARA MEDICARE,11.26,,,,,,,5.6300,131.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",131.00,,,,,,,5.6300,131.0000,percent of total billed charges,100% of $131.00 in Billed Charges for Rev 302 Proc 86709 = $131.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7.98,,,,,,,5.6300,131.0000,fee schedule,$15.95 from Fee Schedule TCUHC24 for Rev 302 Proc 86709 * Qty 1 = $15.95 at 50% = $7.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,11.71,,,,,,,5.6300,131.0000,fee schedule,$11.26 from Fee Schedule UHC_31910 for Rev 302 Proc 86709 * Qty 1 = $11.26 at 104% = $11.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,11.26,,,,,,,5.6300,131.0000,fee schedule,$11.26 from Fee Schedule UHC_31910 for Rev 302 Proc 86709 * Qty 1 = $11.26 at 100% = $11.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,11.26,,,,,,,5.6300,131.0000,fee schedule,$11.26 from Fee Schedule UHC_31910 for Rev 302 Proc 86709 * Qty 1 = $11.26 at 100% = $11.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,13.18,,,,,,,5.6300,131.0000,fee schedule,APG 00394 Proc 86709 at $836.60 (Base Rate) * 0.0153 (Relative Weight) = $12.80 (Total Line Payment) at 103% = $13.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,11.26,,,,,,,5.6300,131.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,11.26,,,,,,,5.6300,131.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,WELLCARE,WELLCARE MEDICAID,131.00,,,,,,,5.6300,131.0000,percent of total billed charges,100% of $131.00 in Billed Charges for Rev 302 Proc 86709 = $131.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HEPATITIS A IGM AB,86709,CPT,302,RC,30200095,CDM,,,,both,,,131.0000,19.6500,WELLCARE,WELLCARE MEDICARE,11.94,,,,,,,5.6300,131.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK CUSTOM TOTAL KNEE BALLAD HEALTH,272,RC,27200002,CDM,,,,,,both,,,1037.2000,155.5800,AETNA,AETNA,442.88,,,,,,,267.7000,1037.2000,percent of total billed charges,"42.7% of $1,037.20 in Billed Charges for Rev 272 = $442.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM TOTAL KNEE BALLAD HEALTH,272,RC,27200002,CDM,,,,,,both,,,1037.2000,155.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,726.04,,,,,,,267.7000,1037.2000,percent of total billed charges,"Rev 272 $1,037.20 in Billed Charges at 70% = $726.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM TOTAL KNEE BALLAD HEALTH,272,RC,27200002,CDM,,,,,,both,,,1037.2000,155.5800,CIGNA HEALTHCARE,CIGNA HMO,432.51,,,,,,,267.7000,1037.2000,percent of total billed charges,"41.7% of $1,037.20 in Billed Charges for Rev 272 = $432.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM TOTAL KNEE BALLAD HEALTH,272,RC,27200002,CDM,,,,,,both,,,1037.2000,155.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,481.26,,,,,,,267.7000,1037.2000,percent of total billed charges,"46.4% of $1,037.20 in Billed Charges for Rev 272 = $481.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM TOTAL KNEE BALLAD HEALTH,272,RC,27200002,CDM,,,,,,both,,,1037.2000,155.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,432.51,,,,,,,267.7000,1037.2000,percent of total billed charges,"41.7% of $1,037.20 in Billed Charges for Rev 272 = $432.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM TOTAL KNEE BALLAD HEALTH,272,RC,27200002,CDM,,,,,,both,,,1037.2000,155.5800,CIGNA HEALTHCARE,CIGNA PPO,432.51,,,,,,,267.7000,1037.2000,percent of total billed charges,"41.7% of $1,037.20 in Billed Charges for Rev 272 = $432.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM TOTAL KNEE BALLAD HEALTH,272,RC,27200002,CDM,,,,,,both,,,1037.2000,155.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,933.48,,,,,,,267.7000,1037.2000,percent of total billed charges,"90% of $1,037.20 in Billed Charges for Rev 272 = $933.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM TOTAL KNEE BALLAD HEALTH,272,RC,27200002,CDM,,,,,,both,,,1037.2000,155.5800,MEDCOST,MEDCOST VHN,493.60,,,,,,,267.7000,1037.2000,percent of total billed charges,"47.59% of $1,037.20 in Billed Charges for Rev 272 = $493.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM TOTAL KNEE BALLAD HEALTH,272,RC,27200002,CDM,,,,,,both,,,1037.2000,155.5800,SENTARA HEALTH,SENTARA HEALTH,267.70,,,,,,,267.7000,1037.2000,percent of total billed charges,"25.81% of $1,037.20 in Billed Charges for Rev 272 = $267.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM TOTAL KNEE BALLAD HEALTH,272,RC,27200002,CDM,,,,,,both,,,1037.2000,155.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1037.20,,,,,,,267.7000,1037.2000,percent of total billed charges,"100% of $1,037.20 in Billed Charges for Rev 272 = $1,037.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM TOTAL KNEE BALLAD HEALTH,272,RC,27200002,CDM,,,,,,both,,,1037.2000,155.5800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,518.60,,,,,,,267.7000,1037.2000,percent of total billed charges,"Rev 272 $1,037.20 in Billed Charges at 50% = $518.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM TOTAL KNEE BALLAD HEALTH,272,RC,27200002,CDM,,,,,,both,,,1037.2000,155.5800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,335.02,,,,,,,267.7000,1037.2000,other,"32.3% of $1,037.20 in Billed Charges for Rev 272 = $335.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK CUSTOM TOTAL KNEE BALLAD HEALTH,272,RC,27200002,CDM,,,,,,both,,,1037.2000,155.5800,UNITED HEALTHCARE,UHC HERITAGE SELECT,318.42,,,,,,,267.7000,1037.2000,other,"30.7% of $1,037.20 in Billed Charges for Rev 272 = $318.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK CUSTOM TOTAL KNEE BALLAD HEALTH,272,RC,27200002,CDM,,,,,,both,,,1037.2000,155.5800,UNITED HEALTHCARE,UNITED HEALTHCARE,335.02,,,,,,,267.7000,1037.2000,percent of total billed charges,"32.3% of $1,037.20 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CUSTOM TOTAL KNEE BALLAD HEALTH,272,RC,27200002,CDM,,,,,,both,,,1037.2000,155.5800,WELLCARE,WELLCARE MEDICAID,1037.20,,,,,,,267.7000,1037.2000,percent of total billed charges,"100% of $1,037.20 in Billed Charges for Rev 272 = $1,037.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABC FLEX 2.3,272,RC,27200002,CDM,,,,,,both,,,2833.3600,425.0000,AETNA,AETNA,1209.84,,,,,,,731.2900,2833.3600,percent of total billed charges,"42.7% of $2,833.36 in Billed Charges for Rev 272 = $1,209.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABC FLEX 2.3,272,RC,27200002,CDM,,,,,,both,,,2833.3600,425.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1983.35,,,,,,,731.2900,2833.3600,percent of total billed charges,"Rev 272 $2,833.36 in Billed Charges at 70% = $1,983.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABC FLEX 2.3,272,RC,27200002,CDM,,,,,,both,,,2833.3600,425.0000,CIGNA HEALTHCARE,CIGNA HMO,1181.51,,,,,,,731.2900,2833.3600,percent of total billed charges,"41.7% of $2,833.36 in Billed Charges for Rev 272 = $1,181.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABC FLEX 2.3,272,RC,27200002,CDM,,,,,,both,,,2833.3600,425.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1314.68,,,,,,,731.2900,2833.3600,percent of total billed charges,"46.4% of $2,833.36 in Billed Charges for Rev 272 = $1,314.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABC FLEX 2.3,272,RC,27200002,CDM,,,,,,both,,,2833.3600,425.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1181.51,,,,,,,731.2900,2833.3600,percent of total billed charges,"41.7% of $2,833.36 in Billed Charges for Rev 272 = $1,181.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABC FLEX 2.3,272,RC,27200002,CDM,,,,,,both,,,2833.3600,425.0000,CIGNA HEALTHCARE,CIGNA PPO,1181.51,,,,,,,731.2900,2833.3600,percent of total billed charges,"41.7% of $2,833.36 in Billed Charges for Rev 272 = $1,181.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABC FLEX 2.3,272,RC,27200002,CDM,,,,,,both,,,2833.3600,425.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2550.02,,,,,,,731.2900,2833.3600,percent of total billed charges,"90% of $2,833.36 in Billed Charges for Rev 272 = $2,550.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABC FLEX 2.3,272,RC,27200002,CDM,,,,,,both,,,2833.3600,425.0000,MEDCOST,MEDCOST VHN,1348.40,,,,,,,731.2900,2833.3600,percent of total billed charges,"47.59% of $2,833.36 in Billed Charges for Rev 272 = $1,348.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABC FLEX 2.3,272,RC,27200002,CDM,,,,,,both,,,2833.3600,425.0000,SENTARA HEALTH,SENTARA HEALTH,731.29,,,,,,,731.2900,2833.3600,percent of total billed charges,"25.81% of $2,833.36 in Billed Charges for Rev 272 = $731.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABC FLEX 2.3,272,RC,27200002,CDM,,,,,,both,,,2833.3600,425.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2833.36,,,,,,,731.2900,2833.3600,percent of total billed charges,"100% of $2,833.36 in Billed Charges for Rev 272 = $2,833.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABC FLEX 2.3,272,RC,27200002,CDM,,,,,,both,,,2833.3600,425.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1416.68,,,,,,,731.2900,2833.3600,percent of total billed charges,"Rev 272 $2,833.36 in Billed Charges at 50% = $1,416.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABC FLEX 2.3,272,RC,27200002,CDM,,,,,,both,,,2833.3600,425.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,915.18,,,,,,,731.2900,2833.3600,other,"32.3% of $2,833.36 in Billed Charges for Rev 272 = $915.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE ABC FLEX 2.3,272,RC,27200002,CDM,,,,,,both,,,2833.3600,425.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,869.84,,,,,,,731.2900,2833.3600,other,"30.7% of $2,833.36 in Billed Charges for Rev 272 = $869.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE ABC FLEX 2.3,272,RC,27200002,CDM,,,,,,both,,,2833.3600,425.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,915.18,,,,,,,731.2900,2833.3600,percent of total billed charges,"32.3% of $2,833.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABC FLEX 2.3,272,RC,27200002,CDM,,,,,,both,,,2833.3600,425.0000,WELLCARE,WELLCARE MEDICAID,2833.36,,,,,,,731.2900,2833.3600,percent of total billed charges,"100% of $2,833.36 in Billed Charges for Rev 272 = $2,833.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,AETNA,AETNA,20.50,,,,,,,2.9100,48.0000,percent of total billed charges,42.7% of $48.00 in Billed Charges for Rev 306 Proc 87210 = $20.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,2.9100,48.0000,fee schedule,APG 00396 Proc 87210 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5.82,,,,,,,2.9100,48.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,AETNA,AETNA HEALTHCARE MEDICARE,5.82,,,,,,,2.9100,48.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,5.82,,,,,,,2.9100,48.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,AMBETTER,AMBETTER,12.69,,,,,,,2.9100,48.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,AMERIGROUP,AMERIGROUP,2.91,,,,,,,2.9100,48.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,6.05,,,,,,,2.9100,48.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,ANTHEM EXCHANGE,5.82,,,,,,,2.9100,48.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,2.9100,48.0000,fee schedule,APG 00396 Proc 87210 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,ANTHEM HMO,5.82,,,,,,,2.9100,48.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5.99,,,,,,,2.9100,48.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5.82,,,,,,,2.9100,48.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,10.16,,,,,,,2.9100,48.0000,fee schedule,$10.16 from Fee Schedule BLDTM_23 for Rev 306 Proc 87210 * Qty 1 = $10.16 at 100% = $10.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,BLUE CROSS E NETWORK,17.95,,,,,,,2.9100,48.0000,fee schedule,$5.61 from Fee Schedule BCFSB for Rev 306 Proc 87210 * Qty 1 = $5.61 at 320% = $17.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,BLUE CROSS MEDICARE,6.05,,,,,,,2.9100,48.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,BLUE CROSS P NETWORK,18.34,,,,,,,2.9100,48.0000,fee schedule,$5.61 from Fee Schedule BCFSB for Rev 306 Proc 87210 * Qty 1 = $5.61 at 327% = $18.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,BLUE CROSS S NETWORK,18.34,,,,,,,2.9100,48.0000,fee schedule,$5.61 from Fee Schedule BCFSB for Rev 306 Proc 87210 * Qty 1 = $5.61 at 327% = $18.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,TENNCARE BLUE CARE,7.86,,,,,,,2.9100,48.0000,fee schedule,$6.78 from Fee Schedule TC_24 for Rev 306 Proc 87210 * Qty 1 = $6.78 at 116% = $7.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,TENNCARE BLUE SELECT,7.86,,,,,,,2.9100,48.0000,fee schedule,$6.78 from Fee Schedule TC_24 for Rev 306 Proc 87210 * Qty 1 = $6.78 at 116% = $7.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,CIGNA HEALTHCARE,CIGNA HMO,17.17,,,,,,,2.9100,48.0000,fee schedule,$17.17 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87210 * Qty 1 = $17.17 at 100% = $17.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12.99,,,,,,,2.9100,48.0000,fee schedule,$12.99 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87210 * Qty 1 = $12.99 at 100% = $12.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,6.11,,,,,,,2.9100,48.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,17.17,,,,,,,2.9100,48.0000,fee schedule,$17.17 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87210 * Qty 1 = $17.17 at 100% = $17.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,CIGNA HEALTHCARE,CIGNA PPO,17.17,,,,,,,2.9100,48.0000,fee schedule,$17.17 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87210 * Qty 1 = $17.17 at 100% = $17.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,6.11,,,,,,,2.9100,48.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,43.20,,,,,,,2.9100,48.0000,percent of total billed charges,90% of $48.00 in Billed Charges for Rev 306 Proc 87210 = $43.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,HUMANA,HUMANA MEDICARE,5.82,,,,,,,2.9100,48.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5.82,,,,,,,2.9100,48.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,MEDCOST,MEDCOST VHN,22.84,,,,,,,2.9100,48.0000,percent of total billed charges,47.59% of $48.00 in Billed Charges for Rev 306 Proc 87210 = $22.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,2.9100,48.0000,fee schedule,APG 00396 Proc 87210 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,6.11,,,,,,,2.9100,48.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,6.11,,,,,,,2.9100,48.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,NHC ADVANTAGE,NHC ADVANTAGE,6.11,,,,,,,2.9100,48.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,2.9100,48.0000,fee schedule,APG 00396 Proc 87210 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,SENTARA HEALTH,SENTARA HEALTH,12.39,,,,,,,2.9100,48.0000,percent of total billed charges,25.81% of $48.00 in Billed Charges for Rev 306 Proc 87210 = $12.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,SENTARA HEALTH,SENTARA MEDICARE,5.82,,,,,,,2.9100,48.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",48.00,,,,,,,2.9100,48.0000,percent of total billed charges,100% of $48.00 in Billed Charges for Rev 306 Proc 87210 = $48.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3.03,,,,,,,2.9100,48.0000,fee schedule,$6.05 from Fee Schedule TCUHC24 for Rev 306 Proc 87210 * Qty 1 = $6.05 at 50% = $3.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,6.05,,,,,,,2.9100,48.0000,fee schedule,$5.82 from Fee Schedule UHC_31910 for Rev 306 Proc 87210 * Qty 1 = $5.82 at 104% = $6.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,5.82,,,,,,,2.9100,48.0000,fee schedule,$5.82 from Fee Schedule UHC_31910 for Rev 306 Proc 87210 * Qty 1 = $5.82 at 100% = $5.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,5.82,,,,,,,2.9100,48.0000,fee schedule,$5.82 from Fee Schedule UHC_31910 for Rev 306 Proc 87210 * Qty 1 = $5.82 at 100% = $5.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,2.9100,48.0000,fee schedule,APG 00396 Proc 87210 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5.82,,,,,,,2.9100,48.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5.82,,,,,,,2.9100,48.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,WELLCARE,WELLCARE MEDICAID,48.00,,,,,,,2.9100,48.0000,percent of total billed charges,100% of $48.00 in Billed Charges for Rev 306 Proc 87210 = $48.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMEAR WET MOUNT INFECT AGENTS,87210,CPT,306,RC,30600035,CDM,,,,both,,,48.0000,7.2000,WELLCARE,WELLCARE MEDICARE,6.17,,,,,,,2.9100,48.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,AETNA,AETNA,20.50,,,,,,,2.1400,48.0000,percent of total billed charges,42.7% of $48.00 in Billed Charges for Rev 306 Proc 87220 = $20.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,2.1400,48.0000,fee schedule,APG 00396 Proc 87220 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,4.27,,,,,,,2.1400,48.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,AETNA,AETNA HEALTHCARE MEDICARE,4.27,,,,,,,2.1400,48.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,4.27,,,,,,,2.1400,48.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,AMBETTER,AMBETTER,9.31,,,,,,,2.1400,48.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,AMERIGROUP,AMERIGROUP,2.14,,,,,,,2.1400,48.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,4.44,,,,,,,2.1400,48.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,ANTHEM EXCHANGE,4.27,,,,,,,2.1400,48.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,2.1400,48.0000,fee schedule,APG 00396 Proc 87220 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,ANTHEM HMO,4.27,,,,,,,2.1400,48.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,4.40,,,,,,,2.1400,48.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4.27,,,,,,,2.1400,48.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,13.44,,,,,,,2.1400,48.0000,fee schedule,$13.44 from Fee Schedule BLDTM_23 for Rev 306 Proc 87220 * Qty 1 = $13.44 at 100% = $13.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,BLUE CROSS E NETWORK,17.95,,,,,,,2.1400,48.0000,fee schedule,$5.61 from Fee Schedule BCFSB for Rev 306 Proc 87220 * Qty 1 = $5.61 at 320% = $17.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,BLUE CROSS MEDICARE,4.44,,,,,,,2.1400,48.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,BLUE CROSS P NETWORK,18.34,,,,,,,2.1400,48.0000,fee schedule,$5.61 from Fee Schedule BCFSB for Rev 306 Proc 87220 * Qty 1 = $5.61 at 327% = $18.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,BLUE CROSS S NETWORK,18.34,,,,,,,2.1400,48.0000,fee schedule,$5.61 from Fee Schedule BCFSB for Rev 306 Proc 87220 * Qty 1 = $5.61 at 327% = $18.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,TENNCARE BLUE CARE,7.86,,,,,,,2.1400,48.0000,fee schedule,$6.78 from Fee Schedule TC_24 for Rev 306 Proc 87220 * Qty 1 = $6.78 at 116% = $7.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,BLUE CROSS,TENNCARE BLUE SELECT,7.86,,,,,,,2.1400,48.0000,fee schedule,$6.78 from Fee Schedule TC_24 for Rev 306 Proc 87220 * Qty 1 = $6.78 at 116% = $7.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,CIGNA HEALTHCARE,CIGNA HMO,17.17,,,,,,,2.1400,48.0000,fee schedule,$17.17 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87220 * Qty 1 = $17.17 at 100% = $17.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,9.38,,,,,,,2.1400,48.0000,fee schedule,$9.38 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87220 * Qty 1 = $9.38 at 100% = $9.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,4.48,,,,,,,2.1400,48.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,17.17,,,,,,,2.1400,48.0000,fee schedule,$17.17 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87220 * Qty 1 = $17.17 at 100% = $17.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,CIGNA HEALTHCARE,CIGNA PPO,17.17,,,,,,,2.1400,48.0000,fee schedule,$17.17 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87220 * Qty 1 = $17.17 at 100% = $17.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,4.48,,,,,,,2.1400,48.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,43.20,,,,,,,2.1400,48.0000,percent of total billed charges,90% of $48.00 in Billed Charges for Rev 306 Proc 87220 = $43.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,HUMANA,HUMANA MEDICARE,4.27,,,,,,,2.1400,48.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,4.27,,,,,,,2.1400,48.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,MEDCOST,MEDCOST VHN,22.84,,,,,,,2.1400,48.0000,percent of total billed charges,47.59% of $48.00 in Billed Charges for Rev 306 Proc 87220 = $22.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,2.1400,48.0000,fee schedule,APG 00396 Proc 87220 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,4.48,,,,,,,2.1400,48.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,4.48,,,,,,,2.1400,48.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,NHC ADVANTAGE,NHC ADVANTAGE,4.48,,,,,,,2.1400,48.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,2.1400,48.0000,fee schedule,APG 00396 Proc 87220 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,SENTARA HEALTH,SENTARA HEALTH,12.39,,,,,,,2.1400,48.0000,percent of total billed charges,25.81% of $48.00 in Billed Charges for Rev 306 Proc 87220 = $12.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,SENTARA HEALTH,SENTARA MEDICARE,4.27,,,,,,,2.1400,48.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",48.00,,,,,,,2.1400,48.0000,percent of total billed charges,100% of $48.00 in Billed Charges for Rev 306 Proc 87220 = $48.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3.03,,,,,,,2.1400,48.0000,fee schedule,$6.05 from Fee Schedule TCUHC24 for Rev 306 Proc 87220 * Qty 1 = $6.05 at 50% = $3.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4.44,,,,,,,2.1400,48.0000,fee schedule,$4.27 from Fee Schedule UHC_31910 for Rev 306 Proc 87220 * Qty 1 = $4.27 at 104% = $4.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,4.27,,,,,,,2.1400,48.0000,fee schedule,$4.27 from Fee Schedule UHC_31910 for Rev 306 Proc 87220 * Qty 1 = $4.27 at 100% = $4.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,4.27,,,,,,,2.1400,48.0000,fee schedule,$4.27 from Fee Schedule UHC_31910 for Rev 306 Proc 87220 * Qty 1 = $4.27 at 100% = $4.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,2.1400,48.0000,fee schedule,APG 00396 Proc 87220 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,4.27,,,,,,,2.1400,48.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,4.27,,,,,,,2.1400,48.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,WELLCARE,WELLCARE MEDICAID,48.00,,,,,,,2.1400,48.0000,percent of total billed charges,100% of $48.00 in Billed Charges for Rev 306 Proc 87220 = $48.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC KOH PREP SKIN HAIR NAILS,87220,CPT,306,RC,30600036,CDM,,,,both,,,48.0000,7.2000,WELLCARE,WELLCARE MEDICARE,4.53,,,,,,,2.1400,48.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,AETNA,AETNA,53.38,,,,,,,9.7800,125.0000,percent of total billed charges,42.7% of $125.00 in Billed Charges for Rev 306 Proc 87250 = $53.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,9.7800,125.0000,fee schedule,APG 00396 Proc 87250 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,19.56,,,,,,,9.7800,125.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,AETNA,AETNA HEALTHCARE MEDICARE,19.56,,,,,,,9.7800,125.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,19.56,,,,,,,9.7800,125.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,AMBETTER,AMBETTER,42.64,,,,,,,9.7800,125.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,AMERIGROUP,AMERIGROUP,9.78,,,,,,,9.7800,125.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,20.34,,,,,,,9.7800,125.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,BLUE CROSS,ANTHEM EXCHANGE,19.56,,,,,,,9.7800,125.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,9.7800,125.0000,fee schedule,APG 00396 Proc 87250 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,BLUE CROSS,ANTHEM HMO,19.56,,,,,,,9.7800,125.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,20.15,,,,,,,9.7800,125.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",19.56,,,,,,,9.7800,125.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,61.72,,,,,,,9.7800,125.0000,fee schedule,$61.72 from Fee Schedule BLDTM_23 for Rev 306 Proc 87250 * Qty 1 = $61.72 at 100% = $61.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,BLUE CROSS,BLUE CROSS E NETWORK,85.38,,,,,,,9.7800,125.0000,fee schedule,$26.68 from Fee Schedule BCFSB for Rev 306 Proc 87250 * Qty 1 = $26.68 at 320% = $85.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,BLUE CROSS,BLUE CROSS MEDICARE,20.34,,,,,,,9.7800,125.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,BLUE CROSS,BLUE CROSS P NETWORK,87.24,,,,,,,9.7800,125.0000,fee schedule,$26.68 from Fee Schedule BCFSB for Rev 306 Proc 87250 * Qty 1 = $26.68 at 327% = $87.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,BLUE CROSS,BLUE CROSS S NETWORK,87.24,,,,,,,9.7800,125.0000,fee schedule,$26.68 from Fee Schedule BCFSB for Rev 306 Proc 87250 * Qty 1 = $26.68 at 327% = $87.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,BLUE CROSS,TENNCARE BLUE CARE,39.02,,,,,,,9.7800,125.0000,fee schedule,$33.64 from Fee Schedule TC_24 for Rev 306 Proc 87250 * Qty 1 = $33.64 at 116% = $39.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,BLUE CROSS,TENNCARE BLUE SELECT,39.02,,,,,,,9.7800,125.0000,fee schedule,$33.64 from Fee Schedule TC_24 for Rev 306 Proc 87250 * Qty 1 = $33.64 at 116% = $39.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,CIGNA HEALTHCARE,CIGNA HMO,78.70,,,,,,,9.7800,125.0000,fee schedule,$78.70 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87250 * Qty 1 = $78.70 at 100% = $78.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,43.31,,,,,,,9.7800,125.0000,fee schedule,$43.31 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87250 * Qty 1 = $43.31 at 100% = $43.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,20.54,,,,,,,9.7800,125.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,78.70,,,,,,,9.7800,125.0000,fee schedule,$78.70 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87250 * Qty 1 = $78.70 at 100% = $78.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,CIGNA HEALTHCARE,CIGNA PPO,78.70,,,,,,,9.7800,125.0000,fee schedule,$78.70 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87250 * Qty 1 = $78.70 at 100% = $78.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,20.54,,,,,,,9.7800,125.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,112.50,,,,,,,9.7800,125.0000,percent of total billed charges,90% of $125.00 in Billed Charges for Rev 306 Proc 87250 = $112.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,HUMANA,HUMANA MEDICARE,19.56,,,,,,,9.7800,125.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,19.56,,,,,,,9.7800,125.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,MEDCOST,MEDCOST VHN,59.49,,,,,,,9.7800,125.0000,percent of total billed charges,47.59% of $125.00 in Billed Charges for Rev 306 Proc 87250 = $59.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,9.7800,125.0000,fee schedule,APG 00396 Proc 87250 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,20.54,,,,,,,9.7800,125.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,20.54,,,,,,,9.7800,125.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,NHC ADVANTAGE,NHC ADVANTAGE,20.54,,,,,,,9.7800,125.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,9.7800,125.0000,fee schedule,APG 00396 Proc 87250 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,SENTARA HEALTH,SENTARA HEALTH,32.26,,,,,,,9.7800,125.0000,percent of total billed charges,25.81% of $125.00 in Billed Charges for Rev 306 Proc 87250 = $32.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,SENTARA HEALTH,SENTARA MEDICARE,19.56,,,,,,,9.7800,125.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",125.00,,,,,,,9.7800,125.0000,percent of total billed charges,100% of $125.00 in Billed Charges for Rev 306 Proc 87250 = $125.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,13.85,,,,,,,9.7800,125.0000,fee schedule,$27.70 from Fee Schedule TCUHC24 for Rev 306 Proc 87250 * Qty 1 = $27.70 at 50% = $13.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,20.34,,,,,,,9.7800,125.0000,fee schedule,$19.56 from Fee Schedule UHC_31910 for Rev 306 Proc 87250 * Qty 1 = $19.56 at 104% = $20.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,19.56,,,,,,,9.7800,125.0000,fee schedule,$19.56 from Fee Schedule UHC_31910 for Rev 306 Proc 87250 * Qty 1 = $19.56 at 100% = $19.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,19.56,,,,,,,9.7800,125.0000,fee schedule,$19.56 from Fee Schedule UHC_31910 for Rev 306 Proc 87250 * Qty 1 = $19.56 at 100% = $19.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,9.7800,125.0000,fee schedule,APG 00396 Proc 87250 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,19.56,,,,,,,9.7800,125.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,19.56,,,,,,,9.7800,125.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,WELLCARE,WELLCARE MEDICAID,125.00,,,,,,,9.7800,125.0000,percent of total billed charges,100% of $125.00 in Billed Charges for Rev 306 Proc 87250 = $125.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRUS ISLTN INOC EGG OBSV&DIS REF,87250,CPT,306,RC,30600038,CDM,,,,both,,,125.0000,18.7500,WELLCARE,WELLCARE MEDICARE,20.73,,,,,,,9.7800,125.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PROBE BALL TIP SAFEOP STIMULATING,272,RC,27200002,CDM,,,,,,both,,,4991.0400,748.6600,AETNA,AETNA,2131.17,,,,,,,1288.1900,4991.0400,percent of total billed charges,"42.7% of $4,991.04 in Billed Charges for Rev 272 = $2,131.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SAFEOP STIMULATING,272,RC,27200002,CDM,,,,,,both,,,4991.0400,748.6600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3493.73,,,,,,,1288.1900,4991.0400,percent of total billed charges,"Rev 272 $4,991.04 in Billed Charges at 70% = $3,493.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SAFEOP STIMULATING,272,RC,27200002,CDM,,,,,,both,,,4991.0400,748.6600,CIGNA HEALTHCARE,CIGNA HMO,2081.26,,,,,,,1288.1900,4991.0400,percent of total billed charges,"41.7% of $4,991.04 in Billed Charges for Rev 272 = $2,081.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SAFEOP STIMULATING,272,RC,27200002,CDM,,,,,,both,,,4991.0400,748.6600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2315.84,,,,,,,1288.1900,4991.0400,percent of total billed charges,"46.4% of $4,991.04 in Billed Charges for Rev 272 = $2,315.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SAFEOP STIMULATING,272,RC,27200002,CDM,,,,,,both,,,4991.0400,748.6600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2081.26,,,,,,,1288.1900,4991.0400,percent of total billed charges,"41.7% of $4,991.04 in Billed Charges for Rev 272 = $2,081.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SAFEOP STIMULATING,272,RC,27200002,CDM,,,,,,both,,,4991.0400,748.6600,CIGNA HEALTHCARE,CIGNA PPO,2081.26,,,,,,,1288.1900,4991.0400,percent of total billed charges,"41.7% of $4,991.04 in Billed Charges for Rev 272 = $2,081.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SAFEOP STIMULATING,272,RC,27200002,CDM,,,,,,both,,,4991.0400,748.6600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4491.94,,,,,,,1288.1900,4991.0400,percent of total billed charges,"90% of $4,991.04 in Billed Charges for Rev 272 = $4,491.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SAFEOP STIMULATING,272,RC,27200002,CDM,,,,,,both,,,4991.0400,748.6600,MEDCOST,MEDCOST VHN,2375.24,,,,,,,1288.1900,4991.0400,percent of total billed charges,"47.59% of $4,991.04 in Billed Charges for Rev 272 = $2,375.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SAFEOP STIMULATING,272,RC,27200002,CDM,,,,,,both,,,4991.0400,748.6600,SENTARA HEALTH,SENTARA HEALTH,1288.19,,,,,,,1288.1900,4991.0400,percent of total billed charges,"25.81% of $4,991.04 in Billed Charges for Rev 272 = $1,288.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SAFEOP STIMULATING,272,RC,27200002,CDM,,,,,,both,,,4991.0400,748.6600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4991.04,,,,,,,1288.1900,4991.0400,percent of total billed charges,"100% of $4,991.04 in Billed Charges for Rev 272 = $4,991.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SAFEOP STIMULATING,272,RC,27200002,CDM,,,,,,both,,,4991.0400,748.6600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2495.52,,,,,,,1288.1900,4991.0400,percent of total billed charges,"Rev 272 $4,991.04 in Billed Charges at 50% = $2,495.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SAFEOP STIMULATING,272,RC,27200002,CDM,,,,,,both,,,4991.0400,748.6600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1612.11,,,,,,,1288.1900,4991.0400,other,"32.3% of $4,991.04 in Billed Charges for Rev 272 = $1,612.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE BALL TIP SAFEOP STIMULATING,272,RC,27200002,CDM,,,,,,both,,,4991.0400,748.6600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1532.25,,,,,,,1288.1900,4991.0400,other,"30.7% of $4,991.04 in Billed Charges for Rev 272 = $1,532.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE BALL TIP SAFEOP STIMULATING,272,RC,27200002,CDM,,,,,,both,,,4991.0400,748.6600,UNITED HEALTHCARE,UNITED HEALTHCARE,1612.11,,,,,,,1288.1900,4991.0400,percent of total billed charges,"32.3% of $4,991.04 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SAFEOP STIMULATING,272,RC,27200002,CDM,,,,,,both,,,4991.0400,748.6600,WELLCARE,WELLCARE MEDICAID,4991.04,,,,,,,1288.1900,4991.0400,percent of total billed charges,"100% of $4,991.04 in Billed Charges for Rev 272 = $4,991.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SO3,272,RC,27200002,CDM,,,,,,both,,,6238.7800,935.8200,AETNA,AETNA,2663.96,,,,,,,1610.2300,6238.7800,percent of total billed charges,"42.7% of $6,238.78 in Billed Charges for Rev 272 = $2,663.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SO3,272,RC,27200002,CDM,,,,,,both,,,6238.7800,935.8200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4367.15,,,,,,,1610.2300,6238.7800,percent of total billed charges,"Rev 272 $6,238.78 in Billed Charges at 70% = $4,367.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SO3,272,RC,27200002,CDM,,,,,,both,,,6238.7800,935.8200,CIGNA HEALTHCARE,CIGNA HMO,2601.57,,,,,,,1610.2300,6238.7800,percent of total billed charges,"41.7% of $6,238.78 in Billed Charges for Rev 272 = $2,601.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SO3,272,RC,27200002,CDM,,,,,,both,,,6238.7800,935.8200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2894.79,,,,,,,1610.2300,6238.7800,percent of total billed charges,"46.4% of $6,238.78 in Billed Charges for Rev 272 = $2,894.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SO3,272,RC,27200002,CDM,,,,,,both,,,6238.7800,935.8200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2601.57,,,,,,,1610.2300,6238.7800,percent of total billed charges,"41.7% of $6,238.78 in Billed Charges for Rev 272 = $2,601.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SO3,272,RC,27200002,CDM,,,,,,both,,,6238.7800,935.8200,CIGNA HEALTHCARE,CIGNA PPO,2601.57,,,,,,,1610.2300,6238.7800,percent of total billed charges,"41.7% of $6,238.78 in Billed Charges for Rev 272 = $2,601.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SO3,272,RC,27200002,CDM,,,,,,both,,,6238.7800,935.8200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5614.90,,,,,,,1610.2300,6238.7800,percent of total billed charges,"90% of $6,238.78 in Billed Charges for Rev 272 = $5,614.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SO3,272,RC,27200002,CDM,,,,,,both,,,6238.7800,935.8200,MEDCOST,MEDCOST VHN,2969.04,,,,,,,1610.2300,6238.7800,percent of total billed charges,"47.59% of $6,238.78 in Billed Charges for Rev 272 = $2,969.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SO3,272,RC,27200002,CDM,,,,,,both,,,6238.7800,935.8200,SENTARA HEALTH,SENTARA HEALTH,1610.23,,,,,,,1610.2300,6238.7800,percent of total billed charges,"25.81% of $6,238.78 in Billed Charges for Rev 272 = $1,610.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SO3,272,RC,27200002,CDM,,,,,,both,,,6238.7800,935.8200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6238.78,,,,,,,1610.2300,6238.7800,percent of total billed charges,"100% of $6,238.78 in Billed Charges for Rev 272 = $6,238.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SO3,272,RC,27200002,CDM,,,,,,both,,,6238.7800,935.8200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3119.39,,,,,,,1610.2300,6238.7800,percent of total billed charges,"Rev 272 $6,238.78 in Billed Charges at 50% = $3,119.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SO3,272,RC,27200002,CDM,,,,,,both,,,6238.7800,935.8200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2015.13,,,,,,,1610.2300,6238.7800,other,"32.3% of $6,238.78 in Billed Charges for Rev 272 = $2,015.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE BALL TIP SO3,272,RC,27200002,CDM,,,,,,both,,,6238.7800,935.8200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1915.31,,,,,,,1610.2300,6238.7800,other,"30.7% of $6,238.78 in Billed Charges for Rev 272 = $1,915.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE BALL TIP SO3,272,RC,27200002,CDM,,,,,,both,,,6238.7800,935.8200,UNITED HEALTHCARE,UNITED HEALTHCARE,2015.13,,,,,,,1610.2300,6238.7800,percent of total billed charges,"32.3% of $6,238.78 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BALL TIP SO3,272,RC,27200002,CDM,,,,,,both,,,6238.7800,935.8200,WELLCARE,WELLCARE MEDICAID,6238.78,,,,,,,1610.2300,6238.7800,percent of total billed charges,"100% of $6,238.78 in Billed Charges for Rev 272 = $6,238.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BEAMER ARGON 2.3X230,272,RC,27200002,CDM,,,,,,both,,,2274.3600,341.1500,AETNA,AETNA,971.15,,,,,,,587.0100,2274.3600,percent of total billed charges,"42.7% of $2,274.36 in Billed Charges for Rev 272 = $971.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BEAMER ARGON 2.3X230,272,RC,27200002,CDM,,,,,,both,,,2274.3600,341.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1592.05,,,,,,,587.0100,2274.3600,percent of total billed charges,"Rev 272 $2,274.36 in Billed Charges at 70% = $1,592.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BEAMER ARGON 2.3X230,272,RC,27200002,CDM,,,,,,both,,,2274.3600,341.1500,CIGNA HEALTHCARE,CIGNA HMO,948.41,,,,,,,587.0100,2274.3600,percent of total billed charges,"41.7% of $2,274.36 in Billed Charges for Rev 272 = $948.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BEAMER ARGON 2.3X230,272,RC,27200002,CDM,,,,,,both,,,2274.3600,341.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1055.30,,,,,,,587.0100,2274.3600,percent of total billed charges,"46.4% of $2,274.36 in Billed Charges for Rev 272 = $1,055.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BEAMER ARGON 2.3X230,272,RC,27200002,CDM,,,,,,both,,,2274.3600,341.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,948.41,,,,,,,587.0100,2274.3600,percent of total billed charges,"41.7% of $2,274.36 in Billed Charges for Rev 272 = $948.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BEAMER ARGON 2.3X230,272,RC,27200002,CDM,,,,,,both,,,2274.3600,341.1500,CIGNA HEALTHCARE,CIGNA PPO,948.41,,,,,,,587.0100,2274.3600,percent of total billed charges,"41.7% of $2,274.36 in Billed Charges for Rev 272 = $948.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BEAMER ARGON 2.3X230,272,RC,27200002,CDM,,,,,,both,,,2274.3600,341.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2046.92,,,,,,,587.0100,2274.3600,percent of total billed charges,"90% of $2,274.36 in Billed Charges for Rev 272 = $2,046.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BEAMER ARGON 2.3X230,272,RC,27200002,CDM,,,,,,both,,,2274.3600,341.1500,MEDCOST,MEDCOST VHN,1082.37,,,,,,,587.0100,2274.3600,percent of total billed charges,"47.59% of $2,274.36 in Billed Charges for Rev 272 = $1,082.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BEAMER ARGON 2.3X230,272,RC,27200002,CDM,,,,,,both,,,2274.3600,341.1500,SENTARA HEALTH,SENTARA HEALTH,587.01,,,,,,,587.0100,2274.3600,percent of total billed charges,"25.81% of $2,274.36 in Billed Charges for Rev 272 = $587.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BEAMER ARGON 2.3X230,272,RC,27200002,CDM,,,,,,both,,,2274.3600,341.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2274.36,,,,,,,587.0100,2274.3600,percent of total billed charges,"100% of $2,274.36 in Billed Charges for Rev 272 = $2,274.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BEAMER ARGON 2.3X230,272,RC,27200002,CDM,,,,,,both,,,2274.3600,341.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1137.18,,,,,,,587.0100,2274.3600,percent of total billed charges,"Rev 272 $2,274.36 in Billed Charges at 50% = $1,137.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BEAMER ARGON 2.3X230,272,RC,27200002,CDM,,,,,,both,,,2274.3600,341.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,734.62,,,,,,,587.0100,2274.3600,other,"32.3% of $2,274.36 in Billed Charges for Rev 272 = $734.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE BEAMER ARGON 2.3X230,272,RC,27200002,CDM,,,,,,both,,,2274.3600,341.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,698.23,,,,,,,587.0100,2274.3600,other,"30.7% of $2,274.36 in Billed Charges for Rev 272 = $698.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE BEAMER ARGON 2.3X230,272,RC,27200002,CDM,,,,,,both,,,2274.3600,341.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,734.62,,,,,,,587.0100,2274.3600,percent of total billed charges,"32.3% of $2,274.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BEAMER ARGON 2.3X230,272,RC,27200002,CDM,,,,,,both,,,2274.3600,341.1500,WELLCARE,WELLCARE MEDICAID,2274.36,,,,,,,587.0100,2274.3600,percent of total billed charges,"100% of $2,274.36 in Billed Charges for Rev 272 = $2,274.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,AETNA,AETNA,130.24,,,,,,,11.5500,305.0000,percent of total billed charges,42.7% of $305.00 in Billed Charges for Rev 306 Proc 87252 = $130.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,11.5500,305.0000,fee schedule,APG 00396 Proc 87252 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,26.07,,,,,,,11.5500,305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,AETNA,AETNA HEALTHCARE MEDICARE,26.07,,,,,,,11.5500,305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,26.07,,,,,,,11.5500,305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,AMBETTER,AMBETTER,56.83,,,,,,,11.5500,305.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,AMERIGROUP,AMERIGROUP,13.04,,,,,,,11.5500,305.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,27.11,,,,,,,11.5500,305.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,ANTHEM EXCHANGE,26.07,,,,,,,11.5500,305.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,11.5500,305.0000,fee schedule,APG 00396 Proc 87252 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,ANTHEM HMO,26.07,,,,,,,11.5500,305.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,26.85,,,,,,,11.5500,305.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",26.07,,,,,,,11.5500,305.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,65.14,,,,,,,11.5500,305.0000,fee schedule,$65.14 from Fee Schedule BLDTM_23 for Rev 306 Proc 87252 * Qty 1 = $65.14 at 100% = $65.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,BLUE CROSS E NETWORK,113.79,,,,,,,11.5500,305.0000,fee schedule,$35.56 from Fee Schedule BCFSB for Rev 306 Proc 87252 * Qty 1 = $35.56 at 320% = $113.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,BLUE CROSS MEDICARE,27.11,,,,,,,11.5500,305.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,BLUE CROSS P NETWORK,116.28,,,,,,,11.5500,305.0000,fee schedule,$35.56 from Fee Schedule BCFSB for Rev 306 Proc 87252 * Qty 1 = $35.56 at 327% = $116.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,BLUE CROSS S NETWORK,116.28,,,,,,,11.5500,305.0000,fee schedule,$35.56 from Fee Schedule BCFSB for Rev 306 Proc 87252 * Qty 1 = $35.56 at 327% = $116.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,TENNCARE BLUE CARE,58.79,,,,,,,11.5500,305.0000,fee schedule,$50.68 from Fee Schedule TC_24 for Rev 306 Proc 87252 * Qty 1 = $50.68 at 116% = $58.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,TENNCARE BLUE SELECT,58.79,,,,,,,11.5500,305.0000,fee schedule,$50.68 from Fee Schedule TC_24 for Rev 306 Proc 87252 * Qty 1 = $50.68 at 116% = $58.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,CIGNA HEALTHCARE,CIGNA HMO,104.88,,,,,,,11.5500,305.0000,fee schedule,$104.88 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87252 * Qty 1 = $104.88 at 100% = $104.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,57.74,,,,,,,11.5500,305.0000,fee schedule,$57.74 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87252 * Qty 1 = $57.74 at 100% = $57.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,27.37,,,,,,,11.5500,305.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,104.88,,,,,,,11.5500,305.0000,fee schedule,$104.88 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87252 * Qty 1 = $104.88 at 100% = $104.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,CIGNA HEALTHCARE,CIGNA PPO,104.88,,,,,,,11.5500,305.0000,fee schedule,$104.88 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87252 * Qty 1 = $104.88 at 100% = $104.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,27.37,,,,,,,11.5500,305.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,274.50,,,,,,,11.5500,305.0000,percent of total billed charges,90% of $305.00 in Billed Charges for Rev 306 Proc 87252 = $274.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,HUMANA,HUMANA MEDICARE,26.07,,,,,,,11.5500,305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,26.07,,,,,,,11.5500,305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,MEDCOST,MEDCOST VHN,145.15,,,,,,,11.5500,305.0000,percent of total billed charges,47.59% of $305.00 in Billed Charges for Rev 306 Proc 87252 = $145.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,11.5500,305.0000,fee schedule,APG 00396 Proc 87252 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,27.37,,,,,,,11.5500,305.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,27.37,,,,,,,11.5500,305.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,NHC ADVANTAGE,NHC ADVANTAGE,27.37,,,,,,,11.5500,305.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,11.5500,305.0000,fee schedule,APG 00396 Proc 87252 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,SENTARA HEALTH,SENTARA HEALTH,78.72,,,,,,,11.5500,305.0000,percent of total billed charges,25.81% of $305.00 in Billed Charges for Rev 306 Proc 87252 = $78.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,SENTARA HEALTH,SENTARA MEDICARE,26.07,,,,,,,11.5500,305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",305.00,,,,,,,11.5500,305.0000,percent of total billed charges,100% of $305.00 in Billed Charges for Rev 306 Proc 87252 = $305.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,18.46,,,,,,,11.5500,305.0000,fee schedule,$36.92 from Fee Schedule TCUHC24 for Rev 306 Proc 87252 * Qty 1 = $36.92 at 50% = $18.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,27.11,,,,,,,11.5500,305.0000,fee schedule,$26.07 from Fee Schedule UHC_31910 for Rev 306 Proc 87252 * Qty 1 = $26.07 at 104% = $27.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,26.07,,,,,,,11.5500,305.0000,fee schedule,$26.07 from Fee Schedule UHC_31910 for Rev 306 Proc 87252 * Qty 1 = $26.07 at 100% = $26.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,26.07,,,,,,,11.5500,305.0000,fee schedule,$26.07 from Fee Schedule UHC_31910 for Rev 306 Proc 87252 * Qty 1 = $26.07 at 100% = $26.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,11.5500,305.0000,fee schedule,APG 00396 Proc 87252 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,26.07,,,,,,,11.5500,305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,26.07,,,,,,,11.5500,305.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,WELLCARE,WELLCARE MEDICAID,305.00,,,,,,,11.5500,305.0000,percent of total billed charges,100% of $305.00 in Billed Charges for Rev 306 Proc 87252 = $305.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRUS CULTURE CYTOPATH EFFECT REF,87252,CPT,306,RC,30600039,CDM,,,,both,,,305.0000,45.7500,WELLCARE,WELLCARE MEDICARE,27.63,,,,,,,11.5500,305.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,AETNA,AETNA,97.36,,,,,,,6.3700,228.0000,percent of total billed charges,42.7% of $228.00 in Billed Charges for Rev 306 Proc 87254 = $97.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,6.3700,228.0000,fee schedule,APG 00396 Proc 87254 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,19.56,,,,,,,6.3700,228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,AETNA,AETNA HEALTHCARE MEDICARE,19.56,,,,,,,6.3700,228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,19.56,,,,,,,6.3700,228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,AMBETTER,AMBETTER,42.64,,,,,,,6.3700,228.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,AMERIGROUP,AMERIGROUP,9.78,,,,,,,6.3700,228.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,20.34,,,,,,,6.3700,228.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,ANTHEM EXCHANGE,19.56,,,,,,,6.3700,228.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,6.3700,228.0000,fee schedule,APG 00396 Proc 87254 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,ANTHEM HMO,19.56,,,,,,,6.3700,228.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,20.15,,,,,,,6.3700,228.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",19.56,,,,,,,6.3700,228.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,17.94,,,,,,,6.3700,228.0000,fee schedule,$17.94 from Fee Schedule BLDTM_23 for Rev 306 Proc 87254 * Qty 1 = $17.94 at 100% = $17.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,BLUE CROSS E NETWORK,85.38,,,,,,,6.3700,228.0000,fee schedule,$26.68 from Fee Schedule BCFSB for Rev 306 Proc 87254 * Qty 1 = $26.68 at 320% = $85.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,BLUE CROSS MEDICARE,20.34,,,,,,,6.3700,228.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,BLUE CROSS P NETWORK,87.24,,,,,,,6.3700,228.0000,fee schedule,$26.68 from Fee Schedule BCFSB for Rev 306 Proc 87254 * Qty 1 = $26.68 at 327% = $87.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,BLUE CROSS S NETWORK,87.24,,,,,,,6.3700,228.0000,fee schedule,$26.68 from Fee Schedule BCFSB for Rev 306 Proc 87254 * Qty 1 = $26.68 at 327% = $87.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,TENNCARE BLUE CARE,6.37,,,,,,,6.3700,228.0000,fee schedule,$5.49 from Fee Schedule TC_24 for Rev 306 Proc 87254 * Qty 1 = $5.49 at 116% = $6.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,BLUE CROSS,TENNCARE BLUE SELECT,6.37,,,,,,,6.3700,228.0000,fee schedule,$5.49 from Fee Schedule TC_24 for Rev 306 Proc 87254 * Qty 1 = $5.49 at 116% = $6.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,CIGNA HEALTHCARE,CIGNA HMO,78.70,,,,,,,6.3700,228.0000,fee schedule,$78.70 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87254 * Qty 1 = $78.70 at 100% = $78.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,43.31,,,,,,,6.3700,228.0000,fee schedule,$43.31 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87254 * Qty 1 = $43.31 at 100% = $43.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,20.54,,,,,,,6.3700,228.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,78.70,,,,,,,6.3700,228.0000,fee schedule,$78.70 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87254 * Qty 1 = $78.70 at 100% = $78.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,CIGNA HEALTHCARE,CIGNA PPO,78.70,,,,,,,6.3700,228.0000,fee schedule,$78.70 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87254 * Qty 1 = $78.70 at 100% = $78.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,20.54,,,,,,,6.3700,228.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,205.20,,,,,,,6.3700,228.0000,percent of total billed charges,90% of $228.00 in Billed Charges for Rev 306 Proc 87254 = $205.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,HUMANA,HUMANA MEDICARE,19.56,,,,,,,6.3700,228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,19.56,,,,,,,6.3700,228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,MEDCOST,MEDCOST VHN,108.51,,,,,,,6.3700,228.0000,percent of total billed charges,47.59% of $228.00 in Billed Charges for Rev 306 Proc 87254 = $108.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,6.3700,228.0000,fee schedule,APG 00396 Proc 87254 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,20.54,,,,,,,6.3700,228.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,20.54,,,,,,,6.3700,228.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,NHC ADVANTAGE,NHC ADVANTAGE,20.54,,,,,,,6.3700,228.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,6.3700,228.0000,fee schedule,APG 00396 Proc 87254 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,SENTARA HEALTH,SENTARA HEALTH,58.85,,,,,,,6.3700,228.0000,percent of total billed charges,25.81% of $228.00 in Billed Charges for Rev 306 Proc 87254 = $58.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,SENTARA HEALTH,SENTARA MEDICARE,19.56,,,,,,,6.3700,228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",228.00,,,,,,,6.3700,228.0000,percent of total billed charges,100% of $228.00 in Billed Charges for Rev 306 Proc 87254 = $228.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,13.85,,,,,,,6.3700,228.0000,fee schedule,$27.70 from Fee Schedule TCUHC24 for Rev 306 Proc 87254 * Qty 1 = $27.70 at 50% = $13.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,20.34,,,,,,,6.3700,228.0000,fee schedule,$19.56 from Fee Schedule UHC_31910 for Rev 306 Proc 87254 * Qty 1 = $19.56 at 104% = $20.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,19.56,,,,,,,6.3700,228.0000,fee schedule,$19.56 from Fee Schedule UHC_31910 for Rev 306 Proc 87254 * Qty 1 = $19.56 at 100% = $19.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,19.56,,,,,,,6.3700,228.0000,fee schedule,$19.56 from Fee Schedule UHC_31910 for Rev 306 Proc 87254 * Qty 1 = $19.56 at 100% = $19.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,6.3700,228.0000,fee schedule,APG 00396 Proc 87254 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,19.56,,,,,,,6.3700,228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,19.56,,,,,,,6.3700,228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,WELLCARE,WELLCARE MEDICAID,228.00,,,,,,,6.3700,228.0000,percent of total billed charges,100% of $228.00 in Billed Charges for Rev 306 Proc 87254 = $228.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRUS CULT SHELL VIAL STAIN REF,87254,CPT,306,RC,30600041,CDM,,,,both,,,228.0000,34.2000,WELLCARE,WELLCARE MEDICARE,20.73,,,,,,,6.3700,228.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,AETNA,AETNA,87.54,,,,,,,16.9300,205.0000,percent of total billed charges,42.7% of $205.00 in Billed Charges for Rev 306 Proc 87255 = $87.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,68.74,,,,,,,16.9300,205.0000,fee schedule,APG 00397 Proc 87255 at $836.60 (Base Rate) * 0.079 (Relative Weight) = $66.09 (Total Line Payment) at 104% = $68.74. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,33.86,,,,,,,16.9300,205.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,AETNA,AETNA HEALTHCARE MEDICARE,33.86,,,,,,,16.9300,205.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,33.86,,,,,,,16.9300,205.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,AMBETTER,AMBETTER,73.81,,,,,,,16.9300,205.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,AMERIGROUP,AMERIGROUP,16.93,,,,,,,16.9300,205.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,35.21,,,,,,,16.9300,205.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,BLUE CROSS,ANTHEM EXCHANGE,33.86,,,,,,,16.9300,205.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,68.07,,,,,,,16.9300,205.0000,fee schedule,APG 00397 Proc 87255 at $836.60 (Base Rate) * 0.079 (Relative Weight) = $66.09 (Total Line Payment) at 103% = $68.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,BLUE CROSS,ANTHEM HMO,33.86,,,,,,,16.9300,205.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,34.88,,,,,,,16.9300,205.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",33.86,,,,,,,16.9300,205.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,54.64,,,,,,,16.9300,205.0000,fee schedule,$54.64 from Fee Schedule BLDTM_23 for Rev 306 Proc 87255 * Qty 1 = $54.64 at 100% = $54.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,BLUE CROSS,BLUE CROSS E NETWORK,147.84,,,,,,,16.9300,205.0000,fee schedule,$46.20 from Fee Schedule BCFSB for Rev 306 Proc 87255 * Qty 1 = $46.20 at 320% = $147.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,BLUE CROSS,BLUE CROSS MEDICARE,35.21,,,,,,,16.9300,205.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,BLUE CROSS,BLUE CROSS P NETWORK,151.07,,,,,,,16.9300,205.0000,fee schedule,$46.20 from Fee Schedule BCFSB for Rev 306 Proc 87255 * Qty 1 = $46.20 at 327% = $151.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,BLUE CROSS,BLUE CROSS S NETWORK,151.07,,,,,,,16.9300,205.0000,fee schedule,$46.20 from Fee Schedule BCFSB for Rev 306 Proc 87255 * Qty 1 = $46.20 at 327% = $151.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,BLUE CROSS,TENNCARE BLUE CARE,42.75,,,,,,,16.9300,205.0000,fee schedule,$36.85 from Fee Schedule TC_24 for Rev 306 Proc 87255 * Qty 1 = $36.85 at 116% = $42.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,BLUE CROSS,TENNCARE BLUE SELECT,42.75,,,,,,,16.9300,205.0000,fee schedule,$36.85 from Fee Schedule TC_24 for Rev 306 Proc 87255 * Qty 1 = $36.85 at 116% = $42.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,CIGNA HEALTHCARE,CIGNA HMO,136.26,,,,,,,16.9300,205.0000,fee schedule,$136.26 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87255 * Qty 1 = $136.26 at 100% = $136.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,74.34,,,,,,,16.9300,205.0000,fee schedule,$74.34 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87255 * Qty 1 = $74.34 at 100% = $74.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,35.55,,,,,,,16.9300,205.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,136.26,,,,,,,16.9300,205.0000,fee schedule,$136.26 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87255 * Qty 1 = $136.26 at 100% = $136.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,CIGNA HEALTHCARE,CIGNA PPO,136.26,,,,,,,16.9300,205.0000,fee schedule,$136.26 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87255 * Qty 1 = $136.26 at 100% = $136.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,35.55,,,,,,,16.9300,205.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,184.50,,,,,,,16.9300,205.0000,percent of total billed charges,90% of $205.00 in Billed Charges for Rev 306 Proc 87255 = $184.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,HUMANA,HUMANA MEDICARE,33.86,,,,,,,16.9300,205.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,33.86,,,,,,,16.9300,205.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,MEDCOST,MEDCOST VHN,97.56,,,,,,,16.9300,205.0000,percent of total billed charges,47.59% of $205.00 in Billed Charges for Rev 306 Proc 87255 = $97.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,69.39,,,,,,,16.9300,205.0000,fee schedule,APG 00397 Proc 87255 at $836.60 (Base Rate) * 0.079 (Relative Weight) = $66.09 (Total Line Payment) at 100% = $66.09... $66.09 at 105% = $69.39 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,35.55,,,,,,,16.9300,205.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,35.55,,,,,,,16.9300,205.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,NHC ADVANTAGE,NHC ADVANTAGE,35.55,,,,,,,16.9300,205.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,68.14,,,,,,,16.9300,205.0000,fee schedule,APG 00397 Proc 87255 at $836.60 (Base Rate) * 0.079 (Relative Weight) = $66.09 (Total Line Payment) at 100% = $66.09... $66.09 at 103.1% = $68.14 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,SENTARA HEALTH,SENTARA HEALTH,52.91,,,,,,,16.9300,205.0000,percent of total billed charges,25.81% of $205.00 in Billed Charges for Rev 306 Proc 87255 = $52.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,SENTARA HEALTH,SENTARA MEDICARE,33.86,,,,,,,16.9300,205.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",205.00,,,,,,,16.9300,205.0000,percent of total billed charges,100% of $205.00 in Billed Charges for Rev 306 Proc 87255 = $205.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,23.99,,,,,,,16.9300,205.0000,fee schedule,$47.97 from Fee Schedule TCUHC24 for Rev 306 Proc 87255 * Qty 1 = $47.97 at 50% = $23.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,35.21,,,,,,,16.9300,205.0000,fee schedule,$33.86 from Fee Schedule UHC_31910 for Rev 306 Proc 87255 * Qty 1 = $33.86 at 104% = $35.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,33.86,,,,,,,16.9300,205.0000,fee schedule,$33.86 from Fee Schedule UHC_31910 for Rev 306 Proc 87255 * Qty 1 = $33.86 at 100% = $33.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,33.86,,,,,,,16.9300,205.0000,fee schedule,$33.86 from Fee Schedule UHC_31910 for Rev 306 Proc 87255 * Qty 1 = $33.86 at 100% = $33.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,68.07,,,,,,,16.9300,205.0000,fee schedule,APG 00397 Proc 87255 at $836.60 (Base Rate) * 0.079 (Relative Weight) = $66.09 (Total Line Payment) at 103% = $68.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,33.86,,,,,,,16.9300,205.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,33.86,,,,,,,16.9300,205.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,WELLCARE,WELLCARE MEDICAID,205.00,,,,,,,16.9300,205.0000,percent of total billed charges,100% of $205.00 in Billed Charges for Rev 306 Proc 87255 = $205.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VIRUS ISOLATION ID NON IMMUNO,87255,CPT,306,RC,30600042,CDM,,,,both,,,205.0000,30.7500,WELLCARE,WELLCARE MEDICARE,35.89,,,,,,,16.9300,205.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,AETNA,AETNA,31.60,,,,,,,7.2200,74.0000,percent of total billed charges,42.7% of $74.00 in Billed Charges for Rev 306 Proc 87260 = $31.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,7.2200,74.0000,fee schedule,APG 00396 Proc 87260 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,14.43,,,,,,,7.2200,74.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,AETNA,AETNA HEALTHCARE MEDICARE,14.43,,,,,,,7.2200,74.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,14.43,,,,,,,7.2200,74.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,AMBETTER,AMBETTER,31.46,,,,,,,7.2200,74.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,AMERIGROUP,AMERIGROUP,7.22,,,,,,,7.2200,74.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,15.01,,,,,,,7.2200,74.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,BLUE CROSS,ANTHEM EXCHANGE,14.43,,,,,,,7.2200,74.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,7.2200,74.0000,fee schedule,APG 00396 Proc 87260 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,BLUE CROSS,ANTHEM HMO,14.43,,,,,,,7.2200,74.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,14.86,,,,,,,7.2200,74.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",14.43,,,,,,,7.2200,74.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,34.21,,,,,,,7.2200,74.0000,fee schedule,$34.21 from Fee Schedule BLDTM_23 for Rev 306 Proc 87260 * Qty 1 = $34.21 at 100% = $34.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,BLUE CROSS,BLUE CROSS E NETWORK,49.98,,,,,,,7.2200,74.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 306 Proc 87260 * Qty 1 = $15.62 at 320% = $49.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,BLUE CROSS,BLUE CROSS MEDICARE,15.01,,,,,,,7.2200,74.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,BLUE CROSS,BLUE CROSS P NETWORK,51.08,,,,,,,7.2200,74.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 306 Proc 87260 * Qty 1 = $15.62 at 327% = $51.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,BLUE CROSS,BLUE CROSS S NETWORK,51.08,,,,,,,7.2200,74.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 306 Proc 87260 * Qty 1 = $15.62 at 327% = $51.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,BLUE CROSS,TENNCARE BLUE CARE,23.17,,,,,,,7.2200,74.0000,fee schedule,$19.97 from Fee Schedule TC_24 for Rev 306 Proc 87260 * Qty 1 = $19.97 at 116% = $23.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,BLUE CROSS,TENNCARE BLUE SELECT,23.17,,,,,,,7.2200,74.0000,fee schedule,$19.97 from Fee Schedule TC_24 for Rev 306 Proc 87260 * Qty 1 = $19.97 at 116% = $23.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,CIGNA HEALTHCARE,CIGNA HMO,48.24,,,,,,,7.2200,74.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87260 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,31.76,,,,,,,7.2200,74.0000,fee schedule,$31.76 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87260 * Qty 1 = $31.76 at 100% = $31.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,15.15,,,,,,,7.2200,74.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,48.24,,,,,,,7.2200,74.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87260 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,CIGNA HEALTHCARE,CIGNA PPO,48.24,,,,,,,7.2200,74.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87260 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,15.15,,,,,,,7.2200,74.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,66.60,,,,,,,7.2200,74.0000,percent of total billed charges,90% of $74.00 in Billed Charges for Rev 306 Proc 87260 = $66.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,HUMANA,HUMANA MEDICARE,14.43,,,,,,,7.2200,74.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,14.43,,,,,,,7.2200,74.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,MEDCOST,MEDCOST VHN,35.22,,,,,,,7.2200,74.0000,percent of total billed charges,47.59% of $74.00 in Billed Charges for Rev 306 Proc 87260 = $35.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,7.2200,74.0000,fee schedule,APG 00396 Proc 87260 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,15.15,,,,,,,7.2200,74.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,15.15,,,,,,,7.2200,74.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,NHC ADVANTAGE,NHC ADVANTAGE,15.15,,,,,,,7.2200,74.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,7.2200,74.0000,fee schedule,APG 00396 Proc 87260 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,SENTARA HEALTH,SENTARA HEALTH,19.10,,,,,,,7.2200,74.0000,percent of total billed charges,25.81% of $74.00 in Billed Charges for Rev 306 Proc 87260 = $19.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,SENTARA HEALTH,SENTARA MEDICARE,14.43,,,,,,,7.2200,74.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",74.00,,,,,,,7.2200,74.0000,percent of total billed charges,100% of $74.00 in Billed Charges for Rev 306 Proc 87260 = $74.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.50,,,,,,,7.2200,74.0000,fee schedule,$16.99 from Fee Schedule TCUHC24 for Rev 306 Proc 87260 * Qty 1 = $16.99 at 50% = $8.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,15.01,,,,,,,7.2200,74.0000,fee schedule,$14.43 from Fee Schedule UHC_31910 for Rev 306 Proc 87260 * Qty 1 = $14.43 at 104% = $15.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,14.43,,,,,,,7.2200,74.0000,fee schedule,$14.43 from Fee Schedule UHC_31910 for Rev 306 Proc 87260 * Qty 1 = $14.43 at 100% = $14.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,14.43,,,,,,,7.2200,74.0000,fee schedule,$14.43 from Fee Schedule UHC_31910 for Rev 306 Proc 87260 * Qty 1 = $14.43 at 100% = $14.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,7.2200,74.0000,fee schedule,APG 00396 Proc 87260 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,14.43,,,,,,,7.2200,74.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,14.43,,,,,,,7.2200,74.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,WELLCARE,WELLCARE MEDICAID,74.00,,,,,,,7.2200,74.0000,percent of total billed charges,100% of $74.00 in Billed Charges for Rev 306 Proc 87260 = $74.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADENOVIRUS AG IF,87260,CPT,306,RC,30600043,CDM,,,,both,,,74.0000,11.1000,WELLCARE,WELLCARE MEDICARE,15.30,,,,,,,7.2200,74.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA,57.22,,,,,,,5.9900,134.0000,percent of total billed charges,42.7% of $134.00 in Billed Charges for Rev 300 Proc 87274 = $57.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,5.9900,134.0000,fee schedule,APG 00396 Proc 87274 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA HEALTHCARE MEDICARE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,AMBETTER,AMBETTER,26.12,,,,,,,5.9900,134.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,AMERIGROUP,AMERIGROUP,5.99,,,,,,,5.9900,134.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,12.46,,,,,,,5.9900,134.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM EXCHANGE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,5.9900,134.0000,fee schedule,APG 00396 Proc 87274 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM HMO,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,12.34,,,,,,,5.9900,134.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,35.57,,,,,,,5.9900,134.0000,fee schedule,$35.57 from Fee Schedule BLDTM_23 for Rev 300 Proc 87274 * Qty 1 = $35.57 at 100% = $35.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS E NETWORK,49.98,,,,,,,5.9900,134.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 300 Proc 87274 * Qty 1 = $15.62 at 320% = $49.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS MEDICARE,12.46,,,,,,,5.9900,134.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS P NETWORK,51.08,,,,,,,5.9900,134.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 300 Proc 87274 * Qty 1 = $15.62 at 327% = $51.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS S NETWORK,51.08,,,,,,,5.9900,134.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 300 Proc 87274 * Qty 1 = $15.62 at 327% = $51.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,TENNCARE BLUE CARE,23.17,,,,,,,5.9900,134.0000,fee schedule,$19.97 from Fee Schedule TC_24 for Rev 300 Proc 87274 * Qty 1 = $19.97 at 116% = $23.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,TENNCARE BLUE SELECT,23.17,,,,,,,5.9900,134.0000,fee schedule,$19.97 from Fee Schedule TC_24 for Rev 300 Proc 87274 * Qty 1 = $19.97 at 116% = $23.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA HMO,48.24,,,,,,,5.9900,134.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 300 Proc 87274 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,26.71,,,,,,,5.9900,134.0000,fee schedule,$26.71 from Fee Schedule CGIFP_25LR for Rev 300 Proc 87274 * Qty 1 = $26.71 at 100% = $26.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,12.58,,,,,,,5.9900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,48.24,,,,,,,5.9900,134.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 300 Proc 87274 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA PPO,48.24,,,,,,,5.9900,134.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 300 Proc 87274 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,12.58,,,,,,,5.9900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,120.60,,,,,,,5.9900,134.0000,percent of total billed charges,90% of $134.00 in Billed Charges for Rev 300 Proc 87274 = $120.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,HUMANA,HUMANA MEDICARE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,MEDCOST,MEDCOST VHN,63.77,,,,,,,5.9900,134.0000,percent of total billed charges,47.59% of $134.00 in Billed Charges for Rev 300 Proc 87274 = $63.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,5.9900,134.0000,fee schedule,APG 00396 Proc 87274 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,12.58,,,,,,,5.9900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,12.58,,,,,,,5.9900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,NHC ADVANTAGE,NHC ADVANTAGE,12.58,,,,,,,5.9900,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,5.9900,134.0000,fee schedule,APG 00396 Proc 87274 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,SENTARA HEALTH,SENTARA HEALTH,34.59,,,,,,,5.9900,134.0000,percent of total billed charges,25.81% of $134.00 in Billed Charges for Rev 300 Proc 87274 = $34.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,SENTARA HEALTH,SENTARA MEDICARE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",134.00,,,,,,,5.9900,134.0000,percent of total billed charges,100% of $134.00 in Billed Charges for Rev 300 Proc 87274 = $134.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.50,,,,,,,5.9900,134.0000,fee schedule,$16.99 from Fee Schedule TCUHC24 for Rev 300 Proc 87274 * Qty 1 = $16.99 at 50% = $8.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12.46,,,,,,,5.9900,134.0000,fee schedule,$11.98 from Fee Schedule UHC_31910 for Rev 300 Proc 87274 * Qty 1 = $11.98 at 104% = $12.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11.98,,,,,,,5.9900,134.0000,fee schedule,$11.98 from Fee Schedule UHC_31910 for Rev 300 Proc 87274 * Qty 1 = $11.98 at 100% = $11.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,11.98,,,,,,,5.9900,134.0000,fee schedule,$11.98 from Fee Schedule UHC_31910 for Rev 300 Proc 87274 * Qty 1 = $11.98 at 100% = $11.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,5.9900,134.0000,fee schedule,APG 00396 Proc 87274 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,11.98,,,,,,,5.9900,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,WELLCARE,WELLCARE MEDICAID,134.00,,,,,,,5.9900,134.0000,percent of total billed charges,100% of $134.00 in Billed Charges for Rev 300 Proc 87274 = $134.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HERPES SIMPLEX 1 AG IF,87274,CPT,300,RC,30000201,CDM,,,,both,,,134.0000,20.1000,WELLCARE,WELLCARE MEDICARE,12.70,,,,,,,5.9900,134.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PROBE COOK SWARTZ DOPPLER LONG CUFF,272,RC,27200002,CDM,,,,,,both,,,5237.3600,785.6000,AETNA,AETNA,2236.35,,,,,,,1351.7600,5237.3600,percent of total billed charges,"42.7% of $5,237.36 in Billed Charges for Rev 272 = $2,236.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE COOK SWARTZ DOPPLER LONG CUFF,272,RC,27200002,CDM,,,,,,both,,,5237.3600,785.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3666.15,,,,,,,1351.7600,5237.3600,percent of total billed charges,"Rev 272 $5,237.36 in Billed Charges at 70% = $3,666.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE COOK SWARTZ DOPPLER LONG CUFF,272,RC,27200002,CDM,,,,,,both,,,5237.3600,785.6000,CIGNA HEALTHCARE,CIGNA HMO,2183.98,,,,,,,1351.7600,5237.3600,percent of total billed charges,"41.7% of $5,237.36 in Billed Charges for Rev 272 = $2,183.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE COOK SWARTZ DOPPLER LONG CUFF,272,RC,27200002,CDM,,,,,,both,,,5237.3600,785.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2430.14,,,,,,,1351.7600,5237.3600,percent of total billed charges,"46.4% of $5,237.36 in Billed Charges for Rev 272 = $2,430.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE COOK SWARTZ DOPPLER LONG CUFF,272,RC,27200002,CDM,,,,,,both,,,5237.3600,785.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2183.98,,,,,,,1351.7600,5237.3600,percent of total billed charges,"41.7% of $5,237.36 in Billed Charges for Rev 272 = $2,183.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE COOK SWARTZ DOPPLER LONG CUFF,272,RC,27200002,CDM,,,,,,both,,,5237.3600,785.6000,CIGNA HEALTHCARE,CIGNA PPO,2183.98,,,,,,,1351.7600,5237.3600,percent of total billed charges,"41.7% of $5,237.36 in Billed Charges for Rev 272 = $2,183.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE COOK SWARTZ DOPPLER LONG CUFF,272,RC,27200002,CDM,,,,,,both,,,5237.3600,785.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4713.62,,,,,,,1351.7600,5237.3600,percent of total billed charges,"90% of $5,237.36 in Billed Charges for Rev 272 = $4,713.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE COOK SWARTZ DOPPLER LONG CUFF,272,RC,27200002,CDM,,,,,,both,,,5237.3600,785.6000,MEDCOST,MEDCOST VHN,2492.46,,,,,,,1351.7600,5237.3600,percent of total billed charges,"47.59% of $5,237.36 in Billed Charges for Rev 272 = $2,492.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE COOK SWARTZ DOPPLER LONG CUFF,272,RC,27200002,CDM,,,,,,both,,,5237.3600,785.6000,SENTARA HEALTH,SENTARA HEALTH,1351.76,,,,,,,1351.7600,5237.3600,percent of total billed charges,"25.81% of $5,237.36 in Billed Charges for Rev 272 = $1,351.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE COOK SWARTZ DOPPLER LONG CUFF,272,RC,27200002,CDM,,,,,,both,,,5237.3600,785.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5237.36,,,,,,,1351.7600,5237.3600,percent of total billed charges,"100% of $5,237.36 in Billed Charges for Rev 272 = $5,237.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE COOK SWARTZ DOPPLER LONG CUFF,272,RC,27200002,CDM,,,,,,both,,,5237.3600,785.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2618.68,,,,,,,1351.7600,5237.3600,percent of total billed charges,"Rev 272 $5,237.36 in Billed Charges at 50% = $2,618.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE COOK SWARTZ DOPPLER LONG CUFF,272,RC,27200002,CDM,,,,,,both,,,5237.3600,785.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1691.67,,,,,,,1351.7600,5237.3600,other,"32.3% of $5,237.36 in Billed Charges for Rev 272 = $1,691.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE COOK SWARTZ DOPPLER LONG CUFF,272,RC,27200002,CDM,,,,,,both,,,5237.3600,785.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1607.87,,,,,,,1351.7600,5237.3600,other,"30.7% of $5,237.36 in Billed Charges for Rev 272 = $1,607.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE COOK SWARTZ DOPPLER LONG CUFF,272,RC,27200002,CDM,,,,,,both,,,5237.3600,785.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,1691.67,,,,,,,1351.7600,5237.3600,percent of total billed charges,"32.3% of $5,237.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE COOK SWARTZ DOPPLER LONG CUFF,272,RC,27200002,CDM,,,,,,both,,,5237.3600,785.6000,WELLCARE,WELLCARE MEDICAID,5237.36,,,,,,,1351.7600,5237.3600,percent of total billed charges,"100% of $5,237.36 in Billed Charges for Rev 272 = $5,237.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DISP MONOPOLAR CORD,272,RC,27200002,CDM,,,,,,both,,,757.0800,113.5600,AETNA,AETNA,323.27,,,,,,,195.4000,757.0800,percent of total billed charges,42.7% of $757.08 in Billed Charges for Rev 272 = $323.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE DISP MONOPOLAR CORD,272,RC,27200002,CDM,,,,,,both,,,757.0800,113.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,529.96,,,,,,,195.4000,757.0800,percent of total billed charges,Rev 272 $757.08 in Billed Charges at 70% = $529.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE DISP MONOPOLAR CORD,272,RC,27200002,CDM,,,,,,both,,,757.0800,113.5600,CIGNA HEALTHCARE,CIGNA HMO,315.70,,,,,,,195.4000,757.0800,percent of total billed charges,41.7% of $757.08 in Billed Charges for Rev 272 = $315.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE DISP MONOPOLAR CORD,272,RC,27200002,CDM,,,,,,both,,,757.0800,113.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,351.29,,,,,,,195.4000,757.0800,percent of total billed charges,46.4% of $757.08 in Billed Charges for Rev 272 = $351.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE DISP MONOPOLAR CORD,272,RC,27200002,CDM,,,,,,both,,,757.0800,113.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,315.70,,,,,,,195.4000,757.0800,percent of total billed charges,41.7% of $757.08 in Billed Charges for Rev 272 = $315.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE DISP MONOPOLAR CORD,272,RC,27200002,CDM,,,,,,both,,,757.0800,113.5600,CIGNA HEALTHCARE,CIGNA PPO,315.70,,,,,,,195.4000,757.0800,percent of total billed charges,41.7% of $757.08 in Billed Charges for Rev 272 = $315.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE DISP MONOPOLAR CORD,272,RC,27200002,CDM,,,,,,both,,,757.0800,113.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,681.37,,,,,,,195.4000,757.0800,percent of total billed charges,90% of $757.08 in Billed Charges for Rev 272 = $681.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE DISP MONOPOLAR CORD,272,RC,27200002,CDM,,,,,,both,,,757.0800,113.5600,MEDCOST,MEDCOST VHN,360.29,,,,,,,195.4000,757.0800,percent of total billed charges,47.59% of $757.08 in Billed Charges for Rev 272 = $360.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE DISP MONOPOLAR CORD,272,RC,27200002,CDM,,,,,,both,,,757.0800,113.5600,SENTARA HEALTH,SENTARA HEALTH,195.40,,,,,,,195.4000,757.0800,percent of total billed charges,25.81% of $757.08 in Billed Charges for Rev 272 = $195.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE DISP MONOPOLAR CORD,272,RC,27200002,CDM,,,,,,both,,,757.0800,113.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",757.08,,,,,,,195.4000,757.0800,percent of total billed charges,100% of $757.08 in Billed Charges for Rev 272 = $757.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE DISP MONOPOLAR CORD,272,RC,27200002,CDM,,,,,,both,,,757.0800,113.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,378.54,,,,,,,195.4000,757.0800,percent of total billed charges,Rev 272 $757.08 in Billed Charges at 50% = $378.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE DISP MONOPOLAR CORD,272,RC,27200002,CDM,,,,,,both,,,757.0800,113.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,244.54,,,,,,,195.4000,757.0800,other,32.3% of $757.08 in Billed Charges for Rev 272 = $244.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PROBE DISP MONOPOLAR CORD,272,RC,27200002,CDM,,,,,,both,,,757.0800,113.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,232.42,,,,,,,195.4000,757.0800,other,30.7% of $757.08 in Billed Charges for Rev 272 = $232.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PROBE DISP MONOPOLAR CORD,272,RC,27200002,CDM,,,,,,both,,,757.0800,113.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,244.54,,,,,,,195.4000,757.0800,percent of total billed charges,32.3% of $757.08 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE DISP MONOPOLAR CORD,272,RC,27200002,CDM,,,,,,both,,,757.0800,113.5600,WELLCARE,WELLCARE MEDICAID,757.08,,,,,,,195.4000,757.0800,percent of total billed charges,100% of $757.08 in Billed Charges for Rev 272 = $757.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PROBE DOPPLER FLOW COOK SWARTZ,272,RC,27200002,CDM,,,,,,both,,,5807.7600,871.1600,AETNA,AETNA,2479.91,,,,,,,1498.9800,5807.7600,percent of total billed charges,"42.7% of $5,807.76 in Billed Charges for Rev 272 = $2,479.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW COOK SWARTZ,272,RC,27200002,CDM,,,,,,both,,,5807.7600,871.1600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4065.43,,,,,,,1498.9800,5807.7600,percent of total billed charges,"Rev 272 $5,807.76 in Billed Charges at 70% = $4,065.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW COOK SWARTZ,272,RC,27200002,CDM,,,,,,both,,,5807.7600,871.1600,CIGNA HEALTHCARE,CIGNA HMO,2421.84,,,,,,,1498.9800,5807.7600,percent of total billed charges,"41.7% of $5,807.76 in Billed Charges for Rev 272 = $2,421.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW COOK SWARTZ,272,RC,27200002,CDM,,,,,,both,,,5807.7600,871.1600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2694.80,,,,,,,1498.9800,5807.7600,percent of total billed charges,"46.4% of $5,807.76 in Billed Charges for Rev 272 = $2,694.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW COOK SWARTZ,272,RC,27200002,CDM,,,,,,both,,,5807.7600,871.1600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2421.84,,,,,,,1498.9800,5807.7600,percent of total billed charges,"41.7% of $5,807.76 in Billed Charges for Rev 272 = $2,421.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW COOK SWARTZ,272,RC,27200002,CDM,,,,,,both,,,5807.7600,871.1600,CIGNA HEALTHCARE,CIGNA PPO,2421.84,,,,,,,1498.9800,5807.7600,percent of total billed charges,"41.7% of $5,807.76 in Billed Charges for Rev 272 = $2,421.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW COOK SWARTZ,272,RC,27200002,CDM,,,,,,both,,,5807.7600,871.1600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5226.98,,,,,,,1498.9800,5807.7600,percent of total billed charges,"90% of $5,807.76 in Billed Charges for Rev 272 = $5,226.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW COOK SWARTZ,272,RC,27200002,CDM,,,,,,both,,,5807.7600,871.1600,MEDCOST,MEDCOST VHN,2763.91,,,,,,,1498.9800,5807.7600,percent of total billed charges,"47.59% of $5,807.76 in Billed Charges for Rev 272 = $2,763.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW COOK SWARTZ,272,RC,27200002,CDM,,,,,,both,,,5807.7600,871.1600,SENTARA HEALTH,SENTARA HEALTH,1498.98,,,,,,,1498.9800,5807.7600,percent of total billed charges,"25.81% of $5,807.76 in Billed Charges for Rev 272 = $1,498.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW COOK SWARTZ,272,RC,27200002,CDM,,,,,,both,,,5807.7600,871.1600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5807.76,,,,,,,1498.9800,5807.7600,percent of total billed charges,"100% of $5,807.76 in Billed Charges for Rev 272 = $5,807.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW COOK SWARTZ,272,RC,27200002,CDM,,,,,,both,,,5807.7600,871.1600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2903.88,,,,,,,1498.9800,5807.7600,percent of total billed charges,"Rev 272 $5,807.76 in Billed Charges at 50% = $2,903.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW COOK SWARTZ,272,RC,27200002,CDM,,,,,,both,,,5807.7600,871.1600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1875.91,,,,,,,1498.9800,5807.7600,other,"32.3% of $5,807.76 in Billed Charges for Rev 272 = $1,875.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE DOPPLER FLOW COOK SWARTZ,272,RC,27200002,CDM,,,,,,both,,,5807.7600,871.1600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1782.98,,,,,,,1498.9800,5807.7600,other,"30.7% of $5,807.76 in Billed Charges for Rev 272 = $1,782.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE DOPPLER FLOW COOK SWARTZ,272,RC,27200002,CDM,,,,,,both,,,5807.7600,871.1600,UNITED HEALTHCARE,UNITED HEALTHCARE,1875.91,,,,,,,1498.9800,5807.7600,percent of total billed charges,"32.3% of $5,807.76 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW COOK SWARTZ,272,RC,27200002,CDM,,,,,,both,,,5807.7600,871.1600,WELLCARE,WELLCARE MEDICAID,5807.76,,,,,,,1498.9800,5807.7600,percent of total billed charges,"100% of $5,807.76 in Billed Charges for Rev 272 = $5,807.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER LOW PROFILE 9MM,272,RC,27200002,CDM,,,,,,both,,,2893.5100,434.0300,AETNA,AETNA,1235.53,,,,,,,746.8100,2893.5100,percent of total billed charges,"42.7% of $2,893.51 in Billed Charges for Rev 272 = $1,235.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER LOW PROFILE 9MM,272,RC,27200002,CDM,,,,,,both,,,2893.5100,434.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2025.46,,,,,,,746.8100,2893.5100,percent of total billed charges,"Rev 272 $2,893.51 in Billed Charges at 70% = $2,025.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER LOW PROFILE 9MM,272,RC,27200002,CDM,,,,,,both,,,2893.5100,434.0300,CIGNA HEALTHCARE,CIGNA HMO,1206.59,,,,,,,746.8100,2893.5100,percent of total billed charges,"41.7% of $2,893.51 in Billed Charges for Rev 272 = $1,206.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER LOW PROFILE 9MM,272,RC,27200002,CDM,,,,,,both,,,2893.5100,434.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1342.59,,,,,,,746.8100,2893.5100,percent of total billed charges,"46.4% of $2,893.51 in Billed Charges for Rev 272 = $1,342.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER LOW PROFILE 9MM,272,RC,27200002,CDM,,,,,,both,,,2893.5100,434.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1206.59,,,,,,,746.8100,2893.5100,percent of total billed charges,"41.7% of $2,893.51 in Billed Charges for Rev 272 = $1,206.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER LOW PROFILE 9MM,272,RC,27200002,CDM,,,,,,both,,,2893.5100,434.0300,CIGNA HEALTHCARE,CIGNA PPO,1206.59,,,,,,,746.8100,2893.5100,percent of total billed charges,"41.7% of $2,893.51 in Billed Charges for Rev 272 = $1,206.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER LOW PROFILE 9MM,272,RC,27200002,CDM,,,,,,both,,,2893.5100,434.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2604.16,,,,,,,746.8100,2893.5100,percent of total billed charges,"90% of $2,893.51 in Billed Charges for Rev 272 = $2,604.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER LOW PROFILE 9MM,272,RC,27200002,CDM,,,,,,both,,,2893.5100,434.0300,MEDCOST,MEDCOST VHN,1377.02,,,,,,,746.8100,2893.5100,percent of total billed charges,"47.59% of $2,893.51 in Billed Charges for Rev 272 = $1,377.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER LOW PROFILE 9MM,272,RC,27200002,CDM,,,,,,both,,,2893.5100,434.0300,SENTARA HEALTH,SENTARA HEALTH,746.81,,,,,,,746.8100,2893.5100,percent of total billed charges,"25.81% of $2,893.51 in Billed Charges for Rev 272 = $746.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER LOW PROFILE 9MM,272,RC,27200002,CDM,,,,,,both,,,2893.5100,434.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2893.51,,,,,,,746.8100,2893.5100,percent of total billed charges,"100% of $2,893.51 in Billed Charges for Rev 272 = $2,893.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER LOW PROFILE 9MM,272,RC,27200002,CDM,,,,,,both,,,2893.5100,434.0300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1446.76,,,,,,,746.8100,2893.5100,percent of total billed charges,"Rev 272 $2,893.51 in Billed Charges at 50% = $1,446.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER LOW PROFILE 9MM,272,RC,27200002,CDM,,,,,,both,,,2893.5100,434.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,934.60,,,,,,,746.8100,2893.5100,other,"32.3% of $2,893.51 in Billed Charges for Rev 272 = $934.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
REAMER LOW PROFILE 9MM,272,RC,27200002,CDM,,,,,,both,,,2893.5100,434.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,888.31,,,,,,,746.8100,2893.5100,other,"30.7% of $2,893.51 in Billed Charges for Rev 272 = $888.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
REAMER LOW PROFILE 9MM,272,RC,27200002,CDM,,,,,,both,,,2893.5100,434.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,934.60,,,,,,,746.8100,2893.5100,percent of total billed charges,"32.3% of $2,893.51 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER LOW PROFILE 9MM,272,RC,27200002,CDM,,,,,,both,,,2893.5100,434.0300,WELLCARE,WELLCARE MEDICAID,2893.51,,,,,,,746.8100,2893.5100,percent of total billed charges,"100% of $2,893.51 in Billed Charges for Rev 272 = $2,893.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA,57.22,,,,,,,7.8000,134.0000,percent of total billed charges,42.7% of $134.00 in Billed Charges for Rev 306 Proc 87278 = $57.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,7.8000,134.0000,fee schedule,APG 00396 Proc 87278 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,15.60,,,,,,,7.8000,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,AETNA,AETNA HEALTHCARE MEDICARE,15.60,,,,,,,7.8000,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,15.60,,,,,,,7.8000,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,AMBETTER,AMBETTER,34.01,,,,,,,7.8000,134.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,AMERIGROUP,AMERIGROUP,7.80,,,,,,,7.8000,134.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,16.22,,,,,,,7.8000,134.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM EXCHANGE,15.60,,,,,,,7.8000,134.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,7.8000,134.0000,fee schedule,APG 00396 Proc 87278 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM HMO,15.60,,,,,,,7.8000,134.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,16.07,,,,,,,7.8000,134.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",15.60,,,,,,,7.8000,134.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,34.21,,,,,,,7.8000,134.0000,fee schedule,$34.21 from Fee Schedule BLDTM_23 for Rev 306 Proc 87278 * Qty 1 = $34.21 at 100% = $34.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS E NETWORK,49.98,,,,,,,7.8000,134.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 306 Proc 87278 * Qty 1 = $15.62 at 320% = $49.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS MEDICARE,16.22,,,,,,,7.8000,134.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS P NETWORK,51.08,,,,,,,7.8000,134.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 306 Proc 87278 * Qty 1 = $15.62 at 327% = $51.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,BLUE CROSS S NETWORK,51.08,,,,,,,7.8000,134.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 306 Proc 87278 * Qty 1 = $15.62 at 327% = $51.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,TENNCARE BLUE CARE,23.17,,,,,,,7.8000,134.0000,fee schedule,$19.97 from Fee Schedule TC_24 for Rev 306 Proc 87278 * Qty 1 = $19.97 at 116% = $23.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,BLUE CROSS,TENNCARE BLUE SELECT,23.17,,,,,,,7.8000,134.0000,fee schedule,$19.97 from Fee Schedule TC_24 for Rev 306 Proc 87278 * Qty 1 = $19.97 at 116% = $23.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA HMO,48.24,,,,,,,7.8000,134.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87278 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,34.65,,,,,,,7.8000,134.0000,fee schedule,$34.65 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87278 * Qty 1 = $34.65 at 100% = $34.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,16.38,,,,,,,7.8000,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,48.24,,,,,,,7.8000,134.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87278 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,CIGNA HEALTHCARE,CIGNA PPO,48.24,,,,,,,7.8000,134.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87278 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,16.38,,,,,,,7.8000,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,120.60,,,,,,,7.8000,134.0000,percent of total billed charges,90% of $134.00 in Billed Charges for Rev 306 Proc 87278 = $120.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,HUMANA,HUMANA MEDICARE,15.60,,,,,,,7.8000,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,15.60,,,,,,,7.8000,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,MEDCOST,MEDCOST VHN,63.77,,,,,,,7.8000,134.0000,percent of total billed charges,47.59% of $134.00 in Billed Charges for Rev 306 Proc 87278 = $63.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,7.8000,134.0000,fee schedule,APG 00396 Proc 87278 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,16.38,,,,,,,7.8000,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,16.38,,,,,,,7.8000,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,NHC ADVANTAGE,NHC ADVANTAGE,16.38,,,,,,,7.8000,134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,7.8000,134.0000,fee schedule,APG 00396 Proc 87278 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,SENTARA HEALTH,SENTARA HEALTH,34.59,,,,,,,7.8000,134.0000,percent of total billed charges,25.81% of $134.00 in Billed Charges for Rev 306 Proc 87278 = $34.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,SENTARA HEALTH,SENTARA MEDICARE,15.60,,,,,,,7.8000,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",134.00,,,,,,,7.8000,134.0000,percent of total billed charges,100% of $134.00 in Billed Charges for Rev 306 Proc 87278 = $134.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.50,,,,,,,7.8000,134.0000,fee schedule,$16.99 from Fee Schedule TCUHC24 for Rev 306 Proc 87278 * Qty 1 = $16.99 at 50% = $8.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,16.22,,,,,,,7.8000,134.0000,fee schedule,$15.60 from Fee Schedule UHC_31910 for Rev 306 Proc 87278 * Qty 1 = $15.60 at 104% = $16.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,15.60,,,,,,,7.8000,134.0000,fee schedule,$15.60 from Fee Schedule UHC_31910 for Rev 306 Proc 87278 * Qty 1 = $15.60 at 100% = $15.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,15.60,,,,,,,7.8000,134.0000,fee schedule,$15.60 from Fee Schedule UHC_31910 for Rev 306 Proc 87278 * Qty 1 = $15.60 at 100% = $15.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,7.8000,134.0000,fee schedule,APG 00396 Proc 87278 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,15.60,,,,,,,7.8000,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,15.60,,,,,,,7.8000,134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,WELLCARE,WELLCARE MEDICAID,134.00,,,,,,,7.8000,134.0000,percent of total billed charges,100% of $134.00 in Billed Charges for Rev 306 Proc 87278 = $134.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LEGIONELLA PNEUMOPHILA AG IF,87278,CPT,306,RC,30600048,CDM,,,,both,,,134.0000,20.1000,WELLCARE,WELLCARE MEDICARE,16.54,,,,,,,7.8000,134.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,AETNA,AETNA,29.46,,,,,,,8.2200,69.0000,percent of total billed charges,42.7% of $69.00 in Billed Charges for Rev 306 Proc 87279 = $29.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,8.2200,69.0000,fee schedule,APG 00396 Proc 87279 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,16.43,,,,,,,8.2200,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,AETNA,AETNA HEALTHCARE MEDICARE,16.43,,,,,,,8.2200,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,16.43,,,,,,,8.2200,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,AMBETTER,AMBETTER,35.82,,,,,,,8.2200,69.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,AMERIGROUP,AMERIGROUP,8.22,,,,,,,8.2200,69.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,17.09,,,,,,,8.2200,69.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,ANTHEM EXCHANGE,16.43,,,,,,,8.2200,69.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,8.2200,69.0000,fee schedule,APG 00396 Proc 87279 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,ANTHEM HMO,16.43,,,,,,,8.2200,69.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,16.92,,,,,,,8.2200,69.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",16.43,,,,,,,8.2200,69.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,42.08,,,,,,,8.2200,69.0000,fee schedule,$42.08 from Fee Schedule BLDTM_23 for Rev 306 Proc 87279 * Qty 1 = $42.08 at 100% = $42.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS E NETWORK,49.98,,,,,,,8.2200,69.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 306 Proc 87279 * Qty 1 = $15.62 at 320% = $49.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS MEDICARE,17.09,,,,,,,8.2200,69.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS P NETWORK,51.08,,,,,,,8.2200,69.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 306 Proc 87279 * Qty 1 = $15.62 at 327% = $51.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,BLUE CROSS S NETWORK,51.08,,,,,,,8.2200,69.0000,fee schedule,$15.62 from Fee Schedule BCFSB for Rev 306 Proc 87279 * Qty 1 = $15.62 at 327% = $51.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,TENNCARE BLUE CARE,14.93,,,,,,,8.2200,69.0000,fee schedule,$12.87 from Fee Schedule TC_24 for Rev 306 Proc 87279 * Qty 1 = $12.87 at 116% = $14.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,BLUE CROSS,TENNCARE BLUE SELECT,14.93,,,,,,,8.2200,69.0000,fee schedule,$12.87 from Fee Schedule TC_24 for Rev 306 Proc 87279 * Qty 1 = $12.87 at 116% = $14.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA HMO,48.24,,,,,,,8.2200,69.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87279 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,36.09,,,,,,,8.2200,69.0000,fee schedule,$36.09 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87279 * Qty 1 = $36.09 at 100% = $36.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,17.25,,,,,,,8.2200,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,48.24,,,,,,,8.2200,69.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87279 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,CIGNA HEALTHCARE,CIGNA PPO,48.24,,,,,,,8.2200,69.0000,fee schedule,$48.24 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87279 * Qty 1 = $48.24 at 100% = $48.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,17.25,,,,,,,8.2200,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,62.10,,,,,,,8.2200,69.0000,percent of total billed charges,90% of $69.00 in Billed Charges for Rev 306 Proc 87279 = $62.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,HUMANA,HUMANA MEDICARE,16.43,,,,,,,8.2200,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,16.43,,,,,,,8.2200,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,MEDCOST,MEDCOST VHN,32.84,,,,,,,8.2200,69.0000,percent of total billed charges,47.59% of $69.00 in Billed Charges for Rev 306 Proc 87279 = $32.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,8.2200,69.0000,fee schedule,APG 00396 Proc 87279 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,17.25,,,,,,,8.2200,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,17.25,,,,,,,8.2200,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,NHC ADVANTAGE,NHC ADVANTAGE,17.25,,,,,,,8.2200,69.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,8.2200,69.0000,fee schedule,APG 00396 Proc 87279 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,SENTARA HEALTH,SENTARA HEALTH,17.81,,,,,,,8.2200,69.0000,percent of total billed charges,25.81% of $69.00 in Billed Charges for Rev 306 Proc 87279 = $17.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,SENTARA HEALTH,SENTARA MEDICARE,16.43,,,,,,,8.2200,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",69.00,,,,,,,8.2200,69.0000,percent of total billed charges,100% of $69.00 in Billed Charges for Rev 306 Proc 87279 = $69.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.50,,,,,,,8.2200,69.0000,fee schedule,$16.99 from Fee Schedule TCUHC24 for Rev 306 Proc 87279 * Qty 1 = $16.99 at 50% = $8.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,17.09,,,,,,,8.2200,69.0000,fee schedule,$16.43 from Fee Schedule UHC_31910 for Rev 306 Proc 87279 * Qty 1 = $16.43 at 104% = $17.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,16.43,,,,,,,8.2200,69.0000,fee schedule,$16.43 from Fee Schedule UHC_31910 for Rev 306 Proc 87279 * Qty 1 = $16.43 at 100% = $16.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,16.43,,,,,,,8.2200,69.0000,fee schedule,$16.43 from Fee Schedule UHC_31910 for Rev 306 Proc 87279 * Qty 1 = $16.43 at 100% = $16.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,8.2200,69.0000,fee schedule,APG 00396 Proc 87279 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,16.43,,,,,,,8.2200,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,16.43,,,,,,,8.2200,69.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,WELLCARE,WELLCARE MEDICAID,69.00,,,,,,,8.2200,69.0000,percent of total billed charges,100% of $69.00 in Billed Charges for Rev 306 Proc 87279 = $69.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PARAINFLU VIRUS AG IF EACH TYPE,87279,CPT,306,RC,30600049,CDM,,,,both,,,69.0000,10.3500,WELLCARE,WELLCARE MEDICARE,17.42,,,,,,,8.2200,69.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,AETNA,AETNA,1105.50,,,,,,,128.7300,2589.0000,percent of total billed charges,"42.7% of $2,589.00 in Billed Charges for Rev 306 Proc 87901 = $1,105.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,189.06,,,,,,,128.7300,2589.0000,fee schedule,APG 00386 Proc 87901 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 104% = $189.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,257.45,,,,,,,128.7300,2589.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,AETNA,AETNA HEALTHCARE MEDICARE,257.45,,,,,,,128.7300,2589.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,257.45,,,,,,,128.7300,2589.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,AMBETTER,AMBETTER,561.24,,,,,,,128.7300,2589.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,AMERIGROUP,AMERIGROUP,128.73,,,,,,,128.7300,2589.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,267.75,,,,,,,128.7300,2589.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,ANTHEM EXCHANGE,257.45,,,,,,,128.7300,2589.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,187.25,,,,,,,128.7300,2589.0000,fee schedule,APG 00386 Proc 87901 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,ANTHEM HMO,257.45,,,,,,,128.7300,2589.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,265.17,,,,,,,128.7300,2589.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",257.45,,,,,,,128.7300,2589.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,660.24,,,,,,,128.7300,2589.0000,fee schedule,$660.24 from Fee Schedule BLDTM_23 for Rev 306 Proc 87901 * Qty 1 = $660.24 at 100% = $660.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,BLUE CROSS E NETWORK,785.18,,,,,,,128.7300,2589.0000,fee schedule,$245.37 from Fee Schedule BCFSB for Rev 306 Proc 87901 * Qty 1 = $245.37 at 320% = $785.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,BLUE CROSS MEDICARE,267.75,,,,,,,128.7300,2589.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,BLUE CROSS P NETWORK,802.36,,,,,,,128.7300,2589.0000,fee schedule,$245.37 from Fee Schedule BCFSB for Rev 306 Proc 87901 * Qty 1 = $245.37 at 327% = $802.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,BLUE CROSS S NETWORK,802.36,,,,,,,128.7300,2589.0000,fee schedule,$245.37 from Fee Schedule BCFSB for Rev 306 Proc 87901 * Qty 1 = $245.37 at 327% = $802.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,TENNCARE BLUE CARE,234.23,,,,,,,128.7300,2589.0000,fee schedule,$201.92 from Fee Schedule TC_24 for Rev 306 Proc 87901 * Qty 1 = $201.92 at 116% = $234.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,TENNCARE BLUE SELECT,234.23,,,,,,,128.7300,2589.0000,fee schedule,$201.92 from Fee Schedule TC_24 for Rev 306 Proc 87901 * Qty 1 = $201.92 at 116% = $234.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,CIGNA HEALTHCARE,CIGNA HMO,1035.78,,,,,,,128.7300,2589.0000,fee schedule,"$1,035.78 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87901 * Qty 1 = $1,035.78 at 100% = $1,035.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,567.32,,,,,,,128.7300,2589.0000,fee schedule,$567.32 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87901 * Qty 1 = $567.32 at 100% = $567.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,270.32,,,,,,,128.7300,2589.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1035.78,,,,,,,128.7300,2589.0000,fee schedule,"$1,035.78 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87901 * Qty 1 = $1,035.78 at 100% = $1,035.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,CIGNA HEALTHCARE,CIGNA PPO,1035.78,,,,,,,128.7300,2589.0000,fee schedule,"$1,035.78 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87901 * Qty 1 = $1,035.78 at 100% = $1,035.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,270.32,,,,,,,128.7300,2589.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2330.10,,,,,,,128.7300,2589.0000,percent of total billed charges,"90% of $2,589.00 in Billed Charges for Rev 306 Proc 87901 = $2,330.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,HUMANA,HUMANA MEDICARE,257.45,,,,,,,128.7300,2589.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,257.45,,,,,,,128.7300,2589.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,MEDCOST,MEDCOST VHN,1232.11,,,,,,,128.7300,2589.0000,percent of total billed charges,"47.59% of $2,589.00 in Billed Charges for Rev 306 Proc 87901 = $1,232.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,190.88,,,,,,,128.7300,2589.0000,fee schedule,APG 00386 Proc 87901 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 105% = $190.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,270.32,,,,,,,128.7300,2589.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,270.32,,,,,,,128.7300,2589.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,NHC ADVANTAGE,NHC ADVANTAGE,270.32,,,,,,,128.7300,2589.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,187.43,,,,,,,128.7300,2589.0000,fee schedule,APG 00386 Proc 87901 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 100% = $181.79... $181.79 at 103.1% = $187.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,SENTARA HEALTH,SENTARA HEALTH,668.22,,,,,,,128.7300,2589.0000,percent of total billed charges,"25.81% of $2,589.00 in Billed Charges for Rev 306 Proc 87901 = $668.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,SENTARA HEALTH,SENTARA MEDICARE,257.45,,,,,,,128.7300,2589.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2589.00,,,,,,,128.7300,2589.0000,percent of total billed charges,"100% of $2,589.00 in Billed Charges for Rev 306 Proc 87901 = $2,589.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,182.32,,,,,,,128.7300,2589.0000,fee schedule,$364.64 from Fee Schedule TCUHC24 for Rev 306 Proc 87901 * Qty 1 = $364.64 at 50% = $182.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,267.75,,,,,,,128.7300,2589.0000,fee schedule,$257.45 from Fee Schedule UHC_31910 for Rev 306 Proc 87901 * Qty 1 = $257.45 at 104% = $267.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,257.45,,,,,,,128.7300,2589.0000,fee schedule,$257.45 from Fee Schedule UHC_31910 for Rev 306 Proc 87901 * Qty 1 = $257.45 at 100% = $257.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,257.45,,,,,,,128.7300,2589.0000,fee schedule,$257.45 from Fee Schedule UHC_31910 for Rev 306 Proc 87901 * Qty 1 = $257.45 at 100% = $257.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,187.25,,,,,,,128.7300,2589.0000,fee schedule,APG 00386 Proc 87901 at $836.60 (Base Rate) * 0.2173 (Relative Weight) = $181.79 (Total Line Payment) at 103% = $187.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,257.45,,,,,,,128.7300,2589.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,257.45,,,,,,,128.7300,2589.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,WELLCARE,WELLCARE MEDICAID,2589.00,,,,,,,128.7300,2589.0000,percent of total billed charges,"100% of $2,589.00 in Billed Charges for Rev 306 Proc 87901 = $2,589.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GENOTYPE DNA HIV REVERSE T,87901,CPT,306,RC,30600099,CDM,,,,both,,,2589.0000,388.3500,WELLCARE,WELLCARE MEDICARE,272.90,,,,,,,128.7300,2589.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,AETNA,AETNA,2435.61,,,,,,,244.3300,5704.0000,percent of total billed charges,"42.7% of $5,704.00 in Billed Charges for Rev 306 Proc 87903 = $2,435.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,421.46,,,,,,,244.3300,5704.0000,fee schedule,APG 00387 Proc 87903 at $836.60 (Base Rate) * 0.4844 (Relative Weight) = $405.25 (Total Line Payment) at 104% = $421.46. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,488.66,,,,,,,244.3300,5704.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,AETNA,AETNA HEALTHCARE MEDICARE,488.66,,,,,,,244.3300,5704.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,488.66,,,,,,,244.3300,5704.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,AMBETTER,AMBETTER,1065.28,,,,,,,244.3300,5704.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,AMERIGROUP,AMERIGROUP,244.33,,,,,,,244.3300,5704.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,508.21,,,,,,,244.3300,5704.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,BLUE CROSS,ANTHEM EXCHANGE,488.66,,,,,,,244.3300,5704.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,417.41,,,,,,,244.3300,5704.0000,fee schedule,APG 00387 Proc 87903 at $836.60 (Base Rate) * 0.4844 (Relative Weight) = $405.25 (Total Line Payment) at 103% = $417.41. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,BLUE CROSS,ANTHEM HMO,488.66,,,,,,,244.3300,5704.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,503.32,,,,,,,244.3300,5704.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",488.66,,,,,,,244.3300,5704.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1793.90,,,,,,,244.3300,5704.0000,fee schedule,"$1,793.90 from Fee Schedule BLDTM_23 for Rev 306 Proc 87903 * Qty 1 = $1,793.90 at 100% = $1,793.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,BLUE CROSS,BLUE CROSS E NETWORK,2133.25,,,,,,,244.3300,5704.0000,fee schedule,"$666.64 from Fee Schedule BCFSB for Rev 306 Proc 87903 * Qty 1 = $666.64 at 320% = $2,133.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,BLUE CROSS,BLUE CROSS MEDICARE,508.21,,,,,,,244.3300,5704.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,BLUE CROSS,BLUE CROSS P NETWORK,2179.91,,,,,,,244.3300,5704.0000,fee schedule,"$666.64 from Fee Schedule BCFSB for Rev 306 Proc 87903 * Qty 1 = $666.64 at 327% = $2,179.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,BLUE CROSS,BLUE CROSS S NETWORK,2179.91,,,,,,,244.3300,5704.0000,fee schedule,"$666.64 from Fee Schedule BCFSB for Rev 306 Proc 87903 * Qty 1 = $666.64 at 327% = $2,179.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,BLUE CROSS,TENNCARE BLUE CARE,636.42,,,,,,,244.3300,5704.0000,fee schedule,$548.64 from Fee Schedule TC_24 for Rev 306 Proc 87903 * Qty 1 = $548.64 at 116% = $636.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,BLUE CROSS,TENNCARE BLUE SELECT,636.42,,,,,,,244.3300,5704.0000,fee schedule,$548.64 from Fee Schedule TC_24 for Rev 306 Proc 87903 * Qty 1 = $548.64 at 116% = $636.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,CIGNA HEALTHCARE,CIGNA HMO,1965.93,,,,,,,244.3300,5704.0000,fee schedule,"$1,965.93 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87903 * Qty 1 = $1,965.93 at 100% = $1,965.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1076.90,,,,,,,244.3300,5704.0000,fee schedule,"$1,076.90 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87903 * Qty 1 = $1,076.90 at 100% = $1,076.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,513.09,,,,,,,244.3300,5704.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1965.93,,,,,,,244.3300,5704.0000,fee schedule,"$1,965.93 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87903 * Qty 1 = $1,965.93 at 100% = $1,965.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,CIGNA HEALTHCARE,CIGNA PPO,1965.93,,,,,,,244.3300,5704.0000,fee schedule,"$1,965.93 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87903 * Qty 1 = $1,965.93 at 100% = $1,965.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,513.09,,,,,,,244.3300,5704.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5133.60,,,,,,,244.3300,5704.0000,percent of total billed charges,"90% of $5,704.00 in Billed Charges for Rev 306 Proc 87903 = $5,133.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,HUMANA,HUMANA MEDICARE,488.66,,,,,,,244.3300,5704.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,488.66,,,,,,,244.3300,5704.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,MEDCOST,MEDCOST VHN,2714.53,,,,,,,244.3300,5704.0000,percent of total billed charges,"47.59% of $5,704.00 in Billed Charges for Rev 306 Proc 87903 = $2,714.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,425.51,,,,,,,244.3300,5704.0000,fee schedule,APG 00387 Proc 87903 at $836.60 (Base Rate) * 0.4844 (Relative Weight) = $405.25 (Total Line Payment) at 100% = $405.25... $405.25 at 105% = $425.51 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,513.09,,,,,,,244.3300,5704.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,513.09,,,,,,,244.3300,5704.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,NHC ADVANTAGE,NHC ADVANTAGE,513.09,,,,,,,244.3300,5704.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,417.81,,,,,,,244.3300,5704.0000,fee schedule,APG 00387 Proc 87903 at $836.60 (Base Rate) * 0.4844 (Relative Weight) = $405.25 (Total Line Payment) at 100% = $405.25... $405.25 at 103.1% = $417.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,SENTARA HEALTH,SENTARA HEALTH,1472.20,,,,,,,244.3300,5704.0000,percent of total billed charges,"25.81% of $5,704.00 in Billed Charges for Rev 306 Proc 87903 = $1,472.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,SENTARA HEALTH,SENTARA MEDICARE,488.66,,,,,,,244.3300,5704.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5704.00,,,,,,,244.3300,5704.0000,percent of total billed charges,"100% of $5,704.00 in Billed Charges for Rev 306 Proc 87903 = $5,704.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,346.05,,,,,,,244.3300,5704.0000,fee schedule,$692.10 from Fee Schedule TCUHC24 for Rev 306 Proc 87903 * Qty 1 = $692.10 at 50% = $346.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,508.21,,,,,,,244.3300,5704.0000,fee schedule,$488.66 from Fee Schedule UHC_31910 for Rev 306 Proc 87903 * Qty 1 = $488.66 at 104% = $508.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,488.66,,,,,,,244.3300,5704.0000,fee schedule,$488.66 from Fee Schedule UHC_31910 for Rev 306 Proc 87903 * Qty 1 = $488.66 at 100% = $488.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,488.66,,,,,,,244.3300,5704.0000,fee schedule,$488.66 from Fee Schedule UHC_31910 for Rev 306 Proc 87903 * Qty 1 = $488.66 at 100% = $488.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,417.41,,,,,,,244.3300,5704.0000,fee schedule,APG 00387 Proc 87903 at $836.60 (Base Rate) * 0.4844 (Relative Weight) = $405.25 (Total Line Payment) at 103% = $417.41. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,488.66,,,,,,,244.3300,5704.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,488.66,,,,,,,244.3300,5704.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,WELLCARE,WELLCARE MEDICAID,5704.00,,,,,,,244.3300,5704.0000,percent of total billed charges,"100% of $5,704.00 in Billed Charges for Rev 306 Proc 87903 = $5,704.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INF AGT PHENO DNA RNA HIV1 1-10,87903,CPT,306,RC,30600096,CDM,,,,both,,,5704.0000,855.6000,WELLCARE,WELLCARE MEDICARE,517.98,,,,,,,244.3300,5704.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,AETNA,AETNA,60.63,,,,,,,6.1100,142.0000,percent of total billed charges,42.7% of $142.00 in Billed Charges for Rev 306 Proc 87905 = $60.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11.66,,,,,,,6.1100,142.0000,fee schedule,APG 00396 Proc 87905 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 104% = $11.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,12.22,,,,,,,6.1100,142.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,AETNA,AETNA HEALTHCARE MEDICARE,12.22,,,,,,,6.1100,142.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,12.22,,,,,,,6.1100,142.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,AMBETTER,AMBETTER,26.64,,,,,,,6.1100,142.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,AMERIGROUP,AMERIGROUP,6.11,,,,,,,6.1100,142.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,12.71,,,,,,,6.1100,142.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,BLUE CROSS,ANTHEM EXCHANGE,12.22,,,,,,,6.1100,142.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11.55,,,,,,,6.1100,142.0000,fee schedule,APG 00396 Proc 87905 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,BLUE CROSS,ANTHEM HMO,12.22,,,,,,,6.1100,142.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,12.59,,,,,,,6.1100,142.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",12.22,,,,,,,6.1100,142.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,17.84,,,,,,,6.1100,142.0000,fee schedule,$17.84 from Fee Schedule BLDTM_23 for Rev 306 Proc 87905 * Qty 1 = $17.84 at 100% = $17.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,BLUE CROSS,BLUE CROSS E NETWORK,53.34,,,,,,,6.1100,142.0000,fee schedule,$16.67 from Fee Schedule BCFSB for Rev 306 Proc 87905 * Qty 1 = $16.67 at 320% = $53.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,BLUE CROSS,BLUE CROSS MEDICARE,12.71,,,,,,,6.1100,142.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,BLUE CROSS,BLUE CROSS P NETWORK,54.51,,,,,,,6.1100,142.0000,fee schedule,$16.67 from Fee Schedule BCFSB for Rev 306 Proc 87905 * Qty 1 = $16.67 at 327% = $54.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,BLUE CROSS,BLUE CROSS S NETWORK,54.51,,,,,,,6.1100,142.0000,fee schedule,$16.67 from Fee Schedule BCFSB for Rev 306 Proc 87905 * Qty 1 = $16.67 at 327% = $54.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,BLUE CROSS,TENNCARE BLUE CARE,16.81,,,,,,,6.1100,142.0000,fee schedule,$14.49 from Fee Schedule TC_24 for Rev 306 Proc 87905 * Qty 1 = $14.49 at 116% = $16.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,BLUE CROSS,TENNCARE BLUE SELECT,16.81,,,,,,,6.1100,142.0000,fee schedule,$14.49 from Fee Schedule TC_24 for Rev 306 Proc 87905 * Qty 1 = $14.49 at 116% = $16.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,CIGNA HEALTHCARE,CIGNA HMO,49.16,,,,,,,6.1100,142.0000,fee schedule,$49.16 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87905 * Qty 1 = $49.16 at 100% = $49.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,26.71,,,,,,,6.1100,142.0000,fee schedule,$26.71 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87905 * Qty 1 = $26.71 at 100% = $26.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,12.83,,,,,,,6.1100,142.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,49.16,,,,,,,6.1100,142.0000,fee schedule,$49.16 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87905 * Qty 1 = $49.16 at 100% = $49.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,CIGNA HEALTHCARE,CIGNA PPO,49.16,,,,,,,6.1100,142.0000,fee schedule,$49.16 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87905 * Qty 1 = $49.16 at 100% = $49.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,12.83,,,,,,,6.1100,142.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,127.80,,,,,,,6.1100,142.0000,percent of total billed charges,90% of $142.00 in Billed Charges for Rev 306 Proc 87905 = $127.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,HUMANA,HUMANA MEDICARE,12.22,,,,,,,6.1100,142.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,12.22,,,,,,,6.1100,142.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,MEDCOST,MEDCOST VHN,67.58,,,,,,,6.1100,142.0000,percent of total billed charges,47.59% of $142.00 in Billed Charges for Rev 306 Proc 87905 = $67.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11.77,,,,,,,6.1100,142.0000,fee schedule,APG 00396 Proc 87905 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 105% = $11.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,12.83,,,,,,,6.1100,142.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,12.83,,,,,,,6.1100,142.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,NHC ADVANTAGE,NHC ADVANTAGE,12.83,,,,,,,6.1100,142.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11.56,,,,,,,6.1100,142.0000,fee schedule,APG 00396 Proc 87905 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 100% = $11.21... $11.21 at 103.1% = $11.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,SENTARA HEALTH,SENTARA HEALTH,36.65,,,,,,,6.1100,142.0000,percent of total billed charges,25.81% of $142.00 in Billed Charges for Rev 306 Proc 87905 = $36.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,SENTARA HEALTH,SENTARA MEDICARE,12.22,,,,,,,6.1100,142.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",142.00,,,,,,,6.1100,142.0000,percent of total billed charges,100% of $142.00 in Billed Charges for Rev 306 Proc 87905 = $142.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.66,,,,,,,6.1100,142.0000,fee schedule,$17.31 from Fee Schedule TCUHC24 for Rev 306 Proc 87905 * Qty 1 = $17.31 at 50% = $8.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12.71,,,,,,,6.1100,142.0000,fee schedule,$12.22 from Fee Schedule UHC_31910 for Rev 306 Proc 87905 * Qty 1 = $12.22 at 104% = $12.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,12.22,,,,,,,6.1100,142.0000,fee schedule,$12.22 from Fee Schedule UHC_31910 for Rev 306 Proc 87905 * Qty 1 = $12.22 at 100% = $12.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,12.22,,,,,,,6.1100,142.0000,fee schedule,$12.22 from Fee Schedule UHC_31910 for Rev 306 Proc 87905 * Qty 1 = $12.22 at 100% = $12.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11.55,,,,,,,6.1100,142.0000,fee schedule,APG 00396 Proc 87905 at $836.60 (Base Rate) * 0.0134 (Relative Weight) = $11.21 (Total Line Payment) at 103% = $11.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,12.22,,,,,,,6.1100,142.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,12.22,,,,,,,6.1100,142.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,WELLCARE,WELLCARE MEDICAID,142.00,,,,,,,6.1100,142.0000,percent of total billed charges,100% of $142.00 in Billed Charges for Rev 306 Proc 87905 = $142.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INF AGT ENZYM ACT OTHER THAN VRUS,87905,CPT,306,RC,30600098,CDM,,,,both,,,142.0000,21.3000,WELLCARE,WELLCARE MEDICARE,12.95,,,,,,,6.1100,142.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,AETNA,AETNA,506.85,,,,,,,64.3700,1187.0000,percent of total billed charges,"42.7% of $1,187.00 in Billed Charges for Rev 306 Proc 87906 = $506.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,212.56,,,,,,,64.3700,1187.0000,fee schedule,APG 00388 Proc 87906 at $836.60 (Base Rate) * 0.2443 (Relative Weight) = $204.38 (Total Line Payment) at 104% = $212.56. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,128.73,,,,,,,64.3700,1187.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,AETNA,AETNA HEALTHCARE MEDICARE,128.73,,,,,,,64.3700,1187.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,128.73,,,,,,,64.3700,1187.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,AMBETTER,AMBETTER,280.63,,,,,,,64.3700,1187.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,AMERIGROUP,AMERIGROUP,64.37,,,,,,,64.3700,1187.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,133.88,,,,,,,64.3700,1187.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,BLUE CROSS,ANTHEM EXCHANGE,128.73,,,,,,,64.3700,1187.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,210.51,,,,,,,64.3700,1187.0000,fee schedule,APG 00388 Proc 87906 at $836.60 (Base Rate) * 0.2443 (Relative Weight) = $204.38 (Total Line Payment) at 103% = $210.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,BLUE CROSS,ANTHEM HMO,128.73,,,,,,,64.3700,1187.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,132.59,,,,,,,64.3700,1187.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",128.73,,,,,,,64.3700,1187.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,126.54,,,,,,,64.3700,1187.0000,fee schedule,$126.54 from Fee Schedule BLDTM_23 for Rev 306 Proc 87906 * Qty 1 = $126.54 at 100% = $126.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,BLUE CROSS,BLUE CROSS E NETWORK,392.54,,,,,,,64.3700,1187.0000,fee schedule,$122.67 from Fee Schedule BCFSB for Rev 306 Proc 87906 * Qty 1 = $122.67 at 320% = $392.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,BLUE CROSS,BLUE CROSS MEDICARE,133.88,,,,,,,64.3700,1187.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,BLUE CROSS,BLUE CROSS P NETWORK,401.13,,,,,,,64.3700,1187.0000,fee schedule,$122.67 from Fee Schedule BCFSB for Rev 306 Proc 87906 * Qty 1 = $122.67 at 327% = $401.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,BLUE CROSS,BLUE CROSS S NETWORK,401.13,,,,,,,64.3700,1187.0000,fee schedule,$122.67 from Fee Schedule BCFSB for Rev 306 Proc 87906 * Qty 1 = $122.67 at 327% = $401.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,BLUE CROSS,TENNCARE BLUE CARE,119.26,,,,,,,64.3700,1187.0000,fee schedule,$102.81 from Fee Schedule TC_24 for Rev 306 Proc 87906 * Qty 1 = $102.81 at 116% = $119.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,BLUE CROSS,TENNCARE BLUE SELECT,119.26,,,,,,,64.3700,1187.0000,fee schedule,$102.81 from Fee Schedule TC_24 for Rev 306 Proc 87906 * Qty 1 = $102.81 at 116% = $119.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,CIGNA HEALTHCARE,CIGNA HMO,517.89,,,,,,,64.3700,1187.0000,fee schedule,$517.89 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87906 * Qty 1 = $517.89 at 100% = $517.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,283.66,,,,,,,64.3700,1187.0000,fee schedule,$283.66 from Fee Schedule CGIFP_25LR for Rev 306 Proc 87906 * Qty 1 = $283.66 at 100% = $283.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,135.17,,,,,,,64.3700,1187.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,517.89,,,,,,,64.3700,1187.0000,fee schedule,$517.89 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87906 * Qty 1 = $517.89 at 100% = $517.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,CIGNA HEALTHCARE,CIGNA PPO,517.89,,,,,,,64.3700,1187.0000,fee schedule,$517.89 from Fee Schedule CIGWHS_23 for Rev 306 Proc 87906 * Qty 1 = $517.89 at 100% = $517.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,135.17,,,,,,,64.3700,1187.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1068.30,,,,,,,64.3700,1187.0000,percent of total billed charges,"90% of $1,187.00 in Billed Charges for Rev 306 Proc 87906 = $1,068.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,HUMANA,HUMANA MEDICARE,128.73,,,,,,,64.3700,1187.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,128.73,,,,,,,64.3700,1187.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,MEDCOST,MEDCOST VHN,564.89,,,,,,,64.3700,1187.0000,percent of total billed charges,"47.59% of $1,187.00 in Billed Charges for Rev 306 Proc 87906 = $564.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,214.60,,,,,,,64.3700,1187.0000,fee schedule,APG 00388 Proc 87906 at $836.60 (Base Rate) * 0.2443 (Relative Weight) = $204.38 (Total Line Payment) at 100% = $204.38... $204.38 at 105% = $214.60 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,135.17,,,,,,,64.3700,1187.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,135.17,,,,,,,64.3700,1187.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,NHC ADVANTAGE,NHC ADVANTAGE,135.17,,,,,,,64.3700,1187.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,210.72,,,,,,,64.3700,1187.0000,fee schedule,APG 00388 Proc 87906 at $836.60 (Base Rate) * 0.2443 (Relative Weight) = $204.38 (Total Line Payment) at 100% = $204.38... $204.38 at 103.1% = $210.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,SENTARA HEALTH,SENTARA HEALTH,306.36,,,,,,,64.3700,1187.0000,percent of total billed charges,"25.81% of $1,187.00 in Billed Charges for Rev 306 Proc 87906 = $306.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,SENTARA HEALTH,SENTARA MEDICARE,128.73,,,,,,,64.3700,1187.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1187.00,,,,,,,64.3700,1187.0000,percent of total billed charges,"100% of $1,187.00 in Billed Charges for Rev 306 Proc 87906 = $1,187.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,91.16,,,,,,,64.3700,1187.0000,fee schedule,$182.32 from Fee Schedule TCUHC24 for Rev 306 Proc 87906 * Qty 1 = $182.32 at 50% = $91.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,133.88,,,,,,,64.3700,1187.0000,fee schedule,$128.73 from Fee Schedule UHC_31910 for Rev 306 Proc 87906 * Qty 1 = $128.73 at 104% = $133.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,128.73,,,,,,,64.3700,1187.0000,fee schedule,$128.73 from Fee Schedule UHC_31910 for Rev 306 Proc 87906 * Qty 1 = $128.73 at 100% = $128.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,128.73,,,,,,,64.3700,1187.0000,fee schedule,$128.73 from Fee Schedule UHC_31910 for Rev 306 Proc 87906 * Qty 1 = $128.73 at 100% = $128.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,210.51,,,,,,,64.3700,1187.0000,fee schedule,APG 00388 Proc 87906 at $836.60 (Base Rate) * 0.2443 (Relative Weight) = $204.38 (Total Line Payment) at 103% = $210.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,128.73,,,,,,,64.3700,1187.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,128.73,,,,,,,64.3700,1187.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,WELLCARE,WELLCARE MEDICAID,1187.00,,,,,,,64.3700,1187.0000,percent of total billed charges,"100% of $1,187.00 in Billed Charges for Rev 306 Proc 87906 = $1,187.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GENOTYPE DNA/RNA HIV-1,87906,CPT,306,RC,30600187,CDM,,,,both,,,1187.0000,178.0500,WELLCARE,WELLCARE MEDICARE,136.45,,,,,,,64.3700,1187.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,AETNA,AETNA,1106.78,,,,,,,128.7300,2592.0000,percent of total billed charges,"42.7% of $2,592.00 in Billed Charges for Rev 300 Proc 87912 = $1,106.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,212.56,,,,,,,128.7300,2592.0000,fee schedule,APG 00388 Proc 87912 at $836.60 (Base Rate) * 0.2443 (Relative Weight) = $204.38 (Total Line Payment) at 104% = $212.56. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,257.45,,,,,,,128.7300,2592.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,AETNA,AETNA HEALTHCARE MEDICARE,257.45,,,,,,,128.7300,2592.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,257.45,,,,,,,128.7300,2592.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,AMBETTER,AMBETTER,561.24,,,,,,,128.7300,2592.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,AMERIGROUP,AMERIGROUP,128.73,,,,,,,128.7300,2592.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,267.75,,,,,,,128.7300,2592.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,BLUE CROSS,ANTHEM EXCHANGE,257.45,,,,,,,128.7300,2592.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,210.51,,,,,,,128.7300,2592.0000,fee schedule,APG 00388 Proc 87912 at $836.60 (Base Rate) * 0.2443 (Relative Weight) = $204.38 (Total Line Payment) at 103% = $210.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,BLUE CROSS,ANTHEM HMO,257.45,,,,,,,128.7300,2592.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,265.17,,,,,,,128.7300,2592.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",257.45,,,,,,,128.7300,2592.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1814.40,,,,,,,128.7300,2592.0000,percent of total billed charges,"Rev 300 Proc 87912 $2,592.00 in Billed Charges at 70% = $1,814.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,BLUE CROSS,BLUE CROSS E NETWORK,785.18,,,,,,,128.7300,2592.0000,fee schedule,$245.37 from Fee Schedule BCFSB for Rev 300 Proc 87912 * Qty 1 = $245.37 at 320% = $785.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,BLUE CROSS,BLUE CROSS MEDICARE,267.75,,,,,,,128.7300,2592.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,BLUE CROSS,BLUE CROSS P NETWORK,802.36,,,,,,,128.7300,2592.0000,fee schedule,$245.37 from Fee Schedule BCFSB for Rev 300 Proc 87912 * Qty 1 = $245.37 at 327% = $802.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,BLUE CROSS,BLUE CROSS S NETWORK,802.36,,,,,,,128.7300,2592.0000,fee schedule,$245.37 from Fee Schedule BCFSB for Rev 300 Proc 87912 * Qty 1 = $245.37 at 327% = $802.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,BLUE CROSS,TENNCARE BLUE CARE,232.99,,,,,,,128.7300,2592.0000,fee schedule,$200.85 from Fee Schedule TC_24 for Rev 300 Proc 87912 * Qty 1 = $200.85 at 116% = $232.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,BLUE CROSS,TENNCARE BLUE SELECT,232.99,,,,,,,128.7300,2592.0000,fee schedule,$200.85 from Fee Schedule TC_24 for Rev 300 Proc 87912 * Qty 1 = $200.85 at 116% = $232.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,CIGNA HEALTHCARE,CIGNA HMO,1080.86,,,,,,,128.7300,2592.0000,percent of total billed charges,"Rev 300 Proc 87912 $2,592.00 in Billed Charges at 41.7% = $1,080.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,567.32,,,,,,,128.7300,2592.0000,fee schedule,$567.32 from Fee Schedule CGIFP_25LR for Rev 300 Proc 87912 * Qty 1 = $567.32 at 100% = $567.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,270.32,,,,,,,128.7300,2592.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1080.86,,,,,,,128.7300,2592.0000,percent of total billed charges,"Rev 300 Proc 87912 $2,592.00 in Billed Charges at 41.7% = $1,080.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,CIGNA HEALTHCARE,CIGNA PPO,1080.86,,,,,,,128.7300,2592.0000,percent of total billed charges,"Rev 300 Proc 87912 $2,592.00 in Billed Charges at 41.7% = $1,080.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,270.32,,,,,,,128.7300,2592.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2332.80,,,,,,,128.7300,2592.0000,percent of total billed charges,"90% of $2,592.00 in Billed Charges for Rev 300 Proc 87912 = $2,332.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,HUMANA,HUMANA MEDICARE,257.45,,,,,,,128.7300,2592.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,257.45,,,,,,,128.7300,2592.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,MEDCOST,MEDCOST VHN,1233.53,,,,,,,128.7300,2592.0000,percent of total billed charges,"47.59% of $2,592.00 in Billed Charges for Rev 300 Proc 87912 = $1,233.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,214.60,,,,,,,128.7300,2592.0000,fee schedule,APG 00388 Proc 87912 at $836.60 (Base Rate) * 0.2443 (Relative Weight) = $204.38 (Total Line Payment) at 100% = $204.38... $204.38 at 105% = $214.60 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,270.32,,,,,,,128.7300,2592.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,270.32,,,,,,,128.7300,2592.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,NHC ADVANTAGE,NHC ADVANTAGE,270.32,,,,,,,128.7300,2592.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,210.72,,,,,,,128.7300,2592.0000,fee schedule,APG 00388 Proc 87912 at $836.60 (Base Rate) * 0.2443 (Relative Weight) = $204.38 (Total Line Payment) at 100% = $204.38... $204.38 at 103.1% = $210.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,SENTARA HEALTH,SENTARA HEALTH,669.00,,,,,,,128.7300,2592.0000,percent of total billed charges,"25.81% of $2,592.00 in Billed Charges for Rev 300 Proc 87912 = $669.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,SENTARA HEALTH,SENTARA MEDICARE,257.45,,,,,,,128.7300,2592.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2592.00,,,,,,,128.7300,2592.0000,percent of total billed charges,"100% of $2,592.00 in Billed Charges for Rev 300 Proc 87912 = $2,592.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,176.94,,,,,,,128.7300,2592.0000,fee schedule,$353.88 from Fee Schedule TCUHC24 for Rev 300 Proc 87912 * Qty 1 = $353.88 at 50% = $176.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,267.75,,,,,,,128.7300,2592.0000,fee schedule,$257.45 from Fee Schedule UHC_31910 for Rev 300 Proc 87912 * Qty 1 = $257.45 at 104% = $267.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,257.45,,,,,,,128.7300,2592.0000,fee schedule,$257.45 from Fee Schedule UHC_31910 for Rev 300 Proc 87912 * Qty 1 = $257.45 at 100% = $257.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,257.45,,,,,,,128.7300,2592.0000,fee schedule,$257.45 from Fee Schedule UHC_31910 for Rev 300 Proc 87912 * Qty 1 = $257.45 at 100% = $257.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,210.51,,,,,,,128.7300,2592.0000,fee schedule,APG 00388 Proc 87912 at $836.60 (Base Rate) * 0.2443 (Relative Weight) = $204.38 (Total Line Payment) at 103% = $210.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,257.45,,,,,,,128.7300,2592.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,257.45,,,,,,,128.7300,2592.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,WELLCARE,WELLCARE MEDICAID,2592.00,,,,,,,128.7300,2592.0000,percent of total billed charges,"100% of $2,592.00 in Billed Charges for Rev 300 Proc 87912 = $2,592.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC HEPATITIS B GENOTYPE DNA,87912,CPT,300,RC,30000221,CDM,,,,both,,,2592.0000,388.8000,WELLCARE,WELLCARE MEDICARE,272.90,,,,,,,128.7300,2592.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,AETNA,AETNA,212.65,,,,,,,5.8500,498.0000,percent of total billed charges,42.7% of $498.00 in Billed Charges for Rev 311 Proc 88106 = $212.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,46.90,,,,,,,5.8500,498.0000,fee schedule,APG 00391 Proc 88106 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 104% = $46.90. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,26.24,,,,,,,5.8500,498.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,AETNA,AETNA HEALTHCARE MEDICARE,26.24,,,,,,,5.8500,498.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,26.24,,,,,,,5.8500,498.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,AMBETTER,AMBETTER,57.21,,,,,,,5.8500,498.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,27.29,,,,,,,5.8500,498.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,BLUE CROSS,ANTHEM EXCHANGE,64.60,,,,,,,5.8500,498.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,46.45,,,,,,,5.8500,498.0000,fee schedule,APG 00391 Proc 88106 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 103% = $46.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,BLUE CROSS,ANTHEM HMO,68.63,,,,,,,5.8500,498.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,27.03,,,,,,,5.8500,498.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",80.74,,,,,,,5.8500,498.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11.80,,,,,,,5.8500,498.0000,fee schedule,$11.80 from Fee Schedule BLDTM_23 for Rev 311 Proc 88106 * Qty 1 = $11.80 at 100% = $11.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,BLUE CROSS,BLUE CROSS E NETWORK,185.89,,,,,,,5.8500,498.0000,fee schedule,$58.09 from Fee Schedule BCFSB for Rev 311 Proc 88106 * Qty 1 = $58.09 at 320% = $185.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,BLUE CROSS,BLUE CROSS MEDICARE,27.29,,,,,,,5.8500,498.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,BLUE CROSS,BLUE CROSS P NETWORK,189.95,,,,,,,5.8500,498.0000,fee schedule,$58.09 from Fee Schedule BCFSB for Rev 311 Proc 88106 * Qty 1 = $58.09 at 327% = $189.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,BLUE CROSS,BLUE CROSS S NETWORK,189.95,,,,,,,5.8500,498.0000,fee schedule,$58.09 from Fee Schedule BCFSB for Rev 311 Proc 88106 * Qty 1 = $58.09 at 327% = $189.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,BLUE CROSS,TENNCARE BLUE CARE,5.85,,,,,,,5.8500,498.0000,fee schedule,$5.04 from Fee Schedule TC_24 for Rev 311 Proc 88106 * Qty 1 = $5.04 at 116% = $5.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,BLUE CROSS,TENNCARE BLUE SELECT,5.85,,,,,,,5.8500,498.0000,fee schedule,$5.04 from Fee Schedule TC_24 for Rev 311 Proc 88106 * Qty 1 = $5.04 at 116% = $5.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,CIGNA HEALTHCARE,CIGNA HMO,153.74,,,,,,,5.8500,498.0000,fee schedule,$153.74 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88106 * Qty 1 = $153.74 at 100% = $153.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,114.20,,,,,,,5.8500,498.0000,fee schedule,$114.20 from Fee Schedule CGIFP_25LR for Rev 311 Proc 88106 * Qty 1 = $114.20 at 100% = $114.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,27.55,,,,,,,5.8500,498.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,153.74,,,,,,,5.8500,498.0000,fee schedule,$153.74 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88106 * Qty 1 = $153.74 at 100% = $153.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,CIGNA HEALTHCARE,CIGNA PPO,153.74,,,,,,,5.8500,498.0000,fee schedule,$153.74 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88106 * Qty 1 = $153.74 at 100% = $153.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,27.55,,,,,,,5.8500,498.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,448.20,,,,,,,5.8500,498.0000,percent of total billed charges,90% of $498.00 in Billed Charges for Rev 311 Proc 88106 = $448.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,HUMANA,HUMANA MEDICARE,26.24,,,,,,,5.8500,498.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,26.24,,,,,,,5.8500,498.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,MEDCOST,MEDCOST VHN,237.00,,,,,,,5.8500,498.0000,percent of total billed charges,47.59% of $498.00 in Billed Charges for Rev 311 Proc 88106 = $237.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,47.34,,,,,,,5.8500,498.0000,fee schedule,APG 00391 Proc 88106 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 100% = $45.09... $45.09 at 105% = $47.34 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,27.55,,,,,,,5.8500,498.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,27.55,,,,,,,5.8500,498.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,NHC ADVANTAGE,NHC ADVANTAGE,27.55,,,,,,,5.8500,498.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,46.49,,,,,,,5.8500,498.0000,fee schedule,APG 00391 Proc 88106 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 100% = $45.09... $45.09 at 103.1% = $46.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,SENTARA HEALTH,SENTARA HEALTH,128.53,,,,,,,5.8500,498.0000,percent of total billed charges,25.81% of $498.00 in Billed Charges for Rev 311 Proc 88106 = $128.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,SENTARA HEALTH,SENTARA MEDICARE,26.24,,,,,,,5.8500,498.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",498.00,,,,,,,5.8500,498.0000,percent of total billed charges,100% of $498.00 in Billed Charges for Rev 311 Proc 88106 = $498.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.54,,,,,,,5.8500,498.0000,fee schedule,$17.08 from Fee Schedule TCUHC24 for Rev 311 Proc 88106 * Qty 1 = $17.08 at 50% = $8.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,23.91,,,,,,,5.8500,498.0000,fee schedule,$22.99 from Fee Schedule UHC_31910 for Rev 311 Proc 88106 * Qty 1 = $22.99 at 104% = $23.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,22.99,,,,,,,5.8500,498.0000,fee schedule,$22.99 from Fee Schedule UHC_31910 for Rev 311 Proc 88106 * Qty 1 = $22.99 at 100% = $22.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,22.99,,,,,,,5.8500,498.0000,fee schedule,$22.99 from Fee Schedule UHC_31910 for Rev 311 Proc 88106 * Qty 1 = $22.99 at 100% = $22.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,46.45,,,,,,,5.8500,498.0000,fee schedule,APG 00391 Proc 88106 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 103% = $46.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,26.24,,,,,,,5.8500,498.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,26.24,,,,,,,5.8500,498.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,WELLCARE,WELLCARE MEDICAID,498.00,,,,,,,5.8500,498.0000,percent of total billed charges,100% of $498.00 in Billed Charges for Rev 311 Proc 88106 = $498.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOPATHOLOGY FILTER NONGYN,88106,CPT,311,RC,31100002,CDM,,,,both,,,498.0000,74.7000,WELLCARE,WELLCARE MEDICARE,27.82,,,,,,,5.8500,498.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
REAMER PILOT HEADED 7.5MM,272,RC,,,,,,,,both,,,2530.5200,379.5800,AETNA,AETNA,1080.53,,,,,,,653.1300,2530.5200,percent of total billed charges,"42.7% of $2,530.52 in Billed Charges for Rev 272 = $1,080.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER PILOT HEADED 7.5MM,272,RC,,,,,,,,both,,,2530.5200,379.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1771.36,,,,,,,653.1300,2530.5200,percent of total billed charges,"Rev 272 $2,530.52 in Billed Charges at 70% = $1,771.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER PILOT HEADED 7.5MM,272,RC,,,,,,,,both,,,2530.5200,379.5800,CIGNA HEALTHCARE,CIGNA HMO,1055.23,,,,,,,653.1300,2530.5200,percent of total billed charges,"41.7% of $2,530.52 in Billed Charges for Rev 272 = $1,055.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER PILOT HEADED 7.5MM,272,RC,,,,,,,,both,,,2530.5200,379.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1174.16,,,,,,,653.1300,2530.5200,percent of total billed charges,"46.4% of $2,530.52 in Billed Charges for Rev 272 = $1,174.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER PILOT HEADED 7.5MM,272,RC,,,,,,,,both,,,2530.5200,379.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1055.23,,,,,,,653.1300,2530.5200,percent of total billed charges,"41.7% of $2,530.52 in Billed Charges for Rev 272 = $1,055.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER PILOT HEADED 7.5MM,272,RC,,,,,,,,both,,,2530.5200,379.5800,CIGNA HEALTHCARE,CIGNA PPO,1055.23,,,,,,,653.1300,2530.5200,percent of total billed charges,"41.7% of $2,530.52 in Billed Charges for Rev 272 = $1,055.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER PILOT HEADED 7.5MM,272,RC,,,,,,,,both,,,2530.5200,379.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2277.47,,,,,,,653.1300,2530.5200,percent of total billed charges,"90% of $2,530.52 in Billed Charges for Rev 272 = $2,277.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER PILOT HEADED 7.5MM,272,RC,,,,,,,,both,,,2530.5200,379.5800,MEDCOST,MEDCOST VHN,1204.27,,,,,,,653.1300,2530.5200,percent of total billed charges,"47.59% of $2,530.52 in Billed Charges for Rev 272 = $1,204.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER PILOT HEADED 7.5MM,272,RC,,,,,,,,both,,,2530.5200,379.5800,SENTARA HEALTH,SENTARA HEALTH,653.13,,,,,,,653.1300,2530.5200,percent of total billed charges,"25.81% of $2,530.52 in Billed Charges for Rev 272 = $653.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER PILOT HEADED 7.5MM,272,RC,,,,,,,,both,,,2530.5200,379.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2530.52,,,,,,,653.1300,2530.5200,percent of total billed charges,"100% of $2,530.52 in Billed Charges for Rev 272 = $2,530.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER PILOT HEADED 7.5MM,272,RC,,,,,,,,both,,,2530.5200,379.5800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1265.26,,,,,,,653.1300,2530.5200,percent of total billed charges,"Rev 272 $2,530.52 in Billed Charges at 50% = $1,265.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER PILOT HEADED 7.5MM,272,RC,,,,,,,,both,,,2530.5200,379.5800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,817.36,,,,,,,653.1300,2530.5200,other,"32.3% of $2,530.52 in Billed Charges for Rev 272 = $817.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
REAMER PILOT HEADED 7.5MM,272,RC,,,,,,,,both,,,2530.5200,379.5800,UNITED HEALTHCARE,UHC HERITAGE SELECT,776.87,,,,,,,653.1300,2530.5200,other,"30.7% of $2,530.52 in Billed Charges for Rev 272 = $776.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
REAMER PILOT HEADED 7.5MM,272,RC,,,,,,,,both,,,2530.5200,379.5800,UNITED HEALTHCARE,UNITED HEALTHCARE,817.36,,,,,,,653.1300,2530.5200,percent of total billed charges,"32.3% of $2,530.52 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER PILOT HEADED 7.5MM,272,RC,,,,,,,,both,,,2530.5200,379.5800,WELLCARE,WELLCARE MEDICAID,2530.52,,,,,,,653.1300,2530.5200,percent of total billed charges,"100% of $2,530.52 in Billed Charges for Rev 272 = $2,530.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,AETNA,AETNA,100.77,,,,,,,10.1300,236.0000,percent of total billed charges,42.7% of $236.00 in Billed Charges for Rev 311 Proc 88142 = $100.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,24.10,,,,,,,10.1300,236.0000,fee schedule,APG 00392 Proc 88142 at $836.60 (Base Rate) * 0.0277 (Relative Weight) = $23.17 (Total Line Payment) at 104% = $24.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,20.26,,,,,,,10.1300,236.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,AETNA,AETNA HEALTHCARE MEDICARE,20.26,,,,,,,10.1300,236.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,20.26,,,,,,,10.1300,236.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,AMBETTER,AMBETTER,44.17,,,,,,,10.1300,236.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,AMERIGROUP,AMERIGROUP,10.13,,,,,,,10.1300,236.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,21.07,,,,,,,10.1300,236.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,BLUE CROSS,ANTHEM EXCHANGE,20.26,,,,,,,10.1300,236.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,23.87,,,,,,,10.1300,236.0000,fee schedule,APG 00392 Proc 88142 at $836.60 (Base Rate) * 0.0277 (Relative Weight) = $23.17 (Total Line Payment) at 103% = $23.87. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,BLUE CROSS,ANTHEM HMO,20.26,,,,,,,10.1300,236.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,20.87,,,,,,,10.1300,236.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",20.26,,,,,,,10.1300,236.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,78.38,,,,,,,10.1300,236.0000,fee schedule,$78.38 from Fee Schedule BLDTM_23 for Rev 311 Proc 88142 * Qty 1 = $78.38 at 100% = $78.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,BLUE CROSS,BLUE CROSS E NETWORK,88.45,,,,,,,10.1300,236.0000,fee schedule,$27.64 from Fee Schedule BCFSB for Rev 311 Proc 88142 * Qty 1 = $27.64 at 320% = $88.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,BLUE CROSS,BLUE CROSS MEDICARE,21.07,,,,,,,10.1300,236.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,BLUE CROSS,BLUE CROSS P NETWORK,90.38,,,,,,,10.1300,236.0000,fee schedule,$27.64 from Fee Schedule BCFSB for Rev 311 Proc 88142 * Qty 1 = $27.64 at 327% = $90.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,BLUE CROSS,BLUE CROSS S NETWORK,90.38,,,,,,,10.1300,236.0000,fee schedule,$27.64 from Fee Schedule BCFSB for Rev 311 Proc 88142 * Qty 1 = $27.64 at 327% = $90.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,BLUE CROSS,TENNCARE BLUE CARE,25.10,,,,,,,10.1300,236.0000,fee schedule,$21.64 from Fee Schedule TC_24 for Rev 311 Proc 88142 * Qty 1 = $21.64 at 116% = $25.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,BLUE CROSS,TENNCARE BLUE SELECT,25.10,,,,,,,10.1300,236.0000,fee schedule,$21.64 from Fee Schedule TC_24 for Rev 311 Proc 88142 * Qty 1 = $21.64 at 116% = $25.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,CIGNA HEALTHCARE,CIGNA HMO,81.54,,,,,,,10.1300,236.0000,fee schedule,$81.54 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88142 * Qty 1 = $81.54 at 100% = $81.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,44.75,,,,,,,10.1300,236.0000,fee schedule,$44.75 from Fee Schedule CGIFP_25LR for Rev 311 Proc 88142 * Qty 1 = $44.75 at 100% = $44.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,21.27,,,,,,,10.1300,236.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,81.54,,,,,,,10.1300,236.0000,fee schedule,$81.54 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88142 * Qty 1 = $81.54 at 100% = $81.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,CIGNA HEALTHCARE,CIGNA PPO,81.54,,,,,,,10.1300,236.0000,fee schedule,$81.54 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88142 * Qty 1 = $81.54 at 100% = $81.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,21.27,,,,,,,10.1300,236.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,212.40,,,,,,,10.1300,236.0000,percent of total billed charges,90% of $236.00 in Billed Charges for Rev 311 Proc 88142 = $212.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,HUMANA,HUMANA MEDICARE,20.26,,,,,,,10.1300,236.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,20.26,,,,,,,10.1300,236.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,MEDCOST,MEDCOST VHN,112.31,,,,,,,10.1300,236.0000,percent of total billed charges,47.59% of $236.00 in Billed Charges for Rev 311 Proc 88142 = $112.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,24.33,,,,,,,10.1300,236.0000,fee schedule,APG 00392 Proc 88142 at $836.60 (Base Rate) * 0.0277 (Relative Weight) = $23.17 (Total Line Payment) at 100% = $23.17... $23.17 at 105% = $24.33 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,21.27,,,,,,,10.1300,236.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,21.27,,,,,,,10.1300,236.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,NHC ADVANTAGE,NHC ADVANTAGE,21.27,,,,,,,10.1300,236.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,23.89,,,,,,,10.1300,236.0000,fee schedule,APG 00392 Proc 88142 at $836.60 (Base Rate) * 0.0277 (Relative Weight) = $23.17 (Total Line Payment) at 100% = $23.17... $23.17 at 103.1% = $23.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,SENTARA HEALTH,SENTARA HEALTH,60.91,,,,,,,10.1300,236.0000,percent of total billed charges,25.81% of $236.00 in Billed Charges for Rev 311 Proc 88142 = $60.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,SENTARA HEALTH,SENTARA MEDICARE,20.26,,,,,,,10.1300,236.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",236.00,,,,,,,10.1300,236.0000,percent of total billed charges,100% of $236.00 in Billed Charges for Rev 311 Proc 88142 = $236.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14.35,,,,,,,10.1300,236.0000,fee schedule,$28.70 from Fee Schedule TCUHC24 for Rev 311 Proc 88142 * Qty 1 = $28.70 at 50% = $14.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,21.07,,,,,,,10.1300,236.0000,fee schedule,$20.26 from Fee Schedule UHC_31910 for Rev 311 Proc 88142 * Qty 1 = $20.26 at 104% = $21.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,20.26,,,,,,,10.1300,236.0000,fee schedule,$20.26 from Fee Schedule UHC_31910 for Rev 311 Proc 88142 * Qty 1 = $20.26 at 100% = $20.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,20.26,,,,,,,10.1300,236.0000,fee schedule,$20.26 from Fee Schedule UHC_31910 for Rev 311 Proc 88142 * Qty 1 = $20.26 at 100% = $20.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,23.87,,,,,,,10.1300,236.0000,fee schedule,APG 00392 Proc 88142 at $836.60 (Base Rate) * 0.0277 (Relative Weight) = $23.17 (Total Line Payment) at 103% = $23.87. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,20.26,,,,,,,10.1300,236.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,20.26,,,,,,,10.1300,236.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,WELLCARE,WELLCARE MEDICAID,236.00,,,,,,,10.1300,236.0000,percent of total billed charges,100% of $236.00 in Billed Charges for Rev 311 Proc 88142 = $236.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCRN UNDER PHYS SUPV,88142,CPT,311,RC,31100023,CDM,,,,both,,,236.0000,35.4000,WELLCARE,WELLCARE MEDICARE,21.48,,,,,,,10.1300,236.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,AETNA,AETNA,124.26,,,,,,,5.5300,291.0000,percent of total billed charges,42.7% of $291.00 in Billed Charges for Rev 311 Proc 88160 = $124.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,46.90,,,,,,,5.5300,291.0000,fee schedule,APG 00391 Proc 88160 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 104% = $46.90. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,26.24,,,,,,,5.5300,291.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,AETNA,AETNA HEALTHCARE MEDICARE,26.24,,,,,,,5.5300,291.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,26.24,,,,,,,5.5300,291.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,AMBETTER,AMBETTER,57.21,,,,,,,5.5300,291.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,27.29,,,,,,,5.5300,291.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,BLUE CROSS,ANTHEM EXCHANGE,64.60,,,,,,,5.5300,291.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,46.45,,,,,,,5.5300,291.0000,fee schedule,APG 00391 Proc 88160 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 103% = $46.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,BLUE CROSS,ANTHEM HMO,68.63,,,,,,,5.5300,291.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,27.03,,,,,,,5.5300,291.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",80.74,,,,,,,5.5300,291.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11.74,,,,,,,5.5300,291.0000,fee schedule,$11.74 from Fee Schedule BLDTM_23 for Rev 311 Proc 88160 * Qty 1 = $11.74 at 100% = $11.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,BLUE CROSS,BLUE CROSS E NETWORK,108.70,,,,,,,5.5300,291.0000,fee schedule,$33.97 from Fee Schedule BCFSB for Rev 311 Proc 88160 * Qty 1 = $33.97 at 320% = $108.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,BLUE CROSS,BLUE CROSS MEDICARE,27.29,,,,,,,5.5300,291.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,BLUE CROSS,BLUE CROSS P NETWORK,111.08,,,,,,,5.5300,291.0000,fee schedule,$33.97 from Fee Schedule BCFSB for Rev 311 Proc 88160 * Qty 1 = $33.97 at 327% = $111.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,BLUE CROSS,BLUE CROSS S NETWORK,111.08,,,,,,,5.5300,291.0000,fee schedule,$33.97 from Fee Schedule BCFSB for Rev 311 Proc 88160 * Qty 1 = $33.97 at 327% = $111.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,BLUE CROSS,TENNCARE BLUE CARE,5.53,,,,,,,5.5300,291.0000,fee schedule,$4.77 from Fee Schedule TC_24 for Rev 311 Proc 88160 * Qty 1 = $4.77 at 116% = $5.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,CIGNA HEALTHCARE,CIGNA HMO,89.93,,,,,,,5.5300,291.0000,fee schedule,$89.93 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88160 * Qty 1 = $89.93 at 100% = $89.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,118.53,,,,,,,5.5300,291.0000,fee schedule,$118.53 from Fee Schedule CGIFP_25LR for Rev 311 Proc 88160 * Qty 1 = $118.53 at 100% = $118.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,27.55,,,,,,,5.5300,291.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,89.93,,,,,,,5.5300,291.0000,fee schedule,$89.93 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88160 * Qty 1 = $89.93 at 100% = $89.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,CIGNA HEALTHCARE,CIGNA PPO,89.93,,,,,,,5.5300,291.0000,fee schedule,$89.93 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88160 * Qty 1 = $89.93 at 100% = $89.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,27.55,,,,,,,5.5300,291.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,261.90,,,,,,,5.5300,291.0000,percent of total billed charges,90% of $291.00 in Billed Charges for Rev 311 Proc 88160 = $261.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,HUMANA,HUMANA MEDICARE,26.24,,,,,,,5.5300,291.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,26.24,,,,,,,5.5300,291.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,MEDCOST,MEDCOST VHN,138.49,,,,,,,5.5300,291.0000,percent of total billed charges,47.59% of $291.00 in Billed Charges for Rev 311 Proc 88160 = $138.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,47.34,,,,,,,5.5300,291.0000,fee schedule,APG 00391 Proc 88160 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 100% = $45.09... $45.09 at 105% = $47.34 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,27.55,,,,,,,5.5300,291.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,27.55,,,,,,,5.5300,291.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,NHC ADVANTAGE,NHC ADVANTAGE,27.55,,,,,,,5.5300,291.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,46.49,,,,,,,5.5300,291.0000,fee schedule,APG 00391 Proc 88160 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 100% = $45.09... $45.09 at 103.1% = $46.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,SENTARA HEALTH,SENTARA HEALTH,75.11,,,,,,,5.5300,291.0000,percent of total billed charges,25.81% of $291.00 in Billed Charges for Rev 311 Proc 88160 = $75.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,SENTARA HEALTH,SENTARA MEDICARE,26.24,,,,,,,5.5300,291.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",291.00,,,,,,,5.5300,291.0000,percent of total billed charges,100% of $291.00 in Billed Charges for Rev 311 Proc 88160 = $291.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.54,,,,,,,5.5300,291.0000,fee schedule,$17.08 from Fee Schedule TCUHC24 for Rev 311 Proc 88160 * Qty 1 = $17.08 at 50% = $8.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,23.91,,,,,,,5.5300,291.0000,fee schedule,$22.99 from Fee Schedule UHC_31910 for Rev 311 Proc 88160 * Qty 1 = $22.99 at 104% = $23.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,22.99,,,,,,,5.5300,291.0000,fee schedule,$22.99 from Fee Schedule UHC_31910 for Rev 311 Proc 88160 * Qty 1 = $22.99 at 100% = $22.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,22.99,,,,,,,5.5300,291.0000,fee schedule,$22.99 from Fee Schedule UHC_31910 for Rev 311 Proc 88160 * Qty 1 = $22.99 at 100% = $22.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,46.45,,,,,,,5.5300,291.0000,fee schedule,APG 00391 Proc 88160 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 103% = $46.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,26.24,,,,,,,5.5300,291.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,26.24,,,,,,,5.5300,291.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,WELLCARE,WELLCARE MEDICAID,291.00,,,,,,,5.5300,291.0000,percent of total billed charges,100% of $291.00 in Billed Charges for Rev 311 Proc 88160 = $291.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CYTOLOGY SMEAR OTHER SOURC,88160,CPT,311,RC,31100007,CDM,,,,both,,,291.0000,43.6500,WELLCARE,WELLCARE MEDICARE,27.82,,,,,,,5.5300,291.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,AETNA,AETNA,149.45,,,,,,,6.5200,350.0000,percent of total billed charges,42.7% of $350.00 in Billed Charges for Rev 311 Proc 88161 = $149.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,46.90,,,,,,,6.5200,350.0000,fee schedule,APG 00391 Proc 88161 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 104% = $46.90. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,26.24,,,,,,,6.5200,350.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,AETNA,AETNA HEALTHCARE MEDICARE,26.24,,,,,,,6.5200,350.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,26.24,,,,,,,6.5200,350.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,AMBETTER,AMBETTER,57.21,,,,,,,6.5200,350.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,27.29,,,,,,,6.5200,350.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,BLUE CROSS,ANTHEM EXCHANGE,64.60,,,,,,,6.5200,350.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,46.45,,,,,,,6.5200,350.0000,fee schedule,APG 00391 Proc 88161 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 103% = $46.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,BLUE CROSS,ANTHEM HMO,68.63,,,,,,,6.5200,350.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,27.03,,,,,,,6.5200,350.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",80.74,,,,,,,6.5200,350.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11.82,,,,,,,6.5200,350.0000,fee schedule,$11.82 from Fee Schedule BLDTM_23 for Rev 311 Proc 88161 * Qty 1 = $11.82 at 100% = $11.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,BLUE CROSS,BLUE CROSS E NETWORK,95.30,,,,,,,6.5200,350.0000,fee schedule,$29.78 from Fee Schedule BCFSB for Rev 311 Proc 88161 * Qty 1 = $29.78 at 320% = $95.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,BLUE CROSS,BLUE CROSS MEDICARE,27.29,,,,,,,6.5200,350.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,BLUE CROSS,BLUE CROSS P NETWORK,97.38,,,,,,,6.5200,350.0000,fee schedule,$29.78 from Fee Schedule BCFSB for Rev 311 Proc 88161 * Qty 1 = $29.78 at 327% = $97.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,BLUE CROSS,BLUE CROSS S NETWORK,97.38,,,,,,,6.5200,350.0000,fee schedule,$29.78 from Fee Schedule BCFSB for Rev 311 Proc 88161 * Qty 1 = $29.78 at 327% = $97.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,BLUE CROSS,TENNCARE BLUE CARE,6.52,,,,,,,6.5200,350.0000,fee schedule,$5.62 from Fee Schedule TC_24 for Rev 311 Proc 88161 * Qty 1 = $5.62 at 116% = $6.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,BLUE CROSS,TENNCARE BLUE SELECT,6.52,,,,,,,6.5200,350.0000,fee schedule,$5.62 from Fee Schedule TC_24 for Rev 311 Proc 88161 * Qty 1 = $5.62 at 116% = $6.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,CIGNA HEALTHCARE,CIGNA HMO,94.74,,,,,,,6.5200,350.0000,fee schedule,$94.74 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88161 * Qty 1 = $94.74 at 100% = $94.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,122.86,,,,,,,6.5200,350.0000,fee schedule,$122.86 from Fee Schedule CGIFP_25LR for Rev 311 Proc 88161 * Qty 1 = $122.86 at 100% = $122.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,27.55,,,,,,,6.5200,350.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,94.74,,,,,,,6.5200,350.0000,fee schedule,$94.74 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88161 * Qty 1 = $94.74 at 100% = $94.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,CIGNA HEALTHCARE,CIGNA PPO,94.74,,,,,,,6.5200,350.0000,fee schedule,$94.74 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88161 * Qty 1 = $94.74 at 100% = $94.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,27.55,,,,,,,6.5200,350.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,315.00,,,,,,,6.5200,350.0000,percent of total billed charges,90% of $350.00 in Billed Charges for Rev 311 Proc 88161 = $315.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,HUMANA,HUMANA MEDICARE,26.24,,,,,,,6.5200,350.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,26.24,,,,,,,6.5200,350.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,MEDCOST,MEDCOST VHN,166.57,,,,,,,6.5200,350.0000,percent of total billed charges,47.59% of $350.00 in Billed Charges for Rev 311 Proc 88161 = $166.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,47.34,,,,,,,6.5200,350.0000,fee schedule,APG 00391 Proc 88161 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 100% = $45.09... $45.09 at 105% = $47.34 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,27.55,,,,,,,6.5200,350.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,27.55,,,,,,,6.5200,350.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,NHC ADVANTAGE,NHC ADVANTAGE,27.55,,,,,,,6.5200,350.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,46.49,,,,,,,6.5200,350.0000,fee schedule,APG 00391 Proc 88161 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 100% = $45.09... $45.09 at 103.1% = $46.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,SENTARA HEALTH,SENTARA HEALTH,90.34,,,,,,,6.5200,350.0000,percent of total billed charges,25.81% of $350.00 in Billed Charges for Rev 311 Proc 88161 = $90.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,SENTARA HEALTH,SENTARA MEDICARE,26.24,,,,,,,6.5200,350.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",350.00,,,,,,,6.5200,350.0000,percent of total billed charges,100% of $350.00 in Billed Charges for Rev 311 Proc 88161 = $350.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8.54,,,,,,,6.5200,350.0000,fee schedule,$17.08 from Fee Schedule TCUHC24 for Rev 311 Proc 88161 * Qty 1 = $17.08 at 50% = $8.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,23.91,,,,,,,6.5200,350.0000,fee schedule,$22.99 from Fee Schedule UHC_31910 for Rev 311 Proc 88161 * Qty 1 = $22.99 at 104% = $23.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,22.99,,,,,,,6.5200,350.0000,fee schedule,$22.99 from Fee Schedule UHC_31910 for Rev 311 Proc 88161 * Qty 1 = $22.99 at 100% = $22.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,22.99,,,,,,,6.5200,350.0000,fee schedule,$22.99 from Fee Schedule UHC_31910 for Rev 311 Proc 88161 * Qty 1 = $22.99 at 100% = $22.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,46.45,,,,,,,6.5200,350.0000,fee schedule,APG 00391 Proc 88161 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 103% = $46.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,26.24,,,,,,,6.5200,350.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,26.24,,,,,,,6.5200,350.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,WELLCARE,WELLCARE MEDICAID,350.00,,,,,,,6.5200,350.0000,percent of total billed charges,100% of $350.00 in Billed Charges for Rev 311 Proc 88161 = $350.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TOUCH PREP,88161,CPT,311,RC,31100008,CDM,,,,both,,,350.0000,52.5000,WELLCARE,WELLCARE MEDICARE,27.82,,,,,,,6.5200,350.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,AETNA,AETNA,52.95,,,,,,,7.4900,124.0000,percent of total billed charges,42.7% of $124.00 in Billed Charges for Rev 311 Proc 88164 = $52.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,24.10,,,,,,,7.4900,124.0000,fee schedule,APG 00392 Proc 88164 at $836.60 (Base Rate) * 0.0277 (Relative Weight) = $23.17 (Total Line Payment) at 104% = $24.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,18.54,,,,,,,7.4900,124.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,AETNA,AETNA HEALTHCARE MEDICARE,18.54,,,,,,,7.4900,124.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,18.54,,,,,,,7.4900,124.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,AMBETTER,AMBETTER,40.42,,,,,,,7.4900,124.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,AMERIGROUP,AMERIGROUP,9.27,,,,,,,7.4900,124.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,19.28,,,,,,,7.4900,124.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,BLUE CROSS,ANTHEM EXCHANGE,18.54,,,,,,,7.4900,124.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,23.87,,,,,,,7.4900,124.0000,fee schedule,APG 00392 Proc 88164 at $836.60 (Base Rate) * 0.0277 (Relative Weight) = $23.17 (Total Line Payment) at 103% = $23.87. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,BLUE CROSS,ANTHEM HMO,18.54,,,,,,,7.4900,124.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,19.10,,,,,,,7.4900,124.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",18.54,,,,,,,7.4900,124.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,38.79,,,,,,,7.4900,124.0000,fee schedule,$38.79 from Fee Schedule BLDTM_23 for Rev 311 Proc 88164 * Qty 1 = $38.79 at 100% = $38.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,BLUE CROSS,BLUE CROSS E NETWORK,46.14,,,,,,,7.4900,124.0000,fee schedule,$14.42 from Fee Schedule BCFSB for Rev 311 Proc 88164 * Qty 1 = $14.42 at 320% = $46.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,BLUE CROSS,BLUE CROSS MEDICARE,19.28,,,,,,,7.4900,124.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,BLUE CROSS,BLUE CROSS P NETWORK,47.15,,,,,,,7.4900,124.0000,fee schedule,$14.42 from Fee Schedule BCFSB for Rev 311 Proc 88164 * Qty 1 = $14.42 at 327% = $47.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,BLUE CROSS,BLUE CROSS S NETWORK,47.15,,,,,,,7.4900,124.0000,fee schedule,$14.42 from Fee Schedule BCFSB for Rev 311 Proc 88164 * Qty 1 = $14.42 at 327% = $47.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,BLUE CROSS,TENNCARE BLUE CARE,10.47,,,,,,,7.4900,124.0000,fee schedule,$9.03 from Fee Schedule TC_24 for Rev 311 Proc 88164 * Qty 1 = $9.03 at 116% = $10.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,BLUE CROSS,TENNCARE BLUE SELECT,10.47,,,,,,,7.4900,124.0000,fee schedule,$9.03 from Fee Schedule TC_24 for Rev 311 Proc 88164 * Qty 1 = $9.03 at 116% = $10.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,CIGNA HEALTHCARE,CIGNA HMO,42.52,,,,,,,7.4900,124.0000,fee schedule,$42.52 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88164 * Qty 1 = $42.52 at 100% = $42.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,38.98,,,,,,,7.4900,124.0000,fee schedule,$38.98 from Fee Schedule CGIFP_25LR for Rev 311 Proc 88164 * Qty 1 = $38.98 at 100% = $38.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,19.47,,,,,,,7.4900,124.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,42.52,,,,,,,7.4900,124.0000,fee schedule,$42.52 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88164 * Qty 1 = $42.52 at 100% = $42.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,CIGNA HEALTHCARE,CIGNA PPO,42.52,,,,,,,7.4900,124.0000,fee schedule,$42.52 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88164 * Qty 1 = $42.52 at 100% = $42.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,19.47,,,,,,,7.4900,124.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,111.60,,,,,,,7.4900,124.0000,percent of total billed charges,90% of $124.00 in Billed Charges for Rev 311 Proc 88164 = $111.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,HUMANA,HUMANA MEDICARE,18.54,,,,,,,7.4900,124.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,18.54,,,,,,,7.4900,124.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,MEDCOST,MEDCOST VHN,59.01,,,,,,,7.4900,124.0000,percent of total billed charges,47.59% of $124.00 in Billed Charges for Rev 311 Proc 88164 = $59.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,24.33,,,,,,,7.4900,124.0000,fee schedule,APG 00392 Proc 88164 at $836.60 (Base Rate) * 0.0277 (Relative Weight) = $23.17 (Total Line Payment) at 100% = $23.17... $23.17 at 105% = $24.33 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,19.47,,,,,,,7.4900,124.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,19.47,,,,,,,7.4900,124.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,NHC ADVANTAGE,NHC ADVANTAGE,19.47,,,,,,,7.4900,124.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,23.89,,,,,,,7.4900,124.0000,fee schedule,APG 00392 Proc 88164 at $836.60 (Base Rate) * 0.0277 (Relative Weight) = $23.17 (Total Line Payment) at 100% = $23.17... $23.17 at 103.1% = $23.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,SENTARA HEALTH,SENTARA HEALTH,32.00,,,,,,,7.4900,124.0000,percent of total billed charges,25.81% of $124.00 in Billed Charges for Rev 311 Proc 88164 = $32.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,SENTARA HEALTH,SENTARA MEDICARE,18.54,,,,,,,7.4900,124.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",124.00,,,,,,,7.4900,124.0000,percent of total billed charges,100% of $124.00 in Billed Charges for Rev 311 Proc 88164 = $124.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7.49,,,,,,,7.4900,124.0000,fee schedule,$14.97 from Fee Schedule TCUHC24 for Rev 311 Proc 88164 * Qty 1 = $14.97 at 50% = $7.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,15.72,,,,,,,7.4900,124.0000,fee schedule,$15.12 from Fee Schedule UHC_31910 for Rev 311 Proc 88164 * Qty 1 = $15.12 at 104% = $15.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,15.12,,,,,,,7.4900,124.0000,fee schedule,$15.12 from Fee Schedule UHC_31910 for Rev 311 Proc 88164 * Qty 1 = $15.12 at 100% = $15.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,15.12,,,,,,,7.4900,124.0000,fee schedule,$15.12 from Fee Schedule UHC_31910 for Rev 311 Proc 88164 * Qty 1 = $15.12 at 100% = $15.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,23.87,,,,,,,7.4900,124.0000,fee schedule,APG 00392 Proc 88164 at $836.60 (Base Rate) * 0.0277 (Relative Weight) = $23.17 (Total Line Payment) at 103% = $23.87. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,18.54,,,,,,,7.4900,124.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,18.54,,,,,,,7.4900,124.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,WELLCARE,WELLCARE MEDICAID,124.00,,,,,,,7.4900,124.0000,percent of total billed charges,100% of $124.00 in Billed Charges for Rev 311 Proc 88164 = $124.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CTYP SLIDES CERV/VAG MNL SCRN UNDER PHYS SUPV,88164,CPT,311,RC,31100022,CDM,,,,both,,,124.0000,18.6000,WELLCARE,WELLCARE MEDICARE,19.65,,,,,,,7.4900,124.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
RING FULL ALLUMINUM 150MM,272,RC,,,,,,,,both,,,10859.4700,1628.9200,AETNA,AETNA,4636.99,,,,,,,2802.8300,10859.4700,percent of total billed charges,"42.7% of $10,859.47 in Billed Charges for Rev 272 = $4,636.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FULL ALLUMINUM 150MM,272,RC,,,,,,,,both,,,10859.4700,1628.9200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7601.63,,,,,,,2802.8300,10859.4700,percent of total billed charges,"Rev 272 $10,859.47 in Billed Charges at 70% = $7,601.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FULL ALLUMINUM 150MM,272,RC,,,,,,,,both,,,10859.4700,1628.9200,CIGNA HEALTHCARE,CIGNA HMO,4528.40,,,,,,,2802.8300,10859.4700,percent of total billed charges,"41.7% of $10,859.47 in Billed Charges for Rev 272 = $4,528.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FULL ALLUMINUM 150MM,272,RC,,,,,,,,both,,,10859.4700,1628.9200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5038.79,,,,,,,2802.8300,10859.4700,percent of total billed charges,"46.4% of $10,859.47 in Billed Charges for Rev 272 = $5,038.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FULL ALLUMINUM 150MM,272,RC,,,,,,,,both,,,10859.4700,1628.9200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4528.40,,,,,,,2802.8300,10859.4700,percent of total billed charges,"41.7% of $10,859.47 in Billed Charges for Rev 272 = $4,528.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FULL ALLUMINUM 150MM,272,RC,,,,,,,,both,,,10859.4700,1628.9200,CIGNA HEALTHCARE,CIGNA PPO,4528.40,,,,,,,2802.8300,10859.4700,percent of total billed charges,"41.7% of $10,859.47 in Billed Charges for Rev 272 = $4,528.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FULL ALLUMINUM 150MM,272,RC,,,,,,,,both,,,10859.4700,1628.9200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9773.52,,,,,,,2802.8300,10859.4700,percent of total billed charges,"90% of $10,859.47 in Billed Charges for Rev 272 = $9,773.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FULL ALLUMINUM 150MM,272,RC,,,,,,,,both,,,10859.4700,1628.9200,MEDCOST,MEDCOST VHN,5168.02,,,,,,,2802.8300,10859.4700,percent of total billed charges,"47.59% of $10,859.47 in Billed Charges for Rev 272 = $5,168.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FULL ALLUMINUM 150MM,272,RC,,,,,,,,both,,,10859.4700,1628.9200,SENTARA HEALTH,SENTARA HEALTH,2802.83,,,,,,,2802.8300,10859.4700,percent of total billed charges,"25.81% of $10,859.47 in Billed Charges for Rev 272 = $2,802.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FULL ALLUMINUM 150MM,272,RC,,,,,,,,both,,,10859.4700,1628.9200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10859.47,,,,,,,2802.8300,10859.4700,percent of total billed charges,"100% of $10,859.47 in Billed Charges for Rev 272 = $10,859.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FULL ALLUMINUM 150MM,272,RC,,,,,,,,both,,,10859.4700,1628.9200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5429.74,,,,,,,2802.8300,10859.4700,percent of total billed charges,"Rev 272 $10,859.47 in Billed Charges at 50% = $5,429.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FULL ALLUMINUM 150MM,272,RC,,,,,,,,both,,,10859.4700,1628.9200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3507.61,,,,,,,2802.8300,10859.4700,other,"32.3% of $10,859.47 in Billed Charges for Rev 272 = $3,507.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RING FULL ALLUMINUM 150MM,272,RC,,,,,,,,both,,,10859.4700,1628.9200,UNITED HEALTHCARE,UHC HERITAGE SELECT,3333.86,,,,,,,2802.8300,10859.4700,other,"30.7% of $10,859.47 in Billed Charges for Rev 272 = $3,333.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RING FULL ALLUMINUM 150MM,272,RC,,,,,,,,both,,,10859.4700,1628.9200,UNITED HEALTHCARE,UNITED HEALTHCARE,3507.61,,,,,,,2802.8300,10859.4700,percent of total billed charges,"32.3% of $10,859.47 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FULL ALLUMINUM 150MM,272,RC,,,,,,,,both,,,10859.4700,1628.9200,WELLCARE,WELLCARE MEDICAID,10859.47,,,,,,,2802.8300,10859.4700,percent of total billed charges,"100% of $10,859.47 in Billed Charges for Rev 272 = $10,859.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,AETNA,AETNA,238.27,,,,,,,15.3200,558.0000,percent of total billed charges,42.7% of $558.00 in Billed Charges for Rev 311 Proc 88182 = $238.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,46.90,,,,,,,15.3200,558.0000,fee schedule,APG 00391 Proc 88182 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 104% = $46.90. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,47.28,,,,,,,15.3200,558.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,AETNA,AETNA HEALTHCARE MEDICARE,47.28,,,,,,,15.3200,558.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,47.28,,,,,,,15.3200,558.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,AMBETTER,AMBETTER,103.07,,,,,,,15.3200,558.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,49.17,,,,,,,15.3200,558.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,BLUE CROSS,ANTHEM EXCHANGE,116.40,,,,,,,15.3200,558.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,46.45,,,,,,,15.3200,558.0000,fee schedule,APG 00391 Proc 88182 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 103% = $46.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,BLUE CROSS,ANTHEM HMO,123.67,,,,,,,15.3200,558.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,48.70,,,,,,,15.3200,558.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",145.49,,,,,,,15.3200,558.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,143.82,,,,,,,15.3200,558.0000,fee schedule,$143.82 from Fee Schedule BLDTM_23 for Rev 311 Proc 88182 * Qty 1 = $143.82 at 100% = $143.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,BLUE CROSS,BLUE CROSS E NETWORK,208.70,,,,,,,15.3200,558.0000,fee schedule,$65.22 from Fee Schedule BCFSB for Rev 311 Proc 88182 * Qty 1 = $65.22 at 320% = $208.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,BLUE CROSS,BLUE CROSS MEDICARE,49.17,,,,,,,15.3200,558.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,BLUE CROSS,BLUE CROSS P NETWORK,213.27,,,,,,,15.3200,558.0000,fee schedule,$65.22 from Fee Schedule BCFSB for Rev 311 Proc 88182 * Qty 1 = $65.22 at 327% = $213.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,BLUE CROSS,BLUE CROSS S NETWORK,213.27,,,,,,,15.3200,558.0000,fee schedule,$65.22 from Fee Schedule BCFSB for Rev 311 Proc 88182 * Qty 1 = $65.22 at 327% = $213.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,BLUE CROSS,TENNCARE BLUE CARE,15.32,,,,,,,15.3200,558.0000,fee schedule,$13.21 from Fee Schedule TC_24 for Rev 311 Proc 88182 * Qty 1 = $13.21 at 116% = $15.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,BLUE CROSS,TENNCARE BLUE SELECT,15.32,,,,,,,15.3200,558.0000,fee schedule,$13.21 from Fee Schedule TC_24 for Rev 311 Proc 88182 * Qty 1 = $13.21 at 116% = $15.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,CIGNA HEALTHCARE,CIGNA HMO,193.37,,,,,,,15.3200,558.0000,fee schedule,$193.37 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88182 * Qty 1 = $193.37 at 100% = $193.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,280.08,,,,,,,15.3200,558.0000,fee schedule,$280.08 from Fee Schedule CGIFP_25LR for Rev 311 Proc 88182 * Qty 1 = $280.08 at 100% = $280.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,49.64,,,,,,,15.3200,558.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,193.37,,,,,,,15.3200,558.0000,fee schedule,$193.37 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88182 * Qty 1 = $193.37 at 100% = $193.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,CIGNA HEALTHCARE,CIGNA PPO,193.37,,,,,,,15.3200,558.0000,fee schedule,$193.37 from Fee Schedule CIGWHS_23 for Rev 311 Proc 88182 * Qty 1 = $193.37 at 100% = $193.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,49.64,,,,,,,15.3200,558.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,502.20,,,,,,,15.3200,558.0000,percent of total billed charges,90% of $558.00 in Billed Charges for Rev 311 Proc 88182 = $502.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,HUMANA,HUMANA MEDICARE,47.28,,,,,,,15.3200,558.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,47.28,,,,,,,15.3200,558.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,MEDCOST,MEDCOST VHN,265.55,,,,,,,15.3200,558.0000,percent of total billed charges,47.59% of $558.00 in Billed Charges for Rev 311 Proc 88182 = $265.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,47.34,,,,,,,15.3200,558.0000,fee schedule,APG 00391 Proc 88182 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 100% = $45.09... $45.09 at 105% = $47.34 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,49.64,,,,,,,15.3200,558.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,49.64,,,,,,,15.3200,558.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,NHC ADVANTAGE,NHC ADVANTAGE,49.64,,,,,,,15.3200,558.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,46.49,,,,,,,15.3200,558.0000,fee schedule,APG 00391 Proc 88182 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 100% = $45.09... $45.09 at 103.1% = $46.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,SENTARA HEALTH,SENTARA HEALTH,144.02,,,,,,,15.3200,558.0000,percent of total billed charges,25.81% of $558.00 in Billed Charges for Rev 311 Proc 88182 = $144.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,SENTARA HEALTH,SENTARA MEDICARE,47.28,,,,,,,15.3200,558.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",558.00,,,,,,,15.3200,558.0000,percent of total billed charges,100% of $558.00 in Billed Charges for Rev 311 Proc 88182 = $558.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,18.41,,,,,,,15.3200,558.0000,fee schedule,$36.81 from Fee Schedule TCUHC24 for Rev 311 Proc 88182 * Qty 1 = $36.81 at 50% = $18.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,51.45,,,,,,,15.3200,558.0000,fee schedule,$49.47 from Fee Schedule UHC_31910 for Rev 311 Proc 88182 * Qty 1 = $49.47 at 104% = $51.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,49.47,,,,,,,15.3200,558.0000,fee schedule,$49.47 from Fee Schedule UHC_31910 for Rev 311 Proc 88182 * Qty 1 = $49.47 at 100% = $49.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,49.47,,,,,,,15.3200,558.0000,fee schedule,$49.47 from Fee Schedule UHC_31910 for Rev 311 Proc 88182 * Qty 1 = $49.47 at 100% = $49.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,46.45,,,,,,,15.3200,558.0000,fee schedule,APG 00391 Proc 88182 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 103% = $46.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,47.28,,,,,,,15.3200,558.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,47.28,,,,,,,15.3200,558.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,WELLCARE,WELLCARE MEDICAID,558.00,,,,,,,15.3200,558.0000,percent of total billed charges,100% of $558.00 in Billed Charges for Rev 311 Proc 88182 = $558.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS,88182,CPT,311,RC,31100021,CDM,,,,both,,,558.0000,83.7000,WELLCARE,WELLCARE MEDICARE,50.12,,,,,,,15.3200,558.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA,353.13,,,,,,,43.0000,827.0000,percent of total billed charges,42.7% of $827.00 in Billed Charges for Rev 440 Proc 92607 = $353.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,401.19,,,,,,,43.0000,827.0000,fee schedule,APG 00272 Proc 92607 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 104% = $401.19. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,116.62,,,,,,,43.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA HEALTHCARE MEDICARE,116.62,,,,,,,43.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,116.62,,,,,,,43.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,AMBETTER,AMBETTER,254.23,,,,,,,43.0000,827.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,AMERIGROUP,AMERIGROUP,108.46,,,,,,,43.0000,827.0000,fee schedule,93.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,121.28,,,,,,,43.0000,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM EXCHANGE,116.62,,,,,,,43.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,397.33,,,,,,,43.0000,827.0000,fee schedule,APG 00272 Proc 92607 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 103% = $397.33. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HMO,116.62,,,,,,,43.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,120.12,,,,,,,43.0000,827.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",116.62,,,,,,,43.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,116.00,,,,,,,43.0000,827.0000,other,Rev 440 Proc 92607 1 Visit at $116.00 per Visit = $116.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS E NETWORK,532.75,,,,,,,43.0000,827.0000,fee schedule,$122.19 from Fee Schedule BCFSG for Rev 440 Proc 92607 * Qty 1 = $122.19 at 436% = $532.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS MEDICARE,121.28,,,,,,,43.0000,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS P NETWORK,543.75,,,,,,,43.0000,827.0000,fee schedule,$122.19 from Fee Schedule BCFSG for Rev 440 Proc 92607 * Qty 1 = $122.19 at 445% = $543.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS S NETWORK,543.75,,,,,,,43.0000,827.0000,fee schedule,$122.19 from Fee Schedule BCFSG for Rev 440 Proc 92607 * Qty 1 = $122.19 at 445% = $543.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,TENNCARE BLUE CARE,98.91,,,,,,,43.0000,827.0000,fee schedule,$85.27 from Fee Schedule TC_24 for Rev 440 Proc 92607 * Qty 1 = $85.27 at 116% = $98.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,TENNCARE BLUE SELECT,98.91,,,,,,,43.0000,827.0000,fee schedule,$85.27 from Fee Schedule TC_24 for Rev 440 Proc 92607 * Qty 1 = $85.27 at 116% = $98.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,CIGNA HEALTHCARE,CIGNA HMO,344.86,,,,,,,43.0000,827.0000,percent of total billed charges,41.7% of $827.00 in Billed Charges for Rev 440 Proc 92607 = $344.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,383.73,,,,,,,43.0000,827.0000,percent of total billed charges,46.4% of $827.00 in Billed Charges for Rev 440 Proc 92607 = $383.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,122.45,,,,,,,43.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,344.86,,,,,,,43.0000,827.0000,percent of total billed charges,41.7% of $827.00 in Billed Charges for Rev 440 Proc 92607 = $344.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,CIGNA HEALTHCARE,CIGNA PPO,344.86,,,,,,,43.0000,827.0000,percent of total billed charges,41.7% of $827.00 in Billed Charges for Rev 440 Proc 92607 = $344.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,122.45,,,,,,,43.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,744.30,,,,,,,43.0000,827.0000,percent of total billed charges,90% of $827.00 in Billed Charges for Rev 440 Proc 92607 = $744.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,HUMANA,HUMANA MEDICARE,116.62,,,,,,,43.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,116.62,,,,,,,43.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,MEDCOST,MEDCOST VHN,393.57,,,,,,,43.0000,827.0000,percent of total billed charges,47.59% of $827.00 in Billed Charges for Rev 440 Proc 92607 = $393.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,405.05,,,,,,,43.0000,827.0000,fee schedule,APG 00272 Proc 92607 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 100% = $385.76... $385.76 at 105% = $405.05 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,122.45,,,,,,,43.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,122.45,,,,,,,43.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,NHC ADVANTAGE,NHC ADVANTAGE,122.45,,,,,,,43.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,397.72,,,,,,,43.0000,827.0000,fee schedule,APG 00272 Proc 92607 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 100% = $385.76... $385.76 at 103.1% = $397.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA HEALTH,213.45,,,,,,,43.0000,827.0000,percent of total billed charges,25.81% of $827.00 in Billed Charges for Rev 440 Proc 92607 = $213.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA MEDICARE,116.62,,,,,,,43.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",827.00,,,,,,,43.0000,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 440 Proc 92607 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,43.00,,,,,,,43.0000,827.0000,other,Rev 440 Proc 92607 1 Visit at $43.00 per Visit = $43.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,257.00,,,,,,,43.0000,827.0000,other,Rev 440 Proc 92607 1 Visit at $257.00 per Visit = $257.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,245.00,,,,,,,43.0000,827.0000,other,Rev 440 Proc 92607 1 Visit at $245.00 per Visit = $245.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,403.00,,,,,,,43.0000,827.0000,other,Rev 440 Proc 92607 1 Visit at $403.00 per Visit = $403.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,397.33,,,,,,,43.0000,827.0000,fee schedule,APG 00272 Proc 92607 at $836.60 (Base Rate) * 0.4611 (Relative Weight) = $385.76 (Total Line Payment) at 103% = $397.33. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,116.62,,,,,,,43.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,116.62,,,,,,,43.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICAID,827.00,,,,,,,43.0000,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 440 Proc 92607 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVAL SPECH DEVICE PRESCRIPTION 1ST HR,92607,CPT,440,RC,44000033,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICARE,123.62,,,,,,,43.0000,827.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,AETNA,AETNA,188.73,,,,,,,13.7800,442.0000,percent of total billed charges,42.7% of $442.00 in Billed Charges for Rev 471 Proc 92650 = $188.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,46.90,,,,,,,13.7800,442.0000,fee schedule,APG 00229 Proc 92650 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 104% = $46.90. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,46.45,,,,,,,13.7800,442.0000,fee schedule,APG 00229 Proc 92650 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 103% = $46.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,309.40,,,,,,,13.7800,442.0000,percent of total billed charges,Rev 471 Proc 92650 $442.00 in Billed Charges at 70% = $309.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,BLUE CROSS,BLUE CROSS E NETWORK,115.54,,,,,,,13.7800,442.0000,fee schedule,$26.50 from Fee Schedule BCFSG for Rev 471 Proc 92650 * Qty 1 = $26.50 at 436% = $115.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,BLUE CROSS,BLUE CROSS P NETWORK,117.93,,,,,,,13.7800,442.0000,fee schedule,$26.50 from Fee Schedule BCFSG for Rev 471 Proc 92650 * Qty 1 = $26.50 at 445% = $117.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,BLUE CROSS,BLUE CROSS S NETWORK,117.93,,,,,,,13.7800,442.0000,fee schedule,$26.50 from Fee Schedule BCFSG for Rev 471 Proc 92650 * Qty 1 = $26.50 at 445% = $117.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,BLUE CROSS,TENNCARE BLUE CARE,26.78,,,,,,,13.7800,442.0000,fee schedule,$23.09 from Fee Schedule TC_24 for Rev 471 Proc 92650 * Qty 1 = $23.09 at 116% = $26.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,BLUE CROSS,TENNCARE BLUE SELECT,26.78,,,,,,,13.7800,442.0000,fee schedule,$23.09 from Fee Schedule TC_24 for Rev 471 Proc 92650 * Qty 1 = $23.09 at 116% = $26.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,CIGNA HEALTHCARE,CIGNA HMO,184.31,,,,,,,13.7800,442.0000,percent of total billed charges,41.7% of $442.00 in Billed Charges for Rev 471 Proc 92650 = $184.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,205.09,,,,,,,13.7800,442.0000,percent of total billed charges,46.4% of $442.00 in Billed Charges for Rev 471 Proc 92650 = $205.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,184.31,,,,,,,13.7800,442.0000,percent of total billed charges,41.7% of $442.00 in Billed Charges for Rev 471 Proc 92650 = $184.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,CIGNA HEALTHCARE,CIGNA PPO,184.31,,,,,,,13.7800,442.0000,percent of total billed charges,41.7% of $442.00 in Billed Charges for Rev 471 Proc 92650 = $184.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,397.80,,,,,,,13.7800,442.0000,percent of total billed charges,90% of $442.00 in Billed Charges for Rev 471 Proc 92650 = $397.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,MEDCOST,MEDCOST VHN,210.35,,,,,,,13.7800,442.0000,percent of total billed charges,47.59% of $442.00 in Billed Charges for Rev 471 Proc 92650 = $210.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,47.34,,,,,,,13.7800,442.0000,fee schedule,APG 00229 Proc 92650 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 100% = $45.09... $45.09 at 105% = $47.34 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,46.49,,,,,,,13.7800,442.0000,fee schedule,APG 00229 Proc 92650 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 100% = $45.09... $45.09 at 103.1% = $46.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,SENTARA HEALTH,SENTARA HEALTH,114.08,,,,,,,13.7800,442.0000,percent of total billed charges,25.81% of $442.00 in Billed Charges for Rev 471 Proc 92650 = $114.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",442.00,,,,,,,13.7800,442.0000,percent of total billed charges,100% of $442.00 in Billed Charges for Rev 471 Proc 92650 = $442.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,13.78,,,,,,,13.7800,442.0000,fee schedule,$27.55 from Fee Schedule TCUHC24 for Rev 471 Proc 92650 * Qty 1 = $27.55 at 50% = $13.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,320.00,,,,,,,13.7800,442.0000,other,Rev 471 Proc 92650 1 Visit at $320.00 per Visit = $320.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,305.00,,,,,,,13.7800,442.0000,other,Rev 471 Proc 92650 1 Visit at $305.00 per Visit = $305.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,442.00,,,,,,,13.7800,442.0000,other,"Rev 471 Proc 92650 1 Visit at $502.00 per Visit = $502.00 (Service Line reduced to $442.00, claim capped at $442.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,46.45,,,,,,,13.7800,442.0000,fee schedule,APG 00229 Proc 92650 at $836.60 (Base Rate) * 0.0539 (Relative Weight) = $45.09 (Total Line Payment) at 103% = $46.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP SCR AUDITORY POTENTIAL W STIMULI AUTO ALYS,92650,CPT,471,RC,47100019,CDM,,,,both,,,442.0000,66.3000,WELLCARE,WELLCARE MEDICAID,442.00,,,,,,,13.7800,442.0000,percent of total billed charges,100% of $442.00 in Billed Charges for Rev 471 Proc 92650 = $442.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,AETNA,AETNA,357.40,,,,,,,112.3300,837.0000,percent of total billed charges,42.7% of $837.00 in Billed Charges for Rev 471 Proc 92652 = $357.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,114.24,,,,,,,112.3300,837.0000,fee schedule,APG 00257 Proc 92652 at $836.60 (Base Rate) * 0.1313 (Relative Weight) = $109.85 (Total Line Payment) at 104% = $114.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,195.90,,,,,,,112.3300,837.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,AETNA,AETNA HEALTHCARE MEDICARE,195.90,,,,,,,112.3300,837.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,195.90,,,,,,,112.3300,837.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,AMBETTER,AMBETTER,427.07,,,,,,,112.3300,837.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,203.74,,,,,,,112.3300,837.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,BLUE CROSS,ANTHEM EXCHANGE,482.33,,,,,,,112.3300,837.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,113.14,,,,,,,112.3300,837.0000,fee schedule,APG 00257 Proc 92652 at $836.60 (Base Rate) * 0.1313 (Relative Weight) = $109.85 (Total Line Payment) at 103% = $113.14. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,BLUE CROSS,ANTHEM HMO,512.44,,,,,,,112.3300,837.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,201.78,,,,,,,112.3300,837.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",602.84,,,,,,,112.3300,837.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,585.90,,,,,,,112.3300,837.0000,percent of total billed charges,Rev 471 Proc 92652 $837.00 in Billed Charges at 70% = $585.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,BLUE CROSS,BLUE CROSS E NETWORK,484.61,,,,,,,112.3300,837.0000,fee schedule,$111.15 from Fee Schedule BCFSG for Rev 471 Proc 92652 * Qty 1 = $111.15 at 436% = $484.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,BLUE CROSS,BLUE CROSS MEDICARE,203.74,,,,,,,112.3300,837.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,BLUE CROSS,BLUE CROSS P NETWORK,494.62,,,,,,,112.3300,837.0000,fee schedule,$111.15 from Fee Schedule BCFSG for Rev 471 Proc 92652 * Qty 1 = $111.15 at 445% = $494.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,BLUE CROSS,BLUE CROSS S NETWORK,494.62,,,,,,,112.3300,837.0000,fee schedule,$111.15 from Fee Schedule BCFSG for Rev 471 Proc 92652 * Qty 1 = $111.15 at 445% = $494.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,BLUE CROSS,TENNCARE BLUE CARE,112.33,,,,,,,112.3300,837.0000,fee schedule,$96.84 from Fee Schedule TC_24 for Rev 471 Proc 92652 * Qty 1 = $96.84 at 116% = $112.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,BLUE CROSS,TENNCARE BLUE SELECT,112.33,,,,,,,112.3300,837.0000,fee schedule,$96.84 from Fee Schedule TC_24 for Rev 471 Proc 92652 * Qty 1 = $96.84 at 116% = $112.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,CIGNA HEALTHCARE,CIGNA HMO,349.03,,,,,,,112.3300,837.0000,percent of total billed charges,41.7% of $837.00 in Billed Charges for Rev 471 Proc 92652 = $349.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,388.37,,,,,,,112.3300,837.0000,percent of total billed charges,46.4% of $837.00 in Billed Charges for Rev 471 Proc 92652 = $388.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,205.70,,,,,,,112.3300,837.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,349.03,,,,,,,112.3300,837.0000,percent of total billed charges,41.7% of $837.00 in Billed Charges for Rev 471 Proc 92652 = $349.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,CIGNA HEALTHCARE,CIGNA PPO,349.03,,,,,,,112.3300,837.0000,percent of total billed charges,41.7% of $837.00 in Billed Charges for Rev 471 Proc 92652 = $349.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,205.70,,,,,,,112.3300,837.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,753.30,,,,,,,112.3300,837.0000,percent of total billed charges,90% of $837.00 in Billed Charges for Rev 471 Proc 92652 = $753.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,HUMANA,HUMANA MEDICARE,195.90,,,,,,,112.3300,837.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,195.90,,,,,,,112.3300,837.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,MEDCOST,MEDCOST VHN,398.33,,,,,,,112.3300,837.0000,percent of total billed charges,47.59% of $837.00 in Billed Charges for Rev 471 Proc 92652 = $398.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,115.34,,,,,,,112.3300,837.0000,fee schedule,APG 00257 Proc 92652 at $836.60 (Base Rate) * 0.1313 (Relative Weight) = $109.85 (Total Line Payment) at 100% = $109.85... $109.85 at 105% = $115.34 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,205.70,,,,,,,112.3300,837.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,205.70,,,,,,,112.3300,837.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,NHC ADVANTAGE,NHC ADVANTAGE,205.70,,,,,,,112.3300,837.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,113.26,,,,,,,112.3300,837.0000,fee schedule,APG 00257 Proc 92652 at $836.60 (Base Rate) * 0.1313 (Relative Weight) = $109.85 (Total Line Payment) at 100% = $109.85... $109.85 at 103.1% = $113.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,SENTARA HEALTH,SENTARA HEALTH,216.03,,,,,,,112.3300,837.0000,percent of total billed charges,25.81% of $837.00 in Billed Charges for Rev 471 Proc 92652 = $216.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,SENTARA HEALTH,SENTARA MEDICARE,195.90,,,,,,,112.3300,837.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",837.00,,,,,,,112.3300,837.0000,percent of total billed charges,100% of $837.00 in Billed Charges for Rev 471 Proc 92652 = $837.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,132.23,,,,,,,112.3300,837.0000,fee schedule,$264.45 from Fee Schedule TCUHC24 for Rev 471 Proc 92652 * Qty 1 = $264.45 at 50% = $132.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,320.00,,,,,,,112.3300,837.0000,other,Rev 471 Proc 92652 1 Visit at $320.00 per Visit = $320.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,305.00,,,,,,,112.3300,837.0000,other,Rev 471 Proc 92652 1 Visit at $305.00 per Visit = $305.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,502.00,,,,,,,112.3300,837.0000,other,Rev 471 Proc 92652 1 Visit at $502.00 per Visit = $502.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,113.14,,,,,,,112.3300,837.0000,fee schedule,APG 00257 Proc 92652 at $836.60 (Base Rate) * 0.1313 (Relative Weight) = $109.85 (Total Line Payment) at 103% = $113.14. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,195.90,,,,,,,112.3300,837.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,195.90,,,,,,,112.3300,837.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,WELLCARE,WELLCARE MEDICAID,837.00,,,,,,,112.3300,837.0000,percent of total billed charges,100% of $837.00 in Billed Charges for Rev 471 Proc 92652 = $837.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R,92652,CPT,471,RC,47100021,CDM,,,,both,,,837.0000,125.5500,WELLCARE,WELLCARE MEDICARE,207.66,,,,,,,112.3300,837.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
RING MALYUGIN 6.25MM,272,RC,27200002,CDM,,,,,,both,,,1553.9200,233.0900,AETNA,AETNA,663.52,,,,,,,401.0700,1553.9200,percent of total billed charges,"42.7% of $1,553.92 in Billed Charges for Rev 272 = $663.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM,272,RC,27200002,CDM,,,,,,both,,,1553.9200,233.0900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1087.74,,,,,,,401.0700,1553.9200,percent of total billed charges,"Rev 272 $1,553.92 in Billed Charges at 70% = $1,087.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM,272,RC,27200002,CDM,,,,,,both,,,1553.9200,233.0900,CIGNA HEALTHCARE,CIGNA HMO,647.98,,,,,,,401.0700,1553.9200,percent of total billed charges,"41.7% of $1,553.92 in Billed Charges for Rev 272 = $647.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM,272,RC,27200002,CDM,,,,,,both,,,1553.9200,233.0900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,721.02,,,,,,,401.0700,1553.9200,percent of total billed charges,"46.4% of $1,553.92 in Billed Charges for Rev 272 = $721.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM,272,RC,27200002,CDM,,,,,,both,,,1553.9200,233.0900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,647.98,,,,,,,401.0700,1553.9200,percent of total billed charges,"41.7% of $1,553.92 in Billed Charges for Rev 272 = $647.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM,272,RC,27200002,CDM,,,,,,both,,,1553.9200,233.0900,CIGNA HEALTHCARE,CIGNA PPO,647.98,,,,,,,401.0700,1553.9200,percent of total billed charges,"41.7% of $1,553.92 in Billed Charges for Rev 272 = $647.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM,272,RC,27200002,CDM,,,,,,both,,,1553.9200,233.0900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1398.53,,,,,,,401.0700,1553.9200,percent of total billed charges,"90% of $1,553.92 in Billed Charges for Rev 272 = $1,398.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM,272,RC,27200002,CDM,,,,,,both,,,1553.9200,233.0900,MEDCOST,MEDCOST VHN,739.51,,,,,,,401.0700,1553.9200,percent of total billed charges,"47.59% of $1,553.92 in Billed Charges for Rev 272 = $739.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM,272,RC,27200002,CDM,,,,,,both,,,1553.9200,233.0900,SENTARA HEALTH,SENTARA HEALTH,401.07,,,,,,,401.0700,1553.9200,percent of total billed charges,"25.81% of $1,553.92 in Billed Charges for Rev 272 = $401.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM,272,RC,27200002,CDM,,,,,,both,,,1553.9200,233.0900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1553.92,,,,,,,401.0700,1553.9200,percent of total billed charges,"100% of $1,553.92 in Billed Charges for Rev 272 = $1,553.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM,272,RC,27200002,CDM,,,,,,both,,,1553.9200,233.0900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,776.96,,,,,,,401.0700,1553.9200,percent of total billed charges,"Rev 272 $1,553.92 in Billed Charges at 50% = $776.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM,272,RC,27200002,CDM,,,,,,both,,,1553.9200,233.0900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,501.92,,,,,,,401.0700,1553.9200,other,"32.3% of $1,553.92 in Billed Charges for Rev 272 = $501.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RING MALYUGIN 6.25MM,272,RC,27200002,CDM,,,,,,both,,,1553.9200,233.0900,UNITED HEALTHCARE,UHC HERITAGE SELECT,477.05,,,,,,,401.0700,1553.9200,other,"30.7% of $1,553.92 in Billed Charges for Rev 272 = $477.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RING MALYUGIN 6.25MM,272,RC,27200002,CDM,,,,,,both,,,1553.9200,233.0900,UNITED HEALTHCARE,UNITED HEALTHCARE,501.92,,,,,,,401.0700,1553.9200,percent of total billed charges,"32.3% of $1,553.92 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM,272,RC,27200002,CDM,,,,,,both,,,1553.9200,233.0900,WELLCARE,WELLCARE MEDICAID,1553.92,,,,,,,401.0700,1553.9200,percent of total billed charges,"100% of $1,553.92 in Billed Charges for Rev 272 = $1,553.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM DIA 2.0 MANIPULATOR INCISIONS,272,RC,27200002,CDM,,,,,,both,,,9323.5300,1398.5300,AETNA,AETNA,3981.15,,,,,,,2406.4000,9323.5300,percent of total billed charges,"42.7% of $9,323.53 in Billed Charges for Rev 272 = $3,981.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM DIA 2.0 MANIPULATOR INCISIONS,272,RC,27200002,CDM,,,,,,both,,,9323.5300,1398.5300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6526.47,,,,,,,2406.4000,9323.5300,percent of total billed charges,"Rev 272 $9,323.53 in Billed Charges at 70% = $6,526.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM DIA 2.0 MANIPULATOR INCISIONS,272,RC,27200002,CDM,,,,,,both,,,9323.5300,1398.5300,CIGNA HEALTHCARE,CIGNA HMO,3887.91,,,,,,,2406.4000,9323.5300,percent of total billed charges,"41.7% of $9,323.53 in Billed Charges for Rev 272 = $3,887.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM DIA 2.0 MANIPULATOR INCISIONS,272,RC,27200002,CDM,,,,,,both,,,9323.5300,1398.5300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4326.12,,,,,,,2406.4000,9323.5300,percent of total billed charges,"46.4% of $9,323.53 in Billed Charges for Rev 272 = $4,326.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM DIA 2.0 MANIPULATOR INCISIONS,272,RC,27200002,CDM,,,,,,both,,,9323.5300,1398.5300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3887.91,,,,,,,2406.4000,9323.5300,percent of total billed charges,"41.7% of $9,323.53 in Billed Charges for Rev 272 = $3,887.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM DIA 2.0 MANIPULATOR INCISIONS,272,RC,27200002,CDM,,,,,,both,,,9323.5300,1398.5300,CIGNA HEALTHCARE,CIGNA PPO,3887.91,,,,,,,2406.4000,9323.5300,percent of total billed charges,"41.7% of $9,323.53 in Billed Charges for Rev 272 = $3,887.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM DIA 2.0 MANIPULATOR INCISIONS,272,RC,27200002,CDM,,,,,,both,,,9323.5300,1398.5300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8391.18,,,,,,,2406.4000,9323.5300,percent of total billed charges,"90% of $9,323.53 in Billed Charges for Rev 272 = $8,391.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM DIA 2.0 MANIPULATOR INCISIONS,272,RC,27200002,CDM,,,,,,both,,,9323.5300,1398.5300,MEDCOST,MEDCOST VHN,4437.07,,,,,,,2406.4000,9323.5300,percent of total billed charges,"47.59% of $9,323.53 in Billed Charges for Rev 272 = $4,437.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM DIA 2.0 MANIPULATOR INCISIONS,272,RC,27200002,CDM,,,,,,both,,,9323.5300,1398.5300,SENTARA HEALTH,SENTARA HEALTH,2406.40,,,,,,,2406.4000,9323.5300,percent of total billed charges,"25.81% of $9,323.53 in Billed Charges for Rev 272 = $2,406.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM DIA 2.0 MANIPULATOR INCISIONS,272,RC,27200002,CDM,,,,,,both,,,9323.5300,1398.5300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9323.53,,,,,,,2406.4000,9323.5300,percent of total billed charges,"100% of $9,323.53 in Billed Charges for Rev 272 = $9,323.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM DIA 2.0 MANIPULATOR INCISIONS,272,RC,27200002,CDM,,,,,,both,,,9323.5300,1398.5300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4661.77,,,,,,,2406.4000,9323.5300,percent of total billed charges,"Rev 272 $9,323.53 in Billed Charges at 50% = $4,661.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM DIA 2.0 MANIPULATOR INCISIONS,272,RC,27200002,CDM,,,,,,both,,,9323.5300,1398.5300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3011.50,,,,,,,2406.4000,9323.5300,other,"32.3% of $9,323.53 in Billed Charges for Rev 272 = $3,011.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RING MALYUGIN 6.25MM DIA 2.0 MANIPULATOR INCISIONS,272,RC,27200002,CDM,,,,,,both,,,9323.5300,1398.5300,UNITED HEALTHCARE,UHC HERITAGE SELECT,2862.32,,,,,,,2406.4000,9323.5300,other,"30.7% of $9,323.53 in Billed Charges for Rev 272 = $2,862.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RING MALYUGIN 6.25MM DIA 2.0 MANIPULATOR INCISIONS,272,RC,27200002,CDM,,,,,,both,,,9323.5300,1398.5300,UNITED HEALTHCARE,UNITED HEALTHCARE,3011.50,,,,,,,2406.4000,9323.5300,percent of total billed charges,"32.3% of $9,323.53 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING MALYUGIN 6.25MM DIA 2.0 MANIPULATOR INCISIONS,272,RC,27200002,CDM,,,,,,both,,,9323.5300,1398.5300,WELLCARE,WELLCARE MEDICAID,9323.53,,,,,,,2406.4000,9323.5300,percent of total billed charges,"100% of $9,323.53 in Billed Charges for Rev 272 = $9,323.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING TITANIUM HALF 150MM,272,RC,,,,,,,,both,,,4163.1300,624.4700,AETNA,AETNA,1777.66,,,,,,,1074.5000,4163.1300,percent of total billed charges,"42.7% of $4,163.13 in Billed Charges for Rev 272 = $1,777.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING TITANIUM HALF 150MM,272,RC,,,,,,,,both,,,4163.1300,624.4700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2914.19,,,,,,,1074.5000,4163.1300,percent of total billed charges,"Rev 272 $4,163.13 in Billed Charges at 70% = $2,914.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING TITANIUM HALF 150MM,272,RC,,,,,,,,both,,,4163.1300,624.4700,CIGNA HEALTHCARE,CIGNA HMO,1736.03,,,,,,,1074.5000,4163.1300,percent of total billed charges,"41.7% of $4,163.13 in Billed Charges for Rev 272 = $1,736.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING TITANIUM HALF 150MM,272,RC,,,,,,,,both,,,4163.1300,624.4700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1931.69,,,,,,,1074.5000,4163.1300,percent of total billed charges,"46.4% of $4,163.13 in Billed Charges for Rev 272 = $1,931.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING TITANIUM HALF 150MM,272,RC,,,,,,,,both,,,4163.1300,624.4700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1736.03,,,,,,,1074.5000,4163.1300,percent of total billed charges,"41.7% of $4,163.13 in Billed Charges for Rev 272 = $1,736.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING TITANIUM HALF 150MM,272,RC,,,,,,,,both,,,4163.1300,624.4700,CIGNA HEALTHCARE,CIGNA PPO,1736.03,,,,,,,1074.5000,4163.1300,percent of total billed charges,"41.7% of $4,163.13 in Billed Charges for Rev 272 = $1,736.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING TITANIUM HALF 150MM,272,RC,,,,,,,,both,,,4163.1300,624.4700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3746.82,,,,,,,1074.5000,4163.1300,percent of total billed charges,"90% of $4,163.13 in Billed Charges for Rev 272 = $3,746.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING TITANIUM HALF 150MM,272,RC,,,,,,,,both,,,4163.1300,624.4700,MEDCOST,MEDCOST VHN,1981.23,,,,,,,1074.5000,4163.1300,percent of total billed charges,"47.59% of $4,163.13 in Billed Charges for Rev 272 = $1,981.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING TITANIUM HALF 150MM,272,RC,,,,,,,,both,,,4163.1300,624.4700,SENTARA HEALTH,SENTARA HEALTH,1074.50,,,,,,,1074.5000,4163.1300,percent of total billed charges,"25.81% of $4,163.13 in Billed Charges for Rev 272 = $1,074.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING TITANIUM HALF 150MM,272,RC,,,,,,,,both,,,4163.1300,624.4700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4163.13,,,,,,,1074.5000,4163.1300,percent of total billed charges,"100% of $4,163.13 in Billed Charges for Rev 272 = $4,163.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING TITANIUM HALF 150MM,272,RC,,,,,,,,both,,,4163.1300,624.4700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2081.57,,,,,,,1074.5000,4163.1300,percent of total billed charges,"Rev 272 $4,163.13 in Billed Charges at 50% = $2,081.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING TITANIUM HALF 150MM,272,RC,,,,,,,,both,,,4163.1300,624.4700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1344.69,,,,,,,1074.5000,4163.1300,other,"32.3% of $4,163.13 in Billed Charges for Rev 272 = $1,344.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RING TITANIUM HALF 150MM,272,RC,,,,,,,,both,,,4163.1300,624.4700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1278.08,,,,,,,1074.5000,4163.1300,other,"30.7% of $4,163.13 in Billed Charges for Rev 272 = $1,278.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RING TITANIUM HALF 150MM,272,RC,,,,,,,,both,,,4163.1300,624.4700,UNITED HEALTHCARE,UNITED HEALTHCARE,1344.69,,,,,,,1074.5000,4163.1300,percent of total billed charges,"32.3% of $4,163.13 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING TITANIUM HALF 150MM,272,RC,,,,,,,,both,,,4163.1300,624.4700,WELLCARE,WELLCARE MEDICAID,4163.13,,,,,,,1074.5000,4163.1300,percent of total billed charges,"100% of $4,163.13 in Billed Charges for Rev 272 = $4,163.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD 120MM EX-FIX,272,RC,,,,,,,,both,,,393.3700,59.0100,AETNA,AETNA,167.97,,,,,,,101.5300,393.3700,percent of total billed charges,42.7% of $393.37 in Billed Charges for Rev 272 = $167.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD 120MM EX-FIX,272,RC,,,,,,,,both,,,393.3700,59.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,275.36,,,,,,,101.5300,393.3700,percent of total billed charges,Rev 272 $393.37 in Billed Charges at 70% = $275.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD 120MM EX-FIX,272,RC,,,,,,,,both,,,393.3700,59.0100,CIGNA HEALTHCARE,CIGNA HMO,164.04,,,,,,,101.5300,393.3700,percent of total billed charges,41.7% of $393.37 in Billed Charges for Rev 272 = $164.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD 120MM EX-FIX,272,RC,,,,,,,,both,,,393.3700,59.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,182.52,,,,,,,101.5300,393.3700,percent of total billed charges,46.4% of $393.37 in Billed Charges for Rev 272 = $182.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD 120MM EX-FIX,272,RC,,,,,,,,both,,,393.3700,59.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,164.04,,,,,,,101.5300,393.3700,percent of total billed charges,41.7% of $393.37 in Billed Charges for Rev 272 = $164.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD 120MM EX-FIX,272,RC,,,,,,,,both,,,393.3700,59.0100,CIGNA HEALTHCARE,CIGNA PPO,164.04,,,,,,,101.5300,393.3700,percent of total billed charges,41.7% of $393.37 in Billed Charges for Rev 272 = $164.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD 120MM EX-FIX,272,RC,,,,,,,,both,,,393.3700,59.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,354.03,,,,,,,101.5300,393.3700,percent of total billed charges,90% of $393.37 in Billed Charges for Rev 272 = $354.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD 120MM EX-FIX,272,RC,,,,,,,,both,,,393.3700,59.0100,MEDCOST,MEDCOST VHN,187.20,,,,,,,101.5300,393.3700,percent of total billed charges,47.59% of $393.37 in Billed Charges for Rev 272 = $187.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD 120MM EX-FIX,272,RC,,,,,,,,both,,,393.3700,59.0100,SENTARA HEALTH,SENTARA HEALTH,101.53,,,,,,,101.5300,393.3700,percent of total billed charges,25.81% of $393.37 in Billed Charges for Rev 272 = $101.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD 120MM EX-FIX,272,RC,,,,,,,,both,,,393.3700,59.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",393.37,,,,,,,101.5300,393.3700,percent of total billed charges,100% of $393.37 in Billed Charges for Rev 272 = $393.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD 120MM EX-FIX,272,RC,,,,,,,,both,,,393.3700,59.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,196.69,,,,,,,101.5300,393.3700,percent of total billed charges,Rev 272 $393.37 in Billed Charges at 50% = $196.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD 120MM EX-FIX,272,RC,,,,,,,,both,,,393.3700,59.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,127.06,,,,,,,101.5300,393.3700,other,32.3% of $393.37 in Billed Charges for Rev 272 = $127.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ROD 120MM EX-FIX,272,RC,,,,,,,,both,,,393.3700,59.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,120.76,,,,,,,101.5300,393.3700,other,30.7% of $393.37 in Billed Charges for Rev 272 = $120.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ROD 120MM EX-FIX,272,RC,,,,,,,,both,,,393.3700,59.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,127.06,,,,,,,101.5300,393.3700,percent of total billed charges,32.3% of $393.37 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD 120MM EX-FIX,272,RC,,,,,,,,both,,,393.3700,59.0100,WELLCARE,WELLCARE MEDICAID,393.37,,,,,,,101.5300,393.3700,percent of total billed charges,100% of $393.37 in Billed Charges for Rev 272 = $393.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD EXTERNAL FIXATION FULL MANDIBLE BENT 182MM,272,RC,27200002,CDM,,,,,,both,,,7849.5000,1177.4300,AETNA,AETNA,3351.74,,,,,,,2025.9600,7849.5000,percent of total billed charges,"42.7% of $7,849.50 in Billed Charges for Rev 272 = $3,351.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD EXTERNAL FIXATION FULL MANDIBLE BENT 182MM,272,RC,27200002,CDM,,,,,,both,,,7849.5000,1177.4300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5494.65,,,,,,,2025.9600,7849.5000,percent of total billed charges,"Rev 272 $7,849.50 in Billed Charges at 70% = $5,494.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD EXTERNAL FIXATION FULL MANDIBLE BENT 182MM,272,RC,27200002,CDM,,,,,,both,,,7849.5000,1177.4300,CIGNA HEALTHCARE,CIGNA HMO,3273.24,,,,,,,2025.9600,7849.5000,percent of total billed charges,"41.7% of $7,849.50 in Billed Charges for Rev 272 = $3,273.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD EXTERNAL FIXATION FULL MANDIBLE BENT 182MM,272,RC,27200002,CDM,,,,,,both,,,7849.5000,1177.4300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3642.17,,,,,,,2025.9600,7849.5000,percent of total billed charges,"46.4% of $7,849.50 in Billed Charges for Rev 272 = $3,642.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD EXTERNAL FIXATION FULL MANDIBLE BENT 182MM,272,RC,27200002,CDM,,,,,,both,,,7849.5000,1177.4300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3273.24,,,,,,,2025.9600,7849.5000,percent of total billed charges,"41.7% of $7,849.50 in Billed Charges for Rev 272 = $3,273.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD EXTERNAL FIXATION FULL MANDIBLE BENT 182MM,272,RC,27200002,CDM,,,,,,both,,,7849.5000,1177.4300,CIGNA HEALTHCARE,CIGNA PPO,3273.24,,,,,,,2025.9600,7849.5000,percent of total billed charges,"41.7% of $7,849.50 in Billed Charges for Rev 272 = $3,273.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD EXTERNAL FIXATION FULL MANDIBLE BENT 182MM,272,RC,27200002,CDM,,,,,,both,,,7849.5000,1177.4300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7064.55,,,,,,,2025.9600,7849.5000,percent of total billed charges,"90% of $7,849.50 in Billed Charges for Rev 272 = $7,064.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD EXTERNAL FIXATION FULL MANDIBLE BENT 182MM,272,RC,27200002,CDM,,,,,,both,,,7849.5000,1177.4300,MEDCOST,MEDCOST VHN,3735.58,,,,,,,2025.9600,7849.5000,percent of total billed charges,"47.59% of $7,849.50 in Billed Charges for Rev 272 = $3,735.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD EXTERNAL FIXATION FULL MANDIBLE BENT 182MM,272,RC,27200002,CDM,,,,,,both,,,7849.5000,1177.4300,SENTARA HEALTH,SENTARA HEALTH,2025.96,,,,,,,2025.9600,7849.5000,percent of total billed charges,"25.81% of $7,849.50 in Billed Charges for Rev 272 = $2,025.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD EXTERNAL FIXATION FULL MANDIBLE BENT 182MM,272,RC,27200002,CDM,,,,,,both,,,7849.5000,1177.4300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7849.50,,,,,,,2025.9600,7849.5000,percent of total billed charges,"100% of $7,849.50 in Billed Charges for Rev 272 = $7,849.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD EXTERNAL FIXATION FULL MANDIBLE BENT 182MM,272,RC,27200002,CDM,,,,,,both,,,7849.5000,1177.4300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3924.75,,,,,,,2025.9600,7849.5000,percent of total billed charges,"Rev 272 $7,849.50 in Billed Charges at 50% = $3,924.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD EXTERNAL FIXATION FULL MANDIBLE BENT 182MM,272,RC,27200002,CDM,,,,,,both,,,7849.5000,1177.4300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2535.39,,,,,,,2025.9600,7849.5000,other,"32.3% of $7,849.50 in Billed Charges for Rev 272 = $2,535.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ROD EXTERNAL FIXATION FULL MANDIBLE BENT 182MM,272,RC,27200002,CDM,,,,,,both,,,7849.5000,1177.4300,UNITED HEALTHCARE,UHC HERITAGE SELECT,2409.80,,,,,,,2025.9600,7849.5000,other,"30.7% of $7,849.50 in Billed Charges for Rev 272 = $2,409.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ROD EXTERNAL FIXATION FULL MANDIBLE BENT 182MM,272,RC,27200002,CDM,,,,,,both,,,7849.5000,1177.4300,UNITED HEALTHCARE,UNITED HEALTHCARE,2535.39,,,,,,,2025.9600,7849.5000,percent of total billed charges,"32.3% of $7,849.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD EXTERNAL FIXATION FULL MANDIBLE BENT 182MM,272,RC,27200002,CDM,,,,,,both,,,7849.5000,1177.4300,WELLCARE,WELLCARE MEDICAID,7849.50,,,,,,,2025.9600,7849.5000,percent of total billed charges,"100% of $7,849.50 in Billed Charges for Rev 272 = $7,849.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD FIXATING CARBON FIBER 4.0 X 180MM,272,RC,,,,,,,,both,,,467.6300,70.1400,AETNA,AETNA,199.68,,,,,,,120.7000,467.6300,percent of total billed charges,42.7% of $467.63 in Billed Charges for Rev 272 = $199.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD FIXATING CARBON FIBER 4.0 X 180MM,272,RC,,,,,,,,both,,,467.6300,70.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,327.34,,,,,,,120.7000,467.6300,percent of total billed charges,Rev 272 $467.63 in Billed Charges at 70% = $327.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD FIXATING CARBON FIBER 4.0 X 180MM,272,RC,,,,,,,,both,,,467.6300,70.1400,CIGNA HEALTHCARE,CIGNA HMO,195.00,,,,,,,120.7000,467.6300,percent of total billed charges,41.7% of $467.63 in Billed Charges for Rev 272 = $195.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD FIXATING CARBON FIBER 4.0 X 180MM,272,RC,,,,,,,,both,,,467.6300,70.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,216.98,,,,,,,120.7000,467.6300,percent of total billed charges,46.4% of $467.63 in Billed Charges for Rev 272 = $216.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD FIXATING CARBON FIBER 4.0 X 180MM,272,RC,,,,,,,,both,,,467.6300,70.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,195.00,,,,,,,120.7000,467.6300,percent of total billed charges,41.7% of $467.63 in Billed Charges for Rev 272 = $195.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD FIXATING CARBON FIBER 4.0 X 180MM,272,RC,,,,,,,,both,,,467.6300,70.1400,CIGNA HEALTHCARE,CIGNA PPO,195.00,,,,,,,120.7000,467.6300,percent of total billed charges,41.7% of $467.63 in Billed Charges for Rev 272 = $195.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD FIXATING CARBON FIBER 4.0 X 180MM,272,RC,,,,,,,,both,,,467.6300,70.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,420.87,,,,,,,120.7000,467.6300,percent of total billed charges,90% of $467.63 in Billed Charges for Rev 272 = $420.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD FIXATING CARBON FIBER 4.0 X 180MM,272,RC,,,,,,,,both,,,467.6300,70.1400,MEDCOST,MEDCOST VHN,222.55,,,,,,,120.7000,467.6300,percent of total billed charges,47.59% of $467.63 in Billed Charges for Rev 272 = $222.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD FIXATING CARBON FIBER 4.0 X 180MM,272,RC,,,,,,,,both,,,467.6300,70.1400,SENTARA HEALTH,SENTARA HEALTH,120.70,,,,,,,120.7000,467.6300,percent of total billed charges,25.81% of $467.63 in Billed Charges for Rev 272 = $120.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD FIXATING CARBON FIBER 4.0 X 180MM,272,RC,,,,,,,,both,,,467.6300,70.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",467.63,,,,,,,120.7000,467.6300,percent of total billed charges,100% of $467.63 in Billed Charges for Rev 272 = $467.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD FIXATING CARBON FIBER 4.0 X 180MM,272,RC,,,,,,,,both,,,467.6300,70.1400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,233.82,,,,,,,120.7000,467.6300,percent of total billed charges,Rev 272 $467.63 in Billed Charges at 50% = $233.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD FIXATING CARBON FIBER 4.0 X 180MM,272,RC,,,,,,,,both,,,467.6300,70.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,151.04,,,,,,,120.7000,467.6300,other,32.3% of $467.63 in Billed Charges for Rev 272 = $151.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ROD FIXATING CARBON FIBER 4.0 X 180MM,272,RC,,,,,,,,both,,,467.6300,70.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,143.56,,,,,,,120.7000,467.6300,other,30.7% of $467.63 in Billed Charges for Rev 272 = $143.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ROD FIXATING CARBON FIBER 4.0 X 180MM,272,RC,,,,,,,,both,,,467.6300,70.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,151.04,,,,,,,120.7000,467.6300,percent of total billed charges,32.3% of $467.63 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
ROD FIXATING CARBON FIBER 4.0 X 180MM,272,RC,,,,,,,,both,,,467.6300,70.1400,WELLCARE,WELLCARE MEDICAID,467.63,,,,,,,120.7000,467.6300,percent of total billed charges,100% of $467.63 in Billed Charges for Rev 272 = $467.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,AETNA,AETNA,357.40,,,,,,,82.2400,837.0000,percent of total billed charges,42.7% of $837.00 in Billed Charges for Rev 471 Proc 92653 = $357.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,114.24,,,,,,,82.2400,837.0000,fee schedule,APG 00257 Proc 92653 at $836.60 (Base Rate) * 0.1313 (Relative Weight) = $109.85 (Total Line Payment) at 104% = $114.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,195.90,,,,,,,82.2400,837.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,AETNA,AETNA HEALTHCARE MEDICARE,195.90,,,,,,,82.2400,837.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,195.90,,,,,,,82.2400,837.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,AMBETTER,AMBETTER,427.07,,,,,,,82.2400,837.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,203.74,,,,,,,82.2400,837.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,BLUE CROSS,ANTHEM EXCHANGE,482.33,,,,,,,82.2400,837.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,113.14,,,,,,,82.2400,837.0000,fee schedule,APG 00257 Proc 92653 at $836.60 (Base Rate) * 0.1313 (Relative Weight) = $109.85 (Total Line Payment) at 103% = $113.14. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,BLUE CROSS,ANTHEM HMO,512.44,,,,,,,82.2400,837.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,201.78,,,,,,,82.2400,837.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",602.84,,,,,,,82.2400,837.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,585.90,,,,,,,82.2400,837.0000,percent of total billed charges,Rev 471 Proc 92653 $837.00 in Billed Charges at 70% = $585.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,BLUE CROSS,BLUE CROSS E NETWORK,354.82,,,,,,,82.2400,837.0000,fee schedule,$81.38 from Fee Schedule BCFSG for Rev 471 Proc 92653 * Qty 1 = $81.38 at 436% = $354.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,BLUE CROSS,BLUE CROSS MEDICARE,203.74,,,,,,,82.2400,837.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,BLUE CROSS,BLUE CROSS P NETWORK,362.14,,,,,,,82.2400,837.0000,fee schedule,$81.38 from Fee Schedule BCFSG for Rev 471 Proc 92653 * Qty 1 = $81.38 at 445% = $362.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,BLUE CROSS,BLUE CROSS S NETWORK,362.14,,,,,,,82.2400,837.0000,fee schedule,$81.38 from Fee Schedule BCFSG for Rev 471 Proc 92653 * Qty 1 = $81.38 at 445% = $362.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,BLUE CROSS,TENNCARE BLUE CARE,82.24,,,,,,,82.2400,837.0000,fee schedule,$70.90 from Fee Schedule TC_24 for Rev 471 Proc 92653 * Qty 1 = $70.90 at 116% = $82.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,BLUE CROSS,TENNCARE BLUE SELECT,82.24,,,,,,,82.2400,837.0000,fee schedule,$70.90 from Fee Schedule TC_24 for Rev 471 Proc 92653 * Qty 1 = $70.90 at 116% = $82.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,CIGNA HEALTHCARE,CIGNA HMO,349.03,,,,,,,82.2400,837.0000,percent of total billed charges,41.7% of $837.00 in Billed Charges for Rev 471 Proc 92653 = $349.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,388.37,,,,,,,82.2400,837.0000,percent of total billed charges,46.4% of $837.00 in Billed Charges for Rev 471 Proc 92653 = $388.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,205.70,,,,,,,82.2400,837.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,349.03,,,,,,,82.2400,837.0000,percent of total billed charges,41.7% of $837.00 in Billed Charges for Rev 471 Proc 92653 = $349.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,CIGNA HEALTHCARE,CIGNA PPO,349.03,,,,,,,82.2400,837.0000,percent of total billed charges,41.7% of $837.00 in Billed Charges for Rev 471 Proc 92653 = $349.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,205.70,,,,,,,82.2400,837.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,753.30,,,,,,,82.2400,837.0000,percent of total billed charges,90% of $837.00 in Billed Charges for Rev 471 Proc 92653 = $753.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,HUMANA,HUMANA MEDICARE,195.90,,,,,,,82.2400,837.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,195.90,,,,,,,82.2400,837.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,MEDCOST,MEDCOST VHN,398.33,,,,,,,82.2400,837.0000,percent of total billed charges,47.59% of $837.00 in Billed Charges for Rev 471 Proc 92653 = $398.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,115.34,,,,,,,82.2400,837.0000,fee schedule,APG 00257 Proc 92653 at $836.60 (Base Rate) * 0.1313 (Relative Weight) = $109.85 (Total Line Payment) at 100% = $109.85... $109.85 at 105% = $115.34 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,205.70,,,,,,,82.2400,837.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,205.70,,,,,,,82.2400,837.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,NHC ADVANTAGE,NHC ADVANTAGE,205.70,,,,,,,82.2400,837.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,113.26,,,,,,,82.2400,837.0000,fee schedule,APG 00257 Proc 92653 at $836.60 (Base Rate) * 0.1313 (Relative Weight) = $109.85 (Total Line Payment) at 100% = $109.85... $109.85 at 103.1% = $113.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,SENTARA HEALTH,SENTARA HEALTH,216.03,,,,,,,82.2400,837.0000,percent of total billed charges,25.81% of $837.00 in Billed Charges for Rev 471 Proc 92653 = $216.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,SENTARA HEALTH,SENTARA MEDICARE,195.90,,,,,,,82.2400,837.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",837.00,,,,,,,82.2400,837.0000,percent of total billed charges,100% of $837.00 in Billed Charges for Rev 471 Proc 92653 = $837.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,132.23,,,,,,,82.2400,837.0000,fee schedule,$264.45 from Fee Schedule TCUHC24 for Rev 471 Proc 92653 * Qty 1 = $264.45 at 50% = $132.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,320.00,,,,,,,82.2400,837.0000,other,Rev 471 Proc 92653 1 Visit at $320.00 per Visit = $320.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,305.00,,,,,,,82.2400,837.0000,other,Rev 471 Proc 92653 1 Visit at $305.00 per Visit = $305.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,502.00,,,,,,,82.2400,837.0000,other,Rev 471 Proc 92653 1 Visit at $502.00 per Visit = $502.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,113.14,,,,,,,82.2400,837.0000,fee schedule,APG 00257 Proc 92653 at $836.60 (Base Rate) * 0.1313 (Relative Weight) = $109.85 (Total Line Payment) at 103% = $113.14. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,195.90,,,,,,,82.2400,837.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,195.90,,,,,,,82.2400,837.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,WELLCARE,WELLCARE MEDICAID,837.00,,,,,,,82.2400,837.0000,percent of total billed charges,100% of $837.00 in Billed Charges for Rev 471 Proc 92653 = $837.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT,92653,CPT,471,RC,47100022,CDM,,,,both,,,837.0000,125.5500,WELLCARE,WELLCARE MEDICARE,207.66,,,,,,,82.2400,837.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,AETNA,AETNA,12404.78,,,,,,,609.4400,29051.0000,percent of total billed charges,"42.7% of $29,051.00 in Billed Charges for Rev 481 Proc 92924 = $12,404.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,12234.58,,,,,,,609.4400,29051.0000,fee schedule,"APG 00099 Proc 92924 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 104% = $12,234.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,10473.75,,,,,,,609.4400,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,AETNA,AETNA HEALTHCARE MEDICARE,10473.75,,,,,,,609.4400,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,10473.75,,,,,,,609.4400,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,AMBETTER,AMBETTER,22832.77,,,,,,,609.4400,29051.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,10892.70,,,,,,,609.4400,29051.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,ANTHEM EXCHANGE,25786.93,,,,,,,609.4400,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,12116.94,,,,,,,609.4400,29051.0000,fee schedule,"APG 00099 Proc 92924 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,ANTHEM HMO,27397.08,,,,,,,609.4400,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,10787.96,,,,,,,609.4400,29051.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",29051.00,,,,,,,609.4400,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,20335.70,,,,,,,609.4400,29051.0000,percent of total billed charges,"Rev 481 Proc 92924 $29,051.00 in Billed Charges at 70% = $20,335.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,BLUE CROSS E NETWORK,21607.00,,,,,,,609.4400,29051.0000,case rate,"Rev 481 Proc 92924 ASG Rate of $21,607.00 at 100% of $21,607.00 = $21,607.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,BLUE CROSS MEDICARE,10892.70,,,,,,,609.4400,29051.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,BLUE CROSS P NETWORK,22094.00,,,,,,,609.4400,29051.0000,case rate,"Rev 481 Proc 92924 ASG Rate of $22,094.00 at 100% of $22,094.00 = $22,094.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,BLUE CROSS S NETWORK,22094.00,,,,,,,609.4400,29051.0000,case rate,"Rev 481 Proc 92924 ASG Rate of $22,094.00 at 100% of $22,094.00 = $22,094.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,TENNCARE BLUE CARE,609.44,,,,,,,609.4400,29051.0000,fee schedule,$525.38 from Fee Schedule TC_24 for Rev 481 Proc 92924 * Qty 1 = $525.38 at 116% = $609.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,TENNCARE BLUE SELECT,609.44,,,,,,,609.4400,29051.0000,fee schedule,$525.38 from Fee Schedule TC_24 for Rev 481 Proc 92924 * Qty 1 = $525.38 at 116% = $609.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,CIGNA HEALTHCARE,CIGNA HMO,12114.27,,,,,,,609.4400,29051.0000,percent of total billed charges,"41.7% of $29,051.00 in Billed Charges for Rev 481 Proc 92924 = $12,114.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,13479.66,,,,,,,609.4400,29051.0000,percent of total billed charges,"46.4% of $29,051.00 in Billed Charges for Rev 481 Proc 92924 = $13,479.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,10997.44,,,,,,,609.4400,29051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,12114.27,,,,,,,609.4400,29051.0000,percent of total billed charges,"41.7% of $29,051.00 in Billed Charges for Rev 481 Proc 92924 = $12,114.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,CIGNA HEALTHCARE,CIGNA PPO,12114.27,,,,,,,609.4400,29051.0000,percent of total billed charges,"41.7% of $29,051.00 in Billed Charges for Rev 481 Proc 92924 = $12,114.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,10997.44,,,,,,,609.4400,29051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,26145.90,,,,,,,609.4400,29051.0000,percent of total billed charges,"90% of $29,051.00 in Billed Charges for Rev 481 Proc 92924 = $26,145.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,HUMANA,HUMANA MEDICARE,10473.75,,,,,,,609.4400,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,10473.75,,,,,,,609.4400,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,MEDCOST,MEDCOST VHN,13825.37,,,,,,,609.4400,29051.0000,percent of total billed charges,"47.59% of $29,051.00 in Billed Charges for Rev 481 Proc 92924 = $13,825.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,12352.22,,,,,,,609.4400,29051.0000,fee schedule,"APG 00099 Proc 92924 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 105% = $12,352.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,10997.44,,,,,,,609.4400,29051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,10997.44,,,,,,,609.4400,29051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,NHC ADVANTAGE,NHC ADVANTAGE,10997.44,,,,,,,609.4400,29051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,12128.70,,,,,,,609.4400,29051.0000,fee schedule,"APG 00099 Proc 92924 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 103.1% = $12,128.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,SENTARA HEALTH,SENTARA HEALTH,7498.06,,,,,,,609.4400,29051.0000,percent of total billed charges,"25.81% of $29,051.00 in Billed Charges for Rev 481 Proc 92924 = $7,498.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,SENTARA HEALTH,SENTARA MEDICARE,10473.75,,,,,,,609.4400,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",29051.00,,,,,,,609.4400,29051.0000,percent of total billed charges,"100% of $29,051.00 in Billed Charges for Rev 481 Proc 92924 = $29,051.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,609.4400,29051.0000,case rate,"Rev 481 Proc 92924 ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,609.4400,29051.0000,case rate,"Rev 481 Proc 92924 ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,609.4400,29051.0000,case rate,"Rev 481 Proc 92924 ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,20054.00,,,,,,,609.4400,29051.0000,case rate,"Rev 481 Proc 92924 ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,12116.94,,,,,,,609.4400,29051.0000,fee schedule,"APG 00099 Proc 92924 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,10473.75,,,,,,,609.4400,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,10473.75,,,,,,,609.4400,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,WELLCARE,WELLCARE MEDICAID,29051.00,,,,,,,609.4400,29051.0000,percent of total billed charges,"100% of $29,051.00 in Billed Charges for Rev 481 Proc 92924 = $29,051.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERECTOMY W/PTCA SGL MAJ ART/BN,92924,CPT,481,RC,48100135,CDM,,,,both,,,29051.0000,4357.6500,WELLCARE,WELLCARE MEDICARE,11102.17,,,,,,,609.4400,29051.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERE W/PTCA ADD BN OF MAJ ART,92925,CPT,481,RC,48100136,CDM,,,,both,,,15080.0000,2262.0000,AETNA,AETNA,6439.16,,,,,,,148.0000,15080.0000,percent of total billed charges,"42.7% of $15,080.00 in Billed Charges for Rev 481 Proc 92925 = $6,439.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERE W/PTCA ADD BN OF MAJ ART,92925,CPT,481,RC,48100136,CDM,,,,both,,,15080.0000,2262.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,12234.58,,,,,,,148.0000,15080.0000,fee schedule,"APG 00099 Proc 92925 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 104% = $12,234.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHERE W/PTCA ADD BN OF MAJ ART,92925,CPT,481,RC,48100136,CDM,,,,both,,,15080.0000,2262.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,12116.94,,,,,,,148.0000,15080.0000,fee schedule,"APG 00099 Proc 92925 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHERE W/PTCA ADD BN OF MAJ ART,92925,CPT,481,RC,48100136,CDM,,,,both,,,15080.0000,2262.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,10556.00,,,,,,,148.0000,15080.0000,percent of total billed charges,"Rev 481 Proc 92925 $15,080.00 in Billed Charges at 70% = $10,556.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERE W/PTCA ADD BN OF MAJ ART,92925,CPT,481,RC,48100136,CDM,,,,both,,,15080.0000,2262.0000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,15080.0000,case rate,Rev 481 Proc 92925 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERE W/PTCA ADD BN OF MAJ ART,92925,CPT,481,RC,48100136,CDM,,,,both,,,15080.0000,2262.0000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,15080.0000,case rate,Rev 481 Proc 92925 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERE W/PTCA ADD BN OF MAJ ART,92925,CPT,481,RC,48100136,CDM,,,,both,,,15080.0000,2262.0000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,15080.0000,case rate,Rev 481 Proc 92925 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ATHERE W/PTCA ADD BN OF MAJ ART,92925,CPT,481,RC,48100136,CDM,,,,both,,,15080.0000,2262.0000,CIGNA HEALTHCARE,CIGNA HMO,6288.36,,,,,,,148.0000,15080.0000,percent of total billed charges,"41.7% of $15,080.00 in Billed Charges for Rev 481 Proc 92925 = $6,288.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERE W/PTCA ADD BN OF MAJ ART,92925,CPT,481,RC,48100136,CDM,,,,both,,,15080.0000,2262.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6997.12,,,,,,,148.0000,15080.0000,percent of total billed charges,"46.4% of $15,080.00 in Billed Charges for Rev 481 Proc 92925 = $6,997.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERE W/PTCA ADD BN OF MAJ ART,92925,CPT,481,RC,48100136,CDM,,,,both,,,15080.0000,2262.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6288.36,,,,,,,148.0000,15080.0000,percent of total billed charges,"41.7% of $15,080.00 in Billed Charges for Rev 481 Proc 92925 = $6,288.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERE W/PTCA ADD BN OF MAJ ART,92925,CPT,481,RC,48100136,CDM,,,,both,,,15080.0000,2262.0000,CIGNA HEALTHCARE,CIGNA PPO,6288.36,,,,,,,148.0000,15080.0000,percent of total billed charges,"41.7% of $15,080.00 in Billed Charges for Rev 481 Proc 92925 = $6,288.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERE W/PTCA ADD BN OF MAJ ART,92925,CPT,481,RC,48100136,CDM,,,,both,,,15080.0000,2262.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13572.00,,,,,,,148.0000,15080.0000,percent of total billed charges,"90% of $15,080.00 in Billed Charges for Rev 481 Proc 92925 = $13,572.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERE W/PTCA ADD BN OF MAJ ART,92925,CPT,481,RC,48100136,CDM,,,,both,,,15080.0000,2262.0000,MEDCOST,MEDCOST VHN,7176.57,,,,,,,148.0000,15080.0000,percent of total billed charges,"47.59% of $15,080.00 in Billed Charges for Rev 481 Proc 92925 = $7,176.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERE W/PTCA ADD BN OF MAJ ART,92925,CPT,481,RC,48100136,CDM,,,,both,,,15080.0000,2262.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,12352.22,,,,,,,148.0000,15080.0000,fee schedule,"APG 00099 Proc 92925 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 105% = $12,352.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHERE W/PTCA ADD BN OF MAJ ART,92925,CPT,481,RC,48100136,CDM,,,,both,,,15080.0000,2262.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,12128.70,,,,,,,148.0000,15080.0000,fee schedule,"APG 00099 Proc 92925 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 103.1% = $12,128.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHERE W/PTCA ADD BN OF MAJ ART,92925,CPT,481,RC,48100136,CDM,,,,both,,,15080.0000,2262.0000,SENTARA HEALTH,SENTARA HEALTH,3892.15,,,,,,,148.0000,15080.0000,percent of total billed charges,"25.81% of $15,080.00 in Billed Charges for Rev 481 Proc 92925 = $3,892.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERE W/PTCA ADD BN OF MAJ ART,92925,CPT,481,RC,48100136,CDM,,,,both,,,15080.0000,2262.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15080.00,,,,,,,148.0000,15080.0000,percent of total billed charges,"100% of $15,080.00 in Billed Charges for Rev 481 Proc 92925 = $15,080.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHERE W/PTCA ADD BN OF MAJ ART,92925,CPT,481,RC,48100136,CDM,,,,both,,,15080.0000,2262.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,148.0000,15080.0000,case rate,"Rev 481 Proc 92925 ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHERE W/PTCA ADD BN OF MAJ ART,92925,CPT,481,RC,48100136,CDM,,,,both,,,15080.0000,2262.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,148.0000,15080.0000,case rate,"Rev 481 Proc 92925 ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHERE W/PTCA ADD BN OF MAJ ART,92925,CPT,481,RC,48100136,CDM,,,,both,,,15080.0000,2262.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,148.0000,15080.0000,case rate,"Rev 481 Proc 92925 ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHERE W/PTCA ADD BN OF MAJ ART,92925,CPT,481,RC,48100136,CDM,,,,both,,,15080.0000,2262.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,15080.00,,,,,,,148.0000,15080.0000,case rate,"Rev 481 Proc 92925 ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total (Service Line reduced to $15,080.00, claim capped at $15,080.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHERE W/PTCA ADD BN OF MAJ ART,92925,CPT,481,RC,48100136,CDM,,,,both,,,15080.0000,2262.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,12116.94,,,,,,,148.0000,15080.0000,fee schedule,"APG 00099 Proc 92925 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHERE W/PTCA ADD BN OF MAJ ART,92925,CPT,481,RC,48100136,CDM,,,,both,,,15080.0000,2262.0000,WELLCARE,WELLCARE MEDICAID,15080.00,,,,,,,148.0000,15080.0000,percent of total billed charges,"100% of $15,080.00 in Billed Charges for Rev 481 Proc 92925 = $15,080.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,AETNA,AETNA,12404.78,,,,,,,568.0300,29051.0000,percent of total billed charges,"42.7% of $29,051.00 in Billed Charges for Rev 481 Proc 92937 = $12,404.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,12234.58,,,,,,,568.0300,29051.0000,fee schedule,"APG 00099 Proc 92937 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 104% = $12,234.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,10473.75,,,,,,,568.0300,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,AETNA,AETNA HEALTHCARE MEDICARE,10473.75,,,,,,,568.0300,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,10473.75,,,,,,,568.0300,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,AMBETTER,AMBETTER,22832.77,,,,,,,568.0300,29051.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,10892.70,,,,,,,568.0300,29051.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,ANTHEM EXCHANGE,25786.93,,,,,,,568.0300,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,12116.94,,,,,,,568.0300,29051.0000,fee schedule,"APG 00099 Proc 92937 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,ANTHEM HMO,27397.08,,,,,,,568.0300,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,10787.96,,,,,,,568.0300,29051.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",29051.00,,,,,,,568.0300,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,20335.70,,,,,,,568.0300,29051.0000,percent of total billed charges,"Rev 481 Proc 92937 $29,051.00 in Billed Charges at 70% = $20,335.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,BLUE CROSS E NETWORK,21607.00,,,,,,,568.0300,29051.0000,case rate,"Rev 481 Proc 92937 ASG Rate of $21,607.00 at 100% of $21,607.00 = $21,607.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,BLUE CROSS MEDICARE,10892.70,,,,,,,568.0300,29051.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,BLUE CROSS P NETWORK,22094.00,,,,,,,568.0300,29051.0000,case rate,"Rev 481 Proc 92937 ASG Rate of $22,094.00 at 100% of $22,094.00 = $22,094.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,BLUE CROSS S NETWORK,22094.00,,,,,,,568.0300,29051.0000,case rate,"Rev 481 Proc 92937 ASG Rate of $22,094.00 at 100% of $22,094.00 = $22,094.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,TENNCARE BLUE CARE,568.03,,,,,,,568.0300,29051.0000,fee schedule,$489.68 from Fee Schedule TC_24 for Rev 481 Proc 92937 * Qty 1 = $489.68 at 116% = $568.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,TENNCARE BLUE SELECT,568.03,,,,,,,568.0300,29051.0000,fee schedule,$489.68 from Fee Schedule TC_24 for Rev 481 Proc 92937 * Qty 1 = $489.68 at 116% = $568.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,CIGNA HEALTHCARE,CIGNA HMO,12114.27,,,,,,,568.0300,29051.0000,percent of total billed charges,"41.7% of $29,051.00 in Billed Charges for Rev 481 Proc 92937 = $12,114.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,13479.66,,,,,,,568.0300,29051.0000,percent of total billed charges,"46.4% of $29,051.00 in Billed Charges for Rev 481 Proc 92937 = $13,479.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,10997.44,,,,,,,568.0300,29051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,12114.27,,,,,,,568.0300,29051.0000,percent of total billed charges,"41.7% of $29,051.00 in Billed Charges for Rev 481 Proc 92937 = $12,114.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,CIGNA HEALTHCARE,CIGNA PPO,12114.27,,,,,,,568.0300,29051.0000,percent of total billed charges,"41.7% of $29,051.00 in Billed Charges for Rev 481 Proc 92937 = $12,114.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,10997.44,,,,,,,568.0300,29051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,26145.90,,,,,,,568.0300,29051.0000,percent of total billed charges,"90% of $29,051.00 in Billed Charges for Rev 481 Proc 92937 = $26,145.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,HUMANA,HUMANA MEDICARE,10473.75,,,,,,,568.0300,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,10473.75,,,,,,,568.0300,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,MEDCOST,MEDCOST VHN,13825.37,,,,,,,568.0300,29051.0000,percent of total billed charges,"47.59% of $29,051.00 in Billed Charges for Rev 481 Proc 92937 = $13,825.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,12352.22,,,,,,,568.0300,29051.0000,fee schedule,"APG 00099 Proc 92937 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 105% = $12,352.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,10997.44,,,,,,,568.0300,29051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,10997.44,,,,,,,568.0300,29051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,NHC ADVANTAGE,NHC ADVANTAGE,10997.44,,,,,,,568.0300,29051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,12128.70,,,,,,,568.0300,29051.0000,fee schedule,"APG 00099 Proc 92937 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 103.1% = $12,128.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,SENTARA HEALTH,SENTARA HEALTH,7498.06,,,,,,,568.0300,29051.0000,percent of total billed charges,"25.81% of $29,051.00 in Billed Charges for Rev 481 Proc 92937 = $7,498.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,SENTARA HEALTH,SENTARA MEDICARE,10473.75,,,,,,,568.0300,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",29051.00,,,,,,,568.0300,29051.0000,percent of total billed charges,"100% of $29,051.00 in Billed Charges for Rev 481 Proc 92937 = $29,051.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,568.0300,29051.0000,case rate,"Rev 481 Proc 92937 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,568.0300,29051.0000,case rate,"Rev 481 Proc 92937 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,568.0300,29051.0000,case rate,"Rev 481 Proc 92937 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,568.0300,29051.0000,case rate,"Rev 481 Proc 92937 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,12116.94,,,,,,,568.0300,29051.0000,fee schedule,"APG 00099 Proc 92937 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,10473.75,,,,,,,568.0300,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,10473.75,,,,,,,568.0300,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,WELLCARE,WELLCARE MEDICAID,29051.00,,,,,,,568.0300,29051.0000,percent of total billed charges,"100% of $29,051.00 in Billed Charges for Rev 481 Proc 92937 = $29,051.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCI BP GRFT-COMBO ST PL ATH-ANGIO,92937,CPT,481,RC,48100090,CDM,,,,both,,,29051.0000,4357.6500,WELLCARE,WELLCARE MEDICARE,11102.17,,,,,,,568.0300,29051.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BYPASS GRAFT EA ADDL BRANCH,92938,CPT,481,RC,48100091,CDM,,,,both,,,13360.0000,2004.0000,AETNA,AETNA,5704.72,,,,,,,148.0000,13360.0000,percent of total billed charges,"42.7% of $13,360.00 in Billed Charges for Rev 481 Proc 92938 = $5,704.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCI BYPASS GRAFT EA ADDL BRANCH,92938,CPT,481,RC,48100091,CDM,,,,both,,,13360.0000,2004.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,12234.58,,,,,,,148.0000,13360.0000,fee schedule,"APG 00099 Proc 92938 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 104% = $12,234.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PCI BYPASS GRAFT EA ADDL BRANCH,92938,CPT,481,RC,48100091,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,12116.94,,,,,,,148.0000,13360.0000,fee schedule,"APG 00099 Proc 92938 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PCI BYPASS GRAFT EA ADDL BRANCH,92938,CPT,481,RC,48100091,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9352.00,,,,,,,148.0000,13360.0000,percent of total billed charges,"Rev 481 Proc 92938 $13,360.00 in Billed Charges at 70% = $9,352.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCI BYPASS GRAFT EA ADDL BRANCH,92938,CPT,481,RC,48100091,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,13360.0000,case rate,Rev 481 Proc 92938 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BYPASS GRAFT EA ADDL BRANCH,92938,CPT,481,RC,48100091,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,13360.0000,case rate,Rev 481 Proc 92938 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BYPASS GRAFT EA ADDL BRANCH,92938,CPT,481,RC,48100091,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,13360.0000,case rate,Rev 481 Proc 92938 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PCI BYPASS GRAFT EA ADDL BRANCH,92938,CPT,481,RC,48100091,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA HMO,5571.12,,,,,,,148.0000,13360.0000,percent of total billed charges,"41.7% of $13,360.00 in Billed Charges for Rev 481 Proc 92938 = $5,571.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCI BYPASS GRAFT EA ADDL BRANCH,92938,CPT,481,RC,48100091,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6199.04,,,,,,,148.0000,13360.0000,percent of total billed charges,"46.4% of $13,360.00 in Billed Charges for Rev 481 Proc 92938 = $6,199.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCI BYPASS GRAFT EA ADDL BRANCH,92938,CPT,481,RC,48100091,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5571.12,,,,,,,148.0000,13360.0000,percent of total billed charges,"41.7% of $13,360.00 in Billed Charges for Rev 481 Proc 92938 = $5,571.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCI BYPASS GRAFT EA ADDL BRANCH,92938,CPT,481,RC,48100091,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA PPO,5571.12,,,,,,,148.0000,13360.0000,percent of total billed charges,"41.7% of $13,360.00 in Billed Charges for Rev 481 Proc 92938 = $5,571.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCI BYPASS GRAFT EA ADDL BRANCH,92938,CPT,481,RC,48100091,CDM,,,,both,,,13360.0000,2004.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12024.00,,,,,,,148.0000,13360.0000,percent of total billed charges,"90% of $13,360.00 in Billed Charges for Rev 481 Proc 92938 = $12,024.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCI BYPASS GRAFT EA ADDL BRANCH,92938,CPT,481,RC,48100091,CDM,,,,both,,,13360.0000,2004.0000,MEDCOST,MEDCOST VHN,6358.02,,,,,,,148.0000,13360.0000,percent of total billed charges,"47.59% of $13,360.00 in Billed Charges for Rev 481 Proc 92938 = $6,358.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCI BYPASS GRAFT EA ADDL BRANCH,92938,CPT,481,RC,48100091,CDM,,,,both,,,13360.0000,2004.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,12352.22,,,,,,,148.0000,13360.0000,fee schedule,"APG 00099 Proc 92938 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 105% = $12,352.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PCI BYPASS GRAFT EA ADDL BRANCH,92938,CPT,481,RC,48100091,CDM,,,,both,,,13360.0000,2004.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,12128.70,,,,,,,148.0000,13360.0000,fee schedule,"APG 00099 Proc 92938 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 103.1% = $12,128.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PCI BYPASS GRAFT EA ADDL BRANCH,92938,CPT,481,RC,48100091,CDM,,,,both,,,13360.0000,2004.0000,SENTARA HEALTH,SENTARA HEALTH,3448.22,,,,,,,148.0000,13360.0000,percent of total billed charges,"25.81% of $13,360.00 in Billed Charges for Rev 481 Proc 92938 = $3,448.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCI BYPASS GRAFT EA ADDL BRANCH,92938,CPT,481,RC,48100091,CDM,,,,both,,,13360.0000,2004.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13360.00,,,,,,,148.0000,13360.0000,percent of total billed charges,"100% of $13,360.00 in Billed Charges for Rev 481 Proc 92938 = $13,360.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PCI BYPASS GRAFT EA ADDL BRANCH,92938,CPT,481,RC,48100091,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,148.0000,13360.0000,case rate,"Rev 481 Proc 92938 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PCI BYPASS GRAFT EA ADDL BRANCH,92938,CPT,481,RC,48100091,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,148.0000,13360.0000,case rate,"Rev 481 Proc 92938 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PCI BYPASS GRAFT EA ADDL BRANCH,92938,CPT,481,RC,48100091,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,148.0000,13360.0000,case rate,"Rev 481 Proc 92938 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PCI BYPASS GRAFT EA ADDL BRANCH,92938,CPT,481,RC,48100091,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,148.0000,13360.0000,case rate,"Rev 481 Proc 92938 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PCI BYPASS GRAFT EA ADDL BRANCH,92938,CPT,481,RC,48100091,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,12116.94,,,,,,,148.0000,13360.0000,fee schedule,"APG 00099 Proc 92938 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PCI BYPASS GRAFT EA ADDL BRANCH,92938,CPT,481,RC,48100091,CDM,,,,both,,,13360.0000,2004.0000,WELLCARE,WELLCARE MEDICAID,13360.00,,,,,,,148.0000,13360.0000,percent of total billed charges,"100% of $13,360.00 in Billed Charges for Rev 481 Proc 92938 = $13,360.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,AETNA,AETNA,12404.78,,,,,,,638.7900,29051.0000,percent of total billed charges,"42.7% of $29,051.00 in Billed Charges for Rev 481 Proc 92941 = $12,404.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,12234.58,,,,,,,638.7900,29051.0000,fee schedule,"APG 00099 Proc 92941 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 104% = $12,234.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,ANTHEM EXCHANGE,25419.59,,,,,,,638.7900,29051.0000,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 481 Proc 92941 * Qty 1 = $12,718.06 at 199.87% = $25,419.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,12116.94,,,,,,,638.7900,29051.0000,fee schedule,"APG 00099 Proc 92941 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,ANTHEM HMO,27006.80,,,,,,,638.7900,29051.0000,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 481 Proc 92941 * Qty 1 = $12,718.06 at 212.35% = $27,006.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",29051.00,,,,,,,638.7900,29051.0000,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 481 Proc 92941 * Qty 1 = $12,718.06 at 249.81% = $31,770.99 (Service Line reduced to $29,051.00, claim capped at $29,051.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,20335.70,,,,,,,638.7900,29051.0000,percent of total billed charges,"Rev 481 Proc 92941 $29,051.00 in Billed Charges at 70% = $20,335.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,BLUE CROSS E NETWORK,21607.00,,,,,,,638.7900,29051.0000,case rate,"Rev 481 Proc 92941 ASG Rate of $21,607.00 at 100% of $21,607.00 = $21,607.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,BLUE CROSS P NETWORK,22094.00,,,,,,,638.7900,29051.0000,case rate,"Rev 481 Proc 92941 ASG Rate of $22,094.00 at 100% of $22,094.00 = $22,094.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,BLUE CROSS S NETWORK,22094.00,,,,,,,638.7900,29051.0000,case rate,"Rev 481 Proc 92941 ASG Rate of $22,094.00 at 100% of $22,094.00 = $22,094.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,TENNCARE BLUE CARE,638.79,,,,,,,638.7900,29051.0000,fee schedule,$550.68 from Fee Schedule TC_24 for Rev 481 Proc 92941 * Qty 1 = $550.68 at 116% = $638.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,TENNCARE BLUE SELECT,638.79,,,,,,,638.7900,29051.0000,fee schedule,$550.68 from Fee Schedule TC_24 for Rev 481 Proc 92941 * Qty 1 = $550.68 at 116% = $638.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,CIGNA HEALTHCARE,CIGNA HMO,12114.27,,,,,,,638.7900,29051.0000,percent of total billed charges,"41.7% of $29,051.00 in Billed Charges for Rev 481 Proc 92941 = $12,114.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,13479.66,,,,,,,638.7900,29051.0000,percent of total billed charges,"46.4% of $29,051.00 in Billed Charges for Rev 481 Proc 92941 = $13,479.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,12114.27,,,,,,,638.7900,29051.0000,percent of total billed charges,"41.7% of $29,051.00 in Billed Charges for Rev 481 Proc 92941 = $12,114.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,CIGNA HEALTHCARE,CIGNA PPO,12114.27,,,,,,,638.7900,29051.0000,percent of total billed charges,"41.7% of $29,051.00 in Billed Charges for Rev 481 Proc 92941 = $12,114.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,26145.90,,,,,,,638.7900,29051.0000,percent of total billed charges,"90% of $29,051.00 in Billed Charges for Rev 481 Proc 92941 = $26,145.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,MEDCOST,MEDCOST VHN,13825.37,,,,,,,638.7900,29051.0000,percent of total billed charges,"47.59% of $29,051.00 in Billed Charges for Rev 481 Proc 92941 = $13,825.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,12352.22,,,,,,,638.7900,29051.0000,fee schedule,"APG 00099 Proc 92941 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 105% = $12,352.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,12128.70,,,,,,,638.7900,29051.0000,fee schedule,"APG 00099 Proc 92941 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 103.1% = $12,128.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,SENTARA HEALTH,SENTARA HEALTH,7498.06,,,,,,,638.7900,29051.0000,percent of total billed charges,"25.81% of $29,051.00 in Billed Charges for Rev 481 Proc 92941 = $7,498.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",29051.00,,,,,,,638.7900,29051.0000,percent of total billed charges,"100% of $29,051.00 in Billed Charges for Rev 481 Proc 92941 = $29,051.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,638.7900,29051.0000,case rate,"Rev 481 Proc 92941 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,638.7900,29051.0000,case rate,"Rev 481 Proc 92941 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,638.7900,29051.0000,case rate,"Rev 481 Proc 92941 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,638.7900,29051.0000,case rate,"Rev 481 Proc 92941 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,12116.94,,,,,,,638.7900,29051.0000,fee schedule,"APG 00099 Proc 92941 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC ACUTE OCCL - AMI SGL VES,92941,CPT,481,RC,48100092,CDM,,,,both,,,29051.0000,4357.6500,WELLCARE,WELLCARE MEDICAID,29051.00,,,,,,,638.7900,29051.0000,percent of total billed charges,"100% of $29,051.00 in Billed Charges for Rev 481 Proc 92941 = $29,051.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,AETNA,AETNA,12404.78,,,,,,,638.4200,29051.0000,percent of total billed charges,"42.7% of $29,051.00 in Billed Charges for Rev 481 Proc 92943 = $12,404.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,12234.58,,,,,,,638.4200,29051.0000,fee schedule,"APG 00099 Proc 92943 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 104% = $12,234.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,10473.75,,,,,,,638.4200,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,AETNA,AETNA HEALTHCARE MEDICARE,10473.75,,,,,,,638.4200,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,10473.75,,,,,,,638.4200,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,AMBETTER,AMBETTER,22832.77,,,,,,,638.4200,29051.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,10892.70,,,,,,,638.4200,29051.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,ANTHEM EXCHANGE,25786.93,,,,,,,638.4200,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,12116.94,,,,,,,638.4200,29051.0000,fee schedule,"APG 00099 Proc 92943 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,ANTHEM HMO,27397.08,,,,,,,638.4200,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,10787.96,,,,,,,638.4200,29051.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",29051.00,,,,,,,638.4200,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,20335.70,,,,,,,638.4200,29051.0000,percent of total billed charges,"Rev 481 Proc 92943 $29,051.00 in Billed Charges at 70% = $20,335.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,BLUE CROSS E NETWORK,21607.00,,,,,,,638.4200,29051.0000,case rate,"Rev 481 Proc 92943 ASG Rate of $21,607.00 at 100% of $21,607.00 = $21,607.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,BLUE CROSS MEDICARE,10892.70,,,,,,,638.4200,29051.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,BLUE CROSS P NETWORK,22094.00,,,,,,,638.4200,29051.0000,case rate,"Rev 481 Proc 92943 ASG Rate of $22,094.00 at 100% of $22,094.00 = $22,094.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,BLUE CROSS S NETWORK,22094.00,,,,,,,638.4200,29051.0000,case rate,"Rev 481 Proc 92943 ASG Rate of $22,094.00 at 100% of $22,094.00 = $22,094.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,TENNCARE BLUE CARE,638.42,,,,,,,638.4200,29051.0000,fee schedule,$550.36 from Fee Schedule TC_24 for Rev 481 Proc 92943 * Qty 1 = $550.36 at 116% = $638.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,BLUE CROSS,TENNCARE BLUE SELECT,638.42,,,,,,,638.4200,29051.0000,fee schedule,$550.36 from Fee Schedule TC_24 for Rev 481 Proc 92943 * Qty 1 = $550.36 at 116% = $638.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,CIGNA HEALTHCARE,CIGNA HMO,12114.27,,,,,,,638.4200,29051.0000,percent of total billed charges,"41.7% of $29,051.00 in Billed Charges for Rev 481 Proc 92943 = $12,114.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,13479.66,,,,,,,638.4200,29051.0000,percent of total billed charges,"46.4% of $29,051.00 in Billed Charges for Rev 481 Proc 92943 = $13,479.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,10997.44,,,,,,,638.4200,29051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,12114.27,,,,,,,638.4200,29051.0000,percent of total billed charges,"41.7% of $29,051.00 in Billed Charges for Rev 481 Proc 92943 = $12,114.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,CIGNA HEALTHCARE,CIGNA PPO,12114.27,,,,,,,638.4200,29051.0000,percent of total billed charges,"41.7% of $29,051.00 in Billed Charges for Rev 481 Proc 92943 = $12,114.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,10997.44,,,,,,,638.4200,29051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,26145.90,,,,,,,638.4200,29051.0000,percent of total billed charges,"90% of $29,051.00 in Billed Charges for Rev 481 Proc 92943 = $26,145.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,HUMANA,HUMANA MEDICARE,10473.75,,,,,,,638.4200,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,10473.75,,,,,,,638.4200,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,MEDCOST,MEDCOST VHN,13825.37,,,,,,,638.4200,29051.0000,percent of total billed charges,"47.59% of $29,051.00 in Billed Charges for Rev 481 Proc 92943 = $13,825.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,12352.22,,,,,,,638.4200,29051.0000,fee schedule,"APG 00099 Proc 92943 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 105% = $12,352.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,10997.44,,,,,,,638.4200,29051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,10997.44,,,,,,,638.4200,29051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,NHC ADVANTAGE,NHC ADVANTAGE,10997.44,,,,,,,638.4200,29051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,12128.70,,,,,,,638.4200,29051.0000,fee schedule,"APG 00099 Proc 92943 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 100% = $11,764.02... $11,764.02 at 103.1% = $12,128.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,SENTARA HEALTH,SENTARA HEALTH,7498.06,,,,,,,638.4200,29051.0000,percent of total billed charges,"25.81% of $29,051.00 in Billed Charges for Rev 481 Proc 92943 = $7,498.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,SENTARA HEALTH,SENTARA MEDICARE,10473.75,,,,,,,638.4200,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",29051.00,,,,,,,638.4200,29051.0000,percent of total billed charges,"100% of $29,051.00 in Billed Charges for Rev 481 Proc 92943 = $29,051.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,638.4200,29051.0000,case rate,"Rev 481 Proc 92943 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,638.4200,29051.0000,case rate,"Rev 481 Proc 92943 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,638.4200,29051.0000,case rate,"Rev 481 Proc 92943 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,638.4200,29051.0000,case rate,"Rev 481 Proc 92943 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,12116.94,,,,,,,638.4200,29051.0000,fee schedule,"APG 00099 Proc 92943 at $836.60 (Base Rate) * 14.0617 (Relative Weight) = $11,764.02 (Total Line Payment) at 103% = $12,116.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,10473.75,,,,,,,638.4200,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,10473.75,,,,,,,638.4200,29051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,WELLCARE,WELLCARE MEDICAID,29051.00,,,,,,,638.4200,29051.0000,percent of total billed charges,"100% of $29,051.00 in Billed Charges for Rev 481 Proc 92943 = $29,051.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVASC CHRON TTL OCCL ADD SGL ART,92943,CPT,481,RC,48100093,CDM,,,,both,,,29051.0000,4357.6500,WELLCARE,WELLCARE MEDICARE,11102.17,,,,,,,638.4200,29051.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ROD FIXATING CARBON FIBER 8.0 X 220MM,272,RC,27200002,CDM,,,,,,both,,,1343.7700,201.5700,AETNA,AETNA,573.79,,,,,,,346.8300,1343.7700,percent of total billed charges,"42.7% of $1,343.77 in Billed Charges for Rev 272 = $573.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD FIXATING CARBON FIBER 8.0 X 220MM,272,RC,27200002,CDM,,,,,,both,,,1343.7700,201.5700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,940.64,,,,,,,346.8300,1343.7700,percent of total billed charges,"Rev 272 $1,343.77 in Billed Charges at 70% = $940.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD FIXATING CARBON FIBER 8.0 X 220MM,272,RC,27200002,CDM,,,,,,both,,,1343.7700,201.5700,CIGNA HEALTHCARE,CIGNA HMO,560.35,,,,,,,346.8300,1343.7700,percent of total billed charges,"41.7% of $1,343.77 in Billed Charges for Rev 272 = $560.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD FIXATING CARBON FIBER 8.0 X 220MM,272,RC,27200002,CDM,,,,,,both,,,1343.7700,201.5700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,623.51,,,,,,,346.8300,1343.7700,percent of total billed charges,"46.4% of $1,343.77 in Billed Charges for Rev 272 = $623.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD FIXATING CARBON FIBER 8.0 X 220MM,272,RC,27200002,CDM,,,,,,both,,,1343.7700,201.5700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,560.35,,,,,,,346.8300,1343.7700,percent of total billed charges,"41.7% of $1,343.77 in Billed Charges for Rev 272 = $560.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD FIXATING CARBON FIBER 8.0 X 220MM,272,RC,27200002,CDM,,,,,,both,,,1343.7700,201.5700,CIGNA HEALTHCARE,CIGNA PPO,560.35,,,,,,,346.8300,1343.7700,percent of total billed charges,"41.7% of $1,343.77 in Billed Charges for Rev 272 = $560.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD FIXATING CARBON FIBER 8.0 X 220MM,272,RC,27200002,CDM,,,,,,both,,,1343.7700,201.5700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1209.39,,,,,,,346.8300,1343.7700,percent of total billed charges,"90% of $1,343.77 in Billed Charges for Rev 272 = $1,209.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD FIXATING CARBON FIBER 8.0 X 220MM,272,RC,27200002,CDM,,,,,,both,,,1343.7700,201.5700,MEDCOST,MEDCOST VHN,639.50,,,,,,,346.8300,1343.7700,percent of total billed charges,"47.59% of $1,343.77 in Billed Charges for Rev 272 = $639.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD FIXATING CARBON FIBER 8.0 X 220MM,272,RC,27200002,CDM,,,,,,both,,,1343.7700,201.5700,SENTARA HEALTH,SENTARA HEALTH,346.83,,,,,,,346.8300,1343.7700,percent of total billed charges,"25.81% of $1,343.77 in Billed Charges for Rev 272 = $346.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD FIXATING CARBON FIBER 8.0 X 220MM,272,RC,27200002,CDM,,,,,,both,,,1343.7700,201.5700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1343.77,,,,,,,346.8300,1343.7700,percent of total billed charges,"100% of $1,343.77 in Billed Charges for Rev 272 = $1,343.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD FIXATING CARBON FIBER 8.0 X 220MM,272,RC,27200002,CDM,,,,,,both,,,1343.7700,201.5700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,671.89,,,,,,,346.8300,1343.7700,percent of total billed charges,"Rev 272 $1,343.77 in Billed Charges at 50% = $671.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD FIXATING CARBON FIBER 8.0 X 220MM,272,RC,27200002,CDM,,,,,,both,,,1343.7700,201.5700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,434.04,,,,,,,346.8300,1343.7700,other,"32.3% of $1,343.77 in Billed Charges for Rev 272 = $434.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ROD FIXATING CARBON FIBER 8.0 X 220MM,272,RC,27200002,CDM,,,,,,both,,,1343.7700,201.5700,UNITED HEALTHCARE,UHC HERITAGE SELECT,412.54,,,,,,,346.8300,1343.7700,other,"30.7% of $1,343.77 in Billed Charges for Rev 272 = $412.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ROD FIXATING CARBON FIBER 8.0 X 220MM,272,RC,27200002,CDM,,,,,,both,,,1343.7700,201.5700,UNITED HEALTHCARE,UNITED HEALTHCARE,434.04,,,,,,,346.8300,1343.7700,percent of total billed charges,"32.3% of $1,343.77 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD FIXATING CARBON FIBER 8.0 X 220MM,272,RC,27200002,CDM,,,,,,both,,,1343.7700,201.5700,WELLCARE,WELLCARE MEDICAID,1343.77,,,,,,,346.8300,1343.7700,percent of total billed charges,"100% of $1,343.77 in Billed Charges for Rev 272 = $1,343.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD REAMING WITH 3MM BALL TIP 3.0 X 950MM STERILE,272,RC,27200002,CDM,,,,,,both,,,1357.4600,203.6200,AETNA,AETNA,579.64,,,,,,,350.3600,1357.4600,percent of total billed charges,"42.7% of $1,357.46 in Billed Charges for Rev 272 = $579.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD REAMING WITH 3MM BALL TIP 3.0 X 950MM STERILE,272,RC,27200002,CDM,,,,,,both,,,1357.4600,203.6200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,950.22,,,,,,,350.3600,1357.4600,percent of total billed charges,"Rev 272 $1,357.46 in Billed Charges at 70% = $950.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD REAMING WITH 3MM BALL TIP 3.0 X 950MM STERILE,272,RC,27200002,CDM,,,,,,both,,,1357.4600,203.6200,CIGNA HEALTHCARE,CIGNA HMO,566.06,,,,,,,350.3600,1357.4600,percent of total billed charges,"41.7% of $1,357.46 in Billed Charges for Rev 272 = $566.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD REAMING WITH 3MM BALL TIP 3.0 X 950MM STERILE,272,RC,27200002,CDM,,,,,,both,,,1357.4600,203.6200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,629.86,,,,,,,350.3600,1357.4600,percent of total billed charges,"46.4% of $1,357.46 in Billed Charges for Rev 272 = $629.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD REAMING WITH 3MM BALL TIP 3.0 X 950MM STERILE,272,RC,27200002,CDM,,,,,,both,,,1357.4600,203.6200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,566.06,,,,,,,350.3600,1357.4600,percent of total billed charges,"41.7% of $1,357.46 in Billed Charges for Rev 272 = $566.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD REAMING WITH 3MM BALL TIP 3.0 X 950MM STERILE,272,RC,27200002,CDM,,,,,,both,,,1357.4600,203.6200,CIGNA HEALTHCARE,CIGNA PPO,566.06,,,,,,,350.3600,1357.4600,percent of total billed charges,"41.7% of $1,357.46 in Billed Charges for Rev 272 = $566.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD REAMING WITH 3MM BALL TIP 3.0 X 950MM STERILE,272,RC,27200002,CDM,,,,,,both,,,1357.4600,203.6200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1221.71,,,,,,,350.3600,1357.4600,percent of total billed charges,"90% of $1,357.46 in Billed Charges for Rev 272 = $1,221.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD REAMING WITH 3MM BALL TIP 3.0 X 950MM STERILE,272,RC,27200002,CDM,,,,,,both,,,1357.4600,203.6200,MEDCOST,MEDCOST VHN,646.02,,,,,,,350.3600,1357.4600,percent of total billed charges,"47.59% of $1,357.46 in Billed Charges for Rev 272 = $646.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD REAMING WITH 3MM BALL TIP 3.0 X 950MM STERILE,272,RC,27200002,CDM,,,,,,both,,,1357.4600,203.6200,SENTARA HEALTH,SENTARA HEALTH,350.36,,,,,,,350.3600,1357.4600,percent of total billed charges,"25.81% of $1,357.46 in Billed Charges for Rev 272 = $350.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD REAMING WITH 3MM BALL TIP 3.0 X 950MM STERILE,272,RC,27200002,CDM,,,,,,both,,,1357.4600,203.6200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1357.46,,,,,,,350.3600,1357.4600,percent of total billed charges,"100% of $1,357.46 in Billed Charges for Rev 272 = $1,357.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD REAMING WITH 3MM BALL TIP 3.0 X 950MM STERILE,272,RC,27200002,CDM,,,,,,both,,,1357.4600,203.6200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,678.73,,,,,,,350.3600,1357.4600,percent of total billed charges,"Rev 272 $1,357.46 in Billed Charges at 50% = $678.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD REAMING WITH 3MM BALL TIP 3.0 X 950MM STERILE,272,RC,27200002,CDM,,,,,,both,,,1357.4600,203.6200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,438.46,,,,,,,350.3600,1357.4600,other,"32.3% of $1,357.46 in Billed Charges for Rev 272 = $438.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ROD REAMING WITH 3MM BALL TIP 3.0 X 950MM STERILE,272,RC,27200002,CDM,,,,,,both,,,1357.4600,203.6200,UNITED HEALTHCARE,UHC HERITAGE SELECT,416.74,,,,,,,350.3600,1357.4600,other,"30.7% of $1,357.46 in Billed Charges for Rev 272 = $416.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ROD REAMING WITH 3MM BALL TIP 3.0 X 950MM STERILE,272,RC,27200002,CDM,,,,,,both,,,1357.4600,203.6200,UNITED HEALTHCARE,UNITED HEALTHCARE,438.46,,,,,,,350.3600,1357.4600,percent of total billed charges,"32.3% of $1,357.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD REAMING WITH 3MM BALL TIP 3.0 X 950MM STERILE,272,RC,27200002,CDM,,,,,,both,,,1357.4600,203.6200,WELLCARE,WELLCARE MEDICAID,1357.46,,,,,,,350.3600,1357.4600,percent of total billed charges,"100% of $1,357.46 in Billed Charges for Rev 272 = $1,357.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1225.5400,183.8300,AETNA,AETNA,523.31,,,,,,,316.3100,1225.5400,percent of total billed charges,"42.7% of $1,225.54 in Billed Charges for Rev 272 = $523.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1225.5400,183.8300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,857.88,,,,,,,316.3100,1225.5400,percent of total billed charges,"Rev 272 $1,225.54 in Billed Charges at 70% = $857.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1225.5400,183.8300,CIGNA HEALTHCARE,CIGNA HMO,511.05,,,,,,,316.3100,1225.5400,percent of total billed charges,"41.7% of $1,225.54 in Billed Charges for Rev 272 = $511.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1225.5400,183.8300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,568.65,,,,,,,316.3100,1225.5400,percent of total billed charges,"46.4% of $1,225.54 in Billed Charges for Rev 272 = $568.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1225.5400,183.8300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,511.05,,,,,,,316.3100,1225.5400,percent of total billed charges,"41.7% of $1,225.54 in Billed Charges for Rev 272 = $511.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1225.5400,183.8300,CIGNA HEALTHCARE,CIGNA PPO,511.05,,,,,,,316.3100,1225.5400,percent of total billed charges,"41.7% of $1,225.54 in Billed Charges for Rev 272 = $511.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1225.5400,183.8300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1102.99,,,,,,,316.3100,1225.5400,percent of total billed charges,"90% of $1,225.54 in Billed Charges for Rev 272 = $1,102.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1225.5400,183.8300,MEDCOST,MEDCOST VHN,583.23,,,,,,,316.3100,1225.5400,percent of total billed charges,"47.59% of $1,225.54 in Billed Charges for Rev 272 = $583.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1225.5400,183.8300,SENTARA HEALTH,SENTARA HEALTH,316.31,,,,,,,316.3100,1225.5400,percent of total billed charges,"25.81% of $1,225.54 in Billed Charges for Rev 272 = $316.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1225.5400,183.8300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1225.54,,,,,,,316.3100,1225.5400,percent of total billed charges,"100% of $1,225.54 in Billed Charges for Rev 272 = $1,225.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1225.5400,183.8300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,612.77,,,,,,,316.3100,1225.5400,percent of total billed charges,"Rev 272 $1,225.54 in Billed Charges at 50% = $612.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1225.5400,183.8300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,395.85,,,,,,,316.3100,1225.5400,other,"32.3% of $1,225.54 in Billed Charges for Rev 272 = $395.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1225.5400,183.8300,UNITED HEALTHCARE,UHC HERITAGE SELECT,376.24,,,,,,,316.3100,1225.5400,other,"30.7% of $1,225.54 in Billed Charges for Rev 272 = $376.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1225.5400,183.8300,UNITED HEALTHCARE,UNITED HEALTHCARE,395.85,,,,,,,316.3100,1225.5400,percent of total billed charges,"32.3% of $1,225.54 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1225.5400,183.8300,WELLCARE,WELLCARE MEDICAID,1225.54,,,,,,,316.3100,1225.5400,percent of total billed charges,"100% of $1,225.54 in Billed Charges for Rev 272 = $1,225.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH DIAGNOSTIC NANO NEEDLE SCOPE,272,RC,27200002,CDM,,,,,,both,,,1991.2300,298.6800,AETNA,AETNA,850.26,,,,,,,513.9400,1991.2300,percent of total billed charges,"42.7% of $1,991.23 in Billed Charges for Rev 272 = $850.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH DIAGNOSTIC NANO NEEDLE SCOPE,272,RC,27200002,CDM,,,,,,both,,,1991.2300,298.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1393.86,,,,,,,513.9400,1991.2300,percent of total billed charges,"Rev 272 $1,991.23 in Billed Charges at 70% = $1,393.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH DIAGNOSTIC NANO NEEDLE SCOPE,272,RC,27200002,CDM,,,,,,both,,,1991.2300,298.6800,CIGNA HEALTHCARE,CIGNA HMO,830.34,,,,,,,513.9400,1991.2300,percent of total billed charges,"41.7% of $1,991.23 in Billed Charges for Rev 272 = $830.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH DIAGNOSTIC NANO NEEDLE SCOPE,272,RC,27200002,CDM,,,,,,both,,,1991.2300,298.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,923.93,,,,,,,513.9400,1991.2300,percent of total billed charges,"46.4% of $1,991.23 in Billed Charges for Rev 272 = $923.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH DIAGNOSTIC NANO NEEDLE SCOPE,272,RC,27200002,CDM,,,,,,both,,,1991.2300,298.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,830.34,,,,,,,513.9400,1991.2300,percent of total billed charges,"41.7% of $1,991.23 in Billed Charges for Rev 272 = $830.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH DIAGNOSTIC NANO NEEDLE SCOPE,272,RC,27200002,CDM,,,,,,both,,,1991.2300,298.6800,CIGNA HEALTHCARE,CIGNA PPO,830.34,,,,,,,513.9400,1991.2300,percent of total billed charges,"41.7% of $1,991.23 in Billed Charges for Rev 272 = $830.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH DIAGNOSTIC NANO NEEDLE SCOPE,272,RC,27200002,CDM,,,,,,both,,,1991.2300,298.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1792.11,,,,,,,513.9400,1991.2300,percent of total billed charges,"90% of $1,991.23 in Billed Charges for Rev 272 = $1,792.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH DIAGNOSTIC NANO NEEDLE SCOPE,272,RC,27200002,CDM,,,,,,both,,,1991.2300,298.6800,MEDCOST,MEDCOST VHN,947.63,,,,,,,513.9400,1991.2300,percent of total billed charges,"47.59% of $1,991.23 in Billed Charges for Rev 272 = $947.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH DIAGNOSTIC NANO NEEDLE SCOPE,272,RC,27200002,CDM,,,,,,both,,,1991.2300,298.6800,SENTARA HEALTH,SENTARA HEALTH,513.94,,,,,,,513.9400,1991.2300,percent of total billed charges,"25.81% of $1,991.23 in Billed Charges for Rev 272 = $513.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH DIAGNOSTIC NANO NEEDLE SCOPE,272,RC,27200002,CDM,,,,,,both,,,1991.2300,298.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1991.23,,,,,,,513.9400,1991.2300,percent of total billed charges,"100% of $1,991.23 in Billed Charges for Rev 272 = $1,991.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH DIAGNOSTIC NANO NEEDLE SCOPE,272,RC,27200002,CDM,,,,,,both,,,1991.2300,298.6800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,995.62,,,,,,,513.9400,1991.2300,percent of total billed charges,"Rev 272 $1,991.23 in Billed Charges at 50% = $995.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH DIAGNOSTIC NANO NEEDLE SCOPE,272,RC,27200002,CDM,,,,,,both,,,1991.2300,298.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,643.17,,,,,,,513.9400,1991.2300,other,"32.3% of $1,991.23 in Billed Charges for Rev 272 = $643.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEATH DIAGNOSTIC NANO NEEDLE SCOPE,272,RC,27200002,CDM,,,,,,both,,,1991.2300,298.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,611.31,,,,,,,513.9400,1991.2300,other,"30.7% of $1,991.23 in Billed Charges for Rev 272 = $611.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEATH DIAGNOSTIC NANO NEEDLE SCOPE,272,RC,27200002,CDM,,,,,,both,,,1991.2300,298.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,643.17,,,,,,,513.9400,1991.2300,percent of total billed charges,"32.3% of $1,991.23 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH DIAGNOSTIC NANO NEEDLE SCOPE,272,RC,27200002,CDM,,,,,,both,,,1991.2300,298.6800,WELLCARE,WELLCARE MEDICAID,1991.23,,,,,,,513.9400,1991.2300,percent of total billed charges,"100% of $1,991.23 in Billed Charges for Rev 272 = $1,991.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,AETNA,AETNA,566.20,,,,,,,81.3100,1723.3000,percent of total billed charges,"42.7% of $1,326.00 in Billed Charges for Rev 410 Proc 94002 = $566.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1706.89,,,,,,,81.3100,1723.3000,fee schedule,"APG 00067 Proc 94002 at $836.60 (Base Rate) * 1.9618 (Relative Weight) = $1,641.24 (Total Line Payment) at 104% = $1,706.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,560.50,,,,,,,81.3100,1723.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,AETNA,AETNA HEALTHCARE MEDICARE,560.50,,,,,,,81.3100,1723.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,560.50,,,,,,,81.3100,1723.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,AMBETTER,AMBETTER,1221.90,,,,,,,81.3100,1723.3000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,582.92,,,,,,,81.3100,1723.3000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,BLUE CROSS,ANTHEM EXCHANGE,1326.00,,,,,,,81.3100,1723.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1326.00,,,,,,,81.3100,1723.3000,fee schedule,"APG 00067 Proc 94002 at $836.60 (Base Rate) * 1.9618 (Relative Weight) = $1,641.24 (Total Line Payment) at 103% = $1,690.48 (Service Line reduced to $1,326.00, claim capped at $1,326.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,BLUE CROSS,ANTHEM HMO,1326.00,,,,,,,81.3100,1723.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,577.32,,,,,,,81.3100,1723.3000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1326.00,,,,,,,81.3100,1723.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,81.31,,,,,,,81.3100,1723.3000,fee schedule,$81.31 from Fee Schedule BLDTM_23 for Rev 410 Proc 94002 * Qty 1 = $81.31 at 100% = $81.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,BLUE CROSS,BLUE CROSS MEDICARE,582.92,,,,,,,81.3100,1723.3000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,BLUE CROSS,TENNCARE BLUE CARE,82.17,,,,,,,81.3100,1723.3000,fee schedule,$70.84 from Fee Schedule TC_24 for Rev 410 Proc 94002 * Qty 1 = $70.84 at 116% = $82.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,BLUE CROSS,TENNCARE BLUE SELECT,82.17,,,,,,,81.3100,1723.3000,fee schedule,$70.84 from Fee Schedule TC_24 for Rev 410 Proc 94002 * Qty 1 = $70.84 at 116% = $82.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,CIGNA HEALTHCARE,CIGNA HMO,552.94,,,,,,,81.3100,1723.3000,percent of total billed charges,"41.7% of $1,326.00 in Billed Charges for Rev 410 Proc 94002 = $552.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,615.26,,,,,,,81.3100,1723.3000,percent of total billed charges,"46.4% of $1,326.00 in Billed Charges for Rev 410 Proc 94002 = $615.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,588.53,,,,,,,81.3100,1723.3000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,552.94,,,,,,,81.3100,1723.3000,percent of total billed charges,"41.7% of $1,326.00 in Billed Charges for Rev 410 Proc 94002 = $552.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,CIGNA HEALTHCARE,CIGNA PPO,552.94,,,,,,,81.3100,1723.3000,percent of total billed charges,"41.7% of $1,326.00 in Billed Charges for Rev 410 Proc 94002 = $552.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,588.53,,,,,,,81.3100,1723.3000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1193.40,,,,,,,81.3100,1723.3000,percent of total billed charges,"90% of $1,326.00 in Billed Charges for Rev 410 Proc 94002 = $1,193.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,HUMANA,HUMANA MEDICARE,560.50,,,,,,,81.3100,1723.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,560.50,,,,,,,81.3100,1723.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,MEDCOST,MEDCOST VHN,631.04,,,,,,,81.3100,1723.3000,percent of total billed charges,"47.59% of $1,326.00 in Billed Charges for Rev 410 Proc 94002 = $631.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1723.30,,,,,,,81.3100,1723.3000,fee schedule,"APG 00067 Proc 94002 at $836.60 (Base Rate) * 1.9618 (Relative Weight) = $1,641.24 (Total Line Payment) at 100% = $1,641.24... $1,641.24 at 105% = $1,723.30 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,588.53,,,,,,,81.3100,1723.3000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,588.53,,,,,,,81.3100,1723.3000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,NHC ADVANTAGE,NHC ADVANTAGE,588.53,,,,,,,81.3100,1723.3000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1692.12,,,,,,,81.3100,1723.3000,fee schedule,"APG 00067 Proc 94002 at $836.60 (Base Rate) * 1.9618 (Relative Weight) = $1,641.24 (Total Line Payment) at 100% = $1,641.24... $1,641.24 at 103.1% = $1,692.12 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,SENTARA HEALTH,SENTARA HEALTH,342.24,,,,,,,81.3100,1723.3000,percent of total billed charges,"25.81% of $1,326.00 in Billed Charges for Rev 410 Proc 94002 = $342.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,SENTARA HEALTH,SENTARA MEDICARE,560.50,,,,,,,81.3100,1723.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1326.00,,,,,,,81.3100,1723.3000,percent of total billed charges,"100% of $1,326.00 in Billed Charges for Rev 410 Proc 94002 = $1,326.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,107.42,,,,,,,81.3100,1723.3000,fee schedule,$214.83 from Fee Schedule TCUHC24 for Rev 410 Proc 94002 * Qty 1 = $214.83 at 50% = $107.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,112.00,,,,,,,81.3100,1723.3000,other,Rev 410 Proc 94002 1 Visit at $112.00 per Visit = $112.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,106.00,,,,,,,81.3100,1723.3000,other,Rev 410 Proc 94002 1 Visit at $106.00 per Visit = $106.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,175.00,,,,,,,81.3100,1723.3000,other,Rev 410 Proc 94002 1 Visit at $175.00 per Visit = $175.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1690.48,,,,,,,81.3100,1723.3000,fee schedule,"APG 00067 Proc 94002 at $836.60 (Base Rate) * 1.9618 (Relative Weight) = $1,641.24 (Total Line Payment) at 103% = $1,690.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,560.50,,,,,,,81.3100,1723.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,560.50,,,,,,,81.3100,1723.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,WELLCARE,WELLCARE MEDICAID,1326.00,,,,,,,81.3100,1723.3000,percent of total billed charges,"100% of $1,326.00 in Billed Charges for Rev 410 Proc 94002 = $1,326.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INIT VENTILATOR ASSIST AND MGMT,94002,CPT,410,RC,41000002,CDM,,,,both,,,1326.0000,198.9000,WELLCARE,WELLCARE MEDICARE,594.13,,,,,,,81.3100,1723.3000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,AETNA,AETNA,245.95,,,,,,,14.8600,576.0000,percent of total billed charges,42.7% of $576.00 in Billed Charges for Rev 460 Proc 94010 = $245.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,83.09,,,,,,,14.8600,576.0000,fee schedule,APG 00412 Proc 94010 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 104% = $83.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,195.90,,,,,,,14.8600,576.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,AETNA,AETNA HEALTHCARE MEDICARE,195.90,,,,,,,14.8600,576.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,195.90,,,,,,,14.8600,576.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,AMBETTER,AMBETTER,427.07,,,,,,,14.8600,576.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,203.74,,,,,,,14.8600,576.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,BLUE CROSS,ANTHEM EXCHANGE,482.33,,,,,,,14.8600,576.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,82.29,,,,,,,14.8600,576.0000,fee schedule,APG 00412 Proc 94010 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 103% = $82.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,BLUE CROSS,ANTHEM HMO,512.44,,,,,,,14.8600,576.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,201.78,,,,,,,14.8600,576.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",576.00,,,,,,,14.8600,576.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,19.51,,,,,,,14.8600,576.0000,fee schedule,$19.51 from Fee Schedule BLDTM_23 for Rev 460 Proc 94010 * Qty 1 = $19.51 at 100% = $19.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,BLUE CROSS,BLUE CROSS E NETWORK,107.43,,,,,,,14.8600,576.0000,fee schedule,$24.64 from Fee Schedule BCFSG for Rev 460 Proc 94010 * Qty 1 = $24.64 at 436% = $107.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,BLUE CROSS,BLUE CROSS MEDICARE,203.74,,,,,,,14.8600,576.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,BLUE CROSS,BLUE CROSS P NETWORK,109.65,,,,,,,14.8600,576.0000,fee schedule,$24.64 from Fee Schedule BCFSG for Rev 460 Proc 94010 * Qty 1 = $24.64 at 445% = $109.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,BLUE CROSS,BLUE CROSS S NETWORK,109.65,,,,,,,14.8600,576.0000,fee schedule,$24.64 from Fee Schedule BCFSG for Rev 460 Proc 94010 * Qty 1 = $24.64 at 445% = $109.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,BLUE CROSS,TENNCARE BLUE CARE,14.86,,,,,,,14.8600,576.0000,fee schedule,$12.81 from Fee Schedule TC_24 for Rev 460 Proc 94010 * Qty 1 = $12.81 at 116% = $14.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,BLUE CROSS,TENNCARE BLUE SELECT,14.86,,,,,,,14.8600,576.0000,fee schedule,$12.81 from Fee Schedule TC_24 for Rev 460 Proc 94010 * Qty 1 = $12.81 at 116% = $14.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,CIGNA HEALTHCARE,CIGNA HMO,240.19,,,,,,,14.8600,576.0000,percent of total billed charges,41.7% of $576.00 in Billed Charges for Rev 460 Proc 94010 = $240.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,267.26,,,,,,,14.8600,576.0000,percent of total billed charges,46.4% of $576.00 in Billed Charges for Rev 460 Proc 94010 = $267.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,205.70,,,,,,,14.8600,576.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,240.19,,,,,,,14.8600,576.0000,percent of total billed charges,41.7% of $576.00 in Billed Charges for Rev 460 Proc 94010 = $240.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,CIGNA HEALTHCARE,CIGNA PPO,240.19,,,,,,,14.8600,576.0000,percent of total billed charges,41.7% of $576.00 in Billed Charges for Rev 460 Proc 94010 = $240.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,205.70,,,,,,,14.8600,576.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,518.40,,,,,,,14.8600,576.0000,percent of total billed charges,90% of $576.00 in Billed Charges for Rev 460 Proc 94010 = $518.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,HUMANA,HUMANA MEDICARE,195.90,,,,,,,14.8600,576.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,195.90,,,,,,,14.8600,576.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,MEDCOST,MEDCOST VHN,274.12,,,,,,,14.8600,576.0000,percent of total billed charges,47.59% of $576.00 in Billed Charges for Rev 460 Proc 94010 = $274.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,83.90,,,,,,,14.8600,576.0000,fee schedule,APG 00412 Proc 94010 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 100% = $79.90... $79.90 at 105% = $83.90 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,205.70,,,,,,,14.8600,576.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,205.70,,,,,,,14.8600,576.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,NHC ADVANTAGE,NHC ADVANTAGE,205.70,,,,,,,14.8600,576.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,82.38,,,,,,,14.8600,576.0000,fee schedule,APG 00412 Proc 94010 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 100% = $79.90... $79.90 at 103.1% = $82.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,SENTARA HEALTH,SENTARA HEALTH,148.67,,,,,,,14.8600,576.0000,percent of total billed charges,25.81% of $576.00 in Billed Charges for Rev 460 Proc 94010 = $148.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,SENTARA HEALTH,SENTARA MEDICARE,195.90,,,,,,,14.8600,576.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",576.00,,,,,,,14.8600,576.0000,percent of total billed charges,100% of $576.00 in Billed Charges for Rev 460 Proc 94010 = $576.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,25.88,,,,,,,14.8600,576.0000,fee schedule,$51.76 from Fee Schedule TCUHC24 for Rev 460 Proc 94010 * Qty 1 = $51.76 at 50% = $25.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,576.00,,,,,,,14.8600,576.0000,other,"Rev 460 Proc 94010 1 Visit at $860.00 per Visit = $860.00 (Service Line reduced to $576.00, claim capped at $576.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,576.00,,,,,,,14.8600,576.0000,other,"Rev 460 Proc 94010 1 Visit at $822.00 per Visit = $822.00 (Service Line reduced to $576.00, claim capped at $576.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,576.00,,,,,,,14.8600,576.0000,other,"Rev 460 Proc 94010 1 Visit at $1,353.00 per Visit = $1,353.00 (Service Line reduced to $576.00, claim capped at $576.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,82.29,,,,,,,14.8600,576.0000,fee schedule,APG 00412 Proc 94010 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 103% = $82.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,195.90,,,,,,,14.8600,576.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,195.90,,,,,,,14.8600,576.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,WELLCARE,WELLCARE MEDICAID,576.00,,,,,,,14.8600,576.0000,percent of total billed charges,100% of $576.00 in Billed Charges for Rev 460 Proc 94010 = $576.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SPIROMETRY W GRAPHIC RECORD,94010,CPT,460,RC,46000001,CDM,,,,both,,,576.0000,86.4000,WELLCARE,WELLCARE MEDICARE,207.66,,,,,,,14.8600,576.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,AETNA,AETNA,80.70,,,,,,,2.9700,254.5000,percent of total billed charges,42.7% of $189.00 in Billed Charges for Rev 460 Proc 94150 = $80.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,83.09,,,,,,,2.9700,254.5000,fee schedule,APG 00412 Proc 94150 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 104% = $83.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,116.74,,,,,,,2.9700,254.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,AETNA,AETNA HEALTHCARE MEDICARE,116.74,,,,,,,2.9700,254.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,116.74,,,,,,,2.9700,254.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,AMBETTER,AMBETTER,254.50,,,,,,,2.9700,254.5000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,121.41,,,,,,,2.9700,254.5000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,BLUE CROSS,ANTHEM EXCHANGE,189.00,,,,,,,2.9700,254.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,82.29,,,,,,,2.9700,254.5000,fee schedule,APG 00412 Proc 94150 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 103% = $82.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,BLUE CROSS,ANTHEM HMO,189.00,,,,,,,2.9700,254.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,120.24,,,,,,,2.9700,254.5000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",189.00,,,,,,,2.9700,254.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5.88,,,,,,,2.9700,254.5000,fee schedule,$5.88 from Fee Schedule BLDTM_23 for Rev 460 Proc 94150 * Qty 1 = $5.88 at 100% = $5.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,BLUE CROSS,BLUE CROSS E NETWORK,83.58,,,,,,,2.9700,254.5000,fee schedule,$19.17 from Fee Schedule BCFSG for Rev 460 Proc 94150 * Qty 1 = $19.17 at 436% = $83.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,BLUE CROSS,BLUE CROSS MEDICARE,121.41,,,,,,,2.9700,254.5000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,BLUE CROSS,BLUE CROSS P NETWORK,85.31,,,,,,,2.9700,254.5000,fee schedule,$19.17 from Fee Schedule BCFSG for Rev 460 Proc 94150 * Qty 1 = $19.17 at 445% = $85.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,BLUE CROSS,BLUE CROSS S NETWORK,85.31,,,,,,,2.9700,254.5000,fee schedule,$19.17 from Fee Schedule BCFSG for Rev 460 Proc 94150 * Qty 1 = $19.17 at 445% = $85.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,BLUE CROSS,TENNCARE BLUE CARE,2.97,,,,,,,2.9700,254.5000,fee schedule,$2.56 from Fee Schedule TC_24 for Rev 460 Proc 94150 * Qty 1 = $2.56 at 116% = $2.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,BLUE CROSS,TENNCARE BLUE SELECT,2.97,,,,,,,2.9700,254.5000,fee schedule,$2.56 from Fee Schedule TC_24 for Rev 460 Proc 94150 * Qty 1 = $2.56 at 116% = $2.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,CIGNA HEALTHCARE,CIGNA HMO,78.81,,,,,,,2.9700,254.5000,percent of total billed charges,41.7% of $189.00 in Billed Charges for Rev 460 Proc 94150 = $78.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,87.70,,,,,,,2.9700,254.5000,percent of total billed charges,46.4% of $189.00 in Billed Charges for Rev 460 Proc 94150 = $87.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,122.58,,,,,,,2.9700,254.5000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,78.81,,,,,,,2.9700,254.5000,percent of total billed charges,41.7% of $189.00 in Billed Charges for Rev 460 Proc 94150 = $78.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,CIGNA HEALTHCARE,CIGNA PPO,78.81,,,,,,,2.9700,254.5000,percent of total billed charges,41.7% of $189.00 in Billed Charges for Rev 460 Proc 94150 = $78.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,122.58,,,,,,,2.9700,254.5000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,170.10,,,,,,,2.9700,254.5000,percent of total billed charges,90% of $189.00 in Billed Charges for Rev 460 Proc 94150 = $170.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,HUMANA,HUMANA MEDICARE,116.74,,,,,,,2.9700,254.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,116.74,,,,,,,2.9700,254.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,MEDCOST,MEDCOST VHN,89.95,,,,,,,2.9700,254.5000,percent of total billed charges,47.59% of $189.00 in Billed Charges for Rev 460 Proc 94150 = $89.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,83.90,,,,,,,2.9700,254.5000,fee schedule,APG 00412 Proc 94150 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 100% = $79.90... $79.90 at 105% = $83.90 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,122.58,,,,,,,2.9700,254.5000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,122.58,,,,,,,2.9700,254.5000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,NHC ADVANTAGE,NHC ADVANTAGE,122.58,,,,,,,2.9700,254.5000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,82.38,,,,,,,2.9700,254.5000,fee schedule,APG 00412 Proc 94150 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 100% = $79.90... $79.90 at 103.1% = $82.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,SENTARA HEALTH,SENTARA HEALTH,48.78,,,,,,,2.9700,254.5000,percent of total billed charges,25.81% of $189.00 in Billed Charges for Rev 460 Proc 94150 = $48.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,SENTARA HEALTH,SENTARA MEDICARE,116.74,,,,,,,2.9700,254.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",189.00,,,,,,,2.9700,254.5000,percent of total billed charges,100% of $189.00 in Billed Charges for Rev 460 Proc 94150 = $189.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,25.88,,,,,,,2.9700,254.5000,fee schedule,$51.76 from Fee Schedule TCUHC24 for Rev 460 Proc 94150 * Qty 1 = $51.76 at 50% = $25.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,189.00,,,,,,,2.9700,254.5000,other,"Rev 460 Proc 94150 1 Visit at $860.00 per Visit = $860.00 (Service Line reduced to $189.00, claim capped at $189.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,189.00,,,,,,,2.9700,254.5000,other,"Rev 460 Proc 94150 1 Visit at $822.00 per Visit = $822.00 (Service Line reduced to $189.00, claim capped at $189.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,189.00,,,,,,,2.9700,254.5000,other,"Rev 460 Proc 94150 1 Visit at $1,353.00 per Visit = $1,353.00 (Service Line reduced to $189.00, claim capped at $189.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,82.29,,,,,,,2.9700,254.5000,fee schedule,APG 00412 Proc 94150 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 103% = $82.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,116.74,,,,,,,2.9700,254.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,116.74,,,,,,,2.9700,254.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,WELLCARE,WELLCARE MEDICAID,189.00,,,,,,,2.9700,254.5000,percent of total billed charges,100% of $189.00 in Billed Charges for Rev 460 Proc 94150 = $189.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC VITAL CAPACITY TOTAL,94150,CPT,460,RC,46000004,CDM,,,,both,,,189.0000,28.3500,WELLCARE,WELLCARE MEDICARE,123.75,,,,,,,2.9700,254.5000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,AETNA,AETNA,82.41,,,,,,,8.7500,193.0000,percent of total billed charges,42.7% of $193.00 in Billed Charges for Rev 460 Proc 94200 = $82.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,83.09,,,,,,,8.7500,193.0000,fee schedule,APG 00412 Proc 94200 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 104% = $83.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,53.52,,,,,,,8.7500,193.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,AETNA,AETNA HEALTHCARE MEDICARE,53.52,,,,,,,8.7500,193.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,53.52,,,,,,,8.7500,193.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,AMBETTER,AMBETTER,116.68,,,,,,,8.7500,193.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,55.66,,,,,,,8.7500,193.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,ANTHEM EXCHANGE,131.77,,,,,,,8.7500,193.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,82.29,,,,,,,8.7500,193.0000,fee schedule,APG 00412 Proc 94200 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 103% = $82.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,ANTHEM HMO,140.00,,,,,,,8.7500,193.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,55.13,,,,,,,8.7500,193.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",164.70,,,,,,,8.7500,193.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,15.47,,,,,,,8.7500,193.0000,fee schedule,$15.47 from Fee Schedule BLDTM_23 for Rev 460 Proc 94200 * Qty 1 = $15.47 at 100% = $15.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,BLUE CROSS E NETWORK,73.77,,,,,,,8.7500,193.0000,fee schedule,$16.92 from Fee Schedule BCFSG for Rev 460 Proc 94200 * Qty 1 = $16.92 at 436% = $73.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,BLUE CROSS MEDICARE,55.66,,,,,,,8.7500,193.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,BLUE CROSS P NETWORK,75.29,,,,,,,8.7500,193.0000,fee schedule,$16.92 from Fee Schedule BCFSG for Rev 460 Proc 94200 * Qty 1 = $16.92 at 445% = $75.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,BLUE CROSS S NETWORK,75.29,,,,,,,8.7500,193.0000,fee schedule,$16.92 from Fee Schedule BCFSG for Rev 460 Proc 94200 * Qty 1 = $16.92 at 445% = $75.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,TENNCARE BLUE CARE,8.75,,,,,,,8.7500,193.0000,fee schedule,$7.54 from Fee Schedule TC_24 for Rev 460 Proc 94200 * Qty 1 = $7.54 at 116% = $8.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,TENNCARE BLUE SELECT,8.75,,,,,,,8.7500,193.0000,fee schedule,$7.54 from Fee Schedule TC_24 for Rev 460 Proc 94200 * Qty 1 = $7.54 at 116% = $8.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,CIGNA HEALTHCARE,CIGNA HMO,80.48,,,,,,,8.7500,193.0000,percent of total billed charges,41.7% of $193.00 in Billed Charges for Rev 460 Proc 94200 = $80.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,89.55,,,,,,,8.7500,193.0000,percent of total billed charges,46.4% of $193.00 in Billed Charges for Rev 460 Proc 94200 = $89.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,56.20,,,,,,,8.7500,193.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,80.48,,,,,,,8.7500,193.0000,percent of total billed charges,41.7% of $193.00 in Billed Charges for Rev 460 Proc 94200 = $80.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,CIGNA HEALTHCARE,CIGNA PPO,80.48,,,,,,,8.7500,193.0000,percent of total billed charges,41.7% of $193.00 in Billed Charges for Rev 460 Proc 94200 = $80.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,56.20,,,,,,,8.7500,193.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,173.70,,,,,,,8.7500,193.0000,percent of total billed charges,90% of $193.00 in Billed Charges for Rev 460 Proc 94200 = $173.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,HUMANA,HUMANA MEDICARE,53.52,,,,,,,8.7500,193.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,53.52,,,,,,,8.7500,193.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,MEDCOST,MEDCOST VHN,91.85,,,,,,,8.7500,193.0000,percent of total billed charges,47.59% of $193.00 in Billed Charges for Rev 460 Proc 94200 = $91.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,83.90,,,,,,,8.7500,193.0000,fee schedule,APG 00412 Proc 94200 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 100% = $79.90... $79.90 at 105% = $83.90 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,56.20,,,,,,,8.7500,193.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,56.20,,,,,,,8.7500,193.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,NHC ADVANTAGE,NHC ADVANTAGE,56.20,,,,,,,8.7500,193.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,82.38,,,,,,,8.7500,193.0000,fee schedule,APG 00412 Proc 94200 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 100% = $79.90... $79.90 at 103.1% = $82.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,SENTARA HEALTH,SENTARA HEALTH,49.81,,,,,,,8.7500,193.0000,percent of total billed charges,25.81% of $193.00 in Billed Charges for Rev 460 Proc 94200 = $49.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,SENTARA HEALTH,SENTARA MEDICARE,53.52,,,,,,,8.7500,193.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",193.00,,,,,,,8.7500,193.0000,percent of total billed charges,100% of $193.00 in Billed Charges for Rev 460 Proc 94200 = $193.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,25.88,,,,,,,8.7500,193.0000,fee schedule,$51.76 from Fee Schedule TCUHC24 for Rev 460 Proc 94200 * Qty 1 = $51.76 at 50% = $25.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,193.00,,,,,,,8.7500,193.0000,other,"Rev 460 Proc 94200 1 Visit at $860.00 per Visit = $860.00 (Service Line reduced to $193.00, claim capped at $193.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,193.00,,,,,,,8.7500,193.0000,other,"Rev 460 Proc 94200 1 Visit at $822.00 per Visit = $822.00 (Service Line reduced to $193.00, claim capped at $193.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,193.00,,,,,,,8.7500,193.0000,other,"Rev 460 Proc 94200 1 Visit at $1,353.00 per Visit = $1,353.00 (Service Line reduced to $193.00, claim capped at $193.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,82.29,,,,,,,8.7500,193.0000,fee schedule,APG 00412 Proc 94200 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 103% = $82.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,53.52,,,,,,,8.7500,193.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,53.52,,,,,,,8.7500,193.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,WELLCARE,WELLCARE MEDICAID,193.00,,,,,,,8.7500,193.0000,percent of total billed charges,100% of $193.00 in Billed Charges for Rev 460 Proc 94200 = $193.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PFT SCREEN SIMPLE SPIRO CONTRACT,94200,CPT,460,RC,46000005,CDM,,,,both,,,193.0000,28.9500,WELLCARE,WELLCARE MEDICARE,56.73,,,,,,,8.7500,193.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,AETNA,AETNA,262.61,,,,,,,17.3100,615.0000,percent of total billed charges,42.7% of $615.00 in Billed Charges for Rev 460 Proc 94375 = $262.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,151.57,,,,,,,17.3100,615.0000,fee schedule,APG 00060 Proc 94375 at $836.60 (Base Rate) * 0.1742 (Relative Weight) = $145.74 (Total Line Payment) at 104% = $151.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,195.90,,,,,,,17.3100,615.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,AETNA,AETNA HEALTHCARE MEDICARE,195.90,,,,,,,17.3100,615.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,195.90,,,,,,,17.3100,615.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,AMBETTER,AMBETTER,427.07,,,,,,,17.3100,615.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,203.74,,,,,,,17.3100,615.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,BLUE CROSS,ANTHEM EXCHANGE,482.33,,,,,,,17.3100,615.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,150.11,,,,,,,17.3100,615.0000,fee schedule,APG 00060 Proc 94375 at $836.60 (Base Rate) * 0.1742 (Relative Weight) = $145.74 (Total Line Payment) at 103% = $150.11. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,BLUE CROSS,ANTHEM HMO,512.44,,,,,,,17.3100,615.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,201.78,,,,,,,17.3100,615.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",602.84,,,,,,,17.3100,615.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,32.11,,,,,,,17.3100,615.0000,fee schedule,$32.11 from Fee Schedule BLDTM_23 for Rev 460 Proc 94375 * Qty 1 = $32.11 at 100% = $32.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,BLUE CROSS,BLUE CROSS E NETWORK,94.79,,,,,,,17.3100,615.0000,fee schedule,$21.74 from Fee Schedule BCFSG for Rev 460 Proc 94375 * Qty 1 = $21.74 at 436% = $94.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,BLUE CROSS,BLUE CROSS MEDICARE,203.74,,,,,,,17.3100,615.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,BLUE CROSS,BLUE CROSS P NETWORK,96.74,,,,,,,17.3100,615.0000,fee schedule,$21.74 from Fee Schedule BCFSG for Rev 460 Proc 94375 * Qty 1 = $21.74 at 445% = $96.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,BLUE CROSS,BLUE CROSS S NETWORK,96.74,,,,,,,17.3100,615.0000,fee schedule,$21.74 from Fee Schedule BCFSG for Rev 460 Proc 94375 * Qty 1 = $21.74 at 445% = $96.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,BLUE CROSS,TENNCARE BLUE CARE,17.31,,,,,,,17.3100,615.0000,fee schedule,$14.92 from Fee Schedule TC_24 for Rev 460 Proc 94375 * Qty 1 = $14.92 at 116% = $17.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,BLUE CROSS,TENNCARE BLUE SELECT,17.31,,,,,,,17.3100,615.0000,fee schedule,$14.92 from Fee Schedule TC_24 for Rev 460 Proc 94375 * Qty 1 = $14.92 at 116% = $17.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,CIGNA HEALTHCARE,CIGNA HMO,256.46,,,,,,,17.3100,615.0000,percent of total billed charges,41.7% of $615.00 in Billed Charges for Rev 460 Proc 94375 = $256.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,285.36,,,,,,,17.3100,615.0000,percent of total billed charges,46.4% of $615.00 in Billed Charges for Rev 460 Proc 94375 = $285.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,205.70,,,,,,,17.3100,615.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,256.46,,,,,,,17.3100,615.0000,percent of total billed charges,41.7% of $615.00 in Billed Charges for Rev 460 Proc 94375 = $256.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,CIGNA HEALTHCARE,CIGNA PPO,256.46,,,,,,,17.3100,615.0000,percent of total billed charges,41.7% of $615.00 in Billed Charges for Rev 460 Proc 94375 = $256.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,205.70,,,,,,,17.3100,615.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,553.50,,,,,,,17.3100,615.0000,percent of total billed charges,90% of $615.00 in Billed Charges for Rev 460 Proc 94375 = $553.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,HUMANA,HUMANA MEDICARE,195.90,,,,,,,17.3100,615.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,195.90,,,,,,,17.3100,615.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,MEDCOST,MEDCOST VHN,292.68,,,,,,,17.3100,615.0000,percent of total billed charges,47.59% of $615.00 in Billed Charges for Rev 460 Proc 94375 = $292.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,153.03,,,,,,,17.3100,615.0000,fee schedule,APG 00060 Proc 94375 at $836.60 (Base Rate) * 0.1742 (Relative Weight) = $145.74 (Total Line Payment) at 100% = $145.74... $145.74 at 105% = $153.03 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,205.70,,,,,,,17.3100,615.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,205.70,,,,,,,17.3100,615.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,NHC ADVANTAGE,NHC ADVANTAGE,205.70,,,,,,,17.3100,615.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,150.26,,,,,,,17.3100,615.0000,fee schedule,APG 00060 Proc 94375 at $836.60 (Base Rate) * 0.1742 (Relative Weight) = $145.74 (Total Line Payment) at 100% = $145.74... $145.74 at 103.1% = $150.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,SENTARA HEALTH,SENTARA HEALTH,158.73,,,,,,,17.3100,615.0000,percent of total billed charges,25.81% of $615.00 in Billed Charges for Rev 460 Proc 94375 = $158.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,SENTARA HEALTH,SENTARA MEDICARE,195.90,,,,,,,17.3100,615.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",615.00,,,,,,,17.3100,615.0000,percent of total billed charges,100% of $615.00 in Billed Charges for Rev 460 Proc 94375 = $615.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,25.88,,,,,,,17.3100,615.0000,fee schedule,$51.76 from Fee Schedule TCUHC24 for Rev 460 Proc 94375 * Qty 1 = $51.76 at 50% = $25.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,615.00,,,,,,,17.3100,615.0000,other,"Rev 460 Proc 94375 1 Visit at $860.00 per Visit = $860.00 (Service Line reduced to $615.00, claim capped at $615.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,615.00,,,,,,,17.3100,615.0000,other,"Rev 460 Proc 94375 1 Visit at $822.00 per Visit = $822.00 (Service Line reduced to $615.00, claim capped at $615.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,615.00,,,,,,,17.3100,615.0000,other,"Rev 460 Proc 94375 1 Visit at $1,353.00 per Visit = $1,353.00 (Service Line reduced to $615.00, claim capped at $615.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,150.11,,,,,,,17.3100,615.0000,fee schedule,APG 00060 Proc 94375 at $836.60 (Base Rate) * 0.1742 (Relative Weight) = $145.74 (Total Line Payment) at 103% = $150.11. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,195.90,,,,,,,17.3100,615.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,195.90,,,,,,,17.3100,615.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,WELLCARE,WELLCARE MEDICAID,615.00,,,,,,,17.3100,615.0000,percent of total billed charges,100% of $615.00 in Billed Charges for Rev 460 Proc 94375 = $615.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FLOW VOLUME LOOP,94375,CPT,460,RC,46000006,CDM,,,,both,,,615.0000,92.2500,WELLCARE,WELLCARE MEDICARE,207.66,,,,,,,17.3100,615.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5175.1300,776.2700,AETNA,AETNA,2209.78,,,,,,,1335.7000,5175.1300,percent of total billed charges,"42.7% of $5,175.13 in Billed Charges for Rev 272 = $2,209.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5175.1300,776.2700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3622.59,,,,,,,1335.7000,5175.1300,percent of total billed charges,"Rev 272 $5,175.13 in Billed Charges at 70% = $3,622.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5175.1300,776.2700,CIGNA HEALTHCARE,CIGNA HMO,2158.03,,,,,,,1335.7000,5175.1300,percent of total billed charges,"41.7% of $5,175.13 in Billed Charges for Rev 272 = $2,158.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5175.1300,776.2700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2401.26,,,,,,,1335.7000,5175.1300,percent of total billed charges,"46.4% of $5,175.13 in Billed Charges for Rev 272 = $2,401.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5175.1300,776.2700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2158.03,,,,,,,1335.7000,5175.1300,percent of total billed charges,"41.7% of $5,175.13 in Billed Charges for Rev 272 = $2,158.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5175.1300,776.2700,CIGNA HEALTHCARE,CIGNA PPO,2158.03,,,,,,,1335.7000,5175.1300,percent of total billed charges,"41.7% of $5,175.13 in Billed Charges for Rev 272 = $2,158.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5175.1300,776.2700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4657.62,,,,,,,1335.7000,5175.1300,percent of total billed charges,"90% of $5,175.13 in Billed Charges for Rev 272 = $4,657.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5175.1300,776.2700,MEDCOST,MEDCOST VHN,2462.84,,,,,,,1335.7000,5175.1300,percent of total billed charges,"47.59% of $5,175.13 in Billed Charges for Rev 272 = $2,462.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5175.1300,776.2700,SENTARA HEALTH,SENTARA HEALTH,1335.70,,,,,,,1335.7000,5175.1300,percent of total billed charges,"25.81% of $5,175.13 in Billed Charges for Rev 272 = $1,335.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5175.1300,776.2700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5175.13,,,,,,,1335.7000,5175.1300,percent of total billed charges,"100% of $5,175.13 in Billed Charges for Rev 272 = $5,175.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5175.1300,776.2700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2587.57,,,,,,,1335.7000,5175.1300,percent of total billed charges,"Rev 272 $5,175.13 in Billed Charges at 50% = $2,587.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5175.1300,776.2700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1671.57,,,,,,,1335.7000,5175.1300,other,"32.3% of $5,175.13 in Billed Charges for Rev 272 = $1,671.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5175.1300,776.2700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1588.76,,,,,,,1335.7000,5175.1300,other,"30.7% of $5,175.13 in Billed Charges for Rev 272 = $1,588.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5175.1300,776.2700,UNITED HEALTHCARE,UNITED HEALTHCARE,1671.57,,,,,,,1335.7000,5175.1300,percent of total billed charges,"32.3% of $5,175.13 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5175.1300,776.2700,WELLCARE,WELLCARE MEDICAID,5175.13,,,,,,,1335.7000,5175.1300,percent of total billed charges,"100% of $5,175.13 in Billed Charges for Rev 272 = $5,175.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5434.4000,815.1600,AETNA,AETNA,2320.49,,,,,,,1402.6200,5434.4000,percent of total billed charges,"42.7% of $5,434.40 in Billed Charges for Rev 272 = $2,320.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5434.4000,815.1600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3804.08,,,,,,,1402.6200,5434.4000,percent of total billed charges,"Rev 272 $5,434.40 in Billed Charges at 70% = $3,804.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5434.4000,815.1600,CIGNA HEALTHCARE,CIGNA HMO,2266.14,,,,,,,1402.6200,5434.4000,percent of total billed charges,"41.7% of $5,434.40 in Billed Charges for Rev 272 = $2,266.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5434.4000,815.1600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2521.56,,,,,,,1402.6200,5434.4000,percent of total billed charges,"46.4% of $5,434.40 in Billed Charges for Rev 272 = $2,521.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5434.4000,815.1600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2266.14,,,,,,,1402.6200,5434.4000,percent of total billed charges,"41.7% of $5,434.40 in Billed Charges for Rev 272 = $2,266.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5434.4000,815.1600,CIGNA HEALTHCARE,CIGNA PPO,2266.14,,,,,,,1402.6200,5434.4000,percent of total billed charges,"41.7% of $5,434.40 in Billed Charges for Rev 272 = $2,266.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5434.4000,815.1600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4890.96,,,,,,,1402.6200,5434.4000,percent of total billed charges,"90% of $5,434.40 in Billed Charges for Rev 272 = $4,890.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5434.4000,815.1600,MEDCOST,MEDCOST VHN,2586.23,,,,,,,1402.6200,5434.4000,percent of total billed charges,"47.59% of $5,434.40 in Billed Charges for Rev 272 = $2,586.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5434.4000,815.1600,SENTARA HEALTH,SENTARA HEALTH,1402.62,,,,,,,1402.6200,5434.4000,percent of total billed charges,"25.81% of $5,434.40 in Billed Charges for Rev 272 = $1,402.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5434.4000,815.1600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5434.40,,,,,,,1402.6200,5434.4000,percent of total billed charges,"100% of $5,434.40 in Billed Charges for Rev 272 = $5,434.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5434.4000,815.1600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2717.20,,,,,,,1402.6200,5434.4000,percent of total billed charges,"Rev 272 $5,434.40 in Billed Charges at 50% = $2,717.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5434.4000,815.1600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1755.31,,,,,,,1402.6200,5434.4000,other,"32.3% of $5,434.40 in Billed Charges for Rev 272 = $1,755.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5434.4000,815.1600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1668.36,,,,,,,1402.6200,5434.4000,other,"30.7% of $5,434.40 in Billed Charges for Rev 272 = $1,668.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5434.4000,815.1600,UNITED HEALTHCARE,UNITED HEALTHCARE,1755.31,,,,,,,1402.6200,5434.4000,percent of total billed charges,"32.3% of $5,434.40 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTRODUCER AFX2 17FR X 45CM,272,RC,,,,,,,,both,,,5434.4000,815.1600,WELLCARE,WELLCARE MEDICAID,5434.40,,,,,,,1402.6200,5434.4000,percent of total billed charges,"100% of $5,434.40 in Billed Charges for Rev 272 = $5,434.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID 4MM X 5MM,272,RC,,,,,,,,both,,,6243.4500,936.5200,AETNA,AETNA,2665.95,,,,,,,1611.4300,6243.4500,percent of total billed charges,"42.7% of $6,243.45 in Billed Charges for Rev 272 = $2,665.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID 4MM X 5MM,272,RC,,,,,,,,both,,,6243.4500,936.5200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4370.42,,,,,,,1611.4300,6243.4500,percent of total billed charges,"Rev 272 $6,243.45 in Billed Charges at 70% = $4,370.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID 4MM X 5MM,272,RC,,,,,,,,both,,,6243.4500,936.5200,CIGNA HEALTHCARE,CIGNA HMO,2603.52,,,,,,,1611.4300,6243.4500,percent of total billed charges,"41.7% of $6,243.45 in Billed Charges for Rev 272 = $2,603.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID 4MM X 5MM,272,RC,,,,,,,,both,,,6243.4500,936.5200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2896.96,,,,,,,1611.4300,6243.4500,percent of total billed charges,"46.4% of $6,243.45 in Billed Charges for Rev 272 = $2,896.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID 4MM X 5MM,272,RC,,,,,,,,both,,,6243.4500,936.5200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2603.52,,,,,,,1611.4300,6243.4500,percent of total billed charges,"41.7% of $6,243.45 in Billed Charges for Rev 272 = $2,603.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID 4MM X 5MM,272,RC,,,,,,,,both,,,6243.4500,936.5200,CIGNA HEALTHCARE,CIGNA PPO,2603.52,,,,,,,1611.4300,6243.4500,percent of total billed charges,"41.7% of $6,243.45 in Billed Charges for Rev 272 = $2,603.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID 4MM X 5MM,272,RC,,,,,,,,both,,,6243.4500,936.5200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5619.11,,,,,,,1611.4300,6243.4500,percent of total billed charges,"90% of $6,243.45 in Billed Charges for Rev 272 = $5,619.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID 4MM X 5MM,272,RC,,,,,,,,both,,,6243.4500,936.5200,MEDCOST,MEDCOST VHN,2971.26,,,,,,,1611.4300,6243.4500,percent of total billed charges,"47.59% of $6,243.45 in Billed Charges for Rev 272 = $2,971.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID 4MM X 5MM,272,RC,,,,,,,,both,,,6243.4500,936.5200,SENTARA HEALTH,SENTARA HEALTH,1611.43,,,,,,,1611.4300,6243.4500,percent of total billed charges,"25.81% of $6,243.45 in Billed Charges for Rev 272 = $1,611.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID 4MM X 5MM,272,RC,,,,,,,,both,,,6243.4500,936.5200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6243.45,,,,,,,1611.4300,6243.4500,percent of total billed charges,"100% of $6,243.45 in Billed Charges for Rev 272 = $6,243.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID 4MM X 5MM,272,RC,,,,,,,,both,,,6243.4500,936.5200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3121.73,,,,,,,1611.4300,6243.4500,percent of total billed charges,"Rev 272 $6,243.45 in Billed Charges at 50% = $3,121.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID 4MM X 5MM,272,RC,,,,,,,,both,,,6243.4500,936.5200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2016.63,,,,,,,1611.4300,6243.4500,other,"32.3% of $6,243.45 in Billed Charges for Rev 272 = $2,016.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHUNT CAROTID 4MM X 5MM,272,RC,,,,,,,,both,,,6243.4500,936.5200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1916.74,,,,,,,1611.4300,6243.4500,other,"30.7% of $6,243.45 in Billed Charges for Rev 272 = $1,916.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHUNT CAROTID 4MM X 5MM,272,RC,,,,,,,,both,,,6243.4500,936.5200,UNITED HEALTHCARE,UNITED HEALTHCARE,2016.63,,,,,,,1611.4300,6243.4500,percent of total billed charges,"32.3% of $6,243.45 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID 4MM X 5MM,272,RC,,,,,,,,both,,,6243.4500,936.5200,WELLCARE,WELLCARE MEDICAID,6243.45,,,,,,,1611.4300,6243.4500,percent of total billed charges,"100% of $6,243.45 in Billed Charges for Rev 272 = $6,243.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID ENDARTERECTOMY EXTERNAL 3MMX5MM,272,RC,27200002,CDM,,,,,,both,,,6914.6600,1037.2000,AETNA,AETNA,2952.56,,,,,,,1784.6700,6914.6600,percent of total billed charges,"42.7% of $6,914.66 in Billed Charges for Rev 272 = $2,952.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID ENDARTERECTOMY EXTERNAL 3MMX5MM,272,RC,27200002,CDM,,,,,,both,,,6914.6600,1037.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4840.26,,,,,,,1784.6700,6914.6600,percent of total billed charges,"Rev 272 $6,914.66 in Billed Charges at 70% = $4,840.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID ENDARTERECTOMY EXTERNAL 3MMX5MM,272,RC,27200002,CDM,,,,,,both,,,6914.6600,1037.2000,CIGNA HEALTHCARE,CIGNA HMO,2883.41,,,,,,,1784.6700,6914.6600,percent of total billed charges,"41.7% of $6,914.66 in Billed Charges for Rev 272 = $2,883.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID ENDARTERECTOMY EXTERNAL 3MMX5MM,272,RC,27200002,CDM,,,,,,both,,,6914.6600,1037.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3208.40,,,,,,,1784.6700,6914.6600,percent of total billed charges,"46.4% of $6,914.66 in Billed Charges for Rev 272 = $3,208.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID ENDARTERECTOMY EXTERNAL 3MMX5MM,272,RC,27200002,CDM,,,,,,both,,,6914.6600,1037.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2883.41,,,,,,,1784.6700,6914.6600,percent of total billed charges,"41.7% of $6,914.66 in Billed Charges for Rev 272 = $2,883.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID ENDARTERECTOMY EXTERNAL 3MMX5MM,272,RC,27200002,CDM,,,,,,both,,,6914.6600,1037.2000,CIGNA HEALTHCARE,CIGNA PPO,2883.41,,,,,,,1784.6700,6914.6600,percent of total billed charges,"41.7% of $6,914.66 in Billed Charges for Rev 272 = $2,883.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID ENDARTERECTOMY EXTERNAL 3MMX5MM,272,RC,27200002,CDM,,,,,,both,,,6914.6600,1037.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6223.19,,,,,,,1784.6700,6914.6600,percent of total billed charges,"90% of $6,914.66 in Billed Charges for Rev 272 = $6,223.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID ENDARTERECTOMY EXTERNAL 3MMX5MM,272,RC,27200002,CDM,,,,,,both,,,6914.6600,1037.2000,MEDCOST,MEDCOST VHN,3290.69,,,,,,,1784.6700,6914.6600,percent of total billed charges,"47.59% of $6,914.66 in Billed Charges for Rev 272 = $3,290.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID ENDARTERECTOMY EXTERNAL 3MMX5MM,272,RC,27200002,CDM,,,,,,both,,,6914.6600,1037.2000,SENTARA HEALTH,SENTARA HEALTH,1784.67,,,,,,,1784.6700,6914.6600,percent of total billed charges,"25.81% of $6,914.66 in Billed Charges for Rev 272 = $1,784.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID ENDARTERECTOMY EXTERNAL 3MMX5MM,272,RC,27200002,CDM,,,,,,both,,,6914.6600,1037.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6914.66,,,,,,,1784.6700,6914.6600,percent of total billed charges,"100% of $6,914.66 in Billed Charges for Rev 272 = $6,914.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID ENDARTERECTOMY EXTERNAL 3MMX5MM,272,RC,27200002,CDM,,,,,,both,,,6914.6600,1037.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3457.33,,,,,,,1784.6700,6914.6600,percent of total billed charges,"Rev 272 $6,914.66 in Billed Charges at 50% = $3,457.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID ENDARTERECTOMY EXTERNAL 3MMX5MM,272,RC,27200002,CDM,,,,,,both,,,6914.6600,1037.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2233.44,,,,,,,1784.6700,6914.6600,other,"32.3% of $6,914.66 in Billed Charges for Rev 272 = $2,233.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHUNT CAROTID ENDARTERECTOMY EXTERNAL 3MMX5MM,272,RC,27200002,CDM,,,,,,both,,,6914.6600,1037.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2122.80,,,,,,,1784.6700,6914.6600,other,"30.7% of $6,914.66 in Billed Charges for Rev 272 = $2,122.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHUNT CAROTID ENDARTERECTOMY EXTERNAL 3MMX5MM,272,RC,27200002,CDM,,,,,,both,,,6914.6600,1037.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,2233.44,,,,,,,1784.6700,6914.6600,percent of total billed charges,"32.3% of $6,914.66 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID ENDARTERECTOMY EXTERNAL 3MMX5MM,272,RC,27200002,CDM,,,,,,both,,,6914.6600,1037.2000,WELLCARE,WELLCARE MEDICAID,6914.66,,,,,,,1784.6700,6914.6600,percent of total billed charges,"100% of $6,914.66 in Billed Charges for Rev 272 = $6,914.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,AETNA,AETNA,261.32,,,,,,,10.3500,612.0000,percent of total billed charges,42.7% of $612.00 in Billed Charges for Rev 460 Proc 94618 = $261.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,83.09,,,,,,,10.3500,612.0000,fee schedule,APG 00412 Proc 94618 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 104% = $83.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,120.71,,,,,,,10.3500,612.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,AETNA,AETNA HEALTHCARE MEDICARE,120.71,,,,,,,10.3500,612.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,120.71,,,,,,,10.3500,612.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,AMBETTER,AMBETTER,263.15,,,,,,,10.3500,612.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,125.54,,,,,,,10.3500,612.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,BLUE CROSS,ANTHEM EXCHANGE,297.21,,,,,,,10.3500,612.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,82.29,,,,,,,10.3500,612.0000,fee schedule,APG 00412 Proc 94618 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 103% = $82.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,BLUE CROSS,ANTHEM HMO,315.76,,,,,,,10.3500,612.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,124.33,,,,,,,10.3500,612.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",371.47,,,,,,,10.3500,612.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,428.40,,,,,,,10.3500,612.0000,percent of total billed charges,Rev 460 Proc 94618 $612.00 in Billed Charges at 70% = $428.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,BLUE CROSS,BLUE CROSS E NETWORK,44.65,,,,,,,10.3500,612.0000,fee schedule,$10.24 from Fee Schedule BCFSG for Rev 460 Proc 94618 * Qty 1 = $10.24 at 436% = $44.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,BLUE CROSS,BLUE CROSS MEDICARE,125.54,,,,,,,10.3500,612.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,BLUE CROSS,BLUE CROSS P NETWORK,45.57,,,,,,,10.3500,612.0000,fee schedule,$10.24 from Fee Schedule BCFSG for Rev 460 Proc 94618 * Qty 1 = $10.24 at 445% = $45.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,BLUE CROSS,BLUE CROSS S NETWORK,45.57,,,,,,,10.3500,612.0000,fee schedule,$10.24 from Fee Schedule BCFSG for Rev 460 Proc 94618 * Qty 1 = $10.24 at 445% = $45.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,BLUE CROSS,TENNCARE BLUE CARE,10.35,,,,,,,10.3500,612.0000,fee schedule,$8.92 from Fee Schedule TC_24 for Rev 460 Proc 94618 * Qty 1 = $8.92 at 116% = $10.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,BLUE CROSS,TENNCARE BLUE SELECT,10.35,,,,,,,10.3500,612.0000,fee schedule,$8.92 from Fee Schedule TC_24 for Rev 460 Proc 94618 * Qty 1 = $8.92 at 116% = $10.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,CIGNA HEALTHCARE,CIGNA HMO,255.20,,,,,,,10.3500,612.0000,percent of total billed charges,41.7% of $612.00 in Billed Charges for Rev 460 Proc 94618 = $255.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,283.97,,,,,,,10.3500,612.0000,percent of total billed charges,46.4% of $612.00 in Billed Charges for Rev 460 Proc 94618 = $283.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,126.75,,,,,,,10.3500,612.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,255.20,,,,,,,10.3500,612.0000,percent of total billed charges,41.7% of $612.00 in Billed Charges for Rev 460 Proc 94618 = $255.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,CIGNA HEALTHCARE,CIGNA PPO,255.20,,,,,,,10.3500,612.0000,percent of total billed charges,41.7% of $612.00 in Billed Charges for Rev 460 Proc 94618 = $255.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,126.75,,,,,,,10.3500,612.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,550.80,,,,,,,10.3500,612.0000,percent of total billed charges,90% of $612.00 in Billed Charges for Rev 460 Proc 94618 = $550.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,HUMANA,HUMANA MEDICARE,120.71,,,,,,,10.3500,612.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,120.71,,,,,,,10.3500,612.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,MEDCOST,MEDCOST VHN,291.25,,,,,,,10.3500,612.0000,percent of total billed charges,47.59% of $612.00 in Billed Charges for Rev 460 Proc 94618 = $291.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,83.90,,,,,,,10.3500,612.0000,fee schedule,APG 00412 Proc 94618 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 100% = $79.90... $79.90 at 105% = $83.90 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,126.75,,,,,,,10.3500,612.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,126.75,,,,,,,10.3500,612.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,NHC ADVANTAGE,NHC ADVANTAGE,126.75,,,,,,,10.3500,612.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,82.38,,,,,,,10.3500,612.0000,fee schedule,APG 00412 Proc 94618 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 100% = $79.90... $79.90 at 103.1% = $82.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,SENTARA HEALTH,SENTARA HEALTH,157.96,,,,,,,10.3500,612.0000,percent of total billed charges,25.81% of $612.00 in Billed Charges for Rev 460 Proc 94618 = $157.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,SENTARA HEALTH,SENTARA MEDICARE,120.71,,,,,,,10.3500,612.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",612.00,,,,,,,10.3500,612.0000,percent of total billed charges,100% of $612.00 in Billed Charges for Rev 460 Proc 94618 = $612.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,52.52,,,,,,,10.3500,612.0000,fee schedule,$105.04 from Fee Schedule TCUHC24 for Rev 460 Proc 94618 * Qty 1 = $105.04 at 50% = $52.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,612.00,,,,,,,10.3500,612.0000,other,"Rev 460 Proc 94618 1 Visit at $860.00 per Visit = $860.00 (Service Line reduced to $612.00, claim capped at $612.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,612.00,,,,,,,10.3500,612.0000,other,"Rev 460 Proc 94618 1 Visit at $822.00 per Visit = $822.00 (Service Line reduced to $612.00, claim capped at $612.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,612.00,,,,,,,10.3500,612.0000,other,"Rev 460 Proc 94618 1 Visit at $1,353.00 per Visit = $1,353.00 (Service Line reduced to $612.00, claim capped at $612.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,82.29,,,,,,,10.3500,612.0000,fee schedule,APG 00412 Proc 94618 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 103% = $82.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,120.71,,,,,,,10.3500,612.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,120.71,,,,,,,10.3500,612.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,WELLCARE,WELLCARE MEDICAID,612.00,,,,,,,10.3500,612.0000,percent of total billed charges,100% of $612.00 in Billed Charges for Rev 460 Proc 94618 = $612.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PULM STRESS TESTING,94618,CPT,460,RC,46000019,CDM,,,,both,,,612.0000,91.8000,WELLCARE,WELLCARE MEDICARE,127.95,,,,,,,10.3500,612.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,AETNA,AETNA,280.54,,,,,,,14.5300,657.0000,percent of total billed charges,42.7% of $657.00 in Billed Charges for Rev 410 Proc 94640 = $280.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,83.09,,,,,,,14.5300,657.0000,fee schedule,APG 00412 Proc 94640 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 104% = $83.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,198.67,,,,,,,14.5300,657.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,AETNA,AETNA HEALTHCARE MEDICARE,198.67,,,,,,,14.5300,657.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,198.67,,,,,,,14.5300,657.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,AMBETTER,AMBETTER,433.11,,,,,,,14.5300,657.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,206.62,,,,,,,14.5300,657.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,BLUE CROSS,ANTHEM EXCHANGE,489.14,,,,,,,14.5300,657.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,82.29,,,,,,,14.5300,657.0000,fee schedule,APG 00412 Proc 94640 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 103% = $82.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,BLUE CROSS,ANTHEM HMO,519.68,,,,,,,14.5300,657.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,204.63,,,,,,,14.5300,657.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",611.36,,,,,,,14.5300,657.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,16.11,,,,,,,14.5300,657.0000,fee schedule,$16.11 from Fee Schedule BLDTM_23 for Rev 410 Proc 94640 * Qty 1 = $16.11 at 100% = $16.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,BLUE CROSS,BLUE CROSS E NETWORK,70.94,,,,,,,14.5300,657.0000,fee schedule,$16.27 from Fee Schedule BCFSG for Rev 410 Proc 94640 * Qty 1 = $16.27 at 436% = $70.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,BLUE CROSS,BLUE CROSS MEDICARE,206.62,,,,,,,14.5300,657.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,BLUE CROSS,BLUE CROSS P NETWORK,72.40,,,,,,,14.5300,657.0000,fee schedule,$16.27 from Fee Schedule BCFSG for Rev 410 Proc 94640 * Qty 1 = $16.27 at 445% = $72.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,BLUE CROSS,BLUE CROSS S NETWORK,72.40,,,,,,,14.5300,657.0000,fee schedule,$16.27 from Fee Schedule BCFSG for Rev 410 Proc 94640 * Qty 1 = $16.27 at 445% = $72.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,BLUE CROSS,TENNCARE BLUE CARE,14.53,,,,,,,14.5300,657.0000,fee schedule,$12.53 from Fee Schedule TC_24 for Rev 410 Proc 94640 * Qty 1 = $12.53 at 116% = $14.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,BLUE CROSS,TENNCARE BLUE SELECT,14.53,,,,,,,14.5300,657.0000,fee schedule,$12.53 from Fee Schedule TC_24 for Rev 410 Proc 94640 * Qty 1 = $12.53 at 116% = $14.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,CIGNA HEALTHCARE,CIGNA HMO,273.97,,,,,,,14.5300,657.0000,percent of total billed charges,41.7% of $657.00 in Billed Charges for Rev 410 Proc 94640 = $273.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,304.85,,,,,,,14.5300,657.0000,percent of total billed charges,46.4% of $657.00 in Billed Charges for Rev 410 Proc 94640 = $304.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,208.61,,,,,,,14.5300,657.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,273.97,,,,,,,14.5300,657.0000,percent of total billed charges,41.7% of $657.00 in Billed Charges for Rev 410 Proc 94640 = $273.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,CIGNA HEALTHCARE,CIGNA PPO,273.97,,,,,,,14.5300,657.0000,percent of total billed charges,41.7% of $657.00 in Billed Charges for Rev 410 Proc 94640 = $273.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,208.61,,,,,,,14.5300,657.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,591.30,,,,,,,14.5300,657.0000,percent of total billed charges,90% of $657.00 in Billed Charges for Rev 410 Proc 94640 = $591.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,HUMANA,HUMANA MEDICARE,198.67,,,,,,,14.5300,657.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,198.67,,,,,,,14.5300,657.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,MEDCOST,MEDCOST VHN,312.67,,,,,,,14.5300,657.0000,percent of total billed charges,47.59% of $657.00 in Billed Charges for Rev 410 Proc 94640 = $312.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,83.90,,,,,,,14.5300,657.0000,fee schedule,APG 00412 Proc 94640 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 100% = $79.90... $79.90 at 105% = $83.90 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,208.61,,,,,,,14.5300,657.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,208.61,,,,,,,14.5300,657.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,NHC ADVANTAGE,NHC ADVANTAGE,208.61,,,,,,,14.5300,657.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,82.38,,,,,,,14.5300,657.0000,fee schedule,APG 00412 Proc 94640 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 100% = $79.90... $79.90 at 103.1% = $82.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,SENTARA HEALTH,SENTARA HEALTH,169.57,,,,,,,14.5300,657.0000,percent of total billed charges,25.81% of $657.00 in Billed Charges for Rev 410 Proc 94640 = $169.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,SENTARA HEALTH,SENTARA MEDICARE,198.67,,,,,,,14.5300,657.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",657.00,,,,,,,14.5300,657.0000,percent of total billed charges,100% of $657.00 in Billed Charges for Rev 410 Proc 94640 = $657.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14.86,,,,,,,14.5300,657.0000,fee schedule,$29.71 from Fee Schedule TCUHC24 for Rev 410 Proc 94640 * Qty 1 = $29.71 at 50% = $14.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,112.00,,,,,,,14.5300,657.0000,other,Rev 410 Proc 94640 1 Visit at $112.00 per Visit = $112.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,106.00,,,,,,,14.5300,657.0000,other,Rev 410 Proc 94640 1 Visit at $106.00 per Visit = $106.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,175.00,,,,,,,14.5300,657.0000,other,Rev 410 Proc 94640 1 Visit at $175.00 per Visit = $175.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,82.29,,,,,,,14.5300,657.0000,fee schedule,APG 00412 Proc 94640 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 103% = $82.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,198.67,,,,,,,14.5300,657.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,198.67,,,,,,,14.5300,657.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,WELLCARE,WELLCARE MEDICAID,657.00,,,,,,,14.5300,657.0000,percent of total billed charges,100% of $657.00 in Billed Charges for Rev 410 Proc 94640 = $657.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL OR VAPOR INHALAT TX INIT,94640,CPT,410,RC,41000004,CDM,,,,both,,,657.0000,98.5500,WELLCARE,WELLCARE MEDICARE,210.59,,,,,,,14.5300,657.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,AETNA,AETNA,171.65,,,,,,,14.5300,433.1100,percent of total billed charges,42.7% of $402.00 in Billed Charges for Rev 410 Proc 94640 Mod 76 = $171.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,83.09,,,,,,,14.5300,433.1100,fee schedule,APG 00412 Proc 94640 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 104% = $83.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,198.67,,,,,,,14.5300,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,AETNA,AETNA HEALTHCARE MEDICARE,198.67,,,,,,,14.5300,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,198.67,,,,,,,14.5300,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,AMBETTER,AMBETTER,433.11,,,,,,,14.5300,433.1100,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,206.62,,,,,,,14.5300,433.1100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,BLUE CROSS,ANTHEM EXCHANGE,402.00,,,,,,,14.5300,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,82.29,,,,,,,14.5300,433.1100,fee schedule,APG 00412 Proc 94640 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 103% = $82.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,BLUE CROSS,ANTHEM HMO,402.00,,,,,,,14.5300,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,204.63,,,,,,,14.5300,433.1100,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",402.00,,,,,,,14.5300,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,16.11,,,,,,,14.5300,433.1100,fee schedule,$16.11 from Fee Schedule BLDTM_23 for Rev 410 Proc 94640 Mod 76 * Qty 1 = $16.11 at 100% = $16.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,BLUE CROSS,BLUE CROSS E NETWORK,70.94,,,,,,,14.5300,433.1100,fee schedule,$16.27 from Fee Schedule BCFSG for Rev 410 Proc 94640 Mod 76 * Qty 1 = $16.27 at 436% = $70.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,BLUE CROSS,BLUE CROSS MEDICARE,206.62,,,,,,,14.5300,433.1100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,BLUE CROSS,BLUE CROSS P NETWORK,72.40,,,,,,,14.5300,433.1100,fee schedule,$16.27 from Fee Schedule BCFSG for Rev 410 Proc 94640 Mod 76 * Qty 1 = $16.27 at 445% = $72.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,BLUE CROSS,BLUE CROSS S NETWORK,72.40,,,,,,,14.5300,433.1100,fee schedule,$16.27 from Fee Schedule BCFSG for Rev 410 Proc 94640 Mod 76 * Qty 1 = $16.27 at 445% = $72.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,BLUE CROSS,TENNCARE BLUE CARE,14.53,,,,,,,14.5300,433.1100,fee schedule,$12.53 from Fee Schedule TC_24 for Rev 410 Proc 94640 Mod 76 * Qty 1 = $12.53 at 116% = $14.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,BLUE CROSS,TENNCARE BLUE SELECT,14.53,,,,,,,14.5300,433.1100,fee schedule,$12.53 from Fee Schedule TC_24 for Rev 410 Proc 94640 Mod 76 * Qty 1 = $12.53 at 116% = $14.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,CIGNA HEALTHCARE,CIGNA HMO,167.63,,,,,,,14.5300,433.1100,percent of total billed charges,41.7% of $402.00 in Billed Charges for Rev 410 Proc 94640 Mod 76 = $167.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,186.53,,,,,,,14.5300,433.1100,percent of total billed charges,46.4% of $402.00 in Billed Charges for Rev 410 Proc 94640 Mod 76 = $186.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,208.61,,,,,,,14.5300,433.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,167.63,,,,,,,14.5300,433.1100,percent of total billed charges,41.7% of $402.00 in Billed Charges for Rev 410 Proc 94640 Mod 76 = $167.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,CIGNA HEALTHCARE,CIGNA PPO,167.63,,,,,,,14.5300,433.1100,percent of total billed charges,41.7% of $402.00 in Billed Charges for Rev 410 Proc 94640 Mod 76 = $167.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,208.61,,,,,,,14.5300,433.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,361.80,,,,,,,14.5300,433.1100,percent of total billed charges,90% of $402.00 in Billed Charges for Rev 410 Proc 94640 Mod 76 = $361.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,HUMANA,HUMANA MEDICARE,198.67,,,,,,,14.5300,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,198.67,,,,,,,14.5300,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,MEDCOST,MEDCOST VHN,191.31,,,,,,,14.5300,433.1100,percent of total billed charges,47.59% of $402.00 in Billed Charges for Rev 410 Proc 94640 Mod 76 = $191.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,83.90,,,,,,,14.5300,433.1100,fee schedule,APG 00412 Proc 94640 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 100% = $79.90... $79.90 at 105% = $83.90 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,208.61,,,,,,,14.5300,433.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,208.61,,,,,,,14.5300,433.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,NHC ADVANTAGE,NHC ADVANTAGE,208.61,,,,,,,14.5300,433.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,82.38,,,,,,,14.5300,433.1100,fee schedule,APG 00412 Proc 94640 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 100% = $79.90... $79.90 at 103.1% = $82.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,SENTARA HEALTH,SENTARA HEALTH,103.76,,,,,,,14.5300,433.1100,percent of total billed charges,25.81% of $402.00 in Billed Charges for Rev 410 Proc 94640 Mod 76 = $103.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,SENTARA HEALTH,SENTARA MEDICARE,198.67,,,,,,,14.5300,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",402.00,,,,,,,14.5300,433.1100,percent of total billed charges,100% of $402.00 in Billed Charges for Rev 410 Proc 94640 Mod 76 = $402.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14.86,,,,,,,14.5300,433.1100,fee schedule,$29.71 from Fee Schedule TCUHC24 for Rev 410 Proc 94640 Mod 76 * Qty 1 = $29.71 at 50% = $14.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,112.00,,,,,,,14.5300,433.1100,other,Rev 410 Proc 94640 Mod 76 1 Visit at $112.00 per Visit = $112.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,106.00,,,,,,,14.5300,433.1100,other,Rev 410 Proc 94640 Mod 76 1 Visit at $106.00 per Visit = $106.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,175.00,,,,,,,14.5300,433.1100,other,Rev 410 Proc 94640 Mod 76 1 Visit at $175.00 per Visit = $175.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,82.29,,,,,,,14.5300,433.1100,fee schedule,APG 00412 Proc 94640 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 103% = $82.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,198.67,,,,,,,14.5300,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,198.67,,,,,,,14.5300,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,WELLCARE,WELLCARE MEDICAID,402.00,,,,,,,14.5300,433.1100,percent of total billed charges,100% of $402.00 in Billed Charges for Rev 410 Proc 94640 Mod 76 = $402.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL OR VAPOR INHALAT TX SUBS,94640,CPT,410,RC,41000005,CDM,,,76,both,,,402.0000,60.3000,WELLCARE,WELLCARE MEDICARE,210.59,,,,,,,14.5300,433.1100,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SHUNT LOFTUS INTERNAL SMALL SHUNT 3.3MM X 15CM,272,RC,,,,,,,,both,,,2700.3000,405.0500,AETNA,AETNA,1153.03,,,,,,,696.9500,2700.3000,percent of total billed charges,"42.7% of $2,700.30 in Billed Charges for Rev 272 = $1,153.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT LOFTUS INTERNAL SMALL SHUNT 3.3MM X 15CM,272,RC,,,,,,,,both,,,2700.3000,405.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1890.21,,,,,,,696.9500,2700.3000,percent of total billed charges,"Rev 272 $2,700.30 in Billed Charges at 70% = $1,890.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT LOFTUS INTERNAL SMALL SHUNT 3.3MM X 15CM,272,RC,,,,,,,,both,,,2700.3000,405.0500,CIGNA HEALTHCARE,CIGNA HMO,1126.03,,,,,,,696.9500,2700.3000,percent of total billed charges,"41.7% of $2,700.30 in Billed Charges for Rev 272 = $1,126.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT LOFTUS INTERNAL SMALL SHUNT 3.3MM X 15CM,272,RC,,,,,,,,both,,,2700.3000,405.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1252.94,,,,,,,696.9500,2700.3000,percent of total billed charges,"46.4% of $2,700.30 in Billed Charges for Rev 272 = $1,252.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT LOFTUS INTERNAL SMALL SHUNT 3.3MM X 15CM,272,RC,,,,,,,,both,,,2700.3000,405.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1126.03,,,,,,,696.9500,2700.3000,percent of total billed charges,"41.7% of $2,700.30 in Billed Charges for Rev 272 = $1,126.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT LOFTUS INTERNAL SMALL SHUNT 3.3MM X 15CM,272,RC,,,,,,,,both,,,2700.3000,405.0500,CIGNA HEALTHCARE,CIGNA PPO,1126.03,,,,,,,696.9500,2700.3000,percent of total billed charges,"41.7% of $2,700.30 in Billed Charges for Rev 272 = $1,126.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT LOFTUS INTERNAL SMALL SHUNT 3.3MM X 15CM,272,RC,,,,,,,,both,,,2700.3000,405.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2430.27,,,,,,,696.9500,2700.3000,percent of total billed charges,"90% of $2,700.30 in Billed Charges for Rev 272 = $2,430.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT LOFTUS INTERNAL SMALL SHUNT 3.3MM X 15CM,272,RC,,,,,,,,both,,,2700.3000,405.0500,MEDCOST,MEDCOST VHN,1285.07,,,,,,,696.9500,2700.3000,percent of total billed charges,"47.59% of $2,700.30 in Billed Charges for Rev 272 = $1,285.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT LOFTUS INTERNAL SMALL SHUNT 3.3MM X 15CM,272,RC,,,,,,,,both,,,2700.3000,405.0500,SENTARA HEALTH,SENTARA HEALTH,696.95,,,,,,,696.9500,2700.3000,percent of total billed charges,"25.81% of $2,700.30 in Billed Charges for Rev 272 = $696.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT LOFTUS INTERNAL SMALL SHUNT 3.3MM X 15CM,272,RC,,,,,,,,both,,,2700.3000,405.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2700.30,,,,,,,696.9500,2700.3000,percent of total billed charges,"100% of $2,700.30 in Billed Charges for Rev 272 = $2,700.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT LOFTUS INTERNAL SMALL SHUNT 3.3MM X 15CM,272,RC,,,,,,,,both,,,2700.3000,405.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1350.15,,,,,,,696.9500,2700.3000,percent of total billed charges,"Rev 272 $2,700.30 in Billed Charges at 50% = $1,350.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT LOFTUS INTERNAL SMALL SHUNT 3.3MM X 15CM,272,RC,,,,,,,,both,,,2700.3000,405.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,872.20,,,,,,,696.9500,2700.3000,other,"32.3% of $2,700.30 in Billed Charges for Rev 272 = $872.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHUNT LOFTUS INTERNAL SMALL SHUNT 3.3MM X 15CM,272,RC,,,,,,,,both,,,2700.3000,405.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,828.99,,,,,,,696.9500,2700.3000,other,"30.7% of $2,700.30 in Billed Charges for Rev 272 = $828.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHUNT LOFTUS INTERNAL SMALL SHUNT 3.3MM X 15CM,272,RC,,,,,,,,both,,,2700.3000,405.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,872.20,,,,,,,696.9500,2700.3000,percent of total billed charges,"32.3% of $2,700.30 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT LOFTUS INTERNAL SMALL SHUNT 3.3MM X 15CM,272,RC,,,,,,,,both,,,2700.3000,405.0500,WELLCARE,WELLCARE MEDICAID,2700.30,,,,,,,696.9500,2700.3000,percent of total billed charges,"100% of $2,700.30 in Billed Charges for Rev 272 = $2,700.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUTTLE 25 DEGREES LEFT,272,RC,,,,,,,,both,,,3920.2400,588.0400,AETNA,AETNA,1673.94,,,,,,,1011.8100,3920.2400,percent of total billed charges,"42.7% of $3,920.24 in Billed Charges for Rev 272 = $1,673.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUTTLE 25 DEGREES LEFT,272,RC,,,,,,,,both,,,3920.2400,588.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2744.17,,,,,,,1011.8100,3920.2400,percent of total billed charges,"Rev 272 $3,920.24 in Billed Charges at 70% = $2,744.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUTTLE 25 DEGREES LEFT,272,RC,,,,,,,,both,,,3920.2400,588.0400,CIGNA HEALTHCARE,CIGNA HMO,1634.74,,,,,,,1011.8100,3920.2400,percent of total billed charges,"41.7% of $3,920.24 in Billed Charges for Rev 272 = $1,634.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUTTLE 25 DEGREES LEFT,272,RC,,,,,,,,both,,,3920.2400,588.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1818.99,,,,,,,1011.8100,3920.2400,percent of total billed charges,"46.4% of $3,920.24 in Billed Charges for Rev 272 = $1,818.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUTTLE 25 DEGREES LEFT,272,RC,,,,,,,,both,,,3920.2400,588.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1634.74,,,,,,,1011.8100,3920.2400,percent of total billed charges,"41.7% of $3,920.24 in Billed Charges for Rev 272 = $1,634.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUTTLE 25 DEGREES LEFT,272,RC,,,,,,,,both,,,3920.2400,588.0400,CIGNA HEALTHCARE,CIGNA PPO,1634.74,,,,,,,1011.8100,3920.2400,percent of total billed charges,"41.7% of $3,920.24 in Billed Charges for Rev 272 = $1,634.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUTTLE 25 DEGREES LEFT,272,RC,,,,,,,,both,,,3920.2400,588.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3528.22,,,,,,,1011.8100,3920.2400,percent of total billed charges,"90% of $3,920.24 in Billed Charges for Rev 272 = $3,528.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUTTLE 25 DEGREES LEFT,272,RC,,,,,,,,both,,,3920.2400,588.0400,MEDCOST,MEDCOST VHN,1865.64,,,,,,,1011.8100,3920.2400,percent of total billed charges,"47.59% of $3,920.24 in Billed Charges for Rev 272 = $1,865.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUTTLE 25 DEGREES LEFT,272,RC,,,,,,,,both,,,3920.2400,588.0400,SENTARA HEALTH,SENTARA HEALTH,1011.81,,,,,,,1011.8100,3920.2400,percent of total billed charges,"25.81% of $3,920.24 in Billed Charges for Rev 272 = $1,011.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUTTLE 25 DEGREES LEFT,272,RC,,,,,,,,both,,,3920.2400,588.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3920.24,,,,,,,1011.8100,3920.2400,percent of total billed charges,"100% of $3,920.24 in Billed Charges for Rev 272 = $3,920.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUTTLE 25 DEGREES LEFT,272,RC,,,,,,,,both,,,3920.2400,588.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1960.12,,,,,,,1011.8100,3920.2400,percent of total billed charges,"Rev 272 $3,920.24 in Billed Charges at 50% = $1,960.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUTTLE 25 DEGREES LEFT,272,RC,,,,,,,,both,,,3920.2400,588.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1266.24,,,,,,,1011.8100,3920.2400,other,"32.3% of $3,920.24 in Billed Charges for Rev 272 = $1,266.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHUTTLE 25 DEGREES LEFT,272,RC,,,,,,,,both,,,3920.2400,588.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1203.51,,,,,,,1011.8100,3920.2400,other,"30.7% of $3,920.24 in Billed Charges for Rev 272 = $1,203.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHUTTLE 25 DEGREES LEFT,272,RC,,,,,,,,both,,,3920.2400,588.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,1266.24,,,,,,,1011.8100,3920.2400,percent of total billed charges,"32.3% of $3,920.24 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUTTLE 25 DEGREES LEFT,272,RC,,,,,,,,both,,,3920.2400,588.0400,WELLCARE,WELLCARE MEDICAID,3920.24,,,,,,,1011.8100,3920.2400,percent of total billed charges,"100% of $3,920.24 in Billed Charges for Rev 272 = $3,920.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,AETNA,AETNA,152.44,,,,,,,49.4000,433.1100,percent of total billed charges,42.7% of $357.00 in Billed Charges for Rev 410 Proc 94642 = $152.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,83.09,,,,,,,49.4000,433.1100,fee schedule,APG 00412 Proc 94642 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 104% = $83.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,198.67,,,,,,,49.4000,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,AETNA,AETNA HEALTHCARE MEDICARE,198.67,,,,,,,49.4000,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,198.67,,,,,,,49.4000,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,AMBETTER,AMBETTER,433.11,,,,,,,49.4000,433.1100,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,206.62,,,,,,,49.4000,433.1100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,BLUE CROSS,ANTHEM EXCHANGE,357.00,,,,,,,49.4000,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,82.29,,,,,,,49.4000,433.1100,fee schedule,APG 00412 Proc 94642 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 103% = $82.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,BLUE CROSS,ANTHEM HMO,357.00,,,,,,,49.4000,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,204.63,,,,,,,49.4000,433.1100,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",357.00,,,,,,,49.4000,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,79.13,,,,,,,49.4000,433.1100,fee schedule,$79.13 from Fee Schedule BLDTM_23 for Rev 410 Proc 94642 * Qty 1 = $79.13 at 100% = $79.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,BLUE CROSS,BLUE CROSS E NETWORK,97.49,,,,,,,49.4000,433.1100,fee schedule,$22.36 from Fee Schedule BCFSG for Rev 410 Proc 94642 * Qty 1 = $22.36 at 436% = $97.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,BLUE CROSS,BLUE CROSS MEDICARE,206.62,,,,,,,49.4000,433.1100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,BLUE CROSS,BLUE CROSS P NETWORK,99.50,,,,,,,49.4000,433.1100,fee schedule,$22.36 from Fee Schedule BCFSG for Rev 410 Proc 94642 * Qty 1 = $22.36 at 445% = $99.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,BLUE CROSS,BLUE CROSS S NETWORK,99.50,,,,,,,49.4000,433.1100,fee schedule,$22.36 from Fee Schedule BCFSG for Rev 410 Proc 94642 * Qty 1 = $22.36 at 445% = $99.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,BLUE CROSS,TENNCARE BLUE CARE,130.67,,,,,,,49.4000,433.1100,fee schedule,$112.65 from Fee Schedule TC_24 for Rev 410 Proc 94642 * Qty 1 = $112.65 at 116% = $130.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,BLUE CROSS,TENNCARE BLUE SELECT,130.67,,,,,,,49.4000,433.1100,fee schedule,$112.65 from Fee Schedule TC_24 for Rev 410 Proc 94642 * Qty 1 = $112.65 at 116% = $130.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,CIGNA HEALTHCARE,CIGNA HMO,148.87,,,,,,,49.4000,433.1100,percent of total billed charges,41.7% of $357.00 in Billed Charges for Rev 410 Proc 94642 = $148.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,165.65,,,,,,,49.4000,433.1100,percent of total billed charges,46.4% of $357.00 in Billed Charges for Rev 410 Proc 94642 = $165.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,208.61,,,,,,,49.4000,433.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,148.87,,,,,,,49.4000,433.1100,percent of total billed charges,41.7% of $357.00 in Billed Charges for Rev 410 Proc 94642 = $148.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,CIGNA HEALTHCARE,CIGNA PPO,148.87,,,,,,,49.4000,433.1100,percent of total billed charges,41.7% of $357.00 in Billed Charges for Rev 410 Proc 94642 = $148.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,208.61,,,,,,,49.4000,433.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,321.30,,,,,,,49.4000,433.1100,percent of total billed charges,90% of $357.00 in Billed Charges for Rev 410 Proc 94642 = $321.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,HUMANA,HUMANA MEDICARE,198.67,,,,,,,49.4000,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,198.67,,,,,,,49.4000,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,MEDCOST,MEDCOST VHN,169.90,,,,,,,49.4000,433.1100,percent of total billed charges,47.59% of $357.00 in Billed Charges for Rev 410 Proc 94642 = $169.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,83.90,,,,,,,49.4000,433.1100,fee schedule,APG 00412 Proc 94642 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 100% = $79.90... $79.90 at 105% = $83.90 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,208.61,,,,,,,49.4000,433.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,208.61,,,,,,,49.4000,433.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,NHC ADVANTAGE,NHC ADVANTAGE,208.61,,,,,,,49.4000,433.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,82.38,,,,,,,49.4000,433.1100,fee schedule,APG 00412 Proc 94642 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 100% = $79.90... $79.90 at 103.1% = $82.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,SENTARA HEALTH,SENTARA HEALTH,92.14,,,,,,,49.4000,433.1100,percent of total billed charges,25.81% of $357.00 in Billed Charges for Rev 410 Proc 94642 = $92.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,SENTARA HEALTH,SENTARA MEDICARE,198.67,,,,,,,49.4000,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",357.00,,,,,,,49.4000,433.1100,percent of total billed charges,100% of $357.00 in Billed Charges for Rev 410 Proc 94642 = $357.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,49.40,,,,,,,49.4000,433.1100,fee schedule,$98.80 from Fee Schedule TCUHC24 for Rev 410 Proc 94642 * Qty 1 = $98.80 at 50% = $49.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,112.00,,,,,,,49.4000,433.1100,other,Rev 410 Proc 94642 1 Visit at $112.00 per Visit = $112.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,106.00,,,,,,,49.4000,433.1100,other,Rev 410 Proc 94642 1 Visit at $106.00 per Visit = $106.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,175.00,,,,,,,49.4000,433.1100,other,Rev 410 Proc 94642 1 Visit at $175.00 per Visit = $175.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,82.29,,,,,,,49.4000,433.1100,fee schedule,APG 00412 Proc 94642 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 103% = $82.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,198.67,,,,,,,49.4000,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,198.67,,,,,,,49.4000,433.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,WELLCARE,WELLCARE MEDICAID,357.00,,,,,,,49.4000,433.1100,percent of total billed charges,100% of $357.00 in Billed Charges for Rev 410 Proc 94642 = $357.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AEROSOL INHALATION PENTAMIDINE,94642,CPT,410,RC,41000006,CDM,,,,both,,,357.0000,53.5500,WELLCARE,WELLCARE MEDICARE,210.59,,,,,,,49.4000,433.1100,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,AETNA,AETNA,123.83,,,,,,,22.8200,290.0000,percent of total billed charges,42.7% of $290.00 in Billed Charges for Rev 410 Proc 94644 = $123.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,83.09,,,,,,,22.8200,290.0000,fee schedule,APG 00412 Proc 94644 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 104% = $83.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,120.71,,,,,,,22.8200,290.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,AETNA,AETNA HEALTHCARE MEDICARE,120.71,,,,,,,22.8200,290.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,120.71,,,,,,,22.8200,290.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,AMBETTER,AMBETTER,263.15,,,,,,,22.8200,290.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,125.54,,,,,,,22.8200,290.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,BLUE CROSS,ANTHEM EXCHANGE,290.00,,,,,,,22.8200,290.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,82.29,,,,,,,22.8200,290.0000,fee schedule,APG 00412 Proc 94644 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 103% = $82.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,BLUE CROSS,ANTHEM HMO,290.00,,,,,,,22.8200,290.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,124.33,,,,,,,22.8200,290.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",290.00,,,,,,,22.8200,290.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,31.19,,,,,,,22.8200,290.0000,fee schedule,$31.19 from Fee Schedule BLDTM_23 for Rev 410 Proc 94644 * Qty 1 = $31.19 at 100% = $31.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,BLUE CROSS,BLUE CROSS E NETWORK,212.51,,,,,,,22.8200,290.0000,fee schedule,$48.74 from Fee Schedule BCFSG for Rev 410 Proc 94644 * Qty 1 = $48.74 at 436% = $212.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,BLUE CROSS,BLUE CROSS MEDICARE,125.54,,,,,,,22.8200,290.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,BLUE CROSS,BLUE CROSS P NETWORK,216.89,,,,,,,22.8200,290.0000,fee schedule,$48.74 from Fee Schedule BCFSG for Rev 410 Proc 94644 * Qty 1 = $48.74 at 445% = $216.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,BLUE CROSS,BLUE CROSS S NETWORK,216.89,,,,,,,22.8200,290.0000,fee schedule,$48.74 from Fee Schedule BCFSG for Rev 410 Proc 94644 * Qty 1 = $48.74 at 445% = $216.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,BLUE CROSS,TENNCARE BLUE CARE,31.52,,,,,,,22.8200,290.0000,fee schedule,$27.17 from Fee Schedule TC_24 for Rev 410 Proc 94644 * Qty 1 = $27.17 at 116% = $31.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,BLUE CROSS,TENNCARE BLUE SELECT,31.52,,,,,,,22.8200,290.0000,fee schedule,$27.17 from Fee Schedule TC_24 for Rev 410 Proc 94644 * Qty 1 = $27.17 at 116% = $31.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,CIGNA HEALTHCARE,CIGNA HMO,120.93,,,,,,,22.8200,290.0000,percent of total billed charges,41.7% of $290.00 in Billed Charges for Rev 410 Proc 94644 = $120.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,134.56,,,,,,,22.8200,290.0000,percent of total billed charges,46.4% of $290.00 in Billed Charges for Rev 410 Proc 94644 = $134.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,126.75,,,,,,,22.8200,290.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,120.93,,,,,,,22.8200,290.0000,percent of total billed charges,41.7% of $290.00 in Billed Charges for Rev 410 Proc 94644 = $120.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,CIGNA HEALTHCARE,CIGNA PPO,120.93,,,,,,,22.8200,290.0000,percent of total billed charges,41.7% of $290.00 in Billed Charges for Rev 410 Proc 94644 = $120.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,126.75,,,,,,,22.8200,290.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,261.00,,,,,,,22.8200,290.0000,percent of total billed charges,90% of $290.00 in Billed Charges for Rev 410 Proc 94644 = $261.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,HUMANA,HUMANA MEDICARE,120.71,,,,,,,22.8200,290.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,120.71,,,,,,,22.8200,290.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,MEDCOST,MEDCOST VHN,138.01,,,,,,,22.8200,290.0000,percent of total billed charges,47.59% of $290.00 in Billed Charges for Rev 410 Proc 94644 = $138.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,83.90,,,,,,,22.8200,290.0000,fee schedule,APG 00412 Proc 94644 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 100% = $79.90... $79.90 at 105% = $83.90 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,126.75,,,,,,,22.8200,290.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,126.75,,,,,,,22.8200,290.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,NHC ADVANTAGE,NHC ADVANTAGE,126.75,,,,,,,22.8200,290.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,82.38,,,,,,,22.8200,290.0000,fee schedule,APG 00412 Proc 94644 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 100% = $79.90... $79.90 at 103.1% = $82.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,SENTARA HEALTH,SENTARA HEALTH,74.85,,,,,,,22.8200,290.0000,percent of total billed charges,25.81% of $290.00 in Billed Charges for Rev 410 Proc 94644 = $74.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,SENTARA HEALTH,SENTARA MEDICARE,120.71,,,,,,,22.8200,290.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",290.00,,,,,,,22.8200,290.0000,percent of total billed charges,100% of $290.00 in Billed Charges for Rev 410 Proc 94644 = $290.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.82,,,,,,,22.8200,290.0000,fee schedule,$45.64 from Fee Schedule TCUHC24 for Rev 410 Proc 94644 * Qty 1 = $45.64 at 50% = $22.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,112.00,,,,,,,22.8200,290.0000,other,Rev 410 Proc 94644 1 Visit at $112.00 per Visit = $112.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,106.00,,,,,,,22.8200,290.0000,other,Rev 410 Proc 94644 1 Visit at $106.00 per Visit = $106.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,175.00,,,,,,,22.8200,290.0000,other,Rev 410 Proc 94644 1 Visit at $175.00 per Visit = $175.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,82.29,,,,,,,22.8200,290.0000,fee schedule,APG 00412 Proc 94644 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 103% = $82.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,120.71,,,,,,,22.8200,290.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,120.71,,,,,,,22.8200,290.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,WELLCARE,WELLCARE MEDICAID,290.00,,,,,,,22.8200,290.0000,percent of total billed charges,100% of $290.00 in Billed Charges for Rev 410 Proc 94644 = $290.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTINUOUS INHALATION TX 1ST HOUR,94644,CPT,410,RC,41000007,CDM,,,,both,,,290.0000,43.5000,WELLCARE,WELLCARE MEDICARE,127.95,,,,,,,22.8200,290.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,AETNA,AETNA,112.73,,,,,,,11.8200,264.0000,percent of total billed charges,42.7% of $264.00 in Billed Charges for Rev 410 Proc 94645 = $112.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,83.09,,,,,,,11.8200,264.0000,fee schedule,APG 00412 Proc 94645 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 104% = $83.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,82.29,,,,,,,11.8200,264.0000,fee schedule,APG 00412 Proc 94645 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 103% = $82.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11.82,,,,,,,11.8200,264.0000,fee schedule,$11.82 from Fee Schedule BLDTM_23 for Rev 410 Proc 94645 * Qty 1 = $11.82 at 100% = $11.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,BLUE CROSS,BLUE CROSS E NETWORK,65.71,,,,,,,11.8200,264.0000,fee schedule,$15.07 from Fee Schedule BCFSG for Rev 410 Proc 94645 * Qty 1 = $15.07 at 436% = $65.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,BLUE CROSS,BLUE CROSS P NETWORK,67.06,,,,,,,11.8200,264.0000,fee schedule,$15.07 from Fee Schedule BCFSG for Rev 410 Proc 94645 * Qty 1 = $15.07 at 445% = $67.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,BLUE CROSS,BLUE CROSS S NETWORK,67.06,,,,,,,11.8200,264.0000,fee schedule,$15.07 from Fee Schedule BCFSG for Rev 410 Proc 94645 * Qty 1 = $15.07 at 445% = $67.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,BLUE CROSS,TENNCARE BLUE CARE,11.95,,,,,,,11.8200,264.0000,fee schedule,$10.30 from Fee Schedule TC_24 for Rev 410 Proc 94645 * Qty 1 = $10.30 at 116% = $11.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,BLUE CROSS,TENNCARE BLUE SELECT,11.95,,,,,,,11.8200,264.0000,fee schedule,$10.30 from Fee Schedule TC_24 for Rev 410 Proc 94645 * Qty 1 = $10.30 at 116% = $11.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,CIGNA HEALTHCARE,CIGNA HMO,110.09,,,,,,,11.8200,264.0000,percent of total billed charges,41.7% of $264.00 in Billed Charges for Rev 410 Proc 94645 = $110.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,122.50,,,,,,,11.8200,264.0000,percent of total billed charges,46.4% of $264.00 in Billed Charges for Rev 410 Proc 94645 = $122.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,110.09,,,,,,,11.8200,264.0000,percent of total billed charges,41.7% of $264.00 in Billed Charges for Rev 410 Proc 94645 = $110.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,CIGNA HEALTHCARE,CIGNA PPO,110.09,,,,,,,11.8200,264.0000,percent of total billed charges,41.7% of $264.00 in Billed Charges for Rev 410 Proc 94645 = $110.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,237.60,,,,,,,11.8200,264.0000,percent of total billed charges,90% of $264.00 in Billed Charges for Rev 410 Proc 94645 = $237.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,MEDCOST,MEDCOST VHN,125.64,,,,,,,11.8200,264.0000,percent of total billed charges,47.59% of $264.00 in Billed Charges for Rev 410 Proc 94645 = $125.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,83.90,,,,,,,11.8200,264.0000,fee schedule,APG 00412 Proc 94645 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 100% = $79.90... $79.90 at 105% = $83.90 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,82.38,,,,,,,11.8200,264.0000,fee schedule,APG 00412 Proc 94645 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 100% = $79.90... $79.90 at 103.1% = $82.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,SENTARA HEALTH,SENTARA HEALTH,68.14,,,,,,,11.8200,264.0000,percent of total billed charges,25.81% of $264.00 in Billed Charges for Rev 410 Proc 94645 = $68.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",264.00,,,,,,,11.8200,264.0000,percent of total billed charges,100% of $264.00 in Billed Charges for Rev 410 Proc 94645 = $264.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.82,,,,,,,11.8200,264.0000,fee schedule,$45.64 from Fee Schedule TCUHC24 for Rev 410 Proc 94645 * Qty 1 = $45.64 at 50% = $22.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,112.00,,,,,,,11.8200,264.0000,other,Rev 410 Proc 94645 1 Visit at $112.00 per Visit = $112.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,106.00,,,,,,,11.8200,264.0000,other,Rev 410 Proc 94645 1 Visit at $106.00 per Visit = $106.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,175.00,,,,,,,11.8200,264.0000,other,Rev 410 Proc 94645 1 Visit at $175.00 per Visit = $175.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,82.29,,,,,,,11.8200,264.0000,fee schedule,APG 00412 Proc 94645 at $836.60 (Base Rate) * 0.0955 (Relative Weight) = $79.90 (Total Line Payment) at 103% = $82.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTINUOUS INHALATION TX EA AD HR,94645,CPT,410,RC,41000008,CDM,,,,both,,,264.0000,39.6000,WELLCARE,WELLCARE MEDICAID,264.00,,,,,,,11.8200,264.0000,percent of total billed charges,100% of $264.00 in Billed Charges for Rev 410 Proc 94645 = $264.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3642.0900,546.3100,AETNA,AETNA,1555.17,,,,,,,940.0200,3642.0900,percent of total billed charges,"42.7% of $3,642.09 in Billed Charges for Rev 272 = $1,555.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3642.0900,546.3100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2549.46,,,,,,,940.0200,3642.0900,percent of total billed charges,"Rev 272 $3,642.09 in Billed Charges at 70% = $2,549.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3642.0900,546.3100,CIGNA HEALTHCARE,CIGNA HMO,1518.75,,,,,,,940.0200,3642.0900,percent of total billed charges,"41.7% of $3,642.09 in Billed Charges for Rev 272 = $1,518.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3642.0900,546.3100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1689.93,,,,,,,940.0200,3642.0900,percent of total billed charges,"46.4% of $3,642.09 in Billed Charges for Rev 272 = $1,689.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3642.0900,546.3100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1518.75,,,,,,,940.0200,3642.0900,percent of total billed charges,"41.7% of $3,642.09 in Billed Charges for Rev 272 = $1,518.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3642.0900,546.3100,CIGNA HEALTHCARE,CIGNA PPO,1518.75,,,,,,,940.0200,3642.0900,percent of total billed charges,"41.7% of $3,642.09 in Billed Charges for Rev 272 = $1,518.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3642.0900,546.3100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3277.88,,,,,,,940.0200,3642.0900,percent of total billed charges,"90% of $3,642.09 in Billed Charges for Rev 272 = $3,277.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3642.0900,546.3100,MEDCOST,MEDCOST VHN,1733.27,,,,,,,940.0200,3642.0900,percent of total billed charges,"47.59% of $3,642.09 in Billed Charges for Rev 272 = $1,733.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3642.0900,546.3100,SENTARA HEALTH,SENTARA HEALTH,940.02,,,,,,,940.0200,3642.0900,percent of total billed charges,"25.81% of $3,642.09 in Billed Charges for Rev 272 = $940.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3642.0900,546.3100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3642.09,,,,,,,940.0200,3642.0900,percent of total billed charges,"100% of $3,642.09 in Billed Charges for Rev 272 = $3,642.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3642.0900,546.3100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1821.05,,,,,,,940.0200,3642.0900,percent of total billed charges,"Rev 272 $3,642.09 in Billed Charges at 50% = $1,821.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3642.0900,546.3100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1176.40,,,,,,,940.0200,3642.0900,other,"32.3% of $3,642.09 in Billed Charges for Rev 272 = $1,176.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3642.0900,546.3100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1118.12,,,,,,,940.0200,3642.0900,other,"30.7% of $3,642.09 in Billed Charges for Rev 272 = $1,118.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3642.0900,546.3100,UNITED HEALTHCARE,UNITED HEALTHCARE,1176.40,,,,,,,940.0200,3642.0900,percent of total billed charges,"32.3% of $3,642.09 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACL DISP SOFT TISSUE FIXATION,272,RC,,,,,,,,both,,,3642.0900,546.3100,WELLCARE,WELLCARE MEDICAID,3642.09,,,,,,,940.0200,3642.0900,percent of total billed charges,"100% of $3,642.09 in Billed Charges for Rev 272 = $3,642.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ARTERIOGRAM,272,RC,,,,,,,,both,,,696.9000,104.5400,AETNA,AETNA,297.58,,,,,,,179.8700,696.9000,percent of total billed charges,42.7% of $696.90 in Billed Charges for Rev 272 = $297.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ARTERIOGRAM,272,RC,,,,,,,,both,,,696.9000,104.5400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,487.83,,,,,,,179.8700,696.9000,percent of total billed charges,Rev 272 $696.90 in Billed Charges at 70% = $487.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ARTERIOGRAM,272,RC,,,,,,,,both,,,696.9000,104.5400,CIGNA HEALTHCARE,CIGNA HMO,290.61,,,,,,,179.8700,696.9000,percent of total billed charges,41.7% of $696.90 in Billed Charges for Rev 272 = $290.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ARTERIOGRAM,272,RC,,,,,,,,both,,,696.9000,104.5400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,323.36,,,,,,,179.8700,696.9000,percent of total billed charges,46.4% of $696.90 in Billed Charges for Rev 272 = $323.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ARTERIOGRAM,272,RC,,,,,,,,both,,,696.9000,104.5400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,290.61,,,,,,,179.8700,696.9000,percent of total billed charges,41.7% of $696.90 in Billed Charges for Rev 272 = $290.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ARTERIOGRAM,272,RC,,,,,,,,both,,,696.9000,104.5400,CIGNA HEALTHCARE,CIGNA PPO,290.61,,,,,,,179.8700,696.9000,percent of total billed charges,41.7% of $696.90 in Billed Charges for Rev 272 = $290.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ARTERIOGRAM,272,RC,,,,,,,,both,,,696.9000,104.5400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,627.21,,,,,,,179.8700,696.9000,percent of total billed charges,90% of $696.90 in Billed Charges for Rev 272 = $627.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ARTERIOGRAM,272,RC,,,,,,,,both,,,696.9000,104.5400,MEDCOST,MEDCOST VHN,331.65,,,,,,,179.8700,696.9000,percent of total billed charges,47.59% of $696.90 in Billed Charges for Rev 272 = $331.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ARTERIOGRAM,272,RC,,,,,,,,both,,,696.9000,104.5400,SENTARA HEALTH,SENTARA HEALTH,179.87,,,,,,,179.8700,696.9000,percent of total billed charges,25.81% of $696.90 in Billed Charges for Rev 272 = $179.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ARTERIOGRAM,272,RC,,,,,,,,both,,,696.9000,104.5400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",696.90,,,,,,,179.8700,696.9000,percent of total billed charges,100% of $696.90 in Billed Charges for Rev 272 = $696.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ARTERIOGRAM,272,RC,,,,,,,,both,,,696.9000,104.5400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,348.45,,,,,,,179.8700,696.9000,percent of total billed charges,Rev 272 $696.90 in Billed Charges at 50% = $348.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ARTERIOGRAM,272,RC,,,,,,,,both,,,696.9000,104.5400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,225.10,,,,,,,179.8700,696.9000,other,32.3% of $696.90 in Billed Charges for Rev 272 = $225.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK ARTERIOGRAM,272,RC,,,,,,,,both,,,696.9000,104.5400,UNITED HEALTHCARE,UHC HERITAGE SELECT,213.95,,,,,,,179.8700,696.9000,other,30.7% of $696.90 in Billed Charges for Rev 272 = $213.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK ARTERIOGRAM,272,RC,,,,,,,,both,,,696.9000,104.5400,UNITED HEALTHCARE,UNITED HEALTHCARE,225.10,,,,,,,179.8700,696.9000,percent of total billed charges,32.3% of $696.90 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK ARTERIOGRAM,272,RC,,,,,,,,both,,,696.9000,104.5400,WELLCARE,WELLCARE MEDICAID,696.90,,,,,,,179.8700,696.9000,percent of total billed charges,100% of $696.90 in Billed Charges for Rev 272 = $696.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BATTERY,272,RC,27200002,CDM,,,,,,both,,,871.6800,130.7500,AETNA,AETNA,372.21,,,,,,,224.9800,871.6800,percent of total billed charges,42.7% of $871.68 in Billed Charges for Rev 272 = $372.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BATTERY,272,RC,27200002,CDM,,,,,,both,,,871.6800,130.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,610.18,,,,,,,224.9800,871.6800,percent of total billed charges,Rev 272 $871.68 in Billed Charges at 70% = $610.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BATTERY,272,RC,27200002,CDM,,,,,,both,,,871.6800,130.7500,CIGNA HEALTHCARE,CIGNA HMO,363.49,,,,,,,224.9800,871.6800,percent of total billed charges,41.7% of $871.68 in Billed Charges for Rev 272 = $363.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BATTERY,272,RC,27200002,CDM,,,,,,both,,,871.6800,130.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,404.46,,,,,,,224.9800,871.6800,percent of total billed charges,46.4% of $871.68 in Billed Charges for Rev 272 = $404.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BATTERY,272,RC,27200002,CDM,,,,,,both,,,871.6800,130.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,363.49,,,,,,,224.9800,871.6800,percent of total billed charges,41.7% of $871.68 in Billed Charges for Rev 272 = $363.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BATTERY,272,RC,27200002,CDM,,,,,,both,,,871.6800,130.7500,CIGNA HEALTHCARE,CIGNA PPO,363.49,,,,,,,224.9800,871.6800,percent of total billed charges,41.7% of $871.68 in Billed Charges for Rev 272 = $363.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BATTERY,272,RC,27200002,CDM,,,,,,both,,,871.6800,130.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,784.51,,,,,,,224.9800,871.6800,percent of total billed charges,90% of $871.68 in Billed Charges for Rev 272 = $784.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BATTERY,272,RC,27200002,CDM,,,,,,both,,,871.6800,130.7500,MEDCOST,MEDCOST VHN,414.83,,,,,,,224.9800,871.6800,percent of total billed charges,47.59% of $871.68 in Billed Charges for Rev 272 = $414.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BATTERY,272,RC,27200002,CDM,,,,,,both,,,871.6800,130.7500,SENTARA HEALTH,SENTARA HEALTH,224.98,,,,,,,224.9800,871.6800,percent of total billed charges,25.81% of $871.68 in Billed Charges for Rev 272 = $224.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BATTERY,272,RC,27200002,CDM,,,,,,both,,,871.6800,130.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",871.68,,,,,,,224.9800,871.6800,percent of total billed charges,100% of $871.68 in Billed Charges for Rev 272 = $871.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BATTERY,272,RC,27200002,CDM,,,,,,both,,,871.6800,130.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,435.84,,,,,,,224.9800,871.6800,percent of total billed charges,Rev 272 $871.68 in Billed Charges at 50% = $435.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BATTERY,272,RC,27200002,CDM,,,,,,both,,,871.6800,130.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,281.55,,,,,,,224.9800,871.6800,other,32.3% of $871.68 in Billed Charges for Rev 272 = $281.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK BATTERY,272,RC,27200002,CDM,,,,,,both,,,871.6800,130.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,267.61,,,,,,,224.9800,871.6800,other,30.7% of $871.68 in Billed Charges for Rev 272 = $267.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK BATTERY,272,RC,27200002,CDM,,,,,,both,,,871.6800,130.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,281.55,,,,,,,224.9800,871.6800,percent of total billed charges,32.3% of $871.68 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BATTERY,272,RC,27200002,CDM,,,,,,both,,,871.6800,130.7500,WELLCARE,WELLCARE MEDICAID,871.68,,,,,,,224.9800,871.6800,percent of total billed charges,100% of $871.68 in Billed Charges for Rev 272 = $871.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL ARTHROSCOPY,272,RC,27200002,CDM,,,,,,both,,,678.2600,101.7400,AETNA,AETNA,289.62,,,,,,,175.0600,678.2600,percent of total billed charges,42.7% of $678.26 in Billed Charges for Rev 272 = $289.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL ARTHROSCOPY,272,RC,27200002,CDM,,,,,,both,,,678.2600,101.7400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,474.78,,,,,,,175.0600,678.2600,percent of total billed charges,Rev 272 $678.26 in Billed Charges at 70% = $474.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL ARTHROSCOPY,272,RC,27200002,CDM,,,,,,both,,,678.2600,101.7400,CIGNA HEALTHCARE,CIGNA HMO,282.83,,,,,,,175.0600,678.2600,percent of total billed charges,41.7% of $678.26 in Billed Charges for Rev 272 = $282.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL ARTHROSCOPY,272,RC,27200002,CDM,,,,,,both,,,678.2600,101.7400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,314.71,,,,,,,175.0600,678.2600,percent of total billed charges,46.4% of $678.26 in Billed Charges for Rev 272 = $314.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL ARTHROSCOPY,272,RC,27200002,CDM,,,,,,both,,,678.2600,101.7400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,282.83,,,,,,,175.0600,678.2600,percent of total billed charges,41.7% of $678.26 in Billed Charges for Rev 272 = $282.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL ARTHROSCOPY,272,RC,27200002,CDM,,,,,,both,,,678.2600,101.7400,CIGNA HEALTHCARE,CIGNA PPO,282.83,,,,,,,175.0600,678.2600,percent of total billed charges,41.7% of $678.26 in Billed Charges for Rev 272 = $282.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL ARTHROSCOPY,272,RC,27200002,CDM,,,,,,both,,,678.2600,101.7400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,610.43,,,,,,,175.0600,678.2600,percent of total billed charges,90% of $678.26 in Billed Charges for Rev 272 = $610.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL ARTHROSCOPY,272,RC,27200002,CDM,,,,,,both,,,678.2600,101.7400,MEDCOST,MEDCOST VHN,322.78,,,,,,,175.0600,678.2600,percent of total billed charges,47.59% of $678.26 in Billed Charges for Rev 272 = $322.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL ARTHROSCOPY,272,RC,27200002,CDM,,,,,,both,,,678.2600,101.7400,SENTARA HEALTH,SENTARA HEALTH,175.06,,,,,,,175.0600,678.2600,percent of total billed charges,25.81% of $678.26 in Billed Charges for Rev 272 = $175.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL ARTHROSCOPY,272,RC,27200002,CDM,,,,,,both,,,678.2600,101.7400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",678.26,,,,,,,175.0600,678.2600,percent of total billed charges,100% of $678.26 in Billed Charges for Rev 272 = $678.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL ARTHROSCOPY,272,RC,27200002,CDM,,,,,,both,,,678.2600,101.7400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,339.13,,,,,,,175.0600,678.2600,percent of total billed charges,Rev 272 $678.26 in Billed Charges at 50% = $339.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL ARTHROSCOPY,272,RC,27200002,CDM,,,,,,both,,,678.2600,101.7400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,219.08,,,,,,,175.0600,678.2600,other,32.3% of $678.26 in Billed Charges for Rev 272 = $219.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK BRISTOL ARTHROSCOPY,272,RC,27200002,CDM,,,,,,both,,,678.2600,101.7400,UNITED HEALTHCARE,UHC HERITAGE SELECT,208.23,,,,,,,175.0600,678.2600,other,30.7% of $678.26 in Billed Charges for Rev 272 = $208.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK BRISTOL ARTHROSCOPY,272,RC,27200002,CDM,,,,,,both,,,678.2600,101.7400,UNITED HEALTHCARE,UNITED HEALTHCARE,219.08,,,,,,,175.0600,678.2600,percent of total billed charges,32.3% of $678.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL ARTHROSCOPY,272,RC,27200002,CDM,,,,,,both,,,678.2600,101.7400,WELLCARE,WELLCARE MEDICAID,678.26,,,,,,,175.0600,678.2600,percent of total billed charges,100% of $678.26 in Billed Charges for Rev 272 = $678.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL C SECTION,272,RC,27200002,CDM,,,,,,both,,,1319.9200,197.9900,AETNA,AETNA,563.61,,,,,,,340.6700,1319.9200,percent of total billed charges,"42.7% of $1,319.92 in Billed Charges for Rev 272 = $563.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL C SECTION,272,RC,27200002,CDM,,,,,,both,,,1319.9200,197.9900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,923.94,,,,,,,340.6700,1319.9200,percent of total billed charges,"Rev 272 $1,319.92 in Billed Charges at 70% = $923.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL C SECTION,272,RC,27200002,CDM,,,,,,both,,,1319.9200,197.9900,CIGNA HEALTHCARE,CIGNA HMO,550.41,,,,,,,340.6700,1319.9200,percent of total billed charges,"41.7% of $1,319.92 in Billed Charges for Rev 272 = $550.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL C SECTION,272,RC,27200002,CDM,,,,,,both,,,1319.9200,197.9900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,612.44,,,,,,,340.6700,1319.9200,percent of total billed charges,"46.4% of $1,319.92 in Billed Charges for Rev 272 = $612.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL C SECTION,272,RC,27200002,CDM,,,,,,both,,,1319.9200,197.9900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,550.41,,,,,,,340.6700,1319.9200,percent of total billed charges,"41.7% of $1,319.92 in Billed Charges for Rev 272 = $550.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL C SECTION,272,RC,27200002,CDM,,,,,,both,,,1319.9200,197.9900,CIGNA HEALTHCARE,CIGNA PPO,550.41,,,,,,,340.6700,1319.9200,percent of total billed charges,"41.7% of $1,319.92 in Billed Charges for Rev 272 = $550.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL C SECTION,272,RC,27200002,CDM,,,,,,both,,,1319.9200,197.9900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1187.93,,,,,,,340.6700,1319.9200,percent of total billed charges,"90% of $1,319.92 in Billed Charges for Rev 272 = $1,187.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL C SECTION,272,RC,27200002,CDM,,,,,,both,,,1319.9200,197.9900,MEDCOST,MEDCOST VHN,628.15,,,,,,,340.6700,1319.9200,percent of total billed charges,"47.59% of $1,319.92 in Billed Charges for Rev 272 = $628.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL C SECTION,272,RC,27200002,CDM,,,,,,both,,,1319.9200,197.9900,SENTARA HEALTH,SENTARA HEALTH,340.67,,,,,,,340.6700,1319.9200,percent of total billed charges,"25.81% of $1,319.92 in Billed Charges for Rev 272 = $340.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL C SECTION,272,RC,27200002,CDM,,,,,,both,,,1319.9200,197.9900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1319.92,,,,,,,340.6700,1319.9200,percent of total billed charges,"100% of $1,319.92 in Billed Charges for Rev 272 = $1,319.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL C SECTION,272,RC,27200002,CDM,,,,,,both,,,1319.9200,197.9900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,659.96,,,,,,,340.6700,1319.9200,percent of total billed charges,"Rev 272 $1,319.92 in Billed Charges at 50% = $659.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL C SECTION,272,RC,27200002,CDM,,,,,,both,,,1319.9200,197.9900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,426.33,,,,,,,340.6700,1319.9200,other,"32.3% of $1,319.92 in Billed Charges for Rev 272 = $426.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK BRISTOL C SECTION,272,RC,27200002,CDM,,,,,,both,,,1319.9200,197.9900,UNITED HEALTHCARE,UHC HERITAGE SELECT,405.22,,,,,,,340.6700,1319.9200,other,"30.7% of $1,319.92 in Billed Charges for Rev 272 = $405.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK BRISTOL C SECTION,272,RC,27200002,CDM,,,,,,both,,,1319.9200,197.9900,UNITED HEALTHCARE,UNITED HEALTHCARE,426.33,,,,,,,340.6700,1319.9200,percent of total billed charges,"32.3% of $1,319.92 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL C SECTION,272,RC,27200002,CDM,,,,,,both,,,1319.9200,197.9900,WELLCARE,WELLCARE MEDICAID,1319.92,,,,,,,340.6700,1319.9200,percent of total billed charges,"100% of $1,319.92 in Billed Charges for Rev 272 = $1,319.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL DELIVERY,272,RC,,,,,,,,both,,,674.8400,101.2300,AETNA,AETNA,288.16,,,,,,,174.1800,674.8400,percent of total billed charges,42.7% of $674.84 in Billed Charges for Rev 272 = $288.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL DELIVERY,272,RC,,,,,,,,both,,,674.8400,101.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,472.39,,,,,,,174.1800,674.8400,percent of total billed charges,Rev 272 $674.84 in Billed Charges at 70% = $472.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL DELIVERY,272,RC,,,,,,,,both,,,674.8400,101.2300,CIGNA HEALTHCARE,CIGNA HMO,281.41,,,,,,,174.1800,674.8400,percent of total billed charges,41.7% of $674.84 in Billed Charges for Rev 272 = $281.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL DELIVERY,272,RC,,,,,,,,both,,,674.8400,101.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,313.13,,,,,,,174.1800,674.8400,percent of total billed charges,46.4% of $674.84 in Billed Charges for Rev 272 = $313.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL DELIVERY,272,RC,,,,,,,,both,,,674.8400,101.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,281.41,,,,,,,174.1800,674.8400,percent of total billed charges,41.7% of $674.84 in Billed Charges for Rev 272 = $281.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL DELIVERY,272,RC,,,,,,,,both,,,674.8400,101.2300,CIGNA HEALTHCARE,CIGNA PPO,281.41,,,,,,,174.1800,674.8400,percent of total billed charges,41.7% of $674.84 in Billed Charges for Rev 272 = $281.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL DELIVERY,272,RC,,,,,,,,both,,,674.8400,101.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,607.36,,,,,,,174.1800,674.8400,percent of total billed charges,90% of $674.84 in Billed Charges for Rev 272 = $607.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL DELIVERY,272,RC,,,,,,,,both,,,674.8400,101.2300,MEDCOST,MEDCOST VHN,321.16,,,,,,,174.1800,674.8400,percent of total billed charges,47.59% of $674.84 in Billed Charges for Rev 272 = $321.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL DELIVERY,272,RC,,,,,,,,both,,,674.8400,101.2300,SENTARA HEALTH,SENTARA HEALTH,174.18,,,,,,,174.1800,674.8400,percent of total billed charges,25.81% of $674.84 in Billed Charges for Rev 272 = $174.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL DELIVERY,272,RC,,,,,,,,both,,,674.8400,101.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",674.84,,,,,,,174.1800,674.8400,percent of total billed charges,100% of $674.84 in Billed Charges for Rev 272 = $674.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL DELIVERY,272,RC,,,,,,,,both,,,674.8400,101.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,337.42,,,,,,,174.1800,674.8400,percent of total billed charges,Rev 272 $674.84 in Billed Charges at 50% = $337.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL DELIVERY,272,RC,,,,,,,,both,,,674.8400,101.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,217.97,,,,,,,174.1800,674.8400,other,32.3% of $674.84 in Billed Charges for Rev 272 = $217.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK BRISTOL DELIVERY,272,RC,,,,,,,,both,,,674.8400,101.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,207.18,,,,,,,174.1800,674.8400,other,30.7% of $674.84 in Billed Charges for Rev 272 = $207.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK BRISTOL DELIVERY,272,RC,,,,,,,,both,,,674.8400,101.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,217.97,,,,,,,174.1800,674.8400,percent of total billed charges,32.3% of $674.84 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL DELIVERY,272,RC,,,,,,,,both,,,674.8400,101.2300,WELLCARE,WELLCARE MEDICAID,674.84,,,,,,,174.1800,674.8400,percent of total billed charges,100% of $674.84 in Billed Charges for Rev 272 = $674.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL FEM POP,272,RC,27200002,CDM,,,,,,both,,,1128.5700,169.2900,AETNA,AETNA,481.90,,,,,,,291.2800,1128.5700,percent of total billed charges,"42.7% of $1,128.57 in Billed Charges for Rev 272 = $481.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL FEM POP,272,RC,27200002,CDM,,,,,,both,,,1128.5700,169.2900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,790.00,,,,,,,291.2800,1128.5700,percent of total billed charges,"Rev 272 $1,128.57 in Billed Charges at 70% = $790.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL FEM POP,272,RC,27200002,CDM,,,,,,both,,,1128.5700,169.2900,CIGNA HEALTHCARE,CIGNA HMO,470.61,,,,,,,291.2800,1128.5700,percent of total billed charges,"41.7% of $1,128.57 in Billed Charges for Rev 272 = $470.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL FEM POP,272,RC,27200002,CDM,,,,,,both,,,1128.5700,169.2900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,523.66,,,,,,,291.2800,1128.5700,percent of total billed charges,"46.4% of $1,128.57 in Billed Charges for Rev 272 = $523.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL FEM POP,272,RC,27200002,CDM,,,,,,both,,,1128.5700,169.2900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,470.61,,,,,,,291.2800,1128.5700,percent of total billed charges,"41.7% of $1,128.57 in Billed Charges for Rev 272 = $470.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL FEM POP,272,RC,27200002,CDM,,,,,,both,,,1128.5700,169.2900,CIGNA HEALTHCARE,CIGNA PPO,470.61,,,,,,,291.2800,1128.5700,percent of total billed charges,"41.7% of $1,128.57 in Billed Charges for Rev 272 = $470.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL FEM POP,272,RC,27200002,CDM,,,,,,both,,,1128.5700,169.2900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1015.71,,,,,,,291.2800,1128.5700,percent of total billed charges,"90% of $1,128.57 in Billed Charges for Rev 272 = $1,015.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL FEM POP,272,RC,27200002,CDM,,,,,,both,,,1128.5700,169.2900,MEDCOST,MEDCOST VHN,537.09,,,,,,,291.2800,1128.5700,percent of total billed charges,"47.59% of $1,128.57 in Billed Charges for Rev 272 = $537.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL FEM POP,272,RC,27200002,CDM,,,,,,both,,,1128.5700,169.2900,SENTARA HEALTH,SENTARA HEALTH,291.28,,,,,,,291.2800,1128.5700,percent of total billed charges,"25.81% of $1,128.57 in Billed Charges for Rev 272 = $291.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL FEM POP,272,RC,27200002,CDM,,,,,,both,,,1128.5700,169.2900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1128.57,,,,,,,291.2800,1128.5700,percent of total billed charges,"100% of $1,128.57 in Billed Charges for Rev 272 = $1,128.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL FEM POP,272,RC,27200002,CDM,,,,,,both,,,1128.5700,169.2900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,564.29,,,,,,,291.2800,1128.5700,percent of total billed charges,"Rev 272 $1,128.57 in Billed Charges at 50% = $564.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL FEM POP,272,RC,27200002,CDM,,,,,,both,,,1128.5700,169.2900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,364.53,,,,,,,291.2800,1128.5700,other,"32.3% of $1,128.57 in Billed Charges for Rev 272 = $364.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK BRISTOL FEM POP,272,RC,27200002,CDM,,,,,,both,,,1128.5700,169.2900,UNITED HEALTHCARE,UHC HERITAGE SELECT,346.47,,,,,,,291.2800,1128.5700,other,"30.7% of $1,128.57 in Billed Charges for Rev 272 = $346.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK BRISTOL FEM POP,272,RC,27200002,CDM,,,,,,both,,,1128.5700,169.2900,UNITED HEALTHCARE,UNITED HEALTHCARE,364.53,,,,,,,291.2800,1128.5700,percent of total billed charges,"32.3% of $1,128.57 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL FEM POP,272,RC,27200002,CDM,,,,,,both,,,1128.5700,169.2900,WELLCARE,WELLCARE MEDICAID,1128.57,,,,,,,291.2800,1128.5700,percent of total billed charges,"100% of $1,128.57 in Billed Charges for Rev 272 = $1,128.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK BRISTOL FRACTURE HIP,272,RC,27200002,CDM,,,,,,both,,,748.6800,112.3000,AETNA,AETNA,319.69,,,,,,,193.2300,748.6800,percent of total billed charges,42.7% of $748.68 in Billed Charges for Rev 272 = $319.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL FRACTURE HIP,272,RC,27200002,CDM,,,,,,both,,,748.6800,112.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,524.08,,,,,,,193.2300,748.6800,percent of total billed charges,Rev 272 $748.68 in Billed Charges at 70% = $524.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL FRACTURE HIP,272,RC,27200002,CDM,,,,,,both,,,748.6800,112.3000,CIGNA HEALTHCARE,CIGNA HMO,312.20,,,,,,,193.2300,748.6800,percent of total billed charges,41.7% of $748.68 in Billed Charges for Rev 272 = $312.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL FRACTURE HIP,272,RC,27200002,CDM,,,,,,both,,,748.6800,112.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,347.39,,,,,,,193.2300,748.6800,percent of total billed charges,46.4% of $748.68 in Billed Charges for Rev 272 = $347.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL FRACTURE HIP,272,RC,27200002,CDM,,,,,,both,,,748.6800,112.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,312.20,,,,,,,193.2300,748.6800,percent of total billed charges,41.7% of $748.68 in Billed Charges for Rev 272 = $312.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL FRACTURE HIP,272,RC,27200002,CDM,,,,,,both,,,748.6800,112.3000,CIGNA HEALTHCARE,CIGNA PPO,312.20,,,,,,,193.2300,748.6800,percent of total billed charges,41.7% of $748.68 in Billed Charges for Rev 272 = $312.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL FRACTURE HIP,272,RC,27200002,CDM,,,,,,both,,,748.6800,112.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,673.81,,,,,,,193.2300,748.6800,percent of total billed charges,90% of $748.68 in Billed Charges for Rev 272 = $673.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL FRACTURE HIP,272,RC,27200002,CDM,,,,,,both,,,748.6800,112.3000,MEDCOST,MEDCOST VHN,356.30,,,,,,,193.2300,748.6800,percent of total billed charges,47.59% of $748.68 in Billed Charges for Rev 272 = $356.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL FRACTURE HIP,272,RC,27200002,CDM,,,,,,both,,,748.6800,112.3000,SENTARA HEALTH,SENTARA HEALTH,193.23,,,,,,,193.2300,748.6800,percent of total billed charges,25.81% of $748.68 in Billed Charges for Rev 272 = $193.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL FRACTURE HIP,272,RC,27200002,CDM,,,,,,both,,,748.6800,112.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",748.68,,,,,,,193.2300,748.6800,percent of total billed charges,100% of $748.68 in Billed Charges for Rev 272 = $748.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL FRACTURE HIP,272,RC,27200002,CDM,,,,,,both,,,748.6800,112.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,374.34,,,,,,,193.2300,748.6800,percent of total billed charges,Rev 272 $748.68 in Billed Charges at 50% = $374.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL FRACTURE HIP,272,RC,27200002,CDM,,,,,,both,,,748.6800,112.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,241.82,,,,,,,193.2300,748.6800,other,32.3% of $748.68 in Billed Charges for Rev 272 = $241.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK BRISTOL FRACTURE HIP,272,RC,27200002,CDM,,,,,,both,,,748.6800,112.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,229.84,,,,,,,193.2300,748.6800,other,30.7% of $748.68 in Billed Charges for Rev 272 = $229.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK BRISTOL FRACTURE HIP,272,RC,27200002,CDM,,,,,,both,,,748.6800,112.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,241.82,,,,,,,193.2300,748.6800,percent of total billed charges,32.3% of $748.68 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL FRACTURE HIP,272,RC,27200002,CDM,,,,,,both,,,748.6800,112.3000,WELLCARE,WELLCARE MEDICAID,748.68,,,,,,,193.2300,748.6800,percent of total billed charges,100% of $748.68 in Billed Charges for Rev 272 = $748.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER SMOOTH ROUND HIGH PROFILE BOOST GEL 520CC,272,RC,27200002,CDM,,,,,,both,,,259.4500,38.9200,AETNA,AETNA,110.79,,,,,,,66.9600,259.4500,percent of total billed charges,42.7% of $259.45 in Billed Charges for Rev 272 = $110.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER SMOOTH ROUND HIGH PROFILE BOOST GEL 520CC,272,RC,27200002,CDM,,,,,,both,,,259.4500,38.9200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,181.62,,,,,,,66.9600,259.4500,percent of total billed charges,Rev 272 $259.45 in Billed Charges at 70% = $181.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER SMOOTH ROUND HIGH PROFILE BOOST GEL 520CC,272,RC,27200002,CDM,,,,,,both,,,259.4500,38.9200,CIGNA HEALTHCARE,CIGNA HMO,108.19,,,,,,,66.9600,259.4500,percent of total billed charges,41.7% of $259.45 in Billed Charges for Rev 272 = $108.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER SMOOTH ROUND HIGH PROFILE BOOST GEL 520CC,272,RC,27200002,CDM,,,,,,both,,,259.4500,38.9200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,120.38,,,,,,,66.9600,259.4500,percent of total billed charges,46.4% of $259.45 in Billed Charges for Rev 272 = $120.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER SMOOTH ROUND HIGH PROFILE BOOST GEL 520CC,272,RC,27200002,CDM,,,,,,both,,,259.4500,38.9200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,108.19,,,,,,,66.9600,259.4500,percent of total billed charges,41.7% of $259.45 in Billed Charges for Rev 272 = $108.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER SMOOTH ROUND HIGH PROFILE BOOST GEL 520CC,272,RC,27200002,CDM,,,,,,both,,,259.4500,38.9200,CIGNA HEALTHCARE,CIGNA PPO,108.19,,,,,,,66.9600,259.4500,percent of total billed charges,41.7% of $259.45 in Billed Charges for Rev 272 = $108.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER SMOOTH ROUND HIGH PROFILE BOOST GEL 520CC,272,RC,27200002,CDM,,,,,,both,,,259.4500,38.9200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,233.51,,,,,,,66.9600,259.4500,percent of total billed charges,90% of $259.45 in Billed Charges for Rev 272 = $233.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER SMOOTH ROUND HIGH PROFILE BOOST GEL 520CC,272,RC,27200002,CDM,,,,,,both,,,259.4500,38.9200,MEDCOST,MEDCOST VHN,123.47,,,,,,,66.9600,259.4500,percent of total billed charges,47.59% of $259.45 in Billed Charges for Rev 272 = $123.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER SMOOTH ROUND HIGH PROFILE BOOST GEL 520CC,272,RC,27200002,CDM,,,,,,both,,,259.4500,38.9200,SENTARA HEALTH,SENTARA HEALTH,66.96,,,,,,,66.9600,259.4500,percent of total billed charges,25.81% of $259.45 in Billed Charges for Rev 272 = $66.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER SMOOTH ROUND HIGH PROFILE BOOST GEL 520CC,272,RC,27200002,CDM,,,,,,both,,,259.4500,38.9200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",259.45,,,,,,,66.9600,259.4500,percent of total billed charges,100% of $259.45 in Billed Charges for Rev 272 = $259.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER SMOOTH ROUND HIGH PROFILE BOOST GEL 520CC,272,RC,27200002,CDM,,,,,,both,,,259.4500,38.9200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,129.73,,,,,,,66.9600,259.4500,percent of total billed charges,Rev 272 $259.45 in Billed Charges at 50% = $129.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER SMOOTH ROUND HIGH PROFILE BOOST GEL 520CC,272,RC,27200002,CDM,,,,,,both,,,259.4500,38.9200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,83.80,,,,,,,66.9600,259.4500,other,32.3% of $259.45 in Billed Charges for Rev 272 = $83.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SIZER SMOOTH ROUND HIGH PROFILE BOOST GEL 520CC,272,RC,27200002,CDM,,,,,,both,,,259.4500,38.9200,UNITED HEALTHCARE,UHC HERITAGE SELECT,79.65,,,,,,,66.9600,259.4500,other,30.7% of $259.45 in Billed Charges for Rev 272 = $79.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SIZER SMOOTH ROUND HIGH PROFILE BOOST GEL 520CC,272,RC,27200002,CDM,,,,,,both,,,259.4500,38.9200,UNITED HEALTHCARE,UNITED HEALTHCARE,83.80,,,,,,,66.9600,259.4500,percent of total billed charges,32.3% of $259.45 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SIZER SMOOTH ROUND HIGH PROFILE BOOST GEL 520CC,272,RC,27200002,CDM,,,,,,both,,,259.4500,38.9200,WELLCARE,WELLCARE MEDICAID,259.45,,,,,,,66.9600,259.4500,percent of total billed charges,100% of $259.45 in Billed Charges for Rev 272 = $259.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL PACEMAKER,272,RC,27200002,CDM,,,,,,both,,,830.2000,124.5300,AETNA,AETNA,354.50,,,,,,,214.2700,830.2000,percent of total billed charges,42.7% of $830.20 in Billed Charges for Rev 272 = $354.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL PACEMAKER,272,RC,27200002,CDM,,,,,,both,,,830.2000,124.5300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,581.14,,,,,,,214.2700,830.2000,percent of total billed charges,Rev 272 $830.20 in Billed Charges at 70% = $581.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL PACEMAKER,272,RC,27200002,CDM,,,,,,both,,,830.2000,124.5300,CIGNA HEALTHCARE,CIGNA HMO,346.19,,,,,,,214.2700,830.2000,percent of total billed charges,41.7% of $830.20 in Billed Charges for Rev 272 = $346.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL PACEMAKER,272,RC,27200002,CDM,,,,,,both,,,830.2000,124.5300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,385.21,,,,,,,214.2700,830.2000,percent of total billed charges,46.4% of $830.20 in Billed Charges for Rev 272 = $385.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL PACEMAKER,272,RC,27200002,CDM,,,,,,both,,,830.2000,124.5300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,346.19,,,,,,,214.2700,830.2000,percent of total billed charges,41.7% of $830.20 in Billed Charges for Rev 272 = $346.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL PACEMAKER,272,RC,27200002,CDM,,,,,,both,,,830.2000,124.5300,CIGNA HEALTHCARE,CIGNA PPO,346.19,,,,,,,214.2700,830.2000,percent of total billed charges,41.7% of $830.20 in Billed Charges for Rev 272 = $346.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL PACEMAKER,272,RC,27200002,CDM,,,,,,both,,,830.2000,124.5300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,747.18,,,,,,,214.2700,830.2000,percent of total billed charges,90% of $830.20 in Billed Charges for Rev 272 = $747.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL PACEMAKER,272,RC,27200002,CDM,,,,,,both,,,830.2000,124.5300,MEDCOST,MEDCOST VHN,395.09,,,,,,,214.2700,830.2000,percent of total billed charges,47.59% of $830.20 in Billed Charges for Rev 272 = $395.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL PACEMAKER,272,RC,27200002,CDM,,,,,,both,,,830.2000,124.5300,SENTARA HEALTH,SENTARA HEALTH,214.27,,,,,,,214.2700,830.2000,percent of total billed charges,25.81% of $830.20 in Billed Charges for Rev 272 = $214.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL PACEMAKER,272,RC,27200002,CDM,,,,,,both,,,830.2000,124.5300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",830.20,,,,,,,214.2700,830.2000,percent of total billed charges,100% of $830.20 in Billed Charges for Rev 272 = $830.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL PACEMAKER,272,RC,27200002,CDM,,,,,,both,,,830.2000,124.5300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,415.10,,,,,,,214.2700,830.2000,percent of total billed charges,Rev 272 $830.20 in Billed Charges at 50% = $415.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL PACEMAKER,272,RC,27200002,CDM,,,,,,both,,,830.2000,124.5300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,268.15,,,,,,,214.2700,830.2000,other,32.3% of $830.20 in Billed Charges for Rev 272 = $268.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK BRISTOL PACEMAKER,272,RC,27200002,CDM,,,,,,both,,,830.2000,124.5300,UNITED HEALTHCARE,UHC HERITAGE SELECT,254.87,,,,,,,214.2700,830.2000,other,30.7% of $830.20 in Billed Charges for Rev 272 = $254.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK BRISTOL PACEMAKER,272,RC,27200002,CDM,,,,,,both,,,830.2000,124.5300,UNITED HEALTHCARE,UNITED HEALTHCARE,268.15,,,,,,,214.2700,830.2000,percent of total billed charges,32.3% of $830.20 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL PACEMAKER,272,RC,27200002,CDM,,,,,,both,,,830.2000,124.5300,WELLCARE,WELLCARE MEDICAID,830.20,,,,,,,214.2700,830.2000,percent of total billed charges,100% of $830.20 in Billed Charges for Rev 272 = $830.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL TOTAL HIP,272,RC,27200002,CDM,,,,,,both,,,936.5000,140.4800,AETNA,AETNA,399.89,,,,,,,241.7100,936.5000,percent of total billed charges,42.7% of $936.50 in Billed Charges for Rev 272 = $399.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL TOTAL HIP,272,RC,27200002,CDM,,,,,,both,,,936.5000,140.4800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,655.55,,,,,,,241.7100,936.5000,percent of total billed charges,Rev 272 $936.50 in Billed Charges at 70% = $655.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL TOTAL HIP,272,RC,27200002,CDM,,,,,,both,,,936.5000,140.4800,CIGNA HEALTHCARE,CIGNA HMO,390.52,,,,,,,241.7100,936.5000,percent of total billed charges,41.7% of $936.50 in Billed Charges for Rev 272 = $390.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL TOTAL HIP,272,RC,27200002,CDM,,,,,,both,,,936.5000,140.4800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,434.54,,,,,,,241.7100,936.5000,percent of total billed charges,46.4% of $936.50 in Billed Charges for Rev 272 = $434.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL TOTAL HIP,272,RC,27200002,CDM,,,,,,both,,,936.5000,140.4800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,390.52,,,,,,,241.7100,936.5000,percent of total billed charges,41.7% of $936.50 in Billed Charges for Rev 272 = $390.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL TOTAL HIP,272,RC,27200002,CDM,,,,,,both,,,936.5000,140.4800,CIGNA HEALTHCARE,CIGNA PPO,390.52,,,,,,,241.7100,936.5000,percent of total billed charges,41.7% of $936.50 in Billed Charges for Rev 272 = $390.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL TOTAL HIP,272,RC,27200002,CDM,,,,,,both,,,936.5000,140.4800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,842.85,,,,,,,241.7100,936.5000,percent of total billed charges,90% of $936.50 in Billed Charges for Rev 272 = $842.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL TOTAL HIP,272,RC,27200002,CDM,,,,,,both,,,936.5000,140.4800,MEDCOST,MEDCOST VHN,445.68,,,,,,,241.7100,936.5000,percent of total billed charges,47.59% of $936.50 in Billed Charges for Rev 272 = $445.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL TOTAL HIP,272,RC,27200002,CDM,,,,,,both,,,936.5000,140.4800,SENTARA HEALTH,SENTARA HEALTH,241.71,,,,,,,241.7100,936.5000,percent of total billed charges,25.81% of $936.50 in Billed Charges for Rev 272 = $241.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL TOTAL HIP,272,RC,27200002,CDM,,,,,,both,,,936.5000,140.4800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",936.50,,,,,,,241.7100,936.5000,percent of total billed charges,100% of $936.50 in Billed Charges for Rev 272 = $936.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL TOTAL HIP,272,RC,27200002,CDM,,,,,,both,,,936.5000,140.4800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,468.25,,,,,,,241.7100,936.5000,percent of total billed charges,Rev 272 $936.50 in Billed Charges at 50% = $468.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL TOTAL HIP,272,RC,27200002,CDM,,,,,,both,,,936.5000,140.4800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,302.49,,,,,,,241.7100,936.5000,other,32.3% of $936.50 in Billed Charges for Rev 272 = $302.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK BRISTOL TOTAL HIP,272,RC,27200002,CDM,,,,,,both,,,936.5000,140.4800,UNITED HEALTHCARE,UHC HERITAGE SELECT,287.51,,,,,,,241.7100,936.5000,other,30.7% of $936.50 in Billed Charges for Rev 272 = $287.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PACK BRISTOL TOTAL HIP,272,RC,27200002,CDM,,,,,,both,,,936.5000,140.4800,UNITED HEALTHCARE,UNITED HEALTHCARE,302.49,,,,,,,241.7100,936.5000,percent of total billed charges,32.3% of $936.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK BRISTOL TOTAL HIP,272,RC,27200002,CDM,,,,,,both,,,936.5000,140.4800,WELLCARE,WELLCARE MEDICAID,936.50,,,,,,,241.7100,936.5000,percent of total billed charges,100% of $936.50 in Billed Charges for Rev 272 = $936.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PACK CRANIOTOMY BRISTOL,272,RC,27200002,CDM,,,,,,both,,,1589.5600,238.4300,AETNA,AETNA,678.74,,,,,,,410.2700,1589.5600,percent of total billed charges,"42.7% of $1,589.56 in Billed Charges for Rev 272 = $678.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CRANIOTOMY BRISTOL,272,RC,27200002,CDM,,,,,,both,,,1589.5600,238.4300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1112.69,,,,,,,410.2700,1589.5600,percent of total billed charges,"Rev 272 $1,589.56 in Billed Charges at 70% = $1,112.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CRANIOTOMY BRISTOL,272,RC,27200002,CDM,,,,,,both,,,1589.5600,238.4300,CIGNA HEALTHCARE,CIGNA HMO,662.85,,,,,,,410.2700,1589.5600,percent of total billed charges,"41.7% of $1,589.56 in Billed Charges for Rev 272 = $662.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CRANIOTOMY BRISTOL,272,RC,27200002,CDM,,,,,,both,,,1589.5600,238.4300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,737.56,,,,,,,410.2700,1589.5600,percent of total billed charges,"46.4% of $1,589.56 in Billed Charges for Rev 272 = $737.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CRANIOTOMY BRISTOL,272,RC,27200002,CDM,,,,,,both,,,1589.5600,238.4300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,662.85,,,,,,,410.2700,1589.5600,percent of total billed charges,"41.7% of $1,589.56 in Billed Charges for Rev 272 = $662.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CRANIOTOMY BRISTOL,272,RC,27200002,CDM,,,,,,both,,,1589.5600,238.4300,CIGNA HEALTHCARE,CIGNA PPO,662.85,,,,,,,410.2700,1589.5600,percent of total billed charges,"41.7% of $1,589.56 in Billed Charges for Rev 272 = $662.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CRANIOTOMY BRISTOL,272,RC,27200002,CDM,,,,,,both,,,1589.5600,238.4300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1430.60,,,,,,,410.2700,1589.5600,percent of total billed charges,"90% of $1,589.56 in Billed Charges for Rev 272 = $1,430.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CRANIOTOMY BRISTOL,272,RC,27200002,CDM,,,,,,both,,,1589.5600,238.4300,MEDCOST,MEDCOST VHN,756.47,,,,,,,410.2700,1589.5600,percent of total billed charges,"47.59% of $1,589.56 in Billed Charges for Rev 272 = $756.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CRANIOTOMY BRISTOL,272,RC,27200002,CDM,,,,,,both,,,1589.5600,238.4300,SENTARA HEALTH,SENTARA HEALTH,410.27,,,,,,,410.2700,1589.5600,percent of total billed charges,"25.81% of $1,589.56 in Billed Charges for Rev 272 = $410.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CRANIOTOMY BRISTOL,272,RC,27200002,CDM,,,,,,both,,,1589.5600,238.4300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1589.56,,,,,,,410.2700,1589.5600,percent of total billed charges,"100% of $1,589.56 in Billed Charges for Rev 272 = $1,589.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CRANIOTOMY BRISTOL,272,RC,27200002,CDM,,,,,,both,,,1589.5600,238.4300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,794.78,,,,,,,410.2700,1589.5600,percent of total billed charges,"Rev 272 $1,589.56 in Billed Charges at 50% = $794.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CRANIOTOMY BRISTOL,272,RC,27200002,CDM,,,,,,both,,,1589.5600,238.4300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,513.43,,,,,,,410.2700,1589.5600,other,"32.3% of $1,589.56 in Billed Charges for Rev 272 = $513.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK CRANIOTOMY BRISTOL,272,RC,27200002,CDM,,,,,,both,,,1589.5600,238.4300,UNITED HEALTHCARE,UHC HERITAGE SELECT,487.99,,,,,,,410.2700,1589.5600,other,"30.7% of $1,589.56 in Billed Charges for Rev 272 = $487.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK CRANIOTOMY BRISTOL,272,RC,27200002,CDM,,,,,,both,,,1589.5600,238.4300,UNITED HEALTHCARE,UNITED HEALTHCARE,513.43,,,,,,,410.2700,1589.5600,percent of total billed charges,"32.3% of $1,589.56 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK CRANIOTOMY BRISTOL,272,RC,27200002,CDM,,,,,,both,,,1589.5600,238.4300,WELLCARE,WELLCARE MEDICAID,1589.56,,,,,,,410.2700,1589.5600,percent of total billed charges,"100% of $1,589.56 in Billed Charges for Rev 272 = $1,589.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK EYE ALCON CUSTOM,272,RC,27200002,CDM,,,,,,both,,,2572.2200,385.8300,AETNA,AETNA,1098.34,,,,,,,663.8900,2572.2200,percent of total billed charges,"42.7% of $2,572.22 in Billed Charges for Rev 272 = $1,098.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK EYE ALCON CUSTOM,272,RC,27200002,CDM,,,,,,both,,,2572.2200,385.8300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1800.55,,,,,,,663.8900,2572.2200,percent of total billed charges,"Rev 272 $2,572.22 in Billed Charges at 70% = $1,800.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK EYE ALCON CUSTOM,272,RC,27200002,CDM,,,,,,both,,,2572.2200,385.8300,CIGNA HEALTHCARE,CIGNA HMO,1072.62,,,,,,,663.8900,2572.2200,percent of total billed charges,"41.7% of $2,572.22 in Billed Charges for Rev 272 = $1,072.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK EYE ALCON CUSTOM,272,RC,27200002,CDM,,,,,,both,,,2572.2200,385.8300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1193.51,,,,,,,663.8900,2572.2200,percent of total billed charges,"46.4% of $2,572.22 in Billed Charges for Rev 272 = $1,193.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK EYE ALCON CUSTOM,272,RC,27200002,CDM,,,,,,both,,,2572.2200,385.8300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1072.62,,,,,,,663.8900,2572.2200,percent of total billed charges,"41.7% of $2,572.22 in Billed Charges for Rev 272 = $1,072.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK EYE ALCON CUSTOM,272,RC,27200002,CDM,,,,,,both,,,2572.2200,385.8300,CIGNA HEALTHCARE,CIGNA PPO,1072.62,,,,,,,663.8900,2572.2200,percent of total billed charges,"41.7% of $2,572.22 in Billed Charges for Rev 272 = $1,072.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK EYE ALCON CUSTOM,272,RC,27200002,CDM,,,,,,both,,,2572.2200,385.8300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2315.00,,,,,,,663.8900,2572.2200,percent of total billed charges,"90% of $2,572.22 in Billed Charges for Rev 272 = $2,315.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK EYE ALCON CUSTOM,272,RC,27200002,CDM,,,,,,both,,,2572.2200,385.8300,MEDCOST,MEDCOST VHN,1224.12,,,,,,,663.8900,2572.2200,percent of total billed charges,"47.59% of $2,572.22 in Billed Charges for Rev 272 = $1,224.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK EYE ALCON CUSTOM,272,RC,27200002,CDM,,,,,,both,,,2572.2200,385.8300,SENTARA HEALTH,SENTARA HEALTH,663.89,,,,,,,663.8900,2572.2200,percent of total billed charges,"25.81% of $2,572.22 in Billed Charges for Rev 272 = $663.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK EYE ALCON CUSTOM,272,RC,27200002,CDM,,,,,,both,,,2572.2200,385.8300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2572.22,,,,,,,663.8900,2572.2200,percent of total billed charges,"100% of $2,572.22 in Billed Charges for Rev 272 = $2,572.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK EYE ALCON CUSTOM,272,RC,27200002,CDM,,,,,,both,,,2572.2200,385.8300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1286.11,,,,,,,663.8900,2572.2200,percent of total billed charges,"Rev 272 $2,572.22 in Billed Charges at 50% = $1,286.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK EYE ALCON CUSTOM,272,RC,27200002,CDM,,,,,,both,,,2572.2200,385.8300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,830.83,,,,,,,663.8900,2572.2200,other,"32.3% of $2,572.22 in Billed Charges for Rev 272 = $830.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK EYE ALCON CUSTOM,272,RC,27200002,CDM,,,,,,both,,,2572.2200,385.8300,UNITED HEALTHCARE,UHC HERITAGE SELECT,789.67,,,,,,,663.8900,2572.2200,other,"30.7% of $2,572.22 in Billed Charges for Rev 272 = $789.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK EYE ALCON CUSTOM,272,RC,27200002,CDM,,,,,,both,,,2572.2200,385.8300,UNITED HEALTHCARE,UNITED HEALTHCARE,830.83,,,,,,,663.8900,2572.2200,percent of total billed charges,"32.3% of $2,572.22 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK EYE ALCON CUSTOM,272,RC,27200002,CDM,,,,,,both,,,2572.2200,385.8300,WELLCARE,WELLCARE MEDICAID,2572.22,,,,,,,663.8900,2572.2200,percent of total billed charges,"100% of $2,572.22 in Billed Charges for Rev 272 = $2,572.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOAD 2.0 TAN 30MM ART SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,5352.1700,802.8300,AETNA,AETNA,2285.38,,,,,,,1381.4000,5352.1700,percent of total billed charges,"42.7% of $5,352.17 in Billed Charges for Rev 272 = $2,285.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOAD 2.0 TAN 30MM ART SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,5352.1700,802.8300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3746.52,,,,,,,1381.4000,5352.1700,percent of total billed charges,"Rev 272 $5,352.17 in Billed Charges at 70% = $3,746.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOAD 2.0 TAN 30MM ART SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,5352.1700,802.8300,CIGNA HEALTHCARE,CIGNA HMO,2231.85,,,,,,,1381.4000,5352.1700,percent of total billed charges,"41.7% of $5,352.17 in Billed Charges for Rev 272 = $2,231.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOAD 2.0 TAN 30MM ART SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,5352.1700,802.8300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2483.41,,,,,,,1381.4000,5352.1700,percent of total billed charges,"46.4% of $5,352.17 in Billed Charges for Rev 272 = $2,483.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOAD 2.0 TAN 30MM ART SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,5352.1700,802.8300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2231.85,,,,,,,1381.4000,5352.1700,percent of total billed charges,"41.7% of $5,352.17 in Billed Charges for Rev 272 = $2,231.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOAD 2.0 TAN 30MM ART SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,5352.1700,802.8300,CIGNA HEALTHCARE,CIGNA PPO,2231.85,,,,,,,1381.4000,5352.1700,percent of total billed charges,"41.7% of $5,352.17 in Billed Charges for Rev 272 = $2,231.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOAD 2.0 TAN 30MM ART SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,5352.1700,802.8300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4816.95,,,,,,,1381.4000,5352.1700,percent of total billed charges,"90% of $5,352.17 in Billed Charges for Rev 272 = $4,816.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOAD 2.0 TAN 30MM ART SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,5352.1700,802.8300,MEDCOST,MEDCOST VHN,2547.10,,,,,,,1381.4000,5352.1700,percent of total billed charges,"47.59% of $5,352.17 in Billed Charges for Rev 272 = $2,547.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOAD 2.0 TAN 30MM ART SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,5352.1700,802.8300,SENTARA HEALTH,SENTARA HEALTH,1381.40,,,,,,,1381.4000,5352.1700,percent of total billed charges,"25.81% of $5,352.17 in Billed Charges for Rev 272 = $1,381.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOAD 2.0 TAN 30MM ART SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,5352.1700,802.8300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5352.17,,,,,,,1381.4000,5352.1700,percent of total billed charges,"100% of $5,352.17 in Billed Charges for Rev 272 = $5,352.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOAD 2.0 TAN 30MM ART SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,5352.1700,802.8300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2676.09,,,,,,,1381.4000,5352.1700,percent of total billed charges,"Rev 272 $5,352.17 in Billed Charges at 50% = $2,676.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOAD 2.0 TAN 30MM ART SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,5352.1700,802.8300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1728.75,,,,,,,1381.4000,5352.1700,other,"32.3% of $5,352.17 in Billed Charges for Rev 272 = $1,728.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLE RELOAD 2.0 TAN 30MM ART SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,5352.1700,802.8300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1643.12,,,,,,,1381.4000,5352.1700,other,"30.7% of $5,352.17 in Billed Charges for Rev 272 = $1,643.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLE RELOAD 2.0 TAN 30MM ART SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,5352.1700,802.8300,UNITED HEALTHCARE,UNITED HEALTHCARE,1728.75,,,,,,,1381.4000,5352.1700,percent of total billed charges,"32.3% of $5,352.17 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOAD 2.0 TAN 30MM ART SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,5352.1700,802.8300,WELLCARE,WELLCARE MEDICAID,5352.17,,,,,,,1381.4000,5352.1700,percent of total billed charges,"100% of $5,352.17 in Billed Charges for Rev 272 = $5,352.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOADABLE TA3035S SURPASS SEE LN 182863,272,RC,,,,,,,,both,,,4149.3600,622.4000,AETNA,AETNA,1771.78,,,,,,,1070.9500,4149.3600,percent of total billed charges,"42.7% of $4,149.36 in Billed Charges for Rev 272 = $1,771.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOADABLE TA3035S SURPASS SEE LN 182863,272,RC,,,,,,,,both,,,4149.3600,622.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2904.55,,,,,,,1070.9500,4149.3600,percent of total billed charges,"Rev 272 $4,149.36 in Billed Charges at 70% = $2,904.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOADABLE TA3035S SURPASS SEE LN 182863,272,RC,,,,,,,,both,,,4149.3600,622.4000,CIGNA HEALTHCARE,CIGNA HMO,1730.28,,,,,,,1070.9500,4149.3600,percent of total billed charges,"41.7% of $4,149.36 in Billed Charges for Rev 272 = $1,730.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOADABLE TA3035S SURPASS SEE LN 182863,272,RC,,,,,,,,both,,,4149.3600,622.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1925.30,,,,,,,1070.9500,4149.3600,percent of total billed charges,"46.4% of $4,149.36 in Billed Charges for Rev 272 = $1,925.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOADABLE TA3035S SURPASS SEE LN 182863,272,RC,,,,,,,,both,,,4149.3600,622.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1730.28,,,,,,,1070.9500,4149.3600,percent of total billed charges,"41.7% of $4,149.36 in Billed Charges for Rev 272 = $1,730.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOADABLE TA3035S SURPASS SEE LN 182863,272,RC,,,,,,,,both,,,4149.3600,622.4000,CIGNA HEALTHCARE,CIGNA PPO,1730.28,,,,,,,1070.9500,4149.3600,percent of total billed charges,"41.7% of $4,149.36 in Billed Charges for Rev 272 = $1,730.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOADABLE TA3035S SURPASS SEE LN 182863,272,RC,,,,,,,,both,,,4149.3600,622.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3734.42,,,,,,,1070.9500,4149.3600,percent of total billed charges,"90% of $4,149.36 in Billed Charges for Rev 272 = $3,734.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOADABLE TA3035S SURPASS SEE LN 182863,272,RC,,,,,,,,both,,,4149.3600,622.4000,MEDCOST,MEDCOST VHN,1974.68,,,,,,,1070.9500,4149.3600,percent of total billed charges,"47.59% of $4,149.36 in Billed Charges for Rev 272 = $1,974.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOADABLE TA3035S SURPASS SEE LN 182863,272,RC,,,,,,,,both,,,4149.3600,622.4000,SENTARA HEALTH,SENTARA HEALTH,1070.95,,,,,,,1070.9500,4149.3600,percent of total billed charges,"25.81% of $4,149.36 in Billed Charges for Rev 272 = $1,070.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOADABLE TA3035S SURPASS SEE LN 182863,272,RC,,,,,,,,both,,,4149.3600,622.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4149.36,,,,,,,1070.9500,4149.3600,percent of total billed charges,"100% of $4,149.36 in Billed Charges for Rev 272 = $4,149.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOADABLE TA3035S SURPASS SEE LN 182863,272,RC,,,,,,,,both,,,4149.3600,622.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2074.68,,,,,,,1070.9500,4149.3600,percent of total billed charges,"Rev 272 $4,149.36 in Billed Charges at 50% = $2,074.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOADABLE TA3035S SURPASS SEE LN 182863,272,RC,,,,,,,,both,,,4149.3600,622.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1340.24,,,,,,,1070.9500,4149.3600,other,"32.3% of $4,149.36 in Billed Charges for Rev 272 = $1,340.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLE RELOADABLE TA3035S SURPASS SEE LN 182863,272,RC,,,,,,,,both,,,4149.3600,622.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1273.85,,,,,,,1070.9500,4149.3600,other,"30.7% of $4,149.36 in Billed Charges for Rev 272 = $1,273.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLE RELOADABLE TA3035S SURPASS SEE LN 182863,272,RC,,,,,,,,both,,,4149.3600,622.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,1340.24,,,,,,,1070.9500,4149.3600,percent of total billed charges,"32.3% of $4,149.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLE RELOADABLE TA3035S SURPASS SEE LN 182863,272,RC,,,,,,,,both,,,4149.3600,622.4000,WELLCARE,WELLCARE MEDICAID,4149.36,,,,,,,1070.9500,4149.3600,percent of total billed charges,"100% of $4,149.36 in Billed Charges for Rev 272 = $4,149.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION DUAL KIT 15MM,272,RC,27200002,CDM,,,,,,both,,,49059.8100,7358.9700,AETNA,AETNA,20948.54,,,,,,,12662.3400,49059.8100,percent of total billed charges,"42.7% of $49,059.81 in Billed Charges for Rev 272 = $20,948.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION DUAL KIT 15MM,272,RC,27200002,CDM,,,,,,both,,,49059.8100,7358.9700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,34341.87,,,,,,,12662.3400,49059.8100,percent of total billed charges,"Rev 272 $49,059.81 in Billed Charges at 70% = $34,341.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION DUAL KIT 15MM,272,RC,27200002,CDM,,,,,,both,,,49059.8100,7358.9700,CIGNA HEALTHCARE,CIGNA HMO,20457.94,,,,,,,12662.3400,49059.8100,percent of total billed charges,"41.7% of $49,059.81 in Billed Charges for Rev 272 = $20,457.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION DUAL KIT 15MM,272,RC,27200002,CDM,,,,,,both,,,49059.8100,7358.9700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,22763.75,,,,,,,12662.3400,49059.8100,percent of total billed charges,"46.4% of $49,059.81 in Billed Charges for Rev 272 = $22,763.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION DUAL KIT 15MM,272,RC,27200002,CDM,,,,,,both,,,49059.8100,7358.9700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,20457.94,,,,,,,12662.3400,49059.8100,percent of total billed charges,"41.7% of $49,059.81 in Billed Charges for Rev 272 = $20,457.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION DUAL KIT 15MM,272,RC,27200002,CDM,,,,,,both,,,49059.8100,7358.9700,CIGNA HEALTHCARE,CIGNA PPO,20457.94,,,,,,,12662.3400,49059.8100,percent of total billed charges,"41.7% of $49,059.81 in Billed Charges for Rev 272 = $20,457.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION DUAL KIT 15MM,272,RC,27200002,CDM,,,,,,both,,,49059.8100,7358.9700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,44153.83,,,,,,,12662.3400,49059.8100,percent of total billed charges,"90% of $49,059.81 in Billed Charges for Rev 272 = $44,153.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION DUAL KIT 15MM,272,RC,27200002,CDM,,,,,,both,,,49059.8100,7358.9700,MEDCOST,MEDCOST VHN,23347.56,,,,,,,12662.3400,49059.8100,percent of total billed charges,"47.59% of $49,059.81 in Billed Charges for Rev 272 = $23,347.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION DUAL KIT 15MM,272,RC,27200002,CDM,,,,,,both,,,49059.8100,7358.9700,SENTARA HEALTH,SENTARA HEALTH,12662.34,,,,,,,12662.3400,49059.8100,percent of total billed charges,"25.81% of $49,059.81 in Billed Charges for Rev 272 = $12,662.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION DUAL KIT 15MM,272,RC,27200002,CDM,,,,,,both,,,49059.8100,7358.9700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",49059.81,,,,,,,12662.3400,49059.8100,percent of total billed charges,"100% of $49,059.81 in Billed Charges for Rev 272 = $49,059.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION DUAL KIT 15MM,272,RC,27200002,CDM,,,,,,both,,,49059.8100,7358.9700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,24529.91,,,,,,,12662.3400,49059.8100,percent of total billed charges,"Rev 272 $49,059.81 in Billed Charges at 50% = $24,529.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION DUAL KIT 15MM,272,RC,27200002,CDM,,,,,,both,,,49059.8100,7358.9700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,15846.32,,,,,,,12662.3400,49059.8100,other,"32.3% of $49,059.81 in Billed Charges for Rev 272 = $15,846.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE ABLATION DUAL KIT 15MM,272,RC,27200002,CDM,,,,,,both,,,49059.8100,7358.9700,UNITED HEALTHCARE,UHC HERITAGE SELECT,15061.36,,,,,,,12662.3400,49059.8100,other,"30.7% of $49,059.81 in Billed Charges for Rev 272 = $15,061.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE ABLATION DUAL KIT 15MM,272,RC,27200002,CDM,,,,,,both,,,49059.8100,7358.9700,UNITED HEALTHCARE,UNITED HEALTHCARE,15846.32,,,,,,,12662.3400,49059.8100,percent of total billed charges,"32.3% of $49,059.81 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION DUAL KIT 15MM,272,RC,27200002,CDM,,,,,,both,,,49059.8100,7358.9700,WELLCARE,WELLCARE MEDICAID,49059.81,,,,,,,12662.3400,49059.8100,percent of total billed charges,"100% of $49,059.81 in Billed Charges for Rev 272 = $49,059.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION KIT RF,272,RC,,,,,,,,both,,,45901.5300,6885.2300,AETNA,AETNA,19599.95,,,,,,,11847.1800,45901.5300,percent of total billed charges,"42.7% of $45,901.53 in Billed Charges for Rev 272 = $19,599.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION KIT RF,272,RC,,,,,,,,both,,,45901.5300,6885.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,32131.07,,,,,,,11847.1800,45901.5300,percent of total billed charges,"Rev 272 $45,901.53 in Billed Charges at 70% = $32,131.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION KIT RF,272,RC,,,,,,,,both,,,45901.5300,6885.2300,CIGNA HEALTHCARE,CIGNA HMO,19140.94,,,,,,,11847.1800,45901.5300,percent of total billed charges,"41.7% of $45,901.53 in Billed Charges for Rev 272 = $19,140.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION KIT RF,272,RC,,,,,,,,both,,,45901.5300,6885.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,21298.31,,,,,,,11847.1800,45901.5300,percent of total billed charges,"46.4% of $45,901.53 in Billed Charges for Rev 272 = $21,298.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION KIT RF,272,RC,,,,,,,,both,,,45901.5300,6885.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,19140.94,,,,,,,11847.1800,45901.5300,percent of total billed charges,"41.7% of $45,901.53 in Billed Charges for Rev 272 = $19,140.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION KIT RF,272,RC,,,,,,,,both,,,45901.5300,6885.2300,CIGNA HEALTHCARE,CIGNA PPO,19140.94,,,,,,,11847.1800,45901.5300,percent of total billed charges,"41.7% of $45,901.53 in Billed Charges for Rev 272 = $19,140.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION KIT RF,272,RC,,,,,,,,both,,,45901.5300,6885.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,41311.38,,,,,,,11847.1800,45901.5300,percent of total billed charges,"90% of $45,901.53 in Billed Charges for Rev 272 = $41,311.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION KIT RF,272,RC,,,,,,,,both,,,45901.5300,6885.2300,MEDCOST,MEDCOST VHN,21844.54,,,,,,,11847.1800,45901.5300,percent of total billed charges,"47.59% of $45,901.53 in Billed Charges for Rev 272 = $21,844.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION KIT RF,272,RC,,,,,,,,both,,,45901.5300,6885.2300,SENTARA HEALTH,SENTARA HEALTH,11847.18,,,,,,,11847.1800,45901.5300,percent of total billed charges,"25.81% of $45,901.53 in Billed Charges for Rev 272 = $11,847.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION KIT RF,272,RC,,,,,,,,both,,,45901.5300,6885.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",45901.53,,,,,,,11847.1800,45901.5300,percent of total billed charges,"100% of $45,901.53 in Billed Charges for Rev 272 = $45,901.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION KIT RF,272,RC,,,,,,,,both,,,45901.5300,6885.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22950.77,,,,,,,11847.1800,45901.5300,percent of total billed charges,"Rev 272 $45,901.53 in Billed Charges at 50% = $22,950.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION KIT RF,272,RC,,,,,,,,both,,,45901.5300,6885.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,14826.19,,,,,,,11847.1800,45901.5300,other,"32.3% of $45,901.53 in Billed Charges for Rev 272 = $14,826.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE ABLATION KIT RF,272,RC,,,,,,,,both,,,45901.5300,6885.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,14091.77,,,,,,,11847.1800,45901.5300,other,"30.7% of $45,901.53 in Billed Charges for Rev 272 = $14,091.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE ABLATION KIT RF,272,RC,,,,,,,,both,,,45901.5300,6885.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,14826.19,,,,,,,11847.1800,45901.5300,percent of total billed charges,"32.3% of $45,901.53 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ABLATION KIT RF,272,RC,,,,,,,,both,,,45901.5300,6885.2300,WELLCARE,WELLCARE MEDICAID,45901.53,,,,,,,11847.1800,45901.5300,percent of total billed charges,"100% of $45,901.53 in Billed Charges for Rev 272 = $45,901.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ANTERIOR VITRECTOMY,272,RC,27200002,CDM,,,,,,both,,,2440.5000,366.0800,AETNA,AETNA,1042.09,,,,,,,629.8900,2440.5000,percent of total billed charges,"42.7% of $2,440.50 in Billed Charges for Rev 272 = $1,042.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ANTERIOR VITRECTOMY,272,RC,27200002,CDM,,,,,,both,,,2440.5000,366.0800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1708.35,,,,,,,629.8900,2440.5000,percent of total billed charges,"Rev 272 $2,440.50 in Billed Charges at 70% = $1,708.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ANTERIOR VITRECTOMY,272,RC,27200002,CDM,,,,,,both,,,2440.5000,366.0800,CIGNA HEALTHCARE,CIGNA HMO,1017.69,,,,,,,629.8900,2440.5000,percent of total billed charges,"41.7% of $2,440.50 in Billed Charges for Rev 272 = $1,017.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ANTERIOR VITRECTOMY,272,RC,27200002,CDM,,,,,,both,,,2440.5000,366.0800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1132.39,,,,,,,629.8900,2440.5000,percent of total billed charges,"46.4% of $2,440.50 in Billed Charges for Rev 272 = $1,132.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ANTERIOR VITRECTOMY,272,RC,27200002,CDM,,,,,,both,,,2440.5000,366.0800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1017.69,,,,,,,629.8900,2440.5000,percent of total billed charges,"41.7% of $2,440.50 in Billed Charges for Rev 272 = $1,017.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ANTERIOR VITRECTOMY,272,RC,27200002,CDM,,,,,,both,,,2440.5000,366.0800,CIGNA HEALTHCARE,CIGNA PPO,1017.69,,,,,,,629.8900,2440.5000,percent of total billed charges,"41.7% of $2,440.50 in Billed Charges for Rev 272 = $1,017.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ANTERIOR VITRECTOMY,272,RC,27200002,CDM,,,,,,both,,,2440.5000,366.0800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2196.45,,,,,,,629.8900,2440.5000,percent of total billed charges,"90% of $2,440.50 in Billed Charges for Rev 272 = $2,196.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ANTERIOR VITRECTOMY,272,RC,27200002,CDM,,,,,,both,,,2440.5000,366.0800,MEDCOST,MEDCOST VHN,1161.43,,,,,,,629.8900,2440.5000,percent of total billed charges,"47.59% of $2,440.50 in Billed Charges for Rev 272 = $1,161.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ANTERIOR VITRECTOMY,272,RC,27200002,CDM,,,,,,both,,,2440.5000,366.0800,SENTARA HEALTH,SENTARA HEALTH,629.89,,,,,,,629.8900,2440.5000,percent of total billed charges,"25.81% of $2,440.50 in Billed Charges for Rev 272 = $629.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ANTERIOR VITRECTOMY,272,RC,27200002,CDM,,,,,,both,,,2440.5000,366.0800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2440.50,,,,,,,629.8900,2440.5000,percent of total billed charges,"100% of $2,440.50 in Billed Charges for Rev 272 = $2,440.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ANTERIOR VITRECTOMY,272,RC,27200002,CDM,,,,,,both,,,2440.5000,366.0800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1220.25,,,,,,,629.8900,2440.5000,percent of total billed charges,"Rev 272 $2,440.50 in Billed Charges at 50% = $1,220.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ANTERIOR VITRECTOMY,272,RC,27200002,CDM,,,,,,both,,,2440.5000,366.0800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,788.28,,,,,,,629.8900,2440.5000,other,"32.3% of $2,440.50 in Billed Charges for Rev 272 = $788.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE ANTERIOR VITRECTOMY,272,RC,27200002,CDM,,,,,,both,,,2440.5000,366.0800,UNITED HEALTHCARE,UHC HERITAGE SELECT,749.23,,,,,,,629.8900,2440.5000,other,"30.7% of $2,440.50 in Billed Charges for Rev 272 = $749.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE ANTERIOR VITRECTOMY,272,RC,27200002,CDM,,,,,,both,,,2440.5000,366.0800,UNITED HEALTHCARE,UNITED HEALTHCARE,788.28,,,,,,,629.8900,2440.5000,percent of total billed charges,"32.3% of $2,440.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE ANTERIOR VITRECTOMY,272,RC,27200002,CDM,,,,,,both,,,2440.5000,366.0800,WELLCARE,WELLCARE MEDICAID,2440.50,,,,,,,629.8900,2440.5000,percent of total billed charges,"100% of $2,440.50 in Billed Charges for Rev 272 = $2,440.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE AUTOLITH BILIARY EHL 1.9FR,272,RC,27200002,CDM,,,,,,both,,,17527.4000,2629.1100,AETNA,AETNA,7484.20,,,,,,,4523.8200,17527.4000,percent of total billed charges,"42.7% of $17,527.40 in Billed Charges for Rev 272 = $7,484.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE AUTOLITH BILIARY EHL 1.9FR,272,RC,27200002,CDM,,,,,,both,,,17527.4000,2629.1100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,12269.18,,,,,,,4523.8200,17527.4000,percent of total billed charges,"Rev 272 $17,527.40 in Billed Charges at 70% = $12,269.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE AUTOLITH BILIARY EHL 1.9FR,272,RC,27200002,CDM,,,,,,both,,,17527.4000,2629.1100,CIGNA HEALTHCARE,CIGNA HMO,7308.93,,,,,,,4523.8200,17527.4000,percent of total billed charges,"41.7% of $17,527.40 in Billed Charges for Rev 272 = $7,308.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE AUTOLITH BILIARY EHL 1.9FR,272,RC,27200002,CDM,,,,,,both,,,17527.4000,2629.1100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8132.71,,,,,,,4523.8200,17527.4000,percent of total billed charges,"46.4% of $17,527.40 in Billed Charges for Rev 272 = $8,132.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE AUTOLITH BILIARY EHL 1.9FR,272,RC,27200002,CDM,,,,,,both,,,17527.4000,2629.1100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7308.93,,,,,,,4523.8200,17527.4000,percent of total billed charges,"41.7% of $17,527.40 in Billed Charges for Rev 272 = $7,308.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE AUTOLITH BILIARY EHL 1.9FR,272,RC,27200002,CDM,,,,,,both,,,17527.4000,2629.1100,CIGNA HEALTHCARE,CIGNA PPO,7308.93,,,,,,,4523.8200,17527.4000,percent of total billed charges,"41.7% of $17,527.40 in Billed Charges for Rev 272 = $7,308.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE AUTOLITH BILIARY EHL 1.9FR,272,RC,27200002,CDM,,,,,,both,,,17527.4000,2629.1100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,15774.66,,,,,,,4523.8200,17527.4000,percent of total billed charges,"90% of $17,527.40 in Billed Charges for Rev 272 = $15,774.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE AUTOLITH BILIARY EHL 1.9FR,272,RC,27200002,CDM,,,,,,both,,,17527.4000,2629.1100,MEDCOST,MEDCOST VHN,8341.29,,,,,,,4523.8200,17527.4000,percent of total billed charges,"47.59% of $17,527.40 in Billed Charges for Rev 272 = $8,341.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE AUTOLITH BILIARY EHL 1.9FR,272,RC,27200002,CDM,,,,,,both,,,17527.4000,2629.1100,SENTARA HEALTH,SENTARA HEALTH,4523.82,,,,,,,4523.8200,17527.4000,percent of total billed charges,"25.81% of $17,527.40 in Billed Charges for Rev 272 = $4,523.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE AUTOLITH BILIARY EHL 1.9FR,272,RC,27200002,CDM,,,,,,both,,,17527.4000,2629.1100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",17527.40,,,,,,,4523.8200,17527.4000,percent of total billed charges,"100% of $17,527.40 in Billed Charges for Rev 272 = $17,527.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE AUTOLITH BILIARY EHL 1.9FR,272,RC,27200002,CDM,,,,,,both,,,17527.4000,2629.1100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8763.70,,,,,,,4523.8200,17527.4000,percent of total billed charges,"Rev 272 $17,527.40 in Billed Charges at 50% = $8,763.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE AUTOLITH BILIARY EHL 1.9FR,272,RC,27200002,CDM,,,,,,both,,,17527.4000,2629.1100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5661.35,,,,,,,4523.8200,17527.4000,other,"32.3% of $17,527.40 in Billed Charges for Rev 272 = $5,661.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE AUTOLITH BILIARY EHL 1.9FR,272,RC,27200002,CDM,,,,,,both,,,17527.4000,2629.1100,UNITED HEALTHCARE,UHC HERITAGE SELECT,5380.91,,,,,,,4523.8200,17527.4000,other,"30.7% of $17,527.40 in Billed Charges for Rev 272 = $5,380.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE AUTOLITH BILIARY EHL 1.9FR,272,RC,27200002,CDM,,,,,,both,,,17527.4000,2629.1100,UNITED HEALTHCARE,UNITED HEALTHCARE,5661.35,,,,,,,4523.8200,17527.4000,percent of total billed charges,"32.3% of $17,527.40 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE AUTOLITH BILIARY EHL 1.9FR,272,RC,27200002,CDM,,,,,,both,,,17527.4000,2629.1100,WELLCARE,WELLCARE MEDICAID,17527.40,,,,,,,4523.8200,17527.4000,percent of total billed charges,"100% of $17,527.40 in Billed Charges for Rev 272 = $17,527.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER 28MM W/3.5MM STAPLES SURPASS SEE LN 131178,272,RC,,,,,,,,both,,,16548.4900,2482.2700,AETNA,AETNA,7066.21,,,,,,,4271.1700,16548.4900,percent of total billed charges,"42.7% of $16,548.49 in Billed Charges for Rev 272 = $7,066.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER 28MM W/3.5MM STAPLES SURPASS SEE LN 131178,272,RC,,,,,,,,both,,,16548.4900,2482.2700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11583.94,,,,,,,4271.1700,16548.4900,percent of total billed charges,"Rev 272 $16,548.49 in Billed Charges at 70% = $11,583.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER 28MM W/3.5MM STAPLES SURPASS SEE LN 131178,272,RC,,,,,,,,both,,,16548.4900,2482.2700,CIGNA HEALTHCARE,CIGNA HMO,6900.72,,,,,,,4271.1700,16548.4900,percent of total billed charges,"41.7% of $16,548.49 in Billed Charges for Rev 272 = $6,900.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER 28MM W/3.5MM STAPLES SURPASS SEE LN 131178,272,RC,,,,,,,,both,,,16548.4900,2482.2700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7678.50,,,,,,,4271.1700,16548.4900,percent of total billed charges,"46.4% of $16,548.49 in Billed Charges for Rev 272 = $7,678.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER 28MM W/3.5MM STAPLES SURPASS SEE LN 131178,272,RC,,,,,,,,both,,,16548.4900,2482.2700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6900.72,,,,,,,4271.1700,16548.4900,percent of total billed charges,"41.7% of $16,548.49 in Billed Charges for Rev 272 = $6,900.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER 28MM W/3.5MM STAPLES SURPASS SEE LN 131178,272,RC,,,,,,,,both,,,16548.4900,2482.2700,CIGNA HEALTHCARE,CIGNA PPO,6900.72,,,,,,,4271.1700,16548.4900,percent of total billed charges,"41.7% of $16,548.49 in Billed Charges for Rev 272 = $6,900.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER 28MM W/3.5MM STAPLES SURPASS SEE LN 131178,272,RC,,,,,,,,both,,,16548.4900,2482.2700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,14893.64,,,,,,,4271.1700,16548.4900,percent of total billed charges,"90% of $16,548.49 in Billed Charges for Rev 272 = $14,893.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER 28MM W/3.5MM STAPLES SURPASS SEE LN 131178,272,RC,,,,,,,,both,,,16548.4900,2482.2700,MEDCOST,MEDCOST VHN,7875.43,,,,,,,4271.1700,16548.4900,percent of total billed charges,"47.59% of $16,548.49 in Billed Charges for Rev 272 = $7,875.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER 28MM W/3.5MM STAPLES SURPASS SEE LN 131178,272,RC,,,,,,,,both,,,16548.4900,2482.2700,SENTARA HEALTH,SENTARA HEALTH,4271.17,,,,,,,4271.1700,16548.4900,percent of total billed charges,"25.81% of $16,548.49 in Billed Charges for Rev 272 = $4,271.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER 28MM W/3.5MM STAPLES SURPASS SEE LN 131178,272,RC,,,,,,,,both,,,16548.4900,2482.2700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",16548.49,,,,,,,4271.1700,16548.4900,percent of total billed charges,"100% of $16,548.49 in Billed Charges for Rev 272 = $16,548.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER 28MM W/3.5MM STAPLES SURPASS SEE LN 131178,272,RC,,,,,,,,both,,,16548.4900,2482.2700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8274.25,,,,,,,4271.1700,16548.4900,percent of total billed charges,"Rev 272 $16,548.49 in Billed Charges at 50% = $8,274.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER 28MM W/3.5MM STAPLES SURPASS SEE LN 131178,272,RC,,,,,,,,both,,,16548.4900,2482.2700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5345.16,,,,,,,4271.1700,16548.4900,other,"32.3% of $16,548.49 in Billed Charges for Rev 272 = $5,345.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER 28MM W/3.5MM STAPLES SURPASS SEE LN 131178,272,RC,,,,,,,,both,,,16548.4900,2482.2700,UNITED HEALTHCARE,UHC HERITAGE SELECT,5080.39,,,,,,,4271.1700,16548.4900,other,"30.7% of $16,548.49 in Billed Charges for Rev 272 = $5,080.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER 28MM W/3.5MM STAPLES SURPASS SEE LN 131178,272,RC,,,,,,,,both,,,16548.4900,2482.2700,UNITED HEALTHCARE,UNITED HEALTHCARE,5345.16,,,,,,,4271.1700,16548.4900,percent of total billed charges,"32.3% of $16,548.49 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER 28MM W/3.5MM STAPLES SURPASS SEE LN 131178,272,RC,,,,,,,,both,,,16548.4900,2482.2700,WELLCARE,WELLCARE MEDICAID,16548.49,,,,,,,4271.1700,16548.4900,percent of total billed charges,"100% of $16,548.49 in Billed Charges for Rev 272 = $16,548.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ABSORBABLE INSORB,272,RC,27200002,CDM,,,,,,both,,,854.5200,128.1800,AETNA,AETNA,364.88,,,,,,,220.5500,854.5200,percent of total billed charges,42.7% of $854.52 in Billed Charges for Rev 272 = $364.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER ABSORBABLE INSORB,272,RC,27200002,CDM,,,,,,both,,,854.5200,128.1800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,598.16,,,,,,,220.5500,854.5200,percent of total billed charges,Rev 272 $854.52 in Billed Charges at 70% = $598.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER ABSORBABLE INSORB,272,RC,27200002,CDM,,,,,,both,,,854.5200,128.1800,CIGNA HEALTHCARE,CIGNA HMO,356.33,,,,,,,220.5500,854.5200,percent of total billed charges,41.7% of $854.52 in Billed Charges for Rev 272 = $356.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER ABSORBABLE INSORB,272,RC,27200002,CDM,,,,,,both,,,854.5200,128.1800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,396.50,,,,,,,220.5500,854.5200,percent of total billed charges,46.4% of $854.52 in Billed Charges for Rev 272 = $396.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER ABSORBABLE INSORB,272,RC,27200002,CDM,,,,,,both,,,854.5200,128.1800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,356.33,,,,,,,220.5500,854.5200,percent of total billed charges,41.7% of $854.52 in Billed Charges for Rev 272 = $356.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER ABSORBABLE INSORB,272,RC,27200002,CDM,,,,,,both,,,854.5200,128.1800,CIGNA HEALTHCARE,CIGNA PPO,356.33,,,,,,,220.5500,854.5200,percent of total billed charges,41.7% of $854.52 in Billed Charges for Rev 272 = $356.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER ABSORBABLE INSORB,272,RC,27200002,CDM,,,,,,both,,,854.5200,128.1800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,769.07,,,,,,,220.5500,854.5200,percent of total billed charges,90% of $854.52 in Billed Charges for Rev 272 = $769.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER ABSORBABLE INSORB,272,RC,27200002,CDM,,,,,,both,,,854.5200,128.1800,MEDCOST,MEDCOST VHN,406.67,,,,,,,220.5500,854.5200,percent of total billed charges,47.59% of $854.52 in Billed Charges for Rev 272 = $406.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER ABSORBABLE INSORB,272,RC,27200002,CDM,,,,,,both,,,854.5200,128.1800,SENTARA HEALTH,SENTARA HEALTH,220.55,,,,,,,220.5500,854.5200,percent of total billed charges,25.81% of $854.52 in Billed Charges for Rev 272 = $220.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER ABSORBABLE INSORB,272,RC,27200002,CDM,,,,,,both,,,854.5200,128.1800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",854.52,,,,,,,220.5500,854.5200,percent of total billed charges,100% of $854.52 in Billed Charges for Rev 272 = $854.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER ABSORBABLE INSORB,272,RC,27200002,CDM,,,,,,both,,,854.5200,128.1800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,427.26,,,,,,,220.5500,854.5200,percent of total billed charges,Rev 272 $854.52 in Billed Charges at 50% = $427.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER ABSORBABLE INSORB,272,RC,27200002,CDM,,,,,,both,,,854.5200,128.1800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,276.01,,,,,,,220.5500,854.5200,other,32.3% of $854.52 in Billed Charges for Rev 272 = $276.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER ABSORBABLE INSORB,272,RC,27200002,CDM,,,,,,both,,,854.5200,128.1800,UNITED HEALTHCARE,UHC HERITAGE SELECT,262.34,,,,,,,220.5500,854.5200,other,30.7% of $854.52 in Billed Charges for Rev 272 = $262.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER ABSORBABLE INSORB,272,RC,27200002,CDM,,,,,,both,,,854.5200,128.1800,UNITED HEALTHCARE,UNITED HEALTHCARE,276.01,,,,,,,220.5500,854.5200,percent of total billed charges,32.3% of $854.52 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER ABSORBABLE INSORB,272,RC,27200002,CDM,,,,,,both,,,854.5200,128.1800,WELLCARE,WELLCARE MEDICAID,854.52,,,,,,,220.5500,854.5200,percent of total billed charges,100% of $854.52 in Billed Charges for Rev 272 = $854.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER ANVIL CIRCLE 25MM,272,RC,,,,,,,,both,,,3919.8200,587.9700,AETNA,AETNA,1673.76,,,,,,,1011.7100,3919.8200,percent of total billed charges,"42.7% of $3,919.82 in Billed Charges for Rev 272 = $1,673.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 25MM,272,RC,,,,,,,,both,,,3919.8200,587.9700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2743.87,,,,,,,1011.7100,3919.8200,percent of total billed charges,"Rev 272 $3,919.82 in Billed Charges at 70% = $2,743.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 25MM,272,RC,,,,,,,,both,,,3919.8200,587.9700,CIGNA HEALTHCARE,CIGNA HMO,1634.56,,,,,,,1011.7100,3919.8200,percent of total billed charges,"41.7% of $3,919.82 in Billed Charges for Rev 272 = $1,634.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 25MM,272,RC,,,,,,,,both,,,3919.8200,587.9700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1818.80,,,,,,,1011.7100,3919.8200,percent of total billed charges,"46.4% of $3,919.82 in Billed Charges for Rev 272 = $1,818.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 25MM,272,RC,,,,,,,,both,,,3919.8200,587.9700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1634.56,,,,,,,1011.7100,3919.8200,percent of total billed charges,"41.7% of $3,919.82 in Billed Charges for Rev 272 = $1,634.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 25MM,272,RC,,,,,,,,both,,,3919.8200,587.9700,CIGNA HEALTHCARE,CIGNA PPO,1634.56,,,,,,,1011.7100,3919.8200,percent of total billed charges,"41.7% of $3,919.82 in Billed Charges for Rev 272 = $1,634.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 25MM,272,RC,,,,,,,,both,,,3919.8200,587.9700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3527.84,,,,,,,1011.7100,3919.8200,percent of total billed charges,"90% of $3,919.82 in Billed Charges for Rev 272 = $3,527.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 25MM,272,RC,,,,,,,,both,,,3919.8200,587.9700,MEDCOST,MEDCOST VHN,1865.44,,,,,,,1011.7100,3919.8200,percent of total billed charges,"47.59% of $3,919.82 in Billed Charges for Rev 272 = $1,865.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 25MM,272,RC,,,,,,,,both,,,3919.8200,587.9700,SENTARA HEALTH,SENTARA HEALTH,1011.71,,,,,,,1011.7100,3919.8200,percent of total billed charges,"25.81% of $3,919.82 in Billed Charges for Rev 272 = $1,011.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 25MM,272,RC,,,,,,,,both,,,3919.8200,587.9700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3919.82,,,,,,,1011.7100,3919.8200,percent of total billed charges,"100% of $3,919.82 in Billed Charges for Rev 272 = $3,919.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 25MM,272,RC,,,,,,,,both,,,3919.8200,587.9700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1959.91,,,,,,,1011.7100,3919.8200,percent of total billed charges,"Rev 272 $3,919.82 in Billed Charges at 50% = $1,959.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 25MM,272,RC,,,,,,,,both,,,3919.8200,587.9700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1266.10,,,,,,,1011.7100,3919.8200,other,"32.3% of $3,919.82 in Billed Charges for Rev 272 = $1,266.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ANVIL CIRCLE 25MM,272,RC,,,,,,,,both,,,3919.8200,587.9700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1203.38,,,,,,,1011.7100,3919.8200,other,"30.7% of $3,919.82 in Billed Charges for Rev 272 = $1,203.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ANVIL CIRCLE 25MM,272,RC,,,,,,,,both,,,3919.8200,587.9700,UNITED HEALTHCARE,UNITED HEALTHCARE,1266.10,,,,,,,1011.7100,3919.8200,percent of total billed charges,"32.3% of $3,919.82 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 25MM,272,RC,,,,,,,,both,,,3919.8200,587.9700,WELLCARE,WELLCARE MEDICAID,3919.82,,,,,,,1011.7100,3919.8200,percent of total billed charges,"100% of $3,919.82 in Billed Charges for Rev 272 = $3,919.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR,272,RC,27200002,CDM,,,,,,both,,,1539.1600,230.8700,AETNA,AETNA,657.22,,,,,,,397.2600,1539.1600,percent of total billed charges,"42.7% of $1,539.16 in Billed Charges for Rev 272 = $657.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR,272,RC,27200002,CDM,,,,,,both,,,1539.1600,230.8700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1077.41,,,,,,,397.2600,1539.1600,percent of total billed charges,"Rev 272 $1,539.16 in Billed Charges at 70% = $1,077.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR,272,RC,27200002,CDM,,,,,,both,,,1539.1600,230.8700,CIGNA HEALTHCARE,CIGNA HMO,641.83,,,,,,,397.2600,1539.1600,percent of total billed charges,"41.7% of $1,539.16 in Billed Charges for Rev 272 = $641.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR,272,RC,27200002,CDM,,,,,,both,,,1539.1600,230.8700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,714.17,,,,,,,397.2600,1539.1600,percent of total billed charges,"46.4% of $1,539.16 in Billed Charges for Rev 272 = $714.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR,272,RC,27200002,CDM,,,,,,both,,,1539.1600,230.8700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,641.83,,,,,,,397.2600,1539.1600,percent of total billed charges,"41.7% of $1,539.16 in Billed Charges for Rev 272 = $641.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR,272,RC,27200002,CDM,,,,,,both,,,1539.1600,230.8700,CIGNA HEALTHCARE,CIGNA PPO,641.83,,,,,,,397.2600,1539.1600,percent of total billed charges,"41.7% of $1,539.16 in Billed Charges for Rev 272 = $641.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR,272,RC,27200002,CDM,,,,,,both,,,1539.1600,230.8700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1385.24,,,,,,,397.2600,1539.1600,percent of total billed charges,"90% of $1,539.16 in Billed Charges for Rev 272 = $1,385.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR,272,RC,27200002,CDM,,,,,,both,,,1539.1600,230.8700,MEDCOST,MEDCOST VHN,732.49,,,,,,,397.2600,1539.1600,percent of total billed charges,"47.59% of $1,539.16 in Billed Charges for Rev 272 = $732.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR,272,RC,27200002,CDM,,,,,,both,,,1539.1600,230.8700,SENTARA HEALTH,SENTARA HEALTH,397.26,,,,,,,397.2600,1539.1600,percent of total billed charges,"25.81% of $1,539.16 in Billed Charges for Rev 272 = $397.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR,272,RC,27200002,CDM,,,,,,both,,,1539.1600,230.8700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1539.16,,,,,,,397.2600,1539.1600,percent of total billed charges,"100% of $1,539.16 in Billed Charges for Rev 272 = $1,539.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR,272,RC,27200002,CDM,,,,,,both,,,1539.1600,230.8700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,769.58,,,,,,,397.2600,1539.1600,percent of total billed charges,"Rev 272 $1,539.16 in Billed Charges at 50% = $769.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR,272,RC,27200002,CDM,,,,,,both,,,1539.1600,230.8700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,497.15,,,,,,,397.2600,1539.1600,other,"32.3% of $1,539.16 in Billed Charges for Rev 272 = $497.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE BIPOLAR,272,RC,27200002,CDM,,,,,,both,,,1539.1600,230.8700,UNITED HEALTHCARE,UHC HERITAGE SELECT,472.52,,,,,,,397.2600,1539.1600,other,"30.7% of $1,539.16 in Billed Charges for Rev 272 = $472.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE BIPOLAR,272,RC,27200002,CDM,,,,,,both,,,1539.1600,230.8700,UNITED HEALTHCARE,UNITED HEALTHCARE,497.15,,,,,,,397.2600,1539.1600,percent of total billed charges,"32.3% of $1,539.16 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR,272,RC,27200002,CDM,,,,,,both,,,1539.1600,230.8700,WELLCARE,WELLCARE MEDICAID,1539.16,,,,,,,397.2600,1539.1600,percent of total billed charges,"100% of $1,539.16 in Billed Charges for Rev 272 = $1,539.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,16178.7600,2426.8100,AETNA,AETNA,6908.33,,,,,,,4175.7400,16178.7600,percent of total billed charges,"42.7% of $16,178.76 in Billed Charges for Rev 272 = $6,908.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,16178.7600,2426.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11325.13,,,,,,,4175.7400,16178.7600,percent of total billed charges,"Rev 272 $16,178.76 in Billed Charges at 70% = $11,325.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,16178.7600,2426.8100,CIGNA HEALTHCARE,CIGNA HMO,6746.54,,,,,,,4175.7400,16178.7600,percent of total billed charges,"41.7% of $16,178.76 in Billed Charges for Rev 272 = $6,746.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,16178.7600,2426.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7506.94,,,,,,,4175.7400,16178.7600,percent of total billed charges,"46.4% of $16,178.76 in Billed Charges for Rev 272 = $7,506.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,16178.7600,2426.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6746.54,,,,,,,4175.7400,16178.7600,percent of total billed charges,"41.7% of $16,178.76 in Billed Charges for Rev 272 = $6,746.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,16178.7600,2426.8100,CIGNA HEALTHCARE,CIGNA PPO,6746.54,,,,,,,4175.7400,16178.7600,percent of total billed charges,"41.7% of $16,178.76 in Billed Charges for Rev 272 = $6,746.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,16178.7600,2426.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,14560.88,,,,,,,4175.7400,16178.7600,percent of total billed charges,"90% of $16,178.76 in Billed Charges for Rev 272 = $14,560.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,16178.7600,2426.8100,MEDCOST,MEDCOST VHN,7699.47,,,,,,,4175.7400,16178.7600,percent of total billed charges,"47.59% of $16,178.76 in Billed Charges for Rev 272 = $7,699.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,16178.7600,2426.8100,SENTARA HEALTH,SENTARA HEALTH,4175.74,,,,,,,4175.7400,16178.7600,percent of total billed charges,"25.81% of $16,178.76 in Billed Charges for Rev 272 = $4,175.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,16178.7600,2426.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",16178.76,,,,,,,4175.7400,16178.7600,percent of total billed charges,"100% of $16,178.76 in Billed Charges for Rev 272 = $16,178.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,16178.7600,2426.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8089.38,,,,,,,4175.7400,16178.7600,percent of total billed charges,"Rev 272 $16,178.76 in Billed Charges at 50% = $8,089.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,16178.7600,2426.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5225.74,,,,,,,4175.7400,16178.7600,other,"32.3% of $16,178.76 in Billed Charges for Rev 272 = $5,225.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE BIPOLAR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,16178.7600,2426.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,4966.88,,,,,,,4175.7400,16178.7600,other,"30.7% of $16,178.76 in Billed Charges for Rev 272 = $4,966.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE BIPOLAR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,16178.7600,2426.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,5225.74,,,,,,,4175.7400,16178.7600,percent of total billed charges,"32.3% of $16,178.76 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE BIPOLAR DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,16178.7600,2426.8100,WELLCARE,WELLCARE MEDICAID,16178.76,,,,,,,4175.7400,16178.7600,percent of total billed charges,"100% of $16,178.76 in Billed Charges for Rev 272 = $16,178.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE CONSTANT WAVE G,272,RC,27200002,CDM,,,,,,both,,,2506.3300,375.9500,AETNA,AETNA,1070.20,,,,,,,646.8800,2506.3300,percent of total billed charges,"42.7% of $2,506.33 in Billed Charges for Rev 272 = $1,070.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE CONSTANT WAVE G,272,RC,27200002,CDM,,,,,,both,,,2506.3300,375.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1754.43,,,,,,,646.8800,2506.3300,percent of total billed charges,"Rev 272 $2,506.33 in Billed Charges at 70% = $1,754.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE CONSTANT WAVE G,272,RC,27200002,CDM,,,,,,both,,,2506.3300,375.9500,CIGNA HEALTHCARE,CIGNA HMO,1045.14,,,,,,,646.8800,2506.3300,percent of total billed charges,"41.7% of $2,506.33 in Billed Charges for Rev 272 = $1,045.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE CONSTANT WAVE G,272,RC,27200002,CDM,,,,,,both,,,2506.3300,375.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1162.94,,,,,,,646.8800,2506.3300,percent of total billed charges,"46.4% of $2,506.33 in Billed Charges for Rev 272 = $1,162.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE CONSTANT WAVE G,272,RC,27200002,CDM,,,,,,both,,,2506.3300,375.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1045.14,,,,,,,646.8800,2506.3300,percent of total billed charges,"41.7% of $2,506.33 in Billed Charges for Rev 272 = $1,045.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE CONSTANT WAVE G,272,RC,27200002,CDM,,,,,,both,,,2506.3300,375.9500,CIGNA HEALTHCARE,CIGNA PPO,1045.14,,,,,,,646.8800,2506.3300,percent of total billed charges,"41.7% of $2,506.33 in Billed Charges for Rev 272 = $1,045.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE CONSTANT WAVE G,272,RC,27200002,CDM,,,,,,both,,,2506.3300,375.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2255.70,,,,,,,646.8800,2506.3300,percent of total billed charges,"90% of $2,506.33 in Billed Charges for Rev 272 = $2,255.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE CONSTANT WAVE G,272,RC,27200002,CDM,,,,,,both,,,2506.3300,375.9500,MEDCOST,MEDCOST VHN,1192.76,,,,,,,646.8800,2506.3300,percent of total billed charges,"47.59% of $2,506.33 in Billed Charges for Rev 272 = $1,192.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE CONSTANT WAVE G,272,RC,27200002,CDM,,,,,,both,,,2506.3300,375.9500,SENTARA HEALTH,SENTARA HEALTH,646.88,,,,,,,646.8800,2506.3300,percent of total billed charges,"25.81% of $2,506.33 in Billed Charges for Rev 272 = $646.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE CONSTANT WAVE G,272,RC,27200002,CDM,,,,,,both,,,2506.3300,375.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2506.33,,,,,,,646.8800,2506.3300,percent of total billed charges,"100% of $2,506.33 in Billed Charges for Rev 272 = $2,506.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE CONSTANT WAVE G,272,RC,27200002,CDM,,,,,,both,,,2506.3300,375.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1253.17,,,,,,,646.8800,2506.3300,percent of total billed charges,"Rev 272 $2,506.33 in Billed Charges at 50% = $1,253.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE CONSTANT WAVE G,272,RC,27200002,CDM,,,,,,both,,,2506.3300,375.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,809.54,,,,,,,646.8800,2506.3300,other,"32.3% of $2,506.33 in Billed Charges for Rev 272 = $809.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE CONSTANT WAVE G,272,RC,27200002,CDM,,,,,,both,,,2506.3300,375.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,769.44,,,,,,,646.8800,2506.3300,other,"30.7% of $2,506.33 in Billed Charges for Rev 272 = $769.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE CONSTANT WAVE G,272,RC,27200002,CDM,,,,,,both,,,2506.3300,375.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,809.54,,,,,,,646.8800,2506.3300,percent of total billed charges,"32.3% of $2,506.33 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE CONSTANT WAVE G,272,RC,27200002,CDM,,,,,,both,,,2506.3300,375.9500,WELLCARE,WELLCARE MEDICAID,2506.33,,,,,,,646.8800,2506.3300,percent of total billed charges,"100% of $2,506.33 in Billed Charges for Rev 272 = $2,506.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW 17.4CML,272,RC,27200002,CDM,,,,,,both,,,5496.6300,824.4900,AETNA,AETNA,2347.06,,,,,,,1418.6800,5496.6300,percent of total billed charges,"42.7% of $5,496.63 in Billed Charges for Rev 272 = $2,347.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW 17.4CML,272,RC,27200002,CDM,,,,,,both,,,5496.6300,824.4900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3847.64,,,,,,,1418.6800,5496.6300,percent of total billed charges,"Rev 272 $5,496.63 in Billed Charges at 70% = $3,847.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW 17.4CML,272,RC,27200002,CDM,,,,,,both,,,5496.6300,824.4900,CIGNA HEALTHCARE,CIGNA HMO,2292.09,,,,,,,1418.6800,5496.6300,percent of total billed charges,"41.7% of $5,496.63 in Billed Charges for Rev 272 = $2,292.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW 17.4CML,272,RC,27200002,CDM,,,,,,both,,,5496.6300,824.4900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2550.44,,,,,,,1418.6800,5496.6300,percent of total billed charges,"46.4% of $5,496.63 in Billed Charges for Rev 272 = $2,550.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW 17.4CML,272,RC,27200002,CDM,,,,,,both,,,5496.6300,824.4900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2292.09,,,,,,,1418.6800,5496.6300,percent of total billed charges,"41.7% of $5,496.63 in Billed Charges for Rev 272 = $2,292.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW 17.4CML,272,RC,27200002,CDM,,,,,,both,,,5496.6300,824.4900,CIGNA HEALTHCARE,CIGNA PPO,2292.09,,,,,,,1418.6800,5496.6300,percent of total billed charges,"41.7% of $5,496.63 in Billed Charges for Rev 272 = $2,292.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW 17.4CML,272,RC,27200002,CDM,,,,,,both,,,5496.6300,824.4900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4946.97,,,,,,,1418.6800,5496.6300,percent of total billed charges,"90% of $5,496.63 in Billed Charges for Rev 272 = $4,946.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW 17.4CML,272,RC,27200002,CDM,,,,,,both,,,5496.6300,824.4900,MEDCOST,MEDCOST VHN,2615.85,,,,,,,1418.6800,5496.6300,percent of total billed charges,"47.59% of $5,496.63 in Billed Charges for Rev 272 = $2,615.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW 17.4CML,272,RC,27200002,CDM,,,,,,both,,,5496.6300,824.4900,SENTARA HEALTH,SENTARA HEALTH,1418.68,,,,,,,1418.6800,5496.6300,percent of total billed charges,"25.81% of $5,496.63 in Billed Charges for Rev 272 = $1,418.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW 17.4CML,272,RC,27200002,CDM,,,,,,both,,,5496.6300,824.4900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5496.63,,,,,,,1418.6800,5496.6300,percent of total billed charges,"100% of $5,496.63 in Billed Charges for Rev 272 = $5,496.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW 17.4CML,272,RC,27200002,CDM,,,,,,both,,,5496.6300,824.4900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2748.32,,,,,,,1418.6800,5496.6300,percent of total billed charges,"Rev 272 $5,496.63 in Billed Charges at 50% = $2,748.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW 17.4CML,272,RC,27200002,CDM,,,,,,both,,,5496.6300,824.4900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1775.41,,,,,,,1418.6800,5496.6300,other,"32.3% of $5,496.63 in Billed Charges for Rev 272 = $1,775.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE DOPPLER FLOW 17.4CML,272,RC,27200002,CDM,,,,,,both,,,5496.6300,824.4900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1687.47,,,,,,,1418.6800,5496.6300,other,"30.7% of $5,496.63 in Billed Charges for Rev 272 = $1,687.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PROBE DOPPLER FLOW 17.4CML,272,RC,27200002,CDM,,,,,,both,,,5496.6300,824.4900,UNITED HEALTHCARE,UNITED HEALTHCARE,1775.41,,,,,,,1418.6800,5496.6300,percent of total billed charges,"32.3% of $5,496.63 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PROBE DOPPLER FLOW 17.4CML,272,RC,27200002,CDM,,,,,,both,,,5496.6300,824.4900,WELLCARE,WELLCARE MEDICAID,5496.63,,,,,,,1418.6800,5496.6300,percent of total billed charges,"100% of $5,496.63 in Billed Charges for Rev 272 = $5,496.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON CONTOUR CURVED CUTTER  WITH BLUE RELOAD 40MM,272,RC,27200002,CDM,,,,,,both,,,5225.2600,783.7900,AETNA,AETNA,2231.19,,,,,,,1348.6400,5225.2600,percent of total billed charges,"42.7% of $5,225.26 in Billed Charges for Rev 272 = $2,231.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON CONTOUR CURVED CUTTER  WITH BLUE RELOAD 40MM,272,RC,27200002,CDM,,,,,,both,,,5225.2600,783.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3657.68,,,,,,,1348.6400,5225.2600,percent of total billed charges,"Rev 272 $5,225.26 in Billed Charges at 70% = $3,657.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON CONTOUR CURVED CUTTER  WITH BLUE RELOAD 40MM,272,RC,27200002,CDM,,,,,,both,,,5225.2600,783.7900,CIGNA HEALTHCARE,CIGNA HMO,2178.93,,,,,,,1348.6400,5225.2600,percent of total billed charges,"41.7% of $5,225.26 in Billed Charges for Rev 272 = $2,178.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON CONTOUR CURVED CUTTER  WITH BLUE RELOAD 40MM,272,RC,27200002,CDM,,,,,,both,,,5225.2600,783.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2424.52,,,,,,,1348.6400,5225.2600,percent of total billed charges,"46.4% of $5,225.26 in Billed Charges for Rev 272 = $2,424.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON CONTOUR CURVED CUTTER  WITH BLUE RELOAD 40MM,272,RC,27200002,CDM,,,,,,both,,,5225.2600,783.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2178.93,,,,,,,1348.6400,5225.2600,percent of total billed charges,"41.7% of $5,225.26 in Billed Charges for Rev 272 = $2,178.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON CONTOUR CURVED CUTTER  WITH BLUE RELOAD 40MM,272,RC,27200002,CDM,,,,,,both,,,5225.2600,783.7900,CIGNA HEALTHCARE,CIGNA PPO,2178.93,,,,,,,1348.6400,5225.2600,percent of total billed charges,"41.7% of $5,225.26 in Billed Charges for Rev 272 = $2,178.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON CONTOUR CURVED CUTTER  WITH BLUE RELOAD 40MM,272,RC,27200002,CDM,,,,,,both,,,5225.2600,783.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4702.73,,,,,,,1348.6400,5225.2600,percent of total billed charges,"90% of $5,225.26 in Billed Charges for Rev 272 = $4,702.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON CONTOUR CURVED CUTTER  WITH BLUE RELOAD 40MM,272,RC,27200002,CDM,,,,,,both,,,5225.2600,783.7900,MEDCOST,MEDCOST VHN,2486.70,,,,,,,1348.6400,5225.2600,percent of total billed charges,"47.59% of $5,225.26 in Billed Charges for Rev 272 = $2,486.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON CONTOUR CURVED CUTTER  WITH BLUE RELOAD 40MM,272,RC,27200002,CDM,,,,,,both,,,5225.2600,783.7900,SENTARA HEALTH,SENTARA HEALTH,1348.64,,,,,,,1348.6400,5225.2600,percent of total billed charges,"25.81% of $5,225.26 in Billed Charges for Rev 272 = $1,348.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON CONTOUR CURVED CUTTER  WITH BLUE RELOAD 40MM,272,RC,27200002,CDM,,,,,,both,,,5225.2600,783.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5225.26,,,,,,,1348.6400,5225.2600,percent of total billed charges,"100% of $5,225.26 in Billed Charges for Rev 272 = $5,225.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON CONTOUR CURVED CUTTER  WITH BLUE RELOAD 40MM,272,RC,27200002,CDM,,,,,,both,,,5225.2600,783.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2612.63,,,,,,,1348.6400,5225.2600,percent of total billed charges,"Rev 272 $5,225.26 in Billed Charges at 50% = $2,612.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON CONTOUR CURVED CUTTER  WITH BLUE RELOAD 40MM,272,RC,27200002,CDM,,,,,,both,,,5225.2600,783.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1687.76,,,,,,,1348.6400,5225.2600,other,"32.3% of $5,225.26 in Billed Charges for Rev 272 = $1,687.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ECHELON CONTOUR CURVED CUTTER  WITH BLUE RELOAD 40MM,272,RC,27200002,CDM,,,,,,both,,,5225.2600,783.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1604.15,,,,,,,1348.6400,5225.2600,other,"30.7% of $5,225.26 in Billed Charges for Rev 272 = $1,604.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ECHELON CONTOUR CURVED CUTTER  WITH BLUE RELOAD 40MM,272,RC,27200002,CDM,,,,,,both,,,5225.2600,783.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,1687.76,,,,,,,1348.6400,5225.2600,percent of total billed charges,"32.3% of $5,225.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON CONTOUR CURVED CUTTER  WITH BLUE RELOAD 40MM,272,RC,27200002,CDM,,,,,,both,,,5225.2600,783.7900,WELLCARE,WELLCARE MEDICAID,5225.26,,,,,,,1348.6400,5225.2600,percent of total billed charges,"100% of $5,225.26 in Billed Charges for Rev 272 = $5,225.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX POWERED VAS W/ADVANCED,272,RC,27200002,CDM,,,,,,both,,,2698.2600,404.7400,AETNA,AETNA,1152.16,,,,,,,696.4200,2698.2600,percent of total billed charges,"42.7% of $2,698.26 in Billed Charges for Rev 272 = $1,152.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX POWERED VAS W/ADVANCED,272,RC,27200002,CDM,,,,,,both,,,2698.2600,404.7400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1888.78,,,,,,,696.4200,2698.2600,percent of total billed charges,"Rev 272 $2,698.26 in Billed Charges at 70% = $1,888.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX POWERED VAS W/ADVANCED,272,RC,27200002,CDM,,,,,,both,,,2698.2600,404.7400,CIGNA HEALTHCARE,CIGNA HMO,1125.17,,,,,,,696.4200,2698.2600,percent of total billed charges,"41.7% of $2,698.26 in Billed Charges for Rev 272 = $1,125.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX POWERED VAS W/ADVANCED,272,RC,27200002,CDM,,,,,,both,,,2698.2600,404.7400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1251.99,,,,,,,696.4200,2698.2600,percent of total billed charges,"46.4% of $2,698.26 in Billed Charges for Rev 272 = $1,251.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX POWERED VAS W/ADVANCED,272,RC,27200002,CDM,,,,,,both,,,2698.2600,404.7400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1125.17,,,,,,,696.4200,2698.2600,percent of total billed charges,"41.7% of $2,698.26 in Billed Charges for Rev 272 = $1,125.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX POWERED VAS W/ADVANCED,272,RC,27200002,CDM,,,,,,both,,,2698.2600,404.7400,CIGNA HEALTHCARE,CIGNA PPO,1125.17,,,,,,,696.4200,2698.2600,percent of total billed charges,"41.7% of $2,698.26 in Billed Charges for Rev 272 = $1,125.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX POWERED VAS W/ADVANCED,272,RC,27200002,CDM,,,,,,both,,,2698.2600,404.7400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2428.43,,,,,,,696.4200,2698.2600,percent of total billed charges,"90% of $2,698.26 in Billed Charges for Rev 272 = $2,428.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX POWERED VAS W/ADVANCED,272,RC,27200002,CDM,,,,,,both,,,2698.2600,404.7400,MEDCOST,MEDCOST VHN,1284.10,,,,,,,696.4200,2698.2600,percent of total billed charges,"47.59% of $2,698.26 in Billed Charges for Rev 272 = $1,284.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX POWERED VAS W/ADVANCED,272,RC,27200002,CDM,,,,,,both,,,2698.2600,404.7400,SENTARA HEALTH,SENTARA HEALTH,696.42,,,,,,,696.4200,2698.2600,percent of total billed charges,"25.81% of $2,698.26 in Billed Charges for Rev 272 = $696.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX POWERED VAS W/ADVANCED,272,RC,27200002,CDM,,,,,,both,,,2698.2600,404.7400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2698.26,,,,,,,696.4200,2698.2600,percent of total billed charges,"100% of $2,698.26 in Billed Charges for Rev 272 = $2,698.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX POWERED VAS W/ADVANCED,272,RC,27200002,CDM,,,,,,both,,,2698.2600,404.7400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1349.13,,,,,,,696.4200,2698.2600,percent of total billed charges,"Rev 272 $2,698.26 in Billed Charges at 50% = $1,349.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX POWERED VAS W/ADVANCED,272,RC,27200002,CDM,,,,,,both,,,2698.2600,404.7400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,871.54,,,,,,,696.4200,2698.2600,other,"32.3% of $2,698.26 in Billed Charges for Rev 272 = $871.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ECHELON FLEX POWERED VAS W/ADVANCED,272,RC,27200002,CDM,,,,,,both,,,2698.2600,404.7400,UNITED HEALTHCARE,UHC HERITAGE SELECT,828.37,,,,,,,696.4200,2698.2600,other,"30.7% of $2,698.26 in Billed Charges for Rev 272 = $828.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ECHELON FLEX POWERED VAS W/ADVANCED,272,RC,27200002,CDM,,,,,,both,,,2698.2600,404.7400,UNITED HEALTHCARE,UNITED HEALTHCARE,871.54,,,,,,,696.4200,2698.2600,percent of total billed charges,"32.3% of $2,698.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ECHELON FLEX POWERED VAS W/ADVANCED,272,RC,27200002,CDM,,,,,,both,,,2698.2600,404.7400,WELLCARE,WELLCARE MEDICAID,2698.26,,,,,,,696.4200,2698.2600,percent of total billed charges,"100% of $2,698.26 in Billed Charges for Rev 272 = $2,698.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULATOR NERVE CHECKPOINT GUARDIAN,272,RC,27200002,CDM,,,,,,both,,,7612.3100,1141.8500,AETNA,AETNA,3250.46,,,,,,,1964.7400,7612.3100,percent of total billed charges,"42.7% of $7,612.31 in Billed Charges for Rev 272 = $3,250.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULATOR NERVE CHECKPOINT GUARDIAN,272,RC,27200002,CDM,,,,,,both,,,7612.3100,1141.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5328.62,,,,,,,1964.7400,7612.3100,percent of total billed charges,"Rev 272 $7,612.31 in Billed Charges at 70% = $5,328.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULATOR NERVE CHECKPOINT GUARDIAN,272,RC,27200002,CDM,,,,,,both,,,7612.3100,1141.8500,CIGNA HEALTHCARE,CIGNA HMO,3174.33,,,,,,,1964.7400,7612.3100,percent of total billed charges,"41.7% of $7,612.31 in Billed Charges for Rev 272 = $3,174.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULATOR NERVE CHECKPOINT GUARDIAN,272,RC,27200002,CDM,,,,,,both,,,7612.3100,1141.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3532.11,,,,,,,1964.7400,7612.3100,percent of total billed charges,"46.4% of $7,612.31 in Billed Charges for Rev 272 = $3,532.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULATOR NERVE CHECKPOINT GUARDIAN,272,RC,27200002,CDM,,,,,,both,,,7612.3100,1141.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3174.33,,,,,,,1964.7400,7612.3100,percent of total billed charges,"41.7% of $7,612.31 in Billed Charges for Rev 272 = $3,174.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULATOR NERVE CHECKPOINT GUARDIAN,272,RC,27200002,CDM,,,,,,both,,,7612.3100,1141.8500,CIGNA HEALTHCARE,CIGNA PPO,3174.33,,,,,,,1964.7400,7612.3100,percent of total billed charges,"41.7% of $7,612.31 in Billed Charges for Rev 272 = $3,174.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULATOR NERVE CHECKPOINT GUARDIAN,272,RC,27200002,CDM,,,,,,both,,,7612.3100,1141.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6851.08,,,,,,,1964.7400,7612.3100,percent of total billed charges,"90% of $7,612.31 in Billed Charges for Rev 272 = $6,851.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULATOR NERVE CHECKPOINT GUARDIAN,272,RC,27200002,CDM,,,,,,both,,,7612.3100,1141.8500,MEDCOST,MEDCOST VHN,3622.70,,,,,,,1964.7400,7612.3100,percent of total billed charges,"47.59% of $7,612.31 in Billed Charges for Rev 272 = $3,622.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULATOR NERVE CHECKPOINT GUARDIAN,272,RC,27200002,CDM,,,,,,both,,,7612.3100,1141.8500,SENTARA HEALTH,SENTARA HEALTH,1964.74,,,,,,,1964.7400,7612.3100,percent of total billed charges,"25.81% of $7,612.31 in Billed Charges for Rev 272 = $1,964.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULATOR NERVE CHECKPOINT GUARDIAN,272,RC,27200002,CDM,,,,,,both,,,7612.3100,1141.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7612.31,,,,,,,1964.7400,7612.3100,percent of total billed charges,"100% of $7,612.31 in Billed Charges for Rev 272 = $7,612.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULATOR NERVE CHECKPOINT GUARDIAN,272,RC,27200002,CDM,,,,,,both,,,7612.3100,1141.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3806.16,,,,,,,1964.7400,7612.3100,percent of total billed charges,"Rev 272 $7,612.31 in Billed Charges at 50% = $3,806.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULATOR NERVE CHECKPOINT GUARDIAN,272,RC,27200002,CDM,,,,,,both,,,7612.3100,1141.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2458.78,,,,,,,1964.7400,7612.3100,other,"32.3% of $7,612.31 in Billed Charges for Rev 272 = $2,458.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STIMULATOR NERVE CHECKPOINT GUARDIAN,272,RC,27200002,CDM,,,,,,both,,,7612.3100,1141.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2336.98,,,,,,,1964.7400,7612.3100,other,"30.7% of $7,612.31 in Billed Charges for Rev 272 = $2,336.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STIMULATOR NERVE CHECKPOINT GUARDIAN,272,RC,27200002,CDM,,,,,,both,,,7612.3100,1141.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,2458.78,,,,,,,1964.7400,7612.3100,percent of total billed charges,"32.3% of $7,612.31 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULATOR NERVE CHECKPOINT GUARDIAN,272,RC,27200002,CDM,,,,,,both,,,7612.3100,1141.8500,WELLCARE,WELLCARE MEDICAID,7612.31,,,,,,,1964.7400,7612.3100,percent of total billed charges,"100% of $7,612.31 in Billed Charges for Rev 272 = $7,612.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STOCKINETTE IMPERVIOUS 14X48,272,RC,27200002,CDM,,,,,,both,,,69.2300,10.3800,AETNA,AETNA,29.56,,,,,,,17.8700,69.2300,percent of total billed charges,42.7% of $69.23 in Billed Charges for Rev 272 = $29.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOCKINETTE IMPERVIOUS 14X48,272,RC,27200002,CDM,,,,,,both,,,69.2300,10.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,48.46,,,,,,,17.8700,69.2300,percent of total billed charges,Rev 272 $69.23 in Billed Charges at 70% = $48.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOCKINETTE IMPERVIOUS 14X48,272,RC,27200002,CDM,,,,,,both,,,69.2300,10.3800,CIGNA HEALTHCARE,CIGNA HMO,28.87,,,,,,,17.8700,69.2300,percent of total billed charges,41.7% of $69.23 in Billed Charges for Rev 272 = $28.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOCKINETTE IMPERVIOUS 14X48,272,RC,27200002,CDM,,,,,,both,,,69.2300,10.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,32.12,,,,,,,17.8700,69.2300,percent of total billed charges,46.4% of $69.23 in Billed Charges for Rev 272 = $32.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOCKINETTE IMPERVIOUS 14X48,272,RC,27200002,CDM,,,,,,both,,,69.2300,10.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,28.87,,,,,,,17.8700,69.2300,percent of total billed charges,41.7% of $69.23 in Billed Charges for Rev 272 = $28.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOCKINETTE IMPERVIOUS 14X48,272,RC,27200002,CDM,,,,,,both,,,69.2300,10.3800,CIGNA HEALTHCARE,CIGNA PPO,28.87,,,,,,,17.8700,69.2300,percent of total billed charges,41.7% of $69.23 in Billed Charges for Rev 272 = $28.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOCKINETTE IMPERVIOUS 14X48,272,RC,27200002,CDM,,,,,,both,,,69.2300,10.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,62.31,,,,,,,17.8700,69.2300,percent of total billed charges,90% of $69.23 in Billed Charges for Rev 272 = $62.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOCKINETTE IMPERVIOUS 14X48,272,RC,27200002,CDM,,,,,,both,,,69.2300,10.3800,MEDCOST,MEDCOST VHN,32.95,,,,,,,17.8700,69.2300,percent of total billed charges,47.59% of $69.23 in Billed Charges for Rev 272 = $32.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOCKINETTE IMPERVIOUS 14X48,272,RC,27200002,CDM,,,,,,both,,,69.2300,10.3800,SENTARA HEALTH,SENTARA HEALTH,17.87,,,,,,,17.8700,69.2300,percent of total billed charges,25.81% of $69.23 in Billed Charges for Rev 272 = $17.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOCKINETTE IMPERVIOUS 14X48,272,RC,27200002,CDM,,,,,,both,,,69.2300,10.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",69.23,,,,,,,17.8700,69.2300,percent of total billed charges,100% of $69.23 in Billed Charges for Rev 272 = $69.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOCKINETTE IMPERVIOUS 14X48,272,RC,27200002,CDM,,,,,,both,,,69.2300,10.3800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,34.62,,,,,,,17.8700,69.2300,percent of total billed charges,Rev 272 $69.23 in Billed Charges at 50% = $34.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOCKINETTE IMPERVIOUS 14X48,272,RC,27200002,CDM,,,,,,both,,,69.2300,10.3800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,22.36,,,,,,,17.8700,69.2300,other,32.3% of $69.23 in Billed Charges for Rev 272 = $22.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STOCKINETTE IMPERVIOUS 14X48,272,RC,27200002,CDM,,,,,,both,,,69.2300,10.3800,UNITED HEALTHCARE,UHC HERITAGE SELECT,21.25,,,,,,,17.8700,69.2300,other,30.7% of $69.23 in Billed Charges for Rev 272 = $21.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STOCKINETTE IMPERVIOUS 14X48,272,RC,27200002,CDM,,,,,,both,,,69.2300,10.3800,UNITED HEALTHCARE,UNITED HEALTHCARE,22.36,,,,,,,17.8700,69.2300,percent of total billed charges,32.3% of $69.23 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOCKINETTE IMPERVIOUS 14X48,272,RC,27200002,CDM,,,,,,both,,,69.2300,10.3800,WELLCARE,WELLCARE MEDICAID,69.23,,,,,,,17.8700,69.2300,percent of total billed charges,100% of $69.23 in Billed Charges for Rev 272 = $69.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOPCOCK 884,272,RC,,,,,,,,both,,,760.4000,114.0600,AETNA,AETNA,324.69,,,,,,,196.2600,760.4000,percent of total billed charges,42.7% of $760.40 in Billed Charges for Rev 272 = $324.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOPCOCK 884,272,RC,,,,,,,,both,,,760.4000,114.0600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,532.28,,,,,,,196.2600,760.4000,percent of total billed charges,Rev 272 $760.40 in Billed Charges at 70% = $532.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOPCOCK 884,272,RC,,,,,,,,both,,,760.4000,114.0600,CIGNA HEALTHCARE,CIGNA HMO,317.09,,,,,,,196.2600,760.4000,percent of total billed charges,41.7% of $760.40 in Billed Charges for Rev 272 = $317.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOPCOCK 884,272,RC,,,,,,,,both,,,760.4000,114.0600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,352.83,,,,,,,196.2600,760.4000,percent of total billed charges,46.4% of $760.40 in Billed Charges for Rev 272 = $352.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOPCOCK 884,272,RC,,,,,,,,both,,,760.4000,114.0600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,317.09,,,,,,,196.2600,760.4000,percent of total billed charges,41.7% of $760.40 in Billed Charges for Rev 272 = $317.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOPCOCK 884,272,RC,,,,,,,,both,,,760.4000,114.0600,CIGNA HEALTHCARE,CIGNA PPO,317.09,,,,,,,196.2600,760.4000,percent of total billed charges,41.7% of $760.40 in Billed Charges for Rev 272 = $317.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOPCOCK 884,272,RC,,,,,,,,both,,,760.4000,114.0600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,684.36,,,,,,,196.2600,760.4000,percent of total billed charges,90% of $760.40 in Billed Charges for Rev 272 = $684.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOPCOCK 884,272,RC,,,,,,,,both,,,760.4000,114.0600,MEDCOST,MEDCOST VHN,361.87,,,,,,,196.2600,760.4000,percent of total billed charges,47.59% of $760.40 in Billed Charges for Rev 272 = $361.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOPCOCK 884,272,RC,,,,,,,,both,,,760.4000,114.0600,SENTARA HEALTH,SENTARA HEALTH,196.26,,,,,,,196.2600,760.4000,percent of total billed charges,25.81% of $760.40 in Billed Charges for Rev 272 = $196.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOPCOCK 884,272,RC,,,,,,,,both,,,760.4000,114.0600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",760.40,,,,,,,196.2600,760.4000,percent of total billed charges,100% of $760.40 in Billed Charges for Rev 272 = $760.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOPCOCK 884,272,RC,,,,,,,,both,,,760.4000,114.0600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,380.20,,,,,,,196.2600,760.4000,percent of total billed charges,Rev 272 $760.40 in Billed Charges at 50% = $380.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOPCOCK 884,272,RC,,,,,,,,both,,,760.4000,114.0600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,245.61,,,,,,,196.2600,760.4000,other,32.3% of $760.40 in Billed Charges for Rev 272 = $245.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STOPCOCK 884,272,RC,,,,,,,,both,,,760.4000,114.0600,UNITED HEALTHCARE,UHC HERITAGE SELECT,233.44,,,,,,,196.2600,760.4000,other,30.7% of $760.40 in Billed Charges for Rev 272 = $233.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STOPCOCK 884,272,RC,,,,,,,,both,,,760.4000,114.0600,UNITED HEALTHCARE,UNITED HEALTHCARE,245.61,,,,,,,196.2600,760.4000,percent of total billed charges,32.3% of $760.40 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOPCOCK 884,272,RC,,,,,,,,both,,,760.4000,114.0600,WELLCARE,WELLCARE MEDICAID,760.40,,,,,,,196.2600,760.4000,percent of total billed charges,100% of $760.40 in Billed Charges for Rev 272 = $760.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STOPCOCK UNIV LUER LOCK,272,RC,27200002,CDM,,,,,,both,,,1445.4100,216.8100,AETNA,AETNA,617.19,,,,,,,373.0600,1445.4100,percent of total billed charges,"42.7% of $1,445.41 in Billed Charges for Rev 272 = $617.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STOPCOCK UNIV LUER LOCK,272,RC,27200002,CDM,,,,,,both,,,1445.4100,216.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1011.79,,,,,,,373.0600,1445.4100,percent of total billed charges,"Rev 272 $1,445.41 in Billed Charges at 70% = $1,011.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STOPCOCK UNIV LUER LOCK,272,RC,27200002,CDM,,,,,,both,,,1445.4100,216.8100,CIGNA HEALTHCARE,CIGNA HMO,602.74,,,,,,,373.0600,1445.4100,percent of total billed charges,"41.7% of $1,445.41 in Billed Charges for Rev 272 = $602.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STOPCOCK UNIV LUER LOCK,272,RC,27200002,CDM,,,,,,both,,,1445.4100,216.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,670.67,,,,,,,373.0600,1445.4100,percent of total billed charges,"46.4% of $1,445.41 in Billed Charges for Rev 272 = $670.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STOPCOCK UNIV LUER LOCK,272,RC,27200002,CDM,,,,,,both,,,1445.4100,216.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,602.74,,,,,,,373.0600,1445.4100,percent of total billed charges,"41.7% of $1,445.41 in Billed Charges for Rev 272 = $602.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STOPCOCK UNIV LUER LOCK,272,RC,27200002,CDM,,,,,,both,,,1445.4100,216.8100,CIGNA HEALTHCARE,CIGNA PPO,602.74,,,,,,,373.0600,1445.4100,percent of total billed charges,"41.7% of $1,445.41 in Billed Charges for Rev 272 = $602.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STOPCOCK UNIV LUER LOCK,272,RC,27200002,CDM,,,,,,both,,,1445.4100,216.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1300.87,,,,,,,373.0600,1445.4100,percent of total billed charges,"90% of $1,445.41 in Billed Charges for Rev 272 = $1,300.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STOPCOCK UNIV LUER LOCK,272,RC,27200002,CDM,,,,,,both,,,1445.4100,216.8100,MEDCOST,MEDCOST VHN,687.87,,,,,,,373.0600,1445.4100,percent of total billed charges,"47.59% of $1,445.41 in Billed Charges for Rev 272 = $687.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STOPCOCK UNIV LUER LOCK,272,RC,27200002,CDM,,,,,,both,,,1445.4100,216.8100,SENTARA HEALTH,SENTARA HEALTH,373.06,,,,,,,373.0600,1445.4100,percent of total billed charges,"25.81% of $1,445.41 in Billed Charges for Rev 272 = $373.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STOPCOCK UNIV LUER LOCK,272,RC,27200002,CDM,,,,,,both,,,1445.4100,216.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1445.41,,,,,,,373.0600,1445.4100,percent of total billed charges,"100% of $1,445.41 in Billed Charges for Rev 272 = $1,445.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STOPCOCK UNIV LUER LOCK,272,RC,27200002,CDM,,,,,,both,,,1445.4100,216.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,722.71,,,,,,,373.0600,1445.4100,percent of total billed charges,"Rev 272 $1,445.41 in Billed Charges at 50% = $722.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STOPCOCK UNIV LUER LOCK,272,RC,27200002,CDM,,,,,,both,,,1445.4100,216.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,466.87,,,,,,,373.0600,1445.4100,other,"32.3% of $1,445.41 in Billed Charges for Rev 272 = $466.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STOPCOCK UNIV LUER LOCK,272,RC,27200002,CDM,,,,,,both,,,1445.4100,216.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,443.74,,,,,,,373.0600,1445.4100,other,"30.7% of $1,445.41 in Billed Charges for Rev 272 = $443.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STOPCOCK UNIV LUER LOCK,272,RC,27200002,CDM,,,,,,both,,,1445.4100,216.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,466.87,,,,,,,373.0600,1445.4100,percent of total billed charges,"32.3% of $1,445.41 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STOPCOCK UNIV LUER LOCK,272,RC,27200002,CDM,,,,,,both,,,1445.4100,216.8100,WELLCARE,WELLCARE MEDICAID,1445.41,,,,,,,373.0600,1445.4100,percent of total billed charges,"100% of $1,445.41 in Billed Charges for Rev 272 = $1,445.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER METATARSAL 22MM,272,RC,27200002,CDM,,,,,,both,,,4900.3000,735.0500,AETNA,AETNA,2092.43,,,,,,,1264.7700,4900.3000,percent of total billed charges,"42.7% of $4,900.30 in Billed Charges for Rev 272 = $2,092.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER METATARSAL 22MM,272,RC,27200002,CDM,,,,,,both,,,4900.3000,735.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3430.21,,,,,,,1264.7700,4900.3000,percent of total billed charges,"Rev 272 $4,900.30 in Billed Charges at 70% = $3,430.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER METATARSAL 22MM,272,RC,27200002,CDM,,,,,,both,,,4900.3000,735.0500,CIGNA HEALTHCARE,CIGNA HMO,2043.43,,,,,,,1264.7700,4900.3000,percent of total billed charges,"41.7% of $4,900.30 in Billed Charges for Rev 272 = $2,043.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER METATARSAL 22MM,272,RC,27200002,CDM,,,,,,both,,,4900.3000,735.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2273.74,,,,,,,1264.7700,4900.3000,percent of total billed charges,"46.4% of $4,900.30 in Billed Charges for Rev 272 = $2,273.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER METATARSAL 22MM,272,RC,27200002,CDM,,,,,,both,,,4900.3000,735.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2043.43,,,,,,,1264.7700,4900.3000,percent of total billed charges,"41.7% of $4,900.30 in Billed Charges for Rev 272 = $2,043.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER METATARSAL 22MM,272,RC,27200002,CDM,,,,,,both,,,4900.3000,735.0500,CIGNA HEALTHCARE,CIGNA PPO,2043.43,,,,,,,1264.7700,4900.3000,percent of total billed charges,"41.7% of $4,900.30 in Billed Charges for Rev 272 = $2,043.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER METATARSAL 22MM,272,RC,27200002,CDM,,,,,,both,,,4900.3000,735.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4410.27,,,,,,,1264.7700,4900.3000,percent of total billed charges,"90% of $4,900.30 in Billed Charges for Rev 272 = $4,410.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER METATARSAL 22MM,272,RC,27200002,CDM,,,,,,both,,,4900.3000,735.0500,MEDCOST,MEDCOST VHN,2332.05,,,,,,,1264.7700,4900.3000,percent of total billed charges,"47.59% of $4,900.30 in Billed Charges for Rev 272 = $2,332.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER METATARSAL 22MM,272,RC,27200002,CDM,,,,,,both,,,4900.3000,735.0500,SENTARA HEALTH,SENTARA HEALTH,1264.77,,,,,,,1264.7700,4900.3000,percent of total billed charges,"25.81% of $4,900.30 in Billed Charges for Rev 272 = $1,264.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER METATARSAL 22MM,272,RC,27200002,CDM,,,,,,both,,,4900.3000,735.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4900.30,,,,,,,1264.7700,4900.3000,percent of total billed charges,"100% of $4,900.30 in Billed Charges for Rev 272 = $4,900.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER METATARSAL 22MM,272,RC,27200002,CDM,,,,,,both,,,4900.3000,735.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2450.15,,,,,,,1264.7700,4900.3000,percent of total billed charges,"Rev 272 $4,900.30 in Billed Charges at 50% = $2,450.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER METATARSAL 22MM,272,RC,27200002,CDM,,,,,,both,,,4900.3000,735.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1582.80,,,,,,,1264.7700,4900.3000,other,"32.3% of $4,900.30 in Billed Charges for Rev 272 = $1,582.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
REAMER METATARSAL 22MM,272,RC,27200002,CDM,,,,,,both,,,4900.3000,735.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1504.39,,,,,,,1264.7700,4900.3000,other,"30.7% of $4,900.30 in Billed Charges for Rev 272 = $1,504.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
REAMER METATARSAL 22MM,272,RC,27200002,CDM,,,,,,both,,,4900.3000,735.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,1582.80,,,,,,,1264.7700,4900.3000,percent of total billed charges,"32.3% of $4,900.30 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER METATARSAL 22MM,272,RC,27200002,CDM,,,,,,both,,,4900.3000,735.0500,WELLCARE,WELLCARE MEDICAID,4900.30,,,,,,,1264.7700,4900.3000,percent of total billed charges,"100% of $4,900.30 in Billed Charges for Rev 272 = $4,900.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STRIP SKIN CLOSURE 8CM SURGICAL,272,RC,27200002,CDM,,,,,,both,,,736.4400,110.4700,AETNA,AETNA,314.46,,,,,,,190.0800,736.4400,percent of total billed charges,42.7% of $736.44 in Billed Charges for Rev 272 = $314.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRIP SKIN CLOSURE 8CM SURGICAL,272,RC,27200002,CDM,,,,,,both,,,736.4400,110.4700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,515.51,,,,,,,190.0800,736.4400,percent of total billed charges,Rev 272 $736.44 in Billed Charges at 70% = $515.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRIP SKIN CLOSURE 8CM SURGICAL,272,RC,27200002,CDM,,,,,,both,,,736.4400,110.4700,CIGNA HEALTHCARE,CIGNA HMO,307.10,,,,,,,190.0800,736.4400,percent of total billed charges,41.7% of $736.44 in Billed Charges for Rev 272 = $307.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRIP SKIN CLOSURE 8CM SURGICAL,272,RC,27200002,CDM,,,,,,both,,,736.4400,110.4700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,341.71,,,,,,,190.0800,736.4400,percent of total billed charges,46.4% of $736.44 in Billed Charges for Rev 272 = $341.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRIP SKIN CLOSURE 8CM SURGICAL,272,RC,27200002,CDM,,,,,,both,,,736.4400,110.4700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,307.10,,,,,,,190.0800,736.4400,percent of total billed charges,41.7% of $736.44 in Billed Charges for Rev 272 = $307.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRIP SKIN CLOSURE 8CM SURGICAL,272,RC,27200002,CDM,,,,,,both,,,736.4400,110.4700,CIGNA HEALTHCARE,CIGNA PPO,307.10,,,,,,,190.0800,736.4400,percent of total billed charges,41.7% of $736.44 in Billed Charges for Rev 272 = $307.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRIP SKIN CLOSURE 8CM SURGICAL,272,RC,27200002,CDM,,,,,,both,,,736.4400,110.4700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,662.80,,,,,,,190.0800,736.4400,percent of total billed charges,90% of $736.44 in Billed Charges for Rev 272 = $662.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRIP SKIN CLOSURE 8CM SURGICAL,272,RC,27200002,CDM,,,,,,both,,,736.4400,110.4700,MEDCOST,MEDCOST VHN,350.47,,,,,,,190.0800,736.4400,percent of total billed charges,47.59% of $736.44 in Billed Charges for Rev 272 = $350.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRIP SKIN CLOSURE 8CM SURGICAL,272,RC,27200002,CDM,,,,,,both,,,736.4400,110.4700,SENTARA HEALTH,SENTARA HEALTH,190.08,,,,,,,190.0800,736.4400,percent of total billed charges,25.81% of $736.44 in Billed Charges for Rev 272 = $190.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRIP SKIN CLOSURE 8CM SURGICAL,272,RC,27200002,CDM,,,,,,both,,,736.4400,110.4700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",736.44,,,,,,,190.0800,736.4400,percent of total billed charges,100% of $736.44 in Billed Charges for Rev 272 = $736.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRIP SKIN CLOSURE 8CM SURGICAL,272,RC,27200002,CDM,,,,,,both,,,736.4400,110.4700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,368.22,,,,,,,190.0800,736.4400,percent of total billed charges,Rev 272 $736.44 in Billed Charges at 50% = $368.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRIP SKIN CLOSURE 8CM SURGICAL,272,RC,27200002,CDM,,,,,,both,,,736.4400,110.4700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,237.87,,,,,,,190.0800,736.4400,other,32.3% of $736.44 in Billed Charges for Rev 272 = $237.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STRIP SKIN CLOSURE 8CM SURGICAL,272,RC,27200002,CDM,,,,,,both,,,736.4400,110.4700,UNITED HEALTHCARE,UHC HERITAGE SELECT,226.09,,,,,,,190.0800,736.4400,other,30.7% of $736.44 in Billed Charges for Rev 272 = $226.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STRIP SKIN CLOSURE 8CM SURGICAL,272,RC,27200002,CDM,,,,,,both,,,736.4400,110.4700,UNITED HEALTHCARE,UNITED HEALTHCARE,237.87,,,,,,,190.0800,736.4400,percent of total billed charges,32.3% of $736.44 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRIP SKIN CLOSURE 8CM SURGICAL,272,RC,27200002,CDM,,,,,,both,,,736.4400,110.4700,WELLCARE,WELLCARE MEDICAID,736.44,,,,,,,190.0800,736.4400,percent of total billed charges,100% of $736.44 in Billed Charges for Rev 272 = $736.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET  GLIDERITE PED,272,RC,,,,,,,,both,,,67.8100,10.1700,AETNA,AETNA,28.95,,,,,,,17.5000,67.8100,percent of total billed charges,42.7% of $67.81 in Billed Charges for Rev 272 = $28.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET  GLIDERITE PED,272,RC,,,,,,,,both,,,67.8100,10.1700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,47.47,,,,,,,17.5000,67.8100,percent of total billed charges,Rev 272 $67.81 in Billed Charges at 70% = $47.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET  GLIDERITE PED,272,RC,,,,,,,,both,,,67.8100,10.1700,CIGNA HEALTHCARE,CIGNA HMO,28.28,,,,,,,17.5000,67.8100,percent of total billed charges,41.7% of $67.81 in Billed Charges for Rev 272 = $28.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET  GLIDERITE PED,272,RC,,,,,,,,both,,,67.8100,10.1700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,31.46,,,,,,,17.5000,67.8100,percent of total billed charges,46.4% of $67.81 in Billed Charges for Rev 272 = $31.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET  GLIDERITE PED,272,RC,,,,,,,,both,,,67.8100,10.1700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,28.28,,,,,,,17.5000,67.8100,percent of total billed charges,41.7% of $67.81 in Billed Charges for Rev 272 = $28.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET  GLIDERITE PED,272,RC,,,,,,,,both,,,67.8100,10.1700,CIGNA HEALTHCARE,CIGNA PPO,28.28,,,,,,,17.5000,67.8100,percent of total billed charges,41.7% of $67.81 in Billed Charges for Rev 272 = $28.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET  GLIDERITE PED,272,RC,,,,,,,,both,,,67.8100,10.1700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,61.03,,,,,,,17.5000,67.8100,percent of total billed charges,90% of $67.81 in Billed Charges for Rev 272 = $61.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET  GLIDERITE PED,272,RC,,,,,,,,both,,,67.8100,10.1700,MEDCOST,MEDCOST VHN,32.27,,,,,,,17.5000,67.8100,percent of total billed charges,47.59% of $67.81 in Billed Charges for Rev 272 = $32.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET  GLIDERITE PED,272,RC,,,,,,,,both,,,67.8100,10.1700,SENTARA HEALTH,SENTARA HEALTH,17.50,,,,,,,17.5000,67.8100,percent of total billed charges,25.81% of $67.81 in Billed Charges for Rev 272 = $17.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET  GLIDERITE PED,272,RC,,,,,,,,both,,,67.8100,10.1700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",67.81,,,,,,,17.5000,67.8100,percent of total billed charges,100% of $67.81 in Billed Charges for Rev 272 = $67.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET  GLIDERITE PED,272,RC,,,,,,,,both,,,67.8100,10.1700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,33.91,,,,,,,17.5000,67.8100,percent of total billed charges,Rev 272 $67.81 in Billed Charges at 50% = $33.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET  GLIDERITE PED,272,RC,,,,,,,,both,,,67.8100,10.1700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,21.90,,,,,,,17.5000,67.8100,other,32.3% of $67.81 in Billed Charges for Rev 272 = $21.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STYLET  GLIDERITE PED,272,RC,,,,,,,,both,,,67.8100,10.1700,UNITED HEALTHCARE,UHC HERITAGE SELECT,20.82,,,,,,,17.5000,67.8100,other,30.7% of $67.81 in Billed Charges for Rev 272 = $20.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STYLET  GLIDERITE PED,272,RC,,,,,,,,both,,,67.8100,10.1700,UNITED HEALTHCARE,UNITED HEALTHCARE,21.90,,,,,,,17.5000,67.8100,percent of total billed charges,32.3% of $67.81 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET  GLIDERITE PED,272,RC,,,,,,,,both,,,67.8100,10.1700,WELLCARE,WELLCARE MEDICAID,67.81,,,,,,,17.5000,67.8100,percent of total billed charges,100% of $67.81 in Billed Charges for Rev 272 = $67.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET BEVEL 11G,272,RC,27200002,CDM,,,,,,both,,,655.9700,98.4000,AETNA,AETNA,280.10,,,,,,,169.3100,655.9700,percent of total billed charges,42.7% of $655.97 in Billed Charges for Rev 272 = $280.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET BEVEL 11G,272,RC,27200002,CDM,,,,,,both,,,655.9700,98.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,459.18,,,,,,,169.3100,655.9700,percent of total billed charges,Rev 272 $655.97 in Billed Charges at 70% = $459.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET BEVEL 11G,272,RC,27200002,CDM,,,,,,both,,,655.9700,98.4000,CIGNA HEALTHCARE,CIGNA HMO,273.54,,,,,,,169.3100,655.9700,percent of total billed charges,41.7% of $655.97 in Billed Charges for Rev 272 = $273.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET BEVEL 11G,272,RC,27200002,CDM,,,,,,both,,,655.9700,98.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,304.37,,,,,,,169.3100,655.9700,percent of total billed charges,46.4% of $655.97 in Billed Charges for Rev 272 = $304.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET BEVEL 11G,272,RC,27200002,CDM,,,,,,both,,,655.9700,98.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,273.54,,,,,,,169.3100,655.9700,percent of total billed charges,41.7% of $655.97 in Billed Charges for Rev 272 = $273.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET BEVEL 11G,272,RC,27200002,CDM,,,,,,both,,,655.9700,98.4000,CIGNA HEALTHCARE,CIGNA PPO,273.54,,,,,,,169.3100,655.9700,percent of total billed charges,41.7% of $655.97 in Billed Charges for Rev 272 = $273.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET BEVEL 11G,272,RC,27200002,CDM,,,,,,both,,,655.9700,98.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,590.37,,,,,,,169.3100,655.9700,percent of total billed charges,90% of $655.97 in Billed Charges for Rev 272 = $590.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET BEVEL 11G,272,RC,27200002,CDM,,,,,,both,,,655.9700,98.4000,MEDCOST,MEDCOST VHN,312.18,,,,,,,169.3100,655.9700,percent of total billed charges,47.59% of $655.97 in Billed Charges for Rev 272 = $312.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET BEVEL 11G,272,RC,27200002,CDM,,,,,,both,,,655.9700,98.4000,SENTARA HEALTH,SENTARA HEALTH,169.31,,,,,,,169.3100,655.9700,percent of total billed charges,25.81% of $655.97 in Billed Charges for Rev 272 = $169.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET BEVEL 11G,272,RC,27200002,CDM,,,,,,both,,,655.9700,98.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",655.97,,,,,,,169.3100,655.9700,percent of total billed charges,100% of $655.97 in Billed Charges for Rev 272 = $655.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET BEVEL 11G,272,RC,27200002,CDM,,,,,,both,,,655.9700,98.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,327.99,,,,,,,169.3100,655.9700,percent of total billed charges,Rev 272 $655.97 in Billed Charges at 50% = $327.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET BEVEL 11G,272,RC,27200002,CDM,,,,,,both,,,655.9700,98.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,211.88,,,,,,,169.3100,655.9700,other,32.3% of $655.97 in Billed Charges for Rev 272 = $211.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STYLET BEVEL 11G,272,RC,27200002,CDM,,,,,,both,,,655.9700,98.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,201.38,,,,,,,169.3100,655.9700,other,30.7% of $655.97 in Billed Charges for Rev 272 = $201.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STYLET BEVEL 11G,272,RC,27200002,CDM,,,,,,both,,,655.9700,98.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,211.88,,,,,,,169.3100,655.9700,percent of total billed charges,32.3% of $655.97 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STYLET BEVEL 11G,272,RC,27200002,CDM,,,,,,both,,,655.9700,98.4000,WELLCARE,WELLCARE MEDICAID,655.97,,,,,,,169.3100,655.9700,percent of total billed charges,100% of $655.97 in Billed Charges for Rev 272 = $655.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
REAMER SHAFT 8 X 885MM,272,RC,27200002,CDM,,,,,,both,,,3235.5400,485.3300,AETNA,AETNA,1381.58,,,,,,,835.0900,3235.5400,percent of total billed charges,"42.7% of $3,235.54 in Billed Charges for Rev 272 = $1,381.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER SHAFT 8 X 885MM,272,RC,27200002,CDM,,,,,,both,,,3235.5400,485.3300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2264.88,,,,,,,835.0900,3235.5400,percent of total billed charges,"Rev 272 $3,235.54 in Billed Charges at 70% = $2,264.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER SHAFT 8 X 885MM,272,RC,27200002,CDM,,,,,,both,,,3235.5400,485.3300,CIGNA HEALTHCARE,CIGNA HMO,1349.22,,,,,,,835.0900,3235.5400,percent of total billed charges,"41.7% of $3,235.54 in Billed Charges for Rev 272 = $1,349.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER SHAFT 8 X 885MM,272,RC,27200002,CDM,,,,,,both,,,3235.5400,485.3300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1501.29,,,,,,,835.0900,3235.5400,percent of total billed charges,"46.4% of $3,235.54 in Billed Charges for Rev 272 = $1,501.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER SHAFT 8 X 885MM,272,RC,27200002,CDM,,,,,,both,,,3235.5400,485.3300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1349.22,,,,,,,835.0900,3235.5400,percent of total billed charges,"41.7% of $3,235.54 in Billed Charges for Rev 272 = $1,349.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER SHAFT 8 X 885MM,272,RC,27200002,CDM,,,,,,both,,,3235.5400,485.3300,CIGNA HEALTHCARE,CIGNA PPO,1349.22,,,,,,,835.0900,3235.5400,percent of total billed charges,"41.7% of $3,235.54 in Billed Charges for Rev 272 = $1,349.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER SHAFT 8 X 885MM,272,RC,27200002,CDM,,,,,,both,,,3235.5400,485.3300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2911.99,,,,,,,835.0900,3235.5400,percent of total billed charges,"90% of $3,235.54 in Billed Charges for Rev 272 = $2,911.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER SHAFT 8 X 885MM,272,RC,27200002,CDM,,,,,,both,,,3235.5400,485.3300,MEDCOST,MEDCOST VHN,1539.79,,,,,,,835.0900,3235.5400,percent of total billed charges,"47.59% of $3,235.54 in Billed Charges for Rev 272 = $1,539.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER SHAFT 8 X 885MM,272,RC,27200002,CDM,,,,,,both,,,3235.5400,485.3300,SENTARA HEALTH,SENTARA HEALTH,835.09,,,,,,,835.0900,3235.5400,percent of total billed charges,"25.81% of $3,235.54 in Billed Charges for Rev 272 = $835.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER SHAFT 8 X 885MM,272,RC,27200002,CDM,,,,,,both,,,3235.5400,485.3300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3235.54,,,,,,,835.0900,3235.5400,percent of total billed charges,"100% of $3,235.54 in Billed Charges for Rev 272 = $3,235.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER SHAFT 8 X 885MM,272,RC,27200002,CDM,,,,,,both,,,3235.5400,485.3300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1617.77,,,,,,,835.0900,3235.5400,percent of total billed charges,"Rev 272 $3,235.54 in Billed Charges at 50% = $1,617.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER SHAFT 8 X 885MM,272,RC,27200002,CDM,,,,,,both,,,3235.5400,485.3300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1045.08,,,,,,,835.0900,3235.5400,other,"32.3% of $3,235.54 in Billed Charges for Rev 272 = $1,045.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
REAMER SHAFT 8 X 885MM,272,RC,27200002,CDM,,,,,,both,,,3235.5400,485.3300,UNITED HEALTHCARE,UHC HERITAGE SELECT,993.31,,,,,,,835.0900,3235.5400,other,"30.7% of $3,235.54 in Billed Charges for Rev 272 = $993.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
REAMER SHAFT 8 X 885MM,272,RC,27200002,CDM,,,,,,both,,,3235.5400,485.3300,UNITED HEALTHCARE,UNITED HEALTHCARE,1045.08,,,,,,,835.0900,3235.5400,percent of total billed charges,"32.3% of $3,235.54 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER SHAFT 8 X 885MM,272,RC,27200002,CDM,,,,,,both,,,3235.5400,485.3300,WELLCARE,WELLCARE MEDICAID,3235.54,,,,,,,835.0900,3235.5400,percent of total billed charges,"100% of $3,235.54 in Billed Charges for Rev 272 = $3,235.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FOOT 180,272,RC,,,,,,,,both,,,15211.4600,2281.7200,AETNA,AETNA,6495.29,,,,,,,3926.0800,15211.4600,percent of total billed charges,"42.7% of $15,211.46 in Billed Charges for Rev 272 = $6,495.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FOOT 180,272,RC,,,,,,,,both,,,15211.4600,2281.7200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,10648.02,,,,,,,3926.0800,15211.4600,percent of total billed charges,"Rev 272 $15,211.46 in Billed Charges at 70% = $10,648.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FOOT 180,272,RC,,,,,,,,both,,,15211.4600,2281.7200,CIGNA HEALTHCARE,CIGNA HMO,6343.18,,,,,,,3926.0800,15211.4600,percent of total billed charges,"41.7% of $15,211.46 in Billed Charges for Rev 272 = $6,343.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FOOT 180,272,RC,,,,,,,,both,,,15211.4600,2281.7200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7058.12,,,,,,,3926.0800,15211.4600,percent of total billed charges,"46.4% of $15,211.46 in Billed Charges for Rev 272 = $7,058.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FOOT 180,272,RC,,,,,,,,both,,,15211.4600,2281.7200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6343.18,,,,,,,3926.0800,15211.4600,percent of total billed charges,"41.7% of $15,211.46 in Billed Charges for Rev 272 = $6,343.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FOOT 180,272,RC,,,,,,,,both,,,15211.4600,2281.7200,CIGNA HEALTHCARE,CIGNA PPO,6343.18,,,,,,,3926.0800,15211.4600,percent of total billed charges,"41.7% of $15,211.46 in Billed Charges for Rev 272 = $6,343.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FOOT 180,272,RC,,,,,,,,both,,,15211.4600,2281.7200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13690.31,,,,,,,3926.0800,15211.4600,percent of total billed charges,"90% of $15,211.46 in Billed Charges for Rev 272 = $13,690.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FOOT 180,272,RC,,,,,,,,both,,,15211.4600,2281.7200,MEDCOST,MEDCOST VHN,7239.13,,,,,,,3926.0800,15211.4600,percent of total billed charges,"47.59% of $15,211.46 in Billed Charges for Rev 272 = $7,239.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FOOT 180,272,RC,,,,,,,,both,,,15211.4600,2281.7200,SENTARA HEALTH,SENTARA HEALTH,3926.08,,,,,,,3926.0800,15211.4600,percent of total billed charges,"25.81% of $15,211.46 in Billed Charges for Rev 272 = $3,926.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FOOT 180,272,RC,,,,,,,,both,,,15211.4600,2281.7200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15211.46,,,,,,,3926.0800,15211.4600,percent of total billed charges,"100% of $15,211.46 in Billed Charges for Rev 272 = $15,211.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FOOT 180,272,RC,,,,,,,,both,,,15211.4600,2281.7200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7605.73,,,,,,,3926.0800,15211.4600,percent of total billed charges,"Rev 272 $15,211.46 in Billed Charges at 50% = $7,605.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FOOT 180,272,RC,,,,,,,,both,,,15211.4600,2281.7200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4913.30,,,,,,,3926.0800,15211.4600,other,"32.3% of $15,211.46 in Billed Charges for Rev 272 = $4,913.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RING FOOT 180,272,RC,,,,,,,,both,,,15211.4600,2281.7200,UNITED HEALTHCARE,UHC HERITAGE SELECT,4669.92,,,,,,,3926.0800,15211.4600,other,"30.7% of $15,211.46 in Billed Charges for Rev 272 = $4,669.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RING FOOT 180,272,RC,,,,,,,,both,,,15211.4600,2281.7200,UNITED HEALTHCARE,UNITED HEALTHCARE,4913.30,,,,,,,3926.0800,15211.4600,percent of total billed charges,"32.3% of $15,211.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RING FOOT 180,272,RC,,,,,,,,both,,,15211.4600,2281.7200,WELLCARE,WELLCARE MEDICAID,15211.46,,,,,,,3926.0800,15211.4600,percent of total billed charges,"100% of $15,211.46 in Billed Charges for Rev 272 = $15,211.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUCTION IRRIGATOR XI ENDOWRIST DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2886.5900,432.9900,AETNA,AETNA,1232.57,,,,,,,745.0300,2886.5900,percent of total billed charges,"42.7% of $2,886.59 in Billed Charges for Rev 272 = $1,232.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUCTION IRRIGATOR XI ENDOWRIST DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2886.5900,432.9900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2020.61,,,,,,,745.0300,2886.5900,percent of total billed charges,"Rev 272 $2,886.59 in Billed Charges at 70% = $2,020.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUCTION IRRIGATOR XI ENDOWRIST DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2886.5900,432.9900,CIGNA HEALTHCARE,CIGNA HMO,1203.71,,,,,,,745.0300,2886.5900,percent of total billed charges,"41.7% of $2,886.59 in Billed Charges for Rev 272 = $1,203.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUCTION IRRIGATOR XI ENDOWRIST DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2886.5900,432.9900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1339.38,,,,,,,745.0300,2886.5900,percent of total billed charges,"46.4% of $2,886.59 in Billed Charges for Rev 272 = $1,339.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUCTION IRRIGATOR XI ENDOWRIST DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2886.5900,432.9900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1203.71,,,,,,,745.0300,2886.5900,percent of total billed charges,"41.7% of $2,886.59 in Billed Charges for Rev 272 = $1,203.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUCTION IRRIGATOR XI ENDOWRIST DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2886.5900,432.9900,CIGNA HEALTHCARE,CIGNA PPO,1203.71,,,,,,,745.0300,2886.5900,percent of total billed charges,"41.7% of $2,886.59 in Billed Charges for Rev 272 = $1,203.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUCTION IRRIGATOR XI ENDOWRIST DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2886.5900,432.9900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2597.93,,,,,,,745.0300,2886.5900,percent of total billed charges,"90% of $2,886.59 in Billed Charges for Rev 272 = $2,597.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUCTION IRRIGATOR XI ENDOWRIST DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2886.5900,432.9900,MEDCOST,MEDCOST VHN,1373.73,,,,,,,745.0300,2886.5900,percent of total billed charges,"47.59% of $2,886.59 in Billed Charges for Rev 272 = $1,373.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUCTION IRRIGATOR XI ENDOWRIST DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2886.5900,432.9900,SENTARA HEALTH,SENTARA HEALTH,745.03,,,,,,,745.0300,2886.5900,percent of total billed charges,"25.81% of $2,886.59 in Billed Charges for Rev 272 = $745.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUCTION IRRIGATOR XI ENDOWRIST DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2886.5900,432.9900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2886.59,,,,,,,745.0300,2886.5900,percent of total billed charges,"100% of $2,886.59 in Billed Charges for Rev 272 = $2,886.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUCTION IRRIGATOR XI ENDOWRIST DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2886.5900,432.9900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1443.30,,,,,,,745.0300,2886.5900,percent of total billed charges,"Rev 272 $2,886.59 in Billed Charges at 50% = $1,443.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUCTION IRRIGATOR XI ENDOWRIST DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2886.5900,432.9900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,932.37,,,,,,,745.0300,2886.5900,other,"32.3% of $2,886.59 in Billed Charges for Rev 272 = $932.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUCTION IRRIGATOR XI ENDOWRIST DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2886.5900,432.9900,UNITED HEALTHCARE,UHC HERITAGE SELECT,886.18,,,,,,,745.0300,2886.5900,other,"30.7% of $2,886.59 in Billed Charges for Rev 272 = $886.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUCTION IRRIGATOR XI ENDOWRIST DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2886.5900,432.9900,UNITED HEALTHCARE,UNITED HEALTHCARE,932.37,,,,,,,745.0300,2886.5900,percent of total billed charges,"32.3% of $2,886.59 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUCTION IRRIGATOR XI ENDOWRIST DA VINCI,272,RC,27200002,CDM,,,,,,both,,,2886.5900,432.9900,WELLCARE,WELLCARE MEDICAID,2886.59,,,,,,,745.0300,2886.5900,percent of total billed charges,"100% of $2,886.59 in Billed Charges for Rev 272 = $2,886.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL 30 MM RESCUE,272,RC,27200002,CDM,,,,,,both,,,1418.2800,212.7400,AETNA,AETNA,605.61,,,,,,,366.0600,1418.2800,percent of total billed charges,"42.7% of $1,418.28 in Billed Charges for Rev 272 = $605.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL 30 MM RESCUE,272,RC,27200002,CDM,,,,,,both,,,1418.2800,212.7400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,992.80,,,,,,,366.0600,1418.2800,percent of total billed charges,"Rev 272 $1,418.28 in Billed Charges at 70% = $992.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL 30 MM RESCUE,272,RC,27200002,CDM,,,,,,both,,,1418.2800,212.7400,CIGNA HEALTHCARE,CIGNA HMO,591.42,,,,,,,366.0600,1418.2800,percent of total billed charges,"41.7% of $1,418.28 in Billed Charges for Rev 272 = $591.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL 30 MM RESCUE,272,RC,27200002,CDM,,,,,,both,,,1418.2800,212.7400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,658.08,,,,,,,366.0600,1418.2800,percent of total billed charges,"46.4% of $1,418.28 in Billed Charges for Rev 272 = $658.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL 30 MM RESCUE,272,RC,27200002,CDM,,,,,,both,,,1418.2800,212.7400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,591.42,,,,,,,366.0600,1418.2800,percent of total billed charges,"41.7% of $1,418.28 in Billed Charges for Rev 272 = $591.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL 30 MM RESCUE,272,RC,27200002,CDM,,,,,,both,,,1418.2800,212.7400,CIGNA HEALTHCARE,CIGNA PPO,591.42,,,,,,,366.0600,1418.2800,percent of total billed charges,"41.7% of $1,418.28 in Billed Charges for Rev 272 = $591.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL 30 MM RESCUE,272,RC,27200002,CDM,,,,,,both,,,1418.2800,212.7400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1276.45,,,,,,,366.0600,1418.2800,percent of total billed charges,"90% of $1,418.28 in Billed Charges for Rev 272 = $1,276.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL 30 MM RESCUE,272,RC,27200002,CDM,,,,,,both,,,1418.2800,212.7400,MEDCOST,MEDCOST VHN,674.96,,,,,,,366.0600,1418.2800,percent of total billed charges,"47.59% of $1,418.28 in Billed Charges for Rev 272 = $674.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL 30 MM RESCUE,272,RC,27200002,CDM,,,,,,both,,,1418.2800,212.7400,SENTARA HEALTH,SENTARA HEALTH,366.06,,,,,,,366.0600,1418.2800,percent of total billed charges,"25.81% of $1,418.28 in Billed Charges for Rev 272 = $366.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL 30 MM RESCUE,272,RC,27200002,CDM,,,,,,both,,,1418.2800,212.7400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1418.28,,,,,,,366.0600,1418.2800,percent of total billed charges,"100% of $1,418.28 in Billed Charges for Rev 272 = $1,418.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL 30 MM RESCUE,272,RC,27200002,CDM,,,,,,both,,,1418.2800,212.7400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,709.14,,,,,,,366.0600,1418.2800,percent of total billed charges,"Rev 272 $1,418.28 in Billed Charges at 50% = $709.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL 30 MM RESCUE,272,RC,27200002,CDM,,,,,,both,,,1418.2800,212.7400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,458.10,,,,,,,366.0600,1418.2800,other,"32.3% of $1,418.28 in Billed Charges for Rev 272 = $458.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NET RETRIEVAL 30 MM RESCUE,272,RC,27200002,CDM,,,,,,both,,,1418.2800,212.7400,UNITED HEALTHCARE,UHC HERITAGE SELECT,435.41,,,,,,,366.0600,1418.2800,other,"30.7% of $1,418.28 in Billed Charges for Rev 272 = $435.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NET RETRIEVAL 30 MM RESCUE,272,RC,27200002,CDM,,,,,,both,,,1418.2800,212.7400,UNITED HEALTHCARE,UNITED HEALTHCARE,458.10,,,,,,,366.0600,1418.2800,percent of total billed charges,"32.3% of $1,418.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL 30 MM RESCUE,272,RC,27200002,CDM,,,,,,both,,,1418.2800,212.7400,WELLCARE,WELLCARE MEDICAID,1418.28,,,,,,,366.0600,1418.2800,percent of total billed charges,"100% of $1,418.28 in Billed Charges for Rev 272 = $1,418.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL ROTH 2.5MM 2,272,RC,27200002,CDM,,,,,,both,,,1005.2800,150.7900,AETNA,AETNA,429.25,,,,,,,259.4600,1005.2800,percent of total billed charges,"42.7% of $1,005.28 in Billed Charges for Rev 272 = $429.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL ROTH 2.5MM 2,272,RC,27200002,CDM,,,,,,both,,,1005.2800,150.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,703.70,,,,,,,259.4600,1005.2800,percent of total billed charges,"Rev 272 $1,005.28 in Billed Charges at 70% = $703.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL ROTH 2.5MM 2,272,RC,27200002,CDM,,,,,,both,,,1005.2800,150.7900,CIGNA HEALTHCARE,CIGNA HMO,419.20,,,,,,,259.4600,1005.2800,percent of total billed charges,"41.7% of $1,005.28 in Billed Charges for Rev 272 = $419.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL ROTH 2.5MM 2,272,RC,27200002,CDM,,,,,,both,,,1005.2800,150.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,466.45,,,,,,,259.4600,1005.2800,percent of total billed charges,"46.4% of $1,005.28 in Billed Charges for Rev 272 = $466.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL ROTH 2.5MM 2,272,RC,27200002,CDM,,,,,,both,,,1005.2800,150.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,419.20,,,,,,,259.4600,1005.2800,percent of total billed charges,"41.7% of $1,005.28 in Billed Charges for Rev 272 = $419.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL ROTH 2.5MM 2,272,RC,27200002,CDM,,,,,,both,,,1005.2800,150.7900,CIGNA HEALTHCARE,CIGNA PPO,419.20,,,,,,,259.4600,1005.2800,percent of total billed charges,"41.7% of $1,005.28 in Billed Charges for Rev 272 = $419.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL ROTH 2.5MM 2,272,RC,27200002,CDM,,,,,,both,,,1005.2800,150.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,904.75,,,,,,,259.4600,1005.2800,percent of total billed charges,"90% of $1,005.28 in Billed Charges for Rev 272 = $904.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL ROTH 2.5MM 2,272,RC,27200002,CDM,,,,,,both,,,1005.2800,150.7900,MEDCOST,MEDCOST VHN,478.41,,,,,,,259.4600,1005.2800,percent of total billed charges,"47.59% of $1,005.28 in Billed Charges for Rev 272 = $478.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL ROTH 2.5MM 2,272,RC,27200002,CDM,,,,,,both,,,1005.2800,150.7900,SENTARA HEALTH,SENTARA HEALTH,259.46,,,,,,,259.4600,1005.2800,percent of total billed charges,"25.81% of $1,005.28 in Billed Charges for Rev 272 = $259.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL ROTH 2.5MM 2,272,RC,27200002,CDM,,,,,,both,,,1005.2800,150.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1005.28,,,,,,,259.4600,1005.2800,percent of total billed charges,"100% of $1,005.28 in Billed Charges for Rev 272 = $1,005.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL ROTH 2.5MM 2,272,RC,27200002,CDM,,,,,,both,,,1005.2800,150.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,502.64,,,,,,,259.4600,1005.2800,percent of total billed charges,"Rev 272 $1,005.28 in Billed Charges at 50% = $502.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL ROTH 2.5MM 2,272,RC,27200002,CDM,,,,,,both,,,1005.2800,150.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,324.71,,,,,,,259.4600,1005.2800,other,"32.3% of $1,005.28 in Billed Charges for Rev 272 = $324.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NET RETRIEVAL ROTH 2.5MM 2,272,RC,27200002,CDM,,,,,,both,,,1005.2800,150.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,308.62,,,,,,,259.4600,1005.2800,other,"30.7% of $1,005.28 in Billed Charges for Rev 272 = $308.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NET RETRIEVAL ROTH 2.5MM 2,272,RC,27200002,CDM,,,,,,both,,,1005.2800,150.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,324.71,,,,,,,259.4600,1005.2800,percent of total billed charges,"32.3% of $1,005.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET RETRIEVAL ROTH 2.5MM 2,272,RC,27200002,CDM,,,,,,both,,,1005.2800,150.7900,WELLCARE,WELLCARE MEDICAID,1005.28,,,,,,,259.4600,1005.2800,percent of total billed charges,"100% of $1,005.28 in Billed Charges for Rev 272 = $1,005.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 12.7MM X 120MM,272,RC,,,,,,,,both,,,2703.7200,405.5600,AETNA,AETNA,1154.49,,,,,,,697.8300,2703.7200,percent of total billed charges,"42.7% of $2,703.72 in Billed Charges for Rev 272 = $1,154.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 12.7MM X 120MM,272,RC,,,,,,,,both,,,2703.7200,405.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1892.60,,,,,,,697.8300,2703.7200,percent of total billed charges,"Rev 272 $2,703.72 in Billed Charges at 70% = $1,892.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 12.7MM X 120MM,272,RC,,,,,,,,both,,,2703.7200,405.5600,CIGNA HEALTHCARE,CIGNA HMO,1127.45,,,,,,,697.8300,2703.7200,percent of total billed charges,"41.7% of $2,703.72 in Billed Charges for Rev 272 = $1,127.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 12.7MM X 120MM,272,RC,,,,,,,,both,,,2703.7200,405.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1254.53,,,,,,,697.8300,2703.7200,percent of total billed charges,"46.4% of $2,703.72 in Billed Charges for Rev 272 = $1,254.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 12.7MM X 120MM,272,RC,,,,,,,,both,,,2703.7200,405.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1127.45,,,,,,,697.8300,2703.7200,percent of total billed charges,"41.7% of $2,703.72 in Billed Charges for Rev 272 = $1,127.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 12.7MM X 120MM,272,RC,,,,,,,,both,,,2703.7200,405.5600,CIGNA HEALTHCARE,CIGNA PPO,1127.45,,,,,,,697.8300,2703.7200,percent of total billed charges,"41.7% of $2,703.72 in Billed Charges for Rev 272 = $1,127.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 12.7MM X 120MM,272,RC,,,,,,,,both,,,2703.7200,405.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2433.35,,,,,,,697.8300,2703.7200,percent of total billed charges,"90% of $2,703.72 in Billed Charges for Rev 272 = $2,433.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 12.7MM X 120MM,272,RC,,,,,,,,both,,,2703.7200,405.5600,MEDCOST,MEDCOST VHN,1286.70,,,,,,,697.8300,2703.7200,percent of total billed charges,"47.59% of $2,703.72 in Billed Charges for Rev 272 = $1,286.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 12.7MM X 120MM,272,RC,,,,,,,,both,,,2703.7200,405.5600,SENTARA HEALTH,SENTARA HEALTH,697.83,,,,,,,697.8300,2703.7200,percent of total billed charges,"25.81% of $2,703.72 in Billed Charges for Rev 272 = $697.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 12.7MM X 120MM,272,RC,,,,,,,,both,,,2703.7200,405.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2703.72,,,,,,,697.8300,2703.7200,percent of total billed charges,"100% of $2,703.72 in Billed Charges for Rev 272 = $2,703.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 12.7MM X 120MM,272,RC,,,,,,,,both,,,2703.7200,405.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1351.86,,,,,,,697.8300,2703.7200,percent of total billed charges,"Rev 272 $2,703.72 in Billed Charges at 50% = $1,351.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 12.7MM X 120MM,272,RC,,,,,,,,both,,,2703.7200,405.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,873.30,,,,,,,697.8300,2703.7200,other,"32.3% of $2,703.72 in Billed Charges for Rev 272 = $873.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
OSTEOTOME CURVED 12.7MM X 120MM,272,RC,,,,,,,,both,,,2703.7200,405.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,830.04,,,,,,,697.8300,2703.7200,other,"30.7% of $2,703.72 in Billed Charges for Rev 272 = $830.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
OSTEOTOME CURVED 12.7MM X 120MM,272,RC,,,,,,,,both,,,2703.7200,405.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,873.30,,,,,,,697.8300,2703.7200,percent of total billed charges,"32.3% of $2,703.72 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 12.7MM X 120MM,272,RC,,,,,,,,both,,,2703.7200,405.5600,WELLCARE,WELLCARE MEDICAID,2703.72,,,,,,,697.8300,2703.7200,percent of total billed charges,"100% of $2,703.72 in Billed Charges for Rev 272 = $2,703.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 46MM DIAMETER CUP,272,RC,,,,,,,,both,,,3941.5000,591.2300,AETNA,AETNA,1683.02,,,,,,,1017.3000,3941.5000,percent of total billed charges,"42.7% of $3,941.50 in Billed Charges for Rev 272 = $1,683.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 46MM DIAMETER CUP,272,RC,,,,,,,,both,,,3941.5000,591.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2759.05,,,,,,,1017.3000,3941.5000,percent of total billed charges,"Rev 272 $3,941.50 in Billed Charges at 70% = $2,759.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 46MM DIAMETER CUP,272,RC,,,,,,,,both,,,3941.5000,591.2300,CIGNA HEALTHCARE,CIGNA HMO,1643.61,,,,,,,1017.3000,3941.5000,percent of total billed charges,"41.7% of $3,941.50 in Billed Charges for Rev 272 = $1,643.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 46MM DIAMETER CUP,272,RC,,,,,,,,both,,,3941.5000,591.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1828.86,,,,,,,1017.3000,3941.5000,percent of total billed charges,"46.4% of $3,941.50 in Billed Charges for Rev 272 = $1,828.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 46MM DIAMETER CUP,272,RC,,,,,,,,both,,,3941.5000,591.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1643.61,,,,,,,1017.3000,3941.5000,percent of total billed charges,"41.7% of $3,941.50 in Billed Charges for Rev 272 = $1,643.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 46MM DIAMETER CUP,272,RC,,,,,,,,both,,,3941.5000,591.2300,CIGNA HEALTHCARE,CIGNA PPO,1643.61,,,,,,,1017.3000,3941.5000,percent of total billed charges,"41.7% of $3,941.50 in Billed Charges for Rev 272 = $1,643.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 46MM DIAMETER CUP,272,RC,,,,,,,,both,,,3941.5000,591.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3547.35,,,,,,,1017.3000,3941.5000,percent of total billed charges,"90% of $3,941.50 in Billed Charges for Rev 272 = $3,547.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 46MM DIAMETER CUP,272,RC,,,,,,,,both,,,3941.5000,591.2300,MEDCOST,MEDCOST VHN,1875.76,,,,,,,1017.3000,3941.5000,percent of total billed charges,"47.59% of $3,941.50 in Billed Charges for Rev 272 = $1,875.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 46MM DIAMETER CUP,272,RC,,,,,,,,both,,,3941.5000,591.2300,SENTARA HEALTH,SENTARA HEALTH,1017.30,,,,,,,1017.3000,3941.5000,percent of total billed charges,"25.81% of $3,941.50 in Billed Charges for Rev 272 = $1,017.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 46MM DIAMETER CUP,272,RC,,,,,,,,both,,,3941.5000,591.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3941.50,,,,,,,1017.3000,3941.5000,percent of total billed charges,"100% of $3,941.50 in Billed Charges for Rev 272 = $3,941.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 46MM DIAMETER CUP,272,RC,,,,,,,,both,,,3941.5000,591.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1970.75,,,,,,,1017.3000,3941.5000,percent of total billed charges,"Rev 272 $3,941.50 in Billed Charges at 50% = $1,970.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 46MM DIAMETER CUP,272,RC,,,,,,,,both,,,3941.5000,591.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1273.10,,,,,,,1017.3000,3941.5000,other,"32.3% of $3,941.50 in Billed Charges for Rev 272 = $1,273.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
OSTEOTOME CURVED 46MM DIAMETER CUP,272,RC,,,,,,,,both,,,3941.5000,591.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1210.04,,,,,,,1017.3000,3941.5000,other,"30.7% of $3,941.50 in Billed Charges for Rev 272 = $1,210.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
OSTEOTOME CURVED 46MM DIAMETER CUP,272,RC,,,,,,,,both,,,3941.5000,591.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,1273.10,,,,,,,1017.3000,3941.5000,percent of total billed charges,"32.3% of $3,941.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 46MM DIAMETER CUP,272,RC,,,,,,,,both,,,3941.5000,591.2300,WELLCARE,WELLCARE MEDICAID,3941.50,,,,,,,1017.3000,3941.5000,percent of total billed charges,"100% of $3,941.50 in Billed Charges for Rev 272 = $3,941.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME FLEXIBLE 12MM X 120MM,272,RC,27200002,CDM,,,,,,both,,,3148.6400,472.3000,AETNA,AETNA,1344.47,,,,,,,812.6600,3148.6400,percent of total billed charges,"42.7% of $3,148.64 in Billed Charges for Rev 272 = $1,344.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME FLEXIBLE 12MM X 120MM,272,RC,27200002,CDM,,,,,,both,,,3148.6400,472.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2204.05,,,,,,,812.6600,3148.6400,percent of total billed charges,"Rev 272 $3,148.64 in Billed Charges at 70% = $2,204.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME FLEXIBLE 12MM X 120MM,272,RC,27200002,CDM,,,,,,both,,,3148.6400,472.3000,CIGNA HEALTHCARE,CIGNA HMO,1312.98,,,,,,,812.6600,3148.6400,percent of total billed charges,"41.7% of $3,148.64 in Billed Charges for Rev 272 = $1,312.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME FLEXIBLE 12MM X 120MM,272,RC,27200002,CDM,,,,,,both,,,3148.6400,472.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1460.97,,,,,,,812.6600,3148.6400,percent of total billed charges,"46.4% of $3,148.64 in Billed Charges for Rev 272 = $1,460.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME FLEXIBLE 12MM X 120MM,272,RC,27200002,CDM,,,,,,both,,,3148.6400,472.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1312.98,,,,,,,812.6600,3148.6400,percent of total billed charges,"41.7% of $3,148.64 in Billed Charges for Rev 272 = $1,312.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME FLEXIBLE 12MM X 120MM,272,RC,27200002,CDM,,,,,,both,,,3148.6400,472.3000,CIGNA HEALTHCARE,CIGNA PPO,1312.98,,,,,,,812.6600,3148.6400,percent of total billed charges,"41.7% of $3,148.64 in Billed Charges for Rev 272 = $1,312.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME FLEXIBLE 12MM X 120MM,272,RC,27200002,CDM,,,,,,both,,,3148.6400,472.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2833.78,,,,,,,812.6600,3148.6400,percent of total billed charges,"90% of $3,148.64 in Billed Charges for Rev 272 = $2,833.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME FLEXIBLE 12MM X 120MM,272,RC,27200002,CDM,,,,,,both,,,3148.6400,472.3000,MEDCOST,MEDCOST VHN,1498.44,,,,,,,812.6600,3148.6400,percent of total billed charges,"47.59% of $3,148.64 in Billed Charges for Rev 272 = $1,498.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME FLEXIBLE 12MM X 120MM,272,RC,27200002,CDM,,,,,,both,,,3148.6400,472.3000,SENTARA HEALTH,SENTARA HEALTH,812.66,,,,,,,812.6600,3148.6400,percent of total billed charges,"25.81% of $3,148.64 in Billed Charges for Rev 272 = $812.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME FLEXIBLE 12MM X 120MM,272,RC,27200002,CDM,,,,,,both,,,3148.6400,472.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3148.64,,,,,,,812.6600,3148.6400,percent of total billed charges,"100% of $3,148.64 in Billed Charges for Rev 272 = $3,148.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME FLEXIBLE 12MM X 120MM,272,RC,27200002,CDM,,,,,,both,,,3148.6400,472.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1574.32,,,,,,,812.6600,3148.6400,percent of total billed charges,"Rev 272 $3,148.64 in Billed Charges at 50% = $1,574.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME FLEXIBLE 12MM X 120MM,272,RC,27200002,CDM,,,,,,both,,,3148.6400,472.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1017.01,,,,,,,812.6600,3148.6400,other,"32.3% of $3,148.64 in Billed Charges for Rev 272 = $1,017.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
OSTEOTOME FLEXIBLE 12MM X 120MM,272,RC,27200002,CDM,,,,,,both,,,3148.6400,472.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,966.63,,,,,,,812.6600,3148.6400,other,"30.7% of $3,148.64 in Billed Charges for Rev 272 = $966.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
OSTEOTOME FLEXIBLE 12MM X 120MM,272,RC,27200002,CDM,,,,,,both,,,3148.6400,472.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,1017.01,,,,,,,812.6600,3148.6400,percent of total billed charges,"32.3% of $3,148.64 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME FLEXIBLE 12MM X 120MM,272,RC,27200002,CDM,,,,,,both,,,3148.6400,472.3000,WELLCARE,WELLCARE MEDICAID,3148.64,,,,,,,812.6600,3148.6400,percent of total billed charges,"100% of $3,148.64 in Billed Charges for Rev 272 = $3,148.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD SYN REAMING / ST BALL TIP 900,272,RC,27200002,CDM,,,,,,both,,,1044.1500,156.6200,AETNA,AETNA,445.85,,,,,,,269.5000,1044.1500,percent of total billed charges,"42.7% of $1,044.15 in Billed Charges for Rev 272 = $445.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD SYN REAMING / ST BALL TIP 900,272,RC,27200002,CDM,,,,,,both,,,1044.1500,156.6200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,730.91,,,,,,,269.5000,1044.1500,percent of total billed charges,"Rev 272 $1,044.15 in Billed Charges at 70% = $730.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD SYN REAMING / ST BALL TIP 900,272,RC,27200002,CDM,,,,,,both,,,1044.1500,156.6200,CIGNA HEALTHCARE,CIGNA HMO,435.41,,,,,,,269.5000,1044.1500,percent of total billed charges,"41.7% of $1,044.15 in Billed Charges for Rev 272 = $435.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD SYN REAMING / ST BALL TIP 900,272,RC,27200002,CDM,,,,,,both,,,1044.1500,156.6200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,484.49,,,,,,,269.5000,1044.1500,percent of total billed charges,"46.4% of $1,044.15 in Billed Charges for Rev 272 = $484.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD SYN REAMING / ST BALL TIP 900,272,RC,27200002,CDM,,,,,,both,,,1044.1500,156.6200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,435.41,,,,,,,269.5000,1044.1500,percent of total billed charges,"41.7% of $1,044.15 in Billed Charges for Rev 272 = $435.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD SYN REAMING / ST BALL TIP 900,272,RC,27200002,CDM,,,,,,both,,,1044.1500,156.6200,CIGNA HEALTHCARE,CIGNA PPO,435.41,,,,,,,269.5000,1044.1500,percent of total billed charges,"41.7% of $1,044.15 in Billed Charges for Rev 272 = $435.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD SYN REAMING / ST BALL TIP 900,272,RC,27200002,CDM,,,,,,both,,,1044.1500,156.6200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,939.74,,,,,,,269.5000,1044.1500,percent of total billed charges,"90% of $1,044.15 in Billed Charges for Rev 272 = $939.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD SYN REAMING / ST BALL TIP 900,272,RC,27200002,CDM,,,,,,both,,,1044.1500,156.6200,MEDCOST,MEDCOST VHN,496.91,,,,,,,269.5000,1044.1500,percent of total billed charges,"47.59% of $1,044.15 in Billed Charges for Rev 272 = $496.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD SYN REAMING / ST BALL TIP 900,272,RC,27200002,CDM,,,,,,both,,,1044.1500,156.6200,SENTARA HEALTH,SENTARA HEALTH,269.50,,,,,,,269.5000,1044.1500,percent of total billed charges,"25.81% of $1,044.15 in Billed Charges for Rev 272 = $269.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD SYN REAMING / ST BALL TIP 900,272,RC,27200002,CDM,,,,,,both,,,1044.1500,156.6200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1044.15,,,,,,,269.5000,1044.1500,percent of total billed charges,"100% of $1,044.15 in Billed Charges for Rev 272 = $1,044.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD SYN REAMING / ST BALL TIP 900,272,RC,27200002,CDM,,,,,,both,,,1044.1500,156.6200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,522.08,,,,,,,269.5000,1044.1500,percent of total billed charges,"Rev 272 $1,044.15 in Billed Charges at 50% = $522.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD SYN REAMING / ST BALL TIP 900,272,RC,27200002,CDM,,,,,,both,,,1044.1500,156.6200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,337.26,,,,,,,269.5000,1044.1500,other,"32.3% of $1,044.15 in Billed Charges for Rev 272 = $337.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ROD SYN REAMING / ST BALL TIP 900,272,RC,27200002,CDM,,,,,,both,,,1044.1500,156.6200,UNITED HEALTHCARE,UHC HERITAGE SELECT,320.55,,,,,,,269.5000,1044.1500,other,"30.7% of $1,044.15 in Billed Charges for Rev 272 = $320.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ROD SYN REAMING / ST BALL TIP 900,272,RC,27200002,CDM,,,,,,both,,,1044.1500,156.6200,UNITED HEALTHCARE,UNITED HEALTHCARE,337.26,,,,,,,269.5000,1044.1500,percent of total billed charges,"32.3% of $1,044.15 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROD SYN REAMING / ST BALL TIP 900,272,RC,27200002,CDM,,,,,,both,,,1044.1500,156.6200,WELLCARE,WELLCARE MEDICAID,1044.15,,,,,,,269.5000,1044.1500,percent of total billed charges,"100% of $1,044.15 in Billed Charges for Rev 272 = $1,044.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER LARGE F3/9TA30,272,RC,,,,,,,,both,,,1829.4400,274.4200,AETNA,AETNA,781.17,,,,,,,472.1800,1829.4400,percent of total billed charges,"42.7% of $1,829.44 in Billed Charges for Rev 272 = $781.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER LARGE F3/9TA30,272,RC,,,,,,,,both,,,1829.4400,274.4200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1280.61,,,,,,,472.1800,1829.4400,percent of total billed charges,"Rev 272 $1,829.44 in Billed Charges at 70% = $1,280.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER LARGE F3/9TA30,272,RC,,,,,,,,both,,,1829.4400,274.4200,CIGNA HEALTHCARE,CIGNA HMO,762.88,,,,,,,472.1800,1829.4400,percent of total billed charges,"41.7% of $1,829.44 in Billed Charges for Rev 272 = $762.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER LARGE F3/9TA30,272,RC,,,,,,,,both,,,1829.4400,274.4200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,848.86,,,,,,,472.1800,1829.4400,percent of total billed charges,"46.4% of $1,829.44 in Billed Charges for Rev 272 = $848.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER LARGE F3/9TA30,272,RC,,,,,,,,both,,,1829.4400,274.4200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,762.88,,,,,,,472.1800,1829.4400,percent of total billed charges,"41.7% of $1,829.44 in Billed Charges for Rev 272 = $762.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER LARGE F3/9TA30,272,RC,,,,,,,,both,,,1829.4400,274.4200,CIGNA HEALTHCARE,CIGNA PPO,762.88,,,,,,,472.1800,1829.4400,percent of total billed charges,"41.7% of $1,829.44 in Billed Charges for Rev 272 = $762.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER LARGE F3/9TA30,272,RC,,,,,,,,both,,,1829.4400,274.4200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1646.50,,,,,,,472.1800,1829.4400,percent of total billed charges,"90% of $1,829.44 in Billed Charges for Rev 272 = $1,646.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER LARGE F3/9TA30,272,RC,,,,,,,,both,,,1829.4400,274.4200,MEDCOST,MEDCOST VHN,870.63,,,,,,,472.1800,1829.4400,percent of total billed charges,"47.59% of $1,829.44 in Billed Charges for Rev 272 = $870.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER LARGE F3/9TA30,272,RC,,,,,,,,both,,,1829.4400,274.4200,SENTARA HEALTH,SENTARA HEALTH,472.18,,,,,,,472.1800,1829.4400,percent of total billed charges,"25.81% of $1,829.44 in Billed Charges for Rev 272 = $472.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER LARGE F3/9TA30,272,RC,,,,,,,,both,,,1829.4400,274.4200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1829.44,,,,,,,472.1800,1829.4400,percent of total billed charges,"100% of $1,829.44 in Billed Charges for Rev 272 = $1,829.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER LARGE F3/9TA30,272,RC,,,,,,,,both,,,1829.4400,274.4200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,914.72,,,,,,,472.1800,1829.4400,percent of total billed charges,"Rev 272 $1,829.44 in Billed Charges at 50% = $914.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER LARGE F3/9TA30,272,RC,,,,,,,,both,,,1829.4400,274.4200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,590.91,,,,,,,472.1800,1829.4400,other,"32.3% of $1,829.44 in Billed Charges for Rev 272 = $590.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ROUTER LARGE F3/9TA30,272,RC,,,,,,,,both,,,1829.4400,274.4200,UNITED HEALTHCARE,UHC HERITAGE SELECT,561.64,,,,,,,472.1800,1829.4400,other,"30.7% of $1,829.44 in Billed Charges for Rev 272 = $561.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ROUTER LARGE F3/9TA30,272,RC,,,,,,,,both,,,1829.4400,274.4200,UNITED HEALTHCARE,UNITED HEALTHCARE,590.91,,,,,,,472.1800,1829.4400,percent of total billed charges,"32.3% of $1,829.44 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER LARGE F3/9TA30,272,RC,,,,,,,,both,,,1829.4400,274.4200,WELLCARE,WELLCARE MEDICAID,1829.44,,,,,,,472.1800,1829.4400,percent of total billed charges,"100% of $1,829.44 in Billed Charges for Rev 272 = $1,829.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1361.3000,204.2000,AETNA,AETNA,581.28,,,,,,,351.3500,1361.3000,percent of total billed charges,"42.7% of $1,361.30 in Billed Charges for Rev 272 = $581.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1361.3000,204.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,952.91,,,,,,,351.3500,1361.3000,percent of total billed charges,"Rev 272 $1,361.30 in Billed Charges at 70% = $952.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1361.3000,204.2000,CIGNA HEALTHCARE,CIGNA HMO,567.66,,,,,,,351.3500,1361.3000,percent of total billed charges,"41.7% of $1,361.30 in Billed Charges for Rev 272 = $567.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1361.3000,204.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,631.64,,,,,,,351.3500,1361.3000,percent of total billed charges,"46.4% of $1,361.30 in Billed Charges for Rev 272 = $631.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1361.3000,204.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,567.66,,,,,,,351.3500,1361.3000,percent of total billed charges,"41.7% of $1,361.30 in Billed Charges for Rev 272 = $567.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1361.3000,204.2000,CIGNA HEALTHCARE,CIGNA PPO,567.66,,,,,,,351.3500,1361.3000,percent of total billed charges,"41.7% of $1,361.30 in Billed Charges for Rev 272 = $567.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1361.3000,204.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1225.17,,,,,,,351.3500,1361.3000,percent of total billed charges,"90% of $1,361.30 in Billed Charges for Rev 272 = $1,225.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1361.3000,204.2000,MEDCOST,MEDCOST VHN,647.84,,,,,,,351.3500,1361.3000,percent of total billed charges,"47.59% of $1,361.30 in Billed Charges for Rev 272 = $647.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1361.3000,204.2000,SENTARA HEALTH,SENTARA HEALTH,351.35,,,,,,,351.3500,1361.3000,percent of total billed charges,"25.81% of $1,361.30 in Billed Charges for Rev 272 = $351.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1361.3000,204.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1361.30,,,,,,,351.3500,1361.3000,percent of total billed charges,"100% of $1,361.30 in Billed Charges for Rev 272 = $1,361.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1361.3000,204.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,680.65,,,,,,,351.3500,1361.3000,percent of total billed charges,"Rev 272 $1,361.30 in Billed Charges at 50% = $680.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1361.3000,204.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,439.70,,,,,,,351.3500,1361.3000,other,"32.3% of $1,361.30 in Billed Charges for Rev 272 = $439.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1361.3000,204.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.92,,,,,,,351.3500,1361.3000,other,"30.7% of $1,361.30 in Billed Charges for Rev 272 = $417.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1361.3000,204.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,439.70,,,,,,,351.3500,1361.3000,percent of total billed charges,"32.3% of $1,361.30 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ROUTER SPIRAL 2.3MM,272,RC,27200002,CDM,,,,,,both,,,1361.3000,204.2000,WELLCARE,WELLCARE MEDICAID,1361.30,,,,,,,351.3500,1361.3000,percent of total billed charges,"100% of $1,361.30 in Billed Charges for Rev 272 = $1,361.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTHRILL,272,RC,27200002,CDM,,,,,,both,,,18667.8000,2800.1700,AETNA,AETNA,7971.15,,,,,,,4818.1600,18667.8000,percent of total billed charges,"42.7% of $18,667.80 in Billed Charges for Rev 272 = $7,971.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTHRILL,272,RC,27200002,CDM,,,,,,both,,,18667.8000,2800.1700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,13067.46,,,,,,,4818.1600,18667.8000,percent of total billed charges,"Rev 272 $18,667.80 in Billed Charges at 70% = $13,067.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTHRILL,272,RC,27200002,CDM,,,,,,both,,,18667.8000,2800.1700,CIGNA HEALTHCARE,CIGNA HMO,7784.47,,,,,,,4818.1600,18667.8000,percent of total billed charges,"41.7% of $18,667.80 in Billed Charges for Rev 272 = $7,784.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTHRILL,272,RC,27200002,CDM,,,,,,both,,,18667.8000,2800.1700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8661.86,,,,,,,4818.1600,18667.8000,percent of total billed charges,"46.4% of $18,667.80 in Billed Charges for Rev 272 = $8,661.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTHRILL,272,RC,27200002,CDM,,,,,,both,,,18667.8000,2800.1700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7784.47,,,,,,,4818.1600,18667.8000,percent of total billed charges,"41.7% of $18,667.80 in Billed Charges for Rev 272 = $7,784.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTHRILL,272,RC,27200002,CDM,,,,,,both,,,18667.8000,2800.1700,CIGNA HEALTHCARE,CIGNA PPO,7784.47,,,,,,,4818.1600,18667.8000,percent of total billed charges,"41.7% of $18,667.80 in Billed Charges for Rev 272 = $7,784.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTHRILL,272,RC,27200002,CDM,,,,,,both,,,18667.8000,2800.1700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,16801.02,,,,,,,4818.1600,18667.8000,percent of total billed charges,"90% of $18,667.80 in Billed Charges for Rev 272 = $16,801.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTHRILL,272,RC,27200002,CDM,,,,,,both,,,18667.8000,2800.1700,MEDCOST,MEDCOST VHN,8884.01,,,,,,,4818.1600,18667.8000,percent of total billed charges,"47.59% of $18,667.80 in Billed Charges for Rev 272 = $8,884.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTHRILL,272,RC,27200002,CDM,,,,,,both,,,18667.8000,2800.1700,SENTARA HEALTH,SENTARA HEALTH,4818.16,,,,,,,4818.1600,18667.8000,percent of total billed charges,"25.81% of $18,667.80 in Billed Charges for Rev 272 = $4,818.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTHRILL,272,RC,27200002,CDM,,,,,,both,,,18667.8000,2800.1700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",18667.80,,,,,,,4818.1600,18667.8000,percent of total billed charges,"100% of $18,667.80 in Billed Charges for Rev 272 = $18,667.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTHRILL,272,RC,27200002,CDM,,,,,,both,,,18667.8000,2800.1700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9333.90,,,,,,,4818.1600,18667.8000,percent of total billed charges,"Rev 272 $18,667.80 in Billed Charges at 50% = $9,333.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTHRILL,272,RC,27200002,CDM,,,,,,both,,,18667.8000,2800.1700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,6029.70,,,,,,,4818.1600,18667.8000,other,"32.3% of $18,667.80 in Billed Charges for Rev 272 = $6,029.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEATH INTHRILL,272,RC,27200002,CDM,,,,,,both,,,18667.8000,2800.1700,UNITED HEALTHCARE,UHC HERITAGE SELECT,5731.01,,,,,,,4818.1600,18667.8000,other,"30.7% of $18,667.80 in Billed Charges for Rev 272 = $5,731.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEATH INTHRILL,272,RC,27200002,CDM,,,,,,both,,,18667.8000,2800.1700,UNITED HEALTHCARE,UNITED HEALTHCARE,6029.70,,,,,,,4818.1600,18667.8000,percent of total billed charges,"32.3% of $18,667.80 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH INTHRILL,272,RC,27200002,CDM,,,,,,both,,,18667.8000,2800.1700,WELLCARE,WELLCARE MEDICAID,18667.80,,,,,,,4818.1600,18667.8000,percent of total billed charges,"100% of $18,667.80 in Billed Charges for Rev 272 = $18,667.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME STRAIGHT 6.4MM X 120MM,272,RC,,,,,,,,both,,,2036.3500,305.4500,AETNA,AETNA,869.52,,,,,,,525.5800,2036.3500,percent of total billed charges,"42.7% of $2,036.35 in Billed Charges for Rev 272 = $869.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME STRAIGHT 6.4MM X 120MM,272,RC,,,,,,,,both,,,2036.3500,305.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1425.45,,,,,,,525.5800,2036.3500,percent of total billed charges,"Rev 272 $2,036.35 in Billed Charges at 70% = $1,425.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME STRAIGHT 6.4MM X 120MM,272,RC,,,,,,,,both,,,2036.3500,305.4500,CIGNA HEALTHCARE,CIGNA HMO,849.16,,,,,,,525.5800,2036.3500,percent of total billed charges,"41.7% of $2,036.35 in Billed Charges for Rev 272 = $849.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME STRAIGHT 6.4MM X 120MM,272,RC,,,,,,,,both,,,2036.3500,305.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,944.87,,,,,,,525.5800,2036.3500,percent of total billed charges,"46.4% of $2,036.35 in Billed Charges for Rev 272 = $944.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME STRAIGHT 6.4MM X 120MM,272,RC,,,,,,,,both,,,2036.3500,305.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,849.16,,,,,,,525.5800,2036.3500,percent of total billed charges,"41.7% of $2,036.35 in Billed Charges for Rev 272 = $849.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME STRAIGHT 6.4MM X 120MM,272,RC,,,,,,,,both,,,2036.3500,305.4500,CIGNA HEALTHCARE,CIGNA PPO,849.16,,,,,,,525.5800,2036.3500,percent of total billed charges,"41.7% of $2,036.35 in Billed Charges for Rev 272 = $849.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME STRAIGHT 6.4MM X 120MM,272,RC,,,,,,,,both,,,2036.3500,305.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1832.72,,,,,,,525.5800,2036.3500,percent of total billed charges,"90% of $2,036.35 in Billed Charges for Rev 272 = $1,832.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME STRAIGHT 6.4MM X 120MM,272,RC,,,,,,,,both,,,2036.3500,305.4500,MEDCOST,MEDCOST VHN,969.10,,,,,,,525.5800,2036.3500,percent of total billed charges,"47.59% of $2,036.35 in Billed Charges for Rev 272 = $969.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME STRAIGHT 6.4MM X 120MM,272,RC,,,,,,,,both,,,2036.3500,305.4500,SENTARA HEALTH,SENTARA HEALTH,525.58,,,,,,,525.5800,2036.3500,percent of total billed charges,"25.81% of $2,036.35 in Billed Charges for Rev 272 = $525.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME STRAIGHT 6.4MM X 120MM,272,RC,,,,,,,,both,,,2036.3500,305.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2036.35,,,,,,,525.5800,2036.3500,percent of total billed charges,"100% of $2,036.35 in Billed Charges for Rev 272 = $2,036.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME STRAIGHT 6.4MM X 120MM,272,RC,,,,,,,,both,,,2036.3500,305.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1018.18,,,,,,,525.5800,2036.3500,percent of total billed charges,"Rev 272 $2,036.35 in Billed Charges at 50% = $1,018.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME STRAIGHT 6.4MM X 120MM,272,RC,,,,,,,,both,,,2036.3500,305.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,657.74,,,,,,,525.5800,2036.3500,other,"32.3% of $2,036.35 in Billed Charges for Rev 272 = $657.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
OSTEOTOME STRAIGHT 6.4MM X 120MM,272,RC,,,,,,,,both,,,2036.3500,305.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,625.16,,,,,,,525.5800,2036.3500,other,"30.7% of $2,036.35 in Billed Charges for Rev 272 = $625.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
OSTEOTOME STRAIGHT 6.4MM X 120MM,272,RC,,,,,,,,both,,,2036.3500,305.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,657.74,,,,,,,525.5800,2036.3500,percent of total billed charges,"32.3% of $2,036.35 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME STRAIGHT 6.4MM X 120MM,272,RC,,,,,,,,both,,,2036.3500,305.4500,WELLCARE,WELLCARE MEDICAID,2036.35,,,,,,,525.5800,2036.3500,percent of total billed charges,"100% of $2,036.35 in Billed Charges for Rev 272 = $2,036.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POINTER AXIUM NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,5890.7300,883.6100,AETNA,AETNA,2515.34,,,,,,,1520.4000,5890.7300,percent of total billed charges,"42.7% of $5,890.73 in Billed Charges for Rev 272 = $2,515.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POINTER AXIUM NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,5890.7300,883.6100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4123.51,,,,,,,1520.4000,5890.7300,percent of total billed charges,"Rev 272 $5,890.73 in Billed Charges at 70% = $4,123.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POINTER AXIUM NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,5890.7300,883.6100,CIGNA HEALTHCARE,CIGNA HMO,2456.43,,,,,,,1520.4000,5890.7300,percent of total billed charges,"41.7% of $5,890.73 in Billed Charges for Rev 272 = $2,456.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POINTER AXIUM NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,5890.7300,883.6100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2733.30,,,,,,,1520.4000,5890.7300,percent of total billed charges,"46.4% of $5,890.73 in Billed Charges for Rev 272 = $2,733.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POINTER AXIUM NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,5890.7300,883.6100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2456.43,,,,,,,1520.4000,5890.7300,percent of total billed charges,"41.7% of $5,890.73 in Billed Charges for Rev 272 = $2,456.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POINTER AXIUM NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,5890.7300,883.6100,CIGNA HEALTHCARE,CIGNA PPO,2456.43,,,,,,,1520.4000,5890.7300,percent of total billed charges,"41.7% of $5,890.73 in Billed Charges for Rev 272 = $2,456.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POINTER AXIUM NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,5890.7300,883.6100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5301.66,,,,,,,1520.4000,5890.7300,percent of total billed charges,"90% of $5,890.73 in Billed Charges for Rev 272 = $5,301.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POINTER AXIUM NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,5890.7300,883.6100,MEDCOST,MEDCOST VHN,2803.40,,,,,,,1520.4000,5890.7300,percent of total billed charges,"47.59% of $5,890.73 in Billed Charges for Rev 272 = $2,803.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POINTER AXIUM NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,5890.7300,883.6100,SENTARA HEALTH,SENTARA HEALTH,1520.40,,,,,,,1520.4000,5890.7300,percent of total billed charges,"25.81% of $5,890.73 in Billed Charges for Rev 272 = $1,520.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POINTER AXIUM NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,5890.7300,883.6100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5890.73,,,,,,,1520.4000,5890.7300,percent of total billed charges,"100% of $5,890.73 in Billed Charges for Rev 272 = $5,890.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POINTER AXIUM NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,5890.7300,883.6100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2945.37,,,,,,,1520.4000,5890.7300,percent of total billed charges,"Rev 272 $5,890.73 in Billed Charges at 50% = $2,945.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POINTER AXIUM NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,5890.7300,883.6100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1902.71,,,,,,,1520.4000,5890.7300,other,"32.3% of $5,890.73 in Billed Charges for Rev 272 = $1,902.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
POINTER AXIUM NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,5890.7300,883.6100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1808.45,,,,,,,1520.4000,5890.7300,other,"30.7% of $5,890.73 in Billed Charges for Rev 272 = $1,808.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
POINTER AXIUM NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,5890.7300,883.6100,UNITED HEALTHCARE,UNITED HEALTHCARE,1902.71,,,,,,,1520.4000,5890.7300,percent of total billed charges,"32.3% of $5,890.73 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POINTER AXIUM NAVIGATION,272,RC,27200002,CDM,,,,,,both,,,5890.7300,883.6100,WELLCARE,WELLCARE MEDICAID,5890.73,,,,,,,1520.4000,5890.7300,percent of total billed charges,"100% of $5,890.73 in Billed Charges for Rev 272 = $5,890.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT ACCESS & OBTURATOR W/BLUNT TIP 12X100MM,272,RC,27200002,CDM,,,,,,both,,,969.2900,145.3900,AETNA,AETNA,413.89,,,,,,,250.1700,969.2900,percent of total billed charges,42.7% of $969.29 in Billed Charges for Rev 272 = $413.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT ACCESS & OBTURATOR W/BLUNT TIP 12X100MM,272,RC,27200002,CDM,,,,,,both,,,969.2900,145.3900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,678.50,,,,,,,250.1700,969.2900,percent of total billed charges,Rev 272 $969.29 in Billed Charges at 70% = $678.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT ACCESS & OBTURATOR W/BLUNT TIP 12X100MM,272,RC,27200002,CDM,,,,,,both,,,969.2900,145.3900,CIGNA HEALTHCARE,CIGNA HMO,404.19,,,,,,,250.1700,969.2900,percent of total billed charges,41.7% of $969.29 in Billed Charges for Rev 272 = $404.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT ACCESS & OBTURATOR W/BLUNT TIP 12X100MM,272,RC,27200002,CDM,,,,,,both,,,969.2900,145.3900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,449.75,,,,,,,250.1700,969.2900,percent of total billed charges,46.4% of $969.29 in Billed Charges for Rev 272 = $449.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT ACCESS & OBTURATOR W/BLUNT TIP 12X100MM,272,RC,27200002,CDM,,,,,,both,,,969.2900,145.3900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,404.19,,,,,,,250.1700,969.2900,percent of total billed charges,41.7% of $969.29 in Billed Charges for Rev 272 = $404.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT ACCESS & OBTURATOR W/BLUNT TIP 12X100MM,272,RC,27200002,CDM,,,,,,both,,,969.2900,145.3900,CIGNA HEALTHCARE,CIGNA PPO,404.19,,,,,,,250.1700,969.2900,percent of total billed charges,41.7% of $969.29 in Billed Charges for Rev 272 = $404.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT ACCESS & OBTURATOR W/BLUNT TIP 12X100MM,272,RC,27200002,CDM,,,,,,both,,,969.2900,145.3900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,872.36,,,,,,,250.1700,969.2900,percent of total billed charges,90% of $969.29 in Billed Charges for Rev 272 = $872.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT ACCESS & OBTURATOR W/BLUNT TIP 12X100MM,272,RC,27200002,CDM,,,,,,both,,,969.2900,145.3900,MEDCOST,MEDCOST VHN,461.29,,,,,,,250.1700,969.2900,percent of total billed charges,47.59% of $969.29 in Billed Charges for Rev 272 = $461.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT ACCESS & OBTURATOR W/BLUNT TIP 12X100MM,272,RC,27200002,CDM,,,,,,both,,,969.2900,145.3900,SENTARA HEALTH,SENTARA HEALTH,250.17,,,,,,,250.1700,969.2900,percent of total billed charges,25.81% of $969.29 in Billed Charges for Rev 272 = $250.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT ACCESS & OBTURATOR W/BLUNT TIP 12X100MM,272,RC,27200002,CDM,,,,,,both,,,969.2900,145.3900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",969.29,,,,,,,250.1700,969.2900,percent of total billed charges,100% of $969.29 in Billed Charges for Rev 272 = $969.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT ACCESS & OBTURATOR W/BLUNT TIP 12X100MM,272,RC,27200002,CDM,,,,,,both,,,969.2900,145.3900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,484.65,,,,,,,250.1700,969.2900,percent of total billed charges,Rev 272 $969.29 in Billed Charges at 50% = $484.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT ACCESS & OBTURATOR W/BLUNT TIP 12X100MM,272,RC,27200002,CDM,,,,,,both,,,969.2900,145.3900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,313.08,,,,,,,250.1700,969.2900,other,32.3% of $969.29 in Billed Charges for Rev 272 = $313.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PORT ACCESS & OBTURATOR W/BLUNT TIP 12X100MM,272,RC,27200002,CDM,,,,,,both,,,969.2900,145.3900,UNITED HEALTHCARE,UHC HERITAGE SELECT,297.57,,,,,,,250.1700,969.2900,other,30.7% of $969.29 in Billed Charges for Rev 272 = $297.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PORT ACCESS & OBTURATOR W/BLUNT TIP 12X100MM,272,RC,27200002,CDM,,,,,,both,,,969.2900,145.3900,UNITED HEALTHCARE,UNITED HEALTHCARE,313.08,,,,,,,250.1700,969.2900,percent of total billed charges,32.3% of $969.29 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT ACCESS & OBTURATOR W/BLUNT TIP 12X100MM,272,RC,27200002,CDM,,,,,,both,,,969.2900,145.3900,WELLCARE,WELLCARE MEDICAID,969.29,,,,,,,250.1700,969.2900,percent of total billed charges,100% of $969.29 in Billed Charges for Rev 272 = $969.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHOULDER STABILIZATION KIT,272,RC,27200002,CDM,,,,,,both,,,652.9600,97.9400,AETNA,AETNA,278.81,,,,,,,168.5300,652.9600,percent of total billed charges,42.7% of $652.96 in Billed Charges for Rev 272 = $278.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHOULDER STABILIZATION KIT,272,RC,27200002,CDM,,,,,,both,,,652.9600,97.9400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,457.07,,,,,,,168.5300,652.9600,percent of total billed charges,Rev 272 $652.96 in Billed Charges at 70% = $457.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHOULDER STABILIZATION KIT,272,RC,27200002,CDM,,,,,,both,,,652.9600,97.9400,CIGNA HEALTHCARE,CIGNA HMO,272.28,,,,,,,168.5300,652.9600,percent of total billed charges,41.7% of $652.96 in Billed Charges for Rev 272 = $272.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHOULDER STABILIZATION KIT,272,RC,27200002,CDM,,,,,,both,,,652.9600,97.9400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,302.97,,,,,,,168.5300,652.9600,percent of total billed charges,46.4% of $652.96 in Billed Charges for Rev 272 = $302.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHOULDER STABILIZATION KIT,272,RC,27200002,CDM,,,,,,both,,,652.9600,97.9400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,272.28,,,,,,,168.5300,652.9600,percent of total billed charges,41.7% of $652.96 in Billed Charges for Rev 272 = $272.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHOULDER STABILIZATION KIT,272,RC,27200002,CDM,,,,,,both,,,652.9600,97.9400,CIGNA HEALTHCARE,CIGNA PPO,272.28,,,,,,,168.5300,652.9600,percent of total billed charges,41.7% of $652.96 in Billed Charges for Rev 272 = $272.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHOULDER STABILIZATION KIT,272,RC,27200002,CDM,,,,,,both,,,652.9600,97.9400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,587.66,,,,,,,168.5300,652.9600,percent of total billed charges,90% of $652.96 in Billed Charges for Rev 272 = $587.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHOULDER STABILIZATION KIT,272,RC,27200002,CDM,,,,,,both,,,652.9600,97.9400,MEDCOST,MEDCOST VHN,310.74,,,,,,,168.5300,652.9600,percent of total billed charges,47.59% of $652.96 in Billed Charges for Rev 272 = $310.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHOULDER STABILIZATION KIT,272,RC,27200002,CDM,,,,,,both,,,652.9600,97.9400,SENTARA HEALTH,SENTARA HEALTH,168.53,,,,,,,168.5300,652.9600,percent of total billed charges,25.81% of $652.96 in Billed Charges for Rev 272 = $168.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHOULDER STABILIZATION KIT,272,RC,27200002,CDM,,,,,,both,,,652.9600,97.9400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",652.96,,,,,,,168.5300,652.9600,percent of total billed charges,100% of $652.96 in Billed Charges for Rev 272 = $652.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHOULDER STABILIZATION KIT,272,RC,27200002,CDM,,,,,,both,,,652.9600,97.9400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,326.48,,,,,,,168.5300,652.9600,percent of total billed charges,Rev 272 $652.96 in Billed Charges at 50% = $326.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHOULDER STABILIZATION KIT,272,RC,27200002,CDM,,,,,,both,,,652.9600,97.9400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,210.91,,,,,,,168.5300,652.9600,other,32.3% of $652.96 in Billed Charges for Rev 272 = $210.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SHOULDER STABILIZATION KIT,272,RC,27200002,CDM,,,,,,both,,,652.9600,97.9400,UNITED HEALTHCARE,UHC HERITAGE SELECT,200.46,,,,,,,168.5300,652.9600,other,30.7% of $652.96 in Billed Charges for Rev 272 = $200.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SHOULDER STABILIZATION KIT,272,RC,27200002,CDM,,,,,,both,,,652.9600,97.9400,UNITED HEALTHCARE,UNITED HEALTHCARE,210.91,,,,,,,168.5300,652.9600,percent of total billed charges,32.3% of $652.96 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHOULDER STABILIZATION KIT,272,RC,27200002,CDM,,,,,,both,,,652.9600,97.9400,WELLCARE,WELLCARE MEDICAID,652.96,,,,,,,168.5300,652.9600,percent of total billed charges,100% of $652.96 in Billed Charges for Rev 272 = $652.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHUNT CAROTID SUNDT 3MMX4M,272,RC,27200002,CDM,,,,,,both,,,6286.0700,942.9100,AETNA,AETNA,2684.15,,,,,,,1622.4300,6286.0700,percent of total billed charges,"42.7% of $6,286.07 in Billed Charges for Rev 272 = $2,684.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID SUNDT 3MMX4M,272,RC,27200002,CDM,,,,,,both,,,6286.0700,942.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4400.25,,,,,,,1622.4300,6286.0700,percent of total billed charges,"Rev 272 $6,286.07 in Billed Charges at 70% = $4,400.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID SUNDT 3MMX4M,272,RC,27200002,CDM,,,,,,both,,,6286.0700,942.9100,CIGNA HEALTHCARE,CIGNA HMO,2621.29,,,,,,,1622.4300,6286.0700,percent of total billed charges,"41.7% of $6,286.07 in Billed Charges for Rev 272 = $2,621.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID SUNDT 3MMX4M,272,RC,27200002,CDM,,,,,,both,,,6286.0700,942.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2916.74,,,,,,,1622.4300,6286.0700,percent of total billed charges,"46.4% of $6,286.07 in Billed Charges for Rev 272 = $2,916.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID SUNDT 3MMX4M,272,RC,27200002,CDM,,,,,,both,,,6286.0700,942.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2621.29,,,,,,,1622.4300,6286.0700,percent of total billed charges,"41.7% of $6,286.07 in Billed Charges for Rev 272 = $2,621.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID SUNDT 3MMX4M,272,RC,27200002,CDM,,,,,,both,,,6286.0700,942.9100,CIGNA HEALTHCARE,CIGNA PPO,2621.29,,,,,,,1622.4300,6286.0700,percent of total billed charges,"41.7% of $6,286.07 in Billed Charges for Rev 272 = $2,621.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID SUNDT 3MMX4M,272,RC,27200002,CDM,,,,,,both,,,6286.0700,942.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5657.46,,,,,,,1622.4300,6286.0700,percent of total billed charges,"90% of $6,286.07 in Billed Charges for Rev 272 = $5,657.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID SUNDT 3MMX4M,272,RC,27200002,CDM,,,,,,both,,,6286.0700,942.9100,MEDCOST,MEDCOST VHN,2991.54,,,,,,,1622.4300,6286.0700,percent of total billed charges,"47.59% of $6,286.07 in Billed Charges for Rev 272 = $2,991.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID SUNDT 3MMX4M,272,RC,27200002,CDM,,,,,,both,,,6286.0700,942.9100,SENTARA HEALTH,SENTARA HEALTH,1622.43,,,,,,,1622.4300,6286.0700,percent of total billed charges,"25.81% of $6,286.07 in Billed Charges for Rev 272 = $1,622.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID SUNDT 3MMX4M,272,RC,27200002,CDM,,,,,,both,,,6286.0700,942.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6286.07,,,,,,,1622.4300,6286.0700,percent of total billed charges,"100% of $6,286.07 in Billed Charges for Rev 272 = $6,286.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID SUNDT 3MMX4M,272,RC,27200002,CDM,,,,,,both,,,6286.0700,942.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3143.04,,,,,,,1622.4300,6286.0700,percent of total billed charges,"Rev 272 $6,286.07 in Billed Charges at 50% = $3,143.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID SUNDT 3MMX4M,272,RC,27200002,CDM,,,,,,both,,,6286.0700,942.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2030.40,,,,,,,1622.4300,6286.0700,other,"32.3% of $6,286.07 in Billed Charges for Rev 272 = $2,030.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHUNT CAROTID SUNDT 3MMX4M,272,RC,27200002,CDM,,,,,,both,,,6286.0700,942.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1929.82,,,,,,,1622.4300,6286.0700,other,"30.7% of $6,286.07 in Billed Charges for Rev 272 = $1,929.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHUNT CAROTID SUNDT 3MMX4M,272,RC,27200002,CDM,,,,,,both,,,6286.0700,942.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,2030.40,,,,,,,1622.4300,6286.0700,percent of total billed charges,"32.3% of $6,286.07 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT CAROTID SUNDT 3MMX4M,272,RC,27200002,CDM,,,,,,both,,,6286.0700,942.9100,WELLCARE,WELLCARE MEDICAID,6286.07,,,,,,,1622.4300,6286.0700,percent of total billed charges,"100% of $6,286.07 in Billed Charges for Rev 272 = $6,286.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT GEL,272,RC,27200002,CDM,,,,,,both,,,7415.2700,1112.2900,AETNA,AETNA,3166.32,,,,,,,1913.8800,7415.2700,percent of total billed charges,"42.7% of $7,415.27 in Billed Charges for Rev 272 = $3,166.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT GEL,272,RC,27200002,CDM,,,,,,both,,,7415.2700,1112.2900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5190.69,,,,,,,1913.8800,7415.2700,percent of total billed charges,"Rev 272 $7,415.27 in Billed Charges at 70% = $5,190.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT GEL,272,RC,27200002,CDM,,,,,,both,,,7415.2700,1112.2900,CIGNA HEALTHCARE,CIGNA HMO,3092.17,,,,,,,1913.8800,7415.2700,percent of total billed charges,"41.7% of $7,415.27 in Billed Charges for Rev 272 = $3,092.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT GEL,272,RC,27200002,CDM,,,,,,both,,,7415.2700,1112.2900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3440.69,,,,,,,1913.8800,7415.2700,percent of total billed charges,"46.4% of $7,415.27 in Billed Charges for Rev 272 = $3,440.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT GEL,272,RC,27200002,CDM,,,,,,both,,,7415.2700,1112.2900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3092.17,,,,,,,1913.8800,7415.2700,percent of total billed charges,"41.7% of $7,415.27 in Billed Charges for Rev 272 = $3,092.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT GEL,272,RC,27200002,CDM,,,,,,both,,,7415.2700,1112.2900,CIGNA HEALTHCARE,CIGNA PPO,3092.17,,,,,,,1913.8800,7415.2700,percent of total billed charges,"41.7% of $7,415.27 in Billed Charges for Rev 272 = $3,092.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT GEL,272,RC,27200002,CDM,,,,,,both,,,7415.2700,1112.2900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6673.74,,,,,,,1913.8800,7415.2700,percent of total billed charges,"90% of $7,415.27 in Billed Charges for Rev 272 = $6,673.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT GEL,272,RC,27200002,CDM,,,,,,both,,,7415.2700,1112.2900,MEDCOST,MEDCOST VHN,3528.93,,,,,,,1913.8800,7415.2700,percent of total billed charges,"47.59% of $7,415.27 in Billed Charges for Rev 272 = $3,528.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT GEL,272,RC,27200002,CDM,,,,,,both,,,7415.2700,1112.2900,SENTARA HEALTH,SENTARA HEALTH,1913.88,,,,,,,1913.8800,7415.2700,percent of total billed charges,"25.81% of $7,415.27 in Billed Charges for Rev 272 = $1,913.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT GEL,272,RC,27200002,CDM,,,,,,both,,,7415.2700,1112.2900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7415.27,,,,,,,1913.8800,7415.2700,percent of total billed charges,"100% of $7,415.27 in Billed Charges for Rev 272 = $7,415.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT GEL,272,RC,27200002,CDM,,,,,,both,,,7415.2700,1112.2900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3707.64,,,,,,,1913.8800,7415.2700,percent of total billed charges,"Rev 272 $7,415.27 in Billed Charges at 50% = $3,707.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT GEL,272,RC,27200002,CDM,,,,,,both,,,7415.2700,1112.2900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2395.13,,,,,,,1913.8800,7415.2700,other,"32.3% of $7,415.27 in Billed Charges for Rev 272 = $2,395.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PORT GEL,272,RC,27200002,CDM,,,,,,both,,,7415.2700,1112.2900,UNITED HEALTHCARE,UHC HERITAGE SELECT,2276.49,,,,,,,1913.8800,7415.2700,other,"30.7% of $7,415.27 in Billed Charges for Rev 272 = $2,276.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PORT GEL,272,RC,27200002,CDM,,,,,,both,,,7415.2700,1112.2900,UNITED HEALTHCARE,UNITED HEALTHCARE,2395.13,,,,,,,1913.8800,7415.2700,percent of total billed charges,"32.3% of $7,415.27 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT GEL,272,RC,27200002,CDM,,,,,,both,,,7415.2700,1112.2900,WELLCARE,WELLCARE MEDICAID,7415.27,,,,,,,1913.8800,7415.2700,percent of total billed charges,"100% of $7,415.27 in Billed Charges for Rev 272 = $7,415.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT SUNDT INTERNAL NON REINFORCED SEGMENT 3.5MM X 4MM,272,RC,27200002,CDM,,,,,,both,,,8007.2400,1201.0900,AETNA,AETNA,3419.09,,,,,,,2066.6700,8007.2400,percent of total billed charges,"42.7% of $8,007.24 in Billed Charges for Rev 272 = $3,419.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT SUNDT INTERNAL NON REINFORCED SEGMENT 3.5MM X 4MM,272,RC,27200002,CDM,,,,,,both,,,8007.2400,1201.0900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5605.07,,,,,,,2066.6700,8007.2400,percent of total billed charges,"Rev 272 $8,007.24 in Billed Charges at 70% = $5,605.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT SUNDT INTERNAL NON REINFORCED SEGMENT 3.5MM X 4MM,272,RC,27200002,CDM,,,,,,both,,,8007.2400,1201.0900,CIGNA HEALTHCARE,CIGNA HMO,3339.02,,,,,,,2066.6700,8007.2400,percent of total billed charges,"41.7% of $8,007.24 in Billed Charges for Rev 272 = $3,339.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT SUNDT INTERNAL NON REINFORCED SEGMENT 3.5MM X 4MM,272,RC,27200002,CDM,,,,,,both,,,8007.2400,1201.0900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3715.36,,,,,,,2066.6700,8007.2400,percent of total billed charges,"46.4% of $8,007.24 in Billed Charges for Rev 272 = $3,715.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT SUNDT INTERNAL NON REINFORCED SEGMENT 3.5MM X 4MM,272,RC,27200002,CDM,,,,,,both,,,8007.2400,1201.0900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3339.02,,,,,,,2066.6700,8007.2400,percent of total billed charges,"41.7% of $8,007.24 in Billed Charges for Rev 272 = $3,339.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT SUNDT INTERNAL NON REINFORCED SEGMENT 3.5MM X 4MM,272,RC,27200002,CDM,,,,,,both,,,8007.2400,1201.0900,CIGNA HEALTHCARE,CIGNA PPO,3339.02,,,,,,,2066.6700,8007.2400,percent of total billed charges,"41.7% of $8,007.24 in Billed Charges for Rev 272 = $3,339.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT SUNDT INTERNAL NON REINFORCED SEGMENT 3.5MM X 4MM,272,RC,27200002,CDM,,,,,,both,,,8007.2400,1201.0900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7206.52,,,,,,,2066.6700,8007.2400,percent of total billed charges,"90% of $8,007.24 in Billed Charges for Rev 272 = $7,206.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT SUNDT INTERNAL NON REINFORCED SEGMENT 3.5MM X 4MM,272,RC,27200002,CDM,,,,,,both,,,8007.2400,1201.0900,MEDCOST,MEDCOST VHN,3810.65,,,,,,,2066.6700,8007.2400,percent of total billed charges,"47.59% of $8,007.24 in Billed Charges for Rev 272 = $3,810.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT SUNDT INTERNAL NON REINFORCED SEGMENT 3.5MM X 4MM,272,RC,27200002,CDM,,,,,,both,,,8007.2400,1201.0900,SENTARA HEALTH,SENTARA HEALTH,2066.67,,,,,,,2066.6700,8007.2400,percent of total billed charges,"25.81% of $8,007.24 in Billed Charges for Rev 272 = $2,066.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT SUNDT INTERNAL NON REINFORCED SEGMENT 3.5MM X 4MM,272,RC,27200002,CDM,,,,,,both,,,8007.2400,1201.0900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8007.24,,,,,,,2066.6700,8007.2400,percent of total billed charges,"100% of $8,007.24 in Billed Charges for Rev 272 = $8,007.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT SUNDT INTERNAL NON REINFORCED SEGMENT 3.5MM X 4MM,272,RC,27200002,CDM,,,,,,both,,,8007.2400,1201.0900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4003.62,,,,,,,2066.6700,8007.2400,percent of total billed charges,"Rev 272 $8,007.24 in Billed Charges at 50% = $4,003.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT SUNDT INTERNAL NON REINFORCED SEGMENT 3.5MM X 4MM,272,RC,27200002,CDM,,,,,,both,,,8007.2400,1201.0900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2586.34,,,,,,,2066.6700,8007.2400,other,"32.3% of $8,007.24 in Billed Charges for Rev 272 = $2,586.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHUNT SUNDT INTERNAL NON REINFORCED SEGMENT 3.5MM X 4MM,272,RC,27200002,CDM,,,,,,both,,,8007.2400,1201.0900,UNITED HEALTHCARE,UHC HERITAGE SELECT,2458.22,,,,,,,2066.6700,8007.2400,other,"30.7% of $8,007.24 in Billed Charges for Rev 272 = $2,458.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHUNT SUNDT INTERNAL NON REINFORCED SEGMENT 3.5MM X 4MM,272,RC,27200002,CDM,,,,,,both,,,8007.2400,1201.0900,UNITED HEALTHCARE,UNITED HEALTHCARE,2586.34,,,,,,,2066.6700,8007.2400,percent of total billed charges,"32.3% of $8,007.24 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHUNT SUNDT INTERNAL NON REINFORCED SEGMENT 3.5MM X 4MM,272,RC,27200002,CDM,,,,,,both,,,8007.2400,1201.0900,WELLCARE,WELLCARE MEDICAID,8007.24,,,,,,,2066.6700,8007.2400,percent of total billed charges,"100% of $8,007.24 in Billed Charges for Rev 272 = $8,007.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POWDER SURGIFOAM 1 GRAM,272,RC,27200002,CDM,,,,,,both,,,559.7700,83.9700,AETNA,AETNA,239.02,,,,,,,144.4800,559.7700,percent of total billed charges,42.7% of $559.77 in Billed Charges for Rev 272 = $239.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
POWDER SURGIFOAM 1 GRAM,272,RC,27200002,CDM,,,,,,both,,,559.7700,83.9700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,391.84,,,,,,,144.4800,559.7700,percent of total billed charges,Rev 272 $559.77 in Billed Charges at 70% = $391.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
POWDER SURGIFOAM 1 GRAM,272,RC,27200002,CDM,,,,,,both,,,559.7700,83.9700,CIGNA HEALTHCARE,CIGNA HMO,233.42,,,,,,,144.4800,559.7700,percent of total billed charges,41.7% of $559.77 in Billed Charges for Rev 272 = $233.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
POWDER SURGIFOAM 1 GRAM,272,RC,27200002,CDM,,,,,,both,,,559.7700,83.9700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,259.73,,,,,,,144.4800,559.7700,percent of total billed charges,46.4% of $559.77 in Billed Charges for Rev 272 = $259.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
POWDER SURGIFOAM 1 GRAM,272,RC,27200002,CDM,,,,,,both,,,559.7700,83.9700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,233.42,,,,,,,144.4800,559.7700,percent of total billed charges,41.7% of $559.77 in Billed Charges for Rev 272 = $233.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
POWDER SURGIFOAM 1 GRAM,272,RC,27200002,CDM,,,,,,both,,,559.7700,83.9700,CIGNA HEALTHCARE,CIGNA PPO,233.42,,,,,,,144.4800,559.7700,percent of total billed charges,41.7% of $559.77 in Billed Charges for Rev 272 = $233.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
POWDER SURGIFOAM 1 GRAM,272,RC,27200002,CDM,,,,,,both,,,559.7700,83.9700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,503.79,,,,,,,144.4800,559.7700,percent of total billed charges,90% of $559.77 in Billed Charges for Rev 272 = $503.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
POWDER SURGIFOAM 1 GRAM,272,RC,27200002,CDM,,,,,,both,,,559.7700,83.9700,MEDCOST,MEDCOST VHN,266.39,,,,,,,144.4800,559.7700,percent of total billed charges,47.59% of $559.77 in Billed Charges for Rev 272 = $266.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
POWDER SURGIFOAM 1 GRAM,272,RC,27200002,CDM,,,,,,both,,,559.7700,83.9700,SENTARA HEALTH,SENTARA HEALTH,144.48,,,,,,,144.4800,559.7700,percent of total billed charges,25.81% of $559.77 in Billed Charges for Rev 272 = $144.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
POWDER SURGIFOAM 1 GRAM,272,RC,27200002,CDM,,,,,,both,,,559.7700,83.9700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",559.77,,,,,,,144.4800,559.7700,percent of total billed charges,100% of $559.77 in Billed Charges for Rev 272 = $559.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
POWDER SURGIFOAM 1 GRAM,272,RC,27200002,CDM,,,,,,both,,,559.7700,83.9700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,279.89,,,,,,,144.4800,559.7700,percent of total billed charges,Rev 272 $559.77 in Billed Charges at 50% = $279.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
POWDER SURGIFOAM 1 GRAM,272,RC,27200002,CDM,,,,,,both,,,559.7700,83.9700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,180.81,,,,,,,144.4800,559.7700,other,32.3% of $559.77 in Billed Charges for Rev 272 = $180.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
POWDER SURGIFOAM 1 GRAM,272,RC,27200002,CDM,,,,,,both,,,559.7700,83.9700,UNITED HEALTHCARE,UHC HERITAGE SELECT,171.85,,,,,,,144.4800,559.7700,other,30.7% of $559.77 in Billed Charges for Rev 272 = $171.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
POWDER SURGIFOAM 1 GRAM,272,RC,27200002,CDM,,,,,,both,,,559.7700,83.9700,UNITED HEALTHCARE,UNITED HEALTHCARE,180.81,,,,,,,144.4800,559.7700,percent of total billed charges,32.3% of $559.77 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
POWDER SURGIFOAM 1 GRAM,272,RC,27200002,CDM,,,,,,both,,,559.7700,83.9700,WELLCARE,WELLCARE MEDICAID,559.77,,,,,,,144.4800,559.7700,percent of total billed charges,100% of $559.77 in Billed Charges for Rev 272 = $559.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
REAMER HEAD DISP 10.0,272,RC,,,,,,,,both,,,4662.5900,699.3900,AETNA,AETNA,1990.93,,,,,,,1203.4100,4662.5900,percent of total billed charges,"42.7% of $4,662.59 in Billed Charges for Rev 272 = $1,990.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER HEAD DISP 10.0,272,RC,,,,,,,,both,,,4662.5900,699.3900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3263.81,,,,,,,1203.4100,4662.5900,percent of total billed charges,"Rev 272 $4,662.59 in Billed Charges at 70% = $3,263.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER HEAD DISP 10.0,272,RC,,,,,,,,both,,,4662.5900,699.3900,CIGNA HEALTHCARE,CIGNA HMO,1944.30,,,,,,,1203.4100,4662.5900,percent of total billed charges,"41.7% of $4,662.59 in Billed Charges for Rev 272 = $1,944.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER HEAD DISP 10.0,272,RC,,,,,,,,both,,,4662.5900,699.3900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2163.44,,,,,,,1203.4100,4662.5900,percent of total billed charges,"46.4% of $4,662.59 in Billed Charges for Rev 272 = $2,163.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER HEAD DISP 10.0,272,RC,,,,,,,,both,,,4662.5900,699.3900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1944.30,,,,,,,1203.4100,4662.5900,percent of total billed charges,"41.7% of $4,662.59 in Billed Charges for Rev 272 = $1,944.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER HEAD DISP 10.0,272,RC,,,,,,,,both,,,4662.5900,699.3900,CIGNA HEALTHCARE,CIGNA PPO,1944.30,,,,,,,1203.4100,4662.5900,percent of total billed charges,"41.7% of $4,662.59 in Billed Charges for Rev 272 = $1,944.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER HEAD DISP 10.0,272,RC,,,,,,,,both,,,4662.5900,699.3900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4196.33,,,,,,,1203.4100,4662.5900,percent of total billed charges,"90% of $4,662.59 in Billed Charges for Rev 272 = $4,196.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER HEAD DISP 10.0,272,RC,,,,,,,,both,,,4662.5900,699.3900,MEDCOST,MEDCOST VHN,2218.93,,,,,,,1203.4100,4662.5900,percent of total billed charges,"47.59% of $4,662.59 in Billed Charges for Rev 272 = $2,218.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER HEAD DISP 10.0,272,RC,,,,,,,,both,,,4662.5900,699.3900,SENTARA HEALTH,SENTARA HEALTH,1203.41,,,,,,,1203.4100,4662.5900,percent of total billed charges,"25.81% of $4,662.59 in Billed Charges for Rev 272 = $1,203.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER HEAD DISP 10.0,272,RC,,,,,,,,both,,,4662.5900,699.3900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4662.59,,,,,,,1203.4100,4662.5900,percent of total billed charges,"100% of $4,662.59 in Billed Charges for Rev 272 = $4,662.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER HEAD DISP 10.0,272,RC,,,,,,,,both,,,4662.5900,699.3900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2331.30,,,,,,,1203.4100,4662.5900,percent of total billed charges,"Rev 272 $4,662.59 in Billed Charges at 50% = $2,331.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER HEAD DISP 10.0,272,RC,,,,,,,,both,,,4662.5900,699.3900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1506.02,,,,,,,1203.4100,4662.5900,other,"32.3% of $4,662.59 in Billed Charges for Rev 272 = $1,506.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
REAMER HEAD DISP 10.0,272,RC,,,,,,,,both,,,4662.5900,699.3900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1431.42,,,,,,,1203.4100,4662.5900,other,"30.7% of $4,662.59 in Billed Charges for Rev 272 = $1,431.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
REAMER HEAD DISP 10.0,272,RC,,,,,,,,both,,,4662.5900,699.3900,UNITED HEALTHCARE,UNITED HEALTHCARE,1506.02,,,,,,,1203.4100,4662.5900,percent of total billed charges,"32.3% of $4,662.59 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER HEAD DISP 10.0,272,RC,,,,,,,,both,,,4662.5900,699.3900,WELLCARE,WELLCARE MEDICAID,4662.59,,,,,,,1203.4100,4662.5900,percent of total billed charges,"100% of $4,662.59 in Billed Charges for Rev 272 = $4,662.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLEOSCOPY 5MM 31CM,272,RC,27200002,CDM,,,,,,both,,,2843.4600,426.5200,AETNA,AETNA,1214.16,,,,,,,733.9000,2843.4600,percent of total billed charges,"42.7% of $2,843.46 in Billed Charges for Rev 272 = $1,214.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLEOSCOPY 5MM 31CM,272,RC,27200002,CDM,,,,,,both,,,2843.4600,426.5200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1990.42,,,,,,,733.9000,2843.4600,percent of total billed charges,"Rev 272 $2,843.46 in Billed Charges at 70% = $1,990.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLEOSCOPY 5MM 31CM,272,RC,27200002,CDM,,,,,,both,,,2843.4600,426.5200,CIGNA HEALTHCARE,CIGNA HMO,1185.72,,,,,,,733.9000,2843.4600,percent of total billed charges,"41.7% of $2,843.46 in Billed Charges for Rev 272 = $1,185.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLEOSCOPY 5MM 31CM,272,RC,27200002,CDM,,,,,,both,,,2843.4600,426.5200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1319.37,,,,,,,733.9000,2843.4600,percent of total billed charges,"46.4% of $2,843.46 in Billed Charges for Rev 272 = $1,319.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLEOSCOPY 5MM 31CM,272,RC,27200002,CDM,,,,,,both,,,2843.4600,426.5200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1185.72,,,,,,,733.9000,2843.4600,percent of total billed charges,"41.7% of $2,843.46 in Billed Charges for Rev 272 = $1,185.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLEOSCOPY 5MM 31CM,272,RC,27200002,CDM,,,,,,both,,,2843.4600,426.5200,CIGNA HEALTHCARE,CIGNA PPO,1185.72,,,,,,,733.9000,2843.4600,percent of total billed charges,"41.7% of $2,843.46 in Billed Charges for Rev 272 = $1,185.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLEOSCOPY 5MM 31CM,272,RC,27200002,CDM,,,,,,both,,,2843.4600,426.5200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2559.11,,,,,,,733.9000,2843.4600,percent of total billed charges,"90% of $2,843.46 in Billed Charges for Rev 272 = $2,559.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLEOSCOPY 5MM 31CM,272,RC,27200002,CDM,,,,,,both,,,2843.4600,426.5200,MEDCOST,MEDCOST VHN,1353.20,,,,,,,733.9000,2843.4600,percent of total billed charges,"47.59% of $2,843.46 in Billed Charges for Rev 272 = $1,353.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLEOSCOPY 5MM 31CM,272,RC,27200002,CDM,,,,,,both,,,2843.4600,426.5200,SENTARA HEALTH,SENTARA HEALTH,733.90,,,,,,,733.9000,2843.4600,percent of total billed charges,"25.81% of $2,843.46 in Billed Charges for Rev 272 = $733.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLEOSCOPY 5MM 31CM,272,RC,27200002,CDM,,,,,,both,,,2843.4600,426.5200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2843.46,,,,,,,733.9000,2843.4600,percent of total billed charges,"100% of $2,843.46 in Billed Charges for Rev 272 = $2,843.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLEOSCOPY 5MM 31CM,272,RC,27200002,CDM,,,,,,both,,,2843.4600,426.5200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1421.73,,,,,,,733.9000,2843.4600,percent of total billed charges,"Rev 272 $2,843.46 in Billed Charges at 50% = $1,421.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLEOSCOPY 5MM 31CM,272,RC,27200002,CDM,,,,,,both,,,2843.4600,426.5200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,918.44,,,,,,,733.9000,2843.4600,other,"32.3% of $2,843.46 in Billed Charges for Rev 272 = $918.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLEOSCOPY 5MM 31CM,272,RC,27200002,CDM,,,,,,both,,,2843.4600,426.5200,UNITED HEALTHCARE,UHC HERITAGE SELECT,872.94,,,,,,,733.9000,2843.4600,other,"30.7% of $2,843.46 in Billed Charges for Rev 272 = $872.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLEOSCOPY 5MM 31CM,272,RC,27200002,CDM,,,,,,both,,,2843.4600,426.5200,UNITED HEALTHCARE,UNITED HEALTHCARE,918.44,,,,,,,733.9000,2843.4600,percent of total billed charges,"32.3% of $2,843.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLEOSCOPY 5MM 31CM,272,RC,27200002,CDM,,,,,,both,,,2843.4600,426.5200,WELLCARE,WELLCARE MEDICAID,2843.46,,,,,,,733.9000,2843.4600,percent of total billed charges,"100% of $2,843.46 in Billed Charges for Rev 272 = $2,843.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MALE WILSON SYSTEM,272,RC,,,,,,,,both,,,4179.5100,626.9300,AETNA,AETNA,1784.65,,,,,,,1078.7300,4179.5100,percent of total billed charges,"42.7% of $4,179.51 in Billed Charges for Rev 272 = $1,784.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MALE WILSON SYSTEM,272,RC,,,,,,,,both,,,4179.5100,626.9300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2925.66,,,,,,,1078.7300,4179.5100,percent of total billed charges,"Rev 272 $4,179.51 in Billed Charges at 70% = $2,925.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MALE WILSON SYSTEM,272,RC,,,,,,,,both,,,4179.5100,626.9300,CIGNA HEALTHCARE,CIGNA HMO,1742.86,,,,,,,1078.7300,4179.5100,percent of total billed charges,"41.7% of $4,179.51 in Billed Charges for Rev 272 = $1,742.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MALE WILSON SYSTEM,272,RC,,,,,,,,both,,,4179.5100,626.9300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1939.29,,,,,,,1078.7300,4179.5100,percent of total billed charges,"46.4% of $4,179.51 in Billed Charges for Rev 272 = $1,939.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MALE WILSON SYSTEM,272,RC,,,,,,,,both,,,4179.5100,626.9300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1742.86,,,,,,,1078.7300,4179.5100,percent of total billed charges,"41.7% of $4,179.51 in Billed Charges for Rev 272 = $1,742.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MALE WILSON SYSTEM,272,RC,,,,,,,,both,,,4179.5100,626.9300,CIGNA HEALTHCARE,CIGNA PPO,1742.86,,,,,,,1078.7300,4179.5100,percent of total billed charges,"41.7% of $4,179.51 in Billed Charges for Rev 272 = $1,742.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MALE WILSON SYSTEM,272,RC,,,,,,,,both,,,4179.5100,626.9300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3761.56,,,,,,,1078.7300,4179.5100,percent of total billed charges,"90% of $4,179.51 in Billed Charges for Rev 272 = $3,761.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MALE WILSON SYSTEM,272,RC,,,,,,,,both,,,4179.5100,626.9300,MEDCOST,MEDCOST VHN,1989.03,,,,,,,1078.7300,4179.5100,percent of total billed charges,"47.59% of $4,179.51 in Billed Charges for Rev 272 = $1,989.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MALE WILSON SYSTEM,272,RC,,,,,,,,both,,,4179.5100,626.9300,SENTARA HEALTH,SENTARA HEALTH,1078.73,,,,,,,1078.7300,4179.5100,percent of total billed charges,"25.81% of $4,179.51 in Billed Charges for Rev 272 = $1,078.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MALE WILSON SYSTEM,272,RC,,,,,,,,both,,,4179.5100,626.9300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4179.51,,,,,,,1078.7300,4179.5100,percent of total billed charges,"100% of $4,179.51 in Billed Charges for Rev 272 = $4,179.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MALE WILSON SYSTEM,272,RC,,,,,,,,both,,,4179.5100,626.9300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2089.76,,,,,,,1078.7300,4179.5100,percent of total billed charges,"Rev 272 $4,179.51 in Billed Charges at 50% = $2,089.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MALE WILSON SYSTEM,272,RC,,,,,,,,both,,,4179.5100,626.9300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1349.98,,,,,,,1078.7300,4179.5100,other,"32.3% of $4,179.51 in Billed Charges for Rev 272 = $1,349.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RETRACTOR MALE WILSON SYSTEM,272,RC,,,,,,,,both,,,4179.5100,626.9300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1283.11,,,,,,,1078.7300,4179.5100,other,"30.7% of $4,179.51 in Billed Charges for Rev 272 = $1,283.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RETRACTOR MALE WILSON SYSTEM,272,RC,,,,,,,,both,,,4179.5100,626.9300,UNITED HEALTHCARE,UNITED HEALTHCARE,1349.98,,,,,,,1078.7300,4179.5100,percent of total billed charges,"32.3% of $4,179.51 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MALE WILSON SYSTEM,272,RC,,,,,,,,both,,,4179.5100,626.9300,WELLCARE,WELLCARE MEDICAID,4179.51,,,,,,,1078.7300,4179.5100,percent of total billed charges,"100% of $4,179.51 in Billed Charges for Rev 272 = $4,179.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MOBIUS LG,272,RC,,,,,,,,both,,,2299.1900,344.8800,AETNA,AETNA,981.75,,,,,,,593.4200,2299.1900,percent of total billed charges,"42.7% of $2,299.19 in Billed Charges for Rev 272 = $981.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MOBIUS LG,272,RC,,,,,,,,both,,,2299.1900,344.8800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1609.43,,,,,,,593.4200,2299.1900,percent of total billed charges,"Rev 272 $2,299.19 in Billed Charges at 70% = $1,609.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MOBIUS LG,272,RC,,,,,,,,both,,,2299.1900,344.8800,CIGNA HEALTHCARE,CIGNA HMO,958.76,,,,,,,593.4200,2299.1900,percent of total billed charges,"41.7% of $2,299.19 in Billed Charges for Rev 272 = $958.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MOBIUS LG,272,RC,,,,,,,,both,,,2299.1900,344.8800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1066.82,,,,,,,593.4200,2299.1900,percent of total billed charges,"46.4% of $2,299.19 in Billed Charges for Rev 272 = $1,066.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MOBIUS LG,272,RC,,,,,,,,both,,,2299.1900,344.8800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,958.76,,,,,,,593.4200,2299.1900,percent of total billed charges,"41.7% of $2,299.19 in Billed Charges for Rev 272 = $958.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MOBIUS LG,272,RC,,,,,,,,both,,,2299.1900,344.8800,CIGNA HEALTHCARE,CIGNA PPO,958.76,,,,,,,593.4200,2299.1900,percent of total billed charges,"41.7% of $2,299.19 in Billed Charges for Rev 272 = $958.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MOBIUS LG,272,RC,,,,,,,,both,,,2299.1900,344.8800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2069.27,,,,,,,593.4200,2299.1900,percent of total billed charges,"90% of $2,299.19 in Billed Charges for Rev 272 = $2,069.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MOBIUS LG,272,RC,,,,,,,,both,,,2299.1900,344.8800,MEDCOST,MEDCOST VHN,1094.18,,,,,,,593.4200,2299.1900,percent of total billed charges,"47.59% of $2,299.19 in Billed Charges for Rev 272 = $1,094.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MOBIUS LG,272,RC,,,,,,,,both,,,2299.1900,344.8800,SENTARA HEALTH,SENTARA HEALTH,593.42,,,,,,,593.4200,2299.1900,percent of total billed charges,"25.81% of $2,299.19 in Billed Charges for Rev 272 = $593.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MOBIUS LG,272,RC,,,,,,,,both,,,2299.1900,344.8800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2299.19,,,,,,,593.4200,2299.1900,percent of total billed charges,"100% of $2,299.19 in Billed Charges for Rev 272 = $2,299.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MOBIUS LG,272,RC,,,,,,,,both,,,2299.1900,344.8800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1149.60,,,,,,,593.4200,2299.1900,percent of total billed charges,"Rev 272 $2,299.19 in Billed Charges at 50% = $1,149.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MOBIUS LG,272,RC,,,,,,,,both,,,2299.1900,344.8800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,742.64,,,,,,,593.4200,2299.1900,other,"32.3% of $2,299.19 in Billed Charges for Rev 272 = $742.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RETRACTOR MOBIUS LG,272,RC,,,,,,,,both,,,2299.1900,344.8800,UNITED HEALTHCARE,UHC HERITAGE SELECT,705.85,,,,,,,593.4200,2299.1900,other,"30.7% of $2,299.19 in Billed Charges for Rev 272 = $705.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RETRACTOR MOBIUS LG,272,RC,,,,,,,,both,,,2299.1900,344.8800,UNITED HEALTHCARE,UNITED HEALTHCARE,742.64,,,,,,,593.4200,2299.1900,percent of total billed charges,"32.3% of $2,299.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR MOBIUS LG,272,RC,,,,,,,,both,,,2299.1900,344.8800,WELLCARE,WELLCARE MEDICAID,2299.19,,,,,,,593.4200,2299.1900,percent of total billed charges,"100% of $2,299.19 in Billed Charges for Rev 272 = $2,299.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR PLASTIC LONESTAR 32.5 X 18.3CM,272,RC,27200002,CDM,,,,,,both,,,1075.2700,161.2900,AETNA,AETNA,459.14,,,,,,,277.5300,1075.2700,percent of total billed charges,"42.7% of $1,075.27 in Billed Charges for Rev 272 = $459.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR PLASTIC LONESTAR 32.5 X 18.3CM,272,RC,27200002,CDM,,,,,,both,,,1075.2700,161.2900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,752.69,,,,,,,277.5300,1075.2700,percent of total billed charges,"Rev 272 $1,075.27 in Billed Charges at 70% = $752.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR PLASTIC LONESTAR 32.5 X 18.3CM,272,RC,27200002,CDM,,,,,,both,,,1075.2700,161.2900,CIGNA HEALTHCARE,CIGNA HMO,448.39,,,,,,,277.5300,1075.2700,percent of total billed charges,"41.7% of $1,075.27 in Billed Charges for Rev 272 = $448.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR PLASTIC LONESTAR 32.5 X 18.3CM,272,RC,27200002,CDM,,,,,,both,,,1075.2700,161.2900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,498.93,,,,,,,277.5300,1075.2700,percent of total billed charges,"46.4% of $1,075.27 in Billed Charges for Rev 272 = $498.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR PLASTIC LONESTAR 32.5 X 18.3CM,272,RC,27200002,CDM,,,,,,both,,,1075.2700,161.2900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,448.39,,,,,,,277.5300,1075.2700,percent of total billed charges,"41.7% of $1,075.27 in Billed Charges for Rev 272 = $448.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR PLASTIC LONESTAR 32.5 X 18.3CM,272,RC,27200002,CDM,,,,,,both,,,1075.2700,161.2900,CIGNA HEALTHCARE,CIGNA PPO,448.39,,,,,,,277.5300,1075.2700,percent of total billed charges,"41.7% of $1,075.27 in Billed Charges for Rev 272 = $448.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR PLASTIC LONESTAR 32.5 X 18.3CM,272,RC,27200002,CDM,,,,,,both,,,1075.2700,161.2900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,967.74,,,,,,,277.5300,1075.2700,percent of total billed charges,"90% of $1,075.27 in Billed Charges for Rev 272 = $967.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR PLASTIC LONESTAR 32.5 X 18.3CM,272,RC,27200002,CDM,,,,,,both,,,1075.2700,161.2900,MEDCOST,MEDCOST VHN,511.72,,,,,,,277.5300,1075.2700,percent of total billed charges,"47.59% of $1,075.27 in Billed Charges for Rev 272 = $511.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR PLASTIC LONESTAR 32.5 X 18.3CM,272,RC,27200002,CDM,,,,,,both,,,1075.2700,161.2900,SENTARA HEALTH,SENTARA HEALTH,277.53,,,,,,,277.5300,1075.2700,percent of total billed charges,"25.81% of $1,075.27 in Billed Charges for Rev 272 = $277.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR PLASTIC LONESTAR 32.5 X 18.3CM,272,RC,27200002,CDM,,,,,,both,,,1075.2700,161.2900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1075.27,,,,,,,277.5300,1075.2700,percent of total billed charges,"100% of $1,075.27 in Billed Charges for Rev 272 = $1,075.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR PLASTIC LONESTAR 32.5 X 18.3CM,272,RC,27200002,CDM,,,,,,both,,,1075.2700,161.2900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,537.64,,,,,,,277.5300,1075.2700,percent of total billed charges,"Rev 272 $1,075.27 in Billed Charges at 50% = $537.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR PLASTIC LONESTAR 32.5 X 18.3CM,272,RC,27200002,CDM,,,,,,both,,,1075.2700,161.2900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,347.31,,,,,,,277.5300,1075.2700,other,"32.3% of $1,075.27 in Billed Charges for Rev 272 = $347.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RETRACTOR PLASTIC LONESTAR 32.5 X 18.3CM,272,RC,27200002,CDM,,,,,,both,,,1075.2700,161.2900,UNITED HEALTHCARE,UHC HERITAGE SELECT,330.11,,,,,,,277.5300,1075.2700,other,"30.7% of $1,075.27 in Billed Charges for Rev 272 = $330.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RETRACTOR PLASTIC LONESTAR 32.5 X 18.3CM,272,RC,27200002,CDM,,,,,,both,,,1075.2700,161.2900,UNITED HEALTHCARE,UNITED HEALTHCARE,347.31,,,,,,,277.5300,1075.2700,percent of total billed charges,"32.3% of $1,075.27 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR PLASTIC LONESTAR 32.5 X 18.3CM,272,RC,27200002,CDM,,,,,,both,,,1075.2700,161.2900,WELLCARE,WELLCARE MEDICAID,1075.27,,,,,,,277.5300,1075.2700,percent of total billed charges,"100% of $1,075.27 in Billed Charges for Rev 272 = $1,075.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR RING DISPOSABLE 16.6CMX16.6CM 3715,272,RC,,,,,,,,both,,,1361.0900,204.1600,AETNA,AETNA,581.19,,,,,,,351.3000,1361.0900,percent of total billed charges,"42.7% of $1,361.09 in Billed Charges for Rev 272 = $581.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR RING DISPOSABLE 16.6CMX16.6CM 3715,272,RC,,,,,,,,both,,,1361.0900,204.1600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,952.76,,,,,,,351.3000,1361.0900,percent of total billed charges,"Rev 272 $1,361.09 in Billed Charges at 70% = $952.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR RING DISPOSABLE 16.6CMX16.6CM 3715,272,RC,,,,,,,,both,,,1361.0900,204.1600,CIGNA HEALTHCARE,CIGNA HMO,567.57,,,,,,,351.3000,1361.0900,percent of total billed charges,"41.7% of $1,361.09 in Billed Charges for Rev 272 = $567.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR RING DISPOSABLE 16.6CMX16.6CM 3715,272,RC,,,,,,,,both,,,1361.0900,204.1600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,631.55,,,,,,,351.3000,1361.0900,percent of total billed charges,"46.4% of $1,361.09 in Billed Charges for Rev 272 = $631.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR RING DISPOSABLE 16.6CMX16.6CM 3715,272,RC,,,,,,,,both,,,1361.0900,204.1600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,567.57,,,,,,,351.3000,1361.0900,percent of total billed charges,"41.7% of $1,361.09 in Billed Charges for Rev 272 = $567.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR RING DISPOSABLE 16.6CMX16.6CM 3715,272,RC,,,,,,,,both,,,1361.0900,204.1600,CIGNA HEALTHCARE,CIGNA PPO,567.57,,,,,,,351.3000,1361.0900,percent of total billed charges,"41.7% of $1,361.09 in Billed Charges for Rev 272 = $567.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR RING DISPOSABLE 16.6CMX16.6CM 3715,272,RC,,,,,,,,both,,,1361.0900,204.1600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1224.98,,,,,,,351.3000,1361.0900,percent of total billed charges,"90% of $1,361.09 in Billed Charges for Rev 272 = $1,224.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR RING DISPOSABLE 16.6CMX16.6CM 3715,272,RC,,,,,,,,both,,,1361.0900,204.1600,MEDCOST,MEDCOST VHN,647.74,,,,,,,351.3000,1361.0900,percent of total billed charges,"47.59% of $1,361.09 in Billed Charges for Rev 272 = $647.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR RING DISPOSABLE 16.6CMX16.6CM 3715,272,RC,,,,,,,,both,,,1361.0900,204.1600,SENTARA HEALTH,SENTARA HEALTH,351.30,,,,,,,351.3000,1361.0900,percent of total billed charges,"25.81% of $1,361.09 in Billed Charges for Rev 272 = $351.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR RING DISPOSABLE 16.6CMX16.6CM 3715,272,RC,,,,,,,,both,,,1361.0900,204.1600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1361.09,,,,,,,351.3000,1361.0900,percent of total billed charges,"100% of $1,361.09 in Billed Charges for Rev 272 = $1,361.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR RING DISPOSABLE 16.6CMX16.6CM 3715,272,RC,,,,,,,,both,,,1361.0900,204.1600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,680.55,,,,,,,351.3000,1361.0900,percent of total billed charges,"Rev 272 $1,361.09 in Billed Charges at 50% = $680.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR RING DISPOSABLE 16.6CMX16.6CM 3715,272,RC,,,,,,,,both,,,1361.0900,204.1600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,439.63,,,,,,,351.3000,1361.0900,other,"32.3% of $1,361.09 in Billed Charges for Rev 272 = $439.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RETRACTOR RING DISPOSABLE 16.6CMX16.6CM 3715,272,RC,,,,,,,,both,,,1361.0900,204.1600,UNITED HEALTHCARE,UHC HERITAGE SELECT,417.85,,,,,,,351.3000,1361.0900,other,"30.7% of $1,361.09 in Billed Charges for Rev 272 = $417.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RETRACTOR RING DISPOSABLE 16.6CMX16.6CM 3715,272,RC,,,,,,,,both,,,1361.0900,204.1600,UNITED HEALTHCARE,UNITED HEALTHCARE,439.63,,,,,,,351.3000,1361.0900,percent of total billed charges,"32.3% of $1,361.09 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR RING DISPOSABLE 16.6CMX16.6CM 3715,272,RC,,,,,,,,both,,,1361.0900,204.1600,WELLCARE,WELLCARE MEDICAID,1361.09,,,,,,,351.3000,1361.0900,percent of total billed charges,"100% of $1,361.09 in Billed Charges for Rev 272 = $1,361.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 21MM W/AD,272,RC,27200002,CDM,,,,,,both,,,3996.2600,599.4400,AETNA,AETNA,1706.40,,,,,,,1031.4300,3996.2600,percent of total billed charges,"42.7% of $3,996.26 in Billed Charges for Rev 272 = $1,706.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 21MM W/AD,272,RC,27200002,CDM,,,,,,both,,,3996.2600,599.4400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2797.38,,,,,,,1031.4300,3996.2600,percent of total billed charges,"Rev 272 $3,996.26 in Billed Charges at 70% = $2,797.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 21MM W/AD,272,RC,27200002,CDM,,,,,,both,,,3996.2600,599.4400,CIGNA HEALTHCARE,CIGNA HMO,1666.44,,,,,,,1031.4300,3996.2600,percent of total billed charges,"41.7% of $3,996.26 in Billed Charges for Rev 272 = $1,666.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 21MM W/AD,272,RC,27200002,CDM,,,,,,both,,,3996.2600,599.4400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1854.26,,,,,,,1031.4300,3996.2600,percent of total billed charges,"46.4% of $3,996.26 in Billed Charges for Rev 272 = $1,854.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 21MM W/AD,272,RC,27200002,CDM,,,,,,both,,,3996.2600,599.4400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1666.44,,,,,,,1031.4300,3996.2600,percent of total billed charges,"41.7% of $3,996.26 in Billed Charges for Rev 272 = $1,666.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 21MM W/AD,272,RC,27200002,CDM,,,,,,both,,,3996.2600,599.4400,CIGNA HEALTHCARE,CIGNA PPO,1666.44,,,,,,,1031.4300,3996.2600,percent of total billed charges,"41.7% of $3,996.26 in Billed Charges for Rev 272 = $1,666.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 21MM W/AD,272,RC,27200002,CDM,,,,,,both,,,3996.2600,599.4400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3596.63,,,,,,,1031.4300,3996.2600,percent of total billed charges,"90% of $3,996.26 in Billed Charges for Rev 272 = $3,596.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 21MM W/AD,272,RC,27200002,CDM,,,,,,both,,,3996.2600,599.4400,MEDCOST,MEDCOST VHN,1901.82,,,,,,,1031.4300,3996.2600,percent of total billed charges,"47.59% of $3,996.26 in Billed Charges for Rev 272 = $1,901.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 21MM W/AD,272,RC,27200002,CDM,,,,,,both,,,3996.2600,599.4400,SENTARA HEALTH,SENTARA HEALTH,1031.43,,,,,,,1031.4300,3996.2600,percent of total billed charges,"25.81% of $3,996.26 in Billed Charges for Rev 272 = $1,031.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 21MM W/AD,272,RC,27200002,CDM,,,,,,both,,,3996.2600,599.4400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3996.26,,,,,,,1031.4300,3996.2600,percent of total billed charges,"100% of $3,996.26 in Billed Charges for Rev 272 = $3,996.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 21MM W/AD,272,RC,27200002,CDM,,,,,,both,,,3996.2600,599.4400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1998.13,,,,,,,1031.4300,3996.2600,percent of total billed charges,"Rev 272 $3,996.26 in Billed Charges at 50% = $1,998.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 21MM W/AD,272,RC,27200002,CDM,,,,,,both,,,3996.2600,599.4400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1290.79,,,,,,,1031.4300,3996.2600,other,"32.3% of $3,996.26 in Billed Charges for Rev 272 = $1,290.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ANVIL CIRCLE 21MM W/AD,272,RC,27200002,CDM,,,,,,both,,,3996.2600,599.4400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1226.85,,,,,,,1031.4300,3996.2600,other,"30.7% of $3,996.26 in Billed Charges for Rev 272 = $1,226.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER ANVIL CIRCLE 21MM W/AD,272,RC,27200002,CDM,,,,,,both,,,3996.2600,599.4400,UNITED HEALTHCARE,UNITED HEALTHCARE,1290.79,,,,,,,1031.4300,3996.2600,percent of total billed charges,"32.3% of $3,996.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER ANVIL CIRCLE 21MM W/AD,272,RC,27200002,CDM,,,,,,both,,,3996.2600,599.4400,WELLCARE,WELLCARE MEDICAID,3996.26,,,,,,,1031.4300,3996.2600,percent of total billed charges,"100% of $3,996.26 in Billed Charges for Rev 272 = $3,996.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER BUTRESS SEAMGUARD,272,RC,,,,,,,,both,,,68163.4000,10224.5100,AETNA,AETNA,29105.77,,,,,,,17592.9700,68163.4000,percent of total billed charges,"42.7% of $68,163.40 in Billed Charges for Rev 272 = $29,105.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER BUTRESS SEAMGUARD,272,RC,,,,,,,,both,,,68163.4000,10224.5100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,47714.38,,,,,,,17592.9700,68163.4000,percent of total billed charges,"Rev 272 $68,163.40 in Billed Charges at 70% = $47,714.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER BUTRESS SEAMGUARD,272,RC,,,,,,,,both,,,68163.4000,10224.5100,CIGNA HEALTHCARE,CIGNA HMO,28424.14,,,,,,,17592.9700,68163.4000,percent of total billed charges,"41.7% of $68,163.40 in Billed Charges for Rev 272 = $28,424.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER BUTRESS SEAMGUARD,272,RC,,,,,,,,both,,,68163.4000,10224.5100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,31627.82,,,,,,,17592.9700,68163.4000,percent of total billed charges,"46.4% of $68,163.40 in Billed Charges for Rev 272 = $31,627.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER BUTRESS SEAMGUARD,272,RC,,,,,,,,both,,,68163.4000,10224.5100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,28424.14,,,,,,,17592.9700,68163.4000,percent of total billed charges,"41.7% of $68,163.40 in Billed Charges for Rev 272 = $28,424.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER BUTRESS SEAMGUARD,272,RC,,,,,,,,both,,,68163.4000,10224.5100,CIGNA HEALTHCARE,CIGNA PPO,28424.14,,,,,,,17592.9700,68163.4000,percent of total billed charges,"41.7% of $68,163.40 in Billed Charges for Rev 272 = $28,424.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER BUTRESS SEAMGUARD,272,RC,,,,,,,,both,,,68163.4000,10224.5100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,61347.06,,,,,,,17592.9700,68163.4000,percent of total billed charges,"90% of $68,163.40 in Billed Charges for Rev 272 = $61,347.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER BUTRESS SEAMGUARD,272,RC,,,,,,,,both,,,68163.4000,10224.5100,MEDCOST,MEDCOST VHN,32438.96,,,,,,,17592.9700,68163.4000,percent of total billed charges,"47.59% of $68,163.40 in Billed Charges for Rev 272 = $32,438.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER BUTRESS SEAMGUARD,272,RC,,,,,,,,both,,,68163.4000,10224.5100,SENTARA HEALTH,SENTARA HEALTH,17592.97,,,,,,,17592.9700,68163.4000,percent of total billed charges,"25.81% of $68,163.40 in Billed Charges for Rev 272 = $17,592.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER BUTRESS SEAMGUARD,272,RC,,,,,,,,both,,,68163.4000,10224.5100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",68163.40,,,,,,,17592.9700,68163.4000,percent of total billed charges,"100% of $68,163.40 in Billed Charges for Rev 272 = $68,163.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER BUTRESS SEAMGUARD,272,RC,,,,,,,,both,,,68163.4000,10224.5100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,34081.70,,,,,,,17592.9700,68163.4000,percent of total billed charges,"Rev 272 $68,163.40 in Billed Charges at 50% = $34,081.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER BUTRESS SEAMGUARD,272,RC,,,,,,,,both,,,68163.4000,10224.5100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,22016.78,,,,,,,17592.9700,68163.4000,other,"32.3% of $68,163.40 in Billed Charges for Rev 272 = $22,016.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER BUTRESS SEAMGUARD,272,RC,,,,,,,,both,,,68163.4000,10224.5100,UNITED HEALTHCARE,UHC HERITAGE SELECT,20926.16,,,,,,,17592.9700,68163.4000,other,"30.7% of $68,163.40 in Billed Charges for Rev 272 = $20,926.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER BUTRESS SEAMGUARD,272,RC,,,,,,,,both,,,68163.4000,10224.5100,UNITED HEALTHCARE,UNITED HEALTHCARE,22016.78,,,,,,,17592.9700,68163.4000,percent of total billed charges,"32.3% of $68,163.40 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER BUTRESS SEAMGUARD,272,RC,,,,,,,,both,,,68163.4000,10224.5100,WELLCARE,WELLCARE MEDICAID,68163.40,,,,,,,17592.9700,68163.4000,percent of total billed charges,"100% of $68,163.40 in Billed Charges for Rev 272 = $68,163.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER CIRCULAR WITH TRI STAPLE TECHNOLOGY SURPASS SEE LN 187376,272,RC,,,,,,,,both,,,11649.1200,1747.3700,AETNA,AETNA,4974.17,,,,,,,3006.6400,11649.1200,percent of total billed charges,"42.7% of $11,649.12 in Billed Charges for Rev 272 = $4,974.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER CIRCULAR WITH TRI STAPLE TECHNOLOGY SURPASS SEE LN 187376,272,RC,,,,,,,,both,,,11649.1200,1747.3700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8154.38,,,,,,,3006.6400,11649.1200,percent of total billed charges,"Rev 272 $11,649.12 in Billed Charges at 70% = $8,154.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER CIRCULAR WITH TRI STAPLE TECHNOLOGY SURPASS SEE LN 187376,272,RC,,,,,,,,both,,,11649.1200,1747.3700,CIGNA HEALTHCARE,CIGNA HMO,4857.68,,,,,,,3006.6400,11649.1200,percent of total billed charges,"41.7% of $11,649.12 in Billed Charges for Rev 272 = $4,857.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER CIRCULAR WITH TRI STAPLE TECHNOLOGY SURPASS SEE LN 187376,272,RC,,,,,,,,both,,,11649.1200,1747.3700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5405.19,,,,,,,3006.6400,11649.1200,percent of total billed charges,"46.4% of $11,649.12 in Billed Charges for Rev 272 = $5,405.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER CIRCULAR WITH TRI STAPLE TECHNOLOGY SURPASS SEE LN 187376,272,RC,,,,,,,,both,,,11649.1200,1747.3700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4857.68,,,,,,,3006.6400,11649.1200,percent of total billed charges,"41.7% of $11,649.12 in Billed Charges for Rev 272 = $4,857.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER CIRCULAR WITH TRI STAPLE TECHNOLOGY SURPASS SEE LN 187376,272,RC,,,,,,,,both,,,11649.1200,1747.3700,CIGNA HEALTHCARE,CIGNA PPO,4857.68,,,,,,,3006.6400,11649.1200,percent of total billed charges,"41.7% of $11,649.12 in Billed Charges for Rev 272 = $4,857.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER CIRCULAR WITH TRI STAPLE TECHNOLOGY SURPASS SEE LN 187376,272,RC,,,,,,,,both,,,11649.1200,1747.3700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10484.21,,,,,,,3006.6400,11649.1200,percent of total billed charges,"90% of $11,649.12 in Billed Charges for Rev 272 = $10,484.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER CIRCULAR WITH TRI STAPLE TECHNOLOGY SURPASS SEE LN 187376,272,RC,,,,,,,,both,,,11649.1200,1747.3700,MEDCOST,MEDCOST VHN,5543.82,,,,,,,3006.6400,11649.1200,percent of total billed charges,"47.59% of $11,649.12 in Billed Charges for Rev 272 = $5,543.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER CIRCULAR WITH TRI STAPLE TECHNOLOGY SURPASS SEE LN 187376,272,RC,,,,,,,,both,,,11649.1200,1747.3700,SENTARA HEALTH,SENTARA HEALTH,3006.64,,,,,,,3006.6400,11649.1200,percent of total billed charges,"25.81% of $11,649.12 in Billed Charges for Rev 272 = $3,006.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER CIRCULAR WITH TRI STAPLE TECHNOLOGY SURPASS SEE LN 187376,272,RC,,,,,,,,both,,,11649.1200,1747.3700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11649.12,,,,,,,3006.6400,11649.1200,percent of total billed charges,"100% of $11,649.12 in Billed Charges for Rev 272 = $11,649.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER CIRCULAR WITH TRI STAPLE TECHNOLOGY SURPASS SEE LN 187376,272,RC,,,,,,,,both,,,11649.1200,1747.3700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5824.56,,,,,,,3006.6400,11649.1200,percent of total billed charges,"Rev 272 $11,649.12 in Billed Charges at 50% = $5,824.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER CIRCULAR WITH TRI STAPLE TECHNOLOGY SURPASS SEE LN 187376,272,RC,,,,,,,,both,,,11649.1200,1747.3700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3762.67,,,,,,,3006.6400,11649.1200,other,"32.3% of $11,649.12 in Billed Charges for Rev 272 = $3,762.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER CIRCULAR WITH TRI STAPLE TECHNOLOGY SURPASS SEE LN 187376,272,RC,,,,,,,,both,,,11649.1200,1747.3700,UNITED HEALTHCARE,UHC HERITAGE SELECT,3576.28,,,,,,,3006.6400,11649.1200,other,"30.7% of $11,649.12 in Billed Charges for Rev 272 = $3,576.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER CIRCULAR WITH TRI STAPLE TECHNOLOGY SURPASS SEE LN 187376,272,RC,,,,,,,,both,,,11649.1200,1747.3700,UNITED HEALTHCARE,UNITED HEALTHCARE,3762.67,,,,,,,3006.6400,11649.1200,percent of total billed charges,"32.3% of $11,649.12 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER CIRCULAR WITH TRI STAPLE TECHNOLOGY SURPASS SEE LN 187376,272,RC,,,,,,,,both,,,11649.1200,1747.3700,WELLCARE,WELLCARE MEDICAID,11649.12,,,,,,,3006.6400,11649.1200,percent of total billed charges,"100% of $11,649.12 in Billed Charges for Rev 272 = $11,649.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR VAGINAL CERVICAL UTERINE ELEVATOR VCARE DX PLUS,272,RC,,,,,,,,both,,,583.7400,87.5600,AETNA,AETNA,249.26,,,,,,,150.6600,583.7400,percent of total billed charges,42.7% of $583.74 in Billed Charges for Rev 272 = $249.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR VAGINAL CERVICAL UTERINE ELEVATOR VCARE DX PLUS,272,RC,,,,,,,,both,,,583.7400,87.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,408.62,,,,,,,150.6600,583.7400,percent of total billed charges,Rev 272 $583.74 in Billed Charges at 70% = $408.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR VAGINAL CERVICAL UTERINE ELEVATOR VCARE DX PLUS,272,RC,,,,,,,,both,,,583.7400,87.5600,CIGNA HEALTHCARE,CIGNA HMO,243.42,,,,,,,150.6600,583.7400,percent of total billed charges,41.7% of $583.74 in Billed Charges for Rev 272 = $243.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR VAGINAL CERVICAL UTERINE ELEVATOR VCARE DX PLUS,272,RC,,,,,,,,both,,,583.7400,87.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,270.86,,,,,,,150.6600,583.7400,percent of total billed charges,46.4% of $583.74 in Billed Charges for Rev 272 = $270.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR VAGINAL CERVICAL UTERINE ELEVATOR VCARE DX PLUS,272,RC,,,,,,,,both,,,583.7400,87.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,243.42,,,,,,,150.6600,583.7400,percent of total billed charges,41.7% of $583.74 in Billed Charges for Rev 272 = $243.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR VAGINAL CERVICAL UTERINE ELEVATOR VCARE DX PLUS,272,RC,,,,,,,,both,,,583.7400,87.5600,CIGNA HEALTHCARE,CIGNA PPO,243.42,,,,,,,150.6600,583.7400,percent of total billed charges,41.7% of $583.74 in Billed Charges for Rev 272 = $243.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR VAGINAL CERVICAL UTERINE ELEVATOR VCARE DX PLUS,272,RC,,,,,,,,both,,,583.7400,87.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,525.37,,,,,,,150.6600,583.7400,percent of total billed charges,90% of $583.74 in Billed Charges for Rev 272 = $525.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR VAGINAL CERVICAL UTERINE ELEVATOR VCARE DX PLUS,272,RC,,,,,,,,both,,,583.7400,87.5600,MEDCOST,MEDCOST VHN,277.80,,,,,,,150.6600,583.7400,percent of total billed charges,47.59% of $583.74 in Billed Charges for Rev 272 = $277.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR VAGINAL CERVICAL UTERINE ELEVATOR VCARE DX PLUS,272,RC,,,,,,,,both,,,583.7400,87.5600,SENTARA HEALTH,SENTARA HEALTH,150.66,,,,,,,150.6600,583.7400,percent of total billed charges,25.81% of $583.74 in Billed Charges for Rev 272 = $150.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR VAGINAL CERVICAL UTERINE ELEVATOR VCARE DX PLUS,272,RC,,,,,,,,both,,,583.7400,87.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",583.74,,,,,,,150.6600,583.7400,percent of total billed charges,100% of $583.74 in Billed Charges for Rev 272 = $583.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR VAGINAL CERVICAL UTERINE ELEVATOR VCARE DX PLUS,272,RC,,,,,,,,both,,,583.7400,87.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,291.87,,,,,,,150.6600,583.7400,percent of total billed charges,Rev 272 $583.74 in Billed Charges at 50% = $291.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR VAGINAL CERVICAL UTERINE ELEVATOR VCARE DX PLUS,272,RC,,,,,,,,both,,,583.7400,87.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,188.55,,,,,,,150.6600,583.7400,other,32.3% of $583.74 in Billed Charges for Rev 272 = $188.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
RETRACTOR VAGINAL CERVICAL UTERINE ELEVATOR VCARE DX PLUS,272,RC,,,,,,,,both,,,583.7400,87.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,179.21,,,,,,,150.6600,583.7400,other,30.7% of $583.74 in Billed Charges for Rev 272 = $179.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
RETRACTOR VAGINAL CERVICAL UTERINE ELEVATOR VCARE DX PLUS,272,RC,,,,,,,,both,,,583.7400,87.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,188.55,,,,,,,150.6600,583.7400,percent of total billed charges,32.3% of $583.74 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR VAGINAL CERVICAL UTERINE ELEVATOR VCARE DX PLUS,272,RC,,,,,,,,both,,,583.7400,87.5600,WELLCARE,WELLCARE MEDICAID,583.74,,,,,,,150.6600,583.7400,percent of total billed charges,100% of $583.74 in Billed Charges for Rev 272 = $583.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR WOUND ALEXIS M 5-9CM,272,RC,27200002,CDM,,,,,,both,,,1659.3600,248.9000,AETNA,AETNA,708.55,,,,,,,428.2800,1659.3600,percent of total billed charges,"42.7% of $1,659.36 in Billed Charges for Rev 272 = $708.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR WOUND ALEXIS M 5-9CM,272,RC,27200002,CDM,,,,,,both,,,1659.3600,248.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1161.55,,,,,,,428.2800,1659.3600,percent of total billed charges,"Rev 272 $1,659.36 in Billed Charges at 70% = $1,161.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR WOUND ALEXIS M 5-9CM,272,RC,27200002,CDM,,,,,,both,,,1659.3600,248.9000,CIGNA HEALTHCARE,CIGNA HMO,691.95,,,,,,,428.2800,1659.3600,percent of total billed charges,"41.7% of $1,659.36 in Billed Charges for Rev 272 = $691.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR WOUND ALEXIS M 5-9CM,272,RC,27200002,CDM,,,,,,both,,,1659.3600,248.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,769.94,,,,,,,428.2800,1659.3600,percent of total billed charges,"46.4% of $1,659.36 in Billed Charges for Rev 272 = $769.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR WOUND ALEXIS M 5-9CM,272,RC,27200002,CDM,,,,,,both,,,1659.3600,248.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,691.95,,,,,,,428.2800,1659.3600,percent of total billed charges,"41.7% of $1,659.36 in Billed Charges for Rev 272 = $691.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR WOUND ALEXIS M 5-9CM,272,RC,27200002,CDM,,,,,,both,,,1659.3600,248.9000,CIGNA HEALTHCARE,CIGNA PPO,691.95,,,,,,,428.2800,1659.3600,percent of total billed charges,"41.7% of $1,659.36 in Billed Charges for Rev 272 = $691.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR WOUND ALEXIS M 5-9CM,272,RC,27200002,CDM,,,,,,both,,,1659.3600,248.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1493.42,,,,,,,428.2800,1659.3600,percent of total billed charges,"90% of $1,659.36 in Billed Charges for Rev 272 = $1,493.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR WOUND ALEXIS M 5-9CM,272,RC,27200002,CDM,,,,,,both,,,1659.3600,248.9000,MEDCOST,MEDCOST VHN,789.69,,,,,,,428.2800,1659.3600,percent of total billed charges,"47.59% of $1,659.36 in Billed Charges for Rev 272 = $789.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR WOUND ALEXIS M 5-9CM,272,RC,27200002,CDM,,,,,,both,,,1659.3600,248.9000,SENTARA HEALTH,SENTARA HEALTH,428.28,,,,,,,428.2800,1659.3600,percent of total billed charges,"25.81% of $1,659.36 in Billed Charges for Rev 272 = $428.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR WOUND ALEXIS M 5-9CM,272,RC,27200002,CDM,,,,,,both,,,1659.3600,248.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1659.36,,,,,,,428.2800,1659.3600,percent of total billed charges,"100% of $1,659.36 in Billed Charges for Rev 272 = $1,659.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR WOUND ALEXIS M 5-9CM,272,RC,27200002,CDM,,,,,,both,,,1659.3600,248.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,829.68,,,,,,,428.2800,1659.3600,percent of total billed charges,"Rev 272 $1,659.36 in Billed Charges at 50% = $829.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR WOUND ALEXIS M 5-9CM,272,RC,27200002,CDM,,,,,,both,,,1659.3600,248.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,535.97,,,,,,,428.2800,1659.3600,other,"32.3% of $1,659.36 in Billed Charges for Rev 272 = $535.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RETRACTOR WOUND ALEXIS M 5-9CM,272,RC,27200002,CDM,,,,,,both,,,1659.3600,248.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,509.42,,,,,,,428.2800,1659.3600,other,"30.7% of $1,659.36 in Billed Charges for Rev 272 = $509.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RETRACTOR WOUND ALEXIS M 5-9CM,272,RC,27200002,CDM,,,,,,both,,,1659.3600,248.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,535.97,,,,,,,428.2800,1659.3600,percent of total billed charges,"32.3% of $1,659.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR WOUND ALEXIS M 5-9CM,272,RC,27200002,CDM,,,,,,both,,,1659.3600,248.9000,WELLCARE,WELLCARE MEDICAID,1659.36,,,,,,,428.2800,1659.3600,percent of total billed charges,"100% of $1,659.36 in Billed Charges for Rev 272 = $1,659.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STENOTOMY WIRE 15,272,RC,,,,,,,,both,,,1012.0400,151.8100,AETNA,AETNA,432.14,,,,,,,261.2100,1012.0400,percent of total billed charges,"42.7% of $1,012.04 in Billed Charges for Rev 272 = $432.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STENOTOMY WIRE 15,272,RC,,,,,,,,both,,,1012.0400,151.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,708.43,,,,,,,261.2100,1012.0400,percent of total billed charges,"Rev 272 $1,012.04 in Billed Charges at 70% = $708.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STENOTOMY WIRE 15,272,RC,,,,,,,,both,,,1012.0400,151.8100,CIGNA HEALTHCARE,CIGNA HMO,422.02,,,,,,,261.2100,1012.0400,percent of total billed charges,"41.7% of $1,012.04 in Billed Charges for Rev 272 = $422.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STENOTOMY WIRE 15,272,RC,,,,,,,,both,,,1012.0400,151.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,469.59,,,,,,,261.2100,1012.0400,percent of total billed charges,"46.4% of $1,012.04 in Billed Charges for Rev 272 = $469.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STENOTOMY WIRE 15,272,RC,,,,,,,,both,,,1012.0400,151.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,422.02,,,,,,,261.2100,1012.0400,percent of total billed charges,"41.7% of $1,012.04 in Billed Charges for Rev 272 = $422.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STENOTOMY WIRE 15,272,RC,,,,,,,,both,,,1012.0400,151.8100,CIGNA HEALTHCARE,CIGNA PPO,422.02,,,,,,,261.2100,1012.0400,percent of total billed charges,"41.7% of $1,012.04 in Billed Charges for Rev 272 = $422.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STENOTOMY WIRE 15,272,RC,,,,,,,,both,,,1012.0400,151.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,910.84,,,,,,,261.2100,1012.0400,percent of total billed charges,"90% of $1,012.04 in Billed Charges for Rev 272 = $910.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STENOTOMY WIRE 15,272,RC,,,,,,,,both,,,1012.0400,151.8100,MEDCOST,MEDCOST VHN,481.63,,,,,,,261.2100,1012.0400,percent of total billed charges,"47.59% of $1,012.04 in Billed Charges for Rev 272 = $481.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STENOTOMY WIRE 15,272,RC,,,,,,,,both,,,1012.0400,151.8100,SENTARA HEALTH,SENTARA HEALTH,261.21,,,,,,,261.2100,1012.0400,percent of total billed charges,"25.81% of $1,012.04 in Billed Charges for Rev 272 = $261.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STENOTOMY WIRE 15,272,RC,,,,,,,,both,,,1012.0400,151.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1012.04,,,,,,,261.2100,1012.0400,percent of total billed charges,"100% of $1,012.04 in Billed Charges for Rev 272 = $1,012.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STENOTOMY WIRE 15,272,RC,,,,,,,,both,,,1012.0400,151.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,506.02,,,,,,,261.2100,1012.0400,percent of total billed charges,"Rev 272 $1,012.04 in Billed Charges at 50% = $506.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STENOTOMY WIRE 15,272,RC,,,,,,,,both,,,1012.0400,151.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,326.89,,,,,,,261.2100,1012.0400,other,"32.3% of $1,012.04 in Billed Charges for Rev 272 = $326.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STENOTOMY WIRE 15,272,RC,,,,,,,,both,,,1012.0400,151.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,310.70,,,,,,,261.2100,1012.0400,other,"30.7% of $1,012.04 in Billed Charges for Rev 272 = $310.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STENOTOMY WIRE 15,272,RC,,,,,,,,both,,,1012.0400,151.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,326.89,,,,,,,261.2100,1012.0400,percent of total billed charges,"32.3% of $1,012.04 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STENOTOMY WIRE 15,272,RC,,,,,,,,both,,,1012.0400,151.8100,WELLCARE,WELLCARE MEDICAID,1012.04,,,,,,,261.2100,1012.0400,percent of total billed charges,"100% of $1,012.04 in Billed Charges for Rev 272 = $1,012.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULAN BULLET MAT AND INTRODUCER,272,RC,27200002,CDM,,,,,,both,,,8141.2400,1221.1900,AETNA,AETNA,3476.31,,,,,,,2101.2500,8141.2400,percent of total billed charges,"42.7% of $8,141.24 in Billed Charges for Rev 272 = $3,476.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULAN BULLET MAT AND INTRODUCER,272,RC,27200002,CDM,,,,,,both,,,8141.2400,1221.1900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5698.87,,,,,,,2101.2500,8141.2400,percent of total billed charges,"Rev 272 $8,141.24 in Billed Charges at 70% = $5,698.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULAN BULLET MAT AND INTRODUCER,272,RC,27200002,CDM,,,,,,both,,,8141.2400,1221.1900,CIGNA HEALTHCARE,CIGNA HMO,3394.90,,,,,,,2101.2500,8141.2400,percent of total billed charges,"41.7% of $8,141.24 in Billed Charges for Rev 272 = $3,394.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULAN BULLET MAT AND INTRODUCER,272,RC,27200002,CDM,,,,,,both,,,8141.2400,1221.1900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3777.54,,,,,,,2101.2500,8141.2400,percent of total billed charges,"46.4% of $8,141.24 in Billed Charges for Rev 272 = $3,777.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULAN BULLET MAT AND INTRODUCER,272,RC,27200002,CDM,,,,,,both,,,8141.2400,1221.1900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3394.90,,,,,,,2101.2500,8141.2400,percent of total billed charges,"41.7% of $8,141.24 in Billed Charges for Rev 272 = $3,394.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULAN BULLET MAT AND INTRODUCER,272,RC,27200002,CDM,,,,,,both,,,8141.2400,1221.1900,CIGNA HEALTHCARE,CIGNA PPO,3394.90,,,,,,,2101.2500,8141.2400,percent of total billed charges,"41.7% of $8,141.24 in Billed Charges for Rev 272 = $3,394.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULAN BULLET MAT AND INTRODUCER,272,RC,27200002,CDM,,,,,,both,,,8141.2400,1221.1900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7327.12,,,,,,,2101.2500,8141.2400,percent of total billed charges,"90% of $8,141.24 in Billed Charges for Rev 272 = $7,327.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULAN BULLET MAT AND INTRODUCER,272,RC,27200002,CDM,,,,,,both,,,8141.2400,1221.1900,MEDCOST,MEDCOST VHN,3874.42,,,,,,,2101.2500,8141.2400,percent of total billed charges,"47.59% of $8,141.24 in Billed Charges for Rev 272 = $3,874.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULAN BULLET MAT AND INTRODUCER,272,RC,27200002,CDM,,,,,,both,,,8141.2400,1221.1900,SENTARA HEALTH,SENTARA HEALTH,2101.25,,,,,,,2101.2500,8141.2400,percent of total billed charges,"25.81% of $8,141.24 in Billed Charges for Rev 272 = $2,101.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULAN BULLET MAT AND INTRODUCER,272,RC,27200002,CDM,,,,,,both,,,8141.2400,1221.1900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8141.24,,,,,,,2101.2500,8141.2400,percent of total billed charges,"100% of $8,141.24 in Billed Charges for Rev 272 = $8,141.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULAN BULLET MAT AND INTRODUCER,272,RC,27200002,CDM,,,,,,both,,,8141.2400,1221.1900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4070.62,,,,,,,2101.2500,8141.2400,percent of total billed charges,"Rev 272 $8,141.24 in Billed Charges at 50% = $4,070.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULAN BULLET MAT AND INTRODUCER,272,RC,27200002,CDM,,,,,,both,,,8141.2400,1221.1900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2629.62,,,,,,,2101.2500,8141.2400,other,"32.3% of $8,141.24 in Billed Charges for Rev 272 = $2,629.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STIMULAN BULLET MAT AND INTRODUCER,272,RC,27200002,CDM,,,,,,both,,,8141.2400,1221.1900,UNITED HEALTHCARE,UHC HERITAGE SELECT,2499.36,,,,,,,2101.2500,8141.2400,other,"30.7% of $8,141.24 in Billed Charges for Rev 272 = $2,499.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STIMULAN BULLET MAT AND INTRODUCER,272,RC,27200002,CDM,,,,,,both,,,8141.2400,1221.1900,UNITED HEALTHCARE,UNITED HEALTHCARE,2629.62,,,,,,,2101.2500,8141.2400,percent of total billed charges,"32.3% of $8,141.24 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STIMULAN BULLET MAT AND INTRODUCER,272,RC,27200002,CDM,,,,,,both,,,8141.2400,1221.1900,WELLCARE,WELLCARE MEDICAID,8141.24,,,,,,,2101.2500,8141.2400,percent of total billed charges,"100% of $8,141.24 in Billed Charges for Rev 272 = $8,141.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRIEVAL NET ROTH DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,906.7200,136.0100,AETNA,AETNA,387.17,,,,,,,234.0200,906.7200,percent of total billed charges,42.7% of $906.72 in Billed Charges for Rev 272 = $387.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRIEVAL NET ROTH DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,906.7200,136.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,634.70,,,,,,,234.0200,906.7200,percent of total billed charges,Rev 272 $906.72 in Billed Charges at 70% = $634.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRIEVAL NET ROTH DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,906.7200,136.0100,CIGNA HEALTHCARE,CIGNA HMO,378.10,,,,,,,234.0200,906.7200,percent of total billed charges,41.7% of $906.72 in Billed Charges for Rev 272 = $378.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRIEVAL NET ROTH DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,906.7200,136.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,420.72,,,,,,,234.0200,906.7200,percent of total billed charges,46.4% of $906.72 in Billed Charges for Rev 272 = $420.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRIEVAL NET ROTH DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,906.7200,136.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,378.10,,,,,,,234.0200,906.7200,percent of total billed charges,41.7% of $906.72 in Billed Charges for Rev 272 = $378.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRIEVAL NET ROTH DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,906.7200,136.0100,CIGNA HEALTHCARE,CIGNA PPO,378.10,,,,,,,234.0200,906.7200,percent of total billed charges,41.7% of $906.72 in Billed Charges for Rev 272 = $378.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRIEVAL NET ROTH DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,906.7200,136.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,816.05,,,,,,,234.0200,906.7200,percent of total billed charges,90% of $906.72 in Billed Charges for Rev 272 = $816.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRIEVAL NET ROTH DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,906.7200,136.0100,MEDCOST,MEDCOST VHN,431.51,,,,,,,234.0200,906.7200,percent of total billed charges,47.59% of $906.72 in Billed Charges for Rev 272 = $431.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRIEVAL NET ROTH DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,906.7200,136.0100,SENTARA HEALTH,SENTARA HEALTH,234.02,,,,,,,234.0200,906.7200,percent of total billed charges,25.81% of $906.72 in Billed Charges for Rev 272 = $234.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRIEVAL NET ROTH DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,906.7200,136.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",906.72,,,,,,,234.0200,906.7200,percent of total billed charges,100% of $906.72 in Billed Charges for Rev 272 = $906.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRIEVAL NET ROTH DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,906.7200,136.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,453.36,,,,,,,234.0200,906.7200,percent of total billed charges,Rev 272 $906.72 in Billed Charges at 50% = $453.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRIEVAL NET ROTH DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,906.7200,136.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,292.87,,,,,,,234.0200,906.7200,other,32.3% of $906.72 in Billed Charges for Rev 272 = $292.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
RETRIEVAL NET ROTH DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,906.7200,136.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,278.36,,,,,,,234.0200,906.7200,other,30.7% of $906.72 in Billed Charges for Rev 272 = $278.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
RETRIEVAL NET ROTH DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,906.7200,136.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,292.87,,,,,,,234.0200,906.7200,percent of total billed charges,32.3% of $906.72 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRIEVAL NET ROTH DISPOSABLE,272,RC,27200002,CDM,,,,,,both,,,906.7200,136.0100,WELLCARE,WELLCARE MEDICAID,906.72,,,,,,,234.0200,906.7200,percent of total billed charges,100% of $906.72 in Billed Charges for Rev 272 = $906.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET T CONNECTOR 6IN TUBING,270,RC,,,,,,,,both,,,23472.1700,3520.8300,AETNA,AETNA,10022.62,,,,,,,6058.1700,23472.1700,percent of total billed charges,"42.7% of $23,472.17 in Billed Charges for Rev 270 = $10,022.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET T CONNECTOR 6IN TUBING,270,RC,,,,,,,,both,,,23472.1700,3520.8300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,16430.52,,,,,,,6058.1700,23472.1700,percent of total billed charges,"Rev 270 $23,472.17 in Billed Charges at 70% = $16,430.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET T CONNECTOR 6IN TUBING,270,RC,,,,,,,,both,,,23472.1700,3520.8300,CIGNA HEALTHCARE,CIGNA HMO,9787.89,,,,,,,6058.1700,23472.1700,percent of total billed charges,"41.7% of $23,472.17 in Billed Charges for Rev 270 = $9,787.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET T CONNECTOR 6IN TUBING,270,RC,,,,,,,,both,,,23472.1700,3520.8300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10891.09,,,,,,,6058.1700,23472.1700,percent of total billed charges,"46.4% of $23,472.17 in Billed Charges for Rev 270 = $10,891.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET T CONNECTOR 6IN TUBING,270,RC,,,,,,,,both,,,23472.1700,3520.8300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9787.89,,,,,,,6058.1700,23472.1700,percent of total billed charges,"41.7% of $23,472.17 in Billed Charges for Rev 270 = $9,787.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET T CONNECTOR 6IN TUBING,270,RC,,,,,,,,both,,,23472.1700,3520.8300,CIGNA HEALTHCARE,CIGNA PPO,9787.89,,,,,,,6058.1700,23472.1700,percent of total billed charges,"41.7% of $23,472.17 in Billed Charges for Rev 270 = $9,787.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET T CONNECTOR 6IN TUBING,270,RC,,,,,,,,both,,,23472.1700,3520.8300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,21124.95,,,,,,,6058.1700,23472.1700,percent of total billed charges,"90% of $23,472.17 in Billed Charges for Rev 270 = $21,124.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET T CONNECTOR 6IN TUBING,270,RC,,,,,,,,both,,,23472.1700,3520.8300,MEDCOST,MEDCOST VHN,11170.41,,,,,,,6058.1700,23472.1700,percent of total billed charges,"47.59% of $23,472.17 in Billed Charges for Rev 270 = $11,170.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET T CONNECTOR 6IN TUBING,270,RC,,,,,,,,both,,,23472.1700,3520.8300,SENTARA HEALTH,SENTARA HEALTH,6058.17,,,,,,,6058.1700,23472.1700,percent of total billed charges,"25.81% of $23,472.17 in Billed Charges for Rev 270 = $6,058.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET T CONNECTOR 6IN TUBING,270,RC,,,,,,,,both,,,23472.1700,3520.8300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",23472.17,,,,,,,6058.1700,23472.1700,percent of total billed charges,"100% of $23,472.17 in Billed Charges for Rev 270 = $23,472.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET T CONNECTOR 6IN TUBING,270,RC,,,,,,,,both,,,23472.1700,3520.8300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11736.09,,,,,,,6058.1700,23472.1700,percent of total billed charges,"Rev 270 $23,472.17 in Billed Charges at 50% = $11,736.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET T CONNECTOR 6IN TUBING,270,RC,,,,,,,,both,,,23472.1700,3520.8300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7581.51,,,,,,,6058.1700,23472.1700,other,"32.3% of $23,472.17 in Billed Charges for Rev 270 = $7,581.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET T CONNECTOR 6IN TUBING,270,RC,,,,,,,,both,,,23472.1700,3520.8300,UNITED HEALTHCARE,UHC HERITAGE SELECT,7205.96,,,,,,,6058.1700,23472.1700,other,"30.7% of $23,472.17 in Billed Charges for Rev 270 = $7,205.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET T CONNECTOR 6IN TUBING,270,RC,,,,,,,,both,,,23472.1700,3520.8300,UNITED HEALTHCARE,UNITED HEALTHCARE,7581.51,,,,,,,6058.1700,23472.1700,percent of total billed charges,"32.3% of $23,472.17 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET T CONNECTOR 6IN TUBING,270,RC,,,,,,,,both,,,23472.1700,3520.8300,WELLCARE,WELLCARE MEDICAID,23472.17,,,,,,,6058.1700,23472.1700,percent of total billed charges,"100% of $23,472.17 in Billed Charges for Rev 270 = $23,472.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET TUBE BIFURCATED SMOKE EVAC FILTER AIRSEAL SEM-EVAC,272,RC,27200002,CDM,,,,,,both,,,801.1600,120.1700,AETNA,AETNA,342.10,,,,,,,206.7800,801.1600,percent of total billed charges,42.7% of $801.16 in Billed Charges for Rev 272 = $342.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET TUBE BIFURCATED SMOKE EVAC FILTER AIRSEAL SEM-EVAC,272,RC,27200002,CDM,,,,,,both,,,801.1600,120.1700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,560.81,,,,,,,206.7800,801.1600,percent of total billed charges,Rev 272 $801.16 in Billed Charges at 70% = $560.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET TUBE BIFURCATED SMOKE EVAC FILTER AIRSEAL SEM-EVAC,272,RC,27200002,CDM,,,,,,both,,,801.1600,120.1700,CIGNA HEALTHCARE,CIGNA HMO,334.08,,,,,,,206.7800,801.1600,percent of total billed charges,41.7% of $801.16 in Billed Charges for Rev 272 = $334.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET TUBE BIFURCATED SMOKE EVAC FILTER AIRSEAL SEM-EVAC,272,RC,27200002,CDM,,,,,,both,,,801.1600,120.1700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,371.74,,,,,,,206.7800,801.1600,percent of total billed charges,46.4% of $801.16 in Billed Charges for Rev 272 = $371.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET TUBE BIFURCATED SMOKE EVAC FILTER AIRSEAL SEM-EVAC,272,RC,27200002,CDM,,,,,,both,,,801.1600,120.1700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,334.08,,,,,,,206.7800,801.1600,percent of total billed charges,41.7% of $801.16 in Billed Charges for Rev 272 = $334.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET TUBE BIFURCATED SMOKE EVAC FILTER AIRSEAL SEM-EVAC,272,RC,27200002,CDM,,,,,,both,,,801.1600,120.1700,CIGNA HEALTHCARE,CIGNA PPO,334.08,,,,,,,206.7800,801.1600,percent of total billed charges,41.7% of $801.16 in Billed Charges for Rev 272 = $334.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET TUBE BIFURCATED SMOKE EVAC FILTER AIRSEAL SEM-EVAC,272,RC,27200002,CDM,,,,,,both,,,801.1600,120.1700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,721.04,,,,,,,206.7800,801.1600,percent of total billed charges,90% of $801.16 in Billed Charges for Rev 272 = $721.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET TUBE BIFURCATED SMOKE EVAC FILTER AIRSEAL SEM-EVAC,272,RC,27200002,CDM,,,,,,both,,,801.1600,120.1700,MEDCOST,MEDCOST VHN,381.27,,,,,,,206.7800,801.1600,percent of total billed charges,47.59% of $801.16 in Billed Charges for Rev 272 = $381.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET TUBE BIFURCATED SMOKE EVAC FILTER AIRSEAL SEM-EVAC,272,RC,27200002,CDM,,,,,,both,,,801.1600,120.1700,SENTARA HEALTH,SENTARA HEALTH,206.78,,,,,,,206.7800,801.1600,percent of total billed charges,25.81% of $801.16 in Billed Charges for Rev 272 = $206.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET TUBE BIFURCATED SMOKE EVAC FILTER AIRSEAL SEM-EVAC,272,RC,27200002,CDM,,,,,,both,,,801.1600,120.1700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",801.16,,,,,,,206.7800,801.1600,percent of total billed charges,100% of $801.16 in Billed Charges for Rev 272 = $801.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET TUBE BIFURCATED SMOKE EVAC FILTER AIRSEAL SEM-EVAC,272,RC,27200002,CDM,,,,,,both,,,801.1600,120.1700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,400.58,,,,,,,206.7800,801.1600,percent of total billed charges,Rev 272 $801.16 in Billed Charges at 50% = $400.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET TUBE BIFURCATED SMOKE EVAC FILTER AIRSEAL SEM-EVAC,272,RC,27200002,CDM,,,,,,both,,,801.1600,120.1700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,258.77,,,,,,,206.7800,801.1600,other,32.3% of $801.16 in Billed Charges for Rev 272 = $258.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SET TUBE BIFURCATED SMOKE EVAC FILTER AIRSEAL SEM-EVAC,272,RC,27200002,CDM,,,,,,both,,,801.1600,120.1700,UNITED HEALTHCARE,UHC HERITAGE SELECT,245.96,,,,,,,206.7800,801.1600,other,30.7% of $801.16 in Billed Charges for Rev 272 = $245.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SET TUBE BIFURCATED SMOKE EVAC FILTER AIRSEAL SEM-EVAC,272,RC,27200002,CDM,,,,,,both,,,801.1600,120.1700,UNITED HEALTHCARE,UNITED HEALTHCARE,258.77,,,,,,,206.7800,801.1600,percent of total billed charges,32.3% of $801.16 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET TUBE BIFURCATED SMOKE EVAC FILTER AIRSEAL SEM-EVAC,272,RC,27200002,CDM,,,,,,both,,,801.1600,120.1700,WELLCARE,WELLCARE MEDICAID,801.16,,,,,,,206.7800,801.1600,percent of total billed charges,100% of $801.16 in Billed Charges for Rev 272 = $801.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,1992.4800,298.8700,AETNA,AETNA,850.79,,,,,,,514.2600,1992.4800,percent of total billed charges,"42.7% of $1,992.48 in Billed Charges for Rev 272 = $850.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,1992.4800,298.8700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1394.74,,,,,,,514.2600,1992.4800,percent of total billed charges,"Rev 272 $1,992.48 in Billed Charges at 70% = $1,394.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,1992.4800,298.8700,CIGNA HEALTHCARE,CIGNA HMO,830.86,,,,,,,514.2600,1992.4800,percent of total billed charges,"41.7% of $1,992.48 in Billed Charges for Rev 272 = $830.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,1992.4800,298.8700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,924.51,,,,,,,514.2600,1992.4800,percent of total billed charges,"46.4% of $1,992.48 in Billed Charges for Rev 272 = $924.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,1992.4800,298.8700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,830.86,,,,,,,514.2600,1992.4800,percent of total billed charges,"41.7% of $1,992.48 in Billed Charges for Rev 272 = $830.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,1992.4800,298.8700,CIGNA HEALTHCARE,CIGNA PPO,830.86,,,,,,,514.2600,1992.4800,percent of total billed charges,"41.7% of $1,992.48 in Billed Charges for Rev 272 = $830.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,1992.4800,298.8700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1793.23,,,,,,,514.2600,1992.4800,percent of total billed charges,"90% of $1,992.48 in Billed Charges for Rev 272 = $1,793.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,1992.4800,298.8700,MEDCOST,MEDCOST VHN,948.22,,,,,,,514.2600,1992.4800,percent of total billed charges,"47.59% of $1,992.48 in Billed Charges for Rev 272 = $948.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,1992.4800,298.8700,SENTARA HEALTH,SENTARA HEALTH,514.26,,,,,,,514.2600,1992.4800,percent of total billed charges,"25.81% of $1,992.48 in Billed Charges for Rev 272 = $514.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,1992.4800,298.8700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1992.48,,,,,,,514.2600,1992.4800,percent of total billed charges,"100% of $1,992.48 in Billed Charges for Rev 272 = $1,992.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,1992.4800,298.8700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,996.24,,,,,,,514.2600,1992.4800,percent of total billed charges,"Rev 272 $1,992.48 in Billed Charges at 50% = $996.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,1992.4800,298.8700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,643.57,,,,,,,514.2600,1992.4800,other,"32.3% of $1,992.48 in Billed Charges for Rev 272 = $643.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,1992.4800,298.8700,UNITED HEALTHCARE,UHC HERITAGE SELECT,611.69,,,,,,,514.2600,1992.4800,other,"30.7% of $1,992.48 in Billed Charges for Rev 272 = $611.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,1992.4800,298.8700,UNITED HEALTHCARE,UNITED HEALTHCARE,643.57,,,,,,,514.2600,1992.4800,percent of total billed charges,"32.3% of $1,992.48 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,1992.4800,298.8700,WELLCARE,WELLCARE MEDICAID,1992.48,,,,,,,514.2600,1992.4800,percent of total billed charges,"100% of $1,992.48 in Billed Charges for Rev 272 = $1,992.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STRIP SKIN CLOSURE 16CM SURGICAL,272,RC,,,,,,,,both,,,840.1500,126.0200,AETNA,AETNA,358.74,,,,,,,216.8400,840.1500,percent of total billed charges,42.7% of $840.15 in Billed Charges for Rev 272 = $358.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRIP SKIN CLOSURE 16CM SURGICAL,272,RC,,,,,,,,both,,,840.1500,126.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,588.11,,,,,,,216.8400,840.1500,percent of total billed charges,Rev 272 $840.15 in Billed Charges at 70% = $588.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRIP SKIN CLOSURE 16CM SURGICAL,272,RC,,,,,,,,both,,,840.1500,126.0200,CIGNA HEALTHCARE,CIGNA HMO,350.34,,,,,,,216.8400,840.1500,percent of total billed charges,41.7% of $840.15 in Billed Charges for Rev 272 = $350.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRIP SKIN CLOSURE 16CM SURGICAL,272,RC,,,,,,,,both,,,840.1500,126.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,389.83,,,,,,,216.8400,840.1500,percent of total billed charges,46.4% of $840.15 in Billed Charges for Rev 272 = $389.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRIP SKIN CLOSURE 16CM SURGICAL,272,RC,,,,,,,,both,,,840.1500,126.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,350.34,,,,,,,216.8400,840.1500,percent of total billed charges,41.7% of $840.15 in Billed Charges for Rev 272 = $350.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRIP SKIN CLOSURE 16CM SURGICAL,272,RC,,,,,,,,both,,,840.1500,126.0200,CIGNA HEALTHCARE,CIGNA PPO,350.34,,,,,,,216.8400,840.1500,percent of total billed charges,41.7% of $840.15 in Billed Charges for Rev 272 = $350.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRIP SKIN CLOSURE 16CM SURGICAL,272,RC,,,,,,,,both,,,840.1500,126.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,756.14,,,,,,,216.8400,840.1500,percent of total billed charges,90% of $840.15 in Billed Charges for Rev 272 = $756.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRIP SKIN CLOSURE 16CM SURGICAL,272,RC,,,,,,,,both,,,840.1500,126.0200,MEDCOST,MEDCOST VHN,399.83,,,,,,,216.8400,840.1500,percent of total billed charges,47.59% of $840.15 in Billed Charges for Rev 272 = $399.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRIP SKIN CLOSURE 16CM SURGICAL,272,RC,,,,,,,,both,,,840.1500,126.0200,SENTARA HEALTH,SENTARA HEALTH,216.84,,,,,,,216.8400,840.1500,percent of total billed charges,25.81% of $840.15 in Billed Charges for Rev 272 = $216.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRIP SKIN CLOSURE 16CM SURGICAL,272,RC,,,,,,,,both,,,840.1500,126.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",840.15,,,,,,,216.8400,840.1500,percent of total billed charges,100% of $840.15 in Billed Charges for Rev 272 = $840.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRIP SKIN CLOSURE 16CM SURGICAL,272,RC,,,,,,,,both,,,840.1500,126.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,420.08,,,,,,,216.8400,840.1500,percent of total billed charges,Rev 272 $840.15 in Billed Charges at 50% = $420.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRIP SKIN CLOSURE 16CM SURGICAL,272,RC,,,,,,,,both,,,840.1500,126.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,271.37,,,,,,,216.8400,840.1500,other,32.3% of $840.15 in Billed Charges for Rev 272 = $271.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STRIP SKIN CLOSURE 16CM SURGICAL,272,RC,,,,,,,,both,,,840.1500,126.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,257.93,,,,,,,216.8400,840.1500,other,30.7% of $840.15 in Billed Charges for Rev 272 = $257.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STRIP SKIN CLOSURE 16CM SURGICAL,272,RC,,,,,,,,both,,,840.1500,126.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,271.37,,,,,,,216.8400,840.1500,percent of total billed charges,32.3% of $840.15 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRIP SKIN CLOSURE 16CM SURGICAL,272,RC,,,,,,,,both,,,840.1500,126.0200,WELLCARE,WELLCARE MEDICAID,840.15,,,,,,,216.8400,840.1500,percent of total billed charges,100% of $840.15 in Billed Charges for Rev 272 = $840.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STRUT AUTO MEDIUM,272,RC,,,,,,,,both,,,21257.4400,3188.6200,AETNA,AETNA,9076.93,,,,,,,5486.5500,21257.4400,percent of total billed charges,"42.7% of $21,257.44 in Billed Charges for Rev 272 = $9,076.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STRUT AUTO MEDIUM,272,RC,,,,,,,,both,,,21257.4400,3188.6200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,14880.21,,,,,,,5486.5500,21257.4400,percent of total billed charges,"Rev 272 $21,257.44 in Billed Charges at 70% = $14,880.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STRUT AUTO MEDIUM,272,RC,,,,,,,,both,,,21257.4400,3188.6200,CIGNA HEALTHCARE,CIGNA HMO,8864.35,,,,,,,5486.5500,21257.4400,percent of total billed charges,"41.7% of $21,257.44 in Billed Charges for Rev 272 = $8,864.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STRUT AUTO MEDIUM,272,RC,,,,,,,,both,,,21257.4400,3188.6200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,9863.45,,,,,,,5486.5500,21257.4400,percent of total billed charges,"46.4% of $21,257.44 in Billed Charges for Rev 272 = $9,863.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STRUT AUTO MEDIUM,272,RC,,,,,,,,both,,,21257.4400,3188.6200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8864.35,,,,,,,5486.5500,21257.4400,percent of total billed charges,"41.7% of $21,257.44 in Billed Charges for Rev 272 = $8,864.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STRUT AUTO MEDIUM,272,RC,,,,,,,,both,,,21257.4400,3188.6200,CIGNA HEALTHCARE,CIGNA PPO,8864.35,,,,,,,5486.5500,21257.4400,percent of total billed charges,"41.7% of $21,257.44 in Billed Charges for Rev 272 = $8,864.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STRUT AUTO MEDIUM,272,RC,,,,,,,,both,,,21257.4400,3188.6200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,19131.70,,,,,,,5486.5500,21257.4400,percent of total billed charges,"90% of $21,257.44 in Billed Charges for Rev 272 = $19,131.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STRUT AUTO MEDIUM,272,RC,,,,,,,,both,,,21257.4400,3188.6200,MEDCOST,MEDCOST VHN,10116.42,,,,,,,5486.5500,21257.4400,percent of total billed charges,"47.59% of $21,257.44 in Billed Charges for Rev 272 = $10,116.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STRUT AUTO MEDIUM,272,RC,,,,,,,,both,,,21257.4400,3188.6200,SENTARA HEALTH,SENTARA HEALTH,5486.55,,,,,,,5486.5500,21257.4400,percent of total billed charges,"25.81% of $21,257.44 in Billed Charges for Rev 272 = $5,486.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STRUT AUTO MEDIUM,272,RC,,,,,,,,both,,,21257.4400,3188.6200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",21257.44,,,,,,,5486.5500,21257.4400,percent of total billed charges,"100% of $21,257.44 in Billed Charges for Rev 272 = $21,257.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STRUT AUTO MEDIUM,272,RC,,,,,,,,both,,,21257.4400,3188.6200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,10628.72,,,,,,,5486.5500,21257.4400,percent of total billed charges,"Rev 272 $21,257.44 in Billed Charges at 50% = $10,628.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STRUT AUTO MEDIUM,272,RC,,,,,,,,both,,,21257.4400,3188.6200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,6866.15,,,,,,,5486.5500,21257.4400,other,"32.3% of $21,257.44 in Billed Charges for Rev 272 = $6,866.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STRUT AUTO MEDIUM,272,RC,,,,,,,,both,,,21257.4400,3188.6200,UNITED HEALTHCARE,UHC HERITAGE SELECT,6526.03,,,,,,,5486.5500,21257.4400,other,"30.7% of $21,257.44 in Billed Charges for Rev 272 = $6,526.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STRUT AUTO MEDIUM,272,RC,,,,,,,,both,,,21257.4400,3188.6200,UNITED HEALTHCARE,UNITED HEALTHCARE,6866.15,,,,,,,5486.5500,21257.4400,percent of total billed charges,"32.3% of $21,257.44 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STRUT AUTO MEDIUM,272,RC,,,,,,,,both,,,21257.4400,3188.6200,WELLCARE,WELLCARE MEDICAID,21257.44,,,,,,,5486.5500,21257.4400,percent of total billed charges,"100% of $21,257.44 in Billed Charges for Rev 272 = $21,257.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 20CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,5311.4900,796.7200,AETNA,AETNA,2268.01,,,,,,,1370.9000,5311.4900,percent of total billed charges,"42.7% of $5,311.49 in Billed Charges for Rev 272 = $2,268.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 20CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,5311.4900,796.7200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3718.04,,,,,,,1370.9000,5311.4900,percent of total billed charges,"Rev 272 $5,311.49 in Billed Charges at 70% = $3,718.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 20CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,5311.4900,796.7200,CIGNA HEALTHCARE,CIGNA HMO,2214.89,,,,,,,1370.9000,5311.4900,percent of total billed charges,"41.7% of $5,311.49 in Billed Charges for Rev 272 = $2,214.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 20CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,5311.4900,796.7200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2464.53,,,,,,,1370.9000,5311.4900,percent of total billed charges,"46.4% of $5,311.49 in Billed Charges for Rev 272 = $2,464.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 20CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,5311.4900,796.7200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2214.89,,,,,,,1370.9000,5311.4900,percent of total billed charges,"41.7% of $5,311.49 in Billed Charges for Rev 272 = $2,214.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 20CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,5311.4900,796.7200,CIGNA HEALTHCARE,CIGNA PPO,2214.89,,,,,,,1370.9000,5311.4900,percent of total billed charges,"41.7% of $5,311.49 in Billed Charges for Rev 272 = $2,214.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 20CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,5311.4900,796.7200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4780.34,,,,,,,1370.9000,5311.4900,percent of total billed charges,"90% of $5,311.49 in Billed Charges for Rev 272 = $4,780.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 20CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,5311.4900,796.7200,MEDCOST,MEDCOST VHN,2527.74,,,,,,,1370.9000,5311.4900,percent of total billed charges,"47.59% of $5,311.49 in Billed Charges for Rev 272 = $2,527.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 20CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,5311.4900,796.7200,SENTARA HEALTH,SENTARA HEALTH,1370.90,,,,,,,1370.9000,5311.4900,percent of total billed charges,"25.81% of $5,311.49 in Billed Charges for Rev 272 = $1,370.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 20CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,5311.4900,796.7200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5311.49,,,,,,,1370.9000,5311.4900,percent of total billed charges,"100% of $5,311.49 in Billed Charges for Rev 272 = $5,311.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 20CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,5311.4900,796.7200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2655.75,,,,,,,1370.9000,5311.4900,percent of total billed charges,"Rev 272 $5,311.49 in Billed Charges at 50% = $2,655.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 20CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,5311.4900,796.7200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1715.61,,,,,,,1370.9000,5311.4900,other,"32.3% of $5,311.49 in Billed Charges for Rev 272 = $1,715.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEARS HARMONIC 1100 20CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,5311.4900,796.7200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1630.63,,,,,,,1370.9000,5311.4900,other,"30.7% of $5,311.49 in Billed Charges for Rev 272 = $1,630.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEARS HARMONIC 1100 20CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,5311.4900,796.7200,UNITED HEALTHCARE,UNITED HEALTHCARE,1715.61,,,,,,,1370.9000,5311.4900,percent of total billed charges,"32.3% of $5,311.49 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 20CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,5311.4900,796.7200,WELLCARE,WELLCARE MEDICAID,5311.49,,,,,,,1370.9000,5311.4900,percent of total billed charges,"100% of $5,311.49 in Billed Charges for Rev 272 = $5,311.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 36CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,6048.2100,907.2300,AETNA,AETNA,2582.59,,,,,,,1561.0400,6048.2100,percent of total billed charges,"42.7% of $6,048.21 in Billed Charges for Rev 272 = $2,582.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 36CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,6048.2100,907.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4233.75,,,,,,,1561.0400,6048.2100,percent of total billed charges,"Rev 272 $6,048.21 in Billed Charges at 70% = $4,233.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 36CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,6048.2100,907.2300,CIGNA HEALTHCARE,CIGNA HMO,2522.10,,,,,,,1561.0400,6048.2100,percent of total billed charges,"41.7% of $6,048.21 in Billed Charges for Rev 272 = $2,522.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 36CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,6048.2100,907.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2806.37,,,,,,,1561.0400,6048.2100,percent of total billed charges,"46.4% of $6,048.21 in Billed Charges for Rev 272 = $2,806.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 36CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,6048.2100,907.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2522.10,,,,,,,1561.0400,6048.2100,percent of total billed charges,"41.7% of $6,048.21 in Billed Charges for Rev 272 = $2,522.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 36CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,6048.2100,907.2300,CIGNA HEALTHCARE,CIGNA PPO,2522.10,,,,,,,1561.0400,6048.2100,percent of total billed charges,"41.7% of $6,048.21 in Billed Charges for Rev 272 = $2,522.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 36CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,6048.2100,907.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5443.39,,,,,,,1561.0400,6048.2100,percent of total billed charges,"90% of $6,048.21 in Billed Charges for Rev 272 = $5,443.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 36CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,6048.2100,907.2300,MEDCOST,MEDCOST VHN,2878.34,,,,,,,1561.0400,6048.2100,percent of total billed charges,"47.59% of $6,048.21 in Billed Charges for Rev 272 = $2,878.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 36CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,6048.2100,907.2300,SENTARA HEALTH,SENTARA HEALTH,1561.04,,,,,,,1561.0400,6048.2100,percent of total billed charges,"25.81% of $6,048.21 in Billed Charges for Rev 272 = $1,561.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 36CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,6048.2100,907.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6048.21,,,,,,,1561.0400,6048.2100,percent of total billed charges,"100% of $6,048.21 in Billed Charges for Rev 272 = $6,048.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 36CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,6048.2100,907.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3024.11,,,,,,,1561.0400,6048.2100,percent of total billed charges,"Rev 272 $6,048.21 in Billed Charges at 50% = $3,024.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 36CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,6048.2100,907.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1953.57,,,,,,,1561.0400,6048.2100,other,"32.3% of $6,048.21 in Billed Charges for Rev 272 = $1,953.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEARS HARMONIC 1100 36CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,6048.2100,907.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1856.80,,,,,,,1561.0400,6048.2100,other,"30.7% of $6,048.21 in Billed Charges for Rev 272 = $1,856.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEARS HARMONIC 1100 36CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,6048.2100,907.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,1953.57,,,,,,,1561.0400,6048.2100,percent of total billed charges,"32.3% of $6,048.21 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 1100 36CM LENGTH,272,RC,27200002,CDM,,,,,,both,,,6048.2100,907.2300,WELLCARE,WELLCARE MEDICAID,6048.21,,,,,,,1561.0400,6048.2100,percent of total billed charges,"100% of $6,048.21 in Billed Charges for Rev 272 = $6,048.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 23CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4085.9000,612.8900,AETNA,AETNA,1744.68,,,,,,,1054.5700,4085.9000,percent of total billed charges,"42.7% of $4,085.90 in Billed Charges for Rev 272 = $1,744.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 23CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4085.9000,612.8900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2860.13,,,,,,,1054.5700,4085.9000,percent of total billed charges,"Rev 272 $4,085.90 in Billed Charges at 70% = $2,860.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 23CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4085.9000,612.8900,CIGNA HEALTHCARE,CIGNA HMO,1703.82,,,,,,,1054.5700,4085.9000,percent of total billed charges,"41.7% of $4,085.90 in Billed Charges for Rev 272 = $1,703.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 23CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4085.9000,612.8900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1895.86,,,,,,,1054.5700,4085.9000,percent of total billed charges,"46.4% of $4,085.90 in Billed Charges for Rev 272 = $1,895.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 23CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4085.9000,612.8900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1703.82,,,,,,,1054.5700,4085.9000,percent of total billed charges,"41.7% of $4,085.90 in Billed Charges for Rev 272 = $1,703.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 23CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4085.9000,612.8900,CIGNA HEALTHCARE,CIGNA PPO,1703.82,,,,,,,1054.5700,4085.9000,percent of total billed charges,"41.7% of $4,085.90 in Billed Charges for Rev 272 = $1,703.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 23CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4085.9000,612.8900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3677.31,,,,,,,1054.5700,4085.9000,percent of total billed charges,"90% of $4,085.90 in Billed Charges for Rev 272 = $3,677.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 23CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4085.9000,612.8900,MEDCOST,MEDCOST VHN,1944.48,,,,,,,1054.5700,4085.9000,percent of total billed charges,"47.59% of $4,085.90 in Billed Charges for Rev 272 = $1,944.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 23CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4085.9000,612.8900,SENTARA HEALTH,SENTARA HEALTH,1054.57,,,,,,,1054.5700,4085.9000,percent of total billed charges,"25.81% of $4,085.90 in Billed Charges for Rev 272 = $1,054.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 23CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4085.9000,612.8900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4085.90,,,,,,,1054.5700,4085.9000,percent of total billed charges,"100% of $4,085.90 in Billed Charges for Rev 272 = $4,085.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 23CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4085.9000,612.8900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2042.95,,,,,,,1054.5700,4085.9000,percent of total billed charges,"Rev 272 $4,085.90 in Billed Charges at 50% = $2,042.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 23CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4085.9000,612.8900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1319.75,,,,,,,1054.5700,4085.9000,other,"32.3% of $4,085.90 in Billed Charges for Rev 272 = $1,319.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEARS HARMONIC 700 23CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4085.9000,612.8900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1254.37,,,,,,,1054.5700,4085.9000,other,"30.7% of $4,085.90 in Billed Charges for Rev 272 = $1,254.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEARS HARMONIC 700 23CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4085.9000,612.8900,UNITED HEALTHCARE,UNITED HEALTHCARE,1319.75,,,,,,,1054.5700,4085.9000,percent of total billed charges,"32.3% of $4,085.90 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 23CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4085.9000,612.8900,WELLCARE,WELLCARE MEDICAID,4085.90,,,,,,,1054.5700,4085.9000,percent of total billed charges,"100% of $4,085.90 in Billed Charges for Rev 272 = $4,085.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STYLET DISPOSABLE 10PCS PRE-CALIBRATED,272,RC,,,,,,,,both,,,5548.4900,832.2700,AETNA,AETNA,2369.21,,,,,,,1432.0700,5548.4900,percent of total billed charges,"42.7% of $5,548.49 in Billed Charges for Rev 272 = $2,369.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STYLET DISPOSABLE 10PCS PRE-CALIBRATED,272,RC,,,,,,,,both,,,5548.4900,832.2700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3883.94,,,,,,,1432.0700,5548.4900,percent of total billed charges,"Rev 272 $5,548.49 in Billed Charges at 70% = $3,883.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STYLET DISPOSABLE 10PCS PRE-CALIBRATED,272,RC,,,,,,,,both,,,5548.4900,832.2700,CIGNA HEALTHCARE,CIGNA HMO,2313.72,,,,,,,1432.0700,5548.4900,percent of total billed charges,"41.7% of $5,548.49 in Billed Charges for Rev 272 = $2,313.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STYLET DISPOSABLE 10PCS PRE-CALIBRATED,272,RC,,,,,,,,both,,,5548.4900,832.2700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2574.50,,,,,,,1432.0700,5548.4900,percent of total billed charges,"46.4% of $5,548.49 in Billed Charges for Rev 272 = $2,574.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STYLET DISPOSABLE 10PCS PRE-CALIBRATED,272,RC,,,,,,,,both,,,5548.4900,832.2700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2313.72,,,,,,,1432.0700,5548.4900,percent of total billed charges,"41.7% of $5,548.49 in Billed Charges for Rev 272 = $2,313.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STYLET DISPOSABLE 10PCS PRE-CALIBRATED,272,RC,,,,,,,,both,,,5548.4900,832.2700,CIGNA HEALTHCARE,CIGNA PPO,2313.72,,,,,,,1432.0700,5548.4900,percent of total billed charges,"41.7% of $5,548.49 in Billed Charges for Rev 272 = $2,313.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STYLET DISPOSABLE 10PCS PRE-CALIBRATED,272,RC,,,,,,,,both,,,5548.4900,832.2700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4993.64,,,,,,,1432.0700,5548.4900,percent of total billed charges,"90% of $5,548.49 in Billed Charges for Rev 272 = $4,993.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STYLET DISPOSABLE 10PCS PRE-CALIBRATED,272,RC,,,,,,,,both,,,5548.4900,832.2700,MEDCOST,MEDCOST VHN,2640.53,,,,,,,1432.0700,5548.4900,percent of total billed charges,"47.59% of $5,548.49 in Billed Charges for Rev 272 = $2,640.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STYLET DISPOSABLE 10PCS PRE-CALIBRATED,272,RC,,,,,,,,both,,,5548.4900,832.2700,SENTARA HEALTH,SENTARA HEALTH,1432.07,,,,,,,1432.0700,5548.4900,percent of total billed charges,"25.81% of $5,548.49 in Billed Charges for Rev 272 = $1,432.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STYLET DISPOSABLE 10PCS PRE-CALIBRATED,272,RC,,,,,,,,both,,,5548.4900,832.2700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5548.49,,,,,,,1432.0700,5548.4900,percent of total billed charges,"100% of $5,548.49 in Billed Charges for Rev 272 = $5,548.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STYLET DISPOSABLE 10PCS PRE-CALIBRATED,272,RC,,,,,,,,both,,,5548.4900,832.2700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2774.25,,,,,,,1432.0700,5548.4900,percent of total billed charges,"Rev 272 $5,548.49 in Billed Charges at 50% = $2,774.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STYLET DISPOSABLE 10PCS PRE-CALIBRATED,272,RC,,,,,,,,both,,,5548.4900,832.2700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1792.16,,,,,,,1432.0700,5548.4900,other,"32.3% of $5,548.49 in Billed Charges for Rev 272 = $1,792.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STYLET DISPOSABLE 10PCS PRE-CALIBRATED,272,RC,,,,,,,,both,,,5548.4900,832.2700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1703.39,,,,,,,1432.0700,5548.4900,other,"30.7% of $5,548.49 in Billed Charges for Rev 272 = $1,703.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STYLET DISPOSABLE 10PCS PRE-CALIBRATED,272,RC,,,,,,,,both,,,5548.4900,832.2700,UNITED HEALTHCARE,UNITED HEALTHCARE,1792.16,,,,,,,1432.0700,5548.4900,percent of total billed charges,"32.3% of $5,548.49 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STYLET DISPOSABLE 10PCS PRE-CALIBRATED,272,RC,,,,,,,,both,,,5548.4900,832.2700,WELLCARE,WELLCARE MEDICAID,5548.49,,,,,,,1432.0700,5548.4900,percent of total billed charges,"100% of $5,548.49 in Billed Charges for Rev 272 = $5,548.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET ENDO RETRIEVAL SWIRLNET STD COLONIC 3X6MM OVAL LOOP 2.5MM TIP DIA 230CML 2.8MM MIN CHANNEL,272,RC,27200002,CDM,,,,,,both,,,9852.4500,1477.8700,AETNA,AETNA,4207.00,,,,,,,2542.9200,9852.4500,percent of total billed charges,"42.7% of $9,852.45 in Billed Charges for Rev 272 = $4,207.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET ENDO RETRIEVAL SWIRLNET STD COLONIC 3X6MM OVAL LOOP 2.5MM TIP DIA 230CML 2.8MM MIN CHANNEL,272,RC,27200002,CDM,,,,,,both,,,9852.4500,1477.8700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6896.72,,,,,,,2542.9200,9852.4500,percent of total billed charges,"Rev 272 $9,852.45 in Billed Charges at 70% = $6,896.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET ENDO RETRIEVAL SWIRLNET STD COLONIC 3X6MM OVAL LOOP 2.5MM TIP DIA 230CML 2.8MM MIN CHANNEL,272,RC,27200002,CDM,,,,,,both,,,9852.4500,1477.8700,CIGNA HEALTHCARE,CIGNA HMO,4108.47,,,,,,,2542.9200,9852.4500,percent of total billed charges,"41.7% of $9,852.45 in Billed Charges for Rev 272 = $4,108.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET ENDO RETRIEVAL SWIRLNET STD COLONIC 3X6MM OVAL LOOP 2.5MM TIP DIA 230CML 2.8MM MIN CHANNEL,272,RC,27200002,CDM,,,,,,both,,,9852.4500,1477.8700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4571.54,,,,,,,2542.9200,9852.4500,percent of total billed charges,"46.4% of $9,852.45 in Billed Charges for Rev 272 = $4,571.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET ENDO RETRIEVAL SWIRLNET STD COLONIC 3X6MM OVAL LOOP 2.5MM TIP DIA 230CML 2.8MM MIN CHANNEL,272,RC,27200002,CDM,,,,,,both,,,9852.4500,1477.8700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4108.47,,,,,,,2542.9200,9852.4500,percent of total billed charges,"41.7% of $9,852.45 in Billed Charges for Rev 272 = $4,108.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET ENDO RETRIEVAL SWIRLNET STD COLONIC 3X6MM OVAL LOOP 2.5MM TIP DIA 230CML 2.8MM MIN CHANNEL,272,RC,27200002,CDM,,,,,,both,,,9852.4500,1477.8700,CIGNA HEALTHCARE,CIGNA PPO,4108.47,,,,,,,2542.9200,9852.4500,percent of total billed charges,"41.7% of $9,852.45 in Billed Charges for Rev 272 = $4,108.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET ENDO RETRIEVAL SWIRLNET STD COLONIC 3X6MM OVAL LOOP 2.5MM TIP DIA 230CML 2.8MM MIN CHANNEL,272,RC,27200002,CDM,,,,,,both,,,9852.4500,1477.8700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8867.21,,,,,,,2542.9200,9852.4500,percent of total billed charges,"90% of $9,852.45 in Billed Charges for Rev 272 = $8,867.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET ENDO RETRIEVAL SWIRLNET STD COLONIC 3X6MM OVAL LOOP 2.5MM TIP DIA 230CML 2.8MM MIN CHANNEL,272,RC,27200002,CDM,,,,,,both,,,9852.4500,1477.8700,MEDCOST,MEDCOST VHN,4688.78,,,,,,,2542.9200,9852.4500,percent of total billed charges,"47.59% of $9,852.45 in Billed Charges for Rev 272 = $4,688.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET ENDO RETRIEVAL SWIRLNET STD COLONIC 3X6MM OVAL LOOP 2.5MM TIP DIA 230CML 2.8MM MIN CHANNEL,272,RC,27200002,CDM,,,,,,both,,,9852.4500,1477.8700,SENTARA HEALTH,SENTARA HEALTH,2542.92,,,,,,,2542.9200,9852.4500,percent of total billed charges,"25.81% of $9,852.45 in Billed Charges for Rev 272 = $2,542.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET ENDO RETRIEVAL SWIRLNET STD COLONIC 3X6MM OVAL LOOP 2.5MM TIP DIA 230CML 2.8MM MIN CHANNEL,272,RC,27200002,CDM,,,,,,both,,,9852.4500,1477.8700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9852.45,,,,,,,2542.9200,9852.4500,percent of total billed charges,"100% of $9,852.45 in Billed Charges for Rev 272 = $9,852.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET ENDO RETRIEVAL SWIRLNET STD COLONIC 3X6MM OVAL LOOP 2.5MM TIP DIA 230CML 2.8MM MIN CHANNEL,272,RC,27200002,CDM,,,,,,both,,,9852.4500,1477.8700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4926.23,,,,,,,2542.9200,9852.4500,percent of total billed charges,"Rev 272 $9,852.45 in Billed Charges at 50% = $4,926.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET ENDO RETRIEVAL SWIRLNET STD COLONIC 3X6MM OVAL LOOP 2.5MM TIP DIA 230CML 2.8MM MIN CHANNEL,272,RC,27200002,CDM,,,,,,both,,,9852.4500,1477.8700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3182.34,,,,,,,2542.9200,9852.4500,other,"32.3% of $9,852.45 in Billed Charges for Rev 272 = $3,182.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NET ENDO RETRIEVAL SWIRLNET STD COLONIC 3X6MM OVAL LOOP 2.5MM TIP DIA 230CML 2.8MM MIN CHANNEL,272,RC,27200002,CDM,,,,,,both,,,9852.4500,1477.8700,UNITED HEALTHCARE,UHC HERITAGE SELECT,3024.70,,,,,,,2542.9200,9852.4500,other,"30.7% of $9,852.45 in Billed Charges for Rev 272 = $3,024.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NET ENDO RETRIEVAL SWIRLNET STD COLONIC 3X6MM OVAL LOOP 2.5MM TIP DIA 230CML 2.8MM MIN CHANNEL,272,RC,27200002,CDM,,,,,,both,,,9852.4500,1477.8700,UNITED HEALTHCARE,UNITED HEALTHCARE,3182.34,,,,,,,2542.9200,9852.4500,percent of total billed charges,"32.3% of $9,852.45 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET ENDO RETRIEVAL SWIRLNET STD COLONIC 3X6MM OVAL LOOP 2.5MM TIP DIA 230CML 2.8MM MIN CHANNEL,272,RC,27200002,CDM,,,,,,both,,,9852.4500,1477.8700,WELLCARE,WELLCARE MEDICAID,9852.45,,,,,,,2542.9200,9852.4500,percent of total billed charges,"100% of $9,852.45 in Billed Charges for Rev 272 = $9,852.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NET POLYP RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,924.6600,138.7000,AETNA,AETNA,394.83,,,,,,,238.6500,924.6600,percent of total billed charges,42.7% of $924.66 in Billed Charges for Rev 272 = $394.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET POLYP RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,924.6600,138.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,647.26,,,,,,,238.6500,924.6600,percent of total billed charges,Rev 272 $924.66 in Billed Charges at 70% = $647.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET POLYP RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,924.6600,138.7000,CIGNA HEALTHCARE,CIGNA HMO,385.58,,,,,,,238.6500,924.6600,percent of total billed charges,41.7% of $924.66 in Billed Charges for Rev 272 = $385.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET POLYP RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,924.6600,138.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,429.04,,,,,,,238.6500,924.6600,percent of total billed charges,46.4% of $924.66 in Billed Charges for Rev 272 = $429.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET POLYP RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,924.6600,138.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,385.58,,,,,,,238.6500,924.6600,percent of total billed charges,41.7% of $924.66 in Billed Charges for Rev 272 = $385.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET POLYP RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,924.6600,138.7000,CIGNA HEALTHCARE,CIGNA PPO,385.58,,,,,,,238.6500,924.6600,percent of total billed charges,41.7% of $924.66 in Billed Charges for Rev 272 = $385.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET POLYP RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,924.6600,138.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,832.19,,,,,,,238.6500,924.6600,percent of total billed charges,90% of $924.66 in Billed Charges for Rev 272 = $832.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET POLYP RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,924.6600,138.7000,MEDCOST,MEDCOST VHN,440.05,,,,,,,238.6500,924.6600,percent of total billed charges,47.59% of $924.66 in Billed Charges for Rev 272 = $440.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET POLYP RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,924.6600,138.7000,SENTARA HEALTH,SENTARA HEALTH,238.65,,,,,,,238.6500,924.6600,percent of total billed charges,25.81% of $924.66 in Billed Charges for Rev 272 = $238.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET POLYP RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,924.6600,138.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",924.66,,,,,,,238.6500,924.6600,percent of total billed charges,100% of $924.66 in Billed Charges for Rev 272 = $924.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET POLYP RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,924.6600,138.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,462.33,,,,,,,238.6500,924.6600,percent of total billed charges,Rev 272 $924.66 in Billed Charges at 50% = $462.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET POLYP RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,924.6600,138.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,298.67,,,,,,,238.6500,924.6600,other,32.3% of $924.66 in Billed Charges for Rev 272 = $298.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NET POLYP RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,924.6600,138.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,283.87,,,,,,,238.6500,924.6600,other,30.7% of $924.66 in Billed Charges for Rev 272 = $283.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NET POLYP RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,924.6600,138.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,298.67,,,,,,,238.6500,924.6600,percent of total billed charges,32.3% of $924.66 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET POLYP RETRIEVAL,272,RC,27200002,CDM,,,,,,both,,,924.6600,138.7000,WELLCARE,WELLCARE MEDICAID,924.66,,,,,,,238.6500,924.6600,percent of total billed charges,100% of $924.66 in Billed Charges for Rev 272 = $924.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEARS HARMONIC 700 36CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4652.6200,697.8900,AETNA,AETNA,1986.67,,,,,,,1200.8400,4652.6200,percent of total billed charges,"42.7% of $4,652.62 in Billed Charges for Rev 272 = $1,986.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 36CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4652.6200,697.8900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3256.83,,,,,,,1200.8400,4652.6200,percent of total billed charges,"Rev 272 $4,652.62 in Billed Charges at 70% = $3,256.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 36CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4652.6200,697.8900,CIGNA HEALTHCARE,CIGNA HMO,1940.14,,,,,,,1200.8400,4652.6200,percent of total billed charges,"41.7% of $4,652.62 in Billed Charges for Rev 272 = $1,940.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 36CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4652.6200,697.8900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2158.82,,,,,,,1200.8400,4652.6200,percent of total billed charges,"46.4% of $4,652.62 in Billed Charges for Rev 272 = $2,158.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 36CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4652.6200,697.8900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1940.14,,,,,,,1200.8400,4652.6200,percent of total billed charges,"41.7% of $4,652.62 in Billed Charges for Rev 272 = $1,940.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 36CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4652.6200,697.8900,CIGNA HEALTHCARE,CIGNA PPO,1940.14,,,,,,,1200.8400,4652.6200,percent of total billed charges,"41.7% of $4,652.62 in Billed Charges for Rev 272 = $1,940.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 36CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4652.6200,697.8900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4187.36,,,,,,,1200.8400,4652.6200,percent of total billed charges,"90% of $4,652.62 in Billed Charges for Rev 272 = $4,187.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 36CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4652.6200,697.8900,MEDCOST,MEDCOST VHN,2214.18,,,,,,,1200.8400,4652.6200,percent of total billed charges,"47.59% of $4,652.62 in Billed Charges for Rev 272 = $2,214.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 36CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4652.6200,697.8900,SENTARA HEALTH,SENTARA HEALTH,1200.84,,,,,,,1200.8400,4652.6200,percent of total billed charges,"25.81% of $4,652.62 in Billed Charges for Rev 272 = $1,200.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 36CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4652.6200,697.8900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4652.62,,,,,,,1200.8400,4652.6200,percent of total billed charges,"100% of $4,652.62 in Billed Charges for Rev 272 = $4,652.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 36CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4652.6200,697.8900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2326.31,,,,,,,1200.8400,4652.6200,percent of total billed charges,"Rev 272 $4,652.62 in Billed Charges at 50% = $2,326.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 36CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4652.6200,697.8900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1502.80,,,,,,,1200.8400,4652.6200,other,"32.3% of $4,652.62 in Billed Charges for Rev 272 = $1,502.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEARS HARMONIC 700 36CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4652.6200,697.8900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1428.35,,,,,,,1200.8400,4652.6200,other,"30.7% of $4,652.62 in Billed Charges for Rev 272 = $1,428.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEARS HARMONIC 700 36CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4652.6200,697.8900,UNITED HEALTHCARE,UNITED HEALTHCARE,1502.80,,,,,,,1200.8400,4652.6200,percent of total billed charges,"32.3% of $4,652.62 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC 700 36CM W/ADVANCED HEMOSTASIS,272,RC,27200002,CDM,,,,,,both,,,4652.6200,697.8900,WELLCARE,WELLCARE MEDICAID,4652.62,,,,,,,1200.8400,4652.6200,percent of total billed charges,"100% of $4,652.62 in Billed Charges for Rev 272 = $4,652.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC HD1000I 20CM,272,RC,,,,,,,,both,,,4640.8800,696.1300,AETNA,AETNA,1981.66,,,,,,,1197.8100,4640.8800,percent of total billed charges,"42.7% of $4,640.88 in Billed Charges for Rev 272 = $1,981.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC HD1000I 20CM,272,RC,,,,,,,,both,,,4640.8800,696.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3248.62,,,,,,,1197.8100,4640.8800,percent of total billed charges,"Rev 272 $4,640.88 in Billed Charges at 70% = $3,248.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC HD1000I 20CM,272,RC,,,,,,,,both,,,4640.8800,696.1300,CIGNA HEALTHCARE,CIGNA HMO,1935.25,,,,,,,1197.8100,4640.8800,percent of total billed charges,"41.7% of $4,640.88 in Billed Charges for Rev 272 = $1,935.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC HD1000I 20CM,272,RC,,,,,,,,both,,,4640.8800,696.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2153.37,,,,,,,1197.8100,4640.8800,percent of total billed charges,"46.4% of $4,640.88 in Billed Charges for Rev 272 = $2,153.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC HD1000I 20CM,272,RC,,,,,,,,both,,,4640.8800,696.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1935.25,,,,,,,1197.8100,4640.8800,percent of total billed charges,"41.7% of $4,640.88 in Billed Charges for Rev 272 = $1,935.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC HD1000I 20CM,272,RC,,,,,,,,both,,,4640.8800,696.1300,CIGNA HEALTHCARE,CIGNA PPO,1935.25,,,,,,,1197.8100,4640.8800,percent of total billed charges,"41.7% of $4,640.88 in Billed Charges for Rev 272 = $1,935.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC HD1000I 20CM,272,RC,,,,,,,,both,,,4640.8800,696.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4176.79,,,,,,,1197.8100,4640.8800,percent of total billed charges,"90% of $4,640.88 in Billed Charges for Rev 272 = $4,176.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC HD1000I 20CM,272,RC,,,,,,,,both,,,4640.8800,696.1300,MEDCOST,MEDCOST VHN,2208.59,,,,,,,1197.8100,4640.8800,percent of total billed charges,"47.59% of $4,640.88 in Billed Charges for Rev 272 = $2,208.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC HD1000I 20CM,272,RC,,,,,,,,both,,,4640.8800,696.1300,SENTARA HEALTH,SENTARA HEALTH,1197.81,,,,,,,1197.8100,4640.8800,percent of total billed charges,"25.81% of $4,640.88 in Billed Charges for Rev 272 = $1,197.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC HD1000I 20CM,272,RC,,,,,,,,both,,,4640.8800,696.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4640.88,,,,,,,1197.8100,4640.8800,percent of total billed charges,"100% of $4,640.88 in Billed Charges for Rev 272 = $4,640.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC HD1000I 20CM,272,RC,,,,,,,,both,,,4640.8800,696.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2320.44,,,,,,,1197.8100,4640.8800,percent of total billed charges,"Rev 272 $4,640.88 in Billed Charges at 50% = $2,320.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC HD1000I 20CM,272,RC,,,,,,,,both,,,4640.8800,696.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1499.00,,,,,,,1197.8100,4640.8800,other,"32.3% of $4,640.88 in Billed Charges for Rev 272 = $1,499.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEARS HARMONIC HD1000I 20CM,272,RC,,,,,,,,both,,,4640.8800,696.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1424.75,,,,,,,1197.8100,4640.8800,other,"30.7% of $4,640.88 in Billed Charges for Rev 272 = $1,424.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEARS HARMONIC HD1000I 20CM,272,RC,,,,,,,,both,,,4640.8800,696.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,1499.00,,,,,,,1197.8100,4640.8800,percent of total billed charges,"32.3% of $4,640.88 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC HD1000I 20CM,272,RC,,,,,,,,both,,,4640.8800,696.1300,WELLCARE,WELLCARE MEDICAID,4640.88,,,,,,,1197.8100,4640.8800,percent of total billed charges,"100% of $4,640.88 in Billed Charges for Rev 272 = $4,640.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH CBDE SUPER,272,RC,27200002,CDM,,,,,,both,,,850.4200,127.5600,AETNA,AETNA,363.13,,,,,,,219.4900,850.4200,percent of total billed charges,42.7% of $850.42 in Billed Charges for Rev 272 = $363.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEATH CBDE SUPER,272,RC,27200002,CDM,,,,,,both,,,850.4200,127.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,595.29,,,,,,,219.4900,850.4200,percent of total billed charges,Rev 272 $850.42 in Billed Charges at 70% = $595.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEATH CBDE SUPER,272,RC,27200002,CDM,,,,,,both,,,850.4200,127.5600,CIGNA HEALTHCARE,CIGNA HMO,354.63,,,,,,,219.4900,850.4200,percent of total billed charges,41.7% of $850.42 in Billed Charges for Rev 272 = $354.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEATH CBDE SUPER,272,RC,27200002,CDM,,,,,,both,,,850.4200,127.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,394.59,,,,,,,219.4900,850.4200,percent of total billed charges,46.4% of $850.42 in Billed Charges for Rev 272 = $394.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEATH CBDE SUPER,272,RC,27200002,CDM,,,,,,both,,,850.4200,127.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,354.63,,,,,,,219.4900,850.4200,percent of total billed charges,41.7% of $850.42 in Billed Charges for Rev 272 = $354.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEATH CBDE SUPER,272,RC,27200002,CDM,,,,,,both,,,850.4200,127.5600,CIGNA HEALTHCARE,CIGNA PPO,354.63,,,,,,,219.4900,850.4200,percent of total billed charges,41.7% of $850.42 in Billed Charges for Rev 272 = $354.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEATH CBDE SUPER,272,RC,27200002,CDM,,,,,,both,,,850.4200,127.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,765.38,,,,,,,219.4900,850.4200,percent of total billed charges,90% of $850.42 in Billed Charges for Rev 272 = $765.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEATH CBDE SUPER,272,RC,27200002,CDM,,,,,,both,,,850.4200,127.5600,MEDCOST,MEDCOST VHN,404.71,,,,,,,219.4900,850.4200,percent of total billed charges,47.59% of $850.42 in Billed Charges for Rev 272 = $404.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEATH CBDE SUPER,272,RC,27200002,CDM,,,,,,both,,,850.4200,127.5600,SENTARA HEALTH,SENTARA HEALTH,219.49,,,,,,,219.4900,850.4200,percent of total billed charges,25.81% of $850.42 in Billed Charges for Rev 272 = $219.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEATH CBDE SUPER,272,RC,27200002,CDM,,,,,,both,,,850.4200,127.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",850.42,,,,,,,219.4900,850.4200,percent of total billed charges,100% of $850.42 in Billed Charges for Rev 272 = $850.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEATH CBDE SUPER,272,RC,27200002,CDM,,,,,,both,,,850.4200,127.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,425.21,,,,,,,219.4900,850.4200,percent of total billed charges,Rev 272 $850.42 in Billed Charges at 50% = $425.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEATH CBDE SUPER,272,RC,27200002,CDM,,,,,,both,,,850.4200,127.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,274.69,,,,,,,219.4900,850.4200,other,32.3% of $850.42 in Billed Charges for Rev 272 = $274.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SHEATH CBDE SUPER,272,RC,27200002,CDM,,,,,,both,,,850.4200,127.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,261.08,,,,,,,219.4900,850.4200,other,30.7% of $850.42 in Billed Charges for Rev 272 = $261.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SHEATH CBDE SUPER,272,RC,27200002,CDM,,,,,,both,,,850.4200,127.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,274.69,,,,,,,219.4900,850.4200,percent of total billed charges,32.3% of $850.42 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEATH CBDE SUPER,272,RC,27200002,CDM,,,,,,both,,,850.4200,127.5600,WELLCARE,WELLCARE MEDICAID,850.42,,,,,,,219.4900,850.4200,percent of total billed charges,100% of $850.42 in Billed Charges for Rev 272 = $850.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET ROTH FOREIGN BODY RETRIEVAL,272,RC,,,,,,,,both,,,954.8400,143.2300,AETNA,AETNA,407.72,,,,,,,246.4400,954.8400,percent of total billed charges,42.7% of $954.84 in Billed Charges for Rev 272 = $407.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET ROTH FOREIGN BODY RETRIEVAL,272,RC,,,,,,,,both,,,954.8400,143.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,668.39,,,,,,,246.4400,954.8400,percent of total billed charges,Rev 272 $954.84 in Billed Charges at 70% = $668.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET ROTH FOREIGN BODY RETRIEVAL,272,RC,,,,,,,,both,,,954.8400,143.2300,CIGNA HEALTHCARE,CIGNA HMO,398.17,,,,,,,246.4400,954.8400,percent of total billed charges,41.7% of $954.84 in Billed Charges for Rev 272 = $398.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET ROTH FOREIGN BODY RETRIEVAL,272,RC,,,,,,,,both,,,954.8400,143.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,443.05,,,,,,,246.4400,954.8400,percent of total billed charges,46.4% of $954.84 in Billed Charges for Rev 272 = $443.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET ROTH FOREIGN BODY RETRIEVAL,272,RC,,,,,,,,both,,,954.8400,143.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,398.17,,,,,,,246.4400,954.8400,percent of total billed charges,41.7% of $954.84 in Billed Charges for Rev 272 = $398.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET ROTH FOREIGN BODY RETRIEVAL,272,RC,,,,,,,,both,,,954.8400,143.2300,CIGNA HEALTHCARE,CIGNA PPO,398.17,,,,,,,246.4400,954.8400,percent of total billed charges,41.7% of $954.84 in Billed Charges for Rev 272 = $398.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET ROTH FOREIGN BODY RETRIEVAL,272,RC,,,,,,,,both,,,954.8400,143.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,859.36,,,,,,,246.4400,954.8400,percent of total billed charges,90% of $954.84 in Billed Charges for Rev 272 = $859.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET ROTH FOREIGN BODY RETRIEVAL,272,RC,,,,,,,,both,,,954.8400,143.2300,MEDCOST,MEDCOST VHN,454.41,,,,,,,246.4400,954.8400,percent of total billed charges,47.59% of $954.84 in Billed Charges for Rev 272 = $454.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET ROTH FOREIGN BODY RETRIEVAL,272,RC,,,,,,,,both,,,954.8400,143.2300,SENTARA HEALTH,SENTARA HEALTH,246.44,,,,,,,246.4400,954.8400,percent of total billed charges,25.81% of $954.84 in Billed Charges for Rev 272 = $246.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET ROTH FOREIGN BODY RETRIEVAL,272,RC,,,,,,,,both,,,954.8400,143.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",954.84,,,,,,,246.4400,954.8400,percent of total billed charges,100% of $954.84 in Billed Charges for Rev 272 = $954.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET ROTH FOREIGN BODY RETRIEVAL,272,RC,,,,,,,,both,,,954.8400,143.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,477.42,,,,,,,246.4400,954.8400,percent of total billed charges,Rev 272 $954.84 in Billed Charges at 50% = $477.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET ROTH FOREIGN BODY RETRIEVAL,272,RC,,,,,,,,both,,,954.8400,143.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,308.41,,,,,,,246.4400,954.8400,other,32.3% of $954.84 in Billed Charges for Rev 272 = $308.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NET ROTH FOREIGN BODY RETRIEVAL,272,RC,,,,,,,,both,,,954.8400,143.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,293.14,,,,,,,246.4400,954.8400,other,30.7% of $954.84 in Billed Charges for Rev 272 = $293.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NET ROTH FOREIGN BODY RETRIEVAL,272,RC,,,,,,,,both,,,954.8400,143.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,308.41,,,,,,,246.4400,954.8400,percent of total billed charges,32.3% of $954.84 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NET ROTH FOREIGN BODY RETRIEVAL,272,RC,,,,,,,,both,,,954.8400,143.2300,WELLCARE,WELLCARE MEDICAID,954.84,,,,,,,246.4400,954.8400,percent of total billed charges,100% of $954.84 in Billed Charges for Rev 272 = $954.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
OCCLUDER COTPO PNEUMO,272,RC,27200002,CDM,,,,,,both,,,2762.8900,414.4300,AETNA,AETNA,1179.75,,,,,,,713.1000,2762.8900,percent of total billed charges,"42.7% of $2,762.89 in Billed Charges for Rev 272 = $1,179.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OCCLUDER COTPO PNEUMO,272,RC,27200002,CDM,,,,,,both,,,2762.8900,414.4300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1934.02,,,,,,,713.1000,2762.8900,percent of total billed charges,"Rev 272 $2,762.89 in Billed Charges at 70% = $1,934.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OCCLUDER COTPO PNEUMO,272,RC,27200002,CDM,,,,,,both,,,2762.8900,414.4300,CIGNA HEALTHCARE,CIGNA HMO,1152.13,,,,,,,713.1000,2762.8900,percent of total billed charges,"41.7% of $2,762.89 in Billed Charges for Rev 272 = $1,152.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OCCLUDER COTPO PNEUMO,272,RC,27200002,CDM,,,,,,both,,,2762.8900,414.4300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1281.98,,,,,,,713.1000,2762.8900,percent of total billed charges,"46.4% of $2,762.89 in Billed Charges for Rev 272 = $1,281.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OCCLUDER COTPO PNEUMO,272,RC,27200002,CDM,,,,,,both,,,2762.8900,414.4300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1152.13,,,,,,,713.1000,2762.8900,percent of total billed charges,"41.7% of $2,762.89 in Billed Charges for Rev 272 = $1,152.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OCCLUDER COTPO PNEUMO,272,RC,27200002,CDM,,,,,,both,,,2762.8900,414.4300,CIGNA HEALTHCARE,CIGNA PPO,1152.13,,,,,,,713.1000,2762.8900,percent of total billed charges,"41.7% of $2,762.89 in Billed Charges for Rev 272 = $1,152.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OCCLUDER COTPO PNEUMO,272,RC,27200002,CDM,,,,,,both,,,2762.8900,414.4300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2486.60,,,,,,,713.1000,2762.8900,percent of total billed charges,"90% of $2,762.89 in Billed Charges for Rev 272 = $2,486.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OCCLUDER COTPO PNEUMO,272,RC,27200002,CDM,,,,,,both,,,2762.8900,414.4300,MEDCOST,MEDCOST VHN,1314.86,,,,,,,713.1000,2762.8900,percent of total billed charges,"47.59% of $2,762.89 in Billed Charges for Rev 272 = $1,314.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OCCLUDER COTPO PNEUMO,272,RC,27200002,CDM,,,,,,both,,,2762.8900,414.4300,SENTARA HEALTH,SENTARA HEALTH,713.10,,,,,,,713.1000,2762.8900,percent of total billed charges,"25.81% of $2,762.89 in Billed Charges for Rev 272 = $713.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OCCLUDER COTPO PNEUMO,272,RC,27200002,CDM,,,,,,both,,,2762.8900,414.4300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2762.89,,,,,,,713.1000,2762.8900,percent of total billed charges,"100% of $2,762.89 in Billed Charges for Rev 272 = $2,762.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OCCLUDER COTPO PNEUMO,272,RC,27200002,CDM,,,,,,both,,,2762.8900,414.4300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1381.45,,,,,,,713.1000,2762.8900,percent of total billed charges,"Rev 272 $2,762.89 in Billed Charges at 50% = $1,381.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OCCLUDER COTPO PNEUMO,272,RC,27200002,CDM,,,,,,both,,,2762.8900,414.4300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,892.41,,,,,,,713.1000,2762.8900,other,"32.3% of $2,762.89 in Billed Charges for Rev 272 = $892.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
OCCLUDER COTPO PNEUMO,272,RC,27200002,CDM,,,,,,both,,,2762.8900,414.4300,UNITED HEALTHCARE,UHC HERITAGE SELECT,848.21,,,,,,,713.1000,2762.8900,other,"30.7% of $2,762.89 in Billed Charges for Rev 272 = $848.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
OCCLUDER COTPO PNEUMO,272,RC,27200002,CDM,,,,,,both,,,2762.8900,414.4300,UNITED HEALTHCARE,UNITED HEALTHCARE,892.41,,,,,,,713.1000,2762.8900,percent of total billed charges,"32.3% of $2,762.89 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OCCLUDER COTPO PNEUMO,272,RC,27200002,CDM,,,,,,both,,,2762.8900,414.4300,WELLCARE,WELLCARE MEDICAID,2762.89,,,,,,,713.1000,2762.8900,percent of total billed charges,"100% of $2,762.89 in Billed Charges for Rev 272 = $2,762.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 6.4MM X 21CM,272,RC,,,,,,,,both,,,3741.8600,561.2800,AETNA,AETNA,1597.77,,,,,,,965.7700,3741.8600,percent of total billed charges,"42.7% of $3,741.86 in Billed Charges for Rev 272 = $1,597.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 6.4MM X 21CM,272,RC,,,,,,,,both,,,3741.8600,561.2800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2619.30,,,,,,,965.7700,3741.8600,percent of total billed charges,"Rev 272 $3,741.86 in Billed Charges at 70% = $2,619.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 6.4MM X 21CM,272,RC,,,,,,,,both,,,3741.8600,561.2800,CIGNA HEALTHCARE,CIGNA HMO,1560.36,,,,,,,965.7700,3741.8600,percent of total billed charges,"41.7% of $3,741.86 in Billed Charges for Rev 272 = $1,560.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 6.4MM X 21CM,272,RC,,,,,,,,both,,,3741.8600,561.2800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1736.22,,,,,,,965.7700,3741.8600,percent of total billed charges,"46.4% of $3,741.86 in Billed Charges for Rev 272 = $1,736.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 6.4MM X 21CM,272,RC,,,,,,,,both,,,3741.8600,561.2800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1560.36,,,,,,,965.7700,3741.8600,percent of total billed charges,"41.7% of $3,741.86 in Billed Charges for Rev 272 = $1,560.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 6.4MM X 21CM,272,RC,,,,,,,,both,,,3741.8600,561.2800,CIGNA HEALTHCARE,CIGNA PPO,1560.36,,,,,,,965.7700,3741.8600,percent of total billed charges,"41.7% of $3,741.86 in Billed Charges for Rev 272 = $1,560.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 6.4MM X 21CM,272,RC,,,,,,,,both,,,3741.8600,561.2800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3367.67,,,,,,,965.7700,3741.8600,percent of total billed charges,"90% of $3,741.86 in Billed Charges for Rev 272 = $3,367.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 6.4MM X 21CM,272,RC,,,,,,,,both,,,3741.8600,561.2800,MEDCOST,MEDCOST VHN,1780.75,,,,,,,965.7700,3741.8600,percent of total billed charges,"47.59% of $3,741.86 in Billed Charges for Rev 272 = $1,780.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 6.4MM X 21CM,272,RC,,,,,,,,both,,,3741.8600,561.2800,SENTARA HEALTH,SENTARA HEALTH,965.77,,,,,,,965.7700,3741.8600,percent of total billed charges,"25.81% of $3,741.86 in Billed Charges for Rev 272 = $965.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 6.4MM X 21CM,272,RC,,,,,,,,both,,,3741.8600,561.2800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3741.86,,,,,,,965.7700,3741.8600,percent of total billed charges,"100% of $3,741.86 in Billed Charges for Rev 272 = $3,741.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 6.4MM X 21CM,272,RC,,,,,,,,both,,,3741.8600,561.2800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1870.93,,,,,,,965.7700,3741.8600,percent of total billed charges,"Rev 272 $3,741.86 in Billed Charges at 50% = $1,870.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 6.4MM X 21CM,272,RC,,,,,,,,both,,,3741.8600,561.2800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1208.62,,,,,,,965.7700,3741.8600,other,"32.3% of $3,741.86 in Billed Charges for Rev 272 = $1,208.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
OSTEOTOME CURVED 6.4MM X 21CM,272,RC,,,,,,,,both,,,3741.8600,561.2800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1148.75,,,,,,,965.7700,3741.8600,other,"30.7% of $3,741.86 in Billed Charges for Rev 272 = $1,148.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
OSTEOTOME CURVED 6.4MM X 21CM,272,RC,,,,,,,,both,,,3741.8600,561.2800,UNITED HEALTHCARE,UNITED HEALTHCARE,1208.62,,,,,,,965.7700,3741.8600,percent of total billed charges,"32.3% of $3,741.86 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME CURVED 6.4MM X 21CM,272,RC,,,,,,,,both,,,3741.8600,561.2800,WELLCARE,WELLCARE MEDICAID,3741.86,,,,,,,965.7700,3741.8600,percent of total billed charges,"100% of $3,741.86 in Billed Charges for Rev 272 = $3,741.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME GRAY REVISION T SPLITTER,272,RC,,,,,,,,both,,,7272.6600,1090.9000,AETNA,AETNA,3105.43,,,,,,,1877.0700,7272.6600,percent of total billed charges,"42.7% of $7,272.66 in Billed Charges for Rev 272 = $3,105.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME GRAY REVISION T SPLITTER,272,RC,,,,,,,,both,,,7272.6600,1090.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5090.86,,,,,,,1877.0700,7272.6600,percent of total billed charges,"Rev 272 $7,272.66 in Billed Charges at 70% = $5,090.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME GRAY REVISION T SPLITTER,272,RC,,,,,,,,both,,,7272.6600,1090.9000,CIGNA HEALTHCARE,CIGNA HMO,3032.70,,,,,,,1877.0700,7272.6600,percent of total billed charges,"41.7% of $7,272.66 in Billed Charges for Rev 272 = $3,032.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME GRAY REVISION T SPLITTER,272,RC,,,,,,,,both,,,7272.6600,1090.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3374.51,,,,,,,1877.0700,7272.6600,percent of total billed charges,"46.4% of $7,272.66 in Billed Charges for Rev 272 = $3,374.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME GRAY REVISION T SPLITTER,272,RC,,,,,,,,both,,,7272.6600,1090.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3032.70,,,,,,,1877.0700,7272.6600,percent of total billed charges,"41.7% of $7,272.66 in Billed Charges for Rev 272 = $3,032.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME GRAY REVISION T SPLITTER,272,RC,,,,,,,,both,,,7272.6600,1090.9000,CIGNA HEALTHCARE,CIGNA PPO,3032.70,,,,,,,1877.0700,7272.6600,percent of total billed charges,"41.7% of $7,272.66 in Billed Charges for Rev 272 = $3,032.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME GRAY REVISION T SPLITTER,272,RC,,,,,,,,both,,,7272.6600,1090.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6545.39,,,,,,,1877.0700,7272.6600,percent of total billed charges,"90% of $7,272.66 in Billed Charges for Rev 272 = $6,545.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME GRAY REVISION T SPLITTER,272,RC,,,,,,,,both,,,7272.6600,1090.9000,MEDCOST,MEDCOST VHN,3461.06,,,,,,,1877.0700,7272.6600,percent of total billed charges,"47.59% of $7,272.66 in Billed Charges for Rev 272 = $3,461.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME GRAY REVISION T SPLITTER,272,RC,,,,,,,,both,,,7272.6600,1090.9000,SENTARA HEALTH,SENTARA HEALTH,1877.07,,,,,,,1877.0700,7272.6600,percent of total billed charges,"25.81% of $7,272.66 in Billed Charges for Rev 272 = $1,877.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME GRAY REVISION T SPLITTER,272,RC,,,,,,,,both,,,7272.6600,1090.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7272.66,,,,,,,1877.0700,7272.6600,percent of total billed charges,"100% of $7,272.66 in Billed Charges for Rev 272 = $7,272.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME GRAY REVISION T SPLITTER,272,RC,,,,,,,,both,,,7272.6600,1090.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3636.33,,,,,,,1877.0700,7272.6600,percent of total billed charges,"Rev 272 $7,272.66 in Billed Charges at 50% = $3,636.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME GRAY REVISION T SPLITTER,272,RC,,,,,,,,both,,,7272.6600,1090.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2349.07,,,,,,,1877.0700,7272.6600,other,"32.3% of $7,272.66 in Billed Charges for Rev 272 = $2,349.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
OSTEOTOME GRAY REVISION T SPLITTER,272,RC,,,,,,,,both,,,7272.6600,1090.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2232.71,,,,,,,1877.0700,7272.6600,other,"30.7% of $7,272.66 in Billed Charges for Rev 272 = $2,232.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
OSTEOTOME GRAY REVISION T SPLITTER,272,RC,,,,,,,,both,,,7272.6600,1090.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,2349.07,,,,,,,1877.0700,7272.6600,percent of total billed charges,"32.3% of $7,272.66 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OSTEOTOME GRAY REVISION T SPLITTER,272,RC,,,,,,,,both,,,7272.6600,1090.9000,WELLCARE,WELLCARE MEDICAID,7272.66,,,,,,,1877.0700,7272.6600,percent of total billed charges,"100% of $7,272.66 in Billed Charges for Rev 272 = $7,272.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OVERTUBE ESOPHAGEAL LONG,272,RC,,,,,,,,both,,,6482.8100,972.4200,AETNA,AETNA,2768.16,,,,,,,1673.2100,6482.8100,percent of total billed charges,"42.7% of $6,482.81 in Billed Charges for Rev 272 = $2,768.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OVERTUBE ESOPHAGEAL LONG,272,RC,,,,,,,,both,,,6482.8100,972.4200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4537.97,,,,,,,1673.2100,6482.8100,percent of total billed charges,"Rev 272 $6,482.81 in Billed Charges at 70% = $4,537.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OVERTUBE ESOPHAGEAL LONG,272,RC,,,,,,,,both,,,6482.8100,972.4200,CIGNA HEALTHCARE,CIGNA HMO,2703.33,,,,,,,1673.2100,6482.8100,percent of total billed charges,"41.7% of $6,482.81 in Billed Charges for Rev 272 = $2,703.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OVERTUBE ESOPHAGEAL LONG,272,RC,,,,,,,,both,,,6482.8100,972.4200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3008.02,,,,,,,1673.2100,6482.8100,percent of total billed charges,"46.4% of $6,482.81 in Billed Charges for Rev 272 = $3,008.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OVERTUBE ESOPHAGEAL LONG,272,RC,,,,,,,,both,,,6482.8100,972.4200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2703.33,,,,,,,1673.2100,6482.8100,percent of total billed charges,"41.7% of $6,482.81 in Billed Charges for Rev 272 = $2,703.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OVERTUBE ESOPHAGEAL LONG,272,RC,,,,,,,,both,,,6482.8100,972.4200,CIGNA HEALTHCARE,CIGNA PPO,2703.33,,,,,,,1673.2100,6482.8100,percent of total billed charges,"41.7% of $6,482.81 in Billed Charges for Rev 272 = $2,703.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OVERTUBE ESOPHAGEAL LONG,272,RC,,,,,,,,both,,,6482.8100,972.4200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5834.53,,,,,,,1673.2100,6482.8100,percent of total billed charges,"90% of $6,482.81 in Billed Charges for Rev 272 = $5,834.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OVERTUBE ESOPHAGEAL LONG,272,RC,,,,,,,,both,,,6482.8100,972.4200,MEDCOST,MEDCOST VHN,3085.17,,,,,,,1673.2100,6482.8100,percent of total billed charges,"47.59% of $6,482.81 in Billed Charges for Rev 272 = $3,085.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OVERTUBE ESOPHAGEAL LONG,272,RC,,,,,,,,both,,,6482.8100,972.4200,SENTARA HEALTH,SENTARA HEALTH,1673.21,,,,,,,1673.2100,6482.8100,percent of total billed charges,"25.81% of $6,482.81 in Billed Charges for Rev 272 = $1,673.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OVERTUBE ESOPHAGEAL LONG,272,RC,,,,,,,,both,,,6482.8100,972.4200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6482.81,,,,,,,1673.2100,6482.8100,percent of total billed charges,"100% of $6,482.81 in Billed Charges for Rev 272 = $6,482.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OVERTUBE ESOPHAGEAL LONG,272,RC,,,,,,,,both,,,6482.8100,972.4200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3241.41,,,,,,,1673.2100,6482.8100,percent of total billed charges,"Rev 272 $6,482.81 in Billed Charges at 50% = $3,241.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OVERTUBE ESOPHAGEAL LONG,272,RC,,,,,,,,both,,,6482.8100,972.4200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2093.95,,,,,,,1673.2100,6482.8100,other,"32.3% of $6,482.81 in Billed Charges for Rev 272 = $2,093.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
OVERTUBE ESOPHAGEAL LONG,272,RC,,,,,,,,both,,,6482.8100,972.4200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1990.22,,,,,,,1673.2100,6482.8100,other,"30.7% of $6,482.81 in Billed Charges for Rev 272 = $1,990.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
OVERTUBE ESOPHAGEAL LONG,272,RC,,,,,,,,both,,,6482.8100,972.4200,UNITED HEALTHCARE,UNITED HEALTHCARE,2093.95,,,,,,,1673.2100,6482.8100,percent of total billed charges,"32.3% of $6,482.81 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
OVERTUBE ESOPHAGEAL LONG,272,RC,,,,,,,,both,,,6482.8100,972.4200,WELLCARE,WELLCARE MEDICAID,6482.81,,,,,,,1673.2100,6482.8100,percent of total billed charges,"100% of $6,482.81 in Billed Charges for Rev 272 = $6,482.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACCESSORY PENILE IMPLANT AMS 700,272,RC,27200002,CDM,,,,,,both,,,11096.9700,1664.5500,AETNA,AETNA,4738.41,,,,,,,2864.1300,11096.9700,percent of total billed charges,"42.7% of $11,096.97 in Billed Charges for Rev 272 = $4,738.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACCESSORY PENILE IMPLANT AMS 700,272,RC,27200002,CDM,,,,,,both,,,11096.9700,1664.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7767.88,,,,,,,2864.1300,11096.9700,percent of total billed charges,"Rev 272 $11,096.97 in Billed Charges at 70% = $7,767.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACCESSORY PENILE IMPLANT AMS 700,272,RC,27200002,CDM,,,,,,both,,,11096.9700,1664.5500,CIGNA HEALTHCARE,CIGNA HMO,4627.44,,,,,,,2864.1300,11096.9700,percent of total billed charges,"41.7% of $11,096.97 in Billed Charges for Rev 272 = $4,627.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACCESSORY PENILE IMPLANT AMS 700,272,RC,27200002,CDM,,,,,,both,,,11096.9700,1664.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5148.99,,,,,,,2864.1300,11096.9700,percent of total billed charges,"46.4% of $11,096.97 in Billed Charges for Rev 272 = $5,148.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACCESSORY PENILE IMPLANT AMS 700,272,RC,27200002,CDM,,,,,,both,,,11096.9700,1664.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4627.44,,,,,,,2864.1300,11096.9700,percent of total billed charges,"41.7% of $11,096.97 in Billed Charges for Rev 272 = $4,627.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACCESSORY PENILE IMPLANT AMS 700,272,RC,27200002,CDM,,,,,,both,,,11096.9700,1664.5500,CIGNA HEALTHCARE,CIGNA PPO,4627.44,,,,,,,2864.1300,11096.9700,percent of total billed charges,"41.7% of $11,096.97 in Billed Charges for Rev 272 = $4,627.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACCESSORY PENILE IMPLANT AMS 700,272,RC,27200002,CDM,,,,,,both,,,11096.9700,1664.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9987.27,,,,,,,2864.1300,11096.9700,percent of total billed charges,"90% of $11,096.97 in Billed Charges for Rev 272 = $9,987.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACCESSORY PENILE IMPLANT AMS 700,272,RC,27200002,CDM,,,,,,both,,,11096.9700,1664.5500,MEDCOST,MEDCOST VHN,5281.05,,,,,,,2864.1300,11096.9700,percent of total billed charges,"47.59% of $11,096.97 in Billed Charges for Rev 272 = $5,281.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACCESSORY PENILE IMPLANT AMS 700,272,RC,27200002,CDM,,,,,,both,,,11096.9700,1664.5500,SENTARA HEALTH,SENTARA HEALTH,2864.13,,,,,,,2864.1300,11096.9700,percent of total billed charges,"25.81% of $11,096.97 in Billed Charges for Rev 272 = $2,864.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACCESSORY PENILE IMPLANT AMS 700,272,RC,27200002,CDM,,,,,,both,,,11096.9700,1664.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11096.97,,,,,,,2864.1300,11096.9700,percent of total billed charges,"100% of $11,096.97 in Billed Charges for Rev 272 = $11,096.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACCESSORY PENILE IMPLANT AMS 700,272,RC,27200002,CDM,,,,,,both,,,11096.9700,1664.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5548.49,,,,,,,2864.1300,11096.9700,percent of total billed charges,"Rev 272 $11,096.97 in Billed Charges at 50% = $5,548.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACCESSORY PENILE IMPLANT AMS 700,272,RC,27200002,CDM,,,,,,both,,,11096.9700,1664.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3584.32,,,,,,,2864.1300,11096.9700,other,"32.3% of $11,096.97 in Billed Charges for Rev 272 = $3,584.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK ACCESSORY PENILE IMPLANT AMS 700,272,RC,27200002,CDM,,,,,,both,,,11096.9700,1664.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3406.77,,,,,,,2864.1300,11096.9700,other,"30.7% of $11,096.97 in Billed Charges for Rev 272 = $3,406.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PACK ACCESSORY PENILE IMPLANT AMS 700,272,RC,27200002,CDM,,,,,,both,,,11096.9700,1664.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,3584.32,,,,,,,2864.1300,11096.9700,percent of total billed charges,"32.3% of $11,096.97 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PACK ACCESSORY PENILE IMPLANT AMS 700,272,RC,27200002,CDM,,,,,,both,,,11096.9700,1664.5500,WELLCARE,WELLCARE MEDICAID,11096.97,,,,,,,2864.1300,11096.9700,percent of total billed charges,"100% of $11,096.97 in Billed Charges for Rev 272 = $11,096.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND MODERATE PLUS PROFILE GEL 700CC,272,RC,27200002,CDM,,,,,,both,,,2385.3300,357.8000,AETNA,AETNA,1018.54,,,,,,,615.6500,2385.3300,percent of total billed charges,"42.7% of $2,385.33 in Billed Charges for Rev 272 = $1,018.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND MODERATE PLUS PROFILE GEL 700CC,272,RC,27200002,CDM,,,,,,both,,,2385.3300,357.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1669.73,,,,,,,615.6500,2385.3300,percent of total billed charges,"Rev 272 $2,385.33 in Billed Charges at 70% = $1,669.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND MODERATE PLUS PROFILE GEL 700CC,272,RC,27200002,CDM,,,,,,both,,,2385.3300,357.8000,CIGNA HEALTHCARE,CIGNA HMO,994.68,,,,,,,615.6500,2385.3300,percent of total billed charges,"41.7% of $2,385.33 in Billed Charges for Rev 272 = $994.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND MODERATE PLUS PROFILE GEL 700CC,272,RC,27200002,CDM,,,,,,both,,,2385.3300,357.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1106.79,,,,,,,615.6500,2385.3300,percent of total billed charges,"46.4% of $2,385.33 in Billed Charges for Rev 272 = $1,106.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND MODERATE PLUS PROFILE GEL 700CC,272,RC,27200002,CDM,,,,,,both,,,2385.3300,357.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,994.68,,,,,,,615.6500,2385.3300,percent of total billed charges,"41.7% of $2,385.33 in Billed Charges for Rev 272 = $994.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND MODERATE PLUS PROFILE GEL 700CC,272,RC,27200002,CDM,,,,,,both,,,2385.3300,357.8000,CIGNA HEALTHCARE,CIGNA PPO,994.68,,,,,,,615.6500,2385.3300,percent of total billed charges,"41.7% of $2,385.33 in Billed Charges for Rev 272 = $994.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND MODERATE PLUS PROFILE GEL 700CC,272,RC,27200002,CDM,,,,,,both,,,2385.3300,357.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2146.80,,,,,,,615.6500,2385.3300,percent of total billed charges,"90% of $2,385.33 in Billed Charges for Rev 272 = $2,146.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND MODERATE PLUS PROFILE GEL 700CC,272,RC,27200002,CDM,,,,,,both,,,2385.3300,357.8000,MEDCOST,MEDCOST VHN,1135.18,,,,,,,615.6500,2385.3300,percent of total billed charges,"47.59% of $2,385.33 in Billed Charges for Rev 272 = $1,135.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND MODERATE PLUS PROFILE GEL 700CC,272,RC,27200002,CDM,,,,,,both,,,2385.3300,357.8000,SENTARA HEALTH,SENTARA HEALTH,615.65,,,,,,,615.6500,2385.3300,percent of total billed charges,"25.81% of $2,385.33 in Billed Charges for Rev 272 = $615.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND MODERATE PLUS PROFILE GEL 700CC,272,RC,27200002,CDM,,,,,,both,,,2385.3300,357.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2385.33,,,,,,,615.6500,2385.3300,percent of total billed charges,"100% of $2,385.33 in Billed Charges for Rev 272 = $2,385.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND MODERATE PLUS PROFILE GEL 700CC,272,RC,27200002,CDM,,,,,,both,,,2385.3300,357.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1192.67,,,,,,,615.6500,2385.3300,percent of total billed charges,"Rev 272 $2,385.33 in Billed Charges at 50% = $1,192.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND MODERATE PLUS PROFILE GEL 700CC,272,RC,27200002,CDM,,,,,,both,,,2385.3300,357.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,770.46,,,,,,,615.6500,2385.3300,other,"32.3% of $2,385.33 in Billed Charges for Rev 272 = $770.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SIZER ROUND MODERATE PLUS PROFILE GEL 700CC,272,RC,27200002,CDM,,,,,,both,,,2385.3300,357.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,732.30,,,,,,,615.6500,2385.3300,other,"30.7% of $2,385.33 in Billed Charges for Rev 272 = $732.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SIZER ROUND MODERATE PLUS PROFILE GEL 700CC,272,RC,27200002,CDM,,,,,,both,,,2385.3300,357.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,770.46,,,,,,,615.6500,2385.3300,percent of total billed charges,"32.3% of $2,385.33 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SIZER ROUND MODERATE PLUS PROFILE GEL 700CC,272,RC,27200002,CDM,,,,,,both,,,2385.3300,357.8000,WELLCARE,WELLCARE MEDICAID,2385.33,,,,,,,615.6500,2385.3300,percent of total billed charges,"100% of $2,385.33 in Billed Charges for Rev 272 = $2,385.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT ACCESS BLUNT TIP 12X120MM,272,RC,,,,,,,,both,,,999.6300,149.9400,AETNA,AETNA,426.84,,,,,,,258.0000,999.6300,percent of total billed charges,42.7% of $999.63 in Billed Charges for Rev 272 = $426.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT ACCESS BLUNT TIP 12X120MM,272,RC,,,,,,,,both,,,999.6300,149.9400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,699.74,,,,,,,258.0000,999.6300,percent of total billed charges,Rev 272 $999.63 in Billed Charges at 70% = $699.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT ACCESS BLUNT TIP 12X120MM,272,RC,,,,,,,,both,,,999.6300,149.9400,CIGNA HEALTHCARE,CIGNA HMO,416.85,,,,,,,258.0000,999.6300,percent of total billed charges,41.7% of $999.63 in Billed Charges for Rev 272 = $416.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT ACCESS BLUNT TIP 12X120MM,272,RC,,,,,,,,both,,,999.6300,149.9400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,463.83,,,,,,,258.0000,999.6300,percent of total billed charges,46.4% of $999.63 in Billed Charges for Rev 272 = $463.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT ACCESS BLUNT TIP 12X120MM,272,RC,,,,,,,,both,,,999.6300,149.9400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,416.85,,,,,,,258.0000,999.6300,percent of total billed charges,41.7% of $999.63 in Billed Charges for Rev 272 = $416.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT ACCESS BLUNT TIP 12X120MM,272,RC,,,,,,,,both,,,999.6300,149.9400,CIGNA HEALTHCARE,CIGNA PPO,416.85,,,,,,,258.0000,999.6300,percent of total billed charges,41.7% of $999.63 in Billed Charges for Rev 272 = $416.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT ACCESS BLUNT TIP 12X120MM,272,RC,,,,,,,,both,,,999.6300,149.9400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,899.67,,,,,,,258.0000,999.6300,percent of total billed charges,90% of $999.63 in Billed Charges for Rev 272 = $899.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT ACCESS BLUNT TIP 12X120MM,272,RC,,,,,,,,both,,,999.6300,149.9400,MEDCOST,MEDCOST VHN,475.72,,,,,,,258.0000,999.6300,percent of total billed charges,47.59% of $999.63 in Billed Charges for Rev 272 = $475.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT ACCESS BLUNT TIP 12X120MM,272,RC,,,,,,,,both,,,999.6300,149.9400,SENTARA HEALTH,SENTARA HEALTH,258.00,,,,,,,258.0000,999.6300,percent of total billed charges,25.81% of $999.63 in Billed Charges for Rev 272 = $258.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT ACCESS BLUNT TIP 12X120MM,272,RC,,,,,,,,both,,,999.6300,149.9400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",999.63,,,,,,,258.0000,999.6300,percent of total billed charges,100% of $999.63 in Billed Charges for Rev 272 = $999.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT ACCESS BLUNT TIP 12X120MM,272,RC,,,,,,,,both,,,999.6300,149.9400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,499.82,,,,,,,258.0000,999.6300,percent of total billed charges,Rev 272 $999.63 in Billed Charges at 50% = $499.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT ACCESS BLUNT TIP 12X120MM,272,RC,,,,,,,,both,,,999.6300,149.9400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,322.88,,,,,,,258.0000,999.6300,other,32.3% of $999.63 in Billed Charges for Rev 272 = $322.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PORT ACCESS BLUNT TIP 12X120MM,272,RC,,,,,,,,both,,,999.6300,149.9400,UNITED HEALTHCARE,UHC HERITAGE SELECT,306.89,,,,,,,258.0000,999.6300,other,30.7% of $999.63 in Billed Charges for Rev 272 = $306.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PORT ACCESS BLUNT TIP 12X120MM,272,RC,,,,,,,,both,,,999.6300,149.9400,UNITED HEALTHCARE,UNITED HEALTHCARE,322.88,,,,,,,258.0000,999.6300,percent of total billed charges,32.3% of $999.63 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT ACCESS BLUNT TIP 12X120MM,272,RC,,,,,,,,both,,,999.6300,149.9400,WELLCARE,WELLCARE MEDICAID,999.63,,,,,,,258.0000,999.6300,percent of total billed charges,100% of $999.63 in Billed Charges for Rev 272 = $999.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT BIOPSY FOR EVS,272,RC,,,,,,,,both,,,1128.3600,169.2500,AETNA,AETNA,481.81,,,,,,,291.2300,1128.3600,percent of total billed charges,"42.7% of $1,128.36 in Billed Charges for Rev 272 = $481.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT BIOPSY FOR EVS,272,RC,,,,,,,,both,,,1128.3600,169.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,789.85,,,,,,,291.2300,1128.3600,percent of total billed charges,"Rev 272 $1,128.36 in Billed Charges at 70% = $789.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT BIOPSY FOR EVS,272,RC,,,,,,,,both,,,1128.3600,169.2500,CIGNA HEALTHCARE,CIGNA HMO,470.53,,,,,,,291.2300,1128.3600,percent of total billed charges,"41.7% of $1,128.36 in Billed Charges for Rev 272 = $470.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT BIOPSY FOR EVS,272,RC,,,,,,,,both,,,1128.3600,169.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,523.56,,,,,,,291.2300,1128.3600,percent of total billed charges,"46.4% of $1,128.36 in Billed Charges for Rev 272 = $523.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT BIOPSY FOR EVS,272,RC,,,,,,,,both,,,1128.3600,169.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,470.53,,,,,,,291.2300,1128.3600,percent of total billed charges,"41.7% of $1,128.36 in Billed Charges for Rev 272 = $470.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT BIOPSY FOR EVS,272,RC,,,,,,,,both,,,1128.3600,169.2500,CIGNA HEALTHCARE,CIGNA PPO,470.53,,,,,,,291.2300,1128.3600,percent of total billed charges,"41.7% of $1,128.36 in Billed Charges for Rev 272 = $470.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT BIOPSY FOR EVS,272,RC,,,,,,,,both,,,1128.3600,169.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1015.52,,,,,,,291.2300,1128.3600,percent of total billed charges,"90% of $1,128.36 in Billed Charges for Rev 272 = $1,015.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT BIOPSY FOR EVS,272,RC,,,,,,,,both,,,1128.3600,169.2500,MEDCOST,MEDCOST VHN,536.99,,,,,,,291.2300,1128.3600,percent of total billed charges,"47.59% of $1,128.36 in Billed Charges for Rev 272 = $536.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT BIOPSY FOR EVS,272,RC,,,,,,,,both,,,1128.3600,169.2500,SENTARA HEALTH,SENTARA HEALTH,291.23,,,,,,,291.2300,1128.3600,percent of total billed charges,"25.81% of $1,128.36 in Billed Charges for Rev 272 = $291.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT BIOPSY FOR EVS,272,RC,,,,,,,,both,,,1128.3600,169.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1128.36,,,,,,,291.2300,1128.3600,percent of total billed charges,"100% of $1,128.36 in Billed Charges for Rev 272 = $1,128.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT BIOPSY FOR EVS,272,RC,,,,,,,,both,,,1128.3600,169.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,564.18,,,,,,,291.2300,1128.3600,percent of total billed charges,"Rev 272 $1,128.36 in Billed Charges at 50% = $564.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT BIOPSY FOR EVS,272,RC,,,,,,,,both,,,1128.3600,169.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,364.46,,,,,,,291.2300,1128.3600,other,"32.3% of $1,128.36 in Billed Charges for Rev 272 = $364.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PORT BIOPSY FOR EVS,272,RC,,,,,,,,both,,,1128.3600,169.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,346.41,,,,,,,291.2300,1128.3600,other,"30.7% of $1,128.36 in Billed Charges for Rev 272 = $346.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PORT BIOPSY FOR EVS,272,RC,,,,,,,,both,,,1128.3600,169.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,364.46,,,,,,,291.2300,1128.3600,percent of total billed charges,"32.3% of $1,128.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT BIOPSY FOR EVS,272,RC,,,,,,,,both,,,1128.3600,169.2500,WELLCARE,WELLCARE MEDICAID,1128.36,,,,,,,291.2300,1128.3600,percent of total billed charges,"100% of $1,128.36 in Billed Charges for Rev 272 = $1,128.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT DOYE II NASAL SEPTAL,272,RC,27200002,CDM,,,,,,both,,,399.2800,59.8900,AETNA,AETNA,170.49,,,,,,,103.0500,399.2800,percent of total billed charges,42.7% of $399.28 in Billed Charges for Rev 272 = $170.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYE II NASAL SEPTAL,272,RC,27200002,CDM,,,,,,both,,,399.2800,59.8900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,279.50,,,,,,,103.0500,399.2800,percent of total billed charges,Rev 272 $399.28 in Billed Charges at 70% = $279.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYE II NASAL SEPTAL,272,RC,27200002,CDM,,,,,,both,,,399.2800,59.8900,CIGNA HEALTHCARE,CIGNA HMO,166.50,,,,,,,103.0500,399.2800,percent of total billed charges,41.7% of $399.28 in Billed Charges for Rev 272 = $166.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYE II NASAL SEPTAL,272,RC,27200002,CDM,,,,,,both,,,399.2800,59.8900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,185.27,,,,,,,103.0500,399.2800,percent of total billed charges,46.4% of $399.28 in Billed Charges for Rev 272 = $185.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYE II NASAL SEPTAL,272,RC,27200002,CDM,,,,,,both,,,399.2800,59.8900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,166.50,,,,,,,103.0500,399.2800,percent of total billed charges,41.7% of $399.28 in Billed Charges for Rev 272 = $166.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYE II NASAL SEPTAL,272,RC,27200002,CDM,,,,,,both,,,399.2800,59.8900,CIGNA HEALTHCARE,CIGNA PPO,166.50,,,,,,,103.0500,399.2800,percent of total billed charges,41.7% of $399.28 in Billed Charges for Rev 272 = $166.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYE II NASAL SEPTAL,272,RC,27200002,CDM,,,,,,both,,,399.2800,59.8900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,359.35,,,,,,,103.0500,399.2800,percent of total billed charges,90% of $399.28 in Billed Charges for Rev 272 = $359.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYE II NASAL SEPTAL,272,RC,27200002,CDM,,,,,,both,,,399.2800,59.8900,MEDCOST,MEDCOST VHN,190.02,,,,,,,103.0500,399.2800,percent of total billed charges,47.59% of $399.28 in Billed Charges for Rev 272 = $190.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYE II NASAL SEPTAL,272,RC,27200002,CDM,,,,,,both,,,399.2800,59.8900,SENTARA HEALTH,SENTARA HEALTH,103.05,,,,,,,103.0500,399.2800,percent of total billed charges,25.81% of $399.28 in Billed Charges for Rev 272 = $103.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYE II NASAL SEPTAL,272,RC,27200002,CDM,,,,,,both,,,399.2800,59.8900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",399.28,,,,,,,103.0500,399.2800,percent of total billed charges,100% of $399.28 in Billed Charges for Rev 272 = $399.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYE II NASAL SEPTAL,272,RC,27200002,CDM,,,,,,both,,,399.2800,59.8900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,199.64,,,,,,,103.0500,399.2800,percent of total billed charges,Rev 272 $399.28 in Billed Charges at 50% = $199.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYE II NASAL SEPTAL,272,RC,27200002,CDM,,,,,,both,,,399.2800,59.8900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,128.97,,,,,,,103.0500,399.2800,other,32.3% of $399.28 in Billed Charges for Rev 272 = $128.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SPLINT DOYE II NASAL SEPTAL,272,RC,27200002,CDM,,,,,,both,,,399.2800,59.8900,UNITED HEALTHCARE,UHC HERITAGE SELECT,122.58,,,,,,,103.0500,399.2800,other,30.7% of $399.28 in Billed Charges for Rev 272 = $122.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SPLINT DOYE II NASAL SEPTAL,272,RC,27200002,CDM,,,,,,both,,,399.2800,59.8900,UNITED HEALTHCARE,UNITED HEALTHCARE,128.97,,,,,,,103.0500,399.2800,percent of total billed charges,32.3% of $399.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYE II NASAL SEPTAL,272,RC,27200002,CDM,,,,,,both,,,399.2800,59.8900,WELLCARE,WELLCARE MEDICAID,399.28,,,,,,,103.0500,399.2800,percent of total billed charges,100% of $399.28 in Billed Charges for Rev 272 = $399.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,728.0400,109.2100,AETNA,AETNA,310.87,,,,,,,187.9100,728.0400,percent of total billed charges,42.7% of $728.04 in Billed Charges for Rev 272 = $310.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,728.0400,109.2100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,509.63,,,,,,,187.9100,728.0400,percent of total billed charges,Rev 272 $728.04 in Billed Charges at 70% = $509.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,728.0400,109.2100,CIGNA HEALTHCARE,CIGNA HMO,303.59,,,,,,,187.9100,728.0400,percent of total billed charges,41.7% of $728.04 in Billed Charges for Rev 272 = $303.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,728.0400,109.2100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,337.81,,,,,,,187.9100,728.0400,percent of total billed charges,46.4% of $728.04 in Billed Charges for Rev 272 = $337.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,728.0400,109.2100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,303.59,,,,,,,187.9100,728.0400,percent of total billed charges,41.7% of $728.04 in Billed Charges for Rev 272 = $303.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,728.0400,109.2100,CIGNA HEALTHCARE,CIGNA PPO,303.59,,,,,,,187.9100,728.0400,percent of total billed charges,41.7% of $728.04 in Billed Charges for Rev 272 = $303.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,728.0400,109.2100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,655.24,,,,,,,187.9100,728.0400,percent of total billed charges,90% of $728.04 in Billed Charges for Rev 272 = $655.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,728.0400,109.2100,MEDCOST,MEDCOST VHN,346.47,,,,,,,187.9100,728.0400,percent of total billed charges,47.59% of $728.04 in Billed Charges for Rev 272 = $346.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,728.0400,109.2100,SENTARA HEALTH,SENTARA HEALTH,187.91,,,,,,,187.9100,728.0400,percent of total billed charges,25.81% of $728.04 in Billed Charges for Rev 272 = $187.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,728.0400,109.2100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",728.04,,,,,,,187.9100,728.0400,percent of total billed charges,100% of $728.04 in Billed Charges for Rev 272 = $728.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,728.0400,109.2100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,364.02,,,,,,,187.9100,728.0400,percent of total billed charges,Rev 272 $728.04 in Billed Charges at 50% = $364.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,728.0400,109.2100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,235.16,,,,,,,187.9100,728.0400,other,32.3% of $728.04 in Billed Charges for Rev 272 = $235.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,728.0400,109.2100,UNITED HEALTHCARE,UHC HERITAGE SELECT,223.51,,,,,,,187.9100,728.0400,other,30.7% of $728.04 in Billed Charges for Rev 272 = $223.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,728.0400,109.2100,UNITED HEALTHCARE,UNITED HEALTHCARE,235.16,,,,,,,187.9100,728.0400,percent of total billed charges,32.3% of $728.04 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,728.0400,109.2100,WELLCARE,WELLCARE MEDICAID,728.04,,,,,,,187.9100,728.0400,percent of total billed charges,100% of $728.04 in Billed Charges for Rev 272 = $728.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 6IN,272,RC,27200002,CDM,,,,,,both,,,823.4600,123.5200,AETNA,AETNA,351.62,,,,,,,212.5400,823.4600,percent of total billed charges,42.7% of $823.46 in Billed Charges for Rev 272 = $351.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 6IN,272,RC,27200002,CDM,,,,,,both,,,823.4600,123.5200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,576.42,,,,,,,212.5400,823.4600,percent of total billed charges,Rev 272 $823.46 in Billed Charges at 70% = $576.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 6IN,272,RC,27200002,CDM,,,,,,both,,,823.4600,123.5200,CIGNA HEALTHCARE,CIGNA HMO,343.38,,,,,,,212.5400,823.4600,percent of total billed charges,41.7% of $823.46 in Billed Charges for Rev 272 = $343.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 6IN,272,RC,27200002,CDM,,,,,,both,,,823.4600,123.5200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,382.09,,,,,,,212.5400,823.4600,percent of total billed charges,46.4% of $823.46 in Billed Charges for Rev 272 = $382.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 6IN,272,RC,27200002,CDM,,,,,,both,,,823.4600,123.5200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,343.38,,,,,,,212.5400,823.4600,percent of total billed charges,41.7% of $823.46 in Billed Charges for Rev 272 = $343.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 6IN,272,RC,27200002,CDM,,,,,,both,,,823.4600,123.5200,CIGNA HEALTHCARE,CIGNA PPO,343.38,,,,,,,212.5400,823.4600,percent of total billed charges,41.7% of $823.46 in Billed Charges for Rev 272 = $343.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 6IN,272,RC,27200002,CDM,,,,,,both,,,823.4600,123.5200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,741.11,,,,,,,212.5400,823.4600,percent of total billed charges,90% of $823.46 in Billed Charges for Rev 272 = $741.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 6IN,272,RC,27200002,CDM,,,,,,both,,,823.4600,123.5200,MEDCOST,MEDCOST VHN,391.88,,,,,,,212.5400,823.4600,percent of total billed charges,47.59% of $823.46 in Billed Charges for Rev 272 = $391.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 6IN,272,RC,27200002,CDM,,,,,,both,,,823.4600,123.5200,SENTARA HEALTH,SENTARA HEALTH,212.54,,,,,,,212.5400,823.4600,percent of total billed charges,25.81% of $823.46 in Billed Charges for Rev 272 = $212.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 6IN,272,RC,27200002,CDM,,,,,,both,,,823.4600,123.5200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",823.46,,,,,,,212.5400,823.4600,percent of total billed charges,100% of $823.46 in Billed Charges for Rev 272 = $823.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 6IN,272,RC,27200002,CDM,,,,,,both,,,823.4600,123.5200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,411.73,,,,,,,212.5400,823.4600,percent of total billed charges,Rev 272 $823.46 in Billed Charges at 50% = $411.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 6IN,272,RC,27200002,CDM,,,,,,both,,,823.4600,123.5200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,265.98,,,,,,,212.5400,823.4600,other,32.3% of $823.46 in Billed Charges for Rev 272 = $265.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SPLINT OCL PLASTER 6IN,272,RC,27200002,CDM,,,,,,both,,,823.4600,123.5200,UNITED HEALTHCARE,UHC HERITAGE SELECT,252.80,,,,,,,212.5400,823.4600,other,30.7% of $823.46 in Billed Charges for Rev 272 = $252.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SPLINT OCL PLASTER 6IN,272,RC,27200002,CDM,,,,,,both,,,823.4600,123.5200,UNITED HEALTHCARE,UNITED HEALTHCARE,265.98,,,,,,,212.5400,823.4600,percent of total billed charges,32.3% of $823.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 6IN,272,RC,27200002,CDM,,,,,,both,,,823.4600,123.5200,WELLCARE,WELLCARE MEDICAID,823.46,,,,,,,212.5400,823.4600,percent of total billed charges,100% of $823.46 in Billed Charges for Rev 272 = $823.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 5INX15FT,272,RC,27200002,CDM,,,,,,both,,,739.9200,110.9900,AETNA,AETNA,315.95,,,,,,,190.9700,739.9200,percent of total billed charges,42.7% of $739.92 in Billed Charges for Rev 272 = $315.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 5INX15FT,272,RC,27200002,CDM,,,,,,both,,,739.9200,110.9900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,517.94,,,,,,,190.9700,739.9200,percent of total billed charges,Rev 272 $739.92 in Billed Charges at 70% = $517.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 5INX15FT,272,RC,27200002,CDM,,,,,,both,,,739.9200,110.9900,CIGNA HEALTHCARE,CIGNA HMO,308.55,,,,,,,190.9700,739.9200,percent of total billed charges,41.7% of $739.92 in Billed Charges for Rev 272 = $308.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 5INX15FT,272,RC,27200002,CDM,,,,,,both,,,739.9200,110.9900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,343.32,,,,,,,190.9700,739.9200,percent of total billed charges,46.4% of $739.92 in Billed Charges for Rev 272 = $343.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 5INX15FT,272,RC,27200002,CDM,,,,,,both,,,739.9200,110.9900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,308.55,,,,,,,190.9700,739.9200,percent of total billed charges,41.7% of $739.92 in Billed Charges for Rev 272 = $308.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 5INX15FT,272,RC,27200002,CDM,,,,,,both,,,739.9200,110.9900,CIGNA HEALTHCARE,CIGNA PPO,308.55,,,,,,,190.9700,739.9200,percent of total billed charges,41.7% of $739.92 in Billed Charges for Rev 272 = $308.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 5INX15FT,272,RC,27200002,CDM,,,,,,both,,,739.9200,110.9900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,665.93,,,,,,,190.9700,739.9200,percent of total billed charges,90% of $739.92 in Billed Charges for Rev 272 = $665.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 5INX15FT,272,RC,27200002,CDM,,,,,,both,,,739.9200,110.9900,MEDCOST,MEDCOST VHN,352.13,,,,,,,190.9700,739.9200,percent of total billed charges,47.59% of $739.92 in Billed Charges for Rev 272 = $352.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 5INX15FT,272,RC,27200002,CDM,,,,,,both,,,739.9200,110.9900,SENTARA HEALTH,SENTARA HEALTH,190.97,,,,,,,190.9700,739.9200,percent of total billed charges,25.81% of $739.92 in Billed Charges for Rev 272 = $190.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 5INX15FT,272,RC,27200002,CDM,,,,,,both,,,739.9200,110.9900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",739.92,,,,,,,190.9700,739.9200,percent of total billed charges,100% of $739.92 in Billed Charges for Rev 272 = $739.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 5INX15FT,272,RC,27200002,CDM,,,,,,both,,,739.9200,110.9900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,369.96,,,,,,,190.9700,739.9200,percent of total billed charges,Rev 272 $739.92 in Billed Charges at 50% = $369.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 5INX15FT,272,RC,27200002,CDM,,,,,,both,,,739.9200,110.9900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,238.99,,,,,,,190.9700,739.9200,other,32.3% of $739.92 in Billed Charges for Rev 272 = $238.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SPLINT ORTHO GLASS 5INX15FT,272,RC,27200002,CDM,,,,,,both,,,739.9200,110.9900,UNITED HEALTHCARE,UHC HERITAGE SELECT,227.16,,,,,,,190.9700,739.9200,other,30.7% of $739.92 in Billed Charges for Rev 272 = $227.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SPLINT ORTHO GLASS 5INX15FT,272,RC,27200002,CDM,,,,,,both,,,739.9200,110.9900,UNITED HEALTHCARE,UNITED HEALTHCARE,238.99,,,,,,,190.9700,739.9200,percent of total billed charges,32.3% of $739.92 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 5INX15FT,272,RC,27200002,CDM,,,,,,both,,,739.9200,110.9900,WELLCARE,WELLCARE MEDICAID,739.92,,,,,,,190.9700,739.9200,percent of total billed charges,100% of $739.92 in Billed Charges for Rev 272 = $739.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PORT POWER 6FR SING LUMEN,272,RC,27200002,CDM,,,,,,both,,,1778.6300,266.7900,AETNA,AETNA,759.48,,,,,,,459.0600,1778.6300,percent of total billed charges,"42.7% of $1,778.63 in Billed Charges for Rev 272 = $759.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT POWER 6FR SING LUMEN,272,RC,27200002,CDM,,,,,,both,,,1778.6300,266.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1245.04,,,,,,,459.0600,1778.6300,percent of total billed charges,"Rev 272 $1,778.63 in Billed Charges at 70% = $1,245.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT POWER 6FR SING LUMEN,272,RC,27200002,CDM,,,,,,both,,,1778.6300,266.7900,CIGNA HEALTHCARE,CIGNA HMO,741.69,,,,,,,459.0600,1778.6300,percent of total billed charges,"41.7% of $1,778.63 in Billed Charges for Rev 272 = $741.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT POWER 6FR SING LUMEN,272,RC,27200002,CDM,,,,,,both,,,1778.6300,266.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,825.28,,,,,,,459.0600,1778.6300,percent of total billed charges,"46.4% of $1,778.63 in Billed Charges for Rev 272 = $825.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT POWER 6FR SING LUMEN,272,RC,27200002,CDM,,,,,,both,,,1778.6300,266.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,741.69,,,,,,,459.0600,1778.6300,percent of total billed charges,"41.7% of $1,778.63 in Billed Charges for Rev 272 = $741.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT POWER 6FR SING LUMEN,272,RC,27200002,CDM,,,,,,both,,,1778.6300,266.7900,CIGNA HEALTHCARE,CIGNA PPO,741.69,,,,,,,459.0600,1778.6300,percent of total billed charges,"41.7% of $1,778.63 in Billed Charges for Rev 272 = $741.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT POWER 6FR SING LUMEN,272,RC,27200002,CDM,,,,,,both,,,1778.6300,266.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1600.77,,,,,,,459.0600,1778.6300,percent of total billed charges,"90% of $1,778.63 in Billed Charges for Rev 272 = $1,600.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT POWER 6FR SING LUMEN,272,RC,27200002,CDM,,,,,,both,,,1778.6300,266.7900,MEDCOST,MEDCOST VHN,846.45,,,,,,,459.0600,1778.6300,percent of total billed charges,"47.59% of $1,778.63 in Billed Charges for Rev 272 = $846.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT POWER 6FR SING LUMEN,272,RC,27200002,CDM,,,,,,both,,,1778.6300,266.7900,SENTARA HEALTH,SENTARA HEALTH,459.06,,,,,,,459.0600,1778.6300,percent of total billed charges,"25.81% of $1,778.63 in Billed Charges for Rev 272 = $459.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT POWER 6FR SING LUMEN,272,RC,27200002,CDM,,,,,,both,,,1778.6300,266.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1778.63,,,,,,,459.0600,1778.6300,percent of total billed charges,"100% of $1,778.63 in Billed Charges for Rev 272 = $1,778.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT POWER 6FR SING LUMEN,272,RC,27200002,CDM,,,,,,both,,,1778.6300,266.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,889.32,,,,,,,459.0600,1778.6300,percent of total billed charges,"Rev 272 $1,778.63 in Billed Charges at 50% = $889.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT POWER 6FR SING LUMEN,272,RC,27200002,CDM,,,,,,both,,,1778.6300,266.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,574.50,,,,,,,459.0600,1778.6300,other,"32.3% of $1,778.63 in Billed Charges for Rev 272 = $574.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PORT POWER 6FR SING LUMEN,272,RC,27200002,CDM,,,,,,both,,,1778.6300,266.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,546.04,,,,,,,459.0600,1778.6300,other,"30.7% of $1,778.63 in Billed Charges for Rev 272 = $546.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PORT POWER 6FR SING LUMEN,272,RC,27200002,CDM,,,,,,both,,,1778.6300,266.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,574.50,,,,,,,459.0600,1778.6300,percent of total billed charges,"32.3% of $1,778.63 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT POWER 6FR SING LUMEN,272,RC,27200002,CDM,,,,,,both,,,1778.6300,266.7900,WELLCARE,WELLCARE MEDICAID,1778.63,,,,,,,459.0600,1778.6300,percent of total billed charges,"100% of $1,778.63 in Billed Charges for Rev 272 = $1,778.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT SMOOTH ACCESS 5MM X 150MM AIRSEAL BLUNT TIP,272,RC,,,,,,,,both,,,1013.3200,152.0000,AETNA,AETNA,432.69,,,,,,,261.5400,1013.3200,percent of total billed charges,"42.7% of $1,013.32 in Billed Charges for Rev 272 = $432.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT SMOOTH ACCESS 5MM X 150MM AIRSEAL BLUNT TIP,272,RC,,,,,,,,both,,,1013.3200,152.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,709.32,,,,,,,261.5400,1013.3200,percent of total billed charges,"Rev 272 $1,013.32 in Billed Charges at 70% = $709.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT SMOOTH ACCESS 5MM X 150MM AIRSEAL BLUNT TIP,272,RC,,,,,,,,both,,,1013.3200,152.0000,CIGNA HEALTHCARE,CIGNA HMO,422.55,,,,,,,261.5400,1013.3200,percent of total billed charges,"41.7% of $1,013.32 in Billed Charges for Rev 272 = $422.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT SMOOTH ACCESS 5MM X 150MM AIRSEAL BLUNT TIP,272,RC,,,,,,,,both,,,1013.3200,152.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,470.18,,,,,,,261.5400,1013.3200,percent of total billed charges,"46.4% of $1,013.32 in Billed Charges for Rev 272 = $470.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT SMOOTH ACCESS 5MM X 150MM AIRSEAL BLUNT TIP,272,RC,,,,,,,,both,,,1013.3200,152.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,422.55,,,,,,,261.5400,1013.3200,percent of total billed charges,"41.7% of $1,013.32 in Billed Charges for Rev 272 = $422.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT SMOOTH ACCESS 5MM X 150MM AIRSEAL BLUNT TIP,272,RC,,,,,,,,both,,,1013.3200,152.0000,CIGNA HEALTHCARE,CIGNA PPO,422.55,,,,,,,261.5400,1013.3200,percent of total billed charges,"41.7% of $1,013.32 in Billed Charges for Rev 272 = $422.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT SMOOTH ACCESS 5MM X 150MM AIRSEAL BLUNT TIP,272,RC,,,,,,,,both,,,1013.3200,152.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,911.99,,,,,,,261.5400,1013.3200,percent of total billed charges,"90% of $1,013.32 in Billed Charges for Rev 272 = $911.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT SMOOTH ACCESS 5MM X 150MM AIRSEAL BLUNT TIP,272,RC,,,,,,,,both,,,1013.3200,152.0000,MEDCOST,MEDCOST VHN,482.24,,,,,,,261.5400,1013.3200,percent of total billed charges,"47.59% of $1,013.32 in Billed Charges for Rev 272 = $482.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT SMOOTH ACCESS 5MM X 150MM AIRSEAL BLUNT TIP,272,RC,,,,,,,,both,,,1013.3200,152.0000,SENTARA HEALTH,SENTARA HEALTH,261.54,,,,,,,261.5400,1013.3200,percent of total billed charges,"25.81% of $1,013.32 in Billed Charges for Rev 272 = $261.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT SMOOTH ACCESS 5MM X 150MM AIRSEAL BLUNT TIP,272,RC,,,,,,,,both,,,1013.3200,152.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1013.32,,,,,,,261.5400,1013.3200,percent of total billed charges,"100% of $1,013.32 in Billed Charges for Rev 272 = $1,013.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT SMOOTH ACCESS 5MM X 150MM AIRSEAL BLUNT TIP,272,RC,,,,,,,,both,,,1013.3200,152.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,506.66,,,,,,,261.5400,1013.3200,percent of total billed charges,"Rev 272 $1,013.32 in Billed Charges at 50% = $506.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT SMOOTH ACCESS 5MM X 150MM AIRSEAL BLUNT TIP,272,RC,,,,,,,,both,,,1013.3200,152.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,327.30,,,,,,,261.5400,1013.3200,other,"32.3% of $1,013.32 in Billed Charges for Rev 272 = $327.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PORT SMOOTH ACCESS 5MM X 150MM AIRSEAL BLUNT TIP,272,RC,,,,,,,,both,,,1013.3200,152.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,311.09,,,,,,,261.5400,1013.3200,other,"30.7% of $1,013.32 in Billed Charges for Rev 272 = $311.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PORT SMOOTH ACCESS 5MM X 150MM AIRSEAL BLUNT TIP,272,RC,,,,,,,,both,,,1013.3200,152.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,327.30,,,,,,,261.5400,1013.3200,percent of total billed charges,"32.3% of $1,013.32 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PORT SMOOTH ACCESS 5MM X 150MM AIRSEAL BLUNT TIP,272,RC,,,,,,,,both,,,1013.3200,152.0000,WELLCARE,WELLCARE MEDICAID,1013.32,,,,,,,261.5400,1013.3200,percent of total billed charges,"100% of $1,013.32 in Billed Charges for Rev 272 = $1,013.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POUCH LAPSAC TISSUE 8INX10IN J-LS-081-000,272,RC,27200002,CDM,,,,,,both,,,1207.8500,181.1800,AETNA,AETNA,515.75,,,,,,,311.7500,1207.8500,percent of total billed charges,"42.7% of $1,207.85 in Billed Charges for Rev 272 = $515.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POUCH LAPSAC TISSUE 8INX10IN J-LS-081-000,272,RC,27200002,CDM,,,,,,both,,,1207.8500,181.1800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,845.50,,,,,,,311.7500,1207.8500,percent of total billed charges,"Rev 272 $1,207.85 in Billed Charges at 70% = $845.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POUCH LAPSAC TISSUE 8INX10IN J-LS-081-000,272,RC,27200002,CDM,,,,,,both,,,1207.8500,181.1800,CIGNA HEALTHCARE,CIGNA HMO,503.67,,,,,,,311.7500,1207.8500,percent of total billed charges,"41.7% of $1,207.85 in Billed Charges for Rev 272 = $503.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POUCH LAPSAC TISSUE 8INX10IN J-LS-081-000,272,RC,27200002,CDM,,,,,,both,,,1207.8500,181.1800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,560.44,,,,,,,311.7500,1207.8500,percent of total billed charges,"46.4% of $1,207.85 in Billed Charges for Rev 272 = $560.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POUCH LAPSAC TISSUE 8INX10IN J-LS-081-000,272,RC,27200002,CDM,,,,,,both,,,1207.8500,181.1800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,503.67,,,,,,,311.7500,1207.8500,percent of total billed charges,"41.7% of $1,207.85 in Billed Charges for Rev 272 = $503.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POUCH LAPSAC TISSUE 8INX10IN J-LS-081-000,272,RC,27200002,CDM,,,,,,both,,,1207.8500,181.1800,CIGNA HEALTHCARE,CIGNA PPO,503.67,,,,,,,311.7500,1207.8500,percent of total billed charges,"41.7% of $1,207.85 in Billed Charges for Rev 272 = $503.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POUCH LAPSAC TISSUE 8INX10IN J-LS-081-000,272,RC,27200002,CDM,,,,,,both,,,1207.8500,181.1800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1087.07,,,,,,,311.7500,1207.8500,percent of total billed charges,"90% of $1,207.85 in Billed Charges for Rev 272 = $1,087.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POUCH LAPSAC TISSUE 8INX10IN J-LS-081-000,272,RC,27200002,CDM,,,,,,both,,,1207.8500,181.1800,MEDCOST,MEDCOST VHN,574.82,,,,,,,311.7500,1207.8500,percent of total billed charges,"47.59% of $1,207.85 in Billed Charges for Rev 272 = $574.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POUCH LAPSAC TISSUE 8INX10IN J-LS-081-000,272,RC,27200002,CDM,,,,,,both,,,1207.8500,181.1800,SENTARA HEALTH,SENTARA HEALTH,311.75,,,,,,,311.7500,1207.8500,percent of total billed charges,"25.81% of $1,207.85 in Billed Charges for Rev 272 = $311.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POUCH LAPSAC TISSUE 8INX10IN J-LS-081-000,272,RC,27200002,CDM,,,,,,both,,,1207.8500,181.1800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1207.85,,,,,,,311.7500,1207.8500,percent of total billed charges,"100% of $1,207.85 in Billed Charges for Rev 272 = $1,207.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POUCH LAPSAC TISSUE 8INX10IN J-LS-081-000,272,RC,27200002,CDM,,,,,,both,,,1207.8500,181.1800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,603.93,,,,,,,311.7500,1207.8500,percent of total billed charges,"Rev 272 $1,207.85 in Billed Charges at 50% = $603.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POUCH LAPSAC TISSUE 8INX10IN J-LS-081-000,272,RC,27200002,CDM,,,,,,both,,,1207.8500,181.1800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,390.14,,,,,,,311.7500,1207.8500,other,"32.3% of $1,207.85 in Billed Charges for Rev 272 = $390.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
POUCH LAPSAC TISSUE 8INX10IN J-LS-081-000,272,RC,27200002,CDM,,,,,,both,,,1207.8500,181.1800,UNITED HEALTHCARE,UHC HERITAGE SELECT,370.81,,,,,,,311.7500,1207.8500,other,"30.7% of $1,207.85 in Billed Charges for Rev 272 = $370.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
POUCH LAPSAC TISSUE 8INX10IN J-LS-081-000,272,RC,27200002,CDM,,,,,,both,,,1207.8500,181.1800,UNITED HEALTHCARE,UNITED HEALTHCARE,390.14,,,,,,,311.7500,1207.8500,percent of total billed charges,"32.3% of $1,207.85 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
POUCH LAPSAC TISSUE 8INX10IN J-LS-081-000,272,RC,27200002,CDM,,,,,,both,,,1207.8500,181.1800,WELLCARE,WELLCARE MEDICAID,1207.85,,,,,,,311.7500,1207.8500,percent of total billed charges,"100% of $1,207.85 in Billed Charges for Rev 272 = $1,207.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT ORTHOG IPS SINGLE JAW LP,272,RC,27200002,CDM,,,,,,both,,,16406.9200,2461.0400,AETNA,AETNA,7005.75,,,,,,,4234.6300,16406.9200,percent of total billed charges,"42.7% of $16,406.92 in Billed Charges for Rev 272 = $7,005.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT ORTHOG IPS SINGLE JAW LP,272,RC,27200002,CDM,,,,,,both,,,16406.9200,2461.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11484.84,,,,,,,4234.6300,16406.9200,percent of total billed charges,"Rev 272 $16,406.92 in Billed Charges at 70% = $11,484.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT ORTHOG IPS SINGLE JAW LP,272,RC,27200002,CDM,,,,,,both,,,16406.9200,2461.0400,CIGNA HEALTHCARE,CIGNA HMO,6841.69,,,,,,,4234.6300,16406.9200,percent of total billed charges,"41.7% of $16,406.92 in Billed Charges for Rev 272 = $6,841.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT ORTHOG IPS SINGLE JAW LP,272,RC,27200002,CDM,,,,,,both,,,16406.9200,2461.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7612.81,,,,,,,4234.6300,16406.9200,percent of total billed charges,"46.4% of $16,406.92 in Billed Charges for Rev 272 = $7,612.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT ORTHOG IPS SINGLE JAW LP,272,RC,27200002,CDM,,,,,,both,,,16406.9200,2461.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6841.69,,,,,,,4234.6300,16406.9200,percent of total billed charges,"41.7% of $16,406.92 in Billed Charges for Rev 272 = $6,841.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT ORTHOG IPS SINGLE JAW LP,272,RC,27200002,CDM,,,,,,both,,,16406.9200,2461.0400,CIGNA HEALTHCARE,CIGNA PPO,6841.69,,,,,,,4234.6300,16406.9200,percent of total billed charges,"41.7% of $16,406.92 in Billed Charges for Rev 272 = $6,841.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT ORTHOG IPS SINGLE JAW LP,272,RC,27200002,CDM,,,,,,both,,,16406.9200,2461.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,14766.23,,,,,,,4234.6300,16406.9200,percent of total billed charges,"90% of $16,406.92 in Billed Charges for Rev 272 = $14,766.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT ORTHOG IPS SINGLE JAW LP,272,RC,27200002,CDM,,,,,,both,,,16406.9200,2461.0400,MEDCOST,MEDCOST VHN,7808.05,,,,,,,4234.6300,16406.9200,percent of total billed charges,"47.59% of $16,406.92 in Billed Charges for Rev 272 = $7,808.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT ORTHOG IPS SINGLE JAW LP,272,RC,27200002,CDM,,,,,,both,,,16406.9200,2461.0400,SENTARA HEALTH,SENTARA HEALTH,4234.63,,,,,,,4234.6300,16406.9200,percent of total billed charges,"25.81% of $16,406.92 in Billed Charges for Rev 272 = $4,234.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT ORTHOG IPS SINGLE JAW LP,272,RC,27200002,CDM,,,,,,both,,,16406.9200,2461.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",16406.92,,,,,,,4234.6300,16406.9200,percent of total billed charges,"100% of $16,406.92 in Billed Charges for Rev 272 = $16,406.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT ORTHOG IPS SINGLE JAW LP,272,RC,27200002,CDM,,,,,,both,,,16406.9200,2461.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8203.46,,,,,,,4234.6300,16406.9200,percent of total billed charges,"Rev 272 $16,406.92 in Billed Charges at 50% = $8,203.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT ORTHOG IPS SINGLE JAW LP,272,RC,27200002,CDM,,,,,,both,,,16406.9200,2461.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5299.44,,,,,,,4234.6300,16406.9200,other,"32.3% of $16,406.92 in Billed Charges for Rev 272 = $5,299.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SPLINT ORTHOG IPS SINGLE JAW LP,272,RC,27200002,CDM,,,,,,both,,,16406.9200,2461.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,5036.92,,,,,,,4234.6300,16406.9200,other,"30.7% of $16,406.92 in Billed Charges for Rev 272 = $5,036.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SPLINT ORTHOG IPS SINGLE JAW LP,272,RC,27200002,CDM,,,,,,both,,,16406.9200,2461.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,5299.44,,,,,,,4234.6300,16406.9200,percent of total billed charges,"32.3% of $16,406.92 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT ORTHOG IPS SINGLE JAW LP,272,RC,27200002,CDM,,,,,,both,,,16406.9200,2461.0400,WELLCARE,WELLCARE MEDICAID,16406.92,,,,,,,4234.6300,16406.9200,percent of total billed charges,"100% of $16,406.92 in Billed Charges for Rev 272 = $16,406.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT ROLL CAST 5 X 15 COMFOR,272,RC,27200002,CDM,,,,,,both,,,641.1400,96.1700,AETNA,AETNA,273.77,,,,,,,165.4800,641.1400,percent of total billed charges,42.7% of $641.14 in Billed Charges for Rev 272 = $273.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL CAST 5 X 15 COMFOR,272,RC,27200002,CDM,,,,,,both,,,641.1400,96.1700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,448.80,,,,,,,165.4800,641.1400,percent of total billed charges,Rev 272 $641.14 in Billed Charges at 70% = $448.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL CAST 5 X 15 COMFOR,272,RC,27200002,CDM,,,,,,both,,,641.1400,96.1700,CIGNA HEALTHCARE,CIGNA HMO,267.36,,,,,,,165.4800,641.1400,percent of total billed charges,41.7% of $641.14 in Billed Charges for Rev 272 = $267.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL CAST 5 X 15 COMFOR,272,RC,27200002,CDM,,,,,,both,,,641.1400,96.1700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,297.49,,,,,,,165.4800,641.1400,percent of total billed charges,46.4% of $641.14 in Billed Charges for Rev 272 = $297.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL CAST 5 X 15 COMFOR,272,RC,27200002,CDM,,,,,,both,,,641.1400,96.1700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,267.36,,,,,,,165.4800,641.1400,percent of total billed charges,41.7% of $641.14 in Billed Charges for Rev 272 = $267.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL CAST 5 X 15 COMFOR,272,RC,27200002,CDM,,,,,,both,,,641.1400,96.1700,CIGNA HEALTHCARE,CIGNA PPO,267.36,,,,,,,165.4800,641.1400,percent of total billed charges,41.7% of $641.14 in Billed Charges for Rev 272 = $267.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL CAST 5 X 15 COMFOR,272,RC,27200002,CDM,,,,,,both,,,641.1400,96.1700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,577.03,,,,,,,165.4800,641.1400,percent of total billed charges,90% of $641.14 in Billed Charges for Rev 272 = $577.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL CAST 5 X 15 COMFOR,272,RC,27200002,CDM,,,,,,both,,,641.1400,96.1700,MEDCOST,MEDCOST VHN,305.12,,,,,,,165.4800,641.1400,percent of total billed charges,47.59% of $641.14 in Billed Charges for Rev 272 = $305.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL CAST 5 X 15 COMFOR,272,RC,27200002,CDM,,,,,,both,,,641.1400,96.1700,SENTARA HEALTH,SENTARA HEALTH,165.48,,,,,,,165.4800,641.1400,percent of total billed charges,25.81% of $641.14 in Billed Charges for Rev 272 = $165.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL CAST 5 X 15 COMFOR,272,RC,27200002,CDM,,,,,,both,,,641.1400,96.1700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",641.14,,,,,,,165.4800,641.1400,percent of total billed charges,100% of $641.14 in Billed Charges for Rev 272 = $641.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL CAST 5 X 15 COMFOR,272,RC,27200002,CDM,,,,,,both,,,641.1400,96.1700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,320.57,,,,,,,165.4800,641.1400,percent of total billed charges,Rev 272 $641.14 in Billed Charges at 50% = $320.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL CAST 5 X 15 COMFOR,272,RC,27200002,CDM,,,,,,both,,,641.1400,96.1700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,207.09,,,,,,,165.4800,641.1400,other,32.3% of $641.14 in Billed Charges for Rev 272 = $207.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SPLINT ROLL CAST 5 X 15 COMFOR,272,RC,27200002,CDM,,,,,,both,,,641.1400,96.1700,UNITED HEALTHCARE,UHC HERITAGE SELECT,196.83,,,,,,,165.4800,641.1400,other,30.7% of $641.14 in Billed Charges for Rev 272 = $196.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SPLINT ROLL CAST 5 X 15 COMFOR,272,RC,27200002,CDM,,,,,,both,,,641.1400,96.1700,UNITED HEALTHCARE,UNITED HEALTHCARE,207.09,,,,,,,165.4800,641.1400,percent of total billed charges,32.3% of $641.14 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL CAST 5 X 15 COMFOR,272,RC,27200002,CDM,,,,,,both,,,641.1400,96.1700,WELLCARE,WELLCARE MEDICAID,641.14,,,,,,,165.4800,641.1400,percent of total billed charges,100% of $641.14 in Billed Charges for Rev 272 = $641.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL ORTHOGLASS 4X15,272,RC,27200002,CDM,,,,,,both,,,647.6700,97.1500,AETNA,AETNA,276.56,,,,,,,167.1600,647.6700,percent of total billed charges,42.7% of $647.67 in Billed Charges for Rev 272 = $276.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL ORTHOGLASS 4X15,272,RC,27200002,CDM,,,,,,both,,,647.6700,97.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,453.37,,,,,,,167.1600,647.6700,percent of total billed charges,Rev 272 $647.67 in Billed Charges at 70% = $453.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL ORTHOGLASS 4X15,272,RC,27200002,CDM,,,,,,both,,,647.6700,97.1500,CIGNA HEALTHCARE,CIGNA HMO,270.08,,,,,,,167.1600,647.6700,percent of total billed charges,41.7% of $647.67 in Billed Charges for Rev 272 = $270.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL ORTHOGLASS 4X15,272,RC,27200002,CDM,,,,,,both,,,647.6700,97.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,300.52,,,,,,,167.1600,647.6700,percent of total billed charges,46.4% of $647.67 in Billed Charges for Rev 272 = $300.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL ORTHOGLASS 4X15,272,RC,27200002,CDM,,,,,,both,,,647.6700,97.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,270.08,,,,,,,167.1600,647.6700,percent of total billed charges,41.7% of $647.67 in Billed Charges for Rev 272 = $270.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL ORTHOGLASS 4X15,272,RC,27200002,CDM,,,,,,both,,,647.6700,97.1500,CIGNA HEALTHCARE,CIGNA PPO,270.08,,,,,,,167.1600,647.6700,percent of total billed charges,41.7% of $647.67 in Billed Charges for Rev 272 = $270.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL ORTHOGLASS 4X15,272,RC,27200002,CDM,,,,,,both,,,647.6700,97.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,582.90,,,,,,,167.1600,647.6700,percent of total billed charges,90% of $647.67 in Billed Charges for Rev 272 = $582.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL ORTHOGLASS 4X15,272,RC,27200002,CDM,,,,,,both,,,647.6700,97.1500,MEDCOST,MEDCOST VHN,308.23,,,,,,,167.1600,647.6700,percent of total billed charges,47.59% of $647.67 in Billed Charges for Rev 272 = $308.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL ORTHOGLASS 4X15,272,RC,27200002,CDM,,,,,,both,,,647.6700,97.1500,SENTARA HEALTH,SENTARA HEALTH,167.16,,,,,,,167.1600,647.6700,percent of total billed charges,25.81% of $647.67 in Billed Charges for Rev 272 = $167.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL ORTHOGLASS 4X15,272,RC,27200002,CDM,,,,,,both,,,647.6700,97.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",647.67,,,,,,,167.1600,647.6700,percent of total billed charges,100% of $647.67 in Billed Charges for Rev 272 = $647.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL ORTHOGLASS 4X15,272,RC,27200002,CDM,,,,,,both,,,647.6700,97.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,323.84,,,,,,,167.1600,647.6700,percent of total billed charges,Rev 272 $647.67 in Billed Charges at 50% = $323.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL ORTHOGLASS 4X15,272,RC,27200002,CDM,,,,,,both,,,647.6700,97.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,209.20,,,,,,,167.1600,647.6700,other,32.3% of $647.67 in Billed Charges for Rev 272 = $209.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SPLINT ROLL ORTHOGLASS 4X15,272,RC,27200002,CDM,,,,,,both,,,647.6700,97.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,198.83,,,,,,,167.1600,647.6700,other,30.7% of $647.67 in Billed Charges for Rev 272 = $198.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SPLINT ROLL ORTHOGLASS 4X15,272,RC,27200002,CDM,,,,,,both,,,647.6700,97.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,209.20,,,,,,,167.1600,647.6700,percent of total billed charges,32.3% of $647.67 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ROLL ORTHOGLASS 4X15,272,RC,27200002,CDM,,,,,,both,,,647.6700,97.1500,WELLCARE,WELLCARE MEDICAID,647.67,,,,,,,167.1600,647.6700,percent of total billed charges,100% of $647.67 in Billed Charges for Rev 272 = $647.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PRASS PROBE PACKAGE,272,RC,27200002,CDM,,,,,,both,,,1748.5500,262.2800,AETNA,AETNA,746.63,,,,,,,451.3000,1748.5500,percent of total billed charges,"42.7% of $1,748.55 in Billed Charges for Rev 272 = $746.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRASS PROBE PACKAGE,272,RC,27200002,CDM,,,,,,both,,,1748.5500,262.2800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1223.99,,,,,,,451.3000,1748.5500,percent of total billed charges,"Rev 272 $1,748.55 in Billed Charges at 70% = $1,223.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRASS PROBE PACKAGE,272,RC,27200002,CDM,,,,,,both,,,1748.5500,262.2800,CIGNA HEALTHCARE,CIGNA HMO,729.15,,,,,,,451.3000,1748.5500,percent of total billed charges,"41.7% of $1,748.55 in Billed Charges for Rev 272 = $729.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRASS PROBE PACKAGE,272,RC,27200002,CDM,,,,,,both,,,1748.5500,262.2800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,811.33,,,,,,,451.3000,1748.5500,percent of total billed charges,"46.4% of $1,748.55 in Billed Charges for Rev 272 = $811.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRASS PROBE PACKAGE,272,RC,27200002,CDM,,,,,,both,,,1748.5500,262.2800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,729.15,,,,,,,451.3000,1748.5500,percent of total billed charges,"41.7% of $1,748.55 in Billed Charges for Rev 272 = $729.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRASS PROBE PACKAGE,272,RC,27200002,CDM,,,,,,both,,,1748.5500,262.2800,CIGNA HEALTHCARE,CIGNA PPO,729.15,,,,,,,451.3000,1748.5500,percent of total billed charges,"41.7% of $1,748.55 in Billed Charges for Rev 272 = $729.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRASS PROBE PACKAGE,272,RC,27200002,CDM,,,,,,both,,,1748.5500,262.2800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1573.70,,,,,,,451.3000,1748.5500,percent of total billed charges,"90% of $1,748.55 in Billed Charges for Rev 272 = $1,573.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRASS PROBE PACKAGE,272,RC,27200002,CDM,,,,,,both,,,1748.5500,262.2800,MEDCOST,MEDCOST VHN,832.13,,,,,,,451.3000,1748.5500,percent of total billed charges,"47.59% of $1,748.55 in Billed Charges for Rev 272 = $832.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRASS PROBE PACKAGE,272,RC,27200002,CDM,,,,,,both,,,1748.5500,262.2800,SENTARA HEALTH,SENTARA HEALTH,451.30,,,,,,,451.3000,1748.5500,percent of total billed charges,"25.81% of $1,748.55 in Billed Charges for Rev 272 = $451.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRASS PROBE PACKAGE,272,RC,27200002,CDM,,,,,,both,,,1748.5500,262.2800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1748.55,,,,,,,451.3000,1748.5500,percent of total billed charges,"100% of $1,748.55 in Billed Charges for Rev 272 = $1,748.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRASS PROBE PACKAGE,272,RC,27200002,CDM,,,,,,both,,,1748.5500,262.2800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,874.28,,,,,,,451.3000,1748.5500,percent of total billed charges,"Rev 272 $1,748.55 in Billed Charges at 50% = $874.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRASS PROBE PACKAGE,272,RC,27200002,CDM,,,,,,both,,,1748.5500,262.2800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,564.78,,,,,,,451.3000,1748.5500,other,"32.3% of $1,748.55 in Billed Charges for Rev 272 = $564.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PRASS PROBE PACKAGE,272,RC,27200002,CDM,,,,,,both,,,1748.5500,262.2800,UNITED HEALTHCARE,UHC HERITAGE SELECT,536.80,,,,,,,451.3000,1748.5500,other,"30.7% of $1,748.55 in Billed Charges for Rev 272 = $536.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PRASS PROBE PACKAGE,272,RC,27200002,CDM,,,,,,both,,,1748.5500,262.2800,UNITED HEALTHCARE,UNITED HEALTHCARE,564.78,,,,,,,451.3000,1748.5500,percent of total billed charges,"32.3% of $1,748.55 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PRASS PROBE PACKAGE,272,RC,27200002,CDM,,,,,,both,,,1748.5500,262.2800,WELLCARE,WELLCARE MEDICAID,1748.55,,,,,,,451.3000,1748.5500,percent of total billed charges,"100% of $1,748.55 in Billed Charges for Rev 272 = $1,748.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STABALIZER TISSUE MOD CABG OCTOPUS 4 29400,272,RC,27200002,CDM,,,,,,both,,,11148.8300,1672.3200,AETNA,AETNA,4760.55,,,,,,,2877.5100,11148.8300,percent of total billed charges,"42.7% of $11,148.83 in Billed Charges for Rev 272 = $4,760.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STABALIZER TISSUE MOD CABG OCTOPUS 4 29400,272,RC,27200002,CDM,,,,,,both,,,11148.8300,1672.3200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7804.18,,,,,,,2877.5100,11148.8300,percent of total billed charges,"Rev 272 $11,148.83 in Billed Charges at 70% = $7,804.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STABALIZER TISSUE MOD CABG OCTOPUS 4 29400,272,RC,27200002,CDM,,,,,,both,,,11148.8300,1672.3200,CIGNA HEALTHCARE,CIGNA HMO,4649.06,,,,,,,2877.5100,11148.8300,percent of total billed charges,"41.7% of $11,148.83 in Billed Charges for Rev 272 = $4,649.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STABALIZER TISSUE MOD CABG OCTOPUS 4 29400,272,RC,27200002,CDM,,,,,,both,,,11148.8300,1672.3200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5173.06,,,,,,,2877.5100,11148.8300,percent of total billed charges,"46.4% of $11,148.83 in Billed Charges for Rev 272 = $5,173.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STABALIZER TISSUE MOD CABG OCTOPUS 4 29400,272,RC,27200002,CDM,,,,,,both,,,11148.8300,1672.3200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4649.06,,,,,,,2877.5100,11148.8300,percent of total billed charges,"41.7% of $11,148.83 in Billed Charges for Rev 272 = $4,649.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STABALIZER TISSUE MOD CABG OCTOPUS 4 29400,272,RC,27200002,CDM,,,,,,both,,,11148.8300,1672.3200,CIGNA HEALTHCARE,CIGNA PPO,4649.06,,,,,,,2877.5100,11148.8300,percent of total billed charges,"41.7% of $11,148.83 in Billed Charges for Rev 272 = $4,649.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STABALIZER TISSUE MOD CABG OCTOPUS 4 29400,272,RC,27200002,CDM,,,,,,both,,,11148.8300,1672.3200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10033.95,,,,,,,2877.5100,11148.8300,percent of total billed charges,"90% of $11,148.83 in Billed Charges for Rev 272 = $10,033.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STABALIZER TISSUE MOD CABG OCTOPUS 4 29400,272,RC,27200002,CDM,,,,,,both,,,11148.8300,1672.3200,MEDCOST,MEDCOST VHN,5305.73,,,,,,,2877.5100,11148.8300,percent of total billed charges,"47.59% of $11,148.83 in Billed Charges for Rev 272 = $5,305.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STABALIZER TISSUE MOD CABG OCTOPUS 4 29400,272,RC,27200002,CDM,,,,,,both,,,11148.8300,1672.3200,SENTARA HEALTH,SENTARA HEALTH,2877.51,,,,,,,2877.5100,11148.8300,percent of total billed charges,"25.81% of $11,148.83 in Billed Charges for Rev 272 = $2,877.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STABALIZER TISSUE MOD CABG OCTOPUS 4 29400,272,RC,27200002,CDM,,,,,,both,,,11148.8300,1672.3200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11148.83,,,,,,,2877.5100,11148.8300,percent of total billed charges,"100% of $11,148.83 in Billed Charges for Rev 272 = $11,148.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STABALIZER TISSUE MOD CABG OCTOPUS 4 29400,272,RC,27200002,CDM,,,,,,both,,,11148.8300,1672.3200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5574.42,,,,,,,2877.5100,11148.8300,percent of total billed charges,"Rev 272 $11,148.83 in Billed Charges at 50% = $5,574.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STABALIZER TISSUE MOD CABG OCTOPUS 4 29400,272,RC,27200002,CDM,,,,,,both,,,11148.8300,1672.3200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3601.07,,,,,,,2877.5100,11148.8300,other,"32.3% of $11,148.83 in Billed Charges for Rev 272 = $3,601.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STABALIZER TISSUE MOD CABG OCTOPUS 4 29400,272,RC,27200002,CDM,,,,,,both,,,11148.8300,1672.3200,UNITED HEALTHCARE,UHC HERITAGE SELECT,3422.69,,,,,,,2877.5100,11148.8300,other,"30.7% of $11,148.83 in Billed Charges for Rev 272 = $3,422.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STABALIZER TISSUE MOD CABG OCTOPUS 4 29400,272,RC,27200002,CDM,,,,,,both,,,11148.8300,1672.3200,UNITED HEALTHCARE,UNITED HEALTHCARE,3601.07,,,,,,,2877.5100,11148.8300,percent of total billed charges,"32.3% of $11,148.83 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STABALIZER TISSUE MOD CABG OCTOPUS 4 29400,272,RC,27200002,CDM,,,,,,both,,,11148.8300,1672.3200,WELLCARE,WELLCARE MEDICAID,11148.83,,,,,,,2877.5100,11148.8300,percent of total billed charges,"100% of $11,148.83 in Billed Charges for Rev 272 = $11,148.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STANDOFF MAXFRAME 100MM,272,RC,,,,,,,,both,,,1298.4500,194.7700,AETNA,AETNA,554.44,,,,,,,335.1300,1298.4500,percent of total billed charges,"42.7% of $1,298.45 in Billed Charges for Rev 272 = $554.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STANDOFF MAXFRAME 100MM,272,RC,,,,,,,,both,,,1298.4500,194.7700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,908.92,,,,,,,335.1300,1298.4500,percent of total billed charges,"Rev 272 $1,298.45 in Billed Charges at 70% = $908.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STANDOFF MAXFRAME 100MM,272,RC,,,,,,,,both,,,1298.4500,194.7700,CIGNA HEALTHCARE,CIGNA HMO,541.45,,,,,,,335.1300,1298.4500,percent of total billed charges,"41.7% of $1,298.45 in Billed Charges for Rev 272 = $541.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STANDOFF MAXFRAME 100MM,272,RC,,,,,,,,both,,,1298.4500,194.7700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,602.48,,,,,,,335.1300,1298.4500,percent of total billed charges,"46.4% of $1,298.45 in Billed Charges for Rev 272 = $602.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STANDOFF MAXFRAME 100MM,272,RC,,,,,,,,both,,,1298.4500,194.7700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,541.45,,,,,,,335.1300,1298.4500,percent of total billed charges,"41.7% of $1,298.45 in Billed Charges for Rev 272 = $541.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STANDOFF MAXFRAME 100MM,272,RC,,,,,,,,both,,,1298.4500,194.7700,CIGNA HEALTHCARE,CIGNA PPO,541.45,,,,,,,335.1300,1298.4500,percent of total billed charges,"41.7% of $1,298.45 in Billed Charges for Rev 272 = $541.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STANDOFF MAXFRAME 100MM,272,RC,,,,,,,,both,,,1298.4500,194.7700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1168.61,,,,,,,335.1300,1298.4500,percent of total billed charges,"90% of $1,298.45 in Billed Charges for Rev 272 = $1,168.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STANDOFF MAXFRAME 100MM,272,RC,,,,,,,,both,,,1298.4500,194.7700,MEDCOST,MEDCOST VHN,617.93,,,,,,,335.1300,1298.4500,percent of total billed charges,"47.59% of $1,298.45 in Billed Charges for Rev 272 = $617.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STANDOFF MAXFRAME 100MM,272,RC,,,,,,,,both,,,1298.4500,194.7700,SENTARA HEALTH,SENTARA HEALTH,335.13,,,,,,,335.1300,1298.4500,percent of total billed charges,"25.81% of $1,298.45 in Billed Charges for Rev 272 = $335.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STANDOFF MAXFRAME 100MM,272,RC,,,,,,,,both,,,1298.4500,194.7700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1298.45,,,,,,,335.1300,1298.4500,percent of total billed charges,"100% of $1,298.45 in Billed Charges for Rev 272 = $1,298.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STANDOFF MAXFRAME 100MM,272,RC,,,,,,,,both,,,1298.4500,194.7700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,649.23,,,,,,,335.1300,1298.4500,percent of total billed charges,"Rev 272 $1,298.45 in Billed Charges at 50% = $649.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STANDOFF MAXFRAME 100MM,272,RC,,,,,,,,both,,,1298.4500,194.7700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,419.40,,,,,,,335.1300,1298.4500,other,"32.3% of $1,298.45 in Billed Charges for Rev 272 = $419.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STANDOFF MAXFRAME 100MM,272,RC,,,,,,,,both,,,1298.4500,194.7700,UNITED HEALTHCARE,UHC HERITAGE SELECT,398.62,,,,,,,335.1300,1298.4500,other,"30.7% of $1,298.45 in Billed Charges for Rev 272 = $398.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STANDOFF MAXFRAME 100MM,272,RC,,,,,,,,both,,,1298.4500,194.7700,UNITED HEALTHCARE,UNITED HEALTHCARE,419.40,,,,,,,335.1300,1298.4500,percent of total billed charges,"32.3% of $1,298.45 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STANDOFF MAXFRAME 100MM,272,RC,,,,,,,,both,,,1298.4500,194.7700,WELLCARE,WELLCARE MEDICAID,1298.45,,,,,,,335.1300,1298.4500,percent of total billed charges,"100% of $1,298.45 in Billed Charges for Rev 272 = $1,298.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR IRIS FLEX TRANSCORNE,272,RC,27200002,CDM,,,,,,both,,,1477.6600,221.6500,AETNA,AETNA,630.96,,,,,,,381.3800,1477.6600,percent of total billed charges,"42.7% of $1,477.66 in Billed Charges for Rev 272 = $630.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR IRIS FLEX TRANSCORNE,272,RC,27200002,CDM,,,,,,both,,,1477.6600,221.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1034.36,,,,,,,381.3800,1477.6600,percent of total billed charges,"Rev 272 $1,477.66 in Billed Charges at 70% = $1,034.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR IRIS FLEX TRANSCORNE,272,RC,27200002,CDM,,,,,,both,,,1477.6600,221.6500,CIGNA HEALTHCARE,CIGNA HMO,616.18,,,,,,,381.3800,1477.6600,percent of total billed charges,"41.7% of $1,477.66 in Billed Charges for Rev 272 = $616.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR IRIS FLEX TRANSCORNE,272,RC,27200002,CDM,,,,,,both,,,1477.6600,221.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,685.63,,,,,,,381.3800,1477.6600,percent of total billed charges,"46.4% of $1,477.66 in Billed Charges for Rev 272 = $685.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR IRIS FLEX TRANSCORNE,272,RC,27200002,CDM,,,,,,both,,,1477.6600,221.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,616.18,,,,,,,381.3800,1477.6600,percent of total billed charges,"41.7% of $1,477.66 in Billed Charges for Rev 272 = $616.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR IRIS FLEX TRANSCORNE,272,RC,27200002,CDM,,,,,,both,,,1477.6600,221.6500,CIGNA HEALTHCARE,CIGNA PPO,616.18,,,,,,,381.3800,1477.6600,percent of total billed charges,"41.7% of $1,477.66 in Billed Charges for Rev 272 = $616.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR IRIS FLEX TRANSCORNE,272,RC,27200002,CDM,,,,,,both,,,1477.6600,221.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1329.89,,,,,,,381.3800,1477.6600,percent of total billed charges,"90% of $1,477.66 in Billed Charges for Rev 272 = $1,329.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR IRIS FLEX TRANSCORNE,272,RC,27200002,CDM,,,,,,both,,,1477.6600,221.6500,MEDCOST,MEDCOST VHN,703.22,,,,,,,381.3800,1477.6600,percent of total billed charges,"47.59% of $1,477.66 in Billed Charges for Rev 272 = $703.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR IRIS FLEX TRANSCORNE,272,RC,27200002,CDM,,,,,,both,,,1477.6600,221.6500,SENTARA HEALTH,SENTARA HEALTH,381.38,,,,,,,381.3800,1477.6600,percent of total billed charges,"25.81% of $1,477.66 in Billed Charges for Rev 272 = $381.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR IRIS FLEX TRANSCORNE,272,RC,27200002,CDM,,,,,,both,,,1477.6600,221.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1477.66,,,,,,,381.3800,1477.6600,percent of total billed charges,"100% of $1,477.66 in Billed Charges for Rev 272 = $1,477.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR IRIS FLEX TRANSCORNE,272,RC,27200002,CDM,,,,,,both,,,1477.6600,221.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,738.83,,,,,,,381.3800,1477.6600,percent of total billed charges,"Rev 272 $1,477.66 in Billed Charges at 50% = $738.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR IRIS FLEX TRANSCORNE,272,RC,27200002,CDM,,,,,,both,,,1477.6600,221.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,477.28,,,,,,,381.3800,1477.6600,other,"32.3% of $1,477.66 in Billed Charges for Rev 272 = $477.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RETRACTOR IRIS FLEX TRANSCORNE,272,RC,27200002,CDM,,,,,,both,,,1477.6600,221.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,453.64,,,,,,,381.3800,1477.6600,other,"30.7% of $1,477.66 in Billed Charges for Rev 272 = $453.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RETRACTOR IRIS FLEX TRANSCORNE,272,RC,27200002,CDM,,,,,,both,,,1477.6600,221.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,477.28,,,,,,,381.3800,1477.6600,percent of total billed charges,"32.3% of $1,477.66 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR IRIS FLEX TRANSCORNE,272,RC,27200002,CDM,,,,,,both,,,1477.6600,221.6500,WELLCARE,WELLCARE MEDICAID,1477.66,,,,,,,381.3800,1477.6600,percent of total billed charges,"100% of $1,477.66 in Billed Charges for Rev 272 = $1,477.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 90 SURPASS SEE LN 58284,272,RC,27200002,CDM,,,,,,both,,,4369.4900,655.4200,AETNA,AETNA,1865.77,,,,,,,1127.7700,4369.4900,percent of total billed charges,"42.7% of $4,369.49 in Billed Charges for Rev 272 = $1,865.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 90 SURPASS SEE LN 58284,272,RC,27200002,CDM,,,,,,both,,,4369.4900,655.4200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3058.64,,,,,,,1127.7700,4369.4900,percent of total billed charges,"Rev 272 $4,369.49 in Billed Charges at 70% = $3,058.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 90 SURPASS SEE LN 58284,272,RC,27200002,CDM,,,,,,both,,,4369.4900,655.4200,CIGNA HEALTHCARE,CIGNA HMO,1822.08,,,,,,,1127.7700,4369.4900,percent of total billed charges,"41.7% of $4,369.49 in Billed Charges for Rev 272 = $1,822.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 90 SURPASS SEE LN 58284,272,RC,27200002,CDM,,,,,,both,,,4369.4900,655.4200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2027.44,,,,,,,1127.7700,4369.4900,percent of total billed charges,"46.4% of $4,369.49 in Billed Charges for Rev 272 = $2,027.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 90 SURPASS SEE LN 58284,272,RC,27200002,CDM,,,,,,both,,,4369.4900,655.4200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1822.08,,,,,,,1127.7700,4369.4900,percent of total billed charges,"41.7% of $4,369.49 in Billed Charges for Rev 272 = $1,822.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 90 SURPASS SEE LN 58284,272,RC,27200002,CDM,,,,,,both,,,4369.4900,655.4200,CIGNA HEALTHCARE,CIGNA PPO,1822.08,,,,,,,1127.7700,4369.4900,percent of total billed charges,"41.7% of $4,369.49 in Billed Charges for Rev 272 = $1,822.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 90 SURPASS SEE LN 58284,272,RC,27200002,CDM,,,,,,both,,,4369.4900,655.4200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3932.54,,,,,,,1127.7700,4369.4900,percent of total billed charges,"90% of $4,369.49 in Billed Charges for Rev 272 = $3,932.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 90 SURPASS SEE LN 58284,272,RC,27200002,CDM,,,,,,both,,,4369.4900,655.4200,MEDCOST,MEDCOST VHN,2079.44,,,,,,,1127.7700,4369.4900,percent of total billed charges,"47.59% of $4,369.49 in Billed Charges for Rev 272 = $2,079.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 90 SURPASS SEE LN 58284,272,RC,27200002,CDM,,,,,,both,,,4369.4900,655.4200,SENTARA HEALTH,SENTARA HEALTH,1127.77,,,,,,,1127.7700,4369.4900,percent of total billed charges,"25.81% of $4,369.49 in Billed Charges for Rev 272 = $1,127.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 90 SURPASS SEE LN 58284,272,RC,27200002,CDM,,,,,,both,,,4369.4900,655.4200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4369.49,,,,,,,1127.7700,4369.4900,percent of total billed charges,"100% of $4,369.49 in Billed Charges for Rev 272 = $4,369.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 90 SURPASS SEE LN 58284,272,RC,27200002,CDM,,,,,,both,,,4369.4900,655.4200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2184.75,,,,,,,1127.7700,4369.4900,percent of total billed charges,"Rev 272 $4,369.49 in Billed Charges at 50% = $2,184.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 90 SURPASS SEE LN 58284,272,RC,27200002,CDM,,,,,,both,,,4369.4900,655.4200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1411.35,,,,,,,1127.7700,4369.4900,other,"32.3% of $4,369.49 in Billed Charges for Rev 272 = $1,411.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER TA 90 SURPASS SEE LN 58284,272,RC,27200002,CDM,,,,,,both,,,4369.4900,655.4200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1341.43,,,,,,,1127.7700,4369.4900,other,"30.7% of $4,369.49 in Billed Charges for Rev 272 = $1,341.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER TA 90 SURPASS SEE LN 58284,272,RC,27200002,CDM,,,,,,both,,,4369.4900,655.4200,UNITED HEALTHCARE,UNITED HEALTHCARE,1411.35,,,,,,,1127.7700,4369.4900,percent of total billed charges,"32.3% of $4,369.49 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 90 SURPASS SEE LN 58284,272,RC,27200002,CDM,,,,,,both,,,4369.4900,655.4200,WELLCARE,WELLCARE MEDICAID,4369.49,,,,,,,1127.7700,4369.4900,percent of total billed charges,"100% of $4,369.49 in Billed Charges for Rev 272 = $4,369.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC CRVD TIP MD,272,RC,,,,,,,,both,,,7452.9700,1117.9500,AETNA,AETNA,3182.42,,,,,,,1923.6100,7452.9700,percent of total billed charges,"42.7% of $7,452.97 in Billed Charges for Rev 272 = $3,182.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC CRVD TIP MD,272,RC,,,,,,,,both,,,7452.9700,1117.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5217.08,,,,,,,1923.6100,7452.9700,percent of total billed charges,"Rev 272 $7,452.97 in Billed Charges at 70% = $5,217.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC CRVD TIP MD,272,RC,,,,,,,,both,,,7452.9700,1117.9500,CIGNA HEALTHCARE,CIGNA HMO,3107.89,,,,,,,1923.6100,7452.9700,percent of total billed charges,"41.7% of $7,452.97 in Billed Charges for Rev 272 = $3,107.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC CRVD TIP MD,272,RC,,,,,,,,both,,,7452.9700,1117.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3458.18,,,,,,,1923.6100,7452.9700,percent of total billed charges,"46.4% of $7,452.97 in Billed Charges for Rev 272 = $3,458.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC CRVD TIP MD,272,RC,,,,,,,,both,,,7452.9700,1117.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3107.89,,,,,,,1923.6100,7452.9700,percent of total billed charges,"41.7% of $7,452.97 in Billed Charges for Rev 272 = $3,107.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC CRVD TIP MD,272,RC,,,,,,,,both,,,7452.9700,1117.9500,CIGNA HEALTHCARE,CIGNA PPO,3107.89,,,,,,,1923.6100,7452.9700,percent of total billed charges,"41.7% of $7,452.97 in Billed Charges for Rev 272 = $3,107.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC CRVD TIP MD,272,RC,,,,,,,,both,,,7452.9700,1117.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6707.67,,,,,,,1923.6100,7452.9700,percent of total billed charges,"90% of $7,452.97 in Billed Charges for Rev 272 = $6,707.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC CRVD TIP MD,272,RC,,,,,,,,both,,,7452.9700,1117.9500,MEDCOST,MEDCOST VHN,3546.87,,,,,,,1923.6100,7452.9700,percent of total billed charges,"47.59% of $7,452.97 in Billed Charges for Rev 272 = $3,546.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC CRVD TIP MD,272,RC,,,,,,,,both,,,7452.9700,1117.9500,SENTARA HEALTH,SENTARA HEALTH,1923.61,,,,,,,1923.6100,7452.9700,percent of total billed charges,"25.81% of $7,452.97 in Billed Charges for Rev 272 = $1,923.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC CRVD TIP MD,272,RC,,,,,,,,both,,,7452.9700,1117.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7452.97,,,,,,,1923.6100,7452.9700,percent of total billed charges,"100% of $7,452.97 in Billed Charges for Rev 272 = $7,452.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC CRVD TIP MD,272,RC,,,,,,,,both,,,7452.9700,1117.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3726.49,,,,,,,1923.6100,7452.9700,percent of total billed charges,"Rev 272 $7,452.97 in Billed Charges at 50% = $3,726.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC CRVD TIP MD,272,RC,,,,,,,,both,,,7452.9700,1117.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2407.31,,,,,,,1923.6100,7452.9700,other,"32.3% of $7,452.97 in Billed Charges for Rev 272 = $2,407.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER VASC ARTIC CRVD TIP MD,272,RC,,,,,,,,both,,,7452.9700,1117.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2288.06,,,,,,,1923.6100,7452.9700,other,"30.7% of $7,452.97 in Billed Charges for Rev 272 = $2,288.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER VASC ARTIC CRVD TIP MD,272,RC,,,,,,,,both,,,7452.9700,1117.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,2407.31,,,,,,,1923.6100,7452.9700,percent of total billed charges,"32.3% of $7,452.97 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC CRVD TIP MD,272,RC,,,,,,,,both,,,7452.9700,1117.9500,WELLCARE,WELLCARE MEDICAID,7452.97,,,,,,,1923.6100,7452.9700,percent of total billed charges,"100% of $7,452.97 in Billed Charges for Rev 272 = $7,452.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 45 SURPASS SEE LN 49568,272,RC,27200002,CDM,,,,,,both,,,7598.0300,1139.7000,AETNA,AETNA,3244.36,,,,,,,1961.0500,7598.0300,percent of total billed charges,"42.7% of $7,598.03 in Billed Charges for Rev 272 = $3,244.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 45 SURPASS SEE LN 49568,272,RC,27200002,CDM,,,,,,both,,,7598.0300,1139.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5318.62,,,,,,,1961.0500,7598.0300,percent of total billed charges,"Rev 272 $7,598.03 in Billed Charges at 70% = $5,318.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 45 SURPASS SEE LN 49568,272,RC,27200002,CDM,,,,,,both,,,7598.0300,1139.7000,CIGNA HEALTHCARE,CIGNA HMO,3168.38,,,,,,,1961.0500,7598.0300,percent of total billed charges,"41.7% of $7,598.03 in Billed Charges for Rev 272 = $3,168.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 45 SURPASS SEE LN 49568,272,RC,27200002,CDM,,,,,,both,,,7598.0300,1139.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3525.49,,,,,,,1961.0500,7598.0300,percent of total billed charges,"46.4% of $7,598.03 in Billed Charges for Rev 272 = $3,525.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 45 SURPASS SEE LN 49568,272,RC,27200002,CDM,,,,,,both,,,7598.0300,1139.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3168.38,,,,,,,1961.0500,7598.0300,percent of total billed charges,"41.7% of $7,598.03 in Billed Charges for Rev 272 = $3,168.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 45 SURPASS SEE LN 49568,272,RC,27200002,CDM,,,,,,both,,,7598.0300,1139.7000,CIGNA HEALTHCARE,CIGNA PPO,3168.38,,,,,,,1961.0500,7598.0300,percent of total billed charges,"41.7% of $7,598.03 in Billed Charges for Rev 272 = $3,168.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 45 SURPASS SEE LN 49568,272,RC,27200002,CDM,,,,,,both,,,7598.0300,1139.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6838.23,,,,,,,1961.0500,7598.0300,percent of total billed charges,"90% of $7,598.03 in Billed Charges for Rev 272 = $6,838.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 45 SURPASS SEE LN 49568,272,RC,27200002,CDM,,,,,,both,,,7598.0300,1139.7000,MEDCOST,MEDCOST VHN,3615.90,,,,,,,1961.0500,7598.0300,percent of total billed charges,"47.59% of $7,598.03 in Billed Charges for Rev 272 = $3,615.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 45 SURPASS SEE LN 49568,272,RC,27200002,CDM,,,,,,both,,,7598.0300,1139.7000,SENTARA HEALTH,SENTARA HEALTH,1961.05,,,,,,,1961.0500,7598.0300,percent of total billed charges,"25.81% of $7,598.03 in Billed Charges for Rev 272 = $1,961.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 45 SURPASS SEE LN 49568,272,RC,27200002,CDM,,,,,,both,,,7598.0300,1139.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7598.03,,,,,,,1961.0500,7598.0300,percent of total billed charges,"100% of $7,598.03 in Billed Charges for Rev 272 = $7,598.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 45 SURPASS SEE LN 49568,272,RC,27200002,CDM,,,,,,both,,,7598.0300,1139.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3799.02,,,,,,,1961.0500,7598.0300,percent of total billed charges,"Rev 272 $7,598.03 in Billed Charges at 50% = $3,799.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 45 SURPASS SEE LN 49568,272,RC,27200002,CDM,,,,,,both,,,7598.0300,1139.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2454.16,,,,,,,1961.0500,7598.0300,other,"32.3% of $7,598.03 in Billed Charges for Rev 272 = $2,454.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER VASC ARTIC EX THICK 45 SURPASS SEE LN 49568,272,RC,27200002,CDM,,,,,,both,,,7598.0300,1139.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2332.60,,,,,,,1961.0500,7598.0300,other,"30.7% of $7,598.03 in Billed Charges for Rev 272 = $2,332.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER VASC ARTIC EX THICK 45 SURPASS SEE LN 49568,272,RC,27200002,CDM,,,,,,both,,,7598.0300,1139.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,2454.16,,,,,,,1961.0500,7598.0300,percent of total billed charges,"32.3% of $7,598.03 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 45 SURPASS SEE LN 49568,272,RC,27200002,CDM,,,,,,both,,,7598.0300,1139.7000,WELLCARE,WELLCARE MEDICAID,7598.03,,,,,,,1961.0500,7598.0300,percent of total billed charges,"100% of $7,598.03 in Billed Charges for Rev 272 = $7,598.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR WOUND,272,RC,27200002,CDM,,,,,,both,,,373.3600,56.0000,AETNA,AETNA,159.42,,,,,,,96.3600,373.3600,percent of total billed charges,42.7% of $373.36 in Billed Charges for Rev 272 = $159.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR WOUND,272,RC,27200002,CDM,,,,,,both,,,373.3600,56.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,261.35,,,,,,,96.3600,373.3600,percent of total billed charges,Rev 272 $373.36 in Billed Charges at 70% = $261.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR WOUND,272,RC,27200002,CDM,,,,,,both,,,373.3600,56.0000,CIGNA HEALTHCARE,CIGNA HMO,155.69,,,,,,,96.3600,373.3600,percent of total billed charges,41.7% of $373.36 in Billed Charges for Rev 272 = $155.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR WOUND,272,RC,27200002,CDM,,,,,,both,,,373.3600,56.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,173.24,,,,,,,96.3600,373.3600,percent of total billed charges,46.4% of $373.36 in Billed Charges for Rev 272 = $173.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR WOUND,272,RC,27200002,CDM,,,,,,both,,,373.3600,56.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,155.69,,,,,,,96.3600,373.3600,percent of total billed charges,41.7% of $373.36 in Billed Charges for Rev 272 = $155.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR WOUND,272,RC,27200002,CDM,,,,,,both,,,373.3600,56.0000,CIGNA HEALTHCARE,CIGNA PPO,155.69,,,,,,,96.3600,373.3600,percent of total billed charges,41.7% of $373.36 in Billed Charges for Rev 272 = $155.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR WOUND,272,RC,27200002,CDM,,,,,,both,,,373.3600,56.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,336.02,,,,,,,96.3600,373.3600,percent of total billed charges,90% of $373.36 in Billed Charges for Rev 272 = $336.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR WOUND,272,RC,27200002,CDM,,,,,,both,,,373.3600,56.0000,MEDCOST,MEDCOST VHN,177.68,,,,,,,96.3600,373.3600,percent of total billed charges,47.59% of $373.36 in Billed Charges for Rev 272 = $177.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR WOUND,272,RC,27200002,CDM,,,,,,both,,,373.3600,56.0000,SENTARA HEALTH,SENTARA HEALTH,96.36,,,,,,,96.3600,373.3600,percent of total billed charges,25.81% of $373.36 in Billed Charges for Rev 272 = $96.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR WOUND,272,RC,27200002,CDM,,,,,,both,,,373.3600,56.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",373.36,,,,,,,96.3600,373.3600,percent of total billed charges,100% of $373.36 in Billed Charges for Rev 272 = $373.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR WOUND,272,RC,27200002,CDM,,,,,,both,,,373.3600,56.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,186.68,,,,,,,96.3600,373.3600,percent of total billed charges,Rev 272 $373.36 in Billed Charges at 50% = $186.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR WOUND,272,RC,27200002,CDM,,,,,,both,,,373.3600,56.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,120.60,,,,,,,96.3600,373.3600,other,32.3% of $373.36 in Billed Charges for Rev 272 = $120.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
RETRACTOR WOUND,272,RC,27200002,CDM,,,,,,both,,,373.3600,56.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,114.62,,,,,,,96.3600,373.3600,other,30.7% of $373.36 in Billed Charges for Rev 272 = $114.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
RETRACTOR WOUND,272,RC,27200002,CDM,,,,,,both,,,373.3600,56.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,120.60,,,,,,,96.3600,373.3600,percent of total billed charges,32.3% of $373.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR WOUND,272,RC,27200002,CDM,,,,,,both,,,373.3600,56.0000,WELLCARE,WELLCARE MEDICAID,373.36,,,,,,,96.3600,373.3600,percent of total billed charges,100% of $373.36 in Billed Charges for Rev 272 = $373.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER VERSA 4.0 595207,272,RC,,,,,,,,both,,,3335.4300,500.3100,AETNA,AETNA,1424.23,,,,,,,860.8700,3335.4300,percent of total billed charges,"42.7% of $3,335.43 in Billed Charges for Rev 272 = $1,424.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VERSA 4.0 595207,272,RC,,,,,,,,both,,,3335.4300,500.3100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2334.80,,,,,,,860.8700,3335.4300,percent of total billed charges,"Rev 272 $3,335.43 in Billed Charges at 70% = $2,334.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VERSA 4.0 595207,272,RC,,,,,,,,both,,,3335.4300,500.3100,CIGNA HEALTHCARE,CIGNA HMO,1390.87,,,,,,,860.8700,3335.4300,percent of total billed charges,"41.7% of $3,335.43 in Billed Charges for Rev 272 = $1,390.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VERSA 4.0 595207,272,RC,,,,,,,,both,,,3335.4300,500.3100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1547.64,,,,,,,860.8700,3335.4300,percent of total billed charges,"46.4% of $3,335.43 in Billed Charges for Rev 272 = $1,547.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VERSA 4.0 595207,272,RC,,,,,,,,both,,,3335.4300,500.3100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1390.87,,,,,,,860.8700,3335.4300,percent of total billed charges,"41.7% of $3,335.43 in Billed Charges for Rev 272 = $1,390.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VERSA 4.0 595207,272,RC,,,,,,,,both,,,3335.4300,500.3100,CIGNA HEALTHCARE,CIGNA PPO,1390.87,,,,,,,860.8700,3335.4300,percent of total billed charges,"41.7% of $3,335.43 in Billed Charges for Rev 272 = $1,390.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VERSA 4.0 595207,272,RC,,,,,,,,both,,,3335.4300,500.3100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3001.89,,,,,,,860.8700,3335.4300,percent of total billed charges,"90% of $3,335.43 in Billed Charges for Rev 272 = $3,001.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VERSA 4.0 595207,272,RC,,,,,,,,both,,,3335.4300,500.3100,MEDCOST,MEDCOST VHN,1587.33,,,,,,,860.8700,3335.4300,percent of total billed charges,"47.59% of $3,335.43 in Billed Charges for Rev 272 = $1,587.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VERSA 4.0 595207,272,RC,,,,,,,,both,,,3335.4300,500.3100,SENTARA HEALTH,SENTARA HEALTH,860.87,,,,,,,860.8700,3335.4300,percent of total billed charges,"25.81% of $3,335.43 in Billed Charges for Rev 272 = $860.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VERSA 4.0 595207,272,RC,,,,,,,,both,,,3335.4300,500.3100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3335.43,,,,,,,860.8700,3335.4300,percent of total billed charges,"100% of $3,335.43 in Billed Charges for Rev 272 = $3,335.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VERSA 4.0 595207,272,RC,,,,,,,,both,,,3335.4300,500.3100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1667.72,,,,,,,860.8700,3335.4300,percent of total billed charges,"Rev 272 $3,335.43 in Billed Charges at 50% = $1,667.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VERSA 4.0 595207,272,RC,,,,,,,,both,,,3335.4300,500.3100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1077.34,,,,,,,860.8700,3335.4300,other,"32.3% of $3,335.43 in Billed Charges for Rev 272 = $1,077.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER VERSA 4.0 595207,272,RC,,,,,,,,both,,,3335.4300,500.3100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1023.98,,,,,,,860.8700,3335.4300,other,"30.7% of $3,335.43 in Billed Charges for Rev 272 = $1,023.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER VERSA 4.0 595207,272,RC,,,,,,,,both,,,3335.4300,500.3100,UNITED HEALTHCARE,UNITED HEALTHCARE,1077.34,,,,,,,860.8700,3335.4300,percent of total billed charges,"32.3% of $3,335.43 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VERSA 4.0 595207,272,RC,,,,,,,,both,,,3335.4300,500.3100,WELLCARE,WELLCARE MEDICAID,3335.43,,,,,,,860.8700,3335.4300,percent of total billed charges,"100% of $3,335.43 in Billed Charges for Rev 272 = $3,335.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER W LOCKOUT 75MM TCT75,272,RC,27200002,CDM,,,,,,both,,,1161.1400,174.1700,AETNA,AETNA,495.81,,,,,,,299.6900,1161.1400,percent of total billed charges,"42.7% of $1,161.14 in Billed Charges for Rev 272 = $495.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER W LOCKOUT 75MM TCT75,272,RC,27200002,CDM,,,,,,both,,,1161.1400,174.1700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,812.80,,,,,,,299.6900,1161.1400,percent of total billed charges,"Rev 272 $1,161.14 in Billed Charges at 70% = $812.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER W LOCKOUT 75MM TCT75,272,RC,27200002,CDM,,,,,,both,,,1161.1400,174.1700,CIGNA HEALTHCARE,CIGNA HMO,484.20,,,,,,,299.6900,1161.1400,percent of total billed charges,"41.7% of $1,161.14 in Billed Charges for Rev 272 = $484.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER W LOCKOUT 75MM TCT75,272,RC,27200002,CDM,,,,,,both,,,1161.1400,174.1700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,538.77,,,,,,,299.6900,1161.1400,percent of total billed charges,"46.4% of $1,161.14 in Billed Charges for Rev 272 = $538.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER W LOCKOUT 75MM TCT75,272,RC,27200002,CDM,,,,,,both,,,1161.1400,174.1700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,484.20,,,,,,,299.6900,1161.1400,percent of total billed charges,"41.7% of $1,161.14 in Billed Charges for Rev 272 = $484.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER W LOCKOUT 75MM TCT75,272,RC,27200002,CDM,,,,,,both,,,1161.1400,174.1700,CIGNA HEALTHCARE,CIGNA PPO,484.20,,,,,,,299.6900,1161.1400,percent of total billed charges,"41.7% of $1,161.14 in Billed Charges for Rev 272 = $484.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER W LOCKOUT 75MM TCT75,272,RC,27200002,CDM,,,,,,both,,,1161.1400,174.1700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1045.03,,,,,,,299.6900,1161.1400,percent of total billed charges,"90% of $1,161.14 in Billed Charges for Rev 272 = $1,045.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER W LOCKOUT 75MM TCT75,272,RC,27200002,CDM,,,,,,both,,,1161.1400,174.1700,MEDCOST,MEDCOST VHN,552.59,,,,,,,299.6900,1161.1400,percent of total billed charges,"47.59% of $1,161.14 in Billed Charges for Rev 272 = $552.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER W LOCKOUT 75MM TCT75,272,RC,27200002,CDM,,,,,,both,,,1161.1400,174.1700,SENTARA HEALTH,SENTARA HEALTH,299.69,,,,,,,299.6900,1161.1400,percent of total billed charges,"25.81% of $1,161.14 in Billed Charges for Rev 272 = $299.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER W LOCKOUT 75MM TCT75,272,RC,27200002,CDM,,,,,,both,,,1161.1400,174.1700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1161.14,,,,,,,299.6900,1161.1400,percent of total billed charges,"100% of $1,161.14 in Billed Charges for Rev 272 = $1,161.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER W LOCKOUT 75MM TCT75,272,RC,27200002,CDM,,,,,,both,,,1161.1400,174.1700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,580.57,,,,,,,299.6900,1161.1400,percent of total billed charges,"Rev 272 $1,161.14 in Billed Charges at 50% = $580.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER W LOCKOUT 75MM TCT75,272,RC,27200002,CDM,,,,,,both,,,1161.1400,174.1700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,375.05,,,,,,,299.6900,1161.1400,other,"32.3% of $1,161.14 in Billed Charges for Rev 272 = $375.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER W LOCKOUT 75MM TCT75,272,RC,27200002,CDM,,,,,,both,,,1161.1400,174.1700,UNITED HEALTHCARE,UHC HERITAGE SELECT,356.47,,,,,,,299.6900,1161.1400,other,"30.7% of $1,161.14 in Billed Charges for Rev 272 = $356.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER W LOCKOUT 75MM TCT75,272,RC,27200002,CDM,,,,,,both,,,1161.1400,174.1700,UNITED HEALTHCARE,UNITED HEALTHCARE,375.05,,,,,,,299.6900,1161.1400,percent of total billed charges,"32.3% of $1,161.14 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER W LOCKOUT 75MM TCT75,272,RC,27200002,CDM,,,,,,both,,,1161.1400,174.1700,WELLCARE,WELLCARE MEDICAID,1161.14,,,,,,,299.6900,1161.1400,percent of total billed charges,"100% of $1,161.14 in Billed Charges for Rev 272 = $1,161.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,2973.3700,446.0100,AETNA,AETNA,1269.63,,,,,,,767.4300,2973.3700,percent of total billed charges,"42.7% of $2,973.37 in Billed Charges for Rev 272 = $1,269.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,2973.3700,446.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2081.36,,,,,,,767.4300,2973.3700,percent of total billed charges,"Rev 272 $2,973.37 in Billed Charges at 70% = $2,081.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,2973.3700,446.0100,CIGNA HEALTHCARE,CIGNA HMO,1239.90,,,,,,,767.4300,2973.3700,percent of total billed charges,"41.7% of $2,973.37 in Billed Charges for Rev 272 = $1,239.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,2973.3700,446.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1379.64,,,,,,,767.4300,2973.3700,percent of total billed charges,"46.4% of $2,973.37 in Billed Charges for Rev 272 = $1,379.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,2973.3700,446.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1239.90,,,,,,,767.4300,2973.3700,percent of total billed charges,"41.7% of $2,973.37 in Billed Charges for Rev 272 = $1,239.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,2973.3700,446.0100,CIGNA HEALTHCARE,CIGNA PPO,1239.90,,,,,,,767.4300,2973.3700,percent of total billed charges,"41.7% of $2,973.37 in Billed Charges for Rev 272 = $1,239.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,2973.3700,446.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2676.03,,,,,,,767.4300,2973.3700,percent of total billed charges,"90% of $2,973.37 in Billed Charges for Rev 272 = $2,676.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,2973.3700,446.0100,MEDCOST,MEDCOST VHN,1415.03,,,,,,,767.4300,2973.3700,percent of total billed charges,"47.59% of $2,973.37 in Billed Charges for Rev 272 = $1,415.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,2973.3700,446.0100,SENTARA HEALTH,SENTARA HEALTH,767.43,,,,,,,767.4300,2973.3700,percent of total billed charges,"25.81% of $2,973.37 in Billed Charges for Rev 272 = $767.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,2973.3700,446.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2973.37,,,,,,,767.4300,2973.3700,percent of total billed charges,"100% of $2,973.37 in Billed Charges for Rev 272 = $2,973.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,2973.3700,446.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1486.69,,,,,,,767.4300,2973.3700,percent of total billed charges,"Rev 272 $2,973.37 in Billed Charges at 50% = $1,486.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,2973.3700,446.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,960.40,,,,,,,767.4300,2973.3700,other,"32.3% of $2,973.37 in Billed Charges for Rev 272 = $960.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,2973.3700,446.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,912.82,,,,,,,767.4300,2973.3700,other,"30.7% of $2,973.37 in Billed Charges for Rev 272 = $912.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,2973.3700,446.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,960.40,,,,,,,767.4300,2973.3700,percent of total billed charges,"32.3% of $2,973.37 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE SCLEROTHERAPY VARIJECT 25GA X 240CM,272,RC,27200002,CDM,,,,,,both,,,2973.3700,446.0100,WELLCARE,WELLCARE MEDICAID,2973.37,,,,,,,767.4300,2973.3700,percent of total billed charges,"100% of $2,973.37 in Billed Charges for Rev 272 = $2,973.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRIEVER HEWSON SUTURE,272,RC,27200002,CDM,,,,,,both,,,918.2500,137.7400,AETNA,AETNA,392.09,,,,,,,237.0000,918.2500,percent of total billed charges,42.7% of $918.25 in Billed Charges for Rev 272 = $392.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRIEVER HEWSON SUTURE,272,RC,27200002,CDM,,,,,,both,,,918.2500,137.7400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,642.78,,,,,,,237.0000,918.2500,percent of total billed charges,Rev 272 $918.25 in Billed Charges at 70% = $642.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRIEVER HEWSON SUTURE,272,RC,27200002,CDM,,,,,,both,,,918.2500,137.7400,CIGNA HEALTHCARE,CIGNA HMO,382.91,,,,,,,237.0000,918.2500,percent of total billed charges,41.7% of $918.25 in Billed Charges for Rev 272 = $382.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRIEVER HEWSON SUTURE,272,RC,27200002,CDM,,,,,,both,,,918.2500,137.7400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,426.07,,,,,,,237.0000,918.2500,percent of total billed charges,46.4% of $918.25 in Billed Charges for Rev 272 = $426.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRIEVER HEWSON SUTURE,272,RC,27200002,CDM,,,,,,both,,,918.2500,137.7400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,382.91,,,,,,,237.0000,918.2500,percent of total billed charges,41.7% of $918.25 in Billed Charges for Rev 272 = $382.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRIEVER HEWSON SUTURE,272,RC,27200002,CDM,,,,,,both,,,918.2500,137.7400,CIGNA HEALTHCARE,CIGNA PPO,382.91,,,,,,,237.0000,918.2500,percent of total billed charges,41.7% of $918.25 in Billed Charges for Rev 272 = $382.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRIEVER HEWSON SUTURE,272,RC,27200002,CDM,,,,,,both,,,918.2500,137.7400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,826.43,,,,,,,237.0000,918.2500,percent of total billed charges,90% of $918.25 in Billed Charges for Rev 272 = $826.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRIEVER HEWSON SUTURE,272,RC,27200002,CDM,,,,,,both,,,918.2500,137.7400,MEDCOST,MEDCOST VHN,437.00,,,,,,,237.0000,918.2500,percent of total billed charges,47.59% of $918.25 in Billed Charges for Rev 272 = $437.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRIEVER HEWSON SUTURE,272,RC,27200002,CDM,,,,,,both,,,918.2500,137.7400,SENTARA HEALTH,SENTARA HEALTH,237.00,,,,,,,237.0000,918.2500,percent of total billed charges,25.81% of $918.25 in Billed Charges for Rev 272 = $237.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRIEVER HEWSON SUTURE,272,RC,27200002,CDM,,,,,,both,,,918.2500,137.7400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",918.25,,,,,,,237.0000,918.2500,percent of total billed charges,100% of $918.25 in Billed Charges for Rev 272 = $918.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRIEVER HEWSON SUTURE,272,RC,27200002,CDM,,,,,,both,,,918.2500,137.7400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,459.13,,,,,,,237.0000,918.2500,percent of total billed charges,Rev 272 $918.25 in Billed Charges at 50% = $459.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRIEVER HEWSON SUTURE,272,RC,27200002,CDM,,,,,,both,,,918.2500,137.7400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,296.59,,,,,,,237.0000,918.2500,other,32.3% of $918.25 in Billed Charges for Rev 272 = $296.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
RETRIEVER HEWSON SUTURE,272,RC,27200002,CDM,,,,,,both,,,918.2500,137.7400,UNITED HEALTHCARE,UHC HERITAGE SELECT,281.90,,,,,,,237.0000,918.2500,other,30.7% of $918.25 in Billed Charges for Rev 272 = $281.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
RETRIEVER HEWSON SUTURE,272,RC,27200002,CDM,,,,,,both,,,918.2500,137.7400,UNITED HEALTHCARE,UNITED HEALTHCARE,296.59,,,,,,,237.0000,918.2500,percent of total billed charges,32.3% of $918.25 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRIEVER HEWSON SUTURE,272,RC,27200002,CDM,,,,,,both,,,918.2500,137.7400,WELLCARE,WELLCARE MEDICAID,918.25,,,,,,,237.0000,918.2500,percent of total billed charges,100% of $918.25 in Billed Charges for Rev 272 = $918.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE STERNAL ZIPFIX STERILE,272,RC,,,,,,,,both,,,987.3200,148.1000,AETNA,AETNA,421.59,,,,,,,254.8300,987.3200,percent of total billed charges,42.7% of $987.32 in Billed Charges for Rev 272 = $421.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE STERNAL ZIPFIX STERILE,272,RC,,,,,,,,both,,,987.3200,148.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,691.12,,,,,,,254.8300,987.3200,percent of total billed charges,Rev 272 $987.32 in Billed Charges at 70% = $691.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE STERNAL ZIPFIX STERILE,272,RC,,,,,,,,both,,,987.3200,148.1000,CIGNA HEALTHCARE,CIGNA HMO,411.71,,,,,,,254.8300,987.3200,percent of total billed charges,41.7% of $987.32 in Billed Charges for Rev 272 = $411.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE STERNAL ZIPFIX STERILE,272,RC,,,,,,,,both,,,987.3200,148.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,458.12,,,,,,,254.8300,987.3200,percent of total billed charges,46.4% of $987.32 in Billed Charges for Rev 272 = $458.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE STERNAL ZIPFIX STERILE,272,RC,,,,,,,,both,,,987.3200,148.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,411.71,,,,,,,254.8300,987.3200,percent of total billed charges,41.7% of $987.32 in Billed Charges for Rev 272 = $411.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE STERNAL ZIPFIX STERILE,272,RC,,,,,,,,both,,,987.3200,148.1000,CIGNA HEALTHCARE,CIGNA PPO,411.71,,,,,,,254.8300,987.3200,percent of total billed charges,41.7% of $987.32 in Billed Charges for Rev 272 = $411.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE STERNAL ZIPFIX STERILE,272,RC,,,,,,,,both,,,987.3200,148.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,888.59,,,,,,,254.8300,987.3200,percent of total billed charges,90% of $987.32 in Billed Charges for Rev 272 = $888.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE STERNAL ZIPFIX STERILE,272,RC,,,,,,,,both,,,987.3200,148.1000,MEDCOST,MEDCOST VHN,469.87,,,,,,,254.8300,987.3200,percent of total billed charges,47.59% of $987.32 in Billed Charges for Rev 272 = $469.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE STERNAL ZIPFIX STERILE,272,RC,,,,,,,,both,,,987.3200,148.1000,SENTARA HEALTH,SENTARA HEALTH,254.83,,,,,,,254.8300,987.3200,percent of total billed charges,25.81% of $987.32 in Billed Charges for Rev 272 = $254.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE STERNAL ZIPFIX STERILE,272,RC,,,,,,,,both,,,987.3200,148.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",987.32,,,,,,,254.8300,987.3200,percent of total billed charges,100% of $987.32 in Billed Charges for Rev 272 = $987.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE STERNAL ZIPFIX STERILE,272,RC,,,,,,,,both,,,987.3200,148.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,493.66,,,,,,,254.8300,987.3200,percent of total billed charges,Rev 272 $987.32 in Billed Charges at 50% = $493.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE STERNAL ZIPFIX STERILE,272,RC,,,,,,,,both,,,987.3200,148.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,318.90,,,,,,,254.8300,987.3200,other,32.3% of $987.32 in Billed Charges for Rev 272 = $318.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE STERNAL ZIPFIX STERILE,272,RC,,,,,,,,both,,,987.3200,148.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,303.11,,,,,,,254.8300,987.3200,other,30.7% of $987.32 in Billed Charges for Rev 272 = $303.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE STERNAL ZIPFIX STERILE,272,RC,,,,,,,,both,,,987.3200,148.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,318.90,,,,,,,254.8300,987.3200,percent of total billed charges,32.3% of $987.32 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE STERNAL ZIPFIX STERILE,272,RC,,,,,,,,both,,,987.3200,148.1000,WELLCARE,WELLCARE MEDICAID,987.32,,,,,,,254.8300,987.3200,percent of total billed charges,100% of $987.32 in Billed Charges for Rev 272 = $987.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE TRANSSEPTAL 98 LARGE CURVE C1,272,RC,,,,,,,,both,,,5133.6500,770.0500,AETNA,AETNA,2192.07,,,,,,,1325.0000,5133.6500,percent of total billed charges,"42.7% of $5,133.65 in Billed Charges for Rev 272 = $2,192.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TRANSSEPTAL 98 LARGE CURVE C1,272,RC,,,,,,,,both,,,5133.6500,770.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3593.56,,,,,,,1325.0000,5133.6500,percent of total billed charges,"Rev 272 $5,133.65 in Billed Charges at 70% = $3,593.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TRANSSEPTAL 98 LARGE CURVE C1,272,RC,,,,,,,,both,,,5133.6500,770.0500,CIGNA HEALTHCARE,CIGNA HMO,2140.73,,,,,,,1325.0000,5133.6500,percent of total billed charges,"41.7% of $5,133.65 in Billed Charges for Rev 272 = $2,140.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TRANSSEPTAL 98 LARGE CURVE C1,272,RC,,,,,,,,both,,,5133.6500,770.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2382.01,,,,,,,1325.0000,5133.6500,percent of total billed charges,"46.4% of $5,133.65 in Billed Charges for Rev 272 = $2,382.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TRANSSEPTAL 98 LARGE CURVE C1,272,RC,,,,,,,,both,,,5133.6500,770.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2140.73,,,,,,,1325.0000,5133.6500,percent of total billed charges,"41.7% of $5,133.65 in Billed Charges for Rev 272 = $2,140.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TRANSSEPTAL 98 LARGE CURVE C1,272,RC,,,,,,,,both,,,5133.6500,770.0500,CIGNA HEALTHCARE,CIGNA PPO,2140.73,,,,,,,1325.0000,5133.6500,percent of total billed charges,"41.7% of $5,133.65 in Billed Charges for Rev 272 = $2,140.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TRANSSEPTAL 98 LARGE CURVE C1,272,RC,,,,,,,,both,,,5133.6500,770.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4620.29,,,,,,,1325.0000,5133.6500,percent of total billed charges,"90% of $5,133.65 in Billed Charges for Rev 272 = $4,620.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TRANSSEPTAL 98 LARGE CURVE C1,272,RC,,,,,,,,both,,,5133.6500,770.0500,MEDCOST,MEDCOST VHN,2443.10,,,,,,,1325.0000,5133.6500,percent of total billed charges,"47.59% of $5,133.65 in Billed Charges for Rev 272 = $2,443.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TRANSSEPTAL 98 LARGE CURVE C1,272,RC,,,,,,,,both,,,5133.6500,770.0500,SENTARA HEALTH,SENTARA HEALTH,1325.00,,,,,,,1325.0000,5133.6500,percent of total billed charges,"25.81% of $5,133.65 in Billed Charges for Rev 272 = $1,325.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TRANSSEPTAL 98 LARGE CURVE C1,272,RC,,,,,,,,both,,,5133.6500,770.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5133.65,,,,,,,1325.0000,5133.6500,percent of total billed charges,"100% of $5,133.65 in Billed Charges for Rev 272 = $5,133.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TRANSSEPTAL 98 LARGE CURVE C1,272,RC,,,,,,,,both,,,5133.6500,770.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2566.83,,,,,,,1325.0000,5133.6500,percent of total billed charges,"Rev 272 $5,133.65 in Billed Charges at 50% = $2,566.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TRANSSEPTAL 98 LARGE CURVE C1,272,RC,,,,,,,,both,,,5133.6500,770.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1658.17,,,,,,,1325.0000,5133.6500,other,"32.3% of $5,133.65 in Billed Charges for Rev 272 = $1,658.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE TRANSSEPTAL 98 LARGE CURVE C1,272,RC,,,,,,,,both,,,5133.6500,770.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1576.03,,,,,,,1325.0000,5133.6500,other,"30.7% of $5,133.65 in Billed Charges for Rev 272 = $1,576.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE TRANSSEPTAL 98 LARGE CURVE C1,272,RC,,,,,,,,both,,,5133.6500,770.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,1658.17,,,,,,,1325.0000,5133.6500,percent of total billed charges,"32.3% of $5,133.65 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TRANSSEPTAL 98 LARGE CURVE C1,272,RC,,,,,,,,both,,,5133.6500,770.0500,WELLCARE,WELLCARE MEDICAID,5133.65,,,,,,,1325.0000,5133.6500,percent of total billed charges,"100% of $5,133.65 in Billed Charges for Rev 272 = $5,133.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,2069.1200,310.3700,AETNA,AETNA,883.51,,,,,,,534.0400,2069.1200,percent of total billed charges,"42.7% of $2,069.12 in Billed Charges for Rev 272 = $883.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,2069.1200,310.3700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1448.38,,,,,,,534.0400,2069.1200,percent of total billed charges,"Rev 272 $2,069.12 in Billed Charges at 70% = $1,448.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,2069.1200,310.3700,CIGNA HEALTHCARE,CIGNA HMO,862.82,,,,,,,534.0400,2069.1200,percent of total billed charges,"41.7% of $2,069.12 in Billed Charges for Rev 272 = $862.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,2069.1200,310.3700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,960.07,,,,,,,534.0400,2069.1200,percent of total billed charges,"46.4% of $2,069.12 in Billed Charges for Rev 272 = $960.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,2069.1200,310.3700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,862.82,,,,,,,534.0400,2069.1200,percent of total billed charges,"41.7% of $2,069.12 in Billed Charges for Rev 272 = $862.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,2069.1200,310.3700,CIGNA HEALTHCARE,CIGNA PPO,862.82,,,,,,,534.0400,2069.1200,percent of total billed charges,"41.7% of $2,069.12 in Billed Charges for Rev 272 = $862.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,2069.1200,310.3700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1862.21,,,,,,,534.0400,2069.1200,percent of total billed charges,"90% of $2,069.12 in Billed Charges for Rev 272 = $1,862.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,2069.1200,310.3700,MEDCOST,MEDCOST VHN,984.69,,,,,,,534.0400,2069.1200,percent of total billed charges,"47.59% of $2,069.12 in Billed Charges for Rev 272 = $984.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,2069.1200,310.3700,SENTARA HEALTH,SENTARA HEALTH,534.04,,,,,,,534.0400,2069.1200,percent of total billed charges,"25.81% of $2,069.12 in Billed Charges for Rev 272 = $534.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,2069.1200,310.3700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2069.12,,,,,,,534.0400,2069.1200,percent of total billed charges,"100% of $2,069.12 in Billed Charges for Rev 272 = $2,069.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,2069.1200,310.3700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1034.56,,,,,,,534.0400,2069.1200,percent of total billed charges,"Rev 272 $2,069.12 in Billed Charges at 50% = $1,034.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,2069.1200,310.3700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,668.33,,,,,,,534.0400,2069.1200,other,"32.3% of $2,069.12 in Billed Charges for Rev 272 = $668.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,2069.1200,310.3700,UNITED HEALTHCARE,UHC HERITAGE SELECT,635.22,,,,,,,534.0400,2069.1200,other,"30.7% of $2,069.12 in Billed Charges for Rev 272 = $635.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,2069.1200,310.3700,UNITED HEALTHCARE,UNITED HEALTHCARE,668.33,,,,,,,534.0400,2069.1200,percent of total billed charges,"32.3% of $2,069.12 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET URETERAL DILATION 6FR TO 16FR .038,272,RC,27200002,CDM,,,,,,both,,,2069.1200,310.3700,WELLCARE,WELLCARE MEDICAID,2069.12,,,,,,,534.0400,2069.1200,percent of total billed charges,"100% of $2,069.12 in Billed Charges for Rev 272 = $2,069.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,832.7900,124.9200,AETNA,AETNA,355.60,,,,,,,214.9400,832.7900,percent of total billed charges,42.7% of $832.79 in Billed Charges for Rev 272 = $355.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,832.7900,124.9200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,582.95,,,,,,,214.9400,832.7900,percent of total billed charges,Rev 272 $832.79 in Billed Charges at 70% = $582.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,832.7900,124.9200,CIGNA HEALTHCARE,CIGNA HMO,347.27,,,,,,,214.9400,832.7900,percent of total billed charges,41.7% of $832.79 in Billed Charges for Rev 272 = $347.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,832.7900,124.9200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,386.41,,,,,,,214.9400,832.7900,percent of total billed charges,46.4% of $832.79 in Billed Charges for Rev 272 = $386.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,832.7900,124.9200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,347.27,,,,,,,214.9400,832.7900,percent of total billed charges,41.7% of $832.79 in Billed Charges for Rev 272 = $347.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,832.7900,124.9200,CIGNA HEALTHCARE,CIGNA PPO,347.27,,,,,,,214.9400,832.7900,percent of total billed charges,41.7% of $832.79 in Billed Charges for Rev 272 = $347.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,832.7900,124.9200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,749.51,,,,,,,214.9400,832.7900,percent of total billed charges,90% of $832.79 in Billed Charges for Rev 272 = $749.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,832.7900,124.9200,MEDCOST,MEDCOST VHN,396.32,,,,,,,214.9400,832.7900,percent of total billed charges,47.59% of $832.79 in Billed Charges for Rev 272 = $396.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,832.7900,124.9200,SENTARA HEALTH,SENTARA HEALTH,214.94,,,,,,,214.9400,832.7900,percent of total billed charges,25.81% of $832.79 in Billed Charges for Rev 272 = $214.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,832.7900,124.9200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",832.79,,,,,,,214.9400,832.7900,percent of total billed charges,100% of $832.79 in Billed Charges for Rev 272 = $832.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,832.7900,124.9200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,416.40,,,,,,,214.9400,832.7900,percent of total billed charges,Rev 272 $832.79 in Billed Charges at 50% = $416.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,832.7900,124.9200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,268.99,,,,,,,214.9400,832.7900,other,32.3% of $832.79 in Billed Charges for Rev 272 = $268.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,832.7900,124.9200,UNITED HEALTHCARE,UHC HERITAGE SELECT,255.67,,,,,,,214.9400,832.7900,other,30.7% of $832.79 in Billed Charges for Rev 272 = $255.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,832.7900,124.9200,UNITED HEALTHCARE,UNITED HEALTHCARE,268.99,,,,,,,214.9400,832.7900,percent of total billed charges,32.3% of $832.79 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,832.7900,124.9200,WELLCARE,WELLCARE MEDICAID,832.79,,,,,,,214.9400,832.7900,percent of total billed charges,100% of $832.79 in Billed Charges for Rev 272 = $832.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,5125.9900,768.9000,AETNA,AETNA,2188.80,,,,,,,1323.0200,5125.9900,percent of total billed charges,"42.7% of $5,125.99 in Billed Charges for Rev 272 = $2,188.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,5125.9900,768.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3588.19,,,,,,,1323.0200,5125.9900,percent of total billed charges,"Rev 272 $5,125.99 in Billed Charges at 70% = $3,588.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,5125.9900,768.9000,CIGNA HEALTHCARE,CIGNA HMO,2137.54,,,,,,,1323.0200,5125.9900,percent of total billed charges,"41.7% of $5,125.99 in Billed Charges for Rev 272 = $2,137.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,5125.9900,768.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2378.46,,,,,,,1323.0200,5125.9900,percent of total billed charges,"46.4% of $5,125.99 in Billed Charges for Rev 272 = $2,378.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,5125.9900,768.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2137.54,,,,,,,1323.0200,5125.9900,percent of total billed charges,"41.7% of $5,125.99 in Billed Charges for Rev 272 = $2,137.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,5125.9900,768.9000,CIGNA HEALTHCARE,CIGNA PPO,2137.54,,,,,,,1323.0200,5125.9900,percent of total billed charges,"41.7% of $5,125.99 in Billed Charges for Rev 272 = $2,137.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,5125.9900,768.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4613.39,,,,,,,1323.0200,5125.9900,percent of total billed charges,"90% of $5,125.99 in Billed Charges for Rev 272 = $4,613.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,5125.9900,768.9000,MEDCOST,MEDCOST VHN,2439.46,,,,,,,1323.0200,5125.9900,percent of total billed charges,"47.59% of $5,125.99 in Billed Charges for Rev 272 = $2,439.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,5125.9900,768.9000,SENTARA HEALTH,SENTARA HEALTH,1323.02,,,,,,,1323.0200,5125.9900,percent of total billed charges,"25.81% of $5,125.99 in Billed Charges for Rev 272 = $1,323.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,5125.9900,768.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5125.99,,,,,,,1323.0200,5125.9900,percent of total billed charges,"100% of $5,125.99 in Billed Charges for Rev 272 = $5,125.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,5125.9900,768.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2563.00,,,,,,,1323.0200,5125.9900,percent of total billed charges,"Rev 272 $5,125.99 in Billed Charges at 50% = $2,563.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,5125.9900,768.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1655.69,,,,,,,1323.0200,5125.9900,other,"32.3% of $5,125.99 in Billed Charges for Rev 272 = $1,655.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,5125.9900,768.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1573.68,,,,,,,1323.0200,5125.9900,other,"30.7% of $5,125.99 in Billed Charges for Rev 272 = $1,573.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,5125.9900,768.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,1655.69,,,,,,,1323.0200,5125.9900,percent of total billed charges,"32.3% of $5,125.99 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS ACE PLUS CURVED 5X45,272,RC,27200002,CDM,,,,,,both,,,5125.9900,768.9000,WELLCARE,WELLCARE MEDICAID,5125.99,,,,,,,1323.0200,5125.9900,percent of total billed charges,"100% of $5,125.99 in Billed Charges for Rev 272 = $5,125.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,3987.2300,598.0800,AETNA,AETNA,1702.55,,,,,,,1029.1000,3987.2300,percent of total billed charges,"42.7% of $3,987.23 in Billed Charges for Rev 272 = $1,702.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,3987.2300,598.0800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2791.06,,,,,,,1029.1000,3987.2300,percent of total billed charges,"Rev 272 $3,987.23 in Billed Charges at 70% = $2,791.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,3987.2300,598.0800,CIGNA HEALTHCARE,CIGNA HMO,1662.67,,,,,,,1029.1000,3987.2300,percent of total billed charges,"41.7% of $3,987.23 in Billed Charges for Rev 272 = $1,662.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,3987.2300,598.0800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1850.07,,,,,,,1029.1000,3987.2300,percent of total billed charges,"46.4% of $3,987.23 in Billed Charges for Rev 272 = $1,850.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,3987.2300,598.0800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1662.67,,,,,,,1029.1000,3987.2300,percent of total billed charges,"41.7% of $3,987.23 in Billed Charges for Rev 272 = $1,662.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,3987.2300,598.0800,CIGNA HEALTHCARE,CIGNA PPO,1662.67,,,,,,,1029.1000,3987.2300,percent of total billed charges,"41.7% of $3,987.23 in Billed Charges for Rev 272 = $1,662.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,3987.2300,598.0800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3588.51,,,,,,,1029.1000,3987.2300,percent of total billed charges,"90% of $3,987.23 in Billed Charges for Rev 272 = $3,588.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,3987.2300,598.0800,MEDCOST,MEDCOST VHN,1897.52,,,,,,,1029.1000,3987.2300,percent of total billed charges,"47.59% of $3,987.23 in Billed Charges for Rev 272 = $1,897.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,3987.2300,598.0800,SENTARA HEALTH,SENTARA HEALTH,1029.10,,,,,,,1029.1000,3987.2300,percent of total billed charges,"25.81% of $3,987.23 in Billed Charges for Rev 272 = $1,029.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,3987.2300,598.0800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3987.23,,,,,,,1029.1000,3987.2300,percent of total billed charges,"100% of $3,987.23 in Billed Charges for Rev 272 = $3,987.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,3987.2300,598.0800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1993.62,,,,,,,1029.1000,3987.2300,percent of total billed charges,"Rev 272 $3,987.23 in Billed Charges at 50% = $1,993.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,3987.2300,598.0800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1287.88,,,,,,,1029.1000,3987.2300,other,"32.3% of $3,987.23 in Billed Charges for Rev 272 = $1,287.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,3987.2300,598.0800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1224.08,,,,,,,1029.1000,3987.2300,other,"30.7% of $3,987.23 in Billed Charges for Rev 272 = $1,224.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,3987.2300,598.0800,UNITED HEALTHCARE,UNITED HEALTHCARE,1287.88,,,,,,,1029.1000,3987.2300,percent of total billed charges,"32.3% of $3,987.23 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,3987.2300,598.0800,WELLCARE,WELLCARE MEDICAID,3987.23,,,,,,,1029.1000,3987.2300,percent of total billed charges,"100% of $3,987.23 in Billed Charges for Rev 272 = $3,987.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,24177.5000,3626.6300,AETNA,AETNA,10323.79,,,,,,,6240.2100,24177.5000,percent of total billed charges,"42.7% of $24,177.50 in Billed Charges for Rev 272 = $10,323.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,24177.5000,3626.6300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,16924.25,,,,,,,6240.2100,24177.5000,percent of total billed charges,"Rev 272 $24,177.50 in Billed Charges at 70% = $16,924.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,24177.5000,3626.6300,CIGNA HEALTHCARE,CIGNA HMO,10082.02,,,,,,,6240.2100,24177.5000,percent of total billed charges,"41.7% of $24,177.50 in Billed Charges for Rev 272 = $10,082.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,24177.5000,3626.6300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11218.36,,,,,,,6240.2100,24177.5000,percent of total billed charges,"46.4% of $24,177.50 in Billed Charges for Rev 272 = $11,218.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,24177.5000,3626.6300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,10082.02,,,,,,,6240.2100,24177.5000,percent of total billed charges,"41.7% of $24,177.50 in Billed Charges for Rev 272 = $10,082.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,24177.5000,3626.6300,CIGNA HEALTHCARE,CIGNA PPO,10082.02,,,,,,,6240.2100,24177.5000,percent of total billed charges,"41.7% of $24,177.50 in Billed Charges for Rev 272 = $10,082.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,24177.5000,3626.6300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,21759.75,,,,,,,6240.2100,24177.5000,percent of total billed charges,"90% of $24,177.50 in Billed Charges for Rev 272 = $21,759.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,24177.5000,3626.6300,MEDCOST,MEDCOST VHN,11506.07,,,,,,,6240.2100,24177.5000,percent of total billed charges,"47.59% of $24,177.50 in Billed Charges for Rev 272 = $11,506.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,24177.5000,3626.6300,SENTARA HEALTH,SENTARA HEALTH,6240.21,,,,,,,6240.2100,24177.5000,percent of total billed charges,"25.81% of $24,177.50 in Billed Charges for Rev 272 = $6,240.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,24177.5000,3626.6300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",24177.50,,,,,,,6240.2100,24177.5000,percent of total billed charges,"100% of $24,177.50 in Billed Charges for Rev 272 = $24,177.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,24177.5000,3626.6300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,12088.75,,,,,,,6240.2100,24177.5000,percent of total billed charges,"Rev 272 $24,177.50 in Billed Charges at 50% = $12,088.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,24177.5000,3626.6300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7809.33,,,,,,,6240.2100,24177.5000,other,"32.3% of $24,177.50 in Billed Charges for Rev 272 = $7,809.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,24177.5000,3626.6300,UNITED HEALTHCARE,UHC HERITAGE SELECT,7422.49,,,,,,,6240.2100,24177.5000,other,"30.7% of $24,177.50 in Billed Charges for Rev 272 = $7,422.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,24177.5000,3626.6300,UNITED HEALTHCARE,UNITED HEALTHCARE,7809.33,,,,,,,6240.2100,24177.5000,percent of total billed charges,"32.3% of $24,177.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS FOCUS 3CM CURVED,272,RC,27200002,CDM,,,,,,both,,,24177.5000,3626.6300,WELLCARE,WELLCARE MEDICAID,24177.50,,,,,,,6240.2100,24177.5000,percent of total billed charges,"100% of $24,177.50 in Billed Charges for Rev 272 = $24,177.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE XPAK  2 TROCAR TIP,272,RC,,,,,,,,both,,,591.6700,88.7500,AETNA,AETNA,252.64,,,,,,,152.7100,591.6700,percent of total billed charges,42.7% of $591.67 in Billed Charges for Rev 272 = $252.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE XPAK  2 TROCAR TIP,272,RC,,,,,,,,both,,,591.6700,88.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,414.17,,,,,,,152.7100,591.6700,percent of total billed charges,Rev 272 $591.67 in Billed Charges at 70% = $414.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE XPAK  2 TROCAR TIP,272,RC,,,,,,,,both,,,591.6700,88.7500,CIGNA HEALTHCARE,CIGNA HMO,246.73,,,,,,,152.7100,591.6700,percent of total billed charges,41.7% of $591.67 in Billed Charges for Rev 272 = $246.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE XPAK  2 TROCAR TIP,272,RC,,,,,,,,both,,,591.6700,88.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,274.53,,,,,,,152.7100,591.6700,percent of total billed charges,46.4% of $591.67 in Billed Charges for Rev 272 = $274.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE XPAK  2 TROCAR TIP,272,RC,,,,,,,,both,,,591.6700,88.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,246.73,,,,,,,152.7100,591.6700,percent of total billed charges,41.7% of $591.67 in Billed Charges for Rev 272 = $246.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE XPAK  2 TROCAR TIP,272,RC,,,,,,,,both,,,591.6700,88.7500,CIGNA HEALTHCARE,CIGNA PPO,246.73,,,,,,,152.7100,591.6700,percent of total billed charges,41.7% of $591.67 in Billed Charges for Rev 272 = $246.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE XPAK  2 TROCAR TIP,272,RC,,,,,,,,both,,,591.6700,88.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,532.50,,,,,,,152.7100,591.6700,percent of total billed charges,90% of $591.67 in Billed Charges for Rev 272 = $532.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE XPAK  2 TROCAR TIP,272,RC,,,,,,,,both,,,591.6700,88.7500,MEDCOST,MEDCOST VHN,281.58,,,,,,,152.7100,591.6700,percent of total billed charges,47.59% of $591.67 in Billed Charges for Rev 272 = $281.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE XPAK  2 TROCAR TIP,272,RC,,,,,,,,both,,,591.6700,88.7500,SENTARA HEALTH,SENTARA HEALTH,152.71,,,,,,,152.7100,591.6700,percent of total billed charges,25.81% of $591.67 in Billed Charges for Rev 272 = $152.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE XPAK  2 TROCAR TIP,272,RC,,,,,,,,both,,,591.6700,88.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",591.67,,,,,,,152.7100,591.6700,percent of total billed charges,100% of $591.67 in Billed Charges for Rev 272 = $591.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE XPAK  2 TROCAR TIP,272,RC,,,,,,,,both,,,591.6700,88.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,295.84,,,,,,,152.7100,591.6700,percent of total billed charges,Rev 272 $591.67 in Billed Charges at 50% = $295.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE XPAK  2 TROCAR TIP,272,RC,,,,,,,,both,,,591.6700,88.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,191.11,,,,,,,152.7100,591.6700,other,32.3% of $591.67 in Billed Charges for Rev 272 = $191.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE XPAK  2 TROCAR TIP,272,RC,,,,,,,,both,,,591.6700,88.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,181.64,,,,,,,152.7100,591.6700,other,30.7% of $591.67 in Billed Charges for Rev 272 = $181.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE XPAK  2 TROCAR TIP,272,RC,,,,,,,,both,,,591.6700,88.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,191.11,,,,,,,152.7100,591.6700,percent of total billed charges,32.3% of $591.67 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE XPAK  2 TROCAR TIP,272,RC,,,,,,,,both,,,591.6700,88.7500,WELLCARE,WELLCARE MEDICAID,591.67,,,,,,,152.7100,591.6700,percent of total billed charges,100% of $591.67 in Billed Charges for Rev 272 = $591.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE-áEZ-SHOT-á3-áPLUS-á25G-áASP-áFNA,272,RC,27200002,CDM,,,,,,both,,,1971.7300,295.7600,AETNA,AETNA,841.93,,,,,,,508.9000,1971.7300,percent of total billed charges,"42.7% of $1,971.73 in Billed Charges for Rev 272 = $841.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE-áEZ-SHOT-á3-áPLUS-á25G-áASP-áFNA,272,RC,27200002,CDM,,,,,,both,,,1971.7300,295.7600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1380.21,,,,,,,508.9000,1971.7300,percent of total billed charges,"Rev 272 $1,971.73 in Billed Charges at 70% = $1,380.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE-áEZ-SHOT-á3-áPLUS-á25G-áASP-áFNA,272,RC,27200002,CDM,,,,,,both,,,1971.7300,295.7600,CIGNA HEALTHCARE,CIGNA HMO,822.21,,,,,,,508.9000,1971.7300,percent of total billed charges,"41.7% of $1,971.73 in Billed Charges for Rev 272 = $822.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE-áEZ-SHOT-á3-áPLUS-á25G-áASP-áFNA,272,RC,27200002,CDM,,,,,,both,,,1971.7300,295.7600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,914.88,,,,,,,508.9000,1971.7300,percent of total billed charges,"46.4% of $1,971.73 in Billed Charges for Rev 272 = $914.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE-áEZ-SHOT-á3-áPLUS-á25G-áASP-áFNA,272,RC,27200002,CDM,,,,,,both,,,1971.7300,295.7600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,822.21,,,,,,,508.9000,1971.7300,percent of total billed charges,"41.7% of $1,971.73 in Billed Charges for Rev 272 = $822.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE-áEZ-SHOT-á3-áPLUS-á25G-áASP-áFNA,272,RC,27200002,CDM,,,,,,both,,,1971.7300,295.7600,CIGNA HEALTHCARE,CIGNA PPO,822.21,,,,,,,508.9000,1971.7300,percent of total billed charges,"41.7% of $1,971.73 in Billed Charges for Rev 272 = $822.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE-áEZ-SHOT-á3-áPLUS-á25G-áASP-áFNA,272,RC,27200002,CDM,,,,,,both,,,1971.7300,295.7600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1774.56,,,,,,,508.9000,1971.7300,percent of total billed charges,"90% of $1,971.73 in Billed Charges for Rev 272 = $1,774.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE-áEZ-SHOT-á3-áPLUS-á25G-áASP-áFNA,272,RC,27200002,CDM,,,,,,both,,,1971.7300,295.7600,MEDCOST,MEDCOST VHN,938.35,,,,,,,508.9000,1971.7300,percent of total billed charges,"47.59% of $1,971.73 in Billed Charges for Rev 272 = $938.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE-áEZ-SHOT-á3-áPLUS-á25G-áASP-áFNA,272,RC,27200002,CDM,,,,,,both,,,1971.7300,295.7600,SENTARA HEALTH,SENTARA HEALTH,508.90,,,,,,,508.9000,1971.7300,percent of total billed charges,"25.81% of $1,971.73 in Billed Charges for Rev 272 = $508.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE-áEZ-SHOT-á3-áPLUS-á25G-áASP-áFNA,272,RC,27200002,CDM,,,,,,both,,,1971.7300,295.7600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1971.73,,,,,,,508.9000,1971.7300,percent of total billed charges,"100% of $1,971.73 in Billed Charges for Rev 272 = $1,971.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE-áEZ-SHOT-á3-áPLUS-á25G-áASP-áFNA,272,RC,27200002,CDM,,,,,,both,,,1971.7300,295.7600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,985.87,,,,,,,508.9000,1971.7300,percent of total billed charges,"Rev 272 $1,971.73 in Billed Charges at 50% = $985.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE-áEZ-SHOT-á3-áPLUS-á25G-áASP-áFNA,272,RC,27200002,CDM,,,,,,both,,,1971.7300,295.7600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,636.87,,,,,,,508.9000,1971.7300,other,"32.3% of $1,971.73 in Billed Charges for Rev 272 = $636.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE-áEZ-SHOT-á3-áPLUS-á25G-áASP-áFNA,272,RC,27200002,CDM,,,,,,both,,,1971.7300,295.7600,UNITED HEALTHCARE,UHC HERITAGE SELECT,605.32,,,,,,,508.9000,1971.7300,other,"30.7% of $1,971.73 in Billed Charges for Rev 272 = $605.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE-áEZ-SHOT-á3-áPLUS-á25G-áASP-áFNA,272,RC,27200002,CDM,,,,,,both,,,1971.7300,295.7600,UNITED HEALTHCARE,UNITED HEALTHCARE,636.87,,,,,,,508.9000,1971.7300,percent of total billed charges,"32.3% of $1,971.73 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE-áEZ-SHOT-á3-áPLUS-á25G-áASP-áFNA,272,RC,27200002,CDM,,,,,,both,,,1971.7300,295.7600,WELLCARE,WELLCARE MEDICAID,1971.73,,,,,,,508.9000,1971.7300,percent of total billed charges,"100% of $1,971.73 in Billed Charges for Rev 272 = $1,971.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NERVE STIMULATOR DISPOSABLE BALL TIP,272,RC,27200002,CDM,,,,,,both,,,774.5100,116.1800,AETNA,AETNA,330.72,,,,,,,199.9000,774.5100,percent of total billed charges,42.7% of $774.51 in Billed Charges for Rev 272 = $330.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NERVE STIMULATOR DISPOSABLE BALL TIP,272,RC,27200002,CDM,,,,,,both,,,774.5100,116.1800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,542.16,,,,,,,199.9000,774.5100,percent of total billed charges,Rev 272 $774.51 in Billed Charges at 70% = $542.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NERVE STIMULATOR DISPOSABLE BALL TIP,272,RC,27200002,CDM,,,,,,both,,,774.5100,116.1800,CIGNA HEALTHCARE,CIGNA HMO,322.97,,,,,,,199.9000,774.5100,percent of total billed charges,41.7% of $774.51 in Billed Charges for Rev 272 = $322.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NERVE STIMULATOR DISPOSABLE BALL TIP,272,RC,27200002,CDM,,,,,,both,,,774.5100,116.1800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,359.37,,,,,,,199.9000,774.5100,percent of total billed charges,46.4% of $774.51 in Billed Charges for Rev 272 = $359.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NERVE STIMULATOR DISPOSABLE BALL TIP,272,RC,27200002,CDM,,,,,,both,,,774.5100,116.1800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,322.97,,,,,,,199.9000,774.5100,percent of total billed charges,41.7% of $774.51 in Billed Charges for Rev 272 = $322.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NERVE STIMULATOR DISPOSABLE BALL TIP,272,RC,27200002,CDM,,,,,,both,,,774.5100,116.1800,CIGNA HEALTHCARE,CIGNA PPO,322.97,,,,,,,199.9000,774.5100,percent of total billed charges,41.7% of $774.51 in Billed Charges for Rev 272 = $322.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NERVE STIMULATOR DISPOSABLE BALL TIP,272,RC,27200002,CDM,,,,,,both,,,774.5100,116.1800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,697.06,,,,,,,199.9000,774.5100,percent of total billed charges,90% of $774.51 in Billed Charges for Rev 272 = $697.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NERVE STIMULATOR DISPOSABLE BALL TIP,272,RC,27200002,CDM,,,,,,both,,,774.5100,116.1800,MEDCOST,MEDCOST VHN,368.59,,,,,,,199.9000,774.5100,percent of total billed charges,47.59% of $774.51 in Billed Charges for Rev 272 = $368.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NERVE STIMULATOR DISPOSABLE BALL TIP,272,RC,27200002,CDM,,,,,,both,,,774.5100,116.1800,SENTARA HEALTH,SENTARA HEALTH,199.90,,,,,,,199.9000,774.5100,percent of total billed charges,25.81% of $774.51 in Billed Charges for Rev 272 = $199.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NERVE STIMULATOR DISPOSABLE BALL TIP,272,RC,27200002,CDM,,,,,,both,,,774.5100,116.1800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",774.51,,,,,,,199.9000,774.5100,percent of total billed charges,100% of $774.51 in Billed Charges for Rev 272 = $774.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NERVE STIMULATOR DISPOSABLE BALL TIP,272,RC,27200002,CDM,,,,,,both,,,774.5100,116.1800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,387.26,,,,,,,199.9000,774.5100,percent of total billed charges,Rev 272 $774.51 in Billed Charges at 50% = $387.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NERVE STIMULATOR DISPOSABLE BALL TIP,272,RC,27200002,CDM,,,,,,both,,,774.5100,116.1800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,250.17,,,,,,,199.9000,774.5100,other,32.3% of $774.51 in Billed Charges for Rev 272 = $250.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NERVE STIMULATOR DISPOSABLE BALL TIP,272,RC,27200002,CDM,,,,,,both,,,774.5100,116.1800,UNITED HEALTHCARE,UHC HERITAGE SELECT,237.77,,,,,,,199.9000,774.5100,other,30.7% of $774.51 in Billed Charges for Rev 272 = $237.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NERVE STIMULATOR DISPOSABLE BALL TIP,272,RC,27200002,CDM,,,,,,both,,,774.5100,116.1800,UNITED HEALTHCARE,UNITED HEALTHCARE,250.17,,,,,,,199.9000,774.5100,percent of total billed charges,32.3% of $774.51 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NERVE STIMULATOR DISPOSABLE BALL TIP,272,RC,27200002,CDM,,,,,,both,,,774.5100,116.1800,WELLCARE,WELLCARE MEDICAID,774.51,,,,,,,199.9000,774.5100,percent of total billed charges,100% of $774.51 in Billed Charges for Rev 272 = $774.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SHEARS HARMONIC LONG 17CM,272,RC,27200002,CDM,,,,,,both,,,4358.9500,653.8400,AETNA,AETNA,1861.27,,,,,,,1125.0500,4358.9500,percent of total billed charges,"42.7% of $4,358.95 in Billed Charges for Rev 272 = $1,861.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC LONG 17CM,272,RC,27200002,CDM,,,,,,both,,,4358.9500,653.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3051.27,,,,,,,1125.0500,4358.9500,percent of total billed charges,"Rev 272 $4,358.95 in Billed Charges at 70% = $3,051.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC LONG 17CM,272,RC,27200002,CDM,,,,,,both,,,4358.9500,653.8400,CIGNA HEALTHCARE,CIGNA HMO,1817.68,,,,,,,1125.0500,4358.9500,percent of total billed charges,"41.7% of $4,358.95 in Billed Charges for Rev 272 = $1,817.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC LONG 17CM,272,RC,27200002,CDM,,,,,,both,,,4358.9500,653.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2022.55,,,,,,,1125.0500,4358.9500,percent of total billed charges,"46.4% of $4,358.95 in Billed Charges for Rev 272 = $2,022.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC LONG 17CM,272,RC,27200002,CDM,,,,,,both,,,4358.9500,653.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1817.68,,,,,,,1125.0500,4358.9500,percent of total billed charges,"41.7% of $4,358.95 in Billed Charges for Rev 272 = $1,817.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC LONG 17CM,272,RC,27200002,CDM,,,,,,both,,,4358.9500,653.8400,CIGNA HEALTHCARE,CIGNA PPO,1817.68,,,,,,,1125.0500,4358.9500,percent of total billed charges,"41.7% of $4,358.95 in Billed Charges for Rev 272 = $1,817.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC LONG 17CM,272,RC,27200002,CDM,,,,,,both,,,4358.9500,653.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3923.06,,,,,,,1125.0500,4358.9500,percent of total billed charges,"90% of $4,358.95 in Billed Charges for Rev 272 = $3,923.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC LONG 17CM,272,RC,27200002,CDM,,,,,,both,,,4358.9500,653.8400,MEDCOST,MEDCOST VHN,2074.42,,,,,,,1125.0500,4358.9500,percent of total billed charges,"47.59% of $4,358.95 in Billed Charges for Rev 272 = $2,074.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC LONG 17CM,272,RC,27200002,CDM,,,,,,both,,,4358.9500,653.8400,SENTARA HEALTH,SENTARA HEALTH,1125.05,,,,,,,1125.0500,4358.9500,percent of total billed charges,"25.81% of $4,358.95 in Billed Charges for Rev 272 = $1,125.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC LONG 17CM,272,RC,27200002,CDM,,,,,,both,,,4358.9500,653.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4358.95,,,,,,,1125.0500,4358.9500,percent of total billed charges,"100% of $4,358.95 in Billed Charges for Rev 272 = $4,358.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC LONG 17CM,272,RC,27200002,CDM,,,,,,both,,,4358.9500,653.8400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2179.48,,,,,,,1125.0500,4358.9500,percent of total billed charges,"Rev 272 $4,358.95 in Billed Charges at 50% = $2,179.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC LONG 17CM,272,RC,27200002,CDM,,,,,,both,,,4358.9500,653.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1407.94,,,,,,,1125.0500,4358.9500,other,"32.3% of $4,358.95 in Billed Charges for Rev 272 = $1,407.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEARS HARMONIC LONG 17CM,272,RC,27200002,CDM,,,,,,both,,,4358.9500,653.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1338.20,,,,,,,1125.0500,4358.9500,other,"30.7% of $4,358.95 in Billed Charges for Rev 272 = $1,338.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEARS HARMONIC LONG 17CM,272,RC,27200002,CDM,,,,,,both,,,4358.9500,653.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,1407.94,,,,,,,1125.0500,4358.9500,percent of total billed charges,"32.3% of $4,358.95 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS HARMONIC LONG 17CM,272,RC,27200002,CDM,,,,,,both,,,4358.9500,653.8400,WELLCARE,WELLCARE MEDICAID,4358.95,,,,,,,1125.0500,4358.9500,percent of total billed charges,"100% of $4,358.95 in Billed Charges for Rev 272 = $4,358.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS XI 8MM HARMONIC ACE CURVED,272,RC,27200002,CDM,,,,,,both,,,5935.6700,890.3500,AETNA,AETNA,2534.53,,,,,,,1532.0000,5935.6700,percent of total billed charges,"42.7% of $5,935.67 in Billed Charges for Rev 272 = $2,534.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS XI 8MM HARMONIC ACE CURVED,272,RC,27200002,CDM,,,,,,both,,,5935.6700,890.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4154.97,,,,,,,1532.0000,5935.6700,percent of total billed charges,"Rev 272 $5,935.67 in Billed Charges at 70% = $4,154.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS XI 8MM HARMONIC ACE CURVED,272,RC,27200002,CDM,,,,,,both,,,5935.6700,890.3500,CIGNA HEALTHCARE,CIGNA HMO,2475.17,,,,,,,1532.0000,5935.6700,percent of total billed charges,"41.7% of $5,935.67 in Billed Charges for Rev 272 = $2,475.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS XI 8MM HARMONIC ACE CURVED,272,RC,27200002,CDM,,,,,,both,,,5935.6700,890.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2754.15,,,,,,,1532.0000,5935.6700,percent of total billed charges,"46.4% of $5,935.67 in Billed Charges for Rev 272 = $2,754.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS XI 8MM HARMONIC ACE CURVED,272,RC,27200002,CDM,,,,,,both,,,5935.6700,890.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2475.17,,,,,,,1532.0000,5935.6700,percent of total billed charges,"41.7% of $5,935.67 in Billed Charges for Rev 272 = $2,475.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS XI 8MM HARMONIC ACE CURVED,272,RC,27200002,CDM,,,,,,both,,,5935.6700,890.3500,CIGNA HEALTHCARE,CIGNA PPO,2475.17,,,,,,,1532.0000,5935.6700,percent of total billed charges,"41.7% of $5,935.67 in Billed Charges for Rev 272 = $2,475.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS XI 8MM HARMONIC ACE CURVED,272,RC,27200002,CDM,,,,,,both,,,5935.6700,890.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5342.10,,,,,,,1532.0000,5935.6700,percent of total billed charges,"90% of $5,935.67 in Billed Charges for Rev 272 = $5,342.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS XI 8MM HARMONIC ACE CURVED,272,RC,27200002,CDM,,,,,,both,,,5935.6700,890.3500,MEDCOST,MEDCOST VHN,2824.79,,,,,,,1532.0000,5935.6700,percent of total billed charges,"47.59% of $5,935.67 in Billed Charges for Rev 272 = $2,824.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS XI 8MM HARMONIC ACE CURVED,272,RC,27200002,CDM,,,,,,both,,,5935.6700,890.3500,SENTARA HEALTH,SENTARA HEALTH,1532.00,,,,,,,1532.0000,5935.6700,percent of total billed charges,"25.81% of $5,935.67 in Billed Charges for Rev 272 = $1,532.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS XI 8MM HARMONIC ACE CURVED,272,RC,27200002,CDM,,,,,,both,,,5935.6700,890.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5935.67,,,,,,,1532.0000,5935.6700,percent of total billed charges,"100% of $5,935.67 in Billed Charges for Rev 272 = $5,935.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS XI 8MM HARMONIC ACE CURVED,272,RC,27200002,CDM,,,,,,both,,,5935.6700,890.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2967.84,,,,,,,1532.0000,5935.6700,percent of total billed charges,"Rev 272 $5,935.67 in Billed Charges at 50% = $2,967.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS XI 8MM HARMONIC ACE CURVED,272,RC,27200002,CDM,,,,,,both,,,5935.6700,890.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1917.22,,,,,,,1532.0000,5935.6700,other,"32.3% of $5,935.67 in Billed Charges for Rev 272 = $1,917.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEARS XI 8MM HARMONIC ACE CURVED,272,RC,27200002,CDM,,,,,,both,,,5935.6700,890.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1822.25,,,,,,,1532.0000,5935.6700,other,"30.7% of $5,935.67 in Billed Charges for Rev 272 = $1,822.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEARS XI 8MM HARMONIC ACE CURVED,272,RC,27200002,CDM,,,,,,both,,,5935.6700,890.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,1917.22,,,,,,,1532.0000,5935.6700,percent of total billed charges,"32.3% of $5,935.67 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEARS XI 8MM HARMONIC ACE CURVED,272,RC,27200002,CDM,,,,,,both,,,5935.6700,890.3500,WELLCARE,WELLCARE MEDICAID,5935.67,,,,,,,1532.0000,5935.6700,percent of total billed charges,"100% of $5,935.67 in Billed Charges for Rev 272 = $5,935.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL HEADLESS 3.2 X 75MM,272,RC,27200002,CDM,,,,,,both,,,3166.2700,474.9400,AETNA,AETNA,1352.00,,,,,,,817.2100,3166.2700,percent of total billed charges,"42.7% of $3,166.27 in Billed Charges for Rev 272 = $1,352.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL HEADLESS 3.2 X 75MM,272,RC,27200002,CDM,,,,,,both,,,3166.2700,474.9400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2216.39,,,,,,,817.2100,3166.2700,percent of total billed charges,"Rev 272 $3,166.27 in Billed Charges at 70% = $2,216.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL HEADLESS 3.2 X 75MM,272,RC,27200002,CDM,,,,,,both,,,3166.2700,474.9400,CIGNA HEALTHCARE,CIGNA HMO,1320.33,,,,,,,817.2100,3166.2700,percent of total billed charges,"41.7% of $3,166.27 in Billed Charges for Rev 272 = $1,320.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL HEADLESS 3.2 X 75MM,272,RC,27200002,CDM,,,,,,both,,,3166.2700,474.9400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1469.15,,,,,,,817.2100,3166.2700,percent of total billed charges,"46.4% of $3,166.27 in Billed Charges for Rev 272 = $1,469.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL HEADLESS 3.2 X 75MM,272,RC,27200002,CDM,,,,,,both,,,3166.2700,474.9400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1320.33,,,,,,,817.2100,3166.2700,percent of total billed charges,"41.7% of $3,166.27 in Billed Charges for Rev 272 = $1,320.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL HEADLESS 3.2 X 75MM,272,RC,27200002,CDM,,,,,,both,,,3166.2700,474.9400,CIGNA HEALTHCARE,CIGNA PPO,1320.33,,,,,,,817.2100,3166.2700,percent of total billed charges,"41.7% of $3,166.27 in Billed Charges for Rev 272 = $1,320.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL HEADLESS 3.2 X 75MM,272,RC,27200002,CDM,,,,,,both,,,3166.2700,474.9400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2849.64,,,,,,,817.2100,3166.2700,percent of total billed charges,"90% of $3,166.27 in Billed Charges for Rev 272 = $2,849.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL HEADLESS 3.2 X 75MM,272,RC,27200002,CDM,,,,,,both,,,3166.2700,474.9400,MEDCOST,MEDCOST VHN,1506.83,,,,,,,817.2100,3166.2700,percent of total billed charges,"47.59% of $3,166.27 in Billed Charges for Rev 272 = $1,506.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL HEADLESS 3.2 X 75MM,272,RC,27200002,CDM,,,,,,both,,,3166.2700,474.9400,SENTARA HEALTH,SENTARA HEALTH,817.21,,,,,,,817.2100,3166.2700,percent of total billed charges,"25.81% of $3,166.27 in Billed Charges for Rev 272 = $817.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL HEADLESS 3.2 X 75MM,272,RC,27200002,CDM,,,,,,both,,,3166.2700,474.9400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3166.27,,,,,,,817.2100,3166.2700,percent of total billed charges,"100% of $3,166.27 in Billed Charges for Rev 272 = $3,166.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL HEADLESS 3.2 X 75MM,272,RC,27200002,CDM,,,,,,both,,,3166.2700,474.9400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1583.14,,,,,,,817.2100,3166.2700,percent of total billed charges,"Rev 272 $3,166.27 in Billed Charges at 50% = $1,583.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL HEADLESS 3.2 X 75MM,272,RC,27200002,CDM,,,,,,both,,,3166.2700,474.9400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1022.71,,,,,,,817.2100,3166.2700,other,"32.3% of $3,166.27 in Billed Charges for Rev 272 = $1,022.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PIN DRILL HEADLESS 3.2 X 75MM,272,RC,27200002,CDM,,,,,,both,,,3166.2700,474.9400,UNITED HEALTHCARE,UHC HERITAGE SELECT,972.04,,,,,,,817.2100,3166.2700,other,"30.7% of $3,166.27 in Billed Charges for Rev 272 = $972.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PIN DRILL HEADLESS 3.2 X 75MM,272,RC,27200002,CDM,,,,,,both,,,3166.2700,474.9400,UNITED HEALTHCARE,UNITED HEALTHCARE,1022.71,,,,,,,817.2100,3166.2700,percent of total billed charges,"32.3% of $3,166.27 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL HEADLESS 3.2 X 75MM,272,RC,27200002,CDM,,,,,,both,,,3166.2700,474.9400,WELLCARE,WELLCARE MEDICAID,3166.27,,,,,,,817.2100,3166.2700,percent of total billed charges,"100% of $3,166.27 in Billed Charges for Rev 272 = $3,166.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN GUIDE 3.2 X 300,272,RC,,,,,,,,both,,,3655.1600,548.2700,AETNA,AETNA,1560.75,,,,,,,943.4000,3655.1600,percent of total billed charges,"42.7% of $3,655.16 in Billed Charges for Rev 272 = $1,560.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN GUIDE 3.2 X 300,272,RC,,,,,,,,both,,,3655.1600,548.2700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2558.61,,,,,,,943.4000,3655.1600,percent of total billed charges,"Rev 272 $3,655.16 in Billed Charges at 70% = $2,558.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN GUIDE 3.2 X 300,272,RC,,,,,,,,both,,,3655.1600,548.2700,CIGNA HEALTHCARE,CIGNA HMO,1524.20,,,,,,,943.4000,3655.1600,percent of total billed charges,"41.7% of $3,655.16 in Billed Charges for Rev 272 = $1,524.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN GUIDE 3.2 X 300,272,RC,,,,,,,,both,,,3655.1600,548.2700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1695.99,,,,,,,943.4000,3655.1600,percent of total billed charges,"46.4% of $3,655.16 in Billed Charges for Rev 272 = $1,695.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN GUIDE 3.2 X 300,272,RC,,,,,,,,both,,,3655.1600,548.2700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1524.20,,,,,,,943.4000,3655.1600,percent of total billed charges,"41.7% of $3,655.16 in Billed Charges for Rev 272 = $1,524.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN GUIDE 3.2 X 300,272,RC,,,,,,,,both,,,3655.1600,548.2700,CIGNA HEALTHCARE,CIGNA PPO,1524.20,,,,,,,943.4000,3655.1600,percent of total billed charges,"41.7% of $3,655.16 in Billed Charges for Rev 272 = $1,524.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN GUIDE 3.2 X 300,272,RC,,,,,,,,both,,,3655.1600,548.2700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3289.64,,,,,,,943.4000,3655.1600,percent of total billed charges,"90% of $3,655.16 in Billed Charges for Rev 272 = $3,289.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN GUIDE 3.2 X 300,272,RC,,,,,,,,both,,,3655.1600,548.2700,MEDCOST,MEDCOST VHN,1739.49,,,,,,,943.4000,3655.1600,percent of total billed charges,"47.59% of $3,655.16 in Billed Charges for Rev 272 = $1,739.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN GUIDE 3.2 X 300,272,RC,,,,,,,,both,,,3655.1600,548.2700,SENTARA HEALTH,SENTARA HEALTH,943.40,,,,,,,943.4000,3655.1600,percent of total billed charges,"25.81% of $3,655.16 in Billed Charges for Rev 272 = $943.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN GUIDE 3.2 X 300,272,RC,,,,,,,,both,,,3655.1600,548.2700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3655.16,,,,,,,943.4000,3655.1600,percent of total billed charges,"100% of $3,655.16 in Billed Charges for Rev 272 = $3,655.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN GUIDE 3.2 X 300,272,RC,,,,,,,,both,,,3655.1600,548.2700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1827.58,,,,,,,943.4000,3655.1600,percent of total billed charges,"Rev 272 $3,655.16 in Billed Charges at 50% = $1,827.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN GUIDE 3.2 X 300,272,RC,,,,,,,,both,,,3655.1600,548.2700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1180.62,,,,,,,943.4000,3655.1600,other,"32.3% of $3,655.16 in Billed Charges for Rev 272 = $1,180.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PIN GUIDE 3.2 X 300,272,RC,,,,,,,,both,,,3655.1600,548.2700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1122.13,,,,,,,943.4000,3655.1600,other,"30.7% of $3,655.16 in Billed Charges for Rev 272 = $1,122.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PIN GUIDE 3.2 X 300,272,RC,,,,,,,,both,,,3655.1600,548.2700,UNITED HEALTHCARE,UNITED HEALTHCARE,1180.62,,,,,,,943.4000,3655.1600,percent of total billed charges,"32.3% of $3,655.16 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN GUIDE 3.2 X 300,272,RC,,,,,,,,both,,,3655.1600,548.2700,WELLCARE,WELLCARE MEDICAID,3655.16,,,,,,,943.4000,3655.1600,percent of total billed charges,"100% of $3,655.16 in Billed Charges for Rev 272 = $3,655.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH ACCESS UROPASS 12 14FR,272,RC,27200002,CDM,,,,,,both,,,1137.3300,170.6000,AETNA,AETNA,485.64,,,,,,,293.5400,1137.3300,percent of total billed charges,"42.7% of $1,137.33 in Billed Charges for Rev 272 = $485.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH ACCESS UROPASS 12 14FR,272,RC,27200002,CDM,,,,,,both,,,1137.3300,170.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,796.13,,,,,,,293.5400,1137.3300,percent of total billed charges,"Rev 272 $1,137.33 in Billed Charges at 70% = $796.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH ACCESS UROPASS 12 14FR,272,RC,27200002,CDM,,,,,,both,,,1137.3300,170.6000,CIGNA HEALTHCARE,CIGNA HMO,474.27,,,,,,,293.5400,1137.3300,percent of total billed charges,"41.7% of $1,137.33 in Billed Charges for Rev 272 = $474.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH ACCESS UROPASS 12 14FR,272,RC,27200002,CDM,,,,,,both,,,1137.3300,170.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,527.72,,,,,,,293.5400,1137.3300,percent of total billed charges,"46.4% of $1,137.33 in Billed Charges for Rev 272 = $527.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH ACCESS UROPASS 12 14FR,272,RC,27200002,CDM,,,,,,both,,,1137.3300,170.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,474.27,,,,,,,293.5400,1137.3300,percent of total billed charges,"41.7% of $1,137.33 in Billed Charges for Rev 272 = $474.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH ACCESS UROPASS 12 14FR,272,RC,27200002,CDM,,,,,,both,,,1137.3300,170.6000,CIGNA HEALTHCARE,CIGNA PPO,474.27,,,,,,,293.5400,1137.3300,percent of total billed charges,"41.7% of $1,137.33 in Billed Charges for Rev 272 = $474.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH ACCESS UROPASS 12 14FR,272,RC,27200002,CDM,,,,,,both,,,1137.3300,170.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1023.60,,,,,,,293.5400,1137.3300,percent of total billed charges,"90% of $1,137.33 in Billed Charges for Rev 272 = $1,023.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH ACCESS UROPASS 12 14FR,272,RC,27200002,CDM,,,,,,both,,,1137.3300,170.6000,MEDCOST,MEDCOST VHN,541.26,,,,,,,293.5400,1137.3300,percent of total billed charges,"47.59% of $1,137.33 in Billed Charges for Rev 272 = $541.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH ACCESS UROPASS 12 14FR,272,RC,27200002,CDM,,,,,,both,,,1137.3300,170.6000,SENTARA HEALTH,SENTARA HEALTH,293.54,,,,,,,293.5400,1137.3300,percent of total billed charges,"25.81% of $1,137.33 in Billed Charges for Rev 272 = $293.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH ACCESS UROPASS 12 14FR,272,RC,27200002,CDM,,,,,,both,,,1137.3300,170.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1137.33,,,,,,,293.5400,1137.3300,percent of total billed charges,"100% of $1,137.33 in Billed Charges for Rev 272 = $1,137.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH ACCESS UROPASS 12 14FR,272,RC,27200002,CDM,,,,,,both,,,1137.3300,170.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,568.67,,,,,,,293.5400,1137.3300,percent of total billed charges,"Rev 272 $1,137.33 in Billed Charges at 50% = $568.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH ACCESS UROPASS 12 14FR,272,RC,27200002,CDM,,,,,,both,,,1137.3300,170.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,367.36,,,,,,,293.5400,1137.3300,other,"32.3% of $1,137.33 in Billed Charges for Rev 272 = $367.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEATH ACCESS UROPASS 12 14FR,272,RC,27200002,CDM,,,,,,both,,,1137.3300,170.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,349.16,,,,,,,293.5400,1137.3300,other,"30.7% of $1,137.33 in Billed Charges for Rev 272 = $349.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SHEATH ACCESS UROPASS 12 14FR,272,RC,27200002,CDM,,,,,,both,,,1137.3300,170.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,367.36,,,,,,,293.5400,1137.3300,percent of total billed charges,"32.3% of $1,137.33 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SHEATH ACCESS UROPASS 12 14FR,272,RC,27200002,CDM,,,,,,both,,,1137.3300,170.6000,WELLCARE,WELLCARE MEDICAID,1137.33,,,,,,,293.5400,1137.3300,percent of total billed charges,"100% of $1,137.33 in Billed Charges for Rev 272 = $1,137.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN POST MULTI-PARALLEL 2 HIGH,272,RC,,,,,,,,both,,,1702.5000,255.3800,AETNA,AETNA,726.97,,,,,,,439.4200,1702.5000,percent of total billed charges,"42.7% of $1,702.50 in Billed Charges for Rev 272 = $726.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN POST MULTI-PARALLEL 2 HIGH,272,RC,,,,,,,,both,,,1702.5000,255.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1191.75,,,,,,,439.4200,1702.5000,percent of total billed charges,"Rev 272 $1,702.50 in Billed Charges at 70% = $1,191.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN POST MULTI-PARALLEL 2 HIGH,272,RC,,,,,,,,both,,,1702.5000,255.3800,CIGNA HEALTHCARE,CIGNA HMO,709.94,,,,,,,439.4200,1702.5000,percent of total billed charges,"41.7% of $1,702.50 in Billed Charges for Rev 272 = $709.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN POST MULTI-PARALLEL 2 HIGH,272,RC,,,,,,,,both,,,1702.5000,255.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,789.96,,,,,,,439.4200,1702.5000,percent of total billed charges,"46.4% of $1,702.50 in Billed Charges for Rev 272 = $789.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN POST MULTI-PARALLEL 2 HIGH,272,RC,,,,,,,,both,,,1702.5000,255.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,709.94,,,,,,,439.4200,1702.5000,percent of total billed charges,"41.7% of $1,702.50 in Billed Charges for Rev 272 = $709.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN POST MULTI-PARALLEL 2 HIGH,272,RC,,,,,,,,both,,,1702.5000,255.3800,CIGNA HEALTHCARE,CIGNA PPO,709.94,,,,,,,439.4200,1702.5000,percent of total billed charges,"41.7% of $1,702.50 in Billed Charges for Rev 272 = $709.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN POST MULTI-PARALLEL 2 HIGH,272,RC,,,,,,,,both,,,1702.5000,255.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1532.25,,,,,,,439.4200,1702.5000,percent of total billed charges,"90% of $1,702.50 in Billed Charges for Rev 272 = $1,532.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN POST MULTI-PARALLEL 2 HIGH,272,RC,,,,,,,,both,,,1702.5000,255.3800,MEDCOST,MEDCOST VHN,810.22,,,,,,,439.4200,1702.5000,percent of total billed charges,"47.59% of $1,702.50 in Billed Charges for Rev 272 = $810.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN POST MULTI-PARALLEL 2 HIGH,272,RC,,,,,,,,both,,,1702.5000,255.3800,SENTARA HEALTH,SENTARA HEALTH,439.42,,,,,,,439.4200,1702.5000,percent of total billed charges,"25.81% of $1,702.50 in Billed Charges for Rev 272 = $439.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN POST MULTI-PARALLEL 2 HIGH,272,RC,,,,,,,,both,,,1702.5000,255.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1702.50,,,,,,,439.4200,1702.5000,percent of total billed charges,"100% of $1,702.50 in Billed Charges for Rev 272 = $1,702.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN POST MULTI-PARALLEL 2 HIGH,272,RC,,,,,,,,both,,,1702.5000,255.3800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,851.25,,,,,,,439.4200,1702.5000,percent of total billed charges,"Rev 272 $1,702.50 in Billed Charges at 50% = $851.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN POST MULTI-PARALLEL 2 HIGH,272,RC,,,,,,,,both,,,1702.5000,255.3800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,549.91,,,,,,,439.4200,1702.5000,other,"32.3% of $1,702.50 in Billed Charges for Rev 272 = $549.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PIN POST MULTI-PARALLEL 2 HIGH,272,RC,,,,,,,,both,,,1702.5000,255.3800,UNITED HEALTHCARE,UHC HERITAGE SELECT,522.67,,,,,,,439.4200,1702.5000,other,"30.7% of $1,702.50 in Billed Charges for Rev 272 = $522.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PIN POST MULTI-PARALLEL 2 HIGH,272,RC,,,,,,,,both,,,1702.5000,255.3800,UNITED HEALTHCARE,UNITED HEALTHCARE,549.91,,,,,,,439.4200,1702.5000,percent of total billed charges,"32.3% of $1,702.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN POST MULTI-PARALLEL 2 HIGH,272,RC,,,,,,,,both,,,1702.5000,255.3800,WELLCARE,WELLCARE MEDICAID,1702.50,,,,,,,439.4200,1702.5000,percent of total billed charges,"100% of $1,702.50 in Billed Charges for Rev 272 = $1,702.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN SELF THREADING L 150MM,272,RC,,,,,,,,both,,,482.2500,72.3400,AETNA,AETNA,205.92,,,,,,,124.4700,482.2500,percent of total billed charges,42.7% of $482.25 in Billed Charges for Rev 272 = $205.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PIN SELF THREADING L 150MM,272,RC,,,,,,,,both,,,482.2500,72.3400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,337.58,,,,,,,124.4700,482.2500,percent of total billed charges,Rev 272 $482.25 in Billed Charges at 70% = $337.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PIN SELF THREADING L 150MM,272,RC,,,,,,,,both,,,482.2500,72.3400,CIGNA HEALTHCARE,CIGNA HMO,201.10,,,,,,,124.4700,482.2500,percent of total billed charges,41.7% of $482.25 in Billed Charges for Rev 272 = $201.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PIN SELF THREADING L 150MM,272,RC,,,,,,,,both,,,482.2500,72.3400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,223.76,,,,,,,124.4700,482.2500,percent of total billed charges,46.4% of $482.25 in Billed Charges for Rev 272 = $223.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PIN SELF THREADING L 150MM,272,RC,,,,,,,,both,,,482.2500,72.3400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,201.10,,,,,,,124.4700,482.2500,percent of total billed charges,41.7% of $482.25 in Billed Charges for Rev 272 = $201.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PIN SELF THREADING L 150MM,272,RC,,,,,,,,both,,,482.2500,72.3400,CIGNA HEALTHCARE,CIGNA PPO,201.10,,,,,,,124.4700,482.2500,percent of total billed charges,41.7% of $482.25 in Billed Charges for Rev 272 = $201.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PIN SELF THREADING L 150MM,272,RC,,,,,,,,both,,,482.2500,72.3400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,434.03,,,,,,,124.4700,482.2500,percent of total billed charges,90% of $482.25 in Billed Charges for Rev 272 = $434.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PIN SELF THREADING L 150MM,272,RC,,,,,,,,both,,,482.2500,72.3400,MEDCOST,MEDCOST VHN,229.50,,,,,,,124.4700,482.2500,percent of total billed charges,47.59% of $482.25 in Billed Charges for Rev 272 = $229.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PIN SELF THREADING L 150MM,272,RC,,,,,,,,both,,,482.2500,72.3400,SENTARA HEALTH,SENTARA HEALTH,124.47,,,,,,,124.4700,482.2500,percent of total billed charges,25.81% of $482.25 in Billed Charges for Rev 272 = $124.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PIN SELF THREADING L 150MM,272,RC,,,,,,,,both,,,482.2500,72.3400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",482.25,,,,,,,124.4700,482.2500,percent of total billed charges,100% of $482.25 in Billed Charges for Rev 272 = $482.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PIN SELF THREADING L 150MM,272,RC,,,,,,,,both,,,482.2500,72.3400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,241.13,,,,,,,124.4700,482.2500,percent of total billed charges,Rev 272 $482.25 in Billed Charges at 50% = $241.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PIN SELF THREADING L 150MM,272,RC,,,,,,,,both,,,482.2500,72.3400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,155.77,,,,,,,124.4700,482.2500,other,32.3% of $482.25 in Billed Charges for Rev 272 = $155.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PIN SELF THREADING L 150MM,272,RC,,,,,,,,both,,,482.2500,72.3400,UNITED HEALTHCARE,UHC HERITAGE SELECT,148.05,,,,,,,124.4700,482.2500,other,30.7% of $482.25 in Billed Charges for Rev 272 = $148.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PIN SELF THREADING L 150MM,272,RC,,,,,,,,both,,,482.2500,72.3400,UNITED HEALTHCARE,UNITED HEALTHCARE,155.77,,,,,,,124.4700,482.2500,percent of total billed charges,32.3% of $482.25 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PIN SELF THREADING L 150MM,272,RC,,,,,,,,both,,,482.2500,72.3400,WELLCARE,WELLCARE MEDICAID,482.25,,,,,,,124.4700,482.2500,percent of total billed charges,100% of $482.25 in Billed Charges for Rev 272 = $482.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PLATE BENDER MINI NO LOCKING,272,RC,,,,,,,,both,,,6780.7700,1017.1200,AETNA,AETNA,2895.39,,,,,,,1750.1200,6780.7700,percent of total billed charges,"42.7% of $6,780.77 in Billed Charges for Rev 272 = $2,895.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE BENDER MINI NO LOCKING,272,RC,,,,,,,,both,,,6780.7700,1017.1200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4746.54,,,,,,,1750.1200,6780.7700,percent of total billed charges,"Rev 272 $6,780.77 in Billed Charges at 70% = $4,746.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE BENDER MINI NO LOCKING,272,RC,,,,,,,,both,,,6780.7700,1017.1200,CIGNA HEALTHCARE,CIGNA HMO,2827.58,,,,,,,1750.1200,6780.7700,percent of total billed charges,"41.7% of $6,780.77 in Billed Charges for Rev 272 = $2,827.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE BENDER MINI NO LOCKING,272,RC,,,,,,,,both,,,6780.7700,1017.1200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3146.28,,,,,,,1750.1200,6780.7700,percent of total billed charges,"46.4% of $6,780.77 in Billed Charges for Rev 272 = $3,146.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE BENDER MINI NO LOCKING,272,RC,,,,,,,,both,,,6780.7700,1017.1200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2827.58,,,,,,,1750.1200,6780.7700,percent of total billed charges,"41.7% of $6,780.77 in Billed Charges for Rev 272 = $2,827.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE BENDER MINI NO LOCKING,272,RC,,,,,,,,both,,,6780.7700,1017.1200,CIGNA HEALTHCARE,CIGNA PPO,2827.58,,,,,,,1750.1200,6780.7700,percent of total billed charges,"41.7% of $6,780.77 in Billed Charges for Rev 272 = $2,827.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE BENDER MINI NO LOCKING,272,RC,,,,,,,,both,,,6780.7700,1017.1200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6102.69,,,,,,,1750.1200,6780.7700,percent of total billed charges,"90% of $6,780.77 in Billed Charges for Rev 272 = $6,102.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE BENDER MINI NO LOCKING,272,RC,,,,,,,,both,,,6780.7700,1017.1200,MEDCOST,MEDCOST VHN,3226.97,,,,,,,1750.1200,6780.7700,percent of total billed charges,"47.59% of $6,780.77 in Billed Charges for Rev 272 = $3,226.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE BENDER MINI NO LOCKING,272,RC,,,,,,,,both,,,6780.7700,1017.1200,SENTARA HEALTH,SENTARA HEALTH,1750.12,,,,,,,1750.1200,6780.7700,percent of total billed charges,"25.81% of $6,780.77 in Billed Charges for Rev 272 = $1,750.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE BENDER MINI NO LOCKING,272,RC,,,,,,,,both,,,6780.7700,1017.1200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6780.77,,,,,,,1750.1200,6780.7700,percent of total billed charges,"100% of $6,780.77 in Billed Charges for Rev 272 = $6,780.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE BENDER MINI NO LOCKING,272,RC,,,,,,,,both,,,6780.7700,1017.1200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3390.39,,,,,,,1750.1200,6780.7700,percent of total billed charges,"Rev 272 $6,780.77 in Billed Charges at 50% = $3,390.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE BENDER MINI NO LOCKING,272,RC,,,,,,,,both,,,6780.7700,1017.1200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2190.19,,,,,,,1750.1200,6780.7700,other,"32.3% of $6,780.77 in Billed Charges for Rev 272 = $2,190.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PLATE BENDER MINI NO LOCKING,272,RC,,,,,,,,both,,,6780.7700,1017.1200,UNITED HEALTHCARE,UHC HERITAGE SELECT,2081.70,,,,,,,1750.1200,6780.7700,other,"30.7% of $6,780.77 in Billed Charges for Rev 272 = $2,081.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PLATE BENDER MINI NO LOCKING,272,RC,,,,,,,,both,,,6780.7700,1017.1200,UNITED HEALTHCARE,UNITED HEALTHCARE,2190.19,,,,,,,1750.1200,6780.7700,percent of total billed charges,"32.3% of $6,780.77 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE BENDER MINI NO LOCKING,272,RC,,,,,,,,both,,,6780.7700,1017.1200,WELLCARE,WELLCARE MEDICAID,6780.77,,,,,,,1750.1200,6780.7700,percent of total billed charges,"100% of $6,780.77 in Billed Charges for Rev 272 = $6,780.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE CONNECTING 3 HOLE,272,RC,,,,,,,,both,,,785.5000,117.8300,AETNA,AETNA,335.41,,,,,,,202.7400,785.5000,percent of total billed charges,42.7% of $785.50 in Billed Charges for Rev 272 = $335.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PLATE CONNECTING 3 HOLE,272,RC,,,,,,,,both,,,785.5000,117.8300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,549.85,,,,,,,202.7400,785.5000,percent of total billed charges,Rev 272 $785.50 in Billed Charges at 70% = $549.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PLATE CONNECTING 3 HOLE,272,RC,,,,,,,,both,,,785.5000,117.8300,CIGNA HEALTHCARE,CIGNA HMO,327.55,,,,,,,202.7400,785.5000,percent of total billed charges,41.7% of $785.50 in Billed Charges for Rev 272 = $327.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PLATE CONNECTING 3 HOLE,272,RC,,,,,,,,both,,,785.5000,117.8300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,364.47,,,,,,,202.7400,785.5000,percent of total billed charges,46.4% of $785.50 in Billed Charges for Rev 272 = $364.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PLATE CONNECTING 3 HOLE,272,RC,,,,,,,,both,,,785.5000,117.8300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,327.55,,,,,,,202.7400,785.5000,percent of total billed charges,41.7% of $785.50 in Billed Charges for Rev 272 = $327.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PLATE CONNECTING 3 HOLE,272,RC,,,,,,,,both,,,785.5000,117.8300,CIGNA HEALTHCARE,CIGNA PPO,327.55,,,,,,,202.7400,785.5000,percent of total billed charges,41.7% of $785.50 in Billed Charges for Rev 272 = $327.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PLATE CONNECTING 3 HOLE,272,RC,,,,,,,,both,,,785.5000,117.8300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,706.95,,,,,,,202.7400,785.5000,percent of total billed charges,90% of $785.50 in Billed Charges for Rev 272 = $706.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PLATE CONNECTING 3 HOLE,272,RC,,,,,,,,both,,,785.5000,117.8300,MEDCOST,MEDCOST VHN,373.82,,,,,,,202.7400,785.5000,percent of total billed charges,47.59% of $785.50 in Billed Charges for Rev 272 = $373.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PLATE CONNECTING 3 HOLE,272,RC,,,,,,,,both,,,785.5000,117.8300,SENTARA HEALTH,SENTARA HEALTH,202.74,,,,,,,202.7400,785.5000,percent of total billed charges,25.81% of $785.50 in Billed Charges for Rev 272 = $202.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PLATE CONNECTING 3 HOLE,272,RC,,,,,,,,both,,,785.5000,117.8300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",785.50,,,,,,,202.7400,785.5000,percent of total billed charges,100% of $785.50 in Billed Charges for Rev 272 = $785.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PLATE CONNECTING 3 HOLE,272,RC,,,,,,,,both,,,785.5000,117.8300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,392.75,,,,,,,202.7400,785.5000,percent of total billed charges,Rev 272 $785.50 in Billed Charges at 50% = $392.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PLATE CONNECTING 3 HOLE,272,RC,,,,,,,,both,,,785.5000,117.8300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,253.72,,,,,,,202.7400,785.5000,other,32.3% of $785.50 in Billed Charges for Rev 272 = $253.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PLATE CONNECTING 3 HOLE,272,RC,,,,,,,,both,,,785.5000,117.8300,UNITED HEALTHCARE,UHC HERITAGE SELECT,241.15,,,,,,,202.7400,785.5000,other,30.7% of $785.50 in Billed Charges for Rev 272 = $241.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
PLATE CONNECTING 3 HOLE,272,RC,,,,,,,,both,,,785.5000,117.8300,UNITED HEALTHCARE,UNITED HEALTHCARE,253.72,,,,,,,202.7400,785.5000,percent of total billed charges,32.3% of $785.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PLATE CONNECTING 3 HOLE,272,RC,,,,,,,,both,,,785.5000,117.8300,WELLCARE,WELLCARE MEDICAID,785.50,,,,,,,202.7400,785.5000,percent of total billed charges,100% of $785.50 in Billed Charges for Rev 272 = $785.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
PLATE SMALL 2 HOLE LEFT,272,RC,,,,,,,,both,,,9898.9100,1484.8400,AETNA,AETNA,4226.83,,,,,,,2554.9100,9898.9100,percent of total billed charges,"42.7% of $9,898.91 in Billed Charges for Rev 272 = $4,226.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE SMALL 2 HOLE LEFT,272,RC,,,,,,,,both,,,9898.9100,1484.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6929.24,,,,,,,2554.9100,9898.9100,percent of total billed charges,"Rev 272 $9,898.91 in Billed Charges at 70% = $6,929.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE SMALL 2 HOLE LEFT,272,RC,,,,,,,,both,,,9898.9100,1484.8400,CIGNA HEALTHCARE,CIGNA HMO,4127.85,,,,,,,2554.9100,9898.9100,percent of total billed charges,"41.7% of $9,898.91 in Billed Charges for Rev 272 = $4,127.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE SMALL 2 HOLE LEFT,272,RC,,,,,,,,both,,,9898.9100,1484.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4593.09,,,,,,,2554.9100,9898.9100,percent of total billed charges,"46.4% of $9,898.91 in Billed Charges for Rev 272 = $4,593.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE SMALL 2 HOLE LEFT,272,RC,,,,,,,,both,,,9898.9100,1484.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4127.85,,,,,,,2554.9100,9898.9100,percent of total billed charges,"41.7% of $9,898.91 in Billed Charges for Rev 272 = $4,127.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE SMALL 2 HOLE LEFT,272,RC,,,,,,,,both,,,9898.9100,1484.8400,CIGNA HEALTHCARE,CIGNA PPO,4127.85,,,,,,,2554.9100,9898.9100,percent of total billed charges,"41.7% of $9,898.91 in Billed Charges for Rev 272 = $4,127.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE SMALL 2 HOLE LEFT,272,RC,,,,,,,,both,,,9898.9100,1484.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8909.02,,,,,,,2554.9100,9898.9100,percent of total billed charges,"90% of $9,898.91 in Billed Charges for Rev 272 = $8,909.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE SMALL 2 HOLE LEFT,272,RC,,,,,,,,both,,,9898.9100,1484.8400,MEDCOST,MEDCOST VHN,4710.89,,,,,,,2554.9100,9898.9100,percent of total billed charges,"47.59% of $9,898.91 in Billed Charges for Rev 272 = $4,710.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE SMALL 2 HOLE LEFT,272,RC,,,,,,,,both,,,9898.9100,1484.8400,SENTARA HEALTH,SENTARA HEALTH,2554.91,,,,,,,2554.9100,9898.9100,percent of total billed charges,"25.81% of $9,898.91 in Billed Charges for Rev 272 = $2,554.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE SMALL 2 HOLE LEFT,272,RC,,,,,,,,both,,,9898.9100,1484.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9898.91,,,,,,,2554.9100,9898.9100,percent of total billed charges,"100% of $9,898.91 in Billed Charges for Rev 272 = $9,898.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE SMALL 2 HOLE LEFT,272,RC,,,,,,,,both,,,9898.9100,1484.8400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4949.46,,,,,,,2554.9100,9898.9100,percent of total billed charges,"Rev 272 $9,898.91 in Billed Charges at 50% = $4,949.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE SMALL 2 HOLE LEFT,272,RC,,,,,,,,both,,,9898.9100,1484.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3197.35,,,,,,,2554.9100,9898.9100,other,"32.3% of $9,898.91 in Billed Charges for Rev 272 = $3,197.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PLATE SMALL 2 HOLE LEFT,272,RC,,,,,,,,both,,,9898.9100,1484.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,3038.97,,,,,,,2554.9100,9898.9100,other,"30.7% of $9,898.91 in Billed Charges for Rev 272 = $3,038.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PLATE SMALL 2 HOLE LEFT,272,RC,,,,,,,,both,,,9898.9100,1484.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,3197.35,,,,,,,2554.9100,9898.9100,percent of total billed charges,"32.3% of $9,898.91 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE SMALL 2 HOLE LEFT,272,RC,,,,,,,,both,,,9898.9100,1484.8400,WELLCARE,WELLCARE MEDICAID,9898.91,,,,,,,2554.9100,9898.9100,percent of total billed charges,"100% of $9,898.91 in Billed Charges for Rev 272 = $9,898.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE VOLAR DISTAL RADIUS 2 COL 6 HL HD 4 HL SH STANDARD 2.4/2.7MM X 70MM LEFT,272,RC,27200002,CDM,,,,,,both,,,18228.3800,2734.2600,AETNA,AETNA,7783.52,,,,,,,4704.7400,18228.3800,percent of total billed charges,"42.7% of $18,228.38 in Billed Charges for Rev 272 = $7,783.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE VOLAR DISTAL RADIUS 2 COL 6 HL HD 4 HL SH STANDARD 2.4/2.7MM X 70MM LEFT,272,RC,27200002,CDM,,,,,,both,,,18228.3800,2734.2600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,12759.87,,,,,,,4704.7400,18228.3800,percent of total billed charges,"Rev 272 $18,228.38 in Billed Charges at 70% = $12,759.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE VOLAR DISTAL RADIUS 2 COL 6 HL HD 4 HL SH STANDARD 2.4/2.7MM X 70MM LEFT,272,RC,27200002,CDM,,,,,,both,,,18228.3800,2734.2600,CIGNA HEALTHCARE,CIGNA HMO,7601.23,,,,,,,4704.7400,18228.3800,percent of total billed charges,"41.7% of $18,228.38 in Billed Charges for Rev 272 = $7,601.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE VOLAR DISTAL RADIUS 2 COL 6 HL HD 4 HL SH STANDARD 2.4/2.7MM X 70MM LEFT,272,RC,27200002,CDM,,,,,,both,,,18228.3800,2734.2600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8457.97,,,,,,,4704.7400,18228.3800,percent of total billed charges,"46.4% of $18,228.38 in Billed Charges for Rev 272 = $8,457.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE VOLAR DISTAL RADIUS 2 COL 6 HL HD 4 HL SH STANDARD 2.4/2.7MM X 70MM LEFT,272,RC,27200002,CDM,,,,,,both,,,18228.3800,2734.2600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7601.23,,,,,,,4704.7400,18228.3800,percent of total billed charges,"41.7% of $18,228.38 in Billed Charges for Rev 272 = $7,601.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE VOLAR DISTAL RADIUS 2 COL 6 HL HD 4 HL SH STANDARD 2.4/2.7MM X 70MM LEFT,272,RC,27200002,CDM,,,,,,both,,,18228.3800,2734.2600,CIGNA HEALTHCARE,CIGNA PPO,7601.23,,,,,,,4704.7400,18228.3800,percent of total billed charges,"41.7% of $18,228.38 in Billed Charges for Rev 272 = $7,601.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE VOLAR DISTAL RADIUS 2 COL 6 HL HD 4 HL SH STANDARD 2.4/2.7MM X 70MM LEFT,272,RC,27200002,CDM,,,,,,both,,,18228.3800,2734.2600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,16405.54,,,,,,,4704.7400,18228.3800,percent of total billed charges,"90% of $18,228.38 in Billed Charges for Rev 272 = $16,405.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE VOLAR DISTAL RADIUS 2 COL 6 HL HD 4 HL SH STANDARD 2.4/2.7MM X 70MM LEFT,272,RC,27200002,CDM,,,,,,both,,,18228.3800,2734.2600,MEDCOST,MEDCOST VHN,8674.89,,,,,,,4704.7400,18228.3800,percent of total billed charges,"47.59% of $18,228.38 in Billed Charges for Rev 272 = $8,674.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE VOLAR DISTAL RADIUS 2 COL 6 HL HD 4 HL SH STANDARD 2.4/2.7MM X 70MM LEFT,272,RC,27200002,CDM,,,,,,both,,,18228.3800,2734.2600,SENTARA HEALTH,SENTARA HEALTH,4704.74,,,,,,,4704.7400,18228.3800,percent of total billed charges,"25.81% of $18,228.38 in Billed Charges for Rev 272 = $4,704.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE VOLAR DISTAL RADIUS 2 COL 6 HL HD 4 HL SH STANDARD 2.4/2.7MM X 70MM LEFT,272,RC,27200002,CDM,,,,,,both,,,18228.3800,2734.2600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",18228.38,,,,,,,4704.7400,18228.3800,percent of total billed charges,"100% of $18,228.38 in Billed Charges for Rev 272 = $18,228.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE VOLAR DISTAL RADIUS 2 COL 6 HL HD 4 HL SH STANDARD 2.4/2.7MM X 70MM LEFT,272,RC,27200002,CDM,,,,,,both,,,18228.3800,2734.2600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9114.19,,,,,,,4704.7400,18228.3800,percent of total billed charges,"Rev 272 $18,228.38 in Billed Charges at 50% = $9,114.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE VOLAR DISTAL RADIUS 2 COL 6 HL HD 4 HL SH STANDARD 2.4/2.7MM X 70MM LEFT,272,RC,27200002,CDM,,,,,,both,,,18228.3800,2734.2600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5887.77,,,,,,,4704.7400,18228.3800,other,"32.3% of $18,228.38 in Billed Charges for Rev 272 = $5,887.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PLATE VOLAR DISTAL RADIUS 2 COL 6 HL HD 4 HL SH STANDARD 2.4/2.7MM X 70MM LEFT,272,RC,27200002,CDM,,,,,,both,,,18228.3800,2734.2600,UNITED HEALTHCARE,UHC HERITAGE SELECT,5596.11,,,,,,,4704.7400,18228.3800,other,"30.7% of $18,228.38 in Billed Charges for Rev 272 = $5,596.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PLATE VOLAR DISTAL RADIUS 2 COL 6 HL HD 4 HL SH STANDARD 2.4/2.7MM X 70MM LEFT,272,RC,27200002,CDM,,,,,,both,,,18228.3800,2734.2600,UNITED HEALTHCARE,UNITED HEALTHCARE,5887.77,,,,,,,4704.7400,18228.3800,percent of total billed charges,"32.3% of $18,228.38 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PLATE VOLAR DISTAL RADIUS 2 COL 6 HL HD 4 HL SH STANDARD 2.4/2.7MM X 70MM LEFT,272,RC,27200002,CDM,,,,,,both,,,18228.3800,2734.2600,WELLCARE,WELLCARE MEDICAID,18228.38,,,,,,,4704.7400,18228.3800,percent of total billed charges,"100% of $18,228.38 in Billed Charges for Rev 272 = $18,228.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,4207.3100,631.1000,AETNA,AETNA,1796.52,,,,,,,1085.9100,4207.3100,percent of total billed charges,"42.7% of $4,207.31 in Billed Charges for Rev 272 = $1,796.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,4207.3100,631.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2945.12,,,,,,,1085.9100,4207.3100,percent of total billed charges,"Rev 272 $4,207.31 in Billed Charges at 70% = $2,945.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,4207.3100,631.1000,CIGNA HEALTHCARE,CIGNA HMO,1754.45,,,,,,,1085.9100,4207.3100,percent of total billed charges,"41.7% of $4,207.31 in Billed Charges for Rev 272 = $1,754.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,4207.3100,631.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1952.19,,,,,,,1085.9100,4207.3100,percent of total billed charges,"46.4% of $4,207.31 in Billed Charges for Rev 272 = $1,952.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,4207.3100,631.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1754.45,,,,,,,1085.9100,4207.3100,percent of total billed charges,"41.7% of $4,207.31 in Billed Charges for Rev 272 = $1,754.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,4207.3100,631.1000,CIGNA HEALTHCARE,CIGNA PPO,1754.45,,,,,,,1085.9100,4207.3100,percent of total billed charges,"41.7% of $4,207.31 in Billed Charges for Rev 272 = $1,754.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,4207.3100,631.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3786.58,,,,,,,1085.9100,4207.3100,percent of total billed charges,"90% of $4,207.31 in Billed Charges for Rev 272 = $3,786.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,4207.3100,631.1000,MEDCOST,MEDCOST VHN,2002.26,,,,,,,1085.9100,4207.3100,percent of total billed charges,"47.59% of $4,207.31 in Billed Charges for Rev 272 = $2,002.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,4207.3100,631.1000,SENTARA HEALTH,SENTARA HEALTH,1085.91,,,,,,,1085.9100,4207.3100,percent of total billed charges,"25.81% of $4,207.31 in Billed Charges for Rev 272 = $1,085.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,4207.3100,631.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4207.31,,,,,,,1085.9100,4207.3100,percent of total billed charges,"100% of $4,207.31 in Billed Charges for Rev 272 = $4,207.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,4207.3100,631.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2103.66,,,,,,,1085.9100,4207.3100,percent of total billed charges,"Rev 272 $4,207.31 in Billed Charges at 50% = $2,103.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,4207.3100,631.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1358.96,,,,,,,1085.9100,4207.3100,other,"32.3% of $4,207.31 in Billed Charges for Rev 272 = $1,358.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
REAMER 2.7,272,RC,,,,,,,,both,,,4207.3100,631.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1291.64,,,,,,,1085.9100,4207.3100,other,"30.7% of $4,207.31 in Billed Charges for Rev 272 = $1,291.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
REAMER 2.7,272,RC,,,,,,,,both,,,4207.3100,631.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,1358.96,,,,,,,1085.9100,4207.3100,percent of total billed charges,"32.3% of $4,207.31 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER 2.7,272,RC,,,,,,,,both,,,4207.3100,631.1000,WELLCARE,WELLCARE MEDICAID,4207.31,,,,,,,1085.9100,4207.3100,percent of total billed charges,"100% of $4,207.31 in Billed Charges for Rev 272 = $4,207.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,3074.2800,461.1400,AETNA,AETNA,1312.72,,,,,,,793.4700,3074.2800,percent of total billed charges,"42.7% of $3,074.28 in Billed Charges for Rev 272 = $1,312.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,3074.2800,461.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2152.00,,,,,,,793.4700,3074.2800,percent of total billed charges,"Rev 272 $3,074.28 in Billed Charges at 70% = $2,152.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,3074.2800,461.1400,CIGNA HEALTHCARE,CIGNA HMO,1281.97,,,,,,,793.4700,3074.2800,percent of total billed charges,"41.7% of $3,074.28 in Billed Charges for Rev 272 = $1,281.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,3074.2800,461.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1426.47,,,,,,,793.4700,3074.2800,percent of total billed charges,"46.4% of $3,074.28 in Billed Charges for Rev 272 = $1,426.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,3074.2800,461.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1281.97,,,,,,,793.4700,3074.2800,percent of total billed charges,"41.7% of $3,074.28 in Billed Charges for Rev 272 = $1,281.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,3074.2800,461.1400,CIGNA HEALTHCARE,CIGNA PPO,1281.97,,,,,,,793.4700,3074.2800,percent of total billed charges,"41.7% of $3,074.28 in Billed Charges for Rev 272 = $1,281.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,3074.2800,461.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2766.85,,,,,,,793.4700,3074.2800,percent of total billed charges,"90% of $3,074.28 in Billed Charges for Rev 272 = $2,766.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,3074.2800,461.1400,MEDCOST,MEDCOST VHN,1463.05,,,,,,,793.4700,3074.2800,percent of total billed charges,"47.59% of $3,074.28 in Billed Charges for Rev 272 = $1,463.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,3074.2800,461.1400,SENTARA HEALTH,SENTARA HEALTH,793.47,,,,,,,793.4700,3074.2800,percent of total billed charges,"25.81% of $3,074.28 in Billed Charges for Rev 272 = $793.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,3074.2800,461.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3074.28,,,,,,,793.4700,3074.2800,percent of total billed charges,"100% of $3,074.28 in Billed Charges for Rev 272 = $3,074.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,3074.2800,461.1400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1537.14,,,,,,,793.4700,3074.2800,percent of total billed charges,"Rev 272 $3,074.28 in Billed Charges at 50% = $1,537.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,3074.2800,461.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,992.99,,,,,,,793.4700,3074.2800,other,"32.3% of $3,074.28 in Billed Charges for Rev 272 = $992.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,3074.2800,461.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,943.80,,,,,,,793.4700,3074.2800,other,"30.7% of $3,074.28 in Billed Charges for Rev 272 = $943.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,3074.2800,461.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,992.99,,,,,,,793.4700,3074.2800,percent of total billed charges,"32.3% of $3,074.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT DOYLE,272,RC,27200002,CDM,,,,,,both,,,3074.2800,461.1400,WELLCARE,WELLCARE MEDICAID,3074.28,,,,,,,793.4700,3074.2800,percent of total billed charges,"100% of $3,074.28 in Billed Charges for Rev 272 = $3,074.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPLINT OCL PLASTER 5IN,272,RC,27200002,CDM,,,,,,both,,,702.3200,105.3500,AETNA,AETNA,299.89,,,,,,,181.2700,702.3200,percent of total billed charges,42.7% of $702.32 in Billed Charges for Rev 272 = $299.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 5IN,272,RC,27200002,CDM,,,,,,both,,,702.3200,105.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,491.62,,,,,,,181.2700,702.3200,percent of total billed charges,Rev 272 $702.32 in Billed Charges at 70% = $491.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 5IN,272,RC,27200002,CDM,,,,,,both,,,702.3200,105.3500,CIGNA HEALTHCARE,CIGNA HMO,292.87,,,,,,,181.2700,702.3200,percent of total billed charges,41.7% of $702.32 in Billed Charges for Rev 272 = $292.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 5IN,272,RC,27200002,CDM,,,,,,both,,,702.3200,105.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,325.88,,,,,,,181.2700,702.3200,percent of total billed charges,46.4% of $702.32 in Billed Charges for Rev 272 = $325.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 5IN,272,RC,27200002,CDM,,,,,,both,,,702.3200,105.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,292.87,,,,,,,181.2700,702.3200,percent of total billed charges,41.7% of $702.32 in Billed Charges for Rev 272 = $292.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 5IN,272,RC,27200002,CDM,,,,,,both,,,702.3200,105.3500,CIGNA HEALTHCARE,CIGNA PPO,292.87,,,,,,,181.2700,702.3200,percent of total billed charges,41.7% of $702.32 in Billed Charges for Rev 272 = $292.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 5IN,272,RC,27200002,CDM,,,,,,both,,,702.3200,105.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,632.09,,,,,,,181.2700,702.3200,percent of total billed charges,90% of $702.32 in Billed Charges for Rev 272 = $632.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 5IN,272,RC,27200002,CDM,,,,,,both,,,702.3200,105.3500,MEDCOST,MEDCOST VHN,334.23,,,,,,,181.2700,702.3200,percent of total billed charges,47.59% of $702.32 in Billed Charges for Rev 272 = $334.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 5IN,272,RC,27200002,CDM,,,,,,both,,,702.3200,105.3500,SENTARA HEALTH,SENTARA HEALTH,181.27,,,,,,,181.2700,702.3200,percent of total billed charges,25.81% of $702.32 in Billed Charges for Rev 272 = $181.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 5IN,272,RC,27200002,CDM,,,,,,both,,,702.3200,105.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",702.32,,,,,,,181.2700,702.3200,percent of total billed charges,100% of $702.32 in Billed Charges for Rev 272 = $702.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 5IN,272,RC,27200002,CDM,,,,,,both,,,702.3200,105.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,351.16,,,,,,,181.2700,702.3200,percent of total billed charges,Rev 272 $702.32 in Billed Charges at 50% = $351.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 5IN,272,RC,27200002,CDM,,,,,,both,,,702.3200,105.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,226.85,,,,,,,181.2700,702.3200,other,32.3% of $702.32 in Billed Charges for Rev 272 = $226.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SPLINT OCL PLASTER 5IN,272,RC,27200002,CDM,,,,,,both,,,702.3200,105.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,215.61,,,,,,,181.2700,702.3200,other,30.7% of $702.32 in Billed Charges for Rev 272 = $215.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SPLINT OCL PLASTER 5IN,272,RC,27200002,CDM,,,,,,both,,,702.3200,105.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,226.85,,,,,,,181.2700,702.3200,percent of total billed charges,32.3% of $702.32 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT OCL PLASTER 5IN,272,RC,27200002,CDM,,,,,,both,,,702.3200,105.3500,WELLCARE,WELLCARE MEDICAID,702.32,,,,,,,181.2700,702.3200,percent of total billed charges,100% of $702.32 in Billed Charges for Rev 272 = $702.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 4INX15FT,272,RC,27200002,CDM,,,,,,both,,,586.0100,87.9000,AETNA,AETNA,250.23,,,,,,,151.2500,586.0100,percent of total billed charges,42.7% of $586.01 in Billed Charges for Rev 272 = $250.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 4INX15FT,272,RC,27200002,CDM,,,,,,both,,,586.0100,87.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,410.21,,,,,,,151.2500,586.0100,percent of total billed charges,Rev 272 $586.01 in Billed Charges at 70% = $410.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 4INX15FT,272,RC,27200002,CDM,,,,,,both,,,586.0100,87.9000,CIGNA HEALTHCARE,CIGNA HMO,244.37,,,,,,,151.2500,586.0100,percent of total billed charges,41.7% of $586.01 in Billed Charges for Rev 272 = $244.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 4INX15FT,272,RC,27200002,CDM,,,,,,both,,,586.0100,87.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,271.91,,,,,,,151.2500,586.0100,percent of total billed charges,46.4% of $586.01 in Billed Charges for Rev 272 = $271.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 4INX15FT,272,RC,27200002,CDM,,,,,,both,,,586.0100,87.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,244.37,,,,,,,151.2500,586.0100,percent of total billed charges,41.7% of $586.01 in Billed Charges for Rev 272 = $244.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 4INX15FT,272,RC,27200002,CDM,,,,,,both,,,586.0100,87.9000,CIGNA HEALTHCARE,CIGNA PPO,244.37,,,,,,,151.2500,586.0100,percent of total billed charges,41.7% of $586.01 in Billed Charges for Rev 272 = $244.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 4INX15FT,272,RC,27200002,CDM,,,,,,both,,,586.0100,87.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,527.41,,,,,,,151.2500,586.0100,percent of total billed charges,90% of $586.01 in Billed Charges for Rev 272 = $527.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 4INX15FT,272,RC,27200002,CDM,,,,,,both,,,586.0100,87.9000,MEDCOST,MEDCOST VHN,278.88,,,,,,,151.2500,586.0100,percent of total billed charges,47.59% of $586.01 in Billed Charges for Rev 272 = $278.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 4INX15FT,272,RC,27200002,CDM,,,,,,both,,,586.0100,87.9000,SENTARA HEALTH,SENTARA HEALTH,151.25,,,,,,,151.2500,586.0100,percent of total billed charges,25.81% of $586.01 in Billed Charges for Rev 272 = $151.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 4INX15FT,272,RC,27200002,CDM,,,,,,both,,,586.0100,87.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",586.01,,,,,,,151.2500,586.0100,percent of total billed charges,100% of $586.01 in Billed Charges for Rev 272 = $586.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 4INX15FT,272,RC,27200002,CDM,,,,,,both,,,586.0100,87.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,293.01,,,,,,,151.2500,586.0100,percent of total billed charges,Rev 272 $586.01 in Billed Charges at 50% = $293.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 4INX15FT,272,RC,27200002,CDM,,,,,,both,,,586.0100,87.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,189.28,,,,,,,151.2500,586.0100,other,32.3% of $586.01 in Billed Charges for Rev 272 = $189.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SPLINT ORTHO GLASS 4INX15FT,272,RC,27200002,CDM,,,,,,both,,,586.0100,87.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,179.91,,,,,,,151.2500,586.0100,other,30.7% of $586.01 in Billed Charges for Rev 272 = $179.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SPLINT ORTHO GLASS 4INX15FT,272,RC,27200002,CDM,,,,,,both,,,586.0100,87.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,189.28,,,,,,,151.2500,586.0100,percent of total billed charges,32.3% of $586.01 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPLINT ORTHO GLASS 4INX15FT,272,RC,27200002,CDM,,,,,,both,,,586.0100,87.9000,WELLCARE,WELLCARE MEDICAID,586.01,,,,,,,151.2500,586.0100,percent of total billed charges,100% of $586.01 in Billed Charges for Rev 272 = $586.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
REAMER CENTERAL LOW PROFILE 48/52/56,272,RC,27200002,CDM,,,,,,both,,,3472.2100,520.8300,AETNA,AETNA,1482.63,,,,,,,896.1800,3472.2100,percent of total billed charges,"42.7% of $3,472.21 in Billed Charges for Rev 272 = $1,482.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER CENTERAL LOW PROFILE 48/52/56,272,RC,27200002,CDM,,,,,,both,,,3472.2100,520.8300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2430.55,,,,,,,896.1800,3472.2100,percent of total billed charges,"Rev 272 $3,472.21 in Billed Charges at 70% = $2,430.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER CENTERAL LOW PROFILE 48/52/56,272,RC,27200002,CDM,,,,,,both,,,3472.2100,520.8300,CIGNA HEALTHCARE,CIGNA HMO,1447.91,,,,,,,896.1800,3472.2100,percent of total billed charges,"41.7% of $3,472.21 in Billed Charges for Rev 272 = $1,447.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER CENTERAL LOW PROFILE 48/52/56,272,RC,27200002,CDM,,,,,,both,,,3472.2100,520.8300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1611.11,,,,,,,896.1800,3472.2100,percent of total billed charges,"46.4% of $3,472.21 in Billed Charges for Rev 272 = $1,611.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER CENTERAL LOW PROFILE 48/52/56,272,RC,27200002,CDM,,,,,,both,,,3472.2100,520.8300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1447.91,,,,,,,896.1800,3472.2100,percent of total billed charges,"41.7% of $3,472.21 in Billed Charges for Rev 272 = $1,447.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER CENTERAL LOW PROFILE 48/52/56,272,RC,27200002,CDM,,,,,,both,,,3472.2100,520.8300,CIGNA HEALTHCARE,CIGNA PPO,1447.91,,,,,,,896.1800,3472.2100,percent of total billed charges,"41.7% of $3,472.21 in Billed Charges for Rev 272 = $1,447.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER CENTERAL LOW PROFILE 48/52/56,272,RC,27200002,CDM,,,,,,both,,,3472.2100,520.8300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3124.99,,,,,,,896.1800,3472.2100,percent of total billed charges,"90% of $3,472.21 in Billed Charges for Rev 272 = $3,124.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER CENTERAL LOW PROFILE 48/52/56,272,RC,27200002,CDM,,,,,,both,,,3472.2100,520.8300,MEDCOST,MEDCOST VHN,1652.42,,,,,,,896.1800,3472.2100,percent of total billed charges,"47.59% of $3,472.21 in Billed Charges for Rev 272 = $1,652.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER CENTERAL LOW PROFILE 48/52/56,272,RC,27200002,CDM,,,,,,both,,,3472.2100,520.8300,SENTARA HEALTH,SENTARA HEALTH,896.18,,,,,,,896.1800,3472.2100,percent of total billed charges,"25.81% of $3,472.21 in Billed Charges for Rev 272 = $896.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER CENTERAL LOW PROFILE 48/52/56,272,RC,27200002,CDM,,,,,,both,,,3472.2100,520.8300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3472.21,,,,,,,896.1800,3472.2100,percent of total billed charges,"100% of $3,472.21 in Billed Charges for Rev 272 = $3,472.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER CENTERAL LOW PROFILE 48/52/56,272,RC,27200002,CDM,,,,,,both,,,3472.2100,520.8300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1736.11,,,,,,,896.1800,3472.2100,percent of total billed charges,"Rev 272 $3,472.21 in Billed Charges at 50% = $1,736.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER CENTERAL LOW PROFILE 48/52/56,272,RC,27200002,CDM,,,,,,both,,,3472.2100,520.8300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1121.52,,,,,,,896.1800,3472.2100,other,"32.3% of $3,472.21 in Billed Charges for Rev 272 = $1,121.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
REAMER CENTERAL LOW PROFILE 48/52/56,272,RC,27200002,CDM,,,,,,both,,,3472.2100,520.8300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1065.97,,,,,,,896.1800,3472.2100,other,"30.7% of $3,472.21 in Billed Charges for Rev 272 = $1,065.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
REAMER CENTERAL LOW PROFILE 48/52/56,272,RC,27200002,CDM,,,,,,both,,,3472.2100,520.8300,UNITED HEALTHCARE,UNITED HEALTHCARE,1121.52,,,,,,,896.1800,3472.2100,percent of total billed charges,"32.3% of $3,472.21 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
REAMER CENTERAL LOW PROFILE 48/52/56,272,RC,27200002,CDM,,,,,,both,,,3472.2100,520.8300,WELLCARE,WELLCARE MEDICAID,3472.21,,,,,,,896.1800,3472.2100,percent of total billed charges,"100% of $3,472.21 in Billed Charges for Rev 272 = $3,472.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE COMPRESSIBLE STRIP SMALL,272,RC,,,,,,,,both,,,17011.3400,2551.7000,AETNA,AETNA,7263.84,,,,,,,4390.6300,17011.3400,percent of total billed charges,"42.7% of $17,011.34 in Billed Charges for Rev 272 = $7,263.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE COMPRESSIBLE STRIP SMALL,272,RC,,,,,,,,both,,,17011.3400,2551.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11907.94,,,,,,,4390.6300,17011.3400,percent of total billed charges,"Rev 272 $17,011.34 in Billed Charges at 70% = $11,907.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE COMPRESSIBLE STRIP SMALL,272,RC,,,,,,,,both,,,17011.3400,2551.7000,CIGNA HEALTHCARE,CIGNA HMO,7093.73,,,,,,,4390.6300,17011.3400,percent of total billed charges,"41.7% of $17,011.34 in Billed Charges for Rev 272 = $7,093.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE COMPRESSIBLE STRIP SMALL,272,RC,,,,,,,,both,,,17011.3400,2551.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7893.26,,,,,,,4390.6300,17011.3400,percent of total billed charges,"46.4% of $17,011.34 in Billed Charges for Rev 272 = $7,893.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE COMPRESSIBLE STRIP SMALL,272,RC,,,,,,,,both,,,17011.3400,2551.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7093.73,,,,,,,4390.6300,17011.3400,percent of total billed charges,"41.7% of $17,011.34 in Billed Charges for Rev 272 = $7,093.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE COMPRESSIBLE STRIP SMALL,272,RC,,,,,,,,both,,,17011.3400,2551.7000,CIGNA HEALTHCARE,CIGNA PPO,7093.73,,,,,,,4390.6300,17011.3400,percent of total billed charges,"41.7% of $17,011.34 in Billed Charges for Rev 272 = $7,093.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE COMPRESSIBLE STRIP SMALL,272,RC,,,,,,,,both,,,17011.3400,2551.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,15310.21,,,,,,,4390.6300,17011.3400,percent of total billed charges,"90% of $17,011.34 in Billed Charges for Rev 272 = $15,310.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE COMPRESSIBLE STRIP SMALL,272,RC,,,,,,,,both,,,17011.3400,2551.7000,MEDCOST,MEDCOST VHN,8095.70,,,,,,,4390.6300,17011.3400,percent of total billed charges,"47.59% of $17,011.34 in Billed Charges for Rev 272 = $8,095.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE COMPRESSIBLE STRIP SMALL,272,RC,,,,,,,,both,,,17011.3400,2551.7000,SENTARA HEALTH,SENTARA HEALTH,4390.63,,,,,,,4390.6300,17011.3400,percent of total billed charges,"25.81% of $17,011.34 in Billed Charges for Rev 272 = $4,390.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE COMPRESSIBLE STRIP SMALL,272,RC,,,,,,,,both,,,17011.3400,2551.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",17011.34,,,,,,,4390.6300,17011.3400,percent of total billed charges,"100% of $17,011.34 in Billed Charges for Rev 272 = $17,011.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE COMPRESSIBLE STRIP SMALL,272,RC,,,,,,,,both,,,17011.3400,2551.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8505.67,,,,,,,4390.6300,17011.3400,percent of total billed charges,"Rev 272 $17,011.34 in Billed Charges at 50% = $8,505.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE COMPRESSIBLE STRIP SMALL,272,RC,,,,,,,,both,,,17011.3400,2551.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5494.66,,,,,,,4390.6300,17011.3400,other,"32.3% of $17,011.34 in Billed Charges for Rev 272 = $5,494.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SPONGE COMPRESSIBLE STRIP SMALL,272,RC,,,,,,,,both,,,17011.3400,2551.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,5222.48,,,,,,,4390.6300,17011.3400,other,"30.7% of $17,011.34 in Billed Charges for Rev 272 = $5,222.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SPONGE COMPRESSIBLE STRIP SMALL,272,RC,,,,,,,,both,,,17011.3400,2551.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,5494.66,,,,,,,4390.6300,17011.3400,percent of total billed charges,"32.3% of $17,011.34 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE COMPRESSIBLE STRIP SMALL,272,RC,,,,,,,,both,,,17011.3400,2551.7000,WELLCARE,WELLCARE MEDICAID,17011.34,,,,,,,4390.6300,17011.3400,percent of total billed charges,"100% of $17,011.34 in Billed Charges for Rev 272 = $17,011.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE DURAGEN 1 X 1,272,RC,27200002,CDM,,,,,,both,,,2491.2000,373.6800,AETNA,AETNA,1063.74,,,,,,,642.9800,2491.2000,percent of total billed charges,"42.7% of $2,491.20 in Billed Charges for Rev 272 = $1,063.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE DURAGEN 1 X 1,272,RC,27200002,CDM,,,,,,both,,,2491.2000,373.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1743.84,,,,,,,642.9800,2491.2000,percent of total billed charges,"Rev 272 $2,491.20 in Billed Charges at 70% = $1,743.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE DURAGEN 1 X 1,272,RC,27200002,CDM,,,,,,both,,,2491.2000,373.6800,CIGNA HEALTHCARE,CIGNA HMO,1038.83,,,,,,,642.9800,2491.2000,percent of total billed charges,"41.7% of $2,491.20 in Billed Charges for Rev 272 = $1,038.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE DURAGEN 1 X 1,272,RC,27200002,CDM,,,,,,both,,,2491.2000,373.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1155.92,,,,,,,642.9800,2491.2000,percent of total billed charges,"46.4% of $2,491.20 in Billed Charges for Rev 272 = $1,155.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE DURAGEN 1 X 1,272,RC,27200002,CDM,,,,,,both,,,2491.2000,373.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1038.83,,,,,,,642.9800,2491.2000,percent of total billed charges,"41.7% of $2,491.20 in Billed Charges for Rev 272 = $1,038.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE DURAGEN 1 X 1,272,RC,27200002,CDM,,,,,,both,,,2491.2000,373.6800,CIGNA HEALTHCARE,CIGNA PPO,1038.83,,,,,,,642.9800,2491.2000,percent of total billed charges,"41.7% of $2,491.20 in Billed Charges for Rev 272 = $1,038.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE DURAGEN 1 X 1,272,RC,27200002,CDM,,,,,,both,,,2491.2000,373.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2242.08,,,,,,,642.9800,2491.2000,percent of total billed charges,"90% of $2,491.20 in Billed Charges for Rev 272 = $2,242.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE DURAGEN 1 X 1,272,RC,27200002,CDM,,,,,,both,,,2491.2000,373.6800,MEDCOST,MEDCOST VHN,1185.56,,,,,,,642.9800,2491.2000,percent of total billed charges,"47.59% of $2,491.20 in Billed Charges for Rev 272 = $1,185.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE DURAGEN 1 X 1,272,RC,27200002,CDM,,,,,,both,,,2491.2000,373.6800,SENTARA HEALTH,SENTARA HEALTH,642.98,,,,,,,642.9800,2491.2000,percent of total billed charges,"25.81% of $2,491.20 in Billed Charges for Rev 272 = $642.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE DURAGEN 1 X 1,272,RC,27200002,CDM,,,,,,both,,,2491.2000,373.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2491.20,,,,,,,642.9800,2491.2000,percent of total billed charges,"100% of $2,491.20 in Billed Charges for Rev 272 = $2,491.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE DURAGEN 1 X 1,272,RC,27200002,CDM,,,,,,both,,,2491.2000,373.6800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1245.60,,,,,,,642.9800,2491.2000,percent of total billed charges,"Rev 272 $2,491.20 in Billed Charges at 50% = $1,245.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE DURAGEN 1 X 1,272,RC,27200002,CDM,,,,,,both,,,2491.2000,373.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,804.66,,,,,,,642.9800,2491.2000,other,"32.3% of $2,491.20 in Billed Charges for Rev 272 = $804.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SPONGE DURAGEN 1 X 1,272,RC,27200002,CDM,,,,,,both,,,2491.2000,373.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,764.80,,,,,,,642.9800,2491.2000,other,"30.7% of $2,491.20 in Billed Charges for Rev 272 = $764.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SPONGE DURAGEN 1 X 1,272,RC,27200002,CDM,,,,,,both,,,2491.2000,373.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,804.66,,,,,,,642.9800,2491.2000,percent of total billed charges,"32.3% of $2,491.20 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE DURAGEN 1 X 1,272,RC,27200002,CDM,,,,,,both,,,2491.2000,373.6800,WELLCARE,WELLCARE MEDICAID,2491.20,,,,,,,642.9800,2491.2000,percent of total billed charges,"100% of $2,491.20 in Billed Charges for Rev 272 = $2,491.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,597.5800,89.6400,AETNA,AETNA,255.17,,,,,,,154.2400,597.5800,percent of total billed charges,42.7% of $597.58 in Billed Charges for Rev 272 = $255.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,597.5800,89.6400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,418.31,,,,,,,154.2400,597.5800,percent of total billed charges,Rev 272 $597.58 in Billed Charges at 70% = $418.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,597.5800,89.6400,CIGNA HEALTHCARE,CIGNA HMO,249.19,,,,,,,154.2400,597.5800,percent of total billed charges,41.7% of $597.58 in Billed Charges for Rev 272 = $249.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,597.5800,89.6400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,277.28,,,,,,,154.2400,597.5800,percent of total billed charges,46.4% of $597.58 in Billed Charges for Rev 272 = $277.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,597.5800,89.6400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,249.19,,,,,,,154.2400,597.5800,percent of total billed charges,41.7% of $597.58 in Billed Charges for Rev 272 = $249.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,597.5800,89.6400,CIGNA HEALTHCARE,CIGNA PPO,249.19,,,,,,,154.2400,597.5800,percent of total billed charges,41.7% of $597.58 in Billed Charges for Rev 272 = $249.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,597.5800,89.6400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,537.82,,,,,,,154.2400,597.5800,percent of total billed charges,90% of $597.58 in Billed Charges for Rev 272 = $537.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,597.5800,89.6400,MEDCOST,MEDCOST VHN,284.39,,,,,,,154.2400,597.5800,percent of total billed charges,47.59% of $597.58 in Billed Charges for Rev 272 = $284.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,597.5800,89.6400,SENTARA HEALTH,SENTARA HEALTH,154.24,,,,,,,154.2400,597.5800,percent of total billed charges,25.81% of $597.58 in Billed Charges for Rev 272 = $154.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,597.5800,89.6400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",597.58,,,,,,,154.2400,597.5800,percent of total billed charges,100% of $597.58 in Billed Charges for Rev 272 = $597.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,597.5800,89.6400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,298.79,,,,,,,154.2400,597.5800,percent of total billed charges,Rev 272 $597.58 in Billed Charges at 50% = $298.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,597.5800,89.6400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,193.02,,,,,,,154.2400,597.5800,other,32.3% of $597.58 in Billed Charges for Rev 272 = $193.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,597.5800,89.6400,UNITED HEALTHCARE,UHC HERITAGE SELECT,183.46,,,,,,,154.2400,597.5800,other,30.7% of $597.58 in Billed Charges for Rev 272 = $183.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,597.5800,89.6400,UNITED HEALTHCARE,UNITED HEALTHCARE,193.02,,,,,,,154.2400,597.5800,percent of total billed charges,32.3% of $597.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,597.5800,89.6400,WELLCARE,WELLCARE MEDICAID,597.58,,,,,,,154.2400,597.5800,percent of total billed charges,100% of $597.58 in Billed Charges for Rev 272 = $597.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,627.8500,94.1800,AETNA,AETNA,268.09,,,,,,,162.0500,627.8500,percent of total billed charges,42.7% of $627.85 in Billed Charges for Rev 272 = $268.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,627.8500,94.1800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,439.50,,,,,,,162.0500,627.8500,percent of total billed charges,Rev 272 $627.85 in Billed Charges at 70% = $439.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,627.8500,94.1800,CIGNA HEALTHCARE,CIGNA HMO,261.81,,,,,,,162.0500,627.8500,percent of total billed charges,41.7% of $627.85 in Billed Charges for Rev 272 = $261.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,627.8500,94.1800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,291.32,,,,,,,162.0500,627.8500,percent of total billed charges,46.4% of $627.85 in Billed Charges for Rev 272 = $291.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,627.8500,94.1800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,261.81,,,,,,,162.0500,627.8500,percent of total billed charges,41.7% of $627.85 in Billed Charges for Rev 272 = $261.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,627.8500,94.1800,CIGNA HEALTHCARE,CIGNA PPO,261.81,,,,,,,162.0500,627.8500,percent of total billed charges,41.7% of $627.85 in Billed Charges for Rev 272 = $261.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,627.8500,94.1800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,565.07,,,,,,,162.0500,627.8500,percent of total billed charges,90% of $627.85 in Billed Charges for Rev 272 = $565.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,627.8500,94.1800,MEDCOST,MEDCOST VHN,298.79,,,,,,,162.0500,627.8500,percent of total billed charges,47.59% of $627.85 in Billed Charges for Rev 272 = $298.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,627.8500,94.1800,SENTARA HEALTH,SENTARA HEALTH,162.05,,,,,,,162.0500,627.8500,percent of total billed charges,25.81% of $627.85 in Billed Charges for Rev 272 = $162.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,627.8500,94.1800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",627.85,,,,,,,162.0500,627.8500,percent of total billed charges,100% of $627.85 in Billed Charges for Rev 272 = $627.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,627.8500,94.1800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,313.93,,,,,,,162.0500,627.8500,percent of total billed charges,Rev 272 $627.85 in Billed Charges at 50% = $313.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,627.8500,94.1800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,202.80,,,,,,,162.0500,627.8500,other,32.3% of $627.85 in Billed Charges for Rev 272 = $202.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,627.8500,94.1800,UNITED HEALTHCARE,UHC HERITAGE SELECT,192.75,,,,,,,162.0500,627.8500,other,30.7% of $627.85 in Billed Charges for Rev 272 = $192.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,627.8500,94.1800,UNITED HEALTHCARE,UNITED HEALTHCARE,202.80,,,,,,,162.0500,627.8500,percent of total billed charges,32.3% of $627.85 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SPONGE HEMOSTAT SURGICEL 2 X 14 ET1951,272,RC,27200002,CDM,,,,,,both,,,627.8500,94.1800,WELLCARE,WELLCARE MEDICAID,627.85,,,,,,,162.0500,627.8500,percent of total billed charges,100% of $627.85 in Billed Charges for Rev 272 = $627.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SUREFOAM 45 SPU CURVED,272,RC,27200002,CDM,,,,,,both,,,5391.1900,808.6800,AETNA,AETNA,2302.04,,,,,,,1391.4700,5391.1900,percent of total billed charges,"42.7% of $5,391.19 in Billed Charges for Rev 272 = $2,302.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFOAM 45 SPU CURVED,272,RC,27200002,CDM,,,,,,both,,,5391.1900,808.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3773.83,,,,,,,1391.4700,5391.1900,percent of total billed charges,"Rev 272 $5,391.19 in Billed Charges at 70% = $3,773.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFOAM 45 SPU CURVED,272,RC,27200002,CDM,,,,,,both,,,5391.1900,808.6800,CIGNA HEALTHCARE,CIGNA HMO,2248.13,,,,,,,1391.4700,5391.1900,percent of total billed charges,"41.7% of $5,391.19 in Billed Charges for Rev 272 = $2,248.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFOAM 45 SPU CURVED,272,RC,27200002,CDM,,,,,,both,,,5391.1900,808.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2501.51,,,,,,,1391.4700,5391.1900,percent of total billed charges,"46.4% of $5,391.19 in Billed Charges for Rev 272 = $2,501.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFOAM 45 SPU CURVED,272,RC,27200002,CDM,,,,,,both,,,5391.1900,808.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2248.13,,,,,,,1391.4700,5391.1900,percent of total billed charges,"41.7% of $5,391.19 in Billed Charges for Rev 272 = $2,248.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFOAM 45 SPU CURVED,272,RC,27200002,CDM,,,,,,both,,,5391.1900,808.6800,CIGNA HEALTHCARE,CIGNA PPO,2248.13,,,,,,,1391.4700,5391.1900,percent of total billed charges,"41.7% of $5,391.19 in Billed Charges for Rev 272 = $2,248.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFOAM 45 SPU CURVED,272,RC,27200002,CDM,,,,,,both,,,5391.1900,808.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4852.07,,,,,,,1391.4700,5391.1900,percent of total billed charges,"90% of $5,391.19 in Billed Charges for Rev 272 = $4,852.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFOAM 45 SPU CURVED,272,RC,27200002,CDM,,,,,,both,,,5391.1900,808.6800,MEDCOST,MEDCOST VHN,2565.67,,,,,,,1391.4700,5391.1900,percent of total billed charges,"47.59% of $5,391.19 in Billed Charges for Rev 272 = $2,565.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFOAM 45 SPU CURVED,272,RC,27200002,CDM,,,,,,both,,,5391.1900,808.6800,SENTARA HEALTH,SENTARA HEALTH,1391.47,,,,,,,1391.4700,5391.1900,percent of total billed charges,"25.81% of $5,391.19 in Billed Charges for Rev 272 = $1,391.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFOAM 45 SPU CURVED,272,RC,27200002,CDM,,,,,,both,,,5391.1900,808.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5391.19,,,,,,,1391.4700,5391.1900,percent of total billed charges,"100% of $5,391.19 in Billed Charges for Rev 272 = $5,391.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFOAM 45 SPU CURVED,272,RC,27200002,CDM,,,,,,both,,,5391.1900,808.6800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2695.60,,,,,,,1391.4700,5391.1900,percent of total billed charges,"Rev 272 $5,391.19 in Billed Charges at 50% = $2,695.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFOAM 45 SPU CURVED,272,RC,27200002,CDM,,,,,,both,,,5391.1900,808.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1741.35,,,,,,,1391.4700,5391.1900,other,"32.3% of $5,391.19 in Billed Charges for Rev 272 = $1,741.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER SUREFOAM 45 SPU CURVED,272,RC,27200002,CDM,,,,,,both,,,5391.1900,808.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1655.10,,,,,,,1391.4700,5391.1900,other,"30.7% of $5,391.19 in Billed Charges for Rev 272 = $1,655.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER SUREFOAM 45 SPU CURVED,272,RC,27200002,CDM,,,,,,both,,,5391.1900,808.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,1741.35,,,,,,,1391.4700,5391.1900,percent of total billed charges,"32.3% of $5,391.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFOAM 45 SPU CURVED,272,RC,27200002,CDM,,,,,,both,,,5391.1900,808.6800,WELLCARE,WELLCARE MEDICAID,5391.19,,,,,,,1391.4700,5391.1900,percent of total billed charges,"100% of $5,391.19 in Billed Charges for Rev 272 = $5,391.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFORM 45,272,RC,27200002,CDM,,,,,,both,,,5009.1900,751.3800,AETNA,AETNA,2138.92,,,,,,,1292.8700,5009.1900,percent of total billed charges,"42.7% of $5,009.19 in Billed Charges for Rev 272 = $2,138.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFORM 45,272,RC,27200002,CDM,,,,,,both,,,5009.1900,751.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3506.43,,,,,,,1292.8700,5009.1900,percent of total billed charges,"Rev 272 $5,009.19 in Billed Charges at 70% = $3,506.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFORM 45,272,RC,27200002,CDM,,,,,,both,,,5009.1900,751.3800,CIGNA HEALTHCARE,CIGNA HMO,2088.83,,,,,,,1292.8700,5009.1900,percent of total billed charges,"41.7% of $5,009.19 in Billed Charges for Rev 272 = $2,088.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFORM 45,272,RC,27200002,CDM,,,,,,both,,,5009.1900,751.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2324.26,,,,,,,1292.8700,5009.1900,percent of total billed charges,"46.4% of $5,009.19 in Billed Charges for Rev 272 = $2,324.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFORM 45,272,RC,27200002,CDM,,,,,,both,,,5009.1900,751.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2088.83,,,,,,,1292.8700,5009.1900,percent of total billed charges,"41.7% of $5,009.19 in Billed Charges for Rev 272 = $2,088.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFORM 45,272,RC,27200002,CDM,,,,,,both,,,5009.1900,751.3800,CIGNA HEALTHCARE,CIGNA PPO,2088.83,,,,,,,1292.8700,5009.1900,percent of total billed charges,"41.7% of $5,009.19 in Billed Charges for Rev 272 = $2,088.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFORM 45,272,RC,27200002,CDM,,,,,,both,,,5009.1900,751.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4508.27,,,,,,,1292.8700,5009.1900,percent of total billed charges,"90% of $5,009.19 in Billed Charges for Rev 272 = $4,508.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFORM 45,272,RC,27200002,CDM,,,,,,both,,,5009.1900,751.3800,MEDCOST,MEDCOST VHN,2383.87,,,,,,,1292.8700,5009.1900,percent of total billed charges,"47.59% of $5,009.19 in Billed Charges for Rev 272 = $2,383.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFORM 45,272,RC,27200002,CDM,,,,,,both,,,5009.1900,751.3800,SENTARA HEALTH,SENTARA HEALTH,1292.87,,,,,,,1292.8700,5009.1900,percent of total billed charges,"25.81% of $5,009.19 in Billed Charges for Rev 272 = $1,292.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFORM 45,272,RC,27200002,CDM,,,,,,both,,,5009.1900,751.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5009.19,,,,,,,1292.8700,5009.1900,percent of total billed charges,"100% of $5,009.19 in Billed Charges for Rev 272 = $5,009.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFORM 45,272,RC,27200002,CDM,,,,,,both,,,5009.1900,751.3800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2504.60,,,,,,,1292.8700,5009.1900,percent of total billed charges,"Rev 272 $5,009.19 in Billed Charges at 50% = $2,504.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFORM 45,272,RC,27200002,CDM,,,,,,both,,,5009.1900,751.3800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1617.97,,,,,,,1292.8700,5009.1900,other,"32.3% of $5,009.19 in Billed Charges for Rev 272 = $1,617.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER SUREFORM 45,272,RC,27200002,CDM,,,,,,both,,,5009.1900,751.3800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1537.82,,,,,,,1292.8700,5009.1900,other,"30.7% of $5,009.19 in Billed Charges for Rev 272 = $1,537.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER SUREFORM 45,272,RC,27200002,CDM,,,,,,both,,,5009.1900,751.3800,UNITED HEALTHCARE,UNITED HEALTHCARE,1617.97,,,,,,,1292.8700,5009.1900,percent of total billed charges,"32.3% of $5,009.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SUREFORM 45,272,RC,27200002,CDM,,,,,,both,,,5009.1900,751.3800,WELLCARE,WELLCARE MEDICAID,5009.19,,,,,,,1292.8700,5009.1900,percent of total billed charges,"100% of $5,009.19 in Billed Charges for Rev 272 = $5,009.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR AUTOSUTURE FAN 176613,272,RC,27200002,CDM,,,,,,both,,,3060.3800,459.0600,AETNA,AETNA,1306.78,,,,,,,789.8800,3060.3800,percent of total billed charges,"42.7% of $3,060.38 in Billed Charges for Rev 272 = $1,306.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR AUTOSUTURE FAN 176613,272,RC,27200002,CDM,,,,,,both,,,3060.3800,459.0600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2142.27,,,,,,,789.8800,3060.3800,percent of total billed charges,"Rev 272 $3,060.38 in Billed Charges at 70% = $2,142.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR AUTOSUTURE FAN 176613,272,RC,27200002,CDM,,,,,,both,,,3060.3800,459.0600,CIGNA HEALTHCARE,CIGNA HMO,1276.18,,,,,,,789.8800,3060.3800,percent of total billed charges,"41.7% of $3,060.38 in Billed Charges for Rev 272 = $1,276.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR AUTOSUTURE FAN 176613,272,RC,27200002,CDM,,,,,,both,,,3060.3800,459.0600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1420.02,,,,,,,789.8800,3060.3800,percent of total billed charges,"46.4% of $3,060.38 in Billed Charges for Rev 272 = $1,420.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR AUTOSUTURE FAN 176613,272,RC,27200002,CDM,,,,,,both,,,3060.3800,459.0600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1276.18,,,,,,,789.8800,3060.3800,percent of total billed charges,"41.7% of $3,060.38 in Billed Charges for Rev 272 = $1,276.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR AUTOSUTURE FAN 176613,272,RC,27200002,CDM,,,,,,both,,,3060.3800,459.0600,CIGNA HEALTHCARE,CIGNA PPO,1276.18,,,,,,,789.8800,3060.3800,percent of total billed charges,"41.7% of $3,060.38 in Billed Charges for Rev 272 = $1,276.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR AUTOSUTURE FAN 176613,272,RC,27200002,CDM,,,,,,both,,,3060.3800,459.0600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2754.34,,,,,,,789.8800,3060.3800,percent of total billed charges,"90% of $3,060.38 in Billed Charges for Rev 272 = $2,754.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR AUTOSUTURE FAN 176613,272,RC,27200002,CDM,,,,,,both,,,3060.3800,459.0600,MEDCOST,MEDCOST VHN,1456.43,,,,,,,789.8800,3060.3800,percent of total billed charges,"47.59% of $3,060.38 in Billed Charges for Rev 272 = $1,456.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR AUTOSUTURE FAN 176613,272,RC,27200002,CDM,,,,,,both,,,3060.3800,459.0600,SENTARA HEALTH,SENTARA HEALTH,789.88,,,,,,,789.8800,3060.3800,percent of total billed charges,"25.81% of $3,060.38 in Billed Charges for Rev 272 = $789.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR AUTOSUTURE FAN 176613,272,RC,27200002,CDM,,,,,,both,,,3060.3800,459.0600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3060.38,,,,,,,789.8800,3060.3800,percent of total billed charges,"100% of $3,060.38 in Billed Charges for Rev 272 = $3,060.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR AUTOSUTURE FAN 176613,272,RC,27200002,CDM,,,,,,both,,,3060.3800,459.0600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1530.19,,,,,,,789.8800,3060.3800,percent of total billed charges,"Rev 272 $3,060.38 in Billed Charges at 50% = $1,530.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR AUTOSUTURE FAN 176613,272,RC,27200002,CDM,,,,,,both,,,3060.3800,459.0600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,988.50,,,,,,,789.8800,3060.3800,other,"32.3% of $3,060.38 in Billed Charges for Rev 272 = $988.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RETRACTOR AUTOSUTURE FAN 176613,272,RC,27200002,CDM,,,,,,both,,,3060.3800,459.0600,UNITED HEALTHCARE,UHC HERITAGE SELECT,939.54,,,,,,,789.8800,3060.3800,other,"30.7% of $3,060.38 in Billed Charges for Rev 272 = $939.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RETRACTOR AUTOSUTURE FAN 176613,272,RC,27200002,CDM,,,,,,both,,,3060.3800,459.0600,UNITED HEALTHCARE,UNITED HEALTHCARE,988.50,,,,,,,789.8800,3060.3800,percent of total billed charges,"32.3% of $3,060.38 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR AUTOSUTURE FAN 176613,272,RC,27200002,CDM,,,,,,both,,,3060.3800,459.0600,WELLCARE,WELLCARE MEDICAID,3060.38,,,,,,,789.8800,3060.3800,percent of total billed charges,"100% of $3,060.38 in Billed Charges for Rev 272 = $3,060.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 30V-3 TA30V3S,272,RC,,,,,,,,both,,,4632.9800,694.9500,AETNA,AETNA,1978.28,,,,,,,1195.7700,4632.9800,percent of total billed charges,"42.7% of $4,632.98 in Billed Charges for Rev 272 = $1,978.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 30V-3 TA30V3S,272,RC,,,,,,,,both,,,4632.9800,694.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3243.09,,,,,,,1195.7700,4632.9800,percent of total billed charges,"Rev 272 $4,632.98 in Billed Charges at 70% = $3,243.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 30V-3 TA30V3S,272,RC,,,,,,,,both,,,4632.9800,694.9500,CIGNA HEALTHCARE,CIGNA HMO,1931.95,,,,,,,1195.7700,4632.9800,percent of total billed charges,"41.7% of $4,632.98 in Billed Charges for Rev 272 = $1,931.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 30V-3 TA30V3S,272,RC,,,,,,,,both,,,4632.9800,694.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2149.70,,,,,,,1195.7700,4632.9800,percent of total billed charges,"46.4% of $4,632.98 in Billed Charges for Rev 272 = $2,149.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 30V-3 TA30V3S,272,RC,,,,,,,,both,,,4632.9800,694.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1931.95,,,,,,,1195.7700,4632.9800,percent of total billed charges,"41.7% of $4,632.98 in Billed Charges for Rev 272 = $1,931.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 30V-3 TA30V3S,272,RC,,,,,,,,both,,,4632.9800,694.9500,CIGNA HEALTHCARE,CIGNA PPO,1931.95,,,,,,,1195.7700,4632.9800,percent of total billed charges,"41.7% of $4,632.98 in Billed Charges for Rev 272 = $1,931.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 30V-3 TA30V3S,272,RC,,,,,,,,both,,,4632.9800,694.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4169.68,,,,,,,1195.7700,4632.9800,percent of total billed charges,"90% of $4,632.98 in Billed Charges for Rev 272 = $4,169.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 30V-3 TA30V3S,272,RC,,,,,,,,both,,,4632.9800,694.9500,MEDCOST,MEDCOST VHN,2204.84,,,,,,,1195.7700,4632.9800,percent of total billed charges,"47.59% of $4,632.98 in Billed Charges for Rev 272 = $2,204.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 30V-3 TA30V3S,272,RC,,,,,,,,both,,,4632.9800,694.9500,SENTARA HEALTH,SENTARA HEALTH,1195.77,,,,,,,1195.7700,4632.9800,percent of total billed charges,"25.81% of $4,632.98 in Billed Charges for Rev 272 = $1,195.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 30V-3 TA30V3S,272,RC,,,,,,,,both,,,4632.9800,694.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4632.98,,,,,,,1195.7700,4632.9800,percent of total billed charges,"100% of $4,632.98 in Billed Charges for Rev 272 = $4,632.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 30V-3 TA30V3S,272,RC,,,,,,,,both,,,4632.9800,694.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2316.49,,,,,,,1195.7700,4632.9800,percent of total billed charges,"Rev 272 $4,632.98 in Billed Charges at 50% = $2,316.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 30V-3 TA30V3S,272,RC,,,,,,,,both,,,4632.9800,694.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1496.45,,,,,,,1195.7700,4632.9800,other,"32.3% of $4,632.98 in Billed Charges for Rev 272 = $1,496.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER TA 30V-3 TA30V3S,272,RC,,,,,,,,both,,,4632.9800,694.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1422.32,,,,,,,1195.7700,4632.9800,other,"30.7% of $4,632.98 in Billed Charges for Rev 272 = $1,422.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER TA 30V-3 TA30V3S,272,RC,,,,,,,,both,,,4632.9800,694.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,1496.45,,,,,,,1195.7700,4632.9800,percent of total billed charges,"32.3% of $4,632.98 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 30V-3 TA30V3S,272,RC,,,,,,,,both,,,4632.9800,694.9500,WELLCARE,WELLCARE MEDICAID,4632.98,,,,,,,1195.7700,4632.9800,percent of total billed charges,"100% of $4,632.98 in Billed Charges for Rev 272 = $4,632.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 45-3.5 TA4535S SURPASS SEE LN 120272,272,RC,,,,,,,,both,,,4497.8500,674.6800,AETNA,AETNA,1920.58,,,,,,,1160.9000,4497.8500,percent of total billed charges,"42.7% of $4,497.85 in Billed Charges for Rev 272 = $1,920.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 45-3.5 TA4535S SURPASS SEE LN 120272,272,RC,,,,,,,,both,,,4497.8500,674.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3148.50,,,,,,,1160.9000,4497.8500,percent of total billed charges,"Rev 272 $4,497.85 in Billed Charges at 70% = $3,148.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 45-3.5 TA4535S SURPASS SEE LN 120272,272,RC,,,,,,,,both,,,4497.8500,674.6800,CIGNA HEALTHCARE,CIGNA HMO,1875.60,,,,,,,1160.9000,4497.8500,percent of total billed charges,"41.7% of $4,497.85 in Billed Charges for Rev 272 = $1,875.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 45-3.5 TA4535S SURPASS SEE LN 120272,272,RC,,,,,,,,both,,,4497.8500,674.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2087.00,,,,,,,1160.9000,4497.8500,percent of total billed charges,"46.4% of $4,497.85 in Billed Charges for Rev 272 = $2,087.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 45-3.5 TA4535S SURPASS SEE LN 120272,272,RC,,,,,,,,both,,,4497.8500,674.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1875.60,,,,,,,1160.9000,4497.8500,percent of total billed charges,"41.7% of $4,497.85 in Billed Charges for Rev 272 = $1,875.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 45-3.5 TA4535S SURPASS SEE LN 120272,272,RC,,,,,,,,both,,,4497.8500,674.6800,CIGNA HEALTHCARE,CIGNA PPO,1875.60,,,,,,,1160.9000,4497.8500,percent of total billed charges,"41.7% of $4,497.85 in Billed Charges for Rev 272 = $1,875.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 45-3.5 TA4535S SURPASS SEE LN 120272,272,RC,,,,,,,,both,,,4497.8500,674.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4048.07,,,,,,,1160.9000,4497.8500,percent of total billed charges,"90% of $4,497.85 in Billed Charges for Rev 272 = $4,048.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 45-3.5 TA4535S SURPASS SEE LN 120272,272,RC,,,,,,,,both,,,4497.8500,674.6800,MEDCOST,MEDCOST VHN,2140.53,,,,,,,1160.9000,4497.8500,percent of total billed charges,"47.59% of $4,497.85 in Billed Charges for Rev 272 = $2,140.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 45-3.5 TA4535S SURPASS SEE LN 120272,272,RC,,,,,,,,both,,,4497.8500,674.6800,SENTARA HEALTH,SENTARA HEALTH,1160.90,,,,,,,1160.9000,4497.8500,percent of total billed charges,"25.81% of $4,497.85 in Billed Charges for Rev 272 = $1,160.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 45-3.5 TA4535S SURPASS SEE LN 120272,272,RC,,,,,,,,both,,,4497.8500,674.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4497.85,,,,,,,1160.9000,4497.8500,percent of total billed charges,"100% of $4,497.85 in Billed Charges for Rev 272 = $4,497.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 45-3.5 TA4535S SURPASS SEE LN 120272,272,RC,,,,,,,,both,,,4497.8500,674.6800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2248.93,,,,,,,1160.9000,4497.8500,percent of total billed charges,"Rev 272 $4,497.85 in Billed Charges at 50% = $2,248.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 45-3.5 TA4535S SURPASS SEE LN 120272,272,RC,,,,,,,,both,,,4497.8500,674.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1452.81,,,,,,,1160.9000,4497.8500,other,"32.3% of $4,497.85 in Billed Charges for Rev 272 = $1,452.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER TA 45-3.5 TA4535S SURPASS SEE LN 120272,272,RC,,,,,,,,both,,,4497.8500,674.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1380.84,,,,,,,1160.9000,4497.8500,other,"30.7% of $4,497.85 in Billed Charges for Rev 272 = $1,380.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER TA 45-3.5 TA4535S SURPASS SEE LN 120272,272,RC,,,,,,,,both,,,4497.8500,674.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,1452.81,,,,,,,1160.9000,4497.8500,percent of total billed charges,"32.3% of $4,497.85 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 45-3.5 TA4535S SURPASS SEE LN 120272,272,RC,,,,,,,,both,,,4497.8500,674.6800,WELLCARE,WELLCARE MEDICAID,4497.85,,,,,,,1160.9000,4497.8500,percent of total billed charges,"100% of $4,497.85 in Billed Charges for Rev 272 = $4,497.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 60-3.5 TA6035S SURPASS SEE LN 120272,272,RC,27200002,CDM,,,,,,both,,,4084.8600,612.7300,AETNA,AETNA,1744.24,,,,,,,1054.3000,4084.8600,percent of total billed charges,"42.7% of $4,084.86 in Billed Charges for Rev 272 = $1,744.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 60-3.5 TA6035S SURPASS SEE LN 120272,272,RC,27200002,CDM,,,,,,both,,,4084.8600,612.7300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2859.40,,,,,,,1054.3000,4084.8600,percent of total billed charges,"Rev 272 $4,084.86 in Billed Charges at 70% = $2,859.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 60-3.5 TA6035S SURPASS SEE LN 120272,272,RC,27200002,CDM,,,,,,both,,,4084.8600,612.7300,CIGNA HEALTHCARE,CIGNA HMO,1703.39,,,,,,,1054.3000,4084.8600,percent of total billed charges,"41.7% of $4,084.86 in Billed Charges for Rev 272 = $1,703.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 60-3.5 TA6035S SURPASS SEE LN 120272,272,RC,27200002,CDM,,,,,,both,,,4084.8600,612.7300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1895.38,,,,,,,1054.3000,4084.8600,percent of total billed charges,"46.4% of $4,084.86 in Billed Charges for Rev 272 = $1,895.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 60-3.5 TA6035S SURPASS SEE LN 120272,272,RC,27200002,CDM,,,,,,both,,,4084.8600,612.7300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1703.39,,,,,,,1054.3000,4084.8600,percent of total billed charges,"41.7% of $4,084.86 in Billed Charges for Rev 272 = $1,703.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 60-3.5 TA6035S SURPASS SEE LN 120272,272,RC,27200002,CDM,,,,,,both,,,4084.8600,612.7300,CIGNA HEALTHCARE,CIGNA PPO,1703.39,,,,,,,1054.3000,4084.8600,percent of total billed charges,"41.7% of $4,084.86 in Billed Charges for Rev 272 = $1,703.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 60-3.5 TA6035S SURPASS SEE LN 120272,272,RC,27200002,CDM,,,,,,both,,,4084.8600,612.7300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3676.37,,,,,,,1054.3000,4084.8600,percent of total billed charges,"90% of $4,084.86 in Billed Charges for Rev 272 = $3,676.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 60-3.5 TA6035S SURPASS SEE LN 120272,272,RC,27200002,CDM,,,,,,both,,,4084.8600,612.7300,MEDCOST,MEDCOST VHN,1943.98,,,,,,,1054.3000,4084.8600,percent of total billed charges,"47.59% of $4,084.86 in Billed Charges for Rev 272 = $1,943.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 60-3.5 TA6035S SURPASS SEE LN 120272,272,RC,27200002,CDM,,,,,,both,,,4084.8600,612.7300,SENTARA HEALTH,SENTARA HEALTH,1054.30,,,,,,,1054.3000,4084.8600,percent of total billed charges,"25.81% of $4,084.86 in Billed Charges for Rev 272 = $1,054.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 60-3.5 TA6035S SURPASS SEE LN 120272,272,RC,27200002,CDM,,,,,,both,,,4084.8600,612.7300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4084.86,,,,,,,1054.3000,4084.8600,percent of total billed charges,"100% of $4,084.86 in Billed Charges for Rev 272 = $4,084.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 60-3.5 TA6035S SURPASS SEE LN 120272,272,RC,27200002,CDM,,,,,,both,,,4084.8600,612.7300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2042.43,,,,,,,1054.3000,4084.8600,percent of total billed charges,"Rev 272 $4,084.86 in Billed Charges at 50% = $2,042.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 60-3.5 TA6035S SURPASS SEE LN 120272,272,RC,27200002,CDM,,,,,,both,,,4084.8600,612.7300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1319.41,,,,,,,1054.3000,4084.8600,other,"32.3% of $4,084.86 in Billed Charges for Rev 272 = $1,319.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER TA 60-3.5 TA6035S SURPASS SEE LN 120272,272,RC,27200002,CDM,,,,,,both,,,4084.8600,612.7300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1254.05,,,,,,,1054.3000,4084.8600,other,"30.7% of $4,084.86 in Billed Charges for Rev 272 = $1,254.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER TA 60-3.5 TA6035S SURPASS SEE LN 120272,272,RC,27200002,CDM,,,,,,both,,,4084.8600,612.7300,UNITED HEALTHCARE,UNITED HEALTHCARE,1319.41,,,,,,,1054.3000,4084.8600,percent of total billed charges,"32.3% of $4,084.86 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TA 60-3.5 TA6035S SURPASS SEE LN 120272,272,RC,27200002,CDM,,,,,,both,,,4084.8600,612.7300,WELLCARE,WELLCARE MEDICAID,4084.86,,,,,,,1054.3000,4084.8600,percent of total billed charges,"100% of $4,084.86 in Billed Charges for Rev 272 = $4,084.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR CREV VAGINAL/EL LG,272,RC,27200002,CDM,,,,,,both,,,590.2000,88.5300,AETNA,AETNA,252.02,,,,,,,152.3300,590.2000,percent of total billed charges,42.7% of $590.20 in Billed Charges for Rev 272 = $252.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR CREV VAGINAL/EL LG,272,RC,27200002,CDM,,,,,,both,,,590.2000,88.5300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,413.14,,,,,,,152.3300,590.2000,percent of total billed charges,Rev 272 $590.20 in Billed Charges at 70% = $413.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR CREV VAGINAL/EL LG,272,RC,27200002,CDM,,,,,,both,,,590.2000,88.5300,CIGNA HEALTHCARE,CIGNA HMO,246.11,,,,,,,152.3300,590.2000,percent of total billed charges,41.7% of $590.20 in Billed Charges for Rev 272 = $246.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR CREV VAGINAL/EL LG,272,RC,27200002,CDM,,,,,,both,,,590.2000,88.5300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,273.85,,,,,,,152.3300,590.2000,percent of total billed charges,46.4% of $590.20 in Billed Charges for Rev 272 = $273.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR CREV VAGINAL/EL LG,272,RC,27200002,CDM,,,,,,both,,,590.2000,88.5300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,246.11,,,,,,,152.3300,590.2000,percent of total billed charges,41.7% of $590.20 in Billed Charges for Rev 272 = $246.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR CREV VAGINAL/EL LG,272,RC,27200002,CDM,,,,,,both,,,590.2000,88.5300,CIGNA HEALTHCARE,CIGNA PPO,246.11,,,,,,,152.3300,590.2000,percent of total billed charges,41.7% of $590.20 in Billed Charges for Rev 272 = $246.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR CREV VAGINAL/EL LG,272,RC,27200002,CDM,,,,,,both,,,590.2000,88.5300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,531.18,,,,,,,152.3300,590.2000,percent of total billed charges,90% of $590.20 in Billed Charges for Rev 272 = $531.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR CREV VAGINAL/EL LG,272,RC,27200002,CDM,,,,,,both,,,590.2000,88.5300,MEDCOST,MEDCOST VHN,280.88,,,,,,,152.3300,590.2000,percent of total billed charges,47.59% of $590.20 in Billed Charges for Rev 272 = $280.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR CREV VAGINAL/EL LG,272,RC,27200002,CDM,,,,,,both,,,590.2000,88.5300,SENTARA HEALTH,SENTARA HEALTH,152.33,,,,,,,152.3300,590.2000,percent of total billed charges,25.81% of $590.20 in Billed Charges for Rev 272 = $152.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR CREV VAGINAL/EL LG,272,RC,27200002,CDM,,,,,,both,,,590.2000,88.5300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",590.20,,,,,,,152.3300,590.2000,percent of total billed charges,100% of $590.20 in Billed Charges for Rev 272 = $590.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR CREV VAGINAL/EL LG,272,RC,27200002,CDM,,,,,,both,,,590.2000,88.5300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,295.10,,,,,,,152.3300,590.2000,percent of total billed charges,Rev 272 $590.20 in Billed Charges at 50% = $295.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR CREV VAGINAL/EL LG,272,RC,27200002,CDM,,,,,,both,,,590.2000,88.5300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,190.63,,,,,,,152.3300,590.2000,other,32.3% of $590.20 in Billed Charges for Rev 272 = $190.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
RETRACTOR CREV VAGINAL/EL LG,272,RC,27200002,CDM,,,,,,both,,,590.2000,88.5300,UNITED HEALTHCARE,UHC HERITAGE SELECT,181.19,,,,,,,152.3300,590.2000,other,30.7% of $590.20 in Billed Charges for Rev 272 = $181.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
RETRACTOR CREV VAGINAL/EL LG,272,RC,27200002,CDM,,,,,,both,,,590.2000,88.5300,UNITED HEALTHCARE,UNITED HEALTHCARE,190.63,,,,,,,152.3300,590.2000,percent of total billed charges,32.3% of $590.20 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR CREV VAGINAL/EL LG,272,RC,27200002,CDM,,,,,,both,,,590.2000,88.5300,WELLCARE,WELLCARE MEDICAID,590.20,,,,,,,152.3300,590.2000,percent of total billed charges,100% of $590.20 in Billed Charges for Rev 272 = $590.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR DEXTRUS SMALL ACCESS,272,RC,27200002,CDM,,,,,,both,,,716.5000,107.4800,AETNA,AETNA,305.95,,,,,,,184.9300,716.5000,percent of total billed charges,42.7% of $716.50 in Billed Charges for Rev 272 = $305.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR DEXTRUS SMALL ACCESS,272,RC,27200002,CDM,,,,,,both,,,716.5000,107.4800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,501.55,,,,,,,184.9300,716.5000,percent of total billed charges,Rev 272 $716.50 in Billed Charges at 70% = $501.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR DEXTRUS SMALL ACCESS,272,RC,27200002,CDM,,,,,,both,,,716.5000,107.4800,CIGNA HEALTHCARE,CIGNA HMO,298.78,,,,,,,184.9300,716.5000,percent of total billed charges,41.7% of $716.50 in Billed Charges for Rev 272 = $298.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR DEXTRUS SMALL ACCESS,272,RC,27200002,CDM,,,,,,both,,,716.5000,107.4800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,332.46,,,,,,,184.9300,716.5000,percent of total billed charges,46.4% of $716.50 in Billed Charges for Rev 272 = $332.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR DEXTRUS SMALL ACCESS,272,RC,27200002,CDM,,,,,,both,,,716.5000,107.4800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,298.78,,,,,,,184.9300,716.5000,percent of total billed charges,41.7% of $716.50 in Billed Charges for Rev 272 = $298.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR DEXTRUS SMALL ACCESS,272,RC,27200002,CDM,,,,,,both,,,716.5000,107.4800,CIGNA HEALTHCARE,CIGNA PPO,298.78,,,,,,,184.9300,716.5000,percent of total billed charges,41.7% of $716.50 in Billed Charges for Rev 272 = $298.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR DEXTRUS SMALL ACCESS,272,RC,27200002,CDM,,,,,,both,,,716.5000,107.4800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,644.85,,,,,,,184.9300,716.5000,percent of total billed charges,90% of $716.50 in Billed Charges for Rev 272 = $644.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR DEXTRUS SMALL ACCESS,272,RC,27200002,CDM,,,,,,both,,,716.5000,107.4800,MEDCOST,MEDCOST VHN,340.98,,,,,,,184.9300,716.5000,percent of total billed charges,47.59% of $716.50 in Billed Charges for Rev 272 = $340.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR DEXTRUS SMALL ACCESS,272,RC,27200002,CDM,,,,,,both,,,716.5000,107.4800,SENTARA HEALTH,SENTARA HEALTH,184.93,,,,,,,184.9300,716.5000,percent of total billed charges,25.81% of $716.50 in Billed Charges for Rev 272 = $184.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR DEXTRUS SMALL ACCESS,272,RC,27200002,CDM,,,,,,both,,,716.5000,107.4800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",716.50,,,,,,,184.9300,716.5000,percent of total billed charges,100% of $716.50 in Billed Charges for Rev 272 = $716.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR DEXTRUS SMALL ACCESS,272,RC,27200002,CDM,,,,,,both,,,716.5000,107.4800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,358.25,,,,,,,184.9300,716.5000,percent of total billed charges,Rev 272 $716.50 in Billed Charges at 50% = $358.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR DEXTRUS SMALL ACCESS,272,RC,27200002,CDM,,,,,,both,,,716.5000,107.4800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,231.43,,,,,,,184.9300,716.5000,other,32.3% of $716.50 in Billed Charges for Rev 272 = $231.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
RETRACTOR DEXTRUS SMALL ACCESS,272,RC,27200002,CDM,,,,,,both,,,716.5000,107.4800,UNITED HEALTHCARE,UHC HERITAGE SELECT,219.97,,,,,,,184.9300,716.5000,other,30.7% of $716.50 in Billed Charges for Rev 272 = $219.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
RETRACTOR DEXTRUS SMALL ACCESS,272,RC,27200002,CDM,,,,,,both,,,716.5000,107.4800,UNITED HEALTHCARE,UNITED HEALTHCARE,231.43,,,,,,,184.9300,716.5000,percent of total billed charges,32.3% of $716.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR DEXTRUS SMALL ACCESS,272,RC,27200002,CDM,,,,,,both,,,716.5000,107.4800,WELLCARE,WELLCARE MEDICAID,716.50,,,,,,,184.9300,716.5000,percent of total billed charges,100% of $716.50 in Billed Charges for Rev 272 = $716.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,747.4000,112.1100,AETNA,AETNA,319.14,,,,,,,192.9000,747.4000,percent of total billed charges,42.7% of $747.40 in Billed Charges for Rev 272 = $319.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,747.4000,112.1100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,523.18,,,,,,,192.9000,747.4000,percent of total billed charges,Rev 272 $747.40 in Billed Charges at 70% = $523.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,747.4000,112.1100,CIGNA HEALTHCARE,CIGNA HMO,311.67,,,,,,,192.9000,747.4000,percent of total billed charges,41.7% of $747.40 in Billed Charges for Rev 272 = $311.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,747.4000,112.1100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,346.79,,,,,,,192.9000,747.4000,percent of total billed charges,46.4% of $747.40 in Billed Charges for Rev 272 = $346.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,747.4000,112.1100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,311.67,,,,,,,192.9000,747.4000,percent of total billed charges,41.7% of $747.40 in Billed Charges for Rev 272 = $311.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,747.4000,112.1100,CIGNA HEALTHCARE,CIGNA PPO,311.67,,,,,,,192.9000,747.4000,percent of total billed charges,41.7% of $747.40 in Billed Charges for Rev 272 = $311.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,747.4000,112.1100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,672.66,,,,,,,192.9000,747.4000,percent of total billed charges,90% of $747.40 in Billed Charges for Rev 272 = $672.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,747.4000,112.1100,MEDCOST,MEDCOST VHN,355.69,,,,,,,192.9000,747.4000,percent of total billed charges,47.59% of $747.40 in Billed Charges for Rev 272 = $355.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,747.4000,112.1100,SENTARA HEALTH,SENTARA HEALTH,192.90,,,,,,,192.9000,747.4000,percent of total billed charges,25.81% of $747.40 in Billed Charges for Rev 272 = $192.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,747.4000,112.1100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",747.40,,,,,,,192.9000,747.4000,percent of total billed charges,100% of $747.40 in Billed Charges for Rev 272 = $747.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,747.4000,112.1100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,373.70,,,,,,,192.9000,747.4000,percent of total billed charges,Rev 272 $747.40 in Billed Charges at 50% = $373.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,747.4000,112.1100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,241.41,,,,,,,192.9000,747.4000,other,32.3% of $747.40 in Billed Charges for Rev 272 = $241.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,747.4000,112.1100,UNITED HEALTHCARE,UHC HERITAGE SELECT,229.45,,,,,,,192.9000,747.4000,other,30.7% of $747.40 in Billed Charges for Rev 272 = $229.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,747.4000,112.1100,UNITED HEALTHCARE,UNITED HEALTHCARE,241.41,,,,,,,192.9000,747.4000,percent of total billed charges,32.3% of $747.40 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,747.4000,112.1100,WELLCARE,WELLCARE MEDICAID,747.40,,,,,,,192.9000,747.4000,percent of total billed charges,100% of $747.40 in Billed Charges for Rev 272 = $747.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,2278.3000,341.7500,AETNA,AETNA,972.83,,,,,,,588.0300,2278.3000,percent of total billed charges,"42.7% of $2,278.30 in Billed Charges for Rev 272 = $972.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,2278.3000,341.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1594.81,,,,,,,588.0300,2278.3000,percent of total billed charges,"Rev 272 $2,278.30 in Billed Charges at 70% = $1,594.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,2278.3000,341.7500,CIGNA HEALTHCARE,CIGNA HMO,950.05,,,,,,,588.0300,2278.3000,percent of total billed charges,"41.7% of $2,278.30 in Billed Charges for Rev 272 = $950.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,2278.3000,341.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1057.13,,,,,,,588.0300,2278.3000,percent of total billed charges,"46.4% of $2,278.30 in Billed Charges for Rev 272 = $1,057.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,2278.3000,341.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,950.05,,,,,,,588.0300,2278.3000,percent of total billed charges,"41.7% of $2,278.30 in Billed Charges for Rev 272 = $950.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,2278.3000,341.7500,CIGNA HEALTHCARE,CIGNA PPO,950.05,,,,,,,588.0300,2278.3000,percent of total billed charges,"41.7% of $2,278.30 in Billed Charges for Rev 272 = $950.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,2278.3000,341.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2050.47,,,,,,,588.0300,2278.3000,percent of total billed charges,"90% of $2,278.30 in Billed Charges for Rev 272 = $2,050.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,2278.3000,341.7500,MEDCOST,MEDCOST VHN,1084.24,,,,,,,588.0300,2278.3000,percent of total billed charges,"47.59% of $2,278.30 in Billed Charges for Rev 272 = $1,084.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,2278.3000,341.7500,SENTARA HEALTH,SENTARA HEALTH,588.03,,,,,,,588.0300,2278.3000,percent of total billed charges,"25.81% of $2,278.30 in Billed Charges for Rev 272 = $588.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,2278.3000,341.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2278.30,,,,,,,588.0300,2278.3000,percent of total billed charges,"100% of $2,278.30 in Billed Charges for Rev 272 = $2,278.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,2278.3000,341.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1139.15,,,,,,,588.0300,2278.3000,percent of total billed charges,"Rev 272 $2,278.30 in Billed Charges at 50% = $1,139.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,2278.3000,341.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,735.89,,,,,,,588.0300,2278.3000,other,"32.3% of $2,278.30 in Billed Charges for Rev 272 = $735.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,2278.3000,341.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,699.44,,,,,,,588.0300,2278.3000,other,"30.7% of $2,278.30 in Billed Charges for Rev 272 = $699.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,2278.3000,341.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,735.89,,,,,,,588.0300,2278.3000,percent of total billed charges,"32.3% of $2,278.30 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER TX30-V3 WHITE,272,RC,27200002,CDM,,,,,,both,,,2278.3000,341.7500,WELLCARE,WELLCARE MEDICAID,2278.30,,,,,,,588.0300,2278.3000,percent of total billed charges,"100% of $2,278.30 in Billed Charges for Rev 272 = $2,278.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 60 SURPASS SEE LN 184179,272,RC,27200002,CDM,,,,,,both,,,8221.0100,1233.1500,AETNA,AETNA,3510.37,,,,,,,2121.8400,8221.0100,percent of total billed charges,"42.7% of $8,221.01 in Billed Charges for Rev 272 = $3,510.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 60 SURPASS SEE LN 184179,272,RC,27200002,CDM,,,,,,both,,,8221.0100,1233.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5754.71,,,,,,,2121.8400,8221.0100,percent of total billed charges,"Rev 272 $8,221.01 in Billed Charges at 70% = $5,754.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 60 SURPASS SEE LN 184179,272,RC,27200002,CDM,,,,,,both,,,8221.0100,1233.1500,CIGNA HEALTHCARE,CIGNA HMO,3428.16,,,,,,,2121.8400,8221.0100,percent of total billed charges,"41.7% of $8,221.01 in Billed Charges for Rev 272 = $3,428.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 60 SURPASS SEE LN 184179,272,RC,27200002,CDM,,,,,,both,,,8221.0100,1233.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3814.55,,,,,,,2121.8400,8221.0100,percent of total billed charges,"46.4% of $8,221.01 in Billed Charges for Rev 272 = $3,814.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 60 SURPASS SEE LN 184179,272,RC,27200002,CDM,,,,,,both,,,8221.0100,1233.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3428.16,,,,,,,2121.8400,8221.0100,percent of total billed charges,"41.7% of $8,221.01 in Billed Charges for Rev 272 = $3,428.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 60 SURPASS SEE LN 184179,272,RC,27200002,CDM,,,,,,both,,,8221.0100,1233.1500,CIGNA HEALTHCARE,CIGNA PPO,3428.16,,,,,,,2121.8400,8221.0100,percent of total billed charges,"41.7% of $8,221.01 in Billed Charges for Rev 272 = $3,428.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 60 SURPASS SEE LN 184179,272,RC,27200002,CDM,,,,,,both,,,8221.0100,1233.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7398.91,,,,,,,2121.8400,8221.0100,percent of total billed charges,"90% of $8,221.01 in Billed Charges for Rev 272 = $7,398.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 60 SURPASS SEE LN 184179,272,RC,27200002,CDM,,,,,,both,,,8221.0100,1233.1500,MEDCOST,MEDCOST VHN,3912.38,,,,,,,2121.8400,8221.0100,percent of total billed charges,"47.59% of $8,221.01 in Billed Charges for Rev 272 = $3,912.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 60 SURPASS SEE LN 184179,272,RC,27200002,CDM,,,,,,both,,,8221.0100,1233.1500,SENTARA HEALTH,SENTARA HEALTH,2121.84,,,,,,,2121.8400,8221.0100,percent of total billed charges,"25.81% of $8,221.01 in Billed Charges for Rev 272 = $2,121.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 60 SURPASS SEE LN 184179,272,RC,27200002,CDM,,,,,,both,,,8221.0100,1233.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8221.01,,,,,,,2121.8400,8221.0100,percent of total billed charges,"100% of $8,221.01 in Billed Charges for Rev 272 = $8,221.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 60 SURPASS SEE LN 184179,272,RC,27200002,CDM,,,,,,both,,,8221.0100,1233.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4110.51,,,,,,,2121.8400,8221.0100,percent of total billed charges,"Rev 272 $8,221.01 in Billed Charges at 50% = $4,110.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 60 SURPASS SEE LN 184179,272,RC,27200002,CDM,,,,,,both,,,8221.0100,1233.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2655.39,,,,,,,2121.8400,8221.0100,other,"32.3% of $8,221.01 in Billed Charges for Rev 272 = $2,655.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER VASC ARTIC EX THICK 60 SURPASS SEE LN 184179,272,RC,27200002,CDM,,,,,,both,,,8221.0100,1233.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2523.85,,,,,,,2121.8400,8221.0100,other,"30.7% of $8,221.01 in Billed Charges for Rev 272 = $2,523.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER VASC ARTIC EX THICK 60 SURPASS SEE LN 184179,272,RC,27200002,CDM,,,,,,both,,,8221.0100,1233.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,2655.39,,,,,,,2121.8400,8221.0100,percent of total billed charges,"32.3% of $8,221.01 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER VASC ARTIC EX THICK 60 SURPASS SEE LN 184179,272,RC,27200002,CDM,,,,,,both,,,8221.0100,1233.1500,WELLCARE,WELLCARE MEDICAID,8221.01,,,,,,,2121.8400,8221.0100,percent of total billed charges,"100% of $8,221.01 in Billed Charges for Rev 272 = $8,221.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLES LOADING GIA 80-3.8 SURPASS SEE LN 106539,272,RC,,,,,,,,both,,,3403.5200,510.5300,AETNA,AETNA,1453.30,,,,,,,878.4500,3403.5200,percent of total billed charges,"42.7% of $3,403.52 in Billed Charges for Rev 272 = $1,453.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLES LOADING GIA 80-3.8 SURPASS SEE LN 106539,272,RC,,,,,,,,both,,,3403.5200,510.5300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2382.46,,,,,,,878.4500,3403.5200,percent of total billed charges,"Rev 272 $3,403.52 in Billed Charges at 70% = $2,382.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLES LOADING GIA 80-3.8 SURPASS SEE LN 106539,272,RC,,,,,,,,both,,,3403.5200,510.5300,CIGNA HEALTHCARE,CIGNA HMO,1419.27,,,,,,,878.4500,3403.5200,percent of total billed charges,"41.7% of $3,403.52 in Billed Charges for Rev 272 = $1,419.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLES LOADING GIA 80-3.8 SURPASS SEE LN 106539,272,RC,,,,,,,,both,,,3403.5200,510.5300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1579.23,,,,,,,878.4500,3403.5200,percent of total billed charges,"46.4% of $3,403.52 in Billed Charges for Rev 272 = $1,579.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLES LOADING GIA 80-3.8 SURPASS SEE LN 106539,272,RC,,,,,,,,both,,,3403.5200,510.5300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1419.27,,,,,,,878.4500,3403.5200,percent of total billed charges,"41.7% of $3,403.52 in Billed Charges for Rev 272 = $1,419.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLES LOADING GIA 80-3.8 SURPASS SEE LN 106539,272,RC,,,,,,,,both,,,3403.5200,510.5300,CIGNA HEALTHCARE,CIGNA PPO,1419.27,,,,,,,878.4500,3403.5200,percent of total billed charges,"41.7% of $3,403.52 in Billed Charges for Rev 272 = $1,419.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLES LOADING GIA 80-3.8 SURPASS SEE LN 106539,272,RC,,,,,,,,both,,,3403.5200,510.5300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3063.17,,,,,,,878.4500,3403.5200,percent of total billed charges,"90% of $3,403.52 in Billed Charges for Rev 272 = $3,063.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLES LOADING GIA 80-3.8 SURPASS SEE LN 106539,272,RC,,,,,,,,both,,,3403.5200,510.5300,MEDCOST,MEDCOST VHN,1619.74,,,,,,,878.4500,3403.5200,percent of total billed charges,"47.59% of $3,403.52 in Billed Charges for Rev 272 = $1,619.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLES LOADING GIA 80-3.8 SURPASS SEE LN 106539,272,RC,,,,,,,,both,,,3403.5200,510.5300,SENTARA HEALTH,SENTARA HEALTH,878.45,,,,,,,878.4500,3403.5200,percent of total billed charges,"25.81% of $3,403.52 in Billed Charges for Rev 272 = $878.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLES LOADING GIA 80-3.8 SURPASS SEE LN 106539,272,RC,,,,,,,,both,,,3403.5200,510.5300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3403.52,,,,,,,878.4500,3403.5200,percent of total billed charges,"100% of $3,403.52 in Billed Charges for Rev 272 = $3,403.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLES LOADING GIA 80-3.8 SURPASS SEE LN 106539,272,RC,,,,,,,,both,,,3403.5200,510.5300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1701.76,,,,,,,878.4500,3403.5200,percent of total billed charges,"Rev 272 $3,403.52 in Billed Charges at 50% = $1,701.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLES LOADING GIA 80-3.8 SURPASS SEE LN 106539,272,RC,,,,,,,,both,,,3403.5200,510.5300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1099.34,,,,,,,878.4500,3403.5200,other,"32.3% of $3,403.52 in Billed Charges for Rev 272 = $1,099.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLES LOADING GIA 80-3.8 SURPASS SEE LN 106539,272,RC,,,,,,,,both,,,3403.5200,510.5300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1044.88,,,,,,,878.4500,3403.5200,other,"30.7% of $3,403.52 in Billed Charges for Rev 272 = $1,044.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLES LOADING GIA 80-3.8 SURPASS SEE LN 106539,272,RC,,,,,,,,both,,,3403.5200,510.5300,UNITED HEALTHCARE,UNITED HEALTHCARE,1099.34,,,,,,,878.4500,3403.5200,percent of total billed charges,"32.3% of $3,403.52 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLES LOADING GIA 80-3.8 SURPASS SEE LN 106539,272,RC,,,,,,,,both,,,3403.5200,510.5300,WELLCARE,WELLCARE MEDICAID,3403.52,,,,,,,878.4500,3403.5200,percent of total billed charges,"100% of $3,403.52 in Billed Charges for Rev 272 = $3,403.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STEEL NEEDLE CUTTING 14IN,272,RC,27200002,CDM,,,,,,both,,,927.3400,139.1000,AETNA,AETNA,395.97,,,,,,,239.3500,927.3400,percent of total billed charges,42.7% of $927.34 in Billed Charges for Rev 272 = $395.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STEEL NEEDLE CUTTING 14IN,272,RC,27200002,CDM,,,,,,both,,,927.3400,139.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,649.14,,,,,,,239.3500,927.3400,percent of total billed charges,Rev 272 $927.34 in Billed Charges at 70% = $649.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STEEL NEEDLE CUTTING 14IN,272,RC,27200002,CDM,,,,,,both,,,927.3400,139.1000,CIGNA HEALTHCARE,CIGNA HMO,386.70,,,,,,,239.3500,927.3400,percent of total billed charges,41.7% of $927.34 in Billed Charges for Rev 272 = $386.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STEEL NEEDLE CUTTING 14IN,272,RC,27200002,CDM,,,,,,both,,,927.3400,139.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,430.29,,,,,,,239.3500,927.3400,percent of total billed charges,46.4% of $927.34 in Billed Charges for Rev 272 = $430.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STEEL NEEDLE CUTTING 14IN,272,RC,27200002,CDM,,,,,,both,,,927.3400,139.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,386.70,,,,,,,239.3500,927.3400,percent of total billed charges,41.7% of $927.34 in Billed Charges for Rev 272 = $386.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STEEL NEEDLE CUTTING 14IN,272,RC,27200002,CDM,,,,,,both,,,927.3400,139.1000,CIGNA HEALTHCARE,CIGNA PPO,386.70,,,,,,,239.3500,927.3400,percent of total billed charges,41.7% of $927.34 in Billed Charges for Rev 272 = $386.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STEEL NEEDLE CUTTING 14IN,272,RC,27200002,CDM,,,,,,both,,,927.3400,139.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,834.61,,,,,,,239.3500,927.3400,percent of total billed charges,90% of $927.34 in Billed Charges for Rev 272 = $834.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STEEL NEEDLE CUTTING 14IN,272,RC,27200002,CDM,,,,,,both,,,927.3400,139.1000,MEDCOST,MEDCOST VHN,441.32,,,,,,,239.3500,927.3400,percent of total billed charges,47.59% of $927.34 in Billed Charges for Rev 272 = $441.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STEEL NEEDLE CUTTING 14IN,272,RC,27200002,CDM,,,,,,both,,,927.3400,139.1000,SENTARA HEALTH,SENTARA HEALTH,239.35,,,,,,,239.3500,927.3400,percent of total billed charges,25.81% of $927.34 in Billed Charges for Rev 272 = $239.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STEEL NEEDLE CUTTING 14IN,272,RC,27200002,CDM,,,,,,both,,,927.3400,139.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",927.34,,,,,,,239.3500,927.3400,percent of total billed charges,100% of $927.34 in Billed Charges for Rev 272 = $927.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STEEL NEEDLE CUTTING 14IN,272,RC,27200002,CDM,,,,,,both,,,927.3400,139.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,463.67,,,,,,,239.3500,927.3400,percent of total billed charges,Rev 272 $927.34 in Billed Charges at 50% = $463.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STEEL NEEDLE CUTTING 14IN,272,RC,27200002,CDM,,,,,,both,,,927.3400,139.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,299.53,,,,,,,239.3500,927.3400,other,32.3% of $927.34 in Billed Charges for Rev 272 = $299.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STEEL NEEDLE CUTTING 14IN,272,RC,27200002,CDM,,,,,,both,,,927.3400,139.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,284.69,,,,,,,239.3500,927.3400,other,30.7% of $927.34 in Billed Charges for Rev 272 = $284.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STEEL NEEDLE CUTTING 14IN,272,RC,27200002,CDM,,,,,,both,,,927.3400,139.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,299.53,,,,,,,239.3500,927.3400,percent of total billed charges,32.3% of $927.34 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STEEL NEEDLE CUTTING 14IN,272,RC,27200002,CDM,,,,,,both,,,927.3400,139.1000,WELLCARE,WELLCARE MEDICAID,927.34,,,,,,,239.3500,927.3400,percent of total billed charges,100% of $927.34 in Billed Charges for Rev 272 = $927.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3017.1700,452.5800,AETNA,AETNA,1288.33,,,,,,,778.7300,3017.1700,percent of total billed charges,"42.7% of $3,017.17 in Billed Charges for Rev 272 = $1,288.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3017.1700,452.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2112.02,,,,,,,778.7300,3017.1700,percent of total billed charges,"Rev 272 $3,017.17 in Billed Charges at 70% = $2,112.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3017.1700,452.5800,CIGNA HEALTHCARE,CIGNA HMO,1258.16,,,,,,,778.7300,3017.1700,percent of total billed charges,"41.7% of $3,017.17 in Billed Charges for Rev 272 = $1,258.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3017.1700,452.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1399.97,,,,,,,778.7300,3017.1700,percent of total billed charges,"46.4% of $3,017.17 in Billed Charges for Rev 272 = $1,399.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3017.1700,452.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1258.16,,,,,,,778.7300,3017.1700,percent of total billed charges,"41.7% of $3,017.17 in Billed Charges for Rev 272 = $1,258.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3017.1700,452.5800,CIGNA HEALTHCARE,CIGNA PPO,1258.16,,,,,,,778.7300,3017.1700,percent of total billed charges,"41.7% of $3,017.17 in Billed Charges for Rev 272 = $1,258.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3017.1700,452.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2715.45,,,,,,,778.7300,3017.1700,percent of total billed charges,"90% of $3,017.17 in Billed Charges for Rev 272 = $2,715.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3017.1700,452.5800,MEDCOST,MEDCOST VHN,1435.87,,,,,,,778.7300,3017.1700,percent of total billed charges,"47.59% of $3,017.17 in Billed Charges for Rev 272 = $1,435.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3017.1700,452.5800,SENTARA HEALTH,SENTARA HEALTH,778.73,,,,,,,778.7300,3017.1700,percent of total billed charges,"25.81% of $3,017.17 in Billed Charges for Rev 272 = $778.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3017.1700,452.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3017.17,,,,,,,778.7300,3017.1700,percent of total billed charges,"100% of $3,017.17 in Billed Charges for Rev 272 = $3,017.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3017.1700,452.5800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1508.59,,,,,,,778.7300,3017.1700,percent of total billed charges,"Rev 272 $3,017.17 in Billed Charges at 50% = $1,508.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3017.1700,452.5800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,974.55,,,,,,,778.7300,3017.1700,other,"32.3% of $3,017.17 in Billed Charges for Rev 272 = $974.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3017.1700,452.5800,UNITED HEALTHCARE,UHC HERITAGE SELECT,926.27,,,,,,,778.7300,3017.1700,other,"30.7% of $3,017.17 in Billed Charges for Rev 272 = $926.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3017.1700,452.5800,UNITED HEALTHCARE,UNITED HEALTHCARE,974.55,,,,,,,778.7300,3017.1700,percent of total billed charges,"32.3% of $3,017.17 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3017.1700,452.5800,WELLCARE,WELLCARE MEDICAID,3017.17,,,,,,,778.7300,3017.1700,percent of total billed charges,"100% of $3,017.17 in Billed Charges for Rev 272 = $3,017.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3984.2700,597.6400,AETNA,AETNA,1701.28,,,,,,,1028.3400,3984.2700,percent of total billed charges,"42.7% of $3,984.27 in Billed Charges for Rev 272 = $1,701.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3984.2700,597.6400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2788.99,,,,,,,1028.3400,3984.2700,percent of total billed charges,"Rev 272 $3,984.27 in Billed Charges at 70% = $2,788.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3984.2700,597.6400,CIGNA HEALTHCARE,CIGNA HMO,1661.44,,,,,,,1028.3400,3984.2700,percent of total billed charges,"41.7% of $3,984.27 in Billed Charges for Rev 272 = $1,661.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3984.2700,597.6400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1848.70,,,,,,,1028.3400,3984.2700,percent of total billed charges,"46.4% of $3,984.27 in Billed Charges for Rev 272 = $1,848.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3984.2700,597.6400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1661.44,,,,,,,1028.3400,3984.2700,percent of total billed charges,"41.7% of $3,984.27 in Billed Charges for Rev 272 = $1,661.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3984.2700,597.6400,CIGNA HEALTHCARE,CIGNA PPO,1661.44,,,,,,,1028.3400,3984.2700,percent of total billed charges,"41.7% of $3,984.27 in Billed Charges for Rev 272 = $1,661.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3984.2700,597.6400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3585.84,,,,,,,1028.3400,3984.2700,percent of total billed charges,"90% of $3,984.27 in Billed Charges for Rev 272 = $3,585.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3984.2700,597.6400,MEDCOST,MEDCOST VHN,1896.11,,,,,,,1028.3400,3984.2700,percent of total billed charges,"47.59% of $3,984.27 in Billed Charges for Rev 272 = $1,896.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3984.2700,597.6400,SENTARA HEALTH,SENTARA HEALTH,1028.34,,,,,,,1028.3400,3984.2700,percent of total billed charges,"25.81% of $3,984.27 in Billed Charges for Rev 272 = $1,028.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3984.2700,597.6400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3984.27,,,,,,,1028.3400,3984.2700,percent of total billed charges,"100% of $3,984.27 in Billed Charges for Rev 272 = $3,984.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3984.2700,597.6400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1992.14,,,,,,,1028.3400,3984.2700,percent of total billed charges,"Rev 272 $3,984.27 in Billed Charges at 50% = $1,992.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3984.2700,597.6400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1286.92,,,,,,,1028.3400,3984.2700,other,"32.3% of $3,984.27 in Billed Charges for Rev 272 = $1,286.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3984.2700,597.6400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1223.17,,,,,,,1028.3400,3984.2700,other,"30.7% of $3,984.27 in Billed Charges for Rev 272 = $1,223.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3984.2700,597.6400,UNITED HEALTHCARE,UNITED HEALTHCARE,1286.92,,,,,,,1028.3400,3984.2700,percent of total billed charges,"32.3% of $3,984.27 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SEPRAFILM,272,RC,27200002,CDM,,,,,,both,,,3984.2700,597.6400,WELLCARE,WELLCARE MEDICAID,3984.27,,,,,,,1028.3400,3984.2700,percent of total billed charges,"100% of $3,984.27 in Billed Charges for Rev 272 = $3,984.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET CARDIOHELP DISPOSABLE,272,RC,27202225,CDM,,,,,,both,,,163284.0000,24492.6000,AETNA,AETNA,69722.27,,,,,,,42143.6000,163284.0000,percent of total billed charges,"42.7% of $163,284.00 in Billed Charges for Rev 272 = $69,722.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET CARDIOHELP DISPOSABLE,272,RC,27202225,CDM,,,,,,both,,,163284.0000,24492.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,114298.80,,,,,,,42143.6000,163284.0000,percent of total billed charges,"Rev 272 $163,284.00 in Billed Charges at 70% = $114,298.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET CARDIOHELP DISPOSABLE,272,RC,27202225,CDM,,,,,,both,,,163284.0000,24492.6000,CIGNA HEALTHCARE,CIGNA HMO,68089.43,,,,,,,42143.6000,163284.0000,percent of total billed charges,"41.7% of $163,284.00 in Billed Charges for Rev 272 = $68,089.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET CARDIOHELP DISPOSABLE,272,RC,27202225,CDM,,,,,,both,,,163284.0000,24492.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,75763.78,,,,,,,42143.6000,163284.0000,percent of total billed charges,"46.4% of $163,284.00 in Billed Charges for Rev 272 = $75,763.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET CARDIOHELP DISPOSABLE,272,RC,27202225,CDM,,,,,,both,,,163284.0000,24492.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,68089.43,,,,,,,42143.6000,163284.0000,percent of total billed charges,"41.7% of $163,284.00 in Billed Charges for Rev 272 = $68,089.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET CARDIOHELP DISPOSABLE,272,RC,27202225,CDM,,,,,,both,,,163284.0000,24492.6000,CIGNA HEALTHCARE,CIGNA PPO,68089.43,,,,,,,42143.6000,163284.0000,percent of total billed charges,"41.7% of $163,284.00 in Billed Charges for Rev 272 = $68,089.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET CARDIOHELP DISPOSABLE,272,RC,27202225,CDM,,,,,,both,,,163284.0000,24492.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,146955.60,,,,,,,42143.6000,163284.0000,percent of total billed charges,"90% of $163,284.00 in Billed Charges for Rev 272 = $146,955.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET CARDIOHELP DISPOSABLE,272,RC,27202225,CDM,,,,,,both,,,163284.0000,24492.6000,MEDCOST,MEDCOST VHN,77706.86,,,,,,,42143.6000,163284.0000,percent of total billed charges,"47.59% of $163,284.00 in Billed Charges for Rev 272 = $77,706.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET CARDIOHELP DISPOSABLE,272,RC,27202225,CDM,,,,,,both,,,163284.0000,24492.6000,SENTARA HEALTH,SENTARA HEALTH,42143.60,,,,,,,42143.6000,163284.0000,percent of total billed charges,"25.81% of $163,284.00 in Billed Charges for Rev 272 = $42,143.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET CARDIOHELP DISPOSABLE,272,RC,27202225,CDM,,,,,,both,,,163284.0000,24492.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",163284.00,,,,,,,42143.6000,163284.0000,percent of total billed charges,"100% of $163,284.00 in Billed Charges for Rev 272 = $163,284.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET CARDIOHELP DISPOSABLE,272,RC,27202225,CDM,,,,,,both,,,163284.0000,24492.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,81642.00,,,,,,,42143.6000,163284.0000,percent of total billed charges,"Rev 272 $163,284.00 in Billed Charges at 50% = $81,642.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET CARDIOHELP DISPOSABLE,272,RC,27202225,CDM,,,,,,both,,,163284.0000,24492.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,52740.73,,,,,,,42143.6000,163284.0000,other,"32.3% of $163,284.00 in Billed Charges for Rev 272 = $52,740.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET CARDIOHELP DISPOSABLE,272,RC,27202225,CDM,,,,,,both,,,163284.0000,24492.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,50128.19,,,,,,,42143.6000,163284.0000,other,"30.7% of $163,284.00 in Billed Charges for Rev 272 = $50,128.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET CARDIOHELP DISPOSABLE,272,RC,27202225,CDM,,,,,,both,,,163284.0000,24492.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,52740.73,,,,,,,42143.6000,163284.0000,percent of total billed charges,"32.3% of $163,284.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET CARDIOHELP DISPOSABLE,272,RC,27202225,CDM,,,,,,both,,,163284.0000,24492.6000,WELLCARE,WELLCARE MEDICAID,163284.00,,,,,,,42143.6000,163284.0000,percent of total billed charges,"100% of $163,284.00 in Billed Charges for Rev 272 = $163,284.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET DRAIN EXT. AND MONITORING  26040 (5871),272,RC,27200002,CDM,,,,,,both,,,4111.0600,616.6600,AETNA,AETNA,1755.42,,,,,,,1061.0600,4111.0600,percent of total billed charges,"42.7% of $4,111.06 in Billed Charges for Rev 272 = $1,755.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET DRAIN EXT. AND MONITORING  26040 (5871),272,RC,27200002,CDM,,,,,,both,,,4111.0600,616.6600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2877.74,,,,,,,1061.0600,4111.0600,percent of total billed charges,"Rev 272 $4,111.06 in Billed Charges at 70% = $2,877.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET DRAIN EXT. AND MONITORING  26040 (5871),272,RC,27200002,CDM,,,,,,both,,,4111.0600,616.6600,CIGNA HEALTHCARE,CIGNA HMO,1714.31,,,,,,,1061.0600,4111.0600,percent of total billed charges,"41.7% of $4,111.06 in Billed Charges for Rev 272 = $1,714.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET DRAIN EXT. AND MONITORING  26040 (5871),272,RC,27200002,CDM,,,,,,both,,,4111.0600,616.6600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1907.53,,,,,,,1061.0600,4111.0600,percent of total billed charges,"46.4% of $4,111.06 in Billed Charges for Rev 272 = $1,907.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET DRAIN EXT. AND MONITORING  26040 (5871),272,RC,27200002,CDM,,,,,,both,,,4111.0600,616.6600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1714.31,,,,,,,1061.0600,4111.0600,percent of total billed charges,"41.7% of $4,111.06 in Billed Charges for Rev 272 = $1,714.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET DRAIN EXT. AND MONITORING  26040 (5871),272,RC,27200002,CDM,,,,,,both,,,4111.0600,616.6600,CIGNA HEALTHCARE,CIGNA PPO,1714.31,,,,,,,1061.0600,4111.0600,percent of total billed charges,"41.7% of $4,111.06 in Billed Charges for Rev 272 = $1,714.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET DRAIN EXT. AND MONITORING  26040 (5871),272,RC,27200002,CDM,,,,,,both,,,4111.0600,616.6600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3699.95,,,,,,,1061.0600,4111.0600,percent of total billed charges,"90% of $4,111.06 in Billed Charges for Rev 272 = $3,699.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET DRAIN EXT. AND MONITORING  26040 (5871),272,RC,27200002,CDM,,,,,,both,,,4111.0600,616.6600,MEDCOST,MEDCOST VHN,1956.45,,,,,,,1061.0600,4111.0600,percent of total billed charges,"47.59% of $4,111.06 in Billed Charges for Rev 272 = $1,956.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET DRAIN EXT. AND MONITORING  26040 (5871),272,RC,27200002,CDM,,,,,,both,,,4111.0600,616.6600,SENTARA HEALTH,SENTARA HEALTH,1061.06,,,,,,,1061.0600,4111.0600,percent of total billed charges,"25.81% of $4,111.06 in Billed Charges for Rev 272 = $1,061.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET DRAIN EXT. AND MONITORING  26040 (5871),272,RC,27200002,CDM,,,,,,both,,,4111.0600,616.6600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4111.06,,,,,,,1061.0600,4111.0600,percent of total billed charges,"100% of $4,111.06 in Billed Charges for Rev 272 = $4,111.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET DRAIN EXT. AND MONITORING  26040 (5871),272,RC,27200002,CDM,,,,,,both,,,4111.0600,616.6600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2055.53,,,,,,,1061.0600,4111.0600,percent of total billed charges,"Rev 272 $4,111.06 in Billed Charges at 50% = $2,055.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET DRAIN EXT. AND MONITORING  26040 (5871),272,RC,27200002,CDM,,,,,,both,,,4111.0600,616.6600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1327.87,,,,,,,1061.0600,4111.0600,other,"32.3% of $4,111.06 in Billed Charges for Rev 272 = $1,327.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET DRAIN EXT. AND MONITORING  26040 (5871),272,RC,27200002,CDM,,,,,,both,,,4111.0600,616.6600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1262.10,,,,,,,1061.0600,4111.0600,other,"30.7% of $4,111.06 in Billed Charges for Rev 272 = $1,262.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET DRAIN EXT. AND MONITORING  26040 (5871),272,RC,27200002,CDM,,,,,,both,,,4111.0600,616.6600,UNITED HEALTHCARE,UNITED HEALTHCARE,1327.87,,,,,,,1061.0600,4111.0600,percent of total billed charges,"32.3% of $4,111.06 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET DRAIN EXT. AND MONITORING  26040 (5871),272,RC,27200002,CDM,,,,,,both,,,4111.0600,616.6600,WELLCARE,WELLCARE MEDICAID,4111.06,,,,,,,1061.0600,4111.0600,percent of total billed charges,"100% of $4,111.06 in Billed Charges for Rev 272 = $4,111.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET MENISCUS MENDER II DISP,272,RC,27200002,CDM,,,,,,both,,,1797.0900,269.5600,AETNA,AETNA,767.36,,,,,,,463.8300,1797.0900,percent of total billed charges,"42.7% of $1,797.09 in Billed Charges for Rev 272 = $767.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET MENISCUS MENDER II DISP,272,RC,27200002,CDM,,,,,,both,,,1797.0900,269.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1257.96,,,,,,,463.8300,1797.0900,percent of total billed charges,"Rev 272 $1,797.09 in Billed Charges at 70% = $1,257.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET MENISCUS MENDER II DISP,272,RC,27200002,CDM,,,,,,both,,,1797.0900,269.5600,CIGNA HEALTHCARE,CIGNA HMO,749.39,,,,,,,463.8300,1797.0900,percent of total billed charges,"41.7% of $1,797.09 in Billed Charges for Rev 272 = $749.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET MENISCUS MENDER II DISP,272,RC,27200002,CDM,,,,,,both,,,1797.0900,269.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,833.85,,,,,,,463.8300,1797.0900,percent of total billed charges,"46.4% of $1,797.09 in Billed Charges for Rev 272 = $833.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET MENISCUS MENDER II DISP,272,RC,27200002,CDM,,,,,,both,,,1797.0900,269.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,749.39,,,,,,,463.8300,1797.0900,percent of total billed charges,"41.7% of $1,797.09 in Billed Charges for Rev 272 = $749.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET MENISCUS MENDER II DISP,272,RC,27200002,CDM,,,,,,both,,,1797.0900,269.5600,CIGNA HEALTHCARE,CIGNA PPO,749.39,,,,,,,463.8300,1797.0900,percent of total billed charges,"41.7% of $1,797.09 in Billed Charges for Rev 272 = $749.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET MENISCUS MENDER II DISP,272,RC,27200002,CDM,,,,,,both,,,1797.0900,269.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1617.38,,,,,,,463.8300,1797.0900,percent of total billed charges,"90% of $1,797.09 in Billed Charges for Rev 272 = $1,617.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET MENISCUS MENDER II DISP,272,RC,27200002,CDM,,,,,,both,,,1797.0900,269.5600,MEDCOST,MEDCOST VHN,855.24,,,,,,,463.8300,1797.0900,percent of total billed charges,"47.59% of $1,797.09 in Billed Charges for Rev 272 = $855.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET MENISCUS MENDER II DISP,272,RC,27200002,CDM,,,,,,both,,,1797.0900,269.5600,SENTARA HEALTH,SENTARA HEALTH,463.83,,,,,,,463.8300,1797.0900,percent of total billed charges,"25.81% of $1,797.09 in Billed Charges for Rev 272 = $463.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET MENISCUS MENDER II DISP,272,RC,27200002,CDM,,,,,,both,,,1797.0900,269.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1797.09,,,,,,,463.8300,1797.0900,percent of total billed charges,"100% of $1,797.09 in Billed Charges for Rev 272 = $1,797.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET MENISCUS MENDER II DISP,272,RC,27200002,CDM,,,,,,both,,,1797.0900,269.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,898.55,,,,,,,463.8300,1797.0900,percent of total billed charges,"Rev 272 $1,797.09 in Billed Charges at 50% = $898.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET MENISCUS MENDER II DISP,272,RC,27200002,CDM,,,,,,both,,,1797.0900,269.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,580.46,,,,,,,463.8300,1797.0900,other,"32.3% of $1,797.09 in Billed Charges for Rev 272 = $580.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET MENISCUS MENDER II DISP,272,RC,27200002,CDM,,,,,,both,,,1797.0900,269.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,551.71,,,,,,,463.8300,1797.0900,other,"30.7% of $1,797.09 in Billed Charges for Rev 272 = $551.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET MENISCUS MENDER II DISP,272,RC,27200002,CDM,,,,,,both,,,1797.0900,269.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,580.46,,,,,,,463.8300,1797.0900,percent of total billed charges,"32.3% of $1,797.09 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET MENISCUS MENDER II DISP,272,RC,27200002,CDM,,,,,,both,,,1797.0900,269.5600,WELLCARE,WELLCARE MEDICAID,1797.09,,,,,,,463.8300,1797.0900,percent of total billed charges,"100% of $1,797.09 in Billed Charges for Rev 272 = $1,797.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NAVIGATOR URETHRAL ACCESS SHEATH 13/15FR 250-206,272,RC,,,,,,,,both,,,1173.5800,176.0400,AETNA,AETNA,501.12,,,,,,,302.9000,1173.5800,percent of total billed charges,"42.7% of $1,173.58 in Billed Charges for Rev 272 = $501.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NAVIGATOR URETHRAL ACCESS SHEATH 13/15FR 250-206,272,RC,,,,,,,,both,,,1173.5800,176.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,821.51,,,,,,,302.9000,1173.5800,percent of total billed charges,"Rev 272 $1,173.58 in Billed Charges at 70% = $821.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NAVIGATOR URETHRAL ACCESS SHEATH 13/15FR 250-206,272,RC,,,,,,,,both,,,1173.5800,176.0400,CIGNA HEALTHCARE,CIGNA HMO,489.38,,,,,,,302.9000,1173.5800,percent of total billed charges,"41.7% of $1,173.58 in Billed Charges for Rev 272 = $489.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NAVIGATOR URETHRAL ACCESS SHEATH 13/15FR 250-206,272,RC,,,,,,,,both,,,1173.5800,176.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,544.54,,,,,,,302.9000,1173.5800,percent of total billed charges,"46.4% of $1,173.58 in Billed Charges for Rev 272 = $544.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NAVIGATOR URETHRAL ACCESS SHEATH 13/15FR 250-206,272,RC,,,,,,,,both,,,1173.5800,176.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,489.38,,,,,,,302.9000,1173.5800,percent of total billed charges,"41.7% of $1,173.58 in Billed Charges for Rev 272 = $489.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NAVIGATOR URETHRAL ACCESS SHEATH 13/15FR 250-206,272,RC,,,,,,,,both,,,1173.5800,176.0400,CIGNA HEALTHCARE,CIGNA PPO,489.38,,,,,,,302.9000,1173.5800,percent of total billed charges,"41.7% of $1,173.58 in Billed Charges for Rev 272 = $489.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NAVIGATOR URETHRAL ACCESS SHEATH 13/15FR 250-206,272,RC,,,,,,,,both,,,1173.5800,176.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1056.22,,,,,,,302.9000,1173.5800,percent of total billed charges,"90% of $1,173.58 in Billed Charges for Rev 272 = $1,056.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NAVIGATOR URETHRAL ACCESS SHEATH 13/15FR 250-206,272,RC,,,,,,,,both,,,1173.5800,176.0400,MEDCOST,MEDCOST VHN,558.51,,,,,,,302.9000,1173.5800,percent of total billed charges,"47.59% of $1,173.58 in Billed Charges for Rev 272 = $558.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NAVIGATOR URETHRAL ACCESS SHEATH 13/15FR 250-206,272,RC,,,,,,,,both,,,1173.5800,176.0400,SENTARA HEALTH,SENTARA HEALTH,302.90,,,,,,,302.9000,1173.5800,percent of total billed charges,"25.81% of $1,173.58 in Billed Charges for Rev 272 = $302.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NAVIGATOR URETHRAL ACCESS SHEATH 13/15FR 250-206,272,RC,,,,,,,,both,,,1173.5800,176.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1173.58,,,,,,,302.9000,1173.5800,percent of total billed charges,"100% of $1,173.58 in Billed Charges for Rev 272 = $1,173.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NAVIGATOR URETHRAL ACCESS SHEATH 13/15FR 250-206,272,RC,,,,,,,,both,,,1173.5800,176.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,586.79,,,,,,,302.9000,1173.5800,percent of total billed charges,"Rev 272 $1,173.58 in Billed Charges at 50% = $586.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NAVIGATOR URETHRAL ACCESS SHEATH 13/15FR 250-206,272,RC,,,,,,,,both,,,1173.5800,176.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,379.07,,,,,,,302.9000,1173.5800,other,"32.3% of $1,173.58 in Billed Charges for Rev 272 = $379.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET NAVIGATOR URETHRAL ACCESS SHEATH 13/15FR 250-206,272,RC,,,,,,,,both,,,1173.5800,176.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,360.29,,,,,,,302.9000,1173.5800,other,"30.7% of $1,173.58 in Billed Charges for Rev 272 = $360.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET NAVIGATOR URETHRAL ACCESS SHEATH 13/15FR 250-206,272,RC,,,,,,,,both,,,1173.5800,176.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,379.07,,,,,,,302.9000,1173.5800,percent of total billed charges,"32.3% of $1,173.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NAVIGATOR URETHRAL ACCESS SHEATH 13/15FR 250-206,272,RC,,,,,,,,both,,,1173.5800,176.0400,WELLCARE,WELLCARE MEDICAID,1173.58,,,,,,,302.9000,1173.5800,percent of total billed charges,"100% of $1,173.58 in Billed Charges for Rev 272 = $1,173.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TARGETING,272,RC,27200002,CDM,,,,,,both,,,1324.9000,198.7400,AETNA,AETNA,565.73,,,,,,,341.9600,1324.9000,percent of total billed charges,"42.7% of $1,324.90 in Billed Charges for Rev 272 = $565.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TARGETING,272,RC,27200002,CDM,,,,,,both,,,1324.9000,198.7400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,927.43,,,,,,,341.9600,1324.9000,percent of total billed charges,"Rev 272 $1,324.90 in Billed Charges at 70% = $927.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TARGETING,272,RC,27200002,CDM,,,,,,both,,,1324.9000,198.7400,CIGNA HEALTHCARE,CIGNA HMO,552.48,,,,,,,341.9600,1324.9000,percent of total billed charges,"41.7% of $1,324.90 in Billed Charges for Rev 272 = $552.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TARGETING,272,RC,27200002,CDM,,,,,,both,,,1324.9000,198.7400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,614.75,,,,,,,341.9600,1324.9000,percent of total billed charges,"46.4% of $1,324.90 in Billed Charges for Rev 272 = $614.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TARGETING,272,RC,27200002,CDM,,,,,,both,,,1324.9000,198.7400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,552.48,,,,,,,341.9600,1324.9000,percent of total billed charges,"41.7% of $1,324.90 in Billed Charges for Rev 272 = $552.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TARGETING,272,RC,27200002,CDM,,,,,,both,,,1324.9000,198.7400,CIGNA HEALTHCARE,CIGNA PPO,552.48,,,,,,,341.9600,1324.9000,percent of total billed charges,"41.7% of $1,324.90 in Billed Charges for Rev 272 = $552.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TARGETING,272,RC,27200002,CDM,,,,,,both,,,1324.9000,198.7400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1192.41,,,,,,,341.9600,1324.9000,percent of total billed charges,"90% of $1,324.90 in Billed Charges for Rev 272 = $1,192.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TARGETING,272,RC,27200002,CDM,,,,,,both,,,1324.9000,198.7400,MEDCOST,MEDCOST VHN,630.52,,,,,,,341.9600,1324.9000,percent of total billed charges,"47.59% of $1,324.90 in Billed Charges for Rev 272 = $630.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TARGETING,272,RC,27200002,CDM,,,,,,both,,,1324.9000,198.7400,SENTARA HEALTH,SENTARA HEALTH,341.96,,,,,,,341.9600,1324.9000,percent of total billed charges,"25.81% of $1,324.90 in Billed Charges for Rev 272 = $341.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TARGETING,272,RC,27200002,CDM,,,,,,both,,,1324.9000,198.7400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1324.90,,,,,,,341.9600,1324.9000,percent of total billed charges,"100% of $1,324.90 in Billed Charges for Rev 272 = $1,324.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TARGETING,272,RC,27200002,CDM,,,,,,both,,,1324.9000,198.7400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,662.45,,,,,,,341.9600,1324.9000,percent of total billed charges,"Rev 272 $1,324.90 in Billed Charges at 50% = $662.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TARGETING,272,RC,27200002,CDM,,,,,,both,,,1324.9000,198.7400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,427.94,,,,,,,341.9600,1324.9000,other,"32.3% of $1,324.90 in Billed Charges for Rev 272 = $427.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE TARGETING,272,RC,27200002,CDM,,,,,,both,,,1324.9000,198.7400,UNITED HEALTHCARE,UHC HERITAGE SELECT,406.74,,,,,,,341.9600,1324.9000,other,"30.7% of $1,324.90 in Billed Charges for Rev 272 = $406.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLE TARGETING,272,RC,27200002,CDM,,,,,,both,,,1324.9000,198.7400,UNITED HEALTHCARE,UNITED HEALTHCARE,427.94,,,,,,,341.9600,1324.9000,percent of total billed charges,"32.3% of $1,324.90 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE TARGETING,272,RC,27200002,CDM,,,,,,both,,,1324.9000,198.7400,WELLCARE,WELLCARE MEDICAID,1324.90,,,,,,,341.9600,1324.9000,percent of total billed charges,"100% of $1,324.90 in Billed Charges for Rev 272 = $1,324.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLE-á TUOHY W/WINGS 17X3 1/2,272,RC,27200002,CDM,,,,,,both,,,116.0500,17.4100,AETNA,AETNA,49.55,,,,,,,29.9500,116.0500,percent of total billed charges,42.7% of $116.05 in Billed Charges for Rev 272 = $49.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE-á TUOHY W/WINGS 17X3 1/2,272,RC,27200002,CDM,,,,,,both,,,116.0500,17.4100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,81.24,,,,,,,29.9500,116.0500,percent of total billed charges,Rev 272 $116.05 in Billed Charges at 70% = $81.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE-á TUOHY W/WINGS 17X3 1/2,272,RC,27200002,CDM,,,,,,both,,,116.0500,17.4100,CIGNA HEALTHCARE,CIGNA HMO,48.39,,,,,,,29.9500,116.0500,percent of total billed charges,41.7% of $116.05 in Billed Charges for Rev 272 = $48.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE-á TUOHY W/WINGS 17X3 1/2,272,RC,27200002,CDM,,,,,,both,,,116.0500,17.4100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,53.85,,,,,,,29.9500,116.0500,percent of total billed charges,46.4% of $116.05 in Billed Charges for Rev 272 = $53.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE-á TUOHY W/WINGS 17X3 1/2,272,RC,27200002,CDM,,,,,,both,,,116.0500,17.4100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,48.39,,,,,,,29.9500,116.0500,percent of total billed charges,41.7% of $116.05 in Billed Charges for Rev 272 = $48.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE-á TUOHY W/WINGS 17X3 1/2,272,RC,27200002,CDM,,,,,,both,,,116.0500,17.4100,CIGNA HEALTHCARE,CIGNA PPO,48.39,,,,,,,29.9500,116.0500,percent of total billed charges,41.7% of $116.05 in Billed Charges for Rev 272 = $48.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE-á TUOHY W/WINGS 17X3 1/2,272,RC,27200002,CDM,,,,,,both,,,116.0500,17.4100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,104.45,,,,,,,29.9500,116.0500,percent of total billed charges,90% of $116.05 in Billed Charges for Rev 272 = $104.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE-á TUOHY W/WINGS 17X3 1/2,272,RC,27200002,CDM,,,,,,both,,,116.0500,17.4100,MEDCOST,MEDCOST VHN,55.23,,,,,,,29.9500,116.0500,percent of total billed charges,47.59% of $116.05 in Billed Charges for Rev 272 = $55.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE-á TUOHY W/WINGS 17X3 1/2,272,RC,27200002,CDM,,,,,,both,,,116.0500,17.4100,SENTARA HEALTH,SENTARA HEALTH,29.95,,,,,,,29.9500,116.0500,percent of total billed charges,25.81% of $116.05 in Billed Charges for Rev 272 = $29.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE-á TUOHY W/WINGS 17X3 1/2,272,RC,27200002,CDM,,,,,,both,,,116.0500,17.4100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",116.05,,,,,,,29.9500,116.0500,percent of total billed charges,100% of $116.05 in Billed Charges for Rev 272 = $116.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE-á TUOHY W/WINGS 17X3 1/2,272,RC,27200002,CDM,,,,,,both,,,116.0500,17.4100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,58.03,,,,,,,29.9500,116.0500,percent of total billed charges,Rev 272 $116.05 in Billed Charges at 50% = $58.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE-á TUOHY W/WINGS 17X3 1/2,272,RC,27200002,CDM,,,,,,both,,,116.0500,17.4100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,37.48,,,,,,,29.9500,116.0500,other,32.3% of $116.05 in Billed Charges for Rev 272 = $37.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE-á TUOHY W/WINGS 17X3 1/2,272,RC,27200002,CDM,,,,,,both,,,116.0500,17.4100,UNITED HEALTHCARE,UHC HERITAGE SELECT,35.63,,,,,,,29.9500,116.0500,other,30.7% of $116.05 in Billed Charges for Rev 272 = $35.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
NEEDLE-á TUOHY W/WINGS 17X3 1/2,272,RC,27200002,CDM,,,,,,both,,,116.0500,17.4100,UNITED HEALTHCARE,UNITED HEALTHCARE,37.48,,,,,,,29.9500,116.0500,percent of total billed charges,32.3% of $116.05 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLE-á TUOHY W/WINGS 17X3 1/2,272,RC,27200002,CDM,,,,,,both,,,116.0500,17.4100,WELLCARE,WELLCARE MEDICAID,116.05,,,,,,,29.9500,116.0500,percent of total billed charges,100% of $116.05 in Billed Charges for Rev 272 = $116.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET PIN AND DRILL 3.2X127MM,272,RC,27200002,CDM,,,,,,both,,,1511.5700,226.7400,AETNA,AETNA,645.44,,,,,,,390.1400,1511.5700,percent of total billed charges,"42.7% of $1,511.57 in Billed Charges for Rev 272 = $645.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET PIN AND DRILL 3.2X127MM,272,RC,27200002,CDM,,,,,,both,,,1511.5700,226.7400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1058.10,,,,,,,390.1400,1511.5700,percent of total billed charges,"Rev 272 $1,511.57 in Billed Charges at 70% = $1,058.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET PIN AND DRILL 3.2X127MM,272,RC,27200002,CDM,,,,,,both,,,1511.5700,226.7400,CIGNA HEALTHCARE,CIGNA HMO,630.32,,,,,,,390.1400,1511.5700,percent of total billed charges,"41.7% of $1,511.57 in Billed Charges for Rev 272 = $630.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET PIN AND DRILL 3.2X127MM,272,RC,27200002,CDM,,,,,,both,,,1511.5700,226.7400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,701.37,,,,,,,390.1400,1511.5700,percent of total billed charges,"46.4% of $1,511.57 in Billed Charges for Rev 272 = $701.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET PIN AND DRILL 3.2X127MM,272,RC,27200002,CDM,,,,,,both,,,1511.5700,226.7400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,630.32,,,,,,,390.1400,1511.5700,percent of total billed charges,"41.7% of $1,511.57 in Billed Charges for Rev 272 = $630.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET PIN AND DRILL 3.2X127MM,272,RC,27200002,CDM,,,,,,both,,,1511.5700,226.7400,CIGNA HEALTHCARE,CIGNA PPO,630.32,,,,,,,390.1400,1511.5700,percent of total billed charges,"41.7% of $1,511.57 in Billed Charges for Rev 272 = $630.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET PIN AND DRILL 3.2X127MM,272,RC,27200002,CDM,,,,,,both,,,1511.5700,226.7400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1360.41,,,,,,,390.1400,1511.5700,percent of total billed charges,"90% of $1,511.57 in Billed Charges for Rev 272 = $1,360.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET PIN AND DRILL 3.2X127MM,272,RC,27200002,CDM,,,,,,both,,,1511.5700,226.7400,MEDCOST,MEDCOST VHN,719.36,,,,,,,390.1400,1511.5700,percent of total billed charges,"47.59% of $1,511.57 in Billed Charges for Rev 272 = $719.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET PIN AND DRILL 3.2X127MM,272,RC,27200002,CDM,,,,,,both,,,1511.5700,226.7400,SENTARA HEALTH,SENTARA HEALTH,390.14,,,,,,,390.1400,1511.5700,percent of total billed charges,"25.81% of $1,511.57 in Billed Charges for Rev 272 = $390.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET PIN AND DRILL 3.2X127MM,272,RC,27200002,CDM,,,,,,both,,,1511.5700,226.7400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1511.57,,,,,,,390.1400,1511.5700,percent of total billed charges,"100% of $1,511.57 in Billed Charges for Rev 272 = $1,511.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET PIN AND DRILL 3.2X127MM,272,RC,27200002,CDM,,,,,,both,,,1511.5700,226.7400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,755.79,,,,,,,390.1400,1511.5700,percent of total billed charges,"Rev 272 $1,511.57 in Billed Charges at 50% = $755.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET PIN AND DRILL 3.2X127MM,272,RC,27200002,CDM,,,,,,both,,,1511.5700,226.7400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,488.24,,,,,,,390.1400,1511.5700,other,"32.3% of $1,511.57 in Billed Charges for Rev 272 = $488.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET PIN AND DRILL 3.2X127MM,272,RC,27200002,CDM,,,,,,both,,,1511.5700,226.7400,UNITED HEALTHCARE,UHC HERITAGE SELECT,464.05,,,,,,,390.1400,1511.5700,other,"30.7% of $1,511.57 in Billed Charges for Rev 272 = $464.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET PIN AND DRILL 3.2X127MM,272,RC,27200002,CDM,,,,,,both,,,1511.5700,226.7400,UNITED HEALTHCARE,UNITED HEALTHCARE,488.24,,,,,,,390.1400,1511.5700,percent of total billed charges,"32.3% of $1,511.57 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET PIN AND DRILL 3.2X127MM,272,RC,27200002,CDM,,,,,,both,,,1511.5700,226.7400,WELLCARE,WELLCARE MEDICAID,1511.57,,,,,,,390.1400,1511.5700,percent of total billed charges,"100% of $1,511.57 in Billed Charges for Rev 272 = $1,511.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET SHAVER IRRIGATION,272,RC,27200002,CDM,,,,,,both,,,630.9600,94.6400,AETNA,AETNA,269.42,,,,,,,162.8500,630.9600,percent of total billed charges,42.7% of $630.96 in Billed Charges for Rev 272 = $269.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET SHAVER IRRIGATION,272,RC,27200002,CDM,,,,,,both,,,630.9600,94.6400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,441.67,,,,,,,162.8500,630.9600,percent of total billed charges,Rev 272 $630.96 in Billed Charges at 70% = $441.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET SHAVER IRRIGATION,272,RC,27200002,CDM,,,,,,both,,,630.9600,94.6400,CIGNA HEALTHCARE,CIGNA HMO,263.11,,,,,,,162.8500,630.9600,percent of total billed charges,41.7% of $630.96 in Billed Charges for Rev 272 = $263.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET SHAVER IRRIGATION,272,RC,27200002,CDM,,,,,,both,,,630.9600,94.6400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,292.77,,,,,,,162.8500,630.9600,percent of total billed charges,46.4% of $630.96 in Billed Charges for Rev 272 = $292.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET SHAVER IRRIGATION,272,RC,27200002,CDM,,,,,,both,,,630.9600,94.6400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,263.11,,,,,,,162.8500,630.9600,percent of total billed charges,41.7% of $630.96 in Billed Charges for Rev 272 = $263.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET SHAVER IRRIGATION,272,RC,27200002,CDM,,,,,,both,,,630.9600,94.6400,CIGNA HEALTHCARE,CIGNA PPO,263.11,,,,,,,162.8500,630.9600,percent of total billed charges,41.7% of $630.96 in Billed Charges for Rev 272 = $263.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET SHAVER IRRIGATION,272,RC,27200002,CDM,,,,,,both,,,630.9600,94.6400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,567.86,,,,,,,162.8500,630.9600,percent of total billed charges,90% of $630.96 in Billed Charges for Rev 272 = $567.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET SHAVER IRRIGATION,272,RC,27200002,CDM,,,,,,both,,,630.9600,94.6400,MEDCOST,MEDCOST VHN,300.27,,,,,,,162.8500,630.9600,percent of total billed charges,47.59% of $630.96 in Billed Charges for Rev 272 = $300.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET SHAVER IRRIGATION,272,RC,27200002,CDM,,,,,,both,,,630.9600,94.6400,SENTARA HEALTH,SENTARA HEALTH,162.85,,,,,,,162.8500,630.9600,percent of total billed charges,25.81% of $630.96 in Billed Charges for Rev 272 = $162.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET SHAVER IRRIGATION,272,RC,27200002,CDM,,,,,,both,,,630.9600,94.6400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",630.96,,,,,,,162.8500,630.9600,percent of total billed charges,100% of $630.96 in Billed Charges for Rev 272 = $630.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET SHAVER IRRIGATION,272,RC,27200002,CDM,,,,,,both,,,630.9600,94.6400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,315.48,,,,,,,162.8500,630.9600,percent of total billed charges,Rev 272 $630.96 in Billed Charges at 50% = $315.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET SHAVER IRRIGATION,272,RC,27200002,CDM,,,,,,both,,,630.9600,94.6400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,203.80,,,,,,,162.8500,630.9600,other,32.3% of $630.96 in Billed Charges for Rev 272 = $203.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SET SHAVER IRRIGATION,272,RC,27200002,CDM,,,,,,both,,,630.9600,94.6400,UNITED HEALTHCARE,UHC HERITAGE SELECT,193.70,,,,,,,162.8500,630.9600,other,30.7% of $630.96 in Billed Charges for Rev 272 = $193.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SET SHAVER IRRIGATION,272,RC,27200002,CDM,,,,,,both,,,630.9600,94.6400,UNITED HEALTHCARE,UNITED HEALTHCARE,203.80,,,,,,,162.8500,630.9600,percent of total billed charges,32.3% of $630.96 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET SHAVER IRRIGATION,272,RC,27200002,CDM,,,,,,both,,,630.9600,94.6400,WELLCARE,WELLCARE MEDICAID,630.96,,,,,,,162.8500,630.9600,percent of total billed charges,100% of $630.96 in Billed Charges for Rev 272 = $630.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
NEEDLEKNIFE RX,272,RC,27200002,CDM,,,,,,both,,,3516.8100,527.5200,AETNA,AETNA,1501.68,,,,,,,907.6900,3516.8100,percent of total billed charges,"42.7% of $3,516.81 in Billed Charges for Rev 272 = $1,501.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLEKNIFE RX,272,RC,27200002,CDM,,,,,,both,,,3516.8100,527.5200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2461.77,,,,,,,907.6900,3516.8100,percent of total billed charges,"Rev 272 $3,516.81 in Billed Charges at 70% = $2,461.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLEKNIFE RX,272,RC,27200002,CDM,,,,,,both,,,3516.8100,527.5200,CIGNA HEALTHCARE,CIGNA HMO,1466.51,,,,,,,907.6900,3516.8100,percent of total billed charges,"41.7% of $3,516.81 in Billed Charges for Rev 272 = $1,466.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLEKNIFE RX,272,RC,27200002,CDM,,,,,,both,,,3516.8100,527.5200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1631.80,,,,,,,907.6900,3516.8100,percent of total billed charges,"46.4% of $3,516.81 in Billed Charges for Rev 272 = $1,631.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLEKNIFE RX,272,RC,27200002,CDM,,,,,,both,,,3516.8100,527.5200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1466.51,,,,,,,907.6900,3516.8100,percent of total billed charges,"41.7% of $3,516.81 in Billed Charges for Rev 272 = $1,466.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLEKNIFE RX,272,RC,27200002,CDM,,,,,,both,,,3516.8100,527.5200,CIGNA HEALTHCARE,CIGNA PPO,1466.51,,,,,,,907.6900,3516.8100,percent of total billed charges,"41.7% of $3,516.81 in Billed Charges for Rev 272 = $1,466.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLEKNIFE RX,272,RC,27200002,CDM,,,,,,both,,,3516.8100,527.5200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3165.13,,,,,,,907.6900,3516.8100,percent of total billed charges,"90% of $3,516.81 in Billed Charges for Rev 272 = $3,165.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLEKNIFE RX,272,RC,27200002,CDM,,,,,,both,,,3516.8100,527.5200,MEDCOST,MEDCOST VHN,1673.65,,,,,,,907.6900,3516.8100,percent of total billed charges,"47.59% of $3,516.81 in Billed Charges for Rev 272 = $1,673.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLEKNIFE RX,272,RC,27200002,CDM,,,,,,both,,,3516.8100,527.5200,SENTARA HEALTH,SENTARA HEALTH,907.69,,,,,,,907.6900,3516.8100,percent of total billed charges,"25.81% of $3,516.81 in Billed Charges for Rev 272 = $907.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLEKNIFE RX,272,RC,27200002,CDM,,,,,,both,,,3516.8100,527.5200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3516.81,,,,,,,907.6900,3516.8100,percent of total billed charges,"100% of $3,516.81 in Billed Charges for Rev 272 = $3,516.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLEKNIFE RX,272,RC,27200002,CDM,,,,,,both,,,3516.8100,527.5200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1758.41,,,,,,,907.6900,3516.8100,percent of total billed charges,"Rev 272 $3,516.81 in Billed Charges at 50% = $1,758.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLEKNIFE RX,272,RC,27200002,CDM,,,,,,both,,,3516.8100,527.5200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1135.93,,,,,,,907.6900,3516.8100,other,"32.3% of $3,516.81 in Billed Charges for Rev 272 = $1,135.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLEKNIFE RX,272,RC,27200002,CDM,,,,,,both,,,3516.8100,527.5200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1079.66,,,,,,,907.6900,3516.8100,other,"30.7% of $3,516.81 in Billed Charges for Rev 272 = $1,079.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
NEEDLEKNIFE RX,272,RC,27200002,CDM,,,,,,both,,,3516.8100,527.5200,UNITED HEALTHCARE,UNITED HEALTHCARE,1135.93,,,,,,,907.6900,3516.8100,percent of total billed charges,"32.3% of $3,516.81 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
NEEDLEKNIFE RX,272,RC,27200002,CDM,,,,,,both,,,3516.8100,527.5200,WELLCARE,WELLCARE MEDICAID,3516.81,,,,,,,907.6900,3516.8100,percent of total billed charges,"100% of $3,516.81 in Billed Charges for Rev 272 = $3,516.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL POINT .094 X 14INCH,272,RC,,,,,,,,both,,,4469.0700,670.3600,AETNA,AETNA,1908.29,,,,,,,1153.4700,4469.0700,percent of total billed charges,"42.7% of $4,469.07 in Billed Charges for Rev 272 = $1,908.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL POINT .094 X 14INCH,272,RC,,,,,,,,both,,,4469.0700,670.3600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3128.35,,,,,,,1153.4700,4469.0700,percent of total billed charges,"Rev 272 $4,469.07 in Billed Charges at 70% = $3,128.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL POINT .094 X 14INCH,272,RC,,,,,,,,both,,,4469.0700,670.3600,CIGNA HEALTHCARE,CIGNA HMO,1863.60,,,,,,,1153.4700,4469.0700,percent of total billed charges,"41.7% of $4,469.07 in Billed Charges for Rev 272 = $1,863.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL POINT .094 X 14INCH,272,RC,,,,,,,,both,,,4469.0700,670.3600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2073.65,,,,,,,1153.4700,4469.0700,percent of total billed charges,"46.4% of $4,469.07 in Billed Charges for Rev 272 = $2,073.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL POINT .094 X 14INCH,272,RC,,,,,,,,both,,,4469.0700,670.3600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1863.60,,,,,,,1153.4700,4469.0700,percent of total billed charges,"41.7% of $4,469.07 in Billed Charges for Rev 272 = $1,863.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL POINT .094 X 14INCH,272,RC,,,,,,,,both,,,4469.0700,670.3600,CIGNA HEALTHCARE,CIGNA PPO,1863.60,,,,,,,1153.4700,4469.0700,percent of total billed charges,"41.7% of $4,469.07 in Billed Charges for Rev 272 = $1,863.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL POINT .094 X 14INCH,272,RC,,,,,,,,both,,,4469.0700,670.3600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4022.16,,,,,,,1153.4700,4469.0700,percent of total billed charges,"90% of $4,469.07 in Billed Charges for Rev 272 = $4,022.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL POINT .094 X 14INCH,272,RC,,,,,,,,both,,,4469.0700,670.3600,MEDCOST,MEDCOST VHN,2126.83,,,,,,,1153.4700,4469.0700,percent of total billed charges,"47.59% of $4,469.07 in Billed Charges for Rev 272 = $2,126.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL POINT .094 X 14INCH,272,RC,,,,,,,,both,,,4469.0700,670.3600,SENTARA HEALTH,SENTARA HEALTH,1153.47,,,,,,,1153.4700,4469.0700,percent of total billed charges,"25.81% of $4,469.07 in Billed Charges for Rev 272 = $1,153.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL POINT .094 X 14INCH,272,RC,,,,,,,,both,,,4469.0700,670.3600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4469.07,,,,,,,1153.4700,4469.0700,percent of total billed charges,"100% of $4,469.07 in Billed Charges for Rev 272 = $4,469.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL POINT .094 X 14INCH,272,RC,,,,,,,,both,,,4469.0700,670.3600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2234.54,,,,,,,1153.4700,4469.0700,percent of total billed charges,"Rev 272 $4,469.07 in Billed Charges at 50% = $2,234.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL POINT .094 X 14INCH,272,RC,,,,,,,,both,,,4469.0700,670.3600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1443.51,,,,,,,1153.4700,4469.0700,other,"32.3% of $4,469.07 in Billed Charges for Rev 272 = $1,443.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PIN DRILL POINT .094 X 14INCH,272,RC,,,,,,,,both,,,4469.0700,670.3600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1372.00,,,,,,,1153.4700,4469.0700,other,"30.7% of $4,469.07 in Billed Charges for Rev 272 = $1,372.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PIN DRILL POINT .094 X 14INCH,272,RC,,,,,,,,both,,,4469.0700,670.3600,UNITED HEALTHCARE,UNITED HEALTHCARE,1443.51,,,,,,,1153.4700,4469.0700,percent of total billed charges,"32.3% of $4,469.07 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN DRILL POINT .094 X 14INCH,272,RC,,,,,,,,both,,,4469.0700,670.3600,WELLCARE,WELLCARE MEDICAID,4469.07,,,,,,,1153.4700,4469.0700,percent of total billed charges,"100% of $4,469.07 in Billed Charges for Rev 272 = $4,469.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN THRD HEADED STERILE,272,RC,,,,,,,,both,,,4101.7300,615.2600,AETNA,AETNA,1751.44,,,,,,,1058.6600,4101.7300,percent of total billed charges,"42.7% of $4,101.73 in Billed Charges for Rev 272 = $1,751.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN THRD HEADED STERILE,272,RC,,,,,,,,both,,,4101.7300,615.2600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2871.21,,,,,,,1058.6600,4101.7300,percent of total billed charges,"Rev 272 $4,101.73 in Billed Charges at 70% = $2,871.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN THRD HEADED STERILE,272,RC,,,,,,,,both,,,4101.7300,615.2600,CIGNA HEALTHCARE,CIGNA HMO,1710.42,,,,,,,1058.6600,4101.7300,percent of total billed charges,"41.7% of $4,101.73 in Billed Charges for Rev 272 = $1,710.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN THRD HEADED STERILE,272,RC,,,,,,,,both,,,4101.7300,615.2600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1903.20,,,,,,,1058.6600,4101.7300,percent of total billed charges,"46.4% of $4,101.73 in Billed Charges for Rev 272 = $1,903.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN THRD HEADED STERILE,272,RC,,,,,,,,both,,,4101.7300,615.2600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1710.42,,,,,,,1058.6600,4101.7300,percent of total billed charges,"41.7% of $4,101.73 in Billed Charges for Rev 272 = $1,710.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN THRD HEADED STERILE,272,RC,,,,,,,,both,,,4101.7300,615.2600,CIGNA HEALTHCARE,CIGNA PPO,1710.42,,,,,,,1058.6600,4101.7300,percent of total billed charges,"41.7% of $4,101.73 in Billed Charges for Rev 272 = $1,710.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN THRD HEADED STERILE,272,RC,,,,,,,,both,,,4101.7300,615.2600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3691.56,,,,,,,1058.6600,4101.7300,percent of total billed charges,"90% of $4,101.73 in Billed Charges for Rev 272 = $3,691.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN THRD HEADED STERILE,272,RC,,,,,,,,both,,,4101.7300,615.2600,MEDCOST,MEDCOST VHN,1952.01,,,,,,,1058.6600,4101.7300,percent of total billed charges,"47.59% of $4,101.73 in Billed Charges for Rev 272 = $1,952.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN THRD HEADED STERILE,272,RC,,,,,,,,both,,,4101.7300,615.2600,SENTARA HEALTH,SENTARA HEALTH,1058.66,,,,,,,1058.6600,4101.7300,percent of total billed charges,"25.81% of $4,101.73 in Billed Charges for Rev 272 = $1,058.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN THRD HEADED STERILE,272,RC,,,,,,,,both,,,4101.7300,615.2600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4101.73,,,,,,,1058.6600,4101.7300,percent of total billed charges,"100% of $4,101.73 in Billed Charges for Rev 272 = $4,101.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN THRD HEADED STERILE,272,RC,,,,,,,,both,,,4101.7300,615.2600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2050.87,,,,,,,1058.6600,4101.7300,percent of total billed charges,"Rev 272 $4,101.73 in Billed Charges at 50% = $2,050.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN THRD HEADED STERILE,272,RC,,,,,,,,both,,,4101.7300,615.2600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1324.86,,,,,,,1058.6600,4101.7300,other,"32.3% of $4,101.73 in Billed Charges for Rev 272 = $1,324.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PIN THRD HEADED STERILE,272,RC,,,,,,,,both,,,4101.7300,615.2600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1259.23,,,,,,,1058.6600,4101.7300,other,"30.7% of $4,101.73 in Billed Charges for Rev 272 = $1,259.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
PIN THRD HEADED STERILE,272,RC,,,,,,,,both,,,4101.7300,615.2600,UNITED HEALTHCARE,UNITED HEALTHCARE,1324.86,,,,,,,1058.6600,4101.7300,percent of total billed charges,"32.3% of $4,101.73 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
PIN THRD HEADED STERILE,272,RC,,,,,,,,both,,,4101.7300,615.2600,WELLCARE,WELLCARE MEDICAID,4101.73,,,,,,,1058.6600,4101.7300,percent of total billed charges,"100% of $4,101.73 in Billed Charges for Rev 272 = $4,101.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO GIA 45MM SURPASS SEE LN 184172,272,RC,27200002,CDM,,,,,,both,,,5799.6300,869.9400,AETNA,AETNA,2476.44,,,,,,,1496.8800,5799.6300,percent of total billed charges,"42.7% of $5,799.63 in Billed Charges for Rev 272 = $2,476.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO GIA 45MM SURPASS SEE LN 184172,272,RC,27200002,CDM,,,,,,both,,,5799.6300,869.9400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4059.74,,,,,,,1496.8800,5799.6300,percent of total billed charges,"Rev 272 $5,799.63 in Billed Charges at 70% = $4,059.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO GIA 45MM SURPASS SEE LN 184172,272,RC,27200002,CDM,,,,,,both,,,5799.6300,869.9400,CIGNA HEALTHCARE,CIGNA HMO,2418.45,,,,,,,1496.8800,5799.6300,percent of total billed charges,"41.7% of $5,799.63 in Billed Charges for Rev 272 = $2,418.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO GIA 45MM SURPASS SEE LN 184172,272,RC,27200002,CDM,,,,,,both,,,5799.6300,869.9400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2691.03,,,,,,,1496.8800,5799.6300,percent of total billed charges,"46.4% of $5,799.63 in Billed Charges for Rev 272 = $2,691.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO GIA 45MM SURPASS SEE LN 184172,272,RC,27200002,CDM,,,,,,both,,,5799.6300,869.9400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2418.45,,,,,,,1496.8800,5799.6300,percent of total billed charges,"41.7% of $5,799.63 in Billed Charges for Rev 272 = $2,418.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO GIA 45MM SURPASS SEE LN 184172,272,RC,27200002,CDM,,,,,,both,,,5799.6300,869.9400,CIGNA HEALTHCARE,CIGNA PPO,2418.45,,,,,,,1496.8800,5799.6300,percent of total billed charges,"41.7% of $5,799.63 in Billed Charges for Rev 272 = $2,418.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO GIA 45MM SURPASS SEE LN 184172,272,RC,27200002,CDM,,,,,,both,,,5799.6300,869.9400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5219.67,,,,,,,1496.8800,5799.6300,percent of total billed charges,"90% of $5,799.63 in Billed Charges for Rev 272 = $5,219.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO GIA 45MM SURPASS SEE LN 184172,272,RC,27200002,CDM,,,,,,both,,,5799.6300,869.9400,MEDCOST,MEDCOST VHN,2760.04,,,,,,,1496.8800,5799.6300,percent of total billed charges,"47.59% of $5,799.63 in Billed Charges for Rev 272 = $2,760.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO GIA 45MM SURPASS SEE LN 184172,272,RC,27200002,CDM,,,,,,both,,,5799.6300,869.9400,SENTARA HEALTH,SENTARA HEALTH,1496.88,,,,,,,1496.8800,5799.6300,percent of total billed charges,"25.81% of $5,799.63 in Billed Charges for Rev 272 = $1,496.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO GIA 45MM SURPASS SEE LN 184172,272,RC,27200002,CDM,,,,,,both,,,5799.6300,869.9400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5799.63,,,,,,,1496.8800,5799.6300,percent of total billed charges,"100% of $5,799.63 in Billed Charges for Rev 272 = $5,799.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO GIA 45MM SURPASS SEE LN 184172,272,RC,27200002,CDM,,,,,,both,,,5799.6300,869.9400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2899.82,,,,,,,1496.8800,5799.6300,percent of total billed charges,"Rev 272 $5,799.63 in Billed Charges at 50% = $2,899.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO GIA 45MM SURPASS SEE LN 184172,272,RC,27200002,CDM,,,,,,both,,,5799.6300,869.9400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1873.28,,,,,,,1496.8800,5799.6300,other,"32.3% of $5,799.63 in Billed Charges for Rev 272 = $1,873.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER RELOAD ENDO GIA 45MM SURPASS SEE LN 184172,272,RC,27200002,CDM,,,,,,both,,,5799.6300,869.9400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1780.49,,,,,,,1496.8800,5799.6300,other,"30.7% of $5,799.63 in Billed Charges for Rev 272 = $1,780.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER RELOAD ENDO GIA 45MM SURPASS SEE LN 184172,272,RC,27200002,CDM,,,,,,both,,,5799.6300,869.9400,UNITED HEALTHCARE,UNITED HEALTHCARE,1873.28,,,,,,,1496.8800,5799.6300,percent of total billed charges,"32.3% of $5,799.63 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO GIA 45MM SURPASS SEE LN 184172,272,RC,27200002,CDM,,,,,,both,,,5799.6300,869.9400,WELLCARE,WELLCARE MEDICAID,5799.63,,,,,,,1496.8800,5799.6300,percent of total billed charges,"100% of $5,799.63 in Billed Charges for Rev 272 = $5,799.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE SURPASS SEE LN 156985,272,RC,27200002,CDM,,,,,,both,,,5903.4600,885.5200,AETNA,AETNA,2520.78,,,,,,,1523.6800,5903.4600,percent of total billed charges,"42.7% of $5,903.46 in Billed Charges for Rev 272 = $2,520.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE SURPASS SEE LN 156985,272,RC,27200002,CDM,,,,,,both,,,5903.4600,885.5200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4132.42,,,,,,,1523.6800,5903.4600,percent of total billed charges,"Rev 272 $5,903.46 in Billed Charges at 70% = $4,132.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE SURPASS SEE LN 156985,272,RC,27200002,CDM,,,,,,both,,,5903.4600,885.5200,CIGNA HEALTHCARE,CIGNA HMO,2461.74,,,,,,,1523.6800,5903.4600,percent of total billed charges,"41.7% of $5,903.46 in Billed Charges for Rev 272 = $2,461.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE SURPASS SEE LN 156985,272,RC,27200002,CDM,,,,,,both,,,5903.4600,885.5200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2739.21,,,,,,,1523.6800,5903.4600,percent of total billed charges,"46.4% of $5,903.46 in Billed Charges for Rev 272 = $2,739.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE SURPASS SEE LN 156985,272,RC,27200002,CDM,,,,,,both,,,5903.4600,885.5200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2461.74,,,,,,,1523.6800,5903.4600,percent of total billed charges,"41.7% of $5,903.46 in Billed Charges for Rev 272 = $2,461.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE SURPASS SEE LN 156985,272,RC,27200002,CDM,,,,,,both,,,5903.4600,885.5200,CIGNA HEALTHCARE,CIGNA PPO,2461.74,,,,,,,1523.6800,5903.4600,percent of total billed charges,"41.7% of $5,903.46 in Billed Charges for Rev 272 = $2,461.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE SURPASS SEE LN 156985,272,RC,27200002,CDM,,,,,,both,,,5903.4600,885.5200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5313.11,,,,,,,1523.6800,5903.4600,percent of total billed charges,"90% of $5,903.46 in Billed Charges for Rev 272 = $5,313.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE SURPASS SEE LN 156985,272,RC,27200002,CDM,,,,,,both,,,5903.4600,885.5200,MEDCOST,MEDCOST VHN,2809.46,,,,,,,1523.6800,5903.4600,percent of total billed charges,"47.59% of $5,903.46 in Billed Charges for Rev 272 = $2,809.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE SURPASS SEE LN 156985,272,RC,27200002,CDM,,,,,,both,,,5903.4600,885.5200,SENTARA HEALTH,SENTARA HEALTH,1523.68,,,,,,,1523.6800,5903.4600,percent of total billed charges,"25.81% of $5,903.46 in Billed Charges for Rev 272 = $1,523.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE SURPASS SEE LN 156985,272,RC,27200002,CDM,,,,,,both,,,5903.4600,885.5200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5903.46,,,,,,,1523.6800,5903.4600,percent of total billed charges,"100% of $5,903.46 in Billed Charges for Rev 272 = $5,903.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE SURPASS SEE LN 156985,272,RC,27200002,CDM,,,,,,both,,,5903.4600,885.5200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2951.73,,,,,,,1523.6800,5903.4600,percent of total billed charges,"Rev 272 $5,903.46 in Billed Charges at 50% = $2,951.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE SURPASS SEE LN 156985,272,RC,27200002,CDM,,,,,,both,,,5903.4600,885.5200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1906.82,,,,,,,1523.6800,5903.4600,other,"32.3% of $5,903.46 in Billed Charges for Rev 272 = $1,906.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER RELOAD TRI STAPLE SURPASS SEE LN 156985,272,RC,27200002,CDM,,,,,,both,,,5903.4600,885.5200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1812.36,,,,,,,1523.6800,5903.4600,other,"30.7% of $5,903.46 in Billed Charges for Rev 272 = $1,812.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER RELOAD TRI STAPLE SURPASS SEE LN 156985,272,RC,27200002,CDM,,,,,,both,,,5903.4600,885.5200,UNITED HEALTHCARE,UNITED HEALTHCARE,1906.82,,,,,,,1523.6800,5903.4600,percent of total billed charges,"32.3% of $5,903.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE SURPASS SEE LN 156985,272,RC,27200002,CDM,,,,,,both,,,5903.4600,885.5200,WELLCARE,WELLCARE MEDICAID,5903.46,,,,,,,1523.6800,5903.4600,percent of total billed charges,"100% of $5,903.46 in Billed Charges for Rev 272 = $5,903.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD VASCULAR ARTIC 30MM MEDIUM,272,RC,,,,,,,,both,,,6224.5700,933.6900,AETNA,AETNA,2657.89,,,,,,,1606.5600,6224.5700,percent of total billed charges,"42.7% of $6,224.57 in Billed Charges for Rev 272 = $2,657.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD VASCULAR ARTIC 30MM MEDIUM,272,RC,,,,,,,,both,,,6224.5700,933.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4357.20,,,,,,,1606.5600,6224.5700,percent of total billed charges,"Rev 272 $6,224.57 in Billed Charges at 70% = $4,357.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD VASCULAR ARTIC 30MM MEDIUM,272,RC,,,,,,,,both,,,6224.5700,933.6900,CIGNA HEALTHCARE,CIGNA HMO,2595.65,,,,,,,1606.5600,6224.5700,percent of total billed charges,"41.7% of $6,224.57 in Billed Charges for Rev 272 = $2,595.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD VASCULAR ARTIC 30MM MEDIUM,272,RC,,,,,,,,both,,,6224.5700,933.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2888.20,,,,,,,1606.5600,6224.5700,percent of total billed charges,"46.4% of $6,224.57 in Billed Charges for Rev 272 = $2,888.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD VASCULAR ARTIC 30MM MEDIUM,272,RC,,,,,,,,both,,,6224.5700,933.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2595.65,,,,,,,1606.5600,6224.5700,percent of total billed charges,"41.7% of $6,224.57 in Billed Charges for Rev 272 = $2,595.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD VASCULAR ARTIC 30MM MEDIUM,272,RC,,,,,,,,both,,,6224.5700,933.6900,CIGNA HEALTHCARE,CIGNA PPO,2595.65,,,,,,,1606.5600,6224.5700,percent of total billed charges,"41.7% of $6,224.57 in Billed Charges for Rev 272 = $2,595.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD VASCULAR ARTIC 30MM MEDIUM,272,RC,,,,,,,,both,,,6224.5700,933.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5602.11,,,,,,,1606.5600,6224.5700,percent of total billed charges,"90% of $6,224.57 in Billed Charges for Rev 272 = $5,602.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD VASCULAR ARTIC 30MM MEDIUM,272,RC,,,,,,,,both,,,6224.5700,933.6900,MEDCOST,MEDCOST VHN,2962.27,,,,,,,1606.5600,6224.5700,percent of total billed charges,"47.59% of $6,224.57 in Billed Charges for Rev 272 = $2,962.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD VASCULAR ARTIC 30MM MEDIUM,272,RC,,,,,,,,both,,,6224.5700,933.6900,SENTARA HEALTH,SENTARA HEALTH,1606.56,,,,,,,1606.5600,6224.5700,percent of total billed charges,"25.81% of $6,224.57 in Billed Charges for Rev 272 = $1,606.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD VASCULAR ARTIC 30MM MEDIUM,272,RC,,,,,,,,both,,,6224.5700,933.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6224.57,,,,,,,1606.5600,6224.5700,percent of total billed charges,"100% of $6,224.57 in Billed Charges for Rev 272 = $6,224.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD VASCULAR ARTIC 30MM MEDIUM,272,RC,,,,,,,,both,,,6224.5700,933.6900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3112.29,,,,,,,1606.5600,6224.5700,percent of total billed charges,"Rev 272 $6,224.57 in Billed Charges at 50% = $3,112.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD VASCULAR ARTIC 30MM MEDIUM,272,RC,,,,,,,,both,,,6224.5700,933.6900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2010.54,,,,,,,1606.5600,6224.5700,other,"32.3% of $6,224.57 in Billed Charges for Rev 272 = $2,010.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER RELOAD VASCULAR ARTIC 30MM MEDIUM,272,RC,,,,,,,,both,,,6224.5700,933.6900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1910.94,,,,,,,1606.5600,6224.5700,other,"30.7% of $6,224.57 in Billed Charges for Rev 272 = $1,910.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER RELOAD VASCULAR ARTIC 30MM MEDIUM,272,RC,,,,,,,,both,,,6224.5700,933.6900,UNITED HEALTHCARE,UNITED HEALTHCARE,2010.54,,,,,,,1606.5600,6224.5700,percent of total billed charges,"32.3% of $6,224.57 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD VASCULAR ARTIC 30MM MEDIUM,272,RC,,,,,,,,both,,,6224.5700,933.6900,WELLCARE,WELLCARE MEDICAID,6224.57,,,,,,,1606.5600,6224.5700,percent of total billed charges,"100% of $6,224.57 in Billed Charges for Rev 272 = $6,224.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SKIN MULTIFIRE ROT SURPASS SEE LN 169652,270,RC,,,,,,,,both,,,531.9300,79.7900,AETNA,AETNA,227.13,,,,,,,137.2900,531.9300,percent of total billed charges,42.7% of $531.93 in Billed Charges for Rev 270 = $227.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SKIN MULTIFIRE ROT SURPASS SEE LN 169652,270,RC,,,,,,,,both,,,531.9300,79.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,372.35,,,,,,,137.2900,531.9300,percent of total billed charges,Rev 270 $531.93 in Billed Charges at 70% = $372.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SKIN MULTIFIRE ROT SURPASS SEE LN 169652,270,RC,,,,,,,,both,,,531.9300,79.7900,CIGNA HEALTHCARE,CIGNA HMO,221.81,,,,,,,137.2900,531.9300,percent of total billed charges,41.7% of $531.93 in Billed Charges for Rev 270 = $221.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SKIN MULTIFIRE ROT SURPASS SEE LN 169652,270,RC,,,,,,,,both,,,531.9300,79.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,246.82,,,,,,,137.2900,531.9300,percent of total billed charges,46.4% of $531.93 in Billed Charges for Rev 270 = $246.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SKIN MULTIFIRE ROT SURPASS SEE LN 169652,270,RC,,,,,,,,both,,,531.9300,79.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,221.81,,,,,,,137.2900,531.9300,percent of total billed charges,41.7% of $531.93 in Billed Charges for Rev 270 = $221.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SKIN MULTIFIRE ROT SURPASS SEE LN 169652,270,RC,,,,,,,,both,,,531.9300,79.7900,CIGNA HEALTHCARE,CIGNA PPO,221.81,,,,,,,137.2900,531.9300,percent of total billed charges,41.7% of $531.93 in Billed Charges for Rev 270 = $221.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SKIN MULTIFIRE ROT SURPASS SEE LN 169652,270,RC,,,,,,,,both,,,531.9300,79.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,478.74,,,,,,,137.2900,531.9300,percent of total billed charges,90% of $531.93 in Billed Charges for Rev 270 = $478.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SKIN MULTIFIRE ROT SURPASS SEE LN 169652,270,RC,,,,,,,,both,,,531.9300,79.7900,MEDCOST,MEDCOST VHN,253.15,,,,,,,137.2900,531.9300,percent of total billed charges,47.59% of $531.93 in Billed Charges for Rev 270 = $253.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SKIN MULTIFIRE ROT SURPASS SEE LN 169652,270,RC,,,,,,,,both,,,531.9300,79.7900,SENTARA HEALTH,SENTARA HEALTH,137.29,,,,,,,137.2900,531.9300,percent of total billed charges,25.81% of $531.93 in Billed Charges for Rev 270 = $137.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SKIN MULTIFIRE ROT SURPASS SEE LN 169652,270,RC,,,,,,,,both,,,531.9300,79.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",531.93,,,,,,,137.2900,531.9300,percent of total billed charges,100% of $531.93 in Billed Charges for Rev 270 = $531.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SKIN MULTIFIRE ROT SURPASS SEE LN 169652,270,RC,,,,,,,,both,,,531.9300,79.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,265.97,,,,,,,137.2900,531.9300,percent of total billed charges,Rev 270 $531.93 in Billed Charges at 50% = $265.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SKIN MULTIFIRE ROT SURPASS SEE LN 169652,270,RC,,,,,,,,both,,,531.9300,79.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,171.81,,,,,,,137.2900,531.9300,other,32.3% of $531.93 in Billed Charges for Rev 270 = $171.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER SKIN MULTIFIRE ROT SURPASS SEE LN 169652,270,RC,,,,,,,,both,,,531.9300,79.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,163.30,,,,,,,137.2900,531.9300,other,30.7% of $531.93 in Billed Charges for Rev 270 = $163.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER SKIN MULTIFIRE ROT SURPASS SEE LN 169652,270,RC,,,,,,,,both,,,531.9300,79.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,171.81,,,,,,,137.2900,531.9300,percent of total billed charges,32.3% of $531.93 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SKIN MULTIFIRE ROT SURPASS SEE LN 169652,270,RC,,,,,,,,both,,,531.9300,79.7900,WELLCARE,WELLCARE MEDICAID,531.93,,,,,,,137.2900,531.9300,percent of total billed charges,100% of $531.93 in Billed Charges for Rev 270 = $531.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
RETRACTOR ENDO PADDLE 12MM DISP,272,RC,27200002,CDM,,,,,,both,,,5041.4200,756.2100,AETNA,AETNA,2152.69,,,,,,,1301.1900,5041.4200,percent of total billed charges,"42.7% of $5,041.42 in Billed Charges for Rev 272 = $2,152.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR ENDO PADDLE 12MM DISP,272,RC,27200002,CDM,,,,,,both,,,5041.4200,756.2100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3528.99,,,,,,,1301.1900,5041.4200,percent of total billed charges,"Rev 272 $5,041.42 in Billed Charges at 70% = $3,528.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR ENDO PADDLE 12MM DISP,272,RC,27200002,CDM,,,,,,both,,,5041.4200,756.2100,CIGNA HEALTHCARE,CIGNA HMO,2102.27,,,,,,,1301.1900,5041.4200,percent of total billed charges,"41.7% of $5,041.42 in Billed Charges for Rev 272 = $2,102.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR ENDO PADDLE 12MM DISP,272,RC,27200002,CDM,,,,,,both,,,5041.4200,756.2100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2339.22,,,,,,,1301.1900,5041.4200,percent of total billed charges,"46.4% of $5,041.42 in Billed Charges for Rev 272 = $2,339.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR ENDO PADDLE 12MM DISP,272,RC,27200002,CDM,,,,,,both,,,5041.4200,756.2100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2102.27,,,,,,,1301.1900,5041.4200,percent of total billed charges,"41.7% of $5,041.42 in Billed Charges for Rev 272 = $2,102.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR ENDO PADDLE 12MM DISP,272,RC,27200002,CDM,,,,,,both,,,5041.4200,756.2100,CIGNA HEALTHCARE,CIGNA PPO,2102.27,,,,,,,1301.1900,5041.4200,percent of total billed charges,"41.7% of $5,041.42 in Billed Charges for Rev 272 = $2,102.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR ENDO PADDLE 12MM DISP,272,RC,27200002,CDM,,,,,,both,,,5041.4200,756.2100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4537.28,,,,,,,1301.1900,5041.4200,percent of total billed charges,"90% of $5,041.42 in Billed Charges for Rev 272 = $4,537.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR ENDO PADDLE 12MM DISP,272,RC,27200002,CDM,,,,,,both,,,5041.4200,756.2100,MEDCOST,MEDCOST VHN,2399.21,,,,,,,1301.1900,5041.4200,percent of total billed charges,"47.59% of $5,041.42 in Billed Charges for Rev 272 = $2,399.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR ENDO PADDLE 12MM DISP,272,RC,27200002,CDM,,,,,,both,,,5041.4200,756.2100,SENTARA HEALTH,SENTARA HEALTH,1301.19,,,,,,,1301.1900,5041.4200,percent of total billed charges,"25.81% of $5,041.42 in Billed Charges for Rev 272 = $1,301.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR ENDO PADDLE 12MM DISP,272,RC,27200002,CDM,,,,,,both,,,5041.4200,756.2100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5041.42,,,,,,,1301.1900,5041.4200,percent of total billed charges,"100% of $5,041.42 in Billed Charges for Rev 272 = $5,041.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR ENDO PADDLE 12MM DISP,272,RC,27200002,CDM,,,,,,both,,,5041.4200,756.2100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2520.71,,,,,,,1301.1900,5041.4200,percent of total billed charges,"Rev 272 $5,041.42 in Billed Charges at 50% = $2,520.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR ENDO PADDLE 12MM DISP,272,RC,27200002,CDM,,,,,,both,,,5041.4200,756.2100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1628.38,,,,,,,1301.1900,5041.4200,other,"32.3% of $5,041.42 in Billed Charges for Rev 272 = $1,628.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RETRACTOR ENDO PADDLE 12MM DISP,272,RC,27200002,CDM,,,,,,both,,,5041.4200,756.2100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1547.72,,,,,,,1301.1900,5041.4200,other,"30.7% of $5,041.42 in Billed Charges for Rev 272 = $1,547.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RETRACTOR ENDO PADDLE 12MM DISP,272,RC,27200002,CDM,,,,,,both,,,5041.4200,756.2100,UNITED HEALTHCARE,UNITED HEALTHCARE,1628.38,,,,,,,1301.1900,5041.4200,percent of total billed charges,"32.3% of $5,041.42 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR ENDO PADDLE 12MM DISP,272,RC,27200002,CDM,,,,,,both,,,5041.4200,756.2100,WELLCARE,WELLCARE MEDICAID,5041.42,,,,,,,1301.1900,5041.4200,percent of total billed charges,"100% of $5,041.42 in Billed Charges for Rev 272 = $5,041.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR FLEXIBLE IRIS,272,RC,27200002,CDM,,,,,,both,,,1563.8600,234.5800,AETNA,AETNA,667.77,,,,,,,403.6300,1563.8600,percent of total billed charges,"42.7% of $1,563.86 in Billed Charges for Rev 272 = $667.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR FLEXIBLE IRIS,272,RC,27200002,CDM,,,,,,both,,,1563.8600,234.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1094.70,,,,,,,403.6300,1563.8600,percent of total billed charges,"Rev 272 $1,563.86 in Billed Charges at 70% = $1,094.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR FLEXIBLE IRIS,272,RC,27200002,CDM,,,,,,both,,,1563.8600,234.5800,CIGNA HEALTHCARE,CIGNA HMO,652.13,,,,,,,403.6300,1563.8600,percent of total billed charges,"41.7% of $1,563.86 in Billed Charges for Rev 272 = $652.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR FLEXIBLE IRIS,272,RC,27200002,CDM,,,,,,both,,,1563.8600,234.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,725.63,,,,,,,403.6300,1563.8600,percent of total billed charges,"46.4% of $1,563.86 in Billed Charges for Rev 272 = $725.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR FLEXIBLE IRIS,272,RC,27200002,CDM,,,,,,both,,,1563.8600,234.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,652.13,,,,,,,403.6300,1563.8600,percent of total billed charges,"41.7% of $1,563.86 in Billed Charges for Rev 272 = $652.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR FLEXIBLE IRIS,272,RC,27200002,CDM,,,,,,both,,,1563.8600,234.5800,CIGNA HEALTHCARE,CIGNA PPO,652.13,,,,,,,403.6300,1563.8600,percent of total billed charges,"41.7% of $1,563.86 in Billed Charges for Rev 272 = $652.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR FLEXIBLE IRIS,272,RC,27200002,CDM,,,,,,both,,,1563.8600,234.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1407.47,,,,,,,403.6300,1563.8600,percent of total billed charges,"90% of $1,563.86 in Billed Charges for Rev 272 = $1,407.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR FLEXIBLE IRIS,272,RC,27200002,CDM,,,,,,both,,,1563.8600,234.5800,MEDCOST,MEDCOST VHN,744.24,,,,,,,403.6300,1563.8600,percent of total billed charges,"47.59% of $1,563.86 in Billed Charges for Rev 272 = $744.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR FLEXIBLE IRIS,272,RC,27200002,CDM,,,,,,both,,,1563.8600,234.5800,SENTARA HEALTH,SENTARA HEALTH,403.63,,,,,,,403.6300,1563.8600,percent of total billed charges,"25.81% of $1,563.86 in Billed Charges for Rev 272 = $403.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR FLEXIBLE IRIS,272,RC,27200002,CDM,,,,,,both,,,1563.8600,234.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1563.86,,,,,,,403.6300,1563.8600,percent of total billed charges,"100% of $1,563.86 in Billed Charges for Rev 272 = $1,563.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR FLEXIBLE IRIS,272,RC,27200002,CDM,,,,,,both,,,1563.8600,234.5800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,781.93,,,,,,,403.6300,1563.8600,percent of total billed charges,"Rev 272 $1,563.86 in Billed Charges at 50% = $781.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR FLEXIBLE IRIS,272,RC,27200002,CDM,,,,,,both,,,1563.8600,234.5800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,505.13,,,,,,,403.6300,1563.8600,other,"32.3% of $1,563.86 in Billed Charges for Rev 272 = $505.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RETRACTOR FLEXIBLE IRIS,272,RC,27200002,CDM,,,,,,both,,,1563.8600,234.5800,UNITED HEALTHCARE,UHC HERITAGE SELECT,480.11,,,,,,,403.6300,1563.8600,other,"30.7% of $1,563.86 in Billed Charges for Rev 272 = $480.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
RETRACTOR FLEXIBLE IRIS,272,RC,27200002,CDM,,,,,,both,,,1563.8600,234.5800,UNITED HEALTHCARE,UNITED HEALTHCARE,505.13,,,,,,,403.6300,1563.8600,percent of total billed charges,"32.3% of $1,563.86 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
RETRACTOR FLEXIBLE IRIS,272,RC,27200002,CDM,,,,,,both,,,1563.8600,234.5800,WELLCARE,WELLCARE MEDICAID,1563.86,,,,,,,403.6300,1563.8600,percent of total billed charges,"100% of $1,563.86 in Billed Charges for Rev 272 = $1,563.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET ARNDT 9FR 78CM SPHER,272,RC,,,,,,,,both,,,2162.3500,324.3500,AETNA,AETNA,923.32,,,,,,,558.1000,2162.3500,percent of total billed charges,"42.7% of $2,162.35 in Billed Charges for Rev 272 = $923.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET ARNDT 9FR 78CM SPHER,272,RC,,,,,,,,both,,,2162.3500,324.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1513.65,,,,,,,558.1000,2162.3500,percent of total billed charges,"Rev 272 $2,162.35 in Billed Charges at 70% = $1,513.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET ARNDT 9FR 78CM SPHER,272,RC,,,,,,,,both,,,2162.3500,324.3500,CIGNA HEALTHCARE,CIGNA HMO,901.70,,,,,,,558.1000,2162.3500,percent of total billed charges,"41.7% of $2,162.35 in Billed Charges for Rev 272 = $901.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET ARNDT 9FR 78CM SPHER,272,RC,,,,,,,,both,,,2162.3500,324.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1003.33,,,,,,,558.1000,2162.3500,percent of total billed charges,"46.4% of $2,162.35 in Billed Charges for Rev 272 = $1,003.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET ARNDT 9FR 78CM SPHER,272,RC,,,,,,,,both,,,2162.3500,324.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,901.70,,,,,,,558.1000,2162.3500,percent of total billed charges,"41.7% of $2,162.35 in Billed Charges for Rev 272 = $901.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET ARNDT 9FR 78CM SPHER,272,RC,,,,,,,,both,,,2162.3500,324.3500,CIGNA HEALTHCARE,CIGNA PPO,901.70,,,,,,,558.1000,2162.3500,percent of total billed charges,"41.7% of $2,162.35 in Billed Charges for Rev 272 = $901.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET ARNDT 9FR 78CM SPHER,272,RC,,,,,,,,both,,,2162.3500,324.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1946.12,,,,,,,558.1000,2162.3500,percent of total billed charges,"90% of $2,162.35 in Billed Charges for Rev 272 = $1,946.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET ARNDT 9FR 78CM SPHER,272,RC,,,,,,,,both,,,2162.3500,324.3500,MEDCOST,MEDCOST VHN,1029.06,,,,,,,558.1000,2162.3500,percent of total billed charges,"47.59% of $2,162.35 in Billed Charges for Rev 272 = $1,029.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET ARNDT 9FR 78CM SPHER,272,RC,,,,,,,,both,,,2162.3500,324.3500,SENTARA HEALTH,SENTARA HEALTH,558.10,,,,,,,558.1000,2162.3500,percent of total billed charges,"25.81% of $2,162.35 in Billed Charges for Rev 272 = $558.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET ARNDT 9FR 78CM SPHER,272,RC,,,,,,,,both,,,2162.3500,324.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2162.35,,,,,,,558.1000,2162.3500,percent of total billed charges,"100% of $2,162.35 in Billed Charges for Rev 272 = $2,162.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET ARNDT 9FR 78CM SPHER,272,RC,,,,,,,,both,,,2162.3500,324.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1081.18,,,,,,,558.1000,2162.3500,percent of total billed charges,"Rev 272 $2,162.35 in Billed Charges at 50% = $1,081.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET ARNDT 9FR 78CM SPHER,272,RC,,,,,,,,both,,,2162.3500,324.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,698.44,,,,,,,558.1000,2162.3500,other,"32.3% of $2,162.35 in Billed Charges for Rev 272 = $698.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET ARNDT 9FR 78CM SPHER,272,RC,,,,,,,,both,,,2162.3500,324.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,663.84,,,,,,,558.1000,2162.3500,other,"30.7% of $2,162.35 in Billed Charges for Rev 272 = $663.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET ARNDT 9FR 78CM SPHER,272,RC,,,,,,,,both,,,2162.3500,324.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,698.44,,,,,,,558.1000,2162.3500,percent of total billed charges,"32.3% of $2,162.35 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET ARNDT 9FR 78CM SPHER,272,RC,,,,,,,,both,,,2162.3500,324.3500,WELLCARE,WELLCARE MEDICAID,2162.35,,,,,,,558.1000,2162.3500,percent of total billed charges,"100% of $2,162.35 in Billed Charges for Rev 272 = $2,162.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET EXCHANGE OPTIA SPECTRA,272,RC,,,,,,,,both,,,3982.8800,597.4300,AETNA,AETNA,1700.69,,,,,,,1027.9800,3982.8800,percent of total billed charges,"42.7% of $3,982.88 in Billed Charges for Rev 272 = $1,700.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET EXCHANGE OPTIA SPECTRA,272,RC,,,,,,,,both,,,3982.8800,597.4300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2788.02,,,,,,,1027.9800,3982.8800,percent of total billed charges,"Rev 272 $3,982.88 in Billed Charges at 70% = $2,788.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET EXCHANGE OPTIA SPECTRA,272,RC,,,,,,,,both,,,3982.8800,597.4300,CIGNA HEALTHCARE,CIGNA HMO,1660.86,,,,,,,1027.9800,3982.8800,percent of total billed charges,"41.7% of $3,982.88 in Billed Charges for Rev 272 = $1,660.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET EXCHANGE OPTIA SPECTRA,272,RC,,,,,,,,both,,,3982.8800,597.4300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1848.06,,,,,,,1027.9800,3982.8800,percent of total billed charges,"46.4% of $3,982.88 in Billed Charges for Rev 272 = $1,848.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET EXCHANGE OPTIA SPECTRA,272,RC,,,,,,,,both,,,3982.8800,597.4300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1660.86,,,,,,,1027.9800,3982.8800,percent of total billed charges,"41.7% of $3,982.88 in Billed Charges for Rev 272 = $1,660.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET EXCHANGE OPTIA SPECTRA,272,RC,,,,,,,,both,,,3982.8800,597.4300,CIGNA HEALTHCARE,CIGNA PPO,1660.86,,,,,,,1027.9800,3982.8800,percent of total billed charges,"41.7% of $3,982.88 in Billed Charges for Rev 272 = $1,660.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET EXCHANGE OPTIA SPECTRA,272,RC,,,,,,,,both,,,3982.8800,597.4300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3584.59,,,,,,,1027.9800,3982.8800,percent of total billed charges,"90% of $3,982.88 in Billed Charges for Rev 272 = $3,584.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET EXCHANGE OPTIA SPECTRA,272,RC,,,,,,,,both,,,3982.8800,597.4300,MEDCOST,MEDCOST VHN,1895.45,,,,,,,1027.9800,3982.8800,percent of total billed charges,"47.59% of $3,982.88 in Billed Charges for Rev 272 = $1,895.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET EXCHANGE OPTIA SPECTRA,272,RC,,,,,,,,both,,,3982.8800,597.4300,SENTARA HEALTH,SENTARA HEALTH,1027.98,,,,,,,1027.9800,3982.8800,percent of total billed charges,"25.81% of $3,982.88 in Billed Charges for Rev 272 = $1,027.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET EXCHANGE OPTIA SPECTRA,272,RC,,,,,,,,both,,,3982.8800,597.4300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3982.88,,,,,,,1027.9800,3982.8800,percent of total billed charges,"100% of $3,982.88 in Billed Charges for Rev 272 = $3,982.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET EXCHANGE OPTIA SPECTRA,272,RC,,,,,,,,both,,,3982.8800,597.4300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1991.44,,,,,,,1027.9800,3982.8800,percent of total billed charges,"Rev 272 $3,982.88 in Billed Charges at 50% = $1,991.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET EXCHANGE OPTIA SPECTRA,272,RC,,,,,,,,both,,,3982.8800,597.4300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1286.47,,,,,,,1027.9800,3982.8800,other,"32.3% of $3,982.88 in Billed Charges for Rev 272 = $1,286.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET EXCHANGE OPTIA SPECTRA,272,RC,,,,,,,,both,,,3982.8800,597.4300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1222.74,,,,,,,1027.9800,3982.8800,other,"30.7% of $3,982.88 in Billed Charges for Rev 272 = $1,222.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET EXCHANGE OPTIA SPECTRA,272,RC,,,,,,,,both,,,3982.8800,597.4300,UNITED HEALTHCARE,UNITED HEALTHCARE,1286.47,,,,,,,1027.9800,3982.8800,percent of total billed charges,"32.3% of $3,982.88 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET EXCHANGE OPTIA SPECTRA,272,RC,,,,,,,,both,,,3982.8800,597.4300,WELLCARE,WELLCARE MEDICAID,3982.88,,,,,,,1027.9800,3982.8800,percent of total billed charges,"100% of $3,982.88 in Billed Charges for Rev 272 = $3,982.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET EXTENSION VENOTUBE 30INCH,272,RC,27200002,CDM,,,,,,both,,,8.1700,1.2300,AETNA,AETNA,3.49,,,,,,,2.1100,8.1700,percent of total billed charges,42.7% of $8.17 in Billed Charges for Rev 272 = $3.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET EXTENSION VENOTUBE 30INCH,272,RC,27200002,CDM,,,,,,both,,,8.1700,1.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5.72,,,,,,,2.1100,8.1700,percent of total billed charges,Rev 272 $8.17 in Billed Charges at 70% = $5.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET EXTENSION VENOTUBE 30INCH,272,RC,27200002,CDM,,,,,,both,,,8.1700,1.2300,CIGNA HEALTHCARE,CIGNA HMO,3.41,,,,,,,2.1100,8.1700,percent of total billed charges,41.7% of $8.17 in Billed Charges for Rev 272 = $3.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET EXTENSION VENOTUBE 30INCH,272,RC,27200002,CDM,,,,,,both,,,8.1700,1.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3.79,,,,,,,2.1100,8.1700,percent of total billed charges,46.4% of $8.17 in Billed Charges for Rev 272 = $3.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET EXTENSION VENOTUBE 30INCH,272,RC,27200002,CDM,,,,,,both,,,8.1700,1.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3.41,,,,,,,2.1100,8.1700,percent of total billed charges,41.7% of $8.17 in Billed Charges for Rev 272 = $3.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET EXTENSION VENOTUBE 30INCH,272,RC,27200002,CDM,,,,,,both,,,8.1700,1.2300,CIGNA HEALTHCARE,CIGNA PPO,3.41,,,,,,,2.1100,8.1700,percent of total billed charges,41.7% of $8.17 in Billed Charges for Rev 272 = $3.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET EXTENSION VENOTUBE 30INCH,272,RC,27200002,CDM,,,,,,both,,,8.1700,1.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7.35,,,,,,,2.1100,8.1700,percent of total billed charges,90% of $8.17 in Billed Charges for Rev 272 = $7.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET EXTENSION VENOTUBE 30INCH,272,RC,27200002,CDM,,,,,,both,,,8.1700,1.2300,MEDCOST,MEDCOST VHN,3.89,,,,,,,2.1100,8.1700,percent of total billed charges,47.59% of $8.17 in Billed Charges for Rev 272 = $3.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET EXTENSION VENOTUBE 30INCH,272,RC,27200002,CDM,,,,,,both,,,8.1700,1.2300,SENTARA HEALTH,SENTARA HEALTH,2.11,,,,,,,2.1100,8.1700,percent of total billed charges,25.81% of $8.17 in Billed Charges for Rev 272 = $2.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET EXTENSION VENOTUBE 30INCH,272,RC,27200002,CDM,,,,,,both,,,8.1700,1.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8.17,,,,,,,2.1100,8.1700,percent of total billed charges,100% of $8.17 in Billed Charges for Rev 272 = $8.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET EXTENSION VENOTUBE 30INCH,272,RC,27200002,CDM,,,,,,both,,,8.1700,1.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4.09,,,,,,,2.1100,8.1700,percent of total billed charges,Rev 272 $8.17 in Billed Charges at 50% = $4.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET EXTENSION VENOTUBE 30INCH,272,RC,27200002,CDM,,,,,,both,,,8.1700,1.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2.64,,,,,,,2.1100,8.1700,other,32.3% of $8.17 in Billed Charges for Rev 272 = $2.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SET EXTENSION VENOTUBE 30INCH,272,RC,27200002,CDM,,,,,,both,,,8.1700,1.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,2.51,,,,,,,2.1100,8.1700,other,30.7% of $8.17 in Billed Charges for Rev 272 = $2.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SET EXTENSION VENOTUBE 30INCH,272,RC,27200002,CDM,,,,,,both,,,8.1700,1.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,2.64,,,,,,,2.1100,8.1700,percent of total billed charges,32.3% of $8.17 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET EXTENSION VENOTUBE 30INCH,272,RC,27200002,CDM,,,,,,both,,,8.1700,1.2300,WELLCARE,WELLCARE MEDICAID,8.17,,,,,,,2.1100,8.1700,percent of total billed charges,100% of $8.17 in Billed Charges for Rev 272 = $8.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SET FLEXIBLE ENDOSCOPY CLIP OTSC 12/6T- (220),272,RC,27200002,CDM,,,,,,both,,,6627.0700,994.0600,AETNA,AETNA,2829.76,,,,,,,1710.4500,6627.0700,percent of total billed charges,"42.7% of $6,627.07 in Billed Charges for Rev 272 = $2,829.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET FLEXIBLE ENDOSCOPY CLIP OTSC 12/6T- (220),272,RC,27200002,CDM,,,,,,both,,,6627.0700,994.0600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4638.95,,,,,,,1710.4500,6627.0700,percent of total billed charges,"Rev 272 $6,627.07 in Billed Charges at 70% = $4,638.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET FLEXIBLE ENDOSCOPY CLIP OTSC 12/6T- (220),272,RC,27200002,CDM,,,,,,both,,,6627.0700,994.0600,CIGNA HEALTHCARE,CIGNA HMO,2763.49,,,,,,,1710.4500,6627.0700,percent of total billed charges,"41.7% of $6,627.07 in Billed Charges for Rev 272 = $2,763.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET FLEXIBLE ENDOSCOPY CLIP OTSC 12/6T- (220),272,RC,27200002,CDM,,,,,,both,,,6627.0700,994.0600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3074.96,,,,,,,1710.4500,6627.0700,percent of total billed charges,"46.4% of $6,627.07 in Billed Charges for Rev 272 = $3,074.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET FLEXIBLE ENDOSCOPY CLIP OTSC 12/6T- (220),272,RC,27200002,CDM,,,,,,both,,,6627.0700,994.0600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2763.49,,,,,,,1710.4500,6627.0700,percent of total billed charges,"41.7% of $6,627.07 in Billed Charges for Rev 272 = $2,763.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET FLEXIBLE ENDOSCOPY CLIP OTSC 12/6T- (220),272,RC,27200002,CDM,,,,,,both,,,6627.0700,994.0600,CIGNA HEALTHCARE,CIGNA PPO,2763.49,,,,,,,1710.4500,6627.0700,percent of total billed charges,"41.7% of $6,627.07 in Billed Charges for Rev 272 = $2,763.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET FLEXIBLE ENDOSCOPY CLIP OTSC 12/6T- (220),272,RC,27200002,CDM,,,,,,both,,,6627.0700,994.0600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5964.36,,,,,,,1710.4500,6627.0700,percent of total billed charges,"90% of $6,627.07 in Billed Charges for Rev 272 = $5,964.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET FLEXIBLE ENDOSCOPY CLIP OTSC 12/6T- (220),272,RC,27200002,CDM,,,,,,both,,,6627.0700,994.0600,MEDCOST,MEDCOST VHN,3153.82,,,,,,,1710.4500,6627.0700,percent of total billed charges,"47.59% of $6,627.07 in Billed Charges for Rev 272 = $3,153.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET FLEXIBLE ENDOSCOPY CLIP OTSC 12/6T- (220),272,RC,27200002,CDM,,,,,,both,,,6627.0700,994.0600,SENTARA HEALTH,SENTARA HEALTH,1710.45,,,,,,,1710.4500,6627.0700,percent of total billed charges,"25.81% of $6,627.07 in Billed Charges for Rev 272 = $1,710.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET FLEXIBLE ENDOSCOPY CLIP OTSC 12/6T- (220),272,RC,27200002,CDM,,,,,,both,,,6627.0700,994.0600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6627.07,,,,,,,1710.4500,6627.0700,percent of total billed charges,"100% of $6,627.07 in Billed Charges for Rev 272 = $6,627.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET FLEXIBLE ENDOSCOPY CLIP OTSC 12/6T- (220),272,RC,27200002,CDM,,,,,,both,,,6627.0700,994.0600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3313.54,,,,,,,1710.4500,6627.0700,percent of total billed charges,"Rev 272 $6,627.07 in Billed Charges at 50% = $3,313.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET FLEXIBLE ENDOSCOPY CLIP OTSC 12/6T- (220),272,RC,27200002,CDM,,,,,,both,,,6627.0700,994.0600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2140.54,,,,,,,1710.4500,6627.0700,other,"32.3% of $6,627.07 in Billed Charges for Rev 272 = $2,140.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET FLEXIBLE ENDOSCOPY CLIP OTSC 12/6T- (220),272,RC,27200002,CDM,,,,,,both,,,6627.0700,994.0600,UNITED HEALTHCARE,UHC HERITAGE SELECT,2034.51,,,,,,,1710.4500,6627.0700,other,"30.7% of $6,627.07 in Billed Charges for Rev 272 = $2,034.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET FLEXIBLE ENDOSCOPY CLIP OTSC 12/6T- (220),272,RC,27200002,CDM,,,,,,both,,,6627.0700,994.0600,UNITED HEALTHCARE,UNITED HEALTHCARE,2140.54,,,,,,,1710.4500,6627.0700,percent of total billed charges,"32.3% of $6,627.07 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET FLEXIBLE ENDOSCOPY CLIP OTSC 12/6T- (220),272,RC,27200002,CDM,,,,,,both,,,6627.0700,994.0600,WELLCARE,WELLCARE MEDICAID,6627.07,,,,,,,1710.4500,6627.0700,percent of total billed charges,"100% of $6,627.07 in Billed Charges for Rev 272 = $6,627.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM NOVOSTITCH PRO MEN,272,RC,,,,,,,,both,,,5963.3300,894.5000,AETNA,AETNA,2546.34,,,,,,,1539.1400,5963.3300,percent of total billed charges,"42.7% of $5,963.33 in Billed Charges for Rev 272 = $2,546.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM NOVOSTITCH PRO MEN,272,RC,,,,,,,,both,,,5963.3300,894.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4174.33,,,,,,,1539.1400,5963.3300,percent of total billed charges,"Rev 272 $5,963.33 in Billed Charges at 70% = $4,174.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM NOVOSTITCH PRO MEN,272,RC,,,,,,,,both,,,5963.3300,894.5000,CIGNA HEALTHCARE,CIGNA HMO,2486.71,,,,,,,1539.1400,5963.3300,percent of total billed charges,"41.7% of $5,963.33 in Billed Charges for Rev 272 = $2,486.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM NOVOSTITCH PRO MEN,272,RC,,,,,,,,both,,,5963.3300,894.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2766.99,,,,,,,1539.1400,5963.3300,percent of total billed charges,"46.4% of $5,963.33 in Billed Charges for Rev 272 = $2,766.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM NOVOSTITCH PRO MEN,272,RC,,,,,,,,both,,,5963.3300,894.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2486.71,,,,,,,1539.1400,5963.3300,percent of total billed charges,"41.7% of $5,963.33 in Billed Charges for Rev 272 = $2,486.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM NOVOSTITCH PRO MEN,272,RC,,,,,,,,both,,,5963.3300,894.5000,CIGNA HEALTHCARE,CIGNA PPO,2486.71,,,,,,,1539.1400,5963.3300,percent of total billed charges,"41.7% of $5,963.33 in Billed Charges for Rev 272 = $2,486.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM NOVOSTITCH PRO MEN,272,RC,,,,,,,,both,,,5963.3300,894.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5367.00,,,,,,,1539.1400,5963.3300,percent of total billed charges,"90% of $5,963.33 in Billed Charges for Rev 272 = $5,367.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM NOVOSTITCH PRO MEN,272,RC,,,,,,,,both,,,5963.3300,894.5000,MEDCOST,MEDCOST VHN,2837.95,,,,,,,1539.1400,5963.3300,percent of total billed charges,"47.59% of $5,963.33 in Billed Charges for Rev 272 = $2,837.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM NOVOSTITCH PRO MEN,272,RC,,,,,,,,both,,,5963.3300,894.5000,SENTARA HEALTH,SENTARA HEALTH,1539.14,,,,,,,1539.1400,5963.3300,percent of total billed charges,"25.81% of $5,963.33 in Billed Charges for Rev 272 = $1,539.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM NOVOSTITCH PRO MEN,272,RC,,,,,,,,both,,,5963.3300,894.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5963.33,,,,,,,1539.1400,5963.3300,percent of total billed charges,"100% of $5,963.33 in Billed Charges for Rev 272 = $5,963.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM NOVOSTITCH PRO MEN,272,RC,,,,,,,,both,,,5963.3300,894.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2981.67,,,,,,,1539.1400,5963.3300,percent of total billed charges,"Rev 272 $5,963.33 in Billed Charges at 50% = $2,981.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM NOVOSTITCH PRO MEN,272,RC,,,,,,,,both,,,5963.3300,894.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1926.16,,,,,,,1539.1400,5963.3300,other,"32.3% of $5,963.33 in Billed Charges for Rev 272 = $1,926.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM NOVOSTITCH PRO MEN,272,RC,,,,,,,,both,,,5963.3300,894.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1830.74,,,,,,,1539.1400,5963.3300,other,"30.7% of $5,963.33 in Billed Charges for Rev 272 = $1,830.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM NOVOSTITCH PRO MEN,272,RC,,,,,,,,both,,,5963.3300,894.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,1926.16,,,,,,,1539.1400,5963.3300,percent of total billed charges,"32.3% of $5,963.33 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM NOVOSTITCH PRO MEN,272,RC,,,,,,,,both,,,5963.3300,894.5000,WELLCARE,WELLCARE MEDICAID,5963.33,,,,,,,1539.1400,5963.3300,percent of total billed charges,"100% of $5,963.33 in Billed Charges for Rev 272 = $5,963.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,621.9100,93.2900,AETNA,AETNA,265.56,,,,,,,160.5200,621.9100,percent of total billed charges,42.7% of $621.91 in Billed Charges for Rev 272 = $265.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,621.9100,93.2900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,435.34,,,,,,,160.5200,621.9100,percent of total billed charges,Rev 272 $621.91 in Billed Charges at 70% = $435.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,621.9100,93.2900,CIGNA HEALTHCARE,CIGNA HMO,259.34,,,,,,,160.5200,621.9100,percent of total billed charges,41.7% of $621.91 in Billed Charges for Rev 272 = $259.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,621.9100,93.2900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,288.57,,,,,,,160.5200,621.9100,percent of total billed charges,46.4% of $621.91 in Billed Charges for Rev 272 = $288.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,621.9100,93.2900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,259.34,,,,,,,160.5200,621.9100,percent of total billed charges,41.7% of $621.91 in Billed Charges for Rev 272 = $259.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,621.9100,93.2900,CIGNA HEALTHCARE,CIGNA PPO,259.34,,,,,,,160.5200,621.9100,percent of total billed charges,41.7% of $621.91 in Billed Charges for Rev 272 = $259.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,621.9100,93.2900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,559.72,,,,,,,160.5200,621.9100,percent of total billed charges,90% of $621.91 in Billed Charges for Rev 272 = $559.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,621.9100,93.2900,MEDCOST,MEDCOST VHN,295.97,,,,,,,160.5200,621.9100,percent of total billed charges,47.59% of $621.91 in Billed Charges for Rev 272 = $295.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,621.9100,93.2900,SENTARA HEALTH,SENTARA HEALTH,160.52,,,,,,,160.5200,621.9100,percent of total billed charges,25.81% of $621.91 in Billed Charges for Rev 272 = $160.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,621.9100,93.2900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",621.91,,,,,,,160.5200,621.9100,percent of total billed charges,100% of $621.91 in Billed Charges for Rev 272 = $621.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,621.9100,93.2900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,310.96,,,,,,,160.5200,621.9100,percent of total billed charges,Rev 272 $621.91 in Billed Charges at 50% = $310.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,621.9100,93.2900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,200.88,,,,,,,160.5200,621.9100,other,32.3% of $621.91 in Billed Charges for Rev 272 = $200.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,621.9100,93.2900,UNITED HEALTHCARE,UHC HERITAGE SELECT,190.93,,,,,,,160.5200,621.9100,other,30.7% of $621.91 in Billed Charges for Rev 272 = $190.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,621.9100,93.2900,UNITED HEALTHCARE,UNITED HEALTHCARE,200.88,,,,,,,160.5200,621.9100,percent of total billed charges,32.3% of $621.91 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,621.9100,93.2900,WELLCARE,WELLCARE MEDICAID,621.91,,,,,,,160.5200,621.9100,percent of total billed charges,100% of $621.91 in Billed Charges for Rev 272 = $621.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM RELEASE NANOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,13741.5800,2061.2400,AETNA,AETNA,5867.65,,,,,,,3546.7000,13741.5800,percent of total billed charges,"42.7% of $13,741.58 in Billed Charges for Rev 272 = $5,867.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM RELEASE NANOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,13741.5800,2061.2400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9619.11,,,,,,,3546.7000,13741.5800,percent of total billed charges,"Rev 272 $13,741.58 in Billed Charges at 70% = $9,619.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM RELEASE NANOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,13741.5800,2061.2400,CIGNA HEALTHCARE,CIGNA HMO,5730.24,,,,,,,3546.7000,13741.5800,percent of total billed charges,"41.7% of $13,741.58 in Billed Charges for Rev 272 = $5,730.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM RELEASE NANOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,13741.5800,2061.2400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6376.09,,,,,,,3546.7000,13741.5800,percent of total billed charges,"46.4% of $13,741.58 in Billed Charges for Rev 272 = $6,376.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM RELEASE NANOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,13741.5800,2061.2400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5730.24,,,,,,,3546.7000,13741.5800,percent of total billed charges,"41.7% of $13,741.58 in Billed Charges for Rev 272 = $5,730.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM RELEASE NANOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,13741.5800,2061.2400,CIGNA HEALTHCARE,CIGNA PPO,5730.24,,,,,,,3546.7000,13741.5800,percent of total billed charges,"41.7% of $13,741.58 in Billed Charges for Rev 272 = $5,730.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM RELEASE NANOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,13741.5800,2061.2400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12367.42,,,,,,,3546.7000,13741.5800,percent of total billed charges,"90% of $13,741.58 in Billed Charges for Rev 272 = $12,367.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM RELEASE NANOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,13741.5800,2061.2400,MEDCOST,MEDCOST VHN,6539.62,,,,,,,3546.7000,13741.5800,percent of total billed charges,"47.59% of $13,741.58 in Billed Charges for Rev 272 = $6,539.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM RELEASE NANOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,13741.5800,2061.2400,SENTARA HEALTH,SENTARA HEALTH,3546.70,,,,,,,3546.7000,13741.5800,percent of total billed charges,"25.81% of $13,741.58 in Billed Charges for Rev 272 = $3,546.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM RELEASE NANOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,13741.5800,2061.2400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13741.58,,,,,,,3546.7000,13741.5800,percent of total billed charges,"100% of $13,741.58 in Billed Charges for Rev 272 = $13,741.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM RELEASE NANOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,13741.5800,2061.2400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6870.79,,,,,,,3546.7000,13741.5800,percent of total billed charges,"Rev 272 $13,741.58 in Billed Charges at 50% = $6,870.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM RELEASE NANOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,13741.5800,2061.2400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4438.53,,,,,,,3546.7000,13741.5800,other,"32.3% of $13,741.58 in Billed Charges for Rev 272 = $4,438.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM RELEASE NANOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,13741.5800,2061.2400,UNITED HEALTHCARE,UHC HERITAGE SELECT,4218.67,,,,,,,3546.7000,13741.5800,other,"30.7% of $13,741.58 in Billed Charges for Rev 272 = $4,218.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM RELEASE NANOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,13741.5800,2061.2400,UNITED HEALTHCARE,UNITED HEALTHCARE,4438.53,,,,,,,3546.7000,13741.5800,percent of total billed charges,"32.3% of $13,741.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM RELEASE NANOSCOPIC,272,RC,27200002,CDM,,,,,,both,,,13741.5800,2061.2400,WELLCARE,WELLCARE MEDICAID,13741.58,,,,,,,3546.7000,13741.5800,percent of total billed charges,"100% of $13,741.58 in Billed Charges for Rev 272 = $13,741.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NOVY CANNULATION,272,RC,27200002,CDM,,,,,,both,,,2497.2300,374.5800,AETNA,AETNA,1066.32,,,,,,,644.5400,2497.2300,percent of total billed charges,"42.7% of $2,497.23 in Billed Charges for Rev 272 = $1,066.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NOVY CANNULATION,272,RC,27200002,CDM,,,,,,both,,,2497.2300,374.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1748.06,,,,,,,644.5400,2497.2300,percent of total billed charges,"Rev 272 $2,497.23 in Billed Charges at 70% = $1,748.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NOVY CANNULATION,272,RC,27200002,CDM,,,,,,both,,,2497.2300,374.5800,CIGNA HEALTHCARE,CIGNA HMO,1041.34,,,,,,,644.5400,2497.2300,percent of total billed charges,"41.7% of $2,497.23 in Billed Charges for Rev 272 = $1,041.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NOVY CANNULATION,272,RC,27200002,CDM,,,,,,both,,,2497.2300,374.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1158.71,,,,,,,644.5400,2497.2300,percent of total billed charges,"46.4% of $2,497.23 in Billed Charges for Rev 272 = $1,158.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NOVY CANNULATION,272,RC,27200002,CDM,,,,,,both,,,2497.2300,374.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1041.34,,,,,,,644.5400,2497.2300,percent of total billed charges,"41.7% of $2,497.23 in Billed Charges for Rev 272 = $1,041.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NOVY CANNULATION,272,RC,27200002,CDM,,,,,,both,,,2497.2300,374.5800,CIGNA HEALTHCARE,CIGNA PPO,1041.34,,,,,,,644.5400,2497.2300,percent of total billed charges,"41.7% of $2,497.23 in Billed Charges for Rev 272 = $1,041.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NOVY CANNULATION,272,RC,27200002,CDM,,,,,,both,,,2497.2300,374.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2247.51,,,,,,,644.5400,2497.2300,percent of total billed charges,"90% of $2,497.23 in Billed Charges for Rev 272 = $2,247.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NOVY CANNULATION,272,RC,27200002,CDM,,,,,,both,,,2497.2300,374.5800,MEDCOST,MEDCOST VHN,1188.43,,,,,,,644.5400,2497.2300,percent of total billed charges,"47.59% of $2,497.23 in Billed Charges for Rev 272 = $1,188.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NOVY CANNULATION,272,RC,27200002,CDM,,,,,,both,,,2497.2300,374.5800,SENTARA HEALTH,SENTARA HEALTH,644.54,,,,,,,644.5400,2497.2300,percent of total billed charges,"25.81% of $2,497.23 in Billed Charges for Rev 272 = $644.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NOVY CANNULATION,272,RC,27200002,CDM,,,,,,both,,,2497.2300,374.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2497.23,,,,,,,644.5400,2497.2300,percent of total billed charges,"100% of $2,497.23 in Billed Charges for Rev 272 = $2,497.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NOVY CANNULATION,272,RC,27200002,CDM,,,,,,both,,,2497.2300,374.5800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1248.62,,,,,,,644.5400,2497.2300,percent of total billed charges,"Rev 272 $2,497.23 in Billed Charges at 50% = $1,248.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NOVY CANNULATION,272,RC,27200002,CDM,,,,,,both,,,2497.2300,374.5800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,806.61,,,,,,,644.5400,2497.2300,other,"32.3% of $2,497.23 in Billed Charges for Rev 272 = $806.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET NOVY CANNULATION,272,RC,27200002,CDM,,,,,,both,,,2497.2300,374.5800,UNITED HEALTHCARE,UHC HERITAGE SELECT,766.65,,,,,,,644.5400,2497.2300,other,"30.7% of $2,497.23 in Billed Charges for Rev 272 = $766.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET NOVY CANNULATION,272,RC,27200002,CDM,,,,,,both,,,2497.2300,374.5800,UNITED HEALTHCARE,UNITED HEALTHCARE,806.61,,,,,,,644.5400,2497.2300,percent of total billed charges,"32.3% of $2,497.23 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET NOVY CANNULATION,272,RC,27200002,CDM,,,,,,both,,,2497.2300,374.5800,WELLCARE,WELLCARE MEDICAID,2497.23,,,,,,,644.5400,2497.2300,percent of total billed charges,"100% of $2,497.23 in Billed Charges for Rev 272 = $2,497.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET QUICK PRESSURE MONITOR 295-2 (1478),272,RC,27200002,CDM,,,,,,both,,,1512.4400,226.8700,AETNA,AETNA,645.81,,,,,,,390.3600,1512.4400,percent of total billed charges,"42.7% of $1,512.44 in Billed Charges for Rev 272 = $645.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET QUICK PRESSURE MONITOR 295-2 (1478),272,RC,27200002,CDM,,,,,,both,,,1512.4400,226.8700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1058.71,,,,,,,390.3600,1512.4400,percent of total billed charges,"Rev 272 $1,512.44 in Billed Charges at 70% = $1,058.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET QUICK PRESSURE MONITOR 295-2 (1478),272,RC,27200002,CDM,,,,,,both,,,1512.4400,226.8700,CIGNA HEALTHCARE,CIGNA HMO,630.69,,,,,,,390.3600,1512.4400,percent of total billed charges,"41.7% of $1,512.44 in Billed Charges for Rev 272 = $630.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET QUICK PRESSURE MONITOR 295-2 (1478),272,RC,27200002,CDM,,,,,,both,,,1512.4400,226.8700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,701.77,,,,,,,390.3600,1512.4400,percent of total billed charges,"46.4% of $1,512.44 in Billed Charges for Rev 272 = $701.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET QUICK PRESSURE MONITOR 295-2 (1478),272,RC,27200002,CDM,,,,,,both,,,1512.4400,226.8700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,630.69,,,,,,,390.3600,1512.4400,percent of total billed charges,"41.7% of $1,512.44 in Billed Charges for Rev 272 = $630.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET QUICK PRESSURE MONITOR 295-2 (1478),272,RC,27200002,CDM,,,,,,both,,,1512.4400,226.8700,CIGNA HEALTHCARE,CIGNA PPO,630.69,,,,,,,390.3600,1512.4400,percent of total billed charges,"41.7% of $1,512.44 in Billed Charges for Rev 272 = $630.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET QUICK PRESSURE MONITOR 295-2 (1478),272,RC,27200002,CDM,,,,,,both,,,1512.4400,226.8700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1361.20,,,,,,,390.3600,1512.4400,percent of total billed charges,"90% of $1,512.44 in Billed Charges for Rev 272 = $1,361.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET QUICK PRESSURE MONITOR 295-2 (1478),272,RC,27200002,CDM,,,,,,both,,,1512.4400,226.8700,MEDCOST,MEDCOST VHN,719.77,,,,,,,390.3600,1512.4400,percent of total billed charges,"47.59% of $1,512.44 in Billed Charges for Rev 272 = $719.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET QUICK PRESSURE MONITOR 295-2 (1478),272,RC,27200002,CDM,,,,,,both,,,1512.4400,226.8700,SENTARA HEALTH,SENTARA HEALTH,390.36,,,,,,,390.3600,1512.4400,percent of total billed charges,"25.81% of $1,512.44 in Billed Charges for Rev 272 = $390.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET QUICK PRESSURE MONITOR 295-2 (1478),272,RC,27200002,CDM,,,,,,both,,,1512.4400,226.8700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1512.44,,,,,,,390.3600,1512.4400,percent of total billed charges,"100% of $1,512.44 in Billed Charges for Rev 272 = $1,512.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET QUICK PRESSURE MONITOR 295-2 (1478),272,RC,27200002,CDM,,,,,,both,,,1512.4400,226.8700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,756.22,,,,,,,390.3600,1512.4400,percent of total billed charges,"Rev 272 $1,512.44 in Billed Charges at 50% = $756.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET QUICK PRESSURE MONITOR 295-2 (1478),272,RC,27200002,CDM,,,,,,both,,,1512.4400,226.8700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,488.52,,,,,,,390.3600,1512.4400,other,"32.3% of $1,512.44 in Billed Charges for Rev 272 = $488.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET QUICK PRESSURE MONITOR 295-2 (1478),272,RC,27200002,CDM,,,,,,both,,,1512.4400,226.8700,UNITED HEALTHCARE,UHC HERITAGE SELECT,464.32,,,,,,,390.3600,1512.4400,other,"30.7% of $1,512.44 in Billed Charges for Rev 272 = $464.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET QUICK PRESSURE MONITOR 295-2 (1478),272,RC,27200002,CDM,,,,,,both,,,1512.4400,226.8700,UNITED HEALTHCARE,UNITED HEALTHCARE,488.52,,,,,,,390.3600,1512.4400,percent of total billed charges,"32.3% of $1,512.44 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET QUICK PRESSURE MONITOR 295-2 (1478),272,RC,27200002,CDM,,,,,,both,,,1512.4400,226.8700,WELLCARE,WELLCARE MEDICAID,1512.44,,,,,,,390.3600,1512.4400,percent of total billed charges,"100% of $1,512.44 in Billed Charges for Rev 272 = $1,512.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET READJUSTMENT LONG PEEK,272,RC,,,,,,,,both,,,4810.4800,721.5700,AETNA,AETNA,2054.08,,,,,,,1241.5800,4810.4800,percent of total billed charges,"42.7% of $4,810.48 in Billed Charges for Rev 272 = $2,054.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET READJUSTMENT LONG PEEK,272,RC,,,,,,,,both,,,4810.4800,721.5700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3367.34,,,,,,,1241.5800,4810.4800,percent of total billed charges,"Rev 272 $4,810.48 in Billed Charges at 70% = $3,367.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET READJUSTMENT LONG PEEK,272,RC,,,,,,,,both,,,4810.4800,721.5700,CIGNA HEALTHCARE,CIGNA HMO,2005.97,,,,,,,1241.5800,4810.4800,percent of total billed charges,"41.7% of $4,810.48 in Billed Charges for Rev 272 = $2,005.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET READJUSTMENT LONG PEEK,272,RC,,,,,,,,both,,,4810.4800,721.5700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2232.06,,,,,,,1241.5800,4810.4800,percent of total billed charges,"46.4% of $4,810.48 in Billed Charges for Rev 272 = $2,232.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET READJUSTMENT LONG PEEK,272,RC,,,,,,,,both,,,4810.4800,721.5700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2005.97,,,,,,,1241.5800,4810.4800,percent of total billed charges,"41.7% of $4,810.48 in Billed Charges for Rev 272 = $2,005.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET READJUSTMENT LONG PEEK,272,RC,,,,,,,,both,,,4810.4800,721.5700,CIGNA HEALTHCARE,CIGNA PPO,2005.97,,,,,,,1241.5800,4810.4800,percent of total billed charges,"41.7% of $4,810.48 in Billed Charges for Rev 272 = $2,005.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET READJUSTMENT LONG PEEK,272,RC,,,,,,,,both,,,4810.4800,721.5700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4329.43,,,,,,,1241.5800,4810.4800,percent of total billed charges,"90% of $4,810.48 in Billed Charges for Rev 272 = $4,329.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET READJUSTMENT LONG PEEK,272,RC,,,,,,,,both,,,4810.4800,721.5700,MEDCOST,MEDCOST VHN,2289.31,,,,,,,1241.5800,4810.4800,percent of total billed charges,"47.59% of $4,810.48 in Billed Charges for Rev 272 = $2,289.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET READJUSTMENT LONG PEEK,272,RC,,,,,,,,both,,,4810.4800,721.5700,SENTARA HEALTH,SENTARA HEALTH,1241.58,,,,,,,1241.5800,4810.4800,percent of total billed charges,"25.81% of $4,810.48 in Billed Charges for Rev 272 = $1,241.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET READJUSTMENT LONG PEEK,272,RC,,,,,,,,both,,,4810.4800,721.5700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4810.48,,,,,,,1241.5800,4810.4800,percent of total billed charges,"100% of $4,810.48 in Billed Charges for Rev 272 = $4,810.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET READJUSTMENT LONG PEEK,272,RC,,,,,,,,both,,,4810.4800,721.5700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2405.24,,,,,,,1241.5800,4810.4800,percent of total billed charges,"Rev 272 $4,810.48 in Billed Charges at 50% = $2,405.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET READJUSTMENT LONG PEEK,272,RC,,,,,,,,both,,,4810.4800,721.5700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1553.79,,,,,,,1241.5800,4810.4800,other,"32.3% of $4,810.48 in Billed Charges for Rev 272 = $1,553.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET READJUSTMENT LONG PEEK,272,RC,,,,,,,,both,,,4810.4800,721.5700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1476.82,,,,,,,1241.5800,4810.4800,other,"30.7% of $4,810.48 in Billed Charges for Rev 272 = $1,476.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SET READJUSTMENT LONG PEEK,272,RC,,,,,,,,both,,,4810.4800,721.5700,UNITED HEALTHCARE,UNITED HEALTHCARE,1553.79,,,,,,,1241.5800,4810.4800,percent of total billed charges,"32.3% of $4,810.48 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SET READJUSTMENT LONG PEEK,272,RC,,,,,,,,both,,,4810.4800,721.5700,WELLCARE,WELLCARE MEDICAID,4810.48,,,,,,,1241.5800,4810.4800,percent of total billed charges,"100% of $4,810.48 in Billed Charges for Rev 272 = $4,810.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TISSUE RETRIVAL 12MMX250ML,272,RC,27200002,CDM,,,,,,both,,,3328.5700,499.2900,AETNA,AETNA,1421.30,,,,,,,859.1000,3328.5700,percent of total billed charges,"42.7% of $3,328.57 in Billed Charges for Rev 272 = $1,421.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TISSUE RETRIVAL 12MMX250ML,272,RC,27200002,CDM,,,,,,both,,,3328.5700,499.2900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2330.00,,,,,,,859.1000,3328.5700,percent of total billed charges,"Rev 272 $3,328.57 in Billed Charges at 70% = $2,330.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TISSUE RETRIVAL 12MMX250ML,272,RC,27200002,CDM,,,,,,both,,,3328.5700,499.2900,CIGNA HEALTHCARE,CIGNA HMO,1388.01,,,,,,,859.1000,3328.5700,percent of total billed charges,"41.7% of $3,328.57 in Billed Charges for Rev 272 = $1,388.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TISSUE RETRIVAL 12MMX250ML,272,RC,27200002,CDM,,,,,,both,,,3328.5700,499.2900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1544.46,,,,,,,859.1000,3328.5700,percent of total billed charges,"46.4% of $3,328.57 in Billed Charges for Rev 272 = $1,544.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TISSUE RETRIVAL 12MMX250ML,272,RC,27200002,CDM,,,,,,both,,,3328.5700,499.2900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1388.01,,,,,,,859.1000,3328.5700,percent of total billed charges,"41.7% of $3,328.57 in Billed Charges for Rev 272 = $1,388.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TISSUE RETRIVAL 12MMX250ML,272,RC,27200002,CDM,,,,,,both,,,3328.5700,499.2900,CIGNA HEALTHCARE,CIGNA PPO,1388.01,,,,,,,859.1000,3328.5700,percent of total billed charges,"41.7% of $3,328.57 in Billed Charges for Rev 272 = $1,388.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TISSUE RETRIVAL 12MMX250ML,272,RC,27200002,CDM,,,,,,both,,,3328.5700,499.2900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2995.71,,,,,,,859.1000,3328.5700,percent of total billed charges,"90% of $3,328.57 in Billed Charges for Rev 272 = $2,995.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TISSUE RETRIVAL 12MMX250ML,272,RC,27200002,CDM,,,,,,both,,,3328.5700,499.2900,MEDCOST,MEDCOST VHN,1584.07,,,,,,,859.1000,3328.5700,percent of total billed charges,"47.59% of $3,328.57 in Billed Charges for Rev 272 = $1,584.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TISSUE RETRIVAL 12MMX250ML,272,RC,27200002,CDM,,,,,,both,,,3328.5700,499.2900,SENTARA HEALTH,SENTARA HEALTH,859.10,,,,,,,859.1000,3328.5700,percent of total billed charges,"25.81% of $3,328.57 in Billed Charges for Rev 272 = $859.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TISSUE RETRIVAL 12MMX250ML,272,RC,27200002,CDM,,,,,,both,,,3328.5700,499.2900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3328.57,,,,,,,859.1000,3328.5700,percent of total billed charges,"100% of $3,328.57 in Billed Charges for Rev 272 = $3,328.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TISSUE RETRIVAL 12MMX250ML,272,RC,27200002,CDM,,,,,,both,,,3328.5700,499.2900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1664.29,,,,,,,859.1000,3328.5700,percent of total billed charges,"Rev 272 $3,328.57 in Billed Charges at 50% = $1,664.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TISSUE RETRIVAL 12MMX250ML,272,RC,27200002,CDM,,,,,,both,,,3328.5700,499.2900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1075.13,,,,,,,859.1000,3328.5700,other,"32.3% of $3,328.57 in Billed Charges for Rev 272 = $1,075.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM TISSUE RETRIVAL 12MMX250ML,272,RC,27200002,CDM,,,,,,both,,,3328.5700,499.2900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1021.87,,,,,,,859.1000,3328.5700,other,"30.7% of $3,328.57 in Billed Charges for Rev 272 = $1,021.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM TISSUE RETRIVAL 12MMX250ML,272,RC,27200002,CDM,,,,,,both,,,3328.5700,499.2900,UNITED HEALTHCARE,UNITED HEALTHCARE,1075.13,,,,,,,859.1000,3328.5700,percent of total billed charges,"32.3% of $3,328.57 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TISSUE RETRIVAL 12MMX250ML,272,RC,27200002,CDM,,,,,,both,,,3328.5700,499.2900,WELLCARE,WELLCARE MEDICAID,3328.57,,,,,,,859.1000,3328.5700,percent of total billed charges,"100% of $3,328.57 in Billed Charges for Rev 272 = $3,328.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 MIDAS REX CURVED BUR 14CM,272,RC,27200002,CDM,,,,,,both,,,6378.1700,956.7300,AETNA,AETNA,2723.48,,,,,,,1646.2100,6378.1700,percent of total billed charges,"42.7% of $6,378.17 in Billed Charges for Rev 272 = $2,723.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 MIDAS REX CURVED BUR 14CM,272,RC,27200002,CDM,,,,,,both,,,6378.1700,956.7300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4464.72,,,,,,,1646.2100,6378.1700,percent of total billed charges,"Rev 272 $6,378.17 in Billed Charges at 70% = $4,464.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 MIDAS REX CURVED BUR 14CM,272,RC,27200002,CDM,,,,,,both,,,6378.1700,956.7300,CIGNA HEALTHCARE,CIGNA HMO,2659.70,,,,,,,1646.2100,6378.1700,percent of total billed charges,"41.7% of $6,378.17 in Billed Charges for Rev 272 = $2,659.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 MIDAS REX CURVED BUR 14CM,272,RC,27200002,CDM,,,,,,both,,,6378.1700,956.7300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2959.47,,,,,,,1646.2100,6378.1700,percent of total billed charges,"46.4% of $6,378.17 in Billed Charges for Rev 272 = $2,959.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 MIDAS REX CURVED BUR 14CM,272,RC,27200002,CDM,,,,,,both,,,6378.1700,956.7300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2659.70,,,,,,,1646.2100,6378.1700,percent of total billed charges,"41.7% of $6,378.17 in Billed Charges for Rev 272 = $2,659.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 MIDAS REX CURVED BUR 14CM,272,RC,27200002,CDM,,,,,,both,,,6378.1700,956.7300,CIGNA HEALTHCARE,CIGNA PPO,2659.70,,,,,,,1646.2100,6378.1700,percent of total billed charges,"41.7% of $6,378.17 in Billed Charges for Rev 272 = $2,659.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 MIDAS REX CURVED BUR 14CM,272,RC,27200002,CDM,,,,,,both,,,6378.1700,956.7300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5740.35,,,,,,,1646.2100,6378.1700,percent of total billed charges,"90% of $6,378.17 in Billed Charges for Rev 272 = $5,740.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 MIDAS REX CURVED BUR 14CM,272,RC,27200002,CDM,,,,,,both,,,6378.1700,956.7300,MEDCOST,MEDCOST VHN,3035.37,,,,,,,1646.2100,6378.1700,percent of total billed charges,"47.59% of $6,378.17 in Billed Charges for Rev 272 = $3,035.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 MIDAS REX CURVED BUR 14CM,272,RC,27200002,CDM,,,,,,both,,,6378.1700,956.7300,SENTARA HEALTH,SENTARA HEALTH,1646.21,,,,,,,1646.2100,6378.1700,percent of total billed charges,"25.81% of $6,378.17 in Billed Charges for Rev 272 = $1,646.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 MIDAS REX CURVED BUR 14CM,272,RC,27200002,CDM,,,,,,both,,,6378.1700,956.7300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6378.17,,,,,,,1646.2100,6378.1700,percent of total billed charges,"100% of $6,378.17 in Billed Charges for Rev 272 = $6,378.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 MIDAS REX CURVED BUR 14CM,272,RC,27200002,CDM,,,,,,both,,,6378.1700,956.7300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3189.09,,,,,,,1646.2100,6378.1700,percent of total billed charges,"Rev 272 $6,378.17 in Billed Charges at 50% = $3,189.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 MIDAS REX CURVED BUR 14CM,272,RC,27200002,CDM,,,,,,both,,,6378.1700,956.7300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2060.15,,,,,,,1646.2100,6378.1700,other,"32.3% of $6,378.17 in Billed Charges for Rev 272 = $2,060.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TOOL MR8 MIDAS REX CURVED BUR 14CM,272,RC,27200002,CDM,,,,,,both,,,6378.1700,956.7300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1958.10,,,,,,,1646.2100,6378.1700,other,"30.7% of $6,378.17 in Billed Charges for Rev 272 = $1,958.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TOOL MR8 MIDAS REX CURVED BUR 14CM,272,RC,27200002,CDM,,,,,,both,,,6378.1700,956.7300,UNITED HEALTHCARE,UNITED HEALTHCARE,2060.15,,,,,,,1646.2100,6378.1700,percent of total billed charges,"32.3% of $6,378.17 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 MIDAS REX CURVED BUR 14CM,272,RC,27200002,CDM,,,,,,both,,,6378.1700,956.7300,WELLCARE,WELLCARE MEDICAID,6378.17,,,,,,,1646.2100,6378.1700,percent of total billed charges,"100% of $6,378.17 in Billed Charges for Rev 272 = $6,378.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY CLEAN VOID,272,RC,,,,,,,,both,,,19.2100,2.8800,AETNA,AETNA,8.20,,,,,,,4.9600,19.2100,percent of total billed charges,42.7% of $19.21 in Billed Charges for Rev 272 = $8.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY CLEAN VOID,272,RC,,,,,,,,both,,,19.2100,2.8800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,13.45,,,,,,,4.9600,19.2100,percent of total billed charges,Rev 272 $19.21 in Billed Charges at 70% = $13.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY CLEAN VOID,272,RC,,,,,,,,both,,,19.2100,2.8800,CIGNA HEALTHCARE,CIGNA HMO,8.01,,,,,,,4.9600,19.2100,percent of total billed charges,41.7% of $19.21 in Billed Charges for Rev 272 = $8.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY CLEAN VOID,272,RC,,,,,,,,both,,,19.2100,2.8800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8.91,,,,,,,4.9600,19.2100,percent of total billed charges,46.4% of $19.21 in Billed Charges for Rev 272 = $8.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY CLEAN VOID,272,RC,,,,,,,,both,,,19.2100,2.8800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8.01,,,,,,,4.9600,19.2100,percent of total billed charges,41.7% of $19.21 in Billed Charges for Rev 272 = $8.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY CLEAN VOID,272,RC,,,,,,,,both,,,19.2100,2.8800,CIGNA HEALTHCARE,CIGNA PPO,8.01,,,,,,,4.9600,19.2100,percent of total billed charges,41.7% of $19.21 in Billed Charges for Rev 272 = $8.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY CLEAN VOID,272,RC,,,,,,,,both,,,19.2100,2.8800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,17.29,,,,,,,4.9600,19.2100,percent of total billed charges,90% of $19.21 in Billed Charges for Rev 272 = $17.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY CLEAN VOID,272,RC,,,,,,,,both,,,19.2100,2.8800,MEDCOST,MEDCOST VHN,9.14,,,,,,,4.9600,19.2100,percent of total billed charges,47.59% of $19.21 in Billed Charges for Rev 272 = $9.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY CLEAN VOID,272,RC,,,,,,,,both,,,19.2100,2.8800,SENTARA HEALTH,SENTARA HEALTH,4.96,,,,,,,4.9600,19.2100,percent of total billed charges,25.81% of $19.21 in Billed Charges for Rev 272 = $4.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY CLEAN VOID,272,RC,,,,,,,,both,,,19.2100,2.8800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",19.21,,,,,,,4.9600,19.2100,percent of total billed charges,100% of $19.21 in Billed Charges for Rev 272 = $19.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY CLEAN VOID,272,RC,,,,,,,,both,,,19.2100,2.8800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9.61,,,,,,,4.9600,19.2100,percent of total billed charges,Rev 272 $19.21 in Billed Charges at 50% = $9.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY CLEAN VOID,272,RC,,,,,,,,both,,,19.2100,2.8800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,6.20,,,,,,,4.9600,19.2100,other,32.3% of $19.21 in Billed Charges for Rev 272 = $6.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TRAY CLEAN VOID,272,RC,,,,,,,,both,,,19.2100,2.8800,UNITED HEALTHCARE,UHC HERITAGE SELECT,5.90,,,,,,,4.9600,19.2100,other,30.7% of $19.21 in Billed Charges for Rev 272 = $5.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TRAY CLEAN VOID,272,RC,,,,,,,,both,,,19.2100,2.8800,UNITED HEALTHCARE,UNITED HEALTHCARE,6.20,,,,,,,4.9600,19.2100,percent of total billed charges,32.3% of $19.21 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY CLEAN VOID,272,RC,,,,,,,,both,,,19.2100,2.8800,WELLCARE,WELLCARE MEDICAID,19.21,,,,,,,4.9600,19.2100,percent of total billed charges,100% of $19.21 in Billed Charges for Rev 272 = $19.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY KYPHON FIRST FX,272,RC,27200002,CDM,,,,,,both,,,28001.7000,4200.2600,AETNA,AETNA,11956.73,,,,,,,7227.2400,28001.7000,percent of total billed charges,"42.7% of $28,001.70 in Billed Charges for Rev 272 = $11,956.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY KYPHON FIRST FX,272,RC,27200002,CDM,,,,,,both,,,28001.7000,4200.2600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,19601.19,,,,,,,7227.2400,28001.7000,percent of total billed charges,"Rev 272 $28,001.70 in Billed Charges at 70% = $19,601.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY KYPHON FIRST FX,272,RC,27200002,CDM,,,,,,both,,,28001.7000,4200.2600,CIGNA HEALTHCARE,CIGNA HMO,11676.71,,,,,,,7227.2400,28001.7000,percent of total billed charges,"41.7% of $28,001.70 in Billed Charges for Rev 272 = $11,676.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY KYPHON FIRST FX,272,RC,27200002,CDM,,,,,,both,,,28001.7000,4200.2600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12992.79,,,,,,,7227.2400,28001.7000,percent of total billed charges,"46.4% of $28,001.70 in Billed Charges for Rev 272 = $12,992.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY KYPHON FIRST FX,272,RC,27200002,CDM,,,,,,both,,,28001.7000,4200.2600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11676.71,,,,,,,7227.2400,28001.7000,percent of total billed charges,"41.7% of $28,001.70 in Billed Charges for Rev 272 = $11,676.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY KYPHON FIRST FX,272,RC,27200002,CDM,,,,,,both,,,28001.7000,4200.2600,CIGNA HEALTHCARE,CIGNA PPO,11676.71,,,,,,,7227.2400,28001.7000,percent of total billed charges,"41.7% of $28,001.70 in Billed Charges for Rev 272 = $11,676.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY KYPHON FIRST FX,272,RC,27200002,CDM,,,,,,both,,,28001.7000,4200.2600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,25201.53,,,,,,,7227.2400,28001.7000,percent of total billed charges,"90% of $28,001.70 in Billed Charges for Rev 272 = $25,201.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY KYPHON FIRST FX,272,RC,27200002,CDM,,,,,,both,,,28001.7000,4200.2600,MEDCOST,MEDCOST VHN,13326.01,,,,,,,7227.2400,28001.7000,percent of total billed charges,"47.59% of $28,001.70 in Billed Charges for Rev 272 = $13,326.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY KYPHON FIRST FX,272,RC,27200002,CDM,,,,,,both,,,28001.7000,4200.2600,SENTARA HEALTH,SENTARA HEALTH,7227.24,,,,,,,7227.2400,28001.7000,percent of total billed charges,"25.81% of $28,001.70 in Billed Charges for Rev 272 = $7,227.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY KYPHON FIRST FX,272,RC,27200002,CDM,,,,,,both,,,28001.7000,4200.2600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",28001.70,,,,,,,7227.2400,28001.7000,percent of total billed charges,"100% of $28,001.70 in Billed Charges for Rev 272 = $28,001.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY KYPHON FIRST FX,272,RC,27200002,CDM,,,,,,both,,,28001.7000,4200.2600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14000.85,,,,,,,7227.2400,28001.7000,percent of total billed charges,"Rev 272 $28,001.70 in Billed Charges at 50% = $14,000.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY KYPHON FIRST FX,272,RC,27200002,CDM,,,,,,both,,,28001.7000,4200.2600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,9044.55,,,,,,,7227.2400,28001.7000,other,"32.3% of $28,001.70 in Billed Charges for Rev 272 = $9,044.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TRAY KYPHON FIRST FX,272,RC,27200002,CDM,,,,,,both,,,28001.7000,4200.2600,UNITED HEALTHCARE,UHC HERITAGE SELECT,8596.52,,,,,,,7227.2400,28001.7000,other,"30.7% of $28,001.70 in Billed Charges for Rev 272 = $8,596.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TRAY KYPHON FIRST FX,272,RC,27200002,CDM,,,,,,both,,,28001.7000,4200.2600,UNITED HEALTHCARE,UNITED HEALTHCARE,9044.55,,,,,,,7227.2400,28001.7000,percent of total billed charges,"32.3% of $28,001.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY KYPHON FIRST FX,272,RC,27200002,CDM,,,,,,both,,,28001.7000,4200.2600,WELLCARE,WELLCARE MEDICAID,28001.70,,,,,,,7227.2400,28001.7000,percent of total billed charges,"100% of $28,001.70 in Billed Charges for Rev 272 = $28,001.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD FEM LRG 53MM SURESPACE A/P 75M/L,272,RC,27200002,CDM,,,,,,both,,,18688.5400,2803.2800,AETNA,AETNA,7980.01,,,,,,,4823.5100,18688.5400,percent of total billed charges,"42.7% of $18,688.54 in Billed Charges for Rev 272 = $7,980.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD FEM LRG 53MM SURESPACE A/P 75M/L,272,RC,27200002,CDM,,,,,,both,,,18688.5400,2803.2800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,13081.98,,,,,,,4823.5100,18688.5400,percent of total billed charges,"Rev 272 $18,688.54 in Billed Charges at 70% = $13,081.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD FEM LRG 53MM SURESPACE A/P 75M/L,272,RC,27200002,CDM,,,,,,both,,,18688.5400,2803.2800,CIGNA HEALTHCARE,CIGNA HMO,7793.12,,,,,,,4823.5100,18688.5400,percent of total billed charges,"41.7% of $18,688.54 in Billed Charges for Rev 272 = $7,793.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD FEM LRG 53MM SURESPACE A/P 75M/L,272,RC,27200002,CDM,,,,,,both,,,18688.5400,2803.2800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8671.48,,,,,,,4823.5100,18688.5400,percent of total billed charges,"46.4% of $18,688.54 in Billed Charges for Rev 272 = $8,671.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD FEM LRG 53MM SURESPACE A/P 75M/L,272,RC,27200002,CDM,,,,,,both,,,18688.5400,2803.2800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7793.12,,,,,,,4823.5100,18688.5400,percent of total billed charges,"41.7% of $18,688.54 in Billed Charges for Rev 272 = $7,793.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD FEM LRG 53MM SURESPACE A/P 75M/L,272,RC,27200002,CDM,,,,,,both,,,18688.5400,2803.2800,CIGNA HEALTHCARE,CIGNA PPO,7793.12,,,,,,,4823.5100,18688.5400,percent of total billed charges,"41.7% of $18,688.54 in Billed Charges for Rev 272 = $7,793.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD FEM LRG 53MM SURESPACE A/P 75M/L,272,RC,27200002,CDM,,,,,,both,,,18688.5400,2803.2800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,16819.69,,,,,,,4823.5100,18688.5400,percent of total billed charges,"90% of $18,688.54 in Billed Charges for Rev 272 = $16,819.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD FEM LRG 53MM SURESPACE A/P 75M/L,272,RC,27200002,CDM,,,,,,both,,,18688.5400,2803.2800,MEDCOST,MEDCOST VHN,8893.88,,,,,,,4823.5100,18688.5400,percent of total billed charges,"47.59% of $18,688.54 in Billed Charges for Rev 272 = $8,893.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD FEM LRG 53MM SURESPACE A/P 75M/L,272,RC,27200002,CDM,,,,,,both,,,18688.5400,2803.2800,SENTARA HEALTH,SENTARA HEALTH,4823.51,,,,,,,4823.5100,18688.5400,percent of total billed charges,"25.81% of $18,688.54 in Billed Charges for Rev 272 = $4,823.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD FEM LRG 53MM SURESPACE A/P 75M/L,272,RC,27200002,CDM,,,,,,both,,,18688.5400,2803.2800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",18688.54,,,,,,,4823.5100,18688.5400,percent of total billed charges,"100% of $18,688.54 in Billed Charges for Rev 272 = $18,688.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD FEM LRG 53MM SURESPACE A/P 75M/L,272,RC,27200002,CDM,,,,,,both,,,18688.5400,2803.2800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9344.27,,,,,,,4823.5100,18688.5400,percent of total billed charges,"Rev 272 $18,688.54 in Billed Charges at 50% = $9,344.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD FEM LRG 53MM SURESPACE A/P 75M/L,272,RC,27200002,CDM,,,,,,both,,,18688.5400,2803.2800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,6036.40,,,,,,,4823.5100,18688.5400,other,"32.3% of $18,688.54 in Billed Charges for Rev 272 = $6,036.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SPACER MOLD FEM LRG 53MM SURESPACE A/P 75M/L,272,RC,27200002,CDM,,,,,,both,,,18688.5400,2803.2800,UNITED HEALTHCARE,UHC HERITAGE SELECT,5737.38,,,,,,,4823.5100,18688.5400,other,"30.7% of $18,688.54 in Billed Charges for Rev 272 = $5,737.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SPACER MOLD FEM LRG 53MM SURESPACE A/P 75M/L,272,RC,27200002,CDM,,,,,,both,,,18688.5400,2803.2800,UNITED HEALTHCARE,UNITED HEALTHCARE,6036.40,,,,,,,4823.5100,18688.5400,percent of total billed charges,"32.3% of $18,688.54 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD FEM LRG 53MM SURESPACE A/P 75M/L,272,RC,27200002,CDM,,,,,,both,,,18688.5400,2803.2800,WELLCARE,WELLCARE MEDICAID,18688.54,,,,,,,4823.5100,18688.5400,percent of total billed charges,"100% of $18,688.54 in Billed Charges for Rev 272 = $18,688.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD TIB LRG 52MM SURESPACE A/P 81MM M/L,272,RC,27200002,CDM,,,,,,both,,,15291.0000,2293.6500,AETNA,AETNA,6529.26,,,,,,,3946.6100,15291.0000,percent of total billed charges,"42.7% of $15,291.00 in Billed Charges for Rev 272 = $6,529.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD TIB LRG 52MM SURESPACE A/P 81MM M/L,272,RC,27200002,CDM,,,,,,both,,,15291.0000,2293.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,10703.70,,,,,,,3946.6100,15291.0000,percent of total billed charges,"Rev 272 $15,291.00 in Billed Charges at 70% = $10,703.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD TIB LRG 52MM SURESPACE A/P 81MM M/L,272,RC,27200002,CDM,,,,,,both,,,15291.0000,2293.6500,CIGNA HEALTHCARE,CIGNA HMO,6376.35,,,,,,,3946.6100,15291.0000,percent of total billed charges,"41.7% of $15,291.00 in Billed Charges for Rev 272 = $6,376.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD TIB LRG 52MM SURESPACE A/P 81MM M/L,272,RC,27200002,CDM,,,,,,both,,,15291.0000,2293.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7095.02,,,,,,,3946.6100,15291.0000,percent of total billed charges,"46.4% of $15,291.00 in Billed Charges for Rev 272 = $7,095.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD TIB LRG 52MM SURESPACE A/P 81MM M/L,272,RC,27200002,CDM,,,,,,both,,,15291.0000,2293.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6376.35,,,,,,,3946.6100,15291.0000,percent of total billed charges,"41.7% of $15,291.00 in Billed Charges for Rev 272 = $6,376.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD TIB LRG 52MM SURESPACE A/P 81MM M/L,272,RC,27200002,CDM,,,,,,both,,,15291.0000,2293.6500,CIGNA HEALTHCARE,CIGNA PPO,6376.35,,,,,,,3946.6100,15291.0000,percent of total billed charges,"41.7% of $15,291.00 in Billed Charges for Rev 272 = $6,376.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD TIB LRG 52MM SURESPACE A/P 81MM M/L,272,RC,27200002,CDM,,,,,,both,,,15291.0000,2293.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13761.90,,,,,,,3946.6100,15291.0000,percent of total billed charges,"90% of $15,291.00 in Billed Charges for Rev 272 = $13,761.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD TIB LRG 52MM SURESPACE A/P 81MM M/L,272,RC,27200002,CDM,,,,,,both,,,15291.0000,2293.6500,MEDCOST,MEDCOST VHN,7276.99,,,,,,,3946.6100,15291.0000,percent of total billed charges,"47.59% of $15,291.00 in Billed Charges for Rev 272 = $7,276.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD TIB LRG 52MM SURESPACE A/P 81MM M/L,272,RC,27200002,CDM,,,,,,both,,,15291.0000,2293.6500,SENTARA HEALTH,SENTARA HEALTH,3946.61,,,,,,,3946.6100,15291.0000,percent of total billed charges,"25.81% of $15,291.00 in Billed Charges for Rev 272 = $3,946.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD TIB LRG 52MM SURESPACE A/P 81MM M/L,272,RC,27200002,CDM,,,,,,both,,,15291.0000,2293.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15291.00,,,,,,,3946.6100,15291.0000,percent of total billed charges,"100% of $15,291.00 in Billed Charges for Rev 272 = $15,291.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD TIB LRG 52MM SURESPACE A/P 81MM M/L,272,RC,27200002,CDM,,,,,,both,,,15291.0000,2293.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7645.50,,,,,,,3946.6100,15291.0000,percent of total billed charges,"Rev 272 $15,291.00 in Billed Charges at 50% = $7,645.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD TIB LRG 52MM SURESPACE A/P 81MM M/L,272,RC,27200002,CDM,,,,,,both,,,15291.0000,2293.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4938.99,,,,,,,3946.6100,15291.0000,other,"32.3% of $15,291.00 in Billed Charges for Rev 272 = $4,938.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SPACER MOLD TIB LRG 52MM SURESPACE A/P 81MM M/L,272,RC,27200002,CDM,,,,,,both,,,15291.0000,2293.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,4694.34,,,,,,,3946.6100,15291.0000,other,"30.7% of $15,291.00 in Billed Charges for Rev 272 = $4,694.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SPACER MOLD TIB LRG 52MM SURESPACE A/P 81MM M/L,272,RC,27200002,CDM,,,,,,both,,,15291.0000,2293.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,4938.99,,,,,,,3946.6100,15291.0000,percent of total billed charges,"32.3% of $15,291.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPACER MOLD TIB LRG 52MM SURESPACE A/P 81MM M/L,272,RC,27200002,CDM,,,,,,both,,,15291.0000,2293.6500,WELLCARE,WELLCARE MEDICAID,15291.00,,,,,,,3946.6100,15291.0000,percent of total billed charges,"100% of $15,291.00 in Billed Charges for Rev 272 = $15,291.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,2311.1800,346.6800,AETNA,AETNA,986.87,,,,,,,596.5200,2311.1800,percent of total billed charges,"42.7% of $2,311.18 in Billed Charges for Rev 272 = $986.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,2311.1800,346.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1617.83,,,,,,,596.5200,2311.1800,percent of total billed charges,"Rev 272 $2,311.18 in Billed Charges at 70% = $1,617.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,2311.1800,346.6800,CIGNA HEALTHCARE,CIGNA HMO,963.76,,,,,,,596.5200,2311.1800,percent of total billed charges,"41.7% of $2,311.18 in Billed Charges for Rev 272 = $963.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,2311.1800,346.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1072.39,,,,,,,596.5200,2311.1800,percent of total billed charges,"46.4% of $2,311.18 in Billed Charges for Rev 272 = $1,072.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,2311.1800,346.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,963.76,,,,,,,596.5200,2311.1800,percent of total billed charges,"41.7% of $2,311.18 in Billed Charges for Rev 272 = $963.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,2311.1800,346.6800,CIGNA HEALTHCARE,CIGNA PPO,963.76,,,,,,,596.5200,2311.1800,percent of total billed charges,"41.7% of $2,311.18 in Billed Charges for Rev 272 = $963.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,2311.1800,346.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2080.06,,,,,,,596.5200,2311.1800,percent of total billed charges,"90% of $2,311.18 in Billed Charges for Rev 272 = $2,080.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,2311.1800,346.6800,MEDCOST,MEDCOST VHN,1099.89,,,,,,,596.5200,2311.1800,percent of total billed charges,"47.59% of $2,311.18 in Billed Charges for Rev 272 = $1,099.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,2311.1800,346.6800,SENTARA HEALTH,SENTARA HEALTH,596.52,,,,,,,596.5200,2311.1800,percent of total billed charges,"25.81% of $2,311.18 in Billed Charges for Rev 272 = $596.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,2311.1800,346.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2311.18,,,,,,,596.5200,2311.1800,percent of total billed charges,"100% of $2,311.18 in Billed Charges for Rev 272 = $2,311.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,2311.1800,346.6800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1155.59,,,,,,,596.5200,2311.1800,percent of total billed charges,"Rev 272 $2,311.18 in Billed Charges at 50% = $1,155.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,2311.1800,346.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,746.51,,,,,,,596.5200,2311.1800,other,"32.3% of $2,311.18 in Billed Charges for Rev 272 = $746.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,2311.1800,346.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,709.53,,,,,,,596.5200,2311.1800,other,"30.7% of $2,311.18 in Billed Charges for Rev 272 = $709.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,2311.1800,346.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,746.51,,,,,,,596.5200,2311.1800,percent of total billed charges,"32.3% of $2,311.18 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,2311.1800,346.6800,WELLCARE,WELLCARE MEDICAID,2311.18,,,,,,,596.5200,2311.1800,percent of total billed charges,"100% of $2,311.18 in Billed Charges for Rev 272 = $2,311.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,5031.2300,754.6800,AETNA,AETNA,2148.34,,,,,,,1298.5600,5031.2300,percent of total billed charges,"42.7% of $5,031.23 in Billed Charges for Rev 272 = $2,148.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,5031.2300,754.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3521.86,,,,,,,1298.5600,5031.2300,percent of total billed charges,"Rev 272 $5,031.23 in Billed Charges at 70% = $3,521.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,5031.2300,754.6800,CIGNA HEALTHCARE,CIGNA HMO,2098.02,,,,,,,1298.5600,5031.2300,percent of total billed charges,"41.7% of $5,031.23 in Billed Charges for Rev 272 = $2,098.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,5031.2300,754.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2334.49,,,,,,,1298.5600,5031.2300,percent of total billed charges,"46.4% of $5,031.23 in Billed Charges for Rev 272 = $2,334.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,5031.2300,754.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2098.02,,,,,,,1298.5600,5031.2300,percent of total billed charges,"41.7% of $5,031.23 in Billed Charges for Rev 272 = $2,098.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,5031.2300,754.6800,CIGNA HEALTHCARE,CIGNA PPO,2098.02,,,,,,,1298.5600,5031.2300,percent of total billed charges,"41.7% of $5,031.23 in Billed Charges for Rev 272 = $2,098.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,5031.2300,754.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4528.11,,,,,,,1298.5600,5031.2300,percent of total billed charges,"90% of $5,031.23 in Billed Charges for Rev 272 = $4,528.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,5031.2300,754.6800,MEDCOST,MEDCOST VHN,2394.36,,,,,,,1298.5600,5031.2300,percent of total billed charges,"47.59% of $5,031.23 in Billed Charges for Rev 272 = $2,394.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,5031.2300,754.6800,SENTARA HEALTH,SENTARA HEALTH,1298.56,,,,,,,1298.5600,5031.2300,percent of total billed charges,"25.81% of $5,031.23 in Billed Charges for Rev 272 = $1,298.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,5031.2300,754.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5031.23,,,,,,,1298.5600,5031.2300,percent of total billed charges,"100% of $5,031.23 in Billed Charges for Rev 272 = $5,031.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,5031.2300,754.6800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2515.62,,,,,,,1298.5600,5031.2300,percent of total billed charges,"Rev 272 $5,031.23 in Billed Charges at 50% = $2,515.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,5031.2300,754.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1625.09,,,,,,,1298.5600,5031.2300,other,"32.3% of $5,031.23 in Billed Charges for Rev 272 = $1,625.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,5031.2300,754.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1544.59,,,,,,,1298.5600,5031.2300,other,"30.7% of $5,031.23 in Billed Charges for Rev 272 = $1,544.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,5031.2300,754.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,1625.09,,,,,,,1298.5600,5031.2300,percent of total billed charges,"32.3% of $5,031.23 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPEED BAND LIGATOR,272,RC,27200002,CDM,,,,,,both,,,5031.2300,754.6800,WELLCARE,WELLCARE MEDICAID,5031.23,,,,,,,1298.5600,5031.2300,percent of total billed charges,"100% of $5,031.23 in Billed Charges for Rev 272 = $5,031.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPHINCTEROTOME ENDO 7MM TIP BILIARY 3-LUMEN,272,RC,27200002,CDM,,,,,,both,,,1819.2800,272.8900,AETNA,AETNA,776.83,,,,,,,469.5600,1819.2800,percent of total billed charges,"42.7% of $1,819.28 in Billed Charges for Rev 272 = $776.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPHINCTEROTOME ENDO 7MM TIP BILIARY 3-LUMEN,272,RC,27200002,CDM,,,,,,both,,,1819.2800,272.8900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1273.50,,,,,,,469.5600,1819.2800,percent of total billed charges,"Rev 272 $1,819.28 in Billed Charges at 70% = $1,273.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPHINCTEROTOME ENDO 7MM TIP BILIARY 3-LUMEN,272,RC,27200002,CDM,,,,,,both,,,1819.2800,272.8900,CIGNA HEALTHCARE,CIGNA HMO,758.64,,,,,,,469.5600,1819.2800,percent of total billed charges,"41.7% of $1,819.28 in Billed Charges for Rev 272 = $758.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPHINCTEROTOME ENDO 7MM TIP BILIARY 3-LUMEN,272,RC,27200002,CDM,,,,,,both,,,1819.2800,272.8900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,844.15,,,,,,,469.5600,1819.2800,percent of total billed charges,"46.4% of $1,819.28 in Billed Charges for Rev 272 = $844.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPHINCTEROTOME ENDO 7MM TIP BILIARY 3-LUMEN,272,RC,27200002,CDM,,,,,,both,,,1819.2800,272.8900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,758.64,,,,,,,469.5600,1819.2800,percent of total billed charges,"41.7% of $1,819.28 in Billed Charges for Rev 272 = $758.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPHINCTEROTOME ENDO 7MM TIP BILIARY 3-LUMEN,272,RC,27200002,CDM,,,,,,both,,,1819.2800,272.8900,CIGNA HEALTHCARE,CIGNA PPO,758.64,,,,,,,469.5600,1819.2800,percent of total billed charges,"41.7% of $1,819.28 in Billed Charges for Rev 272 = $758.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPHINCTEROTOME ENDO 7MM TIP BILIARY 3-LUMEN,272,RC,27200002,CDM,,,,,,both,,,1819.2800,272.8900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1637.35,,,,,,,469.5600,1819.2800,percent of total billed charges,"90% of $1,819.28 in Billed Charges for Rev 272 = $1,637.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPHINCTEROTOME ENDO 7MM TIP BILIARY 3-LUMEN,272,RC,27200002,CDM,,,,,,both,,,1819.2800,272.8900,MEDCOST,MEDCOST VHN,865.80,,,,,,,469.5600,1819.2800,percent of total billed charges,"47.59% of $1,819.28 in Billed Charges for Rev 272 = $865.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPHINCTEROTOME ENDO 7MM TIP BILIARY 3-LUMEN,272,RC,27200002,CDM,,,,,,both,,,1819.2800,272.8900,SENTARA HEALTH,SENTARA HEALTH,469.56,,,,,,,469.5600,1819.2800,percent of total billed charges,"25.81% of $1,819.28 in Billed Charges for Rev 272 = $469.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPHINCTEROTOME ENDO 7MM TIP BILIARY 3-LUMEN,272,RC,27200002,CDM,,,,,,both,,,1819.2800,272.8900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1819.28,,,,,,,469.5600,1819.2800,percent of total billed charges,"100% of $1,819.28 in Billed Charges for Rev 272 = $1,819.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPHINCTEROTOME ENDO 7MM TIP BILIARY 3-LUMEN,272,RC,27200002,CDM,,,,,,both,,,1819.2800,272.8900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,909.64,,,,,,,469.5600,1819.2800,percent of total billed charges,"Rev 272 $1,819.28 in Billed Charges at 50% = $909.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPHINCTEROTOME ENDO 7MM TIP BILIARY 3-LUMEN,272,RC,27200002,CDM,,,,,,both,,,1819.2800,272.8900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,587.63,,,,,,,469.5600,1819.2800,other,"32.3% of $1,819.28 in Billed Charges for Rev 272 = $587.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SPHINCTEROTOME ENDO 7MM TIP BILIARY 3-LUMEN,272,RC,27200002,CDM,,,,,,both,,,1819.2800,272.8900,UNITED HEALTHCARE,UHC HERITAGE SELECT,558.52,,,,,,,469.5600,1819.2800,other,"30.7% of $1,819.28 in Billed Charges for Rev 272 = $558.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SPHINCTEROTOME ENDO 7MM TIP BILIARY 3-LUMEN,272,RC,27200002,CDM,,,,,,both,,,1819.2800,272.8900,UNITED HEALTHCARE,UNITED HEALTHCARE,587.63,,,,,,,469.5600,1819.2800,percent of total billed charges,"32.3% of $1,819.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SPHINCTEROTOME ENDO 7MM TIP BILIARY 3-LUMEN,272,RC,27200002,CDM,,,,,,both,,,1819.2800,272.8900,WELLCARE,WELLCARE MEDICAID,1819.28,,,,,,,469.5600,1819.2800,percent of total billed charges,"100% of $1,819.28 in Billed Charges for Rev 272 = $1,819.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY SURESTEP FOLEY 10FR METER,272,RC,27200002,CDM,,,,,,both,,,250.9000,37.6400,AETNA,AETNA,107.13,,,,,,,64.7600,250.9000,percent of total billed charges,42.7% of $250.90 in Billed Charges for Rev 272 = $107.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY SURESTEP FOLEY 10FR METER,272,RC,27200002,CDM,,,,,,both,,,250.9000,37.6400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,175.63,,,,,,,64.7600,250.9000,percent of total billed charges,Rev 272 $250.90 in Billed Charges at 70% = $175.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY SURESTEP FOLEY 10FR METER,272,RC,27200002,CDM,,,,,,both,,,250.9000,37.6400,CIGNA HEALTHCARE,CIGNA HMO,104.63,,,,,,,64.7600,250.9000,percent of total billed charges,41.7% of $250.90 in Billed Charges for Rev 272 = $104.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY SURESTEP FOLEY 10FR METER,272,RC,27200002,CDM,,,,,,both,,,250.9000,37.6400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,116.42,,,,,,,64.7600,250.9000,percent of total billed charges,46.4% of $250.90 in Billed Charges for Rev 272 = $116.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY SURESTEP FOLEY 10FR METER,272,RC,27200002,CDM,,,,,,both,,,250.9000,37.6400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,104.63,,,,,,,64.7600,250.9000,percent of total billed charges,41.7% of $250.90 in Billed Charges for Rev 272 = $104.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY SURESTEP FOLEY 10FR METER,272,RC,27200002,CDM,,,,,,both,,,250.9000,37.6400,CIGNA HEALTHCARE,CIGNA PPO,104.63,,,,,,,64.7600,250.9000,percent of total billed charges,41.7% of $250.90 in Billed Charges for Rev 272 = $104.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY SURESTEP FOLEY 10FR METER,272,RC,27200002,CDM,,,,,,both,,,250.9000,37.6400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,225.81,,,,,,,64.7600,250.9000,percent of total billed charges,90% of $250.90 in Billed Charges for Rev 272 = $225.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY SURESTEP FOLEY 10FR METER,272,RC,27200002,CDM,,,,,,both,,,250.9000,37.6400,MEDCOST,MEDCOST VHN,119.40,,,,,,,64.7600,250.9000,percent of total billed charges,47.59% of $250.90 in Billed Charges for Rev 272 = $119.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY SURESTEP FOLEY 10FR METER,272,RC,27200002,CDM,,,,,,both,,,250.9000,37.6400,SENTARA HEALTH,SENTARA HEALTH,64.76,,,,,,,64.7600,250.9000,percent of total billed charges,25.81% of $250.90 in Billed Charges for Rev 272 = $64.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY SURESTEP FOLEY 10FR METER,272,RC,27200002,CDM,,,,,,both,,,250.9000,37.6400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",250.90,,,,,,,64.7600,250.9000,percent of total billed charges,100% of $250.90 in Billed Charges for Rev 272 = $250.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY SURESTEP FOLEY 10FR METER,272,RC,27200002,CDM,,,,,,both,,,250.9000,37.6400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,125.45,,,,,,,64.7600,250.9000,percent of total billed charges,Rev 272 $250.90 in Billed Charges at 50% = $125.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY SURESTEP FOLEY 10FR METER,272,RC,27200002,CDM,,,,,,both,,,250.9000,37.6400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,81.04,,,,,,,64.7600,250.9000,other,32.3% of $250.90 in Billed Charges for Rev 272 = $81.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TRAY SURESTEP FOLEY 10FR METER,272,RC,27200002,CDM,,,,,,both,,,250.9000,37.6400,UNITED HEALTHCARE,UHC HERITAGE SELECT,77.03,,,,,,,64.7600,250.9000,other,30.7% of $250.90 in Billed Charges for Rev 272 = $77.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TRAY SURESTEP FOLEY 10FR METER,272,RC,27200002,CDM,,,,,,both,,,250.9000,37.6400,UNITED HEALTHCARE,UNITED HEALTHCARE,81.04,,,,,,,64.7600,250.9000,percent of total billed charges,32.3% of $250.90 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY SURESTEP FOLEY 10FR METER,272,RC,27200002,CDM,,,,,,both,,,250.9000,37.6400,WELLCARE,WELLCARE MEDICAID,250.90,,,,,,,64.7600,250.9000,percent of total billed charges,100% of $250.90 in Billed Charges for Rev 272 = $250.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,1972.1500,295.8200,AETNA,AETNA,842.11,,,,,,,509.0100,1972.1500,percent of total billed charges,"42.7% of $1,972.15 in Billed Charges for Rev 272 = $842.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,1972.1500,295.8200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1380.51,,,,,,,509.0100,1972.1500,percent of total billed charges,"Rev 272 $1,972.15 in Billed Charges at 70% = $1,380.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,1972.1500,295.8200,CIGNA HEALTHCARE,CIGNA HMO,822.39,,,,,,,509.0100,1972.1500,percent of total billed charges,"41.7% of $1,972.15 in Billed Charges for Rev 272 = $822.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,1972.1500,295.8200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,915.08,,,,,,,509.0100,1972.1500,percent of total billed charges,"46.4% of $1,972.15 in Billed Charges for Rev 272 = $915.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,1972.1500,295.8200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,822.39,,,,,,,509.0100,1972.1500,percent of total billed charges,"41.7% of $1,972.15 in Billed Charges for Rev 272 = $822.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,1972.1500,295.8200,CIGNA HEALTHCARE,CIGNA PPO,822.39,,,,,,,509.0100,1972.1500,percent of total billed charges,"41.7% of $1,972.15 in Billed Charges for Rev 272 = $822.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,1972.1500,295.8200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1774.94,,,,,,,509.0100,1972.1500,percent of total billed charges,"90% of $1,972.15 in Billed Charges for Rev 272 = $1,774.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,1972.1500,295.8200,MEDCOST,MEDCOST VHN,938.55,,,,,,,509.0100,1972.1500,percent of total billed charges,"47.59% of $1,972.15 in Billed Charges for Rev 272 = $938.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,1972.1500,295.8200,SENTARA HEALTH,SENTARA HEALTH,509.01,,,,,,,509.0100,1972.1500,percent of total billed charges,"25.81% of $1,972.15 in Billed Charges for Rev 272 = $509.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,1972.1500,295.8200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1972.15,,,,,,,509.0100,1972.1500,percent of total billed charges,"100% of $1,972.15 in Billed Charges for Rev 272 = $1,972.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,1972.1500,295.8200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,986.08,,,,,,,509.0100,1972.1500,percent of total billed charges,"Rev 272 $1,972.15 in Billed Charges at 50% = $986.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,1972.1500,295.8200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,637.00,,,,,,,509.0100,1972.1500,other,"32.3% of $1,972.15 in Billed Charges for Rev 272 = $637.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,1972.1500,295.8200,UNITED HEALTHCARE,UHC HERITAGE SELECT,605.45,,,,,,,509.0100,1972.1500,other,"30.7% of $1,972.15 in Billed Charges for Rev 272 = $605.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,1972.1500,295.8200,UNITED HEALTHCARE,UNITED HEALTHCARE,637.00,,,,,,,509.0100,1972.1500,percent of total billed charges,"32.3% of $1,972.15 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,1972.1500,295.8200,WELLCARE,WELLCARE MEDICAID,1972.15,,,,,,,509.0100,1972.1500,percent of total billed charges,"100% of $1,972.15 in Billed Charges for Rev 272 = $1,972.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,2008.1400,301.2200,AETNA,AETNA,857.48,,,,,,,518.3000,2008.1400,percent of total billed charges,"42.7% of $2,008.14 in Billed Charges for Rev 272 = $857.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,2008.1400,301.2200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1405.70,,,,,,,518.3000,2008.1400,percent of total billed charges,"Rev 272 $2,008.14 in Billed Charges at 70% = $1,405.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,2008.1400,301.2200,CIGNA HEALTHCARE,CIGNA HMO,837.39,,,,,,,518.3000,2008.1400,percent of total billed charges,"41.7% of $2,008.14 in Billed Charges for Rev 272 = $837.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,2008.1400,301.2200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,931.78,,,,,,,518.3000,2008.1400,percent of total billed charges,"46.4% of $2,008.14 in Billed Charges for Rev 272 = $931.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,2008.1400,301.2200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,837.39,,,,,,,518.3000,2008.1400,percent of total billed charges,"41.7% of $2,008.14 in Billed Charges for Rev 272 = $837.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,2008.1400,301.2200,CIGNA HEALTHCARE,CIGNA PPO,837.39,,,,,,,518.3000,2008.1400,percent of total billed charges,"41.7% of $2,008.14 in Billed Charges for Rev 272 = $837.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,2008.1400,301.2200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1807.33,,,,,,,518.3000,2008.1400,percent of total billed charges,"90% of $2,008.14 in Billed Charges for Rev 272 = $1,807.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,2008.1400,301.2200,MEDCOST,MEDCOST VHN,955.67,,,,,,,518.3000,2008.1400,percent of total billed charges,"47.59% of $2,008.14 in Billed Charges for Rev 272 = $955.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,2008.1400,301.2200,SENTARA HEALTH,SENTARA HEALTH,518.30,,,,,,,518.3000,2008.1400,percent of total billed charges,"25.81% of $2,008.14 in Billed Charges for Rev 272 = $518.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,2008.1400,301.2200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2008.14,,,,,,,518.3000,2008.1400,percent of total billed charges,"100% of $2,008.14 in Billed Charges for Rev 272 = $2,008.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,2008.1400,301.2200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1004.07,,,,,,,518.3000,2008.1400,percent of total billed charges,"Rev 272 $2,008.14 in Billed Charges at 50% = $1,004.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,2008.1400,301.2200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,648.63,,,,,,,518.3000,2008.1400,other,"32.3% of $2,008.14 in Billed Charges for Rev 272 = $648.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,2008.1400,301.2200,UNITED HEALTHCARE,UHC HERITAGE SELECT,616.50,,,,,,,518.3000,2008.1400,other,"30.7% of $2,008.14 in Billed Charges for Rev 272 = $616.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,2008.1400,301.2200,UNITED HEALTHCARE,UNITED HEALTHCARE,648.63,,,,,,,518.3000,2008.1400,percent of total billed charges,"32.3% of $2,008.14 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH HYPERFLEX ADJ 8.0MM,272,RC,,,,,,,,both,,,2008.1400,301.2200,WELLCARE,WELLCARE MEDICAID,2008.14,,,,,,,518.3000,2008.1400,percent of total billed charges,"100% of $2,008.14 in Billed Charges for Rev 272 = $2,008.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH PED 3.5,272,RC,,,,,,,,both,,,2736.0800,410.4100,AETNA,AETNA,1168.31,,,,,,,706.1800,2736.0800,percent of total billed charges,"42.7% of $2,736.08 in Billed Charges for Rev 272 = $1,168.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH PED 3.5,272,RC,,,,,,,,both,,,2736.0800,410.4100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1915.26,,,,,,,706.1800,2736.0800,percent of total billed charges,"Rev 272 $2,736.08 in Billed Charges at 70% = $1,915.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH PED 3.5,272,RC,,,,,,,,both,,,2736.0800,410.4100,CIGNA HEALTHCARE,CIGNA HMO,1140.95,,,,,,,706.1800,2736.0800,percent of total billed charges,"41.7% of $2,736.08 in Billed Charges for Rev 272 = $1,140.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH PED 3.5,272,RC,,,,,,,,both,,,2736.0800,410.4100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1269.54,,,,,,,706.1800,2736.0800,percent of total billed charges,"46.4% of $2,736.08 in Billed Charges for Rev 272 = $1,269.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH PED 3.5,272,RC,,,,,,,,both,,,2736.0800,410.4100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1140.95,,,,,,,706.1800,2736.0800,percent of total billed charges,"41.7% of $2,736.08 in Billed Charges for Rev 272 = $1,140.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH PED 3.5,272,RC,,,,,,,,both,,,2736.0800,410.4100,CIGNA HEALTHCARE,CIGNA PPO,1140.95,,,,,,,706.1800,2736.0800,percent of total billed charges,"41.7% of $2,736.08 in Billed Charges for Rev 272 = $1,140.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH PED 3.5,272,RC,,,,,,,,both,,,2736.0800,410.4100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2462.47,,,,,,,706.1800,2736.0800,percent of total billed charges,"90% of $2,736.08 in Billed Charges for Rev 272 = $2,462.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH PED 3.5,272,RC,,,,,,,,both,,,2736.0800,410.4100,MEDCOST,MEDCOST VHN,1302.10,,,,,,,706.1800,2736.0800,percent of total billed charges,"47.59% of $2,736.08 in Billed Charges for Rev 272 = $1,302.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH PED 3.5,272,RC,,,,,,,,both,,,2736.0800,410.4100,SENTARA HEALTH,SENTARA HEALTH,706.18,,,,,,,706.1800,2736.0800,percent of total billed charges,"25.81% of $2,736.08 in Billed Charges for Rev 272 = $706.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH PED 3.5,272,RC,,,,,,,,both,,,2736.0800,410.4100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2736.08,,,,,,,706.1800,2736.0800,percent of total billed charges,"100% of $2,736.08 in Billed Charges for Rev 272 = $2,736.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH PED 3.5,272,RC,,,,,,,,both,,,2736.0800,410.4100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1368.04,,,,,,,706.1800,2736.0800,percent of total billed charges,"Rev 272 $2,736.08 in Billed Charges at 50% = $1,368.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH PED 3.5,272,RC,,,,,,,,both,,,2736.0800,410.4100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,883.75,,,,,,,706.1800,2736.0800,other,"32.3% of $2,736.08 in Billed Charges for Rev 272 = $883.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE TRACH PED 3.5,272,RC,,,,,,,,both,,,2736.0800,410.4100,UNITED HEALTHCARE,UHC HERITAGE SELECT,839.98,,,,,,,706.1800,2736.0800,other,"30.7% of $2,736.08 in Billed Charges for Rev 272 = $839.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE TRACH PED 3.5,272,RC,,,,,,,,both,,,2736.0800,410.4100,UNITED HEALTHCARE,UNITED HEALTHCARE,883.75,,,,,,,706.1800,2736.0800,percent of total billed charges,"32.3% of $2,736.08 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH PED 3.5,272,RC,,,,,,,,both,,,2736.0800,410.4100,WELLCARE,WELLCARE MEDICAID,2736.08,,,,,,,706.1800,2736.0800,percent of total billed charges,"100% of $2,736.08 in Billed Charges for Rev 272 = $2,736.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH SHILEY FEN 6FR,270,RC,,,,,,,,both,,,599.1300,89.8700,AETNA,AETNA,255.83,,,,,,,154.6400,599.1300,percent of total billed charges,42.7% of $599.13 in Billed Charges for Rev 270 = $255.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH SHILEY FEN 6FR,270,RC,,,,,,,,both,,,599.1300,89.8700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,419.39,,,,,,,154.6400,599.1300,percent of total billed charges,Rev 270 $599.13 in Billed Charges at 70% = $419.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH SHILEY FEN 6FR,270,RC,,,,,,,,both,,,599.1300,89.8700,CIGNA HEALTHCARE,CIGNA HMO,249.84,,,,,,,154.6400,599.1300,percent of total billed charges,41.7% of $599.13 in Billed Charges for Rev 270 = $249.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH SHILEY FEN 6FR,270,RC,,,,,,,,both,,,599.1300,89.8700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,278.00,,,,,,,154.6400,599.1300,percent of total billed charges,46.4% of $599.13 in Billed Charges for Rev 270 = $278.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH SHILEY FEN 6FR,270,RC,,,,,,,,both,,,599.1300,89.8700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,249.84,,,,,,,154.6400,599.1300,percent of total billed charges,41.7% of $599.13 in Billed Charges for Rev 270 = $249.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH SHILEY FEN 6FR,270,RC,,,,,,,,both,,,599.1300,89.8700,CIGNA HEALTHCARE,CIGNA PPO,249.84,,,,,,,154.6400,599.1300,percent of total billed charges,41.7% of $599.13 in Billed Charges for Rev 270 = $249.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH SHILEY FEN 6FR,270,RC,,,,,,,,both,,,599.1300,89.8700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,539.22,,,,,,,154.6400,599.1300,percent of total billed charges,90% of $599.13 in Billed Charges for Rev 270 = $539.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH SHILEY FEN 6FR,270,RC,,,,,,,,both,,,599.1300,89.8700,MEDCOST,MEDCOST VHN,285.13,,,,,,,154.6400,599.1300,percent of total billed charges,47.59% of $599.13 in Billed Charges for Rev 270 = $285.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH SHILEY FEN 6FR,270,RC,,,,,,,,both,,,599.1300,89.8700,SENTARA HEALTH,SENTARA HEALTH,154.64,,,,,,,154.6400,599.1300,percent of total billed charges,25.81% of $599.13 in Billed Charges for Rev 270 = $154.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH SHILEY FEN 6FR,270,RC,,,,,,,,both,,,599.1300,89.8700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",599.13,,,,,,,154.6400,599.1300,percent of total billed charges,100% of $599.13 in Billed Charges for Rev 270 = $599.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH SHILEY FEN 6FR,270,RC,,,,,,,,both,,,599.1300,89.8700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,299.57,,,,,,,154.6400,599.1300,percent of total billed charges,Rev 270 $599.13 in Billed Charges at 50% = $299.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH SHILEY FEN 6FR,270,RC,,,,,,,,both,,,599.1300,89.8700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,193.52,,,,,,,154.6400,599.1300,other,32.3% of $599.13 in Billed Charges for Rev 270 = $193.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE TRACH SHILEY FEN 6FR,270,RC,,,,,,,,both,,,599.1300,89.8700,UNITED HEALTHCARE,UHC HERITAGE SELECT,183.93,,,,,,,154.6400,599.1300,other,30.7% of $599.13 in Billed Charges for Rev 270 = $183.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE TRACH SHILEY FEN 6FR,270,RC,,,,,,,,both,,,599.1300,89.8700,UNITED HEALTHCARE,UNITED HEALTHCARE,193.52,,,,,,,154.6400,599.1300,percent of total billed charges,32.3% of $599.13 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH SHILEY FEN 6FR,270,RC,,,,,,,,both,,,599.1300,89.8700,WELLCARE,WELLCARE MEDICAID,599.13,,,,,,,154.6400,599.1300,percent of total billed charges,100% of $599.13 in Billed Charges for Rev 270 = $599.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD 2.0 GRAY 30MM,272,RC,,,,,,,,both,,,5603.8100,840.5700,AETNA,AETNA,2392.83,,,,,,,1446.3400,5603.8100,percent of total billed charges,"42.7% of $5,603.81 in Billed Charges for Rev 272 = $2,392.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD 2.0 GRAY 30MM,272,RC,,,,,,,,both,,,5603.8100,840.5700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3922.67,,,,,,,1446.3400,5603.8100,percent of total billed charges,"Rev 272 $5,603.81 in Billed Charges at 70% = $3,922.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD 2.0 GRAY 30MM,272,RC,,,,,,,,both,,,5603.8100,840.5700,CIGNA HEALTHCARE,CIGNA HMO,2336.79,,,,,,,1446.3400,5603.8100,percent of total billed charges,"41.7% of $5,603.81 in Billed Charges for Rev 272 = $2,336.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD 2.0 GRAY 30MM,272,RC,,,,,,,,both,,,5603.8100,840.5700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2600.17,,,,,,,1446.3400,5603.8100,percent of total billed charges,"46.4% of $5,603.81 in Billed Charges for Rev 272 = $2,600.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD 2.0 GRAY 30MM,272,RC,,,,,,,,both,,,5603.8100,840.5700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2336.79,,,,,,,1446.3400,5603.8100,percent of total billed charges,"41.7% of $5,603.81 in Billed Charges for Rev 272 = $2,336.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD 2.0 GRAY 30MM,272,RC,,,,,,,,both,,,5603.8100,840.5700,CIGNA HEALTHCARE,CIGNA PPO,2336.79,,,,,,,1446.3400,5603.8100,percent of total billed charges,"41.7% of $5,603.81 in Billed Charges for Rev 272 = $2,336.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD 2.0 GRAY 30MM,272,RC,,,,,,,,both,,,5603.8100,840.5700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5043.43,,,,,,,1446.3400,5603.8100,percent of total billed charges,"90% of $5,603.81 in Billed Charges for Rev 272 = $5,043.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD 2.0 GRAY 30MM,272,RC,,,,,,,,both,,,5603.8100,840.5700,MEDCOST,MEDCOST VHN,2666.85,,,,,,,1446.3400,5603.8100,percent of total billed charges,"47.59% of $5,603.81 in Billed Charges for Rev 272 = $2,666.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD 2.0 GRAY 30MM,272,RC,,,,,,,,both,,,5603.8100,840.5700,SENTARA HEALTH,SENTARA HEALTH,1446.34,,,,,,,1446.3400,5603.8100,percent of total billed charges,"25.81% of $5,603.81 in Billed Charges for Rev 272 = $1,446.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD 2.0 GRAY 30MM,272,RC,,,,,,,,both,,,5603.8100,840.5700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5603.81,,,,,,,1446.3400,5603.8100,percent of total billed charges,"100% of $5,603.81 in Billed Charges for Rev 272 = $5,603.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD 2.0 GRAY 30MM,272,RC,,,,,,,,both,,,5603.8100,840.5700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2801.91,,,,,,,1446.3400,5603.8100,percent of total billed charges,"Rev 272 $5,603.81 in Billed Charges at 50% = $2,801.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD 2.0 GRAY 30MM,272,RC,,,,,,,,both,,,5603.8100,840.5700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1810.03,,,,,,,1446.3400,5603.8100,other,"32.3% of $5,603.81 in Billed Charges for Rev 272 = $1,810.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER RELOAD 2.0 GRAY 30MM,272,RC,,,,,,,,both,,,5603.8100,840.5700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1720.37,,,,,,,1446.3400,5603.8100,other,"30.7% of $5,603.81 in Billed Charges for Rev 272 = $1,720.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER RELOAD 2.0 GRAY 30MM,272,RC,,,,,,,,both,,,5603.8100,840.5700,UNITED HEALTHCARE,UNITED HEALTHCARE,1810.03,,,,,,,1446.3400,5603.8100,percent of total billed charges,"32.3% of $5,603.81 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD 2.0 GRAY 30MM,272,RC,,,,,,,,both,,,5603.8100,840.5700,WELLCARE,WELLCARE MEDICAID,5603.81,,,,,,,1446.3400,5603.8100,percent of total billed charges,"100% of $5,603.81 in Billed Charges for Rev 272 = $5,603.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD BLUE GST45B,272,RC,27200002,CDM,,,,,,both,,,1512.3000,226.8500,AETNA,AETNA,645.75,,,,,,,390.3200,1512.3000,percent of total billed charges,"42.7% of $1,512.30 in Billed Charges for Rev 272 = $645.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD BLUE GST45B,272,RC,27200002,CDM,,,,,,both,,,1512.3000,226.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1058.61,,,,,,,390.3200,1512.3000,percent of total billed charges,"Rev 272 $1,512.30 in Billed Charges at 70% = $1,058.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD BLUE GST45B,272,RC,27200002,CDM,,,,,,both,,,1512.3000,226.8500,CIGNA HEALTHCARE,CIGNA HMO,630.63,,,,,,,390.3200,1512.3000,percent of total billed charges,"41.7% of $1,512.30 in Billed Charges for Rev 272 = $630.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD BLUE GST45B,272,RC,27200002,CDM,,,,,,both,,,1512.3000,226.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,701.71,,,,,,,390.3200,1512.3000,percent of total billed charges,"46.4% of $1,512.30 in Billed Charges for Rev 272 = $701.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD BLUE GST45B,272,RC,27200002,CDM,,,,,,both,,,1512.3000,226.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,630.63,,,,,,,390.3200,1512.3000,percent of total billed charges,"41.7% of $1,512.30 in Billed Charges for Rev 272 = $630.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD BLUE GST45B,272,RC,27200002,CDM,,,,,,both,,,1512.3000,226.8500,CIGNA HEALTHCARE,CIGNA PPO,630.63,,,,,,,390.3200,1512.3000,percent of total billed charges,"41.7% of $1,512.30 in Billed Charges for Rev 272 = $630.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD BLUE GST45B,272,RC,27200002,CDM,,,,,,both,,,1512.3000,226.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1361.07,,,,,,,390.3200,1512.3000,percent of total billed charges,"90% of $1,512.30 in Billed Charges for Rev 272 = $1,361.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD BLUE GST45B,272,RC,27200002,CDM,,,,,,both,,,1512.3000,226.8500,MEDCOST,MEDCOST VHN,719.70,,,,,,,390.3200,1512.3000,percent of total billed charges,"47.59% of $1,512.30 in Billed Charges for Rev 272 = $719.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD BLUE GST45B,272,RC,27200002,CDM,,,,,,both,,,1512.3000,226.8500,SENTARA HEALTH,SENTARA HEALTH,390.32,,,,,,,390.3200,1512.3000,percent of total billed charges,"25.81% of $1,512.30 in Billed Charges for Rev 272 = $390.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD BLUE GST45B,272,RC,27200002,CDM,,,,,,both,,,1512.3000,226.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1512.30,,,,,,,390.3200,1512.3000,percent of total billed charges,"100% of $1,512.30 in Billed Charges for Rev 272 = $1,512.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD BLUE GST45B,272,RC,27200002,CDM,,,,,,both,,,1512.3000,226.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,756.15,,,,,,,390.3200,1512.3000,percent of total billed charges,"Rev 272 $1,512.30 in Billed Charges at 50% = $756.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD BLUE GST45B,272,RC,27200002,CDM,,,,,,both,,,1512.3000,226.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,488.47,,,,,,,390.3200,1512.3000,other,"32.3% of $1,512.30 in Billed Charges for Rev 272 = $488.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER RELOAD BLUE GST45B,272,RC,27200002,CDM,,,,,,both,,,1512.3000,226.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,464.28,,,,,,,390.3200,1512.3000,other,"30.7% of $1,512.30 in Billed Charges for Rev 272 = $464.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER RELOAD BLUE GST45B,272,RC,27200002,CDM,,,,,,both,,,1512.3000,226.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,488.47,,,,,,,390.3200,1512.3000,percent of total billed charges,"32.3% of $1,512.30 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD BLUE GST45B,272,RC,27200002,CDM,,,,,,both,,,1512.3000,226.8500,WELLCARE,WELLCARE MEDICAID,1512.30,,,,,,,390.3200,1512.3000,percent of total billed charges,"100% of $1,512.30 in Billed Charges for Rev 272 = $1,512.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING MIDAS REX IRD850,272,RC,,,,,,,,both,,,6606.3300,990.9500,AETNA,AETNA,2820.90,,,,,,,1705.0900,6606.3300,percent of total billed charges,"42.7% of $6,606.33 in Billed Charges for Rev 272 = $2,820.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING MIDAS REX IRD850,272,RC,,,,,,,,both,,,6606.3300,990.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4624.43,,,,,,,1705.0900,6606.3300,percent of total billed charges,"Rev 272 $6,606.33 in Billed Charges at 70% = $4,624.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING MIDAS REX IRD850,272,RC,,,,,,,,both,,,6606.3300,990.9500,CIGNA HEALTHCARE,CIGNA HMO,2754.84,,,,,,,1705.0900,6606.3300,percent of total billed charges,"41.7% of $6,606.33 in Billed Charges for Rev 272 = $2,754.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING MIDAS REX IRD850,272,RC,,,,,,,,both,,,6606.3300,990.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3065.34,,,,,,,1705.0900,6606.3300,percent of total billed charges,"46.4% of $6,606.33 in Billed Charges for Rev 272 = $3,065.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING MIDAS REX IRD850,272,RC,,,,,,,,both,,,6606.3300,990.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2754.84,,,,,,,1705.0900,6606.3300,percent of total billed charges,"41.7% of $6,606.33 in Billed Charges for Rev 272 = $2,754.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING MIDAS REX IRD850,272,RC,,,,,,,,both,,,6606.3300,990.9500,CIGNA HEALTHCARE,CIGNA PPO,2754.84,,,,,,,1705.0900,6606.3300,percent of total billed charges,"41.7% of $6,606.33 in Billed Charges for Rev 272 = $2,754.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING MIDAS REX IRD850,272,RC,,,,,,,,both,,,6606.3300,990.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5945.70,,,,,,,1705.0900,6606.3300,percent of total billed charges,"90% of $6,606.33 in Billed Charges for Rev 272 = $5,945.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING MIDAS REX IRD850,272,RC,,,,,,,,both,,,6606.3300,990.9500,MEDCOST,MEDCOST VHN,3143.95,,,,,,,1705.0900,6606.3300,percent of total billed charges,"47.59% of $6,606.33 in Billed Charges for Rev 272 = $3,143.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING MIDAS REX IRD850,272,RC,,,,,,,,both,,,6606.3300,990.9500,SENTARA HEALTH,SENTARA HEALTH,1705.09,,,,,,,1705.0900,6606.3300,percent of total billed charges,"25.81% of $6,606.33 in Billed Charges for Rev 272 = $1,705.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING MIDAS REX IRD850,272,RC,,,,,,,,both,,,6606.3300,990.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6606.33,,,,,,,1705.0900,6606.3300,percent of total billed charges,"100% of $6,606.33 in Billed Charges for Rev 272 = $6,606.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING MIDAS REX IRD850,272,RC,,,,,,,,both,,,6606.3300,990.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3303.17,,,,,,,1705.0900,6606.3300,percent of total billed charges,"Rev 272 $6,606.33 in Billed Charges at 50% = $3,303.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING MIDAS REX IRD850,272,RC,,,,,,,,both,,,6606.3300,990.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2133.84,,,,,,,1705.0900,6606.3300,other,"32.3% of $6,606.33 in Billed Charges for Rev 272 = $2,133.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBING MIDAS REX IRD850,272,RC,,,,,,,,both,,,6606.3300,990.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2028.14,,,,,,,1705.0900,6606.3300,other,"30.7% of $6,606.33 in Billed Charges for Rev 272 = $2,028.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBING MIDAS REX IRD850,272,RC,,,,,,,,both,,,6606.3300,990.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,2133.84,,,,,,,1705.0900,6606.3300,percent of total billed charges,"32.3% of $6,606.33 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING MIDAS REX IRD850,272,RC,,,,,,,,both,,,6606.3300,990.9500,WELLCARE,WELLCARE MEDICAID,6606.33,,,,,,,1705.0900,6606.3300,percent of total billed charges,"100% of $6,606.33 in Billed Charges for Rev 272 = $6,606.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
UNIVERSAL STAPLER SHORT SURPASS SEE LN 67223,272,RC,27200002,CDM,,,,,,both,,,4795.7000,719.3600,AETNA,AETNA,2047.76,,,,,,,1237.7700,4795.7000,percent of total billed charges,"42.7% of $4,795.70 in Billed Charges for Rev 272 = $2,047.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
UNIVERSAL STAPLER SHORT SURPASS SEE LN 67223,272,RC,27200002,CDM,,,,,,both,,,4795.7000,719.3600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3356.99,,,,,,,1237.7700,4795.7000,percent of total billed charges,"Rev 272 $4,795.70 in Billed Charges at 70% = $3,356.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
UNIVERSAL STAPLER SHORT SURPASS SEE LN 67223,272,RC,27200002,CDM,,,,,,both,,,4795.7000,719.3600,CIGNA HEALTHCARE,CIGNA HMO,1999.81,,,,,,,1237.7700,4795.7000,percent of total billed charges,"41.7% of $4,795.70 in Billed Charges for Rev 272 = $1,999.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
UNIVERSAL STAPLER SHORT SURPASS SEE LN 67223,272,RC,27200002,CDM,,,,,,both,,,4795.7000,719.3600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2225.20,,,,,,,1237.7700,4795.7000,percent of total billed charges,"46.4% of $4,795.70 in Billed Charges for Rev 272 = $2,225.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
UNIVERSAL STAPLER SHORT SURPASS SEE LN 67223,272,RC,27200002,CDM,,,,,,both,,,4795.7000,719.3600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1999.81,,,,,,,1237.7700,4795.7000,percent of total billed charges,"41.7% of $4,795.70 in Billed Charges for Rev 272 = $1,999.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
UNIVERSAL STAPLER SHORT SURPASS SEE LN 67223,272,RC,27200002,CDM,,,,,,both,,,4795.7000,719.3600,CIGNA HEALTHCARE,CIGNA PPO,1999.81,,,,,,,1237.7700,4795.7000,percent of total billed charges,"41.7% of $4,795.70 in Billed Charges for Rev 272 = $1,999.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
UNIVERSAL STAPLER SHORT SURPASS SEE LN 67223,272,RC,27200002,CDM,,,,,,both,,,4795.7000,719.3600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4316.13,,,,,,,1237.7700,4795.7000,percent of total billed charges,"90% of $4,795.70 in Billed Charges for Rev 272 = $4,316.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
UNIVERSAL STAPLER SHORT SURPASS SEE LN 67223,272,RC,27200002,CDM,,,,,,both,,,4795.7000,719.3600,MEDCOST,MEDCOST VHN,2282.27,,,,,,,1237.7700,4795.7000,percent of total billed charges,"47.59% of $4,795.70 in Billed Charges for Rev 272 = $2,282.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
UNIVERSAL STAPLER SHORT SURPASS SEE LN 67223,272,RC,27200002,CDM,,,,,,both,,,4795.7000,719.3600,SENTARA HEALTH,SENTARA HEALTH,1237.77,,,,,,,1237.7700,4795.7000,percent of total billed charges,"25.81% of $4,795.70 in Billed Charges for Rev 272 = $1,237.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
UNIVERSAL STAPLER SHORT SURPASS SEE LN 67223,272,RC,27200002,CDM,,,,,,both,,,4795.7000,719.3600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4795.70,,,,,,,1237.7700,4795.7000,percent of total billed charges,"100% of $4,795.70 in Billed Charges for Rev 272 = $4,795.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
UNIVERSAL STAPLER SHORT SURPASS SEE LN 67223,272,RC,27200002,CDM,,,,,,both,,,4795.7000,719.3600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2397.85,,,,,,,1237.7700,4795.7000,percent of total billed charges,"Rev 272 $4,795.70 in Billed Charges at 50% = $2,397.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
UNIVERSAL STAPLER SHORT SURPASS SEE LN 67223,272,RC,27200002,CDM,,,,,,both,,,4795.7000,719.3600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1549.01,,,,,,,1237.7700,4795.7000,other,"32.3% of $4,795.70 in Billed Charges for Rev 272 = $1,549.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
UNIVERSAL STAPLER SHORT SURPASS SEE LN 67223,272,RC,27200002,CDM,,,,,,both,,,4795.7000,719.3600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1472.28,,,,,,,1237.7700,4795.7000,other,"30.7% of $4,795.70 in Billed Charges for Rev 272 = $1,472.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
UNIVERSAL STAPLER SHORT SURPASS SEE LN 67223,272,RC,27200002,CDM,,,,,,both,,,4795.7000,719.3600,UNITED HEALTHCARE,UNITED HEALTHCARE,1549.01,,,,,,,1237.7700,4795.7000,percent of total billed charges,"32.3% of $4,795.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
UNIVERSAL STAPLER SHORT SURPASS SEE LN 67223,272,RC,27200002,CDM,,,,,,both,,,4795.7000,719.3600,WELLCARE,WELLCARE MEDICAID,4795.70,,,,,,,1237.7700,4795.7000,percent of total billed charges,"100% of $4,795.70 in Billed Charges for Rev 272 = $4,795.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,AETNA,AETNA,2041.91,,,,,,,109.0000,4782.0000,percent of total billed charges,"42.7% of $4,782.00 in Billed Charges for Rev 450 Proc 10121 = $2,041.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1775.80,,,,,,,109.0000,4782.0000,fee schedule,"APG 00010 Proc 10121 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 104% = $1,775.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,109.0000,4782.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,109.0000,4782.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,109.0000,4782.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,AMBETTER,AMBETTER,3266.63,,,,,,,109.0000,4782.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,109.0000,4782.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,BLUE CROSS,ANTHEM EXCHANGE,3689.28,,,,,,,109.0000,4782.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1758.73,,,,,,,109.0000,4782.0000,fee schedule,"APG 00010 Proc 10121 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,BLUE CROSS,ANTHEM HMO,3919.64,,,,,,,109.0000,4782.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,109.0000,4782.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4611.09,,,,,,,109.0000,4782.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,157.00,,,,,,,109.0000,4782.0000,fee schedule,$157.00 from Fee Schedule BLDTM_23 for Rev 450 Proc 10121 * Qty 1 = $157.00 at 100% = $157.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,109.0000,4782.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,109.0000,4782.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,109.0000,4782.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4303.80,,,,,,,109.0000,4782.0000,percent of total billed charges,"90% of $4,782.00 in Billed Charges for Rev 450 Proc 10121 = $4,303.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,109.0000,4782.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,109.0000,4782.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,MEDCOST,MEDCOST VHN,2275.75,,,,,,,109.0000,4782.0000,percent of total billed charges,"47.59% of $4,782.00 in Billed Charges for Rev 450 Proc 10121 = $2,275.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1792.88,,,,,,,109.0000,4782.0000,fee schedule,"APG 00010 Proc 10121 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 105% = $1,792.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,109.0000,4782.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,109.0000,4782.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,109.0000,4782.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1760.43,,,,,,,109.0000,4782.0000,fee schedule,"APG 00010 Proc 10121 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 103.1% = $1,760.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,SENTARA HEALTH,SENTARA HEALTH,1234.23,,,,,,,109.0000,4782.0000,percent of total billed charges,"25.81% of $4,782.00 in Billed Charges for Rev 450 Proc 10121 = $1,234.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,109.0000,4782.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4782.00,,,,,,,109.0000,4782.0000,percent of total billed charges,"100% of $4,782.00 in Billed Charges for Rev 450 Proc 10121 = $4,782.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,4782.0000,case rate,Rev 450 Proc 10121 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,4782.0000,case rate,Rev 450 Proc 10121 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,4782.0000,case rate,Rev 450 Proc 10121 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,4782.0000,case rate,Rev 450 Proc 10121 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1758.73,,,,,,,109.0000,4782.0000,fee schedule,"APG 00010 Proc 10121 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,109.0000,4782.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,109.0000,4782.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,WELLCARE,WELLCARE MEDICAID,4782.00,,,,,,,109.0000,4782.0000,percent of total billed charges,"100% of $4,782.00 in Billed Charges for Rev 450 Proc 10121 = $4,782.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FOREIGN BDY SKIN/SUBQ COMPLICATED,10121,CPT,450,RC,45000019,CDM,,,,both,,,4782.0000,717.3000,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,109.0000,4782.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER RELOAD ECHELON  VAS WHITE,272,RC,27200002,CDM,,,,,,both,,,1477.0700,221.5600,AETNA,AETNA,630.71,,,,,,,381.2300,1477.0700,percent of total billed charges,"42.7% of $1,477.07 in Billed Charges for Rev 272 = $630.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ECHELON  VAS WHITE,272,RC,27200002,CDM,,,,,,both,,,1477.0700,221.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1033.95,,,,,,,381.2300,1477.0700,percent of total billed charges,"Rev 272 $1,477.07 in Billed Charges at 70% = $1,033.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ECHELON  VAS WHITE,272,RC,27200002,CDM,,,,,,both,,,1477.0700,221.5600,CIGNA HEALTHCARE,CIGNA HMO,615.94,,,,,,,381.2300,1477.0700,percent of total billed charges,"41.7% of $1,477.07 in Billed Charges for Rev 272 = $615.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ECHELON  VAS WHITE,272,RC,27200002,CDM,,,,,,both,,,1477.0700,221.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,685.36,,,,,,,381.2300,1477.0700,percent of total billed charges,"46.4% of $1,477.07 in Billed Charges for Rev 272 = $685.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ECHELON  VAS WHITE,272,RC,27200002,CDM,,,,,,both,,,1477.0700,221.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,615.94,,,,,,,381.2300,1477.0700,percent of total billed charges,"41.7% of $1,477.07 in Billed Charges for Rev 272 = $615.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ECHELON  VAS WHITE,272,RC,27200002,CDM,,,,,,both,,,1477.0700,221.5600,CIGNA HEALTHCARE,CIGNA PPO,615.94,,,,,,,381.2300,1477.0700,percent of total billed charges,"41.7% of $1,477.07 in Billed Charges for Rev 272 = $615.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ECHELON  VAS WHITE,272,RC,27200002,CDM,,,,,,both,,,1477.0700,221.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1329.36,,,,,,,381.2300,1477.0700,percent of total billed charges,"90% of $1,477.07 in Billed Charges for Rev 272 = $1,329.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ECHELON  VAS WHITE,272,RC,27200002,CDM,,,,,,both,,,1477.0700,221.5600,MEDCOST,MEDCOST VHN,702.94,,,,,,,381.2300,1477.0700,percent of total billed charges,"47.59% of $1,477.07 in Billed Charges for Rev 272 = $702.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ECHELON  VAS WHITE,272,RC,27200002,CDM,,,,,,both,,,1477.0700,221.5600,SENTARA HEALTH,SENTARA HEALTH,381.23,,,,,,,381.2300,1477.0700,percent of total billed charges,"25.81% of $1,477.07 in Billed Charges for Rev 272 = $381.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ECHELON  VAS WHITE,272,RC,27200002,CDM,,,,,,both,,,1477.0700,221.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1477.07,,,,,,,381.2300,1477.0700,percent of total billed charges,"100% of $1,477.07 in Billed Charges for Rev 272 = $1,477.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ECHELON  VAS WHITE,272,RC,27200002,CDM,,,,,,both,,,1477.0700,221.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,738.54,,,,,,,381.2300,1477.0700,percent of total billed charges,"Rev 272 $1,477.07 in Billed Charges at 50% = $738.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ECHELON  VAS WHITE,272,RC,27200002,CDM,,,,,,both,,,1477.0700,221.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,477.09,,,,,,,381.2300,1477.0700,other,"32.3% of $1,477.07 in Billed Charges for Rev 272 = $477.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER RELOAD ECHELON  VAS WHITE,272,RC,27200002,CDM,,,,,,both,,,1477.0700,221.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,453.46,,,,,,,381.2300,1477.0700,other,"30.7% of $1,477.07 in Billed Charges for Rev 272 = $453.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER RELOAD ECHELON  VAS WHITE,272,RC,27200002,CDM,,,,,,both,,,1477.0700,221.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,477.09,,,,,,,381.2300,1477.0700,percent of total billed charges,"32.3% of $1,477.07 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ECHELON  VAS WHITE,272,RC,27200002,CDM,,,,,,both,,,1477.0700,221.5600,WELLCARE,WELLCARE MEDICAID,1477.07,,,,,,,381.2300,1477.0700,percent of total billed charges,"100% of $1,477.07 in Billed Charges for Rev 272 = $1,477.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO THICK 45MM SURPASS SEE LN 161021,272,RC,27200002,CDM,,,,,,both,,,6106.9900,916.0500,AETNA,AETNA,2607.68,,,,,,,1576.2100,6106.9900,percent of total billed charges,"42.7% of $6,106.99 in Billed Charges for Rev 272 = $2,607.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO THICK 45MM SURPASS SEE LN 161021,272,RC,27200002,CDM,,,,,,both,,,6106.9900,916.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4274.89,,,,,,,1576.2100,6106.9900,percent of total billed charges,"Rev 272 $6,106.99 in Billed Charges at 70% = $4,274.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO THICK 45MM SURPASS SEE LN 161021,272,RC,27200002,CDM,,,,,,both,,,6106.9900,916.0500,CIGNA HEALTHCARE,CIGNA HMO,2546.61,,,,,,,1576.2100,6106.9900,percent of total billed charges,"41.7% of $6,106.99 in Billed Charges for Rev 272 = $2,546.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO THICK 45MM SURPASS SEE LN 161021,272,RC,27200002,CDM,,,,,,both,,,6106.9900,916.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2833.64,,,,,,,1576.2100,6106.9900,percent of total billed charges,"46.4% of $6,106.99 in Billed Charges for Rev 272 = $2,833.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO THICK 45MM SURPASS SEE LN 161021,272,RC,27200002,CDM,,,,,,both,,,6106.9900,916.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2546.61,,,,,,,1576.2100,6106.9900,percent of total billed charges,"41.7% of $6,106.99 in Billed Charges for Rev 272 = $2,546.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO THICK 45MM SURPASS SEE LN 161021,272,RC,27200002,CDM,,,,,,both,,,6106.9900,916.0500,CIGNA HEALTHCARE,CIGNA PPO,2546.61,,,,,,,1576.2100,6106.9900,percent of total billed charges,"41.7% of $6,106.99 in Billed Charges for Rev 272 = $2,546.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO THICK 45MM SURPASS SEE LN 161021,272,RC,27200002,CDM,,,,,,both,,,6106.9900,916.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5496.29,,,,,,,1576.2100,6106.9900,percent of total billed charges,"90% of $6,106.99 in Billed Charges for Rev 272 = $5,496.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO THICK 45MM SURPASS SEE LN 161021,272,RC,27200002,CDM,,,,,,both,,,6106.9900,916.0500,MEDCOST,MEDCOST VHN,2906.32,,,,,,,1576.2100,6106.9900,percent of total billed charges,"47.59% of $6,106.99 in Billed Charges for Rev 272 = $2,906.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO THICK 45MM SURPASS SEE LN 161021,272,RC,27200002,CDM,,,,,,both,,,6106.9900,916.0500,SENTARA HEALTH,SENTARA HEALTH,1576.21,,,,,,,1576.2100,6106.9900,percent of total billed charges,"25.81% of $6,106.99 in Billed Charges for Rev 272 = $1,576.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO THICK 45MM SURPASS SEE LN 161021,272,RC,27200002,CDM,,,,,,both,,,6106.9900,916.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6106.99,,,,,,,1576.2100,6106.9900,percent of total billed charges,"100% of $6,106.99 in Billed Charges for Rev 272 = $6,106.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO THICK 45MM SURPASS SEE LN 161021,272,RC,27200002,CDM,,,,,,both,,,6106.9900,916.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3053.50,,,,,,,1576.2100,6106.9900,percent of total billed charges,"Rev 272 $6,106.99 in Billed Charges at 50% = $3,053.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO THICK 45MM SURPASS SEE LN 161021,272,RC,27200002,CDM,,,,,,both,,,6106.9900,916.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1972.56,,,,,,,1576.2100,6106.9900,other,"32.3% of $6,106.99 in Billed Charges for Rev 272 = $1,972.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER RELOAD ENDO THICK 45MM SURPASS SEE LN 161021,272,RC,27200002,CDM,,,,,,both,,,6106.9900,916.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1874.85,,,,,,,1576.2100,6106.9900,other,"30.7% of $6,106.99 in Billed Charges for Rev 272 = $1,874.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER RELOAD ENDO THICK 45MM SURPASS SEE LN 161021,272,RC,27200002,CDM,,,,,,both,,,6106.9900,916.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,1972.56,,,,,,,1576.2100,6106.9900,percent of total billed charges,"32.3% of $6,106.99 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD ENDO THICK 45MM SURPASS SEE LN 161021,272,RC,27200002,CDM,,,,,,both,,,6106.9900,916.0500,WELLCARE,WELLCARE MEDICAID,6106.99,,,,,,,1576.2100,6106.9900,percent of total billed charges,"100% of $6,106.99 in Billed Charges for Rev 272 = $6,106.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,568.5500,85.2800,AETNA,AETNA,242.77,,,,,,,146.7400,568.5500,percent of total billed charges,42.7% of $568.55 in Billed Charges for Rev 272 = $242.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,568.5500,85.2800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,397.99,,,,,,,146.7400,568.5500,percent of total billed charges,Rev 272 $568.55 in Billed Charges at 70% = $397.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,568.5500,85.2800,CIGNA HEALTHCARE,CIGNA HMO,237.09,,,,,,,146.7400,568.5500,percent of total billed charges,41.7% of $568.55 in Billed Charges for Rev 272 = $237.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,568.5500,85.2800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,263.81,,,,,,,146.7400,568.5500,percent of total billed charges,46.4% of $568.55 in Billed Charges for Rev 272 = $263.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,568.5500,85.2800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,237.09,,,,,,,146.7400,568.5500,percent of total billed charges,41.7% of $568.55 in Billed Charges for Rev 272 = $237.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,568.5500,85.2800,CIGNA HEALTHCARE,CIGNA PPO,237.09,,,,,,,146.7400,568.5500,percent of total billed charges,41.7% of $568.55 in Billed Charges for Rev 272 = $237.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,568.5500,85.2800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,511.70,,,,,,,146.7400,568.5500,percent of total billed charges,90% of $568.55 in Billed Charges for Rev 272 = $511.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,568.5500,85.2800,MEDCOST,MEDCOST VHN,270.57,,,,,,,146.7400,568.5500,percent of total billed charges,47.59% of $568.55 in Billed Charges for Rev 272 = $270.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,568.5500,85.2800,SENTARA HEALTH,SENTARA HEALTH,146.74,,,,,,,146.7400,568.5500,percent of total billed charges,25.81% of $568.55 in Billed Charges for Rev 272 = $146.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,568.5500,85.2800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",568.55,,,,,,,146.7400,568.5500,percent of total billed charges,100% of $568.55 in Billed Charges for Rev 272 = $568.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,568.5500,85.2800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,284.28,,,,,,,146.7400,568.5500,percent of total billed charges,Rev 272 $568.55 in Billed Charges at 50% = $284.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,568.5500,85.2800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,183.64,,,,,,,146.7400,568.5500,other,32.3% of $568.55 in Billed Charges for Rev 272 = $183.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,568.5500,85.2800,UNITED HEALTHCARE,UHC HERITAGE SELECT,174.54,,,,,,,146.7400,568.5500,other,30.7% of $568.55 in Billed Charges for Rev 272 = $174.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,568.5500,85.2800,UNITED HEALTHCARE,UNITED HEALTHCARE,183.64,,,,,,,146.7400,568.5500,percent of total billed charges,32.3% of $568.55 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,568.5500,85.2800,WELLCARE,WELLCARE MEDICAID,568.55,,,,,,,146.7400,568.5500,percent of total billed charges,100% of $568.55 in Billed Charges for Rev 272 = $568.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,694.1300,104.1200,AETNA,AETNA,296.39,,,,,,,179.1600,694.1300,percent of total billed charges,42.7% of $694.13 in Billed Charges for Rev 272 = $296.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,694.1300,104.1200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,485.89,,,,,,,179.1600,694.1300,percent of total billed charges,Rev 272 $694.13 in Billed Charges at 70% = $485.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,694.1300,104.1200,CIGNA HEALTHCARE,CIGNA HMO,289.45,,,,,,,179.1600,694.1300,percent of total billed charges,41.7% of $694.13 in Billed Charges for Rev 272 = $289.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,694.1300,104.1200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,322.08,,,,,,,179.1600,694.1300,percent of total billed charges,46.4% of $694.13 in Billed Charges for Rev 272 = $322.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,694.1300,104.1200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,289.45,,,,,,,179.1600,694.1300,percent of total billed charges,41.7% of $694.13 in Billed Charges for Rev 272 = $289.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,694.1300,104.1200,CIGNA HEALTHCARE,CIGNA PPO,289.45,,,,,,,179.1600,694.1300,percent of total billed charges,41.7% of $694.13 in Billed Charges for Rev 272 = $289.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,694.1300,104.1200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,624.72,,,,,,,179.1600,694.1300,percent of total billed charges,90% of $694.13 in Billed Charges for Rev 272 = $624.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,694.1300,104.1200,MEDCOST,MEDCOST VHN,330.34,,,,,,,179.1600,694.1300,percent of total billed charges,47.59% of $694.13 in Billed Charges for Rev 272 = $330.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,694.1300,104.1200,SENTARA HEALTH,SENTARA HEALTH,179.16,,,,,,,179.1600,694.1300,percent of total billed charges,25.81% of $694.13 in Billed Charges for Rev 272 = $179.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,694.1300,104.1200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",694.13,,,,,,,179.1600,694.1300,percent of total billed charges,100% of $694.13 in Billed Charges for Rev 272 = $694.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,694.1300,104.1200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,347.07,,,,,,,179.1600,694.1300,percent of total billed charges,Rev 272 $694.13 in Billed Charges at 50% = $347.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,694.1300,104.1200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,224.20,,,,,,,179.1600,694.1300,other,32.3% of $694.13 in Billed Charges for Rev 272 = $224.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,694.1300,104.1200,UNITED HEALTHCARE,UHC HERITAGE SELECT,213.10,,,,,,,179.1600,694.1300,other,30.7% of $694.13 in Billed Charges for Rev 272 = $213.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,694.1300,104.1200,UNITED HEALTHCARE,UNITED HEALTHCARE,224.20,,,,,,,179.1600,694.1300,percent of total billed charges,32.3% of $694.13 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD LINEAR CUTTER 75MM TCR75,272,RC,27200002,CDM,,,,,,both,,,694.1300,104.1200,WELLCARE,WELLCARE MEDICAID,694.13,,,,,,,179.1600,694.1300,percent of total billed charges,100% of $694.13 in Billed Charges for Rev 272 = $694.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER RELOAD TRI STAPLE 60 SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,6649.7200,997.4600,AETNA,AETNA,2839.43,,,,,,,1716.2900,6649.7200,percent of total billed charges,"42.7% of $6,649.72 in Billed Charges for Rev 272 = $2,839.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE 60 SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,6649.7200,997.4600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4654.80,,,,,,,1716.2900,6649.7200,percent of total billed charges,"Rev 272 $6,649.72 in Billed Charges at 70% = $4,654.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE 60 SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,6649.7200,997.4600,CIGNA HEALTHCARE,CIGNA HMO,2772.93,,,,,,,1716.2900,6649.7200,percent of total billed charges,"41.7% of $6,649.72 in Billed Charges for Rev 272 = $2,772.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE 60 SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,6649.7200,997.4600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3085.47,,,,,,,1716.2900,6649.7200,percent of total billed charges,"46.4% of $6,649.72 in Billed Charges for Rev 272 = $3,085.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE 60 SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,6649.7200,997.4600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2772.93,,,,,,,1716.2900,6649.7200,percent of total billed charges,"41.7% of $6,649.72 in Billed Charges for Rev 272 = $2,772.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE 60 SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,6649.7200,997.4600,CIGNA HEALTHCARE,CIGNA PPO,2772.93,,,,,,,1716.2900,6649.7200,percent of total billed charges,"41.7% of $6,649.72 in Billed Charges for Rev 272 = $2,772.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE 60 SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,6649.7200,997.4600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5984.75,,,,,,,1716.2900,6649.7200,percent of total billed charges,"90% of $6,649.72 in Billed Charges for Rev 272 = $5,984.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE 60 SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,6649.7200,997.4600,MEDCOST,MEDCOST VHN,3164.60,,,,,,,1716.2900,6649.7200,percent of total billed charges,"47.59% of $6,649.72 in Billed Charges for Rev 272 = $3,164.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE 60 SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,6649.7200,997.4600,SENTARA HEALTH,SENTARA HEALTH,1716.29,,,,,,,1716.2900,6649.7200,percent of total billed charges,"25.81% of $6,649.72 in Billed Charges for Rev 272 = $1,716.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE 60 SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,6649.7200,997.4600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6649.72,,,,,,,1716.2900,6649.7200,percent of total billed charges,"100% of $6,649.72 in Billed Charges for Rev 272 = $6,649.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE 60 SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,6649.7200,997.4600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3324.86,,,,,,,1716.2900,6649.7200,percent of total billed charges,"Rev 272 $6,649.72 in Billed Charges at 50% = $3,324.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE 60 SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,6649.7200,997.4600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2147.86,,,,,,,1716.2900,6649.7200,other,"32.3% of $6,649.72 in Billed Charges for Rev 272 = $2,147.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER RELOAD TRI STAPLE 60 SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,6649.7200,997.4600,UNITED HEALTHCARE,UHC HERITAGE SELECT,2041.46,,,,,,,1716.2900,6649.7200,other,"30.7% of $6,649.72 in Billed Charges for Rev 272 = $2,041.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER RELOAD TRI STAPLE 60 SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,6649.7200,997.4600,UNITED HEALTHCARE,UNITED HEALTHCARE,2147.86,,,,,,,1716.2900,6649.7200,percent of total billed charges,"32.3% of $6,649.72 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER RELOAD TRI STAPLE 60 SURPASS SEE LN 182831,272,RC,27200002,CDM,,,,,,both,,,6649.7200,997.4600,WELLCARE,WELLCARE MEDICAID,6649.72,,,,,,,1716.2900,6649.7200,percent of total billed charges,"100% of $6,649.72 in Billed Charges for Rev 272 = $6,649.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,AETNA,AETNA,2154.64,,,,,,,109.0000,5745.1200,percent of total billed charges,"42.7% of $5,046.00 in Billed Charges for Rev 450 Proc 10180 = $2,154.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1463.97,,,,,,,109.0000,5745.1200,fee schedule,"APG 00018 Proc 10180 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 104% = $1,463.97. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2635.37,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,AETNA,AETNA HEALTHCARE MEDICARE,2635.37,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,2635.37,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,AMBETTER,AMBETTER,5745.12,,,,,,,109.0000,5745.1200,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2740.79,,,,,,,109.0000,5745.1200,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,BLUE CROSS,ANTHEM EXCHANGE,5046.00,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1449.89,,,,,,,109.0000,5745.1200,fee schedule,"APG 00018 Proc 10180 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 103% = $1,449.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,BLUE CROSS,ANTHEM HMO,5046.00,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2714.44,,,,,,,109.0000,5745.1200,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5046.00,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,131.08,,,,,,,109.0000,5745.1200,fee schedule,$131.08 from Fee Schedule BLDTM_23 for Rev 450 Proc 10180 * Qty 1 = $131.08 at 100% = $131.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,BLUE CROSS,BLUE CROSS MEDICARE,2740.79,,,,,,,109.0000,5745.1200,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,2767.14,,,,,,,109.0000,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,2767.14,,,,,,,109.0000,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4541.40,,,,,,,109.0000,5745.1200,percent of total billed charges,"90% of $5,046.00 in Billed Charges for Rev 450 Proc 10180 = $4,541.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,HUMANA,HUMANA MEDICARE,2635.37,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2635.37,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,MEDCOST,MEDCOST VHN,2401.39,,,,,,,109.0000,5745.1200,percent of total billed charges,"47.59% of $5,046.00 in Billed Charges for Rev 450 Proc 10180 = $2,401.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1478.04,,,,,,,109.0000,5745.1200,fee schedule,"APG 00018 Proc 10180 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 100% = $1,407.66... $1,407.66 at 105% = $1,478.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,2767.14,,,,,,,109.0000,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,2767.14,,,,,,,109.0000,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,NHC ADVANTAGE,NHC ADVANTAGE,2767.14,,,,,,,109.0000,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1451.30,,,,,,,109.0000,5745.1200,fee schedule,"APG 00018 Proc 10180 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 100% = $1,407.66... $1,407.66 at 103.1% = $1,451.30 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,SENTARA HEALTH,SENTARA HEALTH,1302.37,,,,,,,109.0000,5745.1200,percent of total billed charges,"25.81% of $5,046.00 in Billed Charges for Rev 450 Proc 10180 = $1,302.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,SENTARA HEALTH,SENTARA MEDICARE,2635.37,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5046.00,,,,,,,109.0000,5745.1200,percent of total billed charges,"100% of $5,046.00 in Billed Charges for Rev 450 Proc 10180 = $5,046.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,5745.1200,case rate,Rev 450 Proc 10180 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,5745.1200,case rate,Rev 450 Proc 10180 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,5745.1200,case rate,Rev 450 Proc 10180 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,5745.1200,case rate,Rev 450 Proc 10180 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1449.89,,,,,,,109.0000,5745.1200,fee schedule,"APG 00018 Proc 10180 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 103% = $1,449.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2635.37,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2635.37,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,WELLCARE,WELLCARE MEDICAID,5046.00,,,,,,,109.0000,5745.1200,percent of total billed charges,"100% of $5,046.00 in Billed Charges for Rev 450 Proc 10180 = $5,046.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D COMPLX POSTOP WOUND INFEC,10180,CPT,450,RC,45000022,CDM,,,,both,,,5046.0000,756.9000,WELLCARE,WELLCARE MEDICARE,2793.50,,,,,,,109.0000,5745.1200,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER SIGNIA SHELL,272,RC,27200002,CDM,,,,,,both,,,5392.2400,808.8400,AETNA,AETNA,2302.49,,,,,,,1391.7400,5392.2400,percent of total billed charges,"42.7% of $5,392.24 in Billed Charges for Rev 272 = $2,302.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SIGNIA SHELL,272,RC,27200002,CDM,,,,,,both,,,5392.2400,808.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3774.57,,,,,,,1391.7400,5392.2400,percent of total billed charges,"Rev 272 $5,392.24 in Billed Charges at 70% = $3,774.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SIGNIA SHELL,272,RC,27200002,CDM,,,,,,both,,,5392.2400,808.8400,CIGNA HEALTHCARE,CIGNA HMO,2248.56,,,,,,,1391.7400,5392.2400,percent of total billed charges,"41.7% of $5,392.24 in Billed Charges for Rev 272 = $2,248.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SIGNIA SHELL,272,RC,27200002,CDM,,,,,,both,,,5392.2400,808.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2502.00,,,,,,,1391.7400,5392.2400,percent of total billed charges,"46.4% of $5,392.24 in Billed Charges for Rev 272 = $2,502.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SIGNIA SHELL,272,RC,27200002,CDM,,,,,,both,,,5392.2400,808.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2248.56,,,,,,,1391.7400,5392.2400,percent of total billed charges,"41.7% of $5,392.24 in Billed Charges for Rev 272 = $2,248.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SIGNIA SHELL,272,RC,27200002,CDM,,,,,,both,,,5392.2400,808.8400,CIGNA HEALTHCARE,CIGNA PPO,2248.56,,,,,,,1391.7400,5392.2400,percent of total billed charges,"41.7% of $5,392.24 in Billed Charges for Rev 272 = $2,248.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SIGNIA SHELL,272,RC,27200002,CDM,,,,,,both,,,5392.2400,808.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4853.02,,,,,,,1391.7400,5392.2400,percent of total billed charges,"90% of $5,392.24 in Billed Charges for Rev 272 = $4,853.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SIGNIA SHELL,272,RC,27200002,CDM,,,,,,both,,,5392.2400,808.8400,MEDCOST,MEDCOST VHN,2566.17,,,,,,,1391.7400,5392.2400,percent of total billed charges,"47.59% of $5,392.24 in Billed Charges for Rev 272 = $2,566.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SIGNIA SHELL,272,RC,27200002,CDM,,,,,,both,,,5392.2400,808.8400,SENTARA HEALTH,SENTARA HEALTH,1391.74,,,,,,,1391.7400,5392.2400,percent of total billed charges,"25.81% of $5,392.24 in Billed Charges for Rev 272 = $1,391.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SIGNIA SHELL,272,RC,27200002,CDM,,,,,,both,,,5392.2400,808.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5392.24,,,,,,,1391.7400,5392.2400,percent of total billed charges,"100% of $5,392.24 in Billed Charges for Rev 272 = $5,392.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SIGNIA SHELL,272,RC,27200002,CDM,,,,,,both,,,5392.2400,808.8400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2696.12,,,,,,,1391.7400,5392.2400,percent of total billed charges,"Rev 272 $5,392.24 in Billed Charges at 50% = $2,696.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SIGNIA SHELL,272,RC,27200002,CDM,,,,,,both,,,5392.2400,808.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1741.69,,,,,,,1391.7400,5392.2400,other,"32.3% of $5,392.24 in Billed Charges for Rev 272 = $1,741.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER SIGNIA SHELL,272,RC,27200002,CDM,,,,,,both,,,5392.2400,808.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1655.42,,,,,,,1391.7400,5392.2400,other,"30.7% of $5,392.24 in Billed Charges for Rev 272 = $1,655.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
STAPLER SIGNIA SHELL,272,RC,27200002,CDM,,,,,,both,,,5392.2400,808.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,1741.69,,,,,,,1391.7400,5392.2400,percent of total billed charges,"32.3% of $5,392.24 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SIGNIA SHELL,272,RC,27200002,CDM,,,,,,both,,,5392.2400,808.8400,WELLCARE,WELLCARE MEDICAID,5392.24,,,,,,,1391.7400,5392.2400,percent of total billed charges,"100% of $5,392.24 in Billed Charges for Rev 272 = $5,392.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
STAPLER SKIN 35 REG FIXED HAD,272,RC,27200002,CDM,,,,,,both,,,124.4700,18.6700,AETNA,AETNA,53.15,,,,,,,32.1300,124.4700,percent of total billed charges,42.7% of $124.47 in Billed Charges for Rev 272 = $53.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SKIN 35 REG FIXED HAD,272,RC,27200002,CDM,,,,,,both,,,124.4700,18.6700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,87.13,,,,,,,32.1300,124.4700,percent of total billed charges,Rev 272 $124.47 in Billed Charges at 70% = $87.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SKIN 35 REG FIXED HAD,272,RC,27200002,CDM,,,,,,both,,,124.4700,18.6700,CIGNA HEALTHCARE,CIGNA HMO,51.90,,,,,,,32.1300,124.4700,percent of total billed charges,41.7% of $124.47 in Billed Charges for Rev 272 = $51.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SKIN 35 REG FIXED HAD,272,RC,27200002,CDM,,,,,,both,,,124.4700,18.6700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,57.75,,,,,,,32.1300,124.4700,percent of total billed charges,46.4% of $124.47 in Billed Charges for Rev 272 = $57.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SKIN 35 REG FIXED HAD,272,RC,27200002,CDM,,,,,,both,,,124.4700,18.6700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,51.90,,,,,,,32.1300,124.4700,percent of total billed charges,41.7% of $124.47 in Billed Charges for Rev 272 = $51.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SKIN 35 REG FIXED HAD,272,RC,27200002,CDM,,,,,,both,,,124.4700,18.6700,CIGNA HEALTHCARE,CIGNA PPO,51.90,,,,,,,32.1300,124.4700,percent of total billed charges,41.7% of $124.47 in Billed Charges for Rev 272 = $51.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SKIN 35 REG FIXED HAD,272,RC,27200002,CDM,,,,,,both,,,124.4700,18.6700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,112.02,,,,,,,32.1300,124.4700,percent of total billed charges,90% of $124.47 in Billed Charges for Rev 272 = $112.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SKIN 35 REG FIXED HAD,272,RC,27200002,CDM,,,,,,both,,,124.4700,18.6700,MEDCOST,MEDCOST VHN,59.24,,,,,,,32.1300,124.4700,percent of total billed charges,47.59% of $124.47 in Billed Charges for Rev 272 = $59.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SKIN 35 REG FIXED HAD,272,RC,27200002,CDM,,,,,,both,,,124.4700,18.6700,SENTARA HEALTH,SENTARA HEALTH,32.13,,,,,,,32.1300,124.4700,percent of total billed charges,25.81% of $124.47 in Billed Charges for Rev 272 = $32.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SKIN 35 REG FIXED HAD,272,RC,27200002,CDM,,,,,,both,,,124.4700,18.6700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",124.47,,,,,,,32.1300,124.4700,percent of total billed charges,100% of $124.47 in Billed Charges for Rev 272 = $124.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SKIN 35 REG FIXED HAD,272,RC,27200002,CDM,,,,,,both,,,124.4700,18.6700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,62.24,,,,,,,32.1300,124.4700,percent of total billed charges,Rev 272 $124.47 in Billed Charges at 50% = $62.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SKIN 35 REG FIXED HAD,272,RC,27200002,CDM,,,,,,both,,,124.4700,18.6700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,40.20,,,,,,,32.1300,124.4700,other,32.3% of $124.47 in Billed Charges for Rev 272 = $40.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER SKIN 35 REG FIXED HAD,272,RC,27200002,CDM,,,,,,both,,,124.4700,18.6700,UNITED HEALTHCARE,UHC HERITAGE SELECT,38.21,,,,,,,32.1300,124.4700,other,30.7% of $124.47 in Billed Charges for Rev 272 = $38.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
STAPLER SKIN 35 REG FIXED HAD,272,RC,27200002,CDM,,,,,,both,,,124.4700,18.6700,UNITED HEALTHCARE,UNITED HEALTHCARE,40.20,,,,,,,32.1300,124.4700,percent of total billed charges,32.3% of $124.47 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
STAPLER SKIN 35 REG FIXED HAD,272,RC,27200002,CDM,,,,,,both,,,124.4700,18.6700,WELLCARE,WELLCARE MEDICAID,124.47,,,,,,,32.1300,124.4700,percent of total billed charges,100% of $124.47 in Billed Charges for Rev 272 = $124.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DEBRID MUSCLE/FASCIA EA ADDL 20 SQ CM,11046,CPT,510,RC,51000011,CDM,,,,both,,,183.0000,27.4500,AETNA,AETNA,78.14,,,,,,,47.2300,1478.0400,percent of total billed charges,42.7% of $183.00 in Billed Charges for Rev 510 Proc 11046 = $78.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DEBRID MUSCLE/FASCIA EA ADDL 20 SQ CM,11046,CPT,510,RC,51000011,CDM,,,,both,,,183.0000,27.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1463.97,,,,,,,47.2300,1478.0400,fee schedule,"APG 00018 Proc 11046 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 104% = $1,463.97. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID MUSCLE/FASCIA EA ADDL 20 SQ CM,11046,CPT,510,RC,51000011,CDM,,,,both,,,183.0000,27.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,183.00,,,,,,,47.2300,1478.0400,fee schedule,"APG 00018 Proc 11046 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 103% = $1,449.89 (Service Line reduced to $183.00, claim capped at $183.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID MUSCLE/FASCIA EA ADDL 20 SQ CM,11046,CPT,510,RC,51000011,CDM,,,,both,,,183.0000,27.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,50.49,,,,,,,47.2300,1478.0400,fee schedule,$50.49 from Fee Schedule BLDTM_23 for Rev 510 Proc 11046 * Qty 1 = $50.49 at 100% = $50.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA EA ADDL 20 SQ CM,11046,CPT,510,RC,51000011,CDM,,,,both,,,183.0000,27.4500,BLUE CROSS,TENNCARE BLUE CARE,51.03,,,,,,,47.2300,1478.0400,fee schedule,$43.99 from Fee Schedule TC_24 for Rev 510 Proc 11046 * Qty 1 = $43.99 at 116% = $51.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA EA ADDL 20 SQ CM,11046,CPT,510,RC,51000011,CDM,,,,both,,,183.0000,27.4500,BLUE CROSS,TENNCARE BLUE SELECT,51.03,,,,,,,47.2300,1478.0400,fee schedule,$43.99 from Fee Schedule TC_24 for Rev 510 Proc 11046 * Qty 1 = $43.99 at 116% = $51.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA EA ADDL 20 SQ CM,11046,CPT,510,RC,51000011,CDM,,,,both,,,183.0000,27.4500,CIGNA HEALTHCARE,CIGNA HMO,76.31,,,,,,,47.2300,1478.0400,percent of total billed charges,41.7% of $183.00 in Billed Charges for Rev 510 Proc 11046 = $76.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DEBRID MUSCLE/FASCIA EA ADDL 20 SQ CM,11046,CPT,510,RC,51000011,CDM,,,,both,,,183.0000,27.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,84.91,,,,,,,47.2300,1478.0400,percent of total billed charges,46.4% of $183.00 in Billed Charges for Rev 510 Proc 11046 = $84.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DEBRID MUSCLE/FASCIA EA ADDL 20 SQ CM,11046,CPT,510,RC,51000011,CDM,,,,both,,,183.0000,27.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,76.31,,,,,,,47.2300,1478.0400,percent of total billed charges,41.7% of $183.00 in Billed Charges for Rev 510 Proc 11046 = $76.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DEBRID MUSCLE/FASCIA EA ADDL 20 SQ CM,11046,CPT,510,RC,51000011,CDM,,,,both,,,183.0000,27.4500,CIGNA HEALTHCARE,CIGNA PPO,76.31,,,,,,,47.2300,1478.0400,percent of total billed charges,41.7% of $183.00 in Billed Charges for Rev 510 Proc 11046 = $76.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DEBRID MUSCLE/FASCIA EA ADDL 20 SQ CM,11046,CPT,510,RC,51000011,CDM,,,,both,,,183.0000,27.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,164.70,,,,,,,47.2300,1478.0400,percent of total billed charges,90% of $183.00 in Billed Charges for Rev 510 Proc 11046 = $164.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DEBRID MUSCLE/FASCIA EA ADDL 20 SQ CM,11046,CPT,510,RC,51000011,CDM,,,,both,,,183.0000,27.4500,MEDCOST,MEDCOST VHN,87.09,,,,,,,47.2300,1478.0400,percent of total billed charges,47.59% of $183.00 in Billed Charges for Rev 510 Proc 11046 = $87.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DEBRID MUSCLE/FASCIA EA ADDL 20 SQ CM,11046,CPT,510,RC,51000011,CDM,,,,both,,,183.0000,27.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1478.04,,,,,,,47.2300,1478.0400,fee schedule,"APG 00018 Proc 11046 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 100% = $1,407.66... $1,407.66 at 105% = $1,478.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID MUSCLE/FASCIA EA ADDL 20 SQ CM,11046,CPT,510,RC,51000011,CDM,,,,both,,,183.0000,27.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1451.30,,,,,,,47.2300,1478.0400,fee schedule,"APG 00018 Proc 11046 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 100% = $1,407.66... $1,407.66 at 103.1% = $1,451.30 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID MUSCLE/FASCIA EA ADDL 20 SQ CM,11046,CPT,510,RC,51000011,CDM,,,,both,,,183.0000,27.4500,SENTARA HEALTH,SENTARA HEALTH,47.23,,,,,,,47.2300,1478.0400,percent of total billed charges,25.81% of $183.00 in Billed Charges for Rev 510 Proc 11046 = $47.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DEBRID MUSCLE/FASCIA EA ADDL 20 SQ CM,11046,CPT,510,RC,51000011,CDM,,,,both,,,183.0000,27.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",183.00,,,,,,,47.2300,1478.0400,percent of total billed charges,100% of $183.00 in Billed Charges for Rev 510 Proc 11046 = $183.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DEBRID MUSCLE/FASCIA EA ADDL 20 SQ CM,11046,CPT,510,RC,51000011,CDM,,,,both,,,183.0000,27.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,59.11,,,,,,,47.2300,1478.0400,other,32.3% of $183.00 in Billed Charges for Rev 510 Proc 11046 = $59.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA EA ADDL 20 SQ CM,11046,CPT,510,RC,51000011,CDM,,,,both,,,183.0000,27.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,56.18,,,,,,,47.2300,1478.0400,other,30.7% of $183.00 in Billed Charges for Rev 510 Proc 11046 = $56.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA EA ADDL 20 SQ CM,11046,CPT,510,RC,51000011,CDM,,,,both,,,183.0000,27.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,59.11,,,,,,,47.2300,1478.0400,percent of total billed charges,32.3% of $183.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DEBRID MUSCLE/FASCIA EA ADDL 20 SQ CM,11046,CPT,510,RC,51000011,CDM,,,,both,,,183.0000,27.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1449.89,,,,,,,47.2300,1478.0400,fee schedule,"APG 00018 Proc 11046 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 103% = $1,449.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID MUSCLE/FASCIA EA ADDL 20 SQ CM,11046,CPT,510,RC,51000011,CDM,,,,both,,,183.0000,27.4500,WELLCARE,WELLCARE MEDICAID,183.00,,,,,,,47.2300,1478.0400,percent of total billed charges,100% of $183.00 in Billed Charges for Rev 510 Proc 11046 = $183.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DEBRD BONE MUSCLE &/FASCIA EA ADDL 20 SQ CM,11047,CPT,510,RC,51000012,CDM,,,,both,,,1966.0000,294.9000,AETNA,AETNA,839.48,,,,,,,82.8900,1966.0000,percent of total billed charges,"42.7% of $1,966.00 in Billed Charges for Rev 510 Proc 11047 = $839.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRD BONE MUSCLE &/FASCIA EA ADDL 20 SQ CM,11047,CPT,510,RC,51000012,CDM,,,,both,,,1966.0000,294.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1463.97,,,,,,,82.8900,1966.0000,fee schedule,"APG 00018 Proc 11047 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 104% = $1,463.97. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRD BONE MUSCLE &/FASCIA EA ADDL 20 SQ CM,11047,CPT,510,RC,51000012,CDM,,,,both,,,1966.0000,294.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1449.89,,,,,,,82.8900,1966.0000,fee schedule,"APG 00018 Proc 11047 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 103% = $1,449.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRD BONE MUSCLE &/FASCIA EA ADDL 20 SQ CM,11047,CPT,510,RC,51000012,CDM,,,,both,,,1966.0000,294.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,82.89,,,,,,,82.8900,1966.0000,fee schedule,$82.89 from Fee Schedule BLDTM_23 for Rev 510 Proc 11047 * Qty 1 = $82.89 at 100% = $82.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA EA ADDL 20 SQ CM,11047,CPT,510,RC,51000012,CDM,,,,both,,,1966.0000,294.9000,BLUE CROSS,TENNCARE BLUE CARE,83.78,,,,,,,82.8900,1966.0000,fee schedule,$72.22 from Fee Schedule TC_24 for Rev 510 Proc 11047 * Qty 1 = $72.22 at 116% = $83.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA EA ADDL 20 SQ CM,11047,CPT,510,RC,51000012,CDM,,,,both,,,1966.0000,294.9000,BLUE CROSS,TENNCARE BLUE SELECT,83.78,,,,,,,82.8900,1966.0000,fee schedule,$72.22 from Fee Schedule TC_24 for Rev 510 Proc 11047 * Qty 1 = $72.22 at 116% = $83.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA EA ADDL 20 SQ CM,11047,CPT,510,RC,51000012,CDM,,,,both,,,1966.0000,294.9000,CIGNA HEALTHCARE,CIGNA HMO,819.82,,,,,,,82.8900,1966.0000,percent of total billed charges,"41.7% of $1,966.00 in Billed Charges for Rev 510 Proc 11047 = $819.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRD BONE MUSCLE &/FASCIA EA ADDL 20 SQ CM,11047,CPT,510,RC,51000012,CDM,,,,both,,,1966.0000,294.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,912.22,,,,,,,82.8900,1966.0000,percent of total billed charges,"46.4% of $1,966.00 in Billed Charges for Rev 510 Proc 11047 = $912.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRD BONE MUSCLE &/FASCIA EA ADDL 20 SQ CM,11047,CPT,510,RC,51000012,CDM,,,,both,,,1966.0000,294.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,819.82,,,,,,,82.8900,1966.0000,percent of total billed charges,"41.7% of $1,966.00 in Billed Charges for Rev 510 Proc 11047 = $819.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRD BONE MUSCLE &/FASCIA EA ADDL 20 SQ CM,11047,CPT,510,RC,51000012,CDM,,,,both,,,1966.0000,294.9000,CIGNA HEALTHCARE,CIGNA PPO,819.82,,,,,,,82.8900,1966.0000,percent of total billed charges,"41.7% of $1,966.00 in Billed Charges for Rev 510 Proc 11047 = $819.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRD BONE MUSCLE &/FASCIA EA ADDL 20 SQ CM,11047,CPT,510,RC,51000012,CDM,,,,both,,,1966.0000,294.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1769.40,,,,,,,82.8900,1966.0000,percent of total billed charges,"90% of $1,966.00 in Billed Charges for Rev 510 Proc 11047 = $1,769.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRD BONE MUSCLE &/FASCIA EA ADDL 20 SQ CM,11047,CPT,510,RC,51000012,CDM,,,,both,,,1966.0000,294.9000,MEDCOST,MEDCOST VHN,935.62,,,,,,,82.8900,1966.0000,percent of total billed charges,"47.59% of $1,966.00 in Billed Charges for Rev 510 Proc 11047 = $935.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRD BONE MUSCLE &/FASCIA EA ADDL 20 SQ CM,11047,CPT,510,RC,51000012,CDM,,,,both,,,1966.0000,294.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1478.04,,,,,,,82.8900,1966.0000,fee schedule,"APG 00018 Proc 11047 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 100% = $1,407.66... $1,407.66 at 105% = $1,478.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRD BONE MUSCLE &/FASCIA EA ADDL 20 SQ CM,11047,CPT,510,RC,51000012,CDM,,,,both,,,1966.0000,294.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1451.30,,,,,,,82.8900,1966.0000,fee schedule,"APG 00018 Proc 11047 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 100% = $1,407.66... $1,407.66 at 103.1% = $1,451.30 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRD BONE MUSCLE &/FASCIA EA ADDL 20 SQ CM,11047,CPT,510,RC,51000012,CDM,,,,both,,,1966.0000,294.9000,SENTARA HEALTH,SENTARA HEALTH,507.42,,,,,,,82.8900,1966.0000,percent of total billed charges,"25.81% of $1,966.00 in Billed Charges for Rev 510 Proc 11047 = $507.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRD BONE MUSCLE &/FASCIA EA ADDL 20 SQ CM,11047,CPT,510,RC,51000012,CDM,,,,both,,,1966.0000,294.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1966.00,,,,,,,82.8900,1966.0000,percent of total billed charges,"100% of $1,966.00 in Billed Charges for Rev 510 Proc 11047 = $1,966.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRD BONE MUSCLE &/FASCIA EA ADDL 20 SQ CM,11047,CPT,510,RC,51000012,CDM,,,,both,,,1966.0000,294.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,635.02,,,,,,,82.8900,1966.0000,other,"32.3% of $1,966.00 in Billed Charges for Rev 510 Proc 11047 = $635.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRD BONE MUSCLE &/FASCIA EA ADDL 20 SQ CM,11047,CPT,510,RC,51000012,CDM,,,,both,,,1966.0000,294.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,603.56,,,,,,,82.8900,1966.0000,other,"30.7% of $1,966.00 in Billed Charges for Rev 510 Proc 11047 = $603.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRD BONE MUSCLE &/FASCIA EA ADDL 20 SQ CM,11047,CPT,510,RC,51000012,CDM,,,,both,,,1966.0000,294.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,635.02,,,,,,,82.8900,1966.0000,percent of total billed charges,"32.3% of $1,966.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRD BONE MUSCLE &/FASCIA EA ADDL 20 SQ CM,11047,CPT,510,RC,51000012,CDM,,,,both,,,1966.0000,294.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1449.89,,,,,,,82.8900,1966.0000,fee schedule,"APG 00018 Proc 11047 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 103% = $1,449.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRD BONE MUSCLE &/FASCIA EA ADDL 20 SQ CM,11047,CPT,510,RC,51000012,CDM,,,,both,,,1966.0000,294.9000,WELLCARE,WELLCARE MEDICAID,1966.00,,,,,,,82.8900,1966.0000,percent of total billed charges,"100% of $1,966.00 in Billed Charges for Rev 510 Proc 11047 = $1,966.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA,111.45,,,,,,,22.6400,396.8300,percent of total billed charges,42.7% of $261.00 in Billed Charges for Rev 510 Proc 11055 = $111.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,22.6400,396.8300,fee schedule,"APG 00003 Proc 11055 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,22.6400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,22.6400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,22.6400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,AMBETTER,AMBETTER,396.83,,,,,,,22.6400,396.8300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,22.6400,396.8300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM EXCHANGE,261.00,,,,,,,22.6400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,22.6400,396.8300,fee schedule,"APG 00003 Proc 11055 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM HMO,261.00,,,,,,,22.6400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,22.6400,396.8300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",261.00,,,,,,,22.6400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,22.64,,,,,,,22.6400,396.8300,fee schedule,$22.64 from Fee Schedule BLDTM_23 for Rev 510 Proc 11055 * Qty 1 = $22.64 at 100% = $22.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,22.6400,396.8300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA HMO,108.84,,,,,,,22.6400,396.8300,percent of total billed charges,41.7% of $261.00 in Billed Charges for Rev 510 Proc 11055 = $108.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,121.10,,,,,,,22.6400,396.8300,percent of total billed charges,46.4% of $261.00 in Billed Charges for Rev 510 Proc 11055 = $121.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,22.6400,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,108.84,,,,,,,22.6400,396.8300,percent of total billed charges,41.7% of $261.00 in Billed Charges for Rev 510 Proc 11055 = $108.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA PPO,108.84,,,,,,,22.6400,396.8300,percent of total billed charges,41.7% of $261.00 in Billed Charges for Rev 510 Proc 11055 = $108.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,22.6400,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,234.90,,,,,,,22.6400,396.8300,percent of total billed charges,90% of $261.00 in Billed Charges for Rev 510 Proc 11055 = $234.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,22.6400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,22.6400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,MEDCOST,MEDCOST VHN,124.21,,,,,,,22.6400,396.8300,percent of total billed charges,47.59% of $261.00 in Billed Charges for Rev 510 Proc 11055 = $124.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,22.6400,396.8300,fee schedule,"APG 00003 Proc 11055 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,22.6400,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,22.6400,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,22.6400,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,22.6400,396.8300,fee schedule,"APG 00003 Proc 11055 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,SENTARA HEALTH,SENTARA HEALTH,67.36,,,,,,,22.6400,396.8300,percent of total billed charges,25.81% of $261.00 in Billed Charges for Rev 510 Proc 11055 = $67.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,22.6400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",261.00,,,,,,,22.6400,396.8300,percent of total billed charges,100% of $261.00 in Billed Charges for Rev 510 Proc 11055 = $261.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,49.25,,,,,,,22.6400,396.8300,fee schedule,$98.49 from Fee Schedule TCUHC24 for Rev 510 Proc 11055 * Qty 1 = $98.49 at 50% = $49.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,84.30,,,,,,,22.6400,396.8300,other,32.3% of $261.00 in Billed Charges for Rev 510 Proc 11055 = $84.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,80.13,,,,,,,22.6400,396.8300,other,30.7% of $261.00 in Billed Charges for Rev 510 Proc 11055 = $80.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,84.30,,,,,,,22.6400,396.8300,percent of total billed charges,32.3% of $261.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,22.6400,396.8300,fee schedule,"APG 00003 Proc 11055 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,22.6400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,22.6400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,WELLCARE,WELLCARE MEDICAID,261.00,,,,,,,22.6400,396.8300,percent of total billed charges,100% of $261.00 in Billed Charges for Rev 510 Proc 11055 = $261.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN SINGLE,11055,CPT,510,RC,51000060,CDM,,,,both,,,261.0000,39.1500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,22.6400,396.8300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,AETNA,AETNA,139.20,,,,,,,29.0700,396.8300,percent of total billed charges,42.7% of $326.00 in Billed Charges for Rev 510 Proc 11056 = $139.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,29.0700,396.8300,fee schedule,"APG 00003 Proc 11056 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,29.0700,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,29.0700,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,29.0700,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,AMBETTER,AMBETTER,396.83,,,,,,,29.0700,396.8300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,29.0700,396.8300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,BLUE CROSS,ANTHEM EXCHANGE,326.00,,,,,,,29.0700,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,29.0700,396.8300,fee schedule,"APG 00003 Proc 11056 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,BLUE CROSS,ANTHEM HMO,326.00,,,,,,,29.0700,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,29.0700,396.8300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",326.00,,,,,,,29.0700,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,29.07,,,,,,,29.0700,396.8300,fee schedule,$29.07 from Fee Schedule BLDTM_23 for Rev 510 Proc 11056 * Qty 1 = $29.07 at 100% = $29.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,29.0700,396.8300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,CIGNA HEALTHCARE,CIGNA HMO,135.94,,,,,,,29.0700,396.8300,percent of total billed charges,41.7% of $326.00 in Billed Charges for Rev 510 Proc 11056 = $135.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,151.26,,,,,,,29.0700,396.8300,percent of total billed charges,46.4% of $326.00 in Billed Charges for Rev 510 Proc 11056 = $151.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,29.0700,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,135.94,,,,,,,29.0700,396.8300,percent of total billed charges,41.7% of $326.00 in Billed Charges for Rev 510 Proc 11056 = $135.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,CIGNA HEALTHCARE,CIGNA PPO,135.94,,,,,,,29.0700,396.8300,percent of total billed charges,41.7% of $326.00 in Billed Charges for Rev 510 Proc 11056 = $135.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,29.0700,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,293.40,,,,,,,29.0700,396.8300,percent of total billed charges,90% of $326.00 in Billed Charges for Rev 510 Proc 11056 = $293.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,HUMANA,HUMANA MEDICARE,182.03,,,,,,,29.0700,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,29.0700,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,MEDCOST,MEDCOST VHN,155.14,,,,,,,29.0700,396.8300,percent of total billed charges,47.59% of $326.00 in Billed Charges for Rev 510 Proc 11056 = $155.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,29.0700,396.8300,fee schedule,"APG 00003 Proc 11056 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,29.0700,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,29.0700,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,29.0700,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,29.0700,396.8300,fee schedule,"APG 00003 Proc 11056 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,SENTARA HEALTH,SENTARA HEALTH,84.14,,,,,,,29.0700,396.8300,percent of total billed charges,25.81% of $326.00 in Billed Charges for Rev 510 Proc 11056 = $84.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,29.0700,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",326.00,,,,,,,29.0700,396.8300,percent of total billed charges,100% of $326.00 in Billed Charges for Rev 510 Proc 11056 = $326.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,29.0700,396.8300,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 510 Proc 11056 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,105.30,,,,,,,29.0700,396.8300,other,32.3% of $326.00 in Billed Charges for Rev 510 Proc 11056 = $105.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,100.08,,,,,,,29.0700,396.8300,other,30.7% of $326.00 in Billed Charges for Rev 510 Proc 11056 = $100.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,105.30,,,,,,,29.0700,396.8300,percent of total billed charges,32.3% of $326.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,29.0700,396.8300,fee schedule,"APG 00003 Proc 11056 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,29.0700,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,29.0700,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,WELLCARE,WELLCARE MEDICAID,326.00,,,,,,,29.0700,396.8300,percent of total billed charges,100% of $326.00 in Billed Charges for Rev 510 Proc 11056 = $326.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN 2-4,11056,CPT,510,RC,51000061,CDM,,,,both,,,326.0000,48.9000,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,29.0700,396.8300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,AETNA,AETNA,886.45,,,,,,,535.8200,2076.0000,percent of total billed charges,"42.7% of $2,076.00 in Billed Charges for Rev 361 Proc 15002 = $886.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1463.97,,,,,,,535.8200,2076.0000,fee schedule,"APG 00018 Proc 15002 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,407.66 at 104% = $1,463.97. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,670.54,,,,,,,535.8200,2076.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,AETNA,AETNA HEALTHCARE MEDICARE,670.54,,,,,,,535.8200,2076.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,670.54,,,,,,,535.8200,2076.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,AMBETTER,AMBETTER,1461.78,,,,,,,535.8200,2076.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,697.36,,,,,,,535.8200,2076.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,BLUE CROSS,ANTHEM EXCHANGE,1650.91,,,,,,,535.8200,2076.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1449.89,,,,,,,535.8200,2076.0000,fee schedule,"APG 00018 Proc 15002 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,407.66 at 103% = $1,449.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,BLUE CROSS,ANTHEM HMO,1753.99,,,,,,,535.8200,2076.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,690.66,,,,,,,535.8200,2076.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2063.41,,,,,,,535.8200,2076.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,948.00,,,,,,,535.8200,2076.0000,case rate,Rev 361 Proc 15002 ASG Rate of $948.00 at 100% of $948.00 = $948.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,535.8200,2076.0000,case rate,"Rev 361 Proc 15002 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,BLUE CROSS,BLUE CROSS MEDICARE,697.36,,,,,,,535.8200,2076.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,535.8200,2076.0000,case rate,"Rev 361 Proc 15002 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,535.8200,2076.0000,case rate,"Rev 361 Proc 15002 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,535.8200,2076.0000,case rate,Rev 361 Proc 15002 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,535.8200,2076.0000,case rate,Rev 361 Proc 15002 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,CIGNA HEALTHCARE,CIGNA HMO,2076.00,,,,,,,535.8200,2076.0000,case rate,"Rev 361 Proc 15002 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total (Limited to $2,076.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,076.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1956.00,,,,,,,535.8200,2076.0000,case rate,"Rev 361 Proc 15002 ASG Rate of $1,956.00 at 100% of $1,956.00 = $1,956.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,704.07,,,,,,,535.8200,2076.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2076.00,,,,,,,535.8200,2076.0000,case rate,"Rev 361 Proc 15002 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total (Limited to $2,076.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,076.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,CIGNA HEALTHCARE,CIGNA PPO,2076.00,,,,,,,535.8200,2076.0000,case rate,"Rev 361 Proc 15002 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total (Limited to $2,076.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,076.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,704.07,,,,,,,535.8200,2076.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1868.40,,,,,,,535.8200,2076.0000,percent of total billed charges,"90% of $2,076.00 in Billed Charges for Rev 361 Proc 15002 = $1,868.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,HUMANA,HUMANA MEDICARE,670.54,,,,,,,535.8200,2076.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,670.54,,,,,,,535.8200,2076.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,MEDCOST,MEDCOST VHN,987.97,,,,,,,535.8200,2076.0000,percent of total billed charges,"47.59% of $2,076.00 in Billed Charges for Rev 361 Proc 15002 = $987.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1478.04,,,,,,,535.8200,2076.0000,fee schedule,"APG 00018 Proc 15002 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,407.66 at 100% = $1,407.66... $1,407.66 at 105% = $1,478.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,704.07,,,,,,,535.8200,2076.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,704.07,,,,,,,535.8200,2076.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,NHC ADVANTAGE,NHC ADVANTAGE,704.07,,,,,,,535.8200,2076.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1451.30,,,,,,,535.8200,2076.0000,fee schedule,"APG 00018 Proc 15002 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,407.66 at 100% = $1,407.66... $1,407.66 at 103.1% = $1,451.30 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,SENTARA HEALTH,SENTARA HEALTH,535.82,,,,,,,535.8200,2076.0000,percent of total billed charges,"25.81% of $2,076.00 in Billed Charges for Rev 361 Proc 15002 = $535.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,SENTARA HEALTH,SENTARA MEDICARE,670.54,,,,,,,535.8200,2076.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2076.00,,,,,,,535.8200,2076.0000,percent of total billed charges,"100% of $2,076.00 in Billed Charges for Rev 361 Proc 15002 = $2,076.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,535.8200,2076.0000,case rate,Rev 361 Proc 15002 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,535.8200,2076.0000,case rate,"Rev 361 Proc 15002 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,535.8200,2076.0000,case rate,"Rev 361 Proc 15002 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,535.8200,2076.0000,case rate,"Rev 361 Proc 15002 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1449.89,,,,,,,535.8200,2076.0000,fee schedule,"APG 00018 Proc 15002 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,407.66 at 103% = $1,449.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,670.54,,,,,,,535.8200,2076.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,670.54,,,,,,,535.8200,2076.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,WELLCARE,WELLCARE MEDICAID,2076.00,,,,,,,535.8200,2076.0000,percent of total billed charges,"100% of $2,076.00 in Billed Charges for Rev 361 Proc 15002 = $2,076.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SITE PREP LOWER FIRST 100 SQCM,15002,CPT,361,RC,36100205,CDM,,,,both,,,2076.0000,311.4000,WELLCARE,WELLCARE MEDICARE,710.77,,,,,,,535.8200,2076.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREP SITE TRUNK/ARM/LEG EA ADDL 100 SQ CM/1% BODY AREA,15003,CPT,510,RC,51000189,CDM,,,,both,,,300.0000,45.0000,AETNA,AETNA,128.10,,,,,,,60.5900,566.2300,percent of total billed charges,42.7% of $300.00 in Billed Charges for Rev 510 Proc 15003 = $128.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREP SITE TRUNK/ARM/LEG EA ADDL 100 SQ CM/1% BODY AREA,15003,CPT,510,RC,51000189,CDM,,,,both,,,300.0000,45.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,60.5900,566.2300,fee schedule,APG 00017 Proc 15003 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment) at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREP SITE TRUNK/ARM/LEG EA ADDL 100 SQ CM/1% BODY AREA,15003,CPT,510,RC,51000189,CDM,,,,both,,,300.0000,45.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,300.00,,,,,,,60.5900,566.2300,fee schedule,"APG 00017 Proc 15003 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment) at 103% = $555.45 (Service Line reduced to $300.00, claim capped at $300.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREP SITE TRUNK/ARM/LEG EA ADDL 100 SQ CM/1% BODY AREA,15003,CPT,510,RC,51000189,CDM,,,,both,,,300.0000,45.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,60.59,,,,,,,60.5900,566.2300,fee schedule,$60.59 from Fee Schedule BLDTM_23 for Rev 510 Proc 15003 * Qty 1 = $60.59 at 100% = $60.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREP SITE TRUNK/ARM/LEG EA ADDL 100 SQ CM/1% BODY AREA,15003,CPT,510,RC,51000189,CDM,,,,both,,,300.0000,45.0000,CIGNA HEALTHCARE,CIGNA HMO,125.10,,,,,,,60.5900,566.2300,percent of total billed charges,41.7% of $300.00 in Billed Charges for Rev 510 Proc 15003 = $125.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREP SITE TRUNK/ARM/LEG EA ADDL 100 SQ CM/1% BODY AREA,15003,CPT,510,RC,51000189,CDM,,,,both,,,300.0000,45.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,139.20,,,,,,,60.5900,566.2300,percent of total billed charges,46.4% of $300.00 in Billed Charges for Rev 510 Proc 15003 = $139.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREP SITE TRUNK/ARM/LEG EA ADDL 100 SQ CM/1% BODY AREA,15003,CPT,510,RC,51000189,CDM,,,,both,,,300.0000,45.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,125.10,,,,,,,60.5900,566.2300,percent of total billed charges,41.7% of $300.00 in Billed Charges for Rev 510 Proc 15003 = $125.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREP SITE TRUNK/ARM/LEG EA ADDL 100 SQ CM/1% BODY AREA,15003,CPT,510,RC,51000189,CDM,,,,both,,,300.0000,45.0000,CIGNA HEALTHCARE,CIGNA PPO,125.10,,,,,,,60.5900,566.2300,percent of total billed charges,41.7% of $300.00 in Billed Charges for Rev 510 Proc 15003 = $125.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREP SITE TRUNK/ARM/LEG EA ADDL 100 SQ CM/1% BODY AREA,15003,CPT,510,RC,51000189,CDM,,,,both,,,300.0000,45.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,270.00,,,,,,,60.5900,566.2300,percent of total billed charges,90% of $300.00 in Billed Charges for Rev 510 Proc 15003 = $270.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREP SITE TRUNK/ARM/LEG EA ADDL 100 SQ CM/1% BODY AREA,15003,CPT,510,RC,51000189,CDM,,,,both,,,300.0000,45.0000,MEDCOST,MEDCOST VHN,142.77,,,,,,,60.5900,566.2300,percent of total billed charges,47.59% of $300.00 in Billed Charges for Rev 510 Proc 15003 = $142.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREP SITE TRUNK/ARM/LEG EA ADDL 100 SQ CM/1% BODY AREA,15003,CPT,510,RC,51000189,CDM,,,,both,,,300.0000,45.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,60.5900,566.2300,fee schedule,APG 00017 Proc 15003 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment) at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREP SITE TRUNK/ARM/LEG EA ADDL 100 SQ CM/1% BODY AREA,15003,CPT,510,RC,51000189,CDM,,,,both,,,300.0000,45.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,60.5900,566.2300,fee schedule,APG 00017 Proc 15003 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment) at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREP SITE TRUNK/ARM/LEG EA ADDL 100 SQ CM/1% BODY AREA,15003,CPT,510,RC,51000189,CDM,,,,both,,,300.0000,45.0000,SENTARA HEALTH,SENTARA HEALTH,77.43,,,,,,,60.5900,566.2300,percent of total billed charges,25.81% of $300.00 in Billed Charges for Rev 510 Proc 15003 = $77.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREP SITE TRUNK/ARM/LEG EA ADDL 100 SQ CM/1% BODY AREA,15003,CPT,510,RC,51000189,CDM,,,,both,,,300.0000,45.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",300.00,,,,,,,60.5900,566.2300,percent of total billed charges,100% of $300.00 in Billed Charges for Rev 510 Proc 15003 = $300.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREP SITE TRUNK/ARM/LEG EA ADDL 100 SQ CM/1% BODY AREA,15003,CPT,510,RC,51000189,CDM,,,,both,,,300.0000,45.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,96.90,,,,,,,60.5900,566.2300,other,32.3% of $300.00 in Billed Charges for Rev 510 Proc 15003 = $96.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREP SITE TRUNK/ARM/LEG EA ADDL 100 SQ CM/1% BODY AREA,15003,CPT,510,RC,51000189,CDM,,,,both,,,300.0000,45.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,92.10,,,,,,,60.5900,566.2300,other,30.7% of $300.00 in Billed Charges for Rev 510 Proc 15003 = $92.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREP SITE TRUNK/ARM/LEG EA ADDL 100 SQ CM/1% BODY AREA,15003,CPT,510,RC,51000189,CDM,,,,both,,,300.0000,45.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,96.90,,,,,,,60.5900,566.2300,percent of total billed charges,32.3% of $300.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREP SITE TRUNK/ARM/LEG EA ADDL 100 SQ CM/1% BODY AREA,15003,CPT,510,RC,51000189,CDM,,,,both,,,300.0000,45.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,60.5900,566.2300,fee schedule,APG 00017 Proc 15003 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment) at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREP SITE TRUNK/ARM/LEG EA ADDL 100 SQ CM/1% BODY AREA,15003,CPT,510,RC,51000189,CDM,,,,both,,,300.0000,45.0000,WELLCARE,WELLCARE MEDICAID,300.00,,,,,,,60.5900,566.2300,percent of total billed charges,100% of $300.00 in Billed Charges for Rev 510 Proc 15003 = $300.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE GORTEX 26MM THX-26,272,RC,,,,,,,,both,,,802.0200,120.3000,AETNA,AETNA,342.46,,,,,,,207.0000,802.0200,percent of total billed charges,42.7% of $802.02 in Billed Charges for Rev 272 = $342.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE GORTEX 26MM THX-26,272,RC,,,,,,,,both,,,802.0200,120.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,561.41,,,,,,,207.0000,802.0200,percent of total billed charges,Rev 272 $802.02 in Billed Charges at 70% = $561.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE GORTEX 26MM THX-26,272,RC,,,,,,,,both,,,802.0200,120.3000,CIGNA HEALTHCARE,CIGNA HMO,334.44,,,,,,,207.0000,802.0200,percent of total billed charges,41.7% of $802.02 in Billed Charges for Rev 272 = $334.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE GORTEX 26MM THX-26,272,RC,,,,,,,,both,,,802.0200,120.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,372.14,,,,,,,207.0000,802.0200,percent of total billed charges,46.4% of $802.02 in Billed Charges for Rev 272 = $372.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE GORTEX 26MM THX-26,272,RC,,,,,,,,both,,,802.0200,120.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,334.44,,,,,,,207.0000,802.0200,percent of total billed charges,41.7% of $802.02 in Billed Charges for Rev 272 = $334.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE GORTEX 26MM THX-26,272,RC,,,,,,,,both,,,802.0200,120.3000,CIGNA HEALTHCARE,CIGNA PPO,334.44,,,,,,,207.0000,802.0200,percent of total billed charges,41.7% of $802.02 in Billed Charges for Rev 272 = $334.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE GORTEX 26MM THX-26,272,RC,,,,,,,,both,,,802.0200,120.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,721.82,,,,,,,207.0000,802.0200,percent of total billed charges,90% of $802.02 in Billed Charges for Rev 272 = $721.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE GORTEX 26MM THX-26,272,RC,,,,,,,,both,,,802.0200,120.3000,MEDCOST,MEDCOST VHN,381.68,,,,,,,207.0000,802.0200,percent of total billed charges,47.59% of $802.02 in Billed Charges for Rev 272 = $381.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE GORTEX 26MM THX-26,272,RC,,,,,,,,both,,,802.0200,120.3000,SENTARA HEALTH,SENTARA HEALTH,207.00,,,,,,,207.0000,802.0200,percent of total billed charges,25.81% of $802.02 in Billed Charges for Rev 272 = $207.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE GORTEX 26MM THX-26,272,RC,,,,,,,,both,,,802.0200,120.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",802.02,,,,,,,207.0000,802.0200,percent of total billed charges,100% of $802.02 in Billed Charges for Rev 272 = $802.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE GORTEX 26MM THX-26,272,RC,,,,,,,,both,,,802.0200,120.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,401.01,,,,,,,207.0000,802.0200,percent of total billed charges,Rev 272 $802.02 in Billed Charges at 50% = $401.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE GORTEX 26MM THX-26,272,RC,,,,,,,,both,,,802.0200,120.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,259.05,,,,,,,207.0000,802.0200,other,32.3% of $802.02 in Billed Charges for Rev 272 = $259.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE GORTEX 26MM THX-26,272,RC,,,,,,,,both,,,802.0200,120.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,246.22,,,,,,,207.0000,802.0200,other,30.7% of $802.02 in Billed Charges for Rev 272 = $246.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE GORTEX 26MM THX-26,272,RC,,,,,,,,both,,,802.0200,120.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,259.05,,,,,,,207.0000,802.0200,percent of total billed charges,32.3% of $802.02 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE GORTEX 26MM THX-26,272,RC,,,,,,,,both,,,802.0200,120.3000,WELLCARE,WELLCARE MEDICAID,802.02,,,,,,,207.0000,802.0200,percent of total billed charges,100% of $802.02 in Billed Charges for Rev 272 = $802.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,AETNA,AETNA,666.97,,,,,,,109.8600,1562.0000,percent of total billed charges,"42.7% of $1,562.00 in Billed Charges for Rev 510 Proc 15050 = $666.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,109.8600,1562.0000,fee schedule,"APG 00009 Proc 15050 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,670.54,,,,,,,109.8600,1562.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,AETNA,AETNA HEALTHCARE MEDICARE,670.54,,,,,,,109.8600,1562.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,670.54,,,,,,,109.8600,1562.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,AMBETTER,AMBETTER,1461.78,,,,,,,109.8600,1562.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,697.36,,,,,,,109.8600,1562.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,BLUE CROSS,ANTHEM EXCHANGE,1562.00,,,,,,,109.8600,1562.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,109.8600,1562.0000,fee schedule,"APG 00009 Proc 15050 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,BLUE CROSS,ANTHEM HMO,1562.00,,,,,,,109.8600,1562.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,690.66,,,,,,,109.8600,1562.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1562.00,,,,,,,109.8600,1562.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,255.77,,,,,,,109.8600,1562.0000,fee schedule,$255.77 from Fee Schedule BLDTM_23 for Rev 510 Proc 15050 * Qty 1 = $255.77 at 100% = $255.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,BLUE CROSS,BLUE CROSS MEDICARE,697.36,,,,,,,109.8600,1562.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,BLUE CROSS,TENNCARE BLUE CARE,109.86,,,,,,,109.8600,1562.0000,fee schedule,$94.71 from Fee Schedule TC_24 for Rev 510 Proc 15050 * Qty 1 = $94.71 at 116% = $109.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,BLUE CROSS,TENNCARE BLUE SELECT,109.86,,,,,,,109.8600,1562.0000,fee schedule,$94.71 from Fee Schedule TC_24 for Rev 510 Proc 15050 * Qty 1 = $94.71 at 116% = $109.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,CIGNA HEALTHCARE,CIGNA HMO,651.35,,,,,,,109.8600,1562.0000,percent of total billed charges,"41.7% of $1,562.00 in Billed Charges for Rev 510 Proc 15050 = $651.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,724.77,,,,,,,109.8600,1562.0000,percent of total billed charges,"46.4% of $1,562.00 in Billed Charges for Rev 510 Proc 15050 = $724.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,704.07,,,,,,,109.8600,1562.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,651.35,,,,,,,109.8600,1562.0000,percent of total billed charges,"41.7% of $1,562.00 in Billed Charges for Rev 510 Proc 15050 = $651.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,CIGNA HEALTHCARE,CIGNA PPO,651.35,,,,,,,109.8600,1562.0000,percent of total billed charges,"41.7% of $1,562.00 in Billed Charges for Rev 510 Proc 15050 = $651.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,704.07,,,,,,,109.8600,1562.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1405.80,,,,,,,109.8600,1562.0000,percent of total billed charges,"90% of $1,562.00 in Billed Charges for Rev 510 Proc 15050 = $1,405.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,HUMANA,HUMANA MEDICARE,670.54,,,,,,,109.8600,1562.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,670.54,,,,,,,109.8600,1562.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,MEDCOST,MEDCOST VHN,743.36,,,,,,,109.8600,1562.0000,percent of total billed charges,"47.59% of $1,562.00 in Billed Charges for Rev 510 Proc 15050 = $743.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,109.8600,1562.0000,fee schedule,"APG 00009 Proc 15050 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,704.07,,,,,,,109.8600,1562.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,704.07,,,,,,,109.8600,1562.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,NHC ADVANTAGE,NHC ADVANTAGE,704.07,,,,,,,109.8600,1562.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,109.8600,1562.0000,fee schedule,"APG 00009 Proc 15050 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,SENTARA HEALTH,SENTARA HEALTH,403.15,,,,,,,109.8600,1562.0000,percent of total billed charges,"25.81% of $1,562.00 in Billed Charges for Rev 510 Proc 15050 = $403.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,SENTARA HEALTH,SENTARA MEDICARE,670.54,,,,,,,109.8600,1562.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1562.00,,,,,,,109.8600,1562.0000,percent of total billed charges,"100% of $1,562.00 in Billed Charges for Rev 510 Proc 15050 = $1,562.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,215.06,,,,,,,109.8600,1562.0000,fee schedule,$430.12 from Fee Schedule TCUHC24 for Rev 510 Proc 15050 * Qty 1 = $430.12 at 50% = $215.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,504.53,,,,,,,109.8600,1562.0000,other,"32.3% of $1,562.00 in Billed Charges for Rev 510 Proc 15050 = $504.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,479.53,,,,,,,109.8600,1562.0000,other,"30.7% of $1,562.00 in Billed Charges for Rev 510 Proc 15050 = $479.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,504.53,,,,,,,109.8600,1562.0000,percent of total billed charges,"32.3% of $1,562.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,109.8600,1562.0000,fee schedule,"APG 00009 Proc 15050 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,670.54,,,,,,,109.8600,1562.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,670.54,,,,,,,109.8600,1562.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,WELLCARE,WELLCARE MEDICAID,1562.00,,,,,,,109.8600,1562.0000,percent of total billed charges,"100% of $1,562.00 in Billed Charges for Rev 510 Proc 15050 = $1,562.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PINCH GFT SNGL/MULTI UP TO 2 CM DIAMETER,15050,CPT,510,RC,51000096,CDM,,,,both,,,1562.0000,234.3000,WELLCARE,WELLCARE MEDICARE,710.77,,,,,,,109.8600,1562.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS EA ADDL 100 SQ CM,15111,CPT,510,RC,51000093,CDM,,,,both,,,1215.0000,182.2500,AETNA,AETNA,518.81,,,,,,,119.3000,2800.7000,percent of total billed charges,"42.7% of $1,215.00 in Billed Charges for Rev 510 Proc 15111 = $518.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS EA ADDL 100 SQ CM,15111,CPT,510,RC,51000093,CDM,,,,both,,,1215.0000,182.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2774.03,,,,,,,119.3000,2800.7000,fee schedule,"APG 00056 Proc 15111 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 104% = $2,774.03. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS EA ADDL 100 SQ CM,15111,CPT,510,RC,51000093,CDM,,,,both,,,1215.0000,182.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1215.00,,,,,,,119.3000,2800.7000,fee schedule,"APG 00056 Proc 15111 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 103% = $2,747.35 (Service Line reduced to $1,215.00, claim capped at $1,215.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS EA ADDL 100 SQ CM,15111,CPT,510,RC,51000093,CDM,,,,both,,,1215.0000,182.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,119.30,,,,,,,119.3000,2800.7000,fee schedule,$119.30 from Fee Schedule BLDTM_23 for Rev 510 Proc 15111 * Qty 1 = $119.30 at 100% = $119.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS EA ADDL 100 SQ CM,15111,CPT,510,RC,51000093,CDM,,,,both,,,1215.0000,182.2500,CIGNA HEALTHCARE,CIGNA HMO,506.66,,,,,,,119.3000,2800.7000,percent of total billed charges,"41.7% of $1,215.00 in Billed Charges for Rev 510 Proc 15111 = $506.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS EA ADDL 100 SQ CM,15111,CPT,510,RC,51000093,CDM,,,,both,,,1215.0000,182.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,563.76,,,,,,,119.3000,2800.7000,percent of total billed charges,"46.4% of $1,215.00 in Billed Charges for Rev 510 Proc 15111 = $563.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS EA ADDL 100 SQ CM,15111,CPT,510,RC,51000093,CDM,,,,both,,,1215.0000,182.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,506.66,,,,,,,119.3000,2800.7000,percent of total billed charges,"41.7% of $1,215.00 in Billed Charges for Rev 510 Proc 15111 = $506.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS EA ADDL 100 SQ CM,15111,CPT,510,RC,51000093,CDM,,,,both,,,1215.0000,182.2500,CIGNA HEALTHCARE,CIGNA PPO,506.66,,,,,,,119.3000,2800.7000,percent of total billed charges,"41.7% of $1,215.00 in Billed Charges for Rev 510 Proc 15111 = $506.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS EA ADDL 100 SQ CM,15111,CPT,510,RC,51000093,CDM,,,,both,,,1215.0000,182.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1093.50,,,,,,,119.3000,2800.7000,percent of total billed charges,"90% of $1,215.00 in Billed Charges for Rev 510 Proc 15111 = $1,093.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS EA ADDL 100 SQ CM,15111,CPT,510,RC,51000093,CDM,,,,both,,,1215.0000,182.2500,MEDCOST,MEDCOST VHN,578.22,,,,,,,119.3000,2800.7000,percent of total billed charges,"47.59% of $1,215.00 in Billed Charges for Rev 510 Proc 15111 = $578.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS EA ADDL 100 SQ CM,15111,CPT,510,RC,51000093,CDM,,,,both,,,1215.0000,182.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2800.70,,,,,,,119.3000,2800.7000,fee schedule,"APG 00056 Proc 15111 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 100% = $2,667.33... $2,667.33 at 105% = $2,800.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS EA ADDL 100 SQ CM,15111,CPT,510,RC,51000093,CDM,,,,both,,,1215.0000,182.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2750.02,,,,,,,119.3000,2800.7000,fee schedule,"APG 00056 Proc 15111 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 100% = $2,667.33... $2,667.33 at 103.1% = $2,750.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS EA ADDL 100 SQ CM,15111,CPT,510,RC,51000093,CDM,,,,both,,,1215.0000,182.2500,SENTARA HEALTH,SENTARA HEALTH,313.59,,,,,,,119.3000,2800.7000,percent of total billed charges,"25.81% of $1,215.00 in Billed Charges for Rev 510 Proc 15111 = $313.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS EA ADDL 100 SQ CM,15111,CPT,510,RC,51000093,CDM,,,,both,,,1215.0000,182.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1215.00,,,,,,,119.3000,2800.7000,percent of total billed charges,"100% of $1,215.00 in Billed Charges for Rev 510 Proc 15111 = $1,215.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS EA ADDL 100 SQ CM,15111,CPT,510,RC,51000093,CDM,,,,both,,,1215.0000,182.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,392.45,,,,,,,119.3000,2800.7000,other,"32.3% of $1,215.00 in Billed Charges for Rev 510 Proc 15111 = $392.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS EA ADDL 100 SQ CM,15111,CPT,510,RC,51000093,CDM,,,,both,,,1215.0000,182.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,373.01,,,,,,,119.3000,2800.7000,other,"30.7% of $1,215.00 in Billed Charges for Rev 510 Proc 15111 = $373.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS EA ADDL 100 SQ CM,15111,CPT,510,RC,51000093,CDM,,,,both,,,1215.0000,182.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,392.45,,,,,,,119.3000,2800.7000,percent of total billed charges,"32.3% of $1,215.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS EA ADDL 100 SQ CM,15111,CPT,510,RC,51000093,CDM,,,,both,,,1215.0000,182.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2747.35,,,,,,,119.3000,2800.7000,fee schedule,"APG 00056 Proc 15111 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 103% = $2,747.35. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS EA ADDL 100 SQ CM,15111,CPT,510,RC,51000093,CDM,,,,both,,,1215.0000,182.2500,WELLCARE,WELLCARE MEDICAID,1215.00,,,,,,,119.3000,2800.7000,percent of total billed charges,"100% of $1,215.00 in Billed Charges for Rev 510 Proc 15111 = $1,215.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G EA ADDL 100 SQ CM,15116,CPT,510,RC,51000095,CDM,,,,both,,,1215.0000,182.2500,AETNA,AETNA,518.81,,,,,,,155.2700,2800.7000,percent of total billed charges,"42.7% of $1,215.00 in Billed Charges for Rev 510 Proc 15116 = $518.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G EA ADDL 100 SQ CM,15116,CPT,510,RC,51000095,CDM,,,,both,,,1215.0000,182.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2774.03,,,,,,,155.2700,2800.7000,fee schedule,"APG 00056 Proc 15116 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 104% = $2,774.03. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G EA ADDL 100 SQ CM,15116,CPT,510,RC,51000095,CDM,,,,both,,,1215.0000,182.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1215.00,,,,,,,155.2700,2800.7000,fee schedule,"APG 00056 Proc 15116 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 103% = $2,747.35 (Service Line reduced to $1,215.00, claim capped at $1,215.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G EA ADDL 100 SQ CM,15116,CPT,510,RC,51000095,CDM,,,,both,,,1215.0000,182.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,155.27,,,,,,,155.2700,2800.7000,fee schedule,$155.27 from Fee Schedule BLDTM_23 for Rev 510 Proc 15116 * Qty 1 = $155.27 at 100% = $155.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G EA ADDL 100 SQ CM,15116,CPT,510,RC,51000095,CDM,,,,both,,,1215.0000,182.2500,CIGNA HEALTHCARE,CIGNA HMO,506.66,,,,,,,155.2700,2800.7000,percent of total billed charges,"41.7% of $1,215.00 in Billed Charges for Rev 510 Proc 15116 = $506.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G EA ADDL 100 SQ CM,15116,CPT,510,RC,51000095,CDM,,,,both,,,1215.0000,182.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,563.76,,,,,,,155.2700,2800.7000,percent of total billed charges,"46.4% of $1,215.00 in Billed Charges for Rev 510 Proc 15116 = $563.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G EA ADDL 100 SQ CM,15116,CPT,510,RC,51000095,CDM,,,,both,,,1215.0000,182.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,506.66,,,,,,,155.2700,2800.7000,percent of total billed charges,"41.7% of $1,215.00 in Billed Charges for Rev 510 Proc 15116 = $506.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G EA ADDL 100 SQ CM,15116,CPT,510,RC,51000095,CDM,,,,both,,,1215.0000,182.2500,CIGNA HEALTHCARE,CIGNA PPO,506.66,,,,,,,155.2700,2800.7000,percent of total billed charges,"41.7% of $1,215.00 in Billed Charges for Rev 510 Proc 15116 = $506.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G EA ADDL 100 SQ CM,15116,CPT,510,RC,51000095,CDM,,,,both,,,1215.0000,182.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1093.50,,,,,,,155.2700,2800.7000,percent of total billed charges,"90% of $1,215.00 in Billed Charges for Rev 510 Proc 15116 = $1,093.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G EA ADDL 100 SQ CM,15116,CPT,510,RC,51000095,CDM,,,,both,,,1215.0000,182.2500,MEDCOST,MEDCOST VHN,578.22,,,,,,,155.2700,2800.7000,percent of total billed charges,"47.59% of $1,215.00 in Billed Charges for Rev 510 Proc 15116 = $578.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G EA ADDL 100 SQ CM,15116,CPT,510,RC,51000095,CDM,,,,both,,,1215.0000,182.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2800.70,,,,,,,155.2700,2800.7000,fee schedule,"APG 00056 Proc 15116 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 100% = $2,667.33... $2,667.33 at 105% = $2,800.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G EA ADDL 100 SQ CM,15116,CPT,510,RC,51000095,CDM,,,,both,,,1215.0000,182.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2750.02,,,,,,,155.2700,2800.7000,fee schedule,"APG 00056 Proc 15116 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 100% = $2,667.33... $2,667.33 at 103.1% = $2,750.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G EA ADDL 100 SQ CM,15116,CPT,510,RC,51000095,CDM,,,,both,,,1215.0000,182.2500,SENTARA HEALTH,SENTARA HEALTH,313.59,,,,,,,155.2700,2800.7000,percent of total billed charges,"25.81% of $1,215.00 in Billed Charges for Rev 510 Proc 15116 = $313.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G EA ADDL 100 SQ CM,15116,CPT,510,RC,51000095,CDM,,,,both,,,1215.0000,182.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1215.00,,,,,,,155.2700,2800.7000,percent of total billed charges,"100% of $1,215.00 in Billed Charges for Rev 510 Proc 15116 = $1,215.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G EA ADDL 100 SQ CM,15116,CPT,510,RC,51000095,CDM,,,,both,,,1215.0000,182.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,392.45,,,,,,,155.2700,2800.7000,other,"32.3% of $1,215.00 in Billed Charges for Rev 510 Proc 15116 = $392.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G EA ADDL 100 SQ CM,15116,CPT,510,RC,51000095,CDM,,,,both,,,1215.0000,182.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,373.01,,,,,,,155.2700,2800.7000,other,"30.7% of $1,215.00 in Billed Charges for Rev 510 Proc 15116 = $373.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G EA ADDL 100 SQ CM,15116,CPT,510,RC,51000095,CDM,,,,both,,,1215.0000,182.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,392.45,,,,,,,155.2700,2800.7000,percent of total billed charges,"32.3% of $1,215.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G EA ADDL 100 SQ CM,15116,CPT,510,RC,51000095,CDM,,,,both,,,1215.0000,182.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2747.35,,,,,,,155.2700,2800.7000,fee schedule,"APG 00056 Proc 15116 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 103% = $2,747.35. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G EA ADDL 100 SQ CM,15116,CPT,510,RC,51000095,CDM,,,,both,,,1215.0000,182.2500,WELLCARE,WELLCARE MEDICAID,1215.00,,,,,,,155.2700,2800.7000,percent of total billed charges,"100% of $1,215.00 in Billed Charges for Rev 510 Proc 15116 = $1,215.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,AETNA,AETNA,1816.46,,,,,,,109.0000,4254.0000,percent of total billed charges,"42.7% of $4,254.00 in Billed Charges for Rev 450 Proc 15240 = $1,816.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2774.03,,,,,,,109.0000,4254.0000,fee schedule,"APG 00056 Proc 15240 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 104% = $2,774.03. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1871.96,,,,,,,109.0000,4254.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,AETNA,AETNA HEALTHCARE MEDICARE,1871.96,,,,,,,109.0000,4254.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,1871.96,,,,,,,109.0000,4254.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,AMBETTER,AMBETTER,4080.88,,,,,,,109.0000,4254.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1946.84,,,,,,,109.0000,4254.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,BLUE CROSS,ANTHEM EXCHANGE,4254.00,,,,,,,109.0000,4254.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2747.35,,,,,,,109.0000,4254.0000,fee schedule,"APG 00056 Proc 15240 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 103% = $2,747.35. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,BLUE CROSS,ANTHEM HMO,4254.00,,,,,,,109.0000,4254.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1928.12,,,,,,,109.0000,4254.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4254.00,,,,,,,109.0000,4254.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,599.61,,,,,,,109.0000,4254.0000,fee schedule,$599.61 from Fee Schedule BLDTM_23 for Rev 450 Proc 15240 * Qty 1 = $599.61 at 100% = $599.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,BLUE CROSS,BLUE CROSS MEDICARE,1946.84,,,,,,,109.0000,4254.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,1965.56,,,,,,,109.0000,4254.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1965.56,,,,,,,109.0000,4254.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3828.60,,,,,,,109.0000,4254.0000,percent of total billed charges,"90% of $4,254.00 in Billed Charges for Rev 450 Proc 15240 = $3,828.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,HUMANA,HUMANA MEDICARE,1871.96,,,,,,,109.0000,4254.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1871.96,,,,,,,109.0000,4254.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,MEDCOST,MEDCOST VHN,2024.48,,,,,,,109.0000,4254.0000,percent of total billed charges,"47.59% of $4,254.00 in Billed Charges for Rev 450 Proc 15240 = $2,024.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2800.70,,,,,,,109.0000,4254.0000,fee schedule,"APG 00056 Proc 15240 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 100% = $2,667.33... $2,667.33 at 105% = $2,800.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1965.56,,,,,,,109.0000,4254.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1965.56,,,,,,,109.0000,4254.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,NHC ADVANTAGE,NHC ADVANTAGE,1965.56,,,,,,,109.0000,4254.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2750.02,,,,,,,109.0000,4254.0000,fee schedule,"APG 00056 Proc 15240 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 100% = $2,667.33... $2,667.33 at 103.1% = $2,750.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,SENTARA HEALTH,SENTARA HEALTH,1097.96,,,,,,,109.0000,4254.0000,percent of total billed charges,"25.81% of $4,254.00 in Billed Charges for Rev 450 Proc 15240 = $1,097.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,SENTARA HEALTH,SENTARA MEDICARE,1871.96,,,,,,,109.0000,4254.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4254.00,,,,,,,109.0000,4254.0000,percent of total billed charges,"100% of $4,254.00 in Billed Charges for Rev 450 Proc 15240 = $4,254.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,4254.0000,case rate,Rev 450 Proc 15240 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,4254.0000,case rate,Rev 450 Proc 15240 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,4254.0000,case rate,Rev 450 Proc 15240 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,4254.0000,case rate,Rev 450 Proc 15240 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2747.35,,,,,,,109.0000,4254.0000,fee schedule,"APG 00056 Proc 15240 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 103% = $2,747.35. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1871.96,,,,,,,109.0000,4254.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1871.96,,,,,,,109.0000,4254.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,WELLCARE,WELLCARE MEDICAID,4254.00,,,,,,,109.0000,4254.0000,percent of total billed charges,"100% of $4,254.00 in Billed Charges for Rev 450 Proc 15240 = $4,254.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SKIN FULL GRFT FACE/GENIT/HF,15240,CPT,450,RC,45000013,CDM,,,,both,,,4254.0000,638.1000,WELLCARE,WELLCARE MEDICARE,1984.28,,,,,,,109.0000,4254.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE GUIDE GABBAY-FRATER,272,RC,27200002,CDM,,,,,,both,,,1263.6000,189.5400,AETNA,AETNA,539.56,,,,,,,326.1400,1263.6000,percent of total billed charges,"42.7% of $1,263.60 in Billed Charges for Rev 272 = $539.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE GUIDE GABBAY-FRATER,272,RC,27200002,CDM,,,,,,both,,,1263.6000,189.5400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,884.52,,,,,,,326.1400,1263.6000,percent of total billed charges,"Rev 272 $1,263.60 in Billed Charges at 70% = $884.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE GUIDE GABBAY-FRATER,272,RC,27200002,CDM,,,,,,both,,,1263.6000,189.5400,CIGNA HEALTHCARE,CIGNA HMO,526.92,,,,,,,326.1400,1263.6000,percent of total billed charges,"41.7% of $1,263.60 in Billed Charges for Rev 272 = $526.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE GUIDE GABBAY-FRATER,272,RC,27200002,CDM,,,,,,both,,,1263.6000,189.5400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,586.31,,,,,,,326.1400,1263.6000,percent of total billed charges,"46.4% of $1,263.60 in Billed Charges for Rev 272 = $586.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE GUIDE GABBAY-FRATER,272,RC,27200002,CDM,,,,,,both,,,1263.6000,189.5400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,526.92,,,,,,,326.1400,1263.6000,percent of total billed charges,"41.7% of $1,263.60 in Billed Charges for Rev 272 = $526.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE GUIDE GABBAY-FRATER,272,RC,27200002,CDM,,,,,,both,,,1263.6000,189.5400,CIGNA HEALTHCARE,CIGNA PPO,526.92,,,,,,,326.1400,1263.6000,percent of total billed charges,"41.7% of $1,263.60 in Billed Charges for Rev 272 = $526.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE GUIDE GABBAY-FRATER,272,RC,27200002,CDM,,,,,,both,,,1263.6000,189.5400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1137.24,,,,,,,326.1400,1263.6000,percent of total billed charges,"90% of $1,263.60 in Billed Charges for Rev 272 = $1,137.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE GUIDE GABBAY-FRATER,272,RC,27200002,CDM,,,,,,both,,,1263.6000,189.5400,MEDCOST,MEDCOST VHN,601.35,,,,,,,326.1400,1263.6000,percent of total billed charges,"47.59% of $1,263.60 in Billed Charges for Rev 272 = $601.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE GUIDE GABBAY-FRATER,272,RC,27200002,CDM,,,,,,both,,,1263.6000,189.5400,SENTARA HEALTH,SENTARA HEALTH,326.14,,,,,,,326.1400,1263.6000,percent of total billed charges,"25.81% of $1,263.60 in Billed Charges for Rev 272 = $326.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE GUIDE GABBAY-FRATER,272,RC,27200002,CDM,,,,,,both,,,1263.6000,189.5400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1263.60,,,,,,,326.1400,1263.6000,percent of total billed charges,"100% of $1,263.60 in Billed Charges for Rev 272 = $1,263.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE GUIDE GABBAY-FRATER,272,RC,27200002,CDM,,,,,,both,,,1263.6000,189.5400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,631.80,,,,,,,326.1400,1263.6000,percent of total billed charges,"Rev 272 $1,263.60 in Billed Charges at 50% = $631.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE GUIDE GABBAY-FRATER,272,RC,27200002,CDM,,,,,,both,,,1263.6000,189.5400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,408.14,,,,,,,326.1400,1263.6000,other,"32.3% of $1,263.60 in Billed Charges for Rev 272 = $408.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE GUIDE GABBAY-FRATER,272,RC,27200002,CDM,,,,,,both,,,1263.6000,189.5400,UNITED HEALTHCARE,UHC HERITAGE SELECT,387.93,,,,,,,326.1400,1263.6000,other,"30.7% of $1,263.60 in Billed Charges for Rev 272 = $387.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE GUIDE GABBAY-FRATER,272,RC,27200002,CDM,,,,,,both,,,1263.6000,189.5400,UNITED HEALTHCARE,UNITED HEALTHCARE,408.14,,,,,,,326.1400,1263.6000,percent of total billed charges,"32.3% of $1,263.60 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE GUIDE GABBAY-FRATER,272,RC,27200002,CDM,,,,,,both,,,1263.6000,189.5400,WELLCARE,WELLCARE MEDICAID,1263.60,,,,,,,326.1400,1263.6000,percent of total billed charges,"100% of $1,263.60 in Billed Charges for Rev 272 = $1,263.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15274,CPT,510,RC,51000064,CDM,,,,both,,,917.0000,137.5500,AETNA,AETNA,391.56,,,,,,,236.6800,2800.7000,percent of total billed charges,42.7% of $917.00 in Billed Charges for Rev 510 Proc 15274 = $391.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15274,CPT,510,RC,51000064,CDM,,,,both,,,917.0000,137.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2774.03,,,,,,,236.6800,2800.7000,fee schedule,"APG 00056 Proc 15274 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 104% = $2,774.03. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15274,CPT,510,RC,51000064,CDM,,,,both,,,917.0000,137.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,917.00,,,,,,,236.6800,2800.7000,fee schedule,"APG 00056 Proc 15274 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 103% = $2,747.35 (Service Line reduced to $917.00, claim capped at $917.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15274,CPT,510,RC,51000064,CDM,,,,both,,,917.0000,137.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,641.90,,,,,,,236.6800,2800.7000,percent of total billed charges,Rev 510 Proc 15274 $917.00 in Billed Charges at 70% = $641.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15274,CPT,510,RC,51000064,CDM,,,,both,,,917.0000,137.5500,CIGNA HEALTHCARE,CIGNA HMO,382.39,,,,,,,236.6800,2800.7000,percent of total billed charges,41.7% of $917.00 in Billed Charges for Rev 510 Proc 15274 = $382.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15274,CPT,510,RC,51000064,CDM,,,,both,,,917.0000,137.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,425.49,,,,,,,236.6800,2800.7000,percent of total billed charges,46.4% of $917.00 in Billed Charges for Rev 510 Proc 15274 = $425.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15274,CPT,510,RC,51000064,CDM,,,,both,,,917.0000,137.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,382.39,,,,,,,236.6800,2800.7000,percent of total billed charges,41.7% of $917.00 in Billed Charges for Rev 510 Proc 15274 = $382.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15274,CPT,510,RC,51000064,CDM,,,,both,,,917.0000,137.5500,CIGNA HEALTHCARE,CIGNA PPO,382.39,,,,,,,236.6800,2800.7000,percent of total billed charges,41.7% of $917.00 in Billed Charges for Rev 510 Proc 15274 = $382.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15274,CPT,510,RC,51000064,CDM,,,,both,,,917.0000,137.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,825.30,,,,,,,236.6800,2800.7000,percent of total billed charges,90% of $917.00 in Billed Charges for Rev 510 Proc 15274 = $825.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15274,CPT,510,RC,51000064,CDM,,,,both,,,917.0000,137.5500,MEDCOST,MEDCOST VHN,436.40,,,,,,,236.6800,2800.7000,percent of total billed charges,47.59% of $917.00 in Billed Charges for Rev 510 Proc 15274 = $436.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15274,CPT,510,RC,51000064,CDM,,,,both,,,917.0000,137.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2800.70,,,,,,,236.6800,2800.7000,fee schedule,"APG 00056 Proc 15274 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 100% = $2,667.33... $2,667.33 at 105% = $2,800.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15274,CPT,510,RC,51000064,CDM,,,,both,,,917.0000,137.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2750.02,,,,,,,236.6800,2800.7000,fee schedule,"APG 00056 Proc 15274 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 100% = $2,667.33... $2,667.33 at 103.1% = $2,750.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15274,CPT,510,RC,51000064,CDM,,,,both,,,917.0000,137.5500,SENTARA HEALTH,SENTARA HEALTH,236.68,,,,,,,236.6800,2800.7000,percent of total billed charges,25.81% of $917.00 in Billed Charges for Rev 510 Proc 15274 = $236.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15274,CPT,510,RC,51000064,CDM,,,,both,,,917.0000,137.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",917.00,,,,,,,236.6800,2800.7000,percent of total billed charges,100% of $917.00 in Billed Charges for Rev 510 Proc 15274 = $917.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15274,CPT,510,RC,51000064,CDM,,,,both,,,917.0000,137.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,296.19,,,,,,,236.6800,2800.7000,other,32.3% of $917.00 in Billed Charges for Rev 510 Proc 15274 = $296.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15274,CPT,510,RC,51000064,CDM,,,,both,,,917.0000,137.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,281.52,,,,,,,236.6800,2800.7000,other,30.7% of $917.00 in Billed Charges for Rev 510 Proc 15274 = $281.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15274,CPT,510,RC,51000064,CDM,,,,both,,,917.0000,137.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,296.19,,,,,,,236.6800,2800.7000,percent of total billed charges,32.3% of $917.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15274,CPT,510,RC,51000064,CDM,,,,both,,,917.0000,137.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2747.35,,,,,,,236.6800,2800.7000,fee schedule,"APG 00056 Proc 15274 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 103% = $2,747.35. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15274,CPT,510,RC,51000064,CDM,,,,both,,,917.0000,137.5500,WELLCARE,WELLCARE MEDICAID,917.00,,,,,,,236.6800,2800.7000,percent of total billed charges,100% of $917.00 in Billed Charges for Rev 510 Proc 15274 = $917.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,AETNA,AETNA,1063.23,,,,,,,642.6700,2800.7000,percent of total billed charges,"42.7% of $2,490.00 in Billed Charges for Rev 510 Proc 15275 = $1,063.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2774.03,,,,,,,642.6700,2800.7000,fee schedule,"APG 00056 Proc 15275 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 104% = $2,774.03. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,670.54,,,,,,,642.6700,2800.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,AETNA,AETNA HEALTHCARE MEDICARE,670.54,,,,,,,642.6700,2800.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,670.54,,,,,,,642.6700,2800.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,AMBETTER,AMBETTER,1461.78,,,,,,,642.6700,2800.7000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,697.36,,,,,,,642.6700,2800.7000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,BLUE CROSS,ANTHEM EXCHANGE,1650.91,,,,,,,642.6700,2800.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2490.00,,,,,,,642.6700,2800.7000,fee schedule,"APG 00056 Proc 15275 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 103% = $2,747.35 (Service Line reduced to $2,490.00, claim capped at $2,490.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,BLUE CROSS,ANTHEM HMO,1753.99,,,,,,,642.6700,2800.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,690.66,,,,,,,642.6700,2800.7000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2063.41,,,,,,,642.6700,2800.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1743.00,,,,,,,642.6700,2800.7000,percent of total billed charges,"Rev 510 Proc 15275 $2,490.00 in Billed Charges at 70% = $1,743.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,BLUE CROSS,BLUE CROSS MEDICARE,697.36,,,,,,,642.6700,2800.7000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,CIGNA HEALTHCARE,CIGNA HMO,1038.33,,,,,,,642.6700,2800.7000,percent of total billed charges,"41.7% of $2,490.00 in Billed Charges for Rev 510 Proc 15275 = $1,038.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1155.36,,,,,,,642.6700,2800.7000,percent of total billed charges,"46.4% of $2,490.00 in Billed Charges for Rev 510 Proc 15275 = $1,155.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,704.07,,,,,,,642.6700,2800.7000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1038.33,,,,,,,642.6700,2800.7000,percent of total billed charges,"41.7% of $2,490.00 in Billed Charges for Rev 510 Proc 15275 = $1,038.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,CIGNA HEALTHCARE,CIGNA PPO,1038.33,,,,,,,642.6700,2800.7000,percent of total billed charges,"41.7% of $2,490.00 in Billed Charges for Rev 510 Proc 15275 = $1,038.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,704.07,,,,,,,642.6700,2800.7000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2241.00,,,,,,,642.6700,2800.7000,percent of total billed charges,"90% of $2,490.00 in Billed Charges for Rev 510 Proc 15275 = $2,241.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,HUMANA,HUMANA MEDICARE,670.54,,,,,,,642.6700,2800.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,670.54,,,,,,,642.6700,2800.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,MEDCOST,MEDCOST VHN,1184.99,,,,,,,642.6700,2800.7000,percent of total billed charges,"47.59% of $2,490.00 in Billed Charges for Rev 510 Proc 15275 = $1,184.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2800.70,,,,,,,642.6700,2800.7000,fee schedule,"APG 00056 Proc 15275 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 100% = $2,667.33... $2,667.33 at 105% = $2,800.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,704.07,,,,,,,642.6700,2800.7000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,704.07,,,,,,,642.6700,2800.7000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,NHC ADVANTAGE,NHC ADVANTAGE,704.07,,,,,,,642.6700,2800.7000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2750.02,,,,,,,642.6700,2800.7000,fee schedule,"APG 00056 Proc 15275 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 100% = $2,667.33... $2,667.33 at 103.1% = $2,750.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,SENTARA HEALTH,SENTARA HEALTH,642.67,,,,,,,642.6700,2800.7000,percent of total billed charges,"25.81% of $2,490.00 in Billed Charges for Rev 510 Proc 15275 = $642.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,SENTARA HEALTH,SENTARA MEDICARE,670.54,,,,,,,642.6700,2800.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2490.00,,,,,,,642.6700,2800.7000,percent of total billed charges,"100% of $2,490.00 in Billed Charges for Rev 510 Proc 15275 = $2,490.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,703.71,,,,,,,642.6700,2800.7000,fee schedule,"$1,407.42 from Fee Schedule TCUHC24 for Rev 510 Proc 15275 * Qty 1 = $1,407.42 at 50% = $703.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,804.27,,,,,,,642.6700,2800.7000,other,"32.3% of $2,490.00 in Billed Charges for Rev 510 Proc 15275 = $804.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,764.43,,,,,,,642.6700,2800.7000,other,"30.7% of $2,490.00 in Billed Charges for Rev 510 Proc 15275 = $764.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,804.27,,,,,,,642.6700,2800.7000,percent of total billed charges,"32.3% of $2,490.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2747.35,,,,,,,642.6700,2800.7000,fee schedule,"APG 00056 Proc 15275 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 103% = $2,747.35. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,670.54,,,,,,,642.6700,2800.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,670.54,,,,,,,642.6700,2800.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,WELLCARE,WELLCARE MEDICAID,2490.00,,,,,,,642.6700,2800.7000,percent of total billed charges,"100% of $2,490.00 in Billed Charges for Rev 510 Proc 15275 = $2,490.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SKIN SUB FACE/SCALP/FEET <25CM,15275,CPT,510,RC,51000022,CDM,,,,both,,,2490.0000,373.5000,WELLCARE,WELLCARE MEDICARE,710.77,,,,,,,642.6700,2800.7000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB FACE/SCALP/FEET ADD25,15276,CPT,510,RC,51000023,CDM,,,,both,,,175.0000,26.2500,AETNA,AETNA,74.73,,,,,,,45.1700,2800.7000,percent of total billed charges,42.7% of $175.00 in Billed Charges for Rev 510 Proc 15276 = $74.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC SKIN SUB FACE/SCALP/FEET ADD25,15276,CPT,510,RC,51000023,CDM,,,,both,,,175.0000,26.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2774.03,,,,,,,45.1700,2800.7000,fee schedule,"APG 00056 Proc 15276 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 104% = $2,774.03. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB FACE/SCALP/FEET ADD25,15276,CPT,510,RC,51000023,CDM,,,,both,,,175.0000,26.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,175.00,,,,,,,45.1700,2800.7000,fee schedule,"APG 00056 Proc 15276 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 103% = $2,747.35 (Service Line reduced to $175.00, claim capped at $175.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB FACE/SCALP/FEET ADD25,15276,CPT,510,RC,51000023,CDM,,,,both,,,175.0000,26.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,122.50,,,,,,,45.1700,2800.7000,percent of total billed charges,Rev 510 Proc 15276 $175.00 in Billed Charges at 70% = $122.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC SKIN SUB FACE/SCALP/FEET ADD25,15276,CPT,510,RC,51000023,CDM,,,,both,,,175.0000,26.2500,CIGNA HEALTHCARE,CIGNA HMO,72.98,,,,,,,45.1700,2800.7000,percent of total billed charges,41.7% of $175.00 in Billed Charges for Rev 510 Proc 15276 = $72.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC SKIN SUB FACE/SCALP/FEET ADD25,15276,CPT,510,RC,51000023,CDM,,,,both,,,175.0000,26.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,81.20,,,,,,,45.1700,2800.7000,percent of total billed charges,46.4% of $175.00 in Billed Charges for Rev 510 Proc 15276 = $81.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC SKIN SUB FACE/SCALP/FEET ADD25,15276,CPT,510,RC,51000023,CDM,,,,both,,,175.0000,26.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,72.98,,,,,,,45.1700,2800.7000,percent of total billed charges,41.7% of $175.00 in Billed Charges for Rev 510 Proc 15276 = $72.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC SKIN SUB FACE/SCALP/FEET ADD25,15276,CPT,510,RC,51000023,CDM,,,,both,,,175.0000,26.2500,CIGNA HEALTHCARE,CIGNA PPO,72.98,,,,,,,45.1700,2800.7000,percent of total billed charges,41.7% of $175.00 in Billed Charges for Rev 510 Proc 15276 = $72.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC SKIN SUB FACE/SCALP/FEET ADD25,15276,CPT,510,RC,51000023,CDM,,,,both,,,175.0000,26.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,157.50,,,,,,,45.1700,2800.7000,percent of total billed charges,90% of $175.00 in Billed Charges for Rev 510 Proc 15276 = $157.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC SKIN SUB FACE/SCALP/FEET ADD25,15276,CPT,510,RC,51000023,CDM,,,,both,,,175.0000,26.2500,MEDCOST,MEDCOST VHN,83.28,,,,,,,45.1700,2800.7000,percent of total billed charges,47.59% of $175.00 in Billed Charges for Rev 510 Proc 15276 = $83.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC SKIN SUB FACE/SCALP/FEET ADD25,15276,CPT,510,RC,51000023,CDM,,,,both,,,175.0000,26.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2800.70,,,,,,,45.1700,2800.7000,fee schedule,"APG 00056 Proc 15276 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 100% = $2,667.33... $2,667.33 at 105% = $2,800.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB FACE/SCALP/FEET ADD25,15276,CPT,510,RC,51000023,CDM,,,,both,,,175.0000,26.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2750.02,,,,,,,45.1700,2800.7000,fee schedule,"APG 00056 Proc 15276 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 100% = $2,667.33... $2,667.33 at 103.1% = $2,750.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB FACE/SCALP/FEET ADD25,15276,CPT,510,RC,51000023,CDM,,,,both,,,175.0000,26.2500,SENTARA HEALTH,SENTARA HEALTH,45.17,,,,,,,45.1700,2800.7000,percent of total billed charges,25.81% of $175.00 in Billed Charges for Rev 510 Proc 15276 = $45.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC SKIN SUB FACE/SCALP/FEET ADD25,15276,CPT,510,RC,51000023,CDM,,,,both,,,175.0000,26.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",175.00,,,,,,,45.1700,2800.7000,percent of total billed charges,100% of $175.00 in Billed Charges for Rev 510 Proc 15276 = $175.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC SKIN SUB FACE/SCALP/FEET ADD25,15276,CPT,510,RC,51000023,CDM,,,,both,,,175.0000,26.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,56.53,,,,,,,45.1700,2800.7000,other,32.3% of $175.00 in Billed Charges for Rev 510 Proc 15276 = $56.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB FACE/SCALP/FEET ADD25,15276,CPT,510,RC,51000023,CDM,,,,both,,,175.0000,26.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,53.73,,,,,,,45.1700,2800.7000,other,30.7% of $175.00 in Billed Charges for Rev 510 Proc 15276 = $53.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB FACE/SCALP/FEET ADD25,15276,CPT,510,RC,51000023,CDM,,,,both,,,175.0000,26.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,56.53,,,,,,,45.1700,2800.7000,percent of total billed charges,32.3% of $175.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC SKIN SUB FACE/SCALP/FEET ADD25,15276,CPT,510,RC,51000023,CDM,,,,both,,,175.0000,26.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2747.35,,,,,,,45.1700,2800.7000,fee schedule,"APG 00056 Proc 15276 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 103% = $2,747.35. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB FACE/SCALP/FEET ADD25,15276,CPT,510,RC,51000023,CDM,,,,both,,,175.0000,26.2500,WELLCARE,WELLCARE MEDICAID,175.00,,,,,,,45.1700,2800.7000,percent of total billed charges,100% of $175.00 in Billed Charges for Rev 510 Proc 15276 = $175.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15278,CPT,510,RC,51000066,CDM,,,,both,,,917.0000,137.5500,AETNA,AETNA,391.56,,,,,,,236.6800,2800.7000,percent of total billed charges,42.7% of $917.00 in Billed Charges for Rev 510 Proc 15278 = $391.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15278,CPT,510,RC,51000066,CDM,,,,both,,,917.0000,137.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2774.03,,,,,,,236.6800,2800.7000,fee schedule,"APG 00056 Proc 15278 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 104% = $2,774.03. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15278,CPT,510,RC,51000066,CDM,,,,both,,,917.0000,137.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,917.00,,,,,,,236.6800,2800.7000,fee schedule,"APG 00056 Proc 15278 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 103% = $2,747.35 (Service Line reduced to $917.00, claim capped at $917.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15278,CPT,510,RC,51000066,CDM,,,,both,,,917.0000,137.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,641.90,,,,,,,236.6800,2800.7000,percent of total billed charges,Rev 510 Proc 15278 $917.00 in Billed Charges at 70% = $641.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15278,CPT,510,RC,51000066,CDM,,,,both,,,917.0000,137.5500,CIGNA HEALTHCARE,CIGNA HMO,382.39,,,,,,,236.6800,2800.7000,percent of total billed charges,41.7% of $917.00 in Billed Charges for Rev 510 Proc 15278 = $382.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15278,CPT,510,RC,51000066,CDM,,,,both,,,917.0000,137.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,425.49,,,,,,,236.6800,2800.7000,percent of total billed charges,46.4% of $917.00 in Billed Charges for Rev 510 Proc 15278 = $425.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15278,CPT,510,RC,51000066,CDM,,,,both,,,917.0000,137.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,382.39,,,,,,,236.6800,2800.7000,percent of total billed charges,41.7% of $917.00 in Billed Charges for Rev 510 Proc 15278 = $382.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15278,CPT,510,RC,51000066,CDM,,,,both,,,917.0000,137.5500,CIGNA HEALTHCARE,CIGNA PPO,382.39,,,,,,,236.6800,2800.7000,percent of total billed charges,41.7% of $917.00 in Billed Charges for Rev 510 Proc 15278 = $382.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15278,CPT,510,RC,51000066,CDM,,,,both,,,917.0000,137.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,825.30,,,,,,,236.6800,2800.7000,percent of total billed charges,90% of $917.00 in Billed Charges for Rev 510 Proc 15278 = $825.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15278,CPT,510,RC,51000066,CDM,,,,both,,,917.0000,137.5500,MEDCOST,MEDCOST VHN,436.40,,,,,,,236.6800,2800.7000,percent of total billed charges,47.59% of $917.00 in Billed Charges for Rev 510 Proc 15278 = $436.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15278,CPT,510,RC,51000066,CDM,,,,both,,,917.0000,137.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2800.70,,,,,,,236.6800,2800.7000,fee schedule,"APG 00056 Proc 15278 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 100% = $2,667.33... $2,667.33 at 105% = $2,800.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15278,CPT,510,RC,51000066,CDM,,,,both,,,917.0000,137.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2750.02,,,,,,,236.6800,2800.7000,fee schedule,"APG 00056 Proc 15278 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 100% = $2,667.33... $2,667.33 at 103.1% = $2,750.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15278,CPT,510,RC,51000066,CDM,,,,both,,,917.0000,137.5500,SENTARA HEALTH,SENTARA HEALTH,236.68,,,,,,,236.6800,2800.7000,percent of total billed charges,25.81% of $917.00 in Billed Charges for Rev 510 Proc 15278 = $236.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15278,CPT,510,RC,51000066,CDM,,,,both,,,917.0000,137.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",917.00,,,,,,,236.6800,2800.7000,percent of total billed charges,100% of $917.00 in Billed Charges for Rev 510 Proc 15278 = $917.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15278,CPT,510,RC,51000066,CDM,,,,both,,,917.0000,137.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,296.19,,,,,,,236.6800,2800.7000,other,32.3% of $917.00 in Billed Charges for Rev 510 Proc 15278 = $296.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15278,CPT,510,RC,51000066,CDM,,,,both,,,917.0000,137.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,281.52,,,,,,,236.6800,2800.7000,other,30.7% of $917.00 in Billed Charges for Rev 510 Proc 15278 = $281.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15278,CPT,510,RC,51000066,CDM,,,,both,,,917.0000,137.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,296.19,,,,,,,236.6800,2800.7000,percent of total billed charges,32.3% of $917.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15278,CPT,510,RC,51000066,CDM,,,,both,,,917.0000,137.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2747.35,,,,,,,236.6800,2800.7000,fee schedule,"APG 00056 Proc 15278 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 103% = $2,747.35. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM EA ADDL 100SQ CM WSA OR EA ADDL 1% BA INF/CHILD,15278,CPT,510,RC,51000066,CDM,,,,both,,,917.0000,137.5500,WELLCARE,WELLCARE MEDICAID,917.00,,,,,,,236.6800,2800.7000,percent of total billed charges,100% of $917.00 in Billed Charges for Rev 510 Proc 15278 = $917.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA,584.99,,,,,,,109.0000,3180.3800,percent of total billed charges,"42.7% of $1,370.00 in Billed Charges for Rev 450 Proc 24655 = $584.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24655 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA HEALTHCARE MEDICARE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,3180.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1370.00,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM EXCHANGE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24655 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM HMO,1370.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1370.00,,,,,,,109.0000,3180.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1370.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,340.66,,,,,,,109.0000,3180.3800,fee schedule,$340.66 from Fee Schedule BLDTM_23 for Rev 450 Proc 24655 * Qty 1 = $340.66 at 100% = $340.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1233.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"90% of $1,370.00 in Billed Charges for Rev 450 Proc 24655 = $1,233.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,HUMANA,HUMANA MEDICARE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,MEDCOST,MEDCOST VHN,651.98,,,,,,,109.0000,3180.3800,percent of total billed charges,"47.59% of $1,370.00 in Billed Charges for Rev 450 Proc 24655 = $651.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24655 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,NHC ADVANTAGE,NHC ADVANTAGE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24655 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,SENTARA HEALTH,SENTARA HEALTH,353.60,,,,,,,109.0000,3180.3800,percent of total billed charges,"25.81% of $1,370.00 in Billed Charges for Rev 450 Proc 24655 = $353.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,SENTARA HEALTH,SENTARA MEDICARE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1370.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,370.00 in Billed Charges for Rev 450 Proc 24655 = $1,370.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 24655 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 24655 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 24655 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 24655 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24655 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1370.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,WELLCARE,WELLCARE MEDICAID,1370.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,370.00 in Billed Charges for Rev 450 Proc 24655 = $1,370.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RAD H N FX W MANIP,24655,CPT,450,RC,45000121,CDM,,,,both,,,1370.0000,205.5000,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,3180.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SYSTEM LAPAROSCOPIC MEDIUM 5-9CML W/12 X 100MM KII FIOS FIRST ENTRY ALEXIS,272,RC,27200002,CDM,,,,,,both,,,2986.8500,448.0300,AETNA,AETNA,1275.39,,,,,,,770.9100,2986.8500,percent of total billed charges,"42.7% of $2,986.85 in Billed Charges for Rev 272 = $1,275.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM LAPAROSCOPIC MEDIUM 5-9CML W/12 X 100MM KII FIOS FIRST ENTRY ALEXIS,272,RC,27200002,CDM,,,,,,both,,,2986.8500,448.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2090.80,,,,,,,770.9100,2986.8500,percent of total billed charges,"Rev 272 $2,986.85 in Billed Charges at 70% = $2,090.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM LAPAROSCOPIC MEDIUM 5-9CML W/12 X 100MM KII FIOS FIRST ENTRY ALEXIS,272,RC,27200002,CDM,,,,,,both,,,2986.8500,448.0300,CIGNA HEALTHCARE,CIGNA HMO,1245.52,,,,,,,770.9100,2986.8500,percent of total billed charges,"41.7% of $2,986.85 in Billed Charges for Rev 272 = $1,245.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM LAPAROSCOPIC MEDIUM 5-9CML W/12 X 100MM KII FIOS FIRST ENTRY ALEXIS,272,RC,27200002,CDM,,,,,,both,,,2986.8500,448.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1385.90,,,,,,,770.9100,2986.8500,percent of total billed charges,"46.4% of $2,986.85 in Billed Charges for Rev 272 = $1,385.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM LAPAROSCOPIC MEDIUM 5-9CML W/12 X 100MM KII FIOS FIRST ENTRY ALEXIS,272,RC,27200002,CDM,,,,,,both,,,2986.8500,448.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1245.52,,,,,,,770.9100,2986.8500,percent of total billed charges,"41.7% of $2,986.85 in Billed Charges for Rev 272 = $1,245.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM LAPAROSCOPIC MEDIUM 5-9CML W/12 X 100MM KII FIOS FIRST ENTRY ALEXIS,272,RC,27200002,CDM,,,,,,both,,,2986.8500,448.0300,CIGNA HEALTHCARE,CIGNA PPO,1245.52,,,,,,,770.9100,2986.8500,percent of total billed charges,"41.7% of $2,986.85 in Billed Charges for Rev 272 = $1,245.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM LAPAROSCOPIC MEDIUM 5-9CML W/12 X 100MM KII FIOS FIRST ENTRY ALEXIS,272,RC,27200002,CDM,,,,,,both,,,2986.8500,448.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2688.17,,,,,,,770.9100,2986.8500,percent of total billed charges,"90% of $2,986.85 in Billed Charges for Rev 272 = $2,688.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM LAPAROSCOPIC MEDIUM 5-9CML W/12 X 100MM KII FIOS FIRST ENTRY ALEXIS,272,RC,27200002,CDM,,,,,,both,,,2986.8500,448.0300,MEDCOST,MEDCOST VHN,1421.44,,,,,,,770.9100,2986.8500,percent of total billed charges,"47.59% of $2,986.85 in Billed Charges for Rev 272 = $1,421.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM LAPAROSCOPIC MEDIUM 5-9CML W/12 X 100MM KII FIOS FIRST ENTRY ALEXIS,272,RC,27200002,CDM,,,,,,both,,,2986.8500,448.0300,SENTARA HEALTH,SENTARA HEALTH,770.91,,,,,,,770.9100,2986.8500,percent of total billed charges,"25.81% of $2,986.85 in Billed Charges for Rev 272 = $770.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM LAPAROSCOPIC MEDIUM 5-9CML W/12 X 100MM KII FIOS FIRST ENTRY ALEXIS,272,RC,27200002,CDM,,,,,,both,,,2986.8500,448.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2986.85,,,,,,,770.9100,2986.8500,percent of total billed charges,"100% of $2,986.85 in Billed Charges for Rev 272 = $2,986.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM LAPAROSCOPIC MEDIUM 5-9CML W/12 X 100MM KII FIOS FIRST ENTRY ALEXIS,272,RC,27200002,CDM,,,,,,both,,,2986.8500,448.0300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1493.43,,,,,,,770.9100,2986.8500,percent of total billed charges,"Rev 272 $2,986.85 in Billed Charges at 50% = $1,493.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM LAPAROSCOPIC MEDIUM 5-9CML W/12 X 100MM KII FIOS FIRST ENTRY ALEXIS,272,RC,27200002,CDM,,,,,,both,,,2986.8500,448.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,964.75,,,,,,,770.9100,2986.8500,other,"32.3% of $2,986.85 in Billed Charges for Rev 272 = $964.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM LAPAROSCOPIC MEDIUM 5-9CML W/12 X 100MM KII FIOS FIRST ENTRY ALEXIS,272,RC,27200002,CDM,,,,,,both,,,2986.8500,448.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,916.96,,,,,,,770.9100,2986.8500,other,"30.7% of $2,986.85 in Billed Charges for Rev 272 = $916.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM LAPAROSCOPIC MEDIUM 5-9CML W/12 X 100MM KII FIOS FIRST ENTRY ALEXIS,272,RC,27200002,CDM,,,,,,both,,,2986.8500,448.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,964.75,,,,,,,770.9100,2986.8500,percent of total billed charges,"32.3% of $2,986.85 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM LAPAROSCOPIC MEDIUM 5-9CML W/12 X 100MM KII FIOS FIRST ENTRY ALEXIS,272,RC,27200002,CDM,,,,,,both,,,2986.8500,448.0300,WELLCARE,WELLCARE MEDICAID,2986.85,,,,,,,770.9100,2986.8500,percent of total billed charges,"100% of $2,986.85 in Billed Charges for Rev 272 = $2,986.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM MIS ILLUMINATION,272,RC,,,,,,,,both,,,13108.9400,1966.3400,AETNA,AETNA,5597.52,,,,,,,3383.4200,13108.9400,percent of total billed charges,"42.7% of $13,108.94 in Billed Charges for Rev 272 = $5,597.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM MIS ILLUMINATION,272,RC,,,,,,,,both,,,13108.9400,1966.3400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9176.26,,,,,,,3383.4200,13108.9400,percent of total billed charges,"Rev 272 $13,108.94 in Billed Charges at 70% = $9,176.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM MIS ILLUMINATION,272,RC,,,,,,,,both,,,13108.9400,1966.3400,CIGNA HEALTHCARE,CIGNA HMO,5466.43,,,,,,,3383.4200,13108.9400,percent of total billed charges,"41.7% of $13,108.94 in Billed Charges for Rev 272 = $5,466.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM MIS ILLUMINATION,272,RC,,,,,,,,both,,,13108.9400,1966.3400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6082.55,,,,,,,3383.4200,13108.9400,percent of total billed charges,"46.4% of $13,108.94 in Billed Charges for Rev 272 = $6,082.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM MIS ILLUMINATION,272,RC,,,,,,,,both,,,13108.9400,1966.3400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5466.43,,,,,,,3383.4200,13108.9400,percent of total billed charges,"41.7% of $13,108.94 in Billed Charges for Rev 272 = $5,466.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM MIS ILLUMINATION,272,RC,,,,,,,,both,,,13108.9400,1966.3400,CIGNA HEALTHCARE,CIGNA PPO,5466.43,,,,,,,3383.4200,13108.9400,percent of total billed charges,"41.7% of $13,108.94 in Billed Charges for Rev 272 = $5,466.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM MIS ILLUMINATION,272,RC,,,,,,,,both,,,13108.9400,1966.3400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11798.05,,,,,,,3383.4200,13108.9400,percent of total billed charges,"90% of $13,108.94 in Billed Charges for Rev 272 = $11,798.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM MIS ILLUMINATION,272,RC,,,,,,,,both,,,13108.9400,1966.3400,MEDCOST,MEDCOST VHN,6238.54,,,,,,,3383.4200,13108.9400,percent of total billed charges,"47.59% of $13,108.94 in Billed Charges for Rev 272 = $6,238.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM MIS ILLUMINATION,272,RC,,,,,,,,both,,,13108.9400,1966.3400,SENTARA HEALTH,SENTARA HEALTH,3383.42,,,,,,,3383.4200,13108.9400,percent of total billed charges,"25.81% of $13,108.94 in Billed Charges for Rev 272 = $3,383.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM MIS ILLUMINATION,272,RC,,,,,,,,both,,,13108.9400,1966.3400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13108.94,,,,,,,3383.4200,13108.9400,percent of total billed charges,"100% of $13,108.94 in Billed Charges for Rev 272 = $13,108.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM MIS ILLUMINATION,272,RC,,,,,,,,both,,,13108.9400,1966.3400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6554.47,,,,,,,3383.4200,13108.9400,percent of total billed charges,"Rev 272 $13,108.94 in Billed Charges at 50% = $6,554.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM MIS ILLUMINATION,272,RC,,,,,,,,both,,,13108.9400,1966.3400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4234.19,,,,,,,3383.4200,13108.9400,other,"32.3% of $13,108.94 in Billed Charges for Rev 272 = $4,234.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM MIS ILLUMINATION,272,RC,,,,,,,,both,,,13108.9400,1966.3400,UNITED HEALTHCARE,UHC HERITAGE SELECT,4024.44,,,,,,,3383.4200,13108.9400,other,"30.7% of $13,108.94 in Billed Charges for Rev 272 = $4,024.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM MIS ILLUMINATION,272,RC,,,,,,,,both,,,13108.9400,1966.3400,UNITED HEALTHCARE,UNITED HEALTHCARE,4234.19,,,,,,,3383.4200,13108.9400,percent of total billed charges,"32.3% of $13,108.94 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM MIS ILLUMINATION,272,RC,,,,,,,,both,,,13108.9400,1966.3400,WELLCARE,WELLCARE MEDICAID,13108.94,,,,,,,3383.4200,13108.9400,percent of total billed charges,"100% of $13,108.94 in Billed Charges for Rev 272 = $13,108.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM PUMP CONTINOUS FLOW SINGLE ACTION VACUUM 10CC SYRINGE,272,RC,27200002,CDM,,,,,,both,,,597.9900,89.7000,AETNA,AETNA,255.34,,,,,,,154.3400,597.9900,percent of total billed charges,42.7% of $597.99 in Billed Charges for Rev 272 = $255.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP CONTINOUS FLOW SINGLE ACTION VACUUM 10CC SYRINGE,272,RC,27200002,CDM,,,,,,both,,,597.9900,89.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,418.59,,,,,,,154.3400,597.9900,percent of total billed charges,Rev 272 $597.99 in Billed Charges at 70% = $418.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP CONTINOUS FLOW SINGLE ACTION VACUUM 10CC SYRINGE,272,RC,27200002,CDM,,,,,,both,,,597.9900,89.7000,CIGNA HEALTHCARE,CIGNA HMO,249.36,,,,,,,154.3400,597.9900,percent of total billed charges,41.7% of $597.99 in Billed Charges for Rev 272 = $249.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP CONTINOUS FLOW SINGLE ACTION VACUUM 10CC SYRINGE,272,RC,27200002,CDM,,,,,,both,,,597.9900,89.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,277.47,,,,,,,154.3400,597.9900,percent of total billed charges,46.4% of $597.99 in Billed Charges for Rev 272 = $277.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP CONTINOUS FLOW SINGLE ACTION VACUUM 10CC SYRINGE,272,RC,27200002,CDM,,,,,,both,,,597.9900,89.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,249.36,,,,,,,154.3400,597.9900,percent of total billed charges,41.7% of $597.99 in Billed Charges for Rev 272 = $249.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP CONTINOUS FLOW SINGLE ACTION VACUUM 10CC SYRINGE,272,RC,27200002,CDM,,,,,,both,,,597.9900,89.7000,CIGNA HEALTHCARE,CIGNA PPO,249.36,,,,,,,154.3400,597.9900,percent of total billed charges,41.7% of $597.99 in Billed Charges for Rev 272 = $249.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP CONTINOUS FLOW SINGLE ACTION VACUUM 10CC SYRINGE,272,RC,27200002,CDM,,,,,,both,,,597.9900,89.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,538.19,,,,,,,154.3400,597.9900,percent of total billed charges,90% of $597.99 in Billed Charges for Rev 272 = $538.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP CONTINOUS FLOW SINGLE ACTION VACUUM 10CC SYRINGE,272,RC,27200002,CDM,,,,,,both,,,597.9900,89.7000,MEDCOST,MEDCOST VHN,284.58,,,,,,,154.3400,597.9900,percent of total billed charges,47.59% of $597.99 in Billed Charges for Rev 272 = $284.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP CONTINOUS FLOW SINGLE ACTION VACUUM 10CC SYRINGE,272,RC,27200002,CDM,,,,,,both,,,597.9900,89.7000,SENTARA HEALTH,SENTARA HEALTH,154.34,,,,,,,154.3400,597.9900,percent of total billed charges,25.81% of $597.99 in Billed Charges for Rev 272 = $154.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP CONTINOUS FLOW SINGLE ACTION VACUUM 10CC SYRINGE,272,RC,27200002,CDM,,,,,,both,,,597.9900,89.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",597.99,,,,,,,154.3400,597.9900,percent of total billed charges,100% of $597.99 in Billed Charges for Rev 272 = $597.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP CONTINOUS FLOW SINGLE ACTION VACUUM 10CC SYRINGE,272,RC,27200002,CDM,,,,,,both,,,597.9900,89.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,299.00,,,,,,,154.3400,597.9900,percent of total billed charges,Rev 272 $597.99 in Billed Charges at 50% = $299.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP CONTINOUS FLOW SINGLE ACTION VACUUM 10CC SYRINGE,272,RC,27200002,CDM,,,,,,both,,,597.9900,89.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,193.15,,,,,,,154.3400,597.9900,other,32.3% of $597.99 in Billed Charges for Rev 272 = $193.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SYSTEM PUMP CONTINOUS FLOW SINGLE ACTION VACUUM 10CC SYRINGE,272,RC,27200002,CDM,,,,,,both,,,597.9900,89.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,183.58,,,,,,,154.3400,597.9900,other,30.7% of $597.99 in Billed Charges for Rev 272 = $183.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SYSTEM PUMP CONTINOUS FLOW SINGLE ACTION VACUUM 10CC SYRINGE,272,RC,27200002,CDM,,,,,,both,,,597.9900,89.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,193.15,,,,,,,154.3400,597.9900,percent of total billed charges,32.3% of $597.99 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP CONTINOUS FLOW SINGLE ACTION VACUUM 10CC SYRINGE,272,RC,27200002,CDM,,,,,,both,,,597.9900,89.7000,WELLCARE,WELLCARE MEDICAID,597.99,,,,,,,154.3400,597.9900,percent of total billed charges,100% of $597.99 in Billed Charges for Rev 272 = $597.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,658.2300,98.7300,AETNA,AETNA,281.06,,,,,,,169.8900,658.2300,percent of total billed charges,42.7% of $658.23 in Billed Charges for Rev 272 = $281.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,658.2300,98.7300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,460.76,,,,,,,169.8900,658.2300,percent of total billed charges,Rev 272 $658.23 in Billed Charges at 70% = $460.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,658.2300,98.7300,CIGNA HEALTHCARE,CIGNA HMO,274.48,,,,,,,169.8900,658.2300,percent of total billed charges,41.7% of $658.23 in Billed Charges for Rev 272 = $274.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,658.2300,98.7300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,305.42,,,,,,,169.8900,658.2300,percent of total billed charges,46.4% of $658.23 in Billed Charges for Rev 272 = $305.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,658.2300,98.7300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,274.48,,,,,,,169.8900,658.2300,percent of total billed charges,41.7% of $658.23 in Billed Charges for Rev 272 = $274.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,658.2300,98.7300,CIGNA HEALTHCARE,CIGNA PPO,274.48,,,,,,,169.8900,658.2300,percent of total billed charges,41.7% of $658.23 in Billed Charges for Rev 272 = $274.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,658.2300,98.7300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,592.41,,,,,,,169.8900,658.2300,percent of total billed charges,90% of $658.23 in Billed Charges for Rev 272 = $592.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,658.2300,98.7300,MEDCOST,MEDCOST VHN,313.25,,,,,,,169.8900,658.2300,percent of total billed charges,47.59% of $658.23 in Billed Charges for Rev 272 = $313.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,658.2300,98.7300,SENTARA HEALTH,SENTARA HEALTH,169.89,,,,,,,169.8900,658.2300,percent of total billed charges,25.81% of $658.23 in Billed Charges for Rev 272 = $169.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,658.2300,98.7300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",658.23,,,,,,,169.8900,658.2300,percent of total billed charges,100% of $658.23 in Billed Charges for Rev 272 = $658.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,658.2300,98.7300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,329.12,,,,,,,169.8900,658.2300,percent of total billed charges,Rev 272 $658.23 in Billed Charges at 50% = $329.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,658.2300,98.7300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,212.61,,,,,,,169.8900,658.2300,other,32.3% of $658.23 in Billed Charges for Rev 272 = $212.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,658.2300,98.7300,UNITED HEALTHCARE,UHC HERITAGE SELECT,202.08,,,,,,,169.8900,658.2300,other,30.7% of $658.23 in Billed Charges for Rev 272 = $202.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,658.2300,98.7300,UNITED HEALTHCARE,UNITED HEALTHCARE,212.61,,,,,,,169.8900,658.2300,percent of total billed charges,32.3% of $658.23 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,658.2300,98.7300,WELLCARE,WELLCARE MEDICAID,658.23,,,,,,,169.8900,658.2300,percent of total billed charges,100% of $658.23 in Billed Charges for Rev 272 = $658.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,AETNA,AETNA,544.00,,,,,,,109.0000,1274.0000,percent of total billed charges,"42.7% of $1,274.00 in Billed Charges for Rev 450 Proc 24670 = $544.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,1274.0000,fee schedule,"APG 00041 Proc 24670 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,1274.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,1274.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,1274.0000,fee schedule,"APG 00041 Proc 24670 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,1274.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,213.02,,,,,,,109.0000,1274.0000,fee schedule,$213.02 from Fee Schedule BLDTM_23 for Rev 450 Proc 24670 * Qty 1 = $213.02 at 100% = $213.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,1274.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1146.60,,,,,,,109.0000,1274.0000,percent of total billed charges,"90% of $1,274.00 in Billed Charges for Rev 450 Proc 24670 = $1,146.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,MEDCOST,MEDCOST VHN,606.30,,,,,,,109.0000,1274.0000,percent of total billed charges,"47.59% of $1,274.00 in Billed Charges for Rev 450 Proc 24670 = $606.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,1274.0000,fee schedule,"APG 00041 Proc 24670 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,1274.0000,fee schedule,"APG 00041 Proc 24670 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,SENTARA HEALTH,SENTARA HEALTH,328.82,,,,,,,109.0000,1274.0000,percent of total billed charges,"25.81% of $1,274.00 in Billed Charges for Rev 450 Proc 24670 = $328.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1274.00,,,,,,,109.0000,1274.0000,percent of total billed charges,"100% of $1,274.00 in Billed Charges for Rev 450 Proc 24670 = $1,274.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1274.0000,case rate,Rev 450 Proc 24670 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1274.0000,case rate,Rev 450 Proc 24670 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1274.0000,case rate,Rev 450 Proc 24670 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1274.0000,case rate,Rev 450 Proc 24670 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,1274.0000,fee schedule,"APG 00041 Proc 24670 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,WELLCARE,WELLCARE MEDICAID,1274.00,,,,,,,109.0000,1274.0000,percent of total billed charges,"100% of $1,274.00 in Billed Charges for Rev 450 Proc 24670 = $1,274.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX ULNAR FX PROX WO MAN,24670,CPT,450,RC,45000122,CDM,,,,both,,,1274.0000,191.1000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,1274.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,AETNA,AETNA,4113.29,,,,,,,109.0000,9633.0000,percent of total billed charges,"42.7% of $9,633.00 in Billed Charges for Rev 450 Proc 25028 = $4,113.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2480.03,,,,,,,109.0000,9633.0000,fee schedule,"APG 00023 Proc 25028 at $836.60 (Base Rate) * 2.8504 (Relative Weight) = $2,384.64 (Total Line Payment) at 104% = $2,480.03. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2968.60,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,AETNA,AETNA HEALTHCARE MEDICARE,2968.60,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,2968.60,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,AMBETTER,AMBETTER,6471.55,,,,,,,109.0000,9633.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3087.35,,,,,,,109.0000,9633.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,BLUE CROSS,ANTHEM EXCHANGE,7308.87,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2456.18,,,,,,,109.0000,9633.0000,fee schedule,"APG 00023 Proc 25028 at $836.60 (Base Rate) * 2.8504 (Relative Weight) = $2,384.64 (Total Line Payment) at 103% = $2,456.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,BLUE CROSS,ANTHEM HMO,7765.24,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3057.66,,,,,,,109.0000,9633.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9135.08,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,302.83,,,,,,,109.0000,9633.0000,fee schedule,$302.83 from Fee Schedule BLDTM_23 for Rev 450 Proc 25028 * Qty 1 = $302.83 at 100% = $302.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,BLUE CROSS,BLUE CROSS MEDICARE,3087.35,,,,,,,109.0000,9633.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,3117.03,,,,,,,109.0000,9633.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3117.03,,,,,,,109.0000,9633.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8669.70,,,,,,,109.0000,9633.0000,percent of total billed charges,"90% of $9,633.00 in Billed Charges for Rev 450 Proc 25028 = $8,669.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,HUMANA,HUMANA MEDICARE,2968.60,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2968.60,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,MEDCOST,MEDCOST VHN,4584.34,,,,,,,109.0000,9633.0000,percent of total billed charges,"47.59% of $9,633.00 in Billed Charges for Rev 450 Proc 25028 = $4,584.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2503.87,,,,,,,109.0000,9633.0000,fee schedule,"APG 00023 Proc 25028 at $836.60 (Base Rate) * 2.8504 (Relative Weight) = $2,384.64 (Total Line Payment) at 100% = $2,384.64... $2,384.64 at 105% = $2,503.87 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3117.03,,,,,,,109.0000,9633.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3117.03,,,,,,,109.0000,9633.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,NHC ADVANTAGE,NHC ADVANTAGE,3117.03,,,,,,,109.0000,9633.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2458.56,,,,,,,109.0000,9633.0000,fee schedule,"APG 00023 Proc 25028 at $836.60 (Base Rate) * 2.8504 (Relative Weight) = $2,384.64 (Total Line Payment) at 100% = $2,384.64... $2,384.64 at 103.1% = $2,458.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,SENTARA HEALTH,SENTARA HEALTH,2486.28,,,,,,,109.0000,9633.0000,percent of total billed charges,"25.81% of $9,633.00 in Billed Charges for Rev 450 Proc 25028 = $2,486.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,SENTARA HEALTH,SENTARA MEDICARE,2968.60,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9633.00,,,,,,,109.0000,9633.0000,percent of total billed charges,"100% of $9,633.00 in Billed Charges for Rev 450 Proc 25028 = $9,633.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,9633.0000,case rate,Rev 450 Proc 25028 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,9633.0000,case rate,Rev 450 Proc 25028 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,9633.0000,case rate,Rev 450 Proc 25028 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,9633.0000,case rate,Rev 450 Proc 25028 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2456.18,,,,,,,109.0000,9633.0000,fee schedule,"APG 00023 Proc 25028 at $836.60 (Base Rate) * 2.8504 (Relative Weight) = $2,384.64 (Total Line Payment) at 103% = $2,456.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2968.60,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2968.60,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,WELLCARE,WELLCARE MEDICAID,9633.00,,,,,,,109.0000,9633.0000,percent of total billed charges,"100% of $9,633.00 in Billed Charges for Rev 450 Proc 25028 = $9,633.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID FOREARM/WRIST DEEP ABSC/HEMATOMA,25028,CPT,450,RC,45000382,CDM,,,,both,,,9633.0000,1444.9500,WELLCARE,WELLCARE MEDICARE,3146.72,,,,,,,109.0000,9633.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA,2059.42,,,,,,,109.0000,4823.0000,percent of total billed charges,"42.7% of $4,823.00 in Billed Charges for Rev 450 Proc 25031 = $2,059.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2480.03,,,,,,,109.0000,4823.0000,fee schedule,"APG 00023 Proc 25031 at $836.60 (Base Rate) * 2.8504 (Relative Weight) = $2,384.64 (Total Line Payment) at 104% = $2,480.03. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,4823.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,4823.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2456.18,,,,,,,109.0000,4823.0000,fee schedule,"APG 00023 Proc 25031 at $836.60 (Base Rate) * 2.8504 (Relative Weight) = $2,384.64 (Total Line Payment) at 103% = $2,456.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,4823.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4489.34,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,221.45,,,,,,,109.0000,4823.0000,fee schedule,$221.45 from Fee Schedule BLDTM_23 for Rev 450 Proc 25031 * Qty 1 = $221.45 at 100% = $221.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,4823.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4340.70,,,,,,,109.0000,4823.0000,percent of total billed charges,"90% of $4,823.00 in Billed Charges for Rev 450 Proc 25031 = $4,340.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,MEDCOST,MEDCOST VHN,2295.27,,,,,,,109.0000,4823.0000,percent of total billed charges,"47.59% of $4,823.00 in Billed Charges for Rev 450 Proc 25031 = $2,295.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2503.87,,,,,,,109.0000,4823.0000,fee schedule,"APG 00023 Proc 25031 at $836.60 (Base Rate) * 2.8504 (Relative Weight) = $2,384.64 (Total Line Payment) at 100% = $2,384.64... $2,384.64 at 105% = $2,503.87 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2458.56,,,,,,,109.0000,4823.0000,fee schedule,"APG 00023 Proc 25031 at $836.60 (Base Rate) * 2.8504 (Relative Weight) = $2,384.64 (Total Line Payment) at 100% = $2,384.64... $2,384.64 at 103.1% = $2,458.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,SENTARA HEALTH,SENTARA HEALTH,1244.82,,,,,,,109.0000,4823.0000,percent of total billed charges,"25.81% of $4,823.00 in Billed Charges for Rev 450 Proc 25031 = $1,244.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4823.00,,,,,,,109.0000,4823.0000,percent of total billed charges,"100% of $4,823.00 in Billed Charges for Rev 450 Proc 25031 = $4,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 25031 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 25031 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 25031 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 25031 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2456.18,,,,,,,109.0000,4823.0000,fee schedule,"APG 00023 Proc 25031 at $836.60 (Base Rate) * 2.8504 (Relative Weight) = $2,384.64 (Total Line Payment) at 103% = $2,456.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,WELLCARE,WELLCARE MEDICAID,4823.00,,,,,,,109.0000,4823.0000,percent of total billed charges,"100% of $4,823.00 in Billed Charges for Rev 450 Proc 25031 = $4,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID FOREARM/WRIST BURSA,25031,CPT,450,RC,45000383,CDM,,,,both,,,4823.0000,723.4500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,4823.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,AETNA,AETNA,1971.03,,,,,,,109.0000,6471.5500,percent of total billed charges,"42.7% of $4,616.00 in Billed Charges for Rev 450 Proc 25260 = $1,971.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2480.03,,,,,,,109.0000,6471.5500,fee schedule,"APG 00023 Proc 25260 at $836.60 (Base Rate) * 2.8504 (Relative Weight) = $2,384.64 (Total Line Payment) at 104% = $2,480.03. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2968.60,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,AETNA,AETNA HEALTHCARE MEDICARE,2968.60,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,2968.60,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,AMBETTER,AMBETTER,6471.55,,,,,,,109.0000,6471.5500,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3087.35,,,,,,,109.0000,6471.5500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,BLUE CROSS,ANTHEM EXCHANGE,4616.00,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2456.18,,,,,,,109.0000,6471.5500,fee schedule,"APG 00023 Proc 25260 at $836.60 (Base Rate) * 2.8504 (Relative Weight) = $2,384.64 (Total Line Payment) at 103% = $2,456.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,BLUE CROSS,ANTHEM HMO,4616.00,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3057.66,,,,,,,109.0000,6471.5500,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4616.00,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,504.44,,,,,,,109.0000,6471.5500,fee schedule,$504.44 from Fee Schedule BLDTM_23 for Rev 450 Proc 25260 * Qty 1 = $504.44 at 100% = $504.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,BLUE CROSS,BLUE CROSS MEDICARE,3087.35,,,,,,,109.0000,6471.5500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,3117.03,,,,,,,109.0000,6471.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3117.03,,,,,,,109.0000,6471.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4154.40,,,,,,,109.0000,6471.5500,percent of total billed charges,"90% of $4,616.00 in Billed Charges for Rev 450 Proc 25260 = $4,154.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,HUMANA,HUMANA MEDICARE,2968.60,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2968.60,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,MEDCOST,MEDCOST VHN,2196.75,,,,,,,109.0000,6471.5500,percent of total billed charges,"47.59% of $4,616.00 in Billed Charges for Rev 450 Proc 25260 = $2,196.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2503.87,,,,,,,109.0000,6471.5500,fee schedule,"APG 00023 Proc 25260 at $836.60 (Base Rate) * 2.8504 (Relative Weight) = $2,384.64 (Total Line Payment) at 100% = $2,384.64... $2,384.64 at 105% = $2,503.87 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3117.03,,,,,,,109.0000,6471.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3117.03,,,,,,,109.0000,6471.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,NHC ADVANTAGE,NHC ADVANTAGE,3117.03,,,,,,,109.0000,6471.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2458.56,,,,,,,109.0000,6471.5500,fee schedule,"APG 00023 Proc 25260 at $836.60 (Base Rate) * 2.8504 (Relative Weight) = $2,384.64 (Total Line Payment) at 100% = $2,384.64... $2,384.64 at 103.1% = $2,458.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,SENTARA HEALTH,SENTARA HEALTH,1191.39,,,,,,,109.0000,6471.5500,percent of total billed charges,"25.81% of $4,616.00 in Billed Charges for Rev 450 Proc 25260 = $1,191.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,SENTARA HEALTH,SENTARA MEDICARE,2968.60,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4616.00,,,,,,,109.0000,6471.5500,percent of total billed charges,"100% of $4,616.00 in Billed Charges for Rev 450 Proc 25260 = $4,616.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,6471.5500,case rate,Rev 450 Proc 25260 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,6471.5500,case rate,Rev 450 Proc 25260 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,6471.5500,case rate,Rev 450 Proc 25260 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,6471.5500,case rate,Rev 450 Proc 25260 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2456.18,,,,,,,109.0000,6471.5500,fee schedule,"APG 00023 Proc 25260 at $836.60 (Base Rate) * 2.8504 (Relative Weight) = $2,384.64 (Total Line Payment) at 103% = $2,456.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2968.60,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2968.60,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,WELLCARE,WELLCARE MEDICAID,4616.00,,,,,,,109.0000,6471.5500,percent of total billed charges,"100% of $4,616.00 in Billed Charges for Rev 450 Proc 25260 = $4,616.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RPR FOREARM FLEX TENDN/MUSC EA,25260,CPT,450,RC,45000124,CDM,,,,both,,,4616.0000,692.4000,WELLCARE,WELLCARE MEDICARE,3146.72,,,,,,,109.0000,6471.5500,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA,584.99,,,,,,,109.0000,3180.3800,percent of total billed charges,"42.7% of $1,370.00 in Billed Charges for Rev 450 Proc 25505 = $584.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25505 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA HEALTHCARE MEDICARE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,3180.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1370.00,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM EXCHANGE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25505 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM HMO,1370.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1370.00,,,,,,,109.0000,3180.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1370.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,345.71,,,,,,,109.0000,3180.3800,fee schedule,$345.71 from Fee Schedule BLDTM_23 for Rev 450 Proc 25505 * Qty 1 = $345.71 at 100% = $345.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1233.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"90% of $1,370.00 in Billed Charges for Rev 450 Proc 25505 = $1,233.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,HUMANA,HUMANA MEDICARE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,MEDCOST,MEDCOST VHN,651.98,,,,,,,109.0000,3180.3800,percent of total billed charges,"47.59% of $1,370.00 in Billed Charges for Rev 450 Proc 25505 = $651.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25505 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,NHC ADVANTAGE,NHC ADVANTAGE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25505 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,SENTARA HEALTH,SENTARA HEALTH,353.60,,,,,,,109.0000,3180.3800,percent of total billed charges,"25.81% of $1,370.00 in Billed Charges for Rev 450 Proc 25505 = $353.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,SENTARA HEALTH,SENTARA MEDICARE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1370.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,370.00 in Billed Charges for Rev 450 Proc 25505 = $1,370.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 25505 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 25505 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 25505 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 25505 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25505 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1370.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1370.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,WELLCARE,WELLCARE MEDICAID,1370.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,370.00 in Billed Charges for Rev 450 Proc 25505 = $1,370.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RAD SHAFT FX W MANIP,25505,CPT,450,RC,45000126,CDM,,,,both,,,1370.0000,205.5000,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,3180.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA,2059.42,,,,,,,109.0000,4823.0000,percent of total billed charges,"42.7% of $4,823.00 in Billed Charges for Rev 450 Proc 25520 = $2,059.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 25520 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,4823.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,4823.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 25520 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,4823.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4489.34,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,446.31,,,,,,,109.0000,4823.0000,fee schedule,$446.31 from Fee Schedule BLDTM_23 for Rev 450 Proc 25520 * Qty 1 = $446.31 at 100% = $446.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,4823.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4340.70,,,,,,,109.0000,4823.0000,percent of total billed charges,"90% of $4,823.00 in Billed Charges for Rev 450 Proc 25520 = $4,340.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,MEDCOST,MEDCOST VHN,2295.27,,,,,,,109.0000,4823.0000,percent of total billed charges,"47.59% of $4,823.00 in Billed Charges for Rev 450 Proc 25520 = $2,295.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 25520 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 25520 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,SENTARA HEALTH,SENTARA HEALTH,1244.82,,,,,,,109.0000,4823.0000,percent of total billed charges,"25.81% of $4,823.00 in Billed Charges for Rev 450 Proc 25520 = $1,244.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4823.00,,,,,,,109.0000,4823.0000,percent of total billed charges,"100% of $4,823.00 in Billed Charges for Rev 450 Proc 25520 = $4,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 25520 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 25520 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 25520 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 25520 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 25520 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,WELLCARE,WELLCARE MEDICAID,4823.00,,,,,,,109.0000,4823.0000,percent of total billed charges,"100% of $4,823.00 in Billed Charges for Rev 450 Proc 25520 = $4,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RDL SHFT FX & CLSD TX DISLOC DSTL RAD/ULN JT,25520,CPT,450,RC,45000384,CDM,,,,both,,,4823.0000,723.4500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,4823.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA,603.35,,,,,,,109.0000,1413.0000,percent of total billed charges,"42.7% of $1,413.00 in Billed Charges for Rev 450 Proc 25535 = $603.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 25535 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,1413.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,1413.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 25535 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,1413.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,340.52,,,,,,,109.0000,1413.0000,fee schedule,$340.52 from Fee Schedule BLDTM_23 for Rev 450 Proc 25535 * Qty 1 = $340.52 at 100% = $340.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,1413.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1271.70,,,,,,,109.0000,1413.0000,percent of total billed charges,"90% of $1,413.00 in Billed Charges for Rev 450 Proc 25535 = $1,271.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,MEDCOST,MEDCOST VHN,672.45,,,,,,,109.0000,1413.0000,percent of total billed charges,"47.59% of $1,413.00 in Billed Charges for Rev 450 Proc 25535 = $672.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 25535 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 25535 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA HEALTH,364.70,,,,,,,109.0000,1413.0000,percent of total billed charges,"25.81% of $1,413.00 in Billed Charges for Rev 450 Proc 25535 = $364.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1413.00,,,,,,,109.0000,1413.0000,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 25535 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 25535 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 25535 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 25535 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 25535 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 25535 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICAID,1413.00,,,,,,,109.0000,1413.0000,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 25535 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ULNAR SHAFT FRACTURE W/O MANIP,25535,CPT,450,RC,45000128,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,1413.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,AETNA,AETNA,783.55,,,,,,,109.0000,3180.3800,percent of total billed charges,"42.7% of $1,835.00 in Billed Charges for Rev 450 Proc 25565 = $783.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25565 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,3180.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,BLUE CROSS,ANTHEM EXCHANGE,1835.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25565 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,BLUE CROSS,ANTHEM HMO,1835.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,3180.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1835.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,393.59,,,,,,,109.0000,3180.3800,fee schedule,$393.59 from Fee Schedule BLDTM_23 for Rev 450 Proc 25565 * Qty 1 = $393.59 at 100% = $393.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1651.50,,,,,,,109.0000,3180.3800,percent of total billed charges,"90% of $1,835.00 in Billed Charges for Rev 450 Proc 25565 = $1,651.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,MEDCOST,MEDCOST VHN,873.28,,,,,,,109.0000,3180.3800,percent of total billed charges,"47.59% of $1,835.00 in Billed Charges for Rev 450 Proc 25565 = $873.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25565 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25565 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,SENTARA HEALTH,SENTARA HEALTH,473.61,,,,,,,109.0000,3180.3800,percent of total billed charges,"25.81% of $1,835.00 in Billed Charges for Rev 450 Proc 25565 = $473.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1835.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,835.00 in Billed Charges for Rev 450 Proc 25565 = $1,835.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 25565 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 25565 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 25565 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 25565 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25565 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,WELLCARE,WELLCARE MEDICAID,1835.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,835.00 in Billed Charges for Rev 450 Proc 25565 = $1,835.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RAD&ULN SHAFT FX W MAN,25565,CPT,450,RC,45000130,CDM,,,,both,,,1835.0000,275.2500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,3180.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,890.3900,133.5600,AETNA,AETNA,380.20,,,,,,,229.8100,890.3900,percent of total billed charges,42.7% of $890.39 in Billed Charges for Rev 272 = $380.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,890.3900,133.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,623.27,,,,,,,229.8100,890.3900,percent of total billed charges,Rev 272 $890.39 in Billed Charges at 70% = $623.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,890.3900,133.5600,CIGNA HEALTHCARE,CIGNA HMO,371.29,,,,,,,229.8100,890.3900,percent of total billed charges,41.7% of $890.39 in Billed Charges for Rev 272 = $371.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,890.3900,133.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,413.14,,,,,,,229.8100,890.3900,percent of total billed charges,46.4% of $890.39 in Billed Charges for Rev 272 = $413.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,890.3900,133.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,371.29,,,,,,,229.8100,890.3900,percent of total billed charges,41.7% of $890.39 in Billed Charges for Rev 272 = $371.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,890.3900,133.5600,CIGNA HEALTHCARE,CIGNA PPO,371.29,,,,,,,229.8100,890.3900,percent of total billed charges,41.7% of $890.39 in Billed Charges for Rev 272 = $371.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,890.3900,133.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,801.35,,,,,,,229.8100,890.3900,percent of total billed charges,90% of $890.39 in Billed Charges for Rev 272 = $801.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,890.3900,133.5600,MEDCOST,MEDCOST VHN,423.74,,,,,,,229.8100,890.3900,percent of total billed charges,47.59% of $890.39 in Billed Charges for Rev 272 = $423.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,890.3900,133.5600,SENTARA HEALTH,SENTARA HEALTH,229.81,,,,,,,229.8100,890.3900,percent of total billed charges,25.81% of $890.39 in Billed Charges for Rev 272 = $229.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,890.3900,133.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",890.39,,,,,,,229.8100,890.3900,percent of total billed charges,100% of $890.39 in Billed Charges for Rev 272 = $890.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,890.3900,133.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,445.20,,,,,,,229.8100,890.3900,percent of total billed charges,Rev 272 $890.39 in Billed Charges at 50% = $445.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,890.3900,133.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,287.60,,,,,,,229.8100,890.3900,other,32.3% of $890.39 in Billed Charges for Rev 272 = $287.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,890.3900,133.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,273.35,,,,,,,229.8100,890.3900,other,30.7% of $890.39 in Billed Charges for Rev 272 = $273.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,890.3900,133.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,287.60,,,,,,,229.8100,890.3900,percent of total billed charges,32.3% of $890.39 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM PUMP SINGLE ACTION 10CC VACUUM SYRINGE,272,RC,27200002,CDM,,,,,,both,,,890.3900,133.5600,WELLCARE,WELLCARE MEDICAID,890.39,,,,,,,229.8100,890.3900,percent of total billed charges,100% of $890.39 in Billed Charges for Rev 272 = $890.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM RETENTION PANNUS 4 PAD 2 STRAP STERILE,272,RC,27200002,CDM,,,,,,both,,,689.6700,103.4500,AETNA,AETNA,294.49,,,,,,,178.0000,689.6700,percent of total billed charges,42.7% of $689.67 in Billed Charges for Rev 272 = $294.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM RETENTION PANNUS 4 PAD 2 STRAP STERILE,272,RC,27200002,CDM,,,,,,both,,,689.6700,103.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,482.77,,,,,,,178.0000,689.6700,percent of total billed charges,Rev 272 $689.67 in Billed Charges at 70% = $482.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM RETENTION PANNUS 4 PAD 2 STRAP STERILE,272,RC,27200002,CDM,,,,,,both,,,689.6700,103.4500,CIGNA HEALTHCARE,CIGNA HMO,287.59,,,,,,,178.0000,689.6700,percent of total billed charges,41.7% of $689.67 in Billed Charges for Rev 272 = $287.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM RETENTION PANNUS 4 PAD 2 STRAP STERILE,272,RC,27200002,CDM,,,,,,both,,,689.6700,103.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,320.01,,,,,,,178.0000,689.6700,percent of total billed charges,46.4% of $689.67 in Billed Charges for Rev 272 = $320.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM RETENTION PANNUS 4 PAD 2 STRAP STERILE,272,RC,27200002,CDM,,,,,,both,,,689.6700,103.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,287.59,,,,,,,178.0000,689.6700,percent of total billed charges,41.7% of $689.67 in Billed Charges for Rev 272 = $287.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM RETENTION PANNUS 4 PAD 2 STRAP STERILE,272,RC,27200002,CDM,,,,,,both,,,689.6700,103.4500,CIGNA HEALTHCARE,CIGNA PPO,287.59,,,,,,,178.0000,689.6700,percent of total billed charges,41.7% of $689.67 in Billed Charges for Rev 272 = $287.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM RETENTION PANNUS 4 PAD 2 STRAP STERILE,272,RC,27200002,CDM,,,,,,both,,,689.6700,103.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,620.70,,,,,,,178.0000,689.6700,percent of total billed charges,90% of $689.67 in Billed Charges for Rev 272 = $620.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM RETENTION PANNUS 4 PAD 2 STRAP STERILE,272,RC,27200002,CDM,,,,,,both,,,689.6700,103.4500,MEDCOST,MEDCOST VHN,328.21,,,,,,,178.0000,689.6700,percent of total billed charges,47.59% of $689.67 in Billed Charges for Rev 272 = $328.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM RETENTION PANNUS 4 PAD 2 STRAP STERILE,272,RC,27200002,CDM,,,,,,both,,,689.6700,103.4500,SENTARA HEALTH,SENTARA HEALTH,178.00,,,,,,,178.0000,689.6700,percent of total billed charges,25.81% of $689.67 in Billed Charges for Rev 272 = $178.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM RETENTION PANNUS 4 PAD 2 STRAP STERILE,272,RC,27200002,CDM,,,,,,both,,,689.6700,103.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",689.67,,,,,,,178.0000,689.6700,percent of total billed charges,100% of $689.67 in Billed Charges for Rev 272 = $689.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM RETENTION PANNUS 4 PAD 2 STRAP STERILE,272,RC,27200002,CDM,,,,,,both,,,689.6700,103.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,344.84,,,,,,,178.0000,689.6700,percent of total billed charges,Rev 272 $689.67 in Billed Charges at 50% = $344.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM RETENTION PANNUS 4 PAD 2 STRAP STERILE,272,RC,27200002,CDM,,,,,,both,,,689.6700,103.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,222.76,,,,,,,178.0000,689.6700,other,32.3% of $689.67 in Billed Charges for Rev 272 = $222.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SYSTEM RETENTION PANNUS 4 PAD 2 STRAP STERILE,272,RC,27200002,CDM,,,,,,both,,,689.6700,103.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,211.73,,,,,,,178.0000,689.6700,other,30.7% of $689.67 in Billed Charges for Rev 272 = $211.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SYSTEM RETENTION PANNUS 4 PAD 2 STRAP STERILE,272,RC,27200002,CDM,,,,,,both,,,689.6700,103.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,222.76,,,,,,,178.0000,689.6700,percent of total billed charges,32.3% of $689.67 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM RETENTION PANNUS 4 PAD 2 STRAP STERILE,272,RC,27200002,CDM,,,,,,both,,,689.6700,103.4500,WELLCARE,WELLCARE MEDICAID,689.67,,,,,,,178.0000,689.6700,percent of total billed charges,100% of $689.67 in Billed Charges for Rev 272 = $689.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM SHOULDER FXBRIDGE TUBEROSITY,272,RC,27200002,CDM,,,,,,both,,,17288.4600,2593.2700,AETNA,AETNA,7382.17,,,,,,,4462.1500,17288.4600,percent of total billed charges,"42.7% of $17,288.46 in Billed Charges for Rev 272 = $7,382.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM SHOULDER FXBRIDGE TUBEROSITY,272,RC,27200002,CDM,,,,,,both,,,17288.4600,2593.2700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,12101.92,,,,,,,4462.1500,17288.4600,percent of total billed charges,"Rev 272 $17,288.46 in Billed Charges at 70% = $12,101.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM SHOULDER FXBRIDGE TUBEROSITY,272,RC,27200002,CDM,,,,,,both,,,17288.4600,2593.2700,CIGNA HEALTHCARE,CIGNA HMO,7209.29,,,,,,,4462.1500,17288.4600,percent of total billed charges,"41.7% of $17,288.46 in Billed Charges for Rev 272 = $7,209.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM SHOULDER FXBRIDGE TUBEROSITY,272,RC,27200002,CDM,,,,,,both,,,17288.4600,2593.2700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8021.85,,,,,,,4462.1500,17288.4600,percent of total billed charges,"46.4% of $17,288.46 in Billed Charges for Rev 272 = $8,021.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM SHOULDER FXBRIDGE TUBEROSITY,272,RC,27200002,CDM,,,,,,both,,,17288.4600,2593.2700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7209.29,,,,,,,4462.1500,17288.4600,percent of total billed charges,"41.7% of $17,288.46 in Billed Charges for Rev 272 = $7,209.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM SHOULDER FXBRIDGE TUBEROSITY,272,RC,27200002,CDM,,,,,,both,,,17288.4600,2593.2700,CIGNA HEALTHCARE,CIGNA PPO,7209.29,,,,,,,4462.1500,17288.4600,percent of total billed charges,"41.7% of $17,288.46 in Billed Charges for Rev 272 = $7,209.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM SHOULDER FXBRIDGE TUBEROSITY,272,RC,27200002,CDM,,,,,,both,,,17288.4600,2593.2700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,15559.61,,,,,,,4462.1500,17288.4600,percent of total billed charges,"90% of $17,288.46 in Billed Charges for Rev 272 = $15,559.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM SHOULDER FXBRIDGE TUBEROSITY,272,RC,27200002,CDM,,,,,,both,,,17288.4600,2593.2700,MEDCOST,MEDCOST VHN,8227.58,,,,,,,4462.1500,17288.4600,percent of total billed charges,"47.59% of $17,288.46 in Billed Charges for Rev 272 = $8,227.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM SHOULDER FXBRIDGE TUBEROSITY,272,RC,27200002,CDM,,,,,,both,,,17288.4600,2593.2700,SENTARA HEALTH,SENTARA HEALTH,4462.15,,,,,,,4462.1500,17288.4600,percent of total billed charges,"25.81% of $17,288.46 in Billed Charges for Rev 272 = $4,462.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM SHOULDER FXBRIDGE TUBEROSITY,272,RC,27200002,CDM,,,,,,both,,,17288.4600,2593.2700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",17288.46,,,,,,,4462.1500,17288.4600,percent of total billed charges,"100% of $17,288.46 in Billed Charges for Rev 272 = $17,288.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM SHOULDER FXBRIDGE TUBEROSITY,272,RC,27200002,CDM,,,,,,both,,,17288.4600,2593.2700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8644.23,,,,,,,4462.1500,17288.4600,percent of total billed charges,"Rev 272 $17,288.46 in Billed Charges at 50% = $8,644.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM SHOULDER FXBRIDGE TUBEROSITY,272,RC,27200002,CDM,,,,,,both,,,17288.4600,2593.2700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5584.17,,,,,,,4462.1500,17288.4600,other,"32.3% of $17,288.46 in Billed Charges for Rev 272 = $5,584.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM SHOULDER FXBRIDGE TUBEROSITY,272,RC,27200002,CDM,,,,,,both,,,17288.4600,2593.2700,UNITED HEALTHCARE,UHC HERITAGE SELECT,5307.56,,,,,,,4462.1500,17288.4600,other,"30.7% of $17,288.46 in Billed Charges for Rev 272 = $5,307.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM SHOULDER FXBRIDGE TUBEROSITY,272,RC,27200002,CDM,,,,,,both,,,17288.4600,2593.2700,UNITED HEALTHCARE,UNITED HEALTHCARE,5584.17,,,,,,,4462.1500,17288.4600,percent of total billed charges,"32.3% of $17,288.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM SHOULDER FXBRIDGE TUBEROSITY,272,RC,27200002,CDM,,,,,,both,,,17288.4600,2593.2700,WELLCARE,WELLCARE MEDICAID,17288.46,,,,,,,4462.1500,17288.4600,percent of total billed charges,"100% of $17,288.46 in Billed Charges for Rev 272 = $17,288.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA,180.19,,,,,,,108.9200,703.3600,percent of total billed charges,42.7% of $422.00 in Billed Charges for Rev 450 Proc 25622 = $180.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 25622 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,AMBETTER,AMBETTER,487.87,,,,,,,108.9200,703.3600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,108.9200,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM EXCHANGE,422.00,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,422.00,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 25622 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HMO,422.00,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,108.9200,703.3600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",422.00,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,199.45,,,,,,,108.9200,703.3600,fee schedule,$199.45 from Fee Schedule BLDTM_23 for Rev 450 Proc 25622 * Qty 1 = $199.45 at 100% = $199.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,108.9200,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,379.80,,,,,,,108.9200,703.3600,percent of total billed charges,90% of $422.00 in Billed Charges for Rev 450 Proc 25622 = $379.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,MEDCOST,MEDCOST VHN,200.83,,,,,,,108.9200,703.3600,percent of total billed charges,47.59% of $422.00 in Billed Charges for Rev 450 Proc 25622 = $200.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 25622 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 25622 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA HEALTH,108.92,,,,,,,108.9200,703.3600,percent of total billed charges,25.81% of $422.00 in Billed Charges for Rev 450 Proc 25622 = $108.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",422.00,,,,,,,108.9200,703.3600,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 25622 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,108.9200,703.3600,case rate,Rev 450 Proc 25622 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,422.00,,,,,,,108.9200,703.3600,case rate,"Rev 450 Proc 25622 at Case Rate $491.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,422.00,,,,,,,108.9200,703.3600,case rate,"Rev 450 Proc 25622 at Case Rate $471.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,422.00,,,,,,,108.9200,703.3600,case rate,"Rev 450 Proc 25622 at Case Rate $847.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 25622 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICAID,422.00,,,,,,,108.9200,703.3600,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 25622 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARPAL SAPH NAV FRACT W/O,25622,CPT,450,RC,45000133,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,108.9200,703.3600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA,603.35,,,,,,,109.0000,3180.3800,percent of total billed charges,"42.7% of $1,413.00 in Billed Charges for Rev 450 Proc 25635 = $603.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25635 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA HEALTHCARE MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,3180.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1413.00,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM EXCHANGE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25635 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HMO,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1413.00,,,,,,,109.0000,3180.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,309.66,,,,,,,109.0000,3180.3800,fee schedule,$309.66 from Fee Schedule BLDTM_23 for Rev 450 Proc 25635 * Qty 1 = $309.66 at 100% = $309.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1271.70,,,,,,,109.0000,3180.3800,percent of total billed charges,"90% of $1,413.00 in Billed Charges for Rev 450 Proc 25635 = $1,271.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,HUMANA,HUMANA MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,MEDCOST,MEDCOST VHN,672.45,,,,,,,109.0000,3180.3800,percent of total billed charges,"47.59% of $1,413.00 in Billed Charges for Rev 450 Proc 25635 = $672.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25635 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,NHC ADVANTAGE,NHC ADVANTAGE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25635 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA HEALTH,364.70,,,,,,,109.0000,3180.3800,percent of total billed charges,"25.81% of $1,413.00 in Billed Charges for Rev 450 Proc 25635 = $364.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1413.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 25635 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 25635 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 25635 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 25635 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 25635 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25635 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICAID,1413.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 25635 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CARPAL FX W MANIP EA,25635,CPT,450,RC,45000136,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,3180.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA,603.35,,,,,,,109.0000,1413.0000,percent of total billed charges,"42.7% of $1,413.00 in Billed Charges for Rev 450 Proc 25675 = $603.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 25675 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,1413.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,1413.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 25675 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,1413.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,286.79,,,,,,,109.0000,1413.0000,fee schedule,$286.79 from Fee Schedule BLDTM_23 for Rev 450 Proc 25675 * Qty 1 = $286.79 at 100% = $286.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,1413.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1271.70,,,,,,,109.0000,1413.0000,percent of total billed charges,"90% of $1,413.00 in Billed Charges for Rev 450 Proc 25675 = $1,271.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,MEDCOST,MEDCOST VHN,672.45,,,,,,,109.0000,1413.0000,percent of total billed charges,"47.59% of $1,413.00 in Billed Charges for Rev 450 Proc 25675 = $672.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 25675 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 25675 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA HEALTH,364.70,,,,,,,109.0000,1413.0000,percent of total billed charges,"25.81% of $1,413.00 in Billed Charges for Rev 450 Proc 25675 = $364.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1413.00,,,,,,,109.0000,1413.0000,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 25675 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 25675 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 25675 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 25675 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 25675 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 25675 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICAID,1413.00,,,,,,,109.0000,1413.0000,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 25675 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX DIS RADIOULNAR DISLOCA,25675,CPT,450,RC,45000139,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,1413.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,AETNA,AETNA,372.77,,,,,,,37.6700,873.0000,percent of total billed charges,42.7% of $873.00 in Billed Charges for Rev 450 Proc 26010 = $372.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,37.6700,873.0000,fee schedule,"APG 00003 Proc 26010 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,37.6700,873.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,37.6700,873.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,37.6700,873.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,AMBETTER,AMBETTER,396.83,,,,,,,37.6700,873.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,37.6700,873.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,37.6700,873.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,37.6700,873.0000,fee schedule,"APG 00003 Proc 26010 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,37.6700,873.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,37.6700,873.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",560.15,,,,,,,37.6700,873.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,95.92,,,,,,,37.6700,873.0000,fee schedule,$95.92 from Fee Schedule BLDTM_23 for Rev 450 Proc 26010 * Qty 1 = $95.92 at 100% = $95.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,37.6700,873.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,BLUE CROSS,TENNCARE BLUE CARE,37.67,,,,,,,37.6700,873.0000,fee schedule,$32.47 from Fee Schedule TC_24 for Rev 450 Proc 26010 * Qty 1 = $32.47 at 116% = $37.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,BLUE CROSS,TENNCARE BLUE SELECT,37.67,,,,,,,37.6700,873.0000,fee schedule,$32.47 from Fee Schedule TC_24 for Rev 450 Proc 26010 * Qty 1 = $32.47 at 116% = $37.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,37.6700,873.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,37.6700,873.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,785.70,,,,,,,37.6700,873.0000,percent of total billed charges,90% of $873.00 in Billed Charges for Rev 450 Proc 26010 = $785.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,37.6700,873.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,37.6700,873.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,MEDCOST,MEDCOST VHN,415.46,,,,,,,37.6700,873.0000,percent of total billed charges,47.59% of $873.00 in Billed Charges for Rev 450 Proc 26010 = $415.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,37.6700,873.0000,fee schedule,"APG 00003 Proc 26010 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,37.6700,873.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,37.6700,873.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,37.6700,873.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,37.6700,873.0000,fee schedule,"APG 00003 Proc 26010 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,SENTARA HEALTH,SENTARA HEALTH,225.32,,,,,,,37.6700,873.0000,percent of total billed charges,25.81% of $873.00 in Billed Charges for Rev 450 Proc 26010 = $225.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,37.6700,873.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",873.00,,,,,,,37.6700,873.0000,percent of total billed charges,100% of $873.00 in Billed Charges for Rev 450 Proc 26010 = $873.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,37.6700,873.0000,case rate,Rev 450 Proc 26010 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,37.6700,873.0000,case rate,Rev 450 Proc 26010 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,37.6700,873.0000,case rate,Rev 450 Proc 26010 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,37.6700,873.0000,case rate,Rev 450 Proc 26010 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,37.6700,873.0000,fee schedule,"APG 00003 Proc 26010 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,37.6700,873.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,37.6700,873.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,WELLCARE,WELLCARE MEDICAID,873.00,,,,,,,37.6700,873.0000,percent of total billed charges,100% of $873.00 in Billed Charges for Rev 450 Proc 26010 = $873.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRAIN FINGER ABSCESS SIMPLE,26010,CPT,450,RC,45000140,CDM,,,,both,,,873.0000,130.9500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,37.6700,873.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TR BAND REGULAR,270,RC,,,,,,,,both,,,9898.9100,1484.8400,AETNA,AETNA,4226.83,,,,,,,2554.9100,9898.9100,percent of total billed charges,"42.7% of $9,898.91 in Billed Charges for Rev 270 = $4,226.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TR BAND REGULAR,270,RC,,,,,,,,both,,,9898.9100,1484.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6929.24,,,,,,,2554.9100,9898.9100,percent of total billed charges,"Rev 270 $9,898.91 in Billed Charges at 70% = $6,929.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TR BAND REGULAR,270,RC,,,,,,,,both,,,9898.9100,1484.8400,CIGNA HEALTHCARE,CIGNA HMO,4127.85,,,,,,,2554.9100,9898.9100,percent of total billed charges,"41.7% of $9,898.91 in Billed Charges for Rev 270 = $4,127.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TR BAND REGULAR,270,RC,,,,,,,,both,,,9898.9100,1484.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4593.09,,,,,,,2554.9100,9898.9100,percent of total billed charges,"46.4% of $9,898.91 in Billed Charges for Rev 270 = $4,593.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TR BAND REGULAR,270,RC,,,,,,,,both,,,9898.9100,1484.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4127.85,,,,,,,2554.9100,9898.9100,percent of total billed charges,"41.7% of $9,898.91 in Billed Charges for Rev 270 = $4,127.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TR BAND REGULAR,270,RC,,,,,,,,both,,,9898.9100,1484.8400,CIGNA HEALTHCARE,CIGNA PPO,4127.85,,,,,,,2554.9100,9898.9100,percent of total billed charges,"41.7% of $9,898.91 in Billed Charges for Rev 270 = $4,127.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TR BAND REGULAR,270,RC,,,,,,,,both,,,9898.9100,1484.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8909.02,,,,,,,2554.9100,9898.9100,percent of total billed charges,"90% of $9,898.91 in Billed Charges for Rev 270 = $8,909.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TR BAND REGULAR,270,RC,,,,,,,,both,,,9898.9100,1484.8400,MEDCOST,MEDCOST VHN,4710.89,,,,,,,2554.9100,9898.9100,percent of total billed charges,"47.59% of $9,898.91 in Billed Charges for Rev 270 = $4,710.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TR BAND REGULAR,270,RC,,,,,,,,both,,,9898.9100,1484.8400,SENTARA HEALTH,SENTARA HEALTH,2554.91,,,,,,,2554.9100,9898.9100,percent of total billed charges,"25.81% of $9,898.91 in Billed Charges for Rev 270 = $2,554.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TR BAND REGULAR,270,RC,,,,,,,,both,,,9898.9100,1484.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9898.91,,,,,,,2554.9100,9898.9100,percent of total billed charges,"100% of $9,898.91 in Billed Charges for Rev 270 = $9,898.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TR BAND REGULAR,270,RC,,,,,,,,both,,,9898.9100,1484.8400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4949.46,,,,,,,2554.9100,9898.9100,percent of total billed charges,"Rev 270 $9,898.91 in Billed Charges at 50% = $4,949.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TR BAND REGULAR,270,RC,,,,,,,,both,,,9898.9100,1484.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3197.35,,,,,,,2554.9100,9898.9100,other,"32.3% of $9,898.91 in Billed Charges for Rev 270 = $3,197.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TR BAND REGULAR,270,RC,,,,,,,,both,,,9898.9100,1484.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,3038.97,,,,,,,2554.9100,9898.9100,other,"30.7% of $9,898.91 in Billed Charges for Rev 270 = $3,038.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TR BAND REGULAR,270,RC,,,,,,,,both,,,9898.9100,1484.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,3197.35,,,,,,,2554.9100,9898.9100,percent of total billed charges,"32.3% of $9,898.91 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TR BAND REGULAR,270,RC,,,,,,,,both,,,9898.9100,1484.8400,WELLCARE,WELLCARE MEDICAID,9898.91,,,,,,,2554.9100,9898.9100,percent of total billed charges,"100% of $9,898.91 in Billed Charges for Rev 270 = $9,898.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACH QUICK 4.0 MM SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1908.1600,286.2200,AETNA,AETNA,814.78,,,,,,,492.5000,1908.1600,percent of total billed charges,"42.7% of $1,908.16 in Billed Charges for Rev 272 = $814.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACH QUICK 4.0 MM SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1908.1600,286.2200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1335.71,,,,,,,492.5000,1908.1600,percent of total billed charges,"Rev 272 $1,908.16 in Billed Charges at 70% = $1,335.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACH QUICK 4.0 MM SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1908.1600,286.2200,CIGNA HEALTHCARE,CIGNA HMO,795.70,,,,,,,492.5000,1908.1600,percent of total billed charges,"41.7% of $1,908.16 in Billed Charges for Rev 272 = $795.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACH QUICK 4.0 MM SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1908.1600,286.2200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,885.39,,,,,,,492.5000,1908.1600,percent of total billed charges,"46.4% of $1,908.16 in Billed Charges for Rev 272 = $885.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACH QUICK 4.0 MM SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1908.1600,286.2200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,795.70,,,,,,,492.5000,1908.1600,percent of total billed charges,"41.7% of $1,908.16 in Billed Charges for Rev 272 = $795.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACH QUICK 4.0 MM SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1908.1600,286.2200,CIGNA HEALTHCARE,CIGNA PPO,795.70,,,,,,,492.5000,1908.1600,percent of total billed charges,"41.7% of $1,908.16 in Billed Charges for Rev 272 = $795.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACH QUICK 4.0 MM SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1908.1600,286.2200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1717.34,,,,,,,492.5000,1908.1600,percent of total billed charges,"90% of $1,908.16 in Billed Charges for Rev 272 = $1,717.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACH QUICK 4.0 MM SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1908.1600,286.2200,MEDCOST,MEDCOST VHN,908.09,,,,,,,492.5000,1908.1600,percent of total billed charges,"47.59% of $1,908.16 in Billed Charges for Rev 272 = $908.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACH QUICK 4.0 MM SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1908.1600,286.2200,SENTARA HEALTH,SENTARA HEALTH,492.50,,,,,,,492.5000,1908.1600,percent of total billed charges,"25.81% of $1,908.16 in Billed Charges for Rev 272 = $492.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACH QUICK 4.0 MM SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1908.1600,286.2200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1908.16,,,,,,,492.5000,1908.1600,percent of total billed charges,"100% of $1,908.16 in Billed Charges for Rev 272 = $1,908.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACH QUICK 4.0 MM SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1908.1600,286.2200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,954.08,,,,,,,492.5000,1908.1600,percent of total billed charges,"Rev 272 $1,908.16 in Billed Charges at 50% = $954.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACH QUICK 4.0 MM SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1908.1600,286.2200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,616.34,,,,,,,492.5000,1908.1600,other,"32.3% of $1,908.16 in Billed Charges for Rev 272 = $616.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TRACH QUICK 4.0 MM SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1908.1600,286.2200,UNITED HEALTHCARE,UHC HERITAGE SELECT,585.81,,,,,,,492.5000,1908.1600,other,"30.7% of $1,908.16 in Billed Charges for Rev 272 = $585.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TRACH QUICK 4.0 MM SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1908.1600,286.2200,UNITED HEALTHCARE,UNITED HEALTHCARE,616.34,,,,,,,492.5000,1908.1600,percent of total billed charges,"32.3% of $1,908.16 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACH QUICK 4.0 MM SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1908.1600,286.2200,WELLCARE,WELLCARE MEDICAID,1908.16,,,,,,,492.5000,1908.1600,percent of total billed charges,"100% of $1,908.16 in Billed Charges for Rev 272 = $1,908.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACH TUBE SHILEY #8 PROX,272,RC,27200002,CDM,,,,,,both,,,534.3100,80.1500,AETNA,AETNA,228.15,,,,,,,137.9100,534.3100,percent of total billed charges,42.7% of $534.31 in Billed Charges for Rev 272 = $228.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRACH TUBE SHILEY #8 PROX,272,RC,27200002,CDM,,,,,,both,,,534.3100,80.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,374.02,,,,,,,137.9100,534.3100,percent of total billed charges,Rev 272 $534.31 in Billed Charges at 70% = $374.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRACH TUBE SHILEY #8 PROX,272,RC,27200002,CDM,,,,,,both,,,534.3100,80.1500,CIGNA HEALTHCARE,CIGNA HMO,222.81,,,,,,,137.9100,534.3100,percent of total billed charges,41.7% of $534.31 in Billed Charges for Rev 272 = $222.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRACH TUBE SHILEY #8 PROX,272,RC,27200002,CDM,,,,,,both,,,534.3100,80.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,247.92,,,,,,,137.9100,534.3100,percent of total billed charges,46.4% of $534.31 in Billed Charges for Rev 272 = $247.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRACH TUBE SHILEY #8 PROX,272,RC,27200002,CDM,,,,,,both,,,534.3100,80.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,222.81,,,,,,,137.9100,534.3100,percent of total billed charges,41.7% of $534.31 in Billed Charges for Rev 272 = $222.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRACH TUBE SHILEY #8 PROX,272,RC,27200002,CDM,,,,,,both,,,534.3100,80.1500,CIGNA HEALTHCARE,CIGNA PPO,222.81,,,,,,,137.9100,534.3100,percent of total billed charges,41.7% of $534.31 in Billed Charges for Rev 272 = $222.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRACH TUBE SHILEY #8 PROX,272,RC,27200002,CDM,,,,,,both,,,534.3100,80.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,480.88,,,,,,,137.9100,534.3100,percent of total billed charges,90% of $534.31 in Billed Charges for Rev 272 = $480.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRACH TUBE SHILEY #8 PROX,272,RC,27200002,CDM,,,,,,both,,,534.3100,80.1500,MEDCOST,MEDCOST VHN,254.28,,,,,,,137.9100,534.3100,percent of total billed charges,47.59% of $534.31 in Billed Charges for Rev 272 = $254.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRACH TUBE SHILEY #8 PROX,272,RC,27200002,CDM,,,,,,both,,,534.3100,80.1500,SENTARA HEALTH,SENTARA HEALTH,137.91,,,,,,,137.9100,534.3100,percent of total billed charges,25.81% of $534.31 in Billed Charges for Rev 272 = $137.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRACH TUBE SHILEY #8 PROX,272,RC,27200002,CDM,,,,,,both,,,534.3100,80.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",534.31,,,,,,,137.9100,534.3100,percent of total billed charges,100% of $534.31 in Billed Charges for Rev 272 = $534.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRACH TUBE SHILEY #8 PROX,272,RC,27200002,CDM,,,,,,both,,,534.3100,80.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,267.16,,,,,,,137.9100,534.3100,percent of total billed charges,Rev 272 $534.31 in Billed Charges at 50% = $267.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRACH TUBE SHILEY #8 PROX,272,RC,27200002,CDM,,,,,,both,,,534.3100,80.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,172.58,,,,,,,137.9100,534.3100,other,32.3% of $534.31 in Billed Charges for Rev 272 = $172.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TRACH TUBE SHILEY #8 PROX,272,RC,27200002,CDM,,,,,,both,,,534.3100,80.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,164.03,,,,,,,137.9100,534.3100,other,30.7% of $534.31 in Billed Charges for Rev 272 = $164.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TRACH TUBE SHILEY #8 PROX,272,RC,27200002,CDM,,,,,,both,,,534.3100,80.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,172.58,,,,,,,137.9100,534.3100,percent of total billed charges,32.3% of $534.31 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRACH TUBE SHILEY #8 PROX,272,RC,27200002,CDM,,,,,,both,,,534.3100,80.1500,WELLCARE,WELLCARE MEDICAID,534.31,,,,,,,137.9100,534.3100,percent of total billed charges,100% of $534.31 in Billed Charges for Rev 272 = $534.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRACKER INSTRUMENT,272,RC,27200002,CDM,,,,,,both,,,1692.3400,253.8500,AETNA,AETNA,722.63,,,,,,,436.7900,1692.3400,percent of total billed charges,"42.7% of $1,692.34 in Billed Charges for Rev 272 = $722.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER INSTRUMENT,272,RC,27200002,CDM,,,,,,both,,,1692.3400,253.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1184.64,,,,,,,436.7900,1692.3400,percent of total billed charges,"Rev 272 $1,692.34 in Billed Charges at 70% = $1,184.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER INSTRUMENT,272,RC,27200002,CDM,,,,,,both,,,1692.3400,253.8500,CIGNA HEALTHCARE,CIGNA HMO,705.71,,,,,,,436.7900,1692.3400,percent of total billed charges,"41.7% of $1,692.34 in Billed Charges for Rev 272 = $705.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER INSTRUMENT,272,RC,27200002,CDM,,,,,,both,,,1692.3400,253.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,785.25,,,,,,,436.7900,1692.3400,percent of total billed charges,"46.4% of $1,692.34 in Billed Charges for Rev 272 = $785.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER INSTRUMENT,272,RC,27200002,CDM,,,,,,both,,,1692.3400,253.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,705.71,,,,,,,436.7900,1692.3400,percent of total billed charges,"41.7% of $1,692.34 in Billed Charges for Rev 272 = $705.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER INSTRUMENT,272,RC,27200002,CDM,,,,,,both,,,1692.3400,253.8500,CIGNA HEALTHCARE,CIGNA PPO,705.71,,,,,,,436.7900,1692.3400,percent of total billed charges,"41.7% of $1,692.34 in Billed Charges for Rev 272 = $705.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER INSTRUMENT,272,RC,27200002,CDM,,,,,,both,,,1692.3400,253.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1523.11,,,,,,,436.7900,1692.3400,percent of total billed charges,"90% of $1,692.34 in Billed Charges for Rev 272 = $1,523.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER INSTRUMENT,272,RC,27200002,CDM,,,,,,both,,,1692.3400,253.8500,MEDCOST,MEDCOST VHN,805.38,,,,,,,436.7900,1692.3400,percent of total billed charges,"47.59% of $1,692.34 in Billed Charges for Rev 272 = $805.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER INSTRUMENT,272,RC,27200002,CDM,,,,,,both,,,1692.3400,253.8500,SENTARA HEALTH,SENTARA HEALTH,436.79,,,,,,,436.7900,1692.3400,percent of total billed charges,"25.81% of $1,692.34 in Billed Charges for Rev 272 = $436.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER INSTRUMENT,272,RC,27200002,CDM,,,,,,both,,,1692.3400,253.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1692.34,,,,,,,436.7900,1692.3400,percent of total billed charges,"100% of $1,692.34 in Billed Charges for Rev 272 = $1,692.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER INSTRUMENT,272,RC,27200002,CDM,,,,,,both,,,1692.3400,253.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,846.17,,,,,,,436.7900,1692.3400,percent of total billed charges,"Rev 272 $1,692.34 in Billed Charges at 50% = $846.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER INSTRUMENT,272,RC,27200002,CDM,,,,,,both,,,1692.3400,253.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,546.63,,,,,,,436.7900,1692.3400,other,"32.3% of $1,692.34 in Billed Charges for Rev 272 = $546.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TRACKER INSTRUMENT,272,RC,27200002,CDM,,,,,,both,,,1692.3400,253.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,519.55,,,,,,,436.7900,1692.3400,other,"30.7% of $1,692.34 in Billed Charges for Rev 272 = $519.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TRACKER INSTRUMENT,272,RC,27200002,CDM,,,,,,both,,,1692.3400,253.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,546.63,,,,,,,436.7900,1692.3400,percent of total billed charges,"32.3% of $1,692.34 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER INSTRUMENT,272,RC,27200002,CDM,,,,,,both,,,1692.3400,253.8500,WELLCARE,WELLCARE MEDICAID,1692.34,,,,,,,436.7900,1692.3400,percent of total billed charges,"100% of $1,692.34 in Billed Charges for Rev 272 = $1,692.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,AETNA,AETNA,194.71,,,,,,,26.6800,456.0000,percent of total billed charges,42.7% of $456.00 in Billed Charges for Rev 521 Proc 29450 = $194.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,283.21,,,,,,,26.6800,456.0000,fee schedule,"APG 00039 Proc 29450 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 104% = $283.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,147.43,,,,,,,26.6800,456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,AETNA,AETNA HEALTHCARE MEDICARE,147.43,,,,,,,26.6800,456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,147.43,,,,,,,26.6800,456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,AMBETTER,AMBETTER,321.40,,,,,,,26.6800,456.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,153.33,,,,,,,26.6800,456.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,BLUE CROSS,ANTHEM EXCHANGE,362.98,,,,,,,26.6800,456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,280.48,,,,,,,26.6800,456.0000,fee schedule,"APG 00039 Proc 29450 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,BLUE CROSS,ANTHEM HMO,385.65,,,,,,,26.6800,456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,151.86,,,,,,,26.6800,456.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",453.68,,,,,,,26.6800,456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,70.26,,,,,,,26.6800,456.0000,fee schedule,$70.26 from Fee Schedule BLDTM_23 for Rev 521 Proc 29450 * Qty 1 = $70.26 at 100% = $70.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,BLUE CROSS,BLUE CROSS MEDICARE,153.33,,,,,,,26.6800,456.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,BLUE CROSS,TENNCARE BLUE CARE,26.68,,,,,,,26.6800,456.0000,fee schedule,$23.00 from Fee Schedule TC_24 for Rev 521 Proc 29450 * Qty 1 = $23.00 at 116% = $26.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,BLUE CROSS,TENNCARE BLUE SELECT,26.68,,,,,,,26.6800,456.0000,fee schedule,$23.00 from Fee Schedule TC_24 for Rev 521 Proc 29450 * Qty 1 = $23.00 at 116% = $26.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,CIGNA HEALTHCARE,CIGNA HMO,190.15,,,,,,,26.6800,456.0000,percent of total billed charges,41.7% of $456.00 in Billed Charges for Rev 521 Proc 29450 = $190.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,211.58,,,,,,,26.6800,456.0000,percent of total billed charges,46.4% of $456.00 in Billed Charges for Rev 521 Proc 29450 = $211.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,154.80,,,,,,,26.6800,456.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,190.15,,,,,,,26.6800,456.0000,percent of total billed charges,41.7% of $456.00 in Billed Charges for Rev 521 Proc 29450 = $190.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,CIGNA HEALTHCARE,CIGNA PPO,190.15,,,,,,,26.6800,456.0000,percent of total billed charges,41.7% of $456.00 in Billed Charges for Rev 521 Proc 29450 = $190.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,154.80,,,,,,,26.6800,456.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,410.40,,,,,,,26.6800,456.0000,percent of total billed charges,90% of $456.00 in Billed Charges for Rev 521 Proc 29450 = $410.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,HUMANA,HUMANA MEDICARE,147.43,,,,,,,26.6800,456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,147.43,,,,,,,26.6800,456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,MEDCOST,MEDCOST VHN,217.01,,,,,,,26.6800,456.0000,percent of total billed charges,47.59% of $456.00 in Billed Charges for Rev 521 Proc 29450 = $217.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,285.93,,,,,,,26.6800,456.0000,fee schedule,"APG 00039 Proc 29450 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 105% = $285.93 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,154.80,,,,,,,26.6800,456.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,154.80,,,,,,,26.6800,456.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,NHC ADVANTAGE,NHC ADVANTAGE,154.80,,,,,,,26.6800,456.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,280.75,,,,,,,26.6800,456.0000,fee schedule,"APG 00039 Proc 29450 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 103.1% = $280.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,SENTARA HEALTH,SENTARA HEALTH,117.69,,,,,,,26.6800,456.0000,percent of total billed charges,25.81% of $456.00 in Billed Charges for Rev 521 Proc 29450 = $117.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,SENTARA HEALTH,SENTARA MEDICARE,147.43,,,,,,,26.6800,456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",456.00,,,,,,,26.6800,456.0000,percent of total billed charges,100% of $456.00 in Billed Charges for Rev 521 Proc 29450 = $456.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,111.65,,,,,,,26.6800,456.0000,fee schedule,$223.29 from Fee Schedule TCUHC24 for Rev 521 Proc 29450 * Qty 1 = $223.29 at 50% = $111.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,280.48,,,,,,,26.6800,456.0000,fee schedule,"APG 00039 Proc 29450 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,147.43,,,,,,,26.6800,456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,147.43,,,,,,,26.6800,456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,WELLCARE,WELLCARE MEDICAID,456.00,,,,,,,26.6800,456.0000,percent of total billed charges,100% of $456.00 in Billed Charges for Rev 521 Proc 29450 = $456.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL CLUBFOOT CAST W MOLD/MAINP LON/SHORT LEG,29450,CPT,521,RC,52100100,CDM,,,,both,,,456.0000,68.4000,WELLCARE,WELLCARE MEDICARE,156.28,,,,,,,26.6800,456.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,AETNA,AETNA,221.61,,,,,,,51.8300,519.0000,percent of total billed charges,42.7% of $519.00 in Billed Charges for Rev 450 Proc 29505 = $221.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,106.23,,,,,,,51.8300,519.0000,fee schedule,"APG 00040 Proc 29505 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 104% = $106.23. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,147.43,,,,,,,51.8300,519.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,AETNA,AETNA HEALTHCARE MEDICARE,147.43,,,,,,,51.8300,519.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,147.43,,,,,,,51.8300,519.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,AMBETTER,AMBETTER,321.40,,,,,,,51.8300,519.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,153.33,,,,,,,51.8300,519.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,BLUE CROSS,ANTHEM EXCHANGE,362.98,,,,,,,51.8300,519.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,105.21,,,,,,,51.8300,519.0000,fee schedule,"APG 00040 Proc 29505 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,BLUE CROSS,ANTHEM HMO,385.65,,,,,,,51.8300,519.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,151.86,,,,,,,51.8300,519.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",453.68,,,,,,,51.8300,519.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,51.83,,,,,,,51.8300,519.0000,fee schedule,$51.83 from Fee Schedule BLDTM_23 for Rev 450 Proc 29505 * Qty 1 = $51.83 at 100% = $51.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,BLUE CROSS,BLUE CROSS MEDICARE,153.33,,,,,,,51.8300,519.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,154.80,,,,,,,51.8300,519.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,154.80,,,,,,,51.8300,519.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,467.10,,,,,,,51.8300,519.0000,percent of total billed charges,90% of $519.00 in Billed Charges for Rev 450 Proc 29505 = $467.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,HUMANA,HUMANA MEDICARE,147.43,,,,,,,51.8300,519.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,147.43,,,,,,,51.8300,519.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,MEDCOST,MEDCOST VHN,246.99,,,,,,,51.8300,519.0000,percent of total billed charges,47.59% of $519.00 in Billed Charges for Rev 450 Proc 29505 = $246.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,107.26,,,,,,,51.8300,519.0000,fee schedule,"APG 00040 Proc 29505 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 100% = $102.15... $102.15 at 105% = $107.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,154.80,,,,,,,51.8300,519.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,154.80,,,,,,,51.8300,519.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,NHC ADVANTAGE,NHC ADVANTAGE,154.80,,,,,,,51.8300,519.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,105.32,,,,,,,51.8300,519.0000,fee schedule,"APG 00040 Proc 29505 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 100% = $102.15... $102.15 at 103.1% = $105.32 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,SENTARA HEALTH,SENTARA HEALTH,133.95,,,,,,,51.8300,519.0000,percent of total billed charges,25.81% of $519.00 in Billed Charges for Rev 450 Proc 29505 = $133.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,SENTARA HEALTH,SENTARA MEDICARE,147.43,,,,,,,51.8300,519.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",519.00,,,,,,,51.8300,519.0000,percent of total billed charges,100% of $519.00 in Billed Charges for Rev 450 Proc 29505 = $519.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,51.8300,519.0000,case rate,Rev 450 Proc 29505 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,51.8300,519.0000,case rate,Rev 450 Proc 29505 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,51.8300,519.0000,case rate,Rev 450 Proc 29505 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,519.00,,,,,,,51.8300,519.0000,case rate,"Rev 450 Proc 29505 at Case Rate $847.00 (Service Line reduced to $519.00, claim capped at $519.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,105.21,,,,,,,51.8300,519.0000,fee schedule,"APG 00040 Proc 29505 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,147.43,,,,,,,51.8300,519.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,147.43,,,,,,,51.8300,519.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,WELLCARE,WELLCARE MEDICAID,519.00,,,,,,,51.8300,519.0000,percent of total billed charges,100% of $519.00 in Billed Charges for Rev 450 Proc 29505 = $519.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY LONG LEG SPLINT,29505,CPT,450,RC,45000204,CDM,,,,both,,,519.0000,77.8500,WELLCARE,WELLCARE MEDICARE,156.28,,,,,,,51.8300,519.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,AETNA,AETNA,146.89,,,,,,,15.6900,344.0000,percent of total billed charges,42.7% of $344.00 in Billed Charges for Rev 450 Proc 29550 = $146.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,106.23,,,,,,,15.6900,344.0000,fee schedule,APG 00040 Proc 29550 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 104% = $106.23. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,53.52,,,,,,,15.6900,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,AETNA,AETNA HEALTHCARE MEDICARE,53.52,,,,,,,15.6900,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,53.52,,,,,,,15.6900,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,AMBETTER,AMBETTER,116.68,,,,,,,15.6900,344.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,55.66,,,,,,,15.6900,344.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,ANTHEM EXCHANGE,131.77,,,,,,,15.6900,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,105.21,,,,,,,15.6900,344.0000,fee schedule,APG 00040 Proc 29550 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,ANTHEM HMO,140.00,,,,,,,15.6900,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,55.13,,,,,,,15.6900,344.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",164.70,,,,,,,15.6900,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,21.06,,,,,,,15.6900,344.0000,fee schedule,$21.06 from Fee Schedule BLDTM_23 for Rev 450 Proc 29550 * Qty 1 = $21.06 at 100% = $21.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,BLUE CROSS MEDICARE,55.66,,,,,,,15.6900,344.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,TENNCARE BLUE CARE,15.69,,,,,,,15.6900,344.0000,fee schedule,$13.53 from Fee Schedule TC_24 for Rev 450 Proc 29550 * Qty 1 = $13.53 at 116% = $15.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,TENNCARE BLUE SELECT,15.69,,,,,,,15.6900,344.0000,fee schedule,$13.53 from Fee Schedule TC_24 for Rev 450 Proc 29550 * Qty 1 = $13.53 at 116% = $15.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,56.20,,,,,,,15.6900,344.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,56.20,,,,,,,15.6900,344.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,309.60,,,,,,,15.6900,344.0000,percent of total billed charges,90% of $344.00 in Billed Charges for Rev 450 Proc 29550 = $309.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,HUMANA,HUMANA MEDICARE,53.52,,,,,,,15.6900,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,53.52,,,,,,,15.6900,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,MEDCOST,MEDCOST VHN,163.71,,,,,,,15.6900,344.0000,percent of total billed charges,47.59% of $344.00 in Billed Charges for Rev 450 Proc 29550 = $163.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,107.26,,,,,,,15.6900,344.0000,fee schedule,APG 00040 Proc 29550 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 100% = $102.15... $102.15 at 105% = $107.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,56.20,,,,,,,15.6900,344.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,56.20,,,,,,,15.6900,344.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,NHC ADVANTAGE,NHC ADVANTAGE,56.20,,,,,,,15.6900,344.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,105.32,,,,,,,15.6900,344.0000,fee schedule,APG 00040 Proc 29550 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 100% = $102.15... $102.15 at 103.1% = $105.32 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,SENTARA HEALTH,SENTARA HEALTH,88.79,,,,,,,15.6900,344.0000,percent of total billed charges,25.81% of $344.00 in Billed Charges for Rev 450 Proc 29550 = $88.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,SENTARA HEALTH,SENTARA MEDICARE,53.52,,,,,,,15.6900,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",344.00,,,,,,,15.6900,344.0000,percent of total billed charges,100% of $344.00 in Billed Charges for Rev 450 Proc 29550 = $344.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,15.6900,344.0000,case rate,Rev 450 Proc 29550 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,344.00,,,,,,,15.6900,344.0000,case rate,"Rev 450 Proc 29550 at Case Rate $491.00 (Service Line reduced to $344.00, claim capped at $344.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,344.00,,,,,,,15.6900,344.0000,case rate,"Rev 450 Proc 29550 at Case Rate $471.00 (Service Line reduced to $344.00, claim capped at $344.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,344.00,,,,,,,15.6900,344.0000,case rate,"Rev 450 Proc 29550 at Case Rate $847.00 (Service Line reduced to $344.00, claim capped at $344.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,105.21,,,,,,,15.6900,344.0000,fee schedule,APG 00040 Proc 29550 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,53.52,,,,,,,15.6900,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,53.52,,,,,,,15.6900,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,WELLCARE,WELLCARE MEDICAID,344.00,,,,,,,15.6900,344.0000,percent of total billed charges,100% of $344.00 in Billed Charges for Rev 450 Proc 29550 = $344.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAPPING TOES,29550,CPT,450,RC,45000208,CDM,,,,both,,,344.0000,51.6000,WELLCARE,WELLCARE MEDICARE,56.73,,,,,,,15.6900,344.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,AETNA,AETNA,171.65,,,,,,,42.7400,482.1000,percent of total billed charges,42.7% of $402.00 in Billed Charges for Rev 510 Proc 29580 Mod 50 = $171.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,424.81,,,,,,,42.7400,482.1000,fee schedule,"APG 00039 Proc 29580 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $408.47 at 104% = $424.81. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,221.15,,,,,,,42.7400,482.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,AETNA,AETNA HEALTHCARE MEDICARE,221.15,,,,,,,42.7400,482.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,221.15,,,,,,,42.7400,482.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,AMBETTER,AMBETTER,482.10,,,,,,,42.7400,482.1000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,229.99,,,,,,,42.7400,482.1000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,BLUE CROSS,ANTHEM EXCHANGE,402.00,,,,,,,42.7400,482.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,402.00,,,,,,,42.7400,482.1000,fee schedule,"APG 00039 Proc 29580 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $408.47 at 103% = $420.72 (Service Line reduced to $402.00, claim capped at $402.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,BLUE CROSS,ANTHEM HMO,402.00,,,,,,,42.7400,482.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,227.78,,,,,,,42.7400,482.1000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",402.00,,,,,,,42.7400,482.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,42.74,,,,,,,42.7400,482.1000,fee schedule,$42.74 from Fee Schedule BLDTM_23 for Rev 510 Proc 29580 Mod 50 * Qty 1 = $42.74 at 100% = $42.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,BLUE CROSS,BLUE CROSS MEDICARE,229.99,,,,,,,42.7400,482.1000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,BLUE CROSS,TENNCARE BLUE CARE,52.19,,,,,,,42.7400,482.1000,fee schedule,$44.99 from Fee Schedule TC_24 for Rev 510 Proc 29580 Mod 50 * Qty 1 = $44.99 at 116% = $52.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,BLUE CROSS,TENNCARE BLUE SELECT,52.19,,,,,,,42.7400,482.1000,fee schedule,$44.99 from Fee Schedule TC_24 for Rev 510 Proc 29580 Mod 50 * Qty 1 = $44.99 at 116% = $52.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,CIGNA HEALTHCARE,CIGNA HMO,167.63,,,,,,,42.7400,482.1000,percent of total billed charges,41.7% of $402.00 in Billed Charges for Rev 510 Proc 29580 Mod 50 = $167.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,186.53,,,,,,,42.7400,482.1000,percent of total billed charges,46.4% of $402.00 in Billed Charges for Rev 510 Proc 29580 Mod 50 = $186.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,232.21,,,,,,,42.7400,482.1000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,167.63,,,,,,,42.7400,482.1000,percent of total billed charges,41.7% of $402.00 in Billed Charges for Rev 510 Proc 29580 Mod 50 = $167.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,CIGNA HEALTHCARE,CIGNA PPO,167.63,,,,,,,42.7400,482.1000,percent of total billed charges,41.7% of $402.00 in Billed Charges for Rev 510 Proc 29580 Mod 50 = $167.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,232.21,,,,,,,42.7400,482.1000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,361.80,,,,,,,42.7400,482.1000,percent of total billed charges,90% of $402.00 in Billed Charges for Rev 510 Proc 29580 Mod 50 = $361.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,HUMANA,HUMANA MEDICARE,221.15,,,,,,,42.7400,482.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,221.15,,,,,,,42.7400,482.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,MEDCOST,MEDCOST VHN,191.31,,,,,,,42.7400,482.1000,percent of total billed charges,47.59% of $402.00 in Billed Charges for Rev 510 Proc 29580 Mod 50 = $191.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,428.89,,,,,,,42.7400,482.1000,fee schedule,"APG 00039 Proc 29580 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $408.47 at 100% = $408.47... $408.47 at 105% = $428.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,232.21,,,,,,,42.7400,482.1000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,232.21,,,,,,,42.7400,482.1000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,NHC ADVANTAGE,NHC ADVANTAGE,232.21,,,,,,,42.7400,482.1000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,421.13,,,,,,,42.7400,482.1000,fee schedule,"APG 00039 Proc 29580 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $408.47 at 100% = $408.47... $408.47 at 103.1% = $421.13 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,SENTARA HEALTH,SENTARA HEALTH,103.76,,,,,,,42.7400,482.1000,percent of total billed charges,25.81% of $402.00 in Billed Charges for Rev 510 Proc 29580 Mod 50 = $103.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,SENTARA HEALTH,SENTARA MEDICARE,221.15,,,,,,,42.7400,482.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",402.00,,,,,,,42.7400,482.1000,percent of total billed charges,100% of $402.00 in Billed Charges for Rev 510 Proc 29580 Mod 50 = $402.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,63.94,,,,,,,42.7400,482.1000,fee schedule,$127.87 from Fee Schedule TCUHC24 for Rev 510 Proc 29580 Mod 50 * Qty 1 = $127.87 at 50% = $63.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,129.85,,,,,,,42.7400,482.1000,other,32.3% of $402.00 in Billed Charges for Rev 510 Proc 29580 Mod 50 = $129.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,123.41,,,,,,,42.7400,482.1000,other,30.7% of $402.00 in Billed Charges for Rev 510 Proc 29580 Mod 50 = $123.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,129.85,,,,,,,42.7400,482.1000,percent of total billed charges,32.3% of $402.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,420.72,,,,,,,42.7400,482.1000,fee schedule,"APG 00039 Proc 29580 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $408.47 at 103% = $420.72. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,221.15,,,,,,,42.7400,482.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,221.15,,,,,,,42.7400,482.1000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,WELLCARE,WELLCARE MEDICAID,402.00,,,,,,,42.7400,482.1000,percent of total billed charges,100% of $402.00 in Billed Charges for Rev 510 Proc 29580 Mod 50 = $402.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNNA BOOT STRAPPING BILAT,29580,CPT,510,RC,51000214,CDM,,,50,both,,,402.0000,60.3000,WELLCARE,WELLCARE MEDICARE,234.42,,,,,,,42.7400,482.1000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TRACKER PATIENT,272,RC,27200002,CDM,,,,,,both,,,2706.8300,406.0200,AETNA,AETNA,1155.82,,,,,,,698.6300,2706.8300,percent of total billed charges,"42.7% of $2,706.83 in Billed Charges for Rev 272 = $1,155.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT,272,RC,27200002,CDM,,,,,,both,,,2706.8300,406.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1894.78,,,,,,,698.6300,2706.8300,percent of total billed charges,"Rev 272 $2,706.83 in Billed Charges at 70% = $1,894.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT,272,RC,27200002,CDM,,,,,,both,,,2706.8300,406.0200,CIGNA HEALTHCARE,CIGNA HMO,1128.75,,,,,,,698.6300,2706.8300,percent of total billed charges,"41.7% of $2,706.83 in Billed Charges for Rev 272 = $1,128.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT,272,RC,27200002,CDM,,,,,,both,,,2706.8300,406.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1255.97,,,,,,,698.6300,2706.8300,percent of total billed charges,"46.4% of $2,706.83 in Billed Charges for Rev 272 = $1,255.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT,272,RC,27200002,CDM,,,,,,both,,,2706.8300,406.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1128.75,,,,,,,698.6300,2706.8300,percent of total billed charges,"41.7% of $2,706.83 in Billed Charges for Rev 272 = $1,128.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT,272,RC,27200002,CDM,,,,,,both,,,2706.8300,406.0200,CIGNA HEALTHCARE,CIGNA PPO,1128.75,,,,,,,698.6300,2706.8300,percent of total billed charges,"41.7% of $2,706.83 in Billed Charges for Rev 272 = $1,128.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT,272,RC,27200002,CDM,,,,,,both,,,2706.8300,406.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2436.15,,,,,,,698.6300,2706.8300,percent of total billed charges,"90% of $2,706.83 in Billed Charges for Rev 272 = $2,436.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT,272,RC,27200002,CDM,,,,,,both,,,2706.8300,406.0200,MEDCOST,MEDCOST VHN,1288.18,,,,,,,698.6300,2706.8300,percent of total billed charges,"47.59% of $2,706.83 in Billed Charges for Rev 272 = $1,288.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT,272,RC,27200002,CDM,,,,,,both,,,2706.8300,406.0200,SENTARA HEALTH,SENTARA HEALTH,698.63,,,,,,,698.6300,2706.8300,percent of total billed charges,"25.81% of $2,706.83 in Billed Charges for Rev 272 = $698.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT,272,RC,27200002,CDM,,,,,,both,,,2706.8300,406.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2706.83,,,,,,,698.6300,2706.8300,percent of total billed charges,"100% of $2,706.83 in Billed Charges for Rev 272 = $2,706.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT,272,RC,27200002,CDM,,,,,,both,,,2706.8300,406.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1353.42,,,,,,,698.6300,2706.8300,percent of total billed charges,"Rev 272 $2,706.83 in Billed Charges at 50% = $1,353.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT,272,RC,27200002,CDM,,,,,,both,,,2706.8300,406.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,874.31,,,,,,,698.6300,2706.8300,other,"32.3% of $2,706.83 in Billed Charges for Rev 272 = $874.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TRACKER PATIENT,272,RC,27200002,CDM,,,,,,both,,,2706.8300,406.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,831.00,,,,,,,698.6300,2706.8300,other,"30.7% of $2,706.83 in Billed Charges for Rev 272 = $831.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TRACKER PATIENT,272,RC,27200002,CDM,,,,,,both,,,2706.8300,406.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,874.31,,,,,,,698.6300,2706.8300,percent of total billed charges,"32.3% of $2,706.83 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT,272,RC,27200002,CDM,,,,,,both,,,2706.8300,406.0200,WELLCARE,WELLCARE MEDICAID,2706.83,,,,,,,698.6300,2706.8300,percent of total billed charges,"100% of $2,706.83 in Billed Charges for Rev 272 = $2,706.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT NONINVASIVE,272,RC,27200002,CDM,,,,,,both,,,2049.5200,307.4300,AETNA,AETNA,875.15,,,,,,,528.9800,2049.5200,percent of total billed charges,"42.7% of $2,049.52 in Billed Charges for Rev 272 = $875.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT NONINVASIVE,272,RC,27200002,CDM,,,,,,both,,,2049.5200,307.4300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1434.66,,,,,,,528.9800,2049.5200,percent of total billed charges,"Rev 272 $2,049.52 in Billed Charges at 70% = $1,434.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT NONINVASIVE,272,RC,27200002,CDM,,,,,,both,,,2049.5200,307.4300,CIGNA HEALTHCARE,CIGNA HMO,854.65,,,,,,,528.9800,2049.5200,percent of total billed charges,"41.7% of $2,049.52 in Billed Charges for Rev 272 = $854.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT NONINVASIVE,272,RC,27200002,CDM,,,,,,both,,,2049.5200,307.4300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,950.98,,,,,,,528.9800,2049.5200,percent of total billed charges,"46.4% of $2,049.52 in Billed Charges for Rev 272 = $950.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT NONINVASIVE,272,RC,27200002,CDM,,,,,,both,,,2049.5200,307.4300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,854.65,,,,,,,528.9800,2049.5200,percent of total billed charges,"41.7% of $2,049.52 in Billed Charges for Rev 272 = $854.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT NONINVASIVE,272,RC,27200002,CDM,,,,,,both,,,2049.5200,307.4300,CIGNA HEALTHCARE,CIGNA PPO,854.65,,,,,,,528.9800,2049.5200,percent of total billed charges,"41.7% of $2,049.52 in Billed Charges for Rev 272 = $854.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT NONINVASIVE,272,RC,27200002,CDM,,,,,,both,,,2049.5200,307.4300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1844.57,,,,,,,528.9800,2049.5200,percent of total billed charges,"90% of $2,049.52 in Billed Charges for Rev 272 = $1,844.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT NONINVASIVE,272,RC,27200002,CDM,,,,,,both,,,2049.5200,307.4300,MEDCOST,MEDCOST VHN,975.37,,,,,,,528.9800,2049.5200,percent of total billed charges,"47.59% of $2,049.52 in Billed Charges for Rev 272 = $975.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT NONINVASIVE,272,RC,27200002,CDM,,,,,,both,,,2049.5200,307.4300,SENTARA HEALTH,SENTARA HEALTH,528.98,,,,,,,528.9800,2049.5200,percent of total billed charges,"25.81% of $2,049.52 in Billed Charges for Rev 272 = $528.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT NONINVASIVE,272,RC,27200002,CDM,,,,,,both,,,2049.5200,307.4300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2049.52,,,,,,,528.9800,2049.5200,percent of total billed charges,"100% of $2,049.52 in Billed Charges for Rev 272 = $2,049.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT NONINVASIVE,272,RC,27200002,CDM,,,,,,both,,,2049.5200,307.4300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1024.76,,,,,,,528.9800,2049.5200,percent of total billed charges,"Rev 272 $2,049.52 in Billed Charges at 50% = $1,024.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT NONINVASIVE,272,RC,27200002,CDM,,,,,,both,,,2049.5200,307.4300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,662.00,,,,,,,528.9800,2049.5200,other,"32.3% of $2,049.52 in Billed Charges for Rev 272 = $662.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TRACKER PATIENT NONINVASIVE,272,RC,27200002,CDM,,,,,,both,,,2049.5200,307.4300,UNITED HEALTHCARE,UHC HERITAGE SELECT,629.20,,,,,,,528.9800,2049.5200,other,"30.7% of $2,049.52 in Billed Charges for Rev 272 = $629.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TRACKER PATIENT NONINVASIVE,272,RC,27200002,CDM,,,,,,both,,,2049.5200,307.4300,UNITED HEALTHCARE,UNITED HEALTHCARE,662.00,,,,,,,528.9800,2049.5200,percent of total billed charges,"32.3% of $2,049.52 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRACKER PATIENT NONINVASIVE,272,RC,27200002,CDM,,,,,,both,,,2049.5200,307.4300,WELLCARE,WELLCARE MEDICAID,2049.52,,,,,,,528.9800,2049.5200,percent of total billed charges,"100% of $2,049.52 in Billed Charges for Rev 272 = $2,049.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY  EPIDURAL CONTINUOUS,272,RC,,,,,,,,both,,,568.6300,85.2900,AETNA,AETNA,242.81,,,,,,,146.7600,568.6300,percent of total billed charges,42.7% of $568.63 in Billed Charges for Rev 272 = $242.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY  EPIDURAL CONTINUOUS,272,RC,,,,,,,,both,,,568.6300,85.2900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,398.04,,,,,,,146.7600,568.6300,percent of total billed charges,Rev 272 $568.63 in Billed Charges at 70% = $398.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY  EPIDURAL CONTINUOUS,272,RC,,,,,,,,both,,,568.6300,85.2900,CIGNA HEALTHCARE,CIGNA HMO,237.12,,,,,,,146.7600,568.6300,percent of total billed charges,41.7% of $568.63 in Billed Charges for Rev 272 = $237.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY  EPIDURAL CONTINUOUS,272,RC,,,,,,,,both,,,568.6300,85.2900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,263.84,,,,,,,146.7600,568.6300,percent of total billed charges,46.4% of $568.63 in Billed Charges for Rev 272 = $263.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY  EPIDURAL CONTINUOUS,272,RC,,,,,,,,both,,,568.6300,85.2900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,237.12,,,,,,,146.7600,568.6300,percent of total billed charges,41.7% of $568.63 in Billed Charges for Rev 272 = $237.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY  EPIDURAL CONTINUOUS,272,RC,,,,,,,,both,,,568.6300,85.2900,CIGNA HEALTHCARE,CIGNA PPO,237.12,,,,,,,146.7600,568.6300,percent of total billed charges,41.7% of $568.63 in Billed Charges for Rev 272 = $237.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY  EPIDURAL CONTINUOUS,272,RC,,,,,,,,both,,,568.6300,85.2900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,511.77,,,,,,,146.7600,568.6300,percent of total billed charges,90% of $568.63 in Billed Charges for Rev 272 = $511.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY  EPIDURAL CONTINUOUS,272,RC,,,,,,,,both,,,568.6300,85.2900,MEDCOST,MEDCOST VHN,270.61,,,,,,,146.7600,568.6300,percent of total billed charges,47.59% of $568.63 in Billed Charges for Rev 272 = $270.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY  EPIDURAL CONTINUOUS,272,RC,,,,,,,,both,,,568.6300,85.2900,SENTARA HEALTH,SENTARA HEALTH,146.76,,,,,,,146.7600,568.6300,percent of total billed charges,25.81% of $568.63 in Billed Charges for Rev 272 = $146.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY  EPIDURAL CONTINUOUS,272,RC,,,,,,,,both,,,568.6300,85.2900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",568.63,,,,,,,146.7600,568.6300,percent of total billed charges,100% of $568.63 in Billed Charges for Rev 272 = $568.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY  EPIDURAL CONTINUOUS,272,RC,,,,,,,,both,,,568.6300,85.2900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,284.32,,,,,,,146.7600,568.6300,percent of total billed charges,Rev 272 $568.63 in Billed Charges at 50% = $284.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY  EPIDURAL CONTINUOUS,272,RC,,,,,,,,both,,,568.6300,85.2900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,183.67,,,,,,,146.7600,568.6300,other,32.3% of $568.63 in Billed Charges for Rev 272 = $183.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TRAY  EPIDURAL CONTINUOUS,272,RC,,,,,,,,both,,,568.6300,85.2900,UNITED HEALTHCARE,UHC HERITAGE SELECT,174.57,,,,,,,146.7600,568.6300,other,30.7% of $568.63 in Billed Charges for Rev 272 = $174.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TRAY  EPIDURAL CONTINUOUS,272,RC,,,,,,,,both,,,568.6300,85.2900,UNITED HEALTHCARE,UNITED HEALTHCARE,183.67,,,,,,,146.7600,568.6300,percent of total billed charges,32.3% of $568.63 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY  EPIDURAL CONTINUOUS,272,RC,,,,,,,,both,,,568.6300,85.2900,WELLCARE,WELLCARE MEDICAID,568.63,,,,,,,146.7600,568.6300,percent of total billed charges,100% of $568.63 in Billed Charges for Rev 272 = $568.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,AETNA,AETNA,209.23,,,,,,,63.9400,490.0000,percent of total billed charges,42.7% of $490.00 in Billed Charges for Rev 510 Proc 29581 = $209.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,283.21,,,,,,,63.9400,490.0000,fee schedule,"APG 00039 Proc 29581 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 104% = $283.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,147.43,,,,,,,63.9400,490.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,AETNA,AETNA HEALTHCARE MEDICARE,147.43,,,,,,,63.9400,490.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,147.43,,,,,,,63.9400,490.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,AMBETTER,AMBETTER,321.40,,,,,,,63.9400,490.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,153.33,,,,,,,63.9400,490.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,BLUE CROSS,ANTHEM EXCHANGE,362.98,,,,,,,63.9400,490.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,280.48,,,,,,,63.9400,490.0000,fee schedule,"APG 00039 Proc 29581 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,BLUE CROSS,ANTHEM HMO,385.65,,,,,,,63.9400,490.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,151.86,,,,,,,63.9400,490.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",453.68,,,,,,,63.9400,490.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,82.07,,,,,,,63.9400,490.0000,fee schedule,$82.07 from Fee Schedule BLDTM_23 for Rev 510 Proc 29581 * Qty 1 = $82.07 at 100% = $82.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,BLUE CROSS,BLUE CROSS MEDICARE,153.33,,,,,,,63.9400,490.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,CIGNA HEALTHCARE,CIGNA HMO,204.33,,,,,,,63.9400,490.0000,percent of total billed charges,41.7% of $490.00 in Billed Charges for Rev 510 Proc 29581 = $204.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,227.36,,,,,,,63.9400,490.0000,percent of total billed charges,46.4% of $490.00 in Billed Charges for Rev 510 Proc 29581 = $227.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,154.80,,,,,,,63.9400,490.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,204.33,,,,,,,63.9400,490.0000,percent of total billed charges,41.7% of $490.00 in Billed Charges for Rev 510 Proc 29581 = $204.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,CIGNA HEALTHCARE,CIGNA PPO,204.33,,,,,,,63.9400,490.0000,percent of total billed charges,41.7% of $490.00 in Billed Charges for Rev 510 Proc 29581 = $204.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,154.80,,,,,,,63.9400,490.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,441.00,,,,,,,63.9400,490.0000,percent of total billed charges,90% of $490.00 in Billed Charges for Rev 510 Proc 29581 = $441.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,HUMANA,HUMANA MEDICARE,147.43,,,,,,,63.9400,490.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,147.43,,,,,,,63.9400,490.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,MEDCOST,MEDCOST VHN,233.19,,,,,,,63.9400,490.0000,percent of total billed charges,47.59% of $490.00 in Billed Charges for Rev 510 Proc 29581 = $233.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,285.93,,,,,,,63.9400,490.0000,fee schedule,"APG 00039 Proc 29581 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 105% = $285.93 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,154.80,,,,,,,63.9400,490.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,154.80,,,,,,,63.9400,490.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,NHC ADVANTAGE,NHC ADVANTAGE,154.80,,,,,,,63.9400,490.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,280.75,,,,,,,63.9400,490.0000,fee schedule,"APG 00039 Proc 29581 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 103.1% = $280.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,SENTARA HEALTH,SENTARA HEALTH,126.47,,,,,,,63.9400,490.0000,percent of total billed charges,25.81% of $490.00 in Billed Charges for Rev 510 Proc 29581 = $126.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,SENTARA HEALTH,SENTARA MEDICARE,147.43,,,,,,,63.9400,490.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",490.00,,,,,,,63.9400,490.0000,percent of total billed charges,100% of $490.00 in Billed Charges for Rev 510 Proc 29581 = $490.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,63.94,,,,,,,63.9400,490.0000,fee schedule,$127.87 from Fee Schedule TCUHC24 for Rev 510 Proc 29581 * Qty 1 = $127.87 at 50% = $63.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,158.27,,,,,,,63.9400,490.0000,other,32.3% of $490.00 in Billed Charges for Rev 510 Proc 29581 = $158.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,150.43,,,,,,,63.9400,490.0000,other,30.7% of $490.00 in Billed Charges for Rev 510 Proc 29581 = $150.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,158.27,,,,,,,63.9400,490.0000,percent of total billed charges,32.3% of $490.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,280.48,,,,,,,63.9400,490.0000,fee schedule,"APG 00039 Proc 29581 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,147.43,,,,,,,63.9400,490.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,147.43,,,,,,,63.9400,490.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,WELLCARE,WELLCARE MEDICAID,490.00,,,,,,,63.9400,490.0000,percent of total billed charges,100% of $490.00 in Billed Charges for Rev 510 Proc 29581 = $490.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS LWR LEG UNILAT,29581,CPT,510,RC,51000007,CDM,,,,both,,,490.0000,73.5000,WELLCARE,WELLCARE MEDICARE,156.28,,,,,,,63.9400,490.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,AETNA,AETNA,82.41,,,,,,,33.2100,553.1900,percent of total billed charges,42.7% of $193.00 in Billed Charges for Rev 450 Proc 29705 = $82.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,283.21,,,,,,,33.2100,553.1900,fee schedule,"APG 00039 Proc 29705 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 104% = $283.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,193.00,,,,,,,33.2100,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,AETNA,AETNA HEALTHCARE MEDICARE,193.00,,,,,,,33.2100,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,193.00,,,,,,,33.2100,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,AMBETTER,AMBETTER,553.19,,,,,,,33.2100,553.1900,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,193.00,,,,,,,33.2100,553.1900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,ANTHEM EXCHANGE,193.00,,,,,,,33.2100,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,193.00,,,,,,,33.2100,553.1900,fee schedule,"APG 00039 Proc 29705 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48 (Service Line reduced to $193.00, claim capped at $193.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,ANTHEM HMO,193.00,,,,,,,33.2100,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,193.00,,,,,,,33.2100,553.1900,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",193.00,,,,,,,33.2100,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,33.21,,,,,,,33.2100,553.1900,fee schedule,$33.21 from Fee Schedule BLDTM_23 for Rev 450 Proc 29705 * Qty 1 = $33.21 at 100% = $33.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,BLUE CROSS,BLUE CROSS MEDICARE,263.91,,,,,,,33.2100,553.1900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,193.00,,,,,,,33.2100,553.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,193.00,,,,,,,33.2100,553.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,173.70,,,,,,,33.2100,553.1900,percent of total billed charges,90% of $193.00 in Billed Charges for Rev 450 Proc 29705 = $173.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,HUMANA,HUMANA MEDICARE,193.00,,,,,,,33.2100,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,193.00,,,,,,,33.2100,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,MEDCOST,MEDCOST VHN,91.85,,,,,,,33.2100,553.1900,percent of total billed charges,47.59% of $193.00 in Billed Charges for Rev 450 Proc 29705 = $91.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,285.93,,,,,,,33.2100,553.1900,fee schedule,"APG 00039 Proc 29705 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 105% = $285.93 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,193.00,,,,,,,33.2100,553.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,193.00,,,,,,,33.2100,553.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,NHC ADVANTAGE,NHC ADVANTAGE,193.00,,,,,,,33.2100,553.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,280.75,,,,,,,33.2100,553.1900,fee schedule,"APG 00039 Proc 29705 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 103.1% = $280.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,SENTARA HEALTH,SENTARA HEALTH,49.81,,,,,,,33.2100,553.1900,percent of total billed charges,25.81% of $193.00 in Billed Charges for Rev 450 Proc 29705 = $49.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,SENTARA HEALTH,SENTARA MEDICARE,193.00,,,,,,,33.2100,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",193.00,,,,,,,33.2100,553.1900,percent of total billed charges,100% of $193.00 in Billed Charges for Rev 450 Proc 29705 = $193.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,33.2100,553.1900,case rate,Rev 450 Proc 29705 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,193.00,,,,,,,33.2100,553.1900,case rate,"Rev 450 Proc 29705 at Case Rate $491.00 (Service Line reduced to $193.00, claim capped at $193.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,193.00,,,,,,,33.2100,553.1900,case rate,"Rev 450 Proc 29705 at Case Rate $471.00 (Service Line reduced to $193.00, claim capped at $193.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,193.00,,,,,,,33.2100,553.1900,case rate,"Rev 450 Proc 29705 at Case Rate $847.00 (Service Line reduced to $193.00, claim capped at $193.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,280.48,,,,,,,33.2100,553.1900,fee schedule,"APG 00039 Proc 29705 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,193.00,,,,,,,33.2100,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,193.00,,,,,,,33.2100,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,WELLCARE,WELLCARE MEDICAID,193.00,,,,,,,33.2100,553.1900,percent of total billed charges,100% of $193.00 in Billed Charges for Rev 450 Proc 29705 = $193.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVE FULL ARM LEG CAST,29705,CPT,450,RC,45000210,CDM,,,,both,,,193.0000,28.9500,WELLCARE,WELLCARE MEDICARE,268.98,,,,,,,33.2100,553.1900,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,AETNA,AETNA,118.71,,,,,,,55.9500,553.1900,percent of total billed charges,42.7% of $278.00 in Billed Charges for Rev 450 Proc 29740 = $118.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,283.21,,,,,,,55.9500,553.1900,fee schedule,"APG 00039 Proc 29740 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 104% = $283.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,253.76,,,,,,,55.9500,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,AETNA,AETNA HEALTHCARE MEDICARE,253.76,,,,,,,55.9500,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,253.76,,,,,,,55.9500,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,AMBETTER,AMBETTER,553.19,,,,,,,55.9500,553.1900,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,263.91,,,,,,,55.9500,553.1900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,BLUE CROSS,ANTHEM EXCHANGE,278.00,,,,,,,55.9500,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,278.00,,,,,,,55.9500,553.1900,fee schedule,"APG 00039 Proc 29740 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48 (Service Line reduced to $278.00, claim capped at $278.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,BLUE CROSS,ANTHEM HMO,278.00,,,,,,,55.9500,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,261.37,,,,,,,55.9500,553.1900,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",278.00,,,,,,,55.9500,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,55.95,,,,,,,55.9500,553.1900,fee schedule,$55.95 from Fee Schedule BLDTM_23 for Rev 450 Proc 29740 * Qty 1 = $55.95 at 100% = $55.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,BLUE CROSS,BLUE CROSS MEDICARE,263.91,,,,,,,55.9500,553.1900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,266.45,,,,,,,55.9500,553.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,266.45,,,,,,,55.9500,553.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,250.20,,,,,,,55.9500,553.1900,percent of total billed charges,90% of $278.00 in Billed Charges for Rev 450 Proc 29740 = $250.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,HUMANA,HUMANA MEDICARE,253.76,,,,,,,55.9500,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,253.76,,,,,,,55.9500,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,MEDCOST,MEDCOST VHN,132.30,,,,,,,55.9500,553.1900,percent of total billed charges,47.59% of $278.00 in Billed Charges for Rev 450 Proc 29740 = $132.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,285.93,,,,,,,55.9500,553.1900,fee schedule,"APG 00039 Proc 29740 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 105% = $285.93 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,266.45,,,,,,,55.9500,553.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,266.45,,,,,,,55.9500,553.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,NHC ADVANTAGE,NHC ADVANTAGE,266.45,,,,,,,55.9500,553.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,280.75,,,,,,,55.9500,553.1900,fee schedule,"APG 00039 Proc 29740 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 103.1% = $280.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,SENTARA HEALTH,SENTARA HEALTH,71.75,,,,,,,55.9500,553.1900,percent of total billed charges,25.81% of $278.00 in Billed Charges for Rev 450 Proc 29740 = $71.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,SENTARA HEALTH,SENTARA MEDICARE,253.76,,,,,,,55.9500,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",278.00,,,,,,,55.9500,553.1900,percent of total billed charges,100% of $278.00 in Billed Charges for Rev 450 Proc 29740 = $278.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,55.9500,553.1900,case rate,Rev 450 Proc 29740 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,278.00,,,,,,,55.9500,553.1900,case rate,"Rev 450 Proc 29740 at Case Rate $491.00 (Service Line reduced to $278.00, claim capped at $278.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,278.00,,,,,,,55.9500,553.1900,case rate,"Rev 450 Proc 29740 at Case Rate $471.00 (Service Line reduced to $278.00, claim capped at $278.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,278.00,,,,,,,55.9500,553.1900,case rate,"Rev 450 Proc 29740 at Case Rate $847.00 (Service Line reduced to $278.00, claim capped at $278.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,280.48,,,,,,,55.9500,553.1900,fee schedule,"APG 00039 Proc 29740 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,253.76,,,,,,,55.9500,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,253.76,,,,,,,55.9500,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,WELLCARE,WELLCARE MEDICAID,278.00,,,,,,,55.9500,553.1900,percent of total billed charges,100% of $278.00 in Billed Charges for Rev 450 Proc 29740 = $278.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WEDGING OF CAST,29740,CPT,450,RC,45000211,CDM,,,,both,,,278.0000,41.7000,WELLCARE,WELLCARE MEDICARE,268.98,,,,,,,55.9500,553.1900,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,AETNA,AETNA,154.57,,,,,,,93.4300,362.0000,percent of total billed charges,42.7% of $362.00 in Billed Charges for Rev 450 Proc 29799 = $154.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,106.23,,,,,,,93.4300,362.0000,fee schedule,"APG 00040 Proc 29799 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 104% = $106.23. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,147.43,,,,,,,93.4300,362.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,AETNA,AETNA HEALTHCARE MEDICARE,147.43,,,,,,,93.4300,362.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,147.43,,,,,,,93.4300,362.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,AMBETTER,AMBETTER,321.40,,,,,,,93.4300,362.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,153.33,,,,,,,93.4300,362.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,BLUE CROSS,ANTHEM EXCHANGE,362.00,,,,,,,93.4300,362.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,105.21,,,,,,,93.4300,362.0000,fee schedule,"APG 00040 Proc 29799 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,BLUE CROSS,ANTHEM HMO,362.00,,,,,,,93.4300,362.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,151.86,,,,,,,93.4300,362.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",362.00,,,,,,,93.4300,362.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,BLUE CROSS,BLUE CROSS MEDICARE,153.33,,,,,,,93.4300,362.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,154.80,,,,,,,93.4300,362.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,154.80,,,,,,,93.4300,362.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,325.80,,,,,,,93.4300,362.0000,percent of total billed charges,90% of $362.00 in Billed Charges for Rev 450 Proc 29799 = $325.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,HUMANA,HUMANA MEDICARE,147.43,,,,,,,93.4300,362.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,147.43,,,,,,,93.4300,362.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,MEDCOST,MEDCOST VHN,172.28,,,,,,,93.4300,362.0000,percent of total billed charges,47.59% of $362.00 in Billed Charges for Rev 450 Proc 29799 = $172.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,107.26,,,,,,,93.4300,362.0000,fee schedule,"APG 00040 Proc 29799 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 100% = $102.15... $102.15 at 105% = $107.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,154.80,,,,,,,93.4300,362.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,154.80,,,,,,,93.4300,362.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,NHC ADVANTAGE,NHC ADVANTAGE,154.80,,,,,,,93.4300,362.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,105.32,,,,,,,93.4300,362.0000,fee schedule,"APG 00040 Proc 29799 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 100% = $102.15... $102.15 at 103.1% = $105.32 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,SENTARA HEALTH,SENTARA HEALTH,93.43,,,,,,,93.4300,362.0000,percent of total billed charges,25.81% of $362.00 in Billed Charges for Rev 450 Proc 29799 = $93.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,SENTARA HEALTH,SENTARA MEDICARE,147.43,,,,,,,93.4300,362.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",362.00,,,,,,,93.4300,362.0000,percent of total billed charges,100% of $362.00 in Billed Charges for Rev 450 Proc 29799 = $362.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,93.4300,362.0000,case rate,Rev 450 Proc 29799 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,362.00,,,,,,,93.4300,362.0000,case rate,"Rev 450 Proc 29799 at Case Rate $491.00 (Service Line reduced to $362.00, claim capped at $362.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,362.00,,,,,,,93.4300,362.0000,case rate,"Rev 450 Proc 29799 at Case Rate $471.00 (Service Line reduced to $362.00, claim capped at $362.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,362.00,,,,,,,93.4300,362.0000,case rate,"Rev 450 Proc 29799 at Case Rate $847.00 (Service Line reduced to $362.00, claim capped at $362.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,105.21,,,,,,,93.4300,362.0000,fee schedule,"APG 00040 Proc 29799 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,147.43,,,,,,,93.4300,362.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,147.43,,,,,,,93.4300,362.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,WELLCARE,WELLCARE MEDICAID,362.00,,,,,,,93.4300,362.0000,percent of total billed charges,100% of $362.00 in Billed Charges for Rev 450 Proc 29799 = $362.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CASTING/STRAPPING PROCEDURE,29799,CPT,450,RC,45000311,CDM,,,,both,,,362.0000,54.3000,WELLCARE,WELLCARE MEDICARE,156.28,,,,,,,93.4300,362.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,AETNA,AETNA,220.33,,,,,,,34.5300,516.0000,percent of total billed charges,42.7% of $516.00 in Billed Charges for Rev 450 Proc 30901 = $220.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,265.28,,,,,,,34.5300,516.0000,fee schedule,APG 00249 Proc 30901 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment) at 104% = $265.28. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,120.71,,,,,,,34.5300,516.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,AETNA,AETNA HEALTHCARE MEDICARE,120.71,,,,,,,34.5300,516.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,120.71,,,,,,,34.5300,516.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,AMBETTER,AMBETTER,263.15,,,,,,,34.5300,516.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,125.54,,,,,,,34.5300,516.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,BLUE CROSS,ANTHEM EXCHANGE,297.21,,,,,,,34.5300,516.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,262.73,,,,,,,34.5300,516.0000,fee schedule,APG 00249 Proc 30901 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment) at 103% = $262.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,BLUE CROSS,ANTHEM HMO,315.76,,,,,,,34.5300,516.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,124.33,,,,,,,34.5300,516.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",371.47,,,,,,,34.5300,516.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,57.60,,,,,,,34.5300,516.0000,fee schedule,$57.60 from Fee Schedule BLDTM_23 for Rev 450 Proc 30901 * Qty 1 = $57.60 at 100% = $57.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,BLUE CROSS,BLUE CROSS MEDICARE,125.54,,,,,,,34.5300,516.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,BLUE CROSS,TENNCARE BLUE CARE,34.53,,,,,,,34.5300,516.0000,fee schedule,$29.77 from Fee Schedule TC_24 for Rev 450 Proc 30901 * Qty 1 = $29.77 at 116% = $34.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,BLUE CROSS,TENNCARE BLUE SELECT,34.53,,,,,,,34.5300,516.0000,fee schedule,$29.77 from Fee Schedule TC_24 for Rev 450 Proc 30901 * Qty 1 = $29.77 at 116% = $34.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,126.75,,,,,,,34.5300,516.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,126.75,,,,,,,34.5300,516.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,464.40,,,,,,,34.5300,516.0000,percent of total billed charges,90% of $516.00 in Billed Charges for Rev 450 Proc 30901 = $464.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,HUMANA,HUMANA MEDICARE,120.71,,,,,,,34.5300,516.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,120.71,,,,,,,34.5300,516.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,MEDCOST,MEDCOST VHN,245.56,,,,,,,34.5300,516.0000,percent of total billed charges,47.59% of $516.00 in Billed Charges for Rev 450 Proc 30901 = $245.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,267.83,,,,,,,34.5300,516.0000,fee schedule,APG 00249 Proc 30901 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment) at 100% = $255.08... $255.08 at 105% = $267.83 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,126.75,,,,,,,34.5300,516.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,126.75,,,,,,,34.5300,516.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,NHC ADVANTAGE,NHC ADVANTAGE,126.75,,,,,,,34.5300,516.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,262.99,,,,,,,34.5300,516.0000,fee schedule,APG 00249 Proc 30901 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment) at 100% = $255.08... $255.08 at 103.1% = $262.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,SENTARA HEALTH,SENTARA HEALTH,133.18,,,,,,,34.5300,516.0000,percent of total billed charges,25.81% of $516.00 in Billed Charges for Rev 450 Proc 30901 = $133.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,SENTARA HEALTH,SENTARA MEDICARE,120.71,,,,,,,34.5300,516.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",516.00,,,,,,,34.5300,516.0000,percent of total billed charges,100% of $516.00 in Billed Charges for Rev 450 Proc 30901 = $516.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,34.5300,516.0000,case rate,Rev 450 Proc 30901 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,34.5300,516.0000,case rate,Rev 450 Proc 30901 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,34.5300,516.0000,case rate,Rev 450 Proc 30901 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,516.00,,,,,,,34.5300,516.0000,case rate,"Rev 450 Proc 30901 at Case Rate $847.00 (Service Line reduced to $516.00, claim capped at $516.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,262.73,,,,,,,34.5300,516.0000,fee schedule,APG 00249 Proc 30901 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment) at 103% = $262.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,120.71,,,,,,,34.5300,516.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,120.71,,,,,,,34.5300,516.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,WELLCARE,WELLCARE MEDICAID,516.00,,,,,,,34.5300,516.0000,percent of total billed charges,100% of $516.00 in Billed Charges for Rev 450 Proc 30901 = $516.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CONTROL NASAL HEMOR ANT SIMPL,30901,CPT,450,RC,45000213,CDM,,,,both,,,516.0000,77.4000,WELLCARE,WELLCARE MEDICARE,127.95,,,,,,,34.5300,516.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TRAY BONE MARROW JAMSHIDI 11G,272,RC,,,,,,,,both,,,422.9300,63.4400,AETNA,AETNA,180.59,,,,,,,109.1600,422.9300,percent of total billed charges,42.7% of $422.93 in Billed Charges for Rev 272 = $180.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY BONE MARROW JAMSHIDI 11G,272,RC,,,,,,,,both,,,422.9300,63.4400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,296.05,,,,,,,109.1600,422.9300,percent of total billed charges,Rev 272 $422.93 in Billed Charges at 70% = $296.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY BONE MARROW JAMSHIDI 11G,272,RC,,,,,,,,both,,,422.9300,63.4400,CIGNA HEALTHCARE,CIGNA HMO,176.36,,,,,,,109.1600,422.9300,percent of total billed charges,41.7% of $422.93 in Billed Charges for Rev 272 = $176.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY BONE MARROW JAMSHIDI 11G,272,RC,,,,,,,,both,,,422.9300,63.4400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,196.24,,,,,,,109.1600,422.9300,percent of total billed charges,46.4% of $422.93 in Billed Charges for Rev 272 = $196.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY BONE MARROW JAMSHIDI 11G,272,RC,,,,,,,,both,,,422.9300,63.4400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,176.36,,,,,,,109.1600,422.9300,percent of total billed charges,41.7% of $422.93 in Billed Charges for Rev 272 = $176.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY BONE MARROW JAMSHIDI 11G,272,RC,,,,,,,,both,,,422.9300,63.4400,CIGNA HEALTHCARE,CIGNA PPO,176.36,,,,,,,109.1600,422.9300,percent of total billed charges,41.7% of $422.93 in Billed Charges for Rev 272 = $176.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY BONE MARROW JAMSHIDI 11G,272,RC,,,,,,,,both,,,422.9300,63.4400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,380.64,,,,,,,109.1600,422.9300,percent of total billed charges,90% of $422.93 in Billed Charges for Rev 272 = $380.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY BONE MARROW JAMSHIDI 11G,272,RC,,,,,,,,both,,,422.9300,63.4400,MEDCOST,MEDCOST VHN,201.27,,,,,,,109.1600,422.9300,percent of total billed charges,47.59% of $422.93 in Billed Charges for Rev 272 = $201.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY BONE MARROW JAMSHIDI 11G,272,RC,,,,,,,,both,,,422.9300,63.4400,SENTARA HEALTH,SENTARA HEALTH,109.16,,,,,,,109.1600,422.9300,percent of total billed charges,25.81% of $422.93 in Billed Charges for Rev 272 = $109.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY BONE MARROW JAMSHIDI 11G,272,RC,,,,,,,,both,,,422.9300,63.4400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",422.93,,,,,,,109.1600,422.9300,percent of total billed charges,100% of $422.93 in Billed Charges for Rev 272 = $422.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY BONE MARROW JAMSHIDI 11G,272,RC,,,,,,,,both,,,422.9300,63.4400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,211.47,,,,,,,109.1600,422.9300,percent of total billed charges,Rev 272 $422.93 in Billed Charges at 50% = $211.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY BONE MARROW JAMSHIDI 11G,272,RC,,,,,,,,both,,,422.9300,63.4400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,136.61,,,,,,,109.1600,422.9300,other,32.3% of $422.93 in Billed Charges for Rev 272 = $136.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TRAY BONE MARROW JAMSHIDI 11G,272,RC,,,,,,,,both,,,422.9300,63.4400,UNITED HEALTHCARE,UHC HERITAGE SELECT,129.84,,,,,,,109.1600,422.9300,other,30.7% of $422.93 in Billed Charges for Rev 272 = $129.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TRAY BONE MARROW JAMSHIDI 11G,272,RC,,,,,,,,both,,,422.9300,63.4400,UNITED HEALTHCARE,UNITED HEALTHCARE,136.61,,,,,,,109.1600,422.9300,percent of total billed charges,32.3% of $422.93 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY BONE MARROW JAMSHIDI 11G,272,RC,,,,,,,,both,,,422.9300,63.4400,WELLCARE,WELLCARE MEDICAID,422.93,,,,,,,109.1600,422.9300,percent of total billed charges,100% of $422.93 in Billed Charges for Rev 272 = $422.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY BONEPLAST SUPP MOLD,272,RC,27200002,CDM,,,,,,both,,,5206.2400,780.9400,AETNA,AETNA,2223.06,,,,,,,1343.7300,5206.2400,percent of total billed charges,"42.7% of $5,206.24 in Billed Charges for Rev 272 = $2,223.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY BONEPLAST SUPP MOLD,272,RC,27200002,CDM,,,,,,both,,,5206.2400,780.9400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3644.37,,,,,,,1343.7300,5206.2400,percent of total billed charges,"Rev 272 $5,206.24 in Billed Charges at 70% = $3,644.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY BONEPLAST SUPP MOLD,272,RC,27200002,CDM,,,,,,both,,,5206.2400,780.9400,CIGNA HEALTHCARE,CIGNA HMO,2171.00,,,,,,,1343.7300,5206.2400,percent of total billed charges,"41.7% of $5,206.24 in Billed Charges for Rev 272 = $2,171.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY BONEPLAST SUPP MOLD,272,RC,27200002,CDM,,,,,,both,,,5206.2400,780.9400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2415.70,,,,,,,1343.7300,5206.2400,percent of total billed charges,"46.4% of $5,206.24 in Billed Charges for Rev 272 = $2,415.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY BONEPLAST SUPP MOLD,272,RC,27200002,CDM,,,,,,both,,,5206.2400,780.9400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2171.00,,,,,,,1343.7300,5206.2400,percent of total billed charges,"41.7% of $5,206.24 in Billed Charges for Rev 272 = $2,171.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY BONEPLAST SUPP MOLD,272,RC,27200002,CDM,,,,,,both,,,5206.2400,780.9400,CIGNA HEALTHCARE,CIGNA PPO,2171.00,,,,,,,1343.7300,5206.2400,percent of total billed charges,"41.7% of $5,206.24 in Billed Charges for Rev 272 = $2,171.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY BONEPLAST SUPP MOLD,272,RC,27200002,CDM,,,,,,both,,,5206.2400,780.9400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4685.62,,,,,,,1343.7300,5206.2400,percent of total billed charges,"90% of $5,206.24 in Billed Charges for Rev 272 = $4,685.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY BONEPLAST SUPP MOLD,272,RC,27200002,CDM,,,,,,both,,,5206.2400,780.9400,MEDCOST,MEDCOST VHN,2477.65,,,,,,,1343.7300,5206.2400,percent of total billed charges,"47.59% of $5,206.24 in Billed Charges for Rev 272 = $2,477.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY BONEPLAST SUPP MOLD,272,RC,27200002,CDM,,,,,,both,,,5206.2400,780.9400,SENTARA HEALTH,SENTARA HEALTH,1343.73,,,,,,,1343.7300,5206.2400,percent of total billed charges,"25.81% of $5,206.24 in Billed Charges for Rev 272 = $1,343.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY BONEPLAST SUPP MOLD,272,RC,27200002,CDM,,,,,,both,,,5206.2400,780.9400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5206.24,,,,,,,1343.7300,5206.2400,percent of total billed charges,"100% of $5,206.24 in Billed Charges for Rev 272 = $5,206.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY BONEPLAST SUPP MOLD,272,RC,27200002,CDM,,,,,,both,,,5206.2400,780.9400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2603.12,,,,,,,1343.7300,5206.2400,percent of total billed charges,"Rev 272 $5,206.24 in Billed Charges at 50% = $2,603.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY BONEPLAST SUPP MOLD,272,RC,27200002,CDM,,,,,,both,,,5206.2400,780.9400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1681.62,,,,,,,1343.7300,5206.2400,other,"32.3% of $5,206.24 in Billed Charges for Rev 272 = $1,681.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TRAY BONEPLAST SUPP MOLD,272,RC,27200002,CDM,,,,,,both,,,5206.2400,780.9400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1598.32,,,,,,,1343.7300,5206.2400,other,"30.7% of $5,206.24 in Billed Charges for Rev 272 = $1,598.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TRAY BONEPLAST SUPP MOLD,272,RC,27200002,CDM,,,,,,both,,,5206.2400,780.9400,UNITED HEALTHCARE,UNITED HEALTHCARE,1681.62,,,,,,,1343.7300,5206.2400,percent of total billed charges,"32.3% of $5,206.24 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY BONEPLAST SUPP MOLD,272,RC,27200002,CDM,,,,,,both,,,5206.2400,780.9400,WELLCARE,WELLCARE MEDICAID,5206.24,,,,,,,1343.7300,5206.2400,percent of total billed charges,"100% of $5,206.24 in Billed Charges for Rev 272 = $5,206.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO CLIP XC200,272,RC,27200002,CDM,,,,,,both,,,617.4700,92.6200,AETNA,AETNA,263.66,,,,,,,159.3700,617.4700,percent of total billed charges,42.7% of $617.47 in Billed Charges for Rev 272 = $263.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ENDO CLIP XC200,272,RC,27200002,CDM,,,,,,both,,,617.4700,92.6200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,432.23,,,,,,,159.3700,617.4700,percent of total billed charges,Rev 272 $617.47 in Billed Charges at 70% = $432.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ENDO CLIP XC200,272,RC,27200002,CDM,,,,,,both,,,617.4700,92.6200,CIGNA HEALTHCARE,CIGNA HMO,257.49,,,,,,,159.3700,617.4700,percent of total billed charges,41.7% of $617.47 in Billed Charges for Rev 272 = $257.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ENDO CLIP XC200,272,RC,27200002,CDM,,,,,,both,,,617.4700,92.6200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,286.51,,,,,,,159.3700,617.4700,percent of total billed charges,46.4% of $617.47 in Billed Charges for Rev 272 = $286.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ENDO CLIP XC200,272,RC,27200002,CDM,,,,,,both,,,617.4700,92.6200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,257.49,,,,,,,159.3700,617.4700,percent of total billed charges,41.7% of $617.47 in Billed Charges for Rev 272 = $257.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ENDO CLIP XC200,272,RC,27200002,CDM,,,,,,both,,,617.4700,92.6200,CIGNA HEALTHCARE,CIGNA PPO,257.49,,,,,,,159.3700,617.4700,percent of total billed charges,41.7% of $617.47 in Billed Charges for Rev 272 = $257.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ENDO CLIP XC200,272,RC,27200002,CDM,,,,,,both,,,617.4700,92.6200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,555.72,,,,,,,159.3700,617.4700,percent of total billed charges,90% of $617.47 in Billed Charges for Rev 272 = $555.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ENDO CLIP XC200,272,RC,27200002,CDM,,,,,,both,,,617.4700,92.6200,MEDCOST,MEDCOST VHN,293.85,,,,,,,159.3700,617.4700,percent of total billed charges,47.59% of $617.47 in Billed Charges for Rev 272 = $293.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ENDO CLIP XC200,272,RC,27200002,CDM,,,,,,both,,,617.4700,92.6200,SENTARA HEALTH,SENTARA HEALTH,159.37,,,,,,,159.3700,617.4700,percent of total billed charges,25.81% of $617.47 in Billed Charges for Rev 272 = $159.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ENDO CLIP XC200,272,RC,27200002,CDM,,,,,,both,,,617.4700,92.6200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",617.47,,,,,,,159.3700,617.4700,percent of total billed charges,100% of $617.47 in Billed Charges for Rev 272 = $617.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ENDO CLIP XC200,272,RC,27200002,CDM,,,,,,both,,,617.4700,92.6200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,308.74,,,,,,,159.3700,617.4700,percent of total billed charges,Rev 272 $617.47 in Billed Charges at 50% = $308.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ENDO CLIP XC200,272,RC,27200002,CDM,,,,,,both,,,617.4700,92.6200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,199.44,,,,,,,159.3700,617.4700,other,32.3% of $617.47 in Billed Charges for Rev 272 = $199.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE ENDO CLIP XC200,272,RC,27200002,CDM,,,,,,both,,,617.4700,92.6200,UNITED HEALTHCARE,UHC HERITAGE SELECT,189.56,,,,,,,159.3700,617.4700,other,30.7% of $617.47 in Billed Charges for Rev 272 = $189.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE ENDO CLIP XC200,272,RC,27200002,CDM,,,,,,both,,,617.4700,92.6200,UNITED HEALTHCARE,UNITED HEALTHCARE,199.44,,,,,,,159.3700,617.4700,percent of total billed charges,32.3% of $617.47 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ENDO CLIP XC200,272,RC,27200002,CDM,,,,,,both,,,617.4700,92.6200,WELLCARE,WELLCARE MEDICAID,617.47,,,,,,,159.3700,617.4700,percent of total billed charges,100% of $617.47 in Billed Charges for Rev 272 = $617.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,4917.8200,737.6700,AETNA,AETNA,2099.91,,,,,,,1269.2900,4917.8200,percent of total billed charges,"42.7% of $4,917.82 in Billed Charges for Rev 272 = $2,099.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,4917.8200,737.6700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3442.47,,,,,,,1269.2900,4917.8200,percent of total billed charges,"Rev 272 $4,917.82 in Billed Charges at 70% = $3,442.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,4917.8200,737.6700,CIGNA HEALTHCARE,CIGNA HMO,2050.73,,,,,,,1269.2900,4917.8200,percent of total billed charges,"41.7% of $4,917.82 in Billed Charges for Rev 272 = $2,050.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,4917.8200,737.6700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2281.87,,,,,,,1269.2900,4917.8200,percent of total billed charges,"46.4% of $4,917.82 in Billed Charges for Rev 272 = $2,281.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,4917.8200,737.6700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2050.73,,,,,,,1269.2900,4917.8200,percent of total billed charges,"41.7% of $4,917.82 in Billed Charges for Rev 272 = $2,050.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,4917.8200,737.6700,CIGNA HEALTHCARE,CIGNA PPO,2050.73,,,,,,,1269.2900,4917.8200,percent of total billed charges,"41.7% of $4,917.82 in Billed Charges for Rev 272 = $2,050.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,4917.8200,737.6700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4426.04,,,,,,,1269.2900,4917.8200,percent of total billed charges,"90% of $4,917.82 in Billed Charges for Rev 272 = $4,426.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,4917.8200,737.6700,MEDCOST,MEDCOST VHN,2340.39,,,,,,,1269.2900,4917.8200,percent of total billed charges,"47.59% of $4,917.82 in Billed Charges for Rev 272 = $2,340.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,4917.8200,737.6700,SENTARA HEALTH,SENTARA HEALTH,1269.29,,,,,,,1269.2900,4917.8200,percent of total billed charges,"25.81% of $4,917.82 in Billed Charges for Rev 272 = $1,269.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,4917.8200,737.6700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4917.82,,,,,,,1269.2900,4917.8200,percent of total billed charges,"100% of $4,917.82 in Billed Charges for Rev 272 = $4,917.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,4917.8200,737.6700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2458.91,,,,,,,1269.2900,4917.8200,percent of total billed charges,"Rev 272 $4,917.82 in Billed Charges at 50% = $2,458.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,4917.8200,737.6700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1588.46,,,,,,,1269.2900,4917.8200,other,"32.3% of $4,917.82 in Billed Charges for Rev 272 = $1,588.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,4917.8200,737.6700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1509.77,,,,,,,1269.2900,4917.8200,other,"30.7% of $4,917.82 in Billed Charges for Rev 272 = $1,509.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,4917.8200,737.6700,UNITED HEALTHCARE,UNITED HEALTHCARE,1588.46,,,,,,,1269.2900,4917.8200,percent of total billed charges,"32.3% of $4,917.82 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,4917.8200,737.6700,WELLCARE,WELLCARE MEDICAID,4917.82,,,,,,,1269.2900,4917.8200,percent of total billed charges,"100% of $4,917.82 in Billed Charges for Rev 272 = $4,917.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ETHIBOND 2-0 PXX77N,272,RC,,,,,,,,both,,,599.2200,89.8800,AETNA,AETNA,255.87,,,,,,,154.6600,599.2200,percent of total billed charges,42.7% of $599.22 in Billed Charges for Rev 272 = $255.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND 2-0 PXX77N,272,RC,,,,,,,,both,,,599.2200,89.8800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,419.45,,,,,,,154.6600,599.2200,percent of total billed charges,Rev 272 $599.22 in Billed Charges at 70% = $419.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND 2-0 PXX77N,272,RC,,,,,,,,both,,,599.2200,89.8800,CIGNA HEALTHCARE,CIGNA HMO,249.87,,,,,,,154.6600,599.2200,percent of total billed charges,41.7% of $599.22 in Billed Charges for Rev 272 = $249.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND 2-0 PXX77N,272,RC,,,,,,,,both,,,599.2200,89.8800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,278.04,,,,,,,154.6600,599.2200,percent of total billed charges,46.4% of $599.22 in Billed Charges for Rev 272 = $278.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND 2-0 PXX77N,272,RC,,,,,,,,both,,,599.2200,89.8800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,249.87,,,,,,,154.6600,599.2200,percent of total billed charges,41.7% of $599.22 in Billed Charges for Rev 272 = $249.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND 2-0 PXX77N,272,RC,,,,,,,,both,,,599.2200,89.8800,CIGNA HEALTHCARE,CIGNA PPO,249.87,,,,,,,154.6600,599.2200,percent of total billed charges,41.7% of $599.22 in Billed Charges for Rev 272 = $249.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND 2-0 PXX77N,272,RC,,,,,,,,both,,,599.2200,89.8800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,539.30,,,,,,,154.6600,599.2200,percent of total billed charges,90% of $599.22 in Billed Charges for Rev 272 = $539.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND 2-0 PXX77N,272,RC,,,,,,,,both,,,599.2200,89.8800,MEDCOST,MEDCOST VHN,285.17,,,,,,,154.6600,599.2200,percent of total billed charges,47.59% of $599.22 in Billed Charges for Rev 272 = $285.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND 2-0 PXX77N,272,RC,,,,,,,,both,,,599.2200,89.8800,SENTARA HEALTH,SENTARA HEALTH,154.66,,,,,,,154.6600,599.2200,percent of total billed charges,25.81% of $599.22 in Billed Charges for Rev 272 = $154.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND 2-0 PXX77N,272,RC,,,,,,,,both,,,599.2200,89.8800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",599.22,,,,,,,154.6600,599.2200,percent of total billed charges,100% of $599.22 in Billed Charges for Rev 272 = $599.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND 2-0 PXX77N,272,RC,,,,,,,,both,,,599.2200,89.8800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,299.61,,,,,,,154.6600,599.2200,percent of total billed charges,Rev 272 $599.22 in Billed Charges at 50% = $299.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND 2-0 PXX77N,272,RC,,,,,,,,both,,,599.2200,89.8800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,193.55,,,,,,,154.6600,599.2200,other,32.3% of $599.22 in Billed Charges for Rev 272 = $193.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE ETHIBOND 2-0 PXX77N,272,RC,,,,,,,,both,,,599.2200,89.8800,UNITED HEALTHCARE,UHC HERITAGE SELECT,183.96,,,,,,,154.6600,599.2200,other,30.7% of $599.22 in Billed Charges for Rev 272 = $183.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE ETHIBOND 2-0 PXX77N,272,RC,,,,,,,,both,,,599.2200,89.8800,UNITED HEALTHCARE,UNITED HEALTHCARE,193.55,,,,,,,154.6600,599.2200,percent of total billed charges,32.3% of $599.22 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND 2-0 PXX77N,272,RC,,,,,,,,both,,,599.2200,89.8800,WELLCARE,WELLCARE MEDICAID,599.22,,,,,,,154.6600,599.2200,percent of total billed charges,100% of $599.22 in Billed Charges for Rev 272 = $599.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND EXTRA 2 PXX52N,272,RC,27200002,CDM,,,,,,both,,,603.8600,90.5800,AETNA,AETNA,257.85,,,,,,,155.8600,603.8600,percent of total billed charges,42.7% of $603.86 in Billed Charges for Rev 272 = $257.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND EXTRA 2 PXX52N,272,RC,27200002,CDM,,,,,,both,,,603.8600,90.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,422.70,,,,,,,155.8600,603.8600,percent of total billed charges,Rev 272 $603.86 in Billed Charges at 70% = $422.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND EXTRA 2 PXX52N,272,RC,27200002,CDM,,,,,,both,,,603.8600,90.5800,CIGNA HEALTHCARE,CIGNA HMO,251.81,,,,,,,155.8600,603.8600,percent of total billed charges,41.7% of $603.86 in Billed Charges for Rev 272 = $251.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND EXTRA 2 PXX52N,272,RC,27200002,CDM,,,,,,both,,,603.8600,90.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,280.19,,,,,,,155.8600,603.8600,percent of total billed charges,46.4% of $603.86 in Billed Charges for Rev 272 = $280.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND EXTRA 2 PXX52N,272,RC,27200002,CDM,,,,,,both,,,603.8600,90.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,251.81,,,,,,,155.8600,603.8600,percent of total billed charges,41.7% of $603.86 in Billed Charges for Rev 272 = $251.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND EXTRA 2 PXX52N,272,RC,27200002,CDM,,,,,,both,,,603.8600,90.5800,CIGNA HEALTHCARE,CIGNA PPO,251.81,,,,,,,155.8600,603.8600,percent of total billed charges,41.7% of $603.86 in Billed Charges for Rev 272 = $251.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND EXTRA 2 PXX52N,272,RC,27200002,CDM,,,,,,both,,,603.8600,90.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,543.47,,,,,,,155.8600,603.8600,percent of total billed charges,90% of $603.86 in Billed Charges for Rev 272 = $543.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND EXTRA 2 PXX52N,272,RC,27200002,CDM,,,,,,both,,,603.8600,90.5800,MEDCOST,MEDCOST VHN,287.38,,,,,,,155.8600,603.8600,percent of total billed charges,47.59% of $603.86 in Billed Charges for Rev 272 = $287.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND EXTRA 2 PXX52N,272,RC,27200002,CDM,,,,,,both,,,603.8600,90.5800,SENTARA HEALTH,SENTARA HEALTH,155.86,,,,,,,155.8600,603.8600,percent of total billed charges,25.81% of $603.86 in Billed Charges for Rev 272 = $155.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND EXTRA 2 PXX52N,272,RC,27200002,CDM,,,,,,both,,,603.8600,90.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",603.86,,,,,,,155.8600,603.8600,percent of total billed charges,100% of $603.86 in Billed Charges for Rev 272 = $603.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND EXTRA 2 PXX52N,272,RC,27200002,CDM,,,,,,both,,,603.8600,90.5800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,301.93,,,,,,,155.8600,603.8600,percent of total billed charges,Rev 272 $603.86 in Billed Charges at 50% = $301.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND EXTRA 2 PXX52N,272,RC,27200002,CDM,,,,,,both,,,603.8600,90.5800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,195.05,,,,,,,155.8600,603.8600,other,32.3% of $603.86 in Billed Charges for Rev 272 = $195.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE ETHIBOND EXTRA 2 PXX52N,272,RC,27200002,CDM,,,,,,both,,,603.8600,90.5800,UNITED HEALTHCARE,UHC HERITAGE SELECT,185.39,,,,,,,155.8600,603.8600,other,30.7% of $603.86 in Billed Charges for Rev 272 = $185.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE ETHIBOND EXTRA 2 PXX52N,272,RC,27200002,CDM,,,,,,both,,,603.8600,90.5800,UNITED HEALTHCARE,UNITED HEALTHCARE,195.05,,,,,,,155.8600,603.8600,percent of total billed charges,32.3% of $603.86 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND EXTRA 2 PXX52N,272,RC,27200002,CDM,,,,,,both,,,603.8600,90.5800,WELLCARE,WELLCARE MEDICAID,603.86,,,,,,,155.8600,603.8600,percent of total billed charges,100% of $603.86 in Billed Charges for Rev 272 = $603.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH PROX. XLT 8.0 80XLTCP (6130),272,RC,27200002,CDM,,,,,,both,,,558.8900,83.8300,AETNA,AETNA,238.65,,,,,,,144.2500,558.8900,percent of total billed charges,42.7% of $558.89 in Billed Charges for Rev 272 = $238.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH PROX. XLT 8.0 80XLTCP (6130),272,RC,27200002,CDM,,,,,,both,,,558.8900,83.8300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,391.22,,,,,,,144.2500,558.8900,percent of total billed charges,Rev 272 $558.89 in Billed Charges at 70% = $391.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH PROX. XLT 8.0 80XLTCP (6130),272,RC,27200002,CDM,,,,,,both,,,558.8900,83.8300,CIGNA HEALTHCARE,CIGNA HMO,233.06,,,,,,,144.2500,558.8900,percent of total billed charges,41.7% of $558.89 in Billed Charges for Rev 272 = $233.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH PROX. XLT 8.0 80XLTCP (6130),272,RC,27200002,CDM,,,,,,both,,,558.8900,83.8300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,259.33,,,,,,,144.2500,558.8900,percent of total billed charges,46.4% of $558.89 in Billed Charges for Rev 272 = $259.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH PROX. XLT 8.0 80XLTCP (6130),272,RC,27200002,CDM,,,,,,both,,,558.8900,83.8300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,233.06,,,,,,,144.2500,558.8900,percent of total billed charges,41.7% of $558.89 in Billed Charges for Rev 272 = $233.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH PROX. XLT 8.0 80XLTCP (6130),272,RC,27200002,CDM,,,,,,both,,,558.8900,83.8300,CIGNA HEALTHCARE,CIGNA PPO,233.06,,,,,,,144.2500,558.8900,percent of total billed charges,41.7% of $558.89 in Billed Charges for Rev 272 = $233.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH PROX. XLT 8.0 80XLTCP (6130),272,RC,27200002,CDM,,,,,,both,,,558.8900,83.8300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,503.00,,,,,,,144.2500,558.8900,percent of total billed charges,90% of $558.89 in Billed Charges for Rev 272 = $503.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH PROX. XLT 8.0 80XLTCP (6130),272,RC,27200002,CDM,,,,,,both,,,558.8900,83.8300,MEDCOST,MEDCOST VHN,265.98,,,,,,,144.2500,558.8900,percent of total billed charges,47.59% of $558.89 in Billed Charges for Rev 272 = $265.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH PROX. XLT 8.0 80XLTCP (6130),272,RC,27200002,CDM,,,,,,both,,,558.8900,83.8300,SENTARA HEALTH,SENTARA HEALTH,144.25,,,,,,,144.2500,558.8900,percent of total billed charges,25.81% of $558.89 in Billed Charges for Rev 272 = $144.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH PROX. XLT 8.0 80XLTCP (6130),272,RC,27200002,CDM,,,,,,both,,,558.8900,83.8300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",558.89,,,,,,,144.2500,558.8900,percent of total billed charges,100% of $558.89 in Billed Charges for Rev 272 = $558.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH PROX. XLT 8.0 80XLTCP (6130),272,RC,27200002,CDM,,,,,,both,,,558.8900,83.8300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,279.45,,,,,,,144.2500,558.8900,percent of total billed charges,Rev 272 $558.89 in Billed Charges at 50% = $279.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH PROX. XLT 8.0 80XLTCP (6130),272,RC,27200002,CDM,,,,,,both,,,558.8900,83.8300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,180.52,,,,,,,144.2500,558.8900,other,32.3% of $558.89 in Billed Charges for Rev 272 = $180.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE TRACH PROX. XLT 8.0 80XLTCP (6130),272,RC,27200002,CDM,,,,,,both,,,558.8900,83.8300,UNITED HEALTHCARE,UHC HERITAGE SELECT,171.58,,,,,,,144.2500,558.8900,other,30.7% of $558.89 in Billed Charges for Rev 272 = $171.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE TRACH PROX. XLT 8.0 80XLTCP (6130),272,RC,27200002,CDM,,,,,,both,,,558.8900,83.8300,UNITED HEALTHCARE,UNITED HEALTHCARE,180.52,,,,,,,144.2500,558.8900,percent of total billed charges,32.3% of $558.89 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH PROX. XLT 8.0 80XLTCP (6130),272,RC,27200002,CDM,,,,,,both,,,558.8900,83.8300,WELLCARE,WELLCARE MEDICAID,558.89,,,,,,,144.2500,558.8900,percent of total billed charges,100% of $558.89 in Billed Charges for Rev 272 = $558.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACHEOSTOMY 10 SHILEY CUFFED FLEXIBLE CANNULA ADULT,272,RC,,,,,,,,both,,,628.4800,94.2700,AETNA,AETNA,268.36,,,,,,,162.2100,628.4800,percent of total billed charges,42.7% of $628.48 in Billed Charges for Rev 272 = $268.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACHEOSTOMY 10 SHILEY CUFFED FLEXIBLE CANNULA ADULT,272,RC,,,,,,,,both,,,628.4800,94.2700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,439.94,,,,,,,162.2100,628.4800,percent of total billed charges,Rev 272 $628.48 in Billed Charges at 70% = $439.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACHEOSTOMY 10 SHILEY CUFFED FLEXIBLE CANNULA ADULT,272,RC,,,,,,,,both,,,628.4800,94.2700,CIGNA HEALTHCARE,CIGNA HMO,262.08,,,,,,,162.2100,628.4800,percent of total billed charges,41.7% of $628.48 in Billed Charges for Rev 272 = $262.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACHEOSTOMY 10 SHILEY CUFFED FLEXIBLE CANNULA ADULT,272,RC,,,,,,,,both,,,628.4800,94.2700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,291.61,,,,,,,162.2100,628.4800,percent of total billed charges,46.4% of $628.48 in Billed Charges for Rev 272 = $291.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACHEOSTOMY 10 SHILEY CUFFED FLEXIBLE CANNULA ADULT,272,RC,,,,,,,,both,,,628.4800,94.2700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,262.08,,,,,,,162.2100,628.4800,percent of total billed charges,41.7% of $628.48 in Billed Charges for Rev 272 = $262.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACHEOSTOMY 10 SHILEY CUFFED FLEXIBLE CANNULA ADULT,272,RC,,,,,,,,both,,,628.4800,94.2700,CIGNA HEALTHCARE,CIGNA PPO,262.08,,,,,,,162.2100,628.4800,percent of total billed charges,41.7% of $628.48 in Billed Charges for Rev 272 = $262.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACHEOSTOMY 10 SHILEY CUFFED FLEXIBLE CANNULA ADULT,272,RC,,,,,,,,both,,,628.4800,94.2700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,565.63,,,,,,,162.2100,628.4800,percent of total billed charges,90% of $628.48 in Billed Charges for Rev 272 = $565.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACHEOSTOMY 10 SHILEY CUFFED FLEXIBLE CANNULA ADULT,272,RC,,,,,,,,both,,,628.4800,94.2700,MEDCOST,MEDCOST VHN,299.09,,,,,,,162.2100,628.4800,percent of total billed charges,47.59% of $628.48 in Billed Charges for Rev 272 = $299.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACHEOSTOMY 10 SHILEY CUFFED FLEXIBLE CANNULA ADULT,272,RC,,,,,,,,both,,,628.4800,94.2700,SENTARA HEALTH,SENTARA HEALTH,162.21,,,,,,,162.2100,628.4800,percent of total billed charges,25.81% of $628.48 in Billed Charges for Rev 272 = $162.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACHEOSTOMY 10 SHILEY CUFFED FLEXIBLE CANNULA ADULT,272,RC,,,,,,,,both,,,628.4800,94.2700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",628.48,,,,,,,162.2100,628.4800,percent of total billed charges,100% of $628.48 in Billed Charges for Rev 272 = $628.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACHEOSTOMY 10 SHILEY CUFFED FLEXIBLE CANNULA ADULT,272,RC,,,,,,,,both,,,628.4800,94.2700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,314.24,,,,,,,162.2100,628.4800,percent of total billed charges,Rev 272 $628.48 in Billed Charges at 50% = $314.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACHEOSTOMY 10 SHILEY CUFFED FLEXIBLE CANNULA ADULT,272,RC,,,,,,,,both,,,628.4800,94.2700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,203.00,,,,,,,162.2100,628.4800,other,32.3% of $628.48 in Billed Charges for Rev 272 = $203.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE TRACHEOSTOMY 10 SHILEY CUFFED FLEXIBLE CANNULA ADULT,272,RC,,,,,,,,both,,,628.4800,94.2700,UNITED HEALTHCARE,UHC HERITAGE SELECT,192.94,,,,,,,162.2100,628.4800,other,30.7% of $628.48 in Billed Charges for Rev 272 = $192.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE TRACHEOSTOMY 10 SHILEY CUFFED FLEXIBLE CANNULA ADULT,272,RC,,,,,,,,both,,,628.4800,94.2700,UNITED HEALTHCARE,UNITED HEALTHCARE,203.00,,,,,,,162.2100,628.4800,percent of total billed charges,32.3% of $628.48 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACHEOSTOMY 10 SHILEY CUFFED FLEXIBLE CANNULA ADULT,272,RC,,,,,,,,both,,,628.4800,94.2700,WELLCARE,WELLCARE MEDICAID,628.48,,,,,,,162.2100,628.4800,percent of total billed charges,100% of $628.48 in Billed Charges for Rev 272 = $628.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACHEOSTOMY 7.0 CUFFED EXTRA LENGTH,272,RC,,,,,,,,both,,,1087.5000,163.1300,AETNA,AETNA,464.36,,,,,,,280.6800,1087.5000,percent of total billed charges,"42.7% of $1,087.50 in Billed Charges for Rev 272 = $464.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACHEOSTOMY 7.0 CUFFED EXTRA LENGTH,272,RC,,,,,,,,both,,,1087.5000,163.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,761.25,,,,,,,280.6800,1087.5000,percent of total billed charges,"Rev 272 $1,087.50 in Billed Charges at 70% = $761.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACHEOSTOMY 7.0 CUFFED EXTRA LENGTH,272,RC,,,,,,,,both,,,1087.5000,163.1300,CIGNA HEALTHCARE,CIGNA HMO,453.49,,,,,,,280.6800,1087.5000,percent of total billed charges,"41.7% of $1,087.50 in Billed Charges for Rev 272 = $453.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACHEOSTOMY 7.0 CUFFED EXTRA LENGTH,272,RC,,,,,,,,both,,,1087.5000,163.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,504.60,,,,,,,280.6800,1087.5000,percent of total billed charges,"46.4% of $1,087.50 in Billed Charges for Rev 272 = $504.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACHEOSTOMY 7.0 CUFFED EXTRA LENGTH,272,RC,,,,,,,,both,,,1087.5000,163.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,453.49,,,,,,,280.6800,1087.5000,percent of total billed charges,"41.7% of $1,087.50 in Billed Charges for Rev 272 = $453.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACHEOSTOMY 7.0 CUFFED EXTRA LENGTH,272,RC,,,,,,,,both,,,1087.5000,163.1300,CIGNA HEALTHCARE,CIGNA PPO,453.49,,,,,,,280.6800,1087.5000,percent of total billed charges,"41.7% of $1,087.50 in Billed Charges for Rev 272 = $453.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACHEOSTOMY 7.0 CUFFED EXTRA LENGTH,272,RC,,,,,,,,both,,,1087.5000,163.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,978.75,,,,,,,280.6800,1087.5000,percent of total billed charges,"90% of $1,087.50 in Billed Charges for Rev 272 = $978.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACHEOSTOMY 7.0 CUFFED EXTRA LENGTH,272,RC,,,,,,,,both,,,1087.5000,163.1300,MEDCOST,MEDCOST VHN,517.54,,,,,,,280.6800,1087.5000,percent of total billed charges,"47.59% of $1,087.50 in Billed Charges for Rev 272 = $517.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACHEOSTOMY 7.0 CUFFED EXTRA LENGTH,272,RC,,,,,,,,both,,,1087.5000,163.1300,SENTARA HEALTH,SENTARA HEALTH,280.68,,,,,,,280.6800,1087.5000,percent of total billed charges,"25.81% of $1,087.50 in Billed Charges for Rev 272 = $280.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACHEOSTOMY 7.0 CUFFED EXTRA LENGTH,272,RC,,,,,,,,both,,,1087.5000,163.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1087.50,,,,,,,280.6800,1087.5000,percent of total billed charges,"100% of $1,087.50 in Billed Charges for Rev 272 = $1,087.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACHEOSTOMY 7.0 CUFFED EXTRA LENGTH,272,RC,,,,,,,,both,,,1087.5000,163.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,543.75,,,,,,,280.6800,1087.5000,percent of total billed charges,"Rev 272 $1,087.50 in Billed Charges at 50% = $543.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACHEOSTOMY 7.0 CUFFED EXTRA LENGTH,272,RC,,,,,,,,both,,,1087.5000,163.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,351.26,,,,,,,280.6800,1087.5000,other,"32.3% of $1,087.50 in Billed Charges for Rev 272 = $351.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE TRACHEOSTOMY 7.0 CUFFED EXTRA LENGTH,272,RC,,,,,,,,both,,,1087.5000,163.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,333.86,,,,,,,280.6800,1087.5000,other,"30.7% of $1,087.50 in Billed Charges for Rev 272 = $333.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE TRACHEOSTOMY 7.0 CUFFED EXTRA LENGTH,272,RC,,,,,,,,both,,,1087.5000,163.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,351.26,,,,,,,280.6800,1087.5000,percent of total billed charges,"32.3% of $1,087.50 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACHEOSTOMY 7.0 CUFFED EXTRA LENGTH,272,RC,,,,,,,,both,,,1087.5000,163.1300,WELLCARE,WELLCARE MEDICAID,1087.50,,,,,,,280.6800,1087.5000,percent of total billed charges,"100% of $1,087.50 in Billed Charges for Rev 272 = $1,087.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING O2 7FT FEMALE CONNECT,270,RC,,,,,,,,both,,,5444.7800,816.7200,AETNA,AETNA,2324.92,,,,,,,1405.3000,5444.7800,percent of total billed charges,"42.7% of $5,444.78 in Billed Charges for Rev 270 = $2,324.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING O2 7FT FEMALE CONNECT,270,RC,,,,,,,,both,,,5444.7800,816.7200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3811.35,,,,,,,1405.3000,5444.7800,percent of total billed charges,"Rev 270 $5,444.78 in Billed Charges at 70% = $3,811.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING O2 7FT FEMALE CONNECT,270,RC,,,,,,,,both,,,5444.7800,816.7200,CIGNA HEALTHCARE,CIGNA HMO,2270.47,,,,,,,1405.3000,5444.7800,percent of total billed charges,"41.7% of $5,444.78 in Billed Charges for Rev 270 = $2,270.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING O2 7FT FEMALE CONNECT,270,RC,,,,,,,,both,,,5444.7800,816.7200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2526.38,,,,,,,1405.3000,5444.7800,percent of total billed charges,"46.4% of $5,444.78 in Billed Charges for Rev 270 = $2,526.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING O2 7FT FEMALE CONNECT,270,RC,,,,,,,,both,,,5444.7800,816.7200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2270.47,,,,,,,1405.3000,5444.7800,percent of total billed charges,"41.7% of $5,444.78 in Billed Charges for Rev 270 = $2,270.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING O2 7FT FEMALE CONNECT,270,RC,,,,,,,,both,,,5444.7800,816.7200,CIGNA HEALTHCARE,CIGNA PPO,2270.47,,,,,,,1405.3000,5444.7800,percent of total billed charges,"41.7% of $5,444.78 in Billed Charges for Rev 270 = $2,270.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING O2 7FT FEMALE CONNECT,270,RC,,,,,,,,both,,,5444.7800,816.7200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4900.30,,,,,,,1405.3000,5444.7800,percent of total billed charges,"90% of $5,444.78 in Billed Charges for Rev 270 = $4,900.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING O2 7FT FEMALE CONNECT,270,RC,,,,,,,,both,,,5444.7800,816.7200,MEDCOST,MEDCOST VHN,2591.17,,,,,,,1405.3000,5444.7800,percent of total billed charges,"47.59% of $5,444.78 in Billed Charges for Rev 270 = $2,591.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING O2 7FT FEMALE CONNECT,270,RC,,,,,,,,both,,,5444.7800,816.7200,SENTARA HEALTH,SENTARA HEALTH,1405.30,,,,,,,1405.3000,5444.7800,percent of total billed charges,"25.81% of $5,444.78 in Billed Charges for Rev 270 = $1,405.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING O2 7FT FEMALE CONNECT,270,RC,,,,,,,,both,,,5444.7800,816.7200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5444.78,,,,,,,1405.3000,5444.7800,percent of total billed charges,"100% of $5,444.78 in Billed Charges for Rev 270 = $5,444.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING O2 7FT FEMALE CONNECT,270,RC,,,,,,,,both,,,5444.7800,816.7200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2722.39,,,,,,,1405.3000,5444.7800,percent of total billed charges,"Rev 270 $5,444.78 in Billed Charges at 50% = $2,722.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING O2 7FT FEMALE CONNECT,270,RC,,,,,,,,both,,,5444.7800,816.7200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1758.66,,,,,,,1405.3000,5444.7800,other,"32.3% of $5,444.78 in Billed Charges for Rev 270 = $1,758.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBING O2 7FT FEMALE CONNECT,270,RC,,,,,,,,both,,,5444.7800,816.7200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1671.55,,,,,,,1405.3000,5444.7800,other,"30.7% of $5,444.78 in Billed Charges for Rev 270 = $1,671.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBING O2 7FT FEMALE CONNECT,270,RC,,,,,,,,both,,,5444.7800,816.7200,UNITED HEALTHCARE,UNITED HEALTHCARE,1758.66,,,,,,,1405.3000,5444.7800,percent of total billed charges,"32.3% of $5,444.78 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBING O2 7FT FEMALE CONNECT,270,RC,,,,,,,,both,,,5444.7800,816.7200,WELLCARE,WELLCARE MEDICAID,5444.78,,,,,,,1405.3000,5444.7800,percent of total billed charges,"100% of $5,444.78 in Billed Charges for Rev 270 = $5,444.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
UNIT HOT/COLD THERAPY W/O WRAP,272,RC,27200002,CDM,,,,,,both,,,911.5100,136.7300,AETNA,AETNA,389.21,,,,,,,235.2600,911.5100,percent of total billed charges,42.7% of $911.51 in Billed Charges for Rev 272 = $389.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
UNIT HOT/COLD THERAPY W/O WRAP,272,RC,27200002,CDM,,,,,,both,,,911.5100,136.7300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,638.06,,,,,,,235.2600,911.5100,percent of total billed charges,Rev 272 $911.51 in Billed Charges at 70% = $638.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
UNIT HOT/COLD THERAPY W/O WRAP,272,RC,27200002,CDM,,,,,,both,,,911.5100,136.7300,CIGNA HEALTHCARE,CIGNA HMO,380.10,,,,,,,235.2600,911.5100,percent of total billed charges,41.7% of $911.51 in Billed Charges for Rev 272 = $380.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
UNIT HOT/COLD THERAPY W/O WRAP,272,RC,27200002,CDM,,,,,,both,,,911.5100,136.7300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,422.94,,,,,,,235.2600,911.5100,percent of total billed charges,46.4% of $911.51 in Billed Charges for Rev 272 = $422.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
UNIT HOT/COLD THERAPY W/O WRAP,272,RC,27200002,CDM,,,,,,both,,,911.5100,136.7300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,380.10,,,,,,,235.2600,911.5100,percent of total billed charges,41.7% of $911.51 in Billed Charges for Rev 272 = $380.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
UNIT HOT/COLD THERAPY W/O WRAP,272,RC,27200002,CDM,,,,,,both,,,911.5100,136.7300,CIGNA HEALTHCARE,CIGNA PPO,380.10,,,,,,,235.2600,911.5100,percent of total billed charges,41.7% of $911.51 in Billed Charges for Rev 272 = $380.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
UNIT HOT/COLD THERAPY W/O WRAP,272,RC,27200002,CDM,,,,,,both,,,911.5100,136.7300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,820.36,,,,,,,235.2600,911.5100,percent of total billed charges,90% of $911.51 in Billed Charges for Rev 272 = $820.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
UNIT HOT/COLD THERAPY W/O WRAP,272,RC,27200002,CDM,,,,,,both,,,911.5100,136.7300,MEDCOST,MEDCOST VHN,433.79,,,,,,,235.2600,911.5100,percent of total billed charges,47.59% of $911.51 in Billed Charges for Rev 272 = $433.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
UNIT HOT/COLD THERAPY W/O WRAP,272,RC,27200002,CDM,,,,,,both,,,911.5100,136.7300,SENTARA HEALTH,SENTARA HEALTH,235.26,,,,,,,235.2600,911.5100,percent of total billed charges,25.81% of $911.51 in Billed Charges for Rev 272 = $235.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
UNIT HOT/COLD THERAPY W/O WRAP,272,RC,27200002,CDM,,,,,,both,,,911.5100,136.7300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",911.51,,,,,,,235.2600,911.5100,percent of total billed charges,100% of $911.51 in Billed Charges for Rev 272 = $911.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
UNIT HOT/COLD THERAPY W/O WRAP,272,RC,27200002,CDM,,,,,,both,,,911.5100,136.7300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,455.76,,,,,,,235.2600,911.5100,percent of total billed charges,Rev 272 $911.51 in Billed Charges at 50% = $455.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
UNIT HOT/COLD THERAPY W/O WRAP,272,RC,27200002,CDM,,,,,,both,,,911.5100,136.7300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,294.42,,,,,,,235.2600,911.5100,other,32.3% of $911.51 in Billed Charges for Rev 272 = $294.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
UNIT HOT/COLD THERAPY W/O WRAP,272,RC,27200002,CDM,,,,,,both,,,911.5100,136.7300,UNITED HEALTHCARE,UHC HERITAGE SELECT,279.83,,,,,,,235.2600,911.5100,other,30.7% of $911.51 in Billed Charges for Rev 272 = $279.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
UNIT HOT/COLD THERAPY W/O WRAP,272,RC,27200002,CDM,,,,,,both,,,911.5100,136.7300,UNITED HEALTHCARE,UNITED HEALTHCARE,294.42,,,,,,,235.2600,911.5100,percent of total billed charges,32.3% of $911.51 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
UNIT HOT/COLD THERAPY W/O WRAP,272,RC,27200002,CDM,,,,,,both,,,911.5100,136.7300,WELLCARE,WELLCARE MEDICAID,911.51,,,,,,,235.2600,911.5100,percent of total billed charges,100% of $911.51 in Billed Charges for Rev 272 = $911.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM CARTER-THOMASON CLOSURE SUTURE PASSER PILOT GUIDES STERILE SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1719.7800,257.9700,AETNA,AETNA,734.35,,,,,,,443.8800,1719.7800,percent of total billed charges,"42.7% of $1,719.78 in Billed Charges for Rev 272 = $734.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CARTER-THOMASON CLOSURE SUTURE PASSER PILOT GUIDES STERILE SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1719.7800,257.9700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1203.85,,,,,,,443.8800,1719.7800,percent of total billed charges,"Rev 272 $1,719.78 in Billed Charges at 70% = $1,203.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CARTER-THOMASON CLOSURE SUTURE PASSER PILOT GUIDES STERILE SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1719.7800,257.9700,CIGNA HEALTHCARE,CIGNA HMO,717.15,,,,,,,443.8800,1719.7800,percent of total billed charges,"41.7% of $1,719.78 in Billed Charges for Rev 272 = $717.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CARTER-THOMASON CLOSURE SUTURE PASSER PILOT GUIDES STERILE SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1719.7800,257.9700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,797.98,,,,,,,443.8800,1719.7800,percent of total billed charges,"46.4% of $1,719.78 in Billed Charges for Rev 272 = $797.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CARTER-THOMASON CLOSURE SUTURE PASSER PILOT GUIDES STERILE SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1719.7800,257.9700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,717.15,,,,,,,443.8800,1719.7800,percent of total billed charges,"41.7% of $1,719.78 in Billed Charges for Rev 272 = $717.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CARTER-THOMASON CLOSURE SUTURE PASSER PILOT GUIDES STERILE SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1719.7800,257.9700,CIGNA HEALTHCARE,CIGNA PPO,717.15,,,,,,,443.8800,1719.7800,percent of total billed charges,"41.7% of $1,719.78 in Billed Charges for Rev 272 = $717.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CARTER-THOMASON CLOSURE SUTURE PASSER PILOT GUIDES STERILE SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1719.7800,257.9700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1547.80,,,,,,,443.8800,1719.7800,percent of total billed charges,"90% of $1,719.78 in Billed Charges for Rev 272 = $1,547.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CARTER-THOMASON CLOSURE SUTURE PASSER PILOT GUIDES STERILE SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1719.7800,257.9700,MEDCOST,MEDCOST VHN,818.44,,,,,,,443.8800,1719.7800,percent of total billed charges,"47.59% of $1,719.78 in Billed Charges for Rev 272 = $818.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CARTER-THOMASON CLOSURE SUTURE PASSER PILOT GUIDES STERILE SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1719.7800,257.9700,SENTARA HEALTH,SENTARA HEALTH,443.88,,,,,,,443.8800,1719.7800,percent of total billed charges,"25.81% of $1,719.78 in Billed Charges for Rev 272 = $443.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CARTER-THOMASON CLOSURE SUTURE PASSER PILOT GUIDES STERILE SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1719.7800,257.9700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1719.78,,,,,,,443.8800,1719.7800,percent of total billed charges,"100% of $1,719.78 in Billed Charges for Rev 272 = $1,719.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CARTER-THOMASON CLOSURE SUTURE PASSER PILOT GUIDES STERILE SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1719.7800,257.9700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,859.89,,,,,,,443.8800,1719.7800,percent of total billed charges,"Rev 272 $1,719.78 in Billed Charges at 50% = $859.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CARTER-THOMASON CLOSURE SUTURE PASSER PILOT GUIDES STERILE SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1719.7800,257.9700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,555.49,,,,,,,443.8800,1719.7800,other,"32.3% of $1,719.78 in Billed Charges for Rev 272 = $555.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM CARTER-THOMASON CLOSURE SUTURE PASSER PILOT GUIDES STERILE SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1719.7800,257.9700,UNITED HEALTHCARE,UHC HERITAGE SELECT,527.97,,,,,,,443.8800,1719.7800,other,"30.7% of $1,719.78 in Billed Charges for Rev 272 = $527.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM CARTER-THOMASON CLOSURE SUTURE PASSER PILOT GUIDES STERILE SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1719.7800,257.9700,UNITED HEALTHCARE,UNITED HEALTHCARE,555.49,,,,,,,443.8800,1719.7800,percent of total billed charges,"32.3% of $1,719.78 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CARTER-THOMASON CLOSURE SUTURE PASSER PILOT GUIDES STERILE SINGLE USE,272,RC,27200002,CDM,,,,,,both,,,1719.7800,257.9700,WELLCARE,WELLCARE MEDICAID,1719.78,,,,,,,443.8800,1719.7800,percent of total billed charges,"100% of $1,719.78 in Billed Charges for Rev 272 = $1,719.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM DUOVISC OPHTHALMIC VISCOELASTIC LARGE,272,RC,27200002,CDM,,,,,,both,,,961.0000,144.1500,AETNA,AETNA,410.35,,,,,,,248.0300,961.0000,percent of total billed charges,42.7% of $961.00 in Billed Charges for Rev 272 = $410.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM DUOVISC OPHTHALMIC VISCOELASTIC LARGE,272,RC,27200002,CDM,,,,,,both,,,961.0000,144.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,672.70,,,,,,,248.0300,961.0000,percent of total billed charges,Rev 272 $961.00 in Billed Charges at 70% = $672.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM DUOVISC OPHTHALMIC VISCOELASTIC LARGE,272,RC,27200002,CDM,,,,,,both,,,961.0000,144.1500,CIGNA HEALTHCARE,CIGNA HMO,400.74,,,,,,,248.0300,961.0000,percent of total billed charges,41.7% of $961.00 in Billed Charges for Rev 272 = $400.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM DUOVISC OPHTHALMIC VISCOELASTIC LARGE,272,RC,27200002,CDM,,,,,,both,,,961.0000,144.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,445.90,,,,,,,248.0300,961.0000,percent of total billed charges,46.4% of $961.00 in Billed Charges for Rev 272 = $445.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM DUOVISC OPHTHALMIC VISCOELASTIC LARGE,272,RC,27200002,CDM,,,,,,both,,,961.0000,144.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,400.74,,,,,,,248.0300,961.0000,percent of total billed charges,41.7% of $961.00 in Billed Charges for Rev 272 = $400.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM DUOVISC OPHTHALMIC VISCOELASTIC LARGE,272,RC,27200002,CDM,,,,,,both,,,961.0000,144.1500,CIGNA HEALTHCARE,CIGNA PPO,400.74,,,,,,,248.0300,961.0000,percent of total billed charges,41.7% of $961.00 in Billed Charges for Rev 272 = $400.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM DUOVISC OPHTHALMIC VISCOELASTIC LARGE,272,RC,27200002,CDM,,,,,,both,,,961.0000,144.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,864.90,,,,,,,248.0300,961.0000,percent of total billed charges,90% of $961.00 in Billed Charges for Rev 272 = $864.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM DUOVISC OPHTHALMIC VISCOELASTIC LARGE,272,RC,27200002,CDM,,,,,,both,,,961.0000,144.1500,MEDCOST,MEDCOST VHN,457.34,,,,,,,248.0300,961.0000,percent of total billed charges,47.59% of $961.00 in Billed Charges for Rev 272 = $457.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM DUOVISC OPHTHALMIC VISCOELASTIC LARGE,272,RC,27200002,CDM,,,,,,both,,,961.0000,144.1500,SENTARA HEALTH,SENTARA HEALTH,248.03,,,,,,,248.0300,961.0000,percent of total billed charges,25.81% of $961.00 in Billed Charges for Rev 272 = $248.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM DUOVISC OPHTHALMIC VISCOELASTIC LARGE,272,RC,27200002,CDM,,,,,,both,,,961.0000,144.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",961.00,,,,,,,248.0300,961.0000,percent of total billed charges,100% of $961.00 in Billed Charges for Rev 272 = $961.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM DUOVISC OPHTHALMIC VISCOELASTIC LARGE,272,RC,27200002,CDM,,,,,,both,,,961.0000,144.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,480.50,,,,,,,248.0300,961.0000,percent of total billed charges,Rev 272 $961.00 in Billed Charges at 50% = $480.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM DUOVISC OPHTHALMIC VISCOELASTIC LARGE,272,RC,27200002,CDM,,,,,,both,,,961.0000,144.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,310.40,,,,,,,248.0300,961.0000,other,32.3% of $961.00 in Billed Charges for Rev 272 = $310.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SYSTEM DUOVISC OPHTHALMIC VISCOELASTIC LARGE,272,RC,27200002,CDM,,,,,,both,,,961.0000,144.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,295.03,,,,,,,248.0300,961.0000,other,30.7% of $961.00 in Billed Charges for Rev 272 = $295.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SYSTEM DUOVISC OPHTHALMIC VISCOELASTIC LARGE,272,RC,27200002,CDM,,,,,,both,,,961.0000,144.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,310.40,,,,,,,248.0300,961.0000,percent of total billed charges,32.3% of $961.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM DUOVISC OPHTHALMIC VISCOELASTIC LARGE,272,RC,27200002,CDM,,,,,,both,,,961.0000,144.1500,WELLCARE,WELLCARE MEDICAID,961.00,,,,,,,248.0300,961.0000,percent of total billed charges,100% of $961.00 in Billed Charges for Rev 272 = $961.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM IMPLANT FDL 4.75MM,272,RC,27200002,CDM,,,,,,both,,,18450.0100,2767.5000,AETNA,AETNA,7878.15,,,,,,,4761.9500,18450.0100,percent of total billed charges,"42.7% of $18,450.01 in Billed Charges for Rev 272 = $7,878.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM IMPLANT FDL 4.75MM,272,RC,27200002,CDM,,,,,,both,,,18450.0100,2767.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,12915.01,,,,,,,4761.9500,18450.0100,percent of total billed charges,"Rev 272 $18,450.01 in Billed Charges at 70% = $12,915.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM IMPLANT FDL 4.75MM,272,RC,27200002,CDM,,,,,,both,,,18450.0100,2767.5000,CIGNA HEALTHCARE,CIGNA HMO,7693.65,,,,,,,4761.9500,18450.0100,percent of total billed charges,"41.7% of $18,450.01 in Billed Charges for Rev 272 = $7,693.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM IMPLANT FDL 4.75MM,272,RC,27200002,CDM,,,,,,both,,,18450.0100,2767.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8560.80,,,,,,,4761.9500,18450.0100,percent of total billed charges,"46.4% of $18,450.01 in Billed Charges for Rev 272 = $8,560.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM IMPLANT FDL 4.75MM,272,RC,27200002,CDM,,,,,,both,,,18450.0100,2767.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7693.65,,,,,,,4761.9500,18450.0100,percent of total billed charges,"41.7% of $18,450.01 in Billed Charges for Rev 272 = $7,693.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM IMPLANT FDL 4.75MM,272,RC,27200002,CDM,,,,,,both,,,18450.0100,2767.5000,CIGNA HEALTHCARE,CIGNA PPO,7693.65,,,,,,,4761.9500,18450.0100,percent of total billed charges,"41.7% of $18,450.01 in Billed Charges for Rev 272 = $7,693.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM IMPLANT FDL 4.75MM,272,RC,27200002,CDM,,,,,,both,,,18450.0100,2767.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,16605.01,,,,,,,4761.9500,18450.0100,percent of total billed charges,"90% of $18,450.01 in Billed Charges for Rev 272 = $16,605.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM IMPLANT FDL 4.75MM,272,RC,27200002,CDM,,,,,,both,,,18450.0100,2767.5000,MEDCOST,MEDCOST VHN,8780.36,,,,,,,4761.9500,18450.0100,percent of total billed charges,"47.59% of $18,450.01 in Billed Charges for Rev 272 = $8,780.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM IMPLANT FDL 4.75MM,272,RC,27200002,CDM,,,,,,both,,,18450.0100,2767.5000,SENTARA HEALTH,SENTARA HEALTH,4761.95,,,,,,,4761.9500,18450.0100,percent of total billed charges,"25.81% of $18,450.01 in Billed Charges for Rev 272 = $4,761.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM IMPLANT FDL 4.75MM,272,RC,27200002,CDM,,,,,,both,,,18450.0100,2767.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",18450.01,,,,,,,4761.9500,18450.0100,percent of total billed charges,"100% of $18,450.01 in Billed Charges for Rev 272 = $18,450.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM IMPLANT FDL 4.75MM,272,RC,27200002,CDM,,,,,,both,,,18450.0100,2767.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,9225.01,,,,,,,4761.9500,18450.0100,percent of total billed charges,"Rev 272 $18,450.01 in Billed Charges at 50% = $9,225.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM IMPLANT FDL 4.75MM,272,RC,27200002,CDM,,,,,,both,,,18450.0100,2767.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5959.35,,,,,,,4761.9500,18450.0100,other,"32.3% of $18,450.01 in Billed Charges for Rev 272 = $5,959.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM IMPLANT FDL 4.75MM,272,RC,27200002,CDM,,,,,,both,,,18450.0100,2767.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,5664.15,,,,,,,4761.9500,18450.0100,other,"30.7% of $18,450.01 in Billed Charges for Rev 272 = $5,664.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM IMPLANT FDL 4.75MM,272,RC,27200002,CDM,,,,,,both,,,18450.0100,2767.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,5959.35,,,,,,,4761.9500,18450.0100,percent of total billed charges,"32.3% of $18,450.01 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM IMPLANT FDL 4.75MM,272,RC,27200002,CDM,,,,,,both,,,18450.0100,2767.5000,WELLCARE,WELLCARE MEDICAID,18450.01,,,,,,,4761.9500,18450.0100,percent of total billed charges,"100% of $18,450.01 in Billed Charges for Rev 272 = $18,450.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,AETNA,AETNA,1341.21,,,,,,,85.0100,3266.6300,percent of total billed charges,"42.7% of $3,141.00 in Billed Charges for Rev 450 Proc 10140 = $1,341.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1591.43,,,,,,,85.0100,3266.6300,fee schedule,"APG 00004 Proc 10140 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment) at 104% = $1,591.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,85.0100,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,85.0100,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,85.0100,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,AMBETTER,AMBETTER,3266.63,,,,,,,85.0100,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,85.0100,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,BLUE CROSS,ANTHEM EXCHANGE,3141.00,,,,,,,85.0100,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1576.13,,,,,,,85.0100,3266.6300,fee schedule,"APG 00004 Proc 10140 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment) at 103% = $1,576.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,BLUE CROSS,ANTHEM HMO,3141.00,,,,,,,85.0100,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,85.0100,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3141.00,,,,,,,85.0100,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,85.01,,,,,,,85.0100,3266.6300,fee schedule,$85.01 from Fee Schedule BLDTM_23 for Rev 450 Proc 10140 * Qty 1 = $85.01 at 100% = $85.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,85.0100,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,85.0100,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,85.0100,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2826.90,,,,,,,85.0100,3266.6300,percent of total billed charges,"90% of $3,141.00 in Billed Charges for Rev 450 Proc 10140 = $2,826.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,85.0100,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,85.0100,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,MEDCOST,MEDCOST VHN,1494.80,,,,,,,85.0100,3266.6300,percent of total billed charges,"47.59% of $3,141.00 in Billed Charges for Rev 450 Proc 10140 = $1,494.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1606.74,,,,,,,85.0100,3266.6300,fee schedule,"APG 00004 Proc 10140 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment) at 100% = $1,530.23... $1,530.23 at 105% = $1,606.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,85.0100,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,85.0100,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,85.0100,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1577.67,,,,,,,85.0100,3266.6300,fee schedule,"APG 00004 Proc 10140 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment) at 100% = $1,530.23... $1,530.23 at 103.1% = $1,577.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,SENTARA HEALTH,SENTARA HEALTH,810.69,,,,,,,85.0100,3266.6300,percent of total billed charges,"25.81% of $3,141.00 in Billed Charges for Rev 450 Proc 10140 = $810.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,85.0100,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3141.00,,,,,,,85.0100,3266.6300,percent of total billed charges,"100% of $3,141.00 in Billed Charges for Rev 450 Proc 10140 = $3,141.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,85.0100,3266.6300,case rate,Rev 450 Proc 10140 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,85.0100,3266.6300,case rate,Rev 450 Proc 10140 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,85.0100,3266.6300,case rate,Rev 450 Proc 10140 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,85.0100,3266.6300,case rate,Rev 450 Proc 10140 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1576.13,,,,,,,85.0100,3266.6300,fee schedule,"APG 00004 Proc 10140 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment) at 103% = $1,576.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,85.0100,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,85.0100,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,WELLCARE,WELLCARE MEDICAID,3141.00,,,,,,,85.0100,3266.6300,percent of total billed charges,"100% of $3,141.00 in Billed Charges for Rev 450 Proc 10140 = $3,141.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D HEMATOMA SEROMA FL COLLECT,10140,CPT,450,RC,45000020,CDM,,,,both,,,3141.0000,471.1500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,85.0100,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,AETNA,AETNA,722.06,,,,,,,29.8200,1691.0000,percent of total billed charges,"42.7% of $1,691.00 in Billed Charges for Rev 450 Proc 10160 = $722.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,29.8200,1691.0000,fee schedule,"APG 00003 Proc 10160 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,29.8200,1691.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,29.8200,1691.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,29.8200,1691.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,AMBETTER,AMBETTER,804.03,,,,,,,29.8200,1691.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,29.8200,1691.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,29.8200,1691.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,29.8200,1691.0000,fee schedule,"APG 00003 Proc 10160 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,29.8200,1691.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,29.8200,1691.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1134.94,,,,,,,29.8200,1691.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,57.75,,,,,,,29.8200,1691.0000,fee schedule,$57.75 from Fee Schedule BLDTM_23 for Rev 450 Proc 10160 * Qty 1 = $57.75 at 100% = $57.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,29.8200,1691.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,BLUE CROSS,TENNCARE BLUE CARE,29.82,,,,,,,29.8200,1691.0000,fee schedule,$25.71 from Fee Schedule TC_24 for Rev 450 Proc 10160 * Qty 1 = $25.71 at 116% = $29.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,BLUE CROSS,TENNCARE BLUE SELECT,29.82,,,,,,,29.8200,1691.0000,fee schedule,$25.71 from Fee Schedule TC_24 for Rev 450 Proc 10160 * Qty 1 = $25.71 at 116% = $29.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,29.8200,1691.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,29.8200,1691.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1521.90,,,,,,,29.8200,1691.0000,percent of total billed charges,"90% of $1,691.00 in Billed Charges for Rev 450 Proc 10160 = $1,521.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,29.8200,1691.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,29.8200,1691.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,MEDCOST,MEDCOST VHN,804.75,,,,,,,29.8200,1691.0000,percent of total billed charges,"47.59% of $1,691.00 in Billed Charges for Rev 450 Proc 10160 = $804.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,29.8200,1691.0000,fee schedule,"APG 00003 Proc 10160 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,29.8200,1691.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,29.8200,1691.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,29.8200,1691.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,29.8200,1691.0000,fee schedule,"APG 00003 Proc 10160 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,SENTARA HEALTH,SENTARA HEALTH,436.45,,,,,,,29.8200,1691.0000,percent of total billed charges,"25.81% of $1,691.00 in Billed Charges for Rev 450 Proc 10160 = $436.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,29.8200,1691.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1691.00,,,,,,,29.8200,1691.0000,percent of total billed charges,"100% of $1,691.00 in Billed Charges for Rev 450 Proc 10160 = $1,691.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,29.8200,1691.0000,case rate,Rev 450 Proc 10160 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,29.8200,1691.0000,case rate,Rev 450 Proc 10160 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,29.8200,1691.0000,case rate,Rev 450 Proc 10160 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,29.8200,1691.0000,case rate,Rev 450 Proc 10160 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,29.8200,1691.0000,fee schedule,"APG 00003 Proc 10160 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,29.8200,1691.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,29.8200,1691.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,WELLCARE,WELLCARE MEDICAID,1691.00,,,,,,,29.8200,1691.0000,percent of total billed charges,"100% of $1,691.00 in Billed Charges for Rev 450 Proc 10160 = $1,691.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PUNCT ASP ABSC HEMA BULLA CYST,10160,CPT,450,RC,45000021,CDM,,,,both,,,1691.0000,253.6500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,29.8200,1691.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,AETNA,AETNA,446.22,,,,,,,38.7500,1045.0000,percent of total billed charges,"42.7% of $1,045.00 in Billed Charges for Rev 450 Proc 11000 = $446.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,38.7500,1045.0000,fee schedule,"APG 00017 Proc 11000 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,38.7500,1045.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,38.7500,1045.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,38.7500,1045.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,AMBETTER,AMBETTER,804.03,,,,,,,38.7500,1045.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,38.7500,1045.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,38.7500,1045.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,38.7500,1045.0000,fee schedule,"APG 00017 Proc 11000 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,38.7500,1045.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,38.7500,1045.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1045.00,,,,,,,38.7500,1045.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,38.75,,,,,,,38.7500,1045.0000,fee schedule,$38.75 from Fee Schedule BLDTM_23 for Rev 450 Proc 11000 * Qty 1 = $38.75 at 100% = $38.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,38.7500,1045.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,38.7500,1045.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,38.7500,1045.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,940.50,,,,,,,38.7500,1045.0000,percent of total billed charges,"90% of $1,045.00 in Billed Charges for Rev 450 Proc 11000 = $940.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,38.7500,1045.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,38.7500,1045.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,MEDCOST,MEDCOST VHN,497.32,,,,,,,38.7500,1045.0000,percent of total billed charges,"47.59% of $1,045.00 in Billed Charges for Rev 450 Proc 11000 = $497.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,38.7500,1045.0000,fee schedule,"APG 00017 Proc 11000 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,38.7500,1045.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,38.7500,1045.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,38.7500,1045.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,38.7500,1045.0000,fee schedule,"APG 00017 Proc 11000 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,SENTARA HEALTH,SENTARA HEALTH,269.71,,,,,,,38.7500,1045.0000,percent of total billed charges,"25.81% of $1,045.00 in Billed Charges for Rev 450 Proc 11000 = $269.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,38.7500,1045.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1045.00,,,,,,,38.7500,1045.0000,percent of total billed charges,"100% of $1,045.00 in Billed Charges for Rev 450 Proc 11000 = $1,045.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,38.7500,1045.0000,case rate,Rev 450 Proc 11000 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,38.7500,1045.0000,case rate,Rev 450 Proc 11000 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,38.7500,1045.0000,case rate,Rev 450 Proc 11000 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,38.7500,1045.0000,case rate,Rev 450 Proc 11000 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,38.7500,1045.0000,fee schedule,"APG 00017 Proc 11000 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,38.7500,1045.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,38.7500,1045.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,WELLCARE,WELLCARE MEDICAID,1045.00,,,,,,,38.7500,1045.0000,percent of total billed charges,"100% of $1,045.00 in Billed Charges for Rev 450 Proc 11000 = $1,045.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID EXT ECZEM INF SKIN 10%,11000,CPT,450,RC,45000023,CDM,,,,both,,,1045.0000,156.7500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,38.7500,1045.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN EA ADDL 10% BDY SURF,11001,CPT,450,RC,45000354,CDM,,,,both,,,208.0000,31.2000,AETNA,AETNA,88.82,,,,,,,22.0300,566.2300,percent of total billed charges,42.7% of $208.00 in Billed Charges for Rev 450 Proc 11001 = $88.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DEBRID EXT ECZEM INF SKIN EA ADDL 10% BDY SURF,11001,CPT,450,RC,45000354,CDM,,,,both,,,208.0000,31.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,22.0300,566.2300,fee schedule,APG 00017 Proc 11001 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment) at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN EA ADDL 10% BDY SURF,11001,CPT,450,RC,45000354,CDM,,,,both,,,208.0000,31.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,208.00,,,,,,,22.0300,566.2300,fee schedule,"APG 00017 Proc 11001 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment) at 103% = $555.45 (Service Line reduced to $208.00, claim capped at $208.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID EXT ECZEM INF SKIN EA ADDL 10% BDY SURF,11001,CPT,450,RC,45000354,CDM,,,,both,,,208.0000,31.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,22.03,,,,,,,22.0300,566.2300,fee schedule,$22.03 from Fee Schedule BLDTM_23 for Rev 450 Proc 11001 * Qty 1 = $22.03 at 100% = $22.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN EA ADDL 10% BDY SURF,11001,CPT,450,RC,45000354,CDM,,,,both,,,208.0000,31.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,187.20,,,,,,,22.0300,566.2300,percent of total billed charges,90% of $208.00 in Billed Charges for Rev 450 Proc 11001 = $187.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DEBRID EXT ECZEM INF SKIN EA ADDL 10% BDY SURF,11001,CPT,450,RC,45000354,CDM,,,,both,,,208.0000,31.2000,MEDCOST,MEDCOST VHN,98.99,,,,,,,22.0300,566.2300,percent of total billed charges,47.59% of $208.00 in Billed Charges for Rev 450 Proc 11001 = $98.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DEBRID EXT ECZEM INF SKIN EA ADDL 10% BDY SURF,11001,CPT,450,RC,45000354,CDM,,,,both,,,208.0000,31.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,22.0300,566.2300,fee schedule,APG 00017 Proc 11001 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment) at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN EA ADDL 10% BDY SURF,11001,CPT,450,RC,45000354,CDM,,,,both,,,208.0000,31.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,22.0300,566.2300,fee schedule,APG 00017 Proc 11001 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment) at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN EA ADDL 10% BDY SURF,11001,CPT,450,RC,45000354,CDM,,,,both,,,208.0000,31.2000,SENTARA HEALTH,SENTARA HEALTH,53.68,,,,,,,22.0300,566.2300,percent of total billed charges,25.81% of $208.00 in Billed Charges for Rev 450 Proc 11001 = $53.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DEBRID EXT ECZEM INF SKIN EA ADDL 10% BDY SURF,11001,CPT,450,RC,45000354,CDM,,,,both,,,208.0000,31.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",208.00,,,,,,,22.0300,566.2300,percent of total billed charges,100% of $208.00 in Billed Charges for Rev 450 Proc 11001 = $208.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DEBRID EXT ECZEM INF SKIN EA ADDL 10% BDY SURF,11001,CPT,450,RC,45000354,CDM,,,,both,,,208.0000,31.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,22.0300,566.2300,case rate,Rev 450 Proc 11001 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN EA ADDL 10% BDY SURF,11001,CPT,450,RC,45000354,CDM,,,,both,,,208.0000,31.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,208.00,,,,,,,22.0300,566.2300,case rate,"Rev 450 Proc 11001 at Case Rate $491.00 (Service Line reduced to $208.00, claim capped at $208.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID EXT ECZEM INF SKIN EA ADDL 10% BDY SURF,11001,CPT,450,RC,45000354,CDM,,,,both,,,208.0000,31.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,208.00,,,,,,,22.0300,566.2300,case rate,"Rev 450 Proc 11001 at Case Rate $471.00 (Service Line reduced to $208.00, claim capped at $208.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID EXT ECZEM INF SKIN EA ADDL 10% BDY SURF,11001,CPT,450,RC,45000354,CDM,,,,both,,,208.0000,31.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,208.00,,,,,,,22.0300,566.2300,case rate,"Rev 450 Proc 11001 at Case Rate $847.00 (Service Line reduced to $208.00, claim capped at $208.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID EXT ECZEM INF SKIN EA ADDL 10% BDY SURF,11001,CPT,450,RC,45000354,CDM,,,,both,,,208.0000,31.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,22.0300,566.2300,fee schedule,APG 00017 Proc 11001 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment) at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID EXT ECZEM INF SKIN EA ADDL 10% BDY SURF,11001,CPT,450,RC,45000354,CDM,,,,both,,,208.0000,31.2000,WELLCARE,WELLCARE MEDICAID,208.00,,,,,,,22.0300,566.2300,percent of total billed charges,100% of $208.00 in Billed Charges for Rev 450 Proc 11001 = $208.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,AETNA,AETNA,982.95,,,,,,,109.0000,2302.0000,percent of total billed charges,"42.7% of $2,302.00 in Billed Charges for Rev 450 Proc 11010 = $982.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,109.0000,2302.0000,fee schedule,"APG 00017 Proc 11010 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,109.0000,2302.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,109.0000,2302.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,109.0000,2302.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,AMBETTER,AMBETTER,1400.59,,,,,,,109.0000,2302.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,109.0000,2302.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,109.0000,2302.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,109.0000,2302.0000,fee schedule,"APG 00017 Proc 11010 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,109.0000,2302.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,109.0000,2302.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1977.02,,,,,,,109.0000,2302.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,306.96,,,,,,,109.0000,2302.0000,fee schedule,$306.96 from Fee Schedule BLDTM_23 for Rev 450 Proc 11010 * Qty 1 = $306.96 at 100% = $306.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,109.0000,2302.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,109.0000,2302.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,109.0000,2302.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2071.80,,,,,,,109.0000,2302.0000,percent of total billed charges,"90% of $2,302.00 in Billed Charges for Rev 450 Proc 11010 = $2,071.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,HUMANA,HUMANA MEDICARE,642.47,,,,,,,109.0000,2302.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,109.0000,2302.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,MEDCOST,MEDCOST VHN,1095.52,,,,,,,109.0000,2302.0000,percent of total billed charges,"47.59% of $2,302.00 in Billed Charges for Rev 450 Proc 11010 = $1,095.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,109.0000,2302.0000,fee schedule,"APG 00017 Proc 11010 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,109.0000,2302.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,109.0000,2302.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,109.0000,2302.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,109.0000,2302.0000,fee schedule,"APG 00017 Proc 11010 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,SENTARA HEALTH,SENTARA HEALTH,594.15,,,,,,,109.0000,2302.0000,percent of total billed charges,"25.81% of $2,302.00 in Billed Charges for Rev 450 Proc 11010 = $594.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,109.0000,2302.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2302.00,,,,,,,109.0000,2302.0000,percent of total billed charges,"100% of $2,302.00 in Billed Charges for Rev 450 Proc 11010 = $2,302.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,2302.0000,case rate,Rev 450 Proc 11010 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,2302.0000,case rate,Rev 450 Proc 11010 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,2302.0000,case rate,Rev 450 Proc 11010 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,2302.0000,case rate,Rev 450 Proc 11010 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,109.0000,2302.0000,fee schedule,"APG 00017 Proc 11010 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,109.0000,2302.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,109.0000,2302.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,WELLCARE,WELLCARE MEDICAID,2302.00,,,,,,,109.0000,2302.0000,percent of total billed charges,"100% of $2,302.00 in Billed Charges for Rev 450 Proc 11010 = $2,302.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID OPEN FX SKIN SUBQ TISSU,11010,CPT,450,RC,45000024,CDM,,,,both,,,2302.0000,345.3000,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,109.0000,2302.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,AETNA,AETNA,839.06,,,,,,,189.2800,1965.0000,percent of total billed charges,"42.7% of $1,965.00 in Billed Charges for Rev 521 Proc 11011 = $839.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,189.2800,1965.0000,fee schedule,"APG 00017 Proc 11011 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,189.2800,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,189.2800,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,189.2800,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,AMBETTER,AMBETTER,1400.59,,,,,,,189.2800,1965.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,189.2800,1965.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,189.2800,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,189.2800,1965.0000,fee schedule,"APG 00017 Proc 11011 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,189.2800,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,189.2800,1965.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1965.00,,,,,,,189.2800,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,370.73,,,,,,,189.2800,1965.0000,fee schedule,$370.73 from Fee Schedule BLDTM_23 for Rev 521 Proc 11011 * Qty 1 = $370.73 at 100% = $370.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,189.2800,1965.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,CIGNA HEALTHCARE,CIGNA HMO,819.41,,,,,,,189.2800,1965.0000,percent of total billed charges,"41.7% of $1,965.00 in Billed Charges for Rev 521 Proc 11011 = $819.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,911.76,,,,,,,189.2800,1965.0000,percent of total billed charges,"46.4% of $1,965.00 in Billed Charges for Rev 521 Proc 11011 = $911.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,189.2800,1965.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,819.41,,,,,,,189.2800,1965.0000,percent of total billed charges,"41.7% of $1,965.00 in Billed Charges for Rev 521 Proc 11011 = $819.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,CIGNA HEALTHCARE,CIGNA PPO,819.41,,,,,,,189.2800,1965.0000,percent of total billed charges,"41.7% of $1,965.00 in Billed Charges for Rev 521 Proc 11011 = $819.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,189.2800,1965.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1768.50,,,,,,,189.2800,1965.0000,percent of total billed charges,"90% of $1,965.00 in Billed Charges for Rev 521 Proc 11011 = $1,768.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,HUMANA,HUMANA MEDICARE,642.47,,,,,,,189.2800,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,189.2800,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,MEDCOST,MEDCOST VHN,935.14,,,,,,,189.2800,1965.0000,percent of total billed charges,"47.59% of $1,965.00 in Billed Charges for Rev 521 Proc 11011 = $935.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,189.2800,1965.0000,fee schedule,"APG 00017 Proc 11011 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,189.2800,1965.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,189.2800,1965.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,189.2800,1965.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,189.2800,1965.0000,fee schedule,"APG 00017 Proc 11011 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,SENTARA HEALTH,SENTARA HEALTH,507.17,,,,,,,189.2800,1965.0000,percent of total billed charges,"25.81% of $1,965.00 in Billed Charges for Rev 521 Proc 11011 = $507.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,189.2800,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1965.00,,,,,,,189.2800,1965.0000,percent of total billed charges,"100% of $1,965.00 in Billed Charges for Rev 521 Proc 11011 = $1,965.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,189.28,,,,,,,189.2800,1965.0000,fee schedule,$378.56 from Fee Schedule TCUHC24 for Rev 521 Proc 11011 * Qty 1 = $378.56 at 50% = $189.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,189.2800,1965.0000,fee schedule,"APG 00017 Proc 11011 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,189.2800,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,189.2800,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,WELLCARE,WELLCARE MEDICAID,1965.00,,,,,,,189.2800,1965.0000,percent of total billed charges,"100% of $1,965.00 in Billed Charges for Rev 521 Proc 11011 = $1,965.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID W/RMVL FM FX & DISLC SKN SUBQ T/M/F MUSC,11011,CPT,521,RC,45000342,CDM,,,,both,,,1965.0000,294.7500,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,189.2800,1965.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,AETNA,AETNA,1032.06,,,,,,,109.0000,5745.1200,percent of total billed charges,"42.7% of $2,417.00 in Billed Charges for Rev 450 Proc 11012 = $1,032.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1463.97,,,,,,,109.0000,5745.1200,fee schedule,"APG 00018 Proc 11012 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 104% = $1,463.97. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2417.00,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,AETNA,AETNA HEALTHCARE MEDICARE,2417.00,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,2417.00,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,AMBETTER,AMBETTER,5745.12,,,,,,,109.0000,5745.1200,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2417.00,,,,,,,109.0000,5745.1200,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,BLUE CROSS,ANTHEM EXCHANGE,2417.00,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1449.89,,,,,,,109.0000,5745.1200,fee schedule,"APG 00018 Proc 11012 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 103% = $1,449.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,BLUE CROSS,ANTHEM HMO,2417.00,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2417.00,,,,,,,109.0000,5745.1200,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2417.00,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,516.59,,,,,,,109.0000,5745.1200,fee schedule,$516.59 from Fee Schedule BLDTM_23 for Rev 450 Proc 11012 * Qty 1 = $516.59 at 100% = $516.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,BLUE CROSS,BLUE CROSS MEDICARE,2740.79,,,,,,,109.0000,5745.1200,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,2417.00,,,,,,,109.0000,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,2417.00,,,,,,,109.0000,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2175.30,,,,,,,109.0000,5745.1200,percent of total billed charges,"90% of $2,417.00 in Billed Charges for Rev 450 Proc 11012 = $2,175.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,HUMANA,HUMANA MEDICARE,2417.00,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2417.00,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,MEDCOST,MEDCOST VHN,1150.25,,,,,,,109.0000,5745.1200,percent of total billed charges,"47.59% of $2,417.00 in Billed Charges for Rev 450 Proc 11012 = $1,150.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1478.04,,,,,,,109.0000,5745.1200,fee schedule,"APG 00018 Proc 11012 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 100% = $1,407.66... $1,407.66 at 105% = $1,478.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,2417.00,,,,,,,109.0000,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,2417.00,,,,,,,109.0000,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,NHC ADVANTAGE,NHC ADVANTAGE,2417.00,,,,,,,109.0000,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1451.30,,,,,,,109.0000,5745.1200,fee schedule,"APG 00018 Proc 11012 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 100% = $1,407.66... $1,407.66 at 103.1% = $1,451.30 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,SENTARA HEALTH,SENTARA HEALTH,623.83,,,,,,,109.0000,5745.1200,percent of total billed charges,"25.81% of $2,417.00 in Billed Charges for Rev 450 Proc 11012 = $623.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,SENTARA HEALTH,SENTARA MEDICARE,2417.00,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2417.00,,,,,,,109.0000,5745.1200,percent of total billed charges,"100% of $2,417.00 in Billed Charges for Rev 450 Proc 11012 = $2,417.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,5745.1200,case rate,Rev 450 Proc 11012 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,5745.1200,case rate,Rev 450 Proc 11012 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,5745.1200,case rate,Rev 450 Proc 11012 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,5745.1200,case rate,Rev 450 Proc 11012 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1449.89,,,,,,,109.0000,5745.1200,fee schedule,"APG 00018 Proc 11012 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 103% = $1,449.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2417.00,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2417.00,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,WELLCARE,WELLCARE MEDICAID,2417.00,,,,,,,109.0000,5745.1200,percent of total billed charges,"100% of $2,417.00 in Billed Charges for Rev 450 Proc 11012 = $2,417.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID OPEN FX SKIN MUSC BONE,11012,CPT,450,RC,45000025,CDM,,,,both,,,2417.0000,362.5500,WELLCARE,WELLCARE MEDICARE,2793.50,,,,,,,109.0000,5745.1200,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,AETNA,AETNA,867.24,,,,,,,70.6500,2031.0000,percent of total billed charges,"42.7% of $2,031.00 in Billed Charges for Rev 450 Proc 11042 = $867.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,70.6500,2031.0000,fee schedule,"APG 00017 Proc 11042 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,70.6500,2031.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,70.6500,2031.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,70.6500,2031.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,AMBETTER,AMBETTER,804.03,,,,,,,70.6500,2031.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,70.6500,2031.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,70.6500,2031.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,70.6500,2031.0000,fee schedule,"APG 00017 Proc 11042 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,70.6500,2031.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,70.6500,2031.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1134.94,,,,,,,70.6500,2031.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,70.65,,,,,,,70.6500,2031.0000,fee schedule,$70.65 from Fee Schedule BLDTM_23 for Rev 450 Proc 11042 * Qty 1 = $70.65 at 100% = $70.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,70.6500,2031.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,BLUE CROSS,TENNCARE BLUE CARE,82.95,,,,,,,70.6500,2031.0000,fee schedule,$71.51 from Fee Schedule TC_24 for Rev 450 Proc 11042 * Qty 1 = $71.51 at 116% = $82.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,BLUE CROSS,TENNCARE BLUE SELECT,82.95,,,,,,,70.6500,2031.0000,fee schedule,$71.51 from Fee Schedule TC_24 for Rev 450 Proc 11042 * Qty 1 = $71.51 at 116% = $82.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,70.6500,2031.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,70.6500,2031.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1827.90,,,,,,,70.6500,2031.0000,percent of total billed charges,"90% of $2,031.00 in Billed Charges for Rev 450 Proc 11042 = $1,827.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,70.6500,2031.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,70.6500,2031.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,MEDCOST,MEDCOST VHN,966.55,,,,,,,70.6500,2031.0000,percent of total billed charges,"47.59% of $2,031.00 in Billed Charges for Rev 450 Proc 11042 = $966.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,70.6500,2031.0000,fee schedule,"APG 00017 Proc 11042 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,70.6500,2031.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,70.6500,2031.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,70.6500,2031.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,70.6500,2031.0000,fee schedule,"APG 00017 Proc 11042 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,SENTARA HEALTH,SENTARA HEALTH,524.20,,,,,,,70.6500,2031.0000,percent of total billed charges,"25.81% of $2,031.00 in Billed Charges for Rev 450 Proc 11042 = $524.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,70.6500,2031.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2031.00,,,,,,,70.6500,2031.0000,percent of total billed charges,"100% of $2,031.00 in Billed Charges for Rev 450 Proc 11042 = $2,031.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,70.6500,2031.0000,case rate,Rev 450 Proc 11042 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,70.6500,2031.0000,case rate,Rev 450 Proc 11042 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,70.6500,2031.0000,case rate,Rev 450 Proc 11042 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,70.6500,2031.0000,case rate,Rev 450 Proc 11042 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,70.6500,2031.0000,fee schedule,"APG 00017 Proc 11042 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,70.6500,2031.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,70.6500,2031.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,WELLCARE,WELLCARE MEDICAID,2031.00,,,,,,,70.6500,2031.0000,percent of total billed charges,"100% of $2,031.00 in Billed Charges for Rev 450 Proc 11042 = $2,031.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID SKIN & SUBQ TISSUE 20 SQ CM/<,11042,CPT,450,RC,45000026,CDM,,,,both,,,2031.0000,304.6500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,70.6500,2031.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,AETNA,AETNA,825.82,,,,,,,141.5700,1934.0000,percent of total billed charges,"42.7% of $1,934.00 in Billed Charges for Rev 510 Proc 11043 = $825.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,141.5700,1934.0000,fee schedule,"APG 00017 Proc 11043 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,670.54,,,,,,,141.5700,1934.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,AETNA,AETNA HEALTHCARE MEDICARE,670.54,,,,,,,141.5700,1934.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,670.54,,,,,,,141.5700,1934.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,AMBETTER,AMBETTER,1461.78,,,,,,,141.5700,1934.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,697.36,,,,,,,141.5700,1934.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,BLUE CROSS,ANTHEM EXCHANGE,1650.91,,,,,,,141.5700,1934.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,141.5700,1934.0000,fee schedule,"APG 00017 Proc 11043 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,BLUE CROSS,ANTHEM HMO,1753.99,,,,,,,141.5700,1934.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,690.66,,,,,,,141.5700,1934.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1934.00,,,,,,,141.5700,1934.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,168.56,,,,,,,141.5700,1934.0000,fee schedule,$168.56 from Fee Schedule BLDTM_23 for Rev 510 Proc 11043 * Qty 1 = $168.56 at 100% = $168.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,BLUE CROSS,BLUE CROSS MEDICARE,697.36,,,,,,,141.5700,1934.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,BLUE CROSS,TENNCARE BLUE CARE,181.53,,,,,,,141.5700,1934.0000,fee schedule,$156.49 from Fee Schedule TC_24 for Rev 510 Proc 11043 * Qty 1 = $156.49 at 116% = $181.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,BLUE CROSS,TENNCARE BLUE SELECT,181.53,,,,,,,141.5700,1934.0000,fee schedule,$156.49 from Fee Schedule TC_24 for Rev 510 Proc 11043 * Qty 1 = $156.49 at 116% = $181.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,CIGNA HEALTHCARE,CIGNA HMO,806.48,,,,,,,141.5700,1934.0000,percent of total billed charges,"41.7% of $1,934.00 in Billed Charges for Rev 510 Proc 11043 = $806.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,897.38,,,,,,,141.5700,1934.0000,percent of total billed charges,"46.4% of $1,934.00 in Billed Charges for Rev 510 Proc 11043 = $897.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,704.07,,,,,,,141.5700,1934.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,806.48,,,,,,,141.5700,1934.0000,percent of total billed charges,"41.7% of $1,934.00 in Billed Charges for Rev 510 Proc 11043 = $806.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,CIGNA HEALTHCARE,CIGNA PPO,806.48,,,,,,,141.5700,1934.0000,percent of total billed charges,"41.7% of $1,934.00 in Billed Charges for Rev 510 Proc 11043 = $806.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,704.07,,,,,,,141.5700,1934.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1740.60,,,,,,,141.5700,1934.0000,percent of total billed charges,"90% of $1,934.00 in Billed Charges for Rev 510 Proc 11043 = $1,740.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,HUMANA,HUMANA MEDICARE,670.54,,,,,,,141.5700,1934.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,670.54,,,,,,,141.5700,1934.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,MEDCOST,MEDCOST VHN,920.39,,,,,,,141.5700,1934.0000,percent of total billed charges,"47.59% of $1,934.00 in Billed Charges for Rev 510 Proc 11043 = $920.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,141.5700,1934.0000,fee schedule,"APG 00017 Proc 11043 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,704.07,,,,,,,141.5700,1934.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,704.07,,,,,,,141.5700,1934.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,NHC ADVANTAGE,NHC ADVANTAGE,704.07,,,,,,,141.5700,1934.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,141.5700,1934.0000,fee schedule,"APG 00017 Proc 11043 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,SENTARA HEALTH,SENTARA HEALTH,499.17,,,,,,,141.5700,1934.0000,percent of total billed charges,"25.81% of $1,934.00 in Billed Charges for Rev 510 Proc 11043 = $499.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,SENTARA HEALTH,SENTARA MEDICARE,670.54,,,,,,,141.5700,1934.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1934.00,,,,,,,141.5700,1934.0000,percent of total billed charges,"100% of $1,934.00 in Billed Charges for Rev 510 Proc 11043 = $1,934.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,141.57,,,,,,,141.5700,1934.0000,fee schedule,$283.14 from Fee Schedule TCUHC24 for Rev 510 Proc 11043 * Qty 1 = $283.14 at 50% = $141.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,624.68,,,,,,,141.5700,1934.0000,other,"32.3% of $1,934.00 in Billed Charges for Rev 510 Proc 11043 = $624.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,593.74,,,,,,,141.5700,1934.0000,other,"30.7% of $1,934.00 in Billed Charges for Rev 510 Proc 11043 = $593.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,624.68,,,,,,,141.5700,1934.0000,percent of total billed charges,"32.3% of $1,934.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,141.5700,1934.0000,fee schedule,"APG 00017 Proc 11043 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,670.54,,,,,,,141.5700,1934.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,670.54,,,,,,,141.5700,1934.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,WELLCARE,WELLCARE MEDICAID,1934.00,,,,,,,141.5700,1934.0000,percent of total billed charges,"100% of $1,934.00 in Billed Charges for Rev 510 Proc 11043 = $1,934.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRID MUSCLE/FASCIA 20 SQ CM/<,11043,CPT,510,RC,51000008,CDM,,,,both,,,1934.0000,290.1000,WELLCARE,WELLCARE MEDICARE,710.77,,,,,,,141.5700,1934.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27200002,CDM,,,,,,both,,,14467.5500,2170.1300,AETNA,AETNA,6177.64,,,,,,,3734.0700,14467.5500,percent of total billed charges,"42.7% of $14,467.55 in Billed Charges for Rev 272 = $6,177.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27200002,CDM,,,,,,both,,,14467.5500,2170.1300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,10127.29,,,,,,,3734.0700,14467.5500,percent of total billed charges,"Rev 272 $14,467.55 in Billed Charges at 70% = $10,127.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27200002,CDM,,,,,,both,,,14467.5500,2170.1300,CIGNA HEALTHCARE,CIGNA HMO,6032.97,,,,,,,3734.0700,14467.5500,percent of total billed charges,"41.7% of $14,467.55 in Billed Charges for Rev 272 = $6,032.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27200002,CDM,,,,,,both,,,14467.5500,2170.1300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6712.94,,,,,,,3734.0700,14467.5500,percent of total billed charges,"46.4% of $14,467.55 in Billed Charges for Rev 272 = $6,712.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27200002,CDM,,,,,,both,,,14467.5500,2170.1300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6032.97,,,,,,,3734.0700,14467.5500,percent of total billed charges,"41.7% of $14,467.55 in Billed Charges for Rev 272 = $6,032.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27200002,CDM,,,,,,both,,,14467.5500,2170.1300,CIGNA HEALTHCARE,CIGNA PPO,6032.97,,,,,,,3734.0700,14467.5500,percent of total billed charges,"41.7% of $14,467.55 in Billed Charges for Rev 272 = $6,032.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27200002,CDM,,,,,,both,,,14467.5500,2170.1300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13020.80,,,,,,,3734.0700,14467.5500,percent of total billed charges,"90% of $14,467.55 in Billed Charges for Rev 272 = $13,020.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27200002,CDM,,,,,,both,,,14467.5500,2170.1300,MEDCOST,MEDCOST VHN,6885.11,,,,,,,3734.0700,14467.5500,percent of total billed charges,"47.59% of $14,467.55 in Billed Charges for Rev 272 = $6,885.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27200002,CDM,,,,,,both,,,14467.5500,2170.1300,SENTARA HEALTH,SENTARA HEALTH,3734.07,,,,,,,3734.0700,14467.5500,percent of total billed charges,"25.81% of $14,467.55 in Billed Charges for Rev 272 = $3,734.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27200002,CDM,,,,,,both,,,14467.5500,2170.1300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",14467.55,,,,,,,3734.0700,14467.5500,percent of total billed charges,"100% of $14,467.55 in Billed Charges for Rev 272 = $14,467.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27200002,CDM,,,,,,both,,,14467.5500,2170.1300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7233.78,,,,,,,3734.0700,14467.5500,percent of total billed charges,"Rev 272 $14,467.55 in Billed Charges at 50% = $7,233.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27200002,CDM,,,,,,both,,,14467.5500,2170.1300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4673.02,,,,,,,3734.0700,14467.5500,other,"32.3% of $14,467.55 in Billed Charges for Rev 272 = $4,673.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27200002,CDM,,,,,,both,,,14467.5500,2170.1300,UNITED HEALTHCARE,UHC HERITAGE SELECT,4441.54,,,,,,,3734.0700,14467.5500,other,"30.7% of $14,467.55 in Billed Charges for Rev 272 = $4,441.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27200002,CDM,,,,,,both,,,14467.5500,2170.1300,UNITED HEALTHCARE,UNITED HEALTHCARE,4673.02,,,,,,,3734.0700,14467.5500,percent of total billed charges,"32.3% of $14,467.55 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM JADA-2002 VACUUM HEMORRHAGE CONTROL,272,RC,27200002,CDM,,,,,,both,,,14467.5500,2170.1300,WELLCARE,WELLCARE MEDICAID,14467.55,,,,,,,3734.0700,14467.5500,percent of total billed charges,"100% of $14,467.55 in Billed Charges for Rev 272 = $14,467.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SPETZLER BARRACUDA UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,7839.6900,1175.9500,AETNA,AETNA,3347.55,,,,,,,2023.4200,7839.6900,percent of total billed charges,"42.7% of $7,839.69 in Billed Charges for Rev 272 = $3,347.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SPETZLER BARRACUDA UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,7839.6900,1175.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5487.78,,,,,,,2023.4200,7839.6900,percent of total billed charges,"Rev 272 $7,839.69 in Billed Charges at 70% = $5,487.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SPETZLER BARRACUDA UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,7839.6900,1175.9500,CIGNA HEALTHCARE,CIGNA HMO,3269.15,,,,,,,2023.4200,7839.6900,percent of total billed charges,"41.7% of $7,839.69 in Billed Charges for Rev 272 = $3,269.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SPETZLER BARRACUDA UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,7839.6900,1175.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3637.62,,,,,,,2023.4200,7839.6900,percent of total billed charges,"46.4% of $7,839.69 in Billed Charges for Rev 272 = $3,637.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SPETZLER BARRACUDA UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,7839.6900,1175.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3269.15,,,,,,,2023.4200,7839.6900,percent of total billed charges,"41.7% of $7,839.69 in Billed Charges for Rev 272 = $3,269.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SPETZLER BARRACUDA UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,7839.6900,1175.9500,CIGNA HEALTHCARE,CIGNA PPO,3269.15,,,,,,,2023.4200,7839.6900,percent of total billed charges,"41.7% of $7,839.69 in Billed Charges for Rev 272 = $3,269.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SPETZLER BARRACUDA UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,7839.6900,1175.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7055.72,,,,,,,2023.4200,7839.6900,percent of total billed charges,"90% of $7,839.69 in Billed Charges for Rev 272 = $7,055.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SPETZLER BARRACUDA UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,7839.6900,1175.9500,MEDCOST,MEDCOST VHN,3730.91,,,,,,,2023.4200,7839.6900,percent of total billed charges,"47.59% of $7,839.69 in Billed Charges for Rev 272 = $3,730.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SPETZLER BARRACUDA UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,7839.6900,1175.9500,SENTARA HEALTH,SENTARA HEALTH,2023.42,,,,,,,2023.4200,7839.6900,percent of total billed charges,"25.81% of $7,839.69 in Billed Charges for Rev 272 = $2,023.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SPETZLER BARRACUDA UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,7839.6900,1175.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7839.69,,,,,,,2023.4200,7839.6900,percent of total billed charges,"100% of $7,839.69 in Billed Charges for Rev 272 = $7,839.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SPETZLER BARRACUDA UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,7839.6900,1175.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3919.85,,,,,,,2023.4200,7839.6900,percent of total billed charges,"Rev 272 $7,839.69 in Billed Charges at 50% = $3,919.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SPETZLER BARRACUDA UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,7839.6900,1175.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2532.22,,,,,,,2023.4200,7839.6900,other,"32.3% of $7,839.69 in Billed Charges for Rev 272 = $2,532.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP SPETZLER BARRACUDA UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,7839.6900,1175.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2406.78,,,,,,,2023.4200,7839.6900,other,"30.7% of $7,839.69 in Billed Charges for Rev 272 = $2,406.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP SPETZLER BARRACUDA UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,7839.6900,1175.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,2532.22,,,,,,,2023.4200,7839.6900,percent of total billed charges,"32.3% of $7,839.69 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP SPETZLER BARRACUDA UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,7839.6900,1175.9500,WELLCARE,WELLCARE MEDICAID,7839.69,,,,,,,2023.4200,7839.6900,percent of total billed charges,"100% of $7,839.69 in Billed Charges for Rev 272 = $7,839.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP STRAIGHT UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,6780.5600,1017.0800,AETNA,AETNA,2895.30,,,,,,,1750.0600,6780.5600,percent of total billed charges,"42.7% of $6,780.56 in Billed Charges for Rev 272 = $2,895.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP STRAIGHT UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,6780.5600,1017.0800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4746.39,,,,,,,1750.0600,6780.5600,percent of total billed charges,"Rev 272 $6,780.56 in Billed Charges at 70% = $4,746.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP STRAIGHT UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,6780.5600,1017.0800,CIGNA HEALTHCARE,CIGNA HMO,2827.49,,,,,,,1750.0600,6780.5600,percent of total billed charges,"41.7% of $6,780.56 in Billed Charges for Rev 272 = $2,827.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP STRAIGHT UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,6780.5600,1017.0800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3146.18,,,,,,,1750.0600,6780.5600,percent of total billed charges,"46.4% of $6,780.56 in Billed Charges for Rev 272 = $3,146.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP STRAIGHT UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,6780.5600,1017.0800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2827.49,,,,,,,1750.0600,6780.5600,percent of total billed charges,"41.7% of $6,780.56 in Billed Charges for Rev 272 = $2,827.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP STRAIGHT UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,6780.5600,1017.0800,CIGNA HEALTHCARE,CIGNA PPO,2827.49,,,,,,,1750.0600,6780.5600,percent of total billed charges,"41.7% of $6,780.56 in Billed Charges for Rev 272 = $2,827.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP STRAIGHT UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,6780.5600,1017.0800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6102.50,,,,,,,1750.0600,6780.5600,percent of total billed charges,"90% of $6,780.56 in Billed Charges for Rev 272 = $6,102.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP STRAIGHT UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,6780.5600,1017.0800,MEDCOST,MEDCOST VHN,3226.87,,,,,,,1750.0600,6780.5600,percent of total billed charges,"47.59% of $6,780.56 in Billed Charges for Rev 272 = $3,226.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP STRAIGHT UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,6780.5600,1017.0800,SENTARA HEALTH,SENTARA HEALTH,1750.06,,,,,,,1750.0600,6780.5600,percent of total billed charges,"25.81% of $6,780.56 in Billed Charges for Rev 272 = $1,750.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP STRAIGHT UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,6780.5600,1017.0800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6780.56,,,,,,,1750.0600,6780.5600,percent of total billed charges,"100% of $6,780.56 in Billed Charges for Rev 272 = $6,780.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP STRAIGHT UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,6780.5600,1017.0800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3390.28,,,,,,,1750.0600,6780.5600,percent of total billed charges,"Rev 272 $6,780.56 in Billed Charges at 50% = $3,390.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP STRAIGHT UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,6780.5600,1017.0800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2190.12,,,,,,,1750.0600,6780.5600,other,"32.3% of $6,780.56 in Billed Charges for Rev 272 = $2,190.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP STRAIGHT UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,6780.5600,1017.0800,UNITED HEALTHCARE,UHC HERITAGE SELECT,2081.63,,,,,,,1750.0600,6780.5600,other,"30.7% of $6,780.56 in Billed Charges for Rev 272 = $2,081.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP STRAIGHT UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,6780.5600,1017.0800,UNITED HEALTHCARE,UNITED HEALTHCARE,2190.12,,,,,,,1750.0600,6780.5600,percent of total billed charges,"32.3% of $6,780.56 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP STRAIGHT UNIVERSAL (USED WITH SONOPET),272,RC,27200002,CDM,,,,,,both,,,6780.5600,1017.0800,WELLCARE,WELLCARE MEDICAID,6780.56,,,,,,,1750.0600,6780.5600,percent of total billed charges,"100% of $6,780.56 in Billed Charges for Rev 272 = $6,780.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP UTERINE MANIP 6.7MM X 12 C,272,RC,27200002,CDM,,,,,,both,,,1192.0000,178.8000,AETNA,AETNA,508.98,,,,,,,307.6600,1192.0000,percent of total billed charges,"42.7% of $1,192.00 in Billed Charges for Rev 272 = $508.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP UTERINE MANIP 6.7MM X 12 C,272,RC,27200002,CDM,,,,,,both,,,1192.0000,178.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,834.40,,,,,,,307.6600,1192.0000,percent of total billed charges,"Rev 272 $1,192.00 in Billed Charges at 70% = $834.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP UTERINE MANIP 6.7MM X 12 C,272,RC,27200002,CDM,,,,,,both,,,1192.0000,178.8000,CIGNA HEALTHCARE,CIGNA HMO,497.06,,,,,,,307.6600,1192.0000,percent of total billed charges,"41.7% of $1,192.00 in Billed Charges for Rev 272 = $497.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP UTERINE MANIP 6.7MM X 12 C,272,RC,27200002,CDM,,,,,,both,,,1192.0000,178.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,553.09,,,,,,,307.6600,1192.0000,percent of total billed charges,"46.4% of $1,192.00 in Billed Charges for Rev 272 = $553.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP UTERINE MANIP 6.7MM X 12 C,272,RC,27200002,CDM,,,,,,both,,,1192.0000,178.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,497.06,,,,,,,307.6600,1192.0000,percent of total billed charges,"41.7% of $1,192.00 in Billed Charges for Rev 272 = $497.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP UTERINE MANIP 6.7MM X 12 C,272,RC,27200002,CDM,,,,,,both,,,1192.0000,178.8000,CIGNA HEALTHCARE,CIGNA PPO,497.06,,,,,,,307.6600,1192.0000,percent of total billed charges,"41.7% of $1,192.00 in Billed Charges for Rev 272 = $497.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP UTERINE MANIP 6.7MM X 12 C,272,RC,27200002,CDM,,,,,,both,,,1192.0000,178.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1072.80,,,,,,,307.6600,1192.0000,percent of total billed charges,"90% of $1,192.00 in Billed Charges for Rev 272 = $1,072.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP UTERINE MANIP 6.7MM X 12 C,272,RC,27200002,CDM,,,,,,both,,,1192.0000,178.8000,MEDCOST,MEDCOST VHN,567.27,,,,,,,307.6600,1192.0000,percent of total billed charges,"47.59% of $1,192.00 in Billed Charges for Rev 272 = $567.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP UTERINE MANIP 6.7MM X 12 C,272,RC,27200002,CDM,,,,,,both,,,1192.0000,178.8000,SENTARA HEALTH,SENTARA HEALTH,307.66,,,,,,,307.6600,1192.0000,percent of total billed charges,"25.81% of $1,192.00 in Billed Charges for Rev 272 = $307.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP UTERINE MANIP 6.7MM X 12 C,272,RC,27200002,CDM,,,,,,both,,,1192.0000,178.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1192.00,,,,,,,307.6600,1192.0000,percent of total billed charges,"100% of $1,192.00 in Billed Charges for Rev 272 = $1,192.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP UTERINE MANIP 6.7MM X 12 C,272,RC,27200002,CDM,,,,,,both,,,1192.0000,178.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,596.00,,,,,,,307.6600,1192.0000,percent of total billed charges,"Rev 272 $1,192.00 in Billed Charges at 50% = $596.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP UTERINE MANIP 6.7MM X 12 C,272,RC,27200002,CDM,,,,,,both,,,1192.0000,178.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,385.02,,,,,,,307.6600,1192.0000,other,"32.3% of $1,192.00 in Billed Charges for Rev 272 = $385.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP UTERINE MANIP 6.7MM X 12 C,272,RC,27200002,CDM,,,,,,both,,,1192.0000,178.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,365.94,,,,,,,307.6600,1192.0000,other,"30.7% of $1,192.00 in Billed Charges for Rev 272 = $365.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP UTERINE MANIP 6.7MM X 12 C,272,RC,27200002,CDM,,,,,,both,,,1192.0000,178.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,385.02,,,,,,,307.6600,1192.0000,percent of total billed charges,"32.3% of $1,192.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP UTERINE MANIP 6.7MM X 12 C,272,RC,27200002,CDM,,,,,,both,,,1192.0000,178.8000,WELLCARE,WELLCARE MEDICAID,1192.00,,,,,,,307.6600,1192.0000,percent of total billed charges,"100% of $1,192.00 in Billed Charges for Rev 272 = $1,192.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4483.7500,672.5600,AETNA,AETNA,1914.56,,,,,,,1157.2600,4483.7500,percent of total billed charges,"42.7% of $4,483.75 in Billed Charges for Rev 272 = $1,914.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4483.7500,672.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3138.63,,,,,,,1157.2600,4483.7500,percent of total billed charges,"Rev 272 $4,483.75 in Billed Charges at 70% = $3,138.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4483.7500,672.5600,CIGNA HEALTHCARE,CIGNA HMO,1869.72,,,,,,,1157.2600,4483.7500,percent of total billed charges,"41.7% of $4,483.75 in Billed Charges for Rev 272 = $1,869.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4483.7500,672.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2080.46,,,,,,,1157.2600,4483.7500,percent of total billed charges,"46.4% of $4,483.75 in Billed Charges for Rev 272 = $2,080.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4483.7500,672.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1869.72,,,,,,,1157.2600,4483.7500,percent of total billed charges,"41.7% of $4,483.75 in Billed Charges for Rev 272 = $1,869.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4483.7500,672.5600,CIGNA HEALTHCARE,CIGNA PPO,1869.72,,,,,,,1157.2600,4483.7500,percent of total billed charges,"41.7% of $4,483.75 in Billed Charges for Rev 272 = $1,869.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4483.7500,672.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4035.38,,,,,,,1157.2600,4483.7500,percent of total billed charges,"90% of $4,483.75 in Billed Charges for Rev 272 = $4,035.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4483.7500,672.5600,MEDCOST,MEDCOST VHN,2133.82,,,,,,,1157.2600,4483.7500,percent of total billed charges,"47.59% of $4,483.75 in Billed Charges for Rev 272 = $2,133.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4483.7500,672.5600,SENTARA HEALTH,SENTARA HEALTH,1157.26,,,,,,,1157.2600,4483.7500,percent of total billed charges,"25.81% of $4,483.75 in Billed Charges for Rev 272 = $1,157.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4483.7500,672.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4483.75,,,,,,,1157.2600,4483.7500,percent of total billed charges,"100% of $4,483.75 in Billed Charges for Rev 272 = $4,483.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4483.7500,672.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2241.88,,,,,,,1157.2600,4483.7500,percent of total billed charges,"Rev 272 $4,483.75 in Billed Charges at 50% = $2,241.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4483.7500,672.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1448.25,,,,,,,1157.2600,4483.7500,other,"32.3% of $4,483.75 in Billed Charges for Rev 272 = $1,448.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4483.7500,672.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1376.51,,,,,,,1157.2600,4483.7500,other,"30.7% of $4,483.75 in Billed Charges for Rev 272 = $1,376.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4483.7500,672.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,1448.25,,,,,,,1157.2600,4483.7500,percent of total billed charges,"32.3% of $4,483.75 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4483.7500,672.5600,WELLCARE,WELLCARE MEDICAID,4483.75,,,,,,,1157.2600,4483.7500,percent of total billed charges,"100% of $4,483.75 in Billed Charges for Rev 272 = $4,483.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LIGASURE LG,272,RC,27200002,CDM,,,,,,both,,,5286.6200,792.9900,AETNA,AETNA,2257.39,,,,,,,1364.4800,5286.6200,percent of total billed charges,"42.7% of $5,286.62 in Billed Charges for Rev 272 = $2,257.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LIGASURE LG,272,RC,27200002,CDM,,,,,,both,,,5286.6200,792.9900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3700.63,,,,,,,1364.4800,5286.6200,percent of total billed charges,"Rev 272 $5,286.62 in Billed Charges at 70% = $3,700.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LIGASURE LG,272,RC,27200002,CDM,,,,,,both,,,5286.6200,792.9900,CIGNA HEALTHCARE,CIGNA HMO,2204.52,,,,,,,1364.4800,5286.6200,percent of total billed charges,"41.7% of $5,286.62 in Billed Charges for Rev 272 = $2,204.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LIGASURE LG,272,RC,27200002,CDM,,,,,,both,,,5286.6200,792.9900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2452.99,,,,,,,1364.4800,5286.6200,percent of total billed charges,"46.4% of $5,286.62 in Billed Charges for Rev 272 = $2,452.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LIGASURE LG,272,RC,27200002,CDM,,,,,,both,,,5286.6200,792.9900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2204.52,,,,,,,1364.4800,5286.6200,percent of total billed charges,"41.7% of $5,286.62 in Billed Charges for Rev 272 = $2,204.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LIGASURE LG,272,RC,27200002,CDM,,,,,,both,,,5286.6200,792.9900,CIGNA HEALTHCARE,CIGNA PPO,2204.52,,,,,,,1364.4800,5286.6200,percent of total billed charges,"41.7% of $5,286.62 in Billed Charges for Rev 272 = $2,204.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LIGASURE LG,272,RC,27200002,CDM,,,,,,both,,,5286.6200,792.9900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4757.96,,,,,,,1364.4800,5286.6200,percent of total billed charges,"90% of $5,286.62 in Billed Charges for Rev 272 = $4,757.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LIGASURE LG,272,RC,27200002,CDM,,,,,,both,,,5286.6200,792.9900,MEDCOST,MEDCOST VHN,2515.90,,,,,,,1364.4800,5286.6200,percent of total billed charges,"47.59% of $5,286.62 in Billed Charges for Rev 272 = $2,515.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LIGASURE LG,272,RC,27200002,CDM,,,,,,both,,,5286.6200,792.9900,SENTARA HEALTH,SENTARA HEALTH,1364.48,,,,,,,1364.4800,5286.6200,percent of total billed charges,"25.81% of $5,286.62 in Billed Charges for Rev 272 = $1,364.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LIGASURE LG,272,RC,27200002,CDM,,,,,,both,,,5286.6200,792.9900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5286.62,,,,,,,1364.4800,5286.6200,percent of total billed charges,"100% of $5,286.62 in Billed Charges for Rev 272 = $5,286.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LIGASURE LG,272,RC,27200002,CDM,,,,,,both,,,5286.6200,792.9900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2643.31,,,,,,,1364.4800,5286.6200,percent of total billed charges,"Rev 272 $5,286.62 in Billed Charges at 50% = $2,643.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LIGASURE LG,272,RC,27200002,CDM,,,,,,both,,,5286.6200,792.9900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1707.58,,,,,,,1364.4800,5286.6200,other,"32.3% of $5,286.62 in Billed Charges for Rev 272 = $1,707.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TISSUE SEALER LIGASURE LG,272,RC,27200002,CDM,,,,,,both,,,5286.6200,792.9900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1622.99,,,,,,,1364.4800,5286.6200,other,"30.7% of $5,286.62 in Billed Charges for Rev 272 = $1,622.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TISSUE SEALER LIGASURE LG,272,RC,27200002,CDM,,,,,,both,,,5286.6200,792.9900,UNITED HEALTHCARE,UNITED HEALTHCARE,1707.58,,,,,,,1364.4800,5286.6200,percent of total billed charges,"32.3% of $5,286.62 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LIGASURE LG,272,RC,27200002,CDM,,,,,,both,,,5286.6200,792.9900,WELLCARE,WELLCARE MEDICAID,5286.62,,,,,,,1364.4800,5286.6200,percent of total billed charges,"100% of $5,286.62 in Billed Charges for Rev 272 = $5,286.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE POPE WO WIRE,272,RC,27200002,CDM,,,,,,both,,,909.7400,136.4600,AETNA,AETNA,388.46,,,,,,,234.8000,909.7400,percent of total billed charges,42.7% of $909.74 in Billed Charges for Rev 272 = $388.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE POPE WO WIRE,272,RC,27200002,CDM,,,,,,both,,,909.7400,136.4600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,636.82,,,,,,,234.8000,909.7400,percent of total billed charges,Rev 272 $909.74 in Billed Charges at 70% = $636.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE POPE WO WIRE,272,RC,27200002,CDM,,,,,,both,,,909.7400,136.4600,CIGNA HEALTHCARE,CIGNA HMO,379.36,,,,,,,234.8000,909.7400,percent of total billed charges,41.7% of $909.74 in Billed Charges for Rev 272 = $379.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE POPE WO WIRE,272,RC,27200002,CDM,,,,,,both,,,909.7400,136.4600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,422.12,,,,,,,234.8000,909.7400,percent of total billed charges,46.4% of $909.74 in Billed Charges for Rev 272 = $422.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE POPE WO WIRE,272,RC,27200002,CDM,,,,,,both,,,909.7400,136.4600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,379.36,,,,,,,234.8000,909.7400,percent of total billed charges,41.7% of $909.74 in Billed Charges for Rev 272 = $379.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE POPE WO WIRE,272,RC,27200002,CDM,,,,,,both,,,909.7400,136.4600,CIGNA HEALTHCARE,CIGNA PPO,379.36,,,,,,,234.8000,909.7400,percent of total billed charges,41.7% of $909.74 in Billed Charges for Rev 272 = $379.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE POPE WO WIRE,272,RC,27200002,CDM,,,,,,both,,,909.7400,136.4600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,818.77,,,,,,,234.8000,909.7400,percent of total billed charges,90% of $909.74 in Billed Charges for Rev 272 = $818.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE POPE WO WIRE,272,RC,27200002,CDM,,,,,,both,,,909.7400,136.4600,MEDCOST,MEDCOST VHN,432.95,,,,,,,234.8000,909.7400,percent of total billed charges,47.59% of $909.74 in Billed Charges for Rev 272 = $432.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE POPE WO WIRE,272,RC,27200002,CDM,,,,,,both,,,909.7400,136.4600,SENTARA HEALTH,SENTARA HEALTH,234.80,,,,,,,234.8000,909.7400,percent of total billed charges,25.81% of $909.74 in Billed Charges for Rev 272 = $234.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE POPE WO WIRE,272,RC,27200002,CDM,,,,,,both,,,909.7400,136.4600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",909.74,,,,,,,234.8000,909.7400,percent of total billed charges,100% of $909.74 in Billed Charges for Rev 272 = $909.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE POPE WO WIRE,272,RC,27200002,CDM,,,,,,both,,,909.7400,136.4600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,454.87,,,,,,,234.8000,909.7400,percent of total billed charges,Rev 272 $909.74 in Billed Charges at 50% = $454.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE POPE WO WIRE,272,RC,27200002,CDM,,,,,,both,,,909.7400,136.4600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,293.85,,,,,,,234.8000,909.7400,other,32.3% of $909.74 in Billed Charges for Rev 272 = $293.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE POPE WO WIRE,272,RC,27200002,CDM,,,,,,both,,,909.7400,136.4600,UNITED HEALTHCARE,UHC HERITAGE SELECT,279.29,,,,,,,234.8000,909.7400,other,30.7% of $909.74 in Billed Charges for Rev 272 = $279.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE POPE WO WIRE,272,RC,27200002,CDM,,,,,,both,,,909.7400,136.4600,UNITED HEALTHCARE,UNITED HEALTHCARE,293.85,,,,,,,234.8000,909.7400,percent of total billed charges,32.3% of $909.74 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE POPE WO WIRE,272,RC,27200002,CDM,,,,,,both,,,909.7400,136.4600,WELLCARE,WELLCARE MEDICAID,909.74,,,,,,,234.8000,909.7400,percent of total billed charges,100% of $909.74 in Billed Charges for Rev 272 = $909.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,AETNA,AETNA,873.22,,,,,,,232.5600,3266.6300,percent of total billed charges,"42.7% of $2,045.00 in Billed Charges for Rev 510 Proc 11044 = $873.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1463.97,,,,,,,232.5600,3266.6300,fee schedule,"APG 00018 Proc 11044 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 104% = $1,463.97. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,232.5600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,232.5600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,232.5600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,AMBETTER,AMBETTER,3266.63,,,,,,,232.5600,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,232.5600,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,BLUE CROSS,ANTHEM EXCHANGE,2045.00,,,,,,,232.5600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1449.89,,,,,,,232.5600,3266.6300,fee schedule,"APG 00018 Proc 11044 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 103% = $1,449.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,BLUE CROSS,ANTHEM HMO,2045.00,,,,,,,232.5600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,232.5600,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2045.00,,,,,,,232.5600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,232.56,,,,,,,232.5600,3266.6300,fee schedule,$232.56 from Fee Schedule BLDTM_23 for Rev 510 Proc 11044 * Qty 1 = $232.56 at 100% = $232.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,232.5600,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,BLUE CROSS,TENNCARE BLUE CARE,276.37,,,,,,,232.5600,3266.6300,fee schedule,$238.25 from Fee Schedule TC_24 for Rev 510 Proc 11044 * Qty 1 = $238.25 at 116% = $276.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,BLUE CROSS,TENNCARE BLUE SELECT,276.37,,,,,,,232.5600,3266.6300,fee schedule,$238.25 from Fee Schedule TC_24 for Rev 510 Proc 11044 * Qty 1 = $238.25 at 116% = $276.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,CIGNA HEALTHCARE,CIGNA HMO,852.77,,,,,,,232.5600,3266.6300,percent of total billed charges,"41.7% of $2,045.00 in Billed Charges for Rev 510 Proc 11044 = $852.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,948.88,,,,,,,232.5600,3266.6300,percent of total billed charges,"46.4% of $2,045.00 in Billed Charges for Rev 510 Proc 11044 = $948.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,232.5600,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,852.77,,,,,,,232.5600,3266.6300,percent of total billed charges,"41.7% of $2,045.00 in Billed Charges for Rev 510 Proc 11044 = $852.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,CIGNA HEALTHCARE,CIGNA PPO,852.77,,,,,,,232.5600,3266.6300,percent of total billed charges,"41.7% of $2,045.00 in Billed Charges for Rev 510 Proc 11044 = $852.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,232.5600,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1840.50,,,,,,,232.5600,3266.6300,percent of total billed charges,"90% of $2,045.00 in Billed Charges for Rev 510 Proc 11044 = $1,840.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,232.5600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,232.5600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,MEDCOST,MEDCOST VHN,973.22,,,,,,,232.5600,3266.6300,percent of total billed charges,"47.59% of $2,045.00 in Billed Charges for Rev 510 Proc 11044 = $973.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1478.04,,,,,,,232.5600,3266.6300,fee schedule,"APG 00018 Proc 11044 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 100% = $1,407.66... $1,407.66 at 105% = $1,478.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,232.5600,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,232.5600,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,232.5600,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1451.30,,,,,,,232.5600,3266.6300,fee schedule,"APG 00018 Proc 11044 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 100% = $1,407.66... $1,407.66 at 103.1% = $1,451.30 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,SENTARA HEALTH,SENTARA HEALTH,527.81,,,,,,,232.5600,3266.6300,percent of total billed charges,"25.81% of $2,045.00 in Billed Charges for Rev 510 Proc 11044 = $527.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,232.5600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2045.00,,,,,,,232.5600,3266.6300,percent of total billed charges,"100% of $2,045.00 in Billed Charges for Rev 510 Proc 11044 = $2,045.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,413.29,,,,,,,232.5600,3266.6300,fee schedule,$826.58 from Fee Schedule TCUHC24 for Rev 510 Proc 11044 * Qty 1 = $826.58 at 50% = $413.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,660.54,,,,,,,232.5600,3266.6300,other,"32.3% of $2,045.00 in Billed Charges for Rev 510 Proc 11044 = $660.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,627.82,,,,,,,232.5600,3266.6300,other,"30.7% of $2,045.00 in Billed Charges for Rev 510 Proc 11044 = $627.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,660.54,,,,,,,232.5600,3266.6300,percent of total billed charges,"32.3% of $2,045.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1449.89,,,,,,,232.5600,3266.6300,fee schedule,"APG 00018 Proc 11044 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 103% = $1,449.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,232.5600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,232.5600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,WELLCARE,WELLCARE MEDICAID,2045.00,,,,,,,232.5600,3266.6300,percent of total billed charges,"100% of $2,045.00 in Billed Charges for Rev 510 Proc 11044 = $2,045.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DEBRD BONE MUSCLE &/FASCIA 20 SQ CM/<,11044,CPT,510,RC,51000009,CDM,,,,both,,,2045.0000,306.7500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,232.5600,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DBRD SKN & SUBQ TISS EA ADDL 20 SQ CM,11045,CPT,510,RC,51000010,CDM,,,,both,,,756.0000,113.4000,AETNA,AETNA,322.81,,,,,,,28.9300,1478.0400,percent of total billed charges,42.7% of $756.00 in Billed Charges for Rev 510 Proc 11045 = $322.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DBRD SKN & SUBQ TISS EA ADDL 20 SQ CM,11045,CPT,510,RC,51000010,CDM,,,,both,,,756.0000,113.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1463.97,,,,,,,28.9300,1478.0400,fee schedule,"APG 00018 Proc 11045 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 104% = $1,463.97. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DBRD SKN & SUBQ TISS EA ADDL 20 SQ CM,11045,CPT,510,RC,51000010,CDM,,,,both,,,756.0000,113.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,756.00,,,,,,,28.9300,1478.0400,fee schedule,"APG 00018 Proc 11045 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 103% = $1,449.89 (Service Line reduced to $756.00, claim capped at $756.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DBRD SKN & SUBQ TISS EA ADDL 20 SQ CM,11045,CPT,510,RC,51000010,CDM,,,,both,,,756.0000,113.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,28.93,,,,,,,28.9300,1478.0400,fee schedule,$28.93 from Fee Schedule BLDTM_23 for Rev 510 Proc 11045 * Qty 1 = $28.93 at 100% = $28.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DBRD SKN & SUBQ TISS EA ADDL 20 SQ CM,11045,CPT,510,RC,51000010,CDM,,,,both,,,756.0000,113.4000,BLUE CROSS,TENNCARE BLUE CARE,29.24,,,,,,,28.9300,1478.0400,fee schedule,$25.21 from Fee Schedule TC_24 for Rev 510 Proc 11045 * Qty 1 = $25.21 at 116% = $29.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DBRD SKN & SUBQ TISS EA ADDL 20 SQ CM,11045,CPT,510,RC,51000010,CDM,,,,both,,,756.0000,113.4000,BLUE CROSS,TENNCARE BLUE SELECT,29.24,,,,,,,28.9300,1478.0400,fee schedule,$25.21 from Fee Schedule TC_24 for Rev 510 Proc 11045 * Qty 1 = $25.21 at 116% = $29.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DBRD SKN & SUBQ TISS EA ADDL 20 SQ CM,11045,CPT,510,RC,51000010,CDM,,,,both,,,756.0000,113.4000,CIGNA HEALTHCARE,CIGNA HMO,315.25,,,,,,,28.9300,1478.0400,percent of total billed charges,41.7% of $756.00 in Billed Charges for Rev 510 Proc 11045 = $315.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DBRD SKN & SUBQ TISS EA ADDL 20 SQ CM,11045,CPT,510,RC,51000010,CDM,,,,both,,,756.0000,113.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,350.78,,,,,,,28.9300,1478.0400,percent of total billed charges,46.4% of $756.00 in Billed Charges for Rev 510 Proc 11045 = $350.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DBRD SKN & SUBQ TISS EA ADDL 20 SQ CM,11045,CPT,510,RC,51000010,CDM,,,,both,,,756.0000,113.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,315.25,,,,,,,28.9300,1478.0400,percent of total billed charges,41.7% of $756.00 in Billed Charges for Rev 510 Proc 11045 = $315.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DBRD SKN & SUBQ TISS EA ADDL 20 SQ CM,11045,CPT,510,RC,51000010,CDM,,,,both,,,756.0000,113.4000,CIGNA HEALTHCARE,CIGNA PPO,315.25,,,,,,,28.9300,1478.0400,percent of total billed charges,41.7% of $756.00 in Billed Charges for Rev 510 Proc 11045 = $315.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DBRD SKN & SUBQ TISS EA ADDL 20 SQ CM,11045,CPT,510,RC,51000010,CDM,,,,both,,,756.0000,113.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,680.40,,,,,,,28.9300,1478.0400,percent of total billed charges,90% of $756.00 in Billed Charges for Rev 510 Proc 11045 = $680.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DBRD SKN & SUBQ TISS EA ADDL 20 SQ CM,11045,CPT,510,RC,51000010,CDM,,,,both,,,756.0000,113.4000,MEDCOST,MEDCOST VHN,359.78,,,,,,,28.9300,1478.0400,percent of total billed charges,47.59% of $756.00 in Billed Charges for Rev 510 Proc 11045 = $359.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DBRD SKN & SUBQ TISS EA ADDL 20 SQ CM,11045,CPT,510,RC,51000010,CDM,,,,both,,,756.0000,113.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1478.04,,,,,,,28.9300,1478.0400,fee schedule,"APG 00018 Proc 11045 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 100% = $1,407.66... $1,407.66 at 105% = $1,478.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DBRD SKN & SUBQ TISS EA ADDL 20 SQ CM,11045,CPT,510,RC,51000010,CDM,,,,both,,,756.0000,113.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1451.30,,,,,,,28.9300,1478.0400,fee schedule,"APG 00018 Proc 11045 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 100% = $1,407.66... $1,407.66 at 103.1% = $1,451.30 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DBRD SKN & SUBQ TISS EA ADDL 20 SQ CM,11045,CPT,510,RC,51000010,CDM,,,,both,,,756.0000,113.4000,SENTARA HEALTH,SENTARA HEALTH,195.12,,,,,,,28.9300,1478.0400,percent of total billed charges,25.81% of $756.00 in Billed Charges for Rev 510 Proc 11045 = $195.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DBRD SKN & SUBQ TISS EA ADDL 20 SQ CM,11045,CPT,510,RC,51000010,CDM,,,,both,,,756.0000,113.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",756.00,,,,,,,28.9300,1478.0400,percent of total billed charges,100% of $756.00 in Billed Charges for Rev 510 Proc 11045 = $756.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DBRD SKN & SUBQ TISS EA ADDL 20 SQ CM,11045,CPT,510,RC,51000010,CDM,,,,both,,,756.0000,113.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,244.19,,,,,,,28.9300,1478.0400,other,32.3% of $756.00 in Billed Charges for Rev 510 Proc 11045 = $244.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DBRD SKN & SUBQ TISS EA ADDL 20 SQ CM,11045,CPT,510,RC,51000010,CDM,,,,both,,,756.0000,113.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,232.09,,,,,,,28.9300,1478.0400,other,30.7% of $756.00 in Billed Charges for Rev 510 Proc 11045 = $232.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DBRD SKN & SUBQ TISS EA ADDL 20 SQ CM,11045,CPT,510,RC,51000010,CDM,,,,both,,,756.0000,113.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,244.19,,,,,,,28.9300,1478.0400,percent of total billed charges,32.3% of $756.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DBRD SKN & SUBQ TISS EA ADDL 20 SQ CM,11045,CPT,510,RC,51000010,CDM,,,,both,,,756.0000,113.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1449.89,,,,,,,28.9300,1478.0400,fee schedule,"APG 00018 Proc 11045 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment) at 103% = $1,449.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DBRD SKN & SUBQ TISS EA ADDL 20 SQ CM,11045,CPT,510,RC,51000010,CDM,,,,both,,,756.0000,113.4000,WELLCARE,WELLCARE MEDICAID,756.00,,,,,,,28.9300,1478.0400,percent of total billed charges,100% of $756.00 in Billed Charges for Rev 510 Proc 11045 = $756.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,AETNA,AETNA,166.53,,,,,,,31.5400,396.8300,percent of total billed charges,42.7% of $390.00 in Billed Charges for Rev 510 Proc 11057 = $166.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,31.5400,396.8300,fee schedule,"APG 00003 Proc 11057 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,31.5400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,31.5400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,31.5400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,AMBETTER,AMBETTER,396.83,,,,,,,31.5400,396.8300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,31.5400,396.8300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,BLUE CROSS,ANTHEM EXCHANGE,390.00,,,,,,,31.5400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,31.5400,396.8300,fee schedule,"APG 00003 Proc 11057 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,BLUE CROSS,ANTHEM HMO,390.00,,,,,,,31.5400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,31.5400,396.8300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",390.00,,,,,,,31.5400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,31.54,,,,,,,31.5400,396.8300,fee schedule,$31.54 from Fee Schedule BLDTM_23 for Rev 510 Proc 11057 * Qty 1 = $31.54 at 100% = $31.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,31.5400,396.8300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,CIGNA HEALTHCARE,CIGNA HMO,162.63,,,,,,,31.5400,396.8300,percent of total billed charges,41.7% of $390.00 in Billed Charges for Rev 510 Proc 11057 = $162.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,180.96,,,,,,,31.5400,396.8300,percent of total billed charges,46.4% of $390.00 in Billed Charges for Rev 510 Proc 11057 = $180.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,31.5400,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,162.63,,,,,,,31.5400,396.8300,percent of total billed charges,41.7% of $390.00 in Billed Charges for Rev 510 Proc 11057 = $162.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,CIGNA HEALTHCARE,CIGNA PPO,162.63,,,,,,,31.5400,396.8300,percent of total billed charges,41.7% of $390.00 in Billed Charges for Rev 510 Proc 11057 = $162.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,31.5400,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,351.00,,,,,,,31.5400,396.8300,percent of total billed charges,90% of $390.00 in Billed Charges for Rev 510 Proc 11057 = $351.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,HUMANA,HUMANA MEDICARE,182.03,,,,,,,31.5400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,31.5400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,MEDCOST,MEDCOST VHN,185.60,,,,,,,31.5400,396.8300,percent of total billed charges,47.59% of $390.00 in Billed Charges for Rev 510 Proc 11057 = $185.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,31.5400,396.8300,fee schedule,"APG 00003 Proc 11057 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,31.5400,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,31.5400,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,31.5400,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,31.5400,396.8300,fee schedule,"APG 00003 Proc 11057 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,SENTARA HEALTH,SENTARA HEALTH,100.66,,,,,,,31.5400,396.8300,percent of total billed charges,25.81% of $390.00 in Billed Charges for Rev 510 Proc 11057 = $100.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,31.5400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",390.00,,,,,,,31.5400,396.8300,percent of total billed charges,100% of $390.00 in Billed Charges for Rev 510 Proc 11057 = $390.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,31.5400,396.8300,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 510 Proc 11057 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,125.97,,,,,,,31.5400,396.8300,other,32.3% of $390.00 in Billed Charges for Rev 510 Proc 11057 = $125.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,119.73,,,,,,,31.5400,396.8300,other,30.7% of $390.00 in Billed Charges for Rev 510 Proc 11057 = $119.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,125.97,,,,,,,31.5400,396.8300,percent of total billed charges,32.3% of $390.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,31.5400,396.8300,fee schedule,"APG 00003 Proc 11057 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,31.5400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,31.5400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,WELLCARE,WELLCARE MEDICAID,390.00,,,,,,,31.5400,396.8300,percent of total billed charges,100% of $390.00 in Billed Charges for Rev 510 Proc 11057 = $390.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BENIGN LESION PARING CALLUS/CORN 4 OR MORE,11057,CPT,510,RC,51000062,CDM,,,,both,,,390.0000,58.5000,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,31.5400,396.8300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA,111.45,,,,,,,67.3600,804.0300,percent of total billed charges,42.7% of $261.00 in Billed Charges for Rev 510 Proc 11102 = $111.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,67.3600,804.0300,fee schedule,"APG 00009 Proc 11102 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,261.00,,,,,,,67.3600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA HEALTHCARE MEDICARE,261.00,,,,,,,67.3600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,261.00,,,,,,,67.3600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,AMBETTER,AMBETTER,804.03,,,,,,,67.3600,804.0300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,261.00,,,,,,,67.3600,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM EXCHANGE,261.00,,,,,,,67.3600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,261.00,,,,,,,67.3600,804.0300,fee schedule,"APG 00009 Proc 11102 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89 (Service Line reduced to $261.00, claim capped at $261.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM HMO,261.00,,,,,,,67.3600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,261.00,,,,,,,67.3600,804.0300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",261.00,,,,,,,67.3600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,182.70,,,,,,,67.3600,804.0300,percent of total billed charges,Rev 510 Proc 11102 $261.00 in Billed Charges at 70% = $182.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,67.3600,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA HMO,108.84,,,,,,,67.3600,804.0300,percent of total billed charges,41.7% of $261.00 in Billed Charges for Rev 510 Proc 11102 = $108.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,121.10,,,,,,,67.3600,804.0300,percent of total billed charges,46.4% of $261.00 in Billed Charges for Rev 510 Proc 11102 = $121.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,261.00,,,,,,,67.3600,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,108.84,,,,,,,67.3600,804.0300,percent of total billed charges,41.7% of $261.00 in Billed Charges for Rev 510 Proc 11102 = $108.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA PPO,108.84,,,,,,,67.3600,804.0300,percent of total billed charges,41.7% of $261.00 in Billed Charges for Rev 510 Proc 11102 = $108.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,261.00,,,,,,,67.3600,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,234.90,,,,,,,67.3600,804.0300,percent of total billed charges,90% of $261.00 in Billed Charges for Rev 510 Proc 11102 = $234.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,HUMANA,HUMANA MEDICARE,261.00,,,,,,,67.3600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,261.00,,,,,,,67.3600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,MEDCOST,MEDCOST VHN,124.21,,,,,,,67.3600,804.0300,percent of total billed charges,47.59% of $261.00 in Billed Charges for Rev 510 Proc 11102 = $124.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,67.3600,804.0300,fee schedule,"APG 00009 Proc 11102 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,261.00,,,,,,,67.3600,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,261.00,,,,,,,67.3600,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,NHC ADVANTAGE,NHC ADVANTAGE,261.00,,,,,,,67.3600,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,67.3600,804.0300,fee schedule,"APG 00009 Proc 11102 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,SENTARA HEALTH,SENTARA HEALTH,67.36,,,,,,,67.3600,804.0300,percent of total billed charges,25.81% of $261.00 in Billed Charges for Rev 510 Proc 11102 = $67.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,SENTARA HEALTH,SENTARA MEDICARE,261.00,,,,,,,67.3600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",261.00,,,,,,,67.3600,804.0300,percent of total billed charges,100% of $261.00 in Billed Charges for Rev 510 Proc 11102 = $261.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,88.23,,,,,,,67.3600,804.0300,fee schedule,$176.45 from Fee Schedule TCUHC24 for Rev 510 Proc 11102 * Qty 1 = $176.45 at 50% = $88.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,84.30,,,,,,,67.3600,804.0300,other,32.3% of $261.00 in Billed Charges for Rev 510 Proc 11102 = $84.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,80.13,,,,,,,67.3600,804.0300,other,30.7% of $261.00 in Billed Charges for Rev 510 Proc 11102 = $80.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,84.30,,,,,,,67.3600,804.0300,percent of total billed charges,32.3% of $261.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,67.3600,804.0300,fee schedule,"APG 00009 Proc 11102 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,261.00,,,,,,,67.3600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,261.00,,,,,,,67.3600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,WELLCARE,WELLCARE MEDICAID,261.00,,,,,,,67.3600,804.0300,percent of total billed charges,100% of $261.00 in Billed Charges for Rev 510 Proc 11102 = $261.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TANGENTIAL BX SKIN SNGL LESION,11102,CPT,510,RC,51000227,CDM,,,,both,,,261.0000,39.1500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,67.3600,804.0300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE T-TUBE SILICONE ELASTROMERIC 10FR,272,RC,27200002,CDM,,,,,,both,,,4025.1900,603.7800,AETNA,AETNA,1718.76,,,,,,,1038.9000,4025.1900,percent of total billed charges,"42.7% of $4,025.19 in Billed Charges for Rev 272 = $1,718.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE T-TUBE SILICONE ELASTROMERIC 10FR,272,RC,27200002,CDM,,,,,,both,,,4025.1900,603.7800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2817.63,,,,,,,1038.9000,4025.1900,percent of total billed charges,"Rev 272 $4,025.19 in Billed Charges at 70% = $2,817.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE T-TUBE SILICONE ELASTROMERIC 10FR,272,RC,27200002,CDM,,,,,,both,,,4025.1900,603.7800,CIGNA HEALTHCARE,CIGNA HMO,1678.50,,,,,,,1038.9000,4025.1900,percent of total billed charges,"41.7% of $4,025.19 in Billed Charges for Rev 272 = $1,678.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE T-TUBE SILICONE ELASTROMERIC 10FR,272,RC,27200002,CDM,,,,,,both,,,4025.1900,603.7800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1867.69,,,,,,,1038.9000,4025.1900,percent of total billed charges,"46.4% of $4,025.19 in Billed Charges for Rev 272 = $1,867.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE T-TUBE SILICONE ELASTROMERIC 10FR,272,RC,27200002,CDM,,,,,,both,,,4025.1900,603.7800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1678.50,,,,,,,1038.9000,4025.1900,percent of total billed charges,"41.7% of $4,025.19 in Billed Charges for Rev 272 = $1,678.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE T-TUBE SILICONE ELASTROMERIC 10FR,272,RC,27200002,CDM,,,,,,both,,,4025.1900,603.7800,CIGNA HEALTHCARE,CIGNA PPO,1678.50,,,,,,,1038.9000,4025.1900,percent of total billed charges,"41.7% of $4,025.19 in Billed Charges for Rev 272 = $1,678.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE T-TUBE SILICONE ELASTROMERIC 10FR,272,RC,27200002,CDM,,,,,,both,,,4025.1900,603.7800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3622.67,,,,,,,1038.9000,4025.1900,percent of total billed charges,"90% of $4,025.19 in Billed Charges for Rev 272 = $3,622.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE T-TUBE SILICONE ELASTROMERIC 10FR,272,RC,27200002,CDM,,,,,,both,,,4025.1900,603.7800,MEDCOST,MEDCOST VHN,1915.59,,,,,,,1038.9000,4025.1900,percent of total billed charges,"47.59% of $4,025.19 in Billed Charges for Rev 272 = $1,915.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE T-TUBE SILICONE ELASTROMERIC 10FR,272,RC,27200002,CDM,,,,,,both,,,4025.1900,603.7800,SENTARA HEALTH,SENTARA HEALTH,1038.90,,,,,,,1038.9000,4025.1900,percent of total billed charges,"25.81% of $4,025.19 in Billed Charges for Rev 272 = $1,038.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE T-TUBE SILICONE ELASTROMERIC 10FR,272,RC,27200002,CDM,,,,,,both,,,4025.1900,603.7800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4025.19,,,,,,,1038.9000,4025.1900,percent of total billed charges,"100% of $4,025.19 in Billed Charges for Rev 272 = $4,025.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE T-TUBE SILICONE ELASTROMERIC 10FR,272,RC,27200002,CDM,,,,,,both,,,4025.1900,603.7800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2012.60,,,,,,,1038.9000,4025.1900,percent of total billed charges,"Rev 272 $4,025.19 in Billed Charges at 50% = $2,012.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE T-TUBE SILICONE ELASTROMERIC 10FR,272,RC,27200002,CDM,,,,,,both,,,4025.1900,603.7800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1300.14,,,,,,,1038.9000,4025.1900,other,"32.3% of $4,025.19 in Billed Charges for Rev 272 = $1,300.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE T-TUBE SILICONE ELASTROMERIC 10FR,272,RC,27200002,CDM,,,,,,both,,,4025.1900,603.7800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1235.73,,,,,,,1038.9000,4025.1900,other,"30.7% of $4,025.19 in Billed Charges for Rev 272 = $1,235.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE T-TUBE SILICONE ELASTROMERIC 10FR,272,RC,27200002,CDM,,,,,,both,,,4025.1900,603.7800,UNITED HEALTHCARE,UNITED HEALTHCARE,1300.14,,,,,,,1038.9000,4025.1900,percent of total billed charges,"32.3% of $4,025.19 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE T-TUBE SILICONE ELASTROMERIC 10FR,272,RC,27200002,CDM,,,,,,both,,,4025.1900,603.7800,WELLCARE,WELLCARE MEDICAID,4025.19,,,,,,,1038.9000,4025.1900,percent of total billed charges,"100% of $4,025.19 in Billed Charges for Rev 272 = $4,025.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,AETNA,AETNA,737.00,,,,,,,109.0000,1726.0000,percent of total billed charges,"42.7% of $1,726.00 in Billed Charges for Rev 450 Proc 15004 = $737.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1463.97,,,,,,,109.0000,1726.0000,fee schedule,"APG 00018 Proc 15004 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,407.66 at 104% = $1,463.97. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,109.0000,1726.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,1726.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,109.0000,1726.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,AMBETTER,AMBETTER,804.03,,,,,,,109.0000,1726.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,109.0000,1726.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,109.0000,1726.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1449.89,,,,,,,109.0000,1726.0000,fee schedule,"APG 00018 Proc 15004 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,407.66 at 103% = $1,449.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,109.0000,1726.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,109.0000,1726.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1134.94,,,,,,,109.0000,1726.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,329.99,,,,,,,109.0000,1726.0000,fee schedule,$329.99 from Fee Schedule BLDTM_23 for Rev 450 Proc 15004 * Qty 1 = $329.99 at 100% = $329.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,109.0000,1726.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,109.0000,1726.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,109.0000,1726.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1553.40,,,,,,,109.0000,1726.0000,percent of total billed charges,"90% of $1,726.00 in Billed Charges for Rev 450 Proc 15004 = $1,553.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,HUMANA,HUMANA MEDICARE,368.82,,,,,,,109.0000,1726.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,109.0000,1726.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,MEDCOST,MEDCOST VHN,821.40,,,,,,,109.0000,1726.0000,percent of total billed charges,"47.59% of $1,726.00 in Billed Charges for Rev 450 Proc 15004 = $821.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1478.04,,,,,,,109.0000,1726.0000,fee schedule,"APG 00018 Proc 15004 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,407.66 at 100% = $1,407.66... $1,407.66 at 105% = $1,478.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,109.0000,1726.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,109.0000,1726.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,109.0000,1726.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1451.30,,,,,,,109.0000,1726.0000,fee schedule,"APG 00018 Proc 15004 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,407.66 at 100% = $1,407.66... $1,407.66 at 103.1% = $1,451.30 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,SENTARA HEALTH,SENTARA HEALTH,445.48,,,,,,,109.0000,1726.0000,percent of total billed charges,"25.81% of $1,726.00 in Billed Charges for Rev 450 Proc 15004 = $445.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,109.0000,1726.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1726.00,,,,,,,109.0000,1726.0000,percent of total billed charges,"100% of $1,726.00 in Billed Charges for Rev 450 Proc 15004 = $1,726.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1726.0000,case rate,Rev 450 Proc 15004 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1726.0000,case rate,Rev 450 Proc 15004 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1726.0000,case rate,Rev 450 Proc 15004 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1726.0000,case rate,Rev 450 Proc 15004 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1449.89,,,,,,,109.0000,1726.0000,fee schedule,"APG 00018 Proc 15004 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,407.66 at 103% = $1,449.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,1726.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,109.0000,1726.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,WELLCARE,WELLCARE MEDICAID,1726.00,,,,,,,109.0000,1726.0000,percent of total billed charges,"100% of $1,726.00 in Billed Charges for Rev 450 Proc 15004 = $1,726.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ED SITE PREP - 100 SQCM,15004,CPT,450,RC,45000012,CDM,,,,both,,,1726.0000,258.9000,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,109.0000,1726.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREP SITE F/S/N/H/F/G/M/D GT EA ADDL 100 SQ CM/1% BODY AREA,15005,CPT,510,RC,51000190,CDM,,,,both,,,563.0000,84.4500,AETNA,AETNA,240.40,,,,,,,102.4900,566.2300,percent of total billed charges,42.7% of $563.00 in Billed Charges for Rev 510 Proc 15005 = $240.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREP SITE F/S/N/H/F/G/M/D GT EA ADDL 100 SQ CM/1% BODY AREA,15005,CPT,510,RC,51000190,CDM,,,,both,,,563.0000,84.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,102.4900,566.2300,fee schedule,APG 00017 Proc 15005 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment) at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREP SITE F/S/N/H/F/G/M/D GT EA ADDL 100 SQ CM/1% BODY AREA,15005,CPT,510,RC,51000190,CDM,,,,both,,,563.0000,84.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,102.4900,566.2300,fee schedule,APG 00017 Proc 15005 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment) at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREP SITE F/S/N/H/F/G/M/D GT EA ADDL 100 SQ CM/1% BODY AREA,15005,CPT,510,RC,51000190,CDM,,,,both,,,563.0000,84.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,102.49,,,,,,,102.4900,566.2300,fee schedule,$102.49 from Fee Schedule BLDTM_23 for Rev 510 Proc 15005 * Qty 1 = $102.49 at 100% = $102.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREP SITE F/S/N/H/F/G/M/D GT EA ADDL 100 SQ CM/1% BODY AREA,15005,CPT,510,RC,51000190,CDM,,,,both,,,563.0000,84.4500,CIGNA HEALTHCARE,CIGNA HMO,234.77,,,,,,,102.4900,566.2300,percent of total billed charges,41.7% of $563.00 in Billed Charges for Rev 510 Proc 15005 = $234.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREP SITE F/S/N/H/F/G/M/D GT EA ADDL 100 SQ CM/1% BODY AREA,15005,CPT,510,RC,51000190,CDM,,,,both,,,563.0000,84.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,261.23,,,,,,,102.4900,566.2300,percent of total billed charges,46.4% of $563.00 in Billed Charges for Rev 510 Proc 15005 = $261.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREP SITE F/S/N/H/F/G/M/D GT EA ADDL 100 SQ CM/1% BODY AREA,15005,CPT,510,RC,51000190,CDM,,,,both,,,563.0000,84.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,234.77,,,,,,,102.4900,566.2300,percent of total billed charges,41.7% of $563.00 in Billed Charges for Rev 510 Proc 15005 = $234.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREP SITE F/S/N/H/F/G/M/D GT EA ADDL 100 SQ CM/1% BODY AREA,15005,CPT,510,RC,51000190,CDM,,,,both,,,563.0000,84.4500,CIGNA HEALTHCARE,CIGNA PPO,234.77,,,,,,,102.4900,566.2300,percent of total billed charges,41.7% of $563.00 in Billed Charges for Rev 510 Proc 15005 = $234.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREP SITE F/S/N/H/F/G/M/D GT EA ADDL 100 SQ CM/1% BODY AREA,15005,CPT,510,RC,51000190,CDM,,,,both,,,563.0000,84.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,506.70,,,,,,,102.4900,566.2300,percent of total billed charges,90% of $563.00 in Billed Charges for Rev 510 Proc 15005 = $506.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREP SITE F/S/N/H/F/G/M/D GT EA ADDL 100 SQ CM/1% BODY AREA,15005,CPT,510,RC,51000190,CDM,,,,both,,,563.0000,84.4500,MEDCOST,MEDCOST VHN,267.93,,,,,,,102.4900,566.2300,percent of total billed charges,47.59% of $563.00 in Billed Charges for Rev 510 Proc 15005 = $267.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREP SITE F/S/N/H/F/G/M/D GT EA ADDL 100 SQ CM/1% BODY AREA,15005,CPT,510,RC,51000190,CDM,,,,both,,,563.0000,84.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,102.4900,566.2300,fee schedule,APG 00017 Proc 15005 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment) at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREP SITE F/S/N/H/F/G/M/D GT EA ADDL 100 SQ CM/1% BODY AREA,15005,CPT,510,RC,51000190,CDM,,,,both,,,563.0000,84.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,102.4900,566.2300,fee schedule,APG 00017 Proc 15005 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment) at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREP SITE F/S/N/H/F/G/M/D GT EA ADDL 100 SQ CM/1% BODY AREA,15005,CPT,510,RC,51000190,CDM,,,,both,,,563.0000,84.4500,SENTARA HEALTH,SENTARA HEALTH,145.31,,,,,,,102.4900,566.2300,percent of total billed charges,25.81% of $563.00 in Billed Charges for Rev 510 Proc 15005 = $145.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREP SITE F/S/N/H/F/G/M/D GT EA ADDL 100 SQ CM/1% BODY AREA,15005,CPT,510,RC,51000190,CDM,,,,both,,,563.0000,84.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",563.00,,,,,,,102.4900,566.2300,percent of total billed charges,100% of $563.00 in Billed Charges for Rev 510 Proc 15005 = $563.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREP SITE F/S/N/H/F/G/M/D GT EA ADDL 100 SQ CM/1% BODY AREA,15005,CPT,510,RC,51000190,CDM,,,,both,,,563.0000,84.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,181.85,,,,,,,102.4900,566.2300,other,32.3% of $563.00 in Billed Charges for Rev 510 Proc 15005 = $181.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREP SITE F/S/N/H/F/G/M/D GT EA ADDL 100 SQ CM/1% BODY AREA,15005,CPT,510,RC,51000190,CDM,,,,both,,,563.0000,84.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,172.84,,,,,,,102.4900,566.2300,other,30.7% of $563.00 in Billed Charges for Rev 510 Proc 15005 = $172.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREP SITE F/S/N/H/F/G/M/D GT EA ADDL 100 SQ CM/1% BODY AREA,15005,CPT,510,RC,51000190,CDM,,,,both,,,563.0000,84.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,181.85,,,,,,,102.4900,566.2300,percent of total billed charges,32.3% of $563.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREP SITE F/S/N/H/F/G/M/D GT EA ADDL 100 SQ CM/1% BODY AREA,15005,CPT,510,RC,51000190,CDM,,,,both,,,563.0000,84.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,102.4900,566.2300,fee schedule,APG 00017 Proc 15005 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment) at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREP SITE F/S/N/H/F/G/M/D GT EA ADDL 100 SQ CM/1% BODY AREA,15005,CPT,510,RC,51000190,CDM,,,,both,,,563.0000,84.4500,WELLCARE,WELLCARE MEDICAID,563.00,,,,,,,102.4900,566.2300,percent of total billed charges,100% of $563.00 in Billed Charges for Rev 510 Proc 15005 = $563.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,AETNA,AETNA,2015.87,,,,,,,215.0600,4721.0000,percent of total billed charges,"42.7% of $4,721.00 in Billed Charges for Rev 510 Proc 15110 = $2,015.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2774.03,,,,,,,215.0600,4721.0000,fee schedule,"APG 00056 Proc 15110 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 104% = $2,774.03. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1871.96,,,,,,,215.0600,4721.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,AETNA,AETNA HEALTHCARE MEDICARE,1871.96,,,,,,,215.0600,4721.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,1871.96,,,,,,,215.0600,4721.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,AMBETTER,AMBETTER,4080.88,,,,,,,215.0600,4721.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1946.84,,,,,,,215.0600,4721.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,BLUE CROSS,ANTHEM EXCHANGE,4608.86,,,,,,,215.0600,4721.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2747.35,,,,,,,215.0600,4721.0000,fee schedule,"APG 00056 Proc 15110 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 103% = $2,747.35. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,BLUE CROSS,ANTHEM HMO,4721.00,,,,,,,215.0600,4721.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1928.12,,,,,,,215.0600,4721.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4721.00,,,,,,,215.0600,4721.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,747.79,,,,,,,215.0600,4721.0000,fee schedule,$747.79 from Fee Schedule BLDTM_23 for Rev 510 Proc 15110 * Qty 1 = $747.79 at 100% = $747.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,BLUE CROSS,BLUE CROSS MEDICARE,1946.84,,,,,,,215.0600,4721.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,CIGNA HEALTHCARE,CIGNA HMO,1968.66,,,,,,,215.0600,4721.0000,percent of total billed charges,"41.7% of $4,721.00 in Billed Charges for Rev 510 Proc 15110 = $1,968.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2190.54,,,,,,,215.0600,4721.0000,percent of total billed charges,"46.4% of $4,721.00 in Billed Charges for Rev 510 Proc 15110 = $2,190.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,1965.56,,,,,,,215.0600,4721.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1968.66,,,,,,,215.0600,4721.0000,percent of total billed charges,"41.7% of $4,721.00 in Billed Charges for Rev 510 Proc 15110 = $1,968.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,CIGNA HEALTHCARE,CIGNA PPO,1968.66,,,,,,,215.0600,4721.0000,percent of total billed charges,"41.7% of $4,721.00 in Billed Charges for Rev 510 Proc 15110 = $1,968.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1965.56,,,,,,,215.0600,4721.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4248.90,,,,,,,215.0600,4721.0000,percent of total billed charges,"90% of $4,721.00 in Billed Charges for Rev 510 Proc 15110 = $4,248.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,HUMANA,HUMANA MEDICARE,1871.96,,,,,,,215.0600,4721.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1871.96,,,,,,,215.0600,4721.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,MEDCOST,MEDCOST VHN,2246.72,,,,,,,215.0600,4721.0000,percent of total billed charges,"47.59% of $4,721.00 in Billed Charges for Rev 510 Proc 15110 = $2,246.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2800.70,,,,,,,215.0600,4721.0000,fee schedule,"APG 00056 Proc 15110 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 100% = $2,667.33... $2,667.33 at 105% = $2,800.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1965.56,,,,,,,215.0600,4721.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1965.56,,,,,,,215.0600,4721.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,NHC ADVANTAGE,NHC ADVANTAGE,1965.56,,,,,,,215.0600,4721.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2750.02,,,,,,,215.0600,4721.0000,fee schedule,"APG 00056 Proc 15110 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 100% = $2,667.33... $2,667.33 at 103.1% = $2,750.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,SENTARA HEALTH,SENTARA HEALTH,1218.49,,,,,,,215.0600,4721.0000,percent of total billed charges,"25.81% of $4,721.00 in Billed Charges for Rev 510 Proc 15110 = $1,218.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,SENTARA HEALTH,SENTARA MEDICARE,1871.96,,,,,,,215.0600,4721.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4721.00,,,,,,,215.0600,4721.0000,percent of total billed charges,"100% of $4,721.00 in Billed Charges for Rev 510 Proc 15110 = $4,721.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,215.06,,,,,,,215.0600,4721.0000,fee schedule,$430.12 from Fee Schedule TCUHC24 for Rev 510 Proc 15110 * Qty 1 = $430.12 at 50% = $215.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1524.88,,,,,,,215.0600,4721.0000,other,"32.3% of $4,721.00 in Billed Charges for Rev 510 Proc 15110 = $1,524.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1449.35,,,,,,,215.0600,4721.0000,other,"30.7% of $4,721.00 in Billed Charges for Rev 510 Proc 15110 = $1,449.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,1524.88,,,,,,,215.0600,4721.0000,percent of total billed charges,"32.3% of $4,721.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2747.35,,,,,,,215.0600,4721.0000,fee schedule,"APG 00056 Proc 15110 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 103% = $2,747.35. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1871.96,,,,,,,215.0600,4721.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1871.96,,,,,,,215.0600,4721.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,WELLCARE,WELLCARE MEDICAID,4721.00,,,,,,,215.0600,4721.0000,percent of total billed charges,"100% of $4,721.00 in Billed Charges for Rev 510 Proc 15110 = $4,721.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT TRUNK/ARMS/LEGS 1ST 100 SQ CM,15110,CPT,510,RC,51000092,CDM,,,,both,,,4721.0000,708.1500,WELLCARE,WELLCARE MEDICARE,1984.28,,,,,,,215.0600,4721.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,AETNA,AETNA,2015.87,,,,,,,703.7100,4721.0000,percent of total billed charges,"42.7% of $4,721.00 in Billed Charges for Rev 510 Proc 15115 = $2,015.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2774.03,,,,,,,703.7100,4721.0000,fee schedule,"APG 00056 Proc 15115 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 104% = $2,774.03. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1871.96,,,,,,,703.7100,4721.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,AETNA,AETNA HEALTHCARE MEDICARE,1871.96,,,,,,,703.7100,4721.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,1871.96,,,,,,,703.7100,4721.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,AMBETTER,AMBETTER,4080.88,,,,,,,703.7100,4721.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1946.84,,,,,,,703.7100,4721.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,BLUE CROSS,ANTHEM EXCHANGE,4608.86,,,,,,,703.7100,4721.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2747.35,,,,,,,703.7100,4721.0000,fee schedule,"APG 00056 Proc 15115 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 103% = $2,747.35. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,BLUE CROSS,ANTHEM HMO,4721.00,,,,,,,703.7100,4721.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1928.12,,,,,,,703.7100,4721.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4721.00,,,,,,,703.7100,4721.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,707.41,,,,,,,703.7100,4721.0000,fee schedule,$707.41 from Fee Schedule BLDTM_23 for Rev 510 Proc 15115 * Qty 1 = $707.41 at 100% = $707.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,BLUE CROSS,BLUE CROSS MEDICARE,1946.84,,,,,,,703.7100,4721.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,CIGNA HEALTHCARE,CIGNA HMO,1968.66,,,,,,,703.7100,4721.0000,percent of total billed charges,"41.7% of $4,721.00 in Billed Charges for Rev 510 Proc 15115 = $1,968.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2190.54,,,,,,,703.7100,4721.0000,percent of total billed charges,"46.4% of $4,721.00 in Billed Charges for Rev 510 Proc 15115 = $2,190.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,1965.56,,,,,,,703.7100,4721.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1968.66,,,,,,,703.7100,4721.0000,percent of total billed charges,"41.7% of $4,721.00 in Billed Charges for Rev 510 Proc 15115 = $1,968.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,CIGNA HEALTHCARE,CIGNA PPO,1968.66,,,,,,,703.7100,4721.0000,percent of total billed charges,"41.7% of $4,721.00 in Billed Charges for Rev 510 Proc 15115 = $1,968.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1965.56,,,,,,,703.7100,4721.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4248.90,,,,,,,703.7100,4721.0000,percent of total billed charges,"90% of $4,721.00 in Billed Charges for Rev 510 Proc 15115 = $4,248.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,HUMANA,HUMANA MEDICARE,1871.96,,,,,,,703.7100,4721.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1871.96,,,,,,,703.7100,4721.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,MEDCOST,MEDCOST VHN,2246.72,,,,,,,703.7100,4721.0000,percent of total billed charges,"47.59% of $4,721.00 in Billed Charges for Rev 510 Proc 15115 = $2,246.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2800.70,,,,,,,703.7100,4721.0000,fee schedule,"APG 00056 Proc 15115 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 100% = $2,667.33... $2,667.33 at 105% = $2,800.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1965.56,,,,,,,703.7100,4721.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1965.56,,,,,,,703.7100,4721.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,NHC ADVANTAGE,NHC ADVANTAGE,1965.56,,,,,,,703.7100,4721.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2750.02,,,,,,,703.7100,4721.0000,fee schedule,"APG 00056 Proc 15115 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 100% = $2,667.33... $2,667.33 at 103.1% = $2,750.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,SENTARA HEALTH,SENTARA HEALTH,1218.49,,,,,,,703.7100,4721.0000,percent of total billed charges,"25.81% of $4,721.00 in Billed Charges for Rev 510 Proc 15115 = $1,218.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,SENTARA HEALTH,SENTARA MEDICARE,1871.96,,,,,,,703.7100,4721.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4721.00,,,,,,,703.7100,4721.0000,percent of total billed charges,"100% of $4,721.00 in Billed Charges for Rev 510 Proc 15115 = $4,721.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,703.71,,,,,,,703.7100,4721.0000,fee schedule,"$1,407.42 from Fee Schedule TCUHC24 for Rev 510 Proc 15115 * Qty 1 = $1,407.42 at 50% = $703.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1524.88,,,,,,,703.7100,4721.0000,other,"32.3% of $4,721.00 in Billed Charges for Rev 510 Proc 15115 = $1,524.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1449.35,,,,,,,703.7100,4721.0000,other,"30.7% of $4,721.00 in Billed Charges for Rev 510 Proc 15115 = $1,449.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,1524.88,,,,,,,703.7100,4721.0000,percent of total billed charges,"32.3% of $4,721.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2747.35,,,,,,,703.7100,4721.0000,fee schedule,"APG 00056 Proc 15115 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 103% = $2,747.35. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1871.96,,,,,,,703.7100,4721.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1871.96,,,,,,,703.7100,4721.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,WELLCARE,WELLCARE MEDICAID,4721.00,,,,,,,703.7100,4721.0000,percent of total billed charges,"100% of $4,721.00 in Billed Charges for Rev 510 Proc 15115 = $4,721.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EPIDERMAL AUTOGRAFT FACE/NECK/HF/G 1ST 100 SQ CM,15115,CPT,510,RC,51000094,CDM,,,,both,,,4721.0000,708.1500,WELLCARE,WELLCARE MEDICARE,1984.28,,,,,,,703.7100,4721.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,AETNA,AETNA,1063.23,,,,,,,642.6700,2800.7000,percent of total billed charges,"42.7% of $2,490.00 in Billed Charges for Rev 510 Proc 15271 = $1,063.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2774.03,,,,,,,642.6700,2800.7000,fee schedule,"APG 00056 Proc 15271 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 104% = $2,774.03. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,670.54,,,,,,,642.6700,2800.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,AETNA,AETNA HEALTHCARE MEDICARE,670.54,,,,,,,642.6700,2800.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,670.54,,,,,,,642.6700,2800.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,AMBETTER,AMBETTER,1461.78,,,,,,,642.6700,2800.7000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,697.36,,,,,,,642.6700,2800.7000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,BLUE CROSS,ANTHEM EXCHANGE,1650.91,,,,,,,642.6700,2800.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2490.00,,,,,,,642.6700,2800.7000,fee schedule,"APG 00056 Proc 15271 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 103% = $2,747.35 (Service Line reduced to $2,490.00, claim capped at $2,490.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,BLUE CROSS,ANTHEM HMO,1753.99,,,,,,,642.6700,2800.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,690.66,,,,,,,642.6700,2800.7000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2063.41,,,,,,,642.6700,2800.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1743.00,,,,,,,642.6700,2800.7000,percent of total billed charges,"Rev 510 Proc 15271 $2,490.00 in Billed Charges at 70% = $1,743.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,BLUE CROSS,BLUE CROSS MEDICARE,697.36,,,,,,,642.6700,2800.7000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,CIGNA HEALTHCARE,CIGNA HMO,1038.33,,,,,,,642.6700,2800.7000,percent of total billed charges,"41.7% of $2,490.00 in Billed Charges for Rev 510 Proc 15271 = $1,038.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1155.36,,,,,,,642.6700,2800.7000,percent of total billed charges,"46.4% of $2,490.00 in Billed Charges for Rev 510 Proc 15271 = $1,155.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,704.07,,,,,,,642.6700,2800.7000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1038.33,,,,,,,642.6700,2800.7000,percent of total billed charges,"41.7% of $2,490.00 in Billed Charges for Rev 510 Proc 15271 = $1,038.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,CIGNA HEALTHCARE,CIGNA PPO,1038.33,,,,,,,642.6700,2800.7000,percent of total billed charges,"41.7% of $2,490.00 in Billed Charges for Rev 510 Proc 15271 = $1,038.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,704.07,,,,,,,642.6700,2800.7000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2241.00,,,,,,,642.6700,2800.7000,percent of total billed charges,"90% of $2,490.00 in Billed Charges for Rev 510 Proc 15271 = $2,241.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,HUMANA,HUMANA MEDICARE,670.54,,,,,,,642.6700,2800.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,670.54,,,,,,,642.6700,2800.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,MEDCOST,MEDCOST VHN,1184.99,,,,,,,642.6700,2800.7000,percent of total billed charges,"47.59% of $2,490.00 in Billed Charges for Rev 510 Proc 15271 = $1,184.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2800.70,,,,,,,642.6700,2800.7000,fee schedule,"APG 00056 Proc 15271 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 100% = $2,667.33... $2,667.33 at 105% = $2,800.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,704.07,,,,,,,642.6700,2800.7000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,704.07,,,,,,,642.6700,2800.7000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,NHC ADVANTAGE,NHC ADVANTAGE,704.07,,,,,,,642.6700,2800.7000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2750.02,,,,,,,642.6700,2800.7000,fee schedule,"APG 00056 Proc 15271 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 100% = $2,667.33... $2,667.33 at 103.1% = $2,750.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,SENTARA HEALTH,SENTARA HEALTH,642.67,,,,,,,642.6700,2800.7000,percent of total billed charges,"25.81% of $2,490.00 in Billed Charges for Rev 510 Proc 15271 = $642.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,SENTARA HEALTH,SENTARA MEDICARE,670.54,,,,,,,642.6700,2800.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2490.00,,,,,,,642.6700,2800.7000,percent of total billed charges,"100% of $2,490.00 in Billed Charges for Rev 510 Proc 15271 = $2,490.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,703.71,,,,,,,642.6700,2800.7000,fee schedule,"$1,407.42 from Fee Schedule TCUHC24 for Rev 510 Proc 15271 * Qty 1 = $1,407.42 at 50% = $703.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,804.27,,,,,,,642.6700,2800.7000,other,"32.3% of $2,490.00 in Billed Charges for Rev 510 Proc 15271 = $804.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,764.43,,,,,,,642.6700,2800.7000,other,"30.7% of $2,490.00 in Billed Charges for Rev 510 Proc 15271 = $764.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,804.27,,,,,,,642.6700,2800.7000,percent of total billed charges,"32.3% of $2,490.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2747.35,,,,,,,642.6700,2800.7000,fee schedule,"APG 00056 Proc 15271 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 103% = $2,747.35. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,670.54,,,,,,,642.6700,2800.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,670.54,,,,,,,642.6700,2800.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,WELLCARE,WELLCARE MEDICAID,2490.00,,,,,,,642.6700,2800.7000,percent of total billed charges,"100% of $2,490.00 in Billed Charges for Rev 510 Proc 15271 = $2,490.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC SKIN SUB GRFT TRNK/ARM/LEG <25,15271,CPT,510,RC,51000020,CDM,,,,both,,,2490.0000,373.5000,WELLCARE,WELLCARE MEDICARE,710.77,,,,,,,642.6700,2800.7000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB TRNK/ARM/LEG EA ADD25,15272,CPT,510,RC,51000021,CDM,,,,both,,,175.0000,26.2500,AETNA,AETNA,74.73,,,,,,,45.1700,2800.7000,percent of total billed charges,42.7% of $175.00 in Billed Charges for Rev 510 Proc 15272 = $74.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC SKIN SUB TRNK/ARM/LEG EA ADD25,15272,CPT,510,RC,51000021,CDM,,,,both,,,175.0000,26.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2774.03,,,,,,,45.1700,2800.7000,fee schedule,"APG 00056 Proc 15272 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 104% = $2,774.03. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB TRNK/ARM/LEG EA ADD25,15272,CPT,510,RC,51000021,CDM,,,,both,,,175.0000,26.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,175.00,,,,,,,45.1700,2800.7000,fee schedule,"APG 00056 Proc 15272 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 103% = $2,747.35 (Service Line reduced to $175.00, claim capped at $175.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB TRNK/ARM/LEG EA ADD25,15272,CPT,510,RC,51000021,CDM,,,,both,,,175.0000,26.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,122.50,,,,,,,45.1700,2800.7000,percent of total billed charges,Rev 510 Proc 15272 $175.00 in Billed Charges at 70% = $122.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC SKIN SUB TRNK/ARM/LEG EA ADD25,15272,CPT,510,RC,51000021,CDM,,,,both,,,175.0000,26.2500,CIGNA HEALTHCARE,CIGNA HMO,72.98,,,,,,,45.1700,2800.7000,percent of total billed charges,41.7% of $175.00 in Billed Charges for Rev 510 Proc 15272 = $72.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC SKIN SUB TRNK/ARM/LEG EA ADD25,15272,CPT,510,RC,51000021,CDM,,,,both,,,175.0000,26.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,81.20,,,,,,,45.1700,2800.7000,percent of total billed charges,46.4% of $175.00 in Billed Charges for Rev 510 Proc 15272 = $81.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC SKIN SUB TRNK/ARM/LEG EA ADD25,15272,CPT,510,RC,51000021,CDM,,,,both,,,175.0000,26.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,72.98,,,,,,,45.1700,2800.7000,percent of total billed charges,41.7% of $175.00 in Billed Charges for Rev 510 Proc 15272 = $72.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC SKIN SUB TRNK/ARM/LEG EA ADD25,15272,CPT,510,RC,51000021,CDM,,,,both,,,175.0000,26.2500,CIGNA HEALTHCARE,CIGNA PPO,72.98,,,,,,,45.1700,2800.7000,percent of total billed charges,41.7% of $175.00 in Billed Charges for Rev 510 Proc 15272 = $72.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC SKIN SUB TRNK/ARM/LEG EA ADD25,15272,CPT,510,RC,51000021,CDM,,,,both,,,175.0000,26.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,157.50,,,,,,,45.1700,2800.7000,percent of total billed charges,90% of $175.00 in Billed Charges for Rev 510 Proc 15272 = $157.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC SKIN SUB TRNK/ARM/LEG EA ADD25,15272,CPT,510,RC,51000021,CDM,,,,both,,,175.0000,26.2500,MEDCOST,MEDCOST VHN,83.28,,,,,,,45.1700,2800.7000,percent of total billed charges,47.59% of $175.00 in Billed Charges for Rev 510 Proc 15272 = $83.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC SKIN SUB TRNK/ARM/LEG EA ADD25,15272,CPT,510,RC,51000021,CDM,,,,both,,,175.0000,26.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2800.70,,,,,,,45.1700,2800.7000,fee schedule,"APG 00056 Proc 15272 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 100% = $2,667.33... $2,667.33 at 105% = $2,800.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB TRNK/ARM/LEG EA ADD25,15272,CPT,510,RC,51000021,CDM,,,,both,,,175.0000,26.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2750.02,,,,,,,45.1700,2800.7000,fee schedule,"APG 00056 Proc 15272 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 100% = $2,667.33... $2,667.33 at 103.1% = $2,750.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB TRNK/ARM/LEG EA ADD25,15272,CPT,510,RC,51000021,CDM,,,,both,,,175.0000,26.2500,SENTARA HEALTH,SENTARA HEALTH,45.17,,,,,,,45.1700,2800.7000,percent of total billed charges,25.81% of $175.00 in Billed Charges for Rev 510 Proc 15272 = $45.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC SKIN SUB TRNK/ARM/LEG EA ADD25,15272,CPT,510,RC,51000021,CDM,,,,both,,,175.0000,26.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",175.00,,,,,,,45.1700,2800.7000,percent of total billed charges,100% of $175.00 in Billed Charges for Rev 510 Proc 15272 = $175.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC SKIN SUB TRNK/ARM/LEG EA ADD25,15272,CPT,510,RC,51000021,CDM,,,,both,,,175.0000,26.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,56.53,,,,,,,45.1700,2800.7000,other,32.3% of $175.00 in Billed Charges for Rev 510 Proc 15272 = $56.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB TRNK/ARM/LEG EA ADD25,15272,CPT,510,RC,51000021,CDM,,,,both,,,175.0000,26.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,53.73,,,,,,,45.1700,2800.7000,other,30.7% of $175.00 in Billed Charges for Rev 510 Proc 15272 = $53.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC SKIN SUB TRNK/ARM/LEG EA ADD25,15272,CPT,510,RC,51000021,CDM,,,,both,,,175.0000,26.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,56.53,,,,,,,45.1700,2800.7000,percent of total billed charges,32.3% of $175.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC SKIN SUB TRNK/ARM/LEG EA ADD25,15272,CPT,510,RC,51000021,CDM,,,,both,,,175.0000,26.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2747.35,,,,,,,45.1700,2800.7000,fee schedule,"APG 00056 Proc 15272 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 103% = $2,747.35. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC SKIN SUB TRNK/ARM/LEG EA ADD25,15272,CPT,510,RC,51000021,CDM,,,,both,,,175.0000,26.2500,WELLCARE,WELLCARE MEDICAID,175.00,,,,,,,45.1700,2800.7000,percent of total billed charges,100% of $175.00 in Billed Charges for Rev 510 Proc 15272 = $175.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,AETNA,AETNA,2450.13,,,,,,,1150.7700,5738.0000,percent of total billed charges,"42.7% of $5,738.00 in Billed Charges for Rev 510 Proc 15273 = $2,450.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2774.03,,,,,,,1150.7700,5738.0000,fee schedule,"APG 00056 Proc 15273 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 104% = $2,774.03. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1871.96,,,,,,,1150.7700,5738.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,AETNA,AETNA HEALTHCARE MEDICARE,1871.96,,,,,,,1150.7700,5738.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,1871.96,,,,,,,1150.7700,5738.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,AMBETTER,AMBETTER,4080.88,,,,,,,1150.7700,5738.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1946.84,,,,,,,1150.7700,5738.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,BLUE CROSS,ANTHEM EXCHANGE,4608.86,,,,,,,1150.7700,5738.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2747.35,,,,,,,1150.7700,5738.0000,fee schedule,"APG 00056 Proc 15273 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 103% = $2,747.35. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,BLUE CROSS,ANTHEM HMO,4896.64,,,,,,,1150.7700,5738.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1928.12,,,,,,,1150.7700,5738.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5738.00,,,,,,,1150.7700,5738.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4016.60,,,,,,,1150.7700,5738.0000,percent of total billed charges,"Rev 510 Proc 15273 $5,738.00 in Billed Charges at 70% = $4,016.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,BLUE CROSS,BLUE CROSS MEDICARE,1946.84,,,,,,,1150.7700,5738.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,CIGNA HEALTHCARE,CIGNA HMO,2392.75,,,,,,,1150.7700,5738.0000,percent of total billed charges,"41.7% of $5,738.00 in Billed Charges for Rev 510 Proc 15273 = $2,392.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2662.43,,,,,,,1150.7700,5738.0000,percent of total billed charges,"46.4% of $5,738.00 in Billed Charges for Rev 510 Proc 15273 = $2,662.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,1965.56,,,,,,,1150.7700,5738.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2392.75,,,,,,,1150.7700,5738.0000,percent of total billed charges,"41.7% of $5,738.00 in Billed Charges for Rev 510 Proc 15273 = $2,392.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,CIGNA HEALTHCARE,CIGNA PPO,2392.75,,,,,,,1150.7700,5738.0000,percent of total billed charges,"41.7% of $5,738.00 in Billed Charges for Rev 510 Proc 15273 = $2,392.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1965.56,,,,,,,1150.7700,5738.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5164.20,,,,,,,1150.7700,5738.0000,percent of total billed charges,"90% of $5,738.00 in Billed Charges for Rev 510 Proc 15273 = $5,164.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,HUMANA,HUMANA MEDICARE,1871.96,,,,,,,1150.7700,5738.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1871.96,,,,,,,1150.7700,5738.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,MEDCOST,MEDCOST VHN,2730.71,,,,,,,1150.7700,5738.0000,percent of total billed charges,"47.59% of $5,738.00 in Billed Charges for Rev 510 Proc 15273 = $2,730.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2800.70,,,,,,,1150.7700,5738.0000,fee schedule,"APG 00056 Proc 15273 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 100% = $2,667.33... $2,667.33 at 105% = $2,800.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1965.56,,,,,,,1150.7700,5738.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1965.56,,,,,,,1150.7700,5738.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,NHC ADVANTAGE,NHC ADVANTAGE,1965.56,,,,,,,1150.7700,5738.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2750.02,,,,,,,1150.7700,5738.0000,fee schedule,"APG 00056 Proc 15273 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 100% = $2,667.33... $2,667.33 at 103.1% = $2,750.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,SENTARA HEALTH,SENTARA HEALTH,1480.98,,,,,,,1150.7700,5738.0000,percent of total billed charges,"25.81% of $5,738.00 in Billed Charges for Rev 510 Proc 15273 = $1,480.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,SENTARA HEALTH,SENTARA MEDICARE,1871.96,,,,,,,1150.7700,5738.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5738.00,,,,,,,1150.7700,5738.0000,percent of total billed charges,"100% of $5,738.00 in Billed Charges for Rev 510 Proc 15273 = $5,738.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1150.77,,,,,,,1150.7700,5738.0000,fee schedule,"$2,301.54 from Fee Schedule TCUHC24 for Rev 510 Proc 15273 * Qty 1 = $2,301.54 at 50% = $1,150.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1853.37,,,,,,,1150.7700,5738.0000,other,"32.3% of $5,738.00 in Billed Charges for Rev 510 Proc 15273 = $1,853.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1761.57,,,,,,,1150.7700,5738.0000,other,"30.7% of $5,738.00 in Billed Charges for Rev 510 Proc 15273 = $1,761.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,1853.37,,,,,,,1150.7700,5738.0000,percent of total billed charges,"32.3% of $5,738.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2747.35,,,,,,,1150.7700,5738.0000,fee schedule,"APG 00056 Proc 15273 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 103% = $2,747.35. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1871.96,,,,,,,1150.7700,5738.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1871.96,,,,,,,1150.7700,5738.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,WELLCARE,WELLCARE MEDICAID,5738.00,,,,,,,1150.7700,5738.0000,percent of total billed charges,"100% of $5,738.00 in Billed Charges for Rev 510 Proc 15273 = $5,738.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT T/A/L AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15273,CPT,510,RC,51000063,CDM,,,,both,,,5738.0000,860.7000,WELLCARE,WELLCARE MEDICARE,1984.28,,,,,,,1150.7700,5738.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ TCAT THER RX DLVR NTRAC RX BALO SEPARATE,0914T,CPT,481,RC,48100242,CDM,,,,both,,,16363.0000,2454.4500,AETNA,AETNA,6987.00,,,,,,,4223.2900,16363.0000,percent of total billed charges,"42.7% of $16,363.00 in Billed Charges for Rev 481 Proc 0914T = $6,987.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ TCAT THER RX DLVR NTRAC RX BALO SEPARATE,0914T,CPT,481,RC,48100242,CDM,,,,both,,,16363.0000,2454.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11454.10,,,,,,,4223.2900,16363.0000,percent of total billed charges,"Rev 481 Proc 0914T $16,363.00 in Billed Charges at 70% = $11,454.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ TCAT THER RX DLVR NTRAC RX BALO SEPARATE,0914T,CPT,481,RC,48100242,CDM,,,,both,,,16363.0000,2454.4500,CIGNA HEALTHCARE,CIGNA HMO,6823.37,,,,,,,4223.2900,16363.0000,percent of total billed charges,"41.7% of $16,363.00 in Billed Charges for Rev 481 Proc 0914T = $6,823.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ TCAT THER RX DLVR NTRAC RX BALO SEPARATE,0914T,CPT,481,RC,48100242,CDM,,,,both,,,16363.0000,2454.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7592.43,,,,,,,4223.2900,16363.0000,percent of total billed charges,"46.4% of $16,363.00 in Billed Charges for Rev 481 Proc 0914T = $7,592.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ TCAT THER RX DLVR NTRAC RX BALO SEPARATE,0914T,CPT,481,RC,48100242,CDM,,,,both,,,16363.0000,2454.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6823.37,,,,,,,4223.2900,16363.0000,percent of total billed charges,"41.7% of $16,363.00 in Billed Charges for Rev 481 Proc 0914T = $6,823.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ TCAT THER RX DLVR NTRAC RX BALO SEPARATE,0914T,CPT,481,RC,48100242,CDM,,,,both,,,16363.0000,2454.4500,CIGNA HEALTHCARE,CIGNA PPO,6823.37,,,,,,,4223.2900,16363.0000,percent of total billed charges,"41.7% of $16,363.00 in Billed Charges for Rev 481 Proc 0914T = $6,823.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ TCAT THER RX DLVR NTRAC RX BALO SEPARATE,0914T,CPT,481,RC,48100242,CDM,,,,both,,,16363.0000,2454.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,14726.70,,,,,,,4223.2900,16363.0000,percent of total billed charges,"90% of $16,363.00 in Billed Charges for Rev 481 Proc 0914T = $14,726.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ TCAT THER RX DLVR NTRAC RX BALO SEPARATE,0914T,CPT,481,RC,48100242,CDM,,,,both,,,16363.0000,2454.4500,MEDCOST,MEDCOST VHN,7787.15,,,,,,,4223.2900,16363.0000,percent of total billed charges,"47.59% of $16,363.00 in Billed Charges for Rev 481 Proc 0914T = $7,787.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ TCAT THER RX DLVR NTRAC RX BALO SEPARATE,0914T,CPT,481,RC,48100242,CDM,,,,both,,,16363.0000,2454.4500,SENTARA HEALTH,SENTARA HEALTH,4223.29,,,,,,,4223.2900,16363.0000,percent of total billed charges,"25.81% of $16,363.00 in Billed Charges for Rev 481 Proc 0914T = $4,223.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ TCAT THER RX DLVR NTRAC RX BALO SEPARATE,0914T,CPT,481,RC,48100242,CDM,,,,both,,,16363.0000,2454.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",16363.00,,,,,,,4223.2900,16363.0000,percent of total billed charges,"100% of $16,363.00 in Billed Charges for Rev 481 Proc 0914T = $16,363.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ TCAT THER RX DLVR NTRAC RX BALO SEPARATE,0914T,CPT,481,RC,48100242,CDM,,,,both,,,16363.0000,2454.4500,WELLCARE,WELLCARE MEDICAID,16363.00,,,,,,,4223.2900,16363.0000,percent of total billed charges,"100% of $16,363.00 in Billed Charges for Rev 481 Proc 0914T = $16,363.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L EA,0974T,CPT,510,RC,51000270,CDM,,,,both,,,574.0000,86.1000,AETNA,AETNA,245.10,,,,,,,148.1500,574.0000,percent of total billed charges,42.7% of $574.00 in Billed Charges for Rev 510 Proc 0974T = $245.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L EA,0974T,CPT,510,RC,51000270,CDM,,,,both,,,574.0000,86.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,401.80,,,,,,,148.1500,574.0000,percent of total billed charges,Rev 510 Proc 0974T $574.00 in Billed Charges at 70% = $401.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L EA,0974T,CPT,510,RC,51000270,CDM,,,,both,,,574.0000,86.1000,CIGNA HEALTHCARE,CIGNA HMO,239.36,,,,,,,148.1500,574.0000,percent of total billed charges,41.7% of $574.00 in Billed Charges for Rev 510 Proc 0974T = $239.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L EA,0974T,CPT,510,RC,51000270,CDM,,,,both,,,574.0000,86.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,266.34,,,,,,,148.1500,574.0000,percent of total billed charges,46.4% of $574.00 in Billed Charges for Rev 510 Proc 0974T = $266.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L EA,0974T,CPT,510,RC,51000270,CDM,,,,both,,,574.0000,86.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,239.36,,,,,,,148.1500,574.0000,percent of total billed charges,41.7% of $574.00 in Billed Charges for Rev 510 Proc 0974T = $239.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L EA,0974T,CPT,510,RC,51000270,CDM,,,,both,,,574.0000,86.1000,CIGNA HEALTHCARE,CIGNA PPO,239.36,,,,,,,148.1500,574.0000,percent of total billed charges,41.7% of $574.00 in Billed Charges for Rev 510 Proc 0974T = $239.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L EA,0974T,CPT,510,RC,51000270,CDM,,,,both,,,574.0000,86.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,516.60,,,,,,,148.1500,574.0000,percent of total billed charges,90% of $574.00 in Billed Charges for Rev 510 Proc 0974T = $516.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L EA,0974T,CPT,510,RC,51000270,CDM,,,,both,,,574.0000,86.1000,MEDCOST,MEDCOST VHN,273.17,,,,,,,148.1500,574.0000,percent of total billed charges,47.59% of $574.00 in Billed Charges for Rev 510 Proc 0974T = $273.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L EA,0974T,CPT,510,RC,51000270,CDM,,,,both,,,574.0000,86.1000,SENTARA HEALTH,SENTARA HEALTH,148.15,,,,,,,148.1500,574.0000,percent of total billed charges,25.81% of $574.00 in Billed Charges for Rev 510 Proc 0974T = $148.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L EA,0974T,CPT,510,RC,51000270,CDM,,,,both,,,574.0000,86.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",574.00,,,,,,,148.1500,574.0000,percent of total billed charges,100% of $574.00 in Billed Charges for Rev 510 Proc 0974T = $574.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L EA,0974T,CPT,510,RC,51000270,CDM,,,,both,,,574.0000,86.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,287.00,,,,,,,148.1500,574.0000,percent of total billed charges,Rev 510 Proc 0974T $574.00 in Billed Charges at 50% = $287.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L EA,0974T,CPT,510,RC,51000270,CDM,,,,both,,,574.0000,86.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,185.40,,,,,,,148.1500,574.0000,other,32.3% of $574.00 in Billed Charges for Rev 510 Proc 0974T = $185.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L EA,0974T,CPT,510,RC,51000270,CDM,,,,both,,,574.0000,86.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,176.22,,,,,,,148.1500,574.0000,other,30.7% of $574.00 in Billed Charges for Rev 510 Proc 0974T = $176.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L EA,0974T,CPT,510,RC,51000270,CDM,,,,both,,,574.0000,86.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,185.40,,,,,,,148.1500,574.0000,percent of total billed charges,32.3% of $574.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L EA,0974T,CPT,510,RC,51000270,CDM,,,,both,,,574.0000,86.1000,WELLCARE,WELLCARE MEDICAID,574.00,,,,,,,148.1500,574.0000,percent of total billed charges,100% of $574.00 in Billed Charges for Rev 510 Proc 0974T = $574.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,AETNA,AETNA,490.20,,,,,,,296.3000,1148.0000,percent of total billed charges,"42.7% of $1,148.00 in Billed Charges for Rev 510 Proc 0975T = $490.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,296.3000,1148.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,296.3000,1148.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,296.3000,1148.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,AMBETTER,AMBETTER,804.03,,,,,,,296.3000,1148.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,296.3000,1148.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,296.3000,1148.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,296.3000,1148.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,296.3000,1148.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1134.94,,,,,,,296.3000,1148.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,803.60,,,,,,,296.3000,1148.0000,percent of total billed charges,"Rev 510 Proc 0975T $1,148.00 in Billed Charges at 70% = $803.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,296.3000,1148.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,CIGNA HEALTHCARE,CIGNA HMO,478.72,,,,,,,296.3000,1148.0000,percent of total billed charges,"41.7% of $1,148.00 in Billed Charges for Rev 510 Proc 0975T = $478.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,532.67,,,,,,,296.3000,1148.0000,percent of total billed charges,"46.4% of $1,148.00 in Billed Charges for Rev 510 Proc 0975T = $532.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,296.3000,1148.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,478.72,,,,,,,296.3000,1148.0000,percent of total billed charges,"41.7% of $1,148.00 in Billed Charges for Rev 510 Proc 0975T = $478.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,CIGNA HEALTHCARE,CIGNA PPO,478.72,,,,,,,296.3000,1148.0000,percent of total billed charges,"41.7% of $1,148.00 in Billed Charges for Rev 510 Proc 0975T = $478.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,296.3000,1148.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1033.20,,,,,,,296.3000,1148.0000,percent of total billed charges,"90% of $1,148.00 in Billed Charges for Rev 510 Proc 0975T = $1,033.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,HUMANA,HUMANA MEDICARE,368.82,,,,,,,296.3000,1148.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,296.3000,1148.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,MEDCOST,MEDCOST VHN,546.33,,,,,,,296.3000,1148.0000,percent of total billed charges,"47.59% of $1,148.00 in Billed Charges for Rev 510 Proc 0975T = $546.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,296.3000,1148.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,296.3000,1148.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,296.3000,1148.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,SENTARA HEALTH,SENTARA HEALTH,296.30,,,,,,,296.3000,1148.0000,percent of total billed charges,"25.81% of $1,148.00 in Billed Charges for Rev 510 Proc 0975T = $296.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,296.3000,1148.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1148.00,,,,,,,296.3000,1148.0000,percent of total billed charges,"100% of $1,148.00 in Billed Charges for Rev 510 Proc 0975T = $1,148.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,574.00,,,,,,,296.3000,1148.0000,percent of total billed charges,"Rev 510 Proc 0975T $1,148.00 in Billed Charges at 50% = $574.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,370.80,,,,,,,296.3000,1148.0000,other,"32.3% of $1,148.00 in Billed Charges for Rev 510 Proc 0975T = $370.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,352.44,,,,,,,296.3000,1148.0000,other,"30.7% of $1,148.00 in Billed Charges for Rev 510 Proc 0975T = $352.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.80,,,,,,,296.3000,1148.0000,percent of total billed charges,"32.3% of $1,148.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,296.3000,1148.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,296.3000,1148.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,WELLCARE,WELLCARE MEDICAID,1148.00,,,,,,,296.3000,1148.0000,percent of total billed charges,"100% of $1,148.00 in Billed Charges for Rev 510 Proc 0975T = $1,148.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD 1,0975T,CPT,510,RC,51000271,CDM,,,,both,,,1148.0000,172.2000,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,296.3000,1148.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD EA,0976T,CPT,510,RC,51000272,CDM,,,,both,,,574.0000,86.1000,AETNA,AETNA,245.10,,,,,,,148.1500,574.0000,percent of total billed charges,42.7% of $574.00 in Billed Charges for Rev 510 Proc 0976T = $245.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD EA,0976T,CPT,510,RC,51000272,CDM,,,,both,,,574.0000,86.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,401.80,,,,,,,148.1500,574.0000,percent of total billed charges,Rev 510 Proc 0976T $574.00 in Billed Charges at 70% = $401.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD EA,0976T,CPT,510,RC,51000272,CDM,,,,both,,,574.0000,86.1000,CIGNA HEALTHCARE,CIGNA HMO,239.36,,,,,,,148.1500,574.0000,percent of total billed charges,41.7% of $574.00 in Billed Charges for Rev 510 Proc 0976T = $239.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD EA,0976T,CPT,510,RC,51000272,CDM,,,,both,,,574.0000,86.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,266.34,,,,,,,148.1500,574.0000,percent of total billed charges,46.4% of $574.00 in Billed Charges for Rev 510 Proc 0976T = $266.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD EA,0976T,CPT,510,RC,51000272,CDM,,,,both,,,574.0000,86.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,239.36,,,,,,,148.1500,574.0000,percent of total billed charges,41.7% of $574.00 in Billed Charges for Rev 510 Proc 0976T = $239.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD EA,0976T,CPT,510,RC,51000272,CDM,,,,both,,,574.0000,86.1000,CIGNA HEALTHCARE,CIGNA PPO,239.36,,,,,,,148.1500,574.0000,percent of total billed charges,41.7% of $574.00 in Billed Charges for Rev 510 Proc 0976T = $239.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD EA,0976T,CPT,510,RC,51000272,CDM,,,,both,,,574.0000,86.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,516.60,,,,,,,148.1500,574.0000,percent of total billed charges,90% of $574.00 in Billed Charges for Rev 510 Proc 0976T = $516.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD EA,0976T,CPT,510,RC,51000272,CDM,,,,both,,,574.0000,86.1000,MEDCOST,MEDCOST VHN,273.17,,,,,,,148.1500,574.0000,percent of total billed charges,47.59% of $574.00 in Billed Charges for Rev 510 Proc 0976T = $273.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD EA,0976T,CPT,510,RC,51000272,CDM,,,,both,,,574.0000,86.1000,SENTARA HEALTH,SENTARA HEALTH,148.15,,,,,,,148.1500,574.0000,percent of total billed charges,25.81% of $574.00 in Billed Charges for Rev 510 Proc 0976T = $148.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD EA,0976T,CPT,510,RC,51000272,CDM,,,,both,,,574.0000,86.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",574.00,,,,,,,148.1500,574.0000,percent of total billed charges,100% of $574.00 in Billed Charges for Rev 510 Proc 0976T = $574.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD EA,0976T,CPT,510,RC,51000272,CDM,,,,both,,,574.0000,86.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,287.00,,,,,,,148.1500,574.0000,percent of total billed charges,Rev 510 Proc 0976T $574.00 in Billed Charges at 50% = $287.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD EA,0976T,CPT,510,RC,51000272,CDM,,,,both,,,574.0000,86.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,185.40,,,,,,,148.1500,574.0000,other,32.3% of $574.00 in Billed Charges for Rev 510 Proc 0976T = $185.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD EA,0976T,CPT,510,RC,51000272,CDM,,,,both,,,574.0000,86.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,176.22,,,,,,,148.1500,574.0000,other,30.7% of $574.00 in Billed Charges for Rev 510 Proc 0976T = $176.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD EA,0976T,CPT,510,RC,51000272,CDM,,,,both,,,574.0000,86.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,185.40,,,,,,,148.1500,574.0000,percent of total billed charges,32.3% of $574.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SLCTV NZMTC DBRDMT BRN ESCHAR ANES S/N/HF&/MD EA,0976T,CPT,510,RC,51000272,CDM,,,,both,,,574.0000,86.1000,WELLCARE,WELLCARE MEDICAID,574.00,,,,,,,148.1500,574.0000,percent of total billed charges,100% of $574.00 in Billed Charges for Rev 510 Proc 0976T = $574.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,AETNA,AETNA,865.53,,,,,,,523.1700,2027.0000,percent of total billed charges,"42.7% of $2,027.00 in Billed Charges for Rev 361 Proc 10007 = $865.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,523.1700,2027.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,523.1700,2027.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,523.1700,2027.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,AMBETTER,AMBETTER,1400.59,,,,,,,523.1700,2027.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,523.1700,2027.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,523.1700,2027.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,523.1700,2027.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,523.1700,2027.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1977.02,,,,,,,523.1700,2027.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,523.1700,2027.0000,case rate,"Rev 361 Proc 10007 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,523.1700,2027.0000,case rate,Rev 361 Proc 10007 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,523.1700,2027.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,523.1700,2027.0000,case rate,Rev 361 Proc 10007 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,523.1700,2027.0000,case rate,Rev 361 Proc 10007 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,523.1700,2027.0000,case rate,Rev 361 Proc 10007 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,523.1700,2027.0000,case rate,Rev 361 Proc 10007 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,CIGNA HEALTHCARE,CIGNA HMO,2027.00,,,,,,,523.1700,2027.0000,case rate,"Rev 361 Proc 10007 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,027.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,027.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,523.1700,2027.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2027.00,,,,,,,523.1700,2027.0000,case rate,"Rev 361 Proc 10007 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,027.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,027.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,CIGNA HEALTHCARE,CIGNA PPO,2027.00,,,,,,,523.1700,2027.0000,case rate,"Rev 361 Proc 10007 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,027.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,027.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,523.1700,2027.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1824.30,,,,,,,523.1700,2027.0000,percent of total billed charges,"90% of $2,027.00 in Billed Charges for Rev 361 Proc 10007 = $1,824.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,HUMANA,HUMANA MEDICARE,642.47,,,,,,,523.1700,2027.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,523.1700,2027.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,MEDCOST,MEDCOST VHN,964.65,,,,,,,523.1700,2027.0000,percent of total billed charges,"47.59% of $2,027.00 in Billed Charges for Rev 361 Proc 10007 = $964.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,523.1700,2027.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,523.1700,2027.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,523.1700,2027.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,SENTARA HEALTH,SENTARA HEALTH,523.17,,,,,,,523.1700,2027.0000,percent of total billed charges,"25.81% of $2,027.00 in Billed Charges for Rev 361 Proc 10007 = $523.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,523.1700,2027.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2027.00,,,,,,,523.1700,2027.0000,percent of total billed charges,"100% of $2,027.00 in Billed Charges for Rev 361 Proc 10007 = $2,027.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,523.1700,2027.0000,case rate,Rev 361 Proc 10007 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,523.1700,2027.0000,case rate,Rev 361 Proc 10007 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,523.1700,2027.0000,case rate,Rev 361 Proc 10007 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,523.1700,2027.0000,case rate,"Rev 361 Proc 10007 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,523.1700,2027.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,523.1700,2027.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,WELLCARE,WELLCARE MEDICAID,2027.00,,,,,,,523.1700,2027.0000,percent of total billed charges,"100% of $2,027.00 in Billed Charges for Rev 361 Proc 10007 = $2,027.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W FLUORO GUID 1ST LESION,10007,CPT,361,RC,36100416,CDM,,,,both,,,2027.0000,304.0500,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,523.1700,2027.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID EA ADDL LESION,10008,CPT,361,RC,36100417,CDM,,,,both,,,1013.0000,151.9500,AETNA,AETNA,432.55,,,,,,,148.0000,1013.0000,percent of total billed charges,"42.7% of $1,013.00 in Billed Charges for Rev 361 Proc 10008 = $432.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W FLUORO GUID EA ADDL LESION,10008,CPT,361,RC,36100417,CDM,,,,both,,,1013.0000,151.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1013.00,,,,,,,148.0000,1013.0000,case rate,"Rev 361 Proc 10008 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $1,013.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,013.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W FLUORO GUID EA ADDL LESION,10008,CPT,361,RC,36100417,CDM,,,,both,,,1013.0000,151.9500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,1013.0000,case rate,Rev 361 Proc 10008 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID EA ADDL LESION,10008,CPT,361,RC,36100417,CDM,,,,both,,,1013.0000,151.9500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,1013.0000,case rate,Rev 361 Proc 10008 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID EA ADDL LESION,10008,CPT,361,RC,36100417,CDM,,,,both,,,1013.0000,151.9500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,1013.0000,case rate,Rev 361 Proc 10008 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID EA ADDL LESION,10008,CPT,361,RC,36100417,CDM,,,,both,,,1013.0000,151.9500,CIGNA HEALTHCARE,CIGNA HMO,1013.00,,,,,,,148.0000,1013.0000,case rate,"Rev 361 Proc 10008 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,013.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,013.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W FLUORO GUID EA ADDL LESION,10008,CPT,361,RC,36100417,CDM,,,,both,,,1013.0000,151.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1013.00,,,,,,,148.0000,1013.0000,case rate,"Rev 361 Proc 10008 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,013.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,013.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W FLUORO GUID EA ADDL LESION,10008,CPT,361,RC,36100417,CDM,,,,both,,,1013.0000,151.9500,CIGNA HEALTHCARE,CIGNA PPO,1013.00,,,,,,,148.0000,1013.0000,case rate,"Rev 361 Proc 10008 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,013.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,013.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W FLUORO GUID EA ADDL LESION,10008,CPT,361,RC,36100417,CDM,,,,both,,,1013.0000,151.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,911.70,,,,,,,148.0000,1013.0000,percent of total billed charges,"90% of $1,013.00 in Billed Charges for Rev 361 Proc 10008 = $911.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W FLUORO GUID EA ADDL LESION,10008,CPT,361,RC,36100417,CDM,,,,both,,,1013.0000,151.9500,MEDCOST,MEDCOST VHN,482.09,,,,,,,148.0000,1013.0000,percent of total billed charges,"47.59% of $1,013.00 in Billed Charges for Rev 361 Proc 10008 = $482.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W FLUORO GUID EA ADDL LESION,10008,CPT,361,RC,36100417,CDM,,,,both,,,1013.0000,151.9500,SENTARA HEALTH,SENTARA HEALTH,261.46,,,,,,,148.0000,1013.0000,percent of total billed charges,"25.81% of $1,013.00 in Billed Charges for Rev 361 Proc 10008 = $261.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W FLUORO GUID EA ADDL LESION,10008,CPT,361,RC,36100417,CDM,,,,both,,,1013.0000,151.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1013.00,,,,,,,148.0000,1013.0000,percent of total billed charges,"100% of $1,013.00 in Billed Charges for Rev 361 Proc 10008 = $1,013.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W FLUORO GUID EA ADDL LESION,10008,CPT,361,RC,36100417,CDM,,,,both,,,1013.0000,151.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,148.0000,1013.0000,case rate,Rev 361 Proc 10008 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID EA ADDL LESION,10008,CPT,361,RC,36100417,CDM,,,,both,,,1013.0000,151.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,148.0000,1013.0000,case rate,Rev 361 Proc 10008 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID EA ADDL LESION,10008,CPT,361,RC,36100417,CDM,,,,both,,,1013.0000,151.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,148.0000,1013.0000,case rate,Rev 361 Proc 10008 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID EA ADDL LESION,10008,CPT,361,RC,36100417,CDM,,,,both,,,1013.0000,151.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,148.0000,1013.0000,case rate,Rev 361 Proc 10008 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W FLUORO GUID EA ADDL LESION,10008,CPT,361,RC,36100417,CDM,,,,both,,,1013.0000,151.9500,WELLCARE,WELLCARE MEDICAID,1013.00,,,,,,,148.0000,1013.0000,percent of total billed charges,"100% of $1,013.00 in Billed Charges for Rev 361 Proc 10008 = $1,013.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,AETNA,AETNA,2129.02,,,,,,,578.0000,4986.0000,percent of total billed charges,"42.7% of $4,986.00 in Billed Charges for Rev 361 Proc 10009 = $2,129.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,578.0000,4986.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,578.0000,4986.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,578.0000,4986.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,AMBETTER,AMBETTER,1400.59,,,,,,,578.0000,4986.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,578.0000,4986.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,578.0000,4986.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,578.0000,4986.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,578.0000,4986.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1977.02,,,,,,,578.0000,4986.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,578.0000,4986.0000,case rate,"Rev 361 Proc 10009 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,578.0000,4986.0000,case rate,Rev 361 Proc 10009 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,578.0000,4986.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,578.0000,4986.0000,case rate,Rev 361 Proc 10009 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,578.0000,4986.0000,case rate,Rev 361 Proc 10009 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,4986.0000,case rate,Rev 361 Proc 10009 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,4986.0000,case rate,Rev 361 Proc 10009 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,578.0000,4986.0000,case rate,"Rev 361 Proc 10009 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,578.0000,4986.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,578.0000,4986.0000,case rate,"Rev 361 Proc 10009 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,578.0000,4986.0000,case rate,"Rev 361 Proc 10009 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,578.0000,4986.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4487.40,,,,,,,578.0000,4986.0000,percent of total billed charges,"90% of $4,986.00 in Billed Charges for Rev 361 Proc 10009 = $4,487.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,HUMANA,HUMANA MEDICARE,642.47,,,,,,,578.0000,4986.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,578.0000,4986.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,MEDCOST,MEDCOST VHN,2372.84,,,,,,,578.0000,4986.0000,percent of total billed charges,"47.59% of $4,986.00 in Billed Charges for Rev 361 Proc 10009 = $2,372.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,578.0000,4986.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,578.0000,4986.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,578.0000,4986.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,SENTARA HEALTH,SENTARA HEALTH,1286.89,,,,,,,578.0000,4986.0000,percent of total billed charges,"25.81% of $4,986.00 in Billed Charges for Rev 361 Proc 10009 = $1,286.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,578.0000,4986.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4986.00,,,,,,,578.0000,4986.0000,percent of total billed charges,"100% of $4,986.00 in Billed Charges for Rev 361 Proc 10009 = $4,986.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,578.0000,4986.0000,case rate,Rev 361 Proc 10009 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,578.0000,4986.0000,case rate,Rev 361 Proc 10009 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,578.0000,4986.0000,case rate,Rev 361 Proc 10009 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,578.0000,4986.0000,case rate,"Rev 361 Proc 10009 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,578.0000,4986.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,578.0000,4986.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,WELLCARE,WELLCARE MEDICAID,4986.00,,,,,,,578.0000,4986.0000,percent of total billed charges,"100% of $4,986.00 in Billed Charges for Rev 361 Proc 10009 = $4,986.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W CT GUID 1ST LESION,10009,CPT,361,RC,36100418,CDM,,,,both,,,4986.0000,747.9000,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,578.0000,4986.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,AETNA,AETNA,865.53,,,,,,,523.1700,2027.0000,percent of total billed charges,"42.7% of $2,027.00 in Billed Charges for Rev 361 Proc 10011 = $865.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,523.1700,2027.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,523.1700,2027.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,523.1700,2027.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,AMBETTER,AMBETTER,1400.59,,,,,,,523.1700,2027.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,523.1700,2027.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,523.1700,2027.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,523.1700,2027.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,523.1700,2027.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1977.02,,,,,,,523.1700,2027.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,523.1700,2027.0000,case rate,"Rev 361 Proc 10011 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,523.1700,2027.0000,case rate,Rev 361 Proc 10011 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,523.1700,2027.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,523.1700,2027.0000,case rate,Rev 361 Proc 10011 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,523.1700,2027.0000,case rate,Rev 361 Proc 10011 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,523.1700,2027.0000,case rate,Rev 361 Proc 10011 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,523.1700,2027.0000,case rate,Rev 361 Proc 10011 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,CIGNA HEALTHCARE,CIGNA HMO,2027.00,,,,,,,523.1700,2027.0000,case rate,"Rev 361 Proc 10011 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,027.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,027.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,523.1700,2027.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2027.00,,,,,,,523.1700,2027.0000,case rate,"Rev 361 Proc 10011 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,027.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,027.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,CIGNA HEALTHCARE,CIGNA PPO,2027.00,,,,,,,523.1700,2027.0000,case rate,"Rev 361 Proc 10011 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,027.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,027.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,523.1700,2027.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1824.30,,,,,,,523.1700,2027.0000,percent of total billed charges,"90% of $2,027.00 in Billed Charges for Rev 361 Proc 10011 = $1,824.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,HUMANA,HUMANA MEDICARE,642.47,,,,,,,523.1700,2027.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,523.1700,2027.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,MEDCOST,MEDCOST VHN,964.65,,,,,,,523.1700,2027.0000,percent of total billed charges,"47.59% of $2,027.00 in Billed Charges for Rev 361 Proc 10011 = $964.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,523.1700,2027.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,523.1700,2027.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,523.1700,2027.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,SENTARA HEALTH,SENTARA HEALTH,523.17,,,,,,,523.1700,2027.0000,percent of total billed charges,"25.81% of $2,027.00 in Billed Charges for Rev 361 Proc 10011 = $523.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,523.1700,2027.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2027.00,,,,,,,523.1700,2027.0000,percent of total billed charges,"100% of $2,027.00 in Billed Charges for Rev 361 Proc 10011 = $2,027.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,523.1700,2027.0000,case rate,Rev 361 Proc 10011 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,523.1700,2027.0000,case rate,Rev 361 Proc 10011 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,523.1700,2027.0000,case rate,Rev 361 Proc 10011 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,523.1700,2027.0000,case rate,"Rev 361 Proc 10011 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,523.1700,2027.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,523.1700,2027.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,WELLCARE,WELLCARE MEDICAID,2027.00,,,,,,,523.1700,2027.0000,percent of total billed charges,"100% of $2,027.00 in Billed Charges for Rev 361 Proc 10011 = $2,027.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W MR GUID 1ST LESION,10011,CPT,361,RC,36100420,CDM,,,,both,,,2027.0000,304.0500,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,523.1700,2027.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,AETNA,AETNA,1472.72,,,,,,,175.0000,3449.0000,percent of total billed charges,"42.7% of $3,449.00 in Billed Charges for Rev 361 Proc 10030 = $1,472.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1591.43,,,,,,,175.0000,3449.0000,fee schedule,"APG 00004 Proc 10030 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 104% = $1,591.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,175.0000,3449.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,175.0000,3449.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,175.0000,3449.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,AMBETTER,AMBETTER,1400.59,,,,,,,175.0000,3449.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,175.0000,3449.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,175.0000,3449.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1576.13,,,,,,,175.0000,3449.0000,fee schedule,"APG 00004 Proc 10030 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 103% = $1,576.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,175.0000,3449.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,175.0000,3449.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1977.02,,,,,,,175.0000,3449.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,175.0000,3449.0000,case rate,"Rev 361 Proc 10030 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,175.0000,3449.0000,case rate,Rev 361 Proc 10030 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,175.0000,3449.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,175.0000,3449.0000,case rate,Rev 361 Proc 10030 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,175.0000,3449.0000,case rate,Rev 361 Proc 10030 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,175.0000,3449.0000,case rate,Rev 361 Proc 10030 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,175.0000,3449.0000,case rate,Rev 361 Proc 10030 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,CIGNA HEALTHCARE,CIGNA HMO,228.00,,,,,,,175.0000,3449.0000,case rate,Rev 361 Proc 10030 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.00,,,,,,,175.0000,3449.0000,case rate,Rev 361 Proc 10030 ASG Rate of $175.00 at 100% of $175.00 = $175.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,175.0000,3449.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.00,,,,,,,175.0000,3449.0000,case rate,Rev 361 Proc 10030 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,CIGNA HEALTHCARE,CIGNA PPO,228.00,,,,,,,175.0000,3449.0000,case rate,Rev 361 Proc 10030 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,175.0000,3449.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3104.10,,,,,,,175.0000,3449.0000,percent of total billed charges,"90% of $3,449.00 in Billed Charges for Rev 361 Proc 10030 = $3,104.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,HUMANA,HUMANA MEDICARE,642.47,,,,,,,175.0000,3449.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,175.0000,3449.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,MEDCOST,MEDCOST VHN,1641.38,,,,,,,175.0000,3449.0000,percent of total billed charges,"47.59% of $3,449.00 in Billed Charges for Rev 361 Proc 10030 = $1,641.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1606.74,,,,,,,175.0000,3449.0000,fee schedule,"APG 00004 Proc 10030 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 100% = $1,530.23... $1,530.23 at 105% = $1,606.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,175.0000,3449.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,175.0000,3449.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,175.0000,3449.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1577.67,,,,,,,175.0000,3449.0000,fee schedule,"APG 00004 Proc 10030 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 100% = $1,530.23... $1,530.23 at 103.1% = $1,577.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,SENTARA HEALTH,SENTARA HEALTH,890.19,,,,,,,175.0000,3449.0000,percent of total billed charges,"25.81% of $3,449.00 in Billed Charges for Rev 361 Proc 10030 = $890.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,175.0000,3449.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3449.00,,,,,,,175.0000,3449.0000,percent of total billed charges,"100% of $3,449.00 in Billed Charges for Rev 361 Proc 10030 = $3,449.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,175.0000,3449.0000,case rate,Rev 361 Proc 10030 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,175.0000,3449.0000,case rate,Rev 361 Proc 10030 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,175.0000,3449.0000,case rate,Rev 361 Proc 10030 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,175.0000,3449.0000,case rate,"Rev 361 Proc 10030 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1576.13,,,,,,,175.0000,3449.0000,fee schedule,"APG 00004 Proc 10030 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 103% = $1,576.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,175.0000,3449.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,175.0000,3449.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,WELLCARE,WELLCARE MEDICAID,3449.00,,,,,,,175.0000,3449.0000,percent of total billed charges,"100% of $3,449.00 in Billed Charges for Rev 361 Proc 10030 = $3,449.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRAIN CTH PERC SOFT TISSUE,10030,CPT,361,RC,36100231,CDM,,,,both,,,3449.0000,517.3500,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,175.0000,3449.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA,237.84,,,,,,,31.3900,557.0000,percent of total billed charges,42.7% of $557.00 in Billed Charges for Rev 521 Proc 10040 = $237.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,31.3900,557.0000,fee schedule,"APG 00003 Proc 10040 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,31.3900,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,31.3900,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,31.3900,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,AMBETTER,AMBETTER,396.83,,,,,,,31.3900,557.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,31.3900,557.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,31.3900,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,31.3900,557.0000,fee schedule,"APG 00003 Proc 10040 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,31.3900,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,31.3900,557.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",557.00,,,,,,,31.3900,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,66.75,,,,,,,31.3900,557.0000,fee schedule,$66.75 from Fee Schedule BLDTM_23 for Rev 521 Proc 10040 * Qty 1 = $66.75 at 100% = $66.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,31.3900,557.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,TENNCARE BLUE CARE,31.39,,,,,,,31.3900,557.0000,fee schedule,$27.06 from Fee Schedule TC_24 for Rev 521 Proc 10040 * Qty 1 = $27.06 at 116% = $31.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,TENNCARE BLUE SELECT,31.39,,,,,,,31.3900,557.0000,fee schedule,$27.06 from Fee Schedule TC_24 for Rev 521 Proc 10040 * Qty 1 = $27.06 at 116% = $31.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA HMO,232.27,,,,,,,31.3900,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 521 Proc 10040 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,258.45,,,,,,,31.3900,557.0000,percent of total billed charges,46.4% of $557.00 in Billed Charges for Rev 521 Proc 10040 = $258.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,31.3900,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,232.27,,,,,,,31.3900,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 521 Proc 10040 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA PPO,232.27,,,,,,,31.3900,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 521 Proc 10040 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,31.3900,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,501.30,,,,,,,31.3900,557.0000,percent of total billed charges,90% of $557.00 in Billed Charges for Rev 521 Proc 10040 = $501.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,31.3900,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,31.3900,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,MEDCOST,MEDCOST VHN,265.08,,,,,,,31.3900,557.0000,percent of total billed charges,47.59% of $557.00 in Billed Charges for Rev 521 Proc 10040 = $265.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,31.3900,557.0000,fee schedule,"APG 00003 Proc 10040 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,31.3900,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,31.3900,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,31.3900,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,31.3900,557.0000,fee schedule,"APG 00003 Proc 10040 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,SENTARA HEALTH,SENTARA HEALTH,143.76,,,,,,,31.3900,557.0000,percent of total billed charges,25.81% of $557.00 in Billed Charges for Rev 521 Proc 10040 = $143.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,31.3900,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",557.00,,,,,,,31.3900,557.0000,percent of total billed charges,100% of $557.00 in Billed Charges for Rev 521 Proc 10040 = $557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,49.25,,,,,,,31.3900,557.0000,fee schedule,$98.49 from Fee Schedule TCUHC24 for Rev 521 Proc 10040 * Qty 1 = $98.49 at 50% = $49.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,31.3900,557.0000,fee schedule,"APG 00003 Proc 10040 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,31.3900,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,31.3900,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,WELLCARE,WELLCARE MEDICAID,557.00,,,,,,,31.3900,557.0000,percent of total billed charges,100% of $557.00 in Billed Charges for Rev 521 Proc 10040 = $557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ACNE SURGERY,10040,CPT,521,RC,45000341,CDM,,,,both,,,557.0000,83.5500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,31.3900,557.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,AETNA,AETNA,245.53,,,,,,,29.8200,575.0000,percent of total billed charges,42.7% of $575.00 in Billed Charges for Rev 450 Proc 10060 = $245.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,29.8200,575.0000,fee schedule,"APG 00003 Proc 10060 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,29.8200,575.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,29.8200,575.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,29.8200,575.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,AMBETTER,AMBETTER,396.83,,,,,,,29.8200,575.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,29.8200,575.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,29.8200,575.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,29.8200,575.0000,fee schedule,"APG 00003 Proc 10060 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,29.8200,575.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,29.8200,575.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",560.15,,,,,,,29.8200,575.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,50.22,,,,,,,29.8200,575.0000,fee schedule,$50.22 from Fee Schedule BLDTM_23 for Rev 450 Proc 10060 * Qty 1 = $50.22 at 100% = $50.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,29.8200,575.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,BLUE CROSS,TENNCARE BLUE CARE,29.82,,,,,,,29.8200,575.0000,fee schedule,$25.71 from Fee Schedule TC_24 for Rev 450 Proc 10060 * Qty 1 = $25.71 at 116% = $29.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,BLUE CROSS,TENNCARE BLUE SELECT,29.82,,,,,,,29.8200,575.0000,fee schedule,$25.71 from Fee Schedule TC_24 for Rev 450 Proc 10060 * Qty 1 = $25.71 at 116% = $29.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,29.8200,575.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,29.8200,575.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,517.50,,,,,,,29.8200,575.0000,percent of total billed charges,90% of $575.00 in Billed Charges for Rev 450 Proc 10060 = $517.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,29.8200,575.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,29.8200,575.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,MEDCOST,MEDCOST VHN,273.64,,,,,,,29.8200,575.0000,percent of total billed charges,47.59% of $575.00 in Billed Charges for Rev 450 Proc 10060 = $273.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,29.8200,575.0000,fee schedule,"APG 00003 Proc 10060 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,29.8200,575.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,29.8200,575.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,29.8200,575.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,29.8200,575.0000,fee schedule,"APG 00003 Proc 10060 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,SENTARA HEALTH,SENTARA HEALTH,148.41,,,,,,,29.8200,575.0000,percent of total billed charges,25.81% of $575.00 in Billed Charges for Rev 450 Proc 10060 = $148.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,29.8200,575.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",575.00,,,,,,,29.8200,575.0000,percent of total billed charges,100% of $575.00 in Billed Charges for Rev 450 Proc 10060 = $575.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,29.8200,575.0000,case rate,Rev 450 Proc 10060 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,29.8200,575.0000,case rate,Rev 450 Proc 10060 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,29.8200,575.0000,case rate,Rev 450 Proc 10060 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,575.00,,,,,,,29.8200,575.0000,case rate,"Rev 450 Proc 10060 at Case Rate $847.00 (Service Line reduced to $575.00, claim capped at $575.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,29.8200,575.0000,fee schedule,"APG 00003 Proc 10060 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,29.8200,575.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,29.8200,575.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,WELLCARE,WELLCARE MEDICAID,575.00,,,,,,,29.8200,575.0000,percent of total billed charges,100% of $575.00 in Billed Charges for Rev 450 Proc 10060 = $575.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC I&D ABSCESS SIMPLE OR SINGLE,10060,CPT,450,RC,45000015,CDM,,,,both,,,575.0000,86.2500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,29.8200,575.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,AETNA,AETNA,450.49,,,,,,,109.0000,1055.0000,percent of total billed charges,"42.7% of $1,055.00 in Billed Charges for Rev 450 Proc 10061 = $450.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,109.0000,1055.0000,fee schedule,"APG 00003 Proc 10061 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,109.0000,1055.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,1055.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,109.0000,1055.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,AMBETTER,AMBETTER,804.03,,,,,,,109.0000,1055.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,109.0000,1055.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,109.0000,1055.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,109.0000,1055.0000,fee schedule,"APG 00003 Proc 10061 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,109.0000,1055.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,109.0000,1055.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1055.00,,,,,,,109.0000,1055.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,136.29,,,,,,,109.0000,1055.0000,fee schedule,$136.29 from Fee Schedule BLDTM_23 for Rev 450 Proc 10061 * Qty 1 = $136.29 at 100% = $136.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,109.0000,1055.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,109.0000,1055.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,109.0000,1055.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,949.50,,,,,,,109.0000,1055.0000,percent of total billed charges,"90% of $1,055.00 in Billed Charges for Rev 450 Proc 10061 = $949.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,109.0000,1055.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,109.0000,1055.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,MEDCOST,MEDCOST VHN,502.07,,,,,,,109.0000,1055.0000,percent of total billed charges,"47.59% of $1,055.00 in Billed Charges for Rev 450 Proc 10061 = $502.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,109.0000,1055.0000,fee schedule,"APG 00003 Proc 10061 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,109.0000,1055.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,109.0000,1055.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,109.0000,1055.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,109.0000,1055.0000,fee schedule,"APG 00003 Proc 10061 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,SENTARA HEALTH,SENTARA HEALTH,272.30,,,,,,,109.0000,1055.0000,percent of total billed charges,"25.81% of $1,055.00 in Billed Charges for Rev 450 Proc 10061 = $272.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,109.0000,1055.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1055.00,,,,,,,109.0000,1055.0000,percent of total billed charges,"100% of $1,055.00 in Billed Charges for Rev 450 Proc 10061 = $1,055.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1055.0000,case rate,Rev 450 Proc 10061 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1055.0000,case rate,Rev 450 Proc 10061 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1055.0000,case rate,Rev 450 Proc 10061 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1055.0000,case rate,Rev 450 Proc 10061 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,109.0000,1055.0000,fee schedule,"APG 00003 Proc 10061 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,1055.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,109.0000,1055.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,WELLCARE,WELLCARE MEDICAID,1055.00,,,,,,,109.0000,1055.0000,percent of total billed charges,"100% of $1,055.00 in Billed Charges for Rev 450 Proc 10061 = $1,055.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D ABSCESS COMPLICATED MULTI,10061,CPT,450,RC,45000016,CDM,,,,both,,,1055.0000,158.2500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,109.0000,1055.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,AETNA,AETNA,342.45,,,,,,,61.8100,804.0300,percent of total billed charges,42.7% of $802.00 in Billed Charges for Rev 450 Proc 10120 = $342.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,61.8100,804.0300,fee schedule,"APG 00003 Proc 10120 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,61.8100,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,61.8100,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,61.8100,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,AMBETTER,AMBETTER,804.03,,,,,,,61.8100,804.0300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,61.8100,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,BLUE CROSS,ANTHEM EXCHANGE,802.00,,,,,,,61.8100,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,61.8100,804.0300,fee schedule,"APG 00003 Proc 10120 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,BLUE CROSS,ANTHEM HMO,802.00,,,,,,,61.8100,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,61.8100,804.0300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",802.00,,,,,,,61.8100,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,61.81,,,,,,,61.8100,804.0300,fee schedule,$61.81 from Fee Schedule BLDTM_23 for Rev 450 Proc 10120 * Qty 1 = $61.81 at 100% = $61.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,61.8100,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,61.8100,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,61.8100,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,721.80,,,,,,,61.8100,804.0300,percent of total billed charges,90% of $802.00 in Billed Charges for Rev 450 Proc 10120 = $721.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,HUMANA,HUMANA MEDICARE,368.82,,,,,,,61.8100,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,61.8100,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,MEDCOST,MEDCOST VHN,381.67,,,,,,,61.8100,804.0300,percent of total billed charges,47.59% of $802.00 in Billed Charges for Rev 450 Proc 10120 = $381.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,61.8100,804.0300,fee schedule,"APG 00003 Proc 10120 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,61.8100,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,61.8100,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,61.8100,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,61.8100,804.0300,fee schedule,"APG 00003 Proc 10120 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,SENTARA HEALTH,SENTARA HEALTH,207.00,,,,,,,61.8100,804.0300,percent of total billed charges,25.81% of $802.00 in Billed Charges for Rev 450 Proc 10120 = $207.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,61.8100,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",802.00,,,,,,,61.8100,804.0300,percent of total billed charges,100% of $802.00 in Billed Charges for Rev 450 Proc 10120 = $802.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,61.8100,804.0300,case rate,Rev 450 Proc 10120 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,61.8100,804.0300,case rate,Rev 450 Proc 10120 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,61.8100,804.0300,case rate,Rev 450 Proc 10120 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,802.00,,,,,,,61.8100,804.0300,case rate,"Rev 450 Proc 10120 at Case Rate $847.00 (Service Line reduced to $802.00, claim capped at $802.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,61.8100,804.0300,fee schedule,"APG 00003 Proc 10120 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,61.8100,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,61.8100,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,WELLCARE,WELLCARE MEDICAID,802.00,,,,,,,61.8100,804.0300,percent of total billed charges,100% of $802.00 in Billed Charges for Rev 450 Proc 10120 = $802.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISE & REMOVAL FB SUBQ SIMP,10120,CPT,450,RC,45000110,CDM,,,,both,,,802.0000,120.3000,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,61.8100,804.0300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,AETNA,AETNA,364.23,,,,,,,65.9200,853.0000,percent of total billed charges,42.7% of $853.00 in Billed Charges for Rev 450 Proc 12051 = $364.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,65.9200,853.0000,fee schedule,"APG 00017 Proc 12051 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,65.9200,853.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,65.9200,853.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,65.9200,853.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,AMBETTER,AMBETTER,804.03,,,,,,,65.9200,853.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,65.9200,853.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,BLUE CROSS,ANTHEM EXCHANGE,853.00,,,,,,,65.9200,853.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,65.9200,853.0000,fee schedule,"APG 00017 Proc 12051 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,BLUE CROSS,ANTHEM HMO,853.00,,,,,,,65.9200,853.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,65.9200,853.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",853.00,,,,,,,65.9200,853.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,162.30,,,,,,,65.9200,853.0000,fee schedule,$162.30 from Fee Schedule BLDTM_23 for Rev 450 Proc 12051 * Qty 1 = $162.30 at 100% = $162.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,65.9200,853.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,BLUE CROSS,TENNCARE BLUE CARE,65.92,,,,,,,65.9200,853.0000,fee schedule,$56.83 from Fee Schedule TC_24 for Rev 450 Proc 12051 * Qty 1 = $56.83 at 116% = $65.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,BLUE CROSS,TENNCARE BLUE SELECT,65.92,,,,,,,65.9200,853.0000,fee schedule,$56.83 from Fee Schedule TC_24 for Rev 450 Proc 12051 * Qty 1 = $56.83 at 116% = $65.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,65.9200,853.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,65.9200,853.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,767.70,,,,,,,65.9200,853.0000,percent of total billed charges,90% of $853.00 in Billed Charges for Rev 450 Proc 12051 = $767.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,65.9200,853.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,65.9200,853.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,MEDCOST,MEDCOST VHN,405.94,,,,,,,65.9200,853.0000,percent of total billed charges,47.59% of $853.00 in Billed Charges for Rev 450 Proc 12051 = $405.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,65.9200,853.0000,fee schedule,"APG 00017 Proc 12051 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,65.9200,853.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,65.9200,853.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,65.9200,853.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,65.9200,853.0000,fee schedule,"APG 00017 Proc 12051 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,SENTARA HEALTH,SENTARA HEALTH,220.16,,,,,,,65.9200,853.0000,percent of total billed charges,25.81% of $853.00 in Billed Charges for Rev 450 Proc 12051 = $220.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,65.9200,853.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",853.00,,,,,,,65.9200,853.0000,percent of total billed charges,100% of $853.00 in Billed Charges for Rev 450 Proc 12051 = $853.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,65.9200,853.0000,case rate,Rev 450 Proc 12051 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,65.9200,853.0000,case rate,Rev 450 Proc 12051 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,65.9200,853.0000,case rate,Rev 450 Proc 12051 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,65.9200,853.0000,case rate,Rev 450 Proc 12051 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,65.9200,853.0000,fee schedule,"APG 00017 Proc 12051 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,65.9200,853.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,65.9200,853.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,WELLCARE,WELLCARE MEDICAID,853.00,,,,,,,65.9200,853.0000,percent of total billed charges,100% of $853.00 in Billed Charges for Rev 450 Proc 12051 = $853.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS FACE LIPS LESS 2.5,12051,CPT,450,RC,45000060,CDM,,,,both,,,853.0000,127.9500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,65.9200,853.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,AETNA,AETNA,774.58,,,,,,,468.1900,4080.8800,percent of total billed charges,"42.7% of $1,814.00 in Billed Charges for Rev 510 Proc 15277 = $774.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2774.03,,,,,,,468.1900,4080.8800,fee schedule,"APG 00056 Proc 15277 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 104% = $2,774.03. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1814.00,,,,,,,468.1900,4080.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,AETNA,AETNA HEALTHCARE MEDICARE,1814.00,,,,,,,468.1900,4080.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,1814.00,,,,,,,468.1900,4080.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,AMBETTER,AMBETTER,4080.88,,,,,,,468.1900,4080.8800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1814.00,,,,,,,468.1900,4080.8800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,BLUE CROSS,ANTHEM EXCHANGE,1814.00,,,,,,,468.1900,4080.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1814.00,,,,,,,468.1900,4080.8800,fee schedule,"APG 00056 Proc 15277 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 103% = $2,747.35 (Service Line reduced to $1,814.00, claim capped at $1,814.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,BLUE CROSS,ANTHEM HMO,1814.00,,,,,,,468.1900,4080.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1814.00,,,,,,,468.1900,4080.8800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1814.00,,,,,,,468.1900,4080.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1269.80,,,,,,,468.1900,4080.8800,percent of total billed charges,"Rev 510 Proc 15277 $1,814.00 in Billed Charges at 70% = $1,269.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,BLUE CROSS,BLUE CROSS MEDICARE,1946.84,,,,,,,468.1900,4080.8800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,CIGNA HEALTHCARE,CIGNA HMO,756.44,,,,,,,468.1900,4080.8800,percent of total billed charges,"41.7% of $1,814.00 in Billed Charges for Rev 510 Proc 15277 = $756.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,841.70,,,,,,,468.1900,4080.8800,percent of total billed charges,"46.4% of $1,814.00 in Billed Charges for Rev 510 Proc 15277 = $841.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,1814.00,,,,,,,468.1900,4080.8800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,756.44,,,,,,,468.1900,4080.8800,percent of total billed charges,"41.7% of $1,814.00 in Billed Charges for Rev 510 Proc 15277 = $756.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,CIGNA HEALTHCARE,CIGNA PPO,756.44,,,,,,,468.1900,4080.8800,percent of total billed charges,"41.7% of $1,814.00 in Billed Charges for Rev 510 Proc 15277 = $756.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1814.00,,,,,,,468.1900,4080.8800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1632.60,,,,,,,468.1900,4080.8800,percent of total billed charges,"90% of $1,814.00 in Billed Charges for Rev 510 Proc 15277 = $1,632.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,HUMANA,HUMANA MEDICARE,1814.00,,,,,,,468.1900,4080.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1814.00,,,,,,,468.1900,4080.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,MEDCOST,MEDCOST VHN,863.28,,,,,,,468.1900,4080.8800,percent of total billed charges,"47.59% of $1,814.00 in Billed Charges for Rev 510 Proc 15277 = $863.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2800.70,,,,,,,468.1900,4080.8800,fee schedule,"APG 00056 Proc 15277 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 100% = $2,667.33... $2,667.33 at 105% = $2,800.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1814.00,,,,,,,468.1900,4080.8800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1814.00,,,,,,,468.1900,4080.8800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,NHC ADVANTAGE,NHC ADVANTAGE,1814.00,,,,,,,468.1900,4080.8800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2750.02,,,,,,,468.1900,4080.8800,fee schedule,"APG 00056 Proc 15277 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 100% = $2,667.33... $2,667.33 at 103.1% = $2,750.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,SENTARA HEALTH,SENTARA HEALTH,468.19,,,,,,,468.1900,4080.8800,percent of total billed charges,"25.81% of $1,814.00 in Billed Charges for Rev 510 Proc 15277 = $468.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,SENTARA HEALTH,SENTARA MEDICARE,1814.00,,,,,,,468.1900,4080.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1814.00,,,,,,,468.1900,4080.8800,percent of total billed charges,"100% of $1,814.00 in Billed Charges for Rev 510 Proc 15277 = $1,814.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,703.71,,,,,,,468.1900,4080.8800,fee schedule,"$1,407.42 from Fee Schedule TCUHC24 for Rev 510 Proc 15277 * Qty 1 = $1,407.42 at 50% = $703.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,585.92,,,,,,,468.1900,4080.8800,other,"32.3% of $1,814.00 in Billed Charges for Rev 510 Proc 15277 = $585.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,556.90,,,,,,,468.1900,4080.8800,other,"30.7% of $1,814.00 in Billed Charges for Rev 510 Proc 15277 = $556.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,585.92,,,,,,,468.1900,4080.8800,percent of total billed charges,"32.3% of $1,814.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2747.35,,,,,,,468.1900,4080.8800,fee schedule,"APG 00056 Proc 15277 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 103% = $2,747.35. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1814.00,,,,,,,468.1900,4080.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1814.00,,,,,,,468.1900,4080.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,WELLCARE,WELLCARE MEDICAID,1814.00,,,,,,,468.1900,4080.8800,percent of total billed charges,"100% of $1,814.00 in Billed Charges for Rev 510 Proc 15277 = $1,814.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SKN SUB GRFT F/S/N/H/F/G/M/D AREA/100SQ CM 1ST 100SQ CM WSA OR 1% BA INF/CHILD,15277,CPT,510,RC,51000065,CDM,,,,both,,,1814.0000,272.1000,WELLCARE,WELLCARE MEDICARE,1984.28,,,,,,,468.1900,4080.8800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,AETNA,AETNA,3483.89,,,,,,,490.4000,8159.0000,percent of total billed charges,"42.7% of $8,159.00 in Billed Charges for Rev 510 Proc 15839 = $3,483.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2575.48,,,,,,,490.4000,8159.0000,fee schedule,"APG 00011 Proc 15839 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 104% = $2,575.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2635.37,,,,,,,490.4000,8159.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,AETNA,AETNA HEALTHCARE MEDICARE,2635.37,,,,,,,490.4000,8159.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,2635.37,,,,,,,490.4000,8159.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,AMBETTER,AMBETTER,5745.12,,,,,,,490.4000,8159.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2740.79,,,,,,,490.4000,8159.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,BLUE CROSS,ANTHEM EXCHANGE,6488.44,,,,,,,490.4000,8159.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2550.71,,,,,,,490.4000,8159.0000,fee schedule,"APG 00011 Proc 15839 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 103% = $2,550.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,BLUE CROSS,ANTHEM HMO,6893.58,,,,,,,490.4000,8159.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2714.44,,,,,,,490.4000,8159.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8109.66,,,,,,,490.4000,8159.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,490.40,,,,,,,490.4000,8159.0000,fee schedule,$490.40 from Fee Schedule BLDTM_23 for Rev 510 Proc 15839 * Qty 1 = $490.40 at 100% = $490.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,BLUE CROSS,BLUE CROSS MEDICARE,2740.79,,,,,,,490.4000,8159.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,CIGNA HEALTHCARE,CIGNA HMO,3402.30,,,,,,,490.4000,8159.0000,percent of total billed charges,"41.7% of $8,159.00 in Billed Charges for Rev 510 Proc 15839 = $3,402.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3785.78,,,,,,,490.4000,8159.0000,percent of total billed charges,"46.4% of $8,159.00 in Billed Charges for Rev 510 Proc 15839 = $3,785.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,2767.14,,,,,,,490.4000,8159.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3402.30,,,,,,,490.4000,8159.0000,percent of total billed charges,"41.7% of $8,159.00 in Billed Charges for Rev 510 Proc 15839 = $3,402.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,CIGNA HEALTHCARE,CIGNA PPO,3402.30,,,,,,,490.4000,8159.0000,percent of total billed charges,"41.7% of $8,159.00 in Billed Charges for Rev 510 Proc 15839 = $3,402.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,2767.14,,,,,,,490.4000,8159.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7343.10,,,,,,,490.4000,8159.0000,percent of total billed charges,"90% of $8,159.00 in Billed Charges for Rev 510 Proc 15839 = $7,343.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,HUMANA,HUMANA MEDICARE,2635.37,,,,,,,490.4000,8159.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2635.37,,,,,,,490.4000,8159.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,MEDCOST,MEDCOST VHN,3882.87,,,,,,,490.4000,8159.0000,percent of total billed charges,"47.59% of $8,159.00 in Billed Charges for Rev 510 Proc 15839 = $3,882.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2600.24,,,,,,,490.4000,8159.0000,fee schedule,"APG 00011 Proc 15839 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 100% = $2,476.42... $2,476.42 at 105% = $2,600.24 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,2767.14,,,,,,,490.4000,8159.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,2767.14,,,,,,,490.4000,8159.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,NHC ADVANTAGE,NHC ADVANTAGE,2767.14,,,,,,,490.4000,8159.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2553.19,,,,,,,490.4000,8159.0000,fee schedule,"APG 00011 Proc 15839 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 100% = $2,476.42... $2,476.42 at 103.1% = $2,553.19 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,SENTARA HEALTH,SENTARA HEALTH,2105.84,,,,,,,490.4000,8159.0000,percent of total billed charges,"25.81% of $8,159.00 in Billed Charges for Rev 510 Proc 15839 = $2,105.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,SENTARA HEALTH,SENTARA MEDICARE,2635.37,,,,,,,490.4000,8159.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8159.00,,,,,,,490.4000,8159.0000,percent of total billed charges,"100% of $8,159.00 in Billed Charges for Rev 510 Proc 15839 = $8,159.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,670.71,,,,,,,490.4000,8159.0000,fee schedule,"$1,341.41 from Fee Schedule TCUHC24 for Rev 510 Proc 15839 * Qty 1 = $1,341.41 at 50% = $670.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2635.36,,,,,,,490.4000,8159.0000,other,"32.3% of $8,159.00 in Billed Charges for Rev 510 Proc 15839 = $2,635.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2504.81,,,,,,,490.4000,8159.0000,other,"30.7% of $8,159.00 in Billed Charges for Rev 510 Proc 15839 = $2,504.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,2635.36,,,,,,,490.4000,8159.0000,percent of total billed charges,"32.3% of $8,159.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2550.71,,,,,,,490.4000,8159.0000,fee schedule,"APG 00011 Proc 15839 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 103% = $2,550.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2635.37,,,,,,,490.4000,8159.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2635.37,,,,,,,490.4000,8159.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,WELLCARE,WELLCARE MEDICAID,8159.00,,,,,,,490.4000,8159.0000,percent of total billed charges,"100% of $8,159.00 in Billed Charges for Rev 510 Proc 15839 = $8,159.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCISE EXCESS SKIN & TISSUE,15839,CPT,510,RC,51000263,CDM,,,,both,,,8159.0000,1223.8500,WELLCARE,WELLCARE MEDICARE,2793.50,,,,,,,490.4000,8159.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA,603.35,,,,,,,109.0000,3180.3800,percent of total billed charges,"42.7% of $1,413.00 in Billed Charges for Rev 450 Proc 24675 = $603.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24675 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA HEALTHCARE MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,3180.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1413.00,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM EXCHANGE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24675 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HMO,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1413.00,,,,,,,109.0000,3180.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,370.92,,,,,,,109.0000,3180.3800,fee schedule,$370.92 from Fee Schedule BLDTM_23 for Rev 450 Proc 24675 * Qty 1 = $370.92 at 100% = $370.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1271.70,,,,,,,109.0000,3180.3800,percent of total billed charges,"90% of $1,413.00 in Billed Charges for Rev 450 Proc 24675 = $1,271.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,HUMANA,HUMANA MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,MEDCOST,MEDCOST VHN,672.45,,,,,,,109.0000,3180.3800,percent of total billed charges,"47.59% of $1,413.00 in Billed Charges for Rev 450 Proc 24675 = $672.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24675 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,NHC ADVANTAGE,NHC ADVANTAGE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24675 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA HEALTH,364.70,,,,,,,109.0000,3180.3800,percent of total billed charges,"25.81% of $1,413.00 in Billed Charges for Rev 450 Proc 24675 = $364.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1413.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 24675 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 24675 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 24675 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 24675 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 24675 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24675 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICAID,1413.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 24675 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX ULNAR FX PROX W MANIP,24675,CPT,450,RC,45000123,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,3180.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM WRIST,25246,CPT,361,RC,36100082,CDM,,,,both,,,405.0000,60.7500,AETNA,AETNA,172.94,,,,,,,37.6700,500.0000,percent of total billed charges,42.7% of $405.00 in Billed Charges for Rev 361 Proc 25246 = $172.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ ARTHROGRAM WRIST,25246,CPT,361,RC,36100082,CDM,,,,both,,,405.0000,60.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,495.24,,,,,,,37.6700,500.0000,fee schedule,APG 00278 Proc 25246 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 104% = $495.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM WRIST,25246,CPT,361,RC,36100082,CDM,,,,both,,,405.0000,60.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,405.00,,,,,,,37.6700,500.0000,fee schedule,"APG 00278 Proc 25246 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 103% = $490.48 (Service Line reduced to $405.00, claim capped at $405.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ARTHROGRAM WRIST,25246,CPT,361,RC,36100082,CDM,,,,both,,,405.0000,60.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,405.00,,,,,,,37.6700,500.0000,case rate,"Rev 361 Proc 25246 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $405.00 in Billed Charges - $0.00 in ASG Allowed Amount = $405.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ARTHROGRAM WRIST,25246,CPT,361,RC,36100082,CDM,,,,both,,,405.0000,60.7500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,37.6700,500.0000,case rate,Rev 361 Proc 25246 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM WRIST,25246,CPT,361,RC,36100082,CDM,,,,both,,,405.0000,60.7500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,37.6700,500.0000,case rate,Rev 361 Proc 25246 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM WRIST,25246,CPT,361,RC,36100082,CDM,,,,both,,,405.0000,60.7500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,37.6700,500.0000,case rate,Rev 361 Proc 25246 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM WRIST,25246,CPT,361,RC,36100082,CDM,,,,both,,,405.0000,60.7500,BLUE CROSS,TENNCARE BLUE CARE,37.67,,,,,,,37.6700,500.0000,fee schedule,$32.47 from Fee Schedule TC_24 for Rev 361 Proc 25246 * Qty 1 = $32.47 at 116% = $37.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM WRIST,25246,CPT,361,RC,36100082,CDM,,,,both,,,405.0000,60.7500,BLUE CROSS,TENNCARE BLUE SELECT,37.67,,,,,,,37.6700,500.0000,fee schedule,$32.47 from Fee Schedule TC_24 for Rev 361 Proc 25246 * Qty 1 = $32.47 at 116% = $37.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM WRIST,25246,CPT,361,RC,36100082,CDM,,,,both,,,405.0000,60.7500,CIGNA HEALTHCARE,CIGNA HMO,405.00,,,,,,,37.6700,500.0000,case rate,"Rev 361 Proc 25246 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $405.00 in Billed Charges - $0.00 in ASG Allowed Amount = $405.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ARTHROGRAM WRIST,25246,CPT,361,RC,36100082,CDM,,,,both,,,405.0000,60.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,405.00,,,,,,,37.6700,500.0000,case rate,"Rev 361 Proc 25246 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $405.00 in Billed Charges - $0.00 in ASG Allowed Amount = $405.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ARTHROGRAM WRIST,25246,CPT,361,RC,36100082,CDM,,,,both,,,405.0000,60.7500,CIGNA HEALTHCARE,CIGNA PPO,405.00,,,,,,,37.6700,500.0000,case rate,"Rev 361 Proc 25246 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $405.00 in Billed Charges - $0.00 in ASG Allowed Amount = $405.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ARTHROGRAM WRIST,25246,CPT,361,RC,36100082,CDM,,,,both,,,405.0000,60.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,364.50,,,,,,,37.6700,500.0000,percent of total billed charges,90% of $405.00 in Billed Charges for Rev 361 Proc 25246 = $364.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ ARTHROGRAM WRIST,25246,CPT,361,RC,36100082,CDM,,,,both,,,405.0000,60.7500,MEDCOST,MEDCOST VHN,192.74,,,,,,,37.6700,500.0000,percent of total billed charges,47.59% of $405.00 in Billed Charges for Rev 361 Proc 25246 = $192.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ ARTHROGRAM WRIST,25246,CPT,361,RC,36100082,CDM,,,,both,,,405.0000,60.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,500.00,,,,,,,37.6700,500.0000,fee schedule,APG 00278 Proc 25246 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 100% = $476.19... $476.19 at 105% = $500.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM WRIST,25246,CPT,361,RC,36100082,CDM,,,,both,,,405.0000,60.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,490.95,,,,,,,37.6700,500.0000,fee schedule,APG 00278 Proc 25246 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 100% = $476.19... $476.19 at 103.1% = $490.95 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM WRIST,25246,CPT,361,RC,36100082,CDM,,,,both,,,405.0000,60.7500,SENTARA HEALTH,SENTARA HEALTH,104.53,,,,,,,37.6700,500.0000,percent of total billed charges,25.81% of $405.00 in Billed Charges for Rev 361 Proc 25246 = $104.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ ARTHROGRAM WRIST,25246,CPT,361,RC,36100082,CDM,,,,both,,,405.0000,60.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",405.00,,,,,,,37.6700,500.0000,percent of total billed charges,100% of $405.00 in Billed Charges for Rev 361 Proc 25246 = $405.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ ARTHROGRAM WRIST,25246,CPT,361,RC,36100082,CDM,,,,both,,,405.0000,60.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,37.6700,500.0000,case rate,Rev 361 Proc 25246 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM WRIST,25246,CPT,361,RC,36100082,CDM,,,,both,,,405.0000,60.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,37.6700,500.0000,case rate,Rev 361 Proc 25246 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM WRIST,25246,CPT,361,RC,36100082,CDM,,,,both,,,405.0000,60.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,37.6700,500.0000,case rate,Rev 361 Proc 25246 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM WRIST,25246,CPT,361,RC,36100082,CDM,,,,both,,,405.0000,60.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,405.00,,,,,,,37.6700,500.0000,case rate,"Rev 361 Proc 25246 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total (Service Line reduced to $405.00, claim capped at $405.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ARTHROGRAM WRIST,25246,CPT,361,RC,36100082,CDM,,,,both,,,405.0000,60.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,490.48,,,,,,,37.6700,500.0000,fee schedule,APG 00278 Proc 25246 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 103% = $490.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM WRIST,25246,CPT,361,RC,36100082,CDM,,,,both,,,405.0000,60.7500,WELLCARE,WELLCARE MEDICAID,405.00,,,,,,,37.6700,500.0000,percent of total billed charges,100% of $405.00 in Billed Charges for Rev 361 Proc 25246 = $405.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,AETNA,AETNA,775.86,,,,,,,109.0000,1817.0000,percent of total billed charges,"42.7% of $1,817.00 in Billed Charges for Rev 450 Proc 12054 = $775.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,109.0000,1817.0000,fee schedule,"APG 00017 Proc 12054 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,109.0000,1817.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,1817.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,109.0000,1817.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,AMBETTER,AMBETTER,804.03,,,,,,,109.0000,1817.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,109.0000,1817.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,109.0000,1817.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,109.0000,1817.0000,fee schedule,"APG 00017 Proc 12054 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,109.0000,1817.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,109.0000,1817.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1134.94,,,,,,,109.0000,1817.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,234.84,,,,,,,109.0000,1817.0000,fee schedule,$234.84 from Fee Schedule BLDTM_23 for Rev 450 Proc 12054 * Qty 1 = $234.84 at 100% = $234.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,109.0000,1817.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,109.0000,1817.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,109.0000,1817.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1635.30,,,,,,,109.0000,1817.0000,percent of total billed charges,"90% of $1,817.00 in Billed Charges for Rev 450 Proc 12054 = $1,635.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,109.0000,1817.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,109.0000,1817.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,MEDCOST,MEDCOST VHN,864.71,,,,,,,109.0000,1817.0000,percent of total billed charges,"47.59% of $1,817.00 in Billed Charges for Rev 450 Proc 12054 = $864.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,109.0000,1817.0000,fee schedule,"APG 00017 Proc 12054 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,109.0000,1817.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,109.0000,1817.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,109.0000,1817.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,109.0000,1817.0000,fee schedule,"APG 00017 Proc 12054 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,SENTARA HEALTH,SENTARA HEALTH,468.97,,,,,,,109.0000,1817.0000,percent of total billed charges,"25.81% of $1,817.00 in Billed Charges for Rev 450 Proc 12054 = $468.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,109.0000,1817.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1817.00,,,,,,,109.0000,1817.0000,percent of total billed charges,"100% of $1,817.00 in Billed Charges for Rev 450 Proc 12054 = $1,817.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1817.0000,case rate,Rev 450 Proc 12054 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1817.0000,case rate,Rev 450 Proc 12054 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1817.0000,case rate,Rev 450 Proc 12054 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1817.0000,case rate,Rev 450 Proc 12054 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,109.0000,1817.0000,fee schedule,"APG 00017 Proc 12054 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,1817.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,109.0000,1817.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,WELLCARE,WELLCARE MEDICAID,1817.00,,,,,,,109.0000,1817.0000,percent of total billed charges,"100% of $1,817.00 in Billed Charges for Rev 450 Proc 12054 = $1,817.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WNDS F/E/N 7.6-12.5,12054,CPT,450,RC,45000063,CDM,,,,both,,,1817.0000,272.5500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,109.0000,1817.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,AETNA,AETNA,853.57,,,,,,,109.0000,1999.0000,percent of total billed charges,"42.7% of $1,999.00 in Billed Charges for Rev 450 Proc 12055 = $853.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,109.0000,1999.0000,fee schedule,"APG 00017 Proc 12055 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,109.0000,1999.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,1999.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,109.0000,1999.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,AMBETTER,AMBETTER,804.03,,,,,,,109.0000,1999.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,109.0000,1999.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,109.0000,1999.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,109.0000,1999.0000,fee schedule,"APG 00017 Proc 12055 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,109.0000,1999.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,109.0000,1999.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1134.94,,,,,,,109.0000,1999.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,298.29,,,,,,,109.0000,1999.0000,fee schedule,$298.29 from Fee Schedule BLDTM_23 for Rev 450 Proc 12055 * Qty 1 = $298.29 at 100% = $298.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,109.0000,1999.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,109.0000,1999.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,109.0000,1999.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1799.10,,,,,,,109.0000,1999.0000,percent of total billed charges,"90% of $1,999.00 in Billed Charges for Rev 450 Proc 12055 = $1,799.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,109.0000,1999.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,109.0000,1999.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,MEDCOST,MEDCOST VHN,951.32,,,,,,,109.0000,1999.0000,percent of total billed charges,"47.59% of $1,999.00 in Billed Charges for Rev 450 Proc 12055 = $951.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,109.0000,1999.0000,fee schedule,"APG 00017 Proc 12055 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,109.0000,1999.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,109.0000,1999.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,109.0000,1999.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,109.0000,1999.0000,fee schedule,"APG 00017 Proc 12055 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,SENTARA HEALTH,SENTARA HEALTH,515.94,,,,,,,109.0000,1999.0000,percent of total billed charges,"25.81% of $1,999.00 in Billed Charges for Rev 450 Proc 12055 = $515.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,109.0000,1999.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1999.00,,,,,,,109.0000,1999.0000,percent of total billed charges,"100% of $1,999.00 in Billed Charges for Rev 450 Proc 12055 = $1,999.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1999.0000,case rate,Rev 450 Proc 12055 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1999.0000,case rate,Rev 450 Proc 12055 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1999.0000,case rate,Rev 450 Proc 12055 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1999.0000,case rate,Rev 450 Proc 12055 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,109.0000,1999.0000,fee schedule,"APG 00017 Proc 12055 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,1999.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,109.0000,1999.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,WELLCARE,WELLCARE MEDICAID,1999.00,,,,,,,109.0000,1999.0000,percent of total billed charges,"100% of $1,999.00 in Billed Charges for Rev 450 Proc 12055 = $1,999.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND F/E/N 12.6-20.0,12055,CPT,450,RC,45000064,CDM,,,,both,,,1999.0000,299.8500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,109.0000,1999.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,AETNA,AETNA,757.07,,,,,,,81.6200,1773.0000,percent of total billed charges,"42.7% of $1,773.00 in Billed Charges for Rev 450 Proc 13100 = $757.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,81.6200,1773.0000,fee schedule,"APG 00009 Proc 13100 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,670.54,,,,,,,81.6200,1773.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,AETNA,AETNA HEALTHCARE MEDICARE,670.54,,,,,,,81.6200,1773.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,670.54,,,,,,,81.6200,1773.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,AMBETTER,AMBETTER,1461.78,,,,,,,81.6200,1773.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,697.36,,,,,,,81.6200,1773.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,BLUE CROSS,ANTHEM EXCHANGE,1650.91,,,,,,,81.6200,1773.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,81.6200,1773.0000,fee schedule,"APG 00009 Proc 13100 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,BLUE CROSS,ANTHEM HMO,1753.99,,,,,,,81.6200,1773.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,690.66,,,,,,,81.6200,1773.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1773.00,,,,,,,81.6200,1773.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,178.27,,,,,,,81.6200,1773.0000,fee schedule,$178.27 from Fee Schedule BLDTM_23 for Rev 450 Proc 13100 * Qty 1 = $178.27 at 100% = $178.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,BLUE CROSS,BLUE CROSS MEDICARE,697.36,,,,,,,81.6200,1773.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,BLUE CROSS,TENNCARE BLUE CARE,81.62,,,,,,,81.6200,1773.0000,fee schedule,$70.36 from Fee Schedule TC_24 for Rev 450 Proc 13100 * Qty 1 = $70.36 at 116% = $81.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,BLUE CROSS,TENNCARE BLUE SELECT,81.62,,,,,,,81.6200,1773.0000,fee schedule,$70.36 from Fee Schedule TC_24 for Rev 450 Proc 13100 * Qty 1 = $70.36 at 116% = $81.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,704.07,,,,,,,81.6200,1773.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,704.07,,,,,,,81.6200,1773.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1595.70,,,,,,,81.6200,1773.0000,percent of total billed charges,"90% of $1,773.00 in Billed Charges for Rev 450 Proc 13100 = $1,595.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,HUMANA,HUMANA MEDICARE,670.54,,,,,,,81.6200,1773.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,670.54,,,,,,,81.6200,1773.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,MEDCOST,MEDCOST VHN,843.77,,,,,,,81.6200,1773.0000,percent of total billed charges,"47.59% of $1,773.00 in Billed Charges for Rev 450 Proc 13100 = $843.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,81.6200,1773.0000,fee schedule,"APG 00009 Proc 13100 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,704.07,,,,,,,81.6200,1773.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,704.07,,,,,,,81.6200,1773.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,NHC ADVANTAGE,NHC ADVANTAGE,704.07,,,,,,,81.6200,1773.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,81.6200,1773.0000,fee schedule,"APG 00009 Proc 13100 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,SENTARA HEALTH,SENTARA HEALTH,457.61,,,,,,,81.6200,1773.0000,percent of total billed charges,"25.81% of $1,773.00 in Billed Charges for Rev 450 Proc 13100 = $457.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,SENTARA HEALTH,SENTARA MEDICARE,670.54,,,,,,,81.6200,1773.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1773.00,,,,,,,81.6200,1773.0000,percent of total billed charges,"100% of $1,773.00 in Billed Charges for Rev 450 Proc 13100 = $1,773.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,81.6200,1773.0000,case rate,Rev 450 Proc 13100 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,81.6200,1773.0000,case rate,Rev 450 Proc 13100 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,81.6200,1773.0000,case rate,Rev 450 Proc 13100 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,81.6200,1773.0000,case rate,Rev 450 Proc 13100 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,81.6200,1773.0000,fee schedule,"APG 00009 Proc 13100 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,670.54,,,,,,,81.6200,1773.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,670.54,,,,,,,81.6200,1773.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,WELLCARE,WELLCARE MEDICAID,1773.00,,,,,,,81.6200,1773.0000,percent of total billed charges,"100% of $1,773.00 in Billed Charges for Rev 450 Proc 13100 = $1,773.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPLX RPR TRUNK 1.1-2.5 CM,13100,CPT,450,RC,45000356,CDM,,,,both,,,1773.0000,265.9500,WELLCARE,WELLCARE MEDICARE,710.77,,,,,,,81.6200,1773.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,AETNA,AETNA,1207.56,,,,,,,109.0000,2828.0000,percent of total billed charges,"42.7% of $2,828.00 in Billed Charges for Rev 450 Proc 13121 = $1,207.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,109.0000,2828.0000,fee schedule,"APG 00009 Proc 13121 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,109.0000,2828.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,2828.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,109.0000,2828.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,AMBETTER,AMBETTER,804.03,,,,,,,109.0000,2828.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,109.0000,2828.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,109.0000,2828.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,109.0000,2828.0000,fee schedule,"APG 00009 Proc 13121 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,109.0000,2828.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,109.0000,2828.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1134.94,,,,,,,109.0000,2828.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,274.31,,,,,,,109.0000,2828.0000,fee schedule,$274.31 from Fee Schedule BLDTM_23 for Rev 450 Proc 13121 * Qty 1 = $274.31 at 100% = $274.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,109.0000,2828.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,109.0000,2828.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,109.0000,2828.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2545.20,,,,,,,109.0000,2828.0000,percent of total billed charges,"90% of $2,828.00 in Billed Charges for Rev 450 Proc 13121 = $2,545.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,HUMANA,HUMANA MEDICARE,368.82,,,,,,,109.0000,2828.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,109.0000,2828.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,MEDCOST,MEDCOST VHN,1345.85,,,,,,,109.0000,2828.0000,percent of total billed charges,"47.59% of $2,828.00 in Billed Charges for Rev 450 Proc 13121 = $1,345.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,109.0000,2828.0000,fee schedule,"APG 00009 Proc 13121 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,109.0000,2828.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,109.0000,2828.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,109.0000,2828.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,109.0000,2828.0000,fee schedule,"APG 00009 Proc 13121 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,SENTARA HEALTH,SENTARA HEALTH,729.91,,,,,,,109.0000,2828.0000,percent of total billed charges,"25.81% of $2,828.00 in Billed Charges for Rev 450 Proc 13121 = $729.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,109.0000,2828.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2828.00,,,,,,,109.0000,2828.0000,percent of total billed charges,"100% of $2,828.00 in Billed Charges for Rev 450 Proc 13121 = $2,828.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,2828.0000,case rate,Rev 450 Proc 13121 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,2828.0000,case rate,Rev 450 Proc 13121 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,2828.0000,case rate,Rev 450 Proc 13121 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,2828.0000,case rate,Rev 450 Proc 13121 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,109.0000,2828.0000,fee schedule,"APG 00009 Proc 13121 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,2828.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,109.0000,2828.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,WELLCARE,WELLCARE MEDICAID,2828.00,,,,,,,109.0000,2828.0000,percent of total billed charges,"100% of $2,828.00 in Billed Charges for Rev 450 Proc 13121 = $2,828.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CMPLX RPR SCLP ARM LEG 2.6-7.5,13121,CPT,450,RC,45000069,CDM,,,,both,,,2828.0000,424.2000,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,109.0000,2828.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMP RPR SCLP ARM LEG EA ADD 5C,13122,CPT,450,RC,45000070,CDM,,,,both,,,2580.0000,387.0000,AETNA,AETNA,1101.66,,,,,,,82.3000,2580.0000,percent of total billed charges,"42.7% of $2,580.00 in Billed Charges for Rev 450 Proc 13122 = $1,101.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CMP RPR SCLP ARM LEG EA ADD 5C,13122,CPT,450,RC,45000070,CDM,,,,both,,,2580.0000,387.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,82.3000,2580.0000,fee schedule,APG 00009 Proc 13122 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMP RPR SCLP ARM LEG EA ADD 5C,13122,CPT,450,RC,45000070,CDM,,,,both,,,2580.0000,387.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,82.3000,2580.0000,fee schedule,APG 00009 Proc 13122 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMP RPR SCLP ARM LEG EA ADD 5C,13122,CPT,450,RC,45000070,CDM,,,,both,,,2580.0000,387.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,82.30,,,,,,,82.3000,2580.0000,fee schedule,$82.30 from Fee Schedule BLDTM_23 for Rev 450 Proc 13122 * Qty 1 = $82.30 at 100% = $82.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMP RPR SCLP ARM LEG EA ADD 5C,13122,CPT,450,RC,45000070,CDM,,,,both,,,2580.0000,387.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2322.00,,,,,,,82.3000,2580.0000,percent of total billed charges,"90% of $2,580.00 in Billed Charges for Rev 450 Proc 13122 = $2,322.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CMP RPR SCLP ARM LEG EA ADD 5C,13122,CPT,450,RC,45000070,CDM,,,,both,,,2580.0000,387.0000,MEDCOST,MEDCOST VHN,1227.82,,,,,,,82.3000,2580.0000,percent of total billed charges,"47.59% of $2,580.00 in Billed Charges for Rev 450 Proc 13122 = $1,227.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CMP RPR SCLP ARM LEG EA ADD 5C,13122,CPT,450,RC,45000070,CDM,,,,both,,,2580.0000,387.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,82.3000,2580.0000,fee schedule,APG 00009 Proc 13122 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMP RPR SCLP ARM LEG EA ADD 5C,13122,CPT,450,RC,45000070,CDM,,,,both,,,2580.0000,387.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,82.3000,2580.0000,fee schedule,APG 00009 Proc 13122 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMP RPR SCLP ARM LEG EA ADD 5C,13122,CPT,450,RC,45000070,CDM,,,,both,,,2580.0000,387.0000,SENTARA HEALTH,SENTARA HEALTH,665.90,,,,,,,82.3000,2580.0000,percent of total billed charges,"25.81% of $2,580.00 in Billed Charges for Rev 450 Proc 13122 = $665.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CMP RPR SCLP ARM LEG EA ADD 5C,13122,CPT,450,RC,45000070,CDM,,,,both,,,2580.0000,387.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2580.00,,,,,,,82.3000,2580.0000,percent of total billed charges,"100% of $2,580.00 in Billed Charges for Rev 450 Proc 13122 = $2,580.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CMP RPR SCLP ARM LEG EA ADD 5C,13122,CPT,450,RC,45000070,CDM,,,,both,,,2580.0000,387.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,82.3000,2580.0000,case rate,Rev 450 Proc 13122 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMP RPR SCLP ARM LEG EA ADD 5C,13122,CPT,450,RC,45000070,CDM,,,,both,,,2580.0000,387.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,82.3000,2580.0000,case rate,Rev 450 Proc 13122 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMP RPR SCLP ARM LEG EA ADD 5C,13122,CPT,450,RC,45000070,CDM,,,,both,,,2580.0000,387.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,82.3000,2580.0000,case rate,Rev 450 Proc 13122 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMP RPR SCLP ARM LEG EA ADD 5C,13122,CPT,450,RC,45000070,CDM,,,,both,,,2580.0000,387.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,82.3000,2580.0000,case rate,Rev 450 Proc 13122 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMP RPR SCLP ARM LEG EA ADD 5C,13122,CPT,450,RC,45000070,CDM,,,,both,,,2580.0000,387.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,82.3000,2580.0000,fee schedule,APG 00009 Proc 13122 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMP RPR SCLP ARM LEG EA ADD 5C,13122,CPT,450,RC,45000070,CDM,,,,both,,,2580.0000,387.0000,WELLCARE,WELLCARE MEDICAID,2580.00,,,,,,,82.3000,2580.0000,percent of total billed charges,"100% of $2,580.00 in Billed Charges for Rev 450 Proc 13122 = $2,580.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,AETNA,AETNA,1221.22,,,,,,,109.0000,2860.0000,percent of total billed charges,"42.7% of $2,860.00 in Billed Charges for Rev 450 Proc 13131 = $1,221.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,109.0000,2860.0000,fee schedule,"APG 00009 Proc 13131 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,109.0000,2860.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,2860.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,109.0000,2860.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,AMBETTER,AMBETTER,804.03,,,,,,,109.0000,2860.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,109.0000,2860.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,109.0000,2860.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,109.0000,2860.0000,fee schedule,"APG 00009 Proc 13131 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,109.0000,2860.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,109.0000,2860.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1134.94,,,,,,,109.0000,2860.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,232.24,,,,,,,109.0000,2860.0000,fee schedule,$232.24 from Fee Schedule BLDTM_23 for Rev 450 Proc 13131 * Qty 1 = $232.24 at 100% = $232.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,109.0000,2860.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,BLUE CROSS,TENNCARE BLUE CARE,109.86,,,,,,,109.0000,2860.0000,fee schedule,$94.71 from Fee Schedule TC_24 for Rev 450 Proc 13131 * Qty 1 = $94.71 at 116% = $109.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,BLUE CROSS,TENNCARE BLUE SELECT,109.86,,,,,,,109.0000,2860.0000,fee schedule,$94.71 from Fee Schedule TC_24 for Rev 450 Proc 13131 * Qty 1 = $94.71 at 116% = $109.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,109.0000,2860.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,109.0000,2860.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2574.00,,,,,,,109.0000,2860.0000,percent of total billed charges,"90% of $2,860.00 in Billed Charges for Rev 450 Proc 13131 = $2,574.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,HUMANA,HUMANA MEDICARE,368.82,,,,,,,109.0000,2860.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,109.0000,2860.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,MEDCOST,MEDCOST VHN,1361.07,,,,,,,109.0000,2860.0000,percent of total billed charges,"47.59% of $2,860.00 in Billed Charges for Rev 450 Proc 13131 = $1,361.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,109.0000,2860.0000,fee schedule,"APG 00009 Proc 13131 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,109.0000,2860.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,109.0000,2860.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,109.0000,2860.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,109.0000,2860.0000,fee schedule,"APG 00009 Proc 13131 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,SENTARA HEALTH,SENTARA HEALTH,738.17,,,,,,,109.0000,2860.0000,percent of total billed charges,"25.81% of $2,860.00 in Billed Charges for Rev 450 Proc 13131 = $738.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,109.0000,2860.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2860.00,,,,,,,109.0000,2860.0000,percent of total billed charges,"100% of $2,860.00 in Billed Charges for Rev 450 Proc 13131 = $2,860.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,2860.0000,case rate,Rev 450 Proc 13131 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,2860.0000,case rate,Rev 450 Proc 13131 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,2860.0000,case rate,Rev 450 Proc 13131 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,2860.0000,case rate,Rev 450 Proc 13131 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,109.0000,2860.0000,fee schedule,"APG 00009 Proc 13131 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,2860.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,109.0000,2860.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,WELLCARE,WELLCARE MEDICAID,2860.00,,,,,,,109.0000,2860.0000,percent of total billed charges,"100% of $2,860.00 in Billed Charges for Rev 450 Proc 13131 = $2,860.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RPR CMPLX FORHEAD FT 1.1-2.5,13131,CPT,450,RC,45000071,CDM,,,,both,,,2860.0000,429.0000,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,109.0000,2860.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,AETNA,AETNA,1225.49,,,,,,,109.0000,2870.0000,percent of total billed charges,"42.7% of $2,870.00 in Billed Charges for Rev 450 Proc 13132 = $1,225.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,109.0000,2870.0000,fee schedule,"APG 00009 Proc 13132 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,109.0000,2870.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,2870.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,109.0000,2870.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,AMBETTER,AMBETTER,804.03,,,,,,,109.0000,2870.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,109.0000,2870.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,109.0000,2870.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,109.0000,2870.0000,fee schedule,"APG 00009 Proc 13132 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,109.0000,2870.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,109.0000,2870.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1134.94,,,,,,,109.0000,2870.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,398.14,,,,,,,109.0000,2870.0000,fee schedule,$398.14 from Fee Schedule BLDTM_23 for Rev 450 Proc 13132 * Qty 1 = $398.14 at 100% = $398.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,109.0000,2870.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,109.0000,2870.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,109.0000,2870.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2583.00,,,,,,,109.0000,2870.0000,percent of total billed charges,"90% of $2,870.00 in Billed Charges for Rev 450 Proc 13132 = $2,583.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,HUMANA,HUMANA MEDICARE,368.82,,,,,,,109.0000,2870.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,109.0000,2870.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,MEDCOST,MEDCOST VHN,1365.83,,,,,,,109.0000,2870.0000,percent of total billed charges,"47.59% of $2,870.00 in Billed Charges for Rev 450 Proc 13132 = $1,365.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,109.0000,2870.0000,fee schedule,"APG 00009 Proc 13132 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,109.0000,2870.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,109.0000,2870.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,109.0000,2870.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,109.0000,2870.0000,fee schedule,"APG 00009 Proc 13132 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,SENTARA HEALTH,SENTARA HEALTH,740.75,,,,,,,109.0000,2870.0000,percent of total billed charges,"25.81% of $2,870.00 in Billed Charges for Rev 450 Proc 13132 = $740.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,109.0000,2870.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2870.00,,,,,,,109.0000,2870.0000,percent of total billed charges,"100% of $2,870.00 in Billed Charges for Rev 450 Proc 13132 = $2,870.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,2870.0000,case rate,Rev 450 Proc 13132 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,2870.0000,case rate,Rev 450 Proc 13132 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,2870.0000,case rate,Rev 450 Proc 13132 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,2870.0000,case rate,Rev 450 Proc 13132 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,109.0000,2870.0000,fee schedule,"APG 00009 Proc 13132 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,2870.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,109.0000,2870.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,WELLCARE,WELLCARE MEDICAID,2870.00,,,,,,,109.0000,2870.0000,percent of total billed charges,"100% of $2,870.00 in Billed Charges for Rev 450 Proc 13132 = $2,870.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RPR CMPLX FRHEAD FT 2.6-7.5,13132,CPT,450,RC,45000072,CDM,,,,both,,,2870.0000,430.5000,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,109.0000,2870.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CPLX FRHEAD FT EA ADD 5,13133,CPT,450,RC,45000073,CDM,,,,both,,,2084.0000,312.6000,AETNA,AETNA,889.87,,,,,,,109.0000,2084.0000,percent of total billed charges,"42.7% of $2,084.00 in Billed Charges for Rev 450 Proc 13133 = $889.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RPR CPLX FRHEAD FT EA ADD 5,13133,CPT,450,RC,45000073,CDM,,,,both,,,2084.0000,312.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,109.0000,2084.0000,fee schedule,APG 00009 Proc 13133 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CPLX FRHEAD FT EA ADD 5,13133,CPT,450,RC,45000073,CDM,,,,both,,,2084.0000,312.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,109.0000,2084.0000,fee schedule,APG 00009 Proc 13133 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CPLX FRHEAD FT EA ADD 5,13133,CPT,450,RC,45000073,CDM,,,,both,,,2084.0000,312.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,127.41,,,,,,,109.0000,2084.0000,fee schedule,$127.41 from Fee Schedule BLDTM_23 for Rev 450 Proc 13133 * Qty 1 = $127.41 at 100% = $127.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CPLX FRHEAD FT EA ADD 5,13133,CPT,450,RC,45000073,CDM,,,,both,,,2084.0000,312.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1875.60,,,,,,,109.0000,2084.0000,percent of total billed charges,"90% of $2,084.00 in Billed Charges for Rev 450 Proc 13133 = $1,875.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RPR CPLX FRHEAD FT EA ADD 5,13133,CPT,450,RC,45000073,CDM,,,,both,,,2084.0000,312.6000,MEDCOST,MEDCOST VHN,991.78,,,,,,,109.0000,2084.0000,percent of total billed charges,"47.59% of $2,084.00 in Billed Charges for Rev 450 Proc 13133 = $991.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RPR CPLX FRHEAD FT EA ADD 5,13133,CPT,450,RC,45000073,CDM,,,,both,,,2084.0000,312.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,109.0000,2084.0000,fee schedule,APG 00009 Proc 13133 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CPLX FRHEAD FT EA ADD 5,13133,CPT,450,RC,45000073,CDM,,,,both,,,2084.0000,312.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,109.0000,2084.0000,fee schedule,APG 00009 Proc 13133 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CPLX FRHEAD FT EA ADD 5,13133,CPT,450,RC,45000073,CDM,,,,both,,,2084.0000,312.6000,SENTARA HEALTH,SENTARA HEALTH,537.88,,,,,,,109.0000,2084.0000,percent of total billed charges,"25.81% of $2,084.00 in Billed Charges for Rev 450 Proc 13133 = $537.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RPR CPLX FRHEAD FT EA ADD 5,13133,CPT,450,RC,45000073,CDM,,,,both,,,2084.0000,312.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2084.00,,,,,,,109.0000,2084.0000,percent of total billed charges,"100% of $2,084.00 in Billed Charges for Rev 450 Proc 13133 = $2,084.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RPR CPLX FRHEAD FT EA ADD 5,13133,CPT,450,RC,45000073,CDM,,,,both,,,2084.0000,312.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,2084.0000,case rate,Rev 450 Proc 13133 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CPLX FRHEAD FT EA ADD 5,13133,CPT,450,RC,45000073,CDM,,,,both,,,2084.0000,312.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,2084.0000,case rate,Rev 450 Proc 13133 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CPLX FRHEAD FT EA ADD 5,13133,CPT,450,RC,45000073,CDM,,,,both,,,2084.0000,312.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,2084.0000,case rate,Rev 450 Proc 13133 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CPLX FRHEAD FT EA ADD 5,13133,CPT,450,RC,45000073,CDM,,,,both,,,2084.0000,312.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,2084.0000,case rate,Rev 450 Proc 13133 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CPLX FRHEAD FT EA ADD 5,13133,CPT,450,RC,45000073,CDM,,,,both,,,2084.0000,312.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,109.0000,2084.0000,fee schedule,APG 00009 Proc 13133 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RPR CPLX FRHEAD FT EA ADD 5,13133,CPT,450,RC,45000073,CDM,,,,both,,,2084.0000,312.6000,WELLCARE,WELLCARE MEDICAID,2084.00,,,,,,,109.0000,2084.0000,percent of total billed charges,"100% of $2,084.00 in Billed Charges for Rev 450 Proc 13133 = $2,084.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,AETNA,AETNA,1348.04,,,,,,,109.0000,3157.0000,percent of total billed charges,"42.7% of $3,157.00 in Billed Charges for Rev 450 Proc 13152 = $1,348.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,109.0000,3157.0000,fee schedule,"APG 00009 Proc 13152 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,670.54,,,,,,,109.0000,3157.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,AETNA,AETNA HEALTHCARE MEDICARE,670.54,,,,,,,109.0000,3157.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,670.54,,,,,,,109.0000,3157.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,AMBETTER,AMBETTER,1461.78,,,,,,,109.0000,3157.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,697.36,,,,,,,109.0000,3157.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,BLUE CROSS,ANTHEM EXCHANGE,1650.91,,,,,,,109.0000,3157.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,109.0000,3157.0000,fee schedule,"APG 00009 Proc 13152 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,BLUE CROSS,ANTHEM HMO,1753.99,,,,,,,109.0000,3157.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,690.66,,,,,,,109.0000,3157.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2063.41,,,,,,,109.0000,3157.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,441.75,,,,,,,109.0000,3157.0000,fee schedule,$441.75 from Fee Schedule BLDTM_23 for Rev 450 Proc 13152 * Qty 1 = $441.75 at 100% = $441.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,BLUE CROSS,BLUE CROSS MEDICARE,697.36,,,,,,,109.0000,3157.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,704.07,,,,,,,109.0000,3157.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,704.07,,,,,,,109.0000,3157.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2841.30,,,,,,,109.0000,3157.0000,percent of total billed charges,"90% of $3,157.00 in Billed Charges for Rev 450 Proc 13152 = $2,841.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,HUMANA,HUMANA MEDICARE,670.54,,,,,,,109.0000,3157.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,670.54,,,,,,,109.0000,3157.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,MEDCOST,MEDCOST VHN,1502.42,,,,,,,109.0000,3157.0000,percent of total billed charges,"47.59% of $3,157.00 in Billed Charges for Rev 450 Proc 13152 = $1,502.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,109.0000,3157.0000,fee schedule,"APG 00009 Proc 13152 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,704.07,,,,,,,109.0000,3157.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,704.07,,,,,,,109.0000,3157.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,NHC ADVANTAGE,NHC ADVANTAGE,704.07,,,,,,,109.0000,3157.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,109.0000,3157.0000,fee schedule,"APG 00009 Proc 13152 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,SENTARA HEALTH,SENTARA HEALTH,814.82,,,,,,,109.0000,3157.0000,percent of total billed charges,"25.81% of $3,157.00 in Billed Charges for Rev 450 Proc 13152 = $814.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,SENTARA HEALTH,SENTARA MEDICARE,670.54,,,,,,,109.0000,3157.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3157.00,,,,,,,109.0000,3157.0000,percent of total billed charges,"100% of $3,157.00 in Billed Charges for Rev 450 Proc 13152 = $3,157.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3157.0000,case rate,Rev 450 Proc 13152 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3157.0000,case rate,Rev 450 Proc 13152 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3157.0000,case rate,Rev 450 Proc 13152 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3157.0000,case rate,Rev 450 Proc 13152 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,109.0000,3157.0000,fee schedule,"APG 00009 Proc 13152 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,670.54,,,,,,,109.0000,3157.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,670.54,,,,,,,109.0000,3157.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,WELLCARE,WELLCARE MEDICAID,3157.00,,,,,,,109.0000,3157.0000,percent of total billed charges,"100% of $3,157.00 in Billed Charges for Rev 450 Proc 13152 = $3,157.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPR CMPLX EYELD LIPS 2.6-7.5,13152,CPT,450,RC,45000076,CDM,,,,both,,,3157.0000,473.5500,WELLCARE,WELLCARE MEDICARE,710.77,,,,,,,109.0000,3157.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,AETNA,AETNA,3491.58,,,,,,,109.0000,8177.0000,percent of total billed charges,"42.7% of $8,177.00 in Billed Charges for Rev 450 Proc 14301 = $3,491.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2774.03,,,,,,,109.0000,8177.0000,fee schedule,"APG 00056 Proc 14301 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 104% = $2,774.03. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3215.13,,,,,,,109.0000,8177.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,AETNA,AETNA HEALTHCARE MEDICARE,3215.13,,,,,,,109.0000,8177.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,3215.13,,,,,,,109.0000,8177.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,AMBETTER,AMBETTER,7008.99,,,,,,,109.0000,8177.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3343.74,,,,,,,109.0000,8177.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,BLUE CROSS,ANTHEM EXCHANGE,7915.83,,,,,,,109.0000,8177.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2747.35,,,,,,,109.0000,8177.0000,fee schedule,"APG 00056 Proc 14301 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 103% = $2,747.35. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,BLUE CROSS,ANTHEM HMO,8177.00,,,,,,,109.0000,8177.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3311.59,,,,,,,109.0000,8177.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8177.00,,,,,,,109.0000,8177.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,979.76,,,,,,,109.0000,8177.0000,fee schedule,$979.76 from Fee Schedule BLDTM_23 for Rev 450 Proc 14301 * Qty 1 = $979.76 at 100% = $979.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,BLUE CROSS,BLUE CROSS MEDICARE,3343.74,,,,,,,109.0000,8177.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,3375.89,,,,,,,109.0000,8177.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3375.89,,,,,,,109.0000,8177.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7359.30,,,,,,,109.0000,8177.0000,percent of total billed charges,"90% of $8,177.00 in Billed Charges for Rev 450 Proc 14301 = $7,359.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,HUMANA,HUMANA MEDICARE,3215.13,,,,,,,109.0000,8177.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3215.13,,,,,,,109.0000,8177.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,MEDCOST,MEDCOST VHN,3891.43,,,,,,,109.0000,8177.0000,percent of total billed charges,"47.59% of $8,177.00 in Billed Charges for Rev 450 Proc 14301 = $3,891.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2800.70,,,,,,,109.0000,8177.0000,fee schedule,"APG 00056 Proc 14301 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 100% = $2,667.33... $2,667.33 at 105% = $2,800.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3375.89,,,,,,,109.0000,8177.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3375.89,,,,,,,109.0000,8177.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,NHC ADVANTAGE,NHC ADVANTAGE,3375.89,,,,,,,109.0000,8177.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2750.02,,,,,,,109.0000,8177.0000,fee schedule,"APG 00056 Proc 14301 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 100% = $2,667.33... $2,667.33 at 103.1% = $2,750.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,SENTARA HEALTH,SENTARA HEALTH,2110.48,,,,,,,109.0000,8177.0000,percent of total billed charges,"25.81% of $8,177.00 in Billed Charges for Rev 450 Proc 14301 = $2,110.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,SENTARA HEALTH,SENTARA MEDICARE,3215.13,,,,,,,109.0000,8177.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8177.00,,,,,,,109.0000,8177.0000,percent of total billed charges,"100% of $8,177.00 in Billed Charges for Rev 450 Proc 14301 = $8,177.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,8177.0000,case rate,Rev 450 Proc 14301 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,8177.0000,case rate,Rev 450 Proc 14301 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,8177.0000,case rate,Rev 450 Proc 14301 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,8177.0000,case rate,Rev 450 Proc 14301 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2747.35,,,,,,,109.0000,8177.0000,fee schedule,"APG 00056 Proc 14301 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,667.33 at 103% = $2,747.35. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3215.13,,,,,,,109.0000,8177.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3215.13,,,,,,,109.0000,8177.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,WELLCARE,WELLCARE MEDICAID,8177.00,,,,,,,109.0000,8177.0000,percent of total billed charges,"100% of $8,177.00 in Billed Charges for Rev 450 Proc 14301 = $8,177.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ADJ TISS TRANSFER ANY AREA 30.1 SQ CM-60.0 SQ CM,14301,CPT,450,RC,45000334,CDM,,,,both,,,8177.0000,1226.5500,WELLCARE,WELLCARE MEDICARE,3408.04,,,,,,,109.0000,8177.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA,353.13,,,,,,,103.5900,827.0000,percent of total billed charges,42.7% of $827.00 in Billed Charges for Rev 450 Proc 23620 = $353.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,103.5900,827.0000,fee schedule,"APG 00041 Proc 23620 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,103.5900,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,103.5900,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,103.5900,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,AMBETTER,AMBETTER,487.87,,,,,,,103.5900,827.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,103.5900,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,103.5900,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,103.5900,827.0000,fee schedule,"APG 00041 Proc 23620 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,103.5900,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,103.5900,827.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,103.5900,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,195.42,,,,,,,103.5900,827.0000,fee schedule,$195.42 from Fee Schedule BLDTM_23 for Rev 450 Proc 23620 * Qty 1 = $195.42 at 100% = $195.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,103.5900,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,TENNCARE BLUE CARE,103.59,,,,,,,103.5900,827.0000,fee schedule,$89.30 from Fee Schedule TC_24 for Rev 450 Proc 23620 * Qty 1 = $89.30 at 116% = $103.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,TENNCARE BLUE SELECT,103.59,,,,,,,103.5900,827.0000,fee schedule,$89.30 from Fee Schedule TC_24 for Rev 450 Proc 23620 * Qty 1 = $89.30 at 116% = $103.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,103.5900,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,103.5900,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,744.30,,,,,,,103.5900,827.0000,percent of total billed charges,90% of $827.00 in Billed Charges for Rev 450 Proc 23620 = $744.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,103.5900,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,103.5900,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,MEDCOST,MEDCOST VHN,393.57,,,,,,,103.5900,827.0000,percent of total billed charges,47.59% of $827.00 in Billed Charges for Rev 450 Proc 23620 = $393.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,103.5900,827.0000,fee schedule,"APG 00041 Proc 23620 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,103.5900,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,103.5900,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,103.5900,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,103.5900,827.0000,fee schedule,"APG 00041 Proc 23620 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA HEALTH,213.45,,,,,,,103.5900,827.0000,percent of total billed charges,25.81% of $827.00 in Billed Charges for Rev 450 Proc 23620 = $213.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,103.5900,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",827.00,,,,,,,103.5900,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 23620 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,103.5900,827.0000,case rate,Rev 450 Proc 23620 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,103.5900,827.0000,case rate,Rev 450 Proc 23620 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,103.5900,827.0000,case rate,Rev 450 Proc 23620 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,827.00,,,,,,,103.5900,827.0000,case rate,"Rev 450 Proc 23620 at Case Rate $847.00 (Service Line reduced to $827.00, claim capped at $827.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,103.5900,827.0000,fee schedule,"APG 00041 Proc 23620 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,103.5900,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,103.5900,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICAID,827.00,,,,,,,103.5900,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 23620 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W/O MANIP,23620,CPT,450,RC,45000374,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,103.5900,827.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA,180.19,,,,,,,108.9200,703.3600,percent of total billed charges,42.7% of $422.00 in Billed Charges for Rev 450 Proc 25500 = $180.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 25500 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,AMBETTER,AMBETTER,487.87,,,,,,,108.9200,703.3600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,108.9200,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM EXCHANGE,422.00,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,422.00,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 25500 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HMO,422.00,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,108.9200,703.3600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",422.00,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,191.76,,,,,,,108.9200,703.3600,fee schedule,$191.76 from Fee Schedule BLDTM_23 for Rev 450 Proc 25500 * Qty 1 = $191.76 at 100% = $191.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,108.9200,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,379.80,,,,,,,108.9200,703.3600,percent of total billed charges,90% of $422.00 in Billed Charges for Rev 450 Proc 25500 = $379.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,MEDCOST,MEDCOST VHN,200.83,,,,,,,108.9200,703.3600,percent of total billed charges,47.59% of $422.00 in Billed Charges for Rev 450 Proc 25500 = $200.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 25500 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 25500 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA HEALTH,108.92,,,,,,,108.9200,703.3600,percent of total billed charges,25.81% of $422.00 in Billed Charges for Rev 450 Proc 25500 = $108.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",422.00,,,,,,,108.9200,703.3600,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 25500 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,108.9200,703.3600,case rate,Rev 450 Proc 25500 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,422.00,,,,,,,108.9200,703.3600,case rate,"Rev 450 Proc 25500 at Case Rate $491.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,422.00,,,,,,,108.9200,703.3600,case rate,"Rev 450 Proc 25500 at Case Rate $471.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,422.00,,,,,,,108.9200,703.3600,case rate,"Rev 450 Proc 25500 at Case Rate $847.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 25500 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICAID,422.00,,,,,,,108.9200,703.3600,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 25500 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC RADIAL SHAFT FRACT W/O MANIP,25500,CPT,450,RC,45000125,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,108.9200,703.3600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA,180.19,,,,,,,108.9200,703.3600,percent of total billed charges,42.7% of $422.00 in Billed Charges for Rev 450 Proc 25530 = $180.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 25530 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,AMBETTER,AMBETTER,487.87,,,,,,,108.9200,703.3600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,108.9200,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM EXCHANGE,422.00,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,422.00,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 25530 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HMO,422.00,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,108.9200,703.3600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",422.00,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,183.63,,,,,,,108.9200,703.3600,fee schedule,$183.63 from Fee Schedule BLDTM_23 for Rev 450 Proc 25530 * Qty 1 = $183.63 at 100% = $183.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,108.9200,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,379.80,,,,,,,108.9200,703.3600,percent of total billed charges,90% of $422.00 in Billed Charges for Rev 450 Proc 25530 = $379.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,MEDCOST,MEDCOST VHN,200.83,,,,,,,108.9200,703.3600,percent of total billed charges,47.59% of $422.00 in Billed Charges for Rev 450 Proc 25530 = $200.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 25530 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 25530 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA HEALTH,108.92,,,,,,,108.9200,703.3600,percent of total billed charges,25.81% of $422.00 in Billed Charges for Rev 450 Proc 25530 = $108.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",422.00,,,,,,,108.9200,703.3600,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 25530 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,108.9200,703.3600,case rate,Rev 450 Proc 25530 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,422.00,,,,,,,108.9200,703.3600,case rate,"Rev 450 Proc 25530 at Case Rate $491.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,422.00,,,,,,,108.9200,703.3600,case rate,"Rev 450 Proc 25530 at Case Rate $471.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,422.00,,,,,,,108.9200,703.3600,case rate,"Rev 450 Proc 25530 at Case Rate $847.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 25530 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICAID,422.00,,,,,,,108.9200,703.3600,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 25530 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ULNAR SHAFT FRACT W/O MANIP,25530,CPT,450,RC,45000127,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,108.9200,703.3600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,AETNA,AETNA,527.35,,,,,,,87.8900,1235.0000,percent of total billed charges,"42.7% of $1,235.00 in Billed Charges for Rev 450 Proc 25560 = $527.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,87.8900,1235.0000,fee schedule,"APG 00041 Proc 25560 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,87.8900,1235.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,87.8900,1235.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,87.8900,1235.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,AMBETTER,AMBETTER,487.87,,,,,,,87.8900,1235.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,87.8900,1235.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,87.8900,1235.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,87.8900,1235.0000,fee schedule,"APG 00041 Proc 25560 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,87.8900,1235.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,87.8900,1235.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,87.8900,1235.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,189.76,,,,,,,87.8900,1235.0000,fee schedule,$189.76 from Fee Schedule BLDTM_23 for Rev 450 Proc 25560 * Qty 1 = $189.76 at 100% = $189.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,87.8900,1235.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,BLUE CROSS,TENNCARE BLUE CARE,87.89,,,,,,,87.8900,1235.0000,fee schedule,$75.77 from Fee Schedule TC_24 for Rev 450 Proc 25560 * Qty 1 = $75.77 at 116% = $87.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,BLUE CROSS,TENNCARE BLUE SELECT,87.89,,,,,,,87.8900,1235.0000,fee schedule,$75.77 from Fee Schedule TC_24 for Rev 450 Proc 25560 * Qty 1 = $75.77 at 116% = $87.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,87.8900,1235.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,87.8900,1235.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1111.50,,,,,,,87.8900,1235.0000,percent of total billed charges,"90% of $1,235.00 in Billed Charges for Rev 450 Proc 25560 = $1,111.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,87.8900,1235.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,87.8900,1235.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,MEDCOST,MEDCOST VHN,587.74,,,,,,,87.8900,1235.0000,percent of total billed charges,"47.59% of $1,235.00 in Billed Charges for Rev 450 Proc 25560 = $587.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,87.8900,1235.0000,fee schedule,"APG 00041 Proc 25560 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,87.8900,1235.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,87.8900,1235.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,87.8900,1235.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,87.8900,1235.0000,fee schedule,"APG 00041 Proc 25560 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,SENTARA HEALTH,SENTARA HEALTH,318.75,,,,,,,87.8900,1235.0000,percent of total billed charges,"25.81% of $1,235.00 in Billed Charges for Rev 450 Proc 25560 = $318.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,87.8900,1235.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1235.00,,,,,,,87.8900,1235.0000,percent of total billed charges,"100% of $1,235.00 in Billed Charges for Rev 450 Proc 25560 = $1,235.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,87.8900,1235.0000,case rate,Rev 450 Proc 25560 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,87.8900,1235.0000,case rate,Rev 450 Proc 25560 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,87.8900,1235.0000,case rate,Rev 450 Proc 25560 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,87.8900,1235.0000,case rate,Rev 450 Proc 25560 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,87.8900,1235.0000,fee schedule,"APG 00041 Proc 25560 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,87.8900,1235.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,87.8900,1235.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,WELLCARE,WELLCARE MEDICAID,1235.00,,,,,,,87.8900,1235.0000,percent of total billed charges,"100% of $1,235.00 in Billed Charges for Rev 450 Proc 25560 = $1,235.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX RAD&ULNA FX WO MANIP,25560,CPT,450,RC,45000129,CDM,,,,both,,,1235.0000,185.2500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,87.8900,1235.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,AETNA,AETNA,673.38,,,,,,,102.0200,1577.0000,percent of total billed charges,"42.7% of $1,577.00 in Billed Charges for Rev 450 Proc 25600 = $673.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,102.0200,1577.0000,fee schedule,"APG 00041 Proc 25600 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,102.0200,1577.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,102.0200,1577.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,102.0200,1577.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,AMBETTER,AMBETTER,487.87,,,,,,,102.0200,1577.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,102.0200,1577.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,102.0200,1577.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,102.0200,1577.0000,fee schedule,"APG 00041 Proc 25600 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,102.0200,1577.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,102.0200,1577.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,102.0200,1577.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,216.43,,,,,,,102.0200,1577.0000,fee schedule,$216.43 from Fee Schedule BLDTM_23 for Rev 450 Proc 25600 * Qty 1 = $216.43 at 100% = $216.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,102.0200,1577.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,BLUE CROSS,TENNCARE BLUE CARE,102.02,,,,,,,102.0200,1577.0000,fee schedule,$87.95 from Fee Schedule TC_24 for Rev 450 Proc 25600 * Qty 1 = $87.95 at 116% = $102.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,BLUE CROSS,TENNCARE BLUE SELECT,102.02,,,,,,,102.0200,1577.0000,fee schedule,$87.95 from Fee Schedule TC_24 for Rev 450 Proc 25600 * Qty 1 = $87.95 at 116% = $102.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,102.0200,1577.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,102.0200,1577.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1419.30,,,,,,,102.0200,1577.0000,percent of total billed charges,"90% of $1,577.00 in Billed Charges for Rev 450 Proc 25600 = $1,419.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,102.0200,1577.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,102.0200,1577.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,MEDCOST,MEDCOST VHN,750.49,,,,,,,102.0200,1577.0000,percent of total billed charges,"47.59% of $1,577.00 in Billed Charges for Rev 450 Proc 25600 = $750.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,102.0200,1577.0000,fee schedule,"APG 00041 Proc 25600 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,102.0200,1577.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,102.0200,1577.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,102.0200,1577.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,102.0200,1577.0000,fee schedule,"APG 00041 Proc 25600 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,SENTARA HEALTH,SENTARA HEALTH,407.02,,,,,,,102.0200,1577.0000,percent of total billed charges,"25.81% of $1,577.00 in Billed Charges for Rev 450 Proc 25600 = $407.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,102.0200,1577.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1577.00,,,,,,,102.0200,1577.0000,percent of total billed charges,"100% of $1,577.00 in Billed Charges for Rev 450 Proc 25600 = $1,577.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,102.0200,1577.0000,case rate,Rev 450 Proc 25600 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,102.0200,1577.0000,case rate,Rev 450 Proc 25600 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,102.0200,1577.0000,case rate,Rev 450 Proc 25600 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,102.0200,1577.0000,case rate,Rev 450 Proc 25600 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,102.0200,1577.0000,fee schedule,"APG 00041 Proc 25600 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,102.0200,1577.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,102.0200,1577.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,WELLCARE,WELLCARE MEDICAID,1577.00,,,,,,,102.0200,1577.0000,percent of total billed charges,"100% of $1,577.00 in Billed Charges for Rev 450 Proc 25600 = $1,577.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX DIST RADIAL FX WO MAN,25600,CPT,450,RC,45000131,CDM,,,,both,,,1577.0000,236.5500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,102.0200,1577.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,AETNA,AETNA,1076.47,,,,,,,109.0000,3180.3800,percent of total billed charges,"42.7% of $2,521.00 in Billed Charges for Rev 450 Proc 25605 = $1,076.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25605 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,3180.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,BLUE CROSS,ANTHEM EXCHANGE,2521.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25605 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,BLUE CROSS,ANTHEM HMO,2521.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,3180.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2521.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,382.23,,,,,,,109.0000,3180.3800,fee schedule,$382.23 from Fee Schedule BLDTM_23 for Rev 450 Proc 25605 * Qty 1 = $382.23 at 100% = $382.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2268.90,,,,,,,109.0000,3180.3800,percent of total billed charges,"90% of $2,521.00 in Billed Charges for Rev 450 Proc 25605 = $2,268.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,MEDCOST,MEDCOST VHN,1199.74,,,,,,,109.0000,3180.3800,percent of total billed charges,"47.59% of $2,521.00 in Billed Charges for Rev 450 Proc 25605 = $1,199.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25605 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25605 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,SENTARA HEALTH,SENTARA HEALTH,650.67,,,,,,,109.0000,3180.3800,percent of total billed charges,"25.81% of $2,521.00 in Billed Charges for Rev 450 Proc 25605 = $650.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2521.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $2,521.00 in Billed Charges for Rev 450 Proc 25605 = $2,521.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 25605 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 25605 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 25605 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 25605 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25605 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,WELLCARE,WELLCARE MEDICAID,2521.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $2,521.00 in Billed Charges for Rev 450 Proc 25605 = $2,521.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX DIST RADIAL FX W MANIP,25605,CPT,450,RC,45000132,CDM,,,,both,,,2521.0000,378.1500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,3180.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA,808.31,,,,,,,109.0000,3180.3800,percent of total billed charges,"42.7% of $1,893.00 in Billed Charges for Rev 450 Proc 25624 = $808.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25624 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,3180.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM EXCHANGE,1893.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25624 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM HMO,1893.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,3180.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1893.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,323.90,,,,,,,109.0000,3180.3800,fee schedule,$323.90 from Fee Schedule BLDTM_23 for Rev 450 Proc 25624 * Qty 1 = $323.90 at 100% = $323.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1703.70,,,,,,,109.0000,3180.3800,percent of total billed charges,"90% of $1,893.00 in Billed Charges for Rev 450 Proc 25624 = $1,703.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,MEDCOST,MEDCOST VHN,900.88,,,,,,,109.0000,3180.3800,percent of total billed charges,"47.59% of $1,893.00 in Billed Charges for Rev 450 Proc 25624 = $900.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25624 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25624 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,SENTARA HEALTH,SENTARA HEALTH,488.58,,,,,,,109.0000,3180.3800,percent of total billed charges,"25.81% of $1,893.00 in Billed Charges for Rev 450 Proc 25624 = $488.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1893.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,893.00 in Billed Charges for Rev 450 Proc 25624 = $1,893.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 25624 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 25624 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 25624 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 25624 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 25624 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,WELLCARE,WELLCARE MEDICAID,1893.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,893.00 in Billed Charges for Rev 450 Proc 25624 = $1,893.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX NAVICULAR FX W MANIP,25624,CPT,450,RC,45000134,CDM,,,,both,,,1893.0000,283.9500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,3180.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA,2059.42,,,,,,,109.0000,4823.0000,percent of total billed charges,"42.7% of $4,823.00 in Billed Charges for Rev 450 Proc 23675 = $2,059.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 23675 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,4823.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,4823.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 23675 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,4823.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4489.34,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,360.54,,,,,,,109.0000,4823.0000,fee schedule,$360.54 from Fee Schedule BLDTM_23 for Rev 450 Proc 23675 * Qty 1 = $360.54 at 100% = $360.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,4823.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4340.70,,,,,,,109.0000,4823.0000,percent of total billed charges,"90% of $4,823.00 in Billed Charges for Rev 450 Proc 23675 = $4,340.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,MEDCOST,MEDCOST VHN,2295.27,,,,,,,109.0000,4823.0000,percent of total billed charges,"47.59% of $4,823.00 in Billed Charges for Rev 450 Proc 23675 = $2,295.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 23675 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 23675 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,SENTARA HEALTH,SENTARA HEALTH,1244.82,,,,,,,109.0000,4823.0000,percent of total billed charges,"25.81% of $4,823.00 in Billed Charges for Rev 450 Proc 23675 = $1,244.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4823.00,,,,,,,109.0000,4823.0000,percent of total billed charges,"100% of $4,823.00 in Billed Charges for Rev 450 Proc 23675 = $4,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 23675 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 23675 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 23675 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 23675 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 23675 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,WELLCARE,WELLCARE MEDICAID,4823.00,,,,,,,109.0000,4823.0000,percent of total billed charges,"100% of $4,823.00 in Billed Charges for Rev 450 Proc 23675 = $4,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX SHOULDER DISLOC W SURG/ANTMCL NECK FX W MANIP,23675,CPT,450,RC,45000376,CDM,,,,both,,,4823.0000,723.4500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,4823.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,AETNA,AETNA,2156.78,,,,,,,109.0000,5745.1200,percent of total billed charges,"42.7% of $5,051.00 in Billed Charges for Rev 450 Proc 23930 = $2,156.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2612.63,,,,,,,109.0000,5745.1200,fee schedule,"APG 00051 Proc 23930 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 104% = $2,612.63. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2635.37,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,AETNA,AETNA HEALTHCARE MEDICARE,2635.37,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,2635.37,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,AMBETTER,AMBETTER,5745.12,,,,,,,109.0000,5745.1200,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2740.79,,,,,,,109.0000,5745.1200,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,BLUE CROSS,ANTHEM EXCHANGE,5051.00,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2587.51,,,,,,,109.0000,5745.1200,fee schedule,"APG 00051 Proc 23930 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,BLUE CROSS,ANTHEM HMO,5051.00,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2714.44,,,,,,,109.0000,5745.1200,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5051.00,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,202.64,,,,,,,109.0000,5745.1200,fee schedule,$202.64 from Fee Schedule BLDTM_23 for Rev 450 Proc 23930 * Qty 1 = $202.64 at 100% = $202.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,BLUE CROSS,BLUE CROSS MEDICARE,2740.79,,,,,,,109.0000,5745.1200,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,2767.14,,,,,,,109.0000,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,2767.14,,,,,,,109.0000,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4545.90,,,,,,,109.0000,5745.1200,percent of total billed charges,"90% of $5,051.00 in Billed Charges for Rev 450 Proc 23930 = $4,545.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,HUMANA,HUMANA MEDICARE,2635.37,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2635.37,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,MEDCOST,MEDCOST VHN,2403.77,,,,,,,109.0000,5745.1200,percent of total billed charges,"47.59% of $5,051.00 in Billed Charges for Rev 450 Proc 23930 = $2,403.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2637.75,,,,,,,109.0000,5745.1200,fee schedule,"APG 00051 Proc 23930 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 105% = $2,637.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,2767.14,,,,,,,109.0000,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,2767.14,,,,,,,109.0000,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,NHC ADVANTAGE,NHC ADVANTAGE,2767.14,,,,,,,109.0000,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2590.02,,,,,,,109.0000,5745.1200,fee schedule,"APG 00051 Proc 23930 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 103.1% = $2,590.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,SENTARA HEALTH,SENTARA HEALTH,1303.66,,,,,,,109.0000,5745.1200,percent of total billed charges,"25.81% of $5,051.00 in Billed Charges for Rev 450 Proc 23930 = $1,303.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,SENTARA HEALTH,SENTARA MEDICARE,2635.37,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5051.00,,,,,,,109.0000,5745.1200,percent of total billed charges,"100% of $5,051.00 in Billed Charges for Rev 450 Proc 23930 = $5,051.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,5745.1200,case rate,Rev 450 Proc 23930 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,5745.1200,case rate,Rev 450 Proc 23930 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,5745.1200,case rate,Rev 450 Proc 23930 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,5745.1200,case rate,Rev 450 Proc 23930 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2587.51,,,,,,,109.0000,5745.1200,fee schedule,"APG 00051 Proc 23930 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2635.37,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2635.37,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,WELLCARE,WELLCARE MEDICAID,5051.00,,,,,,,109.0000,5745.1200,percent of total billed charges,"100% of $5,051.00 in Billed Charges for Rev 450 Proc 23930 = $5,051.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID UPPER ARM/ELBOW DEEP ABSC/HEMATOMA,23930,CPT,450,RC,45000377,CDM,,,,both,,,5051.0000,757.6500,WELLCARE,WELLCARE MEDICARE,2793.50,,,,,,,109.0000,5745.1200,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,AETNA,AETNA,3728.99,,,,,,,109.0000,8733.0000,percent of total billed charges,"42.7% of $8,733.00 in Billed Charges for Rev 450 Proc 24201 = $3,728.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2612.63,,,,,,,109.0000,8733.0000,fee schedule,"APG 00051 Proc 24201 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 104% = $2,612.63. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,AETNA,AETNA HEALTHCARE MEDICARE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,AMBETTER,AMBETTER,5745.12,,,,,,,109.0000,8733.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2740.79,,,,,,,109.0000,8733.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,ANTHEM EXCHANGE,6488.44,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2587.51,,,,,,,109.0000,8733.0000,fee schedule,"APG 00051 Proc 24201 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,ANTHEM HMO,6893.58,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2714.44,,,,,,,109.0000,8733.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8109.66,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,329.21,,,,,,,109.0000,8733.0000,fee schedule,$329.21 from Fee Schedule BLDTM_23 for Rev 450 Proc 24201 * Qty 1 = $329.21 at 100% = $329.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,BLUE CROSS MEDICARE,2740.79,,,,,,,109.0000,8733.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,2767.14,,,,,,,109.0000,8733.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,2767.14,,,,,,,109.0000,8733.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7859.70,,,,,,,109.0000,8733.0000,percent of total billed charges,"90% of $8,733.00 in Billed Charges for Rev 450 Proc 24201 = $7,859.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,HUMANA,HUMANA MEDICARE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,MEDCOST,MEDCOST VHN,4156.03,,,,,,,109.0000,8733.0000,percent of total billed charges,"47.59% of $8,733.00 in Billed Charges for Rev 450 Proc 24201 = $4,156.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2637.75,,,,,,,109.0000,8733.0000,fee schedule,"APG 00051 Proc 24201 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 105% = $2,637.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,2767.14,,,,,,,109.0000,8733.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,2767.14,,,,,,,109.0000,8733.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,NHC ADVANTAGE,NHC ADVANTAGE,2767.14,,,,,,,109.0000,8733.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2590.02,,,,,,,109.0000,8733.0000,fee schedule,"APG 00051 Proc 24201 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 103.1% = $2,590.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,SENTARA HEALTH,SENTARA HEALTH,2253.99,,,,,,,109.0000,8733.0000,percent of total billed charges,"25.81% of $8,733.00 in Billed Charges for Rev 450 Proc 24201 = $2,253.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,SENTARA HEALTH,SENTARA MEDICARE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8733.00,,,,,,,109.0000,8733.0000,percent of total billed charges,"100% of $8,733.00 in Billed Charges for Rev 450 Proc 24201 = $8,733.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,8733.0000,case rate,Rev 450 Proc 24201 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,8733.0000,case rate,Rev 450 Proc 24201 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,8733.0000,case rate,Rev 450 Proc 24201 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,8733.0000,case rate,Rev 450 Proc 24201 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2587.51,,,,,,,109.0000,8733.0000,fee schedule,"APG 00051 Proc 24201 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,WELLCARE,WELLCARE MEDICAID,8733.00,,,,,,,109.0000,8733.0000,percent of total billed charges,"100% of $8,733.00 in Billed Charges for Rev 450 Proc 24201 = $8,733.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL FB UPPER ARM/ELBOW DEEP,24201,CPT,450,RC,45000378,CDM,,,,both,,,8733.0000,1309.9500,WELLCARE,WELLCARE MEDICARE,2793.50,,,,,,,109.0000,8733.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA,180.19,,,,,,,108.9200,703.3600,percent of total billed charges,42.7% of $422.00 in Billed Charges for Rev 450 Proc 25630 = $180.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 25630 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,AMBETTER,AMBETTER,487.87,,,,,,,108.9200,703.3600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,108.9200,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM EXCHANGE,422.00,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,422.00,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 25630 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HMO,422.00,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,108.9200,703.3600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",422.00,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,206.89,,,,,,,108.9200,703.3600,fee schedule,$206.89 from Fee Schedule BLDTM_23 for Rev 450 Proc 25630 * Qty 1 = $206.89 at 100% = $206.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,108.9200,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,379.80,,,,,,,108.9200,703.3600,percent of total billed charges,90% of $422.00 in Billed Charges for Rev 450 Proc 25630 = $379.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,MEDCOST,MEDCOST VHN,200.83,,,,,,,108.9200,703.3600,percent of total billed charges,47.59% of $422.00 in Billed Charges for Rev 450 Proc 25630 = $200.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 25630 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 25630 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA HEALTH,108.92,,,,,,,108.9200,703.3600,percent of total billed charges,25.81% of $422.00 in Billed Charges for Rev 450 Proc 25630 = $108.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",422.00,,,,,,,108.9200,703.3600,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 25630 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,108.9200,703.3600,case rate,Rev 450 Proc 25630 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,422.00,,,,,,,108.9200,703.3600,case rate,"Rev 450 Proc 25630 at Case Rate $491.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,422.00,,,,,,,108.9200,703.3600,case rate,"Rev 450 Proc 25630 at Case Rate $471.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,422.00,,,,,,,108.9200,703.3600,case rate,"Rev 450 Proc 25630 at Case Rate $847.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 25630 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICAID,422.00,,,,,,,108.9200,703.3600,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 25630 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CARPAL FRACT W/O MANIPULATION,25630,CPT,450,RC,45000135,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,108.9200,703.3600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,AETNA,AETNA,544.00,,,,,,,106.7200,1274.0000,percent of total billed charges,"42.7% of $1,274.00 in Billed Charges for Rev 450 Proc 25650 = $544.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,106.7200,1274.0000,fee schedule,"APG 00041 Proc 25650 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,106.7200,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,106.7200,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,106.7200,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,AMBETTER,AMBETTER,487.87,,,,,,,106.7200,1274.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,106.7200,1274.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,106.7200,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,106.7200,1274.0000,fee schedule,"APG 00041 Proc 25650 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,106.7200,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,106.7200,1274.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,106.7200,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,224.84,,,,,,,106.7200,1274.0000,fee schedule,$224.84 from Fee Schedule BLDTM_23 for Rev 450 Proc 25650 * Qty 1 = $224.84 at 100% = $224.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,106.7200,1274.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,TENNCARE BLUE CARE,106.72,,,,,,,106.7200,1274.0000,fee schedule,$92.00 from Fee Schedule TC_24 for Rev 450 Proc 25650 * Qty 1 = $92.00 at 116% = $106.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,TENNCARE BLUE SELECT,106.72,,,,,,,106.7200,1274.0000,fee schedule,$92.00 from Fee Schedule TC_24 for Rev 450 Proc 25650 * Qty 1 = $92.00 at 116% = $106.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,106.7200,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,106.7200,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1146.60,,,,,,,106.7200,1274.0000,percent of total billed charges,"90% of $1,274.00 in Billed Charges for Rev 450 Proc 25650 = $1,146.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,106.7200,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,106.7200,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,MEDCOST,MEDCOST VHN,606.30,,,,,,,106.7200,1274.0000,percent of total billed charges,"47.59% of $1,274.00 in Billed Charges for Rev 450 Proc 25650 = $606.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,106.7200,1274.0000,fee schedule,"APG 00041 Proc 25650 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,106.7200,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,106.7200,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,106.7200,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,106.7200,1274.0000,fee schedule,"APG 00041 Proc 25650 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,SENTARA HEALTH,SENTARA HEALTH,328.82,,,,,,,106.7200,1274.0000,percent of total billed charges,"25.81% of $1,274.00 in Billed Charges for Rev 450 Proc 25650 = $328.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,106.7200,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1274.00,,,,,,,106.7200,1274.0000,percent of total billed charges,"100% of $1,274.00 in Billed Charges for Rev 450 Proc 25650 = $1,274.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,106.7200,1274.0000,case rate,Rev 450 Proc 25650 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,106.7200,1274.0000,case rate,Rev 450 Proc 25650 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,106.7200,1274.0000,case rate,Rev 450 Proc 25650 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,106.7200,1274.0000,case rate,Rev 450 Proc 25650 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,106.7200,1274.0000,fee schedule,"APG 00041 Proc 25650 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,106.7200,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,106.7200,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,WELLCARE,WELLCARE MEDICAID,1274.00,,,,,,,106.7200,1274.0000,percent of total billed charges,"100% of $1,274.00 in Billed Charges for Rev 450 Proc 25650 = $1,274.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX ULNAR STYLOID FX,25650,CPT,450,RC,45000137,CDM,,,,both,,,1274.0000,191.1000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,106.7200,1274.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,AETNA,AETNA,755.36,,,,,,,109.0000,1769.0000,percent of total billed charges,"42.7% of $1,769.00 in Billed Charges for Rev 450 Proc 25660 = $755.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,1769.0000,fee schedule,"APG 00041 Proc 25660 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,1769.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1769.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,1769.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,1769.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,1769.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,1769.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,1769.0000,fee schedule,"APG 00041 Proc 25660 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,1769.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,1769.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,1769.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,246.60,,,,,,,109.0000,1769.0000,fee schedule,$246.60 from Fee Schedule BLDTM_23 for Rev 450 Proc 25660 * Qty 1 = $246.60 at 100% = $246.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,1769.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,1769.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,1769.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1592.10,,,,,,,109.0000,1769.0000,percent of total billed charges,"90% of $1,769.00 in Billed Charges for Rev 450 Proc 25660 = $1,592.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,1769.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,1769.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,MEDCOST,MEDCOST VHN,841.87,,,,,,,109.0000,1769.0000,percent of total billed charges,"47.59% of $1,769.00 in Billed Charges for Rev 450 Proc 25660 = $841.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,1769.0000,fee schedule,"APG 00041 Proc 25660 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,1769.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,1769.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,1769.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,1769.0000,fee schedule,"APG 00041 Proc 25660 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,SENTARA HEALTH,SENTARA HEALTH,456.58,,,,,,,109.0000,1769.0000,percent of total billed charges,"25.81% of $1,769.00 in Billed Charges for Rev 450 Proc 25660 = $456.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,1769.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1769.00,,,,,,,109.0000,1769.0000,percent of total billed charges,"100% of $1,769.00 in Billed Charges for Rev 450 Proc 25660 = $1,769.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1769.0000,case rate,Rev 450 Proc 25660 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1769.0000,case rate,Rev 450 Proc 25660 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1769.0000,case rate,Rev 450 Proc 25660 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1769.0000,case rate,Rev 450 Proc 25660 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,1769.0000,fee schedule,"APG 00041 Proc 25660 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1769.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,1769.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,WELLCARE,WELLCARE MEDICAID,1769.00,,,,,,,109.0000,1769.0000,percent of total billed charges,"100% of $1,769.00 in Billed Charges for Rev 450 Proc 25660 = $1,769.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RADIO INTERCARP DISLOC,25660,CPT,450,RC,45000138,CDM,,,,both,,,1769.0000,265.3500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,1769.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA,353.13,,,,,,,109.0000,827.0000,percent of total billed charges,42.7% of $827.00 in Billed Charges for Rev 450 Proc 25680 = $353.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 25680 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,827.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 25680 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,827.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,316.58,,,,,,,109.0000,827.0000,fee schedule,$316.58 from Fee Schedule BLDTM_23 for Rev 450 Proc 25680 * Qty 1 = $316.58 at 100% = $316.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,744.30,,,,,,,109.0000,827.0000,percent of total billed charges,90% of $827.00 in Billed Charges for Rev 450 Proc 25680 = $744.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,MEDCOST,MEDCOST VHN,393.57,,,,,,,109.0000,827.0000,percent of total billed charges,47.59% of $827.00 in Billed Charges for Rev 450 Proc 25680 = $393.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 25680 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 25680 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA HEALTH,213.45,,,,,,,109.0000,827.0000,percent of total billed charges,25.81% of $827.00 in Billed Charges for Rev 450 Proc 25680 = $213.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",827.00,,,,,,,109.0000,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 25680 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 25680 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 25680 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 25680 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,827.00,,,,,,,109.0000,827.0000,case rate,"Rev 450 Proc 25680 at Case Rate $847.00 (Service Line reduced to $827.00, claim capped at $827.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 25680 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICAID,827.00,,,,,,,109.0000,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 25680 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX TRANS-SCAPHOPERILUNAR TYPE FX W MANIP,25680,CPT,450,RC,45000385,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,827.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA,2059.42,,,,,,,109.0000,4823.0000,percent of total billed charges,"42.7% of $4,823.00 in Billed Charges for Rev 450 Proc 25690 = $2,059.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 25690 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,4823.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,4823.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 25690 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,4823.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4489.34,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,372.68,,,,,,,109.0000,4823.0000,fee schedule,$372.68 from Fee Schedule BLDTM_23 for Rev 450 Proc 25690 * Qty 1 = $372.68 at 100% = $372.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,4823.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4340.70,,,,,,,109.0000,4823.0000,percent of total billed charges,"90% of $4,823.00 in Billed Charges for Rev 450 Proc 25690 = $4,340.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,MEDCOST,MEDCOST VHN,2295.27,,,,,,,109.0000,4823.0000,percent of total billed charges,"47.59% of $4,823.00 in Billed Charges for Rev 450 Proc 25690 = $2,295.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 25690 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 25690 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,SENTARA HEALTH,SENTARA HEALTH,1244.82,,,,,,,109.0000,4823.0000,percent of total billed charges,"25.81% of $4,823.00 in Billed Charges for Rev 450 Proc 25690 = $1,244.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4823.00,,,,,,,109.0000,4823.0000,percent of total billed charges,"100% of $4,823.00 in Billed Charges for Rev 450 Proc 25690 = $4,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 25690 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 25690 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 25690 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 25690 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 25690 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,WELLCARE,WELLCARE MEDICAID,4823.00,,,,,,,109.0000,4823.0000,percent of total billed charges,"100% of $4,823.00 in Billed Charges for Rev 450 Proc 25690 = $4,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX LUNATE DISLOC W MANIP,25690,CPT,450,RC,45000386,CDM,,,,both,,,4823.0000,723.4500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,4823.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,AETNA,AETNA,2020.56,,,,,,,109.0000,4732.0000,percent of total billed charges,"42.7% of $4,732.00 in Billed Charges for Rev 450 Proc 26011 = $2,020.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1591.43,,,,,,,109.0000,4732.0000,fee schedule,"APG 00004 Proc 26011 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment) at 104% = $1,591.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,109.0000,4732.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,109.0000,4732.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,109.0000,4732.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,AMBETTER,AMBETTER,3266.63,,,,,,,109.0000,4732.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,109.0000,4732.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,BLUE CROSS,ANTHEM EXCHANGE,3689.28,,,,,,,109.0000,4732.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1576.13,,,,,,,109.0000,4732.0000,fee schedule,"APG 00004 Proc 26011 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment) at 103% = $1,576.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,BLUE CROSS,ANTHEM HMO,3919.64,,,,,,,109.0000,4732.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,109.0000,4732.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4611.09,,,,,,,109.0000,4732.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,159.67,,,,,,,109.0000,4732.0000,fee schedule,$159.67 from Fee Schedule BLDTM_23 for Rev 450 Proc 26011 * Qty 1 = $159.67 at 100% = $159.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,109.0000,4732.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,109.0000,4732.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,109.0000,4732.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4258.80,,,,,,,109.0000,4732.0000,percent of total billed charges,"90% of $4,732.00 in Billed Charges for Rev 450 Proc 26011 = $4,258.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,109.0000,4732.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,109.0000,4732.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,MEDCOST,MEDCOST VHN,2251.96,,,,,,,109.0000,4732.0000,percent of total billed charges,"47.59% of $4,732.00 in Billed Charges for Rev 450 Proc 26011 = $2,251.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1606.74,,,,,,,109.0000,4732.0000,fee schedule,"APG 00004 Proc 26011 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment) at 100% = $1,530.23... $1,530.23 at 105% = $1,606.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,109.0000,4732.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,109.0000,4732.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,109.0000,4732.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1577.67,,,,,,,109.0000,4732.0000,fee schedule,"APG 00004 Proc 26011 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment) at 100% = $1,530.23... $1,530.23 at 103.1% = $1,577.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,SENTARA HEALTH,SENTARA HEALTH,1221.33,,,,,,,109.0000,4732.0000,percent of total billed charges,"25.81% of $4,732.00 in Billed Charges for Rev 450 Proc 26011 = $1,221.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,109.0000,4732.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4732.00,,,,,,,109.0000,4732.0000,percent of total billed charges,"100% of $4,732.00 in Billed Charges for Rev 450 Proc 26011 = $4,732.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,4732.0000,case rate,Rev 450 Proc 26011 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,4732.0000,case rate,Rev 450 Proc 26011 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,4732.0000,case rate,Rev 450 Proc 26011 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,4732.0000,case rate,Rev 450 Proc 26011 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1576.13,,,,,,,109.0000,4732.0000,fee schedule,"APG 00004 Proc 26011 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment) at 103% = $1,576.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,109.0000,4732.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,109.0000,4732.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,WELLCARE,WELLCARE MEDICAID,4732.00,,,,,,,109.0000,4732.0000,percent of total billed charges,"100% of $4,732.00 in Billed Charges for Rev 450 Proc 26011 = $4,732.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DRAIN FINGER ABSCESS COMPLICAT,26011,CPT,450,RC,45000141,CDM,,,,both,,,4732.0000,709.8000,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,109.0000,4732.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,AETNA,AETNA,194.71,,,,,,,33.2500,456.0000,percent of total billed charges,42.7% of $456.00 in Billed Charges for Rev 521 Proc 29440 = $194.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,283.21,,,,,,,33.2500,456.0000,fee schedule,"APG 00039 Proc 29440 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 104% = $283.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,147.43,,,,,,,33.2500,456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,AETNA,AETNA HEALTHCARE MEDICARE,147.43,,,,,,,33.2500,456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,147.43,,,,,,,33.2500,456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,AMBETTER,AMBETTER,321.40,,,,,,,33.2500,456.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,153.33,,,,,,,33.2500,456.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,BLUE CROSS,ANTHEM EXCHANGE,362.98,,,,,,,33.2500,456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,280.48,,,,,,,33.2500,456.0000,fee schedule,"APG 00039 Proc 29440 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,BLUE CROSS,ANTHEM HMO,385.65,,,,,,,33.2500,456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,151.86,,,,,,,33.2500,456.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",453.68,,,,,,,33.2500,456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,33.25,,,,,,,33.2500,456.0000,fee schedule,$33.25 from Fee Schedule BLDTM_23 for Rev 521 Proc 29440 * Qty 1 = $33.25 at 100% = $33.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,BLUE CROSS,BLUE CROSS MEDICARE,153.33,,,,,,,33.2500,456.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,CIGNA HEALTHCARE,CIGNA HMO,190.15,,,,,,,33.2500,456.0000,percent of total billed charges,41.7% of $456.00 in Billed Charges for Rev 521 Proc 29440 = $190.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,211.58,,,,,,,33.2500,456.0000,percent of total billed charges,46.4% of $456.00 in Billed Charges for Rev 521 Proc 29440 = $211.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,154.80,,,,,,,33.2500,456.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,190.15,,,,,,,33.2500,456.0000,percent of total billed charges,41.7% of $456.00 in Billed Charges for Rev 521 Proc 29440 = $190.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,CIGNA HEALTHCARE,CIGNA PPO,190.15,,,,,,,33.2500,456.0000,percent of total billed charges,41.7% of $456.00 in Billed Charges for Rev 521 Proc 29440 = $190.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,154.80,,,,,,,33.2500,456.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,410.40,,,,,,,33.2500,456.0000,percent of total billed charges,90% of $456.00 in Billed Charges for Rev 521 Proc 29440 = $410.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,HUMANA,HUMANA MEDICARE,147.43,,,,,,,33.2500,456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,147.43,,,,,,,33.2500,456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,MEDCOST,MEDCOST VHN,217.01,,,,,,,33.2500,456.0000,percent of total billed charges,47.59% of $456.00 in Billed Charges for Rev 521 Proc 29440 = $217.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,285.93,,,,,,,33.2500,456.0000,fee schedule,"APG 00039 Proc 29440 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 105% = $285.93 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,154.80,,,,,,,33.2500,456.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,154.80,,,,,,,33.2500,456.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,NHC ADVANTAGE,NHC ADVANTAGE,154.80,,,,,,,33.2500,456.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,280.75,,,,,,,33.2500,456.0000,fee schedule,"APG 00039 Proc 29440 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 103.1% = $280.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,SENTARA HEALTH,SENTARA HEALTH,117.69,,,,,,,33.2500,456.0000,percent of total billed charges,25.81% of $456.00 in Billed Charges for Rev 521 Proc 29440 = $117.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,SENTARA HEALTH,SENTARA MEDICARE,147.43,,,,,,,33.2500,456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",456.00,,,,,,,33.2500,456.0000,percent of total billed charges,100% of $456.00 in Billed Charges for Rev 521 Proc 29440 = $456.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,63.94,,,,,,,33.2500,456.0000,fee schedule,$127.87 from Fee Schedule TCUHC24 for Rev 521 Proc 29440 * Qty 1 = $127.87 at 50% = $63.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,280.48,,,,,,,33.2500,456.0000,fee schedule,"APG 00039 Proc 29440 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,147.43,,,,,,,33.2500,456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,147.43,,,,,,,33.2500,456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,WELLCARE,WELLCARE MEDICAID,456.00,,,,,,,33.2500,456.0000,percent of total billed charges,100% of $456.00 in Billed Charges for Rev 521 Proc 29440 = $456.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADDING WALKER TO PREV APPL CAST,29440,CPT,521,RC,52100099,CDM,,,,both,,,456.0000,68.4000,WELLCARE,WELLCARE MEDICARE,156.28,,,,,,,33.2500,456.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,AETNA,AETNA,369.36,,,,,,,43.0000,865.0000,percent of total billed charges,42.7% of $865.00 in Billed Charges for Rev 420 Proc 29445 = $369.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,283.21,,,,,,,43.0000,865.0000,fee schedule,"APG 00039 Proc 29445 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 104% = $283.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,253.76,,,,,,,43.0000,865.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,AETNA,AETNA HEALTHCARE MEDICARE,253.76,,,,,,,43.0000,865.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,253.76,,,,,,,43.0000,865.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,AMBETTER,AMBETTER,553.19,,,,,,,43.0000,865.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,263.91,,,,,,,43.0000,865.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,BLUE CROSS,ANTHEM EXCHANGE,624.77,,,,,,,43.0000,865.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,280.48,,,,,,,43.0000,865.0000,fee schedule,"APG 00039 Proc 29445 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,BLUE CROSS,ANTHEM HMO,663.78,,,,,,,43.0000,865.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,261.37,,,,,,,43.0000,865.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",780.88,,,,,,,43.0000,865.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,116.00,,,,,,,43.0000,865.0000,other,Rev 420 Proc 29445 1 Visit at $116.00 per Visit = $116.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,BLUE CROSS,BLUE CROSS E NETWORK,557.73,,,,,,,43.0000,865.0000,fee schedule,$127.92 from Fee Schedule BCFSG for Rev 420 Proc 29445 * Qty 1 = $127.92 at 436% = $557.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,BLUE CROSS,BLUE CROSS MEDICARE,263.91,,,,,,,43.0000,865.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,BLUE CROSS,BLUE CROSS P NETWORK,569.24,,,,,,,43.0000,865.0000,fee schedule,$127.92 from Fee Schedule BCFSG for Rev 420 Proc 29445 * Qty 1 = $127.92 at 445% = $569.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,BLUE CROSS,BLUE CROSS S NETWORK,569.24,,,,,,,43.0000,865.0000,fee schedule,$127.92 from Fee Schedule BCFSG for Rev 420 Proc 29445 * Qty 1 = $127.92 at 445% = $569.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,CIGNA HEALTHCARE,CIGNA HMO,360.71,,,,,,,43.0000,865.0000,percent of total billed charges,41.7% of $865.00 in Billed Charges for Rev 420 Proc 29445 = $360.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,401.36,,,,,,,43.0000,865.0000,percent of total billed charges,46.4% of $865.00 in Billed Charges for Rev 420 Proc 29445 = $401.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,266.45,,,,,,,43.0000,865.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,360.71,,,,,,,43.0000,865.0000,percent of total billed charges,41.7% of $865.00 in Billed Charges for Rev 420 Proc 29445 = $360.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,CIGNA HEALTHCARE,CIGNA PPO,360.71,,,,,,,43.0000,865.0000,percent of total billed charges,41.7% of $865.00 in Billed Charges for Rev 420 Proc 29445 = $360.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,266.45,,,,,,,43.0000,865.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,778.50,,,,,,,43.0000,865.0000,percent of total billed charges,90% of $865.00 in Billed Charges for Rev 420 Proc 29445 = $778.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,HUMANA,HUMANA MEDICARE,253.76,,,,,,,43.0000,865.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,253.76,,,,,,,43.0000,865.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,MEDCOST,MEDCOST VHN,411.65,,,,,,,43.0000,865.0000,percent of total billed charges,47.59% of $865.00 in Billed Charges for Rev 420 Proc 29445 = $411.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,285.93,,,,,,,43.0000,865.0000,fee schedule,"APG 00039 Proc 29445 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 105% = $285.93 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,266.45,,,,,,,43.0000,865.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,266.45,,,,,,,43.0000,865.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,NHC ADVANTAGE,NHC ADVANTAGE,266.45,,,,,,,43.0000,865.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,280.75,,,,,,,43.0000,865.0000,fee schedule,"APG 00039 Proc 29445 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 103.1% = $280.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,SENTARA HEALTH,SENTARA HEALTH,223.26,,,,,,,43.0000,865.0000,percent of total billed charges,25.81% of $865.00 in Billed Charges for Rev 420 Proc 29445 = $223.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,SENTARA HEALTH,SENTARA MEDICARE,253.76,,,,,,,43.0000,865.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",865.00,,,,,,,43.0000,865.0000,percent of total billed charges,100% of $865.00 in Billed Charges for Rev 420 Proc 29445 = $865.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,43.00,,,,,,,43.0000,865.0000,other,Rev 420 Proc 29445 1 Visit at $43.00 per Visit = $43.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,257.00,,,,,,,43.0000,865.0000,other,Rev 420 Proc 29445 1 Visit at $257.00 per Visit = $257.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,245.00,,,,,,,43.0000,865.0000,other,Rev 420 Proc 29445 1 Visit at $245.00 per Visit = $245.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,403.00,,,,,,,43.0000,865.0000,other,Rev 420 Proc 29445 1 Visit at $403.00 per Visit = $403.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,280.48,,,,,,,43.0000,865.0000,fee schedule,"APG 00039 Proc 29445 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,253.76,,,,,,,43.0000,865.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,253.76,,,,,,,43.0000,865.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,WELLCARE,WELLCARE MEDICAID,865.00,,,,,,,43.0000,865.0000,percent of total billed charges,100% of $865.00 in Billed Charges for Rev 420 Proc 29445 = $865.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST APPL RIGID CONTACT TOTAL,29445,CPT,420,RC,42000039,CDM,,,,both,,,865.0000,129.7500,WELLCARE,WELLCARE MEDICARE,268.98,,,,,,,43.0000,865.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,AETNA,AETNA,294.20,,,,,,,111.6500,829.7900,percent of total billed charges,42.7% of $689.00 in Billed Charges for Rev 510 Proc 29445 Mod 50 = $294.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,424.81,,,,,,,111.6500,829.7900,fee schedule,"APG 00039 Proc 29445 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $408.47 at 104% = $424.81. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,380.64,,,,,,,111.6500,829.7900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,AETNA,AETNA HEALTHCARE MEDICARE,380.64,,,,,,,111.6500,829.7900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,380.64,,,,,,,111.6500,829.7900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,AMBETTER,AMBETTER,829.79,,,,,,,111.6500,829.7900,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,395.86,,,,,,,111.6500,829.7900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,BLUE CROSS,ANTHEM EXCHANGE,689.00,,,,,,,111.6500,829.7900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,420.72,,,,,,,111.6500,829.7900,fee schedule,"APG 00039 Proc 29445 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $408.47 at 103% = $420.72. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,BLUE CROSS,ANTHEM HMO,689.00,,,,,,,111.6500,829.7900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,392.06,,,,,,,111.6500,829.7900,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",689.00,,,,,,,111.6500,829.7900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,123.93,,,,,,,111.6500,829.7900,fee schedule,$123.93 from Fee Schedule BLDTM_23 for Rev 510 Proc 29445 Mod 50 * Qty 1 = $123.93 at 100% = $123.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,BLUE CROSS,BLUE CROSS MEDICARE,395.86,,,,,,,111.6500,829.7900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,CIGNA HEALTHCARE,CIGNA HMO,287.31,,,,,,,111.6500,829.7900,percent of total billed charges,41.7% of $689.00 in Billed Charges for Rev 510 Proc 29445 Mod 50 = $287.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,319.70,,,,,,,111.6500,829.7900,percent of total billed charges,46.4% of $689.00 in Billed Charges for Rev 510 Proc 29445 Mod 50 = $319.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,399.67,,,,,,,111.6500,829.7900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,287.31,,,,,,,111.6500,829.7900,percent of total billed charges,41.7% of $689.00 in Billed Charges for Rev 510 Proc 29445 Mod 50 = $287.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,CIGNA HEALTHCARE,CIGNA PPO,287.31,,,,,,,111.6500,829.7900,percent of total billed charges,41.7% of $689.00 in Billed Charges for Rev 510 Proc 29445 Mod 50 = $287.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,399.67,,,,,,,111.6500,829.7900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,620.10,,,,,,,111.6500,829.7900,percent of total billed charges,90% of $689.00 in Billed Charges for Rev 510 Proc 29445 Mod 50 = $620.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,HUMANA,HUMANA MEDICARE,380.64,,,,,,,111.6500,829.7900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,380.64,,,,,,,111.6500,829.7900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,MEDCOST,MEDCOST VHN,327.90,,,,,,,111.6500,829.7900,percent of total billed charges,47.59% of $689.00 in Billed Charges for Rev 510 Proc 29445 Mod 50 = $327.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,428.89,,,,,,,111.6500,829.7900,fee schedule,"APG 00039 Proc 29445 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $408.47 at 100% = $408.47... $408.47 at 105% = $428.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,399.67,,,,,,,111.6500,829.7900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,399.67,,,,,,,111.6500,829.7900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,NHC ADVANTAGE,NHC ADVANTAGE,399.67,,,,,,,111.6500,829.7900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,421.13,,,,,,,111.6500,829.7900,fee schedule,"APG 00039 Proc 29445 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $408.47 at 100% = $408.47... $408.47 at 103.1% = $421.13 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,SENTARA HEALTH,SENTARA HEALTH,177.83,,,,,,,111.6500,829.7900,percent of total billed charges,25.81% of $689.00 in Billed Charges for Rev 510 Proc 29445 Mod 50 = $177.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,SENTARA HEALTH,SENTARA MEDICARE,380.64,,,,,,,111.6500,829.7900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",689.00,,,,,,,111.6500,829.7900,percent of total billed charges,100% of $689.00 in Billed Charges for Rev 510 Proc 29445 Mod 50 = $689.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,111.65,,,,,,,111.6500,829.7900,fee schedule,$223.29 from Fee Schedule TCUHC24 for Rev 510 Proc 29445 Mod 50 * Qty 1 = $223.29 at 50% = $111.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,222.55,,,,,,,111.6500,829.7900,other,32.3% of $689.00 in Billed Charges for Rev 510 Proc 29445 Mod 50 = $222.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,211.52,,,,,,,111.6500,829.7900,other,30.7% of $689.00 in Billed Charges for Rev 510 Proc 29445 Mod 50 = $211.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,222.55,,,,,,,111.6500,829.7900,percent of total billed charges,32.3% of $689.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,420.72,,,,,,,111.6500,829.7900,fee schedule,"APG 00039 Proc 29445 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $408.47 at 103% = $420.72. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,380.64,,,,,,,111.6500,829.7900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,380.64,,,,,,,111.6500,829.7900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,WELLCARE,WELLCARE MEDICAID,689.00,,,,,,,111.6500,829.7900,percent of total billed charges,100% of $689.00 in Billed Charges for Rev 510 Proc 29445 Mod 50 = $689.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CAST APPL RIGID CONTACT TOTAL BILAT,29445,CPT,510,RC,51000203,CDM,,,50,both,,,689.0000,103.3500,WELLCARE,WELLCARE MEDICARE,403.47,,,,,,,111.6500,829.7900,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA,603.35,,,,,,,109.0000,3180.3800,percent of total billed charges,"42.7% of $1,413.00 in Billed Charges for Rev 450 Proc 24535 = $603.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24535 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA HEALTHCARE MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,3180.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1413.00,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM EXCHANGE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24535 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HMO,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1413.00,,,,,,,109.0000,3180.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,509.55,,,,,,,109.0000,3180.3800,fee schedule,$509.55 from Fee Schedule BLDTM_23 for Rev 450 Proc 24535 * Qty 1 = $509.55 at 100% = $509.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1271.70,,,,,,,109.0000,3180.3800,percent of total billed charges,"90% of $1,413.00 in Billed Charges for Rev 450 Proc 24535 = $1,271.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,HUMANA,HUMANA MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,MEDCOST,MEDCOST VHN,672.45,,,,,,,109.0000,3180.3800,percent of total billed charges,"47.59% of $1,413.00 in Billed Charges for Rev 450 Proc 24535 = $672.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24535 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,NHC ADVANTAGE,NHC ADVANTAGE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24535 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA HEALTH,364.70,,,,,,,109.0000,3180.3800,percent of total billed charges,"25.81% of $1,413.00 in Billed Charges for Rev 450 Proc 24535 = $364.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1413.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 24535 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 24535 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 24535 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 24535 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 24535 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24535 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICAID,1413.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 24535 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TX SPRCOND HUM FX W MA,24535,CPT,450,RC,45000114,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,3180.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA,353.13,,,,,,,109.0000,827.0000,percent of total billed charges,42.7% of $827.00 in Billed Charges for Rev 450 Proc 24560 = $353.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 24560 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,827.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 24560 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,827.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,231.19,,,,,,,109.0000,827.0000,fee schedule,$231.19 from Fee Schedule BLDTM_23 for Rev 450 Proc 24560 * Qty 1 = $231.19 at 100% = $231.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,744.30,,,,,,,109.0000,827.0000,percent of total billed charges,90% of $827.00 in Billed Charges for Rev 450 Proc 24560 = $744.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,MEDCOST,MEDCOST VHN,393.57,,,,,,,109.0000,827.0000,percent of total billed charges,47.59% of $827.00 in Billed Charges for Rev 450 Proc 24560 = $393.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 24560 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 24560 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA HEALTH,213.45,,,,,,,109.0000,827.0000,percent of total billed charges,25.81% of $827.00 in Billed Charges for Rev 450 Proc 24560 = $213.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",827.00,,,,,,,109.0000,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 24560 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 24560 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 24560 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 24560 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,827.00,,,,,,,109.0000,827.0000,case rate,"Rev 450 Proc 24560 at Case Rate $847.00 (Service Line reduced to $827.00, claim capped at $827.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 24560 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICAID,827.00,,,,,,,109.0000,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 24560 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX HUMERAL EPICOND FX MDL/LAT W/O MANIP,24560,CPT,450,RC,45000379,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,827.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA,808.31,,,,,,,109.0000,3180.3800,percent of total billed charges,"42.7% of $1,893.00 in Billed Charges for Rev 450 Proc 24565 = $808.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24565 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,3180.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM EXCHANGE,1893.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24565 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM HMO,1893.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,3180.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1893.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,405.54,,,,,,,109.0000,3180.3800,fee schedule,$405.54 from Fee Schedule BLDTM_23 for Rev 450 Proc 24565 * Qty 1 = $405.54 at 100% = $405.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1703.70,,,,,,,109.0000,3180.3800,percent of total billed charges,"90% of $1,893.00 in Billed Charges for Rev 450 Proc 24565 = $1,703.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,MEDCOST,MEDCOST VHN,900.88,,,,,,,109.0000,3180.3800,percent of total billed charges,"47.59% of $1,893.00 in Billed Charges for Rev 450 Proc 24565 = $900.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24565 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24565 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,SENTARA HEALTH,SENTARA HEALTH,488.58,,,,,,,109.0000,3180.3800,percent of total billed charges,"25.81% of $1,893.00 in Billed Charges for Rev 450 Proc 24565 = $488.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1893.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,893.00 in Billed Charges for Rev 450 Proc 24565 = $1,893.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 24565 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 24565 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 24565 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 24565 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24565 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,WELLCARE,WELLCARE MEDICAID,1893.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,893.00 in Billed Charges for Rev 450 Proc 24565 = $1,893.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX HUM EPI FX M L W MAN,24565,CPT,450,RC,45000115,CDM,,,,both,,,1893.0000,283.9500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,3180.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA,603.35,,,,,,,109.0000,3180.3800,percent of total billed charges,"42.7% of $1,413.00 in Billed Charges for Rev 450 Proc 24577 = $603.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24577 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA HEALTHCARE MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,3180.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1413.00,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM EXCHANGE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24577 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HMO,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1413.00,,,,,,,109.0000,3180.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,433.87,,,,,,,109.0000,3180.3800,fee schedule,$433.87 from Fee Schedule BLDTM_23 for Rev 450 Proc 24577 * Qty 1 = $433.87 at 100% = $433.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1271.70,,,,,,,109.0000,3180.3800,percent of total billed charges,"90% of $1,413.00 in Billed Charges for Rev 450 Proc 24577 = $1,271.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,HUMANA,HUMANA MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,MEDCOST,MEDCOST VHN,672.45,,,,,,,109.0000,3180.3800,percent of total billed charges,"47.59% of $1,413.00 in Billed Charges for Rev 450 Proc 24577 = $672.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24577 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,NHC ADVANTAGE,NHC ADVANTAGE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24577 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA HEALTH,364.70,,,,,,,109.0000,3180.3800,percent of total billed charges,"25.81% of $1,413.00 in Billed Charges for Rev 450 Proc 24577 = $364.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1413.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 24577 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 24577 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 24577 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 24577 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 24577 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 24577 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICAID,1413.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 24577 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX HUM COND FX M L W MAN,24577,CPT,450,RC,45000117,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,3180.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA,699.85,,,,,,,109.0000,1639.0000,percent of total billed charges,"42.7% of $1,639.00 in Billed Charges for Rev 450 Proc 24600 = $699.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,1639.0000,fee schedule,"APG 00041 Proc 24600 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,1639.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,1639.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,1639.0000,fee schedule,"APG 00041 Proc 24600 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,1639.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,293.96,,,,,,,109.0000,1639.0000,fee schedule,$293.96 from Fee Schedule BLDTM_23 for Rev 450 Proc 24600 * Qty 1 = $293.96 at 100% = $293.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,1639.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1475.10,,,,,,,109.0000,1639.0000,percent of total billed charges,"90% of $1,639.00 in Billed Charges for Rev 450 Proc 24600 = $1,475.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,MEDCOST,MEDCOST VHN,780.00,,,,,,,109.0000,1639.0000,percent of total billed charges,"47.59% of $1,639.00 in Billed Charges for Rev 450 Proc 24600 = $780.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,1639.0000,fee schedule,"APG 00041 Proc 24600 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,1639.0000,fee schedule,"APG 00041 Proc 24600 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,SENTARA HEALTH,SENTARA HEALTH,423.03,,,,,,,109.0000,1639.0000,percent of total billed charges,"25.81% of $1,639.00 in Billed Charges for Rev 450 Proc 24600 = $423.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1639.00,,,,,,,109.0000,1639.0000,percent of total billed charges,"100% of $1,639.00 in Billed Charges for Rev 450 Proc 24600 = $1,639.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1639.0000,case rate,Rev 450 Proc 24600 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1639.0000,case rate,Rev 450 Proc 24600 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1639.0000,case rate,Rev 450 Proc 24600 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1639.0000,case rate,Rev 450 Proc 24600 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,1639.0000,fee schedule,"APG 00041 Proc 24600 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,WELLCARE,WELLCARE MEDICAID,1639.00,,,,,,,109.0000,1639.0000,percent of total billed charges,"100% of $1,639.00 in Billed Charges for Rev 450 Proc 24600 = $1,639.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX CLOS ELB DISLOC WO ANES,24600,CPT,450,RC,45000118,CDM,,,,both,,,1639.0000,245.8500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,1639.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA,2059.42,,,,,,,109.0000,4823.0000,percent of total billed charges,"42.7% of $4,823.00 in Billed Charges for Rev 450 Proc 24620 = $2,059.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 24620 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,4823.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,4823.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 24620 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,4823.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4489.34,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,444.39,,,,,,,109.0000,4823.0000,fee schedule,$444.39 from Fee Schedule BLDTM_23 for Rev 450 Proc 24620 * Qty 1 = $444.39 at 100% = $444.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,4823.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4340.70,,,,,,,109.0000,4823.0000,percent of total billed charges,"90% of $4,823.00 in Billed Charges for Rev 450 Proc 24620 = $4,340.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,MEDCOST,MEDCOST VHN,2295.27,,,,,,,109.0000,4823.0000,percent of total billed charges,"47.59% of $4,823.00 in Billed Charges for Rev 450 Proc 24620 = $2,295.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 24620 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 24620 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,SENTARA HEALTH,SENTARA HEALTH,1244.82,,,,,,,109.0000,4823.0000,percent of total billed charges,"25.81% of $4,823.00 in Billed Charges for Rev 450 Proc 24620 = $1,244.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4823.00,,,,,,,109.0000,4823.0000,percent of total billed charges,"100% of $4,823.00 in Billed Charges for Rev 450 Proc 24620 = $4,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 24620 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 24620 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 24620 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 24620 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 24620 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,WELLCARE,WELLCARE MEDICAID,4823.00,,,,,,,109.0000,4823.0000,percent of total billed charges,"100% of $4,823.00 in Billed Charges for Rev 450 Proc 24620 = $4,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MONTEGGIA FX DISLOC ELBOW W MANIP,24620,CPT,450,RC,45000381,CDM,,,,both,,,4823.0000,723.4500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,4823.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA,584.99,,,,,,,84.1100,1370.0000,percent of total billed charges,"42.7% of $1,370.00 in Billed Charges for Rev 450 Proc 24640 = $584.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,84.1100,1370.0000,fee schedule,"APG 00041 Proc 24640 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,84.1100,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,84.1100,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,84.1100,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,AMBETTER,AMBETTER,487.87,,,,,,,84.1100,1370.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,84.1100,1370.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,84.1100,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,84.1100,1370.0000,fee schedule,"APG 00041 Proc 24640 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,84.1100,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,84.1100,1370.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,84.1100,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,84.11,,,,,,,84.1100,1370.0000,fee schedule,$84.11 from Fee Schedule BLDTM_23 for Rev 450 Proc 24640 * Qty 1 = $84.11 at 100% = $84.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,84.1100,1370.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,84.1100,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,84.1100,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1233.00,,,,,,,84.1100,1370.0000,percent of total billed charges,"90% of $1,370.00 in Billed Charges for Rev 450 Proc 24640 = $1,233.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,84.1100,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,84.1100,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,MEDCOST,MEDCOST VHN,651.98,,,,,,,84.1100,1370.0000,percent of total billed charges,"47.59% of $1,370.00 in Billed Charges for Rev 450 Proc 24640 = $651.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,84.1100,1370.0000,fee schedule,"APG 00041 Proc 24640 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,84.1100,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,84.1100,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,84.1100,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,84.1100,1370.0000,fee schedule,"APG 00041 Proc 24640 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,SENTARA HEALTH,SENTARA HEALTH,353.60,,,,,,,84.1100,1370.0000,percent of total billed charges,"25.81% of $1,370.00 in Billed Charges for Rev 450 Proc 24640 = $353.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,84.1100,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1370.00,,,,,,,84.1100,1370.0000,percent of total billed charges,"100% of $1,370.00 in Billed Charges for Rev 450 Proc 24640 = $1,370.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,84.1100,1370.0000,case rate,Rev 450 Proc 24640 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,84.1100,1370.0000,case rate,Rev 450 Proc 24640 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,84.1100,1370.0000,case rate,Rev 450 Proc 24640 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,84.1100,1370.0000,case rate,Rev 450 Proc 24640 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,84.1100,1370.0000,fee schedule,"APG 00041 Proc 24640 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,84.1100,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,84.1100,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,WELLCARE,WELLCARE MEDICAID,1370.00,,,,,,,84.1100,1370.0000,percent of total billed charges,"100% of $1,370.00 in Billed Charges for Rev 450 Proc 24640 = $1,370.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX RAD HEAD SUBLX CHILD,24640,CPT,450,RC,45000119,CDM,,,,both,,,1370.0000,205.5000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,84.1100,1370.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA,180.19,,,,,,,108.9200,703.3600,percent of total billed charges,42.7% of $422.00 in Billed Charges for Rev 450 Proc 24650 = $180.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 24650 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,AMBETTER,AMBETTER,487.87,,,,,,,108.9200,703.3600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,108.9200,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM EXCHANGE,422.00,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,422.00,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 24650 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HMO,422.00,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,108.9200,703.3600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",422.00,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,214.17,,,,,,,108.9200,703.3600,fee schedule,$214.17 from Fee Schedule BLDTM_23 for Rev 450 Proc 24650 * Qty 1 = $214.17 at 100% = $214.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,108.9200,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,379.80,,,,,,,108.9200,703.3600,percent of total billed charges,90% of $422.00 in Billed Charges for Rev 450 Proc 24650 = $379.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,MEDCOST,MEDCOST VHN,200.83,,,,,,,108.9200,703.3600,percent of total billed charges,47.59% of $422.00 in Billed Charges for Rev 450 Proc 24650 = $200.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 24650 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 24650 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA HEALTH,108.92,,,,,,,108.9200,703.3600,percent of total billed charges,25.81% of $422.00 in Billed Charges for Rev 450 Proc 24650 = $108.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",422.00,,,,,,,108.9200,703.3600,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 24650 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,108.9200,703.3600,case rate,Rev 450 Proc 24650 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,422.00,,,,,,,108.9200,703.3600,case rate,"Rev 450 Proc 24650 at Case Rate $491.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,422.00,,,,,,,108.9200,703.3600,case rate,"Rev 450 Proc 24650 at Case Rate $471.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,422.00,,,,,,,108.9200,703.3600,case rate,"Rev 450 Proc 24650 at Case Rate $847.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 24650 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICAID,422.00,,,,,,,108.9200,703.3600,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 24650 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC RADIAL H/N FRACT W/O MANIPULAT,24650,CPT,450,RC,45000120,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,108.9200,703.3600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA,180.19,,,,,,,51.7900,703.3600,percent of total billed charges,42.7% of $422.00 in Billed Charges for Rev 450 Proc 28630 = $180.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,51.7900,703.3600,fee schedule,"APG 00041 Proc 28630 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,51.7900,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,51.7900,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,51.7900,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,AMBETTER,AMBETTER,487.87,,,,,,,51.7900,703.3600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,51.7900,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM EXCHANGE,422.00,,,,,,,51.7900,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,422.00,,,,,,,51.7900,703.3600,fee schedule,"APG 00041 Proc 28630 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HMO,422.00,,,,,,,51.7900,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,51.7900,703.3600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",422.00,,,,,,,51.7900,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,83.11,,,,,,,51.7900,703.3600,fee schedule,$83.11 from Fee Schedule BLDTM_23 for Rev 450 Proc 28630 * Qty 1 = $83.11 at 100% = $83.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,51.7900,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,TENNCARE BLUE CARE,51.79,,,,,,,51.7900,703.3600,fee schedule,$44.65 from Fee Schedule TC_24 for Rev 450 Proc 28630 * Qty 1 = $44.65 at 116% = $51.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,TENNCARE BLUE SELECT,51.79,,,,,,,51.7900,703.3600,fee schedule,$44.65 from Fee Schedule TC_24 for Rev 450 Proc 28630 * Qty 1 = $44.65 at 116% = $51.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,51.7900,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,51.7900,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,379.80,,,,,,,51.7900,703.3600,percent of total billed charges,90% of $422.00 in Billed Charges for Rev 450 Proc 28630 = $379.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,51.7900,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,51.7900,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,MEDCOST,MEDCOST VHN,200.83,,,,,,,51.7900,703.3600,percent of total billed charges,47.59% of $422.00 in Billed Charges for Rev 450 Proc 28630 = $200.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,51.7900,703.3600,fee schedule,"APG 00041 Proc 28630 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,51.7900,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,51.7900,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,51.7900,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,51.7900,703.3600,fee schedule,"APG 00041 Proc 28630 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA HEALTH,108.92,,,,,,,51.7900,703.3600,percent of total billed charges,25.81% of $422.00 in Billed Charges for Rev 450 Proc 28630 = $108.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,51.7900,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",422.00,,,,,,,51.7900,703.3600,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 28630 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,51.7900,703.3600,case rate,Rev 450 Proc 28630 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,422.00,,,,,,,51.7900,703.3600,case rate,"Rev 450 Proc 28630 at Case Rate $491.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,422.00,,,,,,,51.7900,703.3600,case rate,"Rev 450 Proc 28630 at Case Rate $471.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,422.00,,,,,,,51.7900,703.3600,case rate,"Rev 450 Proc 28630 at Case Rate $847.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,51.7900,703.3600,fee schedule,"APG 00041 Proc 28630 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,51.7900,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,51.7900,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICAID,422.00,,,,,,,51.7900,703.3600,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 28630 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX METATRSOLPHA DIS WO A,28630,CPT,450,RC,45000189,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,51.7900,703.3600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,AETNA,AETNA,3823.79,,,,,,,291.1500,8955.0000,percent of total billed charges,"42.7% of $8,955.00 in Billed Charges for Rev 510 Proc 28820 = $3,823.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3128.66,,,,,,,291.1500,8955.0000,fee schedule,"APG 00035 Proc 28820 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 104% = $3,128.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2968.60,,,,,,,291.1500,8955.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,AETNA,AETNA HEALTHCARE MEDICARE,2968.60,,,,,,,291.1500,8955.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,2968.60,,,,,,,291.1500,8955.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,AMBETTER,AMBETTER,6471.55,,,,,,,291.1500,8955.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3087.35,,,,,,,291.1500,8955.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,BLUE CROSS,ANTHEM EXCHANGE,7308.87,,,,,,,291.1500,8955.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3098.58,,,,,,,291.1500,8955.0000,fee schedule,"APG 00035 Proc 28820 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 103% = $3,098.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,BLUE CROSS,ANTHEM HMO,7765.24,,,,,,,291.1500,8955.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3057.66,,,,,,,291.1500,8955.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8955.00,,,,,,,291.1500,8955.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,291.15,,,,,,,291.1500,8955.0000,fee schedule,$291.15 from Fee Schedule BLDTM_23 for Rev 510 Proc 28820 * Qty 1 = $291.15 at 100% = $291.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,BLUE CROSS,BLUE CROSS MEDICARE,3087.35,,,,,,,291.1500,8955.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,CIGNA HEALTHCARE,CIGNA HMO,3734.24,,,,,,,291.1500,8955.0000,percent of total billed charges,"41.7% of $8,955.00 in Billed Charges for Rev 510 Proc 28820 = $3,734.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4155.12,,,,,,,291.1500,8955.0000,percent of total billed charges,"46.4% of $8,955.00 in Billed Charges for Rev 510 Proc 28820 = $4,155.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,3117.03,,,,,,,291.1500,8955.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3734.24,,,,,,,291.1500,8955.0000,percent of total billed charges,"41.7% of $8,955.00 in Billed Charges for Rev 510 Proc 28820 = $3,734.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,CIGNA HEALTHCARE,CIGNA PPO,3734.24,,,,,,,291.1500,8955.0000,percent of total billed charges,"41.7% of $8,955.00 in Billed Charges for Rev 510 Proc 28820 = $3,734.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3117.03,,,,,,,291.1500,8955.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8059.50,,,,,,,291.1500,8955.0000,percent of total billed charges,"90% of $8,955.00 in Billed Charges for Rev 510 Proc 28820 = $8,059.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,HUMANA,HUMANA MEDICARE,2968.60,,,,,,,291.1500,8955.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2968.60,,,,,,,291.1500,8955.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,MEDCOST,MEDCOST VHN,4261.68,,,,,,,291.1500,8955.0000,percent of total billed charges,"47.59% of $8,955.00 in Billed Charges for Rev 510 Proc 28820 = $4,261.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3158.75,,,,,,,291.1500,8955.0000,fee schedule,"APG 00035 Proc 28820 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 100% = $3,008.33... $3,008.33 at 105% = $3,158.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3117.03,,,,,,,291.1500,8955.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3117.03,,,,,,,291.1500,8955.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,NHC ADVANTAGE,NHC ADVANTAGE,3117.03,,,,,,,291.1500,8955.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3101.59,,,,,,,291.1500,8955.0000,fee schedule,"APG 00035 Proc 28820 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 100% = $3,008.33... $3,008.33 at 103.1% = $3,101.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,SENTARA HEALTH,SENTARA HEALTH,2311.29,,,,,,,291.1500,8955.0000,percent of total billed charges,"25.81% of $8,955.00 in Billed Charges for Rev 510 Proc 28820 = $2,311.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,SENTARA HEALTH,SENTARA MEDICARE,2968.60,,,,,,,291.1500,8955.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8955.00,,,,,,,291.1500,8955.0000,percent of total billed charges,"100% of $8,955.00 in Billed Charges for Rev 510 Proc 28820 = $8,955.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,871.76,,,,,,,291.1500,8955.0000,fee schedule,"$1,743.52 from Fee Schedule TCUHC24 for Rev 510 Proc 28820 * Qty 1 = $1,743.52 at 50% = $871.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2892.47,,,,,,,291.1500,8955.0000,other,"32.3% of $8,955.00 in Billed Charges for Rev 510 Proc 28820 = $2,892.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2749.19,,,,,,,291.1500,8955.0000,other,"30.7% of $8,955.00 in Billed Charges for Rev 510 Proc 28820 = $2,749.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,2892.47,,,,,,,291.1500,8955.0000,percent of total billed charges,"32.3% of $8,955.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3098.58,,,,,,,291.1500,8955.0000,fee schedule,"APG 00035 Proc 28820 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 103% = $3,098.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2968.60,,,,,,,291.1500,8955.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2968.60,,,,,,,291.1500,8955.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,WELLCARE,WELLCARE MEDICAID,8955.00,,,,,,,291.1500,8955.0000,percent of total billed charges,"100% of $8,955.00 in Billed Charges for Rev 510 Proc 28820 = $8,955.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMPUTATION TOE METATARSOPHALANGEAL JOINT,28820,CPT,510,RC,51000241,CDM,,,,both,,,8955.0000,1343.2500,WELLCARE,WELLCARE MEDICARE,3146.72,,,,,,,291.1500,8955.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,AETNA,AETNA,2377.96,,,,,,,109.0000,6471.5500,percent of total billed charges,"42.7% of $5,569.00 in Billed Charges for Rev 450 Proc 28825 = $2,377.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3128.66,,,,,,,109.0000,6471.5500,fee schedule,"APG 00035 Proc 28825 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 104% = $3,128.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2968.60,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,AETNA,AETNA HEALTHCARE MEDICARE,2968.60,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,2968.60,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,AMBETTER,AMBETTER,6471.55,,,,,,,109.0000,6471.5500,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3087.35,,,,,,,109.0000,6471.5500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,BLUE CROSS,ANTHEM EXCHANGE,5569.00,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3098.58,,,,,,,109.0000,6471.5500,fee schedule,"APG 00035 Proc 28825 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 103% = $3,098.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,BLUE CROSS,ANTHEM HMO,5569.00,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3057.66,,,,,,,109.0000,6471.5500,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5569.00,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,200.45,,,,,,,109.0000,6471.5500,fee schedule,$200.45 from Fee Schedule BLDTM_23 for Rev 450 Proc 28825 * Qty 1 = $200.45 at 100% = $200.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,BLUE CROSS,BLUE CROSS MEDICARE,3087.35,,,,,,,109.0000,6471.5500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,3117.03,,,,,,,109.0000,6471.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3117.03,,,,,,,109.0000,6471.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5012.10,,,,,,,109.0000,6471.5500,percent of total billed charges,"90% of $5,569.00 in Billed Charges for Rev 450 Proc 28825 = $5,012.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,HUMANA,HUMANA MEDICARE,2968.60,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2968.60,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,MEDCOST,MEDCOST VHN,2650.29,,,,,,,109.0000,6471.5500,percent of total billed charges,"47.59% of $5,569.00 in Billed Charges for Rev 450 Proc 28825 = $2,650.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3158.75,,,,,,,109.0000,6471.5500,fee schedule,"APG 00035 Proc 28825 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 100% = $3,008.33... $3,008.33 at 105% = $3,158.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3117.03,,,,,,,109.0000,6471.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3117.03,,,,,,,109.0000,6471.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,NHC ADVANTAGE,NHC ADVANTAGE,3117.03,,,,,,,109.0000,6471.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3101.59,,,,,,,109.0000,6471.5500,fee schedule,"APG 00035 Proc 28825 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 100% = $3,008.33... $3,008.33 at 103.1% = $3,101.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,SENTARA HEALTH,SENTARA HEALTH,1437.36,,,,,,,109.0000,6471.5500,percent of total billed charges,"25.81% of $5,569.00 in Billed Charges for Rev 450 Proc 28825 = $1,437.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,SENTARA HEALTH,SENTARA MEDICARE,2968.60,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5569.00,,,,,,,109.0000,6471.5500,percent of total billed charges,"100% of $5,569.00 in Billed Charges for Rev 450 Proc 28825 = $5,569.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,6471.5500,case rate,Rev 450 Proc 28825 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,6471.5500,case rate,Rev 450 Proc 28825 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,6471.5500,case rate,Rev 450 Proc 28825 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,6471.5500,case rate,Rev 450 Proc 28825 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3098.58,,,,,,,109.0000,6471.5500,fee schedule,"APG 00035 Proc 28825 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 103% = $3,098.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2968.60,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2968.60,,,,,,,109.0000,6471.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,WELLCARE,WELLCARE MEDICAID,5569.00,,,,,,,109.0000,6471.5500,percent of total billed charges,"100% of $5,569.00 in Billed Charges for Rev 450 Proc 28825 = $5,569.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AMPUTATION TOE IP JOINT,28825,CPT,450,RC,45000333,CDM,,,,both,,,5569.0000,835.3500,WELLCARE,WELLCARE MEDICARE,3146.72,,,,,,,109.0000,6471.5500,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,AETNA,AETNA,343.74,,,,,,,32.9600,805.0000,percent of total billed charges,42.7% of $805.00 in Billed Charges for Rev 521 Proc 29065 = $343.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,283.21,,,,,,,32.9600,805.0000,fee schedule,"APG 00039 Proc 29065 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 104% = $283.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,253.76,,,,,,,32.9600,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,AETNA,AETNA HEALTHCARE MEDICARE,253.76,,,,,,,32.9600,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,253.76,,,,,,,32.9600,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,AMBETTER,AMBETTER,553.19,,,,,,,32.9600,805.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,263.91,,,,,,,32.9600,805.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,ANTHEM EXCHANGE,624.77,,,,,,,32.9600,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,280.48,,,,,,,32.9600,805.0000,fee schedule,"APG 00039 Proc 29065 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,ANTHEM HMO,663.78,,,,,,,32.9600,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,261.37,,,,,,,32.9600,805.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",780.88,,,,,,,32.9600,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,78.06,,,,,,,32.9600,805.0000,fee schedule,$78.06 from Fee Schedule BLDTM_23 for Rev 521 Proc 29065 * Qty 1 = $78.06 at 100% = $78.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,BLUE CROSS MEDICARE,263.91,,,,,,,32.9600,805.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,TENNCARE BLUE CARE,32.96,,,,,,,32.9600,805.0000,fee schedule,$28.41 from Fee Schedule TC_24 for Rev 521 Proc 29065 * Qty 1 = $28.41 at 116% = $32.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,TENNCARE BLUE SELECT,32.96,,,,,,,32.9600,805.0000,fee schedule,$28.41 from Fee Schedule TC_24 for Rev 521 Proc 29065 * Qty 1 = $28.41 at 116% = $32.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA HMO,335.69,,,,,,,32.9600,805.0000,percent of total billed charges,41.7% of $805.00 in Billed Charges for Rev 521 Proc 29065 = $335.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,373.52,,,,,,,32.9600,805.0000,percent of total billed charges,46.4% of $805.00 in Billed Charges for Rev 521 Proc 29065 = $373.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,266.45,,,,,,,32.9600,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,335.69,,,,,,,32.9600,805.0000,percent of total billed charges,41.7% of $805.00 in Billed Charges for Rev 521 Proc 29065 = $335.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA PPO,335.69,,,,,,,32.9600,805.0000,percent of total billed charges,41.7% of $805.00 in Billed Charges for Rev 521 Proc 29065 = $335.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,266.45,,,,,,,32.9600,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,724.50,,,,,,,32.9600,805.0000,percent of total billed charges,90% of $805.00 in Billed Charges for Rev 521 Proc 29065 = $724.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,HUMANA,HUMANA MEDICARE,253.76,,,,,,,32.9600,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,253.76,,,,,,,32.9600,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,MEDCOST,MEDCOST VHN,383.10,,,,,,,32.9600,805.0000,percent of total billed charges,47.59% of $805.00 in Billed Charges for Rev 521 Proc 29065 = $383.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,285.93,,,,,,,32.9600,805.0000,fee schedule,"APG 00039 Proc 29065 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 105% = $285.93 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,266.45,,,,,,,32.9600,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,266.45,,,,,,,32.9600,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,NHC ADVANTAGE,NHC ADVANTAGE,266.45,,,,,,,32.9600,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,280.75,,,,,,,32.9600,805.0000,fee schedule,"APG 00039 Proc 29065 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 103.1% = $280.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,SENTARA HEALTH,SENTARA HEALTH,207.77,,,,,,,32.9600,805.0000,percent of total billed charges,25.81% of $805.00 in Billed Charges for Rev 521 Proc 29065 = $207.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,SENTARA HEALTH,SENTARA MEDICARE,253.76,,,,,,,32.9600,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",805.00,,,,,,,32.9600,805.0000,percent of total billed charges,100% of $805.00 in Billed Charges for Rev 521 Proc 29065 = $805.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,111.65,,,,,,,32.9600,805.0000,fee schedule,$223.29 from Fee Schedule TCUHC24 for Rev 521 Proc 29065 * Qty 1 = $223.29 at 50% = $111.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,280.48,,,,,,,32.9600,805.0000,fee schedule,"APG 00039 Proc 29065 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,253.76,,,,,,,32.9600,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,253.76,,,,,,,32.9600,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,WELLCARE,WELLCARE MEDICAID,805.00,,,,,,,32.9600,805.0000,percent of total billed charges,100% of $805.00 in Billed Charges for Rev 521 Proc 29065 = $805.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL CAST LONG ARM,29065,CPT,521,RC,52100094,CDM,,,,both,,,805.0000,120.7500,WELLCARE,WELLCARE MEDICARE,268.98,,,,,,,32.9600,805.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,AETNA,AETNA,370.64,,,,,,,26.6800,868.0000,percent of total billed charges,42.7% of $868.00 in Billed Charges for Rev 450 Proc 29075 = $370.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,283.21,,,,,,,26.6800,868.0000,fee schedule,"APG 00039 Proc 29075 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 104% = $283.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,253.76,,,,,,,26.6800,868.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,AETNA,AETNA HEALTHCARE MEDICARE,253.76,,,,,,,26.6800,868.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,253.76,,,,,,,26.6800,868.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,AMBETTER,AMBETTER,553.19,,,,,,,26.6800,868.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,263.91,,,,,,,26.6800,868.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,BLUE CROSS,ANTHEM EXCHANGE,624.77,,,,,,,26.6800,868.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,280.48,,,,,,,26.6800,868.0000,fee schedule,"APG 00039 Proc 29075 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,BLUE CROSS,ANTHEM HMO,663.78,,,,,,,26.6800,868.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,261.37,,,,,,,26.6800,868.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",780.88,,,,,,,26.6800,868.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,64.86,,,,,,,26.6800,868.0000,fee schedule,$64.86 from Fee Schedule BLDTM_23 for Rev 450 Proc 29075 * Qty 1 = $64.86 at 100% = $64.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,BLUE CROSS,BLUE CROSS MEDICARE,263.91,,,,,,,26.6800,868.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,BLUE CROSS,TENNCARE BLUE CARE,26.68,,,,,,,26.6800,868.0000,fee schedule,$23.00 from Fee Schedule TC_24 for Rev 450 Proc 29075 * Qty 1 = $23.00 at 116% = $26.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,BLUE CROSS,TENNCARE BLUE SELECT,26.68,,,,,,,26.6800,868.0000,fee schedule,$23.00 from Fee Schedule TC_24 for Rev 450 Proc 29075 * Qty 1 = $23.00 at 116% = $26.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,266.45,,,,,,,26.6800,868.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,266.45,,,,,,,26.6800,868.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,781.20,,,,,,,26.6800,868.0000,percent of total billed charges,90% of $868.00 in Billed Charges for Rev 450 Proc 29075 = $781.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,HUMANA,HUMANA MEDICARE,253.76,,,,,,,26.6800,868.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,253.76,,,,,,,26.6800,868.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,MEDCOST,MEDCOST VHN,413.08,,,,,,,26.6800,868.0000,percent of total billed charges,47.59% of $868.00 in Billed Charges for Rev 450 Proc 29075 = $413.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,285.93,,,,,,,26.6800,868.0000,fee schedule,"APG 00039 Proc 29075 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 105% = $285.93 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,266.45,,,,,,,26.6800,868.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,266.45,,,,,,,26.6800,868.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,NHC ADVANTAGE,NHC ADVANTAGE,266.45,,,,,,,26.6800,868.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,280.75,,,,,,,26.6800,868.0000,fee schedule,"APG 00039 Proc 29075 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 103.1% = $280.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,SENTARA HEALTH,SENTARA HEALTH,224.03,,,,,,,26.6800,868.0000,percent of total billed charges,25.81% of $868.00 in Billed Charges for Rev 450 Proc 29075 = $224.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,SENTARA HEALTH,SENTARA MEDICARE,253.76,,,,,,,26.6800,868.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",868.00,,,,,,,26.6800,868.0000,percent of total billed charges,100% of $868.00 in Billed Charges for Rev 450 Proc 29075 = $868.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,26.6800,868.0000,case rate,Rev 450 Proc 29075 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,26.6800,868.0000,case rate,Rev 450 Proc 29075 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,26.6800,868.0000,case rate,Rev 450 Proc 29075 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,26.6800,868.0000,case rate,Rev 450 Proc 29075 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,280.48,,,,,,,26.6800,868.0000,fee schedule,"APG 00039 Proc 29075 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,253.76,,,,,,,26.6800,868.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,253.76,,,,,,,26.6800,868.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,WELLCARE,WELLCARE MEDICAID,868.00,,,,,,,26.6800,868.0000,percent of total billed charges,100% of $868.00 in Billed Charges for Rev 450 Proc 29075 = $868.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT ARM CAST,29075,CPT,450,RC,45000192,CDM,,,,both,,,868.0000,130.2000,WELLCARE,WELLCARE MEDICARE,268.98,,,,,,,26.6800,868.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,AETNA,AETNA,125.11,,,,,,,41.8100,321.4000,percent of total billed charges,42.7% of $293.00 in Billed Charges for Rev 450 Proc 29086 = $125.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,283.21,,,,,,,41.8100,321.4000,fee schedule,"APG 00039 Proc 29086 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 104% = $283.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,147.43,,,,,,,41.8100,321.4000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,AETNA,AETNA HEALTHCARE MEDICARE,147.43,,,,,,,41.8100,321.4000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,147.43,,,,,,,41.8100,321.4000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,AMBETTER,AMBETTER,321.40,,,,,,,41.8100,321.4000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,153.33,,,,,,,41.8100,321.4000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,BLUE CROSS,ANTHEM EXCHANGE,293.00,,,,,,,41.8100,321.4000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,280.48,,,,,,,41.8100,321.4000,fee schedule,"APG 00039 Proc 29086 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,BLUE CROSS,ANTHEM HMO,293.00,,,,,,,41.8100,321.4000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,151.86,,,,,,,41.8100,321.4000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",293.00,,,,,,,41.8100,321.4000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,41.81,,,,,,,41.8100,321.4000,fee schedule,$41.81 from Fee Schedule BLDTM_23 for Rev 450 Proc 29086 * Qty 1 = $41.81 at 100% = $41.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,BLUE CROSS,BLUE CROSS MEDICARE,153.33,,,,,,,41.8100,321.4000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,154.80,,,,,,,41.8100,321.4000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,154.80,,,,,,,41.8100,321.4000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,263.70,,,,,,,41.8100,321.4000,percent of total billed charges,90% of $293.00 in Billed Charges for Rev 450 Proc 29086 = $263.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,HUMANA,HUMANA MEDICARE,147.43,,,,,,,41.8100,321.4000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,147.43,,,,,,,41.8100,321.4000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,MEDCOST,MEDCOST VHN,139.44,,,,,,,41.8100,321.4000,percent of total billed charges,47.59% of $293.00 in Billed Charges for Rev 450 Proc 29086 = $139.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,285.93,,,,,,,41.8100,321.4000,fee schedule,"APG 00039 Proc 29086 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 105% = $285.93 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,154.80,,,,,,,41.8100,321.4000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,154.80,,,,,,,41.8100,321.4000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,NHC ADVANTAGE,NHC ADVANTAGE,154.80,,,,,,,41.8100,321.4000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,280.75,,,,,,,41.8100,321.4000,fee schedule,"APG 00039 Proc 29086 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 103.1% = $280.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,SENTARA HEALTH,SENTARA HEALTH,75.62,,,,,,,41.8100,321.4000,percent of total billed charges,25.81% of $293.00 in Billed Charges for Rev 450 Proc 29086 = $75.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,SENTARA HEALTH,SENTARA MEDICARE,147.43,,,,,,,41.8100,321.4000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",293.00,,,,,,,41.8100,321.4000,percent of total billed charges,100% of $293.00 in Billed Charges for Rev 450 Proc 29086 = $293.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,41.8100,321.4000,case rate,Rev 450 Proc 29086 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,293.00,,,,,,,41.8100,321.4000,case rate,"Rev 450 Proc 29086 at Case Rate $491.00 (Service Line reduced to $293.00, claim capped at $293.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,293.00,,,,,,,41.8100,321.4000,case rate,"Rev 450 Proc 29086 at Case Rate $471.00 (Service Line reduced to $293.00, claim capped at $293.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,293.00,,,,,,,41.8100,321.4000,case rate,"Rev 450 Proc 29086 at Case Rate $847.00 (Service Line reduced to $293.00, claim capped at $293.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,280.48,,,,,,,41.8100,321.4000,fee schedule,"APG 00039 Proc 29086 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,147.43,,,,,,,41.8100,321.4000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,147.43,,,,,,,41.8100,321.4000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,WELLCARE,WELLCARE MEDICAID,293.00,,,,,,,41.8100,321.4000,percent of total billed charges,100% of $293.00 in Billed Charges for Rev 450 Proc 29086 = $293.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY FINGER CAST,29086,CPT,450,RC,45000194,CDM,,,,both,,,293.0000,43.9500,WELLCARE,WELLCARE MEDICARE,156.28,,,,,,,41.8100,321.4000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,AETNA,AETNA,307.01,,,,,,,53.4100,719.0000,percent of total billed charges,42.7% of $719.00 in Billed Charges for Rev 450 Proc 29105 = $307.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,106.23,,,,,,,53.4100,719.0000,fee schedule,"APG 00040 Proc 29105 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 104% = $106.23. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,147.43,,,,,,,53.4100,719.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,AETNA,AETNA HEALTHCARE MEDICARE,147.43,,,,,,,53.4100,719.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,147.43,,,,,,,53.4100,719.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,AMBETTER,AMBETTER,321.40,,,,,,,53.4100,719.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,153.33,,,,,,,53.4100,719.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,BLUE CROSS,ANTHEM EXCHANGE,362.98,,,,,,,53.4100,719.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,105.21,,,,,,,53.4100,719.0000,fee schedule,"APG 00040 Proc 29105 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,BLUE CROSS,ANTHEM HMO,385.65,,,,,,,53.4100,719.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,151.86,,,,,,,53.4100,719.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",453.68,,,,,,,53.4100,719.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,53.41,,,,,,,53.4100,719.0000,fee schedule,$53.41 from Fee Schedule BLDTM_23 for Rev 450 Proc 29105 * Qty 1 = $53.41 at 100% = $53.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,BLUE CROSS,BLUE CROSS MEDICARE,153.33,,,,,,,53.4100,719.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,154.80,,,,,,,53.4100,719.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,154.80,,,,,,,53.4100,719.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,647.10,,,,,,,53.4100,719.0000,percent of total billed charges,90% of $719.00 in Billed Charges for Rev 450 Proc 29105 = $647.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,HUMANA,HUMANA MEDICARE,147.43,,,,,,,53.4100,719.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,147.43,,,,,,,53.4100,719.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,MEDCOST,MEDCOST VHN,342.17,,,,,,,53.4100,719.0000,percent of total billed charges,47.59% of $719.00 in Billed Charges for Rev 450 Proc 29105 = $342.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,107.26,,,,,,,53.4100,719.0000,fee schedule,"APG 00040 Proc 29105 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 100% = $102.15... $102.15 at 105% = $107.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,154.80,,,,,,,53.4100,719.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,154.80,,,,,,,53.4100,719.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,NHC ADVANTAGE,NHC ADVANTAGE,154.80,,,,,,,53.4100,719.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,105.32,,,,,,,53.4100,719.0000,fee schedule,"APG 00040 Proc 29105 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 100% = $102.15... $102.15 at 103.1% = $105.32 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,SENTARA HEALTH,SENTARA HEALTH,185.57,,,,,,,53.4100,719.0000,percent of total billed charges,25.81% of $719.00 in Billed Charges for Rev 450 Proc 29105 = $185.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,SENTARA HEALTH,SENTARA MEDICARE,147.43,,,,,,,53.4100,719.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",719.00,,,,,,,53.4100,719.0000,percent of total billed charges,100% of $719.00 in Billed Charges for Rev 450 Proc 29105 = $719.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,53.4100,719.0000,case rate,Rev 450 Proc 29105 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,53.4100,719.0000,case rate,Rev 450 Proc 29105 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,53.4100,719.0000,case rate,Rev 450 Proc 29105 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,719.00,,,,,,,53.4100,719.0000,case rate,"Rev 450 Proc 29105 at Case Rate $847.00 (Service Line reduced to $719.00, claim capped at $719.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,105.21,,,,,,,53.4100,719.0000,fee schedule,"APG 00040 Proc 29105 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,147.43,,,,,,,53.4100,719.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,147.43,,,,,,,53.4100,719.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,WELLCARE,WELLCARE MEDICAID,719.00,,,,,,,53.4100,719.0000,percent of total billed charges,100% of $719.00 in Billed Charges for Rev 450 Proc 29105 = $719.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY LONG ARM SPLINT,29105,CPT,450,RC,45000195,CDM,,,,both,,,719.0000,107.8500,WELLCARE,WELLCARE MEDICARE,156.28,,,,,,,53.4100,719.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,AETNA,AETNA,219.91,,,,,,,18.8400,515.0000,percent of total billed charges,42.7% of $515.00 in Billed Charges for Rev 450 Proc 29125 = $219.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,106.23,,,,,,,18.8400,515.0000,fee schedule,APG 00040 Proc 29125 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 104% = $106.23. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,120.71,,,,,,,18.8400,515.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,AETNA,AETNA HEALTHCARE MEDICARE,120.71,,,,,,,18.8400,515.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,120.71,,,,,,,18.8400,515.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,AMBETTER,AMBETTER,263.15,,,,,,,18.8400,515.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,125.54,,,,,,,18.8400,515.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,BLUE CROSS,ANTHEM EXCHANGE,297.21,,,,,,,18.8400,515.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,105.21,,,,,,,18.8400,515.0000,fee schedule,APG 00040 Proc 29125 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,BLUE CROSS,ANTHEM HMO,315.76,,,,,,,18.8400,515.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,124.33,,,,,,,18.8400,515.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",371.47,,,,,,,18.8400,515.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,43.32,,,,,,,18.8400,515.0000,fee schedule,$43.32 from Fee Schedule BLDTM_23 for Rev 450 Proc 29125 * Qty 1 = $43.32 at 100% = $43.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,BLUE CROSS,BLUE CROSS MEDICARE,125.54,,,,,,,18.8400,515.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,BLUE CROSS,TENNCARE BLUE CARE,18.84,,,,,,,18.8400,515.0000,fee schedule,$16.24 from Fee Schedule TC_24 for Rev 450 Proc 29125 * Qty 1 = $16.24 at 116% = $18.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,BLUE CROSS,TENNCARE BLUE SELECT,18.84,,,,,,,18.8400,515.0000,fee schedule,$16.24 from Fee Schedule TC_24 for Rev 450 Proc 29125 * Qty 1 = $16.24 at 116% = $18.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,126.75,,,,,,,18.8400,515.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,126.75,,,,,,,18.8400,515.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,463.50,,,,,,,18.8400,515.0000,percent of total billed charges,90% of $515.00 in Billed Charges for Rev 450 Proc 29125 = $463.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,HUMANA,HUMANA MEDICARE,120.71,,,,,,,18.8400,515.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,120.71,,,,,,,18.8400,515.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,MEDCOST,MEDCOST VHN,245.09,,,,,,,18.8400,515.0000,percent of total billed charges,47.59% of $515.00 in Billed Charges for Rev 450 Proc 29125 = $245.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,107.26,,,,,,,18.8400,515.0000,fee schedule,APG 00040 Proc 29125 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 100% = $102.15... $102.15 at 105% = $107.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,126.75,,,,,,,18.8400,515.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,126.75,,,,,,,18.8400,515.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,NHC ADVANTAGE,NHC ADVANTAGE,126.75,,,,,,,18.8400,515.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,105.32,,,,,,,18.8400,515.0000,fee schedule,APG 00040 Proc 29125 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 100% = $102.15... $102.15 at 103.1% = $105.32 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,SENTARA HEALTH,SENTARA HEALTH,132.92,,,,,,,18.8400,515.0000,percent of total billed charges,25.81% of $515.00 in Billed Charges for Rev 450 Proc 29125 = $132.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,SENTARA HEALTH,SENTARA MEDICARE,120.71,,,,,,,18.8400,515.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",515.00,,,,,,,18.8400,515.0000,percent of total billed charges,100% of $515.00 in Billed Charges for Rev 450 Proc 29125 = $515.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,18.8400,515.0000,case rate,Rev 450 Proc 29125 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,18.8400,515.0000,case rate,Rev 450 Proc 29125 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,18.8400,515.0000,case rate,Rev 450 Proc 29125 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,515.00,,,,,,,18.8400,515.0000,case rate,"Rev 450 Proc 29125 at Case Rate $847.00 (Service Line reduced to $515.00, claim capped at $515.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,105.21,,,,,,,18.8400,515.0000,fee schedule,APG 00040 Proc 29125 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,120.71,,,,,,,18.8400,515.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,120.71,,,,,,,18.8400,515.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,WELLCARE,WELLCARE MEDICAID,515.00,,,,,,,18.8400,515.0000,percent of total billed charges,100% of $515.00 in Billed Charges for Rev 450 Proc 29125 = $515.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT ARM SPLINT STATIC,29125,CPT,450,RC,45000196,CDM,,,,both,,,515.0000,77.2500,WELLCARE,WELLCARE MEDICARE,127.95,,,,,,,18.8400,515.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,AETNA,AETNA,146.89,,,,,,,12.5500,344.0000,percent of total billed charges,42.7% of $344.00 in Billed Charges for Rev 450 Proc 29130 = $146.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,106.23,,,,,,,12.5500,344.0000,fee schedule,APG 00040 Proc 29130 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 104% = $106.23. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,120.71,,,,,,,12.5500,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,AETNA,AETNA HEALTHCARE MEDICARE,120.71,,,,,,,12.5500,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,120.71,,,,,,,12.5500,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,AMBETTER,AMBETTER,263.15,,,,,,,12.5500,344.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,125.54,,,,,,,12.5500,344.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,ANTHEM EXCHANGE,297.21,,,,,,,12.5500,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,105.21,,,,,,,12.5500,344.0000,fee schedule,APG 00040 Proc 29130 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,ANTHEM HMO,315.76,,,,,,,12.5500,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,124.33,,,,,,,12.5500,344.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",344.00,,,,,,,12.5500,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,29.61,,,,,,,12.5500,344.0000,fee schedule,$29.61 from Fee Schedule BLDTM_23 for Rev 450 Proc 29130 * Qty 1 = $29.61 at 100% = $29.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,BLUE CROSS MEDICARE,125.54,,,,,,,12.5500,344.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,TENNCARE BLUE CARE,12.55,,,,,,,12.5500,344.0000,fee schedule,$10.82 from Fee Schedule TC_24 for Rev 450 Proc 29130 * Qty 1 = $10.82 at 116% = $12.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,TENNCARE BLUE SELECT,12.55,,,,,,,12.5500,344.0000,fee schedule,$10.82 from Fee Schedule TC_24 for Rev 450 Proc 29130 * Qty 1 = $10.82 at 116% = $12.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,126.75,,,,,,,12.5500,344.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,126.75,,,,,,,12.5500,344.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,309.60,,,,,,,12.5500,344.0000,percent of total billed charges,90% of $344.00 in Billed Charges for Rev 450 Proc 29130 = $309.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,HUMANA,HUMANA MEDICARE,120.71,,,,,,,12.5500,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,120.71,,,,,,,12.5500,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,MEDCOST,MEDCOST VHN,163.71,,,,,,,12.5500,344.0000,percent of total billed charges,47.59% of $344.00 in Billed Charges for Rev 450 Proc 29130 = $163.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,107.26,,,,,,,12.5500,344.0000,fee schedule,APG 00040 Proc 29130 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 100% = $102.15... $102.15 at 105% = $107.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,126.75,,,,,,,12.5500,344.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,126.75,,,,,,,12.5500,344.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,NHC ADVANTAGE,NHC ADVANTAGE,126.75,,,,,,,12.5500,344.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,105.32,,,,,,,12.5500,344.0000,fee schedule,APG 00040 Proc 29130 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 100% = $102.15... $102.15 at 103.1% = $105.32 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,SENTARA HEALTH,SENTARA HEALTH,88.79,,,,,,,12.5500,344.0000,percent of total billed charges,25.81% of $344.00 in Billed Charges for Rev 450 Proc 29130 = $88.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,SENTARA HEALTH,SENTARA MEDICARE,120.71,,,,,,,12.5500,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",344.00,,,,,,,12.5500,344.0000,percent of total billed charges,100% of $344.00 in Billed Charges for Rev 450 Proc 29130 = $344.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,12.5500,344.0000,case rate,Rev 450 Proc 29130 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,344.00,,,,,,,12.5500,344.0000,case rate,"Rev 450 Proc 29130 at Case Rate $491.00 (Service Line reduced to $344.00, claim capped at $344.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,344.00,,,,,,,12.5500,344.0000,case rate,"Rev 450 Proc 29130 at Case Rate $471.00 (Service Line reduced to $344.00, claim capped at $344.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,344.00,,,,,,,12.5500,344.0000,case rate,"Rev 450 Proc 29130 at Case Rate $847.00 (Service Line reduced to $344.00, claim capped at $344.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,105.21,,,,,,,12.5500,344.0000,fee schedule,APG 00040 Proc 29130 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,120.71,,,,,,,12.5500,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,120.71,,,,,,,12.5500,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,WELLCARE,WELLCARE MEDICAID,344.00,,,,,,,12.5500,344.0000,percent of total billed charges,100% of $344.00 in Billed Charges for Rev 450 Proc 29130 = $344.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY FINGER SPLINT STATIC,29130,CPT,450,RC,45000198,CDM,,,,both,,,344.0000,51.6000,WELLCARE,WELLCARE MEDICARE,127.95,,,,,,,12.5500,344.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,AETNA,AETNA,93.09,,,,,,,18.8400,218.0000,percent of total billed charges,42.7% of $218.00 in Billed Charges for Rev 450 Proc 29131 = $93.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,106.23,,,,,,,18.8400,218.0000,fee schedule,APG 00040 Proc 29131 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 104% = $106.23. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,53.52,,,,,,,18.8400,218.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,AETNA,AETNA HEALTHCARE MEDICARE,53.52,,,,,,,18.8400,218.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,53.52,,,,,,,18.8400,218.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,AMBETTER,AMBETTER,116.68,,,,,,,18.8400,218.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,55.66,,,,,,,18.8400,218.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,BLUE CROSS,ANTHEM EXCHANGE,131.77,,,,,,,18.8400,218.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,105.21,,,,,,,18.8400,218.0000,fee schedule,APG 00040 Proc 29131 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,BLUE CROSS,ANTHEM HMO,140.00,,,,,,,18.8400,218.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,55.13,,,,,,,18.8400,218.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",164.70,,,,,,,18.8400,218.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,37.11,,,,,,,18.8400,218.0000,fee schedule,$37.11 from Fee Schedule BLDTM_23 for Rev 450 Proc 29131 * Qty 1 = $37.11 at 100% = $37.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,BLUE CROSS,BLUE CROSS MEDICARE,55.66,,,,,,,18.8400,218.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,BLUE CROSS,TENNCARE BLUE CARE,18.84,,,,,,,18.8400,218.0000,fee schedule,$16.24 from Fee Schedule TC_24 for Rev 450 Proc 29131 * Qty 1 = $16.24 at 116% = $18.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,BLUE CROSS,TENNCARE BLUE SELECT,18.84,,,,,,,18.8400,218.0000,fee schedule,$16.24 from Fee Schedule TC_24 for Rev 450 Proc 29131 * Qty 1 = $16.24 at 116% = $18.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,56.20,,,,,,,18.8400,218.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,56.20,,,,,,,18.8400,218.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,196.20,,,,,,,18.8400,218.0000,percent of total billed charges,90% of $218.00 in Billed Charges for Rev 450 Proc 29131 = $196.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,HUMANA,HUMANA MEDICARE,53.52,,,,,,,18.8400,218.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,53.52,,,,,,,18.8400,218.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,MEDCOST,MEDCOST VHN,103.75,,,,,,,18.8400,218.0000,percent of total billed charges,47.59% of $218.00 in Billed Charges for Rev 450 Proc 29131 = $103.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,107.26,,,,,,,18.8400,218.0000,fee schedule,APG 00040 Proc 29131 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 100% = $102.15... $102.15 at 105% = $107.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,56.20,,,,,,,18.8400,218.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,56.20,,,,,,,18.8400,218.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,NHC ADVANTAGE,NHC ADVANTAGE,56.20,,,,,,,18.8400,218.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,105.32,,,,,,,18.8400,218.0000,fee schedule,APG 00040 Proc 29131 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 100% = $102.15... $102.15 at 103.1% = $105.32 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,SENTARA HEALTH,SENTARA HEALTH,56.27,,,,,,,18.8400,218.0000,percent of total billed charges,25.81% of $218.00 in Billed Charges for Rev 450 Proc 29131 = $56.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,SENTARA HEALTH,SENTARA MEDICARE,53.52,,,,,,,18.8400,218.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",218.00,,,,,,,18.8400,218.0000,percent of total billed charges,100% of $218.00 in Billed Charges for Rev 450 Proc 29131 = $218.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,18.8400,218.0000,case rate,Rev 450 Proc 29131 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,218.00,,,,,,,18.8400,218.0000,case rate,"Rev 450 Proc 29131 at Case Rate $491.00 (Service Line reduced to $218.00, claim capped at $218.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,218.00,,,,,,,18.8400,218.0000,case rate,"Rev 450 Proc 29131 at Case Rate $471.00 (Service Line reduced to $218.00, claim capped at $218.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,218.00,,,,,,,18.8400,218.0000,case rate,"Rev 450 Proc 29131 at Case Rate $847.00 (Service Line reduced to $218.00, claim capped at $218.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,105.21,,,,,,,18.8400,218.0000,fee schedule,APG 00040 Proc 29131 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,53.52,,,,,,,18.8400,218.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,53.52,,,,,,,18.8400,218.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,WELLCARE,WELLCARE MEDICAID,218.00,,,,,,,18.8400,218.0000,percent of total billed charges,100% of $218.00 in Billed Charges for Rev 450 Proc 29131 = $218.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY FINGER SPLINT DYNAMIC,29131,CPT,450,RC,45000199,CDM,,,,both,,,218.0000,32.7000,WELLCARE,WELLCARE MEDICARE,56.73,,,,,,,18.8400,218.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,AETNA,AETNA,161.41,,,,,,,15.6900,378.0000,percent of total billed charges,42.7% of $378.00 in Billed Charges for Rev 450 Proc 29280 = $161.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,106.23,,,,,,,15.6900,378.0000,fee schedule,APG 00040 Proc 29280 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 104% = $106.23. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,53.52,,,,,,,15.6900,378.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,AETNA,AETNA HEALTHCARE MEDICARE,53.52,,,,,,,15.6900,378.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,53.52,,,,,,,15.6900,378.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,AMBETTER,AMBETTER,116.68,,,,,,,15.6900,378.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,55.66,,,,,,,15.6900,378.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,BLUE CROSS,ANTHEM EXCHANGE,131.77,,,,,,,15.6900,378.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,105.21,,,,,,,15.6900,378.0000,fee schedule,APG 00040 Proc 29280 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,BLUE CROSS,ANTHEM HMO,140.00,,,,,,,15.6900,378.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,55.13,,,,,,,15.6900,378.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",164.70,,,,,,,15.6900,378.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,23.70,,,,,,,15.6900,378.0000,fee schedule,$23.70 from Fee Schedule BLDTM_23 for Rev 450 Proc 29280 * Qty 1 = $23.70 at 100% = $23.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,BLUE CROSS,BLUE CROSS MEDICARE,55.66,,,,,,,15.6900,378.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,BLUE CROSS,TENNCARE BLUE CARE,15.69,,,,,,,15.6900,378.0000,fee schedule,$13.53 from Fee Schedule TC_24 for Rev 450 Proc 29280 * Qty 1 = $13.53 at 116% = $15.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,BLUE CROSS,TENNCARE BLUE SELECT,15.69,,,,,,,15.6900,378.0000,fee schedule,$13.53 from Fee Schedule TC_24 for Rev 450 Proc 29280 * Qty 1 = $13.53 at 116% = $15.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,56.20,,,,,,,15.6900,378.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,56.20,,,,,,,15.6900,378.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,340.20,,,,,,,15.6900,378.0000,percent of total billed charges,90% of $378.00 in Billed Charges for Rev 450 Proc 29280 = $340.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,HUMANA,HUMANA MEDICARE,53.52,,,,,,,15.6900,378.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,53.52,,,,,,,15.6900,378.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,MEDCOST,MEDCOST VHN,179.89,,,,,,,15.6900,378.0000,percent of total billed charges,47.59% of $378.00 in Billed Charges for Rev 450 Proc 29280 = $179.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,107.26,,,,,,,15.6900,378.0000,fee schedule,APG 00040 Proc 29280 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 100% = $102.15... $102.15 at 105% = $107.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,56.20,,,,,,,15.6900,378.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,56.20,,,,,,,15.6900,378.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,NHC ADVANTAGE,NHC ADVANTAGE,56.20,,,,,,,15.6900,378.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,105.32,,,,,,,15.6900,378.0000,fee schedule,APG 00040 Proc 29280 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 100% = $102.15... $102.15 at 103.1% = $105.32 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,SENTARA HEALTH,SENTARA HEALTH,97.56,,,,,,,15.6900,378.0000,percent of total billed charges,25.81% of $378.00 in Billed Charges for Rev 450 Proc 29280 = $97.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,SENTARA HEALTH,SENTARA MEDICARE,53.52,,,,,,,15.6900,378.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",378.00,,,,,,,15.6900,378.0000,percent of total billed charges,100% of $378.00 in Billed Charges for Rev 450 Proc 29280 = $378.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,15.6900,378.0000,case rate,Rev 450 Proc 29280 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,378.00,,,,,,,15.6900,378.0000,case rate,"Rev 450 Proc 29280 at Case Rate $491.00 (Service Line reduced to $378.00, claim capped at $378.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,378.00,,,,,,,15.6900,378.0000,case rate,"Rev 450 Proc 29280 at Case Rate $471.00 (Service Line reduced to $378.00, claim capped at $378.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,378.00,,,,,,,15.6900,378.0000,case rate,"Rev 450 Proc 29280 at Case Rate $847.00 (Service Line reduced to $378.00, claim capped at $378.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,105.21,,,,,,,15.6900,378.0000,fee schedule,APG 00040 Proc 29280 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,53.52,,,,,,,15.6900,378.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,53.52,,,,,,,15.6900,378.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,WELLCARE,WELLCARE MEDICAID,378.00,,,,,,,15.6900,378.0000,percent of total billed charges,100% of $378.00 in Billed Charges for Rev 450 Proc 29280 = $378.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAPPING HAND OR FINGER,29280,CPT,450,RC,45000202,CDM,,,,both,,,378.0000,56.7000,WELLCARE,WELLCARE MEDICARE,56.73,,,,,,,15.6900,378.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,AETNA,AETNA,343.74,,,,,,,111.6500,805.0000,percent of total billed charges,42.7% of $805.00 in Billed Charges for Rev 521 Proc 29305 = $343.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,283.21,,,,,,,111.6500,805.0000,fee schedule,"APG 00039 Proc 29305 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 104% = $283.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,253.76,,,,,,,111.6500,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,AETNA,AETNA HEALTHCARE MEDICARE,253.76,,,,,,,111.6500,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,253.76,,,,,,,111.6500,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,AMBETTER,AMBETTER,553.19,,,,,,,111.6500,805.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,263.91,,,,,,,111.6500,805.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,ANTHEM EXCHANGE,624.77,,,,,,,111.6500,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,280.48,,,,,,,111.6500,805.0000,fee schedule,"APG 00039 Proc 29305 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,ANTHEM HMO,663.78,,,,,,,111.6500,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,261.37,,,,,,,111.6500,805.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",780.88,,,,,,,111.6500,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,172.64,,,,,,,111.6500,805.0000,fee schedule,$172.64 from Fee Schedule BLDTM_23 for Rev 521 Proc 29305 * Qty 1 = $172.64 at 100% = $172.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,BLUE CROSS MEDICARE,263.91,,,,,,,111.6500,805.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA HMO,335.69,,,,,,,111.6500,805.0000,percent of total billed charges,41.7% of $805.00 in Billed Charges for Rev 521 Proc 29305 = $335.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,373.52,,,,,,,111.6500,805.0000,percent of total billed charges,46.4% of $805.00 in Billed Charges for Rev 521 Proc 29305 = $373.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,266.45,,,,,,,111.6500,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,335.69,,,,,,,111.6500,805.0000,percent of total billed charges,41.7% of $805.00 in Billed Charges for Rev 521 Proc 29305 = $335.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA PPO,335.69,,,,,,,111.6500,805.0000,percent of total billed charges,41.7% of $805.00 in Billed Charges for Rev 521 Proc 29305 = $335.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,266.45,,,,,,,111.6500,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,724.50,,,,,,,111.6500,805.0000,percent of total billed charges,90% of $805.00 in Billed Charges for Rev 521 Proc 29305 = $724.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,HUMANA,HUMANA MEDICARE,253.76,,,,,,,111.6500,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,253.76,,,,,,,111.6500,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,MEDCOST,MEDCOST VHN,383.10,,,,,,,111.6500,805.0000,percent of total billed charges,47.59% of $805.00 in Billed Charges for Rev 521 Proc 29305 = $383.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,285.93,,,,,,,111.6500,805.0000,fee schedule,"APG 00039 Proc 29305 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 105% = $285.93 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,266.45,,,,,,,111.6500,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,266.45,,,,,,,111.6500,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,NHC ADVANTAGE,NHC ADVANTAGE,266.45,,,,,,,111.6500,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,280.75,,,,,,,111.6500,805.0000,fee schedule,"APG 00039 Proc 29305 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 103.1% = $280.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,SENTARA HEALTH,SENTARA HEALTH,207.77,,,,,,,111.6500,805.0000,percent of total billed charges,25.81% of $805.00 in Billed Charges for Rev 521 Proc 29305 = $207.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,SENTARA HEALTH,SENTARA MEDICARE,253.76,,,,,,,111.6500,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",805.00,,,,,,,111.6500,805.0000,percent of total billed charges,100% of $805.00 in Billed Charges for Rev 521 Proc 29305 = $805.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,111.65,,,,,,,111.6500,805.0000,fee schedule,$223.29 from Fee Schedule TCUHC24 for Rev 521 Proc 29305 * Qty 1 = $223.29 at 50% = $111.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,280.48,,,,,,,111.6500,805.0000,fee schedule,"APG 00039 Proc 29305 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,253.76,,,,,,,111.6500,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,253.76,,,,,,,111.6500,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,WELLCARE,WELLCARE MEDICAID,805.00,,,,,,,111.6500,805.0000,percent of total billed charges,100% of $805.00 in Billed Charges for Rev 521 Proc 29305 = $805.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL HIP SPICA CAST 1 LEG,29305,CPT,521,RC,52100095,CDM,,,,both,,,805.0000,120.7500,WELLCARE,WELLCARE MEDICARE,268.98,,,,,,,111.6500,805.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,AETNA,AETNA,184.04,,,,,,,23.5500,431.0000,percent of total billed charges,42.7% of $431.00 in Billed Charges for Rev 450 Proc 29515 = $184.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,106.23,,,,,,,23.5500,431.0000,fee schedule,"APG 00040 Proc 29515 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 104% = $106.23. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,147.43,,,,,,,23.5500,431.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,AETNA,AETNA HEALTHCARE MEDICARE,147.43,,,,,,,23.5500,431.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,147.43,,,,,,,23.5500,431.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,AMBETTER,AMBETTER,321.40,,,,,,,23.5500,431.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,153.33,,,,,,,23.5500,431.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,BLUE CROSS,ANTHEM EXCHANGE,362.98,,,,,,,23.5500,431.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,105.21,,,,,,,23.5500,431.0000,fee schedule,"APG 00040 Proc 29515 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,BLUE CROSS,ANTHEM HMO,385.65,,,,,,,23.5500,431.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,151.86,,,,,,,23.5500,431.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",431.00,,,,,,,23.5500,431.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,55.86,,,,,,,23.5500,431.0000,fee schedule,$55.86 from Fee Schedule BLDTM_23 for Rev 450 Proc 29515 * Qty 1 = $55.86 at 100% = $55.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,BLUE CROSS,BLUE CROSS MEDICARE,153.33,,,,,,,23.5500,431.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,BLUE CROSS,TENNCARE BLUE CARE,23.55,,,,,,,23.5500,431.0000,fee schedule,$20.30 from Fee Schedule TC_24 for Rev 450 Proc 29515 * Qty 1 = $20.30 at 116% = $23.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,BLUE CROSS,TENNCARE BLUE SELECT,23.55,,,,,,,23.5500,431.0000,fee schedule,$20.30 from Fee Schedule TC_24 for Rev 450 Proc 29515 * Qty 1 = $20.30 at 116% = $23.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,154.80,,,,,,,23.5500,431.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,154.80,,,,,,,23.5500,431.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,387.90,,,,,,,23.5500,431.0000,percent of total billed charges,90% of $431.00 in Billed Charges for Rev 450 Proc 29515 = $387.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,HUMANA,HUMANA MEDICARE,147.43,,,,,,,23.5500,431.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,147.43,,,,,,,23.5500,431.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,MEDCOST,MEDCOST VHN,205.11,,,,,,,23.5500,431.0000,percent of total billed charges,47.59% of $431.00 in Billed Charges for Rev 450 Proc 29515 = $205.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,107.26,,,,,,,23.5500,431.0000,fee schedule,"APG 00040 Proc 29515 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 100% = $102.15... $102.15 at 105% = $107.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,154.80,,,,,,,23.5500,431.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,154.80,,,,,,,23.5500,431.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,NHC ADVANTAGE,NHC ADVANTAGE,154.80,,,,,,,23.5500,431.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,105.32,,,,,,,23.5500,431.0000,fee schedule,"APG 00040 Proc 29515 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 100% = $102.15... $102.15 at 103.1% = $105.32 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,SENTARA HEALTH,SENTARA HEALTH,111.24,,,,,,,23.5500,431.0000,percent of total billed charges,25.81% of $431.00 in Billed Charges for Rev 450 Proc 29515 = $111.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,SENTARA HEALTH,SENTARA MEDICARE,147.43,,,,,,,23.5500,431.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",431.00,,,,,,,23.5500,431.0000,percent of total billed charges,100% of $431.00 in Billed Charges for Rev 450 Proc 29515 = $431.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,23.5500,431.0000,case rate,Rev 450 Proc 29515 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,431.00,,,,,,,23.5500,431.0000,case rate,"Rev 450 Proc 29515 at Case Rate $491.00 (Service Line reduced to $431.00, claim capped at $431.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,431.00,,,,,,,23.5500,431.0000,case rate,"Rev 450 Proc 29515 at Case Rate $471.00 (Service Line reduced to $431.00, claim capped at $431.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,431.00,,,,,,,23.5500,431.0000,case rate,"Rev 450 Proc 29515 at Case Rate $847.00 (Service Line reduced to $431.00, claim capped at $431.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,105.21,,,,,,,23.5500,431.0000,fee schedule,"APG 00040 Proc 29515 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,147.43,,,,,,,23.5500,431.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,147.43,,,,,,,23.5500,431.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,WELLCARE,WELLCARE MEDICAID,431.00,,,,,,,23.5500,431.0000,percent of total billed charges,100% of $431.00 in Billed Charges for Rev 450 Proc 29515 = $431.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT LEG SPLINT,29515,CPT,450,RC,45000205,CDM,,,,both,,,431.0000,64.6500,WELLCARE,WELLCARE MEDICARE,156.28,,,,,,,23.5500,431.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,AETNA,AETNA,161.83,,,,,,,18.8400,379.0000,percent of total billed charges,42.7% of $379.00 in Billed Charges for Rev 450 Proc 29530 = $161.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,106.23,,,,,,,18.8400,379.0000,fee schedule,APG 00040 Proc 29530 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 104% = $106.23. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,120.71,,,,,,,18.8400,379.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,AETNA,AETNA HEALTHCARE MEDICARE,120.71,,,,,,,18.8400,379.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,120.71,,,,,,,18.8400,379.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,AMBETTER,AMBETTER,263.15,,,,,,,18.8400,379.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,125.54,,,,,,,18.8400,379.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,ANTHEM EXCHANGE,297.21,,,,,,,18.8400,379.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,105.21,,,,,,,18.8400,379.0000,fee schedule,APG 00040 Proc 29530 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,ANTHEM HMO,315.76,,,,,,,18.8400,379.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,124.33,,,,,,,18.8400,379.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",371.47,,,,,,,18.8400,379.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,28.10,,,,,,,18.8400,379.0000,fee schedule,$28.10 from Fee Schedule BLDTM_23 for Rev 450 Proc 29530 * Qty 1 = $28.10 at 100% = $28.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,BLUE CROSS MEDICARE,125.54,,,,,,,18.8400,379.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,TENNCARE BLUE CARE,18.84,,,,,,,18.8400,379.0000,fee schedule,$16.24 from Fee Schedule TC_24 for Rev 450 Proc 29530 * Qty 1 = $16.24 at 116% = $18.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,TENNCARE BLUE SELECT,18.84,,,,,,,18.8400,379.0000,fee schedule,$16.24 from Fee Schedule TC_24 for Rev 450 Proc 29530 * Qty 1 = $16.24 at 116% = $18.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,126.75,,,,,,,18.8400,379.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,126.75,,,,,,,18.8400,379.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,341.10,,,,,,,18.8400,379.0000,percent of total billed charges,90% of $379.00 in Billed Charges for Rev 450 Proc 29530 = $341.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,HUMANA,HUMANA MEDICARE,120.71,,,,,,,18.8400,379.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,120.71,,,,,,,18.8400,379.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,MEDCOST,MEDCOST VHN,180.37,,,,,,,18.8400,379.0000,percent of total billed charges,47.59% of $379.00 in Billed Charges for Rev 450 Proc 29530 = $180.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,107.26,,,,,,,18.8400,379.0000,fee schedule,APG 00040 Proc 29530 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 100% = $102.15... $102.15 at 105% = $107.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,126.75,,,,,,,18.8400,379.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,126.75,,,,,,,18.8400,379.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,NHC ADVANTAGE,NHC ADVANTAGE,126.75,,,,,,,18.8400,379.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,105.32,,,,,,,18.8400,379.0000,fee schedule,APG 00040 Proc 29530 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 100% = $102.15... $102.15 at 103.1% = $105.32 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,SENTARA HEALTH,SENTARA HEALTH,97.82,,,,,,,18.8400,379.0000,percent of total billed charges,25.81% of $379.00 in Billed Charges for Rev 450 Proc 29530 = $97.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,SENTARA HEALTH,SENTARA MEDICARE,120.71,,,,,,,18.8400,379.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",379.00,,,,,,,18.8400,379.0000,percent of total billed charges,100% of $379.00 in Billed Charges for Rev 450 Proc 29530 = $379.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,18.8400,379.0000,case rate,Rev 450 Proc 29530 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,379.00,,,,,,,18.8400,379.0000,case rate,"Rev 450 Proc 29530 at Case Rate $491.00 (Service Line reduced to $379.00, claim capped at $379.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,379.00,,,,,,,18.8400,379.0000,case rate,"Rev 450 Proc 29530 at Case Rate $471.00 (Service Line reduced to $379.00, claim capped at $379.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,379.00,,,,,,,18.8400,379.0000,case rate,"Rev 450 Proc 29530 at Case Rate $847.00 (Service Line reduced to $379.00, claim capped at $379.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,105.21,,,,,,,18.8400,379.0000,fee schedule,APG 00040 Proc 29530 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,120.71,,,,,,,18.8400,379.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,120.71,,,,,,,18.8400,379.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,WELLCARE,WELLCARE MEDICAID,379.00,,,,,,,18.8400,379.0000,percent of total billed charges,100% of $379.00 in Billed Charges for Rev 450 Proc 29530 = $379.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAP KNEE,29530,CPT,450,RC,45000206,CDM,,,,both,,,379.0000,56.8500,WELLCARE,WELLCARE MEDICARE,127.95,,,,,,,18.8400,379.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,AETNA,AETNA,146.89,,,,,,,15.6900,344.0000,percent of total billed charges,42.7% of $344.00 in Billed Charges for Rev 450 Proc 29540 = $146.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,106.23,,,,,,,15.6900,344.0000,fee schedule,"APG 00040 Proc 29540 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 104% = $106.23. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,147.43,,,,,,,15.6900,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,AETNA,AETNA HEALTHCARE MEDICARE,147.43,,,,,,,15.6900,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,147.43,,,,,,,15.6900,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,AMBETTER,AMBETTER,321.40,,,,,,,15.6900,344.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,153.33,,,,,,,15.6900,344.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,ANTHEM EXCHANGE,344.00,,,,,,,15.6900,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,105.21,,,,,,,15.6900,344.0000,fee schedule,"APG 00040 Proc 29540 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,ANTHEM HMO,344.00,,,,,,,15.6900,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,151.86,,,,,,,15.6900,344.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",344.00,,,,,,,15.6900,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,28.21,,,,,,,15.6900,344.0000,fee schedule,$28.21 from Fee Schedule BLDTM_23 for Rev 450 Proc 29540 * Qty 1 = $28.21 at 100% = $28.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,BLUE CROSS MEDICARE,153.33,,,,,,,15.6900,344.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,TENNCARE BLUE CARE,15.69,,,,,,,15.6900,344.0000,fee schedule,$13.53 from Fee Schedule TC_24 for Rev 450 Proc 29540 * Qty 1 = $13.53 at 116% = $15.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,TENNCARE BLUE SELECT,15.69,,,,,,,15.6900,344.0000,fee schedule,$13.53 from Fee Schedule TC_24 for Rev 450 Proc 29540 * Qty 1 = $13.53 at 116% = $15.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,154.80,,,,,,,15.6900,344.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,154.80,,,,,,,15.6900,344.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,309.60,,,,,,,15.6900,344.0000,percent of total billed charges,90% of $344.00 in Billed Charges for Rev 450 Proc 29540 = $309.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,HUMANA,HUMANA MEDICARE,147.43,,,,,,,15.6900,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,147.43,,,,,,,15.6900,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,MEDCOST,MEDCOST VHN,163.71,,,,,,,15.6900,344.0000,percent of total billed charges,47.59% of $344.00 in Billed Charges for Rev 450 Proc 29540 = $163.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,107.26,,,,,,,15.6900,344.0000,fee schedule,"APG 00040 Proc 29540 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 100% = $102.15... $102.15 at 105% = $107.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,154.80,,,,,,,15.6900,344.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,154.80,,,,,,,15.6900,344.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,NHC ADVANTAGE,NHC ADVANTAGE,154.80,,,,,,,15.6900,344.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,105.32,,,,,,,15.6900,344.0000,fee schedule,"APG 00040 Proc 29540 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 100% = $102.15... $102.15 at 103.1% = $105.32 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,SENTARA HEALTH,SENTARA HEALTH,88.79,,,,,,,15.6900,344.0000,percent of total billed charges,25.81% of $344.00 in Billed Charges for Rev 450 Proc 29540 = $88.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,SENTARA HEALTH,SENTARA MEDICARE,147.43,,,,,,,15.6900,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",344.00,,,,,,,15.6900,344.0000,percent of total billed charges,100% of $344.00 in Billed Charges for Rev 450 Proc 29540 = $344.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,15.6900,344.0000,case rate,Rev 450 Proc 29540 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,344.00,,,,,,,15.6900,344.0000,case rate,"Rev 450 Proc 29540 at Case Rate $491.00 (Service Line reduced to $344.00, claim capped at $344.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,344.00,,,,,,,15.6900,344.0000,case rate,"Rev 450 Proc 29540 at Case Rate $471.00 (Service Line reduced to $344.00, claim capped at $344.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,344.00,,,,,,,15.6900,344.0000,case rate,"Rev 450 Proc 29540 at Case Rate $847.00 (Service Line reduced to $344.00, claim capped at $344.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,105.21,,,,,,,15.6900,344.0000,fee schedule,"APG 00040 Proc 29540 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,147.43,,,,,,,15.6900,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,147.43,,,,,,,15.6900,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,WELLCARE,WELLCARE MEDICAID,344.00,,,,,,,15.6900,344.0000,percent of total billed charges,100% of $344.00 in Billed Charges for Rev 450 Proc 29540 = $344.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAP ANKLE AND OR FOOT,29540,CPT,450,RC,45000207,CDM,,,,both,,,344.0000,51.6000,WELLCARE,WELLCARE MEDICARE,156.28,,,,,,,15.6900,344.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,AETNA,AETNA,141.76,,,,,,,43.0000,332.0000,percent of total billed charges,42.7% of $332.00 in Billed Charges for Rev 420 Proc 29580 = $141.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,283.21,,,,,,,43.0000,332.0000,fee schedule,"APG 00039 Proc 29580 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 104% = $283.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,147.43,,,,,,,43.0000,332.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,AETNA,AETNA HEALTHCARE MEDICARE,147.43,,,,,,,43.0000,332.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,147.43,,,,,,,43.0000,332.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,AMBETTER,AMBETTER,321.40,,,,,,,43.0000,332.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,153.33,,,,,,,43.0000,332.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,BLUE CROSS,ANTHEM EXCHANGE,332.00,,,,,,,43.0000,332.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,280.48,,,,,,,43.0000,332.0000,fee schedule,"APG 00039 Proc 29580 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,BLUE CROSS,ANTHEM HMO,332.00,,,,,,,43.0000,332.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,151.86,,,,,,,43.0000,332.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",332.00,,,,,,,43.0000,332.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,116.00,,,,,,,43.0000,332.0000,other,Rev 420 Proc 29580 1 Visit at $116.00 per Visit = $116.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,BLUE CROSS,BLUE CROSS E NETWORK,213.64,,,,,,,43.0000,332.0000,fee schedule,$49.00 from Fee Schedule BCFSG for Rev 420 Proc 29580 * Qty 1 = $49.00 at 436% = $213.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,BLUE CROSS,BLUE CROSS MEDICARE,153.33,,,,,,,43.0000,332.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,BLUE CROSS,BLUE CROSS P NETWORK,218.05,,,,,,,43.0000,332.0000,fee schedule,$49.00 from Fee Schedule BCFSG for Rev 420 Proc 29580 * Qty 1 = $49.00 at 445% = $218.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,BLUE CROSS,BLUE CROSS S NETWORK,218.05,,,,,,,43.0000,332.0000,fee schedule,$49.00 from Fee Schedule BCFSG for Rev 420 Proc 29580 * Qty 1 = $49.00 at 445% = $218.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,BLUE CROSS,TENNCARE BLUE CARE,52.19,,,,,,,43.0000,332.0000,fee schedule,$44.99 from Fee Schedule TC_24 for Rev 420 Proc 29580 * Qty 1 = $44.99 at 116% = $52.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,BLUE CROSS,TENNCARE BLUE SELECT,52.19,,,,,,,43.0000,332.0000,fee schedule,$44.99 from Fee Schedule TC_24 for Rev 420 Proc 29580 * Qty 1 = $44.99 at 116% = $52.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,CIGNA HEALTHCARE,CIGNA HMO,138.44,,,,,,,43.0000,332.0000,percent of total billed charges,41.7% of $332.00 in Billed Charges for Rev 420 Proc 29580 = $138.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,154.05,,,,,,,43.0000,332.0000,percent of total billed charges,46.4% of $332.00 in Billed Charges for Rev 420 Proc 29580 = $154.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,154.80,,,,,,,43.0000,332.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,138.44,,,,,,,43.0000,332.0000,percent of total billed charges,41.7% of $332.00 in Billed Charges for Rev 420 Proc 29580 = $138.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,CIGNA HEALTHCARE,CIGNA PPO,138.44,,,,,,,43.0000,332.0000,percent of total billed charges,41.7% of $332.00 in Billed Charges for Rev 420 Proc 29580 = $138.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,154.80,,,,,,,43.0000,332.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,298.80,,,,,,,43.0000,332.0000,percent of total billed charges,90% of $332.00 in Billed Charges for Rev 420 Proc 29580 = $298.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,HUMANA,HUMANA MEDICARE,147.43,,,,,,,43.0000,332.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,147.43,,,,,,,43.0000,332.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,MEDCOST,MEDCOST VHN,158.00,,,,,,,43.0000,332.0000,percent of total billed charges,47.59% of $332.00 in Billed Charges for Rev 420 Proc 29580 = $158.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,285.93,,,,,,,43.0000,332.0000,fee schedule,"APG 00039 Proc 29580 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 105% = $285.93 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,154.80,,,,,,,43.0000,332.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,154.80,,,,,,,43.0000,332.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,NHC ADVANTAGE,NHC ADVANTAGE,154.80,,,,,,,43.0000,332.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,280.75,,,,,,,43.0000,332.0000,fee schedule,"APG 00039 Proc 29580 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 103.1% = $280.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,SENTARA HEALTH,SENTARA HEALTH,85.69,,,,,,,43.0000,332.0000,percent of total billed charges,25.81% of $332.00 in Billed Charges for Rev 420 Proc 29580 = $85.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,SENTARA HEALTH,SENTARA MEDICARE,147.43,,,,,,,43.0000,332.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",332.00,,,,,,,43.0000,332.0000,percent of total billed charges,100% of $332.00 in Billed Charges for Rev 420 Proc 29580 = $332.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,43.00,,,,,,,43.0000,332.0000,other,Rev 420 Proc 29580 1 Visit at $43.00 per Visit = $43.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,257.00,,,,,,,43.0000,332.0000,other,Rev 420 Proc 29580 1 Visit at $257.00 per Visit = $257.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,245.00,,,,,,,43.0000,332.0000,other,Rev 420 Proc 29580 1 Visit at $245.00 per Visit = $245.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,332.00,,,,,,,43.0000,332.0000,other,"Rev 420 Proc 29580 1 Visit at $403.00 per Visit = $403.00 (Service Line reduced to $332.00, claim capped at $332.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,280.48,,,,,,,43.0000,332.0000,fee schedule,"APG 00039 Proc 29580 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,147.43,,,,,,,43.0000,332.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,147.43,,,,,,,43.0000,332.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,WELLCARE,WELLCARE MEDICAID,332.00,,,,,,,43.0000,332.0000,percent of total billed charges,100% of $332.00 in Billed Charges for Rev 420 Proc 29580 = $332.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNNA BOOT STRAPPING UNILAT,29580,CPT,420,RC,42000038,CDM,,,,both,,,332.0000,49.8000,WELLCARE,WELLCARE MEDICARE,156.28,,,,,,,43.0000,332.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,AETNA,AETNA,314.27,,,,,,,63.9400,736.0000,percent of total billed charges,42.7% of $736.00 in Billed Charges for Rev 510 Proc 29581 Mod 50 = $314.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,424.81,,,,,,,63.9400,736.0000,fee schedule,"APG 00039 Proc 29581 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $408.47 at 104% = $424.81. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,221.15,,,,,,,63.9400,736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,AETNA,AETNA HEALTHCARE MEDICARE,221.15,,,,,,,63.9400,736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,221.15,,,,,,,63.9400,736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,AMBETTER,AMBETTER,482.10,,,,,,,63.9400,736.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,229.99,,,,,,,63.9400,736.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,BLUE CROSS,ANTHEM EXCHANGE,544.48,,,,,,,63.9400,736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,420.72,,,,,,,63.9400,736.0000,fee schedule,"APG 00039 Proc 29581 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $408.47 at 103% = $420.72. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,BLUE CROSS,ANTHEM HMO,578.47,,,,,,,63.9400,736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,227.78,,,,,,,63.9400,736.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",680.52,,,,,,,63.9400,736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,82.07,,,,,,,63.9400,736.0000,fee schedule,$82.07 from Fee Schedule BLDTM_23 for Rev 510 Proc 29581 Mod 50 * Qty 1 = $82.07 at 100% = $82.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,BLUE CROSS,BLUE CROSS MEDICARE,229.99,,,,,,,63.9400,736.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,CIGNA HEALTHCARE,CIGNA HMO,306.91,,,,,,,63.9400,736.0000,percent of total billed charges,41.7% of $736.00 in Billed Charges for Rev 510 Proc 29581 Mod 50 = $306.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,341.50,,,,,,,63.9400,736.0000,percent of total billed charges,46.4% of $736.00 in Billed Charges for Rev 510 Proc 29581 Mod 50 = $341.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,232.21,,,,,,,63.9400,736.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,306.91,,,,,,,63.9400,736.0000,percent of total billed charges,41.7% of $736.00 in Billed Charges for Rev 510 Proc 29581 Mod 50 = $306.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,CIGNA HEALTHCARE,CIGNA PPO,306.91,,,,,,,63.9400,736.0000,percent of total billed charges,41.7% of $736.00 in Billed Charges for Rev 510 Proc 29581 Mod 50 = $306.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,232.21,,,,,,,63.9400,736.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,662.40,,,,,,,63.9400,736.0000,percent of total billed charges,90% of $736.00 in Billed Charges for Rev 510 Proc 29581 Mod 50 = $662.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,HUMANA,HUMANA MEDICARE,221.15,,,,,,,63.9400,736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,221.15,,,,,,,63.9400,736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,MEDCOST,MEDCOST VHN,350.26,,,,,,,63.9400,736.0000,percent of total billed charges,47.59% of $736.00 in Billed Charges for Rev 510 Proc 29581 Mod 50 = $350.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,428.89,,,,,,,63.9400,736.0000,fee schedule,"APG 00039 Proc 29581 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $408.47 at 100% = $408.47... $408.47 at 105% = $428.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,232.21,,,,,,,63.9400,736.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,232.21,,,,,,,63.9400,736.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,NHC ADVANTAGE,NHC ADVANTAGE,232.21,,,,,,,63.9400,736.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,421.13,,,,,,,63.9400,736.0000,fee schedule,"APG 00039 Proc 29581 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $408.47 at 100% = $408.47... $408.47 at 103.1% = $421.13 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,SENTARA HEALTH,SENTARA HEALTH,189.96,,,,,,,63.9400,736.0000,percent of total billed charges,25.81% of $736.00 in Billed Charges for Rev 510 Proc 29581 Mod 50 = $189.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,SENTARA HEALTH,SENTARA MEDICARE,221.15,,,,,,,63.9400,736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",736.00,,,,,,,63.9400,736.0000,percent of total billed charges,100% of $736.00 in Billed Charges for Rev 510 Proc 29581 Mod 50 = $736.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,63.94,,,,,,,63.9400,736.0000,fee schedule,$127.87 from Fee Schedule TCUHC24 for Rev 510 Proc 29581 Mod 50 * Qty 1 = $127.87 at 50% = $63.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,237.73,,,,,,,63.9400,736.0000,other,32.3% of $736.00 in Billed Charges for Rev 510 Proc 29581 Mod 50 = $237.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,225.95,,,,,,,63.9400,736.0000,other,30.7% of $736.00 in Billed Charges for Rev 510 Proc 29581 Mod 50 = $225.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,237.73,,,,,,,63.9400,736.0000,percent of total billed charges,32.3% of $736.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,420.72,,,,,,,63.9400,736.0000,fee schedule,"APG 00039 Proc 29581 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $408.47 at 103% = $420.72. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,221.15,,,,,,,63.9400,736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,221.15,,,,,,,63.9400,736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,WELLCARE,WELLCARE MEDICAID,736.00,,,,,,,63.9400,736.0000,percent of total billed charges,100% of $736.00 in Billed Charges for Rev 510 Proc 29581 Mod 50 = $736.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS LEG BILAT,29581,CPT,510,RC,51000207,CDM,,,50,both,,,736.0000,110.4000,WELLCARE,WELLCARE MEDICARE,234.42,,,,,,,63.9400,736.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,AETNA,AETNA,343.74,,,,,,,101.4400,805.0000,percent of total billed charges,42.7% of $805.00 in Billed Charges for Rev 521 Proc 29355 = $343.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,283.21,,,,,,,101.4400,805.0000,fee schedule,"APG 00039 Proc 29355 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 104% = $283.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,253.76,,,,,,,101.4400,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,AETNA,AETNA HEALTHCARE MEDICARE,253.76,,,,,,,101.4400,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,253.76,,,,,,,101.4400,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,AMBETTER,AMBETTER,553.19,,,,,,,101.4400,805.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,263.91,,,,,,,101.4400,805.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,ANTHEM EXCHANGE,624.77,,,,,,,101.4400,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,280.48,,,,,,,101.4400,805.0000,fee schedule,"APG 00039 Proc 29355 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,ANTHEM HMO,663.78,,,,,,,101.4400,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,261.37,,,,,,,101.4400,805.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",780.88,,,,,,,101.4400,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,101.44,,,,,,,101.4400,805.0000,fee schedule,$101.44 from Fee Schedule BLDTM_23 for Rev 521 Proc 29355 * Qty 1 = $101.44 at 100% = $101.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,BLUE CROSS MEDICARE,263.91,,,,,,,101.4400,805.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA HMO,335.69,,,,,,,101.4400,805.0000,percent of total billed charges,41.7% of $805.00 in Billed Charges for Rev 521 Proc 29355 = $335.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,373.52,,,,,,,101.4400,805.0000,percent of total billed charges,46.4% of $805.00 in Billed Charges for Rev 521 Proc 29355 = $373.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,266.45,,,,,,,101.4400,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,335.69,,,,,,,101.4400,805.0000,percent of total billed charges,41.7% of $805.00 in Billed Charges for Rev 521 Proc 29355 = $335.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA PPO,335.69,,,,,,,101.4400,805.0000,percent of total billed charges,41.7% of $805.00 in Billed Charges for Rev 521 Proc 29355 = $335.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,266.45,,,,,,,101.4400,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,724.50,,,,,,,101.4400,805.0000,percent of total billed charges,90% of $805.00 in Billed Charges for Rev 521 Proc 29355 = $724.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,HUMANA,HUMANA MEDICARE,253.76,,,,,,,101.4400,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,253.76,,,,,,,101.4400,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,MEDCOST,MEDCOST VHN,383.10,,,,,,,101.4400,805.0000,percent of total billed charges,47.59% of $805.00 in Billed Charges for Rev 521 Proc 29355 = $383.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,285.93,,,,,,,101.4400,805.0000,fee schedule,"APG 00039 Proc 29355 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 105% = $285.93 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,266.45,,,,,,,101.4400,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,266.45,,,,,,,101.4400,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,NHC ADVANTAGE,NHC ADVANTAGE,266.45,,,,,,,101.4400,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,280.75,,,,,,,101.4400,805.0000,fee schedule,"APG 00039 Proc 29355 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 103.1% = $280.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,SENTARA HEALTH,SENTARA HEALTH,207.77,,,,,,,101.4400,805.0000,percent of total billed charges,25.81% of $805.00 in Billed Charges for Rev 521 Proc 29355 = $207.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,SENTARA HEALTH,SENTARA MEDICARE,253.76,,,,,,,101.4400,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",805.00,,,,,,,101.4400,805.0000,percent of total billed charges,100% of $805.00 in Billed Charges for Rev 521 Proc 29355 = $805.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,111.65,,,,,,,101.4400,805.0000,fee schedule,$223.29 from Fee Schedule TCUHC24 for Rev 521 Proc 29355 * Qty 1 = $223.29 at 50% = $111.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,280.48,,,,,,,101.4400,805.0000,fee schedule,"APG 00039 Proc 29355 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,253.76,,,,,,,101.4400,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,253.76,,,,,,,101.4400,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,WELLCARE,WELLCARE MEDICAID,805.00,,,,,,,101.4400,805.0000,percent of total billed charges,100% of $805.00 in Billed Charges for Rev 521 Proc 29355 = $805.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL LONG LEG CAST WALKER/AMBULATORY TYPE,29355,CPT,521,RC,52100096,CDM,,,,both,,,805.0000,120.7500,WELLCARE,WELLCARE MEDICARE,268.98,,,,,,,101.4400,805.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,AETNA,AETNA,343.74,,,,,,,45.5200,805.0000,percent of total billed charges,42.7% of $805.00 in Billed Charges for Rev 521 Proc 29435 = $343.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,283.21,,,,,,,45.5200,805.0000,fee schedule,"APG 00039 Proc 29435 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 104% = $283.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,253.76,,,,,,,45.5200,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,AETNA,AETNA HEALTHCARE MEDICARE,253.76,,,,,,,45.5200,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,253.76,,,,,,,45.5200,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,AMBETTER,AMBETTER,553.19,,,,,,,45.5200,805.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,263.91,,,,,,,45.5200,805.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,ANTHEM EXCHANGE,624.77,,,,,,,45.5200,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,280.48,,,,,,,45.5200,805.0000,fee schedule,"APG 00039 Proc 29435 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,ANTHEM HMO,663.78,,,,,,,45.5200,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,261.37,,,,,,,45.5200,805.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",780.88,,,,,,,45.5200,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,98.13,,,,,,,45.5200,805.0000,fee schedule,$98.13 from Fee Schedule BLDTM_23 for Rev 521 Proc 29435 * Qty 1 = $98.13 at 100% = $98.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,BLUE CROSS MEDICARE,263.91,,,,,,,45.5200,805.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,TENNCARE BLUE CARE,45.52,,,,,,,45.5200,805.0000,fee schedule,$39.24 from Fee Schedule TC_24 for Rev 521 Proc 29435 * Qty 1 = $39.24 at 116% = $45.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,TENNCARE BLUE SELECT,45.52,,,,,,,45.5200,805.0000,fee schedule,$39.24 from Fee Schedule TC_24 for Rev 521 Proc 29435 * Qty 1 = $39.24 at 116% = $45.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA HMO,335.69,,,,,,,45.5200,805.0000,percent of total billed charges,41.7% of $805.00 in Billed Charges for Rev 521 Proc 29435 = $335.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,373.52,,,,,,,45.5200,805.0000,percent of total billed charges,46.4% of $805.00 in Billed Charges for Rev 521 Proc 29435 = $373.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,266.45,,,,,,,45.5200,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,335.69,,,,,,,45.5200,805.0000,percent of total billed charges,41.7% of $805.00 in Billed Charges for Rev 521 Proc 29435 = $335.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA PPO,335.69,,,,,,,45.5200,805.0000,percent of total billed charges,41.7% of $805.00 in Billed Charges for Rev 521 Proc 29435 = $335.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,266.45,,,,,,,45.5200,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,724.50,,,,,,,45.5200,805.0000,percent of total billed charges,90% of $805.00 in Billed Charges for Rev 521 Proc 29435 = $724.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,HUMANA,HUMANA MEDICARE,253.76,,,,,,,45.5200,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,253.76,,,,,,,45.5200,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,MEDCOST,MEDCOST VHN,383.10,,,,,,,45.5200,805.0000,percent of total billed charges,47.59% of $805.00 in Billed Charges for Rev 521 Proc 29435 = $383.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,285.93,,,,,,,45.5200,805.0000,fee schedule,"APG 00039 Proc 29435 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 105% = $285.93 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,266.45,,,,,,,45.5200,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,266.45,,,,,,,45.5200,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,NHC ADVANTAGE,NHC ADVANTAGE,266.45,,,,,,,45.5200,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,280.75,,,,,,,45.5200,805.0000,fee schedule,"APG 00039 Proc 29435 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 103.1% = $280.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,SENTARA HEALTH,SENTARA HEALTH,207.77,,,,,,,45.5200,805.0000,percent of total billed charges,25.81% of $805.00 in Billed Charges for Rev 521 Proc 29435 = $207.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,SENTARA HEALTH,SENTARA MEDICARE,253.76,,,,,,,45.5200,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",805.00,,,,,,,45.5200,805.0000,percent of total billed charges,100% of $805.00 in Billed Charges for Rev 521 Proc 29435 = $805.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,111.65,,,,,,,45.5200,805.0000,fee schedule,$223.29 from Fee Schedule TCUHC24 for Rev 521 Proc 29435 * Qty 1 = $223.29 at 50% = $111.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,280.48,,,,,,,45.5200,805.0000,fee schedule,"APG 00039 Proc 29435 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,253.76,,,,,,,45.5200,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,253.76,,,,,,,45.5200,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,WELLCARE,WELLCARE MEDICAID,805.00,,,,,,,45.5200,805.0000,percent of total billed charges,100% of $805.00 in Billed Charges for Rev 521 Proc 29435 = $805.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AAPL PATELLAR TENDON BEARING CAST,29435,CPT,521,RC,52100098,CDM,,,,both,,,805.0000,120.7500,WELLCARE,WELLCARE MEDICARE,268.98,,,,,,,45.5200,805.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH EA ADD SEQ SAME DRUG,96376,CPT,940,RC,94000021,CDM,,,,both,,,291.0000,43.6500,AETNA,AETNA,124.26,,,,,,,12.4100,291.0000,percent of total billed charges,42.7% of $291.00 in Billed Charges for Rev 940 Proc 96376 = $124.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH EA ADD SEQ SAME DRUG,96376,CPT,940,RC,94000021,CDM,,,,both,,,291.0000,43.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,73.96,,,,,,,12.4100,291.0000,fee schedule,APG 00109 Proc 96376 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 104% = $73.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH EA ADD SEQ SAME DRUG,96376,CPT,940,RC,94000021,CDM,,,,both,,,291.0000,43.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,73.24,,,,,,,12.4100,291.0000,fee schedule,APG 00109 Proc 96376 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH EA ADD SEQ SAME DRUG,96376,CPT,940,RC,94000021,CDM,,,,both,,,291.0000,43.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,13.13,,,,,,,12.4100,291.0000,fee schedule,$13.13 from Fee Schedule BLDTM_23 for Rev 940 Proc 96376 * Qty 1 = $13.13 at 100% = $13.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH EA ADD SEQ SAME DRUG,96376,CPT,940,RC,94000021,CDM,,,,both,,,291.0000,43.6500,BLUE CROSS,TENNCARE BLUE CARE,12.41,,,,,,,12.4100,291.0000,fee schedule,$10.70 from Fee Schedule TC_24 for Rev 940 Proc 96376 * Qty 1 = $10.70 at 116% = $12.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH EA ADD SEQ SAME DRUG,96376,CPT,940,RC,94000021,CDM,,,,both,,,291.0000,43.6500,BLUE CROSS,TENNCARE BLUE SELECT,12.41,,,,,,,12.4100,291.0000,fee schedule,$10.70 from Fee Schedule TC_24 for Rev 940 Proc 96376 * Qty 1 = $10.70 at 116% = $12.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH EA ADD SEQ SAME DRUG,96376,CPT,940,RC,94000021,CDM,,,,both,,,291.0000,43.6500,CIGNA HEALTHCARE,CIGNA HMO,121.35,,,,,,,12.4100,291.0000,percent of total billed charges,41.7% of $291.00 in Billed Charges for Rev 940 Proc 96376 = $121.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH EA ADD SEQ SAME DRUG,96376,CPT,940,RC,94000021,CDM,,,,both,,,291.0000,43.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,135.02,,,,,,,12.4100,291.0000,percent of total billed charges,46.4% of $291.00 in Billed Charges for Rev 940 Proc 96376 = $135.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH EA ADD SEQ SAME DRUG,96376,CPT,940,RC,94000021,CDM,,,,both,,,291.0000,43.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,121.35,,,,,,,12.4100,291.0000,percent of total billed charges,41.7% of $291.00 in Billed Charges for Rev 940 Proc 96376 = $121.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH EA ADD SEQ SAME DRUG,96376,CPT,940,RC,94000021,CDM,,,,both,,,291.0000,43.6500,CIGNA HEALTHCARE,CIGNA PPO,121.35,,,,,,,12.4100,291.0000,percent of total billed charges,41.7% of $291.00 in Billed Charges for Rev 940 Proc 96376 = $121.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH EA ADD SEQ SAME DRUG,96376,CPT,940,RC,94000021,CDM,,,,both,,,291.0000,43.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,261.90,,,,,,,12.4100,291.0000,percent of total billed charges,90% of $291.00 in Billed Charges for Rev 940 Proc 96376 = $261.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH EA ADD SEQ SAME DRUG,96376,CPT,940,RC,94000021,CDM,,,,both,,,291.0000,43.6500,MEDCOST,MEDCOST VHN,138.49,,,,,,,12.4100,291.0000,percent of total billed charges,47.59% of $291.00 in Billed Charges for Rev 940 Proc 96376 = $138.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH EA ADD SEQ SAME DRUG,96376,CPT,940,RC,94000021,CDM,,,,both,,,291.0000,43.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,74.67,,,,,,,12.4100,291.0000,fee schedule,APG 00109 Proc 96376 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 105% = $74.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH EA ADD SEQ SAME DRUG,96376,CPT,940,RC,94000021,CDM,,,,both,,,291.0000,43.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,73.31,,,,,,,12.4100,291.0000,fee schedule,APG 00109 Proc 96376 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 103.1% = $73.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH EA ADD SEQ SAME DRUG,96376,CPT,940,RC,94000021,CDM,,,,both,,,291.0000,43.6500,SENTARA HEALTH,SENTARA HEALTH,75.11,,,,,,,12.4100,291.0000,percent of total billed charges,25.81% of $291.00 in Billed Charges for Rev 940 Proc 96376 = $75.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH EA ADD SEQ SAME DRUG,96376,CPT,940,RC,94000021,CDM,,,,both,,,291.0000,43.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",291.00,,,,,,,12.4100,291.0000,percent of total billed charges,100% of $291.00 in Billed Charges for Rev 940 Proc 96376 = $291.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH EA ADD SEQ SAME DRUG,96376,CPT,940,RC,94000021,CDM,,,,both,,,291.0000,43.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,291.00,,,,,,,12.4100,291.0000,other,"Rev 940 Proc 96376 1 Visit at $1,154.00 per Visit = $1,154.00 (Service Line reduced to $291.00, claim capped at $291.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IV PUSH EA ADD SEQ SAME DRUG,96376,CPT,940,RC,94000021,CDM,,,,both,,,291.0000,43.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,291.00,,,,,,,12.4100,291.0000,other,"Rev 940 Proc 96376 1 Visit at $1,104.00 per Visit = $1,104.00 (Service Line reduced to $291.00, claim capped at $291.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IV PUSH EA ADD SEQ SAME DRUG,96376,CPT,940,RC,94000021,CDM,,,,both,,,291.0000,43.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,291.00,,,,,,,12.4100,291.0000,other,"Rev 940 Proc 96376 1 Visit at $2,426.00 per Visit = $2,426.00 (Service Line reduced to $291.00, claim capped at $291.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IV PUSH EA ADD SEQ SAME DRUG,96376,CPT,940,RC,94000021,CDM,,,,both,,,291.0000,43.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,73.24,,,,,,,12.4100,291.0000,fee schedule,APG 00109 Proc 96376 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH EA ADD SEQ SAME DRUG,96376,CPT,940,RC,94000021,CDM,,,,both,,,291.0000,43.6500,WELLCARE,WELLCARE MEDICAID,291.00,,,,,,,12.4100,291.0000,percent of total billed charges,100% of $291.00 in Billed Charges for Rev 940 Proc 96376 = $291.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,AETNA,AETNA,76.86,,,,,,,42.4800,180.0000,percent of total billed charges,42.7% of $180.00 in Billed Charges for Rev 260 Proc 96377 = $76.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,73.96,,,,,,,42.4800,180.0000,fee schedule,APG 00109 Proc 96377 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 104% = $73.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,42.48,,,,,,,42.4800,180.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,AETNA,AETNA HEALTHCARE MEDICARE,42.48,,,,,,,42.4800,180.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,ALLCARE MEDICARE,ALLCARE MEDICARE,42.48,,,,,,,42.4800,180.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,AMBETTER,AMBETTER,92.61,,,,,,,42.4800,180.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,44.18,,,,,,,42.4800,180.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,BLUE CROSS,ANTHEM EXCHANGE,104.59,,,,,,,42.4800,180.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,73.24,,,,,,,42.4800,180.0000,fee schedule,APG 00109 Proc 96377 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,BLUE CROSS,ANTHEM HMO,111.12,,,,,,,42.4800,180.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,43.76,,,,,,,42.4800,180.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",130.73,,,,,,,42.4800,180.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,126.00,,,,,,,42.4800,180.0000,percent of total billed charges,Rev 260 Proc 96377 $180.00 in Billed Charges at 70% = $126.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,BLUE CROSS,BLUE CROSS E NETWORK,81.00,,,,,,,42.4800,180.0000,percent of total billed charges,45% of $180.00 in Billed Charges for Rev 260 Proc 96377 = $81.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,BLUE CROSS,BLUE CROSS MEDICARE,44.18,,,,,,,42.4800,180.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,BLUE CROSS,BLUE CROSS P NETWORK,81.00,,,,,,,42.4800,180.0000,percent of total billed charges,45% of $180.00 in Billed Charges for Rev 260 Proc 96377 = $81.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,BLUE CROSS,BLUE CROSS S NETWORK,81.00,,,,,,,42.4800,180.0000,percent of total billed charges,45% of $180.00 in Billed Charges for Rev 260 Proc 96377 = $81.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,CIGNA HEALTHCARE,CIGNA HMO,75.06,,,,,,,42.4800,180.0000,percent of total billed charges,41.7% of $180.00 in Billed Charges for Rev 260 Proc 96377 = $75.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,83.52,,,,,,,42.4800,180.0000,percent of total billed charges,46.4% of $180.00 in Billed Charges for Rev 260 Proc 96377 = $83.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,CIGNA HEALTHCARE,CIGNA MEDICARE,44.61,,,,,,,42.4800,180.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,75.06,,,,,,,42.4800,180.0000,percent of total billed charges,41.7% of $180.00 in Billed Charges for Rev 260 Proc 96377 = $75.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,CIGNA HEALTHCARE,CIGNA PPO,75.06,,,,,,,42.4800,180.0000,percent of total billed charges,41.7% of $180.00 in Billed Charges for Rev 260 Proc 96377 = $75.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,44.61,,,,,,,42.4800,180.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,162.00,,,,,,,42.4800,180.0000,percent of total billed charges,90% of $180.00 in Billed Charges for Rev 260 Proc 96377 = $162.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,HUMANA,HUMANA MEDICARE,42.48,,,,,,,42.4800,180.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,42.48,,,,,,,42.4800,180.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,MEDCOST,MEDCOST VHN,85.66,,,,,,,42.4800,180.0000,percent of total billed charges,47.59% of $180.00 in Billed Charges for Rev 260 Proc 96377 = $85.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,74.67,,,,,,,42.4800,180.0000,fee schedule,APG 00109 Proc 96377 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 105% = $74.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,44.61,,,,,,,42.4800,180.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,44.61,,,,,,,42.4800,180.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,NHC ADVANTAGE,NHC ADVANTAGE,44.61,,,,,,,42.4800,180.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,73.31,,,,,,,42.4800,180.0000,fee schedule,APG 00109 Proc 96377 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 103.1% = $73.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,SENTARA HEALTH,SENTARA HEALTH,46.46,,,,,,,42.4800,180.0000,percent of total billed charges,25.81% of $180.00 in Billed Charges for Rev 260 Proc 96377 = $46.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,SENTARA HEALTH,SENTARA MEDICARE,42.48,,,,,,,42.4800,180.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",180.00,,,,,,,42.4800,180.0000,percent of total billed charges,100% of $180.00 in Billed Charges for Rev 260 Proc 96377 = $180.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,163.00,,,,,,,42.4800,180.0000,other,Rev 260 Proc 96377 1 Visit at $163.00 per Visit = $163.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,157.00,,,,,,,42.4800,180.0000,other,Rev 260 Proc 96377 1 Visit at $157.00 per Visit = $157.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,180.00,,,,,,,42.4800,180.0000,other,"Rev 260 Proc 96377 1 Visit at $259.00 per Visit = $259.00 (Service Line reduced to $180.00, claim capped at $180.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,73.24,,,,,,,42.4800,180.0000,fee schedule,APG 00109 Proc 96377 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,42.48,,,,,,,42.4800,180.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,42.48,,,,,,,42.4800,180.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,WELLCARE,WELLCARE MEDICAID,180.00,,,,,,,42.4800,180.0000,percent of total billed charges,100% of $180.00 in Billed Charges for Rev 260 Proc 96377 = $180.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL ON-BODY INJECTOR FOR TIMED SQ INJ,96377,CPT,260,RC,26000001,CDM,,,,both,,,180.0000,27.0000,WELLCARE,WELLCARE MEDICARE,45.03,,,,,,,42.4800,180.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,AETNA,AETNA,152.44,,,,,,,17.4100,357.0000,percent of total billed charges,42.7% of $357.00 in Billed Charges for Rev 331 Proc 96402 = $152.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,73.96,,,,,,,17.4100,357.0000,fee schedule,APG 00109 Proc 96402 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 104% = $73.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,65.32,,,,,,,17.4100,357.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,AETNA,AETNA HEALTHCARE MEDICARE,65.32,,,,,,,17.4100,357.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,65.32,,,,,,,17.4100,357.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,AMBETTER,AMBETTER,142.41,,,,,,,17.4100,357.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,67.94,,,,,,,17.4100,357.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,BLUE CROSS,ANTHEM EXCHANGE,160.84,,,,,,,17.4100,357.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,73.24,,,,,,,17.4100,357.0000,fee schedule,APG 00109 Proc 96402 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,BLUE CROSS,ANTHEM HMO,170.88,,,,,,,17.4100,357.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,67.28,,,,,,,17.4100,357.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",201.02,,,,,,,17.4100,357.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,41.08,,,,,,,17.4100,357.0000,fee schedule,$41.08 from Fee Schedule BLDTM_23 for Rev 331 Proc 96402 * Qty 1 = $41.08 at 100% = $41.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,BLUE CROSS,BLUE CROSS E NETWORK,127.27,,,,,,,17.4100,357.0000,fee schedule,$29.19 from Fee Schedule BCFSG for Rev 331 Proc 96402 * Qty 1 = $29.19 at 436% = $127.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,BLUE CROSS,BLUE CROSS MEDICARE,67.94,,,,,,,17.4100,357.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,BLUE CROSS,BLUE CROSS P NETWORK,129.90,,,,,,,17.4100,357.0000,fee schedule,$29.19 from Fee Schedule BCFSG for Rev 331 Proc 96402 * Qty 1 = $29.19 at 445% = $129.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,BLUE CROSS,BLUE CROSS S NETWORK,129.90,,,,,,,17.4100,357.0000,fee schedule,$29.19 from Fee Schedule BCFSG for Rev 331 Proc 96402 * Qty 1 = $29.19 at 445% = $129.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,BLUE CROSS,TENNCARE BLUE CARE,41.52,,,,,,,17.4100,357.0000,fee schedule,$35.79 from Fee Schedule TC_24 for Rev 331 Proc 96402 * Qty 1 = $35.79 at 116% = $41.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,BLUE CROSS,TENNCARE BLUE SELECT,41.52,,,,,,,17.4100,357.0000,fee schedule,$35.79 from Fee Schedule TC_24 for Rev 331 Proc 96402 * Qty 1 = $35.79 at 116% = $41.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,CIGNA HEALTHCARE,CIGNA HMO,148.87,,,,,,,17.4100,357.0000,percent of total billed charges,41.7% of $357.00 in Billed Charges for Rev 331 Proc 96402 = $148.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,165.65,,,,,,,17.4100,357.0000,percent of total billed charges,46.4% of $357.00 in Billed Charges for Rev 331 Proc 96402 = $165.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,68.59,,,,,,,17.4100,357.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,148.87,,,,,,,17.4100,357.0000,percent of total billed charges,41.7% of $357.00 in Billed Charges for Rev 331 Proc 96402 = $148.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,CIGNA HEALTHCARE,CIGNA PPO,148.87,,,,,,,17.4100,357.0000,percent of total billed charges,41.7% of $357.00 in Billed Charges for Rev 331 Proc 96402 = $148.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,68.59,,,,,,,17.4100,357.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,321.30,,,,,,,17.4100,357.0000,percent of total billed charges,90% of $357.00 in Billed Charges for Rev 331 Proc 96402 = $321.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,HUMANA,HUMANA MEDICARE,65.32,,,,,,,17.4100,357.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,65.32,,,,,,,17.4100,357.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,MEDCOST,MEDCOST VHN,169.90,,,,,,,17.4100,357.0000,percent of total billed charges,47.59% of $357.00 in Billed Charges for Rev 331 Proc 96402 = $169.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,74.67,,,,,,,17.4100,357.0000,fee schedule,APG 00109 Proc 96402 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 105% = $74.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,68.59,,,,,,,17.4100,357.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,68.59,,,,,,,17.4100,357.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,NHC ADVANTAGE,NHC ADVANTAGE,68.59,,,,,,,17.4100,357.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,73.31,,,,,,,17.4100,357.0000,fee schedule,APG 00109 Proc 96402 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 103.1% = $73.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,SENTARA HEALTH,SENTARA HEALTH,92.14,,,,,,,17.4100,357.0000,percent of total billed charges,25.81% of $357.00 in Billed Charges for Rev 331 Proc 96402 = $92.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,SENTARA HEALTH,SENTARA MEDICARE,65.32,,,,,,,17.4100,357.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",357.00,,,,,,,17.4100,357.0000,percent of total billed charges,100% of $357.00 in Billed Charges for Rev 331 Proc 96402 = $357.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,17.41,,,,,,,17.4100,357.0000,fee schedule,$34.81 from Fee Schedule TCUHC24 for Rev 331 Proc 96402 * Qty 1 = $34.81 at 50% = $17.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,357.00,,,,,,,17.4100,357.0000,other,"Rev 331 Proc 96402 1 Visit at $2,444.00 per Visit = $2,444.00 (Service Line reduced to $357.00, claim capped at $357.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,357.00,,,,,,,17.4100,357.0000,other,"Rev 331 Proc 96402 1 Visit at $2,338.00 per Visit = $2,338.00 (Service Line reduced to $357.00, claim capped at $357.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,357.00,,,,,,,17.4100,357.0000,other,"Rev 331 Proc 96402 1 Visit at $4,205.00 per Visit = $4,205.00 (Service Line reduced to $357.00, claim capped at $357.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,73.24,,,,,,,17.4100,357.0000,fee schedule,APG 00109 Proc 96402 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,65.32,,,,,,,17.4100,357.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,65.32,,,,,,,17.4100,357.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,WELLCARE,WELLCARE MEDICAID,357.00,,,,,,,17.4100,357.0000,percent of total billed charges,100% of $357.00 in Billed Charges for Rev 331 Proc 96402 = $357.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM SQ IM HORMONAL ANTINEO,96402,CPT,331,RC,33100003,CDM,,,,both,,,357.0000,53.5500,WELLCARE,WELLCARE MEDICARE,69.24,,,,,,,17.4100,357.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,AETNA,AETNA,122.98,,,,,,,51.3600,420.7000,percent of total billed charges,42.7% of $288.00 in Billed Charges for Rev 331 Proc 96406 = $122.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,73.96,,,,,,,51.3600,420.7000,fee schedule,APG 00109 Proc 96406 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 104% = $73.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,192.98,,,,,,,51.3600,420.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,AETNA,AETNA HEALTHCARE MEDICARE,192.98,,,,,,,51.3600,420.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,192.98,,,,,,,51.3600,420.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,AMBETTER,AMBETTER,420.70,,,,,,,51.3600,420.7000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,200.70,,,,,,,51.3600,420.7000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,ANTHEM EXCHANGE,288.00,,,,,,,51.3600,420.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,73.24,,,,,,,51.3600,420.7000,fee schedule,APG 00109 Proc 96406 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,ANTHEM HMO,288.00,,,,,,,51.3600,420.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,198.77,,,,,,,51.3600,420.7000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",288.00,,,,,,,51.3600,420.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,68.06,,,,,,,51.3600,420.7000,fee schedule,$68.06 from Fee Schedule BLDTM_23 for Rev 331 Proc 96406 * Qty 1 = $68.06 at 100% = $68.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,BLUE CROSS E NETWORK,288.00,,,,,,,51.3600,420.7000,fee schedule,"$104.36 from Fee Schedule BCFSG for Rev 331 Proc 96406 * Qty 1 = $104.36 at 436% = $455.01 (Service Line reduced to $288.00, claim capped at $288.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,BLUE CROSS MEDICARE,200.70,,,,,,,51.3600,420.7000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,BLUE CROSS P NETWORK,288.00,,,,,,,51.3600,420.7000,fee schedule,"$104.36 from Fee Schedule BCFSG for Rev 331 Proc 96406 * Qty 1 = $104.36 at 445% = $464.40 (Service Line reduced to $288.00, claim capped at $288.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,BLUE CROSS S NETWORK,288.00,,,,,,,51.3600,420.7000,fee schedule,"$104.36 from Fee Schedule BCFSG for Rev 331 Proc 96406 * Qty 1 = $104.36 at 445% = $464.40 (Service Line reduced to $288.00, claim capped at $288.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,TENNCARE BLUE CARE,51.36,,,,,,,51.3600,420.7000,fee schedule,$44.28 from Fee Schedule TC_24 for Rev 331 Proc 96406 * Qty 1 = $44.28 at 116% = $51.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,TENNCARE BLUE SELECT,51.36,,,,,,,51.3600,420.7000,fee schedule,$44.28 from Fee Schedule TC_24 for Rev 331 Proc 96406 * Qty 1 = $44.28 at 116% = $51.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,CIGNA HEALTHCARE,CIGNA HMO,120.10,,,,,,,51.3600,420.7000,percent of total billed charges,41.7% of $288.00 in Billed Charges for Rev 331 Proc 96406 = $120.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,133.63,,,,,,,51.3600,420.7000,percent of total billed charges,46.4% of $288.00 in Billed Charges for Rev 331 Proc 96406 = $133.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,202.63,,,,,,,51.3600,420.7000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,120.10,,,,,,,51.3600,420.7000,percent of total billed charges,41.7% of $288.00 in Billed Charges for Rev 331 Proc 96406 = $120.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,CIGNA HEALTHCARE,CIGNA PPO,120.10,,,,,,,51.3600,420.7000,percent of total billed charges,41.7% of $288.00 in Billed Charges for Rev 331 Proc 96406 = $120.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,202.63,,,,,,,51.3600,420.7000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,259.20,,,,,,,51.3600,420.7000,percent of total billed charges,90% of $288.00 in Billed Charges for Rev 331 Proc 96406 = $259.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,HUMANA,HUMANA MEDICARE,192.98,,,,,,,51.3600,420.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,192.98,,,,,,,51.3600,420.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,MEDCOST,MEDCOST VHN,137.06,,,,,,,51.3600,420.7000,percent of total billed charges,47.59% of $288.00 in Billed Charges for Rev 331 Proc 96406 = $137.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,74.67,,,,,,,51.3600,420.7000,fee schedule,APG 00109 Proc 96406 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 105% = $74.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,202.63,,,,,,,51.3600,420.7000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,202.63,,,,,,,51.3600,420.7000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,NHC ADVANTAGE,NHC ADVANTAGE,202.63,,,,,,,51.3600,420.7000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,73.31,,,,,,,51.3600,420.7000,fee schedule,APG 00109 Proc 96406 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 103.1% = $73.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,SENTARA HEALTH,SENTARA HEALTH,74.33,,,,,,,51.3600,420.7000,percent of total billed charges,25.81% of $288.00 in Billed Charges for Rev 331 Proc 96406 = $74.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,SENTARA HEALTH,SENTARA MEDICARE,192.98,,,,,,,51.3600,420.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",288.00,,,,,,,51.3600,420.7000,percent of total billed charges,100% of $288.00 in Billed Charges for Rev 331 Proc 96406 = $288.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,63.32,,,,,,,51.3600,420.7000,fee schedule,$126.64 from Fee Schedule TCUHC24 for Rev 331 Proc 96406 * Qty 1 = $126.64 at 50% = $63.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,288.00,,,,,,,51.3600,420.7000,other,"Rev 331 Proc 96406 1 Visit at $2,444.00 per Visit = $2,444.00 (Service Line reduced to $288.00, claim capped at $288.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,288.00,,,,,,,51.3600,420.7000,other,"Rev 331 Proc 96406 1 Visit at $2,338.00 per Visit = $2,338.00 (Service Line reduced to $288.00, claim capped at $288.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,288.00,,,,,,,51.3600,420.7000,other,"Rev 331 Proc 96406 1 Visit at $4,205.00 per Visit = $4,205.00 (Service Line reduced to $288.00, claim capped at $288.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,73.24,,,,,,,51.3600,420.7000,fee schedule,APG 00109 Proc 96406 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,192.98,,,,,,,51.3600,420.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,192.98,,,,,,,51.3600,420.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,WELLCARE,WELLCARE MEDICAID,288.00,,,,,,,51.3600,420.7000,percent of total billed charges,100% of $288.00 in Billed Charges for Rev 331 Proc 96406 = $288.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRALESIONAL >7,96406,CPT,331,RC,33100005,CDM,,,,both,,,288.0000,43.2000,WELLCARE,WELLCARE MEDICARE,204.56,,,,,,,51.3600,420.7000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,AETNA,AETNA,523.93,,,,,,,63.3200,1227.0000,percent of total billed charges,"42.7% of $1,227.00 in Billed Charges for Rev 335 Proc 96409 = $523.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,73.96,,,,,,,63.3200,1227.0000,fee schedule,APG 00109 Proc 96409 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 104% = $73.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,299.68,,,,,,,63.3200,1227.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,AETNA,AETNA HEALTHCARE MEDICARE,299.68,,,,,,,63.3200,1227.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,299.68,,,,,,,63.3200,1227.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,AMBETTER,AMBETTER,653.30,,,,,,,63.3200,1227.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,311.67,,,,,,,63.3200,1227.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,BLUE CROSS,ANTHEM EXCHANGE,737.82,,,,,,,63.3200,1227.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,73.24,,,,,,,63.3200,1227.0000,fee schedule,APG 00109 Proc 96409 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,BLUE CROSS,ANTHEM HMO,783.89,,,,,,,63.3200,1227.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,308.67,,,,,,,63.3200,1227.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",922.17,,,,,,,63.3200,1227.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,108.13,,,,,,,63.3200,1227.0000,fee schedule,$108.13 from Fee Schedule BLDTM_23 for Rev 335 Proc 96409 * Qty 1 = $108.13 at 100% = $108.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,BLUE CROSS,BLUE CROSS E NETWORK,427.28,,,,,,,63.3200,1227.0000,fee schedule,$98.00 from Fee Schedule BCFSG for Rev 335 Proc 96409 * Qty 1 = $98.00 at 436% = $427.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,BLUE CROSS,BLUE CROSS MEDICARE,311.67,,,,,,,63.3200,1227.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,BLUE CROSS,BLUE CROSS P NETWORK,436.10,,,,,,,63.3200,1227.0000,fee schedule,$98.00 from Fee Schedule BCFSG for Rev 335 Proc 96409 * Qty 1 = $98.00 at 445% = $436.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,BLUE CROSS,BLUE CROSS S NETWORK,436.10,,,,,,,63.3200,1227.0000,fee schedule,$98.00 from Fee Schedule BCFSG for Rev 335 Proc 96409 * Qty 1 = $98.00 at 445% = $436.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,BLUE CROSS,TENNCARE BLUE CARE,109.28,,,,,,,63.3200,1227.0000,fee schedule,$94.21 from Fee Schedule TC_24 for Rev 335 Proc 96409 * Qty 1 = $94.21 at 116% = $109.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,BLUE CROSS,TENNCARE BLUE SELECT,109.28,,,,,,,63.3200,1227.0000,fee schedule,$94.21 from Fee Schedule TC_24 for Rev 335 Proc 96409 * Qty 1 = $94.21 at 116% = $109.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,CIGNA HEALTHCARE,CIGNA HMO,511.66,,,,,,,63.3200,1227.0000,percent of total billed charges,"41.7% of $1,227.00 in Billed Charges for Rev 335 Proc 96409 = $511.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,569.33,,,,,,,63.3200,1227.0000,percent of total billed charges,"46.4% of $1,227.00 in Billed Charges for Rev 335 Proc 96409 = $569.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,314.66,,,,,,,63.3200,1227.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,511.66,,,,,,,63.3200,1227.0000,percent of total billed charges,"41.7% of $1,227.00 in Billed Charges for Rev 335 Proc 96409 = $511.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,CIGNA HEALTHCARE,CIGNA PPO,511.66,,,,,,,63.3200,1227.0000,percent of total billed charges,"41.7% of $1,227.00 in Billed Charges for Rev 335 Proc 96409 = $511.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,314.66,,,,,,,63.3200,1227.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1104.30,,,,,,,63.3200,1227.0000,percent of total billed charges,"90% of $1,227.00 in Billed Charges for Rev 335 Proc 96409 = $1,104.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,HUMANA,HUMANA MEDICARE,299.68,,,,,,,63.3200,1227.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,299.68,,,,,,,63.3200,1227.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,MEDCOST,MEDCOST VHN,583.93,,,,,,,63.3200,1227.0000,percent of total billed charges,"47.59% of $1,227.00 in Billed Charges for Rev 335 Proc 96409 = $583.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,74.67,,,,,,,63.3200,1227.0000,fee schedule,APG 00109 Proc 96409 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 105% = $74.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,314.66,,,,,,,63.3200,1227.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,314.66,,,,,,,63.3200,1227.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,NHC ADVANTAGE,NHC ADVANTAGE,314.66,,,,,,,63.3200,1227.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,73.31,,,,,,,63.3200,1227.0000,fee schedule,APG 00109 Proc 96409 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 103.1% = $73.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,SENTARA HEALTH,SENTARA HEALTH,316.69,,,,,,,63.3200,1227.0000,percent of total billed charges,"25.81% of $1,227.00 in Billed Charges for Rev 335 Proc 96409 = $316.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,SENTARA HEALTH,SENTARA MEDICARE,299.68,,,,,,,63.3200,1227.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1227.00,,,,,,,63.3200,1227.0000,percent of total billed charges,"100% of $1,227.00 in Billed Charges for Rev 335 Proc 96409 = $1,227.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,63.32,,,,,,,63.3200,1227.0000,fee schedule,$126.64 from Fee Schedule TCUHC24 for Rev 335 Proc 96409 * Qty 1 = $126.64 at 50% = $63.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1227.00,,,,,,,63.3200,1227.0000,other,"Rev 335 Proc 96409 1 Visit at $2,444.00 per Visit = $2,444.00 (Service Line reduced to $1,227.00, claim capped at $1,227.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1227.00,,,,,,,63.3200,1227.0000,other,"Rev 335 Proc 96409 1 Visit at $2,338.00 per Visit = $2,338.00 (Service Line reduced to $1,227.00, claim capped at $1,227.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,1227.00,,,,,,,63.3200,1227.0000,other,"Rev 335 Proc 96409 1 Visit at $4,205.00 per Visit = $4,205.00 (Service Line reduced to $1,227.00, claim capped at $1,227.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,73.24,,,,,,,63.3200,1227.0000,fee schedule,APG 00109 Proc 96409 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,299.68,,,,,,,63.3200,1227.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,299.68,,,,,,,63.3200,1227.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,WELLCARE,WELLCARE MEDICAID,1227.00,,,,,,,63.3200,1227.0000,percent of total billed charges,"100% of $1,227.00 in Billed Charges for Rev 335 Proc 96409 = $1,227.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM IV PUSH INITIAL DRUG,96409,CPT,335,RC,33500001,CDM,,,,both,,,1227.0000,184.0500,WELLCARE,WELLCARE MEDICARE,317.66,,,,,,,63.3200,1227.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,AETNA,AETNA,741.27,,,,,,,103.8900,1736.0000,percent of total billed charges,"42.7% of $1,736.00 in Billed Charges for Rev 335 Proc 96413 = $741.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,406.06,,,,,,,103.8900,1736.0000,fee schedule,APG 00111 Proc 96413 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 104% = $406.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,299.68,,,,,,,103.8900,1736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,AETNA,AETNA HEALTHCARE MEDICARE,299.68,,,,,,,103.8900,1736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,299.68,,,,,,,103.8900,1736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,AMBETTER,AMBETTER,653.30,,,,,,,103.8900,1736.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,311.67,,,,,,,103.8900,1736.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,BLUE CROSS,ANTHEM EXCHANGE,737.82,,,,,,,103.8900,1736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,402.15,,,,,,,103.8900,1736.0000,fee schedule,APG 00111 Proc 96413 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 103% = $402.15. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,BLUE CROSS,ANTHEM HMO,783.89,,,,,,,103.8900,1736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,308.67,,,,,,,103.8900,1736.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",922.17,,,,,,,103.8900,1736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,152.43,,,,,,,103.8900,1736.0000,fee schedule,$152.43 from Fee Schedule BLDTM_23 for Rev 335 Proc 96413 * Qty 1 = $152.43 at 100% = $152.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,BLUE CROSS,BLUE CROSS E NETWORK,523.29,,,,,,,103.8900,1736.0000,fee schedule,$120.02 from Fee Schedule BCFSG for Rev 335 Proc 96413 * Qty 1 = $120.02 at 436% = $523.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,BLUE CROSS,BLUE CROSS MEDICARE,311.67,,,,,,,103.8900,1736.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,BLUE CROSS,BLUE CROSS P NETWORK,534.09,,,,,,,103.8900,1736.0000,fee schedule,$120.02 from Fee Schedule BCFSG for Rev 335 Proc 96413 * Qty 1 = $120.02 at 445% = $534.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,BLUE CROSS,BLUE CROSS S NETWORK,534.09,,,,,,,103.8900,1736.0000,fee schedule,$120.02 from Fee Schedule BCFSG for Rev 335 Proc 96413 * Qty 1 = $120.02 at 445% = $534.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,BLUE CROSS,TENNCARE BLUE CARE,154.06,,,,,,,103.8900,1736.0000,fee schedule,$132.81 from Fee Schedule TC_24 for Rev 335 Proc 96413 * Qty 1 = $132.81 at 116% = $154.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,BLUE CROSS,TENNCARE BLUE SELECT,154.06,,,,,,,103.8900,1736.0000,fee schedule,$132.81 from Fee Schedule TC_24 for Rev 335 Proc 96413 * Qty 1 = $132.81 at 116% = $154.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,CIGNA HEALTHCARE,CIGNA HMO,723.91,,,,,,,103.8900,1736.0000,percent of total billed charges,"41.7% of $1,736.00 in Billed Charges for Rev 335 Proc 96413 = $723.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,805.50,,,,,,,103.8900,1736.0000,percent of total billed charges,"46.4% of $1,736.00 in Billed Charges for Rev 335 Proc 96413 = $805.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,314.66,,,,,,,103.8900,1736.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,723.91,,,,,,,103.8900,1736.0000,percent of total billed charges,"41.7% of $1,736.00 in Billed Charges for Rev 335 Proc 96413 = $723.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,CIGNA HEALTHCARE,CIGNA PPO,723.91,,,,,,,103.8900,1736.0000,percent of total billed charges,"41.7% of $1,736.00 in Billed Charges for Rev 335 Proc 96413 = $723.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,314.66,,,,,,,103.8900,1736.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1562.40,,,,,,,103.8900,1736.0000,percent of total billed charges,"90% of $1,736.00 in Billed Charges for Rev 335 Proc 96413 = $1,562.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,HUMANA,HUMANA MEDICARE,299.68,,,,,,,103.8900,1736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,299.68,,,,,,,103.8900,1736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,MEDCOST,MEDCOST VHN,826.16,,,,,,,103.8900,1736.0000,percent of total billed charges,"47.59% of $1,736.00 in Billed Charges for Rev 335 Proc 96413 = $826.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,409.96,,,,,,,103.8900,1736.0000,fee schedule,APG 00111 Proc 96413 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 100% = $390.44... $390.44 at 105% = $409.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,314.66,,,,,,,103.8900,1736.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,314.66,,,,,,,103.8900,1736.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,NHC ADVANTAGE,NHC ADVANTAGE,314.66,,,,,,,103.8900,1736.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,402.54,,,,,,,103.8900,1736.0000,fee schedule,APG 00111 Proc 96413 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 100% = $390.44... $390.44 at 103.1% = $402.54 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,SENTARA HEALTH,SENTARA HEALTH,448.06,,,,,,,103.8900,1736.0000,percent of total billed charges,"25.81% of $1,736.00 in Billed Charges for Rev 335 Proc 96413 = $448.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,SENTARA HEALTH,SENTARA MEDICARE,299.68,,,,,,,103.8900,1736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1736.00,,,,,,,103.8900,1736.0000,percent of total billed charges,"100% of $1,736.00 in Billed Charges for Rev 335 Proc 96413 = $1,736.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,103.89,,,,,,,103.8900,1736.0000,fee schedule,$207.77 from Fee Schedule TCUHC24 for Rev 335 Proc 96413 * Qty 1 = $207.77 at 50% = $103.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1736.00,,,,,,,103.8900,1736.0000,other,"Rev 335 Proc 96413 1 Visit at $2,444.00 per Visit = $2,444.00 (Service Line reduced to $1,736.00, claim capped at $1,736.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1736.00,,,,,,,103.8900,1736.0000,other,"Rev 335 Proc 96413 1 Visit at $2,338.00 per Visit = $2,338.00 (Service Line reduced to $1,736.00, claim capped at $1,736.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,1736.00,,,,,,,103.8900,1736.0000,other,"Rev 335 Proc 96413 1 Visit at $4,205.00 per Visit = $4,205.00 (Service Line reduced to $1,736.00, claim capped at $1,736.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,402.15,,,,,,,103.8900,1736.0000,fee schedule,APG 00111 Proc 96413 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 103% = $402.15. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,299.68,,,,,,,103.8900,1736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,299.68,,,,,,,103.8900,1736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,WELLCARE,WELLCARE MEDICAID,1736.00,,,,,,,103.8900,1736.0000,percent of total billed charges,"100% of $1,736.00 in Billed Charges for Rev 335 Proc 96413 = $1,736.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM IV INF INITIAL TO 1HR,96413,CPT,335,RC,33500003,CDM,,,,both,,,1736.0000,260.4000,WELLCARE,WELLCARE MEDICARE,317.66,,,,,,,103.8900,1736.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,AETNA,AETNA,167.81,,,,,,,17.4100,741.3100,percent of total billed charges,42.7% of $393.00 in Billed Charges for Rev 335 Proc 96415 = $167.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,734.25,,,,,,,17.4100,741.3100,fee schedule,APG 00110 Proc 96415 at $836.60 (Base Rate) * 0.8439 (Relative Weight) = $706.01 (Total Line Payment) at 104% = $734.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,65.32,,,,,,,17.4100,741.3100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,AETNA,AETNA HEALTHCARE MEDICARE,65.32,,,,,,,17.4100,741.3100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,65.32,,,,,,,17.4100,741.3100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,AMBETTER,AMBETTER,142.41,,,,,,,17.4100,741.3100,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,67.94,,,,,,,17.4100,741.3100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,BLUE CROSS,ANTHEM EXCHANGE,160.84,,,,,,,17.4100,741.3100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,393.00,,,,,,,17.4100,741.3100,fee schedule,"APG 00110 Proc 96415 at $836.60 (Base Rate) * 0.8439 (Relative Weight) = $706.01 (Total Line Payment) at 103% = $727.19 (Service Line reduced to $393.00, claim capped at $393.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,BLUE CROSS,ANTHEM HMO,170.88,,,,,,,17.4100,741.3100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,67.28,,,,,,,17.4100,741.3100,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",201.02,,,,,,,17.4100,741.3100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,34.52,,,,,,,17.4100,741.3100,fee schedule,$34.52 from Fee Schedule BLDTM_23 for Rev 335 Proc 96415 * Qty 1 = $34.52 at 100% = $34.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,BLUE CROSS,BLUE CROSS E NETWORK,111.83,,,,,,,17.4100,741.3100,fee schedule,$25.65 from Fee Schedule BCFSG for Rev 335 Proc 96415 * Qty 1 = $25.65 at 436% = $111.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,BLUE CROSS,BLUE CROSS MEDICARE,67.94,,,,,,,17.4100,741.3100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,BLUE CROSS,BLUE CROSS P NETWORK,114.14,,,,,,,17.4100,741.3100,fee schedule,$25.65 from Fee Schedule BCFSG for Rev 335 Proc 96415 * Qty 1 = $25.65 at 445% = $114.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,BLUE CROSS,BLUE CROSS S NETWORK,114.14,,,,,,,17.4100,741.3100,fee schedule,$25.65 from Fee Schedule BCFSG for Rev 335 Proc 96415 * Qty 1 = $25.65 at 445% = $114.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,BLUE CROSS,TENNCARE BLUE CARE,34.88,,,,,,,17.4100,741.3100,fee schedule,$30.07 from Fee Schedule TC_24 for Rev 335 Proc 96415 * Qty 1 = $30.07 at 116% = $34.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,BLUE CROSS,TENNCARE BLUE SELECT,34.88,,,,,,,17.4100,741.3100,fee schedule,$30.07 from Fee Schedule TC_24 for Rev 335 Proc 96415 * Qty 1 = $30.07 at 116% = $34.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,CIGNA HEALTHCARE,CIGNA HMO,163.88,,,,,,,17.4100,741.3100,percent of total billed charges,41.7% of $393.00 in Billed Charges for Rev 335 Proc 96415 = $163.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,182.35,,,,,,,17.4100,741.3100,percent of total billed charges,46.4% of $393.00 in Billed Charges for Rev 335 Proc 96415 = $182.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,68.59,,,,,,,17.4100,741.3100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,163.88,,,,,,,17.4100,741.3100,percent of total billed charges,41.7% of $393.00 in Billed Charges for Rev 335 Proc 96415 = $163.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,CIGNA HEALTHCARE,CIGNA PPO,163.88,,,,,,,17.4100,741.3100,percent of total billed charges,41.7% of $393.00 in Billed Charges for Rev 335 Proc 96415 = $163.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,68.59,,,,,,,17.4100,741.3100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,353.70,,,,,,,17.4100,741.3100,percent of total billed charges,90% of $393.00 in Billed Charges for Rev 335 Proc 96415 = $353.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,HUMANA,HUMANA MEDICARE,65.32,,,,,,,17.4100,741.3100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,65.32,,,,,,,17.4100,741.3100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,MEDCOST,MEDCOST VHN,187.03,,,,,,,17.4100,741.3100,percent of total billed charges,47.59% of $393.00 in Billed Charges for Rev 335 Proc 96415 = $187.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,741.31,,,,,,,17.4100,741.3100,fee schedule,APG 00110 Proc 96415 at $836.60 (Base Rate) * 0.8439 (Relative Weight) = $706.01 (Total Line Payment) at 100% = $706.01... $706.01 at 105% = $741.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,68.59,,,,,,,17.4100,741.3100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,68.59,,,,,,,17.4100,741.3100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,NHC ADVANTAGE,NHC ADVANTAGE,68.59,,,,,,,17.4100,741.3100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,727.90,,,,,,,17.4100,741.3100,fee schedule,APG 00110 Proc 96415 at $836.60 (Base Rate) * 0.8439 (Relative Weight) = $706.01 (Total Line Payment) at 100% = $706.01... $706.01 at 103.1% = $727.90 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,SENTARA HEALTH,SENTARA HEALTH,101.43,,,,,,,17.4100,741.3100,percent of total billed charges,25.81% of $393.00 in Billed Charges for Rev 335 Proc 96415 = $101.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,SENTARA HEALTH,SENTARA MEDICARE,65.32,,,,,,,17.4100,741.3100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",393.00,,,,,,,17.4100,741.3100,percent of total billed charges,100% of $393.00 in Billed Charges for Rev 335 Proc 96415 = $393.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,17.41,,,,,,,17.4100,741.3100,fee schedule,$34.81 from Fee Schedule TCUHC24 for Rev 335 Proc 96415 * Qty 1 = $34.81 at 50% = $17.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,393.00,,,,,,,17.4100,741.3100,other,"Rev 335 Proc 96415 1 Visit at $2,444.00 per Visit = $2,444.00 (Service Line reduced to $393.00, claim capped at $393.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,393.00,,,,,,,17.4100,741.3100,other,"Rev 335 Proc 96415 1 Visit at $2,338.00 per Visit = $2,338.00 (Service Line reduced to $393.00, claim capped at $393.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,393.00,,,,,,,17.4100,741.3100,other,"Rev 335 Proc 96415 1 Visit at $4,205.00 per Visit = $4,205.00 (Service Line reduced to $393.00, claim capped at $393.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,727.19,,,,,,,17.4100,741.3100,fee schedule,APG 00110 Proc 96415 at $836.60 (Base Rate) * 0.8439 (Relative Weight) = $706.01 (Total Line Payment) at 103% = $727.19. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,65.32,,,,,,,17.4100,741.3100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,65.32,,,,,,,17.4100,741.3100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,WELLCARE,WELLCARE MEDICAID,393.00,,,,,,,17.4100,741.3100,percent of total billed charges,100% of $393.00 in Billed Charges for Rev 335 Proc 96415 = $393.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV INF EA ADD HR,96415,CPT,335,RC,33500004,CDM,,,,both,,,393.0000,58.9500,WELLCARE,WELLCARE MEDICARE,69.24,,,,,,,17.4100,741.3100,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,AETNA,AETNA,361.24,,,,,,,36.3500,846.0000,percent of total billed charges,42.7% of $846.00 in Billed Charges for Rev 335 Proc 96417 = $361.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,406.06,,,,,,,36.3500,846.0000,fee schedule,APG 00111 Proc 96417 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 104% = $406.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,65.32,,,,,,,36.3500,846.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,AETNA,AETNA HEALTHCARE MEDICARE,65.32,,,,,,,36.3500,846.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,65.32,,,,,,,36.3500,846.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,AMBETTER,AMBETTER,142.41,,,,,,,36.3500,846.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,67.94,,,,,,,36.3500,846.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,BLUE CROSS,ANTHEM EXCHANGE,160.84,,,,,,,36.3500,846.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,402.15,,,,,,,36.3500,846.0000,fee schedule,APG 00111 Proc 96417 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 103% = $402.15. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,BLUE CROSS,ANTHEM HMO,170.88,,,,,,,36.3500,846.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,67.28,,,,,,,36.3500,846.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",201.02,,,,,,,36.3500,846.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,74.59,,,,,,,36.3500,846.0000,fee schedule,$74.59 from Fee Schedule BLDTM_23 for Rev 335 Proc 96417 * Qty 1 = $74.59 at 100% = $74.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,BLUE CROSS,BLUE CROSS E NETWORK,244.25,,,,,,,36.3500,846.0000,fee schedule,$56.02 from Fee Schedule BCFSG for Rev 335 Proc 96417 * Qty 1 = $56.02 at 436% = $244.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,BLUE CROSS,BLUE CROSS MEDICARE,67.94,,,,,,,36.3500,846.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,BLUE CROSS,BLUE CROSS P NETWORK,249.29,,,,,,,36.3500,846.0000,fee schedule,$56.02 from Fee Schedule BCFSG for Rev 335 Proc 96417 * Qty 1 = $56.02 at 445% = $249.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,BLUE CROSS,BLUE CROSS S NETWORK,249.29,,,,,,,36.3500,846.0000,fee schedule,$56.02 from Fee Schedule BCFSG for Rev 335 Proc 96417 * Qty 1 = $56.02 at 445% = $249.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,BLUE CROSS,TENNCARE BLUE CARE,75.39,,,,,,,36.3500,846.0000,fee schedule,$64.99 from Fee Schedule TC_24 for Rev 335 Proc 96417 * Qty 1 = $64.99 at 116% = $75.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,BLUE CROSS,TENNCARE BLUE SELECT,75.39,,,,,,,36.3500,846.0000,fee schedule,$64.99 from Fee Schedule TC_24 for Rev 335 Proc 96417 * Qty 1 = $64.99 at 116% = $75.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,CIGNA HEALTHCARE,CIGNA HMO,352.78,,,,,,,36.3500,846.0000,percent of total billed charges,41.7% of $846.00 in Billed Charges for Rev 335 Proc 96417 = $352.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,392.54,,,,,,,36.3500,846.0000,percent of total billed charges,46.4% of $846.00 in Billed Charges for Rev 335 Proc 96417 = $392.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,68.59,,,,,,,36.3500,846.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,352.78,,,,,,,36.3500,846.0000,percent of total billed charges,41.7% of $846.00 in Billed Charges for Rev 335 Proc 96417 = $352.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,CIGNA HEALTHCARE,CIGNA PPO,352.78,,,,,,,36.3500,846.0000,percent of total billed charges,41.7% of $846.00 in Billed Charges for Rev 335 Proc 96417 = $352.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,68.59,,,,,,,36.3500,846.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,761.40,,,,,,,36.3500,846.0000,percent of total billed charges,90% of $846.00 in Billed Charges for Rev 335 Proc 96417 = $761.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,HUMANA,HUMANA MEDICARE,65.32,,,,,,,36.3500,846.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,65.32,,,,,,,36.3500,846.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,MEDCOST,MEDCOST VHN,402.61,,,,,,,36.3500,846.0000,percent of total billed charges,47.59% of $846.00 in Billed Charges for Rev 335 Proc 96417 = $402.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,409.96,,,,,,,36.3500,846.0000,fee schedule,APG 00111 Proc 96417 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 100% = $390.44... $390.44 at 105% = $409.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,68.59,,,,,,,36.3500,846.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,68.59,,,,,,,36.3500,846.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,NHC ADVANTAGE,NHC ADVANTAGE,68.59,,,,,,,36.3500,846.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,402.54,,,,,,,36.3500,846.0000,fee schedule,APG 00111 Proc 96417 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 100% = $390.44... $390.44 at 103.1% = $402.54 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,SENTARA HEALTH,SENTARA HEALTH,218.35,,,,,,,36.3500,846.0000,percent of total billed charges,25.81% of $846.00 in Billed Charges for Rev 335 Proc 96417 = $218.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,SENTARA HEALTH,SENTARA MEDICARE,65.32,,,,,,,36.3500,846.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",846.00,,,,,,,36.3500,846.0000,percent of total billed charges,100% of $846.00 in Billed Charges for Rev 335 Proc 96417 = $846.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,36.35,,,,,,,36.3500,846.0000,fee schedule,$72.70 from Fee Schedule TCUHC24 for Rev 335 Proc 96417 * Qty 1 = $72.70 at 50% = $36.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,846.00,,,,,,,36.3500,846.0000,other,"Rev 335 Proc 96417 1 Visit at $2,444.00 per Visit = $2,444.00 (Service Line reduced to $846.00, claim capped at $846.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,846.00,,,,,,,36.3500,846.0000,other,"Rev 335 Proc 96417 1 Visit at $2,338.00 per Visit = $2,338.00 (Service Line reduced to $846.00, claim capped at $846.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,846.00,,,,,,,36.3500,846.0000,other,"Rev 335 Proc 96417 1 Visit at $4,205.00 per Visit = $4,205.00 (Service Line reduced to $846.00, claim capped at $846.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,402.15,,,,,,,36.3500,846.0000,fee schedule,APG 00111 Proc 96417 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 103% = $402.15. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,65.32,,,,,,,36.3500,846.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,65.32,,,,,,,36.3500,846.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,WELLCARE,WELLCARE MEDICAID,846.00,,,,,,,36.3500,846.0000,percent of total billed charges,100% of $846.00 in Billed Charges for Rev 335 Proc 96417 = $846.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV INF EA SEQ UP TO 1HR,96417,CPT,335,RC,33500006,CDM,,,,both,,,846.0000,126.9000,WELLCARE,WELLCARE MEDICARE,69.24,,,,,,,36.3500,846.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,AETNA,AETNA,843.33,,,,,,,36.3500,1975.0000,percent of total billed charges,"42.7% of $1,975.00 in Billed Charges for Rev 330 Proc 96420 = $843.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,73.96,,,,,,,36.3500,1975.0000,fee schedule,APG 00109 Proc 96420 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 104% = $73.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,299.68,,,,,,,36.3500,1975.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,AETNA,AETNA HEALTHCARE MEDICARE,299.68,,,,,,,36.3500,1975.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,299.68,,,,,,,36.3500,1975.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,AMBETTER,AMBETTER,653.30,,,,,,,36.3500,1975.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,311.67,,,,,,,36.3500,1975.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,BLUE CROSS,ANTHEM EXCHANGE,737.82,,,,,,,36.3500,1975.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,73.24,,,,,,,36.3500,1975.0000,fee schedule,APG 00109 Proc 96420 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,BLUE CROSS,ANTHEM HMO,783.89,,,,,,,36.3500,1975.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,308.67,,,,,,,36.3500,1975.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",922.17,,,,,,,36.3500,1975.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,51.08,,,,,,,36.3500,1975.0000,fee schedule,$51.08 from Fee Schedule BLDTM_23 for Rev 330 Proc 96420 * Qty 1 = $51.08 at 100% = $51.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,BLUE CROSS,BLUE CROSS MEDICARE,311.67,,,,,,,36.3500,1975.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,BLUE CROSS,TENNCARE BLUE CARE,44.24,,,,,,,36.3500,1975.0000,fee schedule,$38.14 from Fee Schedule TC_24 for Rev 330 Proc 96420 * Qty 1 = $38.14 at 116% = $44.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,BLUE CROSS,TENNCARE BLUE SELECT,44.24,,,,,,,36.3500,1975.0000,fee schedule,$38.14 from Fee Schedule TC_24 for Rev 330 Proc 96420 * Qty 1 = $38.14 at 116% = $44.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,CIGNA HEALTHCARE,CIGNA HMO,823.58,,,,,,,36.3500,1975.0000,percent of total billed charges,"Rev 330 Proc 96420 $1,975.00 in Billed Charges at 41.7% = $823.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,314.66,,,,,,,36.3500,1975.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,823.58,,,,,,,36.3500,1975.0000,percent of total billed charges,"Rev 330 Proc 96420 $1,975.00 in Billed Charges at 41.7% = $823.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,CIGNA HEALTHCARE,CIGNA PPO,823.58,,,,,,,36.3500,1975.0000,percent of total billed charges,"Rev 330 Proc 96420 $1,975.00 in Billed Charges at 41.7% = $823.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,314.66,,,,,,,36.3500,1975.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1777.50,,,,,,,36.3500,1975.0000,percent of total billed charges,"90% of $1,975.00 in Billed Charges for Rev 330 Proc 96420 = $1,777.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,HUMANA,HUMANA MEDICARE,299.68,,,,,,,36.3500,1975.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,299.68,,,,,,,36.3500,1975.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,MEDCOST,MEDCOST VHN,939.90,,,,,,,36.3500,1975.0000,percent of total billed charges,"47.59% of $1,975.00 in Billed Charges for Rev 330 Proc 96420 = $939.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,74.67,,,,,,,36.3500,1975.0000,fee schedule,APG 00109 Proc 96420 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 105% = $74.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,314.66,,,,,,,36.3500,1975.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,314.66,,,,,,,36.3500,1975.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,NHC ADVANTAGE,NHC ADVANTAGE,314.66,,,,,,,36.3500,1975.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,73.31,,,,,,,36.3500,1975.0000,fee schedule,APG 00109 Proc 96420 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 103.1% = $73.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,SENTARA HEALTH,SENTARA HEALTH,509.75,,,,,,,36.3500,1975.0000,percent of total billed charges,"25.81% of $1,975.00 in Billed Charges for Rev 330 Proc 96420 = $509.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,SENTARA HEALTH,SENTARA MEDICARE,299.68,,,,,,,36.3500,1975.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1975.00,,,,,,,36.3500,1975.0000,percent of total billed charges,"100% of $1,975.00 in Billed Charges for Rev 330 Proc 96420 = $1,975.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,36.35,,,,,,,36.3500,1975.0000,fee schedule,$72.70 from Fee Schedule TCUHC24 for Rev 330 Proc 96420 * Qty 1 = $72.70 at 50% = $36.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1411.00,,,,,,,36.3500,1975.0000,other,"Rev 330 Proc 96420 1 Visit at $1,411.00 per Visit = $1,411.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1350.00,,,,,,,36.3500,1975.0000,other,"Rev 330 Proc 96420 1 Visit at $1,350.00 per Visit = $1,350.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1975.00,,,,,,,36.3500,1975.0000,other,"Rev 330 Proc 96420 1 Visit at $2,224.00 per Visit = $2,224.00 (Service Line reduced to $1,975.00, claim capped at $1,975.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,73.24,,,,,,,36.3500,1975.0000,fee schedule,APG 00109 Proc 96420 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,299.68,,,,,,,36.3500,1975.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,299.68,,,,,,,36.3500,1975.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,WELLCARE,WELLCARE MEDICAID,1975.00,,,,,,,36.3500,1975.0000,percent of total billed charges,"100% of $1,975.00 in Billed Charges for Rev 330 Proc 96420 = $1,975.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO. ADM ARTERIAL PUSH,96420,CPT,330,RC,33000002,CDM,,,,both,,,1975.0000,296.2500,WELLCARE,WELLCARE MEDICARE,317.66,,,,,,,36.3500,1975.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,AETNA,AETNA,181.90,,,,,,,63.3200,653.3000,percent of total billed charges,42.7% of $426.00 in Billed Charges for Rev 331 Proc 96446 = $181.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,406.06,,,,,,,63.3200,653.3000,fee schedule,APG 00111 Proc 96446 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 104% = $406.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,299.68,,,,,,,63.3200,653.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,AETNA,AETNA HEALTHCARE MEDICARE,299.68,,,,,,,63.3200,653.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,299.68,,,,,,,63.3200,653.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,AMBETTER,AMBETTER,653.30,,,,,,,63.3200,653.3000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,311.67,,,,,,,63.3200,653.3000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,ANTHEM EXCHANGE,426.00,,,,,,,63.3200,653.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,402.15,,,,,,,63.3200,653.3000,fee schedule,APG 00111 Proc 96446 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 103% = $402.15. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,ANTHEM HMO,426.00,,,,,,,63.3200,653.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,308.67,,,,,,,63.3200,653.3000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",426.00,,,,,,,63.3200,653.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,167.07,,,,,,,63.3200,653.3000,fee schedule,$167.07 from Fee Schedule BLDTM_23 for Rev 331 Proc 96446 * Qty 1 = $167.07 at 100% = $167.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,BLUE CROSS E NETWORK,426.00,,,,,,,63.3200,653.3000,fee schedule,"$174.13 from Fee Schedule BCFSG for Rev 331 Proc 96446 * Qty 1 = $174.13 at 436% = $759.21 (Service Line reduced to $426.00, claim capped at $426.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,BLUE CROSS MEDICARE,311.67,,,,,,,63.3200,653.3000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,BLUE CROSS P NETWORK,426.00,,,,,,,63.3200,653.3000,fee schedule,"$174.13 from Fee Schedule BCFSG for Rev 331 Proc 96446 * Qty 1 = $174.13 at 445% = $774.88 (Service Line reduced to $426.00, claim capped at $426.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,BLUE CROSS S NETWORK,426.00,,,,,,,63.3200,653.3000,fee schedule,"$174.13 from Fee Schedule BCFSG for Rev 331 Proc 96446 * Qty 1 = $174.13 at 445% = $774.88 (Service Line reduced to $426.00, claim capped at $426.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,TENNCARE BLUE CARE,168.85,,,,,,,63.3200,653.3000,fee schedule,$145.56 from Fee Schedule TC_24 for Rev 331 Proc 96446 * Qty 1 = $145.56 at 116% = $168.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,TENNCARE BLUE SELECT,168.85,,,,,,,63.3200,653.3000,fee schedule,$145.56 from Fee Schedule TC_24 for Rev 331 Proc 96446 * Qty 1 = $145.56 at 116% = $168.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,CIGNA HEALTHCARE,CIGNA HMO,177.64,,,,,,,63.3200,653.3000,percent of total billed charges,41.7% of $426.00 in Billed Charges for Rev 331 Proc 96446 = $177.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,197.66,,,,,,,63.3200,653.3000,percent of total billed charges,46.4% of $426.00 in Billed Charges for Rev 331 Proc 96446 = $197.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,314.66,,,,,,,63.3200,653.3000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,177.64,,,,,,,63.3200,653.3000,percent of total billed charges,41.7% of $426.00 in Billed Charges for Rev 331 Proc 96446 = $177.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,CIGNA HEALTHCARE,CIGNA PPO,177.64,,,,,,,63.3200,653.3000,percent of total billed charges,41.7% of $426.00 in Billed Charges for Rev 331 Proc 96446 = $177.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,314.66,,,,,,,63.3200,653.3000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,383.40,,,,,,,63.3200,653.3000,percent of total billed charges,90% of $426.00 in Billed Charges for Rev 331 Proc 96446 = $383.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,HUMANA,HUMANA MEDICARE,299.68,,,,,,,63.3200,653.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,299.68,,,,,,,63.3200,653.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,MEDCOST,MEDCOST VHN,202.73,,,,,,,63.3200,653.3000,percent of total billed charges,47.59% of $426.00 in Billed Charges for Rev 331 Proc 96446 = $202.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,409.96,,,,,,,63.3200,653.3000,fee schedule,APG 00111 Proc 96446 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 100% = $390.44... $390.44 at 105% = $409.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,314.66,,,,,,,63.3200,653.3000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,314.66,,,,,,,63.3200,653.3000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,NHC ADVANTAGE,NHC ADVANTAGE,314.66,,,,,,,63.3200,653.3000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,402.54,,,,,,,63.3200,653.3000,fee schedule,APG 00111 Proc 96446 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 100% = $390.44... $390.44 at 103.1% = $402.54 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,SENTARA HEALTH,SENTARA HEALTH,109.95,,,,,,,63.3200,653.3000,percent of total billed charges,25.81% of $426.00 in Billed Charges for Rev 331 Proc 96446 = $109.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,SENTARA HEALTH,SENTARA MEDICARE,299.68,,,,,,,63.3200,653.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",426.00,,,,,,,63.3200,653.3000,percent of total billed charges,100% of $426.00 in Billed Charges for Rev 331 Proc 96446 = $426.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,63.32,,,,,,,63.3200,653.3000,fee schedule,$126.64 from Fee Schedule TCUHC24 for Rev 331 Proc 96446 * Qty 1 = $126.64 at 50% = $63.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,426.00,,,,,,,63.3200,653.3000,other,"Rev 331 Proc 96446 1 Visit at $2,444.00 per Visit = $2,444.00 (Service Line reduced to $426.00, claim capped at $426.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,426.00,,,,,,,63.3200,653.3000,other,"Rev 331 Proc 96446 1 Visit at $2,338.00 per Visit = $2,338.00 (Service Line reduced to $426.00, claim capped at $426.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,426.00,,,,,,,63.3200,653.3000,other,"Rev 331 Proc 96446 1 Visit at $4,205.00 per Visit = $4,205.00 (Service Line reduced to $426.00, claim capped at $426.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,402.15,,,,,,,63.3200,653.3000,fee schedule,APG 00111 Proc 96446 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 103% = $402.15. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,299.68,,,,,,,63.3200,653.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,299.68,,,,,,,63.3200,653.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,WELLCARE,WELLCARE MEDICAID,426.00,,,,,,,63.3200,653.3000,percent of total billed charges,100% of $426.00 in Billed Charges for Rev 331 Proc 96446 = $426.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRAPERITONEAL CAVITY VIA PORT/CATH,96446,CPT,331,RC,33100006,CDM,,,,both,,,426.0000,63.9000,WELLCARE,WELLCARE MEDICARE,317.66,,,,,,,63.3200,653.3000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,AETNA,AETNA,630.68,,,,,,,103.8900,1477.0000,percent of total billed charges,"42.7% of $1,477.00 in Billed Charges for Rev 330 Proc 96450 = $630.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,734.25,,,,,,,103.8900,1477.0000,fee schedule,APG 00110 Proc 96450 at $836.60 (Base Rate) * 0.8439 (Relative Weight) = $706.01 (Total Line Payment) at 104% = $734.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,299.68,,,,,,,103.8900,1477.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,AETNA,AETNA HEALTHCARE MEDICARE,299.68,,,,,,,103.8900,1477.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,299.68,,,,,,,103.8900,1477.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,AMBETTER,AMBETTER,653.30,,,,,,,103.8900,1477.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,311.67,,,,,,,103.8900,1477.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,BLUE CROSS,ANTHEM EXCHANGE,737.82,,,,,,,103.8900,1477.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,727.19,,,,,,,103.8900,1477.0000,fee schedule,APG 00110 Proc 96450 at $836.60 (Base Rate) * 0.8439 (Relative Weight) = $706.01 (Total Line Payment) at 103% = $727.19. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,BLUE CROSS,ANTHEM HMO,783.89,,,,,,,103.8900,1477.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,308.67,,,,,,,103.8900,1477.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",922.17,,,,,,,103.8900,1477.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,153.80,,,,,,,103.8900,1477.0000,fee schedule,$153.80 from Fee Schedule BLDTM_23 for Rev 330 Proc 96450 * Qty 1 = $153.80 at 100% = $153.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,BLUE CROSS,BLUE CROSS MEDICARE,311.67,,,,,,,103.8900,1477.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,BLUE CROSS,TENNCARE BLUE CARE,105.78,,,,,,,103.8900,1477.0000,fee schedule,$91.19 from Fee Schedule TC_24 for Rev 330 Proc 96450 * Qty 1 = $91.19 at 116% = $105.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,BLUE CROSS,TENNCARE BLUE SELECT,105.78,,,,,,,103.8900,1477.0000,fee schedule,$91.19 from Fee Schedule TC_24 for Rev 330 Proc 96450 * Qty 1 = $91.19 at 116% = $105.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,CIGNA HEALTHCARE,CIGNA HMO,615.91,,,,,,,103.8900,1477.0000,percent of total billed charges,"Rev 330 Proc 96450 $1,477.00 in Billed Charges at 41.7% = $615.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,314.66,,,,,,,103.8900,1477.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,615.91,,,,,,,103.8900,1477.0000,percent of total billed charges,"Rev 330 Proc 96450 $1,477.00 in Billed Charges at 41.7% = $615.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,CIGNA HEALTHCARE,CIGNA PPO,615.91,,,,,,,103.8900,1477.0000,percent of total billed charges,"Rev 330 Proc 96450 $1,477.00 in Billed Charges at 41.7% = $615.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,314.66,,,,,,,103.8900,1477.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1329.30,,,,,,,103.8900,1477.0000,percent of total billed charges,"90% of $1,477.00 in Billed Charges for Rev 330 Proc 96450 = $1,329.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,HUMANA,HUMANA MEDICARE,299.68,,,,,,,103.8900,1477.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,299.68,,,,,,,103.8900,1477.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,MEDCOST,MEDCOST VHN,702.90,,,,,,,103.8900,1477.0000,percent of total billed charges,"47.59% of $1,477.00 in Billed Charges for Rev 330 Proc 96450 = $702.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,741.31,,,,,,,103.8900,1477.0000,fee schedule,APG 00110 Proc 96450 at $836.60 (Base Rate) * 0.8439 (Relative Weight) = $706.01 (Total Line Payment) at 100% = $706.01... $706.01 at 105% = $741.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,314.66,,,,,,,103.8900,1477.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,314.66,,,,,,,103.8900,1477.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,NHC ADVANTAGE,NHC ADVANTAGE,314.66,,,,,,,103.8900,1477.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,727.90,,,,,,,103.8900,1477.0000,fee schedule,APG 00110 Proc 96450 at $836.60 (Base Rate) * 0.8439 (Relative Weight) = $706.01 (Total Line Payment) at 100% = $706.01... $706.01 at 103.1% = $727.90 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,SENTARA HEALTH,SENTARA HEALTH,381.21,,,,,,,103.8900,1477.0000,percent of total billed charges,"25.81% of $1,477.00 in Billed Charges for Rev 330 Proc 96450 = $381.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,SENTARA HEALTH,SENTARA MEDICARE,299.68,,,,,,,103.8900,1477.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1477.00,,,,,,,103.8900,1477.0000,percent of total billed charges,"100% of $1,477.00 in Billed Charges for Rev 330 Proc 96450 = $1,477.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,103.89,,,,,,,103.8900,1477.0000,fee schedule,$207.77 from Fee Schedule TCUHC24 for Rev 330 Proc 96450 * Qty 1 = $207.77 at 50% = $103.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1411.00,,,,,,,103.8900,1477.0000,other,"Rev 330 Proc 96450 1 Visit at $1,411.00 per Visit = $1,411.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1350.00,,,,,,,103.8900,1477.0000,other,"Rev 330 Proc 96450 1 Visit at $1,350.00 per Visit = $1,350.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,1477.00,,,,,,,103.8900,1477.0000,other,"Rev 330 Proc 96450 1 Visit at $2,224.00 per Visit = $2,224.00 (Service Line reduced to $1,477.00, claim capped at $1,477.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,727.19,,,,,,,103.8900,1477.0000,fee schedule,APG 00110 Proc 96450 at $836.60 (Base Rate) * 0.8439 (Relative Weight) = $706.01 (Total Line Payment) at 103% = $727.19. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,299.68,,,,,,,103.8900,1477.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,299.68,,,,,,,103.8900,1477.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,WELLCARE,WELLCARE MEDICAID,1477.00,,,,,,,103.8900,1477.0000,percent of total billed charges,"100% of $1,477.00 in Billed Charges for Rev 330 Proc 96450 = $1,477.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM CNS INTRATHECAL W/LP,96450,CPT,330,RC,33000003,CDM,,,,both,,,1477.0000,221.5500,WELLCARE,WELLCARE MEDICARE,317.66,,,,,,,103.8900,1477.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,AETNA,AETNA,457.32,,,,,,,63.3200,1071.0000,percent of total billed charges,"42.7% of $1,071.00 in Billed Charges for Rev 335 Proc 96521 = $457.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,73.96,,,,,,,63.3200,1071.0000,fee schedule,APG 00109 Proc 96521 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 104% = $73.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,192.98,,,,,,,63.3200,1071.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,AETNA,AETNA HEALTHCARE MEDICARE,192.98,,,,,,,63.3200,1071.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,192.98,,,,,,,63.3200,1071.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,AMBETTER,AMBETTER,420.70,,,,,,,63.3200,1071.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,200.70,,,,,,,63.3200,1071.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,BLUE CROSS,ANTHEM EXCHANGE,475.13,,,,,,,63.3200,1071.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,73.24,,,,,,,63.3200,1071.0000,fee schedule,APG 00109 Proc 96521 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,BLUE CROSS,ANTHEM HMO,504.80,,,,,,,63.3200,1071.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,198.77,,,,,,,63.3200,1071.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",593.85,,,,,,,63.3200,1071.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,134.98,,,,,,,63.3200,1071.0000,fee schedule,$134.98 from Fee Schedule BLDTM_23 for Rev 335 Proc 96521 * Qty 1 = $134.98 at 100% = $134.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,BLUE CROSS,BLUE CROSS E NETWORK,529.17,,,,,,,63.3200,1071.0000,fee schedule,$121.37 from Fee Schedule BCFSG for Rev 335 Proc 96521 * Qty 1 = $121.37 at 436% = $529.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,BLUE CROSS,BLUE CROSS MEDICARE,200.70,,,,,,,63.3200,1071.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,BLUE CROSS,BLUE CROSS P NETWORK,540.10,,,,,,,63.3200,1071.0000,fee schedule,$121.37 from Fee Schedule BCFSG for Rev 335 Proc 96521 * Qty 1 = $121.37 at 445% = $540.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,BLUE CROSS,BLUE CROSS S NETWORK,540.10,,,,,,,63.3200,1071.0000,fee schedule,$121.37 from Fee Schedule BCFSG for Rev 335 Proc 96521 * Qty 1 = $121.37 at 445% = $540.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,BLUE CROSS,TENNCARE BLUE CARE,136.42,,,,,,,63.3200,1071.0000,fee schedule,$117.60 from Fee Schedule TC_24 for Rev 335 Proc 96521 * Qty 1 = $117.60 at 116% = $136.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,BLUE CROSS,TENNCARE BLUE SELECT,136.42,,,,,,,63.3200,1071.0000,fee schedule,$117.60 from Fee Schedule TC_24 for Rev 335 Proc 96521 * Qty 1 = $117.60 at 116% = $136.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,CIGNA HEALTHCARE,CIGNA HMO,446.61,,,,,,,63.3200,1071.0000,percent of total billed charges,"41.7% of $1,071.00 in Billed Charges for Rev 335 Proc 96521 = $446.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,496.94,,,,,,,63.3200,1071.0000,percent of total billed charges,"46.4% of $1,071.00 in Billed Charges for Rev 335 Proc 96521 = $496.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,202.63,,,,,,,63.3200,1071.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,446.61,,,,,,,63.3200,1071.0000,percent of total billed charges,"41.7% of $1,071.00 in Billed Charges for Rev 335 Proc 96521 = $446.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,CIGNA HEALTHCARE,CIGNA PPO,446.61,,,,,,,63.3200,1071.0000,percent of total billed charges,"41.7% of $1,071.00 in Billed Charges for Rev 335 Proc 96521 = $446.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,202.63,,,,,,,63.3200,1071.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,963.90,,,,,,,63.3200,1071.0000,percent of total billed charges,"90% of $1,071.00 in Billed Charges for Rev 335 Proc 96521 = $963.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,HUMANA,HUMANA MEDICARE,192.98,,,,,,,63.3200,1071.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,192.98,,,,,,,63.3200,1071.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,MEDCOST,MEDCOST VHN,509.69,,,,,,,63.3200,1071.0000,percent of total billed charges,"47.59% of $1,071.00 in Billed Charges for Rev 335 Proc 96521 = $509.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,74.67,,,,,,,63.3200,1071.0000,fee schedule,APG 00109 Proc 96521 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 105% = $74.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,202.63,,,,,,,63.3200,1071.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,202.63,,,,,,,63.3200,1071.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,NHC ADVANTAGE,NHC ADVANTAGE,202.63,,,,,,,63.3200,1071.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,73.31,,,,,,,63.3200,1071.0000,fee schedule,APG 00109 Proc 96521 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 103.1% = $73.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,SENTARA HEALTH,SENTARA HEALTH,276.43,,,,,,,63.3200,1071.0000,percent of total billed charges,"25.81% of $1,071.00 in Billed Charges for Rev 335 Proc 96521 = $276.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,SENTARA HEALTH,SENTARA MEDICARE,192.98,,,,,,,63.3200,1071.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1071.00,,,,,,,63.3200,1071.0000,percent of total billed charges,"100% of $1,071.00 in Billed Charges for Rev 335 Proc 96521 = $1,071.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,63.32,,,,,,,63.3200,1071.0000,fee schedule,$126.64 from Fee Schedule TCUHC24 for Rev 335 Proc 96521 * Qty 1 = $126.64 at 50% = $63.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1071.00,,,,,,,63.3200,1071.0000,other,"Rev 335 Proc 96521 1 Visit at $2,444.00 per Visit = $2,444.00 (Service Line reduced to $1,071.00, claim capped at $1,071.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1071.00,,,,,,,63.3200,1071.0000,other,"Rev 335 Proc 96521 1 Visit at $2,338.00 per Visit = $2,338.00 (Service Line reduced to $1,071.00, claim capped at $1,071.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,1071.00,,,,,,,63.3200,1071.0000,other,"Rev 335 Proc 96521 1 Visit at $4,205.00 per Visit = $4,205.00 (Service Line reduced to $1,071.00, claim capped at $1,071.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,73.24,,,,,,,63.3200,1071.0000,fee schedule,APG 00109 Proc 96521 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,192.98,,,,,,,63.3200,1071.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,192.98,,,,,,,63.3200,1071.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,WELLCARE,WELLCARE MEDICAID,1071.00,,,,,,,63.3200,1071.0000,percent of total billed charges,"100% of $1,071.00 in Billed Charges for Rev 335 Proc 96521 = $1,071.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REFILLING/MAINT OF PORTABLE PUMP,96521,CPT,335,RC,33500007,CDM,,,,both,,,1071.0000,160.6500,WELLCARE,WELLCARE MEDICARE,204.56,,,,,,,63.3200,1071.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,AETNA,AETNA,83.69,,,,,,,21.3300,196.0000,percent of total billed charges,42.7% of $196.00 in Billed Charges for Rev 940 Proc 96523 = $83.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,73.96,,,,,,,21.3300,196.0000,fee schedule,APG 00109 Proc 96523 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 104% = $73.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,53.52,,,,,,,21.3300,196.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,AETNA,AETNA HEALTHCARE MEDICARE,53.52,,,,,,,21.3300,196.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,53.52,,,,,,,21.3300,196.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,AMBETTER,AMBETTER,116.68,,,,,,,21.3300,196.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,55.66,,,,,,,21.3300,196.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,BLUE CROSS,ANTHEM EXCHANGE,131.77,,,,,,,21.3300,196.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,73.24,,,,,,,21.3300,196.0000,fee schedule,APG 00109 Proc 96523 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,BLUE CROSS,ANTHEM HMO,140.00,,,,,,,21.3300,196.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,55.13,,,,,,,21.3300,196.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",164.70,,,,,,,21.3300,196.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,24.74,,,,,,,21.3300,196.0000,fee schedule,$24.74 from Fee Schedule BLDTM_23 for Rev 940 Proc 96523 * Qty 1 = $24.74 at 100% = $24.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,BLUE CROSS,BLUE CROSS E NETWORK,96.84,,,,,,,21.3300,196.0000,fee schedule,$22.21 from Fee Schedule BCFSG for Rev 940 Proc 96523 * Qty 1 = $22.21 at 436% = $96.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,BLUE CROSS,BLUE CROSS MEDICARE,55.66,,,,,,,21.3300,196.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,BLUE CROSS,BLUE CROSS P NETWORK,98.83,,,,,,,21.3300,196.0000,fee schedule,$22.21 from Fee Schedule BCFSG for Rev 940 Proc 96523 * Qty 1 = $22.21 at 445% = $98.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,BLUE CROSS,BLUE CROSS S NETWORK,98.83,,,,,,,21.3300,196.0000,fee schedule,$22.21 from Fee Schedule BCFSG for Rev 940 Proc 96523 * Qty 1 = $22.21 at 445% = $98.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,BLUE CROSS,TENNCARE BLUE CARE,25.01,,,,,,,21.3300,196.0000,fee schedule,$21.56 from Fee Schedule TC_24 for Rev 940 Proc 96523 * Qty 1 = $21.56 at 116% = $25.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,BLUE CROSS,TENNCARE BLUE SELECT,25.01,,,,,,,21.3300,196.0000,fee schedule,$21.56 from Fee Schedule TC_24 for Rev 940 Proc 96523 * Qty 1 = $21.56 at 116% = $25.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,CIGNA HEALTHCARE,CIGNA HMO,81.73,,,,,,,21.3300,196.0000,percent of total billed charges,41.7% of $196.00 in Billed Charges for Rev 940 Proc 96523 = $81.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,90.94,,,,,,,21.3300,196.0000,percent of total billed charges,46.4% of $196.00 in Billed Charges for Rev 940 Proc 96523 = $90.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,56.20,,,,,,,21.3300,196.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,81.73,,,,,,,21.3300,196.0000,percent of total billed charges,41.7% of $196.00 in Billed Charges for Rev 940 Proc 96523 = $81.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,CIGNA HEALTHCARE,CIGNA PPO,81.73,,,,,,,21.3300,196.0000,percent of total billed charges,41.7% of $196.00 in Billed Charges for Rev 940 Proc 96523 = $81.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,56.20,,,,,,,21.3300,196.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,176.40,,,,,,,21.3300,196.0000,percent of total billed charges,90% of $196.00 in Billed Charges for Rev 940 Proc 96523 = $176.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,HUMANA,HUMANA MEDICARE,53.52,,,,,,,21.3300,196.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,53.52,,,,,,,21.3300,196.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,MEDCOST,MEDCOST VHN,93.28,,,,,,,21.3300,196.0000,percent of total billed charges,47.59% of $196.00 in Billed Charges for Rev 940 Proc 96523 = $93.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,74.67,,,,,,,21.3300,196.0000,fee schedule,APG 00109 Proc 96523 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 105% = $74.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,56.20,,,,,,,21.3300,196.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,56.20,,,,,,,21.3300,196.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,NHC ADVANTAGE,NHC ADVANTAGE,56.20,,,,,,,21.3300,196.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,73.31,,,,,,,21.3300,196.0000,fee schedule,APG 00109 Proc 96523 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 103.1% = $73.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,SENTARA HEALTH,SENTARA HEALTH,50.59,,,,,,,21.3300,196.0000,percent of total billed charges,25.81% of $196.00 in Billed Charges for Rev 940 Proc 96523 = $50.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,SENTARA HEALTH,SENTARA MEDICARE,53.52,,,,,,,21.3300,196.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",196.00,,,,,,,21.3300,196.0000,percent of total billed charges,100% of $196.00 in Billed Charges for Rev 940 Proc 96523 = $196.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,21.33,,,,,,,21.3300,196.0000,fee schedule,$42.66 from Fee Schedule TCUHC24 for Rev 940 Proc 96523 * Qty 1 = $42.66 at 50% = $21.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,196.00,,,,,,,21.3300,196.0000,other,"Rev 940 Proc 96523 1 Visit at $1,154.00 per Visit = $1,154.00 (Service Line reduced to $196.00, claim capped at $196.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,196.00,,,,,,,21.3300,196.0000,other,"Rev 940 Proc 96523 1 Visit at $1,104.00 per Visit = $1,104.00 (Service Line reduced to $196.00, claim capped at $196.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,196.00,,,,,,,21.3300,196.0000,other,"Rev 940 Proc 96523 1 Visit at $2,426.00 per Visit = $2,426.00 (Service Line reduced to $196.00, claim capped at $196.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,73.24,,,,,,,21.3300,196.0000,fee schedule,APG 00109 Proc 96523 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,53.52,,,,,,,21.3300,196.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,53.52,,,,,,,21.3300,196.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,WELLCARE,WELLCARE MEDICAID,196.00,,,,,,,21.3300,196.0000,percent of total billed charges,100% of $196.00 in Billed Charges for Rev 940 Proc 96523 = $196.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IRRIGATE IMP VAD DRUG DELIVERY,96523,CPT,940,RC,94000023,CDM,,,,both,,,196.0000,29.4000,WELLCARE,WELLCARE MEDICARE,56.73,,,,,,,21.3300,196.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA,187.45,,,,,,,43.0000,439.0000,percent of total billed charges,42.7% of $439.00 in Billed Charges for Rev 420 Proc 29584 = $187.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,106.23,,,,,,,43.0000,439.0000,fee schedule,"APG 00040 Proc 29584 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 104% = $106.23. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,147.43,,,,,,,43.0000,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA HEALTHCARE MEDICARE,147.43,,,,,,,43.0000,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,147.43,,,,,,,43.0000,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,AMBETTER,AMBETTER,321.40,,,,,,,43.0000,439.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,153.33,,,,,,,43.0000,439.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM EXCHANGE,362.98,,,,,,,43.0000,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,105.21,,,,,,,43.0000,439.0000,fee schedule,"APG 00040 Proc 29584 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM HMO,385.65,,,,,,,43.0000,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,151.86,,,,,,,43.0000,439.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",439.00,,,,,,,43.0000,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,116.00,,,,,,,43.0000,439.0000,other,Rev 420 Proc 29584 1 Visit at $116.00 per Visit = $116.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS E NETWORK,282.70,,,,,,,43.0000,439.0000,fee schedule,$64.84 from Fee Schedule BCFSG for Rev 420 Proc 29584 * Qty 1 = $64.84 at 436% = $282.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS MEDICARE,153.33,,,,,,,43.0000,439.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS P NETWORK,288.54,,,,,,,43.0000,439.0000,fee schedule,$64.84 from Fee Schedule BCFSG for Rev 420 Proc 29584 * Qty 1 = $64.84 at 445% = $288.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS S NETWORK,288.54,,,,,,,43.0000,439.0000,fee schedule,$64.84 from Fee Schedule BCFSG for Rev 420 Proc 29584 * Qty 1 = $64.84 at 445% = $288.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA HMO,183.06,,,,,,,43.0000,439.0000,percent of total billed charges,41.7% of $439.00 in Billed Charges for Rev 420 Proc 29584 = $183.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,203.70,,,,,,,43.0000,439.0000,percent of total billed charges,46.4% of $439.00 in Billed Charges for Rev 420 Proc 29584 = $203.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,154.80,,,,,,,43.0000,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,183.06,,,,,,,43.0000,439.0000,percent of total billed charges,41.7% of $439.00 in Billed Charges for Rev 420 Proc 29584 = $183.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA PPO,183.06,,,,,,,43.0000,439.0000,percent of total billed charges,41.7% of $439.00 in Billed Charges for Rev 420 Proc 29584 = $183.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,154.80,,,,,,,43.0000,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,395.10,,,,,,,43.0000,439.0000,percent of total billed charges,90% of $439.00 in Billed Charges for Rev 420 Proc 29584 = $395.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,HUMANA,HUMANA MEDICARE,147.43,,,,,,,43.0000,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,147.43,,,,,,,43.0000,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,MEDCOST,MEDCOST VHN,208.92,,,,,,,43.0000,439.0000,percent of total billed charges,47.59% of $439.00 in Billed Charges for Rev 420 Proc 29584 = $208.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,107.26,,,,,,,43.0000,439.0000,fee schedule,"APG 00040 Proc 29584 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 100% = $102.15... $102.15 at 105% = $107.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,154.80,,,,,,,43.0000,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,154.80,,,,,,,43.0000,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,NHC ADVANTAGE,NHC ADVANTAGE,154.80,,,,,,,43.0000,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,105.32,,,,,,,43.0000,439.0000,fee schedule,"APG 00040 Proc 29584 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 100% = $102.15... $102.15 at 103.1% = $105.32 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,SENTARA HEALTH,SENTARA HEALTH,113.31,,,,,,,43.0000,439.0000,percent of total billed charges,25.81% of $439.00 in Billed Charges for Rev 420 Proc 29584 = $113.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,SENTARA HEALTH,SENTARA MEDICARE,147.43,,,,,,,43.0000,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",439.00,,,,,,,43.0000,439.0000,percent of total billed charges,100% of $439.00 in Billed Charges for Rev 420 Proc 29584 = $439.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,43.00,,,,,,,43.0000,439.0000,other,Rev 420 Proc 29584 1 Visit at $43.00 per Visit = $43.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,257.00,,,,,,,43.0000,439.0000,other,Rev 420 Proc 29584 1 Visit at $257.00 per Visit = $257.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,245.00,,,,,,,43.0000,439.0000,other,Rev 420 Proc 29584 1 Visit at $245.00 per Visit = $245.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,403.00,,,,,,,43.0000,439.0000,other,Rev 420 Proc 29584 1 Visit at $403.00 per Visit = $403.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,105.21,,,,,,,43.0000,439.0000,fee schedule,"APG 00040 Proc 29584 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $102.15 at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,147.43,,,,,,,43.0000,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,147.43,,,,,,,43.0000,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,WELLCARE,WELLCARE MEDICAID,439.00,,,,,,,43.0000,439.0000,percent of total billed charges,100% of $439.00 in Billed Charges for Rev 420 Proc 29584 = $439.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY MULTLAY COMPRS ARM/HND,29584,CPT,420,RC,42000016,CDM,,,,both,,,439.0000,65.8500,WELLCARE,WELLCARE MEDICARE,156.28,,,,,,,43.0000,439.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,AETNA,AETNA,157.56,,,,,,,23.5500,553.1900,percent of total billed charges,42.7% of $369.00 in Billed Charges for Rev 510 Proc 29700 = $157.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,283.21,,,,,,,23.5500,553.1900,fee schedule,"APG 00039 Proc 29700 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 104% = $283.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,253.76,,,,,,,23.5500,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,AETNA,AETNA HEALTHCARE MEDICARE,253.76,,,,,,,23.5500,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,253.76,,,,,,,23.5500,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,AMBETTER,AMBETTER,553.19,,,,,,,23.5500,553.1900,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,263.91,,,,,,,23.5500,553.1900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,BLUE CROSS,ANTHEM EXCHANGE,369.00,,,,,,,23.5500,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,280.48,,,,,,,23.5500,553.1900,fee schedule,"APG 00039 Proc 29700 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,BLUE CROSS,ANTHEM HMO,369.00,,,,,,,23.5500,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,261.37,,,,,,,23.5500,553.1900,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",369.00,,,,,,,23.5500,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,26.11,,,,,,,23.5500,553.1900,fee schedule,$26.11 from Fee Schedule BLDTM_23 for Rev 510 Proc 29700 * Qty 1 = $26.11 at 100% = $26.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,BLUE CROSS,BLUE CROSS MEDICARE,263.91,,,,,,,23.5500,553.1900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,BLUE CROSS,TENNCARE BLUE CARE,23.55,,,,,,,23.5500,553.1900,fee schedule,$20.30 from Fee Schedule TC_24 for Rev 510 Proc 29700 * Qty 1 = $20.30 at 116% = $23.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,BLUE CROSS,TENNCARE BLUE SELECT,23.55,,,,,,,23.5500,553.1900,fee schedule,$20.30 from Fee Schedule TC_24 for Rev 510 Proc 29700 * Qty 1 = $20.30 at 116% = $23.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,CIGNA HEALTHCARE,CIGNA HMO,153.87,,,,,,,23.5500,553.1900,percent of total billed charges,41.7% of $369.00 in Billed Charges for Rev 510 Proc 29700 = $153.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,171.22,,,,,,,23.5500,553.1900,percent of total billed charges,46.4% of $369.00 in Billed Charges for Rev 510 Proc 29700 = $171.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,266.45,,,,,,,23.5500,553.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,153.87,,,,,,,23.5500,553.1900,percent of total billed charges,41.7% of $369.00 in Billed Charges for Rev 510 Proc 29700 = $153.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,CIGNA HEALTHCARE,CIGNA PPO,153.87,,,,,,,23.5500,553.1900,percent of total billed charges,41.7% of $369.00 in Billed Charges for Rev 510 Proc 29700 = $153.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,266.45,,,,,,,23.5500,553.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,332.10,,,,,,,23.5500,553.1900,percent of total billed charges,90% of $369.00 in Billed Charges for Rev 510 Proc 29700 = $332.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,HUMANA,HUMANA MEDICARE,253.76,,,,,,,23.5500,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,253.76,,,,,,,23.5500,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,MEDCOST,MEDCOST VHN,175.61,,,,,,,23.5500,553.1900,percent of total billed charges,47.59% of $369.00 in Billed Charges for Rev 510 Proc 29700 = $175.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,285.93,,,,,,,23.5500,553.1900,fee schedule,"APG 00039 Proc 29700 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 105% = $285.93 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,266.45,,,,,,,23.5500,553.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,266.45,,,,,,,23.5500,553.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,NHC ADVANTAGE,NHC ADVANTAGE,266.45,,,,,,,23.5500,553.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,280.75,,,,,,,23.5500,553.1900,fee schedule,"APG 00039 Proc 29700 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 103.1% = $280.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,SENTARA HEALTH,SENTARA HEALTH,95.24,,,,,,,23.5500,553.1900,percent of total billed charges,25.81% of $369.00 in Billed Charges for Rev 510 Proc 29700 = $95.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,SENTARA HEALTH,SENTARA MEDICARE,253.76,,,,,,,23.5500,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",369.00,,,,,,,23.5500,553.1900,percent of total billed charges,100% of $369.00 in Billed Charges for Rev 510 Proc 29700 = $369.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,63.94,,,,,,,23.5500,553.1900,fee schedule,$127.87 from Fee Schedule TCUHC24 for Rev 510 Proc 29700 * Qty 1 = $127.87 at 50% = $63.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,119.19,,,,,,,23.5500,553.1900,other,32.3% of $369.00 in Billed Charges for Rev 510 Proc 29700 = $119.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,113.28,,,,,,,23.5500,553.1900,other,30.7% of $369.00 in Billed Charges for Rev 510 Proc 29700 = $113.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,119.19,,,,,,,23.5500,553.1900,percent of total billed charges,32.3% of $369.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,280.48,,,,,,,23.5500,553.1900,fee schedule,"APG 00039 Proc 29700 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,253.76,,,,,,,23.5500,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,253.76,,,,,,,23.5500,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,WELLCARE,WELLCARE MEDICAID,369.00,,,,,,,23.5500,553.1900,percent of total billed charges,100% of $369.00 in Billed Charges for Rev 510 Proc 29700 = $369.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC REMOV/BIVALV GAUNTLT/BOOT CAST,29700,CPT,510,RC,51000068,CDM,,,,both,,,369.0000,55.3500,WELLCARE,WELLCARE MEDICARE,268.98,,,,,,,23.5500,553.1900,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,AETNA,AETNA,169.09,,,,,,,28.2500,396.0000,percent of total billed charges,42.7% of $396.00 in Billed Charges for Rev 450 Proc 30300 = $169.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,265.28,,,,,,,28.2500,396.0000,fee schedule,APG 00249 Proc 30300 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment) at 104% = $265.28. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,120.71,,,,,,,28.2500,396.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,AETNA,AETNA HEALTHCARE MEDICARE,120.71,,,,,,,28.2500,396.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,120.71,,,,,,,28.2500,396.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,AMBETTER,AMBETTER,263.15,,,,,,,28.2500,396.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,125.54,,,,,,,28.2500,396.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,BLUE CROSS,ANTHEM EXCHANGE,297.21,,,,,,,28.2500,396.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,262.73,,,,,,,28.2500,396.0000,fee schedule,APG 00249 Proc 30300 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment) at 103% = $262.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,BLUE CROSS,ANTHEM HMO,315.76,,,,,,,28.2500,396.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,124.33,,,,,,,28.2500,396.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",371.47,,,,,,,28.2500,396.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,51.71,,,,,,,28.2500,396.0000,fee schedule,$51.71 from Fee Schedule BLDTM_23 for Rev 450 Proc 30300 * Qty 1 = $51.71 at 100% = $51.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,BLUE CROSS,BLUE CROSS MEDICARE,125.54,,,,,,,28.2500,396.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,BLUE CROSS,TENNCARE BLUE CARE,28.25,,,,,,,28.2500,396.0000,fee schedule,$24.35 from Fee Schedule TC_24 for Rev 450 Proc 30300 * Qty 1 = $24.35 at 116% = $28.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,BLUE CROSS,TENNCARE BLUE SELECT,28.25,,,,,,,28.2500,396.0000,fee schedule,$24.35 from Fee Schedule TC_24 for Rev 450 Proc 30300 * Qty 1 = $24.35 at 116% = $28.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,126.75,,,,,,,28.2500,396.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,126.75,,,,,,,28.2500,396.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,356.40,,,,,,,28.2500,396.0000,percent of total billed charges,90% of $396.00 in Billed Charges for Rev 450 Proc 30300 = $356.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,HUMANA,HUMANA MEDICARE,120.71,,,,,,,28.2500,396.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,120.71,,,,,,,28.2500,396.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,MEDCOST,MEDCOST VHN,188.46,,,,,,,28.2500,396.0000,percent of total billed charges,47.59% of $396.00 in Billed Charges for Rev 450 Proc 30300 = $188.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,267.83,,,,,,,28.2500,396.0000,fee schedule,APG 00249 Proc 30300 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment) at 100% = $255.08... $255.08 at 105% = $267.83 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,126.75,,,,,,,28.2500,396.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,126.75,,,,,,,28.2500,396.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,NHC ADVANTAGE,NHC ADVANTAGE,126.75,,,,,,,28.2500,396.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,262.99,,,,,,,28.2500,396.0000,fee schedule,APG 00249 Proc 30300 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment) at 100% = $255.08... $255.08 at 103.1% = $262.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,SENTARA HEALTH,SENTARA HEALTH,102.21,,,,,,,28.2500,396.0000,percent of total billed charges,25.81% of $396.00 in Billed Charges for Rev 450 Proc 30300 = $102.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,SENTARA HEALTH,SENTARA MEDICARE,120.71,,,,,,,28.2500,396.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",396.00,,,,,,,28.2500,396.0000,percent of total billed charges,100% of $396.00 in Billed Charges for Rev 450 Proc 30300 = $396.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,28.2500,396.0000,case rate,Rev 450 Proc 30300 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,396.00,,,,,,,28.2500,396.0000,case rate,"Rev 450 Proc 30300 at Case Rate $491.00 (Service Line reduced to $396.00, claim capped at $396.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,396.00,,,,,,,28.2500,396.0000,case rate,"Rev 450 Proc 30300 at Case Rate $471.00 (Service Line reduced to $396.00, claim capped at $396.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,396.00,,,,,,,28.2500,396.0000,case rate,"Rev 450 Proc 30300 at Case Rate $847.00 (Service Line reduced to $396.00, claim capped at $396.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,262.73,,,,,,,28.2500,396.0000,fee schedule,APG 00249 Proc 30300 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment) at 103% = $262.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,120.71,,,,,,,28.2500,396.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,120.71,,,,,,,28.2500,396.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,WELLCARE,WELLCARE MEDICAID,396.00,,,,,,,28.2500,396.0000,percent of total billed charges,100% of $396.00 in Billed Charges for Rev 450 Proc 30300 = $396.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL FB INSTRANASAL,30300,CPT,450,RC,45000212,CDM,,,,both,,,396.0000,59.4000,WELLCARE,WELLCARE MEDICARE,127.95,,,,,,,28.2500,396.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS LATE CHIILDHOOD NEW AGE 5-11 YRS,99383,CPT,510,RC,51000171,CDM,,,,both,,,405.0000,60.7500,AETNA,AETNA,172.94,,,,,,,41.8700,405.0000,percent of total billed charges,42.7% of $405.00 in Billed Charges for Rev 510 Proc 99383 = $172.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS LATE CHIILDHOOD NEW AGE 5-11 YRS,99383,CPT,510,RC,51000171,CDM,,,,both,,,405.0000,60.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,69.79,,,,,,,41.8700,405.0000,fee schedule,$69.79 from Fee Schedule BLDTM_23 for Rev 510 Proc 99383 * Qty 1 = $69.79 at 100% = $69.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS LATE CHIILDHOOD NEW AGE 5-11 YRS,99383,CPT,510,RC,51000171,CDM,,,,both,,,405.0000,60.7500,BLUE CROSS,TENNCARE BLUE CARE,44.15,,,,,,,41.8700,405.0000,fee schedule,$38.06 from Fee Schedule TC_24 for Rev 510 Proc 99383 * Qty 1 = $38.06 at 116% = $44.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS LATE CHIILDHOOD NEW AGE 5-11 YRS,99383,CPT,510,RC,51000171,CDM,,,,both,,,405.0000,60.7500,BLUE CROSS,TENNCARE BLUE SELECT,44.15,,,,,,,41.8700,405.0000,fee schedule,$38.06 from Fee Schedule TC_24 for Rev 510 Proc 99383 * Qty 1 = $38.06 at 116% = $44.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS LATE CHIILDHOOD NEW AGE 5-11 YRS,99383,CPT,510,RC,51000171,CDM,,,,both,,,405.0000,60.7500,CIGNA HEALTHCARE,CIGNA HMO,168.89,,,,,,,41.8700,405.0000,percent of total billed charges,41.7% of $405.00 in Billed Charges for Rev 510 Proc 99383 = $168.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS LATE CHIILDHOOD NEW AGE 5-11 YRS,99383,CPT,510,RC,51000171,CDM,,,,both,,,405.0000,60.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,187.92,,,,,,,41.8700,405.0000,percent of total billed charges,46.4% of $405.00 in Billed Charges for Rev 510 Proc 99383 = $187.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS LATE CHIILDHOOD NEW AGE 5-11 YRS,99383,CPT,510,RC,51000171,CDM,,,,both,,,405.0000,60.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,168.89,,,,,,,41.8700,405.0000,percent of total billed charges,41.7% of $405.00 in Billed Charges for Rev 510 Proc 99383 = $168.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS LATE CHIILDHOOD NEW AGE 5-11 YRS,99383,CPT,510,RC,51000171,CDM,,,,both,,,405.0000,60.7500,CIGNA HEALTHCARE,CIGNA PPO,168.89,,,,,,,41.8700,405.0000,percent of total billed charges,41.7% of $405.00 in Billed Charges for Rev 510 Proc 99383 = $168.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS LATE CHIILDHOOD NEW AGE 5-11 YRS,99383,CPT,510,RC,51000171,CDM,,,,both,,,405.0000,60.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,364.50,,,,,,,41.8700,405.0000,percent of total billed charges,90% of $405.00 in Billed Charges for Rev 510 Proc 99383 = $364.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS LATE CHIILDHOOD NEW AGE 5-11 YRS,99383,CPT,510,RC,51000171,CDM,,,,both,,,405.0000,60.7500,MEDCOST,MEDCOST VHN,192.74,,,,,,,41.8700,405.0000,percent of total billed charges,47.59% of $405.00 in Billed Charges for Rev 510 Proc 99383 = $192.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS LATE CHIILDHOOD NEW AGE 5-11 YRS,99383,CPT,510,RC,51000171,CDM,,,,both,,,405.0000,60.7500,SENTARA HEALTH,SENTARA HEALTH,104.53,,,,,,,41.8700,405.0000,percent of total billed charges,25.81% of $405.00 in Billed Charges for Rev 510 Proc 99383 = $104.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS LATE CHIILDHOOD NEW AGE 5-11 YRS,99383,CPT,510,RC,51000171,CDM,,,,both,,,405.0000,60.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",405.00,,,,,,,41.8700,405.0000,percent of total billed charges,100% of $405.00 in Billed Charges for Rev 510 Proc 99383 = $405.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS LATE CHIILDHOOD NEW AGE 5-11 YRS,99383,CPT,510,RC,51000171,CDM,,,,both,,,405.0000,60.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,41.87,,,,,,,41.8700,405.0000,fee schedule,$83.73 from Fee Schedule TCUHC24 for Rev 510 Proc 99383 * Qty 1 = $83.73 at 50% = $41.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS LATE CHIILDHOOD NEW AGE 5-11 YRS,99383,CPT,510,RC,51000171,CDM,,,,both,,,405.0000,60.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,130.82,,,,,,,41.8700,405.0000,other,32.3% of $405.00 in Billed Charges for Rev 510 Proc 99383 = $130.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS LATE CHIILDHOOD NEW AGE 5-11 YRS,99383,CPT,510,RC,51000171,CDM,,,,both,,,405.0000,60.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,124.34,,,,,,,41.8700,405.0000,other,30.7% of $405.00 in Billed Charges for Rev 510 Proc 99383 = $124.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS LATE CHIILDHOOD NEW AGE 5-11 YRS,99383,CPT,510,RC,51000171,CDM,,,,both,,,405.0000,60.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,130.82,,,,,,,41.8700,405.0000,percent of total billed charges,32.3% of $405.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS LATE CHIILDHOOD NEW AGE 5-11 YRS,99383,CPT,510,RC,51000171,CDM,,,,both,,,405.0000,60.7500,WELLCARE,WELLCARE MEDICAID,405.00,,,,,,,41.8700,405.0000,percent of total billed charges,100% of $405.00 in Billed Charges for Rev 510 Proc 99383 = $405.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - ADOLESCENT 12-17YRS,99384,CPT,510,RC,51000047,CDM,,,,both,,,444.0000,66.6000,AETNA,AETNA,189.59,,,,,,,49.3600,444.0000,percent of total billed charges,42.7% of $444.00 in Billed Charges for Rev 510 Proc 99384 = $189.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - ADOLESCENT 12-17YRS,99384,CPT,510,RC,51000047,CDM,,,,both,,,444.0000,66.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,74.45,,,,,,,49.3600,444.0000,fee schedule,$74.45 from Fee Schedule BLDTM_23 for Rev 510 Proc 99384 * Qty 1 = $74.45 at 100% = $74.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS - ADOLESCENT 12-17YRS,99384,CPT,510,RC,51000047,CDM,,,,both,,,444.0000,66.6000,BLUE CROSS,TENNCARE BLUE CARE,53.36,,,,,,,49.3600,444.0000,fee schedule,$46.00 from Fee Schedule TC_24 for Rev 510 Proc 99384 * Qty 1 = $46.00 at 116% = $53.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS - ADOLESCENT 12-17YRS,99384,CPT,510,RC,51000047,CDM,,,,both,,,444.0000,66.6000,BLUE CROSS,TENNCARE BLUE SELECT,53.36,,,,,,,49.3600,444.0000,fee schedule,$46.00 from Fee Schedule TC_24 for Rev 510 Proc 99384 * Qty 1 = $46.00 at 116% = $53.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS - ADOLESCENT 12-17YRS,99384,CPT,510,RC,51000047,CDM,,,,both,,,444.0000,66.6000,CIGNA HEALTHCARE,CIGNA HMO,185.15,,,,,,,49.3600,444.0000,percent of total billed charges,41.7% of $444.00 in Billed Charges for Rev 510 Proc 99384 = $185.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - ADOLESCENT 12-17YRS,99384,CPT,510,RC,51000047,CDM,,,,both,,,444.0000,66.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,206.02,,,,,,,49.3600,444.0000,percent of total billed charges,46.4% of $444.00 in Billed Charges for Rev 510 Proc 99384 = $206.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - ADOLESCENT 12-17YRS,99384,CPT,510,RC,51000047,CDM,,,,both,,,444.0000,66.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,185.15,,,,,,,49.3600,444.0000,percent of total billed charges,41.7% of $444.00 in Billed Charges for Rev 510 Proc 99384 = $185.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - ADOLESCENT 12-17YRS,99384,CPT,510,RC,51000047,CDM,,,,both,,,444.0000,66.6000,CIGNA HEALTHCARE,CIGNA PPO,185.15,,,,,,,49.3600,444.0000,percent of total billed charges,41.7% of $444.00 in Billed Charges for Rev 510 Proc 99384 = $185.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - ADOLESCENT 12-17YRS,99384,CPT,510,RC,51000047,CDM,,,,both,,,444.0000,66.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,399.60,,,,,,,49.3600,444.0000,percent of total billed charges,90% of $444.00 in Billed Charges for Rev 510 Proc 99384 = $399.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - ADOLESCENT 12-17YRS,99384,CPT,510,RC,51000047,CDM,,,,both,,,444.0000,66.6000,MEDCOST,MEDCOST VHN,211.30,,,,,,,49.3600,444.0000,percent of total billed charges,47.59% of $444.00 in Billed Charges for Rev 510 Proc 99384 = $211.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - ADOLESCENT 12-17YRS,99384,CPT,510,RC,51000047,CDM,,,,both,,,444.0000,66.6000,SENTARA HEALTH,SENTARA HEALTH,114.60,,,,,,,49.3600,444.0000,percent of total billed charges,25.81% of $444.00 in Billed Charges for Rev 510 Proc 99384 = $114.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - ADOLESCENT 12-17YRS,99384,CPT,510,RC,51000047,CDM,,,,both,,,444.0000,66.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",444.00,,,,,,,49.3600,444.0000,percent of total billed charges,100% of $444.00 in Billed Charges for Rev 510 Proc 99384 = $444.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - ADOLESCENT 12-17YRS,99384,CPT,510,RC,51000047,CDM,,,,both,,,444.0000,66.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,49.36,,,,,,,49.3600,444.0000,fee schedule,$98.71 from Fee Schedule TCUHC24 for Rev 510 Proc 99384 * Qty 1 = $98.71 at 50% = $49.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS - ADOLESCENT 12-17YRS,99384,CPT,510,RC,51000047,CDM,,,,both,,,444.0000,66.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,143.41,,,,,,,49.3600,444.0000,other,32.3% of $444.00 in Billed Charges for Rev 510 Proc 99384 = $143.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS - ADOLESCENT 12-17YRS,99384,CPT,510,RC,51000047,CDM,,,,both,,,444.0000,66.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,136.31,,,,,,,49.3600,444.0000,other,30.7% of $444.00 in Billed Charges for Rev 510 Proc 99384 = $136.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS - ADOLESCENT 12-17YRS,99384,CPT,510,RC,51000047,CDM,,,,both,,,444.0000,66.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,143.41,,,,,,,49.3600,444.0000,percent of total billed charges,32.3% of $444.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - ADOLESCENT 12-17YRS,99384,CPT,510,RC,51000047,CDM,,,,both,,,444.0000,66.6000,WELLCARE,WELLCARE MEDICAID,444.00,,,,,,,49.3600,444.0000,percent of total billed charges,100% of $444.00 in Billed Charges for Rev 510 Proc 99384 = $444.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 40-64YRS,99386,CPT,510,RC,51000049,CDM,,,,both,,,488.0000,73.2000,AETNA,AETNA,208.38,,,,,,,57.7000,488.0000,percent of total billed charges,42.7% of $488.00 in Billed Charges for Rev 510 Proc 99386 = $208.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 40-64YRS,99386,CPT,510,RC,51000049,CDM,,,,both,,,488.0000,73.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,110.11,,,,,,,57.7000,488.0000,fee schedule,$110.11 from Fee Schedule BLDTM_23 for Rev 510 Proc 99386 * Qty 1 = $110.11 at 100% = $110.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS - 40-64YRS,99386,CPT,510,RC,51000049,CDM,,,,both,,,488.0000,73.2000,BLUE CROSS,TENNCARE BLUE CARE,64.87,,,,,,,57.7000,488.0000,fee schedule,$55.92 from Fee Schedule TC_24 for Rev 510 Proc 99386 * Qty 1 = $55.92 at 116% = $64.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS - 40-64YRS,99386,CPT,510,RC,51000049,CDM,,,,both,,,488.0000,73.2000,BLUE CROSS,TENNCARE BLUE SELECT,64.87,,,,,,,57.7000,488.0000,fee schedule,$55.92 from Fee Schedule TC_24 for Rev 510 Proc 99386 * Qty 1 = $55.92 at 116% = $64.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS - 40-64YRS,99386,CPT,510,RC,51000049,CDM,,,,both,,,488.0000,73.2000,CIGNA HEALTHCARE,CIGNA HMO,203.50,,,,,,,57.7000,488.0000,percent of total billed charges,41.7% of $488.00 in Billed Charges for Rev 510 Proc 99386 = $203.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 40-64YRS,99386,CPT,510,RC,51000049,CDM,,,,both,,,488.0000,73.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,226.43,,,,,,,57.7000,488.0000,percent of total billed charges,46.4% of $488.00 in Billed Charges for Rev 510 Proc 99386 = $226.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 40-64YRS,99386,CPT,510,RC,51000049,CDM,,,,both,,,488.0000,73.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,203.50,,,,,,,57.7000,488.0000,percent of total billed charges,41.7% of $488.00 in Billed Charges for Rev 510 Proc 99386 = $203.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 40-64YRS,99386,CPT,510,RC,51000049,CDM,,,,both,,,488.0000,73.2000,CIGNA HEALTHCARE,CIGNA PPO,203.50,,,,,,,57.7000,488.0000,percent of total billed charges,41.7% of $488.00 in Billed Charges for Rev 510 Proc 99386 = $203.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 40-64YRS,99386,CPT,510,RC,51000049,CDM,,,,both,,,488.0000,73.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,439.20,,,,,,,57.7000,488.0000,percent of total billed charges,90% of $488.00 in Billed Charges for Rev 510 Proc 99386 = $439.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 40-64YRS,99386,CPT,510,RC,51000049,CDM,,,,both,,,488.0000,73.2000,MEDCOST,MEDCOST VHN,232.24,,,,,,,57.7000,488.0000,percent of total billed charges,47.59% of $488.00 in Billed Charges for Rev 510 Proc 99386 = $232.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 40-64YRS,99386,CPT,510,RC,51000049,CDM,,,,both,,,488.0000,73.2000,SENTARA HEALTH,SENTARA HEALTH,125.95,,,,,,,57.7000,488.0000,percent of total billed charges,25.81% of $488.00 in Billed Charges for Rev 510 Proc 99386 = $125.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 40-64YRS,99386,CPT,510,RC,51000049,CDM,,,,both,,,488.0000,73.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",488.00,,,,,,,57.7000,488.0000,percent of total billed charges,100% of $488.00 in Billed Charges for Rev 510 Proc 99386 = $488.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 40-64YRS,99386,CPT,510,RC,51000049,CDM,,,,both,,,488.0000,73.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,57.70,,,,,,,57.7000,488.0000,fee schedule,$115.39 from Fee Schedule TCUHC24 for Rev 510 Proc 99386 * Qty 1 = $115.39 at 50% = $57.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS - 40-64YRS,99386,CPT,510,RC,51000049,CDM,,,,both,,,488.0000,73.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,157.62,,,,,,,57.7000,488.0000,other,32.3% of $488.00 in Billed Charges for Rev 510 Proc 99386 = $157.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS - 40-64YRS,99386,CPT,510,RC,51000049,CDM,,,,both,,,488.0000,73.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,149.82,,,,,,,57.7000,488.0000,other,30.7% of $488.00 in Billed Charges for Rev 510 Proc 99386 = $149.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS - 40-64YRS,99386,CPT,510,RC,51000049,CDM,,,,both,,,488.0000,73.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,157.62,,,,,,,57.7000,488.0000,percent of total billed charges,32.3% of $488.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 40-64YRS,99386,CPT,510,RC,51000049,CDM,,,,both,,,488.0000,73.2000,WELLCARE,WELLCARE MEDICAID,488.00,,,,,,,57.7000,488.0000,percent of total billed charges,100% of $488.00 in Billed Charges for Rev 510 Proc 99386 = $488.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 65+YRS,99387,CPT,510,RC,51000050,CDM,,,,both,,,510.0000,76.5000,AETNA,AETNA,217.77,,,,,,,62.2900,510.0000,percent of total billed charges,42.7% of $510.00 in Billed Charges for Rev 510 Proc 99387 = $217.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 65+YRS,99387,CPT,510,RC,51000050,CDM,,,,both,,,510.0000,76.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,124.07,,,,,,,62.2900,510.0000,fee schedule,$124.07 from Fee Schedule BLDTM_23 for Rev 510 Proc 99387 * Qty 1 = $124.07 at 100% = $124.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS - 65+YRS,99387,CPT,510,RC,51000050,CDM,,,,both,,,510.0000,76.5000,BLUE CROSS,TENNCARE BLUE CARE,80.97,,,,,,,62.2900,510.0000,fee schedule,$69.80 from Fee Schedule TC_24 for Rev 510 Proc 99387 * Qty 1 = $69.80 at 116% = $80.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS - 65+YRS,99387,CPT,510,RC,51000050,CDM,,,,both,,,510.0000,76.5000,BLUE CROSS,TENNCARE BLUE SELECT,80.97,,,,,,,62.2900,510.0000,fee schedule,$69.80 from Fee Schedule TC_24 for Rev 510 Proc 99387 * Qty 1 = $69.80 at 116% = $80.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS - 65+YRS,99387,CPT,510,RC,51000050,CDM,,,,both,,,510.0000,76.5000,CIGNA HEALTHCARE,CIGNA HMO,212.67,,,,,,,62.2900,510.0000,percent of total billed charges,41.7% of $510.00 in Billed Charges for Rev 510 Proc 99387 = $212.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 65+YRS,99387,CPT,510,RC,51000050,CDM,,,,both,,,510.0000,76.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,236.64,,,,,,,62.2900,510.0000,percent of total billed charges,46.4% of $510.00 in Billed Charges for Rev 510 Proc 99387 = $236.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 65+YRS,99387,CPT,510,RC,51000050,CDM,,,,both,,,510.0000,76.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,212.67,,,,,,,62.2900,510.0000,percent of total billed charges,41.7% of $510.00 in Billed Charges for Rev 510 Proc 99387 = $212.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 65+YRS,99387,CPT,510,RC,51000050,CDM,,,,both,,,510.0000,76.5000,CIGNA HEALTHCARE,CIGNA PPO,212.67,,,,,,,62.2900,510.0000,percent of total billed charges,41.7% of $510.00 in Billed Charges for Rev 510 Proc 99387 = $212.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 65+YRS,99387,CPT,510,RC,51000050,CDM,,,,both,,,510.0000,76.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,459.00,,,,,,,62.2900,510.0000,percent of total billed charges,90% of $510.00 in Billed Charges for Rev 510 Proc 99387 = $459.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 65+YRS,99387,CPT,510,RC,51000050,CDM,,,,both,,,510.0000,76.5000,MEDCOST,MEDCOST VHN,242.71,,,,,,,62.2900,510.0000,percent of total billed charges,47.59% of $510.00 in Billed Charges for Rev 510 Proc 99387 = $242.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 65+YRS,99387,CPT,510,RC,51000050,CDM,,,,both,,,510.0000,76.5000,SENTARA HEALTH,SENTARA HEALTH,131.63,,,,,,,62.2900,510.0000,percent of total billed charges,25.81% of $510.00 in Billed Charges for Rev 510 Proc 99387 = $131.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 65+YRS,99387,CPT,510,RC,51000050,CDM,,,,both,,,510.0000,76.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",510.00,,,,,,,62.2900,510.0000,percent of total billed charges,100% of $510.00 in Billed Charges for Rev 510 Proc 99387 = $510.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 65+YRS,99387,CPT,510,RC,51000050,CDM,,,,both,,,510.0000,76.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,62.29,,,,,,,62.2900,510.0000,fee schedule,$124.58 from Fee Schedule TCUHC24 for Rev 510 Proc 99387 * Qty 1 = $124.58 at 50% = $62.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS - 65+YRS,99387,CPT,510,RC,51000050,CDM,,,,both,,,510.0000,76.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,164.73,,,,,,,62.2900,510.0000,other,32.3% of $510.00 in Billed Charges for Rev 510 Proc 99387 = $164.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS - 65+YRS,99387,CPT,510,RC,51000050,CDM,,,,both,,,510.0000,76.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,156.57,,,,,,,62.2900,510.0000,other,30.7% of $510.00 in Billed Charges for Rev 510 Proc 99387 = $156.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS - 65+YRS,99387,CPT,510,RC,51000050,CDM,,,,both,,,510.0000,76.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,164.73,,,,,,,62.2900,510.0000,percent of total billed charges,32.3% of $510.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 65+YRS,99387,CPT,510,RC,51000050,CDM,,,,both,,,510.0000,76.5000,WELLCARE,WELLCARE MEDICAID,510.00,,,,,,,62.2900,510.0000,percent of total billed charges,100% of $510.00 in Billed Charges for Rev 510 Proc 99387 = $510.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EARLY CHILDHOOD EST 1-4 YRS,99391,CPT,510,RC,51000173,CDM,,,,both,,,379.0000,56.8500,AETNA,AETNA,161.83,,,,,,,33.8700,379.0000,percent of total billed charges,42.7% of $379.00 in Billed Charges for Rev 510 Proc 99391 = $161.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EARLY CHILDHOOD EST 1-4 YRS,99391,CPT,510,RC,51000173,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,49.62,,,,,,,33.8700,379.0000,fee schedule,$49.62 from Fee Schedule BLDTM_23 for Rev 510 Proc 99391 * Qty 1 = $49.62 at 100% = $49.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EARLY CHILDHOOD EST 1-4 YRS,99391,CPT,510,RC,51000173,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,TENNCARE BLUE CARE,47.08,,,,,,,33.8700,379.0000,fee schedule,$40.59 from Fee Schedule TC_24 for Rev 510 Proc 99391 * Qty 1 = $40.59 at 116% = $47.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EARLY CHILDHOOD EST 1-4 YRS,99391,CPT,510,RC,51000173,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,TENNCARE BLUE SELECT,47.08,,,,,,,33.8700,379.0000,fee schedule,$40.59 from Fee Schedule TC_24 for Rev 510 Proc 99391 * Qty 1 = $40.59 at 116% = $47.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EARLY CHILDHOOD EST 1-4 YRS,99391,CPT,510,RC,51000173,CDM,,,,both,,,379.0000,56.8500,CIGNA HEALTHCARE,CIGNA HMO,158.04,,,,,,,33.8700,379.0000,percent of total billed charges,41.7% of $379.00 in Billed Charges for Rev 510 Proc 99391 = $158.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EARLY CHILDHOOD EST 1-4 YRS,99391,CPT,510,RC,51000173,CDM,,,,both,,,379.0000,56.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.86,,,,,,,33.8700,379.0000,percent of total billed charges,46.4% of $379.00 in Billed Charges for Rev 510 Proc 99391 = $175.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EARLY CHILDHOOD EST 1-4 YRS,99391,CPT,510,RC,51000173,CDM,,,,both,,,379.0000,56.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,158.04,,,,,,,33.8700,379.0000,percent of total billed charges,41.7% of $379.00 in Billed Charges for Rev 510 Proc 99391 = $158.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EARLY CHILDHOOD EST 1-4 YRS,99391,CPT,510,RC,51000173,CDM,,,,both,,,379.0000,56.8500,CIGNA HEALTHCARE,CIGNA PPO,158.04,,,,,,,33.8700,379.0000,percent of total billed charges,41.7% of $379.00 in Billed Charges for Rev 510 Proc 99391 = $158.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EARLY CHILDHOOD EST 1-4 YRS,99391,CPT,510,RC,51000173,CDM,,,,both,,,379.0000,56.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,341.10,,,,,,,33.8700,379.0000,percent of total billed charges,90% of $379.00 in Billed Charges for Rev 510 Proc 99391 = $341.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EARLY CHILDHOOD EST 1-4 YRS,99391,CPT,510,RC,51000173,CDM,,,,both,,,379.0000,56.8500,MEDCOST,MEDCOST VHN,180.37,,,,,,,33.8700,379.0000,percent of total billed charges,47.59% of $379.00 in Billed Charges for Rev 510 Proc 99391 = $180.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EARLY CHILDHOOD EST 1-4 YRS,99391,CPT,510,RC,51000173,CDM,,,,both,,,379.0000,56.8500,SENTARA HEALTH,SENTARA HEALTH,97.82,,,,,,,33.8700,379.0000,percent of total billed charges,25.81% of $379.00 in Billed Charges for Rev 510 Proc 99391 = $97.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EARLY CHILDHOOD EST 1-4 YRS,99391,CPT,510,RC,51000173,CDM,,,,both,,,379.0000,56.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",379.00,,,,,,,33.8700,379.0000,percent of total billed charges,100% of $379.00 in Billed Charges for Rev 510 Proc 99391 = $379.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EARLY CHILDHOOD EST 1-4 YRS,99391,CPT,510,RC,51000173,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,33.87,,,,,,,33.8700,379.0000,fee schedule,$67.73 from Fee Schedule TCUHC24 for Rev 510 Proc 99391 * Qty 1 = $67.73 at 50% = $33.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EARLY CHILDHOOD EST 1-4 YRS,99391,CPT,510,RC,51000173,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,122.42,,,,,,,33.8700,379.0000,other,32.3% of $379.00 in Billed Charges for Rev 510 Proc 99391 = $122.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EARLY CHILDHOOD EST 1-4 YRS,99391,CPT,510,RC,51000173,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,116.35,,,,,,,33.8700,379.0000,other,30.7% of $379.00 in Billed Charges for Rev 510 Proc 99391 = $116.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EARLY CHILDHOOD EST 1-4 YRS,99391,CPT,510,RC,51000173,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,122.42,,,,,,,33.8700,379.0000,percent of total billed charges,32.3% of $379.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EARLY CHILDHOOD EST 1-4 YRS,99391,CPT,510,RC,51000173,CDM,,,,both,,,379.0000,56.8500,WELLCARE,WELLCARE MEDICAID,379.00,,,,,,,33.8700,379.0000,percent of total billed charges,100% of $379.00 in Billed Charges for Rev 510 Proc 99391 = $379.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS INFANT EST <1 YR,99391,CPT,510,RC,51000172,CDM,,,,both,,,364.0000,54.6000,AETNA,AETNA,155.43,,,,,,,33.8700,364.0000,percent of total billed charges,42.7% of $364.00 in Billed Charges for Rev 510 Proc 99391 = $155.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS INFANT EST <1 YR,99391,CPT,510,RC,51000172,CDM,,,,both,,,364.0000,54.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,49.62,,,,,,,33.8700,364.0000,fee schedule,$49.62 from Fee Schedule BLDTM_23 for Rev 510 Proc 99391 * Qty 1 = $49.62 at 100% = $49.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS INFANT EST <1 YR,99391,CPT,510,RC,51000172,CDM,,,,both,,,364.0000,54.6000,BLUE CROSS,TENNCARE BLUE CARE,47.08,,,,,,,33.8700,364.0000,fee schedule,$40.59 from Fee Schedule TC_24 for Rev 510 Proc 99391 * Qty 1 = $40.59 at 116% = $47.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS INFANT EST <1 YR,99391,CPT,510,RC,51000172,CDM,,,,both,,,364.0000,54.6000,BLUE CROSS,TENNCARE BLUE SELECT,47.08,,,,,,,33.8700,364.0000,fee schedule,$40.59 from Fee Schedule TC_24 for Rev 510 Proc 99391 * Qty 1 = $40.59 at 116% = $47.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS INFANT EST <1 YR,99391,CPT,510,RC,51000172,CDM,,,,both,,,364.0000,54.6000,CIGNA HEALTHCARE,CIGNA HMO,151.79,,,,,,,33.8700,364.0000,percent of total billed charges,41.7% of $364.00 in Billed Charges for Rev 510 Proc 99391 = $151.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS INFANT EST <1 YR,99391,CPT,510,RC,51000172,CDM,,,,both,,,364.0000,54.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,168.90,,,,,,,33.8700,364.0000,percent of total billed charges,46.4% of $364.00 in Billed Charges for Rev 510 Proc 99391 = $168.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS INFANT EST <1 YR,99391,CPT,510,RC,51000172,CDM,,,,both,,,364.0000,54.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,151.79,,,,,,,33.8700,364.0000,percent of total billed charges,41.7% of $364.00 in Billed Charges for Rev 510 Proc 99391 = $151.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS INFANT EST <1 YR,99391,CPT,510,RC,51000172,CDM,,,,both,,,364.0000,54.6000,CIGNA HEALTHCARE,CIGNA PPO,151.79,,,,,,,33.8700,364.0000,percent of total billed charges,41.7% of $364.00 in Billed Charges for Rev 510 Proc 99391 = $151.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS INFANT EST <1 YR,99391,CPT,510,RC,51000172,CDM,,,,both,,,364.0000,54.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,327.60,,,,,,,33.8700,364.0000,percent of total billed charges,90% of $364.00 in Billed Charges for Rev 510 Proc 99391 = $327.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS INFANT EST <1 YR,99391,CPT,510,RC,51000172,CDM,,,,both,,,364.0000,54.6000,MEDCOST,MEDCOST VHN,173.23,,,,,,,33.8700,364.0000,percent of total billed charges,47.59% of $364.00 in Billed Charges for Rev 510 Proc 99391 = $173.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS INFANT EST <1 YR,99391,CPT,510,RC,51000172,CDM,,,,both,,,364.0000,54.6000,SENTARA HEALTH,SENTARA HEALTH,93.95,,,,,,,33.8700,364.0000,percent of total billed charges,25.81% of $364.00 in Billed Charges for Rev 510 Proc 99391 = $93.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS INFANT EST <1 YR,99391,CPT,510,RC,51000172,CDM,,,,both,,,364.0000,54.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",364.00,,,,,,,33.8700,364.0000,percent of total billed charges,100% of $364.00 in Billed Charges for Rev 510 Proc 99391 = $364.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS INFANT EST <1 YR,99391,CPT,510,RC,51000172,CDM,,,,both,,,364.0000,54.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,33.87,,,,,,,33.8700,364.0000,fee schedule,$67.73 from Fee Schedule TCUHC24 for Rev 510 Proc 99391 * Qty 1 = $67.73 at 50% = $33.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS INFANT EST <1 YR,99391,CPT,510,RC,51000172,CDM,,,,both,,,364.0000,54.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,117.57,,,,,,,33.8700,364.0000,other,32.3% of $364.00 in Billed Charges for Rev 510 Proc 99391 = $117.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS INFANT EST <1 YR,99391,CPT,510,RC,51000172,CDM,,,,both,,,364.0000,54.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,111.75,,,,,,,33.8700,364.0000,other,30.7% of $364.00 in Billed Charges for Rev 510 Proc 99391 = $111.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS INFANT EST <1 YR,99391,CPT,510,RC,51000172,CDM,,,,both,,,364.0000,54.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,117.57,,,,,,,33.8700,364.0000,percent of total billed charges,32.3% of $364.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS INFANT EST <1 YR,99391,CPT,510,RC,51000172,CDM,,,,both,,,364.0000,54.6000,WELLCARE,WELLCARE MEDICAID,364.00,,,,,,,33.8700,364.0000,percent of total billed charges,100% of $364.00 in Billed Charges for Rev 510 Proc 99391 = $364.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS ADOLESCENT EST 12-17 YRS,99394,CPT,510,RC,51000175,CDM,,,,both,,,405.0000,60.7500,AETNA,AETNA,172.94,,,,,,,41.8700,405.0000,percent of total billed charges,42.7% of $405.00 in Billed Charges for Rev 510 Proc 99394 = $172.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS ADOLESCENT EST 12-17 YRS,99394,CPT,510,RC,51000175,CDM,,,,both,,,405.0000,60.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,62.03,,,,,,,41.8700,405.0000,fee schedule,$62.03 from Fee Schedule BLDTM_23 for Rev 510 Proc 99394 * Qty 1 = $62.03 at 100% = $62.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS ADOLESCENT EST 12-17 YRS,99394,CPT,510,RC,51000175,CDM,,,,both,,,405.0000,60.7500,BLUE CROSS,TENNCARE BLUE CARE,44.21,,,,,,,41.8700,405.0000,fee schedule,$38.11 from Fee Schedule TC_24 for Rev 510 Proc 99394 * Qty 1 = $38.11 at 116% = $44.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS ADOLESCENT EST 12-17 YRS,99394,CPT,510,RC,51000175,CDM,,,,both,,,405.0000,60.7500,BLUE CROSS,TENNCARE BLUE SELECT,44.21,,,,,,,41.8700,405.0000,fee schedule,$38.11 from Fee Schedule TC_24 for Rev 510 Proc 99394 * Qty 1 = $38.11 at 116% = $44.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS ADOLESCENT EST 12-17 YRS,99394,CPT,510,RC,51000175,CDM,,,,both,,,405.0000,60.7500,CIGNA HEALTHCARE,CIGNA HMO,168.89,,,,,,,41.8700,405.0000,percent of total billed charges,41.7% of $405.00 in Billed Charges for Rev 510 Proc 99394 = $168.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS ADOLESCENT EST 12-17 YRS,99394,CPT,510,RC,51000175,CDM,,,,both,,,405.0000,60.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,187.92,,,,,,,41.8700,405.0000,percent of total billed charges,46.4% of $405.00 in Billed Charges for Rev 510 Proc 99394 = $187.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS ADOLESCENT EST 12-17 YRS,99394,CPT,510,RC,51000175,CDM,,,,both,,,405.0000,60.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,168.89,,,,,,,41.8700,405.0000,percent of total billed charges,41.7% of $405.00 in Billed Charges for Rev 510 Proc 99394 = $168.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS ADOLESCENT EST 12-17 YRS,99394,CPT,510,RC,51000175,CDM,,,,both,,,405.0000,60.7500,CIGNA HEALTHCARE,CIGNA PPO,168.89,,,,,,,41.8700,405.0000,percent of total billed charges,41.7% of $405.00 in Billed Charges for Rev 510 Proc 99394 = $168.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS ADOLESCENT EST 12-17 YRS,99394,CPT,510,RC,51000175,CDM,,,,both,,,405.0000,60.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,364.50,,,,,,,41.8700,405.0000,percent of total billed charges,90% of $405.00 in Billed Charges for Rev 510 Proc 99394 = $364.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS ADOLESCENT EST 12-17 YRS,99394,CPT,510,RC,51000175,CDM,,,,both,,,405.0000,60.7500,MEDCOST,MEDCOST VHN,192.74,,,,,,,41.8700,405.0000,percent of total billed charges,47.59% of $405.00 in Billed Charges for Rev 510 Proc 99394 = $192.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS ADOLESCENT EST 12-17 YRS,99394,CPT,510,RC,51000175,CDM,,,,both,,,405.0000,60.7500,SENTARA HEALTH,SENTARA HEALTH,104.53,,,,,,,41.8700,405.0000,percent of total billed charges,25.81% of $405.00 in Billed Charges for Rev 510 Proc 99394 = $104.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS ADOLESCENT EST 12-17 YRS,99394,CPT,510,RC,51000175,CDM,,,,both,,,405.0000,60.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",405.00,,,,,,,41.8700,405.0000,percent of total billed charges,100% of $405.00 in Billed Charges for Rev 510 Proc 99394 = $405.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS ADOLESCENT EST 12-17 YRS,99394,CPT,510,RC,51000175,CDM,,,,both,,,405.0000,60.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,41.87,,,,,,,41.8700,405.0000,fee schedule,$83.73 from Fee Schedule TCUHC24 for Rev 510 Proc 99394 * Qty 1 = $83.73 at 50% = $41.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS ADOLESCENT EST 12-17 YRS,99394,CPT,510,RC,51000175,CDM,,,,both,,,405.0000,60.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,130.82,,,,,,,41.8700,405.0000,other,32.3% of $405.00 in Billed Charges for Rev 510 Proc 99394 = $130.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS ADOLESCENT EST 12-17 YRS,99394,CPT,510,RC,51000175,CDM,,,,both,,,405.0000,60.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,124.34,,,,,,,41.8700,405.0000,other,30.7% of $405.00 in Billed Charges for Rev 510 Proc 99394 = $124.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS ADOLESCENT EST 12-17 YRS,99394,CPT,510,RC,51000175,CDM,,,,both,,,405.0000,60.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,130.82,,,,,,,41.8700,405.0000,percent of total billed charges,32.3% of $405.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS ADOLESCENT EST 12-17 YRS,99394,CPT,510,RC,51000175,CDM,,,,both,,,405.0000,60.7500,WELLCARE,WELLCARE MEDICAID,405.00,,,,,,,41.8700,405.0000,percent of total billed charges,100% of $405.00 in Billed Charges for Rev 510 Proc 99394 = $405.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 18-39 YRS,99395,CPT,510,RC,51000176,CDM,,,,both,,,412.0000,61.8000,AETNA,AETNA,175.92,,,,,,,43.0600,412.0000,percent of total billed charges,42.7% of $412.00 in Billed Charges for Rev 510 Proc 99395 = $175.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 18-39 YRS,99395,CPT,510,RC,51000176,CDM,,,,both,,,412.0000,61.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,83.75,,,,,,,43.0600,412.0000,fee schedule,$83.75 from Fee Schedule BLDTM_23 for Rev 510 Proc 99395 * Qty 1 = $83.75 at 100% = $83.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EST 18-39 YRS,99395,CPT,510,RC,51000176,CDM,,,,both,,,412.0000,61.8000,BLUE CROSS,TENNCARE BLUE CARE,48.65,,,,,,,43.0600,412.0000,fee schedule,$41.94 from Fee Schedule TC_24 for Rev 510 Proc 99395 * Qty 1 = $41.94 at 116% = $48.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EST 18-39 YRS,99395,CPT,510,RC,51000176,CDM,,,,both,,,412.0000,61.8000,BLUE CROSS,TENNCARE BLUE SELECT,48.65,,,,,,,43.0600,412.0000,fee schedule,$41.94 from Fee Schedule TC_24 for Rev 510 Proc 99395 * Qty 1 = $41.94 at 116% = $48.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EST 18-39 YRS,99395,CPT,510,RC,51000176,CDM,,,,both,,,412.0000,61.8000,CIGNA HEALTHCARE,CIGNA HMO,171.80,,,,,,,43.0600,412.0000,percent of total billed charges,41.7% of $412.00 in Billed Charges for Rev 510 Proc 99395 = $171.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 18-39 YRS,99395,CPT,510,RC,51000176,CDM,,,,both,,,412.0000,61.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,191.17,,,,,,,43.0600,412.0000,percent of total billed charges,46.4% of $412.00 in Billed Charges for Rev 510 Proc 99395 = $191.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 18-39 YRS,99395,CPT,510,RC,51000176,CDM,,,,both,,,412.0000,61.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,171.80,,,,,,,43.0600,412.0000,percent of total billed charges,41.7% of $412.00 in Billed Charges for Rev 510 Proc 99395 = $171.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 18-39 YRS,99395,CPT,510,RC,51000176,CDM,,,,both,,,412.0000,61.8000,CIGNA HEALTHCARE,CIGNA PPO,171.80,,,,,,,43.0600,412.0000,percent of total billed charges,41.7% of $412.00 in Billed Charges for Rev 510 Proc 99395 = $171.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 18-39 YRS,99395,CPT,510,RC,51000176,CDM,,,,both,,,412.0000,61.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,370.80,,,,,,,43.0600,412.0000,percent of total billed charges,90% of $412.00 in Billed Charges for Rev 510 Proc 99395 = $370.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 18-39 YRS,99395,CPT,510,RC,51000176,CDM,,,,both,,,412.0000,61.8000,MEDCOST,MEDCOST VHN,196.07,,,,,,,43.0600,412.0000,percent of total billed charges,47.59% of $412.00 in Billed Charges for Rev 510 Proc 99395 = $196.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 18-39 YRS,99395,CPT,510,RC,51000176,CDM,,,,both,,,412.0000,61.8000,SENTARA HEALTH,SENTARA HEALTH,106.34,,,,,,,43.0600,412.0000,percent of total billed charges,25.81% of $412.00 in Billed Charges for Rev 510 Proc 99395 = $106.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 18-39 YRS,99395,CPT,510,RC,51000176,CDM,,,,both,,,412.0000,61.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",412.00,,,,,,,43.0600,412.0000,percent of total billed charges,100% of $412.00 in Billed Charges for Rev 510 Proc 99395 = $412.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 18-39 YRS,99395,CPT,510,RC,51000176,CDM,,,,both,,,412.0000,61.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,43.06,,,,,,,43.0600,412.0000,fee schedule,$86.12 from Fee Schedule TCUHC24 for Rev 510 Proc 99395 * Qty 1 = $86.12 at 50% = $43.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EST 18-39 YRS,99395,CPT,510,RC,51000176,CDM,,,,both,,,412.0000,61.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,133.08,,,,,,,43.0600,412.0000,other,32.3% of $412.00 in Billed Charges for Rev 510 Proc 99395 = $133.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EST 18-39 YRS,99395,CPT,510,RC,51000176,CDM,,,,both,,,412.0000,61.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,126.48,,,,,,,43.0600,412.0000,other,30.7% of $412.00 in Billed Charges for Rev 510 Proc 99395 = $126.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EST 18-39 YRS,99395,CPT,510,RC,51000176,CDM,,,,both,,,412.0000,61.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,133.08,,,,,,,43.0600,412.0000,percent of total billed charges,32.3% of $412.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 18-39 YRS,99395,CPT,510,RC,51000176,CDM,,,,both,,,412.0000,61.8000,WELLCARE,WELLCARE MEDICAID,412.00,,,,,,,43.0600,412.0000,percent of total billed charges,100% of $412.00 in Billed Charges for Rev 510 Proc 99395 = $412.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CMPLX CHRON CARE MGMT EA ADDL 30 MIN PER MONTH,99489,CPT,510,RC,51000205,CDM,,,,both,,,131.0000,19.6500,AETNA,AETNA,55.94,,,,,,,33.8100,131.0000,percent of total billed charges,42.7% of $131.00 in Billed Charges for Rev 510 Proc 99489 = $55.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CMPLX CHRON CARE MGMT EA ADDL 30 MIN PER MONTH,99489,CPT,510,RC,51000205,CDM,,,,both,,,131.0000,19.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,83.27,,,,,,,33.8100,131.0000,fee schedule,APG 02070 Proc 99489 at $836.60 (Base Rate) * 0.0957 (Relative Weight) = $80.06 (Total Line Payment) at 104% = $83.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT EA ADDL 30 MIN PER MONTH,99489,CPT,510,RC,51000205,CDM,,,,both,,,131.0000,19.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,82.46,,,,,,,33.8100,131.0000,fee schedule,APG 02070 Proc 99489 at $836.60 (Base Rate) * 0.0957 (Relative Weight) = $80.06 (Total Line Payment) at 103% = $82.46. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT EA ADDL 30 MIN PER MONTH,99489,CPT,510,RC,51000205,CDM,,,,both,,,131.0000,19.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,91.70,,,,,,,33.8100,131.0000,percent of total billed charges,Rev 510 Proc 99489 $131.00 in Billed Charges at 70% = $91.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CMPLX CHRON CARE MGMT EA ADDL 30 MIN PER MONTH,99489,CPT,510,RC,51000205,CDM,,,,both,,,131.0000,19.6500,CIGNA HEALTHCARE,CIGNA HMO,54.63,,,,,,,33.8100,131.0000,percent of total billed charges,41.7% of $131.00 in Billed Charges for Rev 510 Proc 99489 = $54.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CMPLX CHRON CARE MGMT EA ADDL 30 MIN PER MONTH,99489,CPT,510,RC,51000205,CDM,,,,both,,,131.0000,19.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,60.78,,,,,,,33.8100,131.0000,percent of total billed charges,46.4% of $131.00 in Billed Charges for Rev 510 Proc 99489 = $60.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CMPLX CHRON CARE MGMT EA ADDL 30 MIN PER MONTH,99489,CPT,510,RC,51000205,CDM,,,,both,,,131.0000,19.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,54.63,,,,,,,33.8100,131.0000,percent of total billed charges,41.7% of $131.00 in Billed Charges for Rev 510 Proc 99489 = $54.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CMPLX CHRON CARE MGMT EA ADDL 30 MIN PER MONTH,99489,CPT,510,RC,51000205,CDM,,,,both,,,131.0000,19.6500,CIGNA HEALTHCARE,CIGNA PPO,54.63,,,,,,,33.8100,131.0000,percent of total billed charges,41.7% of $131.00 in Billed Charges for Rev 510 Proc 99489 = $54.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CMPLX CHRON CARE MGMT EA ADDL 30 MIN PER MONTH,99489,CPT,510,RC,51000205,CDM,,,,both,,,131.0000,19.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,117.90,,,,,,,33.8100,131.0000,percent of total billed charges,90% of $131.00 in Billed Charges for Rev 510 Proc 99489 = $117.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CMPLX CHRON CARE MGMT EA ADDL 30 MIN PER MONTH,99489,CPT,510,RC,51000205,CDM,,,,both,,,131.0000,19.6500,MEDCOST,MEDCOST VHN,62.34,,,,,,,33.8100,131.0000,percent of total billed charges,47.59% of $131.00 in Billed Charges for Rev 510 Proc 99489 = $62.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CMPLX CHRON CARE MGMT EA ADDL 30 MIN PER MONTH,99489,CPT,510,RC,51000205,CDM,,,,both,,,131.0000,19.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,84.06,,,,,,,33.8100,131.0000,fee schedule,APG 02070 Proc 99489 at $836.60 (Base Rate) * 0.0957 (Relative Weight) = $80.06 (Total Line Payment) at 100% = $80.06... $80.06 at 105% = $84.06 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT EA ADDL 30 MIN PER MONTH,99489,CPT,510,RC,51000205,CDM,,,,both,,,131.0000,19.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,82.54,,,,,,,33.8100,131.0000,fee schedule,APG 02070 Proc 99489 at $836.60 (Base Rate) * 0.0957 (Relative Weight) = $80.06 (Total Line Payment) at 100% = $80.06... $80.06 at 103.1% = $82.54 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT EA ADDL 30 MIN PER MONTH,99489,CPT,510,RC,51000205,CDM,,,,both,,,131.0000,19.6500,SENTARA HEALTH,SENTARA HEALTH,33.81,,,,,,,33.8100,131.0000,percent of total billed charges,25.81% of $131.00 in Billed Charges for Rev 510 Proc 99489 = $33.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CMPLX CHRON CARE MGMT EA ADDL 30 MIN PER MONTH,99489,CPT,510,RC,51000205,CDM,,,,both,,,131.0000,19.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",131.00,,,,,,,33.8100,131.0000,percent of total billed charges,100% of $131.00 in Billed Charges for Rev 510 Proc 99489 = $131.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CMPLX CHRON CARE MGMT EA ADDL 30 MIN PER MONTH,99489,CPT,510,RC,51000205,CDM,,,,both,,,131.0000,19.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,42.31,,,,,,,33.8100,131.0000,other,32.3% of $131.00 in Billed Charges for Rev 510 Proc 99489 = $42.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT EA ADDL 30 MIN PER MONTH,99489,CPT,510,RC,51000205,CDM,,,,both,,,131.0000,19.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,40.22,,,,,,,33.8100,131.0000,other,30.7% of $131.00 in Billed Charges for Rev 510 Proc 99489 = $40.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT EA ADDL 30 MIN PER MONTH,99489,CPT,510,RC,51000205,CDM,,,,both,,,131.0000,19.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,42.31,,,,,,,33.8100,131.0000,percent of total billed charges,32.3% of $131.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CMPLX CHRON CARE MGMT EA ADDL 30 MIN PER MONTH,99489,CPT,510,RC,51000205,CDM,,,,both,,,131.0000,19.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,82.46,,,,,,,33.8100,131.0000,fee schedule,APG 02070 Proc 99489 at $836.60 (Base Rate) * 0.0957 (Relative Weight) = $80.06 (Total Line Payment) at 103% = $82.46. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT EA ADDL 30 MIN PER MONTH,99489,CPT,510,RC,51000205,CDM,,,,both,,,131.0000,19.6500,WELLCARE,WELLCARE MEDICAID,131.00,,,,,,,33.8100,131.0000,percent of total billed charges,100% of $131.00 in Billed Charges for Rev 510 Proc 99489 = $131.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,AETNA,AETNA,109.74,,,,,,,26.8500,257.0000,percent of total billed charges,42.7% of $257.00 in Billed Charges for Rev 510 Proc 99490 = $109.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,83.27,,,,,,,26.8500,257.0000,fee schedule,APG 02070 Proc 99490 at $836.60 (Base Rate) * 0.0957 (Relative Weight) = $80.06 (Total Line Payment) at 104% = $83.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,92.17,,,,,,,26.8500,257.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,AETNA,AETNA HEALTHCARE MEDICARE,92.17,,,,,,,26.8500,257.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,92.17,,,,,,,26.8500,257.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,AMBETTER,AMBETTER,200.93,,,,,,,26.8500,257.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,95.86,,,,,,,26.8500,257.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,BLUE CROSS,ANTHEM EXCHANGE,226.93,,,,,,,26.8500,257.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,82.46,,,,,,,26.8500,257.0000,fee schedule,APG 02070 Proc 99490 at $836.60 (Base Rate) * 0.0957 (Relative Weight) = $80.06 (Total Line Payment) at 103% = $82.46. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,BLUE CROSS,ANTHEM HMO,241.10,,,,,,,26.8500,257.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,94.93,,,,,,,26.8500,257.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",257.00,,,,,,,26.8500,257.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,179.90,,,,,,,26.8500,257.0000,percent of total billed charges,Rev 510 Proc 99490 $257.00 in Billed Charges at 70% = $179.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,BLUE CROSS,BLUE CROSS MEDICARE,95.86,,,,,,,26.8500,257.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,CIGNA HEALTHCARE,CIGNA HMO,107.17,,,,,,,26.8500,257.0000,percent of total billed charges,41.7% of $257.00 in Billed Charges for Rev 510 Proc 99490 = $107.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,119.25,,,,,,,26.8500,257.0000,percent of total billed charges,46.4% of $257.00 in Billed Charges for Rev 510 Proc 99490 = $119.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,96.78,,,,,,,26.8500,257.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,107.17,,,,,,,26.8500,257.0000,percent of total billed charges,41.7% of $257.00 in Billed Charges for Rev 510 Proc 99490 = $107.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,CIGNA HEALTHCARE,CIGNA PPO,107.17,,,,,,,26.8500,257.0000,percent of total billed charges,41.7% of $257.00 in Billed Charges for Rev 510 Proc 99490 = $107.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,96.78,,,,,,,26.8500,257.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,231.30,,,,,,,26.8500,257.0000,percent of total billed charges,90% of $257.00 in Billed Charges for Rev 510 Proc 99490 = $231.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,HUMANA,HUMANA MEDICARE,92.17,,,,,,,26.8500,257.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,92.17,,,,,,,26.8500,257.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,MEDCOST,MEDCOST VHN,122.31,,,,,,,26.8500,257.0000,percent of total billed charges,47.59% of $257.00 in Billed Charges for Rev 510 Proc 99490 = $122.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,84.06,,,,,,,26.8500,257.0000,fee schedule,APG 02070 Proc 99490 at $836.60 (Base Rate) * 0.0957 (Relative Weight) = $80.06 (Total Line Payment) at 100% = $80.06... $80.06 at 105% = $84.06 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,96.78,,,,,,,26.8500,257.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,96.78,,,,,,,26.8500,257.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,NHC ADVANTAGE,NHC ADVANTAGE,96.78,,,,,,,26.8500,257.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,82.54,,,,,,,26.8500,257.0000,fee schedule,APG 02070 Proc 99490 at $836.60 (Base Rate) * 0.0957 (Relative Weight) = $80.06 (Total Line Payment) at 100% = $80.06... $80.06 at 103.1% = $82.54 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,SENTARA HEALTH,SENTARA HEALTH,66.33,,,,,,,26.8500,257.0000,percent of total billed charges,25.81% of $257.00 in Billed Charges for Rev 510 Proc 99490 = $66.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,SENTARA HEALTH,SENTARA MEDICARE,92.17,,,,,,,26.8500,257.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",257.00,,,,,,,26.8500,257.0000,percent of total billed charges,100% of $257.00 in Billed Charges for Rev 510 Proc 99490 = $257.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,26.85,,,,,,,26.8500,257.0000,fee schedule,$53.70 from Fee Schedule TCUHC24 for Rev 510 Proc 99490 * Qty 1 = $53.70 at 50% = $26.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,83.01,,,,,,,26.8500,257.0000,other,32.3% of $257.00 in Billed Charges for Rev 510 Proc 99490 = $83.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,78.90,,,,,,,26.8500,257.0000,other,30.7% of $257.00 in Billed Charges for Rev 510 Proc 99490 = $78.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,83.01,,,,,,,26.8500,257.0000,percent of total billed charges,32.3% of $257.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,82.46,,,,,,,26.8500,257.0000,fee schedule,APG 02070 Proc 99490 at $836.60 (Base Rate) * 0.0957 (Relative Weight) = $80.06 (Total Line Payment) at 103% = $82.46. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,92.17,,,,,,,26.8500,257.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,92.17,,,,,,,26.8500,257.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,WELLCARE,WELLCARE MEDICAID,257.00,,,,,,,26.8500,257.0000,percent of total billed charges,100% of $257.00 in Billed Charges for Rev 510 Proc 99490 = $257.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHRON CARE MGMT SRVC 20 MIN,99490,CPT,510,RC,51000183,CDM,,,,both,,,257.0000,38.5500,WELLCARE,WELLCARE MEDICARE,97.70,,,,,,,26.8500,257.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA,603.35,,,,,,,74.8400,1413.0000,percent of total billed charges,"42.7% of $1,413.00 in Billed Charges for Rev 450 Proc 30903 = $603.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,265.28,,,,,,,74.8400,1413.0000,fee schedule,"APG 00249 Proc 30903 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 104% = $265.28. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,120.71,,,,,,,74.8400,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA HEALTHCARE MEDICARE,120.71,,,,,,,74.8400,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,120.71,,,,,,,74.8400,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,AMBETTER,AMBETTER,263.15,,,,,,,74.8400,1413.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,125.54,,,,,,,74.8400,1413.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM EXCHANGE,297.21,,,,,,,74.8400,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,262.73,,,,,,,74.8400,1413.0000,fee schedule,"APG 00249 Proc 30903 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 103% = $262.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HMO,315.76,,,,,,,74.8400,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,124.33,,,,,,,74.8400,1413.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",371.47,,,,,,,74.8400,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,74.84,,,,,,,74.8400,1413.0000,fee schedule,$74.84 from Fee Schedule BLDTM_23 for Rev 450 Proc 30903 * Qty 1 = $74.84 at 100% = $74.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS MEDICARE,125.54,,,,,,,74.8400,1413.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,126.75,,,,,,,74.8400,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,126.75,,,,,,,74.8400,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1271.70,,,,,,,74.8400,1413.0000,percent of total billed charges,"90% of $1,413.00 in Billed Charges for Rev 450 Proc 30903 = $1,271.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,HUMANA,HUMANA MEDICARE,120.71,,,,,,,74.8400,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,120.71,,,,,,,74.8400,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,MEDCOST,MEDCOST VHN,672.45,,,,,,,74.8400,1413.0000,percent of total billed charges,"47.59% of $1,413.00 in Billed Charges for Rev 450 Proc 30903 = $672.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,267.83,,,,,,,74.8400,1413.0000,fee schedule,"APG 00249 Proc 30903 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 100% = $255.08... $255.08 at 105% = $267.83 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,126.75,,,,,,,74.8400,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,126.75,,,,,,,74.8400,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,NHC ADVANTAGE,NHC ADVANTAGE,126.75,,,,,,,74.8400,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,262.99,,,,,,,74.8400,1413.0000,fee schedule,"APG 00249 Proc 30903 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 100% = $255.08... $255.08 at 103.1% = $262.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA HEALTH,364.70,,,,,,,74.8400,1413.0000,percent of total billed charges,"25.81% of $1,413.00 in Billed Charges for Rev 450 Proc 30903 = $364.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA MEDICARE,120.71,,,,,,,74.8400,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1413.00,,,,,,,74.8400,1413.0000,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 30903 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,74.8400,1413.0000,case rate,Rev 450 Proc 30903 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,74.8400,1413.0000,case rate,Rev 450 Proc 30903 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,74.8400,1413.0000,case rate,Rev 450 Proc 30903 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,74.8400,1413.0000,case rate,Rev 450 Proc 30903 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,262.73,,,,,,,74.8400,1413.0000,fee schedule,"APG 00249 Proc 30903 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 103% = $262.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,120.71,,,,,,,74.8400,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,120.71,,,,,,,74.8400,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICAID,1413.00,,,,,,,74.8400,1413.0000,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 30903 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONTROL NASAL HEMOR ANT COMPLE,30903,CPT,450,RC,45000214,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICARE,127.95,,,,,,,74.8400,1413.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE E PACK DR HOLDEN 8942E,272,RC,,,,,,,,both,,,6504.6900,975.7000,AETNA,AETNA,2777.50,,,,,,,1678.8600,6504.6900,percent of total billed charges,"42.7% of $6,504.69 in Billed Charges for Rev 272 = $2,777.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE E PACK DR HOLDEN 8942E,272,RC,,,,,,,,both,,,6504.6900,975.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4553.28,,,,,,,1678.8600,6504.6900,percent of total billed charges,"Rev 272 $6,504.69 in Billed Charges at 70% = $4,553.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE E PACK DR HOLDEN 8942E,272,RC,,,,,,,,both,,,6504.6900,975.7000,CIGNA HEALTHCARE,CIGNA HMO,2712.46,,,,,,,1678.8600,6504.6900,percent of total billed charges,"41.7% of $6,504.69 in Billed Charges for Rev 272 = $2,712.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE E PACK DR HOLDEN 8942E,272,RC,,,,,,,,both,,,6504.6900,975.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3018.18,,,,,,,1678.8600,6504.6900,percent of total billed charges,"46.4% of $6,504.69 in Billed Charges for Rev 272 = $3,018.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE E PACK DR HOLDEN 8942E,272,RC,,,,,,,,both,,,6504.6900,975.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2712.46,,,,,,,1678.8600,6504.6900,percent of total billed charges,"41.7% of $6,504.69 in Billed Charges for Rev 272 = $2,712.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE E PACK DR HOLDEN 8942E,272,RC,,,,,,,,both,,,6504.6900,975.7000,CIGNA HEALTHCARE,CIGNA PPO,2712.46,,,,,,,1678.8600,6504.6900,percent of total billed charges,"41.7% of $6,504.69 in Billed Charges for Rev 272 = $2,712.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE E PACK DR HOLDEN 8942E,272,RC,,,,,,,,both,,,6504.6900,975.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5854.22,,,,,,,1678.8600,6504.6900,percent of total billed charges,"90% of $6,504.69 in Billed Charges for Rev 272 = $5,854.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE E PACK DR HOLDEN 8942E,272,RC,,,,,,,,both,,,6504.6900,975.7000,MEDCOST,MEDCOST VHN,3095.58,,,,,,,1678.8600,6504.6900,percent of total billed charges,"47.59% of $6,504.69 in Billed Charges for Rev 272 = $3,095.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE E PACK DR HOLDEN 8942E,272,RC,,,,,,,,both,,,6504.6900,975.7000,SENTARA HEALTH,SENTARA HEALTH,1678.86,,,,,,,1678.8600,6504.6900,percent of total billed charges,"25.81% of $6,504.69 in Billed Charges for Rev 272 = $1,678.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE E PACK DR HOLDEN 8942E,272,RC,,,,,,,,both,,,6504.6900,975.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6504.69,,,,,,,1678.8600,6504.6900,percent of total billed charges,"100% of $6,504.69 in Billed Charges for Rev 272 = $6,504.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE E PACK DR HOLDEN 8942E,272,RC,,,,,,,,both,,,6504.6900,975.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3252.35,,,,,,,1678.8600,6504.6900,percent of total billed charges,"Rev 272 $6,504.69 in Billed Charges at 50% = $3,252.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE E PACK DR HOLDEN 8942E,272,RC,,,,,,,,both,,,6504.6900,975.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2101.01,,,,,,,1678.8600,6504.6900,other,"32.3% of $6,504.69 in Billed Charges for Rev 272 = $2,101.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE E PACK DR HOLDEN 8942E,272,RC,,,,,,,,both,,,6504.6900,975.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1996.94,,,,,,,1678.8600,6504.6900,other,"30.7% of $6,504.69 in Billed Charges for Rev 272 = $1,996.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE E PACK DR HOLDEN 8942E,272,RC,,,,,,,,both,,,6504.6900,975.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,2101.01,,,,,,,1678.8600,6504.6900,percent of total billed charges,"32.3% of $6,504.69 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE E PACK DR HOLDEN 8942E,272,RC,,,,,,,,both,,,6504.6900,975.7000,WELLCARE,WELLCARE MEDICAID,6504.69,,,,,,,1678.8600,6504.6900,percent of total billed charges,"100% of $6,504.69 in Billed Charges for Rev 272 = $6,504.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,2036.3100,305.4500,AETNA,AETNA,869.50,,,,,,,525.5700,2036.3100,percent of total billed charges,"42.7% of $2,036.31 in Billed Charges for Rev 272 = $869.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,2036.3100,305.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1425.42,,,,,,,525.5700,2036.3100,percent of total billed charges,"Rev 272 $2,036.31 in Billed Charges at 70% = $1,425.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,2036.3100,305.4500,CIGNA HEALTHCARE,CIGNA HMO,849.14,,,,,,,525.5700,2036.3100,percent of total billed charges,"41.7% of $2,036.31 in Billed Charges for Rev 272 = $849.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,2036.3100,305.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,944.85,,,,,,,525.5700,2036.3100,percent of total billed charges,"46.4% of $2,036.31 in Billed Charges for Rev 272 = $944.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,2036.3100,305.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,849.14,,,,,,,525.5700,2036.3100,percent of total billed charges,"41.7% of $2,036.31 in Billed Charges for Rev 272 = $849.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,2036.3100,305.4500,CIGNA HEALTHCARE,CIGNA PPO,849.14,,,,,,,525.5700,2036.3100,percent of total billed charges,"41.7% of $2,036.31 in Billed Charges for Rev 272 = $849.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,2036.3100,305.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1832.68,,,,,,,525.5700,2036.3100,percent of total billed charges,"90% of $2,036.31 in Billed Charges for Rev 272 = $1,832.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,2036.3100,305.4500,MEDCOST,MEDCOST VHN,969.08,,,,,,,525.5700,2036.3100,percent of total billed charges,"47.59% of $2,036.31 in Billed Charges for Rev 272 = $969.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,2036.3100,305.4500,SENTARA HEALTH,SENTARA HEALTH,525.57,,,,,,,525.5700,2036.3100,percent of total billed charges,"25.81% of $2,036.31 in Billed Charges for Rev 272 = $525.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,2036.3100,305.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2036.31,,,,,,,525.5700,2036.3100,percent of total billed charges,"100% of $2,036.31 in Billed Charges for Rev 272 = $2,036.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,2036.3100,305.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1018.16,,,,,,,525.5700,2036.3100,percent of total billed charges,"Rev 272 $2,036.31 in Billed Charges at 50% = $1,018.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,2036.3100,305.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,657.73,,,,,,,525.5700,2036.3100,other,"32.3% of $2,036.31 in Billed Charges for Rev 272 = $657.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,2036.3100,305.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,625.15,,,,,,,525.5700,2036.3100,other,"30.7% of $2,036.31 in Billed Charges for Rev 272 = $625.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,2036.3100,305.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,657.73,,,,,,,525.5700,2036.3100,percent of total billed charges,"32.3% of $2,036.31 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ENDO SURGIDAC SZ 0 48IN GREEN,272,RC,,,,,,,,both,,,2036.3100,305.4500,WELLCARE,WELLCARE MEDICAID,2036.31,,,,,,,525.5700,2036.3100,percent of total billed charges,"100% of $2,036.31 in Billed Charges for Rev 272 = $2,036.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ETHIBOND 2-0 PXX82,272,RC,,,,,,,,both,,,496.6700,74.5000,AETNA,AETNA,212.08,,,,,,,128.1900,496.6700,percent of total billed charges,42.7% of $496.67 in Billed Charges for Rev 272 = $212.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND 2-0 PXX82,272,RC,,,,,,,,both,,,496.6700,74.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,347.67,,,,,,,128.1900,496.6700,percent of total billed charges,Rev 272 $496.67 in Billed Charges at 70% = $347.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND 2-0 PXX82,272,RC,,,,,,,,both,,,496.6700,74.5000,CIGNA HEALTHCARE,CIGNA HMO,207.11,,,,,,,128.1900,496.6700,percent of total billed charges,41.7% of $496.67 in Billed Charges for Rev 272 = $207.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND 2-0 PXX82,272,RC,,,,,,,,both,,,496.6700,74.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,230.45,,,,,,,128.1900,496.6700,percent of total billed charges,46.4% of $496.67 in Billed Charges for Rev 272 = $230.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND 2-0 PXX82,272,RC,,,,,,,,both,,,496.6700,74.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,207.11,,,,,,,128.1900,496.6700,percent of total billed charges,41.7% of $496.67 in Billed Charges for Rev 272 = $207.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND 2-0 PXX82,272,RC,,,,,,,,both,,,496.6700,74.5000,CIGNA HEALTHCARE,CIGNA PPO,207.11,,,,,,,128.1900,496.6700,percent of total billed charges,41.7% of $496.67 in Billed Charges for Rev 272 = $207.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND 2-0 PXX82,272,RC,,,,,,,,both,,,496.6700,74.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,447.00,,,,,,,128.1900,496.6700,percent of total billed charges,90% of $496.67 in Billed Charges for Rev 272 = $447.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND 2-0 PXX82,272,RC,,,,,,,,both,,,496.6700,74.5000,MEDCOST,MEDCOST VHN,236.37,,,,,,,128.1900,496.6700,percent of total billed charges,47.59% of $496.67 in Billed Charges for Rev 272 = $236.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND 2-0 PXX82,272,RC,,,,,,,,both,,,496.6700,74.5000,SENTARA HEALTH,SENTARA HEALTH,128.19,,,,,,,128.1900,496.6700,percent of total billed charges,25.81% of $496.67 in Billed Charges for Rev 272 = $128.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND 2-0 PXX82,272,RC,,,,,,,,both,,,496.6700,74.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",496.67,,,,,,,128.1900,496.6700,percent of total billed charges,100% of $496.67 in Billed Charges for Rev 272 = $496.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND 2-0 PXX82,272,RC,,,,,,,,both,,,496.6700,74.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,248.34,,,,,,,128.1900,496.6700,percent of total billed charges,Rev 272 $496.67 in Billed Charges at 50% = $248.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND 2-0 PXX82,272,RC,,,,,,,,both,,,496.6700,74.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,160.42,,,,,,,128.1900,496.6700,other,32.3% of $496.67 in Billed Charges for Rev 272 = $160.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE ETHIBOND 2-0 PXX82,272,RC,,,,,,,,both,,,496.6700,74.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,152.48,,,,,,,128.1900,496.6700,other,30.7% of $496.67 in Billed Charges for Rev 272 = $152.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE ETHIBOND 2-0 PXX82,272,RC,,,,,,,,both,,,496.6700,74.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,160.42,,,,,,,128.1900,496.6700,percent of total billed charges,32.3% of $496.67 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND 2-0 PXX82,272,RC,,,,,,,,both,,,496.6700,74.5000,WELLCARE,WELLCARE MEDICAID,496.67,,,,,,,128.1900,496.6700,percent of total billed charges,100% of $496.67 in Billed Charges for Rev 272 = $496.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ETHIBOND D SPEC 4-0 30,272,RC,27200002,CDM,,,,,,both,,,2895.4700,434.3200,AETNA,AETNA,1236.37,,,,,,,747.3200,2895.4700,percent of total billed charges,"42.7% of $2,895.47 in Billed Charges for Rev 272 = $1,236.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ETHIBOND D SPEC 4-0 30,272,RC,27200002,CDM,,,,,,both,,,2895.4700,434.3200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2026.83,,,,,,,747.3200,2895.4700,percent of total billed charges,"Rev 272 $2,895.47 in Billed Charges at 70% = $2,026.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ETHIBOND D SPEC 4-0 30,272,RC,27200002,CDM,,,,,,both,,,2895.4700,434.3200,CIGNA HEALTHCARE,CIGNA HMO,1207.41,,,,,,,747.3200,2895.4700,percent of total billed charges,"41.7% of $2,895.47 in Billed Charges for Rev 272 = $1,207.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ETHIBOND D SPEC 4-0 30,272,RC,27200002,CDM,,,,,,both,,,2895.4700,434.3200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1343.50,,,,,,,747.3200,2895.4700,percent of total billed charges,"46.4% of $2,895.47 in Billed Charges for Rev 272 = $1,343.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ETHIBOND D SPEC 4-0 30,272,RC,27200002,CDM,,,,,,both,,,2895.4700,434.3200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1207.41,,,,,,,747.3200,2895.4700,percent of total billed charges,"41.7% of $2,895.47 in Billed Charges for Rev 272 = $1,207.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ETHIBOND D SPEC 4-0 30,272,RC,27200002,CDM,,,,,,both,,,2895.4700,434.3200,CIGNA HEALTHCARE,CIGNA PPO,1207.41,,,,,,,747.3200,2895.4700,percent of total billed charges,"41.7% of $2,895.47 in Billed Charges for Rev 272 = $1,207.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ETHIBOND D SPEC 4-0 30,272,RC,27200002,CDM,,,,,,both,,,2895.4700,434.3200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2605.92,,,,,,,747.3200,2895.4700,percent of total billed charges,"90% of $2,895.47 in Billed Charges for Rev 272 = $2,605.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ETHIBOND D SPEC 4-0 30,272,RC,27200002,CDM,,,,,,both,,,2895.4700,434.3200,MEDCOST,MEDCOST VHN,1377.95,,,,,,,747.3200,2895.4700,percent of total billed charges,"47.59% of $2,895.47 in Billed Charges for Rev 272 = $1,377.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ETHIBOND D SPEC 4-0 30,272,RC,27200002,CDM,,,,,,both,,,2895.4700,434.3200,SENTARA HEALTH,SENTARA HEALTH,747.32,,,,,,,747.3200,2895.4700,percent of total billed charges,"25.81% of $2,895.47 in Billed Charges for Rev 272 = $747.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ETHIBOND D SPEC 4-0 30,272,RC,27200002,CDM,,,,,,both,,,2895.4700,434.3200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2895.47,,,,,,,747.3200,2895.4700,percent of total billed charges,"100% of $2,895.47 in Billed Charges for Rev 272 = $2,895.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ETHIBOND D SPEC 4-0 30,272,RC,27200002,CDM,,,,,,both,,,2895.4700,434.3200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1447.74,,,,,,,747.3200,2895.4700,percent of total billed charges,"Rev 272 $2,895.47 in Billed Charges at 50% = $1,447.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ETHIBOND D SPEC 4-0 30,272,RC,27200002,CDM,,,,,,both,,,2895.4700,434.3200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,935.24,,,,,,,747.3200,2895.4700,other,"32.3% of $2,895.47 in Billed Charges for Rev 272 = $935.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE ETHIBOND D SPEC 4-0 30,272,RC,27200002,CDM,,,,,,both,,,2895.4700,434.3200,UNITED HEALTHCARE,UHC HERITAGE SELECT,888.91,,,,,,,747.3200,2895.4700,other,"30.7% of $2,895.47 in Billed Charges for Rev 272 = $888.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE ETHIBOND D SPEC 4-0 30,272,RC,27200002,CDM,,,,,,both,,,2895.4700,434.3200,UNITED HEALTHCARE,UNITED HEALTHCARE,935.24,,,,,,,747.3200,2895.4700,percent of total billed charges,"32.3% of $2,895.47 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ETHIBOND D SPEC 4-0 30,272,RC,27200002,CDM,,,,,,both,,,2895.4700,434.3200,WELLCARE,WELLCARE MEDICAID,2895.47,,,,,,,747.3200,2895.4700,percent of total billed charges,"100% of $2,895.47 in Billed Charges for Rev 272 = $2,895.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,AETNA,AETNA,166.10,,,,,,,36.8400,389.0000,percent of total billed charges,42.7% of $389.00 in Billed Charges for Rev 521 Proc 99495 = $166.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,183.24,,,,,,,36.8400,389.0000,fee schedule,APG 00260 Proc 99495 at $836.60 (Base Rate) * 0.2106 (Relative Weight) = $176.19 (Total Line Payment) at 104% = $183.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,120.79,,,,,,,36.8400,389.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,AETNA,AETNA HEALTHCARE MEDICARE,120.79,,,,,,,36.8400,389.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,120.79,,,,,,,36.8400,389.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,AMBETTER,AMBETTER,263.32,,,,,,,36.8400,389.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,125.62,,,,,,,36.8400,389.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,BLUE CROSS,ANTHEM EXCHANGE,297.39,,,,,,,36.8400,389.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,181.47,,,,,,,36.8400,389.0000,fee schedule,APG 00260 Proc 99495 at $836.60 (Base Rate) * 0.2106 (Relative Weight) = $176.19 (Total Line Payment) at 103% = $181.47. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,BLUE CROSS,ANTHEM HMO,315.96,,,,,,,36.8400,389.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,124.41,,,,,,,36.8400,389.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",371.69,,,,,,,36.8400,389.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,272.30,,,,,,,36.8400,389.0000,percent of total billed charges,Rev 521 Proc 99495 $389.00 in Billed Charges at 70% = $272.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,BLUE CROSS,BLUE CROSS MEDICARE,125.62,,,,,,,36.8400,389.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,CIGNA HEALTHCARE,CIGNA HMO,162.21,,,,,,,36.8400,389.0000,percent of total billed charges,41.7% of $389.00 in Billed Charges for Rev 521 Proc 99495 = $162.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,180.50,,,,,,,36.8400,389.0000,percent of total billed charges,46.4% of $389.00 in Billed Charges for Rev 521 Proc 99495 = $180.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,126.83,,,,,,,36.8400,389.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,162.21,,,,,,,36.8400,389.0000,percent of total billed charges,41.7% of $389.00 in Billed Charges for Rev 521 Proc 99495 = $162.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,CIGNA HEALTHCARE,CIGNA PPO,162.21,,,,,,,36.8400,389.0000,percent of total billed charges,41.7% of $389.00 in Billed Charges for Rev 521 Proc 99495 = $162.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,126.83,,,,,,,36.8400,389.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,350.10,,,,,,,36.8400,389.0000,percent of total billed charges,90% of $389.00 in Billed Charges for Rev 521 Proc 99495 = $350.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,HUMANA,HUMANA MEDICARE,120.79,,,,,,,36.8400,389.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,120.79,,,,,,,36.8400,389.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,MEDCOST,MEDCOST VHN,185.13,,,,,,,36.8400,389.0000,percent of total billed charges,47.59% of $389.00 in Billed Charges for Rev 521 Proc 99495 = $185.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,185.00,,,,,,,36.8400,389.0000,fee schedule,APG 00260 Proc 99495 at $836.60 (Base Rate) * 0.2106 (Relative Weight) = $176.19 (Total Line Payment) at 100% = $176.19... $176.19 at 105% = $185.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,126.83,,,,,,,36.8400,389.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,126.83,,,,,,,36.8400,389.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,NHC ADVANTAGE,NHC ADVANTAGE,126.83,,,,,,,36.8400,389.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,181.65,,,,,,,36.8400,389.0000,fee schedule,APG 00260 Proc 99495 at $836.60 (Base Rate) * 0.2106 (Relative Weight) = $176.19 (Total Line Payment) at 100% = $176.19... $176.19 at 103.1% = $181.65 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,SENTARA HEALTH,SENTARA HEALTH,100.40,,,,,,,36.8400,389.0000,percent of total billed charges,25.81% of $389.00 in Billed Charges for Rev 521 Proc 99495 = $100.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,SENTARA HEALTH,SENTARA MEDICARE,120.79,,,,,,,36.8400,389.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",389.00,,,,,,,36.8400,389.0000,percent of total billed charges,100% of $389.00 in Billed Charges for Rev 521 Proc 99495 = $389.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,36.84,,,,,,,36.8400,389.0000,fee schedule,$73.68 from Fee Schedule TCUHC24 for Rev 521 Proc 99495 * Qty 1 = $73.68 at 50% = $36.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,181.47,,,,,,,36.8400,389.0000,fee schedule,APG 00260 Proc 99495 at $836.60 (Base Rate) * 0.2106 (Relative Weight) = $176.19 (Total Line Payment) at 103% = $181.47. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,120.79,,,,,,,36.8400,389.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,120.79,,,,,,,36.8400,389.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,WELLCARE,WELLCARE MEDICAID,389.00,,,,,,,36.8400,389.0000,percent of total billed charges,100% of $389.00 in Billed Charges for Rev 521 Proc 99495 = $389.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRANS CARE MGMT 14 DAY DISCH,99495,CPT,521,RC,52100004,CDM,,,,both,,,389.0000,58.3500,WELLCARE,WELLCARE MEDICARE,128.04,,,,,,,36.8400,389.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,AETNA,AETNA,103.76,,,,,,,62.7200,243.0000,percent of total billed charges,42.7% of $243.00 in Billed Charges for Rev 521 Proc 99497 = $103.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,183.24,,,,,,,62.7200,243.0000,fee schedule,APG 00260 Proc 99497 at $836.60 (Base Rate) * 0.2106 (Relative Weight) = $176.19 (Total Line Payment) at 104% = $183.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,92.17,,,,,,,62.7200,243.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,AETNA,AETNA HEALTHCARE MEDICARE,92.17,,,,,,,62.7200,243.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,92.17,,,,,,,62.7200,243.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,AMBETTER,AMBETTER,200.93,,,,,,,62.7200,243.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,95.86,,,,,,,62.7200,243.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,BLUE CROSS,ANTHEM EXCHANGE,226.93,,,,,,,62.7200,243.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,181.47,,,,,,,62.7200,243.0000,fee schedule,APG 00260 Proc 99497 at $836.60 (Base Rate) * 0.2106 (Relative Weight) = $176.19 (Total Line Payment) at 103% = $181.47. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,BLUE CROSS,ANTHEM HMO,241.10,,,,,,,62.7200,243.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,94.93,,,,,,,62.7200,243.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",243.00,,,,,,,62.7200,243.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,170.10,,,,,,,62.7200,243.0000,percent of total billed charges,Rev 521 Proc 99497 $243.00 in Billed Charges at 70% = $170.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,BLUE CROSS,BLUE CROSS MEDICARE,95.86,,,,,,,62.7200,243.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,CIGNA HEALTHCARE,CIGNA HMO,101.33,,,,,,,62.7200,243.0000,percent of total billed charges,41.7% of $243.00 in Billed Charges for Rev 521 Proc 99497 = $101.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,112.75,,,,,,,62.7200,243.0000,percent of total billed charges,46.4% of $243.00 in Billed Charges for Rev 521 Proc 99497 = $112.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,96.78,,,,,,,62.7200,243.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,101.33,,,,,,,62.7200,243.0000,percent of total billed charges,41.7% of $243.00 in Billed Charges for Rev 521 Proc 99497 = $101.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,CIGNA HEALTHCARE,CIGNA PPO,101.33,,,,,,,62.7200,243.0000,percent of total billed charges,41.7% of $243.00 in Billed Charges for Rev 521 Proc 99497 = $101.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,96.78,,,,,,,62.7200,243.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,218.70,,,,,,,62.7200,243.0000,percent of total billed charges,90% of $243.00 in Billed Charges for Rev 521 Proc 99497 = $218.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,HUMANA,HUMANA MEDICARE,92.17,,,,,,,62.7200,243.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,92.17,,,,,,,62.7200,243.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,MEDCOST,MEDCOST VHN,115.64,,,,,,,62.7200,243.0000,percent of total billed charges,47.59% of $243.00 in Billed Charges for Rev 521 Proc 99497 = $115.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,185.00,,,,,,,62.7200,243.0000,fee schedule,APG 00260 Proc 99497 at $836.60 (Base Rate) * 0.2106 (Relative Weight) = $176.19 (Total Line Payment) at 100% = $176.19... $176.19 at 105% = $185.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,96.78,,,,,,,62.7200,243.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,96.78,,,,,,,62.7200,243.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,NHC ADVANTAGE,NHC ADVANTAGE,96.78,,,,,,,62.7200,243.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,181.65,,,,,,,62.7200,243.0000,fee schedule,APG 00260 Proc 99497 at $836.60 (Base Rate) * 0.2106 (Relative Weight) = $176.19 (Total Line Payment) at 100% = $176.19... $176.19 at 103.1% = $181.65 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,SENTARA HEALTH,SENTARA HEALTH,62.72,,,,,,,62.7200,243.0000,percent of total billed charges,25.81% of $243.00 in Billed Charges for Rev 521 Proc 99497 = $62.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,SENTARA HEALTH,SENTARA MEDICARE,92.17,,,,,,,62.7200,243.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",243.00,,,,,,,62.7200,243.0000,percent of total billed charges,100% of $243.00 in Billed Charges for Rev 521 Proc 99497 = $243.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,181.47,,,,,,,62.7200,243.0000,fee schedule,APG 00260 Proc 99497 at $836.60 (Base Rate) * 0.2106 (Relative Weight) = $176.19 (Total Line Payment) at 103% = $181.47. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,92.17,,,,,,,62.7200,243.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,92.17,,,,,,,62.7200,243.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,WELLCARE,WELLCARE MEDICAID,243.00,,,,,,,62.7200,243.0000,percent of total billed charges,100% of $243.00 in Billed Charges for Rev 521 Proc 99497 = $243.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADVNCD CARE PLAN 30 MIN,99497,CPT,521,RC,52100006,CDM,,,,both,,,243.0000,36.4500,WELLCARE,WELLCARE MEDICARE,97.70,,,,,,,62.7200,243.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCED CARE PLAN ADDL 30 MIN,99498,CPT,521,RC,52100007,CDM,,,,both,,,252.0000,37.8000,AETNA,AETNA,107.60,,,,,,,65.0400,252.0000,percent of total billed charges,42.7% of $252.00 in Billed Charges for Rev 521 Proc 99498 = $107.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADVNCED CARE PLAN ADDL 30 MIN,99498,CPT,521,RC,52100007,CDM,,,,both,,,252.0000,37.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,183.24,,,,,,,65.0400,252.0000,fee schedule,APG 00260 Proc 99498 at $836.60 (Base Rate) * 0.2106 (Relative Weight) = $176.19 (Total Line Payment) at 104% = $183.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCED CARE PLAN ADDL 30 MIN,99498,CPT,521,RC,52100007,CDM,,,,both,,,252.0000,37.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,181.47,,,,,,,65.0400,252.0000,fee schedule,APG 00260 Proc 99498 at $836.60 (Base Rate) * 0.2106 (Relative Weight) = $176.19 (Total Line Payment) at 103% = $181.47. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCED CARE PLAN ADDL 30 MIN,99498,CPT,521,RC,52100007,CDM,,,,both,,,252.0000,37.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,176.40,,,,,,,65.0400,252.0000,percent of total billed charges,Rev 521 Proc 99498 $252.00 in Billed Charges at 70% = $176.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADVNCED CARE PLAN ADDL 30 MIN,99498,CPT,521,RC,52100007,CDM,,,,both,,,252.0000,37.8000,CIGNA HEALTHCARE,CIGNA HMO,105.08,,,,,,,65.0400,252.0000,percent of total billed charges,41.7% of $252.00 in Billed Charges for Rev 521 Proc 99498 = $105.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADVNCED CARE PLAN ADDL 30 MIN,99498,CPT,521,RC,52100007,CDM,,,,both,,,252.0000,37.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,116.93,,,,,,,65.0400,252.0000,percent of total billed charges,46.4% of $252.00 in Billed Charges for Rev 521 Proc 99498 = $116.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADVNCED CARE PLAN ADDL 30 MIN,99498,CPT,521,RC,52100007,CDM,,,,both,,,252.0000,37.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,105.08,,,,,,,65.0400,252.0000,percent of total billed charges,41.7% of $252.00 in Billed Charges for Rev 521 Proc 99498 = $105.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADVNCED CARE PLAN ADDL 30 MIN,99498,CPT,521,RC,52100007,CDM,,,,both,,,252.0000,37.8000,CIGNA HEALTHCARE,CIGNA PPO,105.08,,,,,,,65.0400,252.0000,percent of total billed charges,41.7% of $252.00 in Billed Charges for Rev 521 Proc 99498 = $105.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADVNCED CARE PLAN ADDL 30 MIN,99498,CPT,521,RC,52100007,CDM,,,,both,,,252.0000,37.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,226.80,,,,,,,65.0400,252.0000,percent of total billed charges,90% of $252.00 in Billed Charges for Rev 521 Proc 99498 = $226.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADVNCED CARE PLAN ADDL 30 MIN,99498,CPT,521,RC,52100007,CDM,,,,both,,,252.0000,37.8000,MEDCOST,MEDCOST VHN,119.93,,,,,,,65.0400,252.0000,percent of total billed charges,47.59% of $252.00 in Billed Charges for Rev 521 Proc 99498 = $119.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADVNCED CARE PLAN ADDL 30 MIN,99498,CPT,521,RC,52100007,CDM,,,,both,,,252.0000,37.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,185.00,,,,,,,65.0400,252.0000,fee schedule,APG 00260 Proc 99498 at $836.60 (Base Rate) * 0.2106 (Relative Weight) = $176.19 (Total Line Payment) at 100% = $176.19... $176.19 at 105% = $185.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCED CARE PLAN ADDL 30 MIN,99498,CPT,521,RC,52100007,CDM,,,,both,,,252.0000,37.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,181.65,,,,,,,65.0400,252.0000,fee schedule,APG 00260 Proc 99498 at $836.60 (Base Rate) * 0.2106 (Relative Weight) = $176.19 (Total Line Payment) at 100% = $176.19... $176.19 at 103.1% = $181.65 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCED CARE PLAN ADDL 30 MIN,99498,CPT,521,RC,52100007,CDM,,,,both,,,252.0000,37.8000,SENTARA HEALTH,SENTARA HEALTH,65.04,,,,,,,65.0400,252.0000,percent of total billed charges,25.81% of $252.00 in Billed Charges for Rev 521 Proc 99498 = $65.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADVNCED CARE PLAN ADDL 30 MIN,99498,CPT,521,RC,52100007,CDM,,,,both,,,252.0000,37.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",252.00,,,,,,,65.0400,252.0000,percent of total billed charges,100% of $252.00 in Billed Charges for Rev 521 Proc 99498 = $252.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADVNCED CARE PLAN ADDL 30 MIN,99498,CPT,521,RC,52100007,CDM,,,,both,,,252.0000,37.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,181.47,,,,,,,65.0400,252.0000,fee schedule,APG 00260 Proc 99498 at $836.60 (Base Rate) * 0.2106 (Relative Weight) = $176.19 (Total Line Payment) at 103% = $181.47. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADVNCED CARE PLAN ADDL 30 MIN,99498,CPT,521,RC,52100007,CDM,,,,both,,,252.0000,37.8000,WELLCARE,WELLCARE MEDICAID,252.00,,,,,,,65.0400,252.0000,percent of total billed charges,100% of $252.00 in Billed Charges for Rev 521 Proc 99498 = $252.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,AETNA,AETNA,5675.01,,,,,,,112.9100,11822.9400,percent of total billed charges,"48% of $11,822.94 in Billed Charges for Rev 278 Proc A2006 = $5,675.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,112.91,,,,,,,112.9100,11822.9400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,AETNA,AETNA HEALTHCARE MEDICARE,112.91,,,,,,,112.9100,11822.9400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,ALLCARE MEDICARE,ALLCARE MEDICARE,112.91,,,,,,,112.9100,11822.9400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,AMBETTER,AMBETTER,246.13,,,,,,,112.9100,11822.9400,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,117.42,,,,,,,112.9100,11822.9400,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,BLUE CROSS,ANTHEM EXCHANGE,277.98,,,,,,,112.9100,11822.9400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,BLUE CROSS,ANTHEM HMO,295.34,,,,,,,112.9100,11822.9400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,116.29,,,,,,,112.9100,11822.9400,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",347.44,,,,,,,112.9100,11822.9400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5911.47,,,,,,,112.9100,11822.9400,percent of total billed charges,"50% of $11,822.94 in Billed Charges for Rev 278 Proc A2006 = $5,911.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,BLUE CROSS,BLUE CROSS MEDICARE,117.42,,,,,,,112.9100,11822.9400,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,CIGNA HEALTHCARE,CIGNA HMO,4930.17,,,,,,,112.9100,11822.9400,percent of total billed charges,"41.7% of $11,822.94 in Billed Charges for Rev 278 Proc A2006 = $4,930.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4729.18,,,,,,,112.9100,11822.9400,percent of total billed charges,"40% of $11,822.94 in Billed Charges for Rev 278 Proc A2006 = $4,729.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,CIGNA HEALTHCARE,CIGNA MEDICARE,118.55,,,,,,,112.9100,11822.9400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4930.17,,,,,,,112.9100,11822.9400,percent of total billed charges,"41.7% of $11,822.94 in Billed Charges for Rev 278 Proc A2006 = $4,930.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,CIGNA HEALTHCARE,CIGNA PPO,4930.17,,,,,,,112.9100,11822.9400,percent of total billed charges,"41.7% of $11,822.94 in Billed Charges for Rev 278 Proc A2006 = $4,930.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,118.55,,,,,,,112.9100,11822.9400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10640.65,,,,,,,112.9100,11822.9400,percent of total billed charges,"90% of $11,822.94 in Billed Charges for Rev 278 Proc A2006 = $10,640.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,HUMANA,HUMANA MEDICARE,112.91,,,,,,,112.9100,11822.9400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,MANAGED MEDICAIRE,MANAGED MEDICAIRE,112.91,,,,,,,112.9100,11822.9400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,MEDCOST,MEDCOST VHN,5626.54,,,,,,,112.9100,11822.9400,percent of total billed charges,"47.59% of $11,822.94 in Billed Charges for Rev 278 Proc A2006 = $5,626.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,118.55,,,,,,,112.9100,11822.9400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,118.55,,,,,,,112.9100,11822.9400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,NHC ADVANTAGE,NHC ADVANTAGE,118.55,,,,,,,112.9100,11822.9400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,SENTARA HEALTH,SENTARA HEALTH,3051.50,,,,,,,112.9100,11822.9400,percent of total billed charges,"25.81% of $11,822.94 in Billed Charges for Rev 278 Proc A2006 = $3,051.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,SENTARA HEALTH,SENTARA MEDICARE,112.91,,,,,,,112.9100,11822.9400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11822.94,,,,,,,112.9100,11822.9400,percent of total billed charges,"100% of $11,822.94 in Billed Charges for Rev 278 Proc A2006 = $11,822.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,112.91,,,,,,,112.9100,11822.9400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,112.91,,,,,,,112.9100,11822.9400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,WELLCARE,WELLCARE MEDICAID,11822.94,,,,,,,112.9100,11822.9400,percent of total billed charges,"100% of $11,822.94 in Billed Charges for Rev 278 Proc A2006 = $11,822.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 10 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,11822.9400,1773.4400,WELLCARE,WELLCARE MEDICARE,119.68,,,,,,,112.9100,11822.9400,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,AETNA,AETNA,11350.02,,,,,,,112.9100,23645.8800,percent of total billed charges,"48% of $23,645.88 in Billed Charges for Rev 278 Proc A2006 = $11,350.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,112.91,,,,,,,112.9100,23645.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,AETNA,AETNA HEALTHCARE MEDICARE,112.91,,,,,,,112.9100,23645.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,ALLCARE MEDICARE,ALLCARE MEDICARE,112.91,,,,,,,112.9100,23645.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,AMBETTER,AMBETTER,246.13,,,,,,,112.9100,23645.8800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,117.42,,,,,,,112.9100,23645.8800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,BLUE CROSS,ANTHEM EXCHANGE,277.98,,,,,,,112.9100,23645.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,BLUE CROSS,ANTHEM HMO,295.34,,,,,,,112.9100,23645.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,116.29,,,,,,,112.9100,23645.8800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",347.44,,,,,,,112.9100,23645.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11822.94,,,,,,,112.9100,23645.8800,percent of total billed charges,"50% of $23,645.88 in Billed Charges for Rev 278 Proc A2006 = $11,822.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,BLUE CROSS,BLUE CROSS MEDICARE,117.42,,,,,,,112.9100,23645.8800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,CIGNA HEALTHCARE,CIGNA HMO,9860.33,,,,,,,112.9100,23645.8800,percent of total billed charges,"41.7% of $23,645.88 in Billed Charges for Rev 278 Proc A2006 = $9,860.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,9458.35,,,,,,,112.9100,23645.8800,percent of total billed charges,"40% of $23,645.88 in Billed Charges for Rev 278 Proc A2006 = $9,458.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,CIGNA HEALTHCARE,CIGNA MEDICARE,118.55,,,,,,,112.9100,23645.8800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9860.33,,,,,,,112.9100,23645.8800,percent of total billed charges,"41.7% of $23,645.88 in Billed Charges for Rev 278 Proc A2006 = $9,860.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,CIGNA HEALTHCARE,CIGNA PPO,9860.33,,,,,,,112.9100,23645.8800,percent of total billed charges,"41.7% of $23,645.88 in Billed Charges for Rev 278 Proc A2006 = $9,860.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,118.55,,,,,,,112.9100,23645.8800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,21281.29,,,,,,,112.9100,23645.8800,percent of total billed charges,"90% of $23,645.88 in Billed Charges for Rev 278 Proc A2006 = $21,281.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,HUMANA,HUMANA MEDICARE,112.91,,,,,,,112.9100,23645.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,MANAGED MEDICAIRE,MANAGED MEDICAIRE,112.91,,,,,,,112.9100,23645.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,MEDCOST,MEDCOST VHN,11253.07,,,,,,,112.9100,23645.8800,percent of total billed charges,"47.59% of $23,645.88 in Billed Charges for Rev 278 Proc A2006 = $11,253.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,118.55,,,,,,,112.9100,23645.8800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,118.55,,,,,,,112.9100,23645.8800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,NHC ADVANTAGE,NHC ADVANTAGE,118.55,,,,,,,112.9100,23645.8800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,SENTARA HEALTH,SENTARA HEALTH,6103.00,,,,,,,112.9100,23645.8800,percent of total billed charges,"25.81% of $23,645.88 in Billed Charges for Rev 278 Proc A2006 = $6,103.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,SENTARA HEALTH,SENTARA MEDICARE,112.91,,,,,,,112.9100,23645.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",23645.88,,,,,,,112.9100,23645.8800,percent of total billed charges,"100% of $23,645.88 in Billed Charges for Rev 278 Proc A2006 = $23,645.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1773.44,,,,,,,112.9100,23645.8800,percent of total billed charges,"7.5% of $23,645.88 in Billed Charges for Rev 278 Proc A2006 = $1,773.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1678.86,,,,,,,112.9100,23645.8800,percent of total billed charges,"7.1% of $23,645.88 in Billed Charges for Rev 278 Proc A2006 = $1,678.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,UNITED HEALTHCARE,UNITED HEALTHCARE,1678.86,,,,,,,112.9100,23645.8800,percent of total billed charges,"7.1% of $23,645.88 in Billed Charges for Rev 278 Proc A2006 = $1,678.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,112.91,,,,,,,112.9100,23645.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,112.91,,,,,,,112.9100,23645.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,WELLCARE,WELLCARE MEDICAID,23645.88,,,,,,,112.9100,23645.8800,percent of total billed charges,"100% of $23,645.88 in Billed Charges for Rev 278 Proc A2006 = $23,645.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 10 X 20 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,23645.8800,3546.8800,WELLCARE,WELLCARE MEDICARE,119.68,,,,,,,112.9100,23645.8800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,AETNA,AETNA,43130.08,,,,,,,112.9100,89854.3400,percent of total billed charges,"48% of $89,854.34 in Billed Charges for Rev 278 Proc A2006 = $43,130.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,112.91,,,,,,,112.9100,89854.3400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,AETNA,AETNA HEALTHCARE MEDICARE,112.91,,,,,,,112.9100,89854.3400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,112.91,,,,,,,112.9100,89854.3400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,AMBETTER,AMBETTER,246.13,,,,,,,112.9100,89854.3400,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,117.42,,,,,,,112.9100,89854.3400,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,BLUE CROSS,ANTHEM EXCHANGE,277.98,,,,,,,112.9100,89854.3400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,BLUE CROSS,ANTHEM HMO,295.34,,,,,,,112.9100,89854.3400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,116.29,,,,,,,112.9100,89854.3400,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",347.44,,,,,,,112.9100,89854.3400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,44927.17,,,,,,,112.9100,89854.3400,percent of total billed charges,"50% of $89,854.34 in Billed Charges for Rev 278 Proc A2006 = $44,927.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,BLUE CROSS,BLUE CROSS MEDICARE,117.42,,,,,,,112.9100,89854.3400,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,CIGNA HEALTHCARE,CIGNA HMO,37469.26,,,,,,,112.9100,89854.3400,percent of total billed charges,"41.7% of $89,854.34 in Billed Charges for Rev 278 Proc A2006 = $37,469.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,35941.74,,,,,,,112.9100,89854.3400,percent of total billed charges,"40% of $89,854.34 in Billed Charges for Rev 278 Proc A2006 = $35,941.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,118.55,,,,,,,112.9100,89854.3400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,37469.26,,,,,,,112.9100,89854.3400,percent of total billed charges,"41.7% of $89,854.34 in Billed Charges for Rev 278 Proc A2006 = $37,469.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,CIGNA HEALTHCARE,CIGNA PPO,37469.26,,,,,,,112.9100,89854.3400,percent of total billed charges,"41.7% of $89,854.34 in Billed Charges for Rev 278 Proc A2006 = $37,469.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,118.55,,,,,,,112.9100,89854.3400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,80868.91,,,,,,,112.9100,89854.3400,percent of total billed charges,"90% of $89,854.34 in Billed Charges for Rev 278 Proc A2006 = $80,868.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,HUMANA,HUMANA MEDICARE,112.91,,,,,,,112.9100,89854.3400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,112.91,,,,,,,112.9100,89854.3400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,MEDCOST,MEDCOST VHN,42761.68,,,,,,,112.9100,89854.3400,percent of total billed charges,"47.59% of $89,854.34 in Billed Charges for Rev 278 Proc A2006 = $42,761.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,118.55,,,,,,,112.9100,89854.3400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,118.55,,,,,,,112.9100,89854.3400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,NHC ADVANTAGE,NHC ADVANTAGE,118.55,,,,,,,112.9100,89854.3400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,SENTARA HEALTH,SENTARA HEALTH,23191.41,,,,,,,112.9100,89854.3400,percent of total billed charges,"25.81% of $89,854.34 in Billed Charges for Rev 278 Proc A2006 = $23,191.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,SENTARA HEALTH,SENTARA MEDICARE,112.91,,,,,,,112.9100,89854.3400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",89854.34,,,,,,,112.9100,89854.3400,percent of total billed charges,"100% of $89,854.34 in Billed Charges for Rev 278 Proc A2006 = $89,854.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,6739.08,,,,,,,112.9100,89854.3400,percent of total billed charges,"7.5% of $89,854.34 in Billed Charges for Rev 278 Proc A2006 = $6,739.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,6379.66,,,,,,,112.9100,89854.3400,percent of total billed charges,"7.1% of $89,854.34 in Billed Charges for Rev 278 Proc A2006 = $6,379.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,6379.66,,,,,,,112.9100,89854.3400,percent of total billed charges,"7.1% of $89,854.34 in Billed Charges for Rev 278 Proc A2006 = $6,379.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,112.91,,,,,,,112.9100,89854.3400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,112.91,,,,,,,112.9100,89854.3400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,WELLCARE,WELLCARE MEDICAID,89854.34,,,,,,,112.9100,89854.3400,percent of total billed charges,"100% of $89,854.34 in Billed Charges for Rev 278 Proc A2006 = $89,854.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WOUND MATRIX 20 X 40 NOVOSORB BTM,A2006,HCPCS,278,RC,27800840,CDM,,,,both,,,89854.3400,13478.1500,WELLCARE,WELLCARE MEDICARE,119.68,,,,,,,112.9100,89854.3400,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,AETNA,AETNA,995.40,,,,,,,112.9100,2331.1400,percent of total billed charges,"42.7% of $2,331.14 in Billed Charges for Rev 636 Proc A2011 = $995.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,112.91,,,,,,,112.9100,2331.1400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,AETNA,AETNA HEALTHCARE MEDICARE,112.91,,,,,,,112.9100,2331.1400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,ALLCARE MEDICARE,ALLCARE MEDICARE,112.91,,,,,,,112.9100,2331.1400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,AMBETTER,AMBETTER,246.13,,,,,,,112.9100,2331.1400,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,117.42,,,,,,,112.9100,2331.1400,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,116.29,,,,,,,112.9100,2331.1400,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1631.80,,,,,,,112.9100,2331.1400,percent of total billed charges,"Rev 636 Proc A2011 $2,331.14 in Billed Charges at 70% = $1,631.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,BLUE CROSS,BLUE CROSS MEDICARE,117.42,,,,,,,112.9100,2331.1400,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,CIGNA HEALTHCARE,CIGNA HMO,972.09,,,,,,,112.9100,2331.1400,percent of total billed charges,"41.7% of $2,331.14 in Billed Charges for Rev 636 Proc A2011 = $972.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1704.06,,,,,,,112.9100,2331.1400,percent of total billed charges,"Rev 636 Proc A2011 $2,331.14 in Billed Charges at 73.1% = $1,704.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,CIGNA HEALTHCARE,CIGNA MEDICARE,118.55,,,,,,,112.9100,2331.1400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,972.09,,,,,,,112.9100,2331.1400,percent of total billed charges,"41.7% of $2,331.14 in Billed Charges for Rev 636 Proc A2011 = $972.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,CIGNA HEALTHCARE,CIGNA PPO,972.09,,,,,,,112.9100,2331.1400,percent of total billed charges,"41.7% of $2,331.14 in Billed Charges for Rev 636 Proc A2011 = $972.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,118.55,,,,,,,112.9100,2331.1400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2098.03,,,,,,,112.9100,2331.1400,percent of total billed charges,"90% of $2,331.14 in Billed Charges for Rev 636 Proc A2011 = $2,098.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,HUMANA,HUMANA MEDICARE,112.91,,,,,,,112.9100,2331.1400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,MANAGED MEDICAIRE,MANAGED MEDICAIRE,112.91,,,,,,,112.9100,2331.1400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,MEDCOST,MEDCOST VHN,1109.39,,,,,,,112.9100,2331.1400,percent of total billed charges,"47.59% of $2,331.14 in Billed Charges for Rev 636 Proc A2011 = $1,109.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,118.55,,,,,,,112.9100,2331.1400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,118.55,,,,,,,112.9100,2331.1400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,NHC ADVANTAGE,NHC ADVANTAGE,118.55,,,,,,,112.9100,2331.1400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,SENTARA HEALTH,SENTARA HEALTH,601.67,,,,,,,112.9100,2331.1400,percent of total billed charges,"25.81% of $2,331.14 in Billed Charges for Rev 636 Proc A2011 = $601.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,SENTARA HEALTH,SENTARA MEDICARE,112.91,,,,,,,112.9100,2331.1400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2331.14,,,,,,,112.9100,2331.1400,percent of total billed charges,"100% of $2,331.14 in Billed Charges for Rev 636 Proc A2011 = $2,331.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,112.91,,,,,,,112.9100,2331.1400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,112.91,,,,,,,112.9100,2331.1400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,WELLCARE,WELLCARE MEDICAID,2331.14,,,,,,,112.9100,2331.1400,percent of total billed charges,"100% of $2,331.14 in Billed Charges for Rev 636 Proc A2011 = $2,331.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 2X2CM,A2011,HCPCS,636,RC,,,,,,both,,,2331.1400,349.6700,WELLCARE,WELLCARE MEDICARE,119.68,,,,,,,112.9100,2331.1400,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,AETNA,AETNA,258.31,,,,,,,112.9100,538.1400,percent of total billed charges,48% of $538.14 in Billed Charges for Rev 278 Proc A2011 = $258.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,112.91,,,,,,,112.9100,538.1400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,AETNA,AETNA HEALTHCARE MEDICARE,112.91,,,,,,,112.9100,538.1400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,ALLCARE MEDICARE,ALLCARE MEDICARE,112.91,,,,,,,112.9100,538.1400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,AMBETTER,AMBETTER,246.13,,,,,,,112.9100,538.1400,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,117.42,,,,,,,112.9100,538.1400,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,BLUE CROSS,ANTHEM EXCHANGE,277.98,,,,,,,112.9100,538.1400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,BLUE CROSS,ANTHEM HMO,295.34,,,,,,,112.9100,538.1400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,116.29,,,,,,,112.9100,538.1400,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",347.44,,,,,,,112.9100,538.1400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,269.07,,,,,,,112.9100,538.1400,percent of total billed charges,50% of $538.14 in Billed Charges for Rev 278 Proc A2011 = $269.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,BLUE CROSS,BLUE CROSS MEDICARE,117.42,,,,,,,112.9100,538.1400,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,CIGNA HEALTHCARE,CIGNA HMO,224.40,,,,,,,112.9100,538.1400,percent of total billed charges,41.7% of $538.14 in Billed Charges for Rev 278 Proc A2011 = $224.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,215.26,,,,,,,112.9100,538.1400,percent of total billed charges,40% of $538.14 in Billed Charges for Rev 278 Proc A2011 = $215.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,CIGNA HEALTHCARE,CIGNA MEDICARE,118.55,,,,,,,112.9100,538.1400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,224.40,,,,,,,112.9100,538.1400,percent of total billed charges,41.7% of $538.14 in Billed Charges for Rev 278 Proc A2011 = $224.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,CIGNA HEALTHCARE,CIGNA PPO,224.40,,,,,,,112.9100,538.1400,percent of total billed charges,41.7% of $538.14 in Billed Charges for Rev 278 Proc A2011 = $224.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,118.55,,,,,,,112.9100,538.1400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,484.33,,,,,,,112.9100,538.1400,percent of total billed charges,90% of $538.14 in Billed Charges for Rev 278 Proc A2011 = $484.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,HUMANA,HUMANA MEDICARE,112.91,,,,,,,112.9100,538.1400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,MANAGED MEDICAIRE,MANAGED MEDICAIRE,112.91,,,,,,,112.9100,538.1400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,MEDCOST,MEDCOST VHN,256.10,,,,,,,112.9100,538.1400,percent of total billed charges,47.59% of $538.14 in Billed Charges for Rev 278 Proc A2011 = $256.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,118.55,,,,,,,112.9100,538.1400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,118.55,,,,,,,112.9100,538.1400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,NHC ADVANTAGE,NHC ADVANTAGE,118.55,,,,,,,112.9100,538.1400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,SENTARA HEALTH,SENTARA HEALTH,138.89,,,,,,,112.9100,538.1400,percent of total billed charges,25.81% of $538.14 in Billed Charges for Rev 278 Proc A2011 = $138.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,SENTARA HEALTH,SENTARA MEDICARE,112.91,,,,,,,112.9100,538.1400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",538.14,,,,,,,112.9100,538.1400,percent of total billed charges,100% of $538.14 in Billed Charges for Rev 278 Proc A2011 = $538.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,112.91,,,,,,,112.9100,538.1400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,112.91,,,,,,,112.9100,538.1400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,WELLCARE,WELLCARE MEDICAID,538.14,,,,,,,112.9100,538.1400,percent of total billed charges,100% of $538.14 in Billed Charges for Rev 278 Proc A2011 = $538.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
DRESSING WOUND SUPRA SDRM BIODEGRADABLE MATRIX 5.1X5.1CM,A2011,HCPCS,278,RC,27800841,CDM,,,,both,,,538.1400,80.7200,WELLCARE,WELLCARE MEDICARE,119.68,,,,,,,112.9100,538.1400,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,AETNA,AETNA,2.56,,,,,,,1.5500,246.1300,percent of total billed charges,42.7% of $6.00 in Billed Charges for Rev 636 Proc A2011 = $2.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,6.00,,,,,,,1.5500,246.1300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,AETNA,AETNA HEALTHCARE MEDICARE,6.00,,,,,,,1.5500,246.1300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,6.00,,,,,,,1.5500,246.1300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,AMBETTER,AMBETTER,246.13,,,,,,,1.5500,246.1300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,6.00,,,,,,,1.5500,246.1300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,6.00,,,,,,,1.5500,246.1300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4.20,,,,,,,1.5500,246.1300,percent of total billed charges,Rev 636 Proc A2011 $6.00 in Billed Charges at 70% = $4.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,BLUE CROSS,BLUE CROSS MEDICARE,117.42,,,,,,,1.5500,246.1300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,CIGNA HEALTHCARE,CIGNA HMO,2.50,,,,,,,1.5500,246.1300,percent of total billed charges,41.7% of $6.00 in Billed Charges for Rev 636 Proc A2011 = $2.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4.39,,,,,,,1.5500,246.1300,percent of total billed charges,Rev 636 Proc A2011 $6.00 in Billed Charges at 73.1% = $4.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,6.00,,,,,,,1.5500,246.1300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2.50,,,,,,,1.5500,246.1300,percent of total billed charges,41.7% of $6.00 in Billed Charges for Rev 636 Proc A2011 = $2.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,CIGNA HEALTHCARE,CIGNA PPO,2.50,,,,,,,1.5500,246.1300,percent of total billed charges,41.7% of $6.00 in Billed Charges for Rev 636 Proc A2011 = $2.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,6.00,,,,,,,1.5500,246.1300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5.40,,,,,,,1.5500,246.1300,percent of total billed charges,90% of $6.00 in Billed Charges for Rev 636 Proc A2011 = $5.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,HUMANA,HUMANA MEDICARE,6.00,,,,,,,1.5500,246.1300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,6.00,,,,,,,1.5500,246.1300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,MEDCOST,MEDCOST VHN,2.86,,,,,,,1.5500,246.1300,percent of total billed charges,47.59% of $6.00 in Billed Charges for Rev 636 Proc A2011 = $2.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,6.00,,,,,,,1.5500,246.1300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,6.00,,,,,,,1.5500,246.1300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,NHC ADVANTAGE,NHC ADVANTAGE,6.00,,,,,,,1.5500,246.1300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,SENTARA HEALTH,SENTARA HEALTH,1.55,,,,,,,1.5500,246.1300,percent of total billed charges,25.81% of $6.00 in Billed Charges for Rev 636 Proc A2011 = $1.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,SENTARA HEALTH,SENTARA MEDICARE,6.00,,,,,,,1.5500,246.1300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6.00,,,,,,,1.5500,246.1300,percent of total billed charges,100% of $6.00 in Billed Charges for Rev 636 Proc A2011 = $6.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,6.00,,,,,,,1.5500,246.1300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,6.00,,,,,,,1.5500,246.1300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,WELLCARE,WELLCARE MEDICAID,6.00,,,,,,,1.5500,246.1300,percent of total billed charges,100% of $6.00 in Billed Charges for Rev 636 Proc A2011 = $6.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DRESSING SUPRA SDRM 18MM DISC,A2011,HCPCS,636,RC,63600529,CDM,,,,both,,,6.0000,0.9000,WELLCARE,WELLCARE MEDICARE,119.68,,,,,,,1.5500,246.1300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
ANCHOR HEALIX ADVACNE KNOTLESS PEEK 5.5MM 222585,C1713,HCPCS,278,RC,,,,,,both,,,7164.1800,1074.6300,AETNA,AETNA,3438.81,,,,,,,1849.0700,7164.1800,percent of total billed charges,"48% of $7,164.18 in Billed Charges for Rev 278 Proc C1713 = $3,438.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR HEALIX ADVACNE KNOTLESS PEEK 5.5MM 222585,C1713,HCPCS,278,RC,,,,,,both,,,7164.1800,1074.6300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3582.09,,,,,,,1849.0700,7164.1800,percent of total billed charges,"50% of $7,164.18 in Billed Charges for Rev 278 Proc C1713 = $3,582.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR HEALIX ADVACNE KNOTLESS PEEK 5.5MM 222585,C1713,HCPCS,278,RC,,,,,,both,,,7164.1800,1074.6300,CIGNA HEALTHCARE,CIGNA HMO,2987.46,,,,,,,1849.0700,7164.1800,percent of total billed charges,"41.7% of $7,164.18 in Billed Charges for Rev 278 Proc C1713 = $2,987.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR HEALIX ADVACNE KNOTLESS PEEK 5.5MM 222585,C1713,HCPCS,278,RC,,,,,,both,,,7164.1800,1074.6300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2865.67,,,,,,,1849.0700,7164.1800,percent of total billed charges,"40% of $7,164.18 in Billed Charges for Rev 278 Proc C1713 = $2,865.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR HEALIX ADVACNE KNOTLESS PEEK 5.5MM 222585,C1713,HCPCS,278,RC,,,,,,both,,,7164.1800,1074.6300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2987.46,,,,,,,1849.0700,7164.1800,percent of total billed charges,"41.7% of $7,164.18 in Billed Charges for Rev 278 Proc C1713 = $2,987.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR HEALIX ADVACNE KNOTLESS PEEK 5.5MM 222585,C1713,HCPCS,278,RC,,,,,,both,,,7164.1800,1074.6300,CIGNA HEALTHCARE,CIGNA PPO,2987.46,,,,,,,1849.0700,7164.1800,percent of total billed charges,"41.7% of $7,164.18 in Billed Charges for Rev 278 Proc C1713 = $2,987.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR HEALIX ADVACNE KNOTLESS PEEK 5.5MM 222585,C1713,HCPCS,278,RC,,,,,,both,,,7164.1800,1074.6300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6447.76,,,,,,,1849.0700,7164.1800,percent of total billed charges,"90% of $7,164.18 in Billed Charges for Rev 278 Proc C1713 = $6,447.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR HEALIX ADVACNE KNOTLESS PEEK 5.5MM 222585,C1713,HCPCS,278,RC,,,,,,both,,,7164.1800,1074.6300,MEDCOST,MEDCOST VHN,3409.43,,,,,,,1849.0700,7164.1800,percent of total billed charges,"47.59% of $7,164.18 in Billed Charges for Rev 278 Proc C1713 = $3,409.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR HEALIX ADVACNE KNOTLESS PEEK 5.5MM 222585,C1713,HCPCS,278,RC,,,,,,both,,,7164.1800,1074.6300,SENTARA HEALTH,SENTARA HEALTH,1849.07,,,,,,,1849.0700,7164.1800,percent of total billed charges,"25.81% of $7,164.18 in Billed Charges for Rev 278 Proc C1713 = $1,849.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR HEALIX ADVACNE KNOTLESS PEEK 5.5MM 222585,C1713,HCPCS,278,RC,,,,,,both,,,7164.1800,1074.6300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7164.18,,,,,,,1849.0700,7164.1800,percent of total billed charges,"100% of $7,164.18 in Billed Charges for Rev 278 Proc C1713 = $7,164.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR HEALIX ADVACNE KNOTLESS PEEK 5.5MM 222585,C1713,HCPCS,278,RC,,,,,,both,,,7164.1800,1074.6300,WELLCARE,WELLCARE MEDICAID,7164.18,,,,,,,1849.0700,7164.1800,percent of total billed charges,"100% of $7,164.18 in Billed Charges for Rev 278 Proc C1713 = $7,164.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7409.2500,1111.3900,AETNA,AETNA,3556.44,,,,,,,1912.3300,7409.2500,percent of total billed charges,"48% of $7,409.25 in Billed Charges for Rev 278 Proc C1713 = $3,556.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7409.2500,1111.3900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3704.63,,,,,,,1912.3300,7409.2500,percent of total billed charges,"50% of $7,409.25 in Billed Charges for Rev 278 Proc C1713 = $3,704.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7409.2500,1111.3900,CIGNA HEALTHCARE,CIGNA HMO,3089.66,,,,,,,1912.3300,7409.2500,percent of total billed charges,"41.7% of $7,409.25 in Billed Charges for Rev 278 Proc C1713 = $3,089.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7409.2500,1111.3900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2963.70,,,,,,,1912.3300,7409.2500,percent of total billed charges,"40% of $7,409.25 in Billed Charges for Rev 278 Proc C1713 = $2,963.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7409.2500,1111.3900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3089.66,,,,,,,1912.3300,7409.2500,percent of total billed charges,"41.7% of $7,409.25 in Billed Charges for Rev 278 Proc C1713 = $3,089.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7409.2500,1111.3900,CIGNA HEALTHCARE,CIGNA PPO,3089.66,,,,,,,1912.3300,7409.2500,percent of total billed charges,"41.7% of $7,409.25 in Billed Charges for Rev 278 Proc C1713 = $3,089.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7409.2500,1111.3900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6668.33,,,,,,,1912.3300,7409.2500,percent of total billed charges,"90% of $7,409.25 in Billed Charges for Rev 278 Proc C1713 = $6,668.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7409.2500,1111.3900,MEDCOST,MEDCOST VHN,3526.06,,,,,,,1912.3300,7409.2500,percent of total billed charges,"47.59% of $7,409.25 in Billed Charges for Rev 278 Proc C1713 = $3,526.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7409.2500,1111.3900,SENTARA HEALTH,SENTARA HEALTH,1912.33,,,,,,,1912.3300,7409.2500,percent of total billed charges,"25.81% of $7,409.25 in Billed Charges for Rev 278 Proc C1713 = $1,912.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7409.2500,1111.3900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7409.25,,,,,,,1912.3300,7409.2500,percent of total billed charges,"100% of $7,409.25 in Billed Charges for Rev 278 Proc C1713 = $7,409.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7409.2500,1111.3900,WELLCARE,WELLCARE MEDICAID,7409.25,,,,,,,1912.3300,7409.2500,percent of total billed charges,"100% of $7,409.25 in Billed Charges for Rev 278 Proc C1713 = $7,409.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6762.4100,1014.3600,AETNA,AETNA,3245.96,,,,,,,1745.3800,6762.4100,percent of total billed charges,"48% of $6,762.41 in Billed Charges for Rev 278 Proc C1713 = $3,245.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6762.4100,1014.3600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3381.21,,,,,,,1745.3800,6762.4100,percent of total billed charges,"50% of $6,762.41 in Billed Charges for Rev 278 Proc C1713 = $3,381.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6762.4100,1014.3600,CIGNA HEALTHCARE,CIGNA HMO,2819.93,,,,,,,1745.3800,6762.4100,percent of total billed charges,"41.7% of $6,762.41 in Billed Charges for Rev 278 Proc C1713 = $2,819.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6762.4100,1014.3600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2704.96,,,,,,,1745.3800,6762.4100,percent of total billed charges,"40% of $6,762.41 in Billed Charges for Rev 278 Proc C1713 = $2,704.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6762.4100,1014.3600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2819.93,,,,,,,1745.3800,6762.4100,percent of total billed charges,"41.7% of $6,762.41 in Billed Charges for Rev 278 Proc C1713 = $2,819.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6762.4100,1014.3600,CIGNA HEALTHCARE,CIGNA PPO,2819.93,,,,,,,1745.3800,6762.4100,percent of total billed charges,"41.7% of $6,762.41 in Billed Charges for Rev 278 Proc C1713 = $2,819.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6762.4100,1014.3600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6086.17,,,,,,,1745.3800,6762.4100,percent of total billed charges,"90% of $6,762.41 in Billed Charges for Rev 278 Proc C1713 = $6,086.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6762.4100,1014.3600,MEDCOST,MEDCOST VHN,3218.23,,,,,,,1745.3800,6762.4100,percent of total billed charges,"47.59% of $6,762.41 in Billed Charges for Rev 278 Proc C1713 = $3,218.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6762.4100,1014.3600,SENTARA HEALTH,SENTARA HEALTH,1745.38,,,,,,,1745.3800,6762.4100,percent of total billed charges,"25.81% of $6,762.41 in Billed Charges for Rev 278 Proc C1713 = $1,745.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6762.4100,1014.3600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6762.41,,,,,,,1745.3800,6762.4100,percent of total billed charges,"100% of $6,762.41 in Billed Charges for Rev 278 Proc C1713 = $6,762.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6762.4100,1014.3600,WELLCARE,WELLCARE MEDICAID,6762.41,,,,,,,1745.3800,6762.4100,percent of total billed charges,"100% of $6,762.41 in Billed Charges for Rev 278 Proc C1713 = $6,762.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR HEALIX ADVANCE 6.5MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6440.3900,966.0600,AETNA,AETNA,3091.39,,,,,,,1662.2600,6440.3900,percent of total billed charges,"48% of $6,440.39 in Billed Charges for Rev 278 Proc C1713 = $3,091.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR HEALIX ADVANCE 6.5MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6440.3900,966.0600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3220.20,,,,,,,1662.2600,6440.3900,percent of total billed charges,"50% of $6,440.39 in Billed Charges for Rev 278 Proc C1713 = $3,220.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR HEALIX ADVANCE 6.5MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6440.3900,966.0600,CIGNA HEALTHCARE,CIGNA HMO,2685.64,,,,,,,1662.2600,6440.3900,percent of total billed charges,"41.7% of $6,440.39 in Billed Charges for Rev 278 Proc C1713 = $2,685.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR HEALIX ADVANCE 6.5MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6440.3900,966.0600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2576.16,,,,,,,1662.2600,6440.3900,percent of total billed charges,"40% of $6,440.39 in Billed Charges for Rev 278 Proc C1713 = $2,576.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR HEALIX ADVANCE 6.5MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6440.3900,966.0600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2685.64,,,,,,,1662.2600,6440.3900,percent of total billed charges,"41.7% of $6,440.39 in Billed Charges for Rev 278 Proc C1713 = $2,685.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR HEALIX ADVANCE 6.5MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6440.3900,966.0600,CIGNA HEALTHCARE,CIGNA PPO,2685.64,,,,,,,1662.2600,6440.3900,percent of total billed charges,"41.7% of $6,440.39 in Billed Charges for Rev 278 Proc C1713 = $2,685.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR HEALIX ADVANCE 6.5MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6440.3900,966.0600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5796.35,,,,,,,1662.2600,6440.3900,percent of total billed charges,"90% of $6,440.39 in Billed Charges for Rev 278 Proc C1713 = $5,796.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR HEALIX ADVANCE 6.5MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6440.3900,966.0600,MEDCOST,MEDCOST VHN,3064.98,,,,,,,1662.2600,6440.3900,percent of total billed charges,"47.59% of $6,440.39 in Billed Charges for Rev 278 Proc C1713 = $3,064.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR HEALIX ADVANCE 6.5MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6440.3900,966.0600,SENTARA HEALTH,SENTARA HEALTH,1662.26,,,,,,,1662.2600,6440.3900,percent of total billed charges,"25.81% of $6,440.39 in Billed Charges for Rev 278 Proc C1713 = $1,662.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR HEALIX ADVANCE 6.5MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6440.3900,966.0600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6440.39,,,,,,,1662.2600,6440.3900,percent of total billed charges,"100% of $6,440.39 in Billed Charges for Rev 278 Proc C1713 = $6,440.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR HEALIX ADVANCE 6.5MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6440.3900,966.0600,WELLCARE,WELLCARE MEDICAID,6440.39,,,,,,,1662.2600,6440.3900,percent of total billed charges,"100% of $6,440.39 in Billed Charges for Rev 278 Proc C1713 = $6,440.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6824.1200,1023.6200,AETNA,AETNA,3275.58,,,,,,,1761.3100,6824.1200,percent of total billed charges,"48% of $6,824.12 in Billed Charges for Rev 278 Proc C1713 = $3,275.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6824.1200,1023.6200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3412.06,,,,,,,1761.3100,6824.1200,percent of total billed charges,"50% of $6,824.12 in Billed Charges for Rev 278 Proc C1713 = $3,412.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6824.1200,1023.6200,CIGNA HEALTHCARE,CIGNA HMO,2845.66,,,,,,,1761.3100,6824.1200,percent of total billed charges,"41.7% of $6,824.12 in Billed Charges for Rev 278 Proc C1713 = $2,845.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6824.1200,1023.6200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2729.65,,,,,,,1761.3100,6824.1200,percent of total billed charges,"40% of $6,824.12 in Billed Charges for Rev 278 Proc C1713 = $2,729.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6824.1200,1023.6200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2845.66,,,,,,,1761.3100,6824.1200,percent of total billed charges,"41.7% of $6,824.12 in Billed Charges for Rev 278 Proc C1713 = $2,845.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6824.1200,1023.6200,CIGNA HEALTHCARE,CIGNA PPO,2845.66,,,,,,,1761.3100,6824.1200,percent of total billed charges,"41.7% of $6,824.12 in Billed Charges for Rev 278 Proc C1713 = $2,845.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6824.1200,1023.6200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6141.71,,,,,,,1761.3100,6824.1200,percent of total billed charges,"90% of $6,824.12 in Billed Charges for Rev 278 Proc C1713 = $6,141.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6824.1200,1023.6200,MEDCOST,MEDCOST VHN,3247.60,,,,,,,1761.3100,6824.1200,percent of total billed charges,"47.59% of $6,824.12 in Billed Charges for Rev 278 Proc C1713 = $3,247.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6824.1200,1023.6200,SENTARA HEALTH,SENTARA HEALTH,1761.31,,,,,,,1761.3100,6824.1200,percent of total billed charges,"25.81% of $6,824.12 in Billed Charges for Rev 278 Proc C1713 = $1,761.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6824.1200,1023.6200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6824.12,,,,,,,1761.3100,6824.1200,percent of total billed charges,"100% of $6,824.12 in Billed Charges for Rev 278 Proc C1713 = $6,824.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,6824.1200,1023.6200,WELLCARE,WELLCARE MEDICAID,6824.12,,,,,,,1761.3100,6824.1200,percent of total billed charges,"100% of $6,824.12 in Billed Charges for Rev 278 Proc C1713 = $6,824.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7526.8600,1129.0300,AETNA,AETNA,3612.89,,,,,,,1942.6800,7526.8600,percent of total billed charges,"48% of $7,526.86 in Billed Charges for Rev 278 Proc C1713 = $3,612.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7526.8600,1129.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3763.43,,,,,,,1942.6800,7526.8600,percent of total billed charges,"50% of $7,526.86 in Billed Charges for Rev 278 Proc C1713 = $3,763.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7526.8600,1129.0300,CIGNA HEALTHCARE,CIGNA HMO,3138.70,,,,,,,1942.6800,7526.8600,percent of total billed charges,"41.7% of $7,526.86 in Billed Charges for Rev 278 Proc C1713 = $3,138.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7526.8600,1129.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3010.74,,,,,,,1942.6800,7526.8600,percent of total billed charges,"40% of $7,526.86 in Billed Charges for Rev 278 Proc C1713 = $3,010.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7526.8600,1129.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3138.70,,,,,,,1942.6800,7526.8600,percent of total billed charges,"41.7% of $7,526.86 in Billed Charges for Rev 278 Proc C1713 = $3,138.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7526.8600,1129.0300,CIGNA HEALTHCARE,CIGNA PPO,3138.70,,,,,,,1942.6800,7526.8600,percent of total billed charges,"41.7% of $7,526.86 in Billed Charges for Rev 278 Proc C1713 = $3,138.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7526.8600,1129.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6774.17,,,,,,,1942.6800,7526.8600,percent of total billed charges,"90% of $7,526.86 in Billed Charges for Rev 278 Proc C1713 = $6,774.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7526.8600,1129.0300,MEDCOST,MEDCOST VHN,3582.03,,,,,,,1942.6800,7526.8600,percent of total billed charges,"47.59% of $7,526.86 in Billed Charges for Rev 278 Proc C1713 = $3,582.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7526.8600,1129.0300,SENTARA HEALTH,SENTARA HEALTH,1942.68,,,,,,,1942.6800,7526.8600,percent of total billed charges,"25.81% of $7,526.86 in Billed Charges for Rev 278 Proc C1713 = $1,942.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7526.8600,1129.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7526.86,,,,,,,1942.6800,7526.8600,percent of total billed charges,"100% of $7,526.86 in Billed Charges for Rev 278 Proc C1713 = $7,526.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7526.8600,1129.0300,WELLCARE,WELLCARE MEDICAID,7526.86,,,,,,,1942.6800,7526.8600,percent of total billed charges,"100% of $7,526.86 in Billed Charges for Rev 278 Proc C1713 = $7,526.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANTERIOR CRUCIATE IMPLANT AC OPEN REPAIR KNOTLESS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,22626.9300,3394.0400,AETNA,AETNA,10860.93,,,,,,,1606.5100,22626.9300,percent of total billed charges,"48% of $22,626.93 in Billed Charges for Rev 278 Proc C1713 = $10,860.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANTERIOR CRUCIATE IMPLANT AC OPEN REPAIR KNOTLESS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,22626.9300,3394.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11313.47,,,,,,,1606.5100,22626.9300,percent of total billed charges,"50% of $22,626.93 in Billed Charges for Rev 278 Proc C1713 = $11,313.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANTERIOR CRUCIATE IMPLANT AC OPEN REPAIR KNOTLESS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,22626.9300,3394.0400,CIGNA HEALTHCARE,CIGNA HMO,9435.43,,,,,,,1606.5100,22626.9300,percent of total billed charges,"41.7% of $22,626.93 in Billed Charges for Rev 278 Proc C1713 = $9,435.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANTERIOR CRUCIATE IMPLANT AC OPEN REPAIR KNOTLESS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,22626.9300,3394.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,9050.77,,,,,,,1606.5100,22626.9300,percent of total billed charges,"40% of $22,626.93 in Billed Charges for Rev 278 Proc C1713 = $9,050.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANTERIOR CRUCIATE IMPLANT AC OPEN REPAIR KNOTLESS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,22626.9300,3394.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9435.43,,,,,,,1606.5100,22626.9300,percent of total billed charges,"41.7% of $22,626.93 in Billed Charges for Rev 278 Proc C1713 = $9,435.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANTERIOR CRUCIATE IMPLANT AC OPEN REPAIR KNOTLESS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,22626.9300,3394.0400,CIGNA HEALTHCARE,CIGNA PPO,9435.43,,,,,,,1606.5100,22626.9300,percent of total billed charges,"41.7% of $22,626.93 in Billed Charges for Rev 278 Proc C1713 = $9,435.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANTERIOR CRUCIATE IMPLANT AC OPEN REPAIR KNOTLESS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,22626.9300,3394.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,20364.24,,,,,,,1606.5100,22626.9300,percent of total billed charges,"90% of $22,626.93 in Billed Charges for Rev 278 Proc C1713 = $20,364.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANTERIOR CRUCIATE IMPLANT AC OPEN REPAIR KNOTLESS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,22626.9300,3394.0400,MEDCOST,MEDCOST VHN,10768.16,,,,,,,1606.5100,22626.9300,percent of total billed charges,"47.59% of $22,626.93 in Billed Charges for Rev 278 Proc C1713 = $10,768.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANTERIOR CRUCIATE IMPLANT AC OPEN REPAIR KNOTLESS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,22626.9300,3394.0400,SENTARA HEALTH,SENTARA HEALTH,5840.01,,,,,,,1606.5100,22626.9300,percent of total billed charges,"25.81% of $22,626.93 in Billed Charges for Rev 278 Proc C1713 = $5,840.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANTERIOR CRUCIATE IMPLANT AC OPEN REPAIR KNOTLESS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,22626.9300,3394.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",22626.93,,,,,,,1606.5100,22626.9300,percent of total billed charges,"100% of $22,626.93 in Billed Charges for Rev 278 Proc C1713 = $22,626.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANTERIOR CRUCIATE IMPLANT AC OPEN REPAIR KNOTLESS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,22626.9300,3394.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1697.02,,,,,,,1606.5100,22626.9300,percent of total billed charges,"7.5% of $22,626.93 in Billed Charges for Rev 278 Proc C1713 = $1,697.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANTERIOR CRUCIATE IMPLANT AC OPEN REPAIR KNOTLESS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,22626.9300,3394.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1606.51,,,,,,,1606.5100,22626.9300,percent of total billed charges,"7.1% of $22,626.93 in Billed Charges for Rev 278 Proc C1713 = $1,606.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANTERIOR CRUCIATE IMPLANT AC OPEN REPAIR KNOTLESS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,22626.9300,3394.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,1606.51,,,,,,,1606.5100,22626.9300,percent of total billed charges,"7.1% of $22,626.93 in Billed Charges for Rev 278 Proc C1713 = $1,606.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANTERIOR CRUCIATE IMPLANT AC OPEN REPAIR KNOTLESS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,22626.9300,3394.0400,WELLCARE,WELLCARE MEDICAID,22626.93,,,,,,,1606.5100,22626.9300,percent of total billed charges,"100% of $22,626.93 in Billed Charges for Rev 278 Proc C1713 = $22,626.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,62091.1800,9313.6800,AETNA,AETNA,29803.77,,,,,,,4408.4700,62091.1800,percent of total billed charges,"48% of $62,091.18 in Billed Charges for Rev 278 Proc C1713 = $29,803.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,62091.1800,9313.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,31045.59,,,,,,,4408.4700,62091.1800,percent of total billed charges,"50% of $62,091.18 in Billed Charges for Rev 278 Proc C1713 = $31,045.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,62091.1800,9313.6800,CIGNA HEALTHCARE,CIGNA HMO,25892.02,,,,,,,4408.4700,62091.1800,percent of total billed charges,"41.7% of $62,091.18 in Billed Charges for Rev 278 Proc C1713 = $25,892.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,62091.1800,9313.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,24836.47,,,,,,,4408.4700,62091.1800,percent of total billed charges,"40% of $62,091.18 in Billed Charges for Rev 278 Proc C1713 = $24,836.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,62091.1800,9313.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,25892.02,,,,,,,4408.4700,62091.1800,percent of total billed charges,"41.7% of $62,091.18 in Billed Charges for Rev 278 Proc C1713 = $25,892.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,62091.1800,9313.6800,CIGNA HEALTHCARE,CIGNA PPO,25892.02,,,,,,,4408.4700,62091.1800,percent of total billed charges,"41.7% of $62,091.18 in Billed Charges for Rev 278 Proc C1713 = $25,892.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,62091.1800,9313.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,55882.06,,,,,,,4408.4700,62091.1800,percent of total billed charges,"90% of $62,091.18 in Billed Charges for Rev 278 Proc C1713 = $55,882.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,62091.1800,9313.6800,MEDCOST,MEDCOST VHN,29549.19,,,,,,,4408.4700,62091.1800,percent of total billed charges,"47.59% of $62,091.18 in Billed Charges for Rev 278 Proc C1713 = $29,549.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,62091.1800,9313.6800,SENTARA HEALTH,SENTARA HEALTH,16025.73,,,,,,,4408.4700,62091.1800,percent of total billed charges,"25.81% of $62,091.18 in Billed Charges for Rev 278 Proc C1713 = $16,025.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,62091.1800,9313.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",62091.18,,,,,,,4408.4700,62091.1800,percent of total billed charges,"100% of $62,091.18 in Billed Charges for Rev 278 Proc C1713 = $62,091.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,62091.1800,9313.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4656.84,,,,,,,4408.4700,62091.1800,percent of total billed charges,"7.5% of $62,091.18 in Billed Charges for Rev 278 Proc C1713 = $4,656.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,62091.1800,9313.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,4408.47,,,,,,,4408.4700,62091.1800,percent of total billed charges,"7.1% of $62,091.18 in Billed Charges for Rev 278 Proc C1713 = $4,408.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,62091.1800,9313.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,4408.47,,,,,,,4408.4700,62091.1800,percent of total billed charges,"7.1% of $62,091.18 in Billed Charges for Rev 278 Proc C1713 = $4,408.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,62091.1800,9313.6800,WELLCARE,WELLCARE MEDICAID,62091.18,,,,,,,4408.4700,62091.1800,percent of total billed charges,"100% of $62,091.18 in Billed Charges for Rev 278 Proc C1713 = $62,091.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM COAGULATION EPISENSE 3CM WITH VISITRAX,272,RC,27200002,CDM,,,,,,both,,,124400.1500,18660.0200,AETNA,AETNA,53118.86,,,,,,,32107.6800,124400.1500,percent of total billed charges,"42.7% of $124,400.15 in Billed Charges for Rev 272 = $53,118.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM COAGULATION EPISENSE 3CM WITH VISITRAX,272,RC,27200002,CDM,,,,,,both,,,124400.1500,18660.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,87080.11,,,,,,,32107.6800,124400.1500,percent of total billed charges,"Rev 272 $124,400.15 in Billed Charges at 70% = $87,080.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM COAGULATION EPISENSE 3CM WITH VISITRAX,272,RC,27200002,CDM,,,,,,both,,,124400.1500,18660.0200,CIGNA HEALTHCARE,CIGNA HMO,51874.86,,,,,,,32107.6800,124400.1500,percent of total billed charges,"41.7% of $124,400.15 in Billed Charges for Rev 272 = $51,874.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM COAGULATION EPISENSE 3CM WITH VISITRAX,272,RC,27200002,CDM,,,,,,both,,,124400.1500,18660.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,57721.67,,,,,,,32107.6800,124400.1500,percent of total billed charges,"46.4% of $124,400.15 in Billed Charges for Rev 272 = $57,721.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM COAGULATION EPISENSE 3CM WITH VISITRAX,272,RC,27200002,CDM,,,,,,both,,,124400.1500,18660.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,51874.86,,,,,,,32107.6800,124400.1500,percent of total billed charges,"41.7% of $124,400.15 in Billed Charges for Rev 272 = $51,874.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM COAGULATION EPISENSE 3CM WITH VISITRAX,272,RC,27200002,CDM,,,,,,both,,,124400.1500,18660.0200,CIGNA HEALTHCARE,CIGNA PPO,51874.86,,,,,,,32107.6800,124400.1500,percent of total billed charges,"41.7% of $124,400.15 in Billed Charges for Rev 272 = $51,874.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM COAGULATION EPISENSE 3CM WITH VISITRAX,272,RC,27200002,CDM,,,,,,both,,,124400.1500,18660.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,111960.14,,,,,,,32107.6800,124400.1500,percent of total billed charges,"90% of $124,400.15 in Billed Charges for Rev 272 = $111,960.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM COAGULATION EPISENSE 3CM WITH VISITRAX,272,RC,27200002,CDM,,,,,,both,,,124400.1500,18660.0200,MEDCOST,MEDCOST VHN,59202.03,,,,,,,32107.6800,124400.1500,percent of total billed charges,"47.59% of $124,400.15 in Billed Charges for Rev 272 = $59,202.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM COAGULATION EPISENSE 3CM WITH VISITRAX,272,RC,27200002,CDM,,,,,,both,,,124400.1500,18660.0200,SENTARA HEALTH,SENTARA HEALTH,32107.68,,,,,,,32107.6800,124400.1500,percent of total billed charges,"25.81% of $124,400.15 in Billed Charges for Rev 272 = $32,107.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM COAGULATION EPISENSE 3CM WITH VISITRAX,272,RC,27200002,CDM,,,,,,both,,,124400.1500,18660.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",124400.15,,,,,,,32107.6800,124400.1500,percent of total billed charges,"100% of $124,400.15 in Billed Charges for Rev 272 = $124,400.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM COAGULATION EPISENSE 3CM WITH VISITRAX,272,RC,27200002,CDM,,,,,,both,,,124400.1500,18660.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,62200.08,,,,,,,32107.6800,124400.1500,percent of total billed charges,"Rev 272 $124,400.15 in Billed Charges at 50% = $62,200.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM COAGULATION EPISENSE 3CM WITH VISITRAX,272,RC,27200002,CDM,,,,,,both,,,124400.1500,18660.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,40181.25,,,,,,,32107.6800,124400.1500,other,"32.3% of $124,400.15 in Billed Charges for Rev 272 = $40,181.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM COAGULATION EPISENSE 3CM WITH VISITRAX,272,RC,27200002,CDM,,,,,,both,,,124400.1500,18660.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,38190.85,,,,,,,32107.6800,124400.1500,other,"30.7% of $124,400.15 in Billed Charges for Rev 272 = $38,190.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM COAGULATION EPISENSE 3CM WITH VISITRAX,272,RC,27200002,CDM,,,,,,both,,,124400.1500,18660.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,40181.25,,,,,,,32107.6800,124400.1500,percent of total billed charges,"32.3% of $124,400.15 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM COAGULATION EPISENSE 3CM WITH VISITRAX,272,RC,27200002,CDM,,,,,,both,,,124400.1500,18660.0200,WELLCARE,WELLCARE MEDICAID,124400.15,,,,,,,32107.6800,124400.1500,percent of total billed charges,"100% of $124,400.15 in Billed Charges for Rev 272 = $124,400.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CONDRYL FLAP REPAIR AR-4095S,272,RC,27200002,CDM,,,,,,both,,,8991.6600,1348.7500,AETNA,AETNA,3839.44,,,,,,,2320.7500,8991.6600,percent of total billed charges,"42.7% of $8,991.66 in Billed Charges for Rev 272 = $3,839.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CONDRYL FLAP REPAIR AR-4095S,272,RC,27200002,CDM,,,,,,both,,,8991.6600,1348.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6294.16,,,,,,,2320.7500,8991.6600,percent of total billed charges,"Rev 272 $8,991.66 in Billed Charges at 70% = $6,294.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CONDRYL FLAP REPAIR AR-4095S,272,RC,27200002,CDM,,,,,,both,,,8991.6600,1348.7500,CIGNA HEALTHCARE,CIGNA HMO,3749.52,,,,,,,2320.7500,8991.6600,percent of total billed charges,"41.7% of $8,991.66 in Billed Charges for Rev 272 = $3,749.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CONDRYL FLAP REPAIR AR-4095S,272,RC,27200002,CDM,,,,,,both,,,8991.6600,1348.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4172.13,,,,,,,2320.7500,8991.6600,percent of total billed charges,"46.4% of $8,991.66 in Billed Charges for Rev 272 = $4,172.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CONDRYL FLAP REPAIR AR-4095S,272,RC,27200002,CDM,,,,,,both,,,8991.6600,1348.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3749.52,,,,,,,2320.7500,8991.6600,percent of total billed charges,"41.7% of $8,991.66 in Billed Charges for Rev 272 = $3,749.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CONDRYL FLAP REPAIR AR-4095S,272,RC,27200002,CDM,,,,,,both,,,8991.6600,1348.7500,CIGNA HEALTHCARE,CIGNA PPO,3749.52,,,,,,,2320.7500,8991.6600,percent of total billed charges,"41.7% of $8,991.66 in Billed Charges for Rev 272 = $3,749.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CONDRYL FLAP REPAIR AR-4095S,272,RC,27200002,CDM,,,,,,both,,,8991.6600,1348.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8092.49,,,,,,,2320.7500,8991.6600,percent of total billed charges,"90% of $8,991.66 in Billed Charges for Rev 272 = $8,092.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CONDRYL FLAP REPAIR AR-4095S,272,RC,27200002,CDM,,,,,,both,,,8991.6600,1348.7500,MEDCOST,MEDCOST VHN,4279.13,,,,,,,2320.7500,8991.6600,percent of total billed charges,"47.59% of $8,991.66 in Billed Charges for Rev 272 = $4,279.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CONDRYL FLAP REPAIR AR-4095S,272,RC,27200002,CDM,,,,,,both,,,8991.6600,1348.7500,SENTARA HEALTH,SENTARA HEALTH,2320.75,,,,,,,2320.7500,8991.6600,percent of total billed charges,"25.81% of $8,991.66 in Billed Charges for Rev 272 = $2,320.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CONDRYL FLAP REPAIR AR-4095S,272,RC,27200002,CDM,,,,,,both,,,8991.6600,1348.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8991.66,,,,,,,2320.7500,8991.6600,percent of total billed charges,"100% of $8,991.66 in Billed Charges for Rev 272 = $8,991.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CONDRYL FLAP REPAIR AR-4095S,272,RC,27200002,CDM,,,,,,both,,,8991.6600,1348.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4495.83,,,,,,,2320.7500,8991.6600,percent of total billed charges,"Rev 272 $8,991.66 in Billed Charges at 50% = $4,495.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CONDRYL FLAP REPAIR AR-4095S,272,RC,27200002,CDM,,,,,,both,,,8991.6600,1348.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2904.31,,,,,,,2320.7500,8991.6600,other,"32.3% of $8,991.66 in Billed Charges for Rev 272 = $2,904.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM CONDRYL FLAP REPAIR AR-4095S,272,RC,27200002,CDM,,,,,,both,,,8991.6600,1348.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2760.44,,,,,,,2320.7500,8991.6600,other,"30.7% of $8,991.66 in Billed Charges for Rev 272 = $2,760.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM CONDRYL FLAP REPAIR AR-4095S,272,RC,27200002,CDM,,,,,,both,,,8991.6600,1348.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,2904.31,,,,,,,2320.7500,8991.6600,percent of total billed charges,"32.3% of $8,991.66 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM CONDRYL FLAP REPAIR AR-4095S,272,RC,27200002,CDM,,,,,,both,,,8991.6600,1348.7500,WELLCARE,WELLCARE MEDICAID,8991.66,,,,,,,2320.7500,8991.6600,percent of total billed charges,"100% of $8,991.66 in Billed Charges for Rev 272 = $8,991.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR 10.5MM X 300MM 7106-2300,C1713,HCPCS,278,RC,,,,,,both,,,3095.6400,464.3500,AETNA,AETNA,1485.91,,,,,,,798.9800,3095.6400,percent of total billed charges,"48% of $3,095.64 in Billed Charges for Rev 278 Proc C1713 = $1,485.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR 10.5MM X 300MM 7106-2300,C1713,HCPCS,278,RC,,,,,,both,,,3095.6400,464.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1547.82,,,,,,,798.9800,3095.6400,percent of total billed charges,"50% of $3,095.64 in Billed Charges for Rev 278 Proc C1713 = $1,547.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR 10.5MM X 300MM 7106-2300,C1713,HCPCS,278,RC,,,,,,both,,,3095.6400,464.3500,CIGNA HEALTHCARE,CIGNA HMO,1290.88,,,,,,,798.9800,3095.6400,percent of total billed charges,"41.7% of $3,095.64 in Billed Charges for Rev 278 Proc C1713 = $1,290.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR 10.5MM X 300MM 7106-2300,C1713,HCPCS,278,RC,,,,,,both,,,3095.6400,464.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1238.26,,,,,,,798.9800,3095.6400,percent of total billed charges,"40% of $3,095.64 in Billed Charges for Rev 278 Proc C1713 = $1,238.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR 10.5MM X 300MM 7106-2300,C1713,HCPCS,278,RC,,,,,,both,,,3095.6400,464.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1290.88,,,,,,,798.9800,3095.6400,percent of total billed charges,"41.7% of $3,095.64 in Billed Charges for Rev 278 Proc C1713 = $1,290.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR 10.5MM X 300MM 7106-2300,C1713,HCPCS,278,RC,,,,,,both,,,3095.6400,464.3500,CIGNA HEALTHCARE,CIGNA PPO,1290.88,,,,,,,798.9800,3095.6400,percent of total billed charges,"41.7% of $3,095.64 in Billed Charges for Rev 278 Proc C1713 = $1,290.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR 10.5MM X 300MM 7106-2300,C1713,HCPCS,278,RC,,,,,,both,,,3095.6400,464.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2786.08,,,,,,,798.9800,3095.6400,percent of total billed charges,"90% of $3,095.64 in Billed Charges for Rev 278 Proc C1713 = $2,786.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR 10.5MM X 300MM 7106-2300,C1713,HCPCS,278,RC,,,,,,both,,,3095.6400,464.3500,MEDCOST,MEDCOST VHN,1473.22,,,,,,,798.9800,3095.6400,percent of total billed charges,"47.59% of $3,095.64 in Billed Charges for Rev 278 Proc C1713 = $1,473.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR 10.5MM X 300MM 7106-2300,C1713,HCPCS,278,RC,,,,,,both,,,3095.6400,464.3500,SENTARA HEALTH,SENTARA HEALTH,798.98,,,,,,,798.9800,3095.6400,percent of total billed charges,"25.81% of $3,095.64 in Billed Charges for Rev 278 Proc C1713 = $798.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR 10.5MM X 300MM 7106-2300,C1713,HCPCS,278,RC,,,,,,both,,,3095.6400,464.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3095.64,,,,,,,798.9800,3095.6400,percent of total billed charges,"100% of $3,095.64 in Billed Charges for Rev 278 Proc C1713 = $3,095.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR 10.5MM X 300MM 7106-2300,C1713,HCPCS,278,RC,,,,,,both,,,3095.6400,464.3500,WELLCARE,WELLCARE MEDICAID,3095.64,,,,,,,798.9800,3095.6400,percent of total billed charges,"100% of $3,095.64 in Billed Charges for Rev 278 Proc C1713 = $3,095.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12.5IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,51761.6600,7764.2500,AETNA,AETNA,24845.60,,,,,,,3675.0800,51761.6600,percent of total billed charges,"48% of $51,761.66 in Billed Charges for Rev 278 Proc C1713 = $24,845.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12.5IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,51761.6600,7764.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,25880.83,,,,,,,3675.0800,51761.6600,percent of total billed charges,"50% of $51,761.66 in Billed Charges for Rev 278 Proc C1713 = $25,880.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12.5IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,51761.6600,7764.2500,CIGNA HEALTHCARE,CIGNA HMO,21584.61,,,,,,,3675.0800,51761.6600,percent of total billed charges,"41.7% of $51,761.66 in Billed Charges for Rev 278 Proc C1713 = $21,584.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12.5IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,51761.6600,7764.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,20704.66,,,,,,,3675.0800,51761.6600,percent of total billed charges,"40% of $51,761.66 in Billed Charges for Rev 278 Proc C1713 = $20,704.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12.5IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,51761.6600,7764.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,21584.61,,,,,,,3675.0800,51761.6600,percent of total billed charges,"41.7% of $51,761.66 in Billed Charges for Rev 278 Proc C1713 = $21,584.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12.5IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,51761.6600,7764.2500,CIGNA HEALTHCARE,CIGNA PPO,21584.61,,,,,,,3675.0800,51761.6600,percent of total billed charges,"41.7% of $51,761.66 in Billed Charges for Rev 278 Proc C1713 = $21,584.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12.5IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,51761.6600,7764.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,46585.49,,,,,,,3675.0800,51761.6600,percent of total billed charges,"90% of $51,761.66 in Billed Charges for Rev 278 Proc C1713 = $46,585.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12.5IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,51761.6600,7764.2500,MEDCOST,MEDCOST VHN,24633.37,,,,,,,3675.0800,51761.6600,percent of total billed charges,"47.59% of $51,761.66 in Billed Charges for Rev 278 Proc C1713 = $24,633.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12.5IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,51761.6600,7764.2500,SENTARA HEALTH,SENTARA HEALTH,13359.68,,,,,,,3675.0800,51761.6600,percent of total billed charges,"25.81% of $51,761.66 in Billed Charges for Rev 278 Proc C1713 = $13,359.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12.5IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,51761.6600,7764.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",51761.66,,,,,,,3675.0800,51761.6600,percent of total billed charges,"100% of $51,761.66 in Billed Charges for Rev 278 Proc C1713 = $51,761.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12.5IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,51761.6600,7764.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3882.12,,,,,,,3675.0800,51761.6600,percent of total billed charges,"7.5% of $51,761.66 in Billed Charges for Rev 278 Proc C1713 = $3,882.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12.5IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,51761.6600,7764.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3675.08,,,,,,,3675.0800,51761.6600,percent of total billed charges,"7.1% of $51,761.66 in Billed Charges for Rev 278 Proc C1713 = $3,675.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12.5IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,51761.6600,7764.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,3675.08,,,,,,,3675.0800,51761.6600,percent of total billed charges,"7.1% of $51,761.66 in Billed Charges for Rev 278 Proc C1713 = $3,675.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12.5IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,51761.6600,7764.2500,WELLCARE,WELLCARE MEDICAID,51761.66,,,,,,,3675.0800,51761.6600,percent of total billed charges,"100% of $51,761.66 in Billed Charges for Rev 278 Proc C1713 = $51,761.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,54489.2300,8173.3800,AETNA,AETNA,26154.83,,,,,,,3868.7400,54489.2300,percent of total billed charges,"48% of $54,489.23 in Billed Charges for Rev 278 Proc C1713 = $26,154.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,54489.2300,8173.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,27244.62,,,,,,,3868.7400,54489.2300,percent of total billed charges,"50% of $54,489.23 in Billed Charges for Rev 278 Proc C1713 = $27,244.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,54489.2300,8173.3800,CIGNA HEALTHCARE,CIGNA HMO,22722.01,,,,,,,3868.7400,54489.2300,percent of total billed charges,"41.7% of $54,489.23 in Billed Charges for Rev 278 Proc C1713 = $22,722.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,54489.2300,8173.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,21795.69,,,,,,,3868.7400,54489.2300,percent of total billed charges,"40% of $54,489.23 in Billed Charges for Rev 278 Proc C1713 = $21,795.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,54489.2300,8173.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,22722.01,,,,,,,3868.7400,54489.2300,percent of total billed charges,"41.7% of $54,489.23 in Billed Charges for Rev 278 Proc C1713 = $22,722.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,54489.2300,8173.3800,CIGNA HEALTHCARE,CIGNA PPO,22722.01,,,,,,,3868.7400,54489.2300,percent of total billed charges,"41.7% of $54,489.23 in Billed Charges for Rev 278 Proc C1713 = $22,722.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,54489.2300,8173.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,49040.31,,,,,,,3868.7400,54489.2300,percent of total billed charges,"90% of $54,489.23 in Billed Charges for Rev 278 Proc C1713 = $49,040.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,54489.2300,8173.3800,MEDCOST,MEDCOST VHN,25931.42,,,,,,,3868.7400,54489.2300,percent of total billed charges,"47.59% of $54,489.23 in Billed Charges for Rev 278 Proc C1713 = $25,931.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,54489.2300,8173.3800,SENTARA HEALTH,SENTARA HEALTH,14063.67,,,,,,,3868.7400,54489.2300,percent of total billed charges,"25.81% of $54,489.23 in Billed Charges for Rev 278 Proc C1713 = $14,063.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,54489.2300,8173.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",54489.23,,,,,,,3868.7400,54489.2300,percent of total billed charges,"100% of $54,489.23 in Billed Charges for Rev 278 Proc C1713 = $54,489.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,54489.2300,8173.3800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4086.69,,,,,,,3868.7400,54489.2300,percent of total billed charges,"7.5% of $54,489.23 in Billed Charges for Rev 278 Proc C1713 = $4,086.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,54489.2300,8173.3800,UNITED HEALTHCARE,UHC HERITAGE SELECT,3868.74,,,,,,,3868.7400,54489.2300,percent of total billed charges,"7.1% of $54,489.23 in Billed Charges for Rev 278 Proc C1713 = $3,868.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,54489.2300,8173.3800,UNITED HEALTHCARE,UNITED HEALTHCARE,3868.74,,,,,,,3868.7400,54489.2300,percent of total billed charges,"7.1% of $54,489.23 in Billed Charges for Rev 278 Proc C1713 = $3,868.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS BLU PREBENT TITANIUM 12IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,54489.2300,8173.3800,WELLCARE,WELLCARE MEDICAID,54489.23,,,,,,,3868.7400,54489.2300,percent of total billed charges,"100% of $54,489.23 in Billed Charges for Rev 278 Proc C1713 = $54,489.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,12445.2000,1866.7800,AETNA,AETNA,5973.70,,,,,,,3212.1100,12445.2000,percent of total billed charges,"48% of $12,445.20 in Billed Charges for Rev 278 Proc C1713 = $5,973.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,12445.2000,1866.7800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6222.60,,,,,,,3212.1100,12445.2000,percent of total billed charges,"50% of $12,445.20 in Billed Charges for Rev 278 Proc C1713 = $6,222.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,12445.2000,1866.7800,CIGNA HEALTHCARE,CIGNA HMO,5189.65,,,,,,,3212.1100,12445.2000,percent of total billed charges,"41.7% of $12,445.20 in Billed Charges for Rev 278 Proc C1713 = $5,189.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,12445.2000,1866.7800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4978.08,,,,,,,3212.1100,12445.2000,percent of total billed charges,"40% of $12,445.20 in Billed Charges for Rev 278 Proc C1713 = $4,978.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,12445.2000,1866.7800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5189.65,,,,,,,3212.1100,12445.2000,percent of total billed charges,"41.7% of $12,445.20 in Billed Charges for Rev 278 Proc C1713 = $5,189.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,12445.2000,1866.7800,CIGNA HEALTHCARE,CIGNA PPO,5189.65,,,,,,,3212.1100,12445.2000,percent of total billed charges,"41.7% of $12,445.20 in Billed Charges for Rev 278 Proc C1713 = $5,189.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,12445.2000,1866.7800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11200.68,,,,,,,3212.1100,12445.2000,percent of total billed charges,"90% of $12,445.20 in Billed Charges for Rev 278 Proc C1713 = $11,200.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,12445.2000,1866.7800,MEDCOST,MEDCOST VHN,5922.67,,,,,,,3212.1100,12445.2000,percent of total billed charges,"47.59% of $12,445.20 in Billed Charges for Rev 278 Proc C1713 = $5,922.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,12445.2000,1866.7800,SENTARA HEALTH,SENTARA HEALTH,3212.11,,,,,,,3212.1100,12445.2000,percent of total billed charges,"25.81% of $12,445.20 in Billed Charges for Rev 278 Proc C1713 = $3,212.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,12445.2000,1866.7800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12445.20,,,,,,,3212.1100,12445.2000,percent of total billed charges,"100% of $12,445.20 in Billed Charges for Rev 278 Proc C1713 = $12,445.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,12445.2000,1866.7800,WELLCARE,WELLCARE MEDICAID,12445.20,,,,,,,3212.1100,12445.2000,percent of total billed charges,"100% of $12,445.20 in Billed Charges for Rev 278 Proc C1713 = $12,445.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,22536.1800,3380.4300,AETNA,AETNA,10817.37,,,,,,,1600.0700,22536.1800,percent of total billed charges,"48% of $22,536.18 in Billed Charges for Rev 278 Proc C1713 = $10,817.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,22536.1800,3380.4300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11268.09,,,,,,,1600.0700,22536.1800,percent of total billed charges,"50% of $22,536.18 in Billed Charges for Rev 278 Proc C1713 = $11,268.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,22536.1800,3380.4300,CIGNA HEALTHCARE,CIGNA HMO,9397.59,,,,,,,1600.0700,22536.1800,percent of total billed charges,"41.7% of $22,536.18 in Billed Charges for Rev 278 Proc C1713 = $9,397.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,22536.1800,3380.4300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,9014.47,,,,,,,1600.0700,22536.1800,percent of total billed charges,"40% of $22,536.18 in Billed Charges for Rev 278 Proc C1713 = $9,014.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,22536.1800,3380.4300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,9397.59,,,,,,,1600.0700,22536.1800,percent of total billed charges,"41.7% of $22,536.18 in Billed Charges for Rev 278 Proc C1713 = $9,397.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,22536.1800,3380.4300,CIGNA HEALTHCARE,CIGNA PPO,9397.59,,,,,,,1600.0700,22536.1800,percent of total billed charges,"41.7% of $22,536.18 in Billed Charges for Rev 278 Proc C1713 = $9,397.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,22536.1800,3380.4300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,20282.56,,,,,,,1600.0700,22536.1800,percent of total billed charges,"90% of $22,536.18 in Billed Charges for Rev 278 Proc C1713 = $20,282.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,22536.1800,3380.4300,MEDCOST,MEDCOST VHN,10724.97,,,,,,,1600.0700,22536.1800,percent of total billed charges,"47.59% of $22,536.18 in Billed Charges for Rev 278 Proc C1713 = $10,724.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,22536.1800,3380.4300,SENTARA HEALTH,SENTARA HEALTH,5816.59,,,,,,,1600.0700,22536.1800,percent of total billed charges,"25.81% of $22,536.18 in Billed Charges for Rev 278 Proc C1713 = $5,816.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,22536.1800,3380.4300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",22536.18,,,,,,,1600.0700,22536.1800,percent of total billed charges,"100% of $22,536.18 in Billed Charges for Rev 278 Proc C1713 = $22,536.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,22536.1800,3380.4300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1690.21,,,,,,,1600.0700,22536.1800,percent of total billed charges,"7.5% of $22,536.18 in Billed Charges for Rev 278 Proc C1713 = $1,690.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,22536.1800,3380.4300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1600.07,,,,,,,1600.0700,22536.1800,percent of total billed charges,"7.1% of $22,536.18 in Billed Charges for Rev 278 Proc C1713 = $1,600.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,22536.1800,3380.4300,UNITED HEALTHCARE,UNITED HEALTHCARE,1600.07,,,,,,,1600.0700,22536.1800,percent of total billed charges,"7.1% of $22,536.18 in Billed Charges for Rev 278 Proc C1713 = $1,600.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,22536.1800,3380.4300,WELLCARE,WELLCARE MEDICAID,22536.18,,,,,,,1600.0700,22536.1800,percent of total billed charges,"100% of $22,536.18 in Billed Charges for Rev 278 Proc C1713 = $22,536.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM DUET DRAIN AND MONITOR,272,RC,27200002,CDM,,,,,,both,,,2768.0200,415.2000,AETNA,AETNA,1181.94,,,,,,,714.4300,2768.0200,percent of total billed charges,"42.7% of $2,768.02 in Billed Charges for Rev 272 = $1,181.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM DUET DRAIN AND MONITOR,272,RC,27200002,CDM,,,,,,both,,,2768.0200,415.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1937.61,,,,,,,714.4300,2768.0200,percent of total billed charges,"Rev 272 $2,768.02 in Billed Charges at 70% = $1,937.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM DUET DRAIN AND MONITOR,272,RC,27200002,CDM,,,,,,both,,,2768.0200,415.2000,CIGNA HEALTHCARE,CIGNA HMO,1154.26,,,,,,,714.4300,2768.0200,percent of total billed charges,"41.7% of $2,768.02 in Billed Charges for Rev 272 = $1,154.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM DUET DRAIN AND MONITOR,272,RC,27200002,CDM,,,,,,both,,,2768.0200,415.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1284.36,,,,,,,714.4300,2768.0200,percent of total billed charges,"46.4% of $2,768.02 in Billed Charges for Rev 272 = $1,284.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM DUET DRAIN AND MONITOR,272,RC,27200002,CDM,,,,,,both,,,2768.0200,415.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1154.26,,,,,,,714.4300,2768.0200,percent of total billed charges,"41.7% of $2,768.02 in Billed Charges for Rev 272 = $1,154.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM DUET DRAIN AND MONITOR,272,RC,27200002,CDM,,,,,,both,,,2768.0200,415.2000,CIGNA HEALTHCARE,CIGNA PPO,1154.26,,,,,,,714.4300,2768.0200,percent of total billed charges,"41.7% of $2,768.02 in Billed Charges for Rev 272 = $1,154.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM DUET DRAIN AND MONITOR,272,RC,27200002,CDM,,,,,,both,,,2768.0200,415.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2491.22,,,,,,,714.4300,2768.0200,percent of total billed charges,"90% of $2,768.02 in Billed Charges for Rev 272 = $2,491.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM DUET DRAIN AND MONITOR,272,RC,27200002,CDM,,,,,,both,,,2768.0200,415.2000,MEDCOST,MEDCOST VHN,1317.30,,,,,,,714.4300,2768.0200,percent of total billed charges,"47.59% of $2,768.02 in Billed Charges for Rev 272 = $1,317.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM DUET DRAIN AND MONITOR,272,RC,27200002,CDM,,,,,,both,,,2768.0200,415.2000,SENTARA HEALTH,SENTARA HEALTH,714.43,,,,,,,714.4300,2768.0200,percent of total billed charges,"25.81% of $2,768.02 in Billed Charges for Rev 272 = $714.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM DUET DRAIN AND MONITOR,272,RC,27200002,CDM,,,,,,both,,,2768.0200,415.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2768.02,,,,,,,714.4300,2768.0200,percent of total billed charges,"100% of $2,768.02 in Billed Charges for Rev 272 = $2,768.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM DUET DRAIN AND MONITOR,272,RC,27200002,CDM,,,,,,both,,,2768.0200,415.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1384.01,,,,,,,714.4300,2768.0200,percent of total billed charges,"Rev 272 $2,768.02 in Billed Charges at 50% = $1,384.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM DUET DRAIN AND MONITOR,272,RC,27200002,CDM,,,,,,both,,,2768.0200,415.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,894.07,,,,,,,714.4300,2768.0200,other,"32.3% of $2,768.02 in Billed Charges for Rev 272 = $894.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM DUET DRAIN AND MONITOR,272,RC,27200002,CDM,,,,,,both,,,2768.0200,415.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,849.78,,,,,,,714.4300,2768.0200,other,"30.7% of $2,768.02 in Billed Charges for Rev 272 = $849.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM DUET DRAIN AND MONITOR,272,RC,27200002,CDM,,,,,,both,,,2768.0200,415.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,894.07,,,,,,,714.4300,2768.0200,percent of total billed charges,"32.3% of $2,768.02 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM DUET DRAIN AND MONITOR,272,RC,27200002,CDM,,,,,,both,,,2768.0200,415.2000,WELLCARE,WELLCARE MEDICAID,2768.02,,,,,,,714.4300,2768.0200,percent of total billed charges,"100% of $2,768.02 in Billed Charges for Rev 272 = $2,768.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXT DRAIN CLOSED VOL,272,RC,,,,,,,,both,,,2942.3600,441.3500,AETNA,AETNA,1256.39,,,,,,,759.4200,2942.3600,percent of total billed charges,"42.7% of $2,942.36 in Billed Charges for Rev 272 = $1,256.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXT DRAIN CLOSED VOL,272,RC,,,,,,,,both,,,2942.3600,441.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2059.65,,,,,,,759.4200,2942.3600,percent of total billed charges,"Rev 272 $2,942.36 in Billed Charges at 70% = $2,059.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXT DRAIN CLOSED VOL,272,RC,,,,,,,,both,,,2942.3600,441.3500,CIGNA HEALTHCARE,CIGNA HMO,1226.96,,,,,,,759.4200,2942.3600,percent of total billed charges,"41.7% of $2,942.36 in Billed Charges for Rev 272 = $1,226.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXT DRAIN CLOSED VOL,272,RC,,,,,,,,both,,,2942.3600,441.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1365.26,,,,,,,759.4200,2942.3600,percent of total billed charges,"46.4% of $2,942.36 in Billed Charges for Rev 272 = $1,365.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXT DRAIN CLOSED VOL,272,RC,,,,,,,,both,,,2942.3600,441.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1226.96,,,,,,,759.4200,2942.3600,percent of total billed charges,"41.7% of $2,942.36 in Billed Charges for Rev 272 = $1,226.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXT DRAIN CLOSED VOL,272,RC,,,,,,,,both,,,2942.3600,441.3500,CIGNA HEALTHCARE,CIGNA PPO,1226.96,,,,,,,759.4200,2942.3600,percent of total billed charges,"41.7% of $2,942.36 in Billed Charges for Rev 272 = $1,226.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXT DRAIN CLOSED VOL,272,RC,,,,,,,,both,,,2942.3600,441.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2648.12,,,,,,,759.4200,2942.3600,percent of total billed charges,"90% of $2,942.36 in Billed Charges for Rev 272 = $2,648.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXT DRAIN CLOSED VOL,272,RC,,,,,,,,both,,,2942.3600,441.3500,MEDCOST,MEDCOST VHN,1400.27,,,,,,,759.4200,2942.3600,percent of total billed charges,"47.59% of $2,942.36 in Billed Charges for Rev 272 = $1,400.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXT DRAIN CLOSED VOL,272,RC,,,,,,,,both,,,2942.3600,441.3500,SENTARA HEALTH,SENTARA HEALTH,759.42,,,,,,,759.4200,2942.3600,percent of total billed charges,"25.81% of $2,942.36 in Billed Charges for Rev 272 = $759.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXT DRAIN CLOSED VOL,272,RC,,,,,,,,both,,,2942.3600,441.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2942.36,,,,,,,759.4200,2942.3600,percent of total billed charges,"100% of $2,942.36 in Billed Charges for Rev 272 = $2,942.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXT DRAIN CLOSED VOL,272,RC,,,,,,,,both,,,2942.3600,441.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1471.18,,,,,,,759.4200,2942.3600,percent of total billed charges,"Rev 272 $2,942.36 in Billed Charges at 50% = $1,471.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXT DRAIN CLOSED VOL,272,RC,,,,,,,,both,,,2942.3600,441.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,950.38,,,,,,,759.4200,2942.3600,other,"32.3% of $2,942.36 in Billed Charges for Rev 272 = $950.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM EXT DRAIN CLOSED VOL,272,RC,,,,,,,,both,,,2942.3600,441.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,903.30,,,,,,,759.4200,2942.3600,other,"30.7% of $2,942.36 in Billed Charges for Rev 272 = $903.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM EXT DRAIN CLOSED VOL,272,RC,,,,,,,,both,,,2942.3600,441.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,950.38,,,,,,,759.4200,2942.3600,percent of total billed charges,"32.3% of $2,942.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXT DRAIN CLOSED VOL,272,RC,,,,,,,,both,,,2942.3600,441.3500,WELLCARE,WELLCARE MEDICAID,2942.36,,,,,,,759.4200,2942.3600,percent of total billed charges,"100% of $2,942.36 in Billed Charges for Rev 272 = $2,942.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXTRACTION ALEXIS CONTAINED 14CM W/GELPOINT 3400ML,272,RC,27200002,CDM,,,,,,both,,,11563.6700,1734.5500,AETNA,AETNA,4937.69,,,,,,,2984.5800,11563.6700,percent of total billed charges,"42.7% of $11,563.67 in Billed Charges for Rev 272 = $4,937.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXTRACTION ALEXIS CONTAINED 14CM W/GELPOINT 3400ML,272,RC,27200002,CDM,,,,,,both,,,11563.6700,1734.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8094.57,,,,,,,2984.5800,11563.6700,percent of total billed charges,"Rev 272 $11,563.67 in Billed Charges at 70% = $8,094.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXTRACTION ALEXIS CONTAINED 14CM W/GELPOINT 3400ML,272,RC,27200002,CDM,,,,,,both,,,11563.6700,1734.5500,CIGNA HEALTHCARE,CIGNA HMO,4822.05,,,,,,,2984.5800,11563.6700,percent of total billed charges,"41.7% of $11,563.67 in Billed Charges for Rev 272 = $4,822.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXTRACTION ALEXIS CONTAINED 14CM W/GELPOINT 3400ML,272,RC,27200002,CDM,,,,,,both,,,11563.6700,1734.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5365.54,,,,,,,2984.5800,11563.6700,percent of total billed charges,"46.4% of $11,563.67 in Billed Charges for Rev 272 = $5,365.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXTRACTION ALEXIS CONTAINED 14CM W/GELPOINT 3400ML,272,RC,27200002,CDM,,,,,,both,,,11563.6700,1734.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4822.05,,,,,,,2984.5800,11563.6700,percent of total billed charges,"41.7% of $11,563.67 in Billed Charges for Rev 272 = $4,822.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXTRACTION ALEXIS CONTAINED 14CM W/GELPOINT 3400ML,272,RC,27200002,CDM,,,,,,both,,,11563.6700,1734.5500,CIGNA HEALTHCARE,CIGNA PPO,4822.05,,,,,,,2984.5800,11563.6700,percent of total billed charges,"41.7% of $11,563.67 in Billed Charges for Rev 272 = $4,822.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXTRACTION ALEXIS CONTAINED 14CM W/GELPOINT 3400ML,272,RC,27200002,CDM,,,,,,both,,,11563.6700,1734.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10407.30,,,,,,,2984.5800,11563.6700,percent of total billed charges,"90% of $11,563.67 in Billed Charges for Rev 272 = $10,407.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXTRACTION ALEXIS CONTAINED 14CM W/GELPOINT 3400ML,272,RC,27200002,CDM,,,,,,both,,,11563.6700,1734.5500,MEDCOST,MEDCOST VHN,5503.15,,,,,,,2984.5800,11563.6700,percent of total billed charges,"47.59% of $11,563.67 in Billed Charges for Rev 272 = $5,503.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXTRACTION ALEXIS CONTAINED 14CM W/GELPOINT 3400ML,272,RC,27200002,CDM,,,,,,both,,,11563.6700,1734.5500,SENTARA HEALTH,SENTARA HEALTH,2984.58,,,,,,,2984.5800,11563.6700,percent of total billed charges,"25.81% of $11,563.67 in Billed Charges for Rev 272 = $2,984.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXTRACTION ALEXIS CONTAINED 14CM W/GELPOINT 3400ML,272,RC,27200002,CDM,,,,,,both,,,11563.6700,1734.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11563.67,,,,,,,2984.5800,11563.6700,percent of total billed charges,"100% of $11,563.67 in Billed Charges for Rev 272 = $11,563.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXTRACTION ALEXIS CONTAINED 14CM W/GELPOINT 3400ML,272,RC,27200002,CDM,,,,,,both,,,11563.6700,1734.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5781.84,,,,,,,2984.5800,11563.6700,percent of total billed charges,"Rev 272 $11,563.67 in Billed Charges at 50% = $5,781.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXTRACTION ALEXIS CONTAINED 14CM W/GELPOINT 3400ML,272,RC,27200002,CDM,,,,,,both,,,11563.6700,1734.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3735.07,,,,,,,2984.5800,11563.6700,other,"32.3% of $11,563.67 in Billed Charges for Rev 272 = $3,735.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM EXTRACTION ALEXIS CONTAINED 14CM W/GELPOINT 3400ML,272,RC,27200002,CDM,,,,,,both,,,11563.6700,1734.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3550.05,,,,,,,2984.5800,11563.6700,other,"30.7% of $11,563.67 in Billed Charges for Rev 272 = $3,550.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM EXTRACTION ALEXIS CONTAINED 14CM W/GELPOINT 3400ML,272,RC,27200002,CDM,,,,,,both,,,11563.6700,1734.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,3735.07,,,,,,,2984.5800,11563.6700,percent of total billed charges,"32.3% of $11,563.67 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM EXTRACTION ALEXIS CONTAINED 14CM W/GELPOINT 3400ML,272,RC,27200002,CDM,,,,,,both,,,11563.6700,1734.5500,WELLCARE,WELLCARE MEDICAID,11563.67,,,,,,,2984.5800,11563.6700,percent of total billed charges,"100% of $11,563.67 in Billed Charges for Rev 272 = $11,563.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,766.9400,115.0400,AETNA,AETNA,368.13,,,,,,,197.9500,766.9400,percent of total billed charges,48% of $766.94 in Billed Charges for Rev 278 Proc C1713 = $368.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,766.9400,115.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,383.47,,,,,,,197.9500,766.9400,percent of total billed charges,50% of $766.94 in Billed Charges for Rev 278 Proc C1713 = $383.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,766.9400,115.0400,CIGNA HEALTHCARE,CIGNA HMO,319.81,,,,,,,197.9500,766.9400,percent of total billed charges,41.7% of $766.94 in Billed Charges for Rev 278 Proc C1713 = $319.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,766.9400,115.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,306.78,,,,,,,197.9500,766.9400,percent of total billed charges,40% of $766.94 in Billed Charges for Rev 278 Proc C1713 = $306.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,766.9400,115.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,319.81,,,,,,,197.9500,766.9400,percent of total billed charges,41.7% of $766.94 in Billed Charges for Rev 278 Proc C1713 = $319.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,766.9400,115.0400,CIGNA HEALTHCARE,CIGNA PPO,319.81,,,,,,,197.9500,766.9400,percent of total billed charges,41.7% of $766.94 in Billed Charges for Rev 278 Proc C1713 = $319.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,766.9400,115.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,690.25,,,,,,,197.9500,766.9400,percent of total billed charges,90% of $766.94 in Billed Charges for Rev 278 Proc C1713 = $690.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,766.9400,115.0400,MEDCOST,MEDCOST VHN,364.99,,,,,,,197.9500,766.9400,percent of total billed charges,47.59% of $766.94 in Billed Charges for Rev 278 Proc C1713 = $364.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,766.9400,115.0400,SENTARA HEALTH,SENTARA HEALTH,197.95,,,,,,,197.9500,766.9400,percent of total billed charges,25.81% of $766.94 in Billed Charges for Rev 278 Proc C1713 = $197.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,766.9400,115.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",766.94,,,,,,,197.9500,766.9400,percent of total billed charges,100% of $766.94 in Billed Charges for Rev 278 Proc C1713 = $766.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,766.9400,115.0400,WELLCARE,WELLCARE MEDICAID,766.94,,,,,,,197.9500,766.9400,percent of total billed charges,100% of $766.94 in Billed Charges for Rev 278 Proc C1713 = $766.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
BONE GRAFT BIOACTIVE 1GR,C1713,HCPCS,278,RC,,,,,,both,,,6139.7400,920.9600,AETNA,AETNA,2947.08,,,,,,,1584.6700,6139.7400,percent of total billed charges,"48% of $6,139.74 in Billed Charges for Rev 278 Proc C1713 = $2,947.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT BIOACTIVE 1GR,C1713,HCPCS,278,RC,,,,,,both,,,6139.7400,920.9600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3069.87,,,,,,,1584.6700,6139.7400,percent of total billed charges,"50% of $6,139.74 in Billed Charges for Rev 278 Proc C1713 = $3,069.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT BIOACTIVE 1GR,C1713,HCPCS,278,RC,,,,,,both,,,6139.7400,920.9600,CIGNA HEALTHCARE,CIGNA HMO,2560.27,,,,,,,1584.6700,6139.7400,percent of total billed charges,"41.7% of $6,139.74 in Billed Charges for Rev 278 Proc C1713 = $2,560.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT BIOACTIVE 1GR,C1713,HCPCS,278,RC,,,,,,both,,,6139.7400,920.9600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2455.90,,,,,,,1584.6700,6139.7400,percent of total billed charges,"40% of $6,139.74 in Billed Charges for Rev 278 Proc C1713 = $2,455.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT BIOACTIVE 1GR,C1713,HCPCS,278,RC,,,,,,both,,,6139.7400,920.9600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2560.27,,,,,,,1584.6700,6139.7400,percent of total billed charges,"41.7% of $6,139.74 in Billed Charges for Rev 278 Proc C1713 = $2,560.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT BIOACTIVE 1GR,C1713,HCPCS,278,RC,,,,,,both,,,6139.7400,920.9600,CIGNA HEALTHCARE,CIGNA PPO,2560.27,,,,,,,1584.6700,6139.7400,percent of total billed charges,"41.7% of $6,139.74 in Billed Charges for Rev 278 Proc C1713 = $2,560.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT BIOACTIVE 1GR,C1713,HCPCS,278,RC,,,,,,both,,,6139.7400,920.9600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5525.77,,,,,,,1584.6700,6139.7400,percent of total billed charges,"90% of $6,139.74 in Billed Charges for Rev 278 Proc C1713 = $5,525.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT BIOACTIVE 1GR,C1713,HCPCS,278,RC,,,,,,both,,,6139.7400,920.9600,MEDCOST,MEDCOST VHN,2921.90,,,,,,,1584.6700,6139.7400,percent of total billed charges,"47.59% of $6,139.74 in Billed Charges for Rev 278 Proc C1713 = $2,921.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT BIOACTIVE 1GR,C1713,HCPCS,278,RC,,,,,,both,,,6139.7400,920.9600,SENTARA HEALTH,SENTARA HEALTH,1584.67,,,,,,,1584.6700,6139.7400,percent of total billed charges,"25.81% of $6,139.74 in Billed Charges for Rev 278 Proc C1713 = $1,584.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT BIOACTIVE 1GR,C1713,HCPCS,278,RC,,,,,,both,,,6139.7400,920.9600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6139.74,,,,,,,1584.6700,6139.7400,percent of total billed charges,"100% of $6,139.74 in Billed Charges for Rev 278 Proc C1713 = $6,139.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT BIOACTIVE 1GR,C1713,HCPCS,278,RC,,,,,,both,,,6139.7400,920.9600,WELLCARE,WELLCARE MEDICAID,6139.74,,,,,,,1584.6700,6139.7400,percent of total billed charges,"100% of $6,139.74 in Billed Charges for Rev 278 Proc C1713 = $6,139.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,28547.6300,4282.1400,AETNA,AETNA,13702.86,,,,,,,2026.8800,28547.6300,percent of total billed charges,"48% of $28,547.63 in Billed Charges for Rev 278 Proc C1713 = $13,702.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,28547.6300,4282.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,14273.82,,,,,,,2026.8800,28547.6300,percent of total billed charges,"50% of $28,547.63 in Billed Charges for Rev 278 Proc C1713 = $14,273.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,28547.6300,4282.1400,CIGNA HEALTHCARE,CIGNA HMO,11904.36,,,,,,,2026.8800,28547.6300,percent of total billed charges,"41.7% of $28,547.63 in Billed Charges for Rev 278 Proc C1713 = $11,904.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,28547.6300,4282.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11419.05,,,,,,,2026.8800,28547.6300,percent of total billed charges,"40% of $28,547.63 in Billed Charges for Rev 278 Proc C1713 = $11,419.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,28547.6300,4282.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11904.36,,,,,,,2026.8800,28547.6300,percent of total billed charges,"41.7% of $28,547.63 in Billed Charges for Rev 278 Proc C1713 = $11,904.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,28547.6300,4282.1400,CIGNA HEALTHCARE,CIGNA PPO,11904.36,,,,,,,2026.8800,28547.6300,percent of total billed charges,"41.7% of $28,547.63 in Billed Charges for Rev 278 Proc C1713 = $11,904.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,28547.6300,4282.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,25692.87,,,,,,,2026.8800,28547.6300,percent of total billed charges,"90% of $28,547.63 in Billed Charges for Rev 278 Proc C1713 = $25,692.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,28547.6300,4282.1400,MEDCOST,MEDCOST VHN,13585.82,,,,,,,2026.8800,28547.6300,percent of total billed charges,"47.59% of $28,547.63 in Billed Charges for Rev 278 Proc C1713 = $13,585.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,28547.6300,4282.1400,SENTARA HEALTH,SENTARA HEALTH,7368.14,,,,,,,2026.8800,28547.6300,percent of total billed charges,"25.81% of $28,547.63 in Billed Charges for Rev 278 Proc C1713 = $7,368.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,28547.6300,4282.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",28547.63,,,,,,,2026.8800,28547.6300,percent of total billed charges,"100% of $28,547.63 in Billed Charges for Rev 278 Proc C1713 = $28,547.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,28547.6300,4282.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2141.07,,,,,,,2026.8800,28547.6300,percent of total billed charges,"7.5% of $28,547.63 in Billed Charges for Rev 278 Proc C1713 = $2,141.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,28547.6300,4282.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,2026.88,,,,,,,2026.8800,28547.6300,percent of total billed charges,"7.1% of $28,547.63 in Billed Charges for Rev 278 Proc C1713 = $2,026.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,28547.6300,4282.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,2026.88,,,,,,,2026.8800,28547.6300,percent of total billed charges,"7.1% of $28,547.63 in Billed Charges for Rev 278 Proc C1713 = $2,026.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,28547.6300,4282.1400,WELLCARE,WELLCARE MEDICAID,28547.63,,,,,,,2026.8800,28547.6300,percent of total billed charges,"100% of $28,547.63 in Billed Charges for Rev 278 Proc C1713 = $28,547.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,29387.2700,4408.0900,AETNA,AETNA,14105.89,,,,,,,2086.5000,29387.2700,percent of total billed charges,"48% of $29,387.27 in Billed Charges for Rev 278 Proc C1713 = $14,105.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,29387.2700,4408.0900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,14693.64,,,,,,,2086.5000,29387.2700,percent of total billed charges,"50% of $29,387.27 in Billed Charges for Rev 278 Proc C1713 = $14,693.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,29387.2700,4408.0900,CIGNA HEALTHCARE,CIGNA HMO,12254.49,,,,,,,2086.5000,29387.2700,percent of total billed charges,"41.7% of $29,387.27 in Billed Charges for Rev 278 Proc C1713 = $12,254.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,29387.2700,4408.0900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11754.91,,,,,,,2086.5000,29387.2700,percent of total billed charges,"40% of $29,387.27 in Billed Charges for Rev 278 Proc C1713 = $11,754.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,29387.2700,4408.0900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,12254.49,,,,,,,2086.5000,29387.2700,percent of total billed charges,"41.7% of $29,387.27 in Billed Charges for Rev 278 Proc C1713 = $12,254.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,29387.2700,4408.0900,CIGNA HEALTHCARE,CIGNA PPO,12254.49,,,,,,,2086.5000,29387.2700,percent of total billed charges,"41.7% of $29,387.27 in Billed Charges for Rev 278 Proc C1713 = $12,254.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,29387.2700,4408.0900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,26448.54,,,,,,,2086.5000,29387.2700,percent of total billed charges,"90% of $29,387.27 in Billed Charges for Rev 278 Proc C1713 = $26,448.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,29387.2700,4408.0900,MEDCOST,MEDCOST VHN,13985.40,,,,,,,2086.5000,29387.2700,percent of total billed charges,"47.59% of $29,387.27 in Billed Charges for Rev 278 Proc C1713 = $13,985.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,29387.2700,4408.0900,SENTARA HEALTH,SENTARA HEALTH,7584.85,,,,,,,2086.5000,29387.2700,percent of total billed charges,"25.81% of $29,387.27 in Billed Charges for Rev 278 Proc C1713 = $7,584.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,29387.2700,4408.0900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",29387.27,,,,,,,2086.5000,29387.2700,percent of total billed charges,"100% of $29,387.27 in Billed Charges for Rev 278 Proc C1713 = $29,387.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,29387.2700,4408.0900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2204.05,,,,,,,2086.5000,29387.2700,percent of total billed charges,"7.5% of $29,387.27 in Billed Charges for Rev 278 Proc C1713 = $2,204.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,29387.2700,4408.0900,UNITED HEALTHCARE,UHC HERITAGE SELECT,2086.50,,,,,,,2086.5000,29387.2700,percent of total billed charges,"7.1% of $29,387.27 in Billed Charges for Rev 278 Proc C1713 = $2,086.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,29387.2700,4408.0900,UNITED HEALTHCARE,UNITED HEALTHCARE,2086.50,,,,,,,2086.5000,29387.2700,percent of total billed charges,"7.1% of $29,387.27 in Billed Charges for Rev 278 Proc C1713 = $2,086.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET 10CC,C1713,HCPCS,278,RC,,,,,,both,,,29387.2700,4408.0900,WELLCARE,WELLCARE MEDICAID,29387.27,,,,,,,2086.5000,29387.2700,percent of total billed charges,"100% of $29,387.27 in Billed Charges for Rev 278 Proc C1713 = $29,387.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM GRAFT REVOLVE ADVANCED ADIPOSE,272,RC,,,,,,,,both,,,6056.6600,908.5000,AETNA,AETNA,2586.19,,,,,,,1563.2200,6056.6600,percent of total billed charges,"42.7% of $6,056.66 in Billed Charges for Rev 272 = $2,586.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM GRAFT REVOLVE ADVANCED ADIPOSE,272,RC,,,,,,,,both,,,6056.6600,908.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4239.66,,,,,,,1563.2200,6056.6600,percent of total billed charges,"Rev 272 $6,056.66 in Billed Charges at 70% = $4,239.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM GRAFT REVOLVE ADVANCED ADIPOSE,272,RC,,,,,,,,both,,,6056.6600,908.5000,CIGNA HEALTHCARE,CIGNA HMO,2525.63,,,,,,,1563.2200,6056.6600,percent of total billed charges,"41.7% of $6,056.66 in Billed Charges for Rev 272 = $2,525.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM GRAFT REVOLVE ADVANCED ADIPOSE,272,RC,,,,,,,,both,,,6056.6600,908.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2810.29,,,,,,,1563.2200,6056.6600,percent of total billed charges,"46.4% of $6,056.66 in Billed Charges for Rev 272 = $2,810.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM GRAFT REVOLVE ADVANCED ADIPOSE,272,RC,,,,,,,,both,,,6056.6600,908.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2525.63,,,,,,,1563.2200,6056.6600,percent of total billed charges,"41.7% of $6,056.66 in Billed Charges for Rev 272 = $2,525.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM GRAFT REVOLVE ADVANCED ADIPOSE,272,RC,,,,,,,,both,,,6056.6600,908.5000,CIGNA HEALTHCARE,CIGNA PPO,2525.63,,,,,,,1563.2200,6056.6600,percent of total billed charges,"41.7% of $6,056.66 in Billed Charges for Rev 272 = $2,525.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM GRAFT REVOLVE ADVANCED ADIPOSE,272,RC,,,,,,,,both,,,6056.6600,908.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5450.99,,,,,,,1563.2200,6056.6600,percent of total billed charges,"90% of $6,056.66 in Billed Charges for Rev 272 = $5,450.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM GRAFT REVOLVE ADVANCED ADIPOSE,272,RC,,,,,,,,both,,,6056.6600,908.5000,MEDCOST,MEDCOST VHN,2882.36,,,,,,,1563.2200,6056.6600,percent of total billed charges,"47.59% of $6,056.66 in Billed Charges for Rev 272 = $2,882.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM GRAFT REVOLVE ADVANCED ADIPOSE,272,RC,,,,,,,,both,,,6056.6600,908.5000,SENTARA HEALTH,SENTARA HEALTH,1563.22,,,,,,,1563.2200,6056.6600,percent of total billed charges,"25.81% of $6,056.66 in Billed Charges for Rev 272 = $1,563.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM GRAFT REVOLVE ADVANCED ADIPOSE,272,RC,,,,,,,,both,,,6056.6600,908.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6056.66,,,,,,,1563.2200,6056.6600,percent of total billed charges,"100% of $6,056.66 in Billed Charges for Rev 272 = $6,056.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM GRAFT REVOLVE ADVANCED ADIPOSE,272,RC,,,,,,,,both,,,6056.6600,908.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3028.33,,,,,,,1563.2200,6056.6600,percent of total billed charges,"Rev 272 $6,056.66 in Billed Charges at 50% = $3,028.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM GRAFT REVOLVE ADVANCED ADIPOSE,272,RC,,,,,,,,both,,,6056.6600,908.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1956.30,,,,,,,1563.2200,6056.6600,other,"32.3% of $6,056.66 in Billed Charges for Rev 272 = $1,956.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM GRAFT REVOLVE ADVANCED ADIPOSE,272,RC,,,,,,,,both,,,6056.6600,908.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1859.39,,,,,,,1563.2200,6056.6600,other,"30.7% of $6,056.66 in Billed Charges for Rev 272 = $1,859.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM GRAFT REVOLVE ADVANCED ADIPOSE,272,RC,,,,,,,,both,,,6056.6600,908.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,1956.30,,,,,,,1563.2200,6056.6600,percent of total billed charges,"32.3% of $6,056.66 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM GRAFT REVOLVE ADVANCED ADIPOSE,272,RC,,,,,,,,both,,,6056.6600,908.5000,WELLCARE,WELLCARE MEDICAID,6056.66,,,,,,,1563.2200,6056.6600,percent of total billed charges,"100% of $6,056.66 in Billed Charges for Rev 272 = $6,056.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM INFLATION,272,RC,,,,,,,,both,,,1157.4000,173.6100,AETNA,AETNA,494.21,,,,,,,298.7200,1157.4000,percent of total billed charges,"42.7% of $1,157.40 in Billed Charges for Rev 272 = $494.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM INFLATION,272,RC,,,,,,,,both,,,1157.4000,173.6100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,810.18,,,,,,,298.7200,1157.4000,percent of total billed charges,"Rev 272 $1,157.40 in Billed Charges at 70% = $810.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM INFLATION,272,RC,,,,,,,,both,,,1157.4000,173.6100,CIGNA HEALTHCARE,CIGNA HMO,482.64,,,,,,,298.7200,1157.4000,percent of total billed charges,"41.7% of $1,157.40 in Billed Charges for Rev 272 = $482.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM INFLATION,272,RC,,,,,,,,both,,,1157.4000,173.6100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,537.03,,,,,,,298.7200,1157.4000,percent of total billed charges,"46.4% of $1,157.40 in Billed Charges for Rev 272 = $537.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM INFLATION,272,RC,,,,,,,,both,,,1157.4000,173.6100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,482.64,,,,,,,298.7200,1157.4000,percent of total billed charges,"41.7% of $1,157.40 in Billed Charges for Rev 272 = $482.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM INFLATION,272,RC,,,,,,,,both,,,1157.4000,173.6100,CIGNA HEALTHCARE,CIGNA PPO,482.64,,,,,,,298.7200,1157.4000,percent of total billed charges,"41.7% of $1,157.40 in Billed Charges for Rev 272 = $482.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM INFLATION,272,RC,,,,,,,,both,,,1157.4000,173.6100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1041.66,,,,,,,298.7200,1157.4000,percent of total billed charges,"90% of $1,157.40 in Billed Charges for Rev 272 = $1,041.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM INFLATION,272,RC,,,,,,,,both,,,1157.4000,173.6100,MEDCOST,MEDCOST VHN,550.81,,,,,,,298.7200,1157.4000,percent of total billed charges,"47.59% of $1,157.40 in Billed Charges for Rev 272 = $550.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM INFLATION,272,RC,,,,,,,,both,,,1157.4000,173.6100,SENTARA HEALTH,SENTARA HEALTH,298.72,,,,,,,298.7200,1157.4000,percent of total billed charges,"25.81% of $1,157.40 in Billed Charges for Rev 272 = $298.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM INFLATION,272,RC,,,,,,,,both,,,1157.4000,173.6100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1157.40,,,,,,,298.7200,1157.4000,percent of total billed charges,"100% of $1,157.40 in Billed Charges for Rev 272 = $1,157.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM INFLATION,272,RC,,,,,,,,both,,,1157.4000,173.6100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,578.70,,,,,,,298.7200,1157.4000,percent of total billed charges,"Rev 272 $1,157.40 in Billed Charges at 50% = $578.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM INFLATION,272,RC,,,,,,,,both,,,1157.4000,173.6100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,373.84,,,,,,,298.7200,1157.4000,other,"32.3% of $1,157.40 in Billed Charges for Rev 272 = $373.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM INFLATION,272,RC,,,,,,,,both,,,1157.4000,173.6100,UNITED HEALTHCARE,UHC HERITAGE SELECT,355.32,,,,,,,298.7200,1157.4000,other,"30.7% of $1,157.40 in Billed Charges for Rev 272 = $355.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM INFLATION,272,RC,,,,,,,,both,,,1157.4000,173.6100,UNITED HEALTHCARE,UNITED HEALTHCARE,373.84,,,,,,,298.7200,1157.4000,percent of total billed charges,"32.3% of $1,157.40 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM INFLATION,272,RC,,,,,,,,both,,,1157.4000,173.6100,WELLCARE,WELLCARE MEDICAID,1157.40,,,,,,,298.7200,1157.4000,percent of total billed charges,"100% of $1,157.40 in Billed Charges for Rev 272 = $1,157.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15000.2000,2250.0300,AETNA,AETNA,7200.10,,,,,,,1065.0100,15000.2000,percent of total billed charges,"48% of $15,000.20 in Billed Charges for Rev 278 Proc C1713 = $7,200.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15000.2000,2250.0300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7500.10,,,,,,,1065.0100,15000.2000,percent of total billed charges,"50% of $15,000.20 in Billed Charges for Rev 278 Proc C1713 = $7,500.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15000.2000,2250.0300,CIGNA HEALTHCARE,CIGNA HMO,6255.08,,,,,,,1065.0100,15000.2000,percent of total billed charges,"41.7% of $15,000.20 in Billed Charges for Rev 278 Proc C1713 = $6,255.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15000.2000,2250.0300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6000.08,,,,,,,1065.0100,15000.2000,percent of total billed charges,"40% of $15,000.20 in Billed Charges for Rev 278 Proc C1713 = $6,000.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15000.2000,2250.0300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6255.08,,,,,,,1065.0100,15000.2000,percent of total billed charges,"41.7% of $15,000.20 in Billed Charges for Rev 278 Proc C1713 = $6,255.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15000.2000,2250.0300,CIGNA HEALTHCARE,CIGNA PPO,6255.08,,,,,,,1065.0100,15000.2000,percent of total billed charges,"41.7% of $15,000.20 in Billed Charges for Rev 278 Proc C1713 = $6,255.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15000.2000,2250.0300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13500.18,,,,,,,1065.0100,15000.2000,percent of total billed charges,"90% of $15,000.20 in Billed Charges for Rev 278 Proc C1713 = $13,500.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15000.2000,2250.0300,MEDCOST,MEDCOST VHN,7138.60,,,,,,,1065.0100,15000.2000,percent of total billed charges,"47.59% of $15,000.20 in Billed Charges for Rev 278 Proc C1713 = $7,138.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15000.2000,2250.0300,SENTARA HEALTH,SENTARA HEALTH,3871.55,,,,,,,1065.0100,15000.2000,percent of total billed charges,"25.81% of $15,000.20 in Billed Charges for Rev 278 Proc C1713 = $3,871.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15000.2000,2250.0300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15000.20,,,,,,,1065.0100,15000.2000,percent of total billed charges,"100% of $15,000.20 in Billed Charges for Rev 278 Proc C1713 = $15,000.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15000.2000,2250.0300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1125.02,,,,,,,1065.0100,15000.2000,percent of total billed charges,"7.5% of $15,000.20 in Billed Charges for Rev 278 Proc C1713 = $1,125.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15000.2000,2250.0300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1065.01,,,,,,,1065.0100,15000.2000,percent of total billed charges,"7.1% of $15,000.20 in Billed Charges for Rev 278 Proc C1713 = $1,065.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15000.2000,2250.0300,UNITED HEALTHCARE,UNITED HEALTHCARE,1065.01,,,,,,,1065.0100,15000.2000,percent of total billed charges,"7.1% of $15,000.20 in Billed Charges for Rev 278 Proc C1713 = $1,065.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15000.2000,2250.0300,WELLCARE,WELLCARE MEDICAID,15000.20,,,,,,,1065.0100,15000.2000,percent of total billed charges,"100% of $15,000.20 in Billed Charges for Rev 278 Proc C1713 = $15,000.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15441.3800,2316.2100,AETNA,AETNA,7411.86,,,,,,,1096.3400,15441.3800,percent of total billed charges,"48% of $15,441.38 in Billed Charges for Rev 278 Proc C1713 = $7,411.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15441.3800,2316.2100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7720.69,,,,,,,1096.3400,15441.3800,percent of total billed charges,"50% of $15,441.38 in Billed Charges for Rev 278 Proc C1713 = $7,720.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15441.3800,2316.2100,CIGNA HEALTHCARE,CIGNA HMO,6439.06,,,,,,,1096.3400,15441.3800,percent of total billed charges,"41.7% of $15,441.38 in Billed Charges for Rev 278 Proc C1713 = $6,439.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15441.3800,2316.2100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6176.55,,,,,,,1096.3400,15441.3800,percent of total billed charges,"40% of $15,441.38 in Billed Charges for Rev 278 Proc C1713 = $6,176.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15441.3800,2316.2100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6439.06,,,,,,,1096.3400,15441.3800,percent of total billed charges,"41.7% of $15,441.38 in Billed Charges for Rev 278 Proc C1713 = $6,439.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15441.3800,2316.2100,CIGNA HEALTHCARE,CIGNA PPO,6439.06,,,,,,,1096.3400,15441.3800,percent of total billed charges,"41.7% of $15,441.38 in Billed Charges for Rev 278 Proc C1713 = $6,439.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15441.3800,2316.2100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13897.24,,,,,,,1096.3400,15441.3800,percent of total billed charges,"90% of $15,441.38 in Billed Charges for Rev 278 Proc C1713 = $13,897.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15441.3800,2316.2100,MEDCOST,MEDCOST VHN,7348.55,,,,,,,1096.3400,15441.3800,percent of total billed charges,"47.59% of $15,441.38 in Billed Charges for Rev 278 Proc C1713 = $7,348.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15441.3800,2316.2100,SENTARA HEALTH,SENTARA HEALTH,3985.42,,,,,,,1096.3400,15441.3800,percent of total billed charges,"25.81% of $15,441.38 in Billed Charges for Rev 278 Proc C1713 = $3,985.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15441.3800,2316.2100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15441.38,,,,,,,1096.3400,15441.3800,percent of total billed charges,"100% of $15,441.38 in Billed Charges for Rev 278 Proc C1713 = $15,441.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15441.3800,2316.2100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1158.10,,,,,,,1096.3400,15441.3800,percent of total billed charges,"7.5% of $15,441.38 in Billed Charges for Rev 278 Proc C1713 = $1,158.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15441.3800,2316.2100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1096.34,,,,,,,1096.3400,15441.3800,percent of total billed charges,"7.1% of $15,441.38 in Billed Charges for Rev 278 Proc C1713 = $1,096.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15441.3800,2316.2100,UNITED HEALTHCARE,UNITED HEALTHCARE,1096.34,,,,,,,1096.3400,15441.3800,percent of total billed charges,"7.1% of $15,441.38 in Billed Charges for Rev 278 Proc C1713 = $1,096.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 5CC HA SUB 79-43905,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15441.3800,2316.2100,WELLCARE,WELLCARE MEDICAID,15441.38,,,,,,,1096.3400,15441.3800,percent of total billed charges,"100% of $15,441.38 in Billed Charges for Rev 278 Proc C1713 = $15,441.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MATRIX GRAFTON DBF INJECTABLE 9CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20327.1600,3049.0700,AETNA,AETNA,9757.04,,,,,,,1443.2300,20327.1600,percent of total billed charges,"48% of $20,327.16 in Billed Charges for Rev 278 Proc C1713 = $9,757.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MATRIX GRAFTON DBF INJECTABLE 9CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20327.1600,3049.0700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,10163.58,,,,,,,1443.2300,20327.1600,percent of total billed charges,"50% of $20,327.16 in Billed Charges for Rev 278 Proc C1713 = $10,163.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MATRIX GRAFTON DBF INJECTABLE 9CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20327.1600,3049.0700,CIGNA HEALTHCARE,CIGNA HMO,8476.43,,,,,,,1443.2300,20327.1600,percent of total billed charges,"41.7% of $20,327.16 in Billed Charges for Rev 278 Proc C1713 = $8,476.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MATRIX GRAFTON DBF INJECTABLE 9CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20327.1600,3049.0700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8130.86,,,,,,,1443.2300,20327.1600,percent of total billed charges,"40% of $20,327.16 in Billed Charges for Rev 278 Proc C1713 = $8,130.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MATRIX GRAFTON DBF INJECTABLE 9CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20327.1600,3049.0700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8476.43,,,,,,,1443.2300,20327.1600,percent of total billed charges,"41.7% of $20,327.16 in Billed Charges for Rev 278 Proc C1713 = $8,476.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MATRIX GRAFTON DBF INJECTABLE 9CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20327.1600,3049.0700,CIGNA HEALTHCARE,CIGNA PPO,8476.43,,,,,,,1443.2300,20327.1600,percent of total billed charges,"41.7% of $20,327.16 in Billed Charges for Rev 278 Proc C1713 = $8,476.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MATRIX GRAFTON DBF INJECTABLE 9CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20327.1600,3049.0700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,18294.44,,,,,,,1443.2300,20327.1600,percent of total billed charges,"90% of $20,327.16 in Billed Charges for Rev 278 Proc C1713 = $18,294.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MATRIX GRAFTON DBF INJECTABLE 9CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20327.1600,3049.0700,MEDCOST,MEDCOST VHN,9673.70,,,,,,,1443.2300,20327.1600,percent of total billed charges,"47.59% of $20,327.16 in Billed Charges for Rev 278 Proc C1713 = $9,673.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MATRIX GRAFTON DBF INJECTABLE 9CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20327.1600,3049.0700,SENTARA HEALTH,SENTARA HEALTH,5246.44,,,,,,,1443.2300,20327.1600,percent of total billed charges,"25.81% of $20,327.16 in Billed Charges for Rev 278 Proc C1713 = $5,246.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MATRIX GRAFTON DBF INJECTABLE 9CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20327.1600,3049.0700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",20327.16,,,,,,,1443.2300,20327.1600,percent of total billed charges,"100% of $20,327.16 in Billed Charges for Rev 278 Proc C1713 = $20,327.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MATRIX GRAFTON DBF INJECTABLE 9CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20327.1600,3049.0700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1524.54,,,,,,,1443.2300,20327.1600,percent of total billed charges,"7.5% of $20,327.16 in Billed Charges for Rev 278 Proc C1713 = $1,524.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MATRIX GRAFTON DBF INJECTABLE 9CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20327.1600,3049.0700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1443.23,,,,,,,1443.2300,20327.1600,percent of total billed charges,"7.1% of $20,327.16 in Billed Charges for Rev 278 Proc C1713 = $1,443.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MATRIX GRAFTON DBF INJECTABLE 9CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20327.1600,3049.0700,UNITED HEALTHCARE,UNITED HEALTHCARE,1443.23,,,,,,,1443.2300,20327.1600,percent of total billed charges,"7.1% of $20,327.16 in Billed Charges for Rev 278 Proc C1713 = $1,443.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MATRIX GRAFTON DBF INJECTABLE 9CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20327.1600,3049.0700,WELLCARE,WELLCARE MEDICAID,20327.16,,,,,,,1443.2300,20327.1600,percent of total billed charges,"100% of $20,327.16 in Billed Charges for Rev 278 Proc C1713 = $20,327.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE POSTERIOR TIBIAL TENDON .5X24.5 4161700,C1713,HCPCS,278,RC,,,,,,both,,,20223.4500,3033.5200,AETNA,AETNA,9707.26,,,,,,,1435.8700,20223.4500,percent of total billed charges,"48% of $20,223.45 in Billed Charges for Rev 278 Proc C1713 = $9,707.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE POSTERIOR TIBIAL TENDON .5X24.5 4161700,C1713,HCPCS,278,RC,,,,,,both,,,20223.4500,3033.5200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,10111.73,,,,,,,1435.8700,20223.4500,percent of total billed charges,"50% of $20,223.45 in Billed Charges for Rev 278 Proc C1713 = $10,111.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE POSTERIOR TIBIAL TENDON .5X24.5 4161700,C1713,HCPCS,278,RC,,,,,,both,,,20223.4500,3033.5200,CIGNA HEALTHCARE,CIGNA HMO,8433.18,,,,,,,1435.8700,20223.4500,percent of total billed charges,"41.7% of $20,223.45 in Billed Charges for Rev 278 Proc C1713 = $8,433.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE POSTERIOR TIBIAL TENDON .5X24.5 4161700,C1713,HCPCS,278,RC,,,,,,both,,,20223.4500,3033.5200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8089.38,,,,,,,1435.8700,20223.4500,percent of total billed charges,"40% of $20,223.45 in Billed Charges for Rev 278 Proc C1713 = $8,089.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE POSTERIOR TIBIAL TENDON .5X24.5 4161700,C1713,HCPCS,278,RC,,,,,,both,,,20223.4500,3033.5200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8433.18,,,,,,,1435.8700,20223.4500,percent of total billed charges,"41.7% of $20,223.45 in Billed Charges for Rev 278 Proc C1713 = $8,433.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE POSTERIOR TIBIAL TENDON .5X24.5 4161700,C1713,HCPCS,278,RC,,,,,,both,,,20223.4500,3033.5200,CIGNA HEALTHCARE,CIGNA PPO,8433.18,,,,,,,1435.8700,20223.4500,percent of total billed charges,"41.7% of $20,223.45 in Billed Charges for Rev 278 Proc C1713 = $8,433.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE POSTERIOR TIBIAL TENDON .5X24.5 4161700,C1713,HCPCS,278,RC,,,,,,both,,,20223.4500,3033.5200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,18201.11,,,,,,,1435.8700,20223.4500,percent of total billed charges,"90% of $20,223.45 in Billed Charges for Rev 278 Proc C1713 = $18,201.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE POSTERIOR TIBIAL TENDON .5X24.5 4161700,C1713,HCPCS,278,RC,,,,,,both,,,20223.4500,3033.5200,MEDCOST,MEDCOST VHN,9624.34,,,,,,,1435.8700,20223.4500,percent of total billed charges,"47.59% of $20,223.45 in Billed Charges for Rev 278 Proc C1713 = $9,624.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE POSTERIOR TIBIAL TENDON .5X24.5 4161700,C1713,HCPCS,278,RC,,,,,,both,,,20223.4500,3033.5200,SENTARA HEALTH,SENTARA HEALTH,5219.67,,,,,,,1435.8700,20223.4500,percent of total billed charges,"25.81% of $20,223.45 in Billed Charges for Rev 278 Proc C1713 = $5,219.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE POSTERIOR TIBIAL TENDON .5X24.5 4161700,C1713,HCPCS,278,RC,,,,,,both,,,20223.4500,3033.5200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",20223.45,,,,,,,1435.8700,20223.4500,percent of total billed charges,"100% of $20,223.45 in Billed Charges for Rev 278 Proc C1713 = $20,223.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE POSTERIOR TIBIAL TENDON .5X24.5 4161700,C1713,HCPCS,278,RC,,,,,,both,,,20223.4500,3033.5200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1516.76,,,,,,,1435.8700,20223.4500,percent of total billed charges,"7.5% of $20,223.45 in Billed Charges for Rev 278 Proc C1713 = $1,516.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE POSTERIOR TIBIAL TENDON .5X24.5 4161700,C1713,HCPCS,278,RC,,,,,,both,,,20223.4500,3033.5200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1435.87,,,,,,,1435.8700,20223.4500,percent of total billed charges,"7.1% of $20,223.45 in Billed Charges for Rev 278 Proc C1713 = $1,435.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE POSTERIOR TIBIAL TENDON .5X24.5 4161700,C1713,HCPCS,278,RC,,,,,,both,,,20223.4500,3033.5200,UNITED HEALTHCARE,UNITED HEALTHCARE,1435.87,,,,,,,1435.8700,20223.4500,percent of total billed charges,"7.1% of $20,223.45 in Billed Charges for Rev 278 Proc C1713 = $1,435.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE POSTERIOR TIBIAL TENDON .5X24.5 4161700,C1713,HCPCS,278,RC,,,,,,both,,,20223.4500,3033.5200,WELLCARE,WELLCARE MEDICAID,20223.45,,,,,,,1435.8700,20223.4500,percent of total billed charges,"100% of $20,223.45 in Billed Charges for Rev 278 Proc C1713 = $20,223.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR BLUNT 10MM,272,RC,27200002,CDM,,,,,,both,,,2375.8100,356.3700,AETNA,AETNA,1014.47,,,,,,,613.2000,2375.8100,percent of total billed charges,"42.7% of $2,375.81 in Billed Charges for Rev 272 = $1,014.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR BLUNT 10MM,272,RC,27200002,CDM,,,,,,both,,,2375.8100,356.3700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1663.07,,,,,,,613.2000,2375.8100,percent of total billed charges,"Rev 272 $2,375.81 in Billed Charges at 70% = $1,663.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR BLUNT 10MM,272,RC,27200002,CDM,,,,,,both,,,2375.8100,356.3700,CIGNA HEALTHCARE,CIGNA HMO,990.71,,,,,,,613.2000,2375.8100,percent of total billed charges,"41.7% of $2,375.81 in Billed Charges for Rev 272 = $990.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR BLUNT 10MM,272,RC,27200002,CDM,,,,,,both,,,2375.8100,356.3700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1102.38,,,,,,,613.2000,2375.8100,percent of total billed charges,"46.4% of $2,375.81 in Billed Charges for Rev 272 = $1,102.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR BLUNT 10MM,272,RC,27200002,CDM,,,,,,both,,,2375.8100,356.3700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,990.71,,,,,,,613.2000,2375.8100,percent of total billed charges,"41.7% of $2,375.81 in Billed Charges for Rev 272 = $990.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR BLUNT 10MM,272,RC,27200002,CDM,,,,,,both,,,2375.8100,356.3700,CIGNA HEALTHCARE,CIGNA PPO,990.71,,,,,,,613.2000,2375.8100,percent of total billed charges,"41.7% of $2,375.81 in Billed Charges for Rev 272 = $990.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR BLUNT 10MM,272,RC,27200002,CDM,,,,,,both,,,2375.8100,356.3700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2138.23,,,,,,,613.2000,2375.8100,percent of total billed charges,"90% of $2,375.81 in Billed Charges for Rev 272 = $2,138.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR BLUNT 10MM,272,RC,27200002,CDM,,,,,,both,,,2375.8100,356.3700,MEDCOST,MEDCOST VHN,1130.65,,,,,,,613.2000,2375.8100,percent of total billed charges,"47.59% of $2,375.81 in Billed Charges for Rev 272 = $1,130.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR BLUNT 10MM,272,RC,27200002,CDM,,,,,,both,,,2375.8100,356.3700,SENTARA HEALTH,SENTARA HEALTH,613.20,,,,,,,613.2000,2375.8100,percent of total billed charges,"25.81% of $2,375.81 in Billed Charges for Rev 272 = $613.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR BLUNT 10MM,272,RC,27200002,CDM,,,,,,both,,,2375.8100,356.3700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2375.81,,,,,,,613.2000,2375.8100,percent of total billed charges,"100% of $2,375.81 in Billed Charges for Rev 272 = $2,375.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR BLUNT 10MM,272,RC,27200002,CDM,,,,,,both,,,2375.8100,356.3700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1187.91,,,,,,,613.2000,2375.8100,percent of total billed charges,"Rev 272 $2,375.81 in Billed Charges at 50% = $1,187.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR BLUNT 10MM,272,RC,27200002,CDM,,,,,,both,,,2375.8100,356.3700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,767.39,,,,,,,613.2000,2375.8100,other,"32.3% of $2,375.81 in Billed Charges for Rev 272 = $767.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP TROCAR BLUNT 10MM,272,RC,27200002,CDM,,,,,,both,,,2375.8100,356.3700,UNITED HEALTHCARE,UHC HERITAGE SELECT,729.37,,,,,,,613.2000,2375.8100,other,"30.7% of $2,375.81 in Billed Charges for Rev 272 = $729.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP TROCAR BLUNT 10MM,272,RC,27200002,CDM,,,,,,both,,,2375.8100,356.3700,UNITED HEALTHCARE,UNITED HEALTHCARE,767.39,,,,,,,613.2000,2375.8100,percent of total billed charges,"32.3% of $2,375.81 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR BLUNT 10MM,272,RC,27200002,CDM,,,,,,both,,,2375.8100,356.3700,WELLCARE,WELLCARE MEDICAID,2375.81,,,,,,,613.2000,2375.8100,percent of total billed charges,"100% of $2,375.81 in Billed Charges for Rev 272 = $2,375.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR ENDO 11MM DIA LONG 150MML BLADELESS OPTICAL W/FIX CANN F/TISS ID CLARITY VERSAPORT LF STER DIS,272,RC,,,,,,,,both,,,10658.4800,1598.7700,AETNA,AETNA,4551.17,,,,,,,2750.9500,10658.4800,percent of total billed charges,"42.7% of $10,658.48 in Billed Charges for Rev 272 = $4,551.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR ENDO 11MM DIA LONG 150MML BLADELESS OPTICAL W/FIX CANN F/TISS ID CLARITY VERSAPORT LF STER DIS,272,RC,,,,,,,,both,,,10658.4800,1598.7700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7460.94,,,,,,,2750.9500,10658.4800,percent of total billed charges,"Rev 272 $10,658.48 in Billed Charges at 70% = $7,460.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR ENDO 11MM DIA LONG 150MML BLADELESS OPTICAL W/FIX CANN F/TISS ID CLARITY VERSAPORT LF STER DIS,272,RC,,,,,,,,both,,,10658.4800,1598.7700,CIGNA HEALTHCARE,CIGNA HMO,4444.59,,,,,,,2750.9500,10658.4800,percent of total billed charges,"41.7% of $10,658.48 in Billed Charges for Rev 272 = $4,444.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR ENDO 11MM DIA LONG 150MML BLADELESS OPTICAL W/FIX CANN F/TISS ID CLARITY VERSAPORT LF STER DIS,272,RC,,,,,,,,both,,,10658.4800,1598.7700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4945.53,,,,,,,2750.9500,10658.4800,percent of total billed charges,"46.4% of $10,658.48 in Billed Charges for Rev 272 = $4,945.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR ENDO 11MM DIA LONG 150MML BLADELESS OPTICAL W/FIX CANN F/TISS ID CLARITY VERSAPORT LF STER DIS,272,RC,,,,,,,,both,,,10658.4800,1598.7700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4444.59,,,,,,,2750.9500,10658.4800,percent of total billed charges,"41.7% of $10,658.48 in Billed Charges for Rev 272 = $4,444.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR ENDO 11MM DIA LONG 150MML BLADELESS OPTICAL W/FIX CANN F/TISS ID CLARITY VERSAPORT LF STER DIS,272,RC,,,,,,,,both,,,10658.4800,1598.7700,CIGNA HEALTHCARE,CIGNA PPO,4444.59,,,,,,,2750.9500,10658.4800,percent of total billed charges,"41.7% of $10,658.48 in Billed Charges for Rev 272 = $4,444.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR ENDO 11MM DIA LONG 150MML BLADELESS OPTICAL W/FIX CANN F/TISS ID CLARITY VERSAPORT LF STER DIS,272,RC,,,,,,,,both,,,10658.4800,1598.7700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9592.63,,,,,,,2750.9500,10658.4800,percent of total billed charges,"90% of $10,658.48 in Billed Charges for Rev 272 = $9,592.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR ENDO 11MM DIA LONG 150MML BLADELESS OPTICAL W/FIX CANN F/TISS ID CLARITY VERSAPORT LF STER DIS,272,RC,,,,,,,,both,,,10658.4800,1598.7700,MEDCOST,MEDCOST VHN,5072.37,,,,,,,2750.9500,10658.4800,percent of total billed charges,"47.59% of $10,658.48 in Billed Charges for Rev 272 = $5,072.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR ENDO 11MM DIA LONG 150MML BLADELESS OPTICAL W/FIX CANN F/TISS ID CLARITY VERSAPORT LF STER DIS,272,RC,,,,,,,,both,,,10658.4800,1598.7700,SENTARA HEALTH,SENTARA HEALTH,2750.95,,,,,,,2750.9500,10658.4800,percent of total billed charges,"25.81% of $10,658.48 in Billed Charges for Rev 272 = $2,750.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR ENDO 11MM DIA LONG 150MML BLADELESS OPTICAL W/FIX CANN F/TISS ID CLARITY VERSAPORT LF STER DIS,272,RC,,,,,,,,both,,,10658.4800,1598.7700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10658.48,,,,,,,2750.9500,10658.4800,percent of total billed charges,"100% of $10,658.48 in Billed Charges for Rev 272 = $10,658.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR ENDO 11MM DIA LONG 150MML BLADELESS OPTICAL W/FIX CANN F/TISS ID CLARITY VERSAPORT LF STER DIS,272,RC,,,,,,,,both,,,10658.4800,1598.7700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5329.24,,,,,,,2750.9500,10658.4800,percent of total billed charges,"Rev 272 $10,658.48 in Billed Charges at 50% = $5,329.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR ENDO 11MM DIA LONG 150MML BLADELESS OPTICAL W/FIX CANN F/TISS ID CLARITY VERSAPORT LF STER DIS,272,RC,,,,,,,,both,,,10658.4800,1598.7700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3442.69,,,,,,,2750.9500,10658.4800,other,"32.3% of $10,658.48 in Billed Charges for Rev 272 = $3,442.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP TROCAR ENDO 11MM DIA LONG 150MML BLADELESS OPTICAL W/FIX CANN F/TISS ID CLARITY VERSAPORT LF STER DIS,272,RC,,,,,,,,both,,,10658.4800,1598.7700,UNITED HEALTHCARE,UHC HERITAGE SELECT,3272.15,,,,,,,2750.9500,10658.4800,other,"30.7% of $10,658.48 in Billed Charges for Rev 272 = $3,272.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP TROCAR ENDO 11MM DIA LONG 150MML BLADELESS OPTICAL W/FIX CANN F/TISS ID CLARITY VERSAPORT LF STER DIS,272,RC,,,,,,,,both,,,10658.4800,1598.7700,UNITED HEALTHCARE,UNITED HEALTHCARE,3442.69,,,,,,,2750.9500,10658.4800,percent of total billed charges,"32.3% of $10,658.48 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP TROCAR ENDO 11MM DIA LONG 150MML BLADELESS OPTICAL W/FIX CANN F/TISS ID CLARITY VERSAPORT LF STER DIS,272,RC,,,,,,,,both,,,10658.4800,1598.7700,WELLCARE,WELLCARE MEDICAID,10658.48,,,,,,,2750.9500,10658.4800,percent of total billed charges,"100% of $10,658.48 in Billed Charges for Rev 272 = $10,658.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE HILIX OVERSTITCH,272,RC,27200002,CDM,,,,,,both,,,4391.1500,658.6700,AETNA,AETNA,1875.02,,,,,,,1133.3600,4391.1500,percent of total billed charges,"42.7% of $4,391.15 in Billed Charges for Rev 272 = $1,875.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE HILIX OVERSTITCH,272,RC,27200002,CDM,,,,,,both,,,4391.1500,658.6700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3073.81,,,,,,,1133.3600,4391.1500,percent of total billed charges,"Rev 272 $4,391.15 in Billed Charges at 70% = $3,073.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE HILIX OVERSTITCH,272,RC,27200002,CDM,,,,,,both,,,4391.1500,658.6700,CIGNA HEALTHCARE,CIGNA HMO,1831.11,,,,,,,1133.3600,4391.1500,percent of total billed charges,"41.7% of $4,391.15 in Billed Charges for Rev 272 = $1,831.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE HILIX OVERSTITCH,272,RC,27200002,CDM,,,,,,both,,,4391.1500,658.6700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2037.49,,,,,,,1133.3600,4391.1500,percent of total billed charges,"46.4% of $4,391.15 in Billed Charges for Rev 272 = $2,037.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE HILIX OVERSTITCH,272,RC,27200002,CDM,,,,,,both,,,4391.1500,658.6700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1831.11,,,,,,,1133.3600,4391.1500,percent of total billed charges,"41.7% of $4,391.15 in Billed Charges for Rev 272 = $1,831.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE HILIX OVERSTITCH,272,RC,27200002,CDM,,,,,,both,,,4391.1500,658.6700,CIGNA HEALTHCARE,CIGNA PPO,1831.11,,,,,,,1133.3600,4391.1500,percent of total billed charges,"41.7% of $4,391.15 in Billed Charges for Rev 272 = $1,831.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE HILIX OVERSTITCH,272,RC,27200002,CDM,,,,,,both,,,4391.1500,658.6700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3952.04,,,,,,,1133.3600,4391.1500,percent of total billed charges,"90% of $4,391.15 in Billed Charges for Rev 272 = $3,952.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE HILIX OVERSTITCH,272,RC,27200002,CDM,,,,,,both,,,4391.1500,658.6700,MEDCOST,MEDCOST VHN,2089.75,,,,,,,1133.3600,4391.1500,percent of total billed charges,"47.59% of $4,391.15 in Billed Charges for Rev 272 = $2,089.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE HILIX OVERSTITCH,272,RC,27200002,CDM,,,,,,both,,,4391.1500,658.6700,SENTARA HEALTH,SENTARA HEALTH,1133.36,,,,,,,1133.3600,4391.1500,percent of total billed charges,"25.81% of $4,391.15 in Billed Charges for Rev 272 = $1,133.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE HILIX OVERSTITCH,272,RC,27200002,CDM,,,,,,both,,,4391.1500,658.6700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4391.15,,,,,,,1133.3600,4391.1500,percent of total billed charges,"100% of $4,391.15 in Billed Charges for Rev 272 = $4,391.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE HILIX OVERSTITCH,272,RC,27200002,CDM,,,,,,both,,,4391.1500,658.6700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2195.58,,,,,,,1133.3600,4391.1500,percent of total billed charges,"Rev 272 $4,391.15 in Billed Charges at 50% = $2,195.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE HILIX OVERSTITCH,272,RC,27200002,CDM,,,,,,both,,,4391.1500,658.6700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1418.34,,,,,,,1133.3600,4391.1500,other,"32.3% of $4,391.15 in Billed Charges for Rev 272 = $1,418.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TISSUE HILIX OVERSTITCH,272,RC,27200002,CDM,,,,,,both,,,4391.1500,658.6700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1348.08,,,,,,,1133.3600,4391.1500,other,"30.7% of $4,391.15 in Billed Charges for Rev 272 = $1,348.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TISSUE HILIX OVERSTITCH,272,RC,27200002,CDM,,,,,,both,,,4391.1500,658.6700,UNITED HEALTHCARE,UNITED HEALTHCARE,1418.34,,,,,,,1133.3600,4391.1500,percent of total billed charges,"32.3% of $4,391.15 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE HILIX OVERSTITCH,272,RC,27200002,CDM,,,,,,both,,,4391.1500,658.6700,WELLCARE,WELLCARE MEDICAID,4391.15,,,,,,,1133.3600,4391.1500,percent of total billed charges,"100% of $4,391.15 in Billed Charges for Rev 272 = $4,391.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 CURVED JAW 25CM,272,RC,27200002,CDM,,,,,,both,,,3980.5600,597.0800,AETNA,AETNA,1699.70,,,,,,,1027.3800,3980.5600,percent of total billed charges,"42.7% of $3,980.56 in Billed Charges for Rev 272 = $1,699.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 CURVED JAW 25CM,272,RC,27200002,CDM,,,,,,both,,,3980.5600,597.0800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2786.39,,,,,,,1027.3800,3980.5600,percent of total billed charges,"Rev 272 $3,980.56 in Billed Charges at 70% = $2,786.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 CURVED JAW 25CM,272,RC,27200002,CDM,,,,,,both,,,3980.5600,597.0800,CIGNA HEALTHCARE,CIGNA HMO,1659.89,,,,,,,1027.3800,3980.5600,percent of total billed charges,"41.7% of $3,980.56 in Billed Charges for Rev 272 = $1,659.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 CURVED JAW 25CM,272,RC,27200002,CDM,,,,,,both,,,3980.5600,597.0800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1846.98,,,,,,,1027.3800,3980.5600,percent of total billed charges,"46.4% of $3,980.56 in Billed Charges for Rev 272 = $1,846.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 CURVED JAW 25CM,272,RC,27200002,CDM,,,,,,both,,,3980.5600,597.0800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1659.89,,,,,,,1027.3800,3980.5600,percent of total billed charges,"41.7% of $3,980.56 in Billed Charges for Rev 272 = $1,659.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 CURVED JAW 25CM,272,RC,27200002,CDM,,,,,,both,,,3980.5600,597.0800,CIGNA HEALTHCARE,CIGNA PPO,1659.89,,,,,,,1027.3800,3980.5600,percent of total billed charges,"41.7% of $3,980.56 in Billed Charges for Rev 272 = $1,659.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 CURVED JAW 25CM,272,RC,27200002,CDM,,,,,,both,,,3980.5600,597.0800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3582.50,,,,,,,1027.3800,3980.5600,percent of total billed charges,"90% of $3,980.56 in Billed Charges for Rev 272 = $3,582.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 CURVED JAW 25CM,272,RC,27200002,CDM,,,,,,both,,,3980.5600,597.0800,MEDCOST,MEDCOST VHN,1894.35,,,,,,,1027.3800,3980.5600,percent of total billed charges,"47.59% of $3,980.56 in Billed Charges for Rev 272 = $1,894.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 CURVED JAW 25CM,272,RC,27200002,CDM,,,,,,both,,,3980.5600,597.0800,SENTARA HEALTH,SENTARA HEALTH,1027.38,,,,,,,1027.3800,3980.5600,percent of total billed charges,"25.81% of $3,980.56 in Billed Charges for Rev 272 = $1,027.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 CURVED JAW 25CM,272,RC,27200002,CDM,,,,,,both,,,3980.5600,597.0800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3980.56,,,,,,,1027.3800,3980.5600,percent of total billed charges,"100% of $3,980.56 in Billed Charges for Rev 272 = $3,980.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 CURVED JAW 25CM,272,RC,27200002,CDM,,,,,,both,,,3980.5600,597.0800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1990.28,,,,,,,1027.3800,3980.5600,percent of total billed charges,"Rev 272 $3,980.56 in Billed Charges at 50% = $1,990.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 CURVED JAW 25CM,272,RC,27200002,CDM,,,,,,both,,,3980.5600,597.0800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1285.72,,,,,,,1027.3800,3980.5600,other,"32.3% of $3,980.56 in Billed Charges for Rev 272 = $1,285.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TISSUE SEALER ENSEAL X1 CURVED JAW 25CM,272,RC,27200002,CDM,,,,,,both,,,3980.5600,597.0800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1222.03,,,,,,,1027.3800,3980.5600,other,"30.7% of $3,980.56 in Billed Charges for Rev 272 = $1,222.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TISSUE SEALER ENSEAL X1 CURVED JAW 25CM,272,RC,27200002,CDM,,,,,,both,,,3980.5600,597.0800,UNITED HEALTHCARE,UNITED HEALTHCARE,1285.72,,,,,,,1027.3800,3980.5600,percent of total billed charges,"32.3% of $3,980.56 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 CURVED JAW 25CM,272,RC,27200002,CDM,,,,,,both,,,3980.5600,597.0800,WELLCARE,WELLCARE MEDICAID,3980.56,,,,,,,1027.3800,3980.5600,percent of total billed charges,"100% of $3,980.56 in Billed Charges for Rev 272 = $3,980.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,414.8400,62.2300,AETNA,AETNA,199.12,,,,,,,107.0700,414.8400,percent of total billed charges,48% of $414.84 in Billed Charges for Rev 278 Proc C1713 = $199.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,414.8400,62.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,207.42,,,,,,,107.0700,414.8400,percent of total billed charges,50% of $414.84 in Billed Charges for Rev 278 Proc C1713 = $207.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,414.8400,62.2300,CIGNA HEALTHCARE,CIGNA HMO,172.99,,,,,,,107.0700,414.8400,percent of total billed charges,41.7% of $414.84 in Billed Charges for Rev 278 Proc C1713 = $172.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,414.8400,62.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,165.94,,,,,,,107.0700,414.8400,percent of total billed charges,40% of $414.84 in Billed Charges for Rev 278 Proc C1713 = $165.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,414.8400,62.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,172.99,,,,,,,107.0700,414.8400,percent of total billed charges,41.7% of $414.84 in Billed Charges for Rev 278 Proc C1713 = $172.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,414.8400,62.2300,CIGNA HEALTHCARE,CIGNA PPO,172.99,,,,,,,107.0700,414.8400,percent of total billed charges,41.7% of $414.84 in Billed Charges for Rev 278 Proc C1713 = $172.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,414.8400,62.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,373.36,,,,,,,107.0700,414.8400,percent of total billed charges,90% of $414.84 in Billed Charges for Rev 278 Proc C1713 = $373.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,414.8400,62.2300,MEDCOST,MEDCOST VHN,197.42,,,,,,,107.0700,414.8400,percent of total billed charges,47.59% of $414.84 in Billed Charges for Rev 278 Proc C1713 = $197.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,414.8400,62.2300,SENTARA HEALTH,SENTARA HEALTH,107.07,,,,,,,107.0700,414.8400,percent of total billed charges,25.81% of $414.84 in Billed Charges for Rev 278 Proc C1713 = $107.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,414.8400,62.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",414.84,,,,,,,107.0700,414.8400,percent of total billed charges,100% of $414.84 in Billed Charges for Rev 278 Proc C1713 = $414.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,414.8400,62.2300,WELLCARE,WELLCARE MEDICAID,414.84,,,,,,,107.0700,414.8400,percent of total billed charges,100% of $414.84 in Billed Charges for Rev 278 Proc C1713 = $414.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,829.6800,124.4500,AETNA,AETNA,398.25,,,,,,,214.1400,829.6800,percent of total billed charges,48% of $829.68 in Billed Charges for Rev 278 Proc C1713 = $398.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,829.6800,124.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,414.84,,,,,,,214.1400,829.6800,percent of total billed charges,50% of $829.68 in Billed Charges for Rev 278 Proc C1713 = $414.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,829.6800,124.4500,CIGNA HEALTHCARE,CIGNA HMO,345.98,,,,,,,214.1400,829.6800,percent of total billed charges,41.7% of $829.68 in Billed Charges for Rev 278 Proc C1713 = $345.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,829.6800,124.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,331.87,,,,,,,214.1400,829.6800,percent of total billed charges,40% of $829.68 in Billed Charges for Rev 278 Proc C1713 = $331.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,829.6800,124.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,345.98,,,,,,,214.1400,829.6800,percent of total billed charges,41.7% of $829.68 in Billed Charges for Rev 278 Proc C1713 = $345.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,829.6800,124.4500,CIGNA HEALTHCARE,CIGNA PPO,345.98,,,,,,,214.1400,829.6800,percent of total billed charges,41.7% of $829.68 in Billed Charges for Rev 278 Proc C1713 = $345.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,829.6800,124.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,746.71,,,,,,,214.1400,829.6800,percent of total billed charges,90% of $829.68 in Billed Charges for Rev 278 Proc C1713 = $746.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,829.6800,124.4500,MEDCOST,MEDCOST VHN,394.84,,,,,,,214.1400,829.6800,percent of total billed charges,47.59% of $829.68 in Billed Charges for Rev 278 Proc C1713 = $394.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,829.6800,124.4500,SENTARA HEALTH,SENTARA HEALTH,214.14,,,,,,,214.1400,829.6800,percent of total billed charges,25.81% of $829.68 in Billed Charges for Rev 278 Proc C1713 = $214.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,829.6800,124.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",829.68,,,,,,,214.1400,829.6800,percent of total billed charges,100% of $829.68 in Billed Charges for Rev 278 Proc C1713 = $829.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,829.6800,124.4500,WELLCARE,WELLCARE MEDICAID,829.68,,,,,,,214.1400,829.6800,percent of total billed charges,100% of $829.68 in Billed Charges for Rev 278 Proc C1713 = $829.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TISSUE SEALER ENSEAL X1 STRAIGHT JAW 37CM,272,RC,,,,,,,,both,,,3631.8600,544.7800,AETNA,AETNA,1550.80,,,,,,,937.3800,3631.8600,percent of total billed charges,"42.7% of $3,631.86 in Billed Charges for Rev 272 = $1,550.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 STRAIGHT JAW 37CM,272,RC,,,,,,,,both,,,3631.8600,544.7800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2542.30,,,,,,,937.3800,3631.8600,percent of total billed charges,"Rev 272 $3,631.86 in Billed Charges at 70% = $2,542.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 STRAIGHT JAW 37CM,272,RC,,,,,,,,both,,,3631.8600,544.7800,CIGNA HEALTHCARE,CIGNA HMO,1514.49,,,,,,,937.3800,3631.8600,percent of total billed charges,"41.7% of $3,631.86 in Billed Charges for Rev 272 = $1,514.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 STRAIGHT JAW 37CM,272,RC,,,,,,,,both,,,3631.8600,544.7800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1685.18,,,,,,,937.3800,3631.8600,percent of total billed charges,"46.4% of $3,631.86 in Billed Charges for Rev 272 = $1,685.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 STRAIGHT JAW 37CM,272,RC,,,,,,,,both,,,3631.8600,544.7800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1514.49,,,,,,,937.3800,3631.8600,percent of total billed charges,"41.7% of $3,631.86 in Billed Charges for Rev 272 = $1,514.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 STRAIGHT JAW 37CM,272,RC,,,,,,,,both,,,3631.8600,544.7800,CIGNA HEALTHCARE,CIGNA PPO,1514.49,,,,,,,937.3800,3631.8600,percent of total billed charges,"41.7% of $3,631.86 in Billed Charges for Rev 272 = $1,514.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 STRAIGHT JAW 37CM,272,RC,,,,,,,,both,,,3631.8600,544.7800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3268.67,,,,,,,937.3800,3631.8600,percent of total billed charges,"90% of $3,631.86 in Billed Charges for Rev 272 = $3,268.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 STRAIGHT JAW 37CM,272,RC,,,,,,,,both,,,3631.8600,544.7800,MEDCOST,MEDCOST VHN,1728.40,,,,,,,937.3800,3631.8600,percent of total billed charges,"47.59% of $3,631.86 in Billed Charges for Rev 272 = $1,728.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 STRAIGHT JAW 37CM,272,RC,,,,,,,,both,,,3631.8600,544.7800,SENTARA HEALTH,SENTARA HEALTH,937.38,,,,,,,937.3800,3631.8600,percent of total billed charges,"25.81% of $3,631.86 in Billed Charges for Rev 272 = $937.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 STRAIGHT JAW 37CM,272,RC,,,,,,,,both,,,3631.8600,544.7800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3631.86,,,,,,,937.3800,3631.8600,percent of total billed charges,"100% of $3,631.86 in Billed Charges for Rev 272 = $3,631.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 STRAIGHT JAW 37CM,272,RC,,,,,,,,both,,,3631.8600,544.7800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1815.93,,,,,,,937.3800,3631.8600,percent of total billed charges,"Rev 272 $3,631.86 in Billed Charges at 50% = $1,815.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 STRAIGHT JAW 37CM,272,RC,,,,,,,,both,,,3631.8600,544.7800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1173.09,,,,,,,937.3800,3631.8600,other,"32.3% of $3,631.86 in Billed Charges for Rev 272 = $1,173.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TISSUE SEALER ENSEAL X1 STRAIGHT JAW 37CM,272,RC,,,,,,,,both,,,3631.8600,544.7800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1114.98,,,,,,,937.3800,3631.8600,other,"30.7% of $3,631.86 in Billed Charges for Rev 272 = $1,114.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TISSUE SEALER ENSEAL X1 STRAIGHT JAW 37CM,272,RC,,,,,,,,both,,,3631.8600,544.7800,UNITED HEALTHCARE,UNITED HEALTHCARE,1173.09,,,,,,,937.3800,3631.8600,percent of total billed charges,"32.3% of $3,631.86 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER ENSEAL X1 STRAIGHT JAW 37CM,272,RC,,,,,,,,both,,,3631.8600,544.7800,WELLCARE,WELLCARE MEDICAID,3631.86,,,,,,,937.3800,3631.8600,percent of total billed charges,"100% of $3,631.86 in Billed Charges for Rev 272 = $3,631.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4957.5500,743.6300,AETNA,AETNA,2116.87,,,,,,,1279.5400,4957.5500,percent of total billed charges,"42.7% of $4,957.55 in Billed Charges for Rev 272 = $2,116.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4957.5500,743.6300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3470.29,,,,,,,1279.5400,4957.5500,percent of total billed charges,"Rev 272 $4,957.55 in Billed Charges at 70% = $3,470.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4957.5500,743.6300,CIGNA HEALTHCARE,CIGNA HMO,2067.30,,,,,,,1279.5400,4957.5500,percent of total billed charges,"41.7% of $4,957.55 in Billed Charges for Rev 272 = $2,067.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4957.5500,743.6300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2300.30,,,,,,,1279.5400,4957.5500,percent of total billed charges,"46.4% of $4,957.55 in Billed Charges for Rev 272 = $2,300.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4957.5500,743.6300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2067.30,,,,,,,1279.5400,4957.5500,percent of total billed charges,"41.7% of $4,957.55 in Billed Charges for Rev 272 = $2,067.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4957.5500,743.6300,CIGNA HEALTHCARE,CIGNA PPO,2067.30,,,,,,,1279.5400,4957.5500,percent of total billed charges,"41.7% of $4,957.55 in Billed Charges for Rev 272 = $2,067.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4957.5500,743.6300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4461.80,,,,,,,1279.5400,4957.5500,percent of total billed charges,"90% of $4,957.55 in Billed Charges for Rev 272 = $4,461.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4957.5500,743.6300,MEDCOST,MEDCOST VHN,2359.30,,,,,,,1279.5400,4957.5500,percent of total billed charges,"47.59% of $4,957.55 in Billed Charges for Rev 272 = $2,359.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4957.5500,743.6300,SENTARA HEALTH,SENTARA HEALTH,1279.54,,,,,,,1279.5400,4957.5500,percent of total billed charges,"25.81% of $4,957.55 in Billed Charges for Rev 272 = $1,279.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4957.5500,743.6300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4957.55,,,,,,,1279.5400,4957.5500,percent of total billed charges,"100% of $4,957.55 in Billed Charges for Rev 272 = $4,957.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4957.5500,743.6300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2478.78,,,,,,,1279.5400,4957.5500,percent of total billed charges,"Rev 272 $4,957.55 in Billed Charges at 50% = $2,478.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4957.5500,743.6300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1601.29,,,,,,,1279.5400,4957.5500,other,"32.3% of $4,957.55 in Billed Charges for Rev 272 = $1,601.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4957.5500,743.6300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1521.97,,,,,,,1279.5400,4957.5500,other,"30.7% of $4,957.55 in Billed Charges for Rev 272 = $1,521.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4957.5500,743.6300,UNITED HEALTHCARE,UNITED HEALTHCARE,1601.29,,,,,,,1279.5400,4957.5500,percent of total billed charges,"32.3% of $4,957.55 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TISSUE SEALER LARGE JAW,272,RC,27200002,CDM,,,,,,both,,,4957.5500,743.6300,WELLCARE,WELLCARE MEDICAID,4957.55,,,,,,,1279.5400,4957.5500,percent of total billed charges,"100% of $4,957.55 in Billed Charges for Rev 272 = $4,957.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL CLEARVIEW MIDAS REX 205X14CM,272,RC,,,,,,,,both,,,5648.4600,847.2700,AETNA,AETNA,2411.89,,,,,,,1457.8700,5648.4600,percent of total billed charges,"42.7% of $5,648.46 in Billed Charges for Rev 272 = $2,411.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL CLEARVIEW MIDAS REX 205X14CM,272,RC,,,,,,,,both,,,5648.4600,847.2700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3953.92,,,,,,,1457.8700,5648.4600,percent of total billed charges,"Rev 272 $5,648.46 in Billed Charges at 70% = $3,953.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL CLEARVIEW MIDAS REX 205X14CM,272,RC,,,,,,,,both,,,5648.4600,847.2700,CIGNA HEALTHCARE,CIGNA HMO,2355.41,,,,,,,1457.8700,5648.4600,percent of total billed charges,"41.7% of $5,648.46 in Billed Charges for Rev 272 = $2,355.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL CLEARVIEW MIDAS REX 205X14CM,272,RC,,,,,,,,both,,,5648.4600,847.2700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2620.89,,,,,,,1457.8700,5648.4600,percent of total billed charges,"46.4% of $5,648.46 in Billed Charges for Rev 272 = $2,620.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL CLEARVIEW MIDAS REX 205X14CM,272,RC,,,,,,,,both,,,5648.4600,847.2700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2355.41,,,,,,,1457.8700,5648.4600,percent of total billed charges,"41.7% of $5,648.46 in Billed Charges for Rev 272 = $2,355.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL CLEARVIEW MIDAS REX 205X14CM,272,RC,,,,,,,,both,,,5648.4600,847.2700,CIGNA HEALTHCARE,CIGNA PPO,2355.41,,,,,,,1457.8700,5648.4600,percent of total billed charges,"41.7% of $5,648.46 in Billed Charges for Rev 272 = $2,355.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL CLEARVIEW MIDAS REX 205X14CM,272,RC,,,,,,,,both,,,5648.4600,847.2700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5083.61,,,,,,,1457.8700,5648.4600,percent of total billed charges,"90% of $5,648.46 in Billed Charges for Rev 272 = $5,083.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL CLEARVIEW MIDAS REX 205X14CM,272,RC,,,,,,,,both,,,5648.4600,847.2700,MEDCOST,MEDCOST VHN,2688.10,,,,,,,1457.8700,5648.4600,percent of total billed charges,"47.59% of $5,648.46 in Billed Charges for Rev 272 = $2,688.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL CLEARVIEW MIDAS REX 205X14CM,272,RC,,,,,,,,both,,,5648.4600,847.2700,SENTARA HEALTH,SENTARA HEALTH,1457.87,,,,,,,1457.8700,5648.4600,percent of total billed charges,"25.81% of $5,648.46 in Billed Charges for Rev 272 = $1,457.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL CLEARVIEW MIDAS REX 205X14CM,272,RC,,,,,,,,both,,,5648.4600,847.2700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5648.46,,,,,,,1457.8700,5648.4600,percent of total billed charges,"100% of $5,648.46 in Billed Charges for Rev 272 = $5,648.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL CLEARVIEW MIDAS REX 205X14CM,272,RC,,,,,,,,both,,,5648.4600,847.2700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2824.23,,,,,,,1457.8700,5648.4600,percent of total billed charges,"Rev 272 $5,648.46 in Billed Charges at 50% = $2,824.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL CLEARVIEW MIDAS REX 205X14CM,272,RC,,,,,,,,both,,,5648.4600,847.2700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1824.45,,,,,,,1457.8700,5648.4600,other,"32.3% of $5,648.46 in Billed Charges for Rev 272 = $1,824.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TOOL CLEARVIEW MIDAS REX 205X14CM,272,RC,,,,,,,,both,,,5648.4600,847.2700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1734.08,,,,,,,1457.8700,5648.4600,other,"30.7% of $5,648.46 in Billed Charges for Rev 272 = $1,734.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TOOL CLEARVIEW MIDAS REX 205X14CM,272,RC,,,,,,,,both,,,5648.4600,847.2700,UNITED HEALTHCARE,UNITED HEALTHCARE,1824.45,,,,,,,1457.8700,5648.4600,percent of total billed charges,"32.3% of $5,648.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL CLEARVIEW MIDAS REX 205X14CM,272,RC,,,,,,,,both,,,5648.4600,847.2700,WELLCARE,WELLCARE MEDICAID,5648.46,,,,,,,1457.8700,5648.4600,percent of total billed charges,"100% of $5,648.46 in Billed Charges for Rev 272 = $5,648.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE RALLY MV AB GENTAMICIN,C1713,HCPCS,278,RC,,,,,,both,,,6152.6000,922.8900,AETNA,AETNA,2953.25,,,,,,,1587.9900,6152.6000,percent of total billed charges,"48% of $6,152.60 in Billed Charges for Rev 278 Proc C1713 = $2,953.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE RALLY MV AB GENTAMICIN,C1713,HCPCS,278,RC,,,,,,both,,,6152.6000,922.8900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3076.30,,,,,,,1587.9900,6152.6000,percent of total billed charges,"50% of $6,152.60 in Billed Charges for Rev 278 Proc C1713 = $3,076.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE RALLY MV AB GENTAMICIN,C1713,HCPCS,278,RC,,,,,,both,,,6152.6000,922.8900,CIGNA HEALTHCARE,CIGNA HMO,2565.63,,,,,,,1587.9900,6152.6000,percent of total billed charges,"41.7% of $6,152.60 in Billed Charges for Rev 278 Proc C1713 = $2,565.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE RALLY MV AB GENTAMICIN,C1713,HCPCS,278,RC,,,,,,both,,,6152.6000,922.8900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2461.04,,,,,,,1587.9900,6152.6000,percent of total billed charges,"40% of $6,152.60 in Billed Charges for Rev 278 Proc C1713 = $2,461.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE RALLY MV AB GENTAMICIN,C1713,HCPCS,278,RC,,,,,,both,,,6152.6000,922.8900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2565.63,,,,,,,1587.9900,6152.6000,percent of total billed charges,"41.7% of $6,152.60 in Billed Charges for Rev 278 Proc C1713 = $2,565.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE RALLY MV AB GENTAMICIN,C1713,HCPCS,278,RC,,,,,,both,,,6152.6000,922.8900,CIGNA HEALTHCARE,CIGNA PPO,2565.63,,,,,,,1587.9900,6152.6000,percent of total billed charges,"41.7% of $6,152.60 in Billed Charges for Rev 278 Proc C1713 = $2,565.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE RALLY MV AB GENTAMICIN,C1713,HCPCS,278,RC,,,,,,both,,,6152.6000,922.8900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5537.34,,,,,,,1587.9900,6152.6000,percent of total billed charges,"90% of $6,152.60 in Billed Charges for Rev 278 Proc C1713 = $5,537.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE RALLY MV AB GENTAMICIN,C1713,HCPCS,278,RC,,,,,,both,,,6152.6000,922.8900,MEDCOST,MEDCOST VHN,2928.02,,,,,,,1587.9900,6152.6000,percent of total billed charges,"47.59% of $6,152.60 in Billed Charges for Rev 278 Proc C1713 = $2,928.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE RALLY MV AB GENTAMICIN,C1713,HCPCS,278,RC,,,,,,both,,,6152.6000,922.8900,SENTARA HEALTH,SENTARA HEALTH,1587.99,,,,,,,1587.9900,6152.6000,percent of total billed charges,"25.81% of $6,152.60 in Billed Charges for Rev 278 Proc C1713 = $1,587.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE RALLY MV AB GENTAMICIN,C1713,HCPCS,278,RC,,,,,,both,,,6152.6000,922.8900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6152.60,,,,,,,1587.9900,6152.6000,percent of total billed charges,"100% of $6,152.60 in Billed Charges for Rev 278 Proc C1713 = $6,152.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE RALLY MV AB GENTAMICIN,C1713,HCPCS,278,RC,,,,,,both,,,6152.6000,922.8900,WELLCARE,WELLCARE MEDICAID,6152.60,,,,,,,1587.9900,6152.6000,percent of total billed charges,"100% of $6,152.60 in Billed Charges for Rev 278 Proc C1713 = $6,152.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL METAL CUTTING MIDAS REX MC30,272,RC,,,,,,,,both,,,3009.2500,451.3900,AETNA,AETNA,1284.95,,,,,,,776.6900,3009.2500,percent of total billed charges,"42.7% of $3,009.25 in Billed Charges for Rev 272 = $1,284.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL METAL CUTTING MIDAS REX MC30,272,RC,,,,,,,,both,,,3009.2500,451.3900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2106.48,,,,,,,776.6900,3009.2500,percent of total billed charges,"Rev 272 $3,009.25 in Billed Charges at 70% = $2,106.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL METAL CUTTING MIDAS REX MC30,272,RC,,,,,,,,both,,,3009.2500,451.3900,CIGNA HEALTHCARE,CIGNA HMO,1254.86,,,,,,,776.6900,3009.2500,percent of total billed charges,"41.7% of $3,009.25 in Billed Charges for Rev 272 = $1,254.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL METAL CUTTING MIDAS REX MC30,272,RC,,,,,,,,both,,,3009.2500,451.3900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1396.29,,,,,,,776.6900,3009.2500,percent of total billed charges,"46.4% of $3,009.25 in Billed Charges for Rev 272 = $1,396.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL METAL CUTTING MIDAS REX MC30,272,RC,,,,,,,,both,,,3009.2500,451.3900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1254.86,,,,,,,776.6900,3009.2500,percent of total billed charges,"41.7% of $3,009.25 in Billed Charges for Rev 272 = $1,254.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL METAL CUTTING MIDAS REX MC30,272,RC,,,,,,,,both,,,3009.2500,451.3900,CIGNA HEALTHCARE,CIGNA PPO,1254.86,,,,,,,776.6900,3009.2500,percent of total billed charges,"41.7% of $3,009.25 in Billed Charges for Rev 272 = $1,254.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL METAL CUTTING MIDAS REX MC30,272,RC,,,,,,,,both,,,3009.2500,451.3900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2708.33,,,,,,,776.6900,3009.2500,percent of total billed charges,"90% of $3,009.25 in Billed Charges for Rev 272 = $2,708.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL METAL CUTTING MIDAS REX MC30,272,RC,,,,,,,,both,,,3009.2500,451.3900,MEDCOST,MEDCOST VHN,1432.10,,,,,,,776.6900,3009.2500,percent of total billed charges,"47.59% of $3,009.25 in Billed Charges for Rev 272 = $1,432.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL METAL CUTTING MIDAS REX MC30,272,RC,,,,,,,,both,,,3009.2500,451.3900,SENTARA HEALTH,SENTARA HEALTH,776.69,,,,,,,776.6900,3009.2500,percent of total billed charges,"25.81% of $3,009.25 in Billed Charges for Rev 272 = $776.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL METAL CUTTING MIDAS REX MC30,272,RC,,,,,,,,both,,,3009.2500,451.3900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3009.25,,,,,,,776.6900,3009.2500,percent of total billed charges,"100% of $3,009.25 in Billed Charges for Rev 272 = $3,009.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL METAL CUTTING MIDAS REX MC30,272,RC,,,,,,,,both,,,3009.2500,451.3900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1504.63,,,,,,,776.6900,3009.2500,percent of total billed charges,"Rev 272 $3,009.25 in Billed Charges at 50% = $1,504.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL METAL CUTTING MIDAS REX MC30,272,RC,,,,,,,,both,,,3009.2500,451.3900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,971.99,,,,,,,776.6900,3009.2500,other,"32.3% of $3,009.25 in Billed Charges for Rev 272 = $971.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TOOL METAL CUTTING MIDAS REX MC30,272,RC,,,,,,,,both,,,3009.2500,451.3900,UNITED HEALTHCARE,UHC HERITAGE SELECT,923.84,,,,,,,776.6900,3009.2500,other,"30.7% of $3,009.25 in Billed Charges for Rev 272 = $923.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TOOL METAL CUTTING MIDAS REX MC30,272,RC,,,,,,,,both,,,3009.2500,451.3900,UNITED HEALTHCARE,UNITED HEALTHCARE,971.99,,,,,,,776.6900,3009.2500,percent of total billed charges,"32.3% of $3,009.25 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL METAL CUTTING MIDAS REX MC30,272,RC,,,,,,,,both,,,3009.2500,451.3900,WELLCARE,WELLCARE MEDICAID,3009.25,,,,,,,776.6900,3009.2500,percent of total billed charges,"100% of $3,009.25 in Billed Charges for Rev 272 = $3,009.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 10CM MATCHHEAD,272,RC,27200002,CDM,,,,,,both,,,2240.1400,336.0200,AETNA,AETNA,956.54,,,,,,,578.1800,2240.1400,percent of total billed charges,"42.7% of $2,240.14 in Billed Charges for Rev 272 = $956.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 10CM MATCHHEAD,272,RC,27200002,CDM,,,,,,both,,,2240.1400,336.0200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1568.10,,,,,,,578.1800,2240.1400,percent of total billed charges,"Rev 272 $2,240.14 in Billed Charges at 70% = $1,568.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 10CM MATCHHEAD,272,RC,27200002,CDM,,,,,,both,,,2240.1400,336.0200,CIGNA HEALTHCARE,CIGNA HMO,934.14,,,,,,,578.1800,2240.1400,percent of total billed charges,"41.7% of $2,240.14 in Billed Charges for Rev 272 = $934.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 10CM MATCHHEAD,272,RC,27200002,CDM,,,,,,both,,,2240.1400,336.0200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1039.43,,,,,,,578.1800,2240.1400,percent of total billed charges,"46.4% of $2,240.14 in Billed Charges for Rev 272 = $1,039.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 10CM MATCHHEAD,272,RC,27200002,CDM,,,,,,both,,,2240.1400,336.0200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,934.14,,,,,,,578.1800,2240.1400,percent of total billed charges,"41.7% of $2,240.14 in Billed Charges for Rev 272 = $934.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 10CM MATCHHEAD,272,RC,27200002,CDM,,,,,,both,,,2240.1400,336.0200,CIGNA HEALTHCARE,CIGNA PPO,934.14,,,,,,,578.1800,2240.1400,percent of total billed charges,"41.7% of $2,240.14 in Billed Charges for Rev 272 = $934.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 10CM MATCHHEAD,272,RC,27200002,CDM,,,,,,both,,,2240.1400,336.0200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2016.13,,,,,,,578.1800,2240.1400,percent of total billed charges,"90% of $2,240.14 in Billed Charges for Rev 272 = $2,016.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 10CM MATCHHEAD,272,RC,27200002,CDM,,,,,,both,,,2240.1400,336.0200,MEDCOST,MEDCOST VHN,1066.08,,,,,,,578.1800,2240.1400,percent of total billed charges,"47.59% of $2,240.14 in Billed Charges for Rev 272 = $1,066.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 10CM MATCHHEAD,272,RC,27200002,CDM,,,,,,both,,,2240.1400,336.0200,SENTARA HEALTH,SENTARA HEALTH,578.18,,,,,,,578.1800,2240.1400,percent of total billed charges,"25.81% of $2,240.14 in Billed Charges for Rev 272 = $578.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 10CM MATCHHEAD,272,RC,27200002,CDM,,,,,,both,,,2240.1400,336.0200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2240.14,,,,,,,578.1800,2240.1400,percent of total billed charges,"100% of $2,240.14 in Billed Charges for Rev 272 = $2,240.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 10CM MATCHHEAD,272,RC,27200002,CDM,,,,,,both,,,2240.1400,336.0200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1120.07,,,,,,,578.1800,2240.1400,percent of total billed charges,"Rev 272 $2,240.14 in Billed Charges at 50% = $1,120.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 10CM MATCHHEAD,272,RC,27200002,CDM,,,,,,both,,,2240.1400,336.0200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,723.57,,,,,,,578.1800,2240.1400,other,"32.3% of $2,240.14 in Billed Charges for Rev 272 = $723.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TOOL MR8 10CM MATCHHEAD,272,RC,27200002,CDM,,,,,,both,,,2240.1400,336.0200,UNITED HEALTHCARE,UHC HERITAGE SELECT,687.72,,,,,,,578.1800,2240.1400,other,"30.7% of $2,240.14 in Billed Charges for Rev 272 = $687.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TOOL MR8 10CM MATCHHEAD,272,RC,27200002,CDM,,,,,,both,,,2240.1400,336.0200,UNITED HEALTHCARE,UNITED HEALTHCARE,723.57,,,,,,,578.1800,2240.1400,percent of total billed charges,"32.3% of $2,240.14 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TOOL MR8 10CM MATCHHEAD,272,RC,27200002,CDM,,,,,,both,,,2240.1400,336.0200,WELLCARE,WELLCARE MEDICAID,2240.14,,,,,,,578.1800,2240.1400,percent of total billed charges,"100% of $2,240.14 in Billed Charges for Rev 272 = $2,240.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNOSTOMY 14FR,272,RC,27200002,CDM,,,,,,both,,,1982.2100,297.3300,AETNA,AETNA,846.40,,,,,,,511.6100,1982.2100,percent of total billed charges,"42.7% of $1,982.21 in Billed Charges for Rev 272 = $846.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNOSTOMY 14FR,272,RC,27200002,CDM,,,,,,both,,,1982.2100,297.3300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1387.55,,,,,,,511.6100,1982.2100,percent of total billed charges,"Rev 272 $1,982.21 in Billed Charges at 70% = $1,387.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNOSTOMY 14FR,272,RC,27200002,CDM,,,,,,both,,,1982.2100,297.3300,CIGNA HEALTHCARE,CIGNA HMO,826.58,,,,,,,511.6100,1982.2100,percent of total billed charges,"41.7% of $1,982.21 in Billed Charges for Rev 272 = $826.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNOSTOMY 14FR,272,RC,27200002,CDM,,,,,,both,,,1982.2100,297.3300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,919.75,,,,,,,511.6100,1982.2100,percent of total billed charges,"46.4% of $1,982.21 in Billed Charges for Rev 272 = $919.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNOSTOMY 14FR,272,RC,27200002,CDM,,,,,,both,,,1982.2100,297.3300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,826.58,,,,,,,511.6100,1982.2100,percent of total billed charges,"41.7% of $1,982.21 in Billed Charges for Rev 272 = $826.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNOSTOMY 14FR,272,RC,27200002,CDM,,,,,,both,,,1982.2100,297.3300,CIGNA HEALTHCARE,CIGNA PPO,826.58,,,,,,,511.6100,1982.2100,percent of total billed charges,"41.7% of $1,982.21 in Billed Charges for Rev 272 = $826.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNOSTOMY 14FR,272,RC,27200002,CDM,,,,,,both,,,1982.2100,297.3300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1783.99,,,,,,,511.6100,1982.2100,percent of total billed charges,"90% of $1,982.21 in Billed Charges for Rev 272 = $1,783.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNOSTOMY 14FR,272,RC,27200002,CDM,,,,,,both,,,1982.2100,297.3300,MEDCOST,MEDCOST VHN,943.33,,,,,,,511.6100,1982.2100,percent of total billed charges,"47.59% of $1,982.21 in Billed Charges for Rev 272 = $943.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNOSTOMY 14FR,272,RC,27200002,CDM,,,,,,both,,,1982.2100,297.3300,SENTARA HEALTH,SENTARA HEALTH,511.61,,,,,,,511.6100,1982.2100,percent of total billed charges,"25.81% of $1,982.21 in Billed Charges for Rev 272 = $511.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNOSTOMY 14FR,272,RC,27200002,CDM,,,,,,both,,,1982.2100,297.3300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1982.21,,,,,,,511.6100,1982.2100,percent of total billed charges,"100% of $1,982.21 in Billed Charges for Rev 272 = $1,982.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNOSTOMY 14FR,272,RC,27200002,CDM,,,,,,both,,,1982.2100,297.3300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,991.11,,,,,,,511.6100,1982.2100,percent of total billed charges,"Rev 272 $1,982.21 in Billed Charges at 50% = $991.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNOSTOMY 14FR,272,RC,27200002,CDM,,,,,,both,,,1982.2100,297.3300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,640.25,,,,,,,511.6100,1982.2100,other,"32.3% of $1,982.21 in Billed Charges for Rev 272 = $640.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE JEJUNOSTOMY 14FR,272,RC,27200002,CDM,,,,,,both,,,1982.2100,297.3300,UNITED HEALTHCARE,UHC HERITAGE SELECT,608.54,,,,,,,511.6100,1982.2100,other,"30.7% of $1,982.21 in Billed Charges for Rev 272 = $608.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE JEJUNOSTOMY 14FR,272,RC,27200002,CDM,,,,,,both,,,1982.2100,297.3300,UNITED HEALTHCARE,UNITED HEALTHCARE,640.25,,,,,,,511.6100,1982.2100,percent of total billed charges,"32.3% of $1,982.21 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE JEJUNOSTOMY 14FR,272,RC,27200002,CDM,,,,,,both,,,1982.2100,297.3300,WELLCARE,WELLCARE MEDICAID,1982.21,,,,,,,511.6100,1982.2100,percent of total billed charges,"100% of $1,982.21 in Billed Charges for Rev 272 = $1,982.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE LARYTUBE ONLY SIZE 9/55,272,RC,,,,,,,,both,,,1701.8800,255.2800,AETNA,AETNA,726.70,,,,,,,439.2600,1701.8800,percent of total billed charges,"42.7% of $1,701.88 in Billed Charges for Rev 272 = $726.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE LARYTUBE ONLY SIZE 9/55,272,RC,,,,,,,,both,,,1701.8800,255.2800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1191.32,,,,,,,439.2600,1701.8800,percent of total billed charges,"Rev 272 $1,701.88 in Billed Charges at 70% = $1,191.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE LARYTUBE ONLY SIZE 9/55,272,RC,,,,,,,,both,,,1701.8800,255.2800,CIGNA HEALTHCARE,CIGNA HMO,709.68,,,,,,,439.2600,1701.8800,percent of total billed charges,"41.7% of $1,701.88 in Billed Charges for Rev 272 = $709.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE LARYTUBE ONLY SIZE 9/55,272,RC,,,,,,,,both,,,1701.8800,255.2800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,789.67,,,,,,,439.2600,1701.8800,percent of total billed charges,"46.4% of $1,701.88 in Billed Charges for Rev 272 = $789.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE LARYTUBE ONLY SIZE 9/55,272,RC,,,,,,,,both,,,1701.8800,255.2800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,709.68,,,,,,,439.2600,1701.8800,percent of total billed charges,"41.7% of $1,701.88 in Billed Charges for Rev 272 = $709.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE LARYTUBE ONLY SIZE 9/55,272,RC,,,,,,,,both,,,1701.8800,255.2800,CIGNA HEALTHCARE,CIGNA PPO,709.68,,,,,,,439.2600,1701.8800,percent of total billed charges,"41.7% of $1,701.88 in Billed Charges for Rev 272 = $709.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE LARYTUBE ONLY SIZE 9/55,272,RC,,,,,,,,both,,,1701.8800,255.2800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1531.69,,,,,,,439.2600,1701.8800,percent of total billed charges,"90% of $1,701.88 in Billed Charges for Rev 272 = $1,531.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE LARYTUBE ONLY SIZE 9/55,272,RC,,,,,,,,both,,,1701.8800,255.2800,MEDCOST,MEDCOST VHN,809.92,,,,,,,439.2600,1701.8800,percent of total billed charges,"47.59% of $1,701.88 in Billed Charges for Rev 272 = $809.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE LARYTUBE ONLY SIZE 9/55,272,RC,,,,,,,,both,,,1701.8800,255.2800,SENTARA HEALTH,SENTARA HEALTH,439.26,,,,,,,439.2600,1701.8800,percent of total billed charges,"25.81% of $1,701.88 in Billed Charges for Rev 272 = $439.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE LARYTUBE ONLY SIZE 9/55,272,RC,,,,,,,,both,,,1701.8800,255.2800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1701.88,,,,,,,439.2600,1701.8800,percent of total billed charges,"100% of $1,701.88 in Billed Charges for Rev 272 = $1,701.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE LARYTUBE ONLY SIZE 9/55,272,RC,,,,,,,,both,,,1701.8800,255.2800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,850.94,,,,,,,439.2600,1701.8800,percent of total billed charges,"Rev 272 $1,701.88 in Billed Charges at 50% = $850.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE LARYTUBE ONLY SIZE 9/55,272,RC,,,,,,,,both,,,1701.8800,255.2800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,549.71,,,,,,,439.2600,1701.8800,other,"32.3% of $1,701.88 in Billed Charges for Rev 272 = $549.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE LARYTUBE ONLY SIZE 9/55,272,RC,,,,,,,,both,,,1701.8800,255.2800,UNITED HEALTHCARE,UHC HERITAGE SELECT,522.48,,,,,,,439.2600,1701.8800,other,"30.7% of $1,701.88 in Billed Charges for Rev 272 = $522.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE LARYTUBE ONLY SIZE 9/55,272,RC,,,,,,,,both,,,1701.8800,255.2800,UNITED HEALTHCARE,UNITED HEALTHCARE,549.71,,,,,,,439.2600,1701.8800,percent of total billed charges,"32.3% of $1,701.88 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE LARYTUBE ONLY SIZE 9/55,272,RC,,,,,,,,both,,,1701.8800,255.2800,WELLCARE,WELLCARE MEDICAID,1701.88,,,,,,,439.2600,1701.8800,percent of total billed charges,"100% of $1,701.88 in Billed Charges for Rev 272 = $1,701.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,425.2100,63.7800,AETNA,AETNA,204.10,,,,,,,109.7500,425.2100,percent of total billed charges,48% of $425.21 in Billed Charges for Rev 278 Proc C1713 = $204.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,425.2100,63.7800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,212.61,,,,,,,109.7500,425.2100,percent of total billed charges,50% of $425.21 in Billed Charges for Rev 278 Proc C1713 = $212.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,425.2100,63.7800,CIGNA HEALTHCARE,CIGNA HMO,177.31,,,,,,,109.7500,425.2100,percent of total billed charges,41.7% of $425.21 in Billed Charges for Rev 278 Proc C1713 = $177.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,425.2100,63.7800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,170.08,,,,,,,109.7500,425.2100,percent of total billed charges,40% of $425.21 in Billed Charges for Rev 278 Proc C1713 = $170.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,425.2100,63.7800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,177.31,,,,,,,109.7500,425.2100,percent of total billed charges,41.7% of $425.21 in Billed Charges for Rev 278 Proc C1713 = $177.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,425.2100,63.7800,CIGNA HEALTHCARE,CIGNA PPO,177.31,,,,,,,109.7500,425.2100,percent of total billed charges,41.7% of $425.21 in Billed Charges for Rev 278 Proc C1713 = $177.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,425.2100,63.7800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,382.69,,,,,,,109.7500,425.2100,percent of total billed charges,90% of $425.21 in Billed Charges for Rev 278 Proc C1713 = $382.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,425.2100,63.7800,MEDCOST,MEDCOST VHN,202.36,,,,,,,109.7500,425.2100,percent of total billed charges,47.59% of $425.21 in Billed Charges for Rev 278 Proc C1713 = $202.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,425.2100,63.7800,SENTARA HEALTH,SENTARA HEALTH,109.75,,,,,,,109.7500,425.2100,percent of total billed charges,25.81% of $425.21 in Billed Charges for Rev 278 Proc C1713 = $109.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,425.2100,63.7800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",425.21,,,,,,,109.7500,425.2100,percent of total billed charges,100% of $425.21 in Billed Charges for Rev 278 Proc C1713 = $425.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,425.2100,63.7800,WELLCARE,WELLCARE MEDICAID,425.21,,,,,,,109.7500,425.2100,percent of total billed charges,100% of $425.21 in Billed Charges for Rev 278 Proc C1713 = $425.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,1742.8700,261.4300,AETNA,AETNA,836.58,,,,,,,449.8300,1742.8700,percent of total billed charges,"48% of $1,742.87 in Billed Charges for Rev 278 Proc C1713 = $836.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,1742.8700,261.4300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,871.44,,,,,,,449.8300,1742.8700,percent of total billed charges,"50% of $1,742.87 in Billed Charges for Rev 278 Proc C1713 = $871.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,1742.8700,261.4300,CIGNA HEALTHCARE,CIGNA HMO,726.78,,,,,,,449.8300,1742.8700,percent of total billed charges,"41.7% of $1,742.87 in Billed Charges for Rev 278 Proc C1713 = $726.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,1742.8700,261.4300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,697.15,,,,,,,449.8300,1742.8700,percent of total billed charges,"40% of $1,742.87 in Billed Charges for Rev 278 Proc C1713 = $697.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,1742.8700,261.4300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,726.78,,,,,,,449.8300,1742.8700,percent of total billed charges,"41.7% of $1,742.87 in Billed Charges for Rev 278 Proc C1713 = $726.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,1742.8700,261.4300,CIGNA HEALTHCARE,CIGNA PPO,726.78,,,,,,,449.8300,1742.8700,percent of total billed charges,"41.7% of $1,742.87 in Billed Charges for Rev 278 Proc C1713 = $726.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,1742.8700,261.4300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1568.58,,,,,,,449.8300,1742.8700,percent of total billed charges,"90% of $1,742.87 in Billed Charges for Rev 278 Proc C1713 = $1,568.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,1742.8700,261.4300,MEDCOST,MEDCOST VHN,829.43,,,,,,,449.8300,1742.8700,percent of total billed charges,"47.59% of $1,742.87 in Billed Charges for Rev 278 Proc C1713 = $829.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,1742.8700,261.4300,SENTARA HEALTH,SENTARA HEALTH,449.83,,,,,,,449.8300,1742.8700,percent of total billed charges,"25.81% of $1,742.87 in Billed Charges for Rev 278 Proc C1713 = $449.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,1742.8700,261.4300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1742.87,,,,,,,449.8300,1742.8700,percent of total billed charges,"100% of $1,742.87 in Billed Charges for Rev 278 Proc C1713 = $1,742.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,1742.8700,261.4300,WELLCARE,WELLCARE MEDICAID,1742.87,,,,,,,449.8300,1742.8700,percent of total billed charges,"100% of $1,742.87 in Billed Charges for Rev 278 Proc C1713 = $1,742.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,466.7000,70.0100,AETNA,AETNA,224.02,,,,,,,120.4600,466.7000,percent of total billed charges,48% of $466.70 in Billed Charges for Rev 278 Proc C1713 = $224.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,466.7000,70.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,233.35,,,,,,,120.4600,466.7000,percent of total billed charges,50% of $466.70 in Billed Charges for Rev 278 Proc C1713 = $233.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,466.7000,70.0100,CIGNA HEALTHCARE,CIGNA HMO,194.61,,,,,,,120.4600,466.7000,percent of total billed charges,41.7% of $466.70 in Billed Charges for Rev 278 Proc C1713 = $194.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,466.7000,70.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,186.68,,,,,,,120.4600,466.7000,percent of total billed charges,40% of $466.70 in Billed Charges for Rev 278 Proc C1713 = $186.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,466.7000,70.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,194.61,,,,,,,120.4600,466.7000,percent of total billed charges,41.7% of $466.70 in Billed Charges for Rev 278 Proc C1713 = $194.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,466.7000,70.0100,CIGNA HEALTHCARE,CIGNA PPO,194.61,,,,,,,120.4600,466.7000,percent of total billed charges,41.7% of $466.70 in Billed Charges for Rev 278 Proc C1713 = $194.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,466.7000,70.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,420.03,,,,,,,120.4600,466.7000,percent of total billed charges,90% of $466.70 in Billed Charges for Rev 278 Proc C1713 = $420.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,466.7000,70.0100,MEDCOST,MEDCOST VHN,222.10,,,,,,,120.4600,466.7000,percent of total billed charges,47.59% of $466.70 in Billed Charges for Rev 278 Proc C1713 = $222.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,466.7000,70.0100,SENTARA HEALTH,SENTARA HEALTH,120.46,,,,,,,120.4600,466.7000,percent of total billed charges,25.81% of $466.70 in Billed Charges for Rev 278 Proc C1713 = $120.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,466.7000,70.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",466.70,,,,,,,120.4600,466.7000,percent of total billed charges,100% of $466.70 in Billed Charges for Rev 278 Proc C1713 = $466.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,466.7000,70.0100,WELLCARE,WELLCARE MEDICAID,466.70,,,,,,,120.4600,466.7000,percent of total billed charges,100% of $466.70 in Billed Charges for Rev 278 Proc C1713 = $466.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET ARTHO STRYKER,272,RC,,,,,,,,both,,,654.3100,98.1500,AETNA,AETNA,279.39,,,,,,,168.8800,654.3100,percent of total billed charges,42.7% of $654.31 in Billed Charges for Rev 272 = $279.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET ARTHO STRYKER,272,RC,,,,,,,,both,,,654.3100,98.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,458.02,,,,,,,168.8800,654.3100,percent of total billed charges,Rev 272 $654.31 in Billed Charges at 70% = $458.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET ARTHO STRYKER,272,RC,,,,,,,,both,,,654.3100,98.1500,CIGNA HEALTHCARE,CIGNA HMO,272.85,,,,,,,168.8800,654.3100,percent of total billed charges,41.7% of $654.31 in Billed Charges for Rev 272 = $272.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET ARTHO STRYKER,272,RC,,,,,,,,both,,,654.3100,98.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,303.60,,,,,,,168.8800,654.3100,percent of total billed charges,46.4% of $654.31 in Billed Charges for Rev 272 = $303.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET ARTHO STRYKER,272,RC,,,,,,,,both,,,654.3100,98.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,272.85,,,,,,,168.8800,654.3100,percent of total billed charges,41.7% of $654.31 in Billed Charges for Rev 272 = $272.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET ARTHO STRYKER,272,RC,,,,,,,,both,,,654.3100,98.1500,CIGNA HEALTHCARE,CIGNA PPO,272.85,,,,,,,168.8800,654.3100,percent of total billed charges,41.7% of $654.31 in Billed Charges for Rev 272 = $272.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET ARTHO STRYKER,272,RC,,,,,,,,both,,,654.3100,98.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,588.88,,,,,,,168.8800,654.3100,percent of total billed charges,90% of $654.31 in Billed Charges for Rev 272 = $588.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET ARTHO STRYKER,272,RC,,,,,,,,both,,,654.3100,98.1500,MEDCOST,MEDCOST VHN,311.39,,,,,,,168.8800,654.3100,percent of total billed charges,47.59% of $654.31 in Billed Charges for Rev 272 = $311.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET ARTHO STRYKER,272,RC,,,,,,,,both,,,654.3100,98.1500,SENTARA HEALTH,SENTARA HEALTH,168.88,,,,,,,168.8800,654.3100,percent of total billed charges,25.81% of $654.31 in Billed Charges for Rev 272 = $168.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET ARTHO STRYKER,272,RC,,,,,,,,both,,,654.3100,98.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",654.31,,,,,,,168.8800,654.3100,percent of total billed charges,100% of $654.31 in Billed Charges for Rev 272 = $654.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET ARTHO STRYKER,272,RC,,,,,,,,both,,,654.3100,98.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,327.16,,,,,,,168.8800,654.3100,percent of total billed charges,Rev 272 $654.31 in Billed Charges at 50% = $327.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET ARTHO STRYKER,272,RC,,,,,,,,both,,,654.3100,98.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,211.34,,,,,,,168.8800,654.3100,other,32.3% of $654.31 in Billed Charges for Rev 272 = $211.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE SET ARTHO STRYKER,272,RC,,,,,,,,both,,,654.3100,98.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,200.87,,,,,,,168.8800,654.3100,other,30.7% of $654.31 in Billed Charges for Rev 272 = $200.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE SET ARTHO STRYKER,272,RC,,,,,,,,both,,,654.3100,98.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,211.34,,,,,,,168.8800,654.3100,percent of total billed charges,32.3% of $654.31 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET ARTHO STRYKER,272,RC,,,,,,,,both,,,654.3100,98.1500,WELLCARE,WELLCARE MEDICAID,654.31,,,,,,,168.8800,654.3100,percent of total billed charges,100% of $654.31 in Billed Charges for Rev 272 = $654.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET HYSTEROSCOPIC OUTFLOW,272,RC,27200002,CDM,,,,,,both,,,1395.0000,209.2500,AETNA,AETNA,595.67,,,,,,,360.0500,1395.0000,percent of total billed charges,"42.7% of $1,395.00 in Billed Charges for Rev 272 = $595.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SET HYSTEROSCOPIC OUTFLOW,272,RC,27200002,CDM,,,,,,both,,,1395.0000,209.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,976.50,,,,,,,360.0500,1395.0000,percent of total billed charges,"Rev 272 $1,395.00 in Billed Charges at 70% = $976.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SET HYSTEROSCOPIC OUTFLOW,272,RC,27200002,CDM,,,,,,both,,,1395.0000,209.2500,CIGNA HEALTHCARE,CIGNA HMO,581.72,,,,,,,360.0500,1395.0000,percent of total billed charges,"41.7% of $1,395.00 in Billed Charges for Rev 272 = $581.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SET HYSTEROSCOPIC OUTFLOW,272,RC,27200002,CDM,,,,,,both,,,1395.0000,209.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,647.28,,,,,,,360.0500,1395.0000,percent of total billed charges,"46.4% of $1,395.00 in Billed Charges for Rev 272 = $647.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SET HYSTEROSCOPIC OUTFLOW,272,RC,27200002,CDM,,,,,,both,,,1395.0000,209.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,581.72,,,,,,,360.0500,1395.0000,percent of total billed charges,"41.7% of $1,395.00 in Billed Charges for Rev 272 = $581.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SET HYSTEROSCOPIC OUTFLOW,272,RC,27200002,CDM,,,,,,both,,,1395.0000,209.2500,CIGNA HEALTHCARE,CIGNA PPO,581.72,,,,,,,360.0500,1395.0000,percent of total billed charges,"41.7% of $1,395.00 in Billed Charges for Rev 272 = $581.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SET HYSTEROSCOPIC OUTFLOW,272,RC,27200002,CDM,,,,,,both,,,1395.0000,209.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1255.50,,,,,,,360.0500,1395.0000,percent of total billed charges,"90% of $1,395.00 in Billed Charges for Rev 272 = $1,255.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SET HYSTEROSCOPIC OUTFLOW,272,RC,27200002,CDM,,,,,,both,,,1395.0000,209.2500,MEDCOST,MEDCOST VHN,663.88,,,,,,,360.0500,1395.0000,percent of total billed charges,"47.59% of $1,395.00 in Billed Charges for Rev 272 = $663.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SET HYSTEROSCOPIC OUTFLOW,272,RC,27200002,CDM,,,,,,both,,,1395.0000,209.2500,SENTARA HEALTH,SENTARA HEALTH,360.05,,,,,,,360.0500,1395.0000,percent of total billed charges,"25.81% of $1,395.00 in Billed Charges for Rev 272 = $360.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SET HYSTEROSCOPIC OUTFLOW,272,RC,27200002,CDM,,,,,,both,,,1395.0000,209.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1395.00,,,,,,,360.0500,1395.0000,percent of total billed charges,"100% of $1,395.00 in Billed Charges for Rev 272 = $1,395.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SET HYSTEROSCOPIC OUTFLOW,272,RC,27200002,CDM,,,,,,both,,,1395.0000,209.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,697.50,,,,,,,360.0500,1395.0000,percent of total billed charges,"Rev 272 $1,395.00 in Billed Charges at 50% = $697.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SET HYSTEROSCOPIC OUTFLOW,272,RC,27200002,CDM,,,,,,both,,,1395.0000,209.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,450.59,,,,,,,360.0500,1395.0000,other,"32.3% of $1,395.00 in Billed Charges for Rev 272 = $450.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE SET HYSTEROSCOPIC OUTFLOW,272,RC,27200002,CDM,,,,,,both,,,1395.0000,209.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,428.27,,,,,,,360.0500,1395.0000,other,"30.7% of $1,395.00 in Billed Charges for Rev 272 = $428.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE SET HYSTEROSCOPIC OUTFLOW,272,RC,27200002,CDM,,,,,,both,,,1395.0000,209.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,450.59,,,,,,,360.0500,1395.0000,percent of total billed charges,"32.3% of $1,395.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SET HYSTEROSCOPIC OUTFLOW,272,RC,27200002,CDM,,,,,,both,,,1395.0000,209.2500,WELLCARE,WELLCARE MEDICAID,1395.00,,,,,,,360.0500,1395.0000,percent of total billed charges,"100% of $1,395.00 in Billed Charges for Rev 272 = $1,395.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SET VERATRAC DUO,272,RC,27200002,CDM,,,,,,both,,,746.3200,111.9500,AETNA,AETNA,318.68,,,,,,,192.6300,746.3200,percent of total billed charges,42.7% of $746.32 in Billed Charges for Rev 272 = $318.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET VERATRAC DUO,272,RC,27200002,CDM,,,,,,both,,,746.3200,111.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,522.42,,,,,,,192.6300,746.3200,percent of total billed charges,Rev 272 $746.32 in Billed Charges at 70% = $522.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET VERATRAC DUO,272,RC,27200002,CDM,,,,,,both,,,746.3200,111.9500,CIGNA HEALTHCARE,CIGNA HMO,311.22,,,,,,,192.6300,746.3200,percent of total billed charges,41.7% of $746.32 in Billed Charges for Rev 272 = $311.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET VERATRAC DUO,272,RC,27200002,CDM,,,,,,both,,,746.3200,111.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,346.29,,,,,,,192.6300,746.3200,percent of total billed charges,46.4% of $746.32 in Billed Charges for Rev 272 = $346.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET VERATRAC DUO,272,RC,27200002,CDM,,,,,,both,,,746.3200,111.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,311.22,,,,,,,192.6300,746.3200,percent of total billed charges,41.7% of $746.32 in Billed Charges for Rev 272 = $311.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET VERATRAC DUO,272,RC,27200002,CDM,,,,,,both,,,746.3200,111.9500,CIGNA HEALTHCARE,CIGNA PPO,311.22,,,,,,,192.6300,746.3200,percent of total billed charges,41.7% of $746.32 in Billed Charges for Rev 272 = $311.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET VERATRAC DUO,272,RC,27200002,CDM,,,,,,both,,,746.3200,111.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,671.69,,,,,,,192.6300,746.3200,percent of total billed charges,90% of $746.32 in Billed Charges for Rev 272 = $671.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET VERATRAC DUO,272,RC,27200002,CDM,,,,,,both,,,746.3200,111.9500,MEDCOST,MEDCOST VHN,355.17,,,,,,,192.6300,746.3200,percent of total billed charges,47.59% of $746.32 in Billed Charges for Rev 272 = $355.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET VERATRAC DUO,272,RC,27200002,CDM,,,,,,both,,,746.3200,111.9500,SENTARA HEALTH,SENTARA HEALTH,192.63,,,,,,,192.6300,746.3200,percent of total billed charges,25.81% of $746.32 in Billed Charges for Rev 272 = $192.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET VERATRAC DUO,272,RC,27200002,CDM,,,,,,both,,,746.3200,111.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",746.32,,,,,,,192.6300,746.3200,percent of total billed charges,100% of $746.32 in Billed Charges for Rev 272 = $746.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET VERATRAC DUO,272,RC,27200002,CDM,,,,,,both,,,746.3200,111.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,373.16,,,,,,,192.6300,746.3200,percent of total billed charges,Rev 272 $746.32 in Billed Charges at 50% = $373.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET VERATRAC DUO,272,RC,27200002,CDM,,,,,,both,,,746.3200,111.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,241.06,,,,,,,192.6300,746.3200,other,32.3% of $746.32 in Billed Charges for Rev 272 = $241.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE SET VERATRAC DUO,272,RC,27200002,CDM,,,,,,both,,,746.3200,111.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,229.12,,,,,,,192.6300,746.3200,other,30.7% of $746.32 in Billed Charges for Rev 272 = $229.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE SET VERATRAC DUO,272,RC,27200002,CDM,,,,,,both,,,746.3200,111.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,241.06,,,,,,,192.6300,746.3200,percent of total billed charges,32.3% of $746.32 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SET VERATRAC DUO,272,RC,27200002,CDM,,,,,,both,,,746.3200,111.9500,WELLCARE,WELLCARE MEDICAID,746.32,,,,,,,192.6300,746.3200,percent of total billed charges,100% of $746.32 in Billed Charges for Rev 272 = $746.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE SHEA PROSTHESIS 140911,272,RC,,,,,,,,both,,,2543.7000,381.5600,AETNA,AETNA,1086.16,,,,,,,656.5300,2543.7000,percent of total billed charges,"42.7% of $2,543.70 in Billed Charges for Rev 272 = $1,086.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SHEA PROSTHESIS 140911,272,RC,,,,,,,,both,,,2543.7000,381.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1780.59,,,,,,,656.5300,2543.7000,percent of total billed charges,"Rev 272 $2,543.70 in Billed Charges at 70% = $1,780.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SHEA PROSTHESIS 140911,272,RC,,,,,,,,both,,,2543.7000,381.5600,CIGNA HEALTHCARE,CIGNA HMO,1060.72,,,,,,,656.5300,2543.7000,percent of total billed charges,"41.7% of $2,543.70 in Billed Charges for Rev 272 = $1,060.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SHEA PROSTHESIS 140911,272,RC,,,,,,,,both,,,2543.7000,381.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1180.28,,,,,,,656.5300,2543.7000,percent of total billed charges,"46.4% of $2,543.70 in Billed Charges for Rev 272 = $1,180.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SHEA PROSTHESIS 140911,272,RC,,,,,,,,both,,,2543.7000,381.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1060.72,,,,,,,656.5300,2543.7000,percent of total billed charges,"41.7% of $2,543.70 in Billed Charges for Rev 272 = $1,060.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SHEA PROSTHESIS 140911,272,RC,,,,,,,,both,,,2543.7000,381.5600,CIGNA HEALTHCARE,CIGNA PPO,1060.72,,,,,,,656.5300,2543.7000,percent of total billed charges,"41.7% of $2,543.70 in Billed Charges for Rev 272 = $1,060.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SHEA PROSTHESIS 140911,272,RC,,,,,,,,both,,,2543.7000,381.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2289.33,,,,,,,656.5300,2543.7000,percent of total billed charges,"90% of $2,543.70 in Billed Charges for Rev 272 = $2,289.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SHEA PROSTHESIS 140911,272,RC,,,,,,,,both,,,2543.7000,381.5600,MEDCOST,MEDCOST VHN,1210.55,,,,,,,656.5300,2543.7000,percent of total billed charges,"47.59% of $2,543.70 in Billed Charges for Rev 272 = $1,210.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SHEA PROSTHESIS 140911,272,RC,,,,,,,,both,,,2543.7000,381.5600,SENTARA HEALTH,SENTARA HEALTH,656.53,,,,,,,656.5300,2543.7000,percent of total billed charges,"25.81% of $2,543.70 in Billed Charges for Rev 272 = $656.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SHEA PROSTHESIS 140911,272,RC,,,,,,,,both,,,2543.7000,381.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2543.70,,,,,,,656.5300,2543.7000,percent of total billed charges,"100% of $2,543.70 in Billed Charges for Rev 272 = $2,543.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SHEA PROSTHESIS 140911,272,RC,,,,,,,,both,,,2543.7000,381.5600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1271.85,,,,,,,656.5300,2543.7000,percent of total billed charges,"Rev 272 $2,543.70 in Billed Charges at 50% = $1,271.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SHEA PROSTHESIS 140911,272,RC,,,,,,,,both,,,2543.7000,381.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,821.62,,,,,,,656.5300,2543.7000,other,"32.3% of $2,543.70 in Billed Charges for Rev 272 = $821.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE SHEA PROSTHESIS 140911,272,RC,,,,,,,,both,,,2543.7000,381.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,780.92,,,,,,,656.5300,2543.7000,other,"30.7% of $2,543.70 in Billed Charges for Rev 272 = $780.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE SHEA PROSTHESIS 140911,272,RC,,,,,,,,both,,,2543.7000,381.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,821.62,,,,,,,656.5300,2543.7000,percent of total billed charges,"32.3% of $2,543.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE SHEA PROSTHESIS 140911,272,RC,,,,,,,,both,,,2543.7000,381.5600,WELLCARE,WELLCARE MEDICAID,2543.70,,,,,,,656.5300,2543.7000,percent of total billed charges,"100% of $2,543.70 in Billed Charges for Rev 272 = $2,543.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TEFLON GUIDE HUMEROUS SYSTEM T2,272,RC,,,,,,,,both,,,1588.2100,238.2300,AETNA,AETNA,678.17,,,,,,,409.9200,1588.2100,percent of total billed charges,"42.7% of $1,588.21 in Billed Charges for Rev 272 = $678.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TEFLON GUIDE HUMEROUS SYSTEM T2,272,RC,,,,,,,,both,,,1588.2100,238.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1111.75,,,,,,,409.9200,1588.2100,percent of total billed charges,"Rev 272 $1,588.21 in Billed Charges at 70% = $1,111.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TEFLON GUIDE HUMEROUS SYSTEM T2,272,RC,,,,,,,,both,,,1588.2100,238.2300,CIGNA HEALTHCARE,CIGNA HMO,662.28,,,,,,,409.9200,1588.2100,percent of total billed charges,"41.7% of $1,588.21 in Billed Charges for Rev 272 = $662.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TEFLON GUIDE HUMEROUS SYSTEM T2,272,RC,,,,,,,,both,,,1588.2100,238.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,736.93,,,,,,,409.9200,1588.2100,percent of total billed charges,"46.4% of $1,588.21 in Billed Charges for Rev 272 = $736.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TEFLON GUIDE HUMEROUS SYSTEM T2,272,RC,,,,,,,,both,,,1588.2100,238.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,662.28,,,,,,,409.9200,1588.2100,percent of total billed charges,"41.7% of $1,588.21 in Billed Charges for Rev 272 = $662.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TEFLON GUIDE HUMEROUS SYSTEM T2,272,RC,,,,,,,,both,,,1588.2100,238.2300,CIGNA HEALTHCARE,CIGNA PPO,662.28,,,,,,,409.9200,1588.2100,percent of total billed charges,"41.7% of $1,588.21 in Billed Charges for Rev 272 = $662.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TEFLON GUIDE HUMEROUS SYSTEM T2,272,RC,,,,,,,,both,,,1588.2100,238.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1429.39,,,,,,,409.9200,1588.2100,percent of total billed charges,"90% of $1,588.21 in Billed Charges for Rev 272 = $1,429.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TEFLON GUIDE HUMEROUS SYSTEM T2,272,RC,,,,,,,,both,,,1588.2100,238.2300,MEDCOST,MEDCOST VHN,755.83,,,,,,,409.9200,1588.2100,percent of total billed charges,"47.59% of $1,588.21 in Billed Charges for Rev 272 = $755.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TEFLON GUIDE HUMEROUS SYSTEM T2,272,RC,,,,,,,,both,,,1588.2100,238.2300,SENTARA HEALTH,SENTARA HEALTH,409.92,,,,,,,409.9200,1588.2100,percent of total billed charges,"25.81% of $1,588.21 in Billed Charges for Rev 272 = $409.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TEFLON GUIDE HUMEROUS SYSTEM T2,272,RC,,,,,,,,both,,,1588.2100,238.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1588.21,,,,,,,409.9200,1588.2100,percent of total billed charges,"100% of $1,588.21 in Billed Charges for Rev 272 = $1,588.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TEFLON GUIDE HUMEROUS SYSTEM T2,272,RC,,,,,,,,both,,,1588.2100,238.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,794.11,,,,,,,409.9200,1588.2100,percent of total billed charges,"Rev 272 $1,588.21 in Billed Charges at 50% = $794.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TEFLON GUIDE HUMEROUS SYSTEM T2,272,RC,,,,,,,,both,,,1588.2100,238.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,512.99,,,,,,,409.9200,1588.2100,other,"32.3% of $1,588.21 in Billed Charges for Rev 272 = $512.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE TEFLON GUIDE HUMEROUS SYSTEM T2,272,RC,,,,,,,,both,,,1588.2100,238.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,487.58,,,,,,,409.9200,1588.2100,other,"30.7% of $1,588.21 in Billed Charges for Rev 272 = $487.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE TEFLON GUIDE HUMEROUS SYSTEM T2,272,RC,,,,,,,,both,,,1588.2100,238.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,512.99,,,,,,,409.9200,1588.2100,percent of total billed charges,"32.3% of $1,588.21 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TEFLON GUIDE HUMEROUS SYSTEM T2,272,RC,,,,,,,,both,,,1588.2100,238.2300,WELLCARE,WELLCARE MEDICAID,1588.21,,,,,,,409.9200,1588.2100,percent of total billed charges,"100% of $1,588.21 in Billed Charges for Rev 272 = $1,588.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,2686.0900,402.9100,AETNA,AETNA,1289.32,,,,,,,693.2800,2686.0900,percent of total billed charges,"48% of $2,686.09 in Billed Charges for Rev 278 Proc C1713 = $1,289.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,2686.0900,402.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1343.05,,,,,,,693.2800,2686.0900,percent of total billed charges,"50% of $2,686.09 in Billed Charges for Rev 278 Proc C1713 = $1,343.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,2686.0900,402.9100,CIGNA HEALTHCARE,CIGNA HMO,1120.10,,,,,,,693.2800,2686.0900,percent of total billed charges,"41.7% of $2,686.09 in Billed Charges for Rev 278 Proc C1713 = $1,120.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,2686.0900,402.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1074.44,,,,,,,693.2800,2686.0900,percent of total billed charges,"40% of $2,686.09 in Billed Charges for Rev 278 Proc C1713 = $1,074.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,2686.0900,402.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1120.10,,,,,,,693.2800,2686.0900,percent of total billed charges,"41.7% of $2,686.09 in Billed Charges for Rev 278 Proc C1713 = $1,120.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,2686.0900,402.9100,CIGNA HEALTHCARE,CIGNA PPO,1120.10,,,,,,,693.2800,2686.0900,percent of total billed charges,"41.7% of $2,686.09 in Billed Charges for Rev 278 Proc C1713 = $1,120.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,2686.0900,402.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2417.48,,,,,,,693.2800,2686.0900,percent of total billed charges,"90% of $2,686.09 in Billed Charges for Rev 278 Proc C1713 = $2,417.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,2686.0900,402.9100,MEDCOST,MEDCOST VHN,1278.31,,,,,,,693.2800,2686.0900,percent of total billed charges,"47.59% of $2,686.09 in Billed Charges for Rev 278 Proc C1713 = $1,278.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,2686.0900,402.9100,SENTARA HEALTH,SENTARA HEALTH,693.28,,,,,,,693.2800,2686.0900,percent of total billed charges,"25.81% of $2,686.09 in Billed Charges for Rev 278 Proc C1713 = $693.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,2686.0900,402.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2686.09,,,,,,,693.2800,2686.0900,percent of total billed charges,"100% of $2,686.09 in Billed Charges for Rev 278 Proc C1713 = $2,686.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,2686.0900,402.9100,WELLCARE,WELLCARE MEDICAID,2686.09,,,,,,,693.2800,2686.0900,percent of total billed charges,"100% of $2,686.09 in Billed Charges for Rev 278 Proc C1713 = $2,686.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2873.0800,430.9600,AETNA,AETNA,1379.08,,,,,,,741.5400,2873.0800,percent of total billed charges,"48% of $2,873.08 in Billed Charges for Rev 278 Proc C1713 = $1,379.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2873.0800,430.9600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1436.54,,,,,,,741.5400,2873.0800,percent of total billed charges,"50% of $2,873.08 in Billed Charges for Rev 278 Proc C1713 = $1,436.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2873.0800,430.9600,CIGNA HEALTHCARE,CIGNA HMO,1198.07,,,,,,,741.5400,2873.0800,percent of total billed charges,"41.7% of $2,873.08 in Billed Charges for Rev 278 Proc C1713 = $1,198.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2873.0800,430.9600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1149.23,,,,,,,741.5400,2873.0800,percent of total billed charges,"40% of $2,873.08 in Billed Charges for Rev 278 Proc C1713 = $1,149.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2873.0800,430.9600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1198.07,,,,,,,741.5400,2873.0800,percent of total billed charges,"41.7% of $2,873.08 in Billed Charges for Rev 278 Proc C1713 = $1,198.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2873.0800,430.9600,CIGNA HEALTHCARE,CIGNA PPO,1198.07,,,,,,,741.5400,2873.0800,percent of total billed charges,"41.7% of $2,873.08 in Billed Charges for Rev 278 Proc C1713 = $1,198.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2873.0800,430.9600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2585.77,,,,,,,741.5400,2873.0800,percent of total billed charges,"90% of $2,873.08 in Billed Charges for Rev 278 Proc C1713 = $2,585.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2873.0800,430.9600,MEDCOST,MEDCOST VHN,1367.30,,,,,,,741.5400,2873.0800,percent of total billed charges,"47.59% of $2,873.08 in Billed Charges for Rev 278 Proc C1713 = $1,367.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2873.0800,430.9600,SENTARA HEALTH,SENTARA HEALTH,741.54,,,,,,,741.5400,2873.0800,percent of total billed charges,"25.81% of $2,873.08 in Billed Charges for Rev 278 Proc C1713 = $741.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2873.0800,430.9600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2873.08,,,,,,,741.5400,2873.0800,percent of total billed charges,"100% of $2,873.08 in Billed Charges for Rev 278 Proc C1713 = $2,873.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2873.0800,430.9600,WELLCARE,WELLCARE MEDICAID,2873.08,,,,,,,741.5400,2873.0800,percent of total billed charges,"100% of $2,873.08 in Billed Charges for Rev 278 Proc C1713 = $2,873.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3108.1900,466.2300,AETNA,AETNA,1491.93,,,,,,,802.2200,3108.1900,percent of total billed charges,"48% of $3,108.19 in Billed Charges for Rev 278 Proc C1713 = $1,491.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3108.1900,466.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1554.10,,,,,,,802.2200,3108.1900,percent of total billed charges,"50% of $3,108.19 in Billed Charges for Rev 278 Proc C1713 = $1,554.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3108.1900,466.2300,CIGNA HEALTHCARE,CIGNA HMO,1296.12,,,,,,,802.2200,3108.1900,percent of total billed charges,"41.7% of $3,108.19 in Billed Charges for Rev 278 Proc C1713 = $1,296.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3108.1900,466.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1243.28,,,,,,,802.2200,3108.1900,percent of total billed charges,"40% of $3,108.19 in Billed Charges for Rev 278 Proc C1713 = $1,243.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3108.1900,466.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1296.12,,,,,,,802.2200,3108.1900,percent of total billed charges,"41.7% of $3,108.19 in Billed Charges for Rev 278 Proc C1713 = $1,296.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3108.1900,466.2300,CIGNA HEALTHCARE,CIGNA PPO,1296.12,,,,,,,802.2200,3108.1900,percent of total billed charges,"41.7% of $3,108.19 in Billed Charges for Rev 278 Proc C1713 = $1,296.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3108.1900,466.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2797.37,,,,,,,802.2200,3108.1900,percent of total billed charges,"90% of $3,108.19 in Billed Charges for Rev 278 Proc C1713 = $2,797.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3108.1900,466.2300,MEDCOST,MEDCOST VHN,1479.19,,,,,,,802.2200,3108.1900,percent of total billed charges,"47.59% of $3,108.19 in Billed Charges for Rev 278 Proc C1713 = $1,479.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3108.1900,466.2300,SENTARA HEALTH,SENTARA HEALTH,802.22,,,,,,,802.2200,3108.1900,percent of total billed charges,"25.81% of $3,108.19 in Billed Charges for Rev 278 Proc C1713 = $802.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3108.1900,466.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3108.19,,,,,,,802.2200,3108.1900,percent of total billed charges,"100% of $3,108.19 in Billed Charges for Rev 278 Proc C1713 = $3,108.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3108.1900,466.2300,WELLCARE,WELLCARE MEDICAID,3108.19,,,,,,,802.2200,3108.1900,percent of total billed charges,"100% of $3,108.19 in Billed Charges for Rev 278 Proc C1713 = $3,108.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE ULTRA LOW PROFILE 17MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3354.6000,503.1900,AETNA,AETNA,1610.21,,,,,,,865.8200,3354.6000,percent of total billed charges,"48% of $3,354.60 in Billed Charges for Rev 278 Proc C1713 = $1,610.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE ULTRA LOW PROFILE 17MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3354.6000,503.1900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1677.30,,,,,,,865.8200,3354.6000,percent of total billed charges,"50% of $3,354.60 in Billed Charges for Rev 278 Proc C1713 = $1,677.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE ULTRA LOW PROFILE 17MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3354.6000,503.1900,CIGNA HEALTHCARE,CIGNA HMO,1398.87,,,,,,,865.8200,3354.6000,percent of total billed charges,"41.7% of $3,354.60 in Billed Charges for Rev 278 Proc C1713 = $1,398.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE ULTRA LOW PROFILE 17MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3354.6000,503.1900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1341.84,,,,,,,865.8200,3354.6000,percent of total billed charges,"40% of $3,354.60 in Billed Charges for Rev 278 Proc C1713 = $1,341.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE ULTRA LOW PROFILE 17MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3354.6000,503.1900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1398.87,,,,,,,865.8200,3354.6000,percent of total billed charges,"41.7% of $3,354.60 in Billed Charges for Rev 278 Proc C1713 = $1,398.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE ULTRA LOW PROFILE 17MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3354.6000,503.1900,CIGNA HEALTHCARE,CIGNA PPO,1398.87,,,,,,,865.8200,3354.6000,percent of total billed charges,"41.7% of $3,354.60 in Billed Charges for Rev 278 Proc C1713 = $1,398.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE ULTRA LOW PROFILE 17MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3354.6000,503.1900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3019.14,,,,,,,865.8200,3354.6000,percent of total billed charges,"90% of $3,354.60 in Billed Charges for Rev 278 Proc C1713 = $3,019.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE ULTRA LOW PROFILE 17MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3354.6000,503.1900,MEDCOST,MEDCOST VHN,1596.45,,,,,,,865.8200,3354.6000,percent of total billed charges,"47.59% of $3,354.60 in Billed Charges for Rev 278 Proc C1713 = $1,596.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE ULTRA LOW PROFILE 17MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3354.6000,503.1900,SENTARA HEALTH,SENTARA HEALTH,865.82,,,,,,,865.8200,3354.6000,percent of total billed charges,"25.81% of $3,354.60 in Billed Charges for Rev 278 Proc C1713 = $865.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE ULTRA LOW PROFILE 17MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3354.6000,503.1900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3354.60,,,,,,,865.8200,3354.6000,percent of total billed charges,"100% of $3,354.60 in Billed Charges for Rev 278 Proc C1713 = $3,354.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
COVER BURR HOLE ULTRA LOW PROFILE 17MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3354.6000,503.1900,WELLCARE,WELLCARE MEDICAID,3354.60,,,,,,,865.8200,3354.6000,percent of total billed charges,"100% of $3,354.60 in Billed Charges for Rev 278 Proc C1713 = $3,354.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE TRACH CUFF SZ 6,272,RC,27200002,CDM,,,,,,both,,,529.2300,79.3800,AETNA,AETNA,225.98,,,,,,,136.5900,529.2300,percent of total billed charges,42.7% of $529.23 in Billed Charges for Rev 272 = $225.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH CUFF SZ 6,272,RC,27200002,CDM,,,,,,both,,,529.2300,79.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,370.46,,,,,,,136.5900,529.2300,percent of total billed charges,Rev 272 $529.23 in Billed Charges at 70% = $370.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH CUFF SZ 6,272,RC,27200002,CDM,,,,,,both,,,529.2300,79.3800,CIGNA HEALTHCARE,CIGNA HMO,220.69,,,,,,,136.5900,529.2300,percent of total billed charges,41.7% of $529.23 in Billed Charges for Rev 272 = $220.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH CUFF SZ 6,272,RC,27200002,CDM,,,,,,both,,,529.2300,79.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,245.56,,,,,,,136.5900,529.2300,percent of total billed charges,46.4% of $529.23 in Billed Charges for Rev 272 = $245.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH CUFF SZ 6,272,RC,27200002,CDM,,,,,,both,,,529.2300,79.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,220.69,,,,,,,136.5900,529.2300,percent of total billed charges,41.7% of $529.23 in Billed Charges for Rev 272 = $220.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH CUFF SZ 6,272,RC,27200002,CDM,,,,,,both,,,529.2300,79.3800,CIGNA HEALTHCARE,CIGNA PPO,220.69,,,,,,,136.5900,529.2300,percent of total billed charges,41.7% of $529.23 in Billed Charges for Rev 272 = $220.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH CUFF SZ 6,272,RC,27200002,CDM,,,,,,both,,,529.2300,79.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,476.31,,,,,,,136.5900,529.2300,percent of total billed charges,90% of $529.23 in Billed Charges for Rev 272 = $476.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH CUFF SZ 6,272,RC,27200002,CDM,,,,,,both,,,529.2300,79.3800,MEDCOST,MEDCOST VHN,251.86,,,,,,,136.5900,529.2300,percent of total billed charges,47.59% of $529.23 in Billed Charges for Rev 272 = $251.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH CUFF SZ 6,272,RC,27200002,CDM,,,,,,both,,,529.2300,79.3800,SENTARA HEALTH,SENTARA HEALTH,136.59,,,,,,,136.5900,529.2300,percent of total billed charges,25.81% of $529.23 in Billed Charges for Rev 272 = $136.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH CUFF SZ 6,272,RC,27200002,CDM,,,,,,both,,,529.2300,79.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",529.23,,,,,,,136.5900,529.2300,percent of total billed charges,100% of $529.23 in Billed Charges for Rev 272 = $529.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH CUFF SZ 6,272,RC,27200002,CDM,,,,,,both,,,529.2300,79.3800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,264.62,,,,,,,136.5900,529.2300,percent of total billed charges,Rev 272 $529.23 in Billed Charges at 50% = $264.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH CUFF SZ 6,272,RC,27200002,CDM,,,,,,both,,,529.2300,79.3800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,170.94,,,,,,,136.5900,529.2300,other,32.3% of $529.23 in Billed Charges for Rev 272 = $170.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE TRACH CUFF SZ 6,272,RC,27200002,CDM,,,,,,both,,,529.2300,79.3800,UNITED HEALTHCARE,UHC HERITAGE SELECT,162.47,,,,,,,136.5900,529.2300,other,30.7% of $529.23 in Billed Charges for Rev 272 = $162.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE TRACH CUFF SZ 6,272,RC,27200002,CDM,,,,,,both,,,529.2300,79.3800,UNITED HEALTHCARE,UNITED HEALTHCARE,170.94,,,,,,,136.5900,529.2300,percent of total billed charges,32.3% of $529.23 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE TRACH CUFF SZ 6,272,RC,27200002,CDM,,,,,,both,,,529.2300,79.3800,WELLCARE,WELLCARE MEDICAID,529.23,,,,,,,136.5900,529.2300,percent of total billed charges,100% of $529.23 in Billed Charges for Rev 272 = $529.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,AETNA,AETNA,6987.00,,,,,,,4223.2900,22832.7700,percent of total billed charges,"42.7% of $16,363.00 in Billed Charges for Rev 481 Proc 0913T = $6,987.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,10473.75,,,,,,,4223.2900,22832.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,AETNA,AETNA HEALTHCARE MEDICARE,10473.75,,,,,,,4223.2900,22832.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,10473.75,,,,,,,4223.2900,22832.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,AMBETTER,AMBETTER,22832.77,,,,,,,4223.2900,22832.7700,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,10892.70,,,,,,,4223.2900,22832.7700,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,BLUE CROSS,ANTHEM EXCHANGE,16363.00,,,,,,,4223.2900,22832.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,BLUE CROSS,ANTHEM HMO,16363.00,,,,,,,4223.2900,22832.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,10787.96,,,,,,,4223.2900,22832.7700,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",16363.00,,,,,,,4223.2900,22832.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11454.10,,,,,,,4223.2900,22832.7700,percent of total billed charges,"Rev 481 Proc 0913T $16,363.00 in Billed Charges at 70% = $11,454.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,BLUE CROSS,BLUE CROSS MEDICARE,10892.70,,,,,,,4223.2900,22832.7700,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,CIGNA HEALTHCARE,CIGNA HMO,6823.37,,,,,,,4223.2900,22832.7700,percent of total billed charges,"41.7% of $16,363.00 in Billed Charges for Rev 481 Proc 0913T = $6,823.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7592.43,,,,,,,4223.2900,22832.7700,percent of total billed charges,"46.4% of $16,363.00 in Billed Charges for Rev 481 Proc 0913T = $7,592.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,10997.44,,,,,,,4223.2900,22832.7700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6823.37,,,,,,,4223.2900,22832.7700,percent of total billed charges,"41.7% of $16,363.00 in Billed Charges for Rev 481 Proc 0913T = $6,823.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,CIGNA HEALTHCARE,CIGNA PPO,6823.37,,,,,,,4223.2900,22832.7700,percent of total billed charges,"41.7% of $16,363.00 in Billed Charges for Rev 481 Proc 0913T = $6,823.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,10997.44,,,,,,,4223.2900,22832.7700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,14726.70,,,,,,,4223.2900,22832.7700,percent of total billed charges,"90% of $16,363.00 in Billed Charges for Rev 481 Proc 0913T = $14,726.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,HUMANA,HUMANA MEDICARE,10473.75,,,,,,,4223.2900,22832.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,10473.75,,,,,,,4223.2900,22832.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,MEDCOST,MEDCOST VHN,7787.15,,,,,,,4223.2900,22832.7700,percent of total billed charges,"47.59% of $16,363.00 in Billed Charges for Rev 481 Proc 0913T = $7,787.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,10997.44,,,,,,,4223.2900,22832.7700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,10997.44,,,,,,,4223.2900,22832.7700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,NHC ADVANTAGE,NHC ADVANTAGE,10997.44,,,,,,,4223.2900,22832.7700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,SENTARA HEALTH,SENTARA HEALTH,4223.29,,,,,,,4223.2900,22832.7700,percent of total billed charges,"25.81% of $16,363.00 in Billed Charges for Rev 481 Proc 0913T = $4,223.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,SENTARA HEALTH,SENTARA MEDICARE,10473.75,,,,,,,4223.2900,22832.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",16363.00,,,,,,,4223.2900,22832.7700,percent of total billed charges,"100% of $16,363.00 in Billed Charges for Rev 481 Proc 0913T = $16,363.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,10473.75,,,,,,,4223.2900,22832.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,10473.75,,,,,,,4223.2900,22832.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,WELLCARE,WELLCARE MEDICAID,16363.00,,,,,,,4223.2900,22832.7700,percent of total billed charges,"100% of $16,363.00 in Billed Charges for Rev 481 Proc 0913T = $16,363.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ TCAT THER RX DLVR NTRAC RX BALO 1 MAJ C ART,0913T,CPT,481,RC,48100241,CDM,,,,both,,,16363.0000,2454.4500,WELLCARE,WELLCARE MEDICARE,11102.17,,,,,,,4223.2900,22832.7700,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,AETNA,AETNA,490.20,,,,,,,296.3000,1148.0000,percent of total billed charges,"42.7% of $1,148.00 in Billed Charges for Rev 510 Proc 0973T = $490.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,296.3000,1148.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,296.3000,1148.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,296.3000,1148.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,AMBETTER,AMBETTER,804.03,,,,,,,296.3000,1148.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,296.3000,1148.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,296.3000,1148.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,296.3000,1148.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,296.3000,1148.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1134.94,,,,,,,296.3000,1148.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,803.60,,,,,,,296.3000,1148.0000,percent of total billed charges,"Rev 510 Proc 0973T $1,148.00 in Billed Charges at 70% = $803.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,296.3000,1148.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,CIGNA HEALTHCARE,CIGNA HMO,478.72,,,,,,,296.3000,1148.0000,percent of total billed charges,"41.7% of $1,148.00 in Billed Charges for Rev 510 Proc 0973T = $478.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,532.67,,,,,,,296.3000,1148.0000,percent of total billed charges,"46.4% of $1,148.00 in Billed Charges for Rev 510 Proc 0973T = $532.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,296.3000,1148.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,478.72,,,,,,,296.3000,1148.0000,percent of total billed charges,"41.7% of $1,148.00 in Billed Charges for Rev 510 Proc 0973T = $478.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,CIGNA HEALTHCARE,CIGNA PPO,478.72,,,,,,,296.3000,1148.0000,percent of total billed charges,"41.7% of $1,148.00 in Billed Charges for Rev 510 Proc 0973T = $478.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,296.3000,1148.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1033.20,,,,,,,296.3000,1148.0000,percent of total billed charges,"90% of $1,148.00 in Billed Charges for Rev 510 Proc 0973T = $1,033.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,HUMANA,HUMANA MEDICARE,368.82,,,,,,,296.3000,1148.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,296.3000,1148.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,MEDCOST,MEDCOST VHN,546.33,,,,,,,296.3000,1148.0000,percent of total billed charges,"47.59% of $1,148.00 in Billed Charges for Rev 510 Proc 0973T = $546.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,296.3000,1148.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,296.3000,1148.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,296.3000,1148.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,SENTARA HEALTH,SENTARA HEALTH,296.30,,,,,,,296.3000,1148.0000,percent of total billed charges,"25.81% of $1,148.00 in Billed Charges for Rev 510 Proc 0973T = $296.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,296.3000,1148.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1148.00,,,,,,,296.3000,1148.0000,percent of total billed charges,"100% of $1,148.00 in Billed Charges for Rev 510 Proc 0973T = $1,148.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,574.00,,,,,,,296.3000,1148.0000,percent of total billed charges,"Rev 510 Proc 0973T $1,148.00 in Billed Charges at 50% = $574.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,370.80,,,,,,,296.3000,1148.0000,other,"32.3% of $1,148.00 in Billed Charges for Rev 510 Proc 0973T = $370.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,352.44,,,,,,,296.3000,1148.0000,other,"30.7% of $1,148.00 in Billed Charges for Rev 510 Proc 0973T = $352.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.80,,,,,,,296.3000,1148.0000,percent of total billed charges,"32.3% of $1,148.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,296.3000,1148.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,296.3000,1148.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,WELLCARE,WELLCARE MEDICAID,1148.00,,,,,,,296.3000,1148.0000,percent of total billed charges,"100% of $1,148.00 in Billed Charges for Rev 510 Proc 0973T = $1,148.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SLCTV NZMTC DBRDMT BRN ESCHAR REQ ANES T/A/L 1ST,0973T,CPT,510,RC,51000269,CDM,,,,both,,,1148.0000,172.2000,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,296.3000,1148.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
CRANIAL DROK RIGHT FRONTAL SPHENOID TEMPORAL,C1713,HCPCS,278,RC,,,,,,both,,,95340.6000,14301.0900,AETNA,AETNA,45763.49,,,,,,,6769.1800,95340.6000,percent of total billed charges,"48% of $95,340.60 in Billed Charges for Rev 278 Proc C1713 = $45,763.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL DROK RIGHT FRONTAL SPHENOID TEMPORAL,C1713,HCPCS,278,RC,,,,,,both,,,95340.6000,14301.0900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,47670.30,,,,,,,6769.1800,95340.6000,percent of total billed charges,"50% of $95,340.60 in Billed Charges for Rev 278 Proc C1713 = $47,670.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL DROK RIGHT FRONTAL SPHENOID TEMPORAL,C1713,HCPCS,278,RC,,,,,,both,,,95340.6000,14301.0900,CIGNA HEALTHCARE,CIGNA HMO,39757.03,,,,,,,6769.1800,95340.6000,percent of total billed charges,"41.7% of $95,340.60 in Billed Charges for Rev 278 Proc C1713 = $39,757.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL DROK RIGHT FRONTAL SPHENOID TEMPORAL,C1713,HCPCS,278,RC,,,,,,both,,,95340.6000,14301.0900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,38136.24,,,,,,,6769.1800,95340.6000,percent of total billed charges,"40% of $95,340.60 in Billed Charges for Rev 278 Proc C1713 = $38,136.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL DROK RIGHT FRONTAL SPHENOID TEMPORAL,C1713,HCPCS,278,RC,,,,,,both,,,95340.6000,14301.0900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,39757.03,,,,,,,6769.1800,95340.6000,percent of total billed charges,"41.7% of $95,340.60 in Billed Charges for Rev 278 Proc C1713 = $39,757.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL DROK RIGHT FRONTAL SPHENOID TEMPORAL,C1713,HCPCS,278,RC,,,,,,both,,,95340.6000,14301.0900,CIGNA HEALTHCARE,CIGNA PPO,39757.03,,,,,,,6769.1800,95340.6000,percent of total billed charges,"41.7% of $95,340.60 in Billed Charges for Rev 278 Proc C1713 = $39,757.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL DROK RIGHT FRONTAL SPHENOID TEMPORAL,C1713,HCPCS,278,RC,,,,,,both,,,95340.6000,14301.0900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,85806.54,,,,,,,6769.1800,95340.6000,percent of total billed charges,"90% of $95,340.60 in Billed Charges for Rev 278 Proc C1713 = $85,806.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL DROK RIGHT FRONTAL SPHENOID TEMPORAL,C1713,HCPCS,278,RC,,,,,,both,,,95340.6000,14301.0900,MEDCOST,MEDCOST VHN,45372.59,,,,,,,6769.1800,95340.6000,percent of total billed charges,"47.59% of $95,340.60 in Billed Charges for Rev 278 Proc C1713 = $45,372.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL DROK RIGHT FRONTAL SPHENOID TEMPORAL,C1713,HCPCS,278,RC,,,,,,both,,,95340.6000,14301.0900,SENTARA HEALTH,SENTARA HEALTH,24607.41,,,,,,,6769.1800,95340.6000,percent of total billed charges,"25.81% of $95,340.60 in Billed Charges for Rev 278 Proc C1713 = $24,607.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL DROK RIGHT FRONTAL SPHENOID TEMPORAL,C1713,HCPCS,278,RC,,,,,,both,,,95340.6000,14301.0900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",95340.60,,,,,,,6769.1800,95340.6000,percent of total billed charges,"100% of $95,340.60 in Billed Charges for Rev 278 Proc C1713 = $95,340.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL DROK RIGHT FRONTAL SPHENOID TEMPORAL,C1713,HCPCS,278,RC,,,,,,both,,,95340.6000,14301.0900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7150.55,,,,,,,6769.1800,95340.6000,percent of total billed charges,"7.5% of $95,340.60 in Billed Charges for Rev 278 Proc C1713 = $7,150.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL DROK RIGHT FRONTAL SPHENOID TEMPORAL,C1713,HCPCS,278,RC,,,,,,both,,,95340.6000,14301.0900,UNITED HEALTHCARE,UHC HERITAGE SELECT,6769.18,,,,,,,6769.1800,95340.6000,percent of total billed charges,"7.1% of $95,340.60 in Billed Charges for Rev 278 Proc C1713 = $6,769.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL DROK RIGHT FRONTAL SPHENOID TEMPORAL,C1713,HCPCS,278,RC,,,,,,both,,,95340.6000,14301.0900,UNITED HEALTHCARE,UNITED HEALTHCARE,6769.18,,,,,,,6769.1800,95340.6000,percent of total billed charges,"7.1% of $95,340.60 in Billed Charges for Rev 278 Proc C1713 = $6,769.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL DROK RIGHT FRONTAL SPHENOID TEMPORAL,C1713,HCPCS,278,RC,,,,,,both,,,95340.6000,14301.0900,WELLCARE,WELLCARE MEDICAID,95340.60,,,,,,,6769.1800,95340.6000,percent of total billed charges,"100% of $95,340.60 in Billed Charges for Rev 278 Proc C1713 = $95,340.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 40CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,89067.6000,13360.1400,AETNA,AETNA,42752.45,,,,,,,6323.8000,89067.6000,percent of total billed charges,"48% of $89,067.60 in Billed Charges for Rev 278 Proc C1713 = $42,752.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 40CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,89067.6000,13360.1400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,44533.80,,,,,,,6323.8000,89067.6000,percent of total billed charges,"50% of $89,067.60 in Billed Charges for Rev 278 Proc C1713 = $44,533.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 40CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,89067.6000,13360.1400,CIGNA HEALTHCARE,CIGNA HMO,37141.19,,,,,,,6323.8000,89067.6000,percent of total billed charges,"41.7% of $89,067.60 in Billed Charges for Rev 278 Proc C1713 = $37,141.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 40CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,89067.6000,13360.1400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,35627.04,,,,,,,6323.8000,89067.6000,percent of total billed charges,"40% of $89,067.60 in Billed Charges for Rev 278 Proc C1713 = $35,627.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 40CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,89067.6000,13360.1400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,37141.19,,,,,,,6323.8000,89067.6000,percent of total billed charges,"41.7% of $89,067.60 in Billed Charges for Rev 278 Proc C1713 = $37,141.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 40CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,89067.6000,13360.1400,CIGNA HEALTHCARE,CIGNA PPO,37141.19,,,,,,,6323.8000,89067.6000,percent of total billed charges,"41.7% of $89,067.60 in Billed Charges for Rev 278 Proc C1713 = $37,141.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 40CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,89067.6000,13360.1400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,80160.84,,,,,,,6323.8000,89067.6000,percent of total billed charges,"90% of $89,067.60 in Billed Charges for Rev 278 Proc C1713 = $80,160.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 40CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,89067.6000,13360.1400,MEDCOST,MEDCOST VHN,42387.27,,,,,,,6323.8000,89067.6000,percent of total billed charges,"47.59% of $89,067.60 in Billed Charges for Rev 278 Proc C1713 = $42,387.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 40CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,89067.6000,13360.1400,SENTARA HEALTH,SENTARA HEALTH,22988.35,,,,,,,6323.8000,89067.6000,percent of total billed charges,"25.81% of $89,067.60 in Billed Charges for Rev 278 Proc C1713 = $22,988.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 40CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,89067.6000,13360.1400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",89067.60,,,,,,,6323.8000,89067.6000,percent of total billed charges,"100% of $89,067.60 in Billed Charges for Rev 278 Proc C1713 = $89,067.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 40CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,89067.6000,13360.1400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,6680.07,,,,,,,6323.8000,89067.6000,percent of total billed charges,"7.5% of $89,067.60 in Billed Charges for Rev 278 Proc C1713 = $6,680.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 40CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,89067.6000,13360.1400,UNITED HEALTHCARE,UHC HERITAGE SELECT,6323.80,,,,,,,6323.8000,89067.6000,percent of total billed charges,"7.1% of $89,067.60 in Billed Charges for Rev 278 Proc C1713 = $6,323.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 40CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,89067.6000,13360.1400,UNITED HEALTHCARE,UNITED HEALTHCARE,6323.80,,,,,,,6323.8000,89067.6000,percent of total billed charges,"7.1% of $89,067.60 in Billed Charges for Rev 278 Proc C1713 = $6,323.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 40CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,89067.6000,13360.1400,WELLCARE,WELLCARE MEDICAID,89067.60,,,,,,,6323.8000,89067.6000,percent of total billed charges,"100% of $89,067.60 in Billed Charges for Rev 278 Proc C1713 = $89,067.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,10644.5900,1596.6900,AETNA,AETNA,5109.40,,,,,,,2747.3700,10644.5900,percent of total billed charges,"48% of $10,644.59 in Billed Charges for Rev 278 Proc C1713 = $5,109.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,10644.5900,1596.6900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5322.30,,,,,,,2747.3700,10644.5900,percent of total billed charges,"50% of $10,644.59 in Billed Charges for Rev 278 Proc C1713 = $5,322.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,10644.5900,1596.6900,CIGNA HEALTHCARE,CIGNA HMO,4438.79,,,,,,,2747.3700,10644.5900,percent of total billed charges,"41.7% of $10,644.59 in Billed Charges for Rev 278 Proc C1713 = $4,438.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,10644.5900,1596.6900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4257.84,,,,,,,2747.3700,10644.5900,percent of total billed charges,"40% of $10,644.59 in Billed Charges for Rev 278 Proc C1713 = $4,257.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,10644.5900,1596.6900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4438.79,,,,,,,2747.3700,10644.5900,percent of total billed charges,"41.7% of $10,644.59 in Billed Charges for Rev 278 Proc C1713 = $4,438.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,10644.5900,1596.6900,CIGNA HEALTHCARE,CIGNA PPO,4438.79,,,,,,,2747.3700,10644.5900,percent of total billed charges,"41.7% of $10,644.59 in Billed Charges for Rev 278 Proc C1713 = $4,438.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,10644.5900,1596.6900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9580.13,,,,,,,2747.3700,10644.5900,percent of total billed charges,"90% of $10,644.59 in Billed Charges for Rev 278 Proc C1713 = $9,580.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,10644.5900,1596.6900,MEDCOST,MEDCOST VHN,5065.76,,,,,,,2747.3700,10644.5900,percent of total billed charges,"47.59% of $10,644.59 in Billed Charges for Rev 278 Proc C1713 = $5,065.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,10644.5900,1596.6900,SENTARA HEALTH,SENTARA HEALTH,2747.37,,,,,,,2747.3700,10644.5900,percent of total billed charges,"25.81% of $10,644.59 in Billed Charges for Rev 278 Proc C1713 = $2,747.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,10644.5900,1596.6900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10644.59,,,,,,,2747.3700,10644.5900,percent of total billed charges,"100% of $10,644.59 in Billed Charges for Rev 278 Proc C1713 = $10,644.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,10644.5900,1596.6900,WELLCARE,WELLCARE MEDICAID,10644.59,,,,,,,2747.3700,10644.5900,percent of total billed charges,"100% of $10,644.59 in Billed Charges for Rev 278 Proc C1713 = $10,644.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX WO IMG GUID EA ADDL LESION,10004,CPT,450,RC,45000352,CDM,,,,both,,,576.0000,86.4000,AETNA,AETNA,245.95,,,,,,,109.0000,576.0000,percent of total billed charges,42.7% of $576.00 in Billed Charges for Rev 450 Proc 10004 = $245.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA BX WO IMG GUID EA ADDL LESION,10004,CPT,450,RC,45000352,CDM,,,,both,,,576.0000,86.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,403.20,,,,,,,109.0000,576.0000,percent of total billed charges,Rev 450 Proc 10004 $576.00 in Billed Charges at 70% = $403.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA BX WO IMG GUID EA ADDL LESION,10004,CPT,450,RC,45000352,CDM,,,,both,,,576.0000,86.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,518.40,,,,,,,109.0000,576.0000,percent of total billed charges,90% of $576.00 in Billed Charges for Rev 450 Proc 10004 = $518.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA BX WO IMG GUID EA ADDL LESION,10004,CPT,450,RC,45000352,CDM,,,,both,,,576.0000,86.4000,MEDCOST,MEDCOST VHN,274.12,,,,,,,109.0000,576.0000,percent of total billed charges,47.59% of $576.00 in Billed Charges for Rev 450 Proc 10004 = $274.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA BX WO IMG GUID EA ADDL LESION,10004,CPT,450,RC,45000352,CDM,,,,both,,,576.0000,86.4000,SENTARA HEALTH,SENTARA HEALTH,148.67,,,,,,,109.0000,576.0000,percent of total billed charges,25.81% of $576.00 in Billed Charges for Rev 450 Proc 10004 = $148.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA BX WO IMG GUID EA ADDL LESION,10004,CPT,450,RC,45000352,CDM,,,,both,,,576.0000,86.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",576.00,,,,,,,109.0000,576.0000,percent of total billed charges,100% of $576.00 in Billed Charges for Rev 450 Proc 10004 = $576.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA BX WO IMG GUID EA ADDL LESION,10004,CPT,450,RC,45000352,CDM,,,,both,,,576.0000,86.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,576.0000,case rate,Rev 450 Proc 10004 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID EA ADDL LESION,10004,CPT,450,RC,45000352,CDM,,,,both,,,576.0000,86.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,576.0000,case rate,Rev 450 Proc 10004 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID EA ADDL LESION,10004,CPT,450,RC,45000352,CDM,,,,both,,,576.0000,86.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,576.0000,case rate,Rev 450 Proc 10004 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID EA ADDL LESION,10004,CPT,450,RC,45000352,CDM,,,,both,,,576.0000,86.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,576.00,,,,,,,109.0000,576.0000,case rate,"Rev 450 Proc 10004 at Case Rate $847.00 (Service Line reduced to $576.00, claim capped at $576.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX WO IMG GUID EA ADDL LESION,10004,CPT,450,RC,45000352,CDM,,,,both,,,576.0000,86.4000,WELLCARE,WELLCARE MEDICAID,576.00,,,,,,,109.0000,576.0000,percent of total billed charges,100% of $576.00 in Billed Charges for Rev 450 Proc 10004 = $576.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,AETNA,AETNA,1457.35,,,,,,,578.0000,3413.0000,percent of total billed charges,"42.7% of $3,413.00 in Billed Charges for Rev 361 Proc 10005 = $1,457.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,578.0000,3413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,578.0000,3413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,578.0000,3413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,AMBETTER,AMBETTER,1400.59,,,,,,,578.0000,3413.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,578.0000,3413.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,578.0000,3413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,578.0000,3413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,578.0000,3413.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1977.02,,,,,,,578.0000,3413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,578.0000,3413.0000,case rate,"Rev 361 Proc 10005 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,578.0000,3413.0000,case rate,Rev 361 Proc 10005 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,578.0000,3413.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,578.0000,3413.0000,case rate,Rev 361 Proc 10005 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,578.0000,3413.0000,case rate,Rev 361 Proc 10005 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,3413.0000,case rate,Rev 361 Proc 10005 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,3413.0000,case rate,Rev 361 Proc 10005 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,CIGNA HEALTHCARE,CIGNA HMO,3413.00,,,,,,,578.0000,3413.0000,case rate,"Rev 361 Proc 10005 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $3,413.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,413.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,578.0000,3413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3413.00,,,,,,,578.0000,3413.0000,case rate,"Rev 361 Proc 10005 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $3,413.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,413.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,CIGNA HEALTHCARE,CIGNA PPO,3413.00,,,,,,,578.0000,3413.0000,case rate,"Rev 361 Proc 10005 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $3,413.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,413.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,578.0000,3413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3071.70,,,,,,,578.0000,3413.0000,percent of total billed charges,"90% of $3,413.00 in Billed Charges for Rev 361 Proc 10005 = $3,071.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,HUMANA,HUMANA MEDICARE,642.47,,,,,,,578.0000,3413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,578.0000,3413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,MEDCOST,MEDCOST VHN,1624.25,,,,,,,578.0000,3413.0000,percent of total billed charges,"47.59% of $3,413.00 in Billed Charges for Rev 361 Proc 10005 = $1,624.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,578.0000,3413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,578.0000,3413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,578.0000,3413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,SENTARA HEALTH,SENTARA HEALTH,880.90,,,,,,,578.0000,3413.0000,percent of total billed charges,"25.81% of $3,413.00 in Billed Charges for Rev 361 Proc 10005 = $880.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,578.0000,3413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3413.00,,,,,,,578.0000,3413.0000,percent of total billed charges,"100% of $3,413.00 in Billed Charges for Rev 361 Proc 10005 = $3,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,578.0000,3413.0000,case rate,Rev 361 Proc 10005 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,578.0000,3413.0000,case rate,Rev 361 Proc 10005 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,578.0000,3413.0000,case rate,Rev 361 Proc 10005 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,578.0000,3413.0000,case rate,"Rev 361 Proc 10005 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,578.0000,3413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,578.0000,3413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,WELLCARE,WELLCARE MEDICAID,3413.00,,,,,,,578.0000,3413.0000,percent of total billed charges,"100% of $3,413.00 in Billed Charges for Rev 361 Proc 10005 = $3,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W US GUID 1ST LESION,10005,CPT,361,RC,36100414,CDM,,,,both,,,3413.0000,511.9500,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,578.0000,3413.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID EA ADDL LESION,10006,CPT,361,RC,36100415,CDM,,,,both,,,2560.0000,384.0000,AETNA,AETNA,1093.12,,,,,,,148.0000,2560.0000,percent of total billed charges,"42.7% of $2,560.00 in Billed Charges for Rev 361 Proc 10006 = $1,093.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W US GUID EA ADDL LESION,10006,CPT,361,RC,36100415,CDM,,,,both,,,2560.0000,384.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,148.0000,2560.0000,case rate,"Rev 361 Proc 10006 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W US GUID EA ADDL LESION,10006,CPT,361,RC,36100415,CDM,,,,both,,,2560.0000,384.0000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,2560.0000,case rate,Rev 361 Proc 10006 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID EA ADDL LESION,10006,CPT,361,RC,36100415,CDM,,,,both,,,2560.0000,384.0000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,2560.0000,case rate,Rev 361 Proc 10006 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID EA ADDL LESION,10006,CPT,361,RC,36100415,CDM,,,,both,,,2560.0000,384.0000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,2560.0000,case rate,Rev 361 Proc 10006 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID EA ADDL LESION,10006,CPT,361,RC,36100415,CDM,,,,both,,,2560.0000,384.0000,CIGNA HEALTHCARE,CIGNA HMO,2560.00,,,,,,,148.0000,2560.0000,case rate,"Rev 361 Proc 10006 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,560.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,560.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W US GUID EA ADDL LESION,10006,CPT,361,RC,36100415,CDM,,,,both,,,2560.0000,384.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2560.00,,,,,,,148.0000,2560.0000,case rate,"Rev 361 Proc 10006 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,560.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,560.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W US GUID EA ADDL LESION,10006,CPT,361,RC,36100415,CDM,,,,both,,,2560.0000,384.0000,CIGNA HEALTHCARE,CIGNA PPO,2560.00,,,,,,,148.0000,2560.0000,case rate,"Rev 361 Proc 10006 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,560.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,560.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W US GUID EA ADDL LESION,10006,CPT,361,RC,36100415,CDM,,,,both,,,2560.0000,384.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2304.00,,,,,,,148.0000,2560.0000,percent of total billed charges,"90% of $2,560.00 in Billed Charges for Rev 361 Proc 10006 = $2,304.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W US GUID EA ADDL LESION,10006,CPT,361,RC,36100415,CDM,,,,both,,,2560.0000,384.0000,MEDCOST,MEDCOST VHN,1218.30,,,,,,,148.0000,2560.0000,percent of total billed charges,"47.59% of $2,560.00 in Billed Charges for Rev 361 Proc 10006 = $1,218.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W US GUID EA ADDL LESION,10006,CPT,361,RC,36100415,CDM,,,,both,,,2560.0000,384.0000,SENTARA HEALTH,SENTARA HEALTH,660.74,,,,,,,148.0000,2560.0000,percent of total billed charges,"25.81% of $2,560.00 in Billed Charges for Rev 361 Proc 10006 = $660.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W US GUID EA ADDL LESION,10006,CPT,361,RC,36100415,CDM,,,,both,,,2560.0000,384.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2560.00,,,,,,,148.0000,2560.0000,percent of total billed charges,"100% of $2,560.00 in Billed Charges for Rev 361 Proc 10006 = $2,560.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W US GUID EA ADDL LESION,10006,CPT,361,RC,36100415,CDM,,,,both,,,2560.0000,384.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,148.0000,2560.0000,case rate,Rev 361 Proc 10006 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID EA ADDL LESION,10006,CPT,361,RC,36100415,CDM,,,,both,,,2560.0000,384.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,148.0000,2560.0000,case rate,Rev 361 Proc 10006 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID EA ADDL LESION,10006,CPT,361,RC,36100415,CDM,,,,both,,,2560.0000,384.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,148.0000,2560.0000,case rate,Rev 361 Proc 10006 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID EA ADDL LESION,10006,CPT,361,RC,36100415,CDM,,,,both,,,2560.0000,384.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,148.0000,2560.0000,case rate,Rev 361 Proc 10006 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W US GUID EA ADDL LESION,10006,CPT,361,RC,36100415,CDM,,,,both,,,2560.0000,384.0000,WELLCARE,WELLCARE MEDICAID,2560.00,,,,,,,148.0000,2560.0000,percent of total billed charges,"100% of $2,560.00 in Billed Charges for Rev 361 Proc 10006 = $2,560.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W CT GUID EA ADDL LESION,10010,CPT,361,RC,36100419,CDM,,,,both,,,1013.0000,151.9500,AETNA,AETNA,432.55,,,,,,,148.0000,1013.0000,percent of total billed charges,"42.7% of $1,013.00 in Billed Charges for Rev 361 Proc 10010 = $432.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W CT GUID EA ADDL LESION,10010,CPT,361,RC,36100419,CDM,,,,both,,,1013.0000,151.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1013.00,,,,,,,148.0000,1013.0000,case rate,"Rev 361 Proc 10010 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $1,013.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,013.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W CT GUID EA ADDL LESION,10010,CPT,361,RC,36100419,CDM,,,,both,,,1013.0000,151.9500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,1013.0000,case rate,Rev 361 Proc 10010 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID EA ADDL LESION,10010,CPT,361,RC,36100419,CDM,,,,both,,,1013.0000,151.9500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,1013.0000,case rate,Rev 361 Proc 10010 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID EA ADDL LESION,10010,CPT,361,RC,36100419,CDM,,,,both,,,1013.0000,151.9500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,1013.0000,case rate,Rev 361 Proc 10010 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID EA ADDL LESION,10010,CPT,361,RC,36100419,CDM,,,,both,,,1013.0000,151.9500,CIGNA HEALTHCARE,CIGNA HMO,1013.00,,,,,,,148.0000,1013.0000,case rate,"Rev 361 Proc 10010 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,013.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,013.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W CT GUID EA ADDL LESION,10010,CPT,361,RC,36100419,CDM,,,,both,,,1013.0000,151.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1013.00,,,,,,,148.0000,1013.0000,case rate,"Rev 361 Proc 10010 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,013.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,013.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W CT GUID EA ADDL LESION,10010,CPT,361,RC,36100419,CDM,,,,both,,,1013.0000,151.9500,CIGNA HEALTHCARE,CIGNA PPO,1013.00,,,,,,,148.0000,1013.0000,case rate,"Rev 361 Proc 10010 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,013.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,013.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W CT GUID EA ADDL LESION,10010,CPT,361,RC,36100419,CDM,,,,both,,,1013.0000,151.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,911.70,,,,,,,148.0000,1013.0000,percent of total billed charges,"90% of $1,013.00 in Billed Charges for Rev 361 Proc 10010 = $911.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W CT GUID EA ADDL LESION,10010,CPT,361,RC,36100419,CDM,,,,both,,,1013.0000,151.9500,MEDCOST,MEDCOST VHN,482.09,,,,,,,148.0000,1013.0000,percent of total billed charges,"47.59% of $1,013.00 in Billed Charges for Rev 361 Proc 10010 = $482.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W CT GUID EA ADDL LESION,10010,CPT,361,RC,36100419,CDM,,,,both,,,1013.0000,151.9500,SENTARA HEALTH,SENTARA HEALTH,261.46,,,,,,,148.0000,1013.0000,percent of total billed charges,"25.81% of $1,013.00 in Billed Charges for Rev 361 Proc 10010 = $261.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W CT GUID EA ADDL LESION,10010,CPT,361,RC,36100419,CDM,,,,both,,,1013.0000,151.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1013.00,,,,,,,148.0000,1013.0000,percent of total billed charges,"100% of $1,013.00 in Billed Charges for Rev 361 Proc 10010 = $1,013.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W CT GUID EA ADDL LESION,10010,CPT,361,RC,36100419,CDM,,,,both,,,1013.0000,151.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,148.0000,1013.0000,case rate,Rev 361 Proc 10010 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID EA ADDL LESION,10010,CPT,361,RC,36100419,CDM,,,,both,,,1013.0000,151.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,148.0000,1013.0000,case rate,Rev 361 Proc 10010 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID EA ADDL LESION,10010,CPT,361,RC,36100419,CDM,,,,both,,,1013.0000,151.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,148.0000,1013.0000,case rate,Rev 361 Proc 10010 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID EA ADDL LESION,10010,CPT,361,RC,36100419,CDM,,,,both,,,1013.0000,151.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,148.0000,1013.0000,case rate,Rev 361 Proc 10010 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W CT GUID EA ADDL LESION,10010,CPT,361,RC,36100419,CDM,,,,both,,,1013.0000,151.9500,WELLCARE,WELLCARE MEDICAID,1013.00,,,,,,,148.0000,1013.0000,percent of total billed charges,"100% of $1,013.00 in Billed Charges for Rev 361 Proc 10010 = $1,013.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W MR GUID EA ADDL LESION,10012,CPT,361,RC,36100421,CDM,,,,both,,,1013.0000,151.9500,AETNA,AETNA,432.55,,,,,,,148.0000,1013.0000,percent of total billed charges,"42.7% of $1,013.00 in Billed Charges for Rev 361 Proc 10012 = $432.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W MR GUID EA ADDL LESION,10012,CPT,361,RC,36100421,CDM,,,,both,,,1013.0000,151.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1013.00,,,,,,,148.0000,1013.0000,case rate,"Rev 361 Proc 10012 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $1,013.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,013.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W MR GUID EA ADDL LESION,10012,CPT,361,RC,36100421,CDM,,,,both,,,1013.0000,151.9500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,1013.0000,case rate,Rev 361 Proc 10012 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID EA ADDL LESION,10012,CPT,361,RC,36100421,CDM,,,,both,,,1013.0000,151.9500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,1013.0000,case rate,Rev 361 Proc 10012 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID EA ADDL LESION,10012,CPT,361,RC,36100421,CDM,,,,both,,,1013.0000,151.9500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,1013.0000,case rate,Rev 361 Proc 10012 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID EA ADDL LESION,10012,CPT,361,RC,36100421,CDM,,,,both,,,1013.0000,151.9500,CIGNA HEALTHCARE,CIGNA HMO,1013.00,,,,,,,148.0000,1013.0000,case rate,"Rev 361 Proc 10012 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,013.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,013.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W MR GUID EA ADDL LESION,10012,CPT,361,RC,36100421,CDM,,,,both,,,1013.0000,151.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1013.00,,,,,,,148.0000,1013.0000,case rate,"Rev 361 Proc 10012 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,013.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,013.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W MR GUID EA ADDL LESION,10012,CPT,361,RC,36100421,CDM,,,,both,,,1013.0000,151.9500,CIGNA HEALTHCARE,CIGNA PPO,1013.00,,,,,,,148.0000,1013.0000,case rate,"Rev 361 Proc 10012 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,013.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,013.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC FNA BX W MR GUID EA ADDL LESION,10012,CPT,361,RC,36100421,CDM,,,,both,,,1013.0000,151.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,911.70,,,,,,,148.0000,1013.0000,percent of total billed charges,"90% of $1,013.00 in Billed Charges for Rev 361 Proc 10012 = $911.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W MR GUID EA ADDL LESION,10012,CPT,361,RC,36100421,CDM,,,,both,,,1013.0000,151.9500,MEDCOST,MEDCOST VHN,482.09,,,,,,,148.0000,1013.0000,percent of total billed charges,"47.59% of $1,013.00 in Billed Charges for Rev 361 Proc 10012 = $482.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W MR GUID EA ADDL LESION,10012,CPT,361,RC,36100421,CDM,,,,both,,,1013.0000,151.9500,SENTARA HEALTH,SENTARA HEALTH,261.46,,,,,,,148.0000,1013.0000,percent of total billed charges,"25.81% of $1,013.00 in Billed Charges for Rev 361 Proc 10012 = $261.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W MR GUID EA ADDL LESION,10012,CPT,361,RC,36100421,CDM,,,,both,,,1013.0000,151.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1013.00,,,,,,,148.0000,1013.0000,percent of total billed charges,"100% of $1,013.00 in Billed Charges for Rev 361 Proc 10012 = $1,013.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX W MR GUID EA ADDL LESION,10012,CPT,361,RC,36100421,CDM,,,,both,,,1013.0000,151.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,148.0000,1013.0000,case rate,Rev 361 Proc 10012 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID EA ADDL LESION,10012,CPT,361,RC,36100421,CDM,,,,both,,,1013.0000,151.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,148.0000,1013.0000,case rate,Rev 361 Proc 10012 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID EA ADDL LESION,10012,CPT,361,RC,36100421,CDM,,,,both,,,1013.0000,151.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,148.0000,1013.0000,case rate,Rev 361 Proc 10012 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID EA ADDL LESION,10012,CPT,361,RC,36100421,CDM,,,,both,,,1013.0000,151.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,148.0000,1013.0000,case rate,Rev 361 Proc 10012 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX W MR GUID EA ADDL LESION,10012,CPT,361,RC,36100421,CDM,,,,both,,,1013.0000,151.9500,WELLCARE,WELLCARE MEDICAID,1013.00,,,,,,,148.0000,1013.0000,percent of total billed charges,"100% of $1,013.00 in Billed Charges for Rev 361 Proc 10012 = $1,013.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,AETNA,AETNA,389.00,,,,,,,18.2700,911.0000,percent of total billed charges,42.7% of $911.00 in Billed Charges for Rev 450 Proc 10021 = $389.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,18.2700,911.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,18.2700,911.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,18.2700,911.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,AMBETTER,AMBETTER,804.03,,,,,,,18.2700,911.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,18.2700,911.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,18.2700,911.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,BLUE CROSS,ANTHEM HMO,911.00,,,,,,,18.2700,911.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,18.2700,911.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",911.00,,,,,,,18.2700,911.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,18.27,,,,,,,18.2700,911.0000,fee schedule,$18.27 from Fee Schedule BLDTM_23 for Rev 450 Proc 10021 * Qty 1 = $18.27 at 100% = $18.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,18.2700,911.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,18.2700,911.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,18.2700,911.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,819.90,,,,,,,18.2700,911.0000,percent of total billed charges,90% of $911.00 in Billed Charges for Rev 450 Proc 10021 = $819.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,18.2700,911.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,18.2700,911.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,MEDCOST,MEDCOST VHN,433.54,,,,,,,18.2700,911.0000,percent of total billed charges,47.59% of $911.00 in Billed Charges for Rev 450 Proc 10021 = $433.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,18.2700,911.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,18.2700,911.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,18.2700,911.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,SENTARA HEALTH,SENTARA HEALTH,235.13,,,,,,,18.2700,911.0000,percent of total billed charges,25.81% of $911.00 in Billed Charges for Rev 450 Proc 10021 = $235.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,18.2700,911.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",911.00,,,,,,,18.2700,911.0000,percent of total billed charges,100% of $911.00 in Billed Charges for Rev 450 Proc 10021 = $911.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,18.2700,911.0000,case rate,Rev 450 Proc 10021 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,18.2700,911.0000,case rate,Rev 450 Proc 10021 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,18.2700,911.0000,case rate,Rev 450 Proc 10021 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,18.2700,911.0000,case rate,Rev 450 Proc 10021 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,18.2700,911.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,18.2700,911.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,WELLCARE,WELLCARE MEDICAID,911.00,,,,,,,18.2700,911.0000,percent of total billed charges,100% of $911.00 in Billed Charges for Rev 450 Proc 10021 = $911.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC FNA BX WO IMG GUID 1ST LESION,10021,CPT,450,RC,45000014,CDM,,,,both,,,911.0000,136.6500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,18.2700,911.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,AETNA,AETNA,897.55,,,,,,,542.5300,2102.0000,percent of total billed charges,"42.7% of $2,102.00 in Billed Charges for Rev 361 Proc 10035 = $897.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1591.43,,,,,,,542.5300,2102.0000,fee schedule,"APG 00004 Proc 10035 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 104% = $1,591.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,542.5300,2102.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,542.5300,2102.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,542.5300,2102.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,AMBETTER,AMBETTER,1400.59,,,,,,,542.5300,2102.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,542.5300,2102.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,542.5300,2102.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1576.13,,,,,,,542.5300,2102.0000,fee schedule,"APG 00004 Proc 10035 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 103% = $1,576.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,542.5300,2102.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,542.5300,2102.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1977.02,,,,,,,542.5300,2102.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,542.5300,2102.0000,case rate,"Rev 361 Proc 10035 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,542.5300,2102.0000,case rate,Rev 361 Proc 10035 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,542.5300,2102.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,542.5300,2102.0000,case rate,Rev 361 Proc 10035 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,542.5300,2102.0000,case rate,Rev 361 Proc 10035 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,CIGNA HEALTHCARE,CIGNA HMO,2102.00,,,,,,,542.5300,2102.0000,case rate,"Rev 361 Proc 10035 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total (Limited to $2,102.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,102.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1956.00,,,,,,,542.5300,2102.0000,case rate,"Rev 361 Proc 10035 ASG Rate of $1,956.00 at 100% of $1,956.00 = $1,956.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,542.5300,2102.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2102.00,,,,,,,542.5300,2102.0000,case rate,"Rev 361 Proc 10035 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total (Limited to $2,102.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,102.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,CIGNA HEALTHCARE,CIGNA PPO,2102.00,,,,,,,542.5300,2102.0000,case rate,"Rev 361 Proc 10035 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total (Limited to $2,102.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,102.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,542.5300,2102.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1891.80,,,,,,,542.5300,2102.0000,percent of total billed charges,"90% of $2,102.00 in Billed Charges for Rev 361 Proc 10035 = $1,891.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,HUMANA,HUMANA MEDICARE,642.47,,,,,,,542.5300,2102.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,542.5300,2102.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,MEDCOST,MEDCOST VHN,1000.34,,,,,,,542.5300,2102.0000,percent of total billed charges,"47.59% of $2,102.00 in Billed Charges for Rev 361 Proc 10035 = $1,000.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1606.74,,,,,,,542.5300,2102.0000,fee schedule,"APG 00004 Proc 10035 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 100% = $1,530.23... $1,530.23 at 105% = $1,606.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,542.5300,2102.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,542.5300,2102.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,542.5300,2102.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1577.67,,,,,,,542.5300,2102.0000,fee schedule,"APG 00004 Proc 10035 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 100% = $1,530.23... $1,530.23 at 103.1% = $1,577.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,SENTARA HEALTH,SENTARA HEALTH,542.53,,,,,,,542.5300,2102.0000,percent of total billed charges,"25.81% of $2,102.00 in Billed Charges for Rev 361 Proc 10035 = $542.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,542.5300,2102.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2102.00,,,,,,,542.5300,2102.0000,percent of total billed charges,"100% of $2,102.00 in Billed Charges for Rev 361 Proc 10035 = $2,102.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,542.5300,2102.0000,case rate,Rev 361 Proc 10035 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,542.5300,2102.0000,case rate,Rev 361 Proc 10035 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,542.5300,2102.0000,case rate,Rev 361 Proc 10035 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,542.5300,2102.0000,case rate,"Rev 361 Proc 10035 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1576.13,,,,,,,542.5300,2102.0000,fee schedule,"APG 00004 Proc 10035 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 103% = $1,576.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,542.5300,2102.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,542.5300,2102.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,WELLCARE,WELLCARE MEDICAID,2102.00,,,,,,,542.5300,2102.0000,percent of total billed charges,"100% of $2,102.00 in Billed Charges for Rev 361 Proc 10035 = $2,102.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE SOFT TISSUE LOC DEVICE PERCU FIRST LESION,10035,CPT,361,RC,36100299,CDM,,,,both,,,2102.0000,315.3000,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,542.5300,2102.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU EA ADDL LESION,10036,CPT,361,RC,36100300,CDM,,,,both,,,608.0000,91.2000,AETNA,AETNA,259.62,,,,,,,148.0000,1606.7400,percent of total billed charges,42.7% of $608.00 in Billed Charges for Rev 361 Proc 10036 = $259.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLACE SOFT TISSUE LOC DEVICE PERCU EA ADDL LESION,10036,CPT,361,RC,36100300,CDM,,,,both,,,608.0000,91.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1591.43,,,,,,,148.0000,1606.7400,fee schedule,"APG 00004 Proc 10036 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment) at 104% = $1,591.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE SOFT TISSUE LOC DEVICE PERCU EA ADDL LESION,10036,CPT,361,RC,36100300,CDM,,,,both,,,608.0000,91.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,608.00,,,,,,,148.0000,1606.7400,fee schedule,"APG 00004 Proc 10036 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment) at 103% = $1,576.13 (Service Line reduced to $608.00, claim capped at $608.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE SOFT TISSUE LOC DEVICE PERCU EA ADDL LESION,10036,CPT,361,RC,36100300,CDM,,,,both,,,608.0000,91.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,608.00,,,,,,,148.0000,1606.7400,case rate,"Rev 361 Proc 10036 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $608.00 in Billed Charges - $0.00 in ASG Allowed Amount = $608.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE SOFT TISSUE LOC DEVICE PERCU EA ADDL LESION,10036,CPT,361,RC,36100300,CDM,,,,both,,,608.0000,91.2000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,1606.7400,case rate,Rev 361 Proc 10036 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU EA ADDL LESION,10036,CPT,361,RC,36100300,CDM,,,,both,,,608.0000,91.2000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,1606.7400,case rate,Rev 361 Proc 10036 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU EA ADDL LESION,10036,CPT,361,RC,36100300,CDM,,,,both,,,608.0000,91.2000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,1606.7400,case rate,Rev 361 Proc 10036 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU EA ADDL LESION,10036,CPT,361,RC,36100300,CDM,,,,both,,,608.0000,91.2000,CIGNA HEALTHCARE,CIGNA HMO,608.00,,,,,,,148.0000,1606.7400,case rate,"Rev 361 Proc 10036 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $608.00 in Billed Charges - $0.00 in ASG Allowed Amount = $608.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE SOFT TISSUE LOC DEVICE PERCU EA ADDL LESION,10036,CPT,361,RC,36100300,CDM,,,,both,,,608.0000,91.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,608.00,,,,,,,148.0000,1606.7400,case rate,"Rev 361 Proc 10036 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $608.00 in Billed Charges - $0.00 in ASG Allowed Amount = $608.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE SOFT TISSUE LOC DEVICE PERCU EA ADDL LESION,10036,CPT,361,RC,36100300,CDM,,,,both,,,608.0000,91.2000,CIGNA HEALTHCARE,CIGNA PPO,608.00,,,,,,,148.0000,1606.7400,case rate,"Rev 361 Proc 10036 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $608.00 in Billed Charges - $0.00 in ASG Allowed Amount = $608.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE SOFT TISSUE LOC DEVICE PERCU EA ADDL LESION,10036,CPT,361,RC,36100300,CDM,,,,both,,,608.0000,91.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,547.20,,,,,,,148.0000,1606.7400,percent of total billed charges,90% of $608.00 in Billed Charges for Rev 361 Proc 10036 = $547.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLACE SOFT TISSUE LOC DEVICE PERCU EA ADDL LESION,10036,CPT,361,RC,36100300,CDM,,,,both,,,608.0000,91.2000,MEDCOST,MEDCOST VHN,289.35,,,,,,,148.0000,1606.7400,percent of total billed charges,47.59% of $608.00 in Billed Charges for Rev 361 Proc 10036 = $289.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLACE SOFT TISSUE LOC DEVICE PERCU EA ADDL LESION,10036,CPT,361,RC,36100300,CDM,,,,both,,,608.0000,91.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1606.74,,,,,,,148.0000,1606.7400,fee schedule,"APG 00004 Proc 10036 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment) at 100% = $1,530.23... $1,530.23 at 105% = $1,606.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE SOFT TISSUE LOC DEVICE PERCU EA ADDL LESION,10036,CPT,361,RC,36100300,CDM,,,,both,,,608.0000,91.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1577.67,,,,,,,148.0000,1606.7400,fee schedule,"APG 00004 Proc 10036 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment) at 100% = $1,530.23... $1,530.23 at 103.1% = $1,577.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE SOFT TISSUE LOC DEVICE PERCU EA ADDL LESION,10036,CPT,361,RC,36100300,CDM,,,,both,,,608.0000,91.2000,SENTARA HEALTH,SENTARA HEALTH,156.92,,,,,,,148.0000,1606.7400,percent of total billed charges,25.81% of $608.00 in Billed Charges for Rev 361 Proc 10036 = $156.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLACE SOFT TISSUE LOC DEVICE PERCU EA ADDL LESION,10036,CPT,361,RC,36100300,CDM,,,,both,,,608.0000,91.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",608.00,,,,,,,148.0000,1606.7400,percent of total billed charges,100% of $608.00 in Billed Charges for Rev 361 Proc 10036 = $608.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PLACE SOFT TISSUE LOC DEVICE PERCU EA ADDL LESION,10036,CPT,361,RC,36100300,CDM,,,,both,,,608.0000,91.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,148.0000,1606.7400,case rate,Rev 361 Proc 10036 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU EA ADDL LESION,10036,CPT,361,RC,36100300,CDM,,,,both,,,608.0000,91.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,148.0000,1606.7400,case rate,Rev 361 Proc 10036 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU EA ADDL LESION,10036,CPT,361,RC,36100300,CDM,,,,both,,,608.0000,91.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,148.0000,1606.7400,case rate,Rev 361 Proc 10036 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU EA ADDL LESION,10036,CPT,361,RC,36100300,CDM,,,,both,,,608.0000,91.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,148.0000,1606.7400,case rate,Rev 361 Proc 10036 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE SOFT TISSUE LOC DEVICE PERCU EA ADDL LESION,10036,CPT,361,RC,36100300,CDM,,,,both,,,608.0000,91.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1576.13,,,,,,,148.0000,1606.7400,fee schedule,"APG 00004 Proc 10036 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment) at 103% = $1,576.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE SOFT TISSUE LOC DEVICE PERCU EA ADDL LESION,10036,CPT,361,RC,36100300,CDM,,,,both,,,608.0000,91.2000,WELLCARE,WELLCARE MEDICAID,608.00,,,,,,,148.0000,1606.7400,percent of total billed charges,100% of $608.00 in Billed Charges for Rev 361 Proc 10036 = $608.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRAFT PUTTY BONE REFICIO ALLOGRAFT 0.5ML DBM PK,C1713,HCPCS,278,RC,,,,,,both,,,747.7500,112.1600,AETNA,AETNA,358.92,,,,,,,192.9900,747.7500,percent of total billed charges,48% of $747.75 in Billed Charges for Rev 278 Proc C1713 = $358.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRAFT PUTTY BONE REFICIO ALLOGRAFT 0.5ML DBM PK,C1713,HCPCS,278,RC,,,,,,both,,,747.7500,112.1600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,373.88,,,,,,,192.9900,747.7500,percent of total billed charges,50% of $747.75 in Billed Charges for Rev 278 Proc C1713 = $373.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRAFT PUTTY BONE REFICIO ALLOGRAFT 0.5ML DBM PK,C1713,HCPCS,278,RC,,,,,,both,,,747.7500,112.1600,CIGNA HEALTHCARE,CIGNA HMO,311.81,,,,,,,192.9900,747.7500,percent of total billed charges,41.7% of $747.75 in Billed Charges for Rev 278 Proc C1713 = $311.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRAFT PUTTY BONE REFICIO ALLOGRAFT 0.5ML DBM PK,C1713,HCPCS,278,RC,,,,,,both,,,747.7500,112.1600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,299.10,,,,,,,192.9900,747.7500,percent of total billed charges,40% of $747.75 in Billed Charges for Rev 278 Proc C1713 = $299.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRAFT PUTTY BONE REFICIO ALLOGRAFT 0.5ML DBM PK,C1713,HCPCS,278,RC,,,,,,both,,,747.7500,112.1600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,311.81,,,,,,,192.9900,747.7500,percent of total billed charges,41.7% of $747.75 in Billed Charges for Rev 278 Proc C1713 = $311.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRAFT PUTTY BONE REFICIO ALLOGRAFT 0.5ML DBM PK,C1713,HCPCS,278,RC,,,,,,both,,,747.7500,112.1600,CIGNA HEALTHCARE,CIGNA PPO,311.81,,,,,,,192.9900,747.7500,percent of total billed charges,41.7% of $747.75 in Billed Charges for Rev 278 Proc C1713 = $311.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRAFT PUTTY BONE REFICIO ALLOGRAFT 0.5ML DBM PK,C1713,HCPCS,278,RC,,,,,,both,,,747.7500,112.1600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,672.98,,,,,,,192.9900,747.7500,percent of total billed charges,90% of $747.75 in Billed Charges for Rev 278 Proc C1713 = $672.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRAFT PUTTY BONE REFICIO ALLOGRAFT 0.5ML DBM PK,C1713,HCPCS,278,RC,,,,,,both,,,747.7500,112.1600,MEDCOST,MEDCOST VHN,355.85,,,,,,,192.9900,747.7500,percent of total billed charges,47.59% of $747.75 in Billed Charges for Rev 278 Proc C1713 = $355.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRAFT PUTTY BONE REFICIO ALLOGRAFT 0.5ML DBM PK,C1713,HCPCS,278,RC,,,,,,both,,,747.7500,112.1600,SENTARA HEALTH,SENTARA HEALTH,192.99,,,,,,,192.9900,747.7500,percent of total billed charges,25.81% of $747.75 in Billed Charges for Rev 278 Proc C1713 = $192.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRAFT PUTTY BONE REFICIO ALLOGRAFT 0.5ML DBM PK,C1713,HCPCS,278,RC,,,,,,both,,,747.7500,112.1600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",747.75,,,,,,,192.9900,747.7500,percent of total billed charges,100% of $747.75 in Billed Charges for Rev 278 Proc C1713 = $747.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRAFT PUTTY BONE REFICIO ALLOGRAFT 0.5ML DBM PK,C1713,HCPCS,278,RC,,,,,,both,,,747.7500,112.1600,WELLCARE,WELLCARE MEDICAID,747.75,,,,,,,192.9900,747.7500,percent of total billed charges,100% of $747.75 in Billed Charges for Rev 278 Proc C1713 = $747.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
GRAFT TRUEMATCH CAGE LONG BONE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,168243.5500,25236.5300,AETNA,AETNA,80756.90,,,,,,,11945.2900,168243.5500,percent of total billed charges,"48% of $168,243.55 in Billed Charges for Rev 278 Proc C1713 = $80,756.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT TRUEMATCH CAGE LONG BONE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,168243.5500,25236.5300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,84121.78,,,,,,,11945.2900,168243.5500,percent of total billed charges,"50% of $168,243.55 in Billed Charges for Rev 278 Proc C1713 = $84,121.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT TRUEMATCH CAGE LONG BONE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,168243.5500,25236.5300,CIGNA HEALTHCARE,CIGNA HMO,70157.56,,,,,,,11945.2900,168243.5500,percent of total billed charges,"41.7% of $168,243.55 in Billed Charges for Rev 278 Proc C1713 = $70,157.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT TRUEMATCH CAGE LONG BONE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,168243.5500,25236.5300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,67297.42,,,,,,,11945.2900,168243.5500,percent of total billed charges,"40% of $168,243.55 in Billed Charges for Rev 278 Proc C1713 = $67,297.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT TRUEMATCH CAGE LONG BONE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,168243.5500,25236.5300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,70157.56,,,,,,,11945.2900,168243.5500,percent of total billed charges,"41.7% of $168,243.55 in Billed Charges for Rev 278 Proc C1713 = $70,157.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT TRUEMATCH CAGE LONG BONE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,168243.5500,25236.5300,CIGNA HEALTHCARE,CIGNA PPO,70157.56,,,,,,,11945.2900,168243.5500,percent of total billed charges,"41.7% of $168,243.55 in Billed Charges for Rev 278 Proc C1713 = $70,157.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT TRUEMATCH CAGE LONG BONE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,168243.5500,25236.5300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,151419.20,,,,,,,11945.2900,168243.5500,percent of total billed charges,"90% of $168,243.55 in Billed Charges for Rev 278 Proc C1713 = $151,419.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT TRUEMATCH CAGE LONG BONE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,168243.5500,25236.5300,MEDCOST,MEDCOST VHN,80067.11,,,,,,,11945.2900,168243.5500,percent of total billed charges,"47.59% of $168,243.55 in Billed Charges for Rev 278 Proc C1713 = $80,067.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT TRUEMATCH CAGE LONG BONE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,168243.5500,25236.5300,SENTARA HEALTH,SENTARA HEALTH,43423.66,,,,,,,11945.2900,168243.5500,percent of total billed charges,"25.81% of $168,243.55 in Billed Charges for Rev 278 Proc C1713 = $43,423.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT TRUEMATCH CAGE LONG BONE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,168243.5500,25236.5300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",168243.55,,,,,,,11945.2900,168243.5500,percent of total billed charges,"100% of $168,243.55 in Billed Charges for Rev 278 Proc C1713 = $168,243.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT TRUEMATCH CAGE LONG BONE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,168243.5500,25236.5300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12618.27,,,,,,,11945.2900,168243.5500,percent of total billed charges,"7.5% of $168,243.55 in Billed Charges for Rev 278 Proc C1713 = $12,618.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT TRUEMATCH CAGE LONG BONE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,168243.5500,25236.5300,UNITED HEALTHCARE,UHC HERITAGE SELECT,11945.29,,,,,,,11945.2900,168243.5500,percent of total billed charges,"7.1% of $168,243.55 in Billed Charges for Rev 278 Proc C1713 = $11,945.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT TRUEMATCH CAGE LONG BONE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,168243.5500,25236.5300,UNITED HEALTHCARE,UNITED HEALTHCARE,11945.29,,,,,,,11945.2900,168243.5500,percent of total billed charges,"7.1% of $168,243.55 in Billed Charges for Rev 278 Proc C1713 = $11,945.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT TRUEMATCH CAGE LONG BONE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,168243.5500,25236.5300,WELLCARE,WELLCARE MEDICAID,168243.55,,,,,,,11945.2900,168243.5500,percent of total billed charges,"100% of $168,243.55 in Billed Charges for Rev 278 Proc C1713 = $168,243.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,11887.2400,1783.0900,AETNA,AETNA,5705.88,,,,,,,3068.1000,11887.2400,percent of total billed charges,"48% of $11,887.24 in Billed Charges for Rev 278 Proc C1713 = $5,705.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,11887.2400,1783.0900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5943.62,,,,,,,3068.1000,11887.2400,percent of total billed charges,"50% of $11,887.24 in Billed Charges for Rev 278 Proc C1713 = $5,943.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,11887.2400,1783.0900,CIGNA HEALTHCARE,CIGNA HMO,4956.98,,,,,,,3068.1000,11887.2400,percent of total billed charges,"41.7% of $11,887.24 in Billed Charges for Rev 278 Proc C1713 = $4,956.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,11887.2400,1783.0900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4754.90,,,,,,,3068.1000,11887.2400,percent of total billed charges,"40% of $11,887.24 in Billed Charges for Rev 278 Proc C1713 = $4,754.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,11887.2400,1783.0900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4956.98,,,,,,,3068.1000,11887.2400,percent of total billed charges,"41.7% of $11,887.24 in Billed Charges for Rev 278 Proc C1713 = $4,956.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,11887.2400,1783.0900,CIGNA HEALTHCARE,CIGNA PPO,4956.98,,,,,,,3068.1000,11887.2400,percent of total billed charges,"41.7% of $11,887.24 in Billed Charges for Rev 278 Proc C1713 = $4,956.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,11887.2400,1783.0900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10698.52,,,,,,,3068.1000,11887.2400,percent of total billed charges,"90% of $11,887.24 in Billed Charges for Rev 278 Proc C1713 = $10,698.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,11887.2400,1783.0900,MEDCOST,MEDCOST VHN,5657.14,,,,,,,3068.1000,11887.2400,percent of total billed charges,"47.59% of $11,887.24 in Billed Charges for Rev 278 Proc C1713 = $5,657.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,11887.2400,1783.0900,SENTARA HEALTH,SENTARA HEALTH,3068.10,,,,,,,3068.1000,11887.2400,percent of total billed charges,"25.81% of $11,887.24 in Billed Charges for Rev 278 Proc C1713 = $3,068.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,11887.2400,1783.0900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11887.24,,,,,,,3068.1000,11887.2400,percent of total billed charges,"100% of $11,887.24 in Billed Charges for Rev 278 Proc C1713 = $11,887.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,11887.2400,1783.0900,WELLCARE,WELLCARE MEDICAID,11887.24,,,,,,,3068.1000,11887.2400,percent of total billed charges,"100% of $11,887.24 in Billed Charges for Rev 278 Proc C1713 = $11,887.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,AETNA,AETNA,349.29,,,,,,,40.8100,1400.5900,percent of total billed charges,42.7% of $818.00 in Billed Charges for Rev 450 Proc 10080 = $349.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,40.8100,1400.5900,fee schedule,"APG 00003 Proc 10080 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,40.8100,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,40.8100,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,40.8100,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,AMBETTER,AMBETTER,1400.59,,,,,,,40.8100,1400.5900,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,40.8100,1400.5900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,BLUE CROSS,ANTHEM EXCHANGE,818.00,,,,,,,40.8100,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,40.8100,1400.5900,fee schedule,"APG 00003 Proc 10080 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,BLUE CROSS,ANTHEM HMO,818.00,,,,,,,40.8100,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,40.8100,1400.5900,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",818.00,,,,,,,40.8100,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,76.07,,,,,,,40.8100,1400.5900,fee schedule,$76.07 from Fee Schedule BLDTM_23 for Rev 450 Proc 10080 * Qty 1 = $76.07 at 100% = $76.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,40.8100,1400.5900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,BLUE CROSS,TENNCARE BLUE CARE,40.81,,,,,,,40.8100,1400.5900,fee schedule,$35.18 from Fee Schedule TC_24 for Rev 450 Proc 10080 * Qty 1 = $35.18 at 116% = $40.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,BLUE CROSS,TENNCARE BLUE SELECT,40.81,,,,,,,40.8100,1400.5900,fee schedule,$35.18 from Fee Schedule TC_24 for Rev 450 Proc 10080 * Qty 1 = $35.18 at 116% = $40.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,40.8100,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,40.8100,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,736.20,,,,,,,40.8100,1400.5900,percent of total billed charges,90% of $818.00 in Billed Charges for Rev 450 Proc 10080 = $736.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,HUMANA,HUMANA MEDICARE,642.47,,,,,,,40.8100,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,40.8100,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,MEDCOST,MEDCOST VHN,389.29,,,,,,,40.8100,1400.5900,percent of total billed charges,47.59% of $818.00 in Billed Charges for Rev 450 Proc 10080 = $389.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,40.8100,1400.5900,fee schedule,"APG 00003 Proc 10080 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,40.8100,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,40.8100,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,40.8100,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,40.8100,1400.5900,fee schedule,"APG 00003 Proc 10080 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,SENTARA HEALTH,SENTARA HEALTH,211.13,,,,,,,40.8100,1400.5900,percent of total billed charges,25.81% of $818.00 in Billed Charges for Rev 450 Proc 10080 = $211.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,40.8100,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",818.00,,,,,,,40.8100,1400.5900,percent of total billed charges,100% of $818.00 in Billed Charges for Rev 450 Proc 10080 = $818.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,40.8100,1400.5900,case rate,Rev 450 Proc 10080 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,40.8100,1400.5900,case rate,Rev 450 Proc 10080 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,40.8100,1400.5900,case rate,Rev 450 Proc 10080 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,818.00,,,,,,,40.8100,1400.5900,case rate,"Rev 450 Proc 10080 at Case Rate $847.00 (Service Line reduced to $818.00, claim capped at $818.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,40.8100,1400.5900,fee schedule,"APG 00003 Proc 10080 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,40.8100,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,40.8100,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,WELLCARE,WELLCARE MEDICAID,818.00,,,,,,,40.8100,1400.5900,percent of total billed charges,100% of $818.00 in Billed Charges for Rev 450 Proc 10080 = $818.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC I&D PILONIDAL CYST SIMPLE,10080,CPT,450,RC,45000017,CDM,,,,both,,,818.0000,122.7000,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,40.8100,1400.5900,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,AETNA,AETNA,1541.04,,,,,,,109.0000,3609.0000,percent of total billed charges,"42.7% of $3,609.00 in Billed Charges for Rev 450 Proc 10081 = $1,541.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1591.43,,,,,,,109.0000,3609.0000,fee schedule,"APG 00004 Proc 10081 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 104% = $1,591.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,109.0000,3609.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,109.0000,3609.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,109.0000,3609.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,AMBETTER,AMBETTER,1400.59,,,,,,,109.0000,3609.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,109.0000,3609.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,109.0000,3609.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1576.13,,,,,,,109.0000,3609.0000,fee schedule,"APG 00004 Proc 10081 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 103% = $1,576.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,109.0000,3609.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,109.0000,3609.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1977.02,,,,,,,109.0000,3609.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,150.37,,,,,,,109.0000,3609.0000,fee schedule,$150.37 from Fee Schedule BLDTM_23 for Rev 450 Proc 10081 * Qty 1 = $150.37 at 100% = $150.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,109.0000,3609.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,109.0000,3609.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,109.0000,3609.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3248.10,,,,,,,109.0000,3609.0000,percent of total billed charges,"90% of $3,609.00 in Billed Charges for Rev 450 Proc 10081 = $3,248.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,HUMANA,HUMANA MEDICARE,642.47,,,,,,,109.0000,3609.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,109.0000,3609.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,MEDCOST,MEDCOST VHN,1717.52,,,,,,,109.0000,3609.0000,percent of total billed charges,"47.59% of $3,609.00 in Billed Charges for Rev 450 Proc 10081 = $1,717.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1606.74,,,,,,,109.0000,3609.0000,fee schedule,"APG 00004 Proc 10081 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 100% = $1,530.23... $1,530.23 at 105% = $1,606.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,109.0000,3609.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,109.0000,3609.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,109.0000,3609.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1577.67,,,,,,,109.0000,3609.0000,fee schedule,"APG 00004 Proc 10081 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 100% = $1,530.23... $1,530.23 at 103.1% = $1,577.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,SENTARA HEALTH,SENTARA HEALTH,931.48,,,,,,,109.0000,3609.0000,percent of total billed charges,"25.81% of $3,609.00 in Billed Charges for Rev 450 Proc 10081 = $931.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,109.0000,3609.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3609.00,,,,,,,109.0000,3609.0000,percent of total billed charges,"100% of $3,609.00 in Billed Charges for Rev 450 Proc 10081 = $3,609.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3609.0000,case rate,Rev 450 Proc 10081 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3609.0000,case rate,Rev 450 Proc 10081 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3609.0000,case rate,Rev 450 Proc 10081 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3609.0000,case rate,Rev 450 Proc 10081 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1576.13,,,,,,,109.0000,3609.0000,fee schedule,"APG 00004 Proc 10081 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 103% = $1,576.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,109.0000,3609.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,109.0000,3609.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,WELLCARE,WELLCARE MEDICAID,3609.00,,,,,,,109.0000,3609.0000,percent of total billed charges,"100% of $3,609.00 in Billed Charges for Rev 450 Proc 10081 = $3,609.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC I&D PILONIDAL CYST COMPLICATED,10081,CPT,450,RC,45000018,CDM,,,,both,,,3609.0000,541.3500,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,109.0000,3609.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,AETNA,AETNA,388.57,,,,,,,109.0000,1461.7800,percent of total billed charges,42.7% of $910.00 in Billed Charges for Rev 450 Proc 12046 = $388.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,109.0000,1461.7800,fee schedule,"APG 00017 Proc 12046 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,670.54,,,,,,,109.0000,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,AETNA,AETNA HEALTHCARE MEDICARE,670.54,,,,,,,109.0000,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,670.54,,,,,,,109.0000,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,AMBETTER,AMBETTER,1461.78,,,,,,,109.0000,1461.7800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,697.36,,,,,,,109.0000,1461.7800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,BLUE CROSS,ANTHEM EXCHANGE,910.00,,,,,,,109.0000,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,109.0000,1461.7800,fee schedule,"APG 00017 Proc 12046 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,BLUE CROSS,ANTHEM HMO,910.00,,,,,,,109.0000,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,690.66,,,,,,,109.0000,1461.7800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",910.00,,,,,,,109.0000,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,287.99,,,,,,,109.0000,1461.7800,fee schedule,$287.99 from Fee Schedule BLDTM_23 for Rev 450 Proc 12046 * Qty 1 = $287.99 at 100% = $287.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,BLUE CROSS,BLUE CROSS MEDICARE,697.36,,,,,,,109.0000,1461.7800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,704.07,,,,,,,109.0000,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,704.07,,,,,,,109.0000,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,819.00,,,,,,,109.0000,1461.7800,percent of total billed charges,90% of $910.00 in Billed Charges for Rev 450 Proc 12046 = $819.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,HUMANA,HUMANA MEDICARE,670.54,,,,,,,109.0000,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,670.54,,,,,,,109.0000,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,MEDCOST,MEDCOST VHN,433.07,,,,,,,109.0000,1461.7800,percent of total billed charges,47.59% of $910.00 in Billed Charges for Rev 450 Proc 12046 = $433.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,109.0000,1461.7800,fee schedule,"APG 00017 Proc 12046 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,704.07,,,,,,,109.0000,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,704.07,,,,,,,109.0000,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,NHC ADVANTAGE,NHC ADVANTAGE,704.07,,,,,,,109.0000,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,109.0000,1461.7800,fee schedule,"APG 00017 Proc 12046 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,SENTARA HEALTH,SENTARA HEALTH,234.87,,,,,,,109.0000,1461.7800,percent of total billed charges,25.81% of $910.00 in Billed Charges for Rev 450 Proc 12046 = $234.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,SENTARA HEALTH,SENTARA MEDICARE,670.54,,,,,,,109.0000,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",910.00,,,,,,,109.0000,1461.7800,percent of total billed charges,100% of $910.00 in Billed Charges for Rev 450 Proc 12046 = $910.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1461.7800,case rate,Rev 450 Proc 12046 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1461.7800,case rate,Rev 450 Proc 12046 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1461.7800,case rate,Rev 450 Proc 12046 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1461.7800,case rate,Rev 450 Proc 12046 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,109.0000,1461.7800,fee schedule,"APG 00017 Proc 12046 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,670.54,,,,,,,109.0000,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,670.54,,,,,,,109.0000,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,WELLCARE,WELLCARE MEDICAID,910.00,,,,,,,109.0000,1461.7800,percent of total billed charges,100% of $910.00 in Billed Charges for Rev 450 Proc 12046 = $910.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS WND N/H/F 20.1-30.0,12046,CPT,450,RC,45000059,CDM,,,,both,,,910.0000,136.5000,WELLCARE,WELLCARE MEDICARE,710.77,,,,,,,109.0000,1461.7800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,AETNA,AETNA,2332.70,,,,,,,109.0000,5463.0000,percent of total billed charges,"42.7% of $5,463.00 in Billed Charges for Rev 450 Proc 12047 = $2,332.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,109.0000,5463.0000,fee schedule,"APG 00017 Proc 12047 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1871.96,,,,,,,109.0000,5463.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,AETNA,AETNA HEALTHCARE MEDICARE,1871.96,,,,,,,109.0000,5463.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,1871.96,,,,,,,109.0000,5463.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,AMBETTER,AMBETTER,4080.88,,,,,,,109.0000,5463.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1946.84,,,,,,,109.0000,5463.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,BLUE CROSS,ANTHEM EXCHANGE,4608.86,,,,,,,109.0000,5463.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,109.0000,5463.0000,fee schedule,"APG 00017 Proc 12047 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,BLUE CROSS,ANTHEM HMO,4896.64,,,,,,,109.0000,5463.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1928.12,,,,,,,109.0000,5463.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5463.00,,,,,,,109.0000,5463.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,344.42,,,,,,,109.0000,5463.0000,fee schedule,$344.42 from Fee Schedule BLDTM_23 for Rev 450 Proc 12047 * Qty 1 = $344.42 at 100% = $344.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,BLUE CROSS,BLUE CROSS MEDICARE,1946.84,,,,,,,109.0000,5463.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,1965.56,,,,,,,109.0000,5463.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1965.56,,,,,,,109.0000,5463.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4916.70,,,,,,,109.0000,5463.0000,percent of total billed charges,"90% of $5,463.00 in Billed Charges for Rev 450 Proc 12047 = $4,916.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,HUMANA,HUMANA MEDICARE,1871.96,,,,,,,109.0000,5463.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1871.96,,,,,,,109.0000,5463.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,MEDCOST,MEDCOST VHN,2599.84,,,,,,,109.0000,5463.0000,percent of total billed charges,"47.59% of $5,463.00 in Billed Charges for Rev 450 Proc 12047 = $2,599.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,109.0000,5463.0000,fee schedule,"APG 00017 Proc 12047 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1965.56,,,,,,,109.0000,5463.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1965.56,,,,,,,109.0000,5463.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,NHC ADVANTAGE,NHC ADVANTAGE,1965.56,,,,,,,109.0000,5463.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,109.0000,5463.0000,fee schedule,"APG 00017 Proc 12047 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,SENTARA HEALTH,SENTARA HEALTH,1410.00,,,,,,,109.0000,5463.0000,percent of total billed charges,"25.81% of $5,463.00 in Billed Charges for Rev 450 Proc 12047 = $1,410.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,SENTARA HEALTH,SENTARA MEDICARE,1871.96,,,,,,,109.0000,5463.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5463.00,,,,,,,109.0000,5463.0000,percent of total billed charges,"100% of $5,463.00 in Billed Charges for Rev 450 Proc 12047 = $5,463.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,5463.0000,case rate,Rev 450 Proc 12047 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,5463.0000,case rate,Rev 450 Proc 12047 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,5463.0000,case rate,Rev 450 Proc 12047 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,5463.0000,case rate,Rev 450 Proc 12047 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,109.0000,5463.0000,fee schedule,"APG 00017 Proc 12047 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1871.96,,,,,,,109.0000,5463.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1871.96,,,,,,,109.0000,5463.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,WELLCARE,WELLCARE MEDICAID,5463.00,,,,,,,109.0000,5463.0000,percent of total billed charges,"100% of $5,463.00 in Billed Charges for Rev 450 Proc 12047 = $5,463.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND N/H/F OVER 30.0CM,12047,CPT,450,RC,45000338,CDM,,,,both,,,5463.0000,819.4500,WELLCARE,WELLCARE MEDICARE,1984.28,,,,,,,109.0000,5463.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,AETNA,AETNA,497.88,,,,,,,109.0000,1166.0000,percent of total billed charges,"42.7% of $1,166.00 in Billed Charges for Rev 450 Proc 12052 = $497.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,109.0000,1166.0000,fee schedule,"APG 00017 Proc 12052 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,109.0000,1166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,1166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,109.0000,1166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,AMBETTER,AMBETTER,804.03,,,,,,,109.0000,1166.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,109.0000,1166.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,109.0000,1166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,109.0000,1166.0000,fee schedule,"APG 00017 Proc 12052 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,109.0000,1166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,109.0000,1166.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1134.94,,,,,,,109.0000,1166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,171.16,,,,,,,109.0000,1166.0000,fee schedule,$171.16 from Fee Schedule BLDTM_23 for Rev 450 Proc 12052 * Qty 1 = $171.16 at 100% = $171.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,109.0000,1166.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,109.0000,1166.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,109.0000,1166.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1049.40,,,,,,,109.0000,1166.0000,percent of total billed charges,"90% of $1,166.00 in Billed Charges for Rev 450 Proc 12052 = $1,049.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,HUMANA,HUMANA MEDICARE,368.82,,,,,,,109.0000,1166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,109.0000,1166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,MEDCOST,MEDCOST VHN,554.90,,,,,,,109.0000,1166.0000,percent of total billed charges,"47.59% of $1,166.00 in Billed Charges for Rev 450 Proc 12052 = $554.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,109.0000,1166.0000,fee schedule,"APG 00017 Proc 12052 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,109.0000,1166.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,109.0000,1166.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,109.0000,1166.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,109.0000,1166.0000,fee schedule,"APG 00017 Proc 12052 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,SENTARA HEALTH,SENTARA HEALTH,300.94,,,,,,,109.0000,1166.0000,percent of total billed charges,"25.81% of $1,166.00 in Billed Charges for Rev 450 Proc 12052 = $300.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,109.0000,1166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1166.00,,,,,,,109.0000,1166.0000,percent of total billed charges,"100% of $1,166.00 in Billed Charges for Rev 450 Proc 12052 = $1,166.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1166.0000,case rate,Rev 450 Proc 12052 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1166.0000,case rate,Rev 450 Proc 12052 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1166.0000,case rate,Rev 450 Proc 12052 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1166.0000,case rate,Rev 450 Proc 12052 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,109.0000,1166.0000,fee schedule,"APG 00017 Proc 12052 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,1166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,109.0000,1166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,WELLCARE,WELLCARE MEDICAID,1166.00,,,,,,,109.0000,1166.0000,percent of total billed charges,"100% of $1,166.00 in Billed Charges for Rev 450 Proc 12052 = $1,166.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS FACE LIPS 2.6-5,12052,CPT,450,RC,45000061,CDM,,,,both,,,1166.0000,174.9000,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,109.0000,1166.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE SA83H,272,RC,27200002,CDM,,,,,,both,,,792.6800,118.9000,AETNA,AETNA,338.47,,,,,,,204.5900,792.6800,percent of total billed charges,42.7% of $792.68 in Billed Charges for Rev 272 = $338.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SA83H,272,RC,27200002,CDM,,,,,,both,,,792.6800,118.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,554.88,,,,,,,204.5900,792.6800,percent of total billed charges,Rev 272 $792.68 in Billed Charges at 70% = $554.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SA83H,272,RC,27200002,CDM,,,,,,both,,,792.6800,118.9000,CIGNA HEALTHCARE,CIGNA HMO,330.55,,,,,,,204.5900,792.6800,percent of total billed charges,41.7% of $792.68 in Billed Charges for Rev 272 = $330.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SA83H,272,RC,27200002,CDM,,,,,,both,,,792.6800,118.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,367.80,,,,,,,204.5900,792.6800,percent of total billed charges,46.4% of $792.68 in Billed Charges for Rev 272 = $367.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SA83H,272,RC,27200002,CDM,,,,,,both,,,792.6800,118.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,330.55,,,,,,,204.5900,792.6800,percent of total billed charges,41.7% of $792.68 in Billed Charges for Rev 272 = $330.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SA83H,272,RC,27200002,CDM,,,,,,both,,,792.6800,118.9000,CIGNA HEALTHCARE,CIGNA PPO,330.55,,,,,,,204.5900,792.6800,percent of total billed charges,41.7% of $792.68 in Billed Charges for Rev 272 = $330.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SA83H,272,RC,27200002,CDM,,,,,,both,,,792.6800,118.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,713.41,,,,,,,204.5900,792.6800,percent of total billed charges,90% of $792.68 in Billed Charges for Rev 272 = $713.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SA83H,272,RC,27200002,CDM,,,,,,both,,,792.6800,118.9000,MEDCOST,MEDCOST VHN,377.24,,,,,,,204.5900,792.6800,percent of total billed charges,47.59% of $792.68 in Billed Charges for Rev 272 = $377.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SA83H,272,RC,27200002,CDM,,,,,,both,,,792.6800,118.9000,SENTARA HEALTH,SENTARA HEALTH,204.59,,,,,,,204.5900,792.6800,percent of total billed charges,25.81% of $792.68 in Billed Charges for Rev 272 = $204.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SA83H,272,RC,27200002,CDM,,,,,,both,,,792.6800,118.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",792.68,,,,,,,204.5900,792.6800,percent of total billed charges,100% of $792.68 in Billed Charges for Rev 272 = $792.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SA83H,272,RC,27200002,CDM,,,,,,both,,,792.6800,118.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,396.34,,,,,,,204.5900,792.6800,percent of total billed charges,Rev 272 $792.68 in Billed Charges at 50% = $396.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SA83H,272,RC,27200002,CDM,,,,,,both,,,792.6800,118.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,256.04,,,,,,,204.5900,792.6800,other,32.3% of $792.68 in Billed Charges for Rev 272 = $256.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE SA83H,272,RC,27200002,CDM,,,,,,both,,,792.6800,118.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,243.35,,,,,,,204.5900,792.6800,other,30.7% of $792.68 in Billed Charges for Rev 272 = $243.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE SA83H,272,RC,27200002,CDM,,,,,,both,,,792.6800,118.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,256.04,,,,,,,204.5900,792.6800,percent of total billed charges,32.3% of $792.68 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SA83H,272,RC,27200002,CDM,,,,,,both,,,792.6800,118.9000,WELLCARE,WELLCARE MEDICAID,792.68,,,,,,,204.5900,792.6800,percent of total billed charges,100% of $792.68 in Billed Charges for Rev 272 = $792.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SILK 6.0 P1 639G,270,RC,,,,,,,,both,,,37.1600,5.5700,AETNA,AETNA,15.87,,,,,,,9.5900,37.1600,percent of total billed charges,42.7% of $37.16 in Billed Charges for Rev 270 = $15.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SILK 6.0 P1 639G,270,RC,,,,,,,,both,,,37.1600,5.5700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,26.01,,,,,,,9.5900,37.1600,percent of total billed charges,Rev 270 $37.16 in Billed Charges at 70% = $26.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SILK 6.0 P1 639G,270,RC,,,,,,,,both,,,37.1600,5.5700,CIGNA HEALTHCARE,CIGNA HMO,15.50,,,,,,,9.5900,37.1600,percent of total billed charges,41.7% of $37.16 in Billed Charges for Rev 270 = $15.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SILK 6.0 P1 639G,270,RC,,,,,,,,both,,,37.1600,5.5700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,17.24,,,,,,,9.5900,37.1600,percent of total billed charges,46.4% of $37.16 in Billed Charges for Rev 270 = $17.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SILK 6.0 P1 639G,270,RC,,,,,,,,both,,,37.1600,5.5700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,15.50,,,,,,,9.5900,37.1600,percent of total billed charges,41.7% of $37.16 in Billed Charges for Rev 270 = $15.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SILK 6.0 P1 639G,270,RC,,,,,,,,both,,,37.1600,5.5700,CIGNA HEALTHCARE,CIGNA PPO,15.50,,,,,,,9.5900,37.1600,percent of total billed charges,41.7% of $37.16 in Billed Charges for Rev 270 = $15.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SILK 6.0 P1 639G,270,RC,,,,,,,,both,,,37.1600,5.5700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,33.44,,,,,,,9.5900,37.1600,percent of total billed charges,90% of $37.16 in Billed Charges for Rev 270 = $33.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SILK 6.0 P1 639G,270,RC,,,,,,,,both,,,37.1600,5.5700,MEDCOST,MEDCOST VHN,17.68,,,,,,,9.5900,37.1600,percent of total billed charges,47.59% of $37.16 in Billed Charges for Rev 270 = $17.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SILK 6.0 P1 639G,270,RC,,,,,,,,both,,,37.1600,5.5700,SENTARA HEALTH,SENTARA HEALTH,9.59,,,,,,,9.5900,37.1600,percent of total billed charges,25.81% of $37.16 in Billed Charges for Rev 270 = $9.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SILK 6.0 P1 639G,270,RC,,,,,,,,both,,,37.1600,5.5700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",37.16,,,,,,,9.5900,37.1600,percent of total billed charges,100% of $37.16 in Billed Charges for Rev 270 = $37.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SILK 6.0 P1 639G,270,RC,,,,,,,,both,,,37.1600,5.5700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,18.58,,,,,,,9.5900,37.1600,percent of total billed charges,Rev 270 $37.16 in Billed Charges at 50% = $18.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SILK 6.0 P1 639G,270,RC,,,,,,,,both,,,37.1600,5.5700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12.00,,,,,,,9.5900,37.1600,other,32.3% of $37.16 in Billed Charges for Rev 270 = $12.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE SILK 6.0 P1 639G,270,RC,,,,,,,,both,,,37.1600,5.5700,UNITED HEALTHCARE,UHC HERITAGE SELECT,11.41,,,,,,,9.5900,37.1600,other,30.7% of $37.16 in Billed Charges for Rev 270 = $11.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE SILK 6.0 P1 639G,270,RC,,,,,,,,both,,,37.1600,5.5700,UNITED HEALTHCARE,UNITED HEALTHCARE,12.00,,,,,,,9.5900,37.1600,percent of total billed charges,32.3% of $37.16 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SILK 6.0 P1 639G,270,RC,,,,,,,,both,,,37.1600,5.5700,WELLCARE,WELLCARE MEDICAID,37.16,,,,,,,9.5900,37.1600,percent of total billed charges,100% of $37.16 in Billed Charges for Rev 270 = $37.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,AETNA,AETNA,705.40,,,,,,,109.0000,1652.0000,percent of total billed charges,"42.7% of $1,652.00 in Billed Charges for Rev 450 Proc 12053 = $705.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,109.0000,1652.0000,fee schedule,"APG 00017 Proc 12053 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,109.0000,1652.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,1652.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,109.0000,1652.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,AMBETTER,AMBETTER,804.03,,,,,,,109.0000,1652.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,109.0000,1652.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,109.0000,1652.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,109.0000,1652.0000,fee schedule,"APG 00017 Proc 12053 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,109.0000,1652.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,109.0000,1652.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1134.94,,,,,,,109.0000,1652.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,193.92,,,,,,,109.0000,1652.0000,fee schedule,$193.92 from Fee Schedule BLDTM_23 for Rev 450 Proc 12053 * Qty 1 = $193.92 at 100% = $193.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,109.0000,1652.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,109.0000,1652.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,109.0000,1652.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1486.80,,,,,,,109.0000,1652.0000,percent of total billed charges,"90% of $1,652.00 in Billed Charges for Rev 450 Proc 12053 = $1,486.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,HUMANA,HUMANA MEDICARE,368.82,,,,,,,109.0000,1652.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,109.0000,1652.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,MEDCOST,MEDCOST VHN,786.19,,,,,,,109.0000,1652.0000,percent of total billed charges,"47.59% of $1,652.00 in Billed Charges for Rev 450 Proc 12053 = $786.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,109.0000,1652.0000,fee schedule,"APG 00017 Proc 12053 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,109.0000,1652.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,109.0000,1652.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,109.0000,1652.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,109.0000,1652.0000,fee schedule,"APG 00017 Proc 12053 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,SENTARA HEALTH,SENTARA HEALTH,426.38,,,,,,,109.0000,1652.0000,percent of total billed charges,"25.81% of $1,652.00 in Billed Charges for Rev 450 Proc 12053 = $426.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,109.0000,1652.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1652.00,,,,,,,109.0000,1652.0000,percent of total billed charges,"100% of $1,652.00 in Billed Charges for Rev 450 Proc 12053 = $1,652.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1652.0000,case rate,Rev 450 Proc 12053 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1652.0000,case rate,Rev 450 Proc 12053 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1652.0000,case rate,Rev 450 Proc 12053 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1652.0000,case rate,Rev 450 Proc 12053 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,109.0000,1652.0000,fee schedule,"APG 00017 Proc 12053 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,1652.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,109.0000,1652.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,WELLCARE,WELLCARE MEDICAID,1652.00,,,,,,,109.0000,1652.0000,percent of total billed charges,"100% of $1,652.00 in Billed Charges for Rev 450 Proc 12053 = $1,652.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WNDS F/E/N 5.1-7.5,12053,CPT,450,RC,45000062,CDM,,,,both,,,1652.0000,247.8000,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,109.0000,1652.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,AETNA,AETNA,938.97,,,,,,,109.0000,2199.0000,percent of total billed charges,"42.7% of $2,199.00 in Billed Charges for Rev 450 Proc 12056 = $938.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,109.0000,2199.0000,fee schedule,"APG 00017 Proc 12056 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,109.0000,2199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,2199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,109.0000,2199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,AMBETTER,AMBETTER,804.03,,,,,,,109.0000,2199.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,109.0000,2199.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,109.0000,2199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,109.0000,2199.0000,fee schedule,"APG 00017 Proc 12056 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,109.0000,2199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,109.0000,2199.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1134.94,,,,,,,109.0000,2199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,386.72,,,,,,,109.0000,2199.0000,fee schedule,$386.72 from Fee Schedule BLDTM_23 for Rev 450 Proc 12056 * Qty 1 = $386.72 at 100% = $386.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,109.0000,2199.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,109.0000,2199.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,109.0000,2199.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1979.10,,,,,,,109.0000,2199.0000,percent of total billed charges,"90% of $2,199.00 in Billed Charges for Rev 450 Proc 12056 = $1,979.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,109.0000,2199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,109.0000,2199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,MEDCOST,MEDCOST VHN,1046.50,,,,,,,109.0000,2199.0000,percent of total billed charges,"47.59% of $2,199.00 in Billed Charges for Rev 450 Proc 12056 = $1,046.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,109.0000,2199.0000,fee schedule,"APG 00017 Proc 12056 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,109.0000,2199.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,109.0000,2199.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,109.0000,2199.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,109.0000,2199.0000,fee schedule,"APG 00017 Proc 12056 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,SENTARA HEALTH,SENTARA HEALTH,567.56,,,,,,,109.0000,2199.0000,percent of total billed charges,"25.81% of $2,199.00 in Billed Charges for Rev 450 Proc 12056 = $567.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,109.0000,2199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2199.00,,,,,,,109.0000,2199.0000,percent of total billed charges,"100% of $2,199.00 in Billed Charges for Rev 450 Proc 12056 = $2,199.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,2199.0000,case rate,Rev 450 Proc 12056 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,2199.0000,case rate,Rev 450 Proc 12056 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,2199.0000,case rate,Rev 450 Proc 12056 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,2199.0000,case rate,Rev 450 Proc 12056 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,109.0000,2199.0000,fee schedule,"APG 00017 Proc 12056 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,2199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,109.0000,2199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,WELLCARE,WELLCARE MEDICAID,2199.00,,,,,,,109.0000,2199.0000,percent of total billed charges,"100% of $2,199.00 in Billed Charges for Rev 450 Proc 12056 = $2,199.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND F/E/N 20.1-30.0,12056,CPT,450,RC,45000065,CDM,,,,both,,,2199.0000,329.8500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,109.0000,2199.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,AETNA,AETNA,1032.49,,,,,,,109.0000,2418.0000,percent of total billed charges,"42.7% of $2,418.00 in Billed Charges for Rev 450 Proc 12057 = $1,032.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,109.0000,2418.0000,fee schedule,"APG 00017 Proc 12057 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,109.0000,2418.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,2418.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,109.0000,2418.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,AMBETTER,AMBETTER,804.03,,,,,,,109.0000,2418.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,109.0000,2418.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,109.0000,2418.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,109.0000,2418.0000,fee schedule,"APG 00017 Proc 12057 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,109.0000,2418.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,109.0000,2418.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1134.94,,,,,,,109.0000,2418.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,433.25,,,,,,,109.0000,2418.0000,fee schedule,$433.25 from Fee Schedule BLDTM_23 for Rev 450 Proc 12057 * Qty 1 = $433.25 at 100% = $433.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,109.0000,2418.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,109.0000,2418.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,109.0000,2418.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2176.20,,,,,,,109.0000,2418.0000,percent of total billed charges,"90% of $2,418.00 in Billed Charges for Rev 450 Proc 12057 = $2,176.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,HUMANA,HUMANA MEDICARE,368.82,,,,,,,109.0000,2418.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,109.0000,2418.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,MEDCOST,MEDCOST VHN,1150.73,,,,,,,109.0000,2418.0000,percent of total billed charges,"47.59% of $2,418.00 in Billed Charges for Rev 450 Proc 12057 = $1,150.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,109.0000,2418.0000,fee schedule,"APG 00017 Proc 12057 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,109.0000,2418.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,109.0000,2418.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,109.0000,2418.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,109.0000,2418.0000,fee schedule,"APG 00017 Proc 12057 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,SENTARA HEALTH,SENTARA HEALTH,624.09,,,,,,,109.0000,2418.0000,percent of total billed charges,"25.81% of $2,418.00 in Billed Charges for Rev 450 Proc 12057 = $624.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,109.0000,2418.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2418.00,,,,,,,109.0000,2418.0000,percent of total billed charges,"100% of $2,418.00 in Billed Charges for Rev 450 Proc 12057 = $2,418.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,2418.0000,case rate,Rev 450 Proc 12057 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,2418.0000,case rate,Rev 450 Proc 12057 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,2418.0000,case rate,Rev 450 Proc 12057 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,2418.0000,case rate,Rev 450 Proc 12057 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,109.0000,2418.0000,fee schedule,"APG 00017 Proc 12057 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,2418.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,109.0000,2418.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,WELLCARE,WELLCARE MEDICAID,2418.00,,,,,,,109.0000,2418.0000,percent of total billed charges,"100% of $2,418.00 in Billed Charges for Rev 450 Proc 12057 = $2,418.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LAYER CLOS WND F/E/N >30.0 CM,12057,CPT,450,RC,45000343,CDM,,,,both,,,2418.0000,362.7000,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,109.0000,2418.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,AETNA,AETNA,1208.84,,,,,,,109.0000,2831.0000,percent of total billed charges,"42.7% of $2,831.00 in Billed Charges for Rev 450 Proc 13101 = $1,208.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,109.0000,2831.0000,fee schedule,"APG 00009 Proc 13101 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,670.54,,,,,,,109.0000,2831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,AETNA,AETNA HEALTHCARE MEDICARE,670.54,,,,,,,109.0000,2831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,670.54,,,,,,,109.0000,2831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,AMBETTER,AMBETTER,1461.78,,,,,,,109.0000,2831.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,697.36,,,,,,,109.0000,2831.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,BLUE CROSS,ANTHEM EXCHANGE,1650.91,,,,,,,109.0000,2831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,109.0000,2831.0000,fee schedule,"APG 00009 Proc 13101 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,BLUE CROSS,ANTHEM HMO,1753.99,,,,,,,109.0000,2831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,690.66,,,,,,,109.0000,2831.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2063.41,,,,,,,109.0000,2831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,238.49,,,,,,,109.0000,2831.0000,fee schedule,$238.49 from Fee Schedule BLDTM_23 for Rev 450 Proc 13101 * Qty 1 = $238.49 at 100% = $238.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,BLUE CROSS,BLUE CROSS MEDICARE,697.36,,,,,,,109.0000,2831.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,704.07,,,,,,,109.0000,2831.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,704.07,,,,,,,109.0000,2831.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2547.90,,,,,,,109.0000,2831.0000,percent of total billed charges,"90% of $2,831.00 in Billed Charges for Rev 450 Proc 13101 = $2,547.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,HUMANA,HUMANA MEDICARE,670.54,,,,,,,109.0000,2831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,670.54,,,,,,,109.0000,2831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,MEDCOST,MEDCOST VHN,1347.27,,,,,,,109.0000,2831.0000,percent of total billed charges,"47.59% of $2,831.00 in Billed Charges for Rev 450 Proc 13101 = $1,347.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,109.0000,2831.0000,fee schedule,"APG 00009 Proc 13101 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,704.07,,,,,,,109.0000,2831.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,704.07,,,,,,,109.0000,2831.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,NHC ADVANTAGE,NHC ADVANTAGE,704.07,,,,,,,109.0000,2831.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,109.0000,2831.0000,fee schedule,"APG 00009 Proc 13101 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,SENTARA HEALTH,SENTARA HEALTH,730.68,,,,,,,109.0000,2831.0000,percent of total billed charges,"25.81% of $2,831.00 in Billed Charges for Rev 450 Proc 13101 = $730.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,SENTARA HEALTH,SENTARA MEDICARE,670.54,,,,,,,109.0000,2831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2831.00,,,,,,,109.0000,2831.0000,percent of total billed charges,"100% of $2,831.00 in Billed Charges for Rev 450 Proc 13101 = $2,831.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,2831.0000,case rate,Rev 450 Proc 13101 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,2831.0000,case rate,Rev 450 Proc 13101 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,2831.0000,case rate,Rev 450 Proc 13101 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,2831.0000,case rate,Rev 450 Proc 13101 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,109.0000,2831.0000,fee schedule,"APG 00009 Proc 13101 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,670.54,,,,,,,109.0000,2831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,670.54,,,,,,,109.0000,2831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,WELLCARE,WELLCARE MEDICAID,2831.00,,,,,,,109.0000,2831.0000,percent of total billed charges,"100% of $2,831.00 in Billed Charges for Rev 450 Proc 13101 = $2,831.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPLX RPR TRUNK 2.6-7.5,13101,CPT,450,RC,45000066,CDM,,,,both,,,2831.0000,424.6500,WELLCARE,WELLCARE MEDICARE,710.77,,,,,,,109.0000,2831.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK EA ADD 5CM,13102,CPT,450,RC,45000067,CDM,,,,both,,,2580.0000,387.0000,AETNA,AETNA,1101.66,,,,,,,69.1600,2580.0000,percent of total billed charges,"42.7% of $2,580.00 in Billed Charges for Rev 450 Proc 13102 = $1,101.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPLX RPR TRUNK EA ADD 5CM,13102,CPT,450,RC,45000067,CDM,,,,both,,,2580.0000,387.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,69.1600,2580.0000,fee schedule,APG 00009 Proc 13102 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK EA ADD 5CM,13102,CPT,450,RC,45000067,CDM,,,,both,,,2580.0000,387.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,69.1600,2580.0000,fee schedule,APG 00009 Proc 13102 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK EA ADD 5CM,13102,CPT,450,RC,45000067,CDM,,,,both,,,2580.0000,387.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,69.16,,,,,,,69.1600,2580.0000,fee schedule,$69.16 from Fee Schedule BLDTM_23 for Rev 450 Proc 13102 * Qty 1 = $69.16 at 100% = $69.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK EA ADD 5CM,13102,CPT,450,RC,45000067,CDM,,,,both,,,2580.0000,387.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2322.00,,,,,,,69.1600,2580.0000,percent of total billed charges,"90% of $2,580.00 in Billed Charges for Rev 450 Proc 13102 = $2,322.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPLX RPR TRUNK EA ADD 5CM,13102,CPT,450,RC,45000067,CDM,,,,both,,,2580.0000,387.0000,MEDCOST,MEDCOST VHN,1227.82,,,,,,,69.1600,2580.0000,percent of total billed charges,"47.59% of $2,580.00 in Billed Charges for Rev 450 Proc 13102 = $1,227.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPLX RPR TRUNK EA ADD 5CM,13102,CPT,450,RC,45000067,CDM,,,,both,,,2580.0000,387.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,69.1600,2580.0000,fee schedule,APG 00009 Proc 13102 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK EA ADD 5CM,13102,CPT,450,RC,45000067,CDM,,,,both,,,2580.0000,387.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,69.1600,2580.0000,fee schedule,APG 00009 Proc 13102 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK EA ADD 5CM,13102,CPT,450,RC,45000067,CDM,,,,both,,,2580.0000,387.0000,SENTARA HEALTH,SENTARA HEALTH,665.90,,,,,,,69.1600,2580.0000,percent of total billed charges,"25.81% of $2,580.00 in Billed Charges for Rev 450 Proc 13102 = $665.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPLX RPR TRUNK EA ADD 5CM,13102,CPT,450,RC,45000067,CDM,,,,both,,,2580.0000,387.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2580.00,,,,,,,69.1600,2580.0000,percent of total billed charges,"100% of $2,580.00 in Billed Charges for Rev 450 Proc 13102 = $2,580.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC COMPLX RPR TRUNK EA ADD 5CM,13102,CPT,450,RC,45000067,CDM,,,,both,,,2580.0000,387.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,69.1600,2580.0000,case rate,Rev 450 Proc 13102 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK EA ADD 5CM,13102,CPT,450,RC,45000067,CDM,,,,both,,,2580.0000,387.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,69.1600,2580.0000,case rate,Rev 450 Proc 13102 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK EA ADD 5CM,13102,CPT,450,RC,45000067,CDM,,,,both,,,2580.0000,387.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,69.1600,2580.0000,case rate,Rev 450 Proc 13102 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK EA ADD 5CM,13102,CPT,450,RC,45000067,CDM,,,,both,,,2580.0000,387.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,69.1600,2580.0000,case rate,Rev 450 Proc 13102 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK EA ADD 5CM,13102,CPT,450,RC,45000067,CDM,,,,both,,,2580.0000,387.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,69.1600,2580.0000,fee schedule,APG 00009 Proc 13102 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC COMPLX RPR TRUNK EA ADD 5CM,13102,CPT,450,RC,45000067,CDM,,,,both,,,2580.0000,387.0000,WELLCARE,WELLCARE MEDICAID,2580.00,,,,,,,69.1600,2580.0000,percent of total billed charges,"100% of $2,580.00 in Billed Charges for Rev 450 Proc 13102 = $2,580.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,AETNA,AETNA,1185.35,,,,,,,109.0000,2776.0000,percent of total billed charges,"42.7% of $2,776.00 in Billed Charges for Rev 450 Proc 13120 = $1,185.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,109.0000,2776.0000,fee schedule,"APG 00009 Proc 13120 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,109.0000,2776.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,2776.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,109.0000,2776.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,AMBETTER,AMBETTER,804.03,,,,,,,109.0000,2776.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,109.0000,2776.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,109.0000,2776.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,109.0000,2776.0000,fee schedule,"APG 00009 Proc 13120 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,109.0000,2776.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,109.0000,2776.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1134.94,,,,,,,109.0000,2776.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,192.71,,,,,,,109.0000,2776.0000,fee schedule,$192.71 from Fee Schedule BLDTM_23 for Rev 450 Proc 13120 * Qty 1 = $192.71 at 100% = $192.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,109.0000,2776.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,109.0000,2776.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,109.0000,2776.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2498.40,,,,,,,109.0000,2776.0000,percent of total billed charges,"90% of $2,776.00 in Billed Charges for Rev 450 Proc 13120 = $2,498.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,HUMANA,HUMANA MEDICARE,368.82,,,,,,,109.0000,2776.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,109.0000,2776.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,MEDCOST,MEDCOST VHN,1321.10,,,,,,,109.0000,2776.0000,percent of total billed charges,"47.59% of $2,776.00 in Billed Charges for Rev 450 Proc 13120 = $1,321.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,109.0000,2776.0000,fee schedule,"APG 00009 Proc 13120 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,109.0000,2776.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,109.0000,2776.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,109.0000,2776.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,109.0000,2776.0000,fee schedule,"APG 00009 Proc 13120 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,SENTARA HEALTH,SENTARA HEALTH,716.49,,,,,,,109.0000,2776.0000,percent of total billed charges,"25.81% of $2,776.00 in Billed Charges for Rev 450 Proc 13120 = $716.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,109.0000,2776.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2776.00,,,,,,,109.0000,2776.0000,percent of total billed charges,"100% of $2,776.00 in Billed Charges for Rev 450 Proc 13120 = $2,776.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,2776.0000,case rate,Rev 450 Proc 13120 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,2776.0000,case rate,Rev 450 Proc 13120 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,2776.0000,case rate,Rev 450 Proc 13120 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,2776.0000,case rate,Rev 450 Proc 13120 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,109.0000,2776.0000,fee schedule,"APG 00009 Proc 13120 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,2776.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,109.0000,2776.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,WELLCARE,WELLCARE MEDICAID,2776.00,,,,,,,109.0000,2776.0000,percent of total billed charges,"100% of $2,776.00 in Billed Charges for Rev 450 Proc 13120 = $2,776.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CMPLX RPR SCLP ARM LEG 1.1-2.5,13120,CPT,450,RC,45000068,CDM,,,,both,,,2776.0000,416.4000,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,109.0000,2776.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE TAPE 1.7MM,272,RC,27200002,CDM,,,,,,both,,,865.9800,129.9000,AETNA,AETNA,369.77,,,,,,,223.5100,865.9800,percent of total billed charges,42.7% of $865.98 in Billed Charges for Rev 272 = $369.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE 1.7MM,272,RC,27200002,CDM,,,,,,both,,,865.9800,129.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,606.19,,,,,,,223.5100,865.9800,percent of total billed charges,Rev 272 $865.98 in Billed Charges at 70% = $606.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE 1.7MM,272,RC,27200002,CDM,,,,,,both,,,865.9800,129.9000,CIGNA HEALTHCARE,CIGNA HMO,361.11,,,,,,,223.5100,865.9800,percent of total billed charges,41.7% of $865.98 in Billed Charges for Rev 272 = $361.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE 1.7MM,272,RC,27200002,CDM,,,,,,both,,,865.9800,129.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,401.81,,,,,,,223.5100,865.9800,percent of total billed charges,46.4% of $865.98 in Billed Charges for Rev 272 = $401.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE 1.7MM,272,RC,27200002,CDM,,,,,,both,,,865.9800,129.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,361.11,,,,,,,223.5100,865.9800,percent of total billed charges,41.7% of $865.98 in Billed Charges for Rev 272 = $361.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE 1.7MM,272,RC,27200002,CDM,,,,,,both,,,865.9800,129.9000,CIGNA HEALTHCARE,CIGNA PPO,361.11,,,,,,,223.5100,865.9800,percent of total billed charges,41.7% of $865.98 in Billed Charges for Rev 272 = $361.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE 1.7MM,272,RC,27200002,CDM,,,,,,both,,,865.9800,129.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,779.38,,,,,,,223.5100,865.9800,percent of total billed charges,90% of $865.98 in Billed Charges for Rev 272 = $779.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE 1.7MM,272,RC,27200002,CDM,,,,,,both,,,865.9800,129.9000,MEDCOST,MEDCOST VHN,412.12,,,,,,,223.5100,865.9800,percent of total billed charges,47.59% of $865.98 in Billed Charges for Rev 272 = $412.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE 1.7MM,272,RC,27200002,CDM,,,,,,both,,,865.9800,129.9000,SENTARA HEALTH,SENTARA HEALTH,223.51,,,,,,,223.5100,865.9800,percent of total billed charges,25.81% of $865.98 in Billed Charges for Rev 272 = $223.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE 1.7MM,272,RC,27200002,CDM,,,,,,both,,,865.9800,129.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",865.98,,,,,,,223.5100,865.9800,percent of total billed charges,100% of $865.98 in Billed Charges for Rev 272 = $865.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE 1.7MM,272,RC,27200002,CDM,,,,,,both,,,865.9800,129.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,432.99,,,,,,,223.5100,865.9800,percent of total billed charges,Rev 272 $865.98 in Billed Charges at 50% = $432.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE 1.7MM,272,RC,27200002,CDM,,,,,,both,,,865.9800,129.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,279.71,,,,,,,223.5100,865.9800,other,32.3% of $865.98 in Billed Charges for Rev 272 = $279.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE TAPE 1.7MM,272,RC,27200002,CDM,,,,,,both,,,865.9800,129.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,265.86,,,,,,,223.5100,865.9800,other,30.7% of $865.98 in Billed Charges for Rev 272 = $265.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE TAPE 1.7MM,272,RC,27200002,CDM,,,,,,both,,,865.9800,129.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,279.71,,,,,,,223.5100,865.9800,percent of total billed charges,32.3% of $865.98 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE 1.7MM,272,RC,27200002,CDM,,,,,,both,,,865.9800,129.9000,WELLCARE,WELLCARE MEDICAID,865.98,,,,,,,223.5100,865.9800,percent of total billed charges,100% of $865.98 in Billed Charges for Rev 272 = $865.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE BROADBAND 38IN,272,RC,27200002,CDM,,,,,,both,,,786.7400,118.0100,AETNA,AETNA,335.94,,,,,,,203.0600,786.7400,percent of total billed charges,42.7% of $786.74 in Billed Charges for Rev 272 = $335.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE BROADBAND 38IN,272,RC,27200002,CDM,,,,,,both,,,786.7400,118.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,550.72,,,,,,,203.0600,786.7400,percent of total billed charges,Rev 272 $786.74 in Billed Charges at 70% = $550.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE BROADBAND 38IN,272,RC,27200002,CDM,,,,,,both,,,786.7400,118.0100,CIGNA HEALTHCARE,CIGNA HMO,328.07,,,,,,,203.0600,786.7400,percent of total billed charges,41.7% of $786.74 in Billed Charges for Rev 272 = $328.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE BROADBAND 38IN,272,RC,27200002,CDM,,,,,,both,,,786.7400,118.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,365.05,,,,,,,203.0600,786.7400,percent of total billed charges,46.4% of $786.74 in Billed Charges for Rev 272 = $365.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE BROADBAND 38IN,272,RC,27200002,CDM,,,,,,both,,,786.7400,118.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,328.07,,,,,,,203.0600,786.7400,percent of total billed charges,41.7% of $786.74 in Billed Charges for Rev 272 = $328.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE BROADBAND 38IN,272,RC,27200002,CDM,,,,,,both,,,786.7400,118.0100,CIGNA HEALTHCARE,CIGNA PPO,328.07,,,,,,,203.0600,786.7400,percent of total billed charges,41.7% of $786.74 in Billed Charges for Rev 272 = $328.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE BROADBAND 38IN,272,RC,27200002,CDM,,,,,,both,,,786.7400,118.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,708.07,,,,,,,203.0600,786.7400,percent of total billed charges,90% of $786.74 in Billed Charges for Rev 272 = $708.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE BROADBAND 38IN,272,RC,27200002,CDM,,,,,,both,,,786.7400,118.0100,MEDCOST,MEDCOST VHN,374.41,,,,,,,203.0600,786.7400,percent of total billed charges,47.59% of $786.74 in Billed Charges for Rev 272 = $374.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE BROADBAND 38IN,272,RC,27200002,CDM,,,,,,both,,,786.7400,118.0100,SENTARA HEALTH,SENTARA HEALTH,203.06,,,,,,,203.0600,786.7400,percent of total billed charges,25.81% of $786.74 in Billed Charges for Rev 272 = $203.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE BROADBAND 38IN,272,RC,27200002,CDM,,,,,,both,,,786.7400,118.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",786.74,,,,,,,203.0600,786.7400,percent of total billed charges,100% of $786.74 in Billed Charges for Rev 272 = $786.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE BROADBAND 38IN,272,RC,27200002,CDM,,,,,,both,,,786.7400,118.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,393.37,,,,,,,203.0600,786.7400,percent of total billed charges,Rev 272 $786.74 in Billed Charges at 50% = $393.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE BROADBAND 38IN,272,RC,27200002,CDM,,,,,,both,,,786.7400,118.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,254.12,,,,,,,203.0600,786.7400,other,32.3% of $786.74 in Billed Charges for Rev 272 = $254.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE TAPE BROADBAND 38IN,272,RC,27200002,CDM,,,,,,both,,,786.7400,118.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,241.53,,,,,,,203.0600,786.7400,other,30.7% of $786.74 in Billed Charges for Rev 272 = $241.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE TAPE BROADBAND 38IN,272,RC,27200002,CDM,,,,,,both,,,786.7400,118.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,254.12,,,,,,,203.0600,786.7400,percent of total billed charges,32.3% of $786.74 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE BROADBAND 38IN,272,RC,27200002,CDM,,,,,,both,,,786.7400,118.0100,WELLCARE,WELLCARE MEDICAID,786.74,,,,,,,203.0600,786.7400,percent of total billed charges,100% of $786.74 in Billed Charges for Rev 272 = $786.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,AETNA,AETNA,1257.52,,,,,,,109.0000,2945.0000,percent of total billed charges,"42.7% of $2,945.00 in Billed Charges for Rev 450 Proc 13151 = $1,257.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,109.0000,2945.0000,fee schedule,"APG 00009 Proc 13151 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,670.54,,,,,,,109.0000,2945.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,AETNA,AETNA HEALTHCARE MEDICARE,670.54,,,,,,,109.0000,2945.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,670.54,,,,,,,109.0000,2945.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,AMBETTER,AMBETTER,1461.78,,,,,,,109.0000,2945.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,697.36,,,,,,,109.0000,2945.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,BLUE CROSS,ANTHEM EXCHANGE,1650.91,,,,,,,109.0000,2945.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,109.0000,2945.0000,fee schedule,"APG 00009 Proc 13151 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,BLUE CROSS,ANTHEM HMO,1753.99,,,,,,,109.0000,2945.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,690.66,,,,,,,109.0000,2945.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2063.41,,,,,,,109.0000,2945.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,282.22,,,,,,,109.0000,2945.0000,fee schedule,$282.22 from Fee Schedule BLDTM_23 for Rev 450 Proc 13151 * Qty 1 = $282.22 at 100% = $282.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,BLUE CROSS,BLUE CROSS MEDICARE,697.36,,,,,,,109.0000,2945.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,BLUE CROSS,TENNCARE BLUE CARE,131.83,,,,,,,109.0000,2945.0000,fee schedule,$113.65 from Fee Schedule TC_24 for Rev 450 Proc 13151 * Qty 1 = $113.65 at 116% = $131.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,BLUE CROSS,TENNCARE BLUE SELECT,131.83,,,,,,,109.0000,2945.0000,fee schedule,$113.65 from Fee Schedule TC_24 for Rev 450 Proc 13151 * Qty 1 = $113.65 at 116% = $131.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,704.07,,,,,,,109.0000,2945.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,704.07,,,,,,,109.0000,2945.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2650.50,,,,,,,109.0000,2945.0000,percent of total billed charges,"90% of $2,945.00 in Billed Charges for Rev 450 Proc 13151 = $2,650.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,HUMANA,HUMANA MEDICARE,670.54,,,,,,,109.0000,2945.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,670.54,,,,,,,109.0000,2945.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,MEDCOST,MEDCOST VHN,1401.53,,,,,,,109.0000,2945.0000,percent of total billed charges,"47.59% of $2,945.00 in Billed Charges for Rev 450 Proc 13151 = $1,401.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,109.0000,2945.0000,fee schedule,"APG 00009 Proc 13151 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,704.07,,,,,,,109.0000,2945.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,704.07,,,,,,,109.0000,2945.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,NHC ADVANTAGE,NHC ADVANTAGE,704.07,,,,,,,109.0000,2945.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,109.0000,2945.0000,fee schedule,"APG 00009 Proc 13151 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,SENTARA HEALTH,SENTARA HEALTH,760.10,,,,,,,109.0000,2945.0000,percent of total billed charges,"25.81% of $2,945.00 in Billed Charges for Rev 450 Proc 13151 = $760.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,SENTARA HEALTH,SENTARA MEDICARE,670.54,,,,,,,109.0000,2945.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2945.00,,,,,,,109.0000,2945.0000,percent of total billed charges,"100% of $2,945.00 in Billed Charges for Rev 450 Proc 13151 = $2,945.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,2945.0000,case rate,Rev 450 Proc 13151 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,2945.0000,case rate,Rev 450 Proc 13151 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,2945.0000,case rate,Rev 450 Proc 13151 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,2945.0000,case rate,Rev 450 Proc 13151 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,109.0000,2945.0000,fee schedule,"APG 00009 Proc 13151 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,670.54,,,,,,,109.0000,2945.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,670.54,,,,,,,109.0000,2945.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,WELLCARE,WELLCARE MEDICAID,2945.00,,,,,,,109.0000,2945.0000,percent of total billed charges,"100% of $2,945.00 in Billed Charges for Rev 450 Proc 13151 = $2,945.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPR CMPLX EYELD LIPS 1.1-2.5,13151,CPT,450,RC,45000075,CDM,,,,both,,,2945.0000,441.7500,WELLCARE,WELLCARE MEDICARE,710.77,,,,,,,109.0000,2945.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS EA ADD 5,13153,CPT,450,RC,45000077,CDM,,,,both,,,2780.0000,417.0000,AETNA,AETNA,1187.06,,,,,,,109.0000,2780.0000,percent of total billed charges,"42.7% of $2,780.00 in Billed Charges for Rev 450 Proc 13153 = $1,187.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPR CMPLX EYELD LIPS EA ADD 5,13153,CPT,450,RC,45000077,CDM,,,,both,,,2780.0000,417.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1775.80,,,,,,,109.0000,2780.0000,fee schedule,"APG 00010 Proc 13153 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 104% = $1,775.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPR CMPLX EYELD LIPS EA ADD 5,13153,CPT,450,RC,45000077,CDM,,,,both,,,2780.0000,417.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1758.73,,,,,,,109.0000,2780.0000,fee schedule,"APG 00010 Proc 13153 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPR CMPLX EYELD LIPS EA ADD 5,13153,CPT,450,RC,45000077,CDM,,,,both,,,2780.0000,417.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,136.94,,,,,,,109.0000,2780.0000,fee schedule,$136.94 from Fee Schedule BLDTM_23 for Rev 450 Proc 13153 * Qty 1 = $136.94 at 100% = $136.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS EA ADD 5,13153,CPT,450,RC,45000077,CDM,,,,both,,,2780.0000,417.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2502.00,,,,,,,109.0000,2780.0000,percent of total billed charges,"90% of $2,780.00 in Billed Charges for Rev 450 Proc 13153 = $2,502.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPR CMPLX EYELD LIPS EA ADD 5,13153,CPT,450,RC,45000077,CDM,,,,both,,,2780.0000,417.0000,MEDCOST,MEDCOST VHN,1323.00,,,,,,,109.0000,2780.0000,percent of total billed charges,"47.59% of $2,780.00 in Billed Charges for Rev 450 Proc 13153 = $1,323.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPR CMPLX EYELD LIPS EA ADD 5,13153,CPT,450,RC,45000077,CDM,,,,both,,,2780.0000,417.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1792.88,,,,,,,109.0000,2780.0000,fee schedule,"APG 00010 Proc 13153 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 105% = $1,792.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPR CMPLX EYELD LIPS EA ADD 5,13153,CPT,450,RC,45000077,CDM,,,,both,,,2780.0000,417.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1760.43,,,,,,,109.0000,2780.0000,fee schedule,"APG 00010 Proc 13153 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 103.1% = $1,760.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPR CMPLX EYELD LIPS EA ADD 5,13153,CPT,450,RC,45000077,CDM,,,,both,,,2780.0000,417.0000,SENTARA HEALTH,SENTARA HEALTH,717.52,,,,,,,109.0000,2780.0000,percent of total billed charges,"25.81% of $2,780.00 in Billed Charges for Rev 450 Proc 13153 = $717.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPR CMPLX EYELD LIPS EA ADD 5,13153,CPT,450,RC,45000077,CDM,,,,both,,,2780.0000,417.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2780.00,,,,,,,109.0000,2780.0000,percent of total billed charges,"100% of $2,780.00 in Billed Charges for Rev 450 Proc 13153 = $2,780.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPR CMPLX EYELD LIPS EA ADD 5,13153,CPT,450,RC,45000077,CDM,,,,both,,,2780.0000,417.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,2780.0000,case rate,Rev 450 Proc 13153 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS EA ADD 5,13153,CPT,450,RC,45000077,CDM,,,,both,,,2780.0000,417.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,2780.0000,case rate,Rev 450 Proc 13153 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS EA ADD 5,13153,CPT,450,RC,45000077,CDM,,,,both,,,2780.0000,417.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,2780.0000,case rate,Rev 450 Proc 13153 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS EA ADD 5,13153,CPT,450,RC,45000077,CDM,,,,both,,,2780.0000,417.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,2780.0000,case rate,Rev 450 Proc 13153 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPR CMPLX EYELD LIPS EA ADD 5,13153,CPT,450,RC,45000077,CDM,,,,both,,,2780.0000,417.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1758.73,,,,,,,109.0000,2780.0000,fee schedule,"APG 00010 Proc 13153 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPR CMPLX EYELD LIPS EA ADD 5,13153,CPT,450,RC,45000077,CDM,,,,both,,,2780.0000,417.0000,WELLCARE,WELLCARE MEDICAID,2780.00,,,,,,,109.0000,2780.0000,percent of total billed charges,"100% of $2,780.00 in Billed Charges for Rev 450 Proc 13153 = $2,780.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ADJ TISS TRANSFER ANY AREA EA ADDL 30.0 SQ CM,14302,CPT,450,RC,45000335,CDM,,,,both,,,638.0000,95.7000,AETNA,AETNA,272.43,,,,,,,109.0000,2800.7000,percent of total billed charges,42.7% of $638.00 in Billed Charges for Rev 450 Proc 14302 = $272.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADJ TISS TRANSFER ANY AREA EA ADDL 30.0 SQ CM,14302,CPT,450,RC,45000335,CDM,,,,both,,,638.0000,95.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2774.03,,,,,,,109.0000,2800.7000,fee schedule,"APG 00056 Proc 14302 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 104% = $2,774.03. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ADJ TISS TRANSFER ANY AREA EA ADDL 30.0 SQ CM,14302,CPT,450,RC,45000335,CDM,,,,both,,,638.0000,95.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,638.00,,,,,,,109.0000,2800.7000,fee schedule,"APG 00056 Proc 14302 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 103% = $2,747.35 (Service Line reduced to $638.00, claim capped at $638.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ADJ TISS TRANSFER ANY AREA EA ADDL 30.0 SQ CM,14302,CPT,450,RC,45000335,CDM,,,,both,,,638.0000,95.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,215.92,,,,,,,109.0000,2800.7000,fee schedule,$215.92 from Fee Schedule BLDTM_23 for Rev 450 Proc 14302 * Qty 1 = $215.92 at 100% = $215.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA EA ADDL 30.0 SQ CM,14302,CPT,450,RC,45000335,CDM,,,,both,,,638.0000,95.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,574.20,,,,,,,109.0000,2800.7000,percent of total billed charges,90% of $638.00 in Billed Charges for Rev 450 Proc 14302 = $574.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADJ TISS TRANSFER ANY AREA EA ADDL 30.0 SQ CM,14302,CPT,450,RC,45000335,CDM,,,,both,,,638.0000,95.7000,MEDCOST,MEDCOST VHN,303.62,,,,,,,109.0000,2800.7000,percent of total billed charges,47.59% of $638.00 in Billed Charges for Rev 450 Proc 14302 = $303.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADJ TISS TRANSFER ANY AREA EA ADDL 30.0 SQ CM,14302,CPT,450,RC,45000335,CDM,,,,both,,,638.0000,95.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2800.70,,,,,,,109.0000,2800.7000,fee schedule,"APG 00056 Proc 14302 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 100% = $2,667.33... $2,667.33 at 105% = $2,800.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ADJ TISS TRANSFER ANY AREA EA ADDL 30.0 SQ CM,14302,CPT,450,RC,45000335,CDM,,,,both,,,638.0000,95.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2750.02,,,,,,,109.0000,2800.7000,fee schedule,"APG 00056 Proc 14302 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 100% = $2,667.33... $2,667.33 at 103.1% = $2,750.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ADJ TISS TRANSFER ANY AREA EA ADDL 30.0 SQ CM,14302,CPT,450,RC,45000335,CDM,,,,both,,,638.0000,95.7000,SENTARA HEALTH,SENTARA HEALTH,164.67,,,,,,,109.0000,2800.7000,percent of total billed charges,25.81% of $638.00 in Billed Charges for Rev 450 Proc 14302 = $164.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADJ TISS TRANSFER ANY AREA EA ADDL 30.0 SQ CM,14302,CPT,450,RC,45000335,CDM,,,,both,,,638.0000,95.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",638.00,,,,,,,109.0000,2800.7000,percent of total billed charges,100% of $638.00 in Billed Charges for Rev 450 Proc 14302 = $638.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ADJ TISS TRANSFER ANY AREA EA ADDL 30.0 SQ CM,14302,CPT,450,RC,45000335,CDM,,,,both,,,638.0000,95.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,2800.7000,case rate,Rev 450 Proc 14302 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA EA ADDL 30.0 SQ CM,14302,CPT,450,RC,45000335,CDM,,,,both,,,638.0000,95.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,2800.7000,case rate,Rev 450 Proc 14302 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA EA ADDL 30.0 SQ CM,14302,CPT,450,RC,45000335,CDM,,,,both,,,638.0000,95.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,2800.7000,case rate,Rev 450 Proc 14302 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ADJ TISS TRANSFER ANY AREA EA ADDL 30.0 SQ CM,14302,CPT,450,RC,45000335,CDM,,,,both,,,638.0000,95.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,638.00,,,,,,,109.0000,2800.7000,case rate,"Rev 450 Proc 14302 at Case Rate $847.00 (Service Line reduced to $638.00, claim capped at $638.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ADJ TISS TRANSFER ANY AREA EA ADDL 30.0 SQ CM,14302,CPT,450,RC,45000335,CDM,,,,both,,,638.0000,95.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2747.35,,,,,,,109.0000,2800.7000,fee schedule,"APG 00056 Proc 14302 at $836.60 (Base Rate) * 3.1883 (Relative Weight) = $2,667.33 (Total Line Payment) at 103% = $2,747.35. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ADJ TISS TRANSFER ANY AREA EA ADDL 30.0 SQ CM,14302,CPT,450,RC,45000335,CDM,,,,both,,,638.0000,95.7000,WELLCARE,WELLCARE MEDICAID,638.00,,,,,,,109.0000,2800.7000,percent of total billed charges,100% of $638.00 in Billed Charges for Rev 450 Proc 14302 = $638.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,AETNA,AETNA,1790.84,,,,,,,109.0000,4194.0000,percent of total billed charges,"42.7% of $4,194.00 in Billed Charges for Rev 450 Proc 23605 = $1,790.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,4194.0000,fee schedule,APG 00041 Proc 23605 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,4194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,4194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,4194.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,4194.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,109.0000,4194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,4194.0000,fee schedule,APG 00041 Proc 23605 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,109.0000,4194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,4194.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4194.00,,,,,,,109.0000,4194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,353.72,,,,,,,109.0000,4194.0000,fee schedule,$353.72 from Fee Schedule BLDTM_23 for Rev 450 Proc 23605 * Qty 1 = $353.72 at 100% = $353.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,4194.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,4194.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,4194.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3774.60,,,,,,,109.0000,4194.0000,percent of total billed charges,"90% of $4,194.00 in Billed Charges for Rev 450 Proc 23605 = $3,774.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,4194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,4194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,MEDCOST,MEDCOST VHN,1995.92,,,,,,,109.0000,4194.0000,percent of total billed charges,"47.59% of $4,194.00 in Billed Charges for Rev 450 Proc 23605 = $1,995.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,4194.0000,fee schedule,APG 00041 Proc 23605 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,4194.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,4194.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,4194.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,4194.0000,fee schedule,APG 00041 Proc 23605 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,SENTARA HEALTH,SENTARA HEALTH,1082.47,,,,,,,109.0000,4194.0000,percent of total billed charges,"25.81% of $4,194.00 in Billed Charges for Rev 450 Proc 23605 = $1,082.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,4194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4194.00,,,,,,,109.0000,4194.0000,percent of total billed charges,"100% of $4,194.00 in Billed Charges for Rev 450 Proc 23605 = $4,194.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,4194.0000,case rate,Rev 450 Proc 23605 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,4194.0000,case rate,Rev 450 Proc 23605 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,4194.0000,case rate,Rev 450 Proc 23605 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,4194.0000,case rate,Rev 450 Proc 23605 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,4194.0000,fee schedule,APG 00041 Proc 23605 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,4194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,WELLCARE,WELLCARE MEDICAID,4194.00,,,,,,,109.0000,4194.0000,percent of total billed charges,"100% of $4,194.00 in Billed Charges for Rev 450 Proc 23605 = $4,194.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX HUM FX W MANIP WOW TR,23605,CPT,450,RC,45000108,CDM,,,,both,,,4194.0000,629.1000,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,4194.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE ULTRA BRAID C BRAID 2 7210915,272,RC,,,,,,,,both,,,2221.8800,333.2800,AETNA,AETNA,948.74,,,,,,,573.4700,2221.8800,percent of total billed charges,"42.7% of $2,221.88 in Billed Charges for Rev 272 = $948.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ULTRA BRAID C BRAID 2 7210915,272,RC,,,,,,,,both,,,2221.8800,333.2800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1555.32,,,,,,,573.4700,2221.8800,percent of total billed charges,"Rev 272 $2,221.88 in Billed Charges at 70% = $1,555.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ULTRA BRAID C BRAID 2 7210915,272,RC,,,,,,,,both,,,2221.8800,333.2800,CIGNA HEALTHCARE,CIGNA HMO,926.52,,,,,,,573.4700,2221.8800,percent of total billed charges,"41.7% of $2,221.88 in Billed Charges for Rev 272 = $926.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ULTRA BRAID C BRAID 2 7210915,272,RC,,,,,,,,both,,,2221.8800,333.2800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1030.95,,,,,,,573.4700,2221.8800,percent of total billed charges,"46.4% of $2,221.88 in Billed Charges for Rev 272 = $1,030.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ULTRA BRAID C BRAID 2 7210915,272,RC,,,,,,,,both,,,2221.8800,333.2800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,926.52,,,,,,,573.4700,2221.8800,percent of total billed charges,"41.7% of $2,221.88 in Billed Charges for Rev 272 = $926.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ULTRA BRAID C BRAID 2 7210915,272,RC,,,,,,,,both,,,2221.8800,333.2800,CIGNA HEALTHCARE,CIGNA PPO,926.52,,,,,,,573.4700,2221.8800,percent of total billed charges,"41.7% of $2,221.88 in Billed Charges for Rev 272 = $926.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ULTRA BRAID C BRAID 2 7210915,272,RC,,,,,,,,both,,,2221.8800,333.2800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1999.69,,,,,,,573.4700,2221.8800,percent of total billed charges,"90% of $2,221.88 in Billed Charges for Rev 272 = $1,999.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ULTRA BRAID C BRAID 2 7210915,272,RC,,,,,,,,both,,,2221.8800,333.2800,MEDCOST,MEDCOST VHN,1057.39,,,,,,,573.4700,2221.8800,percent of total billed charges,"47.59% of $2,221.88 in Billed Charges for Rev 272 = $1,057.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ULTRA BRAID C BRAID 2 7210915,272,RC,,,,,,,,both,,,2221.8800,333.2800,SENTARA HEALTH,SENTARA HEALTH,573.47,,,,,,,573.4700,2221.8800,percent of total billed charges,"25.81% of $2,221.88 in Billed Charges for Rev 272 = $573.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ULTRA BRAID C BRAID 2 7210915,272,RC,,,,,,,,both,,,2221.8800,333.2800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2221.88,,,,,,,573.4700,2221.8800,percent of total billed charges,"100% of $2,221.88 in Billed Charges for Rev 272 = $2,221.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ULTRA BRAID C BRAID 2 7210915,272,RC,,,,,,,,both,,,2221.8800,333.2800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1110.94,,,,,,,573.4700,2221.8800,percent of total billed charges,"Rev 272 $2,221.88 in Billed Charges at 50% = $1,110.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ULTRA BRAID C BRAID 2 7210915,272,RC,,,,,,,,both,,,2221.8800,333.2800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,717.67,,,,,,,573.4700,2221.8800,other,"32.3% of $2,221.88 in Billed Charges for Rev 272 = $717.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE ULTRA BRAID C BRAID 2 7210915,272,RC,,,,,,,,both,,,2221.8800,333.2800,UNITED HEALTHCARE,UHC HERITAGE SELECT,682.12,,,,,,,573.4700,2221.8800,other,"30.7% of $2,221.88 in Billed Charges for Rev 272 = $682.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE ULTRA BRAID C BRAID 2 7210915,272,RC,,,,,,,,both,,,2221.8800,333.2800,UNITED HEALTHCARE,UNITED HEALTHCARE,717.67,,,,,,,573.4700,2221.8800,percent of total billed charges,"32.3% of $2,221.88 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE ULTRA BRAID C BRAID 2 7210915,272,RC,,,,,,,,both,,,2221.8800,333.2800,WELLCARE,WELLCARE MEDICAID,2221.88,,,,,,,573.4700,2221.8800,percent of total billed charges,"100% of $2,221.88 in Billed Charges for Rev 272 = $2,221.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 2 D5961,272,RC,27200002,CDM,,,,,,both,,,1708.3900,256.2600,AETNA,AETNA,729.48,,,,,,,440.9400,1708.3900,percent of total billed charges,"42.7% of $1,708.39 in Billed Charges for Rev 272 = $729.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 2 D5961,272,RC,27200002,CDM,,,,,,both,,,1708.3900,256.2600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1195.87,,,,,,,440.9400,1708.3900,percent of total billed charges,"Rev 272 $1,708.39 in Billed Charges at 70% = $1,195.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 2 D5961,272,RC,27200002,CDM,,,,,,both,,,1708.3900,256.2600,CIGNA HEALTHCARE,CIGNA HMO,712.40,,,,,,,440.9400,1708.3900,percent of total billed charges,"41.7% of $1,708.39 in Billed Charges for Rev 272 = $712.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 2 D5961,272,RC,27200002,CDM,,,,,,both,,,1708.3900,256.2600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,792.69,,,,,,,440.9400,1708.3900,percent of total billed charges,"46.4% of $1,708.39 in Billed Charges for Rev 272 = $792.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 2 D5961,272,RC,27200002,CDM,,,,,,both,,,1708.3900,256.2600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,712.40,,,,,,,440.9400,1708.3900,percent of total billed charges,"41.7% of $1,708.39 in Billed Charges for Rev 272 = $712.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 2 D5961,272,RC,27200002,CDM,,,,,,both,,,1708.3900,256.2600,CIGNA HEALTHCARE,CIGNA PPO,712.40,,,,,,,440.9400,1708.3900,percent of total billed charges,"41.7% of $1,708.39 in Billed Charges for Rev 272 = $712.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 2 D5961,272,RC,27200002,CDM,,,,,,both,,,1708.3900,256.2600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1537.55,,,,,,,440.9400,1708.3900,percent of total billed charges,"90% of $1,708.39 in Billed Charges for Rev 272 = $1,537.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 2 D5961,272,RC,27200002,CDM,,,,,,both,,,1708.3900,256.2600,MEDCOST,MEDCOST VHN,813.02,,,,,,,440.9400,1708.3900,percent of total billed charges,"47.59% of $1,708.39 in Billed Charges for Rev 272 = $813.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 2 D5961,272,RC,27200002,CDM,,,,,,both,,,1708.3900,256.2600,SENTARA HEALTH,SENTARA HEALTH,440.94,,,,,,,440.9400,1708.3900,percent of total billed charges,"25.81% of $1,708.39 in Billed Charges for Rev 272 = $440.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 2 D5961,272,RC,27200002,CDM,,,,,,both,,,1708.3900,256.2600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1708.39,,,,,,,440.9400,1708.3900,percent of total billed charges,"100% of $1,708.39 in Billed Charges for Rev 272 = $1,708.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 2 D5961,272,RC,27200002,CDM,,,,,,both,,,1708.3900,256.2600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,854.20,,,,,,,440.9400,1708.3900,percent of total billed charges,"Rev 272 $1,708.39 in Billed Charges at 50% = $854.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 2 D5961,272,RC,27200002,CDM,,,,,,both,,,1708.3900,256.2600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,551.81,,,,,,,440.9400,1708.3900,other,"32.3% of $1,708.39 in Billed Charges for Rev 272 = $551.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE VICRYL 2 D5961,272,RC,27200002,CDM,,,,,,both,,,1708.3900,256.2600,UNITED HEALTHCARE,UHC HERITAGE SELECT,524.48,,,,,,,440.9400,1708.3900,other,"30.7% of $1,708.39 in Billed Charges for Rev 272 = $524.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE VICRYL 2 D5961,272,RC,27200002,CDM,,,,,,both,,,1708.3900,256.2600,UNITED HEALTHCARE,UNITED HEALTHCARE,551.81,,,,,,,440.9400,1708.3900,percent of total billed charges,"32.3% of $1,708.39 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 2 D5961,272,RC,27200002,CDM,,,,,,both,,,1708.3900,256.2600,WELLCARE,WELLCARE MEDICAID,1708.39,,,,,,,440.9400,1708.3900,percent of total billed charges,"100% of $1,708.39 in Billed Charges for Rev 272 = $1,708.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE VICRYL 2-0 UNDYED BRAIDED,272,RC,27200002,CDM,,,,,,both,,,960.9800,144.1500,AETNA,AETNA,410.34,,,,,,,248.0300,960.9800,percent of total billed charges,42.7% of $960.98 in Billed Charges for Rev 272 = $410.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE VICRYL 2-0 UNDYED BRAIDED,272,RC,27200002,CDM,,,,,,both,,,960.9800,144.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,672.69,,,,,,,248.0300,960.9800,percent of total billed charges,Rev 272 $960.98 in Billed Charges at 70% = $672.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE VICRYL 2-0 UNDYED BRAIDED,272,RC,27200002,CDM,,,,,,both,,,960.9800,144.1500,CIGNA HEALTHCARE,CIGNA HMO,400.73,,,,,,,248.0300,960.9800,percent of total billed charges,41.7% of $960.98 in Billed Charges for Rev 272 = $400.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE VICRYL 2-0 UNDYED BRAIDED,272,RC,27200002,CDM,,,,,,both,,,960.9800,144.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,445.89,,,,,,,248.0300,960.9800,percent of total billed charges,46.4% of $960.98 in Billed Charges for Rev 272 = $445.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE VICRYL 2-0 UNDYED BRAIDED,272,RC,27200002,CDM,,,,,,both,,,960.9800,144.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,400.73,,,,,,,248.0300,960.9800,percent of total billed charges,41.7% of $960.98 in Billed Charges for Rev 272 = $400.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE VICRYL 2-0 UNDYED BRAIDED,272,RC,27200002,CDM,,,,,,both,,,960.9800,144.1500,CIGNA HEALTHCARE,CIGNA PPO,400.73,,,,,,,248.0300,960.9800,percent of total billed charges,41.7% of $960.98 in Billed Charges for Rev 272 = $400.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE VICRYL 2-0 UNDYED BRAIDED,272,RC,27200002,CDM,,,,,,both,,,960.9800,144.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,864.88,,,,,,,248.0300,960.9800,percent of total billed charges,90% of $960.98 in Billed Charges for Rev 272 = $864.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE VICRYL 2-0 UNDYED BRAIDED,272,RC,27200002,CDM,,,,,,both,,,960.9800,144.1500,MEDCOST,MEDCOST VHN,457.33,,,,,,,248.0300,960.9800,percent of total billed charges,47.59% of $960.98 in Billed Charges for Rev 272 = $457.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE VICRYL 2-0 UNDYED BRAIDED,272,RC,27200002,CDM,,,,,,both,,,960.9800,144.1500,SENTARA HEALTH,SENTARA HEALTH,248.03,,,,,,,248.0300,960.9800,percent of total billed charges,25.81% of $960.98 in Billed Charges for Rev 272 = $248.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE VICRYL 2-0 UNDYED BRAIDED,272,RC,27200002,CDM,,,,,,both,,,960.9800,144.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",960.98,,,,,,,248.0300,960.9800,percent of total billed charges,100% of $960.98 in Billed Charges for Rev 272 = $960.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE VICRYL 2-0 UNDYED BRAIDED,272,RC,27200002,CDM,,,,,,both,,,960.9800,144.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,480.49,,,,,,,248.0300,960.9800,percent of total billed charges,Rev 272 $960.98 in Billed Charges at 50% = $480.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE VICRYL 2-0 UNDYED BRAIDED,272,RC,27200002,CDM,,,,,,both,,,960.9800,144.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,310.40,,,,,,,248.0300,960.9800,other,32.3% of $960.98 in Billed Charges for Rev 272 = $310.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE VICRYL 2-0 UNDYED BRAIDED,272,RC,27200002,CDM,,,,,,both,,,960.9800,144.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,295.02,,,,,,,248.0300,960.9800,other,30.7% of $960.98 in Billed Charges for Rev 272 = $295.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE VICRYL 2-0 UNDYED BRAIDED,272,RC,27200002,CDM,,,,,,both,,,960.9800,144.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,310.40,,,,,,,248.0300,960.9800,percent of total billed charges,32.3% of $960.98 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE VICRYL 2-0 UNDYED BRAIDED,272,RC,27200002,CDM,,,,,,both,,,960.9800,144.1500,WELLCARE,WELLCARE MEDICAID,960.98,,,,,,,248.0300,960.9800,percent of total billed charges,100% of $960.98 in Billed Charges for Rev 272 = $960.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA,2059.42,,,,,,,109.0000,4823.0000,percent of total billed charges,"42.7% of $4,823.00 in Billed Charges for Rev 450 Proc 23625 = $2,059.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 23625 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,4823.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,4823.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 23625 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,4823.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4489.34,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,284.28,,,,,,,109.0000,4823.0000,fee schedule,$284.28 from Fee Schedule BLDTM_23 for Rev 450 Proc 23625 * Qty 1 = $284.28 at 100% = $284.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,4823.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4340.70,,,,,,,109.0000,4823.0000,percent of total billed charges,"90% of $4,823.00 in Billed Charges for Rev 450 Proc 23625 = $4,340.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,MEDCOST,MEDCOST VHN,2295.27,,,,,,,109.0000,4823.0000,percent of total billed charges,"47.59% of $4,823.00 in Billed Charges for Rev 450 Proc 23625 = $2,295.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 23625 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 23625 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,SENTARA HEALTH,SENTARA HEALTH,1244.82,,,,,,,109.0000,4823.0000,percent of total billed charges,"25.81% of $4,823.00 in Billed Charges for Rev 450 Proc 23625 = $1,244.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4823.00,,,,,,,109.0000,4823.0000,percent of total billed charges,"100% of $4,823.00 in Billed Charges for Rev 450 Proc 23625 = $4,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 23625 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 23625 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 23625 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 23625 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 23625 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,WELLCARE,WELLCARE MEDICAID,4823.00,,,,,,,109.0000,4823.0000,percent of total billed charges,"100% of $4,823.00 in Billed Charges for Rev 450 Proc 23625 = $4,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX GRTR HUMERAL TUBEROSITY FX W MANIP,23625,CPT,450,RC,45000375,CDM,,,,both,,,4823.0000,723.4500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,4823.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA,699.85,,,,,,,102.0200,1639.0000,percent of total billed charges,"42.7% of $1,639.00 in Billed Charges for Rev 450 Proc 23650 = $699.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,102.0200,1639.0000,fee schedule,"APG 00041 Proc 23650 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,102.0200,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,102.0200,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,102.0200,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,AMBETTER,AMBETTER,487.87,,,,,,,102.0200,1639.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,102.0200,1639.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,102.0200,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,102.0200,1639.0000,fee schedule,"APG 00041 Proc 23650 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,102.0200,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,102.0200,1639.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,102.0200,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,195.08,,,,,,,102.0200,1639.0000,fee schedule,$195.08 from Fee Schedule BLDTM_23 for Rev 450 Proc 23650 * Qty 1 = $195.08 at 100% = $195.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,102.0200,1639.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,TENNCARE BLUE CARE,102.02,,,,,,,102.0200,1639.0000,fee schedule,$87.95 from Fee Schedule TC_24 for Rev 450 Proc 23650 * Qty 1 = $87.95 at 116% = $102.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,TENNCARE BLUE SELECT,102.02,,,,,,,102.0200,1639.0000,fee schedule,$87.95 from Fee Schedule TC_24 for Rev 450 Proc 23650 * Qty 1 = $87.95 at 116% = $102.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,102.0200,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,102.0200,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1475.10,,,,,,,102.0200,1639.0000,percent of total billed charges,"90% of $1,639.00 in Billed Charges for Rev 450 Proc 23650 = $1,475.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,102.0200,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,102.0200,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,MEDCOST,MEDCOST VHN,780.00,,,,,,,102.0200,1639.0000,percent of total billed charges,"47.59% of $1,639.00 in Billed Charges for Rev 450 Proc 23650 = $780.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,102.0200,1639.0000,fee schedule,"APG 00041 Proc 23650 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,102.0200,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,102.0200,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,102.0200,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,102.0200,1639.0000,fee schedule,"APG 00041 Proc 23650 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,SENTARA HEALTH,SENTARA HEALTH,423.03,,,,,,,102.0200,1639.0000,percent of total billed charges,"25.81% of $1,639.00 in Billed Charges for Rev 450 Proc 23650 = $423.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,102.0200,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1639.00,,,,,,,102.0200,1639.0000,percent of total billed charges,"100% of $1,639.00 in Billed Charges for Rev 450 Proc 23650 = $1,639.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,102.0200,1639.0000,case rate,Rev 450 Proc 23650 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,102.0200,1639.0000,case rate,Rev 450 Proc 23650 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,102.0200,1639.0000,case rate,Rev 450 Proc 23650 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,102.0200,1639.0000,case rate,Rev 450 Proc 23650 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,102.0200,1639.0000,fee schedule,"APG 00041 Proc 23650 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,102.0200,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,102.0200,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,WELLCARE,WELLCARE MEDICAID,1639.00,,,,,,,102.0200,1639.0000,percent of total billed charges,"100% of $1,639.00 in Billed Charges for Rev 450 Proc 23650 = $1,639.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX SHLDR DISLC WOW MANIP,23650,CPT,450,RC,45000109,CDM,,,,both,,,1639.0000,245.8500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,102.0200,1639.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,AETNA,AETNA,1814.32,,,,,,,109.0000,4249.0000,percent of total billed charges,"42.7% of $4,249.00 in Billed Charges for Rev 450 Proc 23655 = $1,814.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1450.92,,,,,,,109.0000,4249.0000,fee schedule,"APG 00044 Proc 23655 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 104% = $1,450.92. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,4249.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4249.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,4249.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,4249.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,4249.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,109.0000,4249.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1436.97,,,,,,,109.0000,4249.0000,fee schedule,"APG 00044 Proc 23655 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 103% = $1,436.97. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,109.0000,4249.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,4249.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4249.00,,,,,,,109.0000,4249.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,270.31,,,,,,,109.0000,4249.0000,fee schedule,$270.31 from Fee Schedule BLDTM_23 for Rev 450 Proc 23655 * Qty 1 = $270.31 at 100% = $270.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,4249.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,4249.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,4249.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3824.10,,,,,,,109.0000,4249.0000,percent of total billed charges,"90% of $4,249.00 in Billed Charges for Rev 450 Proc 23655 = $3,824.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,4249.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,4249.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,MEDCOST,MEDCOST VHN,2022.10,,,,,,,109.0000,4249.0000,percent of total billed charges,"47.59% of $4,249.00 in Billed Charges for Rev 450 Proc 23655 = $2,022.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1464.87,,,,,,,109.0000,4249.0000,fee schedule,"APG 00044 Proc 23655 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 100% = $1,395.11... $1,395.11 at 105% = $1,464.87 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,4249.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,4249.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,4249.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1438.36,,,,,,,109.0000,4249.0000,fee schedule,"APG 00044 Proc 23655 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 100% = $1,395.11... $1,395.11 at 103.1% = $1,438.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,SENTARA HEALTH,SENTARA HEALTH,1096.67,,,,,,,109.0000,4249.0000,percent of total billed charges,"25.81% of $4,249.00 in Billed Charges for Rev 450 Proc 23655 = $1,096.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,4249.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4249.00,,,,,,,109.0000,4249.0000,percent of total billed charges,"100% of $4,249.00 in Billed Charges for Rev 450 Proc 23655 = $4,249.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,4249.0000,case rate,Rev 450 Proc 23655 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,4249.0000,case rate,Rev 450 Proc 23655 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,4249.0000,case rate,Rev 450 Proc 23655 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,4249.0000,case rate,Rev 450 Proc 23655 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1436.97,,,,,,,109.0000,4249.0000,fee schedule,"APG 00044 Proc 23655 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 103% = $1,436.97. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4249.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,4249.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,WELLCARE,WELLCARE MEDICAID,4249.00,,,,,,,109.0000,4249.0000,percent of total billed charges,"100% of $4,249.00 in Billed Charges for Rev 450 Proc 23655 = $4,249.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX SHLD DISLC W MAN W ANE,23655,CPT,450,RC,45000091,CDM,,,,both,,,4249.0000,637.3500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,4249.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,AETNA,AETNA,1156.74,,,,,,,109.0000,3180.3800,percent of total billed charges,"42.7% of $2,709.00 in Billed Charges for Rev 450 Proc 23665 = $1,156.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 23665 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,3180.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,BLUE CROSS,ANTHEM EXCHANGE,2709.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 23665 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,BLUE CROSS,ANTHEM HMO,2709.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,3180.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2709.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,283.59,,,,,,,109.0000,3180.3800,fee schedule,$283.59 from Fee Schedule BLDTM_23 for Rev 450 Proc 23665 * Qty 1 = $283.59 at 100% = $283.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2438.10,,,,,,,109.0000,3180.3800,percent of total billed charges,"90% of $2,709.00 in Billed Charges for Rev 450 Proc 23665 = $2,438.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,MEDCOST,MEDCOST VHN,1289.21,,,,,,,109.0000,3180.3800,percent of total billed charges,"47.59% of $2,709.00 in Billed Charges for Rev 450 Proc 23665 = $1,289.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 23665 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 23665 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,SENTARA HEALTH,SENTARA HEALTH,699.19,,,,,,,109.0000,3180.3800,percent of total billed charges,"25.81% of $2,709.00 in Billed Charges for Rev 450 Proc 23665 = $699.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2709.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $2,709.00 in Billed Charges for Rev 450 Proc 23665 = $2,709.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 23665 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 23665 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 23665 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 23665 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 23665 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,WELLCARE,WELLCARE MEDICAID,2709.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $2,709.00 in Billed Charges for Rev 450 Proc 23665 = $2,709.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX SHLDR DISLOC W FX GT,23665,CPT,450,RC,45000111,CDM,,,,both,,,2709.0000,406.3500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,3180.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,AETNA,AETNA,1924.49,,,,,,,45.5200,4507.0000,percent of total billed charges,"42.7% of $4,507.00 in Billed Charges for Rev 521 Proc 23931 = $1,924.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2612.63,,,,,,,45.5200,4507.0000,fee schedule,"APG 00051 Proc 23931 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 104% = $2,612.63. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,45.5200,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,45.5200,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,45.5200,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,AMBETTER,AMBETTER,3266.63,,,,,,,45.5200,4507.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,45.5200,4507.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,ANTHEM EXCHANGE,3689.28,,,,,,,45.5200,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2587.51,,,,,,,45.5200,4507.0000,fee schedule,"APG 00051 Proc 23931 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,ANTHEM HMO,3919.64,,,,,,,45.5200,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,45.5200,4507.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4507.00,,,,,,,45.5200,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,128.48,,,,,,,45.5200,4507.0000,fee schedule,$128.48 from Fee Schedule BLDTM_23 for Rev 521 Proc 23931 * Qty 1 = $128.48 at 100% = $128.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,45.5200,4507.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,TENNCARE BLUE CARE,45.52,,,,,,,45.5200,4507.0000,fee schedule,$39.24 from Fee Schedule TC_24 for Rev 521 Proc 23931 * Qty 1 = $39.24 at 116% = $45.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,TENNCARE BLUE SELECT,45.52,,,,,,,45.5200,4507.0000,fee schedule,$39.24 from Fee Schedule TC_24 for Rev 521 Proc 23931 * Qty 1 = $39.24 at 116% = $45.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,CIGNA HEALTHCARE,CIGNA HMO,1879.42,,,,,,,45.5200,4507.0000,percent of total billed charges,"41.7% of $4,507.00 in Billed Charges for Rev 521 Proc 23931 = $1,879.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2091.25,,,,,,,45.5200,4507.0000,percent of total billed charges,"46.4% of $4,507.00 in Billed Charges for Rev 521 Proc 23931 = $2,091.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,45.5200,4507.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1879.42,,,,,,,45.5200,4507.0000,percent of total billed charges,"41.7% of $4,507.00 in Billed Charges for Rev 521 Proc 23931 = $1,879.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,CIGNA HEALTHCARE,CIGNA PPO,1879.42,,,,,,,45.5200,4507.0000,percent of total billed charges,"41.7% of $4,507.00 in Billed Charges for Rev 521 Proc 23931 = $1,879.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,45.5200,4507.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4056.30,,,,,,,45.5200,4507.0000,percent of total billed charges,"90% of $4,507.00 in Billed Charges for Rev 521 Proc 23931 = $4,056.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,45.5200,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,45.5200,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,MEDCOST,MEDCOST VHN,2144.88,,,,,,,45.5200,4507.0000,percent of total billed charges,"47.59% of $4,507.00 in Billed Charges for Rev 521 Proc 23931 = $2,144.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2637.75,,,,,,,45.5200,4507.0000,fee schedule,"APG 00051 Proc 23931 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 105% = $2,637.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,45.5200,4507.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,45.5200,4507.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,45.5200,4507.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2590.02,,,,,,,45.5200,4507.0000,fee schedule,"APG 00051 Proc 23931 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 103.1% = $2,590.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,SENTARA HEALTH,SENTARA HEALTH,1163.26,,,,,,,45.5200,4507.0000,percent of total billed charges,"25.81% of $4,507.00 in Billed Charges for Rev 521 Proc 23931 = $1,163.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,45.5200,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4507.00,,,,,,,45.5200,4507.0000,percent of total billed charges,"100% of $4,507.00 in Billed Charges for Rev 521 Proc 23931 = $4,507.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,432.98,,,,,,,45.5200,4507.0000,fee schedule,$865.96 from Fee Schedule TCUHC24 for Rev 521 Proc 23931 * Qty 1 = $865.96 at 50% = $432.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2587.51,,,,,,,45.5200,4507.0000,fee schedule,"APG 00051 Proc 23931 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,45.5200,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,45.5200,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,WELLCARE,WELLCARE MEDICAID,4507.00,,,,,,,45.5200,4507.0000,percent of total billed charges,"100% of $4,507.00 in Billed Charges for Rev 521 Proc 23931 = $4,507.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID UPPER ARM.ELBOW BURSA,23931,CPT,521,RC,52100089,CDM,,,,both,,,4507.0000,676.0500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,45.5200,4507.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,AETNA,AETNA,1852.75,,,,,,,578.0000,4339.0000,percent of total billed charges,"42.7% of $4,339.00 in Billed Charges for Rev 361 Proc 24065 = $1,852.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2612.63,,,,,,,578.0000,4339.0000,fee schedule,"APG 00051 Proc 24065 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 104% = $2,612.63. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,578.0000,4339.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,578.0000,4339.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,578.0000,4339.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,AMBETTER,AMBETTER,3266.63,,,,,,,578.0000,4339.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,578.0000,4339.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,BLUE CROSS,ANTHEM EXCHANGE,3689.28,,,,,,,578.0000,4339.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2587.51,,,,,,,578.0000,4339.0000,fee schedule,"APG 00051 Proc 24065 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,BLUE CROSS,ANTHEM HMO,3919.64,,,,,,,578.0000,4339.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,578.0000,4339.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4339.00,,,,,,,578.0000,4339.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,578.0000,4339.0000,case rate,Rev 361 Proc 24065 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,578.0000,4339.0000,case rate,"Rev 361 Proc 24065 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,578.0000,4339.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,578.0000,4339.0000,case rate,"Rev 361 Proc 24065 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,578.0000,4339.0000,case rate,"Rev 361 Proc 24065 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,4339.0000,case rate,Rev 361 Proc 24065 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,4339.0000,case rate,Rev 361 Proc 24065 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,578.0000,4339.0000,case rate,"Rev 361 Proc 24065 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,578.0000,4339.0000,case rate,"Rev 361 Proc 24065 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,578.0000,4339.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,578.0000,4339.0000,case rate,"Rev 361 Proc 24065 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,578.0000,4339.0000,case rate,"Rev 361 Proc 24065 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,578.0000,4339.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3905.10,,,,,,,578.0000,4339.0000,percent of total billed charges,"90% of $4,339.00 in Billed Charges for Rev 361 Proc 24065 = $3,905.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,578.0000,4339.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,578.0000,4339.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,MEDCOST,MEDCOST VHN,2064.93,,,,,,,578.0000,4339.0000,percent of total billed charges,"47.59% of $4,339.00 in Billed Charges for Rev 361 Proc 24065 = $2,064.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2637.75,,,,,,,578.0000,4339.0000,fee schedule,"APG 00051 Proc 24065 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 105% = $2,637.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,578.0000,4339.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,578.0000,4339.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,578.0000,4339.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2590.02,,,,,,,578.0000,4339.0000,fee schedule,"APG 00051 Proc 24065 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 103.1% = $2,590.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,SENTARA HEALTH,SENTARA HEALTH,1119.90,,,,,,,578.0000,4339.0000,percent of total billed charges,"25.81% of $4,339.00 in Billed Charges for Rev 361 Proc 24065 = $1,119.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,578.0000,4339.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4339.00,,,,,,,578.0000,4339.0000,percent of total billed charges,"100% of $4,339.00 in Billed Charges for Rev 361 Proc 24065 = $4,339.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,578.0000,4339.0000,case rate,Rev 361 Proc 24065 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,578.0000,4339.0000,case rate,"Rev 361 Proc 24065 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,578.0000,4339.0000,case rate,"Rev 361 Proc 24065 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,578.0000,4339.0000,case rate,"Rev 361 Proc 24065 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2587.51,,,,,,,578.0000,4339.0000,fee schedule,"APG 00051 Proc 24065 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,578.0000,4339.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,578.0000,4339.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,WELLCARE,WELLCARE MEDICAID,4339.00,,,,,,,578.0000,4339.0000,percent of total billed charges,"100% of $4,339.00 in Billed Charges for Rev 361 Proc 24065 = $4,339.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX ARM UPPER/ELBOW SUPERFICAL,24065,CPT,361,RC,36100079,CDM,,,,both,,,4339.0000,650.8500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,578.0000,4339.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA,603.35,,,,,,,109.0000,3266.6300,percent of total billed charges,"42.7% of $1,413.00 in Billed Charges for Rev 450 Proc 24200 = $603.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2612.63,,,,,,,109.0000,3266.6300,fee schedule,"APG 00051 Proc 24200 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 104% = $2,612.63. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1413.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA HEALTHCARE MEDICARE,1413.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,1413.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,AMBETTER,AMBETTER,3266.63,,,,,,,109.0000,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1413.00,,,,,,,109.0000,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM EXCHANGE,1413.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1413.00,,,,,,,109.0000,3266.6300,fee schedule,"APG 00051 Proc 24200 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51 (Service Line reduced to $1,413.00, claim capped at $1,413.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HMO,1413.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1413.00,,,,,,,109.0000,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1413.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,118.49,,,,,,,109.0000,3266.6300,fee schedule,$118.49 from Fee Schedule BLDTM_23 for Rev 450 Proc 24200 * Qty 1 = $118.49 at 100% = $118.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,109.0000,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,1413.00,,,,,,,109.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1413.00,,,,,,,109.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1271.70,,,,,,,109.0000,3266.6300,percent of total billed charges,"90% of $1,413.00 in Billed Charges for Rev 450 Proc 24200 = $1,271.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,HUMANA,HUMANA MEDICARE,1413.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1413.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,MEDCOST,MEDCOST VHN,672.45,,,,,,,109.0000,3266.6300,percent of total billed charges,"47.59% of $1,413.00 in Billed Charges for Rev 450 Proc 24200 = $672.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2637.75,,,,,,,109.0000,3266.6300,fee schedule,"APG 00051 Proc 24200 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 105% = $2,637.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1413.00,,,,,,,109.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1413.00,,,,,,,109.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,NHC ADVANTAGE,NHC ADVANTAGE,1413.00,,,,,,,109.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2590.02,,,,,,,109.0000,3266.6300,fee schedule,"APG 00051 Proc 24200 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 103.1% = $2,590.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA HEALTH,364.70,,,,,,,109.0000,3266.6300,percent of total billed charges,"25.81% of $1,413.00 in Billed Charges for Rev 450 Proc 24200 = $364.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA MEDICARE,1413.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1413.00,,,,,,,109.0000,3266.6300,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 24200 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3266.6300,case rate,Rev 450 Proc 24200 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3266.6300,case rate,Rev 450 Proc 24200 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3266.6300,case rate,Rev 450 Proc 24200 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3266.6300,case rate,Rev 450 Proc 24200 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2587.51,,,,,,,109.0000,3266.6300,fee schedule,"APG 00051 Proc 24200 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1413.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1413.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICAID,1413.00,,,,,,,109.0000,3266.6300,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 24200 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVL FB UPPER ARM ELB SUBQ,24200,CPT,450,RC,45000112,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,109.0000,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM ELBOW,24220,CPT,361,RC,36100081,CDM,,,,both,,,411.0000,61.6500,AETNA,AETNA,175.50,,,,,,,106.0800,500.0000,percent of total billed charges,42.7% of $411.00 in Billed Charges for Rev 361 Proc 24220 = $175.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ ARTHROGRAM ELBOW,24220,CPT,361,RC,36100081,CDM,,,,both,,,411.0000,61.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,495.24,,,,,,,106.0800,500.0000,fee schedule,APG 00278 Proc 24220 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 104% = $495.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM ELBOW,24220,CPT,361,RC,36100081,CDM,,,,both,,,411.0000,61.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,411.00,,,,,,,106.0800,500.0000,fee schedule,"APG 00278 Proc 24220 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 103% = $490.48 (Service Line reduced to $411.00, claim capped at $411.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ARTHROGRAM ELBOW,24220,CPT,361,RC,36100081,CDM,,,,both,,,411.0000,61.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,411.00,,,,,,,106.0800,500.0000,case rate,"Rev 361 Proc 24220 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $411.00 in Billed Charges - $0.00 in ASG Allowed Amount = $411.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ARTHROGRAM ELBOW,24220,CPT,361,RC,36100081,CDM,,,,both,,,411.0000,61.6500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,106.0800,500.0000,case rate,Rev 361 Proc 24220 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM ELBOW,24220,CPT,361,RC,36100081,CDM,,,,both,,,411.0000,61.6500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,106.0800,500.0000,case rate,Rev 361 Proc 24220 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM ELBOW,24220,CPT,361,RC,36100081,CDM,,,,both,,,411.0000,61.6500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,106.0800,500.0000,case rate,Rev 361 Proc 24220 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM ELBOW,24220,CPT,361,RC,36100081,CDM,,,,both,,,411.0000,61.6500,BLUE CROSS,TENNCARE BLUE CARE,411.00,,,,,,,106.0800,500.0000,case rate,"Rev 361 Proc 24220 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total (Service Line reduced to $411.00, claim capped at $411.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ARTHROGRAM ELBOW,24220,CPT,361,RC,36100081,CDM,,,,both,,,411.0000,61.6500,BLUE CROSS,TENNCARE BLUE SELECT,411.00,,,,,,,106.0800,500.0000,case rate,"Rev 361 Proc 24220 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total (Service Line reduced to $411.00, claim capped at $411.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ARTHROGRAM ELBOW,24220,CPT,361,RC,36100081,CDM,,,,both,,,411.0000,61.6500,CIGNA HEALTHCARE,CIGNA HMO,411.00,,,,,,,106.0800,500.0000,case rate,"Rev 361 Proc 24220 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $411.00 in Billed Charges - $0.00 in ASG Allowed Amount = $411.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ARTHROGRAM ELBOW,24220,CPT,361,RC,36100081,CDM,,,,both,,,411.0000,61.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,411.00,,,,,,,106.0800,500.0000,case rate,"Rev 361 Proc 24220 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $411.00 in Billed Charges - $0.00 in ASG Allowed Amount = $411.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ARTHROGRAM ELBOW,24220,CPT,361,RC,36100081,CDM,,,,both,,,411.0000,61.6500,CIGNA HEALTHCARE,CIGNA PPO,411.00,,,,,,,106.0800,500.0000,case rate,"Rev 361 Proc 24220 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $411.00 in Billed Charges - $0.00 in ASG Allowed Amount = $411.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ARTHROGRAM ELBOW,24220,CPT,361,RC,36100081,CDM,,,,both,,,411.0000,61.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,369.90,,,,,,,106.0800,500.0000,percent of total billed charges,90% of $411.00 in Billed Charges for Rev 361 Proc 24220 = $369.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ ARTHROGRAM ELBOW,24220,CPT,361,RC,36100081,CDM,,,,both,,,411.0000,61.6500,MEDCOST,MEDCOST VHN,195.59,,,,,,,106.0800,500.0000,percent of total billed charges,47.59% of $411.00 in Billed Charges for Rev 361 Proc 24220 = $195.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ ARTHROGRAM ELBOW,24220,CPT,361,RC,36100081,CDM,,,,both,,,411.0000,61.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,500.00,,,,,,,106.0800,500.0000,fee schedule,APG 00278 Proc 24220 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 100% = $476.19... $476.19 at 105% = $500.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM ELBOW,24220,CPT,361,RC,36100081,CDM,,,,both,,,411.0000,61.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,490.95,,,,,,,106.0800,500.0000,fee schedule,APG 00278 Proc 24220 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 100% = $476.19... $476.19 at 103.1% = $490.95 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM ELBOW,24220,CPT,361,RC,36100081,CDM,,,,both,,,411.0000,61.6500,SENTARA HEALTH,SENTARA HEALTH,106.08,,,,,,,106.0800,500.0000,percent of total billed charges,25.81% of $411.00 in Billed Charges for Rev 361 Proc 24220 = $106.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ ARTHROGRAM ELBOW,24220,CPT,361,RC,36100081,CDM,,,,both,,,411.0000,61.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",411.00,,,,,,,106.0800,500.0000,percent of total billed charges,100% of $411.00 in Billed Charges for Rev 361 Proc 24220 = $411.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ ARTHROGRAM ELBOW,24220,CPT,361,RC,36100081,CDM,,,,both,,,411.0000,61.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,106.0800,500.0000,case rate,Rev 361 Proc 24220 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM ELBOW,24220,CPT,361,RC,36100081,CDM,,,,both,,,411.0000,61.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,106.0800,500.0000,case rate,Rev 361 Proc 24220 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM ELBOW,24220,CPT,361,RC,36100081,CDM,,,,both,,,411.0000,61.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,106.0800,500.0000,case rate,Rev 361 Proc 24220 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM ELBOW,24220,CPT,361,RC,36100081,CDM,,,,both,,,411.0000,61.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,411.00,,,,,,,106.0800,500.0000,case rate,"Rev 361 Proc 24220 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total (Service Line reduced to $411.00, claim capped at $411.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ARTHROGRAM ELBOW,24220,CPT,361,RC,36100081,CDM,,,,both,,,411.0000,61.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,490.48,,,,,,,106.0800,500.0000,fee schedule,APG 00278 Proc 24220 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 103% = $490.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM ELBOW,24220,CPT,361,RC,36100081,CDM,,,,both,,,411.0000,61.6500,WELLCARE,WELLCARE MEDICAID,411.00,,,,,,,106.0800,500.0000,percent of total billed charges,100% of $411.00 in Billed Charges for Rev 361 Proc 24220 = $411.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA,180.19,,,,,,,108.9200,3180.3800,percent of total billed charges,42.7% of $422.00 in Billed Charges for Rev 450 Proc 24505 = $180.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,108.9200,3180.3800,fee schedule,APG 00041 Proc 24505 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,422.00,,,,,,,108.9200,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA HEALTHCARE MEDICARE,422.00,,,,,,,108.9200,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,422.00,,,,,,,108.9200,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,AMBETTER,AMBETTER,3180.38,,,,,,,108.9200,3180.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,422.00,,,,,,,108.9200,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM EXCHANGE,422.00,,,,,,,108.9200,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,422.00,,,,,,,108.9200,3180.3800,fee schedule,"APG 00041 Proc 24505 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HMO,422.00,,,,,,,108.9200,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,422.00,,,,,,,108.9200,3180.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",422.00,,,,,,,108.9200,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,422.00,,,,,,,108.9200,3180.3800,fee schedule,$429.79 from Fee Schedule BLDTM_23 for Rev 450 Proc 24505 * Qty 1 = $429.79 at 100% = $429.79 (Limited to $422.00 in Billed Charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,108.9200,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,422.00,,,,,,,108.9200,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,422.00,,,,,,,108.9200,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,379.80,,,,,,,108.9200,3180.3800,percent of total billed charges,90% of $422.00 in Billed Charges for Rev 450 Proc 24505 = $379.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,HUMANA,HUMANA MEDICARE,422.00,,,,,,,108.9200,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,422.00,,,,,,,108.9200,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,MEDCOST,MEDCOST VHN,200.83,,,,,,,108.9200,3180.3800,percent of total billed charges,47.59% of $422.00 in Billed Charges for Rev 450 Proc 24505 = $200.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,108.9200,3180.3800,fee schedule,APG 00041 Proc 24505 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,422.00,,,,,,,108.9200,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,422.00,,,,,,,108.9200,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,NHC ADVANTAGE,NHC ADVANTAGE,422.00,,,,,,,108.9200,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,108.9200,3180.3800,fee schedule,APG 00041 Proc 24505 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA HEALTH,108.92,,,,,,,108.9200,3180.3800,percent of total billed charges,25.81% of $422.00 in Billed Charges for Rev 450 Proc 24505 = $108.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA MEDICARE,422.00,,,,,,,108.9200,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",422.00,,,,,,,108.9200,3180.3800,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 24505 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,108.9200,3180.3800,case rate,Rev 450 Proc 24505 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,422.00,,,,,,,108.9200,3180.3800,case rate,"Rev 450 Proc 24505 at Case Rate $491.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,422.00,,,,,,,108.9200,3180.3800,case rate,"Rev 450 Proc 24505 at Case Rate $471.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,422.00,,,,,,,108.9200,3180.3800,case rate,"Rev 450 Proc 24505 at Case Rate $847.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,108.9200,3180.3800,fee schedule,APG 00041 Proc 24505 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,422.00,,,,,,,108.9200,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,422.00,,,,,,,108.9200,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICAID,422.00,,,,,,,108.9200,3180.3800,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 24505 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC HUMERAL SHAFT FX W/CLOSED RED,24505,CPT,450,RC,45000314,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,108.9200,3180.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TAPE SUTURE 1.3MM,272,RC,,,,,,,,both,,,435.5800,65.3400,AETNA,AETNA,185.99,,,,,,,112.4200,435.5800,percent of total billed charges,42.7% of $435.58 in Billed Charges for Rev 272 = $185.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TAPE SUTURE 1.3MM,272,RC,,,,,,,,both,,,435.5800,65.3400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,304.91,,,,,,,112.4200,435.5800,percent of total billed charges,Rev 272 $435.58 in Billed Charges at 70% = $304.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TAPE SUTURE 1.3MM,272,RC,,,,,,,,both,,,435.5800,65.3400,CIGNA HEALTHCARE,CIGNA HMO,181.64,,,,,,,112.4200,435.5800,percent of total billed charges,41.7% of $435.58 in Billed Charges for Rev 272 = $181.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TAPE SUTURE 1.3MM,272,RC,,,,,,,,both,,,435.5800,65.3400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,202.11,,,,,,,112.4200,435.5800,percent of total billed charges,46.4% of $435.58 in Billed Charges for Rev 272 = $202.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TAPE SUTURE 1.3MM,272,RC,,,,,,,,both,,,435.5800,65.3400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,181.64,,,,,,,112.4200,435.5800,percent of total billed charges,41.7% of $435.58 in Billed Charges for Rev 272 = $181.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TAPE SUTURE 1.3MM,272,RC,,,,,,,,both,,,435.5800,65.3400,CIGNA HEALTHCARE,CIGNA PPO,181.64,,,,,,,112.4200,435.5800,percent of total billed charges,41.7% of $435.58 in Billed Charges for Rev 272 = $181.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TAPE SUTURE 1.3MM,272,RC,,,,,,,,both,,,435.5800,65.3400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,392.02,,,,,,,112.4200,435.5800,percent of total billed charges,90% of $435.58 in Billed Charges for Rev 272 = $392.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TAPE SUTURE 1.3MM,272,RC,,,,,,,,both,,,435.5800,65.3400,MEDCOST,MEDCOST VHN,207.29,,,,,,,112.4200,435.5800,percent of total billed charges,47.59% of $435.58 in Billed Charges for Rev 272 = $207.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TAPE SUTURE 1.3MM,272,RC,,,,,,,,both,,,435.5800,65.3400,SENTARA HEALTH,SENTARA HEALTH,112.42,,,,,,,112.4200,435.5800,percent of total billed charges,25.81% of $435.58 in Billed Charges for Rev 272 = $112.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TAPE SUTURE 1.3MM,272,RC,,,,,,,,both,,,435.5800,65.3400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",435.58,,,,,,,112.4200,435.5800,percent of total billed charges,100% of $435.58 in Billed Charges for Rev 272 = $435.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TAPE SUTURE 1.3MM,272,RC,,,,,,,,both,,,435.5800,65.3400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,217.79,,,,,,,112.4200,435.5800,percent of total billed charges,Rev 272 $435.58 in Billed Charges at 50% = $217.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TAPE SUTURE 1.3MM,272,RC,,,,,,,,both,,,435.5800,65.3400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,140.69,,,,,,,112.4200,435.5800,other,32.3% of $435.58 in Billed Charges for Rev 272 = $140.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TAPE SUTURE 1.3MM,272,RC,,,,,,,,both,,,435.5800,65.3400,UNITED HEALTHCARE,UHC HERITAGE SELECT,133.72,,,,,,,112.4200,435.5800,other,30.7% of $435.58 in Billed Charges for Rev 272 = $133.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TAPE SUTURE 1.3MM,272,RC,,,,,,,,both,,,435.5800,65.3400,UNITED HEALTHCARE,UNITED HEALTHCARE,140.69,,,,,,,112.4200,435.5800,percent of total billed charges,32.3% of $435.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TAPE SUTURE 1.3MM,272,RC,,,,,,,,both,,,435.5800,65.3400,WELLCARE,WELLCARE MEDICAID,435.58,,,,,,,112.4200,435.5800,percent of total billed charges,100% of $435.58 in Billed Charges for Rev 272 = $435.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA,180.19,,,,,,,108.9200,703.3600,percent of total billed charges,42.7% of $422.00 in Billed Charges for Rev 450 Proc 24530 = $180.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 24530 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,AMBETTER,AMBETTER,487.87,,,,,,,108.9200,703.3600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,108.9200,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM EXCHANGE,422.00,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,422.00,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 24530 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HMO,422.00,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,108.9200,703.3600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",422.00,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,288.13,,,,,,,108.9200,703.3600,fee schedule,$288.13 from Fee Schedule BLDTM_23 for Rev 450 Proc 24530 * Qty 1 = $288.13 at 100% = $288.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,108.9200,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,379.80,,,,,,,108.9200,703.3600,percent of total billed charges,90% of $422.00 in Billed Charges for Rev 450 Proc 24530 = $379.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,MEDCOST,MEDCOST VHN,200.83,,,,,,,108.9200,703.3600,percent of total billed charges,47.59% of $422.00 in Billed Charges for Rev 450 Proc 24530 = $200.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 24530 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,108.9200,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 24530 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA HEALTH,108.92,,,,,,,108.9200,703.3600,percent of total billed charges,25.81% of $422.00 in Billed Charges for Rev 450 Proc 24530 = $108.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",422.00,,,,,,,108.9200,703.3600,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 24530 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,108.9200,703.3600,case rate,Rev 450 Proc 24530 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,422.00,,,,,,,108.9200,703.3600,case rate,"Rev 450 Proc 24530 at Case Rate $491.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,422.00,,,,,,,108.9200,703.3600,case rate,"Rev 450 Proc 24530 at Case Rate $471.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,422.00,,,,,,,108.9200,703.3600,case rate,"Rev 450 Proc 24530 at Case Rate $847.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,108.9200,703.3600,fee schedule,"APG 00041 Proc 24530 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,108.9200,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICAID,422.00,,,,,,,108.9200,703.3600,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 24530 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SUPRA HUMERAL FRACT W/O MANIP,24530,CPT,450,RC,45000113,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,108.9200,703.3600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,AETNA,AETNA,544.00,,,,,,,92.6000,1274.0000,percent of total billed charges,"42.7% of $1,274.00 in Billed Charges for Rev 450 Proc 24576 = $544.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,92.6000,1274.0000,fee schedule,"APG 00041 Proc 24576 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,92.6000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,92.6000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,92.6000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,AMBETTER,AMBETTER,487.87,,,,,,,92.6000,1274.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,92.6000,1274.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,92.6000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,92.6000,1274.0000,fee schedule,"APG 00041 Proc 24576 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,92.6000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,92.6000,1274.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,92.6000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,234.20,,,,,,,92.6000,1274.0000,fee schedule,$234.20 from Fee Schedule BLDTM_23 for Rev 450 Proc 24576 * Qty 1 = $234.20 at 100% = $234.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,92.6000,1274.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,TENNCARE BLUE CARE,92.60,,,,,,,92.6000,1274.0000,fee schedule,$79.83 from Fee Schedule TC_24 for Rev 450 Proc 24576 * Qty 1 = $79.83 at 116% = $92.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,TENNCARE BLUE SELECT,92.60,,,,,,,92.6000,1274.0000,fee schedule,$79.83 from Fee Schedule TC_24 for Rev 450 Proc 24576 * Qty 1 = $79.83 at 116% = $92.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,92.6000,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,92.6000,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1146.60,,,,,,,92.6000,1274.0000,percent of total billed charges,"90% of $1,274.00 in Billed Charges for Rev 450 Proc 24576 = $1,146.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,92.6000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,92.6000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,MEDCOST,MEDCOST VHN,606.30,,,,,,,92.6000,1274.0000,percent of total billed charges,"47.59% of $1,274.00 in Billed Charges for Rev 450 Proc 24576 = $606.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,92.6000,1274.0000,fee schedule,"APG 00041 Proc 24576 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,92.6000,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,92.6000,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,92.6000,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,92.6000,1274.0000,fee schedule,"APG 00041 Proc 24576 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,SENTARA HEALTH,SENTARA HEALTH,328.82,,,,,,,92.6000,1274.0000,percent of total billed charges,"25.81% of $1,274.00 in Billed Charges for Rev 450 Proc 24576 = $328.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,92.6000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1274.00,,,,,,,92.6000,1274.0000,percent of total billed charges,"100% of $1,274.00 in Billed Charges for Rev 450 Proc 24576 = $1,274.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,92.6000,1274.0000,case rate,Rev 450 Proc 24576 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,92.6000,1274.0000,case rate,Rev 450 Proc 24576 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,92.6000,1274.0000,case rate,Rev 450 Proc 24576 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,92.6000,1274.0000,case rate,Rev 450 Proc 24576 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,92.6000,1274.0000,fee schedule,"APG 00041 Proc 24576 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,92.6000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,92.6000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,WELLCARE,WELLCARE MEDICAID,1274.00,,,,,,,92.6000,1274.0000,percent of total billed charges,"100% of $1,274.00 in Billed Charges for Rev 450 Proc 24576 = $1,274.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX HUM CON M L FX WO MA,24576,CPT,450,RC,45000116,CDM,,,,both,,,1274.0000,191.1000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,92.6000,1274.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA,2059.42,,,,,,,109.0000,4823.0000,percent of total billed charges,"42.7% of $4,823.00 in Billed Charges for Rev 450 Proc 24605 = $2,059.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1450.92,,,,,,,109.0000,4823.0000,fee schedule,"APG 00044 Proc 24605 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 104% = $1,450.92. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,4823.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,4823.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1436.97,,,,,,,109.0000,4823.0000,fee schedule,"APG 00044 Proc 24605 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 103% = $1,436.97. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,4823.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4489.34,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,324.07,,,,,,,109.0000,4823.0000,fee schedule,$324.07 from Fee Schedule BLDTM_23 for Rev 450 Proc 24605 * Qty 1 = $324.07 at 100% = $324.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,4823.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4340.70,,,,,,,109.0000,4823.0000,percent of total billed charges,"90% of $4,823.00 in Billed Charges for Rev 450 Proc 24605 = $4,340.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,MEDCOST,MEDCOST VHN,2295.27,,,,,,,109.0000,4823.0000,percent of total billed charges,"47.59% of $4,823.00 in Billed Charges for Rev 450 Proc 24605 = $2,295.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1464.87,,,,,,,109.0000,4823.0000,fee schedule,"APG 00044 Proc 24605 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 100% = $1,395.11... $1,395.11 at 105% = $1,464.87 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1438.36,,,,,,,109.0000,4823.0000,fee schedule,"APG 00044 Proc 24605 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 100% = $1,395.11... $1,395.11 at 103.1% = $1,438.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,SENTARA HEALTH,SENTARA HEALTH,1244.82,,,,,,,109.0000,4823.0000,percent of total billed charges,"25.81% of $4,823.00 in Billed Charges for Rev 450 Proc 24605 = $1,244.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4823.00,,,,,,,109.0000,4823.0000,percent of total billed charges,"100% of $4,823.00 in Billed Charges for Rev 450 Proc 24605 = $4,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 24605 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 24605 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 24605 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 24605 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1436.97,,,,,,,109.0000,4823.0000,fee schedule,"APG 00044 Proc 24605 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 103% = $1,436.97. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,WELLCARE,WELLCARE MEDICAID,4823.00,,,,,,,109.0000,4823.0000,percent of total billed charges,"100% of $4,823.00 in Billed Charges for Rev 450 Proc 24605 = $4,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX CLSD ELBOW DISLOC REQ ANES,24605,CPT,450,RC,45000380,CDM,,,,both,,,4823.0000,723.4500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,4823.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,AETNA,AETNA,207.10,,,,,,,67.9800,703.3600,percent of total billed charges,42.7% of $485.00 in Billed Charges for Rev 450 Proc 28660 = $207.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,67.9800,703.3600,fee schedule,"APG 00041 Proc 28660 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,67.9800,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,67.9800,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,67.9800,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,AMBETTER,AMBETTER,487.87,,,,,,,67.9800,703.3600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,67.9800,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,BLUE CROSS,ANTHEM EXCHANGE,485.00,,,,,,,67.9800,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,485.00,,,,,,,67.9800,703.3600,fee schedule,"APG 00041 Proc 28660 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96 (Service Line reduced to $485.00, claim capped at $485.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,BLUE CROSS,ANTHEM HMO,485.00,,,,,,,67.9800,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,67.9800,703.3600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",485.00,,,,,,,67.9800,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,67.98,,,,,,,67.9800,703.3600,fee schedule,$67.98 from Fee Schedule BLDTM_23 for Rev 450 Proc 28660 * Qty 1 = $67.98 at 100% = $67.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,67.9800,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,67.9800,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,67.9800,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,436.50,,,,,,,67.9800,703.3600,percent of total billed charges,90% of $485.00 in Billed Charges for Rev 450 Proc 28660 = $436.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,67.9800,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,67.9800,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,MEDCOST,MEDCOST VHN,230.81,,,,,,,67.9800,703.3600,percent of total billed charges,47.59% of $485.00 in Billed Charges for Rev 450 Proc 28660 = $230.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,67.9800,703.3600,fee schedule,"APG 00041 Proc 28660 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,67.9800,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,67.9800,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,67.9800,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,67.9800,703.3600,fee schedule,"APG 00041 Proc 28660 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,SENTARA HEALTH,SENTARA HEALTH,125.18,,,,,,,67.9800,703.3600,percent of total billed charges,25.81% of $485.00 in Billed Charges for Rev 450 Proc 28660 = $125.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,67.9800,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",485.00,,,,,,,67.9800,703.3600,percent of total billed charges,100% of $485.00 in Billed Charges for Rev 450 Proc 28660 = $485.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,67.9800,703.3600,case rate,Rev 450 Proc 28660 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,485.00,,,,,,,67.9800,703.3600,case rate,"Rev 450 Proc 28660 at Case Rate $491.00 (Service Line reduced to $485.00, claim capped at $485.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,67.9800,703.3600,case rate,Rev 450 Proc 28660 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,485.00,,,,,,,67.9800,703.3600,case rate,"Rev 450 Proc 28660 at Case Rate $847.00 (Service Line reduced to $485.00, claim capped at $485.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,67.9800,703.3600,fee schedule,"APG 00041 Proc 28660 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,67.9800,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,67.9800,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,WELLCARE,WELLCARE MEDICAID,485.00,,,,,,,67.9800,703.3600,percent of total billed charges,100% of $485.00 in Billed Charges for Rev 450 Proc 28660 = $485.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX IP JOINT DISLOC WO AN,28660,CPT,450,RC,45000190,CDM,,,,both,,,485.0000,72.7500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,67.9800,703.3600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,AETNA,AETNA,171.65,,,,,,,25.1100,553.1900,percent of total billed charges,42.7% of $402.00 in Billed Charges for Rev 450 Proc 29049 = $171.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,283.21,,,,,,,25.1100,553.1900,fee schedule,"APG 00039 Proc 29049 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 104% = $283.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,253.76,,,,,,,25.1100,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,AETNA,AETNA HEALTHCARE MEDICARE,253.76,,,,,,,25.1100,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,253.76,,,,,,,25.1100,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,AMBETTER,AMBETTER,553.19,,,,,,,25.1100,553.1900,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,263.91,,,,,,,25.1100,553.1900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,BLUE CROSS,ANTHEM EXCHANGE,402.00,,,,,,,25.1100,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,280.48,,,,,,,25.1100,553.1900,fee schedule,"APG 00039 Proc 29049 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,BLUE CROSS,ANTHEM HMO,402.00,,,,,,,25.1100,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,261.37,,,,,,,25.1100,553.1900,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",402.00,,,,,,,25.1100,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,70.85,,,,,,,25.1100,553.1900,fee schedule,$70.85 from Fee Schedule BLDTM_23 for Rev 450 Proc 29049 * Qty 1 = $70.85 at 100% = $70.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,BLUE CROSS,BLUE CROSS MEDICARE,263.91,,,,,,,25.1100,553.1900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,BLUE CROSS,TENNCARE BLUE CARE,25.11,,,,,,,25.1100,553.1900,fee schedule,$21.65 from Fee Schedule TC_24 for Rev 450 Proc 29049 * Qty 1 = $21.65 at 116% = $25.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,BLUE CROSS,TENNCARE BLUE SELECT,25.11,,,,,,,25.1100,553.1900,fee schedule,$21.65 from Fee Schedule TC_24 for Rev 450 Proc 29049 * Qty 1 = $21.65 at 116% = $25.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,266.45,,,,,,,25.1100,553.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,266.45,,,,,,,25.1100,553.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,361.80,,,,,,,25.1100,553.1900,percent of total billed charges,90% of $402.00 in Billed Charges for Rev 450 Proc 29049 = $361.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,HUMANA,HUMANA MEDICARE,253.76,,,,,,,25.1100,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,253.76,,,,,,,25.1100,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,MEDCOST,MEDCOST VHN,191.31,,,,,,,25.1100,553.1900,percent of total billed charges,47.59% of $402.00 in Billed Charges for Rev 450 Proc 29049 = $191.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,285.93,,,,,,,25.1100,553.1900,fee schedule,"APG 00039 Proc 29049 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 105% = $285.93 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,266.45,,,,,,,25.1100,553.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,266.45,,,,,,,25.1100,553.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,NHC ADVANTAGE,NHC ADVANTAGE,266.45,,,,,,,25.1100,553.1900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,280.75,,,,,,,25.1100,553.1900,fee schedule,"APG 00039 Proc 29049 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 103.1% = $280.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,SENTARA HEALTH,SENTARA HEALTH,103.76,,,,,,,25.1100,553.1900,percent of total billed charges,25.81% of $402.00 in Billed Charges for Rev 450 Proc 29049 = $103.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,SENTARA HEALTH,SENTARA MEDICARE,253.76,,,,,,,25.1100,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",402.00,,,,,,,25.1100,553.1900,percent of total billed charges,100% of $402.00 in Billed Charges for Rev 450 Proc 29049 = $402.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,25.1100,553.1900,case rate,Rev 450 Proc 29049 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,402.00,,,,,,,25.1100,553.1900,case rate,"Rev 450 Proc 29049 at Case Rate $491.00 (Service Line reduced to $402.00, claim capped at $402.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,402.00,,,,,,,25.1100,553.1900,case rate,"Rev 450 Proc 29049 at Case Rate $471.00 (Service Line reduced to $402.00, claim capped at $402.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,402.00,,,,,,,25.1100,553.1900,case rate,"Rev 450 Proc 29049 at Case Rate $847.00 (Service Line reduced to $402.00, claim capped at $402.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,280.48,,,,,,,25.1100,553.1900,fee schedule,"APG 00039 Proc 29049 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,253.76,,,,,,,25.1100,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,253.76,,,,,,,25.1100,553.1900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,WELLCARE,WELLCARE MEDICAID,402.00,,,,,,,25.1100,553.1900,percent of total billed charges,100% of $402.00 in Billed Charges for Rev 450 Proc 29049 = $402.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY FIGURE 8 CAST,29049,CPT,450,RC,45000191,CDM,,,,both,,,402.0000,60.3000,WELLCARE,WELLCARE MEDICARE,268.98,,,,,,,25.1100,553.1900,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,AETNA,AETNA,156.28,,,,,,,26.6800,366.0000,percent of total billed charges,42.7% of $366.00 in Billed Charges for Rev 450 Proc 29085 = $156.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,283.21,,,,,,,26.6800,366.0000,fee schedule,"APG 00039 Proc 29085 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 104% = $283.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,147.43,,,,,,,26.6800,366.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,AETNA,AETNA HEALTHCARE MEDICARE,147.43,,,,,,,26.6800,366.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,147.43,,,,,,,26.6800,366.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,AMBETTER,AMBETTER,321.40,,,,,,,26.6800,366.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,153.33,,,,,,,26.6800,366.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,BLUE CROSS,ANTHEM EXCHANGE,362.98,,,,,,,26.6800,366.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,280.48,,,,,,,26.6800,366.0000,fee schedule,"APG 00039 Proc 29085 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,BLUE CROSS,ANTHEM HMO,366.00,,,,,,,26.6800,366.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,151.86,,,,,,,26.6800,366.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",366.00,,,,,,,26.6800,366.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,61.05,,,,,,,26.6800,366.0000,fee schedule,$61.05 from Fee Schedule BLDTM_23 for Rev 450 Proc 29085 * Qty 1 = $61.05 at 100% = $61.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,BLUE CROSS,BLUE CROSS MEDICARE,153.33,,,,,,,26.6800,366.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,BLUE CROSS,TENNCARE BLUE CARE,26.68,,,,,,,26.6800,366.0000,fee schedule,$23.00 from Fee Schedule TC_24 for Rev 450 Proc 29085 * Qty 1 = $23.00 at 116% = $26.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,BLUE CROSS,TENNCARE BLUE SELECT,26.68,,,,,,,26.6800,366.0000,fee schedule,$23.00 from Fee Schedule TC_24 for Rev 450 Proc 29085 * Qty 1 = $23.00 at 116% = $26.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,154.80,,,,,,,26.6800,366.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,154.80,,,,,,,26.6800,366.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,329.40,,,,,,,26.6800,366.0000,percent of total billed charges,90% of $366.00 in Billed Charges for Rev 450 Proc 29085 = $329.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,HUMANA,HUMANA MEDICARE,147.43,,,,,,,26.6800,366.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,147.43,,,,,,,26.6800,366.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,MEDCOST,MEDCOST VHN,174.18,,,,,,,26.6800,366.0000,percent of total billed charges,47.59% of $366.00 in Billed Charges for Rev 450 Proc 29085 = $174.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,285.93,,,,,,,26.6800,366.0000,fee schedule,"APG 00039 Proc 29085 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 105% = $285.93 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,154.80,,,,,,,26.6800,366.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,154.80,,,,,,,26.6800,366.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,NHC ADVANTAGE,NHC ADVANTAGE,154.80,,,,,,,26.6800,366.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,280.75,,,,,,,26.6800,366.0000,fee schedule,"APG 00039 Proc 29085 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 103.1% = $280.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,SENTARA HEALTH,SENTARA HEALTH,94.46,,,,,,,26.6800,366.0000,percent of total billed charges,25.81% of $366.00 in Billed Charges for Rev 450 Proc 29085 = $94.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,SENTARA HEALTH,SENTARA MEDICARE,147.43,,,,,,,26.6800,366.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",366.00,,,,,,,26.6800,366.0000,percent of total billed charges,100% of $366.00 in Billed Charges for Rev 450 Proc 29085 = $366.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,26.6800,366.0000,case rate,Rev 450 Proc 29085 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,366.00,,,,,,,26.6800,366.0000,case rate,"Rev 450 Proc 29085 at Case Rate $491.00 (Service Line reduced to $366.00, claim capped at $366.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,366.00,,,,,,,26.6800,366.0000,case rate,"Rev 450 Proc 29085 at Case Rate $471.00 (Service Line reduced to $366.00, claim capped at $366.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,366.00,,,,,,,26.6800,366.0000,case rate,"Rev 450 Proc 29085 at Case Rate $847.00 (Service Line reduced to $366.00, claim capped at $366.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,280.48,,,,,,,26.6800,366.0000,fee schedule,"APG 00039 Proc 29085 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,147.43,,,,,,,26.6800,366.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,147.43,,,,,,,26.6800,366.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,WELLCARE,WELLCARE MEDICAID,366.00,,,,,,,26.6800,366.0000,percent of total billed charges,100% of $366.00 in Billed Charges for Rev 450 Proc 29085 = $366.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT ARM GAUNTLET,29085,CPT,450,RC,45000193,CDM,,,,both,,,366.0000,54.9000,WELLCARE,WELLCARE MEDICARE,156.28,,,,,,,26.6800,366.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TIP BONE CUTTING 12CM IQ APEX 360,272,RC,27200002,CDM,,,,,,both,,,11730.5600,1759.5800,AETNA,AETNA,5008.95,,,,,,,3027.6600,11730.5600,percent of total billed charges,"42.7% of $11,730.56 in Billed Charges for Rev 272 = $5,008.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 12CM IQ APEX 360,272,RC,27200002,CDM,,,,,,both,,,11730.5600,1759.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8211.39,,,,,,,3027.6600,11730.5600,percent of total billed charges,"Rev 272 $11,730.56 in Billed Charges at 70% = $8,211.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 12CM IQ APEX 360,272,RC,27200002,CDM,,,,,,both,,,11730.5600,1759.5800,CIGNA HEALTHCARE,CIGNA HMO,4891.64,,,,,,,3027.6600,11730.5600,percent of total billed charges,"41.7% of $11,730.56 in Billed Charges for Rev 272 = $4,891.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 12CM IQ APEX 360,272,RC,27200002,CDM,,,,,,both,,,11730.5600,1759.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5442.98,,,,,,,3027.6600,11730.5600,percent of total billed charges,"46.4% of $11,730.56 in Billed Charges for Rev 272 = $5,442.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 12CM IQ APEX 360,272,RC,27200002,CDM,,,,,,both,,,11730.5600,1759.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4891.64,,,,,,,3027.6600,11730.5600,percent of total billed charges,"41.7% of $11,730.56 in Billed Charges for Rev 272 = $4,891.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 12CM IQ APEX 360,272,RC,27200002,CDM,,,,,,both,,,11730.5600,1759.5800,CIGNA HEALTHCARE,CIGNA PPO,4891.64,,,,,,,3027.6600,11730.5600,percent of total billed charges,"41.7% of $11,730.56 in Billed Charges for Rev 272 = $4,891.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 12CM IQ APEX 360,272,RC,27200002,CDM,,,,,,both,,,11730.5600,1759.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10557.50,,,,,,,3027.6600,11730.5600,percent of total billed charges,"90% of $11,730.56 in Billed Charges for Rev 272 = $10,557.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 12CM IQ APEX 360,272,RC,27200002,CDM,,,,,,both,,,11730.5600,1759.5800,MEDCOST,MEDCOST VHN,5582.57,,,,,,,3027.6600,11730.5600,percent of total billed charges,"47.59% of $11,730.56 in Billed Charges for Rev 272 = $5,582.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 12CM IQ APEX 360,272,RC,27200002,CDM,,,,,,both,,,11730.5600,1759.5800,SENTARA HEALTH,SENTARA HEALTH,3027.66,,,,,,,3027.6600,11730.5600,percent of total billed charges,"25.81% of $11,730.56 in Billed Charges for Rev 272 = $3,027.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 12CM IQ APEX 360,272,RC,27200002,CDM,,,,,,both,,,11730.5600,1759.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11730.56,,,,,,,3027.6600,11730.5600,percent of total billed charges,"100% of $11,730.56 in Billed Charges for Rev 272 = $11,730.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 12CM IQ APEX 360,272,RC,27200002,CDM,,,,,,both,,,11730.5600,1759.5800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5865.28,,,,,,,3027.6600,11730.5600,percent of total billed charges,"Rev 272 $11,730.56 in Billed Charges at 50% = $5,865.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 12CM IQ APEX 360,272,RC,27200002,CDM,,,,,,both,,,11730.5600,1759.5800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3788.97,,,,,,,3027.6600,11730.5600,other,"32.3% of $11,730.56 in Billed Charges for Rev 272 = $3,788.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP BONE CUTTING 12CM IQ APEX 360,272,RC,27200002,CDM,,,,,,both,,,11730.5600,1759.5800,UNITED HEALTHCARE,UHC HERITAGE SELECT,3601.28,,,,,,,3027.6600,11730.5600,other,"30.7% of $11,730.56 in Billed Charges for Rev 272 = $3,601.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP BONE CUTTING 12CM IQ APEX 360,272,RC,27200002,CDM,,,,,,both,,,11730.5600,1759.5800,UNITED HEALTHCARE,UNITED HEALTHCARE,3788.97,,,,,,,3027.6600,11730.5600,percent of total billed charges,"32.3% of $11,730.56 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP BONE CUTTING 12CM IQ APEX 360,272,RC,27200002,CDM,,,,,,both,,,11730.5600,1759.5800,WELLCARE,WELLCARE MEDICAID,11730.56,,,,,,,3027.6600,11730.5600,percent of total billed charges,"100% of $11,730.56 in Billed Charges for Rev 272 = $11,730.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 8.2MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,3764.1500,564.6200,AETNA,AETNA,1607.29,,,,,,,971.5300,3764.1500,percent of total billed charges,"42.7% of $3,764.15 in Billed Charges for Rev 272 = $1,607.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 8.2MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,3764.1500,564.6200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2634.91,,,,,,,971.5300,3764.1500,percent of total billed charges,"Rev 272 $3,764.15 in Billed Charges at 70% = $2,634.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 8.2MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,3764.1500,564.6200,CIGNA HEALTHCARE,CIGNA HMO,1569.65,,,,,,,971.5300,3764.1500,percent of total billed charges,"41.7% of $3,764.15 in Billed Charges for Rev 272 = $1,569.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 8.2MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,3764.1500,564.6200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1746.57,,,,,,,971.5300,3764.1500,percent of total billed charges,"46.4% of $3,764.15 in Billed Charges for Rev 272 = $1,746.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 8.2MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,3764.1500,564.6200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1569.65,,,,,,,971.5300,3764.1500,percent of total billed charges,"41.7% of $3,764.15 in Billed Charges for Rev 272 = $1,569.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 8.2MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,3764.1500,564.6200,CIGNA HEALTHCARE,CIGNA PPO,1569.65,,,,,,,971.5300,3764.1500,percent of total billed charges,"41.7% of $3,764.15 in Billed Charges for Rev 272 = $1,569.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 8.2MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,3764.1500,564.6200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3387.74,,,,,,,971.5300,3764.1500,percent of total billed charges,"90% of $3,764.15 in Billed Charges for Rev 272 = $3,387.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 8.2MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,3764.1500,564.6200,MEDCOST,MEDCOST VHN,1791.36,,,,,,,971.5300,3764.1500,percent of total billed charges,"47.59% of $3,764.15 in Billed Charges for Rev 272 = $1,791.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 8.2MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,3764.1500,564.6200,SENTARA HEALTH,SENTARA HEALTH,971.53,,,,,,,971.5300,3764.1500,percent of total billed charges,"25.81% of $3,764.15 in Billed Charges for Rev 272 = $971.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 8.2MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,3764.1500,564.6200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3764.15,,,,,,,971.5300,3764.1500,percent of total billed charges,"100% of $3,764.15 in Billed Charges for Rev 272 = $3,764.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 8.2MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,3764.1500,564.6200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1882.08,,,,,,,971.5300,3764.1500,percent of total billed charges,"Rev 272 $3,764.15 in Billed Charges at 50% = $1,882.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 8.2MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,3764.1500,564.6200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1215.82,,,,,,,971.5300,3764.1500,other,"32.3% of $3,764.15 in Billed Charges for Rev 272 = $1,215.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE ENDOTRACHEAL 6MM X 8.2MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,3764.1500,564.6200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1155.59,,,,,,,971.5300,3764.1500,other,"30.7% of $3,764.15 in Billed Charges for Rev 272 = $1,155.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE ENDOTRACHEAL 6MM X 8.2MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,3764.1500,564.6200,UNITED HEALTHCARE,UNITED HEALTHCARE,1215.82,,,,,,,971.5300,3764.1500,percent of total billed charges,"32.3% of $3,764.15 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 8.2MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,3764.1500,564.6200,WELLCARE,WELLCARE MEDICAID,3764.15,,,,,,,971.5300,3764.1500,percent of total billed charges,"100% of $3,764.15 in Billed Charges for Rev 272 = $3,764.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,AETNA,AETNA,379.60,,,,,,,49.2700,889.0000,percent of total billed charges,42.7% of $889.00 in Billed Charges for Rev 450 Proc 29126 = $379.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,106.23,,,,,,,49.2700,889.0000,fee schedule,APG 00040 Proc 29126 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 104% = $106.23. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,120.71,,,,,,,49.2700,889.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,AETNA,AETNA HEALTHCARE MEDICARE,120.71,,,,,,,49.2700,889.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,120.71,,,,,,,49.2700,889.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,AMBETTER,AMBETTER,263.15,,,,,,,49.2700,889.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,125.54,,,,,,,49.2700,889.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,BLUE CROSS,ANTHEM EXCHANGE,297.21,,,,,,,49.2700,889.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,105.21,,,,,,,49.2700,889.0000,fee schedule,APG 00040 Proc 29126 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,BLUE CROSS,ANTHEM HMO,315.76,,,,,,,49.2700,889.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,124.33,,,,,,,49.2700,889.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",371.47,,,,,,,49.2700,889.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,49.27,,,,,,,49.2700,889.0000,fee schedule,$49.27 from Fee Schedule BLDTM_23 for Rev 450 Proc 29126 * Qty 1 = $49.27 at 100% = $49.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,BLUE CROSS,BLUE CROSS MEDICARE,125.54,,,,,,,49.2700,889.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,126.75,,,,,,,49.2700,889.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,126.75,,,,,,,49.2700,889.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,800.10,,,,,,,49.2700,889.0000,percent of total billed charges,90% of $889.00 in Billed Charges for Rev 450 Proc 29126 = $800.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,HUMANA,HUMANA MEDICARE,120.71,,,,,,,49.2700,889.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,120.71,,,,,,,49.2700,889.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,MEDCOST,MEDCOST VHN,423.08,,,,,,,49.2700,889.0000,percent of total billed charges,47.59% of $889.00 in Billed Charges for Rev 450 Proc 29126 = $423.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,107.26,,,,,,,49.2700,889.0000,fee schedule,APG 00040 Proc 29126 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 100% = $102.15... $102.15 at 105% = $107.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,126.75,,,,,,,49.2700,889.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,126.75,,,,,,,49.2700,889.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,NHC ADVANTAGE,NHC ADVANTAGE,126.75,,,,,,,49.2700,889.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,105.32,,,,,,,49.2700,889.0000,fee schedule,APG 00040 Proc 29126 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 100% = $102.15... $102.15 at 103.1% = $105.32 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,SENTARA HEALTH,SENTARA HEALTH,229.45,,,,,,,49.2700,889.0000,percent of total billed charges,25.81% of $889.00 in Billed Charges for Rev 450 Proc 29126 = $229.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,SENTARA HEALTH,SENTARA MEDICARE,120.71,,,,,,,49.2700,889.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",889.00,,,,,,,49.2700,889.0000,percent of total billed charges,100% of $889.00 in Billed Charges for Rev 450 Proc 29126 = $889.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,49.2700,889.0000,case rate,Rev 450 Proc 29126 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,49.2700,889.0000,case rate,Rev 450 Proc 29126 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,49.2700,889.0000,case rate,Rev 450 Proc 29126 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,49.2700,889.0000,case rate,Rev 450 Proc 29126 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,105.21,,,,,,,49.2700,889.0000,fee schedule,APG 00040 Proc 29126 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,120.71,,,,,,,49.2700,889.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,120.71,,,,,,,49.2700,889.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,WELLCARE,WELLCARE MEDICAID,889.00,,,,,,,49.2700,889.0000,percent of total billed charges,100% of $889.00 in Billed Charges for Rev 450 Proc 29126 = $889.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT ARM SPLINT DYNAMIC,29126,CPT,450,RC,45000197,CDM,,,,both,,,889.0000,133.3500,WELLCARE,WELLCARE MEDICARE,127.95,,,,,,,49.2700,889.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA,111.45,,,,,,,12.5500,263.1500,percent of total billed charges,42.7% of $261.00 in Billed Charges for Rev 430 Proc 29130 = $111.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,106.23,,,,,,,12.5500,263.1500,fee schedule,APG 00040 Proc 29130 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 104% = $106.23. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,120.71,,,,,,,12.5500,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA HEALTHCARE MEDICARE,120.71,,,,,,,12.5500,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,120.71,,,,,,,12.5500,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,AMBETTER,AMBETTER,263.15,,,,,,,12.5500,263.1500,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,125.54,,,,,,,12.5500,263.1500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM EXCHANGE,261.00,,,,,,,12.5500,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,105.21,,,,,,,12.5500,263.1500,fee schedule,APG 00040 Proc 29130 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM HMO,261.00,,,,,,,12.5500,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,124.33,,,,,,,12.5500,263.1500,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",261.00,,,,,,,12.5500,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,116.00,,,,,,,12.5500,263.1500,other,Rev 430 Proc 29130 1 Visit at $116.00 per Visit = $116.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,BLUE CROSS E NETWORK,167.99,,,,,,,12.5500,263.1500,fee schedule,$38.53 from Fee Schedule BCFSG for Rev 430 Proc 29130 * Qty 1 = $38.53 at 436% = $167.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,BLUE CROSS MEDICARE,125.54,,,,,,,12.5500,263.1500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,BLUE CROSS P NETWORK,171.46,,,,,,,12.5500,263.1500,fee schedule,$38.53 from Fee Schedule BCFSG for Rev 430 Proc 29130 * Qty 1 = $38.53 at 445% = $171.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,BLUE CROSS S NETWORK,171.46,,,,,,,12.5500,263.1500,fee schedule,$38.53 from Fee Schedule BCFSG for Rev 430 Proc 29130 * Qty 1 = $38.53 at 445% = $171.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,TENNCARE BLUE CARE,12.55,,,,,,,12.5500,263.1500,fee schedule,$10.82 from Fee Schedule TC_24 for Rev 430 Proc 29130 * Qty 1 = $10.82 at 116% = $12.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,TENNCARE BLUE SELECT,12.55,,,,,,,12.5500,263.1500,fee schedule,$10.82 from Fee Schedule TC_24 for Rev 430 Proc 29130 * Qty 1 = $10.82 at 116% = $12.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA HMO,108.84,,,,,,,12.5500,263.1500,percent of total billed charges,41.7% of $261.00 in Billed Charges for Rev 430 Proc 29130 = $108.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,121.10,,,,,,,12.5500,263.1500,percent of total billed charges,46.4% of $261.00 in Billed Charges for Rev 430 Proc 29130 = $121.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,126.75,,,,,,,12.5500,263.1500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,108.84,,,,,,,12.5500,263.1500,percent of total billed charges,41.7% of $261.00 in Billed Charges for Rev 430 Proc 29130 = $108.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA PPO,108.84,,,,,,,12.5500,263.1500,percent of total billed charges,41.7% of $261.00 in Billed Charges for Rev 430 Proc 29130 = $108.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,126.75,,,,,,,12.5500,263.1500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,234.90,,,,,,,12.5500,263.1500,percent of total billed charges,90% of $261.00 in Billed Charges for Rev 430 Proc 29130 = $234.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,HUMANA,HUMANA MEDICARE,120.71,,,,,,,12.5500,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,120.71,,,,,,,12.5500,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,MEDCOST,MEDCOST VHN,124.21,,,,,,,12.5500,263.1500,percent of total billed charges,47.59% of $261.00 in Billed Charges for Rev 430 Proc 29130 = $124.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,107.26,,,,,,,12.5500,263.1500,fee schedule,APG 00040 Proc 29130 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 100% = $102.15... $102.15 at 105% = $107.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,126.75,,,,,,,12.5500,263.1500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,126.75,,,,,,,12.5500,263.1500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,NHC ADVANTAGE,NHC ADVANTAGE,126.75,,,,,,,12.5500,263.1500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,105.32,,,,,,,12.5500,263.1500,fee schedule,APG 00040 Proc 29130 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 100% = $102.15... $102.15 at 103.1% = $105.32 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,SENTARA HEALTH,SENTARA HEALTH,67.36,,,,,,,12.5500,263.1500,percent of total billed charges,25.81% of $261.00 in Billed Charges for Rev 430 Proc 29130 = $67.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,SENTARA HEALTH,SENTARA MEDICARE,120.71,,,,,,,12.5500,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",261.00,,,,,,,12.5500,263.1500,percent of total billed charges,100% of $261.00 in Billed Charges for Rev 430 Proc 29130 = $261.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,43.00,,,,,,,12.5500,263.1500,other,Rev 430 Proc 29130 1 Visit at $43.00 per Visit = $43.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,257.00,,,,,,,12.5500,263.1500,other,Rev 430 Proc 29130 1 Visit at $257.00 per Visit = $257.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,245.00,,,,,,,12.5500,263.1500,other,Rev 430 Proc 29130 1 Visit at $245.00 per Visit = $245.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,261.00,,,,,,,12.5500,263.1500,other,"Rev 430 Proc 29130 1 Visit at $403.00 per Visit = $403.00 (Service Line reduced to $261.00, claim capped at $261.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,105.21,,,,,,,12.5500,263.1500,fee schedule,APG 00040 Proc 29130 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,120.71,,,,,,,12.5500,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,120.71,,,,,,,12.5500,263.1500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,WELLCARE,WELLCARE MEDICAID,261.00,,,,,,,12.5500,263.1500,percent of total billed charges,100% of $261.00 in Billed Charges for Rev 430 Proc 29130 = $261.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THERAPY FINGER SPLINT STATIC,29130,CPT,430,RC,43000008,CDM,,,,both,,,261.0000,39.1500,WELLCARE,WELLCARE MEDICARE,127.95,,,,,,,12.5500,263.1500,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,AETNA,AETNA,146.89,,,,,,,31.0700,344.0000,percent of total billed charges,42.7% of $344.00 in Billed Charges for Rev 450 Proc 29240 = $146.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,106.23,,,,,,,31.0700,344.0000,fee schedule,APG 00040 Proc 29240 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 104% = $106.23. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,120.71,,,,,,,31.0700,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,AETNA,AETNA HEALTHCARE MEDICARE,120.71,,,,,,,31.0700,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,120.71,,,,,,,31.0700,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,AMBETTER,AMBETTER,263.15,,,,,,,31.0700,344.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,125.54,,,,,,,31.0700,344.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,ANTHEM EXCHANGE,297.21,,,,,,,31.0700,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,105.21,,,,,,,31.0700,344.0000,fee schedule,APG 00040 Proc 29240 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,ANTHEM HMO,315.76,,,,,,,31.0700,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,124.33,,,,,,,31.0700,344.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",344.00,,,,,,,31.0700,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,31.07,,,,,,,31.0700,344.0000,fee schedule,$31.07 from Fee Schedule BLDTM_23 for Rev 450 Proc 29240 * Qty 1 = $31.07 at 100% = $31.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,BLUE CROSS,BLUE CROSS MEDICARE,125.54,,,,,,,31.0700,344.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,126.75,,,,,,,31.0700,344.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,126.75,,,,,,,31.0700,344.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,309.60,,,,,,,31.0700,344.0000,percent of total billed charges,90% of $344.00 in Billed Charges for Rev 450 Proc 29240 = $309.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,HUMANA,HUMANA MEDICARE,120.71,,,,,,,31.0700,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,120.71,,,,,,,31.0700,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,MEDCOST,MEDCOST VHN,163.71,,,,,,,31.0700,344.0000,percent of total billed charges,47.59% of $344.00 in Billed Charges for Rev 450 Proc 29240 = $163.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,107.26,,,,,,,31.0700,344.0000,fee schedule,APG 00040 Proc 29240 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 100% = $102.15... $102.15 at 105% = $107.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,126.75,,,,,,,31.0700,344.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,126.75,,,,,,,31.0700,344.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,NHC ADVANTAGE,NHC ADVANTAGE,126.75,,,,,,,31.0700,344.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,105.32,,,,,,,31.0700,344.0000,fee schedule,APG 00040 Proc 29240 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 100% = $102.15... $102.15 at 103.1% = $105.32 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,SENTARA HEALTH,SENTARA HEALTH,88.79,,,,,,,31.0700,344.0000,percent of total billed charges,25.81% of $344.00 in Billed Charges for Rev 450 Proc 29240 = $88.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,SENTARA HEALTH,SENTARA MEDICARE,120.71,,,,,,,31.0700,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",344.00,,,,,,,31.0700,344.0000,percent of total billed charges,100% of $344.00 in Billed Charges for Rev 450 Proc 29240 = $344.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,31.0700,344.0000,case rate,Rev 450 Proc 29240 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,344.00,,,,,,,31.0700,344.0000,case rate,"Rev 450 Proc 29240 at Case Rate $491.00 (Service Line reduced to $344.00, claim capped at $344.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,344.00,,,,,,,31.0700,344.0000,case rate,"Rev 450 Proc 29240 at Case Rate $471.00 (Service Line reduced to $344.00, claim capped at $344.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,344.00,,,,,,,31.0700,344.0000,case rate,"Rev 450 Proc 29240 at Case Rate $847.00 (Service Line reduced to $344.00, claim capped at $344.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,105.21,,,,,,,31.0700,344.0000,fee schedule,APG 00040 Proc 29240 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,120.71,,,,,,,31.0700,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,120.71,,,,,,,31.0700,344.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,WELLCARE,WELLCARE MEDICAID,344.00,,,,,,,31.0700,344.0000,percent of total billed charges,100% of $344.00 in Billed Charges for Rev 450 Proc 29240 = $344.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAPPING SHOULDER (VALPEARU),29240,CPT,450,RC,45000200,CDM,,,,both,,,344.0000,51.6000,WELLCARE,WELLCARE MEDICARE,127.95,,,,,,,31.0700,344.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,AETNA,AETNA,106.32,,,,,,,15.6900,249.0000,percent of total billed charges,42.7% of $249.00 in Billed Charges for Rev 450 Proc 29260 = $106.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,106.23,,,,,,,15.6900,249.0000,fee schedule,APG 00040 Proc 29260 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 104% = $106.23. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,53.52,,,,,,,15.6900,249.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,AETNA,AETNA HEALTHCARE MEDICARE,53.52,,,,,,,15.6900,249.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,53.52,,,,,,,15.6900,249.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,AMBETTER,AMBETTER,116.68,,,,,,,15.6900,249.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,55.66,,,,,,,15.6900,249.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,BLUE CROSS,ANTHEM EXCHANGE,131.77,,,,,,,15.6900,249.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,105.21,,,,,,,15.6900,249.0000,fee schedule,APG 00040 Proc 29260 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,BLUE CROSS,ANTHEM HMO,140.00,,,,,,,15.6900,249.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,55.13,,,,,,,15.6900,249.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",164.70,,,,,,,15.6900,249.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,25.02,,,,,,,15.6900,249.0000,fee schedule,$25.02 from Fee Schedule BLDTM_23 for Rev 450 Proc 29260 * Qty 1 = $25.02 at 100% = $25.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,BLUE CROSS,BLUE CROSS MEDICARE,55.66,,,,,,,15.6900,249.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,BLUE CROSS,TENNCARE BLUE CARE,15.69,,,,,,,15.6900,249.0000,fee schedule,$13.53 from Fee Schedule TC_24 for Rev 450 Proc 29260 * Qty 1 = $13.53 at 116% = $15.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,BLUE CROSS,TENNCARE BLUE SELECT,15.69,,,,,,,15.6900,249.0000,fee schedule,$13.53 from Fee Schedule TC_24 for Rev 450 Proc 29260 * Qty 1 = $13.53 at 116% = $15.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,56.20,,,,,,,15.6900,249.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,56.20,,,,,,,15.6900,249.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,224.10,,,,,,,15.6900,249.0000,percent of total billed charges,90% of $249.00 in Billed Charges for Rev 450 Proc 29260 = $224.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,HUMANA,HUMANA MEDICARE,53.52,,,,,,,15.6900,249.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,53.52,,,,,,,15.6900,249.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,MEDCOST,MEDCOST VHN,118.50,,,,,,,15.6900,249.0000,percent of total billed charges,47.59% of $249.00 in Billed Charges for Rev 450 Proc 29260 = $118.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,107.26,,,,,,,15.6900,249.0000,fee schedule,APG 00040 Proc 29260 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 100% = $102.15... $102.15 at 105% = $107.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,56.20,,,,,,,15.6900,249.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,56.20,,,,,,,15.6900,249.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,NHC ADVANTAGE,NHC ADVANTAGE,56.20,,,,,,,15.6900,249.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,105.32,,,,,,,15.6900,249.0000,fee schedule,APG 00040 Proc 29260 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 100% = $102.15... $102.15 at 103.1% = $105.32 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,SENTARA HEALTH,SENTARA HEALTH,64.27,,,,,,,15.6900,249.0000,percent of total billed charges,25.81% of $249.00 in Billed Charges for Rev 450 Proc 29260 = $64.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,SENTARA HEALTH,SENTARA MEDICARE,53.52,,,,,,,15.6900,249.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",249.00,,,,,,,15.6900,249.0000,percent of total billed charges,100% of $249.00 in Billed Charges for Rev 450 Proc 29260 = $249.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,15.6900,249.0000,case rate,Rev 450 Proc 29260 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,249.00,,,,,,,15.6900,249.0000,case rate,"Rev 450 Proc 29260 at Case Rate $491.00 (Service Line reduced to $249.00, claim capped at $249.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,249.00,,,,,,,15.6900,249.0000,case rate,"Rev 450 Proc 29260 at Case Rate $471.00 (Service Line reduced to $249.00, claim capped at $249.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,249.00,,,,,,,15.6900,249.0000,case rate,"Rev 450 Proc 29260 at Case Rate $847.00 (Service Line reduced to $249.00, claim capped at $249.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,105.21,,,,,,,15.6900,249.0000,fee schedule,APG 00040 Proc 29260 at $836.60 (Base Rate) * 0.1221 (Relative Weight) = $102.15 (Total Line Payment) at 103% = $105.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,53.52,,,,,,,15.6900,249.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,53.52,,,,,,,15.6900,249.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,WELLCARE,WELLCARE MEDICAID,249.00,,,,,,,15.6900,249.0000,percent of total billed charges,100% of $249.00 in Billed Charges for Rev 450 Proc 29260 = $249.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC STRAPPING ELBOW OR WRIST,29260,CPT,450,RC,45000201,CDM,,,,both,,,249.0000,37.3500,WELLCARE,WELLCARE MEDICARE,56.73,,,,,,,15.6900,249.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,AETNA,AETNA,266.88,,,,,,,47.0800,625.0000,percent of total billed charges,42.7% of $625.00 in Billed Charges for Rev 450 Proc 29345 = $266.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,283.21,,,,,,,47.0800,625.0000,fee schedule,"APG 00039 Proc 29345 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 104% = $283.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,253.76,,,,,,,47.0800,625.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,AETNA,AETNA HEALTHCARE MEDICARE,253.76,,,,,,,47.0800,625.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,253.76,,,,,,,47.0800,625.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,AMBETTER,AMBETTER,553.19,,,,,,,47.0800,625.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,263.91,,,,,,,47.0800,625.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,BLUE CROSS,ANTHEM EXCHANGE,624.77,,,,,,,47.0800,625.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,280.48,,,,,,,47.0800,625.0000,fee schedule,"APG 00039 Proc 29345 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,BLUE CROSS,ANTHEM HMO,625.00,,,,,,,47.0800,625.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,261.37,,,,,,,47.0800,625.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",625.00,,,,,,,47.0800,625.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,115.17,,,,,,,47.0800,625.0000,fee schedule,$115.17 from Fee Schedule BLDTM_23 for Rev 450 Proc 29345 * Qty 1 = $115.17 at 100% = $115.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,BLUE CROSS,BLUE CROSS MEDICARE,263.91,,,,,,,47.0800,625.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,BLUE CROSS,TENNCARE BLUE CARE,47.08,,,,,,,47.0800,625.0000,fee schedule,$40.59 from Fee Schedule TC_24 for Rev 450 Proc 29345 * Qty 1 = $40.59 at 116% = $47.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,BLUE CROSS,TENNCARE BLUE SELECT,47.08,,,,,,,47.0800,625.0000,fee schedule,$40.59 from Fee Schedule TC_24 for Rev 450 Proc 29345 * Qty 1 = $40.59 at 116% = $47.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,266.45,,,,,,,47.0800,625.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,266.45,,,,,,,47.0800,625.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,562.50,,,,,,,47.0800,625.0000,percent of total billed charges,90% of $625.00 in Billed Charges for Rev 450 Proc 29345 = $562.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,HUMANA,HUMANA MEDICARE,253.76,,,,,,,47.0800,625.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,253.76,,,,,,,47.0800,625.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,MEDCOST,MEDCOST VHN,297.44,,,,,,,47.0800,625.0000,percent of total billed charges,47.59% of $625.00 in Billed Charges for Rev 450 Proc 29345 = $297.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,285.93,,,,,,,47.0800,625.0000,fee schedule,"APG 00039 Proc 29345 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 105% = $285.93 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,266.45,,,,,,,47.0800,625.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,266.45,,,,,,,47.0800,625.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,NHC ADVANTAGE,NHC ADVANTAGE,266.45,,,,,,,47.0800,625.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,280.75,,,,,,,47.0800,625.0000,fee schedule,"APG 00039 Proc 29345 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 103.1% = $280.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,SENTARA HEALTH,SENTARA HEALTH,161.31,,,,,,,47.0800,625.0000,percent of total billed charges,25.81% of $625.00 in Billed Charges for Rev 450 Proc 29345 = $161.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,SENTARA HEALTH,SENTARA MEDICARE,253.76,,,,,,,47.0800,625.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",625.00,,,,,,,47.0800,625.0000,percent of total billed charges,100% of $625.00 in Billed Charges for Rev 450 Proc 29345 = $625.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,47.0800,625.0000,case rate,Rev 450 Proc 29345 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,47.0800,625.0000,case rate,Rev 450 Proc 29345 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,47.0800,625.0000,case rate,Rev 450 Proc 29345 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,625.00,,,,,,,47.0800,625.0000,case rate,"Rev 450 Proc 29345 at Case Rate $847.00 (Service Line reduced to $625.00, claim capped at $625.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,280.48,,,,,,,47.0800,625.0000,fee schedule,"APG 00039 Proc 29345 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,253.76,,,,,,,47.0800,625.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,253.76,,,,,,,47.0800,625.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,WELLCARE,WELLCARE MEDICAID,625.00,,,,,,,47.0800,625.0000,percent of total billed charges,100% of $625.00 in Billed Charges for Rev 450 Proc 29345 = $625.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLICATION OF LONG LEG CAST,29345,CPT,450,RC,45000322,CDM,,,,both,,,625.0000,93.7500,WELLCARE,WELLCARE MEDICARE,268.98,,,,,,,47.0800,625.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,AETNA,AETNA,283.53,,,,,,,31.3900,664.0000,percent of total billed charges,42.7% of $664.00 in Billed Charges for Rev 450 Proc 29405 = $283.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,283.21,,,,,,,31.3900,664.0000,fee schedule,"APG 00039 Proc 29405 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 104% = $283.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,253.76,,,,,,,31.3900,664.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,AETNA,AETNA HEALTHCARE MEDICARE,253.76,,,,,,,31.3900,664.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,253.76,,,,,,,31.3900,664.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,AMBETTER,AMBETTER,553.19,,,,,,,31.3900,664.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,263.91,,,,,,,31.3900,664.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,BLUE CROSS,ANTHEM EXCHANGE,624.77,,,,,,,31.3900,664.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,280.48,,,,,,,31.3900,664.0000,fee schedule,"APG 00039 Proc 29405 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,BLUE CROSS,ANTHEM HMO,663.78,,,,,,,31.3900,664.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,261.37,,,,,,,31.3900,664.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",664.00,,,,,,,31.3900,664.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,88.82,,,,,,,31.3900,664.0000,fee schedule,$88.82 from Fee Schedule BLDTM_23 for Rev 450 Proc 29405 * Qty 1 = $88.82 at 100% = $88.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,BLUE CROSS,BLUE CROSS MEDICARE,263.91,,,,,,,31.3900,664.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,BLUE CROSS,TENNCARE BLUE CARE,31.39,,,,,,,31.3900,664.0000,fee schedule,$27.06 from Fee Schedule TC_24 for Rev 450 Proc 29405 * Qty 1 = $27.06 at 116% = $31.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,BLUE CROSS,TENNCARE BLUE SELECT,31.39,,,,,,,31.3900,664.0000,fee schedule,$27.06 from Fee Schedule TC_24 for Rev 450 Proc 29405 * Qty 1 = $27.06 at 116% = $31.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,266.45,,,,,,,31.3900,664.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,266.45,,,,,,,31.3900,664.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,597.60,,,,,,,31.3900,664.0000,percent of total billed charges,90% of $664.00 in Billed Charges for Rev 450 Proc 29405 = $597.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,HUMANA,HUMANA MEDICARE,253.76,,,,,,,31.3900,664.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,253.76,,,,,,,31.3900,664.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,MEDCOST,MEDCOST VHN,316.00,,,,,,,31.3900,664.0000,percent of total billed charges,47.59% of $664.00 in Billed Charges for Rev 450 Proc 29405 = $316.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,285.93,,,,,,,31.3900,664.0000,fee schedule,"APG 00039 Proc 29405 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 105% = $285.93 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,266.45,,,,,,,31.3900,664.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,266.45,,,,,,,31.3900,664.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,NHC ADVANTAGE,NHC ADVANTAGE,266.45,,,,,,,31.3900,664.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,280.75,,,,,,,31.3900,664.0000,fee schedule,"APG 00039 Proc 29405 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 103.1% = $280.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,SENTARA HEALTH,SENTARA HEALTH,171.38,,,,,,,31.3900,664.0000,percent of total billed charges,25.81% of $664.00 in Billed Charges for Rev 450 Proc 29405 = $171.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,SENTARA HEALTH,SENTARA MEDICARE,253.76,,,,,,,31.3900,664.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",664.00,,,,,,,31.3900,664.0000,percent of total billed charges,100% of $664.00 in Billed Charges for Rev 450 Proc 29405 = $664.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,31.3900,664.0000,case rate,Rev 450 Proc 29405 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,31.3900,664.0000,case rate,Rev 450 Proc 29405 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,31.3900,664.0000,case rate,Rev 450 Proc 29405 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,664.00,,,,,,,31.3900,664.0000,case rate,"Rev 450 Proc 29405 at Case Rate $847.00 (Service Line reduced to $664.00, claim capped at $664.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,280.48,,,,,,,31.3900,664.0000,fee schedule,"APG 00039 Proc 29405 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,253.76,,,,,,,31.3900,664.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,253.76,,,,,,,31.3900,664.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,WELLCARE,WELLCARE MEDICAID,664.00,,,,,,,31.3900,664.0000,percent of total billed charges,100% of $664.00 in Billed Charges for Rev 450 Proc 29405 = $664.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPLY SHORT LEG CAST,29405,CPT,450,RC,45000203,CDM,,,,both,,,664.0000,99.6000,WELLCARE,WELLCARE MEDICARE,268.98,,,,,,,31.3900,664.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE ENDOTRACHEAL 6MM X 9.0MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,4120.6100,618.0900,AETNA,AETNA,1759.50,,,,,,,1063.5300,4120.6100,percent of total billed charges,"42.7% of $4,120.61 in Billed Charges for Rev 272 = $1,759.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 9.0MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,4120.6100,618.0900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2884.43,,,,,,,1063.5300,4120.6100,percent of total billed charges,"Rev 272 $4,120.61 in Billed Charges at 70% = $2,884.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 9.0MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,4120.6100,618.0900,CIGNA HEALTHCARE,CIGNA HMO,1718.29,,,,,,,1063.5300,4120.6100,percent of total billed charges,"41.7% of $4,120.61 in Billed Charges for Rev 272 = $1,718.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 9.0MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,4120.6100,618.0900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1911.96,,,,,,,1063.5300,4120.6100,percent of total billed charges,"46.4% of $4,120.61 in Billed Charges for Rev 272 = $1,911.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 9.0MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,4120.6100,618.0900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1718.29,,,,,,,1063.5300,4120.6100,percent of total billed charges,"41.7% of $4,120.61 in Billed Charges for Rev 272 = $1,718.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 9.0MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,4120.6100,618.0900,CIGNA HEALTHCARE,CIGNA PPO,1718.29,,,,,,,1063.5300,4120.6100,percent of total billed charges,"41.7% of $4,120.61 in Billed Charges for Rev 272 = $1,718.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 9.0MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,4120.6100,618.0900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3708.55,,,,,,,1063.5300,4120.6100,percent of total billed charges,"90% of $4,120.61 in Billed Charges for Rev 272 = $3,708.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 9.0MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,4120.6100,618.0900,MEDCOST,MEDCOST VHN,1961.00,,,,,,,1063.5300,4120.6100,percent of total billed charges,"47.59% of $4,120.61 in Billed Charges for Rev 272 = $1,961.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 9.0MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,4120.6100,618.0900,SENTARA HEALTH,SENTARA HEALTH,1063.53,,,,,,,1063.5300,4120.6100,percent of total billed charges,"25.81% of $4,120.61 in Billed Charges for Rev 272 = $1,063.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 9.0MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,4120.6100,618.0900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4120.61,,,,,,,1063.5300,4120.6100,percent of total billed charges,"100% of $4,120.61 in Billed Charges for Rev 272 = $4,120.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 9.0MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,4120.6100,618.0900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2060.31,,,,,,,1063.5300,4120.6100,percent of total billed charges,"Rev 272 $4,120.61 in Billed Charges at 50% = $2,060.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 9.0MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,4120.6100,618.0900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1330.96,,,,,,,1063.5300,4120.6100,other,"32.3% of $4,120.61 in Billed Charges for Rev 272 = $1,330.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE ENDOTRACHEAL 6MM X 9.0MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,4120.6100,618.0900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1265.03,,,,,,,1063.5300,4120.6100,other,"30.7% of $4,120.61 in Billed Charges for Rev 272 = $1,265.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE ENDOTRACHEAL 6MM X 9.0MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,4120.6100,618.0900,UNITED HEALTHCARE,UNITED HEALTHCARE,1330.96,,,,,,,1063.5300,4120.6100,percent of total billed charges,"32.3% of $4,120.61 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 6MM X 9.0MM NIM CONTACT,272,RC,27200002,CDM,,,,,,both,,,4120.6100,618.0900,WELLCARE,WELLCARE MEDICAID,4120.61,,,,,,,1063.5300,4120.6100,percent of total billed charges,"100% of $4,120.61 in Billed Charges for Rev 272 = $4,120.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,AETNA,AETNA,343.74,,,,,,,37.6700,805.0000,percent of total billed charges,42.7% of $805.00 in Billed Charges for Rev 521 Proc 29425 = $343.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,283.21,,,,,,,37.6700,805.0000,fee schedule,"APG 00039 Proc 29425 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 104% = $283.21. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,253.76,,,,,,,37.6700,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,AETNA,AETNA HEALTHCARE MEDICARE,253.76,,,,,,,37.6700,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,253.76,,,,,,,37.6700,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,AMBETTER,AMBETTER,553.19,,,,,,,37.6700,805.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,263.91,,,,,,,37.6700,805.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,ANTHEM EXCHANGE,624.77,,,,,,,37.6700,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,280.48,,,,,,,37.6700,805.0000,fee schedule,"APG 00039 Proc 29425 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,ANTHEM HMO,663.78,,,,,,,37.6700,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,261.37,,,,,,,37.6700,805.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",780.88,,,,,,,37.6700,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,88.80,,,,,,,37.6700,805.0000,fee schedule,$88.80 from Fee Schedule BLDTM_23 for Rev 521 Proc 29425 * Qty 1 = $88.80 at 100% = $88.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,BLUE CROSS MEDICARE,263.91,,,,,,,37.6700,805.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,TENNCARE BLUE CARE,37.67,,,,,,,37.6700,805.0000,fee schedule,$32.47 from Fee Schedule TC_24 for Rev 521 Proc 29425 * Qty 1 = $32.47 at 116% = $37.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,TENNCARE BLUE SELECT,37.67,,,,,,,37.6700,805.0000,fee schedule,$32.47 from Fee Schedule TC_24 for Rev 521 Proc 29425 * Qty 1 = $32.47 at 116% = $37.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA HMO,335.69,,,,,,,37.6700,805.0000,percent of total billed charges,41.7% of $805.00 in Billed Charges for Rev 521 Proc 29425 = $335.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,373.52,,,,,,,37.6700,805.0000,percent of total billed charges,46.4% of $805.00 in Billed Charges for Rev 521 Proc 29425 = $373.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,266.45,,,,,,,37.6700,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,335.69,,,,,,,37.6700,805.0000,percent of total billed charges,41.7% of $805.00 in Billed Charges for Rev 521 Proc 29425 = $335.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA PPO,335.69,,,,,,,37.6700,805.0000,percent of total billed charges,41.7% of $805.00 in Billed Charges for Rev 521 Proc 29425 = $335.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,266.45,,,,,,,37.6700,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,724.50,,,,,,,37.6700,805.0000,percent of total billed charges,90% of $805.00 in Billed Charges for Rev 521 Proc 29425 = $724.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,HUMANA,HUMANA MEDICARE,253.76,,,,,,,37.6700,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,253.76,,,,,,,37.6700,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,MEDCOST,MEDCOST VHN,383.10,,,,,,,37.6700,805.0000,percent of total billed charges,47.59% of $805.00 in Billed Charges for Rev 521 Proc 29425 = $383.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,285.93,,,,,,,37.6700,805.0000,fee schedule,"APG 00039 Proc 29425 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 105% = $285.93 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,266.45,,,,,,,37.6700,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,266.45,,,,,,,37.6700,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,NHC ADVANTAGE,NHC ADVANTAGE,266.45,,,,,,,37.6700,805.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,280.75,,,,,,,37.6700,805.0000,fee schedule,"APG 00039 Proc 29425 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 100% = $272.31... $272.31 at 103.1% = $280.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,SENTARA HEALTH,SENTARA HEALTH,207.77,,,,,,,37.6700,805.0000,percent of total billed charges,25.81% of $805.00 in Billed Charges for Rev 521 Proc 29425 = $207.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,SENTARA HEALTH,SENTARA MEDICARE,253.76,,,,,,,37.6700,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",805.00,,,,,,,37.6700,805.0000,percent of total billed charges,100% of $805.00 in Billed Charges for Rev 521 Proc 29425 = $805.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,111.65,,,,,,,37.6700,805.0000,fee schedule,$223.29 from Fee Schedule TCUHC24 for Rev 521 Proc 29425 * Qty 1 = $223.29 at 50% = $111.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,280.48,,,,,,,37.6700,805.0000,fee schedule,"APG 00039 Proc 29425 at $836.60 (Base Rate) * 0.3255 (Relative Weight) = $272.31 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $272.31 at 103% = $280.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,253.76,,,,,,,37.6700,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,253.76,,,,,,,37.6700,805.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,WELLCARE,WELLCARE MEDICAID,805.00,,,,,,,37.6700,805.0000,percent of total billed charges,100% of $805.00 in Billed Charges for Rev 521 Proc 29425 = $805.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC APPL SHORT LEG CAST WALKER/AMBULATORY TYPE,29425,CPT,521,RC,52100097,CDM,,,,both,,,805.0000,120.7500,WELLCARE,WELLCARE MEDICARE,268.98,,,,,,,37.6700,805.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,AETNA,AETNA,169.95,,,,,,,17.4100,420.7000,percent of total billed charges,42.7% of $398.00 in Billed Charges for Rev 940 Proc 96374 = $169.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,73.96,,,,,,,17.4100,420.7000,fee schedule,APG 00109 Proc 96374 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 104% = $73.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,192.98,,,,,,,17.4100,420.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,AETNA,AETNA HEALTHCARE MEDICARE,192.98,,,,,,,17.4100,420.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,192.98,,,,,,,17.4100,420.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,AMBETTER,AMBETTER,420.70,,,,,,,17.4100,420.7000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,200.70,,,,,,,17.4100,420.7000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,BLUE CROSS,ANTHEM EXCHANGE,398.00,,,,,,,17.4100,420.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,73.24,,,,,,,17.4100,420.7000,fee schedule,APG 00109 Proc 96374 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,BLUE CROSS,ANTHEM HMO,398.00,,,,,,,17.4100,420.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,198.77,,,,,,,17.4100,420.7000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",398.00,,,,,,,17.4100,420.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,48.73,,,,,,,17.4100,420.7000,fee schedule,$48.73 from Fee Schedule BLDTM_23 for Rev 940 Proc 96374 * Qty 1 = $48.73 at 100% = $48.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,BLUE CROSS,BLUE CROSS MEDICARE,200.70,,,,,,,17.4100,420.7000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,BLUE CROSS,TENNCARE BLUE CARE,49.25,,,,,,,17.4100,420.7000,fee schedule,$42.46 from Fee Schedule TC_24 for Rev 940 Proc 96374 * Qty 1 = $42.46 at 116% = $49.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,BLUE CROSS,TENNCARE BLUE SELECT,49.25,,,,,,,17.4100,420.7000,fee schedule,$42.46 from Fee Schedule TC_24 for Rev 940 Proc 96374 * Qty 1 = $42.46 at 116% = $49.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,CIGNA HEALTHCARE,CIGNA HMO,165.97,,,,,,,17.4100,420.7000,percent of total billed charges,41.7% of $398.00 in Billed Charges for Rev 940 Proc 96374 = $165.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,184.67,,,,,,,17.4100,420.7000,percent of total billed charges,46.4% of $398.00 in Billed Charges for Rev 940 Proc 96374 = $184.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,202.63,,,,,,,17.4100,420.7000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,165.97,,,,,,,17.4100,420.7000,percent of total billed charges,41.7% of $398.00 in Billed Charges for Rev 940 Proc 96374 = $165.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,CIGNA HEALTHCARE,CIGNA PPO,165.97,,,,,,,17.4100,420.7000,percent of total billed charges,41.7% of $398.00 in Billed Charges for Rev 940 Proc 96374 = $165.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,202.63,,,,,,,17.4100,420.7000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,358.20,,,,,,,17.4100,420.7000,percent of total billed charges,90% of $398.00 in Billed Charges for Rev 940 Proc 96374 = $358.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,HUMANA,HUMANA MEDICARE,192.98,,,,,,,17.4100,420.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,192.98,,,,,,,17.4100,420.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,MEDCOST,MEDCOST VHN,189.41,,,,,,,17.4100,420.7000,percent of total billed charges,47.59% of $398.00 in Billed Charges for Rev 940 Proc 96374 = $189.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,74.67,,,,,,,17.4100,420.7000,fee schedule,APG 00109 Proc 96374 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 105% = $74.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,202.63,,,,,,,17.4100,420.7000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,202.63,,,,,,,17.4100,420.7000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,NHC ADVANTAGE,NHC ADVANTAGE,202.63,,,,,,,17.4100,420.7000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,73.31,,,,,,,17.4100,420.7000,fee schedule,APG 00109 Proc 96374 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 103.1% = $73.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,SENTARA HEALTH,SENTARA HEALTH,102.72,,,,,,,17.4100,420.7000,percent of total billed charges,25.81% of $398.00 in Billed Charges for Rev 940 Proc 96374 = $102.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,SENTARA HEALTH,SENTARA MEDICARE,192.98,,,,,,,17.4100,420.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",398.00,,,,,,,17.4100,420.7000,percent of total billed charges,100% of $398.00 in Billed Charges for Rev 940 Proc 96374 = $398.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,17.41,,,,,,,17.4100,420.7000,fee schedule,$34.81 from Fee Schedule TCUHC24 for Rev 940 Proc 96374 * Qty 1 = $34.81 at 50% = $17.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,398.00,,,,,,,17.4100,420.7000,other,"Rev 940 Proc 96374 1 Visit at $1,154.00 per Visit = $1,154.00 (Service Line reduced to $398.00, claim capped at $398.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,398.00,,,,,,,17.4100,420.7000,other,"Rev 940 Proc 96374 1 Visit at $1,104.00 per Visit = $1,104.00 (Service Line reduced to $398.00, claim capped at $398.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,398.00,,,,,,,17.4100,420.7000,other,"Rev 940 Proc 96374 1 Visit at $2,426.00 per Visit = $2,426.00 (Service Line reduced to $398.00, claim capped at $398.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,73.24,,,,,,,17.4100,420.7000,fee schedule,APG 00109 Proc 96374 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,192.98,,,,,,,17.4100,420.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,192.98,,,,,,,17.4100,420.7000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,WELLCARE,WELLCARE MEDICAID,398.00,,,,,,,17.4100,420.7000,percent of total billed charges,100% of $398.00 in Billed Charges for Rev 940 Proc 96374 = $398.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH TX/PROPH/DX INITIAL,96374,CPT,940,RC,94000015,CDM,,,,both,,,398.0000,59.7000,WELLCARE,WELLCARE MEDICARE,204.56,,,,,,,17.4100,420.7000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,AETNA,AETNA,79.00,,,,,,,17.4100,185.0000,percent of total billed charges,42.7% of $185.00 in Billed Charges for Rev 940 Proc 96375 = $79.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,73.96,,,,,,,17.4100,185.0000,fee schedule,APG 00109 Proc 96375 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 104% = $73.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,42.48,,,,,,,17.4100,185.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,AETNA,AETNA HEALTHCARE MEDICARE,42.48,,,,,,,17.4100,185.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,42.48,,,,,,,17.4100,185.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,AMBETTER,AMBETTER,92.61,,,,,,,17.4100,185.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,44.18,,,,,,,17.4100,185.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,BLUE CROSS,ANTHEM EXCHANGE,104.59,,,,,,,17.4100,185.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,73.24,,,,,,,17.4100,185.0000,fee schedule,APG 00109 Proc 96375 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,BLUE CROSS,ANTHEM HMO,111.12,,,,,,,17.4100,185.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,43.76,,,,,,,17.4100,185.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",130.73,,,,,,,17.4100,185.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,21.16,,,,,,,17.4100,185.0000,fee schedule,$21.16 from Fee Schedule BLDTM_23 for Rev 940 Proc 96375 * Qty 1 = $21.16 at 100% = $21.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,BLUE CROSS,BLUE CROSS MEDICARE,44.18,,,,,,,17.4100,185.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,BLUE CROSS,TENNCARE BLUE CARE,21.39,,,,,,,17.4100,185.0000,fee schedule,$18.44 from Fee Schedule TC_24 for Rev 940 Proc 96375 * Qty 1 = $18.44 at 116% = $21.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,BLUE CROSS,TENNCARE BLUE SELECT,21.39,,,,,,,17.4100,185.0000,fee schedule,$18.44 from Fee Schedule TC_24 for Rev 940 Proc 96375 * Qty 1 = $18.44 at 116% = $21.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,CIGNA HEALTHCARE,CIGNA HMO,77.15,,,,,,,17.4100,185.0000,percent of total billed charges,41.7% of $185.00 in Billed Charges for Rev 940 Proc 96375 = $77.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,85.84,,,,,,,17.4100,185.0000,percent of total billed charges,46.4% of $185.00 in Billed Charges for Rev 940 Proc 96375 = $85.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,44.61,,,,,,,17.4100,185.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,77.15,,,,,,,17.4100,185.0000,percent of total billed charges,41.7% of $185.00 in Billed Charges for Rev 940 Proc 96375 = $77.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,CIGNA HEALTHCARE,CIGNA PPO,77.15,,,,,,,17.4100,185.0000,percent of total billed charges,41.7% of $185.00 in Billed Charges for Rev 940 Proc 96375 = $77.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,44.61,,,,,,,17.4100,185.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,166.50,,,,,,,17.4100,185.0000,percent of total billed charges,90% of $185.00 in Billed Charges for Rev 940 Proc 96375 = $166.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,HUMANA,HUMANA MEDICARE,42.48,,,,,,,17.4100,185.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,42.48,,,,,,,17.4100,185.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,MEDCOST,MEDCOST VHN,88.04,,,,,,,17.4100,185.0000,percent of total billed charges,47.59% of $185.00 in Billed Charges for Rev 940 Proc 96375 = $88.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,74.67,,,,,,,17.4100,185.0000,fee schedule,APG 00109 Proc 96375 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 105% = $74.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,44.61,,,,,,,17.4100,185.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,44.61,,,,,,,17.4100,185.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,NHC ADVANTAGE,NHC ADVANTAGE,44.61,,,,,,,17.4100,185.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,73.31,,,,,,,17.4100,185.0000,fee schedule,APG 00109 Proc 96375 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 103.1% = $73.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,SENTARA HEALTH,SENTARA HEALTH,47.75,,,,,,,17.4100,185.0000,percent of total billed charges,25.81% of $185.00 in Billed Charges for Rev 940 Proc 96375 = $47.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,SENTARA HEALTH,SENTARA MEDICARE,42.48,,,,,,,17.4100,185.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",185.00,,,,,,,17.4100,185.0000,percent of total billed charges,100% of $185.00 in Billed Charges for Rev 940 Proc 96375 = $185.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,17.41,,,,,,,17.4100,185.0000,fee schedule,$34.81 from Fee Schedule TCUHC24 for Rev 940 Proc 96375 * Qty 1 = $34.81 at 50% = $17.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,185.00,,,,,,,17.4100,185.0000,other,"Rev 940 Proc 96375 1 Visit at $1,154.00 per Visit = $1,154.00 (Service Line reduced to $185.00, claim capped at $185.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,185.00,,,,,,,17.4100,185.0000,other,"Rev 940 Proc 96375 1 Visit at $1,104.00 per Visit = $1,104.00 (Service Line reduced to $185.00, claim capped at $185.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,185.00,,,,,,,17.4100,185.0000,other,"Rev 940 Proc 96375 1 Visit at $2,426.00 per Visit = $2,426.00 (Service Line reduced to $185.00, claim capped at $185.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,73.24,,,,,,,17.4100,185.0000,fee schedule,APG 00109 Proc 96375 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,42.48,,,,,,,17.4100,185.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,42.48,,,,,,,17.4100,185.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,WELLCARE,WELLCARE MEDICAID,185.00,,,,,,,17.4100,185.0000,percent of total billed charges,100% of $185.00 in Billed Charges for Rev 940 Proc 96375 = $185.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC IV PUSH TX/PROPH/DX EA SEQ NEW,96375,CPT,940,RC,94000019,CDM,,,,both,,,185.0000,27.7500,WELLCARE,WELLCARE MEDICARE,45.03,,,,,,,17.4100,185.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,AETNA,AETNA,55.08,,,,,,,12.4100,129.0000,percent of total billed charges,42.7% of $129.00 in Billed Charges for Rev 940 Proc 96379 = $55.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,73.96,,,,,,,12.4100,129.0000,fee schedule,APG 00109 Proc 96379 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 104% = $73.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,42.48,,,,,,,12.4100,129.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,AETNA,AETNA HEALTHCARE MEDICARE,42.48,,,,,,,12.4100,129.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,42.48,,,,,,,12.4100,129.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,AMBETTER,AMBETTER,92.61,,,,,,,12.4100,129.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,44.18,,,,,,,12.4100,129.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,BLUE CROSS,ANTHEM EXCHANGE,104.59,,,,,,,12.4100,129.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,73.24,,,,,,,12.4100,129.0000,fee schedule,APG 00109 Proc 96379 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,BLUE CROSS,ANTHEM HMO,111.12,,,,,,,12.4100,129.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,43.76,,,,,,,12.4100,129.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",129.00,,,,,,,12.4100,129.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,BLUE CROSS,BLUE CROSS MEDICARE,44.18,,,,,,,12.4100,129.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,CIGNA HEALTHCARE,CIGNA HMO,53.79,,,,,,,12.4100,129.0000,percent of total billed charges,41.7% of $129.00 in Billed Charges for Rev 940 Proc 96379 = $53.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,59.86,,,,,,,12.4100,129.0000,percent of total billed charges,46.4% of $129.00 in Billed Charges for Rev 940 Proc 96379 = $59.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,44.61,,,,,,,12.4100,129.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,53.79,,,,,,,12.4100,129.0000,percent of total billed charges,41.7% of $129.00 in Billed Charges for Rev 940 Proc 96379 = $53.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,CIGNA HEALTHCARE,CIGNA PPO,53.79,,,,,,,12.4100,129.0000,percent of total billed charges,41.7% of $129.00 in Billed Charges for Rev 940 Proc 96379 = $53.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,44.61,,,,,,,12.4100,129.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,116.10,,,,,,,12.4100,129.0000,percent of total billed charges,90% of $129.00 in Billed Charges for Rev 940 Proc 96379 = $116.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,HUMANA,HUMANA MEDICARE,42.48,,,,,,,12.4100,129.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,42.48,,,,,,,12.4100,129.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,MEDCOST,MEDCOST VHN,61.39,,,,,,,12.4100,129.0000,percent of total billed charges,47.59% of $129.00 in Billed Charges for Rev 940 Proc 96379 = $61.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,74.67,,,,,,,12.4100,129.0000,fee schedule,APG 00109 Proc 96379 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 105% = $74.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,44.61,,,,,,,12.4100,129.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,44.61,,,,,,,12.4100,129.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,NHC ADVANTAGE,NHC ADVANTAGE,44.61,,,,,,,12.4100,129.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,73.31,,,,,,,12.4100,129.0000,fee schedule,APG 00109 Proc 96379 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 103.1% = $73.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,SENTARA HEALTH,SENTARA HEALTH,33.29,,,,,,,12.4100,129.0000,percent of total billed charges,25.81% of $129.00 in Billed Charges for Rev 940 Proc 96379 = $33.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,SENTARA HEALTH,SENTARA MEDICARE,42.48,,,,,,,12.4100,129.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",129.00,,,,,,,12.4100,129.0000,percent of total billed charges,100% of $129.00 in Billed Charges for Rev 940 Proc 96379 = $129.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,12.41,,,,,,,12.4100,129.0000,fee schedule,$24.81 from Fee Schedule TCUHC24 for Rev 940 Proc 96379 * Qty 1 = $24.81 at 50% = $12.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,129.00,,,,,,,12.4100,129.0000,other,"Rev 940 Proc 96379 1 Visit at $1,154.00 per Visit = $1,154.00 (Service Line reduced to $129.00, claim capped at $129.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,129.00,,,,,,,12.4100,129.0000,other,"Rev 940 Proc 96379 1 Visit at $1,104.00 per Visit = $1,104.00 (Service Line reduced to $129.00, claim capped at $129.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,129.00,,,,,,,12.4100,129.0000,other,"Rev 940 Proc 96379 1 Visit at $2,426.00 per Visit = $2,426.00 (Service Line reduced to $129.00, claim capped at $129.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,73.24,,,,,,,12.4100,129.0000,fee schedule,APG 00109 Proc 96379 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,42.48,,,,,,,12.4100,129.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,42.48,,,,,,,12.4100,129.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,WELLCARE,WELLCARE MEDICAID,129.00,,,,,,,12.4100,129.0000,percent of total billed charges,100% of $129.00 in Billed Charges for Rev 940 Proc 96379 = $129.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS,96379,CPT,940,RC,94000026,CDM,,,,both,,,129.0000,19.3500,WELLCARE,WELLCARE MEDICARE,45.03,,,,,,,12.4100,129.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,AETNA,AETNA,250.65,,,,,,,17.4100,587.0000,percent of total billed charges,42.7% of $587.00 in Billed Charges for Rev 331 Proc 96401 = $250.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,73.96,,,,,,,17.4100,587.0000,fee schedule,APG 00109 Proc 96401 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 104% = $73.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,65.32,,,,,,,17.4100,587.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,AETNA,AETNA HEALTHCARE MEDICARE,65.32,,,,,,,17.4100,587.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,65.32,,,,,,,17.4100,587.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,AMBETTER,AMBETTER,142.41,,,,,,,17.4100,587.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,67.94,,,,,,,17.4100,587.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,BLUE CROSS,ANTHEM EXCHANGE,160.84,,,,,,,17.4100,587.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,73.24,,,,,,,17.4100,587.0000,fee schedule,APG 00109 Proc 96401 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,BLUE CROSS,ANTHEM HMO,170.88,,,,,,,17.4100,587.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,67.28,,,,,,,17.4100,587.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",201.02,,,,,,,17.4100,587.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,47.17,,,,,,,17.4100,587.0000,fee schedule,$47.17 from Fee Schedule BLDTM_23 for Rev 331 Proc 96401 * Qty 1 = $47.17 at 100% = $47.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,BLUE CROSS,BLUE CROSS E NETWORK,289.94,,,,,,,17.4100,587.0000,fee schedule,$66.50 from Fee Schedule BCFSG for Rev 331 Proc 96401 * Qty 1 = $66.50 at 436% = $289.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,BLUE CROSS,BLUE CROSS MEDICARE,67.94,,,,,,,17.4100,587.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,BLUE CROSS,BLUE CROSS P NETWORK,295.93,,,,,,,17.4100,587.0000,fee schedule,$66.50 from Fee Schedule BCFSG for Rev 331 Proc 96401 * Qty 1 = $66.50 at 445% = $295.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,BLUE CROSS,BLUE CROSS S NETWORK,295.93,,,,,,,17.4100,587.0000,fee schedule,$66.50 from Fee Schedule BCFSG for Rev 331 Proc 96401 * Qty 1 = $66.50 at 445% = $295.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,BLUE CROSS,TENNCARE BLUE CARE,47.66,,,,,,,17.4100,587.0000,fee schedule,$41.09 from Fee Schedule TC_24 for Rev 331 Proc 96401 * Qty 1 = $41.09 at 116% = $47.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,BLUE CROSS,TENNCARE BLUE SELECT,47.66,,,,,,,17.4100,587.0000,fee schedule,$41.09 from Fee Schedule TC_24 for Rev 331 Proc 96401 * Qty 1 = $41.09 at 116% = $47.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,CIGNA HEALTHCARE,CIGNA HMO,244.78,,,,,,,17.4100,587.0000,percent of total billed charges,41.7% of $587.00 in Billed Charges for Rev 331 Proc 96401 = $244.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,272.37,,,,,,,17.4100,587.0000,percent of total billed charges,46.4% of $587.00 in Billed Charges for Rev 331 Proc 96401 = $272.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,68.59,,,,,,,17.4100,587.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,244.78,,,,,,,17.4100,587.0000,percent of total billed charges,41.7% of $587.00 in Billed Charges for Rev 331 Proc 96401 = $244.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,CIGNA HEALTHCARE,CIGNA PPO,244.78,,,,,,,17.4100,587.0000,percent of total billed charges,41.7% of $587.00 in Billed Charges for Rev 331 Proc 96401 = $244.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,68.59,,,,,,,17.4100,587.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,528.30,,,,,,,17.4100,587.0000,percent of total billed charges,90% of $587.00 in Billed Charges for Rev 331 Proc 96401 = $528.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,HUMANA,HUMANA MEDICARE,65.32,,,,,,,17.4100,587.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,65.32,,,,,,,17.4100,587.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,MEDCOST,MEDCOST VHN,279.35,,,,,,,17.4100,587.0000,percent of total billed charges,47.59% of $587.00 in Billed Charges for Rev 331 Proc 96401 = $279.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,74.67,,,,,,,17.4100,587.0000,fee schedule,APG 00109 Proc 96401 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 105% = $74.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,68.59,,,,,,,17.4100,587.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,68.59,,,,,,,17.4100,587.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,NHC ADVANTAGE,NHC ADVANTAGE,68.59,,,,,,,17.4100,587.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,73.31,,,,,,,17.4100,587.0000,fee schedule,APG 00109 Proc 96401 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 103.1% = $73.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,SENTARA HEALTH,SENTARA HEALTH,151.50,,,,,,,17.4100,587.0000,percent of total billed charges,25.81% of $587.00 in Billed Charges for Rev 331 Proc 96401 = $151.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,SENTARA HEALTH,SENTARA MEDICARE,65.32,,,,,,,17.4100,587.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",587.00,,,,,,,17.4100,587.0000,percent of total billed charges,100% of $587.00 in Billed Charges for Rev 331 Proc 96401 = $587.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,17.41,,,,,,,17.4100,587.0000,fee schedule,$34.81 from Fee Schedule TCUHC24 for Rev 331 Proc 96401 * Qty 1 = $34.81 at 50% = $17.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,587.00,,,,,,,17.4100,587.0000,other,"Rev 331 Proc 96401 1 Visit at $2,444.00 per Visit = $2,444.00 (Service Line reduced to $587.00, claim capped at $587.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,587.00,,,,,,,17.4100,587.0000,other,"Rev 331 Proc 96401 1 Visit at $2,338.00 per Visit = $2,338.00 (Service Line reduced to $587.00, claim capped at $587.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,587.00,,,,,,,17.4100,587.0000,other,"Rev 331 Proc 96401 1 Visit at $4,205.00 per Visit = $4,205.00 (Service Line reduced to $587.00, claim capped at $587.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,73.24,,,,,,,17.4100,587.0000,fee schedule,APG 00109 Proc 96401 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,65.32,,,,,,,17.4100,587.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,65.32,,,,,,,17.4100,587.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,WELLCARE,WELLCARE MEDICAID,587.00,,,,,,,17.4100,587.0000,percent of total billed charges,100% of $587.00 in Billed Charges for Rev 331 Proc 96401 = $587.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM SQ IM NON HORM ANTINEO,96401,CPT,331,RC,33100001,CDM,,,,both,,,587.0000,88.0500,WELLCARE,WELLCARE MEDICARE,69.24,,,,,,,17.4100,587.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA,111.45,,,,,,,17.4100,261.0000,percent of total billed charges,42.7% of $261.00 in Billed Charges for Rev 331 Proc 96405 = $111.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,73.96,,,,,,,17.4100,261.0000,fee schedule,APG 00109 Proc 96405 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 104% = $73.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,65.32,,,,,,,17.4100,261.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA HEALTHCARE MEDICARE,65.32,,,,,,,17.4100,261.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,65.32,,,,,,,17.4100,261.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,AMBETTER,AMBETTER,142.41,,,,,,,17.4100,261.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,67.94,,,,,,,17.4100,261.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM EXCHANGE,160.84,,,,,,,17.4100,261.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,73.24,,,,,,,17.4100,261.0000,fee schedule,APG 00109 Proc 96405 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM HMO,170.88,,,,,,,17.4100,261.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,67.28,,,,,,,17.4100,261.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",201.02,,,,,,,17.4100,261.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,47.75,,,,,,,17.4100,261.0000,fee schedule,$47.75 from Fee Schedule BLDTM_23 for Rev 331 Proc 96405 * Qty 1 = $47.75 at 100% = $47.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,BLUE CROSS E NETWORK,261.00,,,,,,,17.4100,261.0000,fee schedule,"$74.52 from Fee Schedule BCFSG for Rev 331 Proc 96405 * Qty 1 = $74.52 at 436% = $324.91 (Service Line reduced to $261.00, claim capped at $261.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,BLUE CROSS MEDICARE,67.94,,,,,,,17.4100,261.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,BLUE CROSS P NETWORK,261.00,,,,,,,17.4100,261.0000,fee schedule,"$74.52 from Fee Schedule BCFSG for Rev 331 Proc 96405 * Qty 1 = $74.52 at 445% = $331.61 (Service Line reduced to $261.00, claim capped at $261.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,BLUE CROSS S NETWORK,261.00,,,,,,,17.4100,261.0000,fee schedule,"$74.52 from Fee Schedule BCFSG for Rev 331 Proc 96405 * Qty 1 = $74.52 at 445% = $331.61 (Service Line reduced to $261.00, claim capped at $261.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,TENNCARE BLUE CARE,33.91,,,,,,,17.4100,261.0000,fee schedule,$29.23 from Fee Schedule TC_24 for Rev 331 Proc 96405 * Qty 1 = $29.23 at 116% = $33.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,TENNCARE BLUE SELECT,33.91,,,,,,,17.4100,261.0000,fee schedule,$29.23 from Fee Schedule TC_24 for Rev 331 Proc 96405 * Qty 1 = $29.23 at 116% = $33.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA HMO,108.84,,,,,,,17.4100,261.0000,percent of total billed charges,41.7% of $261.00 in Billed Charges for Rev 331 Proc 96405 = $108.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,121.10,,,,,,,17.4100,261.0000,percent of total billed charges,46.4% of $261.00 in Billed Charges for Rev 331 Proc 96405 = $121.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,68.59,,,,,,,17.4100,261.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,108.84,,,,,,,17.4100,261.0000,percent of total billed charges,41.7% of $261.00 in Billed Charges for Rev 331 Proc 96405 = $108.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA PPO,108.84,,,,,,,17.4100,261.0000,percent of total billed charges,41.7% of $261.00 in Billed Charges for Rev 331 Proc 96405 = $108.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,68.59,,,,,,,17.4100,261.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,234.90,,,,,,,17.4100,261.0000,percent of total billed charges,90% of $261.00 in Billed Charges for Rev 331 Proc 96405 = $234.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,HUMANA,HUMANA MEDICARE,65.32,,,,,,,17.4100,261.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,65.32,,,,,,,17.4100,261.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,MEDCOST,MEDCOST VHN,124.21,,,,,,,17.4100,261.0000,percent of total billed charges,47.59% of $261.00 in Billed Charges for Rev 331 Proc 96405 = $124.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,74.67,,,,,,,17.4100,261.0000,fee schedule,APG 00109 Proc 96405 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 105% = $74.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,68.59,,,,,,,17.4100,261.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,68.59,,,,,,,17.4100,261.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,NHC ADVANTAGE,NHC ADVANTAGE,68.59,,,,,,,17.4100,261.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,73.31,,,,,,,17.4100,261.0000,fee schedule,APG 00109 Proc 96405 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 103.1% = $73.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,SENTARA HEALTH,SENTARA HEALTH,67.36,,,,,,,17.4100,261.0000,percent of total billed charges,25.81% of $261.00 in Billed Charges for Rev 331 Proc 96405 = $67.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,SENTARA HEALTH,SENTARA MEDICARE,65.32,,,,,,,17.4100,261.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",261.00,,,,,,,17.4100,261.0000,percent of total billed charges,100% of $261.00 in Billed Charges for Rev 331 Proc 96405 = $261.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,17.41,,,,,,,17.4100,261.0000,fee schedule,$34.81 from Fee Schedule TCUHC24 for Rev 331 Proc 96405 * Qty 1 = $34.81 at 50% = $17.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,261.00,,,,,,,17.4100,261.0000,other,"Rev 331 Proc 96405 1 Visit at $2,444.00 per Visit = $2,444.00 (Service Line reduced to $261.00, claim capped at $261.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,261.00,,,,,,,17.4100,261.0000,other,"Rev 331 Proc 96405 1 Visit at $2,338.00 per Visit = $2,338.00 (Service Line reduced to $261.00, claim capped at $261.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,261.00,,,,,,,17.4100,261.0000,other,"Rev 331 Proc 96405 1 Visit at $4,205.00 per Visit = $4,205.00 (Service Line reduced to $261.00, claim capped at $261.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,73.24,,,,,,,17.4100,261.0000,fee schedule,APG 00109 Proc 96405 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,65.32,,,,,,,17.4100,261.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,65.32,,,,,,,17.4100,261.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,WELLCARE,WELLCARE MEDICAID,261.00,,,,,,,17.4100,261.0000,percent of total billed charges,100% of $261.00 in Billed Charges for Rev 331 Proc 96405 = $261.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADMIN INTRALESIONAL 1-7,96405,CPT,331,RC,33100004,CDM,,,,both,,,261.0000,39.1500,WELLCARE,WELLCARE MEDICARE,69.24,,,,,,,17.4100,261.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WIREPASS,272,RC,,,,,,,,both,,,1673.1500,250.9700,AETNA,AETNA,714.44,,,,,,,431.8400,1673.1500,percent of total billed charges,"42.7% of $1,673.15 in Billed Charges for Rev 272 = $714.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIREPASS,272,RC,,,,,,,,both,,,1673.1500,250.9700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1171.21,,,,,,,431.8400,1673.1500,percent of total billed charges,"Rev 272 $1,673.15 in Billed Charges at 70% = $1,171.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIREPASS,272,RC,,,,,,,,both,,,1673.1500,250.9700,CIGNA HEALTHCARE,CIGNA HMO,697.70,,,,,,,431.8400,1673.1500,percent of total billed charges,"41.7% of $1,673.15 in Billed Charges for Rev 272 = $697.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIREPASS,272,RC,,,,,,,,both,,,1673.1500,250.9700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,776.34,,,,,,,431.8400,1673.1500,percent of total billed charges,"46.4% of $1,673.15 in Billed Charges for Rev 272 = $776.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIREPASS,272,RC,,,,,,,,both,,,1673.1500,250.9700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,697.70,,,,,,,431.8400,1673.1500,percent of total billed charges,"41.7% of $1,673.15 in Billed Charges for Rev 272 = $697.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIREPASS,272,RC,,,,,,,,both,,,1673.1500,250.9700,CIGNA HEALTHCARE,CIGNA PPO,697.70,,,,,,,431.8400,1673.1500,percent of total billed charges,"41.7% of $1,673.15 in Billed Charges for Rev 272 = $697.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIREPASS,272,RC,,,,,,,,both,,,1673.1500,250.9700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1505.84,,,,,,,431.8400,1673.1500,percent of total billed charges,"90% of $1,673.15 in Billed Charges for Rev 272 = $1,505.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIREPASS,272,RC,,,,,,,,both,,,1673.1500,250.9700,MEDCOST,MEDCOST VHN,796.25,,,,,,,431.8400,1673.1500,percent of total billed charges,"47.59% of $1,673.15 in Billed Charges for Rev 272 = $796.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIREPASS,272,RC,,,,,,,,both,,,1673.1500,250.9700,SENTARA HEALTH,SENTARA HEALTH,431.84,,,,,,,431.8400,1673.1500,percent of total billed charges,"25.81% of $1,673.15 in Billed Charges for Rev 272 = $431.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIREPASS,272,RC,,,,,,,,both,,,1673.1500,250.9700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1673.15,,,,,,,431.8400,1673.1500,percent of total billed charges,"100% of $1,673.15 in Billed Charges for Rev 272 = $1,673.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIREPASS,272,RC,,,,,,,,both,,,1673.1500,250.9700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,836.58,,,,,,,431.8400,1673.1500,percent of total billed charges,"Rev 272 $1,673.15 in Billed Charges at 50% = $836.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIREPASS,272,RC,,,,,,,,both,,,1673.1500,250.9700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,540.43,,,,,,,431.8400,1673.1500,other,"32.3% of $1,673.15 in Billed Charges for Rev 272 = $540.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WIREPASS,272,RC,,,,,,,,both,,,1673.1500,250.9700,UNITED HEALTHCARE,UHC HERITAGE SELECT,513.66,,,,,,,431.8400,1673.1500,other,"30.7% of $1,673.15 in Billed Charges for Rev 272 = $513.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WIREPASS,272,RC,,,,,,,,both,,,1673.1500,250.9700,UNITED HEALTHCARE,UNITED HEALTHCARE,540.43,,,,,,,431.8400,1673.1500,percent of total billed charges,"32.3% of $1,673.15 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIREPASS,272,RC,,,,,,,,both,,,1673.1500,250.9700,WELLCARE,WELLCARE MEDICAID,1673.15,,,,,,,431.8400,1673.1500,percent of total billed charges,"100% of $1,673.15 in Billed Charges for Rev 272 = $1,673.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WRENCH TORQUE,272,RC,,,,,,,,both,,,741.5300,111.2300,AETNA,AETNA,316.63,,,,,,,191.3900,741.5300,percent of total billed charges,42.7% of $741.53 in Billed Charges for Rev 272 = $316.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WRENCH TORQUE,272,RC,,,,,,,,both,,,741.5300,111.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,519.07,,,,,,,191.3900,741.5300,percent of total billed charges,Rev 272 $741.53 in Billed Charges at 70% = $519.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WRENCH TORQUE,272,RC,,,,,,,,both,,,741.5300,111.2300,CIGNA HEALTHCARE,CIGNA HMO,309.22,,,,,,,191.3900,741.5300,percent of total billed charges,41.7% of $741.53 in Billed Charges for Rev 272 = $309.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WRENCH TORQUE,272,RC,,,,,,,,both,,,741.5300,111.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,344.07,,,,,,,191.3900,741.5300,percent of total billed charges,46.4% of $741.53 in Billed Charges for Rev 272 = $344.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WRENCH TORQUE,272,RC,,,,,,,,both,,,741.5300,111.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,309.22,,,,,,,191.3900,741.5300,percent of total billed charges,41.7% of $741.53 in Billed Charges for Rev 272 = $309.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WRENCH TORQUE,272,RC,,,,,,,,both,,,741.5300,111.2300,CIGNA HEALTHCARE,CIGNA PPO,309.22,,,,,,,191.3900,741.5300,percent of total billed charges,41.7% of $741.53 in Billed Charges for Rev 272 = $309.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WRENCH TORQUE,272,RC,,,,,,,,both,,,741.5300,111.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,667.38,,,,,,,191.3900,741.5300,percent of total billed charges,90% of $741.53 in Billed Charges for Rev 272 = $667.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WRENCH TORQUE,272,RC,,,,,,,,both,,,741.5300,111.2300,MEDCOST,MEDCOST VHN,352.89,,,,,,,191.3900,741.5300,percent of total billed charges,47.59% of $741.53 in Billed Charges for Rev 272 = $352.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WRENCH TORQUE,272,RC,,,,,,,,both,,,741.5300,111.2300,SENTARA HEALTH,SENTARA HEALTH,191.39,,,,,,,191.3900,741.5300,percent of total billed charges,25.81% of $741.53 in Billed Charges for Rev 272 = $191.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WRENCH TORQUE,272,RC,,,,,,,,both,,,741.5300,111.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",741.53,,,,,,,191.3900,741.5300,percent of total billed charges,100% of $741.53 in Billed Charges for Rev 272 = $741.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WRENCH TORQUE,272,RC,,,,,,,,both,,,741.5300,111.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,370.77,,,,,,,191.3900,741.5300,percent of total billed charges,Rev 272 $741.53 in Billed Charges at 50% = $370.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WRENCH TORQUE,272,RC,,,,,,,,both,,,741.5300,111.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,239.51,,,,,,,191.3900,741.5300,other,32.3% of $741.53 in Billed Charges for Rev 272 = $239.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WRENCH TORQUE,272,RC,,,,,,,,both,,,741.5300,111.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,227.65,,,,,,,191.3900,741.5300,other,30.7% of $741.53 in Billed Charges for Rev 272 = $227.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WRENCH TORQUE,272,RC,,,,,,,,both,,,741.5300,111.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,239.51,,,,,,,191.3900,741.5300,percent of total billed charges,32.3% of $741.53 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WRENCH TORQUE,272,RC,,,,,,,,both,,,741.5300,111.2300,WELLCARE,WELLCARE MEDICAID,741.53,,,,,,,191.3900,741.5300,percent of total billed charges,100% of $741.53 in Billed Charges for Rev 272 = $741.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
XI CABLE ENERGY ACTIVATION ETHICON,272,RC,,,,,,,,both,,,10350.2600,1552.5400,AETNA,AETNA,4419.56,,,,,,,2671.4000,10350.2600,percent of total billed charges,"42.7% of $10,350.26 in Billed Charges for Rev 272 = $4,419.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI CABLE ENERGY ACTIVATION ETHICON,272,RC,,,,,,,,both,,,10350.2600,1552.5400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7245.18,,,,,,,2671.4000,10350.2600,percent of total billed charges,"Rev 272 $10,350.26 in Billed Charges at 70% = $7,245.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI CABLE ENERGY ACTIVATION ETHICON,272,RC,,,,,,,,both,,,10350.2600,1552.5400,CIGNA HEALTHCARE,CIGNA HMO,4316.06,,,,,,,2671.4000,10350.2600,percent of total billed charges,"41.7% of $10,350.26 in Billed Charges for Rev 272 = $4,316.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI CABLE ENERGY ACTIVATION ETHICON,272,RC,,,,,,,,both,,,10350.2600,1552.5400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4802.52,,,,,,,2671.4000,10350.2600,percent of total billed charges,"46.4% of $10,350.26 in Billed Charges for Rev 272 = $4,802.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI CABLE ENERGY ACTIVATION ETHICON,272,RC,,,,,,,,both,,,10350.2600,1552.5400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4316.06,,,,,,,2671.4000,10350.2600,percent of total billed charges,"41.7% of $10,350.26 in Billed Charges for Rev 272 = $4,316.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI CABLE ENERGY ACTIVATION ETHICON,272,RC,,,,,,,,both,,,10350.2600,1552.5400,CIGNA HEALTHCARE,CIGNA PPO,4316.06,,,,,,,2671.4000,10350.2600,percent of total billed charges,"41.7% of $10,350.26 in Billed Charges for Rev 272 = $4,316.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI CABLE ENERGY ACTIVATION ETHICON,272,RC,,,,,,,,both,,,10350.2600,1552.5400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9315.23,,,,,,,2671.4000,10350.2600,percent of total billed charges,"90% of $10,350.26 in Billed Charges for Rev 272 = $9,315.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI CABLE ENERGY ACTIVATION ETHICON,272,RC,,,,,,,,both,,,10350.2600,1552.5400,MEDCOST,MEDCOST VHN,4925.69,,,,,,,2671.4000,10350.2600,percent of total billed charges,"47.59% of $10,350.26 in Billed Charges for Rev 272 = $4,925.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI CABLE ENERGY ACTIVATION ETHICON,272,RC,,,,,,,,both,,,10350.2600,1552.5400,SENTARA HEALTH,SENTARA HEALTH,2671.40,,,,,,,2671.4000,10350.2600,percent of total billed charges,"25.81% of $10,350.26 in Billed Charges for Rev 272 = $2,671.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI CABLE ENERGY ACTIVATION ETHICON,272,RC,,,,,,,,both,,,10350.2600,1552.5400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10350.26,,,,,,,2671.4000,10350.2600,percent of total billed charges,"100% of $10,350.26 in Billed Charges for Rev 272 = $10,350.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI CABLE ENERGY ACTIVATION ETHICON,272,RC,,,,,,,,both,,,10350.2600,1552.5400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5175.13,,,,,,,2671.4000,10350.2600,percent of total billed charges,"Rev 272 $10,350.26 in Billed Charges at 50% = $5,175.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI CABLE ENERGY ACTIVATION ETHICON,272,RC,,,,,,,,both,,,10350.2600,1552.5400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3343.13,,,,,,,2671.4000,10350.2600,other,"32.3% of $10,350.26 in Billed Charges for Rev 272 = $3,343.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
XI CABLE ENERGY ACTIVATION ETHICON,272,RC,,,,,,,,both,,,10350.2600,1552.5400,UNITED HEALTHCARE,UHC HERITAGE SELECT,3177.53,,,,,,,2671.4000,10350.2600,other,"30.7% of $10,350.26 in Billed Charges for Rev 272 = $3,177.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
XI CABLE ENERGY ACTIVATION ETHICON,272,RC,,,,,,,,both,,,10350.2600,1552.5400,UNITED HEALTHCARE,UNITED HEALTHCARE,3343.13,,,,,,,2671.4000,10350.2600,percent of total billed charges,"32.3% of $10,350.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI CABLE ENERGY ACTIVATION ETHICON,272,RC,,,,,,,,both,,,10350.2600,1552.5400,WELLCARE,WELLCARE MEDICAID,10350.26,,,,,,,2671.4000,10350.2600,percent of total billed charges,"100% of $10,350.26 in Billed Charges for Rev 272 = $10,350.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,AETNA,AETNA,304.45,,,,,,,36.3500,713.0000,percent of total billed charges,42.7% of $713.00 in Billed Charges for Rev 335 Proc 96411 = $304.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,73.96,,,,,,,36.3500,713.0000,fee schedule,APG 00109 Proc 96411 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 104% = $73.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,65.32,,,,,,,36.3500,713.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,AETNA,AETNA HEALTHCARE MEDICARE,65.32,,,,,,,36.3500,713.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,65.32,,,,,,,36.3500,713.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,AMBETTER,AMBETTER,142.41,,,,,,,36.3500,713.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,67.94,,,,,,,36.3500,713.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,BLUE CROSS,ANTHEM EXCHANGE,160.84,,,,,,,36.3500,713.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,73.24,,,,,,,36.3500,713.0000,fee schedule,APG 00109 Proc 96411 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,BLUE CROSS,ANTHEM HMO,170.88,,,,,,,36.3500,713.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,67.28,,,,,,,36.3500,713.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",201.02,,,,,,,36.3500,713.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,62.65,,,,,,,36.3500,713.0000,fee schedule,$62.65 from Fee Schedule BLDTM_23 for Rev 335 Proc 96411 * Qty 1 = $62.65 at 100% = $62.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,BLUE CROSS,BLUE CROSS E NETWORK,241.28,,,,,,,36.3500,713.0000,fee schedule,$55.34 from Fee Schedule BCFSG for Rev 335 Proc 96411 * Qty 1 = $55.34 at 436% = $241.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,BLUE CROSS,BLUE CROSS MEDICARE,67.94,,,,,,,36.3500,713.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,BLUE CROSS,BLUE CROSS P NETWORK,246.26,,,,,,,36.3500,713.0000,fee schedule,$55.34 from Fee Schedule BCFSG for Rev 335 Proc 96411 * Qty 1 = $55.34 at 445% = $246.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,BLUE CROSS,BLUE CROSS S NETWORK,246.26,,,,,,,36.3500,713.0000,fee schedule,$55.34 from Fee Schedule BCFSG for Rev 335 Proc 96411 * Qty 1 = $55.34 at 445% = $246.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,BLUE CROSS,TENNCARE BLUE CARE,63.31,,,,,,,36.3500,713.0000,fee schedule,$54.58 from Fee Schedule TC_24 for Rev 335 Proc 96411 * Qty 1 = $54.58 at 116% = $63.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,BLUE CROSS,TENNCARE BLUE SELECT,63.31,,,,,,,36.3500,713.0000,fee schedule,$54.58 from Fee Schedule TC_24 for Rev 335 Proc 96411 * Qty 1 = $54.58 at 116% = $63.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,CIGNA HEALTHCARE,CIGNA HMO,297.32,,,,,,,36.3500,713.0000,percent of total billed charges,41.7% of $713.00 in Billed Charges for Rev 335 Proc 96411 = $297.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,330.83,,,,,,,36.3500,713.0000,percent of total billed charges,46.4% of $713.00 in Billed Charges for Rev 335 Proc 96411 = $330.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,68.59,,,,,,,36.3500,713.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,297.32,,,,,,,36.3500,713.0000,percent of total billed charges,41.7% of $713.00 in Billed Charges for Rev 335 Proc 96411 = $297.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,CIGNA HEALTHCARE,CIGNA PPO,297.32,,,,,,,36.3500,713.0000,percent of total billed charges,41.7% of $713.00 in Billed Charges for Rev 335 Proc 96411 = $297.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,68.59,,,,,,,36.3500,713.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,641.70,,,,,,,36.3500,713.0000,percent of total billed charges,90% of $713.00 in Billed Charges for Rev 335 Proc 96411 = $641.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,HUMANA,HUMANA MEDICARE,65.32,,,,,,,36.3500,713.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,65.32,,,,,,,36.3500,713.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,MEDCOST,MEDCOST VHN,339.32,,,,,,,36.3500,713.0000,percent of total billed charges,47.59% of $713.00 in Billed Charges for Rev 335 Proc 96411 = $339.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,74.67,,,,,,,36.3500,713.0000,fee schedule,APG 00109 Proc 96411 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 105% = $74.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,68.59,,,,,,,36.3500,713.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,68.59,,,,,,,36.3500,713.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,NHC ADVANTAGE,NHC ADVANTAGE,68.59,,,,,,,36.3500,713.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,73.31,,,,,,,36.3500,713.0000,fee schedule,APG 00109 Proc 96411 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 103.1% = $73.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,SENTARA HEALTH,SENTARA HEALTH,184.03,,,,,,,36.3500,713.0000,percent of total billed charges,25.81% of $713.00 in Billed Charges for Rev 335 Proc 96411 = $184.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,SENTARA HEALTH,SENTARA MEDICARE,65.32,,,,,,,36.3500,713.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",713.00,,,,,,,36.3500,713.0000,percent of total billed charges,100% of $713.00 in Billed Charges for Rev 335 Proc 96411 = $713.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,36.35,,,,,,,36.3500,713.0000,fee schedule,$72.70 from Fee Schedule TCUHC24 for Rev 335 Proc 96411 * Qty 1 = $72.70 at 50% = $36.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,713.00,,,,,,,36.3500,713.0000,other,"Rev 335 Proc 96411 1 Visit at $2,444.00 per Visit = $2,444.00 (Service Line reduced to $713.00, claim capped at $713.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,713.00,,,,,,,36.3500,713.0000,other,"Rev 335 Proc 96411 1 Visit at $2,338.00 per Visit = $2,338.00 (Service Line reduced to $713.00, claim capped at $713.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,713.00,,,,,,,36.3500,713.0000,other,"Rev 335 Proc 96411 1 Visit at $4,205.00 per Visit = $4,205.00 (Service Line reduced to $713.00, claim capped at $713.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,73.24,,,,,,,36.3500,713.0000,fee schedule,APG 00109 Proc 96411 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,65.32,,,,,,,36.3500,713.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,65.32,,,,,,,36.3500,713.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,WELLCARE,WELLCARE MEDICAID,713.00,,,,,,,36.3500,713.0000,percent of total billed charges,100% of $713.00 in Billed Charges for Rev 335 Proc 96411 = $713.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMO ADM IV PUSH EA ADD DRUG,96411,CPT,335,RC,33500002,CDM,,,,both,,,713.0000,106.9500,WELLCARE,WELLCARE MEDICARE,69.24,,,,,,,36.3500,713.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,AETNA,AETNA,796.78,,,,,,,103.8900,1866.0000,percent of total billed charges,"42.7% of $1,866.00 in Billed Charges for Rev 335 Proc 96416 = $796.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,734.25,,,,,,,103.8900,1866.0000,fee schedule,APG 00110 Proc 96416 at $836.60 (Base Rate) * 0.8439 (Relative Weight) = $706.01 (Total Line Payment) at 104% = $734.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,299.68,,,,,,,103.8900,1866.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,AETNA,AETNA HEALTHCARE MEDICARE,299.68,,,,,,,103.8900,1866.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,299.68,,,,,,,103.8900,1866.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,AMBETTER,AMBETTER,653.30,,,,,,,103.8900,1866.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,311.67,,,,,,,103.8900,1866.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,BLUE CROSS,ANTHEM EXCHANGE,737.82,,,,,,,103.8900,1866.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,727.19,,,,,,,103.8900,1866.0000,fee schedule,APG 00110 Proc 96416 at $836.60 (Base Rate) * 0.8439 (Relative Weight) = $706.01 (Total Line Payment) at 103% = $727.19. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,BLUE CROSS,ANTHEM HMO,783.89,,,,,,,103.8900,1866.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,308.67,,,,,,,103.8900,1866.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",922.17,,,,,,,103.8900,1866.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,163.44,,,,,,,103.8900,1866.0000,fee schedule,$163.44 from Fee Schedule BLDTM_23 for Rev 335 Proc 96416 * Qty 1 = $163.44 at 100% = $163.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,BLUE CROSS,BLUE CROSS E NETWORK,543.43,,,,,,,103.8900,1866.0000,fee schedule,$124.64 from Fee Schedule BCFSG for Rev 335 Proc 96416 * Qty 1 = $124.64 at 436% = $543.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,BLUE CROSS,BLUE CROSS MEDICARE,311.67,,,,,,,103.8900,1866.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,BLUE CROSS,BLUE CROSS P NETWORK,554.65,,,,,,,103.8900,1866.0000,fee schedule,$124.64 from Fee Schedule BCFSG for Rev 335 Proc 96416 * Qty 1 = $124.64 at 445% = $554.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,BLUE CROSS,BLUE CROSS S NETWORK,554.65,,,,,,,103.8900,1866.0000,fee schedule,$124.64 from Fee Schedule BCFSG for Rev 335 Proc 96416 * Qty 1 = $124.64 at 445% = $554.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,BLUE CROSS,TENNCARE BLUE CARE,165.17,,,,,,,103.8900,1866.0000,fee schedule,$142.39 from Fee Schedule TC_24 for Rev 335 Proc 96416 * Qty 1 = $142.39 at 116% = $165.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,BLUE CROSS,TENNCARE BLUE SELECT,165.17,,,,,,,103.8900,1866.0000,fee schedule,$142.39 from Fee Schedule TC_24 for Rev 335 Proc 96416 * Qty 1 = $142.39 at 116% = $165.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,CIGNA HEALTHCARE,CIGNA HMO,778.12,,,,,,,103.8900,1866.0000,percent of total billed charges,"41.7% of $1,866.00 in Billed Charges for Rev 335 Proc 96416 = $778.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,865.82,,,,,,,103.8900,1866.0000,percent of total billed charges,"46.4% of $1,866.00 in Billed Charges for Rev 335 Proc 96416 = $865.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,314.66,,,,,,,103.8900,1866.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,778.12,,,,,,,103.8900,1866.0000,percent of total billed charges,"41.7% of $1,866.00 in Billed Charges for Rev 335 Proc 96416 = $778.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,CIGNA HEALTHCARE,CIGNA PPO,778.12,,,,,,,103.8900,1866.0000,percent of total billed charges,"41.7% of $1,866.00 in Billed Charges for Rev 335 Proc 96416 = $778.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,314.66,,,,,,,103.8900,1866.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1679.40,,,,,,,103.8900,1866.0000,percent of total billed charges,"90% of $1,866.00 in Billed Charges for Rev 335 Proc 96416 = $1,679.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,HUMANA,HUMANA MEDICARE,299.68,,,,,,,103.8900,1866.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,299.68,,,,,,,103.8900,1866.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,MEDCOST,MEDCOST VHN,888.03,,,,,,,103.8900,1866.0000,percent of total billed charges,"47.59% of $1,866.00 in Billed Charges for Rev 335 Proc 96416 = $888.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,741.31,,,,,,,103.8900,1866.0000,fee schedule,APG 00110 Proc 96416 at $836.60 (Base Rate) * 0.8439 (Relative Weight) = $706.01 (Total Line Payment) at 100% = $706.01... $706.01 at 105% = $741.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,314.66,,,,,,,103.8900,1866.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,314.66,,,,,,,103.8900,1866.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,NHC ADVANTAGE,NHC ADVANTAGE,314.66,,,,,,,103.8900,1866.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,727.90,,,,,,,103.8900,1866.0000,fee schedule,APG 00110 Proc 96416 at $836.60 (Base Rate) * 0.8439 (Relative Weight) = $706.01 (Total Line Payment) at 100% = $706.01... $706.01 at 103.1% = $727.90 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,SENTARA HEALTH,SENTARA HEALTH,481.61,,,,,,,103.8900,1866.0000,percent of total billed charges,"25.81% of $1,866.00 in Billed Charges for Rev 335 Proc 96416 = $481.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,SENTARA HEALTH,SENTARA MEDICARE,299.68,,,,,,,103.8900,1866.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1866.00,,,,,,,103.8900,1866.0000,percent of total billed charges,"100% of $1,866.00 in Billed Charges for Rev 335 Proc 96416 = $1,866.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,103.89,,,,,,,103.8900,1866.0000,fee schedule,$207.77 from Fee Schedule TCUHC24 for Rev 335 Proc 96416 * Qty 1 = $207.77 at 50% = $103.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1866.00,,,,,,,103.8900,1866.0000,other,"Rev 335 Proc 96416 1 Visit at $2,444.00 per Visit = $2,444.00 (Service Line reduced to $1,866.00, claim capped at $1,866.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1866.00,,,,,,,103.8900,1866.0000,other,"Rev 335 Proc 96416 1 Visit at $2,338.00 per Visit = $2,338.00 (Service Line reduced to $1,866.00, claim capped at $1,866.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,1866.00,,,,,,,103.8900,1866.0000,other,"Rev 335 Proc 96416 1 Visit at $4,205.00 per Visit = $4,205.00 (Service Line reduced to $1,866.00, claim capped at $1,866.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,727.19,,,,,,,103.8900,1866.0000,fee schedule,APG 00110 Proc 96416 at $836.60 (Base Rate) * 0.8439 (Relative Weight) = $706.01 (Total Line Payment) at 103% = $727.19. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,299.68,,,,,,,103.8900,1866.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,299.68,,,,,,,103.8900,1866.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,WELLCARE,WELLCARE MEDICAID,1866.00,,,,,,,103.8900,1866.0000,percent of total billed charges,"100% of $1,866.00 in Billed Charges for Rev 335 Proc 96416 = $1,866.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ADM INF IV PRLNG>8HR W/PUMP,96416,CPT,335,RC,33500005,CDM,,,,both,,,1866.0000,279.9000,WELLCARE,WELLCARE MEDICARE,317.66,,,,,,,103.8900,1866.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,AETNA,AETNA,843.33,,,,,,,43.5300,1975.0000,percent of total billed charges,"42.7% of $1,975.00 in Billed Charges for Rev 330 Proc 96422 = $843.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,406.06,,,,,,,43.5300,1975.0000,fee schedule,APG 00111 Proc 96422 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 104% = $406.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,299.68,,,,,,,43.5300,1975.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,AETNA,AETNA HEALTHCARE MEDICARE,299.68,,,,,,,43.5300,1975.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,299.68,,,,,,,43.5300,1975.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,AMBETTER,AMBETTER,653.30,,,,,,,43.5300,1975.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,311.67,,,,,,,43.5300,1975.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,BLUE CROSS,ANTHEM EXCHANGE,737.82,,,,,,,43.5300,1975.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,402.15,,,,,,,43.5300,1975.0000,fee schedule,APG 00111 Proc 96422 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 103% = $402.15. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,BLUE CROSS,ANTHEM HMO,783.89,,,,,,,43.5300,1975.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,308.67,,,,,,,43.5300,1975.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",922.17,,,,,,,43.5300,1975.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,50.32,,,,,,,43.5300,1975.0000,fee schedule,$50.32 from Fee Schedule BLDTM_23 for Rev 330 Proc 96422 * Qty 1 = $50.32 at 100% = $50.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,BLUE CROSS,BLUE CROSS MEDICARE,311.67,,,,,,,43.5300,1975.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,BLUE CROSS,TENNCARE BLUE CARE,43.53,,,,,,,43.5300,1975.0000,fee schedule,$37.53 from Fee Schedule TC_24 for Rev 330 Proc 96422 * Qty 1 = $37.53 at 116% = $43.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,BLUE CROSS,TENNCARE BLUE SELECT,43.53,,,,,,,43.5300,1975.0000,fee schedule,$37.53 from Fee Schedule TC_24 for Rev 330 Proc 96422 * Qty 1 = $37.53 at 116% = $43.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,CIGNA HEALTHCARE,CIGNA HMO,823.58,,,,,,,43.5300,1975.0000,percent of total billed charges,"Rev 330 Proc 96422 $1,975.00 in Billed Charges at 41.7% = $823.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,314.66,,,,,,,43.5300,1975.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,823.58,,,,,,,43.5300,1975.0000,percent of total billed charges,"Rev 330 Proc 96422 $1,975.00 in Billed Charges at 41.7% = $823.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,CIGNA HEALTHCARE,CIGNA PPO,823.58,,,,,,,43.5300,1975.0000,percent of total billed charges,"Rev 330 Proc 96422 $1,975.00 in Billed Charges at 41.7% = $823.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,314.66,,,,,,,43.5300,1975.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1777.50,,,,,,,43.5300,1975.0000,percent of total billed charges,"90% of $1,975.00 in Billed Charges for Rev 330 Proc 96422 = $1,777.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,HUMANA,HUMANA MEDICARE,299.68,,,,,,,43.5300,1975.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,299.68,,,,,,,43.5300,1975.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,MEDCOST,MEDCOST VHN,939.90,,,,,,,43.5300,1975.0000,percent of total billed charges,"47.59% of $1,975.00 in Billed Charges for Rev 330 Proc 96422 = $939.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,409.96,,,,,,,43.5300,1975.0000,fee schedule,APG 00111 Proc 96422 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 100% = $390.44... $390.44 at 105% = $409.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,314.66,,,,,,,43.5300,1975.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,314.66,,,,,,,43.5300,1975.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,NHC ADVANTAGE,NHC ADVANTAGE,314.66,,,,,,,43.5300,1975.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,402.54,,,,,,,43.5300,1975.0000,fee schedule,APG 00111 Proc 96422 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 100% = $390.44... $390.44 at 103.1% = $402.54 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,SENTARA HEALTH,SENTARA HEALTH,509.75,,,,,,,43.5300,1975.0000,percent of total billed charges,"25.81% of $1,975.00 in Billed Charges for Rev 330 Proc 96422 = $509.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,SENTARA HEALTH,SENTARA MEDICARE,299.68,,,,,,,43.5300,1975.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1975.00,,,,,,,43.5300,1975.0000,percent of total billed charges,"100% of $1,975.00 in Billed Charges for Rev 330 Proc 96422 = $1,975.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,103.89,,,,,,,43.5300,1975.0000,fee schedule,$207.77 from Fee Schedule TCUHC24 for Rev 330 Proc 96422 * Qty 1 = $207.77 at 50% = $103.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1411.00,,,,,,,43.5300,1975.0000,other,"Rev 330 Proc 96422 1 Visit at $1,411.00 per Visit = $1,411.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1350.00,,,,,,,43.5300,1975.0000,other,"Rev 330 Proc 96422 1 Visit at $1,350.00 per Visit = $1,350.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1975.00,,,,,,,43.5300,1975.0000,other,"Rev 330 Proc 96422 1 Visit at $2,224.00 per Visit = $2,224.00 (Service Line reduced to $1,975.00, claim capped at $1,975.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,402.15,,,,,,,43.5300,1975.0000,fee schedule,APG 00111 Proc 96422 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 103% = $402.15. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,299.68,,,,,,,43.5300,1975.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,299.68,,,,,,,43.5300,1975.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,WELLCARE,WELLCARE MEDICAID,1975.00,,,,,,,43.5300,1975.0000,percent of total billed charges,"100% of $1,975.00 in Billed Charges for Rev 330 Proc 96422 = $1,975.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHEMO ARTERY INFUSION UP TO 1 HR,96422,CPT,330,RC,33000001,CDM,,,,both,,,1975.0000,296.2500,WELLCARE,WELLCARE MEDICARE,317.66,,,,,,,43.5300,1975.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
XI STAPLER 30 CURVED-TIP BOX OF 50,272,RC,27200002,CDM,,,,,,both,,,1568.1000,235.2200,AETNA,AETNA,669.58,,,,,,,404.7300,1568.1000,percent of total billed charges,"42.7% of $1,568.10 in Billed Charges for Rev 272 = $669.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 CURVED-TIP BOX OF 50,272,RC,27200002,CDM,,,,,,both,,,1568.1000,235.2200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1097.67,,,,,,,404.7300,1568.1000,percent of total billed charges,"Rev 272 $1,568.10 in Billed Charges at 70% = $1,097.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 CURVED-TIP BOX OF 50,272,RC,27200002,CDM,,,,,,both,,,1568.1000,235.2200,CIGNA HEALTHCARE,CIGNA HMO,653.90,,,,,,,404.7300,1568.1000,percent of total billed charges,"41.7% of $1,568.10 in Billed Charges for Rev 272 = $653.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 CURVED-TIP BOX OF 50,272,RC,27200002,CDM,,,,,,both,,,1568.1000,235.2200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,727.60,,,,,,,404.7300,1568.1000,percent of total billed charges,"46.4% of $1,568.10 in Billed Charges for Rev 272 = $727.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 CURVED-TIP BOX OF 50,272,RC,27200002,CDM,,,,,,both,,,1568.1000,235.2200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,653.90,,,,,,,404.7300,1568.1000,percent of total billed charges,"41.7% of $1,568.10 in Billed Charges for Rev 272 = $653.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 CURVED-TIP BOX OF 50,272,RC,27200002,CDM,,,,,,both,,,1568.1000,235.2200,CIGNA HEALTHCARE,CIGNA PPO,653.90,,,,,,,404.7300,1568.1000,percent of total billed charges,"41.7% of $1,568.10 in Billed Charges for Rev 272 = $653.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 CURVED-TIP BOX OF 50,272,RC,27200002,CDM,,,,,,both,,,1568.1000,235.2200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1411.29,,,,,,,404.7300,1568.1000,percent of total billed charges,"90% of $1,568.10 in Billed Charges for Rev 272 = $1,411.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 CURVED-TIP BOX OF 50,272,RC,27200002,CDM,,,,,,both,,,1568.1000,235.2200,MEDCOST,MEDCOST VHN,746.26,,,,,,,404.7300,1568.1000,percent of total billed charges,"47.59% of $1,568.10 in Billed Charges for Rev 272 = $746.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 CURVED-TIP BOX OF 50,272,RC,27200002,CDM,,,,,,both,,,1568.1000,235.2200,SENTARA HEALTH,SENTARA HEALTH,404.73,,,,,,,404.7300,1568.1000,percent of total billed charges,"25.81% of $1,568.10 in Billed Charges for Rev 272 = $404.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 CURVED-TIP BOX OF 50,272,RC,27200002,CDM,,,,,,both,,,1568.1000,235.2200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1568.10,,,,,,,404.7300,1568.1000,percent of total billed charges,"100% of $1,568.10 in Billed Charges for Rev 272 = $1,568.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 CURVED-TIP BOX OF 50,272,RC,27200002,CDM,,,,,,both,,,1568.1000,235.2200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,784.05,,,,,,,404.7300,1568.1000,percent of total billed charges,"Rev 272 $1,568.10 in Billed Charges at 50% = $784.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 CURVED-TIP BOX OF 50,272,RC,27200002,CDM,,,,,,both,,,1568.1000,235.2200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,506.50,,,,,,,404.7300,1568.1000,other,"32.3% of $1,568.10 in Billed Charges for Rev 272 = $506.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
XI STAPLER 30 CURVED-TIP BOX OF 50,272,RC,27200002,CDM,,,,,,both,,,1568.1000,235.2200,UNITED HEALTHCARE,UHC HERITAGE SELECT,481.41,,,,,,,404.7300,1568.1000,other,"30.7% of $1,568.10 in Billed Charges for Rev 272 = $481.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
XI STAPLER 30 CURVED-TIP BOX OF 50,272,RC,27200002,CDM,,,,,,both,,,1568.1000,235.2200,UNITED HEALTHCARE,UNITED HEALTHCARE,506.50,,,,,,,404.7300,1568.1000,percent of total billed charges,"32.3% of $1,568.10 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 CURVED-TIP BOX OF 50,272,RC,27200002,CDM,,,,,,both,,,1568.1000,235.2200,WELLCARE,WELLCARE MEDICAID,1568.10,,,,,,,404.7300,1568.1000,percent of total billed charges,"100% of $1,568.10 in Billed Charges for Rev 272 = $1,568.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1480.9800,222.1500,AETNA,AETNA,632.38,,,,,,,382.2400,1480.9800,percent of total billed charges,"42.7% of $1,480.98 in Billed Charges for Rev 272 = $632.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1480.9800,222.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1036.69,,,,,,,382.2400,1480.9800,percent of total billed charges,"Rev 272 $1,480.98 in Billed Charges at 70% = $1,036.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1480.9800,222.1500,CIGNA HEALTHCARE,CIGNA HMO,617.57,,,,,,,382.2400,1480.9800,percent of total billed charges,"41.7% of $1,480.98 in Billed Charges for Rev 272 = $617.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1480.9800,222.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,687.17,,,,,,,382.2400,1480.9800,percent of total billed charges,"46.4% of $1,480.98 in Billed Charges for Rev 272 = $687.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1480.9800,222.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,617.57,,,,,,,382.2400,1480.9800,percent of total billed charges,"41.7% of $1,480.98 in Billed Charges for Rev 272 = $617.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1480.9800,222.1500,CIGNA HEALTHCARE,CIGNA PPO,617.57,,,,,,,382.2400,1480.9800,percent of total billed charges,"41.7% of $1,480.98 in Billed Charges for Rev 272 = $617.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1480.9800,222.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1332.88,,,,,,,382.2400,1480.9800,percent of total billed charges,"90% of $1,480.98 in Billed Charges for Rev 272 = $1,332.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1480.9800,222.1500,MEDCOST,MEDCOST VHN,704.80,,,,,,,382.2400,1480.9800,percent of total billed charges,"47.59% of $1,480.98 in Billed Charges for Rev 272 = $704.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1480.9800,222.1500,SENTARA HEALTH,SENTARA HEALTH,382.24,,,,,,,382.2400,1480.9800,percent of total billed charges,"25.81% of $1,480.98 in Billed Charges for Rev 272 = $382.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1480.9800,222.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1480.98,,,,,,,382.2400,1480.9800,percent of total billed charges,"100% of $1,480.98 in Billed Charges for Rev 272 = $1,480.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1480.9800,222.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,740.49,,,,,,,382.2400,1480.9800,percent of total billed charges,"Rev 272 $1,480.98 in Billed Charges at 50% = $740.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1480.9800,222.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,478.36,,,,,,,382.2400,1480.9800,other,"32.3% of $1,480.98 in Billed Charges for Rev 272 = $478.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
XI STAPLER 30 DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1480.9800,222.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,454.66,,,,,,,382.2400,1480.9800,other,"30.7% of $1,480.98 in Billed Charges for Rev 272 = $454.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
XI STAPLER 30 DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1480.9800,222.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,478.36,,,,,,,382.2400,1480.9800,percent of total billed charges,"32.3% of $1,480.98 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER 30 DA VINCI,272,RC,27200002,CDM,,,,,,both,,,1480.9800,222.1500,WELLCARE,WELLCARE MEDICAID,1480.98,,,,,,,382.2400,1480.9800,percent of total billed charges,"100% of $1,480.98 in Billed Charges for Rev 272 = $1,480.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER SUREFORM 60 480460,272,RC,27200002,CDM,,,,,,both,,,5771.4600,865.7200,AETNA,AETNA,2464.41,,,,,,,1489.6100,5771.4600,percent of total billed charges,"42.7% of $5,771.46 in Billed Charges for Rev 272 = $2,464.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER SUREFORM 60 480460,272,RC,27200002,CDM,,,,,,both,,,5771.4600,865.7200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4040.02,,,,,,,1489.6100,5771.4600,percent of total billed charges,"Rev 272 $5,771.46 in Billed Charges at 70% = $4,040.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER SUREFORM 60 480460,272,RC,27200002,CDM,,,,,,both,,,5771.4600,865.7200,CIGNA HEALTHCARE,CIGNA HMO,2406.70,,,,,,,1489.6100,5771.4600,percent of total billed charges,"41.7% of $5,771.46 in Billed Charges for Rev 272 = $2,406.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER SUREFORM 60 480460,272,RC,27200002,CDM,,,,,,both,,,5771.4600,865.7200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2677.96,,,,,,,1489.6100,5771.4600,percent of total billed charges,"46.4% of $5,771.46 in Billed Charges for Rev 272 = $2,677.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER SUREFORM 60 480460,272,RC,27200002,CDM,,,,,,both,,,5771.4600,865.7200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2406.70,,,,,,,1489.6100,5771.4600,percent of total billed charges,"41.7% of $5,771.46 in Billed Charges for Rev 272 = $2,406.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER SUREFORM 60 480460,272,RC,27200002,CDM,,,,,,both,,,5771.4600,865.7200,CIGNA HEALTHCARE,CIGNA PPO,2406.70,,,,,,,1489.6100,5771.4600,percent of total billed charges,"41.7% of $5,771.46 in Billed Charges for Rev 272 = $2,406.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER SUREFORM 60 480460,272,RC,27200002,CDM,,,,,,both,,,5771.4600,865.7200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5194.31,,,,,,,1489.6100,5771.4600,percent of total billed charges,"90% of $5,771.46 in Billed Charges for Rev 272 = $5,194.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER SUREFORM 60 480460,272,RC,27200002,CDM,,,,,,both,,,5771.4600,865.7200,MEDCOST,MEDCOST VHN,2746.64,,,,,,,1489.6100,5771.4600,percent of total billed charges,"47.59% of $5,771.46 in Billed Charges for Rev 272 = $2,746.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER SUREFORM 60 480460,272,RC,27200002,CDM,,,,,,both,,,5771.4600,865.7200,SENTARA HEALTH,SENTARA HEALTH,1489.61,,,,,,,1489.6100,5771.4600,percent of total billed charges,"25.81% of $5,771.46 in Billed Charges for Rev 272 = $1,489.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER SUREFORM 60 480460,272,RC,27200002,CDM,,,,,,both,,,5771.4600,865.7200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5771.46,,,,,,,1489.6100,5771.4600,percent of total billed charges,"100% of $5,771.46 in Billed Charges for Rev 272 = $5,771.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER SUREFORM 60 480460,272,RC,27200002,CDM,,,,,,both,,,5771.4600,865.7200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2885.73,,,,,,,1489.6100,5771.4600,percent of total billed charges,"Rev 272 $5,771.46 in Billed Charges at 50% = $2,885.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER SUREFORM 60 480460,272,RC,27200002,CDM,,,,,,both,,,5771.4600,865.7200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1864.18,,,,,,,1489.6100,5771.4600,other,"32.3% of $5,771.46 in Billed Charges for Rev 272 = $1,864.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
XI STAPLER SUREFORM 60 480460,272,RC,27200002,CDM,,,,,,both,,,5771.4600,865.7200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1771.84,,,,,,,1489.6100,5771.4600,other,"30.7% of $5,771.46 in Billed Charges for Rev 272 = $1,771.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
XI STAPLER SUREFORM 60 480460,272,RC,27200002,CDM,,,,,,both,,,5771.4600,865.7200,UNITED HEALTHCARE,UNITED HEALTHCARE,1864.18,,,,,,,1489.6100,5771.4600,percent of total billed charges,"32.3% of $5,771.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
XI STAPLER SUREFORM 60 480460,272,RC,27200002,CDM,,,,,,both,,,5771.4600,865.7200,WELLCARE,WELLCARE MEDICAID,5771.46,,,,,,,1489.6100,5771.4600,percent of total billed charges,"100% of $5,771.46 in Billed Charges for Rev 272 = $5,771.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,AETNA,AETNA,78.14,,,,,,,17.1000,183.0000,percent of total billed charges,42.7% of $183.00 in Billed Charges for Rev 301 Proc 0024U = $78.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,33.15,,,,,,,17.1000,183.0000,fee schedule,APG 00401 Proc 0024U at $836.60 (Base Rate) * 0.0381 (Relative Weight) = $31.87 (Total Line Payment) at 104% = $33.15. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,34.19,,,,,,,17.1000,183.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,AETNA,AETNA HEALTHCARE MEDICARE,34.19,,,,,,,17.1000,183.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,34.19,,,,,,,17.1000,183.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,AMBETTER,AMBETTER,74.53,,,,,,,17.1000,183.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,AMERIGROUP,AMERIGROUP,17.10,,,,,,,17.1000,183.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,35.56,,,,,,,17.1000,183.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,BLUE CROSS,ANTHEM EXCHANGE,34.19,,,,,,,17.1000,183.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,32.83,,,,,,,17.1000,183.0000,fee schedule,APG 00401 Proc 0024U at $836.60 (Base Rate) * 0.0381 (Relative Weight) = $31.87 (Total Line Payment) at 103% = $32.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,BLUE CROSS,ANTHEM HMO,34.19,,,,,,,17.1000,183.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,35.22,,,,,,,17.1000,183.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",34.19,,,,,,,17.1000,183.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,128.10,,,,,,,17.1000,183.0000,percent of total billed charges,Rev 301 Proc 0024U $183.00 in Billed Charges at 70% = $128.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,BLUE CROSS,BLUE CROSS E NETWORK,112.19,,,,,,,17.1000,183.0000,fee schedule,$35.06 from Fee Schedule BCFSB for Rev 301 Proc 0024U * Qty 1 = $35.06 at 320% = $112.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,BLUE CROSS,BLUE CROSS MEDICARE,35.56,,,,,,,17.1000,183.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,BLUE CROSS,BLUE CROSS P NETWORK,114.65,,,,,,,17.1000,183.0000,fee schedule,$35.06 from Fee Schedule BCFSB for Rev 301 Proc 0024U * Qty 1 = $35.06 at 327% = $114.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,BLUE CROSS,BLUE CROSS S NETWORK,114.65,,,,,,,17.1000,183.0000,fee schedule,$35.06 from Fee Schedule BCFSB for Rev 301 Proc 0024U * Qty 1 = $35.06 at 327% = $114.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,CIGNA HEALTHCARE,CIGNA HMO,76.31,,,,,,,17.1000,183.0000,percent of total billed charges,Rev 301 Proc 0024U $183.00 in Billed Charges at 41.7% = $76.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,75.07,,,,,,,17.1000,183.0000,fee schedule,$75.07 from Fee Schedule CGIFP_25LR for Rev 301 Proc 0024U * Qty 1 = $75.07 at 100% = $75.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,35.90,,,,,,,17.1000,183.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,76.31,,,,,,,17.1000,183.0000,percent of total billed charges,Rev 301 Proc 0024U $183.00 in Billed Charges at 41.7% = $76.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,CIGNA HEALTHCARE,CIGNA PPO,76.31,,,,,,,17.1000,183.0000,percent of total billed charges,Rev 301 Proc 0024U $183.00 in Billed Charges at 41.7% = $76.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,35.90,,,,,,,17.1000,183.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,164.70,,,,,,,17.1000,183.0000,percent of total billed charges,90% of $183.00 in Billed Charges for Rev 301 Proc 0024U = $164.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,HUMANA,HUMANA MEDICARE,34.19,,,,,,,17.1000,183.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,34.19,,,,,,,17.1000,183.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,MEDCOST,MEDCOST VHN,87.09,,,,,,,17.1000,183.0000,percent of total billed charges,47.59% of $183.00 in Billed Charges for Rev 301 Proc 0024U = $87.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,33.46,,,,,,,17.1000,183.0000,fee schedule,APG 00401 Proc 0024U at $836.60 (Base Rate) * 0.0381 (Relative Weight) = $31.87 (Total Line Payment) at 100% = $31.87... $31.87 at 105% = $33.46 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,35.90,,,,,,,17.1000,183.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,35.90,,,,,,,17.1000,183.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,NHC ADVANTAGE,NHC ADVANTAGE,35.90,,,,,,,17.1000,183.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,32.86,,,,,,,17.1000,183.0000,fee schedule,APG 00401 Proc 0024U at $836.60 (Base Rate) * 0.0381 (Relative Weight) = $31.87 (Total Line Payment) at 100% = $31.87... $31.87 at 103.1% = $32.86 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,SENTARA HEALTH,SENTARA HEALTH,47.23,,,,,,,17.1000,183.0000,percent of total billed charges,25.81% of $183.00 in Billed Charges for Rev 301 Proc 0024U = $47.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,SENTARA HEALTH,SENTARA MEDICARE,34.19,,,,,,,17.1000,183.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",183.00,,,,,,,17.1000,183.0000,percent of total billed charges,100% of $183.00 in Billed Charges for Rev 301 Proc 0024U = $183.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,17.53,,,,,,,17.1000,183.0000,fee schedule,$35.06 from Fee Schedule TCUHC24 for Rev 301 Proc 0024U * Qty 1 = $35.06 at 50% = $17.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,35.56,,,,,,,17.1000,183.0000,fee schedule,$34.19 from Fee Schedule UHC_31910 for Rev 301 Proc 0024U * Qty 1 = $34.19 at 104% = $35.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,34.19,,,,,,,17.1000,183.0000,fee schedule,$34.19 from Fee Schedule UHC_31910 for Rev 301 Proc 0024U * Qty 1 = $34.19 at 100% = $34.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,34.19,,,,,,,17.1000,183.0000,fee schedule,$34.19 from Fee Schedule UHC_31910 for Rev 301 Proc 0024U * Qty 1 = $34.19 at 100% = $34.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,32.83,,,,,,,17.1000,183.0000,fee schedule,APG 00401 Proc 0024U at $836.60 (Base Rate) * 0.0381 (Relative Weight) = $31.87 (Total Line Payment) at 103% = $32.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,34.19,,,,,,,17.1000,183.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,34.19,,,,,,,17.1000,183.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,WELLCARE,WELLCARE MEDICAID,183.00,,,,,,,17.1000,183.0000,percent of total billed charges,100% of $183.00 in Billed Charges for Rev 301 Proc 0024U = $183.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC GLYCA NUC MR SPECTROSCOPY QUANTITATIVE,0024U,CPT,301,RC,30100541,CDM,,,,both,,,183.0000,27.4500,WELLCARE,WELLCARE MEDICARE,36.24,,,,,,,17.1000,183.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD PERFUSION W CON,0042T,CPT,351,RC,35100016,CDM,,,,both,,,12263.0000,1839.4500,AETNA,AETNA,5236.30,,,,,,,321.5100,12263.0000,percent of total billed charges,"42.7% of $12,263.00 in Billed Charges for Rev 351 Proc 0042T = $5,236.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT HEAD PERFUSION W CON,0042T,CPT,351,RC,35100016,CDM,,,,both,,,12263.0000,1839.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,459.22,,,,,,,321.5100,12263.0000,fee schedule,APG 00300 Proc 0042T at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 104% = $459.22. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD PERFUSION W CON,0042T,CPT,351,RC,35100016,CDM,,,,both,,,12263.0000,1839.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,454.80,,,,,,,321.5100,12263.0000,fee schedule,APG 00300 Proc 0042T at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 103% = $454.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD PERFUSION W CON,0042T,CPT,351,RC,35100016,CDM,,,,both,,,12263.0000,1839.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8584.10,,,,,,,321.5100,12263.0000,percent of total billed charges,"Rev 351 Proc 0042T $12,263.00 in Billed Charges at 70% = $8,584.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT HEAD PERFUSION W CON,0042T,CPT,351,RC,35100016,CDM,,,,both,,,12263.0000,1839.4500,BLUE CROSS,BLUE CROSS E NETWORK,1091.65,,,,,,,321.5100,12263.0000,fee schedule,"$341.14 from Fee Schedule BCFSD for Rev 351 Proc 0042T * Qty 1 = $341.14 at 320% = $1,091.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT HEAD PERFUSION W CON,0042T,CPT,351,RC,35100016,CDM,,,,both,,,12263.0000,1839.4500,BLUE CROSS,BLUE CROSS P NETWORK,1115.53,,,,,,,321.5100,12263.0000,fee schedule,"$341.14 from Fee Schedule BCFSD for Rev 351 Proc 0042T * Qty 1 = $341.14 at 327% = $1,115.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT HEAD PERFUSION W CON,0042T,CPT,351,RC,35100016,CDM,,,,both,,,12263.0000,1839.4500,BLUE CROSS,BLUE CROSS S NETWORK,1115.53,,,,,,,321.5100,12263.0000,fee schedule,"$341.14 from Fee Schedule BCFSD for Rev 351 Proc 0042T * Qty 1 = $341.14 at 327% = $1,115.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT HEAD PERFUSION W CON,0042T,CPT,351,RC,35100016,CDM,,,,both,,,12263.0000,1839.4500,BLUE CROSS,TENNCARE BLUE CARE,321.51,,,,,,,321.5100,12263.0000,fee schedule,$277.16 from Fee Schedule TC_24 for Rev 351 Proc 0042T * Qty 1 = $277.16 at 116% = $321.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD PERFUSION W CON,0042T,CPT,351,RC,35100016,CDM,,,,both,,,12263.0000,1839.4500,BLUE CROSS,TENNCARE BLUE SELECT,321.51,,,,,,,321.5100,12263.0000,fee schedule,$277.16 from Fee Schedule TC_24 for Rev 351 Proc 0042T * Qty 1 = $277.16 at 116% = $321.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD PERFUSION W CON,0042T,CPT,351,RC,35100016,CDM,,,,both,,,12263.0000,1839.4500,CIGNA HEALTHCARE,CIGNA HMO,642.00,,,,,,,321.5100,12263.0000,other,Rev 351 Proc 0042T Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD PERFUSION W CON,0042T,CPT,351,RC,35100016,CDM,,,,both,,,12263.0000,1839.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,427.00,,,,,,,321.5100,12263.0000,other,Rev 351 Proc 0042T Qty 1 * $427.00 = $427.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD PERFUSION W CON,0042T,CPT,351,RC,35100016,CDM,,,,both,,,12263.0000,1839.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,642.00,,,,,,,321.5100,12263.0000,other,Rev 351 Proc 0042T Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD PERFUSION W CON,0042T,CPT,351,RC,35100016,CDM,,,,both,,,12263.0000,1839.4500,CIGNA HEALTHCARE,CIGNA PPO,642.00,,,,,,,321.5100,12263.0000,other,Rev 351 Proc 0042T Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD PERFUSION W CON,0042T,CPT,351,RC,35100016,CDM,,,,both,,,12263.0000,1839.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11036.70,,,,,,,321.5100,12263.0000,percent of total billed charges,"90% of $12,263.00 in Billed Charges for Rev 351 Proc 0042T = $11,036.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT HEAD PERFUSION W CON,0042T,CPT,351,RC,35100016,CDM,,,,both,,,12263.0000,1839.4500,MEDCOST,MEDCOST VHN,5835.96,,,,,,,321.5100,12263.0000,percent of total billed charges,"47.59% of $12,263.00 in Billed Charges for Rev 351 Proc 0042T = $5,835.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT HEAD PERFUSION W CON,0042T,CPT,351,RC,35100016,CDM,,,,both,,,12263.0000,1839.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,463.64,,,,,,,321.5100,12263.0000,fee schedule,APG 00300 Proc 0042T at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 100% = $441.56... $441.56 at 105% = $463.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD PERFUSION W CON,0042T,CPT,351,RC,35100016,CDM,,,,both,,,12263.0000,1839.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,455.25,,,,,,,321.5100,12263.0000,fee schedule,APG 00300 Proc 0042T at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 100% = $441.56... $441.56 at 103.1% = $455.25 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD PERFUSION W CON,0042T,CPT,351,RC,35100016,CDM,,,,both,,,12263.0000,1839.4500,SENTARA HEALTH,SENTARA HEALTH,3165.08,,,,,,,321.5100,12263.0000,percent of total billed charges,"25.81% of $12,263.00 in Billed Charges for Rev 351 Proc 0042T = $3,165.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT HEAD PERFUSION W CON,0042T,CPT,351,RC,35100016,CDM,,,,both,,,12263.0000,1839.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12263.00,,,,,,,321.5100,12263.0000,percent of total billed charges,"100% of $12,263.00 in Billed Charges for Rev 351 Proc 0042T = $12,263.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT HEAD PERFUSION W CON,0042T,CPT,351,RC,35100016,CDM,,,,both,,,12263.0000,1839.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1919.00,,,,,,,321.5100,12263.0000,other,"Rev 351 Proc 0042T 1 Visit at $1,919.00 per Visit = $1,919.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT HEAD PERFUSION W CON,0042T,CPT,351,RC,35100016,CDM,,,,both,,,12263.0000,1839.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1835.00,,,,,,,321.5100,12263.0000,other,"Rev 351 Proc 0042T 1 Visit at $1,835.00 per Visit = $1,835.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT HEAD PERFUSION W CON,0042T,CPT,351,RC,35100016,CDM,,,,both,,,12263.0000,1839.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,3026.00,,,,,,,321.5100,12263.0000,other,"Rev 351 Proc 0042T 1 Visit at $3,026.00 per Visit = $3,026.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT HEAD PERFUSION W CON,0042T,CPT,351,RC,35100016,CDM,,,,both,,,12263.0000,1839.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,454.80,,,,,,,321.5100,12263.0000,fee schedule,APG 00300 Proc 0042T at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 103% = $454.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT HEAD PERFUSION W CON,0042T,CPT,351,RC,35100016,CDM,,,,both,,,12263.0000,1839.4500,WELLCARE,WELLCARE MEDICAID,12263.00,,,,,,,321.5100,12263.0000,percent of total billed charges,"100% of $12,263.00 in Billed Charges for Rev 351 Proc 0042T = $12,263.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,AETNA,AETNA,8461.01,,,,,,,608.2600,19815.0000,percent of total billed charges,"42.7% of $19,815.00 in Billed Charges for Rev 481 Proc 0075T = $8,461.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,9404.09,,,,,,,608.2600,19815.0000,fee schedule,"APG 00079 Proc 0075T at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 104% = $9,404.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,BLUE CROSS,ANTHEM EXCHANGE,1385.82,,,,,,,608.2600,19815.0000,fee schedule,"$693.36 from Fee Schedule ANT_C_APC for Rev 481 Proc 0075T * Qty 1 = $693.36 at 199.87% = $1,385.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,9313.66,,,,,,,608.2600,19815.0000,fee schedule,"APG 00079 Proc 0075T at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 103% = $9,313.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,BLUE CROSS,ANTHEM HMO,1472.35,,,,,,,608.2600,19815.0000,fee schedule,"$693.36 from Fee Schedule ANT_C_APC for Rev 481 Proc 0075T * Qty 1 = $693.36 at 212.35% = $1,472.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1732.08,,,,,,,608.2600,19815.0000,fee schedule,"$693.36 from Fee Schedule ANT_C_APC for Rev 481 Proc 0075T * Qty 1 = $693.36 at 249.81% = $1,732.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,608.26,,,,,,,608.2600,19815.0000,fee schedule,$608.26 from Fee Schedule BLDTM_23 for Rev 481 Proc 0075T * Qty 1 = $608.26 at 100% = $608.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,608.2600,19815.0000,case rate,"Rev 481 Proc 0075T ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,608.2600,19815.0000,case rate,"Rev 481 Proc 0075T ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,608.2600,19815.0000,case rate,"Rev 481 Proc 0075T ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,BLUE CROSS,TENNCARE BLUE CARE,662.04,,,,,,,608.2600,19815.0000,fee schedule,$570.72 from Fee Schedule TC_24 for Rev 481 Proc 0075T * Qty 1 = $570.72 at 116% = $662.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,BLUE CROSS,TENNCARE BLUE SELECT,662.04,,,,,,,608.2600,19815.0000,fee schedule,$570.72 from Fee Schedule TC_24 for Rev 481 Proc 0075T * Qty 1 = $570.72 at 116% = $662.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,CIGNA HEALTHCARE,CIGNA HMO,8262.86,,,,,,,608.2600,19815.0000,percent of total billed charges,"41.7% of $19,815.00 in Billed Charges for Rev 481 Proc 0075T = $8,262.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,9194.16,,,,,,,608.2600,19815.0000,percent of total billed charges,"46.4% of $19,815.00 in Billed Charges for Rev 481 Proc 0075T = $9,194.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8262.86,,,,,,,608.2600,19815.0000,percent of total billed charges,"41.7% of $19,815.00 in Billed Charges for Rev 481 Proc 0075T = $8,262.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,CIGNA HEALTHCARE,CIGNA PPO,8262.86,,,,,,,608.2600,19815.0000,percent of total billed charges,"41.7% of $19,815.00 in Billed Charges for Rev 481 Proc 0075T = $8,262.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,17833.50,,,,,,,608.2600,19815.0000,percent of total billed charges,"90% of $19,815.00 in Billed Charges for Rev 481 Proc 0075T = $17,833.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,MEDCOST,MEDCOST VHN,9429.96,,,,,,,608.2600,19815.0000,percent of total billed charges,"47.59% of $19,815.00 in Billed Charges for Rev 481 Proc 0075T = $9,429.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,9494.51,,,,,,,608.2600,19815.0000,fee schedule,"APG 00079 Proc 0075T at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 100% = $9,042.39... $9,042.39 at 105% = $9,494.51 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,9322.70,,,,,,,608.2600,19815.0000,fee schedule,"APG 00079 Proc 0075T at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 100% = $9,042.39... $9,042.39 at 103.1% = $9,322.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,SENTARA HEALTH,SENTARA HEALTH,5114.25,,,,,,,608.2600,19815.0000,percent of total billed charges,"25.81% of $19,815.00 in Billed Charges for Rev 481 Proc 0075T = $5,114.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",19815.00,,,,,,,608.2600,19815.0000,percent of total billed charges,"100% of $19,815.00 in Billed Charges for Rev 481 Proc 0075T = $19,815.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,608.2600,19815.0000,case rate,Rev 481 Proc 0075T ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,608.2600,19815.0000,case rate,"Rev 481 Proc 0075T ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,608.2600,19815.0000,case rate,"Rev 481 Proc 0075T ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,608.2600,19815.0000,case rate,"Rev 481 Proc 0075T ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,9313.66,,,,,,,608.2600,19815.0000,fee schedule,"APG 00079 Proc 0075T at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 103% = $9,313.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLC VERT/THORAC 1ST VES,0075T,CPT,481,RC,48100122,CDM,,,,both,,,19815.0000,2972.2500,WELLCARE,WELLCARE MEDICAID,19815.00,,,,,,,608.2600,19815.0000,percent of total billed charges,"100% of $19,815.00 in Billed Charges for Rev 481 Proc 0075T = $19,815.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH PLCMT EXTRACR VERT ART STENT OPEN/PERCU RS&I INIT VESSEL,0075T,CPT,361,RC,36100363,CDM,,,,both,,,18915.0000,2837.2500,AETNA,AETNA,8076.71,,,,,,,890.0000,18915.0000,percent of total billed charges,"42.7% of $18,915.00 in Billed Charges for Rev 361 Proc 0075T = $8,076.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH PLCMT EXTRACR VERT ART STENT OPEN/PERCU RS&I INIT VESSEL,0075T,CPT,361,RC,36100363,CDM,,,,both,,,18915.0000,2837.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,9404.09,,,,,,,890.0000,18915.0000,fee schedule,"APG 00079 Proc 0075T at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 104% = $9,404.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH PLCMT EXTRACR VERT ART STENT OPEN/PERCU RS&I INIT VESSEL,0075T,CPT,361,RC,36100363,CDM,,,,both,,,18915.0000,2837.2500,BLUE CROSS,ANTHEM EXCHANGE,1385.82,,,,,,,890.0000,18915.0000,fee schedule,"$693.36 from Fee Schedule ANT_C_APC for Rev 361 Proc 0075T * Qty 1 = $693.36 at 199.87% = $1,385.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH PLCMT EXTRACR VERT ART STENT OPEN/PERCU RS&I INIT VESSEL,0075T,CPT,361,RC,36100363,CDM,,,,both,,,18915.0000,2837.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,9313.66,,,,,,,890.0000,18915.0000,fee schedule,"APG 00079 Proc 0075T at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 103% = $9,313.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH PLCMT EXTRACR VERT ART STENT OPEN/PERCU RS&I INIT VESSEL,0075T,CPT,361,RC,36100363,CDM,,,,both,,,18915.0000,2837.2500,BLUE CROSS,ANTHEM HMO,1472.35,,,,,,,890.0000,18915.0000,fee schedule,"$693.36 from Fee Schedule ANT_C_APC for Rev 361 Proc 0075T * Qty 1 = $693.36 at 212.35% = $1,472.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH PLCMT EXTRACR VERT ART STENT OPEN/PERCU RS&I INIT VESSEL,0075T,CPT,361,RC,36100363,CDM,,,,both,,,18915.0000,2837.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1732.08,,,,,,,890.0000,18915.0000,fee schedule,"$693.36 from Fee Schedule ANT_C_APC for Rev 361 Proc 0075T * Qty 1 = $693.36 at 249.81% = $1,732.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH PLCMT EXTRACR VERT ART STENT OPEN/PERCU RS&I INIT VESSEL,0075T,CPT,361,RC,36100363,CDM,,,,both,,,18915.0000,2837.2500,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,890.0000,18915.0000,case rate,"Rev 361 Proc 0075T ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH PLCMT EXTRACR VERT ART STENT OPEN/PERCU RS&I INIT VESSEL,0075T,CPT,361,RC,36100363,CDM,,,,both,,,18915.0000,2837.2500,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,890.0000,18915.0000,case rate,"Rev 361 Proc 0075T ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH PLCMT EXTRACR VERT ART STENT OPEN/PERCU RS&I INIT VESSEL,0075T,CPT,361,RC,36100363,CDM,,,,both,,,18915.0000,2837.2500,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,890.0000,18915.0000,case rate,"Rev 361 Proc 0075T ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH PLCMT EXTRACR VERT ART STENT OPEN/PERCU RS&I INIT VESSEL,0075T,CPT,361,RC,36100363,CDM,,,,both,,,18915.0000,2837.2500,BLUE CROSS,TENNCARE BLUE CARE,890.00,,,,,,,890.0000,18915.0000,case rate,Rev 361 Proc 0075T ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH PLCMT EXTRACR VERT ART STENT OPEN/PERCU RS&I INIT VESSEL,0075T,CPT,361,RC,36100363,CDM,,,,both,,,18915.0000,2837.2500,BLUE CROSS,TENNCARE BLUE SELECT,890.00,,,,,,,890.0000,18915.0000,case rate,Rev 361 Proc 0075T ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH PLCMT EXTRACR VERT ART STENT OPEN/PERCU RS&I INIT VESSEL,0075T,CPT,361,RC,36100363,CDM,,,,both,,,18915.0000,2837.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,17023.50,,,,,,,890.0000,18915.0000,percent of total billed charges,"90% of $18,915.00 in Billed Charges for Rev 361 Proc 0075T = $17,023.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH PLCMT EXTRACR VERT ART STENT OPEN/PERCU RS&I INIT VESSEL,0075T,CPT,361,RC,36100363,CDM,,,,both,,,18915.0000,2837.2500,MEDCOST,MEDCOST VHN,9001.65,,,,,,,890.0000,18915.0000,percent of total billed charges,"47.59% of $18,915.00 in Billed Charges for Rev 361 Proc 0075T = $9,001.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH PLCMT EXTRACR VERT ART STENT OPEN/PERCU RS&I INIT VESSEL,0075T,CPT,361,RC,36100363,CDM,,,,both,,,18915.0000,2837.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,9494.51,,,,,,,890.0000,18915.0000,fee schedule,"APG 00079 Proc 0075T at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 100% = $9,042.39... $9,042.39 at 105% = $9,494.51 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH PLCMT EXTRACR VERT ART STENT OPEN/PERCU RS&I INIT VESSEL,0075T,CPT,361,RC,36100363,CDM,,,,both,,,18915.0000,2837.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,9322.70,,,,,,,890.0000,18915.0000,fee schedule,"APG 00079 Proc 0075T at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 100% = $9,042.39... $9,042.39 at 103.1% = $9,322.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH PLCMT EXTRACR VERT ART STENT OPEN/PERCU RS&I INIT VESSEL,0075T,CPT,361,RC,36100363,CDM,,,,both,,,18915.0000,2837.2500,SENTARA HEALTH,SENTARA HEALTH,4881.96,,,,,,,890.0000,18915.0000,percent of total billed charges,"25.81% of $18,915.00 in Billed Charges for Rev 361 Proc 0075T = $4,881.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH PLCMT EXTRACR VERT ART STENT OPEN/PERCU RS&I INIT VESSEL,0075T,CPT,361,RC,36100363,CDM,,,,both,,,18915.0000,2837.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",18915.00,,,,,,,890.0000,18915.0000,percent of total billed charges,"100% of $18,915.00 in Billed Charges for Rev 361 Proc 0075T = $18,915.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH PLCMT EXTRACR VERT ART STENT OPEN/PERCU RS&I INIT VESSEL,0075T,CPT,361,RC,36100363,CDM,,,,both,,,18915.0000,2837.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,890.0000,18915.0000,case rate,Rev 361 Proc 0075T ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH PLCMT EXTRACR VERT ART STENT OPEN/PERCU RS&I INIT VESSEL,0075T,CPT,361,RC,36100363,CDM,,,,both,,,18915.0000,2837.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,890.0000,18915.0000,case rate,"Rev 361 Proc 0075T ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH PLCMT EXTRACR VERT ART STENT OPEN/PERCU RS&I INIT VESSEL,0075T,CPT,361,RC,36100363,CDM,,,,both,,,18915.0000,2837.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,890.0000,18915.0000,case rate,"Rev 361 Proc 0075T ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH PLCMT EXTRACR VERT ART STENT OPEN/PERCU RS&I INIT VESSEL,0075T,CPT,361,RC,36100363,CDM,,,,both,,,18915.0000,2837.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,890.0000,18915.0000,case rate,"Rev 361 Proc 0075T ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH PLCMT EXTRACR VERT ART STENT OPEN/PERCU RS&I INIT VESSEL,0075T,CPT,361,RC,36100363,CDM,,,,both,,,18915.0000,2837.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,9313.66,,,,,,,890.0000,18915.0000,fee schedule,"APG 00079 Proc 0075T at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 103% = $9,313.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH PLCMT EXTRACR VERT ART STENT OPEN/PERCU RS&I INIT VESSEL,0075T,CPT,361,RC,36100363,CDM,,,,both,,,18915.0000,2837.2500,WELLCARE,WELLCARE MEDICAID,18915.00,,,,,,,890.0000,18915.0000,percent of total billed charges,"100% of $18,915.00 in Billed Charges for Rev 361 Proc 0075T = $18,915.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,AETNA,AETNA,2629.89,,,,,,,360.0000,6159.0000,percent of total billed charges,"42.7% of $6,159.00 in Billed Charges for Rev 300 Proc 0084U = $2,629.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,771.31,,,,,,,360.0000,6159.0000,fee schedule,APG 02044 Proc 0084U at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 104% = $771.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,720.00,,,,,,,360.0000,6159.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,AETNA,AETNA HEALTHCARE MEDICARE,720.00,,,,,,,360.0000,6159.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,720.00,,,,,,,360.0000,6159.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,AMBETTER,AMBETTER,1569.60,,,,,,,360.0000,6159.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,AMERIGROUP,AMERIGROUP,360.00,,,,,,,360.0000,6159.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,748.80,,,,,,,360.0000,6159.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,BLUE CROSS,ANTHEM EXCHANGE,720.00,,,,,,,360.0000,6159.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,763.90,,,,,,,360.0000,6159.0000,fee schedule,APG 02044 Proc 0084U at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 103% = $763.90. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,BLUE CROSS,ANTHEM HMO,720.00,,,,,,,360.0000,6159.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,741.60,,,,,,,360.0000,6159.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",720.00,,,,,,,360.0000,6159.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4311.30,,,,,,,360.0000,6159.0000,percent of total billed charges,"Rev 300 Proc 0084U $6,159.00 in Billed Charges at 70% = $4,311.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,BLUE CROSS,BLUE CROSS E NETWORK,2304.00,,,,,,,360.0000,6159.0000,fee schedule,"$720.00 from Fee Schedule BCFSB for Rev 300 Proc 0084U * Qty 1 = $720.00 at 320% = $2,304.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,BLUE CROSS,BLUE CROSS MEDICARE,748.80,,,,,,,360.0000,6159.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,BLUE CROSS,BLUE CROSS P NETWORK,2354.40,,,,,,,360.0000,6159.0000,fee schedule,"$720.00 from Fee Schedule BCFSB for Rev 300 Proc 0084U * Qty 1 = $720.00 at 327% = $2,354.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,BLUE CROSS,BLUE CROSS S NETWORK,2354.40,,,,,,,360.0000,6159.0000,fee schedule,"$720.00 from Fee Schedule BCFSB for Rev 300 Proc 0084U * Qty 1 = $720.00 at 327% = $2,354.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,CIGNA HEALTHCARE,CIGNA HMO,2568.30,,,,,,,360.0000,6159.0000,percent of total billed charges,"Rev 300 Proc 0084U $6,159.00 in Billed Charges at 41.7% = $2,568.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1587.19,,,,,,,360.0000,6159.0000,fee schedule,"$1,587.19 from Fee Schedule CGIFP_25LR for Rev 300 Proc 0084U * Qty 1 = $1,587.19 at 100% = $1,587.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,756.00,,,,,,,360.0000,6159.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2568.30,,,,,,,360.0000,6159.0000,percent of total billed charges,"Rev 300 Proc 0084U $6,159.00 in Billed Charges at 41.7% = $2,568.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,CIGNA HEALTHCARE,CIGNA PPO,2568.30,,,,,,,360.0000,6159.0000,percent of total billed charges,"Rev 300 Proc 0084U $6,159.00 in Billed Charges at 41.7% = $2,568.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,756.00,,,,,,,360.0000,6159.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5543.10,,,,,,,360.0000,6159.0000,percent of total billed charges,"90% of $6,159.00 in Billed Charges for Rev 300 Proc 0084U = $5,543.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,HUMANA,HUMANA MEDICARE,720.00,,,,,,,360.0000,6159.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,720.00,,,,,,,360.0000,6159.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,MEDCOST,MEDCOST VHN,2931.07,,,,,,,360.0000,6159.0000,percent of total billed charges,"47.59% of $6,159.00 in Billed Charges for Rev 300 Proc 0084U = $2,931.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,778.73,,,,,,,360.0000,6159.0000,fee schedule,APG 02044 Proc 0084U at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 100% = $741.65... $741.65 at 105% = $778.73 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,756.00,,,,,,,360.0000,6159.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,756.00,,,,,,,360.0000,6159.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,NHC ADVANTAGE,NHC ADVANTAGE,756.00,,,,,,,360.0000,6159.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,764.64,,,,,,,360.0000,6159.0000,fee schedule,APG 02044 Proc 0084U at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 100% = $741.65... $741.65 at 103.1% = $764.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,SENTARA HEALTH,SENTARA HEALTH,1589.64,,,,,,,360.0000,6159.0000,percent of total billed charges,"25.81% of $6,159.00 in Billed Charges for Rev 300 Proc 0084U = $1,589.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,SENTARA HEALTH,SENTARA MEDICARE,720.00,,,,,,,360.0000,6159.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6159.00,,,,,,,360.0000,6159.0000,percent of total billed charges,"100% of $6,159.00 in Billed Charges for Rev 300 Proc 0084U = $6,159.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,360.00,,,,,,,360.0000,6159.0000,fee schedule,$720.00 from Fee Schedule TCUHC24 for Rev 300 Proc 0084U * Qty 1 = $720.00 at 50% = $360.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,748.80,,,,,,,360.0000,6159.0000,fee schedule,$720.00 from Fee Schedule UHC_31910 for Rev 300 Proc 0084U * Qty 1 = $720.00 at 104% = $748.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,720.00,,,,,,,360.0000,6159.0000,fee schedule,$720.00 from Fee Schedule UHC_31910 for Rev 300 Proc 0084U * Qty 1 = $720.00 at 100% = $720.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,720.00,,,,,,,360.0000,6159.0000,fee schedule,$720.00 from Fee Schedule UHC_31910 for Rev 300 Proc 0084U * Qty 1 = $720.00 at 100% = $720.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,763.90,,,,,,,360.0000,6159.0000,fee schedule,APG 02044 Proc 0084U at $836.60 (Base Rate) * 0.8865 (Relative Weight) = $741.65 (Total Line Payment) at 103% = $763.90. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,720.00,,,,,,,360.0000,6159.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,720.00,,,,,,,360.0000,6159.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,WELLCARE,WELLCARE MEDICAID,6159.00,,,,,,,360.0000,6159.0000,percent of total billed charges,"100% of $6,159.00 in Billed Charges for Rev 300 Proc 0084U = $6,159.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RBC DNA GNOTYP 10 BLD GROUPS,0084U,CPT,300,RC,30000300,CDM,,,,both,,,6159.0000,923.8500,WELLCARE,WELLCARE MEDICARE,763.20,,,,,,,360.0000,6159.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,AETNA,AETNA,375.76,,,,,,,63.3200,880.0000,percent of total billed charges,42.7% of $880.00 in Billed Charges for Rev 335 Proc 96522 = $375.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,73.96,,,,,,,63.3200,880.0000,fee schedule,APG 00109 Proc 96522 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 104% = $73.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,192.98,,,,,,,63.3200,880.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,AETNA,AETNA HEALTHCARE MEDICARE,192.98,,,,,,,63.3200,880.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,ALLCARE MEDICARE,ALLCARE MEDICARE,192.98,,,,,,,63.3200,880.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,AMBETTER,AMBETTER,420.70,,,,,,,63.3200,880.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,200.70,,,,,,,63.3200,880.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,BLUE CROSS,ANTHEM EXCHANGE,475.13,,,,,,,63.3200,880.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,73.24,,,,,,,63.3200,880.0000,fee schedule,APG 00109 Proc 96522 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,BLUE CROSS,ANTHEM HMO,504.80,,,,,,,63.3200,880.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,198.77,,,,,,,63.3200,880.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",593.85,,,,,,,63.3200,880.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,97.67,,,,,,,63.3200,880.0000,fee schedule,$97.67 from Fee Schedule BLDTM_23 for Rev 335 Proc 96522 * Qty 1 = $97.67 at 100% = $97.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,BLUE CROSS,BLUE CROSS E NETWORK,435.22,,,,,,,63.3200,880.0000,fee schedule,$99.82 from Fee Schedule BCFSG for Rev 335 Proc 96522 * Qty 1 = $99.82 at 436% = $435.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,BLUE CROSS,BLUE CROSS MEDICARE,200.70,,,,,,,63.3200,880.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,BLUE CROSS,BLUE CROSS P NETWORK,444.20,,,,,,,63.3200,880.0000,fee schedule,$99.82 from Fee Schedule BCFSG for Rev 335 Proc 96522 * Qty 1 = $99.82 at 445% = $444.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,BLUE CROSS,BLUE CROSS S NETWORK,444.20,,,,,,,63.3200,880.0000,fee schedule,$99.82 from Fee Schedule BCFSG for Rev 335 Proc 96522 * Qty 1 = $99.82 at 445% = $444.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,BLUE CROSS,TENNCARE BLUE CARE,98.72,,,,,,,63.3200,880.0000,fee schedule,$85.10 from Fee Schedule TC_24 for Rev 335 Proc 96522 * Qty 1 = $85.10 at 116% = $98.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,BLUE CROSS,TENNCARE BLUE SELECT,98.72,,,,,,,63.3200,880.0000,fee schedule,$85.10 from Fee Schedule TC_24 for Rev 335 Proc 96522 * Qty 1 = $85.10 at 116% = $98.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,CIGNA HEALTHCARE,CIGNA HMO,366.96,,,,,,,63.3200,880.0000,percent of total billed charges,41.7% of $880.00 in Billed Charges for Rev 335 Proc 96522 = $366.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,408.32,,,,,,,63.3200,880.0000,percent of total billed charges,46.4% of $880.00 in Billed Charges for Rev 335 Proc 96522 = $408.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,CIGNA HEALTHCARE,CIGNA MEDICARE,202.63,,,,,,,63.3200,880.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,366.96,,,,,,,63.3200,880.0000,percent of total billed charges,41.7% of $880.00 in Billed Charges for Rev 335 Proc 96522 = $366.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,CIGNA HEALTHCARE,CIGNA PPO,366.96,,,,,,,63.3200,880.0000,percent of total billed charges,41.7% of $880.00 in Billed Charges for Rev 335 Proc 96522 = $366.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,202.63,,,,,,,63.3200,880.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,792.00,,,,,,,63.3200,880.0000,percent of total billed charges,90% of $880.00 in Billed Charges for Rev 335 Proc 96522 = $792.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,HUMANA,HUMANA MEDICARE,192.98,,,,,,,63.3200,880.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,192.98,,,,,,,63.3200,880.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,MEDCOST,MEDCOST VHN,418.79,,,,,,,63.3200,880.0000,percent of total billed charges,47.59% of $880.00 in Billed Charges for Rev 335 Proc 96522 = $418.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,74.67,,,,,,,63.3200,880.0000,fee schedule,APG 00109 Proc 96522 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 105% = $74.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,202.63,,,,,,,63.3200,880.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,202.63,,,,,,,63.3200,880.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,NHC ADVANTAGE,NHC ADVANTAGE,202.63,,,,,,,63.3200,880.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,73.31,,,,,,,63.3200,880.0000,fee schedule,APG 00109 Proc 96522 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 103.1% = $73.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,SENTARA HEALTH,SENTARA HEALTH,227.13,,,,,,,63.3200,880.0000,percent of total billed charges,25.81% of $880.00 in Billed Charges for Rev 335 Proc 96522 = $227.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,SENTARA HEALTH,SENTARA MEDICARE,192.98,,,,,,,63.3200,880.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",880.00,,,,,,,63.3200,880.0000,percent of total billed charges,100% of $880.00 in Billed Charges for Rev 335 Proc 96522 = $880.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,63.32,,,,,,,63.3200,880.0000,fee schedule,$126.64 from Fee Schedule TCUHC24 for Rev 335 Proc 96522 * Qty 1 = $126.64 at 50% = $63.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,880.00,,,,,,,63.3200,880.0000,other,"Rev 335 Proc 96522 1 Visit at $2,444.00 per Visit = $2,444.00 (Service Line reduced to $880.00, claim capped at $880.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,880.00,,,,,,,63.3200,880.0000,other,"Rev 335 Proc 96522 1 Visit at $2,338.00 per Visit = $2,338.00 (Service Line reduced to $880.00, claim capped at $880.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,880.00,,,,,,,63.3200,880.0000,other,"Rev 335 Proc 96522 1 Visit at $4,205.00 per Visit = $4,205.00 (Service Line reduced to $880.00, claim capped at $880.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,73.24,,,,,,,63.3200,880.0000,fee schedule,APG 00109 Proc 96522 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,192.98,,,,,,,63.3200,880.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,192.98,,,,,,,63.3200,880.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,WELLCARE,WELLCARE MEDICAID,880.00,,,,,,,63.3200,880.0000,percent of total billed charges,100% of $880.00 in Billed Charges for Rev 335 Proc 96522 = $880.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REFILL AND MAINT IMPLANTED PUMP,96522,CPT,335,RC,33500008,CDM,,,,both,,,880.0000,132.0000,WELLCARE,WELLCARE MEDICARE,204.56,,,,,,,63.3200,880.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,AETNA,AETNA,133.65,,,,,,,36.3500,653.3000,percent of total billed charges,42.7% of $313.00 in Billed Charges for Rev 335 Proc 96542 = $133.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,73.96,,,,,,,36.3500,653.3000,fee schedule,APG 00109 Proc 96542 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 104% = $73.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,299.68,,,,,,,36.3500,653.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,AETNA,AETNA HEALTHCARE MEDICARE,299.68,,,,,,,36.3500,653.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,299.68,,,,,,,36.3500,653.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,AMBETTER,AMBETTER,653.30,,,,,,,36.3500,653.3000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,311.67,,,,,,,36.3500,653.3000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,BLUE CROSS,ANTHEM EXCHANGE,313.00,,,,,,,36.3500,653.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,73.24,,,,,,,36.3500,653.3000,fee schedule,APG 00109 Proc 96542 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,BLUE CROSS,ANTHEM HMO,313.00,,,,,,,36.3500,653.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,308.67,,,,,,,36.3500,653.3000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",313.00,,,,,,,36.3500,653.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,123.45,,,,,,,36.3500,653.3000,fee schedule,$123.45 from Fee Schedule BLDTM_23 for Rev 335 Proc 96542 * Qty 1 = $123.45 at 100% = $123.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,BLUE CROSS,BLUE CROSS E NETWORK,313.00,,,,,,,36.3500,653.3000,fee schedule,"$108.68 from Fee Schedule BCFSG for Rev 335 Proc 96542 * Qty 1 = $108.68 at 436% = $473.84 (Service Line reduced to $313.00, claim capped at $313.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,BLUE CROSS,BLUE CROSS MEDICARE,311.67,,,,,,,36.3500,653.3000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,BLUE CROSS,BLUE CROSS P NETWORK,313.00,,,,,,,36.3500,653.3000,fee schedule,"$108.68 from Fee Schedule BCFSG for Rev 335 Proc 96542 * Qty 1 = $108.68 at 445% = $483.63 (Service Line reduced to $313.00, claim capped at $313.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,BLUE CROSS,BLUE CROSS S NETWORK,313.00,,,,,,,36.3500,653.3000,fee schedule,"$108.68 from Fee Schedule BCFSG for Rev 335 Proc 96542 * Qty 1 = $108.68 at 445% = $483.63 (Service Line reduced to $313.00, claim capped at $313.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,BLUE CROSS,TENNCARE BLUE CARE,96.41,,,,,,,36.3500,653.3000,fee schedule,$83.11 from Fee Schedule TC_24 for Rev 335 Proc 96542 * Qty 1 = $83.11 at 116% = $96.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,BLUE CROSS,TENNCARE BLUE SELECT,96.41,,,,,,,36.3500,653.3000,fee schedule,$83.11 from Fee Schedule TC_24 for Rev 335 Proc 96542 * Qty 1 = $83.11 at 116% = $96.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,CIGNA HEALTHCARE,CIGNA HMO,130.52,,,,,,,36.3500,653.3000,percent of total billed charges,41.7% of $313.00 in Billed Charges for Rev 335 Proc 96542 = $130.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,145.23,,,,,,,36.3500,653.3000,percent of total billed charges,46.4% of $313.00 in Billed Charges for Rev 335 Proc 96542 = $145.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,313.00,,,,,,,36.3500,653.3000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,130.52,,,,,,,36.3500,653.3000,percent of total billed charges,41.7% of $313.00 in Billed Charges for Rev 335 Proc 96542 = $130.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,CIGNA HEALTHCARE,CIGNA PPO,130.52,,,,,,,36.3500,653.3000,percent of total billed charges,41.7% of $313.00 in Billed Charges for Rev 335 Proc 96542 = $130.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,313.00,,,,,,,36.3500,653.3000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,281.70,,,,,,,36.3500,653.3000,percent of total billed charges,90% of $313.00 in Billed Charges for Rev 335 Proc 96542 = $281.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,HUMANA,HUMANA MEDICARE,299.68,,,,,,,36.3500,653.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,299.68,,,,,,,36.3500,653.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,MEDCOST,MEDCOST VHN,148.96,,,,,,,36.3500,653.3000,percent of total billed charges,47.59% of $313.00 in Billed Charges for Rev 335 Proc 96542 = $148.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,74.67,,,,,,,36.3500,653.3000,fee schedule,APG 00109 Proc 96542 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 105% = $74.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,313.00,,,,,,,36.3500,653.3000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,313.00,,,,,,,36.3500,653.3000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,NHC ADVANTAGE,NHC ADVANTAGE,313.00,,,,,,,36.3500,653.3000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,73.31,,,,,,,36.3500,653.3000,fee schedule,APG 00109 Proc 96542 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 100% = $71.11... $71.11 at 103.1% = $73.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,SENTARA HEALTH,SENTARA HEALTH,80.79,,,,,,,36.3500,653.3000,percent of total billed charges,25.81% of $313.00 in Billed Charges for Rev 335 Proc 96542 = $80.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,SENTARA HEALTH,SENTARA MEDICARE,299.68,,,,,,,36.3500,653.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",313.00,,,,,,,36.3500,653.3000,percent of total billed charges,100% of $313.00 in Billed Charges for Rev 335 Proc 96542 = $313.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,36.35,,,,,,,36.3500,653.3000,fee schedule,$72.70 from Fee Schedule TCUHC24 for Rev 335 Proc 96542 * Qty 1 = $72.70 at 50% = $36.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,313.00,,,,,,,36.3500,653.3000,other,"Rev 335 Proc 96542 1 Visit at $2,444.00 per Visit = $2,444.00 (Service Line reduced to $313.00, claim capped at $313.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,313.00,,,,,,,36.3500,653.3000,other,"Rev 335 Proc 96542 1 Visit at $2,338.00 per Visit = $2,338.00 (Service Line reduced to $313.00, claim capped at $313.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,313.00,,,,,,,36.3500,653.3000,other,"Rev 335 Proc 96542 1 Visit at $4,205.00 per Visit = $4,205.00 (Service Line reduced to $313.00, claim capped at $313.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,73.24,,,,,,,36.3500,653.3000,fee schedule,APG 00109 Proc 96542 at $836.60 (Base Rate) * 0.085 (Relative Weight) = $71.11 (Total Line Payment) at 103% = $73.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,299.68,,,,,,,36.3500,653.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,299.68,,,,,,,36.3500,653.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,WELLCARE,WELLCARE MEDICAID,313.00,,,,,,,36.3500,653.3000,percent of total billed charges,100% of $313.00 in Billed Charges for Rev 335 Proc 96542 = $313.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEM INJ SUBARCH/INTRAVNT RSV,96542,CPT,335,RC,33500009,CDM,,,,both,,,313.0000,46.9500,WELLCARE,WELLCARE MEDICARE,317.66,,,,,,,36.3500,653.3000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,AETNA,AETNA,48.25,,,,,,,12.4100,409.9600,percent of total billed charges,42.7% of $113.00 in Billed Charges for Rev 335 Proc 96549 = $48.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,406.06,,,,,,,12.4100,409.9600,fee schedule,APG 00111 Proc 96549 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 104% = $406.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,42.48,,,,,,,12.4100,409.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,AETNA,AETNA HEALTHCARE MEDICARE,42.48,,,,,,,12.4100,409.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,42.48,,,,,,,12.4100,409.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,AMBETTER,AMBETTER,92.61,,,,,,,12.4100,409.9600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,44.18,,,,,,,12.4100,409.9600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,ANTHEM EXCHANGE,104.59,,,,,,,12.4100,409.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,113.00,,,,,,,12.4100,409.9600,fee schedule,"APG 00111 Proc 96549 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 103% = $402.15 (Service Line reduced to $113.00, claim capped at $113.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,ANTHEM HMO,111.12,,,,,,,12.4100,409.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,43.76,,,,,,,12.4100,409.9600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",113.00,,,,,,,12.4100,409.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,BLUE CROSS,BLUE CROSS MEDICARE,44.18,,,,,,,12.4100,409.9600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA HMO,47.12,,,,,,,12.4100,409.9600,percent of total billed charges,41.7% of $113.00 in Billed Charges for Rev 335 Proc 96549 = $47.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,52.43,,,,,,,12.4100,409.9600,percent of total billed charges,46.4% of $113.00 in Billed Charges for Rev 335 Proc 96549 = $52.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,44.61,,,,,,,12.4100,409.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,47.12,,,,,,,12.4100,409.9600,percent of total billed charges,41.7% of $113.00 in Billed Charges for Rev 335 Proc 96549 = $47.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,CIGNA HEALTHCARE,CIGNA PPO,47.12,,,,,,,12.4100,409.9600,percent of total billed charges,41.7% of $113.00 in Billed Charges for Rev 335 Proc 96549 = $47.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,44.61,,,,,,,12.4100,409.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,101.70,,,,,,,12.4100,409.9600,percent of total billed charges,90% of $113.00 in Billed Charges for Rev 335 Proc 96549 = $101.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,HUMANA,HUMANA MEDICARE,42.48,,,,,,,12.4100,409.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,42.48,,,,,,,12.4100,409.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,MEDCOST,MEDCOST VHN,53.78,,,,,,,12.4100,409.9600,percent of total billed charges,47.59% of $113.00 in Billed Charges for Rev 335 Proc 96549 = $53.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,409.96,,,,,,,12.4100,409.9600,fee schedule,APG 00111 Proc 96549 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 100% = $390.44... $390.44 at 105% = $409.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,44.61,,,,,,,12.4100,409.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,44.61,,,,,,,12.4100,409.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,NHC ADVANTAGE,NHC ADVANTAGE,44.61,,,,,,,12.4100,409.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,402.54,,,,,,,12.4100,409.9600,fee schedule,APG 00111 Proc 96549 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 100% = $390.44... $390.44 at 103.1% = $402.54 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,SENTARA HEALTH,SENTARA HEALTH,29.17,,,,,,,12.4100,409.9600,percent of total billed charges,25.81% of $113.00 in Billed Charges for Rev 335 Proc 96549 = $29.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,SENTARA HEALTH,SENTARA MEDICARE,42.48,,,,,,,12.4100,409.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",113.00,,,,,,,12.4100,409.9600,percent of total billed charges,100% of $113.00 in Billed Charges for Rev 335 Proc 96549 = $113.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,12.41,,,,,,,12.4100,409.9600,fee schedule,$24.81 from Fee Schedule TCUHC24 for Rev 335 Proc 96549 * Qty 1 = $24.81 at 50% = $12.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,113.00,,,,,,,12.4100,409.9600,other,"Rev 335 Proc 96549 1 Visit at $2,444.00 per Visit = $2,444.00 (Service Line reduced to $113.00, claim capped at $113.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,113.00,,,,,,,12.4100,409.9600,other,"Rev 335 Proc 96549 1 Visit at $2,338.00 per Visit = $2,338.00 (Service Line reduced to $113.00, claim capped at $113.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,113.00,,,,,,,12.4100,409.9600,other,"Rev 335 Proc 96549 1 Visit at $4,205.00 per Visit = $4,205.00 (Service Line reduced to $113.00, claim capped at $113.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,402.15,,,,,,,12.4100,409.9600,fee schedule,APG 00111 Proc 96549 at $836.60 (Base Rate) * 0.4667 (Relative Weight) = $390.44 (Total Line Payment) at 103% = $402.15. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,42.48,,,,,,,12.4100,409.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,42.48,,,,,,,12.4100,409.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,WELLCARE,WELLCARE MEDICAID,113.00,,,,,,,12.4100,409.9600,percent of total billed charges,100% of $113.00 in Billed Charges for Rev 335 Proc 96549 = $113.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC UNLISTED CHEMO PROC,96549,CPT,335,RC,33500011,CDM,,,,both,,,113.0000,16.9500,WELLCARE,WELLCARE MEDICARE,45.03,,,,,,,12.4100,409.9600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EARLY CHILDHOOD NEW AGE 1-4 YRS,99382,CPT,510,RC,51000170,CDM,,,,both,,,393.0000,58.9500,AETNA,AETNA,167.81,,,,,,,39.4900,393.0000,percent of total billed charges,42.7% of $393.00 in Billed Charges for Rev 510 Proc 99382 = $167.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EARLY CHILDHOOD NEW AGE 1-4 YRS,99382,CPT,510,RC,51000170,CDM,,,,both,,,393.0000,58.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,65.13,,,,,,,39.4900,393.0000,fee schedule,$65.13 from Fee Schedule BLDTM_23 for Rev 510 Proc 99382 * Qty 1 = $65.13 at 100% = $65.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EARLY CHILDHOOD NEW AGE 1-4 YRS,99382,CPT,510,RC,51000170,CDM,,,,both,,,393.0000,58.9500,BLUE CROSS,TENNCARE BLUE CARE,42.42,,,,,,,39.4900,393.0000,fee schedule,$36.57 from Fee Schedule TC_24 for Rev 510 Proc 99382 * Qty 1 = $36.57 at 116% = $42.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EARLY CHILDHOOD NEW AGE 1-4 YRS,99382,CPT,510,RC,51000170,CDM,,,,both,,,393.0000,58.9500,BLUE CROSS,TENNCARE BLUE SELECT,42.42,,,,,,,39.4900,393.0000,fee schedule,$36.57 from Fee Schedule TC_24 for Rev 510 Proc 99382 * Qty 1 = $36.57 at 116% = $42.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EARLY CHILDHOOD NEW AGE 1-4 YRS,99382,CPT,510,RC,51000170,CDM,,,,both,,,393.0000,58.9500,CIGNA HEALTHCARE,CIGNA HMO,163.88,,,,,,,39.4900,393.0000,percent of total billed charges,41.7% of $393.00 in Billed Charges for Rev 510 Proc 99382 = $163.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EARLY CHILDHOOD NEW AGE 1-4 YRS,99382,CPT,510,RC,51000170,CDM,,,,both,,,393.0000,58.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,182.35,,,,,,,39.4900,393.0000,percent of total billed charges,46.4% of $393.00 in Billed Charges for Rev 510 Proc 99382 = $182.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EARLY CHILDHOOD NEW AGE 1-4 YRS,99382,CPT,510,RC,51000170,CDM,,,,both,,,393.0000,58.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,163.88,,,,,,,39.4900,393.0000,percent of total billed charges,41.7% of $393.00 in Billed Charges for Rev 510 Proc 99382 = $163.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EARLY CHILDHOOD NEW AGE 1-4 YRS,99382,CPT,510,RC,51000170,CDM,,,,both,,,393.0000,58.9500,CIGNA HEALTHCARE,CIGNA PPO,163.88,,,,,,,39.4900,393.0000,percent of total billed charges,41.7% of $393.00 in Billed Charges for Rev 510 Proc 99382 = $163.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EARLY CHILDHOOD NEW AGE 1-4 YRS,99382,CPT,510,RC,51000170,CDM,,,,both,,,393.0000,58.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,353.70,,,,,,,39.4900,393.0000,percent of total billed charges,90% of $393.00 in Billed Charges for Rev 510 Proc 99382 = $353.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EARLY CHILDHOOD NEW AGE 1-4 YRS,99382,CPT,510,RC,51000170,CDM,,,,both,,,393.0000,58.9500,MEDCOST,MEDCOST VHN,187.03,,,,,,,39.4900,393.0000,percent of total billed charges,47.59% of $393.00 in Billed Charges for Rev 510 Proc 99382 = $187.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EARLY CHILDHOOD NEW AGE 1-4 YRS,99382,CPT,510,RC,51000170,CDM,,,,both,,,393.0000,58.9500,SENTARA HEALTH,SENTARA HEALTH,101.43,,,,,,,39.4900,393.0000,percent of total billed charges,25.81% of $393.00 in Billed Charges for Rev 510 Proc 99382 = $101.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EARLY CHILDHOOD NEW AGE 1-4 YRS,99382,CPT,510,RC,51000170,CDM,,,,both,,,393.0000,58.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",393.00,,,,,,,39.4900,393.0000,percent of total billed charges,100% of $393.00 in Billed Charges for Rev 510 Proc 99382 = $393.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EARLY CHILDHOOD NEW AGE 1-4 YRS,99382,CPT,510,RC,51000170,CDM,,,,both,,,393.0000,58.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,39.49,,,,,,,39.4900,393.0000,fee schedule,$78.97 from Fee Schedule TCUHC24 for Rev 510 Proc 99382 * Qty 1 = $78.97 at 50% = $39.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EARLY CHILDHOOD NEW AGE 1-4 YRS,99382,CPT,510,RC,51000170,CDM,,,,both,,,393.0000,58.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,126.94,,,,,,,39.4900,393.0000,other,32.3% of $393.00 in Billed Charges for Rev 510 Proc 99382 = $126.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EARLY CHILDHOOD NEW AGE 1-4 YRS,99382,CPT,510,RC,51000170,CDM,,,,both,,,393.0000,58.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,120.65,,,,,,,39.4900,393.0000,other,30.7% of $393.00 in Billed Charges for Rev 510 Proc 99382 = $120.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EARLY CHILDHOOD NEW AGE 1-4 YRS,99382,CPT,510,RC,51000170,CDM,,,,both,,,393.0000,58.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,126.94,,,,,,,39.4900,393.0000,percent of total billed charges,32.3% of $393.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EARLY CHILDHOOD NEW AGE 1-4 YRS,99382,CPT,510,RC,51000170,CDM,,,,both,,,393.0000,58.9500,WELLCARE,WELLCARE MEDICAID,393.00,,,,,,,39.4900,393.0000,percent of total billed charges,100% of $393.00 in Billed Charges for Rev 510 Proc 99382 = $393.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 18-39YRS,99385,CPT,510,RC,51000048,CDM,,,,both,,,469.0000,70.3500,AETNA,AETNA,200.26,,,,,,,47.6600,469.0000,percent of total billed charges,42.7% of $469.00 in Billed Charges for Rev 510 Proc 99385 = $200.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 18-39YRS,99385,CPT,510,RC,51000048,CDM,,,,both,,,469.0000,70.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,100.81,,,,,,,47.6600,469.0000,fee schedule,$100.81 from Fee Schedule BLDTM_23 for Rev 510 Proc 99385 * Qty 1 = $100.81 at 100% = $100.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS - 18-39YRS,99385,CPT,510,RC,51000048,CDM,,,,both,,,469.0000,70.3500,BLUE CROSS,TENNCARE BLUE CARE,53.15,,,,,,,47.6600,469.0000,fee schedule,$45.82 from Fee Schedule TC_24 for Rev 510 Proc 99385 * Qty 1 = $45.82 at 116% = $53.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS - 18-39YRS,99385,CPT,510,RC,51000048,CDM,,,,both,,,469.0000,70.3500,BLUE CROSS,TENNCARE BLUE SELECT,53.15,,,,,,,47.6600,469.0000,fee schedule,$45.82 from Fee Schedule TC_24 for Rev 510 Proc 99385 * Qty 1 = $45.82 at 116% = $53.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS - 18-39YRS,99385,CPT,510,RC,51000048,CDM,,,,both,,,469.0000,70.3500,CIGNA HEALTHCARE,CIGNA HMO,195.57,,,,,,,47.6600,469.0000,percent of total billed charges,41.7% of $469.00 in Billed Charges for Rev 510 Proc 99385 = $195.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 18-39YRS,99385,CPT,510,RC,51000048,CDM,,,,both,,,469.0000,70.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,217.62,,,,,,,47.6600,469.0000,percent of total billed charges,46.4% of $469.00 in Billed Charges for Rev 510 Proc 99385 = $217.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 18-39YRS,99385,CPT,510,RC,51000048,CDM,,,,both,,,469.0000,70.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,195.57,,,,,,,47.6600,469.0000,percent of total billed charges,41.7% of $469.00 in Billed Charges for Rev 510 Proc 99385 = $195.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 18-39YRS,99385,CPT,510,RC,51000048,CDM,,,,both,,,469.0000,70.3500,CIGNA HEALTHCARE,CIGNA PPO,195.57,,,,,,,47.6600,469.0000,percent of total billed charges,41.7% of $469.00 in Billed Charges for Rev 510 Proc 99385 = $195.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 18-39YRS,99385,CPT,510,RC,51000048,CDM,,,,both,,,469.0000,70.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,422.10,,,,,,,47.6600,469.0000,percent of total billed charges,90% of $469.00 in Billed Charges for Rev 510 Proc 99385 = $422.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 18-39YRS,99385,CPT,510,RC,51000048,CDM,,,,both,,,469.0000,70.3500,MEDCOST,MEDCOST VHN,223.20,,,,,,,47.6600,469.0000,percent of total billed charges,47.59% of $469.00 in Billed Charges for Rev 510 Proc 99385 = $223.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 18-39YRS,99385,CPT,510,RC,51000048,CDM,,,,both,,,469.0000,70.3500,SENTARA HEALTH,SENTARA HEALTH,121.05,,,,,,,47.6600,469.0000,percent of total billed charges,25.81% of $469.00 in Billed Charges for Rev 510 Proc 99385 = $121.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 18-39YRS,99385,CPT,510,RC,51000048,CDM,,,,both,,,469.0000,70.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",469.00,,,,,,,47.6600,469.0000,percent of total billed charges,100% of $469.00 in Billed Charges for Rev 510 Proc 99385 = $469.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 18-39YRS,99385,CPT,510,RC,51000048,CDM,,,,both,,,469.0000,70.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,47.66,,,,,,,47.6600,469.0000,fee schedule,$95.31 from Fee Schedule TCUHC24 for Rev 510 Proc 99385 * Qty 1 = $95.31 at 50% = $47.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS - 18-39YRS,99385,CPT,510,RC,51000048,CDM,,,,both,,,469.0000,70.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,151.49,,,,,,,47.6600,469.0000,other,32.3% of $469.00 in Billed Charges for Rev 510 Proc 99385 = $151.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS - 18-39YRS,99385,CPT,510,RC,51000048,CDM,,,,both,,,469.0000,70.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,143.98,,,,,,,47.6600,469.0000,other,30.7% of $469.00 in Billed Charges for Rev 510 Proc 99385 = $143.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS - 18-39YRS,99385,CPT,510,RC,51000048,CDM,,,,both,,,469.0000,70.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,151.49,,,,,,,47.6600,469.0000,percent of total billed charges,32.3% of $469.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS - 18-39YRS,99385,CPT,510,RC,51000048,CDM,,,,both,,,469.0000,70.3500,WELLCARE,WELLCARE MEDICAID,469.00,,,,,,,47.6600,469.0000,percent of total billed charges,100% of $469.00 in Billed Charges for Rev 510 Proc 99385 = $469.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS LATE CHILDHOOD EST 5-11 YRS,99393,CPT,510,RC,51000174,CDM,,,,both,,,379.0000,56.8500,AETNA,AETNA,161.83,,,,,,,37.1000,379.0000,percent of total billed charges,42.7% of $379.00 in Billed Charges for Rev 510 Proc 99393 = $161.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS LATE CHILDHOOD EST 5-11 YRS,99393,CPT,510,RC,51000174,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,57.38,,,,,,,37.1000,379.0000,fee schedule,$57.38 from Fee Schedule BLDTM_23 for Rev 510 Proc 99393 * Qty 1 = $57.38 at 100% = $57.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS LATE CHILDHOOD EST 5-11 YRS,99393,CPT,510,RC,51000174,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,TENNCARE BLUE CARE,53.36,,,,,,,37.1000,379.0000,fee schedule,$46.00 from Fee Schedule TC_24 for Rev 510 Proc 99393 * Qty 1 = $46.00 at 116% = $53.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS LATE CHILDHOOD EST 5-11 YRS,99393,CPT,510,RC,51000174,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,TENNCARE BLUE SELECT,53.36,,,,,,,37.1000,379.0000,fee schedule,$46.00 from Fee Schedule TC_24 for Rev 510 Proc 99393 * Qty 1 = $46.00 at 116% = $53.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS LATE CHILDHOOD EST 5-11 YRS,99393,CPT,510,RC,51000174,CDM,,,,both,,,379.0000,56.8500,CIGNA HEALTHCARE,CIGNA HMO,158.04,,,,,,,37.1000,379.0000,percent of total billed charges,41.7% of $379.00 in Billed Charges for Rev 510 Proc 99393 = $158.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS LATE CHILDHOOD EST 5-11 YRS,99393,CPT,510,RC,51000174,CDM,,,,both,,,379.0000,56.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.86,,,,,,,37.1000,379.0000,percent of total billed charges,46.4% of $379.00 in Billed Charges for Rev 510 Proc 99393 = $175.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS LATE CHILDHOOD EST 5-11 YRS,99393,CPT,510,RC,51000174,CDM,,,,both,,,379.0000,56.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,158.04,,,,,,,37.1000,379.0000,percent of total billed charges,41.7% of $379.00 in Billed Charges for Rev 510 Proc 99393 = $158.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS LATE CHILDHOOD EST 5-11 YRS,99393,CPT,510,RC,51000174,CDM,,,,both,,,379.0000,56.8500,CIGNA HEALTHCARE,CIGNA PPO,158.04,,,,,,,37.1000,379.0000,percent of total billed charges,41.7% of $379.00 in Billed Charges for Rev 510 Proc 99393 = $158.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS LATE CHILDHOOD EST 5-11 YRS,99393,CPT,510,RC,51000174,CDM,,,,both,,,379.0000,56.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,341.10,,,,,,,37.1000,379.0000,percent of total billed charges,90% of $379.00 in Billed Charges for Rev 510 Proc 99393 = $341.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS LATE CHILDHOOD EST 5-11 YRS,99393,CPT,510,RC,51000174,CDM,,,,both,,,379.0000,56.8500,MEDCOST,MEDCOST VHN,180.37,,,,,,,37.1000,379.0000,percent of total billed charges,47.59% of $379.00 in Billed Charges for Rev 510 Proc 99393 = $180.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS LATE CHILDHOOD EST 5-11 YRS,99393,CPT,510,RC,51000174,CDM,,,,both,,,379.0000,56.8500,SENTARA HEALTH,SENTARA HEALTH,97.82,,,,,,,37.1000,379.0000,percent of total billed charges,25.81% of $379.00 in Billed Charges for Rev 510 Proc 99393 = $97.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS LATE CHILDHOOD EST 5-11 YRS,99393,CPT,510,RC,51000174,CDM,,,,both,,,379.0000,56.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",379.00,,,,,,,37.1000,379.0000,percent of total billed charges,100% of $379.00 in Billed Charges for Rev 510 Proc 99393 = $379.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS LATE CHILDHOOD EST 5-11 YRS,99393,CPT,510,RC,51000174,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,37.10,,,,,,,37.1000,379.0000,fee schedule,$74.20 from Fee Schedule TCUHC24 for Rev 510 Proc 99393 * Qty 1 = $74.20 at 50% = $37.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS LATE CHILDHOOD EST 5-11 YRS,99393,CPT,510,RC,51000174,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,122.42,,,,,,,37.1000,379.0000,other,32.3% of $379.00 in Billed Charges for Rev 510 Proc 99393 = $122.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS LATE CHILDHOOD EST 5-11 YRS,99393,CPT,510,RC,51000174,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,116.35,,,,,,,37.1000,379.0000,other,30.7% of $379.00 in Billed Charges for Rev 510 Proc 99393 = $116.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS LATE CHILDHOOD EST 5-11 YRS,99393,CPT,510,RC,51000174,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,122.42,,,,,,,37.1000,379.0000,percent of total billed charges,32.3% of $379.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS LATE CHILDHOOD EST 5-11 YRS,99393,CPT,510,RC,51000174,CDM,,,,both,,,379.0000,56.8500,WELLCARE,WELLCARE MEDICAID,379.00,,,,,,,37.1000,379.0000,percent of total billed charges,100% of $379.00 in Billed Charges for Rev 510 Proc 99393 = $379.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 40-64 YRS,99396,CPT,510,RC,51000177,CDM,,,,both,,,433.0000,64.9500,AETNA,AETNA,184.89,,,,,,,46.9700,433.0000,percent of total billed charges,42.7% of $433.00 in Billed Charges for Rev 510 Proc 99396 = $184.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 40-64 YRS,99396,CPT,510,RC,51000177,CDM,,,,both,,,433.0000,64.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,91.50,,,,,,,46.9700,433.0000,fee schedule,$91.50 from Fee Schedule BLDTM_23 for Rev 510 Proc 99396 * Qty 1 = $91.50 at 100% = $91.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EST 40-64 YRS,99396,CPT,510,RC,51000177,CDM,,,,both,,,433.0000,64.9500,BLUE CROSS,TENNCARE BLUE CARE,68.27,,,,,,,46.9700,433.0000,fee schedule,$58.85 from Fee Schedule TC_24 for Rev 510 Proc 99396 * Qty 1 = $58.85 at 116% = $68.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EST 40-64 YRS,99396,CPT,510,RC,51000177,CDM,,,,both,,,433.0000,64.9500,BLUE CROSS,TENNCARE BLUE SELECT,68.27,,,,,,,46.9700,433.0000,fee schedule,$58.85 from Fee Schedule TC_24 for Rev 510 Proc 99396 * Qty 1 = $58.85 at 116% = $68.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EST 40-64 YRS,99396,CPT,510,RC,51000177,CDM,,,,both,,,433.0000,64.9500,CIGNA HEALTHCARE,CIGNA HMO,180.56,,,,,,,46.9700,433.0000,percent of total billed charges,41.7% of $433.00 in Billed Charges for Rev 510 Proc 99396 = $180.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 40-64 YRS,99396,CPT,510,RC,51000177,CDM,,,,both,,,433.0000,64.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,200.91,,,,,,,46.9700,433.0000,percent of total billed charges,46.4% of $433.00 in Billed Charges for Rev 510 Proc 99396 = $200.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 40-64 YRS,99396,CPT,510,RC,51000177,CDM,,,,both,,,433.0000,64.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,180.56,,,,,,,46.9700,433.0000,percent of total billed charges,41.7% of $433.00 in Billed Charges for Rev 510 Proc 99396 = $180.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 40-64 YRS,99396,CPT,510,RC,51000177,CDM,,,,both,,,433.0000,64.9500,CIGNA HEALTHCARE,CIGNA PPO,180.56,,,,,,,46.9700,433.0000,percent of total billed charges,41.7% of $433.00 in Billed Charges for Rev 510 Proc 99396 = $180.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 40-64 YRS,99396,CPT,510,RC,51000177,CDM,,,,both,,,433.0000,64.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,389.70,,,,,,,46.9700,433.0000,percent of total billed charges,90% of $433.00 in Billed Charges for Rev 510 Proc 99396 = $389.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 40-64 YRS,99396,CPT,510,RC,51000177,CDM,,,,both,,,433.0000,64.9500,MEDCOST,MEDCOST VHN,206.06,,,,,,,46.9700,433.0000,percent of total billed charges,47.59% of $433.00 in Billed Charges for Rev 510 Proc 99396 = $206.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 40-64 YRS,99396,CPT,510,RC,51000177,CDM,,,,both,,,433.0000,64.9500,SENTARA HEALTH,SENTARA HEALTH,111.76,,,,,,,46.9700,433.0000,percent of total billed charges,25.81% of $433.00 in Billed Charges for Rev 510 Proc 99396 = $111.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 40-64 YRS,99396,CPT,510,RC,51000177,CDM,,,,both,,,433.0000,64.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",433.00,,,,,,,46.9700,433.0000,percent of total billed charges,100% of $433.00 in Billed Charges for Rev 510 Proc 99396 = $433.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 40-64 YRS,99396,CPT,510,RC,51000177,CDM,,,,both,,,433.0000,64.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,46.97,,,,,,,46.9700,433.0000,fee schedule,$93.94 from Fee Schedule TCUHC24 for Rev 510 Proc 99396 * Qty 1 = $93.94 at 50% = $46.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EST 40-64 YRS,99396,CPT,510,RC,51000177,CDM,,,,both,,,433.0000,64.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,139.86,,,,,,,46.9700,433.0000,other,32.3% of $433.00 in Billed Charges for Rev 510 Proc 99396 = $139.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EST 40-64 YRS,99396,CPT,510,RC,51000177,CDM,,,,both,,,433.0000,64.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,132.93,,,,,,,46.9700,433.0000,other,30.7% of $433.00 in Billed Charges for Rev 510 Proc 99396 = $132.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EST 40-64 YRS,99396,CPT,510,RC,51000177,CDM,,,,both,,,433.0000,64.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,139.86,,,,,,,46.9700,433.0000,percent of total billed charges,32.3% of $433.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 40-64 YRS,99396,CPT,510,RC,51000177,CDM,,,,both,,,433.0000,64.9500,WELLCARE,WELLCARE MEDICAID,433.00,,,,,,,46.9700,433.0000,percent of total billed charges,100% of $433.00 in Billed Charges for Rev 510 Proc 99396 = $433.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 65+ YRS,99397,CPT,510,RC,51000178,CDM,,,,both,,,444.0000,66.6000,AETNA,AETNA,189.59,,,,,,,49.8700,444.0000,percent of total billed charges,42.7% of $444.00 in Billed Charges for Rev 510 Proc 99397 = $189.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 65+ YRS,99397,CPT,510,RC,51000178,CDM,,,,both,,,444.0000,66.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,103.91,,,,,,,49.8700,444.0000,fee schedule,$103.91 from Fee Schedule BLDTM_23 for Rev 510 Proc 99397 * Qty 1 = $103.91 at 100% = $103.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EST 65+ YRS,99397,CPT,510,RC,51000178,CDM,,,,both,,,444.0000,66.6000,BLUE CROSS,TENNCARE BLUE CARE,63.77,,,,,,,49.8700,444.0000,fee schedule,$54.97 from Fee Schedule TC_24 for Rev 510 Proc 99397 * Qty 1 = $54.97 at 116% = $63.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EST 65+ YRS,99397,CPT,510,RC,51000178,CDM,,,,both,,,444.0000,66.6000,BLUE CROSS,TENNCARE BLUE SELECT,63.77,,,,,,,49.8700,444.0000,fee schedule,$54.97 from Fee Schedule TC_24 for Rev 510 Proc 99397 * Qty 1 = $54.97 at 116% = $63.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EST 65+ YRS,99397,CPT,510,RC,51000178,CDM,,,,both,,,444.0000,66.6000,CIGNA HEALTHCARE,CIGNA HMO,185.15,,,,,,,49.8700,444.0000,percent of total billed charges,41.7% of $444.00 in Billed Charges for Rev 510 Proc 99397 = $185.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 65+ YRS,99397,CPT,510,RC,51000178,CDM,,,,both,,,444.0000,66.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,206.02,,,,,,,49.8700,444.0000,percent of total billed charges,46.4% of $444.00 in Billed Charges for Rev 510 Proc 99397 = $206.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 65+ YRS,99397,CPT,510,RC,51000178,CDM,,,,both,,,444.0000,66.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,185.15,,,,,,,49.8700,444.0000,percent of total billed charges,41.7% of $444.00 in Billed Charges for Rev 510 Proc 99397 = $185.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 65+ YRS,99397,CPT,510,RC,51000178,CDM,,,,both,,,444.0000,66.6000,CIGNA HEALTHCARE,CIGNA PPO,185.15,,,,,,,49.8700,444.0000,percent of total billed charges,41.7% of $444.00 in Billed Charges for Rev 510 Proc 99397 = $185.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 65+ YRS,99397,CPT,510,RC,51000178,CDM,,,,both,,,444.0000,66.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,399.60,,,,,,,49.8700,444.0000,percent of total billed charges,90% of $444.00 in Billed Charges for Rev 510 Proc 99397 = $399.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 65+ YRS,99397,CPT,510,RC,51000178,CDM,,,,both,,,444.0000,66.6000,MEDCOST,MEDCOST VHN,211.30,,,,,,,49.8700,444.0000,percent of total billed charges,47.59% of $444.00 in Billed Charges for Rev 510 Proc 99397 = $211.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 65+ YRS,99397,CPT,510,RC,51000178,CDM,,,,both,,,444.0000,66.6000,SENTARA HEALTH,SENTARA HEALTH,114.60,,,,,,,49.8700,444.0000,percent of total billed charges,25.81% of $444.00 in Billed Charges for Rev 510 Proc 99397 = $114.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 65+ YRS,99397,CPT,510,RC,51000178,CDM,,,,both,,,444.0000,66.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",444.00,,,,,,,49.8700,444.0000,percent of total billed charges,100% of $444.00 in Billed Charges for Rev 510 Proc 99397 = $444.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 65+ YRS,99397,CPT,510,RC,51000178,CDM,,,,both,,,444.0000,66.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,49.87,,,,,,,49.8700,444.0000,fee schedule,$99.73 from Fee Schedule TCUHC24 for Rev 510 Proc 99397 * Qty 1 = $99.73 at 50% = $49.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EST 65+ YRS,99397,CPT,510,RC,51000178,CDM,,,,both,,,444.0000,66.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,143.41,,,,,,,49.8700,444.0000,other,32.3% of $444.00 in Billed Charges for Rev 510 Proc 99397 = $143.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EST 65+ YRS,99397,CPT,510,RC,51000178,CDM,,,,both,,,444.0000,66.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,136.31,,,,,,,49.8700,444.0000,other,30.7% of $444.00 in Billed Charges for Rev 510 Proc 99397 = $136.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WELLNESS EST 65+ YRS,99397,CPT,510,RC,51000178,CDM,,,,both,,,444.0000,66.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,143.41,,,,,,,49.8700,444.0000,percent of total billed charges,32.3% of $444.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WELLNESS EST 65+ YRS,99397,CPT,510,RC,51000178,CDM,,,,both,,,444.0000,66.6000,WELLCARE,WELLCARE MEDICAID,444.00,,,,,,,49.8700,444.0000,percent of total billed charges,100% of $444.00 in Billed Charges for Rev 510 Proc 99397 = $444.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS,99456,CPT,519,RC,51900001,CDM,,,,both,,,868.0000,130.2000,AETNA,AETNA,370.64,,,,,,,224.0300,868.0000,percent of total billed charges,42.7% of $868.00 in Billed Charges for Rev 519 Proc 99456 = $370.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS,99456,CPT,519,RC,51900001,CDM,,,,both,,,868.0000,130.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,252.00,,,,,,,224.0300,868.0000,fee schedule,$252.00 from Fee Schedule BLDTM_23 for Rev 519 Proc 99456 * Qty 1 = $252.00 at 100% = $252.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS,99456,CPT,519,RC,51900001,CDM,,,,both,,,868.0000,130.2000,CIGNA HEALTHCARE,CIGNA HMO,361.96,,,,,,,224.0300,868.0000,percent of total billed charges,41.7% of $868.00 in Billed Charges for Rev 519 Proc 99456 = $361.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS,99456,CPT,519,RC,51900001,CDM,,,,both,,,868.0000,130.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,402.75,,,,,,,224.0300,868.0000,percent of total billed charges,46.4% of $868.00 in Billed Charges for Rev 519 Proc 99456 = $402.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS,99456,CPT,519,RC,51900001,CDM,,,,both,,,868.0000,130.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,361.96,,,,,,,224.0300,868.0000,percent of total billed charges,41.7% of $868.00 in Billed Charges for Rev 519 Proc 99456 = $361.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS,99456,CPT,519,RC,51900001,CDM,,,,both,,,868.0000,130.2000,CIGNA HEALTHCARE,CIGNA PPO,361.96,,,,,,,224.0300,868.0000,percent of total billed charges,41.7% of $868.00 in Billed Charges for Rev 519 Proc 99456 = $361.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS,99456,CPT,519,RC,51900001,CDM,,,,both,,,868.0000,130.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,781.20,,,,,,,224.0300,868.0000,percent of total billed charges,90% of $868.00 in Billed Charges for Rev 519 Proc 99456 = $781.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS,99456,CPT,519,RC,51900001,CDM,,,,both,,,868.0000,130.2000,MEDCOST,MEDCOST VHN,413.08,,,,,,,224.0300,868.0000,percent of total billed charges,47.59% of $868.00 in Billed Charges for Rev 519 Proc 99456 = $413.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS,99456,CPT,519,RC,51900001,CDM,,,,both,,,868.0000,130.2000,SENTARA HEALTH,SENTARA HEALTH,224.03,,,,,,,224.0300,868.0000,percent of total billed charges,25.81% of $868.00 in Billed Charges for Rev 519 Proc 99456 = $224.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS,99456,CPT,519,RC,51900001,CDM,,,,both,,,868.0000,130.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",868.00,,,,,,,224.0300,868.0000,percent of total billed charges,100% of $868.00 in Billed Charges for Rev 519 Proc 99456 = $868.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS,99456,CPT,519,RC,51900001,CDM,,,,both,,,868.0000,130.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,280.36,,,,,,,224.0300,868.0000,other,32.3% of $868.00 in Billed Charges for Rev 519 Proc 99456 = $280.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS,99456,CPT,519,RC,51900001,CDM,,,,both,,,868.0000,130.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,266.48,,,,,,,224.0300,868.0000,other,30.7% of $868.00 in Billed Charges for Rev 519 Proc 99456 = $266.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS,99456,CPT,519,RC,51900001,CDM,,,,both,,,868.0000,130.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,280.36,,,,,,,224.0300,868.0000,percent of total billed charges,32.3% of $868.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS,99456,CPT,519,RC,51900001,CDM,,,,both,,,868.0000,130.2000,WELLCARE,WELLCARE MEDICAID,868.00,,,,,,,224.0300,868.0000,percent of total billed charges,100% of $868.00 in Billed Charges for Rev 519 Proc 99456 = $868.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,AETNA,AETNA,370.64,,,,,,,12.0000,1307.2500,percent of total billed charges,42.7% of $868.00 in Billed Charges for Rev 720 Proc 99465 = $370.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1062.17,,,,,,,12.0000,1307.2500,fee schedule,"APG 00092 Proc 99465 at $836.60 (Base Rate) * 1.2208 (Relative Weight) = $1,021.32 (Total Line Payment) at 104% = $1,062.17. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,599.66,,,,,,,12.0000,1307.2500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,AETNA,AETNA HEALTHCARE MEDICARE,599.66,,,,,,,12.0000,1307.2500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,599.66,,,,,,,12.0000,1307.2500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,AMBETTER,AMBETTER,1307.25,,,,,,,12.0000,1307.2500,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,623.64,,,,,,,12.0000,1307.2500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,BLUE CROSS,ANTHEM EXCHANGE,868.00,,,,,,,12.0000,1307.2500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,868.00,,,,,,,12.0000,1307.2500,fee schedule,"APG 00092 Proc 99465 at $836.60 (Base Rate) * 1.2208 (Relative Weight) = $1,021.32 (Total Line Payment) at 103% = $1,051.96 (Service Line reduced to $868.00, claim capped at $868.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,BLUE CROSS,ANTHEM HMO,868.00,,,,,,,12.0000,1307.2500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,617.65,,,,,,,12.0000,1307.2500,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",868.00,,,,,,,12.0000,1307.2500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,139.41,,,,,,,12.0000,1307.2500,fee schedule,$139.41 from Fee Schedule BLDTM_23 for Rev 720 Proc 99465 * Qty 1 = $139.41 at 100% = $139.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,BLUE CROSS,BLUE CROSS E NETWORK,46.00,,,,,,,12.0000,1307.2500,other,Rev 720 Proc 99465 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,BLUE CROSS,BLUE CROSS MEDICARE,623.64,,,,,,,12.0000,1307.2500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,BLUE CROSS,BLUE CROSS P NETWORK,46.00,,,,,,,12.0000,1307.2500,other,Rev 720 Proc 99465 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,BLUE CROSS,BLUE CROSS S NETWORK,46.00,,,,,,,12.0000,1307.2500,other,Rev 720 Proc 99465 Qty 1 * $46.00 = $46.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,BLUE CROSS,TENNCARE BLUE CARE,12.00,,,,,,,12.0000,1307.2500,other,Rev 720 Proc 99465 Qty 1 * $12.00 = $12.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,BLUE CROSS,TENNCARE BLUE SELECT,12.00,,,,,,,12.0000,1307.2500,other,Rev 720 Proc 99465 Qty 1 * $12.00 = $12.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,CIGNA HEALTHCARE,CIGNA HMO,361.96,,,,,,,12.0000,1307.2500,percent of total billed charges,41.7% of $868.00 in Billed Charges for Rev 720 Proc 99465 = $361.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,402.75,,,,,,,12.0000,1307.2500,percent of total billed charges,46.4% of $868.00 in Billed Charges for Rev 720 Proc 99465 = $402.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,629.64,,,,,,,12.0000,1307.2500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,361.96,,,,,,,12.0000,1307.2500,percent of total billed charges,41.7% of $868.00 in Billed Charges for Rev 720 Proc 99465 = $361.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,CIGNA HEALTHCARE,CIGNA PPO,361.96,,,,,,,12.0000,1307.2500,percent of total billed charges,41.7% of $868.00 in Billed Charges for Rev 720 Proc 99465 = $361.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,629.64,,,,,,,12.0000,1307.2500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,781.20,,,,,,,12.0000,1307.2500,percent of total billed charges,90% of $868.00 in Billed Charges for Rev 720 Proc 99465 = $781.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,HUMANA,HUMANA MEDICARE,599.66,,,,,,,12.0000,1307.2500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,599.66,,,,,,,12.0000,1307.2500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,MEDCOST,MEDCOST VHN,413.08,,,,,,,12.0000,1307.2500,percent of total billed charges,47.59% of $868.00 in Billed Charges for Rev 720 Proc 99465 = $413.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1072.39,,,,,,,12.0000,1307.2500,fee schedule,"APG 00092 Proc 99465 at $836.60 (Base Rate) * 1.2208 (Relative Weight) = $1,021.32 (Total Line Payment) at 100% = $1,021.32... $1,021.32 at 105% = $1,072.39 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,629.64,,,,,,,12.0000,1307.2500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,629.64,,,,,,,12.0000,1307.2500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,NHC ADVANTAGE,NHC ADVANTAGE,629.64,,,,,,,12.0000,1307.2500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1052.98,,,,,,,12.0000,1307.2500,fee schedule,"APG 00092 Proc 99465 at $836.60 (Base Rate) * 1.2208 (Relative Weight) = $1,021.32 (Total Line Payment) at 100% = $1,021.32... $1,021.32 at 103.1% = $1,052.98 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,SENTARA HEALTH,SENTARA HEALTH,224.03,,,,,,,12.0000,1307.2500,percent of total billed charges,25.81% of $868.00 in Billed Charges for Rev 720 Proc 99465 = $224.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,SENTARA HEALTH,SENTARA MEDICARE,599.66,,,,,,,12.0000,1307.2500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",868.00,,,,,,,12.0000,1307.2500,percent of total billed charges,100% of $868.00 in Billed Charges for Rev 720 Proc 99465 = $868.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,78.04,,,,,,,12.0000,1307.2500,fee schedule,$156.07 from Fee Schedule TCUHC24 for Rev 720 Proc 99465 * Qty 1 = $156.07 at 50% = $78.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,259.00,,,,,,,12.0000,1307.2500,other,Rev 720 Proc 99465 1 Visit at $259.00 per Visit = $259.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,247.00,,,,,,,12.0000,1307.2500,other,Rev 720 Proc 99465 1 Visit at $247.00 per Visit = $247.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,408.00,,,,,,,12.0000,1307.2500,other,Rev 720 Proc 99465 1 Visit at $408.00 per Visit = $408.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1051.96,,,,,,,12.0000,1307.2500,fee schedule,"APG 00092 Proc 99465 at $836.60 (Base Rate) * 1.2208 (Relative Weight) = $1,021.32 (Total Line Payment) at 103% = $1,051.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,599.66,,,,,,,12.0000,1307.2500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,599.66,,,,,,,12.0000,1307.2500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,WELLCARE,WELLCARE MEDICAID,868.00,,,,,,,12.0000,1307.2500,percent of total billed charges,100% of $868.00 in Billed Charges for Rev 720 Proc 99465 = $868.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC NEWBORN RESUSCITATION,99465,CPT,720,RC,72000006,CDM,,,,both,,,868.0000,130.2000,WELLCARE,WELLCARE MEDICARE,635.64,,,,,,,12.0000,1307.2500,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,AETNA,AETNA,4047.11,,,,,,,1881.0000,14351.7600,percent of total billed charges,"42.7% of $9,478.00 in Billed Charges for Rev 361 Proc 0201T = $4,047.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,7174.98,,,,,,,1881.0000,14351.7600,fee schedule,"APG 00028 Proc 0201T at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 104% = $7,174.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,6583.38,,,,,,,1881.0000,14351.7600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,AETNA,AETNA HEALTHCARE MEDICARE,6583.38,,,,,,,1881.0000,14351.7600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,6583.38,,,,,,,1881.0000,14351.7600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,AMBETTER,AMBETTER,14351.76,,,,,,,1881.0000,14351.7600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,6846.71,,,,,,,1881.0000,14351.7600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,ANTHEM EXCHANGE,9478.00,,,,,,,1881.0000,14351.7600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,7105.99,,,,,,,1881.0000,14351.7600,fee schedule,"APG 00028 Proc 0201T at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 103% = $7,105.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,ANTHEM HMO,9478.00,,,,,,,1881.0000,14351.7600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,6780.88,,,,,,,1881.0000,14351.7600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9478.00,,,,,,,1881.0000,14351.7600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,1881.0000,14351.7600,case rate,"Rev 361 Proc 0201T ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,BLUE CROSS MEDICARE,6846.71,,,,,,,1881.0000,14351.7600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,1881.0000,14351.7600,case rate,"Rev 361 Proc 0201T ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,1881.0000,14351.7600,case rate,"Rev 361 Proc 0201T ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,CIGNA HEALTHCARE,CIGNA HMO,8003.00,,,,,,,1881.0000,14351.7600,case rate,"Rev 361 Proc 0201T ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6048.00,,,,,,,1881.0000,14351.7600,case rate,"Rev 361 Proc 0201T ASG Rate of $6,048.00 at 100% of $6,048.00 = $6,048.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,6912.55,,,,,,,1881.0000,14351.7600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8003.00,,,,,,,1881.0000,14351.7600,case rate,"Rev 361 Proc 0201T ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,CIGNA HEALTHCARE,CIGNA PPO,8003.00,,,,,,,1881.0000,14351.7600,case rate,"Rev 361 Proc 0201T ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,6912.55,,,,,,,1881.0000,14351.7600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8530.20,,,,,,,1881.0000,14351.7600,percent of total billed charges,"90% of $9,478.00 in Billed Charges for Rev 361 Proc 0201T = $8,530.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,HUMANA,HUMANA MEDICARE,6583.38,,,,,,,1881.0000,14351.7600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,6583.38,,,,,,,1881.0000,14351.7600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,MEDCOST,MEDCOST VHN,4510.58,,,,,,,1881.0000,14351.7600,percent of total billed charges,"47.59% of $9,478.00 in Billed Charges for Rev 361 Proc 0201T = $4,510.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,7243.97,,,,,,,1881.0000,14351.7600,fee schedule,"APG 00028 Proc 0201T at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 100% = $6,899.02... $6,899.02 at 105% = $7,243.97 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,6912.55,,,,,,,1881.0000,14351.7600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,6912.55,,,,,,,1881.0000,14351.7600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,NHC ADVANTAGE,NHC ADVANTAGE,6912.55,,,,,,,1881.0000,14351.7600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,7112.89,,,,,,,1881.0000,14351.7600,fee schedule,"APG 00028 Proc 0201T at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 100% = $6,899.02... $6,899.02 at 103.1% = $7,112.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,SENTARA HEALTH,SENTARA HEALTH,2446.27,,,,,,,1881.0000,14351.7600,percent of total billed charges,"25.81% of $9,478.00 in Billed Charges for Rev 361 Proc 0201T = $2,446.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,SENTARA HEALTH,SENTARA MEDICARE,6583.38,,,,,,,1881.0000,14351.7600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9478.00,,,,,,,1881.0000,14351.7600,percent of total billed charges,"100% of $9,478.00 in Billed Charges for Rev 361 Proc 0201T = $9,478.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,1881.0000,14351.7600,case rate,"Rev 361 Proc 0201T ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,1881.0000,14351.7600,case rate,"Rev 361 Proc 0201T ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,1881.0000,14351.7600,case rate,"Rev 361 Proc 0201T ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,1881.0000,14351.7600,case rate,"Rev 361 Proc 0201T ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,7105.99,,,,,,,1881.0000,14351.7600,fee schedule,"APG 00028 Proc 0201T at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 103% = $7,105.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,6583.38,,,,,,,1881.0000,14351.7600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,6583.38,,,,,,,1881.0000,14351.7600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,WELLCARE,WELLCARE MEDICAID,9478.00,,,,,,,1881.0000,14351.7600,percent of total billed charges,"100% of $9,478.00 in Billed Charges for Rev 361 Proc 0201T = $9,478.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU SACRAL AUGMENT BIL,0201T,CPT,361,RC,36100279,CDM,,,,both,,,9478.0000,1421.7000,WELLCARE,WELLCARE MEDICARE,6978.38,,,,,,,1881.0000,14351.7600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,AETNA,AETNA,343.74,,,,,,,207.7700,908.5800,percent of total billed charges,42.7% of $805.00 in Billed Charges for Rev 310 Proc 0202U = $343.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,421.46,,,,,,,207.7700,908.5800,fee schedule,APG 00387 Proc 0202U at $836.60 (Base Rate) * 0.4844 (Relative Weight) = $405.25 (Total Line Payment) at 104% = $421.46. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,416.78,,,,,,,207.7700,908.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,AETNA,AETNA HEALTHCARE MEDICARE,416.78,,,,,,,207.7700,908.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,416.78,,,,,,,207.7700,908.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,AMBETTER,AMBETTER,908.58,,,,,,,207.7700,908.5800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,AMERIGROUP,AMERIGROUP,208.39,,,,,,,207.7700,908.5800,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,433.45,,,,,,,207.7700,908.5800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,ANTHEM EXCHANGE,416.78,,,,,,,207.7700,908.5800,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,417.41,,,,,,,207.7700,908.5800,fee schedule,APG 00387 Proc 0202U at $836.60 (Base Rate) * 0.4844 (Relative Weight) = $405.25 (Total Line Payment) at 103% = $417.41. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,ANTHEM HMO,416.78,,,,,,,207.7700,908.5800,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,429.28,,,,,,,207.7700,908.5800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",416.78,,,,,,,207.7700,908.5800,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,563.50,,,,,,,207.7700,908.5800,percent of total billed charges,Rev 310 Proc 0202U $805.00 in Billed Charges at 70% = $563.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,BLUE CROSS E NETWORK,805.00,,,,,,,207.7700,908.5800,fee schedule,"$298.60 from Fee Schedule BCFSB for Rev 310 Proc 0202U * Qty 1 = $298.60 at 320% = $955.52 (Service Line reduced to $805.00, claim capped at $805.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,BLUE CROSS MEDICARE,433.45,,,,,,,207.7700,908.5800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,BLUE CROSS P NETWORK,805.00,,,,,,,207.7700,908.5800,fee schedule,"$298.60 from Fee Schedule BCFSB for Rev 310 Proc 0202U * Qty 1 = $298.60 at 327% = $976.42 (Service Line reduced to $805.00, claim capped at $805.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,BLUE CROSS S NETWORK,805.00,,,,,,,207.7700,908.5800,fee schedule,"$298.60 from Fee Schedule BCFSB for Rev 310 Proc 0202U * Qty 1 = $298.60 at 327% = $976.42 (Service Line reduced to $805.00, claim capped at $805.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,TENNCARE BLUE CARE,301.79,,,,,,,207.7700,908.5800,fee schedule,$260.16 from Fee Schedule TC_24 for Rev 310 Proc 0202U * Qty 1 = $260.16 at 116% = $301.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,BLUE CROSS,TENNCARE BLUE SELECT,301.79,,,,,,,207.7700,908.5800,fee schedule,$260.16 from Fee Schedule TC_24 for Rev 310 Proc 0202U * Qty 1 = $260.16 at 116% = $301.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA HMO,335.69,,,,,,,207.7700,908.5800,percent of total billed charges,Rev 310 Proc 0202U $805.00 in Billed Charges at 41.7% = $335.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,805.00,,,,,,,207.7700,908.5800,fee schedule,$918.83 from Fee Schedule CGIFP_25LR for Rev 310 Proc 0202U * Qty 1 = $918.83 at 100% = $918.83 (Limited to $805.00 in Billed Charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,437.62,,,,,,,207.7700,908.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,335.69,,,,,,,207.7700,908.5800,percent of total billed charges,Rev 310 Proc 0202U $805.00 in Billed Charges at 41.7% = $335.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,CIGNA HEALTHCARE,CIGNA PPO,335.69,,,,,,,207.7700,908.5800,percent of total billed charges,Rev 310 Proc 0202U $805.00 in Billed Charges at 41.7% = $335.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,437.62,,,,,,,207.7700,908.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,724.50,,,,,,,207.7700,908.5800,percent of total billed charges,90% of $805.00 in Billed Charges for Rev 310 Proc 0202U = $724.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,HUMANA,HUMANA MEDICARE,416.78,,,,,,,207.7700,908.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,416.78,,,,,,,207.7700,908.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,MEDCOST,MEDCOST VHN,383.10,,,,,,,207.7700,908.5800,percent of total billed charges,47.59% of $805.00 in Billed Charges for Rev 310 Proc 0202U = $383.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,425.51,,,,,,,207.7700,908.5800,fee schedule,APG 00387 Proc 0202U at $836.60 (Base Rate) * 0.4844 (Relative Weight) = $405.25 (Total Line Payment) at 100% = $405.25... $405.25 at 105% = $425.51 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,437.62,,,,,,,207.7700,908.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,437.62,,,,,,,207.7700,908.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,NHC ADVANTAGE,NHC ADVANTAGE,437.62,,,,,,,207.7700,908.5800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,417.81,,,,,,,207.7700,908.5800,fee schedule,APG 00387 Proc 0202U at $836.60 (Base Rate) * 0.4844 (Relative Weight) = $405.25 (Total Line Payment) at 100% = $405.25... $405.25 at 103.1% = $417.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,SENTARA HEALTH,SENTARA HEALTH,207.77,,,,,,,207.7700,908.5800,percent of total billed charges,25.81% of $805.00 in Billed Charges for Rev 310 Proc 0202U = $207.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,SENTARA HEALTH,SENTARA MEDICARE,416.78,,,,,,,207.7700,908.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",805.00,,,,,,,207.7700,908.5800,percent of total billed charges,100% of $805.00 in Billed Charges for Rev 310 Proc 0202U = $805.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,208.39,,,,,,,207.7700,908.5800,fee schedule,$416.78 from Fee Schedule TCUHC24 for Rev 310 Proc 0202U * Qty 1 = $416.78 at 50% = $208.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,433.45,,,,,,,207.7700,908.5800,fee schedule,$416.78 from Fee Schedule UHC_31910 for Rev 310 Proc 0202U * Qty 1 = $416.78 at 104% = $433.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,416.78,,,,,,,207.7700,908.5800,fee schedule,$416.78 from Fee Schedule UHC_31910 for Rev 310 Proc 0202U * Qty 1 = $416.78 at 100% = $416.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,416.78,,,,,,,207.7700,908.5800,fee schedule,$416.78 from Fee Schedule UHC_31910 for Rev 310 Proc 0202U * Qty 1 = $416.78 at 100% = $416.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,417.41,,,,,,,207.7700,908.5800,fee schedule,APG 00387 Proc 0202U at $836.60 (Base Rate) * 0.4844 (Relative Weight) = $405.25 (Total Line Payment) at 103% = $417.41. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,416.78,,,,,,,207.7700,908.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,416.78,,,,,,,207.7700,908.5800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,WELLCARE,WELLCARE MEDICAID,805.00,,,,,,,207.7700,908.5800,percent of total billed charges,100% of $805.00 in Billed Charges for Rev 310 Proc 0202U = $805.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INFCT DS 22 TRGT SARS-COV-2,0202U,CPT,310,RC,30000203,CDM,,,,both,,,805.0000,120.7500,WELLCARE,WELLCARE MEDICARE,441.79,,,,,,,207.7700,908.5800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,AETNA,AETNA,9803.07,,,,,,,1733.0000,22958.0000,percent of total billed charges,"42.7% of $22,958.00 in Billed Charges for Rev 361 Proc 0234T = $9,803.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,22177.24,,,,,,,1733.0000,22958.0000,fee schedule,"APG 00122 Proc 0234T at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 104% = $22,177.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,10473.75,,,,,,,1733.0000,22958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,AETNA,AETNA HEALTHCARE MEDICARE,10473.75,,,,,,,1733.0000,22958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,10473.75,,,,,,,1733.0000,22958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,AMBETTER,AMBETTER,22832.77,,,,,,,1733.0000,22958.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,10892.70,,,,,,,1733.0000,22958.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,BLUE CROSS,ANTHEM EXCHANGE,22958.00,,,,,,,1733.0000,22958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,21963.99,,,,,,,1733.0000,22958.0000,fee schedule,"APG 00122 Proc 0234T at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,BLUE CROSS,ANTHEM HMO,22958.00,,,,,,,1733.0000,22958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,10787.96,,,,,,,1733.0000,22958.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",22958.00,,,,,,,1733.0000,22958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,BLUE CROSS,BLUE CROSS E NETWORK,8571.00,,,,,,,1733.0000,22958.0000,case rate,"Rev 361 Proc 0234T ASG Rate of $8,571.00 at 100% of $8,571.00 = $8,571.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,BLUE CROSS,BLUE CROSS MEDICARE,10892.70,,,,,,,1733.0000,22958.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,BLUE CROSS,BLUE CROSS P NETWORK,8764.00,,,,,,,1733.0000,22958.0000,case rate,"Rev 361 Proc 0234T ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,BLUE CROSS,BLUE CROSS S NETWORK,8764.00,,,,,,,1733.0000,22958.0000,case rate,"Rev 361 Proc 0234T ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,BLUE CROSS,TENNCARE BLUE CARE,1733.00,,,,,,,1733.0000,22958.0000,case rate,"Rev 361 Proc 0234T ASG Rate of $1,733.00 at 100% of $1,733.00 = $1,733.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,BLUE CROSS,TENNCARE BLUE SELECT,1733.00,,,,,,,1733.0000,22958.0000,case rate,"Rev 361 Proc 0234T ASG Rate of $1,733.00 at 100% of $1,733.00 = $1,733.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,10997.44,,,,,,,1733.0000,22958.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,10997.44,,,,,,,1733.0000,22958.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,20662.20,,,,,,,1733.0000,22958.0000,percent of total billed charges,"90% of $22,958.00 in Billed Charges for Rev 361 Proc 0234T = $20,662.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,HUMANA,HUMANA MEDICARE,10473.75,,,,,,,1733.0000,22958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,10473.75,,,,,,,1733.0000,22958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,MEDCOST,MEDCOST VHN,10925.71,,,,,,,1733.0000,22958.0000,percent of total billed charges,"47.59% of $22,958.00 in Billed Charges for Rev 361 Proc 0234T = $10,925.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,22390.47,,,,,,,1733.0000,22958.0000,fee schedule,"APG 00122 Proc 0234T at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 105% = $22,390.47 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,10997.44,,,,,,,1733.0000,22958.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,10997.44,,,,,,,1733.0000,22958.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,NHC ADVANTAGE,NHC ADVANTAGE,10997.44,,,,,,,1733.0000,22958.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,21985.31,,,,,,,1733.0000,22958.0000,fee schedule,"APG 00122 Proc 0234T at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 103.1% = $21,985.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,SENTARA HEALTH,SENTARA HEALTH,5925.46,,,,,,,1733.0000,22958.0000,percent of total billed charges,"25.81% of $22,958.00 in Billed Charges for Rev 361 Proc 0234T = $5,925.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,SENTARA HEALTH,SENTARA MEDICARE,10473.75,,,,,,,1733.0000,22958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",22958.00,,,,,,,1733.0000,22958.0000,percent of total billed charges,"100% of $22,958.00 in Billed Charges for Rev 361 Proc 0234T = $22,958.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,1733.0000,22958.0000,case rate,"Rev 361 Proc 0234T ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,1733.0000,22958.0000,case rate,"Rev 361 Proc 0234T ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,1733.0000,22958.0000,case rate,"Rev 361 Proc 0234T ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,20054.00,,,,,,,1733.0000,22958.0000,case rate,"Rev 361 Proc 0234T ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,21963.99,,,,,,,1733.0000,22958.0000,fee schedule,"APG 00122 Proc 0234T at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,10473.75,,,,,,,1733.0000,22958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,10473.75,,,,,,,1733.0000,22958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,WELLCARE,WELLCARE MEDICAID,22958.00,,,,,,,1733.0000,22958.0000,percent of total billed charges,"100% of $22,958.00 in Billed Charges for Rev 361 Proc 0234T = $22,958.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SP ATHER RENAL EA VESSEL,0234T,CPT,361,RC,36100210,CDM,,,,both,,,22958.0000,3443.7000,WELLCARE,WELLCARE MEDICARE,11102.17,,,,,,,1733.0000,22958.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER VISCERAL EA VESSEL,0235T,CPT,361,RC,36100211,CDM,,,,both,,,22956.0000,3443.4000,AETNA,AETNA,9802.21,,,,,,,968.0000,22956.0000,percent of total billed charges,"42.7% of $22,956.00 in Billed Charges for Rev 361 Proc 0235T = $9,802.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SP ATHER VISCERAL EA VESSEL,0235T,CPT,361,RC,36100211,CDM,,,,both,,,22956.0000,3443.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,9404.09,,,,,,,968.0000,22956.0000,fee schedule,"APG 00079 Proc 0235T at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 104% = $9,404.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER VISCERAL EA VESSEL,0235T,CPT,361,RC,36100211,CDM,,,,both,,,22956.0000,3443.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,9313.66,,,,,,,968.0000,22956.0000,fee schedule,"APG 00079 Proc 0235T at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 103% = $9,313.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER VISCERAL EA VESSEL,0235T,CPT,361,RC,36100211,CDM,,,,both,,,22956.0000,3443.4000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,968.0000,22956.0000,case rate,"Rev 361 Proc 0235T ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER VISCERAL EA VESSEL,0235T,CPT,361,RC,36100211,CDM,,,,both,,,22956.0000,3443.4000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,968.0000,22956.0000,case rate,"Rev 361 Proc 0235T ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER VISCERAL EA VESSEL,0235T,CPT,361,RC,36100211,CDM,,,,both,,,22956.0000,3443.4000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,968.0000,22956.0000,case rate,"Rev 361 Proc 0235T ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER VISCERAL EA VESSEL,0235T,CPT,361,RC,36100211,CDM,,,,both,,,22956.0000,3443.4000,BLUE CROSS,TENNCARE BLUE CARE,1733.00,,,,,,,968.0000,22956.0000,case rate,"Rev 361 Proc 0235T ASG Rate of $1,733.00 at 100% of $1,733.00 = $1,733.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER VISCERAL EA VESSEL,0235T,CPT,361,RC,36100211,CDM,,,,both,,,22956.0000,3443.4000,BLUE CROSS,TENNCARE BLUE SELECT,1733.00,,,,,,,968.0000,22956.0000,case rate,"Rev 361 Proc 0235T ASG Rate of $1,733.00 at 100% of $1,733.00 = $1,733.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER VISCERAL EA VESSEL,0235T,CPT,361,RC,36100211,CDM,,,,both,,,22956.0000,3443.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,20660.40,,,,,,,968.0000,22956.0000,percent of total billed charges,"90% of $22,956.00 in Billed Charges for Rev 361 Proc 0235T = $20,660.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SP ATHER VISCERAL EA VESSEL,0235T,CPT,361,RC,36100211,CDM,,,,both,,,22956.0000,3443.4000,MEDCOST,MEDCOST VHN,10924.76,,,,,,,968.0000,22956.0000,percent of total billed charges,"47.59% of $22,956.00 in Billed Charges for Rev 361 Proc 0235T = $10,924.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SP ATHER VISCERAL EA VESSEL,0235T,CPT,361,RC,36100211,CDM,,,,both,,,22956.0000,3443.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,9494.51,,,,,,,968.0000,22956.0000,fee schedule,"APG 00079 Proc 0235T at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 100% = $9,042.39... $9,042.39 at 105% = $9,494.51 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER VISCERAL EA VESSEL,0235T,CPT,361,RC,36100211,CDM,,,,both,,,22956.0000,3443.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,9322.70,,,,,,,968.0000,22956.0000,fee schedule,"APG 00079 Proc 0235T at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 100% = $9,042.39... $9,042.39 at 103.1% = $9,322.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER VISCERAL EA VESSEL,0235T,CPT,361,RC,36100211,CDM,,,,both,,,22956.0000,3443.4000,SENTARA HEALTH,SENTARA HEALTH,5924.94,,,,,,,968.0000,22956.0000,percent of total billed charges,"25.81% of $22,956.00 in Billed Charges for Rev 361 Proc 0235T = $5,924.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SP ATHER VISCERAL EA VESSEL,0235T,CPT,361,RC,36100211,CDM,,,,both,,,22956.0000,3443.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",22956.00,,,,,,,968.0000,22956.0000,percent of total billed charges,"100% of $22,956.00 in Billed Charges for Rev 361 Proc 0235T = $22,956.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SP ATHER VISCERAL EA VESSEL,0235T,CPT,361,RC,36100211,CDM,,,,both,,,22956.0000,3443.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,968.0000,22956.0000,case rate,Rev 361 Proc 0235T ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER VISCERAL EA VESSEL,0235T,CPT,361,RC,36100211,CDM,,,,both,,,22956.0000,3443.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,968.0000,22956.0000,case rate,"Rev 361 Proc 0235T ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER VISCERAL EA VESSEL,0235T,CPT,361,RC,36100211,CDM,,,,both,,,22956.0000,3443.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,968.0000,22956.0000,case rate,"Rev 361 Proc 0235T ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER VISCERAL EA VESSEL,0235T,CPT,361,RC,36100211,CDM,,,,both,,,22956.0000,3443.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,968.0000,22956.0000,case rate,"Rev 361 Proc 0235T ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER VISCERAL EA VESSEL,0235T,CPT,361,RC,36100211,CDM,,,,both,,,22956.0000,3443.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,9313.66,,,,,,,968.0000,22956.0000,fee schedule,"APG 00079 Proc 0235T at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 103% = $9,313.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER VISCERAL EA VESSEL,0235T,CPT,361,RC,36100211,CDM,,,,both,,,22956.0000,3443.4000,WELLCARE,WELLCARE MEDICAID,22956.00,,,,,,,968.0000,22956.0000,percent of total billed charges,"100% of $22,956.00 in Billed Charges for Rev 361 Proc 0235T = $22,956.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,AETNA,AETNA,11946.18,,,,,,,6290.0000,27977.0000,percent of total billed charges,"42.7% of $27,977.00 in Billed Charges for Rev 481 Proc 0237T = $11,946.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15721.62,,,,,,,6290.0000,27977.0000,fee schedule,"APG 00085 Proc 0237T at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 104% = $15,721.62. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,10473.75,,,,,,,6290.0000,27977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,AETNA,AETNA HEALTHCARE MEDICARE,10473.75,,,,,,,6290.0000,27977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,10473.75,,,,,,,6290.0000,27977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,AMBETTER,AMBETTER,22832.77,,,,,,,6290.0000,27977.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,10892.70,,,,,,,6290.0000,27977.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,BLUE CROSS,ANTHEM EXCHANGE,25786.93,,,,,,,6290.0000,27977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15570.45,,,,,,,6290.0000,27977.0000,fee schedule,"APG 00085 Proc 0237T at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,BLUE CROSS,ANTHEM HMO,27397.08,,,,,,,6290.0000,27977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,10787.96,,,,,,,6290.0000,27977.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",27977.00,,,,,,,6290.0000,27977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,19583.90,,,,,,,6290.0000,27977.0000,percent of total billed charges,"Rev 481 Proc 0237T $27,977.00 in Billed Charges at 70% = $19,583.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,BLUE CROSS,BLUE CROSS E NETWORK,8571.00,,,,,,,6290.0000,27977.0000,case rate,"Rev 481 Proc 0237T ASG Rate of $8,571.00 at 100% of $8,571.00 = $8,571.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,BLUE CROSS,BLUE CROSS MEDICARE,10892.70,,,,,,,6290.0000,27977.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,BLUE CROSS,BLUE CROSS P NETWORK,8764.00,,,,,,,6290.0000,27977.0000,case rate,"Rev 481 Proc 0237T ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,BLUE CROSS,BLUE CROSS S NETWORK,8764.00,,,,,,,6290.0000,27977.0000,case rate,"Rev 481 Proc 0237T ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,CIGNA HEALTHCARE,CIGNA HMO,11666.41,,,,,,,6290.0000,27977.0000,percent of total billed charges,"41.7% of $27,977.00 in Billed Charges for Rev 481 Proc 0237T = $11,666.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12981.33,,,,,,,6290.0000,27977.0000,percent of total billed charges,"46.4% of $27,977.00 in Billed Charges for Rev 481 Proc 0237T = $12,981.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,10997.44,,,,,,,6290.0000,27977.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11666.41,,,,,,,6290.0000,27977.0000,percent of total billed charges,"41.7% of $27,977.00 in Billed Charges for Rev 481 Proc 0237T = $11,666.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,CIGNA HEALTHCARE,CIGNA PPO,11666.41,,,,,,,6290.0000,27977.0000,percent of total billed charges,"41.7% of $27,977.00 in Billed Charges for Rev 481 Proc 0237T = $11,666.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,10997.44,,,,,,,6290.0000,27977.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,25179.30,,,,,,,6290.0000,27977.0000,percent of total billed charges,"90% of $27,977.00 in Billed Charges for Rev 481 Proc 0237T = $25,179.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,HUMANA,HUMANA MEDICARE,10473.75,,,,,,,6290.0000,27977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,10473.75,,,,,,,6290.0000,27977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,MEDCOST,MEDCOST VHN,13314.25,,,,,,,6290.0000,27977.0000,percent of total billed charges,"47.59% of $27,977.00 in Billed Charges for Rev 481 Proc 0237T = $13,314.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15872.79,,,,,,,6290.0000,27977.0000,fee schedule,"APG 00085 Proc 0237T at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 105% = $15,872.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,10997.44,,,,,,,6290.0000,27977.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,10997.44,,,,,,,6290.0000,27977.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,NHC ADVANTAGE,NHC ADVANTAGE,10997.44,,,,,,,6290.0000,27977.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15585.57,,,,,,,6290.0000,27977.0000,fee schedule,"APG 00085 Proc 0237T at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 103.1% = $15,585.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,SENTARA HEALTH,SENTARA HEALTH,7220.86,,,,,,,6290.0000,27977.0000,percent of total billed charges,"25.81% of $27,977.00 in Billed Charges for Rev 481 Proc 0237T = $7,220.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,SENTARA HEALTH,SENTARA MEDICARE,10473.75,,,,,,,6290.0000,27977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",27977.00,,,,,,,6290.0000,27977.0000,percent of total billed charges,"100% of $27,977.00 in Billed Charges for Rev 481 Proc 0237T = $27,977.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,6290.0000,27977.0000,case rate,"Rev 481 Proc 0237T ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,6290.0000,27977.0000,case rate,"Rev 481 Proc 0237T ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,6290.0000,27977.0000,case rate,"Rev 481 Proc 0237T ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,20054.00,,,,,,,6290.0000,27977.0000,case rate,"Rev 481 Proc 0237T ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15570.45,,,,,,,6290.0000,27977.0000,fee schedule,"APG 00085 Proc 0237T at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,10473.75,,,,,,,6290.0000,27977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,10473.75,,,,,,,6290.0000,27977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,WELLCARE,WELLCARE MEDICAID,27977.00,,,,,,,6290.0000,27977.0000,percent of total billed charges,"100% of $27,977.00 in Billed Charges for Rev 481 Proc 0237T = $27,977.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTRA BRACHIOCEPHALIC EACH VESSEL,0237T,CPT,481,RC,48100123,CDM,,,,both,,,27977.0000,4196.5500,WELLCARE,WELLCARE MEDICARE,11102.17,,,,,,,6290.0000,27977.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,AETNA,AETNA,11946.18,,,,,,,6290.0000,36257.3800,percent of total billed charges,"42.7% of $27,977.00 in Billed Charges for Rev 481 Proc 0238T = $11,946.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15721.62,,,,,,,6290.0000,36257.3800,fee schedule,"APG 00085 Proc 0238T at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 104% = $15,721.62. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,16631.83,,,,,,,6290.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,AETNA,AETNA HEALTHCARE MEDICARE,16631.83,,,,,,,6290.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,16631.83,,,,,,,6290.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,AMBETTER,AMBETTER,36257.38,,,,,,,6290.0000,36257.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,17297.10,,,,,,,6290.0000,36257.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,BLUE CROSS,ANTHEM EXCHANGE,27977.00,,,,,,,6290.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15570.45,,,,,,,6290.0000,36257.3800,fee schedule,"APG 00085 Proc 0238T at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,BLUE CROSS,ANTHEM HMO,27977.00,,,,,,,6290.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,17130.78,,,,,,,6290.0000,36257.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",27977.00,,,,,,,6290.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,19583.90,,,,,,,6290.0000,36257.3800,percent of total billed charges,"Rev 481 Proc 0238T $27,977.00 in Billed Charges at 70% = $19,583.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,BLUE CROSS,BLUE CROSS E NETWORK,9347.00,,,,,,,6290.0000,36257.3800,case rate,"Rev 481 Proc 0238T ASG Rate of $9,347.00 at 100% of $9,347.00 = $9,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,BLUE CROSS,BLUE CROSS MEDICARE,17297.10,,,,,,,6290.0000,36257.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,BLUE CROSS,BLUE CROSS P NETWORK,9558.00,,,,,,,6290.0000,36257.3800,case rate,"Rev 481 Proc 0238T ASG Rate of $9,558.00 at 100% of $9,558.00 = $9,558.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,BLUE CROSS,BLUE CROSS S NETWORK,9558.00,,,,,,,6290.0000,36257.3800,case rate,"Rev 481 Proc 0238T ASG Rate of $9,558.00 at 100% of $9,558.00 = $9,558.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,CIGNA HEALTHCARE,CIGNA HMO,11666.41,,,,,,,6290.0000,36257.3800,percent of total billed charges,"41.7% of $27,977.00 in Billed Charges for Rev 481 Proc 0238T = $11,666.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12981.33,,,,,,,6290.0000,36257.3800,percent of total billed charges,"46.4% of $27,977.00 in Billed Charges for Rev 481 Proc 0238T = $12,981.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,17463.42,,,,,,,6290.0000,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11666.41,,,,,,,6290.0000,36257.3800,percent of total billed charges,"41.7% of $27,977.00 in Billed Charges for Rev 481 Proc 0238T = $11,666.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,CIGNA HEALTHCARE,CIGNA PPO,11666.41,,,,,,,6290.0000,36257.3800,percent of total billed charges,"41.7% of $27,977.00 in Billed Charges for Rev 481 Proc 0238T = $11,666.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,17463.42,,,,,,,6290.0000,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,25179.30,,,,,,,6290.0000,36257.3800,percent of total billed charges,"90% of $27,977.00 in Billed Charges for Rev 481 Proc 0238T = $25,179.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,HUMANA,HUMANA MEDICARE,16631.83,,,,,,,6290.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,16631.83,,,,,,,6290.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,MEDCOST,MEDCOST VHN,13314.25,,,,,,,6290.0000,36257.3800,percent of total billed charges,"47.59% of $27,977.00 in Billed Charges for Rev 481 Proc 0238T = $13,314.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15872.79,,,,,,,6290.0000,36257.3800,fee schedule,"APG 00085 Proc 0238T at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 105% = $15,872.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,17463.42,,,,,,,6290.0000,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,17463.42,,,,,,,6290.0000,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,NHC ADVANTAGE,NHC ADVANTAGE,17463.42,,,,,,,6290.0000,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15585.57,,,,,,,6290.0000,36257.3800,fee schedule,"APG 00085 Proc 0238T at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 103.1% = $15,585.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,SENTARA HEALTH,SENTARA HEALTH,7220.86,,,,,,,6290.0000,36257.3800,percent of total billed charges,"25.81% of $27,977.00 in Billed Charges for Rev 481 Proc 0238T = $7,220.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,SENTARA HEALTH,SENTARA MEDICARE,16631.83,,,,,,,6290.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",27977.00,,,,,,,6290.0000,36257.3800,percent of total billed charges,"100% of $27,977.00 in Billed Charges for Rev 481 Proc 0238T = $27,977.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,6290.0000,36257.3800,case rate,"Rev 481 Proc 0238T ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,6290.0000,36257.3800,case rate,"Rev 481 Proc 0238T ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,6290.0000,36257.3800,case rate,"Rev 481 Proc 0238T ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,20054.00,,,,,,,6290.0000,36257.3800,case rate,"Rev 481 Proc 0238T ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15570.45,,,,,,,6290.0000,36257.3800,fee schedule,"APG 00085 Proc 0238T at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,16631.83,,,,,,,6290.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,16631.83,,,,,,,6290.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,WELLCARE,WELLCARE MEDICAID,27977.00,,,,,,,6290.0000,36257.3800,percent of total billed charges,"100% of $27,977.00 in Billed Charges for Rev 481 Proc 0238T = $27,977.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTRA ILIAC EACH VESSEL,0238T,CPT,481,RC,48100124,CDM,,,,both,,,27977.0000,4196.5500,WELLCARE,WELLCARE MEDICARE,17629.74,,,,,,,6290.0000,36257.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,AETNA,AETNA,70.88,,,,,,,26.1900,166.0000,percent of total billed charges,42.7% of $166.00 in Billed Charges for Rev 510 Proc 11721 = $70.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,95.10,,,,,,,26.1900,166.0000,fee schedule,APG 00005 Proc 11721 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 104% = $95.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,53.52,,,,,,,26.1900,166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,AETNA,AETNA HEALTHCARE MEDICARE,53.52,,,,,,,26.1900,166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,53.52,,,,,,,26.1900,166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,AMBETTER,AMBETTER,116.68,,,,,,,26.1900,166.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,55.66,,,,,,,26.1900,166.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,BLUE CROSS,ANTHEM EXCHANGE,131.77,,,,,,,26.1900,166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,94.18,,,,,,,26.1900,166.0000,fee schedule,APG 00005 Proc 11721 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 103% = $94.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,BLUE CROSS,ANTHEM HMO,140.00,,,,,,,26.1900,166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,55.13,,,,,,,26.1900,166.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",164.70,,,,,,,26.1900,166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,45.11,,,,,,,26.1900,166.0000,fee schedule,$45.11 from Fee Schedule BLDTM_23 for Rev 510 Proc 11721 * Qty 1 = $45.11 at 100% = $45.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,BLUE CROSS,BLUE CROSS MEDICARE,55.66,,,,,,,26.1900,166.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,BLUE CROSS,TENNCARE BLUE CARE,36.10,,,,,,,26.1900,166.0000,fee schedule,$31.12 from Fee Schedule TC_24 for Rev 510 Proc 11721 * Qty 1 = $31.12 at 116% = $36.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,BLUE CROSS,TENNCARE BLUE SELECT,36.10,,,,,,,26.1900,166.0000,fee schedule,$31.12 from Fee Schedule TC_24 for Rev 510 Proc 11721 * Qty 1 = $31.12 at 116% = $36.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,CIGNA HEALTHCARE,CIGNA HMO,69.22,,,,,,,26.1900,166.0000,percent of total billed charges,41.7% of $166.00 in Billed Charges for Rev 510 Proc 11721 = $69.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,77.02,,,,,,,26.1900,166.0000,percent of total billed charges,46.4% of $166.00 in Billed Charges for Rev 510 Proc 11721 = $77.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,56.20,,,,,,,26.1900,166.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,69.22,,,,,,,26.1900,166.0000,percent of total billed charges,41.7% of $166.00 in Billed Charges for Rev 510 Proc 11721 = $69.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,CIGNA HEALTHCARE,CIGNA PPO,69.22,,,,,,,26.1900,166.0000,percent of total billed charges,41.7% of $166.00 in Billed Charges for Rev 510 Proc 11721 = $69.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,56.20,,,,,,,26.1900,166.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,149.40,,,,,,,26.1900,166.0000,percent of total billed charges,90% of $166.00 in Billed Charges for Rev 510 Proc 11721 = $149.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,HUMANA,HUMANA MEDICARE,53.52,,,,,,,26.1900,166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,53.52,,,,,,,26.1900,166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,MEDCOST,MEDCOST VHN,79.00,,,,,,,26.1900,166.0000,percent of total billed charges,47.59% of $166.00 in Billed Charges for Rev 510 Proc 11721 = $79.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,96.01,,,,,,,26.1900,166.0000,fee schedule,APG 00005 Proc 11721 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 100% = $91.44... $91.44 at 105% = $96.01 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,56.20,,,,,,,26.1900,166.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,56.20,,,,,,,26.1900,166.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,NHC ADVANTAGE,NHC ADVANTAGE,56.20,,,,,,,26.1900,166.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,94.27,,,,,,,26.1900,166.0000,fee schedule,APG 00005 Proc 11721 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 100% = $91.44... $91.44 at 103.1% = $94.27 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,SENTARA HEALTH,SENTARA HEALTH,42.84,,,,,,,26.1900,166.0000,percent of total billed charges,25.81% of $166.00 in Billed Charges for Rev 510 Proc 11721 = $42.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,SENTARA HEALTH,SENTARA MEDICARE,53.52,,,,,,,26.1900,166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",166.00,,,,,,,26.1900,166.0000,percent of total billed charges,100% of $166.00 in Billed Charges for Rev 510 Proc 11721 = $166.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,26.19,,,,,,,26.1900,166.0000,fee schedule,$52.37 from Fee Schedule TCUHC24 for Rev 510 Proc 11721 * Qty 1 = $52.37 at 50% = $26.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,53.62,,,,,,,26.1900,166.0000,other,32.3% of $166.00 in Billed Charges for Rev 510 Proc 11721 = $53.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,50.96,,,,,,,26.1900,166.0000,other,30.7% of $166.00 in Billed Charges for Rev 510 Proc 11721 = $50.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,53.62,,,,,,,26.1900,166.0000,percent of total billed charges,32.3% of $166.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,94.18,,,,,,,26.1900,166.0000,fee schedule,APG 00005 Proc 11721 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 103% = $94.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,53.52,,,,,,,26.1900,166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,53.52,,,,,,,26.1900,166.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,WELLCARE,WELLCARE MEDICAID,166.00,,,,,,,26.1900,166.0000,percent of total billed charges,100% of $166.00 in Billed Charges for Rev 510 Proc 11721 = $166.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC DEBRID NAILS 6 OR MORE,11721,CPT,510,RC,51000018,CDM,,,,both,,,166.0000,24.9000,WELLCARE,WELLCARE MEDICARE,56.73,,,,,,,26.1900,166.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,AETNA,AETNA,836.07,,,,,,,92.9300,1958.0000,percent of total billed charges,"42.7% of $1,958.00 in Billed Charges for Rev 521 Proc 11755 = $836.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,92.9300,1958.0000,fee schedule,"APG 00009 Proc 11755 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,92.9300,1958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,92.9300,1958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,92.9300,1958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,AMBETTER,AMBETTER,1400.59,,,,,,,92.9300,1958.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,92.9300,1958.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,92.9300,1958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,92.9300,1958.0000,fee schedule,"APG 00009 Proc 11755 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,92.9300,1958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,92.9300,1958.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1958.00,,,,,,,92.9300,1958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,92.93,,,,,,,92.9300,1958.0000,fee schedule,$92.93 from Fee Schedule BLDTM_23 for Rev 521 Proc 11755 * Qty 1 = $92.93 at 100% = $92.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,92.9300,1958.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,CIGNA HEALTHCARE,CIGNA HMO,816.49,,,,,,,92.9300,1958.0000,percent of total billed charges,"41.7% of $1,958.00 in Billed Charges for Rev 521 Proc 11755 = $816.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,908.51,,,,,,,92.9300,1958.0000,percent of total billed charges,"46.4% of $1,958.00 in Billed Charges for Rev 521 Proc 11755 = $908.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,92.9300,1958.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,816.49,,,,,,,92.9300,1958.0000,percent of total billed charges,"41.7% of $1,958.00 in Billed Charges for Rev 521 Proc 11755 = $816.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,CIGNA HEALTHCARE,CIGNA PPO,816.49,,,,,,,92.9300,1958.0000,percent of total billed charges,"41.7% of $1,958.00 in Billed Charges for Rev 521 Proc 11755 = $816.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,92.9300,1958.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1762.20,,,,,,,92.9300,1958.0000,percent of total billed charges,"90% of $1,958.00 in Billed Charges for Rev 521 Proc 11755 = $1,762.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,HUMANA,HUMANA MEDICARE,642.47,,,,,,,92.9300,1958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,92.9300,1958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,MEDCOST,MEDCOST VHN,931.81,,,,,,,92.9300,1958.0000,percent of total billed charges,"47.59% of $1,958.00 in Billed Charges for Rev 521 Proc 11755 = $931.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,92.9300,1958.0000,fee schedule,"APG 00009 Proc 11755 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,92.9300,1958.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,92.9300,1958.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,92.9300,1958.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,92.9300,1958.0000,fee schedule,"APG 00009 Proc 11755 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,SENTARA HEALTH,SENTARA HEALTH,505.36,,,,,,,92.9300,1958.0000,percent of total billed charges,"25.81% of $1,958.00 in Billed Charges for Rev 521 Proc 11755 = $505.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,92.9300,1958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1958.00,,,,,,,92.9300,1958.0000,percent of total billed charges,"100% of $1,958.00 in Billed Charges for Rev 521 Proc 11755 = $1,958.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,189.28,,,,,,,92.9300,1958.0000,fee schedule,$378.56 from Fee Schedule TCUHC24 for Rev 521 Proc 11755 * Qty 1 = $378.56 at 50% = $189.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,92.9300,1958.0000,fee schedule,"APG 00009 Proc 11755 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,92.9300,1958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,92.9300,1958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,WELLCARE,WELLCARE MEDICAID,1958.00,,,,,,,92.9300,1958.0000,percent of total billed charges,"100% of $1,958.00 in Billed Charges for Rev 521 Proc 11755 = $1,958.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX NAIL UNIT,11755,CPT,521,RC,52100056,CDM,,,,both,,,1958.0000,293.7000,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,92.9300,1958.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,AETNA,AETNA,112.30,,,,,,,35.9700,263.0000,percent of total billed charges,42.7% of $263.00 in Billed Charges for Rev 510 Proc 99483 = $112.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,136.51,,,,,,,35.9700,263.0000,fee schedule,APG 00320 Proc 99483 at $836.60 (Base Rate) * 0.1569 (Relative Weight) = $131.26 (Total Line Payment) at 104% = $136.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,92.17,,,,,,,35.9700,263.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,AETNA,AETNA HEALTHCARE MEDICARE,92.17,,,,,,,35.9700,263.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,92.17,,,,,,,35.9700,263.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,AMBETTER,AMBETTER,200.93,,,,,,,35.9700,263.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,95.86,,,,,,,35.9700,263.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,BLUE CROSS,ANTHEM EXCHANGE,226.93,,,,,,,35.9700,263.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,135.20,,,,,,,35.9700,263.0000,fee schedule,APG 00320 Proc 99483 at $836.60 (Base Rate) * 0.1569 (Relative Weight) = $131.26 (Total Line Payment) at 103% = $135.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,BLUE CROSS,ANTHEM HMO,241.10,,,,,,,35.9700,263.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,94.93,,,,,,,35.9700,263.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",263.00,,,,,,,35.9700,263.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,184.10,,,,,,,35.9700,263.0000,percent of total billed charges,Rev 510 Proc 99483 $263.00 in Billed Charges at 70% = $184.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,BLUE CROSS,BLUE CROSS MEDICARE,95.86,,,,,,,35.9700,263.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,CIGNA HEALTHCARE,CIGNA HMO,109.67,,,,,,,35.9700,263.0000,percent of total billed charges,41.7% of $263.00 in Billed Charges for Rev 510 Proc 99483 = $109.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,122.03,,,,,,,35.9700,263.0000,percent of total billed charges,46.4% of $263.00 in Billed Charges for Rev 510 Proc 99483 = $122.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,96.78,,,,,,,35.9700,263.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,109.67,,,,,,,35.9700,263.0000,percent of total billed charges,41.7% of $263.00 in Billed Charges for Rev 510 Proc 99483 = $109.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,CIGNA HEALTHCARE,CIGNA PPO,109.67,,,,,,,35.9700,263.0000,percent of total billed charges,41.7% of $263.00 in Billed Charges for Rev 510 Proc 99483 = $109.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,96.78,,,,,,,35.9700,263.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,236.70,,,,,,,35.9700,263.0000,percent of total billed charges,90% of $263.00 in Billed Charges for Rev 510 Proc 99483 = $236.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,HUMANA,HUMANA MEDICARE,92.17,,,,,,,35.9700,263.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,92.17,,,,,,,35.9700,263.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,MEDCOST,MEDCOST VHN,125.16,,,,,,,35.9700,263.0000,percent of total billed charges,47.59% of $263.00 in Billed Charges for Rev 510 Proc 99483 = $125.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,137.82,,,,,,,35.9700,263.0000,fee schedule,APG 00320 Proc 99483 at $836.60 (Base Rate) * 0.1569 (Relative Weight) = $131.26 (Total Line Payment) at 100% = $131.26... $131.26 at 105% = $137.82 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,96.78,,,,,,,35.9700,263.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,96.78,,,,,,,35.9700,263.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,NHC ADVANTAGE,NHC ADVANTAGE,96.78,,,,,,,35.9700,263.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,135.33,,,,,,,35.9700,263.0000,fee schedule,APG 00320 Proc 99483 at $836.60 (Base Rate) * 0.1569 (Relative Weight) = $131.26 (Total Line Payment) at 100% = $131.26... $131.26 at 103.1% = $135.33 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,SENTARA HEALTH,SENTARA HEALTH,67.88,,,,,,,35.9700,263.0000,percent of total billed charges,25.81% of $263.00 in Billed Charges for Rev 510 Proc 99483 = $67.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,SENTARA HEALTH,SENTARA MEDICARE,92.17,,,,,,,35.9700,263.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",263.00,,,,,,,35.9700,263.0000,percent of total billed charges,100% of $263.00 in Billed Charges for Rev 510 Proc 99483 = $263.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,35.97,,,,,,,35.9700,263.0000,fee schedule,$71.94 from Fee Schedule TCUHC24 for Rev 510 Proc 99483 * Qty 1 = $71.94 at 50% = $35.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,84.95,,,,,,,35.9700,263.0000,other,32.3% of $263.00 in Billed Charges for Rev 510 Proc 99483 = $84.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,80.74,,,,,,,35.9700,263.0000,other,30.7% of $263.00 in Billed Charges for Rev 510 Proc 99483 = $80.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,84.95,,,,,,,35.9700,263.0000,percent of total billed charges,32.3% of $263.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,135.20,,,,,,,35.9700,263.0000,fee schedule,APG 00320 Proc 99483 at $836.60 (Base Rate) * 0.1569 (Relative Weight) = $131.26 (Total Line Payment) at 103% = $135.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,92.17,,,,,,,35.9700,263.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,92.17,,,,,,,35.9700,263.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,WELLCARE,WELLCARE MEDICAID,263.00,,,,,,,35.9700,263.0000,percent of total billed charges,100% of $263.00 in Billed Charges for Rev 510 Proc 99483 = $263.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT,99483,CPT,510,RC,51000197,CDM,,,,both,,,263.0000,39.4500,WELLCARE,WELLCARE MEDICARE,97.70,,,,,,,35.9700,263.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,AETNA,AETNA,112.30,,,,,,,67.8800,351.0600,percent of total billed charges,42.7% of $263.00 in Billed Charges for Rev 510 Proc 99487 = $112.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,83.27,,,,,,,67.8800,351.0600,fee schedule,APG 02070 Proc 99487 at $836.60 (Base Rate) * 0.0957 (Relative Weight) = $80.06 (Total Line Payment) at 104% = $83.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,161.04,,,,,,,67.8800,351.0600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,AETNA,AETNA HEALTHCARE MEDICARE,161.04,,,,,,,67.8800,351.0600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,161.04,,,,,,,67.8800,351.0600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,AMBETTER,AMBETTER,351.06,,,,,,,67.8800,351.0600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,167.48,,,,,,,67.8800,351.0600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,BLUE CROSS,ANTHEM EXCHANGE,263.00,,,,,,,67.8800,351.0600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,82.46,,,,,,,67.8800,351.0600,fee schedule,APG 02070 Proc 99487 at $836.60 (Base Rate) * 0.0957 (Relative Weight) = $80.06 (Total Line Payment) at 103% = $82.46. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,BLUE CROSS,ANTHEM HMO,263.00,,,,,,,67.8800,351.0600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,165.87,,,,,,,67.8800,351.0600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",263.00,,,,,,,67.8800,351.0600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,184.10,,,,,,,67.8800,351.0600,percent of total billed charges,Rev 510 Proc 99487 $263.00 in Billed Charges at 70% = $184.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,BLUE CROSS,BLUE CROSS MEDICARE,167.48,,,,,,,67.8800,351.0600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,CIGNA HEALTHCARE,CIGNA HMO,109.67,,,,,,,67.8800,351.0600,percent of total billed charges,41.7% of $263.00 in Billed Charges for Rev 510 Proc 99487 = $109.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,122.03,,,,,,,67.8800,351.0600,percent of total billed charges,46.4% of $263.00 in Billed Charges for Rev 510 Proc 99487 = $122.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,169.09,,,,,,,67.8800,351.0600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,109.67,,,,,,,67.8800,351.0600,percent of total billed charges,41.7% of $263.00 in Billed Charges for Rev 510 Proc 99487 = $109.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,CIGNA HEALTHCARE,CIGNA PPO,109.67,,,,,,,67.8800,351.0600,percent of total billed charges,41.7% of $263.00 in Billed Charges for Rev 510 Proc 99487 = $109.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,169.09,,,,,,,67.8800,351.0600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,236.70,,,,,,,67.8800,351.0600,percent of total billed charges,90% of $263.00 in Billed Charges for Rev 510 Proc 99487 = $236.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,HUMANA,HUMANA MEDICARE,161.04,,,,,,,67.8800,351.0600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,161.04,,,,,,,67.8800,351.0600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,MEDCOST,MEDCOST VHN,125.16,,,,,,,67.8800,351.0600,percent of total billed charges,47.59% of $263.00 in Billed Charges for Rev 510 Proc 99487 = $125.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,84.06,,,,,,,67.8800,351.0600,fee schedule,APG 02070 Proc 99487 at $836.60 (Base Rate) * 0.0957 (Relative Weight) = $80.06 (Total Line Payment) at 100% = $80.06... $80.06 at 105% = $84.06 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,169.09,,,,,,,67.8800,351.0600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,169.09,,,,,,,67.8800,351.0600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,NHC ADVANTAGE,NHC ADVANTAGE,169.09,,,,,,,67.8800,351.0600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,82.54,,,,,,,67.8800,351.0600,fee schedule,APG 02070 Proc 99487 at $836.60 (Base Rate) * 0.0957 (Relative Weight) = $80.06 (Total Line Payment) at 100% = $80.06... $80.06 at 103.1% = $82.54 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,SENTARA HEALTH,SENTARA HEALTH,67.88,,,,,,,67.8800,351.0600,percent of total billed charges,25.81% of $263.00 in Billed Charges for Rev 510 Proc 99487 = $67.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,SENTARA HEALTH,SENTARA MEDICARE,161.04,,,,,,,67.8800,351.0600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",263.00,,,,,,,67.8800,351.0600,percent of total billed charges,100% of $263.00 in Billed Charges for Rev 510 Proc 99487 = $263.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,84.95,,,,,,,67.8800,351.0600,other,32.3% of $263.00 in Billed Charges for Rev 510 Proc 99487 = $84.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,80.74,,,,,,,67.8800,351.0600,other,30.7% of $263.00 in Billed Charges for Rev 510 Proc 99487 = $80.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,84.95,,,,,,,67.8800,351.0600,percent of total billed charges,32.3% of $263.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,82.46,,,,,,,67.8800,351.0600,fee schedule,APG 02070 Proc 99487 at $836.60 (Base Rate) * 0.0957 (Relative Weight) = $80.06 (Total Line Payment) at 103% = $82.46. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,161.04,,,,,,,67.8800,351.0600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,161.04,,,,,,,67.8800,351.0600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,WELLCARE,WELLCARE MEDICAID,263.00,,,,,,,67.8800,351.0600,percent of total billed charges,100% of $263.00 in Billed Charges for Rev 510 Proc 99487 = $263.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MONT,99487,CPT,510,RC,51000204,CDM,,,,both,,,263.0000,39.4500,WELLCARE,WELLCARE MEDICARE,170.70,,,,,,,67.8800,351.0600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,AETNA,AETNA,166.10,,,,,,,48.4800,389.0000,percent of total billed charges,42.7% of $389.00 in Billed Charges for Rev 521 Proc 99496 = $166.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,183.24,,,,,,,48.4800,389.0000,fee schedule,APG 00260 Proc 99496 at $836.60 (Base Rate) * 0.2106 (Relative Weight) = $176.19 (Total Line Payment) at 104% = $183.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,120.79,,,,,,,48.4800,389.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,AETNA,AETNA HEALTHCARE MEDICARE,120.79,,,,,,,48.4800,389.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,120.79,,,,,,,48.4800,389.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,AMBETTER,AMBETTER,263.32,,,,,,,48.4800,389.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,125.62,,,,,,,48.4800,389.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,BLUE CROSS,ANTHEM EXCHANGE,297.39,,,,,,,48.4800,389.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,181.47,,,,,,,48.4800,389.0000,fee schedule,APG 00260 Proc 99496 at $836.60 (Base Rate) * 0.2106 (Relative Weight) = $176.19 (Total Line Payment) at 103% = $181.47. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,BLUE CROSS,ANTHEM HMO,315.96,,,,,,,48.4800,389.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,124.41,,,,,,,48.4800,389.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",371.69,,,,,,,48.4800,389.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,272.30,,,,,,,48.4800,389.0000,percent of total billed charges,Rev 521 Proc 99496 $389.00 in Billed Charges at 70% = $272.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,BLUE CROSS,BLUE CROSS MEDICARE,125.62,,,,,,,48.4800,389.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,CIGNA HEALTHCARE,CIGNA HMO,162.21,,,,,,,48.4800,389.0000,percent of total billed charges,41.7% of $389.00 in Billed Charges for Rev 521 Proc 99496 = $162.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,180.50,,,,,,,48.4800,389.0000,percent of total billed charges,46.4% of $389.00 in Billed Charges for Rev 521 Proc 99496 = $180.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,126.83,,,,,,,48.4800,389.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,162.21,,,,,,,48.4800,389.0000,percent of total billed charges,41.7% of $389.00 in Billed Charges for Rev 521 Proc 99496 = $162.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,CIGNA HEALTHCARE,CIGNA PPO,162.21,,,,,,,48.4800,389.0000,percent of total billed charges,41.7% of $389.00 in Billed Charges for Rev 521 Proc 99496 = $162.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,126.83,,,,,,,48.4800,389.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,350.10,,,,,,,48.4800,389.0000,percent of total billed charges,90% of $389.00 in Billed Charges for Rev 521 Proc 99496 = $350.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,HUMANA,HUMANA MEDICARE,120.79,,,,,,,48.4800,389.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,120.79,,,,,,,48.4800,389.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,MEDCOST,MEDCOST VHN,185.13,,,,,,,48.4800,389.0000,percent of total billed charges,47.59% of $389.00 in Billed Charges for Rev 521 Proc 99496 = $185.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,185.00,,,,,,,48.4800,389.0000,fee schedule,APG 00260 Proc 99496 at $836.60 (Base Rate) * 0.2106 (Relative Weight) = $176.19 (Total Line Payment) at 100% = $176.19... $176.19 at 105% = $185.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,126.83,,,,,,,48.4800,389.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,126.83,,,,,,,48.4800,389.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,NHC ADVANTAGE,NHC ADVANTAGE,126.83,,,,,,,48.4800,389.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,181.65,,,,,,,48.4800,389.0000,fee schedule,APG 00260 Proc 99496 at $836.60 (Base Rate) * 0.2106 (Relative Weight) = $176.19 (Total Line Payment) at 100% = $176.19... $176.19 at 103.1% = $181.65 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,SENTARA HEALTH,SENTARA HEALTH,100.40,,,,,,,48.4800,389.0000,percent of total billed charges,25.81% of $389.00 in Billed Charges for Rev 521 Proc 99496 = $100.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,SENTARA HEALTH,SENTARA MEDICARE,120.79,,,,,,,48.4800,389.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",389.00,,,,,,,48.4800,389.0000,percent of total billed charges,100% of $389.00 in Billed Charges for Rev 521 Proc 99496 = $389.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,48.48,,,,,,,48.4800,389.0000,fee schedule,$96.96 from Fee Schedule TCUHC24 for Rev 521 Proc 99496 * Qty 1 = $96.96 at 50% = $48.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,181.47,,,,,,,48.4800,389.0000,fee schedule,APG 00260 Proc 99496 at $836.60 (Base Rate) * 0.2106 (Relative Weight) = $176.19 (Total Line Payment) at 103% = $181.47. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,120.79,,,,,,,48.4800,389.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,120.79,,,,,,,48.4800,389.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,WELLCARE,WELLCARE MEDICAID,389.00,,,,,,,48.4800,389.0000,percent of total billed charges,100% of $389.00 in Billed Charges for Rev 521 Proc 99496 = $389.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TRANS CARE MGMT 7 DAY DISCH,99496,CPT,521,RC,52100005,CDM,,,,both,,,389.0000,58.3500,WELLCARE,WELLCARE MEDICARE,128.04,,,,,,,48.4800,389.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,AETNA,AETNA,12992.79,,,,,,,112.9100,27068.3100,percent of total billed charges,"48% of $27,068.31 in Billed Charges for Rev 278 Proc A2011 = $12,992.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,112.91,,,,,,,112.9100,27068.3100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,AETNA,AETNA HEALTHCARE MEDICARE,112.91,,,,,,,112.9100,27068.3100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,112.91,,,,,,,112.9100,27068.3100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,AMBETTER,AMBETTER,246.13,,,,,,,112.9100,27068.3100,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,117.42,,,,,,,112.9100,27068.3100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,BLUE CROSS,ANTHEM EXCHANGE,277.98,,,,,,,112.9100,27068.3100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,BLUE CROSS,ANTHEM HMO,295.34,,,,,,,112.9100,27068.3100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,116.29,,,,,,,112.9100,27068.3100,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",347.44,,,,,,,112.9100,27068.3100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,13534.16,,,,,,,112.9100,27068.3100,percent of total billed charges,"50% of $27,068.31 in Billed Charges for Rev 278 Proc A2011 = $13,534.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,BLUE CROSS,BLUE CROSS MEDICARE,117.42,,,,,,,112.9100,27068.3100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,CIGNA HEALTHCARE,CIGNA HMO,11287.49,,,,,,,112.9100,27068.3100,percent of total billed charges,"41.7% of $27,068.31 in Billed Charges for Rev 278 Proc A2011 = $11,287.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10827.32,,,,,,,112.9100,27068.3100,percent of total billed charges,"40% of $27,068.31 in Billed Charges for Rev 278 Proc A2011 = $10,827.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,118.55,,,,,,,112.9100,27068.3100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11287.49,,,,,,,112.9100,27068.3100,percent of total billed charges,"41.7% of $27,068.31 in Billed Charges for Rev 278 Proc A2011 = $11,287.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,CIGNA HEALTHCARE,CIGNA PPO,11287.49,,,,,,,112.9100,27068.3100,percent of total billed charges,"41.7% of $27,068.31 in Billed Charges for Rev 278 Proc A2011 = $11,287.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,118.55,,,,,,,112.9100,27068.3100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,24361.48,,,,,,,112.9100,27068.3100,percent of total billed charges,"90% of $27,068.31 in Billed Charges for Rev 278 Proc A2011 = $24,361.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,HUMANA,HUMANA MEDICARE,112.91,,,,,,,112.9100,27068.3100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,112.91,,,,,,,112.9100,27068.3100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,MEDCOST,MEDCOST VHN,12881.81,,,,,,,112.9100,27068.3100,percent of total billed charges,"47.59% of $27,068.31 in Billed Charges for Rev 278 Proc A2011 = $12,881.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,118.55,,,,,,,112.9100,27068.3100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,118.55,,,,,,,112.9100,27068.3100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,NHC ADVANTAGE,NHC ADVANTAGE,118.55,,,,,,,112.9100,27068.3100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,SENTARA HEALTH,SENTARA HEALTH,6986.33,,,,,,,112.9100,27068.3100,percent of total billed charges,"25.81% of $27,068.31 in Billed Charges for Rev 278 Proc A2011 = $6,986.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,SENTARA HEALTH,SENTARA MEDICARE,112.91,,,,,,,112.9100,27068.3100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",27068.31,,,,,,,112.9100,27068.3100,percent of total billed charges,"100% of $27,068.31 in Billed Charges for Rev 278 Proc A2011 = $27,068.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2030.12,,,,,,,112.9100,27068.3100,percent of total billed charges,"7.5% of $27,068.31 in Billed Charges for Rev 278 Proc A2011 = $2,030.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1921.85,,,,,,,112.9100,27068.3100,percent of total billed charges,"7.1% of $27,068.31 in Billed Charges for Rev 278 Proc A2011 = $1,921.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1921.85,,,,,,,112.9100,27068.3100,percent of total billed charges,"7.1% of $27,068.31 in Billed Charges for Rev 278 Proc A2011 = $1,921.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,112.91,,,,,,,112.9100,27068.3100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,112.91,,,,,,,112.9100,27068.3100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,WELLCARE,WELLCARE MEDICAID,27068.31,,,,,,,112.9100,27068.3100,percent of total billed charges,"100% of $27,068.31 in Billed Charges for Rev 278 Proc A2011 = $27,068.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING MATRIX SDRM 9X12CM,A2011,HCPCS,278,RC,,,,,,both,,,27068.3100,4060.2500,WELLCARE,WELLCARE MEDICARE,119.68,,,,,,,112.9100,27068.3100,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,AETNA,AETNA,2785.92,,,,,,,112.9100,6524.4000,percent of total billed charges,"42.7% of $6,524.40 in Billed Charges for Rev 636 Proc A2011 = $2,785.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,112.91,,,,,,,112.9100,6524.4000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,AETNA,AETNA HEALTHCARE MEDICARE,112.91,,,,,,,112.9100,6524.4000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,ALLCARE MEDICARE,ALLCARE MEDICARE,112.91,,,,,,,112.9100,6524.4000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,AMBETTER,AMBETTER,246.13,,,,,,,112.9100,6524.4000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,117.42,,,,,,,112.9100,6524.4000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,116.29,,,,,,,112.9100,6524.4000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4567.08,,,,,,,112.9100,6524.4000,percent of total billed charges,"Rev 636 Proc A2011 $6,524.40 in Billed Charges at 70% = $4,567.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,BLUE CROSS,BLUE CROSS MEDICARE,117.42,,,,,,,112.9100,6524.4000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,CIGNA HEALTHCARE,CIGNA HMO,2720.67,,,,,,,112.9100,6524.4000,percent of total billed charges,"41.7% of $6,524.40 in Billed Charges for Rev 636 Proc A2011 = $2,720.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4769.34,,,,,,,112.9100,6524.4000,percent of total billed charges,"Rev 636 Proc A2011 $6,524.40 in Billed Charges at 73.1% = $4,769.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,CIGNA HEALTHCARE,CIGNA MEDICARE,118.55,,,,,,,112.9100,6524.4000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2720.67,,,,,,,112.9100,6524.4000,percent of total billed charges,"41.7% of $6,524.40 in Billed Charges for Rev 636 Proc A2011 = $2,720.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,CIGNA HEALTHCARE,CIGNA PPO,2720.67,,,,,,,112.9100,6524.4000,percent of total billed charges,"41.7% of $6,524.40 in Billed Charges for Rev 636 Proc A2011 = $2,720.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,118.55,,,,,,,112.9100,6524.4000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5871.96,,,,,,,112.9100,6524.4000,percent of total billed charges,"90% of $6,524.40 in Billed Charges for Rev 636 Proc A2011 = $5,871.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,HUMANA,HUMANA MEDICARE,112.91,,,,,,,112.9100,6524.4000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,MANAGED MEDICAIRE,MANAGED MEDICAIRE,112.91,,,,,,,112.9100,6524.4000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,MEDCOST,MEDCOST VHN,3104.96,,,,,,,112.9100,6524.4000,percent of total billed charges,"47.59% of $6,524.40 in Billed Charges for Rev 636 Proc A2011 = $3,104.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,118.55,,,,,,,112.9100,6524.4000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,118.55,,,,,,,112.9100,6524.4000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,NHC ADVANTAGE,NHC ADVANTAGE,118.55,,,,,,,112.9100,6524.4000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,SENTARA HEALTH,SENTARA HEALTH,1683.95,,,,,,,112.9100,6524.4000,percent of total billed charges,"25.81% of $6,524.40 in Billed Charges for Rev 636 Proc A2011 = $1,683.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,SENTARA HEALTH,SENTARA MEDICARE,112.91,,,,,,,112.9100,6524.4000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6524.40,,,,,,,112.9100,6524.4000,percent of total billed charges,"100% of $6,524.40 in Billed Charges for Rev 636 Proc A2011 = $6,524.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,112.91,,,,,,,112.9100,6524.4000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,112.91,,,,,,,112.9100,6524.4000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,WELLCARE,WELLCARE MEDICAID,6524.40,,,,,,,112.9100,6524.4000,percent of total billed charges,"100% of $6,524.40 in Billed Charges for Rev 636 Proc A2011 = $6,524.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM 18MM DISC,A2011,HCPCS,636,RC,,,,,,both,,,6524.4000,978.6600,WELLCARE,WELLCARE MEDICARE,119.68,,,,,,,112.9100,6524.4000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,AETNA,AETNA,4011.88,,,,,,,112.9100,9395.5000,percent of total billed charges,"42.7% of $9,395.50 in Billed Charges for Rev 636 Proc A2011 = $4,011.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,112.91,,,,,,,112.9100,9395.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,AETNA,AETNA HEALTHCARE MEDICARE,112.91,,,,,,,112.9100,9395.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,ALLCARE MEDICARE,ALLCARE MEDICARE,112.91,,,,,,,112.9100,9395.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,AMBETTER,AMBETTER,246.13,,,,,,,112.9100,9395.5000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,117.42,,,,,,,112.9100,9395.5000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,116.29,,,,,,,112.9100,9395.5000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6576.85,,,,,,,112.9100,9395.5000,percent of total billed charges,"Rev 636 Proc A2011 $9,395.50 in Billed Charges at 70% = $6,576.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,BLUE CROSS,BLUE CROSS MEDICARE,117.42,,,,,,,112.9100,9395.5000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,CIGNA HEALTHCARE,CIGNA HMO,3917.92,,,,,,,112.9100,9395.5000,percent of total billed charges,"41.7% of $9,395.50 in Billed Charges for Rev 636 Proc A2011 = $3,917.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6868.11,,,,,,,112.9100,9395.5000,percent of total billed charges,"Rev 636 Proc A2011 $9,395.50 in Billed Charges at 73.1% = $6,868.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,CIGNA HEALTHCARE,CIGNA MEDICARE,118.55,,,,,,,112.9100,9395.5000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3917.92,,,,,,,112.9100,9395.5000,percent of total billed charges,"41.7% of $9,395.50 in Billed Charges for Rev 636 Proc A2011 = $3,917.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,CIGNA HEALTHCARE,CIGNA PPO,3917.92,,,,,,,112.9100,9395.5000,percent of total billed charges,"41.7% of $9,395.50 in Billed Charges for Rev 636 Proc A2011 = $3,917.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,118.55,,,,,,,112.9100,9395.5000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8455.95,,,,,,,112.9100,9395.5000,percent of total billed charges,"90% of $9,395.50 in Billed Charges for Rev 636 Proc A2011 = $8,455.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,HUMANA,HUMANA MEDICARE,112.91,,,,,,,112.9100,9395.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,MANAGED MEDICAIRE,MANAGED MEDICAIRE,112.91,,,,,,,112.9100,9395.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,MEDCOST,MEDCOST VHN,4471.32,,,,,,,112.9100,9395.5000,percent of total billed charges,"47.59% of $9,395.50 in Billed Charges for Rev 636 Proc A2011 = $4,471.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,118.55,,,,,,,112.9100,9395.5000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,118.55,,,,,,,112.9100,9395.5000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,NHC ADVANTAGE,NHC ADVANTAGE,118.55,,,,,,,112.9100,9395.5000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,SENTARA HEALTH,SENTARA HEALTH,2424.98,,,,,,,112.9100,9395.5000,percent of total billed charges,"25.81% of $9,395.50 in Billed Charges for Rev 636 Proc A2011 = $2,424.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,SENTARA HEALTH,SENTARA MEDICARE,112.91,,,,,,,112.9100,9395.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9395.50,,,,,,,112.9100,9395.5000,percent of total billed charges,"100% of $9,395.50 in Billed Charges for Rev 636 Proc A2011 = $9,395.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,112.91,,,,,,,112.9100,9395.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,112.91,,,,,,,112.9100,9395.5000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,WELLCARE,WELLCARE MEDICAID,9395.50,,,,,,,112.9100,9395.5000,percent of total billed charges,"100% of $9,395.50 in Billed Charges for Rev 636 Proc A2011 = $9,395.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM-RYLON BUNDLE 2X2,A2011,HCPCS,636,RC,63600235,CDM,,,,both,,,9395.5000,1409.3300,WELLCARE,WELLCARE MEDICARE,119.68,,,,,,,112.9100,9395.5000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,AETNA,AETNA,196.85,,,,,,,21.9700,804.0300,percent of total billed charges,42.7% of $461.00 in Billed Charges for Rev 450 Proc 11765 = $196.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,95.10,,,,,,,21.9700,804.0300,fee schedule,"APG 00005 Proc 11765 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $91.44 at 104% = $95.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,21.9700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,21.9700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,21.9700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,AMBETTER,AMBETTER,804.03,,,,,,,21.9700,804.0300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,21.9700,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,BLUE CROSS,ANTHEM EXCHANGE,461.00,,,,,,,21.9700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,94.18,,,,,,,21.9700,804.0300,fee schedule,"APG 00005 Proc 11765 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $91.44 at 103% = $94.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,BLUE CROSS,ANTHEM HMO,461.00,,,,,,,21.9700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,21.9700,804.0300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",461.00,,,,,,,21.9700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,51.61,,,,,,,21.9700,804.0300,fee schedule,$51.61 from Fee Schedule BLDTM_23 for Rev 450 Proc 11765 * Qty 1 = $51.61 at 100% = $51.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,21.9700,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,BLUE CROSS,TENNCARE BLUE CARE,21.97,,,,,,,21.9700,804.0300,fee schedule,$18.94 from Fee Schedule TC_24 for Rev 450 Proc 11765 * Qty 1 = $18.94 at 116% = $21.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,BLUE CROSS,TENNCARE BLUE SELECT,21.97,,,,,,,21.9700,804.0300,fee schedule,$18.94 from Fee Schedule TC_24 for Rev 450 Proc 11765 * Qty 1 = $18.94 at 116% = $21.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,21.9700,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,21.9700,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,414.90,,,,,,,21.9700,804.0300,percent of total billed charges,90% of $461.00 in Billed Charges for Rev 450 Proc 11765 = $414.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,21.9700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,21.9700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,MEDCOST,MEDCOST VHN,219.39,,,,,,,21.9700,804.0300,percent of total billed charges,47.59% of $461.00 in Billed Charges for Rev 450 Proc 11765 = $219.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,96.01,,,,,,,21.9700,804.0300,fee schedule,"APG 00005 Proc 11765 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $91.44 at 100% = $91.44... $91.44 at 105% = $96.01 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,21.9700,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,21.9700,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,21.9700,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,94.27,,,,,,,21.9700,804.0300,fee schedule,"APG 00005 Proc 11765 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $91.44 at 100% = $91.44... $91.44 at 103.1% = $94.27 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,SENTARA HEALTH,SENTARA HEALTH,118.98,,,,,,,21.9700,804.0300,percent of total billed charges,25.81% of $461.00 in Billed Charges for Rev 450 Proc 11765 = $118.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,21.9700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",461.00,,,,,,,21.9700,804.0300,percent of total billed charges,100% of $461.00 in Billed Charges for Rev 450 Proc 11765 = $461.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,21.9700,804.0300,case rate,Rev 450 Proc 11765 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,461.00,,,,,,,21.9700,804.0300,case rate,"Rev 450 Proc 11765 at Case Rate $491.00 (Service Line reduced to $461.00, claim capped at $461.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,461.00,,,,,,,21.9700,804.0300,case rate,"Rev 450 Proc 11765 at Case Rate $471.00 (Service Line reduced to $461.00, claim capped at $461.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,461.00,,,,,,,21.9700,804.0300,case rate,"Rev 450 Proc 11765 at Case Rate $847.00 (Service Line reduced to $461.00, claim capped at $461.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,94.18,,,,,,,21.9700,804.0300,fee schedule,"APG 00005 Proc 11765 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $91.44 at 103% = $94.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,21.9700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,21.9700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,WELLCARE,WELLCARE MEDICAID,461.00,,,,,,,21.9700,804.0300,percent of total billed charges,100% of $461.00 in Billed Charges for Rev 450 Proc 11765 = $461.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WEDGE EXCISION NAIL FOLD,11765,CPT,450,RC,45000036,CDM,,,,both,,,461.0000,69.1500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,21.9700,804.0300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,AETNA,AETNA,3343.84,,,,,,,213.7100,7831.0000,percent of total billed charges,"42.7% of $7,831.00 in Billed Charges for Rev 521 Proc 11770 = $3,343.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1775.80,,,,,,,213.7100,7831.0000,fee schedule,"APG 00010 Proc 11770 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 104% = $1,775.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2635.37,,,,,,,213.7100,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,AETNA,AETNA HEALTHCARE MEDICARE,2635.37,,,,,,,213.7100,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,2635.37,,,,,,,213.7100,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,AMBETTER,AMBETTER,5745.12,,,,,,,213.7100,7831.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2740.79,,,,,,,213.7100,7831.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,BLUE CROSS,ANTHEM EXCHANGE,6488.44,,,,,,,213.7100,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1758.73,,,,,,,213.7100,7831.0000,fee schedule,"APG 00010 Proc 11770 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,BLUE CROSS,ANTHEM HMO,6893.58,,,,,,,213.7100,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2714.44,,,,,,,213.7100,7831.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",7831.00,,,,,,,213.7100,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,213.71,,,,,,,213.7100,7831.0000,fee schedule,$213.71 from Fee Schedule BLDTM_23 for Rev 521 Proc 11770 * Qty 1 = $213.71 at 100% = $213.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,BLUE CROSS,BLUE CROSS MEDICARE,2740.79,,,,,,,213.7100,7831.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,CIGNA HEALTHCARE,CIGNA HMO,3265.53,,,,,,,213.7100,7831.0000,percent of total billed charges,"41.7% of $7,831.00 in Billed Charges for Rev 521 Proc 11770 = $3,265.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3633.58,,,,,,,213.7100,7831.0000,percent of total billed charges,"46.4% of $7,831.00 in Billed Charges for Rev 521 Proc 11770 = $3,633.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,2767.14,,,,,,,213.7100,7831.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3265.53,,,,,,,213.7100,7831.0000,percent of total billed charges,"41.7% of $7,831.00 in Billed Charges for Rev 521 Proc 11770 = $3,265.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,CIGNA HEALTHCARE,CIGNA PPO,3265.53,,,,,,,213.7100,7831.0000,percent of total billed charges,"41.7% of $7,831.00 in Billed Charges for Rev 521 Proc 11770 = $3,265.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,2767.14,,,,,,,213.7100,7831.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7047.90,,,,,,,213.7100,7831.0000,percent of total billed charges,"90% of $7,831.00 in Billed Charges for Rev 521 Proc 11770 = $7,047.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,HUMANA,HUMANA MEDICARE,2635.37,,,,,,,213.7100,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2635.37,,,,,,,213.7100,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,MEDCOST,MEDCOST VHN,3726.77,,,,,,,213.7100,7831.0000,percent of total billed charges,"47.59% of $7,831.00 in Billed Charges for Rev 521 Proc 11770 = $3,726.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1792.88,,,,,,,213.7100,7831.0000,fee schedule,"APG 00010 Proc 11770 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 105% = $1,792.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,2767.14,,,,,,,213.7100,7831.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,2767.14,,,,,,,213.7100,7831.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,NHC ADVANTAGE,NHC ADVANTAGE,2767.14,,,,,,,213.7100,7831.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1760.43,,,,,,,213.7100,7831.0000,fee schedule,"APG 00010 Proc 11770 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 103.1% = $1,760.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,SENTARA HEALTH,SENTARA HEALTH,2021.18,,,,,,,213.7100,7831.0000,percent of total billed charges,"25.81% of $7,831.00 in Billed Charges for Rev 521 Proc 11770 = $2,021.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,SENTARA HEALTH,SENTARA MEDICARE,2635.37,,,,,,,213.7100,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7831.00,,,,,,,213.7100,7831.0000,percent of total billed charges,"100% of $7,831.00 in Billed Charges for Rev 521 Proc 11770 = $7,831.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,912.16,,,,,,,213.7100,7831.0000,fee schedule,"$1,824.31 from Fee Schedule TCUHC24 for Rev 521 Proc 11770 * Qty 1 = $1,824.31 at 50% = $912.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1758.73,,,,,,,213.7100,7831.0000,fee schedule,"APG 00010 Proc 11770 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2635.37,,,,,,,213.7100,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2635.37,,,,,,,213.7100,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,WELLCARE,WELLCARE MEDICAID,7831.00,,,,,,,213.7100,7831.0000,percent of total billed charges,"100% of $7,831.00 in Billed Charges for Rev 521 Proc 11770 = $7,831.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC PILONIDAL CYST/SINUS SIMPLE,11770,CPT,521,RC,52100058,CDM,,,,both,,,7831.0000,1174.6500,WELLCARE,WELLCARE MEDICARE,2793.50,,,,,,,213.7100,7831.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA,237.84,,,,,,,23.5500,557.0000,percent of total billed charges,42.7% of $557.00 in Billed Charges for Rev 521 Proc 11901 = $237.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,23.5500,557.0000,fee schedule,"APG 00003 Proc 11901 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,23.5500,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,23.5500,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,23.5500,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,AMBETTER,AMBETTER,396.83,,,,,,,23.5500,557.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,23.5500,557.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,23.5500,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,23.5500,557.0000,fee schedule,"APG 00003 Proc 11901 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,23.5500,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,23.5500,557.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",557.00,,,,,,,23.5500,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,51.12,,,,,,,23.5500,557.0000,fee schedule,$51.12 from Fee Schedule BLDTM_23 for Rev 521 Proc 11901 * Qty 1 = $51.12 at 100% = $51.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,23.5500,557.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,TENNCARE BLUE CARE,23.55,,,,,,,23.5500,557.0000,fee schedule,$20.30 from Fee Schedule TC_24 for Rev 521 Proc 11901 * Qty 1 = $20.30 at 116% = $23.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,TENNCARE BLUE SELECT,23.55,,,,,,,23.5500,557.0000,fee schedule,$20.30 from Fee Schedule TC_24 for Rev 521 Proc 11901 * Qty 1 = $20.30 at 116% = $23.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA HMO,232.27,,,,,,,23.5500,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 521 Proc 11901 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,258.45,,,,,,,23.5500,557.0000,percent of total billed charges,46.4% of $557.00 in Billed Charges for Rev 521 Proc 11901 = $258.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,23.5500,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,232.27,,,,,,,23.5500,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 521 Proc 11901 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA PPO,232.27,,,,,,,23.5500,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 521 Proc 11901 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,23.5500,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,501.30,,,,,,,23.5500,557.0000,percent of total billed charges,90% of $557.00 in Billed Charges for Rev 521 Proc 11901 = $501.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,23.5500,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,23.5500,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,MEDCOST,MEDCOST VHN,265.08,,,,,,,23.5500,557.0000,percent of total billed charges,47.59% of $557.00 in Billed Charges for Rev 521 Proc 11901 = $265.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,23.5500,557.0000,fee schedule,"APG 00003 Proc 11901 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,23.5500,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,23.5500,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,23.5500,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,23.5500,557.0000,fee schedule,"APG 00003 Proc 11901 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,SENTARA HEALTH,SENTARA HEALTH,143.76,,,,,,,23.5500,557.0000,percent of total billed charges,25.81% of $557.00 in Billed Charges for Rev 521 Proc 11901 = $143.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,23.5500,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",557.00,,,,,,,23.5500,557.0000,percent of total billed charges,100% of $557.00 in Billed Charges for Rev 521 Proc 11901 = $557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,49.25,,,,,,,23.5500,557.0000,fee schedule,$98.49 from Fee Schedule TCUHC24 for Rev 521 Proc 11901 * Qty 1 = $98.49 at 50% = $49.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,23.5500,557.0000,fee schedule,"APG 00003 Proc 11901 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,23.5500,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,23.5500,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,WELLCARE,WELLCARE MEDICAID,557.00,,,,,,,23.5500,557.0000,percent of total billed charges,100% of $557.00 in Billed Charges for Rev 521 Proc 11901 = $557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ INTRALESIONAL UP TO & INCL>7 LESIONS,11901,CPT,521,RC,52100061,CDM,,,,both,,,557.0000,83.5500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,23.5500,557.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,AETNA,AETNA,157.56,,,,,,,65.8800,369.0000,percent of total billed charges,42.7% of $369.00 in Billed Charges for Rev 510 Proc 11981 = $157.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,65.8800,369.0000,fee schedule,APG 00003 Proc 11981 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,120.71,,,,,,,65.8800,369.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,AETNA,AETNA HEALTHCARE MEDICARE,120.71,,,,,,,65.8800,369.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,120.71,,,,,,,65.8800,369.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,AMBETTER,AMBETTER,263.15,,,,,,,65.8800,369.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,125.54,,,,,,,65.8800,369.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,BLUE CROSS,ANTHEM EXCHANGE,297.21,,,,,,,65.8800,369.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,65.8800,369.0000,fee schedule,APG 00003 Proc 11981 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,BLUE CROSS,ANTHEM HMO,315.76,,,,,,,65.8800,369.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,124.33,,,,,,,65.8800,369.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",369.00,,,,,,,65.8800,369.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,128.86,,,,,,,65.8800,369.0000,fee schedule,$128.86 from Fee Schedule BLDTM_23 for Rev 510 Proc 11981 * Qty 1 = $128.86 at 100% = $128.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,BLUE CROSS,BLUE CROSS MEDICARE,125.54,,,,,,,65.8800,369.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,CIGNA HEALTHCARE,CIGNA HMO,153.87,,,,,,,65.8800,369.0000,percent of total billed charges,41.7% of $369.00 in Billed Charges for Rev 510 Proc 11981 = $153.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,171.22,,,,,,,65.8800,369.0000,percent of total billed charges,46.4% of $369.00 in Billed Charges for Rev 510 Proc 11981 = $171.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,126.75,,,,,,,65.8800,369.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,153.87,,,,,,,65.8800,369.0000,percent of total billed charges,41.7% of $369.00 in Billed Charges for Rev 510 Proc 11981 = $153.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,CIGNA HEALTHCARE,CIGNA PPO,153.87,,,,,,,65.8800,369.0000,percent of total billed charges,41.7% of $369.00 in Billed Charges for Rev 510 Proc 11981 = $153.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,126.75,,,,,,,65.8800,369.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,332.10,,,,,,,65.8800,369.0000,percent of total billed charges,90% of $369.00 in Billed Charges for Rev 510 Proc 11981 = $332.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,HUMANA,HUMANA MEDICARE,120.71,,,,,,,65.8800,369.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,120.71,,,,,,,65.8800,369.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,MEDCOST,MEDCOST VHN,175.61,,,,,,,65.8800,369.0000,percent of total billed charges,47.59% of $369.00 in Billed Charges for Rev 510 Proc 11981 = $175.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,65.8800,369.0000,fee schedule,APG 00003 Proc 11981 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,126.75,,,,,,,65.8800,369.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,126.75,,,,,,,65.8800,369.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,NHC ADVANTAGE,NHC ADVANTAGE,126.75,,,,,,,65.8800,369.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,65.8800,369.0000,fee schedule,APG 00003 Proc 11981 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,SENTARA HEALTH,SENTARA HEALTH,95.24,,,,,,,65.8800,369.0000,percent of total billed charges,25.81% of $369.00 in Billed Charges for Rev 510 Proc 11981 = $95.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,SENTARA HEALTH,SENTARA MEDICARE,120.71,,,,,,,65.8800,369.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",369.00,,,,,,,65.8800,369.0000,percent of total billed charges,100% of $369.00 in Billed Charges for Rev 510 Proc 11981 = $369.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,65.88,,,,,,,65.8800,369.0000,fee schedule,$131.75 from Fee Schedule TCUHC24 for Rev 510 Proc 11981 * Qty 1 = $131.75 at 50% = $65.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,119.19,,,,,,,65.8800,369.0000,other,32.3% of $369.00 in Billed Charges for Rev 510 Proc 11981 = $119.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,113.28,,,,,,,65.8800,369.0000,other,30.7% of $369.00 in Billed Charges for Rev 510 Proc 11981 = $113.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,119.19,,,,,,,65.8800,369.0000,percent of total billed charges,32.3% of $369.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,65.8800,369.0000,fee schedule,APG 00003 Proc 11981 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,120.71,,,,,,,65.8800,369.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,120.71,,,,,,,65.8800,369.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,WELLCARE,WELLCARE MEDICAID,369.00,,,,,,,65.8800,369.0000,percent of total billed charges,100% of $369.00 in Billed Charges for Rev 510 Proc 11981 = $369.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INSERTION DRUG DELIVERY IMPLANT,11981,CPT,510,RC,51000244,CDM,,,,both,,,369.0000,55.3500,WELLCARE,WELLCARE MEDICARE,127.95,,,,,,,65.8800,369.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,AETNA,AETNA,365.51,,,,,,,65.8800,883.5600,percent of total billed charges,42.7% of $856.00 in Billed Charges for Rev 510 Proc 11982 = $365.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,65.8800,883.5600,fee schedule,APG 00003 Proc 11982 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,405.30,,,,,,,65.8800,883.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,AETNA,AETNA HEALTHCARE MEDICARE,405.30,,,,,,,65.8800,883.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,405.30,,,,,,,65.8800,883.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,AMBETTER,AMBETTER,883.56,,,,,,,65.8800,883.5600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,421.51,,,,,,,65.8800,883.5600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,BLUE CROSS,ANTHEM EXCHANGE,856.00,,,,,,,65.8800,883.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,65.8800,883.5600,fee schedule,APG 00003 Proc 11982 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,BLUE CROSS,ANTHEM HMO,856.00,,,,,,,65.8800,883.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,417.46,,,,,,,65.8800,883.5600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",856.00,,,,,,,65.8800,883.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,147.14,,,,,,,65.8800,883.5600,fee schedule,$147.14 from Fee Schedule BLDTM_23 for Rev 510 Proc 11982 * Qty 1 = $147.14 at 100% = $147.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,BLUE CROSS,BLUE CROSS MEDICARE,421.51,,,,,,,65.8800,883.5600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,CIGNA HEALTHCARE,CIGNA HMO,356.95,,,,,,,65.8800,883.5600,percent of total billed charges,41.7% of $856.00 in Billed Charges for Rev 510 Proc 11982 = $356.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,397.18,,,,,,,65.8800,883.5600,percent of total billed charges,46.4% of $856.00 in Billed Charges for Rev 510 Proc 11982 = $397.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,425.57,,,,,,,65.8800,883.5600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,356.95,,,,,,,65.8800,883.5600,percent of total billed charges,41.7% of $856.00 in Billed Charges for Rev 510 Proc 11982 = $356.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,CIGNA HEALTHCARE,CIGNA PPO,356.95,,,,,,,65.8800,883.5600,percent of total billed charges,41.7% of $856.00 in Billed Charges for Rev 510 Proc 11982 = $356.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,425.57,,,,,,,65.8800,883.5600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,770.40,,,,,,,65.8800,883.5600,percent of total billed charges,90% of $856.00 in Billed Charges for Rev 510 Proc 11982 = $770.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,HUMANA,HUMANA MEDICARE,405.30,,,,,,,65.8800,883.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,405.30,,,,,,,65.8800,883.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,MEDCOST,MEDCOST VHN,407.37,,,,,,,65.8800,883.5600,percent of total billed charges,47.59% of $856.00 in Billed Charges for Rev 510 Proc 11982 = $407.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,65.8800,883.5600,fee schedule,APG 00003 Proc 11982 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,425.57,,,,,,,65.8800,883.5600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,425.57,,,,,,,65.8800,883.5600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,NHC ADVANTAGE,NHC ADVANTAGE,425.57,,,,,,,65.8800,883.5600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,65.8800,883.5600,fee schedule,APG 00003 Proc 11982 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,SENTARA HEALTH,SENTARA HEALTH,220.93,,,,,,,65.8800,883.5600,percent of total billed charges,25.81% of $856.00 in Billed Charges for Rev 510 Proc 11982 = $220.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,SENTARA HEALTH,SENTARA MEDICARE,405.30,,,,,,,65.8800,883.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",856.00,,,,,,,65.8800,883.5600,percent of total billed charges,100% of $856.00 in Billed Charges for Rev 510 Proc 11982 = $856.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,65.88,,,,,,,65.8800,883.5600,fee schedule,$131.75 from Fee Schedule TCUHC24 for Rev 510 Proc 11982 * Qty 1 = $131.75 at 50% = $65.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,276.49,,,,,,,65.8800,883.5600,other,32.3% of $856.00 in Billed Charges for Rev 510 Proc 11982 = $276.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,262.79,,,,,,,65.8800,883.5600,other,30.7% of $856.00 in Billed Charges for Rev 510 Proc 11982 = $262.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,276.49,,,,,,,65.8800,883.5600,percent of total billed charges,32.3% of $856.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,65.8800,883.5600,fee schedule,APG 00003 Proc 11982 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,405.30,,,,,,,65.8800,883.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,405.30,,,,,,,65.8800,883.5600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,WELLCARE,WELLCARE MEDICAID,856.00,,,,,,,65.8800,883.5600,percent of total billed charges,100% of $856.00 in Billed Charges for Rev 510 Proc 11982 = $856.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT,11982,CPT,510,RC,51000243,CDM,,,,both,,,856.0000,128.4000,WELLCARE,WELLCARE MEDICARE,429.62,,,,,,,65.8800,883.5600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,AETNA,AETNA,513.25,,,,,,,65.8800,1202.0000,percent of total billed charges,"42.7% of $1,202.00 in Billed Charges for Rev 510 Proc 11983 = $513.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,65.8800,1202.0000,fee schedule,APG 00003 Proc 11983 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,405.30,,,,,,,65.8800,1202.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,AETNA,AETNA HEALTHCARE MEDICARE,405.30,,,,,,,65.8800,1202.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,405.30,,,,,,,65.8800,1202.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,AMBETTER,AMBETTER,883.56,,,,,,,65.8800,1202.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,421.51,,,,,,,65.8800,1202.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,BLUE CROSS,ANTHEM EXCHANGE,997.87,,,,,,,65.8800,1202.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,65.8800,1202.0000,fee schedule,APG 00003 Proc 11983 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,BLUE CROSS,ANTHEM HMO,1060.18,,,,,,,65.8800,1202.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,417.46,,,,,,,65.8800,1202.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1202.00,,,,,,,65.8800,1202.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,239.54,,,,,,,65.8800,1202.0000,fee schedule,$239.54 from Fee Schedule BLDTM_23 for Rev 510 Proc 11983 * Qty 1 = $239.54 at 100% = $239.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,BLUE CROSS,BLUE CROSS MEDICARE,421.51,,,,,,,65.8800,1202.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,CIGNA HEALTHCARE,CIGNA HMO,501.23,,,,,,,65.8800,1202.0000,percent of total billed charges,"41.7% of $1,202.00 in Billed Charges for Rev 510 Proc 11983 = $501.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,557.73,,,,,,,65.8800,1202.0000,percent of total billed charges,"46.4% of $1,202.00 in Billed Charges for Rev 510 Proc 11983 = $557.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,425.57,,,,,,,65.8800,1202.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,501.23,,,,,,,65.8800,1202.0000,percent of total billed charges,"41.7% of $1,202.00 in Billed Charges for Rev 510 Proc 11983 = $501.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,CIGNA HEALTHCARE,CIGNA PPO,501.23,,,,,,,65.8800,1202.0000,percent of total billed charges,"41.7% of $1,202.00 in Billed Charges for Rev 510 Proc 11983 = $501.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,425.57,,,,,,,65.8800,1202.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1081.80,,,,,,,65.8800,1202.0000,percent of total billed charges,"90% of $1,202.00 in Billed Charges for Rev 510 Proc 11983 = $1,081.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,HUMANA,HUMANA MEDICARE,405.30,,,,,,,65.8800,1202.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,405.30,,,,,,,65.8800,1202.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,MEDCOST,MEDCOST VHN,572.03,,,,,,,65.8800,1202.0000,percent of total billed charges,"47.59% of $1,202.00 in Billed Charges for Rev 510 Proc 11983 = $572.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,65.8800,1202.0000,fee schedule,APG 00003 Proc 11983 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,425.57,,,,,,,65.8800,1202.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,425.57,,,,,,,65.8800,1202.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,NHC ADVANTAGE,NHC ADVANTAGE,425.57,,,,,,,65.8800,1202.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,65.8800,1202.0000,fee schedule,APG 00003 Proc 11983 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,SENTARA HEALTH,SENTARA HEALTH,310.24,,,,,,,65.8800,1202.0000,percent of total billed charges,"25.81% of $1,202.00 in Billed Charges for Rev 510 Proc 11983 = $310.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,SENTARA HEALTH,SENTARA MEDICARE,405.30,,,,,,,65.8800,1202.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1202.00,,,,,,,65.8800,1202.0000,percent of total billed charges,"100% of $1,202.00 in Billed Charges for Rev 510 Proc 11983 = $1,202.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,65.88,,,,,,,65.8800,1202.0000,fee schedule,$131.75 from Fee Schedule TCUHC24 for Rev 510 Proc 11983 * Qty 1 = $131.75 at 50% = $65.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,388.25,,,,,,,65.8800,1202.0000,other,"32.3% of $1,202.00 in Billed Charges for Rev 510 Proc 11983 = $388.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,369.01,,,,,,,65.8800,1202.0000,other,"30.7% of $1,202.00 in Billed Charges for Rev 510 Proc 11983 = $369.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,388.25,,,,,,,65.8800,1202.0000,percent of total billed charges,"32.3% of $1,202.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,65.8800,1202.0000,fee schedule,APG 00003 Proc 11983 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,405.30,,,,,,,65.8800,1202.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,405.30,,,,,,,65.8800,1202.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,WELLCARE,WELLCARE MEDICAID,1202.00,,,,,,,65.8800,1202.0000,percent of total billed charges,"100% of $1,202.00 in Billed Charges for Rev 510 Proc 11983 = $1,202.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT,11983,CPT,510,RC,51000255,CDM,,,,both,,,1202.0000,180.3000,WELLCARE,WELLCARE MEDICARE,429.62,,,,,,,65.8800,1202.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,AETNA,AETNA,239.12,,,,,,,42.3700,560.0000,percent of total billed charges,42.7% of $560.00 in Billed Charges for Rev 450 Proc 12001 = $239.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,272.07,,,,,,,42.3700,560.0000,fee schedule,"APG 00016 Proc 12001 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 104% = $272.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,42.3700,560.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,42.3700,560.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,42.3700,560.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,AMBETTER,AMBETTER,396.83,,,,,,,42.3700,560.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,42.3700,560.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,42.3700,560.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,269.45,,,,,,,42.3700,560.0000,fee schedule,"APG 00016 Proc 12001 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,42.3700,560.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,42.3700,560.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",560.00,,,,,,,42.3700,560.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,85.04,,,,,,,42.3700,560.0000,fee schedule,$85.04 from Fee Schedule BLDTM_23 for Rev 450 Proc 12001 * Qty 1 = $85.04 at 100% = $85.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,42.3700,560.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,BLUE CROSS,TENNCARE BLUE CARE,42.37,,,,,,,42.3700,560.0000,fee schedule,$36.53 from Fee Schedule TC_24 for Rev 450 Proc 12001 * Qty 1 = $36.53 at 116% = $42.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,BLUE CROSS,TENNCARE BLUE SELECT,42.37,,,,,,,42.3700,560.0000,fee schedule,$36.53 from Fee Schedule TC_24 for Rev 450 Proc 12001 * Qty 1 = $36.53 at 116% = $42.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,42.3700,560.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,42.3700,560.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,504.00,,,,,,,42.3700,560.0000,percent of total billed charges,90% of $560.00 in Billed Charges for Rev 450 Proc 12001 = $504.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,HUMANA,HUMANA MEDICARE,182.03,,,,,,,42.3700,560.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,42.3700,560.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,MEDCOST,MEDCOST VHN,266.50,,,,,,,42.3700,560.0000,percent of total billed charges,47.59% of $560.00 in Billed Charges for Rev 450 Proc 12001 = $266.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,274.68,,,,,,,42.3700,560.0000,fee schedule,"APG 00016 Proc 12001 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 105% = $274.68 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,42.3700,560.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,42.3700,560.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,42.3700,560.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,269.71,,,,,,,42.3700,560.0000,fee schedule,"APG 00016 Proc 12001 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 103.1% = $269.71 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,SENTARA HEALTH,SENTARA HEALTH,144.54,,,,,,,42.3700,560.0000,percent of total billed charges,25.81% of $560.00 in Billed Charges for Rev 450 Proc 12001 = $144.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,42.3700,560.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",560.00,,,,,,,42.3700,560.0000,percent of total billed charges,100% of $560.00 in Billed Charges for Rev 450 Proc 12001 = $560.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,42.3700,560.0000,case rate,Rev 450 Proc 12001 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,42.3700,560.0000,case rate,Rev 450 Proc 12001 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,42.3700,560.0000,case rate,Rev 450 Proc 12001 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,560.00,,,,,,,42.3700,560.0000,case rate,"Rev 450 Proc 12001 at Case Rate $847.00 (Service Line reduced to $560.00, claim capped at $560.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,269.45,,,,,,,42.3700,560.0000,fee schedule,"APG 00016 Proc 12001 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,42.3700,560.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,42.3700,560.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,WELLCARE,WELLCARE MEDICAID,560.00,,,,,,,42.3700,560.0000,percent of total billed charges,100% of $560.00 in Billed Charges for Rev 450 Proc 12001 = $560.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMPL REPR SCLP TRUNK LESS 2.5,12001,CPT,450,RC,45000037,CDM,,,,both,,,560.0000,84.0000,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,42.3700,560.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,AETNA,AETNA,6004.67,,,,,,,112.9100,14062.4500,percent of total billed charges,"42.7% of $14,062.45 in Billed Charges for Rev 636 Proc A2011 = $6,004.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,112.91,,,,,,,112.9100,14062.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,AETNA,AETNA HEALTHCARE MEDICARE,112.91,,,,,,,112.9100,14062.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,ALLCARE MEDICARE,ALLCARE MEDICARE,112.91,,,,,,,112.9100,14062.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,AMBETTER,AMBETTER,246.13,,,,,,,112.9100,14062.4500,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,117.42,,,,,,,112.9100,14062.4500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,116.29,,,,,,,112.9100,14062.4500,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9843.72,,,,,,,112.9100,14062.4500,percent of total billed charges,"Rev 636 Proc A2011 $14,062.45 in Billed Charges at 70% = $9,843.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,BLUE CROSS,BLUE CROSS MEDICARE,117.42,,,,,,,112.9100,14062.4500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,CIGNA HEALTHCARE,CIGNA HMO,5864.04,,,,,,,112.9100,14062.4500,percent of total billed charges,"41.7% of $14,062.45 in Billed Charges for Rev 636 Proc A2011 = $5,864.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,10279.65,,,,,,,112.9100,14062.4500,percent of total billed charges,"Rev 636 Proc A2011 $14,062.45 in Billed Charges at 73.1% = $10,279.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,CIGNA HEALTHCARE,CIGNA MEDICARE,118.55,,,,,,,112.9100,14062.4500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5864.04,,,,,,,112.9100,14062.4500,percent of total billed charges,"41.7% of $14,062.45 in Billed Charges for Rev 636 Proc A2011 = $5,864.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,CIGNA HEALTHCARE,CIGNA PPO,5864.04,,,,,,,112.9100,14062.4500,percent of total billed charges,"41.7% of $14,062.45 in Billed Charges for Rev 636 Proc A2011 = $5,864.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,118.55,,,,,,,112.9100,14062.4500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12656.21,,,,,,,112.9100,14062.4500,percent of total billed charges,"90% of $14,062.45 in Billed Charges for Rev 636 Proc A2011 = $12,656.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,HUMANA,HUMANA MEDICARE,112.91,,,,,,,112.9100,14062.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,MANAGED MEDICAIRE,MANAGED MEDICAIRE,112.91,,,,,,,112.9100,14062.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,MEDCOST,MEDCOST VHN,6692.32,,,,,,,112.9100,14062.4500,percent of total billed charges,"47.59% of $14,062.45 in Billed Charges for Rev 636 Proc A2011 = $6,692.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,118.55,,,,,,,112.9100,14062.4500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,118.55,,,,,,,112.9100,14062.4500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,NHC ADVANTAGE,NHC ADVANTAGE,118.55,,,,,,,112.9100,14062.4500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,SENTARA HEALTH,SENTARA HEALTH,3629.52,,,,,,,112.9100,14062.4500,percent of total billed charges,"25.81% of $14,062.45 in Billed Charges for Rev 636 Proc A2011 = $3,629.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,SENTARA HEALTH,SENTARA MEDICARE,112.91,,,,,,,112.9100,14062.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",14062.45,,,,,,,112.9100,14062.4500,percent of total billed charges,"100% of $14,062.45 in Billed Charges for Rev 636 Proc A2011 = $14,062.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,112.91,,,,,,,112.9100,14062.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,112.91,,,,,,,112.9100,14062.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,WELLCARE,WELLCARE MEDICAID,14062.45,,,,,,,112.9100,14062.4500,percent of total billed charges,"100% of $14,062.45 in Billed Charges for Rev 636 Proc A2011 = $14,062.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
DRESSING SDRM-RYLON BUNDLE 5.1X5.1,A2011,HCPCS,636,RC,,,,,,both,,,14062.4500,2109.3700,WELLCARE,WELLCARE MEDICARE,119.68,,,,,,,112.9100,14062.4500,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,5797.3900,869.6100,AETNA,AETNA,2782.75,,,,,,,1496.3100,5797.3900,percent of total billed charges,"48% of $5,797.39 in Billed Charges for Rev 278 Proc C1713 = $2,782.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,5797.3900,869.6100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2898.70,,,,,,,1496.3100,5797.3900,percent of total billed charges,"50% of $5,797.39 in Billed Charges for Rev 278 Proc C1713 = $2,898.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,5797.3900,869.6100,CIGNA HEALTHCARE,CIGNA HMO,2417.51,,,,,,,1496.3100,5797.3900,percent of total billed charges,"41.7% of $5,797.39 in Billed Charges for Rev 278 Proc C1713 = $2,417.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,5797.3900,869.6100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2318.96,,,,,,,1496.3100,5797.3900,percent of total billed charges,"40% of $5,797.39 in Billed Charges for Rev 278 Proc C1713 = $2,318.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,5797.3900,869.6100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2417.51,,,,,,,1496.3100,5797.3900,percent of total billed charges,"41.7% of $5,797.39 in Billed Charges for Rev 278 Proc C1713 = $2,417.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,5797.3900,869.6100,CIGNA HEALTHCARE,CIGNA PPO,2417.51,,,,,,,1496.3100,5797.3900,percent of total billed charges,"41.7% of $5,797.39 in Billed Charges for Rev 278 Proc C1713 = $2,417.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,5797.3900,869.6100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5217.65,,,,,,,1496.3100,5797.3900,percent of total billed charges,"90% of $5,797.39 in Billed Charges for Rev 278 Proc C1713 = $5,217.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,5797.3900,869.6100,MEDCOST,MEDCOST VHN,2758.98,,,,,,,1496.3100,5797.3900,percent of total billed charges,"47.59% of $5,797.39 in Billed Charges for Rev 278 Proc C1713 = $2,758.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,5797.3900,869.6100,SENTARA HEALTH,SENTARA HEALTH,1496.31,,,,,,,1496.3100,5797.3900,percent of total billed charges,"25.81% of $5,797.39 in Billed Charges for Rev 278 Proc C1713 = $1,496.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,5797.3900,869.6100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5797.39,,,,,,,1496.3100,5797.3900,percent of total billed charges,"100% of $5,797.39 in Billed Charges for Rev 278 Proc C1713 = $5,797.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,5797.3900,869.6100,WELLCARE,WELLCARE MEDICAID,5797.39,,,,,,,1496.3100,5797.3900,percent of total billed charges,"100% of $5,797.39 in Billed Charges for Rev 278 Proc C1713 = $5,797.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,AETNA,AETNA,516.24,,,,,,,109.0000,1209.0000,percent of total billed charges,"42.7% of $1,209.00 in Billed Charges for Rev 450 Proc 12006 = $516.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,272.07,,,,,,,109.0000,1209.0000,fee schedule,"APG 00016 Proc 12006 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 104% = $272.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,109.0000,1209.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,1209.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,109.0000,1209.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,AMBETTER,AMBETTER,804.03,,,,,,,109.0000,1209.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,109.0000,1209.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,109.0000,1209.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,269.45,,,,,,,109.0000,1209.0000,fee schedule,"APG 00016 Proc 12006 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,109.0000,1209.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,109.0000,1209.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1134.94,,,,,,,109.0000,1209.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,223.91,,,,,,,109.0000,1209.0000,fee schedule,$223.91 from Fee Schedule BLDTM_23 for Rev 450 Proc 12006 * Qty 1 = $223.91 at 100% = $223.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,109.0000,1209.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,109.0000,1209.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,109.0000,1209.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1088.10,,,,,,,109.0000,1209.0000,percent of total billed charges,"90% of $1,209.00 in Billed Charges for Rev 450 Proc 12006 = $1,088.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,109.0000,1209.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,109.0000,1209.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,MEDCOST,MEDCOST VHN,575.36,,,,,,,109.0000,1209.0000,percent of total billed charges,"47.59% of $1,209.00 in Billed Charges for Rev 450 Proc 12006 = $575.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,274.68,,,,,,,109.0000,1209.0000,fee schedule,"APG 00016 Proc 12006 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 105% = $274.68 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,109.0000,1209.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,109.0000,1209.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,109.0000,1209.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,269.71,,,,,,,109.0000,1209.0000,fee schedule,"APG 00016 Proc 12006 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 103.1% = $269.71 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,SENTARA HEALTH,SENTARA HEALTH,312.04,,,,,,,109.0000,1209.0000,percent of total billed charges,"25.81% of $1,209.00 in Billed Charges for Rev 450 Proc 12006 = $312.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,109.0000,1209.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1209.00,,,,,,,109.0000,1209.0000,percent of total billed charges,"100% of $1,209.00 in Billed Charges for Rev 450 Proc 12006 = $1,209.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1209.0000,case rate,Rev 450 Proc 12006 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1209.0000,case rate,Rev 450 Proc 12006 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1209.0000,case rate,Rev 450 Proc 12006 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1209.0000,case rate,Rev 450 Proc 12006 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,269.45,,,,,,,109.0000,1209.0000,fee schedule,"APG 00016 Proc 12006 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,1209.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,109.0000,1209.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,WELLCARE,WELLCARE MEDICAID,1209.00,,,,,,,109.0000,1209.0000,percent of total billed charges,"100% of $1,209.00 in Billed Charges for Rev 450 Proc 12006 = $1,209.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMP REP SCLP TRUNK 20.1-30,12006,CPT,450,RC,45000041,CDM,,,,both,,,1209.0000,181.3500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,109.0000,1209.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,AETNA,AETNA,1389.89,,,,,,,775.0000,3266.6300,percent of total billed charges,"42.7% of $3,255.00 in Billed Charges for Rev 361 Proc 20225 = $1,389.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2612.63,,,,,,,775.0000,3266.6300,fee schedule,"APG 00051 Proc 20225 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 104% = $2,612.63. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,775.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,775.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,775.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,AMBETTER,AMBETTER,3266.63,,,,,,,775.0000,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,775.0000,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,BLUE CROSS,ANTHEM EXCHANGE,3255.00,,,,,,,775.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2587.51,,,,,,,775.0000,3266.6300,fee schedule,"APG 00051 Proc 20225 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,BLUE CROSS,ANTHEM HMO,3255.00,,,,,,,775.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,775.0000,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3255.00,,,,,,,775.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,948.00,,,,,,,775.0000,3266.6300,case rate,Rev 361 Proc 20225 ASG Rate of $948.00 at 100% of $948.00 = $948.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,775.0000,3266.6300,case rate,"Rev 361 Proc 20225 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,775.0000,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,775.0000,3266.6300,case rate,"Rev 361 Proc 20225 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,775.0000,3266.6300,case rate,"Rev 361 Proc 20225 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,3266.6300,case rate,Rev 361 Proc 20225 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,3266.6300,case rate,Rev 361 Proc 20225 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,CIGNA HEALTHCARE,CIGNA HMO,2588.00,,,,,,,775.0000,3266.6300,case rate,"Rev 361 Proc 20225 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1956.00,,,,,,,775.0000,3266.6300,case rate,"Rev 361 Proc 20225 ASG Rate of $1,956.00 at 100% of $1,956.00 = $1,956.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,775.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2588.00,,,,,,,775.0000,3266.6300,case rate,"Rev 361 Proc 20225 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,CIGNA HEALTHCARE,CIGNA PPO,2588.00,,,,,,,775.0000,3266.6300,case rate,"Rev 361 Proc 20225 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,775.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2929.50,,,,,,,775.0000,3266.6300,percent of total billed charges,"90% of $3,255.00 in Billed Charges for Rev 361 Proc 20225 = $2,929.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,775.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,775.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,MEDCOST,MEDCOST VHN,1549.05,,,,,,,775.0000,3266.6300,percent of total billed charges,"47.59% of $3,255.00 in Billed Charges for Rev 361 Proc 20225 = $1,549.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2637.75,,,,,,,775.0000,3266.6300,fee schedule,"APG 00051 Proc 20225 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 105% = $2,637.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,775.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,775.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,775.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2590.02,,,,,,,775.0000,3266.6300,fee schedule,"APG 00051 Proc 20225 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 103.1% = $2,590.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,SENTARA HEALTH,SENTARA HEALTH,840.12,,,,,,,775.0000,3266.6300,percent of total billed charges,"25.81% of $3,255.00 in Billed Charges for Rev 361 Proc 20225 = $840.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,775.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3255.00,,,,,,,775.0000,3266.6300,percent of total billed charges,"100% of $3,255.00 in Billed Charges for Rev 361 Proc 20225 = $3,255.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,775.0000,3266.6300,case rate,Rev 361 Proc 20225 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,775.0000,3266.6300,case rate,"Rev 361 Proc 20225 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,775.0000,3266.6300,case rate,"Rev 361 Proc 20225 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,775.0000,3266.6300,case rate,"Rev 361 Proc 20225 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2587.51,,,,,,,775.0000,3266.6300,fee schedule,"APG 00051 Proc 20225 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,775.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,775.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,WELLCARE,WELLCARE MEDICAID,3255.00,,,,,,,775.0000,3266.6300,percent of total billed charges,"100% of $3,255.00 in Billed Charges for Rev 361 Proc 20225 = $3,255.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX BONE TROCAR NEEDLE DEEP,20225,CPT,361,RC,36100067,CDM,,,,both,,,3255.0000,488.2500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,775.0000,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINOGRAM,20501,CPT,361,RC,36100069,CDM,,,,both,,,1351.0000,202.6500,AETNA,AETNA,576.88,,,,,,,148.0000,1351.0000,percent of total billed charges,"42.7% of $1,351.00 in Billed Charges for Rev 361 Proc 20501 = $576.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ SINOGRAM,20501,CPT,361,RC,36100069,CDM,,,,both,,,1351.0000,202.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,495.24,,,,,,,148.0000,1351.0000,fee schedule,APG 00278 Proc 20501 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 104% = $495.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINOGRAM,20501,CPT,361,RC,36100069,CDM,,,,both,,,1351.0000,202.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,490.48,,,,,,,148.0000,1351.0000,fee schedule,APG 00278 Proc 20501 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 103% = $490.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINOGRAM,20501,CPT,361,RC,36100069,CDM,,,,both,,,1351.0000,202.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1351.00,,,,,,,148.0000,1351.0000,case rate,"Rev 361 Proc 20501 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $1,351.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,351.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ SINOGRAM,20501,CPT,361,RC,36100069,CDM,,,,both,,,1351.0000,202.6500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,1351.0000,case rate,Rev 361 Proc 20501 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINOGRAM,20501,CPT,361,RC,36100069,CDM,,,,both,,,1351.0000,202.6500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,1351.0000,case rate,Rev 361 Proc 20501 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINOGRAM,20501,CPT,361,RC,36100069,CDM,,,,both,,,1351.0000,202.6500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,1351.0000,case rate,Rev 361 Proc 20501 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINOGRAM,20501,CPT,361,RC,36100069,CDM,,,,both,,,1351.0000,202.6500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,148.0000,1351.0000,case rate,Rev 361 Proc 20501 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINOGRAM,20501,CPT,361,RC,36100069,CDM,,,,both,,,1351.0000,202.6500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,148.0000,1351.0000,case rate,Rev 361 Proc 20501 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINOGRAM,20501,CPT,361,RC,36100069,CDM,,,,both,,,1351.0000,202.6500,CIGNA HEALTHCARE,CIGNA HMO,1351.00,,,,,,,148.0000,1351.0000,case rate,"Rev 361 Proc 20501 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,351.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,351.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ SINOGRAM,20501,CPT,361,RC,36100069,CDM,,,,both,,,1351.0000,202.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1351.00,,,,,,,148.0000,1351.0000,case rate,"Rev 361 Proc 20501 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,351.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,351.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ SINOGRAM,20501,CPT,361,RC,36100069,CDM,,,,both,,,1351.0000,202.6500,CIGNA HEALTHCARE,CIGNA PPO,1351.00,,,,,,,148.0000,1351.0000,case rate,"Rev 361 Proc 20501 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,351.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,351.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ SINOGRAM,20501,CPT,361,RC,36100069,CDM,,,,both,,,1351.0000,202.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1215.90,,,,,,,148.0000,1351.0000,percent of total billed charges,"90% of $1,351.00 in Billed Charges for Rev 361 Proc 20501 = $1,215.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ SINOGRAM,20501,CPT,361,RC,36100069,CDM,,,,both,,,1351.0000,202.6500,MEDCOST,MEDCOST VHN,642.94,,,,,,,148.0000,1351.0000,percent of total billed charges,"47.59% of $1,351.00 in Billed Charges for Rev 361 Proc 20501 = $642.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ SINOGRAM,20501,CPT,361,RC,36100069,CDM,,,,both,,,1351.0000,202.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,500.00,,,,,,,148.0000,1351.0000,fee schedule,APG 00278 Proc 20501 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 100% = $476.19... $476.19 at 105% = $500.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINOGRAM,20501,CPT,361,RC,36100069,CDM,,,,both,,,1351.0000,202.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,490.95,,,,,,,148.0000,1351.0000,fee schedule,APG 00278 Proc 20501 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 100% = $476.19... $476.19 at 103.1% = $490.95 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINOGRAM,20501,CPT,361,RC,36100069,CDM,,,,both,,,1351.0000,202.6500,SENTARA HEALTH,SENTARA HEALTH,348.69,,,,,,,148.0000,1351.0000,percent of total billed charges,"25.81% of $1,351.00 in Billed Charges for Rev 361 Proc 20501 = $348.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ SINOGRAM,20501,CPT,361,RC,36100069,CDM,,,,both,,,1351.0000,202.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1351.00,,,,,,,148.0000,1351.0000,percent of total billed charges,"100% of $1,351.00 in Billed Charges for Rev 361 Proc 20501 = $1,351.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ SINOGRAM,20501,CPT,361,RC,36100069,CDM,,,,both,,,1351.0000,202.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,148.0000,1351.0000,case rate,Rev 361 Proc 20501 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINOGRAM,20501,CPT,361,RC,36100069,CDM,,,,both,,,1351.0000,202.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,148.0000,1351.0000,case rate,Rev 361 Proc 20501 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINOGRAM,20501,CPT,361,RC,36100069,CDM,,,,both,,,1351.0000,202.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,148.0000,1351.0000,case rate,Rev 361 Proc 20501 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINOGRAM,20501,CPT,361,RC,36100069,CDM,,,,both,,,1351.0000,202.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,148.0000,1351.0000,case rate,Rev 361 Proc 20501 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINOGRAM,20501,CPT,361,RC,36100069,CDM,,,,both,,,1351.0000,202.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,490.48,,,,,,,148.0000,1351.0000,fee schedule,APG 00278 Proc 20501 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 103% = $490.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINOGRAM,20501,CPT,361,RC,36100069,CDM,,,,both,,,1351.0000,202.6500,WELLCARE,WELLCARE MEDICAID,1351.00,,,,,,,148.0000,1351.0000,percent of total billed charges,"100% of $1,351.00 in Billed Charges for Rev 361 Proc 20501 = $1,351.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR G2 QUICK 2 MITEK 222983,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7739.0500,1160.8600,AETNA,AETNA,3714.74,,,,,,,1997.4500,7739.0500,percent of total billed charges,"48% of $7,739.05 in Billed Charges for Rev 278 Proc C1713 = $3,714.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR G2 QUICK 2 MITEK 222983,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7739.0500,1160.8600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3869.53,,,,,,,1997.4500,7739.0500,percent of total billed charges,"50% of $7,739.05 in Billed Charges for Rev 278 Proc C1713 = $3,869.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR G2 QUICK 2 MITEK 222983,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7739.0500,1160.8600,CIGNA HEALTHCARE,CIGNA HMO,3227.18,,,,,,,1997.4500,7739.0500,percent of total billed charges,"41.7% of $7,739.05 in Billed Charges for Rev 278 Proc C1713 = $3,227.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR G2 QUICK 2 MITEK 222983,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7739.0500,1160.8600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3095.62,,,,,,,1997.4500,7739.0500,percent of total billed charges,"40% of $7,739.05 in Billed Charges for Rev 278 Proc C1713 = $3,095.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR G2 QUICK 2 MITEK 222983,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7739.0500,1160.8600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3227.18,,,,,,,1997.4500,7739.0500,percent of total billed charges,"41.7% of $7,739.05 in Billed Charges for Rev 278 Proc C1713 = $3,227.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR G2 QUICK 2 MITEK 222983,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7739.0500,1160.8600,CIGNA HEALTHCARE,CIGNA PPO,3227.18,,,,,,,1997.4500,7739.0500,percent of total billed charges,"41.7% of $7,739.05 in Billed Charges for Rev 278 Proc C1713 = $3,227.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR G2 QUICK 2 MITEK 222983,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7739.0500,1160.8600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6965.15,,,,,,,1997.4500,7739.0500,percent of total billed charges,"90% of $7,739.05 in Billed Charges for Rev 278 Proc C1713 = $6,965.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR G2 QUICK 2 MITEK 222983,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7739.0500,1160.8600,MEDCOST,MEDCOST VHN,3683.01,,,,,,,1997.4500,7739.0500,percent of total billed charges,"47.59% of $7,739.05 in Billed Charges for Rev 278 Proc C1713 = $3,683.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR G2 QUICK 2 MITEK 222983,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7739.0500,1160.8600,SENTARA HEALTH,SENTARA HEALTH,1997.45,,,,,,,1997.4500,7739.0500,percent of total billed charges,"25.81% of $7,739.05 in Billed Charges for Rev 278 Proc C1713 = $1,997.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR G2 QUICK 2 MITEK 222983,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7739.0500,1160.8600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7739.05,,,,,,,1997.4500,7739.0500,percent of total billed charges,"100% of $7,739.05 in Billed Charges for Rev 278 Proc C1713 = $7,739.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR G2 QUICK 2 MITEK 222983,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7739.0500,1160.8600,WELLCARE,WELLCARE MEDICAID,7739.05,,,,,,,1997.4500,7739.0500,percent of total billed charges,"100% of $7,739.05 in Billed Charges for Rev 278 Proc C1713 = $7,739.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GII QUICK,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7487.4500,1123.1200,AETNA,AETNA,3593.98,,,,,,,1932.5100,7487.4500,percent of total billed charges,"48% of $7,487.45 in Billed Charges for Rev 278 Proc C1713 = $3,593.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GII QUICK,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7487.4500,1123.1200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3743.73,,,,,,,1932.5100,7487.4500,percent of total billed charges,"50% of $7,487.45 in Billed Charges for Rev 278 Proc C1713 = $3,743.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GII QUICK,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7487.4500,1123.1200,CIGNA HEALTHCARE,CIGNA HMO,3122.27,,,,,,,1932.5100,7487.4500,percent of total billed charges,"41.7% of $7,487.45 in Billed Charges for Rev 278 Proc C1713 = $3,122.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GII QUICK,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7487.4500,1123.1200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2994.98,,,,,,,1932.5100,7487.4500,percent of total billed charges,"40% of $7,487.45 in Billed Charges for Rev 278 Proc C1713 = $2,994.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GII QUICK,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7487.4500,1123.1200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3122.27,,,,,,,1932.5100,7487.4500,percent of total billed charges,"41.7% of $7,487.45 in Billed Charges for Rev 278 Proc C1713 = $3,122.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GII QUICK,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7487.4500,1123.1200,CIGNA HEALTHCARE,CIGNA PPO,3122.27,,,,,,,1932.5100,7487.4500,percent of total billed charges,"41.7% of $7,487.45 in Billed Charges for Rev 278 Proc C1713 = $3,122.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GII QUICK,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7487.4500,1123.1200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6738.71,,,,,,,1932.5100,7487.4500,percent of total billed charges,"90% of $7,487.45 in Billed Charges for Rev 278 Proc C1713 = $6,738.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GII QUICK,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7487.4500,1123.1200,MEDCOST,MEDCOST VHN,3563.28,,,,,,,1932.5100,7487.4500,percent of total billed charges,"47.59% of $7,487.45 in Billed Charges for Rev 278 Proc C1713 = $3,563.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GII QUICK,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7487.4500,1123.1200,SENTARA HEALTH,SENTARA HEALTH,1932.51,,,,,,,1932.5100,7487.4500,percent of total billed charges,"25.81% of $7,487.45 in Billed Charges for Rev 278 Proc C1713 = $1,932.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GII QUICK,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7487.4500,1123.1200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7487.45,,,,,,,1932.5100,7487.4500,percent of total billed charges,"100% of $7,487.45 in Billed Charges for Rev 278 Proc C1713 = $7,487.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GII QUICK,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7487.4500,1123.1200,WELLCARE,WELLCARE MEDICAID,7487.45,,,,,,,1932.5100,7487.4500,percent of total billed charges,"100% of $7,487.45 in Billed Charges for Rev 278 Proc C1713 = $7,487.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GLENOID CROSSLINK 44MM,C1713,HCPCS,278,RC,,,,,,both,,,16505.4500,2475.8200,AETNA,AETNA,7922.62,,,,,,,1171.8900,16505.4500,percent of total billed charges,"48% of $16,505.45 in Billed Charges for Rev 278 Proc C1713 = $7,922.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GLENOID CROSSLINK 44MM,C1713,HCPCS,278,RC,,,,,,both,,,16505.4500,2475.8200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8252.73,,,,,,,1171.8900,16505.4500,percent of total billed charges,"50% of $16,505.45 in Billed Charges for Rev 278 Proc C1713 = $8,252.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GLENOID CROSSLINK 44MM,C1713,HCPCS,278,RC,,,,,,both,,,16505.4500,2475.8200,CIGNA HEALTHCARE,CIGNA HMO,6882.77,,,,,,,1171.8900,16505.4500,percent of total billed charges,"41.7% of $16,505.45 in Billed Charges for Rev 278 Proc C1713 = $6,882.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GLENOID CROSSLINK 44MM,C1713,HCPCS,278,RC,,,,,,both,,,16505.4500,2475.8200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6602.18,,,,,,,1171.8900,16505.4500,percent of total billed charges,"40% of $16,505.45 in Billed Charges for Rev 278 Proc C1713 = $6,602.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GLENOID CROSSLINK 44MM,C1713,HCPCS,278,RC,,,,,,both,,,16505.4500,2475.8200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6882.77,,,,,,,1171.8900,16505.4500,percent of total billed charges,"41.7% of $16,505.45 in Billed Charges for Rev 278 Proc C1713 = $6,882.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GLENOID CROSSLINK 44MM,C1713,HCPCS,278,RC,,,,,,both,,,16505.4500,2475.8200,CIGNA HEALTHCARE,CIGNA PPO,6882.77,,,,,,,1171.8900,16505.4500,percent of total billed charges,"41.7% of $16,505.45 in Billed Charges for Rev 278 Proc C1713 = $6,882.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GLENOID CROSSLINK 44MM,C1713,HCPCS,278,RC,,,,,,both,,,16505.4500,2475.8200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,14854.91,,,,,,,1171.8900,16505.4500,percent of total billed charges,"90% of $16,505.45 in Billed Charges for Rev 278 Proc C1713 = $14,854.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GLENOID CROSSLINK 44MM,C1713,HCPCS,278,RC,,,,,,both,,,16505.4500,2475.8200,MEDCOST,MEDCOST VHN,7854.94,,,,,,,1171.8900,16505.4500,percent of total billed charges,"47.59% of $16,505.45 in Billed Charges for Rev 278 Proc C1713 = $7,854.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GLENOID CROSSLINK 44MM,C1713,HCPCS,278,RC,,,,,,both,,,16505.4500,2475.8200,SENTARA HEALTH,SENTARA HEALTH,4260.06,,,,,,,1171.8900,16505.4500,percent of total billed charges,"25.81% of $16,505.45 in Billed Charges for Rev 278 Proc C1713 = $4,260.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GLENOID CROSSLINK 44MM,C1713,HCPCS,278,RC,,,,,,both,,,16505.4500,2475.8200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",16505.45,,,,,,,1171.8900,16505.4500,percent of total billed charges,"100% of $16,505.45 in Billed Charges for Rev 278 Proc C1713 = $16,505.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GLENOID CROSSLINK 44MM,C1713,HCPCS,278,RC,,,,,,both,,,16505.4500,2475.8200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1237.91,,,,,,,1171.8900,16505.4500,percent of total billed charges,"7.5% of $16,505.45 in Billed Charges for Rev 278 Proc C1713 = $1,237.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GLENOID CROSSLINK 44MM,C1713,HCPCS,278,RC,,,,,,both,,,16505.4500,2475.8200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1171.89,,,,,,,1171.8900,16505.4500,percent of total billed charges,"7.1% of $16,505.45 in Billed Charges for Rev 278 Proc C1713 = $1,171.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GLENOID CROSSLINK 44MM,C1713,HCPCS,278,RC,,,,,,both,,,16505.4500,2475.8200,UNITED HEALTHCARE,UNITED HEALTHCARE,1171.89,,,,,,,1171.8900,16505.4500,percent of total billed charges,"7.1% of $16,505.45 in Billed Charges for Rev 278 Proc C1713 = $1,171.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GLENOID CROSSLINK 44MM,C1713,HCPCS,278,RC,,,,,,both,,,16505.4500,2475.8200,WELLCARE,WELLCARE MEDICAID,16505.45,,,,,,,1171.8900,16505.4500,percent of total billed charges,"100% of $16,505.45 in Billed Charges for Rev 278 Proc C1713 = $16,505.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GRYPHON W/PERMACORD,C1713,HCPCS,278,RC,,,,,,both,,,6919.2200,1037.8800,AETNA,AETNA,3321.23,,,,,,,1785.8500,6919.2200,percent of total billed charges,"48% of $6,919.22 in Billed Charges for Rev 278 Proc C1713 = $3,321.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GRYPHON W/PERMACORD,C1713,HCPCS,278,RC,,,,,,both,,,6919.2200,1037.8800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3459.61,,,,,,,1785.8500,6919.2200,percent of total billed charges,"50% of $6,919.22 in Billed Charges for Rev 278 Proc C1713 = $3,459.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GRYPHON W/PERMACORD,C1713,HCPCS,278,RC,,,,,,both,,,6919.2200,1037.8800,CIGNA HEALTHCARE,CIGNA HMO,2885.31,,,,,,,1785.8500,6919.2200,percent of total billed charges,"41.7% of $6,919.22 in Billed Charges for Rev 278 Proc C1713 = $2,885.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GRYPHON W/PERMACORD,C1713,HCPCS,278,RC,,,,,,both,,,6919.2200,1037.8800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2767.69,,,,,,,1785.8500,6919.2200,percent of total billed charges,"40% of $6,919.22 in Billed Charges for Rev 278 Proc C1713 = $2,767.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GRYPHON W/PERMACORD,C1713,HCPCS,278,RC,,,,,,both,,,6919.2200,1037.8800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2885.31,,,,,,,1785.8500,6919.2200,percent of total billed charges,"41.7% of $6,919.22 in Billed Charges for Rev 278 Proc C1713 = $2,885.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GRYPHON W/PERMACORD,C1713,HCPCS,278,RC,,,,,,both,,,6919.2200,1037.8800,CIGNA HEALTHCARE,CIGNA PPO,2885.31,,,,,,,1785.8500,6919.2200,percent of total billed charges,"41.7% of $6,919.22 in Billed Charges for Rev 278 Proc C1713 = $2,885.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GRYPHON W/PERMACORD,C1713,HCPCS,278,RC,,,,,,both,,,6919.2200,1037.8800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6227.30,,,,,,,1785.8500,6919.2200,percent of total billed charges,"90% of $6,919.22 in Billed Charges for Rev 278 Proc C1713 = $6,227.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GRYPHON W/PERMACORD,C1713,HCPCS,278,RC,,,,,,both,,,6919.2200,1037.8800,MEDCOST,MEDCOST VHN,3292.86,,,,,,,1785.8500,6919.2200,percent of total billed charges,"47.59% of $6,919.22 in Billed Charges for Rev 278 Proc C1713 = $3,292.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GRYPHON W/PERMACORD,C1713,HCPCS,278,RC,,,,,,both,,,6919.2200,1037.8800,SENTARA HEALTH,SENTARA HEALTH,1785.85,,,,,,,1785.8500,6919.2200,percent of total billed charges,"25.81% of $6,919.22 in Billed Charges for Rev 278 Proc C1713 = $1,785.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GRYPHON W/PERMACORD,C1713,HCPCS,278,RC,,,,,,both,,,6919.2200,1037.8800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6919.22,,,,,,,1785.8500,6919.2200,percent of total billed charges,"100% of $6,919.22 in Billed Charges for Rev 278 Proc C1713 = $6,919.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
ANCHOR GRYPHON W/PERMACORD,C1713,HCPCS,278,RC,,,,,,both,,,6919.2200,1037.8800,WELLCARE,WELLCARE MEDICAID,6919.22,,,,,,,1785.8500,6919.2200,percent of total billed charges,"100% of $6,919.22 in Billed Charges for Rev 278 Proc C1713 = $6,919.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,7938.4800,1190.7700,AETNA,AETNA,3810.47,,,,,,,2048.9200,7938.4800,percent of total billed charges,"48% of $7,938.48 in Billed Charges for Rev 278 Proc C1713 = $3,810.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,7938.4800,1190.7700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3969.24,,,,,,,2048.9200,7938.4800,percent of total billed charges,"50% of $7,938.48 in Billed Charges for Rev 278 Proc C1713 = $3,969.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,7938.4800,1190.7700,CIGNA HEALTHCARE,CIGNA HMO,3310.35,,,,,,,2048.9200,7938.4800,percent of total billed charges,"41.7% of $7,938.48 in Billed Charges for Rev 278 Proc C1713 = $3,310.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,7938.4800,1190.7700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3175.39,,,,,,,2048.9200,7938.4800,percent of total billed charges,"40% of $7,938.48 in Billed Charges for Rev 278 Proc C1713 = $3,175.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,7938.4800,1190.7700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3310.35,,,,,,,2048.9200,7938.4800,percent of total billed charges,"41.7% of $7,938.48 in Billed Charges for Rev 278 Proc C1713 = $3,310.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,7938.4800,1190.7700,CIGNA HEALTHCARE,CIGNA PPO,3310.35,,,,,,,2048.9200,7938.4800,percent of total billed charges,"41.7% of $7,938.48 in Billed Charges for Rev 278 Proc C1713 = $3,310.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,7938.4800,1190.7700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7144.63,,,,,,,2048.9200,7938.4800,percent of total billed charges,"90% of $7,938.48 in Billed Charges for Rev 278 Proc C1713 = $7,144.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,7938.4800,1190.7700,MEDCOST,MEDCOST VHN,3777.92,,,,,,,2048.9200,7938.4800,percent of total billed charges,"47.59% of $7,938.48 in Billed Charges for Rev 278 Proc C1713 = $3,777.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,7938.4800,1190.7700,SENTARA HEALTH,SENTARA HEALTH,2048.92,,,,,,,2048.9200,7938.4800,percent of total billed charges,"25.81% of $7,938.48 in Billed Charges for Rev 278 Proc C1713 = $2,048.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,7938.4800,1190.7700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7938.48,,,,,,,2048.9200,7938.4800,percent of total billed charges,"100% of $7,938.48 in Billed Charges for Rev 278 Proc C1713 = $7,938.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,7938.4800,1190.7700,WELLCARE,WELLCARE MEDICAID,7938.48,,,,,,,2048.9200,7938.4800,percent of total billed charges,"100% of $7,938.48 in Billed Charges for Rev 278 Proc C1713 = $7,938.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7497.4000,1124.6100,AETNA,AETNA,3598.75,,,,,,,1935.0800,7497.4000,percent of total billed charges,"48% of $7,497.40 in Billed Charges for Rev 278 Proc C1713 = $3,598.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7497.4000,1124.6100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3748.70,,,,,,,1935.0800,7497.4000,percent of total billed charges,"50% of $7,497.40 in Billed Charges for Rev 278 Proc C1713 = $3,748.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7497.4000,1124.6100,CIGNA HEALTHCARE,CIGNA HMO,3126.42,,,,,,,1935.0800,7497.4000,percent of total billed charges,"41.7% of $7,497.40 in Billed Charges for Rev 278 Proc C1713 = $3,126.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7497.4000,1124.6100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2998.96,,,,,,,1935.0800,7497.4000,percent of total billed charges,"40% of $7,497.40 in Billed Charges for Rev 278 Proc C1713 = $2,998.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7497.4000,1124.6100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3126.42,,,,,,,1935.0800,7497.4000,percent of total billed charges,"41.7% of $7,497.40 in Billed Charges for Rev 278 Proc C1713 = $3,126.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7497.4000,1124.6100,CIGNA HEALTHCARE,CIGNA PPO,3126.42,,,,,,,1935.0800,7497.4000,percent of total billed charges,"41.7% of $7,497.40 in Billed Charges for Rev 278 Proc C1713 = $3,126.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7497.4000,1124.6100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6747.66,,,,,,,1935.0800,7497.4000,percent of total billed charges,"90% of $7,497.40 in Billed Charges for Rev 278 Proc C1713 = $6,747.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7497.4000,1124.6100,MEDCOST,MEDCOST VHN,3568.01,,,,,,,1935.0800,7497.4000,percent of total billed charges,"47.59% of $7,497.40 in Billed Charges for Rev 278 Proc C1713 = $3,568.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7497.4000,1124.6100,SENTARA HEALTH,SENTARA HEALTH,1935.08,,,,,,,1935.0800,7497.4000,percent of total billed charges,"25.81% of $7,497.40 in Billed Charges for Rev 278 Proc C1713 = $1,935.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7497.4000,1124.6100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7497.40,,,,,,,1935.0800,7497.4000,percent of total billed charges,"100% of $7,497.40 in Billed Charges for Rev 278 Proc C1713 = $7,497.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,7497.4000,1124.6100,WELLCARE,WELLCARE MEDICAID,7497.40,,,,,,,1935.0800,7497.4000,percent of total billed charges,"100% of $7,497.40 in Billed Charges for Rev 278 Proc C1713 = $7,497.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,AETNA,AETNA,472.26,,,,,,,56.9100,1106.0000,percent of total billed charges,"42.7% of $1,106.00 in Billed Charges for Rev 510 Proc 20526 Mod 50 = $472.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,532.48,,,,,,,56.9100,1106.0000,fee schedule,"APG 00049 Proc 20526 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $512.00 at 104% = $532.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,417.73,,,,,,,56.9100,1106.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,AETNA,AETNA HEALTHCARE MEDICARE,417.73,,,,,,,56.9100,1106.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,417.73,,,,,,,56.9100,1106.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,AMBETTER,AMBETTER,910.66,,,,,,,56.9100,1106.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,434.44,,,,,,,56.9100,1106.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,BLUE CROSS,ANTHEM EXCHANGE,1028.48,,,,,,,56.9100,1106.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,527.36,,,,,,,56.9100,1106.0000,fee schedule,"APG 00049 Proc 20526 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $512.00 at 103% = $527.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,BLUE CROSS,ANTHEM HMO,1092.70,,,,,,,56.9100,1106.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,430.27,,,,,,,56.9100,1106.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1106.00,,,,,,,56.9100,1106.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,56.91,,,,,,,56.9100,1106.0000,fee schedule,$56.91 from Fee Schedule BLDTM_23 for Rev 510 Proc 20526 Mod 50 * Qty 1 = $56.91 at 100% = $56.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,BLUE CROSS,BLUE CROSS MEDICARE,434.44,,,,,,,56.9100,1106.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,CIGNA HEALTHCARE,CIGNA HMO,461.20,,,,,,,56.9100,1106.0000,percent of total billed charges,"41.7% of $1,106.00 in Billed Charges for Rev 510 Proc 20526 Mod 50 = $461.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,513.18,,,,,,,56.9100,1106.0000,percent of total billed charges,"46.4% of $1,106.00 in Billed Charges for Rev 510 Proc 20526 Mod 50 = $513.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,438.62,,,,,,,56.9100,1106.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,461.20,,,,,,,56.9100,1106.0000,percent of total billed charges,"41.7% of $1,106.00 in Billed Charges for Rev 510 Proc 20526 Mod 50 = $461.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,CIGNA HEALTHCARE,CIGNA PPO,461.20,,,,,,,56.9100,1106.0000,percent of total billed charges,"41.7% of $1,106.00 in Billed Charges for Rev 510 Proc 20526 Mod 50 = $461.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,438.62,,,,,,,56.9100,1106.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,995.40,,,,,,,56.9100,1106.0000,percent of total billed charges,"90% of $1,106.00 in Billed Charges for Rev 510 Proc 20526 Mod 50 = $995.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,HUMANA,HUMANA MEDICARE,417.73,,,,,,,56.9100,1106.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,417.73,,,,,,,56.9100,1106.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,MEDCOST,MEDCOST VHN,526.35,,,,,,,56.9100,1106.0000,percent of total billed charges,"47.59% of $1,106.00 in Billed Charges for Rev 510 Proc 20526 Mod 50 = $526.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,537.60,,,,,,,56.9100,1106.0000,fee schedule,"APG 00049 Proc 20526 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $512.00 at 100% = $512.00... $512.00 at 105% = $537.60 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,438.62,,,,,,,56.9100,1106.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,438.62,,,,,,,56.9100,1106.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,NHC ADVANTAGE,NHC ADVANTAGE,438.62,,,,,,,56.9100,1106.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,527.87,,,,,,,56.9100,1106.0000,fee schedule,"APG 00049 Proc 20526 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $512.00 at 100% = $512.00... $512.00 at 103.1% = $527.87 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,SENTARA HEALTH,SENTARA HEALTH,285.46,,,,,,,56.9100,1106.0000,percent of total billed charges,"25.81% of $1,106.00 in Billed Charges for Rev 510 Proc 20526 Mod 50 = $285.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,SENTARA HEALTH,SENTARA MEDICARE,417.73,,,,,,,56.9100,1106.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1106.00,,,,,,,56.9100,1106.0000,percent of total billed charges,"100% of $1,106.00 in Billed Charges for Rev 510 Proc 20526 Mod 50 = $1,106.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,105.61,,,,,,,56.9100,1106.0000,fee schedule,$211.21 from Fee Schedule TCUHC24 for Rev 510 Proc 20526 Mod 50 * Qty 1 = $211.21 at 50% = $105.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,357.24,,,,,,,56.9100,1106.0000,other,"32.3% of $1,106.00 in Billed Charges for Rev 510 Proc 20526 Mod 50 = $357.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,339.54,,,,,,,56.9100,1106.0000,other,"30.7% of $1,106.00 in Billed Charges for Rev 510 Proc 20526 Mod 50 = $339.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,357.24,,,,,,,56.9100,1106.0000,percent of total billed charges,"32.3% of $1,106.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,527.36,,,,,,,56.9100,1106.0000,fee schedule,"APG 00049 Proc 20526 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $512.00 at 103% = $527.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,417.73,,,,,,,56.9100,1106.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,417.73,,,,,,,56.9100,1106.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,WELLCARE,WELLCARE MEDICAID,1106.00,,,,,,,56.9100,1106.0000,percent of total billed charges,"100% of $1,106.00 in Billed Charges for Rev 510 Proc 20526 Mod 50 = $1,106.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECT CARPAL TUNNEL MOD50,20526,CPT,510,RC,51000026,CDM,,,50,both,,,1106.0000,165.9000,WELLCARE,WELLCARE MEDICARE,442.80,,,,,,,56.9100,1106.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,AETNA,AETNA,669.96,,,,,,,23.5500,1569.0000,percent of total billed charges,"42.7% of $1,569.00 in Billed Charges for Rev 450 Proc 20550 = $669.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,354.99,,,,,,,23.5500,1569.0000,fee schedule,"APG 00049 Proc 20550 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 104% = $354.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,278.49,,,,,,,23.5500,1569.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,AETNA,AETNA HEALTHCARE MEDICARE,278.49,,,,,,,23.5500,1569.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,278.49,,,,,,,23.5500,1569.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,AMBETTER,AMBETTER,607.11,,,,,,,23.5500,1569.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,289.63,,,,,,,23.5500,1569.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,BLUE CROSS,ANTHEM EXCHANGE,685.65,,,,,,,23.5500,1569.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,351.57,,,,,,,23.5500,1569.0000,fee schedule,"APG 00049 Proc 20550 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 103% = $351.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,BLUE CROSS,ANTHEM HMO,728.47,,,,,,,23.5500,1569.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,286.84,,,,,,,23.5500,1569.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",856.97,,,,,,,23.5500,1569.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,47.63,,,,,,,23.5500,1569.0000,fee schedule,$47.63 from Fee Schedule BLDTM_23 for Rev 450 Proc 20550 * Qty 1 = $47.63 at 100% = $47.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,BLUE CROSS,BLUE CROSS MEDICARE,289.63,,,,,,,23.5500,1569.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,BLUE CROSS,TENNCARE BLUE CARE,23.55,,,,,,,23.5500,1569.0000,fee schedule,$20.30 from Fee Schedule TC_24 for Rev 450 Proc 20550 * Qty 1 = $20.30 at 116% = $23.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,BLUE CROSS,TENNCARE BLUE SELECT,23.55,,,,,,,23.5500,1569.0000,fee schedule,$20.30 from Fee Schedule TC_24 for Rev 450 Proc 20550 * Qty 1 = $20.30 at 116% = $23.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,292.41,,,,,,,23.5500,1569.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,292.41,,,,,,,23.5500,1569.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1412.10,,,,,,,23.5500,1569.0000,percent of total billed charges,"90% of $1,569.00 in Billed Charges for Rev 450 Proc 20550 = $1,412.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,HUMANA,HUMANA MEDICARE,278.49,,,,,,,23.5500,1569.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,278.49,,,,,,,23.5500,1569.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,MEDCOST,MEDCOST VHN,746.69,,,,,,,23.5500,1569.0000,percent of total billed charges,"47.59% of $1,569.00 in Billed Charges for Rev 450 Proc 20550 = $746.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,358.40,,,,,,,23.5500,1569.0000,fee schedule,"APG 00049 Proc 20550 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 100% = $341.33... $341.33 at 105% = $358.40 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,292.41,,,,,,,23.5500,1569.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,292.41,,,,,,,23.5500,1569.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,NHC ADVANTAGE,NHC ADVANTAGE,292.41,,,,,,,23.5500,1569.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,351.91,,,,,,,23.5500,1569.0000,fee schedule,"APG 00049 Proc 20550 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 100% = $341.33... $341.33 at 103.1% = $351.91 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,SENTARA HEALTH,SENTARA HEALTH,404.96,,,,,,,23.5500,1569.0000,percent of total billed charges,"25.81% of $1,569.00 in Billed Charges for Rev 450 Proc 20550 = $404.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,SENTARA HEALTH,SENTARA MEDICARE,278.49,,,,,,,23.5500,1569.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1569.00,,,,,,,23.5500,1569.0000,percent of total billed charges,"100% of $1,569.00 in Billed Charges for Rev 450 Proc 20550 = $1,569.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,23.5500,1569.0000,case rate,Rev 450 Proc 20550 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,23.5500,1569.0000,case rate,Rev 450 Proc 20550 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,23.5500,1569.0000,case rate,Rev 450 Proc 20550 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,23.5500,1569.0000,case rate,Rev 450 Proc 20550 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,351.57,,,,,,,23.5500,1569.0000,fee schedule,"APG 00049 Proc 20550 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 103% = $351.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,278.49,,,,,,,23.5500,1569.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,278.49,,,,,,,23.5500,1569.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,WELLCARE,WELLCARE MEDICAID,1569.00,,,,,,,23.5500,1569.0000,percent of total billed charges,"100% of $1,569.00 in Billed Charges for Rev 450 Proc 20550 = $1,569.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ 1 TENDON SHEATH/LIGAMENT APONEUROSIS,20550,CPT,450,RC,45000087,CDM,,,,both,,,1569.0000,235.3500,WELLCARE,WELLCARE MEDICARE,295.20,,,,,,,23.5500,1569.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA,699.85,,,,,,,56.9100,1639.0000,percent of total billed charges,"42.7% of $1,639.00 in Billed Charges for Rev 450 Proc 20552 = $699.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,354.99,,,,,,,56.9100,1639.0000,fee schedule,"APG 00049 Proc 20552 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 104% = $354.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,278.49,,,,,,,56.9100,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA HEALTHCARE MEDICARE,278.49,,,,,,,56.9100,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,278.49,,,,,,,56.9100,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,AMBETTER,AMBETTER,607.11,,,,,,,56.9100,1639.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,289.63,,,,,,,56.9100,1639.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM EXCHANGE,685.65,,,,,,,56.9100,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,351.57,,,,,,,56.9100,1639.0000,fee schedule,"APG 00049 Proc 20552 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 103% = $351.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM HMO,728.47,,,,,,,56.9100,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,286.84,,,,,,,56.9100,1639.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",856.97,,,,,,,56.9100,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,56.91,,,,,,,56.9100,1639.0000,fee schedule,$56.91 from Fee Schedule BLDTM_23 for Rev 450 Proc 20552 * Qty 1 = $56.91 at 100% = $56.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,BLUE CROSS MEDICARE,289.63,,,,,,,56.9100,1639.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,292.41,,,,,,,56.9100,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,292.41,,,,,,,56.9100,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1475.10,,,,,,,56.9100,1639.0000,percent of total billed charges,"90% of $1,639.00 in Billed Charges for Rev 450 Proc 20552 = $1,475.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,HUMANA,HUMANA MEDICARE,278.49,,,,,,,56.9100,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,278.49,,,,,,,56.9100,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,MEDCOST,MEDCOST VHN,780.00,,,,,,,56.9100,1639.0000,percent of total billed charges,"47.59% of $1,639.00 in Billed Charges for Rev 450 Proc 20552 = $780.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,358.40,,,,,,,56.9100,1639.0000,fee schedule,"APG 00049 Proc 20552 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 100% = $341.33... $341.33 at 105% = $358.40 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,292.41,,,,,,,56.9100,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,292.41,,,,,,,56.9100,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,NHC ADVANTAGE,NHC ADVANTAGE,292.41,,,,,,,56.9100,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,351.91,,,,,,,56.9100,1639.0000,fee schedule,"APG 00049 Proc 20552 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 100% = $341.33... $341.33 at 103.1% = $351.91 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,SENTARA HEALTH,SENTARA HEALTH,423.03,,,,,,,56.9100,1639.0000,percent of total billed charges,"25.81% of $1,639.00 in Billed Charges for Rev 450 Proc 20552 = $423.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,SENTARA HEALTH,SENTARA MEDICARE,278.49,,,,,,,56.9100,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1639.00,,,,,,,56.9100,1639.0000,percent of total billed charges,"100% of $1,639.00 in Billed Charges for Rev 450 Proc 20552 = $1,639.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,56.9100,1639.0000,case rate,Rev 450 Proc 20552 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,56.9100,1639.0000,case rate,Rev 450 Proc 20552 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,56.9100,1639.0000,case rate,Rev 450 Proc 20552 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,56.9100,1639.0000,case rate,Rev 450 Proc 20552 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,351.57,,,,,,,56.9100,1639.0000,fee schedule,"APG 00049 Proc 20552 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 103% = $351.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,278.49,,,,,,,56.9100,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,278.49,,,,,,,56.9100,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,WELLCARE,WELLCARE MEDICAID,1639.00,,,,,,,56.9100,1639.0000,percent of total billed charges,"100% of $1,639.00 in Billed Charges for Rev 450 Proc 20552 = $1,639.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ONE MX TRIG POINT 1/2 MUSC,20552,CPT,450,RC,45000088,CDM,,,,both,,,1639.0000,245.8500,WELLCARE,WELLCARE MEDICARE,295.20,,,,,,,56.9100,1639.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,8291.3000,1243.7000,AETNA,AETNA,3979.82,,,,,,,2139.9800,8291.3000,percent of total billed charges,"48% of $8,291.30 in Billed Charges for Rev 278 Proc C1713 = $3,979.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,8291.3000,1243.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4145.65,,,,,,,2139.9800,8291.3000,percent of total billed charges,"50% of $8,291.30 in Billed Charges for Rev 278 Proc C1713 = $4,145.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,8291.3000,1243.7000,CIGNA HEALTHCARE,CIGNA HMO,3457.47,,,,,,,2139.9800,8291.3000,percent of total billed charges,"41.7% of $8,291.30 in Billed Charges for Rev 278 Proc C1713 = $3,457.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,8291.3000,1243.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3316.52,,,,,,,2139.9800,8291.3000,percent of total billed charges,"40% of $8,291.30 in Billed Charges for Rev 278 Proc C1713 = $3,316.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,8291.3000,1243.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3457.47,,,,,,,2139.9800,8291.3000,percent of total billed charges,"41.7% of $8,291.30 in Billed Charges for Rev 278 Proc C1713 = $3,457.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,8291.3000,1243.7000,CIGNA HEALTHCARE,CIGNA PPO,3457.47,,,,,,,2139.9800,8291.3000,percent of total billed charges,"41.7% of $8,291.30 in Billed Charges for Rev 278 Proc C1713 = $3,457.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,8291.3000,1243.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7462.17,,,,,,,2139.9800,8291.3000,percent of total billed charges,"90% of $8,291.30 in Billed Charges for Rev 278 Proc C1713 = $7,462.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,8291.3000,1243.7000,MEDCOST,MEDCOST VHN,3945.83,,,,,,,2139.9800,8291.3000,percent of total billed charges,"47.59% of $8,291.30 in Billed Charges for Rev 278 Proc C1713 = $3,945.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,8291.3000,1243.7000,SENTARA HEALTH,SENTARA HEALTH,2139.98,,,,,,,2139.9800,8291.3000,percent of total billed charges,"25.81% of $8,291.30 in Billed Charges for Rev 278 Proc C1713 = $2,139.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,8291.3000,1243.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8291.30,,,,,,,2139.9800,8291.3000,percent of total billed charges,"100% of $8,291.30 in Billed Charges for Rev 278 Proc C1713 = $8,291.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,8291.3000,1243.7000,WELLCARE,WELLCARE MEDICAID,8291.30,,,,,,,2139.9800,8291.3000,percent of total billed charges,"100% of $8,291.30 in Billed Charges for Rev 278 Proc C1713 = $8,291.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER W/ENDOANCHOR HELL-FX,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,52217.9900,7832.7000,AETNA,AETNA,25064.64,,,,,,,3707.4800,52217.9900,percent of total billed charges,"48% of $52,217.99 in Billed Charges for Rev 278 Proc C1713 = $25,064.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER W/ENDOANCHOR HELL-FX,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,52217.9900,7832.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,26109.00,,,,,,,3707.4800,52217.9900,percent of total billed charges,"50% of $52,217.99 in Billed Charges for Rev 278 Proc C1713 = $26,109.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER W/ENDOANCHOR HELL-FX,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,52217.9900,7832.7000,CIGNA HEALTHCARE,CIGNA HMO,21774.90,,,,,,,3707.4800,52217.9900,percent of total billed charges,"41.7% of $52,217.99 in Billed Charges for Rev 278 Proc C1713 = $21,774.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER W/ENDOANCHOR HELL-FX,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,52217.9900,7832.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,20887.20,,,,,,,3707.4800,52217.9900,percent of total billed charges,"40% of $52,217.99 in Billed Charges for Rev 278 Proc C1713 = $20,887.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER W/ENDOANCHOR HELL-FX,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,52217.9900,7832.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,21774.90,,,,,,,3707.4800,52217.9900,percent of total billed charges,"41.7% of $52,217.99 in Billed Charges for Rev 278 Proc C1713 = $21,774.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER W/ENDOANCHOR HELL-FX,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,52217.9900,7832.7000,CIGNA HEALTHCARE,CIGNA PPO,21774.90,,,,,,,3707.4800,52217.9900,percent of total billed charges,"41.7% of $52,217.99 in Billed Charges for Rev 278 Proc C1713 = $21,774.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER W/ENDOANCHOR HELL-FX,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,52217.9900,7832.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,46996.19,,,,,,,3707.4800,52217.9900,percent of total billed charges,"90% of $52,217.99 in Billed Charges for Rev 278 Proc C1713 = $46,996.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER W/ENDOANCHOR HELL-FX,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,52217.9900,7832.7000,MEDCOST,MEDCOST VHN,24850.54,,,,,,,3707.4800,52217.9900,percent of total billed charges,"47.59% of $52,217.99 in Billed Charges for Rev 278 Proc C1713 = $24,850.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER W/ENDOANCHOR HELL-FX,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,52217.9900,7832.7000,SENTARA HEALTH,SENTARA HEALTH,13477.46,,,,,,,3707.4800,52217.9900,percent of total billed charges,"25.81% of $52,217.99 in Billed Charges for Rev 278 Proc C1713 = $13,477.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER W/ENDOANCHOR HELL-FX,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,52217.9900,7832.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",52217.99,,,,,,,3707.4800,52217.9900,percent of total billed charges,"100% of $52,217.99 in Billed Charges for Rev 278 Proc C1713 = $52,217.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER W/ENDOANCHOR HELL-FX,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,52217.9900,7832.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3916.35,,,,,,,3707.4800,52217.9900,percent of total billed charges,"7.5% of $52,217.99 in Billed Charges for Rev 278 Proc C1713 = $3,916.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER W/ENDOANCHOR HELL-FX,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,52217.9900,7832.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3707.48,,,,,,,3707.4800,52217.9900,percent of total billed charges,"7.1% of $52,217.99 in Billed Charges for Rev 278 Proc C1713 = $3,707.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER W/ENDOANCHOR HELL-FX,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,52217.9900,7832.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,3707.48,,,,,,,3707.4800,52217.9900,percent of total billed charges,"7.1% of $52,217.99 in Billed Charges for Rev 278 Proc C1713 = $3,707.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
APPLIER W/ENDOANCHOR HELL-FX,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,52217.9900,7832.7000,WELLCARE,WELLCARE MEDICAID,52217.99,,,,,,,3707.4800,52217.9900,percent of total billed charges,"100% of $52,217.99 in Billed Charges for Rev 278 Proc C1713 = $52,217.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,AETNA,AETNA,161.83,,,,,,,23.5500,910.6600,percent of total billed charges,42.7% of $379.00 in Billed Charges for Rev 510 Proc 20610 Mod 50 = $161.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,532.48,,,,,,,23.5500,910.6600,fee schedule,"APG 00049 Proc 20610 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $512.00 at 104% = $532.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,379.00,,,,,,,23.5500,910.6600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,AETNA,AETNA HEALTHCARE MEDICARE,379.00,,,,,,,23.5500,910.6600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,379.00,,,,,,,23.5500,910.6600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,AMBETTER,AMBETTER,910.66,,,,,,,23.5500,910.6600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,379.00,,,,,,,23.5500,910.6600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,BLUE CROSS,ANTHEM EXCHANGE,379.00,,,,,,,23.5500,910.6600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,379.00,,,,,,,23.5500,910.6600,fee schedule,"APG 00049 Proc 20610 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $512.00 at 103% = $527.36 (Service Line reduced to $379.00, claim capped at $379.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,BLUE CROSS,ANTHEM HMO,379.00,,,,,,,23.5500,910.6600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.00,,,,,,,23.5500,910.6600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",379.00,,,,,,,23.5500,910.6600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,51.80,,,,,,,23.5500,910.6600,fee schedule,$51.80 from Fee Schedule BLDTM_23 for Rev 510 Proc 20610 Mod 50 * Qty 1 = $51.80 at 100% = $51.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,BLUE CROSS,BLUE CROSS MEDICARE,434.44,,,,,,,23.5500,910.6600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,BLUE CROSS,TENNCARE BLUE CARE,23.55,,,,,,,23.5500,910.6600,fee schedule,$20.30 from Fee Schedule TC_24 for Rev 510 Proc 20610 Mod 50 * Qty 1 = $20.30 at 116% = $23.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,BLUE CROSS,TENNCARE BLUE SELECT,23.55,,,,,,,23.5500,910.6600,fee schedule,$20.30 from Fee Schedule TC_24 for Rev 510 Proc 20610 Mod 50 * Qty 1 = $20.30 at 116% = $23.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,CIGNA HEALTHCARE,CIGNA HMO,158.04,,,,,,,23.5500,910.6600,percent of total billed charges,41.7% of $379.00 in Billed Charges for Rev 510 Proc 20610 Mod 50 = $158.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.86,,,,,,,23.5500,910.6600,percent of total billed charges,46.4% of $379.00 in Billed Charges for Rev 510 Proc 20610 Mod 50 = $175.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,379.00,,,,,,,23.5500,910.6600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,158.04,,,,,,,23.5500,910.6600,percent of total billed charges,41.7% of $379.00 in Billed Charges for Rev 510 Proc 20610 Mod 50 = $158.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,CIGNA HEALTHCARE,CIGNA PPO,158.04,,,,,,,23.5500,910.6600,percent of total billed charges,41.7% of $379.00 in Billed Charges for Rev 510 Proc 20610 Mod 50 = $158.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,379.00,,,,,,,23.5500,910.6600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,341.10,,,,,,,23.5500,910.6600,percent of total billed charges,90% of $379.00 in Billed Charges for Rev 510 Proc 20610 Mod 50 = $341.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,HUMANA,HUMANA MEDICARE,379.00,,,,,,,23.5500,910.6600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,379.00,,,,,,,23.5500,910.6600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,MEDCOST,MEDCOST VHN,180.37,,,,,,,23.5500,910.6600,percent of total billed charges,47.59% of $379.00 in Billed Charges for Rev 510 Proc 20610 Mod 50 = $180.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,537.60,,,,,,,23.5500,910.6600,fee schedule,"APG 00049 Proc 20610 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $512.00 at 100% = $512.00... $512.00 at 105% = $537.60 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,379.00,,,,,,,23.5500,910.6600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,379.00,,,,,,,23.5500,910.6600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,NHC ADVANTAGE,NHC ADVANTAGE,379.00,,,,,,,23.5500,910.6600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,527.87,,,,,,,23.5500,910.6600,fee schedule,"APG 00049 Proc 20610 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $512.00 at 100% = $512.00... $512.00 at 103.1% = $527.87 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,SENTARA HEALTH,SENTARA HEALTH,97.82,,,,,,,23.5500,910.6600,percent of total billed charges,25.81% of $379.00 in Billed Charges for Rev 510 Proc 20610 Mod 50 = $97.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,SENTARA HEALTH,SENTARA MEDICARE,379.00,,,,,,,23.5500,910.6600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",379.00,,,,,,,23.5500,910.6600,percent of total billed charges,100% of $379.00 in Billed Charges for Rev 510 Proc 20610 Mod 50 = $379.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,105.61,,,,,,,23.5500,910.6600,fee schedule,$211.21 from Fee Schedule TCUHC24 for Rev 510 Proc 20610 Mod 50 * Qty 1 = $211.21 at 50% = $105.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,122.42,,,,,,,23.5500,910.6600,other,32.3% of $379.00 in Billed Charges for Rev 510 Proc 20610 Mod 50 = $122.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,116.35,,,,,,,23.5500,910.6600,other,30.7% of $379.00 in Billed Charges for Rev 510 Proc 20610 Mod 50 = $116.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,122.42,,,,,,,23.5500,910.6600,percent of total billed charges,32.3% of $379.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,527.36,,,,,,,23.5500,910.6600,fee schedule,"APG 00049 Proc 20610 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $512.00 at 103% = $527.36. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,379.00,,,,,,,23.5500,910.6600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,379.00,,,,,,,23.5500,910.6600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,WELLCARE,WELLCARE MEDICAID,379.00,,,,,,,23.5500,910.6600,percent of total billed charges,100% of $379.00 in Billed Charges for Rev 510 Proc 20610 Mod 50 = $379.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID BILAT,20610,CPT,510,RC,51000027,CDM,,,50,both,,,379.0000,56.8500,WELLCARE,WELLCARE MEDICARE,442.80,,,,,,,23.5500,910.6600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,AETNA,AETNA,724.19,,,,,,,56.3700,1696.0000,percent of total billed charges,"42.7% of $1,696.00 in Billed Charges for Rev 450 Proc 20612 = $724.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,354.99,,,,,,,56.3700,1696.0000,fee schedule,"APG 00049 Proc 20612 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 104% = $354.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,278.49,,,,,,,56.3700,1696.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,AETNA,AETNA HEALTHCARE MEDICARE,278.49,,,,,,,56.3700,1696.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,278.49,,,,,,,56.3700,1696.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,AMBETTER,AMBETTER,607.11,,,,,,,56.3700,1696.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,289.63,,,,,,,56.3700,1696.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,BLUE CROSS,ANTHEM EXCHANGE,685.65,,,,,,,56.3700,1696.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,351.57,,,,,,,56.3700,1696.0000,fee schedule,"APG 00049 Proc 20612 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 103% = $351.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,BLUE CROSS,ANTHEM HMO,728.47,,,,,,,56.3700,1696.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,286.84,,,,,,,56.3700,1696.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",856.97,,,,,,,56.3700,1696.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,56.37,,,,,,,56.3700,1696.0000,fee schedule,$56.37 from Fee Schedule BLDTM_23 for Rev 450 Proc 20612 * Qty 1 = $56.37 at 100% = $56.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,BLUE CROSS,BLUE CROSS MEDICARE,289.63,,,,,,,56.3700,1696.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,292.41,,,,,,,56.3700,1696.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,292.41,,,,,,,56.3700,1696.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1526.40,,,,,,,56.3700,1696.0000,percent of total billed charges,"90% of $1,696.00 in Billed Charges for Rev 450 Proc 20612 = $1,526.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,HUMANA,HUMANA MEDICARE,278.49,,,,,,,56.3700,1696.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,278.49,,,,,,,56.3700,1696.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,MEDCOST,MEDCOST VHN,807.13,,,,,,,56.3700,1696.0000,percent of total billed charges,"47.59% of $1,696.00 in Billed Charges for Rev 450 Proc 20612 = $807.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,358.40,,,,,,,56.3700,1696.0000,fee schedule,"APG 00049 Proc 20612 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 100% = $341.33... $341.33 at 105% = $358.40 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,292.41,,,,,,,56.3700,1696.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,292.41,,,,,,,56.3700,1696.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,NHC ADVANTAGE,NHC ADVANTAGE,292.41,,,,,,,56.3700,1696.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,351.91,,,,,,,56.3700,1696.0000,fee schedule,"APG 00049 Proc 20612 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 100% = $341.33... $341.33 at 103.1% = $351.91 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,SENTARA HEALTH,SENTARA HEALTH,437.74,,,,,,,56.3700,1696.0000,percent of total billed charges,"25.81% of $1,696.00 in Billed Charges for Rev 450 Proc 20612 = $437.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,SENTARA HEALTH,SENTARA MEDICARE,278.49,,,,,,,56.3700,1696.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1696.00,,,,,,,56.3700,1696.0000,percent of total billed charges,"100% of $1,696.00 in Billed Charges for Rev 450 Proc 20612 = $1,696.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,56.3700,1696.0000,case rate,Rev 450 Proc 20612 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,56.3700,1696.0000,case rate,Rev 450 Proc 20612 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,56.3700,1696.0000,case rate,Rev 450 Proc 20612 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,56.3700,1696.0000,case rate,Rev 450 Proc 20612 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,351.57,,,,,,,56.3700,1696.0000,fee schedule,"APG 00049 Proc 20612 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 103% = $351.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,278.49,,,,,,,56.3700,1696.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,278.49,,,,,,,56.3700,1696.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,WELLCARE,WELLCARE MEDICAID,1696.00,,,,,,,56.3700,1696.0000,percent of total billed charges,"100% of $1,696.00 in Billed Charges for Rev 450 Proc 20612 = $1,696.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIRATE INJECT GANGLION CYST,20612,CPT,450,RC,45000093,CDM,,,,both,,,1696.0000,254.4000,WELLCARE,WELLCARE MEDICARE,295.20,,,,,,,56.3700,1696.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,AETNA,AETNA,839.06,,,,,,,113.7500,1965.0000,percent of total billed charges,"42.7% of $1,965.00 in Billed Charges for Rev 521 Proc 20615 = $839.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,638.80,,,,,,,113.7500,1965.0000,fee schedule,"APG 00050 Proc 20615 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $614.23 at 104% = $638.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,113.7500,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,113.7500,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,113.7500,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,AMBETTER,AMBETTER,1400.59,,,,,,,113.7500,1965.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,113.7500,1965.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,113.7500,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,632.66,,,,,,,113.7500,1965.0000,fee schedule,"APG 00050 Proc 20615 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $614.23 at 103% = $632.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,113.7500,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,113.7500,1965.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1965.00,,,,,,,113.7500,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,113.75,,,,,,,113.7500,1965.0000,fee schedule,$113.75 from Fee Schedule BLDTM_23 for Rev 521 Proc 20615 * Qty 1 = $113.75 at 100% = $113.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,113.7500,1965.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,CIGNA HEALTHCARE,CIGNA HMO,819.41,,,,,,,113.7500,1965.0000,percent of total billed charges,"41.7% of $1,965.00 in Billed Charges for Rev 521 Proc 20615 = $819.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,911.76,,,,,,,113.7500,1965.0000,percent of total billed charges,"46.4% of $1,965.00 in Billed Charges for Rev 521 Proc 20615 = $911.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,113.7500,1965.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,819.41,,,,,,,113.7500,1965.0000,percent of total billed charges,"41.7% of $1,965.00 in Billed Charges for Rev 521 Proc 20615 = $819.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,CIGNA HEALTHCARE,CIGNA PPO,819.41,,,,,,,113.7500,1965.0000,percent of total billed charges,"41.7% of $1,965.00 in Billed Charges for Rev 521 Proc 20615 = $819.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,113.7500,1965.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1768.50,,,,,,,113.7500,1965.0000,percent of total billed charges,"90% of $1,965.00 in Billed Charges for Rev 521 Proc 20615 = $1,768.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,HUMANA,HUMANA MEDICARE,642.47,,,,,,,113.7500,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,113.7500,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,MEDCOST,MEDCOST VHN,935.14,,,,,,,113.7500,1965.0000,percent of total billed charges,"47.59% of $1,965.00 in Billed Charges for Rev 521 Proc 20615 = $935.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,644.94,,,,,,,113.7500,1965.0000,fee schedule,"APG 00050 Proc 20615 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $614.23 at 100% = $614.23... $614.23 at 105% = $644.94 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,113.7500,1965.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,113.7500,1965.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,113.7500,1965.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,633.27,,,,,,,113.7500,1965.0000,fee schedule,"APG 00050 Proc 20615 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $614.23 at 100% = $614.23... $614.23 at 103.1% = $633.27 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,SENTARA HEALTH,SENTARA HEALTH,507.17,,,,,,,113.7500,1965.0000,percent of total billed charges,"25.81% of $1,965.00 in Billed Charges for Rev 521 Proc 20615 = $507.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,113.7500,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1965.00,,,,,,,113.7500,1965.0000,percent of total billed charges,"100% of $1,965.00 in Billed Charges for Rev 521 Proc 20615 = $1,965.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,243.67,,,,,,,113.7500,1965.0000,fee schedule,$487.34 from Fee Schedule TCUHC24 for Rev 521 Proc 20615 * Qty 1 = $487.34 at 50% = $243.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,632.66,,,,,,,113.7500,1965.0000,fee schedule,"APG 00050 Proc 20615 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $614.23 at 103% = $632.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,113.7500,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,113.7500,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,WELLCARE,WELLCARE MEDICAID,1965.00,,,,,,,113.7500,1965.0000,percent of total billed charges,"100% of $1,965.00 in Billed Charges for Rev 521 Proc 20615 = $1,965.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASP & INJ TX BONE CYST,20615,CPT,521,RC,52100088,CDM,,,,both,,,1965.0000,294.7500,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,113.7500,1965.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
AUGMENT INJECTABLE,C1713,HCPCS,278,RC,,,,,,both,,,19580.4500,2937.0700,AETNA,AETNA,9398.62,,,,,,,1390.2100,19580.4500,percent of total billed charges,"48% of $19,580.45 in Billed Charges for Rev 278 Proc C1713 = $9,398.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT INJECTABLE,C1713,HCPCS,278,RC,,,,,,both,,,19580.4500,2937.0700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9790.23,,,,,,,1390.2100,19580.4500,percent of total billed charges,"50% of $19,580.45 in Billed Charges for Rev 278 Proc C1713 = $9,790.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT INJECTABLE,C1713,HCPCS,278,RC,,,,,,both,,,19580.4500,2937.0700,CIGNA HEALTHCARE,CIGNA HMO,8165.05,,,,,,,1390.2100,19580.4500,percent of total billed charges,"41.7% of $19,580.45 in Billed Charges for Rev 278 Proc C1713 = $8,165.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT INJECTABLE,C1713,HCPCS,278,RC,,,,,,both,,,19580.4500,2937.0700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7832.18,,,,,,,1390.2100,19580.4500,percent of total billed charges,"40% of $19,580.45 in Billed Charges for Rev 278 Proc C1713 = $7,832.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT INJECTABLE,C1713,HCPCS,278,RC,,,,,,both,,,19580.4500,2937.0700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8165.05,,,,,,,1390.2100,19580.4500,percent of total billed charges,"41.7% of $19,580.45 in Billed Charges for Rev 278 Proc C1713 = $8,165.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT INJECTABLE,C1713,HCPCS,278,RC,,,,,,both,,,19580.4500,2937.0700,CIGNA HEALTHCARE,CIGNA PPO,8165.05,,,,,,,1390.2100,19580.4500,percent of total billed charges,"41.7% of $19,580.45 in Billed Charges for Rev 278 Proc C1713 = $8,165.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT INJECTABLE,C1713,HCPCS,278,RC,,,,,,both,,,19580.4500,2937.0700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,17622.41,,,,,,,1390.2100,19580.4500,percent of total billed charges,"90% of $19,580.45 in Billed Charges for Rev 278 Proc C1713 = $17,622.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT INJECTABLE,C1713,HCPCS,278,RC,,,,,,both,,,19580.4500,2937.0700,MEDCOST,MEDCOST VHN,9318.34,,,,,,,1390.2100,19580.4500,percent of total billed charges,"47.59% of $19,580.45 in Billed Charges for Rev 278 Proc C1713 = $9,318.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT INJECTABLE,C1713,HCPCS,278,RC,,,,,,both,,,19580.4500,2937.0700,SENTARA HEALTH,SENTARA HEALTH,5053.71,,,,,,,1390.2100,19580.4500,percent of total billed charges,"25.81% of $19,580.45 in Billed Charges for Rev 278 Proc C1713 = $5,053.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT INJECTABLE,C1713,HCPCS,278,RC,,,,,,both,,,19580.4500,2937.0700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",19580.45,,,,,,,1390.2100,19580.4500,percent of total billed charges,"100% of $19,580.45 in Billed Charges for Rev 278 Proc C1713 = $19,580.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT INJECTABLE,C1713,HCPCS,278,RC,,,,,,both,,,19580.4500,2937.0700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1468.53,,,,,,,1390.2100,19580.4500,percent of total billed charges,"7.5% of $19,580.45 in Billed Charges for Rev 278 Proc C1713 = $1,468.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT INJECTABLE,C1713,HCPCS,278,RC,,,,,,both,,,19580.4500,2937.0700,UNITED HEALTHCARE,UHC HERITAGE SELECT,1390.21,,,,,,,1390.2100,19580.4500,percent of total billed charges,"7.1% of $19,580.45 in Billed Charges for Rev 278 Proc C1713 = $1,390.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT INJECTABLE,C1713,HCPCS,278,RC,,,,,,both,,,19580.4500,2937.0700,UNITED HEALTHCARE,UNITED HEALTHCARE,1390.21,,,,,,,1390.2100,19580.4500,percent of total billed charges,"7.1% of $19,580.45 in Billed Charges for Rev 278 Proc C1713 = $1,390.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT INJECTABLE,C1713,HCPCS,278,RC,,,,,,both,,,19580.4500,2937.0700,WELLCARE,WELLCARE MEDICAID,19580.45,,,,,,,1390.2100,19580.4500,percent of total billed charges,"100% of $19,580.45 in Billed Charges for Rev 278 Proc C1713 = $19,580.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT TF ACETABULAR REVISION 10MM 50/52MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,27537.0800,4130.5600,AETNA,AETNA,13217.80,,,,,,,1955.1300,27537.0800,percent of total billed charges,"48% of $27,537.08 in Billed Charges for Rev 278 Proc C1713 = $13,217.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT TF ACETABULAR REVISION 10MM 50/52MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,27537.0800,4130.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,13768.54,,,,,,,1955.1300,27537.0800,percent of total billed charges,"50% of $27,537.08 in Billed Charges for Rev 278 Proc C1713 = $13,768.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT TF ACETABULAR REVISION 10MM 50/52MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,27537.0800,4130.5600,CIGNA HEALTHCARE,CIGNA HMO,11482.96,,,,,,,1955.1300,27537.0800,percent of total billed charges,"41.7% of $27,537.08 in Billed Charges for Rev 278 Proc C1713 = $11,482.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT TF ACETABULAR REVISION 10MM 50/52MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,27537.0800,4130.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11014.83,,,,,,,1955.1300,27537.0800,percent of total billed charges,"40% of $27,537.08 in Billed Charges for Rev 278 Proc C1713 = $11,014.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT TF ACETABULAR REVISION 10MM 50/52MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,27537.0800,4130.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11482.96,,,,,,,1955.1300,27537.0800,percent of total billed charges,"41.7% of $27,537.08 in Billed Charges for Rev 278 Proc C1713 = $11,482.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT TF ACETABULAR REVISION 10MM 50/52MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,27537.0800,4130.5600,CIGNA HEALTHCARE,CIGNA PPO,11482.96,,,,,,,1955.1300,27537.0800,percent of total billed charges,"41.7% of $27,537.08 in Billed Charges for Rev 278 Proc C1713 = $11,482.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT TF ACETABULAR REVISION 10MM 50/52MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,27537.0800,4130.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,24783.37,,,,,,,1955.1300,27537.0800,percent of total billed charges,"90% of $27,537.08 in Billed Charges for Rev 278 Proc C1713 = $24,783.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT TF ACETABULAR REVISION 10MM 50/52MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,27537.0800,4130.5600,MEDCOST,MEDCOST VHN,13104.90,,,,,,,1955.1300,27537.0800,percent of total billed charges,"47.59% of $27,537.08 in Billed Charges for Rev 278 Proc C1713 = $13,104.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT TF ACETABULAR REVISION 10MM 50/52MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,27537.0800,4130.5600,SENTARA HEALTH,SENTARA HEALTH,7107.32,,,,,,,1955.1300,27537.0800,percent of total billed charges,"25.81% of $27,537.08 in Billed Charges for Rev 278 Proc C1713 = $7,107.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT TF ACETABULAR REVISION 10MM 50/52MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,27537.0800,4130.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",27537.08,,,,,,,1955.1300,27537.0800,percent of total billed charges,"100% of $27,537.08 in Billed Charges for Rev 278 Proc C1713 = $27,537.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT TF ACETABULAR REVISION 10MM 50/52MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,27537.0800,4130.5600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2065.28,,,,,,,1955.1300,27537.0800,percent of total billed charges,"7.5% of $27,537.08 in Billed Charges for Rev 278 Proc C1713 = $2,065.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT TF ACETABULAR REVISION 10MM 50/52MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,27537.0800,4130.5600,UNITED HEALTHCARE,UHC HERITAGE SELECT,1955.13,,,,,,,1955.1300,27537.0800,percent of total billed charges,"7.1% of $27,537.08 in Billed Charges for Rev 278 Proc C1713 = $1,955.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT TF ACETABULAR REVISION 10MM 50/52MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,27537.0800,4130.5600,UNITED HEALTHCARE,UNITED HEALTHCARE,1955.13,,,,,,,1955.1300,27537.0800,percent of total billed charges,"7.1% of $27,537.08 in Billed Charges for Rev 278 Proc C1713 = $1,955.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
AUGMENT TF ACETABULAR REVISION 10MM 50/52MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,27537.0800,4130.5600,WELLCARE,WELLCARE MEDICAID,27537.08,,,,,,,1955.1300,27537.0800,percent of total billed charges,"100% of $27,537.08 in Billed Charges for Rev 278 Proc C1713 = $27,537.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR 6MM X 185MM,C1713,HCPCS,278,RC,,,,,,both,,,1497.5700,224.6400,AETNA,AETNA,718.83,,,,,,,386.5200,1497.5700,percent of total billed charges,"48% of $1,497.57 in Billed Charges for Rev 278 Proc C1713 = $718.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR 6MM X 185MM,C1713,HCPCS,278,RC,,,,,,both,,,1497.5700,224.6400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,748.79,,,,,,,386.5200,1497.5700,percent of total billed charges,"50% of $1,497.57 in Billed Charges for Rev 278 Proc C1713 = $748.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR 6MM X 185MM,C1713,HCPCS,278,RC,,,,,,both,,,1497.5700,224.6400,CIGNA HEALTHCARE,CIGNA HMO,624.49,,,,,,,386.5200,1497.5700,percent of total billed charges,"41.7% of $1,497.57 in Billed Charges for Rev 278 Proc C1713 = $624.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR 6MM X 185MM,C1713,HCPCS,278,RC,,,,,,both,,,1497.5700,224.6400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,599.03,,,,,,,386.5200,1497.5700,percent of total billed charges,"40% of $1,497.57 in Billed Charges for Rev 278 Proc C1713 = $599.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR 6MM X 185MM,C1713,HCPCS,278,RC,,,,,,both,,,1497.5700,224.6400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,624.49,,,,,,,386.5200,1497.5700,percent of total billed charges,"41.7% of $1,497.57 in Billed Charges for Rev 278 Proc C1713 = $624.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR 6MM X 185MM,C1713,HCPCS,278,RC,,,,,,both,,,1497.5700,224.6400,CIGNA HEALTHCARE,CIGNA PPO,624.49,,,,,,,386.5200,1497.5700,percent of total billed charges,"41.7% of $1,497.57 in Billed Charges for Rev 278 Proc C1713 = $624.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR 6MM X 185MM,C1713,HCPCS,278,RC,,,,,,both,,,1497.5700,224.6400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1347.81,,,,,,,386.5200,1497.5700,percent of total billed charges,"90% of $1,497.57 in Billed Charges for Rev 278 Proc C1713 = $1,347.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR 6MM X 185MM,C1713,HCPCS,278,RC,,,,,,both,,,1497.5700,224.6400,MEDCOST,MEDCOST VHN,712.69,,,,,,,386.5200,1497.5700,percent of total billed charges,"47.59% of $1,497.57 in Billed Charges for Rev 278 Proc C1713 = $712.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR 6MM X 185MM,C1713,HCPCS,278,RC,,,,,,both,,,1497.5700,224.6400,SENTARA HEALTH,SENTARA HEALTH,386.52,,,,,,,386.5200,1497.5700,percent of total billed charges,"25.81% of $1,497.57 in Billed Charges for Rev 278 Proc C1713 = $386.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR 6MM X 185MM,C1713,HCPCS,278,RC,,,,,,both,,,1497.5700,224.6400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1497.57,,,,,,,386.5200,1497.5700,percent of total billed charges,"100% of $1,497.57 in Billed Charges for Rev 278 Proc C1713 = $1,497.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR 6MM X 185MM,C1713,HCPCS,278,RC,,,,,,both,,,1497.5700,224.6400,WELLCARE,WELLCARE MEDICAID,1497.57,,,,,,,386.5200,1497.5700,percent of total billed charges,"100% of $1,497.57 in Billed Charges for Rev 278 Proc C1713 = $1,497.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS SUPPORT 14IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20441.2400,3066.1900,AETNA,AETNA,9811.80,,,,,,,1451.3300,20441.2400,percent of total billed charges,"48% of $20,441.24 in Billed Charges for Rev 278 Proc C1713 = $9,811.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS SUPPORT 14IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20441.2400,3066.1900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,10220.62,,,,,,,1451.3300,20441.2400,percent of total billed charges,"50% of $20,441.24 in Billed Charges for Rev 278 Proc C1713 = $10,220.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS SUPPORT 14IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20441.2400,3066.1900,CIGNA HEALTHCARE,CIGNA HMO,8524.00,,,,,,,1451.3300,20441.2400,percent of total billed charges,"41.7% of $20,441.24 in Billed Charges for Rev 278 Proc C1713 = $8,524.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS SUPPORT 14IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20441.2400,3066.1900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8176.50,,,,,,,1451.3300,20441.2400,percent of total billed charges,"40% of $20,441.24 in Billed Charges for Rev 278 Proc C1713 = $8,176.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS SUPPORT 14IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20441.2400,3066.1900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8524.00,,,,,,,1451.3300,20441.2400,percent of total billed charges,"41.7% of $20,441.24 in Billed Charges for Rev 278 Proc C1713 = $8,524.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS SUPPORT 14IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20441.2400,3066.1900,CIGNA HEALTHCARE,CIGNA PPO,8524.00,,,,,,,1451.3300,20441.2400,percent of total billed charges,"41.7% of $20,441.24 in Billed Charges for Rev 278 Proc C1713 = $8,524.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS SUPPORT 14IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20441.2400,3066.1900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,18397.12,,,,,,,1451.3300,20441.2400,percent of total billed charges,"90% of $20,441.24 in Billed Charges for Rev 278 Proc C1713 = $18,397.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS SUPPORT 14IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20441.2400,3066.1900,MEDCOST,MEDCOST VHN,9727.99,,,,,,,1451.3300,20441.2400,percent of total billed charges,"47.59% of $20,441.24 in Billed Charges for Rev 278 Proc C1713 = $9,727.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS SUPPORT 14IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20441.2400,3066.1900,SENTARA HEALTH,SENTARA HEALTH,5275.88,,,,,,,1451.3300,20441.2400,percent of total billed charges,"25.81% of $20,441.24 in Billed Charges for Rev 278 Proc C1713 = $5,275.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS SUPPORT 14IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20441.2400,3066.1900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",20441.24,,,,,,,1451.3300,20441.2400,percent of total billed charges,"100% of $20,441.24 in Billed Charges for Rev 278 Proc C1713 = $20,441.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS SUPPORT 14IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20441.2400,3066.1900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1533.09,,,,,,,1451.3300,20441.2400,percent of total billed charges,"7.5% of $20,441.24 in Billed Charges for Rev 278 Proc C1713 = $1,533.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS SUPPORT 14IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20441.2400,3066.1900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1451.33,,,,,,,1451.3300,20441.2400,percent of total billed charges,"7.1% of $20,441.24 in Billed Charges for Rev 278 Proc C1713 = $1,451.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS SUPPORT 14IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20441.2400,3066.1900,UNITED HEALTHCARE,UNITED HEALTHCARE,1451.33,,,,,,,1451.3300,20441.2400,percent of total billed charges,"7.1% of $20,441.24 in Billed Charges for Rev 278 Proc C1713 = $1,451.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR PECTUS SUPPORT 14IN,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20441.2400,3066.1900,WELLCARE,WELLCARE MEDICAID,20441.24,,,,,,,1451.3300,20441.2400,percent of total billed charges,"100% of $20,441.24 in Billed Charges for Rev 278 Proc C1713 = $20,441.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,AETNA,AETNA,544.00,,,,,,,109.0000,1274.0000,percent of total billed charges,"42.7% of $1,274.00 in Billed Charges for Rev 450 Proc 27750 = $544.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,1274.0000,fee schedule,"APG 00041 Proc 27750 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,1274.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,1274.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,1274.0000,fee schedule,"APG 00041 Proc 27750 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,1274.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,280.25,,,,,,,109.0000,1274.0000,fee schedule,$280.25 from Fee Schedule BLDTM_23 for Rev 450 Proc 27750 * Qty 1 = $280.25 at 100% = $280.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,1274.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1146.60,,,,,,,109.0000,1274.0000,percent of total billed charges,"90% of $1,274.00 in Billed Charges for Rev 450 Proc 27750 = $1,146.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,MEDCOST,MEDCOST VHN,606.30,,,,,,,109.0000,1274.0000,percent of total billed charges,"47.59% of $1,274.00 in Billed Charges for Rev 450 Proc 27750 = $606.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,1274.0000,fee schedule,"APG 00041 Proc 27750 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,1274.0000,fee schedule,"APG 00041 Proc 27750 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,SENTARA HEALTH,SENTARA HEALTH,328.82,,,,,,,109.0000,1274.0000,percent of total billed charges,"25.81% of $1,274.00 in Billed Charges for Rev 450 Proc 27750 = $328.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1274.00,,,,,,,109.0000,1274.0000,percent of total billed charges,"100% of $1,274.00 in Billed Charges for Rev 450 Proc 27750 = $1,274.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1274.0000,case rate,Rev 450 Proc 27750 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1274.0000,case rate,Rev 450 Proc 27750 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1274.0000,case rate,Rev 450 Proc 27750 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1274.0000,case rate,Rev 450 Proc 27750 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,1274.0000,fee schedule,"APG 00041 Proc 27750 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,WELLCARE,WELLCARE MEDICAID,1274.00,,,,,,,109.0000,1274.0000,percent of total billed charges,"100% of $1,274.00 in Billed Charges for Rev 450 Proc 27750 = $1,274.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX TIBL SHAFT FX WO MAN,27750,CPT,450,RC,45000163,CDM,,,,both,,,1274.0000,191.1000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,1274.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,AETNA,AETNA,1646.51,,,,,,,109.0000,3856.0000,percent of total billed charges,"42.7% of $3,856.00 in Billed Charges for Rev 450 Proc 27752 = $1,646.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,3856.0000,fee schedule,APG 00041 Proc 27752 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,3856.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,3856.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,3856.0000,fee schedule,APG 00041 Proc 27752 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,3856.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3856.00,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,448.54,,,,,,,109.0000,3856.0000,fee schedule,$448.54 from Fee Schedule BLDTM_23 for Rev 450 Proc 27752 * Qty 1 = $448.54 at 100% = $448.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,3856.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,3856.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,3856.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3470.40,,,,,,,109.0000,3856.0000,percent of total billed charges,"90% of $3,856.00 in Billed Charges for Rev 450 Proc 27752 = $3,470.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,MEDCOST,MEDCOST VHN,1835.07,,,,,,,109.0000,3856.0000,percent of total billed charges,"47.59% of $3,856.00 in Billed Charges for Rev 450 Proc 27752 = $1,835.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,3856.0000,fee schedule,APG 00041 Proc 27752 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,3856.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,3856.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,3856.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,3856.0000,fee schedule,APG 00041 Proc 27752 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,SENTARA HEALTH,SENTARA HEALTH,995.23,,,,,,,109.0000,3856.0000,percent of total billed charges,"25.81% of $3,856.00 in Billed Charges for Rev 450 Proc 27752 = $995.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3856.00,,,,,,,109.0000,3856.0000,percent of total billed charges,"100% of $3,856.00 in Billed Charges for Rev 450 Proc 27752 = $3,856.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3856.0000,case rate,Rev 450 Proc 27752 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3856.0000,case rate,Rev 450 Proc 27752 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3856.0000,case rate,Rev 450 Proc 27752 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3856.0000,case rate,Rev 450 Proc 27752 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,3856.0000,fee schedule,APG 00041 Proc 27752 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,WELLCARE,WELLCARE MEDICAID,3856.00,,,,,,,109.0000,3856.0000,percent of total billed charges,"100% of $3,856.00 in Billed Charges for Rev 450 Proc 27752 = $3,856.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX TIB FX W MANIP WOW TR,27752,CPT,450,RC,45000164,CDM,,,,both,,,3856.0000,578.4000,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,3856.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,AETNA,AETNA,1646.51,,,,,,,109.0000,3856.0000,percent of total billed charges,"42.7% of $3,856.00 in Billed Charges for Rev 450 Proc 27762 = $1,646.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,3856.0000,fee schedule,APG 00041 Proc 27762 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,3856.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,3856.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,3856.0000,fee schedule,APG 00041 Proc 27762 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,3856.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3856.00,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,357.33,,,,,,,109.0000,3856.0000,fee schedule,$357.33 from Fee Schedule BLDTM_23 for Rev 450 Proc 27762 * Qty 1 = $357.33 at 100% = $357.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,3856.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,3856.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,3856.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3470.40,,,,,,,109.0000,3856.0000,percent of total billed charges,"90% of $3,856.00 in Billed Charges for Rev 450 Proc 27762 = $3,470.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,MEDCOST,MEDCOST VHN,1835.07,,,,,,,109.0000,3856.0000,percent of total billed charges,"47.59% of $3,856.00 in Billed Charges for Rev 450 Proc 27762 = $1,835.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,3856.0000,fee schedule,APG 00041 Proc 27762 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,3856.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,3856.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,3856.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,3856.0000,fee schedule,APG 00041 Proc 27762 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,SENTARA HEALTH,SENTARA HEALTH,995.23,,,,,,,109.0000,3856.0000,percent of total billed charges,"25.81% of $3,856.00 in Billed Charges for Rev 450 Proc 27762 = $995.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3856.00,,,,,,,109.0000,3856.0000,percent of total billed charges,"100% of $3,856.00 in Billed Charges for Rev 450 Proc 27762 = $3,856.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3856.0000,case rate,Rev 450 Proc 27762 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3856.0000,case rate,Rev 450 Proc 27762 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3856.0000,case rate,Rev 450 Proc 27762 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3856.0000,case rate,Rev 450 Proc 27762 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,3856.0000,fee schedule,APG 00041 Proc 27762 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,3856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,WELLCARE,WELLCARE MEDICAID,3856.00,,,,,,,109.0000,3856.0000,percent of total billed charges,"100% of $3,856.00 in Billed Charges for Rev 450 Proc 27762 = $3,856.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MED MALLELOUS FX W MA,27762,CPT,450,RC,45000166,CDM,,,,both,,,3856.0000,578.4000,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,3856.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA,699.85,,,,,,,109.0000,3180.3800,percent of total billed charges,"42.7% of $1,639.00 in Billed Charges for Rev 450 Proc 27781 = $699.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27781 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,3180.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM EXCHANGE,1639.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27781 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM HMO,1639.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,3180.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1639.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,317.86,,,,,,,109.0000,3180.3800,fee schedule,$317.86 from Fee Schedule BLDTM_23 for Rev 450 Proc 27781 * Qty 1 = $317.86 at 100% = $317.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1475.10,,,,,,,109.0000,3180.3800,percent of total billed charges,"90% of $1,639.00 in Billed Charges for Rev 450 Proc 27781 = $1,475.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,MEDCOST,MEDCOST VHN,780.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"47.59% of $1,639.00 in Billed Charges for Rev 450 Proc 27781 = $780.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27781 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27781 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,SENTARA HEALTH,SENTARA HEALTH,423.03,,,,,,,109.0000,3180.3800,percent of total billed charges,"25.81% of $1,639.00 in Billed Charges for Rev 450 Proc 27781 = $423.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1639.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,639.00 in Billed Charges for Rev 450 Proc 27781 = $1,639.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 27781 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 27781 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 27781 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 27781 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27781 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,WELLCARE,WELLCARE MEDICAID,1639.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,639.00 in Billed Charges for Rev 450 Proc 27781 = $1,639.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX PROX FIB SHAFT FX W MA,27781,CPT,450,RC,45000168,CDM,,,,both,,,1639.0000,245.8500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,3180.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BAR STRAIGHT EXTERNAL FIXATION 160MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,4698.2700,704.7400,AETNA,AETNA,2255.17,,,,,,,1212.6200,4698.2700,percent of total billed charges,"48% of $4,698.27 in Billed Charges for Rev 278 Proc C1713 = $2,255.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR STRAIGHT EXTERNAL FIXATION 160MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,4698.2700,704.7400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2349.14,,,,,,,1212.6200,4698.2700,percent of total billed charges,"50% of $4,698.27 in Billed Charges for Rev 278 Proc C1713 = $2,349.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR STRAIGHT EXTERNAL FIXATION 160MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,4698.2700,704.7400,CIGNA HEALTHCARE,CIGNA HMO,1959.18,,,,,,,1212.6200,4698.2700,percent of total billed charges,"41.7% of $4,698.27 in Billed Charges for Rev 278 Proc C1713 = $1,959.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR STRAIGHT EXTERNAL FIXATION 160MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,4698.2700,704.7400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1879.31,,,,,,,1212.6200,4698.2700,percent of total billed charges,"40% of $4,698.27 in Billed Charges for Rev 278 Proc C1713 = $1,879.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR STRAIGHT EXTERNAL FIXATION 160MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,4698.2700,704.7400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1959.18,,,,,,,1212.6200,4698.2700,percent of total billed charges,"41.7% of $4,698.27 in Billed Charges for Rev 278 Proc C1713 = $1,959.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR STRAIGHT EXTERNAL FIXATION 160MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,4698.2700,704.7400,CIGNA HEALTHCARE,CIGNA PPO,1959.18,,,,,,,1212.6200,4698.2700,percent of total billed charges,"41.7% of $4,698.27 in Billed Charges for Rev 278 Proc C1713 = $1,959.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR STRAIGHT EXTERNAL FIXATION 160MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,4698.2700,704.7400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4228.44,,,,,,,1212.6200,4698.2700,percent of total billed charges,"90% of $4,698.27 in Billed Charges for Rev 278 Proc C1713 = $4,228.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR STRAIGHT EXTERNAL FIXATION 160MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,4698.2700,704.7400,MEDCOST,MEDCOST VHN,2235.91,,,,,,,1212.6200,4698.2700,percent of total billed charges,"47.59% of $4,698.27 in Billed Charges for Rev 278 Proc C1713 = $2,235.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR STRAIGHT EXTERNAL FIXATION 160MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,4698.2700,704.7400,SENTARA HEALTH,SENTARA HEALTH,1212.62,,,,,,,1212.6200,4698.2700,percent of total billed charges,"25.81% of $4,698.27 in Billed Charges for Rev 278 Proc C1713 = $1,212.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR STRAIGHT EXTERNAL FIXATION 160MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,4698.2700,704.7400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4698.27,,,,,,,1212.6200,4698.2700,percent of total billed charges,"100% of $4,698.27 in Billed Charges for Rev 278 Proc C1713 = $4,698.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR STRAIGHT EXTERNAL FIXATION 160MM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,4698.2700,704.7400,WELLCARE,WELLCARE MEDICAID,4698.27,,,,,,,1212.6200,4698.2700,percent of total billed charges,"100% of $4,698.27 in Billed Charges for Rev 278 Proc C1713 = $4,698.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR TO BAR CLAMP STRIGHT,C1713,HCPCS,278,RC,,,,,,both,,,7298.6900,1094.8000,AETNA,AETNA,3503.37,,,,,,,1883.7900,7298.6900,percent of total billed charges,"48% of $7,298.69 in Billed Charges for Rev 278 Proc C1713 = $3,503.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR TO BAR CLAMP STRIGHT,C1713,HCPCS,278,RC,,,,,,both,,,7298.6900,1094.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3649.35,,,,,,,1883.7900,7298.6900,percent of total billed charges,"50% of $7,298.69 in Billed Charges for Rev 278 Proc C1713 = $3,649.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR TO BAR CLAMP STRIGHT,C1713,HCPCS,278,RC,,,,,,both,,,7298.6900,1094.8000,CIGNA HEALTHCARE,CIGNA HMO,3043.55,,,,,,,1883.7900,7298.6900,percent of total billed charges,"41.7% of $7,298.69 in Billed Charges for Rev 278 Proc C1713 = $3,043.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR TO BAR CLAMP STRIGHT,C1713,HCPCS,278,RC,,,,,,both,,,7298.6900,1094.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2919.48,,,,,,,1883.7900,7298.6900,percent of total billed charges,"40% of $7,298.69 in Billed Charges for Rev 278 Proc C1713 = $2,919.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR TO BAR CLAMP STRIGHT,C1713,HCPCS,278,RC,,,,,,both,,,7298.6900,1094.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3043.55,,,,,,,1883.7900,7298.6900,percent of total billed charges,"41.7% of $7,298.69 in Billed Charges for Rev 278 Proc C1713 = $3,043.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR TO BAR CLAMP STRIGHT,C1713,HCPCS,278,RC,,,,,,both,,,7298.6900,1094.8000,CIGNA HEALTHCARE,CIGNA PPO,3043.55,,,,,,,1883.7900,7298.6900,percent of total billed charges,"41.7% of $7,298.69 in Billed Charges for Rev 278 Proc C1713 = $3,043.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR TO BAR CLAMP STRIGHT,C1713,HCPCS,278,RC,,,,,,both,,,7298.6900,1094.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6568.82,,,,,,,1883.7900,7298.6900,percent of total billed charges,"90% of $7,298.69 in Billed Charges for Rev 278 Proc C1713 = $6,568.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR TO BAR CLAMP STRIGHT,C1713,HCPCS,278,RC,,,,,,both,,,7298.6900,1094.8000,MEDCOST,MEDCOST VHN,3473.45,,,,,,,1883.7900,7298.6900,percent of total billed charges,"47.59% of $7,298.69 in Billed Charges for Rev 278 Proc C1713 = $3,473.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR TO BAR CLAMP STRIGHT,C1713,HCPCS,278,RC,,,,,,both,,,7298.6900,1094.8000,SENTARA HEALTH,SENTARA HEALTH,1883.79,,,,,,,1883.7900,7298.6900,percent of total billed charges,"25.81% of $7,298.69 in Billed Charges for Rev 278 Proc C1713 = $1,883.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR TO BAR CLAMP STRIGHT,C1713,HCPCS,278,RC,,,,,,both,,,7298.6900,1094.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7298.69,,,,,,,1883.7900,7298.6900,percent of total billed charges,"100% of $7,298.69 in Billed Charges for Rev 278 Proc C1713 = $7,298.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BAR TO BAR CLAMP STRIGHT,C1713,HCPCS,278,RC,,,,,,both,,,7298.6900,1094.8000,WELLCARE,WELLCARE MEDICAID,7298.69,,,,,,,1883.7900,7298.6900,percent of total billed charges,"100% of $7,298.69 in Billed Charges for Rev 278 Proc C1713 = $7,298.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BB-TAK ANKLE FRACTURE SYSTEM THREADED,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,1047.4700,157.1200,AETNA,AETNA,502.79,,,,,,,270.3500,1047.4700,percent of total billed charges,"48% of $1,047.47 in Billed Charges for Rev 278 Proc C1713 = $502.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BB-TAK ANKLE FRACTURE SYSTEM THREADED,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,1047.4700,157.1200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,523.74,,,,,,,270.3500,1047.4700,percent of total billed charges,"50% of $1,047.47 in Billed Charges for Rev 278 Proc C1713 = $523.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BB-TAK ANKLE FRACTURE SYSTEM THREADED,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,1047.4700,157.1200,CIGNA HEALTHCARE,CIGNA HMO,436.80,,,,,,,270.3500,1047.4700,percent of total billed charges,"41.7% of $1,047.47 in Billed Charges for Rev 278 Proc C1713 = $436.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BB-TAK ANKLE FRACTURE SYSTEM THREADED,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,1047.4700,157.1200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,418.99,,,,,,,270.3500,1047.4700,percent of total billed charges,"40% of $1,047.47 in Billed Charges for Rev 278 Proc C1713 = $418.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BB-TAK ANKLE FRACTURE SYSTEM THREADED,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,1047.4700,157.1200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,436.80,,,,,,,270.3500,1047.4700,percent of total billed charges,"41.7% of $1,047.47 in Billed Charges for Rev 278 Proc C1713 = $436.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BB-TAK ANKLE FRACTURE SYSTEM THREADED,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,1047.4700,157.1200,CIGNA HEALTHCARE,CIGNA PPO,436.80,,,,,,,270.3500,1047.4700,percent of total billed charges,"41.7% of $1,047.47 in Billed Charges for Rev 278 Proc C1713 = $436.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BB-TAK ANKLE FRACTURE SYSTEM THREADED,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,1047.4700,157.1200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,942.72,,,,,,,270.3500,1047.4700,percent of total billed charges,"90% of $1,047.47 in Billed Charges for Rev 278 Proc C1713 = $942.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BB-TAK ANKLE FRACTURE SYSTEM THREADED,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,1047.4700,157.1200,MEDCOST,MEDCOST VHN,498.49,,,,,,,270.3500,1047.4700,percent of total billed charges,"47.59% of $1,047.47 in Billed Charges for Rev 278 Proc C1713 = $498.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BB-TAK ANKLE FRACTURE SYSTEM THREADED,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,1047.4700,157.1200,SENTARA HEALTH,SENTARA HEALTH,270.35,,,,,,,270.3500,1047.4700,percent of total billed charges,"25.81% of $1,047.47 in Billed Charges for Rev 278 Proc C1713 = $270.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BB-TAK ANKLE FRACTURE SYSTEM THREADED,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,1047.4700,157.1200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1047.47,,,,,,,270.3500,1047.4700,percent of total billed charges,"100% of $1,047.47 in Billed Charges for Rev 278 Proc C1713 = $1,047.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BB-TAK ANKLE FRACTURE SYSTEM THREADED,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,1047.4700,157.1200,WELLCARE,WELLCARE MEDICAID,1047.47,,,,,,,270.3500,1047.4700,percent of total billed charges,"100% of $1,047.47 in Billed Charges for Rev 278 Proc C1713 = $1,047.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,622.2600,93.3400,AETNA,AETNA,298.68,,,,,,,160.6100,622.2600,percent of total billed charges,48% of $622.26 in Billed Charges for Rev 278 Proc C1713 = $298.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,622.2600,93.3400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,311.13,,,,,,,160.6100,622.2600,percent of total billed charges,50% of $622.26 in Billed Charges for Rev 278 Proc C1713 = $311.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,622.2600,93.3400,CIGNA HEALTHCARE,CIGNA HMO,259.48,,,,,,,160.6100,622.2600,percent of total billed charges,41.7% of $622.26 in Billed Charges for Rev 278 Proc C1713 = $259.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,622.2600,93.3400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,248.90,,,,,,,160.6100,622.2600,percent of total billed charges,40% of $622.26 in Billed Charges for Rev 278 Proc C1713 = $248.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,622.2600,93.3400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,259.48,,,,,,,160.6100,622.2600,percent of total billed charges,41.7% of $622.26 in Billed Charges for Rev 278 Proc C1713 = $259.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,622.2600,93.3400,CIGNA HEALTHCARE,CIGNA PPO,259.48,,,,,,,160.6100,622.2600,percent of total billed charges,41.7% of $622.26 in Billed Charges for Rev 278 Proc C1713 = $259.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,622.2600,93.3400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,560.03,,,,,,,160.6100,622.2600,percent of total billed charges,90% of $622.26 in Billed Charges for Rev 278 Proc C1713 = $560.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,622.2600,93.3400,MEDCOST,MEDCOST VHN,296.13,,,,,,,160.6100,622.2600,percent of total billed charges,47.59% of $622.26 in Billed Charges for Rev 278 Proc C1713 = $296.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,622.2600,93.3400,SENTARA HEALTH,SENTARA HEALTH,160.61,,,,,,,160.6100,622.2600,percent of total billed charges,25.81% of $622.26 in Billed Charges for Rev 278 Proc C1713 = $160.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,622.2600,93.3400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",622.26,,,,,,,160.6100,622.2600,percent of total billed charges,100% of $622.26 in Billed Charges for Rev 278 Proc C1713 = $622.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,622.2600,93.3400,WELLCARE,WELLCARE MEDICAID,622.26,,,,,,,160.6100,622.2600,percent of total billed charges,100% of $622.26 in Billed Charges for Rev 278 Proc C1713 = $622.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,AETNA,AETNA,544.00,,,,,,,105.1500,1274.0000,percent of total billed charges,"42.7% of $1,274.00 in Billed Charges for Rev 450 Proc 27808 = $544.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,105.1500,1274.0000,fee schedule,"APG 00041 Proc 27808 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,105.1500,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,105.1500,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,105.1500,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,AMBETTER,AMBETTER,487.87,,,,,,,105.1500,1274.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,105.1500,1274.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,105.1500,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,105.1500,1274.0000,fee schedule,"APG 00041 Proc 27808 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,105.1500,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,105.1500,1274.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,105.1500,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,251.14,,,,,,,105.1500,1274.0000,fee schedule,$251.14 from Fee Schedule BLDTM_23 for Rev 450 Proc 27808 * Qty 1 = $251.14 at 100% = $251.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,105.1500,1274.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,TENNCARE BLUE CARE,105.15,,,,,,,105.1500,1274.0000,fee schedule,$90.65 from Fee Schedule TC_24 for Rev 450 Proc 27808 * Qty 1 = $90.65 at 116% = $105.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,TENNCARE BLUE SELECT,105.15,,,,,,,105.1500,1274.0000,fee schedule,$90.65 from Fee Schedule TC_24 for Rev 450 Proc 27808 * Qty 1 = $90.65 at 116% = $105.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,105.1500,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,105.1500,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1146.60,,,,,,,105.1500,1274.0000,percent of total billed charges,"90% of $1,274.00 in Billed Charges for Rev 450 Proc 27808 = $1,146.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,105.1500,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,105.1500,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,MEDCOST,MEDCOST VHN,606.30,,,,,,,105.1500,1274.0000,percent of total billed charges,"47.59% of $1,274.00 in Billed Charges for Rev 450 Proc 27808 = $606.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,105.1500,1274.0000,fee schedule,"APG 00041 Proc 27808 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,105.1500,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,105.1500,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,105.1500,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,105.1500,1274.0000,fee schedule,"APG 00041 Proc 27808 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,SENTARA HEALTH,SENTARA HEALTH,328.82,,,,,,,105.1500,1274.0000,percent of total billed charges,"25.81% of $1,274.00 in Billed Charges for Rev 450 Proc 27808 = $328.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,105.1500,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1274.00,,,,,,,105.1500,1274.0000,percent of total billed charges,"100% of $1,274.00 in Billed Charges for Rev 450 Proc 27808 = $1,274.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,105.1500,1274.0000,case rate,Rev 450 Proc 27808 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,105.1500,1274.0000,case rate,Rev 450 Proc 27808 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,105.1500,1274.0000,case rate,Rev 450 Proc 27808 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,105.1500,1274.0000,case rate,Rev 450 Proc 27808 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,105.1500,1274.0000,fee schedule,"APG 00041 Proc 27808 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,105.1500,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,105.1500,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,WELLCARE,WELLCARE MEDICAID,1274.00,,,,,,,105.1500,1274.0000,percent of total billed charges,"100% of $1,274.00 in Billed Charges for Rev 450 Proc 27808 = $1,274.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX BIMALLEOLAR FX WO MAN,27808,CPT,450,RC,45000171,CDM,,,,both,,,1274.0000,191.1000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,105.1500,1274.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA,603.35,,,,,,,109.0000,3180.3800,percent of total billed charges,"42.7% of $1,413.00 in Billed Charges for Rev 450 Proc 27810 = $603.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27810 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA HEALTHCARE MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,3180.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1413.00,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM EXCHANGE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27810 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HMO,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1413.00,,,,,,,109.0000,3180.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,404.42,,,,,,,109.0000,3180.3800,fee schedule,$404.42 from Fee Schedule BLDTM_23 for Rev 450 Proc 27810 * Qty 1 = $404.42 at 100% = $404.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1271.70,,,,,,,109.0000,3180.3800,percent of total billed charges,"90% of $1,413.00 in Billed Charges for Rev 450 Proc 27810 = $1,271.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,HUMANA,HUMANA MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,MEDCOST,MEDCOST VHN,672.45,,,,,,,109.0000,3180.3800,percent of total billed charges,"47.59% of $1,413.00 in Billed Charges for Rev 450 Proc 27810 = $672.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27810 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,NHC ADVANTAGE,NHC ADVANTAGE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27810 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA HEALTH,364.70,,,,,,,109.0000,3180.3800,percent of total billed charges,"25.81% of $1,413.00 in Billed Charges for Rev 450 Proc 27810 = $364.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1413.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 27810 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 27810 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 27810 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 27810 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 27810 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27810 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1413.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICAID,1413.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 27810 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX BIMALLEOLAR ANK FX W M,27810,CPT,450,RC,45000172,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,3180.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,AETNA,AETNA,8771.01,,,,,,,890.0000,20541.0000,percent of total billed charges,"42.7% of $20,541.00 in Billed Charges for Rev 360 Proc 27814 = $8,771.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,7785.77,,,,,,,890.0000,20541.0000,fee schedule,"APG 00043 Proc 27814 at $836.60 (Base Rate) * 8.9485 (Relative Weight) = $7,486.32 (Total Line Payment) at 104% = $7,785.77. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,6583.38,,,,,,,890.0000,20541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,AETNA,AETNA HEALTHCARE MEDICARE,6583.38,,,,,,,890.0000,20541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,6583.38,,,,,,,890.0000,20541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,AMBETTER,AMBETTER,14351.76,,,,,,,890.0000,20541.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,6846.71,,,,,,,890.0000,20541.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,BLUE CROSS,ANTHEM EXCHANGE,16208.64,,,,,,,890.0000,20541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,7710.90,,,,,,,890.0000,20541.0000,fee schedule,"APG 00043 Proc 27814 at $836.60 (Base Rate) * 8.9485 (Relative Weight) = $7,486.32 (Total Line Payment) at 103% = $7,710.90. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,BLUE CROSS,ANTHEM HMO,17220.71,,,,,,,890.0000,20541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,6780.88,,,,,,,890.0000,20541.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",20258.57,,,,,,,890.0000,20541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1082.00,,,,,,,890.0000,20541.0000,case rate,"Rev 360 Proc 27814 ASG Rate of $1,082.00 at 100% of $1,082.00 = $1,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,890.0000,20541.0000,case rate,"Rev 360 Proc 27814 ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,BLUE CROSS,BLUE CROSS MEDICARE,6846.71,,,,,,,890.0000,20541.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,890.0000,20541.0000,case rate,"Rev 360 Proc 27814 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,890.0000,20541.0000,case rate,"Rev 360 Proc 27814 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,BLUE CROSS,TENNCARE BLUE CARE,890.00,,,,,,,890.0000,20541.0000,case rate,Rev 360 Proc 27814 ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,BLUE CROSS,TENNCARE BLUE SELECT,890.00,,,,,,,890.0000,20541.0000,case rate,Rev 360 Proc 27814 ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,CIGNA HEALTHCARE,CIGNA HMO,2967.00,,,,,,,890.0000,20541.0000,case rate,"Rev 360 Proc 27814 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2246.00,,,,,,,890.0000,20541.0000,case rate,"Rev 360 Proc 27814 ASG Rate of $2,246.00 at 100% of $2,246.00 = $2,246.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,6912.55,,,,,,,890.0000,20541.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2967.00,,,,,,,890.0000,20541.0000,case rate,"Rev 360 Proc 27814 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,CIGNA HEALTHCARE,CIGNA PPO,2967.00,,,,,,,890.0000,20541.0000,case rate,"Rev 360 Proc 27814 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,6912.55,,,,,,,890.0000,20541.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,18486.90,,,,,,,890.0000,20541.0000,percent of total billed charges,"90% of $20,541.00 in Billed Charges for Rev 360 Proc 27814 = $18,486.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,HUMANA,HUMANA MEDICARE,6583.38,,,,,,,890.0000,20541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,6583.38,,,,,,,890.0000,20541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,MEDCOST,MEDCOST VHN,9775.46,,,,,,,890.0000,20541.0000,percent of total billed charges,"47.59% of $20,541.00 in Billed Charges for Rev 360 Proc 27814 = $9,775.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,7860.64,,,,,,,890.0000,20541.0000,fee schedule,"APG 00043 Proc 27814 at $836.60 (Base Rate) * 8.9485 (Relative Weight) = $7,486.32 (Total Line Payment) at 100% = $7,486.32... $7,486.32 at 105% = $7,860.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,6912.55,,,,,,,890.0000,20541.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,6912.55,,,,,,,890.0000,20541.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,NHC ADVANTAGE,NHC ADVANTAGE,6912.55,,,,,,,890.0000,20541.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,7718.40,,,,,,,890.0000,20541.0000,fee schedule,"APG 00043 Proc 27814 at $836.60 (Base Rate) * 8.9485 (Relative Weight) = $7,486.32 (Total Line Payment) at 100% = $7,486.32... $7,486.32 at 103.1% = $7,718.40 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,SENTARA HEALTH,SENTARA HEALTH,5301.63,,,,,,,890.0000,20541.0000,percent of total billed charges,"25.81% of $20,541.00 in Billed Charges for Rev 360 Proc 27814 = $5,301.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,SENTARA HEALTH,SENTARA MEDICARE,6583.38,,,,,,,890.0000,20541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",20541.00,,,,,,,890.0000,20541.0000,percent of total billed charges,"100% of $20,541.00 in Billed Charges for Rev 360 Proc 27814 = $20,541.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,890.0000,20541.0000,case rate,"Rev 360 Proc 27814 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,890.0000,20541.0000,case rate,"Rev 360 Proc 27814 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,890.0000,20541.0000,case rate,"Rev 360 Proc 27814 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,890.0000,20541.0000,case rate,"Rev 360 Proc 27814 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,7710.90,,,,,,,890.0000,20541.0000,fee schedule,"APG 00043 Proc 27814 at $836.60 (Base Rate) * 8.9485 (Relative Weight) = $7,486.32 (Total Line Payment) at 103% = $7,710.90. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,6583.38,,,,,,,890.0000,20541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,6583.38,,,,,,,890.0000,20541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,WELLCARE,WELLCARE MEDICAID,20541.00,,,,,,,890.0000,20541.0000,percent of total billed charges,"100% of $20,541.00 in Billed Charges for Rev 360 Proc 27814 = $20,541.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE,27814,CPT,360,RC,36000270,CDM,,,,both,,,20541.0000,3081.1500,WELLCARE,WELLCARE MEDICARE,6978.38,,,,,,,890.0000,20541.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA,584.99,,,,,,,109.0000,1370.0000,percent of total billed charges,"42.7% of $1,370.00 in Billed Charges for Rev 450 Proc 27824 = $584.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,1370.0000,fee schedule,"APG 00041 Proc 27824 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,1370.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,1370.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,1370.0000,fee schedule,"APG 00041 Proc 27824 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,1370.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,265.11,,,,,,,109.0000,1370.0000,fee schedule,$265.11 from Fee Schedule BLDTM_23 for Rev 450 Proc 27824 * Qty 1 = $265.11 at 100% = $265.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,1370.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1233.00,,,,,,,109.0000,1370.0000,percent of total billed charges,"90% of $1,370.00 in Billed Charges for Rev 450 Proc 27824 = $1,233.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,MEDCOST,MEDCOST VHN,651.98,,,,,,,109.0000,1370.0000,percent of total billed charges,"47.59% of $1,370.00 in Billed Charges for Rev 450 Proc 27824 = $651.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,1370.0000,fee schedule,"APG 00041 Proc 27824 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,1370.0000,fee schedule,"APG 00041 Proc 27824 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,SENTARA HEALTH,SENTARA HEALTH,353.60,,,,,,,109.0000,1370.0000,percent of total billed charges,"25.81% of $1,370.00 in Billed Charges for Rev 450 Proc 27824 = $353.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1370.00,,,,,,,109.0000,1370.0000,percent of total billed charges,"100% of $1,370.00 in Billed Charges for Rev 450 Proc 27824 = $1,370.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1370.0000,case rate,Rev 450 Proc 27824 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1370.0000,case rate,Rev 450 Proc 27824 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1370.0000,case rate,Rev 450 Proc 27824 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1370.0000,case rate,Rev 450 Proc 27824 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,1370.0000,fee schedule,"APG 00041 Proc 27824 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,WELLCARE,WELLCARE MEDICAID,1370.00,,,,,,,109.0000,1370.0000,percent of total billed charges,"100% of $1,370.00 in Billed Charges for Rev 450 Proc 27824 = $1,370.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLS TX FX ARTIC DIST TIB WO M,27824,CPT,450,RC,45000174,CDM,,,,both,,,1370.0000,205.5000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,1370.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BONE FIBULA SHAFT SEGMENT FYO 46-65MM STERILE 405008,C1713,HCPCS,278,RC,,,,,,both,,,4086.1700,612.9300,AETNA,AETNA,1961.36,,,,,,,1054.6400,4086.1700,percent of total billed charges,"48% of $4,086.17 in Billed Charges for Rev 278 Proc C1713 = $1,961.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FIBULA SHAFT SEGMENT FYO 46-65MM STERILE 405008,C1713,HCPCS,278,RC,,,,,,both,,,4086.1700,612.9300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2043.09,,,,,,,1054.6400,4086.1700,percent of total billed charges,"50% of $4,086.17 in Billed Charges for Rev 278 Proc C1713 = $2,043.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FIBULA SHAFT SEGMENT FYO 46-65MM STERILE 405008,C1713,HCPCS,278,RC,,,,,,both,,,4086.1700,612.9300,CIGNA HEALTHCARE,CIGNA HMO,1703.93,,,,,,,1054.6400,4086.1700,percent of total billed charges,"41.7% of $4,086.17 in Billed Charges for Rev 278 Proc C1713 = $1,703.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FIBULA SHAFT SEGMENT FYO 46-65MM STERILE 405008,C1713,HCPCS,278,RC,,,,,,both,,,4086.1700,612.9300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1634.47,,,,,,,1054.6400,4086.1700,percent of total billed charges,"40% of $4,086.17 in Billed Charges for Rev 278 Proc C1713 = $1,634.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FIBULA SHAFT SEGMENT FYO 46-65MM STERILE 405008,C1713,HCPCS,278,RC,,,,,,both,,,4086.1700,612.9300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1703.93,,,,,,,1054.6400,4086.1700,percent of total billed charges,"41.7% of $4,086.17 in Billed Charges for Rev 278 Proc C1713 = $1,703.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FIBULA SHAFT SEGMENT FYO 46-65MM STERILE 405008,C1713,HCPCS,278,RC,,,,,,both,,,4086.1700,612.9300,CIGNA HEALTHCARE,CIGNA PPO,1703.93,,,,,,,1054.6400,4086.1700,percent of total billed charges,"41.7% of $4,086.17 in Billed Charges for Rev 278 Proc C1713 = $1,703.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FIBULA SHAFT SEGMENT FYO 46-65MM STERILE 405008,C1713,HCPCS,278,RC,,,,,,both,,,4086.1700,612.9300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3677.55,,,,,,,1054.6400,4086.1700,percent of total billed charges,"90% of $4,086.17 in Billed Charges for Rev 278 Proc C1713 = $3,677.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FIBULA SHAFT SEGMENT FYO 46-65MM STERILE 405008,C1713,HCPCS,278,RC,,,,,,both,,,4086.1700,612.9300,MEDCOST,MEDCOST VHN,1944.61,,,,,,,1054.6400,4086.1700,percent of total billed charges,"47.59% of $4,086.17 in Billed Charges for Rev 278 Proc C1713 = $1,944.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FIBULA SHAFT SEGMENT FYO 46-65MM STERILE 405008,C1713,HCPCS,278,RC,,,,,,both,,,4086.1700,612.9300,SENTARA HEALTH,SENTARA HEALTH,1054.64,,,,,,,1054.6400,4086.1700,percent of total billed charges,"25.81% of $4,086.17 in Billed Charges for Rev 278 Proc C1713 = $1,054.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FIBULA SHAFT SEGMENT FYO 46-65MM STERILE 405008,C1713,HCPCS,278,RC,,,,,,both,,,4086.1700,612.9300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4086.17,,,,,,,1054.6400,4086.1700,percent of total billed charges,"100% of $4,086.17 in Billed Charges for Rev 278 Proc C1713 = $4,086.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FIBULA SHAFT SEGMENT FYO 46-65MM STERILE 405008,C1713,HCPCS,278,RC,,,,,,both,,,4086.1700,612.9300,WELLCARE,WELLCARE MEDICAID,4086.17,,,,,,,1054.6400,4086.1700,percent of total billed charges,"100% of $4,086.17 in Billed Charges for Rev 278 Proc C1713 = $4,086.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FIBULAR SEGMENT 60,C1713,HCPCS,278,RC,,,,,,both,,,6953.7600,1043.0600,AETNA,AETNA,3337.80,,,,,,,1794.7700,6953.7600,percent of total billed charges,"48% of $6,953.76 in Billed Charges for Rev 278 Proc C1713 = $3,337.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FIBULAR SEGMENT 60,C1713,HCPCS,278,RC,,,,,,both,,,6953.7600,1043.0600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3476.88,,,,,,,1794.7700,6953.7600,percent of total billed charges,"50% of $6,953.76 in Billed Charges for Rev 278 Proc C1713 = $3,476.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FIBULAR SEGMENT 60,C1713,HCPCS,278,RC,,,,,,both,,,6953.7600,1043.0600,CIGNA HEALTHCARE,CIGNA HMO,2899.72,,,,,,,1794.7700,6953.7600,percent of total billed charges,"41.7% of $6,953.76 in Billed Charges for Rev 278 Proc C1713 = $2,899.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FIBULAR SEGMENT 60,C1713,HCPCS,278,RC,,,,,,both,,,6953.7600,1043.0600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2781.50,,,,,,,1794.7700,6953.7600,percent of total billed charges,"40% of $6,953.76 in Billed Charges for Rev 278 Proc C1713 = $2,781.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FIBULAR SEGMENT 60,C1713,HCPCS,278,RC,,,,,,both,,,6953.7600,1043.0600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2899.72,,,,,,,1794.7700,6953.7600,percent of total billed charges,"41.7% of $6,953.76 in Billed Charges for Rev 278 Proc C1713 = $2,899.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FIBULAR SEGMENT 60,C1713,HCPCS,278,RC,,,,,,both,,,6953.7600,1043.0600,CIGNA HEALTHCARE,CIGNA PPO,2899.72,,,,,,,1794.7700,6953.7600,percent of total billed charges,"41.7% of $6,953.76 in Billed Charges for Rev 278 Proc C1713 = $2,899.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FIBULAR SEGMENT 60,C1713,HCPCS,278,RC,,,,,,both,,,6953.7600,1043.0600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6258.38,,,,,,,1794.7700,6953.7600,percent of total billed charges,"90% of $6,953.76 in Billed Charges for Rev 278 Proc C1713 = $6,258.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FIBULAR SEGMENT 60,C1713,HCPCS,278,RC,,,,,,both,,,6953.7600,1043.0600,MEDCOST,MEDCOST VHN,3309.29,,,,,,,1794.7700,6953.7600,percent of total billed charges,"47.59% of $6,953.76 in Billed Charges for Rev 278 Proc C1713 = $3,309.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FIBULAR SEGMENT 60,C1713,HCPCS,278,RC,,,,,,both,,,6953.7600,1043.0600,SENTARA HEALTH,SENTARA HEALTH,1794.77,,,,,,,1794.7700,6953.7600,percent of total billed charges,"25.81% of $6,953.76 in Billed Charges for Rev 278 Proc C1713 = $1,794.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FIBULAR SEGMENT 60,C1713,HCPCS,278,RC,,,,,,both,,,6953.7600,1043.0600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6953.76,,,,,,,1794.7700,6953.7600,percent of total billed charges,"100% of $6,953.76 in Billed Charges for Rev 278 Proc C1713 = $6,953.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FIBULAR SEGMENT 60,C1713,HCPCS,278,RC,,,,,,both,,,6953.7600,1043.0600,WELLCARE,WELLCARE MEDICAID,6953.76,,,,,,,1794.7700,6953.7600,percent of total billed charges,"100% of $6,953.76 in Billed Charges for Rev 278 Proc C1713 = $6,953.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FILLER HYDROSET 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35290.4900,5293.5700,AETNA,AETNA,16939.44,,,,,,,2505.6200,35290.4900,percent of total billed charges,"48% of $35,290.49 in Billed Charges for Rev 278 Proc C1713 = $16,939.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FILLER HYDROSET 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35290.4900,5293.5700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,17645.25,,,,,,,2505.6200,35290.4900,percent of total billed charges,"50% of $35,290.49 in Billed Charges for Rev 278 Proc C1713 = $17,645.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FILLER HYDROSET 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35290.4900,5293.5700,CIGNA HEALTHCARE,CIGNA HMO,14716.13,,,,,,,2505.6200,35290.4900,percent of total billed charges,"41.7% of $35,290.49 in Billed Charges for Rev 278 Proc C1713 = $14,716.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FILLER HYDROSET 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35290.4900,5293.5700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,14116.20,,,,,,,2505.6200,35290.4900,percent of total billed charges,"40% of $35,290.49 in Billed Charges for Rev 278 Proc C1713 = $14,116.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FILLER HYDROSET 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35290.4900,5293.5700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,14716.13,,,,,,,2505.6200,35290.4900,percent of total billed charges,"41.7% of $35,290.49 in Billed Charges for Rev 278 Proc C1713 = $14,716.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FILLER HYDROSET 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35290.4900,5293.5700,CIGNA HEALTHCARE,CIGNA PPO,14716.13,,,,,,,2505.6200,35290.4900,percent of total billed charges,"41.7% of $35,290.49 in Billed Charges for Rev 278 Proc C1713 = $14,716.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FILLER HYDROSET 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35290.4900,5293.5700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,31761.44,,,,,,,2505.6200,35290.4900,percent of total billed charges,"90% of $35,290.49 in Billed Charges for Rev 278 Proc C1713 = $31,761.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FILLER HYDROSET 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35290.4900,5293.5700,MEDCOST,MEDCOST VHN,16794.74,,,,,,,2505.6200,35290.4900,percent of total billed charges,"47.59% of $35,290.49 in Billed Charges for Rev 278 Proc C1713 = $16,794.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FILLER HYDROSET 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35290.4900,5293.5700,SENTARA HEALTH,SENTARA HEALTH,9108.48,,,,,,,2505.6200,35290.4900,percent of total billed charges,"25.81% of $35,290.49 in Billed Charges for Rev 278 Proc C1713 = $9,108.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FILLER HYDROSET 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35290.4900,5293.5700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",35290.49,,,,,,,2505.6200,35290.4900,percent of total billed charges,"100% of $35,290.49 in Billed Charges for Rev 278 Proc C1713 = $35,290.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FILLER HYDROSET 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35290.4900,5293.5700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2646.79,,,,,,,2505.6200,35290.4900,percent of total billed charges,"7.5% of $35,290.49 in Billed Charges for Rev 278 Proc C1713 = $2,646.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FILLER HYDROSET 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35290.4900,5293.5700,UNITED HEALTHCARE,UHC HERITAGE SELECT,2505.62,,,,,,,2505.6200,35290.4900,percent of total billed charges,"7.1% of $35,290.49 in Billed Charges for Rev 278 Proc C1713 = $2,505.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FILLER HYDROSET 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35290.4900,5293.5700,UNITED HEALTHCARE,UNITED HEALTHCARE,2505.62,,,,,,,2505.6200,35290.4900,percent of total billed charges,"7.1% of $35,290.49 in Billed Charges for Rev 278 Proc C1713 = $2,505.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE FILLER HYDROSET 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35290.4900,5293.5700,WELLCARE,WELLCARE MEDICAID,35290.49,,,,,,,2505.6200,35290.4900,percent of total billed charges,"100% of $35,290.49 in Billed Charges for Rev 278 Proc C1713 = $35,290.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT INFUSE MEDIUM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40446.9000,6067.0400,AETNA,AETNA,19414.51,,,,,,,2871.7300,40446.9000,percent of total billed charges,"48% of $40,446.90 in Billed Charges for Rev 278 Proc C1713 = $19,414.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT INFUSE MEDIUM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40446.9000,6067.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,20223.45,,,,,,,2871.7300,40446.9000,percent of total billed charges,"50% of $40,446.90 in Billed Charges for Rev 278 Proc C1713 = $20,223.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT INFUSE MEDIUM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40446.9000,6067.0400,CIGNA HEALTHCARE,CIGNA HMO,16866.36,,,,,,,2871.7300,40446.9000,percent of total billed charges,"41.7% of $40,446.90 in Billed Charges for Rev 278 Proc C1713 = $16,866.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT INFUSE MEDIUM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40446.9000,6067.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,16178.76,,,,,,,2871.7300,40446.9000,percent of total billed charges,"40% of $40,446.90 in Billed Charges for Rev 278 Proc C1713 = $16,178.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT INFUSE MEDIUM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40446.9000,6067.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,16866.36,,,,,,,2871.7300,40446.9000,percent of total billed charges,"41.7% of $40,446.90 in Billed Charges for Rev 278 Proc C1713 = $16,866.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT INFUSE MEDIUM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40446.9000,6067.0400,CIGNA HEALTHCARE,CIGNA PPO,16866.36,,,,,,,2871.7300,40446.9000,percent of total billed charges,"41.7% of $40,446.90 in Billed Charges for Rev 278 Proc C1713 = $16,866.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT INFUSE MEDIUM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40446.9000,6067.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,36402.21,,,,,,,2871.7300,40446.9000,percent of total billed charges,"90% of $40,446.90 in Billed Charges for Rev 278 Proc C1713 = $36,402.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT INFUSE MEDIUM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40446.9000,6067.0400,MEDCOST,MEDCOST VHN,19248.68,,,,,,,2871.7300,40446.9000,percent of total billed charges,"47.59% of $40,446.90 in Billed Charges for Rev 278 Proc C1713 = $19,248.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT INFUSE MEDIUM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40446.9000,6067.0400,SENTARA HEALTH,SENTARA HEALTH,10439.34,,,,,,,2871.7300,40446.9000,percent of total billed charges,"25.81% of $40,446.90 in Billed Charges for Rev 278 Proc C1713 = $10,439.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT INFUSE MEDIUM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40446.9000,6067.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",40446.90,,,,,,,2871.7300,40446.9000,percent of total billed charges,"100% of $40,446.90 in Billed Charges for Rev 278 Proc C1713 = $40,446.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT INFUSE MEDIUM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40446.9000,6067.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3033.52,,,,,,,2871.7300,40446.9000,percent of total billed charges,"7.5% of $40,446.90 in Billed Charges for Rev 278 Proc C1713 = $3,033.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT INFUSE MEDIUM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40446.9000,6067.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,2871.73,,,,,,,2871.7300,40446.9000,percent of total billed charges,"7.1% of $40,446.90 in Billed Charges for Rev 278 Proc C1713 = $2,871.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT INFUSE MEDIUM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40446.9000,6067.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,2871.73,,,,,,,2871.7300,40446.9000,percent of total billed charges,"7.1% of $40,446.90 in Billed Charges for Rev 278 Proc C1713 = $2,871.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE GRAFT INFUSE MEDIUM,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40446.9000,6067.0400,WELLCARE,WELLCARE MEDICAID,40446.90,,,,,,,2871.7300,40446.9000,percent of total billed charges,"100% of $40,446.90 in Billed Charges for Rev 278 Proc C1713 = $40,446.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI-V LEAD UPGRAD PM/ICD,33225,CPT,481,RC,48100017,CDM,,,,both,,,18096.0000,2714.4000,AETNA,AETNA,7726.99,,,,,,,148.0000,18096.0000,percent of total billed charges,"42.7% of $18,096.00 in Billed Charges for Rev 481 Proc 33225 = $7,726.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI-V LEAD UPGRAD PM/ICD,33225,CPT,481,RC,48100017,CDM,,,,both,,,18096.0000,2714.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11330.93,,,,,,,148.0000,18096.0000,fee schedule,"APG 00086 Proc 33225 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 104% = $11,330.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI-V LEAD UPGRAD PM/ICD,33225,CPT,481,RC,48100017,CDM,,,,both,,,18096.0000,2714.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11221.98,,,,,,,148.0000,18096.0000,fee schedule,"APG 00086 Proc 33225 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI-V LEAD UPGRAD PM/ICD,33225,CPT,481,RC,48100017,CDM,,,,both,,,18096.0000,2714.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,445.23,,,,,,,148.0000,18096.0000,fee schedule,$445.23 from Fee Schedule BLDTM_23 for Rev 481 Proc 33225 * Qty 1 = $445.23 at 100% = $445.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD UPGRAD PM/ICD,33225,CPT,481,RC,48100017,CDM,,,,both,,,18096.0000,2714.4000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,18096.0000,case rate,Rev 481 Proc 33225 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD UPGRAD PM/ICD,33225,CPT,481,RC,48100017,CDM,,,,both,,,18096.0000,2714.4000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,18096.0000,case rate,Rev 481 Proc 33225 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD UPGRAD PM/ICD,33225,CPT,481,RC,48100017,CDM,,,,both,,,18096.0000,2714.4000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,18096.0000,case rate,Rev 481 Proc 33225 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD UPGRAD PM/ICD,33225,CPT,481,RC,48100017,CDM,,,,both,,,18096.0000,2714.4000,CIGNA HEALTHCARE,CIGNA HMO,7546.03,,,,,,,148.0000,18096.0000,percent of total billed charges,"41.7% of $18,096.00 in Billed Charges for Rev 481 Proc 33225 = $7,546.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI-V LEAD UPGRAD PM/ICD,33225,CPT,481,RC,48100017,CDM,,,,both,,,18096.0000,2714.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8396.54,,,,,,,148.0000,18096.0000,percent of total billed charges,"46.4% of $18,096.00 in Billed Charges for Rev 481 Proc 33225 = $8,396.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI-V LEAD UPGRAD PM/ICD,33225,CPT,481,RC,48100017,CDM,,,,both,,,18096.0000,2714.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7546.03,,,,,,,148.0000,18096.0000,percent of total billed charges,"41.7% of $18,096.00 in Billed Charges for Rev 481 Proc 33225 = $7,546.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI-V LEAD UPGRAD PM/ICD,33225,CPT,481,RC,48100017,CDM,,,,both,,,18096.0000,2714.4000,CIGNA HEALTHCARE,CIGNA PPO,7546.03,,,,,,,148.0000,18096.0000,percent of total billed charges,"41.7% of $18,096.00 in Billed Charges for Rev 481 Proc 33225 = $7,546.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI-V LEAD UPGRAD PM/ICD,33225,CPT,481,RC,48100017,CDM,,,,both,,,18096.0000,2714.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,16286.40,,,,,,,148.0000,18096.0000,percent of total billed charges,"90% of $18,096.00 in Billed Charges for Rev 481 Proc 33225 = $16,286.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI-V LEAD UPGRAD PM/ICD,33225,CPT,481,RC,48100017,CDM,,,,both,,,18096.0000,2714.4000,MEDCOST,MEDCOST VHN,8611.89,,,,,,,148.0000,18096.0000,percent of total billed charges,"47.59% of $18,096.00 in Billed Charges for Rev 481 Proc 33225 = $8,611.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI-V LEAD UPGRAD PM/ICD,33225,CPT,481,RC,48100017,CDM,,,,both,,,18096.0000,2714.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11439.89,,,,,,,148.0000,18096.0000,fee schedule,"APG 00086 Proc 33225 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 105% = $11,439.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI-V LEAD UPGRAD PM/ICD,33225,CPT,481,RC,48100017,CDM,,,,both,,,18096.0000,2714.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11232.88,,,,,,,148.0000,18096.0000,fee schedule,"APG 00086 Proc 33225 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 103.1% = $11,232.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI-V LEAD UPGRAD PM/ICD,33225,CPT,481,RC,48100017,CDM,,,,both,,,18096.0000,2714.4000,SENTARA HEALTH,SENTARA HEALTH,4670.58,,,,,,,148.0000,18096.0000,percent of total billed charges,"25.81% of $18,096.00 in Billed Charges for Rev 481 Proc 33225 = $4,670.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI-V LEAD UPGRAD PM/ICD,33225,CPT,481,RC,48100017,CDM,,,,both,,,18096.0000,2714.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",18096.00,,,,,,,148.0000,18096.0000,percent of total billed charges,"100% of $18,096.00 in Billed Charges for Rev 481 Proc 33225 = $18,096.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI-V LEAD UPGRAD PM/ICD,33225,CPT,481,RC,48100017,CDM,,,,both,,,18096.0000,2714.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8660.00,,,,,,,148.0000,18096.0000,case rate,"Rev 481 Proc 33225 ASG Rate of $8,660.00 at 100% of $8,660.00 = $8,660.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI-V LEAD UPGRAD PM/ICD,33225,CPT,481,RC,48100017,CDM,,,,both,,,18096.0000,2714.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12800.00,,,,,,,148.0000,18096.0000,case rate,"Rev 481 Proc 33225 ASG Rate of $12,800.00 at 100% of $12,800.00 = $12,800.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI-V LEAD UPGRAD PM/ICD,33225,CPT,481,RC,48100017,CDM,,,,both,,,18096.0000,2714.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,12245.00,,,,,,,148.0000,18096.0000,case rate,"Rev 481 Proc 33225 ASG Rate of $12,245.00 at 100% of $12,245.00 = $12,245.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI-V LEAD UPGRAD PM/ICD,33225,CPT,481,RC,48100017,CDM,,,,both,,,18096.0000,2714.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,18096.00,,,,,,,148.0000,18096.0000,case rate,"Rev 481 Proc 33225 ASG Rate of $20,790.00 at 100% of $20,790.00 = $20,790.00 Total (Service Line reduced to $18,096.00, claim capped at $18,096.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI-V LEAD UPGRAD PM/ICD,33225,CPT,481,RC,48100017,CDM,,,,both,,,18096.0000,2714.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11221.98,,,,,,,148.0000,18096.0000,fee schedule,"APG 00086 Proc 33225 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI-V LEAD UPGRAD PM/ICD,33225,CPT,481,RC,48100017,CDM,,,,both,,,18096.0000,2714.4000,WELLCARE,WELLCARE MEDICAID,18096.00,,,,,,,148.0000,18096.0000,percent of total billed charges,"100% of $18,096.00 in Billed Charges for Rev 481 Proc 33225 = $18,096.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA,5175.67,,,,,,,483.3200,12121.0000,percent of total billed charges,"42.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33226 = $5,175.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,10321.74,,,,,,,483.3200,12121.0000,fee schedule,"APG 00087 Proc 33226 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 104% = $10,321.74. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2864.70,,,,,,,483.3200,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA HEALTHCARE MEDICARE,2864.70,,,,,,,483.3200,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,2864.70,,,,,,,483.3200,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,AMBETTER,AMBETTER,6245.05,,,,,,,483.3200,12121.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2979.29,,,,,,,483.3200,12121.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM EXCHANGE,7053.05,,,,,,,483.3200,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,10222.50,,,,,,,483.3200,12121.0000,fee schedule,"APG 00087 Proc 33226 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 103% = $10,222.50. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM HMO,7493.45,,,,,,,483.3200,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2950.64,,,,,,,483.3200,12121.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8815.35,,,,,,,483.3200,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,483.32,,,,,,,483.3200,12121.0000,fee schedule,$483.32 from Fee Schedule BLDTM_23 for Rev 481 Proc 33226 * Qty 1 = $483.32 at 100% = $483.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,483.3200,12121.0000,case rate,"Rev 481 Proc 33226 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS MEDICARE,2979.29,,,,,,,483.3200,12121.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,483.3200,12121.0000,case rate,"Rev 481 Proc 33226 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,483.3200,12121.0000,case rate,"Rev 481 Proc 33226 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA HMO,5054.46,,,,,,,483.3200,12121.0000,percent of total billed charges,"41.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33226 = $5,054.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5624.14,,,,,,,483.3200,12121.0000,percent of total billed charges,"46.4% of $12,121.00 in Billed Charges for Rev 481 Proc 33226 = $5,624.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,3007.94,,,,,,,483.3200,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5054.46,,,,,,,483.3200,12121.0000,percent of total billed charges,"41.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33226 = $5,054.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA PPO,5054.46,,,,,,,483.3200,12121.0000,percent of total billed charges,"41.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33226 = $5,054.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3007.94,,,,,,,483.3200,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10908.90,,,,,,,483.3200,12121.0000,percent of total billed charges,"90% of $12,121.00 in Billed Charges for Rev 481 Proc 33226 = $10,908.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,HUMANA,HUMANA MEDICARE,2864.70,,,,,,,483.3200,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2864.70,,,,,,,483.3200,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,MEDCOST,MEDCOST VHN,5768.38,,,,,,,483.3200,12121.0000,percent of total billed charges,"47.59% of $12,121.00 in Billed Charges for Rev 481 Proc 33226 = $5,768.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,10420.99,,,,,,,483.3200,12121.0000,fee schedule,"APG 00087 Proc 33226 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 100% = $9,924.75... $9,924.75 at 105% = $10,420.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3007.94,,,,,,,483.3200,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3007.94,,,,,,,483.3200,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,NHC ADVANTAGE,NHC ADVANTAGE,3007.94,,,,,,,483.3200,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,10232.42,,,,,,,483.3200,12121.0000,fee schedule,"APG 00087 Proc 33226 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 100% = $9,924.75... $9,924.75 at 103.1% = $10,232.42 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,SENTARA HEALTH,SENTARA HEALTH,3128.43,,,,,,,483.3200,12121.0000,percent of total billed charges,"25.81% of $12,121.00 in Billed Charges for Rev 481 Proc 33226 = $3,128.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,SENTARA HEALTH,SENTARA MEDICARE,2864.70,,,,,,,483.3200,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12121.00,,,,,,,483.3200,12121.0000,percent of total billed charges,"100% of $12,121.00 in Billed Charges for Rev 481 Proc 33226 = $12,121.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,483.3200,12121.0000,case rate,"Rev 481 Proc 33226 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,483.3200,12121.0000,case rate,"Rev 481 Proc 33226 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,483.3200,12121.0000,case rate,"Rev 481 Proc 33226 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,483.3200,12121.0000,case rate,"Rev 481 Proc 33226 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,10222.50,,,,,,,483.3200,12121.0000,fee schedule,"APG 00087 Proc 33226 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 103% = $10,222.50. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2864.70,,,,,,,483.3200,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2864.70,,,,,,,483.3200,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,WELLCARE,WELLCARE MEDICAID,12121.00,,,,,,,483.3200,12121.0000,percent of total billed charges,"100% of $12,121.00 in Billed Charges for Rev 481 Proc 33226 = $12,121.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION LEFT VENTRIC LEAD,33226,CPT,481,RC,48100144,CDM,,,,both,,,12121.0000,1818.1500,WELLCARE,WELLCARE MEDICARE,3036.58,,,,,,,483.3200,12121.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,AETNA,AETNA,37760.46,,,,,,,12398.0000,88432.0000,percent of total billed charges,"42.7% of $88,432.00 in Billed Charges for Rev 481 Proc 33231 = $37,760.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,32079.69,,,,,,,12398.0000,88432.0000,fee schedule,"APG 00097 Proc 33231 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 104% = $32,079.69. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,28478.32,,,,,,,12398.0000,88432.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,AETNA,AETNA HEALTHCARE MEDICARE,28478.32,,,,,,,12398.0000,88432.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,28478.32,,,,,,,12398.0000,88432.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,AMBETTER,AMBETTER,62082.73,,,,,,,12398.0000,88432.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,29617.45,,,,,,,12398.0000,88432.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,BLUE CROSS,ANTHEM EXCHANGE,70115.16,,,,,,,12398.0000,88432.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,31771.24,,,,,,,12398.0000,88432.0000,fee schedule,"APG 00097 Proc 33231 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 103% = $31,771.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,BLUE CROSS,ANTHEM HMO,74493.19,,,,,,,12398.0000,88432.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,29332.66,,,,,,,12398.0000,88432.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",87634.30,,,,,,,12398.0000,88432.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,61902.40,,,,,,,12398.0000,88432.0000,percent of total billed charges,"Rev 481 Proc 33231 $88,432.00 in Billed Charges at 70% = $61,902.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,BLUE CROSS,BLUE CROSS E NETWORK,12398.00,,,,,,,12398.0000,88432.0000,case rate,"Rev 481 Proc 33231 ASG Rate of $12,398.00 at 100% of $12,398.00 = $12,398.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,BLUE CROSS,BLUE CROSS MEDICARE,29617.45,,,,,,,12398.0000,88432.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,BLUE CROSS,BLUE CROSS P NETWORK,12677.00,,,,,,,12398.0000,88432.0000,case rate,"Rev 481 Proc 33231 ASG Rate of $12,677.00 at 100% of $12,677.00 = $12,677.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,BLUE CROSS,BLUE CROSS S NETWORK,12677.00,,,,,,,12398.0000,88432.0000,case rate,"Rev 481 Proc 33231 ASG Rate of $12,677.00 at 100% of $12,677.00 = $12,677.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,CIGNA HEALTHCARE,CIGNA HMO,36876.14,,,,,,,12398.0000,88432.0000,percent of total billed charges,"41.7% of $88,432.00 in Billed Charges for Rev 481 Proc 33231 = $36,876.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,41032.45,,,,,,,12398.0000,88432.0000,percent of total billed charges,"46.4% of $88,432.00 in Billed Charges for Rev 481 Proc 33231 = $41,032.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,29902.23,,,,,,,12398.0000,88432.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,36876.14,,,,,,,12398.0000,88432.0000,percent of total billed charges,"41.7% of $88,432.00 in Billed Charges for Rev 481 Proc 33231 = $36,876.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,CIGNA HEALTHCARE,CIGNA PPO,36876.14,,,,,,,12398.0000,88432.0000,percent of total billed charges,"41.7% of $88,432.00 in Billed Charges for Rev 481 Proc 33231 = $36,876.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,29902.23,,,,,,,12398.0000,88432.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,79588.80,,,,,,,12398.0000,88432.0000,percent of total billed charges,"90% of $88,432.00 in Billed Charges for Rev 481 Proc 33231 = $79,588.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,HUMANA,HUMANA MEDICARE,28478.32,,,,,,,12398.0000,88432.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,28478.32,,,,,,,12398.0000,88432.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,MEDCOST,MEDCOST VHN,42084.79,,,,,,,12398.0000,88432.0000,percent of total billed charges,"47.59% of $88,432.00 in Billed Charges for Rev 481 Proc 33231 = $42,084.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,32388.15,,,,,,,12398.0000,88432.0000,fee schedule,"APG 00097 Proc 33231 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 100% = $30,845.86... $30,845.86 at 105% = $32,388.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,29902.23,,,,,,,12398.0000,88432.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,29902.23,,,,,,,12398.0000,88432.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,NHC ADVANTAGE,NHC ADVANTAGE,29902.23,,,,,,,12398.0000,88432.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,31802.08,,,,,,,12398.0000,88432.0000,fee schedule,"APG 00097 Proc 33231 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 100% = $30,845.86... $30,845.86 at 103.1% = $31,802.08 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,SENTARA HEALTH,SENTARA HEALTH,22824.30,,,,,,,12398.0000,88432.0000,percent of total billed charges,"25.81% of $88,432.00 in Billed Charges for Rev 481 Proc 33231 = $22,824.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,SENTARA HEALTH,SENTARA MEDICARE,28478.32,,,,,,,12398.0000,88432.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",88432.00,,,,,,,12398.0000,88432.0000,percent of total billed charges,"100% of $88,432.00 in Billed Charges for Rev 481 Proc 33231 = $88,432.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14690.00,,,,,,,12398.0000,88432.0000,case rate,"Rev 481 Proc 33231 ASG Rate of $14,690.00 at 100% of $14,690.00 = $14,690.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13326.00,,,,,,,12398.0000,88432.0000,case rate,"Rev 481 Proc 33231 ASG Rate of $13,326.00 at 100% of $13,326.00 = $13,326.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,12749.00,,,,,,,12398.0000,88432.0000,case rate,"Rev 481 Proc 33231 ASG Rate of $12,749.00 at 100% of $12,749.00 = $12,749.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,21642.00,,,,,,,12398.0000,88432.0000,case rate,"Rev 481 Proc 33231 ASG Rate of $21,642.00 at 100% of $21,642.00 = $21,642.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,31771.24,,,,,,,12398.0000,88432.0000,fee schedule,"APG 00097 Proc 33231 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 103% = $31,771.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,28478.32,,,,,,,12398.0000,88432.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,28478.32,,,,,,,12398.0000,88432.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,WELLCARE,WELLCARE MEDICAID,88432.00,,,,,,,12398.0000,88432.0000,percent of total billed charges,"100% of $88,432.00 in Billed Charges for Rev 481 Proc 33231 = $88,432.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT PULSE GEN W/MULT LEADS,33231,CPT,481,RC,48100022,CDM,,,,both,,,88432.0000,13264.8000,WELLCARE,WELLCARE MEDICARE,30187.01,,,,,,,12398.0000,88432.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,AETNA,AETNA,3811.83,,,,,,,222.4500,16367.5500,percent of total billed charges,"42.7% of $8,927.00 in Billed Charges for Rev 481 Proc 33233 = $3,811.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,10321.74,,,,,,,222.4500,16367.5500,fee schedule,"APG 00087 Proc 33233 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 104% = $10,321.74. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,7508.05,,,,,,,222.4500,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,AETNA,AETNA HEALTHCARE MEDICARE,7508.05,,,,,,,222.4500,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,7508.05,,,,,,,222.4500,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,AMBETTER,AMBETTER,16367.55,,,,,,,222.4500,16367.5500,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,7808.37,,,,,,,222.4500,16367.5500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,BLUE CROSS,ANTHEM EXCHANGE,8927.00,,,,,,,222.4500,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,8927.00,,,,,,,222.4500,16367.5500,fee schedule,"APG 00087 Proc 33233 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 103% = $10,222.50 (Service Line reduced to $8,927.00, claim capped at $8,927.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,BLUE CROSS,ANTHEM HMO,8927.00,,,,,,,222.4500,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,7733.29,,,,,,,222.4500,16367.5500,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8927.00,,,,,,,222.4500,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,222.45,,,,,,,222.4500,16367.5500,fee schedule,$222.45 from Fee Schedule BLDTM_23 for Rev 481 Proc 33233 * Qty 1 = $222.45 at 100% = $222.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,222.4500,16367.5500,case rate,"Rev 481 Proc 33233 ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,BLUE CROSS,BLUE CROSS MEDICARE,7808.37,,,,,,,222.4500,16367.5500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,222.4500,16367.5500,case rate,"Rev 481 Proc 33233 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,222.4500,16367.5500,case rate,"Rev 481 Proc 33233 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,CIGNA HEALTHCARE,CIGNA HMO,3722.56,,,,,,,222.4500,16367.5500,percent of total billed charges,"41.7% of $8,927.00 in Billed Charges for Rev 481 Proc 33233 = $3,722.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4142.13,,,,,,,222.4500,16367.5500,percent of total billed charges,"46.4% of $8,927.00 in Billed Charges for Rev 481 Proc 33233 = $4,142.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,7883.45,,,,,,,222.4500,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3722.56,,,,,,,222.4500,16367.5500,percent of total billed charges,"41.7% of $8,927.00 in Billed Charges for Rev 481 Proc 33233 = $3,722.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,CIGNA HEALTHCARE,CIGNA PPO,3722.56,,,,,,,222.4500,16367.5500,percent of total billed charges,"41.7% of $8,927.00 in Billed Charges for Rev 481 Proc 33233 = $3,722.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,7883.45,,,,,,,222.4500,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8034.30,,,,,,,222.4500,16367.5500,percent of total billed charges,"90% of $8,927.00 in Billed Charges for Rev 481 Proc 33233 = $8,034.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,HUMANA,HUMANA MEDICARE,7508.05,,,,,,,222.4500,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,7508.05,,,,,,,222.4500,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,MEDCOST,MEDCOST VHN,4248.36,,,,,,,222.4500,16367.5500,percent of total billed charges,"47.59% of $8,927.00 in Billed Charges for Rev 481 Proc 33233 = $4,248.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,10420.99,,,,,,,222.4500,16367.5500,fee schedule,"APG 00087 Proc 33233 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 100% = $9,924.75... $9,924.75 at 105% = $10,420.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,7883.45,,,,,,,222.4500,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,7883.45,,,,,,,222.4500,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,NHC ADVANTAGE,NHC ADVANTAGE,7883.45,,,,,,,222.4500,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,10232.42,,,,,,,222.4500,16367.5500,fee schedule,"APG 00087 Proc 33233 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 100% = $9,924.75... $9,924.75 at 103.1% = $10,232.42 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,SENTARA HEALTH,SENTARA HEALTH,2304.06,,,,,,,222.4500,16367.5500,percent of total billed charges,"25.81% of $8,927.00 in Billed Charges for Rev 481 Proc 33233 = $2,304.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,SENTARA HEALTH,SENTARA MEDICARE,7508.05,,,,,,,222.4500,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8927.00,,,,,,,222.4500,16367.5500,percent of total billed charges,"100% of $8,927.00 in Billed Charges for Rev 481 Proc 33233 = $8,927.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,222.4500,16367.5500,case rate,"Rev 481 Proc 33233 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,222.4500,16367.5500,case rate,"Rev 481 Proc 33233 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,222.4500,16367.5500,case rate,"Rev 481 Proc 33233 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,222.4500,16367.5500,case rate,"Rev 481 Proc 33233 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,10222.50,,,,,,,222.4500,16367.5500,fee schedule,"APG 00087 Proc 33233 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 103% = $10,222.50. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,7508.05,,,,,,,222.4500,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,7508.05,,,,,,,222.4500,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,WELLCARE,WELLCARE MEDICAID,8927.00,,,,,,,222.4500,16367.5500,percent of total billed charges,"100% of $8,927.00 in Billed Charges for Rev 481 Proc 33233 = $8,927.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL PERM PM PULSE GENER,33233,CPT,481,RC,48100023,CDM,,,,both,,,8927.0000,1339.0500,WELLCARE,WELLCARE MEDICARE,7958.53,,,,,,,222.4500,16367.5500,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA,5175.67,,,,,,,413.7300,12121.0000,percent of total billed charges,"42.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33234 = $5,175.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2176.64,,,,,,,413.7300,12121.0000,fee schedule,"APG 00074 Proc 33234 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 104% = $2,176.64. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3390.45,,,,,,,413.7300,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA HEALTHCARE MEDICARE,3390.45,,,,,,,413.7300,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,3390.45,,,,,,,413.7300,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,AMBETTER,AMBETTER,7391.18,,,,,,,413.7300,12121.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3526.07,,,,,,,413.7300,12121.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM EXCHANGE,8347.47,,,,,,,413.7300,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2155.71,,,,,,,413.7300,12121.0000,fee schedule,"APG 00074 Proc 33234 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM HMO,8868.69,,,,,,,413.7300,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3492.16,,,,,,,413.7300,12121.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",10433.19,,,,,,,413.7300,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,413.73,,,,,,,413.7300,12121.0000,fee schedule,$413.73 from Fee Schedule BLDTM_23 for Rev 481 Proc 33234 * Qty 1 = $413.73 at 100% = $413.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,413.7300,12121.0000,case rate,"Rev 481 Proc 33234 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS MEDICARE,3526.07,,,,,,,413.7300,12121.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,413.7300,12121.0000,case rate,"Rev 481 Proc 33234 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,413.7300,12121.0000,case rate,"Rev 481 Proc 33234 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA HMO,5054.46,,,,,,,413.7300,12121.0000,percent of total billed charges,"41.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33234 = $5,054.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5624.14,,,,,,,413.7300,12121.0000,percent of total billed charges,"46.4% of $12,121.00 in Billed Charges for Rev 481 Proc 33234 = $5,624.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,3559.97,,,,,,,413.7300,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5054.46,,,,,,,413.7300,12121.0000,percent of total billed charges,"41.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33234 = $5,054.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA PPO,5054.46,,,,,,,413.7300,12121.0000,percent of total billed charges,"41.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33234 = $5,054.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3559.97,,,,,,,413.7300,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10908.90,,,,,,,413.7300,12121.0000,percent of total billed charges,"90% of $12,121.00 in Billed Charges for Rev 481 Proc 33234 = $10,908.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,HUMANA,HUMANA MEDICARE,3390.45,,,,,,,413.7300,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3390.45,,,,,,,413.7300,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,MEDCOST,MEDCOST VHN,5768.38,,,,,,,413.7300,12121.0000,percent of total billed charges,"47.59% of $12,121.00 in Billed Charges for Rev 481 Proc 33234 = $5,768.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2197.57,,,,,,,413.7300,12121.0000,fee schedule,"APG 00074 Proc 33234 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 105% = $2,197.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3559.97,,,,,,,413.7300,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3559.97,,,,,,,413.7300,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,NHC ADVANTAGE,NHC ADVANTAGE,3559.97,,,,,,,413.7300,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2157.80,,,,,,,413.7300,12121.0000,fee schedule,"APG 00074 Proc 33234 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 103.1% = $2,157.80 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,SENTARA HEALTH,SENTARA HEALTH,3128.43,,,,,,,413.7300,12121.0000,percent of total billed charges,"25.81% of $12,121.00 in Billed Charges for Rev 481 Proc 33234 = $3,128.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,SENTARA HEALTH,SENTARA MEDICARE,3390.45,,,,,,,413.7300,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12121.00,,,,,,,413.7300,12121.0000,percent of total billed charges,"100% of $12,121.00 in Billed Charges for Rev 481 Proc 33234 = $12,121.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,413.7300,12121.0000,case rate,"Rev 481 Proc 33234 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,413.7300,12121.0000,case rate,"Rev 481 Proc 33234 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,413.7300,12121.0000,case rate,"Rev 481 Proc 33234 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,413.7300,12121.0000,case rate,"Rev 481 Proc 33234 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2155.71,,,,,,,413.7300,12121.0000,fee schedule,"APG 00074 Proc 33234 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3390.45,,,,,,,413.7300,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3390.45,,,,,,,413.7300,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,WELLCARE,WELLCARE MEDICAID,12121.00,,,,,,,413.7300,12121.0000,percent of total billed charges,"100% of $12,121.00 in Billed Charges for Rev 481 Proc 33234 = $12,121.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL TRANSVEN LEAD PM SG,33234,CPT,481,RC,48100024,CDM,,,,both,,,12121.0000,1818.1500,WELLCARE,WELLCARE MEDICARE,3593.87,,,,,,,413.7300,12121.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40966.6900,6145.0000,AETNA,AETNA,19664.01,,,,,,,2908.6400,40966.6900,percent of total billed charges,"48% of $40,966.69 in Billed Charges for Rev 278 Proc C1713 = $19,664.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40966.6900,6145.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,20483.35,,,,,,,2908.6400,40966.6900,percent of total billed charges,"50% of $40,966.69 in Billed Charges for Rev 278 Proc C1713 = $20,483.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40966.6900,6145.0000,CIGNA HEALTHCARE,CIGNA HMO,17083.11,,,,,,,2908.6400,40966.6900,percent of total billed charges,"41.7% of $40,966.69 in Billed Charges for Rev 278 Proc C1713 = $17,083.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40966.6900,6145.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,16386.68,,,,,,,2908.6400,40966.6900,percent of total billed charges,"40% of $40,966.69 in Billed Charges for Rev 278 Proc C1713 = $16,386.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40966.6900,6145.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,17083.11,,,,,,,2908.6400,40966.6900,percent of total billed charges,"41.7% of $40,966.69 in Billed Charges for Rev 278 Proc C1713 = $17,083.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40966.6900,6145.0000,CIGNA HEALTHCARE,CIGNA PPO,17083.11,,,,,,,2908.6400,40966.6900,percent of total billed charges,"41.7% of $40,966.69 in Billed Charges for Rev 278 Proc C1713 = $17,083.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40966.6900,6145.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,36870.02,,,,,,,2908.6400,40966.6900,percent of total billed charges,"90% of $40,966.69 in Billed Charges for Rev 278 Proc C1713 = $36,870.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40966.6900,6145.0000,MEDCOST,MEDCOST VHN,19496.05,,,,,,,2908.6400,40966.6900,percent of total billed charges,"47.59% of $40,966.69 in Billed Charges for Rev 278 Proc C1713 = $19,496.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40966.6900,6145.0000,SENTARA HEALTH,SENTARA HEALTH,10573.50,,,,,,,2908.6400,40966.6900,percent of total billed charges,"25.81% of $40,966.69 in Billed Charges for Rev 278 Proc C1713 = $10,573.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40966.6900,6145.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",40966.69,,,,,,,2908.6400,40966.6900,percent of total billed charges,"100% of $40,966.69 in Billed Charges for Rev 278 Proc C1713 = $40,966.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40966.6900,6145.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3072.50,,,,,,,2908.6400,40966.6900,percent of total billed charges,"7.5% of $40,966.69 in Billed Charges for Rev 278 Proc C1713 = $3,072.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40966.6900,6145.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2908.64,,,,,,,2908.6400,40966.6900,percent of total billed charges,"7.1% of $40,966.69 in Billed Charges for Rev 278 Proc C1713 = $2,908.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40966.6900,6145.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,2908.64,,,,,,,2908.6400,40966.6900,percent of total billed charges,"7.1% of $40,966.69 in Billed Charges for Rev 278 Proc C1713 = $2,908.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,40966.6900,6145.0000,WELLCARE,WELLCARE MEDICAID,40966.69,,,,,,,2908.6400,40966.6900,percent of total billed charges,"100% of $40,966.69 in Billed Charges for Rev 278 Proc C1713 = $40,966.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,42171.6000,6325.7400,AETNA,AETNA,20242.37,,,,,,,2994.1800,42171.6000,percent of total billed charges,"48% of $42,171.60 in Billed Charges for Rev 278 Proc C1713 = $20,242.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,42171.6000,6325.7400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,21085.80,,,,,,,2994.1800,42171.6000,percent of total billed charges,"50% of $42,171.60 in Billed Charges for Rev 278 Proc C1713 = $21,085.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,42171.6000,6325.7400,CIGNA HEALTHCARE,CIGNA HMO,17585.56,,,,,,,2994.1800,42171.6000,percent of total billed charges,"41.7% of $42,171.60 in Billed Charges for Rev 278 Proc C1713 = $17,585.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,42171.6000,6325.7400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,16868.64,,,,,,,2994.1800,42171.6000,percent of total billed charges,"40% of $42,171.60 in Billed Charges for Rev 278 Proc C1713 = $16,868.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,42171.6000,6325.7400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,17585.56,,,,,,,2994.1800,42171.6000,percent of total billed charges,"41.7% of $42,171.60 in Billed Charges for Rev 278 Proc C1713 = $17,585.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,42171.6000,6325.7400,CIGNA HEALTHCARE,CIGNA PPO,17585.56,,,,,,,2994.1800,42171.6000,percent of total billed charges,"41.7% of $42,171.60 in Billed Charges for Rev 278 Proc C1713 = $17,585.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,42171.6000,6325.7400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,37954.44,,,,,,,2994.1800,42171.6000,percent of total billed charges,"90% of $42,171.60 in Billed Charges for Rev 278 Proc C1713 = $37,954.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,42171.6000,6325.7400,MEDCOST,MEDCOST VHN,20069.46,,,,,,,2994.1800,42171.6000,percent of total billed charges,"47.59% of $42,171.60 in Billed Charges for Rev 278 Proc C1713 = $20,069.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,42171.6000,6325.7400,SENTARA HEALTH,SENTARA HEALTH,10884.49,,,,,,,2994.1800,42171.6000,percent of total billed charges,"25.81% of $42,171.60 in Billed Charges for Rev 278 Proc C1713 = $10,884.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,42171.6000,6325.7400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",42171.60,,,,,,,2994.1800,42171.6000,percent of total billed charges,"100% of $42,171.60 in Billed Charges for Rev 278 Proc C1713 = $42,171.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,42171.6000,6325.7400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3162.87,,,,,,,2994.1800,42171.6000,percent of total billed charges,"7.5% of $42,171.60 in Billed Charges for Rev 278 Proc C1713 = $3,162.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,42171.6000,6325.7400,UNITED HEALTHCARE,UHC HERITAGE SELECT,2994.18,,,,,,,2994.1800,42171.6000,percent of total billed charges,"7.1% of $42,171.60 in Billed Charges for Rev 278 Proc C1713 = $2,994.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,42171.6000,6325.7400,UNITED HEALTHCARE,UNITED HEALTHCARE,2994.18,,,,,,,2994.1800,42171.6000,percent of total billed charges,"7.1% of $42,171.60 in Billed Charges for Rev 278 Proc C1713 = $2,994.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE HYDROSET INJECTABLE 15CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,42171.6000,6325.7400,WELLCARE,WELLCARE MEDICAID,42171.60,,,,,,,2994.1800,42171.6000,percent of total billed charges,"100% of $42,171.60 in Billed Charges for Rev 278 Proc C1713 = $42,171.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,6741.1500,1011.1700,AETNA,AETNA,3235.75,,,,,,,1739.8900,6741.1500,percent of total billed charges,"48% of $6,741.15 in Billed Charges for Rev 278 Proc C1713 = $3,235.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,6741.1500,1011.1700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3370.58,,,,,,,1739.8900,6741.1500,percent of total billed charges,"50% of $6,741.15 in Billed Charges for Rev 278 Proc C1713 = $3,370.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,6741.1500,1011.1700,CIGNA HEALTHCARE,CIGNA HMO,2811.06,,,,,,,1739.8900,6741.1500,percent of total billed charges,"41.7% of $6,741.15 in Billed Charges for Rev 278 Proc C1713 = $2,811.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,6741.1500,1011.1700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2696.46,,,,,,,1739.8900,6741.1500,percent of total billed charges,"40% of $6,741.15 in Billed Charges for Rev 278 Proc C1713 = $2,696.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,6741.1500,1011.1700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2811.06,,,,,,,1739.8900,6741.1500,percent of total billed charges,"41.7% of $6,741.15 in Billed Charges for Rev 278 Proc C1713 = $2,811.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,6741.1500,1011.1700,CIGNA HEALTHCARE,CIGNA PPO,2811.06,,,,,,,1739.8900,6741.1500,percent of total billed charges,"41.7% of $6,741.15 in Billed Charges for Rev 278 Proc C1713 = $2,811.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,6741.1500,1011.1700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6067.04,,,,,,,1739.8900,6741.1500,percent of total billed charges,"90% of $6,741.15 in Billed Charges for Rev 278 Proc C1713 = $6,067.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,6741.1500,1011.1700,MEDCOST,MEDCOST VHN,3208.11,,,,,,,1739.8900,6741.1500,percent of total billed charges,"47.59% of $6,741.15 in Billed Charges for Rev 278 Proc C1713 = $3,208.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,6741.1500,1011.1700,SENTARA HEALTH,SENTARA HEALTH,1739.89,,,,,,,1739.8900,6741.1500,percent of total billed charges,"25.81% of $6,741.15 in Billed Charges for Rev 278 Proc C1713 = $1,739.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,6741.1500,1011.1700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6741.15,,,,,,,1739.8900,6741.1500,percent of total billed charges,"100% of $6,741.15 in Billed Charges for Rev 278 Proc C1713 = $6,741.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,6741.1500,1011.1700,WELLCARE,WELLCARE MEDICAID,6741.15,,,,,,,1739.8900,6741.1500,percent of total billed charges,"100% of $6,741.15 in Billed Charges for Rev 278 Proc C1713 = $6,741.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,AETNA,AETNA,42025.77,,,,,,,488.8000,98421.0000,percent of total billed charges,"42.7% of $98,421.00 in Billed Charges for Rev 481 Proc 33240 = $42,025.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,32079.69,,,,,,,488.8000,98421.0000,fee schedule,"APG 00097 Proc 33240 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 104% = $32,079.69. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,20181.03,,,,,,,488.8000,98421.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,AETNA,AETNA HEALTHCARE MEDICARE,20181.03,,,,,,,488.8000,98421.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,20181.03,,,,,,,488.8000,98421.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,AMBETTER,AMBETTER,43994.64,,,,,,,488.8000,98421.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,20988.27,,,,,,,488.8000,98421.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,BLUE CROSS,ANTHEM EXCHANGE,49686.78,,,,,,,488.8000,98421.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,31771.24,,,,,,,488.8000,98421.0000,fee schedule,"APG 00097 Proc 33240 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 103% = $31,771.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,BLUE CROSS,ANTHEM HMO,52789.25,,,,,,,488.8000,98421.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,20786.46,,,,,,,488.8000,98421.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",62101.64,,,,,,,488.8000,98421.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,488.80,,,,,,,488.8000,98421.0000,fee schedule,$488.80 from Fee Schedule BLDTM_23 for Rev 481 Proc 33240 * Qty 1 = $488.80 at 100% = $488.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,BLUE CROSS,BLUE CROSS E NETWORK,12398.00,,,,,,,488.8000,98421.0000,case rate,"Rev 481 Proc 33240 ASG Rate of $12,398.00 at 100% of $12,398.00 = $12,398.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,BLUE CROSS,BLUE CROSS MEDICARE,20988.27,,,,,,,488.8000,98421.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,BLUE CROSS,BLUE CROSS P NETWORK,12677.00,,,,,,,488.8000,98421.0000,case rate,"Rev 481 Proc 33240 ASG Rate of $12,677.00 at 100% of $12,677.00 = $12,677.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,BLUE CROSS,BLUE CROSS S NETWORK,12677.00,,,,,,,488.8000,98421.0000,case rate,"Rev 481 Proc 33240 ASG Rate of $12,677.00 at 100% of $12,677.00 = $12,677.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,CIGNA HEALTHCARE,CIGNA HMO,41041.56,,,,,,,488.8000,98421.0000,percent of total billed charges,"41.7% of $98,421.00 in Billed Charges for Rev 481 Proc 33240 = $41,041.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,45667.34,,,,,,,488.8000,98421.0000,percent of total billed charges,"46.4% of $98,421.00 in Billed Charges for Rev 481 Proc 33240 = $45,667.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,21190.08,,,,,,,488.8000,98421.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,41041.56,,,,,,,488.8000,98421.0000,percent of total billed charges,"41.7% of $98,421.00 in Billed Charges for Rev 481 Proc 33240 = $41,041.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,CIGNA HEALTHCARE,CIGNA PPO,41041.56,,,,,,,488.8000,98421.0000,percent of total billed charges,"41.7% of $98,421.00 in Billed Charges for Rev 481 Proc 33240 = $41,041.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,21190.08,,,,,,,488.8000,98421.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,88578.90,,,,,,,488.8000,98421.0000,percent of total billed charges,"90% of $98,421.00 in Billed Charges for Rev 481 Proc 33240 = $88,578.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,HUMANA,HUMANA MEDICARE,20181.03,,,,,,,488.8000,98421.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,20181.03,,,,,,,488.8000,98421.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,MEDCOST,MEDCOST VHN,46838.55,,,,,,,488.8000,98421.0000,percent of total billed charges,"47.59% of $98,421.00 in Billed Charges for Rev 481 Proc 33240 = $46,838.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,32388.15,,,,,,,488.8000,98421.0000,fee schedule,"APG 00097 Proc 33240 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 100% = $30,845.86... $30,845.86 at 105% = $32,388.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,21190.08,,,,,,,488.8000,98421.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,21190.08,,,,,,,488.8000,98421.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,NHC ADVANTAGE,NHC ADVANTAGE,21190.08,,,,,,,488.8000,98421.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,31802.08,,,,,,,488.8000,98421.0000,fee schedule,"APG 00097 Proc 33240 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 100% = $30,845.86... $30,845.86 at 103.1% = $31,802.08 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,SENTARA HEALTH,SENTARA HEALTH,25402.46,,,,,,,488.8000,98421.0000,percent of total billed charges,"25.81% of $98,421.00 in Billed Charges for Rev 481 Proc 33240 = $25,402.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,SENTARA HEALTH,SENTARA MEDICARE,20181.03,,,,,,,488.8000,98421.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",98421.00,,,,,,,488.8000,98421.0000,percent of total billed charges,"100% of $98,421.00 in Billed Charges for Rev 481 Proc 33240 = $98,421.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14690.00,,,,,,,488.8000,98421.0000,case rate,"Rev 481 Proc 33240 ASG Rate of $14,690.00 at 100% of $14,690.00 = $14,690.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13326.00,,,,,,,488.8000,98421.0000,case rate,"Rev 481 Proc 33240 ASG Rate of $13,326.00 at 100% of $13,326.00 = $13,326.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,12749.00,,,,,,,488.8000,98421.0000,case rate,"Rev 481 Proc 33240 ASG Rate of $12,749.00 at 100% of $12,749.00 = $12,749.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,21642.00,,,,,,,488.8000,98421.0000,case rate,"Rev 481 Proc 33240 ASG Rate of $21,642.00 at 100% of $21,642.00 = $21,642.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,31771.24,,,,,,,488.8000,98421.0000,fee schedule,"APG 00097 Proc 33240 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 103% = $31,771.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,20181.03,,,,,,,488.8000,98421.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,20181.03,,,,,,,488.8000,98421.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,WELLCARE,WELLCARE MEDICAID,98421.00,,,,,,,488.8000,98421.0000,percent of total billed charges,"100% of $98,421.00 in Billed Charges for Rev 481 Proc 33240 = $98,421.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT ICD PULSE GEN,33240,CPT,481,RC,48100026,CDM,,,,both,,,98421.0000,14763.1500,WELLCARE,WELLCARE MEDICARE,21391.89,,,,,,,488.8000,98421.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,AETNA,AETNA,4086.39,,,,,,,215.3700,10420.9900,percent of total billed charges,"42.7% of $9,570.00 in Billed Charges for Rev 481 Proc 33241 = $4,086.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,10321.74,,,,,,,215.3700,10420.9900,fee schedule,"APG 00087 Proc 33241 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $9,924.75 at 104% = $10,321.74. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3390.45,,,,,,,215.3700,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,AETNA,AETNA HEALTHCARE MEDICARE,3390.45,,,,,,,215.3700,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,3390.45,,,,,,,215.3700,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,AMBETTER,AMBETTER,7391.18,,,,,,,215.3700,10420.9900,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3526.07,,,,,,,215.3700,10420.9900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,BLUE CROSS,ANTHEM EXCHANGE,8347.47,,,,,,,215.3700,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,9570.00,,,,,,,215.3700,10420.9900,fee schedule,"APG 00087 Proc 33241 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $9,924.75 at 103% = $10,222.50 (Service Line reduced to $9,570.00, claim capped at $9,570.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,BLUE CROSS,ANTHEM HMO,8868.69,,,,,,,215.3700,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3492.16,,,,,,,215.3700,10420.9900,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9570.00,,,,,,,215.3700,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,215.37,,,,,,,215.3700,10420.9900,fee schedule,$215.37 from Fee Schedule BLDTM_23 for Rev 481 Proc 33241 * Qty 1 = $215.37 at 100% = $215.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,215.3700,10420.9900,case rate,"Rev 481 Proc 33241 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,BLUE CROSS,BLUE CROSS MEDICARE,3526.07,,,,,,,215.3700,10420.9900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,215.3700,10420.9900,case rate,"Rev 481 Proc 33241 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,215.3700,10420.9900,case rate,"Rev 481 Proc 33241 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,CIGNA HEALTHCARE,CIGNA HMO,3990.69,,,,,,,215.3700,10420.9900,percent of total billed charges,"41.7% of $9,570.00 in Billed Charges for Rev 481 Proc 33241 = $3,990.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4440.48,,,,,,,215.3700,10420.9900,percent of total billed charges,"46.4% of $9,570.00 in Billed Charges for Rev 481 Proc 33241 = $4,440.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,3559.97,,,,,,,215.3700,10420.9900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3990.69,,,,,,,215.3700,10420.9900,percent of total billed charges,"41.7% of $9,570.00 in Billed Charges for Rev 481 Proc 33241 = $3,990.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,CIGNA HEALTHCARE,CIGNA PPO,3990.69,,,,,,,215.3700,10420.9900,percent of total billed charges,"41.7% of $9,570.00 in Billed Charges for Rev 481 Proc 33241 = $3,990.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3559.97,,,,,,,215.3700,10420.9900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8613.00,,,,,,,215.3700,10420.9900,percent of total billed charges,"90% of $9,570.00 in Billed Charges for Rev 481 Proc 33241 = $8,613.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,HUMANA,HUMANA MEDICARE,3390.45,,,,,,,215.3700,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3390.45,,,,,,,215.3700,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,MEDCOST,MEDCOST VHN,4554.36,,,,,,,215.3700,10420.9900,percent of total billed charges,"47.59% of $9,570.00 in Billed Charges for Rev 481 Proc 33241 = $4,554.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,10420.99,,,,,,,215.3700,10420.9900,fee schedule,"APG 00087 Proc 33241 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $9,924.75 at 100% = $9,924.75... $9,924.75 at 105% = $10,420.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3559.97,,,,,,,215.3700,10420.9900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3559.97,,,,,,,215.3700,10420.9900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,NHC ADVANTAGE,NHC ADVANTAGE,3559.97,,,,,,,215.3700,10420.9900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,10232.42,,,,,,,215.3700,10420.9900,fee schedule,"APG 00087 Proc 33241 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $9,924.75 at 100% = $9,924.75... $9,924.75 at 103.1% = $10,232.42 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,SENTARA HEALTH,SENTARA HEALTH,2470.02,,,,,,,215.3700,10420.9900,percent of total billed charges,"25.81% of $9,570.00 in Billed Charges for Rev 481 Proc 33241 = $2,470.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,SENTARA HEALTH,SENTARA MEDICARE,3390.45,,,,,,,215.3700,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9570.00,,,,,,,215.3700,10420.9900,percent of total billed charges,"100% of $9,570.00 in Billed Charges for Rev 481 Proc 33241 = $9,570.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,215.3700,10420.9900,case rate,"Rev 481 Proc 33241 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,215.3700,10420.9900,case rate,"Rev 481 Proc 33241 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,215.3700,10420.9900,case rate,"Rev 481 Proc 33241 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,215.3700,10420.9900,case rate,"Rev 481 Proc 33241 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,10222.50,,,,,,,215.3700,10420.9900,fee schedule,"APG 00087 Proc 33241 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $9,924.75 at 103% = $10,222.50. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3390.45,,,,,,,215.3700,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3390.45,,,,,,,215.3700,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,WELLCARE,WELLCARE MEDICAID,9570.00,,,,,,,215.3700,10420.9900,percent of total billed charges,"100% of $9,570.00 in Billed Charges for Rev 481 Proc 33241 = $9,570.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL ICD PULSE GEN,33241,CPT,481,RC,48100028,CDM,,,,both,,,9570.0000,1435.5000,WELLCARE,WELLCARE MEDICARE,3593.87,,,,,,,215.3700,10420.9900,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,AETNA,AETNA,44657.80,,,,,,,1017.9200,104585.0000,percent of total billed charges,"42.7% of $104,585.00 in Billed Charges for Rev 480 Proc 33249 = $44,657.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,32079.69,,,,,,,1017.9200,104585.0000,fee schedule,"APG 00097 Proc 33249 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 104% = $32,079.69. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,28478.32,,,,,,,1017.9200,104585.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,AETNA,AETNA HEALTHCARE MEDICARE,28478.32,,,,,,,1017.9200,104585.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,28478.32,,,,,,,1017.9200,104585.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,AMBETTER,AMBETTER,62082.73,,,,,,,1017.9200,104585.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,29617.45,,,,,,,1017.9200,104585.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,BLUE CROSS,ANTHEM EXCHANGE,70115.16,,,,,,,1017.9200,104585.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,31771.24,,,,,,,1017.9200,104585.0000,fee schedule,"APG 00097 Proc 33249 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 103% = $31,771.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,BLUE CROSS,ANTHEM HMO,74493.19,,,,,,,1017.9200,104585.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,29332.66,,,,,,,1017.9200,104585.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",87634.30,,,,,,,1017.9200,104585.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1017.92,,,,,,,1017.9200,104585.0000,fee schedule,"$1,017.92 from Fee Schedule BLDTM_23 for Rev 480 Proc 33249 * Qty 1 = $1,017.92 at 100% = $1,017.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,BLUE CROSS,BLUE CROSS E NETWORK,23732.00,,,,,,,1017.9200,104585.0000,case rate,"Rev 480 Proc 33249 ASG Rate of $23,732.00 at 100% of $23,732.00 = $23,732.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,BLUE CROSS,BLUE CROSS MEDICARE,29617.45,,,,,,,1017.9200,104585.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,BLUE CROSS,BLUE CROSS P NETWORK,24267.00,,,,,,,1017.9200,104585.0000,case rate,"Rev 480 Proc 33249 ASG Rate of $24,267.00 at 100% of $24,267.00 = $24,267.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,BLUE CROSS,BLUE CROSS S NETWORK,24267.00,,,,,,,1017.9200,104585.0000,case rate,"Rev 480 Proc 33249 ASG Rate of $24,267.00 at 100% of $24,267.00 = $24,267.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,CIGNA HEALTHCARE,CIGNA HMO,43611.95,,,,,,,1017.9200,104585.0000,percent of total billed charges,"41.7% of $104,585.00 in Billed Charges for Rev 480 Proc 33249 = $43,611.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,48527.44,,,,,,,1017.9200,104585.0000,percent of total billed charges,"46.4% of $104,585.00 in Billed Charges for Rev 480 Proc 33249 = $48,527.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,29902.23,,,,,,,1017.9200,104585.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,43611.95,,,,,,,1017.9200,104585.0000,percent of total billed charges,"41.7% of $104,585.00 in Billed Charges for Rev 480 Proc 33249 = $43,611.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,CIGNA HEALTHCARE,CIGNA PPO,43611.95,,,,,,,1017.9200,104585.0000,percent of total billed charges,"41.7% of $104,585.00 in Billed Charges for Rev 480 Proc 33249 = $43,611.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,29902.23,,,,,,,1017.9200,104585.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,94126.50,,,,,,,1017.9200,104585.0000,percent of total billed charges,"90% of $104,585.00 in Billed Charges for Rev 480 Proc 33249 = $94,126.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,HUMANA,HUMANA MEDICARE,28478.32,,,,,,,1017.9200,104585.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,28478.32,,,,,,,1017.9200,104585.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,MEDCOST,MEDCOST VHN,49772.00,,,,,,,1017.9200,104585.0000,percent of total billed charges,"47.59% of $104,585.00 in Billed Charges for Rev 480 Proc 33249 = $49,772.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,32388.15,,,,,,,1017.9200,104585.0000,fee schedule,"APG 00097 Proc 33249 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 100% = $30,845.86... $30,845.86 at 105% = $32,388.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,29902.23,,,,,,,1017.9200,104585.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,29902.23,,,,,,,1017.9200,104585.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,NHC ADVANTAGE,NHC ADVANTAGE,29902.23,,,,,,,1017.9200,104585.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,31802.08,,,,,,,1017.9200,104585.0000,fee schedule,"APG 00097 Proc 33249 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 100% = $30,845.86... $30,845.86 at 103.1% = $31,802.08 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,SENTARA HEALTH,SENTARA HEALTH,26993.39,,,,,,,1017.9200,104585.0000,percent of total billed charges,"25.81% of $104,585.00 in Billed Charges for Rev 480 Proc 33249 = $26,993.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,SENTARA HEALTH,SENTARA MEDICARE,28478.32,,,,,,,1017.9200,104585.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",104585.00,,,,,,,1017.9200,104585.0000,percent of total billed charges,"100% of $104,585.00 in Billed Charges for Rev 480 Proc 33249 = $104,585.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,15409.22,,,,,,,1017.9200,104585.0000,fee schedule,"$30,818.44 from Fee Schedule TCUHC24 for Rev 480 Proc 33249 * Qty 1 = $30,818.44 at 50% = $15,409.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1642.00,,,,,,,1017.9200,104585.0000,other,"Rev 480 Proc 33249 1 Visit at $1,642.00 per Visit = $1,642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1571.00,,,,,,,1017.9200,104585.0000,other,"Rev 480 Proc 33249 1 Visit at $1,571.00 per Visit = $1,571.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,3097.00,,,,,,,1017.9200,104585.0000,other,"Rev 480 Proc 33249 1 Visit at $3,097.00 per Visit = $3,097.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,31771.24,,,,,,,1017.9200,104585.0000,fee schedule,"APG 00097 Proc 33249 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 103% = $31,771.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,28478.32,,,,,,,1017.9200,104585.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,28478.32,,,,,,,1017.9200,104585.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,WELLCARE,WELLCARE MEDICAID,104585.00,,,,,,,1017.9200,104585.0000,percent of total billed charges,"100% of $104,585.00 in Billed Charges for Rev 480 Proc 33249 = $104,585.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT/REPL LEAD/GEN ICD SGL/DUAL,33249,CPT,480,RC,48100030,CDM,,,,both,,,104585.0000,15687.7500,WELLCARE,WELLCARE MEDICARE,30187.01,,,,,,,1017.9200,104585.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,AETNA,AETNA,34392.29,,,,,,,12749.0000,80544.0000,percent of total billed charges,"42.7% of $80,544.00 in Billed Charges for Rev 481 Proc 33262 = $34,392.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,32079.69,,,,,,,12749.0000,80544.0000,fee schedule,"APG 00097 Proc 33262 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 104% = $32,079.69. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,20181.03,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,AETNA,AETNA HEALTHCARE MEDICARE,20181.03,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,20181.03,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,AMBETTER,AMBETTER,43994.64,,,,,,,12749.0000,80544.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,20988.27,,,,,,,12749.0000,80544.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,ANTHEM EXCHANGE,49686.78,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,31771.24,,,,,,,12749.0000,80544.0000,fee schedule,"APG 00097 Proc 33262 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 103% = $31,771.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,ANTHEM HMO,52789.25,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,20786.46,,,,,,,12749.0000,80544.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",62101.64,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,56380.80,,,,,,,12749.0000,80544.0000,percent of total billed charges,"Rev 481 Proc 33262 $80,544.00 in Billed Charges at 70% = $56,380.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,BLUE CROSS E NETWORK,19122.00,,,,,,,12749.0000,80544.0000,case rate,"Rev 481 Proc 33262 ASG Rate of $19,122.00 at 100% of $19,122.00 = $19,122.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,BLUE CROSS MEDICARE,20988.27,,,,,,,12749.0000,80544.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,BLUE CROSS P NETWORK,19553.00,,,,,,,12749.0000,80544.0000,case rate,"Rev 481 Proc 33262 ASG Rate of $19,553.00 at 100% of $19,553.00 = $19,553.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,BLUE CROSS S NETWORK,19553.00,,,,,,,12749.0000,80544.0000,case rate,"Rev 481 Proc 33262 ASG Rate of $19,553.00 at 100% of $19,553.00 = $19,553.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,CIGNA HEALTHCARE,CIGNA HMO,33586.85,,,,,,,12749.0000,80544.0000,percent of total billed charges,"41.7% of $80,544.00 in Billed Charges for Rev 481 Proc 33262 = $33,586.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,37372.42,,,,,,,12749.0000,80544.0000,percent of total billed charges,"46.4% of $80,544.00 in Billed Charges for Rev 481 Proc 33262 = $37,372.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,21190.08,,,,,,,12749.0000,80544.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,33586.85,,,,,,,12749.0000,80544.0000,percent of total billed charges,"41.7% of $80,544.00 in Billed Charges for Rev 481 Proc 33262 = $33,586.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,CIGNA HEALTHCARE,CIGNA PPO,33586.85,,,,,,,12749.0000,80544.0000,percent of total billed charges,"41.7% of $80,544.00 in Billed Charges for Rev 481 Proc 33262 = $33,586.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,21190.08,,,,,,,12749.0000,80544.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,72489.60,,,,,,,12749.0000,80544.0000,percent of total billed charges,"90% of $80,544.00 in Billed Charges for Rev 481 Proc 33262 = $72,489.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,HUMANA,HUMANA MEDICARE,20181.03,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,20181.03,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,MEDCOST,MEDCOST VHN,38330.89,,,,,,,12749.0000,80544.0000,percent of total billed charges,"47.59% of $80,544.00 in Billed Charges for Rev 481 Proc 33262 = $38,330.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,32388.15,,,,,,,12749.0000,80544.0000,fee schedule,"APG 00097 Proc 33262 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 100% = $30,845.86... $30,845.86 at 105% = $32,388.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,21190.08,,,,,,,12749.0000,80544.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,21190.08,,,,,,,12749.0000,80544.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,NHC ADVANTAGE,NHC ADVANTAGE,21190.08,,,,,,,12749.0000,80544.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,31802.08,,,,,,,12749.0000,80544.0000,fee schedule,"APG 00097 Proc 33262 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 100% = $30,845.86... $30,845.86 at 103.1% = $31,802.08 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,SENTARA HEALTH,SENTARA HEALTH,20788.41,,,,,,,12749.0000,80544.0000,percent of total billed charges,"25.81% of $80,544.00 in Billed Charges for Rev 481 Proc 33262 = $20,788.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,SENTARA HEALTH,SENTARA MEDICARE,20181.03,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",80544.00,,,,,,,12749.0000,80544.0000,percent of total billed charges,"100% of $80,544.00 in Billed Charges for Rev 481 Proc 33262 = $80,544.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14690.00,,,,,,,12749.0000,80544.0000,case rate,"Rev 481 Proc 33262 ASG Rate of $14,690.00 at 100% of $14,690.00 = $14,690.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13326.00,,,,,,,12749.0000,80544.0000,case rate,"Rev 481 Proc 33262 ASG Rate of $13,326.00 at 100% of $13,326.00 = $13,326.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,12749.00,,,,,,,12749.0000,80544.0000,case rate,"Rev 481 Proc 33262 ASG Rate of $12,749.00 at 100% of $12,749.00 = $12,749.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,21642.00,,,,,,,12749.0000,80544.0000,case rate,"Rev 481 Proc 33262 ASG Rate of $21,642.00 at 100% of $21,642.00 = $21,642.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,31771.24,,,,,,,12749.0000,80544.0000,fee schedule,"APG 00097 Proc 33262 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 103% = $31,771.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,20181.03,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,20181.03,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,WELLCARE,WELLCARE MEDICAID,80544.00,,,,,,,12749.0000,80544.0000,percent of total billed charges,"100% of $80,544.00 in Billed Charges for Rev 481 Proc 33262 = $80,544.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPL CVD GEN SING LEAD,33262,CPT,481,RC,48100031,CDM,,,,both,,,80544.0000,12081.6000,WELLCARE,WELLCARE MEDICARE,21391.89,,,,,,,12749.0000,80544.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,AETNA,AETNA,34392.29,,,,,,,12749.0000,80544.0000,percent of total billed charges,"42.7% of $80,544.00 in Billed Charges for Rev 481 Proc 33263 = $34,392.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,32079.69,,,,,,,12749.0000,80544.0000,fee schedule,"APG 00097 Proc 33263 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 104% = $32,079.69. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,20181.03,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,AETNA,AETNA HEALTHCARE MEDICARE,20181.03,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,20181.03,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,AMBETTER,AMBETTER,43994.64,,,,,,,12749.0000,80544.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,20988.27,,,,,,,12749.0000,80544.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,ANTHEM EXCHANGE,49686.78,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,31771.24,,,,,,,12749.0000,80544.0000,fee schedule,"APG 00097 Proc 33263 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 103% = $31,771.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,ANTHEM HMO,52789.25,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,20786.46,,,,,,,12749.0000,80544.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",62101.64,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,56380.80,,,,,,,12749.0000,80544.0000,percent of total billed charges,"Rev 481 Proc 33263 $80,544.00 in Billed Charges at 70% = $56,380.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,BLUE CROSS E NETWORK,19122.00,,,,,,,12749.0000,80544.0000,case rate,"Rev 481 Proc 33263 ASG Rate of $19,122.00 at 100% of $19,122.00 = $19,122.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,BLUE CROSS MEDICARE,20988.27,,,,,,,12749.0000,80544.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,BLUE CROSS P NETWORK,19553.00,,,,,,,12749.0000,80544.0000,case rate,"Rev 481 Proc 33263 ASG Rate of $19,553.00 at 100% of $19,553.00 = $19,553.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,BLUE CROSS S NETWORK,19553.00,,,,,,,12749.0000,80544.0000,case rate,"Rev 481 Proc 33263 ASG Rate of $19,553.00 at 100% of $19,553.00 = $19,553.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,CIGNA HEALTHCARE,CIGNA HMO,33586.85,,,,,,,12749.0000,80544.0000,percent of total billed charges,"41.7% of $80,544.00 in Billed Charges for Rev 481 Proc 33263 = $33,586.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,37372.42,,,,,,,12749.0000,80544.0000,percent of total billed charges,"46.4% of $80,544.00 in Billed Charges for Rev 481 Proc 33263 = $37,372.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,21190.08,,,,,,,12749.0000,80544.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,33586.85,,,,,,,12749.0000,80544.0000,percent of total billed charges,"41.7% of $80,544.00 in Billed Charges for Rev 481 Proc 33263 = $33,586.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,CIGNA HEALTHCARE,CIGNA PPO,33586.85,,,,,,,12749.0000,80544.0000,percent of total billed charges,"41.7% of $80,544.00 in Billed Charges for Rev 481 Proc 33263 = $33,586.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,21190.08,,,,,,,12749.0000,80544.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,72489.60,,,,,,,12749.0000,80544.0000,percent of total billed charges,"90% of $80,544.00 in Billed Charges for Rev 481 Proc 33263 = $72,489.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,HUMANA,HUMANA MEDICARE,20181.03,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,20181.03,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,MEDCOST,MEDCOST VHN,38330.89,,,,,,,12749.0000,80544.0000,percent of total billed charges,"47.59% of $80,544.00 in Billed Charges for Rev 481 Proc 33263 = $38,330.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,32388.15,,,,,,,12749.0000,80544.0000,fee schedule,"APG 00097 Proc 33263 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 100% = $30,845.86... $30,845.86 at 105% = $32,388.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,21190.08,,,,,,,12749.0000,80544.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,21190.08,,,,,,,12749.0000,80544.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,NHC ADVANTAGE,NHC ADVANTAGE,21190.08,,,,,,,12749.0000,80544.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,31802.08,,,,,,,12749.0000,80544.0000,fee schedule,"APG 00097 Proc 33263 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 100% = $30,845.86... $30,845.86 at 103.1% = $31,802.08 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,SENTARA HEALTH,SENTARA HEALTH,20788.41,,,,,,,12749.0000,80544.0000,percent of total billed charges,"25.81% of $80,544.00 in Billed Charges for Rev 481 Proc 33263 = $20,788.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,SENTARA HEALTH,SENTARA MEDICARE,20181.03,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",80544.00,,,,,,,12749.0000,80544.0000,percent of total billed charges,"100% of $80,544.00 in Billed Charges for Rev 481 Proc 33263 = $80,544.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14690.00,,,,,,,12749.0000,80544.0000,case rate,"Rev 481 Proc 33263 ASG Rate of $14,690.00 at 100% of $14,690.00 = $14,690.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13326.00,,,,,,,12749.0000,80544.0000,case rate,"Rev 481 Proc 33263 ASG Rate of $13,326.00 at 100% of $13,326.00 = $13,326.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,12749.00,,,,,,,12749.0000,80544.0000,case rate,"Rev 481 Proc 33263 ASG Rate of $12,749.00 at 100% of $12,749.00 = $12,749.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,21642.00,,,,,,,12749.0000,80544.0000,case rate,"Rev 481 Proc 33263 ASG Rate of $21,642.00 at 100% of $21,642.00 = $21,642.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,31771.24,,,,,,,12749.0000,80544.0000,fee schedule,"APG 00097 Proc 33263 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 103% = $31,771.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,20181.03,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,20181.03,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,WELLCARE,WELLCARE MEDICAID,80544.00,,,,,,,12749.0000,80544.0000,percent of total billed charges,"100% of $80,544.00 in Billed Charges for Rev 481 Proc 33263 = $80,544.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPL CVD GEN DUAL LEAD,33263,CPT,481,RC,48100032,CDM,,,,both,,,80544.0000,12081.6000,WELLCARE,WELLCARE MEDICARE,21391.89,,,,,,,12749.0000,80544.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,AETNA,AETNA,11367.59,,,,,,,1571.0000,26622.0000,percent of total billed charges,"42.7% of $26,622.00 in Billed Charges for Rev 480 Proc 33271 = $11,367.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2176.64,,,,,,,1571.0000,26622.0000,fee schedule,"APG 00074 Proc 33271 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 104% = $2,176.64. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,7508.05,,,,,,,1571.0000,26622.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,AETNA,AETNA HEALTHCARE MEDICARE,7508.05,,,,,,,1571.0000,26622.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,7508.05,,,,,,,1571.0000,26622.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,AMBETTER,AMBETTER,16367.55,,,,,,,1571.0000,26622.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,7808.37,,,,,,,1571.0000,26622.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,BLUE CROSS,ANTHEM EXCHANGE,18485.22,,,,,,,1571.0000,26622.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2155.71,,,,,,,1571.0000,26622.0000,fee schedule,"APG 00074 Proc 33271 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,BLUE CROSS,ANTHEM HMO,19639.44,,,,,,,1571.0000,26622.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,7733.29,,,,,,,1571.0000,26622.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",23103.98,,,,,,,1571.0000,26622.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,18635.40,,,,,,,1571.0000,26622.0000,percent of total billed charges,"Rev 480 Proc 33271 $26,622.00 in Billed Charges at 70% = $18,635.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,1571.0000,26622.0000,case rate,"Rev 480 Proc 33271 ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,BLUE CROSS,BLUE CROSS MEDICARE,7808.37,,,,,,,1571.0000,26622.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,1571.0000,26622.0000,case rate,"Rev 480 Proc 33271 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,1571.0000,26622.0000,case rate,"Rev 480 Proc 33271 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,CIGNA HEALTHCARE,CIGNA HMO,11101.37,,,,,,,1571.0000,26622.0000,percent of total billed charges,"41.7% of $26,622.00 in Billed Charges for Rev 480 Proc 33271 = $11,101.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12352.61,,,,,,,1571.0000,26622.0000,percent of total billed charges,"46.4% of $26,622.00 in Billed Charges for Rev 480 Proc 33271 = $12,352.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,7883.45,,,,,,,1571.0000,26622.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11101.37,,,,,,,1571.0000,26622.0000,percent of total billed charges,"41.7% of $26,622.00 in Billed Charges for Rev 480 Proc 33271 = $11,101.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,CIGNA HEALTHCARE,CIGNA PPO,11101.37,,,,,,,1571.0000,26622.0000,percent of total billed charges,"41.7% of $26,622.00 in Billed Charges for Rev 480 Proc 33271 = $11,101.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,7883.45,,,,,,,1571.0000,26622.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,23959.80,,,,,,,1571.0000,26622.0000,percent of total billed charges,"90% of $26,622.00 in Billed Charges for Rev 480 Proc 33271 = $23,959.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,HUMANA,HUMANA MEDICARE,7508.05,,,,,,,1571.0000,26622.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,7508.05,,,,,,,1571.0000,26622.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,MEDCOST,MEDCOST VHN,12669.41,,,,,,,1571.0000,26622.0000,percent of total billed charges,"47.59% of $26,622.00 in Billed Charges for Rev 480 Proc 33271 = $12,669.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2197.57,,,,,,,1571.0000,26622.0000,fee schedule,"APG 00074 Proc 33271 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 100% = $2,092.92... $2,092.92 at 105% = $2,197.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,7883.45,,,,,,,1571.0000,26622.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,7883.45,,,,,,,1571.0000,26622.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,NHC ADVANTAGE,NHC ADVANTAGE,7883.45,,,,,,,1571.0000,26622.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2157.80,,,,,,,1571.0000,26622.0000,fee schedule,"APG 00074 Proc 33271 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 100% = $2,092.92... $2,092.92 at 103.1% = $2,157.80 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,SENTARA HEALTH,SENTARA HEALTH,6871.14,,,,,,,1571.0000,26622.0000,percent of total billed charges,"25.81% of $26,622.00 in Billed Charges for Rev 480 Proc 33271 = $6,871.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,SENTARA HEALTH,SENTARA MEDICARE,7508.05,,,,,,,1571.0000,26622.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",26622.00,,,,,,,1571.0000,26622.0000,percent of total billed charges,"100% of $26,622.00 in Billed Charges for Rev 480 Proc 33271 = $26,622.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3272.67,,,,,,,1571.0000,26622.0000,fee schedule,"$6,545.34 from Fee Schedule TCUHC24 for Rev 480 Proc 33271 * Qty 1 = $6,545.34 at 50% = $3,272.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1642.00,,,,,,,1571.0000,26622.0000,other,"Rev 480 Proc 33271 1 Visit at $1,642.00 per Visit = $1,642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1571.00,,,,,,,1571.0000,26622.0000,other,"Rev 480 Proc 33271 1 Visit at $1,571.00 per Visit = $1,571.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,3097.00,,,,,,,1571.0000,26622.0000,other,"Rev 480 Proc 33271 1 Visit at $3,097.00 per Visit = $3,097.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2155.71,,,,,,,1571.0000,26622.0000,fee schedule,"APG 00074 Proc 33271 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,7508.05,,,,,,,1571.0000,26622.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,7508.05,,,,,,,1571.0000,26622.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,WELLCARE,WELLCARE MEDICAID,26622.00,,,,,,,1571.0000,26622.0000,percent of total billed charges,"100% of $26,622.00 in Billed Charges for Rev 480 Proc 33271 = $26,622.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION SQ ICD ELECTRODE,33271,CPT,480,RC,48000055,CDM,,,,both,,,26622.0000,3993.3000,WELLCARE,WELLCARE MEDICARE,7958.53,,,,,,,1571.0000,26622.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
BONE MIX DBX/CANCELLOUS 20CC 058200,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35772.2800,5365.8400,AETNA,AETNA,17170.69,,,,,,,2539.8300,35772.2800,percent of total billed charges,"48% of $35,772.28 in Billed Charges for Rev 278 Proc C1713 = $17,170.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MIX DBX/CANCELLOUS 20CC 058200,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35772.2800,5365.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,17886.14,,,,,,,2539.8300,35772.2800,percent of total billed charges,"50% of $35,772.28 in Billed Charges for Rev 278 Proc C1713 = $17,886.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MIX DBX/CANCELLOUS 20CC 058200,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35772.2800,5365.8400,CIGNA HEALTHCARE,CIGNA HMO,14917.04,,,,,,,2539.8300,35772.2800,percent of total billed charges,"41.7% of $35,772.28 in Billed Charges for Rev 278 Proc C1713 = $14,917.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MIX DBX/CANCELLOUS 20CC 058200,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35772.2800,5365.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,14308.91,,,,,,,2539.8300,35772.2800,percent of total billed charges,"40% of $35,772.28 in Billed Charges for Rev 278 Proc C1713 = $14,308.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MIX DBX/CANCELLOUS 20CC 058200,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35772.2800,5365.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,14917.04,,,,,,,2539.8300,35772.2800,percent of total billed charges,"41.7% of $35,772.28 in Billed Charges for Rev 278 Proc C1713 = $14,917.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MIX DBX/CANCELLOUS 20CC 058200,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35772.2800,5365.8400,CIGNA HEALTHCARE,CIGNA PPO,14917.04,,,,,,,2539.8300,35772.2800,percent of total billed charges,"41.7% of $35,772.28 in Billed Charges for Rev 278 Proc C1713 = $14,917.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MIX DBX/CANCELLOUS 20CC 058200,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35772.2800,5365.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,32195.05,,,,,,,2539.8300,35772.2800,percent of total billed charges,"90% of $35,772.28 in Billed Charges for Rev 278 Proc C1713 = $32,195.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MIX DBX/CANCELLOUS 20CC 058200,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35772.2800,5365.8400,MEDCOST,MEDCOST VHN,17024.03,,,,,,,2539.8300,35772.2800,percent of total billed charges,"47.59% of $35,772.28 in Billed Charges for Rev 278 Proc C1713 = $17,024.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MIX DBX/CANCELLOUS 20CC 058200,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35772.2800,5365.8400,SENTARA HEALTH,SENTARA HEALTH,9232.83,,,,,,,2539.8300,35772.2800,percent of total billed charges,"25.81% of $35,772.28 in Billed Charges for Rev 278 Proc C1713 = $9,232.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MIX DBX/CANCELLOUS 20CC 058200,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35772.2800,5365.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",35772.28,,,,,,,2539.8300,35772.2800,percent of total billed charges,"100% of $35,772.28 in Billed Charges for Rev 278 Proc C1713 = $35,772.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MIX DBX/CANCELLOUS 20CC 058200,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35772.2800,5365.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2682.92,,,,,,,2539.8300,35772.2800,percent of total billed charges,"7.5% of $35,772.28 in Billed Charges for Rev 278 Proc C1713 = $2,682.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MIX DBX/CANCELLOUS 20CC 058200,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35772.2800,5365.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,2539.83,,,,,,,2539.8300,35772.2800,percent of total billed charges,"7.1% of $35,772.28 in Billed Charges for Rev 278 Proc C1713 = $2,539.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MIX DBX/CANCELLOUS 20CC 058200,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35772.2800,5365.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,2539.83,,,,,,,2539.8300,35772.2800,percent of total billed charges,"7.1% of $35,772.28 in Billed Charges for Rev 278 Proc C1713 = $2,539.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
BONE MIX DBX/CANCELLOUS 20CC 058200,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,35772.2800,5365.8400,WELLCARE,WELLCARE MEDICAID,35772.28,,,,,,,2539.8300,35772.2800,percent of total billed charges,"100% of $35,772.28 in Billed Charges for Rev 278 Proc C1713 = $35,772.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAP RETROGRADE FEMORAL NAIL,C1713,HCPCS,278,RC,,,,,,both,,,1968.0000,295.2000,AETNA,AETNA,944.64,,,,,,,507.9400,1968.0000,percent of total billed charges,"48% of $1,968.00 in Billed Charges for Rev 278 Proc C1713 = $944.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAP RETROGRADE FEMORAL NAIL,C1713,HCPCS,278,RC,,,,,,both,,,1968.0000,295.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,984.00,,,,,,,507.9400,1968.0000,percent of total billed charges,"50% of $1,968.00 in Billed Charges for Rev 278 Proc C1713 = $984.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAP RETROGRADE FEMORAL NAIL,C1713,HCPCS,278,RC,,,,,,both,,,1968.0000,295.2000,CIGNA HEALTHCARE,CIGNA HMO,820.66,,,,,,,507.9400,1968.0000,percent of total billed charges,"41.7% of $1,968.00 in Billed Charges for Rev 278 Proc C1713 = $820.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAP RETROGRADE FEMORAL NAIL,C1713,HCPCS,278,RC,,,,,,both,,,1968.0000,295.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,787.20,,,,,,,507.9400,1968.0000,percent of total billed charges,"40% of $1,968.00 in Billed Charges for Rev 278 Proc C1713 = $787.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAP RETROGRADE FEMORAL NAIL,C1713,HCPCS,278,RC,,,,,,both,,,1968.0000,295.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,820.66,,,,,,,507.9400,1968.0000,percent of total billed charges,"41.7% of $1,968.00 in Billed Charges for Rev 278 Proc C1713 = $820.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAP RETROGRADE FEMORAL NAIL,C1713,HCPCS,278,RC,,,,,,both,,,1968.0000,295.2000,CIGNA HEALTHCARE,CIGNA PPO,820.66,,,,,,,507.9400,1968.0000,percent of total billed charges,"41.7% of $1,968.00 in Billed Charges for Rev 278 Proc C1713 = $820.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAP RETROGRADE FEMORAL NAIL,C1713,HCPCS,278,RC,,,,,,both,,,1968.0000,295.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1771.20,,,,,,,507.9400,1968.0000,percent of total billed charges,"90% of $1,968.00 in Billed Charges for Rev 278 Proc C1713 = $1,771.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAP RETROGRADE FEMORAL NAIL,C1713,HCPCS,278,RC,,,,,,both,,,1968.0000,295.2000,MEDCOST,MEDCOST VHN,936.57,,,,,,,507.9400,1968.0000,percent of total billed charges,"47.59% of $1,968.00 in Billed Charges for Rev 278 Proc C1713 = $936.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAP RETROGRADE FEMORAL NAIL,C1713,HCPCS,278,RC,,,,,,both,,,1968.0000,295.2000,SENTARA HEALTH,SENTARA HEALTH,507.94,,,,,,,507.9400,1968.0000,percent of total billed charges,"25.81% of $1,968.00 in Billed Charges for Rev 278 Proc C1713 = $507.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAP RETROGRADE FEMORAL NAIL,C1713,HCPCS,278,RC,,,,,,both,,,1968.0000,295.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1968.00,,,,,,,507.9400,1968.0000,percent of total billed charges,"100% of $1,968.00 in Billed Charges for Rev 278 Proc C1713 = $1,968.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAP RETROGRADE FEMORAL NAIL,C1713,HCPCS,278,RC,,,,,,both,,,1968.0000,295.2000,WELLCARE,WELLCARE MEDICAID,1968.00,,,,,,,507.9400,1968.0000,percent of total billed charges,"100% of $1,968.00 in Billed Charges for Rev 278 Proc C1713 = $1,968.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,518.5500,77.7800,AETNA,AETNA,248.90,,,,,,,133.8400,518.5500,percent of total billed charges,48% of $518.55 in Billed Charges for Rev 278 Proc C1713 = $248.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,518.5500,77.7800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,259.28,,,,,,,133.8400,518.5500,percent of total billed charges,50% of $518.55 in Billed Charges for Rev 278 Proc C1713 = $259.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,518.5500,77.7800,CIGNA HEALTHCARE,CIGNA HMO,216.24,,,,,,,133.8400,518.5500,percent of total billed charges,41.7% of $518.55 in Billed Charges for Rev 278 Proc C1713 = $216.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,518.5500,77.7800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,207.42,,,,,,,133.8400,518.5500,percent of total billed charges,40% of $518.55 in Billed Charges for Rev 278 Proc C1713 = $207.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,518.5500,77.7800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,216.24,,,,,,,133.8400,518.5500,percent of total billed charges,41.7% of $518.55 in Billed Charges for Rev 278 Proc C1713 = $216.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,518.5500,77.7800,CIGNA HEALTHCARE,CIGNA PPO,216.24,,,,,,,133.8400,518.5500,percent of total billed charges,41.7% of $518.55 in Billed Charges for Rev 278 Proc C1713 = $216.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,518.5500,77.7800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,466.70,,,,,,,133.8400,518.5500,percent of total billed charges,90% of $518.55 in Billed Charges for Rev 278 Proc C1713 = $466.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,518.5500,77.7800,MEDCOST,MEDCOST VHN,246.78,,,,,,,133.8400,518.5500,percent of total billed charges,47.59% of $518.55 in Billed Charges for Rev 278 Proc C1713 = $246.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,518.5500,77.7800,SENTARA HEALTH,SENTARA HEALTH,133.84,,,,,,,133.8400,518.5500,percent of total billed charges,25.81% of $518.55 in Billed Charges for Rev 278 Proc C1713 = $133.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,518.5500,77.7800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",518.55,,,,,,,133.8400,518.5500,percent of total billed charges,100% of $518.55 in Billed Charges for Rev 278 Proc C1713 = $518.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,518.5500,77.7800,WELLCARE,WELLCARE MEDICAID,518.55,,,,,,,133.8400,518.5500,percent of total billed charges,100% of $518.55 in Billed Charges for Rev 278 Proc C1713 = $518.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CAPCODE TOTAL REVERSE SHOULDER WITH AUGMENT,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,80634.5300,12095.1800,AETNA,AETNA,38704.57,,,,,,,5725.0500,80634.5300,percent of total billed charges,"48% of $80,634.53 in Billed Charges for Rev 278 Proc C1713 = $38,704.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPCODE TOTAL REVERSE SHOULDER WITH AUGMENT,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,80634.5300,12095.1800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,40317.27,,,,,,,5725.0500,80634.5300,percent of total billed charges,"50% of $80,634.53 in Billed Charges for Rev 278 Proc C1713 = $40,317.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPCODE TOTAL REVERSE SHOULDER WITH AUGMENT,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,80634.5300,12095.1800,CIGNA HEALTHCARE,CIGNA HMO,33624.60,,,,,,,5725.0500,80634.5300,percent of total billed charges,"41.7% of $80,634.53 in Billed Charges for Rev 278 Proc C1713 = $33,624.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPCODE TOTAL REVERSE SHOULDER WITH AUGMENT,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,80634.5300,12095.1800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,32253.81,,,,,,,5725.0500,80634.5300,percent of total billed charges,"40% of $80,634.53 in Billed Charges for Rev 278 Proc C1713 = $32,253.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPCODE TOTAL REVERSE SHOULDER WITH AUGMENT,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,80634.5300,12095.1800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,33624.60,,,,,,,5725.0500,80634.5300,percent of total billed charges,"41.7% of $80,634.53 in Billed Charges for Rev 278 Proc C1713 = $33,624.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPCODE TOTAL REVERSE SHOULDER WITH AUGMENT,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,80634.5300,12095.1800,CIGNA HEALTHCARE,CIGNA PPO,33624.60,,,,,,,5725.0500,80634.5300,percent of total billed charges,"41.7% of $80,634.53 in Billed Charges for Rev 278 Proc C1713 = $33,624.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPCODE TOTAL REVERSE SHOULDER WITH AUGMENT,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,80634.5300,12095.1800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,72571.08,,,,,,,5725.0500,80634.5300,percent of total billed charges,"90% of $80,634.53 in Billed Charges for Rev 278 Proc C1713 = $72,571.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPCODE TOTAL REVERSE SHOULDER WITH AUGMENT,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,80634.5300,12095.1800,MEDCOST,MEDCOST VHN,38373.97,,,,,,,5725.0500,80634.5300,percent of total billed charges,"47.59% of $80,634.53 in Billed Charges for Rev 278 Proc C1713 = $38,373.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPCODE TOTAL REVERSE SHOULDER WITH AUGMENT,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,80634.5300,12095.1800,SENTARA HEALTH,SENTARA HEALTH,20811.77,,,,,,,5725.0500,80634.5300,percent of total billed charges,"25.81% of $80,634.53 in Billed Charges for Rev 278 Proc C1713 = $20,811.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPCODE TOTAL REVERSE SHOULDER WITH AUGMENT,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,80634.5300,12095.1800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",80634.53,,,,,,,5725.0500,80634.5300,percent of total billed charges,"100% of $80,634.53 in Billed Charges for Rev 278 Proc C1713 = $80,634.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPCODE TOTAL REVERSE SHOULDER WITH AUGMENT,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,80634.5300,12095.1800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,6047.59,,,,,,,5725.0500,80634.5300,percent of total billed charges,"7.5% of $80,634.53 in Billed Charges for Rev 278 Proc C1713 = $6,047.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPCODE TOTAL REVERSE SHOULDER WITH AUGMENT,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,80634.5300,12095.1800,UNITED HEALTHCARE,UHC HERITAGE SELECT,5725.05,,,,,,,5725.0500,80634.5300,percent of total billed charges,"7.1% of $80,634.53 in Billed Charges for Rev 278 Proc C1713 = $5,725.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPCODE TOTAL REVERSE SHOULDER WITH AUGMENT,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,80634.5300,12095.1800,UNITED HEALTHCARE,UNITED HEALTHCARE,5725.05,,,,,,,5725.0500,80634.5300,percent of total billed charges,"7.1% of $80,634.53 in Billed Charges for Rev 278 Proc C1713 = $5,725.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CAPCODE TOTAL REVERSE SHOULDER WITH AUGMENT,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,80634.5300,12095.1800,WELLCARE,WELLCARE MEDICAID,80634.53,,,,,,,5725.0500,80634.5300,percent of total billed charges,"100% of $80,634.53 in Billed Charges for Rev 278 Proc C1713 = $80,634.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,1524.5400,228.6800,AETNA,AETNA,731.78,,,,,,,393.4800,1524.5400,percent of total billed charges,"48% of $1,524.54 in Billed Charges for Rev 278 Proc C1713 = $731.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,1524.5400,228.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,762.27,,,,,,,393.4800,1524.5400,percent of total billed charges,"50% of $1,524.54 in Billed Charges for Rev 278 Proc C1713 = $762.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,1524.5400,228.6800,CIGNA HEALTHCARE,CIGNA HMO,635.73,,,,,,,393.4800,1524.5400,percent of total billed charges,"41.7% of $1,524.54 in Billed Charges for Rev 278 Proc C1713 = $635.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,1524.5400,228.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,609.82,,,,,,,393.4800,1524.5400,percent of total billed charges,"40% of $1,524.54 in Billed Charges for Rev 278 Proc C1713 = $609.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,1524.5400,228.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,635.73,,,,,,,393.4800,1524.5400,percent of total billed charges,"41.7% of $1,524.54 in Billed Charges for Rev 278 Proc C1713 = $635.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,1524.5400,228.6800,CIGNA HEALTHCARE,CIGNA PPO,635.73,,,,,,,393.4800,1524.5400,percent of total billed charges,"41.7% of $1,524.54 in Billed Charges for Rev 278 Proc C1713 = $635.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,1524.5400,228.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1372.09,,,,,,,393.4800,1524.5400,percent of total billed charges,"90% of $1,524.54 in Billed Charges for Rev 278 Proc C1713 = $1,372.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,1524.5400,228.6800,MEDCOST,MEDCOST VHN,725.53,,,,,,,393.4800,1524.5400,percent of total billed charges,"47.59% of $1,524.54 in Billed Charges for Rev 278 Proc C1713 = $725.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,1524.5400,228.6800,SENTARA HEALTH,SENTARA HEALTH,393.48,,,,,,,393.4800,1524.5400,percent of total billed charges,"25.81% of $1,524.54 in Billed Charges for Rev 278 Proc C1713 = $393.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,1524.5400,228.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1524.54,,,,,,,393.4800,1524.5400,percent of total billed charges,"100% of $1,524.54 in Billed Charges for Rev 278 Proc C1713 = $1,524.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,1524.5400,228.6800,WELLCARE,WELLCARE MEDICAID,1524.54,,,,,,,393.4800,1524.5400,percent of total billed charges,"100% of $1,524.54 in Billed Charges for Rev 278 Proc C1713 = $1,524.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE OS6 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,1250.7400,187.6100,AETNA,AETNA,534.07,,,,,,,322.8200,1250.7400,percent of total billed charges,"42.7% of $1,250.74 in Billed Charges for Rev 272 = $534.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE OS6 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,1250.7400,187.6100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,875.52,,,,,,,322.8200,1250.7400,percent of total billed charges,"Rev 272 $1,250.74 in Billed Charges at 70% = $875.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE OS6 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,1250.7400,187.6100,CIGNA HEALTHCARE,CIGNA HMO,521.56,,,,,,,322.8200,1250.7400,percent of total billed charges,"41.7% of $1,250.74 in Billed Charges for Rev 272 = $521.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE OS6 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,1250.7400,187.6100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,580.34,,,,,,,322.8200,1250.7400,percent of total billed charges,"46.4% of $1,250.74 in Billed Charges for Rev 272 = $580.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE OS6 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,1250.7400,187.6100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,521.56,,,,,,,322.8200,1250.7400,percent of total billed charges,"41.7% of $1,250.74 in Billed Charges for Rev 272 = $521.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE OS6 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,1250.7400,187.6100,CIGNA HEALTHCARE,CIGNA PPO,521.56,,,,,,,322.8200,1250.7400,percent of total billed charges,"41.7% of $1,250.74 in Billed Charges for Rev 272 = $521.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE OS6 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,1250.7400,187.6100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1125.67,,,,,,,322.8200,1250.7400,percent of total billed charges,"90% of $1,250.74 in Billed Charges for Rev 272 = $1,125.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE OS6 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,1250.7400,187.6100,MEDCOST,MEDCOST VHN,595.23,,,,,,,322.8200,1250.7400,percent of total billed charges,"47.59% of $1,250.74 in Billed Charges for Rev 272 = $595.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE OS6 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,1250.7400,187.6100,SENTARA HEALTH,SENTARA HEALTH,322.82,,,,,,,322.8200,1250.7400,percent of total billed charges,"25.81% of $1,250.74 in Billed Charges for Rev 272 = $322.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE OS6 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,1250.7400,187.6100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1250.74,,,,,,,322.8200,1250.7400,percent of total billed charges,"100% of $1,250.74 in Billed Charges for Rev 272 = $1,250.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE OS6 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,1250.7400,187.6100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,625.37,,,,,,,322.8200,1250.7400,percent of total billed charges,"Rev 272 $1,250.74 in Billed Charges at 50% = $625.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE OS6 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,1250.7400,187.6100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,403.99,,,,,,,322.8200,1250.7400,other,"32.3% of $1,250.74 in Billed Charges for Rev 272 = $403.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PERMATAPE 1.3 BLUE OS6 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,1250.7400,187.6100,UNITED HEALTHCARE,UHC HERITAGE SELECT,383.98,,,,,,,322.8200,1250.7400,other,"30.7% of $1,250.74 in Billed Charges for Rev 272 = $383.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PERMATAPE 1.3 BLUE OS6 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,1250.7400,187.6100,UNITED HEALTHCARE,UNITED HEALTHCARE,403.99,,,,,,,322.8200,1250.7400,percent of total billed charges,"32.3% of $1,250.74 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE OS6 NEEDLE,272,RC,27200002,CDM,,,,,,both,,,1250.7400,187.6100,WELLCARE,WELLCARE MEDICAID,1250.74,,,,,,,322.8200,1250.7400,percent of total billed charges,"100% of $1,250.74 in Billed Charges for Rev 272 = $1,250.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE WHITE/BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,7546.4600,1131.9700,AETNA,AETNA,3222.34,,,,,,,1947.7400,7546.4600,percent of total billed charges,"42.7% of $7,546.46 in Billed Charges for Rev 272 = $3,222.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE WHITE/BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,7546.4600,1131.9700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5282.52,,,,,,,1947.7400,7546.4600,percent of total billed charges,"Rev 272 $7,546.46 in Billed Charges at 70% = $5,282.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE WHITE/BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,7546.4600,1131.9700,CIGNA HEALTHCARE,CIGNA HMO,3146.87,,,,,,,1947.7400,7546.4600,percent of total billed charges,"41.7% of $7,546.46 in Billed Charges for Rev 272 = $3,146.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE WHITE/BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,7546.4600,1131.9700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3501.56,,,,,,,1947.7400,7546.4600,percent of total billed charges,"46.4% of $7,546.46 in Billed Charges for Rev 272 = $3,501.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE WHITE/BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,7546.4600,1131.9700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3146.87,,,,,,,1947.7400,7546.4600,percent of total billed charges,"41.7% of $7,546.46 in Billed Charges for Rev 272 = $3,146.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE WHITE/BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,7546.4600,1131.9700,CIGNA HEALTHCARE,CIGNA PPO,3146.87,,,,,,,1947.7400,7546.4600,percent of total billed charges,"41.7% of $7,546.46 in Billed Charges for Rev 272 = $3,146.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE WHITE/BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,7546.4600,1131.9700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6791.81,,,,,,,1947.7400,7546.4600,percent of total billed charges,"90% of $7,546.46 in Billed Charges for Rev 272 = $6,791.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE WHITE/BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,7546.4600,1131.9700,MEDCOST,MEDCOST VHN,3591.36,,,,,,,1947.7400,7546.4600,percent of total billed charges,"47.59% of $7,546.46 in Billed Charges for Rev 272 = $3,591.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE WHITE/BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,7546.4600,1131.9700,SENTARA HEALTH,SENTARA HEALTH,1947.74,,,,,,,1947.7400,7546.4600,percent of total billed charges,"25.81% of $7,546.46 in Billed Charges for Rev 272 = $1,947.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE WHITE/BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,7546.4600,1131.9700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7546.46,,,,,,,1947.7400,7546.4600,percent of total billed charges,"100% of $7,546.46 in Billed Charges for Rev 272 = $7,546.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE WHITE/BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,7546.4600,1131.9700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3773.23,,,,,,,1947.7400,7546.4600,percent of total billed charges,"Rev 272 $7,546.46 in Billed Charges at 50% = $3,773.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE WHITE/BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,7546.4600,1131.9700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2437.51,,,,,,,1947.7400,7546.4600,other,"32.3% of $7,546.46 in Billed Charges for Rev 272 = $2,437.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PERMATAPE WHITE/BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,7546.4600,1131.9700,UNITED HEALTHCARE,UHC HERITAGE SELECT,2316.76,,,,,,,1947.7400,7546.4600,other,"30.7% of $7,546.46 in Billed Charges for Rev 272 = $2,316.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PERMATAPE WHITE/BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,7546.4600,1131.9700,UNITED HEALTHCARE,UNITED HEALTHCARE,2437.51,,,,,,,1947.7400,7546.4600,percent of total billed charges,"32.3% of $7,546.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE WHITE/BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,7546.4600,1131.9700,WELLCARE,WELLCARE MEDICAID,7546.46,,,,,,,1947.7400,7546.4600,percent of total billed charges,"100% of $7,546.46 in Billed Charges for Rev 272 = $7,546.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE POLYPROPYLENE OVERSTITCH 2-0,272,RC,27200002,CDM,,,,,,both,,,1315.6600,197.3500,AETNA,AETNA,561.79,,,,,,,339.5700,1315.6600,percent of total billed charges,"42.7% of $1,315.66 in Billed Charges for Rev 272 = $561.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE POLYPROPYLENE OVERSTITCH 2-0,272,RC,27200002,CDM,,,,,,both,,,1315.6600,197.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,920.96,,,,,,,339.5700,1315.6600,percent of total billed charges,"Rev 272 $1,315.66 in Billed Charges at 70% = $920.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE POLYPROPYLENE OVERSTITCH 2-0,272,RC,27200002,CDM,,,,,,both,,,1315.6600,197.3500,CIGNA HEALTHCARE,CIGNA HMO,548.63,,,,,,,339.5700,1315.6600,percent of total billed charges,"41.7% of $1,315.66 in Billed Charges for Rev 272 = $548.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE POLYPROPYLENE OVERSTITCH 2-0,272,RC,27200002,CDM,,,,,,both,,,1315.6600,197.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,610.47,,,,,,,339.5700,1315.6600,percent of total billed charges,"46.4% of $1,315.66 in Billed Charges for Rev 272 = $610.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE POLYPROPYLENE OVERSTITCH 2-0,272,RC,27200002,CDM,,,,,,both,,,1315.6600,197.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,548.63,,,,,,,339.5700,1315.6600,percent of total billed charges,"41.7% of $1,315.66 in Billed Charges for Rev 272 = $548.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE POLYPROPYLENE OVERSTITCH 2-0,272,RC,27200002,CDM,,,,,,both,,,1315.6600,197.3500,CIGNA HEALTHCARE,CIGNA PPO,548.63,,,,,,,339.5700,1315.6600,percent of total billed charges,"41.7% of $1,315.66 in Billed Charges for Rev 272 = $548.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE POLYPROPYLENE OVERSTITCH 2-0,272,RC,27200002,CDM,,,,,,both,,,1315.6600,197.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1184.09,,,,,,,339.5700,1315.6600,percent of total billed charges,"90% of $1,315.66 in Billed Charges for Rev 272 = $1,184.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE POLYPROPYLENE OVERSTITCH 2-0,272,RC,27200002,CDM,,,,,,both,,,1315.6600,197.3500,MEDCOST,MEDCOST VHN,626.12,,,,,,,339.5700,1315.6600,percent of total billed charges,"47.59% of $1,315.66 in Billed Charges for Rev 272 = $626.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE POLYPROPYLENE OVERSTITCH 2-0,272,RC,27200002,CDM,,,,,,both,,,1315.6600,197.3500,SENTARA HEALTH,SENTARA HEALTH,339.57,,,,,,,339.5700,1315.6600,percent of total billed charges,"25.81% of $1,315.66 in Billed Charges for Rev 272 = $339.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE POLYPROPYLENE OVERSTITCH 2-0,272,RC,27200002,CDM,,,,,,both,,,1315.6600,197.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1315.66,,,,,,,339.5700,1315.6600,percent of total billed charges,"100% of $1,315.66 in Billed Charges for Rev 272 = $1,315.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE POLYPROPYLENE OVERSTITCH 2-0,272,RC,27200002,CDM,,,,,,both,,,1315.6600,197.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,657.83,,,,,,,339.5700,1315.6600,percent of total billed charges,"Rev 272 $1,315.66 in Billed Charges at 50% = $657.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE POLYPROPYLENE OVERSTITCH 2-0,272,RC,27200002,CDM,,,,,,both,,,1315.6600,197.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,424.96,,,,,,,339.5700,1315.6600,other,"32.3% of $1,315.66 in Billed Charges for Rev 272 = $424.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE POLYPROPYLENE OVERSTITCH 2-0,272,RC,27200002,CDM,,,,,,both,,,1315.6600,197.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,403.91,,,,,,,339.5700,1315.6600,other,"30.7% of $1,315.66 in Billed Charges for Rev 272 = $403.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE POLYPROPYLENE OVERSTITCH 2-0,272,RC,27200002,CDM,,,,,,both,,,1315.6600,197.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,424.96,,,,,,,339.5700,1315.6600,percent of total billed charges,"32.3% of $1,315.66 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE POLYPROPYLENE OVERSTITCH 2-0,272,RC,27200002,CDM,,,,,,both,,,1315.6600,197.3500,WELLCARE,WELLCARE MEDICAID,1315.66,,,,,,,339.5700,1315.6600,percent of total billed charges,"100% of $1,315.66 in Billed Charges for Rev 272 = $1,315.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 1-0 8425H,270,RC,,,,,,,,both,,,449.5800,67.4400,AETNA,AETNA,191.97,,,,,,,116.0400,449.5800,percent of total billed charges,42.7% of $449.58 in Billed Charges for Rev 270 = $191.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 1-0 8425H,270,RC,,,,,,,,both,,,449.5800,67.4400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,314.71,,,,,,,116.0400,449.5800,percent of total billed charges,Rev 270 $449.58 in Billed Charges at 70% = $314.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 1-0 8425H,270,RC,,,,,,,,both,,,449.5800,67.4400,CIGNA HEALTHCARE,CIGNA HMO,187.47,,,,,,,116.0400,449.5800,percent of total billed charges,41.7% of $449.58 in Billed Charges for Rev 270 = $187.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 1-0 8425H,270,RC,,,,,,,,both,,,449.5800,67.4400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,208.61,,,,,,,116.0400,449.5800,percent of total billed charges,46.4% of $449.58 in Billed Charges for Rev 270 = $208.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 1-0 8425H,270,RC,,,,,,,,both,,,449.5800,67.4400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,187.47,,,,,,,116.0400,449.5800,percent of total billed charges,41.7% of $449.58 in Billed Charges for Rev 270 = $187.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 1-0 8425H,270,RC,,,,,,,,both,,,449.5800,67.4400,CIGNA HEALTHCARE,CIGNA PPO,187.47,,,,,,,116.0400,449.5800,percent of total billed charges,41.7% of $449.58 in Billed Charges for Rev 270 = $187.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 1-0 8425H,270,RC,,,,,,,,both,,,449.5800,67.4400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,404.62,,,,,,,116.0400,449.5800,percent of total billed charges,90% of $449.58 in Billed Charges for Rev 270 = $404.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 1-0 8425H,270,RC,,,,,,,,both,,,449.5800,67.4400,MEDCOST,MEDCOST VHN,213.96,,,,,,,116.0400,449.5800,percent of total billed charges,47.59% of $449.58 in Billed Charges for Rev 270 = $213.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 1-0 8425H,270,RC,,,,,,,,both,,,449.5800,67.4400,SENTARA HEALTH,SENTARA HEALTH,116.04,,,,,,,116.0400,449.5800,percent of total billed charges,25.81% of $449.58 in Billed Charges for Rev 270 = $116.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 1-0 8425H,270,RC,,,,,,,,both,,,449.5800,67.4400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",449.58,,,,,,,116.0400,449.5800,percent of total billed charges,100% of $449.58 in Billed Charges for Rev 270 = $449.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 1-0 8425H,270,RC,,,,,,,,both,,,449.5800,67.4400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,224.79,,,,,,,116.0400,449.5800,percent of total billed charges,Rev 270 $449.58 in Billed Charges at 50% = $224.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 1-0 8425H,270,RC,,,,,,,,both,,,449.5800,67.4400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,145.21,,,,,,,116.0400,449.5800,other,32.3% of $449.58 in Billed Charges for Rev 270 = $145.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE PROLENE 1-0 8425H,270,RC,,,,,,,,both,,,449.5800,67.4400,UNITED HEALTHCARE,UHC HERITAGE SELECT,138.02,,,,,,,116.0400,449.5800,other,30.7% of $449.58 in Billed Charges for Rev 270 = $138.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE PROLENE 1-0 8425H,270,RC,,,,,,,,both,,,449.5800,67.4400,UNITED HEALTHCARE,UNITED HEALTHCARE,145.21,,,,,,,116.0400,449.5800,percent of total billed charges,32.3% of $449.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 1-0 8425H,270,RC,,,,,,,,both,,,449.5800,67.4400,WELLCARE,WELLCARE MEDICAID,449.58,,,,,,,116.0400,449.5800,percent of total billed charges,100% of $449.58 in Billed Charges for Rev 270 = $449.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 4-0 D7160,272,RC,27200002,CDM,,,,,,both,,,1536.7500,230.5100,AETNA,AETNA,656.19,,,,,,,396.6400,1536.7500,percent of total billed charges,"42.7% of $1,536.75 in Billed Charges for Rev 272 = $656.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 4-0 D7160,272,RC,27200002,CDM,,,,,,both,,,1536.7500,230.5100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1075.73,,,,,,,396.6400,1536.7500,percent of total billed charges,"Rev 272 $1,536.75 in Billed Charges at 70% = $1,075.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 4-0 D7160,272,RC,27200002,CDM,,,,,,both,,,1536.7500,230.5100,CIGNA HEALTHCARE,CIGNA HMO,640.82,,,,,,,396.6400,1536.7500,percent of total billed charges,"41.7% of $1,536.75 in Billed Charges for Rev 272 = $640.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 4-0 D7160,272,RC,27200002,CDM,,,,,,both,,,1536.7500,230.5100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,713.05,,,,,,,396.6400,1536.7500,percent of total billed charges,"46.4% of $1,536.75 in Billed Charges for Rev 272 = $713.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 4-0 D7160,272,RC,27200002,CDM,,,,,,both,,,1536.7500,230.5100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,640.82,,,,,,,396.6400,1536.7500,percent of total billed charges,"41.7% of $1,536.75 in Billed Charges for Rev 272 = $640.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 4-0 D7160,272,RC,27200002,CDM,,,,,,both,,,1536.7500,230.5100,CIGNA HEALTHCARE,CIGNA PPO,640.82,,,,,,,396.6400,1536.7500,percent of total billed charges,"41.7% of $1,536.75 in Billed Charges for Rev 272 = $640.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 4-0 D7160,272,RC,27200002,CDM,,,,,,both,,,1536.7500,230.5100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1383.08,,,,,,,396.6400,1536.7500,percent of total billed charges,"90% of $1,536.75 in Billed Charges for Rev 272 = $1,383.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 4-0 D7160,272,RC,27200002,CDM,,,,,,both,,,1536.7500,230.5100,MEDCOST,MEDCOST VHN,731.34,,,,,,,396.6400,1536.7500,percent of total billed charges,"47.59% of $1,536.75 in Billed Charges for Rev 272 = $731.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 4-0 D7160,272,RC,27200002,CDM,,,,,,both,,,1536.7500,230.5100,SENTARA HEALTH,SENTARA HEALTH,396.64,,,,,,,396.6400,1536.7500,percent of total billed charges,"25.81% of $1,536.75 in Billed Charges for Rev 272 = $396.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 4-0 D7160,272,RC,27200002,CDM,,,,,,both,,,1536.7500,230.5100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1536.75,,,,,,,396.6400,1536.7500,percent of total billed charges,"100% of $1,536.75 in Billed Charges for Rev 272 = $1,536.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 4-0 D7160,272,RC,27200002,CDM,,,,,,both,,,1536.7500,230.5100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,768.38,,,,,,,396.6400,1536.7500,percent of total billed charges,"Rev 272 $1,536.75 in Billed Charges at 50% = $768.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 4-0 D7160,272,RC,27200002,CDM,,,,,,both,,,1536.7500,230.5100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,496.37,,,,,,,396.6400,1536.7500,other,"32.3% of $1,536.75 in Billed Charges for Rev 272 = $496.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PROLENE 4-0 D7160,272,RC,27200002,CDM,,,,,,both,,,1536.7500,230.5100,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.78,,,,,,,396.6400,1536.7500,other,"30.7% of $1,536.75 in Billed Charges for Rev 272 = $471.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PROLENE 4-0 D7160,272,RC,27200002,CDM,,,,,,both,,,1536.7500,230.5100,UNITED HEALTHCARE,UNITED HEALTHCARE,496.37,,,,,,,396.6400,1536.7500,percent of total billed charges,"32.3% of $1,536.75 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 4-0 D7160,272,RC,27200002,CDM,,,,,,both,,,1536.7500,230.5100,WELLCARE,WELLCARE MEDICAID,1536.75,,,,,,,396.6400,1536.7500,percent of total billed charges,"100% of $1,536.75 in Billed Charges for Rev 272 = $1,536.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,570.4100,85.5600,AETNA,AETNA,273.80,,,,,,,147.2200,570.4100,percent of total billed charges,48% of $570.41 in Billed Charges for Rev 278 Proc C1713 = $273.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,570.4100,85.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,285.21,,,,,,,147.2200,570.4100,percent of total billed charges,50% of $570.41 in Billed Charges for Rev 278 Proc C1713 = $285.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,570.4100,85.5600,CIGNA HEALTHCARE,CIGNA HMO,237.86,,,,,,,147.2200,570.4100,percent of total billed charges,41.7% of $570.41 in Billed Charges for Rev 278 Proc C1713 = $237.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,570.4100,85.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,228.16,,,,,,,147.2200,570.4100,percent of total billed charges,40% of $570.41 in Billed Charges for Rev 278 Proc C1713 = $228.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,570.4100,85.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,237.86,,,,,,,147.2200,570.4100,percent of total billed charges,41.7% of $570.41 in Billed Charges for Rev 278 Proc C1713 = $237.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,570.4100,85.5600,CIGNA HEALTHCARE,CIGNA PPO,237.86,,,,,,,147.2200,570.4100,percent of total billed charges,41.7% of $570.41 in Billed Charges for Rev 278 Proc C1713 = $237.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,570.4100,85.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,513.37,,,,,,,147.2200,570.4100,percent of total billed charges,90% of $570.41 in Billed Charges for Rev 278 Proc C1713 = $513.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,570.4100,85.5600,MEDCOST,MEDCOST VHN,271.46,,,,,,,147.2200,570.4100,percent of total billed charges,47.59% of $570.41 in Billed Charges for Rev 278 Proc C1713 = $271.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,570.4100,85.5600,SENTARA HEALTH,SENTARA HEALTH,147.22,,,,,,,147.2200,570.4100,percent of total billed charges,25.81% of $570.41 in Billed Charges for Rev 278 Proc C1713 = $147.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,570.4100,85.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",570.41,,,,,,,147.2200,570.4100,percent of total billed charges,100% of $570.41 in Billed Charges for Rev 278 Proc C1713 = $570.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,570.4100,85.5600,WELLCARE,WELLCARE MEDICAID,570.41,,,,,,,147.2200,570.4100,percent of total billed charges,100% of $570.41 in Billed Charges for Rev 278 Proc C1713 = $570.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,1763.0700,264.4600,AETNA,AETNA,846.27,,,,,,,455.0500,1763.0700,percent of total billed charges,"48% of $1,763.07 in Billed Charges for Rev 278 Proc C1713 = $846.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,1763.0700,264.4600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,881.54,,,,,,,455.0500,1763.0700,percent of total billed charges,"50% of $1,763.07 in Billed Charges for Rev 278 Proc C1713 = $881.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,1763.0700,264.4600,CIGNA HEALTHCARE,CIGNA HMO,735.20,,,,,,,455.0500,1763.0700,percent of total billed charges,"41.7% of $1,763.07 in Billed Charges for Rev 278 Proc C1713 = $735.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,1763.0700,264.4600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,705.23,,,,,,,455.0500,1763.0700,percent of total billed charges,"40% of $1,763.07 in Billed Charges for Rev 278 Proc C1713 = $705.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,1763.0700,264.4600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,735.20,,,,,,,455.0500,1763.0700,percent of total billed charges,"41.7% of $1,763.07 in Billed Charges for Rev 278 Proc C1713 = $735.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,1763.0700,264.4600,CIGNA HEALTHCARE,CIGNA PPO,735.20,,,,,,,455.0500,1763.0700,percent of total billed charges,"41.7% of $1,763.07 in Billed Charges for Rev 278 Proc C1713 = $735.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,1763.0700,264.4600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1586.76,,,,,,,455.0500,1763.0700,percent of total billed charges,"90% of $1,763.07 in Billed Charges for Rev 278 Proc C1713 = $1,586.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,1763.0700,264.4600,MEDCOST,MEDCOST VHN,839.05,,,,,,,455.0500,1763.0700,percent of total billed charges,"47.59% of $1,763.07 in Billed Charges for Rev 278 Proc C1713 = $839.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,1763.0700,264.4600,SENTARA HEALTH,SENTARA HEALTH,455.05,,,,,,,455.0500,1763.0700,percent of total billed charges,"25.81% of $1,763.07 in Billed Charges for Rev 278 Proc C1713 = $455.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,1763.0700,264.4600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1763.07,,,,,,,455.0500,1763.0700,percent of total billed charges,"100% of $1,763.07 in Billed Charges for Rev 278 Proc C1713 = $1,763.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,1763.0700,264.4600,WELLCARE,WELLCARE MEDICAID,1763.07,,,,,,,455.0500,1763.0700,percent of total billed charges,"100% of $1,763.07 in Billed Charges for Rev 278 Proc C1713 = $1,763.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE AUTOPLEX W MIXER,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,9556.8800,1433.5300,AETNA,AETNA,4587.30,,,,,,,2466.6300,9556.8800,percent of total billed charges,"48% of $9,556.88 in Billed Charges for Rev 278 Proc C1713 = $4,587.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE AUTOPLEX W MIXER,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,9556.8800,1433.5300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4778.44,,,,,,,2466.6300,9556.8800,percent of total billed charges,"50% of $9,556.88 in Billed Charges for Rev 278 Proc C1713 = $4,778.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE AUTOPLEX W MIXER,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,9556.8800,1433.5300,CIGNA HEALTHCARE,CIGNA HMO,3985.22,,,,,,,2466.6300,9556.8800,percent of total billed charges,"41.7% of $9,556.88 in Billed Charges for Rev 278 Proc C1713 = $3,985.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE AUTOPLEX W MIXER,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,9556.8800,1433.5300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3822.75,,,,,,,2466.6300,9556.8800,percent of total billed charges,"40% of $9,556.88 in Billed Charges for Rev 278 Proc C1713 = $3,822.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE AUTOPLEX W MIXER,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,9556.8800,1433.5300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3985.22,,,,,,,2466.6300,9556.8800,percent of total billed charges,"41.7% of $9,556.88 in Billed Charges for Rev 278 Proc C1713 = $3,985.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE AUTOPLEX W MIXER,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,9556.8800,1433.5300,CIGNA HEALTHCARE,CIGNA PPO,3985.22,,,,,,,2466.6300,9556.8800,percent of total billed charges,"41.7% of $9,556.88 in Billed Charges for Rev 278 Proc C1713 = $3,985.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE AUTOPLEX W MIXER,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,9556.8800,1433.5300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8601.19,,,,,,,2466.6300,9556.8800,percent of total billed charges,"90% of $9,556.88 in Billed Charges for Rev 278 Proc C1713 = $8,601.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE AUTOPLEX W MIXER,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,9556.8800,1433.5300,MEDCOST,MEDCOST VHN,4548.12,,,,,,,2466.6300,9556.8800,percent of total billed charges,"47.59% of $9,556.88 in Billed Charges for Rev 278 Proc C1713 = $4,548.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE AUTOPLEX W MIXER,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,9556.8800,1433.5300,SENTARA HEALTH,SENTARA HEALTH,2466.63,,,,,,,2466.6300,9556.8800,percent of total billed charges,"25.81% of $9,556.88 in Billed Charges for Rev 278 Proc C1713 = $2,466.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE AUTOPLEX W MIXER,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,9556.8800,1433.5300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9556.88,,,,,,,2466.6300,9556.8800,percent of total billed charges,"100% of $9,556.88 in Billed Charges for Rev 278 Proc C1713 = $9,556.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE AUTOPLEX W MIXER,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,9556.8800,1433.5300,WELLCARE,WELLCARE MEDICAID,9556.88,,,,,,,2466.6300,9556.8800,percent of total billed charges,"100% of $9,556.88 in Billed Charges for Rev 278 Proc C1713 = $9,556.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE INJECTABLE TRAUMACEM V+ STERILE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3922.5200,588.3800,AETNA,AETNA,1882.81,,,,,,,1012.4000,3922.5200,percent of total billed charges,"48% of $3,922.52 in Billed Charges for Rev 278 Proc C1713 = $1,882.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE INJECTABLE TRAUMACEM V+ STERILE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3922.5200,588.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1961.26,,,,,,,1012.4000,3922.5200,percent of total billed charges,"50% of $3,922.52 in Billed Charges for Rev 278 Proc C1713 = $1,961.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE INJECTABLE TRAUMACEM V+ STERILE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3922.5200,588.3800,CIGNA HEALTHCARE,CIGNA HMO,1635.69,,,,,,,1012.4000,3922.5200,percent of total billed charges,"41.7% of $3,922.52 in Billed Charges for Rev 278 Proc C1713 = $1,635.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE INJECTABLE TRAUMACEM V+ STERILE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3922.5200,588.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1569.01,,,,,,,1012.4000,3922.5200,percent of total billed charges,"40% of $3,922.52 in Billed Charges for Rev 278 Proc C1713 = $1,569.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE INJECTABLE TRAUMACEM V+ STERILE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3922.5200,588.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1635.69,,,,,,,1012.4000,3922.5200,percent of total billed charges,"41.7% of $3,922.52 in Billed Charges for Rev 278 Proc C1713 = $1,635.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE INJECTABLE TRAUMACEM V+ STERILE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3922.5200,588.3800,CIGNA HEALTHCARE,CIGNA PPO,1635.69,,,,,,,1012.4000,3922.5200,percent of total billed charges,"41.7% of $3,922.52 in Billed Charges for Rev 278 Proc C1713 = $1,635.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE INJECTABLE TRAUMACEM V+ STERILE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3922.5200,588.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3530.27,,,,,,,1012.4000,3922.5200,percent of total billed charges,"90% of $3,922.52 in Billed Charges for Rev 278 Proc C1713 = $3,530.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE INJECTABLE TRAUMACEM V+ STERILE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3922.5200,588.3800,MEDCOST,MEDCOST VHN,1866.73,,,,,,,1012.4000,3922.5200,percent of total billed charges,"47.59% of $3,922.52 in Billed Charges for Rev 278 Proc C1713 = $1,866.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE INJECTABLE TRAUMACEM V+ STERILE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3922.5200,588.3800,SENTARA HEALTH,SENTARA HEALTH,1012.40,,,,,,,1012.4000,3922.5200,percent of total billed charges,"25.81% of $3,922.52 in Billed Charges for Rev 278 Proc C1713 = $1,012.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE INJECTABLE TRAUMACEM V+ STERILE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3922.5200,588.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3922.52,,,,,,,1012.4000,3922.5200,percent of total billed charges,"100% of $3,922.52 in Billed Charges for Rev 278 Proc C1713 = $3,922.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE INJECTABLE TRAUMACEM V+ STERILE,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,3922.5200,588.3800,WELLCARE,WELLCARE MEDICAID,3922.52,,,,,,,1012.4000,3922.5200,percent of total billed charges,"100% of $3,922.52 in Billed Charges for Rev 278 Proc C1713 = $3,922.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 5-0 HS-7,270,RC,,,,,,,,both,,,16826.9500,2524.0400,AETNA,AETNA,7185.11,,,,,,,4343.0400,16826.9500,percent of total billed charges,"42.7% of $16,826.95 in Billed Charges for Rev 270 = $7,185.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 5-0 HS-7,270,RC,,,,,,,,both,,,16826.9500,2524.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,11778.87,,,,,,,4343.0400,16826.9500,percent of total billed charges,"Rev 270 $16,826.95 in Billed Charges at 70% = $11,778.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 5-0 HS-7,270,RC,,,,,,,,both,,,16826.9500,2524.0400,CIGNA HEALTHCARE,CIGNA HMO,7016.84,,,,,,,4343.0400,16826.9500,percent of total billed charges,"41.7% of $16,826.95 in Billed Charges for Rev 270 = $7,016.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 5-0 HS-7,270,RC,,,,,,,,both,,,16826.9500,2524.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7807.70,,,,,,,4343.0400,16826.9500,percent of total billed charges,"46.4% of $16,826.95 in Billed Charges for Rev 270 = $7,807.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 5-0 HS-7,270,RC,,,,,,,,both,,,16826.9500,2524.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7016.84,,,,,,,4343.0400,16826.9500,percent of total billed charges,"41.7% of $16,826.95 in Billed Charges for Rev 270 = $7,016.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 5-0 HS-7,270,RC,,,,,,,,both,,,16826.9500,2524.0400,CIGNA HEALTHCARE,CIGNA PPO,7016.84,,,,,,,4343.0400,16826.9500,percent of total billed charges,"41.7% of $16,826.95 in Billed Charges for Rev 270 = $7,016.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 5-0 HS-7,270,RC,,,,,,,,both,,,16826.9500,2524.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,15144.26,,,,,,,4343.0400,16826.9500,percent of total billed charges,"90% of $16,826.95 in Billed Charges for Rev 270 = $15,144.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 5-0 HS-7,270,RC,,,,,,,,both,,,16826.9500,2524.0400,MEDCOST,MEDCOST VHN,8007.95,,,,,,,4343.0400,16826.9500,percent of total billed charges,"47.59% of $16,826.95 in Billed Charges for Rev 270 = $8,007.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 5-0 HS-7,270,RC,,,,,,,,both,,,16826.9500,2524.0400,SENTARA HEALTH,SENTARA HEALTH,4343.04,,,,,,,4343.0400,16826.9500,percent of total billed charges,"25.81% of $16,826.95 in Billed Charges for Rev 270 = $4,343.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 5-0 HS-7,270,RC,,,,,,,,both,,,16826.9500,2524.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",16826.95,,,,,,,4343.0400,16826.9500,percent of total billed charges,"100% of $16,826.95 in Billed Charges for Rev 270 = $16,826.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 5-0 HS-7,270,RC,,,,,,,,both,,,16826.9500,2524.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8413.48,,,,,,,4343.0400,16826.9500,percent of total billed charges,"Rev 270 $16,826.95 in Billed Charges at 50% = $8,413.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 5-0 HS-7,270,RC,,,,,,,,both,,,16826.9500,2524.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5435.10,,,,,,,4343.0400,16826.9500,other,"32.3% of $16,826.95 in Billed Charges for Rev 270 = $5,435.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PROLENE 5-0 HS-7,270,RC,,,,,,,,both,,,16826.9500,2524.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,5165.87,,,,,,,4343.0400,16826.9500,other,"30.7% of $16,826.95 in Billed Charges for Rev 270 = $5,165.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PROLENE 5-0 HS-7,270,RC,,,,,,,,both,,,16826.9500,2524.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,5435.10,,,,,,,4343.0400,16826.9500,percent of total billed charges,"32.3% of $16,826.95 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 5-0 HS-7,270,RC,,,,,,,,both,,,16826.9500,2524.0400,WELLCARE,WELLCARE MEDICAID,16826.95,,,,,,,4343.0400,16826.9500,percent of total billed charges,"100% of $16,826.95 in Billed Charges for Rev 270 = $16,826.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 5.0 M8725,272,RC,,,,,,,,both,,,495.5700,74.3400,AETNA,AETNA,211.61,,,,,,,127.9100,495.5700,percent of total billed charges,42.7% of $495.57 in Billed Charges for Rev 272 = $211.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 5.0 M8725,272,RC,,,,,,,,both,,,495.5700,74.3400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,346.90,,,,,,,127.9100,495.5700,percent of total billed charges,Rev 272 $495.57 in Billed Charges at 70% = $346.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 5.0 M8725,272,RC,,,,,,,,both,,,495.5700,74.3400,CIGNA HEALTHCARE,CIGNA HMO,206.65,,,,,,,127.9100,495.5700,percent of total billed charges,41.7% of $495.57 in Billed Charges for Rev 272 = $206.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 5.0 M8725,272,RC,,,,,,,,both,,,495.5700,74.3400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,229.94,,,,,,,127.9100,495.5700,percent of total billed charges,46.4% of $495.57 in Billed Charges for Rev 272 = $229.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 5.0 M8725,272,RC,,,,,,,,both,,,495.5700,74.3400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,206.65,,,,,,,127.9100,495.5700,percent of total billed charges,41.7% of $495.57 in Billed Charges for Rev 272 = $206.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 5.0 M8725,272,RC,,,,,,,,both,,,495.5700,74.3400,CIGNA HEALTHCARE,CIGNA PPO,206.65,,,,,,,127.9100,495.5700,percent of total billed charges,41.7% of $495.57 in Billed Charges for Rev 272 = $206.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 5.0 M8725,272,RC,,,,,,,,both,,,495.5700,74.3400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,446.01,,,,,,,127.9100,495.5700,percent of total billed charges,90% of $495.57 in Billed Charges for Rev 272 = $446.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 5.0 M8725,272,RC,,,,,,,,both,,,495.5700,74.3400,MEDCOST,MEDCOST VHN,235.84,,,,,,,127.9100,495.5700,percent of total billed charges,47.59% of $495.57 in Billed Charges for Rev 272 = $235.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 5.0 M8725,272,RC,,,,,,,,both,,,495.5700,74.3400,SENTARA HEALTH,SENTARA HEALTH,127.91,,,,,,,127.9100,495.5700,percent of total billed charges,25.81% of $495.57 in Billed Charges for Rev 272 = $127.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 5.0 M8725,272,RC,,,,,,,,both,,,495.5700,74.3400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",495.57,,,,,,,127.9100,495.5700,percent of total billed charges,100% of $495.57 in Billed Charges for Rev 272 = $495.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 5.0 M8725,272,RC,,,,,,,,both,,,495.5700,74.3400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,247.79,,,,,,,127.9100,495.5700,percent of total billed charges,Rev 272 $495.57 in Billed Charges at 50% = $247.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 5.0 M8725,272,RC,,,,,,,,both,,,495.5700,74.3400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,160.07,,,,,,,127.9100,495.5700,other,32.3% of $495.57 in Billed Charges for Rev 272 = $160.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE PROLENE 5.0 M8725,272,RC,,,,,,,,both,,,495.5700,74.3400,UNITED HEALTHCARE,UHC HERITAGE SELECT,152.14,,,,,,,127.9100,495.5700,other,30.7% of $495.57 in Billed Charges for Rev 272 = $152.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE PROLENE 5.0 M8725,272,RC,,,,,,,,both,,,495.5700,74.3400,UNITED HEALTHCARE,UNITED HEALTHCARE,160.07,,,,,,,127.9100,495.5700,percent of total billed charges,32.3% of $495.57 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 5.0 M8725,272,RC,,,,,,,,both,,,495.5700,74.3400,WELLCARE,WELLCARE MEDICAID,495.57,,,,,,,127.9100,495.5700,percent of total billed charges,100% of $495.57 in Billed Charges for Rev 272 = $495.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 6-0 M8709,272,RC,27200002,CDM,,,,,,both,,,528.3900,79.2600,AETNA,AETNA,225.62,,,,,,,136.3800,528.3900,percent of total billed charges,42.7% of $528.39 in Billed Charges for Rev 272 = $225.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 6-0 M8709,272,RC,27200002,CDM,,,,,,both,,,528.3900,79.2600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,369.87,,,,,,,136.3800,528.3900,percent of total billed charges,Rev 272 $528.39 in Billed Charges at 70% = $369.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 6-0 M8709,272,RC,27200002,CDM,,,,,,both,,,528.3900,79.2600,CIGNA HEALTHCARE,CIGNA HMO,220.34,,,,,,,136.3800,528.3900,percent of total billed charges,41.7% of $528.39 in Billed Charges for Rev 272 = $220.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 6-0 M8709,272,RC,27200002,CDM,,,,,,both,,,528.3900,79.2600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,245.17,,,,,,,136.3800,528.3900,percent of total billed charges,46.4% of $528.39 in Billed Charges for Rev 272 = $245.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 6-0 M8709,272,RC,27200002,CDM,,,,,,both,,,528.3900,79.2600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,220.34,,,,,,,136.3800,528.3900,percent of total billed charges,41.7% of $528.39 in Billed Charges for Rev 272 = $220.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 6-0 M8709,272,RC,27200002,CDM,,,,,,both,,,528.3900,79.2600,CIGNA HEALTHCARE,CIGNA PPO,220.34,,,,,,,136.3800,528.3900,percent of total billed charges,41.7% of $528.39 in Billed Charges for Rev 272 = $220.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 6-0 M8709,272,RC,27200002,CDM,,,,,,both,,,528.3900,79.2600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,475.55,,,,,,,136.3800,528.3900,percent of total billed charges,90% of $528.39 in Billed Charges for Rev 272 = $475.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 6-0 M8709,272,RC,27200002,CDM,,,,,,both,,,528.3900,79.2600,MEDCOST,MEDCOST VHN,251.46,,,,,,,136.3800,528.3900,percent of total billed charges,47.59% of $528.39 in Billed Charges for Rev 272 = $251.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 6-0 M8709,272,RC,27200002,CDM,,,,,,both,,,528.3900,79.2600,SENTARA HEALTH,SENTARA HEALTH,136.38,,,,,,,136.3800,528.3900,percent of total billed charges,25.81% of $528.39 in Billed Charges for Rev 272 = $136.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 6-0 M8709,272,RC,27200002,CDM,,,,,,both,,,528.3900,79.2600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",528.39,,,,,,,136.3800,528.3900,percent of total billed charges,100% of $528.39 in Billed Charges for Rev 272 = $528.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 6-0 M8709,272,RC,27200002,CDM,,,,,,both,,,528.3900,79.2600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,264.20,,,,,,,136.3800,528.3900,percent of total billed charges,Rev 272 $528.39 in Billed Charges at 50% = $264.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 6-0 M8709,272,RC,27200002,CDM,,,,,,both,,,528.3900,79.2600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,170.67,,,,,,,136.3800,528.3900,other,32.3% of $528.39 in Billed Charges for Rev 272 = $170.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE PROLENE 6-0 M8709,272,RC,27200002,CDM,,,,,,both,,,528.3900,79.2600,UNITED HEALTHCARE,UHC HERITAGE SELECT,162.22,,,,,,,136.3800,528.3900,other,30.7% of $528.39 in Billed Charges for Rev 272 = $162.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE PROLENE 6-0 M8709,272,RC,27200002,CDM,,,,,,both,,,528.3900,79.2600,UNITED HEALTHCARE,UNITED HEALTHCARE,170.67,,,,,,,136.3800,528.3900,percent of total billed charges,32.3% of $528.39 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 6-0 M8709,272,RC,27200002,CDM,,,,,,both,,,528.3900,79.2600,WELLCARE,WELLCARE MEDICAID,528.39,,,,,,,136.3800,528.3900,percent of total billed charges,100% of $528.39 in Billed Charges for Rev 272 = $528.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 EPM8751,272,RC,,,,,,,,both,,,957.8700,143.6800,AETNA,AETNA,409.01,,,,,,,247.2300,957.8700,percent of total billed charges,42.7% of $957.87 in Billed Charges for Rev 272 = $409.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 EPM8751,272,RC,,,,,,,,both,,,957.8700,143.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,670.51,,,,,,,247.2300,957.8700,percent of total billed charges,Rev 272 $957.87 in Billed Charges at 70% = $670.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 EPM8751,272,RC,,,,,,,,both,,,957.8700,143.6800,CIGNA HEALTHCARE,CIGNA HMO,399.43,,,,,,,247.2300,957.8700,percent of total billed charges,41.7% of $957.87 in Billed Charges for Rev 272 = $399.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 EPM8751,272,RC,,,,,,,,both,,,957.8700,143.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,444.45,,,,,,,247.2300,957.8700,percent of total billed charges,46.4% of $957.87 in Billed Charges for Rev 272 = $444.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 EPM8751,272,RC,,,,,,,,both,,,957.8700,143.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,399.43,,,,,,,247.2300,957.8700,percent of total billed charges,41.7% of $957.87 in Billed Charges for Rev 272 = $399.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 EPM8751,272,RC,,,,,,,,both,,,957.8700,143.6800,CIGNA HEALTHCARE,CIGNA PPO,399.43,,,,,,,247.2300,957.8700,percent of total billed charges,41.7% of $957.87 in Billed Charges for Rev 272 = $399.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 EPM8751,272,RC,,,,,,,,both,,,957.8700,143.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,862.08,,,,,,,247.2300,957.8700,percent of total billed charges,90% of $957.87 in Billed Charges for Rev 272 = $862.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 EPM8751,272,RC,,,,,,,,both,,,957.8700,143.6800,MEDCOST,MEDCOST VHN,455.85,,,,,,,247.2300,957.8700,percent of total billed charges,47.59% of $957.87 in Billed Charges for Rev 272 = $455.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 EPM8751,272,RC,,,,,,,,both,,,957.8700,143.6800,SENTARA HEALTH,SENTARA HEALTH,247.23,,,,,,,247.2300,957.8700,percent of total billed charges,25.81% of $957.87 in Billed Charges for Rev 272 = $247.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 EPM8751,272,RC,,,,,,,,both,,,957.8700,143.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",957.87,,,,,,,247.2300,957.8700,percent of total billed charges,100% of $957.87 in Billed Charges for Rev 272 = $957.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 EPM8751,272,RC,,,,,,,,both,,,957.8700,143.6800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,478.94,,,,,,,247.2300,957.8700,percent of total billed charges,Rev 272 $957.87 in Billed Charges at 50% = $478.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 EPM8751,272,RC,,,,,,,,both,,,957.8700,143.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,309.39,,,,,,,247.2300,957.8700,other,32.3% of $957.87 in Billed Charges for Rev 272 = $309.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE PROLENE 7-0 EPM8751,272,RC,,,,,,,,both,,,957.8700,143.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,294.07,,,,,,,247.2300,957.8700,other,30.7% of $957.87 in Billed Charges for Rev 272 = $294.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE PROLENE 7-0 EPM8751,272,RC,,,,,,,,both,,,957.8700,143.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,309.39,,,,,,,247.2300,957.8700,percent of total billed charges,32.3% of $957.87 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 EPM8751,272,RC,,,,,,,,both,,,957.8700,143.6800,WELLCARE,WELLCARE MEDICAID,957.87,,,,,,,247.2300,957.8700,percent of total billed charges,100% of $957.87 in Billed Charges for Rev 272 = $957.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8703,272,RC,27200002,CDM,,,,,,both,,,547.4000,82.1100,AETNA,AETNA,233.74,,,,,,,141.2800,547.4000,percent of total billed charges,42.7% of $547.40 in Billed Charges for Rev 272 = $233.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8703,272,RC,27200002,CDM,,,,,,both,,,547.4000,82.1100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,383.18,,,,,,,141.2800,547.4000,percent of total billed charges,Rev 272 $547.40 in Billed Charges at 70% = $383.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8703,272,RC,27200002,CDM,,,,,,both,,,547.4000,82.1100,CIGNA HEALTHCARE,CIGNA HMO,228.27,,,,,,,141.2800,547.4000,percent of total billed charges,41.7% of $547.40 in Billed Charges for Rev 272 = $228.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8703,272,RC,27200002,CDM,,,,,,both,,,547.4000,82.1100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,253.99,,,,,,,141.2800,547.4000,percent of total billed charges,46.4% of $547.40 in Billed Charges for Rev 272 = $253.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8703,272,RC,27200002,CDM,,,,,,both,,,547.4000,82.1100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.27,,,,,,,141.2800,547.4000,percent of total billed charges,41.7% of $547.40 in Billed Charges for Rev 272 = $228.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8703,272,RC,27200002,CDM,,,,,,both,,,547.4000,82.1100,CIGNA HEALTHCARE,CIGNA PPO,228.27,,,,,,,141.2800,547.4000,percent of total billed charges,41.7% of $547.40 in Billed Charges for Rev 272 = $228.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8703,272,RC,27200002,CDM,,,,,,both,,,547.4000,82.1100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,492.66,,,,,,,141.2800,547.4000,percent of total billed charges,90% of $547.40 in Billed Charges for Rev 272 = $492.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8703,272,RC,27200002,CDM,,,,,,both,,,547.4000,82.1100,MEDCOST,MEDCOST VHN,260.51,,,,,,,141.2800,547.4000,percent of total billed charges,47.59% of $547.40 in Billed Charges for Rev 272 = $260.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8703,272,RC,27200002,CDM,,,,,,both,,,547.4000,82.1100,SENTARA HEALTH,SENTARA HEALTH,141.28,,,,,,,141.2800,547.4000,percent of total billed charges,25.81% of $547.40 in Billed Charges for Rev 272 = $141.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8703,272,RC,27200002,CDM,,,,,,both,,,547.4000,82.1100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",547.40,,,,,,,141.2800,547.4000,percent of total billed charges,100% of $547.40 in Billed Charges for Rev 272 = $547.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8703,272,RC,27200002,CDM,,,,,,both,,,547.4000,82.1100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,273.70,,,,,,,141.2800,547.4000,percent of total billed charges,Rev 272 $547.40 in Billed Charges at 50% = $273.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8703,272,RC,27200002,CDM,,,,,,both,,,547.4000,82.1100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,176.81,,,,,,,141.2800,547.4000,other,32.3% of $547.40 in Billed Charges for Rev 272 = $176.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE PROLENE 7-0 M8703,272,RC,27200002,CDM,,,,,,both,,,547.4000,82.1100,UNITED HEALTHCARE,UHC HERITAGE SELECT,168.05,,,,,,,141.2800,547.4000,other,30.7% of $547.40 in Billed Charges for Rev 272 = $168.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE PROLENE 7-0 M8703,272,RC,27200002,CDM,,,,,,both,,,547.4000,82.1100,UNITED HEALTHCARE,UNITED HEALTHCARE,176.81,,,,,,,141.2800,547.4000,percent of total billed charges,32.3% of $547.40 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8703,272,RC,27200002,CDM,,,,,,both,,,547.4000,82.1100,WELLCARE,WELLCARE MEDICAID,547.40,,,,,,,141.2800,547.4000,percent of total billed charges,100% of $547.40 in Billed Charges for Rev 272 = $547.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CEMENT BONE KYPHON,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2176.2500,326.4400,AETNA,AETNA,1044.60,,,,,,,561.6900,2176.2500,percent of total billed charges,"48% of $2,176.25 in Billed Charges for Rev 278 Proc C1713 = $1,044.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE KYPHON,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2176.2500,326.4400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1088.13,,,,,,,561.6900,2176.2500,percent of total billed charges,"50% of $2,176.25 in Billed Charges for Rev 278 Proc C1713 = $1,088.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE KYPHON,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2176.2500,326.4400,CIGNA HEALTHCARE,CIGNA HMO,907.50,,,,,,,561.6900,2176.2500,percent of total billed charges,"41.7% of $2,176.25 in Billed Charges for Rev 278 Proc C1713 = $907.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE KYPHON,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2176.2500,326.4400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,870.50,,,,,,,561.6900,2176.2500,percent of total billed charges,"40% of $2,176.25 in Billed Charges for Rev 278 Proc C1713 = $870.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE KYPHON,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2176.2500,326.4400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,907.50,,,,,,,561.6900,2176.2500,percent of total billed charges,"41.7% of $2,176.25 in Billed Charges for Rev 278 Proc C1713 = $907.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE KYPHON,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2176.2500,326.4400,CIGNA HEALTHCARE,CIGNA PPO,907.50,,,,,,,561.6900,2176.2500,percent of total billed charges,"41.7% of $2,176.25 in Billed Charges for Rev 278 Proc C1713 = $907.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE KYPHON,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2176.2500,326.4400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1958.63,,,,,,,561.6900,2176.2500,percent of total billed charges,"90% of $2,176.25 in Billed Charges for Rev 278 Proc C1713 = $1,958.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE KYPHON,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2176.2500,326.4400,MEDCOST,MEDCOST VHN,1035.68,,,,,,,561.6900,2176.2500,percent of total billed charges,"47.59% of $2,176.25 in Billed Charges for Rev 278 Proc C1713 = $1,035.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE KYPHON,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2176.2500,326.4400,SENTARA HEALTH,SENTARA HEALTH,561.69,,,,,,,561.6900,2176.2500,percent of total billed charges,"25.81% of $2,176.25 in Billed Charges for Rev 278 Proc C1713 = $561.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE KYPHON,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2176.2500,326.4400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2176.25,,,,,,,561.6900,2176.2500,percent of total billed charges,"100% of $2,176.25 in Billed Charges for Rev 278 Proc C1713 = $2,176.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CEMENT BONE KYPHON,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2176.2500,326.4400,WELLCARE,WELLCARE MEDICAID,2176.25,,,,,,,561.6900,2176.2500,percent of total billed charges,"100% of $2,176.25 in Billed Charges for Rev 278 Proc C1713 = $2,176.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,3785.4200,567.8100,AETNA,AETNA,1817.00,,,,,,,977.0200,3785.4200,percent of total billed charges,"48% of $3,785.42 in Billed Charges for Rev 278 Proc C1713 = $1,817.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,3785.4200,567.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1892.71,,,,,,,977.0200,3785.4200,percent of total billed charges,"50% of $3,785.42 in Billed Charges for Rev 278 Proc C1713 = $1,892.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,3785.4200,567.8100,CIGNA HEALTHCARE,CIGNA HMO,1578.52,,,,,,,977.0200,3785.4200,percent of total billed charges,"41.7% of $3,785.42 in Billed Charges for Rev 278 Proc C1713 = $1,578.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,3785.4200,567.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1514.17,,,,,,,977.0200,3785.4200,percent of total billed charges,"40% of $3,785.42 in Billed Charges for Rev 278 Proc C1713 = $1,514.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,3785.4200,567.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1578.52,,,,,,,977.0200,3785.4200,percent of total billed charges,"41.7% of $3,785.42 in Billed Charges for Rev 278 Proc C1713 = $1,578.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,3785.4200,567.8100,CIGNA HEALTHCARE,CIGNA PPO,1578.52,,,,,,,977.0200,3785.4200,percent of total billed charges,"41.7% of $3,785.42 in Billed Charges for Rev 278 Proc C1713 = $1,578.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,3785.4200,567.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3406.88,,,,,,,977.0200,3785.4200,percent of total billed charges,"90% of $3,785.42 in Billed Charges for Rev 278 Proc C1713 = $3,406.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,3785.4200,567.8100,MEDCOST,MEDCOST VHN,1801.48,,,,,,,977.0200,3785.4200,percent of total billed charges,"47.59% of $3,785.42 in Billed Charges for Rev 278 Proc C1713 = $1,801.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,3785.4200,567.8100,SENTARA HEALTH,SENTARA HEALTH,977.02,,,,,,,977.0200,3785.4200,percent of total billed charges,"25.81% of $3,785.42 in Billed Charges for Rev 278 Proc C1713 = $977.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,3785.4200,567.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3785.42,,,,,,,977.0200,3785.4200,percent of total billed charges,"100% of $3,785.42 in Billed Charges for Rev 278 Proc C1713 = $3,785.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,3785.4200,567.8100,WELLCARE,WELLCARE MEDICAID,3785.42,,,,,,,977.0200,3785.4200,percent of total billed charges,"100% of $3,785.42 in Billed Charges for Rev 278 Proc C1713 = $3,785.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,2945.3600,441.8000,AETNA,AETNA,1413.77,,,,,,,760.2000,2945.3600,percent of total billed charges,"48% of $2,945.36 in Billed Charges for Rev 278 Proc C1713 = $1,413.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,2945.3600,441.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1472.68,,,,,,,760.2000,2945.3600,percent of total billed charges,"50% of $2,945.36 in Billed Charges for Rev 278 Proc C1713 = $1,472.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,2945.3600,441.8000,CIGNA HEALTHCARE,CIGNA HMO,1228.22,,,,,,,760.2000,2945.3600,percent of total billed charges,"41.7% of $2,945.36 in Billed Charges for Rev 278 Proc C1713 = $1,228.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,2945.3600,441.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1178.14,,,,,,,760.2000,2945.3600,percent of total billed charges,"40% of $2,945.36 in Billed Charges for Rev 278 Proc C1713 = $1,178.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,2945.3600,441.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1228.22,,,,,,,760.2000,2945.3600,percent of total billed charges,"41.7% of $2,945.36 in Billed Charges for Rev 278 Proc C1713 = $1,228.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,2945.3600,441.8000,CIGNA HEALTHCARE,CIGNA PPO,1228.22,,,,,,,760.2000,2945.3600,percent of total billed charges,"41.7% of $2,945.36 in Billed Charges for Rev 278 Proc C1713 = $1,228.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,2945.3600,441.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2650.82,,,,,,,760.2000,2945.3600,percent of total billed charges,"90% of $2,945.36 in Billed Charges for Rev 278 Proc C1713 = $2,650.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,2945.3600,441.8000,MEDCOST,MEDCOST VHN,1401.70,,,,,,,760.2000,2945.3600,percent of total billed charges,"47.59% of $2,945.36 in Billed Charges for Rev 278 Proc C1713 = $1,401.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,2945.3600,441.8000,SENTARA HEALTH,SENTARA HEALTH,760.20,,,,,,,760.2000,2945.3600,percent of total billed charges,"25.81% of $2,945.36 in Billed Charges for Rev 278 Proc C1713 = $760.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,2945.3600,441.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2945.36,,,,,,,760.2000,2945.3600,percent of total billed charges,"100% of $2,945.36 in Billed Charges for Rev 278 Proc C1713 = $2,945.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,2945.3600,441.8000,WELLCARE,WELLCARE MEDICAID,2945.36,,,,,,,760.2000,2945.3600,percent of total billed charges,"100% of $2,945.36 in Billed Charges for Rev 278 Proc C1713 = $2,945.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 7-0 M8745,272,RC,27200002,CDM,,,,,,both,,,832.9200,124.9400,AETNA,AETNA,355.66,,,,,,,214.9800,832.9200,percent of total billed charges,42.7% of $832.92 in Billed Charges for Rev 272 = $355.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8745,272,RC,27200002,CDM,,,,,,both,,,832.9200,124.9400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,583.04,,,,,,,214.9800,832.9200,percent of total billed charges,Rev 272 $832.92 in Billed Charges at 70% = $583.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8745,272,RC,27200002,CDM,,,,,,both,,,832.9200,124.9400,CIGNA HEALTHCARE,CIGNA HMO,347.33,,,,,,,214.9800,832.9200,percent of total billed charges,41.7% of $832.92 in Billed Charges for Rev 272 = $347.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8745,272,RC,27200002,CDM,,,,,,both,,,832.9200,124.9400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,386.47,,,,,,,214.9800,832.9200,percent of total billed charges,46.4% of $832.92 in Billed Charges for Rev 272 = $386.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8745,272,RC,27200002,CDM,,,,,,both,,,832.9200,124.9400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,347.33,,,,,,,214.9800,832.9200,percent of total billed charges,41.7% of $832.92 in Billed Charges for Rev 272 = $347.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8745,272,RC,27200002,CDM,,,,,,both,,,832.9200,124.9400,CIGNA HEALTHCARE,CIGNA PPO,347.33,,,,,,,214.9800,832.9200,percent of total billed charges,41.7% of $832.92 in Billed Charges for Rev 272 = $347.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8745,272,RC,27200002,CDM,,,,,,both,,,832.9200,124.9400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,749.63,,,,,,,214.9800,832.9200,percent of total billed charges,90% of $832.92 in Billed Charges for Rev 272 = $749.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8745,272,RC,27200002,CDM,,,,,,both,,,832.9200,124.9400,MEDCOST,MEDCOST VHN,396.39,,,,,,,214.9800,832.9200,percent of total billed charges,47.59% of $832.92 in Billed Charges for Rev 272 = $396.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8745,272,RC,27200002,CDM,,,,,,both,,,832.9200,124.9400,SENTARA HEALTH,SENTARA HEALTH,214.98,,,,,,,214.9800,832.9200,percent of total billed charges,25.81% of $832.92 in Billed Charges for Rev 272 = $214.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8745,272,RC,27200002,CDM,,,,,,both,,,832.9200,124.9400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",832.92,,,,,,,214.9800,832.9200,percent of total billed charges,100% of $832.92 in Billed Charges for Rev 272 = $832.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8745,272,RC,27200002,CDM,,,,,,both,,,832.9200,124.9400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,416.46,,,,,,,214.9800,832.9200,percent of total billed charges,Rev 272 $832.92 in Billed Charges at 50% = $416.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8745,272,RC,27200002,CDM,,,,,,both,,,832.9200,124.9400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,269.03,,,,,,,214.9800,832.9200,other,32.3% of $832.92 in Billed Charges for Rev 272 = $269.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE PROLENE 7-0 M8745,272,RC,27200002,CDM,,,,,,both,,,832.9200,124.9400,UNITED HEALTHCARE,UHC HERITAGE SELECT,255.71,,,,,,,214.9800,832.9200,other,30.7% of $832.92 in Billed Charges for Rev 272 = $255.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE PROLENE 7-0 M8745,272,RC,27200002,CDM,,,,,,both,,,832.9200,124.9400,UNITED HEALTHCARE,UNITED HEALTHCARE,269.03,,,,,,,214.9800,832.9200,percent of total billed charges,32.3% of $832.92 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 M8745,272,RC,27200002,CDM,,,,,,both,,,832.9200,124.9400,WELLCARE,WELLCARE MEDICAID,832.92,,,,,,,214.9800,832.9200,percent of total billed charges,100% of $832.92 in Billed Charges for Rev 272 = $832.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
CONS S C BIL STENT 12X40X7,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,9256.1200,1388.4200,AETNA,AETNA,4442.94,,,,,,,2389.0000,9256.1200,percent of total billed charges,"48% of $9,256.12 in Billed Charges for Rev 278 Proc C1713 = $4,442.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONS S C BIL STENT 12X40X7,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,9256.1200,1388.4200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4628.06,,,,,,,2389.0000,9256.1200,percent of total billed charges,"50% of $9,256.12 in Billed Charges for Rev 278 Proc C1713 = $4,628.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONS S C BIL STENT 12X40X7,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,9256.1200,1388.4200,CIGNA HEALTHCARE,CIGNA HMO,3859.80,,,,,,,2389.0000,9256.1200,percent of total billed charges,"41.7% of $9,256.12 in Billed Charges for Rev 278 Proc C1713 = $3,859.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONS S C BIL STENT 12X40X7,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,9256.1200,1388.4200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3702.45,,,,,,,2389.0000,9256.1200,percent of total billed charges,"40% of $9,256.12 in Billed Charges for Rev 278 Proc C1713 = $3,702.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONS S C BIL STENT 12X40X7,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,9256.1200,1388.4200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3859.80,,,,,,,2389.0000,9256.1200,percent of total billed charges,"41.7% of $9,256.12 in Billed Charges for Rev 278 Proc C1713 = $3,859.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONS S C BIL STENT 12X40X7,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,9256.1200,1388.4200,CIGNA HEALTHCARE,CIGNA PPO,3859.80,,,,,,,2389.0000,9256.1200,percent of total billed charges,"41.7% of $9,256.12 in Billed Charges for Rev 278 Proc C1713 = $3,859.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONS S C BIL STENT 12X40X7,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,9256.1200,1388.4200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8330.51,,,,,,,2389.0000,9256.1200,percent of total billed charges,"90% of $9,256.12 in Billed Charges for Rev 278 Proc C1713 = $8,330.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONS S C BIL STENT 12X40X7,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,9256.1200,1388.4200,MEDCOST,MEDCOST VHN,4404.99,,,,,,,2389.0000,9256.1200,percent of total billed charges,"47.59% of $9,256.12 in Billed Charges for Rev 278 Proc C1713 = $4,404.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONS S C BIL STENT 12X40X7,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,9256.1200,1388.4200,SENTARA HEALTH,SENTARA HEALTH,2389.00,,,,,,,2389.0000,9256.1200,percent of total billed charges,"25.81% of $9,256.12 in Billed Charges for Rev 278 Proc C1713 = $2,389.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONS S C BIL STENT 12X40X7,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,9256.1200,1388.4200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9256.12,,,,,,,2389.0000,9256.1200,percent of total billed charges,"100% of $9,256.12 in Billed Charges for Rev 278 Proc C1713 = $9,256.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CONS S C BIL STENT 12X40X7,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,9256.1200,1388.4200,WELLCARE,WELLCARE MEDICAID,9256.12,,,,,,,2389.0000,9256.1200,percent of total billed charges,"100% of $9,256.12 in Billed Charges for Rev 278 Proc C1713 = $9,256.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,10371.0000,1555.6500,AETNA,AETNA,4978.08,,,,,,,2676.7600,10371.0000,percent of total billed charges,"48% of $10,371.00 in Billed Charges for Rev 278 Proc C1713 = $4,978.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,10371.0000,1555.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5185.50,,,,,,,2676.7600,10371.0000,percent of total billed charges,"50% of $10,371.00 in Billed Charges for Rev 278 Proc C1713 = $5,185.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,10371.0000,1555.6500,CIGNA HEALTHCARE,CIGNA HMO,4324.71,,,,,,,2676.7600,10371.0000,percent of total billed charges,"41.7% of $10,371.00 in Billed Charges for Rev 278 Proc C1713 = $4,324.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,10371.0000,1555.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4148.40,,,,,,,2676.7600,10371.0000,percent of total billed charges,"40% of $10,371.00 in Billed Charges for Rev 278 Proc C1713 = $4,148.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,10371.0000,1555.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4324.71,,,,,,,2676.7600,10371.0000,percent of total billed charges,"41.7% of $10,371.00 in Billed Charges for Rev 278 Proc C1713 = $4,324.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,10371.0000,1555.6500,CIGNA HEALTHCARE,CIGNA PPO,4324.71,,,,,,,2676.7600,10371.0000,percent of total billed charges,"41.7% of $10,371.00 in Billed Charges for Rev 278 Proc C1713 = $4,324.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,10371.0000,1555.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9333.90,,,,,,,2676.7600,10371.0000,percent of total billed charges,"90% of $10,371.00 in Billed Charges for Rev 278 Proc C1713 = $9,333.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,10371.0000,1555.6500,MEDCOST,MEDCOST VHN,4935.56,,,,,,,2676.7600,10371.0000,percent of total billed charges,"47.59% of $10,371.00 in Billed Charges for Rev 278 Proc C1713 = $4,935.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,10371.0000,1555.6500,SENTARA HEALTH,SENTARA HEALTH,2676.76,,,,,,,2676.7600,10371.0000,percent of total billed charges,"25.81% of $10,371.00 in Billed Charges for Rev 278 Proc C1713 = $2,676.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,10371.0000,1555.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10371.00,,,,,,,2676.7600,10371.0000,percent of total billed charges,"100% of $10,371.00 in Billed Charges for Rev 278 Proc C1713 = $10,371.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,10371.0000,1555.6500,WELLCARE,WELLCARE MEDICAID,10371.00,,,,,,,2676.7600,10371.0000,percent of total billed charges,"100% of $10,371.00 in Billed Charges for Rev 278 Proc C1713 = $10,371.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,4936.6000,740.4900,AETNA,AETNA,2369.57,,,,,,,1274.1400,4936.6000,percent of total billed charges,"48% of $4,936.60 in Billed Charges for Rev 278 Proc C1713 = $2,369.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,4936.6000,740.4900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2468.30,,,,,,,1274.1400,4936.6000,percent of total billed charges,"50% of $4,936.60 in Billed Charges for Rev 278 Proc C1713 = $2,468.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,4936.6000,740.4900,CIGNA HEALTHCARE,CIGNA HMO,2058.56,,,,,,,1274.1400,4936.6000,percent of total billed charges,"41.7% of $4,936.60 in Billed Charges for Rev 278 Proc C1713 = $2,058.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,4936.6000,740.4900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1974.64,,,,,,,1274.1400,4936.6000,percent of total billed charges,"40% of $4,936.60 in Billed Charges for Rev 278 Proc C1713 = $1,974.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,4936.6000,740.4900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2058.56,,,,,,,1274.1400,4936.6000,percent of total billed charges,"41.7% of $4,936.60 in Billed Charges for Rev 278 Proc C1713 = $2,058.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,4936.6000,740.4900,CIGNA HEALTHCARE,CIGNA PPO,2058.56,,,,,,,1274.1400,4936.6000,percent of total billed charges,"41.7% of $4,936.60 in Billed Charges for Rev 278 Proc C1713 = $2,058.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,4936.6000,740.4900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4442.94,,,,,,,1274.1400,4936.6000,percent of total billed charges,"90% of $4,936.60 in Billed Charges for Rev 278 Proc C1713 = $4,442.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,4936.6000,740.4900,MEDCOST,MEDCOST VHN,2349.33,,,,,,,1274.1400,4936.6000,percent of total billed charges,"47.59% of $4,936.60 in Billed Charges for Rev 278 Proc C1713 = $2,349.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,4936.6000,740.4900,SENTARA HEALTH,SENTARA HEALTH,1274.14,,,,,,,1274.1400,4936.6000,percent of total billed charges,"25.81% of $4,936.60 in Billed Charges for Rev 278 Proc C1713 = $1,274.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,4936.6000,740.4900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4936.60,,,,,,,1274.1400,4936.6000,percent of total billed charges,"100% of $4,936.60 in Billed Charges for Rev 278 Proc C1713 = $4,936.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,4936.6000,740.4900,WELLCARE,WELLCARE MEDICAID,4936.60,,,,,,,1274.1400,4936.6000,percent of total billed charges,"100% of $4,936.60 in Billed Charges for Rev 278 Proc C1713 = $4,936.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CORKSCREW BIO 5.5,C1713,HCPCS,278,RC,,,,,,both,,,4215.8100,632.3700,AETNA,AETNA,2023.59,,,,,,,1088.1000,4215.8100,percent of total billed charges,"48% of $4,215.81 in Billed Charges for Rev 278 Proc C1713 = $2,023.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CORKSCREW BIO 5.5,C1713,HCPCS,278,RC,,,,,,both,,,4215.8100,632.3700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2107.91,,,,,,,1088.1000,4215.8100,percent of total billed charges,"50% of $4,215.81 in Billed Charges for Rev 278 Proc C1713 = $2,107.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CORKSCREW BIO 5.5,C1713,HCPCS,278,RC,,,,,,both,,,4215.8100,632.3700,CIGNA HEALTHCARE,CIGNA HMO,1757.99,,,,,,,1088.1000,4215.8100,percent of total billed charges,"41.7% of $4,215.81 in Billed Charges for Rev 278 Proc C1713 = $1,757.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CORKSCREW BIO 5.5,C1713,HCPCS,278,RC,,,,,,both,,,4215.8100,632.3700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1686.32,,,,,,,1088.1000,4215.8100,percent of total billed charges,"40% of $4,215.81 in Billed Charges for Rev 278 Proc C1713 = $1,686.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CORKSCREW BIO 5.5,C1713,HCPCS,278,RC,,,,,,both,,,4215.8100,632.3700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1757.99,,,,,,,1088.1000,4215.8100,percent of total billed charges,"41.7% of $4,215.81 in Billed Charges for Rev 278 Proc C1713 = $1,757.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CORKSCREW BIO 5.5,C1713,HCPCS,278,RC,,,,,,both,,,4215.8100,632.3700,CIGNA HEALTHCARE,CIGNA PPO,1757.99,,,,,,,1088.1000,4215.8100,percent of total billed charges,"41.7% of $4,215.81 in Billed Charges for Rev 278 Proc C1713 = $1,757.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CORKSCREW BIO 5.5,C1713,HCPCS,278,RC,,,,,,both,,,4215.8100,632.3700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3794.23,,,,,,,1088.1000,4215.8100,percent of total billed charges,"90% of $4,215.81 in Billed Charges for Rev 278 Proc C1713 = $3,794.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CORKSCREW BIO 5.5,C1713,HCPCS,278,RC,,,,,,both,,,4215.8100,632.3700,MEDCOST,MEDCOST VHN,2006.30,,,,,,,1088.1000,4215.8100,percent of total billed charges,"47.59% of $4,215.81 in Billed Charges for Rev 278 Proc C1713 = $2,006.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CORKSCREW BIO 5.5,C1713,HCPCS,278,RC,,,,,,both,,,4215.8100,632.3700,SENTARA HEALTH,SENTARA HEALTH,1088.10,,,,,,,1088.1000,4215.8100,percent of total billed charges,"25.81% of $4,215.81 in Billed Charges for Rev 278 Proc C1713 = $1,088.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CORKSCREW BIO 5.5,C1713,HCPCS,278,RC,,,,,,both,,,4215.8100,632.3700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4215.81,,,,,,,1088.1000,4215.8100,percent of total billed charges,"100% of $4,215.81 in Billed Charges for Rev 278 Proc C1713 = $4,215.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CORKSCREW BIO 5.5,C1713,HCPCS,278,RC,,,,,,both,,,4215.8100,632.3700,WELLCARE,WELLCARE MEDICAID,4215.81,,,,,,,1088.1000,4215.8100,percent of total billed charges,"100% of $4,215.81 in Billed Charges for Rev 278 Proc C1713 = $4,215.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP OC 4.5MM,272,RC,27200002,CDM,,,,,,both,,,1524.5400,228.6800,AETNA,AETNA,650.98,,,,,,,393.4800,1524.5400,percent of total billed charges,"42.7% of $1,524.54 in Billed Charges for Rev 272 = $650.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP OC 4.5MM,272,RC,27200002,CDM,,,,,,both,,,1524.5400,228.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1067.18,,,,,,,393.4800,1524.5400,percent of total billed charges,"Rev 272 $1,524.54 in Billed Charges at 70% = $1,067.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP OC 4.5MM,272,RC,27200002,CDM,,,,,,both,,,1524.5400,228.6800,CIGNA HEALTHCARE,CIGNA HMO,635.73,,,,,,,393.4800,1524.5400,percent of total billed charges,"41.7% of $1,524.54 in Billed Charges for Rev 272 = $635.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP OC 4.5MM,272,RC,27200002,CDM,,,,,,both,,,1524.5400,228.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,707.39,,,,,,,393.4800,1524.5400,percent of total billed charges,"46.4% of $1,524.54 in Billed Charges for Rev 272 = $707.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP OC 4.5MM,272,RC,27200002,CDM,,,,,,both,,,1524.5400,228.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,635.73,,,,,,,393.4800,1524.5400,percent of total billed charges,"41.7% of $1,524.54 in Billed Charges for Rev 272 = $635.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP OC 4.5MM,272,RC,27200002,CDM,,,,,,both,,,1524.5400,228.6800,CIGNA HEALTHCARE,CIGNA PPO,635.73,,,,,,,393.4800,1524.5400,percent of total billed charges,"41.7% of $1,524.54 in Billed Charges for Rev 272 = $635.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP OC 4.5MM,272,RC,27200002,CDM,,,,,,both,,,1524.5400,228.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1372.09,,,,,,,393.4800,1524.5400,percent of total billed charges,"90% of $1,524.54 in Billed Charges for Rev 272 = $1,372.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP OC 4.5MM,272,RC,27200002,CDM,,,,,,both,,,1524.5400,228.6800,MEDCOST,MEDCOST VHN,725.53,,,,,,,393.4800,1524.5400,percent of total billed charges,"47.59% of $1,524.54 in Billed Charges for Rev 272 = $725.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP OC 4.5MM,272,RC,27200002,CDM,,,,,,both,,,1524.5400,228.6800,SENTARA HEALTH,SENTARA HEALTH,393.48,,,,,,,393.4800,1524.5400,percent of total billed charges,"25.81% of $1,524.54 in Billed Charges for Rev 272 = $393.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP OC 4.5MM,272,RC,27200002,CDM,,,,,,both,,,1524.5400,228.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1524.54,,,,,,,393.4800,1524.5400,percent of total billed charges,"100% of $1,524.54 in Billed Charges for Rev 272 = $1,524.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP OC 4.5MM,272,RC,27200002,CDM,,,,,,both,,,1524.5400,228.6800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,762.27,,,,,,,393.4800,1524.5400,percent of total billed charges,"Rev 272 $1,524.54 in Billed Charges at 50% = $762.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP OC 4.5MM,272,RC,27200002,CDM,,,,,,both,,,1524.5400,228.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,492.43,,,,,,,393.4800,1524.5400,other,"32.3% of $1,524.54 in Billed Charges for Rev 272 = $492.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TAP OC 4.5MM,272,RC,27200002,CDM,,,,,,both,,,1524.5400,228.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,468.03,,,,,,,393.4800,1524.5400,other,"30.7% of $1,524.54 in Billed Charges for Rev 272 = $468.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TAP OC 4.5MM,272,RC,27200002,CDM,,,,,,both,,,1524.5400,228.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,492.43,,,,,,,393.4800,1524.5400,percent of total billed charges,"32.3% of $1,524.54 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP OC 4.5MM,272,RC,27200002,CDM,,,,,,both,,,1524.5400,228.6800,WELLCARE,WELLCARE MEDICAID,1524.54,,,,,,,393.4800,1524.5400,percent of total billed charges,"100% of $1,524.54 in Billed Charges for Rev 272 = $1,524.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CORKSCREW TIGERTAIL AR-1920BX,C1713,HCPCS,278,RC,,,,,,both,,,2903.8800,435.5800,AETNA,AETNA,1393.86,,,,,,,749.4900,2903.8800,percent of total billed charges,"48% of $2,903.88 in Billed Charges for Rev 278 Proc C1713 = $1,393.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CORKSCREW TIGERTAIL AR-1920BX,C1713,HCPCS,278,RC,,,,,,both,,,2903.8800,435.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1451.94,,,,,,,749.4900,2903.8800,percent of total billed charges,"50% of $2,903.88 in Billed Charges for Rev 278 Proc C1713 = $1,451.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CORKSCREW TIGERTAIL AR-1920BX,C1713,HCPCS,278,RC,,,,,,both,,,2903.8800,435.5800,CIGNA HEALTHCARE,CIGNA HMO,1210.92,,,,,,,749.4900,2903.8800,percent of total billed charges,"41.7% of $2,903.88 in Billed Charges for Rev 278 Proc C1713 = $1,210.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CORKSCREW TIGERTAIL AR-1920BX,C1713,HCPCS,278,RC,,,,,,both,,,2903.8800,435.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1161.55,,,,,,,749.4900,2903.8800,percent of total billed charges,"40% of $2,903.88 in Billed Charges for Rev 278 Proc C1713 = $1,161.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CORKSCREW TIGERTAIL AR-1920BX,C1713,HCPCS,278,RC,,,,,,both,,,2903.8800,435.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1210.92,,,,,,,749.4900,2903.8800,percent of total billed charges,"41.7% of $2,903.88 in Billed Charges for Rev 278 Proc C1713 = $1,210.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CORKSCREW TIGERTAIL AR-1920BX,C1713,HCPCS,278,RC,,,,,,both,,,2903.8800,435.5800,CIGNA HEALTHCARE,CIGNA PPO,1210.92,,,,,,,749.4900,2903.8800,percent of total billed charges,"41.7% of $2,903.88 in Billed Charges for Rev 278 Proc C1713 = $1,210.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CORKSCREW TIGERTAIL AR-1920BX,C1713,HCPCS,278,RC,,,,,,both,,,2903.8800,435.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2613.49,,,,,,,749.4900,2903.8800,percent of total billed charges,"90% of $2,903.88 in Billed Charges for Rev 278 Proc C1713 = $2,613.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CORKSCREW TIGERTAIL AR-1920BX,C1713,HCPCS,278,RC,,,,,,both,,,2903.8800,435.5800,MEDCOST,MEDCOST VHN,1381.96,,,,,,,749.4900,2903.8800,percent of total billed charges,"47.59% of $2,903.88 in Billed Charges for Rev 278 Proc C1713 = $1,381.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CORKSCREW TIGERTAIL AR-1920BX,C1713,HCPCS,278,RC,,,,,,both,,,2903.8800,435.5800,SENTARA HEALTH,SENTARA HEALTH,749.49,,,,,,,749.4900,2903.8800,percent of total billed charges,"25.81% of $2,903.88 in Billed Charges for Rev 278 Proc C1713 = $749.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CORKSCREW TIGERTAIL AR-1920BX,C1713,HCPCS,278,RC,,,,,,both,,,2903.8800,435.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2903.88,,,,,,,749.4900,2903.8800,percent of total billed charges,"100% of $2,903.88 in Billed Charges for Rev 278 Proc C1713 = $2,903.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CORKSCREW TIGERTAIL AR-1920BX,C1713,HCPCS,278,RC,,,,,,both,,,2903.8800,435.5800,WELLCARE,WELLCARE MEDICAID,2903.88,,,,,,,749.4900,2903.8800,percent of total billed charges,"100% of $2,903.88 in Billed Charges for Rev 278 Proc C1713 = $2,903.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2810.5400,421.5800,AETNA,AETNA,1349.06,,,,,,,725.4000,2810.5400,percent of total billed charges,"48% of $2,810.54 in Billed Charges for Rev 278 Proc C1713 = $1,349.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2810.5400,421.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1405.27,,,,,,,725.4000,2810.5400,percent of total billed charges,"50% of $2,810.54 in Billed Charges for Rev 278 Proc C1713 = $1,405.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2810.5400,421.5800,CIGNA HEALTHCARE,CIGNA HMO,1172.00,,,,,,,725.4000,2810.5400,percent of total billed charges,"41.7% of $2,810.54 in Billed Charges for Rev 278 Proc C1713 = $1,172.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2810.5400,421.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1124.22,,,,,,,725.4000,2810.5400,percent of total billed charges,"40% of $2,810.54 in Billed Charges for Rev 278 Proc C1713 = $1,124.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2810.5400,421.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1172.00,,,,,,,725.4000,2810.5400,percent of total billed charges,"41.7% of $2,810.54 in Billed Charges for Rev 278 Proc C1713 = $1,172.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2810.5400,421.5800,CIGNA HEALTHCARE,CIGNA PPO,1172.00,,,,,,,725.4000,2810.5400,percent of total billed charges,"41.7% of $2,810.54 in Billed Charges for Rev 278 Proc C1713 = $1,172.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2810.5400,421.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2529.49,,,,,,,725.4000,2810.5400,percent of total billed charges,"90% of $2,810.54 in Billed Charges for Rev 278 Proc C1713 = $2,529.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2810.5400,421.5800,MEDCOST,MEDCOST VHN,1337.54,,,,,,,725.4000,2810.5400,percent of total billed charges,"47.59% of $2,810.54 in Billed Charges for Rev 278 Proc C1713 = $1,337.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2810.5400,421.5800,SENTARA HEALTH,SENTARA HEALTH,725.40,,,,,,,725.4000,2810.5400,percent of total billed charges,"25.81% of $2,810.54 in Billed Charges for Rev 278 Proc C1713 = $725.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2810.5400,421.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2810.54,,,,,,,725.4000,2810.5400,percent of total billed charges,"100% of $2,810.54 in Billed Charges for Rev 278 Proc C1713 = $2,810.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,2810.5400,421.5800,WELLCARE,WELLCARE MEDICAID,2810.54,,,,,,,725.4000,2810.5400,percent of total billed charges,"100% of $2,810.54 in Billed Charges for Rev 278 Proc C1713 = $2,810.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL IMPLANT IPS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,133464.4000,20019.6600,AETNA,AETNA,64062.91,,,,,,,9475.9700,133464.4000,percent of total billed charges,"48% of $133,464.40 in Billed Charges for Rev 278 Proc C1713 = $64,062.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL IMPLANT IPS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,133464.4000,20019.6600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,66732.20,,,,,,,9475.9700,133464.4000,percent of total billed charges,"50% of $133,464.40 in Billed Charges for Rev 278 Proc C1713 = $66,732.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL IMPLANT IPS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,133464.4000,20019.6600,CIGNA HEALTHCARE,CIGNA HMO,55654.65,,,,,,,9475.9700,133464.4000,percent of total billed charges,"41.7% of $133,464.40 in Billed Charges for Rev 278 Proc C1713 = $55,654.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL IMPLANT IPS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,133464.4000,20019.6600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,53385.76,,,,,,,9475.9700,133464.4000,percent of total billed charges,"40% of $133,464.40 in Billed Charges for Rev 278 Proc C1713 = $53,385.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL IMPLANT IPS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,133464.4000,20019.6600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,55654.65,,,,,,,9475.9700,133464.4000,percent of total billed charges,"41.7% of $133,464.40 in Billed Charges for Rev 278 Proc C1713 = $55,654.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL IMPLANT IPS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,133464.4000,20019.6600,CIGNA HEALTHCARE,CIGNA PPO,55654.65,,,,,,,9475.9700,133464.4000,percent of total billed charges,"41.7% of $133,464.40 in Billed Charges for Rev 278 Proc C1713 = $55,654.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL IMPLANT IPS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,133464.4000,20019.6600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,120117.96,,,,,,,9475.9700,133464.4000,percent of total billed charges,"90% of $133,464.40 in Billed Charges for Rev 278 Proc C1713 = $120,117.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL IMPLANT IPS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,133464.4000,20019.6600,MEDCOST,MEDCOST VHN,63515.71,,,,,,,9475.9700,133464.4000,percent of total billed charges,"47.59% of $133,464.40 in Billed Charges for Rev 278 Proc C1713 = $63,515.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL IMPLANT IPS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,133464.4000,20019.6600,SENTARA HEALTH,SENTARA HEALTH,34447.16,,,,,,,9475.9700,133464.4000,percent of total billed charges,"25.81% of $133,464.40 in Billed Charges for Rev 278 Proc C1713 = $34,447.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL IMPLANT IPS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,133464.4000,20019.6600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",133464.40,,,,,,,9475.9700,133464.4000,percent of total billed charges,"100% of $133,464.40 in Billed Charges for Rev 278 Proc C1713 = $133,464.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL IMPLANT IPS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,133464.4000,20019.6600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,10009.83,,,,,,,9475.9700,133464.4000,percent of total billed charges,"7.5% of $133,464.40 in Billed Charges for Rev 278 Proc C1713 = $10,009.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL IMPLANT IPS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,133464.4000,20019.6600,UNITED HEALTHCARE,UHC HERITAGE SELECT,9475.97,,,,,,,9475.9700,133464.4000,percent of total billed charges,"7.1% of $133,464.40 in Billed Charges for Rev 278 Proc C1713 = $9,475.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL IMPLANT IPS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,133464.4000,20019.6600,UNITED HEALTHCARE,UNITED HEALTHCARE,9475.97,,,,,,,9475.9700,133464.4000,percent of total billed charges,"7.1% of $133,464.40 in Billed Charges for Rev 278 Proc C1713 = $9,475.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
CRANIAL IMPLANT IPS,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,133464.4000,20019.6600,WELLCARE,WELLCARE MEDICAID,133464.40,,,,,,,9475.9700,133464.4000,percent of total billed charges,"100% of $133,464.40 in Billed Charges for Rev 278 Proc C1713 = $133,464.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800821,CDM,,,,both,,,37335.6000,5600.3400,AETNA,AETNA,17921.09,,,,,,,2650.8300,37335.6000,percent of total billed charges,"48% of $37,335.60 in Billed Charges for Rev 278 Proc C1713 = $17,921.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800821,CDM,,,,both,,,37335.6000,5600.3400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,18667.80,,,,,,,2650.8300,37335.6000,percent of total billed charges,"50% of $37,335.60 in Billed Charges for Rev 278 Proc C1713 = $18,667.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800821,CDM,,,,both,,,37335.6000,5600.3400,CIGNA HEALTHCARE,CIGNA HMO,15568.95,,,,,,,2650.8300,37335.6000,percent of total billed charges,"41.7% of $37,335.60 in Billed Charges for Rev 278 Proc C1713 = $15,568.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800821,CDM,,,,both,,,37335.6000,5600.3400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,14934.24,,,,,,,2650.8300,37335.6000,percent of total billed charges,"40% of $37,335.60 in Billed Charges for Rev 278 Proc C1713 = $14,934.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800821,CDM,,,,both,,,37335.6000,5600.3400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,15568.95,,,,,,,2650.8300,37335.6000,percent of total billed charges,"41.7% of $37,335.60 in Billed Charges for Rev 278 Proc C1713 = $15,568.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800821,CDM,,,,both,,,37335.6000,5600.3400,CIGNA HEALTHCARE,CIGNA PPO,15568.95,,,,,,,2650.8300,37335.6000,percent of total billed charges,"41.7% of $37,335.60 in Billed Charges for Rev 278 Proc C1713 = $15,568.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800821,CDM,,,,both,,,37335.6000,5600.3400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,33602.04,,,,,,,2650.8300,37335.6000,percent of total billed charges,"90% of $37,335.60 in Billed Charges for Rev 278 Proc C1713 = $33,602.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800821,CDM,,,,both,,,37335.6000,5600.3400,MEDCOST,MEDCOST VHN,17768.01,,,,,,,2650.8300,37335.6000,percent of total billed charges,"47.59% of $37,335.60 in Billed Charges for Rev 278 Proc C1713 = $17,768.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800821,CDM,,,,both,,,37335.6000,5600.3400,SENTARA HEALTH,SENTARA HEALTH,9636.32,,,,,,,2650.8300,37335.6000,percent of total billed charges,"25.81% of $37,335.60 in Billed Charges for Rev 278 Proc C1713 = $9,636.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800821,CDM,,,,both,,,37335.6000,5600.3400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",37335.60,,,,,,,2650.8300,37335.6000,percent of total billed charges,"100% of $37,335.60 in Billed Charges for Rev 278 Proc C1713 = $37,335.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800821,CDM,,,,both,,,37335.6000,5600.3400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2800.17,,,,,,,2650.8300,37335.6000,percent of total billed charges,"7.5% of $37,335.60 in Billed Charges for Rev 278 Proc C1713 = $2,800.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800821,CDM,,,,both,,,37335.6000,5600.3400,UNITED HEALTHCARE,UHC HERITAGE SELECT,2650.83,,,,,,,2650.8300,37335.6000,percent of total billed charges,"7.1% of $37,335.60 in Billed Charges for Rev 278 Proc C1713 = $2,650.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800821,CDM,,,,both,,,37335.6000,5600.3400,UNITED HEALTHCARE,UNITED HEALTHCARE,2650.83,,,,,,,2650.8300,37335.6000,percent of total billed charges,"7.1% of $37,335.60 in Billed Charges for Rev 278 Proc C1713 = $2,650.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,27800821,CDM,,,,both,,,37335.6000,5600.3400,WELLCARE,WELLCARE MEDICAID,37335.60,,,,,,,2650.8300,37335.6000,percent of total billed charges,"100% of $37,335.60 in Billed Charges for Rev 278 Proc C1713 = $37,335.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 10CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20723.3300,3108.5000,AETNA,AETNA,9947.20,,,,,,,1471.3600,20723.3300,percent of total billed charges,"48% of $20,723.33 in Billed Charges for Rev 278 Proc C1713 = $9,947.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 10CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20723.3300,3108.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,10361.67,,,,,,,1471.3600,20723.3300,percent of total billed charges,"50% of $20,723.33 in Billed Charges for Rev 278 Proc C1713 = $10,361.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 10CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20723.3300,3108.5000,CIGNA HEALTHCARE,CIGNA HMO,8641.63,,,,,,,1471.3600,20723.3300,percent of total billed charges,"41.7% of $20,723.33 in Billed Charges for Rev 278 Proc C1713 = $8,641.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 10CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20723.3300,3108.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8289.33,,,,,,,1471.3600,20723.3300,percent of total billed charges,"40% of $20,723.33 in Billed Charges for Rev 278 Proc C1713 = $8,289.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 10CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20723.3300,3108.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8641.63,,,,,,,1471.3600,20723.3300,percent of total billed charges,"41.7% of $20,723.33 in Billed Charges for Rev 278 Proc C1713 = $8,641.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 10CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20723.3300,3108.5000,CIGNA HEALTHCARE,CIGNA PPO,8641.63,,,,,,,1471.3600,20723.3300,percent of total billed charges,"41.7% of $20,723.33 in Billed Charges for Rev 278 Proc C1713 = $8,641.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 10CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20723.3300,3108.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,18651.00,,,,,,,1471.3600,20723.3300,percent of total billed charges,"90% of $20,723.33 in Billed Charges for Rev 278 Proc C1713 = $18,651.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 10CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20723.3300,3108.5000,MEDCOST,MEDCOST VHN,9862.23,,,,,,,1471.3600,20723.3300,percent of total billed charges,"47.59% of $20,723.33 in Billed Charges for Rev 278 Proc C1713 = $9,862.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 10CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20723.3300,3108.5000,SENTARA HEALTH,SENTARA HEALTH,5348.69,,,,,,,1471.3600,20723.3300,percent of total billed charges,"25.81% of $20,723.33 in Billed Charges for Rev 278 Proc C1713 = $5,348.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 10CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20723.3300,3108.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",20723.33,,,,,,,1471.3600,20723.3300,percent of total billed charges,"100% of $20,723.33 in Billed Charges for Rev 278 Proc C1713 = $20,723.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 10CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20723.3300,3108.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1554.25,,,,,,,1471.3600,20723.3300,percent of total billed charges,"7.5% of $20,723.33 in Billed Charges for Rev 278 Proc C1713 = $1,554.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 10CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20723.3300,3108.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1471.36,,,,,,,1471.3600,20723.3300,percent of total billed charges,"7.1% of $20,723.33 in Billed Charges for Rev 278 Proc C1713 = $1,471.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 10CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20723.3300,3108.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,1471.36,,,,,,,1471.3600,20723.3300,percent of total billed charges,"7.1% of $20,723.33 in Billed Charges for Rev 278 Proc C1713 = $1,471.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 10CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,20723.3300,3108.5000,WELLCARE,WELLCARE MEDICAID,20723.33,,,,,,,1471.3600,20723.3300,percent of total billed charges,"100% of $20,723.33 in Billed Charges for Rev 278 Proc C1713 = $20,723.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 20CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,44533.8000,6680.0700,AETNA,AETNA,21376.22,,,,,,,3161.9000,44533.8000,percent of total billed charges,"48% of $44,533.80 in Billed Charges for Rev 278 Proc C1713 = $21,376.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 20CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,44533.8000,6680.0700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,22266.90,,,,,,,3161.9000,44533.8000,percent of total billed charges,"50% of $44,533.80 in Billed Charges for Rev 278 Proc C1713 = $22,266.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 20CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,44533.8000,6680.0700,CIGNA HEALTHCARE,CIGNA HMO,18570.59,,,,,,,3161.9000,44533.8000,percent of total billed charges,"41.7% of $44,533.80 in Billed Charges for Rev 278 Proc C1713 = $18,570.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 20CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,44533.8000,6680.0700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,17813.52,,,,,,,3161.9000,44533.8000,percent of total billed charges,"40% of $44,533.80 in Billed Charges for Rev 278 Proc C1713 = $17,813.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 20CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,44533.8000,6680.0700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,18570.59,,,,,,,3161.9000,44533.8000,percent of total billed charges,"41.7% of $44,533.80 in Billed Charges for Rev 278 Proc C1713 = $18,570.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 20CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,44533.8000,6680.0700,CIGNA HEALTHCARE,CIGNA PPO,18570.59,,,,,,,3161.9000,44533.8000,percent of total billed charges,"41.7% of $44,533.80 in Billed Charges for Rev 278 Proc C1713 = $18,570.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 20CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,44533.8000,6680.0700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,40080.42,,,,,,,3161.9000,44533.8000,percent of total billed charges,"90% of $44,533.80 in Billed Charges for Rev 278 Proc C1713 = $40,080.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 20CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,44533.8000,6680.0700,MEDCOST,MEDCOST VHN,21193.64,,,,,,,3161.9000,44533.8000,percent of total billed charges,"47.59% of $44,533.80 in Billed Charges for Rev 278 Proc C1713 = $21,193.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 20CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,44533.8000,6680.0700,SENTARA HEALTH,SENTARA HEALTH,11494.17,,,,,,,3161.9000,44533.8000,percent of total billed charges,"25.81% of $44,533.80 in Billed Charges for Rev 278 Proc C1713 = $11,494.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 20CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,44533.8000,6680.0700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",44533.80,,,,,,,3161.9000,44533.8000,percent of total billed charges,"100% of $44,533.80 in Billed Charges for Rev 278 Proc C1713 = $44,533.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 20CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,44533.8000,6680.0700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3340.04,,,,,,,3161.9000,44533.8000,percent of total billed charges,"7.5% of $44,533.80 in Billed Charges for Rev 278 Proc C1713 = $3,340.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 20CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,44533.8000,6680.0700,UNITED HEALTHCARE,UHC HERITAGE SELECT,3161.90,,,,,,,3161.9000,44533.8000,percent of total billed charges,"7.1% of $44,533.80 in Billed Charges for Rev 278 Proc C1713 = $3,161.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 20CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,44533.8000,6680.0700,UNITED HEALTHCARE,UNITED HEALTHCARE,3161.90,,,,,,,3161.9000,44533.8000,percent of total billed charges,"7.1% of $44,533.80 in Billed Charges for Rev 278 Proc C1713 = $3,161.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT BONE SIGNAFUSE 20CC,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,44533.8000,6680.0700,WELLCARE,WELLCARE MEDICAID,44533.80,,,,,,,3161.9000,44533.8000,percent of total billed charges,"100% of $44,533.80 in Billed Charges for Rev 278 Proc C1713 = $44,533.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR VERSASTEP NB 12MM,272,RC,27200002,CDM,,,,,,both,,,1568.9600,235.3400,AETNA,AETNA,669.95,,,,,,,404.9500,1568.9600,percent of total billed charges,"42.7% of $1,568.96 in Billed Charges for Rev 272 = $669.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR VERSASTEP NB 12MM,272,RC,27200002,CDM,,,,,,both,,,1568.9600,235.3400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1098.27,,,,,,,404.9500,1568.9600,percent of total billed charges,"Rev 272 $1,568.96 in Billed Charges at 70% = $1,098.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR VERSASTEP NB 12MM,272,RC,27200002,CDM,,,,,,both,,,1568.9600,235.3400,CIGNA HEALTHCARE,CIGNA HMO,654.26,,,,,,,404.9500,1568.9600,percent of total billed charges,"41.7% of $1,568.96 in Billed Charges for Rev 272 = $654.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR VERSASTEP NB 12MM,272,RC,27200002,CDM,,,,,,both,,,1568.9600,235.3400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,728.00,,,,,,,404.9500,1568.9600,percent of total billed charges,"46.4% of $1,568.96 in Billed Charges for Rev 272 = $728.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR VERSASTEP NB 12MM,272,RC,27200002,CDM,,,,,,both,,,1568.9600,235.3400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,654.26,,,,,,,404.9500,1568.9600,percent of total billed charges,"41.7% of $1,568.96 in Billed Charges for Rev 272 = $654.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR VERSASTEP NB 12MM,272,RC,27200002,CDM,,,,,,both,,,1568.9600,235.3400,CIGNA HEALTHCARE,CIGNA PPO,654.26,,,,,,,404.9500,1568.9600,percent of total billed charges,"41.7% of $1,568.96 in Billed Charges for Rev 272 = $654.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR VERSASTEP NB 12MM,272,RC,27200002,CDM,,,,,,both,,,1568.9600,235.3400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1412.06,,,,,,,404.9500,1568.9600,percent of total billed charges,"90% of $1,568.96 in Billed Charges for Rev 272 = $1,412.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR VERSASTEP NB 12MM,272,RC,27200002,CDM,,,,,,both,,,1568.9600,235.3400,MEDCOST,MEDCOST VHN,746.67,,,,,,,404.9500,1568.9600,percent of total billed charges,"47.59% of $1,568.96 in Billed Charges for Rev 272 = $746.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR VERSASTEP NB 12MM,272,RC,27200002,CDM,,,,,,both,,,1568.9600,235.3400,SENTARA HEALTH,SENTARA HEALTH,404.95,,,,,,,404.9500,1568.9600,percent of total billed charges,"25.81% of $1,568.96 in Billed Charges for Rev 272 = $404.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR VERSASTEP NB 12MM,272,RC,27200002,CDM,,,,,,both,,,1568.9600,235.3400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1568.96,,,,,,,404.9500,1568.9600,percent of total billed charges,"100% of $1,568.96 in Billed Charges for Rev 272 = $1,568.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR VERSASTEP NB 12MM,272,RC,27200002,CDM,,,,,,both,,,1568.9600,235.3400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,784.48,,,,,,,404.9500,1568.9600,percent of total billed charges,"Rev 272 $1,568.96 in Billed Charges at 50% = $784.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR VERSASTEP NB 12MM,272,RC,27200002,CDM,,,,,,both,,,1568.9600,235.3400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,506.77,,,,,,,404.9500,1568.9600,other,"32.3% of $1,568.96 in Billed Charges for Rev 272 = $506.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TROCAR VERSASTEP NB 12MM,272,RC,27200002,CDM,,,,,,both,,,1568.9600,235.3400,UNITED HEALTHCARE,UHC HERITAGE SELECT,481.67,,,,,,,404.9500,1568.9600,other,"30.7% of $1,568.96 in Billed Charges for Rev 272 = $481.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TROCAR VERSASTEP NB 12MM,272,RC,27200002,CDM,,,,,,both,,,1568.9600,235.3400,UNITED HEALTHCARE,UNITED HEALTHCARE,506.77,,,,,,,404.9500,1568.9600,percent of total billed charges,"32.3% of $1,568.96 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR VERSASTEP NB 12MM,272,RC,27200002,CDM,,,,,,both,,,1568.9600,235.3400,WELLCARE,WELLCARE MEDICAID,1568.96,,,,,,,404.9500,1568.9600,percent of total billed charges,"100% of $1,568.96 in Billed Charges for Rev 272 = $1,568.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT OSTEOAMP FLOWABLE 2.5C,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,12183.7500,1827.5600,AETNA,AETNA,5848.20,,,,,,,3144.6300,12183.7500,percent of total billed charges,"48% of $12,183.75 in Billed Charges for Rev 278 Proc C1713 = $5,848.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT OSTEOAMP FLOWABLE 2.5C,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,12183.7500,1827.5600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6091.88,,,,,,,3144.6300,12183.7500,percent of total billed charges,"50% of $12,183.75 in Billed Charges for Rev 278 Proc C1713 = $6,091.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT OSTEOAMP FLOWABLE 2.5C,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,12183.7500,1827.5600,CIGNA HEALTHCARE,CIGNA HMO,5080.62,,,,,,,3144.6300,12183.7500,percent of total billed charges,"41.7% of $12,183.75 in Billed Charges for Rev 278 Proc C1713 = $5,080.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT OSTEOAMP FLOWABLE 2.5C,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,12183.7500,1827.5600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4873.50,,,,,,,3144.6300,12183.7500,percent of total billed charges,"40% of $12,183.75 in Billed Charges for Rev 278 Proc C1713 = $4,873.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT OSTEOAMP FLOWABLE 2.5C,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,12183.7500,1827.5600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5080.62,,,,,,,3144.6300,12183.7500,percent of total billed charges,"41.7% of $12,183.75 in Billed Charges for Rev 278 Proc C1713 = $5,080.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT OSTEOAMP FLOWABLE 2.5C,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,12183.7500,1827.5600,CIGNA HEALTHCARE,CIGNA PPO,5080.62,,,,,,,3144.6300,12183.7500,percent of total billed charges,"41.7% of $12,183.75 in Billed Charges for Rev 278 Proc C1713 = $5,080.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT OSTEOAMP FLOWABLE 2.5C,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,12183.7500,1827.5600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10965.38,,,,,,,3144.6300,12183.7500,percent of total billed charges,"90% of $12,183.75 in Billed Charges for Rev 278 Proc C1713 = $10,965.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT OSTEOAMP FLOWABLE 2.5C,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,12183.7500,1827.5600,MEDCOST,MEDCOST VHN,5798.25,,,,,,,3144.6300,12183.7500,percent of total billed charges,"47.59% of $12,183.75 in Billed Charges for Rev 278 Proc C1713 = $5,798.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT OSTEOAMP FLOWABLE 2.5C,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,12183.7500,1827.5600,SENTARA HEALTH,SENTARA HEALTH,3144.63,,,,,,,3144.6300,12183.7500,percent of total billed charges,"25.81% of $12,183.75 in Billed Charges for Rev 278 Proc C1713 = $3,144.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT OSTEOAMP FLOWABLE 2.5C,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,12183.7500,1827.5600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12183.75,,,,,,,3144.6300,12183.7500,percent of total billed charges,"100% of $12,183.75 in Billed Charges for Rev 278 Proc C1713 = $12,183.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRAFT OSTEOAMP FLOWABLE 2.5C,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,12183.7500,1827.5600,WELLCARE,WELLCARE MEDICAID,12183.75,,,,,,,3144.6300,12183.7500,percent of total billed charges,"100% of $12,183.75 in Billed Charges for Rev 278 Proc C1713 = $12,183.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE BLAKEMORE ESOPH NASOGAST,272,RC,27200002,CDM,,,,,,both,,,4010.2600,601.5400,AETNA,AETNA,1712.38,,,,,,,1035.0500,4010.2600,percent of total billed charges,"42.7% of $4,010.26 in Billed Charges for Rev 272 = $1,712.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE BLAKEMORE ESOPH NASOGAST,272,RC,27200002,CDM,,,,,,both,,,4010.2600,601.5400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2807.18,,,,,,,1035.0500,4010.2600,percent of total billed charges,"Rev 272 $4,010.26 in Billed Charges at 70% = $2,807.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE BLAKEMORE ESOPH NASOGAST,272,RC,27200002,CDM,,,,,,both,,,4010.2600,601.5400,CIGNA HEALTHCARE,CIGNA HMO,1672.28,,,,,,,1035.0500,4010.2600,percent of total billed charges,"41.7% of $4,010.26 in Billed Charges for Rev 272 = $1,672.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE BLAKEMORE ESOPH NASOGAST,272,RC,27200002,CDM,,,,,,both,,,4010.2600,601.5400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1860.76,,,,,,,1035.0500,4010.2600,percent of total billed charges,"46.4% of $4,010.26 in Billed Charges for Rev 272 = $1,860.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE BLAKEMORE ESOPH NASOGAST,272,RC,27200002,CDM,,,,,,both,,,4010.2600,601.5400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1672.28,,,,,,,1035.0500,4010.2600,percent of total billed charges,"41.7% of $4,010.26 in Billed Charges for Rev 272 = $1,672.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE BLAKEMORE ESOPH NASOGAST,272,RC,27200002,CDM,,,,,,both,,,4010.2600,601.5400,CIGNA HEALTHCARE,CIGNA PPO,1672.28,,,,,,,1035.0500,4010.2600,percent of total billed charges,"41.7% of $4,010.26 in Billed Charges for Rev 272 = $1,672.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE BLAKEMORE ESOPH NASOGAST,272,RC,27200002,CDM,,,,,,both,,,4010.2600,601.5400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3609.23,,,,,,,1035.0500,4010.2600,percent of total billed charges,"90% of $4,010.26 in Billed Charges for Rev 272 = $3,609.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE BLAKEMORE ESOPH NASOGAST,272,RC,27200002,CDM,,,,,,both,,,4010.2600,601.5400,MEDCOST,MEDCOST VHN,1908.48,,,,,,,1035.0500,4010.2600,percent of total billed charges,"47.59% of $4,010.26 in Billed Charges for Rev 272 = $1,908.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE BLAKEMORE ESOPH NASOGAST,272,RC,27200002,CDM,,,,,,both,,,4010.2600,601.5400,SENTARA HEALTH,SENTARA HEALTH,1035.05,,,,,,,1035.0500,4010.2600,percent of total billed charges,"25.81% of $4,010.26 in Billed Charges for Rev 272 = $1,035.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE BLAKEMORE ESOPH NASOGAST,272,RC,27200002,CDM,,,,,,both,,,4010.2600,601.5400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4010.26,,,,,,,1035.0500,4010.2600,percent of total billed charges,"100% of $4,010.26 in Billed Charges for Rev 272 = $4,010.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE BLAKEMORE ESOPH NASOGAST,272,RC,27200002,CDM,,,,,,both,,,4010.2600,601.5400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2005.13,,,,,,,1035.0500,4010.2600,percent of total billed charges,"Rev 272 $4,010.26 in Billed Charges at 50% = $2,005.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE BLAKEMORE ESOPH NASOGAST,272,RC,27200002,CDM,,,,,,both,,,4010.2600,601.5400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1295.31,,,,,,,1035.0500,4010.2600,other,"32.3% of $4,010.26 in Billed Charges for Rev 272 = $1,295.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE BLAKEMORE ESOPH NASOGAST,272,RC,27200002,CDM,,,,,,both,,,4010.2600,601.5400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1231.15,,,,,,,1035.0500,4010.2600,other,"30.7% of $4,010.26 in Billed Charges for Rev 272 = $1,231.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE BLAKEMORE ESOPH NASOGAST,272,RC,27200002,CDM,,,,,,both,,,4010.2600,601.5400,UNITED HEALTHCARE,UNITED HEALTHCARE,1295.31,,,,,,,1035.0500,4010.2600,percent of total billed charges,"32.3% of $4,010.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE BLAKEMORE ESOPH NASOGAST,272,RC,27200002,CDM,,,,,,both,,,4010.2600,601.5400,WELLCARE,WELLCARE MEDICAID,4010.26,,,,,,,1035.0500,4010.2600,percent of total billed charges,"100% of $4,010.26 in Billed Charges for Rev 272 = $4,010.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PLASMA PROCISE MAX,272,RC,27200002,CDM,,,,,,both,,,3708.2500,556.2400,AETNA,AETNA,1583.42,,,,,,,957.1000,3708.2500,percent of total billed charges,"42.7% of $3,708.25 in Billed Charges for Rev 272 = $1,583.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PLASMA PROCISE MAX,272,RC,27200002,CDM,,,,,,both,,,3708.2500,556.2400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2595.78,,,,,,,957.1000,3708.2500,percent of total billed charges,"Rev 272 $3,708.25 in Billed Charges at 70% = $2,595.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PLASMA PROCISE MAX,272,RC,27200002,CDM,,,,,,both,,,3708.2500,556.2400,CIGNA HEALTHCARE,CIGNA HMO,1546.34,,,,,,,957.1000,3708.2500,percent of total billed charges,"41.7% of $3,708.25 in Billed Charges for Rev 272 = $1,546.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PLASMA PROCISE MAX,272,RC,27200002,CDM,,,,,,both,,,3708.2500,556.2400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1720.63,,,,,,,957.1000,3708.2500,percent of total billed charges,"46.4% of $3,708.25 in Billed Charges for Rev 272 = $1,720.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PLASMA PROCISE MAX,272,RC,27200002,CDM,,,,,,both,,,3708.2500,556.2400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1546.34,,,,,,,957.1000,3708.2500,percent of total billed charges,"41.7% of $3,708.25 in Billed Charges for Rev 272 = $1,546.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PLASMA PROCISE MAX,272,RC,27200002,CDM,,,,,,both,,,3708.2500,556.2400,CIGNA HEALTHCARE,CIGNA PPO,1546.34,,,,,,,957.1000,3708.2500,percent of total billed charges,"41.7% of $3,708.25 in Billed Charges for Rev 272 = $1,546.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PLASMA PROCISE MAX,272,RC,27200002,CDM,,,,,,both,,,3708.2500,556.2400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3337.43,,,,,,,957.1000,3708.2500,percent of total billed charges,"90% of $3,708.25 in Billed Charges for Rev 272 = $3,337.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PLASMA PROCISE MAX,272,RC,27200002,CDM,,,,,,both,,,3708.2500,556.2400,MEDCOST,MEDCOST VHN,1764.76,,,,,,,957.1000,3708.2500,percent of total billed charges,"47.59% of $3,708.25 in Billed Charges for Rev 272 = $1,764.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PLASMA PROCISE MAX,272,RC,27200002,CDM,,,,,,both,,,3708.2500,556.2400,SENTARA HEALTH,SENTARA HEALTH,957.10,,,,,,,957.1000,3708.2500,percent of total billed charges,"25.81% of $3,708.25 in Billed Charges for Rev 272 = $957.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PLASMA PROCISE MAX,272,RC,27200002,CDM,,,,,,both,,,3708.2500,556.2400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3708.25,,,,,,,957.1000,3708.2500,percent of total billed charges,"100% of $3,708.25 in Billed Charges for Rev 272 = $3,708.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PLASMA PROCISE MAX,272,RC,27200002,CDM,,,,,,both,,,3708.2500,556.2400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1854.13,,,,,,,957.1000,3708.2500,percent of total billed charges,"Rev 272 $3,708.25 in Billed Charges at 50% = $1,854.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PLASMA PROCISE MAX,272,RC,27200002,CDM,,,,,,both,,,3708.2500,556.2400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1197.76,,,,,,,957.1000,3708.2500,other,"32.3% of $3,708.25 in Billed Charges for Rev 272 = $1,197.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND PLASMA PROCISE MAX,272,RC,27200002,CDM,,,,,,both,,,3708.2500,556.2400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1138.43,,,,,,,957.1000,3708.2500,other,"30.7% of $3,708.25 in Billed Charges for Rev 272 = $1,138.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND PLASMA PROCISE MAX,272,RC,27200002,CDM,,,,,,both,,,3708.2500,556.2400,UNITED HEALTHCARE,UNITED HEALTHCARE,1197.76,,,,,,,957.1000,3708.2500,percent of total billed charges,"32.3% of $3,708.25 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PLASMA PROCISE MAX,272,RC,27200002,CDM,,,,,,both,,,3708.2500,556.2400,WELLCARE,WELLCARE MEDICAID,3708.25,,,,,,,957.1000,3708.2500,percent of total billed charges,"100% of $3,708.25 in Billed Charges for Rev 272 = $3,708.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,19171.3100,2875.7000,AETNA,AETNA,9202.23,,,,,,,1361.1600,19171.3100,percent of total billed charges,"48% of $19,171.31 in Billed Charges for Rev 278 Proc C1713 = $9,202.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,19171.3100,2875.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,9585.66,,,,,,,1361.1600,19171.3100,percent of total billed charges,"50% of $19,171.31 in Billed Charges for Rev 278 Proc C1713 = $9,585.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,19171.3100,2875.7000,CIGNA HEALTHCARE,CIGNA HMO,7994.44,,,,,,,1361.1600,19171.3100,percent of total billed charges,"41.7% of $19,171.31 in Billed Charges for Rev 278 Proc C1713 = $7,994.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,19171.3100,2875.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7668.52,,,,,,,1361.1600,19171.3100,percent of total billed charges,"40% of $19,171.31 in Billed Charges for Rev 278 Proc C1713 = $7,668.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,19171.3100,2875.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7994.44,,,,,,,1361.1600,19171.3100,percent of total billed charges,"41.7% of $19,171.31 in Billed Charges for Rev 278 Proc C1713 = $7,994.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,19171.3100,2875.7000,CIGNA HEALTHCARE,CIGNA PPO,7994.44,,,,,,,1361.1600,19171.3100,percent of total billed charges,"41.7% of $19,171.31 in Billed Charges for Rev 278 Proc C1713 = $7,994.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,19171.3100,2875.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,17254.18,,,,,,,1361.1600,19171.3100,percent of total billed charges,"90% of $19,171.31 in Billed Charges for Rev 278 Proc C1713 = $17,254.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,19171.3100,2875.7000,MEDCOST,MEDCOST VHN,9123.63,,,,,,,1361.1600,19171.3100,percent of total billed charges,"47.59% of $19,171.31 in Billed Charges for Rev 278 Proc C1713 = $9,123.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,19171.3100,2875.7000,SENTARA HEALTH,SENTARA HEALTH,4948.12,,,,,,,1361.1600,19171.3100,percent of total billed charges,"25.81% of $19,171.31 in Billed Charges for Rev 278 Proc C1713 = $4,948.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,19171.3100,2875.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",19171.31,,,,,,,1361.1600,19171.3100,percent of total billed charges,"100% of $19,171.31 in Billed Charges for Rev 278 Proc C1713 = $19,171.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,19171.3100,2875.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1437.85,,,,,,,1361.1600,19171.3100,percent of total billed charges,"7.5% of $19,171.31 in Billed Charges for Rev 278 Proc C1713 = $1,437.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,19171.3100,2875.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1361.16,,,,,,,1361.1600,19171.3100,percent of total billed charges,"7.1% of $19,171.31 in Billed Charges for Rev 278 Proc C1713 = $1,361.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,19171.3100,2875.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,1361.16,,,,,,,1361.1600,19171.3100,percent of total billed charges,"7.1% of $19,171.31 in Billed Charges for Rev 278 Proc C1713 = $1,361.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
"ANCHOR/SCREW BN/BN,TIS/BN",C1713,HCPCS,278,RC,,,,,,both,,,19171.3100,2875.7000,WELLCARE,WELLCARE MEDICAID,19171.31,,,,,,,1361.1600,19171.3100,percent of total billed charges,"100% of $19,171.31 in Billed Charges for Rev 278 Proc C1713 = $19,171.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRIP PLATE MEDIUM 150MM LONG W/2 2.0MM CABLES,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15486.5000,2322.9800,AETNA,AETNA,7433.52,,,,,,,1099.5400,15486.5000,percent of total billed charges,"48% of $15,486.50 in Billed Charges for Rev 278 Proc C1713 = $7,433.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRIP PLATE MEDIUM 150MM LONG W/2 2.0MM CABLES,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15486.5000,2322.9800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7743.25,,,,,,,1099.5400,15486.5000,percent of total billed charges,"50% of $15,486.50 in Billed Charges for Rev 278 Proc C1713 = $7,743.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRIP PLATE MEDIUM 150MM LONG W/2 2.0MM CABLES,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15486.5000,2322.9800,CIGNA HEALTHCARE,CIGNA HMO,6457.87,,,,,,,1099.5400,15486.5000,percent of total billed charges,"41.7% of $15,486.50 in Billed Charges for Rev 278 Proc C1713 = $6,457.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRIP PLATE MEDIUM 150MM LONG W/2 2.0MM CABLES,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15486.5000,2322.9800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6194.60,,,,,,,1099.5400,15486.5000,percent of total billed charges,"40% of $15,486.50 in Billed Charges for Rev 278 Proc C1713 = $6,194.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRIP PLATE MEDIUM 150MM LONG W/2 2.0MM CABLES,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15486.5000,2322.9800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6457.87,,,,,,,1099.5400,15486.5000,percent of total billed charges,"41.7% of $15,486.50 in Billed Charges for Rev 278 Proc C1713 = $6,457.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRIP PLATE MEDIUM 150MM LONG W/2 2.0MM CABLES,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15486.5000,2322.9800,CIGNA HEALTHCARE,CIGNA PPO,6457.87,,,,,,,1099.5400,15486.5000,percent of total billed charges,"41.7% of $15,486.50 in Billed Charges for Rev 278 Proc C1713 = $6,457.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRIP PLATE MEDIUM 150MM LONG W/2 2.0MM CABLES,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15486.5000,2322.9800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13937.85,,,,,,,1099.5400,15486.5000,percent of total billed charges,"90% of $15,486.50 in Billed Charges for Rev 278 Proc C1713 = $13,937.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRIP PLATE MEDIUM 150MM LONG W/2 2.0MM CABLES,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15486.5000,2322.9800,MEDCOST,MEDCOST VHN,7370.03,,,,,,,1099.5400,15486.5000,percent of total billed charges,"47.59% of $15,486.50 in Billed Charges for Rev 278 Proc C1713 = $7,370.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRIP PLATE MEDIUM 150MM LONG W/2 2.0MM CABLES,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15486.5000,2322.9800,SENTARA HEALTH,SENTARA HEALTH,3997.07,,,,,,,1099.5400,15486.5000,percent of total billed charges,"25.81% of $15,486.50 in Billed Charges for Rev 278 Proc C1713 = $3,997.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRIP PLATE MEDIUM 150MM LONG W/2 2.0MM CABLES,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15486.5000,2322.9800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15486.50,,,,,,,1099.5400,15486.5000,percent of total billed charges,"100% of $15,486.50 in Billed Charges for Rev 278 Proc C1713 = $15,486.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRIP PLATE MEDIUM 150MM LONG W/2 2.0MM CABLES,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15486.5000,2322.9800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1161.49,,,,,,,1099.5400,15486.5000,percent of total billed charges,"7.5% of $15,486.50 in Billed Charges for Rev 278 Proc C1713 = $1,161.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRIP PLATE MEDIUM 150MM LONG W/2 2.0MM CABLES,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15486.5000,2322.9800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1099.54,,,,,,,1099.5400,15486.5000,percent of total billed charges,"7.1% of $15,486.50 in Billed Charges for Rev 278 Proc C1713 = $1,099.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRIP PLATE MEDIUM 150MM LONG W/2 2.0MM CABLES,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15486.5000,2322.9800,UNITED HEALTHCARE,UNITED HEALTHCARE,1099.54,,,,,,,1099.5400,15486.5000,percent of total billed charges,"7.1% of $15,486.50 in Billed Charges for Rev 278 Proc C1713 = $1,099.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
GRIP PLATE MEDIUM 150MM LONG W/2 2.0MM CABLES,C1713,HCPCS,278,RC,27800002,CDM,,,,both,,,15486.5000,2322.9800,WELLCARE,WELLCARE MEDICAID,15486.50,,,,,,,1099.5400,15486.5000,percent of total billed charges,"100% of $15,486.50 in Billed Charges for Rev 278 Proc C1713 = $15,486.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE SMARTSTITCH CO-BRAID,272,RC,,,,,,,,both,,,1731.8500,259.7800,AETNA,AETNA,739.50,,,,,,,446.9900,1731.8500,percent of total billed charges,"42.7% of $1,731.85 in Billed Charges for Rev 272 = $739.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE SMARTSTITCH CO-BRAID,272,RC,,,,,,,,both,,,1731.8500,259.7800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1212.30,,,,,,,446.9900,1731.8500,percent of total billed charges,"Rev 272 $1,731.85 in Billed Charges at 70% = $1,212.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE SMARTSTITCH CO-BRAID,272,RC,,,,,,,,both,,,1731.8500,259.7800,CIGNA HEALTHCARE,CIGNA HMO,722.18,,,,,,,446.9900,1731.8500,percent of total billed charges,"41.7% of $1,731.85 in Billed Charges for Rev 272 = $722.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE SMARTSTITCH CO-BRAID,272,RC,,,,,,,,both,,,1731.8500,259.7800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,803.58,,,,,,,446.9900,1731.8500,percent of total billed charges,"46.4% of $1,731.85 in Billed Charges for Rev 272 = $803.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE SMARTSTITCH CO-BRAID,272,RC,,,,,,,,both,,,1731.8500,259.7800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,722.18,,,,,,,446.9900,1731.8500,percent of total billed charges,"41.7% of $1,731.85 in Billed Charges for Rev 272 = $722.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE SMARTSTITCH CO-BRAID,272,RC,,,,,,,,both,,,1731.8500,259.7800,CIGNA HEALTHCARE,CIGNA PPO,722.18,,,,,,,446.9900,1731.8500,percent of total billed charges,"41.7% of $1,731.85 in Billed Charges for Rev 272 = $722.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE SMARTSTITCH CO-BRAID,272,RC,,,,,,,,both,,,1731.8500,259.7800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1558.67,,,,,,,446.9900,1731.8500,percent of total billed charges,"90% of $1,731.85 in Billed Charges for Rev 272 = $1,558.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE SMARTSTITCH CO-BRAID,272,RC,,,,,,,,both,,,1731.8500,259.7800,MEDCOST,MEDCOST VHN,824.19,,,,,,,446.9900,1731.8500,percent of total billed charges,"47.59% of $1,731.85 in Billed Charges for Rev 272 = $824.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE SMARTSTITCH CO-BRAID,272,RC,,,,,,,,both,,,1731.8500,259.7800,SENTARA HEALTH,SENTARA HEALTH,446.99,,,,,,,446.9900,1731.8500,percent of total billed charges,"25.81% of $1,731.85 in Billed Charges for Rev 272 = $446.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE SMARTSTITCH CO-BRAID,272,RC,,,,,,,,both,,,1731.8500,259.7800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1731.85,,,,,,,446.9900,1731.8500,percent of total billed charges,"100% of $1,731.85 in Billed Charges for Rev 272 = $1,731.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE SMARTSTITCH CO-BRAID,272,RC,,,,,,,,both,,,1731.8500,259.7800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,865.93,,,,,,,446.9900,1731.8500,percent of total billed charges,"Rev 272 $1,731.85 in Billed Charges at 50% = $865.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE SMARTSTITCH CO-BRAID,272,RC,,,,,,,,both,,,1731.8500,259.7800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,559.39,,,,,,,446.9900,1731.8500,other,"32.3% of $1,731.85 in Billed Charges for Rev 272 = $559.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE SMARTSTITCH CO-BRAID,272,RC,,,,,,,,both,,,1731.8500,259.7800,UNITED HEALTHCARE,UHC HERITAGE SELECT,531.68,,,,,,,446.9900,1731.8500,other,"30.7% of $1,731.85 in Billed Charges for Rev 272 = $531.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE SMARTSTITCH CO-BRAID,272,RC,,,,,,,,both,,,1731.8500,259.7800,UNITED HEALTHCARE,UNITED HEALTHCARE,559.39,,,,,,,446.9900,1731.8500,percent of total billed charges,"32.3% of $1,731.85 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE SMARTSTITCH CO-BRAID,272,RC,,,,,,,,both,,,1731.8500,259.7800,WELLCARE,WELLCARE MEDICAID,1731.85,,,,,,,446.9900,1731.8500,percent of total billed charges,"100% of $1,731.85 in Billed Charges for Rev 272 = $1,731.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE STRATAFIX 2-0 9,272,RC,,,,,,,,both,,,259.5300,38.9300,AETNA,AETNA,110.82,,,,,,,66.9800,259.5300,percent of total billed charges,42.7% of $259.53 in Billed Charges for Rev 272 = $110.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE STRATAFIX 2-0 9,272,RC,,,,,,,,both,,,259.5300,38.9300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,181.67,,,,,,,66.9800,259.5300,percent of total billed charges,Rev 272 $259.53 in Billed Charges at 70% = $181.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE STRATAFIX 2-0 9,272,RC,,,,,,,,both,,,259.5300,38.9300,CIGNA HEALTHCARE,CIGNA HMO,108.22,,,,,,,66.9800,259.5300,percent of total billed charges,41.7% of $259.53 in Billed Charges for Rev 272 = $108.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE STRATAFIX 2-0 9,272,RC,,,,,,,,both,,,259.5300,38.9300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,120.42,,,,,,,66.9800,259.5300,percent of total billed charges,46.4% of $259.53 in Billed Charges for Rev 272 = $120.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE STRATAFIX 2-0 9,272,RC,,,,,,,,both,,,259.5300,38.9300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,108.22,,,,,,,66.9800,259.5300,percent of total billed charges,41.7% of $259.53 in Billed Charges for Rev 272 = $108.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE STRATAFIX 2-0 9,272,RC,,,,,,,,both,,,259.5300,38.9300,CIGNA HEALTHCARE,CIGNA PPO,108.22,,,,,,,66.9800,259.5300,percent of total billed charges,41.7% of $259.53 in Billed Charges for Rev 272 = $108.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE STRATAFIX 2-0 9,272,RC,,,,,,,,both,,,259.5300,38.9300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,233.58,,,,,,,66.9800,259.5300,percent of total billed charges,90% of $259.53 in Billed Charges for Rev 272 = $233.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE STRATAFIX 2-0 9,272,RC,,,,,,,,both,,,259.5300,38.9300,MEDCOST,MEDCOST VHN,123.51,,,,,,,66.9800,259.5300,percent of total billed charges,47.59% of $259.53 in Billed Charges for Rev 272 = $123.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE STRATAFIX 2-0 9,272,RC,,,,,,,,both,,,259.5300,38.9300,SENTARA HEALTH,SENTARA HEALTH,66.98,,,,,,,66.9800,259.5300,percent of total billed charges,25.81% of $259.53 in Billed Charges for Rev 272 = $66.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE STRATAFIX 2-0 9,272,RC,,,,,,,,both,,,259.5300,38.9300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",259.53,,,,,,,66.9800,259.5300,percent of total billed charges,100% of $259.53 in Billed Charges for Rev 272 = $259.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE STRATAFIX 2-0 9,272,RC,,,,,,,,both,,,259.5300,38.9300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,129.77,,,,,,,66.9800,259.5300,percent of total billed charges,Rev 272 $259.53 in Billed Charges at 50% = $129.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE STRATAFIX 2-0 9,272,RC,,,,,,,,both,,,259.5300,38.9300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,83.83,,,,,,,66.9800,259.5300,other,32.3% of $259.53 in Billed Charges for Rev 272 = $83.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE STRATAFIX 2-0 9,272,RC,,,,,,,,both,,,259.5300,38.9300,UNITED HEALTHCARE,UHC HERITAGE SELECT,79.68,,,,,,,66.9800,259.5300,other,30.7% of $259.53 in Billed Charges for Rev 272 = $79.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE STRATAFIX 2-0 9,272,RC,,,,,,,,both,,,259.5300,38.9300,UNITED HEALTHCARE,UNITED HEALTHCARE,83.83,,,,,,,66.9800,259.5300,percent of total billed charges,32.3% of $259.53 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE STRATAFIX 2-0 9,272,RC,,,,,,,,both,,,259.5300,38.9300,WELLCARE,WELLCARE MEDICAID,259.53,,,,,,,66.9800,259.5300,percent of total billed charges,100% of $259.53 in Billed Charges for Rev 272 = $259.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WAND PROCISE EZ VIEW COBLATOR,272,RC,,,,,,,,both,,,3497.6200,524.6400,AETNA,AETNA,1493.48,,,,,,,902.7400,3497.6200,percent of total billed charges,"42.7% of $3,497.62 in Billed Charges for Rev 272 = $1,493.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PROCISE EZ VIEW COBLATOR,272,RC,,,,,,,,both,,,3497.6200,524.6400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2448.33,,,,,,,902.7400,3497.6200,percent of total billed charges,"Rev 272 $3,497.62 in Billed Charges at 70% = $2,448.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PROCISE EZ VIEW COBLATOR,272,RC,,,,,,,,both,,,3497.6200,524.6400,CIGNA HEALTHCARE,CIGNA HMO,1458.51,,,,,,,902.7400,3497.6200,percent of total billed charges,"41.7% of $3,497.62 in Billed Charges for Rev 272 = $1,458.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PROCISE EZ VIEW COBLATOR,272,RC,,,,,,,,both,,,3497.6200,524.6400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1622.90,,,,,,,902.7400,3497.6200,percent of total billed charges,"46.4% of $3,497.62 in Billed Charges for Rev 272 = $1,622.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PROCISE EZ VIEW COBLATOR,272,RC,,,,,,,,both,,,3497.6200,524.6400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1458.51,,,,,,,902.7400,3497.6200,percent of total billed charges,"41.7% of $3,497.62 in Billed Charges for Rev 272 = $1,458.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PROCISE EZ VIEW COBLATOR,272,RC,,,,,,,,both,,,3497.6200,524.6400,CIGNA HEALTHCARE,CIGNA PPO,1458.51,,,,,,,902.7400,3497.6200,percent of total billed charges,"41.7% of $3,497.62 in Billed Charges for Rev 272 = $1,458.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PROCISE EZ VIEW COBLATOR,272,RC,,,,,,,,both,,,3497.6200,524.6400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3147.86,,,,,,,902.7400,3497.6200,percent of total billed charges,"90% of $3,497.62 in Billed Charges for Rev 272 = $3,147.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PROCISE EZ VIEW COBLATOR,272,RC,,,,,,,,both,,,3497.6200,524.6400,MEDCOST,MEDCOST VHN,1664.52,,,,,,,902.7400,3497.6200,percent of total billed charges,"47.59% of $3,497.62 in Billed Charges for Rev 272 = $1,664.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PROCISE EZ VIEW COBLATOR,272,RC,,,,,,,,both,,,3497.6200,524.6400,SENTARA HEALTH,SENTARA HEALTH,902.74,,,,,,,902.7400,3497.6200,percent of total billed charges,"25.81% of $3,497.62 in Billed Charges for Rev 272 = $902.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PROCISE EZ VIEW COBLATOR,272,RC,,,,,,,,both,,,3497.6200,524.6400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3497.62,,,,,,,902.7400,3497.6200,percent of total billed charges,"100% of $3,497.62 in Billed Charges for Rev 272 = $3,497.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PROCISE EZ VIEW COBLATOR,272,RC,,,,,,,,both,,,3497.6200,524.6400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1748.81,,,,,,,902.7400,3497.6200,percent of total billed charges,"Rev 272 $3,497.62 in Billed Charges at 50% = $1,748.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PROCISE EZ VIEW COBLATOR,272,RC,,,,,,,,both,,,3497.6200,524.6400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1129.73,,,,,,,902.7400,3497.6200,other,"32.3% of $3,497.62 in Billed Charges for Rev 272 = $1,129.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND PROCISE EZ VIEW COBLATOR,272,RC,,,,,,,,both,,,3497.6200,524.6400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1073.77,,,,,,,902.7400,3497.6200,other,"30.7% of $3,497.62 in Billed Charges for Rev 272 = $1,073.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND PROCISE EZ VIEW COBLATOR,272,RC,,,,,,,,both,,,3497.6200,524.6400,UNITED HEALTHCARE,UNITED HEALTHCARE,1129.73,,,,,,,902.7400,3497.6200,percent of total billed charges,"32.3% of $3,497.62 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND PROCISE EZ VIEW COBLATOR,272,RC,,,,,,,,both,,,3497.6200,524.6400,WELLCARE,WELLCARE MEDICAID,3497.62,,,,,,,902.7400,3497.6200,percent of total billed charges,"100% of $3,497.62 in Billed Charges for Rev 272 = $3,497.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SABER 30DG ANG 3.0 AC4330-01,272,RC,,,,,,,,both,,,1980.4500,297.0700,AETNA,AETNA,845.65,,,,,,,511.1500,1980.4500,percent of total billed charges,"42.7% of $1,980.45 in Billed Charges for Rev 272 = $845.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SABER 30DG ANG 3.0 AC4330-01,272,RC,,,,,,,,both,,,1980.4500,297.0700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1386.32,,,,,,,511.1500,1980.4500,percent of total billed charges,"Rev 272 $1,980.45 in Billed Charges at 70% = $1,386.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SABER 30DG ANG 3.0 AC4330-01,272,RC,,,,,,,,both,,,1980.4500,297.0700,CIGNA HEALTHCARE,CIGNA HMO,825.85,,,,,,,511.1500,1980.4500,percent of total billed charges,"41.7% of $1,980.45 in Billed Charges for Rev 272 = $825.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SABER 30DG ANG 3.0 AC4330-01,272,RC,,,,,,,,both,,,1980.4500,297.0700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,918.93,,,,,,,511.1500,1980.4500,percent of total billed charges,"46.4% of $1,980.45 in Billed Charges for Rev 272 = $918.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SABER 30DG ANG 3.0 AC4330-01,272,RC,,,,,,,,both,,,1980.4500,297.0700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,825.85,,,,,,,511.1500,1980.4500,percent of total billed charges,"41.7% of $1,980.45 in Billed Charges for Rev 272 = $825.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SABER 30DG ANG 3.0 AC4330-01,272,RC,,,,,,,,both,,,1980.4500,297.0700,CIGNA HEALTHCARE,CIGNA PPO,825.85,,,,,,,511.1500,1980.4500,percent of total billed charges,"41.7% of $1,980.45 in Billed Charges for Rev 272 = $825.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SABER 30DG ANG 3.0 AC4330-01,272,RC,,,,,,,,both,,,1980.4500,297.0700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1782.41,,,,,,,511.1500,1980.4500,percent of total billed charges,"90% of $1,980.45 in Billed Charges for Rev 272 = $1,782.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SABER 30DG ANG 3.0 AC4330-01,272,RC,,,,,,,,both,,,1980.4500,297.0700,MEDCOST,MEDCOST VHN,942.50,,,,,,,511.1500,1980.4500,percent of total billed charges,"47.59% of $1,980.45 in Billed Charges for Rev 272 = $942.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SABER 30DG ANG 3.0 AC4330-01,272,RC,,,,,,,,both,,,1980.4500,297.0700,SENTARA HEALTH,SENTARA HEALTH,511.15,,,,,,,511.1500,1980.4500,percent of total billed charges,"25.81% of $1,980.45 in Billed Charges for Rev 272 = $511.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SABER 30DG ANG 3.0 AC4330-01,272,RC,,,,,,,,both,,,1980.4500,297.0700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1980.45,,,,,,,511.1500,1980.4500,percent of total billed charges,"100% of $1,980.45 in Billed Charges for Rev 272 = $1,980.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SABER 30DG ANG 3.0 AC4330-01,272,RC,,,,,,,,both,,,1980.4500,297.0700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,990.23,,,,,,,511.1500,1980.4500,percent of total billed charges,"Rev 272 $1,980.45 in Billed Charges at 50% = $990.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SABER 30DG ANG 3.0 AC4330-01,272,RC,,,,,,,,both,,,1980.4500,297.0700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,639.69,,,,,,,511.1500,1980.4500,other,"32.3% of $1,980.45 in Billed Charges for Rev 272 = $639.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND SABER 30DG ANG 3.0 AC4330-01,272,RC,,,,,,,,both,,,1980.4500,297.0700,UNITED HEALTHCARE,UHC HERITAGE SELECT,608.00,,,,,,,511.1500,1980.4500,other,"30.7% of $1,980.45 in Billed Charges for Rev 272 = $608.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND SABER 30DG ANG 3.0 AC4330-01,272,RC,,,,,,,,both,,,1980.4500,297.0700,UNITED HEALTHCARE,UNITED HEALTHCARE,639.69,,,,,,,511.1500,1980.4500,percent of total billed charges,"32.3% of $1,980.45 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SABER 30DG ANG 3.0 AC4330-01,272,RC,,,,,,,,both,,,1980.4500,297.0700,WELLCARE,WELLCARE MEDICAID,1980.45,,,,,,,511.1500,1980.4500,percent of total billed charges,"100% of $1,980.45 in Billed Charges for Rev 272 = $1,980.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SUP TURBOVAC 90 FINGER,272,RC,27200002,CDM,,,,,,both,,,5383.9000,807.5900,AETNA,AETNA,2298.93,,,,,,,1389.5800,5383.9000,percent of total billed charges,"42.7% of $5,383.90 in Billed Charges for Rev 272 = $2,298.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SUP TURBOVAC 90 FINGER,272,RC,27200002,CDM,,,,,,both,,,5383.9000,807.5900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3768.73,,,,,,,1389.5800,5383.9000,percent of total billed charges,"Rev 272 $5,383.90 in Billed Charges at 70% = $3,768.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SUP TURBOVAC 90 FINGER,272,RC,27200002,CDM,,,,,,both,,,5383.9000,807.5900,CIGNA HEALTHCARE,CIGNA HMO,2245.09,,,,,,,1389.5800,5383.9000,percent of total billed charges,"41.7% of $5,383.90 in Billed Charges for Rev 272 = $2,245.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SUP TURBOVAC 90 FINGER,272,RC,27200002,CDM,,,,,,both,,,5383.9000,807.5900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2498.13,,,,,,,1389.5800,5383.9000,percent of total billed charges,"46.4% of $5,383.90 in Billed Charges for Rev 272 = $2,498.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SUP TURBOVAC 90 FINGER,272,RC,27200002,CDM,,,,,,both,,,5383.9000,807.5900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2245.09,,,,,,,1389.5800,5383.9000,percent of total billed charges,"41.7% of $5,383.90 in Billed Charges for Rev 272 = $2,245.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SUP TURBOVAC 90 FINGER,272,RC,27200002,CDM,,,,,,both,,,5383.9000,807.5900,CIGNA HEALTHCARE,CIGNA PPO,2245.09,,,,,,,1389.5800,5383.9000,percent of total billed charges,"41.7% of $5,383.90 in Billed Charges for Rev 272 = $2,245.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SUP TURBOVAC 90 FINGER,272,RC,27200002,CDM,,,,,,both,,,5383.9000,807.5900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4845.51,,,,,,,1389.5800,5383.9000,percent of total billed charges,"90% of $5,383.90 in Billed Charges for Rev 272 = $4,845.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SUP TURBOVAC 90 FINGER,272,RC,27200002,CDM,,,,,,both,,,5383.9000,807.5900,MEDCOST,MEDCOST VHN,2562.20,,,,,,,1389.5800,5383.9000,percent of total billed charges,"47.59% of $5,383.90 in Billed Charges for Rev 272 = $2,562.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SUP TURBOVAC 90 FINGER,272,RC,27200002,CDM,,,,,,both,,,5383.9000,807.5900,SENTARA HEALTH,SENTARA HEALTH,1389.58,,,,,,,1389.5800,5383.9000,percent of total billed charges,"25.81% of $5,383.90 in Billed Charges for Rev 272 = $1,389.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SUP TURBOVAC 90 FINGER,272,RC,27200002,CDM,,,,,,both,,,5383.9000,807.5900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5383.90,,,,,,,1389.5800,5383.9000,percent of total billed charges,"100% of $5,383.90 in Billed Charges for Rev 272 = $5,383.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SUP TURBOVAC 90 FINGER,272,RC,27200002,CDM,,,,,,both,,,5383.9000,807.5900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2691.95,,,,,,,1389.5800,5383.9000,percent of total billed charges,"Rev 272 $5,383.90 in Billed Charges at 50% = $2,691.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SUP TURBOVAC 90 FINGER,272,RC,27200002,CDM,,,,,,both,,,5383.9000,807.5900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1739.00,,,,,,,1389.5800,5383.9000,other,"32.3% of $5,383.90 in Billed Charges for Rev 272 = $1,739.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND SUP TURBOVAC 90 FINGER,272,RC,27200002,CDM,,,,,,both,,,5383.9000,807.5900,UNITED HEALTHCARE,UHC HERITAGE SELECT,1652.86,,,,,,,1389.5800,5383.9000,other,"30.7% of $5,383.90 in Billed Charges for Rev 272 = $1,652.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND SUP TURBOVAC 90 FINGER,272,RC,27200002,CDM,,,,,,both,,,5383.9000,807.5900,UNITED HEALTHCARE,UNITED HEALTHCARE,1739.00,,,,,,,1389.5800,5383.9000,percent of total billed charges,"32.3% of $5,383.90 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND SUP TURBOVAC 90 FINGER,272,RC,27200002,CDM,,,,,,both,,,5383.9000,807.5900,WELLCARE,WELLCARE MEDICAID,5383.90,,,,,,,1389.5800,5383.9000,percent of total billed charges,"100% of $5,383.90 in Billed Charges for Rev 272 = $5,383.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE SURGICAL SHARPSHOOTER,272,RC,,,,,,,,both,,,946.0400,141.9100,AETNA,AETNA,403.96,,,,,,,244.1700,946.0400,percent of total billed charges,42.7% of $946.04 in Billed Charges for Rev 272 = $403.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SURGICAL SHARPSHOOTER,272,RC,,,,,,,,both,,,946.0400,141.9100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,662.23,,,,,,,244.1700,946.0400,percent of total billed charges,Rev 272 $946.04 in Billed Charges at 70% = $662.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SURGICAL SHARPSHOOTER,272,RC,,,,,,,,both,,,946.0400,141.9100,CIGNA HEALTHCARE,CIGNA HMO,394.50,,,,,,,244.1700,946.0400,percent of total billed charges,41.7% of $946.04 in Billed Charges for Rev 272 = $394.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SURGICAL SHARPSHOOTER,272,RC,,,,,,,,both,,,946.0400,141.9100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,438.96,,,,,,,244.1700,946.0400,percent of total billed charges,46.4% of $946.04 in Billed Charges for Rev 272 = $438.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SURGICAL SHARPSHOOTER,272,RC,,,,,,,,both,,,946.0400,141.9100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,394.50,,,,,,,244.1700,946.0400,percent of total billed charges,41.7% of $946.04 in Billed Charges for Rev 272 = $394.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SURGICAL SHARPSHOOTER,272,RC,,,,,,,,both,,,946.0400,141.9100,CIGNA HEALTHCARE,CIGNA PPO,394.50,,,,,,,244.1700,946.0400,percent of total billed charges,41.7% of $946.04 in Billed Charges for Rev 272 = $394.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SURGICAL SHARPSHOOTER,272,RC,,,,,,,,both,,,946.0400,141.9100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,851.44,,,,,,,244.1700,946.0400,percent of total billed charges,90% of $946.04 in Billed Charges for Rev 272 = $851.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SURGICAL SHARPSHOOTER,272,RC,,,,,,,,both,,,946.0400,141.9100,MEDCOST,MEDCOST VHN,450.22,,,,,,,244.1700,946.0400,percent of total billed charges,47.59% of $946.04 in Billed Charges for Rev 272 = $450.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SURGICAL SHARPSHOOTER,272,RC,,,,,,,,both,,,946.0400,141.9100,SENTARA HEALTH,SENTARA HEALTH,244.17,,,,,,,244.1700,946.0400,percent of total billed charges,25.81% of $946.04 in Billed Charges for Rev 272 = $244.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SURGICAL SHARPSHOOTER,272,RC,,,,,,,,both,,,946.0400,141.9100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",946.04,,,,,,,244.1700,946.0400,percent of total billed charges,100% of $946.04 in Billed Charges for Rev 272 = $946.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SURGICAL SHARPSHOOTER,272,RC,,,,,,,,both,,,946.0400,141.9100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,473.02,,,,,,,244.1700,946.0400,percent of total billed charges,Rev 272 $946.04 in Billed Charges at 50% = $473.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SURGICAL SHARPSHOOTER,272,RC,,,,,,,,both,,,946.0400,141.9100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,305.57,,,,,,,244.1700,946.0400,other,32.3% of $946.04 in Billed Charges for Rev 272 = $305.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE SURGICAL SHARPSHOOTER,272,RC,,,,,,,,both,,,946.0400,141.9100,UNITED HEALTHCARE,UHC HERITAGE SELECT,290.43,,,,,,,244.1700,946.0400,other,30.7% of $946.04 in Billed Charges for Rev 272 = $290.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE SURGICAL SHARPSHOOTER,272,RC,,,,,,,,both,,,946.0400,141.9100,UNITED HEALTHCARE,UNITED HEALTHCARE,305.57,,,,,,,244.1700,946.0400,percent of total billed charges,32.3% of $946.04 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE SURGICAL SHARPSHOOTER,272,RC,,,,,,,,both,,,946.0400,141.9100,WELLCARE,WELLCARE MEDICAID,946.04,,,,,,,244.1700,946.0400,percent of total billed charges,100% of $946.04 in Billed Charges for Rev 272 = $946.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WAND TONSIL/ADENOID EVAC 70,272,RC,27200002,CDM,,,,,,both,,,3520.7500,528.1100,AETNA,AETNA,1503.36,,,,,,,908.7100,3520.7500,percent of total billed charges,"42.7% of $3,520.75 in Billed Charges for Rev 272 = $1,503.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL/ADENOID EVAC 70,272,RC,27200002,CDM,,,,,,both,,,3520.7500,528.1100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2464.53,,,,,,,908.7100,3520.7500,percent of total billed charges,"Rev 272 $3,520.75 in Billed Charges at 70% = $2,464.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL/ADENOID EVAC 70,272,RC,27200002,CDM,,,,,,both,,,3520.7500,528.1100,CIGNA HEALTHCARE,CIGNA HMO,1468.15,,,,,,,908.7100,3520.7500,percent of total billed charges,"41.7% of $3,520.75 in Billed Charges for Rev 272 = $1,468.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL/ADENOID EVAC 70,272,RC,27200002,CDM,,,,,,both,,,3520.7500,528.1100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1633.63,,,,,,,908.7100,3520.7500,percent of total billed charges,"46.4% of $3,520.75 in Billed Charges for Rev 272 = $1,633.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL/ADENOID EVAC 70,272,RC,27200002,CDM,,,,,,both,,,3520.7500,528.1100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1468.15,,,,,,,908.7100,3520.7500,percent of total billed charges,"41.7% of $3,520.75 in Billed Charges for Rev 272 = $1,468.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL/ADENOID EVAC 70,272,RC,27200002,CDM,,,,,,both,,,3520.7500,528.1100,CIGNA HEALTHCARE,CIGNA PPO,1468.15,,,,,,,908.7100,3520.7500,percent of total billed charges,"41.7% of $3,520.75 in Billed Charges for Rev 272 = $1,468.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL/ADENOID EVAC 70,272,RC,27200002,CDM,,,,,,both,,,3520.7500,528.1100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3168.68,,,,,,,908.7100,3520.7500,percent of total billed charges,"90% of $3,520.75 in Billed Charges for Rev 272 = $3,168.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL/ADENOID EVAC 70,272,RC,27200002,CDM,,,,,,both,,,3520.7500,528.1100,MEDCOST,MEDCOST VHN,1675.52,,,,,,,908.7100,3520.7500,percent of total billed charges,"47.59% of $3,520.75 in Billed Charges for Rev 272 = $1,675.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL/ADENOID EVAC 70,272,RC,27200002,CDM,,,,,,both,,,3520.7500,528.1100,SENTARA HEALTH,SENTARA HEALTH,908.71,,,,,,,908.7100,3520.7500,percent of total billed charges,"25.81% of $3,520.75 in Billed Charges for Rev 272 = $908.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL/ADENOID EVAC 70,272,RC,27200002,CDM,,,,,,both,,,3520.7500,528.1100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3520.75,,,,,,,908.7100,3520.7500,percent of total billed charges,"100% of $3,520.75 in Billed Charges for Rev 272 = $3,520.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL/ADENOID EVAC 70,272,RC,27200002,CDM,,,,,,both,,,3520.7500,528.1100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1760.38,,,,,,,908.7100,3520.7500,percent of total billed charges,"Rev 272 $3,520.75 in Billed Charges at 50% = $1,760.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL/ADENOID EVAC 70,272,RC,27200002,CDM,,,,,,both,,,3520.7500,528.1100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1137.20,,,,,,,908.7100,3520.7500,other,"32.3% of $3,520.75 in Billed Charges for Rev 272 = $1,137.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND TONSIL/ADENOID EVAC 70,272,RC,27200002,CDM,,,,,,both,,,3520.7500,528.1100,UNITED HEALTHCARE,UHC HERITAGE SELECT,1080.87,,,,,,,908.7100,3520.7500,other,"30.7% of $3,520.75 in Billed Charges for Rev 272 = $1,080.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND TONSIL/ADENOID EVAC 70,272,RC,27200002,CDM,,,,,,both,,,3520.7500,528.1100,UNITED HEALTHCARE,UNITED HEALTHCARE,1137.20,,,,,,,908.7100,3520.7500,percent of total billed charges,"32.3% of $3,520.75 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL/ADENOID EVAC 70,272,RC,27200002,CDM,,,,,,both,,,3520.7500,528.1100,WELLCARE,WELLCARE MEDICAID,3520.75,,,,,,,908.7100,3520.7500,percent of total billed charges,"100% of $3,520.75 in Billed Charges for Rev 272 = $3,520.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR HOOK 3.5,272,RC,,,,,,,,both,,,4224.0000,633.6000,AETNA,AETNA,1803.65,,,,,,,1090.2100,4224.0000,percent of total billed charges,"42.7% of $4,224.00 in Billed Charges for Rev 272 = $1,803.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR HOOK 3.5,272,RC,,,,,,,,both,,,4224.0000,633.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2956.80,,,,,,,1090.2100,4224.0000,percent of total billed charges,"Rev 272 $4,224.00 in Billed Charges at 70% = $2,956.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR HOOK 3.5,272,RC,,,,,,,,both,,,4224.0000,633.6000,CIGNA HEALTHCARE,CIGNA HMO,1761.41,,,,,,,1090.2100,4224.0000,percent of total billed charges,"41.7% of $4,224.00 in Billed Charges for Rev 272 = $1,761.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR HOOK 3.5,272,RC,,,,,,,,both,,,4224.0000,633.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1959.94,,,,,,,1090.2100,4224.0000,percent of total billed charges,"46.4% of $4,224.00 in Billed Charges for Rev 272 = $1,959.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR HOOK 3.5,272,RC,,,,,,,,both,,,4224.0000,633.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1761.41,,,,,,,1090.2100,4224.0000,percent of total billed charges,"41.7% of $4,224.00 in Billed Charges for Rev 272 = $1,761.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR HOOK 3.5,272,RC,,,,,,,,both,,,4224.0000,633.6000,CIGNA HEALTHCARE,CIGNA PPO,1761.41,,,,,,,1090.2100,4224.0000,percent of total billed charges,"41.7% of $4,224.00 in Billed Charges for Rev 272 = $1,761.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR HOOK 3.5,272,RC,,,,,,,,both,,,4224.0000,633.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3801.60,,,,,,,1090.2100,4224.0000,percent of total billed charges,"90% of $4,224.00 in Billed Charges for Rev 272 = $3,801.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR HOOK 3.5,272,RC,,,,,,,,both,,,4224.0000,633.6000,MEDCOST,MEDCOST VHN,2010.20,,,,,,,1090.2100,4224.0000,percent of total billed charges,"47.59% of $4,224.00 in Billed Charges for Rev 272 = $2,010.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR HOOK 3.5,272,RC,,,,,,,,both,,,4224.0000,633.6000,SENTARA HEALTH,SENTARA HEALTH,1090.21,,,,,,,1090.2100,4224.0000,percent of total billed charges,"25.81% of $4,224.00 in Billed Charges for Rev 272 = $1,090.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR HOOK 3.5,272,RC,,,,,,,,both,,,4224.0000,633.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4224.00,,,,,,,1090.2100,4224.0000,percent of total billed charges,"100% of $4,224.00 in Billed Charges for Rev 272 = $4,224.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR HOOK 3.5,272,RC,,,,,,,,both,,,4224.0000,633.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2112.00,,,,,,,1090.2100,4224.0000,percent of total billed charges,"Rev 272 $4,224.00 in Billed Charges at 50% = $2,112.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR HOOK 3.5,272,RC,,,,,,,,both,,,4224.0000,633.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1364.35,,,,,,,1090.2100,4224.0000,other,"32.3% of $4,224.00 in Billed Charges for Rev 272 = $1,364.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND VAPR HOOK 3.5,272,RC,,,,,,,,both,,,4224.0000,633.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1296.77,,,,,,,1090.2100,4224.0000,other,"30.7% of $4,224.00 in Billed Charges for Rev 272 = $1,296.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND VAPR HOOK 3.5,272,RC,,,,,,,,both,,,4224.0000,633.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,1364.35,,,,,,,1090.2100,4224.0000,percent of total billed charges,"32.3% of $4,224.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR HOOK 3.5,272,RC,,,,,,,,both,,,4224.0000,633.6000,WELLCARE,WELLCARE MEDICAID,4224.00,,,,,,,1090.2100,4224.0000,percent of total billed charges,"100% of $4,224.00 in Billed Charges for Rev 272 = $4,224.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIPE BABY SENSITIVE PAMPERS NO ALCOHOL OR FRAGRANCE,270,RC,,,,,,,,both,,,2.4800,0.3700,AETNA,AETNA,1.06,,,,,,,0.6400,2.4800,percent of total billed charges,42.7% of $2.48 in Billed Charges for Rev 270 = $1.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WIPE BABY SENSITIVE PAMPERS NO ALCOHOL OR FRAGRANCE,270,RC,,,,,,,,both,,,2.4800,0.3700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1.74,,,,,,,0.6400,2.4800,percent of total billed charges,Rev 270 $2.48 in Billed Charges at 70% = $1.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WIPE BABY SENSITIVE PAMPERS NO ALCOHOL OR FRAGRANCE,270,RC,,,,,,,,both,,,2.4800,0.3700,CIGNA HEALTHCARE,CIGNA HMO,1.03,,,,,,,0.6400,2.4800,percent of total billed charges,41.7% of $2.48 in Billed Charges for Rev 270 = $1.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WIPE BABY SENSITIVE PAMPERS NO ALCOHOL OR FRAGRANCE,270,RC,,,,,,,,both,,,2.4800,0.3700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1.15,,,,,,,0.6400,2.4800,percent of total billed charges,46.4% of $2.48 in Billed Charges for Rev 270 = $1.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WIPE BABY SENSITIVE PAMPERS NO ALCOHOL OR FRAGRANCE,270,RC,,,,,,,,both,,,2.4800,0.3700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1.03,,,,,,,0.6400,2.4800,percent of total billed charges,41.7% of $2.48 in Billed Charges for Rev 270 = $1.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WIPE BABY SENSITIVE PAMPERS NO ALCOHOL OR FRAGRANCE,270,RC,,,,,,,,both,,,2.4800,0.3700,CIGNA HEALTHCARE,CIGNA PPO,1.03,,,,,,,0.6400,2.4800,percent of total billed charges,41.7% of $2.48 in Billed Charges for Rev 270 = $1.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WIPE BABY SENSITIVE PAMPERS NO ALCOHOL OR FRAGRANCE,270,RC,,,,,,,,both,,,2.4800,0.3700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2.23,,,,,,,0.6400,2.4800,percent of total billed charges,90% of $2.48 in Billed Charges for Rev 270 = $2.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WIPE BABY SENSITIVE PAMPERS NO ALCOHOL OR FRAGRANCE,270,RC,,,,,,,,both,,,2.4800,0.3700,MEDCOST,MEDCOST VHN,1.18,,,,,,,0.6400,2.4800,percent of total billed charges,47.59% of $2.48 in Billed Charges for Rev 270 = $1.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WIPE BABY SENSITIVE PAMPERS NO ALCOHOL OR FRAGRANCE,270,RC,,,,,,,,both,,,2.4800,0.3700,SENTARA HEALTH,SENTARA HEALTH,0.64,,,,,,,0.6400,2.4800,percent of total billed charges,25.81% of $2.48 in Billed Charges for Rev 270 = $0.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WIPE BABY SENSITIVE PAMPERS NO ALCOHOL OR FRAGRANCE,270,RC,,,,,,,,both,,,2.4800,0.3700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2.48,,,,,,,0.6400,2.4800,percent of total billed charges,100% of $2.48 in Billed Charges for Rev 270 = $2.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WIPE BABY SENSITIVE PAMPERS NO ALCOHOL OR FRAGRANCE,270,RC,,,,,,,,both,,,2.4800,0.3700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1.24,,,,,,,0.6400,2.4800,percent of total billed charges,Rev 270 $2.48 in Billed Charges at 50% = $1.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WIPE BABY SENSITIVE PAMPERS NO ALCOHOL OR FRAGRANCE,270,RC,,,,,,,,both,,,2.4800,0.3700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,0.80,,,,,,,0.6400,2.4800,other,32.3% of $2.48 in Billed Charges for Rev 270 = $0.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WIPE BABY SENSITIVE PAMPERS NO ALCOHOL OR FRAGRANCE,270,RC,,,,,,,,both,,,2.4800,0.3700,UNITED HEALTHCARE,UHC HERITAGE SELECT,0.76,,,,,,,0.6400,2.4800,other,30.7% of $2.48 in Billed Charges for Rev 270 = $0.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WIPE BABY SENSITIVE PAMPERS NO ALCOHOL OR FRAGRANCE,270,RC,,,,,,,,both,,,2.4800,0.3700,UNITED HEALTHCARE,UNITED HEALTHCARE,0.80,,,,,,,0.6400,2.4800,percent of total billed charges,32.3% of $2.48 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WIPE BABY SENSITIVE PAMPERS NO ALCOHOL OR FRAGRANCE,270,RC,,,,,,,,both,,,2.4800,0.3700,WELLCARE,WELLCARE MEDICAID,2.48,,,,,,,0.6400,2.4800,percent of total billed charges,100% of $2.48 in Billed Charges for Rev 270 = $2.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
WIRE GUIDE FLUTED TIP 2.8 X 300MM,272,RC,27200002,CDM,,,,,,both,,,1089.5800,163.4400,AETNA,AETNA,465.25,,,,,,,281.2200,1089.5800,percent of total billed charges,"42.7% of $1,089.58 in Billed Charges for Rev 272 = $465.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIRE GUIDE FLUTED TIP 2.8 X 300MM,272,RC,27200002,CDM,,,,,,both,,,1089.5800,163.4400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,762.71,,,,,,,281.2200,1089.5800,percent of total billed charges,"Rev 272 $1,089.58 in Billed Charges at 70% = $762.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIRE GUIDE FLUTED TIP 2.8 X 300MM,272,RC,27200002,CDM,,,,,,both,,,1089.5800,163.4400,CIGNA HEALTHCARE,CIGNA HMO,454.35,,,,,,,281.2200,1089.5800,percent of total billed charges,"41.7% of $1,089.58 in Billed Charges for Rev 272 = $454.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIRE GUIDE FLUTED TIP 2.8 X 300MM,272,RC,27200002,CDM,,,,,,both,,,1089.5800,163.4400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,505.57,,,,,,,281.2200,1089.5800,percent of total billed charges,"46.4% of $1,089.58 in Billed Charges for Rev 272 = $505.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIRE GUIDE FLUTED TIP 2.8 X 300MM,272,RC,27200002,CDM,,,,,,both,,,1089.5800,163.4400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,454.35,,,,,,,281.2200,1089.5800,percent of total billed charges,"41.7% of $1,089.58 in Billed Charges for Rev 272 = $454.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIRE GUIDE FLUTED TIP 2.8 X 300MM,272,RC,27200002,CDM,,,,,,both,,,1089.5800,163.4400,CIGNA HEALTHCARE,CIGNA PPO,454.35,,,,,,,281.2200,1089.5800,percent of total billed charges,"41.7% of $1,089.58 in Billed Charges for Rev 272 = $454.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIRE GUIDE FLUTED TIP 2.8 X 300MM,272,RC,27200002,CDM,,,,,,both,,,1089.5800,163.4400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,980.62,,,,,,,281.2200,1089.5800,percent of total billed charges,"90% of $1,089.58 in Billed Charges for Rev 272 = $980.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIRE GUIDE FLUTED TIP 2.8 X 300MM,272,RC,27200002,CDM,,,,,,both,,,1089.5800,163.4400,MEDCOST,MEDCOST VHN,518.53,,,,,,,281.2200,1089.5800,percent of total billed charges,"47.59% of $1,089.58 in Billed Charges for Rev 272 = $518.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIRE GUIDE FLUTED TIP 2.8 X 300MM,272,RC,27200002,CDM,,,,,,both,,,1089.5800,163.4400,SENTARA HEALTH,SENTARA HEALTH,281.22,,,,,,,281.2200,1089.5800,percent of total billed charges,"25.81% of $1,089.58 in Billed Charges for Rev 272 = $281.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIRE GUIDE FLUTED TIP 2.8 X 300MM,272,RC,27200002,CDM,,,,,,both,,,1089.5800,163.4400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1089.58,,,,,,,281.2200,1089.5800,percent of total billed charges,"100% of $1,089.58 in Billed Charges for Rev 272 = $1,089.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIRE GUIDE FLUTED TIP 2.8 X 300MM,272,RC,27200002,CDM,,,,,,both,,,1089.5800,163.4400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,544.79,,,,,,,281.2200,1089.5800,percent of total billed charges,"Rev 272 $1,089.58 in Billed Charges at 50% = $544.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIRE GUIDE FLUTED TIP 2.8 X 300MM,272,RC,27200002,CDM,,,,,,both,,,1089.5800,163.4400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,351.93,,,,,,,281.2200,1089.5800,other,"32.3% of $1,089.58 in Billed Charges for Rev 272 = $351.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WIRE GUIDE FLUTED TIP 2.8 X 300MM,272,RC,27200002,CDM,,,,,,both,,,1089.5800,163.4400,UNITED HEALTHCARE,UHC HERITAGE SELECT,334.50,,,,,,,281.2200,1089.5800,other,"30.7% of $1,089.58 in Billed Charges for Rev 272 = $334.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WIRE GUIDE FLUTED TIP 2.8 X 300MM,272,RC,27200002,CDM,,,,,,both,,,1089.5800,163.4400,UNITED HEALTHCARE,UNITED HEALTHCARE,351.93,,,,,,,281.2200,1089.5800,percent of total billed charges,"32.3% of $1,089.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIRE GUIDE FLUTED TIP 2.8 X 300MM,272,RC,27200002,CDM,,,,,,both,,,1089.5800,163.4400,WELLCARE,WELLCARE MEDICAID,1089.58,,,,,,,281.2200,1089.5800,percent of total billed charges,"100% of $1,089.58 in Billed Charges for Rev 272 = $1,089.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE TAPE TIGER,272,RC,27200002,CDM,,,,,,both,,,606.7000,91.0100,AETNA,AETNA,259.06,,,,,,,156.5900,606.7000,percent of total billed charges,42.7% of $606.70 in Billed Charges for Rev 272 = $259.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE TIGER,272,RC,27200002,CDM,,,,,,both,,,606.7000,91.0100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,424.69,,,,,,,156.5900,606.7000,percent of total billed charges,Rev 272 $606.70 in Billed Charges at 70% = $424.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE TIGER,272,RC,27200002,CDM,,,,,,both,,,606.7000,91.0100,CIGNA HEALTHCARE,CIGNA HMO,252.99,,,,,,,156.5900,606.7000,percent of total billed charges,41.7% of $606.70 in Billed Charges for Rev 272 = $252.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE TIGER,272,RC,27200002,CDM,,,,,,both,,,606.7000,91.0100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,281.51,,,,,,,156.5900,606.7000,percent of total billed charges,46.4% of $606.70 in Billed Charges for Rev 272 = $281.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE TIGER,272,RC,27200002,CDM,,,,,,both,,,606.7000,91.0100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,252.99,,,,,,,156.5900,606.7000,percent of total billed charges,41.7% of $606.70 in Billed Charges for Rev 272 = $252.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE TIGER,272,RC,27200002,CDM,,,,,,both,,,606.7000,91.0100,CIGNA HEALTHCARE,CIGNA PPO,252.99,,,,,,,156.5900,606.7000,percent of total billed charges,41.7% of $606.70 in Billed Charges for Rev 272 = $252.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE TIGER,272,RC,27200002,CDM,,,,,,both,,,606.7000,91.0100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,546.03,,,,,,,156.5900,606.7000,percent of total billed charges,90% of $606.70 in Billed Charges for Rev 272 = $546.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE TIGER,272,RC,27200002,CDM,,,,,,both,,,606.7000,91.0100,MEDCOST,MEDCOST VHN,288.73,,,,,,,156.5900,606.7000,percent of total billed charges,47.59% of $606.70 in Billed Charges for Rev 272 = $288.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE TIGER,272,RC,27200002,CDM,,,,,,both,,,606.7000,91.0100,SENTARA HEALTH,SENTARA HEALTH,156.59,,,,,,,156.5900,606.7000,percent of total billed charges,25.81% of $606.70 in Billed Charges for Rev 272 = $156.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE TIGER,272,RC,27200002,CDM,,,,,,both,,,606.7000,91.0100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",606.70,,,,,,,156.5900,606.7000,percent of total billed charges,100% of $606.70 in Billed Charges for Rev 272 = $606.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE TIGER,272,RC,27200002,CDM,,,,,,both,,,606.7000,91.0100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,303.35,,,,,,,156.5900,606.7000,percent of total billed charges,Rev 272 $606.70 in Billed Charges at 50% = $303.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE TIGER,272,RC,27200002,CDM,,,,,,both,,,606.7000,91.0100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,195.96,,,,,,,156.5900,606.7000,other,32.3% of $606.70 in Billed Charges for Rev 272 = $195.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE TAPE TIGER,272,RC,27200002,CDM,,,,,,both,,,606.7000,91.0100,UNITED HEALTHCARE,UHC HERITAGE SELECT,186.26,,,,,,,156.5900,606.7000,other,30.7% of $606.70 in Billed Charges for Rev 272 = $186.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE TAPE TIGER,272,RC,27200002,CDM,,,,,,both,,,606.7000,91.0100,UNITED HEALTHCARE,UNITED HEALTHCARE,195.96,,,,,,,156.5900,606.7000,percent of total billed charges,32.3% of $606.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TAPE TIGER,272,RC,27200002,CDM,,,,,,both,,,606.7000,91.0100,WELLCARE,WELLCARE MEDICAID,606.70,,,,,,,156.5900,606.7000,percent of total billed charges,100% of $606.70 in Billed Charges for Rev 272 = $606.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TIGERLINK,272,RC,,,,,,,,both,,,674.1200,101.1200,AETNA,AETNA,287.85,,,,,,,173.9900,674.1200,percent of total billed charges,42.7% of $674.12 in Billed Charges for Rev 272 = $287.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TIGERLINK,272,RC,,,,,,,,both,,,674.1200,101.1200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,471.88,,,,,,,173.9900,674.1200,percent of total billed charges,Rev 272 $674.12 in Billed Charges at 70% = $471.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TIGERLINK,272,RC,,,,,,,,both,,,674.1200,101.1200,CIGNA HEALTHCARE,CIGNA HMO,281.11,,,,,,,173.9900,674.1200,percent of total billed charges,41.7% of $674.12 in Billed Charges for Rev 272 = $281.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TIGERLINK,272,RC,,,,,,,,both,,,674.1200,101.1200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,312.79,,,,,,,173.9900,674.1200,percent of total billed charges,46.4% of $674.12 in Billed Charges for Rev 272 = $312.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TIGERLINK,272,RC,,,,,,,,both,,,674.1200,101.1200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,281.11,,,,,,,173.9900,674.1200,percent of total billed charges,41.7% of $674.12 in Billed Charges for Rev 272 = $281.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TIGERLINK,272,RC,,,,,,,,both,,,674.1200,101.1200,CIGNA HEALTHCARE,CIGNA PPO,281.11,,,,,,,173.9900,674.1200,percent of total billed charges,41.7% of $674.12 in Billed Charges for Rev 272 = $281.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TIGERLINK,272,RC,,,,,,,,both,,,674.1200,101.1200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,606.71,,,,,,,173.9900,674.1200,percent of total billed charges,90% of $674.12 in Billed Charges for Rev 272 = $606.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TIGERLINK,272,RC,,,,,,,,both,,,674.1200,101.1200,MEDCOST,MEDCOST VHN,320.81,,,,,,,173.9900,674.1200,percent of total billed charges,47.59% of $674.12 in Billed Charges for Rev 272 = $320.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TIGERLINK,272,RC,,,,,,,,both,,,674.1200,101.1200,SENTARA HEALTH,SENTARA HEALTH,173.99,,,,,,,173.9900,674.1200,percent of total billed charges,25.81% of $674.12 in Billed Charges for Rev 272 = $173.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TIGERLINK,272,RC,,,,,,,,both,,,674.1200,101.1200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",674.12,,,,,,,173.9900,674.1200,percent of total billed charges,100% of $674.12 in Billed Charges for Rev 272 = $674.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TIGERLINK,272,RC,,,,,,,,both,,,674.1200,101.1200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,337.06,,,,,,,173.9900,674.1200,percent of total billed charges,Rev 272 $674.12 in Billed Charges at 50% = $337.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TIGERLINK,272,RC,,,,,,,,both,,,674.1200,101.1200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,217.74,,,,,,,173.9900,674.1200,other,32.3% of $674.12 in Billed Charges for Rev 272 = $217.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE TIGERLINK,272,RC,,,,,,,,both,,,674.1200,101.1200,UNITED HEALTHCARE,UHC HERITAGE SELECT,206.95,,,,,,,173.9900,674.1200,other,30.7% of $674.12 in Billed Charges for Rev 272 = $206.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE TIGERLINK,272,RC,,,,,,,,both,,,674.1200,101.1200,UNITED HEALTHCARE,UNITED HEALTHCARE,217.74,,,,,,,173.9900,674.1200,percent of total billed charges,32.3% of $674.12 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE TIGERLINK,272,RC,,,,,,,,both,,,674.1200,101.1200,WELLCARE,WELLCARE MEDICAID,674.12,,,,,,,173.9900,674.1200,percent of total billed charges,100% of $674.12 in Billed Charges for Rev 272 = $674.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,AETNA,AETNA,920.19,,,,,,,152.0400,3266.6300,percent of total billed charges,"42.7% of $2,155.00 in Billed Charges for Rev 521 Proc 11423 = $920.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1775.80,,,,,,,152.0400,3266.6300,fee schedule,"APG 00010 Proc 11423 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 104% = $1,775.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,152.0400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,152.0400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,152.0400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,AMBETTER,AMBETTER,3266.63,,,,,,,152.0400,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,152.0400,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,BLUE CROSS,ANTHEM EXCHANGE,2155.00,,,,,,,152.0400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1758.73,,,,,,,152.0400,3266.6300,fee schedule,"APG 00010 Proc 11423 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,BLUE CROSS,ANTHEM HMO,2155.00,,,,,,,152.0400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,152.0400,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2155.00,,,,,,,152.0400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,152.04,,,,,,,152.0400,3266.6300,fee schedule,$152.04 from Fee Schedule BLDTM_23 for Rev 521 Proc 11423 * Qty 1 = $152.04 at 100% = $152.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,152.0400,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,CIGNA HEALTHCARE,CIGNA HMO,898.64,,,,,,,152.0400,3266.6300,percent of total billed charges,"41.7% of $2,155.00 in Billed Charges for Rev 521 Proc 11423 = $898.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,999.92,,,,,,,152.0400,3266.6300,percent of total billed charges,"46.4% of $2,155.00 in Billed Charges for Rev 521 Proc 11423 = $999.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,152.0400,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,898.64,,,,,,,152.0400,3266.6300,percent of total billed charges,"41.7% of $2,155.00 in Billed Charges for Rev 521 Proc 11423 = $898.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,CIGNA HEALTHCARE,CIGNA PPO,898.64,,,,,,,152.0400,3266.6300,percent of total billed charges,"41.7% of $2,155.00 in Billed Charges for Rev 521 Proc 11423 = $898.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,152.0400,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1939.50,,,,,,,152.0400,3266.6300,percent of total billed charges,"90% of $2,155.00 in Billed Charges for Rev 521 Proc 11423 = $1,939.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,152.0400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,152.0400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,MEDCOST,MEDCOST VHN,1025.56,,,,,,,152.0400,3266.6300,percent of total billed charges,"47.59% of $2,155.00 in Billed Charges for Rev 521 Proc 11423 = $1,025.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1792.88,,,,,,,152.0400,3266.6300,fee schedule,"APG 00010 Proc 11423 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 105% = $1,792.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,152.0400,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,152.0400,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,152.0400,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1760.43,,,,,,,152.0400,3266.6300,fee schedule,"APG 00010 Proc 11423 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 103.1% = $1,760.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,SENTARA HEALTH,SENTARA HEALTH,556.21,,,,,,,152.0400,3266.6300,percent of total billed charges,"25.81% of $2,155.00 in Billed Charges for Rev 521 Proc 11423 = $556.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,152.0400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2155.00,,,,,,,152.0400,3266.6300,percent of total billed charges,"100% of $2,155.00 in Billed Charges for Rev 521 Proc 11423 = $2,155.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,670.71,,,,,,,152.0400,3266.6300,fee schedule,"$1,341.41 from Fee Schedule TCUHC24 for Rev 521 Proc 11423 * Qty 1 = $1,341.41 at 50% = $670.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1758.73,,,,,,,152.0400,3266.6300,fee schedule,"APG 00010 Proc 11423 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,152.0400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,152.0400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,WELLCARE,WELLCARE MEDICAID,2155.00,,,,,,,152.0400,3266.6300,percent of total billed charges,"100% of $2,155.00 in Billed Charges for Rev 521 Proc 11423 = $2,155.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0 CM,11423,CPT,521,RC,52100031,CDM,,,,both,,,2155.0000,323.2500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,152.0400,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,AETNA,AETNA,836.07,,,,,,,152.0400,3266.6300,percent of total billed charges,"42.7% of $1,958.00 in Billed Charges for Rev 510 Proc 11423 = $836.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1775.80,,,,,,,152.0400,3266.6300,fee schedule,"APG 00010 Proc 11423 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 104% = $1,775.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,152.0400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,152.0400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,152.0400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,AMBETTER,AMBETTER,3266.63,,,,,,,152.0400,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,152.0400,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,BLUE CROSS,ANTHEM EXCHANGE,1958.00,,,,,,,152.0400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1758.73,,,,,,,152.0400,3266.6300,fee schedule,"APG 00010 Proc 11423 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,BLUE CROSS,ANTHEM HMO,1958.00,,,,,,,152.0400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,152.0400,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1958.00,,,,,,,152.0400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,152.04,,,,,,,152.0400,3266.6300,fee schedule,$152.04 from Fee Schedule BLDTM_23 for Rev 510 Proc 11423 * Qty 1 = $152.04 at 100% = $152.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,152.0400,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,CIGNA HEALTHCARE,CIGNA HMO,816.49,,,,,,,152.0400,3266.6300,percent of total billed charges,"41.7% of $1,958.00 in Billed Charges for Rev 510 Proc 11423 = $816.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,908.51,,,,,,,152.0400,3266.6300,percent of total billed charges,"46.4% of $1,958.00 in Billed Charges for Rev 510 Proc 11423 = $908.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,152.0400,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,816.49,,,,,,,152.0400,3266.6300,percent of total billed charges,"41.7% of $1,958.00 in Billed Charges for Rev 510 Proc 11423 = $816.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,CIGNA HEALTHCARE,CIGNA PPO,816.49,,,,,,,152.0400,3266.6300,percent of total billed charges,"41.7% of $1,958.00 in Billed Charges for Rev 510 Proc 11423 = $816.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,152.0400,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1762.20,,,,,,,152.0400,3266.6300,percent of total billed charges,"90% of $1,958.00 in Billed Charges for Rev 510 Proc 11423 = $1,762.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,152.0400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,152.0400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,MEDCOST,MEDCOST VHN,931.81,,,,,,,152.0400,3266.6300,percent of total billed charges,"47.59% of $1,958.00 in Billed Charges for Rev 510 Proc 11423 = $931.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1792.88,,,,,,,152.0400,3266.6300,fee schedule,"APG 00010 Proc 11423 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 105% = $1,792.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,152.0400,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,152.0400,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,152.0400,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1760.43,,,,,,,152.0400,3266.6300,fee schedule,"APG 00010 Proc 11423 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 103.1% = $1,760.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,SENTARA HEALTH,SENTARA HEALTH,505.36,,,,,,,152.0400,3266.6300,percent of total billed charges,"25.81% of $1,958.00 in Billed Charges for Rev 510 Proc 11423 = $505.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,152.0400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1958.00,,,,,,,152.0400,3266.6300,percent of total billed charges,"100% of $1,958.00 in Billed Charges for Rev 510 Proc 11423 = $1,958.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,670.71,,,,,,,152.0400,3266.6300,fee schedule,"$1,341.41 from Fee Schedule TCUHC24 for Rev 510 Proc 11423 * Qty 1 = $1,341.41 at 50% = $670.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,632.43,,,,,,,152.0400,3266.6300,other,"32.3% of $1,958.00 in Billed Charges for Rev 510 Proc 11423 = $632.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,601.11,,,,,,,152.0400,3266.6300,other,"30.7% of $1,958.00 in Billed Charges for Rev 510 Proc 11423 = $601.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,632.43,,,,,,,152.0400,3266.6300,percent of total billed charges,"32.3% of $1,958.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1758.73,,,,,,,152.0400,3266.6300,fee schedule,"APG 00010 Proc 11423 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,152.0400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,152.0400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,WELLCARE,WELLCARE MEDICAID,1958.00,,,,,,,152.0400,3266.6300,percent of total billed charges,"100% of $1,958.00 in Billed Charges for Rev 510 Proc 11423 = $1,958.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 2.1-3 CM REMAINDR BODY,11423,CPT,510,RC,51000120,CDM,,,,both,,,1958.0000,293.7000,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,152.0400,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,AETNA,AETNA,1011.56,,,,,,,164.4300,3266.6300,percent of total billed charges,"42.7% of $2,369.00 in Billed Charges for Rev 521 Proc 11424 = $1,011.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1775.80,,,,,,,164.4300,3266.6300,fee schedule,"APG 00010 Proc 11424 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 104% = $1,775.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,164.4300,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,164.4300,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,164.4300,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,AMBETTER,AMBETTER,3266.63,,,,,,,164.4300,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,164.4300,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,BLUE CROSS,ANTHEM EXCHANGE,2369.00,,,,,,,164.4300,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1758.73,,,,,,,164.4300,3266.6300,fee schedule,"APG 00010 Proc 11424 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,BLUE CROSS,ANTHEM HMO,2369.00,,,,,,,164.4300,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,164.4300,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2369.00,,,,,,,164.4300,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,164.43,,,,,,,164.4300,3266.6300,fee schedule,$164.43 from Fee Schedule BLDTM_23 for Rev 521 Proc 11424 * Qty 1 = $164.43 at 100% = $164.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,164.4300,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,CIGNA HEALTHCARE,CIGNA HMO,987.87,,,,,,,164.4300,3266.6300,percent of total billed charges,"41.7% of $2,369.00 in Billed Charges for Rev 521 Proc 11424 = $987.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1099.22,,,,,,,164.4300,3266.6300,percent of total billed charges,"46.4% of $2,369.00 in Billed Charges for Rev 521 Proc 11424 = $1,099.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,164.4300,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,987.87,,,,,,,164.4300,3266.6300,percent of total billed charges,"41.7% of $2,369.00 in Billed Charges for Rev 521 Proc 11424 = $987.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,CIGNA HEALTHCARE,CIGNA PPO,987.87,,,,,,,164.4300,3266.6300,percent of total billed charges,"41.7% of $2,369.00 in Billed Charges for Rev 521 Proc 11424 = $987.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,164.4300,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2132.10,,,,,,,164.4300,3266.6300,percent of total billed charges,"90% of $2,369.00 in Billed Charges for Rev 521 Proc 11424 = $2,132.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,164.4300,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,164.4300,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,MEDCOST,MEDCOST VHN,1127.41,,,,,,,164.4300,3266.6300,percent of total billed charges,"47.59% of $2,369.00 in Billed Charges for Rev 521 Proc 11424 = $1,127.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1792.88,,,,,,,164.4300,3266.6300,fee schedule,"APG 00010 Proc 11424 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 105% = $1,792.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,164.4300,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,164.4300,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,164.4300,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1760.43,,,,,,,164.4300,3266.6300,fee schedule,"APG 00010 Proc 11424 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 103.1% = $1,760.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,SENTARA HEALTH,SENTARA HEALTH,611.44,,,,,,,164.4300,3266.6300,percent of total billed charges,"25.81% of $2,369.00 in Billed Charges for Rev 521 Proc 11424 = $611.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,164.4300,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2369.00,,,,,,,164.4300,3266.6300,percent of total billed charges,"100% of $2,369.00 in Billed Charges for Rev 521 Proc 11424 = $2,369.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,670.71,,,,,,,164.4300,3266.6300,fee schedule,"$1,341.41 from Fee Schedule TCUHC24 for Rev 521 Proc 11424 * Qty 1 = $1,341.41 at 50% = $670.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1758.73,,,,,,,164.4300,3266.6300,fee schedule,"APG 00010 Proc 11424 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,164.4300,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,164.4300,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,WELLCARE,WELLCARE MEDICAID,2369.00,,,,,,,164.4300,3266.6300,percent of total billed charges,"100% of $2,369.00 in Billed Charges for Rev 521 Proc 11424 = $2,369.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM,11424,CPT,521,RC,52100161,CDM,,,,both,,,2369.0000,355.3500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,164.4300,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,AETNA,AETNA,386.01,,,,,,,34.5300,1400.5900,percent of total billed charges,42.7% of $904.00 in Billed Charges for Rev 521 Proc 11440 = $386.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,34.5300,1400.5900,fee schedule,"APG 00009 Proc 11440 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,34.5300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,34.5300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,34.5300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,AMBETTER,AMBETTER,1400.59,,,,,,,34.5300,1400.5900,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,34.5300,1400.5900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,BLUE CROSS,ANTHEM EXCHANGE,904.00,,,,,,,34.5300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,34.5300,1400.5900,fee schedule,"APG 00009 Proc 11440 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,BLUE CROSS,ANTHEM HMO,904.00,,,,,,,34.5300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,34.5300,1400.5900,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",904.00,,,,,,,34.5300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,90.08,,,,,,,34.5300,1400.5900,fee schedule,$90.08 from Fee Schedule BLDTM_23 for Rev 521 Proc 11440 * Qty 1 = $90.08 at 100% = $90.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,34.5300,1400.5900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,BLUE CROSS,TENNCARE BLUE CARE,34.53,,,,,,,34.5300,1400.5900,fee schedule,$29.77 from Fee Schedule TC_24 for Rev 521 Proc 11440 * Qty 1 = $29.77 at 116% = $34.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,BLUE CROSS,TENNCARE BLUE SELECT,34.53,,,,,,,34.5300,1400.5900,fee schedule,$29.77 from Fee Schedule TC_24 for Rev 521 Proc 11440 * Qty 1 = $29.77 at 116% = $34.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,CIGNA HEALTHCARE,CIGNA HMO,376.97,,,,,,,34.5300,1400.5900,percent of total billed charges,41.7% of $904.00 in Billed Charges for Rev 521 Proc 11440 = $376.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,419.46,,,,,,,34.5300,1400.5900,percent of total billed charges,46.4% of $904.00 in Billed Charges for Rev 521 Proc 11440 = $419.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,34.5300,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,376.97,,,,,,,34.5300,1400.5900,percent of total billed charges,41.7% of $904.00 in Billed Charges for Rev 521 Proc 11440 = $376.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,CIGNA HEALTHCARE,CIGNA PPO,376.97,,,,,,,34.5300,1400.5900,percent of total billed charges,41.7% of $904.00 in Billed Charges for Rev 521 Proc 11440 = $376.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,34.5300,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,813.60,,,,,,,34.5300,1400.5900,percent of total billed charges,90% of $904.00 in Billed Charges for Rev 521 Proc 11440 = $813.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,HUMANA,HUMANA MEDICARE,642.47,,,,,,,34.5300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,34.5300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,MEDCOST,MEDCOST VHN,430.21,,,,,,,34.5300,1400.5900,percent of total billed charges,47.59% of $904.00 in Billed Charges for Rev 521 Proc 11440 = $430.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,34.5300,1400.5900,fee schedule,"APG 00009 Proc 11440 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,34.5300,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,34.5300,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,34.5300,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,34.5300,1400.5900,fee schedule,"APG 00009 Proc 11440 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,SENTARA HEALTH,SENTARA HEALTH,233.32,,,,,,,34.5300,1400.5900,percent of total billed charges,25.81% of $904.00 in Billed Charges for Rev 521 Proc 11440 = $233.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,34.5300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",904.00,,,,,,,34.5300,1400.5900,percent of total billed charges,100% of $904.00 in Billed Charges for Rev 521 Proc 11440 = $904.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,189.28,,,,,,,34.5300,1400.5900,fee schedule,$378.56 from Fee Schedule TCUHC24 for Rev 521 Proc 11440 * Qty 1 = $378.56 at 50% = $189.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,34.5300,1400.5900,fee schedule,"APG 00009 Proc 11440 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,34.5300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,34.5300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,WELLCARE,WELLCARE MEDICAID,904.00,,,,,,,34.5300,1400.5900,percent of total billed charges,100% of $904.00 in Billed Charges for Rev 521 Proc 11440 = $904.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM OR LESS,11440,CPT,521,RC,52100033,CDM,,,,both,,,904.0000,135.6000,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,34.5300,1400.5900,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,AETNA,AETNA,920.19,,,,,,,45.5200,2155.0000,percent of total billed charges,"42.7% of $2,155.00 in Billed Charges for Rev 510 Proc 11441 = $920.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,45.5200,2155.0000,fee schedule,"APG 00009 Proc 11441 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,45.5200,2155.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,45.5200,2155.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,45.5200,2155.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,AMBETTER,AMBETTER,1400.59,,,,,,,45.5200,2155.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,45.5200,2155.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,45.5200,2155.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,45.5200,2155.0000,fee schedule,"APG 00009 Proc 11441 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,45.5200,2155.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,45.5200,2155.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1977.02,,,,,,,45.5200,2155.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,115.21,,,,,,,45.5200,2155.0000,fee schedule,$115.21 from Fee Schedule BLDTM_23 for Rev 510 Proc 11441 * Qty 1 = $115.21 at 100% = $115.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,45.5200,2155.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,BLUE CROSS,TENNCARE BLUE CARE,45.52,,,,,,,45.5200,2155.0000,fee schedule,$39.24 from Fee Schedule TC_24 for Rev 510 Proc 11441 * Qty 1 = $39.24 at 116% = $45.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,BLUE CROSS,TENNCARE BLUE SELECT,45.52,,,,,,,45.5200,2155.0000,fee schedule,$39.24 from Fee Schedule TC_24 for Rev 510 Proc 11441 * Qty 1 = $39.24 at 116% = $45.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,CIGNA HEALTHCARE,CIGNA HMO,898.64,,,,,,,45.5200,2155.0000,percent of total billed charges,"41.7% of $2,155.00 in Billed Charges for Rev 510 Proc 11441 = $898.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,999.92,,,,,,,45.5200,2155.0000,percent of total billed charges,"46.4% of $2,155.00 in Billed Charges for Rev 510 Proc 11441 = $999.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,45.5200,2155.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,898.64,,,,,,,45.5200,2155.0000,percent of total billed charges,"41.7% of $2,155.00 in Billed Charges for Rev 510 Proc 11441 = $898.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,CIGNA HEALTHCARE,CIGNA PPO,898.64,,,,,,,45.5200,2155.0000,percent of total billed charges,"41.7% of $2,155.00 in Billed Charges for Rev 510 Proc 11441 = $898.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,45.5200,2155.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1939.50,,,,,,,45.5200,2155.0000,percent of total billed charges,"90% of $2,155.00 in Billed Charges for Rev 510 Proc 11441 = $1,939.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,HUMANA,HUMANA MEDICARE,642.47,,,,,,,45.5200,2155.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,45.5200,2155.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,MEDCOST,MEDCOST VHN,1025.56,,,,,,,45.5200,2155.0000,percent of total billed charges,"47.59% of $2,155.00 in Billed Charges for Rev 510 Proc 11441 = $1,025.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,45.5200,2155.0000,fee schedule,"APG 00009 Proc 11441 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,45.5200,2155.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,45.5200,2155.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,45.5200,2155.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,45.5200,2155.0000,fee schedule,"APG 00009 Proc 11441 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,SENTARA HEALTH,SENTARA HEALTH,556.21,,,,,,,45.5200,2155.0000,percent of total billed charges,"25.81% of $2,155.00 in Billed Charges for Rev 510 Proc 11441 = $556.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,45.5200,2155.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2155.00,,,,,,,45.5200,2155.0000,percent of total billed charges,"100% of $2,155.00 in Billed Charges for Rev 510 Proc 11441 = $2,155.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,189.28,,,,,,,45.5200,2155.0000,fee schedule,$378.56 from Fee Schedule TCUHC24 for Rev 510 Proc 11441 * Qty 1 = $378.56 at 50% = $189.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,696.07,,,,,,,45.5200,2155.0000,other,"32.3% of $2,155.00 in Billed Charges for Rev 510 Proc 11441 = $696.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,661.59,,,,,,,45.5200,2155.0000,other,"30.7% of $2,155.00 in Billed Charges for Rev 510 Proc 11441 = $661.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,696.07,,,,,,,45.5200,2155.0000,percent of total billed charges,"32.3% of $2,155.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,45.5200,2155.0000,fee schedule,"APG 00009 Proc 11441 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,45.5200,2155.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,45.5200,2155.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,WELLCARE,WELLCARE MEDICAID,2155.00,,,,,,,45.5200,2155.0000,percent of total billed charges,"100% of $2,155.00 in Billed Charges for Rev 510 Proc 11441 = $2,155.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 0.6-1 CM FACE FACIAL,11441,CPT,510,RC,51000122,CDM,,,,both,,,2155.0000,323.2500,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,45.5200,2155.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,AETNA,AETNA,467.14,,,,,,,176.3000,3266.6300,percent of total billed charges,"42.7% of $1,094.00 in Billed Charges for Rev 521 Proc 11443 = $467.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1775.80,,,,,,,176.3000,3266.6300,fee schedule,"APG 00010 Proc 11443 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 104% = $1,775.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1094.00,,,,,,,176.3000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,AETNA,AETNA HEALTHCARE MEDICARE,1094.00,,,,,,,176.3000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,1094.00,,,,,,,176.3000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,AMBETTER,AMBETTER,3266.63,,,,,,,176.3000,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1094.00,,,,,,,176.3000,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,BLUE CROSS,ANTHEM EXCHANGE,1094.00,,,,,,,176.3000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1094.00,,,,,,,176.3000,3266.6300,fee schedule,"APG 00010 Proc 11443 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73 (Service Line reduced to $1,094.00, claim capped at $1,094.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,BLUE CROSS,ANTHEM HMO,1094.00,,,,,,,176.3000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1094.00,,,,,,,176.3000,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1094.00,,,,,,,176.3000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,176.30,,,,,,,176.3000,3266.6300,fee schedule,$176.30 from Fee Schedule BLDTM_23 for Rev 521 Proc 11443 * Qty 1 = $176.30 at 100% = $176.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,176.3000,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,CIGNA HEALTHCARE,CIGNA HMO,456.20,,,,,,,176.3000,3266.6300,percent of total billed charges,"41.7% of $1,094.00 in Billed Charges for Rev 521 Proc 11443 = $456.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,507.62,,,,,,,176.3000,3266.6300,percent of total billed charges,"46.4% of $1,094.00 in Billed Charges for Rev 521 Proc 11443 = $507.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,1094.00,,,,,,,176.3000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,456.20,,,,,,,176.3000,3266.6300,percent of total billed charges,"41.7% of $1,094.00 in Billed Charges for Rev 521 Proc 11443 = $456.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,CIGNA HEALTHCARE,CIGNA PPO,456.20,,,,,,,176.3000,3266.6300,percent of total billed charges,"41.7% of $1,094.00 in Billed Charges for Rev 521 Proc 11443 = $456.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1094.00,,,,,,,176.3000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,984.60,,,,,,,176.3000,3266.6300,percent of total billed charges,"90% of $1,094.00 in Billed Charges for Rev 521 Proc 11443 = $984.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,HUMANA,HUMANA MEDICARE,1094.00,,,,,,,176.3000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1094.00,,,,,,,176.3000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,MEDCOST,MEDCOST VHN,520.63,,,,,,,176.3000,3266.6300,percent of total billed charges,"47.59% of $1,094.00 in Billed Charges for Rev 521 Proc 11443 = $520.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1792.88,,,,,,,176.3000,3266.6300,fee schedule,"APG 00010 Proc 11443 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 105% = $1,792.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1094.00,,,,,,,176.3000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1094.00,,,,,,,176.3000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,NHC ADVANTAGE,NHC ADVANTAGE,1094.00,,,,,,,176.3000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1760.43,,,,,,,176.3000,3266.6300,fee schedule,"APG 00010 Proc 11443 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 103.1% = $1,760.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,SENTARA HEALTH,SENTARA HEALTH,282.36,,,,,,,176.3000,3266.6300,percent of total billed charges,"25.81% of $1,094.00 in Billed Charges for Rev 521 Proc 11443 = $282.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,SENTARA HEALTH,SENTARA MEDICARE,1094.00,,,,,,,176.3000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1094.00,,,,,,,176.3000,3266.6300,percent of total billed charges,"100% of $1,094.00 in Billed Charges for Rev 521 Proc 11443 = $1,094.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,413.29,,,,,,,176.3000,3266.6300,fee schedule,$826.58 from Fee Schedule TCUHC24 for Rev 521 Proc 11443 * Qty 1 = $826.58 at 50% = $413.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1758.73,,,,,,,176.3000,3266.6300,fee schedule,"APG 00010 Proc 11443 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1094.00,,,,,,,176.3000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1094.00,,,,,,,176.3000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,WELLCARE,WELLCARE MEDICAID,1094.00,,,,,,,176.3000,3266.6300,percent of total billed charges,"100% of $1,094.00 in Billed Charges for Rev 521 Proc 11443 = $1,094.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0 CM,11443,CPT,521,RC,52100036,CDM,,,,both,,,1094.0000,164.1000,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,176.3000,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TEMPLATE 26 HOLE PLATE,272,RC,,,,,,,,both,,,696.7200,104.5100,AETNA,AETNA,297.50,,,,,,,179.8200,696.7200,percent of total billed charges,42.7% of $696.72 in Billed Charges for Rev 272 = $297.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TEMPLATE 26 HOLE PLATE,272,RC,,,,,,,,both,,,696.7200,104.5100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,487.70,,,,,,,179.8200,696.7200,percent of total billed charges,Rev 272 $696.72 in Billed Charges at 70% = $487.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TEMPLATE 26 HOLE PLATE,272,RC,,,,,,,,both,,,696.7200,104.5100,CIGNA HEALTHCARE,CIGNA HMO,290.53,,,,,,,179.8200,696.7200,percent of total billed charges,41.7% of $696.72 in Billed Charges for Rev 272 = $290.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TEMPLATE 26 HOLE PLATE,272,RC,,,,,,,,both,,,696.7200,104.5100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,323.28,,,,,,,179.8200,696.7200,percent of total billed charges,46.4% of $696.72 in Billed Charges for Rev 272 = $323.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TEMPLATE 26 HOLE PLATE,272,RC,,,,,,,,both,,,696.7200,104.5100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,290.53,,,,,,,179.8200,696.7200,percent of total billed charges,41.7% of $696.72 in Billed Charges for Rev 272 = $290.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TEMPLATE 26 HOLE PLATE,272,RC,,,,,,,,both,,,696.7200,104.5100,CIGNA HEALTHCARE,CIGNA PPO,290.53,,,,,,,179.8200,696.7200,percent of total billed charges,41.7% of $696.72 in Billed Charges for Rev 272 = $290.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TEMPLATE 26 HOLE PLATE,272,RC,,,,,,,,both,,,696.7200,104.5100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,627.05,,,,,,,179.8200,696.7200,percent of total billed charges,90% of $696.72 in Billed Charges for Rev 272 = $627.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TEMPLATE 26 HOLE PLATE,272,RC,,,,,,,,both,,,696.7200,104.5100,MEDCOST,MEDCOST VHN,331.57,,,,,,,179.8200,696.7200,percent of total billed charges,47.59% of $696.72 in Billed Charges for Rev 272 = $331.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TEMPLATE 26 HOLE PLATE,272,RC,,,,,,,,both,,,696.7200,104.5100,SENTARA HEALTH,SENTARA HEALTH,179.82,,,,,,,179.8200,696.7200,percent of total billed charges,25.81% of $696.72 in Billed Charges for Rev 272 = $179.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TEMPLATE 26 HOLE PLATE,272,RC,,,,,,,,both,,,696.7200,104.5100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",696.72,,,,,,,179.8200,696.7200,percent of total billed charges,100% of $696.72 in Billed Charges for Rev 272 = $696.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TEMPLATE 26 HOLE PLATE,272,RC,,,,,,,,both,,,696.7200,104.5100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,348.36,,,,,,,179.8200,696.7200,percent of total billed charges,Rev 272 $696.72 in Billed Charges at 50% = $348.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TEMPLATE 26 HOLE PLATE,272,RC,,,,,,,,both,,,696.7200,104.5100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,225.04,,,,,,,179.8200,696.7200,other,32.3% of $696.72 in Billed Charges for Rev 272 = $225.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TEMPLATE 26 HOLE PLATE,272,RC,,,,,,,,both,,,696.7200,104.5100,UNITED HEALTHCARE,UHC HERITAGE SELECT,213.89,,,,,,,179.8200,696.7200,other,30.7% of $696.72 in Billed Charges for Rev 272 = $213.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TEMPLATE 26 HOLE PLATE,272,RC,,,,,,,,both,,,696.7200,104.5100,UNITED HEALTHCARE,UNITED HEALTHCARE,225.04,,,,,,,179.8200,696.7200,percent of total billed charges,32.3% of $696.72 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TEMPLATE 26 HOLE PLATE,272,RC,,,,,,,,both,,,696.7200,104.5100,WELLCARE,WELLCARE MEDICAID,696.72,,,,,,,179.8200,696.7200,percent of total billed charges,100% of $696.72 in Billed Charges for Rev 272 = $696.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,AETNA,AETNA,424.44,,,,,,,73.7600,994.0000,percent of total billed charges,42.7% of $994.00 in Billed Charges for Rev 510 Proc 11602 = $424.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,73.7600,994.0000,fee schedule,"APG 00009 Proc 11602 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,73.7600,994.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,73.7600,994.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,73.7600,994.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,AMBETTER,AMBETTER,804.03,,,,,,,73.7600,994.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,73.7600,994.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,73.7600,994.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,73.7600,994.0000,fee schedule,"APG 00009 Proc 11602 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,73.7600,994.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,73.7600,994.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",994.00,,,,,,,73.7600,994.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,156.78,,,,,,,73.7600,994.0000,fee schedule,$156.78 from Fee Schedule BLDTM_23 for Rev 510 Proc 11602 * Qty 1 = $156.78 at 100% = $156.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,73.7600,994.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,BLUE CROSS,TENNCARE BLUE CARE,73.76,,,,,,,73.7600,994.0000,fee schedule,$63.59 from Fee Schedule TC_24 for Rev 510 Proc 11602 * Qty 1 = $63.59 at 116% = $73.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,BLUE CROSS,TENNCARE BLUE SELECT,73.76,,,,,,,73.7600,994.0000,fee schedule,$63.59 from Fee Schedule TC_24 for Rev 510 Proc 11602 * Qty 1 = $63.59 at 116% = $73.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,CIGNA HEALTHCARE,CIGNA HMO,414.50,,,,,,,73.7600,994.0000,percent of total billed charges,41.7% of $994.00 in Billed Charges for Rev 510 Proc 11602 = $414.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,461.22,,,,,,,73.7600,994.0000,percent of total billed charges,46.4% of $994.00 in Billed Charges for Rev 510 Proc 11602 = $461.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,73.7600,994.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,414.50,,,,,,,73.7600,994.0000,percent of total billed charges,41.7% of $994.00 in Billed Charges for Rev 510 Proc 11602 = $414.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,CIGNA HEALTHCARE,CIGNA PPO,414.50,,,,,,,73.7600,994.0000,percent of total billed charges,41.7% of $994.00 in Billed Charges for Rev 510 Proc 11602 = $414.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,73.7600,994.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,894.60,,,,,,,73.7600,994.0000,percent of total billed charges,90% of $994.00 in Billed Charges for Rev 510 Proc 11602 = $894.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,HUMANA,HUMANA MEDICARE,368.82,,,,,,,73.7600,994.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,73.7600,994.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,MEDCOST,MEDCOST VHN,473.04,,,,,,,73.7600,994.0000,percent of total billed charges,47.59% of $994.00 in Billed Charges for Rev 510 Proc 11602 = $473.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,73.7600,994.0000,fee schedule,"APG 00009 Proc 11602 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,73.7600,994.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,73.7600,994.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,73.7600,994.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,73.7600,994.0000,fee schedule,"APG 00009 Proc 11602 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,SENTARA HEALTH,SENTARA HEALTH,256.55,,,,,,,73.7600,994.0000,percent of total billed charges,25.81% of $994.00 in Billed Charges for Rev 510 Proc 11602 = $256.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,73.7600,994.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",994.00,,,,,,,73.7600,994.0000,percent of total billed charges,100% of $994.00 in Billed Charges for Rev 510 Proc 11602 = $994.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,189.28,,,,,,,73.7600,994.0000,fee schedule,$378.56 from Fee Schedule TCUHC24 for Rev 510 Proc 11602 * Qty 1 = $378.56 at 50% = $189.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,321.06,,,,,,,73.7600,994.0000,other,32.3% of $994.00 in Billed Charges for Rev 510 Proc 11602 = $321.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,305.16,,,,,,,73.7600,994.0000,other,30.7% of $994.00 in Billed Charges for Rev 510 Proc 11602 = $305.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,321.06,,,,,,,73.7600,994.0000,percent of total billed charges,32.3% of $994.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,73.7600,994.0000,fee schedule,"APG 00009 Proc 11602 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,73.7600,994.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,73.7600,994.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,WELLCARE,WELLCARE MEDICAID,994.00,,,,,,,73.7600,994.0000,percent of total billed charges,100% of $994.00 in Billed Charges for Rev 510 Proc 11602 = $994.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC MALG LESION TRUNK/ARM/LEG 1.1-2.0 CM,11602,CPT,510,RC,51000126,CDM,,,,both,,,994.0000,149.1000,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,73.7600,994.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,AETNA,AETNA,467.14,,,,,,,86.3300,1400.5900,percent of total billed charges,"42.7% of $1,094.00 in Billed Charges for Rev 510 Proc 11603 = $467.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,86.3300,1400.5900,fee schedule,"APG 00009 Proc 11603 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,86.3300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,86.3300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,86.3300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,AMBETTER,AMBETTER,1400.59,,,,,,,86.3300,1400.5900,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,86.3300,1400.5900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,BLUE CROSS,ANTHEM EXCHANGE,1094.00,,,,,,,86.3300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,86.3300,1400.5900,fee schedule,"APG 00009 Proc 11603 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,BLUE CROSS,ANTHEM HMO,1094.00,,,,,,,86.3300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,86.3300,1400.5900,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1094.00,,,,,,,86.3300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,190.43,,,,,,,86.3300,1400.5900,fee schedule,$190.43 from Fee Schedule BLDTM_23 for Rev 510 Proc 11603 * Qty 1 = $190.43 at 100% = $190.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,86.3300,1400.5900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,BLUE CROSS,TENNCARE BLUE CARE,86.33,,,,,,,86.3300,1400.5900,fee schedule,$74.42 from Fee Schedule TC_24 for Rev 510 Proc 11603 * Qty 1 = $74.42 at 116% = $86.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,BLUE CROSS,TENNCARE BLUE SELECT,86.33,,,,,,,86.3300,1400.5900,fee schedule,$74.42 from Fee Schedule TC_24 for Rev 510 Proc 11603 * Qty 1 = $74.42 at 116% = $86.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,CIGNA HEALTHCARE,CIGNA HMO,456.20,,,,,,,86.3300,1400.5900,percent of total billed charges,"41.7% of $1,094.00 in Billed Charges for Rev 510 Proc 11603 = $456.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,507.62,,,,,,,86.3300,1400.5900,percent of total billed charges,"46.4% of $1,094.00 in Billed Charges for Rev 510 Proc 11603 = $507.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,86.3300,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,456.20,,,,,,,86.3300,1400.5900,percent of total billed charges,"41.7% of $1,094.00 in Billed Charges for Rev 510 Proc 11603 = $456.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,CIGNA HEALTHCARE,CIGNA PPO,456.20,,,,,,,86.3300,1400.5900,percent of total billed charges,"41.7% of $1,094.00 in Billed Charges for Rev 510 Proc 11603 = $456.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,86.3300,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,984.60,,,,,,,86.3300,1400.5900,percent of total billed charges,"90% of $1,094.00 in Billed Charges for Rev 510 Proc 11603 = $984.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,HUMANA,HUMANA MEDICARE,642.47,,,,,,,86.3300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,86.3300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,MEDCOST,MEDCOST VHN,520.63,,,,,,,86.3300,1400.5900,percent of total billed charges,"47.59% of $1,094.00 in Billed Charges for Rev 510 Proc 11603 = $520.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,86.3300,1400.5900,fee schedule,"APG 00009 Proc 11603 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,86.3300,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,86.3300,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,86.3300,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,86.3300,1400.5900,fee schedule,"APG 00009 Proc 11603 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,SENTARA HEALTH,SENTARA HEALTH,282.36,,,,,,,86.3300,1400.5900,percent of total billed charges,"25.81% of $1,094.00 in Billed Charges for Rev 510 Proc 11603 = $282.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,86.3300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1094.00,,,,,,,86.3300,1400.5900,percent of total billed charges,"100% of $1,094.00 in Billed Charges for Rev 510 Proc 11603 = $1,094.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,413.29,,,,,,,86.3300,1400.5900,fee schedule,$826.58 from Fee Schedule TCUHC24 for Rev 510 Proc 11603 * Qty 1 = $826.58 at 50% = $413.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,353.36,,,,,,,86.3300,1400.5900,other,"32.3% of $1,094.00 in Billed Charges for Rev 510 Proc 11603 = $353.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,335.86,,,,,,,86.3300,1400.5900,other,"30.7% of $1,094.00 in Billed Charges for Rev 510 Proc 11603 = $335.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,353.36,,,,,,,86.3300,1400.5900,percent of total billed charges,"32.3% of $1,094.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,86.3300,1400.5900,fee schedule,"APG 00009 Proc 11603 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,86.3300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,86.3300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,WELLCARE,WELLCARE MEDICAID,1094.00,,,,,,,86.3300,1400.5900,percent of total billed charges,"100% of $1,094.00 in Billed Charges for Rev 510 Proc 11603 = $1,094.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION TRUNK/ARM/LEG 2.1-3.0 CM,11603,CPT,510,RC,51000127,CDM,,,,both,,,1094.0000,164.1000,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,86.3300,1400.5900,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,AETNA,AETNA,1924.49,,,,,,,50.2300,4507.0000,percent of total billed charges,"42.7% of $4,507.00 in Billed Charges for Rev 521 Proc 11620 = $1,924.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1775.80,,,,,,,50.2300,4507.0000,fee schedule,"APG 00010 Proc 11620 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 104% = $1,775.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,50.2300,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,50.2300,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,50.2300,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,AMBETTER,AMBETTER,3266.63,,,,,,,50.2300,4507.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,50.2300,4507.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,ANTHEM EXCHANGE,3689.28,,,,,,,50.2300,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1758.73,,,,,,,50.2300,4507.0000,fee schedule,"APG 00010 Proc 11620 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,ANTHEM HMO,3919.64,,,,,,,50.2300,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,50.2300,4507.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4507.00,,,,,,,50.2300,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,111.56,,,,,,,50.2300,4507.0000,fee schedule,$111.56 from Fee Schedule BLDTM_23 for Rev 521 Proc 11620 * Qty 1 = $111.56 at 100% = $111.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,50.2300,4507.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,TENNCARE BLUE CARE,50.23,,,,,,,50.2300,4507.0000,fee schedule,$43.30 from Fee Schedule TC_24 for Rev 521 Proc 11620 * Qty 1 = $43.30 at 116% = $50.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,TENNCARE BLUE SELECT,50.23,,,,,,,50.2300,4507.0000,fee schedule,$43.30 from Fee Schedule TC_24 for Rev 521 Proc 11620 * Qty 1 = $43.30 at 116% = $50.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,CIGNA HEALTHCARE,CIGNA HMO,1879.42,,,,,,,50.2300,4507.0000,percent of total billed charges,"41.7% of $4,507.00 in Billed Charges for Rev 521 Proc 11620 = $1,879.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2091.25,,,,,,,50.2300,4507.0000,percent of total billed charges,"46.4% of $4,507.00 in Billed Charges for Rev 521 Proc 11620 = $2,091.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,50.2300,4507.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1879.42,,,,,,,50.2300,4507.0000,percent of total billed charges,"41.7% of $4,507.00 in Billed Charges for Rev 521 Proc 11620 = $1,879.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,CIGNA HEALTHCARE,CIGNA PPO,1879.42,,,,,,,50.2300,4507.0000,percent of total billed charges,"41.7% of $4,507.00 in Billed Charges for Rev 521 Proc 11620 = $1,879.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,50.2300,4507.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4056.30,,,,,,,50.2300,4507.0000,percent of total billed charges,"90% of $4,507.00 in Billed Charges for Rev 521 Proc 11620 = $4,056.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,50.2300,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,50.2300,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,MEDCOST,MEDCOST VHN,2144.88,,,,,,,50.2300,4507.0000,percent of total billed charges,"47.59% of $4,507.00 in Billed Charges for Rev 521 Proc 11620 = $2,144.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1792.88,,,,,,,50.2300,4507.0000,fee schedule,"APG 00010 Proc 11620 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 105% = $1,792.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,50.2300,4507.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,50.2300,4507.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,50.2300,4507.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1760.43,,,,,,,50.2300,4507.0000,fee schedule,"APG 00010 Proc 11620 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 103.1% = $1,760.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,SENTARA HEALTH,SENTARA HEALTH,1163.26,,,,,,,50.2300,4507.0000,percent of total billed charges,"25.81% of $4,507.00 in Billed Charges for Rev 521 Proc 11620 = $1,163.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,50.2300,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4507.00,,,,,,,50.2300,4507.0000,percent of total billed charges,"100% of $4,507.00 in Billed Charges for Rev 521 Proc 11620 = $4,507.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,413.29,,,,,,,50.2300,4507.0000,fee schedule,$826.58 from Fee Schedule TCUHC24 for Rev 521 Proc 11620 * Qty 1 = $826.58 at 50% = $413.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1758.73,,,,,,,50.2300,4507.0000,fee schedule,"APG 00010 Proc 11620 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,50.2300,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,50.2300,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,WELLCARE,WELLCARE MEDICAID,4507.00,,,,,,,50.2300,4507.0000,percent of total billed charges,"100% of $4,507.00 in Billed Charges for Rev 521 Proc 11620 = $4,507.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G 0.5 CM OR LESS,11620,CPT,521,RC,52100044,CDM,,,,both,,,4507.0000,676.0500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,50.2300,4507.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,AETNA,AETNA,621.71,,,,,,,86.3300,1456.0000,percent of total billed charges,"42.7% of $1,456.00 in Billed Charges for Rev 510 Proc 11622 = $621.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,86.3300,1456.0000,fee schedule,"APG 00009 Proc 11622 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,86.3300,1456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,86.3300,1456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,86.3300,1456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,AMBETTER,AMBETTER,1400.59,,,,,,,86.3300,1456.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,86.3300,1456.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,BLUE CROSS,ANTHEM EXCHANGE,1456.00,,,,,,,86.3300,1456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,86.3300,1456.0000,fee schedule,"APG 00009 Proc 11622 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,BLUE CROSS,ANTHEM HMO,1456.00,,,,,,,86.3300,1456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,86.3300,1456.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1456.00,,,,,,,86.3300,1456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,179.36,,,,,,,86.3300,1456.0000,fee schedule,$179.36 from Fee Schedule BLDTM_23 for Rev 510 Proc 11622 * Qty 1 = $179.36 at 100% = $179.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,86.3300,1456.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,BLUE CROSS,TENNCARE BLUE CARE,86.33,,,,,,,86.3300,1456.0000,fee schedule,$74.42 from Fee Schedule TC_24 for Rev 510 Proc 11622 * Qty 1 = $74.42 at 116% = $86.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,BLUE CROSS,TENNCARE BLUE SELECT,86.33,,,,,,,86.3300,1456.0000,fee schedule,$74.42 from Fee Schedule TC_24 for Rev 510 Proc 11622 * Qty 1 = $74.42 at 116% = $86.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,CIGNA HEALTHCARE,CIGNA HMO,607.15,,,,,,,86.3300,1456.0000,percent of total billed charges,"41.7% of $1,456.00 in Billed Charges for Rev 510 Proc 11622 = $607.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,675.58,,,,,,,86.3300,1456.0000,percent of total billed charges,"46.4% of $1,456.00 in Billed Charges for Rev 510 Proc 11622 = $675.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,86.3300,1456.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,607.15,,,,,,,86.3300,1456.0000,percent of total billed charges,"41.7% of $1,456.00 in Billed Charges for Rev 510 Proc 11622 = $607.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,CIGNA HEALTHCARE,CIGNA PPO,607.15,,,,,,,86.3300,1456.0000,percent of total billed charges,"41.7% of $1,456.00 in Billed Charges for Rev 510 Proc 11622 = $607.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,86.3300,1456.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1310.40,,,,,,,86.3300,1456.0000,percent of total billed charges,"90% of $1,456.00 in Billed Charges for Rev 510 Proc 11622 = $1,310.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,HUMANA,HUMANA MEDICARE,642.47,,,,,,,86.3300,1456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,86.3300,1456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,MEDCOST,MEDCOST VHN,692.91,,,,,,,86.3300,1456.0000,percent of total billed charges,"47.59% of $1,456.00 in Billed Charges for Rev 510 Proc 11622 = $692.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,86.3300,1456.0000,fee schedule,"APG 00009 Proc 11622 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,86.3300,1456.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,86.3300,1456.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,86.3300,1456.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,86.3300,1456.0000,fee schedule,"APG 00009 Proc 11622 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,SENTARA HEALTH,SENTARA HEALTH,375.79,,,,,,,86.3300,1456.0000,percent of total billed charges,"25.81% of $1,456.00 in Billed Charges for Rev 510 Proc 11622 = $375.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,86.3300,1456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1456.00,,,,,,,86.3300,1456.0000,percent of total billed charges,"100% of $1,456.00 in Billed Charges for Rev 510 Proc 11622 = $1,456.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,413.29,,,,,,,86.3300,1456.0000,fee schedule,$826.58 from Fee Schedule TCUHC24 for Rev 510 Proc 11622 * Qty 1 = $826.58 at 50% = $413.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,470.29,,,,,,,86.3300,1456.0000,other,"32.3% of $1,456.00 in Billed Charges for Rev 510 Proc 11622 = $470.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,446.99,,,,,,,86.3300,1456.0000,other,"30.7% of $1,456.00 in Billed Charges for Rev 510 Proc 11622 = $446.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,470.29,,,,,,,86.3300,1456.0000,percent of total billed charges,"32.3% of $1,456.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,86.3300,1456.0000,fee schedule,"APG 00009 Proc 11622 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,86.3300,1456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,86.3300,1456.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,WELLCARE,WELLCARE MEDICAID,1456.00,,,,,,,86.3300,1456.0000,percent of total billed charges,"100% of $1,456.00 in Billed Charges for Rev 510 Proc 11622 = $1,456.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION S/N/H/F/G 1.1-2.0 CM,11622,CPT,510,RC,51000130,CDM,,,,both,,,1456.0000,218.4000,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,86.3300,1456.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,AETNA,AETNA,752.37,,,,,,,84.7500,1762.0000,percent of total billed charges,"42.7% of $1,762.00 in Billed Charges for Rev 510 Proc 11641 = $752.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,84.7500,1762.0000,fee schedule,"APG 00009 Proc 11641 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,84.7500,1762.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,84.7500,1762.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,84.7500,1762.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,AMBETTER,AMBETTER,1400.59,,,,,,,84.7500,1762.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,84.7500,1762.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,84.7500,1762.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,84.7500,1762.0000,fee schedule,"APG 00009 Proc 11641 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,84.7500,1762.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,84.7500,1762.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1762.00,,,,,,,84.7500,1762.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,192.51,,,,,,,84.7500,1762.0000,fee schedule,$192.51 from Fee Schedule BLDTM_23 for Rev 510 Proc 11641 * Qty 1 = $192.51 at 100% = $192.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,84.7500,1762.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,BLUE CROSS,TENNCARE BLUE CARE,84.75,,,,,,,84.7500,1762.0000,fee schedule,$73.06 from Fee Schedule TC_24 for Rev 510 Proc 11641 * Qty 1 = $73.06 at 116% = $84.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,BLUE CROSS,TENNCARE BLUE SELECT,84.75,,,,,,,84.7500,1762.0000,fee schedule,$73.06 from Fee Schedule TC_24 for Rev 510 Proc 11641 * Qty 1 = $73.06 at 116% = $84.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,CIGNA HEALTHCARE,CIGNA HMO,734.75,,,,,,,84.7500,1762.0000,percent of total billed charges,"41.7% of $1,762.00 in Billed Charges for Rev 510 Proc 11641 = $734.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,817.57,,,,,,,84.7500,1762.0000,percent of total billed charges,"46.4% of $1,762.00 in Billed Charges for Rev 510 Proc 11641 = $817.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,84.7500,1762.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,734.75,,,,,,,84.7500,1762.0000,percent of total billed charges,"41.7% of $1,762.00 in Billed Charges for Rev 510 Proc 11641 = $734.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,CIGNA HEALTHCARE,CIGNA PPO,734.75,,,,,,,84.7500,1762.0000,percent of total billed charges,"41.7% of $1,762.00 in Billed Charges for Rev 510 Proc 11641 = $734.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,84.7500,1762.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1585.80,,,,,,,84.7500,1762.0000,percent of total billed charges,"90% of $1,762.00 in Billed Charges for Rev 510 Proc 11641 = $1,585.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,HUMANA,HUMANA MEDICARE,642.47,,,,,,,84.7500,1762.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,84.7500,1762.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,MEDCOST,MEDCOST VHN,838.54,,,,,,,84.7500,1762.0000,percent of total billed charges,"47.59% of $1,762.00 in Billed Charges for Rev 510 Proc 11641 = $838.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,84.7500,1762.0000,fee schedule,"APG 00009 Proc 11641 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,84.7500,1762.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,84.7500,1762.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,84.7500,1762.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,84.7500,1762.0000,fee schedule,"APG 00009 Proc 11641 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,SENTARA HEALTH,SENTARA HEALTH,454.77,,,,,,,84.7500,1762.0000,percent of total billed charges,"25.81% of $1,762.00 in Billed Charges for Rev 510 Proc 11641 = $454.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,84.7500,1762.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1762.00,,,,,,,84.7500,1762.0000,percent of total billed charges,"100% of $1,762.00 in Billed Charges for Rev 510 Proc 11641 = $1,762.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,413.29,,,,,,,84.7500,1762.0000,fee schedule,$826.58 from Fee Schedule TCUHC24 for Rev 510 Proc 11641 * Qty 1 = $826.58 at 50% = $413.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,569.13,,,,,,,84.7500,1762.0000,other,"32.3% of $1,762.00 in Billed Charges for Rev 510 Proc 11641 = $569.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,540.93,,,,,,,84.7500,1762.0000,other,"30.7% of $1,762.00 in Billed Charges for Rev 510 Proc 11641 = $540.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,569.13,,,,,,,84.7500,1762.0000,percent of total billed charges,"32.3% of $1,762.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,84.7500,1762.0000,fee schedule,"APG 00009 Proc 11641 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,84.7500,1762.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,84.7500,1762.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,WELLCARE,WELLCARE MEDICAID,1762.00,,,,,,,84.7500,1762.0000,percent of total billed charges,"100% of $1,762.00 in Billed Charges for Rev 510 Proc 11641 = $1,762.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 0.6-1.0 CM,11641,CPT,510,RC,51000132,CDM,,,,both,,,1762.0000,264.3000,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,84.7500,1762.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,AETNA,AETNA,839.06,,,,,,,213.8900,1965.0000,percent of total billed charges,"42.7% of $1,965.00 in Billed Charges for Rev 521 Proc 11642 = $839.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,213.8900,1965.0000,fee schedule,"APG 00009 Proc 11642 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,213.8900,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,213.8900,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,213.8900,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,AMBETTER,AMBETTER,1400.59,,,,,,,213.8900,1965.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,213.8900,1965.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,213.8900,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,213.8900,1965.0000,fee schedule,"APG 00009 Proc 11642 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,213.8900,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,213.8900,1965.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1965.00,,,,,,,213.8900,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,213.89,,,,,,,213.8900,1965.0000,fee schedule,$213.89 from Fee Schedule BLDTM_23 for Rev 521 Proc 11642 * Qty 1 = $213.89 at 100% = $213.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,213.8900,1965.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,CIGNA HEALTHCARE,CIGNA HMO,819.41,,,,,,,213.8900,1965.0000,percent of total billed charges,"41.7% of $1,965.00 in Billed Charges for Rev 521 Proc 11642 = $819.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,911.76,,,,,,,213.8900,1965.0000,percent of total billed charges,"46.4% of $1,965.00 in Billed Charges for Rev 521 Proc 11642 = $911.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,213.8900,1965.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,819.41,,,,,,,213.8900,1965.0000,percent of total billed charges,"41.7% of $1,965.00 in Billed Charges for Rev 521 Proc 11642 = $819.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,CIGNA HEALTHCARE,CIGNA PPO,819.41,,,,,,,213.8900,1965.0000,percent of total billed charges,"41.7% of $1,965.00 in Billed Charges for Rev 521 Proc 11642 = $819.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,213.8900,1965.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1768.50,,,,,,,213.8900,1965.0000,percent of total billed charges,"90% of $1,965.00 in Billed Charges for Rev 521 Proc 11642 = $1,768.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,HUMANA,HUMANA MEDICARE,642.47,,,,,,,213.8900,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,213.8900,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,MEDCOST,MEDCOST VHN,935.14,,,,,,,213.8900,1965.0000,percent of total billed charges,"47.59% of $1,965.00 in Billed Charges for Rev 521 Proc 11642 = $935.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,213.8900,1965.0000,fee schedule,"APG 00009 Proc 11642 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,213.8900,1965.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,213.8900,1965.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,213.8900,1965.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,213.8900,1965.0000,fee schedule,"APG 00009 Proc 11642 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,SENTARA HEALTH,SENTARA HEALTH,507.17,,,,,,,213.8900,1965.0000,percent of total billed charges,"25.81% of $1,965.00 in Billed Charges for Rev 521 Proc 11642 = $507.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,213.8900,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1965.00,,,,,,,213.8900,1965.0000,percent of total billed charges,"100% of $1,965.00 in Billed Charges for Rev 521 Proc 11642 = $1,965.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,413.29,,,,,,,213.8900,1965.0000,fee schedule,$826.58 from Fee Schedule TCUHC24 for Rev 521 Proc 11642 * Qty 1 = $826.58 at 50% = $413.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,213.8900,1965.0000,fee schedule,"APG 00009 Proc 11642 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,213.8900,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,213.8900,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,WELLCARE,WELLCARE MEDICAID,1965.00,,,,,,,213.8900,1965.0000,percent of total billed charges,"100% of $1,965.00 in Billed Charges for Rev 521 Proc 11642 = $1,965.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION F/E/E/N/L/ 1.1-2.0 CM,11642,CPT,521,RC,52100052,CDM,,,,both,,,1965.0000,294.7500,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,213.8900,1965.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,AETNA,AETNA,922.75,,,,,,,394.4200,5745.1200,percent of total billed charges,"42.7% of $2,161.00 in Billed Charges for Rev 521 Proc 11646 = $922.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2575.48,,,,,,,394.4200,5745.1200,fee schedule,"APG 00011 Proc 11646 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 104% = $2,575.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2161.00,,,,,,,394.4200,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,AETNA,AETNA HEALTHCARE MEDICARE,2161.00,,,,,,,394.4200,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,2161.00,,,,,,,394.4200,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,AMBETTER,AMBETTER,5745.12,,,,,,,394.4200,5745.1200,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2161.00,,,,,,,394.4200,5745.1200,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,BLUE CROSS,ANTHEM EXCHANGE,2161.00,,,,,,,394.4200,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2161.00,,,,,,,394.4200,5745.1200,fee schedule,"APG 00011 Proc 11646 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 103% = $2,550.71 (Service Line reduced to $2,161.00, claim capped at $2,161.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,BLUE CROSS,ANTHEM HMO,2161.00,,,,,,,394.4200,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2161.00,,,,,,,394.4200,5745.1200,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2161.00,,,,,,,394.4200,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,394.42,,,,,,,394.4200,5745.1200,fee schedule,$394.42 from Fee Schedule BLDTM_23 for Rev 521 Proc 11646 * Qty 1 = $394.42 at 100% = $394.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,BLUE CROSS,BLUE CROSS MEDICARE,2740.79,,,,,,,394.4200,5745.1200,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,CIGNA HEALTHCARE,CIGNA HMO,901.14,,,,,,,394.4200,5745.1200,percent of total billed charges,"41.7% of $2,161.00 in Billed Charges for Rev 521 Proc 11646 = $901.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1002.70,,,,,,,394.4200,5745.1200,percent of total billed charges,"46.4% of $2,161.00 in Billed Charges for Rev 521 Proc 11646 = $1,002.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,2161.00,,,,,,,394.4200,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,901.14,,,,,,,394.4200,5745.1200,percent of total billed charges,"41.7% of $2,161.00 in Billed Charges for Rev 521 Proc 11646 = $901.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,CIGNA HEALTHCARE,CIGNA PPO,901.14,,,,,,,394.4200,5745.1200,percent of total billed charges,"41.7% of $2,161.00 in Billed Charges for Rev 521 Proc 11646 = $901.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,2161.00,,,,,,,394.4200,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1944.90,,,,,,,394.4200,5745.1200,percent of total billed charges,"90% of $2,161.00 in Billed Charges for Rev 521 Proc 11646 = $1,944.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,HUMANA,HUMANA MEDICARE,2161.00,,,,,,,394.4200,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2161.00,,,,,,,394.4200,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,MEDCOST,MEDCOST VHN,1028.42,,,,,,,394.4200,5745.1200,percent of total billed charges,"47.59% of $2,161.00 in Billed Charges for Rev 521 Proc 11646 = $1,028.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2600.24,,,,,,,394.4200,5745.1200,fee schedule,"APG 00011 Proc 11646 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 100% = $2,476.42... $2,476.42 at 105% = $2,600.24 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,2161.00,,,,,,,394.4200,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,2161.00,,,,,,,394.4200,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,NHC ADVANTAGE,NHC ADVANTAGE,2161.00,,,,,,,394.4200,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2553.19,,,,,,,394.4200,5745.1200,fee schedule,"APG 00011 Proc 11646 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 100% = $2,476.42... $2,476.42 at 103.1% = $2,553.19 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,SENTARA HEALTH,SENTARA HEALTH,557.75,,,,,,,394.4200,5745.1200,percent of total billed charges,"25.81% of $2,161.00 in Billed Charges for Rev 521 Proc 11646 = $557.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,SENTARA HEALTH,SENTARA MEDICARE,2161.00,,,,,,,394.4200,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2161.00,,,,,,,394.4200,5745.1200,percent of total billed charges,"100% of $2,161.00 in Billed Charges for Rev 521 Proc 11646 = $2,161.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,912.16,,,,,,,394.4200,5745.1200,fee schedule,"$1,824.31 from Fee Schedule TCUHC24 for Rev 521 Proc 11646 * Qty 1 = $1,824.31 at 50% = $912.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2550.71,,,,,,,394.4200,5745.1200,fee schedule,"APG 00011 Proc 11646 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 103% = $2,550.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2161.00,,,,,,,394.4200,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2161.00,,,,,,,394.4200,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,WELLCARE,WELLCARE MEDICAID,2161.00,,,,,,,394.4200,5745.1200,percent of total billed charges,"100% of $2,161.00 in Billed Charges for Rev 521 Proc 11646 = $2,161.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION F/E/E/N/L >4.0 CM,11646,CPT,521,RC,52100055,CDM,,,,both,,,2161.0000,324.1500,WELLCARE,WELLCARE MEDICARE,2793.50,,,,,,,394.4200,5745.1200,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TEMPLATE BENDING MANDIBLE 12 HOLE,272,RC,27200002,CDM,,,,,,both,,,858.5100,128.7800,AETNA,AETNA,366.58,,,,,,,221.5800,858.5100,percent of total billed charges,42.7% of $858.51 in Billed Charges for Rev 272 = $366.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TEMPLATE BENDING MANDIBLE 12 HOLE,272,RC,27200002,CDM,,,,,,both,,,858.5100,128.7800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,600.96,,,,,,,221.5800,858.5100,percent of total billed charges,Rev 272 $858.51 in Billed Charges at 70% = $600.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TEMPLATE BENDING MANDIBLE 12 HOLE,272,RC,27200002,CDM,,,,,,both,,,858.5100,128.7800,CIGNA HEALTHCARE,CIGNA HMO,358.00,,,,,,,221.5800,858.5100,percent of total billed charges,41.7% of $858.51 in Billed Charges for Rev 272 = $358.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TEMPLATE BENDING MANDIBLE 12 HOLE,272,RC,27200002,CDM,,,,,,both,,,858.5100,128.7800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,398.35,,,,,,,221.5800,858.5100,percent of total billed charges,46.4% of $858.51 in Billed Charges for Rev 272 = $398.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TEMPLATE BENDING MANDIBLE 12 HOLE,272,RC,27200002,CDM,,,,,,both,,,858.5100,128.7800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,358.00,,,,,,,221.5800,858.5100,percent of total billed charges,41.7% of $858.51 in Billed Charges for Rev 272 = $358.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TEMPLATE BENDING MANDIBLE 12 HOLE,272,RC,27200002,CDM,,,,,,both,,,858.5100,128.7800,CIGNA HEALTHCARE,CIGNA PPO,358.00,,,,,,,221.5800,858.5100,percent of total billed charges,41.7% of $858.51 in Billed Charges for Rev 272 = $358.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TEMPLATE BENDING MANDIBLE 12 HOLE,272,RC,27200002,CDM,,,,,,both,,,858.5100,128.7800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,772.66,,,,,,,221.5800,858.5100,percent of total billed charges,90% of $858.51 in Billed Charges for Rev 272 = $772.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TEMPLATE BENDING MANDIBLE 12 HOLE,272,RC,27200002,CDM,,,,,,both,,,858.5100,128.7800,MEDCOST,MEDCOST VHN,408.56,,,,,,,221.5800,858.5100,percent of total billed charges,47.59% of $858.51 in Billed Charges for Rev 272 = $408.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TEMPLATE BENDING MANDIBLE 12 HOLE,272,RC,27200002,CDM,,,,,,both,,,858.5100,128.7800,SENTARA HEALTH,SENTARA HEALTH,221.58,,,,,,,221.5800,858.5100,percent of total billed charges,25.81% of $858.51 in Billed Charges for Rev 272 = $221.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TEMPLATE BENDING MANDIBLE 12 HOLE,272,RC,27200002,CDM,,,,,,both,,,858.5100,128.7800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",858.51,,,,,,,221.5800,858.5100,percent of total billed charges,100% of $858.51 in Billed Charges for Rev 272 = $858.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TEMPLATE BENDING MANDIBLE 12 HOLE,272,RC,27200002,CDM,,,,,,both,,,858.5100,128.7800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,429.26,,,,,,,221.5800,858.5100,percent of total billed charges,Rev 272 $858.51 in Billed Charges at 50% = $429.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TEMPLATE BENDING MANDIBLE 12 HOLE,272,RC,27200002,CDM,,,,,,both,,,858.5100,128.7800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,277.30,,,,,,,221.5800,858.5100,other,32.3% of $858.51 in Billed Charges for Rev 272 = $277.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TEMPLATE BENDING MANDIBLE 12 HOLE,272,RC,27200002,CDM,,,,,,both,,,858.5100,128.7800,UNITED HEALTHCARE,UHC HERITAGE SELECT,263.56,,,,,,,221.5800,858.5100,other,30.7% of $858.51 in Billed Charges for Rev 272 = $263.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TEMPLATE BENDING MANDIBLE 12 HOLE,272,RC,27200002,CDM,,,,,,both,,,858.5100,128.7800,UNITED HEALTHCARE,UNITED HEALTHCARE,277.30,,,,,,,221.5800,858.5100,percent of total billed charges,32.3% of $858.51 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TEMPLATE BENDING MANDIBLE 12 HOLE,272,RC,27200002,CDM,,,,,,both,,,858.5100,128.7800,WELLCARE,WELLCARE MEDICAID,858.51,,,,,,,221.5800,858.5100,percent of total billed charges,100% of $858.51 in Billed Charges for Rev 272 = $858.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TIP 12CM IQ LARGE,272,RC,27200002,CDM,,,,,,both,,,9165.4200,1374.8100,AETNA,AETNA,3913.63,,,,,,,2365.5900,9165.4200,percent of total billed charges,"42.7% of $9,165.42 in Billed Charges for Rev 272 = $3,913.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP 12CM IQ LARGE,272,RC,27200002,CDM,,,,,,both,,,9165.4200,1374.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6415.79,,,,,,,2365.5900,9165.4200,percent of total billed charges,"Rev 272 $9,165.42 in Billed Charges at 70% = $6,415.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP 12CM IQ LARGE,272,RC,27200002,CDM,,,,,,both,,,9165.4200,1374.8100,CIGNA HEALTHCARE,CIGNA HMO,3821.98,,,,,,,2365.5900,9165.4200,percent of total billed charges,"41.7% of $9,165.42 in Billed Charges for Rev 272 = $3,821.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP 12CM IQ LARGE,272,RC,27200002,CDM,,,,,,both,,,9165.4200,1374.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4252.75,,,,,,,2365.5900,9165.4200,percent of total billed charges,"46.4% of $9,165.42 in Billed Charges for Rev 272 = $4,252.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP 12CM IQ LARGE,272,RC,27200002,CDM,,,,,,both,,,9165.4200,1374.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3821.98,,,,,,,2365.5900,9165.4200,percent of total billed charges,"41.7% of $9,165.42 in Billed Charges for Rev 272 = $3,821.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP 12CM IQ LARGE,272,RC,27200002,CDM,,,,,,both,,,9165.4200,1374.8100,CIGNA HEALTHCARE,CIGNA PPO,3821.98,,,,,,,2365.5900,9165.4200,percent of total billed charges,"41.7% of $9,165.42 in Billed Charges for Rev 272 = $3,821.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP 12CM IQ LARGE,272,RC,27200002,CDM,,,,,,both,,,9165.4200,1374.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8248.88,,,,,,,2365.5900,9165.4200,percent of total billed charges,"90% of $9,165.42 in Billed Charges for Rev 272 = $8,248.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP 12CM IQ LARGE,272,RC,27200002,CDM,,,,,,both,,,9165.4200,1374.8100,MEDCOST,MEDCOST VHN,4361.82,,,,,,,2365.5900,9165.4200,percent of total billed charges,"47.59% of $9,165.42 in Billed Charges for Rev 272 = $4,361.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP 12CM IQ LARGE,272,RC,27200002,CDM,,,,,,both,,,9165.4200,1374.8100,SENTARA HEALTH,SENTARA HEALTH,2365.59,,,,,,,2365.5900,9165.4200,percent of total billed charges,"25.81% of $9,165.42 in Billed Charges for Rev 272 = $2,365.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP 12CM IQ LARGE,272,RC,27200002,CDM,,,,,,both,,,9165.4200,1374.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9165.42,,,,,,,2365.5900,9165.4200,percent of total billed charges,"100% of $9,165.42 in Billed Charges for Rev 272 = $9,165.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP 12CM IQ LARGE,272,RC,27200002,CDM,,,,,,both,,,9165.4200,1374.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4582.71,,,,,,,2365.5900,9165.4200,percent of total billed charges,"Rev 272 $9,165.42 in Billed Charges at 50% = $4,582.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP 12CM IQ LARGE,272,RC,27200002,CDM,,,,,,both,,,9165.4200,1374.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2960.43,,,,,,,2365.5900,9165.4200,other,"32.3% of $9,165.42 in Billed Charges for Rev 272 = $2,960.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP 12CM IQ LARGE,272,RC,27200002,CDM,,,,,,both,,,9165.4200,1374.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,2813.78,,,,,,,2365.5900,9165.4200,other,"30.7% of $9,165.42 in Billed Charges for Rev 272 = $2,813.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TIP 12CM IQ LARGE,272,RC,27200002,CDM,,,,,,both,,,9165.4200,1374.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,2960.43,,,,,,,2365.5900,9165.4200,percent of total billed charges,"32.3% of $9,165.42 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TIP 12CM IQ LARGE,272,RC,27200002,CDM,,,,,,both,,,9165.4200,1374.8100,WELLCARE,WELLCARE MEDICAID,9165.42,,,,,,,2365.5900,9165.4200,percent of total billed charges,"100% of $9,165.42 in Billed Charges for Rev 272 = $9,165.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,AETNA,AETNA,316.41,,,,,,,141.5700,804.0300,percent of total billed charges,42.7% of $741.00 in Billed Charges for Rev 521 Proc 17283 = $316.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,141.5700,804.0300,fee schedule,"APG 00003 Proc 17283 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,141.5700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,141.5700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,141.5700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,AMBETTER,AMBETTER,804.03,,,,,,,141.5700,804.0300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,141.5700,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,ANTHEM EXCHANGE,741.00,,,,,,,141.5700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,141.5700,804.0300,fee schedule,"APG 00003 Proc 17283 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,ANTHEM HMO,741.00,,,,,,,141.5700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,141.5700,804.0300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",741.00,,,,,,,141.5700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,184.28,,,,,,,141.5700,804.0300,fee schedule,$184.28 from Fee Schedule BLDTM_23 for Rev 521 Proc 17283 * Qty 1 = $184.28 at 100% = $184.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,141.5700,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,CIGNA HEALTHCARE,CIGNA HMO,309.00,,,,,,,141.5700,804.0300,percent of total billed charges,41.7% of $741.00 in Billed Charges for Rev 521 Proc 17283 = $309.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,343.82,,,,,,,141.5700,804.0300,percent of total billed charges,46.4% of $741.00 in Billed Charges for Rev 521 Proc 17283 = $343.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,141.5700,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,309.00,,,,,,,141.5700,804.0300,percent of total billed charges,41.7% of $741.00 in Billed Charges for Rev 521 Proc 17283 = $309.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,CIGNA HEALTHCARE,CIGNA PPO,309.00,,,,,,,141.5700,804.0300,percent of total billed charges,41.7% of $741.00 in Billed Charges for Rev 521 Proc 17283 = $309.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,141.5700,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,666.90,,,,,,,141.5700,804.0300,percent of total billed charges,90% of $741.00 in Billed Charges for Rev 521 Proc 17283 = $666.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,141.5700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,141.5700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,MEDCOST,MEDCOST VHN,352.64,,,,,,,141.5700,804.0300,percent of total billed charges,47.59% of $741.00 in Billed Charges for Rev 521 Proc 17283 = $352.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,141.5700,804.0300,fee schedule,"APG 00003 Proc 17283 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,141.5700,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,141.5700,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,141.5700,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,141.5700,804.0300,fee schedule,"APG 00003 Proc 17283 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,SENTARA HEALTH,SENTARA HEALTH,191.25,,,,,,,141.5700,804.0300,percent of total billed charges,25.81% of $741.00 in Billed Charges for Rev 521 Proc 17283 = $191.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,141.5700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",741.00,,,,,,,141.5700,804.0300,percent of total billed charges,100% of $741.00 in Billed Charges for Rev 521 Proc 17283 = $741.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,141.57,,,,,,,141.5700,804.0300,fee schedule,$283.14 from Fee Schedule TCUHC24 for Rev 521 Proc 17283 * Qty 1 = $283.14 at 50% = $141.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,141.5700,804.0300,fee schedule,"APG 00003 Proc 17283 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,141.5700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,141.5700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,WELLCARE,WELLCARE MEDICAID,741.00,,,,,,,141.5700,804.0300,percent of total billed charges,100% of $741.00 in Billed Charges for Rev 521 Proc 17283 = $741.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 2.1-3.0 CM,17283,CPT,521,RC,52100082,CDM,,,,both,,,741.0000,111.1500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,141.5700,804.0300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,AETNA,AETNA,348.01,,,,,,,141.5700,1461.7800,percent of total billed charges,42.7% of $815.00 in Billed Charges for Rev 521 Proc 17284 = $348.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,141.5700,1461.7800,fee schedule,"APG 00003 Proc 17284 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,670.54,,,,,,,141.5700,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,AETNA,AETNA HEALTHCARE MEDICARE,670.54,,,,,,,141.5700,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,670.54,,,,,,,141.5700,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,AMBETTER,AMBETTER,1461.78,,,,,,,141.5700,1461.7800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,697.36,,,,,,,141.5700,1461.7800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,BLUE CROSS,ANTHEM EXCHANGE,815.00,,,,,,,141.5700,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,141.5700,1461.7800,fee schedule,"APG 00003 Proc 17284 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,BLUE CROSS,ANTHEM HMO,815.00,,,,,,,141.5700,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,690.66,,,,,,,141.5700,1461.7800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",815.00,,,,,,,141.5700,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,218.93,,,,,,,141.5700,1461.7800,fee schedule,$218.93 from Fee Schedule BLDTM_23 for Rev 521 Proc 17284 * Qty 1 = $218.93 at 100% = $218.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,BLUE CROSS,BLUE CROSS MEDICARE,697.36,,,,,,,141.5700,1461.7800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,CIGNA HEALTHCARE,CIGNA HMO,339.86,,,,,,,141.5700,1461.7800,percent of total billed charges,41.7% of $815.00 in Billed Charges for Rev 521 Proc 17284 = $339.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,378.16,,,,,,,141.5700,1461.7800,percent of total billed charges,46.4% of $815.00 in Billed Charges for Rev 521 Proc 17284 = $378.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,704.07,,,,,,,141.5700,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,339.86,,,,,,,141.5700,1461.7800,percent of total billed charges,41.7% of $815.00 in Billed Charges for Rev 521 Proc 17284 = $339.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,CIGNA HEALTHCARE,CIGNA PPO,339.86,,,,,,,141.5700,1461.7800,percent of total billed charges,41.7% of $815.00 in Billed Charges for Rev 521 Proc 17284 = $339.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,704.07,,,,,,,141.5700,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,733.50,,,,,,,141.5700,1461.7800,percent of total billed charges,90% of $815.00 in Billed Charges for Rev 521 Proc 17284 = $733.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,HUMANA,HUMANA MEDICARE,670.54,,,,,,,141.5700,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,670.54,,,,,,,141.5700,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,MEDCOST,MEDCOST VHN,387.86,,,,,,,141.5700,1461.7800,percent of total billed charges,47.59% of $815.00 in Billed Charges for Rev 521 Proc 17284 = $387.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,141.5700,1461.7800,fee schedule,"APG 00003 Proc 17284 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,704.07,,,,,,,141.5700,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,704.07,,,,,,,141.5700,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,NHC ADVANTAGE,NHC ADVANTAGE,704.07,,,,,,,141.5700,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,141.5700,1461.7800,fee schedule,"APG 00003 Proc 17284 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,SENTARA HEALTH,SENTARA HEALTH,210.35,,,,,,,141.5700,1461.7800,percent of total billed charges,25.81% of $815.00 in Billed Charges for Rev 521 Proc 17284 = $210.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,SENTARA HEALTH,SENTARA MEDICARE,670.54,,,,,,,141.5700,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",815.00,,,,,,,141.5700,1461.7800,percent of total billed charges,100% of $815.00 in Billed Charges for Rev 521 Proc 17284 = $815.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,141.57,,,,,,,141.5700,1461.7800,fee schedule,$283.14 from Fee Schedule TCUHC24 for Rev 521 Proc 17284 * Qty 1 = $283.14 at 50% = $141.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,141.5700,1461.7800,fee schedule,"APG 00003 Proc 17284 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,670.54,,,,,,,141.5700,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,670.54,,,,,,,141.5700,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,WELLCARE,WELLCARE MEDICAID,815.00,,,,,,,141.5700,1461.7800,percent of total billed charges,100% of $815.00 in Billed Charges for Rev 521 Proc 17284 = $815.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 3.1-4.0 CM,17284,CPT,521,RC,52100083,CDM,,,,both,,,815.0000,122.2500,WELLCARE,WELLCARE MEDICARE,710.77,,,,,,,141.5700,1461.7800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,AETNA,AETNA,2156.78,,,,,,,109.0000,5051.0000,percent of total billed charges,"42.7% of $5,051.00 in Billed Charges for Rev 450 Proc 19020 = $2,156.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1899.70,,,,,,,109.0000,5051.0000,fee schedule,"APG 00020 Proc 19020 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 104% = $1,899.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,109.0000,5051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,109.0000,5051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,109.0000,5051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,AMBETTER,AMBETTER,3266.63,,,,,,,109.0000,5051.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,109.0000,5051.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,BLUE CROSS,ANTHEM EXCHANGE,3689.28,,,,,,,109.0000,5051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1881.43,,,,,,,109.0000,5051.0000,fee schedule,"APG 00020 Proc 19020 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,BLUE CROSS,ANTHEM HMO,3919.64,,,,,,,109.0000,5051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,109.0000,5051.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4611.09,,,,,,,109.0000,5051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,224.48,,,,,,,109.0000,5051.0000,fee schedule,$224.48 from Fee Schedule BLDTM_23 for Rev 450 Proc 19020 * Qty 1 = $224.48 at 100% = $224.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,109.0000,5051.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,109.0000,5051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,109.0000,5051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4545.90,,,,,,,109.0000,5051.0000,percent of total billed charges,"90% of $5,051.00 in Billed Charges for Rev 450 Proc 19020 = $4,545.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,109.0000,5051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,109.0000,5051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,MEDCOST,MEDCOST VHN,2403.77,,,,,,,109.0000,5051.0000,percent of total billed charges,"47.59% of $5,051.00 in Billed Charges for Rev 450 Proc 19020 = $2,403.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1917.96,,,,,,,109.0000,5051.0000,fee schedule,"APG 00020 Proc 19020 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 105% = $1,917.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,109.0000,5051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,109.0000,5051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,109.0000,5051.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1883.26,,,,,,,109.0000,5051.0000,fee schedule,"APG 00020 Proc 19020 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 103.1% = $1,883.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,SENTARA HEALTH,SENTARA HEALTH,1303.66,,,,,,,109.0000,5051.0000,percent of total billed charges,"25.81% of $5,051.00 in Billed Charges for Rev 450 Proc 19020 = $1,303.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,109.0000,5051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5051.00,,,,,,,109.0000,5051.0000,percent of total billed charges,"100% of $5,051.00 in Billed Charges for Rev 450 Proc 19020 = $5,051.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,5051.0000,case rate,Rev 450 Proc 19020 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,5051.0000,case rate,Rev 450 Proc 19020 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,5051.0000,case rate,Rev 450 Proc 19020 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,5051.0000,case rate,Rev 450 Proc 19020 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1881.43,,,,,,,109.0000,5051.0000,fee schedule,"APG 00020 Proc 19020 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,109.0000,5051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,109.0000,5051.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,WELLCARE,WELLCARE MEDICAID,5051.00,,,,,,,109.0000,5051.0000,percent of total billed charges,"100% of $5,051.00 in Billed Charges for Rev 450 Proc 19020 = $5,051.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MASTOTOMY W EXPL/DRNG ABSC DEEP,19020,CPT,450,RC,45000357,CDM,,,,both,,,5051.0000,757.6500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,109.0000,5051.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM BILAT,19030,CPT,361,RC,36100389,CDM,,,50,both,,,1614.0000,242.1000,AETNA,AETNA,689.18,,,,,,,222.0000,1614.0000,percent of total billed charges,"42.7% of $1,614.00 in Billed Charges for Rev 361 Proc 19030 Mod 50 = $689.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ DUCTOGRAM GALACTOGRAM BILAT,19030,CPT,361,RC,36100389,CDM,,,50,both,,,1614.0000,242.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,742.86,,,,,,,222.0000,1614.0000,fee schedule,APG 00278 Proc 19030 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 150% Mod Percentage = $714.29 at 104% = $742.86. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM BILAT,19030,CPT,361,RC,36100389,CDM,,,50,both,,,1614.0000,242.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,735.72,,,,,,,222.0000,1614.0000,fee schedule,APG 00278 Proc 19030 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 150% Mod Percentage = $714.29 at 103% = $735.72. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM BILAT,19030,CPT,361,RC,36100389,CDM,,,50,both,,,1614.0000,242.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1056.00,,,,,,,222.0000,1614.0000,case rate,"Rev 361 Proc 19030 Mod 50 ASG Rate of $704.00 at 100% of $704.00 + 50% of $704.00 = $1,056.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ DUCTOGRAM GALACTOGRAM BILAT,19030,CPT,361,RC,36100389,CDM,,,50,both,,,1614.0000,242.1000,BLUE CROSS,BLUE CROSS E NETWORK,222.00,,,,,,,222.0000,1614.0000,case rate,Rev 361 Proc 19030 Mod 50 ASG Rate of $148.00 at 100% of $148.00 + 50% of $148.00 = $222.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM BILAT,19030,CPT,361,RC,36100389,CDM,,,50,both,,,1614.0000,242.1000,BLUE CROSS,BLUE CROSS P NETWORK,226.50,,,,,,,222.0000,1614.0000,case rate,Rev 361 Proc 19030 Mod 50 ASG Rate of $151.00 at 100% of $151.00 + 50% of $151.00 = $226.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM BILAT,19030,CPT,361,RC,36100389,CDM,,,50,both,,,1614.0000,242.1000,BLUE CROSS,BLUE CROSS S NETWORK,226.50,,,,,,,222.0000,1614.0000,case rate,Rev 361 Proc 19030 Mod 50 ASG Rate of $151.00 at 100% of $151.00 + 50% of $151.00 = $226.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM BILAT,19030,CPT,361,RC,36100389,CDM,,,50,both,,,1614.0000,242.1000,BLUE CROSS,TENNCARE BLUE CARE,867.00,,,,,,,222.0000,1614.0000,case rate,Rev 361 Proc 19030 Mod 50 ASG Rate of $578.00 at 100% of $578.00 + 50% of $578.00 = $867.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM BILAT,19030,CPT,361,RC,36100389,CDM,,,50,both,,,1614.0000,242.1000,BLUE CROSS,TENNCARE BLUE SELECT,867.00,,,,,,,222.0000,1614.0000,case rate,Rev 361 Proc 19030 Mod 50 ASG Rate of $578.00 at 100% of $578.00 + 50% of $578.00 = $867.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM BILAT,19030,CPT,361,RC,36100389,CDM,,,50,both,,,1614.0000,242.1000,CIGNA HEALTHCARE,CIGNA HMO,1614.00,,,,,,,222.0000,1614.0000,case rate,"Rev 361 Proc 19030 Mod 50 ASG Rate of $4,239.00 at 100% of $4,239.00 + 50% of $4,239.00 = $6,358.50 Total (Limited to $1,614.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,614.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ DUCTOGRAM GALACTOGRAM BILAT,19030,CPT,361,RC,36100389,CDM,,,50,both,,,1614.0000,242.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1614.00,,,,,,,222.0000,1614.0000,case rate,"Rev 361 Proc 19030 Mod 50 ASG Rate of $4,239.00 at 100% of $4,239.00 + 50% of $4,239.00 = $6,358.50 Total (Limited to $1,614.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,614.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ DUCTOGRAM GALACTOGRAM BILAT,19030,CPT,361,RC,36100389,CDM,,,50,both,,,1614.0000,242.1000,CIGNA HEALTHCARE,CIGNA PPO,1614.00,,,,,,,222.0000,1614.0000,case rate,"Rev 361 Proc 19030 Mod 50 ASG Rate of $4,239.00 at 100% of $4,239.00 + 50% of $4,239.00 = $6,358.50 Total (Limited to $1,614.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,614.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ DUCTOGRAM GALACTOGRAM BILAT,19030,CPT,361,RC,36100389,CDM,,,50,both,,,1614.0000,242.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1452.60,,,,,,,222.0000,1614.0000,percent of total billed charges,"90% of $1,614.00 in Billed Charges for Rev 361 Proc 19030 Mod 50 = $1,452.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ DUCTOGRAM GALACTOGRAM BILAT,19030,CPT,361,RC,36100389,CDM,,,50,both,,,1614.0000,242.1000,MEDCOST,MEDCOST VHN,768.10,,,,,,,222.0000,1614.0000,percent of total billed charges,"47.59% of $1,614.00 in Billed Charges for Rev 361 Proc 19030 Mod 50 = $768.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ DUCTOGRAM GALACTOGRAM BILAT,19030,CPT,361,RC,36100389,CDM,,,50,both,,,1614.0000,242.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,750.00,,,,,,,222.0000,1614.0000,fee schedule,APG 00278 Proc 19030 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 150% Mod Percentage = $714.29 at 100% = $714.29... $714.29 at 105% = $750.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM BILAT,19030,CPT,361,RC,36100389,CDM,,,50,both,,,1614.0000,242.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,736.43,,,,,,,222.0000,1614.0000,fee schedule,APG 00278 Proc 19030 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 150% Mod Percentage = $714.29 at 100% = $714.29... $714.29 at 103.1% = $736.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM BILAT,19030,CPT,361,RC,36100389,CDM,,,50,both,,,1614.0000,242.1000,SENTARA HEALTH,SENTARA HEALTH,416.57,,,,,,,222.0000,1614.0000,percent of total billed charges,"25.81% of $1,614.00 in Billed Charges for Rev 361 Proc 19030 Mod 50 = $416.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ DUCTOGRAM GALACTOGRAM BILAT,19030,CPT,361,RC,36100389,CDM,,,50,both,,,1614.0000,242.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1614.00,,,,,,,222.0000,1614.0000,percent of total billed charges,"100% of $1,614.00 in Billed Charges for Rev 361 Proc 19030 Mod 50 = $1,614.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ DUCTOGRAM GALACTOGRAM BILAT,19030,CPT,361,RC,36100389,CDM,,,50,both,,,1614.0000,242.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,259.50,,,,,,,222.0000,1614.0000,case rate,Rev 361 Proc 19030 Mod 50 ASG Rate of $173.00 at 100% of $173.00 + 50% of $173.00 = $259.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM BILAT,19030,CPT,361,RC,36100389,CDM,,,50,both,,,1614.0000,242.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,433.50,,,,,,,222.0000,1614.0000,case rate,Rev 361 Proc 19030 Mod 50 ASG Rate of $289.00 at 100% of $289.00 + 50% of $289.00 = $433.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM BILAT,19030,CPT,361,RC,36100389,CDM,,,50,both,,,1614.0000,242.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,415.50,,,,,,,222.0000,1614.0000,case rate,Rev 361 Proc 19030 Mod 50 ASG Rate of $277.00 at 100% of $277.00 + 50% of $277.00 = $415.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM BILAT,19030,CPT,361,RC,36100389,CDM,,,50,both,,,1614.0000,242.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,792.00,,,,,,,222.0000,1614.0000,case rate,Rev 361 Proc 19030 Mod 50 ASG Rate of $528.00 at 100% of $528.00 + 50% of $528.00 = $792.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM BILAT,19030,CPT,361,RC,36100389,CDM,,,50,both,,,1614.0000,242.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,735.72,,,,,,,222.0000,1614.0000,fee schedule,APG 00278 Proc 19030 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 150% Mod Percentage = $714.29 at 103% = $735.72. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM BILAT,19030,CPT,361,RC,36100389,CDM,,,50,both,,,1614.0000,242.1000,WELLCARE,WELLCARE MEDICAID,1614.00,,,,,,,222.0000,1614.0000,percent of total billed charges,"100% of $1,614.00 in Billed Charges for Rev 361 Proc 19030 Mod 50 = $1,614.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,AETNA,AETNA,1231.47,,,,,,,744.3600,3266.6300,percent of total billed charges,"42.7% of $2,884.00 in Billed Charges for Rev 361 Proc 19081 = $1,231.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1899.70,,,,,,,744.3600,3266.6300,fee schedule,"APG 00020 Proc 19081 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 104% = $1,899.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,744.3600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,744.3600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,744.3600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,AMBETTER,AMBETTER,3266.63,,,,,,,744.3600,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,744.3600,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,BLUE CROSS,ANTHEM EXCHANGE,2884.00,,,,,,,744.3600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1881.43,,,,,,,744.3600,3266.6300,fee schedule,"APG 00020 Proc 19081 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,BLUE CROSS,ANTHEM HMO,2884.00,,,,,,,744.3600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,744.3600,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2884.00,,,,,,,744.3600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,744.3600,3266.6300,case rate,"Rev 361 Proc 19081 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,744.3600,3266.6300,case rate,"Rev 361 Proc 19081 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,744.3600,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,744.3600,3266.6300,case rate,"Rev 361 Proc 19081 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,744.3600,3266.6300,case rate,"Rev 361 Proc 19081 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,744.3600,3266.6300,case rate,Rev 361 Proc 19081 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,744.3600,3266.6300,case rate,Rev 361 Proc 19081 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,CIGNA HEALTHCARE,CIGNA HMO,2884.00,,,,,,,744.3600,3266.6300,case rate,"Rev 361 Proc 19081 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total (Limited to $2,884.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,884.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2246.00,,,,,,,744.3600,3266.6300,case rate,"Rev 361 Proc 19081 ASG Rate of $2,246.00 at 100% of $2,246.00 = $2,246.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,744.3600,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2884.00,,,,,,,744.3600,3266.6300,case rate,"Rev 361 Proc 19081 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total (Limited to $2,884.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,884.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,CIGNA HEALTHCARE,CIGNA PPO,2884.00,,,,,,,744.3600,3266.6300,case rate,"Rev 361 Proc 19081 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total (Limited to $2,884.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,884.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,744.3600,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2595.60,,,,,,,744.3600,3266.6300,percent of total billed charges,"90% of $2,884.00 in Billed Charges for Rev 361 Proc 19081 = $2,595.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,744.3600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,744.3600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,MEDCOST,MEDCOST VHN,1372.50,,,,,,,744.3600,3266.6300,percent of total billed charges,"47.59% of $2,884.00 in Billed Charges for Rev 361 Proc 19081 = $1,372.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1917.96,,,,,,,744.3600,3266.6300,fee schedule,"APG 00020 Proc 19081 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 105% = $1,917.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,744.3600,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,744.3600,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,744.3600,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1883.26,,,,,,,744.3600,3266.6300,fee schedule,"APG 00020 Proc 19081 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 103.1% = $1,883.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,SENTARA HEALTH,SENTARA HEALTH,744.36,,,,,,,744.3600,3266.6300,percent of total billed charges,"25.81% of $2,884.00 in Billed Charges for Rev 361 Proc 19081 = $744.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,744.3600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2884.00,,,,,,,744.3600,3266.6300,percent of total billed charges,"100% of $2,884.00 in Billed Charges for Rev 361 Proc 19081 = $2,884.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,744.3600,3266.6300,case rate,Rev 361 Proc 19081 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,744.3600,3266.6300,case rate,"Rev 361 Proc 19081 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,744.3600,3266.6300,case rate,"Rev 361 Proc 19081 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,744.3600,3266.6300,case rate,"Rev 361 Proc 19081 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1881.43,,,,,,,744.3600,3266.6300,fee schedule,"APG 00020 Proc 19081 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,744.3600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,744.3600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,WELLCARE,WELLCARE MEDICAID,2884.00,,,,,,,744.3600,3266.6300,percent of total billed charges,"100% of $2,884.00 in Billed Charges for Rev 361 Proc 19081 = $2,884.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CB STEREO LOC BRST BX 1ST LESION,19081,CPT,361,RC,36100252,CDM,,,,both,,,2884.0000,432.6000,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,744.3600,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST BX EA ADD,19082,CPT,361,RC,36100217,CDM,,,,both,,,608.0000,91.2000,AETNA,AETNA,259.62,,,,,,,148.0000,1917.9600,percent of total billed charges,42.7% of $608.00 in Billed Charges for Rev 361 Proc 19082 = $259.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CB STERO LOC BRST BX EA ADD,19082,CPT,361,RC,36100217,CDM,,,,both,,,608.0000,91.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1899.70,,,,,,,148.0000,1917.9600,fee schedule,"APG 00020 Proc 19082 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 104% = $1,899.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST BX EA ADD,19082,CPT,361,RC,36100217,CDM,,,,both,,,608.0000,91.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,608.00,,,,,,,148.0000,1917.9600,fee schedule,"APG 00020 Proc 19082 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43 (Service Line reduced to $608.00, claim capped at $608.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST BX EA ADD,19082,CPT,361,RC,36100217,CDM,,,,both,,,608.0000,91.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,608.00,,,,,,,148.0000,1917.9600,case rate,"Rev 361 Proc 19082 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $608.00 in Billed Charges - $0.00 in ASG Allowed Amount = $608.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST BX EA ADD,19082,CPT,361,RC,36100217,CDM,,,,both,,,608.0000,91.2000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,1917.9600,case rate,Rev 361 Proc 19082 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST BX EA ADD,19082,CPT,361,RC,36100217,CDM,,,,both,,,608.0000,91.2000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,1917.9600,case rate,Rev 361 Proc 19082 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST BX EA ADD,19082,CPT,361,RC,36100217,CDM,,,,both,,,608.0000,91.2000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,1917.9600,case rate,Rev 361 Proc 19082 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST BX EA ADD,19082,CPT,361,RC,36100217,CDM,,,,both,,,608.0000,91.2000,CIGNA HEALTHCARE,CIGNA HMO,608.00,,,,,,,148.0000,1917.9600,case rate,"Rev 361 Proc 19082 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $608.00 in Billed Charges - $0.00 in ASG Allowed Amount = $608.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST BX EA ADD,19082,CPT,361,RC,36100217,CDM,,,,both,,,608.0000,91.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,608.00,,,,,,,148.0000,1917.9600,case rate,"Rev 361 Proc 19082 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $608.00 in Billed Charges - $0.00 in ASG Allowed Amount = $608.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST BX EA ADD,19082,CPT,361,RC,36100217,CDM,,,,both,,,608.0000,91.2000,CIGNA HEALTHCARE,CIGNA PPO,608.00,,,,,,,148.0000,1917.9600,case rate,"Rev 361 Proc 19082 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $608.00 in Billed Charges - $0.00 in ASG Allowed Amount = $608.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST BX EA ADD,19082,CPT,361,RC,36100217,CDM,,,,both,,,608.0000,91.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,547.20,,,,,,,148.0000,1917.9600,percent of total billed charges,90% of $608.00 in Billed Charges for Rev 361 Proc 19082 = $547.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CB STERO LOC BRST BX EA ADD,19082,CPT,361,RC,36100217,CDM,,,,both,,,608.0000,91.2000,MEDCOST,MEDCOST VHN,289.35,,,,,,,148.0000,1917.9600,percent of total billed charges,47.59% of $608.00 in Billed Charges for Rev 361 Proc 19082 = $289.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CB STERO LOC BRST BX EA ADD,19082,CPT,361,RC,36100217,CDM,,,,both,,,608.0000,91.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1917.96,,,,,,,148.0000,1917.9600,fee schedule,"APG 00020 Proc 19082 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 105% = $1,917.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST BX EA ADD,19082,CPT,361,RC,36100217,CDM,,,,both,,,608.0000,91.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1883.26,,,,,,,148.0000,1917.9600,fee schedule,"APG 00020 Proc 19082 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 103.1% = $1,883.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST BX EA ADD,19082,CPT,361,RC,36100217,CDM,,,,both,,,608.0000,91.2000,SENTARA HEALTH,SENTARA HEALTH,156.92,,,,,,,148.0000,1917.9600,percent of total billed charges,25.81% of $608.00 in Billed Charges for Rev 361 Proc 19082 = $156.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CB STERO LOC BRST BX EA ADD,19082,CPT,361,RC,36100217,CDM,,,,both,,,608.0000,91.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",608.00,,,,,,,148.0000,1917.9600,percent of total billed charges,100% of $608.00 in Billed Charges for Rev 361 Proc 19082 = $608.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CB STERO LOC BRST BX EA ADD,19082,CPT,361,RC,36100217,CDM,,,,both,,,608.0000,91.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,148.0000,1917.9600,case rate,Rev 361 Proc 19082 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST BX EA ADD,19082,CPT,361,RC,36100217,CDM,,,,both,,,608.0000,91.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,148.0000,1917.9600,case rate,Rev 361 Proc 19082 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST BX EA ADD,19082,CPT,361,RC,36100217,CDM,,,,both,,,608.0000,91.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,148.0000,1917.9600,case rate,Rev 361 Proc 19082 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST BX EA ADD,19082,CPT,361,RC,36100217,CDM,,,,both,,,608.0000,91.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,148.0000,1917.9600,case rate,Rev 361 Proc 19082 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST BX EA ADD,19082,CPT,361,RC,36100217,CDM,,,,both,,,608.0000,91.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1881.43,,,,,,,148.0000,1917.9600,fee schedule,"APG 00020 Proc 19082 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST BX EA ADD,19082,CPT,361,RC,36100217,CDM,,,,both,,,608.0000,91.2000,WELLCARE,WELLCARE MEDICAID,608.00,,,,,,,148.0000,1917.9600,percent of total billed charges,100% of $608.00 in Billed Charges for Rev 361 Proc 19082 = $608.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,AETNA,AETNA,1675.98,,,,,,,775.0000,3925.0000,percent of total billed charges,"42.7% of $3,925.00 in Billed Charges for Rev 361 Proc 19085 = $1,675.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1899.70,,,,,,,775.0000,3925.0000,fee schedule,"APG 00020 Proc 19085 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 104% = $1,899.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,775.0000,3925.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,775.0000,3925.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,775.0000,3925.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,AMBETTER,AMBETTER,3266.63,,,,,,,775.0000,3925.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,775.0000,3925.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,BLUE CROSS,ANTHEM EXCHANGE,3689.28,,,,,,,775.0000,3925.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1881.43,,,,,,,775.0000,3925.0000,fee schedule,"APG 00020 Proc 19085 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,BLUE CROSS,ANTHEM HMO,3919.64,,,,,,,775.0000,3925.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,775.0000,3925.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3925.00,,,,,,,775.0000,3925.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,775.0000,3925.0000,case rate,"Rev 361 Proc 19085 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,775.0000,3925.0000,case rate,"Rev 361 Proc 19085 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,775.0000,3925.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,775.0000,3925.0000,case rate,"Rev 361 Proc 19085 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,775.0000,3925.0000,case rate,"Rev 361 Proc 19085 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,3925.0000,case rate,Rev 361 Proc 19085 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,3925.0000,case rate,Rev 361 Proc 19085 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,CIGNA HEALTHCARE,CIGNA HMO,2967.00,,,,,,,775.0000,3925.0000,case rate,"Rev 361 Proc 19085 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2246.00,,,,,,,775.0000,3925.0000,case rate,"Rev 361 Proc 19085 ASG Rate of $2,246.00 at 100% of $2,246.00 = $2,246.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,775.0000,3925.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2967.00,,,,,,,775.0000,3925.0000,case rate,"Rev 361 Proc 19085 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,CIGNA HEALTHCARE,CIGNA PPO,2967.00,,,,,,,775.0000,3925.0000,case rate,"Rev 361 Proc 19085 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,775.0000,3925.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3532.50,,,,,,,775.0000,3925.0000,percent of total billed charges,"90% of $3,925.00 in Billed Charges for Rev 361 Proc 19085 = $3,532.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,775.0000,3925.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,775.0000,3925.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,MEDCOST,MEDCOST VHN,1867.91,,,,,,,775.0000,3925.0000,percent of total billed charges,"47.59% of $3,925.00 in Billed Charges for Rev 361 Proc 19085 = $1,867.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1917.96,,,,,,,775.0000,3925.0000,fee schedule,"APG 00020 Proc 19085 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 105% = $1,917.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,775.0000,3925.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,775.0000,3925.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,775.0000,3925.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1883.26,,,,,,,775.0000,3925.0000,fee schedule,"APG 00020 Proc 19085 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 103.1% = $1,883.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,SENTARA HEALTH,SENTARA HEALTH,1013.04,,,,,,,775.0000,3925.0000,percent of total billed charges,"25.81% of $3,925.00 in Billed Charges for Rev 361 Proc 19085 = $1,013.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,775.0000,3925.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3925.00,,,,,,,775.0000,3925.0000,percent of total billed charges,"100% of $3,925.00 in Billed Charges for Rev 361 Proc 19085 = $3,925.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,775.0000,3925.0000,case rate,Rev 361 Proc 19085 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,775.0000,3925.0000,case rate,"Rev 361 Proc 19085 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,775.0000,3925.0000,case rate,"Rev 361 Proc 19085 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,775.0000,3925.0000,case rate,"Rev 361 Proc 19085 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1881.43,,,,,,,775.0000,3925.0000,fee schedule,"APG 00020 Proc 19085 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,775.0000,3925.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,775.0000,3925.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,WELLCARE,WELLCARE MEDICAID,3925.00,,,,,,,775.0000,3925.0000,percent of total billed charges,"100% of $3,925.00 in Billed Charges for Rev 361 Proc 19085 = $3,925.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR GUID BREAST BX 1ST LESION,19085,CPT,361,RC,36100223,CDM,,,,both,,,3925.0000,588.7500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,775.0000,3925.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE ENDOBRONCHIAL 37 FR.LEFT,272,RC,,,,,,,,both,,,1039.2800,155.8900,AETNA,AETNA,443.77,,,,,,,268.2400,1039.2800,percent of total billed charges,"42.7% of $1,039.28 in Billed Charges for Rev 272 = $443.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOBRONCHIAL 37 FR.LEFT,272,RC,,,,,,,,both,,,1039.2800,155.8900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,727.50,,,,,,,268.2400,1039.2800,percent of total billed charges,"Rev 272 $1,039.28 in Billed Charges at 70% = $727.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOBRONCHIAL 37 FR.LEFT,272,RC,,,,,,,,both,,,1039.2800,155.8900,CIGNA HEALTHCARE,CIGNA HMO,433.38,,,,,,,268.2400,1039.2800,percent of total billed charges,"41.7% of $1,039.28 in Billed Charges for Rev 272 = $433.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOBRONCHIAL 37 FR.LEFT,272,RC,,,,,,,,both,,,1039.2800,155.8900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,482.23,,,,,,,268.2400,1039.2800,percent of total billed charges,"46.4% of $1,039.28 in Billed Charges for Rev 272 = $482.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOBRONCHIAL 37 FR.LEFT,272,RC,,,,,,,,both,,,1039.2800,155.8900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,433.38,,,,,,,268.2400,1039.2800,percent of total billed charges,"41.7% of $1,039.28 in Billed Charges for Rev 272 = $433.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOBRONCHIAL 37 FR.LEFT,272,RC,,,,,,,,both,,,1039.2800,155.8900,CIGNA HEALTHCARE,CIGNA PPO,433.38,,,,,,,268.2400,1039.2800,percent of total billed charges,"41.7% of $1,039.28 in Billed Charges for Rev 272 = $433.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOBRONCHIAL 37 FR.LEFT,272,RC,,,,,,,,both,,,1039.2800,155.8900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,935.35,,,,,,,268.2400,1039.2800,percent of total billed charges,"90% of $1,039.28 in Billed Charges for Rev 272 = $935.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOBRONCHIAL 37 FR.LEFT,272,RC,,,,,,,,both,,,1039.2800,155.8900,MEDCOST,MEDCOST VHN,494.59,,,,,,,268.2400,1039.2800,percent of total billed charges,"47.59% of $1,039.28 in Billed Charges for Rev 272 = $494.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOBRONCHIAL 37 FR.LEFT,272,RC,,,,,,,,both,,,1039.2800,155.8900,SENTARA HEALTH,SENTARA HEALTH,268.24,,,,,,,268.2400,1039.2800,percent of total billed charges,"25.81% of $1,039.28 in Billed Charges for Rev 272 = $268.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOBRONCHIAL 37 FR.LEFT,272,RC,,,,,,,,both,,,1039.2800,155.8900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1039.28,,,,,,,268.2400,1039.2800,percent of total billed charges,"100% of $1,039.28 in Billed Charges for Rev 272 = $1,039.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOBRONCHIAL 37 FR.LEFT,272,RC,,,,,,,,both,,,1039.2800,155.8900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,519.64,,,,,,,268.2400,1039.2800,percent of total billed charges,"Rev 272 $1,039.28 in Billed Charges at 50% = $519.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOBRONCHIAL 37 FR.LEFT,272,RC,,,,,,,,both,,,1039.2800,155.8900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,335.69,,,,,,,268.2400,1039.2800,other,"32.3% of $1,039.28 in Billed Charges for Rev 272 = $335.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE ENDOBRONCHIAL 37 FR.LEFT,272,RC,,,,,,,,both,,,1039.2800,155.8900,UNITED HEALTHCARE,UHC HERITAGE SELECT,319.06,,,,,,,268.2400,1039.2800,other,"30.7% of $1,039.28 in Billed Charges for Rev 272 = $319.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE ENDOBRONCHIAL 37 FR.LEFT,272,RC,,,,,,,,both,,,1039.2800,155.8900,UNITED HEALTHCARE,UNITED HEALTHCARE,335.69,,,,,,,268.2400,1039.2800,percent of total billed charges,"32.3% of $1,039.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOBRONCHIAL 37 FR.LEFT,272,RC,,,,,,,,both,,,1039.2800,155.8900,WELLCARE,WELLCARE MEDICAID,1039.28,,,,,,,268.2400,1039.2800,percent of total billed charges,"100% of $1,039.28 in Billed Charges for Rev 272 = $1,039.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOBRONCHIAL 37FR LEFT,272,RC,,,,,,,,both,,,697.8600,104.6800,AETNA,AETNA,297.99,,,,,,,180.1200,697.8600,percent of total billed charges,42.7% of $697.86 in Billed Charges for Rev 272 = $297.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE ENDOBRONCHIAL 37FR LEFT,272,RC,,,,,,,,both,,,697.8600,104.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,488.50,,,,,,,180.1200,697.8600,percent of total billed charges,Rev 272 $697.86 in Billed Charges at 70% = $488.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE ENDOBRONCHIAL 37FR LEFT,272,RC,,,,,,,,both,,,697.8600,104.6800,CIGNA HEALTHCARE,CIGNA HMO,291.01,,,,,,,180.1200,697.8600,percent of total billed charges,41.7% of $697.86 in Billed Charges for Rev 272 = $291.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE ENDOBRONCHIAL 37FR LEFT,272,RC,,,,,,,,both,,,697.8600,104.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,323.81,,,,,,,180.1200,697.8600,percent of total billed charges,46.4% of $697.86 in Billed Charges for Rev 272 = $323.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE ENDOBRONCHIAL 37FR LEFT,272,RC,,,,,,,,both,,,697.8600,104.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,291.01,,,,,,,180.1200,697.8600,percent of total billed charges,41.7% of $697.86 in Billed Charges for Rev 272 = $291.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE ENDOBRONCHIAL 37FR LEFT,272,RC,,,,,,,,both,,,697.8600,104.6800,CIGNA HEALTHCARE,CIGNA PPO,291.01,,,,,,,180.1200,697.8600,percent of total billed charges,41.7% of $697.86 in Billed Charges for Rev 272 = $291.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE ENDOBRONCHIAL 37FR LEFT,272,RC,,,,,,,,both,,,697.8600,104.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,628.07,,,,,,,180.1200,697.8600,percent of total billed charges,90% of $697.86 in Billed Charges for Rev 272 = $628.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE ENDOBRONCHIAL 37FR LEFT,272,RC,,,,,,,,both,,,697.8600,104.6800,MEDCOST,MEDCOST VHN,332.11,,,,,,,180.1200,697.8600,percent of total billed charges,47.59% of $697.86 in Billed Charges for Rev 272 = $332.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE ENDOBRONCHIAL 37FR LEFT,272,RC,,,,,,,,both,,,697.8600,104.6800,SENTARA HEALTH,SENTARA HEALTH,180.12,,,,,,,180.1200,697.8600,percent of total billed charges,25.81% of $697.86 in Billed Charges for Rev 272 = $180.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE ENDOBRONCHIAL 37FR LEFT,272,RC,,,,,,,,both,,,697.8600,104.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",697.86,,,,,,,180.1200,697.8600,percent of total billed charges,100% of $697.86 in Billed Charges for Rev 272 = $697.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE ENDOBRONCHIAL 37FR LEFT,272,RC,,,,,,,,both,,,697.8600,104.6800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,348.93,,,,,,,180.1200,697.8600,percent of total billed charges,Rev 272 $697.86 in Billed Charges at 50% = $348.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE ENDOBRONCHIAL 37FR LEFT,272,RC,,,,,,,,both,,,697.8600,104.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,225.41,,,,,,,180.1200,697.8600,other,32.3% of $697.86 in Billed Charges for Rev 272 = $225.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE ENDOBRONCHIAL 37FR LEFT,272,RC,,,,,,,,both,,,697.8600,104.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,214.24,,,,,,,180.1200,697.8600,other,30.7% of $697.86 in Billed Charges for Rev 272 = $214.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE ENDOBRONCHIAL 37FR LEFT,272,RC,,,,,,,,both,,,697.8600,104.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,225.41,,,,,,,180.1200,697.8600,percent of total billed charges,32.3% of $697.86 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE ENDOBRONCHIAL 37FR LEFT,272,RC,,,,,,,,both,,,697.8600,104.6800,WELLCARE,WELLCARE MEDICAID,697.86,,,,,,,180.1200,697.8600,percent of total billed charges,100% of $697.86 in Billed Charges for Rev 272 = $697.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE ENDOTRACHEAL 8MM NIM CONTACT 8229508,272,RC,27200002,CDM,,,,,,both,,,4573.6100,686.0400,AETNA,AETNA,1952.93,,,,,,,1180.4500,4573.6100,percent of total billed charges,"42.7% of $4,573.61 in Billed Charges for Rev 272 = $1,952.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 8MM NIM CONTACT 8229508,272,RC,27200002,CDM,,,,,,both,,,4573.6100,686.0400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3201.53,,,,,,,1180.4500,4573.6100,percent of total billed charges,"Rev 272 $4,573.61 in Billed Charges at 70% = $3,201.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 8MM NIM CONTACT 8229508,272,RC,27200002,CDM,,,,,,both,,,4573.6100,686.0400,CIGNA HEALTHCARE,CIGNA HMO,1907.20,,,,,,,1180.4500,4573.6100,percent of total billed charges,"41.7% of $4,573.61 in Billed Charges for Rev 272 = $1,907.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 8MM NIM CONTACT 8229508,272,RC,27200002,CDM,,,,,,both,,,4573.6100,686.0400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2122.16,,,,,,,1180.4500,4573.6100,percent of total billed charges,"46.4% of $4,573.61 in Billed Charges for Rev 272 = $2,122.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 8MM NIM CONTACT 8229508,272,RC,27200002,CDM,,,,,,both,,,4573.6100,686.0400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1907.20,,,,,,,1180.4500,4573.6100,percent of total billed charges,"41.7% of $4,573.61 in Billed Charges for Rev 272 = $1,907.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 8MM NIM CONTACT 8229508,272,RC,27200002,CDM,,,,,,both,,,4573.6100,686.0400,CIGNA HEALTHCARE,CIGNA PPO,1907.20,,,,,,,1180.4500,4573.6100,percent of total billed charges,"41.7% of $4,573.61 in Billed Charges for Rev 272 = $1,907.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 8MM NIM CONTACT 8229508,272,RC,27200002,CDM,,,,,,both,,,4573.6100,686.0400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4116.25,,,,,,,1180.4500,4573.6100,percent of total billed charges,"90% of $4,573.61 in Billed Charges for Rev 272 = $4,116.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 8MM NIM CONTACT 8229508,272,RC,27200002,CDM,,,,,,both,,,4573.6100,686.0400,MEDCOST,MEDCOST VHN,2176.58,,,,,,,1180.4500,4573.6100,percent of total billed charges,"47.59% of $4,573.61 in Billed Charges for Rev 272 = $2,176.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 8MM NIM CONTACT 8229508,272,RC,27200002,CDM,,,,,,both,,,4573.6100,686.0400,SENTARA HEALTH,SENTARA HEALTH,1180.45,,,,,,,1180.4500,4573.6100,percent of total billed charges,"25.81% of $4,573.61 in Billed Charges for Rev 272 = $1,180.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 8MM NIM CONTACT 8229508,272,RC,27200002,CDM,,,,,,both,,,4573.6100,686.0400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4573.61,,,,,,,1180.4500,4573.6100,percent of total billed charges,"100% of $4,573.61 in Billed Charges for Rev 272 = $4,573.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 8MM NIM CONTACT 8229508,272,RC,27200002,CDM,,,,,,both,,,4573.6100,686.0400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2286.81,,,,,,,1180.4500,4573.6100,percent of total billed charges,"Rev 272 $4,573.61 in Billed Charges at 50% = $2,286.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 8MM NIM CONTACT 8229508,272,RC,27200002,CDM,,,,,,both,,,4573.6100,686.0400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1477.28,,,,,,,1180.4500,4573.6100,other,"32.3% of $4,573.61 in Billed Charges for Rev 272 = $1,477.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE ENDOTRACHEAL 8MM NIM CONTACT 8229508,272,RC,27200002,CDM,,,,,,both,,,4573.6100,686.0400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1404.10,,,,,,,1180.4500,4573.6100,other,"30.7% of $4,573.61 in Billed Charges for Rev 272 = $1,404.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE ENDOTRACHEAL 8MM NIM CONTACT 8229508,272,RC,27200002,CDM,,,,,,both,,,4573.6100,686.0400,UNITED HEALTHCARE,UNITED HEALTHCARE,1477.28,,,,,,,1180.4500,4573.6100,percent of total billed charges,"32.3% of $4,573.61 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ENDOTRACHEAL 8MM NIM CONTACT 8229508,272,RC,27200002,CDM,,,,,,both,,,4573.6100,686.0400,WELLCARE,WELLCARE MEDICAID,4573.61,,,,,,,1180.4500,4573.6100,percent of total billed charges,"100% of $4,573.61 in Billed Charges for Rev 272 = $4,573.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ET COBRA 3 PLATE EMG 6MM,272,RC,,,,,,,,both,,,17630.7000,2644.6100,AETNA,AETNA,7528.31,,,,,,,4550.4800,17630.7000,percent of total billed charges,"42.7% of $17,630.70 in Billed Charges for Rev 272 = $7,528.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ET COBRA 3 PLATE EMG 6MM,272,RC,,,,,,,,both,,,17630.7000,2644.6100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,12341.49,,,,,,,4550.4800,17630.7000,percent of total billed charges,"Rev 272 $17,630.70 in Billed Charges at 70% = $12,341.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ET COBRA 3 PLATE EMG 6MM,272,RC,,,,,,,,both,,,17630.7000,2644.6100,CIGNA HEALTHCARE,CIGNA HMO,7352.00,,,,,,,4550.4800,17630.7000,percent of total billed charges,"41.7% of $17,630.70 in Billed Charges for Rev 272 = $7,352.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ET COBRA 3 PLATE EMG 6MM,272,RC,,,,,,,,both,,,17630.7000,2644.6100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8180.64,,,,,,,4550.4800,17630.7000,percent of total billed charges,"46.4% of $17,630.70 in Billed Charges for Rev 272 = $8,180.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ET COBRA 3 PLATE EMG 6MM,272,RC,,,,,,,,both,,,17630.7000,2644.6100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7352.00,,,,,,,4550.4800,17630.7000,percent of total billed charges,"41.7% of $17,630.70 in Billed Charges for Rev 272 = $7,352.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ET COBRA 3 PLATE EMG 6MM,272,RC,,,,,,,,both,,,17630.7000,2644.6100,CIGNA HEALTHCARE,CIGNA PPO,7352.00,,,,,,,4550.4800,17630.7000,percent of total billed charges,"41.7% of $17,630.70 in Billed Charges for Rev 272 = $7,352.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ET COBRA 3 PLATE EMG 6MM,272,RC,,,,,,,,both,,,17630.7000,2644.6100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,15867.63,,,,,,,4550.4800,17630.7000,percent of total billed charges,"90% of $17,630.70 in Billed Charges for Rev 272 = $15,867.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ET COBRA 3 PLATE EMG 6MM,272,RC,,,,,,,,both,,,17630.7000,2644.6100,MEDCOST,MEDCOST VHN,8390.45,,,,,,,4550.4800,17630.7000,percent of total billed charges,"47.59% of $17,630.70 in Billed Charges for Rev 272 = $8,390.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ET COBRA 3 PLATE EMG 6MM,272,RC,,,,,,,,both,,,17630.7000,2644.6100,SENTARA HEALTH,SENTARA HEALTH,4550.48,,,,,,,4550.4800,17630.7000,percent of total billed charges,"25.81% of $17,630.70 in Billed Charges for Rev 272 = $4,550.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ET COBRA 3 PLATE EMG 6MM,272,RC,,,,,,,,both,,,17630.7000,2644.6100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",17630.70,,,,,,,4550.4800,17630.7000,percent of total billed charges,"100% of $17,630.70 in Billed Charges for Rev 272 = $17,630.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ET COBRA 3 PLATE EMG 6MM,272,RC,,,,,,,,both,,,17630.7000,2644.6100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8815.35,,,,,,,4550.4800,17630.7000,percent of total billed charges,"Rev 272 $17,630.70 in Billed Charges at 50% = $8,815.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ET COBRA 3 PLATE EMG 6MM,272,RC,,,,,,,,both,,,17630.7000,2644.6100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5694.72,,,,,,,4550.4800,17630.7000,other,"32.3% of $17,630.70 in Billed Charges for Rev 272 = $5,694.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE ET COBRA 3 PLATE EMG 6MM,272,RC,,,,,,,,both,,,17630.7000,2644.6100,UNITED HEALTHCARE,UHC HERITAGE SELECT,5412.62,,,,,,,4550.4800,17630.7000,other,"30.7% of $17,630.70 in Billed Charges for Rev 272 = $5,412.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE ET COBRA 3 PLATE EMG 6MM,272,RC,,,,,,,,both,,,17630.7000,2644.6100,UNITED HEALTHCARE,UNITED HEALTHCARE,5694.72,,,,,,,4550.4800,17630.7000,percent of total billed charges,"32.3% of $17,630.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE ET COBRA 3 PLATE EMG 6MM,272,RC,,,,,,,,both,,,17630.7000,2644.6100,WELLCARE,WELLCARE MEDICAID,17630.70,,,,,,,4550.4800,17630.7000,percent of total billed charges,"100% of $17,630.70 in Billed Charges for Rev 272 = $17,630.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR GUID BREAST BX EA ADD,19086,CPT,361,RC,36100224,CDM,,,,both,,,468.0000,70.2000,AETNA,AETNA,199.84,,,,,,,120.7900,1917.9600,percent of total billed charges,42.7% of $468.00 in Billed Charges for Rev 361 Proc 19086 = $199.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MR GUID BREAST BX EA ADD,19086,CPT,361,RC,36100224,CDM,,,,both,,,468.0000,70.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1899.70,,,,,,,120.7900,1917.9600,fee schedule,"APG 00020 Proc 19086 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 104% = $1,899.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX EA ADD,19086,CPT,361,RC,36100224,CDM,,,,both,,,468.0000,70.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,468.00,,,,,,,120.7900,1917.9600,fee schedule,"APG 00020 Proc 19086 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43 (Service Line reduced to $468.00, claim capped at $468.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX EA ADD,19086,CPT,361,RC,36100224,CDM,,,,both,,,468.0000,70.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,468.00,,,,,,,120.7900,1917.9600,case rate,"Rev 361 Proc 19086 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $468.00 in Billed Charges - $0.00 in ASG Allowed Amount = $468.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX EA ADD,19086,CPT,361,RC,36100224,CDM,,,,both,,,468.0000,70.2000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,120.7900,1917.9600,case rate,Rev 361 Proc 19086 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX EA ADD,19086,CPT,361,RC,36100224,CDM,,,,both,,,468.0000,70.2000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,120.7900,1917.9600,case rate,Rev 361 Proc 19086 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX EA ADD,19086,CPT,361,RC,36100224,CDM,,,,both,,,468.0000,70.2000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,120.7900,1917.9600,case rate,Rev 361 Proc 19086 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX EA ADD,19086,CPT,361,RC,36100224,CDM,,,,both,,,468.0000,70.2000,CIGNA HEALTHCARE,CIGNA HMO,468.00,,,,,,,120.7900,1917.9600,case rate,"Rev 361 Proc 19086 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $468.00 in Billed Charges - $0.00 in ASG Allowed Amount = $468.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX EA ADD,19086,CPT,361,RC,36100224,CDM,,,,both,,,468.0000,70.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,468.00,,,,,,,120.7900,1917.9600,case rate,"Rev 361 Proc 19086 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $468.00 in Billed Charges - $0.00 in ASG Allowed Amount = $468.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX EA ADD,19086,CPT,361,RC,36100224,CDM,,,,both,,,468.0000,70.2000,CIGNA HEALTHCARE,CIGNA PPO,468.00,,,,,,,120.7900,1917.9600,case rate,"Rev 361 Proc 19086 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $468.00 in Billed Charges - $0.00 in ASG Allowed Amount = $468.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX EA ADD,19086,CPT,361,RC,36100224,CDM,,,,both,,,468.0000,70.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,421.20,,,,,,,120.7900,1917.9600,percent of total billed charges,90% of $468.00 in Billed Charges for Rev 361 Proc 19086 = $421.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MR GUID BREAST BX EA ADD,19086,CPT,361,RC,36100224,CDM,,,,both,,,468.0000,70.2000,MEDCOST,MEDCOST VHN,222.72,,,,,,,120.7900,1917.9600,percent of total billed charges,47.59% of $468.00 in Billed Charges for Rev 361 Proc 19086 = $222.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MR GUID BREAST BX EA ADD,19086,CPT,361,RC,36100224,CDM,,,,both,,,468.0000,70.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1917.96,,,,,,,120.7900,1917.9600,fee schedule,"APG 00020 Proc 19086 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 105% = $1,917.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX EA ADD,19086,CPT,361,RC,36100224,CDM,,,,both,,,468.0000,70.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1883.26,,,,,,,120.7900,1917.9600,fee schedule,"APG 00020 Proc 19086 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 103.1% = $1,883.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX EA ADD,19086,CPT,361,RC,36100224,CDM,,,,both,,,468.0000,70.2000,SENTARA HEALTH,SENTARA HEALTH,120.79,,,,,,,120.7900,1917.9600,percent of total billed charges,25.81% of $468.00 in Billed Charges for Rev 361 Proc 19086 = $120.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MR GUID BREAST BX EA ADD,19086,CPT,361,RC,36100224,CDM,,,,both,,,468.0000,70.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",468.00,,,,,,,120.7900,1917.9600,percent of total billed charges,100% of $468.00 in Billed Charges for Rev 361 Proc 19086 = $468.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MR GUID BREAST BX EA ADD,19086,CPT,361,RC,36100224,CDM,,,,both,,,468.0000,70.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,120.7900,1917.9600,case rate,Rev 361 Proc 19086 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX EA ADD,19086,CPT,361,RC,36100224,CDM,,,,both,,,468.0000,70.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,120.7900,1917.9600,case rate,Rev 361 Proc 19086 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX EA ADD,19086,CPT,361,RC,36100224,CDM,,,,both,,,468.0000,70.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,120.7900,1917.9600,case rate,Rev 361 Proc 19086 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR GUID BREAST BX EA ADD,19086,CPT,361,RC,36100224,CDM,,,,both,,,468.0000,70.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,468.00,,,,,,,120.7900,1917.9600,case rate,"Rev 361 Proc 19086 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total (Service Line reduced to $468.00, claim capped at $468.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX EA ADD,19086,CPT,361,RC,36100224,CDM,,,,both,,,468.0000,70.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1881.43,,,,,,,120.7900,1917.9600,fee schedule,"APG 00020 Proc 19086 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR GUID BREAST BX EA ADD,19086,CPT,361,RC,36100224,CDM,,,,both,,,468.0000,70.2000,WELLCARE,WELLCARE MEDICAID,468.00,,,,,,,120.7900,1917.9600,percent of total billed charges,100% of $468.00 in Billed Charges for Rev 361 Proc 19086 = $468.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,AETNA,AETNA,687.47,,,,,,,415.5400,3266.6300,percent of total billed charges,"42.7% of $1,610.00 in Billed Charges for Rev 361 Proc 19281 = $687.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1899.70,,,,,,,415.5400,3266.6300,fee schedule,"APG 00020 Proc 19281 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 104% = $1,899.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,415.5400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,415.5400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,415.5400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,AMBETTER,AMBETTER,3266.63,,,,,,,415.5400,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,415.5400,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,ANTHEM EXCHANGE,1610.00,,,,,,,415.5400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1610.00,,,,,,,415.5400,3266.6300,fee schedule,"APG 00020 Proc 19281 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43 (Service Line reduced to $1,610.00, claim capped at $1,610.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,ANTHEM HMO,1610.00,,,,,,,415.5400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,415.5400,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1610.00,,,,,,,415.5400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,415.5400,3266.6300,case rate,"Rev 361 Proc 19281 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,BLUE CROSS E NETWORK,1610.00,,,,,,,415.5400,3266.6300,case rate,"Rev 361 Proc 19281 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total (Service Line reduced to $1,610.00, claim capped at $1,610.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,415.5400,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,BLUE CROSS P NETWORK,1610.00,,,,,,,415.5400,3266.6300,case rate,"Rev 361 Proc 19281 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total (Service Line reduced to $1,610.00, claim capped at $1,610.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,BLUE CROSS S NETWORK,1610.00,,,,,,,415.5400,3266.6300,case rate,"Rev 361 Proc 19281 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total (Service Line reduced to $1,610.00, claim capped at $1,610.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,CIGNA HEALTHCARE,CIGNA HMO,1610.00,,,,,,,415.5400,3266.6300,case rate,"Rev 361 Proc 19281 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,610.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,610.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,415.5400,3266.6300,case rate,"Rev 361 Proc 19281 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,415.5400,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1610.00,,,,,,,415.5400,3266.6300,case rate,"Rev 361 Proc 19281 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,610.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,610.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,CIGNA HEALTHCARE,CIGNA PPO,1610.00,,,,,,,415.5400,3266.6300,case rate,"Rev 361 Proc 19281 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,610.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,610.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,415.5400,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1449.00,,,,,,,415.5400,3266.6300,percent of total billed charges,"90% of $1,610.00 in Billed Charges for Rev 361 Proc 19281 = $1,449.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,415.5400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,415.5400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,MEDCOST,MEDCOST VHN,766.20,,,,,,,415.5400,3266.6300,percent of total billed charges,"47.59% of $1,610.00 in Billed Charges for Rev 361 Proc 19281 = $766.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1917.96,,,,,,,415.5400,3266.6300,fee schedule,"APG 00020 Proc 19281 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 105% = $1,917.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,415.5400,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,415.5400,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,415.5400,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1883.26,,,,,,,415.5400,3266.6300,fee schedule,"APG 00020 Proc 19281 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 103.1% = $1,883.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,SENTARA HEALTH,SENTARA HEALTH,415.54,,,,,,,415.5400,3266.6300,percent of total billed charges,"25.81% of $1,610.00 in Billed Charges for Rev 361 Proc 19281 = $415.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,415.5400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1610.00,,,,,,,415.5400,3266.6300,percent of total billed charges,"100% of $1,610.00 in Billed Charges for Rev 361 Proc 19281 = $1,610.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,415.5400,3266.6300,case rate,Rev 361 Proc 19281 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,415.5400,3266.6300,case rate,"Rev 361 Proc 19281 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,415.5400,3266.6300,case rate,"Rev 361 Proc 19281 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,1610.00,,,,,,,415.5400,3266.6300,case rate,"Rev 361 Proc 19281 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total (Service Line reduced to $1,610.00, claim capped at $1,610.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1881.43,,,,,,,415.5400,3266.6300,fee schedule,"APG 00020 Proc 19281 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,415.5400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,415.5400,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,WELLCARE,WELLCARE MEDICAID,1610.00,,,,,,,415.5400,3266.6300,percent of total billed charges,"100% of $1,610.00 in Billed Charges for Rev 361 Proc 19281 = $1,610.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PREOP PLACE NEEDLE LOC WIRE 1ST LESION,19281,CPT,361,RC,36100062,CDM,,,,both,,,1610.0000,241.5000,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,415.5400,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE LOC WIRE ADDT,19282,CPT,361,RC,36100063,CDM,,,,both,,,366.0000,54.9000,AETNA,AETNA,156.28,,,,,,,94.4600,1917.9600,percent of total billed charges,42.7% of $366.00 in Billed Charges for Rev 361 Proc 19282 = $156.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREOP PLACE LOC WIRE ADDT,19282,CPT,361,RC,36100063,CDM,,,,both,,,366.0000,54.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1899.70,,,,,,,94.4600,1917.9600,fee schedule,"APG 00020 Proc 19282 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 104% = $1,899.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE LOC WIRE ADDT,19282,CPT,361,RC,36100063,CDM,,,,both,,,366.0000,54.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,366.00,,,,,,,94.4600,1917.9600,fee schedule,"APG 00020 Proc 19282 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43 (Service Line reduced to $366.00, claim capped at $366.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE LOC WIRE ADDT,19282,CPT,361,RC,36100063,CDM,,,,both,,,366.0000,54.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,366.00,,,,,,,94.4600,1917.9600,case rate,"Rev 361 Proc 19282 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $366.00 in Billed Charges - $0.00 in ASG Allowed Amount = $366.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE LOC WIRE ADDT,19282,CPT,361,RC,36100063,CDM,,,,both,,,366.0000,54.9000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,94.4600,1917.9600,case rate,Rev 361 Proc 19282 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE LOC WIRE ADDT,19282,CPT,361,RC,36100063,CDM,,,,both,,,366.0000,54.9000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,94.4600,1917.9600,case rate,Rev 361 Proc 19282 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE LOC WIRE ADDT,19282,CPT,361,RC,36100063,CDM,,,,both,,,366.0000,54.9000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,94.4600,1917.9600,case rate,Rev 361 Proc 19282 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE LOC WIRE ADDT,19282,CPT,361,RC,36100063,CDM,,,,both,,,366.0000,54.9000,CIGNA HEALTHCARE,CIGNA HMO,366.00,,,,,,,94.4600,1917.9600,case rate,"Rev 361 Proc 19282 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $366.00 in Billed Charges - $0.00 in ASG Allowed Amount = $366.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE LOC WIRE ADDT,19282,CPT,361,RC,36100063,CDM,,,,both,,,366.0000,54.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,366.00,,,,,,,94.4600,1917.9600,case rate,"Rev 361 Proc 19282 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $366.00 in Billed Charges - $0.00 in ASG Allowed Amount = $366.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE LOC WIRE ADDT,19282,CPT,361,RC,36100063,CDM,,,,both,,,366.0000,54.9000,CIGNA HEALTHCARE,CIGNA PPO,366.00,,,,,,,94.4600,1917.9600,case rate,"Rev 361 Proc 19282 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $366.00 in Billed Charges - $0.00 in ASG Allowed Amount = $366.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE LOC WIRE ADDT,19282,CPT,361,RC,36100063,CDM,,,,both,,,366.0000,54.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,329.40,,,,,,,94.4600,1917.9600,percent of total billed charges,90% of $366.00 in Billed Charges for Rev 361 Proc 19282 = $329.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREOP PLACE LOC WIRE ADDT,19282,CPT,361,RC,36100063,CDM,,,,both,,,366.0000,54.9000,MEDCOST,MEDCOST VHN,174.18,,,,,,,94.4600,1917.9600,percent of total billed charges,47.59% of $366.00 in Billed Charges for Rev 361 Proc 19282 = $174.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREOP PLACE LOC WIRE ADDT,19282,CPT,361,RC,36100063,CDM,,,,both,,,366.0000,54.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1917.96,,,,,,,94.4600,1917.9600,fee schedule,"APG 00020 Proc 19282 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 105% = $1,917.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE LOC WIRE ADDT,19282,CPT,361,RC,36100063,CDM,,,,both,,,366.0000,54.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1883.26,,,,,,,94.4600,1917.9600,fee schedule,"APG 00020 Proc 19282 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 103.1% = $1,883.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE LOC WIRE ADDT,19282,CPT,361,RC,36100063,CDM,,,,both,,,366.0000,54.9000,SENTARA HEALTH,SENTARA HEALTH,94.46,,,,,,,94.4600,1917.9600,percent of total billed charges,25.81% of $366.00 in Billed Charges for Rev 361 Proc 19282 = $94.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREOP PLACE LOC WIRE ADDT,19282,CPT,361,RC,36100063,CDM,,,,both,,,366.0000,54.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",366.00,,,,,,,94.4600,1917.9600,percent of total billed charges,100% of $366.00 in Billed Charges for Rev 361 Proc 19282 = $366.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PREOP PLACE LOC WIRE ADDT,19282,CPT,361,RC,36100063,CDM,,,,both,,,366.0000,54.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,94.4600,1917.9600,case rate,Rev 361 Proc 19282 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE LOC WIRE ADDT,19282,CPT,361,RC,36100063,CDM,,,,both,,,366.0000,54.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,94.4600,1917.9600,case rate,Rev 361 Proc 19282 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE LOC WIRE ADDT,19282,CPT,361,RC,36100063,CDM,,,,both,,,366.0000,54.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,94.4600,1917.9600,case rate,Rev 361 Proc 19282 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PREOP PLACE LOC WIRE ADDT,19282,CPT,361,RC,36100063,CDM,,,,both,,,366.0000,54.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,366.00,,,,,,,94.4600,1917.9600,case rate,"Rev 361 Proc 19282 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total (Service Line reduced to $366.00, claim capped at $366.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE LOC WIRE ADDT,19282,CPT,361,RC,36100063,CDM,,,,both,,,366.0000,54.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1881.43,,,,,,,94.4600,1917.9600,fee schedule,"APG 00020 Proc 19282 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PREOP PLACE LOC WIRE ADDT,19282,CPT,361,RC,36100063,CDM,,,,both,,,366.0000,54.9000,WELLCARE,WELLCARE MEDICAID,366.00,,,,,,,94.4600,1917.9600,percent of total billed charges,100% of $366.00 in Billed Charges for Rev 361 Proc 19282 = $366.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,AETNA,AETNA,798.06,,,,,,,482.3900,1917.9600,percent of total billed charges,"42.7% of $1,869.00 in Billed Charges for Rev 361 Proc 19285 = $798.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1899.70,,,,,,,482.3900,1917.9600,fee schedule,"APG 00020 Proc 19285 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,826.63 at 104% = $1,899.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,AMBETTER,AMBETTER,1400.59,,,,,,,482.3900,1917.9600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,482.3900,1917.9600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1869.00,,,,,,,482.3900,1917.9600,fee schedule,"APG 00020 Proc 19285 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,826.63 at 103% = $1,881.43 (Service Line reduced to $1,869.00, claim capped at $1,869.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,482.3900,1917.9600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1869.00,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,482.3900,1917.9600,case rate,"Rev 361 Proc 19285 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,482.3900,1917.9600,case rate,Rev 361 Proc 19285 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,482.3900,1917.9600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,482.3900,1917.9600,case rate,Rev 361 Proc 19285 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,482.3900,1917.9600,case rate,Rev 361 Proc 19285 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,CIGNA HEALTHCARE,CIGNA HMO,1869.00,,,,,,,482.3900,1917.9600,case rate,"Rev 361 Proc 19285 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,869.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,869.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,482.3900,1917.9600,case rate,"Rev 361 Proc 19285 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,482.3900,1917.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1869.00,,,,,,,482.3900,1917.9600,case rate,"Rev 361 Proc 19285 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,869.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,869.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,CIGNA HEALTHCARE,CIGNA PPO,1869.00,,,,,,,482.3900,1917.9600,case rate,"Rev 361 Proc 19285 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,869.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,869.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,482.3900,1917.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1682.10,,,,,,,482.3900,1917.9600,percent of total billed charges,"90% of $1,869.00 in Billed Charges for Rev 361 Proc 19285 = $1,682.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,HUMANA,HUMANA MEDICARE,642.47,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,MEDCOST,MEDCOST VHN,889.46,,,,,,,482.3900,1917.9600,percent of total billed charges,"47.59% of $1,869.00 in Billed Charges for Rev 361 Proc 19285 = $889.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1917.96,,,,,,,482.3900,1917.9600,fee schedule,"APG 00020 Proc 19285 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,826.63 at 100% = $1,826.63... $1,826.63 at 105% = $1,917.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,482.3900,1917.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,482.3900,1917.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,482.3900,1917.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1883.26,,,,,,,482.3900,1917.9600,fee schedule,"APG 00020 Proc 19285 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,826.63 at 100% = $1,826.63... $1,826.63 at 103.1% = $1,883.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,SENTARA HEALTH,SENTARA HEALTH,482.39,,,,,,,482.3900,1917.9600,percent of total billed charges,"25.81% of $1,869.00 in Billed Charges for Rev 361 Proc 19285 = $482.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1869.00,,,,,,,482.3900,1917.9600,percent of total billed charges,"100% of $1,869.00 in Billed Charges for Rev 361 Proc 19285 = $1,869.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,482.3900,1917.9600,case rate,Rev 361 Proc 19285 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,482.3900,1917.9600,case rate,Rev 361 Proc 19285 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,482.3900,1917.9600,case rate,Rev 361 Proc 19285 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,482.3900,1917.9600,case rate,"Rev 361 Proc 19285 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1881.43,,,,,,,482.3900,1917.9600,fee schedule,"APG 00020 Proc 19285 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,826.63 at 103% = $1,881.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,WELLCARE,WELLCARE MEDICAID,1869.00,,,,,,,482.3900,1917.9600,percent of total billed charges,"100% of $1,869.00 in Billed Charges for Rev 361 Proc 19285 = $1,869.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CBU BREAST PLC WIRE 1ST LESION,19285,CPT,361,RC,36100221,CDM,,,,both,,,1869.0000,280.3500,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,482.3900,1917.9600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE EA ADD,19288,CPT,361,RC,36100226,CDM,,,,both,,,468.0000,70.2000,AETNA,AETNA,199.84,,,,,,,120.7900,1917.9600,percent of total billed charges,42.7% of $468.00 in Billed Charges for Rev 361 Proc 19288 = $199.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MR BREAST PLC WIRE EA ADD,19288,CPT,361,RC,36100226,CDM,,,,both,,,468.0000,70.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1899.70,,,,,,,120.7900,1917.9600,fee schedule,"APG 00020 Proc 19288 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 104% = $1,899.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BREAST PLC WIRE EA ADD,19288,CPT,361,RC,36100226,CDM,,,,both,,,468.0000,70.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,468.00,,,,,,,120.7900,1917.9600,fee schedule,"APG 00020 Proc 19288 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43 (Service Line reduced to $468.00, claim capped at $468.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BREAST PLC WIRE EA ADD,19288,CPT,361,RC,36100226,CDM,,,,both,,,468.0000,70.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,468.00,,,,,,,120.7900,1917.9600,case rate,"Rev 361 Proc 19288 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $468.00 in Billed Charges - $0.00 in ASG Allowed Amount = $468.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BREAST PLC WIRE EA ADD,19288,CPT,361,RC,36100226,CDM,,,,both,,,468.0000,70.2000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,120.7900,1917.9600,case rate,Rev 361 Proc 19288 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE EA ADD,19288,CPT,361,RC,36100226,CDM,,,,both,,,468.0000,70.2000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,120.7900,1917.9600,case rate,Rev 361 Proc 19288 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE EA ADD,19288,CPT,361,RC,36100226,CDM,,,,both,,,468.0000,70.2000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,120.7900,1917.9600,case rate,Rev 361 Proc 19288 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE EA ADD,19288,CPT,361,RC,36100226,CDM,,,,both,,,468.0000,70.2000,CIGNA HEALTHCARE,CIGNA HMO,468.00,,,,,,,120.7900,1917.9600,case rate,"Rev 361 Proc 19288 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $468.00 in Billed Charges - $0.00 in ASG Allowed Amount = $468.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BREAST PLC WIRE EA ADD,19288,CPT,361,RC,36100226,CDM,,,,both,,,468.0000,70.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,468.00,,,,,,,120.7900,1917.9600,case rate,"Rev 361 Proc 19288 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $468.00 in Billed Charges - $0.00 in ASG Allowed Amount = $468.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BREAST PLC WIRE EA ADD,19288,CPT,361,RC,36100226,CDM,,,,both,,,468.0000,70.2000,CIGNA HEALTHCARE,CIGNA PPO,468.00,,,,,,,120.7900,1917.9600,case rate,"Rev 361 Proc 19288 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $468.00 in Billed Charges - $0.00 in ASG Allowed Amount = $468.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BREAST PLC WIRE EA ADD,19288,CPT,361,RC,36100226,CDM,,,,both,,,468.0000,70.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,421.20,,,,,,,120.7900,1917.9600,percent of total billed charges,90% of $468.00 in Billed Charges for Rev 361 Proc 19288 = $421.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MR BREAST PLC WIRE EA ADD,19288,CPT,361,RC,36100226,CDM,,,,both,,,468.0000,70.2000,MEDCOST,MEDCOST VHN,222.72,,,,,,,120.7900,1917.9600,percent of total billed charges,47.59% of $468.00 in Billed Charges for Rev 361 Proc 19288 = $222.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MR BREAST PLC WIRE EA ADD,19288,CPT,361,RC,36100226,CDM,,,,both,,,468.0000,70.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1917.96,,,,,,,120.7900,1917.9600,fee schedule,"APG 00020 Proc 19288 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 105% = $1,917.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BREAST PLC WIRE EA ADD,19288,CPT,361,RC,36100226,CDM,,,,both,,,468.0000,70.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1883.26,,,,,,,120.7900,1917.9600,fee schedule,"APG 00020 Proc 19288 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 103.1% = $1,883.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BREAST PLC WIRE EA ADD,19288,CPT,361,RC,36100226,CDM,,,,both,,,468.0000,70.2000,SENTARA HEALTH,SENTARA HEALTH,120.79,,,,,,,120.7900,1917.9600,percent of total billed charges,25.81% of $468.00 in Billed Charges for Rev 361 Proc 19288 = $120.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MR BREAST PLC WIRE EA ADD,19288,CPT,361,RC,36100226,CDM,,,,both,,,468.0000,70.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",468.00,,,,,,,120.7900,1917.9600,percent of total billed charges,100% of $468.00 in Billed Charges for Rev 361 Proc 19288 = $468.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MR BREAST PLC WIRE EA ADD,19288,CPT,361,RC,36100226,CDM,,,,both,,,468.0000,70.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,120.7900,1917.9600,case rate,Rev 361 Proc 19288 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE EA ADD,19288,CPT,361,RC,36100226,CDM,,,,both,,,468.0000,70.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,120.7900,1917.9600,case rate,Rev 361 Proc 19288 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE EA ADD,19288,CPT,361,RC,36100226,CDM,,,,both,,,468.0000,70.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,120.7900,1917.9600,case rate,Rev 361 Proc 19288 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE EA ADD,19288,CPT,361,RC,36100226,CDM,,,,both,,,468.0000,70.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,468.00,,,,,,,120.7900,1917.9600,case rate,"Rev 361 Proc 19288 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total (Service Line reduced to $468.00, claim capped at $468.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BREAST PLC WIRE EA ADD,19288,CPT,361,RC,36100226,CDM,,,,both,,,468.0000,70.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1881.43,,,,,,,120.7900,1917.9600,fee schedule,"APG 00020 Proc 19288 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BREAST PLC WIRE EA ADD,19288,CPT,361,RC,36100226,CDM,,,,both,,,468.0000,70.2000,WELLCARE,WELLCARE MEDICAID,468.00,,,,,,,120.7900,1917.9600,percent of total billed charges,100% of $468.00 in Billed Charges for Rev 361 Proc 19288 = $468.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEED CORTRAK2 10X43 ENFIT,272,RC,27200002,CDM,,,,,,both,,,710.1100,106.5200,AETNA,AETNA,303.22,,,,,,,183.2800,710.1100,percent of total billed charges,42.7% of $710.11 in Billed Charges for Rev 272 = $303.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEED CORTRAK2 10X43 ENFIT,272,RC,27200002,CDM,,,,,,both,,,710.1100,106.5200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,497.08,,,,,,,183.2800,710.1100,percent of total billed charges,Rev 272 $710.11 in Billed Charges at 70% = $497.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEED CORTRAK2 10X43 ENFIT,272,RC,27200002,CDM,,,,,,both,,,710.1100,106.5200,CIGNA HEALTHCARE,CIGNA HMO,296.12,,,,,,,183.2800,710.1100,percent of total billed charges,41.7% of $710.11 in Billed Charges for Rev 272 = $296.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEED CORTRAK2 10X43 ENFIT,272,RC,27200002,CDM,,,,,,both,,,710.1100,106.5200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,329.49,,,,,,,183.2800,710.1100,percent of total billed charges,46.4% of $710.11 in Billed Charges for Rev 272 = $329.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEED CORTRAK2 10X43 ENFIT,272,RC,27200002,CDM,,,,,,both,,,710.1100,106.5200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,296.12,,,,,,,183.2800,710.1100,percent of total billed charges,41.7% of $710.11 in Billed Charges for Rev 272 = $296.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEED CORTRAK2 10X43 ENFIT,272,RC,27200002,CDM,,,,,,both,,,710.1100,106.5200,CIGNA HEALTHCARE,CIGNA PPO,296.12,,,,,,,183.2800,710.1100,percent of total billed charges,41.7% of $710.11 in Billed Charges for Rev 272 = $296.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEED CORTRAK2 10X43 ENFIT,272,RC,27200002,CDM,,,,,,both,,,710.1100,106.5200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,639.10,,,,,,,183.2800,710.1100,percent of total billed charges,90% of $710.11 in Billed Charges for Rev 272 = $639.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEED CORTRAK2 10X43 ENFIT,272,RC,27200002,CDM,,,,,,both,,,710.1100,106.5200,MEDCOST,MEDCOST VHN,337.94,,,,,,,183.2800,710.1100,percent of total billed charges,47.59% of $710.11 in Billed Charges for Rev 272 = $337.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEED CORTRAK2 10X43 ENFIT,272,RC,27200002,CDM,,,,,,both,,,710.1100,106.5200,SENTARA HEALTH,SENTARA HEALTH,183.28,,,,,,,183.2800,710.1100,percent of total billed charges,25.81% of $710.11 in Billed Charges for Rev 272 = $183.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEED CORTRAK2 10X43 ENFIT,272,RC,27200002,CDM,,,,,,both,,,710.1100,106.5200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",710.11,,,,,,,183.2800,710.1100,percent of total billed charges,100% of $710.11 in Billed Charges for Rev 272 = $710.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEED CORTRAK2 10X43 ENFIT,272,RC,27200002,CDM,,,,,,both,,,710.1100,106.5200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,355.06,,,,,,,183.2800,710.1100,percent of total billed charges,Rev 272 $710.11 in Billed Charges at 50% = $355.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEED CORTRAK2 10X43 ENFIT,272,RC,27200002,CDM,,,,,,both,,,710.1100,106.5200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,229.37,,,,,,,183.2800,710.1100,other,32.3% of $710.11 in Billed Charges for Rev 272 = $229.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE FEED CORTRAK2 10X43 ENFIT,272,RC,27200002,CDM,,,,,,both,,,710.1100,106.5200,UNITED HEALTHCARE,UHC HERITAGE SELECT,218.00,,,,,,,183.2800,710.1100,other,30.7% of $710.11 in Billed Charges for Rev 272 = $218.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE FEED CORTRAK2 10X43 ENFIT,272,RC,27200002,CDM,,,,,,both,,,710.1100,106.5200,UNITED HEALTHCARE,UNITED HEALTHCARE,229.37,,,,,,,183.2800,710.1100,percent of total billed charges,32.3% of $710.11 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEED CORTRAK2 10X43 ENFIT,272,RC,27200002,CDM,,,,,,both,,,710.1100,106.5200,WELLCARE,WELLCARE MEDICAID,710.11,,,,,,,183.2800,710.1100,percent of total billed charges,100% of $710.11 in Billed Charges for Rev 272 = $710.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE FEED JEJUNAL 12 FR. MIC,272,RC,27200002,CDM,,,,,,both,,,1415.4300,212.3100,AETNA,AETNA,604.39,,,,,,,365.3200,1415.4300,percent of total billed charges,"42.7% of $1,415.43 in Billed Charges for Rev 272 = $604.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEED JEJUNAL 12 FR. MIC,272,RC,27200002,CDM,,,,,,both,,,1415.4300,212.3100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,990.80,,,,,,,365.3200,1415.4300,percent of total billed charges,"Rev 272 $1,415.43 in Billed Charges at 70% = $990.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEED JEJUNAL 12 FR. MIC,272,RC,27200002,CDM,,,,,,both,,,1415.4300,212.3100,CIGNA HEALTHCARE,CIGNA HMO,590.23,,,,,,,365.3200,1415.4300,percent of total billed charges,"41.7% of $1,415.43 in Billed Charges for Rev 272 = $590.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEED JEJUNAL 12 FR. MIC,272,RC,27200002,CDM,,,,,,both,,,1415.4300,212.3100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,656.76,,,,,,,365.3200,1415.4300,percent of total billed charges,"46.4% of $1,415.43 in Billed Charges for Rev 272 = $656.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEED JEJUNAL 12 FR. MIC,272,RC,27200002,CDM,,,,,,both,,,1415.4300,212.3100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,590.23,,,,,,,365.3200,1415.4300,percent of total billed charges,"41.7% of $1,415.43 in Billed Charges for Rev 272 = $590.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEED JEJUNAL 12 FR. MIC,272,RC,27200002,CDM,,,,,,both,,,1415.4300,212.3100,CIGNA HEALTHCARE,CIGNA PPO,590.23,,,,,,,365.3200,1415.4300,percent of total billed charges,"41.7% of $1,415.43 in Billed Charges for Rev 272 = $590.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEED JEJUNAL 12 FR. MIC,272,RC,27200002,CDM,,,,,,both,,,1415.4300,212.3100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1273.89,,,,,,,365.3200,1415.4300,percent of total billed charges,"90% of $1,415.43 in Billed Charges for Rev 272 = $1,273.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEED JEJUNAL 12 FR. MIC,272,RC,27200002,CDM,,,,,,both,,,1415.4300,212.3100,MEDCOST,MEDCOST VHN,673.60,,,,,,,365.3200,1415.4300,percent of total billed charges,"47.59% of $1,415.43 in Billed Charges for Rev 272 = $673.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEED JEJUNAL 12 FR. MIC,272,RC,27200002,CDM,,,,,,both,,,1415.4300,212.3100,SENTARA HEALTH,SENTARA HEALTH,365.32,,,,,,,365.3200,1415.4300,percent of total billed charges,"25.81% of $1,415.43 in Billed Charges for Rev 272 = $365.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEED JEJUNAL 12 FR. MIC,272,RC,27200002,CDM,,,,,,both,,,1415.4300,212.3100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1415.43,,,,,,,365.3200,1415.4300,percent of total billed charges,"100% of $1,415.43 in Billed Charges for Rev 272 = $1,415.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEED JEJUNAL 12 FR. MIC,272,RC,27200002,CDM,,,,,,both,,,1415.4300,212.3100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,707.72,,,,,,,365.3200,1415.4300,percent of total billed charges,"Rev 272 $1,415.43 in Billed Charges at 50% = $707.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEED JEJUNAL 12 FR. MIC,272,RC,27200002,CDM,,,,,,both,,,1415.4300,212.3100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,457.18,,,,,,,365.3200,1415.4300,other,"32.3% of $1,415.43 in Billed Charges for Rev 272 = $457.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE FEED JEJUNAL 12 FR. MIC,272,RC,27200002,CDM,,,,,,both,,,1415.4300,212.3100,UNITED HEALTHCARE,UHC HERITAGE SELECT,434.54,,,,,,,365.3200,1415.4300,other,"30.7% of $1,415.43 in Billed Charges for Rev 272 = $434.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE FEED JEJUNAL 12 FR. MIC,272,RC,27200002,CDM,,,,,,both,,,1415.4300,212.3100,UNITED HEALTHCARE,UNITED HEALTHCARE,457.18,,,,,,,365.3200,1415.4300,percent of total billed charges,"32.3% of $1,415.43 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEED JEJUNAL 12 FR. MIC,272,RC,27200002,CDM,,,,,,both,,,1415.4300,212.3100,WELLCARE,WELLCARE MEDICAID,1415.43,,,,,,,365.3200,1415.4300,percent of total billed charges,"100% of $1,415.43 in Billed Charges for Rev 272 = $1,415.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING CORFLO-ULTRA LT 10FR X 43 W/STYLET 20-9431,270,RC,,,,,,,,both,,,32108.6200,4816.2900,AETNA,AETNA,13710.38,,,,,,,8287.2300,32108.6200,percent of total billed charges,"42.7% of $32,108.62 in Billed Charges for Rev 270 = $13,710.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING CORFLO-ULTRA LT 10FR X 43 W/STYLET 20-9431,270,RC,,,,,,,,both,,,32108.6200,4816.2900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,22476.03,,,,,,,8287.2300,32108.6200,percent of total billed charges,"Rev 270 $32,108.62 in Billed Charges at 70% = $22,476.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING CORFLO-ULTRA LT 10FR X 43 W/STYLET 20-9431,270,RC,,,,,,,,both,,,32108.6200,4816.2900,CIGNA HEALTHCARE,CIGNA HMO,13389.29,,,,,,,8287.2300,32108.6200,percent of total billed charges,"41.7% of $32,108.62 in Billed Charges for Rev 270 = $13,389.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING CORFLO-ULTRA LT 10FR X 43 W/STYLET 20-9431,270,RC,,,,,,,,both,,,32108.6200,4816.2900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,14898.40,,,,,,,8287.2300,32108.6200,percent of total billed charges,"46.4% of $32,108.62 in Billed Charges for Rev 270 = $14,898.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING CORFLO-ULTRA LT 10FR X 43 W/STYLET 20-9431,270,RC,,,,,,,,both,,,32108.6200,4816.2900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,13389.29,,,,,,,8287.2300,32108.6200,percent of total billed charges,"41.7% of $32,108.62 in Billed Charges for Rev 270 = $13,389.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING CORFLO-ULTRA LT 10FR X 43 W/STYLET 20-9431,270,RC,,,,,,,,both,,,32108.6200,4816.2900,CIGNA HEALTHCARE,CIGNA PPO,13389.29,,,,,,,8287.2300,32108.6200,percent of total billed charges,"41.7% of $32,108.62 in Billed Charges for Rev 270 = $13,389.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING CORFLO-ULTRA LT 10FR X 43 W/STYLET 20-9431,270,RC,,,,,,,,both,,,32108.6200,4816.2900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,28897.76,,,,,,,8287.2300,32108.6200,percent of total billed charges,"90% of $32,108.62 in Billed Charges for Rev 270 = $28,897.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING CORFLO-ULTRA LT 10FR X 43 W/STYLET 20-9431,270,RC,,,,,,,,both,,,32108.6200,4816.2900,MEDCOST,MEDCOST VHN,15280.49,,,,,,,8287.2300,32108.6200,percent of total billed charges,"47.59% of $32,108.62 in Billed Charges for Rev 270 = $15,280.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING CORFLO-ULTRA LT 10FR X 43 W/STYLET 20-9431,270,RC,,,,,,,,both,,,32108.6200,4816.2900,SENTARA HEALTH,SENTARA HEALTH,8287.23,,,,,,,8287.2300,32108.6200,percent of total billed charges,"25.81% of $32,108.62 in Billed Charges for Rev 270 = $8,287.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING CORFLO-ULTRA LT 10FR X 43 W/STYLET 20-9431,270,RC,,,,,,,,both,,,32108.6200,4816.2900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",32108.62,,,,,,,8287.2300,32108.6200,percent of total billed charges,"100% of $32,108.62 in Billed Charges for Rev 270 = $32,108.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING CORFLO-ULTRA LT 10FR X 43 W/STYLET 20-9431,270,RC,,,,,,,,both,,,32108.6200,4816.2900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,16054.31,,,,,,,8287.2300,32108.6200,percent of total billed charges,"Rev 270 $32,108.62 in Billed Charges at 50% = $16,054.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING CORFLO-ULTRA LT 10FR X 43 W/STYLET 20-9431,270,RC,,,,,,,,both,,,32108.6200,4816.2900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,10371.08,,,,,,,8287.2300,32108.6200,other,"32.3% of $32,108.62 in Billed Charges for Rev 270 = $10,371.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE FEEDING CORFLO-ULTRA LT 10FR X 43 W/STYLET 20-9431,270,RC,,,,,,,,both,,,32108.6200,4816.2900,UNITED HEALTHCARE,UHC HERITAGE SELECT,9857.35,,,,,,,8287.2300,32108.6200,other,"30.7% of $32,108.62 in Billed Charges for Rev 270 = $9,857.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE FEEDING CORFLO-ULTRA LT 10FR X 43 W/STYLET 20-9431,270,RC,,,,,,,,both,,,32108.6200,4816.2900,UNITED HEALTHCARE,UNITED HEALTHCARE,10371.08,,,,,,,8287.2300,32108.6200,percent of total billed charges,"32.3% of $32,108.62 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE FEEDING CORFLO-ULTRA LT 10FR X 43 W/STYLET 20-9431,270,RC,,,,,,,,both,,,32108.6200,4816.2900,WELLCARE,WELLCARE MEDICAID,32108.62,,,,,,,8287.2300,32108.6200,percent of total billed charges,"100% of $32,108.62 in Billed Charges for Rev 270 = $32,108.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,AETNA,AETNA,633.24,,,,,,,109.0000,3266.6300,percent of total billed charges,"42.7% of $1,483.00 in Billed Charges for Rev 450 Proc 20103 = $633.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,109.0000,3266.6300,fee schedule,APG 00017 Proc 20103 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment) at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1483.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,AETNA,AETNA HEALTHCARE MEDICARE,1483.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,1483.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,AMBETTER,AMBETTER,3266.63,,,,,,,109.0000,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1483.00,,,,,,,109.0000,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,BLUE CROSS,ANTHEM EXCHANGE,1483.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,109.0000,3266.6300,fee schedule,APG 00017 Proc 20103 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment) at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,BLUE CROSS,ANTHEM HMO,1483.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1483.00,,,,,,,109.0000,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1483.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,278.91,,,,,,,109.0000,3266.6300,fee schedule,$278.91 from Fee Schedule BLDTM_23 for Rev 450 Proc 20103 * Qty 1 = $278.91 at 100% = $278.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,109.0000,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,1483.00,,,,,,,109.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1483.00,,,,,,,109.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1334.70,,,,,,,109.0000,3266.6300,percent of total billed charges,"90% of $1,483.00 in Billed Charges for Rev 450 Proc 20103 = $1,334.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,HUMANA,HUMANA MEDICARE,1483.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1483.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,MEDCOST,MEDCOST VHN,705.76,,,,,,,109.0000,3266.6300,percent of total billed charges,"47.59% of $1,483.00 in Billed Charges for Rev 450 Proc 20103 = $705.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,109.0000,3266.6300,fee schedule,APG 00017 Proc 20103 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment) at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1483.00,,,,,,,109.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1483.00,,,,,,,109.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,NHC ADVANTAGE,NHC ADVANTAGE,1483.00,,,,,,,109.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,109.0000,3266.6300,fee schedule,APG 00017 Proc 20103 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment) at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,SENTARA HEALTH,SENTARA HEALTH,382.76,,,,,,,109.0000,3266.6300,percent of total billed charges,"25.81% of $1,483.00 in Billed Charges for Rev 450 Proc 20103 = $382.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,SENTARA HEALTH,SENTARA MEDICARE,1483.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1483.00,,,,,,,109.0000,3266.6300,percent of total billed charges,"100% of $1,483.00 in Billed Charges for Rev 450 Proc 20103 = $1,483.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3266.6300,case rate,Rev 450 Proc 20103 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3266.6300,case rate,Rev 450 Proc 20103 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3266.6300,case rate,Rev 450 Proc 20103 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3266.6300,case rate,Rev 450 Proc 20103 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,109.0000,3266.6300,fee schedule,APG 00017 Proc 20103 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment) at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1483.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1483.00,,,,,,,109.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,WELLCARE,WELLCARE MEDICAID,1483.00,,,,,,,109.0000,3266.6300,percent of total billed charges,"100% of $1,483.00 in Billed Charges for Rev 450 Proc 20103 = $1,483.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXPL PENETRAT WOUND EXTREMITY,20103,CPT,450,RC,45000085,CDM,,,,both,,,1483.0000,222.4500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,109.0000,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,AETNA,AETNA,1192.18,,,,,,,578.0000,3266.6300,percent of total billed charges,"42.7% of $2,792.00 in Billed Charges for Rev 361 Proc 20206 = $1,192.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,AMBETTER,AMBETTER,3266.63,,,,,,,578.0000,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,578.0000,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,ANTHEM EXCHANGE,2792.00,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,ANTHEM HMO,2792.00,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,578.0000,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2792.00,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,578.0000,3266.6300,case rate,Rev 361 Proc 20206 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 20206 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,578.0000,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 20206 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 20206 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,3266.6300,case rate,Rev 361 Proc 20206 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,3266.6300,case rate,Rev 361 Proc 20206 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 20206 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 20206 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,578.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 20206 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 20206 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,578.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2512.80,,,,,,,578.0000,3266.6300,percent of total billed charges,"90% of $2,792.00 in Billed Charges for Rev 361 Proc 20206 = $2,512.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,MEDCOST,MEDCOST VHN,1328.71,,,,,,,578.0000,3266.6300,percent of total billed charges,"47.59% of $2,792.00 in Billed Charges for Rev 361 Proc 20206 = $1,328.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,578.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,578.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,578.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,SENTARA HEALTH,SENTARA HEALTH,720.62,,,,,,,578.0000,3266.6300,percent of total billed charges,"25.81% of $2,792.00 in Billed Charges for Rev 361 Proc 20206 = $720.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2792.00,,,,,,,578.0000,3266.6300,percent of total billed charges,"100% of $2,792.00 in Billed Charges for Rev 361 Proc 20206 = $2,792.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,578.0000,3266.6300,case rate,Rev 361 Proc 20206 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 20206 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 20206 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 20206 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,WELLCARE,WELLCARE MEDICAID,2792.00,,,,,,,578.0000,3266.6300,percent of total billed charges,"100% of $2,792.00 in Billed Charges for Rev 361 Proc 20206 = $2,792.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX MUSCLE PERC,20206,CPT,361,RC,36100065,CDM,,,,both,,,2792.0000,418.8000,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,578.0000,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION SACROILIAC JOINT UNILAT,27096,CPT,510,RC,51000043,CDM,,,,both,,,1521.0000,228.1500,AETNA,AETNA,649.47,,,,,,,162.3400,1521.0000,percent of total billed charges,"42.7% of $1,521.00 in Billed Charges for Rev 510 Proc 27096 = $649.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION SACROILIAC JOINT UNILAT,27096,CPT,510,RC,51000043,CDM,,,,both,,,1521.0000,228.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,638.80,,,,,,,162.3400,1521.0000,fee schedule,APG 00050 Proc 27096 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment) at 104% = $638.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION SACROILIAC JOINT UNILAT,27096,CPT,510,RC,51000043,CDM,,,,both,,,1521.0000,228.1500,BLUE CROSS,ANTHEM EXCHANGE,162.34,,,,,,,162.3400,1521.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION SACROILIAC JOINT UNILAT,27096,CPT,510,RC,51000043,CDM,,,,both,,,1521.0000,228.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,632.66,,,,,,,162.3400,1521.0000,fee schedule,APG 00050 Proc 27096 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment) at 103% = $632.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION SACROILIAC JOINT UNILAT,27096,CPT,510,RC,51000043,CDM,,,,both,,,1521.0000,228.1500,BLUE CROSS,ANTHEM HMO,162.34,,,,,,,162.3400,1521.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION SACROILIAC JOINT UNILAT,27096,CPT,510,RC,51000043,CDM,,,,both,,,1521.0000,228.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",162.34,,,,,,,162.3400,1521.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION SACROILIAC JOINT UNILAT,27096,CPT,510,RC,51000043,CDM,,,,both,,,1521.0000,228.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,393.75,,,,,,,162.3400,1521.0000,fee schedule,$393.75 from Fee Schedule BLDTM_23 for Rev 510 Proc 27096 * Qty 1 = $393.75 at 100% = $393.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION SACROILIAC JOINT UNILAT,27096,CPT,510,RC,51000043,CDM,,,,both,,,1521.0000,228.1500,CIGNA HEALTHCARE,CIGNA HMO,634.26,,,,,,,162.3400,1521.0000,percent of total billed charges,"41.7% of $1,521.00 in Billed Charges for Rev 510 Proc 27096 = $634.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION SACROILIAC JOINT UNILAT,27096,CPT,510,RC,51000043,CDM,,,,both,,,1521.0000,228.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,705.74,,,,,,,162.3400,1521.0000,percent of total billed charges,"46.4% of $1,521.00 in Billed Charges for Rev 510 Proc 27096 = $705.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION SACROILIAC JOINT UNILAT,27096,CPT,510,RC,51000043,CDM,,,,both,,,1521.0000,228.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,634.26,,,,,,,162.3400,1521.0000,percent of total billed charges,"41.7% of $1,521.00 in Billed Charges for Rev 510 Proc 27096 = $634.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION SACROILIAC JOINT UNILAT,27096,CPT,510,RC,51000043,CDM,,,,both,,,1521.0000,228.1500,CIGNA HEALTHCARE,CIGNA PPO,634.26,,,,,,,162.3400,1521.0000,percent of total billed charges,"41.7% of $1,521.00 in Billed Charges for Rev 510 Proc 27096 = $634.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION SACROILIAC JOINT UNILAT,27096,CPT,510,RC,51000043,CDM,,,,both,,,1521.0000,228.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1368.90,,,,,,,162.3400,1521.0000,percent of total billed charges,"90% of $1,521.00 in Billed Charges for Rev 510 Proc 27096 = $1,368.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION SACROILIAC JOINT UNILAT,27096,CPT,510,RC,51000043,CDM,,,,both,,,1521.0000,228.1500,MEDCOST,MEDCOST VHN,723.84,,,,,,,162.3400,1521.0000,percent of total billed charges,"47.59% of $1,521.00 in Billed Charges for Rev 510 Proc 27096 = $723.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION SACROILIAC JOINT UNILAT,27096,CPT,510,RC,51000043,CDM,,,,both,,,1521.0000,228.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,644.94,,,,,,,162.3400,1521.0000,fee schedule,APG 00050 Proc 27096 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment) at 100% = $614.23... $614.23 at 105% = $644.94 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION SACROILIAC JOINT UNILAT,27096,CPT,510,RC,51000043,CDM,,,,both,,,1521.0000,228.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,633.27,,,,,,,162.3400,1521.0000,fee schedule,APG 00050 Proc 27096 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment) at 100% = $614.23... $614.23 at 103.1% = $633.27 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION SACROILIAC JOINT UNILAT,27096,CPT,510,RC,51000043,CDM,,,,both,,,1521.0000,228.1500,SENTARA HEALTH,SENTARA HEALTH,392.57,,,,,,,162.3400,1521.0000,percent of total billed charges,"25.81% of $1,521.00 in Billed Charges for Rev 510 Proc 27096 = $392.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION SACROILIAC JOINT UNILAT,27096,CPT,510,RC,51000043,CDM,,,,both,,,1521.0000,228.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1521.00,,,,,,,162.3400,1521.0000,percent of total billed charges,"100% of $1,521.00 in Billed Charges for Rev 510 Proc 27096 = $1,521.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION SACROILIAC JOINT UNILAT,27096,CPT,510,RC,51000043,CDM,,,,both,,,1521.0000,228.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.28,,,,,,,162.3400,1521.0000,other,"32.3% of $1,521.00 in Billed Charges for Rev 510 Proc 27096 = $491.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECTION SACROILIAC JOINT UNILAT,27096,CPT,510,RC,51000043,CDM,,,,both,,,1521.0000,228.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,466.95,,,,,,,162.3400,1521.0000,other,"30.7% of $1,521.00 in Billed Charges for Rev 510 Proc 27096 = $466.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECTION SACROILIAC JOINT UNILAT,27096,CPT,510,RC,51000043,CDM,,,,both,,,1521.0000,228.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,491.28,,,,,,,162.3400,1521.0000,percent of total billed charges,"32.3% of $1,521.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION SACROILIAC JOINT UNILAT,27096,CPT,510,RC,51000043,CDM,,,,both,,,1521.0000,228.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,632.66,,,,,,,162.3400,1521.0000,fee schedule,APG 00050 Proc 27096 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment) at 103% = $632.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION SACROILIAC JOINT UNILAT,27096,CPT,510,RC,51000043,CDM,,,,both,,,1521.0000,228.1500,WELLCARE,WELLCARE MEDICAID,1521.00,,,,,,,162.3400,1521.0000,percent of total billed charges,"100% of $1,521.00 in Billed Charges for Rev 510 Proc 27096 = $1,521.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA,353.13,,,,,,,109.0000,3180.3800,percent of total billed charges,42.7% of $827.00 in Billed Charges for Rev 450 Proc 27238 = $353.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27238 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,827.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA HEALTHCARE MEDICARE,827.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,827.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,3180.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,827.00,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM EXCHANGE,827.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27238 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HMO,827.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,827.00,,,,,,,109.0000,3180.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",827.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,431.30,,,,,,,109.0000,3180.3800,fee schedule,$431.30 from Fee Schedule BLDTM_23 for Rev 450 Proc 27238 * Qty 1 = $431.30 at 100% = $431.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,827.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,827.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,744.30,,,,,,,109.0000,3180.3800,percent of total billed charges,90% of $827.00 in Billed Charges for Rev 450 Proc 27238 = $744.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,HUMANA,HUMANA MEDICARE,827.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,827.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,MEDCOST,MEDCOST VHN,393.57,,,,,,,109.0000,3180.3800,percent of total billed charges,47.59% of $827.00 in Billed Charges for Rev 450 Proc 27238 = $393.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27238 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,827.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,827.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,NHC ADVANTAGE,NHC ADVANTAGE,827.00,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27238 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA HEALTH,213.45,,,,,,,109.0000,3180.3800,percent of total billed charges,25.81% of $827.00 in Billed Charges for Rev 450 Proc 27238 = $213.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA MEDICARE,827.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",827.00,,,,,,,109.0000,3180.3800,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 27238 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 27238 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 27238 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 27238 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,827.00,,,,,,,109.0000,3180.3800,case rate,"Rev 450 Proc 27238 at Case Rate $847.00 (Service Line reduced to $827.00, claim capped at $827.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27238 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,827.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,827.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICAID,827.00,,,,,,,109.0000,3180.3800,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 27238 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TREAT THIGH FRACTURE,27238,CPT,450,RC,45000395,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,3180.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA,2059.42,,,,,,,109.0000,4823.0000,percent of total billed charges,"42.7% of $4,823.00 in Billed Charges for Rev 450 Proc 27252 = $2,059.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1450.92,,,,,,,109.0000,4823.0000,fee schedule,"APG 00044 Proc 27252 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 104% = $1,450.92. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,4823.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,4823.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1436.97,,,,,,,109.0000,4823.0000,fee schedule,"APG 00044 Proc 27252 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 103% = $1,436.97. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,4823.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4489.34,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,596.62,,,,,,,109.0000,4823.0000,fee schedule,$596.62 from Fee Schedule BLDTM_23 for Rev 450 Proc 27252 * Qty 1 = $596.62 at 100% = $596.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,4823.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4340.70,,,,,,,109.0000,4823.0000,percent of total billed charges,"90% of $4,823.00 in Billed Charges for Rev 450 Proc 27252 = $4,340.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,MEDCOST,MEDCOST VHN,2295.27,,,,,,,109.0000,4823.0000,percent of total billed charges,"47.59% of $4,823.00 in Billed Charges for Rev 450 Proc 27252 = $2,295.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1464.87,,,,,,,109.0000,4823.0000,fee schedule,"APG 00044 Proc 27252 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 100% = $1,395.11... $1,395.11 at 105% = $1,464.87 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1438.36,,,,,,,109.0000,4823.0000,fee schedule,"APG 00044 Proc 27252 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 100% = $1,395.11... $1,395.11 at 103.1% = $1,438.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,SENTARA HEALTH,SENTARA HEALTH,1244.82,,,,,,,109.0000,4823.0000,percent of total billed charges,"25.81% of $4,823.00 in Billed Charges for Rev 450 Proc 27252 = $1,244.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4823.00,,,,,,,109.0000,4823.0000,percent of total billed charges,"100% of $4,823.00 in Billed Charges for Rev 450 Proc 27252 = $4,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 27252 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 27252 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 27252 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 27252 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1436.97,,,,,,,109.0000,4823.0000,fee schedule,"APG 00044 Proc 27252 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 103% = $1,436.97. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,WELLCARE,WELLCARE MEDICAID,4823.00,,,,,,,109.0000,4823.0000,percent of total billed charges,"100% of $4,823.00 in Billed Charges for Rev 450 Proc 27252 = $4,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX HIP DISLOC TRAUMATIC REQ ANES,27252,CPT,450,RC,45000398,CDM,,,,both,,,4823.0000,723.4500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,4823.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,AETNA,AETNA,1334.38,,,,,,,270.5000,3125.0000,percent of total billed charges,"42.7% of $3,125.00 in Billed Charges for Rev 300 Proc 0035U = $1,334.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,421.46,,,,,,,270.5000,3125.0000,fee schedule,APG 00387 Proc 0035U at $836.60 (Base Rate) * 0.4844 (Relative Weight) = $405.25 (Total Line Payment) at 104% = $421.46. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,540.99,,,,,,,270.5000,3125.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,AETNA,AETNA HEALTHCARE MEDICARE,540.99,,,,,,,270.5000,3125.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,540.99,,,,,,,270.5000,3125.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,AMBETTER,AMBETTER,1179.36,,,,,,,270.5000,3125.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,AMERIGROUP,AMERIGROUP,270.50,,,,,,,270.5000,3125.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,562.63,,,,,,,270.5000,3125.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,BLUE CROSS,ANTHEM EXCHANGE,540.99,,,,,,,270.5000,3125.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,417.41,,,,,,,270.5000,3125.0000,fee schedule,APG 00387 Proc 0035U at $836.60 (Base Rate) * 0.4844 (Relative Weight) = $405.25 (Total Line Payment) at 103% = $417.41. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,BLUE CROSS,ANTHEM HMO,540.99,,,,,,,270.5000,3125.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,557.22,,,,,,,270.5000,3125.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",540.99,,,,,,,270.5000,3125.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2187.50,,,,,,,270.5000,3125.0000,percent of total billed charges,"Rev 300 Proc 0035U $3,125.00 in Billed Charges at 70% = $2,187.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,BLUE CROSS,BLUE CROSS E NETWORK,1731.17,,,,,,,270.5000,3125.0000,fee schedule,"$540.99 from Fee Schedule BCFSB for Rev 300 Proc 0035U * Qty 1 = $540.99 at 320% = $1,731.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,BLUE CROSS,BLUE CROSS MEDICARE,562.63,,,,,,,270.5000,3125.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,BLUE CROSS,BLUE CROSS P NETWORK,1769.04,,,,,,,270.5000,3125.0000,fee schedule,"$540.99 from Fee Schedule BCFSB for Rev 300 Proc 0035U * Qty 1 = $540.99 at 327% = $1,769.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,BLUE CROSS,BLUE CROSS S NETWORK,1769.04,,,,,,,270.5000,3125.0000,fee schedule,"$540.99 from Fee Schedule BCFSB for Rev 300 Proc 0035U * Qty 1 = $540.99 at 327% = $1,769.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,CIGNA HEALTHCARE,CIGNA HMO,1303.13,,,,,,,270.5000,3125.0000,percent of total billed charges,"Rev 300 Proc 0035U $3,125.00 in Billed Charges at 41.7% = $1,303.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1192.38,,,,,,,270.5000,3125.0000,fee schedule,"$1,192.38 from Fee Schedule CGIFP_25LR for Rev 300 Proc 0035U * Qty 1 = $1,192.38 at 100% = $1,192.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,568.04,,,,,,,270.5000,3125.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1303.13,,,,,,,270.5000,3125.0000,percent of total billed charges,"Rev 300 Proc 0035U $3,125.00 in Billed Charges at 41.7% = $1,303.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,CIGNA HEALTHCARE,CIGNA PPO,1303.13,,,,,,,270.5000,3125.0000,percent of total billed charges,"Rev 300 Proc 0035U $3,125.00 in Billed Charges at 41.7% = $1,303.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,568.04,,,,,,,270.5000,3125.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2812.50,,,,,,,270.5000,3125.0000,percent of total billed charges,"90% of $3,125.00 in Billed Charges for Rev 300 Proc 0035U = $2,812.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,HUMANA,HUMANA MEDICARE,540.99,,,,,,,270.5000,3125.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,540.99,,,,,,,270.5000,3125.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,MEDCOST,MEDCOST VHN,1487.19,,,,,,,270.5000,3125.0000,percent of total billed charges,"47.59% of $3,125.00 in Billed Charges for Rev 300 Proc 0035U = $1,487.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,425.51,,,,,,,270.5000,3125.0000,fee schedule,APG 00387 Proc 0035U at $836.60 (Base Rate) * 0.4844 (Relative Weight) = $405.25 (Total Line Payment) at 100% = $405.25... $405.25 at 105% = $425.51 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,568.04,,,,,,,270.5000,3125.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,568.04,,,,,,,270.5000,3125.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,NHC ADVANTAGE,NHC ADVANTAGE,568.04,,,,,,,270.5000,3125.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,417.81,,,,,,,270.5000,3125.0000,fee schedule,APG 00387 Proc 0035U at $836.60 (Base Rate) * 0.4844 (Relative Weight) = $405.25 (Total Line Payment) at 100% = $405.25... $405.25 at 103.1% = $417.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,SENTARA HEALTH,SENTARA HEALTH,806.56,,,,,,,270.5000,3125.0000,percent of total billed charges,"25.81% of $3,125.00 in Billed Charges for Rev 300 Proc 0035U = $806.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,SENTARA HEALTH,SENTARA MEDICARE,540.99,,,,,,,270.5000,3125.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3125.00,,,,,,,270.5000,3125.0000,percent of total billed charges,"100% of $3,125.00 in Billed Charges for Rev 300 Proc 0035U = $3,125.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,270.50,,,,,,,270.5000,3125.0000,fee schedule,$540.99 from Fee Schedule TCUHC24 for Rev 300 Proc 0035U * Qty 1 = $540.99 at 50% = $270.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,562.63,,,,,,,270.5000,3125.0000,fee schedule,$540.99 from Fee Schedule UHC_31910 for Rev 300 Proc 0035U * Qty 1 = $540.99 at 104% = $562.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,540.99,,,,,,,270.5000,3125.0000,fee schedule,$540.99 from Fee Schedule UHC_31910 for Rev 300 Proc 0035U * Qty 1 = $540.99 at 100% = $540.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,540.99,,,,,,,270.5000,3125.0000,fee schedule,$540.99 from Fee Schedule UHC_31910 for Rev 300 Proc 0035U * Qty 1 = $540.99 at 100% = $540.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,417.41,,,,,,,270.5000,3125.0000,fee schedule,APG 00387 Proc 0035U at $836.60 (Base Rate) * 0.4844 (Relative Weight) = $405.25 (Total Line Payment) at 103% = $417.41. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,540.99,,,,,,,270.5000,3125.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,540.99,,,,,,,270.5000,3125.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,WELLCARE,WELLCARE MEDICAID,3125.00,,,,,,,270.5000,3125.0000,percent of total billed charges,"100% of $3,125.00 in Billed Charges for Rev 300 Proc 0035U = $3,125.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NEURO CSF DETCJ PRION PRTN QUAKG CONF CONV QUAL,0035U,CPT,300,RC,30000327,CDM,,,,both,,,3125.0000,468.7500,WELLCARE,WELLCARE MEDICARE,573.45,,,,,,,270.5000,3125.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA,584.99,,,,,,,109.0000,1370.0000,percent of total billed charges,"42.7% of $1,370.00 in Billed Charges for Rev 450 Proc 27265 = $584.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,1370.0000,fee schedule,"APG 00041 Proc 27265 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,1370.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,1370.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,1370.0000,fee schedule,"APG 00041 Proc 27265 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,1370.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,350.39,,,,,,,109.0000,1370.0000,fee schedule,$350.39 from Fee Schedule BLDTM_23 for Rev 450 Proc 27265 * Qty 1 = $350.39 at 100% = $350.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,1370.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1233.00,,,,,,,109.0000,1370.0000,percent of total billed charges,"90% of $1,370.00 in Billed Charges for Rev 450 Proc 27265 = $1,233.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,MEDCOST,MEDCOST VHN,651.98,,,,,,,109.0000,1370.0000,percent of total billed charges,"47.59% of $1,370.00 in Billed Charges for Rev 450 Proc 27265 = $651.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,1370.0000,fee schedule,"APG 00041 Proc 27265 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,1370.0000,fee schedule,"APG 00041 Proc 27265 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,SENTARA HEALTH,SENTARA HEALTH,353.60,,,,,,,109.0000,1370.0000,percent of total billed charges,"25.81% of $1,370.00 in Billed Charges for Rev 450 Proc 27265 = $353.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1370.00,,,,,,,109.0000,1370.0000,percent of total billed charges,"100% of $1,370.00 in Billed Charges for Rev 450 Proc 27265 = $1,370.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1370.0000,case rate,Rev 450 Proc 27265 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1370.0000,case rate,Rev 450 Proc 27265 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1370.0000,case rate,Rev 450 Proc 27265 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1370.0000,case rate,Rev 450 Proc 27265 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,1370.0000,fee schedule,"APG 00041 Proc 27265 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,WELLCARE,WELLCARE MEDICAID,1370.00,,,,,,,109.0000,1370.0000,percent of total billed charges,"100% of $1,370.00 in Billed Charges for Rev 450 Proc 27265 = $1,370.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX HIP ARTHPLST DISL WO A,27265,CPT,450,RC,45000158,CDM,,,,both,,,1370.0000,205.5000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,1370.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,AETNA,AETNA,4113.29,,,,,,,109.0000,9633.0000,percent of total billed charges,"42.7% of $9,633.00 in Billed Charges for Rev 450 Proc 27267 = $4,113.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,9633.0000,fee schedule,APG 00041 Proc 27267 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2968.60,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,AETNA,AETNA HEALTHCARE MEDICARE,2968.60,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,2968.60,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,AMBETTER,AMBETTER,6471.55,,,,,,,109.0000,9633.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3087.35,,,,,,,109.0000,9633.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,BLUE CROSS,ANTHEM EXCHANGE,7308.87,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,9633.0000,fee schedule,APG 00041 Proc 27267 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,BLUE CROSS,ANTHEM HMO,7765.24,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3057.66,,,,,,,109.0000,9633.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9135.08,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,349.52,,,,,,,109.0000,9633.0000,fee schedule,$349.52 from Fee Schedule BLDTM_23 for Rev 450 Proc 27267 * Qty 1 = $349.52 at 100% = $349.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,BLUE CROSS,BLUE CROSS MEDICARE,3087.35,,,,,,,109.0000,9633.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,3117.03,,,,,,,109.0000,9633.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3117.03,,,,,,,109.0000,9633.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8669.70,,,,,,,109.0000,9633.0000,percent of total billed charges,"90% of $9,633.00 in Billed Charges for Rev 450 Proc 27267 = $8,669.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,HUMANA,HUMANA MEDICARE,2968.60,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2968.60,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,MEDCOST,MEDCOST VHN,4584.34,,,,,,,109.0000,9633.0000,percent of total billed charges,"47.59% of $9,633.00 in Billed Charges for Rev 450 Proc 27267 = $4,584.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,9633.0000,fee schedule,APG 00041 Proc 27267 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3117.03,,,,,,,109.0000,9633.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3117.03,,,,,,,109.0000,9633.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,NHC ADVANTAGE,NHC ADVANTAGE,3117.03,,,,,,,109.0000,9633.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,9633.0000,fee schedule,APG 00041 Proc 27267 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,SENTARA HEALTH,SENTARA HEALTH,2486.28,,,,,,,109.0000,9633.0000,percent of total billed charges,"25.81% of $9,633.00 in Billed Charges for Rev 450 Proc 27267 = $2,486.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,SENTARA HEALTH,SENTARA MEDICARE,2968.60,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9633.00,,,,,,,109.0000,9633.0000,percent of total billed charges,"100% of $9,633.00 in Billed Charges for Rev 450 Proc 27267 = $9,633.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,9633.0000,case rate,Rev 450 Proc 27267 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,9633.0000,case rate,Rev 450 Proc 27267 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,9633.0000,case rate,Rev 450 Proc 27267 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,9633.0000,case rate,Rev 450 Proc 27267 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,9633.0000,fee schedule,APG 00041 Proc 27267 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2968.60,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2968.60,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,WELLCARE,WELLCARE MEDICAID,9633.00,,,,,,,109.0000,9633.0000,percent of total billed charges,"100% of $9,633.00 in Billed Charges for Rev 450 Proc 27267 = $9,633.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX FEM FX PROX END HEAD W/O MANIP,27267,CPT,450,RC,45000400,CDM,,,,both,,,9633.0000,1444.9500,WELLCARE,WELLCARE MEDICARE,3146.72,,,,,,,109.0000,9633.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,AETNA,AETNA,3728.99,,,,,,,109.0000,8733.0000,percent of total billed charges,"42.7% of $8,733.00 in Billed Charges for Rev 450 Proc 27301 = $3,728.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2612.63,,,,,,,109.0000,8733.0000,fee schedule,"APG 00051 Proc 27301 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 104% = $2,612.63. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,AETNA,AETNA HEALTHCARE MEDICARE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,AMBETTER,AMBETTER,5745.12,,,,,,,109.0000,8733.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2740.79,,,,,,,109.0000,8733.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,ANTHEM EXCHANGE,6488.44,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2587.51,,,,,,,109.0000,8733.0000,fee schedule,"APG 00051 Proc 27301 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,ANTHEM HMO,6893.58,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2714.44,,,,,,,109.0000,8733.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8109.66,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,549.85,,,,,,,109.0000,8733.0000,fee schedule,$549.85 from Fee Schedule BLDTM_23 for Rev 450 Proc 27301 * Qty 1 = $549.85 at 100% = $549.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,BLUE CROSS,BLUE CROSS MEDICARE,2740.79,,,,,,,109.0000,8733.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,2767.14,,,,,,,109.0000,8733.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,2767.14,,,,,,,109.0000,8733.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7859.70,,,,,,,109.0000,8733.0000,percent of total billed charges,"90% of $8,733.00 in Billed Charges for Rev 450 Proc 27301 = $7,859.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,HUMANA,HUMANA MEDICARE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,MEDCOST,MEDCOST VHN,4156.03,,,,,,,109.0000,8733.0000,percent of total billed charges,"47.59% of $8,733.00 in Billed Charges for Rev 450 Proc 27301 = $4,156.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2637.75,,,,,,,109.0000,8733.0000,fee schedule,"APG 00051 Proc 27301 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 105% = $2,637.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,2767.14,,,,,,,109.0000,8733.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,2767.14,,,,,,,109.0000,8733.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,NHC ADVANTAGE,NHC ADVANTAGE,2767.14,,,,,,,109.0000,8733.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2590.02,,,,,,,109.0000,8733.0000,fee schedule,"APG 00051 Proc 27301 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 103.1% = $2,590.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,SENTARA HEALTH,SENTARA HEALTH,2253.99,,,,,,,109.0000,8733.0000,percent of total billed charges,"25.81% of $8,733.00 in Billed Charges for Rev 450 Proc 27301 = $2,253.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,SENTARA HEALTH,SENTARA MEDICARE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8733.00,,,,,,,109.0000,8733.0000,percent of total billed charges,"100% of $8,733.00 in Billed Charges for Rev 450 Proc 27301 = $8,733.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,8733.0000,case rate,Rev 450 Proc 27301 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,8733.0000,case rate,Rev 450 Proc 27301 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,8733.0000,case rate,Rev 450 Proc 27301 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,8733.0000,case rate,Rev 450 Proc 27301 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2587.51,,,,,,,109.0000,8733.0000,fee schedule,"APG 00051 Proc 27301 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2635.37,,,,,,,109.0000,8733.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,WELLCARE,WELLCARE MEDICAID,8733.00,,,,,,,109.0000,8733.0000,percent of total billed charges,"100% of $8,733.00 in Billed Charges for Rev 450 Proc 27301 = $8,733.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ID DEEP ABSC/BURSA/HEMATOMA THIGH/KNEE REGION,27301,CPT,450,RC,45000401,CDM,,,,both,,,8733.0000,1309.9500,WELLCARE,WELLCARE MEDICARE,2793.50,,,,,,,109.0000,8733.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC CNTRST KNEE ARTHROGRAPHY/CNTRST ENHNCD CT/MRI KNEE,27369,CPT,361,RC,36100422,CDM,,,,both,,,1127.0000,169.0500,AETNA,AETNA,481.23,,,,,,,148.0000,1127.0000,percent of total billed charges,"42.7% of $1,127.00 in Billed Charges for Rev 361 Proc 27369 = $481.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ PROC CNTRST KNEE ARTHROGRAPHY/CNTRST ENHNCD CT/MRI KNEE,27369,CPT,361,RC,36100422,CDM,,,,both,,,1127.0000,169.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,495.24,,,,,,,148.0000,1127.0000,fee schedule,APG 00278 Proc 27369 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 104% = $495.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC CNTRST KNEE ARTHROGRAPHY/CNTRST ENHNCD CT/MRI KNEE,27369,CPT,361,RC,36100422,CDM,,,,both,,,1127.0000,169.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,490.48,,,,,,,148.0000,1127.0000,fee schedule,APG 00278 Proc 27369 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 103% = $490.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC CNTRST KNEE ARTHROGRAPHY/CNTRST ENHNCD CT/MRI KNEE,27369,CPT,361,RC,36100422,CDM,,,,both,,,1127.0000,169.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1127.00,,,,,,,148.0000,1127.0000,case rate,"Rev 361 Proc 27369 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $1,127.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,127.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ PROC CNTRST KNEE ARTHROGRAPHY/CNTRST ENHNCD CT/MRI KNEE,27369,CPT,361,RC,36100422,CDM,,,,both,,,1127.0000,169.0500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,1127.0000,case rate,Rev 361 Proc 27369 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC CNTRST KNEE ARTHROGRAPHY/CNTRST ENHNCD CT/MRI KNEE,27369,CPT,361,RC,36100422,CDM,,,,both,,,1127.0000,169.0500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,1127.0000,case rate,Rev 361 Proc 27369 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC CNTRST KNEE ARTHROGRAPHY/CNTRST ENHNCD CT/MRI KNEE,27369,CPT,361,RC,36100422,CDM,,,,both,,,1127.0000,169.0500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,1127.0000,case rate,Rev 361 Proc 27369 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC CNTRST KNEE ARTHROGRAPHY/CNTRST ENHNCD CT/MRI KNEE,27369,CPT,361,RC,36100422,CDM,,,,both,,,1127.0000,169.0500,CIGNA HEALTHCARE,CIGNA HMO,1127.00,,,,,,,148.0000,1127.0000,case rate,"Rev 361 Proc 27369 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,127.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,127.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ PROC CNTRST KNEE ARTHROGRAPHY/CNTRST ENHNCD CT/MRI KNEE,27369,CPT,361,RC,36100422,CDM,,,,both,,,1127.0000,169.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1127.00,,,,,,,148.0000,1127.0000,case rate,"Rev 361 Proc 27369 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $1,127.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,127.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ PROC CNTRST KNEE ARTHROGRAPHY/CNTRST ENHNCD CT/MRI KNEE,27369,CPT,361,RC,36100422,CDM,,,,both,,,1127.0000,169.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1127.00,,,,,,,148.0000,1127.0000,case rate,"Rev 361 Proc 27369 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,127.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,127.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ PROC CNTRST KNEE ARTHROGRAPHY/CNTRST ENHNCD CT/MRI KNEE,27369,CPT,361,RC,36100422,CDM,,,,both,,,1127.0000,169.0500,CIGNA HEALTHCARE,CIGNA PPO,1127.00,,,,,,,148.0000,1127.0000,case rate,"Rev 361 Proc 27369 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,127.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,127.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ PROC CNTRST KNEE ARTHROGRAPHY/CNTRST ENHNCD CT/MRI KNEE,27369,CPT,361,RC,36100422,CDM,,,,both,,,1127.0000,169.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1014.30,,,,,,,148.0000,1127.0000,percent of total billed charges,"90% of $1,127.00 in Billed Charges for Rev 361 Proc 27369 = $1,014.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ PROC CNTRST KNEE ARTHROGRAPHY/CNTRST ENHNCD CT/MRI KNEE,27369,CPT,361,RC,36100422,CDM,,,,both,,,1127.0000,169.0500,MEDCOST,MEDCOST VHN,536.34,,,,,,,148.0000,1127.0000,percent of total billed charges,"47.59% of $1,127.00 in Billed Charges for Rev 361 Proc 27369 = $536.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ PROC CNTRST KNEE ARTHROGRAPHY/CNTRST ENHNCD CT/MRI KNEE,27369,CPT,361,RC,36100422,CDM,,,,both,,,1127.0000,169.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,500.00,,,,,,,148.0000,1127.0000,fee schedule,APG 00278 Proc 27369 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 100% = $476.19... $476.19 at 105% = $500.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC CNTRST KNEE ARTHROGRAPHY/CNTRST ENHNCD CT/MRI KNEE,27369,CPT,361,RC,36100422,CDM,,,,both,,,1127.0000,169.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,490.95,,,,,,,148.0000,1127.0000,fee schedule,APG 00278 Proc 27369 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 100% = $476.19... $476.19 at 103.1% = $490.95 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC CNTRST KNEE ARTHROGRAPHY/CNTRST ENHNCD CT/MRI KNEE,27369,CPT,361,RC,36100422,CDM,,,,both,,,1127.0000,169.0500,SENTARA HEALTH,SENTARA HEALTH,290.88,,,,,,,148.0000,1127.0000,percent of total billed charges,"25.81% of $1,127.00 in Billed Charges for Rev 361 Proc 27369 = $290.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ PROC CNTRST KNEE ARTHROGRAPHY/CNTRST ENHNCD CT/MRI KNEE,27369,CPT,361,RC,36100422,CDM,,,,both,,,1127.0000,169.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1127.00,,,,,,,148.0000,1127.0000,percent of total billed charges,"100% of $1,127.00 in Billed Charges for Rev 361 Proc 27369 = $1,127.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ PROC CNTRST KNEE ARTHROGRAPHY/CNTRST ENHNCD CT/MRI KNEE,27369,CPT,361,RC,36100422,CDM,,,,both,,,1127.0000,169.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,148.0000,1127.0000,case rate,Rev 361 Proc 27369 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC CNTRST KNEE ARTHROGRAPHY/CNTRST ENHNCD CT/MRI KNEE,27369,CPT,361,RC,36100422,CDM,,,,both,,,1127.0000,169.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,148.0000,1127.0000,case rate,Rev 361 Proc 27369 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC CNTRST KNEE ARTHROGRAPHY/CNTRST ENHNCD CT/MRI KNEE,27369,CPT,361,RC,36100422,CDM,,,,both,,,1127.0000,169.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,148.0000,1127.0000,case rate,Rev 361 Proc 27369 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC CNTRST KNEE ARTHROGRAPHY/CNTRST ENHNCD CT/MRI KNEE,27369,CPT,361,RC,36100422,CDM,,,,both,,,1127.0000,169.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,148.0000,1127.0000,case rate,Rev 361 Proc 27369 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC CNTRST KNEE ARTHROGRAPHY/CNTRST ENHNCD CT/MRI KNEE,27369,CPT,361,RC,36100422,CDM,,,,both,,,1127.0000,169.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,490.48,,,,,,,148.0000,1127.0000,fee schedule,APG 00278 Proc 27369 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 103% = $490.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC CNTRST KNEE ARTHROGRAPHY/CNTRST ENHNCD CT/MRI KNEE,27369,CPT,361,RC,36100422,CDM,,,,both,,,1127.0000,169.0500,WELLCARE,WELLCARE MEDICAID,1127.00,,,,,,,148.0000,1127.0000,percent of total billed charges,"100% of $1,127.00 in Billed Charges for Rev 361 Proc 27369 = $1,127.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA,353.13,,,,,,,109.0000,827.0000,percent of total billed charges,42.7% of $827.00 in Billed Charges for Rev 450 Proc 27500 = $353.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27500 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,827.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27500 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,827.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,667.50,,,,,,,109.0000,827.0000,fee schedule,$667.50 from Fee Schedule BLDTM_23 for Rev 450 Proc 27500 * Qty 1 = $667.50 at 100% = $667.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,744.30,,,,,,,109.0000,827.0000,percent of total billed charges,90% of $827.00 in Billed Charges for Rev 450 Proc 27500 = $744.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,MEDCOST,MEDCOST VHN,393.57,,,,,,,109.0000,827.0000,percent of total billed charges,47.59% of $827.00 in Billed Charges for Rev 450 Proc 27500 = $393.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27500 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27500 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA HEALTH,213.45,,,,,,,109.0000,827.0000,percent of total billed charges,25.81% of $827.00 in Billed Charges for Rev 450 Proc 27500 = $213.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",827.00,,,,,,,109.0000,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 27500 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 27500 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 27500 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 27500 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,827.00,,,,,,,109.0000,827.0000,case rate,"Rev 450 Proc 27500 at Case Rate $847.00 (Service Line reduced to $827.00, claim capped at $827.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27500 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICAID,827.00,,,,,,,109.0000,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 27500 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX FEM SHAFT FX W/O MANIP,27500,CPT,450,RC,45000402,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,827.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA,353.13,,,,,,,109.0000,827.0000,percent of total billed charges,42.7% of $827.00 in Billed Charges for Rev 450 Proc 27501 = $353.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27501 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,827.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27501 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,827.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,679.15,,,,,,,109.0000,827.0000,fee schedule,$679.15 from Fee Schedule BLDTM_23 for Rev 450 Proc 27501 * Qty 1 = $679.15 at 100% = $679.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,744.30,,,,,,,109.0000,827.0000,percent of total billed charges,90% of $827.00 in Billed Charges for Rev 450 Proc 27501 = $744.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,MEDCOST,MEDCOST VHN,393.57,,,,,,,109.0000,827.0000,percent of total billed charges,47.59% of $827.00 in Billed Charges for Rev 450 Proc 27501 = $393.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27501 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27501 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA HEALTH,213.45,,,,,,,109.0000,827.0000,percent of total billed charges,25.81% of $827.00 in Billed Charges for Rev 450 Proc 27501 = $213.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",827.00,,,,,,,109.0000,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 27501 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 27501 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 27501 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 27501 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,827.00,,,,,,,109.0000,827.0000,case rate,"Rev 450 Proc 27501 at Case Rate $847.00 (Service Line reduced to $827.00, claim capped at $827.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27501 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICAID,827.00,,,,,,,109.0000,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 27501 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX SUPRA/TRANSCONDYLAR FEM FX W/O MANIP,27501,CPT,450,RC,45000403,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,827.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,AETNA,AETNA,1790.84,,,,,,,109.0000,4194.0000,percent of total billed charges,"42.7% of $4,194.00 in Billed Charges for Rev 450 Proc 27503 = $1,790.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,4194.0000,fee schedule,APG 00041 Proc 27503 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,4194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,4194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,4194.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,4194.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,109.0000,4194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,4194.0000,fee schedule,APG 00041 Proc 27503 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,109.0000,4194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,4194.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4194.00,,,,,,,109.0000,4194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,964.55,,,,,,,109.0000,4194.0000,fee schedule,$964.55 from Fee Schedule BLDTM_23 for Rev 450 Proc 27503 * Qty 1 = $964.55 at 100% = $964.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,4194.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,4194.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,4194.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3774.60,,,,,,,109.0000,4194.0000,percent of total billed charges,"90% of $4,194.00 in Billed Charges for Rev 450 Proc 27503 = $3,774.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,4194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,4194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,MEDCOST,MEDCOST VHN,1995.92,,,,,,,109.0000,4194.0000,percent of total billed charges,"47.59% of $4,194.00 in Billed Charges for Rev 450 Proc 27503 = $1,995.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,4194.0000,fee schedule,APG 00041 Proc 27503 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,4194.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,4194.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,4194.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,4194.0000,fee schedule,APG 00041 Proc 27503 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,SENTARA HEALTH,SENTARA HEALTH,1082.47,,,,,,,109.0000,4194.0000,percent of total billed charges,"25.81% of $4,194.00 in Billed Charges for Rev 450 Proc 27503 = $1,082.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,4194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4194.00,,,,,,,109.0000,4194.0000,percent of total billed charges,"100% of $4,194.00 in Billed Charges for Rev 450 Proc 27503 = $4,194.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,4194.0000,case rate,Rev 450 Proc 27503 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,4194.0000,case rate,Rev 450 Proc 27503 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,4194.0000,case rate,Rev 450 Proc 27503 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,4194.0000,case rate,Rev 450 Proc 27503 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,4194.0000,fee schedule,APG 00041 Proc 27503 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,4194.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,WELLCARE,WELLCARE MEDICAID,4194.00,,,,,,,109.0000,4194.0000,percent of total billed charges,"100% of $4,194.00 in Billed Charges for Rev 450 Proc 27503 = $4,194.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSE TX SUPRA/TRNSCNDYLR FMRAL FX WOW INTRCNDYLR EXT W MNP WOW TRCT,27503,CPT,450,RC,45000337,CDM,,,,both,,,4194.0000,629.1000,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,4194.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,AETNA,AETNA,4452.76,,,,,,,148.0000,15872.7900,percent of total billed charges,"42.7% of $10,428.00 in Billed Charges for Rev 481 Proc 0076T = $4,452.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15721.62,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 0076T at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 104% = $15,721.62. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,BLUE CROSS,ANTHEM EXCHANGE,1385.82,,,,,,,148.0000,15872.7900,fee schedule,"$693.36 from Fee Schedule ANT_C_APC for Rev 481 Proc 0076T * Qty 1 = $693.36 at 199.87% = $1,385.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,10428.00,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 0076T at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45 (Service Line reduced to $10,428.00, claim capped at $10,428.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,BLUE CROSS,ANTHEM HMO,1472.35,,,,,,,148.0000,15872.7900,fee schedule,"$693.36 from Fee Schedule ANT_C_APC for Rev 481 Proc 0076T * Qty 1 = $693.36 at 212.35% = $1,472.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1732.08,,,,,,,148.0000,15872.7900,fee schedule,"$693.36 from Fee Schedule ANT_C_APC for Rev 481 Proc 0076T * Qty 1 = $693.36 at 249.81% = $1,732.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,304.13,,,,,,,148.0000,15872.7900,fee schedule,$304.13 from Fee Schedule BLDTM_23 for Rev 481 Proc 0076T * Qty 1 = $304.13 at 100% = $304.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,15872.7900,case rate,Rev 481 Proc 0076T ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,15872.7900,case rate,Rev 481 Proc 0076T ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,15872.7900,case rate,Rev 481 Proc 0076T ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,BLUE CROSS,TENNCARE BLUE CARE,331.04,,,,,,,148.0000,15872.7900,fee schedule,$285.38 from Fee Schedule TC_24 for Rev 481 Proc 0076T * Qty 1 = $285.38 at 116% = $331.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,BLUE CROSS,TENNCARE BLUE SELECT,331.04,,,,,,,148.0000,15872.7900,fee schedule,$285.38 from Fee Schedule TC_24 for Rev 481 Proc 0076T * Qty 1 = $285.38 at 116% = $331.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,CIGNA HEALTHCARE,CIGNA HMO,4348.48,,,,,,,148.0000,15872.7900,percent of total billed charges,"41.7% of $10,428.00 in Billed Charges for Rev 481 Proc 0076T = $4,348.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4838.59,,,,,,,148.0000,15872.7900,percent of total billed charges,"46.4% of $10,428.00 in Billed Charges for Rev 481 Proc 0076T = $4,838.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4348.48,,,,,,,148.0000,15872.7900,percent of total billed charges,"41.7% of $10,428.00 in Billed Charges for Rev 481 Proc 0076T = $4,348.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,CIGNA HEALTHCARE,CIGNA PPO,4348.48,,,,,,,148.0000,15872.7900,percent of total billed charges,"41.7% of $10,428.00 in Billed Charges for Rev 481 Proc 0076T = $4,348.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9385.20,,,,,,,148.0000,15872.7900,percent of total billed charges,"90% of $10,428.00 in Billed Charges for Rev 481 Proc 0076T = $9,385.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,MEDCOST,MEDCOST VHN,4962.69,,,,,,,148.0000,15872.7900,percent of total billed charges,"47.59% of $10,428.00 in Billed Charges for Rev 481 Proc 0076T = $4,962.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15872.79,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 0076T at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 105% = $15,872.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15585.57,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 0076T at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 103.1% = $15,585.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,SENTARA HEALTH,SENTARA HEALTH,2691.47,,,,,,,148.0000,15872.7900,percent of total billed charges,"25.81% of $10,428.00 in Billed Charges for Rev 481 Proc 0076T = $2,691.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10428.00,,,,,,,148.0000,15872.7900,percent of total billed charges,"100% of $10,428.00 in Billed Charges for Rev 481 Proc 0076T = $10,428.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,148.0000,15872.7900,case rate,Rev 481 Proc 0076T ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,148.0000,15872.7900,case rate,"Rev 481 Proc 0076T ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,148.0000,15872.7900,case rate,"Rev 481 Proc 0076T ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,148.0000,15872.7900,case rate,"Rev 481 Proc 0076T ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15570.45,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 0076T at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CCL STENT PLC VERT OPEN/PERCU EA ADD VES,0076T,CPT,481,RC,48100139,CDM,,,,both,,,10428.0000,1564.2000,WELLCARE,WELLCARE MEDICAID,10428.00,,,,,,,148.0000,15872.7900,percent of total billed charges,"100% of $10,428.00 in Billed Charges for Rev 481 Proc 0076T = $10,428.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,AETNA,AETNA,5244.41,,,,,,,1063.1000,12282.0000,percent of total billed charges,"42.7% of $12,282.00 in Billed Charges for Rev 310 Proc 0152U = $5,244.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2771.15,,,,,,,1063.1000,12282.0000,fee schedule,"APG 02045 Proc 0152U at $836.60 (Base Rate) * 3.185 (Relative Weight) = $2,664.57 (Total Line Payment) at 104% = $2,771.15. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2126.20,,,,,,,1063.1000,12282.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,AETNA,AETNA HEALTHCARE MEDICARE,2126.20,,,,,,,1063.1000,12282.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,2126.20,,,,,,,1063.1000,12282.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,AMBETTER,AMBETTER,4635.12,,,,,,,1063.1000,12282.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,AMERIGROUP,AMERIGROUP,1063.10,,,,,,,1063.1000,12282.0000,fee schedule,50.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2211.25,,,,,,,1063.1000,12282.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,BLUE CROSS,ANTHEM EXCHANGE,2126.20,,,,,,,1063.1000,12282.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2744.51,,,,,,,1063.1000,12282.0000,fee schedule,"APG 02045 Proc 0152U at $836.60 (Base Rate) * 3.185 (Relative Weight) = $2,664.57 (Total Line Payment) at 103% = $2,744.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,BLUE CROSS,ANTHEM HMO,2126.20,,,,,,,1063.1000,12282.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2189.99,,,,,,,1063.1000,12282.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2126.20,,,,,,,1063.1000,12282.0000,fee schedule,100.00% of Medicare CLIA The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8597.40,,,,,,,1063.1000,12282.0000,percent of total billed charges,"Rev 310 Proc 0152U $12,282.00 in Billed Charges at 70% = $8,597.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,BLUE CROSS,BLUE CROSS E NETWORK,6803.84,,,,,,,1063.1000,12282.0000,fee schedule,"$2,126.20 from Fee Schedule BCFSB for Rev 310 Proc 0152U * Qty 1 = $2,126.20 at 320% = $6,803.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,BLUE CROSS,BLUE CROSS MEDICARE,2211.25,,,,,,,1063.1000,12282.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,BLUE CROSS,BLUE CROSS P NETWORK,6952.67,,,,,,,1063.1000,12282.0000,fee schedule,"$2,126.20 from Fee Schedule BCFSB for Rev 310 Proc 0152U * Qty 1 = $2,126.20 at 327% = $6,952.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,BLUE CROSS,BLUE CROSS S NETWORK,6952.67,,,,,,,1063.1000,12282.0000,fee schedule,"$2,126.20 from Fee Schedule BCFSB for Rev 310 Proc 0152U * Qty 1 = $2,126.20 at 327% = $6,952.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,CIGNA HEALTHCARE,CIGNA HMO,5121.59,,,,,,,1063.1000,12282.0000,percent of total billed charges,"Rev 310 Proc 0152U $12,282.00 in Billed Charges at 41.7% = $5,121.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4686.51,,,,,,,1063.1000,12282.0000,fee schedule,"$4,686.51 from Fee Schedule CGIFP_25LR for Rev 310 Proc 0152U * Qty 1 = $4,686.51 at 100% = $4,686.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,2232.51,,,,,,,1063.1000,12282.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5121.59,,,,,,,1063.1000,12282.0000,percent of total billed charges,"Rev 310 Proc 0152U $12,282.00 in Billed Charges at 41.7% = $5,121.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,CIGNA HEALTHCARE,CIGNA PPO,5121.59,,,,,,,1063.1000,12282.0000,percent of total billed charges,"Rev 310 Proc 0152U $12,282.00 in Billed Charges at 41.7% = $5,121.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,2232.51,,,,,,,1063.1000,12282.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11053.80,,,,,,,1063.1000,12282.0000,percent of total billed charges,"90% of $12,282.00 in Billed Charges for Rev 310 Proc 0152U = $11,053.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,HUMANA,HUMANA MEDICARE,2126.20,,,,,,,1063.1000,12282.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2126.20,,,,,,,1063.1000,12282.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,MEDCOST,MEDCOST VHN,5845.00,,,,,,,1063.1000,12282.0000,percent of total billed charges,"47.59% of $12,282.00 in Billed Charges for Rev 310 Proc 0152U = $5,845.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2797.80,,,,,,,1063.1000,12282.0000,fee schedule,"APG 02045 Proc 0152U at $836.60 (Base Rate) * 3.185 (Relative Weight) = $2,664.57 (Total Line Payment) at 100% = $2,664.57... $2,664.57 at 105% = $2,797.80 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,2232.51,,,,,,,1063.1000,12282.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,2232.51,,,,,,,1063.1000,12282.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,NHC ADVANTAGE,NHC ADVANTAGE,2232.51,,,,,,,1063.1000,12282.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2747.17,,,,,,,1063.1000,12282.0000,fee schedule,"APG 02045 Proc 0152U at $836.60 (Base Rate) * 3.185 (Relative Weight) = $2,664.57 (Total Line Payment) at 100% = $2,664.57... $2,664.57 at 103.1% = $2,747.17 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,SENTARA HEALTH,SENTARA HEALTH,3169.98,,,,,,,1063.1000,12282.0000,percent of total billed charges,"25.81% of $12,282.00 in Billed Charges for Rev 310 Proc 0152U = $3,169.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,SENTARA HEALTH,SENTARA MEDICARE,2126.20,,,,,,,1063.1000,12282.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12282.00,,,,,,,1063.1000,12282.0000,percent of total billed charges,"100% of $12,282.00 in Billed Charges for Rev 310 Proc 0152U = $12,282.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1063.10,,,,,,,1063.1000,12282.0000,fee schedule,"$2,126.20 from Fee Schedule TCUHC24 for Rev 310 Proc 0152U * Qty 1 = $2,126.20 at 50% = $1,063.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2211.25,,,,,,,1063.1000,12282.0000,fee schedule,"$2,126.20 from Fee Schedule UHC_31910 for Rev 310 Proc 0152U * Qty 1 = $2,126.20 at 104% = $2,211.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2126.20,,,,,,,1063.1000,12282.0000,fee schedule,"$2,126.20 from Fee Schedule UHC_31910 for Rev 310 Proc 0152U * Qty 1 = $2,126.20 at 100% = $2,126.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,2126.20,,,,,,,1063.1000,12282.0000,fee schedule,"$2,126.20 from Fee Schedule UHC_31910 for Rev 310 Proc 0152U * Qty 1 = $2,126.20 at 100% = $2,126.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2744.51,,,,,,,1063.1000,12282.0000,fee schedule,"APG 02045 Proc 0152U at $836.60 (Base Rate) * 3.185 (Relative Weight) = $2,664.57 (Total Line Payment) at 103% = $2,744.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2126.20,,,,,,,1063.1000,12282.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2126.20,,,,,,,1063.1000,12282.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,WELLCARE,WELLCARE MEDICAID,12282.00,,,,,,,1063.1000,12282.0000,percent of total billed charges,"100% of $12,282.00 in Billed Charges for Rev 310 Proc 0152U = $12,282.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC KARIUS TEST-NFCT DS MCRB CLL FR DNA UNTRGT NEXT GENRJ SEQ,0152U,CPT,310,RC,31000052,CDM,,,,both,,,12282.0000,1842.3000,WELLCARE,WELLCARE MEDICARE,2253.77,,,,,,,1063.1000,12282.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,AETNA,AETNA,4047.11,,,,,,,1881.0000,14351.7600,percent of total billed charges,"42.7% of $9,478.00 in Billed Charges for Rev 361 Proc 0200T = $4,047.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,7174.98,,,,,,,1881.0000,14351.7600,fee schedule,"APG 00028 Proc 0200T at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 104% = $7,174.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,6583.38,,,,,,,1881.0000,14351.7600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,AETNA,AETNA HEALTHCARE MEDICARE,6583.38,,,,,,,1881.0000,14351.7600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,6583.38,,,,,,,1881.0000,14351.7600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,AMBETTER,AMBETTER,14351.76,,,,,,,1881.0000,14351.7600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,6846.71,,,,,,,1881.0000,14351.7600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,ANTHEM EXCHANGE,9478.00,,,,,,,1881.0000,14351.7600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,7105.99,,,,,,,1881.0000,14351.7600,fee schedule,"APG 00028 Proc 0200T at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 103% = $7,105.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,ANTHEM HMO,9478.00,,,,,,,1881.0000,14351.7600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,6780.88,,,,,,,1881.0000,14351.7600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9478.00,,,,,,,1881.0000,14351.7600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,1881.0000,14351.7600,case rate,"Rev 361 Proc 0200T ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,BLUE CROSS MEDICARE,6846.71,,,,,,,1881.0000,14351.7600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,1881.0000,14351.7600,case rate,"Rev 361 Proc 0200T ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,1881.0000,14351.7600,case rate,"Rev 361 Proc 0200T ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,CIGNA HEALTHCARE,CIGNA HMO,5761.00,,,,,,,1881.0000,14351.7600,case rate,"Rev 361 Proc 0200T ASG Rate of $5,761.00 at 100% of $5,761.00 = $5,761.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4353.00,,,,,,,1881.0000,14351.7600,case rate,"Rev 361 Proc 0200T ASG Rate of $4,353.00 at 100% of $4,353.00 = $4,353.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,6912.55,,,,,,,1881.0000,14351.7600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5761.00,,,,,,,1881.0000,14351.7600,case rate,"Rev 361 Proc 0200T ASG Rate of $5,761.00 at 100% of $5,761.00 = $5,761.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,CIGNA HEALTHCARE,CIGNA PPO,5761.00,,,,,,,1881.0000,14351.7600,case rate,"Rev 361 Proc 0200T ASG Rate of $5,761.00 at 100% of $5,761.00 = $5,761.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,6912.55,,,,,,,1881.0000,14351.7600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8530.20,,,,,,,1881.0000,14351.7600,percent of total billed charges,"90% of $9,478.00 in Billed Charges for Rev 361 Proc 0200T = $8,530.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,HUMANA,HUMANA MEDICARE,6583.38,,,,,,,1881.0000,14351.7600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,6583.38,,,,,,,1881.0000,14351.7600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,MEDCOST,MEDCOST VHN,4510.58,,,,,,,1881.0000,14351.7600,percent of total billed charges,"47.59% of $9,478.00 in Billed Charges for Rev 361 Proc 0200T = $4,510.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,7243.97,,,,,,,1881.0000,14351.7600,fee schedule,"APG 00028 Proc 0200T at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 100% = $6,899.02... $6,899.02 at 105% = $7,243.97 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,6912.55,,,,,,,1881.0000,14351.7600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,6912.55,,,,,,,1881.0000,14351.7600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,NHC ADVANTAGE,NHC ADVANTAGE,6912.55,,,,,,,1881.0000,14351.7600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,7112.89,,,,,,,1881.0000,14351.7600,fee schedule,"APG 00028 Proc 0200T at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 100% = $6,899.02... $6,899.02 at 103.1% = $7,112.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,SENTARA HEALTH,SENTARA HEALTH,2446.27,,,,,,,1881.0000,14351.7600,percent of total billed charges,"25.81% of $9,478.00 in Billed Charges for Rev 361 Proc 0200T = $2,446.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,SENTARA HEALTH,SENTARA MEDICARE,6583.38,,,,,,,1881.0000,14351.7600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9478.00,,,,,,,1881.0000,14351.7600,percent of total billed charges,"100% of $9,478.00 in Billed Charges for Rev 361 Proc 0200T = $9,478.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,1881.0000,14351.7600,case rate,"Rev 361 Proc 0200T ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,1881.0000,14351.7600,case rate,"Rev 361 Proc 0200T ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,1881.0000,14351.7600,case rate,"Rev 361 Proc 0200T ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,1881.0000,14351.7600,case rate,"Rev 361 Proc 0200T ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,7105.99,,,,,,,1881.0000,14351.7600,fee schedule,"APG 00028 Proc 0200T at $836.60 (Base Rate) * 8.2465 (Relative Weight) = $6,899.02 (Total Line Payment) at 103% = $7,105.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,6583.38,,,,,,,1881.0000,14351.7600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,6583.38,,,,,,,1881.0000,14351.7600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,WELLCARE,WELLCARE MEDICAID,9478.00,,,,,,,1881.0000,14351.7600,percent of total billed charges,"100% of $9,478.00 in Billed Charges for Rev 361 Proc 0200T = $9,478.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU SACRAL AUGMENT UNIL,0200T,CPT,361,RC,36100278,CDM,,,,both,,,9478.0000,1421.7000,WELLCARE,WELLCARE MEDICARE,6978.38,,,,,,,1881.0000,14351.7600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,AETNA,AETNA,275.42,,,,,,,84.5500,703.3600,percent of total billed charges,42.7% of $645.00 in Billed Charges for Rev 510 Proc 27516 = $275.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,84.5500,703.3600,fee schedule,"APG 00041 Proc 27516 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,84.5500,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,84.5500,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,84.5500,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,AMBETTER,AMBETTER,487.87,,,,,,,84.5500,703.3600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,84.5500,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,84.5500,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,645.00,,,,,,,84.5500,703.3600,fee schedule,"APG 00041 Proc 27516 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96 (Service Line reduced to $645.00, claim capped at $645.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,84.5500,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,84.5500,703.3600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",645.00,,,,,,,84.5500,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,570.31,,,,,,,84.5500,703.3600,fee schedule,$570.31 from Fee Schedule BLDTM_23 for Rev 510 Proc 27516 * Qty 1 = $570.31 at 100% = $570.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,84.5500,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,CIGNA HEALTHCARE,CIGNA HMO,268.97,,,,,,,84.5500,703.3600,percent of total billed charges,41.7% of $645.00 in Billed Charges for Rev 510 Proc 27516 = $268.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,299.28,,,,,,,84.5500,703.3600,percent of total billed charges,46.4% of $645.00 in Billed Charges for Rev 510 Proc 27516 = $299.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,84.5500,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,268.97,,,,,,,84.5500,703.3600,percent of total billed charges,41.7% of $645.00 in Billed Charges for Rev 510 Proc 27516 = $268.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,CIGNA HEALTHCARE,CIGNA PPO,268.97,,,,,,,84.5500,703.3600,percent of total billed charges,41.7% of $645.00 in Billed Charges for Rev 510 Proc 27516 = $268.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,84.5500,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,580.50,,,,,,,84.5500,703.3600,percent of total billed charges,90% of $645.00 in Billed Charges for Rev 510 Proc 27516 = $580.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,84.5500,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,84.5500,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,MEDCOST,MEDCOST VHN,306.96,,,,,,,84.5500,703.3600,percent of total billed charges,47.59% of $645.00 in Billed Charges for Rev 510 Proc 27516 = $306.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,84.5500,703.3600,fee schedule,"APG 00041 Proc 27516 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,84.5500,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,84.5500,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,84.5500,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,84.5500,703.3600,fee schedule,"APG 00041 Proc 27516 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,SENTARA HEALTH,SENTARA HEALTH,166.47,,,,,,,84.5500,703.3600,percent of total billed charges,25.81% of $645.00 in Billed Charges for Rev 510 Proc 27516 = $166.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,84.5500,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",645.00,,,,,,,84.5500,703.3600,percent of total billed charges,100% of $645.00 in Billed Charges for Rev 510 Proc 27516 = $645.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,84.55,,,,,,,84.5500,703.3600,fee schedule,$169.09 from Fee Schedule TCUHC24 for Rev 510 Proc 27516 * Qty 1 = $169.09 at 50% = $84.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,208.34,,,,,,,84.5500,703.3600,other,32.3% of $645.00 in Billed Charges for Rev 510 Proc 27516 = $208.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,198.02,,,,,,,84.5500,703.3600,other,30.7% of $645.00 in Billed Charges for Rev 510 Proc 27516 = $198.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,208.34,,,,,,,84.5500,703.3600,percent of total billed charges,32.3% of $645.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,84.5500,703.3600,fee schedule,"APG 00041 Proc 27516 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,84.5500,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,84.5500,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,WELLCARE,WELLCARE MEDICAID,645.00,,,,,,,84.5500,703.3600,percent of total billed charges,100% of $645.00 in Billed Charges for Rev 510 Proc 27516 = $645.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ,27516,CPT,510,RC,51000274,CDM,,,,both,,,645.0000,96.7500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,84.5500,703.3600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,AETNA,AETNA,3922.42,,,,,,,578.0000,9186.0000,percent of total billed charges,"42.7% of $9,186.00 in Billed Charges for Rev 361 Proc 32550 = $3,922.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1446.31,,,,,,,578.0000,9186.0000,fee schedule,"APG 00068 Proc 32550 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 104% = $1,446.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3248.41,,,,,,,578.0000,9186.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,AETNA,AETNA HEALTHCARE MEDICARE,3248.41,,,,,,,578.0000,9186.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,3248.41,,,,,,,578.0000,9186.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,AMBETTER,AMBETTER,7081.52,,,,,,,578.0000,9186.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3378.34,,,,,,,578.0000,9186.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,BLUE CROSS,ANTHEM EXCHANGE,7997.76,,,,,,,578.0000,9186.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1432.40,,,,,,,578.0000,9186.0000,fee schedule,"APG 00068 Proc 32550 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,BLUE CROSS,ANTHEM HMO,8497.14,,,,,,,578.0000,9186.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3345.86,,,,,,,578.0000,9186.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9186.00,,,,,,,578.0000,9186.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1082.00,,,,,,,578.0000,9186.0000,case rate,"Rev 361 Proc 32550 ASG Rate of $1,082.00 at 100% of $1,082.00 = $1,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,578.0000,9186.0000,case rate,"Rev 361 Proc 32550 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,BLUE CROSS,BLUE CROSS MEDICARE,3378.34,,,,,,,578.0000,9186.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,578.0000,9186.0000,case rate,"Rev 361 Proc 32550 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,578.0000,9186.0000,case rate,"Rev 361 Proc 32550 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,9186.0000,case rate,Rev 361 Proc 32550 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,9186.0000,case rate,Rev 361 Proc 32550 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,CIGNA HEALTHCARE,CIGNA HMO,8003.00,,,,,,,578.0000,9186.0000,case rate,"Rev 361 Proc 32550 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6048.00,,,,,,,578.0000,9186.0000,case rate,"Rev 361 Proc 32550 ASG Rate of $6,048.00 at 100% of $6,048.00 = $6,048.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,3410.83,,,,,,,578.0000,9186.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8003.00,,,,,,,578.0000,9186.0000,case rate,"Rev 361 Proc 32550 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,CIGNA HEALTHCARE,CIGNA PPO,8003.00,,,,,,,578.0000,9186.0000,case rate,"Rev 361 Proc 32550 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3410.83,,,,,,,578.0000,9186.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8267.40,,,,,,,578.0000,9186.0000,percent of total billed charges,"90% of $9,186.00 in Billed Charges for Rev 361 Proc 32550 = $8,267.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,HUMANA,HUMANA MEDICARE,3248.41,,,,,,,578.0000,9186.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3248.41,,,,,,,578.0000,9186.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,MEDCOST,MEDCOST VHN,4371.62,,,,,,,578.0000,9186.0000,percent of total billed charges,"47.59% of $9,186.00 in Billed Charges for Rev 361 Proc 32550 = $4,371.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1460.21,,,,,,,578.0000,9186.0000,fee schedule,"APG 00068 Proc 32550 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 100% = $1,390.68... $1,390.68 at 105% = $1,460.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3410.83,,,,,,,578.0000,9186.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3410.83,,,,,,,578.0000,9186.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,NHC ADVANTAGE,NHC ADVANTAGE,3410.83,,,,,,,578.0000,9186.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1433.79,,,,,,,578.0000,9186.0000,fee schedule,"APG 00068 Proc 32550 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 100% = $1,390.68... $1,390.68 at 103.1% = $1,433.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,SENTARA HEALTH,SENTARA HEALTH,2370.91,,,,,,,578.0000,9186.0000,percent of total billed charges,"25.81% of $9,186.00 in Billed Charges for Rev 361 Proc 32550 = $2,370.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,SENTARA HEALTH,SENTARA MEDICARE,3248.41,,,,,,,578.0000,9186.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9186.00,,,,,,,578.0000,9186.0000,percent of total billed charges,"100% of $9,186.00 in Billed Charges for Rev 361 Proc 32550 = $9,186.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,578.0000,9186.0000,case rate,"Rev 361 Proc 32550 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,578.0000,9186.0000,case rate,"Rev 361 Proc 32550 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,578.0000,9186.0000,case rate,"Rev 361 Proc 32550 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,578.0000,9186.0000,case rate,"Rev 361 Proc 32550 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1432.40,,,,,,,578.0000,9186.0000,fee schedule,"APG 00068 Proc 32550 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3248.41,,,,,,,578.0000,9186.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3248.41,,,,,,,578.0000,9186.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,WELLCARE,WELLCARE MEDICAID,9186.00,,,,,,,578.0000,9186.0000,percent of total billed charges,"100% of $9,186.00 in Billed Charges for Rev 361 Proc 32550 = $9,186.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT INDWELLING TUNNELED PLEURAL CATH W CUFF,32550,CPT,361,RC,36100296,CDM,,,,both,,,9186.0000,1377.9000,WELLCARE,WELLCARE MEDICARE,3443.31,,,,,,,578.0000,9186.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,AETNA,AETNA,689.18,,,,,,,175.0000,1614.0000,percent of total billed charges,"42.7% of $1,614.00 in Billed Charges for Rev 361 Proc 32552 = $689.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1446.31,,,,,,,175.0000,1614.0000,fee schedule,"APG 00068 Proc 32552 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,390.68 at 104% = $1,446.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,569.14,,,,,,,175.0000,1614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,AETNA,AETNA HEALTHCARE MEDICARE,569.14,,,,,,,175.0000,1614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,569.14,,,,,,,175.0000,1614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,AMBETTER,AMBETTER,1240.72,,,,,,,175.0000,1614.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,591.90,,,,,,,175.0000,1614.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,BLUE CROSS,ANTHEM EXCHANGE,1401.25,,,,,,,175.0000,1614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1432.40,,,,,,,175.0000,1614.0000,fee schedule,"APG 00068 Proc 32552 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,390.68 at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,BLUE CROSS,ANTHEM HMO,1488.74,,,,,,,175.0000,1614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,586.21,,,,,,,175.0000,1614.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1614.00,,,,,,,175.0000,1614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,175.0000,1614.0000,case rate,Rev 361 Proc 32552 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,175.0000,1614.0000,case rate,Rev 361 Proc 32552 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,BLUE CROSS,BLUE CROSS MEDICARE,591.90,,,,,,,175.0000,1614.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,175.0000,1614.0000,case rate,Rev 361 Proc 32552 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,175.0000,1614.0000,case rate,Rev 361 Proc 32552 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,CIGNA HEALTHCARE,CIGNA HMO,228.00,,,,,,,175.0000,1614.0000,case rate,Rev 361 Proc 32552 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.00,,,,,,,175.0000,1614.0000,case rate,Rev 361 Proc 32552 ASG Rate of $175.00 at 100% of $175.00 = $175.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,597.59,,,,,,,175.0000,1614.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.00,,,,,,,175.0000,1614.0000,case rate,Rev 361 Proc 32552 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,CIGNA HEALTHCARE,CIGNA PPO,228.00,,,,,,,175.0000,1614.0000,case rate,Rev 361 Proc 32552 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,597.59,,,,,,,175.0000,1614.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1452.60,,,,,,,175.0000,1614.0000,percent of total billed charges,"90% of $1,614.00 in Billed Charges for Rev 361 Proc 32552 = $1,452.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,HUMANA,HUMANA MEDICARE,569.14,,,,,,,175.0000,1614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,569.14,,,,,,,175.0000,1614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,MEDCOST,MEDCOST VHN,768.10,,,,,,,175.0000,1614.0000,percent of total billed charges,"47.59% of $1,614.00 in Billed Charges for Rev 361 Proc 32552 = $768.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1460.21,,,,,,,175.0000,1614.0000,fee schedule,"APG 00068 Proc 32552 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,390.68 at 100% = $1,390.68... $1,390.68 at 105% = $1,460.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,597.59,,,,,,,175.0000,1614.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,597.59,,,,,,,175.0000,1614.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,NHC ADVANTAGE,NHC ADVANTAGE,597.59,,,,,,,175.0000,1614.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1433.79,,,,,,,175.0000,1614.0000,fee schedule,"APG 00068 Proc 32552 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,390.68 at 100% = $1,390.68... $1,390.68 at 103.1% = $1,433.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,SENTARA HEALTH,SENTARA HEALTH,416.57,,,,,,,175.0000,1614.0000,percent of total billed charges,"25.81% of $1,614.00 in Billed Charges for Rev 361 Proc 32552 = $416.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,SENTARA HEALTH,SENTARA MEDICARE,569.14,,,,,,,175.0000,1614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1614.00,,,,,,,175.0000,1614.0000,percent of total billed charges,"100% of $1,614.00 in Billed Charges for Rev 361 Proc 32552 = $1,614.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,175.0000,1614.0000,case rate,Rev 361 Proc 32552 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,175.0000,1614.0000,case rate,Rev 361 Proc 32552 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,175.0000,1614.0000,case rate,Rev 361 Proc 32552 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,175.0000,1614.0000,case rate,"Rev 361 Proc 32552 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1432.40,,,,,,,175.0000,1614.0000,fee schedule,"APG 00068 Proc 32552 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,390.68 at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,569.14,,,,,,,175.0000,1614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,569.14,,,,,,,175.0000,1614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,WELLCARE,WELLCARE MEDICAID,1614.00,,,,,,,175.0000,1614.0000,percent of total billed charges,"100% of $1,614.00 in Billed Charges for Rev 361 Proc 32552 = $1,614.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL INDWELLING TUNNELED PLEURAL CATH,32552,CPT,361,RC,36100262,CDM,,,,both,,,1614.0000,242.1000,WELLCARE,WELLCARE MEDICARE,603.28,,,,,,,175.0000,1614.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,AETNA,AETNA,263.46,,,,,,,29.8200,617.0000,percent of total billed charges,42.7% of $617.00 in Billed Charges for Rev 450 Proc 11730 = $263.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,95.10,,,,,,,29.8200,617.0000,fee schedule,"APG 00005 Proc 11730 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $91.44 at 104% = $95.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,29.8200,617.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,29.8200,617.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,29.8200,617.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,AMBETTER,AMBETTER,396.83,,,,,,,29.8200,617.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,29.8200,617.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,29.8200,617.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,94.18,,,,,,,29.8200,617.0000,fee schedule,"APG 00005 Proc 11730 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $91.44 at 103% = $94.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,29.8200,617.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,29.8200,617.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",560.15,,,,,,,29.8200,617.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,53.92,,,,,,,29.8200,617.0000,fee schedule,$53.92 from Fee Schedule BLDTM_23 for Rev 450 Proc 11730 * Qty 1 = $53.92 at 100% = $53.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,29.8200,617.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,BLUE CROSS,TENNCARE BLUE CARE,29.82,,,,,,,29.8200,617.0000,fee schedule,$25.71 from Fee Schedule TC_24 for Rev 450 Proc 11730 * Qty 1 = $25.71 at 116% = $29.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,BLUE CROSS,TENNCARE BLUE SELECT,29.82,,,,,,,29.8200,617.0000,fee schedule,$25.71 from Fee Schedule TC_24 for Rev 450 Proc 11730 * Qty 1 = $25.71 at 116% = $29.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,29.8200,617.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,29.8200,617.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,555.30,,,,,,,29.8200,617.0000,percent of total billed charges,90% of $617.00 in Billed Charges for Rev 450 Proc 11730 = $555.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,29.8200,617.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,29.8200,617.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,MEDCOST,MEDCOST VHN,293.63,,,,,,,29.8200,617.0000,percent of total billed charges,47.59% of $617.00 in Billed Charges for Rev 450 Proc 11730 = $293.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,96.01,,,,,,,29.8200,617.0000,fee schedule,"APG 00005 Proc 11730 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $91.44 at 100% = $91.44... $91.44 at 105% = $96.01 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,29.8200,617.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,29.8200,617.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,29.8200,617.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,94.27,,,,,,,29.8200,617.0000,fee schedule,"APG 00005 Proc 11730 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $91.44 at 100% = $91.44... $91.44 at 103.1% = $94.27 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,SENTARA HEALTH,SENTARA HEALTH,159.25,,,,,,,29.8200,617.0000,percent of total billed charges,25.81% of $617.00 in Billed Charges for Rev 450 Proc 11730 = $159.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,29.8200,617.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",617.00,,,,,,,29.8200,617.0000,percent of total billed charges,100% of $617.00 in Billed Charges for Rev 450 Proc 11730 = $617.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,29.8200,617.0000,case rate,Rev 450 Proc 11730 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,29.8200,617.0000,case rate,Rev 450 Proc 11730 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,29.8200,617.0000,case rate,Rev 450 Proc 11730 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,617.00,,,,,,,29.8200,617.0000,case rate,"Rev 450 Proc 11730 at Case Rate $847.00 (Service Line reduced to $617.00, claim capped at $617.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,94.18,,,,,,,29.8200,617.0000,fee schedule,"APG 00005 Proc 11730 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $91.44 at 103% = $94.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,29.8200,617.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,29.8200,617.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,WELLCARE,WELLCARE MEDICAID,617.00,,,,,,,29.8200,617.0000,percent of total billed charges,100% of $617.00 in Billed Charges for Rev 450 Proc 11730 = $617.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AVUL NAIL PLAT PART CMPL SINGL,11730,CPT,450,RC,45000030,CDM,,,,both,,,617.0000,92.5500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,29.8200,617.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLATE EA ADDITIONAL,11732,CPT,450,RC,45000031,CDM,,,,both,,,274.0000,41.1000,AETNA,AETNA,117.00,,,,,,,33.1300,274.0000,percent of total billed charges,42.7% of $274.00 in Billed Charges for Rev 450 Proc 11732 = $117.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AVUL NAIL PLATE EA ADDITIONAL,11732,CPT,450,RC,45000031,CDM,,,,both,,,274.0000,41.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,95.10,,,,,,,33.1300,274.0000,fee schedule,APG 00005 Proc 11732 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 104% = $95.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLATE EA ADDITIONAL,11732,CPT,450,RC,45000031,CDM,,,,both,,,274.0000,41.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,94.18,,,,,,,33.1300,274.0000,fee schedule,APG 00005 Proc 11732 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 103% = $94.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLATE EA ADDITIONAL,11732,CPT,450,RC,45000031,CDM,,,,both,,,274.0000,41.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,33.13,,,,,,,33.1300,274.0000,fee schedule,$33.13 from Fee Schedule BLDTM_23 for Rev 450 Proc 11732 * Qty 1 = $33.13 at 100% = $33.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLATE EA ADDITIONAL,11732,CPT,450,RC,45000031,CDM,,,,both,,,274.0000,41.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,246.60,,,,,,,33.1300,274.0000,percent of total billed charges,90% of $274.00 in Billed Charges for Rev 450 Proc 11732 = $246.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AVUL NAIL PLATE EA ADDITIONAL,11732,CPT,450,RC,45000031,CDM,,,,both,,,274.0000,41.1000,MEDCOST,MEDCOST VHN,130.40,,,,,,,33.1300,274.0000,percent of total billed charges,47.59% of $274.00 in Billed Charges for Rev 450 Proc 11732 = $130.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AVUL NAIL PLATE EA ADDITIONAL,11732,CPT,450,RC,45000031,CDM,,,,both,,,274.0000,41.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,96.01,,,,,,,33.1300,274.0000,fee schedule,APG 00005 Proc 11732 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 100% = $91.44... $91.44 at 105% = $96.01 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLATE EA ADDITIONAL,11732,CPT,450,RC,45000031,CDM,,,,both,,,274.0000,41.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,94.27,,,,,,,33.1300,274.0000,fee schedule,APG 00005 Proc 11732 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 100% = $91.44... $91.44 at 103.1% = $94.27 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLATE EA ADDITIONAL,11732,CPT,450,RC,45000031,CDM,,,,both,,,274.0000,41.1000,SENTARA HEALTH,SENTARA HEALTH,70.72,,,,,,,33.1300,274.0000,percent of total billed charges,25.81% of $274.00 in Billed Charges for Rev 450 Proc 11732 = $70.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AVUL NAIL PLATE EA ADDITIONAL,11732,CPT,450,RC,45000031,CDM,,,,both,,,274.0000,41.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",274.00,,,,,,,33.1300,274.0000,percent of total billed charges,100% of $274.00 in Billed Charges for Rev 450 Proc 11732 = $274.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC AVUL NAIL PLATE EA ADDITIONAL,11732,CPT,450,RC,45000031,CDM,,,,both,,,274.0000,41.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,33.1300,274.0000,case rate,Rev 450 Proc 11732 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLATE EA ADDITIONAL,11732,CPT,450,RC,45000031,CDM,,,,both,,,274.0000,41.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,274.00,,,,,,,33.1300,274.0000,case rate,"Rev 450 Proc 11732 at Case Rate $491.00 (Service Line reduced to $274.00, claim capped at $274.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AVUL NAIL PLATE EA ADDITIONAL,11732,CPT,450,RC,45000031,CDM,,,,both,,,274.0000,41.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,274.00,,,,,,,33.1300,274.0000,case rate,"Rev 450 Proc 11732 at Case Rate $471.00 (Service Line reduced to $274.00, claim capped at $274.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AVUL NAIL PLATE EA ADDITIONAL,11732,CPT,450,RC,45000031,CDM,,,,both,,,274.0000,41.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,274.00,,,,,,,33.1300,274.0000,case rate,"Rev 450 Proc 11732 at Case Rate $847.00 (Service Line reduced to $274.00, claim capped at $274.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AVUL NAIL PLATE EA ADDITIONAL,11732,CPT,450,RC,45000031,CDM,,,,both,,,274.0000,41.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,94.18,,,,,,,33.1300,274.0000,fee schedule,APG 00005 Proc 11732 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 103% = $94.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AVUL NAIL PLATE EA ADDITIONAL,11732,CPT,450,RC,45000031,CDM,,,,both,,,274.0000,41.1000,WELLCARE,WELLCARE MEDICAID,274.00,,,,,,,33.1300,274.0000,percent of total billed charges,100% of $274.00 in Billed Charges for Rev 450 Proc 11732 = $274.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,AETNA,AETNA,116.57,,,,,,,14.1300,273.0000,percent of total billed charges,42.7% of $273.00 in Billed Charges for Rev 450 Proc 11740 = $116.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,95.10,,,,,,,14.1300,273.0000,fee schedule,APG 00005 Proc 11740 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 104% = $95.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,120.71,,,,,,,14.1300,273.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,AETNA,AETNA HEALTHCARE MEDICARE,120.71,,,,,,,14.1300,273.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,120.71,,,,,,,14.1300,273.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,AMBETTER,AMBETTER,263.15,,,,,,,14.1300,273.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,125.54,,,,,,,14.1300,273.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,BLUE CROSS,ANTHEM EXCHANGE,273.00,,,,,,,14.1300,273.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,94.18,,,,,,,14.1300,273.0000,fee schedule,APG 00005 Proc 11740 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 103% = $94.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,BLUE CROSS,ANTHEM HMO,273.00,,,,,,,14.1300,273.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,124.33,,,,,,,14.1300,273.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",273.00,,,,,,,14.1300,273.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,32.36,,,,,,,14.1300,273.0000,fee schedule,$32.36 from Fee Schedule BLDTM_23 for Rev 450 Proc 11740 * Qty 1 = $32.36 at 100% = $32.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,BLUE CROSS,BLUE CROSS MEDICARE,125.54,,,,,,,14.1300,273.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,BLUE CROSS,TENNCARE BLUE CARE,14.13,,,,,,,14.1300,273.0000,fee schedule,$12.18 from Fee Schedule TC_24 for Rev 450 Proc 11740 * Qty 1 = $12.18 at 116% = $14.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,BLUE CROSS,TENNCARE BLUE SELECT,14.13,,,,,,,14.1300,273.0000,fee schedule,$12.18 from Fee Schedule TC_24 for Rev 450 Proc 11740 * Qty 1 = $12.18 at 116% = $14.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,126.75,,,,,,,14.1300,273.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,126.75,,,,,,,14.1300,273.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,245.70,,,,,,,14.1300,273.0000,percent of total billed charges,90% of $273.00 in Billed Charges for Rev 450 Proc 11740 = $245.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,HUMANA,HUMANA MEDICARE,120.71,,,,,,,14.1300,273.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,120.71,,,,,,,14.1300,273.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,MEDCOST,MEDCOST VHN,129.92,,,,,,,14.1300,273.0000,percent of total billed charges,47.59% of $273.00 in Billed Charges for Rev 450 Proc 11740 = $129.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,96.01,,,,,,,14.1300,273.0000,fee schedule,APG 00005 Proc 11740 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 100% = $91.44... $91.44 at 105% = $96.01 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,126.75,,,,,,,14.1300,273.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,126.75,,,,,,,14.1300,273.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,NHC ADVANTAGE,NHC ADVANTAGE,126.75,,,,,,,14.1300,273.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,94.27,,,,,,,14.1300,273.0000,fee schedule,APG 00005 Proc 11740 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 100% = $91.44... $91.44 at 103.1% = $94.27 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,SENTARA HEALTH,SENTARA HEALTH,70.46,,,,,,,14.1300,273.0000,percent of total billed charges,25.81% of $273.00 in Billed Charges for Rev 450 Proc 11740 = $70.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,SENTARA HEALTH,SENTARA MEDICARE,120.71,,,,,,,14.1300,273.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",273.00,,,,,,,14.1300,273.0000,percent of total billed charges,100% of $273.00 in Billed Charges for Rev 450 Proc 11740 = $273.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,14.1300,273.0000,case rate,Rev 450 Proc 11740 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,273.00,,,,,,,14.1300,273.0000,case rate,"Rev 450 Proc 11740 at Case Rate $491.00 (Service Line reduced to $273.00, claim capped at $273.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,273.00,,,,,,,14.1300,273.0000,case rate,"Rev 450 Proc 11740 at Case Rate $471.00 (Service Line reduced to $273.00, claim capped at $273.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,273.00,,,,,,,14.1300,273.0000,case rate,"Rev 450 Proc 11740 at Case Rate $847.00 (Service Line reduced to $273.00, claim capped at $273.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,94.18,,,,,,,14.1300,273.0000,fee schedule,APG 00005 Proc 11740 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 103% = $94.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,120.71,,,,,,,14.1300,273.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,120.71,,,,,,,14.1300,273.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,WELLCARE,WELLCARE MEDICAID,273.00,,,,,,,14.1300,273.0000,percent of total billed charges,100% of $273.00 in Billed Charges for Rev 450 Proc 11740 = $273.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVACUATION SUBUNGUAL HEMATOMA,11740,CPT,450,RC,45000032,CDM,,,,both,,,273.0000,40.9500,WELLCARE,WELLCARE MEDICARE,127.95,,,,,,,14.1300,273.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,AETNA,AETNA,609.76,,,,,,,72.2000,1428.0000,percent of total billed charges,"42.7% of $1,428.00 in Billed Charges for Rev 450 Proc 11750 = $609.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,72.2000,1428.0000,fee schedule,"APG 00009 Proc 11750 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,72.2000,1428.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,72.2000,1428.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,72.2000,1428.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,AMBETTER,AMBETTER,804.03,,,,,,,72.2000,1428.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,72.2000,1428.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,72.2000,1428.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,72.2000,1428.0000,fee schedule,"APG 00009 Proc 11750 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,72.2000,1428.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,72.2000,1428.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1134.94,,,,,,,72.2000,1428.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,175.69,,,,,,,72.2000,1428.0000,fee schedule,$175.69 from Fee Schedule BLDTM_23 for Rev 450 Proc 11750 * Qty 1 = $175.69 at 100% = $175.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,72.2000,1428.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,BLUE CROSS,TENNCARE BLUE CARE,72.20,,,,,,,72.2000,1428.0000,fee schedule,$62.24 from Fee Schedule TC_24 for Rev 450 Proc 11750 * Qty 1 = $62.24 at 116% = $72.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,BLUE CROSS,TENNCARE BLUE SELECT,72.20,,,,,,,72.2000,1428.0000,fee schedule,$62.24 from Fee Schedule TC_24 for Rev 450 Proc 11750 * Qty 1 = $62.24 at 116% = $72.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,72.2000,1428.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,72.2000,1428.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1285.20,,,,,,,72.2000,1428.0000,percent of total billed charges,"90% of $1,428.00 in Billed Charges for Rev 450 Proc 11750 = $1,285.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,HUMANA,HUMANA MEDICARE,368.82,,,,,,,72.2000,1428.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,72.2000,1428.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,MEDCOST,MEDCOST VHN,679.59,,,,,,,72.2000,1428.0000,percent of total billed charges,"47.59% of $1,428.00 in Billed Charges for Rev 450 Proc 11750 = $679.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,72.2000,1428.0000,fee schedule,"APG 00009 Proc 11750 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,72.2000,1428.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,72.2000,1428.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,72.2000,1428.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,72.2000,1428.0000,fee schedule,"APG 00009 Proc 11750 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,SENTARA HEALTH,SENTARA HEALTH,368.57,,,,,,,72.2000,1428.0000,percent of total billed charges,"25.81% of $1,428.00 in Billed Charges for Rev 450 Proc 11750 = $368.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,72.2000,1428.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1428.00,,,,,,,72.2000,1428.0000,percent of total billed charges,"100% of $1,428.00 in Billed Charges for Rev 450 Proc 11750 = $1,428.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,72.2000,1428.0000,case rate,Rev 450 Proc 11750 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,72.2000,1428.0000,case rate,Rev 450 Proc 11750 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,72.2000,1428.0000,case rate,Rev 450 Proc 11750 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,72.2000,1428.0000,case rate,Rev 450 Proc 11750 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,72.2000,1428.0000,fee schedule,"APG 00009 Proc 11750 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,72.2000,1428.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,72.2000,1428.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,WELLCARE,WELLCARE MEDICAID,1428.00,,,,,,,72.2000,1428.0000,percent of total billed charges,"100% of $1,428.00 in Billed Charges for Rev 450 Proc 11750 = $1,428.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC NAIL&MATRIX PART CMPL PERM,11750,CPT,450,RC,45000033,CDM,,,,both,,,1428.0000,214.2000,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,72.2000,1428.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,AETNA,AETNA,181.48,,,,,,,94.1800,1461.7800,percent of total billed charges,42.7% of $425.00 in Billed Charges for Rev 450 Proc 11760 = $181.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,95.10,,,,,,,94.1800,1461.7800,fee schedule,"APG 00005 Proc 11760 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $91.44 at 104% = $95.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,425.00,,,,,,,94.1800,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,AETNA,AETNA HEALTHCARE MEDICARE,425.00,,,,,,,94.1800,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,425.00,,,,,,,94.1800,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,AMBETTER,AMBETTER,1461.78,,,,,,,94.1800,1461.7800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,425.00,,,,,,,94.1800,1461.7800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,BLUE CROSS,ANTHEM EXCHANGE,425.00,,,,,,,94.1800,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,94.18,,,,,,,94.1800,1461.7800,fee schedule,"APG 00005 Proc 11760 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $91.44 at 103% = $94.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,BLUE CROSS,ANTHEM HMO,425.00,,,,,,,94.1800,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,425.00,,,,,,,94.1800,1461.7800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",425.00,,,,,,,94.1800,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,109.17,,,,,,,94.1800,1461.7800,fee schedule,$109.17 from Fee Schedule BLDTM_23 for Rev 450 Proc 11760 * Qty 1 = $109.17 at 100% = $109.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,BLUE CROSS,BLUE CROSS MEDICARE,697.36,,,,,,,94.1800,1461.7800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,425.00,,,,,,,94.1800,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,425.00,,,,,,,94.1800,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,382.50,,,,,,,94.1800,1461.7800,percent of total billed charges,90% of $425.00 in Billed Charges for Rev 450 Proc 11760 = $382.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,HUMANA,HUMANA MEDICARE,425.00,,,,,,,94.1800,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,425.00,,,,,,,94.1800,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,MEDCOST,MEDCOST VHN,202.26,,,,,,,94.1800,1461.7800,percent of total billed charges,47.59% of $425.00 in Billed Charges for Rev 450 Proc 11760 = $202.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,96.01,,,,,,,94.1800,1461.7800,fee schedule,"APG 00005 Proc 11760 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $91.44 at 100% = $91.44... $91.44 at 105% = $96.01 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,425.00,,,,,,,94.1800,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,425.00,,,,,,,94.1800,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,NHC ADVANTAGE,NHC ADVANTAGE,425.00,,,,,,,94.1800,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,94.27,,,,,,,94.1800,1461.7800,fee schedule,"APG 00005 Proc 11760 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $91.44 at 100% = $91.44... $91.44 at 103.1% = $94.27 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,SENTARA HEALTH,SENTARA HEALTH,109.69,,,,,,,94.1800,1461.7800,percent of total billed charges,25.81% of $425.00 in Billed Charges for Rev 450 Proc 11760 = $109.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,SENTARA HEALTH,SENTARA MEDICARE,425.00,,,,,,,94.1800,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",425.00,,,,,,,94.1800,1461.7800,percent of total billed charges,100% of $425.00 in Billed Charges for Rev 450 Proc 11760 = $425.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,94.1800,1461.7800,case rate,Rev 450 Proc 11760 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,425.00,,,,,,,94.1800,1461.7800,case rate,"Rev 450 Proc 11760 at Case Rate $491.00 (Service Line reduced to $425.00, claim capped at $425.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,425.00,,,,,,,94.1800,1461.7800,case rate,"Rev 450 Proc 11760 at Case Rate $471.00 (Service Line reduced to $425.00, claim capped at $425.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,425.00,,,,,,,94.1800,1461.7800,case rate,"Rev 450 Proc 11760 at Case Rate $847.00 (Service Line reduced to $425.00, claim capped at $425.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,94.18,,,,,,,94.1800,1461.7800,fee schedule,"APG 00005 Proc 11760 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $91.44 at 103% = $94.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,425.00,,,,,,,94.1800,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,425.00,,,,,,,94.1800,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,WELLCARE,WELLCARE MEDICAID,425.00,,,,,,,94.1800,1461.7800,percent of total billed charges,100% of $425.00 in Billed Charges for Rev 450 Proc 11760 = $425.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REPAIR NAIL BED,11760,CPT,450,RC,45000035,CDM,,,,both,,,425.0000,63.7500,WELLCARE,WELLCARE MEDICARE,710.77,,,,,,,94.1800,1461.7800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,AETNA,AETNA,2221.68,,,,,,,213.3900,5203.0000,percent of total billed charges,"42.7% of $5,203.00 in Billed Charges for Rev 521 Proc 11762 = $2,221.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1775.80,,,,,,,213.3900,5203.0000,fee schedule,"APG 00010 Proc 11762 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,707.50 at 104% = $1,775.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1871.96,,,,,,,213.3900,5203.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,AETNA,AETNA HEALTHCARE MEDICARE,1871.96,,,,,,,213.3900,5203.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,1871.96,,,,,,,213.3900,5203.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,AMBETTER,AMBETTER,4080.88,,,,,,,213.3900,5203.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1946.84,,,,,,,213.3900,5203.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,BLUE CROSS,ANTHEM EXCHANGE,4608.86,,,,,,,213.3900,5203.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1758.73,,,,,,,213.3900,5203.0000,fee schedule,"APG 00010 Proc 11762 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,707.50 at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,BLUE CROSS,ANTHEM HMO,4896.64,,,,,,,213.3900,5203.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1928.12,,,,,,,213.3900,5203.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5203.00,,,,,,,213.3900,5203.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,213.39,,,,,,,213.3900,5203.0000,fee schedule,$213.39 from Fee Schedule BLDTM_23 for Rev 521 Proc 11762 * Qty 1 = $213.39 at 100% = $213.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,BLUE CROSS,BLUE CROSS MEDICARE,1946.84,,,,,,,213.3900,5203.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,CIGNA HEALTHCARE,CIGNA HMO,2169.65,,,,,,,213.3900,5203.0000,percent of total billed charges,"41.7% of $5,203.00 in Billed Charges for Rev 521 Proc 11762 = $2,169.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2414.19,,,,,,,213.3900,5203.0000,percent of total billed charges,"46.4% of $5,203.00 in Billed Charges for Rev 521 Proc 11762 = $2,414.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,1965.56,,,,,,,213.3900,5203.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2169.65,,,,,,,213.3900,5203.0000,percent of total billed charges,"41.7% of $5,203.00 in Billed Charges for Rev 521 Proc 11762 = $2,169.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,CIGNA HEALTHCARE,CIGNA PPO,2169.65,,,,,,,213.3900,5203.0000,percent of total billed charges,"41.7% of $5,203.00 in Billed Charges for Rev 521 Proc 11762 = $2,169.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1965.56,,,,,,,213.3900,5203.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4682.70,,,,,,,213.3900,5203.0000,percent of total billed charges,"90% of $5,203.00 in Billed Charges for Rev 521 Proc 11762 = $4,682.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,HUMANA,HUMANA MEDICARE,1871.96,,,,,,,213.3900,5203.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1871.96,,,,,,,213.3900,5203.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,MEDCOST,MEDCOST VHN,2476.11,,,,,,,213.3900,5203.0000,percent of total billed charges,"47.59% of $5,203.00 in Billed Charges for Rev 521 Proc 11762 = $2,476.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1792.88,,,,,,,213.3900,5203.0000,fee schedule,"APG 00010 Proc 11762 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,707.50 at 100% = $1,707.50... $1,707.50 at 105% = $1,792.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1965.56,,,,,,,213.3900,5203.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1965.56,,,,,,,213.3900,5203.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,NHC ADVANTAGE,NHC ADVANTAGE,1965.56,,,,,,,213.3900,5203.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1760.43,,,,,,,213.3900,5203.0000,fee schedule,"APG 00010 Proc 11762 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,707.50 at 100% = $1,707.50... $1,707.50 at 103.1% = $1,760.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,SENTARA HEALTH,SENTARA HEALTH,1342.89,,,,,,,213.3900,5203.0000,percent of total billed charges,"25.81% of $5,203.00 in Billed Charges for Rev 521 Proc 11762 = $1,342.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,SENTARA HEALTH,SENTARA MEDICARE,1871.96,,,,,,,213.3900,5203.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5203.00,,,,,,,213.3900,5203.0000,percent of total billed charges,"100% of $5,203.00 in Billed Charges for Rev 521 Proc 11762 = $5,203.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,703.71,,,,,,,213.3900,5203.0000,fee schedule,"$1,407.42 from Fee Schedule TCUHC24 for Rev 521 Proc 11762 * Qty 1 = $1,407.42 at 50% = $703.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1758.73,,,,,,,213.3900,5203.0000,fee schedule,"APG 00010 Proc 11762 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,707.50 at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1871.96,,,,,,,213.3900,5203.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1871.96,,,,,,,213.3900,5203.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,WELLCARE,WELLCARE MEDICAID,5203.00,,,,,,,213.3900,5203.0000,percent of total billed charges,"100% of $5,203.00 in Billed Charges for Rev 521 Proc 11762 = $5,203.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RECONST NAIL BED W GRAFT,11762,CPT,521,RC,52100057,CDM,,,,both,,,5203.0000,780.4500,WELLCARE,WELLCARE MEDICARE,1984.28,,,,,,,213.3900,5203.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,AETNA,AETNA,2012.02,,,,,,,109.0000,4712.0000,percent of total billed charges,"42.7% of $4,712.00 in Billed Charges for Rev 450 Proc 32554 Mod 50 = $2,012.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2169.46,,,,,,,109.0000,4712.0000,fee schedule,"APG 00068 Proc 32554 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $2,086.02 at 104% = $2,169.46. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,853.70,,,,,,,109.0000,4712.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,AETNA,AETNA HEALTHCARE MEDICARE,853.70,,,,,,,109.0000,4712.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,853.70,,,,,,,109.0000,4712.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,AMBETTER,AMBETTER,1861.07,,,,,,,109.0000,4712.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,887.85,,,,,,,109.0000,4712.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,BLUE CROSS,ANTHEM EXCHANGE,2101.87,,,,,,,109.0000,4712.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2148.60,,,,,,,109.0000,4712.0000,fee schedule,"APG 00068 Proc 32554 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $2,086.02 at 103% = $2,148.60. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,BLUE CROSS,ANTHEM HMO,2233.12,,,,,,,109.0000,4712.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,879.32,,,,,,,109.0000,4712.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2627.05,,,,,,,109.0000,4712.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3298.40,,,,,,,109.0000,4712.0000,percent of total billed charges,"Rev 450 Proc 32554 Mod 50 $4,712.00 in Billed Charges at 70% = $3,298.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,BLUE CROSS,BLUE CROSS MEDICARE,887.85,,,,,,,109.0000,4712.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,896.39,,,,,,,109.0000,4712.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,896.39,,,,,,,109.0000,4712.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4240.80,,,,,,,109.0000,4712.0000,percent of total billed charges,"90% of $4,712.00 in Billed Charges for Rev 450 Proc 32554 Mod 50 = $4,240.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,HUMANA,HUMANA MEDICARE,853.70,,,,,,,109.0000,4712.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,853.70,,,,,,,109.0000,4712.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,MEDCOST,MEDCOST VHN,2242.44,,,,,,,109.0000,4712.0000,percent of total billed charges,"47.59% of $4,712.00 in Billed Charges for Rev 450 Proc 32554 Mod 50 = $2,242.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2190.32,,,,,,,109.0000,4712.0000,fee schedule,"APG 00068 Proc 32554 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $2,086.02 at 100% = $2,086.02... $2,086.02 at 105% = $2,190.32 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,896.39,,,,,,,109.0000,4712.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,896.39,,,,,,,109.0000,4712.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,NHC ADVANTAGE,NHC ADVANTAGE,896.39,,,,,,,109.0000,4712.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2150.69,,,,,,,109.0000,4712.0000,fee schedule,"APG 00068 Proc 32554 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $2,086.02 at 100% = $2,086.02... $2,086.02 at 103.1% = $2,150.69 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,SENTARA HEALTH,SENTARA HEALTH,1216.17,,,,,,,109.0000,4712.0000,percent of total billed charges,"25.81% of $4,712.00 in Billed Charges for Rev 450 Proc 32554 Mod 50 = $1,216.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,SENTARA HEALTH,SENTARA MEDICARE,853.70,,,,,,,109.0000,4712.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4712.00,,,,,,,109.0000,4712.0000,percent of total billed charges,"100% of $4,712.00 in Billed Charges for Rev 450 Proc 32554 Mod 50 = $4,712.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,4712.0000,case rate,Rev 450 Proc 32554 Mod 50 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,4712.0000,case rate,Rev 450 Proc 32554 Mod 50 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,4712.0000,case rate,Rev 450 Proc 32554 Mod 50 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,4712.0000,case rate,Rev 450 Proc 32554 Mod 50 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2148.60,,,,,,,109.0000,4712.0000,fee schedule,"APG 00068 Proc 32554 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $2,086.02 at 103% = $2,148.60. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,853.70,,,,,,,109.0000,4712.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,853.70,,,,,,,109.0000,4712.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,WELLCARE,WELLCARE MEDICAID,4712.00,,,,,,,109.0000,4712.0000,percent of total billed charges,"100% of $4,712.00 in Billed Charges for Rev 450 Proc 32554 Mod 50 = $4,712.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACENTESIS ASPIRAT WO GUID BI,32554,CPT,450,RC,45000227,CDM,,,50,both,,,4712.0000,706.8000,WELLCARE,WELLCARE MEDICARE,904.93,,,,,,,109.0000,4712.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,AETNA,AETNA,1092.69,,,,,,,569.1400,2559.0000,percent of total billed charges,"42.7% of $2,559.00 in Billed Charges for Rev 361 Proc 32555 = $1,092.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1446.31,,,,,,,569.1400,2559.0000,fee schedule,"APG 00068 Proc 32555 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,390.68 at 104% = $1,446.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,569.14,,,,,,,569.1400,2559.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,AETNA,AETNA HEALTHCARE MEDICARE,569.14,,,,,,,569.1400,2559.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,569.14,,,,,,,569.1400,2559.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,AMBETTER,AMBETTER,1240.72,,,,,,,569.1400,2559.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,591.90,,,,,,,569.1400,2559.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,BLUE CROSS,ANTHEM EXCHANGE,1401.25,,,,,,,569.1400,2559.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1432.40,,,,,,,569.1400,2559.0000,fee schedule,"APG 00068 Proc 32555 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,390.68 at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,BLUE CROSS,ANTHEM HMO,1488.74,,,,,,,569.1400,2559.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,586.21,,,,,,,569.1400,2559.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1751.37,,,,,,,569.1400,2559.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,569.1400,2559.0000,case rate,"Rev 361 Proc 32555 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,569.1400,2559.0000,case rate,Rev 361 Proc 32555 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,BLUE CROSS,BLUE CROSS MEDICARE,591.90,,,,,,,569.1400,2559.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,569.1400,2559.0000,case rate,Rev 361 Proc 32555 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,569.1400,2559.0000,case rate,Rev 361 Proc 32555 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,569.1400,2559.0000,case rate,Rev 361 Proc 32555 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,569.1400,2559.0000,case rate,Rev 361 Proc 32555 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,569.1400,2559.0000,case rate,"Rev 361 Proc 32555 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,569.1400,2559.0000,case rate,"Rev 361 Proc 32555 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,597.59,,,,,,,569.1400,2559.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,569.1400,2559.0000,case rate,"Rev 361 Proc 32555 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,569.1400,2559.0000,case rate,"Rev 361 Proc 32555 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,597.59,,,,,,,569.1400,2559.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2303.10,,,,,,,569.1400,2559.0000,percent of total billed charges,"90% of $2,559.00 in Billed Charges for Rev 361 Proc 32555 = $2,303.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,HUMANA,HUMANA MEDICARE,569.14,,,,,,,569.1400,2559.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,569.14,,,,,,,569.1400,2559.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,MEDCOST,MEDCOST VHN,1217.83,,,,,,,569.1400,2559.0000,percent of total billed charges,"47.59% of $2,559.00 in Billed Charges for Rev 361 Proc 32555 = $1,217.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1460.21,,,,,,,569.1400,2559.0000,fee schedule,"APG 00068 Proc 32555 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,390.68 at 100% = $1,390.68... $1,390.68 at 105% = $1,460.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,597.59,,,,,,,569.1400,2559.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,597.59,,,,,,,569.1400,2559.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,NHC ADVANTAGE,NHC ADVANTAGE,597.59,,,,,,,569.1400,2559.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1433.79,,,,,,,569.1400,2559.0000,fee schedule,"APG 00068 Proc 32555 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,390.68 at 100% = $1,390.68... $1,390.68 at 103.1% = $1,433.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,SENTARA HEALTH,SENTARA HEALTH,660.48,,,,,,,569.1400,2559.0000,percent of total billed charges,"25.81% of $2,559.00 in Billed Charges for Rev 361 Proc 32555 = $660.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,SENTARA HEALTH,SENTARA MEDICARE,569.14,,,,,,,569.1400,2559.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2559.00,,,,,,,569.1400,2559.0000,percent of total billed charges,"100% of $2,559.00 in Billed Charges for Rev 361 Proc 32555 = $2,559.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,569.1400,2559.0000,case rate,Rev 361 Proc 32555 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,569.1400,2559.0000,case rate,Rev 361 Proc 32555 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,569.1400,2559.0000,case rate,Rev 361 Proc 32555 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,569.1400,2559.0000,case rate,"Rev 361 Proc 32555 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1432.40,,,,,,,569.1400,2559.0000,fee schedule,"APG 00068 Proc 32555 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,390.68 at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,569.14,,,,,,,569.1400,2559.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,569.14,,,,,,,569.1400,2559.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,WELLCARE,WELLCARE MEDICAID,2559.00,,,,,,,569.1400,2559.0000,percent of total billed charges,"100% of $2,559.00 in Billed Charges for Rev 361 Proc 32555 = $2,559.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACENTESIS ASPIR W IMAG GUID,32555,CPT,361,RC,36100095,CDM,,,,both,,,2559.0000,383.8500,WELLCARE,WELLCARE MEDICARE,603.28,,,,,,,569.1400,2559.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,AETNA,AETNA,11333.01,,,,,,,512.1600,26541.0000,percent of total billed charges,"42.7% of $26,541.00 in Billed Charges for Rev 481 Proc 33206 = $11,333.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11330.93,,,,,,,512.1600,26541.0000,fee schedule,"APG 00086 Proc 33206 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 104% = $11,330.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,9482.83,,,,,,,512.1600,26541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,AETNA,AETNA HEALTHCARE MEDICARE,9482.83,,,,,,,512.1600,26541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,9482.83,,,,,,,512.1600,26541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,AMBETTER,AMBETTER,20672.57,,,,,,,512.1600,26541.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,9862.14,,,,,,,512.1600,26541.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,BLUE CROSS,ANTHEM EXCHANGE,23347.23,,,,,,,512.1600,26541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11221.98,,,,,,,512.1600,26541.0000,fee schedule,"APG 00086 Proc 33206 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,BLUE CROSS,ANTHEM HMO,24805.05,,,,,,,512.1600,26541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,9767.31,,,,,,,512.1600,26541.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",26541.00,,,,,,,512.1600,26541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,512.16,,,,,,,512.1600,26541.0000,fee schedule,$512.16 from Fee Schedule BLDTM_23 for Rev 481 Proc 33206 * Qty 1 = $512.16 at 100% = $512.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,BLUE CROSS,BLUE CROSS E NETWORK,8571.00,,,,,,,512.1600,26541.0000,case rate,"Rev 481 Proc 33206 ASG Rate of $8,571.00 at 100% of $8,571.00 = $8,571.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,BLUE CROSS,BLUE CROSS MEDICARE,9862.14,,,,,,,512.1600,26541.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,BLUE CROSS,BLUE CROSS P NETWORK,8764.00,,,,,,,512.1600,26541.0000,case rate,"Rev 481 Proc 33206 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,BLUE CROSS,BLUE CROSS S NETWORK,8764.00,,,,,,,512.1600,26541.0000,case rate,"Rev 481 Proc 33206 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,CIGNA HEALTHCARE,CIGNA HMO,11067.60,,,,,,,512.1600,26541.0000,percent of total billed charges,"41.7% of $26,541.00 in Billed Charges for Rev 481 Proc 33206 = $11,067.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12315.02,,,,,,,512.1600,26541.0000,percent of total billed charges,"46.4% of $26,541.00 in Billed Charges for Rev 481 Proc 33206 = $12,315.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,9956.97,,,,,,,512.1600,26541.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11067.60,,,,,,,512.1600,26541.0000,percent of total billed charges,"41.7% of $26,541.00 in Billed Charges for Rev 481 Proc 33206 = $11,067.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,CIGNA HEALTHCARE,CIGNA PPO,11067.60,,,,,,,512.1600,26541.0000,percent of total billed charges,"41.7% of $26,541.00 in Billed Charges for Rev 481 Proc 33206 = $11,067.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,9956.97,,,,,,,512.1600,26541.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,23886.90,,,,,,,512.1600,26541.0000,percent of total billed charges,"90% of $26,541.00 in Billed Charges for Rev 481 Proc 33206 = $23,886.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,HUMANA,HUMANA MEDICARE,9482.83,,,,,,,512.1600,26541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,9482.83,,,,,,,512.1600,26541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,MEDCOST,MEDCOST VHN,12630.86,,,,,,,512.1600,26541.0000,percent of total billed charges,"47.59% of $26,541.00 in Billed Charges for Rev 481 Proc 33206 = $12,630.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11439.89,,,,,,,512.1600,26541.0000,fee schedule,"APG 00086 Proc 33206 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 105% = $11,439.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,9956.97,,,,,,,512.1600,26541.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,9956.97,,,,,,,512.1600,26541.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,NHC ADVANTAGE,NHC ADVANTAGE,9956.97,,,,,,,512.1600,26541.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11232.88,,,,,,,512.1600,26541.0000,fee schedule,"APG 00086 Proc 33206 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 103.1% = $11,232.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,SENTARA HEALTH,SENTARA HEALTH,6850.23,,,,,,,512.1600,26541.0000,percent of total billed charges,"25.81% of $26,541.00 in Billed Charges for Rev 481 Proc 33206 = $6,850.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,SENTARA HEALTH,SENTARA MEDICARE,9482.83,,,,,,,512.1600,26541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",26541.00,,,,,,,512.1600,26541.0000,percent of total billed charges,"100% of $26,541.00 in Billed Charges for Rev 481 Proc 33206 = $26,541.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,512.1600,26541.0000,case rate,"Rev 481 Proc 33206 ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,512.1600,26541.0000,case rate,"Rev 481 Proc 33206 ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,512.1600,26541.0000,case rate,"Rev 481 Proc 33206 ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,20054.00,,,,,,,512.1600,26541.0000,case rate,"Rev 481 Proc 33206 ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11221.98,,,,,,,512.1600,26541.0000,fee schedule,"APG 00086 Proc 33206 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,9482.83,,,,,,,512.1600,26541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,9482.83,,,,,,,512.1600,26541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,WELLCARE,WELLCARE MEDICAID,26541.00,,,,,,,512.1600,26541.0000,percent of total billed charges,"100% of $26,541.00 in Billed Charges for Rev 481 Proc 33206 = $26,541.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT/REPLC PACEMAKER ATRIAL,33206,CPT,481,RC,48100001,CDM,,,,both,,,26541.0000,3981.1500,WELLCARE,WELLCARE MEDICARE,10051.80,,,,,,,512.1600,26541.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,AETNA,AETNA,11333.01,,,,,,,608.3200,26541.0000,percent of total billed charges,"42.7% of $26,541.00 in Billed Charges for Rev 481 Proc 33207 = $11,333.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11330.93,,,,,,,608.3200,26541.0000,fee schedule,"APG 00086 Proc 33207 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 104% = $11,330.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,9482.83,,,,,,,608.3200,26541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,AETNA,AETNA HEALTHCARE MEDICARE,9482.83,,,,,,,608.3200,26541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,9482.83,,,,,,,608.3200,26541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,AMBETTER,AMBETTER,20672.57,,,,,,,608.3200,26541.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,9862.14,,,,,,,608.3200,26541.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,BLUE CROSS,ANTHEM EXCHANGE,23347.23,,,,,,,608.3200,26541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11221.98,,,,,,,608.3200,26541.0000,fee schedule,"APG 00086 Proc 33207 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,BLUE CROSS,ANTHEM HMO,24805.05,,,,,,,608.3200,26541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,9767.31,,,,,,,608.3200,26541.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",26541.00,,,,,,,608.3200,26541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,608.32,,,,,,,608.3200,26541.0000,fee schedule,$608.32 from Fee Schedule BLDTM_23 for Rev 481 Proc 33207 * Qty 1 = $608.32 at 100% = $608.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,BLUE CROSS,BLUE CROSS E NETWORK,8571.00,,,,,,,608.3200,26541.0000,case rate,"Rev 481 Proc 33207 ASG Rate of $8,571.00 at 100% of $8,571.00 = $8,571.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,BLUE CROSS,BLUE CROSS MEDICARE,9862.14,,,,,,,608.3200,26541.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,BLUE CROSS,BLUE CROSS P NETWORK,8764.00,,,,,,,608.3200,26541.0000,case rate,"Rev 481 Proc 33207 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,BLUE CROSS,BLUE CROSS S NETWORK,8764.00,,,,,,,608.3200,26541.0000,case rate,"Rev 481 Proc 33207 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,CIGNA HEALTHCARE,CIGNA HMO,11067.60,,,,,,,608.3200,26541.0000,percent of total billed charges,"41.7% of $26,541.00 in Billed Charges for Rev 481 Proc 33207 = $11,067.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12315.02,,,,,,,608.3200,26541.0000,percent of total billed charges,"46.4% of $26,541.00 in Billed Charges for Rev 481 Proc 33207 = $12,315.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,9956.97,,,,,,,608.3200,26541.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11067.60,,,,,,,608.3200,26541.0000,percent of total billed charges,"41.7% of $26,541.00 in Billed Charges for Rev 481 Proc 33207 = $11,067.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,CIGNA HEALTHCARE,CIGNA PPO,11067.60,,,,,,,608.3200,26541.0000,percent of total billed charges,"41.7% of $26,541.00 in Billed Charges for Rev 481 Proc 33207 = $11,067.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,9956.97,,,,,,,608.3200,26541.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,23886.90,,,,,,,608.3200,26541.0000,percent of total billed charges,"90% of $26,541.00 in Billed Charges for Rev 481 Proc 33207 = $23,886.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,HUMANA,HUMANA MEDICARE,9482.83,,,,,,,608.3200,26541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,9482.83,,,,,,,608.3200,26541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,MEDCOST,MEDCOST VHN,12630.86,,,,,,,608.3200,26541.0000,percent of total billed charges,"47.59% of $26,541.00 in Billed Charges for Rev 481 Proc 33207 = $12,630.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11439.89,,,,,,,608.3200,26541.0000,fee schedule,"APG 00086 Proc 33207 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 105% = $11,439.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,9956.97,,,,,,,608.3200,26541.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,9956.97,,,,,,,608.3200,26541.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,NHC ADVANTAGE,NHC ADVANTAGE,9956.97,,,,,,,608.3200,26541.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11232.88,,,,,,,608.3200,26541.0000,fee schedule,"APG 00086 Proc 33207 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 103.1% = $11,232.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,SENTARA HEALTH,SENTARA HEALTH,6850.23,,,,,,,608.3200,26541.0000,percent of total billed charges,"25.81% of $26,541.00 in Billed Charges for Rev 481 Proc 33207 = $6,850.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,SENTARA HEALTH,SENTARA MEDICARE,9482.83,,,,,,,608.3200,26541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",26541.00,,,,,,,608.3200,26541.0000,percent of total billed charges,"100% of $26,541.00 in Billed Charges for Rev 481 Proc 33207 = $26,541.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,608.3200,26541.0000,case rate,"Rev 481 Proc 33207 ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,608.3200,26541.0000,case rate,"Rev 481 Proc 33207 ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,608.3200,26541.0000,case rate,"Rev 481 Proc 33207 ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,20054.00,,,,,,,608.3200,26541.0000,case rate,"Rev 481 Proc 33207 ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11221.98,,,,,,,608.3200,26541.0000,fee schedule,"APG 00086 Proc 33207 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,9482.83,,,,,,,608.3200,26541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,9482.83,,,,,,,608.3200,26541.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,WELLCARE,WELLCARE MEDICAID,26541.00,,,,,,,608.3200,26541.0000,percent of total billed charges,"100% of $26,541.00 in Billed Charges for Rev 481 Proc 33207 = $26,541.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PACEMAKER VENT,33207,CPT,481,RC,48100002,CDM,,,,both,,,26541.0000,3981.1500,WELLCARE,WELLCARE MEDICARE,10051.80,,,,,,,608.3200,26541.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,AETNA,AETNA,5404.54,,,,,,,334.7000,16367.5500,percent of total billed charges,"42.7% of $12,657.00 in Billed Charges for Rev 481 Proc 33210 = $5,404.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2176.64,,,,,,,334.7000,16367.5500,fee schedule,"APG 00074 Proc 33210 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 104% = $2,176.64. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,7508.05,,,,,,,334.7000,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,AETNA,AETNA HEALTHCARE MEDICARE,7508.05,,,,,,,334.7000,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,7508.05,,,,,,,334.7000,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,AMBETTER,AMBETTER,16367.55,,,,,,,334.7000,16367.5500,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,7808.37,,,,,,,334.7000,16367.5500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,ANTHEM EXCHANGE,12657.00,,,,,,,334.7000,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2155.71,,,,,,,334.7000,16367.5500,fee schedule,"APG 00074 Proc 33210 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,ANTHEM HMO,12657.00,,,,,,,334.7000,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,7733.29,,,,,,,334.7000,16367.5500,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",12657.00,,,,,,,334.7000,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,334.70,,,,,,,334.7000,16367.5500,fee schedule,$334.70 from Fee Schedule BLDTM_23 for Rev 481 Proc 33210 * Qty 1 = $334.70 at 100% = $334.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,334.7000,16367.5500,case rate,"Rev 481 Proc 33210 ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,BLUE CROSS MEDICARE,7808.37,,,,,,,334.7000,16367.5500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,334.7000,16367.5500,case rate,"Rev 481 Proc 33210 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,334.7000,16367.5500,case rate,"Rev 481 Proc 33210 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,CIGNA HEALTHCARE,CIGNA HMO,5277.97,,,,,,,334.7000,16367.5500,percent of total billed charges,"41.7% of $12,657.00 in Billed Charges for Rev 481 Proc 33210 = $5,277.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5872.85,,,,,,,334.7000,16367.5500,percent of total billed charges,"46.4% of $12,657.00 in Billed Charges for Rev 481 Proc 33210 = $5,872.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,7883.45,,,,,,,334.7000,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5277.97,,,,,,,334.7000,16367.5500,percent of total billed charges,"41.7% of $12,657.00 in Billed Charges for Rev 481 Proc 33210 = $5,277.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,CIGNA HEALTHCARE,CIGNA PPO,5277.97,,,,,,,334.7000,16367.5500,percent of total billed charges,"41.7% of $12,657.00 in Billed Charges for Rev 481 Proc 33210 = $5,277.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,7883.45,,,,,,,334.7000,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11391.30,,,,,,,334.7000,16367.5500,percent of total billed charges,"90% of $12,657.00 in Billed Charges for Rev 481 Proc 33210 = $11,391.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,HUMANA,HUMANA MEDICARE,7508.05,,,,,,,334.7000,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,7508.05,,,,,,,334.7000,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,MEDCOST,MEDCOST VHN,6023.47,,,,,,,334.7000,16367.5500,percent of total billed charges,"47.59% of $12,657.00 in Billed Charges for Rev 481 Proc 33210 = $6,023.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2197.57,,,,,,,334.7000,16367.5500,fee schedule,"APG 00074 Proc 33210 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 100% = $2,092.92... $2,092.92 at 105% = $2,197.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,7883.45,,,,,,,334.7000,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,7883.45,,,,,,,334.7000,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,NHC ADVANTAGE,NHC ADVANTAGE,7883.45,,,,,,,334.7000,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2157.80,,,,,,,334.7000,16367.5500,fee schedule,"APG 00074 Proc 33210 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 100% = $2,092.92... $2,092.92 at 103.1% = $2,157.80 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,SENTARA HEALTH,SENTARA HEALTH,3266.77,,,,,,,334.7000,16367.5500,percent of total billed charges,"25.81% of $12,657.00 in Billed Charges for Rev 481 Proc 33210 = $3,266.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,SENTARA HEALTH,SENTARA MEDICARE,7508.05,,,,,,,334.7000,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12657.00,,,,,,,334.7000,16367.5500,percent of total billed charges,"100% of $12,657.00 in Billed Charges for Rev 481 Proc 33210 = $12,657.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,334.7000,16367.5500,case rate,"Rev 481 Proc 33210 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,334.7000,16367.5500,case rate,"Rev 481 Proc 33210 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,334.7000,16367.5500,case rate,"Rev 481 Proc 33210 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,334.7000,16367.5500,case rate,"Rev 481 Proc 33210 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2155.71,,,,,,,334.7000,16367.5500,fee schedule,"APG 00074 Proc 33210 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,7508.05,,,,,,,334.7000,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,7508.05,,,,,,,334.7000,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,WELLCARE,WELLCARE MEDICAID,12657.00,,,,,,,334.7000,16367.5500,percent of total billed charges,"100% of $12,657.00 in Billed Charges for Rev 481 Proc 33210 = $12,657.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TEMP PACEMKR INSERT REPL SGL,33210,CPT,481,RC,48100004,CDM,,,,both,,,12657.0000,1898.5500,WELLCARE,WELLCARE MEDICARE,7958.53,,,,,,,334.7000,16367.5500,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,AETNA,AETNA,3678.18,,,,,,,440.1500,8614.0000,percent of total billed charges,"42.7% of $8,614.00 in Billed Charges for Rev 521 Proc 11771 = $3,678.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2575.48,,,,,,,440.1500,8614.0000,fee schedule,"APG 00011 Proc 11771 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 104% = $2,575.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2635.37,,,,,,,440.1500,8614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,AETNA,AETNA HEALTHCARE MEDICARE,2635.37,,,,,,,440.1500,8614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,2635.37,,,,,,,440.1500,8614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,AMBETTER,AMBETTER,5745.12,,,,,,,440.1500,8614.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2740.79,,,,,,,440.1500,8614.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,BLUE CROSS,ANTHEM EXCHANGE,6488.44,,,,,,,440.1500,8614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2550.71,,,,,,,440.1500,8614.0000,fee schedule,"APG 00011 Proc 11771 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 103% = $2,550.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,BLUE CROSS,ANTHEM HMO,6893.58,,,,,,,440.1500,8614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2714.44,,,,,,,440.1500,8614.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8109.66,,,,,,,440.1500,8614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,440.15,,,,,,,440.1500,8614.0000,fee schedule,$440.15 from Fee Schedule BLDTM_23 for Rev 521 Proc 11771 * Qty 1 = $440.15 at 100% = $440.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,BLUE CROSS,BLUE CROSS MEDICARE,2740.79,,,,,,,440.1500,8614.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,CIGNA HEALTHCARE,CIGNA HMO,3592.04,,,,,,,440.1500,8614.0000,percent of total billed charges,"41.7% of $8,614.00 in Billed Charges for Rev 521 Proc 11771 = $3,592.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3996.90,,,,,,,440.1500,8614.0000,percent of total billed charges,"46.4% of $8,614.00 in Billed Charges for Rev 521 Proc 11771 = $3,996.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,2767.14,,,,,,,440.1500,8614.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3592.04,,,,,,,440.1500,8614.0000,percent of total billed charges,"41.7% of $8,614.00 in Billed Charges for Rev 521 Proc 11771 = $3,592.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,CIGNA HEALTHCARE,CIGNA PPO,3592.04,,,,,,,440.1500,8614.0000,percent of total billed charges,"41.7% of $8,614.00 in Billed Charges for Rev 521 Proc 11771 = $3,592.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,2767.14,,,,,,,440.1500,8614.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7752.60,,,,,,,440.1500,8614.0000,percent of total billed charges,"90% of $8,614.00 in Billed Charges for Rev 521 Proc 11771 = $7,752.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,HUMANA,HUMANA MEDICARE,2635.37,,,,,,,440.1500,8614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2635.37,,,,,,,440.1500,8614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,MEDCOST,MEDCOST VHN,4099.40,,,,,,,440.1500,8614.0000,percent of total billed charges,"47.59% of $8,614.00 in Billed Charges for Rev 521 Proc 11771 = $4,099.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2600.24,,,,,,,440.1500,8614.0000,fee schedule,"APG 00011 Proc 11771 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 100% = $2,476.42... $2,476.42 at 105% = $2,600.24 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,2767.14,,,,,,,440.1500,8614.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,2767.14,,,,,,,440.1500,8614.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,NHC ADVANTAGE,NHC ADVANTAGE,2767.14,,,,,,,440.1500,8614.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2553.19,,,,,,,440.1500,8614.0000,fee schedule,"APG 00011 Proc 11771 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 100% = $2,476.42... $2,476.42 at 103.1% = $2,553.19 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,SENTARA HEALTH,SENTARA HEALTH,2223.27,,,,,,,440.1500,8614.0000,percent of total billed charges,"25.81% of $8,614.00 in Billed Charges for Rev 521 Proc 11771 = $2,223.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,SENTARA HEALTH,SENTARA MEDICARE,2635.37,,,,,,,440.1500,8614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8614.00,,,,,,,440.1500,8614.0000,percent of total billed charges,"100% of $8,614.00 in Billed Charges for Rev 521 Proc 11771 = $8,614.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,912.16,,,,,,,440.1500,8614.0000,fee schedule,"$1,824.31 from Fee Schedule TCUHC24 for Rev 521 Proc 11771 * Qty 1 = $1,824.31 at 50% = $912.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2550.71,,,,,,,440.1500,8614.0000,fee schedule,"APG 00011 Proc 11771 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 103% = $2,550.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2635.37,,,,,,,440.1500,8614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2635.37,,,,,,,440.1500,8614.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,WELLCARE,WELLCARE MEDICAID,8614.00,,,,,,,440.1500,8614.0000,percent of total billed charges,"100% of $8,614.00 in Billed Charges for Rev 521 Proc 11771 = $8,614.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HX EXC PILONIAL CYST/SINUS EXTENSIVE,11771,CPT,521,RC,52100059,CDM,,,,both,,,8614.0000,1292.1000,WELLCARE,WELLCARE MEDICARE,2793.50,,,,,,,440.1500,8614.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,AETNA,AETNA,4046.25,,,,,,,490.9200,9476.0000,percent of total billed charges,"42.7% of $9,476.00 in Billed Charges for Rev 521 Proc 11772 = $4,046.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2575.48,,,,,,,490.9200,9476.0000,fee schedule,"APG 00011 Proc 11772 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 104% = $2,575.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2635.37,,,,,,,490.9200,9476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,AETNA,AETNA HEALTHCARE MEDICARE,2635.37,,,,,,,490.9200,9476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,2635.37,,,,,,,490.9200,9476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,AMBETTER,AMBETTER,5745.12,,,,,,,490.9200,9476.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2740.79,,,,,,,490.9200,9476.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,BLUE CROSS,ANTHEM EXCHANGE,6488.44,,,,,,,490.9200,9476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2550.71,,,,,,,490.9200,9476.0000,fee schedule,"APG 00011 Proc 11772 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 103% = $2,550.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,BLUE CROSS,ANTHEM HMO,6893.58,,,,,,,490.9200,9476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2714.44,,,,,,,490.9200,9476.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8109.66,,,,,,,490.9200,9476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,490.92,,,,,,,490.9200,9476.0000,fee schedule,$490.92 from Fee Schedule BLDTM_23 for Rev 521 Proc 11772 * Qty 1 = $490.92 at 100% = $490.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,BLUE CROSS,BLUE CROSS MEDICARE,2740.79,,,,,,,490.9200,9476.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,CIGNA HEALTHCARE,CIGNA HMO,3951.49,,,,,,,490.9200,9476.0000,percent of total billed charges,"41.7% of $9,476.00 in Billed Charges for Rev 521 Proc 11772 = $3,951.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4396.86,,,,,,,490.9200,9476.0000,percent of total billed charges,"46.4% of $9,476.00 in Billed Charges for Rev 521 Proc 11772 = $4,396.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,2767.14,,,,,,,490.9200,9476.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3951.49,,,,,,,490.9200,9476.0000,percent of total billed charges,"41.7% of $9,476.00 in Billed Charges for Rev 521 Proc 11772 = $3,951.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,CIGNA HEALTHCARE,CIGNA PPO,3951.49,,,,,,,490.9200,9476.0000,percent of total billed charges,"41.7% of $9,476.00 in Billed Charges for Rev 521 Proc 11772 = $3,951.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,2767.14,,,,,,,490.9200,9476.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8528.40,,,,,,,490.9200,9476.0000,percent of total billed charges,"90% of $9,476.00 in Billed Charges for Rev 521 Proc 11772 = $8,528.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,HUMANA,HUMANA MEDICARE,2635.37,,,,,,,490.9200,9476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2635.37,,,,,,,490.9200,9476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,MEDCOST,MEDCOST VHN,4509.63,,,,,,,490.9200,9476.0000,percent of total billed charges,"47.59% of $9,476.00 in Billed Charges for Rev 521 Proc 11772 = $4,509.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2600.24,,,,,,,490.9200,9476.0000,fee schedule,"APG 00011 Proc 11772 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 100% = $2,476.42... $2,476.42 at 105% = $2,600.24 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,2767.14,,,,,,,490.9200,9476.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,2767.14,,,,,,,490.9200,9476.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,NHC ADVANTAGE,NHC ADVANTAGE,2767.14,,,,,,,490.9200,9476.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2553.19,,,,,,,490.9200,9476.0000,fee schedule,"APG 00011 Proc 11772 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 100% = $2,476.42... $2,476.42 at 103.1% = $2,553.19 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,SENTARA HEALTH,SENTARA HEALTH,2445.76,,,,,,,490.9200,9476.0000,percent of total billed charges,"25.81% of $9,476.00 in Billed Charges for Rev 521 Proc 11772 = $2,445.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,SENTARA HEALTH,SENTARA MEDICARE,2635.37,,,,,,,490.9200,9476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9476.00,,,,,,,490.9200,9476.0000,percent of total billed charges,"100% of $9,476.00 in Billed Charges for Rev 521 Proc 11772 = $9,476.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,912.16,,,,,,,490.9200,9476.0000,fee schedule,"$1,824.31 from Fee Schedule TCUHC24 for Rev 521 Proc 11772 * Qty 1 = $1,824.31 at 50% = $912.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2550.71,,,,,,,490.9200,9476.0000,fee schedule,"APG 00011 Proc 11772 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 103% = $2,550.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2635.37,,,,,,,490.9200,9476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2635.37,,,,,,,490.9200,9476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,WELLCARE,WELLCARE MEDICAID,9476.00,,,,,,,490.9200,9476.0000,percent of total billed charges,"100% of $9,476.00 in Billed Charges for Rev 521 Proc 11772 = $9,476.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC PILONIDAL CYST/SINUS COMPLICATED,11772,CPT,521,RC,52100060,CDM,,,,both,,,9476.0000,1421.4000,WELLCARE,WELLCARE MEDICARE,2793.50,,,,,,,490.9200,9476.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA,237.84,,,,,,,14.1300,557.0000,percent of total billed charges,42.7% of $557.00 in Billed Charges for Rev 510 Proc 11900 = $237.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,14.1300,557.0000,fee schedule,"APG 00003 Proc 11900 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,14.1300,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,14.1300,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,14.1300,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,AMBETTER,AMBETTER,396.83,,,,,,,14.1300,557.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,14.1300,557.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,14.1300,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,14.1300,557.0000,fee schedule,"APG 00003 Proc 11900 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,14.1300,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,14.1300,557.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",557.00,,,,,,,14.1300,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,35.47,,,,,,,14.1300,557.0000,fee schedule,$35.47 from Fee Schedule BLDTM_23 for Rev 510 Proc 11900 * Qty 1 = $35.47 at 100% = $35.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,14.1300,557.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,TENNCARE BLUE CARE,14.13,,,,,,,14.1300,557.0000,fee schedule,$12.18 from Fee Schedule TC_24 for Rev 510 Proc 11900 * Qty 1 = $12.18 at 116% = $14.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,TENNCARE BLUE SELECT,14.13,,,,,,,14.1300,557.0000,fee schedule,$12.18 from Fee Schedule TC_24 for Rev 510 Proc 11900 * Qty 1 = $12.18 at 116% = $14.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA HMO,232.27,,,,,,,14.1300,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 510 Proc 11900 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,258.45,,,,,,,14.1300,557.0000,percent of total billed charges,46.4% of $557.00 in Billed Charges for Rev 510 Proc 11900 = $258.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,14.1300,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,232.27,,,,,,,14.1300,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 510 Proc 11900 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA PPO,232.27,,,,,,,14.1300,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 510 Proc 11900 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,14.1300,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,501.30,,,,,,,14.1300,557.0000,percent of total billed charges,90% of $557.00 in Billed Charges for Rev 510 Proc 11900 = $501.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,14.1300,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,14.1300,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,MEDCOST,MEDCOST VHN,265.08,,,,,,,14.1300,557.0000,percent of total billed charges,47.59% of $557.00 in Billed Charges for Rev 510 Proc 11900 = $265.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,14.1300,557.0000,fee schedule,"APG 00003 Proc 11900 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,14.1300,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,14.1300,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,14.1300,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,14.1300,557.0000,fee schedule,"APG 00003 Proc 11900 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,SENTARA HEALTH,SENTARA HEALTH,143.76,,,,,,,14.1300,557.0000,percent of total billed charges,25.81% of $557.00 in Billed Charges for Rev 510 Proc 11900 = $143.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,14.1300,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",557.00,,,,,,,14.1300,557.0000,percent of total billed charges,100% of $557.00 in Billed Charges for Rev 510 Proc 11900 = $557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,49.25,,,,,,,14.1300,557.0000,fee schedule,$98.49 from Fee Schedule TCUHC24 for Rev 510 Proc 11900 * Qty 1 = $98.49 at 50% = $49.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,179.91,,,,,,,14.1300,557.0000,other,32.3% of $557.00 in Billed Charges for Rev 510 Proc 11900 = $179.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,171.00,,,,,,,14.1300,557.0000,other,30.7% of $557.00 in Billed Charges for Rev 510 Proc 11900 = $171.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,179.91,,,,,,,14.1300,557.0000,percent of total billed charges,32.3% of $557.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,14.1300,557.0000,fee schedule,"APG 00003 Proc 11900 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,14.1300,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,14.1300,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,WELLCARE,WELLCARE MEDICAID,557.00,,,,,,,14.1300,557.0000,percent of total billed charges,100% of $557.00 in Billed Charges for Rev 510 Proc 11900 = $557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ INTRALESIONAL UP TO & INCL 7 LESIONS,11900,CPT,510,RC,51000103,CDM,,,,both,,,557.0000,83.5500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,14.1300,557.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,AETNA,AETNA,908.66,,,,,,,87.8900,2128.0000,percent of total billed charges,"42.7% of $2,128.00 in Billed Charges for Rev 450 Proc 11976 = $908.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,87.8900,2128.0000,fee schedule,"APG 00009 Proc 11976 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,87.8900,2128.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,87.8900,2128.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,87.8900,2128.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,AMBETTER,AMBETTER,1400.59,,,,,,,87.8900,2128.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,87.8900,2128.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,87.8900,2128.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,87.8900,2128.0000,fee schedule,"APG 00009 Proc 11976 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,87.8900,2128.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,87.8900,2128.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1977.02,,,,,,,87.8900,2128.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,133.06,,,,,,,87.8900,2128.0000,fee schedule,$133.06 from Fee Schedule BLDTM_23 for Rev 450 Proc 11976 * Qty 1 = $133.06 at 100% = $133.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,87.8900,2128.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,TENNCARE BLUE CARE,87.89,,,,,,,87.8900,2128.0000,fee schedule,$75.77 from Fee Schedule TC_24 for Rev 450 Proc 11976 * Qty 1 = $75.77 at 116% = $87.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,BLUE CROSS,TENNCARE BLUE SELECT,87.89,,,,,,,87.8900,2128.0000,fee schedule,$75.77 from Fee Schedule TC_24 for Rev 450 Proc 11976 * Qty 1 = $75.77 at 116% = $87.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,87.8900,2128.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,87.8900,2128.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1915.20,,,,,,,87.8900,2128.0000,percent of total billed charges,"90% of $2,128.00 in Billed Charges for Rev 450 Proc 11976 = $1,915.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,HUMANA,HUMANA MEDICARE,642.47,,,,,,,87.8900,2128.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,87.8900,2128.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,MEDCOST,MEDCOST VHN,1012.72,,,,,,,87.8900,2128.0000,percent of total billed charges,"47.59% of $2,128.00 in Billed Charges for Rev 450 Proc 11976 = $1,012.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,87.8900,2128.0000,fee schedule,"APG 00009 Proc 11976 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,87.8900,2128.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,87.8900,2128.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,87.8900,2128.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,87.8900,2128.0000,fee schedule,"APG 00009 Proc 11976 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,SENTARA HEALTH,SENTARA HEALTH,549.24,,,,,,,87.8900,2128.0000,percent of total billed charges,"25.81% of $2,128.00 in Billed Charges for Rev 450 Proc 11976 = $549.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,87.8900,2128.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2128.00,,,,,,,87.8900,2128.0000,percent of total billed charges,"100% of $2,128.00 in Billed Charges for Rev 450 Proc 11976 = $2,128.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,87.8900,2128.0000,case rate,Rev 450 Proc 11976 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,87.8900,2128.0000,case rate,Rev 450 Proc 11976 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,87.8900,2128.0000,case rate,Rev 450 Proc 11976 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,87.8900,2128.0000,case rate,Rev 450 Proc 11976 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,87.8900,2128.0000,fee schedule,"APG 00009 Proc 11976 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,87.8900,2128.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,87.8900,2128.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,WELLCARE,WELLCARE MEDICAID,2128.00,,,,,,,87.8900,2128.0000,percent of total billed charges,"100% of $2,128.00 in Billed Charges for Rev 450 Proc 11976 = $2,128.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMVL IMPL CONTRACEPTIVE CAPSULES,11976,CPT,450,RC,45000355,CDM,,,,both,,,2128.0000,319.2000,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,87.8900,2128.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,AETNA,AETNA,243.39,,,,,,,50.2300,570.0000,percent of total billed charges,42.7% of $570.00 in Billed Charges for Rev 450 Proc 12002 = $243.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,272.07,,,,,,,50.2300,570.0000,fee schedule,"APG 00016 Proc 12002 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 104% = $272.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,50.2300,570.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,50.2300,570.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,50.2300,570.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,AMBETTER,AMBETTER,396.83,,,,,,,50.2300,570.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,50.2300,570.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,50.2300,570.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,269.45,,,,,,,50.2300,570.0000,fee schedule,"APG 00016 Proc 12002 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,50.2300,570.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,50.2300,570.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",560.15,,,,,,,50.2300,570.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,107.43,,,,,,,50.2300,570.0000,fee schedule,$107.43 from Fee Schedule BLDTM_23 for Rev 450 Proc 12002 * Qty 1 = $107.43 at 100% = $107.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,50.2300,570.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,BLUE CROSS,TENNCARE BLUE CARE,50.23,,,,,,,50.2300,570.0000,fee schedule,$43.30 from Fee Schedule TC_24 for Rev 450 Proc 12002 * Qty 1 = $43.30 at 116% = $50.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,BLUE CROSS,TENNCARE BLUE SELECT,50.23,,,,,,,50.2300,570.0000,fee schedule,$43.30 from Fee Schedule TC_24 for Rev 450 Proc 12002 * Qty 1 = $43.30 at 116% = $50.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,50.2300,570.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,50.2300,570.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,513.00,,,,,,,50.2300,570.0000,percent of total billed charges,90% of $570.00 in Billed Charges for Rev 450 Proc 12002 = $513.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,HUMANA,HUMANA MEDICARE,182.03,,,,,,,50.2300,570.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,50.2300,570.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,MEDCOST,MEDCOST VHN,271.26,,,,,,,50.2300,570.0000,percent of total billed charges,47.59% of $570.00 in Billed Charges for Rev 450 Proc 12002 = $271.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,274.68,,,,,,,50.2300,570.0000,fee schedule,"APG 00016 Proc 12002 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 105% = $274.68 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,50.2300,570.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,50.2300,570.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,50.2300,570.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,269.71,,,,,,,50.2300,570.0000,fee schedule,"APG 00016 Proc 12002 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 103.1% = $269.71 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,SENTARA HEALTH,SENTARA HEALTH,147.12,,,,,,,50.2300,570.0000,percent of total billed charges,25.81% of $570.00 in Billed Charges for Rev 450 Proc 12002 = $147.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,50.2300,570.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",570.00,,,,,,,50.2300,570.0000,percent of total billed charges,100% of $570.00 in Billed Charges for Rev 450 Proc 12002 = $570.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,50.2300,570.0000,case rate,Rev 450 Proc 12002 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,50.2300,570.0000,case rate,Rev 450 Proc 12002 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,50.2300,570.0000,case rate,Rev 450 Proc 12002 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,570.00,,,,,,,50.2300,570.0000,case rate,"Rev 450 Proc 12002 at Case Rate $847.00 (Service Line reduced to $570.00, claim capped at $570.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,269.45,,,,,,,50.2300,570.0000,fee schedule,"APG 00016 Proc 12002 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,50.2300,570.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,50.2300,570.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,WELLCARE,WELLCARE MEDICAID,570.00,,,,,,,50.2300,570.0000,percent of total billed charges,100% of $570.00 in Billed Charges for Rev 450 Proc 12002 = $570.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SIMP RPR SCLP TRUNK 2.6-7.5,12002,CPT,450,RC,45000038,CDM,,,,both,,,570.0000,85.5000,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,50.2300,570.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,AETNA,AETNA,353.56,,,,,,,109.0000,828.0000,percent of total billed charges,42.7% of $828.00 in Billed Charges for Rev 450 Proc 12004 = $353.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,272.07,,,,,,,109.0000,828.0000,fee schedule,"APG 00016 Proc 12004 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 104% = $272.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,109.0000,828.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,109.0000,828.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,109.0000,828.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,AMBETTER,AMBETTER,396.83,,,,,,,109.0000,828.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,109.0000,828.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,109.0000,828.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,269.45,,,,,,,109.0000,828.0000,fee schedule,"APG 00016 Proc 12004 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,109.0000,828.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,109.0000,828.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",560.15,,,,,,,109.0000,828.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,138.76,,,,,,,109.0000,828.0000,fee schedule,$138.76 from Fee Schedule BLDTM_23 for Rev 450 Proc 12004 * Qty 1 = $138.76 at 100% = $138.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,109.0000,828.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,109.0000,828.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,109.0000,828.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,745.20,,,,,,,109.0000,828.0000,percent of total billed charges,90% of $828.00 in Billed Charges for Rev 450 Proc 12004 = $745.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,HUMANA,HUMANA MEDICARE,182.03,,,,,,,109.0000,828.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,109.0000,828.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,MEDCOST,MEDCOST VHN,394.05,,,,,,,109.0000,828.0000,percent of total billed charges,47.59% of $828.00 in Billed Charges for Rev 450 Proc 12004 = $394.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,274.68,,,,,,,109.0000,828.0000,fee schedule,"APG 00016 Proc 12004 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 105% = $274.68 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,109.0000,828.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,109.0000,828.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,109.0000,828.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,269.71,,,,,,,109.0000,828.0000,fee schedule,"APG 00016 Proc 12004 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 103.1% = $269.71 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,SENTARA HEALTH,SENTARA HEALTH,213.71,,,,,,,109.0000,828.0000,percent of total billed charges,25.81% of $828.00 in Billed Charges for Rev 450 Proc 12004 = $213.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,109.0000,828.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",828.00,,,,,,,109.0000,828.0000,percent of total billed charges,100% of $828.00 in Billed Charges for Rev 450 Proc 12004 = $828.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,828.0000,case rate,Rev 450 Proc 12004 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,828.0000,case rate,Rev 450 Proc 12004 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,828.0000,case rate,Rev 450 Proc 12004 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,828.00,,,,,,,109.0000,828.0000,case rate,"Rev 450 Proc 12004 at Case Rate $847.00 (Service Line reduced to $828.00, claim capped at $828.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,269.45,,,,,,,109.0000,828.0000,fee schedule,"APG 00016 Proc 12004 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,109.0000,828.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,109.0000,828.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,WELLCARE,WELLCARE MEDICAID,828.00,,,,,,,109.0000,828.0000,percent of total billed charges,100% of $828.00 in Billed Charges for Rev 450 Proc 12004 = $828.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SMP REP SCLP TRUNK 7.6-12.5,12004,CPT,450,RC,45000039,CDM,,,,both,,,828.0000,124.2000,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,109.0000,828.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,AETNA,AETNA,844.18,,,,,,,109.0000,1977.0000,percent of total billed charges,"42.7% of $1,977.00 in Billed Charges for Rev 450 Proc 12005 = $844.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,272.07,,,,,,,109.0000,1977.0000,fee schedule,"APG 00016 Proc 12005 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 104% = $272.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,109.0000,1977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,1977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,109.0000,1977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,AMBETTER,AMBETTER,804.03,,,,,,,109.0000,1977.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,109.0000,1977.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,109.0000,1977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,269.45,,,,,,,109.0000,1977.0000,fee schedule,"APG 00016 Proc 12005 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,109.0000,1977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,109.0000,1977.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1134.94,,,,,,,109.0000,1977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,175.62,,,,,,,109.0000,1977.0000,fee schedule,$175.62 from Fee Schedule BLDTM_23 for Rev 450 Proc 12005 * Qty 1 = $175.62 at 100% = $175.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,109.0000,1977.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,109.0000,1977.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,109.0000,1977.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1779.30,,,,,,,109.0000,1977.0000,percent of total billed charges,"90% of $1,977.00 in Billed Charges for Rev 450 Proc 12005 = $1,779.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,109.0000,1977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,109.0000,1977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,MEDCOST,MEDCOST VHN,940.85,,,,,,,109.0000,1977.0000,percent of total billed charges,"47.59% of $1,977.00 in Billed Charges for Rev 450 Proc 12005 = $940.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,274.68,,,,,,,109.0000,1977.0000,fee schedule,"APG 00016 Proc 12005 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 105% = $274.68 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,109.0000,1977.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,109.0000,1977.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,109.0000,1977.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,269.71,,,,,,,109.0000,1977.0000,fee schedule,"APG 00016 Proc 12005 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 103.1% = $269.71 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,SENTARA HEALTH,SENTARA HEALTH,510.26,,,,,,,109.0000,1977.0000,percent of total billed charges,"25.81% of $1,977.00 in Billed Charges for Rev 450 Proc 12005 = $510.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,109.0000,1977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1977.00,,,,,,,109.0000,1977.0000,percent of total billed charges,"100% of $1,977.00 in Billed Charges for Rev 450 Proc 12005 = $1,977.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1977.0000,case rate,Rev 450 Proc 12005 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1977.0000,case rate,Rev 450 Proc 12005 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1977.0000,case rate,Rev 450 Proc 12005 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1977.0000,case rate,Rev 450 Proc 12005 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,269.45,,,,,,,109.0000,1977.0000,fee schedule,"APG 00016 Proc 12005 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,1977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,109.0000,1977.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,WELLCARE,WELLCARE MEDICAID,1977.00,,,,,,,109.0000,1977.0000,percent of total billed charges,"100% of $1,977.00 in Billed Charges for Rev 450 Proc 12005 = $1,977.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMP REP SCLP TRUNK 12.6-20,12005,CPT,450,RC,45000040,CDM,,,,both,,,1977.0000,296.5500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,109.0000,1977.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,AETNA,AETNA,11332.15,,,,,,,399.5100,26539.0000,percent of total billed charges,"42.7% of $26,539.00 in Billed Charges for Rev 481 Proc 33212 = $11,332.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11330.93,,,,,,,399.5100,26539.0000,fee schedule,"APG 00086 Proc 33212 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 104% = $11,330.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,7508.05,,,,,,,399.5100,26539.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,AETNA,AETNA HEALTHCARE MEDICARE,7508.05,,,,,,,399.5100,26539.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,7508.05,,,,,,,399.5100,26539.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,AMBETTER,AMBETTER,16367.55,,,,,,,399.5100,26539.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,7808.37,,,,,,,399.5100,26539.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,BLUE CROSS,ANTHEM EXCHANGE,18485.22,,,,,,,399.5100,26539.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11221.98,,,,,,,399.5100,26539.0000,fee schedule,"APG 00086 Proc 33212 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,BLUE CROSS,ANTHEM HMO,19639.44,,,,,,,399.5100,26539.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,7733.29,,,,,,,399.5100,26539.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",23103.98,,,,,,,399.5100,26539.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,399.51,,,,,,,399.5100,26539.0000,fee schedule,$399.51 from Fee Schedule BLDTM_23 for Rev 481 Proc 33212 * Qty 1 = $399.51 at 100% = $399.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,399.5100,26539.0000,case rate,"Rev 481 Proc 33212 ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,BLUE CROSS,BLUE CROSS MEDICARE,7808.37,,,,,,,399.5100,26539.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,399.5100,26539.0000,case rate,"Rev 481 Proc 33212 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,399.5100,26539.0000,case rate,"Rev 481 Proc 33212 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,CIGNA HEALTHCARE,CIGNA HMO,11066.76,,,,,,,399.5100,26539.0000,percent of total billed charges,"41.7% of $26,539.00 in Billed Charges for Rev 481 Proc 33212 = $11,066.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12314.10,,,,,,,399.5100,26539.0000,percent of total billed charges,"46.4% of $26,539.00 in Billed Charges for Rev 481 Proc 33212 = $12,314.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,7883.45,,,,,,,399.5100,26539.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11066.76,,,,,,,399.5100,26539.0000,percent of total billed charges,"41.7% of $26,539.00 in Billed Charges for Rev 481 Proc 33212 = $11,066.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,CIGNA HEALTHCARE,CIGNA PPO,11066.76,,,,,,,399.5100,26539.0000,percent of total billed charges,"41.7% of $26,539.00 in Billed Charges for Rev 481 Proc 33212 = $11,066.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,7883.45,,,,,,,399.5100,26539.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,23885.10,,,,,,,399.5100,26539.0000,percent of total billed charges,"90% of $26,539.00 in Billed Charges for Rev 481 Proc 33212 = $23,885.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,HUMANA,HUMANA MEDICARE,7508.05,,,,,,,399.5100,26539.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,7508.05,,,,,,,399.5100,26539.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,MEDCOST,MEDCOST VHN,12629.91,,,,,,,399.5100,26539.0000,percent of total billed charges,"47.59% of $26,539.00 in Billed Charges for Rev 481 Proc 33212 = $12,629.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11439.89,,,,,,,399.5100,26539.0000,fee schedule,"APG 00086 Proc 33212 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 105% = $11,439.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,7883.45,,,,,,,399.5100,26539.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,7883.45,,,,,,,399.5100,26539.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,NHC ADVANTAGE,NHC ADVANTAGE,7883.45,,,,,,,399.5100,26539.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11232.88,,,,,,,399.5100,26539.0000,fee schedule,"APG 00086 Proc 33212 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 103.1% = $11,232.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,SENTARA HEALTH,SENTARA HEALTH,6849.72,,,,,,,399.5100,26539.0000,percent of total billed charges,"25.81% of $26,539.00 in Billed Charges for Rev 481 Proc 33212 = $6,849.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,SENTARA HEALTH,SENTARA MEDICARE,7508.05,,,,,,,399.5100,26539.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",26539.00,,,,,,,399.5100,26539.0000,percent of total billed charges,"100% of $26,539.00 in Billed Charges for Rev 481 Proc 33212 = $26,539.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,399.5100,26539.0000,case rate,"Rev 481 Proc 33212 ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,399.5100,26539.0000,case rate,"Rev 481 Proc 33212 ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,399.5100,26539.0000,case rate,"Rev 481 Proc 33212 ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,20054.00,,,,,,,399.5100,26539.0000,case rate,"Rev 481 Proc 33212 ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11221.98,,,,,,,399.5100,26539.0000,fee schedule,"APG 00086 Proc 33212 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,7508.05,,,,,,,399.5100,26539.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,7508.05,,,,,,,399.5100,26539.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,WELLCARE,WELLCARE MEDICAID,26539.00,,,,,,,399.5100,26539.0000,percent of total billed charges,"100% of $26,539.00 in Billed Charges for Rev 481 Proc 33212 = $26,539.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PM GENER SINGL,33212,CPT,481,RC,48100006,CDM,,,,both,,,26539.0000,3980.8500,WELLCARE,WELLCARE MEDICARE,7958.53,,,,,,,399.5100,26539.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,AETNA,AETNA,5404.54,,,,,,,382.2800,16367.5500,percent of total billed charges,"42.7% of $12,657.00 in Billed Charges for Rev 481 Proc 33216 = $5,404.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2176.64,,,,,,,382.2800,16367.5500,fee schedule,"APG 00074 Proc 33216 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 104% = $2,176.64. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,7508.05,,,,,,,382.2800,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,AETNA,AETNA HEALTHCARE MEDICARE,7508.05,,,,,,,382.2800,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,7508.05,,,,,,,382.2800,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,AMBETTER,AMBETTER,16367.55,,,,,,,382.2800,16367.5500,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,7808.37,,,,,,,382.2800,16367.5500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,ANTHEM EXCHANGE,12657.00,,,,,,,382.2800,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2155.71,,,,,,,382.2800,16367.5500,fee schedule,"APG 00074 Proc 33216 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,ANTHEM HMO,12657.00,,,,,,,382.2800,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,7733.29,,,,,,,382.2800,16367.5500,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",12657.00,,,,,,,382.2800,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,382.28,,,,,,,382.2800,16367.5500,fee schedule,$382.28 from Fee Schedule BLDTM_23 for Rev 481 Proc 33216 * Qty 1 = $382.28 at 100% = $382.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,382.2800,16367.5500,case rate,"Rev 481 Proc 33216 ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,BLUE CROSS MEDICARE,7808.37,,,,,,,382.2800,16367.5500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,382.2800,16367.5500,case rate,"Rev 481 Proc 33216 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,382.2800,16367.5500,case rate,"Rev 481 Proc 33216 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,CIGNA HEALTHCARE,CIGNA HMO,5277.97,,,,,,,382.2800,16367.5500,percent of total billed charges,"41.7% of $12,657.00 in Billed Charges for Rev 481 Proc 33216 = $5,277.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5872.85,,,,,,,382.2800,16367.5500,percent of total billed charges,"46.4% of $12,657.00 in Billed Charges for Rev 481 Proc 33216 = $5,872.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,7883.45,,,,,,,382.2800,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5277.97,,,,,,,382.2800,16367.5500,percent of total billed charges,"41.7% of $12,657.00 in Billed Charges for Rev 481 Proc 33216 = $5,277.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,CIGNA HEALTHCARE,CIGNA PPO,5277.97,,,,,,,382.2800,16367.5500,percent of total billed charges,"41.7% of $12,657.00 in Billed Charges for Rev 481 Proc 33216 = $5,277.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,7883.45,,,,,,,382.2800,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11391.30,,,,,,,382.2800,16367.5500,percent of total billed charges,"90% of $12,657.00 in Billed Charges for Rev 481 Proc 33216 = $11,391.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,HUMANA,HUMANA MEDICARE,7508.05,,,,,,,382.2800,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,7508.05,,,,,,,382.2800,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,MEDCOST,MEDCOST VHN,6023.47,,,,,,,382.2800,16367.5500,percent of total billed charges,"47.59% of $12,657.00 in Billed Charges for Rev 481 Proc 33216 = $6,023.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2197.57,,,,,,,382.2800,16367.5500,fee schedule,"APG 00074 Proc 33216 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 100% = $2,092.92... $2,092.92 at 105% = $2,197.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,7883.45,,,,,,,382.2800,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,7883.45,,,,,,,382.2800,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,NHC ADVANTAGE,NHC ADVANTAGE,7883.45,,,,,,,382.2800,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2157.80,,,,,,,382.2800,16367.5500,fee schedule,"APG 00074 Proc 33216 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 100% = $2,092.92... $2,092.92 at 103.1% = $2,157.80 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,SENTARA HEALTH,SENTARA HEALTH,3266.77,,,,,,,382.2800,16367.5500,percent of total billed charges,"25.81% of $12,657.00 in Billed Charges for Rev 481 Proc 33216 = $3,266.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,SENTARA HEALTH,SENTARA MEDICARE,7508.05,,,,,,,382.2800,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12657.00,,,,,,,382.2800,16367.5500,percent of total billed charges,"100% of $12,657.00 in Billed Charges for Rev 481 Proc 33216 = $12,657.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,382.2800,16367.5500,case rate,"Rev 481 Proc 33216 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,382.2800,16367.5500,case rate,"Rev 481 Proc 33216 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,382.2800,16367.5500,case rate,"Rev 481 Proc 33216 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,382.2800,16367.5500,case rate,"Rev 481 Proc 33216 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2155.71,,,,,,,382.2800,16367.5500,fee schedule,"APG 00074 Proc 33216 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,7508.05,,,,,,,382.2800,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,7508.05,,,,,,,382.2800,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,WELLCARE,WELLCARE MEDICAID,12657.00,,,,,,,382.2800,16367.5500,percent of total billed charges,"100% of $12,657.00 in Billed Charges for Rev 481 Proc 33216 = $12,657.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT SGL TV LEAD PM/ICD,33216,CPT,481,RC,48100010,CDM,,,,both,,,12657.0000,1898.5500,WELLCARE,WELLCARE MEDICARE,7958.53,,,,,,,382.2800,16367.5500,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,AETNA,AETNA,5404.54,,,,,,,400.8600,16367.5500,percent of total billed charges,"42.7% of $12,657.00 in Billed Charges for Rev 481 Proc 33217 = $5,404.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2176.64,,,,,,,400.8600,16367.5500,fee schedule,"APG 00074 Proc 33217 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 104% = $2,176.64. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,7508.05,,,,,,,400.8600,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,AETNA,AETNA HEALTHCARE MEDICARE,7508.05,,,,,,,400.8600,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,7508.05,,,,,,,400.8600,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,AMBETTER,AMBETTER,16367.55,,,,,,,400.8600,16367.5500,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,7808.37,,,,,,,400.8600,16367.5500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,ANTHEM EXCHANGE,12657.00,,,,,,,400.8600,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2155.71,,,,,,,400.8600,16367.5500,fee schedule,"APG 00074 Proc 33217 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,ANTHEM HMO,12657.00,,,,,,,400.8600,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,7733.29,,,,,,,400.8600,16367.5500,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",12657.00,,,,,,,400.8600,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,400.86,,,,,,,400.8600,16367.5500,fee schedule,$400.86 from Fee Schedule BLDTM_23 for Rev 481 Proc 33217 * Qty 1 = $400.86 at 100% = $400.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,400.8600,16367.5500,case rate,"Rev 481 Proc 33217 ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,BLUE CROSS MEDICARE,7808.37,,,,,,,400.8600,16367.5500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,400.8600,16367.5500,case rate,"Rev 481 Proc 33217 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,400.8600,16367.5500,case rate,"Rev 481 Proc 33217 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,CIGNA HEALTHCARE,CIGNA HMO,5277.97,,,,,,,400.8600,16367.5500,percent of total billed charges,"41.7% of $12,657.00 in Billed Charges for Rev 481 Proc 33217 = $5,277.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5872.85,,,,,,,400.8600,16367.5500,percent of total billed charges,"46.4% of $12,657.00 in Billed Charges for Rev 481 Proc 33217 = $5,872.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,7883.45,,,,,,,400.8600,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5277.97,,,,,,,400.8600,16367.5500,percent of total billed charges,"41.7% of $12,657.00 in Billed Charges for Rev 481 Proc 33217 = $5,277.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,CIGNA HEALTHCARE,CIGNA PPO,5277.97,,,,,,,400.8600,16367.5500,percent of total billed charges,"41.7% of $12,657.00 in Billed Charges for Rev 481 Proc 33217 = $5,277.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,7883.45,,,,,,,400.8600,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11391.30,,,,,,,400.8600,16367.5500,percent of total billed charges,"90% of $12,657.00 in Billed Charges for Rev 481 Proc 33217 = $11,391.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,HUMANA,HUMANA MEDICARE,7508.05,,,,,,,400.8600,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,7508.05,,,,,,,400.8600,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,MEDCOST,MEDCOST VHN,6023.47,,,,,,,400.8600,16367.5500,percent of total billed charges,"47.59% of $12,657.00 in Billed Charges for Rev 481 Proc 33217 = $6,023.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2197.57,,,,,,,400.8600,16367.5500,fee schedule,"APG 00074 Proc 33217 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 100% = $2,092.92... $2,092.92 at 105% = $2,197.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,7883.45,,,,,,,400.8600,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,7883.45,,,,,,,400.8600,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,NHC ADVANTAGE,NHC ADVANTAGE,7883.45,,,,,,,400.8600,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2157.80,,,,,,,400.8600,16367.5500,fee schedule,"APG 00074 Proc 33217 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 100% = $2,092.92... $2,092.92 at 103.1% = $2,157.80 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,SENTARA HEALTH,SENTARA HEALTH,3266.77,,,,,,,400.8600,16367.5500,percent of total billed charges,"25.81% of $12,657.00 in Billed Charges for Rev 481 Proc 33217 = $3,266.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,SENTARA HEALTH,SENTARA MEDICARE,7508.05,,,,,,,400.8600,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12657.00,,,,,,,400.8600,16367.5500,percent of total billed charges,"100% of $12,657.00 in Billed Charges for Rev 481 Proc 33217 = $12,657.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,400.8600,16367.5500,case rate,"Rev 481 Proc 33217 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,400.8600,16367.5500,case rate,"Rev 481 Proc 33217 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,400.8600,16367.5500,case rate,"Rev 481 Proc 33217 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,400.8600,16367.5500,case rate,"Rev 481 Proc 33217 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2155.71,,,,,,,400.8600,16367.5500,fee schedule,"APG 00074 Proc 33217 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,7508.05,,,,,,,400.8600,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,7508.05,,,,,,,400.8600,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,WELLCARE,WELLCARE MEDICAID,12657.00,,,,,,,400.8600,16367.5500,percent of total billed charges,"100% of $12,657.00 in Billed Charges for Rev 481 Proc 33217 = $12,657.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT DUAL TV LEADS PM/ICD,33217,CPT,481,RC,48100011,CDM,,,,both,,,12657.0000,1898.5500,WELLCARE,WELLCARE MEDICARE,7958.53,,,,,,,400.8600,16367.5500,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,AETNA,AETNA,7062.58,,,,,,,376.8100,16540.0000,percent of total billed charges,"42.7% of $16,540.00 in Billed Charges for Rev 481 Proc 33220 = $7,062.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2176.64,,,,,,,376.8100,16540.0000,fee schedule,"APG 00074 Proc 33220 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 104% = $2,176.64. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3390.45,,,,,,,376.8100,16540.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,AETNA,AETNA HEALTHCARE MEDICARE,3390.45,,,,,,,376.8100,16540.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,ALLCARE MEDICARE,ALLCARE MEDICARE,3390.45,,,,,,,376.8100,16540.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,AMBETTER,AMBETTER,7391.18,,,,,,,376.8100,16540.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3526.07,,,,,,,376.8100,16540.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,BLUE CROSS,ANTHEM EXCHANGE,8347.47,,,,,,,376.8100,16540.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2155.71,,,,,,,376.8100,16540.0000,fee schedule,"APG 00074 Proc 33220 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,BLUE CROSS,ANTHEM HMO,8868.69,,,,,,,376.8100,16540.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3492.16,,,,,,,376.8100,16540.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",10433.19,,,,,,,376.8100,16540.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,376.81,,,,,,,376.8100,16540.0000,fee schedule,$376.81 from Fee Schedule BLDTM_23 for Rev 481 Proc 33220 * Qty 1 = $376.81 at 100% = $376.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,376.8100,16540.0000,case rate,"Rev 481 Proc 33220 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,BLUE CROSS,BLUE CROSS MEDICARE,3526.07,,,,,,,376.8100,16540.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,376.8100,16540.0000,case rate,"Rev 481 Proc 33220 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,376.8100,16540.0000,case rate,"Rev 481 Proc 33220 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,CIGNA HEALTHCARE,CIGNA HMO,6897.18,,,,,,,376.8100,16540.0000,percent of total billed charges,"41.7% of $16,540.00 in Billed Charges for Rev 481 Proc 33220 = $6,897.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7674.56,,,,,,,376.8100,16540.0000,percent of total billed charges,"46.4% of $16,540.00 in Billed Charges for Rev 481 Proc 33220 = $7,674.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,CIGNA HEALTHCARE,CIGNA MEDICARE,3559.97,,,,,,,376.8100,16540.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6897.18,,,,,,,376.8100,16540.0000,percent of total billed charges,"41.7% of $16,540.00 in Billed Charges for Rev 481 Proc 33220 = $6,897.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,CIGNA HEALTHCARE,CIGNA PPO,6897.18,,,,,,,376.8100,16540.0000,percent of total billed charges,"41.7% of $16,540.00 in Billed Charges for Rev 481 Proc 33220 = $6,897.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3559.97,,,,,,,376.8100,16540.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,14886.00,,,,,,,376.8100,16540.0000,percent of total billed charges,"90% of $16,540.00 in Billed Charges for Rev 481 Proc 33220 = $14,886.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,HUMANA,HUMANA MEDICARE,3390.45,,,,,,,376.8100,16540.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3390.45,,,,,,,376.8100,16540.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,MEDCOST,MEDCOST VHN,7871.39,,,,,,,376.8100,16540.0000,percent of total billed charges,"47.59% of $16,540.00 in Billed Charges for Rev 481 Proc 33220 = $7,871.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2197.57,,,,,,,376.8100,16540.0000,fee schedule,"APG 00074 Proc 33220 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 105% = $2,197.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3559.97,,,,,,,376.8100,16540.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3559.97,,,,,,,376.8100,16540.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,NHC ADVANTAGE,NHC ADVANTAGE,3559.97,,,,,,,376.8100,16540.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2157.80,,,,,,,376.8100,16540.0000,fee schedule,"APG 00074 Proc 33220 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 103.1% = $2,157.80 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,SENTARA HEALTH,SENTARA HEALTH,4268.97,,,,,,,376.8100,16540.0000,percent of total billed charges,"25.81% of $16,540.00 in Billed Charges for Rev 481 Proc 33220 = $4,268.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,SENTARA HEALTH,SENTARA MEDICARE,3390.45,,,,,,,376.8100,16540.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",16540.00,,,,,,,376.8100,16540.0000,percent of total billed charges,"100% of $16,540.00 in Billed Charges for Rev 481 Proc 33220 = $16,540.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,376.8100,16540.0000,case rate,"Rev 481 Proc 33220 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,376.8100,16540.0000,case rate,"Rev 481 Proc 33220 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,376.8100,16540.0000,case rate,"Rev 481 Proc 33220 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,376.8100,16540.0000,case rate,"Rev 481 Proc 33220 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2155.71,,,,,,,376.8100,16540.0000,fee schedule,"APG 00074 Proc 33220 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3390.45,,,,,,,376.8100,16540.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3390.45,,,,,,,376.8100,16540.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,WELLCARE,WELLCARE MEDICAID,16540.00,,,,,,,376.8100,16540.0000,percent of total billed charges,"100% of $16,540.00 in Billed Charges for Rev 481 Proc 33220 = $16,540.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR DUAL TV LEADS PM/ICD,33220,CPT,481,RC,48100013,CDM,,,,both,,,16540.0000,2481.0000,WELLCARE,WELLCARE MEDICARE,3593.87,,,,,,,376.8100,16540.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE MANAGER NANOPASS REACH 45 DEG CRESCENT,272,RC,,,,,,,,both,,,3180.5800,477.0900,AETNA,AETNA,1358.11,,,,,,,820.9100,3180.5800,percent of total billed charges,"42.7% of $3,180.58 in Billed Charges for Rev 272 = $1,358.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE MANAGER NANOPASS REACH 45 DEG CRESCENT,272,RC,,,,,,,,both,,,3180.5800,477.0900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2226.41,,,,,,,820.9100,3180.5800,percent of total billed charges,"Rev 272 $3,180.58 in Billed Charges at 70% = $2,226.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE MANAGER NANOPASS REACH 45 DEG CRESCENT,272,RC,,,,,,,,both,,,3180.5800,477.0900,CIGNA HEALTHCARE,CIGNA HMO,1326.30,,,,,,,820.9100,3180.5800,percent of total billed charges,"41.7% of $3,180.58 in Billed Charges for Rev 272 = $1,326.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE MANAGER NANOPASS REACH 45 DEG CRESCENT,272,RC,,,,,,,,both,,,3180.5800,477.0900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1475.79,,,,,,,820.9100,3180.5800,percent of total billed charges,"46.4% of $3,180.58 in Billed Charges for Rev 272 = $1,475.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE MANAGER NANOPASS REACH 45 DEG CRESCENT,272,RC,,,,,,,,both,,,3180.5800,477.0900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1326.30,,,,,,,820.9100,3180.5800,percent of total billed charges,"41.7% of $3,180.58 in Billed Charges for Rev 272 = $1,326.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE MANAGER NANOPASS REACH 45 DEG CRESCENT,272,RC,,,,,,,,both,,,3180.5800,477.0900,CIGNA HEALTHCARE,CIGNA PPO,1326.30,,,,,,,820.9100,3180.5800,percent of total billed charges,"41.7% of $3,180.58 in Billed Charges for Rev 272 = $1,326.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE MANAGER NANOPASS REACH 45 DEG CRESCENT,272,RC,,,,,,,,both,,,3180.5800,477.0900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2862.52,,,,,,,820.9100,3180.5800,percent of total billed charges,"90% of $3,180.58 in Billed Charges for Rev 272 = $2,862.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE MANAGER NANOPASS REACH 45 DEG CRESCENT,272,RC,,,,,,,,both,,,3180.5800,477.0900,MEDCOST,MEDCOST VHN,1513.64,,,,,,,820.9100,3180.5800,percent of total billed charges,"47.59% of $3,180.58 in Billed Charges for Rev 272 = $1,513.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE MANAGER NANOPASS REACH 45 DEG CRESCENT,272,RC,,,,,,,,both,,,3180.5800,477.0900,SENTARA HEALTH,SENTARA HEALTH,820.91,,,,,,,820.9100,3180.5800,percent of total billed charges,"25.81% of $3,180.58 in Billed Charges for Rev 272 = $820.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE MANAGER NANOPASS REACH 45 DEG CRESCENT,272,RC,,,,,,,,both,,,3180.5800,477.0900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3180.58,,,,,,,820.9100,3180.5800,percent of total billed charges,"100% of $3,180.58 in Billed Charges for Rev 272 = $3,180.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE MANAGER NANOPASS REACH 45 DEG CRESCENT,272,RC,,,,,,,,both,,,3180.5800,477.0900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1590.29,,,,,,,820.9100,3180.5800,percent of total billed charges,"Rev 272 $3,180.58 in Billed Charges at 50% = $1,590.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE MANAGER NANOPASS REACH 45 DEG CRESCENT,272,RC,,,,,,,,both,,,3180.5800,477.0900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1027.33,,,,,,,820.9100,3180.5800,other,"32.3% of $3,180.58 in Billed Charges for Rev 272 = $1,027.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE MANAGER NANOPASS REACH 45 DEG CRESCENT,272,RC,,,,,,,,both,,,3180.5800,477.0900,UNITED HEALTHCARE,UHC HERITAGE SELECT,976.44,,,,,,,820.9100,3180.5800,other,"30.7% of $3,180.58 in Billed Charges for Rev 272 = $976.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE MANAGER NANOPASS REACH 45 DEG CRESCENT,272,RC,,,,,,,,both,,,3180.5800,477.0900,UNITED HEALTHCARE,UNITED HEALTHCARE,1027.33,,,,,,,820.9100,3180.5800,percent of total billed charges,"32.3% of $3,180.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE MANAGER NANOPASS REACH 45 DEG CRESCENT,272,RC,,,,,,,,both,,,3180.5800,477.0900,WELLCARE,WELLCARE MEDICAID,3180.58,,,,,,,820.9100,3180.5800,percent of total billed charges,"100% of $3,180.58 in Billed Charges for Rev 272 = $3,180.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,AETNA,AETNA,880.90,,,,,,,109.0000,2063.0000,percent of total billed charges,"42.7% of $2,063.00 in Billed Charges for Rev 450 Proc 12007 = $880.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,272.07,,,,,,,109.0000,2063.0000,fee schedule,"APG 00016 Proc 12007 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 104% = $272.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,109.0000,2063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,109.0000,2063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,109.0000,2063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,AMBETTER,AMBETTER,396.83,,,,,,,109.0000,2063.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,109.0000,2063.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,109.0000,2063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,269.45,,,,,,,109.0000,2063.0000,fee schedule,"APG 00016 Proc 12007 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,109.0000,2063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,109.0000,2063.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",560.15,,,,,,,109.0000,2063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,245.14,,,,,,,109.0000,2063.0000,fee schedule,$245.14 from Fee Schedule BLDTM_23 for Rev 450 Proc 12007 * Qty 1 = $245.14 at 100% = $245.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,109.0000,2063.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,109.0000,2063.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,109.0000,2063.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1856.70,,,,,,,109.0000,2063.0000,percent of total billed charges,"90% of $2,063.00 in Billed Charges for Rev 450 Proc 12007 = $1,856.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,109.0000,2063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,109.0000,2063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,MEDCOST,MEDCOST VHN,981.78,,,,,,,109.0000,2063.0000,percent of total billed charges,"47.59% of $2,063.00 in Billed Charges for Rev 450 Proc 12007 = $981.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,274.68,,,,,,,109.0000,2063.0000,fee schedule,"APG 00016 Proc 12007 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 105% = $274.68 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,109.0000,2063.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,109.0000,2063.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,109.0000,2063.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,269.71,,,,,,,109.0000,2063.0000,fee schedule,"APG 00016 Proc 12007 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 103.1% = $269.71 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,SENTARA HEALTH,SENTARA HEALTH,532.46,,,,,,,109.0000,2063.0000,percent of total billed charges,"25.81% of $2,063.00 in Billed Charges for Rev 450 Proc 12007 = $532.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,109.0000,2063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2063.00,,,,,,,109.0000,2063.0000,percent of total billed charges,"100% of $2,063.00 in Billed Charges for Rev 450 Proc 12007 = $2,063.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,2063.0000,case rate,Rev 450 Proc 12007 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,2063.0000,case rate,Rev 450 Proc 12007 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,2063.0000,case rate,Rev 450 Proc 12007 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,2063.0000,case rate,Rev 450 Proc 12007 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,269.45,,,,,,,109.0000,2063.0000,fee schedule,"APG 00016 Proc 12007 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,109.0000,2063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,109.0000,2063.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,WELLCARE,WELLCARE MEDICAID,2063.00,,,,,,,109.0000,2063.0000,percent of total billed charges,"100% of $2,063.00 in Billed Charges for Rev 450 Proc 12007 = $2,063.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SMP REP SCLP TRUNK OVER 30CM,12007,CPT,450,RC,45000042,CDM,,,,both,,,2063.0000,309.4500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,109.0000,2063.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,AETNA,AETNA,757.07,,,,,,,79.5300,3068.8100,percent of total billed charges,"42.7% of $1,773.00 in Billed Charges for Rev 521 Proc 20500 = $757.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2036.73,,,,,,,79.5300,3068.8100,fee schedule,"APG 00252 Proc 20500 at $836.60 (Base Rate) * 2.3409 (Relative Weight) = $1,958.40 (Total Line Payment) at 104% = $2,036.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1407.71,,,,,,,79.5300,3068.8100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,AETNA,AETNA HEALTHCARE MEDICARE,1407.71,,,,,,,79.5300,3068.8100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,1407.71,,,,,,,79.5300,3068.8100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,AMBETTER,AMBETTER,3068.81,,,,,,,79.5300,3068.8100,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1464.02,,,,,,,79.5300,3068.8100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,BLUE CROSS,ANTHEM EXCHANGE,1773.00,,,,,,,79.5300,3068.8100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1773.00,,,,,,,79.5300,3068.8100,fee schedule,"APG 00252 Proc 20500 at $836.60 (Base Rate) * 2.3409 (Relative Weight) = $1,958.40 (Total Line Payment) at 103% = $2,017.15 (Service Line reduced to $1,773.00, claim capped at $1,773.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,BLUE CROSS,ANTHEM HMO,1773.00,,,,,,,79.5300,3068.8100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1449.94,,,,,,,79.5300,3068.8100,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1773.00,,,,,,,79.5300,3068.8100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,79.53,,,,,,,79.5300,3068.8100,fee schedule,$79.53 from Fee Schedule BLDTM_23 for Rev 521 Proc 20500 * Qty 1 = $79.53 at 100% = $79.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,BLUE CROSS,BLUE CROSS MEDICARE,1464.02,,,,,,,79.5300,3068.8100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,CIGNA HEALTHCARE,CIGNA HMO,739.34,,,,,,,79.5300,3068.8100,percent of total billed charges,"41.7% of $1,773.00 in Billed Charges for Rev 521 Proc 20500 = $739.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,822.67,,,,,,,79.5300,3068.8100,percent of total billed charges,"46.4% of $1,773.00 in Billed Charges for Rev 521 Proc 20500 = $822.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,1478.10,,,,,,,79.5300,3068.8100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,739.34,,,,,,,79.5300,3068.8100,percent of total billed charges,"41.7% of $1,773.00 in Billed Charges for Rev 521 Proc 20500 = $739.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,CIGNA HEALTHCARE,CIGNA PPO,739.34,,,,,,,79.5300,3068.8100,percent of total billed charges,"41.7% of $1,773.00 in Billed Charges for Rev 521 Proc 20500 = $739.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1478.10,,,,,,,79.5300,3068.8100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1595.70,,,,,,,79.5300,3068.8100,percent of total billed charges,"90% of $1,773.00 in Billed Charges for Rev 521 Proc 20500 = $1,595.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,HUMANA,HUMANA MEDICARE,1407.71,,,,,,,79.5300,3068.8100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1407.71,,,,,,,79.5300,3068.8100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,MEDCOST,MEDCOST VHN,843.77,,,,,,,79.5300,3068.8100,percent of total billed charges,"47.59% of $1,773.00 in Billed Charges for Rev 521 Proc 20500 = $843.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2056.32,,,,,,,79.5300,3068.8100,fee schedule,"APG 00252 Proc 20500 at $836.60 (Base Rate) * 2.3409 (Relative Weight) = $1,958.40 (Total Line Payment) at 100% = $1,958.40... $1,958.40 at 105% = $2,056.32 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1478.10,,,,,,,79.5300,3068.8100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1478.10,,,,,,,79.5300,3068.8100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,NHC ADVANTAGE,NHC ADVANTAGE,1478.10,,,,,,,79.5300,3068.8100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2019.11,,,,,,,79.5300,3068.8100,fee schedule,"APG 00252 Proc 20500 at $836.60 (Base Rate) * 2.3409 (Relative Weight) = $1,958.40 (Total Line Payment) at 100% = $1,958.40... $1,958.40 at 103.1% = $2,019.11 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,SENTARA HEALTH,SENTARA HEALTH,457.61,,,,,,,79.5300,3068.8100,percent of total billed charges,"25.81% of $1,773.00 in Billed Charges for Rev 521 Proc 20500 = $457.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,SENTARA HEALTH,SENTARA MEDICARE,1407.71,,,,,,,79.5300,3068.8100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1773.00,,,,,,,79.5300,3068.8100,percent of total billed charges,"100% of $1,773.00 in Billed Charges for Rev 521 Proc 20500 = $1,773.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,323.33,,,,,,,79.5300,3068.8100,fee schedule,$646.66 from Fee Schedule TCUHC24 for Rev 521 Proc 20500 * Qty 1 = $646.66 at 50% = $323.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2017.15,,,,,,,79.5300,3068.8100,fee schedule,"APG 00252 Proc 20500 at $836.60 (Base Rate) * 2.3409 (Relative Weight) = $1,958.40 (Total Line Payment) at 103% = $2,017.15. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1407.71,,,,,,,79.5300,3068.8100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1407.71,,,,,,,79.5300,3068.8100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,WELLCARE,WELLCARE MEDICAID,1773.00,,,,,,,79.5300,3068.8100,percent of total billed charges,"100% of $1,773.00 in Billed Charges for Rev 521 Proc 20500 = $1,773.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ SINUS TRACT TX,20500,CPT,521,RC,52100085,CDM,,,,both,,,1773.0000,265.9500,WELLCARE,WELLCARE MEDICARE,1492.17,,,,,,,79.5300,3068.8100,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA,603.35,,,,,,,48.6500,3266.6300,percent of total billed charges,"42.7% of $1,413.00 in Billed Charges for Rev 450 Proc 20520 = $603.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2612.63,,,,,,,48.6500,3266.6300,fee schedule,"APG 00051 Proc 20520 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 104% = $2,612.63. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1413.00,,,,,,,48.6500,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA HEALTHCARE MEDICARE,1413.00,,,,,,,48.6500,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,1413.00,,,,,,,48.6500,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,AMBETTER,AMBETTER,3266.63,,,,,,,48.6500,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1413.00,,,,,,,48.6500,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM EXCHANGE,1413.00,,,,,,,48.6500,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1413.00,,,,,,,48.6500,3266.6300,fee schedule,"APG 00051 Proc 20520 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51 (Service Line reduced to $1,413.00, claim capped at $1,413.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HMO,1413.00,,,,,,,48.6500,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1413.00,,,,,,,48.6500,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1413.00,,,,,,,48.6500,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,108.81,,,,,,,48.6500,3266.6300,fee schedule,$108.81 from Fee Schedule BLDTM_23 for Rev 450 Proc 20520 * Qty 1 = $108.81 at 100% = $108.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,48.6500,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,TENNCARE BLUE CARE,48.65,,,,,,,48.6500,3266.6300,fee schedule,$41.94 from Fee Schedule TC_24 for Rev 450 Proc 20520 * Qty 1 = $41.94 at 116% = $48.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,TENNCARE BLUE SELECT,48.65,,,,,,,48.6500,3266.6300,fee schedule,$41.94 from Fee Schedule TC_24 for Rev 450 Proc 20520 * Qty 1 = $41.94 at 116% = $48.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,1413.00,,,,,,,48.6500,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1413.00,,,,,,,48.6500,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1271.70,,,,,,,48.6500,3266.6300,percent of total billed charges,"90% of $1,413.00 in Billed Charges for Rev 450 Proc 20520 = $1,271.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,HUMANA,HUMANA MEDICARE,1413.00,,,,,,,48.6500,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1413.00,,,,,,,48.6500,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,MEDCOST,MEDCOST VHN,672.45,,,,,,,48.6500,3266.6300,percent of total billed charges,"47.59% of $1,413.00 in Billed Charges for Rev 450 Proc 20520 = $672.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2637.75,,,,,,,48.6500,3266.6300,fee schedule,"APG 00051 Proc 20520 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 105% = $2,637.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1413.00,,,,,,,48.6500,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1413.00,,,,,,,48.6500,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,NHC ADVANTAGE,NHC ADVANTAGE,1413.00,,,,,,,48.6500,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2590.02,,,,,,,48.6500,3266.6300,fee schedule,"APG 00051 Proc 20520 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 103.1% = $2,590.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA HEALTH,364.70,,,,,,,48.6500,3266.6300,percent of total billed charges,"25.81% of $1,413.00 in Billed Charges for Rev 450 Proc 20520 = $364.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA MEDICARE,1413.00,,,,,,,48.6500,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1413.00,,,,,,,48.6500,3266.6300,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 20520 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,48.6500,3266.6300,case rate,Rev 450 Proc 20520 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,48.6500,3266.6300,case rate,Rev 450 Proc 20520 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,48.6500,3266.6300,case rate,Rev 450 Proc 20520 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,48.6500,3266.6300,case rate,Rev 450 Proc 20520 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2587.51,,,,,,,48.6500,3266.6300,fee schedule,"APG 00051 Proc 20520 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1413.00,,,,,,,48.6500,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1413.00,,,,,,,48.6500,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICAID,1413.00,,,,,,,48.6500,3266.6300,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 20520 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMVE FB MUSC TENDON SH SIMPLE,20520,CPT,450,RC,45000086,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,48.6500,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,AETNA,AETNA,2310.50,,,,,,,109.0000,5745.1200,percent of total billed charges,"42.7% of $5,411.00 in Billed Charges for Rev 450 Proc 20525 = $2,310.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2612.63,,,,,,,109.0000,5745.1200,fee schedule,"APG 00051 Proc 20525 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 104% = $2,612.63. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2635.37,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,AETNA,AETNA HEALTHCARE MEDICARE,2635.37,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,2635.37,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,AMBETTER,AMBETTER,5745.12,,,,,,,109.0000,5745.1200,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2740.79,,,,,,,109.0000,5745.1200,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,BLUE CROSS,ANTHEM EXCHANGE,5411.00,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2587.51,,,,,,,109.0000,5745.1200,fee schedule,"APG 00051 Proc 20525 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,BLUE CROSS,ANTHEM HMO,5411.00,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2714.44,,,,,,,109.0000,5745.1200,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5411.00,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,220.05,,,,,,,109.0000,5745.1200,fee schedule,$220.05 from Fee Schedule BLDTM_23 for Rev 450 Proc 20525 * Qty 1 = $220.05 at 100% = $220.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,BLUE CROSS,BLUE CROSS MEDICARE,2740.79,,,,,,,109.0000,5745.1200,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,2767.14,,,,,,,109.0000,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,2767.14,,,,,,,109.0000,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4869.90,,,,,,,109.0000,5745.1200,percent of total billed charges,"90% of $5,411.00 in Billed Charges for Rev 450 Proc 20525 = $4,869.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,HUMANA,HUMANA MEDICARE,2635.37,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2635.37,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,MEDCOST,MEDCOST VHN,2575.09,,,,,,,109.0000,5745.1200,percent of total billed charges,"47.59% of $5,411.00 in Billed Charges for Rev 450 Proc 20525 = $2,575.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2637.75,,,,,,,109.0000,5745.1200,fee schedule,"APG 00051 Proc 20525 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 105% = $2,637.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,2767.14,,,,,,,109.0000,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,2767.14,,,,,,,109.0000,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,NHC ADVANTAGE,NHC ADVANTAGE,2767.14,,,,,,,109.0000,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2590.02,,,,,,,109.0000,5745.1200,fee schedule,"APG 00051 Proc 20525 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 103.1% = $2,590.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,SENTARA HEALTH,SENTARA HEALTH,1396.58,,,,,,,109.0000,5745.1200,percent of total billed charges,"25.81% of $5,411.00 in Billed Charges for Rev 450 Proc 20525 = $1,396.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,SENTARA HEALTH,SENTARA MEDICARE,2635.37,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5411.00,,,,,,,109.0000,5745.1200,percent of total billed charges,"100% of $5,411.00 in Billed Charges for Rev 450 Proc 20525 = $5,411.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,5745.1200,case rate,Rev 450 Proc 20525 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,5745.1200,case rate,Rev 450 Proc 20525 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,5745.1200,case rate,Rev 450 Proc 20525 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,5745.1200,case rate,Rev 450 Proc 20525 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2587.51,,,,,,,109.0000,5745.1200,fee schedule,"APG 00051 Proc 20525 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2635.37,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2635.37,,,,,,,109.0000,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,WELLCARE,WELLCARE MEDICAID,5411.00,,,,,,,109.0000,5745.1200,percent of total billed charges,"100% of $5,411.00 in Billed Charges for Rev 450 Proc 20525 = $5,411.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE FB MUSCLE TENDON DEEP OR COMPLICATED,20525,CPT,450,RC,45000331,CDM,,,,both,,,5411.0000,811.6500,WELLCARE,WELLCARE MEDICARE,2793.50,,,,,,,109.0000,5745.1200,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,AETNA,AETNA,161.83,,,,,,,56.9100,607.1100,percent of total billed charges,42.7% of $379.00 in Billed Charges for Rev 510 Proc 20526 = $161.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,354.99,,,,,,,56.9100,607.1100,fee schedule,"APG 00049 Proc 20526 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 104% = $354.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,278.49,,,,,,,56.9100,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,AETNA,AETNA HEALTHCARE MEDICARE,278.49,,,,,,,56.9100,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,278.49,,,,,,,56.9100,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,AMBETTER,AMBETTER,607.11,,,,,,,56.9100,607.1100,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,289.63,,,,,,,56.9100,607.1100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,ANTHEM EXCHANGE,379.00,,,,,,,56.9100,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,351.57,,,,,,,56.9100,607.1100,fee schedule,"APG 00049 Proc 20526 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 103% = $351.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,ANTHEM HMO,379.00,,,,,,,56.9100,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,286.84,,,,,,,56.9100,607.1100,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",379.00,,,,,,,56.9100,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,56.91,,,,,,,56.9100,607.1100,fee schedule,$56.91 from Fee Schedule BLDTM_23 for Rev 510 Proc 20526 * Qty 1 = $56.91 at 100% = $56.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,BLUE CROSS MEDICARE,289.63,,,,,,,56.9100,607.1100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,CIGNA HEALTHCARE,CIGNA HMO,158.04,,,,,,,56.9100,607.1100,percent of total billed charges,41.7% of $379.00 in Billed Charges for Rev 510 Proc 20526 = $158.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.86,,,,,,,56.9100,607.1100,percent of total billed charges,46.4% of $379.00 in Billed Charges for Rev 510 Proc 20526 = $175.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,292.41,,,,,,,56.9100,607.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,158.04,,,,,,,56.9100,607.1100,percent of total billed charges,41.7% of $379.00 in Billed Charges for Rev 510 Proc 20526 = $158.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,CIGNA HEALTHCARE,CIGNA PPO,158.04,,,,,,,56.9100,607.1100,percent of total billed charges,41.7% of $379.00 in Billed Charges for Rev 510 Proc 20526 = $158.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,292.41,,,,,,,56.9100,607.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,341.10,,,,,,,56.9100,607.1100,percent of total billed charges,90% of $379.00 in Billed Charges for Rev 510 Proc 20526 = $341.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,HUMANA,HUMANA MEDICARE,278.49,,,,,,,56.9100,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,278.49,,,,,,,56.9100,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,MEDCOST,MEDCOST VHN,180.37,,,,,,,56.9100,607.1100,percent of total billed charges,47.59% of $379.00 in Billed Charges for Rev 510 Proc 20526 = $180.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,358.40,,,,,,,56.9100,607.1100,fee schedule,"APG 00049 Proc 20526 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 100% = $341.33... $341.33 at 105% = $358.40 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,292.41,,,,,,,56.9100,607.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,292.41,,,,,,,56.9100,607.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,NHC ADVANTAGE,NHC ADVANTAGE,292.41,,,,,,,56.9100,607.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,351.91,,,,,,,56.9100,607.1100,fee schedule,"APG 00049 Proc 20526 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 100% = $341.33... $341.33 at 103.1% = $351.91 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,SENTARA HEALTH,SENTARA HEALTH,97.82,,,,,,,56.9100,607.1100,percent of total billed charges,25.81% of $379.00 in Billed Charges for Rev 510 Proc 20526 = $97.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,SENTARA HEALTH,SENTARA MEDICARE,278.49,,,,,,,56.9100,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",379.00,,,,,,,56.9100,607.1100,percent of total billed charges,100% of $379.00 in Billed Charges for Rev 510 Proc 20526 = $379.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,105.61,,,,,,,56.9100,607.1100,fee schedule,$211.21 from Fee Schedule TCUHC24 for Rev 510 Proc 20526 * Qty 1 = $211.21 at 50% = $105.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,122.42,,,,,,,56.9100,607.1100,other,32.3% of $379.00 in Billed Charges for Rev 510 Proc 20526 = $122.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,116.35,,,,,,,56.9100,607.1100,other,30.7% of $379.00 in Billed Charges for Rev 510 Proc 20526 = $116.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,122.42,,,,,,,56.9100,607.1100,percent of total billed charges,32.3% of $379.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,351.57,,,,,,,56.9100,607.1100,fee schedule,"APG 00049 Proc 20526 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 103% = $351.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,278.49,,,,,,,56.9100,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,278.49,,,,,,,56.9100,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,WELLCARE,WELLCARE MEDICAID,379.00,,,,,,,56.9100,607.1100,percent of total billed charges,100% of $379.00 in Billed Charges for Rev 510 Proc 20526 = $379.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJECT CARPAL TUNNEL,20526,CPT,510,RC,51000024,CDM,,,,both,,,379.0000,56.8500,WELLCARE,WELLCARE MEDICARE,295.20,,,,,,,56.9100,607.1100,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,AETNA,AETNA,359.11,,,,,,,105.6100,841.0000,percent of total billed charges,42.7% of $841.00 in Billed Charges for Rev 521 Proc 20527 = $359.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,354.99,,,,,,,105.6100,841.0000,fee schedule,"APG 00049 Proc 20527 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 104% = $354.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,278.49,,,,,,,105.6100,841.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,AETNA,AETNA HEALTHCARE MEDICARE,278.49,,,,,,,105.6100,841.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,278.49,,,,,,,105.6100,841.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,AMBETTER,AMBETTER,607.11,,,,,,,105.6100,841.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,289.63,,,,,,,105.6100,841.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,BLUE CROSS,ANTHEM EXCHANGE,685.65,,,,,,,105.6100,841.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,351.57,,,,,,,105.6100,841.0000,fee schedule,"APG 00049 Proc 20527 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 103% = $351.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,BLUE CROSS,ANTHEM HMO,728.47,,,,,,,105.6100,841.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,286.84,,,,,,,105.6100,841.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",841.00,,,,,,,105.6100,841.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,588.70,,,,,,,105.6100,841.0000,percent of total billed charges,Rev 521 Proc 20527 $841.00 in Billed Charges at 70% = $588.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,BLUE CROSS,BLUE CROSS MEDICARE,289.63,,,,,,,105.6100,841.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,CIGNA HEALTHCARE,CIGNA HMO,350.70,,,,,,,105.6100,841.0000,percent of total billed charges,41.7% of $841.00 in Billed Charges for Rev 521 Proc 20527 = $350.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,390.22,,,,,,,105.6100,841.0000,percent of total billed charges,46.4% of $841.00 in Billed Charges for Rev 521 Proc 20527 = $390.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,292.41,,,,,,,105.6100,841.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,350.70,,,,,,,105.6100,841.0000,percent of total billed charges,41.7% of $841.00 in Billed Charges for Rev 521 Proc 20527 = $350.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,CIGNA HEALTHCARE,CIGNA PPO,350.70,,,,,,,105.6100,841.0000,percent of total billed charges,41.7% of $841.00 in Billed Charges for Rev 521 Proc 20527 = $350.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,292.41,,,,,,,105.6100,841.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,756.90,,,,,,,105.6100,841.0000,percent of total billed charges,90% of $841.00 in Billed Charges for Rev 521 Proc 20527 = $756.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,HUMANA,HUMANA MEDICARE,278.49,,,,,,,105.6100,841.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,278.49,,,,,,,105.6100,841.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,MEDCOST,MEDCOST VHN,400.23,,,,,,,105.6100,841.0000,percent of total billed charges,47.59% of $841.00 in Billed Charges for Rev 521 Proc 20527 = $400.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,358.40,,,,,,,105.6100,841.0000,fee schedule,"APG 00049 Proc 20527 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 100% = $341.33... $341.33 at 105% = $358.40 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,292.41,,,,,,,105.6100,841.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,292.41,,,,,,,105.6100,841.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,NHC ADVANTAGE,NHC ADVANTAGE,292.41,,,,,,,105.6100,841.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,351.91,,,,,,,105.6100,841.0000,fee schedule,"APG 00049 Proc 20527 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 100% = $341.33... $341.33 at 103.1% = $351.91 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,SENTARA HEALTH,SENTARA HEALTH,217.06,,,,,,,105.6100,841.0000,percent of total billed charges,25.81% of $841.00 in Billed Charges for Rev 521 Proc 20527 = $217.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,SENTARA HEALTH,SENTARA MEDICARE,278.49,,,,,,,105.6100,841.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",841.00,,,,,,,105.6100,841.0000,percent of total billed charges,100% of $841.00 in Billed Charges for Rev 521 Proc 20527 = $841.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,105.61,,,,,,,105.6100,841.0000,fee schedule,$211.21 from Fee Schedule TCUHC24 for Rev 521 Proc 20527 * Qty 1 = $211.21 at 50% = $105.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,351.57,,,,,,,105.6100,841.0000,fee schedule,"APG 00049 Proc 20527 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 103% = $351.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,278.49,,,,,,,105.6100,841.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,278.49,,,,,,,105.6100,841.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,WELLCARE,WELLCARE MEDICAID,841.00,,,,,,,105.6100,841.0000,percent of total billed charges,100% of $841.00 in Billed Charges for Rev 521 Proc 20527 = $841.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ ENZYME PALMAR FASCIAL CORD,20527,CPT,521,RC,52100086,CDM,,,,both,,,841.0000,126.1500,WELLCARE,WELLCARE MEDICARE,295.20,,,,,,,105.6100,841.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,AETNA,AETNA,161.83,,,,,,,56.9100,607.1100,percent of total billed charges,42.7% of $379.00 in Billed Charges for Rev 510 Proc 20551 = $161.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,354.99,,,,,,,56.9100,607.1100,fee schedule,"APG 00049 Proc 20551 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 104% = $354.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,278.49,,,,,,,56.9100,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,AETNA,AETNA HEALTHCARE MEDICARE,278.49,,,,,,,56.9100,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,278.49,,,,,,,56.9100,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,AMBETTER,AMBETTER,607.11,,,,,,,56.9100,607.1100,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,289.63,,,,,,,56.9100,607.1100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,ANTHEM EXCHANGE,379.00,,,,,,,56.9100,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,351.57,,,,,,,56.9100,607.1100,fee schedule,"APG 00049 Proc 20551 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 103% = $351.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,ANTHEM HMO,379.00,,,,,,,56.9100,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,286.84,,,,,,,56.9100,607.1100,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",379.00,,,,,,,56.9100,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,56.91,,,,,,,56.9100,607.1100,fee schedule,$56.91 from Fee Schedule BLDTM_23 for Rev 510 Proc 20551 * Qty 1 = $56.91 at 100% = $56.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,BLUE CROSS,BLUE CROSS MEDICARE,289.63,,,,,,,56.9100,607.1100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,CIGNA HEALTHCARE,CIGNA HMO,158.04,,,,,,,56.9100,607.1100,percent of total billed charges,41.7% of $379.00 in Billed Charges for Rev 510 Proc 20551 = $158.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.86,,,,,,,56.9100,607.1100,percent of total billed charges,46.4% of $379.00 in Billed Charges for Rev 510 Proc 20551 = $175.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,292.41,,,,,,,56.9100,607.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,158.04,,,,,,,56.9100,607.1100,percent of total billed charges,41.7% of $379.00 in Billed Charges for Rev 510 Proc 20551 = $158.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,CIGNA HEALTHCARE,CIGNA PPO,158.04,,,,,,,56.9100,607.1100,percent of total billed charges,41.7% of $379.00 in Billed Charges for Rev 510 Proc 20551 = $158.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,292.41,,,,,,,56.9100,607.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,341.10,,,,,,,56.9100,607.1100,percent of total billed charges,90% of $379.00 in Billed Charges for Rev 510 Proc 20551 = $341.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,HUMANA,HUMANA MEDICARE,278.49,,,,,,,56.9100,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,278.49,,,,,,,56.9100,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,MEDCOST,MEDCOST VHN,180.37,,,,,,,56.9100,607.1100,percent of total billed charges,47.59% of $379.00 in Billed Charges for Rev 510 Proc 20551 = $180.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,358.40,,,,,,,56.9100,607.1100,fee schedule,"APG 00049 Proc 20551 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 100% = $341.33... $341.33 at 105% = $358.40 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,292.41,,,,,,,56.9100,607.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,292.41,,,,,,,56.9100,607.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,NHC ADVANTAGE,NHC ADVANTAGE,292.41,,,,,,,56.9100,607.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,351.91,,,,,,,56.9100,607.1100,fee schedule,"APG 00049 Proc 20551 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 100% = $341.33... $341.33 at 103.1% = $351.91 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,SENTARA HEALTH,SENTARA HEALTH,97.82,,,,,,,56.9100,607.1100,percent of total billed charges,25.81% of $379.00 in Billed Charges for Rev 510 Proc 20551 = $97.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,SENTARA HEALTH,SENTARA MEDICARE,278.49,,,,,,,56.9100,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",379.00,,,,,,,56.9100,607.1100,percent of total billed charges,100% of $379.00 in Billed Charges for Rev 510 Proc 20551 = $379.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,105.61,,,,,,,56.9100,607.1100,fee schedule,$211.21 from Fee Schedule TCUHC24 for Rev 510 Proc 20551 * Qty 1 = $211.21 at 50% = $105.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,122.42,,,,,,,56.9100,607.1100,other,32.3% of $379.00 in Billed Charges for Rev 510 Proc 20551 = $122.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,116.35,,,,,,,56.9100,607.1100,other,30.7% of $379.00 in Billed Charges for Rev 510 Proc 20551 = $116.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,122.42,,,,,,,56.9100,607.1100,percent of total billed charges,32.3% of $379.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,351.57,,,,,,,56.9100,607.1100,fee schedule,"APG 00049 Proc 20551 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 103% = $351.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,278.49,,,,,,,56.9100,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,278.49,,,,,,,56.9100,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,WELLCARE,WELLCARE MEDICAID,379.00,,,,,,,56.9100,607.1100,percent of total billed charges,100% of $379.00 in Billed Charges for Rev 510 Proc 20551 = $379.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INJ SNGL TENDON ORIGIN/INSERTION,20551,CPT,510,RC,51000141,CDM,,,,both,,,379.0000,56.8500,WELLCARE,WELLCARE MEDICARE,295.20,,,,,,,56.9100,607.1100,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE ORTHORCORD 2,272,RC,,,,,,,,both,,,765.2600,114.7900,AETNA,AETNA,326.77,,,,,,,197.5100,765.2600,percent of total billed charges,42.7% of $765.26 in Billed Charges for Rev 272 = $326.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ORTHORCORD 2,272,RC,,,,,,,,both,,,765.2600,114.7900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,535.68,,,,,,,197.5100,765.2600,percent of total billed charges,Rev 272 $765.26 in Billed Charges at 70% = $535.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ORTHORCORD 2,272,RC,,,,,,,,both,,,765.2600,114.7900,CIGNA HEALTHCARE,CIGNA HMO,319.11,,,,,,,197.5100,765.2600,percent of total billed charges,41.7% of $765.26 in Billed Charges for Rev 272 = $319.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ORTHORCORD 2,272,RC,,,,,,,,both,,,765.2600,114.7900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,355.08,,,,,,,197.5100,765.2600,percent of total billed charges,46.4% of $765.26 in Billed Charges for Rev 272 = $355.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ORTHORCORD 2,272,RC,,,,,,,,both,,,765.2600,114.7900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,319.11,,,,,,,197.5100,765.2600,percent of total billed charges,41.7% of $765.26 in Billed Charges for Rev 272 = $319.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ORTHORCORD 2,272,RC,,,,,,,,both,,,765.2600,114.7900,CIGNA HEALTHCARE,CIGNA PPO,319.11,,,,,,,197.5100,765.2600,percent of total billed charges,41.7% of $765.26 in Billed Charges for Rev 272 = $319.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ORTHORCORD 2,272,RC,,,,,,,,both,,,765.2600,114.7900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,688.73,,,,,,,197.5100,765.2600,percent of total billed charges,90% of $765.26 in Billed Charges for Rev 272 = $688.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ORTHORCORD 2,272,RC,,,,,,,,both,,,765.2600,114.7900,MEDCOST,MEDCOST VHN,364.19,,,,,,,197.5100,765.2600,percent of total billed charges,47.59% of $765.26 in Billed Charges for Rev 272 = $364.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ORTHORCORD 2,272,RC,,,,,,,,both,,,765.2600,114.7900,SENTARA HEALTH,SENTARA HEALTH,197.51,,,,,,,197.5100,765.2600,percent of total billed charges,25.81% of $765.26 in Billed Charges for Rev 272 = $197.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ORTHORCORD 2,272,RC,,,,,,,,both,,,765.2600,114.7900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",765.26,,,,,,,197.5100,765.2600,percent of total billed charges,100% of $765.26 in Billed Charges for Rev 272 = $765.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ORTHORCORD 2,272,RC,,,,,,,,both,,,765.2600,114.7900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,382.63,,,,,,,197.5100,765.2600,percent of total billed charges,Rev 272 $765.26 in Billed Charges at 50% = $382.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ORTHORCORD 2,272,RC,,,,,,,,both,,,765.2600,114.7900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,247.18,,,,,,,197.5100,765.2600,other,32.3% of $765.26 in Billed Charges for Rev 272 = $247.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE ORTHORCORD 2,272,RC,,,,,,,,both,,,765.2600,114.7900,UNITED HEALTHCARE,UHC HERITAGE SELECT,234.93,,,,,,,197.5100,765.2600,other,30.7% of $765.26 in Billed Charges for Rev 272 = $234.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE ORTHORCORD 2,272,RC,,,,,,,,both,,,765.2600,114.7900,UNITED HEALTHCARE,UNITED HEALTHCARE,247.18,,,,,,,197.5100,765.2600,percent of total billed charges,32.3% of $765.26 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE ORTHORCORD 2,272,RC,,,,,,,,both,,,765.2600,114.7900,WELLCARE,WELLCARE MEDICAID,765.26,,,,,,,197.5100,765.2600,percent of total billed charges,100% of $765.26 in Billed Charges for Rev 272 = $765.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PASSER  EXPRESS SEW,272,RC,27200002,CDM,,,,,,both,,,3157.7400,473.6600,AETNA,AETNA,1348.36,,,,,,,815.0100,3157.7400,percent of total billed charges,"42.7% of $3,157.74 in Billed Charges for Rev 272 = $1,348.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER  EXPRESS SEW,272,RC,27200002,CDM,,,,,,both,,,3157.7400,473.6600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2210.42,,,,,,,815.0100,3157.7400,percent of total billed charges,"Rev 272 $3,157.74 in Billed Charges at 70% = $2,210.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER  EXPRESS SEW,272,RC,27200002,CDM,,,,,,both,,,3157.7400,473.6600,CIGNA HEALTHCARE,CIGNA HMO,1316.78,,,,,,,815.0100,3157.7400,percent of total billed charges,"41.7% of $3,157.74 in Billed Charges for Rev 272 = $1,316.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER  EXPRESS SEW,272,RC,27200002,CDM,,,,,,both,,,3157.7400,473.6600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1465.19,,,,,,,815.0100,3157.7400,percent of total billed charges,"46.4% of $3,157.74 in Billed Charges for Rev 272 = $1,465.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER  EXPRESS SEW,272,RC,27200002,CDM,,,,,,both,,,3157.7400,473.6600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1316.78,,,,,,,815.0100,3157.7400,percent of total billed charges,"41.7% of $3,157.74 in Billed Charges for Rev 272 = $1,316.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER  EXPRESS SEW,272,RC,27200002,CDM,,,,,,both,,,3157.7400,473.6600,CIGNA HEALTHCARE,CIGNA PPO,1316.78,,,,,,,815.0100,3157.7400,percent of total billed charges,"41.7% of $3,157.74 in Billed Charges for Rev 272 = $1,316.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER  EXPRESS SEW,272,RC,27200002,CDM,,,,,,both,,,3157.7400,473.6600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2841.97,,,,,,,815.0100,3157.7400,percent of total billed charges,"90% of $3,157.74 in Billed Charges for Rev 272 = $2,841.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER  EXPRESS SEW,272,RC,27200002,CDM,,,,,,both,,,3157.7400,473.6600,MEDCOST,MEDCOST VHN,1502.77,,,,,,,815.0100,3157.7400,percent of total billed charges,"47.59% of $3,157.74 in Billed Charges for Rev 272 = $1,502.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER  EXPRESS SEW,272,RC,27200002,CDM,,,,,,both,,,3157.7400,473.6600,SENTARA HEALTH,SENTARA HEALTH,815.01,,,,,,,815.0100,3157.7400,percent of total billed charges,"25.81% of $3,157.74 in Billed Charges for Rev 272 = $815.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER  EXPRESS SEW,272,RC,27200002,CDM,,,,,,both,,,3157.7400,473.6600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3157.74,,,,,,,815.0100,3157.7400,percent of total billed charges,"100% of $3,157.74 in Billed Charges for Rev 272 = $3,157.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER  EXPRESS SEW,272,RC,27200002,CDM,,,,,,both,,,3157.7400,473.6600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1578.87,,,,,,,815.0100,3157.7400,percent of total billed charges,"Rev 272 $3,157.74 in Billed Charges at 50% = $1,578.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER  EXPRESS SEW,272,RC,27200002,CDM,,,,,,both,,,3157.7400,473.6600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1019.95,,,,,,,815.0100,3157.7400,other,"32.3% of $3,157.74 in Billed Charges for Rev 272 = $1,019.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PASSER  EXPRESS SEW,272,RC,27200002,CDM,,,,,,both,,,3157.7400,473.6600,UNITED HEALTHCARE,UHC HERITAGE SELECT,969.43,,,,,,,815.0100,3157.7400,other,"30.7% of $3,157.74 in Billed Charges for Rev 272 = $969.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PASSER  EXPRESS SEW,272,RC,27200002,CDM,,,,,,both,,,3157.7400,473.6600,UNITED HEALTHCARE,UNITED HEALTHCARE,1019.95,,,,,,,815.0100,3157.7400,percent of total billed charges,"32.3% of $3,157.74 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER  EXPRESS SEW,272,RC,27200002,CDM,,,,,,both,,,3157.7400,473.6600,WELLCARE,WELLCARE MEDICAID,3157.74,,,,,,,815.0100,3157.7400,percent of total billed charges,"100% of $3,157.74 in Billed Charges for Rev 272 = $3,157.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER CHIA PERPASSER,272,RC,,,,,,,,both,,,2459.9400,368.9900,AETNA,AETNA,1050.39,,,,,,,634.9100,2459.9400,percent of total billed charges,"42.7% of $2,459.94 in Billed Charges for Rev 272 = $1,050.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER CHIA PERPASSER,272,RC,,,,,,,,both,,,2459.9400,368.9900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1721.96,,,,,,,634.9100,2459.9400,percent of total billed charges,"Rev 272 $2,459.94 in Billed Charges at 70% = $1,721.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER CHIA PERPASSER,272,RC,,,,,,,,both,,,2459.9400,368.9900,CIGNA HEALTHCARE,CIGNA HMO,1025.80,,,,,,,634.9100,2459.9400,percent of total billed charges,"41.7% of $2,459.94 in Billed Charges for Rev 272 = $1,025.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER CHIA PERPASSER,272,RC,,,,,,,,both,,,2459.9400,368.9900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1141.41,,,,,,,634.9100,2459.9400,percent of total billed charges,"46.4% of $2,459.94 in Billed Charges for Rev 272 = $1,141.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER CHIA PERPASSER,272,RC,,,,,,,,both,,,2459.9400,368.9900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1025.80,,,,,,,634.9100,2459.9400,percent of total billed charges,"41.7% of $2,459.94 in Billed Charges for Rev 272 = $1,025.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER CHIA PERPASSER,272,RC,,,,,,,,both,,,2459.9400,368.9900,CIGNA HEALTHCARE,CIGNA PPO,1025.80,,,,,,,634.9100,2459.9400,percent of total billed charges,"41.7% of $2,459.94 in Billed Charges for Rev 272 = $1,025.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER CHIA PERPASSER,272,RC,,,,,,,,both,,,2459.9400,368.9900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2213.95,,,,,,,634.9100,2459.9400,percent of total billed charges,"90% of $2,459.94 in Billed Charges for Rev 272 = $2,213.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER CHIA PERPASSER,272,RC,,,,,,,,both,,,2459.9400,368.9900,MEDCOST,MEDCOST VHN,1170.69,,,,,,,634.9100,2459.9400,percent of total billed charges,"47.59% of $2,459.94 in Billed Charges for Rev 272 = $1,170.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER CHIA PERPASSER,272,RC,,,,,,,,both,,,2459.9400,368.9900,SENTARA HEALTH,SENTARA HEALTH,634.91,,,,,,,634.9100,2459.9400,percent of total billed charges,"25.81% of $2,459.94 in Billed Charges for Rev 272 = $634.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER CHIA PERPASSER,272,RC,,,,,,,,both,,,2459.9400,368.9900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2459.94,,,,,,,634.9100,2459.9400,percent of total billed charges,"100% of $2,459.94 in Billed Charges for Rev 272 = $2,459.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER CHIA PERPASSER,272,RC,,,,,,,,both,,,2459.9400,368.9900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1229.97,,,,,,,634.9100,2459.9400,percent of total billed charges,"Rev 272 $2,459.94 in Billed Charges at 50% = $1,229.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER CHIA PERPASSER,272,RC,,,,,,,,both,,,2459.9400,368.9900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,794.56,,,,,,,634.9100,2459.9400,other,"32.3% of $2,459.94 in Billed Charges for Rev 272 = $794.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PASSER CHIA PERPASSER,272,RC,,,,,,,,both,,,2459.9400,368.9900,UNITED HEALTHCARE,UHC HERITAGE SELECT,755.20,,,,,,,634.9100,2459.9400,other,"30.7% of $2,459.94 in Billed Charges for Rev 272 = $755.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PASSER CHIA PERPASSER,272,RC,,,,,,,,both,,,2459.9400,368.9900,UNITED HEALTHCARE,UNITED HEALTHCARE,794.56,,,,,,,634.9100,2459.9400,percent of total billed charges,"32.3% of $2,459.94 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER CHIA PERPASSER,272,RC,,,,,,,,both,,,2459.9400,368.9900,WELLCARE,WELLCARE MEDICAID,2459.94,,,,,,,634.9100,2459.9400,percent of total billed charges,"100% of $2,459.94 in Billed Charges for Rev 272 = $2,459.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SELF CAPTURE,272,RC,27200002,CDM,,,,,,both,,,1919.8800,287.9800,AETNA,AETNA,819.79,,,,,,,495.5200,1919.8800,percent of total billed charges,"42.7% of $1,919.88 in Billed Charges for Rev 272 = $819.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SELF CAPTURE,272,RC,27200002,CDM,,,,,,both,,,1919.8800,287.9800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1343.92,,,,,,,495.5200,1919.8800,percent of total billed charges,"Rev 272 $1,919.88 in Billed Charges at 70% = $1,343.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SELF CAPTURE,272,RC,27200002,CDM,,,,,,both,,,1919.8800,287.9800,CIGNA HEALTHCARE,CIGNA HMO,800.59,,,,,,,495.5200,1919.8800,percent of total billed charges,"41.7% of $1,919.88 in Billed Charges for Rev 272 = $800.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SELF CAPTURE,272,RC,27200002,CDM,,,,,,both,,,1919.8800,287.9800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,890.82,,,,,,,495.5200,1919.8800,percent of total billed charges,"46.4% of $1,919.88 in Billed Charges for Rev 272 = $890.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SELF CAPTURE,272,RC,27200002,CDM,,,,,,both,,,1919.8800,287.9800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,800.59,,,,,,,495.5200,1919.8800,percent of total billed charges,"41.7% of $1,919.88 in Billed Charges for Rev 272 = $800.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SELF CAPTURE,272,RC,27200002,CDM,,,,,,both,,,1919.8800,287.9800,CIGNA HEALTHCARE,CIGNA PPO,800.59,,,,,,,495.5200,1919.8800,percent of total billed charges,"41.7% of $1,919.88 in Billed Charges for Rev 272 = $800.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SELF CAPTURE,272,RC,27200002,CDM,,,,,,both,,,1919.8800,287.9800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1727.89,,,,,,,495.5200,1919.8800,percent of total billed charges,"90% of $1,919.88 in Billed Charges for Rev 272 = $1,727.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SELF CAPTURE,272,RC,27200002,CDM,,,,,,both,,,1919.8800,287.9800,MEDCOST,MEDCOST VHN,913.67,,,,,,,495.5200,1919.8800,percent of total billed charges,"47.59% of $1,919.88 in Billed Charges for Rev 272 = $913.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SELF CAPTURE,272,RC,27200002,CDM,,,,,,both,,,1919.8800,287.9800,SENTARA HEALTH,SENTARA HEALTH,495.52,,,,,,,495.5200,1919.8800,percent of total billed charges,"25.81% of $1,919.88 in Billed Charges for Rev 272 = $495.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SELF CAPTURE,272,RC,27200002,CDM,,,,,,both,,,1919.8800,287.9800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1919.88,,,,,,,495.5200,1919.8800,percent of total billed charges,"100% of $1,919.88 in Billed Charges for Rev 272 = $1,919.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SELF CAPTURE,272,RC,27200002,CDM,,,,,,both,,,1919.8800,287.9800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,959.94,,,,,,,495.5200,1919.8800,percent of total billed charges,"Rev 272 $1,919.88 in Billed Charges at 50% = $959.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SELF CAPTURE,272,RC,27200002,CDM,,,,,,both,,,1919.8800,287.9800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,620.12,,,,,,,495.5200,1919.8800,other,"32.3% of $1,919.88 in Billed Charges for Rev 272 = $620.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PASSER SELF CAPTURE,272,RC,27200002,CDM,,,,,,both,,,1919.8800,287.9800,UNITED HEALTHCARE,UHC HERITAGE SELECT,589.40,,,,,,,495.5200,1919.8800,other,"30.7% of $1,919.88 in Billed Charges for Rev 272 = $589.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PASSER SELF CAPTURE,272,RC,27200002,CDM,,,,,,both,,,1919.8800,287.9800,UNITED HEALTHCARE,UNITED HEALTHCARE,620.12,,,,,,,495.5200,1919.8800,percent of total billed charges,"32.3% of $1,919.88 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SELF CAPTURE,272,RC,27200002,CDM,,,,,,both,,,1919.8800,287.9800,WELLCARE,WELLCARE MEDICAID,1919.88,,,,,,,495.5200,1919.8800,percent of total billed charges,"100% of $1,919.88 in Billed Charges for Rev 272 = $1,919.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,AETNA,AETNA,669.96,,,,,,,56.9100,1569.0000,percent of total billed charges,"42.7% of $1,569.00 in Billed Charges for Rev 450 Proc 20553 = $669.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,354.99,,,,,,,56.9100,1569.0000,fee schedule,"APG 00049 Proc 20553 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 104% = $354.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,278.49,,,,,,,56.9100,1569.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,AETNA,AETNA HEALTHCARE MEDICARE,278.49,,,,,,,56.9100,1569.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,278.49,,,,,,,56.9100,1569.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,AMBETTER,AMBETTER,607.11,,,,,,,56.9100,1569.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,289.63,,,,,,,56.9100,1569.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,BLUE CROSS,ANTHEM EXCHANGE,685.65,,,,,,,56.9100,1569.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,351.57,,,,,,,56.9100,1569.0000,fee schedule,"APG 00049 Proc 20553 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 103% = $351.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,BLUE CROSS,ANTHEM HMO,728.47,,,,,,,56.9100,1569.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,286.84,,,,,,,56.9100,1569.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",856.97,,,,,,,56.9100,1569.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,56.91,,,,,,,56.9100,1569.0000,fee schedule,$56.91 from Fee Schedule BLDTM_23 for Rev 450 Proc 20553 * Qty 1 = $56.91 at 100% = $56.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,BLUE CROSS,BLUE CROSS MEDICARE,289.63,,,,,,,56.9100,1569.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,292.41,,,,,,,56.9100,1569.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,292.41,,,,,,,56.9100,1569.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1412.10,,,,,,,56.9100,1569.0000,percent of total billed charges,"90% of $1,569.00 in Billed Charges for Rev 450 Proc 20553 = $1,412.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,HUMANA,HUMANA MEDICARE,278.49,,,,,,,56.9100,1569.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,278.49,,,,,,,56.9100,1569.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,MEDCOST,MEDCOST VHN,746.69,,,,,,,56.9100,1569.0000,percent of total billed charges,"47.59% of $1,569.00 in Billed Charges for Rev 450 Proc 20553 = $746.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,358.40,,,,,,,56.9100,1569.0000,fee schedule,"APG 00049 Proc 20553 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 100% = $341.33... $341.33 at 105% = $358.40 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,292.41,,,,,,,56.9100,1569.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,292.41,,,,,,,56.9100,1569.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,NHC ADVANTAGE,NHC ADVANTAGE,292.41,,,,,,,56.9100,1569.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,351.91,,,,,,,56.9100,1569.0000,fee schedule,"APG 00049 Proc 20553 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 100% = $341.33... $341.33 at 103.1% = $351.91 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,SENTARA HEALTH,SENTARA HEALTH,404.96,,,,,,,56.9100,1569.0000,percent of total billed charges,"25.81% of $1,569.00 in Billed Charges for Rev 450 Proc 20553 = $404.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,SENTARA HEALTH,SENTARA MEDICARE,278.49,,,,,,,56.9100,1569.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1569.00,,,,,,,56.9100,1569.0000,percent of total billed charges,"100% of $1,569.00 in Billed Charges for Rev 450 Proc 20553 = $1,569.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,56.9100,1569.0000,case rate,Rev 450 Proc 20553 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,56.9100,1569.0000,case rate,Rev 450 Proc 20553 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,56.9100,1569.0000,case rate,Rev 450 Proc 20553 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,56.9100,1569.0000,case rate,Rev 450 Proc 20553 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,351.57,,,,,,,56.9100,1569.0000,fee schedule,"APG 00049 Proc 20553 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 103% = $351.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,278.49,,,,,,,56.9100,1569.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,278.49,,,,,,,56.9100,1569.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,WELLCARE,WELLCARE MEDICAID,1569.00,,,,,,,56.9100,1569.0000,percent of total billed charges,"100% of $1,569.00 in Billed Charges for Rev 450 Proc 20553 = $1,569.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ONE MX TRIG POINT 3> MUSC,20553,CPT,450,RC,45000089,CDM,,,,both,,,1569.0000,235.3500,WELLCARE,WELLCARE MEDICARE,295.20,,,,,,,56.9100,1569.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,AETNA,AETNA,254.92,,,,,,,21.9700,607.1100,percent of total billed charges,42.7% of $597.00 in Billed Charges for Rev 450 Proc 20600 = $254.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,354.99,,,,,,,21.9700,607.1100,fee schedule,"APG 00049 Proc 20600 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 104% = $354.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,278.49,,,,,,,21.9700,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,AETNA,AETNA HEALTHCARE MEDICARE,278.49,,,,,,,21.9700,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,278.49,,,,,,,21.9700,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,AMBETTER,AMBETTER,607.11,,,,,,,21.9700,607.1100,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,289.63,,,,,,,21.9700,607.1100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,BLUE CROSS,ANTHEM EXCHANGE,597.00,,,,,,,21.9700,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,351.57,,,,,,,21.9700,607.1100,fee schedule,"APG 00049 Proc 20600 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 103% = $351.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,BLUE CROSS,ANTHEM HMO,597.00,,,,,,,21.9700,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,286.84,,,,,,,21.9700,607.1100,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",597.00,,,,,,,21.9700,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,43.66,,,,,,,21.9700,607.1100,fee schedule,$43.66 from Fee Schedule BLDTM_23 for Rev 450 Proc 20600 * Qty 1 = $43.66 at 100% = $43.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,BLUE CROSS,BLUE CROSS MEDICARE,289.63,,,,,,,21.9700,607.1100,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,BLUE CROSS,TENNCARE BLUE CARE,21.97,,,,,,,21.9700,607.1100,fee schedule,$18.94 from Fee Schedule TC_24 for Rev 450 Proc 20600 * Qty 1 = $18.94 at 116% = $21.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,BLUE CROSS,TENNCARE BLUE SELECT,21.97,,,,,,,21.9700,607.1100,fee schedule,$18.94 from Fee Schedule TC_24 for Rev 450 Proc 20600 * Qty 1 = $18.94 at 116% = $21.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,292.41,,,,,,,21.9700,607.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,292.41,,,,,,,21.9700,607.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,537.30,,,,,,,21.9700,607.1100,percent of total billed charges,90% of $597.00 in Billed Charges for Rev 450 Proc 20600 = $537.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,HUMANA,HUMANA MEDICARE,278.49,,,,,,,21.9700,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,278.49,,,,,,,21.9700,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,MEDCOST,MEDCOST VHN,284.11,,,,,,,21.9700,607.1100,percent of total billed charges,47.59% of $597.00 in Billed Charges for Rev 450 Proc 20600 = $284.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,358.40,,,,,,,21.9700,607.1100,fee schedule,"APG 00049 Proc 20600 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 100% = $341.33... $341.33 at 105% = $358.40 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,292.41,,,,,,,21.9700,607.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,292.41,,,,,,,21.9700,607.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,NHC ADVANTAGE,NHC ADVANTAGE,292.41,,,,,,,21.9700,607.1100,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,351.91,,,,,,,21.9700,607.1100,fee schedule,"APG 00049 Proc 20600 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 100% = $341.33... $341.33 at 103.1% = $351.91 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,SENTARA HEALTH,SENTARA HEALTH,154.09,,,,,,,21.9700,607.1100,percent of total billed charges,25.81% of $597.00 in Billed Charges for Rev 450 Proc 20600 = $154.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,SENTARA HEALTH,SENTARA MEDICARE,278.49,,,,,,,21.9700,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",597.00,,,,,,,21.9700,607.1100,percent of total billed charges,100% of $597.00 in Billed Charges for Rev 450 Proc 20600 = $597.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,21.9700,607.1100,case rate,Rev 450 Proc 20600 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,21.9700,607.1100,case rate,Rev 450 Proc 20600 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,21.9700,607.1100,case rate,Rev 450 Proc 20600 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,597.00,,,,,,,21.9700,607.1100,case rate,"Rev 450 Proc 20600 at Case Rate $847.00 (Service Line reduced to $597.00, claim capped at $597.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,351.57,,,,,,,21.9700,607.1100,fee schedule,"APG 00049 Proc 20600 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 103% = $351.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,278.49,,,,,,,21.9700,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,278.49,,,,,,,21.9700,607.1100,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,WELLCARE,WELLCARE MEDICAID,597.00,,,,,,,21.9700,607.1100,percent of total billed charges,100% of $597.00 in Billed Charges for Rev 450 Proc 20600 = $597.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ASPIRATE INJECT SMALL JOINT W/O US GUID,20600,CPT,450,RC,45000090,CDM,,,,both,,,597.0000,89.5500,WELLCARE,WELLCARE MEDICARE,295.20,,,,,,,21.9700,607.1100,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,AETNA,AETNA,507.28,,,,,,,173.0000,1188.0000,percent of total billed charges,"42.7% of $1,188.00 in Billed Charges for Rev 361 Proc 20604 = $507.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,638.80,,,,,,,173.0000,1188.0000,fee schedule,"APG 00050 Proc 20604 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $614.23 at 104% = $638.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,278.49,,,,,,,173.0000,1188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,AETNA,AETNA HEALTHCARE MEDICARE,278.49,,,,,,,173.0000,1188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,278.49,,,,,,,173.0000,1188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,AMBETTER,AMBETTER,607.11,,,,,,,173.0000,1188.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,289.63,,,,,,,173.0000,1188.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,BLUE CROSS,ANTHEM EXCHANGE,685.65,,,,,,,173.0000,1188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,632.66,,,,,,,173.0000,1188.0000,fee schedule,"APG 00050 Proc 20604 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $614.23 at 103% = $632.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,BLUE CROSS,ANTHEM HMO,728.47,,,,,,,173.0000,1188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,286.84,,,,,,,173.0000,1188.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",856.97,,,,,,,173.0000,1188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1188.00,,,,,,,173.0000,1188.0000,case rate,"Rev 361 Proc 20604 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $1,188.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,188.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,173.0000,1188.0000,case rate,Rev 361 Proc 20604 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,BLUE CROSS,BLUE CROSS MEDICARE,289.63,,,,,,,173.0000,1188.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,173.0000,1188.0000,case rate,Rev 361 Proc 20604 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,173.0000,1188.0000,case rate,Rev 361 Proc 20604 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,CIGNA HEALTHCARE,CIGNA HMO,228.00,,,,,,,173.0000,1188.0000,case rate,Rev 361 Proc 20604 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.00,,,,,,,173.0000,1188.0000,case rate,Rev 361 Proc 20604 ASG Rate of $175.00 at 100% of $175.00 = $175.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,292.41,,,,,,,173.0000,1188.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.00,,,,,,,173.0000,1188.0000,case rate,Rev 361 Proc 20604 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,CIGNA HEALTHCARE,CIGNA PPO,228.00,,,,,,,173.0000,1188.0000,case rate,Rev 361 Proc 20604 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,292.41,,,,,,,173.0000,1188.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1069.20,,,,,,,173.0000,1188.0000,percent of total billed charges,"90% of $1,188.00 in Billed Charges for Rev 361 Proc 20604 = $1,069.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,HUMANA,HUMANA MEDICARE,278.49,,,,,,,173.0000,1188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,278.49,,,,,,,173.0000,1188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,MEDCOST,MEDCOST VHN,565.37,,,,,,,173.0000,1188.0000,percent of total billed charges,"47.59% of $1,188.00 in Billed Charges for Rev 361 Proc 20604 = $565.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,644.94,,,,,,,173.0000,1188.0000,fee schedule,"APG 00050 Proc 20604 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $614.23 at 100% = $614.23... $614.23 at 105% = $644.94 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,292.41,,,,,,,173.0000,1188.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,292.41,,,,,,,173.0000,1188.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,NHC ADVANTAGE,NHC ADVANTAGE,292.41,,,,,,,173.0000,1188.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,633.27,,,,,,,173.0000,1188.0000,fee schedule,"APG 00050 Proc 20604 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $614.23 at 100% = $614.23... $614.23 at 103.1% = $633.27 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,SENTARA HEALTH,SENTARA HEALTH,306.62,,,,,,,173.0000,1188.0000,percent of total billed charges,"25.81% of $1,188.00 in Billed Charges for Rev 361 Proc 20604 = $306.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,SENTARA HEALTH,SENTARA MEDICARE,278.49,,,,,,,173.0000,1188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1188.00,,,,,,,173.0000,1188.0000,percent of total billed charges,"100% of $1,188.00 in Billed Charges for Rev 361 Proc 20604 = $1,188.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,173.0000,1188.0000,case rate,Rev 361 Proc 20604 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,173.0000,1188.0000,case rate,Rev 361 Proc 20604 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,173.0000,1188.0000,case rate,Rev 361 Proc 20604 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,173.0000,1188.0000,case rate,Rev 361 Proc 20604 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,632.66,,,,,,,173.0000,1188.0000,fee schedule,"APG 00050 Proc 20604 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $614.23 at 103% = $632.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,278.49,,,,,,,173.0000,1188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,278.49,,,,,,,173.0000,1188.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,WELLCARE,WELLCARE MEDICAID,1188.00,,,,,,,173.0000,1188.0000,percent of total billed charges,"100% of $1,188.00 in Billed Charges for Rev 361 Proc 20604 = $1,188.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIRATE INJECT SMALL JOINT W US GUID,20604,CPT,361,RC,36100265,CDM,,,,both,,,1188.0000,178.2000,WELLCARE,WELLCARE MEDICARE,295.20,,,,,,,173.0000,1188.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,AETNA,AETNA,760.06,,,,,,,21.9700,1780.0000,percent of total billed charges,"42.7% of $1,780.00 in Billed Charges for Rev 361 Proc 20605 = $760.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,354.99,,,,,,,21.9700,1780.0000,fee schedule,"APG 00049 Proc 20605 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 104% = $354.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,278.49,,,,,,,21.9700,1780.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,AETNA,AETNA HEALTHCARE MEDICARE,278.49,,,,,,,21.9700,1780.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,ALLCARE MEDICARE,ALLCARE MEDICARE,278.49,,,,,,,21.9700,1780.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,AMBETTER,AMBETTER,607.11,,,,,,,21.9700,1780.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,289.63,,,,,,,21.9700,1780.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,BLUE CROSS,ANTHEM EXCHANGE,685.65,,,,,,,21.9700,1780.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,351.57,,,,,,,21.9700,1780.0000,fee schedule,"APG 00049 Proc 20605 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 103% = $351.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,BLUE CROSS,ANTHEM HMO,728.47,,,,,,,21.9700,1780.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,286.84,,,,,,,21.9700,1780.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",856.97,,,,,,,21.9700,1780.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,21.9700,1780.0000,case rate,Rev 361 Proc 20605 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,21.9700,1780.0000,case rate,Rev 361 Proc 20605 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,BLUE CROSS,BLUE CROSS MEDICARE,289.63,,,,,,,21.9700,1780.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,21.9700,1780.0000,case rate,Rev 361 Proc 20605 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,21.9700,1780.0000,case rate,Rev 361 Proc 20605 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,BLUE CROSS,TENNCARE BLUE CARE,21.97,,,,,,,21.9700,1780.0000,fee schedule,$18.94 from Fee Schedule TC_24 for Rev 361 Proc 20605 * Qty 1 = $18.94 at 116% = $21.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,BLUE CROSS,TENNCARE BLUE SELECT,21.97,,,,,,,21.9700,1780.0000,fee schedule,$18.94 from Fee Schedule TC_24 for Rev 361 Proc 20605 * Qty 1 = $18.94 at 116% = $21.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,CIGNA HEALTHCARE,CIGNA HMO,1780.00,,,,,,,21.9700,1780.0000,case rate,"Rev 361 Proc 20605 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,780.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,780.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,21.9700,1780.0000,case rate,"Rev 361 Proc 20605 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,CIGNA HEALTHCARE,CIGNA MEDICARE,292.41,,,,,,,21.9700,1780.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1780.00,,,,,,,21.9700,1780.0000,case rate,"Rev 361 Proc 20605 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,780.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,780.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,CIGNA HEALTHCARE,CIGNA PPO,1780.00,,,,,,,21.9700,1780.0000,case rate,"Rev 361 Proc 20605 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,780.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,780.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,292.41,,,,,,,21.9700,1780.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1602.00,,,,,,,21.9700,1780.0000,percent of total billed charges,"90% of $1,780.00 in Billed Charges for Rev 361 Proc 20605 = $1,602.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,HUMANA,HUMANA MEDICARE,278.49,,,,,,,21.9700,1780.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,278.49,,,,,,,21.9700,1780.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,MEDCOST,MEDCOST VHN,847.10,,,,,,,21.9700,1780.0000,percent of total billed charges,"47.59% of $1,780.00 in Billed Charges for Rev 361 Proc 20605 = $847.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,358.40,,,,,,,21.9700,1780.0000,fee schedule,"APG 00049 Proc 20605 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 100% = $341.33... $341.33 at 105% = $358.40 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,292.41,,,,,,,21.9700,1780.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,292.41,,,,,,,21.9700,1780.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,NHC ADVANTAGE,NHC ADVANTAGE,292.41,,,,,,,21.9700,1780.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,351.91,,,,,,,21.9700,1780.0000,fee schedule,"APG 00049 Proc 20605 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 100% = $341.33... $341.33 at 103.1% = $351.91 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,SENTARA HEALTH,SENTARA HEALTH,459.42,,,,,,,21.9700,1780.0000,percent of total billed charges,"25.81% of $1,780.00 in Billed Charges for Rev 361 Proc 20605 = $459.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,SENTARA HEALTH,SENTARA MEDICARE,278.49,,,,,,,21.9700,1780.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1780.00,,,,,,,21.9700,1780.0000,percent of total billed charges,"100% of $1,780.00 in Billed Charges for Rev 361 Proc 20605 = $1,780.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,21.9700,1780.0000,case rate,Rev 361 Proc 20605 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,21.9700,1780.0000,case rate,Rev 361 Proc 20605 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,21.9700,1780.0000,case rate,Rev 361 Proc 20605 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,21.9700,1780.0000,case rate,Rev 361 Proc 20605 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,351.57,,,,,,,21.9700,1780.0000,fee schedule,"APG 00049 Proc 20605 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 103% = $351.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,278.49,,,,,,,21.9700,1780.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,278.49,,,,,,,21.9700,1780.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,WELLCARE,WELLCARE MEDICAID,1780.00,,,,,,,21.9700,1780.0000,percent of total billed charges,"100% of $1,780.00 in Billed Charges for Rev 361 Proc 20605 = $1,780.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ INT JT W/O US GUID,20605,CPT,361,RC,36100070,CDM,,,,both,,,1780.0000,267.0000,WELLCARE,WELLCARE MEDICARE,295.20,,,,,,,21.9700,1780.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,AETNA,AETNA,687.47,,,,,,,175.0000,1610.0000,percent of total billed charges,"42.7% of $1,610.00 in Billed Charges for Rev 361 Proc 20606 = $687.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,638.80,,,,,,,175.0000,1610.0000,fee schedule,"APG 00050 Proc 20606 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $614.23 at 104% = $638.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,640.43,,,,,,,175.0000,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,AETNA,AETNA HEALTHCARE MEDICARE,640.43,,,,,,,175.0000,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,640.43,,,,,,,175.0000,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,AMBETTER,AMBETTER,1396.13,,,,,,,175.0000,1610.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,666.04,,,,,,,175.0000,1610.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,ANTHEM EXCHANGE,1576.77,,,,,,,175.0000,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,632.66,,,,,,,175.0000,1610.0000,fee schedule,"APG 00050 Proc 20606 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $614.23 at 103% = $632.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,ANTHEM HMO,1610.00,,,,,,,175.0000,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,659.64,,,,,,,175.0000,1610.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1610.00,,,,,,,175.0000,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,175.0000,1610.0000,case rate,"Rev 361 Proc 20606 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,175.0000,1610.0000,case rate,Rev 361 Proc 20606 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,BLUE CROSS MEDICARE,666.04,,,,,,,175.0000,1610.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,175.0000,1610.0000,case rate,Rev 361 Proc 20606 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,175.0000,1610.0000,case rate,Rev 361 Proc 20606 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,CIGNA HEALTHCARE,CIGNA HMO,228.00,,,,,,,175.0000,1610.0000,case rate,Rev 361 Proc 20606 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.00,,,,,,,175.0000,1610.0000,case rate,Rev 361 Proc 20606 ASG Rate of $175.00 at 100% of $175.00 = $175.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,672.45,,,,,,,175.0000,1610.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.00,,,,,,,175.0000,1610.0000,case rate,Rev 361 Proc 20606 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,CIGNA HEALTHCARE,CIGNA PPO,228.00,,,,,,,175.0000,1610.0000,case rate,Rev 361 Proc 20606 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,672.45,,,,,,,175.0000,1610.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1449.00,,,,,,,175.0000,1610.0000,percent of total billed charges,"90% of $1,610.00 in Billed Charges for Rev 361 Proc 20606 = $1,449.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,HUMANA,HUMANA MEDICARE,640.43,,,,,,,175.0000,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,640.43,,,,,,,175.0000,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,MEDCOST,MEDCOST VHN,766.20,,,,,,,175.0000,1610.0000,percent of total billed charges,"47.59% of $1,610.00 in Billed Charges for Rev 361 Proc 20606 = $766.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,644.94,,,,,,,175.0000,1610.0000,fee schedule,"APG 00050 Proc 20606 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $614.23 at 100% = $614.23... $614.23 at 105% = $644.94 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,672.45,,,,,,,175.0000,1610.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,672.45,,,,,,,175.0000,1610.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,NHC ADVANTAGE,NHC ADVANTAGE,672.45,,,,,,,175.0000,1610.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,633.27,,,,,,,175.0000,1610.0000,fee schedule,"APG 00050 Proc 20606 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $614.23 at 100% = $614.23... $614.23 at 103.1% = $633.27 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,SENTARA HEALTH,SENTARA HEALTH,415.54,,,,,,,175.0000,1610.0000,percent of total billed charges,"25.81% of $1,610.00 in Billed Charges for Rev 361 Proc 20606 = $415.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,SENTARA HEALTH,SENTARA MEDICARE,640.43,,,,,,,175.0000,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1610.00,,,,,,,175.0000,1610.0000,percent of total billed charges,"100% of $1,610.00 in Billed Charges for Rev 361 Proc 20606 = $1,610.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,175.0000,1610.0000,case rate,Rev 361 Proc 20606 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,175.0000,1610.0000,case rate,Rev 361 Proc 20606 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,175.0000,1610.0000,case rate,Rev 361 Proc 20606 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,175.0000,1610.0000,case rate,"Rev 361 Proc 20606 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,632.66,,,,,,,175.0000,1610.0000,fee schedule,"APG 00050 Proc 20606 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $614.23 at 103% = $632.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,640.43,,,,,,,175.0000,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,640.43,,,,,,,175.0000,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,WELLCARE,WELLCARE MEDICAID,1610.00,,,,,,,175.0000,1610.0000,percent of total billed charges,"100% of $1,610.00 in Billed Charges for Rev 361 Proc 20606 = $1,610.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ INT JT W US GUID,20606,CPT,361,RC,36100266,CDM,,,,both,,,1610.0000,241.5000,WELLCARE,WELLCARE MEDICARE,678.85,,,,,,,175.0000,1610.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,AETNA,AETNA,839.91,,,,,,,23.5500,1967.0000,percent of total billed charges,"42.7% of $1,967.00 in Billed Charges for Rev 361 Proc 20610 = $839.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,354.99,,,,,,,23.5500,1967.0000,fee schedule,"APG 00049 Proc 20610 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 104% = $354.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,278.49,,,,,,,23.5500,1967.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,AETNA,AETNA HEALTHCARE MEDICARE,278.49,,,,,,,23.5500,1967.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,278.49,,,,,,,23.5500,1967.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,AMBETTER,AMBETTER,607.11,,,,,,,23.5500,1967.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,289.63,,,,,,,23.5500,1967.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,BLUE CROSS,ANTHEM EXCHANGE,685.65,,,,,,,23.5500,1967.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,351.57,,,,,,,23.5500,1967.0000,fee schedule,"APG 00049 Proc 20610 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 103% = $351.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,BLUE CROSS,ANTHEM HMO,728.47,,,,,,,23.5500,1967.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,286.84,,,,,,,23.5500,1967.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",856.97,,,,,,,23.5500,1967.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,23.5500,1967.0000,case rate,Rev 361 Proc 20610 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,23.5500,1967.0000,case rate,Rev 361 Proc 20610 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,BLUE CROSS,BLUE CROSS MEDICARE,289.63,,,,,,,23.5500,1967.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,23.5500,1967.0000,case rate,Rev 361 Proc 20610 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,23.5500,1967.0000,case rate,Rev 361 Proc 20610 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,BLUE CROSS,TENNCARE BLUE CARE,23.55,,,,,,,23.5500,1967.0000,fee schedule,$20.30 from Fee Schedule TC_24 for Rev 361 Proc 20610 * Qty 1 = $20.30 at 116% = $23.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,BLUE CROSS,TENNCARE BLUE SELECT,23.55,,,,,,,23.5500,1967.0000,fee schedule,$20.30 from Fee Schedule TC_24 for Rev 361 Proc 20610 * Qty 1 = $20.30 at 116% = $23.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,23.5500,1967.0000,case rate,"Rev 361 Proc 20610 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,23.5500,1967.0000,case rate,"Rev 361 Proc 20610 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,292.41,,,,,,,23.5500,1967.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,23.5500,1967.0000,case rate,"Rev 361 Proc 20610 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,23.5500,1967.0000,case rate,"Rev 361 Proc 20610 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,292.41,,,,,,,23.5500,1967.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1770.30,,,,,,,23.5500,1967.0000,percent of total billed charges,"90% of $1,967.00 in Billed Charges for Rev 361 Proc 20610 = $1,770.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,HUMANA,HUMANA MEDICARE,278.49,,,,,,,23.5500,1967.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,278.49,,,,,,,23.5500,1967.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,MEDCOST,MEDCOST VHN,936.10,,,,,,,23.5500,1967.0000,percent of total billed charges,"47.59% of $1,967.00 in Billed Charges for Rev 361 Proc 20610 = $936.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,358.40,,,,,,,23.5500,1967.0000,fee schedule,"APG 00049 Proc 20610 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 100% = $341.33... $341.33 at 105% = $358.40 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,292.41,,,,,,,23.5500,1967.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,292.41,,,,,,,23.5500,1967.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,NHC ADVANTAGE,NHC ADVANTAGE,292.41,,,,,,,23.5500,1967.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,351.91,,,,,,,23.5500,1967.0000,fee schedule,"APG 00049 Proc 20610 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 100% = $341.33... $341.33 at 103.1% = $351.91 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,SENTARA HEALTH,SENTARA HEALTH,507.68,,,,,,,23.5500,1967.0000,percent of total billed charges,"25.81% of $1,967.00 in Billed Charges for Rev 361 Proc 20610 = $507.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,SENTARA HEALTH,SENTARA MEDICARE,278.49,,,,,,,23.5500,1967.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1967.00,,,,,,,23.5500,1967.0000,percent of total billed charges,"100% of $1,967.00 in Billed Charges for Rev 361 Proc 20610 = $1,967.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,23.5500,1967.0000,case rate,Rev 361 Proc 20610 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,23.5500,1967.0000,case rate,Rev 361 Proc 20610 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,23.5500,1967.0000,case rate,Rev 361 Proc 20610 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,23.5500,1967.0000,case rate,Rev 361 Proc 20610 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,351.57,,,,,,,23.5500,1967.0000,fee schedule,"APG 00049 Proc 20610 at $836.60 (Base Rate) * 0.408 (Relative Weight) = $341.33 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $341.33 at 103% = $351.57. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,278.49,,,,,,,23.5500,1967.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,278.49,,,,,,,23.5500,1967.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,WELLCARE,WELLCARE MEDICAID,1967.00,,,,,,,23.5500,1967.0000,percent of total billed charges,"100% of $1,967.00 in Billed Charges for Rev 361 Proc 20610 = $1,967.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ MAJ JT W/O US GUID UNILAT,20610,CPT,361,RC,36100071,CDM,,,,both,,,1967.0000,295.0500,WELLCARE,WELLCARE MEDICARE,295.20,,,,,,,23.5500,1967.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA,699.85,,,,,,,173.0000,1639.0000,percent of total billed charges,"42.7% of $1,639.00 in Billed Charges for Rev 361 Proc 20611 = $699.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,638.80,,,,,,,173.0000,1639.0000,fee schedule,"APG 00050 Proc 20611 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $614.23 at 104% = $638.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,278.49,,,,,,,173.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA HEALTHCARE MEDICARE,278.49,,,,,,,173.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,278.49,,,,,,,173.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,AMBETTER,AMBETTER,607.11,,,,,,,173.0000,1639.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,289.63,,,,,,,173.0000,1639.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM EXCHANGE,685.65,,,,,,,173.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,632.66,,,,,,,173.0000,1639.0000,fee schedule,"APG 00050 Proc 20611 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $614.23 at 103% = $632.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM HMO,728.47,,,,,,,173.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,286.84,,,,,,,173.0000,1639.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",856.97,,,,,,,173.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,173.0000,1639.0000,case rate,"Rev 361 Proc 20611 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,173.0000,1639.0000,case rate,Rev 361 Proc 20611 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,BLUE CROSS MEDICARE,289.63,,,,,,,173.0000,1639.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,173.0000,1639.0000,case rate,Rev 361 Proc 20611 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,173.0000,1639.0000,case rate,Rev 361 Proc 20611 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,CIGNA HEALTHCARE,CIGNA HMO,228.00,,,,,,,173.0000,1639.0000,case rate,Rev 361 Proc 20611 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.00,,,,,,,173.0000,1639.0000,case rate,Rev 361 Proc 20611 ASG Rate of $175.00 at 100% of $175.00 = $175.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,292.41,,,,,,,173.0000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.00,,,,,,,173.0000,1639.0000,case rate,Rev 361 Proc 20611 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,CIGNA HEALTHCARE,CIGNA PPO,228.00,,,,,,,173.0000,1639.0000,case rate,Rev 361 Proc 20611 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,292.41,,,,,,,173.0000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1475.10,,,,,,,173.0000,1639.0000,percent of total billed charges,"90% of $1,639.00 in Billed Charges for Rev 361 Proc 20611 = $1,475.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,HUMANA,HUMANA MEDICARE,278.49,,,,,,,173.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,278.49,,,,,,,173.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,MEDCOST,MEDCOST VHN,780.00,,,,,,,173.0000,1639.0000,percent of total billed charges,"47.59% of $1,639.00 in Billed Charges for Rev 361 Proc 20611 = $780.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,644.94,,,,,,,173.0000,1639.0000,fee schedule,"APG 00050 Proc 20611 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $614.23 at 100% = $614.23... $614.23 at 105% = $644.94 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,292.41,,,,,,,173.0000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,292.41,,,,,,,173.0000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,NHC ADVANTAGE,NHC ADVANTAGE,292.41,,,,,,,173.0000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,633.27,,,,,,,173.0000,1639.0000,fee schedule,"APG 00050 Proc 20611 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $614.23 at 100% = $614.23... $614.23 at 103.1% = $633.27 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,SENTARA HEALTH,SENTARA HEALTH,423.03,,,,,,,173.0000,1639.0000,percent of total billed charges,"25.81% of $1,639.00 in Billed Charges for Rev 361 Proc 20611 = $423.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,SENTARA HEALTH,SENTARA MEDICARE,278.49,,,,,,,173.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1639.00,,,,,,,173.0000,1639.0000,percent of total billed charges,"100% of $1,639.00 in Billed Charges for Rev 361 Proc 20611 = $1,639.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,173.0000,1639.0000,case rate,Rev 361 Proc 20611 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,173.0000,1639.0000,case rate,Rev 361 Proc 20611 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,173.0000,1639.0000,case rate,Rev 361 Proc 20611 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,173.0000,1639.0000,case rate,Rev 361 Proc 20611 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,632.66,,,,,,,173.0000,1639.0000,fee schedule,"APG 00050 Proc 20611 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $614.23 at 103% = $632.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,278.49,,,,,,,173.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,278.49,,,,,,,173.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,WELLCARE,WELLCARE MEDICAID,1639.00,,,,,,,173.0000,1639.0000,percent of total billed charges,"100% of $1,639.00 in Billed Charges for Rev 361 Proc 20611 = $1,639.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROCENTESIS ASP INJ MAJ JT W US GUID,20611,CPT,361,RC,36100267,CDM,,,,both,,,1639.0000,245.8500,WELLCARE,WELLCARE MEDICARE,295.20,,,,,,,173.0000,1639.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE PERMALOOP,272,RC,27200002,CDM,,,,,,both,,,1186.3400,177.9500,AETNA,AETNA,506.57,,,,,,,306.1900,1186.3400,percent of total billed charges,"42.7% of $1,186.34 in Billed Charges for Rev 272 = $506.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMALOOP,272,RC,27200002,CDM,,,,,,both,,,1186.3400,177.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,830.44,,,,,,,306.1900,1186.3400,percent of total billed charges,"Rev 272 $1,186.34 in Billed Charges at 70% = $830.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMALOOP,272,RC,27200002,CDM,,,,,,both,,,1186.3400,177.9500,CIGNA HEALTHCARE,CIGNA HMO,494.70,,,,,,,306.1900,1186.3400,percent of total billed charges,"41.7% of $1,186.34 in Billed Charges for Rev 272 = $494.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMALOOP,272,RC,27200002,CDM,,,,,,both,,,1186.3400,177.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,550.46,,,,,,,306.1900,1186.3400,percent of total billed charges,"46.4% of $1,186.34 in Billed Charges for Rev 272 = $550.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMALOOP,272,RC,27200002,CDM,,,,,,both,,,1186.3400,177.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,494.70,,,,,,,306.1900,1186.3400,percent of total billed charges,"41.7% of $1,186.34 in Billed Charges for Rev 272 = $494.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMALOOP,272,RC,27200002,CDM,,,,,,both,,,1186.3400,177.9500,CIGNA HEALTHCARE,CIGNA PPO,494.70,,,,,,,306.1900,1186.3400,percent of total billed charges,"41.7% of $1,186.34 in Billed Charges for Rev 272 = $494.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMALOOP,272,RC,27200002,CDM,,,,,,both,,,1186.3400,177.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1067.71,,,,,,,306.1900,1186.3400,percent of total billed charges,"90% of $1,186.34 in Billed Charges for Rev 272 = $1,067.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMALOOP,272,RC,27200002,CDM,,,,,,both,,,1186.3400,177.9500,MEDCOST,MEDCOST VHN,564.58,,,,,,,306.1900,1186.3400,percent of total billed charges,"47.59% of $1,186.34 in Billed Charges for Rev 272 = $564.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMALOOP,272,RC,27200002,CDM,,,,,,both,,,1186.3400,177.9500,SENTARA HEALTH,SENTARA HEALTH,306.19,,,,,,,306.1900,1186.3400,percent of total billed charges,"25.81% of $1,186.34 in Billed Charges for Rev 272 = $306.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMALOOP,272,RC,27200002,CDM,,,,,,both,,,1186.3400,177.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1186.34,,,,,,,306.1900,1186.3400,percent of total billed charges,"100% of $1,186.34 in Billed Charges for Rev 272 = $1,186.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMALOOP,272,RC,27200002,CDM,,,,,,both,,,1186.3400,177.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,593.17,,,,,,,306.1900,1186.3400,percent of total billed charges,"Rev 272 $1,186.34 in Billed Charges at 50% = $593.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMALOOP,272,RC,27200002,CDM,,,,,,both,,,1186.3400,177.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,383.19,,,,,,,306.1900,1186.3400,other,"32.3% of $1,186.34 in Billed Charges for Rev 272 = $383.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PERMALOOP,272,RC,27200002,CDM,,,,,,both,,,1186.3400,177.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,364.21,,,,,,,306.1900,1186.3400,other,"30.7% of $1,186.34 in Billed Charges for Rev 272 = $364.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PERMALOOP,272,RC,27200002,CDM,,,,,,both,,,1186.3400,177.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,383.19,,,,,,,306.1900,1186.3400,percent of total billed charges,"32.3% of $1,186.34 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMALOOP,272,RC,27200002,CDM,,,,,,both,,,1186.3400,177.9500,WELLCARE,WELLCARE MEDICAID,1186.34,,,,,,,306.1900,1186.3400,percent of total billed charges,"100% of $1,186.34 in Billed Charges for Rev 272 = $1,186.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE MO-7,272,RC,27200002,CDM,,,,,,both,,,1196.0900,179.4100,AETNA,AETNA,510.73,,,,,,,308.7100,1196.0900,percent of total billed charges,"42.7% of $1,196.09 in Billed Charges for Rev 272 = $510.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE MO-7,272,RC,27200002,CDM,,,,,,both,,,1196.0900,179.4100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,837.26,,,,,,,308.7100,1196.0900,percent of total billed charges,"Rev 272 $1,196.09 in Billed Charges at 70% = $837.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE MO-7,272,RC,27200002,CDM,,,,,,both,,,1196.0900,179.4100,CIGNA HEALTHCARE,CIGNA HMO,498.77,,,,,,,308.7100,1196.0900,percent of total billed charges,"41.7% of $1,196.09 in Billed Charges for Rev 272 = $498.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE MO-7,272,RC,27200002,CDM,,,,,,both,,,1196.0900,179.4100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,554.99,,,,,,,308.7100,1196.0900,percent of total billed charges,"46.4% of $1,196.09 in Billed Charges for Rev 272 = $554.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE MO-7,272,RC,27200002,CDM,,,,,,both,,,1196.0900,179.4100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,498.77,,,,,,,308.7100,1196.0900,percent of total billed charges,"41.7% of $1,196.09 in Billed Charges for Rev 272 = $498.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE MO-7,272,RC,27200002,CDM,,,,,,both,,,1196.0900,179.4100,CIGNA HEALTHCARE,CIGNA PPO,498.77,,,,,,,308.7100,1196.0900,percent of total billed charges,"41.7% of $1,196.09 in Billed Charges for Rev 272 = $498.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE MO-7,272,RC,27200002,CDM,,,,,,both,,,1196.0900,179.4100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1076.48,,,,,,,308.7100,1196.0900,percent of total billed charges,"90% of $1,196.09 in Billed Charges for Rev 272 = $1,076.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE MO-7,272,RC,27200002,CDM,,,,,,both,,,1196.0900,179.4100,MEDCOST,MEDCOST VHN,569.22,,,,,,,308.7100,1196.0900,percent of total billed charges,"47.59% of $1,196.09 in Billed Charges for Rev 272 = $569.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE MO-7,272,RC,27200002,CDM,,,,,,both,,,1196.0900,179.4100,SENTARA HEALTH,SENTARA HEALTH,308.71,,,,,,,308.7100,1196.0900,percent of total billed charges,"25.81% of $1,196.09 in Billed Charges for Rev 272 = $308.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE MO-7,272,RC,27200002,CDM,,,,,,both,,,1196.0900,179.4100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1196.09,,,,,,,308.7100,1196.0900,percent of total billed charges,"100% of $1,196.09 in Billed Charges for Rev 272 = $1,196.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE MO-7,272,RC,27200002,CDM,,,,,,both,,,1196.0900,179.4100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,598.05,,,,,,,308.7100,1196.0900,percent of total billed charges,"Rev 272 $1,196.09 in Billed Charges at 50% = $598.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE MO-7,272,RC,27200002,CDM,,,,,,both,,,1196.0900,179.4100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,386.34,,,,,,,308.7100,1196.0900,other,"32.3% of $1,196.09 in Billed Charges for Rev 272 = $386.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PERMATAPE 1.3 BLUE MO-7,272,RC,27200002,CDM,,,,,,both,,,1196.0900,179.4100,UNITED HEALTHCARE,UHC HERITAGE SELECT,367.20,,,,,,,308.7100,1196.0900,other,"30.7% of $1,196.09 in Billed Charges for Rev 272 = $367.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PERMATAPE 1.3 BLUE MO-7,272,RC,27200002,CDM,,,,,,both,,,1196.0900,179.4100,UNITED HEALTHCARE,UNITED HEALTHCARE,386.34,,,,,,,308.7100,1196.0900,percent of total billed charges,"32.3% of $1,196.09 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE 1.3 BLUE MO-7,272,RC,27200002,CDM,,,,,,both,,,1196.0900,179.4100,WELLCARE,WELLCARE MEDICAID,1196.09,,,,,,,308.7100,1196.0900,percent of total billed charges,"100% of $1,196.09 in Billed Charges for Rev 272 = $1,196.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA,584.99,,,,,,,109.0000,1370.0000,percent of total billed charges,"42.7% of $1,370.00 in Billed Charges for Rev 450 Proc 27550 = $584.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,1370.0000,fee schedule,"APG 00041 Proc 27550 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,1370.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,1370.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,1370.0000,fee schedule,"APG 00041 Proc 27550 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,1370.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,490.19,,,,,,,109.0000,1370.0000,fee schedule,$490.19 from Fee Schedule BLDTM_23 for Rev 450 Proc 27550 * Qty 1 = $490.19 at 100% = $490.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,1370.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1233.00,,,,,,,109.0000,1370.0000,percent of total billed charges,"90% of $1,370.00 in Billed Charges for Rev 450 Proc 27550 = $1,233.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,MEDCOST,MEDCOST VHN,651.98,,,,,,,109.0000,1370.0000,percent of total billed charges,"47.59% of $1,370.00 in Billed Charges for Rev 450 Proc 27550 = $651.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,1370.0000,fee schedule,"APG 00041 Proc 27550 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,1370.0000,fee schedule,"APG 00041 Proc 27550 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,SENTARA HEALTH,SENTARA HEALTH,353.60,,,,,,,109.0000,1370.0000,percent of total billed charges,"25.81% of $1,370.00 in Billed Charges for Rev 450 Proc 27550 = $353.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1370.00,,,,,,,109.0000,1370.0000,percent of total billed charges,"100% of $1,370.00 in Billed Charges for Rev 450 Proc 27550 = $1,370.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1370.0000,case rate,Rev 450 Proc 27550 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1370.0000,case rate,Rev 450 Proc 27550 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1370.0000,case rate,Rev 450 Proc 27550 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1370.0000,case rate,Rev 450 Proc 27550 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,1370.0000,fee schedule,"APG 00041 Proc 27550 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,WELLCARE,WELLCARE MEDICAID,1370.00,,,,,,,109.0000,1370.0000,percent of total billed charges,"100% of $1,370.00 in Billed Charges for Rev 450 Proc 27550 = $1,370.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLS TX KNEE DISLOCATION WO AN,27550,CPT,450,RC,45000161,CDM,,,,both,,,1370.0000,205.5000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,1370.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,AETNA,AETNA,1876.67,,,,,,,109.0000,4395.0000,percent of total billed charges,"42.7% of $4,395.00 in Billed Charges for Rev 450 Proc 27552 = $1,876.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1450.92,,,,,,,109.0000,4395.0000,fee schedule,"APG 00044 Proc 27552 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 104% = $1,450.92. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,4395.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4395.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,4395.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,4395.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,4395.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,109.0000,4395.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1436.97,,,,,,,109.0000,4395.0000,fee schedule,"APG 00044 Proc 27552 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 103% = $1,436.97. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,109.0000,4395.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,4395.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4395.00,,,,,,,109.0000,4395.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,620.72,,,,,,,109.0000,4395.0000,fee schedule,$620.72 from Fee Schedule BLDTM_23 for Rev 450 Proc 27552 * Qty 1 = $620.72 at 100% = $620.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,4395.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,4395.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,4395.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3955.50,,,,,,,109.0000,4395.0000,percent of total billed charges,"90% of $4,395.00 in Billed Charges for Rev 450 Proc 27552 = $3,955.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,4395.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,4395.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,MEDCOST,MEDCOST VHN,2091.58,,,,,,,109.0000,4395.0000,percent of total billed charges,"47.59% of $4,395.00 in Billed Charges for Rev 450 Proc 27552 = $2,091.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1464.87,,,,,,,109.0000,4395.0000,fee schedule,"APG 00044 Proc 27552 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 100% = $1,395.11... $1,395.11 at 105% = $1,464.87 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,4395.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,4395.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,4395.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1438.36,,,,,,,109.0000,4395.0000,fee schedule,"APG 00044 Proc 27552 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 100% = $1,395.11... $1,395.11 at 103.1% = $1,438.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,SENTARA HEALTH,SENTARA HEALTH,1134.35,,,,,,,109.0000,4395.0000,percent of total billed charges,"25.81% of $4,395.00 in Billed Charges for Rev 450 Proc 27552 = $1,134.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,4395.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4395.00,,,,,,,109.0000,4395.0000,percent of total billed charges,"100% of $4,395.00 in Billed Charges for Rev 450 Proc 27552 = $4,395.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,4395.0000,case rate,Rev 450 Proc 27552 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,4395.0000,case rate,Rev 450 Proc 27552 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,4395.0000,case rate,Rev 450 Proc 27552 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,4395.0000,case rate,Rev 450 Proc 27552 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1436.97,,,,,,,109.0000,4395.0000,fee schedule,"APG 00044 Proc 27552 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 103% = $1,436.97. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4395.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,4395.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,WELLCARE,WELLCARE MEDICAID,4395.00,,,,,,,109.0000,4395.0000,percent of total billed charges,"100% of $4,395.00 in Billed Charges for Rev 450 Proc 27552 = $4,395.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TX KNEE DISLOCATION W/ANESTHESIA,27552,CPT,450,RC,45000423,CDM,,,,both,,,4395.0000,659.2500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,4395.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA,584.99,,,,,,,109.0000,1370.0000,percent of total billed charges,"42.7% of $1,370.00 in Billed Charges for Rev 450 Proc 27560 = $584.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,1370.0000,fee schedule,"APG 00041 Proc 27560 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,1370.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,1370.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,1370.0000,fee schedule,"APG 00041 Proc 27560 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,1370.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,330.53,,,,,,,109.0000,1370.0000,fee schedule,$330.53 from Fee Schedule BLDTM_23 for Rev 450 Proc 27560 * Qty 1 = $330.53 at 100% = $330.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,1370.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1233.00,,,,,,,109.0000,1370.0000,percent of total billed charges,"90% of $1,370.00 in Billed Charges for Rev 450 Proc 27560 = $1,233.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,MEDCOST,MEDCOST VHN,651.98,,,,,,,109.0000,1370.0000,percent of total billed charges,"47.59% of $1,370.00 in Billed Charges for Rev 450 Proc 27560 = $651.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,1370.0000,fee schedule,"APG 00041 Proc 27560 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,1370.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,1370.0000,fee schedule,"APG 00041 Proc 27560 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,SENTARA HEALTH,SENTARA HEALTH,353.60,,,,,,,109.0000,1370.0000,percent of total billed charges,"25.81% of $1,370.00 in Billed Charges for Rev 450 Proc 27560 = $353.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1370.00,,,,,,,109.0000,1370.0000,percent of total billed charges,"100% of $1,370.00 in Billed Charges for Rev 450 Proc 27560 = $1,370.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1370.0000,case rate,Rev 450 Proc 27560 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1370.0000,case rate,Rev 450 Proc 27560 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1370.0000,case rate,Rev 450 Proc 27560 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1370.0000,case rate,Rev 450 Proc 27560 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,1370.0000,fee schedule,"APG 00041 Proc 27560 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,1370.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,WELLCARE,WELLCARE MEDICAID,1370.00,,,,,,,109.0000,1370.0000,percent of total billed charges,"100% of $1,370.00 in Billed Charges for Rev 450 Proc 27560 = $1,370.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOS TX PATR DISLOC WO ANES,27560,CPT,450,RC,45000162,CDM,,,,both,,,1370.0000,205.5000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,1370.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,AETNA,AETNA,4208.51,,,,,,,109.0000,9856.0000,percent of total billed charges,"42.7% of $9,856.00 in Billed Charges for Rev 450 Proc 27602 = $4,208.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,4702.78,,,,,,,109.0000,9856.0000,fee schedule,"APG 00026 Proc 27602 at $836.60 (Base Rate) * 5.4051 (Relative Weight) = $4,521.91 (Total Line Payment) at 104% = $4,702.78. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2968.60,,,,,,,109.0000,9856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,AETNA,AETNA HEALTHCARE MEDICARE,2968.60,,,,,,,109.0000,9856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,2968.60,,,,,,,109.0000,9856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,AMBETTER,AMBETTER,6471.55,,,,,,,109.0000,9856.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3087.35,,,,,,,109.0000,9856.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,BLUE CROSS,ANTHEM EXCHANGE,7308.87,,,,,,,109.0000,9856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,4657.56,,,,,,,109.0000,9856.0000,fee schedule,"APG 00026 Proc 27602 at $836.60 (Base Rate) * 5.4051 (Relative Weight) = $4,521.91 (Total Line Payment) at 103% = $4,657.56. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,BLUE CROSS,ANTHEM HMO,7765.24,,,,,,,109.0000,9856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3057.66,,,,,,,109.0000,9856.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9135.08,,,,,,,109.0000,9856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,434.30,,,,,,,109.0000,9856.0000,fee schedule,$434.30 from Fee Schedule BLDTM_23 for Rev 450 Proc 27602 * Qty 1 = $434.30 at 100% = $434.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,BLUE CROSS,BLUE CROSS MEDICARE,3087.35,,,,,,,109.0000,9856.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,3117.03,,,,,,,109.0000,9856.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3117.03,,,,,,,109.0000,9856.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8870.40,,,,,,,109.0000,9856.0000,percent of total billed charges,"90% of $9,856.00 in Billed Charges for Rev 450 Proc 27602 = $8,870.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,HUMANA,HUMANA MEDICARE,2968.60,,,,,,,109.0000,9856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2968.60,,,,,,,109.0000,9856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,MEDCOST,MEDCOST VHN,4690.47,,,,,,,109.0000,9856.0000,percent of total billed charges,"47.59% of $9,856.00 in Billed Charges for Rev 450 Proc 27602 = $4,690.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,4748.01,,,,,,,109.0000,9856.0000,fee schedule,"APG 00026 Proc 27602 at $836.60 (Base Rate) * 5.4051 (Relative Weight) = $4,521.91 (Total Line Payment) at 100% = $4,521.91... $4,521.91 at 105% = $4,748.01 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3117.03,,,,,,,109.0000,9856.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3117.03,,,,,,,109.0000,9856.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,NHC ADVANTAGE,NHC ADVANTAGE,3117.03,,,,,,,109.0000,9856.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,4662.09,,,,,,,109.0000,9856.0000,fee schedule,"APG 00026 Proc 27602 at $836.60 (Base Rate) * 5.4051 (Relative Weight) = $4,521.91 (Total Line Payment) at 100% = $4,521.91... $4,521.91 at 103.1% = $4,662.09 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,SENTARA HEALTH,SENTARA HEALTH,2543.83,,,,,,,109.0000,9856.0000,percent of total billed charges,"25.81% of $9,856.00 in Billed Charges for Rev 450 Proc 27602 = $2,543.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,SENTARA HEALTH,SENTARA MEDICARE,2968.60,,,,,,,109.0000,9856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9856.00,,,,,,,109.0000,9856.0000,percent of total billed charges,"100% of $9,856.00 in Billed Charges for Rev 450 Proc 27602 = $9,856.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,9856.0000,case rate,Rev 450 Proc 27602 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,9856.0000,case rate,Rev 450 Proc 27602 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,9856.0000,case rate,Rev 450 Proc 27602 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,9856.0000,case rate,Rev 450 Proc 27602 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,4657.56,,,,,,,109.0000,9856.0000,fee schedule,"APG 00026 Proc 27602 at $836.60 (Base Rate) * 5.4051 (Relative Weight) = $4,521.91 (Total Line Payment) at 103% = $4,657.56. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2968.60,,,,,,,109.0000,9856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2968.60,,,,,,,109.0000,9856.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,WELLCARE,WELLCARE MEDICAID,9856.00,,,,,,,109.0000,9856.0000,percent of total billed charges,"100% of $9,856.00 in Billed Charges for Rev 450 Proc 27602 = $9,856.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DECOMP FASCIOTOMY LEG ANTERIOR &/OR LATERAL,27602,CPT,450,RC,45000319,CDM,,,,both,,,9856.0000,1478.4000,WELLCARE,WELLCARE MEDICARE,3146.72,,,,,,,109.0000,9856.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,AETNA,AETNA,1966.76,,,,,,,704.0000,4606.0000,percent of total billed charges,"42.7% of $4,606.00 in Billed Charges for Rev 361 Proc 27605 = $1,966.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3128.66,,,,,,,704.0000,4606.0000,fee schedule,"APG 00035 Proc 27605 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 104% = $3,128.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,704.0000,4606.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,704.0000,4606.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,704.0000,4606.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,AMBETTER,AMBETTER,3180.38,,,,,,,704.0000,4606.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,704.0000,4606.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,704.0000,4606.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3098.58,,,,,,,704.0000,4606.0000,fee schedule,"APG 00035 Proc 27605 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 103% = $3,098.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,704.0000,4606.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,704.0000,4606.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4489.34,,,,,,,704.0000,4606.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,704.0000,4606.0000,case rate,Rev 361 Proc 27605 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,704.0000,4606.0000,case rate,"Rev 361 Proc 27605 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,704.0000,4606.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,704.0000,4606.0000,case rate,"Rev 361 Proc 27605 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,704.0000,4606.0000,case rate,"Rev 361 Proc 27605 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,BLUE CROSS,TENNCARE BLUE CARE,890.00,,,,,,,704.0000,4606.0000,case rate,Rev 361 Proc 27605 ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,BLUE CROSS,TENNCARE BLUE SELECT,890.00,,,,,,,704.0000,4606.0000,case rate,Rev 361 Proc 27605 ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,704.0000,4606.0000,case rate,"Rev 361 Proc 27605 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,704.0000,4606.0000,case rate,"Rev 361 Proc 27605 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,704.0000,4606.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,704.0000,4606.0000,case rate,"Rev 361 Proc 27605 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,704.0000,4606.0000,case rate,"Rev 361 Proc 27605 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,704.0000,4606.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4145.40,,,,,,,704.0000,4606.0000,percent of total billed charges,"90% of $4,606.00 in Billed Charges for Rev 361 Proc 27605 = $4,145.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,704.0000,4606.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,704.0000,4606.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,MEDCOST,MEDCOST VHN,2192.00,,,,,,,704.0000,4606.0000,percent of total billed charges,"47.59% of $4,606.00 in Billed Charges for Rev 361 Proc 27605 = $2,192.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3158.75,,,,,,,704.0000,4606.0000,fee schedule,"APG 00035 Proc 27605 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 100% = $3,008.33... $3,008.33 at 105% = $3,158.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,704.0000,4606.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,704.0000,4606.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,704.0000,4606.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3101.59,,,,,,,704.0000,4606.0000,fee schedule,"APG 00035 Proc 27605 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 100% = $3,008.33... $3,008.33 at 103.1% = $3,101.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,SENTARA HEALTH,SENTARA HEALTH,1188.81,,,,,,,704.0000,4606.0000,percent of total billed charges,"25.81% of $4,606.00 in Billed Charges for Rev 361 Proc 27605 = $1,188.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,704.0000,4606.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4606.00,,,,,,,704.0000,4606.0000,percent of total billed charges,"100% of $4,606.00 in Billed Charges for Rev 361 Proc 27605 = $4,606.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1418.00,,,,,,,704.0000,4606.0000,case rate,"Rev 361 Proc 27605 ASG Rate of $1,418.00 at 100% of $1,418.00 = $1,418.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2547.00,,,,,,,704.0000,4606.0000,case rate,"Rev 361 Proc 27605 ASG Rate of $2,547.00 at 100% of $2,547.00 = $2,547.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2436.00,,,,,,,704.0000,4606.0000,case rate,"Rev 361 Proc 27605 ASG Rate of $2,436.00 at 100% of $2,436.00 = $2,436.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,4296.00,,,,,,,704.0000,4606.0000,case rate,"Rev 361 Proc 27605 ASG Rate of $4,296.00 at 100% of $4,296.00 = $4,296.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3098.58,,,,,,,704.0000,4606.0000,fee schedule,"APG 00035 Proc 27605 at $836.60 (Base Rate) * 3.5959 (Relative Weight) = $3,008.33 (Total Line Payment) at 103% = $3,098.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,704.0000,4606.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,704.0000,4606.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,WELLCARE,WELLCARE MEDICAID,4606.00,,,,,,,704.0000,4606.0000,percent of total billed charges,"100% of $4,606.00 in Billed Charges for Rev 361 Proc 27605 = $4,606.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TENTOMY PERC ACHILLES TENDON LOCAL ANES,27605,CPT,361,RC,36100514,CDM,,,,both,,,4606.0000,690.9000,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,704.0000,4606.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC ANKLE ARTHROGRAM,27648,CPT,361,RC,36100356,CDM,,,,both,,,1035.0000,155.2500,AETNA,AETNA,441.95,,,,,,,148.0000,1035.0000,percent of total billed charges,"42.7% of $1,035.00 in Billed Charges for Rev 361 Proc 27648 = $441.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ PROC ANKLE ARTHROGRAM,27648,CPT,361,RC,36100356,CDM,,,,both,,,1035.0000,155.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,495.24,,,,,,,148.0000,1035.0000,fee schedule,APG 00278 Proc 27648 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 104% = $495.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC ANKLE ARTHROGRAM,27648,CPT,361,RC,36100356,CDM,,,,both,,,1035.0000,155.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,490.48,,,,,,,148.0000,1035.0000,fee schedule,APG 00278 Proc 27648 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 103% = $490.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC ANKLE ARTHROGRAM,27648,CPT,361,RC,36100356,CDM,,,,both,,,1035.0000,155.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1035.00,,,,,,,148.0000,1035.0000,case rate,"Rev 361 Proc 27648 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $1,035.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,035.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ PROC ANKLE ARTHROGRAM,27648,CPT,361,RC,36100356,CDM,,,,both,,,1035.0000,155.2500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,1035.0000,case rate,Rev 361 Proc 27648 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC ANKLE ARTHROGRAM,27648,CPT,361,RC,36100356,CDM,,,,both,,,1035.0000,155.2500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,1035.0000,case rate,Rev 361 Proc 27648 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC ANKLE ARTHROGRAM,27648,CPT,361,RC,36100356,CDM,,,,both,,,1035.0000,155.2500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,1035.0000,case rate,Rev 361 Proc 27648 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC ANKLE ARTHROGRAM,27648,CPT,361,RC,36100356,CDM,,,,both,,,1035.0000,155.2500,CIGNA HEALTHCARE,CIGNA HMO,1035.00,,,,,,,148.0000,1035.0000,case rate,"Rev 361 Proc 27648 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,035.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,035.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ PROC ANKLE ARTHROGRAM,27648,CPT,361,RC,36100356,CDM,,,,both,,,1035.0000,155.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1035.00,,,,,,,148.0000,1035.0000,case rate,"Rev 361 Proc 27648 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,035.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,035.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ PROC ANKLE ARTHROGRAM,27648,CPT,361,RC,36100356,CDM,,,,both,,,1035.0000,155.2500,CIGNA HEALTHCARE,CIGNA PPO,1035.00,,,,,,,148.0000,1035.0000,case rate,"Rev 361 Proc 27648 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,035.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,035.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ PROC ANKLE ARTHROGRAM,27648,CPT,361,RC,36100356,CDM,,,,both,,,1035.0000,155.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,931.50,,,,,,,148.0000,1035.0000,percent of total billed charges,"90% of $1,035.00 in Billed Charges for Rev 361 Proc 27648 = $931.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ PROC ANKLE ARTHROGRAM,27648,CPT,361,RC,36100356,CDM,,,,both,,,1035.0000,155.2500,MEDCOST,MEDCOST VHN,492.56,,,,,,,148.0000,1035.0000,percent of total billed charges,"47.59% of $1,035.00 in Billed Charges for Rev 361 Proc 27648 = $492.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ PROC ANKLE ARTHROGRAM,27648,CPT,361,RC,36100356,CDM,,,,both,,,1035.0000,155.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,500.00,,,,,,,148.0000,1035.0000,fee schedule,APG 00278 Proc 27648 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 100% = $476.19... $476.19 at 105% = $500.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC ANKLE ARTHROGRAM,27648,CPT,361,RC,36100356,CDM,,,,both,,,1035.0000,155.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,490.95,,,,,,,148.0000,1035.0000,fee schedule,APG 00278 Proc 27648 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 100% = $476.19... $476.19 at 103.1% = $490.95 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC ANKLE ARTHROGRAM,27648,CPT,361,RC,36100356,CDM,,,,both,,,1035.0000,155.2500,SENTARA HEALTH,SENTARA HEALTH,267.13,,,,,,,148.0000,1035.0000,percent of total billed charges,"25.81% of $1,035.00 in Billed Charges for Rev 361 Proc 27648 = $267.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ PROC ANKLE ARTHROGRAM,27648,CPT,361,RC,36100356,CDM,,,,both,,,1035.0000,155.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1035.00,,,,,,,148.0000,1035.0000,percent of total billed charges,"100% of $1,035.00 in Billed Charges for Rev 361 Proc 27648 = $1,035.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ PROC ANKLE ARTHROGRAM,27648,CPT,361,RC,36100356,CDM,,,,both,,,1035.0000,155.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,148.0000,1035.0000,case rate,Rev 361 Proc 27648 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC ANKLE ARTHROGRAM,27648,CPT,361,RC,36100356,CDM,,,,both,,,1035.0000,155.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,148.0000,1035.0000,case rate,Rev 361 Proc 27648 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC ANKLE ARTHROGRAM,27648,CPT,361,RC,36100356,CDM,,,,both,,,1035.0000,155.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,148.0000,1035.0000,case rate,Rev 361 Proc 27648 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC ANKLE ARTHROGRAM,27648,CPT,361,RC,36100356,CDM,,,,both,,,1035.0000,155.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,148.0000,1035.0000,case rate,Rev 361 Proc 27648 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC ANKLE ARTHROGRAM,27648,CPT,361,RC,36100356,CDM,,,,both,,,1035.0000,155.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,490.48,,,,,,,148.0000,1035.0000,fee schedule,APG 00278 Proc 27648 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 103% = $490.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ PROC ANKLE ARTHROGRAM,27648,CPT,361,RC,36100356,CDM,,,,both,,,1035.0000,155.2500,WELLCARE,WELLCARE MEDICAID,1035.00,,,,,,,148.0000,1035.0000,percent of total billed charges,"100% of $1,035.00 in Billed Charges for Rev 361 Proc 27648 = $1,035.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,AETNA,AETNA,544.00,,,,,,,109.0000,1274.0000,percent of total billed charges,"42.7% of $1,274.00 in Billed Charges for Rev 450 Proc 27760 = $544.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,1274.0000,fee schedule,"APG 00041 Proc 27760 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,1274.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,1274.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,1274.0000,fee schedule,"APG 00041 Proc 27760 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,1274.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,237.34,,,,,,,109.0000,1274.0000,fee schedule,$237.34 from Fee Schedule BLDTM_23 for Rev 450 Proc 27760 * Qty 1 = $237.34 at 100% = $237.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,1274.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1146.60,,,,,,,109.0000,1274.0000,percent of total billed charges,"90% of $1,274.00 in Billed Charges for Rev 450 Proc 27760 = $1,146.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,MEDCOST,MEDCOST VHN,606.30,,,,,,,109.0000,1274.0000,percent of total billed charges,"47.59% of $1,274.00 in Billed Charges for Rev 450 Proc 27760 = $606.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,1274.0000,fee schedule,"APG 00041 Proc 27760 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,1274.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,1274.0000,fee schedule,"APG 00041 Proc 27760 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,SENTARA HEALTH,SENTARA HEALTH,328.82,,,,,,,109.0000,1274.0000,percent of total billed charges,"25.81% of $1,274.00 in Billed Charges for Rev 450 Proc 27760 = $328.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1274.00,,,,,,,109.0000,1274.0000,percent of total billed charges,"100% of $1,274.00 in Billed Charges for Rev 450 Proc 27760 = $1,274.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1274.0000,case rate,Rev 450 Proc 27760 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1274.0000,case rate,Rev 450 Proc 27760 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1274.0000,case rate,Rev 450 Proc 27760 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1274.0000,case rate,Rev 450 Proc 27760 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,1274.0000,fee schedule,"APG 00041 Proc 27760 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,1274.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,WELLCARE,WELLCARE MEDICAID,1274.00,,,,,,,109.0000,1274.0000,percent of total billed charges,"100% of $1,274.00 in Billed Charges for Rev 450 Proc 27760 = $1,274.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX MED MALLEOLUS WO MANI,27760,CPT,450,RC,45000165,CDM,,,,both,,,1274.0000,191.1000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,1274.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SYSTEM TUBE RETAINING 12FR NASAL BRIDAL,272,RC,27200002,CDM,,,,,,both,,,9509.1700,1426.3800,AETNA,AETNA,4060.42,,,,,,,2454.3200,9509.1700,percent of total billed charges,"42.7% of $9,509.17 in Billed Charges for Rev 272 = $4,060.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TUBE RETAINING 12FR NASAL BRIDAL,272,RC,27200002,CDM,,,,,,both,,,9509.1700,1426.3800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6656.42,,,,,,,2454.3200,9509.1700,percent of total billed charges,"Rev 272 $9,509.17 in Billed Charges at 70% = $6,656.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TUBE RETAINING 12FR NASAL BRIDAL,272,RC,27200002,CDM,,,,,,both,,,9509.1700,1426.3800,CIGNA HEALTHCARE,CIGNA HMO,3965.32,,,,,,,2454.3200,9509.1700,percent of total billed charges,"41.7% of $9,509.17 in Billed Charges for Rev 272 = $3,965.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TUBE RETAINING 12FR NASAL BRIDAL,272,RC,27200002,CDM,,,,,,both,,,9509.1700,1426.3800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4412.25,,,,,,,2454.3200,9509.1700,percent of total billed charges,"46.4% of $9,509.17 in Billed Charges for Rev 272 = $4,412.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TUBE RETAINING 12FR NASAL BRIDAL,272,RC,27200002,CDM,,,,,,both,,,9509.1700,1426.3800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3965.32,,,,,,,2454.3200,9509.1700,percent of total billed charges,"41.7% of $9,509.17 in Billed Charges for Rev 272 = $3,965.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TUBE RETAINING 12FR NASAL BRIDAL,272,RC,27200002,CDM,,,,,,both,,,9509.1700,1426.3800,CIGNA HEALTHCARE,CIGNA PPO,3965.32,,,,,,,2454.3200,9509.1700,percent of total billed charges,"41.7% of $9,509.17 in Billed Charges for Rev 272 = $3,965.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TUBE RETAINING 12FR NASAL BRIDAL,272,RC,27200002,CDM,,,,,,both,,,9509.1700,1426.3800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8558.25,,,,,,,2454.3200,9509.1700,percent of total billed charges,"90% of $9,509.17 in Billed Charges for Rev 272 = $8,558.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TUBE RETAINING 12FR NASAL BRIDAL,272,RC,27200002,CDM,,,,,,both,,,9509.1700,1426.3800,MEDCOST,MEDCOST VHN,4525.41,,,,,,,2454.3200,9509.1700,percent of total billed charges,"47.59% of $9,509.17 in Billed Charges for Rev 272 = $4,525.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TUBE RETAINING 12FR NASAL BRIDAL,272,RC,27200002,CDM,,,,,,both,,,9509.1700,1426.3800,SENTARA HEALTH,SENTARA HEALTH,2454.32,,,,,,,2454.3200,9509.1700,percent of total billed charges,"25.81% of $9,509.17 in Billed Charges for Rev 272 = $2,454.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TUBE RETAINING 12FR NASAL BRIDAL,272,RC,27200002,CDM,,,,,,both,,,9509.1700,1426.3800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9509.17,,,,,,,2454.3200,9509.1700,percent of total billed charges,"100% of $9,509.17 in Billed Charges for Rev 272 = $9,509.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TUBE RETAINING 12FR NASAL BRIDAL,272,RC,27200002,CDM,,,,,,both,,,9509.1700,1426.3800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4754.59,,,,,,,2454.3200,9509.1700,percent of total billed charges,"Rev 272 $9,509.17 in Billed Charges at 50% = $4,754.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TUBE RETAINING 12FR NASAL BRIDAL,272,RC,27200002,CDM,,,,,,both,,,9509.1700,1426.3800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3071.46,,,,,,,2454.3200,9509.1700,other,"32.3% of $9,509.17 in Billed Charges for Rev 272 = $3,071.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM TUBE RETAINING 12FR NASAL BRIDAL,272,RC,27200002,CDM,,,,,,both,,,9509.1700,1426.3800,UNITED HEALTHCARE,UHC HERITAGE SELECT,2919.32,,,,,,,2454.3200,9509.1700,other,"30.7% of $9,509.17 in Billed Charges for Rev 272 = $2,919.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SYSTEM TUBE RETAINING 12FR NASAL BRIDAL,272,RC,27200002,CDM,,,,,,both,,,9509.1700,1426.3800,UNITED HEALTHCARE,UNITED HEALTHCARE,3071.46,,,,,,,2454.3200,9509.1700,percent of total billed charges,"32.3% of $9,509.17 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM TUBE RETAINING 12FR NASAL BRIDAL,272,RC,27200002,CDM,,,,,,both,,,9509.1700,1426.3800,WELLCARE,WELLCARE MEDICAID,9509.17,,,,,,,2454.3200,9509.1700,percent of total billed charges,"100% of $9,509.17 in Billed Charges for Rev 272 = $9,509.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SYSTEM VISIBILITY LAPAROVUE,272,RC,27200002,CDM,,,,,,both,,,311.1300,46.6700,AETNA,AETNA,132.85,,,,,,,80.3000,311.1300,percent of total billed charges,42.7% of $311.13 in Billed Charges for Rev 272 = $132.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM VISIBILITY LAPAROVUE,272,RC,27200002,CDM,,,,,,both,,,311.1300,46.6700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,217.79,,,,,,,80.3000,311.1300,percent of total billed charges,Rev 272 $311.13 in Billed Charges at 70% = $217.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM VISIBILITY LAPAROVUE,272,RC,27200002,CDM,,,,,,both,,,311.1300,46.6700,CIGNA HEALTHCARE,CIGNA HMO,129.74,,,,,,,80.3000,311.1300,percent of total billed charges,41.7% of $311.13 in Billed Charges for Rev 272 = $129.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM VISIBILITY LAPAROVUE,272,RC,27200002,CDM,,,,,,both,,,311.1300,46.6700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,144.36,,,,,,,80.3000,311.1300,percent of total billed charges,46.4% of $311.13 in Billed Charges for Rev 272 = $144.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM VISIBILITY LAPAROVUE,272,RC,27200002,CDM,,,,,,both,,,311.1300,46.6700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,129.74,,,,,,,80.3000,311.1300,percent of total billed charges,41.7% of $311.13 in Billed Charges for Rev 272 = $129.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM VISIBILITY LAPAROVUE,272,RC,27200002,CDM,,,,,,both,,,311.1300,46.6700,CIGNA HEALTHCARE,CIGNA PPO,129.74,,,,,,,80.3000,311.1300,percent of total billed charges,41.7% of $311.13 in Billed Charges for Rev 272 = $129.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM VISIBILITY LAPAROVUE,272,RC,27200002,CDM,,,,,,both,,,311.1300,46.6700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,280.02,,,,,,,80.3000,311.1300,percent of total billed charges,90% of $311.13 in Billed Charges for Rev 272 = $280.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM VISIBILITY LAPAROVUE,272,RC,27200002,CDM,,,,,,both,,,311.1300,46.6700,MEDCOST,MEDCOST VHN,148.07,,,,,,,80.3000,311.1300,percent of total billed charges,47.59% of $311.13 in Billed Charges for Rev 272 = $148.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM VISIBILITY LAPAROVUE,272,RC,27200002,CDM,,,,,,both,,,311.1300,46.6700,SENTARA HEALTH,SENTARA HEALTH,80.30,,,,,,,80.3000,311.1300,percent of total billed charges,25.81% of $311.13 in Billed Charges for Rev 272 = $80.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM VISIBILITY LAPAROVUE,272,RC,27200002,CDM,,,,,,both,,,311.1300,46.6700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",311.13,,,,,,,80.3000,311.1300,percent of total billed charges,100% of $311.13 in Billed Charges for Rev 272 = $311.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM VISIBILITY LAPAROVUE,272,RC,27200002,CDM,,,,,,both,,,311.1300,46.6700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,155.57,,,,,,,80.3000,311.1300,percent of total billed charges,Rev 272 $311.13 in Billed Charges at 50% = $155.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM VISIBILITY LAPAROVUE,272,RC,27200002,CDM,,,,,,both,,,311.1300,46.6700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,100.50,,,,,,,80.3000,311.1300,other,32.3% of $311.13 in Billed Charges for Rev 272 = $100.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SYSTEM VISIBILITY LAPAROVUE,272,RC,27200002,CDM,,,,,,both,,,311.1300,46.6700,UNITED HEALTHCARE,UHC HERITAGE SELECT,95.52,,,,,,,80.3000,311.1300,other,30.7% of $311.13 in Billed Charges for Rev 272 = $95.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SYSTEM VISIBILITY LAPAROVUE,272,RC,27200002,CDM,,,,,,both,,,311.1300,46.6700,UNITED HEALTHCARE,UNITED HEALTHCARE,100.50,,,,,,,80.3000,311.1300,percent of total billed charges,32.3% of $311.13 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SYSTEM VISIBILITY LAPAROVUE,272,RC,27200002,CDM,,,,,,both,,,311.1300,46.6700,WELLCARE,WELLCARE MEDICAID,311.13,,,,,,,80.3000,311.1300,percent of total billed charges,100% of $311.13 in Billed Charges for Rev 272 = $311.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,AETNA,AETNA,1876.67,,,,,,,109.0000,4395.0000,percent of total billed charges,"42.7% of $4,395.00 in Billed Charges for Rev 450 Proc 27768 = $1,876.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,4395.0000,fee schedule,APG 00041 Proc 27768 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,4395.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4395.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,4395.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,4395.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,4395.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,109.0000,4395.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,4395.0000,fee schedule,APG 00041 Proc 27768 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,109.0000,4395.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,4395.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4395.00,,,,,,,109.0000,4395.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,330.86,,,,,,,109.0000,4395.0000,fee schedule,$330.86 from Fee Schedule BLDTM_23 for Rev 450 Proc 27768 * Qty 1 = $330.86 at 100% = $330.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,4395.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,4395.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,4395.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3955.50,,,,,,,109.0000,4395.0000,percent of total billed charges,"90% of $4,395.00 in Billed Charges for Rev 450 Proc 27768 = $3,955.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,4395.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,4395.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,MEDCOST,MEDCOST VHN,2091.58,,,,,,,109.0000,4395.0000,percent of total billed charges,"47.59% of $4,395.00 in Billed Charges for Rev 450 Proc 27768 = $2,091.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,4395.0000,fee schedule,APG 00041 Proc 27768 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,4395.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,4395.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,4395.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,4395.0000,fee schedule,APG 00041 Proc 27768 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,SENTARA HEALTH,SENTARA HEALTH,1134.35,,,,,,,109.0000,4395.0000,percent of total billed charges,"25.81% of $4,395.00 in Billed Charges for Rev 450 Proc 27768 = $1,134.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,4395.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4395.00,,,,,,,109.0000,4395.0000,percent of total billed charges,"100% of $4,395.00 in Billed Charges for Rev 450 Proc 27768 = $4,395.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,4395.0000,case rate,Rev 450 Proc 27768 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,4395.0000,case rate,Rev 450 Proc 27768 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,4395.0000,case rate,Rev 450 Proc 27768 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,4395.0000,case rate,Rev 450 Proc 27768 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,4395.0000,fee schedule,APG 00041 Proc 27768 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4395.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,4395.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,WELLCARE,WELLCARE MEDICAID,4395.00,,,,,,,109.0000,4395.0000,percent of total billed charges,"100% of $4,395.00 in Billed Charges for Rev 450 Proc 27768 = $4,395.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ,27768,CPT,450,RC,45000420,CDM,,,,both,,,4395.0000,659.2500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,4395.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,AETNA,AETNA,630.25,,,,,,,109.0000,1476.0000,percent of total billed charges,"42.7% of $1,476.00 in Billed Charges for Rev 450 Proc 27780 = $630.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,1476.0000,fee schedule,"APG 00041 Proc 27780 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,1476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,1476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,1476.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,1476.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,1476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,1476.0000,fee schedule,"APG 00041 Proc 27780 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,1476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,1476.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,1476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,193.83,,,,,,,109.0000,1476.0000,fee schedule,$193.83 from Fee Schedule BLDTM_23 for Rev 450 Proc 27780 * Qty 1 = $193.83 at 100% = $193.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,1476.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,1476.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,1476.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1328.40,,,,,,,109.0000,1476.0000,percent of total billed charges,"90% of $1,476.00 in Billed Charges for Rev 450 Proc 27780 = $1,328.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,1476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,1476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,MEDCOST,MEDCOST VHN,702.43,,,,,,,109.0000,1476.0000,percent of total billed charges,"47.59% of $1,476.00 in Billed Charges for Rev 450 Proc 27780 = $702.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,1476.0000,fee schedule,"APG 00041 Proc 27780 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,1476.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,1476.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,1476.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,1476.0000,fee schedule,"APG 00041 Proc 27780 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,SENTARA HEALTH,SENTARA HEALTH,380.96,,,,,,,109.0000,1476.0000,percent of total billed charges,"25.81% of $1,476.00 in Billed Charges for Rev 450 Proc 27780 = $380.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,1476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1476.00,,,,,,,109.0000,1476.0000,percent of total billed charges,"100% of $1,476.00 in Billed Charges for Rev 450 Proc 27780 = $1,476.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1476.0000,case rate,Rev 450 Proc 27780 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1476.0000,case rate,Rev 450 Proc 27780 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1476.0000,case rate,Rev 450 Proc 27780 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1476.0000,case rate,Rev 450 Proc 27780 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,1476.0000,fee schedule,"APG 00041 Proc 27780 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,1476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,WELLCARE,WELLCARE MEDICAID,1476.00,,,,,,,109.0000,1476.0000,percent of total billed charges,"100% of $1,476.00 in Billed Charges for Rev 450 Proc 27780 = $1,476.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX PROX FIB SHFT FX WO M,27780,CPT,450,RC,45000167,CDM,,,,both,,,1476.0000,221.4000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,1476.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,AETNA,AETNA,687.47,,,,,,,100.4400,1610.0000,percent of total billed charges,"42.7% of $1,610.00 in Billed Charges for Rev 450 Proc 27786 = $687.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,100.4400,1610.0000,fee schedule,"APG 00041 Proc 27786 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,100.4400,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,100.4400,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,100.4400,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,AMBETTER,AMBETTER,487.87,,,,,,,100.4400,1610.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,100.4400,1610.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,100.4400,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,100.4400,1610.0000,fee schedule,"APG 00041 Proc 27786 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,100.4400,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,100.4400,1610.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,100.4400,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,236.91,,,,,,,100.4400,1610.0000,fee schedule,$236.91 from Fee Schedule BLDTM_23 for Rev 450 Proc 27786 * Qty 1 = $236.91 at 100% = $236.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,100.4400,1610.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,TENNCARE BLUE CARE,100.44,,,,,,,100.4400,1610.0000,fee schedule,$86.59 from Fee Schedule TC_24 for Rev 450 Proc 27786 * Qty 1 = $86.59 at 116% = $100.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,BLUE CROSS,TENNCARE BLUE SELECT,100.44,,,,,,,100.4400,1610.0000,fee schedule,$86.59 from Fee Schedule TC_24 for Rev 450 Proc 27786 * Qty 1 = $86.59 at 116% = $100.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,100.4400,1610.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,100.4400,1610.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1449.00,,,,,,,100.4400,1610.0000,percent of total billed charges,"90% of $1,610.00 in Billed Charges for Rev 450 Proc 27786 = $1,449.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,100.4400,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,100.4400,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,MEDCOST,MEDCOST VHN,766.20,,,,,,,100.4400,1610.0000,percent of total billed charges,"47.59% of $1,610.00 in Billed Charges for Rev 450 Proc 27786 = $766.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,100.4400,1610.0000,fee schedule,"APG 00041 Proc 27786 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,100.4400,1610.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,100.4400,1610.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,100.4400,1610.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,100.4400,1610.0000,fee schedule,"APG 00041 Proc 27786 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,SENTARA HEALTH,SENTARA HEALTH,415.54,,,,,,,100.4400,1610.0000,percent of total billed charges,"25.81% of $1,610.00 in Billed Charges for Rev 450 Proc 27786 = $415.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,100.4400,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1610.00,,,,,,,100.4400,1610.0000,percent of total billed charges,"100% of $1,610.00 in Billed Charges for Rev 450 Proc 27786 = $1,610.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,100.4400,1610.0000,case rate,Rev 450 Proc 27786 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,100.4400,1610.0000,case rate,Rev 450 Proc 27786 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,100.4400,1610.0000,case rate,Rev 450 Proc 27786 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,100.4400,1610.0000,case rate,Rev 450 Proc 27786 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,100.4400,1610.0000,fee schedule,"APG 00041 Proc 27786 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,100.4400,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,100.4400,1610.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,WELLCARE,WELLCARE MEDICAID,1610.00,,,,,,,100.4400,1610.0000,percent of total billed charges,"100% of $1,610.00 in Billed Charges for Rev 450 Proc 27786 = $1,610.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX DISTAL FIB FX WO MAN,27786,CPT,450,RC,45000169,CDM,,,,both,,,1610.0000,241.5000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,100.4400,1610.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA,603.35,,,,,,,109.0000,1413.0000,percent of total billed charges,"42.7% of $1,413.00 in Billed Charges for Rev 450 Proc 27788 = $603.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 27788 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,1413.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,1413.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 27788 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,1413.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,319.19,,,,,,,109.0000,1413.0000,fee schedule,$319.19 from Fee Schedule BLDTM_23 for Rev 450 Proc 27788 * Qty 1 = $319.19 at 100% = $319.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,1413.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1271.70,,,,,,,109.0000,1413.0000,percent of total billed charges,"90% of $1,413.00 in Billed Charges for Rev 450 Proc 27788 = $1,271.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,MEDCOST,MEDCOST VHN,672.45,,,,,,,109.0000,1413.0000,percent of total billed charges,"47.59% of $1,413.00 in Billed Charges for Rev 450 Proc 27788 = $672.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 27788 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,1413.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 27788 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA HEALTH,364.70,,,,,,,109.0000,1413.0000,percent of total billed charges,"25.81% of $1,413.00 in Billed Charges for Rev 450 Proc 27788 = $364.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1413.00,,,,,,,109.0000,1413.0000,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 27788 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 27788 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 27788 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 27788 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1413.0000,case rate,Rev 450 Proc 27788 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,1413.0000,fee schedule,"APG 00041 Proc 27788 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,1413.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICAID,1413.00,,,,,,,109.0000,1413.0000,percent of total billed charges,"100% of $1,413.00 in Billed Charges for Rev 450 Proc 27788 = $1,413.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX DISTAL FIB FX W MAN,27788,CPT,450,RC,45000170,CDM,,,,both,,,1413.0000,211.9500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,1413.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,AETNA,AETNA,652.46,,,,,,,109.0000,1528.0000,percent of total billed charges,"42.7% of $1,528.00 in Billed Charges for Rev 450 Proc 27816 = $652.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,1528.0000,fee schedule,"APG 00041 Proc 27816 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,1528.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1528.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,1528.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,1528.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,1528.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,1528.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,1528.0000,fee schedule,"APG 00041 Proc 27816 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,1528.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,1528.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,1528.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,264.12,,,,,,,109.0000,1528.0000,fee schedule,$264.12 from Fee Schedule BLDTM_23 for Rev 450 Proc 27816 * Qty 1 = $264.12 at 100% = $264.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,1528.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,1528.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,1528.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1375.20,,,,,,,109.0000,1528.0000,percent of total billed charges,"90% of $1,528.00 in Billed Charges for Rev 450 Proc 27816 = $1,375.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,1528.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,1528.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,MEDCOST,MEDCOST VHN,727.18,,,,,,,109.0000,1528.0000,percent of total billed charges,"47.59% of $1,528.00 in Billed Charges for Rev 450 Proc 27816 = $727.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,1528.0000,fee schedule,"APG 00041 Proc 27816 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,1528.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,1528.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,1528.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,1528.0000,fee schedule,"APG 00041 Proc 27816 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,SENTARA HEALTH,SENTARA HEALTH,394.38,,,,,,,109.0000,1528.0000,percent of total billed charges,"25.81% of $1,528.00 in Billed Charges for Rev 450 Proc 27816 = $394.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,1528.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1528.00,,,,,,,109.0000,1528.0000,percent of total billed charges,"100% of $1,528.00 in Billed Charges for Rev 450 Proc 27816 = $1,528.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1528.0000,case rate,Rev 450 Proc 27816 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1528.0000,case rate,Rev 450 Proc 27816 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1528.0000,case rate,Rev 450 Proc 27816 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1528.0000,case rate,Rev 450 Proc 27816 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,1528.0000,fee schedule,"APG 00041 Proc 27816 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1528.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,1528.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,WELLCARE,WELLCARE MEDICAID,1528.00,,,,,,,109.0000,1528.0000,percent of total billed charges,"100% of $1,528.00 in Billed Charges for Rev 450 Proc 27816 = $1,528.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX TRIMALLEOLAR FX WO MA,27816,CPT,450,RC,45000315,CDM,,,,both,,,1528.0000,229.2000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,1528.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,AETNA,AETNA,959.47,,,,,,,109.0000,3180.3800,percent of total billed charges,"42.7% of $2,247.00 in Billed Charges for Rev 450 Proc 27818 = $959.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27818 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,3180.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,BLUE CROSS,ANTHEM EXCHANGE,2247.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27818 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,BLUE CROSS,ANTHEM HMO,2247.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,3180.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2247.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,450.74,,,,,,,109.0000,3180.3800,fee schedule,$450.74 from Fee Schedule BLDTM_23 for Rev 450 Proc 27818 * Qty 1 = $450.74 at 100% = $450.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2022.30,,,,,,,109.0000,3180.3800,percent of total billed charges,"90% of $2,247.00 in Billed Charges for Rev 450 Proc 27818 = $2,022.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,MEDCOST,MEDCOST VHN,1069.35,,,,,,,109.0000,3180.3800,percent of total billed charges,"47.59% of $2,247.00 in Billed Charges for Rev 450 Proc 27818 = $1,069.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27818 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27818 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,SENTARA HEALTH,SENTARA HEALTH,579.95,,,,,,,109.0000,3180.3800,percent of total billed charges,"25.81% of $2,247.00 in Billed Charges for Rev 450 Proc 27818 = $579.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2247.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $2,247.00 in Billed Charges for Rev 450 Proc 27818 = $2,247.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 27818 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 27818 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 27818 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 27818 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,3180.3800,fee schedule,APG 00041 Proc 27818 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,WELLCARE,WELLCARE MEDICAID,2247.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $2,247.00 in Billed Charges for Rev 450 Proc 27818 = $2,247.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX TRIMALLEOLAR FX W MANI,27818,CPT,450,RC,45000173,CDM,,,,both,,,2247.0000,337.0500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,3180.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TAP BB TAK SMALL NON-THREADED 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1804.5500,270.6800,AETNA,AETNA,770.54,,,,,,,465.7500,1804.5500,percent of total billed charges,"42.7% of $1,804.55 in Billed Charges for Rev 272 = $770.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP BB TAK SMALL NON-THREADED 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1804.5500,270.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1263.19,,,,,,,465.7500,1804.5500,percent of total billed charges,"Rev 272 $1,804.55 in Billed Charges at 70% = $1,263.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP BB TAK SMALL NON-THREADED 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1804.5500,270.6800,CIGNA HEALTHCARE,CIGNA HMO,752.50,,,,,,,465.7500,1804.5500,percent of total billed charges,"41.7% of $1,804.55 in Billed Charges for Rev 272 = $752.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP BB TAK SMALL NON-THREADED 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1804.5500,270.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,837.31,,,,,,,465.7500,1804.5500,percent of total billed charges,"46.4% of $1,804.55 in Billed Charges for Rev 272 = $837.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP BB TAK SMALL NON-THREADED 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1804.5500,270.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,752.50,,,,,,,465.7500,1804.5500,percent of total billed charges,"41.7% of $1,804.55 in Billed Charges for Rev 272 = $752.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP BB TAK SMALL NON-THREADED 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1804.5500,270.6800,CIGNA HEALTHCARE,CIGNA PPO,752.50,,,,,,,465.7500,1804.5500,percent of total billed charges,"41.7% of $1,804.55 in Billed Charges for Rev 272 = $752.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP BB TAK SMALL NON-THREADED 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1804.5500,270.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1624.10,,,,,,,465.7500,1804.5500,percent of total billed charges,"90% of $1,804.55 in Billed Charges for Rev 272 = $1,624.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP BB TAK SMALL NON-THREADED 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1804.5500,270.6800,MEDCOST,MEDCOST VHN,858.79,,,,,,,465.7500,1804.5500,percent of total billed charges,"47.59% of $1,804.55 in Billed Charges for Rev 272 = $858.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP BB TAK SMALL NON-THREADED 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1804.5500,270.6800,SENTARA HEALTH,SENTARA HEALTH,465.75,,,,,,,465.7500,1804.5500,percent of total billed charges,"25.81% of $1,804.55 in Billed Charges for Rev 272 = $465.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP BB TAK SMALL NON-THREADED 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1804.5500,270.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1804.55,,,,,,,465.7500,1804.5500,percent of total billed charges,"100% of $1,804.55 in Billed Charges for Rev 272 = $1,804.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP BB TAK SMALL NON-THREADED 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1804.5500,270.6800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,902.28,,,,,,,465.7500,1804.5500,percent of total billed charges,"Rev 272 $1,804.55 in Billed Charges at 50% = $902.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP BB TAK SMALL NON-THREADED 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1804.5500,270.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,582.87,,,,,,,465.7500,1804.5500,other,"32.3% of $1,804.55 in Billed Charges for Rev 272 = $582.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TAP BB TAK SMALL NON-THREADED 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1804.5500,270.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,554.00,,,,,,,465.7500,1804.5500,other,"30.7% of $1,804.55 in Billed Charges for Rev 272 = $554.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TAP BB TAK SMALL NON-THREADED 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1804.5500,270.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,582.87,,,,,,,465.7500,1804.5500,percent of total billed charges,"32.3% of $1,804.55 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP BB TAK SMALL NON-THREADED 2.4MM,272,RC,27200002,CDM,,,,,,both,,,1804.5500,270.6800,WELLCARE,WELLCARE MEDICAID,1804.55,,,,,,,465.7500,1804.5500,percent of total billed charges,"100% of $1,804.55 in Billed Charges for Rev 272 = $1,804.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY TRACH SINGLE USE,272,RC,,,,,,,,both,,,1592.6900,238.9000,AETNA,AETNA,680.08,,,,,,,411.0700,1592.6900,percent of total billed charges,"42.7% of $1,592.69 in Billed Charges for Rev 272 = $680.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY TRACH SINGLE USE,272,RC,,,,,,,,both,,,1592.6900,238.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1114.88,,,,,,,411.0700,1592.6900,percent of total billed charges,"Rev 272 $1,592.69 in Billed Charges at 70% = $1,114.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY TRACH SINGLE USE,272,RC,,,,,,,,both,,,1592.6900,238.9000,CIGNA HEALTHCARE,CIGNA HMO,664.15,,,,,,,411.0700,1592.6900,percent of total billed charges,"41.7% of $1,592.69 in Billed Charges for Rev 272 = $664.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY TRACH SINGLE USE,272,RC,,,,,,,,both,,,1592.6900,238.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,739.01,,,,,,,411.0700,1592.6900,percent of total billed charges,"46.4% of $1,592.69 in Billed Charges for Rev 272 = $739.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY TRACH SINGLE USE,272,RC,,,,,,,,both,,,1592.6900,238.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,664.15,,,,,,,411.0700,1592.6900,percent of total billed charges,"41.7% of $1,592.69 in Billed Charges for Rev 272 = $664.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY TRACH SINGLE USE,272,RC,,,,,,,,both,,,1592.6900,238.9000,CIGNA HEALTHCARE,CIGNA PPO,664.15,,,,,,,411.0700,1592.6900,percent of total billed charges,"41.7% of $1,592.69 in Billed Charges for Rev 272 = $664.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY TRACH SINGLE USE,272,RC,,,,,,,,both,,,1592.6900,238.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1433.42,,,,,,,411.0700,1592.6900,percent of total billed charges,"90% of $1,592.69 in Billed Charges for Rev 272 = $1,433.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY TRACH SINGLE USE,272,RC,,,,,,,,both,,,1592.6900,238.9000,MEDCOST,MEDCOST VHN,757.96,,,,,,,411.0700,1592.6900,percent of total billed charges,"47.59% of $1,592.69 in Billed Charges for Rev 272 = $757.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY TRACH SINGLE USE,272,RC,,,,,,,,both,,,1592.6900,238.9000,SENTARA HEALTH,SENTARA HEALTH,411.07,,,,,,,411.0700,1592.6900,percent of total billed charges,"25.81% of $1,592.69 in Billed Charges for Rev 272 = $411.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY TRACH SINGLE USE,272,RC,,,,,,,,both,,,1592.6900,238.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1592.69,,,,,,,411.0700,1592.6900,percent of total billed charges,"100% of $1,592.69 in Billed Charges for Rev 272 = $1,592.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY TRACH SINGLE USE,272,RC,,,,,,,,both,,,1592.6900,238.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,796.35,,,,,,,411.0700,1592.6900,percent of total billed charges,"Rev 272 $1,592.69 in Billed Charges at 50% = $796.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY TRACH SINGLE USE,272,RC,,,,,,,,both,,,1592.6900,238.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,514.44,,,,,,,411.0700,1592.6900,other,"32.3% of $1,592.69 in Billed Charges for Rev 272 = $514.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TRAY TRACH SINGLE USE,272,RC,,,,,,,,both,,,1592.6900,238.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,488.96,,,,,,,411.0700,1592.6900,other,"30.7% of $1,592.69 in Billed Charges for Rev 272 = $488.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TRAY TRACH SINGLE USE,272,RC,,,,,,,,both,,,1592.6900,238.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,514.44,,,,,,,411.0700,1592.6900,percent of total billed charges,"32.3% of $1,592.69 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY TRACH SINGLE USE,272,RC,,,,,,,,both,,,1592.6900,238.9000,WELLCARE,WELLCARE MEDICAID,1592.69,,,,,,,411.0700,1592.6900,percent of total billed charges,"100% of $1,592.69 in Billed Charges for Rev 272 = $1,592.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY VASCULAR CATHETER INSERTION,272,RC,27200002,CDM,,,,,,both,,,907.0700,136.0600,AETNA,AETNA,387.32,,,,,,,234.1100,907.0700,percent of total billed charges,42.7% of $907.07 in Billed Charges for Rev 272 = $387.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY VASCULAR CATHETER INSERTION,272,RC,27200002,CDM,,,,,,both,,,907.0700,136.0600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,634.95,,,,,,,234.1100,907.0700,percent of total billed charges,Rev 272 $907.07 in Billed Charges at 70% = $634.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY VASCULAR CATHETER INSERTION,272,RC,27200002,CDM,,,,,,both,,,907.0700,136.0600,CIGNA HEALTHCARE,CIGNA HMO,378.25,,,,,,,234.1100,907.0700,percent of total billed charges,41.7% of $907.07 in Billed Charges for Rev 272 = $378.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY VASCULAR CATHETER INSERTION,272,RC,27200002,CDM,,,,,,both,,,907.0700,136.0600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,420.88,,,,,,,234.1100,907.0700,percent of total billed charges,46.4% of $907.07 in Billed Charges for Rev 272 = $420.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY VASCULAR CATHETER INSERTION,272,RC,27200002,CDM,,,,,,both,,,907.0700,136.0600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,378.25,,,,,,,234.1100,907.0700,percent of total billed charges,41.7% of $907.07 in Billed Charges for Rev 272 = $378.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY VASCULAR CATHETER INSERTION,272,RC,27200002,CDM,,,,,,both,,,907.0700,136.0600,CIGNA HEALTHCARE,CIGNA PPO,378.25,,,,,,,234.1100,907.0700,percent of total billed charges,41.7% of $907.07 in Billed Charges for Rev 272 = $378.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY VASCULAR CATHETER INSERTION,272,RC,27200002,CDM,,,,,,both,,,907.0700,136.0600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,816.36,,,,,,,234.1100,907.0700,percent of total billed charges,90% of $907.07 in Billed Charges for Rev 272 = $816.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY VASCULAR CATHETER INSERTION,272,RC,27200002,CDM,,,,,,both,,,907.0700,136.0600,MEDCOST,MEDCOST VHN,431.67,,,,,,,234.1100,907.0700,percent of total billed charges,47.59% of $907.07 in Billed Charges for Rev 272 = $431.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY VASCULAR CATHETER INSERTION,272,RC,27200002,CDM,,,,,,both,,,907.0700,136.0600,SENTARA HEALTH,SENTARA HEALTH,234.11,,,,,,,234.1100,907.0700,percent of total billed charges,25.81% of $907.07 in Billed Charges for Rev 272 = $234.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY VASCULAR CATHETER INSERTION,272,RC,27200002,CDM,,,,,,both,,,907.0700,136.0600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",907.07,,,,,,,234.1100,907.0700,percent of total billed charges,100% of $907.07 in Billed Charges for Rev 272 = $907.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY VASCULAR CATHETER INSERTION,272,RC,27200002,CDM,,,,,,both,,,907.0700,136.0600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,453.54,,,,,,,234.1100,907.0700,percent of total billed charges,Rev 272 $907.07 in Billed Charges at 50% = $453.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY VASCULAR CATHETER INSERTION,272,RC,27200002,CDM,,,,,,both,,,907.0700,136.0600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,292.98,,,,,,,234.1100,907.0700,other,32.3% of $907.07 in Billed Charges for Rev 272 = $292.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TRAY VASCULAR CATHETER INSERTION,272,RC,27200002,CDM,,,,,,both,,,907.0700,136.0600,UNITED HEALTHCARE,UHC HERITAGE SELECT,278.47,,,,,,,234.1100,907.0700,other,30.7% of $907.07 in Billed Charges for Rev 272 = $278.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TRAY VASCULAR CATHETER INSERTION,272,RC,27200002,CDM,,,,,,both,,,907.0700,136.0600,UNITED HEALTHCARE,UNITED HEALTHCARE,292.98,,,,,,,234.1100,907.0700,percent of total billed charges,32.3% of $907.07 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY VASCULAR CATHETER INSERTION,272,RC,27200002,CDM,,,,,,both,,,907.0700,136.0600,WELLCARE,WELLCARE MEDICAID,907.07,,,,,,,234.1100,907.0700,percent of total billed charges,100% of $907.07 in Billed Charges for Rev 272 = $907.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA,5175.67,,,,,,,381.1000,12121.0000,percent of total billed charges,"42.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33222 = $5,175.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2176.64,,,,,,,381.1000,12121.0000,fee schedule,"APG 00074 Proc 33222 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 104% = $2,176.64. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1871.96,,,,,,,381.1000,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA HEALTHCARE MEDICARE,1871.96,,,,,,,381.1000,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,1871.96,,,,,,,381.1000,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,AMBETTER,AMBETTER,4080.88,,,,,,,381.1000,12121.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1946.84,,,,,,,381.1000,12121.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM EXCHANGE,4608.86,,,,,,,381.1000,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2155.71,,,,,,,381.1000,12121.0000,fee schedule,"APG 00074 Proc 33222 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM HMO,4896.64,,,,,,,381.1000,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1928.12,,,,,,,381.1000,12121.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5760.44,,,,,,,381.1000,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,381.10,,,,,,,381.1000,12121.0000,fee schedule,$381.10 from Fee Schedule BLDTM_23 for Rev 481 Proc 33222 * Qty 1 = $381.10 at 100% = $381.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,381.1000,12121.0000,case rate,"Rev 481 Proc 33222 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS MEDICARE,1946.84,,,,,,,381.1000,12121.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,381.1000,12121.0000,case rate,"Rev 481 Proc 33222 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,381.1000,12121.0000,case rate,"Rev 481 Proc 33222 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA HMO,5054.46,,,,,,,381.1000,12121.0000,percent of total billed charges,"41.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33222 = $5,054.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5624.14,,,,,,,381.1000,12121.0000,percent of total billed charges,"46.4% of $12,121.00 in Billed Charges for Rev 481 Proc 33222 = $5,624.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,1965.56,,,,,,,381.1000,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5054.46,,,,,,,381.1000,12121.0000,percent of total billed charges,"41.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33222 = $5,054.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA PPO,5054.46,,,,,,,381.1000,12121.0000,percent of total billed charges,"41.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33222 = $5,054.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1965.56,,,,,,,381.1000,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10908.90,,,,,,,381.1000,12121.0000,percent of total billed charges,"90% of $12,121.00 in Billed Charges for Rev 481 Proc 33222 = $10,908.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,HUMANA,HUMANA MEDICARE,1871.96,,,,,,,381.1000,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1871.96,,,,,,,381.1000,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,MEDCOST,MEDCOST VHN,5768.38,,,,,,,381.1000,12121.0000,percent of total billed charges,"47.59% of $12,121.00 in Billed Charges for Rev 481 Proc 33222 = $5,768.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2197.57,,,,,,,381.1000,12121.0000,fee schedule,"APG 00074 Proc 33222 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 105% = $2,197.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1965.56,,,,,,,381.1000,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1965.56,,,,,,,381.1000,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,NHC ADVANTAGE,NHC ADVANTAGE,1965.56,,,,,,,381.1000,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2157.80,,,,,,,381.1000,12121.0000,fee schedule,"APG 00074 Proc 33222 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 103.1% = $2,157.80 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,SENTARA HEALTH,SENTARA HEALTH,3128.43,,,,,,,381.1000,12121.0000,percent of total billed charges,"25.81% of $12,121.00 in Billed Charges for Rev 481 Proc 33222 = $3,128.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,SENTARA HEALTH,SENTARA MEDICARE,1871.96,,,,,,,381.1000,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12121.00,,,,,,,381.1000,12121.0000,percent of total billed charges,"100% of $12,121.00 in Billed Charges for Rev 481 Proc 33222 = $12,121.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,381.1000,12121.0000,case rate,Rev 481 Proc 33222 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,381.1000,12121.0000,case rate,"Rev 481 Proc 33222 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,381.1000,12121.0000,case rate,"Rev 481 Proc 33222 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,381.1000,12121.0000,case rate,"Rev 481 Proc 33222 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2155.71,,,,,,,381.1000,12121.0000,fee schedule,"APG 00074 Proc 33222 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1871.96,,,,,,,381.1000,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1871.96,,,,,,,381.1000,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,WELLCARE,WELLCARE MEDICAID,12121.00,,,,,,,381.1000,12121.0000,percent of total billed charges,"100% of $12,121.00 in Billed Charges for Rev 481 Proc 33222 = $12,121.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVISION/RELOC PM SKIN POCKET,33222,CPT,481,RC,48100015,CDM,,,,both,,,12121.0000,1818.1500,WELLCARE,WELLCARE MEDICARE,1984.28,,,,,,,381.1000,12121.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA,5175.67,,,,,,,456.2400,12121.0000,percent of total billed charges,"42.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33223 = $5,175.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2176.64,,,,,,,456.2400,12121.0000,fee schedule,"APG 00074 Proc 33223 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 104% = $2,176.64. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1871.96,,,,,,,456.2400,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA HEALTHCARE MEDICARE,1871.96,,,,,,,456.2400,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,1871.96,,,,,,,456.2400,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,AMBETTER,AMBETTER,4080.88,,,,,,,456.2400,12121.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1946.84,,,,,,,456.2400,12121.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM EXCHANGE,4608.86,,,,,,,456.2400,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2155.71,,,,,,,456.2400,12121.0000,fee schedule,"APG 00074 Proc 33223 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM HMO,4896.64,,,,,,,456.2400,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1928.12,,,,,,,456.2400,12121.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5760.44,,,,,,,456.2400,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,456.24,,,,,,,456.2400,12121.0000,fee schedule,$456.24 from Fee Schedule BLDTM_23 for Rev 481 Proc 33223 * Qty 1 = $456.24 at 100% = $456.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,456.2400,12121.0000,case rate,"Rev 481 Proc 33223 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS MEDICARE,1946.84,,,,,,,456.2400,12121.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,456.2400,12121.0000,case rate,"Rev 481 Proc 33223 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,456.2400,12121.0000,case rate,"Rev 481 Proc 33223 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA HMO,5054.46,,,,,,,456.2400,12121.0000,percent of total billed charges,"41.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33223 = $5,054.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5624.14,,,,,,,456.2400,12121.0000,percent of total billed charges,"46.4% of $12,121.00 in Billed Charges for Rev 481 Proc 33223 = $5,624.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,1965.56,,,,,,,456.2400,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5054.46,,,,,,,456.2400,12121.0000,percent of total billed charges,"41.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33223 = $5,054.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA PPO,5054.46,,,,,,,456.2400,12121.0000,percent of total billed charges,"41.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33223 = $5,054.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1965.56,,,,,,,456.2400,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10908.90,,,,,,,456.2400,12121.0000,percent of total billed charges,"90% of $12,121.00 in Billed Charges for Rev 481 Proc 33223 = $10,908.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,HUMANA,HUMANA MEDICARE,1871.96,,,,,,,456.2400,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1871.96,,,,,,,456.2400,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,MEDCOST,MEDCOST VHN,5768.38,,,,,,,456.2400,12121.0000,percent of total billed charges,"47.59% of $12,121.00 in Billed Charges for Rev 481 Proc 33223 = $5,768.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2197.57,,,,,,,456.2400,12121.0000,fee schedule,"APG 00074 Proc 33223 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 105% = $2,197.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1965.56,,,,,,,456.2400,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1965.56,,,,,,,456.2400,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,NHC ADVANTAGE,NHC ADVANTAGE,1965.56,,,,,,,456.2400,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2157.80,,,,,,,456.2400,12121.0000,fee schedule,"APG 00074 Proc 33223 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 103.1% = $2,157.80 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,SENTARA HEALTH,SENTARA HEALTH,3128.43,,,,,,,456.2400,12121.0000,percent of total billed charges,"25.81% of $12,121.00 in Billed Charges for Rev 481 Proc 33223 = $3,128.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,SENTARA HEALTH,SENTARA MEDICARE,1871.96,,,,,,,456.2400,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12121.00,,,,,,,456.2400,12121.0000,percent of total billed charges,"100% of $12,121.00 in Billed Charges for Rev 481 Proc 33223 = $12,121.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,456.2400,12121.0000,case rate,Rev 481 Proc 33223 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,456.2400,12121.0000,case rate,"Rev 481 Proc 33223 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,456.2400,12121.0000,case rate,"Rev 481 Proc 33223 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,456.2400,12121.0000,case rate,"Rev 481 Proc 33223 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2155.71,,,,,,,456.2400,12121.0000,fee schedule,"APG 00074 Proc 33223 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1871.96,,,,,,,456.2400,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1871.96,,,,,,,456.2400,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,WELLCARE,WELLCARE MEDICAID,12121.00,,,,,,,456.2400,12121.0000,percent of total billed charges,"100% of $12,121.00 in Billed Charges for Rev 481 Proc 33223 = $12,121.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RELOCATION ICD SKIN POCKET,33223,CPT,481,RC,48100142,CDM,,,,both,,,12121.0000,1818.1500,WELLCARE,WELLCARE MEDICARE,1984.28,,,,,,,456.2400,12121.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,AETNA,AETNA,7726.99,,,,,,,502.0200,20672.5700,percent of total billed charges,"42.7% of $18,096.00 in Billed Charges for Rev 481 Proc 33224 = $7,726.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11330.93,,,,,,,502.0200,20672.5700,fee schedule,"APG 00086 Proc 33224 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 104% = $11,330.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,9482.83,,,,,,,502.0200,20672.5700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,AETNA,AETNA HEALTHCARE MEDICARE,9482.83,,,,,,,502.0200,20672.5700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,9482.83,,,,,,,502.0200,20672.5700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,AMBETTER,AMBETTER,20672.57,,,,,,,502.0200,20672.5700,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,9862.14,,,,,,,502.0200,20672.5700,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,BLUE CROSS,ANTHEM EXCHANGE,18096.00,,,,,,,502.0200,20672.5700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11221.98,,,,,,,502.0200,20672.5700,fee schedule,"APG 00086 Proc 33224 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,BLUE CROSS,ANTHEM HMO,18096.00,,,,,,,502.0200,20672.5700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,9767.31,,,,,,,502.0200,20672.5700,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",18096.00,,,,,,,502.0200,20672.5700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,502.02,,,,,,,502.0200,20672.5700,fee schedule,$502.02 from Fee Schedule BLDTM_23 for Rev 481 Proc 33224 * Qty 1 = $502.02 at 100% = $502.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,BLUE CROSS,BLUE CROSS E NETWORK,8571.00,,,,,,,502.0200,20672.5700,case rate,"Rev 481 Proc 33224 ASG Rate of $8,571.00 at 100% of $8,571.00 = $8,571.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,BLUE CROSS,BLUE CROSS MEDICARE,9862.14,,,,,,,502.0200,20672.5700,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,BLUE CROSS,BLUE CROSS P NETWORK,8764.00,,,,,,,502.0200,20672.5700,case rate,"Rev 481 Proc 33224 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,BLUE CROSS,BLUE CROSS S NETWORK,8764.00,,,,,,,502.0200,20672.5700,case rate,"Rev 481 Proc 33224 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,CIGNA HEALTHCARE,CIGNA HMO,7546.03,,,,,,,502.0200,20672.5700,percent of total billed charges,"41.7% of $18,096.00 in Billed Charges for Rev 481 Proc 33224 = $7,546.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8396.54,,,,,,,502.0200,20672.5700,percent of total billed charges,"46.4% of $18,096.00 in Billed Charges for Rev 481 Proc 33224 = $8,396.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,9956.97,,,,,,,502.0200,20672.5700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7546.03,,,,,,,502.0200,20672.5700,percent of total billed charges,"41.7% of $18,096.00 in Billed Charges for Rev 481 Proc 33224 = $7,546.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,CIGNA HEALTHCARE,CIGNA PPO,7546.03,,,,,,,502.0200,20672.5700,percent of total billed charges,"41.7% of $18,096.00 in Billed Charges for Rev 481 Proc 33224 = $7,546.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,9956.97,,,,,,,502.0200,20672.5700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,16286.40,,,,,,,502.0200,20672.5700,percent of total billed charges,"90% of $18,096.00 in Billed Charges for Rev 481 Proc 33224 = $16,286.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,HUMANA,HUMANA MEDICARE,9482.83,,,,,,,502.0200,20672.5700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,9482.83,,,,,,,502.0200,20672.5700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,MEDCOST,MEDCOST VHN,8611.89,,,,,,,502.0200,20672.5700,percent of total billed charges,"47.59% of $18,096.00 in Billed Charges for Rev 481 Proc 33224 = $8,611.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11439.89,,,,,,,502.0200,20672.5700,fee schedule,"APG 00086 Proc 33224 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 105% = $11,439.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,9956.97,,,,,,,502.0200,20672.5700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,9956.97,,,,,,,502.0200,20672.5700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,NHC ADVANTAGE,NHC ADVANTAGE,9956.97,,,,,,,502.0200,20672.5700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11232.88,,,,,,,502.0200,20672.5700,fee schedule,"APG 00086 Proc 33224 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 103.1% = $11,232.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,SENTARA HEALTH,SENTARA HEALTH,4670.58,,,,,,,502.0200,20672.5700,percent of total billed charges,"25.81% of $18,096.00 in Billed Charges for Rev 481 Proc 33224 = $4,670.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,SENTARA HEALTH,SENTARA MEDICARE,9482.83,,,,,,,502.0200,20672.5700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",18096.00,,,,,,,502.0200,20672.5700,percent of total billed charges,"100% of $18,096.00 in Billed Charges for Rev 481 Proc 33224 = $18,096.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8660.00,,,,,,,502.0200,20672.5700,case rate,"Rev 481 Proc 33224 ASG Rate of $8,660.00 at 100% of $8,660.00 = $8,660.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12800.00,,,,,,,502.0200,20672.5700,case rate,"Rev 481 Proc 33224 ASG Rate of $12,800.00 at 100% of $12,800.00 = $12,800.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,12245.00,,,,,,,502.0200,20672.5700,case rate,"Rev 481 Proc 33224 ASG Rate of $12,245.00 at 100% of $12,245.00 = $12,245.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,18096.00,,,,,,,502.0200,20672.5700,case rate,"Rev 481 Proc 33224 ASG Rate of $20,790.00 at 100% of $20,790.00 = $20,790.00 Total (Service Line reduced to $18,096.00, claim capped at $18,096.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11221.98,,,,,,,502.0200,20672.5700,fee schedule,"APG 00086 Proc 33224 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,9482.83,,,,,,,502.0200,20672.5700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,9482.83,,,,,,,502.0200,20672.5700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,WELLCARE,WELLCARE MEDICAID,18096.00,,,,,,,502.0200,20672.5700,percent of total billed charges,"100% of $18,096.00 in Billed Charges for Rev 481 Proc 33224 = $18,096.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI-V LEAD PREV PM/ICD,33224,CPT,481,RC,48100016,CDM,,,,both,,,18096.0000,2714.4000,WELLCARE,WELLCARE MEDICARE,10051.80,,,,,,,502.0200,20672.5700,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,AETNA,AETNA,10638.71,,,,,,,6290.0000,24915.0000,percent of total billed charges,"42.7% of $24,915.00 in Billed Charges for Rev 481 Proc 33227 = $10,638.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11330.93,,,,,,,6290.0000,24915.0000,fee schedule,"APG 00086 Proc 33227 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 104% = $11,330.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,7508.05,,,,,,,6290.0000,24915.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,AETNA,AETNA HEALTHCARE MEDICARE,7508.05,,,,,,,6290.0000,24915.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,7508.05,,,,,,,6290.0000,24915.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,AMBETTER,AMBETTER,16367.55,,,,,,,6290.0000,24915.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,7808.37,,,,,,,6290.0000,24915.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,BLUE CROSS,ANTHEM EXCHANGE,18485.22,,,,,,,6290.0000,24915.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11221.98,,,,,,,6290.0000,24915.0000,fee schedule,"APG 00086 Proc 33227 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,BLUE CROSS,ANTHEM HMO,19639.44,,,,,,,6290.0000,24915.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,7733.29,,,,,,,6290.0000,24915.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",23103.98,,,,,,,6290.0000,24915.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,17440.50,,,,,,,6290.0000,24915.0000,percent of total billed charges,"Rev 481 Proc 33227 $24,915.00 in Billed Charges at 70% = $17,440.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,6290.0000,24915.0000,case rate,"Rev 481 Proc 33227 ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,BLUE CROSS,BLUE CROSS MEDICARE,7808.37,,,,,,,6290.0000,24915.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,6290.0000,24915.0000,case rate,"Rev 481 Proc 33227 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,6290.0000,24915.0000,case rate,"Rev 481 Proc 33227 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,CIGNA HEALTHCARE,CIGNA HMO,10389.56,,,,,,,6290.0000,24915.0000,percent of total billed charges,"41.7% of $24,915.00 in Billed Charges for Rev 481 Proc 33227 = $10,389.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,11560.56,,,,,,,6290.0000,24915.0000,percent of total billed charges,"46.4% of $24,915.00 in Billed Charges for Rev 481 Proc 33227 = $11,560.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,7883.45,,,,,,,6290.0000,24915.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,10389.56,,,,,,,6290.0000,24915.0000,percent of total billed charges,"41.7% of $24,915.00 in Billed Charges for Rev 481 Proc 33227 = $10,389.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,CIGNA HEALTHCARE,CIGNA PPO,10389.56,,,,,,,6290.0000,24915.0000,percent of total billed charges,"41.7% of $24,915.00 in Billed Charges for Rev 481 Proc 33227 = $10,389.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,7883.45,,,,,,,6290.0000,24915.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,22423.50,,,,,,,6290.0000,24915.0000,percent of total billed charges,"90% of $24,915.00 in Billed Charges for Rev 481 Proc 33227 = $22,423.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,HUMANA,HUMANA MEDICARE,7508.05,,,,,,,6290.0000,24915.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,7508.05,,,,,,,6290.0000,24915.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,MEDCOST,MEDCOST VHN,11857.05,,,,,,,6290.0000,24915.0000,percent of total billed charges,"47.59% of $24,915.00 in Billed Charges for Rev 481 Proc 33227 = $11,857.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11439.89,,,,,,,6290.0000,24915.0000,fee schedule,"APG 00086 Proc 33227 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 105% = $11,439.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,7883.45,,,,,,,6290.0000,24915.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,7883.45,,,,,,,6290.0000,24915.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,NHC ADVANTAGE,NHC ADVANTAGE,7883.45,,,,,,,6290.0000,24915.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11232.88,,,,,,,6290.0000,24915.0000,fee schedule,"APG 00086 Proc 33227 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 103.1% = $11,232.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,SENTARA HEALTH,SENTARA HEALTH,6430.56,,,,,,,6290.0000,24915.0000,percent of total billed charges,"25.81% of $24,915.00 in Billed Charges for Rev 481 Proc 33227 = $6,430.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,SENTARA HEALTH,SENTARA MEDICARE,7508.05,,,,,,,6290.0000,24915.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",24915.00,,,,,,,6290.0000,24915.0000,percent of total billed charges,"100% of $24,915.00 in Billed Charges for Rev 481 Proc 33227 = $24,915.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,6290.0000,24915.0000,case rate,"Rev 481 Proc 33227 ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,6290.0000,24915.0000,case rate,"Rev 481 Proc 33227 ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,6290.0000,24915.0000,case rate,"Rev 481 Proc 33227 ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,20054.00,,,,,,,6290.0000,24915.0000,case rate,"Rev 481 Proc 33227 ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11221.98,,,,,,,6290.0000,24915.0000,fee schedule,"APG 00086 Proc 33227 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,7508.05,,,,,,,6290.0000,24915.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,7508.05,,,,,,,6290.0000,24915.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,WELLCARE,WELLCARE MEDICAID,24915.00,,,,,,,6290.0000,24915.0000,percent of total billed charges,"100% of $24,915.00 in Billed Charges for Rev 481 Proc 33227 = $24,915.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE & REPLACE PM GEN SINGL,33227,CPT,481,RC,48100018,CDM,,,,both,,,24915.0000,3737.2500,WELLCARE,WELLCARE MEDICARE,7958.53,,,,,,,6290.0000,24915.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,AETNA,AETNA,11046.92,,,,,,,6290.0000,25871.0000,percent of total billed charges,"42.7% of $25,871.00 in Billed Charges for Rev 481 Proc 33228 = $11,046.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11330.93,,,,,,,6290.0000,25871.0000,fee schedule,"APG 00086 Proc 33228 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 104% = $11,330.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,9482.83,,,,,,,6290.0000,25871.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,AETNA,AETNA HEALTHCARE MEDICARE,9482.83,,,,,,,6290.0000,25871.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,9482.83,,,,,,,6290.0000,25871.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,AMBETTER,AMBETTER,20672.57,,,,,,,6290.0000,25871.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,9862.14,,,,,,,6290.0000,25871.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,BLUE CROSS,ANTHEM EXCHANGE,23347.23,,,,,,,6290.0000,25871.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11221.98,,,,,,,6290.0000,25871.0000,fee schedule,"APG 00086 Proc 33228 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,BLUE CROSS,ANTHEM HMO,24805.05,,,,,,,6290.0000,25871.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,9767.31,,,,,,,6290.0000,25871.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",25871.00,,,,,,,6290.0000,25871.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,18109.70,,,,,,,6290.0000,25871.0000,percent of total billed charges,"Rev 481 Proc 33228 $25,871.00 in Billed Charges at 70% = $18,109.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,BLUE CROSS,BLUE CROSS E NETWORK,8571.00,,,,,,,6290.0000,25871.0000,case rate,"Rev 481 Proc 33228 ASG Rate of $8,571.00 at 100% of $8,571.00 = $8,571.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,BLUE CROSS,BLUE CROSS MEDICARE,9862.14,,,,,,,6290.0000,25871.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,BLUE CROSS,BLUE CROSS P NETWORK,8764.00,,,,,,,6290.0000,25871.0000,case rate,"Rev 481 Proc 33228 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,BLUE CROSS,BLUE CROSS S NETWORK,8764.00,,,,,,,6290.0000,25871.0000,case rate,"Rev 481 Proc 33228 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,CIGNA HEALTHCARE,CIGNA HMO,10788.21,,,,,,,6290.0000,25871.0000,percent of total billed charges,"41.7% of $25,871.00 in Billed Charges for Rev 481 Proc 33228 = $10,788.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12004.14,,,,,,,6290.0000,25871.0000,percent of total billed charges,"46.4% of $25,871.00 in Billed Charges for Rev 481 Proc 33228 = $12,004.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,9956.97,,,,,,,6290.0000,25871.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,10788.21,,,,,,,6290.0000,25871.0000,percent of total billed charges,"41.7% of $25,871.00 in Billed Charges for Rev 481 Proc 33228 = $10,788.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,CIGNA HEALTHCARE,CIGNA PPO,10788.21,,,,,,,6290.0000,25871.0000,percent of total billed charges,"41.7% of $25,871.00 in Billed Charges for Rev 481 Proc 33228 = $10,788.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,9956.97,,,,,,,6290.0000,25871.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,23283.90,,,,,,,6290.0000,25871.0000,percent of total billed charges,"90% of $25,871.00 in Billed Charges for Rev 481 Proc 33228 = $23,283.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,HUMANA,HUMANA MEDICARE,9482.83,,,,,,,6290.0000,25871.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,9482.83,,,,,,,6290.0000,25871.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,MEDCOST,MEDCOST VHN,12312.01,,,,,,,6290.0000,25871.0000,percent of total billed charges,"47.59% of $25,871.00 in Billed Charges for Rev 481 Proc 33228 = $12,312.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11439.89,,,,,,,6290.0000,25871.0000,fee schedule,"APG 00086 Proc 33228 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 105% = $11,439.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,9956.97,,,,,,,6290.0000,25871.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,9956.97,,,,,,,6290.0000,25871.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,NHC ADVANTAGE,NHC ADVANTAGE,9956.97,,,,,,,6290.0000,25871.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11232.88,,,,,,,6290.0000,25871.0000,fee schedule,"APG 00086 Proc 33228 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 103.1% = $11,232.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,SENTARA HEALTH,SENTARA HEALTH,6677.31,,,,,,,6290.0000,25871.0000,percent of total billed charges,"25.81% of $25,871.00 in Billed Charges for Rev 481 Proc 33228 = $6,677.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,SENTARA HEALTH,SENTARA MEDICARE,9482.83,,,,,,,6290.0000,25871.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",25871.00,,,,,,,6290.0000,25871.0000,percent of total billed charges,"100% of $25,871.00 in Billed Charges for Rev 481 Proc 33228 = $25,871.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,6290.0000,25871.0000,case rate,"Rev 481 Proc 33228 ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,6290.0000,25871.0000,case rate,"Rev 481 Proc 33228 ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,6290.0000,25871.0000,case rate,"Rev 481 Proc 33228 ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,20054.00,,,,,,,6290.0000,25871.0000,case rate,"Rev 481 Proc 33228 ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11221.98,,,,,,,6290.0000,25871.0000,fee schedule,"APG 00086 Proc 33228 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,9482.83,,,,,,,6290.0000,25871.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,9482.83,,,,,,,6290.0000,25871.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,WELLCARE,WELLCARE MEDICAID,25871.00,,,,,,,6290.0000,25871.0000,percent of total billed charges,"100% of $25,871.00 in Billed Charges for Rev 481 Proc 33228 = $25,871.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC PM GEN DUAL LEAD,33228,CPT,481,RC,48100019,CDM,,,,both,,,25871.0000,3880.6500,WELLCARE,WELLCARE MEDICARE,10051.80,,,,,,,6290.0000,25871.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,AETNA,AETNA,11458.12,,,,,,,6290.0000,38096.9000,percent of total billed charges,"42.7% of $26,834.00 in Billed Charges for Rev 481 Proc 33229 = $11,458.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11330.93,,,,,,,6290.0000,38096.9000,fee schedule,"APG 00086 Proc 33229 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 104% = $11,330.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,17475.64,,,,,,,6290.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,AETNA,AETNA HEALTHCARE MEDICARE,17475.64,,,,,,,6290.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,17475.64,,,,,,,6290.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,AMBETTER,AMBETTER,38096.90,,,,,,,6290.0000,38096.9000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,18174.67,,,,,,,6290.0000,38096.9000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,ANTHEM EXCHANGE,26834.00,,,,,,,6290.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11221.98,,,,,,,6290.0000,38096.9000,fee schedule,"APG 00086 Proc 33229 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,ANTHEM HMO,26834.00,,,,,,,6290.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,17999.91,,,,,,,6290.0000,38096.9000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",26834.00,,,,,,,6290.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,18783.80,,,,,,,6290.0000,38096.9000,percent of total billed charges,"Rev 481 Proc 33229 $26,834.00 in Billed Charges at 70% = $18,783.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,BLUE CROSS E NETWORK,11219.00,,,,,,,6290.0000,38096.9000,case rate,"Rev 481 Proc 33229 ASG Rate of $11,219.00 at 100% of $11,219.00 = $11,219.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,BLUE CROSS MEDICARE,18174.67,,,,,,,6290.0000,38096.9000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,BLUE CROSS P NETWORK,11472.00,,,,,,,6290.0000,38096.9000,case rate,"Rev 481 Proc 33229 ASG Rate of $11,472.00 at 100% of $11,472.00 = $11,472.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,BLUE CROSS,BLUE CROSS S NETWORK,11472.00,,,,,,,6290.0000,38096.9000,case rate,"Rev 481 Proc 33229 ASG Rate of $11,472.00 at 100% of $11,472.00 = $11,472.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,CIGNA HEALTHCARE,CIGNA HMO,11189.78,,,,,,,6290.0000,38096.9000,percent of total billed charges,"41.7% of $26,834.00 in Billed Charges for Rev 481 Proc 33229 = $11,189.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12450.98,,,,,,,6290.0000,38096.9000,percent of total billed charges,"46.4% of $26,834.00 in Billed Charges for Rev 481 Proc 33229 = $12,450.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,18349.42,,,,,,,6290.0000,38096.9000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11189.78,,,,,,,6290.0000,38096.9000,percent of total billed charges,"41.7% of $26,834.00 in Billed Charges for Rev 481 Proc 33229 = $11,189.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,CIGNA HEALTHCARE,CIGNA PPO,11189.78,,,,,,,6290.0000,38096.9000,percent of total billed charges,"41.7% of $26,834.00 in Billed Charges for Rev 481 Proc 33229 = $11,189.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,18349.42,,,,,,,6290.0000,38096.9000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,24150.60,,,,,,,6290.0000,38096.9000,percent of total billed charges,"90% of $26,834.00 in Billed Charges for Rev 481 Proc 33229 = $24,150.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,HUMANA,HUMANA MEDICARE,17475.64,,,,,,,6290.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,17475.64,,,,,,,6290.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,MEDCOST,MEDCOST VHN,12770.30,,,,,,,6290.0000,38096.9000,percent of total billed charges,"47.59% of $26,834.00 in Billed Charges for Rev 481 Proc 33229 = $12,770.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11439.89,,,,,,,6290.0000,38096.9000,fee schedule,"APG 00086 Proc 33229 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 105% = $11,439.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,18349.42,,,,,,,6290.0000,38096.9000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,18349.42,,,,,,,6290.0000,38096.9000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,NHC ADVANTAGE,NHC ADVANTAGE,18349.42,,,,,,,6290.0000,38096.9000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11232.88,,,,,,,6290.0000,38096.9000,fee schedule,"APG 00086 Proc 33229 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 103.1% = $11,232.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,SENTARA HEALTH,SENTARA HEALTH,6925.86,,,,,,,6290.0000,38096.9000,percent of total billed charges,"25.81% of $26,834.00 in Billed Charges for Rev 481 Proc 33229 = $6,925.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,SENTARA HEALTH,SENTARA MEDICARE,17475.64,,,,,,,6290.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",26834.00,,,,,,,6290.0000,38096.9000,percent of total billed charges,"100% of $26,834.00 in Billed Charges for Rev 481 Proc 33229 = $26,834.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,6290.0000,38096.9000,case rate,"Rev 481 Proc 33229 ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,6290.0000,38096.9000,case rate,"Rev 481 Proc 33229 ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,6290.0000,38096.9000,case rate,"Rev 481 Proc 33229 ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,20054.00,,,,,,,6290.0000,38096.9000,case rate,"Rev 481 Proc 33229 ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11221.98,,,,,,,6290.0000,38096.9000,fee schedule,"APG 00086 Proc 33229 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,17475.64,,,,,,,6290.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,17475.64,,,,,,,6290.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,WELLCARE,WELLCARE MEDICAID,26834.00,,,,,,,6290.0000,38096.9000,percent of total billed charges,"100% of $26,834.00 in Billed Charges for Rev 481 Proc 33229 = $26,834.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC PM GEN MULT LEAD,33229,CPT,481,RC,48100020,CDM,,,,both,,,26834.0000,4025.1000,WELLCARE,WELLCARE MEDICARE,18524.18,,,,,,,6290.0000,38096.9000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,AETNA,AETNA,37760.46,,,,,,,12398.0000,88432.0000,percent of total billed charges,"42.7% of $88,432.00 in Billed Charges for Rev 481 Proc 33230 = $37,760.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,32079.69,,,,,,,12398.0000,88432.0000,fee schedule,"APG 00097 Proc 33230 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 104% = $32,079.69. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,20181.03,,,,,,,12398.0000,88432.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,AETNA,AETNA HEALTHCARE MEDICARE,20181.03,,,,,,,12398.0000,88432.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,20181.03,,,,,,,12398.0000,88432.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,AMBETTER,AMBETTER,43994.64,,,,,,,12398.0000,88432.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,20988.27,,,,,,,12398.0000,88432.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,BLUE CROSS,ANTHEM EXCHANGE,49686.78,,,,,,,12398.0000,88432.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,31771.24,,,,,,,12398.0000,88432.0000,fee schedule,"APG 00097 Proc 33230 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 103% = $31,771.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,BLUE CROSS,ANTHEM HMO,52789.25,,,,,,,12398.0000,88432.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,20786.46,,,,,,,12398.0000,88432.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",62101.64,,,,,,,12398.0000,88432.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,61902.40,,,,,,,12398.0000,88432.0000,percent of total billed charges,"Rev 481 Proc 33230 $88,432.00 in Billed Charges at 70% = $61,902.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,BLUE CROSS,BLUE CROSS E NETWORK,12398.00,,,,,,,12398.0000,88432.0000,case rate,"Rev 481 Proc 33230 ASG Rate of $12,398.00 at 100% of $12,398.00 = $12,398.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,BLUE CROSS,BLUE CROSS MEDICARE,20988.27,,,,,,,12398.0000,88432.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,BLUE CROSS,BLUE CROSS P NETWORK,12677.00,,,,,,,12398.0000,88432.0000,case rate,"Rev 481 Proc 33230 ASG Rate of $12,677.00 at 100% of $12,677.00 = $12,677.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,BLUE CROSS,BLUE CROSS S NETWORK,12677.00,,,,,,,12398.0000,88432.0000,case rate,"Rev 481 Proc 33230 ASG Rate of $12,677.00 at 100% of $12,677.00 = $12,677.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,CIGNA HEALTHCARE,CIGNA HMO,36876.14,,,,,,,12398.0000,88432.0000,percent of total billed charges,"41.7% of $88,432.00 in Billed Charges for Rev 481 Proc 33230 = $36,876.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,41032.45,,,,,,,12398.0000,88432.0000,percent of total billed charges,"46.4% of $88,432.00 in Billed Charges for Rev 481 Proc 33230 = $41,032.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,21190.08,,,,,,,12398.0000,88432.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,36876.14,,,,,,,12398.0000,88432.0000,percent of total billed charges,"41.7% of $88,432.00 in Billed Charges for Rev 481 Proc 33230 = $36,876.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,CIGNA HEALTHCARE,CIGNA PPO,36876.14,,,,,,,12398.0000,88432.0000,percent of total billed charges,"41.7% of $88,432.00 in Billed Charges for Rev 481 Proc 33230 = $36,876.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,21190.08,,,,,,,12398.0000,88432.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,79588.80,,,,,,,12398.0000,88432.0000,percent of total billed charges,"90% of $88,432.00 in Billed Charges for Rev 481 Proc 33230 = $79,588.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,HUMANA,HUMANA MEDICARE,20181.03,,,,,,,12398.0000,88432.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,20181.03,,,,,,,12398.0000,88432.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,MEDCOST,MEDCOST VHN,42084.79,,,,,,,12398.0000,88432.0000,percent of total billed charges,"47.59% of $88,432.00 in Billed Charges for Rev 481 Proc 33230 = $42,084.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,32388.15,,,,,,,12398.0000,88432.0000,fee schedule,"APG 00097 Proc 33230 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 100% = $30,845.86... $30,845.86 at 105% = $32,388.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,21190.08,,,,,,,12398.0000,88432.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,21190.08,,,,,,,12398.0000,88432.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,NHC ADVANTAGE,NHC ADVANTAGE,21190.08,,,,,,,12398.0000,88432.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,31802.08,,,,,,,12398.0000,88432.0000,fee schedule,"APG 00097 Proc 33230 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 100% = $30,845.86... $30,845.86 at 103.1% = $31,802.08 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,SENTARA HEALTH,SENTARA HEALTH,22824.30,,,,,,,12398.0000,88432.0000,percent of total billed charges,"25.81% of $88,432.00 in Billed Charges for Rev 481 Proc 33230 = $22,824.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,SENTARA HEALTH,SENTARA MEDICARE,20181.03,,,,,,,12398.0000,88432.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",88432.00,,,,,,,12398.0000,88432.0000,percent of total billed charges,"100% of $88,432.00 in Billed Charges for Rev 481 Proc 33230 = $88,432.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14690.00,,,,,,,12398.0000,88432.0000,case rate,"Rev 481 Proc 33230 ASG Rate of $14,690.00 at 100% of $14,690.00 = $14,690.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13326.00,,,,,,,12398.0000,88432.0000,case rate,"Rev 481 Proc 33230 ASG Rate of $13,326.00 at 100% of $13,326.00 = $13,326.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,12749.00,,,,,,,12398.0000,88432.0000,case rate,"Rev 481 Proc 33230 ASG Rate of $12,749.00 at 100% of $12,749.00 = $12,749.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,21642.00,,,,,,,12398.0000,88432.0000,case rate,"Rev 481 Proc 33230 ASG Rate of $21,642.00 at 100% of $21,642.00 = $21,642.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,31771.24,,,,,,,12398.0000,88432.0000,fee schedule,"APG 00097 Proc 33230 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 103% = $31,771.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,20181.03,,,,,,,12398.0000,88432.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,20181.03,,,,,,,12398.0000,88432.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,WELLCARE,WELLCARE MEDICAID,88432.00,,,,,,,12398.0000,88432.0000,percent of total billed charges,"100% of $88,432.00 in Billed Charges for Rev 481 Proc 33230 = $88,432.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT PULSE GEN W/DUAL LEADS,33230,CPT,481,RC,48100021,CDM,,,,both,,,88432.0000,13264.8000,WELLCARE,WELLCARE MEDICARE,21391.89,,,,,,,12398.0000,88432.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TROCAR AIRSEAL 5MM BLADELESS,272,RC,27200002,CDM,,,,,,both,,,952.5800,142.8900,AETNA,AETNA,406.75,,,,,,,245.8600,952.5800,percent of total billed charges,42.7% of $952.58 in Billed Charges for Rev 272 = $406.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AIRSEAL 5MM BLADELESS,272,RC,27200002,CDM,,,,,,both,,,952.5800,142.8900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,666.81,,,,,,,245.8600,952.5800,percent of total billed charges,Rev 272 $952.58 in Billed Charges at 70% = $666.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AIRSEAL 5MM BLADELESS,272,RC,27200002,CDM,,,,,,both,,,952.5800,142.8900,CIGNA HEALTHCARE,CIGNA HMO,397.23,,,,,,,245.8600,952.5800,percent of total billed charges,41.7% of $952.58 in Billed Charges for Rev 272 = $397.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AIRSEAL 5MM BLADELESS,272,RC,27200002,CDM,,,,,,both,,,952.5800,142.8900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,442.00,,,,,,,245.8600,952.5800,percent of total billed charges,46.4% of $952.58 in Billed Charges for Rev 272 = $442.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AIRSEAL 5MM BLADELESS,272,RC,27200002,CDM,,,,,,both,,,952.5800,142.8900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,397.23,,,,,,,245.8600,952.5800,percent of total billed charges,41.7% of $952.58 in Billed Charges for Rev 272 = $397.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AIRSEAL 5MM BLADELESS,272,RC,27200002,CDM,,,,,,both,,,952.5800,142.8900,CIGNA HEALTHCARE,CIGNA PPO,397.23,,,,,,,245.8600,952.5800,percent of total billed charges,41.7% of $952.58 in Billed Charges for Rev 272 = $397.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AIRSEAL 5MM BLADELESS,272,RC,27200002,CDM,,,,,,both,,,952.5800,142.8900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,857.32,,,,,,,245.8600,952.5800,percent of total billed charges,90% of $952.58 in Billed Charges for Rev 272 = $857.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AIRSEAL 5MM BLADELESS,272,RC,27200002,CDM,,,,,,both,,,952.5800,142.8900,MEDCOST,MEDCOST VHN,453.33,,,,,,,245.8600,952.5800,percent of total billed charges,47.59% of $952.58 in Billed Charges for Rev 272 = $453.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AIRSEAL 5MM BLADELESS,272,RC,27200002,CDM,,,,,,both,,,952.5800,142.8900,SENTARA HEALTH,SENTARA HEALTH,245.86,,,,,,,245.8600,952.5800,percent of total billed charges,25.81% of $952.58 in Billed Charges for Rev 272 = $245.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AIRSEAL 5MM BLADELESS,272,RC,27200002,CDM,,,,,,both,,,952.5800,142.8900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",952.58,,,,,,,245.8600,952.5800,percent of total billed charges,100% of $952.58 in Billed Charges for Rev 272 = $952.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AIRSEAL 5MM BLADELESS,272,RC,27200002,CDM,,,,,,both,,,952.5800,142.8900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,476.29,,,,,,,245.8600,952.5800,percent of total billed charges,Rev 272 $952.58 in Billed Charges at 50% = $476.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AIRSEAL 5MM BLADELESS,272,RC,27200002,CDM,,,,,,both,,,952.5800,142.8900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,307.68,,,,,,,245.8600,952.5800,other,32.3% of $952.58 in Billed Charges for Rev 272 = $307.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TROCAR AIRSEAL 5MM BLADELESS,272,RC,27200002,CDM,,,,,,both,,,952.5800,142.8900,UNITED HEALTHCARE,UHC HERITAGE SELECT,292.44,,,,,,,245.8600,952.5800,other,30.7% of $952.58 in Billed Charges for Rev 272 = $292.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TROCAR AIRSEAL 5MM BLADELESS,272,RC,27200002,CDM,,,,,,both,,,952.5800,142.8900,UNITED HEALTHCARE,UNITED HEALTHCARE,307.68,,,,,,,245.8600,952.5800,percent of total billed charges,32.3% of $952.58 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AIRSEAL 5MM BLADELESS,272,RC,27200002,CDM,,,,,,both,,,952.5800,142.8900,WELLCARE,WELLCARE MEDICAID,952.58,,,,,,,245.8600,952.5800,percent of total billed charges,100% of $952.58 in Billed Charges for Rev 272 = $952.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,AETNA,AETNA,3874.60,,,,,,,487.0400,9074.0000,percent of total billed charges,"42.7% of $9,074.00 in Billed Charges for Rev 481 Proc 33235 = $3,874.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2176.64,,,,,,,487.0400,9074.0000,fee schedule,"APG 00074 Proc 33235 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 104% = $2,176.64. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3390.45,,,,,,,487.0400,9074.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,AETNA,AETNA HEALTHCARE MEDICARE,3390.45,,,,,,,487.0400,9074.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,3390.45,,,,,,,487.0400,9074.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,AMBETTER,AMBETTER,7391.18,,,,,,,487.0400,9074.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3526.07,,,,,,,487.0400,9074.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,BLUE CROSS,ANTHEM EXCHANGE,8347.47,,,,,,,487.0400,9074.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2155.71,,,,,,,487.0400,9074.0000,fee schedule,"APG 00074 Proc 33235 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,BLUE CROSS,ANTHEM HMO,8868.69,,,,,,,487.0400,9074.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3492.16,,,,,,,487.0400,9074.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9074.00,,,,,,,487.0400,9074.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,487.04,,,,,,,487.0400,9074.0000,fee schedule,$487.04 from Fee Schedule BLDTM_23 for Rev 481 Proc 33235 * Qty 1 = $487.04 at 100% = $487.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,487.0400,9074.0000,case rate,"Rev 481 Proc 33235 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,BLUE CROSS,BLUE CROSS MEDICARE,3526.07,,,,,,,487.0400,9074.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,487.0400,9074.0000,case rate,"Rev 481 Proc 33235 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,487.0400,9074.0000,case rate,"Rev 481 Proc 33235 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,CIGNA HEALTHCARE,CIGNA HMO,3783.86,,,,,,,487.0400,9074.0000,percent of total billed charges,"41.7% of $9,074.00 in Billed Charges for Rev 481 Proc 33235 = $3,783.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4210.34,,,,,,,487.0400,9074.0000,percent of total billed charges,"46.4% of $9,074.00 in Billed Charges for Rev 481 Proc 33235 = $4,210.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,3559.97,,,,,,,487.0400,9074.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3783.86,,,,,,,487.0400,9074.0000,percent of total billed charges,"41.7% of $9,074.00 in Billed Charges for Rev 481 Proc 33235 = $3,783.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,CIGNA HEALTHCARE,CIGNA PPO,3783.86,,,,,,,487.0400,9074.0000,percent of total billed charges,"41.7% of $9,074.00 in Billed Charges for Rev 481 Proc 33235 = $3,783.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3559.97,,,,,,,487.0400,9074.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8166.60,,,,,,,487.0400,9074.0000,percent of total billed charges,"90% of $9,074.00 in Billed Charges for Rev 481 Proc 33235 = $8,166.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,HUMANA,HUMANA MEDICARE,3390.45,,,,,,,487.0400,9074.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3390.45,,,,,,,487.0400,9074.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,MEDCOST,MEDCOST VHN,4318.32,,,,,,,487.0400,9074.0000,percent of total billed charges,"47.59% of $9,074.00 in Billed Charges for Rev 481 Proc 33235 = $4,318.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2197.57,,,,,,,487.0400,9074.0000,fee schedule,"APG 00074 Proc 33235 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 105% = $2,197.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3559.97,,,,,,,487.0400,9074.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3559.97,,,,,,,487.0400,9074.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,NHC ADVANTAGE,NHC ADVANTAGE,3559.97,,,,,,,487.0400,9074.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2157.80,,,,,,,487.0400,9074.0000,fee schedule,"APG 00074 Proc 33235 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 103.1% = $2,157.80 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,SENTARA HEALTH,SENTARA HEALTH,2342.00,,,,,,,487.0400,9074.0000,percent of total billed charges,"25.81% of $9,074.00 in Billed Charges for Rev 481 Proc 33235 = $2,342.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,SENTARA HEALTH,SENTARA MEDICARE,3390.45,,,,,,,487.0400,9074.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9074.00,,,,,,,487.0400,9074.0000,percent of total billed charges,"100% of $9,074.00 in Billed Charges for Rev 481 Proc 33235 = $9,074.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,487.0400,9074.0000,case rate,"Rev 481 Proc 33235 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,487.0400,9074.0000,case rate,"Rev 481 Proc 33235 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,487.0400,9074.0000,case rate,"Rev 481 Proc 33235 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,487.0400,9074.0000,case rate,"Rev 481 Proc 33235 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2155.71,,,,,,,487.0400,9074.0000,fee schedule,"APG 00074 Proc 33235 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3390.45,,,,,,,487.0400,9074.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3390.45,,,,,,,487.0400,9074.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,WELLCARE,WELLCARE MEDICAID,9074.00,,,,,,,487.0400,9074.0000,percent of total billed charges,"100% of $9,074.00 in Billed Charges for Rev 481 Proc 33235 = $9,074.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVE TRANSVEN LEADS PM DUAL,33235,CPT,481,RC,48100025,CDM,,,,both,,,9074.0000,1361.1000,WELLCARE,WELLCARE MEDICARE,3593.87,,,,,,,487.0400,9074.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA,5175.67,,,,,,,653.7600,12121.0000,percent of total billed charges,"42.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33244 = $5,175.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2176.64,,,,,,,653.7600,12121.0000,fee schedule,"APG 00074 Proc 33244 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 104% = $2,176.64. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3390.45,,,,,,,653.7600,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA HEALTHCARE MEDICARE,3390.45,,,,,,,653.7600,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,3390.45,,,,,,,653.7600,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,AMBETTER,AMBETTER,7391.18,,,,,,,653.7600,12121.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3526.07,,,,,,,653.7600,12121.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM EXCHANGE,8347.47,,,,,,,653.7600,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2155.71,,,,,,,653.7600,12121.0000,fee schedule,"APG 00074 Proc 33244 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM HMO,8868.69,,,,,,,653.7600,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3492.16,,,,,,,653.7600,12121.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",10433.19,,,,,,,653.7600,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,653.76,,,,,,,653.7600,12121.0000,fee schedule,$653.76 from Fee Schedule BLDTM_23 for Rev 481 Proc 33244 * Qty 1 = $653.76 at 100% = $653.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,653.7600,12121.0000,case rate,"Rev 481 Proc 33244 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS MEDICARE,3526.07,,,,,,,653.7600,12121.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,653.7600,12121.0000,case rate,"Rev 481 Proc 33244 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,653.7600,12121.0000,case rate,"Rev 481 Proc 33244 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA HMO,5054.46,,,,,,,653.7600,12121.0000,percent of total billed charges,"41.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33244 = $5,054.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5624.14,,,,,,,653.7600,12121.0000,percent of total billed charges,"46.4% of $12,121.00 in Billed Charges for Rev 481 Proc 33244 = $5,624.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,3559.97,,,,,,,653.7600,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5054.46,,,,,,,653.7600,12121.0000,percent of total billed charges,"41.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33244 = $5,054.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA PPO,5054.46,,,,,,,653.7600,12121.0000,percent of total billed charges,"41.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33244 = $5,054.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3559.97,,,,,,,653.7600,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10908.90,,,,,,,653.7600,12121.0000,percent of total billed charges,"90% of $12,121.00 in Billed Charges for Rev 481 Proc 33244 = $10,908.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,HUMANA,HUMANA MEDICARE,3390.45,,,,,,,653.7600,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3390.45,,,,,,,653.7600,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,MEDCOST,MEDCOST VHN,5768.38,,,,,,,653.7600,12121.0000,percent of total billed charges,"47.59% of $12,121.00 in Billed Charges for Rev 481 Proc 33244 = $5,768.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2197.57,,,,,,,653.7600,12121.0000,fee schedule,"APG 00074 Proc 33244 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 105% = $2,197.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3559.97,,,,,,,653.7600,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3559.97,,,,,,,653.7600,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,NHC ADVANTAGE,NHC ADVANTAGE,3559.97,,,,,,,653.7600,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2157.80,,,,,,,653.7600,12121.0000,fee schedule,"APG 00074 Proc 33244 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 103.1% = $2,157.80 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,SENTARA HEALTH,SENTARA HEALTH,3128.43,,,,,,,653.7600,12121.0000,percent of total billed charges,"25.81% of $12,121.00 in Billed Charges for Rev 481 Proc 33244 = $3,128.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,SENTARA HEALTH,SENTARA MEDICARE,3390.45,,,,,,,653.7600,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12121.00,,,,,,,653.7600,12121.0000,percent of total billed charges,"100% of $12,121.00 in Billed Charges for Rev 481 Proc 33244 = $12,121.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,653.7600,12121.0000,case rate,"Rev 481 Proc 33244 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,653.7600,12121.0000,case rate,"Rev 481 Proc 33244 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,653.7600,12121.0000,case rate,"Rev 481 Proc 33244 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,653.7600,12121.0000,case rate,"Rev 481 Proc 33244 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2155.71,,,,,,,653.7600,12121.0000,fee schedule,"APG 00074 Proc 33244 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3390.45,,,,,,,653.7600,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3390.45,,,,,,,653.7600,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,WELLCARE,WELLCARE MEDICAID,12121.00,,,,,,,653.7600,12121.0000,percent of total billed charges,"100% of $12,121.00 in Billed Charges for Rev 481 Proc 33244 = $12,121.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL LEAD(S) TRANSVEN ICD,33244,CPT,481,RC,48100029,CDM,,,,both,,,12121.0000,1818.1500,WELLCARE,WELLCARE MEDICARE,3593.87,,,,,,,653.7600,12121.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,AETNA,AETNA,34392.29,,,,,,,12749.0000,80544.0000,percent of total billed charges,"42.7% of $80,544.00 in Billed Charges for Rev 481 Proc 33264 = $34,392.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,32079.69,,,,,,,12749.0000,80544.0000,fee schedule,"APG 00097 Proc 33264 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 104% = $32,079.69. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,28478.32,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,AETNA,AETNA HEALTHCARE MEDICARE,28478.32,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,28478.32,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,AMBETTER,AMBETTER,62082.73,,,,,,,12749.0000,80544.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,29617.45,,,,,,,12749.0000,80544.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,ANTHEM EXCHANGE,70115.16,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,31771.24,,,,,,,12749.0000,80544.0000,fee schedule,"APG 00097 Proc 33264 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 103% = $31,771.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,ANTHEM HMO,74493.19,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,29332.66,,,,,,,12749.0000,80544.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",80544.00,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,56380.80,,,,,,,12749.0000,80544.0000,percent of total billed charges,"Rev 481 Proc 33264 $80,544.00 in Billed Charges at 70% = $56,380.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,BLUE CROSS E NETWORK,23732.00,,,,,,,12749.0000,80544.0000,case rate,"Rev 481 Proc 33264 ASG Rate of $23,732.00 at 100% of $23,732.00 = $23,732.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,BLUE CROSS MEDICARE,29617.45,,,,,,,12749.0000,80544.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,BLUE CROSS P NETWORK,24267.00,,,,,,,12749.0000,80544.0000,case rate,"Rev 481 Proc 33264 ASG Rate of $24,267.00 at 100% of $24,267.00 = $24,267.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,BLUE CROSS,BLUE CROSS S NETWORK,24267.00,,,,,,,12749.0000,80544.0000,case rate,"Rev 481 Proc 33264 ASG Rate of $24,267.00 at 100% of $24,267.00 = $24,267.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,CIGNA HEALTHCARE,CIGNA HMO,33586.85,,,,,,,12749.0000,80544.0000,percent of total billed charges,"41.7% of $80,544.00 in Billed Charges for Rev 481 Proc 33264 = $33,586.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,37372.42,,,,,,,12749.0000,80544.0000,percent of total billed charges,"46.4% of $80,544.00 in Billed Charges for Rev 481 Proc 33264 = $37,372.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,29902.23,,,,,,,12749.0000,80544.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,33586.85,,,,,,,12749.0000,80544.0000,percent of total billed charges,"41.7% of $80,544.00 in Billed Charges for Rev 481 Proc 33264 = $33,586.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,CIGNA HEALTHCARE,CIGNA PPO,33586.85,,,,,,,12749.0000,80544.0000,percent of total billed charges,"41.7% of $80,544.00 in Billed Charges for Rev 481 Proc 33264 = $33,586.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,29902.23,,,,,,,12749.0000,80544.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,72489.60,,,,,,,12749.0000,80544.0000,percent of total billed charges,"90% of $80,544.00 in Billed Charges for Rev 481 Proc 33264 = $72,489.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,HUMANA,HUMANA MEDICARE,28478.32,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,28478.32,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,MEDCOST,MEDCOST VHN,38330.89,,,,,,,12749.0000,80544.0000,percent of total billed charges,"47.59% of $80,544.00 in Billed Charges for Rev 481 Proc 33264 = $38,330.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,32388.15,,,,,,,12749.0000,80544.0000,fee schedule,"APG 00097 Proc 33264 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 100% = $30,845.86... $30,845.86 at 105% = $32,388.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,29902.23,,,,,,,12749.0000,80544.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,29902.23,,,,,,,12749.0000,80544.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,NHC ADVANTAGE,NHC ADVANTAGE,29902.23,,,,,,,12749.0000,80544.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,31802.08,,,,,,,12749.0000,80544.0000,fee schedule,"APG 00097 Proc 33264 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 100% = $30,845.86... $30,845.86 at 103.1% = $31,802.08 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,SENTARA HEALTH,SENTARA HEALTH,20788.41,,,,,,,12749.0000,80544.0000,percent of total billed charges,"25.81% of $80,544.00 in Billed Charges for Rev 481 Proc 33264 = $20,788.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,SENTARA HEALTH,SENTARA MEDICARE,28478.32,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",80544.00,,,,,,,12749.0000,80544.0000,percent of total billed charges,"100% of $80,544.00 in Billed Charges for Rev 481 Proc 33264 = $80,544.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14690.00,,,,,,,12749.0000,80544.0000,case rate,"Rev 481 Proc 33264 ASG Rate of $14,690.00 at 100% of $14,690.00 = $14,690.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13326.00,,,,,,,12749.0000,80544.0000,case rate,"Rev 481 Proc 33264 ASG Rate of $13,326.00 at 100% of $13,326.00 = $13,326.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,12749.00,,,,,,,12749.0000,80544.0000,case rate,"Rev 481 Proc 33264 ASG Rate of $12,749.00 at 100% of $12,749.00 = $12,749.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,21642.00,,,,,,,12749.0000,80544.0000,case rate,"Rev 481 Proc 33264 ASG Rate of $21,642.00 at 100% of $21,642.00 = $21,642.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,31771.24,,,,,,,12749.0000,80544.0000,fee schedule,"APG 00097 Proc 33264 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 103% = $31,771.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,28478.32,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,28478.32,,,,,,,12749.0000,80544.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,WELLCARE,WELLCARE MEDICAID,80544.00,,,,,,,12749.0000,80544.0000,percent of total billed charges,"100% of $80,544.00 in Billed Charges for Rev 481 Proc 33264 = $80,544.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMV & REPLC CVD GEN MULT LEA,33264,CPT,481,RC,48100033,CDM,,,,both,,,80544.0000,12081.6000,WELLCARE,WELLCARE MEDICARE,30187.01,,,,,,,12749.0000,80544.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,AETNA,AETNA,41832.76,,,,,,,1571.0000,97969.0000,percent of total billed charges,"42.7% of $97,969.00 in Billed Charges for Rev 480 Proc 33270 = $41,832.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,32079.69,,,,,,,1571.0000,97969.0000,fee schedule,"APG 00097 Proc 33270 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 104% = $32,079.69. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,28478.32,,,,,,,1571.0000,97969.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,AETNA,AETNA HEALTHCARE MEDICARE,28478.32,,,,,,,1571.0000,97969.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,28478.32,,,,,,,1571.0000,97969.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,AMBETTER,AMBETTER,62082.73,,,,,,,1571.0000,97969.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,29617.45,,,,,,,1571.0000,97969.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,BLUE CROSS,ANTHEM EXCHANGE,70115.16,,,,,,,1571.0000,97969.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,31771.24,,,,,,,1571.0000,97969.0000,fee schedule,"APG 00097 Proc 33270 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 103% = $31,771.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,BLUE CROSS,ANTHEM HMO,74493.19,,,,,,,1571.0000,97969.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,29332.66,,,,,,,1571.0000,97969.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",87634.30,,,,,,,1571.0000,97969.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,68578.30,,,,,,,1571.0000,97969.0000,percent of total billed charges,"Rev 480 Proc 33270 $97,969.00 in Billed Charges at 70% = $68,578.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,BLUE CROSS,BLUE CROSS E NETWORK,23732.00,,,,,,,1571.0000,97969.0000,case rate,"Rev 480 Proc 33270 ASG Rate of $23,732.00 at 100% of $23,732.00 = $23,732.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,BLUE CROSS,BLUE CROSS MEDICARE,29617.45,,,,,,,1571.0000,97969.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,BLUE CROSS,BLUE CROSS P NETWORK,24267.00,,,,,,,1571.0000,97969.0000,case rate,"Rev 480 Proc 33270 ASG Rate of $24,267.00 at 100% of $24,267.00 = $24,267.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,BLUE CROSS,BLUE CROSS S NETWORK,24267.00,,,,,,,1571.0000,97969.0000,case rate,"Rev 480 Proc 33270 ASG Rate of $24,267.00 at 100% of $24,267.00 = $24,267.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,CIGNA HEALTHCARE,CIGNA HMO,40853.07,,,,,,,1571.0000,97969.0000,percent of total billed charges,"41.7% of $97,969.00 in Billed Charges for Rev 480 Proc 33270 = $40,853.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,45457.62,,,,,,,1571.0000,97969.0000,percent of total billed charges,"46.4% of $97,969.00 in Billed Charges for Rev 480 Proc 33270 = $45,457.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,29902.23,,,,,,,1571.0000,97969.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,40853.07,,,,,,,1571.0000,97969.0000,percent of total billed charges,"41.7% of $97,969.00 in Billed Charges for Rev 480 Proc 33270 = $40,853.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,CIGNA HEALTHCARE,CIGNA PPO,40853.07,,,,,,,1571.0000,97969.0000,percent of total billed charges,"41.7% of $97,969.00 in Billed Charges for Rev 480 Proc 33270 = $40,853.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,29902.23,,,,,,,1571.0000,97969.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,88172.10,,,,,,,1571.0000,97969.0000,percent of total billed charges,"90% of $97,969.00 in Billed Charges for Rev 480 Proc 33270 = $88,172.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,HUMANA,HUMANA MEDICARE,28478.32,,,,,,,1571.0000,97969.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,28478.32,,,,,,,1571.0000,97969.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,MEDCOST,MEDCOST VHN,46623.45,,,,,,,1571.0000,97969.0000,percent of total billed charges,"47.59% of $97,969.00 in Billed Charges for Rev 480 Proc 33270 = $46,623.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,32388.15,,,,,,,1571.0000,97969.0000,fee schedule,"APG 00097 Proc 33270 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 100% = $30,845.86... $30,845.86 at 105% = $32,388.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,29902.23,,,,,,,1571.0000,97969.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,29902.23,,,,,,,1571.0000,97969.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,NHC ADVANTAGE,NHC ADVANTAGE,29902.23,,,,,,,1571.0000,97969.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,31802.08,,,,,,,1571.0000,97969.0000,fee schedule,"APG 00097 Proc 33270 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 100% = $30,845.86... $30,845.86 at 103.1% = $31,802.08 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,SENTARA HEALTH,SENTARA HEALTH,25285.80,,,,,,,1571.0000,97969.0000,percent of total billed charges,"25.81% of $97,969.00 in Billed Charges for Rev 480 Proc 33270 = $25,285.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,SENTARA HEALTH,SENTARA MEDICARE,28478.32,,,,,,,1571.0000,97969.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",97969.00,,,,,,,1571.0000,97969.0000,percent of total billed charges,"100% of $97,969.00 in Billed Charges for Rev 480 Proc 33270 = $97,969.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,15409.22,,,,,,,1571.0000,97969.0000,fee schedule,"$30,818.44 from Fee Schedule TCUHC24 for Rev 480 Proc 33270 * Qty 1 = $30,818.44 at 50% = $15,409.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1642.00,,,,,,,1571.0000,97969.0000,other,"Rev 480 Proc 33270 1 Visit at $1,642.00 per Visit = $1,642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1571.00,,,,,,,1571.0000,97969.0000,other,"Rev 480 Proc 33270 1 Visit at $1,571.00 per Visit = $1,571.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,3097.00,,,,,,,1571.0000,97969.0000,other,"Rev 480 Proc 33270 1 Visit at $3,097.00 per Visit = $3,097.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,31771.24,,,,,,,1571.0000,97969.0000,fee schedule,"APG 00097 Proc 33270 at $836.60 (Base Rate) * 36.8705 (Relative Weight) = $30,845.86 (Total Line Payment) at 103% = $31,771.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,28478.32,,,,,,,1571.0000,97969.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,28478.32,,,,,,,1571.0000,97969.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,WELLCARE,WELLCARE MEDICAID,97969.00,,,,,,,1571.0000,97969.0000,percent of total billed charges,"100% of $97,969.00 in Billed Charges for Rev 480 Proc 33270 = $97,969.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION/REPLCMT SQ ICD W SQ ELECTRODE,33270,CPT,480,RC,48000054,CDM,,,,both,,,97969.0000,14695.3500,WELLCARE,WELLCARE MEDICARE,30187.01,,,,,,,1571.0000,97969.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,AETNA,AETNA,4077.42,,,,,,,1173.6200,9549.0000,percent of total billed charges,"42.7% of $9,549.00 in Billed Charges for Rev 480 Proc 33272 = $4,077.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2176.64,,,,,,,1173.6200,9549.0000,fee schedule,"APG 00074 Proc 33272 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 104% = $2,176.64. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3390.45,,,,,,,1173.6200,9549.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,AETNA,AETNA HEALTHCARE MEDICARE,3390.45,,,,,,,1173.6200,9549.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,3390.45,,,,,,,1173.6200,9549.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,AMBETTER,AMBETTER,7391.18,,,,,,,1173.6200,9549.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3526.07,,,,,,,1173.6200,9549.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,BLUE CROSS,ANTHEM EXCHANGE,8347.47,,,,,,,1173.6200,9549.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2155.71,,,,,,,1173.6200,9549.0000,fee schedule,"APG 00074 Proc 33272 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,BLUE CROSS,ANTHEM HMO,8868.69,,,,,,,1173.6200,9549.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3492.16,,,,,,,1173.6200,9549.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9549.00,,,,,,,1173.6200,9549.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6684.30,,,,,,,1173.6200,9549.0000,percent of total billed charges,"Rev 480 Proc 33272 $9,549.00 in Billed Charges at 70% = $6,684.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,1173.6200,9549.0000,case rate,"Rev 480 Proc 33272 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,BLUE CROSS,BLUE CROSS MEDICARE,3526.07,,,,,,,1173.6200,9549.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,1173.6200,9549.0000,case rate,"Rev 480 Proc 33272 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,1173.6200,9549.0000,case rate,"Rev 480 Proc 33272 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,CIGNA HEALTHCARE,CIGNA HMO,3981.93,,,,,,,1173.6200,9549.0000,percent of total billed charges,"41.7% of $9,549.00 in Billed Charges for Rev 480 Proc 33272 = $3,981.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4430.74,,,,,,,1173.6200,9549.0000,percent of total billed charges,"46.4% of $9,549.00 in Billed Charges for Rev 480 Proc 33272 = $4,430.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,3559.97,,,,,,,1173.6200,9549.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3981.93,,,,,,,1173.6200,9549.0000,percent of total billed charges,"41.7% of $9,549.00 in Billed Charges for Rev 480 Proc 33272 = $3,981.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,CIGNA HEALTHCARE,CIGNA PPO,3981.93,,,,,,,1173.6200,9549.0000,percent of total billed charges,"41.7% of $9,549.00 in Billed Charges for Rev 480 Proc 33272 = $3,981.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3559.97,,,,,,,1173.6200,9549.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8594.10,,,,,,,1173.6200,9549.0000,percent of total billed charges,"90% of $9,549.00 in Billed Charges for Rev 480 Proc 33272 = $8,594.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,HUMANA,HUMANA MEDICARE,3390.45,,,,,,,1173.6200,9549.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3390.45,,,,,,,1173.6200,9549.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,MEDCOST,MEDCOST VHN,4544.37,,,,,,,1173.6200,9549.0000,percent of total billed charges,"47.59% of $9,549.00 in Billed Charges for Rev 480 Proc 33272 = $4,544.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2197.57,,,,,,,1173.6200,9549.0000,fee schedule,"APG 00074 Proc 33272 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 105% = $2,197.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3559.97,,,,,,,1173.6200,9549.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3559.97,,,,,,,1173.6200,9549.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,NHC ADVANTAGE,NHC ADVANTAGE,3559.97,,,,,,,1173.6200,9549.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2157.80,,,,,,,1173.6200,9549.0000,fee schedule,"APG 00074 Proc 33272 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 103.1% = $2,157.80 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,SENTARA HEALTH,SENTARA HEALTH,2464.60,,,,,,,1173.6200,9549.0000,percent of total billed charges,"25.81% of $9,549.00 in Billed Charges for Rev 480 Proc 33272 = $2,464.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,SENTARA HEALTH,SENTARA MEDICARE,3390.45,,,,,,,1173.6200,9549.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9549.00,,,,,,,1173.6200,9549.0000,percent of total billed charges,"100% of $9,549.00 in Billed Charges for Rev 480 Proc 33272 = $9,549.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1173.62,,,,,,,1173.6200,9549.0000,fee schedule,"$2,347.24 from Fee Schedule TCUHC24 for Rev 480 Proc 33272 * Qty 1 = $2,347.24 at 50% = $1,173.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1642.00,,,,,,,1173.6200,9549.0000,other,"Rev 480 Proc 33272 1 Visit at $1,642.00 per Visit = $1,642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1571.00,,,,,,,1173.6200,9549.0000,other,"Rev 480 Proc 33272 1 Visit at $1,571.00 per Visit = $1,571.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,3097.00,,,,,,,1173.6200,9549.0000,other,"Rev 480 Proc 33272 1 Visit at $3,097.00 per Visit = $3,097.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2155.71,,,,,,,1173.6200,9549.0000,fee schedule,"APG 00074 Proc 33272 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3390.45,,,,,,,1173.6200,9549.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3390.45,,,,,,,1173.6200,9549.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,WELLCARE,WELLCARE MEDICAID,9549.00,,,,,,,1173.6200,9549.0000,percent of total billed charges,"100% of $9,549.00 in Billed Charges for Rev 480 Proc 33272 = $9,549.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SQ ICD ELECTRODE,33272,CPT,480,RC,48000056,CDM,,,,both,,,9549.0000,1432.3500,WELLCARE,WELLCARE MEDICARE,3593.87,,,,,,,1173.6200,9549.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,AETNA,AETNA,4077.42,,,,,,,1173.6200,9549.0000,percent of total billed charges,"42.7% of $9,549.00 in Billed Charges for Rev 480 Proc 33273 = $4,077.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2176.64,,,,,,,1173.6200,9549.0000,fee schedule,"APG 00074 Proc 33273 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 104% = $2,176.64. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3390.45,,,,,,,1173.6200,9549.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,AETNA,AETNA HEALTHCARE MEDICARE,3390.45,,,,,,,1173.6200,9549.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,3390.45,,,,,,,1173.6200,9549.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,AMBETTER,AMBETTER,7391.18,,,,,,,1173.6200,9549.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3526.07,,,,,,,1173.6200,9549.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,BLUE CROSS,ANTHEM EXCHANGE,8347.47,,,,,,,1173.6200,9549.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2155.71,,,,,,,1173.6200,9549.0000,fee schedule,"APG 00074 Proc 33273 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,BLUE CROSS,ANTHEM HMO,8868.69,,,,,,,1173.6200,9549.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3492.16,,,,,,,1173.6200,9549.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9549.00,,,,,,,1173.6200,9549.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6684.30,,,,,,,1173.6200,9549.0000,percent of total billed charges,"Rev 480 Proc 33273 $9,549.00 in Billed Charges at 70% = $6,684.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,1173.6200,9549.0000,case rate,"Rev 480 Proc 33273 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,BLUE CROSS,BLUE CROSS MEDICARE,3526.07,,,,,,,1173.6200,9549.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,1173.6200,9549.0000,case rate,"Rev 480 Proc 33273 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,1173.6200,9549.0000,case rate,"Rev 480 Proc 33273 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,CIGNA HEALTHCARE,CIGNA HMO,3981.93,,,,,,,1173.6200,9549.0000,percent of total billed charges,"41.7% of $9,549.00 in Billed Charges for Rev 480 Proc 33273 = $3,981.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4430.74,,,,,,,1173.6200,9549.0000,percent of total billed charges,"46.4% of $9,549.00 in Billed Charges for Rev 480 Proc 33273 = $4,430.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,3559.97,,,,,,,1173.6200,9549.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3981.93,,,,,,,1173.6200,9549.0000,percent of total billed charges,"41.7% of $9,549.00 in Billed Charges for Rev 480 Proc 33273 = $3,981.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,CIGNA HEALTHCARE,CIGNA PPO,3981.93,,,,,,,1173.6200,9549.0000,percent of total billed charges,"41.7% of $9,549.00 in Billed Charges for Rev 480 Proc 33273 = $3,981.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3559.97,,,,,,,1173.6200,9549.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8594.10,,,,,,,1173.6200,9549.0000,percent of total billed charges,"90% of $9,549.00 in Billed Charges for Rev 480 Proc 33273 = $8,594.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,HUMANA,HUMANA MEDICARE,3390.45,,,,,,,1173.6200,9549.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3390.45,,,,,,,1173.6200,9549.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,MEDCOST,MEDCOST VHN,4544.37,,,,,,,1173.6200,9549.0000,percent of total billed charges,"47.59% of $9,549.00 in Billed Charges for Rev 480 Proc 33273 = $4,544.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2197.57,,,,,,,1173.6200,9549.0000,fee schedule,"APG 00074 Proc 33273 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 105% = $2,197.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3559.97,,,,,,,1173.6200,9549.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3559.97,,,,,,,1173.6200,9549.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,NHC ADVANTAGE,NHC ADVANTAGE,3559.97,,,,,,,1173.6200,9549.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2157.80,,,,,,,1173.6200,9549.0000,fee schedule,"APG 00074 Proc 33273 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 103.1% = $2,157.80 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,SENTARA HEALTH,SENTARA HEALTH,2464.60,,,,,,,1173.6200,9549.0000,percent of total billed charges,"25.81% of $9,549.00 in Billed Charges for Rev 480 Proc 33273 = $2,464.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,SENTARA HEALTH,SENTARA MEDICARE,3390.45,,,,,,,1173.6200,9549.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9549.00,,,,,,,1173.6200,9549.0000,percent of total billed charges,"100% of $9,549.00 in Billed Charges for Rev 480 Proc 33273 = $9,549.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1173.62,,,,,,,1173.6200,9549.0000,fee schedule,"$2,347.24 from Fee Schedule TCUHC24 for Rev 480 Proc 33273 * Qty 1 = $2,347.24 at 50% = $1,173.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1642.00,,,,,,,1173.6200,9549.0000,other,"Rev 480 Proc 33273 1 Visit at $1,642.00 per Visit = $1,642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1571.00,,,,,,,1173.6200,9549.0000,other,"Rev 480 Proc 33273 1 Visit at $1,571.00 per Visit = $1,571.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,3097.00,,,,,,,1173.6200,9549.0000,other,"Rev 480 Proc 33273 1 Visit at $3,097.00 per Visit = $3,097.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2155.71,,,,,,,1173.6200,9549.0000,fee schedule,"APG 00074 Proc 33273 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3390.45,,,,,,,1173.6200,9549.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3390.45,,,,,,,1173.6200,9549.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,WELLCARE,WELLCARE MEDICAID,9549.00,,,,,,,1173.6200,9549.0000,percent of total billed charges,"100% of $9,549.00 in Billed Charges for Rev 480 Proc 33273 = $9,549.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION PREV IMPLNT SQ ICD ELECTRODE,33273,CPT,480,RC,48000057,CDM,,,,both,,,9549.0000,1432.3500,WELLCARE,WELLCARE MEDICARE,3593.87,,,,,,,1173.6200,9549.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,AETNA,AETNA,19890.94,,,,,,,890.0000,46583.0000,percent of total billed charges,"42.7% of $46,583.00 in Billed Charges for Rev 361 Proc 33274 = $19,890.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11330.93,,,,,,,890.0000,46583.0000,fee schedule,"APG 00086 Proc 33274 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 104% = $11,330.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,17475.64,,,,,,,890.0000,46583.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,AETNA,AETNA HEALTHCARE MEDICARE,17475.64,,,,,,,890.0000,46583.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,17475.64,,,,,,,890.0000,46583.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,AMBETTER,AMBETTER,38096.90,,,,,,,890.0000,46583.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,18174.67,,,,,,,890.0000,46583.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,BLUE CROSS,ANTHEM EXCHANGE,43025.97,,,,,,,890.0000,46583.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11221.98,,,,,,,890.0000,46583.0000,fee schedule,"APG 00086 Proc 33274 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,BLUE CROSS,ANTHEM HMO,45712.54,,,,,,,890.0000,46583.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,17999.91,,,,,,,890.0000,46583.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",46583.00,,,,,,,890.0000,46583.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,890.0000,46583.0000,case rate,"Rev 361 Proc 33274 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,BLUE CROSS,BLUE CROSS E NETWORK,11219.00,,,,,,,890.0000,46583.0000,case rate,"Rev 361 Proc 33274 ASG Rate of $11,219.00 at 100% of $11,219.00 = $11,219.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,BLUE CROSS,BLUE CROSS MEDICARE,18174.67,,,,,,,890.0000,46583.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,BLUE CROSS,BLUE CROSS P NETWORK,11472.00,,,,,,,890.0000,46583.0000,case rate,"Rev 361 Proc 33274 ASG Rate of $11,472.00 at 100% of $11,472.00 = $11,472.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,BLUE CROSS,BLUE CROSS S NETWORK,11472.00,,,,,,,890.0000,46583.0000,case rate,"Rev 361 Proc 33274 ASG Rate of $11,472.00 at 100% of $11,472.00 = $11,472.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,BLUE CROSS,TENNCARE BLUE CARE,890.00,,,,,,,890.0000,46583.0000,case rate,Rev 361 Proc 33274 ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,BLUE CROSS,TENNCARE BLUE SELECT,890.00,,,,,,,890.0000,46583.0000,case rate,Rev 361 Proc 33274 ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,890.0000,46583.0000,case rate,"Rev 361 Proc 33274 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,890.0000,46583.0000,case rate,"Rev 361 Proc 33274 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,18349.42,,,,,,,890.0000,46583.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,890.0000,46583.0000,case rate,"Rev 361 Proc 33274 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,890.0000,46583.0000,case rate,"Rev 361 Proc 33274 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,18349.42,,,,,,,890.0000,46583.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,41924.70,,,,,,,890.0000,46583.0000,percent of total billed charges,"90% of $46,583.00 in Billed Charges for Rev 361 Proc 33274 = $41,924.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,HUMANA,HUMANA MEDICARE,17475.64,,,,,,,890.0000,46583.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,17475.64,,,,,,,890.0000,46583.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,MEDCOST,MEDCOST VHN,22168.85,,,,,,,890.0000,46583.0000,percent of total billed charges,"47.59% of $46,583.00 in Billed Charges for Rev 361 Proc 33274 = $22,168.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11439.89,,,,,,,890.0000,46583.0000,fee schedule,"APG 00086 Proc 33274 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 105% = $11,439.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,18349.42,,,,,,,890.0000,46583.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,18349.42,,,,,,,890.0000,46583.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,NHC ADVANTAGE,NHC ADVANTAGE,18349.42,,,,,,,890.0000,46583.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11232.88,,,,,,,890.0000,46583.0000,fee schedule,"APG 00086 Proc 33274 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 103.1% = $11,232.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,SENTARA HEALTH,SENTARA HEALTH,12023.07,,,,,,,890.0000,46583.0000,percent of total billed charges,"25.81% of $46,583.00 in Billed Charges for Rev 361 Proc 33274 = $12,023.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,SENTARA HEALTH,SENTARA MEDICARE,17475.64,,,,,,,890.0000,46583.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",46583.00,,,,,,,890.0000,46583.0000,percent of total billed charges,"100% of $46,583.00 in Billed Charges for Rev 361 Proc 33274 = $46,583.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11895.00,,,,,,,890.0000,46583.0000,case rate,"Rev 361 Proc 33274 ASG Rate of $11,895.00 at 100% of $11,895.00 = $11,895.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13136.00,,,,,,,890.0000,46583.0000,case rate,"Rev 361 Proc 33274 ASG Rate of $13,136.00 at 100% of $13,136.00 = $13,136.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,12568.00,,,,,,,890.0000,46583.0000,case rate,"Rev 361 Proc 33274 ASG Rate of $12,568.00 at 100% of $12,568.00 = $12,568.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,21337.00,,,,,,,890.0000,46583.0000,case rate,"Rev 361 Proc 33274 ASG Rate of $21,337.00 at 100% of $21,337.00 = $21,337.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11221.98,,,,,,,890.0000,46583.0000,fee schedule,"APG 00086 Proc 33274 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,17475.64,,,,,,,890.0000,46583.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,17475.64,,,,,,,890.0000,46583.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,WELLCARE,WELLCARE MEDICAID,46583.00,,,,,,,890.0000,46583.0000,percent of total billed charges,"100% of $46,583.00 in Billed Charges for Rev 361 Proc 33274 = $46,583.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH INSERT/REPLC PERM LEADLASS PM RV INCL IMG GUID,33274,CPT,361,RC,36100412,CDM,,,,both,,,46583.0000,6987.4500,WELLCARE,WELLCARE MEDICARE,18524.18,,,,,,,890.0000,46583.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,AETNA,AETNA,4281.10,,,,,,,578.0000,10420.9900,percent of total billed charges,"42.7% of $10,026.00 in Billed Charges for Rev 361 Proc 33275 = $4,281.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,10321.74,,,,,,,578.0000,10420.9900,fee schedule,"APG 00087 Proc 33275 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 104% = $10,321.74. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2864.70,,,,,,,578.0000,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,AETNA,AETNA HEALTHCARE MEDICARE,2864.70,,,,,,,578.0000,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,2864.70,,,,,,,578.0000,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,AMBETTER,AMBETTER,6245.05,,,,,,,578.0000,10420.9900,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2979.29,,,,,,,578.0000,10420.9900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,BLUE CROSS,ANTHEM EXCHANGE,7053.05,,,,,,,578.0000,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,10026.00,,,,,,,578.0000,10420.9900,fee schedule,"APG 00087 Proc 33275 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 103% = $10,222.50 (Service Line reduced to $10,026.00, claim capped at $10,026.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,BLUE CROSS,ANTHEM HMO,7493.45,,,,,,,578.0000,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2950.64,,,,,,,578.0000,10420.9900,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8815.35,,,,,,,578.0000,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,578.0000,10420.9900,case rate,"Rev 361 Proc 33275 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,578.0000,10420.9900,case rate,"Rev 361 Proc 33275 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,BLUE CROSS,BLUE CROSS MEDICARE,2979.29,,,,,,,578.0000,10420.9900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,578.0000,10420.9900,case rate,"Rev 361 Proc 33275 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,578.0000,10420.9900,case rate,"Rev 361 Proc 33275 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,10420.9900,case rate,Rev 361 Proc 33275 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,10420.9900,case rate,Rev 361 Proc 33275 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,578.0000,10420.9900,case rate,"Rev 361 Proc 33275 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,578.0000,10420.9900,case rate,"Rev 361 Proc 33275 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,3007.94,,,,,,,578.0000,10420.9900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,578.0000,10420.9900,case rate,"Rev 361 Proc 33275 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,578.0000,10420.9900,case rate,"Rev 361 Proc 33275 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3007.94,,,,,,,578.0000,10420.9900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9023.40,,,,,,,578.0000,10420.9900,percent of total billed charges,"90% of $10,026.00 in Billed Charges for Rev 361 Proc 33275 = $9,023.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,HUMANA,HUMANA MEDICARE,2864.70,,,,,,,578.0000,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2864.70,,,,,,,578.0000,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,MEDCOST,MEDCOST VHN,4771.37,,,,,,,578.0000,10420.9900,percent of total billed charges,"47.59% of $10,026.00 in Billed Charges for Rev 361 Proc 33275 = $4,771.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,10420.99,,,,,,,578.0000,10420.9900,fee schedule,"APG 00087 Proc 33275 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 100% = $9,924.75... $9,924.75 at 105% = $10,420.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3007.94,,,,,,,578.0000,10420.9900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3007.94,,,,,,,578.0000,10420.9900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,NHC ADVANTAGE,NHC ADVANTAGE,3007.94,,,,,,,578.0000,10420.9900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,10232.42,,,,,,,578.0000,10420.9900,fee schedule,"APG 00087 Proc 33275 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 100% = $9,924.75... $9,924.75 at 103.1% = $10,232.42 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,SENTARA HEALTH,SENTARA HEALTH,2587.71,,,,,,,578.0000,10420.9900,percent of total billed charges,"25.81% of $10,026.00 in Billed Charges for Rev 361 Proc 33275 = $2,587.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,SENTARA HEALTH,SENTARA MEDICARE,2864.70,,,,,,,578.0000,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10026.00,,,,,,,578.0000,10420.9900,percent of total billed charges,"100% of $10,026.00 in Billed Charges for Rev 361 Proc 33275 = $10,026.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,578.0000,10420.9900,case rate,"Rev 361 Proc 33275 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,578.0000,10420.9900,case rate,"Rev 361 Proc 33275 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,578.0000,10420.9900,case rate,"Rev 361 Proc 33275 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,578.0000,10420.9900,case rate,"Rev 361 Proc 33275 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,10222.50,,,,,,,578.0000,10420.9900,fee schedule,"APG 00087 Proc 33275 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 103% = $10,222.50. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2864.70,,,,,,,578.0000,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2864.70,,,,,,,578.0000,10420.9900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,WELLCARE,WELLCARE MEDICAID,10026.00,,,,,,,578.0000,10420.9900,percent of total billed charges,"100% of $10,026.00 in Billed Charges for Rev 361 Proc 33275 = $10,026.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH REMOVAL PERM LEADLASS PM RV INCL IMG GUID,33275,CPT,361,RC,36100413,CDM,,,,both,,,10026.0000,1503.9000,WELLCARE,WELLCARE MEDICARE,3036.58,,,,,,,578.0000,10420.9900,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TROCAR AIRSEAL 8MM,272,RC,27200002,CDM,,,,,,both,,,964.3300,144.6500,AETNA,AETNA,411.77,,,,,,,248.8900,964.3300,percent of total billed charges,42.7% of $964.33 in Billed Charges for Rev 272 = $411.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AIRSEAL 8MM,272,RC,27200002,CDM,,,,,,both,,,964.3300,144.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,675.03,,,,,,,248.8900,964.3300,percent of total billed charges,Rev 272 $964.33 in Billed Charges at 70% = $675.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AIRSEAL 8MM,272,RC,27200002,CDM,,,,,,both,,,964.3300,144.6500,CIGNA HEALTHCARE,CIGNA HMO,402.13,,,,,,,248.8900,964.3300,percent of total billed charges,41.7% of $964.33 in Billed Charges for Rev 272 = $402.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AIRSEAL 8MM,272,RC,27200002,CDM,,,,,,both,,,964.3300,144.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,447.45,,,,,,,248.8900,964.3300,percent of total billed charges,46.4% of $964.33 in Billed Charges for Rev 272 = $447.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AIRSEAL 8MM,272,RC,27200002,CDM,,,,,,both,,,964.3300,144.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,402.13,,,,,,,248.8900,964.3300,percent of total billed charges,41.7% of $964.33 in Billed Charges for Rev 272 = $402.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AIRSEAL 8MM,272,RC,27200002,CDM,,,,,,both,,,964.3300,144.6500,CIGNA HEALTHCARE,CIGNA PPO,402.13,,,,,,,248.8900,964.3300,percent of total billed charges,41.7% of $964.33 in Billed Charges for Rev 272 = $402.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AIRSEAL 8MM,272,RC,27200002,CDM,,,,,,both,,,964.3300,144.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,867.90,,,,,,,248.8900,964.3300,percent of total billed charges,90% of $964.33 in Billed Charges for Rev 272 = $867.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AIRSEAL 8MM,272,RC,27200002,CDM,,,,,,both,,,964.3300,144.6500,MEDCOST,MEDCOST VHN,458.92,,,,,,,248.8900,964.3300,percent of total billed charges,47.59% of $964.33 in Billed Charges for Rev 272 = $458.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AIRSEAL 8MM,272,RC,27200002,CDM,,,,,,both,,,964.3300,144.6500,SENTARA HEALTH,SENTARA HEALTH,248.89,,,,,,,248.8900,964.3300,percent of total billed charges,25.81% of $964.33 in Billed Charges for Rev 272 = $248.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AIRSEAL 8MM,272,RC,27200002,CDM,,,,,,both,,,964.3300,144.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",964.33,,,,,,,248.8900,964.3300,percent of total billed charges,100% of $964.33 in Billed Charges for Rev 272 = $964.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AIRSEAL 8MM,272,RC,27200002,CDM,,,,,,both,,,964.3300,144.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,482.17,,,,,,,248.8900,964.3300,percent of total billed charges,Rev 272 $964.33 in Billed Charges at 50% = $482.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AIRSEAL 8MM,272,RC,27200002,CDM,,,,,,both,,,964.3300,144.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,311.48,,,,,,,248.8900,964.3300,other,32.3% of $964.33 in Billed Charges for Rev 272 = $311.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TROCAR AIRSEAL 8MM,272,RC,27200002,CDM,,,,,,both,,,964.3300,144.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,296.05,,,,,,,248.8900,964.3300,other,30.7% of $964.33 in Billed Charges for Rev 272 = $296.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TROCAR AIRSEAL 8MM,272,RC,27200002,CDM,,,,,,both,,,964.3300,144.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,311.48,,,,,,,248.8900,964.3300,percent of total billed charges,32.3% of $964.33 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AIRSEAL 8MM,272,RC,27200002,CDM,,,,,,both,,,964.3300,144.6500,WELLCARE,WELLCARE MEDICAID,964.33,,,,,,,248.8900,964.3300,percent of total billed charges,100% of $964.33 in Billed Charges for Rev 272 = $964.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR AND DIAMOND SZ3,272,RC,27200002,CDM,,,,,,both,,,3545.8400,531.8800,AETNA,AETNA,1514.07,,,,,,,915.1800,3545.8400,percent of total billed charges,"42.7% of $3,545.84 in Billed Charges for Rev 272 = $1,514.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AND DIAMOND SZ3,272,RC,27200002,CDM,,,,,,both,,,3545.8400,531.8800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2482.09,,,,,,,915.1800,3545.8400,percent of total billed charges,"Rev 272 $3,545.84 in Billed Charges at 70% = $2,482.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AND DIAMOND SZ3,272,RC,27200002,CDM,,,,,,both,,,3545.8400,531.8800,CIGNA HEALTHCARE,CIGNA HMO,1478.62,,,,,,,915.1800,3545.8400,percent of total billed charges,"41.7% of $3,545.84 in Billed Charges for Rev 272 = $1,478.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AND DIAMOND SZ3,272,RC,27200002,CDM,,,,,,both,,,3545.8400,531.8800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1645.27,,,,,,,915.1800,3545.8400,percent of total billed charges,"46.4% of $3,545.84 in Billed Charges for Rev 272 = $1,645.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AND DIAMOND SZ3,272,RC,27200002,CDM,,,,,,both,,,3545.8400,531.8800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1478.62,,,,,,,915.1800,3545.8400,percent of total billed charges,"41.7% of $3,545.84 in Billed Charges for Rev 272 = $1,478.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AND DIAMOND SZ3,272,RC,27200002,CDM,,,,,,both,,,3545.8400,531.8800,CIGNA HEALTHCARE,CIGNA PPO,1478.62,,,,,,,915.1800,3545.8400,percent of total billed charges,"41.7% of $3,545.84 in Billed Charges for Rev 272 = $1,478.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AND DIAMOND SZ3,272,RC,27200002,CDM,,,,,,both,,,3545.8400,531.8800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3191.26,,,,,,,915.1800,3545.8400,percent of total billed charges,"90% of $3,545.84 in Billed Charges for Rev 272 = $3,191.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AND DIAMOND SZ3,272,RC,27200002,CDM,,,,,,both,,,3545.8400,531.8800,MEDCOST,MEDCOST VHN,1687.47,,,,,,,915.1800,3545.8400,percent of total billed charges,"47.59% of $3,545.84 in Billed Charges for Rev 272 = $1,687.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AND DIAMOND SZ3,272,RC,27200002,CDM,,,,,,both,,,3545.8400,531.8800,SENTARA HEALTH,SENTARA HEALTH,915.18,,,,,,,915.1800,3545.8400,percent of total billed charges,"25.81% of $3,545.84 in Billed Charges for Rev 272 = $915.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AND DIAMOND SZ3,272,RC,27200002,CDM,,,,,,both,,,3545.8400,531.8800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3545.84,,,,,,,915.1800,3545.8400,percent of total billed charges,"100% of $3,545.84 in Billed Charges for Rev 272 = $3,545.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AND DIAMOND SZ3,272,RC,27200002,CDM,,,,,,both,,,3545.8400,531.8800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1772.92,,,,,,,915.1800,3545.8400,percent of total billed charges,"Rev 272 $3,545.84 in Billed Charges at 50% = $1,772.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AND DIAMOND SZ3,272,RC,27200002,CDM,,,,,,both,,,3545.8400,531.8800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1145.31,,,,,,,915.1800,3545.8400,other,"32.3% of $3,545.84 in Billed Charges for Rev 272 = $1,145.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TROCAR AND DIAMOND SZ3,272,RC,27200002,CDM,,,,,,both,,,3545.8400,531.8800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1088.57,,,,,,,915.1800,3545.8400,other,"30.7% of $3,545.84 in Billed Charges for Rev 272 = $1,088.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TROCAR AND DIAMOND SZ3,272,RC,27200002,CDM,,,,,,both,,,3545.8400,531.8800,UNITED HEALTHCARE,UNITED HEALTHCARE,1145.31,,,,,,,915.1800,3545.8400,percent of total billed charges,"32.3% of $3,545.84 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AND DIAMOND SZ3,272,RC,27200002,CDM,,,,,,both,,,3545.8400,531.8800,WELLCARE,WELLCARE MEDICAID,3545.84,,,,,,,915.1800,3545.8400,percent of total billed charges,"100% of $3,545.84 in Billed Charges for Rev 272 = $3,545.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,AETNA,AETNA,39782.74,,,,,,,12398.0000,93168.0000,percent of total billed charges,"42.7% of $93,168.00 in Billed Charges for Rev 481 Proc 33276 = $39,782.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,27743.30,,,,,,,12398.0000,93168.0000,fee schedule,"APG 00224 Proc 33276 at $836.60 (Base Rate) * 31.8865 (Relative Weight) = $26,676.25 (Total Line Payment) at 104% = $27,743.30. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,39962.24,,,,,,,12398.0000,93168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,AETNA,AETNA HEALTHCARE MEDICARE,39962.24,,,,,,,12398.0000,93168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,39962.24,,,,,,,12398.0000,93168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,AMBETTER,AMBETTER,87117.69,,,,,,,12398.0000,93168.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,41560.73,,,,,,,12398.0000,93168.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,BLUE CROSS,ANTHEM EXCHANGE,45000.50,,,,,,,12398.0000,93168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,27476.53,,,,,,,12398.0000,93168.0000,fee schedule,"APG 00224 Proc 33276 at $836.60 (Base Rate) * 31.8865 (Relative Weight) = $26,676.25 (Total Line Payment) at 103% = $27,476.53. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,BLUE CROSS,ANTHEM HMO,45000.50,,,,,,,12398.0000,93168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,41161.11,,,,,,,12398.0000,93168.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",45000.50,,,,,,,12398.0000,93168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,65217.60,,,,,,,12398.0000,93168.0000,percent of total billed charges,"Rev 481 Proc 33276 $93,168.00 in Billed Charges at 70% = $65,217.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,BLUE CROSS,BLUE CROSS E NETWORK,12398.00,,,,,,,12398.0000,93168.0000,case rate,"Rev 481 Proc 33276 ASG Rate of $12,398.00 at 100% of $12,398.00 = $12,398.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,BLUE CROSS,BLUE CROSS MEDICARE,41560.73,,,,,,,12398.0000,93168.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,BLUE CROSS,BLUE CROSS P NETWORK,12677.00,,,,,,,12398.0000,93168.0000,case rate,"Rev 481 Proc 33276 ASG Rate of $12,677.00 at 100% of $12,677.00 = $12,677.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,BLUE CROSS,BLUE CROSS S NETWORK,12677.00,,,,,,,12398.0000,93168.0000,case rate,"Rev 481 Proc 33276 ASG Rate of $12,677.00 at 100% of $12,677.00 = $12,677.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,CIGNA HEALTHCARE,CIGNA HMO,38851.06,,,,,,,12398.0000,93168.0000,percent of total billed charges,"41.7% of $93,168.00 in Billed Charges for Rev 481 Proc 33276 = $38,851.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,43229.95,,,,,,,12398.0000,93168.0000,percent of total billed charges,"46.4% of $93,168.00 in Billed Charges for Rev 481 Proc 33276 = $43,229.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,41960.36,,,,,,,12398.0000,93168.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,38851.06,,,,,,,12398.0000,93168.0000,percent of total billed charges,"41.7% of $93,168.00 in Billed Charges for Rev 481 Proc 33276 = $38,851.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,CIGNA HEALTHCARE,CIGNA PPO,38851.06,,,,,,,12398.0000,93168.0000,percent of total billed charges,"41.7% of $93,168.00 in Billed Charges for Rev 481 Proc 33276 = $38,851.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,41960.36,,,,,,,12398.0000,93168.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,83851.20,,,,,,,12398.0000,93168.0000,percent of total billed charges,"90% of $93,168.00 in Billed Charges for Rev 481 Proc 33276 = $83,851.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,HUMANA,HUMANA MEDICARE,39962.24,,,,,,,12398.0000,93168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,39962.24,,,,,,,12398.0000,93168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,MEDCOST,MEDCOST VHN,44338.65,,,,,,,12398.0000,93168.0000,percent of total billed charges,"47.59% of $93,168.00 in Billed Charges for Rev 481 Proc 33276 = $44,338.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,28010.06,,,,,,,12398.0000,93168.0000,fee schedule,"APG 00224 Proc 33276 at $836.60 (Base Rate) * 31.8865 (Relative Weight) = $26,676.25 (Total Line Payment) at 100% = $26,676.25... $26,676.25 at 105% = $28,010.06 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,41960.36,,,,,,,12398.0000,93168.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,41960.36,,,,,,,12398.0000,93168.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,NHC ADVANTAGE,NHC ADVANTAGE,41960.36,,,,,,,12398.0000,93168.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,27503.21,,,,,,,12398.0000,93168.0000,fee schedule,"APG 00224 Proc 33276 at $836.60 (Base Rate) * 31.8865 (Relative Weight) = $26,676.25 (Total Line Payment) at 100% = $26,676.25... $26,676.25 at 103.1% = $27,503.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,SENTARA HEALTH,SENTARA HEALTH,24046.66,,,,,,,12398.0000,93168.0000,percent of total billed charges,"25.81% of $93,168.00 in Billed Charges for Rev 481 Proc 33276 = $24,046.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,SENTARA HEALTH,SENTARA MEDICARE,39962.24,,,,,,,12398.0000,93168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",93168.00,,,,,,,12398.0000,93168.0000,percent of total billed charges,"100% of $93,168.00 in Billed Charges for Rev 481 Proc 33276 = $93,168.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,14690.00,,,,,,,12398.0000,93168.0000,case rate,"Rev 481 Proc 33276 ASG Rate of $14,690.00 at 100% of $14,690.00 = $14,690.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13326.00,,,,,,,12398.0000,93168.0000,case rate,"Rev 481 Proc 33276 ASG Rate of $13,326.00 at 100% of $13,326.00 = $13,326.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,12749.00,,,,,,,12398.0000,93168.0000,case rate,"Rev 481 Proc 33276 ASG Rate of $12,749.00 at 100% of $12,749.00 = $12,749.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,21642.00,,,,,,,12398.0000,93168.0000,case rate,"Rev 481 Proc 33276 ASG Rate of $21,642.00 at 100% of $21,642.00 = $21,642.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,27476.53,,,,,,,12398.0000,93168.0000,fee schedule,"APG 00224 Proc 33276 at $836.60 (Base Rate) * 31.8865 (Relative Weight) = $26,676.25 (Total Line Payment) at 103% = $27,476.53. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,39962.24,,,,,,,12398.0000,93168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,39962.24,,,,,,,12398.0000,93168.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,WELLCARE,WELLCARE MEDICAID,93168.00,,,,,,,12398.0000,93168.0000,percent of total billed charges,"100% of $93,168.00 in Billed Charges for Rev 481 Proc 33276 = $93,168.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERTION PHRENIC NERVE STIMULATOR SYSTEM,33276,CPT,481,RC,48100222,CDM,,,,both,,,93168.0000,13975.2000,WELLCARE,WELLCARE MEDICARE,42359.98,,,,,,,12398.0000,93168.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE PERMATAPE BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,1257.7900,188.6700,AETNA,AETNA,537.08,,,,,,,324.6400,1257.7900,percent of total billed charges,"42.7% of $1,257.79 in Billed Charges for Rev 272 = $537.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,1257.7900,188.6700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,880.45,,,,,,,324.6400,1257.7900,percent of total billed charges,"Rev 272 $1,257.79 in Billed Charges at 70% = $880.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,1257.7900,188.6700,CIGNA HEALTHCARE,CIGNA HMO,524.50,,,,,,,324.6400,1257.7900,percent of total billed charges,"41.7% of $1,257.79 in Billed Charges for Rev 272 = $524.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,1257.7900,188.6700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,583.61,,,,,,,324.6400,1257.7900,percent of total billed charges,"46.4% of $1,257.79 in Billed Charges for Rev 272 = $583.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,1257.7900,188.6700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,524.50,,,,,,,324.6400,1257.7900,percent of total billed charges,"41.7% of $1,257.79 in Billed Charges for Rev 272 = $524.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,1257.7900,188.6700,CIGNA HEALTHCARE,CIGNA PPO,524.50,,,,,,,324.6400,1257.7900,percent of total billed charges,"41.7% of $1,257.79 in Billed Charges for Rev 272 = $524.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,1257.7900,188.6700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1132.01,,,,,,,324.6400,1257.7900,percent of total billed charges,"90% of $1,257.79 in Billed Charges for Rev 272 = $1,132.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,1257.7900,188.6700,MEDCOST,MEDCOST VHN,598.58,,,,,,,324.6400,1257.7900,percent of total billed charges,"47.59% of $1,257.79 in Billed Charges for Rev 272 = $598.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,1257.7900,188.6700,SENTARA HEALTH,SENTARA HEALTH,324.64,,,,,,,324.6400,1257.7900,percent of total billed charges,"25.81% of $1,257.79 in Billed Charges for Rev 272 = $324.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,1257.7900,188.6700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1257.79,,,,,,,324.6400,1257.7900,percent of total billed charges,"100% of $1,257.79 in Billed Charges for Rev 272 = $1,257.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,1257.7900,188.6700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,628.90,,,,,,,324.6400,1257.7900,percent of total billed charges,"Rev 272 $1,257.79 in Billed Charges at 50% = $628.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,1257.7900,188.6700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,406.27,,,,,,,324.6400,1257.7900,other,"32.3% of $1,257.79 in Billed Charges for Rev 272 = $406.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PERMATAPE BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,1257.7900,188.6700,UNITED HEALTHCARE,UHC HERITAGE SELECT,386.14,,,,,,,324.6400,1257.7900,other,"30.7% of $1,257.79 in Billed Charges for Rev 272 = $386.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PERMATAPE BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,1257.7900,188.6700,UNITED HEALTHCARE,UNITED HEALTHCARE,406.27,,,,,,,324.6400,1257.7900,percent of total billed charges,"32.3% of $1,257.79 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PERMATAPE BLUE BRAIDED FLAT 2.5MM,272,RC,,,,,,,,both,,,1257.7900,188.6700,WELLCARE,WELLCARE MEDICAID,1257.79,,,,,,,324.6400,1257.7900,percent of total billed charges,"100% of $1,257.79 in Billed Charges for Rev 272 = $1,257.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 3-0 D8977,272,RC,,,,,,,,both,,,912.9900,136.9500,AETNA,AETNA,389.85,,,,,,,235.6400,912.9900,percent of total billed charges,42.7% of $912.99 in Billed Charges for Rev 272 = $389.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 3-0 D8977,272,RC,,,,,,,,both,,,912.9900,136.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,639.09,,,,,,,235.6400,912.9900,percent of total billed charges,Rev 272 $912.99 in Billed Charges at 70% = $639.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 3-0 D8977,272,RC,,,,,,,,both,,,912.9900,136.9500,CIGNA HEALTHCARE,CIGNA HMO,380.72,,,,,,,235.6400,912.9900,percent of total billed charges,41.7% of $912.99 in Billed Charges for Rev 272 = $380.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 3-0 D8977,272,RC,,,,,,,,both,,,912.9900,136.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,423.63,,,,,,,235.6400,912.9900,percent of total billed charges,46.4% of $912.99 in Billed Charges for Rev 272 = $423.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 3-0 D8977,272,RC,,,,,,,,both,,,912.9900,136.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,380.72,,,,,,,235.6400,912.9900,percent of total billed charges,41.7% of $912.99 in Billed Charges for Rev 272 = $380.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 3-0 D8977,272,RC,,,,,,,,both,,,912.9900,136.9500,CIGNA HEALTHCARE,CIGNA PPO,380.72,,,,,,,235.6400,912.9900,percent of total billed charges,41.7% of $912.99 in Billed Charges for Rev 272 = $380.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 3-0 D8977,272,RC,,,,,,,,both,,,912.9900,136.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,821.69,,,,,,,235.6400,912.9900,percent of total billed charges,90% of $912.99 in Billed Charges for Rev 272 = $821.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 3-0 D8977,272,RC,,,,,,,,both,,,912.9900,136.9500,MEDCOST,MEDCOST VHN,434.49,,,,,,,235.6400,912.9900,percent of total billed charges,47.59% of $912.99 in Billed Charges for Rev 272 = $434.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 3-0 D8977,272,RC,,,,,,,,both,,,912.9900,136.9500,SENTARA HEALTH,SENTARA HEALTH,235.64,,,,,,,235.6400,912.9900,percent of total billed charges,25.81% of $912.99 in Billed Charges for Rev 272 = $235.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 3-0 D8977,272,RC,,,,,,,,both,,,912.9900,136.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",912.99,,,,,,,235.6400,912.9900,percent of total billed charges,100% of $912.99 in Billed Charges for Rev 272 = $912.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 3-0 D8977,272,RC,,,,,,,,both,,,912.9900,136.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,456.50,,,,,,,235.6400,912.9900,percent of total billed charges,Rev 272 $912.99 in Billed Charges at 50% = $456.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 3-0 D8977,272,RC,,,,,,,,both,,,912.9900,136.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,294.90,,,,,,,235.6400,912.9900,other,32.3% of $912.99 in Billed Charges for Rev 272 = $294.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE PROLENE 3-0 D8977,272,RC,,,,,,,,both,,,912.9900,136.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,280.29,,,,,,,235.6400,912.9900,other,30.7% of $912.99 in Billed Charges for Rev 272 = $280.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE PROLENE 3-0 D8977,272,RC,,,,,,,,both,,,912.9900,136.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,294.90,,,,,,,235.6400,912.9900,percent of total billed charges,32.3% of $912.99 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 3-0 D8977,272,RC,,,,,,,,both,,,912.9900,136.9500,WELLCARE,WELLCARE MEDICAID,912.99,,,,,,,235.6400,912.9900,percent of total billed charges,100% of $912.99 in Billed Charges for Rev 272 = $912.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 4-0 BB 8581H,272,RC,27200002,CDM,,,,,,both,,,1877.1700,281.5800,AETNA,AETNA,801.55,,,,,,,484.5000,1877.1700,percent of total billed charges,"42.7% of $1,877.17 in Billed Charges for Rev 272 = $801.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 4-0 BB 8581H,272,RC,27200002,CDM,,,,,,both,,,1877.1700,281.5800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1314.02,,,,,,,484.5000,1877.1700,percent of total billed charges,"Rev 272 $1,877.17 in Billed Charges at 70% = $1,314.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 4-0 BB 8581H,272,RC,27200002,CDM,,,,,,both,,,1877.1700,281.5800,CIGNA HEALTHCARE,CIGNA HMO,782.78,,,,,,,484.5000,1877.1700,percent of total billed charges,"41.7% of $1,877.17 in Billed Charges for Rev 272 = $782.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 4-0 BB 8581H,272,RC,27200002,CDM,,,,,,both,,,1877.1700,281.5800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,871.01,,,,,,,484.5000,1877.1700,percent of total billed charges,"46.4% of $1,877.17 in Billed Charges for Rev 272 = $871.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 4-0 BB 8581H,272,RC,27200002,CDM,,,,,,both,,,1877.1700,281.5800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,782.78,,,,,,,484.5000,1877.1700,percent of total billed charges,"41.7% of $1,877.17 in Billed Charges for Rev 272 = $782.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 4-0 BB 8581H,272,RC,27200002,CDM,,,,,,both,,,1877.1700,281.5800,CIGNA HEALTHCARE,CIGNA PPO,782.78,,,,,,,484.5000,1877.1700,percent of total billed charges,"41.7% of $1,877.17 in Billed Charges for Rev 272 = $782.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 4-0 BB 8581H,272,RC,27200002,CDM,,,,,,both,,,1877.1700,281.5800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1689.45,,,,,,,484.5000,1877.1700,percent of total billed charges,"90% of $1,877.17 in Billed Charges for Rev 272 = $1,689.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 4-0 BB 8581H,272,RC,27200002,CDM,,,,,,both,,,1877.1700,281.5800,MEDCOST,MEDCOST VHN,893.35,,,,,,,484.5000,1877.1700,percent of total billed charges,"47.59% of $1,877.17 in Billed Charges for Rev 272 = $893.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 4-0 BB 8581H,272,RC,27200002,CDM,,,,,,both,,,1877.1700,281.5800,SENTARA HEALTH,SENTARA HEALTH,484.50,,,,,,,484.5000,1877.1700,percent of total billed charges,"25.81% of $1,877.17 in Billed Charges for Rev 272 = $484.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 4-0 BB 8581H,272,RC,27200002,CDM,,,,,,both,,,1877.1700,281.5800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1877.17,,,,,,,484.5000,1877.1700,percent of total billed charges,"100% of $1,877.17 in Billed Charges for Rev 272 = $1,877.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 4-0 BB 8581H,272,RC,27200002,CDM,,,,,,both,,,1877.1700,281.5800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,938.59,,,,,,,484.5000,1877.1700,percent of total billed charges,"Rev 272 $1,877.17 in Billed Charges at 50% = $938.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 4-0 BB 8581H,272,RC,27200002,CDM,,,,,,both,,,1877.1700,281.5800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,606.33,,,,,,,484.5000,1877.1700,other,"32.3% of $1,877.17 in Billed Charges for Rev 272 = $606.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PROLENE 4-0 BB 8581H,272,RC,27200002,CDM,,,,,,both,,,1877.1700,281.5800,UNITED HEALTHCARE,UHC HERITAGE SELECT,576.29,,,,,,,484.5000,1877.1700,other,"30.7% of $1,877.17 in Billed Charges for Rev 272 = $576.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PROLENE 4-0 BB 8581H,272,RC,27200002,CDM,,,,,,both,,,1877.1700,281.5800,UNITED HEALTHCARE,UNITED HEALTHCARE,606.33,,,,,,,484.5000,1877.1700,percent of total billed charges,"32.3% of $1,877.17 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 4-0 BB 8581H,272,RC,27200002,CDM,,,,,,both,,,1877.1700,281.5800,WELLCARE,WELLCARE MEDICAID,1877.17,,,,,,,484.5000,1877.1700,percent of total billed charges,"100% of $1,877.17 in Billed Charges for Rev 272 = $1,877.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,11298.8900,1694.8300,AETNA,AETNA,4824.63,,,,,,,2916.2400,11298.8900,percent of total billed charges,"42.7% of $11,298.89 in Billed Charges for Rev 272 = $4,824.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,11298.8900,1694.8300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7909.22,,,,,,,2916.2400,11298.8900,percent of total billed charges,"Rev 272 $11,298.89 in Billed Charges at 70% = $7,909.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,11298.8900,1694.8300,CIGNA HEALTHCARE,CIGNA HMO,4711.64,,,,,,,2916.2400,11298.8900,percent of total billed charges,"41.7% of $11,298.89 in Billed Charges for Rev 272 = $4,711.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,11298.8900,1694.8300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5242.69,,,,,,,2916.2400,11298.8900,percent of total billed charges,"46.4% of $11,298.89 in Billed Charges for Rev 272 = $5,242.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,11298.8900,1694.8300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4711.64,,,,,,,2916.2400,11298.8900,percent of total billed charges,"41.7% of $11,298.89 in Billed Charges for Rev 272 = $4,711.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,11298.8900,1694.8300,CIGNA HEALTHCARE,CIGNA PPO,4711.64,,,,,,,2916.2400,11298.8900,percent of total billed charges,"41.7% of $11,298.89 in Billed Charges for Rev 272 = $4,711.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,11298.8900,1694.8300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10169.00,,,,,,,2916.2400,11298.8900,percent of total billed charges,"90% of $11,298.89 in Billed Charges for Rev 272 = $10,169.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,11298.8900,1694.8300,MEDCOST,MEDCOST VHN,5377.14,,,,,,,2916.2400,11298.8900,percent of total billed charges,"47.59% of $11,298.89 in Billed Charges for Rev 272 = $5,377.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,11298.8900,1694.8300,SENTARA HEALTH,SENTARA HEALTH,2916.24,,,,,,,2916.2400,11298.8900,percent of total billed charges,"25.81% of $11,298.89 in Billed Charges for Rev 272 = $2,916.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,11298.8900,1694.8300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11298.89,,,,,,,2916.2400,11298.8900,percent of total billed charges,"100% of $11,298.89 in Billed Charges for Rev 272 = $11,298.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,11298.8900,1694.8300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5649.45,,,,,,,2916.2400,11298.8900,percent of total billed charges,"Rev 272 $11,298.89 in Billed Charges at 50% = $5,649.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,11298.8900,1694.8300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3649.54,,,,,,,2916.2400,11298.8900,other,"32.3% of $11,298.89 in Billed Charges for Rev 272 = $3,649.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,11298.8900,1694.8300,UNITED HEALTHCARE,UHC HERITAGE SELECT,3468.76,,,,,,,2916.2400,11298.8900,other,"30.7% of $11,298.89 in Billed Charges for Rev 272 = $3,468.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,11298.8900,1694.8300,UNITED HEALTHCARE,UNITED HEALTHCARE,3649.54,,,,,,,2916.2400,11298.8900,percent of total billed charges,"32.3% of $11,298.89 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,11298.8900,1694.8300,WELLCARE,WELLCARE MEDICAID,11298.89,,,,,,,2916.2400,11298.8900,percent of total billed charges,"100% of $11,298.89 in Billed Charges for Rev 272 = $11,298.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE HEART MTRL ROTATABLE 35MM,278,RC,,,,,,,,both,,,44180.4600,6627.0700,AETNA,AETNA,21206.62,,,,,,,3136.8100,44180.4600,percent of total billed charges,"48% of $44,180.46 in Billed Charges for Rev 278 = $21,206.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE HEART MTRL ROTATABLE 35MM,278,RC,,,,,,,,both,,,44180.4600,6627.0700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,22090.23,,,,,,,3136.8100,44180.4600,percent of total billed charges,"50% of $44,180.46 in Billed Charges for Rev 278 = $22,090.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE HEART MTRL ROTATABLE 35MM,278,RC,,,,,,,,both,,,44180.4600,6627.0700,CIGNA HEALTHCARE,CIGNA HMO,18423.25,,,,,,,3136.8100,44180.4600,percent of total billed charges,"41.7% of $44,180.46 in Billed Charges for Rev 278 = $18,423.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE HEART MTRL ROTATABLE 35MM,278,RC,,,,,,,,both,,,44180.4600,6627.0700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,17672.18,,,,,,,3136.8100,44180.4600,percent of total billed charges,"40% of $44,180.46 in Billed Charges for Rev 278 = $17,672.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE HEART MTRL ROTATABLE 35MM,278,RC,,,,,,,,both,,,44180.4600,6627.0700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,18423.25,,,,,,,3136.8100,44180.4600,percent of total billed charges,"41.7% of $44,180.46 in Billed Charges for Rev 278 = $18,423.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE HEART MTRL ROTATABLE 35MM,278,RC,,,,,,,,both,,,44180.4600,6627.0700,CIGNA HEALTHCARE,CIGNA PPO,18423.25,,,,,,,3136.8100,44180.4600,percent of total billed charges,"41.7% of $44,180.46 in Billed Charges for Rev 278 = $18,423.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE HEART MTRL ROTATABLE 35MM,278,RC,,,,,,,,both,,,44180.4600,6627.0700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,39762.41,,,,,,,3136.8100,44180.4600,percent of total billed charges,"90% of $44,180.46 in Billed Charges for Rev 278 = $39,762.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE HEART MTRL ROTATABLE 35MM,278,RC,,,,,,,,both,,,44180.4600,6627.0700,MEDCOST,MEDCOST VHN,21025.48,,,,,,,3136.8100,44180.4600,percent of total billed charges,"47.59% of $44,180.46 in Billed Charges for Rev 278 = $21,025.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE HEART MTRL ROTATABLE 35MM,278,RC,,,,,,,,both,,,44180.4600,6627.0700,SENTARA HEALTH,SENTARA HEALTH,11402.98,,,,,,,3136.8100,44180.4600,percent of total billed charges,"25.81% of $44,180.46 in Billed Charges for Rev 278 = $11,402.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE HEART MTRL ROTATABLE 35MM,278,RC,,,,,,,,both,,,44180.4600,6627.0700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",44180.46,,,,,,,3136.8100,44180.4600,percent of total billed charges,"100% of $44,180.46 in Billed Charges for Rev 278 = $44,180.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE HEART MTRL ROTATABLE 35MM,278,RC,,,,,,,,both,,,44180.4600,6627.0700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22090.23,,,,,,,3136.8100,44180.4600,percent of total billed charges,"Rev 278 $44,180.46 in Billed Charges at 50% = $22,090.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE HEART MTRL ROTATABLE 35MM,278,RC,,,,,,,,both,,,44180.4600,6627.0700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3313.53,,,,,,,3136.8100,44180.4600,percent of total billed charges,"7.5% of $44,180.46 in Billed Charges for Rev 278 = $3,313.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE HEART MTRL ROTATABLE 35MM,278,RC,,,,,,,,both,,,44180.4600,6627.0700,UNITED HEALTHCARE,UHC HERITAGE SELECT,3136.81,,,,,,,3136.8100,44180.4600,percent of total billed charges,"7.1% of $44,180.46 in Billed Charges for Rev 278 = $3,136.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE HEART MTRL ROTATABLE 35MM,278,RC,,,,,,,,both,,,44180.4600,6627.0700,UNITED HEALTHCARE,UNITED HEALTHCARE,3136.81,,,,,,,3136.8100,44180.4600,percent of total billed charges,"7.1% of $44,180.46 in Billed Charges for Rev 278 = $3,136.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE HEART MTRL ROTATABLE 35MM,278,RC,,,,,,,,both,,,44180.4600,6627.0700,WELLCARE,WELLCARE MEDICAID,44180.46,,,,,,,3136.8100,44180.4600,percent of total billed charges,"100% of $44,180.46 in Billed Charges for Rev 278 = $44,180.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 6.0 M8307,272,RC,,,,,,,,both,,,6258.5100,938.7800,AETNA,AETNA,2672.38,,,,,,,1615.3200,6258.5100,percent of total billed charges,"42.7% of $6,258.51 in Billed Charges for Rev 272 = $2,672.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 6.0 M8307,272,RC,,,,,,,,both,,,6258.5100,938.7800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4380.96,,,,,,,1615.3200,6258.5100,percent of total billed charges,"Rev 272 $6,258.51 in Billed Charges at 70% = $4,380.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 6.0 M8307,272,RC,,,,,,,,both,,,6258.5100,938.7800,CIGNA HEALTHCARE,CIGNA HMO,2609.80,,,,,,,1615.3200,6258.5100,percent of total billed charges,"41.7% of $6,258.51 in Billed Charges for Rev 272 = $2,609.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 6.0 M8307,272,RC,,,,,,,,both,,,6258.5100,938.7800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2903.95,,,,,,,1615.3200,6258.5100,percent of total billed charges,"46.4% of $6,258.51 in Billed Charges for Rev 272 = $2,903.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 6.0 M8307,272,RC,,,,,,,,both,,,6258.5100,938.7800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2609.80,,,,,,,1615.3200,6258.5100,percent of total billed charges,"41.7% of $6,258.51 in Billed Charges for Rev 272 = $2,609.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 6.0 M8307,272,RC,,,,,,,,both,,,6258.5100,938.7800,CIGNA HEALTHCARE,CIGNA PPO,2609.80,,,,,,,1615.3200,6258.5100,percent of total billed charges,"41.7% of $6,258.51 in Billed Charges for Rev 272 = $2,609.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 6.0 M8307,272,RC,,,,,,,,both,,,6258.5100,938.7800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5632.66,,,,,,,1615.3200,6258.5100,percent of total billed charges,"90% of $6,258.51 in Billed Charges for Rev 272 = $5,632.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 6.0 M8307,272,RC,,,,,,,,both,,,6258.5100,938.7800,MEDCOST,MEDCOST VHN,2978.42,,,,,,,1615.3200,6258.5100,percent of total billed charges,"47.59% of $6,258.51 in Billed Charges for Rev 272 = $2,978.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 6.0 M8307,272,RC,,,,,,,,both,,,6258.5100,938.7800,SENTARA HEALTH,SENTARA HEALTH,1615.32,,,,,,,1615.3200,6258.5100,percent of total billed charges,"25.81% of $6,258.51 in Billed Charges for Rev 272 = $1,615.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 6.0 M8307,272,RC,,,,,,,,both,,,6258.5100,938.7800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6258.51,,,,,,,1615.3200,6258.5100,percent of total billed charges,"100% of $6,258.51 in Billed Charges for Rev 272 = $6,258.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 6.0 M8307,272,RC,,,,,,,,both,,,6258.5100,938.7800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3129.26,,,,,,,1615.3200,6258.5100,percent of total billed charges,"Rev 272 $6,258.51 in Billed Charges at 50% = $3,129.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 6.0 M8307,272,RC,,,,,,,,both,,,6258.5100,938.7800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2021.50,,,,,,,1615.3200,6258.5100,other,"32.3% of $6,258.51 in Billed Charges for Rev 272 = $2,021.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PROLENE 6.0 M8307,272,RC,,,,,,,,both,,,6258.5100,938.7800,UNITED HEALTHCARE,UHC HERITAGE SELECT,1921.36,,,,,,,1615.3200,6258.5100,other,"30.7% of $6,258.51 in Billed Charges for Rev 272 = $1,921.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PROLENE 6.0 M8307,272,RC,,,,,,,,both,,,6258.5100,938.7800,UNITED HEALTHCARE,UNITED HEALTHCARE,2021.50,,,,,,,1615.3200,6258.5100,percent of total billed charges,"32.3% of $6,258.51 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 6.0 M8307,272,RC,,,,,,,,both,,,6258.5100,938.7800,WELLCARE,WELLCARE MEDICAID,6258.51,,,,,,,1615.3200,6258.5100,percent of total billed charges,"100% of $6,258.51 in Billed Charges for Rev 272 = $6,258.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 7-0 BLUE 4 X 24INCH BV-1 DOUBLE ARM,272,RC,,,,,,,,both,,,738.9900,110.8500,AETNA,AETNA,315.55,,,,,,,190.7300,738.9900,percent of total billed charges,42.7% of $738.99 in Billed Charges for Rev 272 = $315.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 BLUE 4 X 24INCH BV-1 DOUBLE ARM,272,RC,,,,,,,,both,,,738.9900,110.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,517.29,,,,,,,190.7300,738.9900,percent of total billed charges,Rev 272 $738.99 in Billed Charges at 70% = $517.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 BLUE 4 X 24INCH BV-1 DOUBLE ARM,272,RC,,,,,,,,both,,,738.9900,110.8500,CIGNA HEALTHCARE,CIGNA HMO,308.16,,,,,,,190.7300,738.9900,percent of total billed charges,41.7% of $738.99 in Billed Charges for Rev 272 = $308.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 BLUE 4 X 24INCH BV-1 DOUBLE ARM,272,RC,,,,,,,,both,,,738.9900,110.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,342.89,,,,,,,190.7300,738.9900,percent of total billed charges,46.4% of $738.99 in Billed Charges for Rev 272 = $342.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 BLUE 4 X 24INCH BV-1 DOUBLE ARM,272,RC,,,,,,,,both,,,738.9900,110.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,308.16,,,,,,,190.7300,738.9900,percent of total billed charges,41.7% of $738.99 in Billed Charges for Rev 272 = $308.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 BLUE 4 X 24INCH BV-1 DOUBLE ARM,272,RC,,,,,,,,both,,,738.9900,110.8500,CIGNA HEALTHCARE,CIGNA PPO,308.16,,,,,,,190.7300,738.9900,percent of total billed charges,41.7% of $738.99 in Billed Charges for Rev 272 = $308.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 BLUE 4 X 24INCH BV-1 DOUBLE ARM,272,RC,,,,,,,,both,,,738.9900,110.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,665.09,,,,,,,190.7300,738.9900,percent of total billed charges,90% of $738.99 in Billed Charges for Rev 272 = $665.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 BLUE 4 X 24INCH BV-1 DOUBLE ARM,272,RC,,,,,,,,both,,,738.9900,110.8500,MEDCOST,MEDCOST VHN,351.69,,,,,,,190.7300,738.9900,percent of total billed charges,47.59% of $738.99 in Billed Charges for Rev 272 = $351.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 BLUE 4 X 24INCH BV-1 DOUBLE ARM,272,RC,,,,,,,,both,,,738.9900,110.8500,SENTARA HEALTH,SENTARA HEALTH,190.73,,,,,,,190.7300,738.9900,percent of total billed charges,25.81% of $738.99 in Billed Charges for Rev 272 = $190.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 BLUE 4 X 24INCH BV-1 DOUBLE ARM,272,RC,,,,,,,,both,,,738.9900,110.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",738.99,,,,,,,190.7300,738.9900,percent of total billed charges,100% of $738.99 in Billed Charges for Rev 272 = $738.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 BLUE 4 X 24INCH BV-1 DOUBLE ARM,272,RC,,,,,,,,both,,,738.9900,110.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,369.50,,,,,,,190.7300,738.9900,percent of total billed charges,Rev 272 $738.99 in Billed Charges at 50% = $369.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 BLUE 4 X 24INCH BV-1 DOUBLE ARM,272,RC,,,,,,,,both,,,738.9900,110.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,238.69,,,,,,,190.7300,738.9900,other,32.3% of $738.99 in Billed Charges for Rev 272 = $238.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE PROLENE 7-0 BLUE 4 X 24INCH BV-1 DOUBLE ARM,272,RC,,,,,,,,both,,,738.9900,110.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,226.87,,,,,,,190.7300,738.9900,other,30.7% of $738.99 in Billed Charges for Rev 272 = $226.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE PROLENE 7-0 BLUE 4 X 24INCH BV-1 DOUBLE ARM,272,RC,,,,,,,,both,,,738.9900,110.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,238.69,,,,,,,190.7300,738.9900,percent of total billed charges,32.3% of $738.99 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7-0 BLUE 4 X 24INCH BV-1 DOUBLE ARM,272,RC,,,,,,,,both,,,738.9900,110.8500,WELLCARE,WELLCARE MEDICAID,738.99,,,,,,,190.7300,738.9900,percent of total billed charges,100% of $738.99 in Billed Charges for Rev 272 = $738.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
VITRECTOR INFINITI,272,RC,,,,,,,,both,,,1372.0800,205.8100,AETNA,AETNA,585.88,,,,,,,354.1300,1372.0800,percent of total billed charges,"42.7% of $1,372.08 in Billed Charges for Rev 272 = $585.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VITRECTOR INFINITI,272,RC,,,,,,,,both,,,1372.0800,205.8100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,960.46,,,,,,,354.1300,1372.0800,percent of total billed charges,"Rev 272 $1,372.08 in Billed Charges at 70% = $960.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VITRECTOR INFINITI,272,RC,,,,,,,,both,,,1372.0800,205.8100,CIGNA HEALTHCARE,CIGNA HMO,572.16,,,,,,,354.1300,1372.0800,percent of total billed charges,"41.7% of $1,372.08 in Billed Charges for Rev 272 = $572.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VITRECTOR INFINITI,272,RC,,,,,,,,both,,,1372.0800,205.8100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,636.65,,,,,,,354.1300,1372.0800,percent of total billed charges,"46.4% of $1,372.08 in Billed Charges for Rev 272 = $636.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VITRECTOR INFINITI,272,RC,,,,,,,,both,,,1372.0800,205.8100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,572.16,,,,,,,354.1300,1372.0800,percent of total billed charges,"41.7% of $1,372.08 in Billed Charges for Rev 272 = $572.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VITRECTOR INFINITI,272,RC,,,,,,,,both,,,1372.0800,205.8100,CIGNA HEALTHCARE,CIGNA PPO,572.16,,,,,,,354.1300,1372.0800,percent of total billed charges,"41.7% of $1,372.08 in Billed Charges for Rev 272 = $572.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VITRECTOR INFINITI,272,RC,,,,,,,,both,,,1372.0800,205.8100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1234.87,,,,,,,354.1300,1372.0800,percent of total billed charges,"90% of $1,372.08 in Billed Charges for Rev 272 = $1,234.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VITRECTOR INFINITI,272,RC,,,,,,,,both,,,1372.0800,205.8100,MEDCOST,MEDCOST VHN,652.97,,,,,,,354.1300,1372.0800,percent of total billed charges,"47.59% of $1,372.08 in Billed Charges for Rev 272 = $652.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VITRECTOR INFINITI,272,RC,,,,,,,,both,,,1372.0800,205.8100,SENTARA HEALTH,SENTARA HEALTH,354.13,,,,,,,354.1300,1372.0800,percent of total billed charges,"25.81% of $1,372.08 in Billed Charges for Rev 272 = $354.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VITRECTOR INFINITI,272,RC,,,,,,,,both,,,1372.0800,205.8100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1372.08,,,,,,,354.1300,1372.0800,percent of total billed charges,"100% of $1,372.08 in Billed Charges for Rev 272 = $1,372.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VITRECTOR INFINITI,272,RC,,,,,,,,both,,,1372.0800,205.8100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,686.04,,,,,,,354.1300,1372.0800,percent of total billed charges,"Rev 272 $1,372.08 in Billed Charges at 50% = $686.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VITRECTOR INFINITI,272,RC,,,,,,,,both,,,1372.0800,205.8100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,443.18,,,,,,,354.1300,1372.0800,other,"32.3% of $1,372.08 in Billed Charges for Rev 272 = $443.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
VITRECTOR INFINITI,272,RC,,,,,,,,both,,,1372.0800,205.8100,UNITED HEALTHCARE,UHC HERITAGE SELECT,421.23,,,,,,,354.1300,1372.0800,other,"30.7% of $1,372.08 in Billed Charges for Rev 272 = $421.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
VITRECTOR INFINITI,272,RC,,,,,,,,both,,,1372.0800,205.8100,UNITED HEALTHCARE,UNITED HEALTHCARE,443.18,,,,,,,354.1300,1372.0800,percent of total billed charges,"32.3% of $1,372.08 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VITRECTOR INFINITI,272,RC,,,,,,,,both,,,1372.0800,205.8100,WELLCARE,WELLCARE MEDICAID,1372.08,,,,,,,354.1300,1372.0800,percent of total billed charges,"100% of $1,372.08 in Billed Charges for Rev 272 = $1,372.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND AMBIENT SUPER MULTIVAC 5,272,RC,27200002,CDM,,,,,,both,,,5372.9000,805.9400,AETNA,AETNA,2294.23,,,,,,,1386.7500,5372.9000,percent of total billed charges,"42.7% of $5,372.90 in Billed Charges for Rev 272 = $2,294.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND AMBIENT SUPER MULTIVAC 5,272,RC,27200002,CDM,,,,,,both,,,5372.9000,805.9400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3761.03,,,,,,,1386.7500,5372.9000,percent of total billed charges,"Rev 272 $5,372.90 in Billed Charges at 70% = $3,761.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND AMBIENT SUPER MULTIVAC 5,272,RC,27200002,CDM,,,,,,both,,,5372.9000,805.9400,CIGNA HEALTHCARE,CIGNA HMO,2240.50,,,,,,,1386.7500,5372.9000,percent of total billed charges,"41.7% of $5,372.90 in Billed Charges for Rev 272 = $2,240.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND AMBIENT SUPER MULTIVAC 5,272,RC,27200002,CDM,,,,,,both,,,5372.9000,805.9400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2493.03,,,,,,,1386.7500,5372.9000,percent of total billed charges,"46.4% of $5,372.90 in Billed Charges for Rev 272 = $2,493.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND AMBIENT SUPER MULTIVAC 5,272,RC,27200002,CDM,,,,,,both,,,5372.9000,805.9400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2240.50,,,,,,,1386.7500,5372.9000,percent of total billed charges,"41.7% of $5,372.90 in Billed Charges for Rev 272 = $2,240.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND AMBIENT SUPER MULTIVAC 5,272,RC,27200002,CDM,,,,,,both,,,5372.9000,805.9400,CIGNA HEALTHCARE,CIGNA PPO,2240.50,,,,,,,1386.7500,5372.9000,percent of total billed charges,"41.7% of $5,372.90 in Billed Charges for Rev 272 = $2,240.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND AMBIENT SUPER MULTIVAC 5,272,RC,27200002,CDM,,,,,,both,,,5372.9000,805.9400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4835.61,,,,,,,1386.7500,5372.9000,percent of total billed charges,"90% of $5,372.90 in Billed Charges for Rev 272 = $4,835.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND AMBIENT SUPER MULTIVAC 5,272,RC,27200002,CDM,,,,,,both,,,5372.9000,805.9400,MEDCOST,MEDCOST VHN,2556.96,,,,,,,1386.7500,5372.9000,percent of total billed charges,"47.59% of $5,372.90 in Billed Charges for Rev 272 = $2,556.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND AMBIENT SUPER MULTIVAC 5,272,RC,27200002,CDM,,,,,,both,,,5372.9000,805.9400,SENTARA HEALTH,SENTARA HEALTH,1386.75,,,,,,,1386.7500,5372.9000,percent of total billed charges,"25.81% of $5,372.90 in Billed Charges for Rev 272 = $1,386.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND AMBIENT SUPER MULTIVAC 5,272,RC,27200002,CDM,,,,,,both,,,5372.9000,805.9400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5372.90,,,,,,,1386.7500,5372.9000,percent of total billed charges,"100% of $5,372.90 in Billed Charges for Rev 272 = $5,372.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND AMBIENT SUPER MULTIVAC 5,272,RC,27200002,CDM,,,,,,both,,,5372.9000,805.9400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2686.45,,,,,,,1386.7500,5372.9000,percent of total billed charges,"Rev 272 $5,372.90 in Billed Charges at 50% = $2,686.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND AMBIENT SUPER MULTIVAC 5,272,RC,27200002,CDM,,,,,,both,,,5372.9000,805.9400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1735.45,,,,,,,1386.7500,5372.9000,other,"32.3% of $5,372.90 in Billed Charges for Rev 272 = $1,735.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND AMBIENT SUPER MULTIVAC 5,272,RC,27200002,CDM,,,,,,both,,,5372.9000,805.9400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1649.48,,,,,,,1386.7500,5372.9000,other,"30.7% of $5,372.90 in Billed Charges for Rev 272 = $1,649.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND AMBIENT SUPER MULTIVAC 5,272,RC,27200002,CDM,,,,,,both,,,5372.9000,805.9400,UNITED HEALTHCARE,UNITED HEALTHCARE,1735.45,,,,,,,1386.7500,5372.9000,percent of total billed charges,"32.3% of $5,372.90 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND AMBIENT SUPER MULTIVAC 5,272,RC,27200002,CDM,,,,,,both,,,5372.9000,805.9400,WELLCARE,WELLCARE MEDICAID,5372.90,,,,,,,1386.7500,5372.9000,percent of total billed charges,"100% of $5,372.90 in Billed Charges for Rev 272 = $5,372.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 7.0 EPM8745,272,RC,27200002,CDM,,,,,,both,,,1102.9500,165.4400,AETNA,AETNA,470.96,,,,,,,284.6700,1102.9500,percent of total billed charges,"42.7% of $1,102.95 in Billed Charges for Rev 272 = $470.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 7.0 EPM8745,272,RC,27200002,CDM,,,,,,both,,,1102.9500,165.4400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,772.07,,,,,,,284.6700,1102.9500,percent of total billed charges,"Rev 272 $1,102.95 in Billed Charges at 70% = $772.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 7.0 EPM8745,272,RC,27200002,CDM,,,,,,both,,,1102.9500,165.4400,CIGNA HEALTHCARE,CIGNA HMO,459.93,,,,,,,284.6700,1102.9500,percent of total billed charges,"41.7% of $1,102.95 in Billed Charges for Rev 272 = $459.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 7.0 EPM8745,272,RC,27200002,CDM,,,,,,both,,,1102.9500,165.4400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,511.77,,,,,,,284.6700,1102.9500,percent of total billed charges,"46.4% of $1,102.95 in Billed Charges for Rev 272 = $511.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 7.0 EPM8745,272,RC,27200002,CDM,,,,,,both,,,1102.9500,165.4400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,459.93,,,,,,,284.6700,1102.9500,percent of total billed charges,"41.7% of $1,102.95 in Billed Charges for Rev 272 = $459.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 7.0 EPM8745,272,RC,27200002,CDM,,,,,,both,,,1102.9500,165.4400,CIGNA HEALTHCARE,CIGNA PPO,459.93,,,,,,,284.6700,1102.9500,percent of total billed charges,"41.7% of $1,102.95 in Billed Charges for Rev 272 = $459.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 7.0 EPM8745,272,RC,27200002,CDM,,,,,,both,,,1102.9500,165.4400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,992.66,,,,,,,284.6700,1102.9500,percent of total billed charges,"90% of $1,102.95 in Billed Charges for Rev 272 = $992.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 7.0 EPM8745,272,RC,27200002,CDM,,,,,,both,,,1102.9500,165.4400,MEDCOST,MEDCOST VHN,524.89,,,,,,,284.6700,1102.9500,percent of total billed charges,"47.59% of $1,102.95 in Billed Charges for Rev 272 = $524.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 7.0 EPM8745,272,RC,27200002,CDM,,,,,,both,,,1102.9500,165.4400,SENTARA HEALTH,SENTARA HEALTH,284.67,,,,,,,284.6700,1102.9500,percent of total billed charges,"25.81% of $1,102.95 in Billed Charges for Rev 272 = $284.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 7.0 EPM8745,272,RC,27200002,CDM,,,,,,both,,,1102.9500,165.4400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1102.95,,,,,,,284.6700,1102.9500,percent of total billed charges,"100% of $1,102.95 in Billed Charges for Rev 272 = $1,102.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 7.0 EPM8745,272,RC,27200002,CDM,,,,,,both,,,1102.9500,165.4400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,551.48,,,,,,,284.6700,1102.9500,percent of total billed charges,"Rev 272 $1,102.95 in Billed Charges at 50% = $551.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 7.0 EPM8745,272,RC,27200002,CDM,,,,,,both,,,1102.9500,165.4400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,356.25,,,,,,,284.6700,1102.9500,other,"32.3% of $1,102.95 in Billed Charges for Rev 272 = $356.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PROLENE 7.0 EPM8745,272,RC,27200002,CDM,,,,,,both,,,1102.9500,165.4400,UNITED HEALTHCARE,UHC HERITAGE SELECT,338.61,,,,,,,284.6700,1102.9500,other,"30.7% of $1,102.95 in Billed Charges for Rev 272 = $338.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PROLENE 7.0 EPM8745,272,RC,27200002,CDM,,,,,,both,,,1102.9500,165.4400,UNITED HEALTHCARE,UNITED HEALTHCARE,356.25,,,,,,,284.6700,1102.9500,percent of total billed charges,"32.3% of $1,102.95 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 7.0 EPM8745,272,RC,27200002,CDM,,,,,,both,,,1102.9500,165.4400,WELLCARE,WELLCARE MEDICAID,1102.95,,,,,,,284.6700,1102.9500,percent of total billed charges,"100% of $1,102.95 in Billed Charges for Rev 272 = $1,102.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PROLENE 7.0 M8727,272,RC,,,,,,,,both,,,522.3600,78.3500,AETNA,AETNA,223.05,,,,,,,134.8200,522.3600,percent of total billed charges,42.7% of $522.36 in Billed Charges for Rev 272 = $223.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7.0 M8727,272,RC,,,,,,,,both,,,522.3600,78.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,365.65,,,,,,,134.8200,522.3600,percent of total billed charges,Rev 272 $522.36 in Billed Charges at 70% = $365.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7.0 M8727,272,RC,,,,,,,,both,,,522.3600,78.3500,CIGNA HEALTHCARE,CIGNA HMO,217.82,,,,,,,134.8200,522.3600,percent of total billed charges,41.7% of $522.36 in Billed Charges for Rev 272 = $217.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7.0 M8727,272,RC,,,,,,,,both,,,522.3600,78.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,242.38,,,,,,,134.8200,522.3600,percent of total billed charges,46.4% of $522.36 in Billed Charges for Rev 272 = $242.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7.0 M8727,272,RC,,,,,,,,both,,,522.3600,78.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,217.82,,,,,,,134.8200,522.3600,percent of total billed charges,41.7% of $522.36 in Billed Charges for Rev 272 = $217.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7.0 M8727,272,RC,,,,,,,,both,,,522.3600,78.3500,CIGNA HEALTHCARE,CIGNA PPO,217.82,,,,,,,134.8200,522.3600,percent of total billed charges,41.7% of $522.36 in Billed Charges for Rev 272 = $217.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7.0 M8727,272,RC,,,,,,,,both,,,522.3600,78.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,470.12,,,,,,,134.8200,522.3600,percent of total billed charges,90% of $522.36 in Billed Charges for Rev 272 = $470.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7.0 M8727,272,RC,,,,,,,,both,,,522.3600,78.3500,MEDCOST,MEDCOST VHN,248.59,,,,,,,134.8200,522.3600,percent of total billed charges,47.59% of $522.36 in Billed Charges for Rev 272 = $248.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7.0 M8727,272,RC,,,,,,,,both,,,522.3600,78.3500,SENTARA HEALTH,SENTARA HEALTH,134.82,,,,,,,134.8200,522.3600,percent of total billed charges,25.81% of $522.36 in Billed Charges for Rev 272 = $134.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7.0 M8727,272,RC,,,,,,,,both,,,522.3600,78.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",522.36,,,,,,,134.8200,522.3600,percent of total billed charges,100% of $522.36 in Billed Charges for Rev 272 = $522.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7.0 M8727,272,RC,,,,,,,,both,,,522.3600,78.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,261.18,,,,,,,134.8200,522.3600,percent of total billed charges,Rev 272 $522.36 in Billed Charges at 50% = $261.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7.0 M8727,272,RC,,,,,,,,both,,,522.3600,78.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,168.72,,,,,,,134.8200,522.3600,other,32.3% of $522.36 in Billed Charges for Rev 272 = $168.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE PROLENE 7.0 M8727,272,RC,,,,,,,,both,,,522.3600,78.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,160.36,,,,,,,134.8200,522.3600,other,30.7% of $522.36 in Billed Charges for Rev 272 = $160.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE PROLENE 7.0 M8727,272,RC,,,,,,,,both,,,522.3600,78.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,168.72,,,,,,,134.8200,522.3600,percent of total billed charges,32.3% of $522.36 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PROLENE 7.0 M8727,272,RC,,,,,,,,both,,,522.3600,78.3500,WELLCARE,WELLCARE MEDICAID,522.36,,,,,,,134.8200,522.3600,percent of total billed charges,100% of $522.36 in Billed Charges for Rev 272 = $522.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TANGENTIAL BX SKIN EA ADDL LESION,11103,CPT,510,RC,51000228,CDM,,,,both,,,139.0000,20.8500,AETNA,AETNA,59.35,,,,,,,35.8800,623.7700,percent of total billed charges,42.7% of $139.00 in Billed Charges for Rev 510 Proc 11103 = $59.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TANGENTIAL BX SKIN EA ADDL LESION,11103,CPT,510,RC,51000228,CDM,,,,both,,,139.0000,20.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,35.8800,623.7700,fee schedule,APG 00009 Proc 11103 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN EA ADDL LESION,11103,CPT,510,RC,51000228,CDM,,,,both,,,139.0000,20.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,139.00,,,,,,,35.8800,623.7700,fee schedule,"APG 00009 Proc 11103 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 103% = $611.89 (Service Line reduced to $139.00, claim capped at $139.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TANGENTIAL BX SKIN EA ADDL LESION,11103,CPT,510,RC,51000228,CDM,,,,both,,,139.0000,20.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,97.30,,,,,,,35.8800,623.7700,percent of total billed charges,Rev 510 Proc 11103 $139.00 in Billed Charges at 70% = $97.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TANGENTIAL BX SKIN EA ADDL LESION,11103,CPT,510,RC,51000228,CDM,,,,both,,,139.0000,20.8500,CIGNA HEALTHCARE,CIGNA HMO,57.96,,,,,,,35.8800,623.7700,percent of total billed charges,41.7% of $139.00 in Billed Charges for Rev 510 Proc 11103 = $57.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TANGENTIAL BX SKIN EA ADDL LESION,11103,CPT,510,RC,51000228,CDM,,,,both,,,139.0000,20.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,64.50,,,,,,,35.8800,623.7700,percent of total billed charges,46.4% of $139.00 in Billed Charges for Rev 510 Proc 11103 = $64.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TANGENTIAL BX SKIN EA ADDL LESION,11103,CPT,510,RC,51000228,CDM,,,,both,,,139.0000,20.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,57.96,,,,,,,35.8800,623.7700,percent of total billed charges,41.7% of $139.00 in Billed Charges for Rev 510 Proc 11103 = $57.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TANGENTIAL BX SKIN EA ADDL LESION,11103,CPT,510,RC,51000228,CDM,,,,both,,,139.0000,20.8500,CIGNA HEALTHCARE,CIGNA PPO,57.96,,,,,,,35.8800,623.7700,percent of total billed charges,41.7% of $139.00 in Billed Charges for Rev 510 Proc 11103 = $57.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TANGENTIAL BX SKIN EA ADDL LESION,11103,CPT,510,RC,51000228,CDM,,,,both,,,139.0000,20.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,125.10,,,,,,,35.8800,623.7700,percent of total billed charges,90% of $139.00 in Billed Charges for Rev 510 Proc 11103 = $125.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TANGENTIAL BX SKIN EA ADDL LESION,11103,CPT,510,RC,51000228,CDM,,,,both,,,139.0000,20.8500,MEDCOST,MEDCOST VHN,66.15,,,,,,,35.8800,623.7700,percent of total billed charges,47.59% of $139.00 in Billed Charges for Rev 510 Proc 11103 = $66.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TANGENTIAL BX SKIN EA ADDL LESION,11103,CPT,510,RC,51000228,CDM,,,,both,,,139.0000,20.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,35.8800,623.7700,fee schedule,APG 00009 Proc 11103 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN EA ADDL LESION,11103,CPT,510,RC,51000228,CDM,,,,both,,,139.0000,20.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,35.8800,623.7700,fee schedule,APG 00009 Proc 11103 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN EA ADDL LESION,11103,CPT,510,RC,51000228,CDM,,,,both,,,139.0000,20.8500,SENTARA HEALTH,SENTARA HEALTH,35.88,,,,,,,35.8800,623.7700,percent of total billed charges,25.81% of $139.00 in Billed Charges for Rev 510 Proc 11103 = $35.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TANGENTIAL BX SKIN EA ADDL LESION,11103,CPT,510,RC,51000228,CDM,,,,both,,,139.0000,20.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",139.00,,,,,,,35.8800,623.7700,percent of total billed charges,100% of $139.00 in Billed Charges for Rev 510 Proc 11103 = $139.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TANGENTIAL BX SKIN EA ADDL LESION,11103,CPT,510,RC,51000228,CDM,,,,both,,,139.0000,20.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,44.90,,,,,,,35.8800,623.7700,other,32.3% of $139.00 in Billed Charges for Rev 510 Proc 11103 = $44.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN EA ADDL LESION,11103,CPT,510,RC,51000228,CDM,,,,both,,,139.0000,20.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,42.67,,,,,,,35.8800,623.7700,other,30.7% of $139.00 in Billed Charges for Rev 510 Proc 11103 = $42.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN EA ADDL LESION,11103,CPT,510,RC,51000228,CDM,,,,both,,,139.0000,20.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,44.90,,,,,,,35.8800,623.7700,percent of total billed charges,32.3% of $139.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC TANGENTIAL BX SKIN EA ADDL LESION,11103,CPT,510,RC,51000228,CDM,,,,both,,,139.0000,20.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,35.8800,623.7700,fee schedule,APG 00009 Proc 11103 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TANGENTIAL BX SKIN EA ADDL LESION,11103,CPT,510,RC,51000228,CDM,,,,both,,,139.0000,20.8500,WELLCARE,WELLCARE MEDICAID,139.00,,,,,,,35.8800,623.7700,percent of total billed charges,100% of $139.00 in Billed Charges for Rev 510 Proc 11103 = $139.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,AETNA,AETNA,324.95,,,,,,,157.0400,1461.7800,percent of total billed charges,42.7% of $761.00 in Billed Charges for Rev 510 Proc 11106 = $324.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,157.0400,1461.7800,fee schedule,"APG 00009 Proc 11106 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,670.54,,,,,,,157.0400,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,AETNA,AETNA HEALTHCARE MEDICARE,670.54,,,,,,,157.0400,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,670.54,,,,,,,157.0400,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,AMBETTER,AMBETTER,1461.78,,,,,,,157.0400,1461.7800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,697.36,,,,,,,157.0400,1461.7800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,BLUE CROSS,ANTHEM EXCHANGE,761.00,,,,,,,157.0400,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,157.0400,1461.7800,fee schedule,"APG 00009 Proc 11106 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,BLUE CROSS,ANTHEM HMO,761.00,,,,,,,157.0400,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,690.66,,,,,,,157.0400,1461.7800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",761.00,,,,,,,157.0400,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,532.70,,,,,,,157.0400,1461.7800,percent of total billed charges,Rev 510 Proc 11106 $761.00 in Billed Charges at 70% = $532.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,BLUE CROSS,BLUE CROSS MEDICARE,697.36,,,,,,,157.0400,1461.7800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,CIGNA HEALTHCARE,CIGNA HMO,317.34,,,,,,,157.0400,1461.7800,percent of total billed charges,41.7% of $761.00 in Billed Charges for Rev 510 Proc 11106 = $317.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,353.10,,,,,,,157.0400,1461.7800,percent of total billed charges,46.4% of $761.00 in Billed Charges for Rev 510 Proc 11106 = $353.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,704.07,,,,,,,157.0400,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,317.34,,,,,,,157.0400,1461.7800,percent of total billed charges,41.7% of $761.00 in Billed Charges for Rev 510 Proc 11106 = $317.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,CIGNA HEALTHCARE,CIGNA PPO,317.34,,,,,,,157.0400,1461.7800,percent of total billed charges,41.7% of $761.00 in Billed Charges for Rev 510 Proc 11106 = $317.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,704.07,,,,,,,157.0400,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,684.90,,,,,,,157.0400,1461.7800,percent of total billed charges,90% of $761.00 in Billed Charges for Rev 510 Proc 11106 = $684.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,HUMANA,HUMANA MEDICARE,670.54,,,,,,,157.0400,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,670.54,,,,,,,157.0400,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,MEDCOST,MEDCOST VHN,362.16,,,,,,,157.0400,1461.7800,percent of total billed charges,47.59% of $761.00 in Billed Charges for Rev 510 Proc 11106 = $362.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,157.0400,1461.7800,fee schedule,"APG 00009 Proc 11106 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,704.07,,,,,,,157.0400,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,704.07,,,,,,,157.0400,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,NHC ADVANTAGE,NHC ADVANTAGE,704.07,,,,,,,157.0400,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,157.0400,1461.7800,fee schedule,"APG 00009 Proc 11106 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,SENTARA HEALTH,SENTARA HEALTH,196.41,,,,,,,157.0400,1461.7800,percent of total billed charges,25.81% of $761.00 in Billed Charges for Rev 510 Proc 11106 = $196.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,SENTARA HEALTH,SENTARA MEDICARE,670.54,,,,,,,157.0400,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",761.00,,,,,,,157.0400,1461.7800,percent of total billed charges,100% of $761.00 in Billed Charges for Rev 510 Proc 11106 = $761.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,157.04,,,,,,,157.0400,1461.7800,fee schedule,$314.08 from Fee Schedule TCUHC24 for Rev 510 Proc 11106 * Qty 1 = $314.08 at 50% = $157.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,245.80,,,,,,,157.0400,1461.7800,other,32.3% of $761.00 in Billed Charges for Rev 510 Proc 11106 = $245.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,233.63,,,,,,,157.0400,1461.7800,other,30.7% of $761.00 in Billed Charges for Rev 510 Proc 11106 = $233.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,245.80,,,,,,,157.0400,1461.7800,percent of total billed charges,32.3% of $761.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,157.0400,1461.7800,fee schedule,"APG 00009 Proc 11106 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,670.54,,,,,,,157.0400,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,670.54,,,,,,,157.0400,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,WELLCARE,WELLCARE MEDICAID,761.00,,,,,,,157.0400,1461.7800,percent of total billed charges,100% of $761.00 in Billed Charges for Rev 510 Proc 11106 = $761.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN SNGL LESION,11106,CPT,510,RC,51000231,CDM,,,,both,,,761.0000,114.1500,WELLCARE,WELLCARE MEDICARE,710.77,,,,,,,157.0400,1461.7800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,AETNA,AETNA,108.89,,,,,,,21.9700,396.8300,percent of total billed charges,42.7% of $255.00 in Billed Charges for Rev 450 Proc 11200 = $108.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,21.9700,396.8300,fee schedule,"APG 00003 Proc 11200 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,21.9700,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,21.9700,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,21.9700,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,AMBETTER,AMBETTER,396.83,,,,,,,21.9700,396.8300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,21.9700,396.8300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,BLUE CROSS,ANTHEM EXCHANGE,255.00,,,,,,,21.9700,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,21.9700,396.8300,fee schedule,"APG 00003 Proc 11200 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,BLUE CROSS,ANTHEM HMO,255.00,,,,,,,21.9700,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,21.9700,396.8300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",255.00,,,,,,,21.9700,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,52.47,,,,,,,21.9700,396.8300,fee schedule,$52.47 from Fee Schedule BLDTM_23 for Rev 450 Proc 11200 * Qty 1 = $52.47 at 100% = $52.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,21.9700,396.8300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,BLUE CROSS,TENNCARE BLUE CARE,21.97,,,,,,,21.9700,396.8300,fee schedule,$18.94 from Fee Schedule TC_24 for Rev 450 Proc 11200 * Qty 1 = $18.94 at 116% = $21.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,BLUE CROSS,TENNCARE BLUE SELECT,21.97,,,,,,,21.9700,396.8300,fee schedule,$18.94 from Fee Schedule TC_24 for Rev 450 Proc 11200 * Qty 1 = $18.94 at 116% = $21.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,21.9700,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,21.9700,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,229.50,,,,,,,21.9700,396.8300,percent of total billed charges,90% of $255.00 in Billed Charges for Rev 450 Proc 11200 = $229.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,21.9700,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,21.9700,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,MEDCOST,MEDCOST VHN,121.35,,,,,,,21.9700,396.8300,percent of total billed charges,47.59% of $255.00 in Billed Charges for Rev 450 Proc 11200 = $121.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,21.9700,396.8300,fee schedule,"APG 00003 Proc 11200 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,21.9700,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,21.9700,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,21.9700,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,21.9700,396.8300,fee schedule,"APG 00003 Proc 11200 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,SENTARA HEALTH,SENTARA HEALTH,65.82,,,,,,,21.9700,396.8300,percent of total billed charges,25.81% of $255.00 in Billed Charges for Rev 450 Proc 11200 = $65.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,21.9700,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",255.00,,,,,,,21.9700,396.8300,percent of total billed charges,100% of $255.00 in Billed Charges for Rev 450 Proc 11200 = $255.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,21.9700,396.8300,case rate,Rev 450 Proc 11200 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,255.00,,,,,,,21.9700,396.8300,case rate,"Rev 450 Proc 11200 at Case Rate $491.00 (Service Line reduced to $255.00, claim capped at $255.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,255.00,,,,,,,21.9700,396.8300,case rate,"Rev 450 Proc 11200 at Case Rate $471.00 (Service Line reduced to $255.00, claim capped at $255.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,255.00,,,,,,,21.9700,396.8300,case rate,"Rev 450 Proc 11200 at Case Rate $847.00 (Service Line reduced to $255.00, claim capped at $255.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,21.9700,396.8300,fee schedule,"APG 00003 Proc 11200 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,21.9700,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,21.9700,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,WELLCARE,WELLCARE MEDICAID,255.00,,,,,,,21.9700,396.8300,percent of total billed charges,100% of $255.00 in Billed Charges for Rev 450 Proc 11200 = $255.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMV SKIN TAGS TO 15 LESIONS,11200,CPT,450,RC,45000027,CDM,,,,both,,,255.0000,38.2500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,21.9700,396.8300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SKIN TAGS EACH ADD 10,11201,CPT,510,RC,51000104,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA,237.84,,,,,,,7.8500,557.0000,percent of total billed charges,42.7% of $557.00 in Billed Charges for Rev 510 Proc 11201 = $237.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL OF SKIN TAGS EACH ADD 10,11201,CPT,510,RC,51000104,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,7.8500,557.0000,fee schedule,APG 00003 Proc 11201 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SKIN TAGS EACH ADD 10,11201,CPT,510,RC,51000104,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,7.8500,557.0000,fee schedule,APG 00003 Proc 11201 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SKIN TAGS EACH ADD 10,11201,CPT,510,RC,51000104,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,20.75,,,,,,,7.8500,557.0000,fee schedule,$20.75 from Fee Schedule BLDTM_23 for Rev 510 Proc 11201 * Qty 1 = $20.75 at 100% = $20.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SKIN TAGS EACH ADD 10,11201,CPT,510,RC,51000104,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,TENNCARE BLUE CARE,7.85,,,,,,,7.8500,557.0000,fee schedule,$6.77 from Fee Schedule TC_24 for Rev 510 Proc 11201 * Qty 1 = $6.77 at 116% = $7.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SKIN TAGS EACH ADD 10,11201,CPT,510,RC,51000104,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,TENNCARE BLUE SELECT,7.85,,,,,,,7.8500,557.0000,fee schedule,$6.77 from Fee Schedule TC_24 for Rev 510 Proc 11201 * Qty 1 = $6.77 at 116% = $7.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SKIN TAGS EACH ADD 10,11201,CPT,510,RC,51000104,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA HMO,232.27,,,,,,,7.8500,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 510 Proc 11201 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL OF SKIN TAGS EACH ADD 10,11201,CPT,510,RC,51000104,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,258.45,,,,,,,7.8500,557.0000,percent of total billed charges,46.4% of $557.00 in Billed Charges for Rev 510 Proc 11201 = $258.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL OF SKIN TAGS EACH ADD 10,11201,CPT,510,RC,51000104,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,232.27,,,,,,,7.8500,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 510 Proc 11201 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL OF SKIN TAGS EACH ADD 10,11201,CPT,510,RC,51000104,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA PPO,232.27,,,,,,,7.8500,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 510 Proc 11201 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL OF SKIN TAGS EACH ADD 10,11201,CPT,510,RC,51000104,CDM,,,,both,,,557.0000,83.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,501.30,,,,,,,7.8500,557.0000,percent of total billed charges,90% of $557.00 in Billed Charges for Rev 510 Proc 11201 = $501.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL OF SKIN TAGS EACH ADD 10,11201,CPT,510,RC,51000104,CDM,,,,both,,,557.0000,83.5500,MEDCOST,MEDCOST VHN,265.08,,,,,,,7.8500,557.0000,percent of total billed charges,47.59% of $557.00 in Billed Charges for Rev 510 Proc 11201 = $265.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL OF SKIN TAGS EACH ADD 10,11201,CPT,510,RC,51000104,CDM,,,,both,,,557.0000,83.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,7.8500,557.0000,fee schedule,APG 00003 Proc 11201 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SKIN TAGS EACH ADD 10,11201,CPT,510,RC,51000104,CDM,,,,both,,,557.0000,83.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,7.8500,557.0000,fee schedule,APG 00003 Proc 11201 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SKIN TAGS EACH ADD 10,11201,CPT,510,RC,51000104,CDM,,,,both,,,557.0000,83.5500,SENTARA HEALTH,SENTARA HEALTH,143.76,,,,,,,7.8500,557.0000,percent of total billed charges,25.81% of $557.00 in Billed Charges for Rev 510 Proc 11201 = $143.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL OF SKIN TAGS EACH ADD 10,11201,CPT,510,RC,51000104,CDM,,,,both,,,557.0000,83.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",557.00,,,,,,,7.8500,557.0000,percent of total billed charges,100% of $557.00 in Billed Charges for Rev 510 Proc 11201 = $557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL OF SKIN TAGS EACH ADD 10,11201,CPT,510,RC,51000104,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,179.91,,,,,,,7.8500,557.0000,other,32.3% of $557.00 in Billed Charges for Rev 510 Proc 11201 = $179.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SKIN TAGS EACH ADD 10,11201,CPT,510,RC,51000104,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,171.00,,,,,,,7.8500,557.0000,other,30.7% of $557.00 in Billed Charges for Rev 510 Proc 11201 = $171.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SKIN TAGS EACH ADD 10,11201,CPT,510,RC,51000104,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,179.91,,,,,,,7.8500,557.0000,percent of total billed charges,32.3% of $557.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC REMOVAL OF SKIN TAGS EACH ADD 10,11201,CPT,510,RC,51000104,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,7.8500,557.0000,fee schedule,APG 00003 Proc 11201 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL OF SKIN TAGS EACH ADD 10,11201,CPT,510,RC,51000104,CDM,,,,both,,,557.0000,83.5500,WELLCARE,WELLCARE MEDICAID,557.00,,,,,,,7.8500,557.0000,percent of total billed charges,100% of $557.00 in Billed Charges for Rev 510 Proc 11201 = $557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA,237.84,,,,,,,20.4000,804.0300,percent of total billed charges,42.7% of $557.00 in Billed Charges for Rev 521 Proc 11300 = $237.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,20.4000,804.0300,fee schedule,"APG 00003 Proc 11300 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,20.4000,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,20.4000,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,20.4000,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,AMBETTER,AMBETTER,804.03,,,,,,,20.4000,804.0300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,20.4000,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM EXCHANGE,557.00,,,,,,,20.4000,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,20.4000,804.0300,fee schedule,"APG 00003 Proc 11300 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM HMO,557.00,,,,,,,20.4000,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,20.4000,804.0300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",557.00,,,,,,,20.4000,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,46.78,,,,,,,20.4000,804.0300,fee schedule,$46.78 from Fee Schedule BLDTM_23 for Rev 521 Proc 11300 * Qty 1 = $46.78 at 100% = $46.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,20.4000,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,TENNCARE BLUE CARE,20.40,,,,,,,20.4000,804.0300,fee schedule,$17.59 from Fee Schedule TC_24 for Rev 521 Proc 11300 * Qty 1 = $17.59 at 116% = $20.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,TENNCARE BLUE SELECT,20.40,,,,,,,20.4000,804.0300,fee schedule,$17.59 from Fee Schedule TC_24 for Rev 521 Proc 11300 * Qty 1 = $17.59 at 116% = $20.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA HMO,232.27,,,,,,,20.4000,804.0300,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 521 Proc 11300 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,258.45,,,,,,,20.4000,804.0300,percent of total billed charges,46.4% of $557.00 in Billed Charges for Rev 521 Proc 11300 = $258.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,20.4000,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,232.27,,,,,,,20.4000,804.0300,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 521 Proc 11300 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA PPO,232.27,,,,,,,20.4000,804.0300,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 521 Proc 11300 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,20.4000,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,501.30,,,,,,,20.4000,804.0300,percent of total billed charges,90% of $557.00 in Billed Charges for Rev 521 Proc 11300 = $501.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,20.4000,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,20.4000,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,MEDCOST,MEDCOST VHN,265.08,,,,,,,20.4000,804.0300,percent of total billed charges,47.59% of $557.00 in Billed Charges for Rev 521 Proc 11300 = $265.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,20.4000,804.0300,fee schedule,"APG 00003 Proc 11300 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,20.4000,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,20.4000,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,20.4000,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,20.4000,804.0300,fee schedule,"APG 00003 Proc 11300 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,SENTARA HEALTH,SENTARA HEALTH,143.76,,,,,,,20.4000,804.0300,percent of total billed charges,25.81% of $557.00 in Billed Charges for Rev 521 Proc 11300 = $143.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,20.4000,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",557.00,,,,,,,20.4000,804.0300,percent of total billed charges,100% of $557.00 in Billed Charges for Rev 521 Proc 11300 = $557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,20.4000,804.0300,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 521 Proc 11300 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,20.4000,804.0300,fee schedule,"APG 00003 Proc 11300 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,20.4000,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,20.4000,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,WELLCARE,WELLCARE MEDICAID,557.00,,,,,,,20.4000,804.0300,percent of total billed charges,100% of $557.00 in Billed Charges for Rev 521 Proc 11300 = $557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5 CM OR LESS,11300,CPT,521,RC,52100019,CDM,,,,both,,,557.0000,83.5500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,20.4000,804.0300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TAP NAV3606040 4.0MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,3049.0700,457.3600,AETNA,AETNA,1301.95,,,,,,,786.9700,3049.0700,percent of total billed charges,"42.7% of $3,049.07 in Billed Charges for Rev 272 = $1,301.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP NAV3606040 4.0MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,3049.0700,457.3600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2134.35,,,,,,,786.9700,3049.0700,percent of total billed charges,"Rev 272 $3,049.07 in Billed Charges at 70% = $2,134.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP NAV3606040 4.0MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,3049.0700,457.3600,CIGNA HEALTHCARE,CIGNA HMO,1271.46,,,,,,,786.9700,3049.0700,percent of total billed charges,"41.7% of $3,049.07 in Billed Charges for Rev 272 = $1,271.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP NAV3606040 4.0MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,3049.0700,457.3600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1414.77,,,,,,,786.9700,3049.0700,percent of total billed charges,"46.4% of $3,049.07 in Billed Charges for Rev 272 = $1,414.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP NAV3606040 4.0MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,3049.0700,457.3600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1271.46,,,,,,,786.9700,3049.0700,percent of total billed charges,"41.7% of $3,049.07 in Billed Charges for Rev 272 = $1,271.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP NAV3606040 4.0MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,3049.0700,457.3600,CIGNA HEALTHCARE,CIGNA PPO,1271.46,,,,,,,786.9700,3049.0700,percent of total billed charges,"41.7% of $3,049.07 in Billed Charges for Rev 272 = $1,271.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP NAV3606040 4.0MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,3049.0700,457.3600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2744.16,,,,,,,786.9700,3049.0700,percent of total billed charges,"90% of $3,049.07 in Billed Charges for Rev 272 = $2,744.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP NAV3606040 4.0MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,3049.0700,457.3600,MEDCOST,MEDCOST VHN,1451.05,,,,,,,786.9700,3049.0700,percent of total billed charges,"47.59% of $3,049.07 in Billed Charges for Rev 272 = $1,451.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP NAV3606040 4.0MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,3049.0700,457.3600,SENTARA HEALTH,SENTARA HEALTH,786.97,,,,,,,786.9700,3049.0700,percent of total billed charges,"25.81% of $3,049.07 in Billed Charges for Rev 272 = $786.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP NAV3606040 4.0MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,3049.0700,457.3600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3049.07,,,,,,,786.9700,3049.0700,percent of total billed charges,"100% of $3,049.07 in Billed Charges for Rev 272 = $3,049.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP NAV3606040 4.0MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,3049.0700,457.3600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1524.54,,,,,,,786.9700,3049.0700,percent of total billed charges,"Rev 272 $3,049.07 in Billed Charges at 50% = $1,524.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP NAV3606040 4.0MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,3049.0700,457.3600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,984.85,,,,,,,786.9700,3049.0700,other,"32.3% of $3,049.07 in Billed Charges for Rev 272 = $984.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TAP NAV3606040 4.0MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,3049.0700,457.3600,UNITED HEALTHCARE,UHC HERITAGE SELECT,936.06,,,,,,,786.9700,3049.0700,other,"30.7% of $3,049.07 in Billed Charges for Rev 272 = $936.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TAP NAV3606040 4.0MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,3049.0700,457.3600,UNITED HEALTHCARE,UNITED HEALTHCARE,984.85,,,,,,,786.9700,3049.0700,percent of total billed charges,"32.3% of $3,049.07 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP NAV3606040 4.0MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,3049.0700,457.3600,WELLCARE,WELLCARE MEDICAID,3049.07,,,,,,,786.9700,3049.0700,percent of total billed charges,"100% of $3,049.07 in Billed Charges for Rev 272 = $3,049.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP SOLERA AWL TIPTAP 5.5MM,272,RC,27200002,CDM,,,,,,both,,,5444.7800,816.7200,AETNA,AETNA,2324.92,,,,,,,1405.3000,5444.7800,percent of total billed charges,"42.7% of $5,444.78 in Billed Charges for Rev 272 = $2,324.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP SOLERA AWL TIPTAP 5.5MM,272,RC,27200002,CDM,,,,,,both,,,5444.7800,816.7200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3811.35,,,,,,,1405.3000,5444.7800,percent of total billed charges,"Rev 272 $5,444.78 in Billed Charges at 70% = $3,811.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP SOLERA AWL TIPTAP 5.5MM,272,RC,27200002,CDM,,,,,,both,,,5444.7800,816.7200,CIGNA HEALTHCARE,CIGNA HMO,2270.47,,,,,,,1405.3000,5444.7800,percent of total billed charges,"41.7% of $5,444.78 in Billed Charges for Rev 272 = $2,270.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP SOLERA AWL TIPTAP 5.5MM,272,RC,27200002,CDM,,,,,,both,,,5444.7800,816.7200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2526.38,,,,,,,1405.3000,5444.7800,percent of total billed charges,"46.4% of $5,444.78 in Billed Charges for Rev 272 = $2,526.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP SOLERA AWL TIPTAP 5.5MM,272,RC,27200002,CDM,,,,,,both,,,5444.7800,816.7200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2270.47,,,,,,,1405.3000,5444.7800,percent of total billed charges,"41.7% of $5,444.78 in Billed Charges for Rev 272 = $2,270.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP SOLERA AWL TIPTAP 5.5MM,272,RC,27200002,CDM,,,,,,both,,,5444.7800,816.7200,CIGNA HEALTHCARE,CIGNA PPO,2270.47,,,,,,,1405.3000,5444.7800,percent of total billed charges,"41.7% of $5,444.78 in Billed Charges for Rev 272 = $2,270.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP SOLERA AWL TIPTAP 5.5MM,272,RC,27200002,CDM,,,,,,both,,,5444.7800,816.7200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4900.30,,,,,,,1405.3000,5444.7800,percent of total billed charges,"90% of $5,444.78 in Billed Charges for Rev 272 = $4,900.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP SOLERA AWL TIPTAP 5.5MM,272,RC,27200002,CDM,,,,,,both,,,5444.7800,816.7200,MEDCOST,MEDCOST VHN,2591.17,,,,,,,1405.3000,5444.7800,percent of total billed charges,"47.59% of $5,444.78 in Billed Charges for Rev 272 = $2,591.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP SOLERA AWL TIPTAP 5.5MM,272,RC,27200002,CDM,,,,,,both,,,5444.7800,816.7200,SENTARA HEALTH,SENTARA HEALTH,1405.30,,,,,,,1405.3000,5444.7800,percent of total billed charges,"25.81% of $5,444.78 in Billed Charges for Rev 272 = $1,405.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP SOLERA AWL TIPTAP 5.5MM,272,RC,27200002,CDM,,,,,,both,,,5444.7800,816.7200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5444.78,,,,,,,1405.3000,5444.7800,percent of total billed charges,"100% of $5,444.78 in Billed Charges for Rev 272 = $5,444.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP SOLERA AWL TIPTAP 5.5MM,272,RC,27200002,CDM,,,,,,both,,,5444.7800,816.7200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2722.39,,,,,,,1405.3000,5444.7800,percent of total billed charges,"Rev 272 $5,444.78 in Billed Charges at 50% = $2,722.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP SOLERA AWL TIPTAP 5.5MM,272,RC,27200002,CDM,,,,,,both,,,5444.7800,816.7200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1758.66,,,,,,,1405.3000,5444.7800,other,"32.3% of $5,444.78 in Billed Charges for Rev 272 = $1,758.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TAP SOLERA AWL TIPTAP 5.5MM,272,RC,27200002,CDM,,,,,,both,,,5444.7800,816.7200,UNITED HEALTHCARE,UHC HERITAGE SELECT,1671.55,,,,,,,1405.3000,5444.7800,other,"30.7% of $5,444.78 in Billed Charges for Rev 272 = $1,671.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TAP SOLERA AWL TIPTAP 5.5MM,272,RC,27200002,CDM,,,,,,both,,,5444.7800,816.7200,UNITED HEALTHCARE,UNITED HEALTHCARE,1758.66,,,,,,,1405.3000,5444.7800,percent of total billed charges,"32.3% of $5,444.78 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP SOLERA AWL TIPTAP 5.5MM,272,RC,27200002,CDM,,,,,,both,,,5444.7800,816.7200,WELLCARE,WELLCARE MEDICAID,5444.78,,,,,,,1405.3000,5444.7800,percent of total billed charges,"100% of $5,444.78 in Billed Charges for Rev 272 = $5,444.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA,111.45,,,,,,,32.9600,396.8300,percent of total billed charges,42.7% of $261.00 in Billed Charges for Rev 510 Proc 11306 = $111.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,32.9600,396.8300,fee schedule,"APG 00003 Proc 11306 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,32.9600,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,32.9600,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,32.9600,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,AMBETTER,AMBETTER,396.83,,,,,,,32.9600,396.8300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,32.9600,396.8300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM EXCHANGE,261.00,,,,,,,32.9600,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,32.9600,396.8300,fee schedule,"APG 00003 Proc 11306 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM HMO,261.00,,,,,,,32.9600,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,32.9600,396.8300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",261.00,,,,,,,32.9600,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,65.68,,,,,,,32.9600,396.8300,fee schedule,$65.68 from Fee Schedule BLDTM_23 for Rev 510 Proc 11306 * Qty 1 = $65.68 at 100% = $65.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,32.9600,396.8300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,TENNCARE BLUE CARE,32.96,,,,,,,32.9600,396.8300,fee schedule,$28.41 from Fee Schedule TC_24 for Rev 510 Proc 11306 * Qty 1 = $28.41 at 116% = $32.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,TENNCARE BLUE SELECT,32.96,,,,,,,32.9600,396.8300,fee schedule,$28.41 from Fee Schedule TC_24 for Rev 510 Proc 11306 * Qty 1 = $28.41 at 116% = $32.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA HMO,108.84,,,,,,,32.9600,396.8300,percent of total billed charges,41.7% of $261.00 in Billed Charges for Rev 510 Proc 11306 = $108.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,121.10,,,,,,,32.9600,396.8300,percent of total billed charges,46.4% of $261.00 in Billed Charges for Rev 510 Proc 11306 = $121.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,32.9600,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,108.84,,,,,,,32.9600,396.8300,percent of total billed charges,41.7% of $261.00 in Billed Charges for Rev 510 Proc 11306 = $108.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA PPO,108.84,,,,,,,32.9600,396.8300,percent of total billed charges,41.7% of $261.00 in Billed Charges for Rev 510 Proc 11306 = $108.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,32.9600,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,234.90,,,,,,,32.9600,396.8300,percent of total billed charges,90% of $261.00 in Billed Charges for Rev 510 Proc 11306 = $234.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,32.9600,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,32.9600,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,MEDCOST,MEDCOST VHN,124.21,,,,,,,32.9600,396.8300,percent of total billed charges,47.59% of $261.00 in Billed Charges for Rev 510 Proc 11306 = $124.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,32.9600,396.8300,fee schedule,"APG 00003 Proc 11306 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,32.9600,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,32.9600,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,32.9600,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,32.9600,396.8300,fee schedule,"APG 00003 Proc 11306 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,SENTARA HEALTH,SENTARA HEALTH,67.36,,,,,,,32.9600,396.8300,percent of total billed charges,25.81% of $261.00 in Billed Charges for Rev 510 Proc 11306 = $67.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,32.9600,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",261.00,,,,,,,32.9600,396.8300,percent of total billed charges,100% of $261.00 in Billed Charges for Rev 510 Proc 11306 = $261.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,32.9600,396.8300,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 510 Proc 11306 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,84.30,,,,,,,32.9600,396.8300,other,32.3% of $261.00 in Billed Charges for Rev 510 Proc 11306 = $84.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,80.13,,,,,,,32.9600,396.8300,other,30.7% of $261.00 in Billed Charges for Rev 510 Proc 11306 = $80.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,84.30,,,,,,,32.9600,396.8300,percent of total billed charges,32.3% of $261.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,32.9600,396.8300,fee schedule,"APG 00003 Proc 11306 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,32.9600,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,32.9600,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,WELLCARE,WELLCARE MEDICAID,261.00,,,,,,,32.9600,396.8300,percent of total billed charges,100% of $261.00 in Billed Charges for Rev 510 Proc 11306 = $261.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0,11306,CPT,510,RC,51000111,CDM,,,,both,,,261.0000,39.1500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,32.9600,396.8300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,AETNA,AETNA,122.98,,,,,,,39.2400,396.8300,percent of total billed charges,42.7% of $288.00 in Billed Charges for Rev 510 Proc 11307 = $122.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,39.2400,396.8300,fee schedule,"APG 00003 Proc 11307 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,39.2400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,39.2400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,39.2400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,AMBETTER,AMBETTER,396.83,,,,,,,39.2400,396.8300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,39.2400,396.8300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,ANTHEM EXCHANGE,288.00,,,,,,,39.2400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,39.2400,396.8300,fee schedule,"APG 00003 Proc 11307 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,ANTHEM HMO,288.00,,,,,,,39.2400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,39.2400,396.8300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",288.00,,,,,,,39.2400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,82.22,,,,,,,39.2400,396.8300,fee schedule,$82.22 from Fee Schedule BLDTM_23 for Rev 510 Proc 11307 * Qty 1 = $82.22 at 100% = $82.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,39.2400,396.8300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,TENNCARE BLUE CARE,39.24,,,,,,,39.2400,396.8300,fee schedule,$33.83 from Fee Schedule TC_24 for Rev 510 Proc 11307 * Qty 1 = $33.83 at 116% = $39.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,TENNCARE BLUE SELECT,39.24,,,,,,,39.2400,396.8300,fee schedule,$33.83 from Fee Schedule TC_24 for Rev 510 Proc 11307 * Qty 1 = $33.83 at 116% = $39.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,CIGNA HEALTHCARE,CIGNA HMO,120.10,,,,,,,39.2400,396.8300,percent of total billed charges,41.7% of $288.00 in Billed Charges for Rev 510 Proc 11307 = $120.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,133.63,,,,,,,39.2400,396.8300,percent of total billed charges,46.4% of $288.00 in Billed Charges for Rev 510 Proc 11307 = $133.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,39.2400,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,120.10,,,,,,,39.2400,396.8300,percent of total billed charges,41.7% of $288.00 in Billed Charges for Rev 510 Proc 11307 = $120.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,CIGNA HEALTHCARE,CIGNA PPO,120.10,,,,,,,39.2400,396.8300,percent of total billed charges,41.7% of $288.00 in Billed Charges for Rev 510 Proc 11307 = $120.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,39.2400,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,259.20,,,,,,,39.2400,396.8300,percent of total billed charges,90% of $288.00 in Billed Charges for Rev 510 Proc 11307 = $259.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,HUMANA,HUMANA MEDICARE,182.03,,,,,,,39.2400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,39.2400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,MEDCOST,MEDCOST VHN,137.06,,,,,,,39.2400,396.8300,percent of total billed charges,47.59% of $288.00 in Billed Charges for Rev 510 Proc 11307 = $137.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,39.2400,396.8300,fee schedule,"APG 00003 Proc 11307 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,39.2400,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,39.2400,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,39.2400,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,39.2400,396.8300,fee schedule,"APG 00003 Proc 11307 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,SENTARA HEALTH,SENTARA HEALTH,74.33,,,,,,,39.2400,396.8300,percent of total billed charges,25.81% of $288.00 in Billed Charges for Rev 510 Proc 11307 = $74.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,39.2400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",288.00,,,,,,,39.2400,396.8300,percent of total billed charges,100% of $288.00 in Billed Charges for Rev 510 Proc 11307 = $288.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,39.2400,396.8300,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 510 Proc 11307 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,93.02,,,,,,,39.2400,396.8300,other,32.3% of $288.00 in Billed Charges for Rev 510 Proc 11307 = $93.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,88.42,,,,,,,39.2400,396.8300,other,30.7% of $288.00 in Billed Charges for Rev 510 Proc 11307 = $88.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,93.02,,,,,,,39.2400,396.8300,percent of total billed charges,32.3% of $288.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,39.2400,396.8300,fee schedule,"APG 00003 Proc 11307 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,39.2400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,39.2400,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,WELLCARE,WELLCARE MEDICAID,288.00,,,,,,,39.2400,396.8300,percent of total billed charges,100% of $288.00 in Billed Charges for Rev 510 Proc 11307 = $288.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM,11307,CPT,510,RC,51000112,CDM,,,,both,,,288.0000,43.2000,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,39.2400,396.8300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,AETNA,AETNA,261.75,,,,,,,53.3600,804.0300,percent of total billed charges,42.7% of $613.00 in Billed Charges for Rev 521 Proc 11308 = $261.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,53.3600,804.0300,fee schedule,"APG 00003 Proc 11308 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,53.3600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,53.3600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,53.3600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,AMBETTER,AMBETTER,804.03,,,,,,,53.3600,804.0300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,53.3600,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,ANTHEM EXCHANGE,613.00,,,,,,,53.3600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,53.3600,804.0300,fee schedule,"APG 00003 Proc 11308 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,ANTHEM HMO,613.00,,,,,,,53.3600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,53.3600,804.0300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",613.00,,,,,,,53.3600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,108.37,,,,,,,53.3600,804.0300,fee schedule,$108.37 from Fee Schedule BLDTM_23 for Rev 521 Proc 11308 * Qty 1 = $108.37 at 100% = $108.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,53.3600,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,TENNCARE BLUE CARE,53.36,,,,,,,53.3600,804.0300,fee schedule,$46.00 from Fee Schedule TC_24 for Rev 521 Proc 11308 * Qty 1 = $46.00 at 116% = $53.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,TENNCARE BLUE SELECT,53.36,,,,,,,53.3600,804.0300,fee schedule,$46.00 from Fee Schedule TC_24 for Rev 521 Proc 11308 * Qty 1 = $46.00 at 116% = $53.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA HMO,255.62,,,,,,,53.3600,804.0300,percent of total billed charges,41.7% of $613.00 in Billed Charges for Rev 521 Proc 11308 = $255.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,284.43,,,,,,,53.3600,804.0300,percent of total billed charges,46.4% of $613.00 in Billed Charges for Rev 521 Proc 11308 = $284.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,53.3600,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,255.62,,,,,,,53.3600,804.0300,percent of total billed charges,41.7% of $613.00 in Billed Charges for Rev 521 Proc 11308 = $255.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA PPO,255.62,,,,,,,53.3600,804.0300,percent of total billed charges,41.7% of $613.00 in Billed Charges for Rev 521 Proc 11308 = $255.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,53.3600,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,551.70,,,,,,,53.3600,804.0300,percent of total billed charges,90% of $613.00 in Billed Charges for Rev 521 Proc 11308 = $551.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,53.3600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,53.3600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,MEDCOST,MEDCOST VHN,291.73,,,,,,,53.3600,804.0300,percent of total billed charges,47.59% of $613.00 in Billed Charges for Rev 521 Proc 11308 = $291.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,53.3600,804.0300,fee schedule,"APG 00003 Proc 11308 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,53.3600,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,53.3600,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,53.3600,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,53.3600,804.0300,fee schedule,"APG 00003 Proc 11308 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,SENTARA HEALTH,SENTARA HEALTH,158.22,,,,,,,53.3600,804.0300,percent of total billed charges,25.81% of $613.00 in Billed Charges for Rev 521 Proc 11308 = $158.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,53.3600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",613.00,,,,,,,53.3600,804.0300,percent of total billed charges,100% of $613.00 in Billed Charges for Rev 521 Proc 11308 = $613.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,53.3600,804.0300,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 521 Proc 11308 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,53.3600,804.0300,fee schedule,"APG 00003 Proc 11308 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,53.3600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,53.3600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,WELLCARE,WELLCARE MEDICAID,613.00,,,,,,,53.3600,804.0300,percent of total billed charges,100% of $613.00 in Billed Charges for Rev 521 Proc 11308 = $613.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM>2.0 CM,11308,CPT,521,RC,52100025,CDM,,,,both,,,613.0000,91.9500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,53.3600,804.0300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA,111.45,,,,,,,26.6800,396.8300,percent of total billed charges,42.7% of $261.00 in Billed Charges for Rev 521 Proc 11310 = $111.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,26.6800,396.8300,fee schedule,"APG 00003 Proc 11310 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,26.6800,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,26.6800,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,26.6800,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,AMBETTER,AMBETTER,396.83,,,,,,,26.6800,396.8300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,26.6800,396.8300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM EXCHANGE,261.00,,,,,,,26.6800,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,26.6800,396.8300,fee schedule,"APG 00003 Proc 11310 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM HMO,261.00,,,,,,,26.6800,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,26.6800,396.8300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",261.00,,,,,,,26.6800,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,59.97,,,,,,,26.6800,396.8300,fee schedule,$59.97 from Fee Schedule BLDTM_23 for Rev 521 Proc 11310 * Qty 1 = $59.97 at 100% = $59.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,26.6800,396.8300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,TENNCARE BLUE CARE,26.68,,,,,,,26.6800,396.8300,fee schedule,$23.00 from Fee Schedule TC_24 for Rev 521 Proc 11310 * Qty 1 = $23.00 at 116% = $26.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,TENNCARE BLUE SELECT,26.68,,,,,,,26.6800,396.8300,fee schedule,$23.00 from Fee Schedule TC_24 for Rev 521 Proc 11310 * Qty 1 = $23.00 at 116% = $26.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA HMO,108.84,,,,,,,26.6800,396.8300,percent of total billed charges,41.7% of $261.00 in Billed Charges for Rev 521 Proc 11310 = $108.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,121.10,,,,,,,26.6800,396.8300,percent of total billed charges,46.4% of $261.00 in Billed Charges for Rev 521 Proc 11310 = $121.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,26.6800,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,108.84,,,,,,,26.6800,396.8300,percent of total billed charges,41.7% of $261.00 in Billed Charges for Rev 521 Proc 11310 = $108.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA PPO,108.84,,,,,,,26.6800,396.8300,percent of total billed charges,41.7% of $261.00 in Billed Charges for Rev 521 Proc 11310 = $108.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,26.6800,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,234.90,,,,,,,26.6800,396.8300,percent of total billed charges,90% of $261.00 in Billed Charges for Rev 521 Proc 11310 = $234.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,26.6800,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,26.6800,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,MEDCOST,MEDCOST VHN,124.21,,,,,,,26.6800,396.8300,percent of total billed charges,47.59% of $261.00 in Billed Charges for Rev 521 Proc 11310 = $124.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,26.6800,396.8300,fee schedule,"APG 00003 Proc 11310 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,26.6800,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,26.6800,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,26.6800,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,26.6800,396.8300,fee schedule,"APG 00003 Proc 11310 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,SENTARA HEALTH,SENTARA HEALTH,67.36,,,,,,,26.6800,396.8300,percent of total billed charges,25.81% of $261.00 in Billed Charges for Rev 521 Proc 11310 = $67.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,26.6800,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",261.00,,,,,,,26.6800,396.8300,percent of total billed charges,100% of $261.00 in Billed Charges for Rev 521 Proc 11310 = $261.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,26.6800,396.8300,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 521 Proc 11310 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,26.6800,396.8300,fee schedule,"APG 00003 Proc 11310 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,26.6800,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,26.6800,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,WELLCARE,WELLCARE MEDICAID,261.00,,,,,,,26.6800,396.8300,percent of total billed charges,100% of $261.00 in Billed Charges for Rev 521 Proc 11310 = $261.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM OR LESS,11310,CPT,521,RC,52100001,CDM,,,,both,,,261.0000,39.1500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,26.6800,396.8300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,AETNA,AETNA,134.93,,,,,,,43.9400,804.0300,percent of total billed charges,42.7% of $316.00 in Billed Charges for Rev 521 Proc 11312 = $134.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,43.9400,804.0300,fee schedule,"APG 00003 Proc 11312 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,316.00,,,,,,,43.9400,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,AETNA,AETNA HEALTHCARE MEDICARE,316.00,,,,,,,43.9400,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,316.00,,,,,,,43.9400,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,AMBETTER,AMBETTER,804.03,,,,,,,43.9400,804.0300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,316.00,,,,,,,43.9400,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,BLUE CROSS,ANTHEM EXCHANGE,316.00,,,,,,,43.9400,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,43.9400,804.0300,fee schedule,"APG 00003 Proc 11312 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,BLUE CROSS,ANTHEM HMO,316.00,,,,,,,43.9400,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,316.00,,,,,,,43.9400,804.0300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",316.00,,,,,,,43.9400,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,90.81,,,,,,,43.9400,804.0300,fee schedule,$90.81 from Fee Schedule BLDTM_23 for Rev 521 Proc 11312 * Qty 1 = $90.81 at 100% = $90.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,43.9400,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,BLUE CROSS,TENNCARE BLUE CARE,43.94,,,,,,,43.9400,804.0300,fee schedule,$37.88 from Fee Schedule TC_24 for Rev 521 Proc 11312 * Qty 1 = $37.88 at 116% = $43.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,BLUE CROSS,TENNCARE BLUE SELECT,43.94,,,,,,,43.9400,804.0300,fee schedule,$37.88 from Fee Schedule TC_24 for Rev 521 Proc 11312 * Qty 1 = $37.88 at 116% = $43.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,CIGNA HEALTHCARE,CIGNA HMO,131.77,,,,,,,43.9400,804.0300,percent of total billed charges,41.7% of $316.00 in Billed Charges for Rev 521 Proc 11312 = $131.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,146.62,,,,,,,43.9400,804.0300,percent of total billed charges,46.4% of $316.00 in Billed Charges for Rev 521 Proc 11312 = $146.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,316.00,,,,,,,43.9400,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,131.77,,,,,,,43.9400,804.0300,percent of total billed charges,41.7% of $316.00 in Billed Charges for Rev 521 Proc 11312 = $131.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,CIGNA HEALTHCARE,CIGNA PPO,131.77,,,,,,,43.9400,804.0300,percent of total billed charges,41.7% of $316.00 in Billed Charges for Rev 521 Proc 11312 = $131.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,316.00,,,,,,,43.9400,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,284.40,,,,,,,43.9400,804.0300,percent of total billed charges,90% of $316.00 in Billed Charges for Rev 521 Proc 11312 = $284.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,HUMANA,HUMANA MEDICARE,316.00,,,,,,,43.9400,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,316.00,,,,,,,43.9400,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,MEDCOST,MEDCOST VHN,150.38,,,,,,,43.9400,804.0300,percent of total billed charges,47.59% of $316.00 in Billed Charges for Rev 521 Proc 11312 = $150.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,43.9400,804.0300,fee schedule,"APG 00003 Proc 11312 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,316.00,,,,,,,43.9400,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,316.00,,,,,,,43.9400,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,NHC ADVANTAGE,NHC ADVANTAGE,316.00,,,,,,,43.9400,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,43.9400,804.0300,fee schedule,"APG 00003 Proc 11312 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,SENTARA HEALTH,SENTARA HEALTH,81.56,,,,,,,43.9400,804.0300,percent of total billed charges,25.81% of $316.00 in Billed Charges for Rev 521 Proc 11312 = $81.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,SENTARA HEALTH,SENTARA MEDICARE,316.00,,,,,,,43.9400,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",316.00,,,,,,,43.9400,804.0300,percent of total billed charges,100% of $316.00 in Billed Charges for Rev 521 Proc 11312 = $316.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,43.9400,804.0300,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 521 Proc 11312 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,43.9400,804.0300,fee schedule,"APG 00003 Proc 11312 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,316.00,,,,,,,43.9400,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,316.00,,,,,,,43.9400,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,WELLCARE,WELLCARE MEDICAID,316.00,,,,,,,43.9400,804.0300,percent of total billed charges,100% of $316.00 in Billed Charges for Rev 521 Proc 11312 = $316.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM,11312,CPT,521,RC,52100027,CDM,,,,both,,,316.0000,47.4000,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,43.9400,804.0300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,AETNA,AETNA,502.15,,,,,,,26.6800,1400.5900,percent of total billed charges,"42.7% of $1,176.00 in Billed Charges for Rev 510 Proc 11400 = $502.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,26.6800,1400.5900,fee schedule,"APG 00009 Proc 11400 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,26.6800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,26.6800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,26.6800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,AMBETTER,AMBETTER,1400.59,,,,,,,26.6800,1400.5900,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,26.6800,1400.5900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,BLUE CROSS,ANTHEM EXCHANGE,1176.00,,,,,,,26.6800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,26.6800,1400.5900,fee schedule,"APG 00009 Proc 11400 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,BLUE CROSS,ANTHEM HMO,1176.00,,,,,,,26.6800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,26.6800,1400.5900,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1176.00,,,,,,,26.6800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,71.20,,,,,,,26.6800,1400.5900,fee schedule,$71.20 from Fee Schedule BLDTM_23 for Rev 510 Proc 11400 * Qty 1 = $71.20 at 100% = $71.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,26.6800,1400.5900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,BLUE CROSS,TENNCARE BLUE CARE,26.68,,,,,,,26.6800,1400.5900,fee schedule,$23.00 from Fee Schedule TC_24 for Rev 510 Proc 11400 * Qty 1 = $23.00 at 116% = $26.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,BLUE CROSS,TENNCARE BLUE SELECT,26.68,,,,,,,26.6800,1400.5900,fee schedule,$23.00 from Fee Schedule TC_24 for Rev 510 Proc 11400 * Qty 1 = $23.00 at 116% = $26.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,CIGNA HEALTHCARE,CIGNA HMO,490.39,,,,,,,26.6800,1400.5900,percent of total billed charges,"41.7% of $1,176.00 in Billed Charges for Rev 510 Proc 11400 = $490.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,545.66,,,,,,,26.6800,1400.5900,percent of total billed charges,"46.4% of $1,176.00 in Billed Charges for Rev 510 Proc 11400 = $545.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,26.6800,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,490.39,,,,,,,26.6800,1400.5900,percent of total billed charges,"41.7% of $1,176.00 in Billed Charges for Rev 510 Proc 11400 = $490.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,CIGNA HEALTHCARE,CIGNA PPO,490.39,,,,,,,26.6800,1400.5900,percent of total billed charges,"41.7% of $1,176.00 in Billed Charges for Rev 510 Proc 11400 = $490.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,26.6800,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1058.40,,,,,,,26.6800,1400.5900,percent of total billed charges,"90% of $1,176.00 in Billed Charges for Rev 510 Proc 11400 = $1,058.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,HUMANA,HUMANA MEDICARE,642.47,,,,,,,26.6800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,26.6800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,MEDCOST,MEDCOST VHN,559.66,,,,,,,26.6800,1400.5900,percent of total billed charges,"47.59% of $1,176.00 in Billed Charges for Rev 510 Proc 11400 = $559.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,26.6800,1400.5900,fee schedule,"APG 00009 Proc 11400 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,26.6800,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,26.6800,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,26.6800,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,26.6800,1400.5900,fee schedule,"APG 00009 Proc 11400 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,SENTARA HEALTH,SENTARA HEALTH,303.53,,,,,,,26.6800,1400.5900,percent of total billed charges,"25.81% of $1,176.00 in Billed Charges for Rev 510 Proc 11400 = $303.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,26.6800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1176.00,,,,,,,26.6800,1400.5900,percent of total billed charges,"100% of $1,176.00 in Billed Charges for Rev 510 Proc 11400 = $1,176.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,189.28,,,,,,,26.6800,1400.5900,fee schedule,$378.56 from Fee Schedule TCUHC24 for Rev 510 Proc 11400 * Qty 1 = $378.56 at 50% = $189.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,379.85,,,,,,,26.6800,1400.5900,other,"32.3% of $1,176.00 in Billed Charges for Rev 510 Proc 11400 = $379.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,361.03,,,,,,,26.6800,1400.5900,other,"30.7% of $1,176.00 in Billed Charges for Rev 510 Proc 11400 = $361.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,379.85,,,,,,,26.6800,1400.5900,percent of total billed charges,"32.3% of $1,176.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,26.6800,1400.5900,fee schedule,"APG 00009 Proc 11400 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,26.6800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,26.6800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,WELLCARE,WELLCARE MEDICAID,1176.00,,,,,,,26.6800,1400.5900,percent of total billed charges,"100% of $1,176.00 in Billed Charges for Rev 510 Proc 11400 = $1,176.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MRGN XCP SK TG T/A/L 0.5 CM/<,11400,CPT,510,RC,51000237,CDM,,,,both,,,1176.0000,176.4000,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,26.6800,1400.5900,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,AETNA,AETNA,575.17,,,,,,,47.0800,1400.5900,percent of total billed charges,"42.7% of $1,347.00 in Billed Charges for Rev 361 Proc 11402 = $575.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,47.0800,1400.5900,fee schedule,"APG 00009 Proc 11402 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,47.0800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,47.0800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,47.0800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,AMBETTER,AMBETTER,1400.59,,,,,,,47.0800,1400.5900,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,47.0800,1400.5900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,BLUE CROSS,ANTHEM EXCHANGE,1347.00,,,,,,,47.0800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,47.0800,1400.5900,fee schedule,"APG 00009 Proc 11402 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,BLUE CROSS,ANTHEM HMO,1347.00,,,,,,,47.0800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,47.0800,1400.5900,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1347.00,,,,,,,47.0800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,47.0800,1400.5900,case rate,Rev 361 Proc 11402 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,47.0800,1400.5900,case rate,Rev 361 Proc 11402 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,47.0800,1400.5900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,47.0800,1400.5900,case rate,Rev 361 Proc 11402 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,47.0800,1400.5900,case rate,Rev 361 Proc 11402 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,BLUE CROSS,TENNCARE BLUE CARE,47.08,,,,,,,47.0800,1400.5900,fee schedule,$40.59 from Fee Schedule TC_24 for Rev 361 Proc 11402 * Qty 1 = $40.59 at 116% = $47.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,BLUE CROSS,TENNCARE BLUE SELECT,47.08,,,,,,,47.0800,1400.5900,fee schedule,$40.59 from Fee Schedule TC_24 for Rev 361 Proc 11402 * Qty 1 = $40.59 at 116% = $47.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,CIGNA HEALTHCARE,CIGNA HMO,1347.00,,,,,,,47.0800,1400.5900,case rate,"Rev 361 Proc 11402 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,347.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,347.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1347.00,,,,,,,47.0800,1400.5900,case rate,"Rev 361 Proc 11402 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total (Limited to $1,347.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,347.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,47.0800,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1347.00,,,,,,,47.0800,1400.5900,case rate,"Rev 361 Proc 11402 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,347.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,347.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,CIGNA HEALTHCARE,CIGNA PPO,1347.00,,,,,,,47.0800,1400.5900,case rate,"Rev 361 Proc 11402 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,347.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,347.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,47.0800,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1212.30,,,,,,,47.0800,1400.5900,percent of total billed charges,"90% of $1,347.00 in Billed Charges for Rev 361 Proc 11402 = $1,212.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,HUMANA,HUMANA MEDICARE,642.47,,,,,,,47.0800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,47.0800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,MEDCOST,MEDCOST VHN,641.04,,,,,,,47.0800,1400.5900,percent of total billed charges,"47.59% of $1,347.00 in Billed Charges for Rev 361 Proc 11402 = $641.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,47.0800,1400.5900,fee schedule,"APG 00009 Proc 11402 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,47.0800,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,47.0800,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,47.0800,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,47.0800,1400.5900,fee schedule,"APG 00009 Proc 11402 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,SENTARA HEALTH,SENTARA HEALTH,347.66,,,,,,,47.0800,1400.5900,percent of total billed charges,"25.81% of $1,347.00 in Billed Charges for Rev 361 Proc 11402 = $347.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,47.0800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1347.00,,,,,,,47.0800,1400.5900,percent of total billed charges,"100% of $1,347.00 in Billed Charges for Rev 361 Proc 11402 = $1,347.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,47.0800,1400.5900,case rate,Rev 361 Proc 11402 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,47.0800,1400.5900,case rate,Rev 361 Proc 11402 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,47.0800,1400.5900,case rate,Rev 361 Proc 11402 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,47.0800,1400.5900,case rate,"Rev 361 Proc 11402 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,47.0800,1400.5900,fee schedule,"APG 00009 Proc 11402 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,47.0800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,47.0800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,WELLCARE,WELLCARE MEDICAID,1347.00,,,,,,,47.0800,1400.5900,percent of total billed charges,"100% of $1,347.00 in Billed Charges for Rev 361 Proc 11402 = $1,347.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION 1.1 TO 2.0CM,11402,CPT,361,RC,36100044,CDM,,,,both,,,1347.0000,202.0500,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,47.0800,1400.5900,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,AETNA,AETNA,632.81,,,,,,,58.0700,1482.0000,percent of total billed charges,"42.7% of $1,482.00 in Billed Charges for Rev 361 Proc 11403 = $632.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,58.0700,1482.0000,fee schedule,"APG 00009 Proc 11403 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,58.0700,1482.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,58.0700,1482.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,58.0700,1482.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,AMBETTER,AMBETTER,1400.59,,,,,,,58.0700,1482.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,58.0700,1482.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,BLUE CROSS,ANTHEM EXCHANGE,1482.00,,,,,,,58.0700,1482.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,58.0700,1482.0000,fee schedule,"APG 00009 Proc 11403 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,BLUE CROSS,ANTHEM HMO,1482.00,,,,,,,58.0700,1482.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,58.0700,1482.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1482.00,,,,,,,58.0700,1482.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,58.0700,1482.0000,case rate,Rev 361 Proc 11403 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,58.0700,1482.0000,case rate,Rev 361 Proc 11403 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,58.0700,1482.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,58.0700,1482.0000,case rate,Rev 361 Proc 11403 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,58.0700,1482.0000,case rate,Rev 361 Proc 11403 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,BLUE CROSS,TENNCARE BLUE CARE,58.07,,,,,,,58.0700,1482.0000,fee schedule,$50.06 from Fee Schedule TC_24 for Rev 361 Proc 11403 * Qty 1 = $50.06 at 116% = $58.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,BLUE CROSS,TENNCARE BLUE SELECT,58.07,,,,,,,58.0700,1482.0000,fee schedule,$50.06 from Fee Schedule TC_24 for Rev 361 Proc 11403 * Qty 1 = $50.06 at 116% = $58.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,CIGNA HEALTHCARE,CIGNA HMO,1482.00,,,,,,,58.0700,1482.0000,case rate,"Rev 361 Proc 11403 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,482.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,482.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,58.0700,1482.0000,case rate,"Rev 361 Proc 11403 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,58.0700,1482.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1482.00,,,,,,,58.0700,1482.0000,case rate,"Rev 361 Proc 11403 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,482.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,482.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,CIGNA HEALTHCARE,CIGNA PPO,1482.00,,,,,,,58.0700,1482.0000,case rate,"Rev 361 Proc 11403 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,482.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,482.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,58.0700,1482.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1333.80,,,,,,,58.0700,1482.0000,percent of total billed charges,"90% of $1,482.00 in Billed Charges for Rev 361 Proc 11403 = $1,333.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,HUMANA,HUMANA MEDICARE,642.47,,,,,,,58.0700,1482.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,58.0700,1482.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,MEDCOST,MEDCOST VHN,705.28,,,,,,,58.0700,1482.0000,percent of total billed charges,"47.59% of $1,482.00 in Billed Charges for Rev 361 Proc 11403 = $705.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,58.0700,1482.0000,fee schedule,"APG 00009 Proc 11403 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,58.0700,1482.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,58.0700,1482.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,58.0700,1482.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,58.0700,1482.0000,fee schedule,"APG 00009 Proc 11403 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,SENTARA HEALTH,SENTARA HEALTH,382.50,,,,,,,58.0700,1482.0000,percent of total billed charges,"25.81% of $1,482.00 in Billed Charges for Rev 361 Proc 11403 = $382.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,58.0700,1482.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1482.00,,,,,,,58.0700,1482.0000,percent of total billed charges,"100% of $1,482.00 in Billed Charges for Rev 361 Proc 11403 = $1,482.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,58.0700,1482.0000,case rate,Rev 361 Proc 11403 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,58.0700,1482.0000,case rate,Rev 361 Proc 11403 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,58.0700,1482.0000,case rate,Rev 361 Proc 11403 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,58.0700,1482.0000,case rate,"Rev 361 Proc 11403 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,58.0700,1482.0000,fee schedule,"APG 00009 Proc 11403 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,58.0700,1482.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,58.0700,1482.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,WELLCARE,WELLCARE MEDICAID,1482.00,,,,,,,58.0700,1482.0000,percent of total billed charges,"100% of $1,482.00 in Billed Charges for Rev 361 Proc 11403 = $1,482.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION 2.1 TO 3.0CM,11403,CPT,361,RC,36100045,CDM,,,,both,,,1482.0000,222.3000,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,58.0700,1482.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,AETNA,AETNA,696.44,,,,,,,67.4900,3266.6300,percent of total billed charges,"42.7% of $1,631.00 in Billed Charges for Rev 361 Proc 11404 = $696.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1775.80,,,,,,,67.4900,3266.6300,fee schedule,"APG 00010 Proc 11404 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 104% = $1,775.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,67.4900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,67.4900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,67.4900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,AMBETTER,AMBETTER,3266.63,,,,,,,67.4900,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,67.4900,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,BLUE CROSS,ANTHEM EXCHANGE,1631.00,,,,,,,67.4900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1631.00,,,,,,,67.4900,3266.6300,fee schedule,"APG 00010 Proc 11404 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73 (Service Line reduced to $1,631.00, claim capped at $1,631.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,BLUE CROSS,ANTHEM HMO,1631.00,,,,,,,67.4900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,67.4900,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1631.00,,,,,,,67.4900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,67.4900,3266.6300,case rate,Rev 361 Proc 11404 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,BLUE CROSS,BLUE CROSS E NETWORK,1631.00,,,,,,,67.4900,3266.6300,case rate,"Rev 361 Proc 11404 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total (Service Line reduced to $1,631.00, claim capped at $1,631.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,67.4900,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,BLUE CROSS,BLUE CROSS P NETWORK,1631.00,,,,,,,67.4900,3266.6300,case rate,"Rev 361 Proc 11404 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total (Service Line reduced to $1,631.00, claim capped at $1,631.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,BLUE CROSS,BLUE CROSS S NETWORK,1631.00,,,,,,,67.4900,3266.6300,case rate,"Rev 361 Proc 11404 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total (Service Line reduced to $1,631.00, claim capped at $1,631.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,BLUE CROSS,TENNCARE BLUE CARE,67.49,,,,,,,67.4900,3266.6300,fee schedule,$58.18 from Fee Schedule TC_24 for Rev 361 Proc 11404 * Qty 1 = $58.18 at 116% = $67.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,BLUE CROSS,TENNCARE BLUE SELECT,67.49,,,,,,,67.4900,3266.6300,fee schedule,$58.18 from Fee Schedule TC_24 for Rev 361 Proc 11404 * Qty 1 = $58.18 at 116% = $67.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,CIGNA HEALTHCARE,CIGNA HMO,1631.00,,,,,,,67.4900,3266.6300,case rate,"Rev 361 Proc 11404 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,631.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,631.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,67.4900,3266.6300,case rate,"Rev 361 Proc 11404 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,67.4900,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1631.00,,,,,,,67.4900,3266.6300,case rate,"Rev 361 Proc 11404 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,631.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,631.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,CIGNA HEALTHCARE,CIGNA PPO,1631.00,,,,,,,67.4900,3266.6300,case rate,"Rev 361 Proc 11404 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,631.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,631.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,67.4900,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1467.90,,,,,,,67.4900,3266.6300,percent of total billed charges,"90% of $1,631.00 in Billed Charges for Rev 361 Proc 11404 = $1,467.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,67.4900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,67.4900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,MEDCOST,MEDCOST VHN,776.19,,,,,,,67.4900,3266.6300,percent of total billed charges,"47.59% of $1,631.00 in Billed Charges for Rev 361 Proc 11404 = $776.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1792.88,,,,,,,67.4900,3266.6300,fee schedule,"APG 00010 Proc 11404 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 105% = $1,792.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,67.4900,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,67.4900,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,67.4900,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1760.43,,,,,,,67.4900,3266.6300,fee schedule,"APG 00010 Proc 11404 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 103.1% = $1,760.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,SENTARA HEALTH,SENTARA HEALTH,420.96,,,,,,,67.4900,3266.6300,percent of total billed charges,"25.81% of $1,631.00 in Billed Charges for Rev 361 Proc 11404 = $420.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,67.4900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1631.00,,,,,,,67.4900,3266.6300,percent of total billed charges,"100% of $1,631.00 in Billed Charges for Rev 361 Proc 11404 = $1,631.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,67.4900,3266.6300,case rate,Rev 361 Proc 11404 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,67.4900,3266.6300,case rate,"Rev 361 Proc 11404 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,67.4900,3266.6300,case rate,"Rev 361 Proc 11404 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,1631.00,,,,,,,67.4900,3266.6300,case rate,"Rev 361 Proc 11404 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total (Service Line reduced to $1,631.00, claim capped at $1,631.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1758.73,,,,,,,67.4900,3266.6300,fee schedule,"APG 00010 Proc 11404 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,67.4900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,67.4900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,WELLCARE,WELLCARE MEDICAID,1631.00,,,,,,,67.4900,3266.6300,percent of total billed charges,"100% of $1,631.00 in Billed Charges for Rev 361 Proc 11404 = $1,631.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION 3.1 TO 4.0CM,11404,CPT,361,RC,36100046,CDM,,,,both,,,1631.0000,244.6500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,67.4900,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TROCAR CLOSURE DEVICE M-CLOSE,272,RC,27200002,CDM,,,,,,both,,,933.2900,139.9900,AETNA,AETNA,398.51,,,,,,,240.8800,933.2900,percent of total billed charges,42.7% of $933.29 in Billed Charges for Rev 272 = $398.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR CLOSURE DEVICE M-CLOSE,272,RC,27200002,CDM,,,,,,both,,,933.2900,139.9900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,653.30,,,,,,,240.8800,933.2900,percent of total billed charges,Rev 272 $933.29 in Billed Charges at 70% = $653.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR CLOSURE DEVICE M-CLOSE,272,RC,27200002,CDM,,,,,,both,,,933.2900,139.9900,CIGNA HEALTHCARE,CIGNA HMO,389.18,,,,,,,240.8800,933.2900,percent of total billed charges,41.7% of $933.29 in Billed Charges for Rev 272 = $389.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR CLOSURE DEVICE M-CLOSE,272,RC,27200002,CDM,,,,,,both,,,933.2900,139.9900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,433.05,,,,,,,240.8800,933.2900,percent of total billed charges,46.4% of $933.29 in Billed Charges for Rev 272 = $433.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR CLOSURE DEVICE M-CLOSE,272,RC,27200002,CDM,,,,,,both,,,933.2900,139.9900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,389.18,,,,,,,240.8800,933.2900,percent of total billed charges,41.7% of $933.29 in Billed Charges for Rev 272 = $389.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR CLOSURE DEVICE M-CLOSE,272,RC,27200002,CDM,,,,,,both,,,933.2900,139.9900,CIGNA HEALTHCARE,CIGNA PPO,389.18,,,,,,,240.8800,933.2900,percent of total billed charges,41.7% of $933.29 in Billed Charges for Rev 272 = $389.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR CLOSURE DEVICE M-CLOSE,272,RC,27200002,CDM,,,,,,both,,,933.2900,139.9900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,839.96,,,,,,,240.8800,933.2900,percent of total billed charges,90% of $933.29 in Billed Charges for Rev 272 = $839.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR CLOSURE DEVICE M-CLOSE,272,RC,27200002,CDM,,,,,,both,,,933.2900,139.9900,MEDCOST,MEDCOST VHN,444.15,,,,,,,240.8800,933.2900,percent of total billed charges,47.59% of $933.29 in Billed Charges for Rev 272 = $444.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR CLOSURE DEVICE M-CLOSE,272,RC,27200002,CDM,,,,,,both,,,933.2900,139.9900,SENTARA HEALTH,SENTARA HEALTH,240.88,,,,,,,240.8800,933.2900,percent of total billed charges,25.81% of $933.29 in Billed Charges for Rev 272 = $240.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR CLOSURE DEVICE M-CLOSE,272,RC,27200002,CDM,,,,,,both,,,933.2900,139.9900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",933.29,,,,,,,240.8800,933.2900,percent of total billed charges,100% of $933.29 in Billed Charges for Rev 272 = $933.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR CLOSURE DEVICE M-CLOSE,272,RC,27200002,CDM,,,,,,both,,,933.2900,139.9900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,466.65,,,,,,,240.8800,933.2900,percent of total billed charges,Rev 272 $933.29 in Billed Charges at 50% = $466.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR CLOSURE DEVICE M-CLOSE,272,RC,27200002,CDM,,,,,,both,,,933.2900,139.9900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,301.45,,,,,,,240.8800,933.2900,other,32.3% of $933.29 in Billed Charges for Rev 272 = $301.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TROCAR CLOSURE DEVICE M-CLOSE,272,RC,27200002,CDM,,,,,,both,,,933.2900,139.9900,UNITED HEALTHCARE,UHC HERITAGE SELECT,286.52,,,,,,,240.8800,933.2900,other,30.7% of $933.29 in Billed Charges for Rev 272 = $286.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TROCAR CLOSURE DEVICE M-CLOSE,272,RC,27200002,CDM,,,,,,both,,,933.2900,139.9900,UNITED HEALTHCARE,UNITED HEALTHCARE,301.45,,,,,,,240.8800,933.2900,percent of total billed charges,32.3% of $933.29 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR CLOSURE DEVICE M-CLOSE,272,RC,27200002,CDM,,,,,,both,,,933.2900,139.9900,WELLCARE,WELLCARE MEDICAID,933.29,,,,,,,240.8800,933.2900,percent of total billed charges,100% of $933.29 in Billed Charges for Rev 272 = $933.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR CLOSURE SYSTEM FASCIAL 12MM,272,RC,27200002,CDM,,,,,,both,,,1753.7400,263.0600,AETNA,AETNA,748.85,,,,,,,452.6400,1753.7400,percent of total billed charges,"42.7% of $1,753.74 in Billed Charges for Rev 272 = $748.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR CLOSURE SYSTEM FASCIAL 12MM,272,RC,27200002,CDM,,,,,,both,,,1753.7400,263.0600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1227.62,,,,,,,452.6400,1753.7400,percent of total billed charges,"Rev 272 $1,753.74 in Billed Charges at 70% = $1,227.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR CLOSURE SYSTEM FASCIAL 12MM,272,RC,27200002,CDM,,,,,,both,,,1753.7400,263.0600,CIGNA HEALTHCARE,CIGNA HMO,731.31,,,,,,,452.6400,1753.7400,percent of total billed charges,"41.7% of $1,753.74 in Billed Charges for Rev 272 = $731.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR CLOSURE SYSTEM FASCIAL 12MM,272,RC,27200002,CDM,,,,,,both,,,1753.7400,263.0600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,813.74,,,,,,,452.6400,1753.7400,percent of total billed charges,"46.4% of $1,753.74 in Billed Charges for Rev 272 = $813.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR CLOSURE SYSTEM FASCIAL 12MM,272,RC,27200002,CDM,,,,,,both,,,1753.7400,263.0600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,731.31,,,,,,,452.6400,1753.7400,percent of total billed charges,"41.7% of $1,753.74 in Billed Charges for Rev 272 = $731.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR CLOSURE SYSTEM FASCIAL 12MM,272,RC,27200002,CDM,,,,,,both,,,1753.7400,263.0600,CIGNA HEALTHCARE,CIGNA PPO,731.31,,,,,,,452.6400,1753.7400,percent of total billed charges,"41.7% of $1,753.74 in Billed Charges for Rev 272 = $731.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR CLOSURE SYSTEM FASCIAL 12MM,272,RC,27200002,CDM,,,,,,both,,,1753.7400,263.0600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1578.37,,,,,,,452.6400,1753.7400,percent of total billed charges,"90% of $1,753.74 in Billed Charges for Rev 272 = $1,578.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR CLOSURE SYSTEM FASCIAL 12MM,272,RC,27200002,CDM,,,,,,both,,,1753.7400,263.0600,MEDCOST,MEDCOST VHN,834.60,,,,,,,452.6400,1753.7400,percent of total billed charges,"47.59% of $1,753.74 in Billed Charges for Rev 272 = $834.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR CLOSURE SYSTEM FASCIAL 12MM,272,RC,27200002,CDM,,,,,,both,,,1753.7400,263.0600,SENTARA HEALTH,SENTARA HEALTH,452.64,,,,,,,452.6400,1753.7400,percent of total billed charges,"25.81% of $1,753.74 in Billed Charges for Rev 272 = $452.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR CLOSURE SYSTEM FASCIAL 12MM,272,RC,27200002,CDM,,,,,,both,,,1753.7400,263.0600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1753.74,,,,,,,452.6400,1753.7400,percent of total billed charges,"100% of $1,753.74 in Billed Charges for Rev 272 = $1,753.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR CLOSURE SYSTEM FASCIAL 12MM,272,RC,27200002,CDM,,,,,,both,,,1753.7400,263.0600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,876.87,,,,,,,452.6400,1753.7400,percent of total billed charges,"Rev 272 $1,753.74 in Billed Charges at 50% = $876.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR CLOSURE SYSTEM FASCIAL 12MM,272,RC,27200002,CDM,,,,,,both,,,1753.7400,263.0600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,566.46,,,,,,,452.6400,1753.7400,other,"32.3% of $1,753.74 in Billed Charges for Rev 272 = $566.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TROCAR CLOSURE SYSTEM FASCIAL 12MM,272,RC,27200002,CDM,,,,,,both,,,1753.7400,263.0600,UNITED HEALTHCARE,UHC HERITAGE SELECT,538.40,,,,,,,452.6400,1753.7400,other,"30.7% of $1,753.74 in Billed Charges for Rev 272 = $538.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TROCAR CLOSURE SYSTEM FASCIAL 12MM,272,RC,27200002,CDM,,,,,,both,,,1753.7400,263.0600,UNITED HEALTHCARE,UNITED HEALTHCARE,566.46,,,,,,,452.6400,1753.7400,percent of total billed charges,"32.3% of $1,753.74 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR CLOSURE SYSTEM FASCIAL 12MM,272,RC,27200002,CDM,,,,,,both,,,1753.7400,263.0600,WELLCARE,WELLCARE MEDICAID,1753.74,,,,,,,452.6400,1753.7400,percent of total billed charges,"100% of $1,753.74 in Billed Charges for Rev 272 = $1,753.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,AETNA,AETNA,765.61,,,,,,,462.7700,3266.6300,percent of total billed charges,"42.7% of $1,793.00 in Billed Charges for Rev 361 Proc 11406 = $765.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2575.48,,,,,,,462.7700,3266.6300,fee schedule,"APG 00011 Proc 11406 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 104% = $2,575.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,462.7700,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,462.7700,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,462.7700,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,AMBETTER,AMBETTER,3266.63,,,,,,,462.7700,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,462.7700,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,BLUE CROSS,ANTHEM EXCHANGE,1793.00,,,,,,,462.7700,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1793.00,,,,,,,462.7700,3266.6300,fee schedule,"APG 00011 Proc 11406 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 103% = $2,550.71 (Service Line reduced to $1,793.00, claim capped at $1,793.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,BLUE CROSS,ANTHEM HMO,1793.00,,,,,,,462.7700,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,462.7700,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1793.00,,,,,,,462.7700,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,948.00,,,,,,,462.7700,3266.6300,case rate,Rev 361 Proc 11406 ASG Rate of $948.00 at 100% of $948.00 = $948.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,BLUE CROSS,BLUE CROSS E NETWORK,1793.00,,,,,,,462.7700,3266.6300,case rate,"Rev 361 Proc 11406 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total (Service Line reduced to $1,793.00, claim capped at $1,793.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,462.7700,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,BLUE CROSS,BLUE CROSS P NETWORK,1793.00,,,,,,,462.7700,3266.6300,case rate,"Rev 361 Proc 11406 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total (Service Line reduced to $1,793.00, claim capped at $1,793.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,BLUE CROSS,BLUE CROSS S NETWORK,1793.00,,,,,,,462.7700,3266.6300,case rate,"Rev 361 Proc 11406 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total (Service Line reduced to $1,793.00, claim capped at $1,793.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,462.7700,3266.6300,case rate,Rev 361 Proc 11406 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,462.7700,3266.6300,case rate,Rev 361 Proc 11406 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,CIGNA HEALTHCARE,CIGNA HMO,1793.00,,,,,,,462.7700,3266.6300,case rate,"Rev 361 Proc 11406 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total (Limited to $1,793.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,793.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1793.00,,,,,,,462.7700,3266.6300,case rate,"Rev 361 Proc 11406 ASG Rate of $1,956.00 at 100% of $1,956.00 = $1,956.00 Total (Limited to $1,793.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,793.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,462.7700,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1793.00,,,,,,,462.7700,3266.6300,case rate,"Rev 361 Proc 11406 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total (Limited to $1,793.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,793.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,CIGNA HEALTHCARE,CIGNA PPO,1793.00,,,,,,,462.7700,3266.6300,case rate,"Rev 361 Proc 11406 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total (Limited to $1,793.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,793.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,462.7700,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1613.70,,,,,,,462.7700,3266.6300,percent of total billed charges,"90% of $1,793.00 in Billed Charges for Rev 361 Proc 11406 = $1,613.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,462.7700,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,462.7700,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,MEDCOST,MEDCOST VHN,853.29,,,,,,,462.7700,3266.6300,percent of total billed charges,"47.59% of $1,793.00 in Billed Charges for Rev 361 Proc 11406 = $853.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2600.24,,,,,,,462.7700,3266.6300,fee schedule,"APG 00011 Proc 11406 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 100% = $2,476.42... $2,476.42 at 105% = $2,600.24 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,462.7700,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,462.7700,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,462.7700,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2553.19,,,,,,,462.7700,3266.6300,fee schedule,"APG 00011 Proc 11406 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 100% = $2,476.42... $2,476.42 at 103.1% = $2,553.19 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,SENTARA HEALTH,SENTARA HEALTH,462.77,,,,,,,462.7700,3266.6300,percent of total billed charges,"25.81% of $1,793.00 in Billed Charges for Rev 361 Proc 11406 = $462.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,462.7700,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1793.00,,,,,,,462.7700,3266.6300,percent of total billed charges,"100% of $1,793.00 in Billed Charges for Rev 361 Proc 11406 = $1,793.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,462.7700,3266.6300,case rate,Rev 361 Proc 11406 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,462.7700,3266.6300,case rate,"Rev 361 Proc 11406 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,462.7700,3266.6300,case rate,"Rev 361 Proc 11406 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,1793.00,,,,,,,462.7700,3266.6300,case rate,"Rev 361 Proc 11406 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total (Service Line reduced to $1,793.00, claim capped at $1,793.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2550.71,,,,,,,462.7700,3266.6300,fee schedule,"APG 00011 Proc 11406 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 103% = $2,550.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,462.7700,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,462.7700,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,WELLCARE,WELLCARE MEDICAID,1793.00,,,,,,,462.7700,3266.6300,percent of total billed charges,"100% of $1,793.00 in Billed Charges for Rev 361 Proc 11406 = $1,793.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION OVER 4 CM,11406,CPT,361,RC,36100047,CDM,,,,both,,,1793.0000,268.9500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,462.7700,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,AETNA,AETNA,2363.45,,,,,,,53.9500,5535.0000,percent of total billed charges,"42.7% of $5,535.00 in Billed Charges for Rev 450 Proc 15851 = $2,363.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1775.80,,,,,,,53.9500,5535.0000,fee schedule,"APG 00010 Proc 15851 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,707.50 at 104% = $1,775.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1871.96,,,,,,,53.9500,5535.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,AETNA,AETNA HEALTHCARE MEDICARE,1871.96,,,,,,,53.9500,5535.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,1871.96,,,,,,,53.9500,5535.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,AMBETTER,AMBETTER,4080.88,,,,,,,53.9500,5535.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1946.84,,,,,,,53.9500,5535.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,BLUE CROSS,ANTHEM EXCHANGE,4608.86,,,,,,,53.9500,5535.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1758.73,,,,,,,53.9500,5535.0000,fee schedule,"APG 00010 Proc 15851 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,707.50 at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,BLUE CROSS,ANTHEM HMO,4896.64,,,,,,,53.9500,5535.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1928.12,,,,,,,53.9500,5535.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5535.00,,,,,,,53.9500,5535.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,53.95,,,,,,,53.9500,5535.0000,fee schedule,$53.95 from Fee Schedule BLDTM_23 for Rev 450 Proc 15851 * Qty 1 = $53.95 at 100% = $53.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,BLUE CROSS,BLUE CROSS MEDICARE,1946.84,,,,,,,53.9500,5535.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,1965.56,,,,,,,53.9500,5535.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1965.56,,,,,,,53.9500,5535.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4981.50,,,,,,,53.9500,5535.0000,percent of total billed charges,"90% of $5,535.00 in Billed Charges for Rev 450 Proc 15851 = $4,981.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,HUMANA,HUMANA MEDICARE,1871.96,,,,,,,53.9500,5535.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1871.96,,,,,,,53.9500,5535.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,MEDCOST,MEDCOST VHN,2634.11,,,,,,,53.9500,5535.0000,percent of total billed charges,"47.59% of $5,535.00 in Billed Charges for Rev 450 Proc 15851 = $2,634.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1792.88,,,,,,,53.9500,5535.0000,fee schedule,"APG 00010 Proc 15851 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,707.50 at 100% = $1,707.50... $1,707.50 at 105% = $1,792.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1965.56,,,,,,,53.9500,5535.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1965.56,,,,,,,53.9500,5535.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,NHC ADVANTAGE,NHC ADVANTAGE,1965.56,,,,,,,53.9500,5535.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1760.43,,,,,,,53.9500,5535.0000,fee schedule,"APG 00010 Proc 15851 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,707.50 at 100% = $1,707.50... $1,707.50 at 103.1% = $1,760.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,SENTARA HEALTH,SENTARA HEALTH,1428.58,,,,,,,53.9500,5535.0000,percent of total billed charges,"25.81% of $5,535.00 in Billed Charges for Rev 450 Proc 15851 = $1,428.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,SENTARA HEALTH,SENTARA MEDICARE,1871.96,,,,,,,53.9500,5535.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5535.00,,,,,,,53.9500,5535.0000,percent of total billed charges,"100% of $5,535.00 in Billed Charges for Rev 450 Proc 15851 = $5,535.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,53.9500,5535.0000,case rate,Rev 450 Proc 15851 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,53.9500,5535.0000,case rate,Rev 450 Proc 15851 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,53.9500,5535.0000,case rate,Rev 450 Proc 15851 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,53.9500,5535.0000,case rate,Rev 450 Proc 15851 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1758.73,,,,,,,53.9500,5535.0000,fee schedule,"APG 00010 Proc 15851 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,707.50 at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1871.96,,,,,,,53.9500,5535.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1871.96,,,,,,,53.9500,5535.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,WELLCARE,WELLCARE MEDICAID,5535.00,,,,,,,53.9500,5535.0000,percent of total billed charges,"100% of $5,535.00 in Billed Charges for Rev 450 Proc 15851 = $5,535.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL SUTURES/STAPLES REQUIRING ANES,15851,CPT,450,RC,45000411,CDM,,,,both,,,5535.0000,830.2500,WELLCARE,WELLCARE MEDICARE,1984.28,,,,,,,53.9500,5535.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HB REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA,15854,CPT,450,RC,45000412,CDM,,,,both,,,634.0000,95.1000,AETNA,AETNA,270.72,,,,,,,109.0000,634.0000,percent of total billed charges,42.7% of $634.00 in Billed Charges for Rev 450 Proc 15854 = $270.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HB REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA,15854,CPT,450,RC,45000412,CDM,,,,both,,,634.0000,95.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,443.80,,,,,,,109.0000,634.0000,percent of total billed charges,Rev 450 Proc 15854 $634.00 in Billed Charges at 70% = $443.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HB REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA,15854,CPT,450,RC,45000412,CDM,,,,both,,,634.0000,95.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,570.60,,,,,,,109.0000,634.0000,percent of total billed charges,90% of $634.00 in Billed Charges for Rev 450 Proc 15854 = $570.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HB REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA,15854,CPT,450,RC,45000412,CDM,,,,both,,,634.0000,95.1000,MEDCOST,MEDCOST VHN,301.72,,,,,,,109.0000,634.0000,percent of total billed charges,47.59% of $634.00 in Billed Charges for Rev 450 Proc 15854 = $301.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HB REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA,15854,CPT,450,RC,45000412,CDM,,,,both,,,634.0000,95.1000,SENTARA HEALTH,SENTARA HEALTH,163.64,,,,,,,109.0000,634.0000,percent of total billed charges,25.81% of $634.00 in Billed Charges for Rev 450 Proc 15854 = $163.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HB REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA,15854,CPT,450,RC,45000412,CDM,,,,both,,,634.0000,95.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",634.00,,,,,,,109.0000,634.0000,percent of total billed charges,100% of $634.00 in Billed Charges for Rev 450 Proc 15854 = $634.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HB REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA,15854,CPT,450,RC,45000412,CDM,,,,both,,,634.0000,95.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,634.0000,case rate,Rev 450 Proc 15854 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HB REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA,15854,CPT,450,RC,45000412,CDM,,,,both,,,634.0000,95.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,634.0000,case rate,Rev 450 Proc 15854 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HB REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA,15854,CPT,450,RC,45000412,CDM,,,,both,,,634.0000,95.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,634.0000,case rate,Rev 450 Proc 15854 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HB REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA,15854,CPT,450,RC,45000412,CDM,,,,both,,,634.0000,95.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,634.00,,,,,,,109.0000,634.0000,case rate,"Rev 450 Proc 15854 at Case Rate $847.00 (Service Line reduced to $634.00, claim capped at $634.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HB REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA,15854,CPT,450,RC,45000412,CDM,,,,both,,,634.0000,95.1000,WELLCARE,WELLCARE MEDICAID,634.00,,,,,,,109.0000,634.0000,percent of total billed charges,100% of $634.00 in Billed Charges for Rev 450 Proc 15854 = $634.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,AETNA,AETNA,185.75,,,,,,,51.9400,435.0000,percent of total billed charges,42.7% of $435.00 in Billed Charges for Rev 450 Proc 16000 = $185.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,272.07,,,,,,,51.9400,435.0000,fee schedule,"APG 00016 Proc 16000 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 104% = $272.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,51.9400,435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,51.9400,435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,51.9400,435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,AMBETTER,AMBETTER,396.83,,,,,,,51.9400,435.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,51.9400,435.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,BLUE CROSS,ANTHEM EXCHANGE,435.00,,,,,,,51.9400,435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,269.45,,,,,,,51.9400,435.0000,fee schedule,"APG 00016 Proc 16000 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,BLUE CROSS,ANTHEM HMO,435.00,,,,,,,51.9400,435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,51.9400,435.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",435.00,,,,,,,51.9400,435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,51.94,,,,,,,51.9400,435.0000,fee schedule,$51.94 from Fee Schedule BLDTM_23 for Rev 450 Proc 16000 * Qty 1 = $51.94 at 100% = $51.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,51.9400,435.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,51.9400,435.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,51.9400,435.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,391.50,,,,,,,51.9400,435.0000,percent of total billed charges,90% of $435.00 in Billed Charges for Rev 450 Proc 16000 = $391.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,51.9400,435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,51.9400,435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,MEDCOST,MEDCOST VHN,207.02,,,,,,,51.9400,435.0000,percent of total billed charges,47.59% of $435.00 in Billed Charges for Rev 450 Proc 16000 = $207.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,274.68,,,,,,,51.9400,435.0000,fee schedule,"APG 00016 Proc 16000 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 105% = $274.68 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,51.9400,435.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,51.9400,435.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,51.9400,435.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,269.71,,,,,,,51.9400,435.0000,fee schedule,"APG 00016 Proc 16000 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 103.1% = $269.71 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,SENTARA HEALTH,SENTARA HEALTH,112.27,,,,,,,51.9400,435.0000,percent of total billed charges,25.81% of $435.00 in Billed Charges for Rev 450 Proc 16000 = $112.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,51.9400,435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",435.00,,,,,,,51.9400,435.0000,percent of total billed charges,100% of $435.00 in Billed Charges for Rev 450 Proc 16000 = $435.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,51.9400,435.0000,case rate,Rev 450 Proc 16000 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,435.00,,,,,,,51.9400,435.0000,case rate,"Rev 450 Proc 16000 at Case Rate $491.00 (Service Line reduced to $435.00, claim capped at $435.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,435.00,,,,,,,51.9400,435.0000,case rate,"Rev 450 Proc 16000 at Case Rate $471.00 (Service Line reduced to $435.00, claim capped at $435.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,435.00,,,,,,,51.9400,435.0000,case rate,"Rev 450 Proc 16000 at Case Rate $847.00 (Service Line reduced to $435.00, claim capped at $435.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,269.45,,,,,,,51.9400,435.0000,fee schedule,"APG 00016 Proc 16000 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,51.9400,435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,51.9400,435.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,WELLCARE,WELLCARE MEDICAID,435.00,,,,,,,51.9400,435.0000,percent of total billed charges,100% of $435.00 in Billed Charges for Rev 450 Proc 16000 = $435.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INIT TX 1ST DEGR BURN LOCAL,16000,CPT,450,RC,45000078,CDM,,,,both,,,435.0000,65.2500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,51.9400,435.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,AETNA,AETNA,216.06,,,,,,,21.9700,506.0000,percent of total billed charges,42.7% of $506.00 in Billed Charges for Rev 450 Proc 16020 = $216.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,272.07,,,,,,,21.9700,506.0000,fee schedule,"APG 00016 Proc 16020 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 104% = $272.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,21.9700,506.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,21.9700,506.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,21.9700,506.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,AMBETTER,AMBETTER,396.83,,,,,,,21.9700,506.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,21.9700,506.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,21.9700,506.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,269.45,,,,,,,21.9700,506.0000,fee schedule,"APG 00016 Proc 16020 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,21.9700,506.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,21.9700,506.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",506.00,,,,,,,21.9700,506.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,52.10,,,,,,,21.9700,506.0000,fee schedule,$52.10 from Fee Schedule BLDTM_23 for Rev 450 Proc 16020 * Qty 1 = $52.10 at 100% = $52.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,21.9700,506.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,BLUE CROSS,TENNCARE BLUE CARE,21.97,,,,,,,21.9700,506.0000,fee schedule,$18.94 from Fee Schedule TC_24 for Rev 450 Proc 16020 * Qty 1 = $18.94 at 116% = $21.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,BLUE CROSS,TENNCARE BLUE SELECT,21.97,,,,,,,21.9700,506.0000,fee schedule,$18.94 from Fee Schedule TC_24 for Rev 450 Proc 16020 * Qty 1 = $18.94 at 116% = $21.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,21.9700,506.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,21.9700,506.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,455.40,,,,,,,21.9700,506.0000,percent of total billed charges,90% of $506.00 in Billed Charges for Rev 450 Proc 16020 = $455.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,HUMANA,HUMANA MEDICARE,182.03,,,,,,,21.9700,506.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,21.9700,506.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,MEDCOST,MEDCOST VHN,240.81,,,,,,,21.9700,506.0000,percent of total billed charges,47.59% of $506.00 in Billed Charges for Rev 450 Proc 16020 = $240.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,274.68,,,,,,,21.9700,506.0000,fee schedule,"APG 00016 Proc 16020 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 105% = $274.68 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,21.9700,506.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,21.9700,506.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,21.9700,506.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,269.71,,,,,,,21.9700,506.0000,fee schedule,"APG 00016 Proc 16020 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 103.1% = $269.71 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,SENTARA HEALTH,SENTARA HEALTH,130.60,,,,,,,21.9700,506.0000,percent of total billed charges,25.81% of $506.00 in Billed Charges for Rev 450 Proc 16020 = $130.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,21.9700,506.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",506.00,,,,,,,21.9700,506.0000,percent of total billed charges,100% of $506.00 in Billed Charges for Rev 450 Proc 16020 = $506.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,21.9700,506.0000,case rate,Rev 450 Proc 16020 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,21.9700,506.0000,case rate,Rev 450 Proc 16020 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,21.9700,506.0000,case rate,Rev 450 Proc 16020 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,506.00,,,,,,,21.9700,506.0000,case rate,"Rev 450 Proc 16020 at Case Rate $847.00 (Service Line reduced to $506.00, claim capped at $506.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,269.45,,,,,,,21.9700,506.0000,fee schedule,"APG 00016 Proc 16020 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,21.9700,506.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,21.9700,506.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,WELLCARE,WELLCARE MEDICAID,506.00,,,,,,,21.9700,506.0000,percent of total billed charges,100% of $506.00 in Billed Charges for Rev 450 Proc 16020 = $506.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DSG DEBRID INIT SUBS SM <5%,16020,CPT,450,RC,45000079,CDM,,,,both,,,506.0000,75.9000,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,21.9700,506.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,AETNA,AETNA,290.36,,,,,,,109.0000,804.0300,percent of total billed charges,42.7% of $680.00 in Billed Charges for Rev 450 Proc 16030 = $290.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,109.0000,804.0300,fee schedule,"APG 00017 Proc 16030 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,109.0000,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,109.0000,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,AMBETTER,AMBETTER,804.03,,,,,,,109.0000,804.0300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,109.0000,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,BLUE CROSS,ANTHEM EXCHANGE,680.00,,,,,,,109.0000,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,555.45,,,,,,,109.0000,804.0300,fee schedule,"APG 00017 Proc 16030 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,BLUE CROSS,ANTHEM HMO,680.00,,,,,,,109.0000,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,109.0000,804.0300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",680.00,,,,,,,109.0000,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,115.32,,,,,,,109.0000,804.0300,fee schedule,$115.32 from Fee Schedule BLDTM_23 for Rev 450 Proc 16030 * Qty 1 = $115.32 at 100% = $115.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,109.0000,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,109.0000,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,109.0000,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,612.00,,,,,,,109.0000,804.0300,percent of total billed charges,90% of $680.00 in Billed Charges for Rev 450 Proc 16030 = $612.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,HUMANA,HUMANA MEDICARE,368.82,,,,,,,109.0000,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,109.0000,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,MEDCOST,MEDCOST VHN,323.61,,,,,,,109.0000,804.0300,percent of total billed charges,47.59% of $680.00 in Billed Charges for Rev 450 Proc 16030 = $323.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,109.0000,804.0300,fee schedule,"APG 00017 Proc 16030 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,109.0000,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,109.0000,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,109.0000,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,109.0000,804.0300,fee schedule,"APG 00017 Proc 16030 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,SENTARA HEALTH,SENTARA HEALTH,175.51,,,,,,,109.0000,804.0300,percent of total billed charges,25.81% of $680.00 in Billed Charges for Rev 450 Proc 16030 = $175.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,109.0000,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",680.00,,,,,,,109.0000,804.0300,percent of total billed charges,100% of $680.00 in Billed Charges for Rev 450 Proc 16030 = $680.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,804.0300,case rate,Rev 450 Proc 16030 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,804.0300,case rate,Rev 450 Proc 16030 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,804.0300,case rate,Rev 450 Proc 16030 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,680.00,,,,,,,109.0000,804.0300,case rate,"Rev 450 Proc 16030 at Case Rate $847.00 (Service Line reduced to $680.00, claim capped at $680.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,109.0000,804.0300,fee schedule,"APG 00017 Proc 16030 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,109.0000,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,109.0000,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,WELLCARE,WELLCARE MEDICAID,680.00,,,,,,,109.0000,804.0300,percent of total billed charges,100% of $680.00 in Billed Charges for Rev 450 Proc 16030 = $680.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DSG DEBR INIT SUBS LG >10%,16030,CPT,450,RC,45000081,CDM,,,,both,,,680.0000,102.0000,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,109.0000,804.0300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,AETNA,AETNA,283.53,,,,,,,20.4000,664.0000,percent of total billed charges,42.7% of $664.00 in Billed Charges for Rev 510 Proc 17000 = $283.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,20.4000,664.0000,fee schedule,"APG 00003 Proc 17000 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,20.4000,664.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,20.4000,664.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,20.4000,664.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,AMBETTER,AMBETTER,396.83,,,,,,,20.4000,664.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,20.4000,664.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,20.4000,664.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,20.4000,664.0000,fee schedule,"APG 00003 Proc 17000 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,20.4000,664.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,20.4000,664.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",560.15,,,,,,,20.4000,664.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,44.48,,,,,,,20.4000,664.0000,fee schedule,$44.48 from Fee Schedule BLDTM_23 for Rev 510 Proc 17000 * Qty 1 = $44.48 at 100% = $44.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,20.4000,664.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,BLUE CROSS,TENNCARE BLUE CARE,20.40,,,,,,,20.4000,664.0000,fee schedule,$17.59 from Fee Schedule TC_24 for Rev 510 Proc 17000 * Qty 1 = $17.59 at 116% = $20.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,BLUE CROSS,TENNCARE BLUE SELECT,20.40,,,,,,,20.4000,664.0000,fee schedule,$17.59 from Fee Schedule TC_24 for Rev 510 Proc 17000 * Qty 1 = $17.59 at 116% = $20.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,CIGNA HEALTHCARE,CIGNA HMO,276.89,,,,,,,20.4000,664.0000,percent of total billed charges,41.7% of $664.00 in Billed Charges for Rev 510 Proc 17000 = $276.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,308.10,,,,,,,20.4000,664.0000,percent of total billed charges,46.4% of $664.00 in Billed Charges for Rev 510 Proc 17000 = $308.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,20.4000,664.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,276.89,,,,,,,20.4000,664.0000,percent of total billed charges,41.7% of $664.00 in Billed Charges for Rev 510 Proc 17000 = $276.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,CIGNA HEALTHCARE,CIGNA PPO,276.89,,,,,,,20.4000,664.0000,percent of total billed charges,41.7% of $664.00 in Billed Charges for Rev 510 Proc 17000 = $276.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,20.4000,664.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,597.60,,,,,,,20.4000,664.0000,percent of total billed charges,90% of $664.00 in Billed Charges for Rev 510 Proc 17000 = $597.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,HUMANA,HUMANA MEDICARE,182.03,,,,,,,20.4000,664.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,20.4000,664.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,MEDCOST,MEDCOST VHN,316.00,,,,,,,20.4000,664.0000,percent of total billed charges,47.59% of $664.00 in Billed Charges for Rev 510 Proc 17000 = $316.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,20.4000,664.0000,fee schedule,"APG 00003 Proc 17000 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,20.4000,664.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,20.4000,664.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,20.4000,664.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,20.4000,664.0000,fee schedule,"APG 00003 Proc 17000 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,SENTARA HEALTH,SENTARA HEALTH,171.38,,,,,,,20.4000,664.0000,percent of total billed charges,25.81% of $664.00 in Billed Charges for Rev 510 Proc 17000 = $171.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,20.4000,664.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",664.00,,,,,,,20.4000,664.0000,percent of total billed charges,100% of $664.00 in Billed Charges for Rev 510 Proc 17000 = $664.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,20.4000,664.0000,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 510 Proc 17000 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,214.47,,,,,,,20.4000,664.0000,other,32.3% of $664.00 in Billed Charges for Rev 510 Proc 17000 = $214.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,203.85,,,,,,,20.4000,664.0000,other,30.7% of $664.00 in Billed Charges for Rev 510 Proc 17000 = $203.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,214.47,,,,,,,20.4000,664.0000,percent of total billed charges,32.3% of $664.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,20.4000,664.0000,fee schedule,"APG 00003 Proc 17000 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,20.4000,664.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,20.4000,664.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,WELLCARE,WELLCARE MEDICAID,664.00,,,,,,,20.4000,664.0000,percent of total billed charges,100% of $664.00 in Billed Charges for Rev 510 Proc 17000 = $664.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION PREMALIGNANT LESION FIRST LESION,17000,CPT,510,RC,51000067,CDM,,,,both,,,664.0000,99.6000,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,20.4000,664.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 2-14 EA,17003,CPT,521,RC,52100002,CDM,,,,both,,,184.0000,27.6000,AETNA,AETNA,78.57,,,,,,,15.3100,252.2800,percent of total billed charges,42.7% of $184.00 in Billed Charges for Rev 521 Proc 17003 = $78.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION PREMALIGNANT LESION 2-14 EA,17003,CPT,521,RC,52100002,CDM,,,,both,,,184.0000,27.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,15.3100,252.2800,fee schedule,APG 00003 Proc 17003 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 2-14 EA,17003,CPT,521,RC,52100002,CDM,,,,both,,,184.0000,27.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,184.00,,,,,,,15.3100,252.2800,fee schedule,"APG 00003 Proc 17003 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 103% = $247.48 (Service Line reduced to $184.00, claim capped at $184.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCTION PREMALIGNANT LESION 2-14 EA,17003,CPT,521,RC,52100002,CDM,,,,both,,,184.0000,27.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,15.31,,,,,,,15.3100,252.2800,fee schedule,$15.31 from Fee Schedule BLDTM_23 for Rev 521 Proc 17003 * Qty 1 = $15.31 at 100% = $15.31 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 2-14 EA,17003,CPT,521,RC,52100002,CDM,,,,both,,,184.0000,27.6000,CIGNA HEALTHCARE,CIGNA HMO,76.73,,,,,,,15.3100,252.2800,percent of total billed charges,41.7% of $184.00 in Billed Charges for Rev 521 Proc 17003 = $76.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION PREMALIGNANT LESION 2-14 EA,17003,CPT,521,RC,52100002,CDM,,,,both,,,184.0000,27.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,85.38,,,,,,,15.3100,252.2800,percent of total billed charges,46.4% of $184.00 in Billed Charges for Rev 521 Proc 17003 = $85.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION PREMALIGNANT LESION 2-14 EA,17003,CPT,521,RC,52100002,CDM,,,,both,,,184.0000,27.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,76.73,,,,,,,15.3100,252.2800,percent of total billed charges,41.7% of $184.00 in Billed Charges for Rev 521 Proc 17003 = $76.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION PREMALIGNANT LESION 2-14 EA,17003,CPT,521,RC,52100002,CDM,,,,both,,,184.0000,27.6000,CIGNA HEALTHCARE,CIGNA PPO,76.73,,,,,,,15.3100,252.2800,percent of total billed charges,41.7% of $184.00 in Billed Charges for Rev 521 Proc 17003 = $76.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION PREMALIGNANT LESION 2-14 EA,17003,CPT,521,RC,52100002,CDM,,,,both,,,184.0000,27.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,165.60,,,,,,,15.3100,252.2800,percent of total billed charges,90% of $184.00 in Billed Charges for Rev 521 Proc 17003 = $165.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION PREMALIGNANT LESION 2-14 EA,17003,CPT,521,RC,52100002,CDM,,,,both,,,184.0000,27.6000,MEDCOST,MEDCOST VHN,87.57,,,,,,,15.3100,252.2800,percent of total billed charges,47.59% of $184.00 in Billed Charges for Rev 521 Proc 17003 = $87.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION PREMALIGNANT LESION 2-14 EA,17003,CPT,521,RC,52100002,CDM,,,,both,,,184.0000,27.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,15.3100,252.2800,fee schedule,APG 00003 Proc 17003 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 2-14 EA,17003,CPT,521,RC,52100002,CDM,,,,both,,,184.0000,27.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,15.3100,252.2800,fee schedule,APG 00003 Proc 17003 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 2-14 EA,17003,CPT,521,RC,52100002,CDM,,,,both,,,184.0000,27.6000,SENTARA HEALTH,SENTARA HEALTH,47.49,,,,,,,15.3100,252.2800,percent of total billed charges,25.81% of $184.00 in Billed Charges for Rev 521 Proc 17003 = $47.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION PREMALIGNANT LESION 2-14 EA,17003,CPT,521,RC,52100002,CDM,,,,both,,,184.0000,27.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",184.00,,,,,,,15.3100,252.2800,percent of total billed charges,100% of $184.00 in Billed Charges for Rev 521 Proc 17003 = $184.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION PREMALIGNANT LESION 2-14 EA,17003,CPT,521,RC,52100002,CDM,,,,both,,,184.0000,27.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,15.3100,252.2800,fee schedule,APG 00003 Proc 17003 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment) at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 2-14 EA,17003,CPT,521,RC,52100002,CDM,,,,both,,,184.0000,27.6000,WELLCARE,WELLCARE MEDICAID,184.00,,,,,,,15.3100,252.2800,percent of total billed charges,100% of $184.00 in Billed Charges for Rev 521 Proc 17003 = $184.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR FOR NAILS 8-13MM LONG,272,RC,27200002,CDM,,,,,,both,,,1030.5700,154.5900,AETNA,AETNA,440.05,,,,,,,265.9900,1030.5700,percent of total billed charges,"42.7% of $1,030.57 in Billed Charges for Rev 272 = $440.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR FOR NAILS 8-13MM LONG,272,RC,27200002,CDM,,,,,,both,,,1030.5700,154.5900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,721.40,,,,,,,265.9900,1030.5700,percent of total billed charges,"Rev 272 $1,030.57 in Billed Charges at 70% = $721.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR FOR NAILS 8-13MM LONG,272,RC,27200002,CDM,,,,,,both,,,1030.5700,154.5900,CIGNA HEALTHCARE,CIGNA HMO,429.75,,,,,,,265.9900,1030.5700,percent of total billed charges,"41.7% of $1,030.57 in Billed Charges for Rev 272 = $429.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR FOR NAILS 8-13MM LONG,272,RC,27200002,CDM,,,,,,both,,,1030.5700,154.5900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,478.18,,,,,,,265.9900,1030.5700,percent of total billed charges,"46.4% of $1,030.57 in Billed Charges for Rev 272 = $478.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR FOR NAILS 8-13MM LONG,272,RC,27200002,CDM,,,,,,both,,,1030.5700,154.5900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,429.75,,,,,,,265.9900,1030.5700,percent of total billed charges,"41.7% of $1,030.57 in Billed Charges for Rev 272 = $429.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR FOR NAILS 8-13MM LONG,272,RC,27200002,CDM,,,,,,both,,,1030.5700,154.5900,CIGNA HEALTHCARE,CIGNA PPO,429.75,,,,,,,265.9900,1030.5700,percent of total billed charges,"41.7% of $1,030.57 in Billed Charges for Rev 272 = $429.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR FOR NAILS 8-13MM LONG,272,RC,27200002,CDM,,,,,,both,,,1030.5700,154.5900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,927.51,,,,,,,265.9900,1030.5700,percent of total billed charges,"90% of $1,030.57 in Billed Charges for Rev 272 = $927.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR FOR NAILS 8-13MM LONG,272,RC,27200002,CDM,,,,,,both,,,1030.5700,154.5900,MEDCOST,MEDCOST VHN,490.45,,,,,,,265.9900,1030.5700,percent of total billed charges,"47.59% of $1,030.57 in Billed Charges for Rev 272 = $490.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR FOR NAILS 8-13MM LONG,272,RC,27200002,CDM,,,,,,both,,,1030.5700,154.5900,SENTARA HEALTH,SENTARA HEALTH,265.99,,,,,,,265.9900,1030.5700,percent of total billed charges,"25.81% of $1,030.57 in Billed Charges for Rev 272 = $265.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR FOR NAILS 8-13MM LONG,272,RC,27200002,CDM,,,,,,both,,,1030.5700,154.5900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1030.57,,,,,,,265.9900,1030.5700,percent of total billed charges,"100% of $1,030.57 in Billed Charges for Rev 272 = $1,030.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR FOR NAILS 8-13MM LONG,272,RC,27200002,CDM,,,,,,both,,,1030.5700,154.5900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,515.29,,,,,,,265.9900,1030.5700,percent of total billed charges,"Rev 272 $1,030.57 in Billed Charges at 50% = $515.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR FOR NAILS 8-13MM LONG,272,RC,27200002,CDM,,,,,,both,,,1030.5700,154.5900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,332.87,,,,,,,265.9900,1030.5700,other,"32.3% of $1,030.57 in Billed Charges for Rev 272 = $332.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TROCAR FOR NAILS 8-13MM LONG,272,RC,27200002,CDM,,,,,,both,,,1030.5700,154.5900,UNITED HEALTHCARE,UHC HERITAGE SELECT,316.39,,,,,,,265.9900,1030.5700,other,"30.7% of $1,030.57 in Billed Charges for Rev 272 = $316.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TROCAR FOR NAILS 8-13MM LONG,272,RC,27200002,CDM,,,,,,both,,,1030.5700,154.5900,UNITED HEALTHCARE,UNITED HEALTHCARE,332.87,,,,,,,265.9900,1030.5700,percent of total billed charges,"32.3% of $1,030.57 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR FOR NAILS 8-13MM LONG,272,RC,27200002,CDM,,,,,,both,,,1030.5700,154.5900,WELLCARE,WELLCARE MEDICAID,1030.57,,,,,,,265.9900,1030.5700,percent of total billed charges,"100% of $1,030.57 in Billed Charges for Rev 272 = $1,030.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR NAILS 8-11MM LONG,272,RC,27200002,CDM,,,,,,both,,,1021.5400,153.2300,AETNA,AETNA,436.20,,,,,,,263.6600,1021.5400,percent of total billed charges,"42.7% of $1,021.54 in Billed Charges for Rev 272 = $436.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR NAILS 8-11MM LONG,272,RC,27200002,CDM,,,,,,both,,,1021.5400,153.2300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,715.08,,,,,,,263.6600,1021.5400,percent of total billed charges,"Rev 272 $1,021.54 in Billed Charges at 70% = $715.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR NAILS 8-11MM LONG,272,RC,27200002,CDM,,,,,,both,,,1021.5400,153.2300,CIGNA HEALTHCARE,CIGNA HMO,425.98,,,,,,,263.6600,1021.5400,percent of total billed charges,"41.7% of $1,021.54 in Billed Charges for Rev 272 = $425.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR NAILS 8-11MM LONG,272,RC,27200002,CDM,,,,,,both,,,1021.5400,153.2300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,473.99,,,,,,,263.6600,1021.5400,percent of total billed charges,"46.4% of $1,021.54 in Billed Charges for Rev 272 = $473.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR NAILS 8-11MM LONG,272,RC,27200002,CDM,,,,,,both,,,1021.5400,153.2300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,425.98,,,,,,,263.6600,1021.5400,percent of total billed charges,"41.7% of $1,021.54 in Billed Charges for Rev 272 = $425.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR NAILS 8-11MM LONG,272,RC,27200002,CDM,,,,,,both,,,1021.5400,153.2300,CIGNA HEALTHCARE,CIGNA PPO,425.98,,,,,,,263.6600,1021.5400,percent of total billed charges,"41.7% of $1,021.54 in Billed Charges for Rev 272 = $425.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR NAILS 8-11MM LONG,272,RC,27200002,CDM,,,,,,both,,,1021.5400,153.2300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,919.39,,,,,,,263.6600,1021.5400,percent of total billed charges,"90% of $1,021.54 in Billed Charges for Rev 272 = $919.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR NAILS 8-11MM LONG,272,RC,27200002,CDM,,,,,,both,,,1021.5400,153.2300,MEDCOST,MEDCOST VHN,486.15,,,,,,,263.6600,1021.5400,percent of total billed charges,"47.59% of $1,021.54 in Billed Charges for Rev 272 = $486.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR NAILS 8-11MM LONG,272,RC,27200002,CDM,,,,,,both,,,1021.5400,153.2300,SENTARA HEALTH,SENTARA HEALTH,263.66,,,,,,,263.6600,1021.5400,percent of total billed charges,"25.81% of $1,021.54 in Billed Charges for Rev 272 = $263.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR NAILS 8-11MM LONG,272,RC,27200002,CDM,,,,,,both,,,1021.5400,153.2300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1021.54,,,,,,,263.6600,1021.5400,percent of total billed charges,"100% of $1,021.54 in Billed Charges for Rev 272 = $1,021.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR NAILS 8-11MM LONG,272,RC,27200002,CDM,,,,,,both,,,1021.5400,153.2300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,510.77,,,,,,,263.6600,1021.5400,percent of total billed charges,"Rev 272 $1,021.54 in Billed Charges at 50% = $510.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR NAILS 8-11MM LONG,272,RC,27200002,CDM,,,,,,both,,,1021.5400,153.2300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,329.96,,,,,,,263.6600,1021.5400,other,"32.3% of $1,021.54 in Billed Charges for Rev 272 = $329.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TROCAR NAILS 8-11MM LONG,272,RC,27200002,CDM,,,,,,both,,,1021.5400,153.2300,UNITED HEALTHCARE,UHC HERITAGE SELECT,313.61,,,,,,,263.6600,1021.5400,other,"30.7% of $1,021.54 in Billed Charges for Rev 272 = $313.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TROCAR NAILS 8-11MM LONG,272,RC,27200002,CDM,,,,,,both,,,1021.5400,153.2300,UNITED HEALTHCARE,UNITED HEALTHCARE,329.96,,,,,,,263.6600,1021.5400,percent of total billed charges,"32.3% of $1,021.54 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR NAILS 8-11MM LONG,272,RC,27200002,CDM,,,,,,both,,,1021.5400,153.2300,WELLCARE,WELLCARE MEDICAID,1021.54,,,,,,,263.6600,1021.5400,percent of total billed charges,"100% of $1,021.54 in Billed Charges for Rev 272 = $1,021.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR PERITONEAL DIALYS CATH,272,RC,27200002,CDM,,,,,,both,,,1361.6100,204.2400,AETNA,AETNA,581.41,,,,,,,351.4300,1361.6100,percent of total billed charges,"42.7% of $1,361.61 in Billed Charges for Rev 272 = $581.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR PERITONEAL DIALYS CATH,272,RC,27200002,CDM,,,,,,both,,,1361.6100,204.2400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,953.13,,,,,,,351.4300,1361.6100,percent of total billed charges,"Rev 272 $1,361.61 in Billed Charges at 70% = $953.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR PERITONEAL DIALYS CATH,272,RC,27200002,CDM,,,,,,both,,,1361.6100,204.2400,CIGNA HEALTHCARE,CIGNA HMO,567.79,,,,,,,351.4300,1361.6100,percent of total billed charges,"41.7% of $1,361.61 in Billed Charges for Rev 272 = $567.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR PERITONEAL DIALYS CATH,272,RC,27200002,CDM,,,,,,both,,,1361.6100,204.2400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,631.79,,,,,,,351.4300,1361.6100,percent of total billed charges,"46.4% of $1,361.61 in Billed Charges for Rev 272 = $631.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR PERITONEAL DIALYS CATH,272,RC,27200002,CDM,,,,,,both,,,1361.6100,204.2400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,567.79,,,,,,,351.4300,1361.6100,percent of total billed charges,"41.7% of $1,361.61 in Billed Charges for Rev 272 = $567.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR PERITONEAL DIALYS CATH,272,RC,27200002,CDM,,,,,,both,,,1361.6100,204.2400,CIGNA HEALTHCARE,CIGNA PPO,567.79,,,,,,,351.4300,1361.6100,percent of total billed charges,"41.7% of $1,361.61 in Billed Charges for Rev 272 = $567.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR PERITONEAL DIALYS CATH,272,RC,27200002,CDM,,,,,,both,,,1361.6100,204.2400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1225.45,,,,,,,351.4300,1361.6100,percent of total billed charges,"90% of $1,361.61 in Billed Charges for Rev 272 = $1,225.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR PERITONEAL DIALYS CATH,272,RC,27200002,CDM,,,,,,both,,,1361.6100,204.2400,MEDCOST,MEDCOST VHN,647.99,,,,,,,351.4300,1361.6100,percent of total billed charges,"47.59% of $1,361.61 in Billed Charges for Rev 272 = $647.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR PERITONEAL DIALYS CATH,272,RC,27200002,CDM,,,,,,both,,,1361.6100,204.2400,SENTARA HEALTH,SENTARA HEALTH,351.43,,,,,,,351.4300,1361.6100,percent of total billed charges,"25.81% of $1,361.61 in Billed Charges for Rev 272 = $351.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR PERITONEAL DIALYS CATH,272,RC,27200002,CDM,,,,,,both,,,1361.6100,204.2400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1361.61,,,,,,,351.4300,1361.6100,percent of total billed charges,"100% of $1,361.61 in Billed Charges for Rev 272 = $1,361.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR PERITONEAL DIALYS CATH,272,RC,27200002,CDM,,,,,,both,,,1361.6100,204.2400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,680.81,,,,,,,351.4300,1361.6100,percent of total billed charges,"Rev 272 $1,361.61 in Billed Charges at 50% = $680.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR PERITONEAL DIALYS CATH,272,RC,27200002,CDM,,,,,,both,,,1361.6100,204.2400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,439.80,,,,,,,351.4300,1361.6100,other,"32.3% of $1,361.61 in Billed Charges for Rev 272 = $439.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TROCAR PERITONEAL DIALYS CATH,272,RC,27200002,CDM,,,,,,both,,,1361.6100,204.2400,UNITED HEALTHCARE,UHC HERITAGE SELECT,418.01,,,,,,,351.4300,1361.6100,other,"30.7% of $1,361.61 in Billed Charges for Rev 272 = $418.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TROCAR PERITONEAL DIALYS CATH,272,RC,27200002,CDM,,,,,,both,,,1361.6100,204.2400,UNITED HEALTHCARE,UNITED HEALTHCARE,439.80,,,,,,,351.4300,1361.6100,percent of total billed charges,"32.3% of $1,361.61 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR PERITONEAL DIALYS CATH,272,RC,27200002,CDM,,,,,,both,,,1361.6100,204.2400,WELLCARE,WELLCARE MEDICAID,1361.61,,,,,,,351.4300,1361.6100,percent of total billed charges,"100% of $1,361.61 in Billed Charges for Rev 272 = $1,361.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR RESPOSABLE 10/11MM,272,RC,,,,,,,,both,,,132.6600,19.9000,AETNA,AETNA,56.65,,,,,,,34.2400,132.6600,percent of total billed charges,42.7% of $132.66 in Billed Charges for Rev 272 = $56.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR RESPOSABLE 10/11MM,272,RC,,,,,,,,both,,,132.6600,19.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,92.86,,,,,,,34.2400,132.6600,percent of total billed charges,Rev 272 $132.66 in Billed Charges at 70% = $92.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR RESPOSABLE 10/11MM,272,RC,,,,,,,,both,,,132.6600,19.9000,CIGNA HEALTHCARE,CIGNA HMO,55.32,,,,,,,34.2400,132.6600,percent of total billed charges,41.7% of $132.66 in Billed Charges for Rev 272 = $55.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR RESPOSABLE 10/11MM,272,RC,,,,,,,,both,,,132.6600,19.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,61.55,,,,,,,34.2400,132.6600,percent of total billed charges,46.4% of $132.66 in Billed Charges for Rev 272 = $61.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR RESPOSABLE 10/11MM,272,RC,,,,,,,,both,,,132.6600,19.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,55.32,,,,,,,34.2400,132.6600,percent of total billed charges,41.7% of $132.66 in Billed Charges for Rev 272 = $55.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR RESPOSABLE 10/11MM,272,RC,,,,,,,,both,,,132.6600,19.9000,CIGNA HEALTHCARE,CIGNA PPO,55.32,,,,,,,34.2400,132.6600,percent of total billed charges,41.7% of $132.66 in Billed Charges for Rev 272 = $55.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR RESPOSABLE 10/11MM,272,RC,,,,,,,,both,,,132.6600,19.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,119.39,,,,,,,34.2400,132.6600,percent of total billed charges,90% of $132.66 in Billed Charges for Rev 272 = $119.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR RESPOSABLE 10/11MM,272,RC,,,,,,,,both,,,132.6600,19.9000,MEDCOST,MEDCOST VHN,63.13,,,,,,,34.2400,132.6600,percent of total billed charges,47.59% of $132.66 in Billed Charges for Rev 272 = $63.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR RESPOSABLE 10/11MM,272,RC,,,,,,,,both,,,132.6600,19.9000,SENTARA HEALTH,SENTARA HEALTH,34.24,,,,,,,34.2400,132.6600,percent of total billed charges,25.81% of $132.66 in Billed Charges for Rev 272 = $34.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR RESPOSABLE 10/11MM,272,RC,,,,,,,,both,,,132.6600,19.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",132.66,,,,,,,34.2400,132.6600,percent of total billed charges,100% of $132.66 in Billed Charges for Rev 272 = $132.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR RESPOSABLE 10/11MM,272,RC,,,,,,,,both,,,132.6600,19.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,66.33,,,,,,,34.2400,132.6600,percent of total billed charges,Rev 272 $132.66 in Billed Charges at 50% = $66.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR RESPOSABLE 10/11MM,272,RC,,,,,,,,both,,,132.6600,19.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,42.85,,,,,,,34.2400,132.6600,other,32.3% of $132.66 in Billed Charges for Rev 272 = $42.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TROCAR RESPOSABLE 10/11MM,272,RC,,,,,,,,both,,,132.6600,19.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,40.73,,,,,,,34.2400,132.6600,other,30.7% of $132.66 in Billed Charges for Rev 272 = $40.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TROCAR RESPOSABLE 10/11MM,272,RC,,,,,,,,both,,,132.6600,19.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,42.85,,,,,,,34.2400,132.6600,percent of total billed charges,32.3% of $132.66 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR RESPOSABLE 10/11MM,272,RC,,,,,,,,both,,,132.6600,19.9000,WELLCARE,WELLCARE MEDICAID,132.66,,,,,,,34.2400,132.6600,percent of total billed charges,100% of $132.66 in Billed Charges for Rev 272 = $132.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TROCAR SPLIT DISP NEURO,272,RC,27200002,CDM,,,,,,both,,,2972.9500,445.9400,AETNA,AETNA,1269.45,,,,,,,767.3200,2972.9500,percent of total billed charges,"42.7% of $2,972.95 in Billed Charges for Rev 272 = $1,269.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR SPLIT DISP NEURO,272,RC,27200002,CDM,,,,,,both,,,2972.9500,445.9400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2081.07,,,,,,,767.3200,2972.9500,percent of total billed charges,"Rev 272 $2,972.95 in Billed Charges at 70% = $2,081.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR SPLIT DISP NEURO,272,RC,27200002,CDM,,,,,,both,,,2972.9500,445.9400,CIGNA HEALTHCARE,CIGNA HMO,1239.72,,,,,,,767.3200,2972.9500,percent of total billed charges,"41.7% of $2,972.95 in Billed Charges for Rev 272 = $1,239.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR SPLIT DISP NEURO,272,RC,27200002,CDM,,,,,,both,,,2972.9500,445.9400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1379.45,,,,,,,767.3200,2972.9500,percent of total billed charges,"46.4% of $2,972.95 in Billed Charges for Rev 272 = $1,379.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR SPLIT DISP NEURO,272,RC,27200002,CDM,,,,,,both,,,2972.9500,445.9400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1239.72,,,,,,,767.3200,2972.9500,percent of total billed charges,"41.7% of $2,972.95 in Billed Charges for Rev 272 = $1,239.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR SPLIT DISP NEURO,272,RC,27200002,CDM,,,,,,both,,,2972.9500,445.9400,CIGNA HEALTHCARE,CIGNA PPO,1239.72,,,,,,,767.3200,2972.9500,percent of total billed charges,"41.7% of $2,972.95 in Billed Charges for Rev 272 = $1,239.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR SPLIT DISP NEURO,272,RC,27200002,CDM,,,,,,both,,,2972.9500,445.9400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2675.66,,,,,,,767.3200,2972.9500,percent of total billed charges,"90% of $2,972.95 in Billed Charges for Rev 272 = $2,675.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR SPLIT DISP NEURO,272,RC,27200002,CDM,,,,,,both,,,2972.9500,445.9400,MEDCOST,MEDCOST VHN,1414.83,,,,,,,767.3200,2972.9500,percent of total billed charges,"47.59% of $2,972.95 in Billed Charges for Rev 272 = $1,414.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR SPLIT DISP NEURO,272,RC,27200002,CDM,,,,,,both,,,2972.9500,445.9400,SENTARA HEALTH,SENTARA HEALTH,767.32,,,,,,,767.3200,2972.9500,percent of total billed charges,"25.81% of $2,972.95 in Billed Charges for Rev 272 = $767.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR SPLIT DISP NEURO,272,RC,27200002,CDM,,,,,,both,,,2972.9500,445.9400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2972.95,,,,,,,767.3200,2972.9500,percent of total billed charges,"100% of $2,972.95 in Billed Charges for Rev 272 = $2,972.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR SPLIT DISP NEURO,272,RC,27200002,CDM,,,,,,both,,,2972.9500,445.9400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1486.48,,,,,,,767.3200,2972.9500,percent of total billed charges,"Rev 272 $2,972.95 in Billed Charges at 50% = $1,486.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR SPLIT DISP NEURO,272,RC,27200002,CDM,,,,,,both,,,2972.9500,445.9400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,960.26,,,,,,,767.3200,2972.9500,other,"32.3% of $2,972.95 in Billed Charges for Rev 272 = $960.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TROCAR SPLIT DISP NEURO,272,RC,27200002,CDM,,,,,,both,,,2972.9500,445.9400,UNITED HEALTHCARE,UHC HERITAGE SELECT,912.70,,,,,,,767.3200,2972.9500,other,"30.7% of $2,972.95 in Billed Charges for Rev 272 = $912.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TROCAR SPLIT DISP NEURO,272,RC,27200002,CDM,,,,,,both,,,2972.9500,445.9400,UNITED HEALTHCARE,UNITED HEALTHCARE,960.26,,,,,,,767.3200,2972.9500,percent of total billed charges,"32.3% of $2,972.95 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR SPLIT DISP NEURO,272,RC,27200002,CDM,,,,,,both,,,2972.9500,445.9400,WELLCARE,WELLCARE MEDICAID,2972.95,,,,,,,767.3200,2972.9500,percent of total billed charges,"100% of $2,972.95 in Billed Charges for Rev 272 = $2,972.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR TIP WIRE 1.1MM X 35.6CM,272,RC,,,,,,,,both,,,2342.2900,351.3400,AETNA,AETNA,1000.16,,,,,,,604.5500,2342.2900,percent of total billed charges,"42.7% of $2,342.29 in Billed Charges for Rev 272 = $1,000.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR TIP WIRE 1.1MM X 35.6CM,272,RC,,,,,,,,both,,,2342.2900,351.3400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1639.60,,,,,,,604.5500,2342.2900,percent of total billed charges,"Rev 272 $2,342.29 in Billed Charges at 70% = $1,639.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR TIP WIRE 1.1MM X 35.6CM,272,RC,,,,,,,,both,,,2342.2900,351.3400,CIGNA HEALTHCARE,CIGNA HMO,976.73,,,,,,,604.5500,2342.2900,percent of total billed charges,"41.7% of $2,342.29 in Billed Charges for Rev 272 = $976.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR TIP WIRE 1.1MM X 35.6CM,272,RC,,,,,,,,both,,,2342.2900,351.3400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1086.82,,,,,,,604.5500,2342.2900,percent of total billed charges,"46.4% of $2,342.29 in Billed Charges for Rev 272 = $1,086.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR TIP WIRE 1.1MM X 35.6CM,272,RC,,,,,,,,both,,,2342.2900,351.3400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,976.73,,,,,,,604.5500,2342.2900,percent of total billed charges,"41.7% of $2,342.29 in Billed Charges for Rev 272 = $976.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR TIP WIRE 1.1MM X 35.6CM,272,RC,,,,,,,,both,,,2342.2900,351.3400,CIGNA HEALTHCARE,CIGNA PPO,976.73,,,,,,,604.5500,2342.2900,percent of total billed charges,"41.7% of $2,342.29 in Billed Charges for Rev 272 = $976.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR TIP WIRE 1.1MM X 35.6CM,272,RC,,,,,,,,both,,,2342.2900,351.3400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2108.06,,,,,,,604.5500,2342.2900,percent of total billed charges,"90% of $2,342.29 in Billed Charges for Rev 272 = $2,108.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR TIP WIRE 1.1MM X 35.6CM,272,RC,,,,,,,,both,,,2342.2900,351.3400,MEDCOST,MEDCOST VHN,1114.70,,,,,,,604.5500,2342.2900,percent of total billed charges,"47.59% of $2,342.29 in Billed Charges for Rev 272 = $1,114.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR TIP WIRE 1.1MM X 35.6CM,272,RC,,,,,,,,both,,,2342.2900,351.3400,SENTARA HEALTH,SENTARA HEALTH,604.55,,,,,,,604.5500,2342.2900,percent of total billed charges,"25.81% of $2,342.29 in Billed Charges for Rev 272 = $604.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR TIP WIRE 1.1MM X 35.6CM,272,RC,,,,,,,,both,,,2342.2900,351.3400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2342.29,,,,,,,604.5500,2342.2900,percent of total billed charges,"100% of $2,342.29 in Billed Charges for Rev 272 = $2,342.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR TIP WIRE 1.1MM X 35.6CM,272,RC,,,,,,,,both,,,2342.2900,351.3400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1171.15,,,,,,,604.5500,2342.2900,percent of total billed charges,"Rev 272 $2,342.29 in Billed Charges at 50% = $1,171.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR TIP WIRE 1.1MM X 35.6CM,272,RC,,,,,,,,both,,,2342.2900,351.3400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,756.56,,,,,,,604.5500,2342.2900,other,"32.3% of $2,342.29 in Billed Charges for Rev 272 = $756.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TROCAR TIP WIRE 1.1MM X 35.6CM,272,RC,,,,,,,,both,,,2342.2900,351.3400,UNITED HEALTHCARE,UHC HERITAGE SELECT,719.08,,,,,,,604.5500,2342.2900,other,"30.7% of $2,342.29 in Billed Charges for Rev 272 = $719.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TROCAR TIP WIRE 1.1MM X 35.6CM,272,RC,,,,,,,,both,,,2342.2900,351.3400,UNITED HEALTHCARE,UNITED HEALTHCARE,756.56,,,,,,,604.5500,2342.2900,percent of total billed charges,"32.3% of $2,342.29 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR TIP WIRE 1.1MM X 35.6CM,272,RC,,,,,,,,both,,,2342.2900,351.3400,WELLCARE,WELLCARE MEDICAID,2342.29,,,,,,,604.5500,2342.2900,percent of total billed charges,"100% of $2,342.29 in Billed Charges for Rev 272 = $2,342.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE CEMENT INJECTOR,272,RC,27200002,CDM,,,,,,both,,,645.9100,96.8900,AETNA,AETNA,275.80,,,,,,,166.7100,645.9100,percent of total billed charges,42.7% of $645.91 in Billed Charges for Rev 272 = $275.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE CEMENT INJECTOR,272,RC,27200002,CDM,,,,,,both,,,645.9100,96.8900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,452.14,,,,,,,166.7100,645.9100,percent of total billed charges,Rev 272 $645.91 in Billed Charges at 70% = $452.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE CEMENT INJECTOR,272,RC,27200002,CDM,,,,,,both,,,645.9100,96.8900,CIGNA HEALTHCARE,CIGNA HMO,269.34,,,,,,,166.7100,645.9100,percent of total billed charges,41.7% of $645.91 in Billed Charges for Rev 272 = $269.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE CEMENT INJECTOR,272,RC,27200002,CDM,,,,,,both,,,645.9100,96.8900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,299.70,,,,,,,166.7100,645.9100,percent of total billed charges,46.4% of $645.91 in Billed Charges for Rev 272 = $299.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE CEMENT INJECTOR,272,RC,27200002,CDM,,,,,,both,,,645.9100,96.8900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,269.34,,,,,,,166.7100,645.9100,percent of total billed charges,41.7% of $645.91 in Billed Charges for Rev 272 = $269.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE CEMENT INJECTOR,272,RC,27200002,CDM,,,,,,both,,,645.9100,96.8900,CIGNA HEALTHCARE,CIGNA PPO,269.34,,,,,,,166.7100,645.9100,percent of total billed charges,41.7% of $645.91 in Billed Charges for Rev 272 = $269.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE CEMENT INJECTOR,272,RC,27200002,CDM,,,,,,both,,,645.9100,96.8900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,581.32,,,,,,,166.7100,645.9100,percent of total billed charges,90% of $645.91 in Billed Charges for Rev 272 = $581.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE CEMENT INJECTOR,272,RC,27200002,CDM,,,,,,both,,,645.9100,96.8900,MEDCOST,MEDCOST VHN,307.39,,,,,,,166.7100,645.9100,percent of total billed charges,47.59% of $645.91 in Billed Charges for Rev 272 = $307.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE CEMENT INJECTOR,272,RC,27200002,CDM,,,,,,both,,,645.9100,96.8900,SENTARA HEALTH,SENTARA HEALTH,166.71,,,,,,,166.7100,645.9100,percent of total billed charges,25.81% of $645.91 in Billed Charges for Rev 272 = $166.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE CEMENT INJECTOR,272,RC,27200002,CDM,,,,,,both,,,645.9100,96.8900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",645.91,,,,,,,166.7100,645.9100,percent of total billed charges,100% of $645.91 in Billed Charges for Rev 272 = $645.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE CEMENT INJECTOR,272,RC,27200002,CDM,,,,,,both,,,645.9100,96.8900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,322.96,,,,,,,166.7100,645.9100,percent of total billed charges,Rev 272 $645.91 in Billed Charges at 50% = $322.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE CEMENT INJECTOR,272,RC,27200002,CDM,,,,,,both,,,645.9100,96.8900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,208.63,,,,,,,166.7100,645.9100,other,32.3% of $645.91 in Billed Charges for Rev 272 = $208.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE CEMENT INJECTOR,272,RC,27200002,CDM,,,,,,both,,,645.9100,96.8900,UNITED HEALTHCARE,UHC HERITAGE SELECT,198.29,,,,,,,166.7100,645.9100,other,30.7% of $645.91 in Billed Charges for Rev 272 = $198.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TUBE CEMENT INJECTOR,272,RC,27200002,CDM,,,,,,both,,,645.9100,96.8900,UNITED HEALTHCARE,UNITED HEALTHCARE,208.63,,,,,,,166.7100,645.9100,percent of total billed charges,32.3% of $645.91 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE CEMENT INJECTOR,272,RC,27200002,CDM,,,,,,both,,,645.9100,96.8900,WELLCARE,WELLCARE MEDICAID,645.91,,,,,,,166.7100,645.9100,percent of total billed charges,100% of $645.91 in Billed Charges for Rev 272 = $645.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TUBE DISPOS RETRACTOR 9561819,272,RC,,,,,,,,both,,,2053.8700,308.0800,AETNA,AETNA,877.00,,,,,,,530.1000,2053.8700,percent of total billed charges,"42.7% of $2,053.87 in Billed Charges for Rev 272 = $877.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE DISPOS RETRACTOR 9561819,272,RC,,,,,,,,both,,,2053.8700,308.0800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1437.71,,,,,,,530.1000,2053.8700,percent of total billed charges,"Rev 272 $2,053.87 in Billed Charges at 70% = $1,437.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE DISPOS RETRACTOR 9561819,272,RC,,,,,,,,both,,,2053.8700,308.0800,CIGNA HEALTHCARE,CIGNA HMO,856.46,,,,,,,530.1000,2053.8700,percent of total billed charges,"41.7% of $2,053.87 in Billed Charges for Rev 272 = $856.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE DISPOS RETRACTOR 9561819,272,RC,,,,,,,,both,,,2053.8700,308.0800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,953.00,,,,,,,530.1000,2053.8700,percent of total billed charges,"46.4% of $2,053.87 in Billed Charges for Rev 272 = $953.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE DISPOS RETRACTOR 9561819,272,RC,,,,,,,,both,,,2053.8700,308.0800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,856.46,,,,,,,530.1000,2053.8700,percent of total billed charges,"41.7% of $2,053.87 in Billed Charges for Rev 272 = $856.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE DISPOS RETRACTOR 9561819,272,RC,,,,,,,,both,,,2053.8700,308.0800,CIGNA HEALTHCARE,CIGNA PPO,856.46,,,,,,,530.1000,2053.8700,percent of total billed charges,"41.7% of $2,053.87 in Billed Charges for Rev 272 = $856.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE DISPOS RETRACTOR 9561819,272,RC,,,,,,,,both,,,2053.8700,308.0800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1848.48,,,,,,,530.1000,2053.8700,percent of total billed charges,"90% of $2,053.87 in Billed Charges for Rev 272 = $1,848.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE DISPOS RETRACTOR 9561819,272,RC,,,,,,,,both,,,2053.8700,308.0800,MEDCOST,MEDCOST VHN,977.44,,,,,,,530.1000,2053.8700,percent of total billed charges,"47.59% of $2,053.87 in Billed Charges for Rev 272 = $977.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE DISPOS RETRACTOR 9561819,272,RC,,,,,,,,both,,,2053.8700,308.0800,SENTARA HEALTH,SENTARA HEALTH,530.10,,,,,,,530.1000,2053.8700,percent of total billed charges,"25.81% of $2,053.87 in Billed Charges for Rev 272 = $530.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE DISPOS RETRACTOR 9561819,272,RC,,,,,,,,both,,,2053.8700,308.0800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2053.87,,,,,,,530.1000,2053.8700,percent of total billed charges,"100% of $2,053.87 in Billed Charges for Rev 272 = $2,053.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE DISPOS RETRACTOR 9561819,272,RC,,,,,,,,both,,,2053.8700,308.0800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1026.94,,,,,,,530.1000,2053.8700,percent of total billed charges,"Rev 272 $2,053.87 in Billed Charges at 50% = $1,026.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE DISPOS RETRACTOR 9561819,272,RC,,,,,,,,both,,,2053.8700,308.0800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,663.40,,,,,,,530.1000,2053.8700,other,"32.3% of $2,053.87 in Billed Charges for Rev 272 = $663.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE DISPOS RETRACTOR 9561819,272,RC,,,,,,,,both,,,2053.8700,308.0800,UNITED HEALTHCARE,UHC HERITAGE SELECT,630.54,,,,,,,530.1000,2053.8700,other,"30.7% of $2,053.87 in Billed Charges for Rev 272 = $630.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TUBE DISPOS RETRACTOR 9561819,272,RC,,,,,,,,both,,,2053.8700,308.0800,UNITED HEALTHCARE,UNITED HEALTHCARE,663.40,,,,,,,530.1000,2053.8700,percent of total billed charges,"32.3% of $2,053.87 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TUBE DISPOS RETRACTOR 9561819,272,RC,,,,,,,,both,,,2053.8700,308.0800,WELLCARE,WELLCARE MEDICAID,2053.87,,,,,,,530.1000,2053.8700,percent of total billed charges,"100% of $2,053.87 in Billed Charges for Rev 272 = $2,053.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,AETNA,AETNA,455.18,,,,,,,141.5700,1606.7400,percent of total billed charges,"42.7% of $1,066.00 in Billed Charges for Rev 521 Proc 17106 = $455.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1591.43,,,,,,,141.5700,1606.7400,fee schedule,"APG 00004 Proc 17106 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 104% = $1,591.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,141.5700,1606.7400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,141.5700,1606.7400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,141.5700,1606.7400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,AMBETTER,AMBETTER,804.03,,,,,,,141.5700,1606.7400,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,141.5700,1606.7400,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,141.5700,1606.7400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1066.00,,,,,,,141.5700,1606.7400,fee schedule,"APG 00004 Proc 17106 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 103% = $1,576.13 (Service Line reduced to $1,066.00, claim capped at $1,066.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,141.5700,1606.7400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,141.5700,1606.7400,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1066.00,,,,,,,141.5700,1606.7400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,233.03,,,,,,,141.5700,1606.7400,fee schedule,$233.03 from Fee Schedule BLDTM_23 for Rev 521 Proc 17106 * Qty 1 = $233.03 at 100% = $233.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,141.5700,1606.7400,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,CIGNA HEALTHCARE,CIGNA HMO,444.52,,,,,,,141.5700,1606.7400,percent of total billed charges,"41.7% of $1,066.00 in Billed Charges for Rev 521 Proc 17106 = $444.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,494.62,,,,,,,141.5700,1606.7400,percent of total billed charges,"46.4% of $1,066.00 in Billed Charges for Rev 521 Proc 17106 = $494.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,141.5700,1606.7400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,444.52,,,,,,,141.5700,1606.7400,percent of total billed charges,"41.7% of $1,066.00 in Billed Charges for Rev 521 Proc 17106 = $444.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,CIGNA HEALTHCARE,CIGNA PPO,444.52,,,,,,,141.5700,1606.7400,percent of total billed charges,"41.7% of $1,066.00 in Billed Charges for Rev 521 Proc 17106 = $444.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,141.5700,1606.7400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,959.40,,,,,,,141.5700,1606.7400,percent of total billed charges,"90% of $1,066.00 in Billed Charges for Rev 521 Proc 17106 = $959.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,HUMANA,HUMANA MEDICARE,368.82,,,,,,,141.5700,1606.7400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,141.5700,1606.7400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,MEDCOST,MEDCOST VHN,507.31,,,,,,,141.5700,1606.7400,percent of total billed charges,"47.59% of $1,066.00 in Billed Charges for Rev 521 Proc 17106 = $507.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1606.74,,,,,,,141.5700,1606.7400,fee schedule,"APG 00004 Proc 17106 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 100% = $1,530.23... $1,530.23 at 105% = $1,606.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,141.5700,1606.7400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,141.5700,1606.7400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,141.5700,1606.7400,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1577.67,,,,,,,141.5700,1606.7400,fee schedule,"APG 00004 Proc 17106 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 100% = $1,530.23... $1,530.23 at 103.1% = $1,577.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,SENTARA HEALTH,SENTARA HEALTH,275.13,,,,,,,141.5700,1606.7400,percent of total billed charges,"25.81% of $1,066.00 in Billed Charges for Rev 521 Proc 17106 = $275.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,141.5700,1606.7400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1066.00,,,,,,,141.5700,1606.7400,percent of total billed charges,"100% of $1,066.00 in Billed Charges for Rev 521 Proc 17106 = $1,066.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,141.57,,,,,,,141.5700,1606.7400,fee schedule,$283.14 from Fee Schedule TCUHC24 for Rev 521 Proc 17106 * Qty 1 = $283.14 at 50% = $141.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1576.13,,,,,,,141.5700,1606.7400,fee schedule,"APG 00004 Proc 17106 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 103% = $1,576.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,141.5700,1606.7400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,141.5700,1606.7400,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,WELLCARE,WELLCARE MEDICAID,1066.00,,,,,,,141.5700,1606.7400,percent of total billed charges,"100% of $1,066.00 in Billed Charges for Rev 521 Proc 17106 = $1,066.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS <10 SQ CM,17106,CPT,521,RC,52100063,CDM,,,,both,,,1066.0000,159.9000,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,141.5700,1606.7400,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,AETNA,AETNA,704.98,,,,,,,141.5700,1651.0000,percent of total billed charges,"42.7% of $1,651.00 in Billed Charges for Rev 521 Proc 17107 = $704.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1591.43,,,,,,,141.5700,1651.0000,fee schedule,"APG 00004 Proc 17107 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 104% = $1,591.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,670.54,,,,,,,141.5700,1651.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,AETNA,AETNA HEALTHCARE MEDICARE,670.54,,,,,,,141.5700,1651.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,670.54,,,,,,,141.5700,1651.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,AMBETTER,AMBETTER,1461.78,,,,,,,141.5700,1651.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,697.36,,,,,,,141.5700,1651.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,BLUE CROSS,ANTHEM EXCHANGE,1650.91,,,,,,,141.5700,1651.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1576.13,,,,,,,141.5700,1651.0000,fee schedule,"APG 00004 Proc 17107 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 103% = $1,576.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,BLUE CROSS,ANTHEM HMO,1651.00,,,,,,,141.5700,1651.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,690.66,,,,,,,141.5700,1651.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1651.00,,,,,,,141.5700,1651.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,454.43,,,,,,,141.5700,1651.0000,fee schedule,$454.43 from Fee Schedule BLDTM_23 for Rev 521 Proc 17107 * Qty 1 = $454.43 at 100% = $454.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,BLUE CROSS,BLUE CROSS MEDICARE,697.36,,,,,,,141.5700,1651.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,CIGNA HEALTHCARE,CIGNA HMO,688.47,,,,,,,141.5700,1651.0000,percent of total billed charges,"41.7% of $1,651.00 in Billed Charges for Rev 521 Proc 17107 = $688.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,766.06,,,,,,,141.5700,1651.0000,percent of total billed charges,"46.4% of $1,651.00 in Billed Charges for Rev 521 Proc 17107 = $766.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,704.07,,,,,,,141.5700,1651.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,688.47,,,,,,,141.5700,1651.0000,percent of total billed charges,"41.7% of $1,651.00 in Billed Charges for Rev 521 Proc 17107 = $688.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,CIGNA HEALTHCARE,CIGNA PPO,688.47,,,,,,,141.5700,1651.0000,percent of total billed charges,"41.7% of $1,651.00 in Billed Charges for Rev 521 Proc 17107 = $688.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,704.07,,,,,,,141.5700,1651.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1485.90,,,,,,,141.5700,1651.0000,percent of total billed charges,"90% of $1,651.00 in Billed Charges for Rev 521 Proc 17107 = $1,485.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,HUMANA,HUMANA MEDICARE,670.54,,,,,,,141.5700,1651.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,670.54,,,,,,,141.5700,1651.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,MEDCOST,MEDCOST VHN,785.71,,,,,,,141.5700,1651.0000,percent of total billed charges,"47.59% of $1,651.00 in Billed Charges for Rev 521 Proc 17107 = $785.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1606.74,,,,,,,141.5700,1651.0000,fee schedule,"APG 00004 Proc 17107 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 100% = $1,530.23... $1,530.23 at 105% = $1,606.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,704.07,,,,,,,141.5700,1651.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,704.07,,,,,,,141.5700,1651.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,NHC ADVANTAGE,NHC ADVANTAGE,704.07,,,,,,,141.5700,1651.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1577.67,,,,,,,141.5700,1651.0000,fee schedule,"APG 00004 Proc 17107 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 100% = $1,530.23... $1,530.23 at 103.1% = $1,577.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,SENTARA HEALTH,SENTARA HEALTH,426.12,,,,,,,141.5700,1651.0000,percent of total billed charges,"25.81% of $1,651.00 in Billed Charges for Rev 521 Proc 17107 = $426.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,SENTARA HEALTH,SENTARA MEDICARE,670.54,,,,,,,141.5700,1651.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1651.00,,,,,,,141.5700,1651.0000,percent of total billed charges,"100% of $1,651.00 in Billed Charges for Rev 521 Proc 17107 = $1,651.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,141.57,,,,,,,141.5700,1651.0000,fee schedule,$283.14 from Fee Schedule TCUHC24 for Rev 521 Proc 17107 * Qty 1 = $283.14 at 50% = $141.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1576.13,,,,,,,141.5700,1651.0000,fee schedule,"APG 00004 Proc 17107 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 103% = $1,576.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,670.54,,,,,,,141.5700,1651.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,670.54,,,,,,,141.5700,1651.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,WELLCARE,WELLCARE MEDICAID,1651.00,,,,,,,141.5700,1651.0000,percent of total billed charges,"100% of $1,651.00 in Billed Charges for Rev 521 Proc 17107 = $1,651.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS 10.0-50.0 SQ CM,17107,CPT,521,RC,52100064,CDM,,,,both,,,1651.0000,247.6500,WELLCARE,WELLCARE MEDICARE,710.77,,,,,,,141.5700,1651.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,AETNA,AETNA,2221.68,,,,,,,141.5700,5203.0000,percent of total billed charges,"42.7% of $5,203.00 in Billed Charges for Rev 521 Proc 17108 = $2,221.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1591.43,,,,,,,141.5700,5203.0000,fee schedule,"APG 00004 Proc 17108 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 104% = $1,591.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1871.96,,,,,,,141.5700,5203.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,AETNA,AETNA HEALTHCARE MEDICARE,1871.96,,,,,,,141.5700,5203.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,1871.96,,,,,,,141.5700,5203.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,AMBETTER,AMBETTER,4080.88,,,,,,,141.5700,5203.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1946.84,,,,,,,141.5700,5203.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,BLUE CROSS,ANTHEM EXCHANGE,4608.86,,,,,,,141.5700,5203.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1576.13,,,,,,,141.5700,5203.0000,fee schedule,"APG 00004 Proc 17108 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 103% = $1,576.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,BLUE CROSS,ANTHEM HMO,4896.64,,,,,,,141.5700,5203.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1928.12,,,,,,,141.5700,5203.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5203.00,,,,,,,141.5700,5203.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,755.61,,,,,,,141.5700,5203.0000,fee schedule,$755.61 from Fee Schedule BLDTM_23 for Rev 521 Proc 17108 * Qty 1 = $755.61 at 100% = $755.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,BLUE CROSS,BLUE CROSS MEDICARE,1946.84,,,,,,,141.5700,5203.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,CIGNA HEALTHCARE,CIGNA HMO,2169.65,,,,,,,141.5700,5203.0000,percent of total billed charges,"41.7% of $5,203.00 in Billed Charges for Rev 521 Proc 17108 = $2,169.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2414.19,,,,,,,141.5700,5203.0000,percent of total billed charges,"46.4% of $5,203.00 in Billed Charges for Rev 521 Proc 17108 = $2,414.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,1965.56,,,,,,,141.5700,5203.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2169.65,,,,,,,141.5700,5203.0000,percent of total billed charges,"41.7% of $5,203.00 in Billed Charges for Rev 521 Proc 17108 = $2,169.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,CIGNA HEALTHCARE,CIGNA PPO,2169.65,,,,,,,141.5700,5203.0000,percent of total billed charges,"41.7% of $5,203.00 in Billed Charges for Rev 521 Proc 17108 = $2,169.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1965.56,,,,,,,141.5700,5203.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4682.70,,,,,,,141.5700,5203.0000,percent of total billed charges,"90% of $5,203.00 in Billed Charges for Rev 521 Proc 17108 = $4,682.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,HUMANA,HUMANA MEDICARE,1871.96,,,,,,,141.5700,5203.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1871.96,,,,,,,141.5700,5203.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,MEDCOST,MEDCOST VHN,2476.11,,,,,,,141.5700,5203.0000,percent of total billed charges,"47.59% of $5,203.00 in Billed Charges for Rev 521 Proc 17108 = $2,476.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1606.74,,,,,,,141.5700,5203.0000,fee schedule,"APG 00004 Proc 17108 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 100% = $1,530.23... $1,530.23 at 105% = $1,606.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1965.56,,,,,,,141.5700,5203.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1965.56,,,,,,,141.5700,5203.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,NHC ADVANTAGE,NHC ADVANTAGE,1965.56,,,,,,,141.5700,5203.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1577.67,,,,,,,141.5700,5203.0000,fee schedule,"APG 00004 Proc 17108 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 100% = $1,530.23... $1,530.23 at 103.1% = $1,577.67 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,SENTARA HEALTH,SENTARA HEALTH,1342.89,,,,,,,141.5700,5203.0000,percent of total billed charges,"25.81% of $5,203.00 in Billed Charges for Rev 521 Proc 17108 = $1,342.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,SENTARA HEALTH,SENTARA MEDICARE,1871.96,,,,,,,141.5700,5203.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5203.00,,,,,,,141.5700,5203.0000,percent of total billed charges,"100% of $5,203.00 in Billed Charges for Rev 521 Proc 17108 = $5,203.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,141.57,,,,,,,141.5700,5203.0000,fee schedule,$283.14 from Fee Schedule TCUHC24 for Rev 521 Proc 17108 * Qty 1 = $283.14 at 50% = $141.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1576.13,,,,,,,141.5700,5203.0000,fee schedule,"APG 00004 Proc 17108 at $836.60 (Base Rate) * 1.8291 (Relative Weight) = $1,530.23 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,530.23 at 103% = $1,576.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1871.96,,,,,,,141.5700,5203.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1871.96,,,,,,,141.5700,5203.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,WELLCARE,WELLCARE MEDICAID,5203.00,,,,,,,141.5700,5203.0000,percent of total billed charges,"100% of $5,203.00 in Billed Charges for Rev 521 Proc 17108 = $5,203.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCT CUTANEOUS VASC PROLIF LESIONS >50.0 SQ CM,17108,CPT,521,RC,52100065,CDM,,,,both,,,5203.0000,780.4500,WELLCARE,WELLCARE MEDICARE,1984.28,,,,,,,141.5700,5203.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,AETNA,AETNA,383.02,,,,,,,141.5700,897.0000,percent of total billed charges,42.7% of $897.00 in Billed Charges for Rev 521 Proc 17266 = $383.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,141.5700,897.0000,fee schedule,"APG 00003 Proc 17266 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,141.5700,897.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,141.5700,897.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,141.5700,897.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,AMBETTER,AMBETTER,804.03,,,,,,,141.5700,897.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,141.5700,897.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,BLUE CROSS,ANTHEM EXCHANGE,897.00,,,,,,,141.5700,897.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,141.5700,897.0000,fee schedule,"APG 00003 Proc 17266 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,BLUE CROSS,ANTHEM HMO,897.00,,,,,,,141.5700,897.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,141.5700,897.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",897.00,,,,,,,141.5700,897.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,178.76,,,,,,,141.5700,897.0000,fee schedule,$178.76 from Fee Schedule BLDTM_23 for Rev 521 Proc 17266 * Qty 1 = $178.76 at 100% = $178.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,141.5700,897.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,CIGNA HEALTHCARE,CIGNA HMO,374.05,,,,,,,141.5700,897.0000,percent of total billed charges,41.7% of $897.00 in Billed Charges for Rev 521 Proc 17266 = $374.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,416.21,,,,,,,141.5700,897.0000,percent of total billed charges,46.4% of $897.00 in Billed Charges for Rev 521 Proc 17266 = $416.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,141.5700,897.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,374.05,,,,,,,141.5700,897.0000,percent of total billed charges,41.7% of $897.00 in Billed Charges for Rev 521 Proc 17266 = $374.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,CIGNA HEALTHCARE,CIGNA PPO,374.05,,,,,,,141.5700,897.0000,percent of total billed charges,41.7% of $897.00 in Billed Charges for Rev 521 Proc 17266 = $374.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,141.5700,897.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,807.30,,,,,,,141.5700,897.0000,percent of total billed charges,90% of $897.00 in Billed Charges for Rev 521 Proc 17266 = $807.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,141.5700,897.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,141.5700,897.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,MEDCOST,MEDCOST VHN,426.88,,,,,,,141.5700,897.0000,percent of total billed charges,47.59% of $897.00 in Billed Charges for Rev 521 Proc 17266 = $426.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,141.5700,897.0000,fee schedule,"APG 00003 Proc 17266 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,141.5700,897.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,141.5700,897.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,141.5700,897.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,141.5700,897.0000,fee schedule,"APG 00003 Proc 17266 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,SENTARA HEALTH,SENTARA HEALTH,231.52,,,,,,,141.5700,897.0000,percent of total billed charges,25.81% of $897.00 in Billed Charges for Rev 521 Proc 17266 = $231.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,141.5700,897.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",897.00,,,,,,,141.5700,897.0000,percent of total billed charges,100% of $897.00 in Billed Charges for Rev 521 Proc 17266 = $897.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,141.57,,,,,,,141.5700,897.0000,fee schedule,$283.14 from Fee Schedule TCUHC24 for Rev 521 Proc 17266 * Qty 1 = $283.14 at 50% = $141.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,141.5700,897.0000,fee schedule,"APG 00003 Proc 17266 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,141.5700,897.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,141.5700,897.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,WELLCARE,WELLCARE MEDICAID,897.00,,,,,,,141.5700,897.0000,percent of total billed charges,100% of $897.00 in Billed Charges for Rev 521 Proc 17266 = $897.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L >4.0 CM,17266,CPT,521,RC,52100072,CDM,,,,both,,,897.0000,134.5500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,141.5700,897.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,AETNA,AETNA,261.75,,,,,,,73.0700,613.0000,percent of total billed charges,42.7% of $613.00 in Billed Charges for Rev 521 Proc 17271 = $261.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,73.0700,613.0000,fee schedule,"APG 00003 Proc 17271 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,AMBETTER,AMBETTER,396.83,,,,,,,73.0700,613.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,73.0700,613.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,73.0700,613.0000,fee schedule,"APG 00003 Proc 17271 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,73.0700,613.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",560.15,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,107.29,,,,,,,73.0700,613.0000,fee schedule,$107.29 from Fee Schedule BLDTM_23 for Rev 521 Proc 17271 * Qty 1 = $107.29 at 100% = $107.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,73.0700,613.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA HMO,255.62,,,,,,,73.0700,613.0000,percent of total billed charges,41.7% of $613.00 in Billed Charges for Rev 521 Proc 17271 = $255.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,284.43,,,,,,,73.0700,613.0000,percent of total billed charges,46.4% of $613.00 in Billed Charges for Rev 521 Proc 17271 = $284.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,73.0700,613.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,255.62,,,,,,,73.0700,613.0000,percent of total billed charges,41.7% of $613.00 in Billed Charges for Rev 521 Proc 17271 = $255.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA PPO,255.62,,,,,,,73.0700,613.0000,percent of total billed charges,41.7% of $613.00 in Billed Charges for Rev 521 Proc 17271 = $255.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,73.0700,613.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,551.70,,,,,,,73.0700,613.0000,percent of total billed charges,90% of $613.00 in Billed Charges for Rev 521 Proc 17271 = $551.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,MEDCOST,MEDCOST VHN,291.73,,,,,,,73.0700,613.0000,percent of total billed charges,47.59% of $613.00 in Billed Charges for Rev 521 Proc 17271 = $291.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,73.0700,613.0000,fee schedule,"APG 00003 Proc 17271 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,73.0700,613.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,73.0700,613.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,73.0700,613.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,73.0700,613.0000,fee schedule,"APG 00003 Proc 17271 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,SENTARA HEALTH,SENTARA HEALTH,158.22,,,,,,,73.0700,613.0000,percent of total billed charges,25.81% of $613.00 in Billed Charges for Rev 521 Proc 17271 = $158.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",613.00,,,,,,,73.0700,613.0000,percent of total billed charges,100% of $613.00 in Billed Charges for Rev 521 Proc 17271 = $613.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,73.0700,613.0000,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 521 Proc 17271 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,73.0700,613.0000,fee schedule,"APG 00003 Proc 17271 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,WELLCARE,WELLCARE MEDICAID,613.00,,,,,,,73.0700,613.0000,percent of total billed charges,100% of $613.00 in Billed Charges for Rev 521 Proc 17271 = $613.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.6-1.0 CM,17271,CPT,521,RC,52100074,CDM,,,,both,,,613.0000,91.9500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,73.0700,613.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,AETNA,AETNA,348.01,,,,,,,141.5700,815.0000,percent of total billed charges,42.7% of $815.00 in Billed Charges for Rev 521 Proc 17274 = $348.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,141.5700,815.0000,fee schedule,"APG 00003 Proc 17274 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,141.5700,815.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,141.5700,815.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,141.5700,815.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,AMBETTER,AMBETTER,804.03,,,,,,,141.5700,815.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,141.5700,815.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,BLUE CROSS,ANTHEM EXCHANGE,815.00,,,,,,,141.5700,815.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,141.5700,815.0000,fee schedule,"APG 00003 Proc 17274 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,BLUE CROSS,ANTHEM HMO,815.00,,,,,,,141.5700,815.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,141.5700,815.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",815.00,,,,,,,141.5700,815.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,187.83,,,,,,,141.5700,815.0000,fee schedule,$187.83 from Fee Schedule BLDTM_23 for Rev 521 Proc 17274 * Qty 1 = $187.83 at 100% = $187.83 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,141.5700,815.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,CIGNA HEALTHCARE,CIGNA HMO,339.86,,,,,,,141.5700,815.0000,percent of total billed charges,41.7% of $815.00 in Billed Charges for Rev 521 Proc 17274 = $339.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,378.16,,,,,,,141.5700,815.0000,percent of total billed charges,46.4% of $815.00 in Billed Charges for Rev 521 Proc 17274 = $378.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,141.5700,815.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,339.86,,,,,,,141.5700,815.0000,percent of total billed charges,41.7% of $815.00 in Billed Charges for Rev 521 Proc 17274 = $339.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,CIGNA HEALTHCARE,CIGNA PPO,339.86,,,,,,,141.5700,815.0000,percent of total billed charges,41.7% of $815.00 in Billed Charges for Rev 521 Proc 17274 = $339.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,141.5700,815.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,733.50,,,,,,,141.5700,815.0000,percent of total billed charges,90% of $815.00 in Billed Charges for Rev 521 Proc 17274 = $733.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,141.5700,815.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,141.5700,815.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,MEDCOST,MEDCOST VHN,387.86,,,,,,,141.5700,815.0000,percent of total billed charges,47.59% of $815.00 in Billed Charges for Rev 521 Proc 17274 = $387.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,141.5700,815.0000,fee schedule,"APG 00003 Proc 17274 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,141.5700,815.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,141.5700,815.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,141.5700,815.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,141.5700,815.0000,fee schedule,"APG 00003 Proc 17274 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,SENTARA HEALTH,SENTARA HEALTH,210.35,,,,,,,141.5700,815.0000,percent of total billed charges,25.81% of $815.00 in Billed Charges for Rev 521 Proc 17274 = $210.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,141.5700,815.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",815.00,,,,,,,141.5700,815.0000,percent of total billed charges,100% of $815.00 in Billed Charges for Rev 521 Proc 17274 = $815.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,141.57,,,,,,,141.5700,815.0000,fee schedule,$283.14 from Fee Schedule TCUHC24 for Rev 521 Proc 17274 * Qty 1 = $283.14 at 50% = $141.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,141.5700,815.0000,fee schedule,"APG 00003 Proc 17274 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,141.5700,815.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,141.5700,815.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,WELLCARE,WELLCARE MEDICAID,815.00,,,,,,,141.5700,815.0000,percent of total billed charges,100% of $815.00 in Billed Charges for Rev 521 Proc 17274 = $815.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 3.1-4.0 CM,17274,CPT,521,RC,52100077,CDM,,,,both,,,815.0000,122.2500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,141.5700,815.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WAND REFLEX 45 TURBINATE REDUCTION EICA4845-01,272,RC,27200002,CDM,,,,,,both,,,3172.2800,475.8400,AETNA,AETNA,1354.56,,,,,,,818.7700,3172.2800,percent of total billed charges,"42.7% of $3,172.28 in Billed Charges for Rev 272 = $1,354.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX 45 TURBINATE REDUCTION EICA4845-01,272,RC,27200002,CDM,,,,,,both,,,3172.2800,475.8400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2220.60,,,,,,,818.7700,3172.2800,percent of total billed charges,"Rev 272 $3,172.28 in Billed Charges at 70% = $2,220.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX 45 TURBINATE REDUCTION EICA4845-01,272,RC,27200002,CDM,,,,,,both,,,3172.2800,475.8400,CIGNA HEALTHCARE,CIGNA HMO,1322.84,,,,,,,818.7700,3172.2800,percent of total billed charges,"41.7% of $3,172.28 in Billed Charges for Rev 272 = $1,322.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX 45 TURBINATE REDUCTION EICA4845-01,272,RC,27200002,CDM,,,,,,both,,,3172.2800,475.8400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1471.94,,,,,,,818.7700,3172.2800,percent of total billed charges,"46.4% of $3,172.28 in Billed Charges for Rev 272 = $1,471.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX 45 TURBINATE REDUCTION EICA4845-01,272,RC,27200002,CDM,,,,,,both,,,3172.2800,475.8400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1322.84,,,,,,,818.7700,3172.2800,percent of total billed charges,"41.7% of $3,172.28 in Billed Charges for Rev 272 = $1,322.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX 45 TURBINATE REDUCTION EICA4845-01,272,RC,27200002,CDM,,,,,,both,,,3172.2800,475.8400,CIGNA HEALTHCARE,CIGNA PPO,1322.84,,,,,,,818.7700,3172.2800,percent of total billed charges,"41.7% of $3,172.28 in Billed Charges for Rev 272 = $1,322.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX 45 TURBINATE REDUCTION EICA4845-01,272,RC,27200002,CDM,,,,,,both,,,3172.2800,475.8400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2855.05,,,,,,,818.7700,3172.2800,percent of total billed charges,"90% of $3,172.28 in Billed Charges for Rev 272 = $2,855.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX 45 TURBINATE REDUCTION EICA4845-01,272,RC,27200002,CDM,,,,,,both,,,3172.2800,475.8400,MEDCOST,MEDCOST VHN,1509.69,,,,,,,818.7700,3172.2800,percent of total billed charges,"47.59% of $3,172.28 in Billed Charges for Rev 272 = $1,509.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX 45 TURBINATE REDUCTION EICA4845-01,272,RC,27200002,CDM,,,,,,both,,,3172.2800,475.8400,SENTARA HEALTH,SENTARA HEALTH,818.77,,,,,,,818.7700,3172.2800,percent of total billed charges,"25.81% of $3,172.28 in Billed Charges for Rev 272 = $818.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX 45 TURBINATE REDUCTION EICA4845-01,272,RC,27200002,CDM,,,,,,both,,,3172.2800,475.8400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3172.28,,,,,,,818.7700,3172.2800,percent of total billed charges,"100% of $3,172.28 in Billed Charges for Rev 272 = $3,172.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX 45 TURBINATE REDUCTION EICA4845-01,272,RC,27200002,CDM,,,,,,both,,,3172.2800,475.8400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1586.14,,,,,,,818.7700,3172.2800,percent of total billed charges,"Rev 272 $3,172.28 in Billed Charges at 50% = $1,586.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX 45 TURBINATE REDUCTION EICA4845-01,272,RC,27200002,CDM,,,,,,both,,,3172.2800,475.8400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1024.65,,,,,,,818.7700,3172.2800,other,"32.3% of $3,172.28 in Billed Charges for Rev 272 = $1,024.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND REFLEX 45 TURBINATE REDUCTION EICA4845-01,272,RC,27200002,CDM,,,,,,both,,,3172.2800,475.8400,UNITED HEALTHCARE,UHC HERITAGE SELECT,973.89,,,,,,,818.7700,3172.2800,other,"30.7% of $3,172.28 in Billed Charges for Rev 272 = $973.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND REFLEX 45 TURBINATE REDUCTION EICA4845-01,272,RC,27200002,CDM,,,,,,both,,,3172.2800,475.8400,UNITED HEALTHCARE,UNITED HEALTHCARE,1024.65,,,,,,,818.7700,3172.2800,percent of total billed charges,"32.3% of $3,172.28 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX 45 TURBINATE REDUCTION EICA4845-01,272,RC,27200002,CDM,,,,,,both,,,3172.2800,475.8400,WELLCARE,WELLCARE MEDICAID,3172.28,,,,,,,818.7700,3172.2800,percent of total billed charges,"100% of $3,172.28 in Billed Charges for Rev 272 = $3,172.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX ULTRA 55 W/CABLE,272,RC,,,,,,,,both,,,3241.4600,486.2200,AETNA,AETNA,1384.10,,,,,,,836.6200,3241.4600,percent of total billed charges,"42.7% of $3,241.46 in Billed Charges for Rev 272 = $1,384.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX ULTRA 55 W/CABLE,272,RC,,,,,,,,both,,,3241.4600,486.2200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2269.02,,,,,,,836.6200,3241.4600,percent of total billed charges,"Rev 272 $3,241.46 in Billed Charges at 70% = $2,269.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX ULTRA 55 W/CABLE,272,RC,,,,,,,,both,,,3241.4600,486.2200,CIGNA HEALTHCARE,CIGNA HMO,1351.69,,,,,,,836.6200,3241.4600,percent of total billed charges,"41.7% of $3,241.46 in Billed Charges for Rev 272 = $1,351.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX ULTRA 55 W/CABLE,272,RC,,,,,,,,both,,,3241.4600,486.2200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1504.04,,,,,,,836.6200,3241.4600,percent of total billed charges,"46.4% of $3,241.46 in Billed Charges for Rev 272 = $1,504.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX ULTRA 55 W/CABLE,272,RC,,,,,,,,both,,,3241.4600,486.2200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1351.69,,,,,,,836.6200,3241.4600,percent of total billed charges,"41.7% of $3,241.46 in Billed Charges for Rev 272 = $1,351.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX ULTRA 55 W/CABLE,272,RC,,,,,,,,both,,,3241.4600,486.2200,CIGNA HEALTHCARE,CIGNA PPO,1351.69,,,,,,,836.6200,3241.4600,percent of total billed charges,"41.7% of $3,241.46 in Billed Charges for Rev 272 = $1,351.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX ULTRA 55 W/CABLE,272,RC,,,,,,,,both,,,3241.4600,486.2200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2917.31,,,,,,,836.6200,3241.4600,percent of total billed charges,"90% of $3,241.46 in Billed Charges for Rev 272 = $2,917.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX ULTRA 55 W/CABLE,272,RC,,,,,,,,both,,,3241.4600,486.2200,MEDCOST,MEDCOST VHN,1542.61,,,,,,,836.6200,3241.4600,percent of total billed charges,"47.59% of $3,241.46 in Billed Charges for Rev 272 = $1,542.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX ULTRA 55 W/CABLE,272,RC,,,,,,,,both,,,3241.4600,486.2200,SENTARA HEALTH,SENTARA HEALTH,836.62,,,,,,,836.6200,3241.4600,percent of total billed charges,"25.81% of $3,241.46 in Billed Charges for Rev 272 = $836.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX ULTRA 55 W/CABLE,272,RC,,,,,,,,both,,,3241.4600,486.2200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3241.46,,,,,,,836.6200,3241.4600,percent of total billed charges,"100% of $3,241.46 in Billed Charges for Rev 272 = $3,241.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX ULTRA 55 W/CABLE,272,RC,,,,,,,,both,,,3241.4600,486.2200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1620.73,,,,,,,836.6200,3241.4600,percent of total billed charges,"Rev 272 $3,241.46 in Billed Charges at 50% = $1,620.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX ULTRA 55 W/CABLE,272,RC,,,,,,,,both,,,3241.4600,486.2200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1046.99,,,,,,,836.6200,3241.4600,other,"32.3% of $3,241.46 in Billed Charges for Rev 272 = $1,046.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND REFLEX ULTRA 55 W/CABLE,272,RC,,,,,,,,both,,,3241.4600,486.2200,UNITED HEALTHCARE,UHC HERITAGE SELECT,995.13,,,,,,,836.6200,3241.4600,other,"30.7% of $3,241.46 in Billed Charges for Rev 272 = $995.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND REFLEX ULTRA 55 W/CABLE,272,RC,,,,,,,,both,,,3241.4600,486.2200,UNITED HEALTHCARE,UNITED HEALTHCARE,1046.99,,,,,,,836.6200,3241.4600,percent of total billed charges,"32.3% of $3,241.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND REFLEX ULTRA 55 W/CABLE,272,RC,,,,,,,,both,,,3241.4600,486.2200,WELLCARE,WELLCARE MEDICAID,3241.46,,,,,,,836.6200,3241.4600,percent of total billed charges,"100% of $3,241.46 in Billed Charges for Rev 272 = $3,241.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,AETNA,AETNA,4113.29,,,,,,,109.0000,9633.0000,percent of total billed charges,"42.7% of $9,633.00 in Billed Charges for Rev 450 Proc 26075 = $4,113.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1909.01,,,,,,,109.0000,9633.0000,fee schedule,"APG 00033 Proc 26075 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 104% = $1,909.01. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2968.60,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,AETNA,AETNA HEALTHCARE MEDICARE,2968.60,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,2968.60,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,AMBETTER,AMBETTER,6471.55,,,,,,,109.0000,9633.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3087.35,,,,,,,109.0000,9633.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,BLUE CROSS,ANTHEM EXCHANGE,7308.87,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1890.65,,,,,,,109.0000,9633.0000,fee schedule,"APG 00033 Proc 26075 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 103% = $1,890.65. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,BLUE CROSS,ANTHEM HMO,7765.24,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3057.66,,,,,,,109.0000,9633.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9135.08,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,309.89,,,,,,,109.0000,9633.0000,fee schedule,$309.89 from Fee Schedule BLDTM_23 for Rev 450 Proc 26075 * Qty 1 = $309.89 at 100% = $309.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,BLUE CROSS,BLUE CROSS MEDICARE,3087.35,,,,,,,109.0000,9633.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,3117.03,,,,,,,109.0000,9633.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3117.03,,,,,,,109.0000,9633.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8669.70,,,,,,,109.0000,9633.0000,percent of total billed charges,"90% of $9,633.00 in Billed Charges for Rev 450 Proc 26075 = $8,669.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,HUMANA,HUMANA MEDICARE,2968.60,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2968.60,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,MEDCOST,MEDCOST VHN,4584.34,,,,,,,109.0000,9633.0000,percent of total billed charges,"47.59% of $9,633.00 in Billed Charges for Rev 450 Proc 26075 = $4,584.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1927.36,,,,,,,109.0000,9633.0000,fee schedule,"APG 00033 Proc 26075 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 100% = $1,835.58... $1,835.58 at 105% = $1,927.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3117.03,,,,,,,109.0000,9633.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3117.03,,,,,,,109.0000,9633.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,NHC ADVANTAGE,NHC ADVANTAGE,3117.03,,,,,,,109.0000,9633.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1892.48,,,,,,,109.0000,9633.0000,fee schedule,"APG 00033 Proc 26075 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 100% = $1,835.58... $1,835.58 at 103.1% = $1,892.48 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,SENTARA HEALTH,SENTARA HEALTH,2486.28,,,,,,,109.0000,9633.0000,percent of total billed charges,"25.81% of $9,633.00 in Billed Charges for Rev 450 Proc 26075 = $2,486.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,SENTARA HEALTH,SENTARA MEDICARE,2968.60,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9633.00,,,,,,,109.0000,9633.0000,percent of total billed charges,"100% of $9,633.00 in Billed Charges for Rev 450 Proc 26075 = $9,633.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,9633.0000,case rate,Rev 450 Proc 26075 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,9633.0000,case rate,Rev 450 Proc 26075 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,9633.0000,case rate,Rev 450 Proc 26075 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,9633.0000,case rate,Rev 450 Proc 26075 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1890.65,,,,,,,109.0000,9633.0000,fee schedule,"APG 00033 Proc 26075 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 103% = $1,890.65. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2968.60,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2968.60,,,,,,,109.0000,9633.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,WELLCARE,WELLCARE MEDICAID,9633.00,,,,,,,109.0000,9633.0000,percent of total billed charges,"100% of $9,633.00 in Billed Charges for Rev 450 Proc 26075 = $9,633.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROTOMY W EXPL DRNG/RMVL FB MCP JT EA,26075,CPT,450,RC,45000388,CDM,,,,both,,,9633.0000,1444.9500,WELLCARE,WELLCARE MEDICARE,3146.72,,,,,,,109.0000,9633.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA,2059.42,,,,,,,109.0000,4823.0000,percent of total billed charges,"42.7% of $4,823.00 in Billed Charges for Rev 450 Proc 26080 = $2,059.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1909.01,,,,,,,109.0000,4823.0000,fee schedule,"APG 00033 Proc 26080 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 104% = $1,909.01. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,4823.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,4823.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1890.65,,,,,,,109.0000,4823.0000,fee schedule,"APG 00033 Proc 26080 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 103% = $1,890.65. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,4823.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4489.34,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,311.54,,,,,,,109.0000,4823.0000,fee schedule,$311.54 from Fee Schedule BLDTM_23 for Rev 450 Proc 26080 * Qty 1 = $311.54 at 100% = $311.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,4823.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4340.70,,,,,,,109.0000,4823.0000,percent of total billed charges,"90% of $4,823.00 in Billed Charges for Rev 450 Proc 26080 = $4,340.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,MEDCOST,MEDCOST VHN,2295.27,,,,,,,109.0000,4823.0000,percent of total billed charges,"47.59% of $4,823.00 in Billed Charges for Rev 450 Proc 26080 = $2,295.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1927.36,,,,,,,109.0000,4823.0000,fee schedule,"APG 00033 Proc 26080 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 100% = $1,835.58... $1,835.58 at 105% = $1,927.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1892.48,,,,,,,109.0000,4823.0000,fee schedule,"APG 00033 Proc 26080 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 100% = $1,835.58... $1,835.58 at 103.1% = $1,892.48 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,SENTARA HEALTH,SENTARA HEALTH,1244.82,,,,,,,109.0000,4823.0000,percent of total billed charges,"25.81% of $4,823.00 in Billed Charges for Rev 450 Proc 26080 = $1,244.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4823.00,,,,,,,109.0000,4823.0000,percent of total billed charges,"100% of $4,823.00 in Billed Charges for Rev 450 Proc 26080 = $4,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 26080 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 26080 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 26080 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 26080 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1890.65,,,,,,,109.0000,4823.0000,fee schedule,"APG 00033 Proc 26080 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 103% = $1,890.65. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,WELLCARE,WELLCARE MEDICAID,4823.00,,,,,,,109.0000,4823.0000,percent of total billed charges,"100% of $4,823.00 in Billed Charges for Rev 450 Proc 26080 = $4,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ARTHROTOMY W EXPL DRNG/RMVL FB IP JT EA,26080,CPT,450,RC,45000389,CDM,,,,both,,,4823.0000,723.4500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,4823.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,AETNA,AETNA,1924.49,,,,,,,233.5400,4507.0000,percent of total billed charges,"42.7% of $4,507.00 in Billed Charges for Rev 521 Proc 26115 = $1,924.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1909.01,,,,,,,233.5400,4507.0000,fee schedule,"APG 00033 Proc 26115 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 104% = $1,909.01. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,233.5400,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,233.5400,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,233.5400,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,AMBETTER,AMBETTER,3266.63,,,,,,,233.5400,4507.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,233.5400,4507.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,ANTHEM EXCHANGE,3689.28,,,,,,,233.5400,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1890.65,,,,,,,233.5400,4507.0000,fee schedule,"APG 00033 Proc 26115 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 103% = $1,890.65. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,ANTHEM HMO,3919.64,,,,,,,233.5400,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,233.5400,4507.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4507.00,,,,,,,233.5400,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,233.54,,,,,,,233.5400,4507.0000,fee schedule,$233.54 from Fee Schedule BLDTM_23 for Rev 521 Proc 26115 * Qty 1 = $233.54 at 100% = $233.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,233.5400,4507.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,CIGNA HEALTHCARE,CIGNA HMO,1879.42,,,,,,,233.5400,4507.0000,percent of total billed charges,"41.7% of $4,507.00 in Billed Charges for Rev 521 Proc 26115 = $1,879.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2091.25,,,,,,,233.5400,4507.0000,percent of total billed charges,"46.4% of $4,507.00 in Billed Charges for Rev 521 Proc 26115 = $2,091.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,233.5400,4507.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1879.42,,,,,,,233.5400,4507.0000,percent of total billed charges,"41.7% of $4,507.00 in Billed Charges for Rev 521 Proc 26115 = $1,879.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,CIGNA HEALTHCARE,CIGNA PPO,1879.42,,,,,,,233.5400,4507.0000,percent of total billed charges,"41.7% of $4,507.00 in Billed Charges for Rev 521 Proc 26115 = $1,879.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,233.5400,4507.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4056.30,,,,,,,233.5400,4507.0000,percent of total billed charges,"90% of $4,507.00 in Billed Charges for Rev 521 Proc 26115 = $4,056.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,233.5400,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,233.5400,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,MEDCOST,MEDCOST VHN,2144.88,,,,,,,233.5400,4507.0000,percent of total billed charges,"47.59% of $4,507.00 in Billed Charges for Rev 521 Proc 26115 = $2,144.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1927.36,,,,,,,233.5400,4507.0000,fee schedule,"APG 00033 Proc 26115 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 100% = $1,835.58... $1,835.58 at 105% = $1,927.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,233.5400,4507.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,233.5400,4507.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,233.5400,4507.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1892.48,,,,,,,233.5400,4507.0000,fee schedule,"APG 00033 Proc 26115 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 100% = $1,835.58... $1,835.58 at 103.1% = $1,892.48 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,SENTARA HEALTH,SENTARA HEALTH,1163.26,,,,,,,233.5400,4507.0000,percent of total billed charges,"25.81% of $4,507.00 in Billed Charges for Rev 521 Proc 26115 = $1,163.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,233.5400,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4507.00,,,,,,,233.5400,4507.0000,percent of total billed charges,"100% of $4,507.00 in Billed Charges for Rev 521 Proc 26115 = $4,507.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,670.71,,,,,,,233.5400,4507.0000,fee schedule,"$1,341.41 from Fee Schedule TCUHC24 for Rev 521 Proc 26115 * Qty 1 = $1,341.41 at 50% = $670.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1890.65,,,,,,,233.5400,4507.0000,fee schedule,"APG 00033 Proc 26115 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 103% = $1,890.65. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,233.5400,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,233.5400,4507.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,WELLCARE,WELLCARE MEDICAID,4507.00,,,,,,,233.5400,4507.0000,percent of total billed charges,"100% of $4,507.00 in Billed Charges for Rev 521 Proc 26115 = $4,507.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ LESS THAN 1.5 CM,26115,CPT,521,RC,52100090,CDM,,,,both,,,4507.0000,676.0500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,233.5400,4507.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,AETNA,AETNA,1970.61,,,,,,,890.0000,4615.0000,percent of total billed charges,"42.7% of $4,615.00 in Billed Charges for Rev 360 Proc 26236 = $1,970.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1909.01,,,,,,,890.0000,4615.0000,fee schedule,"APG 00033 Proc 26236 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 104% = $1,909.01. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,890.0000,4615.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,890.0000,4615.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,890.0000,4615.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,AMBETTER,AMBETTER,3180.38,,,,,,,890.0000,4615.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,890.0000,4615.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,890.0000,4615.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1890.65,,,,,,,890.0000,4615.0000,fee schedule,"APG 00033 Proc 26236 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 103% = $1,890.65. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,890.0000,4615.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,890.0000,4615.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4489.34,,,,,,,890.0000,4615.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1082.00,,,,,,,890.0000,4615.0000,case rate,"Rev 360 Proc 26236 ASG Rate of $1,082.00 at 100% of $1,082.00 = $1,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,890.0000,4615.0000,case rate,"Rev 360 Proc 26236 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,890.0000,4615.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,890.0000,4615.0000,case rate,"Rev 360 Proc 26236 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,890.0000,4615.0000,case rate,"Rev 360 Proc 26236 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,BLUE CROSS,TENNCARE BLUE CARE,890.00,,,,,,,890.0000,4615.0000,case rate,Rev 360 Proc 26236 ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,BLUE CROSS,TENNCARE BLUE SELECT,890.00,,,,,,,890.0000,4615.0000,case rate,Rev 360 Proc 26236 ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,CIGNA HEALTHCARE,CIGNA HMO,2967.00,,,,,,,890.0000,4615.0000,case rate,"Rev 360 Proc 26236 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2246.00,,,,,,,890.0000,4615.0000,case rate,"Rev 360 Proc 26236 ASG Rate of $2,246.00 at 100% of $2,246.00 = $2,246.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,890.0000,4615.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2967.00,,,,,,,890.0000,4615.0000,case rate,"Rev 360 Proc 26236 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,CIGNA HEALTHCARE,CIGNA PPO,2967.00,,,,,,,890.0000,4615.0000,case rate,"Rev 360 Proc 26236 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,890.0000,4615.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4153.50,,,,,,,890.0000,4615.0000,percent of total billed charges,"90% of $4,615.00 in Billed Charges for Rev 360 Proc 26236 = $4,153.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,890.0000,4615.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,890.0000,4615.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,MEDCOST,MEDCOST VHN,2196.28,,,,,,,890.0000,4615.0000,percent of total billed charges,"47.59% of $4,615.00 in Billed Charges for Rev 360 Proc 26236 = $2,196.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1927.36,,,,,,,890.0000,4615.0000,fee schedule,"APG 00033 Proc 26236 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 100% = $1,835.58... $1,835.58 at 105% = $1,927.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,890.0000,4615.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,890.0000,4615.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,890.0000,4615.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1892.48,,,,,,,890.0000,4615.0000,fee schedule,"APG 00033 Proc 26236 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 100% = $1,835.58... $1,835.58 at 103.1% = $1,892.48 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,SENTARA HEALTH,SENTARA HEALTH,1191.13,,,,,,,890.0000,4615.0000,percent of total billed charges,"25.81% of $4,615.00 in Billed Charges for Rev 360 Proc 26236 = $1,191.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,890.0000,4615.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4615.00,,,,,,,890.0000,4615.0000,percent of total billed charges,"100% of $4,615.00 in Billed Charges for Rev 360 Proc 26236 = $4,615.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,890.0000,4615.0000,case rate,Rev 360 Proc 26236 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,890.0000,4615.0000,case rate,"Rev 360 Proc 26236 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,890.0000,4615.0000,case rate,"Rev 360 Proc 26236 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,890.0000,4615.0000,case rate,"Rev 360 Proc 26236 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1890.65,,,,,,,890.0000,4615.0000,fee schedule,"APG 00033 Proc 26236 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 103% = $1,890.65. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,890.0000,4615.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,890.0000,4615.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,WELLCARE,WELLCARE MEDICAID,4615.00,,,,,,,890.0000,4615.0000,percent of total billed charges,"100% of $4,615.00 in Billed Charges for Rev 360 Proc 26236 = $4,615.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PARTIAL EXCISION DISTAL PHALANX FINGER,26236,CPT,360,RC,36000268,CDM,,,,both,,,4615.0000,692.2500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,890.0000,4615.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,AETNA,AETNA,1009.86,,,,,,,109.0000,3180.3800,percent of total billed charges,"42.7% of $2,365.00 in Billed Charges for Rev 450 Proc 26418 = $1,009.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1909.01,,,,,,,109.0000,3180.3800,fee schedule,"APG 00033 Proc 26418 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 104% = $1,909.01. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,3180.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,BLUE CROSS,ANTHEM EXCHANGE,2365.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1890.65,,,,,,,109.0000,3180.3800,fee schedule,"APG 00033 Proc 26418 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 103% = $1,890.65. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,BLUE CROSS,ANTHEM HMO,2365.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,3180.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2365.00,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,335.87,,,,,,,109.0000,3180.3800,fee schedule,$335.87 from Fee Schedule BLDTM_23 for Rev 450 Proc 26418 * Qty 1 = $335.87 at 100% = $335.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2128.50,,,,,,,109.0000,3180.3800,percent of total billed charges,"90% of $2,365.00 in Billed Charges for Rev 450 Proc 26418 = $2,128.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,MEDCOST,MEDCOST VHN,1125.50,,,,,,,109.0000,3180.3800,percent of total billed charges,"47.59% of $2,365.00 in Billed Charges for Rev 450 Proc 26418 = $1,125.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1927.36,,,,,,,109.0000,3180.3800,fee schedule,"APG 00033 Proc 26418 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 100% = $1,835.58... $1,835.58 at 105% = $1,927.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1892.48,,,,,,,109.0000,3180.3800,fee schedule,"APG 00033 Proc 26418 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 100% = $1,835.58... $1,835.58 at 103.1% = $1,892.48 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,SENTARA HEALTH,SENTARA HEALTH,610.41,,,,,,,109.0000,3180.3800,percent of total billed charges,"25.81% of $2,365.00 in Billed Charges for Rev 450 Proc 26418 = $610.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2365.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $2,365.00 in Billed Charges for Rev 450 Proc 26418 = $2,365.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 26418 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 26418 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 26418 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3180.3800,case rate,Rev 450 Proc 26418 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1890.65,,,,,,,109.0000,3180.3800,fee schedule,"APG 00033 Proc 26418 at $836.60 (Base Rate) * 2.1941 (Relative Weight) = $1,835.58 (Total Line Payment) at 103% = $1,890.65. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,WELLCARE,WELLCARE MEDICAID,2365.00,,,,,,,109.0000,3180.3800,percent of total billed charges,"100% of $2,365.00 in Billed Charges for Rev 450 Proc 26418 = $2,365.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR EXTENSOR TENDON FINGER,26418,CPT,450,RC,45000143,CDM,,,,both,,,2365.0000,354.7500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,3180.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA,2059.42,,,,,,,109.0000,4823.0000,percent of total billed charges,"42.7% of $4,823.00 in Billed Charges for Rev 450 Proc 26645 = $2,059.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 26645 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,4823.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,4823.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 26645 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,4823.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4489.34,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,270.80,,,,,,,109.0000,4823.0000,fee schedule,$270.80 from Fee Schedule BLDTM_23 for Rev 450 Proc 26645 * Qty 1 = $270.80 at 100% = $270.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,4823.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4340.70,,,,,,,109.0000,4823.0000,percent of total billed charges,"90% of $4,823.00 in Billed Charges for Rev 450 Proc 26645 = $4,340.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,MEDCOST,MEDCOST VHN,2295.27,,,,,,,109.0000,4823.0000,percent of total billed charges,"47.59% of $4,823.00 in Billed Charges for Rev 450 Proc 26645 = $2,295.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 26645 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 26645 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,SENTARA HEALTH,SENTARA HEALTH,1244.82,,,,,,,109.0000,4823.0000,percent of total billed charges,"25.81% of $4,823.00 in Billed Charges for Rev 450 Proc 26645 = $1,244.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4823.00,,,,,,,109.0000,4823.0000,percent of total billed charges,"100% of $4,823.00 in Billed Charges for Rev 450 Proc 26645 = $4,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 26645 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 26645 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 26645 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 26645 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,4823.0000,fee schedule,APG 00041 Proc 26645 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,WELLCARE,WELLCARE MEDICAID,4823.00,,,,,,,109.0000,4823.0000,percent of total billed charges,"100% of $4,823.00 in Billed Charges for Rev 450 Proc 26645 = $4,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX CMC FX DISLOC THUMB W MANIP,26645,CPT,450,RC,45000390,CDM,,,,both,,,4823.0000,723.4500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,4823.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,AETNA,AETNA,369.78,,,,,,,109.0000,866.0000,percent of total billed charges,42.7% of $866.00 in Billed Charges for Rev 450 Proc 26670 = $369.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,866.0000,fee schedule,"APG 00041 Proc 26670 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,866.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,866.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,866.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,866.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,866.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,866.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,866.0000,fee schedule,"APG 00041 Proc 26670 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,866.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,866.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,866.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,203.96,,,,,,,109.0000,866.0000,fee schedule,$203.96 from Fee Schedule BLDTM_23 for Rev 450 Proc 26670 * Qty 1 = $203.96 at 100% = $203.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,866.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,866.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,866.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,779.40,,,,,,,109.0000,866.0000,percent of total billed charges,90% of $866.00 in Billed Charges for Rev 450 Proc 26670 = $779.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,866.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,866.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,MEDCOST,MEDCOST VHN,412.13,,,,,,,109.0000,866.0000,percent of total billed charges,47.59% of $866.00 in Billed Charges for Rev 450 Proc 26670 = $412.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,866.0000,fee schedule,"APG 00041 Proc 26670 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,866.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,866.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,866.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,866.0000,fee schedule,"APG 00041 Proc 26670 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,SENTARA HEALTH,SENTARA HEALTH,223.51,,,,,,,109.0000,866.0000,percent of total billed charges,25.81% of $866.00 in Billed Charges for Rev 450 Proc 26670 = $223.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,866.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",866.00,,,,,,,109.0000,866.0000,percent of total billed charges,100% of $866.00 in Billed Charges for Rev 450 Proc 26670 = $866.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,866.0000,case rate,Rev 450 Proc 26670 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,866.0000,case rate,Rev 450 Proc 26670 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,866.0000,case rate,Rev 450 Proc 26670 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,866.0000,case rate,Rev 450 Proc 26670 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,866.0000,fee schedule,"APG 00041 Proc 26670 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,866.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,866.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,WELLCARE,WELLCARE MEDICAID,866.00,,,,,,,109.0000,866.0000,percent of total billed charges,100% of $866.00 in Billed Charges for Rev 450 Proc 26670 = $866.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX CARPMETA DISL W MAN,26670,CPT,450,RC,45000147,CDM,,,,both,,,866.0000,129.9000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,866.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WAND TONSIL PROCISE LW EICA 7070-01,272,RC,27200002,CDM,,,,,,both,,,9413.6500,1412.0500,AETNA,AETNA,4019.63,,,,,,,2429.6600,9413.6500,percent of total billed charges,"42.7% of $9,413.65 in Billed Charges for Rev 272 = $4,019.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE LW EICA 7070-01,272,RC,27200002,CDM,,,,,,both,,,9413.6500,1412.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6589.56,,,,,,,2429.6600,9413.6500,percent of total billed charges,"Rev 272 $9,413.65 in Billed Charges at 70% = $6,589.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE LW EICA 7070-01,272,RC,27200002,CDM,,,,,,both,,,9413.6500,1412.0500,CIGNA HEALTHCARE,CIGNA HMO,3925.49,,,,,,,2429.6600,9413.6500,percent of total billed charges,"41.7% of $9,413.65 in Billed Charges for Rev 272 = $3,925.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE LW EICA 7070-01,272,RC,27200002,CDM,,,,,,both,,,9413.6500,1412.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4367.93,,,,,,,2429.6600,9413.6500,percent of total billed charges,"46.4% of $9,413.65 in Billed Charges for Rev 272 = $4,367.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE LW EICA 7070-01,272,RC,27200002,CDM,,,,,,both,,,9413.6500,1412.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3925.49,,,,,,,2429.6600,9413.6500,percent of total billed charges,"41.7% of $9,413.65 in Billed Charges for Rev 272 = $3,925.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE LW EICA 7070-01,272,RC,27200002,CDM,,,,,,both,,,9413.6500,1412.0500,CIGNA HEALTHCARE,CIGNA PPO,3925.49,,,,,,,2429.6600,9413.6500,percent of total billed charges,"41.7% of $9,413.65 in Billed Charges for Rev 272 = $3,925.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE LW EICA 7070-01,272,RC,27200002,CDM,,,,,,both,,,9413.6500,1412.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8472.29,,,,,,,2429.6600,9413.6500,percent of total billed charges,"90% of $9,413.65 in Billed Charges for Rev 272 = $8,472.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE LW EICA 7070-01,272,RC,27200002,CDM,,,,,,both,,,9413.6500,1412.0500,MEDCOST,MEDCOST VHN,4479.96,,,,,,,2429.6600,9413.6500,percent of total billed charges,"47.59% of $9,413.65 in Billed Charges for Rev 272 = $4,479.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE LW EICA 7070-01,272,RC,27200002,CDM,,,,,,both,,,9413.6500,1412.0500,SENTARA HEALTH,SENTARA HEALTH,2429.66,,,,,,,2429.6600,9413.6500,percent of total billed charges,"25.81% of $9,413.65 in Billed Charges for Rev 272 = $2,429.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE LW EICA 7070-01,272,RC,27200002,CDM,,,,,,both,,,9413.6500,1412.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9413.65,,,,,,,2429.6600,9413.6500,percent of total billed charges,"100% of $9,413.65 in Billed Charges for Rev 272 = $9,413.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE LW EICA 7070-01,272,RC,27200002,CDM,,,,,,both,,,9413.6500,1412.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4706.83,,,,,,,2429.6600,9413.6500,percent of total billed charges,"Rev 272 $9,413.65 in Billed Charges at 50% = $4,706.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE LW EICA 7070-01,272,RC,27200002,CDM,,,,,,both,,,9413.6500,1412.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3040.61,,,,,,,2429.6600,9413.6500,other,"32.3% of $9,413.65 in Billed Charges for Rev 272 = $3,040.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND TONSIL PROCISE LW EICA 7070-01,272,RC,27200002,CDM,,,,,,both,,,9413.6500,1412.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2889.99,,,,,,,2429.6600,9413.6500,other,"30.7% of $9,413.65 in Billed Charges for Rev 272 = $2,889.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND TONSIL PROCISE LW EICA 7070-01,272,RC,27200002,CDM,,,,,,both,,,9413.6500,1412.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,3040.61,,,,,,,2429.6600,9413.6500,percent of total billed charges,"32.3% of $9,413.65 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE LW EICA 7070-01,272,RC,27200002,CDM,,,,,,both,,,9413.6500,1412.0500,WELLCARE,WELLCARE MEDICAID,9413.65,,,,,,,2429.6600,9413.6500,percent of total billed charges,"100% of $9,413.65 in Billed Charges for Rev 272 = $9,413.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE MLW EICA7071-01,272,RC,27200002,CDM,,,,,,both,,,9884.2900,1482.6400,AETNA,AETNA,4220.59,,,,,,,2551.1400,9884.2900,percent of total billed charges,"42.7% of $9,884.29 in Billed Charges for Rev 272 = $4,220.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE MLW EICA7071-01,272,RC,27200002,CDM,,,,,,both,,,9884.2900,1482.6400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6919.00,,,,,,,2551.1400,9884.2900,percent of total billed charges,"Rev 272 $9,884.29 in Billed Charges at 70% = $6,919.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE MLW EICA7071-01,272,RC,27200002,CDM,,,,,,both,,,9884.2900,1482.6400,CIGNA HEALTHCARE,CIGNA HMO,4121.75,,,,,,,2551.1400,9884.2900,percent of total billed charges,"41.7% of $9,884.29 in Billed Charges for Rev 272 = $4,121.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE MLW EICA7071-01,272,RC,27200002,CDM,,,,,,both,,,9884.2900,1482.6400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4586.31,,,,,,,2551.1400,9884.2900,percent of total billed charges,"46.4% of $9,884.29 in Billed Charges for Rev 272 = $4,586.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE MLW EICA7071-01,272,RC,27200002,CDM,,,,,,both,,,9884.2900,1482.6400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4121.75,,,,,,,2551.1400,9884.2900,percent of total billed charges,"41.7% of $9,884.29 in Billed Charges for Rev 272 = $4,121.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE MLW EICA7071-01,272,RC,27200002,CDM,,,,,,both,,,9884.2900,1482.6400,CIGNA HEALTHCARE,CIGNA PPO,4121.75,,,,,,,2551.1400,9884.2900,percent of total billed charges,"41.7% of $9,884.29 in Billed Charges for Rev 272 = $4,121.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE MLW EICA7071-01,272,RC,27200002,CDM,,,,,,both,,,9884.2900,1482.6400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8895.86,,,,,,,2551.1400,9884.2900,percent of total billed charges,"90% of $9,884.29 in Billed Charges for Rev 272 = $8,895.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE MLW EICA7071-01,272,RC,27200002,CDM,,,,,,both,,,9884.2900,1482.6400,MEDCOST,MEDCOST VHN,4703.93,,,,,,,2551.1400,9884.2900,percent of total billed charges,"47.59% of $9,884.29 in Billed Charges for Rev 272 = $4,703.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE MLW EICA7071-01,272,RC,27200002,CDM,,,,,,both,,,9884.2900,1482.6400,SENTARA HEALTH,SENTARA HEALTH,2551.14,,,,,,,2551.1400,9884.2900,percent of total billed charges,"25.81% of $9,884.29 in Billed Charges for Rev 272 = $2,551.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE MLW EICA7071-01,272,RC,27200002,CDM,,,,,,both,,,9884.2900,1482.6400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9884.29,,,,,,,2551.1400,9884.2900,percent of total billed charges,"100% of $9,884.29 in Billed Charges for Rev 272 = $9,884.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE MLW EICA7071-01,272,RC,27200002,CDM,,,,,,both,,,9884.2900,1482.6400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4942.15,,,,,,,2551.1400,9884.2900,percent of total billed charges,"Rev 272 $9,884.29 in Billed Charges at 50% = $4,942.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE MLW EICA7071-01,272,RC,27200002,CDM,,,,,,both,,,9884.2900,1482.6400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3192.63,,,,,,,2551.1400,9884.2900,other,"32.3% of $9,884.29 in Billed Charges for Rev 272 = $3,192.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND TONSIL PROCISE MLW EICA7071-01,272,RC,27200002,CDM,,,,,,both,,,9884.2900,1482.6400,UNITED HEALTHCARE,UHC HERITAGE SELECT,3034.48,,,,,,,2551.1400,9884.2900,other,"30.7% of $9,884.29 in Billed Charges for Rev 272 = $3,034.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND TONSIL PROCISE MLW EICA7071-01,272,RC,27200002,CDM,,,,,,both,,,9884.2900,1482.6400,UNITED HEALTHCARE,UNITED HEALTHCARE,3192.63,,,,,,,2551.1400,9884.2900,percent of total billed charges,"32.3% of $9,884.29 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND TONSIL PROCISE MLW EICA7071-01,272,RC,27200002,CDM,,,,,,both,,,9884.2900,1482.6400,WELLCARE,WELLCARE MEDICAID,9884.29,,,,,,,2551.1400,9884.2900,percent of total billed charges,"100% of $9,884.29 in Billed Charges for Rev 272 = $9,884.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR S ELECTRODE 4.0,272,RC,27200002,CDM,,,,,,both,,,3655.5700,548.3400,AETNA,AETNA,1560.93,,,,,,,943.5000,3655.5700,percent of total billed charges,"42.7% of $3,655.57 in Billed Charges for Rev 272 = $1,560.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR S ELECTRODE 4.0,272,RC,27200002,CDM,,,,,,both,,,3655.5700,548.3400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2558.90,,,,,,,943.5000,3655.5700,percent of total billed charges,"Rev 272 $3,655.57 in Billed Charges at 70% = $2,558.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR S ELECTRODE 4.0,272,RC,27200002,CDM,,,,,,both,,,3655.5700,548.3400,CIGNA HEALTHCARE,CIGNA HMO,1524.37,,,,,,,943.5000,3655.5700,percent of total billed charges,"41.7% of $3,655.57 in Billed Charges for Rev 272 = $1,524.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR S ELECTRODE 4.0,272,RC,27200002,CDM,,,,,,both,,,3655.5700,548.3400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1696.18,,,,,,,943.5000,3655.5700,percent of total billed charges,"46.4% of $3,655.57 in Billed Charges for Rev 272 = $1,696.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR S ELECTRODE 4.0,272,RC,27200002,CDM,,,,,,both,,,3655.5700,548.3400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1524.37,,,,,,,943.5000,3655.5700,percent of total billed charges,"41.7% of $3,655.57 in Billed Charges for Rev 272 = $1,524.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR S ELECTRODE 4.0,272,RC,27200002,CDM,,,,,,both,,,3655.5700,548.3400,CIGNA HEALTHCARE,CIGNA PPO,1524.37,,,,,,,943.5000,3655.5700,percent of total billed charges,"41.7% of $3,655.57 in Billed Charges for Rev 272 = $1,524.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR S ELECTRODE 4.0,272,RC,27200002,CDM,,,,,,both,,,3655.5700,548.3400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3290.01,,,,,,,943.5000,3655.5700,percent of total billed charges,"90% of $3,655.57 in Billed Charges for Rev 272 = $3,290.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR S ELECTRODE 4.0,272,RC,27200002,CDM,,,,,,both,,,3655.5700,548.3400,MEDCOST,MEDCOST VHN,1739.69,,,,,,,943.5000,3655.5700,percent of total billed charges,"47.59% of $3,655.57 in Billed Charges for Rev 272 = $1,739.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR S ELECTRODE 4.0,272,RC,27200002,CDM,,,,,,both,,,3655.5700,548.3400,SENTARA HEALTH,SENTARA HEALTH,943.50,,,,,,,943.5000,3655.5700,percent of total billed charges,"25.81% of $3,655.57 in Billed Charges for Rev 272 = $943.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR S ELECTRODE 4.0,272,RC,27200002,CDM,,,,,,both,,,3655.5700,548.3400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3655.57,,,,,,,943.5000,3655.5700,percent of total billed charges,"100% of $3,655.57 in Billed Charges for Rev 272 = $3,655.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR S ELECTRODE 4.0,272,RC,27200002,CDM,,,,,,both,,,3655.5700,548.3400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1827.79,,,,,,,943.5000,3655.5700,percent of total billed charges,"Rev 272 $3,655.57 in Billed Charges at 50% = $1,827.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR S ELECTRODE 4.0,272,RC,27200002,CDM,,,,,,both,,,3655.5700,548.3400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1180.75,,,,,,,943.5000,3655.5700,other,"32.3% of $3,655.57 in Billed Charges for Rev 272 = $1,180.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND VAPR S ELECTRODE 4.0,272,RC,27200002,CDM,,,,,,both,,,3655.5700,548.3400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1122.26,,,,,,,943.5000,3655.5700,other,"30.7% of $3,655.57 in Billed Charges for Rev 272 = $1,122.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND VAPR S ELECTRODE 4.0,272,RC,27200002,CDM,,,,,,both,,,3655.5700,548.3400,UNITED HEALTHCARE,UNITED HEALTHCARE,1180.75,,,,,,,943.5000,3655.5700,percent of total billed charges,"32.3% of $3,655.57 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND VAPR S ELECTRODE 4.0,272,RC,27200002,CDM,,,,,,both,,,3655.5700,548.3400,WELLCARE,WELLCARE MEDICAID,3655.57,,,,,,,943.5000,3655.5700,percent of total billed charges,"100% of $3,655.57 in Billed Charges for Rev 272 = $3,655.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA,353.13,,,,,,,109.0000,827.0000,percent of total billed charges,42.7% of $827.00 in Billed Charges for Rev 450 Proc 26740 = $353.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 26740 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,827.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 26740 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,827.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,119.68,,,,,,,109.0000,827.0000,fee schedule,$119.68 from Fee Schedule BLDTM_23 for Rev 450 Proc 26740 * Qty 1 = $119.68 at 100% = $119.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,744.30,,,,,,,109.0000,827.0000,percent of total billed charges,90% of $827.00 in Billed Charges for Rev 450 Proc 26740 = $744.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,MEDCOST,MEDCOST VHN,393.57,,,,,,,109.0000,827.0000,percent of total billed charges,47.59% of $827.00 in Billed Charges for Rev 450 Proc 26740 = $393.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 26740 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 26740 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA HEALTH,213.45,,,,,,,109.0000,827.0000,percent of total billed charges,25.81% of $827.00 in Billed Charges for Rev 450 Proc 26740 = $213.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",827.00,,,,,,,109.0000,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 26740 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 26740 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 26740 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 26740 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,827.00,,,,,,,109.0000,827.0000,case rate,"Rev 450 Proc 26740 at Case Rate $847.00 (Service Line reduced to $827.00, claim capped at $827.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 26740 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICAID,827.00,,,,,,,109.0000,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 26740 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX ARTCLR FX INVL MCP/IP JT W/O MANIP,26740,CPT,450,RC,45000391,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,827.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA,180.19,,,,,,,108.9200,3180.3800,percent of total billed charges,42.7% of $422.00 in Billed Charges for Rev 450 Proc 26742 = $180.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,108.9200,3180.3800,fee schedule,APG 00041 Proc 26742 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,422.00,,,,,,,108.9200,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,AETNA,AETNA HEALTHCARE MEDICARE,422.00,,,,,,,108.9200,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,422.00,,,,,,,108.9200,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,AMBETTER,AMBETTER,3180.38,,,,,,,108.9200,3180.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,422.00,,,,,,,108.9200,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM EXCHANGE,422.00,,,,,,,108.9200,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,422.00,,,,,,,108.9200,3180.3800,fee schedule,"APG 00041 Proc 26742 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM HMO,422.00,,,,,,,108.9200,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,422.00,,,,,,,108.9200,3180.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",422.00,,,,,,,108.9200,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,245.96,,,,,,,108.9200,3180.3800,fee schedule,$245.96 from Fee Schedule BLDTM_23 for Rev 450 Proc 26742 * Qty 1 = $245.96 at 100% = $245.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,108.9200,3180.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,422.00,,,,,,,108.9200,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,422.00,,,,,,,108.9200,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,379.80,,,,,,,108.9200,3180.3800,percent of total billed charges,90% of $422.00 in Billed Charges for Rev 450 Proc 26742 = $379.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,HUMANA,HUMANA MEDICARE,422.00,,,,,,,108.9200,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,422.00,,,,,,,108.9200,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,MEDCOST,MEDCOST VHN,200.83,,,,,,,108.9200,3180.3800,percent of total billed charges,47.59% of $422.00 in Billed Charges for Rev 450 Proc 26742 = $200.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,108.9200,3180.3800,fee schedule,APG 00041 Proc 26742 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,422.00,,,,,,,108.9200,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,422.00,,,,,,,108.9200,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,NHC ADVANTAGE,NHC ADVANTAGE,422.00,,,,,,,108.9200,3180.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,108.9200,3180.3800,fee schedule,APG 00041 Proc 26742 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA HEALTH,108.92,,,,,,,108.9200,3180.3800,percent of total billed charges,25.81% of $422.00 in Billed Charges for Rev 450 Proc 26742 = $108.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,SENTARA HEALTH,SENTARA MEDICARE,422.00,,,,,,,108.9200,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",422.00,,,,,,,108.9200,3180.3800,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 26742 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,108.9200,3180.3800,case rate,Rev 450 Proc 26742 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,422.00,,,,,,,108.9200,3180.3800,case rate,"Rev 450 Proc 26742 at Case Rate $491.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,422.00,,,,,,,108.9200,3180.3800,case rate,"Rev 450 Proc 26742 at Case Rate $471.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,422.00,,,,,,,108.9200,3180.3800,case rate,"Rev 450 Proc 26742 at Case Rate $847.00 (Service Line reduced to $422.00, claim capped at $422.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,108.9200,3180.3800,fee schedule,APG 00041 Proc 26742 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,422.00,,,,,,,108.9200,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,422.00,,,,,,,108.9200,3180.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICAID,422.00,,,,,,,108.9200,3180.3800,percent of total billed charges,100% of $422.00 in Billed Charges for Rev 450 Proc 26742 = $422.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOSED TX ARTICULAR FX W/MANIP,26742,CPT,450,RC,45000152,CDM,,,,both,,,422.0000,63.3000,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,108.9200,3180.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,AETNA,AETNA,130.24,,,,,,,47.0800,703.3600,percent of total billed charges,42.7% of $305.00 in Billed Charges for Rev 450 Proc 26750 = $130.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,47.0800,703.3600,fee schedule,"APG 00041 Proc 26750 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,47.0800,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,47.0800,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,47.0800,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,AMBETTER,AMBETTER,487.87,,,,,,,47.0800,703.3600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,47.0800,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,ANTHEM EXCHANGE,305.00,,,,,,,47.0800,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,305.00,,,,,,,47.0800,703.3600,fee schedule,"APG 00041 Proc 26750 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96 (Service Line reduced to $305.00, claim capped at $305.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,ANTHEM HMO,305.00,,,,,,,47.0800,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,47.0800,703.3600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",305.00,,,,,,,47.0800,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,100.86,,,,,,,47.0800,703.3600,fee schedule,$100.86 from Fee Schedule BLDTM_23 for Rev 450 Proc 26750 * Qty 1 = $100.86 at 100% = $100.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,47.0800,703.3600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,TENNCARE BLUE CARE,47.08,,,,,,,47.0800,703.3600,fee schedule,$40.59 from Fee Schedule TC_24 for Rev 450 Proc 26750 * Qty 1 = $40.59 at 116% = $47.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,BLUE CROSS,TENNCARE BLUE SELECT,47.08,,,,,,,47.0800,703.3600,fee schedule,$40.59 from Fee Schedule TC_24 for Rev 450 Proc 26750 * Qty 1 = $40.59 at 116% = $47.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,47.0800,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,47.0800,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,274.50,,,,,,,47.0800,703.3600,percent of total billed charges,90% of $305.00 in Billed Charges for Rev 450 Proc 26750 = $274.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,47.0800,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,47.0800,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,MEDCOST,MEDCOST VHN,145.15,,,,,,,47.0800,703.3600,percent of total billed charges,47.59% of $305.00 in Billed Charges for Rev 450 Proc 26750 = $145.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,47.0800,703.3600,fee schedule,"APG 00041 Proc 26750 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,47.0800,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,47.0800,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,47.0800,703.3600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,47.0800,703.3600,fee schedule,"APG 00041 Proc 26750 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,SENTARA HEALTH,SENTARA HEALTH,78.72,,,,,,,47.0800,703.3600,percent of total billed charges,25.81% of $305.00 in Billed Charges for Rev 450 Proc 26750 = $78.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,47.0800,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",305.00,,,,,,,47.0800,703.3600,percent of total billed charges,100% of $305.00 in Billed Charges for Rev 450 Proc 26750 = $305.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,47.0800,703.3600,case rate,Rev 450 Proc 26750 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,305.00,,,,,,,47.0800,703.3600,case rate,"Rev 450 Proc 26750 at Case Rate $491.00 (Service Line reduced to $305.00, claim capped at $305.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,305.00,,,,,,,47.0800,703.3600,case rate,"Rev 450 Proc 26750 at Case Rate $471.00 (Service Line reduced to $305.00, claim capped at $305.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,305.00,,,,,,,47.0800,703.3600,case rate,"Rev 450 Proc 26750 at Case Rate $847.00 (Service Line reduced to $305.00, claim capped at $305.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,47.0800,703.3600,fee schedule,"APG 00041 Proc 26750 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,47.0800,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,47.0800,703.3600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,WELLCARE,WELLCARE MEDICAID,305.00,,,,,,,47.0800,703.3600,percent of total billed charges,100% of $305.00 in Billed Charges for Rev 450 Proc 26750 = $305.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX DIS PHALANG FX WO MAN,26750,CPT,450,RC,45000153,CDM,,,,both,,,305.0000,45.7500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,47.0800,703.3600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WIRE POST SHORT,272,RC,,,,,,,,both,,,1815.9600,272.3900,AETNA,AETNA,775.41,,,,,,,468.7000,1815.9600,percent of total billed charges,"42.7% of $1,815.96 in Billed Charges for Rev 272 = $775.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIRE POST SHORT,272,RC,,,,,,,,both,,,1815.9600,272.3900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1271.17,,,,,,,468.7000,1815.9600,percent of total billed charges,"Rev 272 $1,815.96 in Billed Charges at 70% = $1,271.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIRE POST SHORT,272,RC,,,,,,,,both,,,1815.9600,272.3900,CIGNA HEALTHCARE,CIGNA HMO,757.26,,,,,,,468.7000,1815.9600,percent of total billed charges,"41.7% of $1,815.96 in Billed Charges for Rev 272 = $757.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIRE POST SHORT,272,RC,,,,,,,,both,,,1815.9600,272.3900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,842.61,,,,,,,468.7000,1815.9600,percent of total billed charges,"46.4% of $1,815.96 in Billed Charges for Rev 272 = $842.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIRE POST SHORT,272,RC,,,,,,,,both,,,1815.9600,272.3900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,757.26,,,,,,,468.7000,1815.9600,percent of total billed charges,"41.7% of $1,815.96 in Billed Charges for Rev 272 = $757.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIRE POST SHORT,272,RC,,,,,,,,both,,,1815.9600,272.3900,CIGNA HEALTHCARE,CIGNA PPO,757.26,,,,,,,468.7000,1815.9600,percent of total billed charges,"41.7% of $1,815.96 in Billed Charges for Rev 272 = $757.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIRE POST SHORT,272,RC,,,,,,,,both,,,1815.9600,272.3900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1634.36,,,,,,,468.7000,1815.9600,percent of total billed charges,"90% of $1,815.96 in Billed Charges for Rev 272 = $1,634.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIRE POST SHORT,272,RC,,,,,,,,both,,,1815.9600,272.3900,MEDCOST,MEDCOST VHN,864.22,,,,,,,468.7000,1815.9600,percent of total billed charges,"47.59% of $1,815.96 in Billed Charges for Rev 272 = $864.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIRE POST SHORT,272,RC,,,,,,,,both,,,1815.9600,272.3900,SENTARA HEALTH,SENTARA HEALTH,468.70,,,,,,,468.7000,1815.9600,percent of total billed charges,"25.81% of $1,815.96 in Billed Charges for Rev 272 = $468.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIRE POST SHORT,272,RC,,,,,,,,both,,,1815.9600,272.3900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1815.96,,,,,,,468.7000,1815.9600,percent of total billed charges,"100% of $1,815.96 in Billed Charges for Rev 272 = $1,815.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIRE POST SHORT,272,RC,,,,,,,,both,,,1815.9600,272.3900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,907.98,,,,,,,468.7000,1815.9600,percent of total billed charges,"Rev 272 $1,815.96 in Billed Charges at 50% = $907.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIRE POST SHORT,272,RC,,,,,,,,both,,,1815.9600,272.3900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,586.56,,,,,,,468.7000,1815.9600,other,"32.3% of $1,815.96 in Billed Charges for Rev 272 = $586.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WIRE POST SHORT,272,RC,,,,,,,,both,,,1815.9600,272.3900,UNITED HEALTHCARE,UHC HERITAGE SELECT,557.50,,,,,,,468.7000,1815.9600,other,"30.7% of $1,815.96 in Billed Charges for Rev 272 = $557.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WIRE POST SHORT,272,RC,,,,,,,,both,,,1815.9600,272.3900,UNITED HEALTHCARE,UNITED HEALTHCARE,586.56,,,,,,,468.7000,1815.9600,percent of total billed charges,"32.3% of $1,815.96 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WIRE POST SHORT,272,RC,,,,,,,,both,,,1815.9600,272.3900,WELLCARE,WELLCARE MEDICAID,1815.96,,,,,,,468.7000,1815.9600,percent of total billed charges,"100% of $1,815.96 in Billed Charges for Rev 272 = $1,815.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,AETNA,AETNA,744.26,,,,,,,29.8200,3266.6300,percent of total billed charges,"42.7% of $1,743.00 in Billed Charges for Rev 450 Proc 11420 = $744.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1775.80,,,,,,,29.8200,3266.6300,fee schedule,"APG 00010 Proc 11420 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 104% = $1,775.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,29.8200,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,29.8200,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,29.8200,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,AMBETTER,AMBETTER,3266.63,,,,,,,29.8200,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,29.8200,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,BLUE CROSS,ANTHEM EXCHANGE,1743.00,,,,,,,29.8200,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1743.00,,,,,,,29.8200,3266.6300,fee schedule,"APG 00010 Proc 11420 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73 (Service Line reduced to $1,743.00, claim capped at $1,743.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,BLUE CROSS,ANTHEM HMO,1743.00,,,,,,,29.8200,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,29.8200,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1743.00,,,,,,,29.8200,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,76.91,,,,,,,29.8200,3266.6300,fee schedule,$76.91 from Fee Schedule BLDTM_23 for Rev 450 Proc 11420 * Qty 1 = $76.91 at 100% = $76.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,29.8200,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,BLUE CROSS,TENNCARE BLUE CARE,29.82,,,,,,,29.8200,3266.6300,fee schedule,$25.71 from Fee Schedule TC_24 for Rev 450 Proc 11420 * Qty 1 = $25.71 at 116% = $29.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,BLUE CROSS,TENNCARE BLUE SELECT,29.82,,,,,,,29.8200,3266.6300,fee schedule,$25.71 from Fee Schedule TC_24 for Rev 450 Proc 11420 * Qty 1 = $25.71 at 116% = $29.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,29.8200,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,29.8200,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1568.70,,,,,,,29.8200,3266.6300,percent of total billed charges,"90% of $1,743.00 in Billed Charges for Rev 450 Proc 11420 = $1,568.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,29.8200,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,29.8200,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,MEDCOST,MEDCOST VHN,829.49,,,,,,,29.8200,3266.6300,percent of total billed charges,"47.59% of $1,743.00 in Billed Charges for Rev 450 Proc 11420 = $829.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1792.88,,,,,,,29.8200,3266.6300,fee schedule,"APG 00010 Proc 11420 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 105% = $1,792.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,29.8200,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,29.8200,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,29.8200,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1760.43,,,,,,,29.8200,3266.6300,fee schedule,"APG 00010 Proc 11420 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 103.1% = $1,760.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,SENTARA HEALTH,SENTARA HEALTH,449.87,,,,,,,29.8200,3266.6300,percent of total billed charges,"25.81% of $1,743.00 in Billed Charges for Rev 450 Proc 11420 = $449.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,29.8200,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1743.00,,,,,,,29.8200,3266.6300,percent of total billed charges,"100% of $1,743.00 in Billed Charges for Rev 450 Proc 11420 = $1,743.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,29.8200,3266.6300,case rate,Rev 450 Proc 11420 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,29.8200,3266.6300,case rate,Rev 450 Proc 11420 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,29.8200,3266.6300,case rate,Rev 450 Proc 11420 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,29.8200,3266.6300,case rate,Rev 450 Proc 11420 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1758.73,,,,,,,29.8200,3266.6300,fee schedule,"APG 00010 Proc 11420 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,29.8200,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,29.8200,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,WELLCARE,WELLCARE MEDICAID,1743.00,,,,,,,29.8200,3266.6300,percent of total billed charges,"100% of $1,743.00 in Billed Charges for Rev 450 Proc 11420 = $1,743.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<,11420,CPT,450,RC,45000301,CDM,,,,both,,,1743.0000,261.4500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,29.8200,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,AETNA,AETNA,109.74,,,,,,,42.3700,1400.5900,percent of total billed charges,42.7% of $257.00 in Billed Charges for Rev 510 Proc 11421 = $109.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,42.3700,1400.5900,fee schedule,"APG 00009 Proc 11421 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,257.00,,,,,,,42.3700,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,AETNA,AETNA HEALTHCARE MEDICARE,257.00,,,,,,,42.3700,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,257.00,,,,,,,42.3700,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,AMBETTER,AMBETTER,1400.59,,,,,,,42.3700,1400.5900,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,257.00,,,,,,,42.3700,1400.5900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,BLUE CROSS,ANTHEM EXCHANGE,257.00,,,,,,,42.3700,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,257.00,,,,,,,42.3700,1400.5900,fee schedule,"APG 00009 Proc 11421 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89 (Service Line reduced to $257.00, claim capped at $257.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,BLUE CROSS,ANTHEM HMO,257.00,,,,,,,42.3700,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,257.00,,,,,,,42.3700,1400.5900,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",257.00,,,,,,,42.3700,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,101.19,,,,,,,42.3700,1400.5900,fee schedule,$101.19 from Fee Schedule BLDTM_23 for Rev 510 Proc 11421 * Qty 1 = $101.19 at 100% = $101.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,42.3700,1400.5900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,BLUE CROSS,TENNCARE BLUE CARE,42.37,,,,,,,42.3700,1400.5900,fee schedule,$36.53 from Fee Schedule TC_24 for Rev 510 Proc 11421 * Qty 1 = $36.53 at 116% = $42.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,BLUE CROSS,TENNCARE BLUE SELECT,42.37,,,,,,,42.3700,1400.5900,fee schedule,$36.53 from Fee Schedule TC_24 for Rev 510 Proc 11421 * Qty 1 = $36.53 at 116% = $42.37 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,CIGNA HEALTHCARE,CIGNA HMO,107.17,,,,,,,42.3700,1400.5900,percent of total billed charges,41.7% of $257.00 in Billed Charges for Rev 510 Proc 11421 = $107.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,119.25,,,,,,,42.3700,1400.5900,percent of total billed charges,46.4% of $257.00 in Billed Charges for Rev 510 Proc 11421 = $119.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,257.00,,,,,,,42.3700,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,107.17,,,,,,,42.3700,1400.5900,percent of total billed charges,41.7% of $257.00 in Billed Charges for Rev 510 Proc 11421 = $107.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,CIGNA HEALTHCARE,CIGNA PPO,107.17,,,,,,,42.3700,1400.5900,percent of total billed charges,41.7% of $257.00 in Billed Charges for Rev 510 Proc 11421 = $107.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,257.00,,,,,,,42.3700,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,231.30,,,,,,,42.3700,1400.5900,percent of total billed charges,90% of $257.00 in Billed Charges for Rev 510 Proc 11421 = $231.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,HUMANA,HUMANA MEDICARE,257.00,,,,,,,42.3700,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,257.00,,,,,,,42.3700,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,MEDCOST,MEDCOST VHN,122.31,,,,,,,42.3700,1400.5900,percent of total billed charges,47.59% of $257.00 in Billed Charges for Rev 510 Proc 11421 = $122.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,42.3700,1400.5900,fee schedule,"APG 00009 Proc 11421 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,257.00,,,,,,,42.3700,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,257.00,,,,,,,42.3700,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,NHC ADVANTAGE,NHC ADVANTAGE,257.00,,,,,,,42.3700,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,42.3700,1400.5900,fee schedule,"APG 00009 Proc 11421 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,SENTARA HEALTH,SENTARA HEALTH,66.33,,,,,,,42.3700,1400.5900,percent of total billed charges,25.81% of $257.00 in Billed Charges for Rev 510 Proc 11421 = $66.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,SENTARA HEALTH,SENTARA MEDICARE,257.00,,,,,,,42.3700,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",257.00,,,,,,,42.3700,1400.5900,percent of total billed charges,100% of $257.00 in Billed Charges for Rev 510 Proc 11421 = $257.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,257.00,,,,,,,42.3700,1400.5900,fee schedule,$826.58 from Fee Schedule TCUHC24 for Rev 510 Proc 11421 * Qty 1 = $826.58 at 50% = $413.29 (Limited to $257.00 in Billed Charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,83.01,,,,,,,42.3700,1400.5900,other,32.3% of $257.00 in Billed Charges for Rev 510 Proc 11421 = $83.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,78.90,,,,,,,42.3700,1400.5900,other,30.7% of $257.00 in Billed Charges for Rev 510 Proc 11421 = $78.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,83.01,,,,,,,42.3700,1400.5900,percent of total billed charges,32.3% of $257.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,42.3700,1400.5900,fee schedule,"APG 00009 Proc 11421 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,257.00,,,,,,,42.3700,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,257.00,,,,,,,42.3700,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,WELLCARE,WELLCARE MEDICAID,257.00,,,,,,,42.3700,1400.5900,percent of total billed charges,100% of $257.00 in Billed Charges for Rev 510 Proc 11421 = $257.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC SKIN BENIG 0.6-1 CM REMAINDR BODY,11421,CPT,510,RC,51000118,CDM,,,,both,,,257.0000,38.5500,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,42.3700,1400.5900,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,AETNA,AETNA,2156.78,,,,,,,97.5700,5745.1200,percent of total billed charges,"42.7% of $5,051.00 in Billed Charges for Rev 450 Proc 27086 = $2,156.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2612.63,,,,,,,97.5700,5745.1200,fee schedule,"APG 00051 Proc 27086 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 104% = $2,612.63. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2635.37,,,,,,,97.5700,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,AETNA,AETNA HEALTHCARE MEDICARE,2635.37,,,,,,,97.5700,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,2635.37,,,,,,,97.5700,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,AMBETTER,AMBETTER,5745.12,,,,,,,97.5700,5745.1200,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2740.79,,,,,,,97.5700,5745.1200,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,BLUE CROSS,ANTHEM EXCHANGE,5051.00,,,,,,,97.5700,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2587.51,,,,,,,97.5700,5745.1200,fee schedule,"APG 00051 Proc 27086 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,BLUE CROSS,ANTHEM HMO,5051.00,,,,,,,97.5700,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2714.44,,,,,,,97.5700,5745.1200,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5051.00,,,,,,,97.5700,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,97.57,,,,,,,97.5700,5745.1200,fee schedule,$97.57 from Fee Schedule BLDTM_23 for Rev 450 Proc 27086 * Qty 1 = $97.57 at 100% = $97.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,BLUE CROSS,BLUE CROSS MEDICARE,2740.79,,,,,,,97.5700,5745.1200,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,2767.14,,,,,,,97.5700,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,2767.14,,,,,,,97.5700,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4545.90,,,,,,,97.5700,5745.1200,percent of total billed charges,"90% of $5,051.00 in Billed Charges for Rev 450 Proc 27086 = $4,545.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,HUMANA,HUMANA MEDICARE,2635.37,,,,,,,97.5700,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2635.37,,,,,,,97.5700,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,MEDCOST,MEDCOST VHN,2403.77,,,,,,,97.5700,5745.1200,percent of total billed charges,"47.59% of $5,051.00 in Billed Charges for Rev 450 Proc 27086 = $2,403.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2637.75,,,,,,,97.5700,5745.1200,fee schedule,"APG 00051 Proc 27086 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 105% = $2,637.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,2767.14,,,,,,,97.5700,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,2767.14,,,,,,,97.5700,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,NHC ADVANTAGE,NHC ADVANTAGE,2767.14,,,,,,,97.5700,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2590.02,,,,,,,97.5700,5745.1200,fee schedule,"APG 00051 Proc 27086 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 103.1% = $2,590.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,SENTARA HEALTH,SENTARA HEALTH,1303.66,,,,,,,97.5700,5745.1200,percent of total billed charges,"25.81% of $5,051.00 in Billed Charges for Rev 450 Proc 27086 = $1,303.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,SENTARA HEALTH,SENTARA MEDICARE,2635.37,,,,,,,97.5700,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5051.00,,,,,,,97.5700,5745.1200,percent of total billed charges,"100% of $5,051.00 in Billed Charges for Rev 450 Proc 27086 = $5,051.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,97.5700,5745.1200,case rate,Rev 450 Proc 27086 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,97.5700,5745.1200,case rate,Rev 450 Proc 27086 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,97.5700,5745.1200,case rate,Rev 450 Proc 27086 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,97.5700,5745.1200,case rate,Rev 450 Proc 27086 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2587.51,,,,,,,97.5700,5745.1200,fee schedule,"APG 00051 Proc 27086 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2635.37,,,,,,,97.5700,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2635.37,,,,,,,97.5700,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,WELLCARE,WELLCARE MEDICAID,5051.00,,,,,,,97.5700,5745.1200,percent of total billed charges,"100% of $5,051.00 in Billed Charges for Rev 450 Proc 27086 = $5,051.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL FB PELVIS/HIP SUBCU,27086,CPT,450,RC,45000392,CDM,,,,both,,,5051.0000,757.6500,WELLCARE,WELLCARE MEDICARE,2793.50,,,,,,,97.5700,5745.1200,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA,699.85,,,,,,,109.0000,1639.0000,percent of total billed charges,"42.7% of $1,639.00 in Billed Charges for Rev 450 Proc 30905 = $699.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,265.28,,,,,,,109.0000,1639.0000,fee schedule,"APG 00249 Proc 30905 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 104% = $265.28. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,120.71,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA HEALTHCARE MEDICARE,120.71,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,120.71,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,AMBETTER,AMBETTER,263.15,,,,,,,109.0000,1639.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,125.54,,,,,,,109.0000,1639.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM EXCHANGE,297.21,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,262.73,,,,,,,109.0000,1639.0000,fee schedule,"APG 00249 Proc 30905 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 103% = $262.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM HMO,315.76,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,124.33,,,,,,,109.0000,1639.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",371.47,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,117.78,,,,,,,109.0000,1639.0000,fee schedule,$117.78 from Fee Schedule BLDTM_23 for Rev 450 Proc 30905 * Qty 1 = $117.78 at 100% = $117.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,BLUE CROSS MEDICARE,125.54,,,,,,,109.0000,1639.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,126.75,,,,,,,109.0000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,126.75,,,,,,,109.0000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1475.10,,,,,,,109.0000,1639.0000,percent of total billed charges,"90% of $1,639.00 in Billed Charges for Rev 450 Proc 30905 = $1,475.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,HUMANA,HUMANA MEDICARE,120.71,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,120.71,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,MEDCOST,MEDCOST VHN,780.00,,,,,,,109.0000,1639.0000,percent of total billed charges,"47.59% of $1,639.00 in Billed Charges for Rev 450 Proc 30905 = $780.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,267.83,,,,,,,109.0000,1639.0000,fee schedule,"APG 00249 Proc 30905 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 100% = $255.08... $255.08 at 105% = $267.83 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,126.75,,,,,,,109.0000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,126.75,,,,,,,109.0000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,NHC ADVANTAGE,NHC ADVANTAGE,126.75,,,,,,,109.0000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,262.99,,,,,,,109.0000,1639.0000,fee schedule,"APG 00249 Proc 30905 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 100% = $255.08... $255.08 at 103.1% = $262.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,SENTARA HEALTH,SENTARA HEALTH,423.03,,,,,,,109.0000,1639.0000,percent of total billed charges,"25.81% of $1,639.00 in Billed Charges for Rev 450 Proc 30905 = $423.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,SENTARA HEALTH,SENTARA MEDICARE,120.71,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1639.00,,,,,,,109.0000,1639.0000,percent of total billed charges,"100% of $1,639.00 in Billed Charges for Rev 450 Proc 30905 = $1,639.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1639.0000,case rate,Rev 450 Proc 30905 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1639.0000,case rate,Rev 450 Proc 30905 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1639.0000,case rate,Rev 450 Proc 30905 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1639.0000,case rate,Rev 450 Proc 30905 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,262.73,,,,,,,109.0000,1639.0000,fee schedule,"APG 00249 Proc 30905 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 103% = $262.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,120.71,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,120.71,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,WELLCARE,WELLCARE MEDICAID,1639.00,,,,,,,109.0000,1639.0000,percent of total billed charges,"100% of $1,639.00 in Billed Charges for Rev 450 Proc 30905 = $1,639.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CONTROL NASAL HEMOR POST INIT,30905,CPT,450,RC,45000215,CDM,,,,both,,,1639.0000,245.8500,WELLCARE,WELLCARE MEDICARE,127.95,,,,,,,109.0000,1639.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,AETNA,AETNA,2159.77,,,,,,,109.0000,5058.0000,percent of total billed charges,"42.7% of $5,058.00 in Billed Charges for Rev 450 Proc 31238 = $2,159.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2736.87,,,,,,,109.0000,5058.0000,fee schedule,"APG 00063 Proc 31238 at $836.60 (Base Rate) * 3.1456 (Relative Weight) = $2,631.61 (Total Line Payment) at 104% = $2,736.87. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1614.86,,,,,,,109.0000,5058.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,AETNA,AETNA HEALTHCARE MEDICARE,1614.86,,,,,,,109.0000,5058.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,1614.86,,,,,,,109.0000,5058.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,AMBETTER,AMBETTER,3520.39,,,,,,,109.0000,5058.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1679.45,,,,,,,109.0000,5058.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,BLUE CROSS,ANTHEM EXCHANGE,3975.85,,,,,,,109.0000,5058.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2710.56,,,,,,,109.0000,5058.0000,fee schedule,"APG 00063 Proc 31238 at $836.60 (Base Rate) * 3.1456 (Relative Weight) = $2,631.61 (Total Line Payment) at 103% = $2,710.56. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,BLUE CROSS,ANTHEM HMO,4224.11,,,,,,,109.0000,5058.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1663.30,,,,,,,109.0000,5058.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4969.27,,,,,,,109.0000,5058.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,202.66,,,,,,,109.0000,5058.0000,fee schedule,$202.66 from Fee Schedule BLDTM_23 for Rev 450 Proc 31238 * Qty 1 = $202.66 at 100% = $202.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,BLUE CROSS,BLUE CROSS MEDICARE,1679.45,,,,,,,109.0000,5058.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,1695.60,,,,,,,109.0000,5058.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1695.60,,,,,,,109.0000,5058.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4552.20,,,,,,,109.0000,5058.0000,percent of total billed charges,"90% of $5,058.00 in Billed Charges for Rev 450 Proc 31238 = $4,552.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,HUMANA,HUMANA MEDICARE,1614.86,,,,,,,109.0000,5058.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1614.86,,,,,,,109.0000,5058.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,MEDCOST,MEDCOST VHN,2407.10,,,,,,,109.0000,5058.0000,percent of total billed charges,"47.59% of $5,058.00 in Billed Charges for Rev 450 Proc 31238 = $2,407.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2763.19,,,,,,,109.0000,5058.0000,fee schedule,"APG 00063 Proc 31238 at $836.60 (Base Rate) * 3.1456 (Relative Weight) = $2,631.61 (Total Line Payment) at 100% = $2,631.61... $2,631.61 at 105% = $2,763.19 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1695.60,,,,,,,109.0000,5058.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1695.60,,,,,,,109.0000,5058.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,NHC ADVANTAGE,NHC ADVANTAGE,1695.60,,,,,,,109.0000,5058.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2713.19,,,,,,,109.0000,5058.0000,fee schedule,"APG 00063 Proc 31238 at $836.60 (Base Rate) * 3.1456 (Relative Weight) = $2,631.61 (Total Line Payment) at 100% = $2,631.61... $2,631.61 at 103.1% = $2,713.19 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,SENTARA HEALTH,SENTARA HEALTH,1305.47,,,,,,,109.0000,5058.0000,percent of total billed charges,"25.81% of $5,058.00 in Billed Charges for Rev 450 Proc 31238 = $1,305.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,SENTARA HEALTH,SENTARA MEDICARE,1614.86,,,,,,,109.0000,5058.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5058.00,,,,,,,109.0000,5058.0000,percent of total billed charges,"100% of $5,058.00 in Billed Charges for Rev 450 Proc 31238 = $5,058.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,5058.0000,case rate,Rev 450 Proc 31238 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,5058.0000,case rate,Rev 450 Proc 31238 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,5058.0000,case rate,Rev 450 Proc 31238 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,5058.0000,case rate,Rev 450 Proc 31238 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2710.56,,,,,,,109.0000,5058.0000,fee schedule,"APG 00063 Proc 31238 at $836.60 (Base Rate) * 3.1456 (Relative Weight) = $2,631.61 (Total Line Payment) at 103% = $2,710.56. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1614.86,,,,,,,109.0000,5058.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1614.86,,,,,,,109.0000,5058.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,WELLCARE,WELLCARE MEDICAID,5058.00,,,,,,,109.0000,5058.0000,percent of total billed charges,"100% of $5,058.00 in Billed Charges for Rev 450 Proc 31238 = $5,058.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC NASAL/SINUS ENDOSCOPY W/CONTROL NASAL HEM,31238,CPT,450,RC,45000415,CDM,,,,both,,,5058.0000,758.7000,WELLCARE,WELLCARE MEDICARE,1711.75,,,,,,,109.0000,5058.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,AETNA,AETNA,669.11,,,,,,,173.0000,1567.0000,percent of total billed charges,"42.7% of $1,567.00 in Billed Charges for Rev 361 Proc 31500 = $669.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1062.17,,,,,,,173.0000,1567.0000,fee schedule,"APG 00092 Proc 31500 at $836.60 (Base Rate) * 1.2208 (Relative Weight) = $1,021.32 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,021.32 at 104% = $1,062.17. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,214.89,,,,,,,173.0000,1567.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,AETNA,AETNA HEALTHCARE MEDICARE,214.89,,,,,,,173.0000,1567.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,214.89,,,,,,,173.0000,1567.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,AMBETTER,AMBETTER,468.46,,,,,,,173.0000,1567.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,223.48,,,,,,,173.0000,1567.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,BLUE CROSS,ANTHEM EXCHANGE,529.08,,,,,,,173.0000,1567.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1051.96,,,,,,,173.0000,1567.0000,fee schedule,"APG 00092 Proc 31500 at $836.60 (Base Rate) * 1.2208 (Relative Weight) = $1,021.32 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,021.32 at 103% = $1,051.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,BLUE CROSS,ANTHEM HMO,562.11,,,,,,,173.0000,1567.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,221.33,,,,,,,173.0000,1567.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",661.27,,,,,,,173.0000,1567.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,173.0000,1567.0000,case rate,"Rev 361 Proc 31500 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,173.0000,1567.0000,case rate,Rev 361 Proc 31500 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,BLUE CROSS,BLUE CROSS MEDICARE,223.48,,,,,,,173.0000,1567.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,173.0000,1567.0000,case rate,Rev 361 Proc 31500 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,173.0000,1567.0000,case rate,Rev 361 Proc 31500 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,173.0000,1567.0000,case rate,Rev 361 Proc 31500 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,173.0000,1567.0000,case rate,Rev 361 Proc 31500 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,CIGNA HEALTHCARE,CIGNA HMO,1567.00,,,,,,,173.0000,1567.0000,case rate,"Rev 361 Proc 31500 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,567.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,567.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,173.0000,1567.0000,case rate,"Rev 361 Proc 31500 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,225.63,,,,,,,173.0000,1567.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1567.00,,,,,,,173.0000,1567.0000,case rate,"Rev 361 Proc 31500 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,567.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,567.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,CIGNA HEALTHCARE,CIGNA PPO,1567.00,,,,,,,173.0000,1567.0000,case rate,"Rev 361 Proc 31500 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,567.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,567.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,225.63,,,,,,,173.0000,1567.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1410.30,,,,,,,173.0000,1567.0000,percent of total billed charges,"90% of $1,567.00 in Billed Charges for Rev 361 Proc 31500 = $1,410.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,HUMANA,HUMANA MEDICARE,214.89,,,,,,,173.0000,1567.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,214.89,,,,,,,173.0000,1567.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,MEDCOST,MEDCOST VHN,745.74,,,,,,,173.0000,1567.0000,percent of total billed charges,"47.59% of $1,567.00 in Billed Charges for Rev 361 Proc 31500 = $745.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1072.39,,,,,,,173.0000,1567.0000,fee schedule,"APG 00092 Proc 31500 at $836.60 (Base Rate) * 1.2208 (Relative Weight) = $1,021.32 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,021.32 at 100% = $1,021.32... $1,021.32 at 105% = $1,072.39 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,225.63,,,,,,,173.0000,1567.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,225.63,,,,,,,173.0000,1567.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,NHC ADVANTAGE,NHC ADVANTAGE,225.63,,,,,,,173.0000,1567.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1052.98,,,,,,,173.0000,1567.0000,fee schedule,"APG 00092 Proc 31500 at $836.60 (Base Rate) * 1.2208 (Relative Weight) = $1,021.32 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,021.32 at 100% = $1,021.32... $1,021.32 at 103.1% = $1,052.98 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,SENTARA HEALTH,SENTARA HEALTH,404.44,,,,,,,173.0000,1567.0000,percent of total billed charges,"25.81% of $1,567.00 in Billed Charges for Rev 361 Proc 31500 = $404.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,SENTARA HEALTH,SENTARA MEDICARE,214.89,,,,,,,173.0000,1567.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1567.00,,,,,,,173.0000,1567.0000,percent of total billed charges,"100% of $1,567.00 in Billed Charges for Rev 361 Proc 31500 = $1,567.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,173.0000,1567.0000,case rate,Rev 361 Proc 31500 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,173.0000,1567.0000,case rate,Rev 361 Proc 31500 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,173.0000,1567.0000,case rate,Rev 361 Proc 31500 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,173.0000,1567.0000,case rate,Rev 361 Proc 31500 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1051.96,,,,,,,173.0000,1567.0000,fee schedule,"APG 00092 Proc 31500 at $836.60 (Base Rate) * 1.2208 (Relative Weight) = $1,021.32 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,021.32 at 103% = $1,051.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,214.89,,,,,,,173.0000,1567.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,214.89,,,,,,,173.0000,1567.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,WELLCARE,WELLCARE MEDICAID,1567.00,,,,,,,173.0000,1567.0000,percent of total billed charges,"100% of $1,567.00 in Billed Charges for Rev 361 Proc 31500 = $1,567.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INTUBATION ENDOTRACHEAL EMER PROC,31500,CPT,361,RC,36100092,CDM,,,,both,,,1567.0000,235.0500,WELLCARE,WELLCARE MEDICARE,227.78,,,,,,,173.0000,1567.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,AETNA,AETNA,702.42,,,,,,,52.4000,1645.0000,percent of total billed charges,"42.7% of $1,645.00 in Billed Charges for Rev 450 Proc 31502 = $702.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,265.28,,,,,,,52.4000,1645.0000,fee schedule,"APG 00249 Proc 31502 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 104% = $265.28. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,214.89,,,,,,,52.4000,1645.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,AETNA,AETNA HEALTHCARE MEDICARE,214.89,,,,,,,52.4000,1645.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,214.89,,,,,,,52.4000,1645.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,AMBETTER,AMBETTER,468.46,,,,,,,52.4000,1645.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,223.48,,,,,,,52.4000,1645.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,BLUE CROSS,ANTHEM EXCHANGE,529.08,,,,,,,52.4000,1645.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,262.73,,,,,,,52.4000,1645.0000,fee schedule,"APG 00249 Proc 31502 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 103% = $262.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,BLUE CROSS,ANTHEM HMO,562.11,,,,,,,52.4000,1645.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,221.33,,,,,,,52.4000,1645.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",661.27,,,,,,,52.4000,1645.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,52.40,,,,,,,52.4000,1645.0000,fee schedule,$52.40 from Fee Schedule BLDTM_23 for Rev 450 Proc 31502 * Qty 1 = $52.40 at 100% = $52.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,BLUE CROSS,BLUE CROSS MEDICARE,223.48,,,,,,,52.4000,1645.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,225.63,,,,,,,52.4000,1645.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,225.63,,,,,,,52.4000,1645.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1480.50,,,,,,,52.4000,1645.0000,percent of total billed charges,"90% of $1,645.00 in Billed Charges for Rev 450 Proc 31502 = $1,480.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,HUMANA,HUMANA MEDICARE,214.89,,,,,,,52.4000,1645.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,214.89,,,,,,,52.4000,1645.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,MEDCOST,MEDCOST VHN,782.86,,,,,,,52.4000,1645.0000,percent of total billed charges,"47.59% of $1,645.00 in Billed Charges for Rev 450 Proc 31502 = $782.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,267.83,,,,,,,52.4000,1645.0000,fee schedule,"APG 00249 Proc 31502 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 100% = $255.08... $255.08 at 105% = $267.83 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,225.63,,,,,,,52.4000,1645.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,225.63,,,,,,,52.4000,1645.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,NHC ADVANTAGE,NHC ADVANTAGE,225.63,,,,,,,52.4000,1645.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,262.99,,,,,,,52.4000,1645.0000,fee schedule,"APG 00249 Proc 31502 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 100% = $255.08... $255.08 at 103.1% = $262.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,SENTARA HEALTH,SENTARA HEALTH,424.57,,,,,,,52.4000,1645.0000,percent of total billed charges,"25.81% of $1,645.00 in Billed Charges for Rev 450 Proc 31502 = $424.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,SENTARA HEALTH,SENTARA MEDICARE,214.89,,,,,,,52.4000,1645.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1645.00,,,,,,,52.4000,1645.0000,percent of total billed charges,"100% of $1,645.00 in Billed Charges for Rev 450 Proc 31502 = $1,645.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,52.4000,1645.0000,case rate,Rev 450 Proc 31502 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,52.4000,1645.0000,case rate,Rev 450 Proc 31502 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,52.4000,1645.0000,case rate,Rev 450 Proc 31502 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,52.4000,1645.0000,case rate,Rev 450 Proc 31502 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,262.73,,,,,,,52.4000,1645.0000,fee schedule,"APG 00249 Proc 31502 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 103% = $262.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,214.89,,,,,,,52.4000,1645.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,214.89,,,,,,,52.4000,1645.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,WELLCARE,WELLCARE MEDICAID,1645.00,,,,,,,52.4000,1645.0000,percent of total billed charges,"100% of $1,645.00 in Billed Charges for Rev 450 Proc 31502 = $1,645.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRACH TUBE CHG PRIOR EST FISTU,31502,CPT,450,RC,45000217,CDM,,,,both,,,1645.0000,246.7500,WELLCARE,WELLCARE MEDICARE,227.78,,,,,,,52.4000,1645.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,AETNA,AETNA,1705.87,,,,,,,109.0000,3995.0000,percent of total billed charges,"42.7% of $3,995.00 in Billed Charges for Rev 450 Proc 31530 = $1,705.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,838.05,,,,,,,109.0000,3995.0000,fee schedule,APG 00062 Proc 31530 at $836.60 (Base Rate) * 0.9632 (Relative Weight) = $805.81 (Total Line Payment) at 104% = $838.05. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1614.86,,,,,,,109.0000,3995.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,AETNA,AETNA HEALTHCARE MEDICARE,1614.86,,,,,,,109.0000,3995.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,1614.86,,,,,,,109.0000,3995.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,AMBETTER,AMBETTER,3520.39,,,,,,,109.0000,3995.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1679.45,,,,,,,109.0000,3995.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,BLUE CROSS,ANTHEM EXCHANGE,3975.85,,,,,,,109.0000,3995.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,829.99,,,,,,,109.0000,3995.0000,fee schedule,APG 00062 Proc 31530 at $836.60 (Base Rate) * 0.9632 (Relative Weight) = $805.81 (Total Line Payment) at 103% = $829.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,BLUE CROSS,ANTHEM HMO,3995.00,,,,,,,109.0000,3995.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1663.30,,,,,,,109.0000,3995.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3995.00,,,,,,,109.0000,3995.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,298.66,,,,,,,109.0000,3995.0000,fee schedule,$298.66 from Fee Schedule BLDTM_23 for Rev 450 Proc 31530 * Qty 1 = $298.66 at 100% = $298.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,BLUE CROSS,BLUE CROSS MEDICARE,1679.45,,,,,,,109.0000,3995.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,1695.60,,,,,,,109.0000,3995.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1695.60,,,,,,,109.0000,3995.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3595.50,,,,,,,109.0000,3995.0000,percent of total billed charges,"90% of $3,995.00 in Billed Charges for Rev 450 Proc 31530 = $3,595.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,HUMANA,HUMANA MEDICARE,1614.86,,,,,,,109.0000,3995.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1614.86,,,,,,,109.0000,3995.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,MEDCOST,MEDCOST VHN,1901.22,,,,,,,109.0000,3995.0000,percent of total billed charges,"47.59% of $3,995.00 in Billed Charges for Rev 450 Proc 31530 = $1,901.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,846.10,,,,,,,109.0000,3995.0000,fee schedule,APG 00062 Proc 31530 at $836.60 (Base Rate) * 0.9632 (Relative Weight) = $805.81 (Total Line Payment) at 100% = $805.81... $805.81 at 105% = $846.10 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1695.60,,,,,,,109.0000,3995.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1695.60,,,,,,,109.0000,3995.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,NHC ADVANTAGE,NHC ADVANTAGE,1695.60,,,,,,,109.0000,3995.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,830.79,,,,,,,109.0000,3995.0000,fee schedule,APG 00062 Proc 31530 at $836.60 (Base Rate) * 0.9632 (Relative Weight) = $805.81 (Total Line Payment) at 100% = $805.81... $805.81 at 103.1% = $830.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,SENTARA HEALTH,SENTARA HEALTH,1031.11,,,,,,,109.0000,3995.0000,percent of total billed charges,"25.81% of $3,995.00 in Billed Charges for Rev 450 Proc 31530 = $1,031.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,SENTARA HEALTH,SENTARA MEDICARE,1614.86,,,,,,,109.0000,3995.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3995.00,,,,,,,109.0000,3995.0000,percent of total billed charges,"100% of $3,995.00 in Billed Charges for Rev 450 Proc 31530 = $3,995.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3995.0000,case rate,Rev 450 Proc 31530 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3995.0000,case rate,Rev 450 Proc 31530 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3995.0000,case rate,Rev 450 Proc 31530 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3995.0000,case rate,Rev 450 Proc 31530 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,829.99,,,,,,,109.0000,3995.0000,fee schedule,APG 00062 Proc 31530 at $836.60 (Base Rate) * 0.9632 (Relative Weight) = $805.81 (Total Line Payment) at 103% = $829.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1614.86,,,,,,,109.0000,3995.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1614.86,,,,,,,109.0000,3995.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,WELLCARE,WELLCARE MEDICAID,3995.00,,,,,,,109.0000,3995.0000,percent of total billed charges,"100% of $3,995.00 in Billed Charges for Rev 450 Proc 31530 = $3,995.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DIRECT LARYNGOSCOPE FB REMOVAL,31530,CPT,450,RC,45000219,CDM,,,,both,,,3995.0000,599.2500,WELLCARE,WELLCARE MEDICARE,1711.75,,,,,,,109.0000,3995.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,AETNA,AETNA,146.03,,,,,,,88.2700,394.7900,percent of total billed charges,42.7% of $342.00 in Billed Charges for Rev 450 Proc 31575 = $146.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,265.28,,,,,,,88.2700,394.7900,fee schedule,"APG 00249 Proc 31575 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 104% = $265.28. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,181.10,,,,,,,88.2700,394.7900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,AETNA,AETNA HEALTHCARE MEDICARE,181.10,,,,,,,88.2700,394.7900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,181.10,,,,,,,88.2700,394.7900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,AMBETTER,AMBETTER,394.79,,,,,,,88.2700,394.7900,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,188.34,,,,,,,88.2700,394.7900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,BLUE CROSS,ANTHEM EXCHANGE,342.00,,,,,,,88.2700,394.7900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,262.73,,,,,,,88.2700,394.7900,fee schedule,"APG 00249 Proc 31575 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 103% = $262.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,BLUE CROSS,ANTHEM HMO,342.00,,,,,,,88.2700,394.7900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,186.53,,,,,,,88.2700,394.7900,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",342.00,,,,,,,88.2700,394.7900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,114.06,,,,,,,88.2700,394.7900,fee schedule,$114.06 from Fee Schedule BLDTM_23 for Rev 450 Proc 31575 * Qty 1 = $114.06 at 100% = $114.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,BLUE CROSS,BLUE CROSS MEDICARE,188.34,,,,,,,88.2700,394.7900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,190.15,,,,,,,88.2700,394.7900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,190.15,,,,,,,88.2700,394.7900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,307.80,,,,,,,88.2700,394.7900,percent of total billed charges,90% of $342.00 in Billed Charges for Rev 450 Proc 31575 = $307.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,HUMANA,HUMANA MEDICARE,181.10,,,,,,,88.2700,394.7900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,181.10,,,,,,,88.2700,394.7900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,MEDCOST,MEDCOST VHN,162.76,,,,,,,88.2700,394.7900,percent of total billed charges,47.59% of $342.00 in Billed Charges for Rev 450 Proc 31575 = $162.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,267.83,,,,,,,88.2700,394.7900,fee schedule,"APG 00249 Proc 31575 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 100% = $255.08... $255.08 at 105% = $267.83 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,190.15,,,,,,,88.2700,394.7900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,190.15,,,,,,,88.2700,394.7900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,NHC ADVANTAGE,NHC ADVANTAGE,190.15,,,,,,,88.2700,394.7900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,262.99,,,,,,,88.2700,394.7900,fee schedule,"APG 00249 Proc 31575 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 100% = $255.08... $255.08 at 103.1% = $262.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,SENTARA HEALTH,SENTARA HEALTH,88.27,,,,,,,88.2700,394.7900,percent of total billed charges,25.81% of $342.00 in Billed Charges for Rev 450 Proc 31575 = $88.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,SENTARA HEALTH,SENTARA MEDICARE,181.10,,,,,,,88.2700,394.7900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",342.00,,,,,,,88.2700,394.7900,percent of total billed charges,100% of $342.00 in Billed Charges for Rev 450 Proc 31575 = $342.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,88.2700,394.7900,case rate,Rev 450 Proc 31575 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,342.00,,,,,,,88.2700,394.7900,case rate,"Rev 450 Proc 31575 at Case Rate $491.00 (Service Line reduced to $342.00, claim capped at $342.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,342.00,,,,,,,88.2700,394.7900,case rate,"Rev 450 Proc 31575 at Case Rate $471.00 (Service Line reduced to $342.00, claim capped at $342.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,342.00,,,,,,,88.2700,394.7900,case rate,"Rev 450 Proc 31575 at Case Rate $847.00 (Service Line reduced to $342.00, claim capped at $342.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,262.73,,,,,,,88.2700,394.7900,fee schedule,"APG 00249 Proc 31575 at $836.60 (Base Rate) * 0.3049 (Relative Weight) = $255.08 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $255.08 at 103% = $262.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,181.10,,,,,,,88.2700,394.7900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,181.10,,,,,,,88.2700,394.7900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,WELLCARE,WELLCARE MEDICAID,342.00,,,,,,,88.2700,394.7900,percent of total billed charges,100% of $342.00 in Billed Charges for Rev 450 Proc 31575 = $342.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DIAGNOSTIC LARYNGOSCOPY,31575,CPT,450,RC,45000220,CDM,,,,both,,,342.0000,51.3000,WELLCARE,WELLCARE MEDICARE,191.96,,,,,,,88.2700,394.7900,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,AETNA,AETNA,836.07,,,,,,,50.2300,3266.6300,percent of total billed charges,"42.7% of $1,958.00 in Billed Charges for Rev 521 Proc 11422 = $836.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1775.80,,,,,,,50.2300,3266.6300,fee schedule,"APG 00010 Proc 11422 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 104% = $1,775.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,50.2300,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,50.2300,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,50.2300,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,AMBETTER,AMBETTER,3266.63,,,,,,,50.2300,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,50.2300,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,BLUE CROSS,ANTHEM EXCHANGE,1958.00,,,,,,,50.2300,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1758.73,,,,,,,50.2300,3266.6300,fee schedule,"APG 00010 Proc 11422 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,BLUE CROSS,ANTHEM HMO,1958.00,,,,,,,50.2300,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,50.2300,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1958.00,,,,,,,50.2300,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,123.67,,,,,,,50.2300,3266.6300,fee schedule,$123.67 from Fee Schedule BLDTM_23 for Rev 521 Proc 11422 * Qty 1 = $123.67 at 100% = $123.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,50.2300,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,BLUE CROSS,TENNCARE BLUE CARE,50.23,,,,,,,50.2300,3266.6300,fee schedule,$43.30 from Fee Schedule TC_24 for Rev 521 Proc 11422 * Qty 1 = $43.30 at 116% = $50.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,BLUE CROSS,TENNCARE BLUE SELECT,50.23,,,,,,,50.2300,3266.6300,fee schedule,$43.30 from Fee Schedule TC_24 for Rev 521 Proc 11422 * Qty 1 = $43.30 at 116% = $50.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,CIGNA HEALTHCARE,CIGNA HMO,816.49,,,,,,,50.2300,3266.6300,percent of total billed charges,"41.7% of $1,958.00 in Billed Charges for Rev 521 Proc 11422 = $816.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,908.51,,,,,,,50.2300,3266.6300,percent of total billed charges,"46.4% of $1,958.00 in Billed Charges for Rev 521 Proc 11422 = $908.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,50.2300,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,816.49,,,,,,,50.2300,3266.6300,percent of total billed charges,"41.7% of $1,958.00 in Billed Charges for Rev 521 Proc 11422 = $816.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,CIGNA HEALTHCARE,CIGNA PPO,816.49,,,,,,,50.2300,3266.6300,percent of total billed charges,"41.7% of $1,958.00 in Billed Charges for Rev 521 Proc 11422 = $816.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,50.2300,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1762.20,,,,,,,50.2300,3266.6300,percent of total billed charges,"90% of $1,958.00 in Billed Charges for Rev 521 Proc 11422 = $1,762.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,50.2300,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,50.2300,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,MEDCOST,MEDCOST VHN,931.81,,,,,,,50.2300,3266.6300,percent of total billed charges,"47.59% of $1,958.00 in Billed Charges for Rev 521 Proc 11422 = $931.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1792.88,,,,,,,50.2300,3266.6300,fee schedule,"APG 00010 Proc 11422 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 105% = $1,792.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,50.2300,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,50.2300,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,50.2300,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1760.43,,,,,,,50.2300,3266.6300,fee schedule,"APG 00010 Proc 11422 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 103.1% = $1,760.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,SENTARA HEALTH,SENTARA HEALTH,505.36,,,,,,,50.2300,3266.6300,percent of total billed charges,"25.81% of $1,958.00 in Billed Charges for Rev 521 Proc 11422 = $505.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,50.2300,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1958.00,,,,,,,50.2300,3266.6300,percent of total billed charges,"100% of $1,958.00 in Billed Charges for Rev 521 Proc 11422 = $1,958.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,413.29,,,,,,,50.2300,3266.6300,fee schedule,$826.58 from Fee Schedule TCUHC24 for Rev 521 Proc 11422 * Qty 1 = $826.58 at 50% = $413.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1758.73,,,,,,,50.2300,3266.6300,fee schedule,"APG 00010 Proc 11422 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,50.2300,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,50.2300,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,WELLCARE,WELLCARE MEDICAID,1958.00,,,,,,,50.2300,3266.6300,percent of total billed charges,"100% of $1,958.00 in Billed Charges for Rev 521 Proc 11422 = $1,958.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0 CM,11422,CPT,521,RC,52100030,CDM,,,,both,,,1958.0000,293.7000,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,50.2300,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,AETNA,AETNA,1112.76,,,,,,,233.2400,5745.1200,percent of total billed charges,"42.7% of $2,606.00 in Billed Charges for Rev 521 Proc 11426 = $1,112.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2575.48,,,,,,,233.2400,5745.1200,fee schedule,"APG 00011 Proc 11426 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 104% = $2,575.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2606.00,,,,,,,233.2400,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,AETNA,AETNA HEALTHCARE MEDICARE,2606.00,,,,,,,233.2400,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,2606.00,,,,,,,233.2400,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,AMBETTER,AMBETTER,5745.12,,,,,,,233.2400,5745.1200,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2606.00,,,,,,,233.2400,5745.1200,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,BLUE CROSS,ANTHEM EXCHANGE,2606.00,,,,,,,233.2400,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2550.71,,,,,,,233.2400,5745.1200,fee schedule,"APG 00011 Proc 11426 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 103% = $2,550.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,BLUE CROSS,ANTHEM HMO,2606.00,,,,,,,233.2400,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2606.00,,,,,,,233.2400,5745.1200,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2606.00,,,,,,,233.2400,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,233.24,,,,,,,233.2400,5745.1200,fee schedule,$233.24 from Fee Schedule BLDTM_23 for Rev 521 Proc 11426 * Qty 1 = $233.24 at 100% = $233.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,BLUE CROSS,BLUE CROSS MEDICARE,2740.79,,,,,,,233.2400,5745.1200,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,CIGNA HEALTHCARE,CIGNA HMO,1086.70,,,,,,,233.2400,5745.1200,percent of total billed charges,"41.7% of $2,606.00 in Billed Charges for Rev 521 Proc 11426 = $1,086.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1209.18,,,,,,,233.2400,5745.1200,percent of total billed charges,"46.4% of $2,606.00 in Billed Charges for Rev 521 Proc 11426 = $1,209.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,2606.00,,,,,,,233.2400,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1086.70,,,,,,,233.2400,5745.1200,percent of total billed charges,"41.7% of $2,606.00 in Billed Charges for Rev 521 Proc 11426 = $1,086.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,CIGNA HEALTHCARE,CIGNA PPO,1086.70,,,,,,,233.2400,5745.1200,percent of total billed charges,"41.7% of $2,606.00 in Billed Charges for Rev 521 Proc 11426 = $1,086.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,2606.00,,,,,,,233.2400,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2345.40,,,,,,,233.2400,5745.1200,percent of total billed charges,"90% of $2,606.00 in Billed Charges for Rev 521 Proc 11426 = $2,345.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,HUMANA,HUMANA MEDICARE,2606.00,,,,,,,233.2400,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2606.00,,,,,,,233.2400,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,MEDCOST,MEDCOST VHN,1240.20,,,,,,,233.2400,5745.1200,percent of total billed charges,"47.59% of $2,606.00 in Billed Charges for Rev 521 Proc 11426 = $1,240.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2600.24,,,,,,,233.2400,5745.1200,fee schedule,"APG 00011 Proc 11426 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 100% = $2,476.42... $2,476.42 at 105% = $2,600.24 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,2606.00,,,,,,,233.2400,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,2606.00,,,,,,,233.2400,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,NHC ADVANTAGE,NHC ADVANTAGE,2606.00,,,,,,,233.2400,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2553.19,,,,,,,233.2400,5745.1200,fee schedule,"APG 00011 Proc 11426 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 100% = $2,476.42... $2,476.42 at 103.1% = $2,553.19 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,SENTARA HEALTH,SENTARA HEALTH,672.61,,,,,,,233.2400,5745.1200,percent of total billed charges,"25.81% of $2,606.00 in Billed Charges for Rev 521 Proc 11426 = $672.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,SENTARA HEALTH,SENTARA MEDICARE,2606.00,,,,,,,233.2400,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2606.00,,,,,,,233.2400,5745.1200,percent of total billed charges,"100% of $2,606.00 in Billed Charges for Rev 521 Proc 11426 = $2,606.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,912.16,,,,,,,233.2400,5745.1200,fee schedule,"$1,824.31 from Fee Schedule TCUHC24 for Rev 521 Proc 11426 * Qty 1 = $1,824.31 at 50% = $912.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2550.71,,,,,,,233.2400,5745.1200,fee schedule,"APG 00011 Proc 11426 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 103% = $2,550.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2606.00,,,,,,,233.2400,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2606.00,,,,,,,233.2400,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,WELLCARE,WELLCARE MEDICAID,2606.00,,,,,,,233.2400,5745.1200,percent of total billed charges,"100% of $2,606.00 in Billed Charges for Rev 521 Proc 11426 = $2,606.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG S/N/H/F/G >4.0 CM,11426,CPT,521,RC,52100032,CDM,,,,both,,,2606.0000,390.9000,WELLCARE,WELLCARE MEDICARE,2793.50,,,,,,,233.2400,5745.1200,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,AETNA,AETNA,424.44,,,,,,,56.5000,1400.5900,percent of total billed charges,42.7% of $994.00 in Billed Charges for Rev 521 Proc 11442 = $424.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,56.5000,1400.5900,fee schedule,"APG 00009 Proc 11442 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,56.5000,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,56.5000,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,56.5000,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,AMBETTER,AMBETTER,1400.59,,,,,,,56.5000,1400.5900,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,56.5000,1400.5900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,BLUE CROSS,ANTHEM EXCHANGE,994.00,,,,,,,56.5000,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,56.5000,1400.5900,fee schedule,"APG 00009 Proc 11442 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,BLUE CROSS,ANTHEM HMO,994.00,,,,,,,56.5000,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,56.5000,1400.5900,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",994.00,,,,,,,56.5000,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,136.10,,,,,,,56.5000,1400.5900,fee schedule,$136.10 from Fee Schedule BLDTM_23 for Rev 521 Proc 11442 * Qty 1 = $136.10 at 100% = $136.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,56.5000,1400.5900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,BLUE CROSS,TENNCARE BLUE CARE,56.50,,,,,,,56.5000,1400.5900,fee schedule,$48.71 from Fee Schedule TC_24 for Rev 521 Proc 11442 * Qty 1 = $48.71 at 116% = $56.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,BLUE CROSS,TENNCARE BLUE SELECT,56.50,,,,,,,56.5000,1400.5900,fee schedule,$48.71 from Fee Schedule TC_24 for Rev 521 Proc 11442 * Qty 1 = $48.71 at 116% = $56.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,CIGNA HEALTHCARE,CIGNA HMO,414.50,,,,,,,56.5000,1400.5900,percent of total billed charges,41.7% of $994.00 in Billed Charges for Rev 521 Proc 11442 = $414.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,461.22,,,,,,,56.5000,1400.5900,percent of total billed charges,46.4% of $994.00 in Billed Charges for Rev 521 Proc 11442 = $461.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,56.5000,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,414.50,,,,,,,56.5000,1400.5900,percent of total billed charges,41.7% of $994.00 in Billed Charges for Rev 521 Proc 11442 = $414.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,CIGNA HEALTHCARE,CIGNA PPO,414.50,,,,,,,56.5000,1400.5900,percent of total billed charges,41.7% of $994.00 in Billed Charges for Rev 521 Proc 11442 = $414.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,56.5000,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,894.60,,,,,,,56.5000,1400.5900,percent of total billed charges,90% of $994.00 in Billed Charges for Rev 521 Proc 11442 = $894.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,HUMANA,HUMANA MEDICARE,642.47,,,,,,,56.5000,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,56.5000,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,MEDCOST,MEDCOST VHN,473.04,,,,,,,56.5000,1400.5900,percent of total billed charges,47.59% of $994.00 in Billed Charges for Rev 521 Proc 11442 = $473.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,56.5000,1400.5900,fee schedule,"APG 00009 Proc 11442 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,56.5000,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,56.5000,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,56.5000,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,56.5000,1400.5900,fee schedule,"APG 00009 Proc 11442 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,SENTARA HEALTH,SENTARA HEALTH,256.55,,,,,,,56.5000,1400.5900,percent of total billed charges,25.81% of $994.00 in Billed Charges for Rev 521 Proc 11442 = $256.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,56.5000,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",994.00,,,,,,,56.5000,1400.5900,percent of total billed charges,100% of $994.00 in Billed Charges for Rev 521 Proc 11442 = $994.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,413.29,,,,,,,56.5000,1400.5900,fee schedule,$826.58 from Fee Schedule TCUHC24 for Rev 521 Proc 11442 * Qty 1 = $826.58 at 50% = $413.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,56.5000,1400.5900,fee schedule,"APG 00009 Proc 11442 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,56.5000,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,56.5000,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,WELLCARE,WELLCARE MEDICAID,994.00,,,,,,,56.5000,1400.5900,percent of total billed charges,100% of $994.00 in Billed Charges for Rev 521 Proc 11442 = $994.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC BENIGN LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0 CM,11442,CPT,521,RC,52100035,CDM,,,,both,,,994.0000,149.1000,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,56.5000,1400.5900,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,AETNA,AETNA,1011.56,,,,,,,176.3000,3266.6300,percent of total billed charges,"42.7% of $2,369.00 in Billed Charges for Rev 510 Proc 11443 = $1,011.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1775.80,,,,,,,176.3000,3266.6300,fee schedule,"APG 00010 Proc 11443 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 104% = $1,775.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,176.3000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,176.3000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,176.3000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,AMBETTER,AMBETTER,3266.63,,,,,,,176.3000,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,176.3000,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,BLUE CROSS,ANTHEM EXCHANGE,2369.00,,,,,,,176.3000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1758.73,,,,,,,176.3000,3266.6300,fee schedule,"APG 00010 Proc 11443 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,BLUE CROSS,ANTHEM HMO,2369.00,,,,,,,176.3000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,176.3000,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2369.00,,,,,,,176.3000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,176.30,,,,,,,176.3000,3266.6300,fee schedule,$176.30 from Fee Schedule BLDTM_23 for Rev 510 Proc 11443 * Qty 1 = $176.30 at 100% = $176.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,176.3000,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,CIGNA HEALTHCARE,CIGNA HMO,987.87,,,,,,,176.3000,3266.6300,percent of total billed charges,"41.7% of $2,369.00 in Billed Charges for Rev 510 Proc 11443 = $987.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1099.22,,,,,,,176.3000,3266.6300,percent of total billed charges,"46.4% of $2,369.00 in Billed Charges for Rev 510 Proc 11443 = $1,099.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,176.3000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,987.87,,,,,,,176.3000,3266.6300,percent of total billed charges,"41.7% of $2,369.00 in Billed Charges for Rev 510 Proc 11443 = $987.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,CIGNA HEALTHCARE,CIGNA PPO,987.87,,,,,,,176.3000,3266.6300,percent of total billed charges,"41.7% of $2,369.00 in Billed Charges for Rev 510 Proc 11443 = $987.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,176.3000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2132.10,,,,,,,176.3000,3266.6300,percent of total billed charges,"90% of $2,369.00 in Billed Charges for Rev 510 Proc 11443 = $2,132.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,176.3000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,176.3000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,MEDCOST,MEDCOST VHN,1127.41,,,,,,,176.3000,3266.6300,percent of total billed charges,"47.59% of $2,369.00 in Billed Charges for Rev 510 Proc 11443 = $1,127.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1792.88,,,,,,,176.3000,3266.6300,fee schedule,"APG 00010 Proc 11443 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 105% = $1,792.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,176.3000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,176.3000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,176.3000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1760.43,,,,,,,176.3000,3266.6300,fee schedule,"APG 00010 Proc 11443 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 103.1% = $1,760.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,SENTARA HEALTH,SENTARA HEALTH,611.44,,,,,,,176.3000,3266.6300,percent of total billed charges,"25.81% of $2,369.00 in Billed Charges for Rev 510 Proc 11443 = $611.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,176.3000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2369.00,,,,,,,176.3000,3266.6300,percent of total billed charges,"100% of $2,369.00 in Billed Charges for Rev 510 Proc 11443 = $2,369.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,413.29,,,,,,,176.3000,3266.6300,fee schedule,$826.58 from Fee Schedule TCUHC24 for Rev 510 Proc 11443 * Qty 1 = $826.58 at 50% = $413.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,765.19,,,,,,,176.3000,3266.6300,other,"32.3% of $2,369.00 in Billed Charges for Rev 510 Proc 11443 = $765.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,727.28,,,,,,,176.3000,3266.6300,other,"30.7% of $2,369.00 in Billed Charges for Rev 510 Proc 11443 = $727.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,765.19,,,,,,,176.3000,3266.6300,percent of total billed charges,"32.3% of $2,369.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1758.73,,,,,,,176.3000,3266.6300,fee schedule,"APG 00010 Proc 11443 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,176.3000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,176.3000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,WELLCARE,WELLCARE MEDICAID,2369.00,,,,,,,176.3000,3266.6300,percent of total billed charges,"100% of $2,369.00 in Billed Charges for Rev 510 Proc 11443 = $2,369.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN BENIG 2.1-3 CM FACE FACIAL,11443,CPT,510,RC,51000124,CDM,,,,both,,,2369.0000,355.3500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,176.3000,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,AETNA,AETNA,513.68,,,,,,,215.0900,3266.6300,percent of total billed charges,"42.7% of $1,203.00 in Billed Charges for Rev 521 Proc 11444 = $513.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1775.80,,,,,,,215.0900,3266.6300,fee schedule,"APG 00010 Proc 11444 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 104% = $1,775.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1203.00,,,,,,,215.0900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,AETNA,AETNA HEALTHCARE MEDICARE,1203.00,,,,,,,215.0900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,1203.00,,,,,,,215.0900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,AMBETTER,AMBETTER,3266.63,,,,,,,215.0900,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1203.00,,,,,,,215.0900,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,BLUE CROSS,ANTHEM EXCHANGE,1203.00,,,,,,,215.0900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1203.00,,,,,,,215.0900,3266.6300,fee schedule,"APG 00010 Proc 11444 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73 (Service Line reduced to $1,203.00, claim capped at $1,203.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,BLUE CROSS,ANTHEM HMO,1203.00,,,,,,,215.0900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1203.00,,,,,,,215.0900,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1203.00,,,,,,,215.0900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,215.09,,,,,,,215.0900,3266.6300,fee schedule,$215.09 from Fee Schedule BLDTM_23 for Rev 521 Proc 11444 * Qty 1 = $215.09 at 100% = $215.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,215.0900,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,CIGNA HEALTHCARE,CIGNA HMO,501.65,,,,,,,215.0900,3266.6300,percent of total billed charges,"41.7% of $1,203.00 in Billed Charges for Rev 521 Proc 11444 = $501.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,558.19,,,,,,,215.0900,3266.6300,percent of total billed charges,"46.4% of $1,203.00 in Billed Charges for Rev 521 Proc 11444 = $558.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,1203.00,,,,,,,215.0900,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,501.65,,,,,,,215.0900,3266.6300,percent of total billed charges,"41.7% of $1,203.00 in Billed Charges for Rev 521 Proc 11444 = $501.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,CIGNA HEALTHCARE,CIGNA PPO,501.65,,,,,,,215.0900,3266.6300,percent of total billed charges,"41.7% of $1,203.00 in Billed Charges for Rev 521 Proc 11444 = $501.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1203.00,,,,,,,215.0900,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1082.70,,,,,,,215.0900,3266.6300,percent of total billed charges,"90% of $1,203.00 in Billed Charges for Rev 521 Proc 11444 = $1,082.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,HUMANA,HUMANA MEDICARE,1203.00,,,,,,,215.0900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1203.00,,,,,,,215.0900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,MEDCOST,MEDCOST VHN,572.51,,,,,,,215.0900,3266.6300,percent of total billed charges,"47.59% of $1,203.00 in Billed Charges for Rev 521 Proc 11444 = $572.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1792.88,,,,,,,215.0900,3266.6300,fee schedule,"APG 00010 Proc 11444 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 105% = $1,792.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1203.00,,,,,,,215.0900,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1203.00,,,,,,,215.0900,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,NHC ADVANTAGE,NHC ADVANTAGE,1203.00,,,,,,,215.0900,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1760.43,,,,,,,215.0900,3266.6300,fee schedule,"APG 00010 Proc 11444 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 103.1% = $1,760.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,SENTARA HEALTH,SENTARA HEALTH,310.49,,,,,,,215.0900,3266.6300,percent of total billed charges,"25.81% of $1,203.00 in Billed Charges for Rev 521 Proc 11444 = $310.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,SENTARA HEALTH,SENTARA MEDICARE,1203.00,,,,,,,215.0900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1203.00,,,,,,,215.0900,3266.6300,percent of total billed charges,"100% of $1,203.00 in Billed Charges for Rev 521 Proc 11444 = $1,203.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,413.29,,,,,,,215.0900,3266.6300,fee schedule,$826.58 from Fee Schedule TCUHC24 for Rev 521 Proc 11444 * Qty 1 = $826.58 at 50% = $413.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1758.73,,,,,,,215.0900,3266.6300,fee schedule,"APG 00010 Proc 11444 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1203.00,,,,,,,215.0900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1203.00,,,,,,,215.0900,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,WELLCARE,WELLCARE MEDICAID,1203.00,,,,,,,215.0900,3266.6300,percent of total billed charges,"100% of $1,203.00 in Billed Charges for Rev 521 Proc 11444 = $1,203.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LES MARGN XCP SK TG F/E/E/N/L/M 3.1-4.0 CM,11444,CPT,521,RC,52100037,CDM,,,,both,,,1203.0000,180.4500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,215.0900,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,AETNA,AETNA,3343.84,,,,,,,261.2200,7831.0000,percent of total billed charges,"42.7% of $7,831.00 in Billed Charges for Rev 531 Proc 11446 = $3,343.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2575.48,,,,,,,261.2200,7831.0000,fee schedule,"APG 00011 Proc 11446 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 104% = $2,575.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2635.37,,,,,,,261.2200,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,AETNA,AETNA HEALTHCARE MEDICARE,2635.37,,,,,,,261.2200,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,2635.37,,,,,,,261.2200,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,AMBETTER,AMBETTER,5745.12,,,,,,,261.2200,7831.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2740.79,,,,,,,261.2200,7831.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,BLUE CROSS,ANTHEM EXCHANGE,6488.44,,,,,,,261.2200,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2550.71,,,,,,,261.2200,7831.0000,fee schedule,"APG 00011 Proc 11446 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 103% = $2,550.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,BLUE CROSS,ANTHEM HMO,6893.58,,,,,,,261.2200,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2714.44,,,,,,,261.2200,7831.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",7831.00,,,,,,,261.2200,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,261.22,,,,,,,261.2200,7831.0000,fee schedule,$261.22 from Fee Schedule BLDTM_23 for Rev 531 Proc 11446 * Qty 1 = $261.22 at 100% = $261.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,BLUE CROSS,BLUE CROSS MEDICARE,2740.79,,,,,,,261.2200,7831.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,CIGNA HEALTHCARE,CIGNA HMO,3265.53,,,,,,,261.2200,7831.0000,percent of total billed charges,"41.7% of $7,831.00 in Billed Charges for Rev 531 Proc 11446 = $3,265.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3633.58,,,,,,,261.2200,7831.0000,percent of total billed charges,"46.4% of $7,831.00 in Billed Charges for Rev 531 Proc 11446 = $3,633.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,2767.14,,,,,,,261.2200,7831.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3265.53,,,,,,,261.2200,7831.0000,percent of total billed charges,"41.7% of $7,831.00 in Billed Charges for Rev 531 Proc 11446 = $3,265.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,CIGNA HEALTHCARE,CIGNA PPO,3265.53,,,,,,,261.2200,7831.0000,percent of total billed charges,"41.7% of $7,831.00 in Billed Charges for Rev 531 Proc 11446 = $3,265.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,2767.14,,,,,,,261.2200,7831.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7047.90,,,,,,,261.2200,7831.0000,percent of total billed charges,"90% of $7,831.00 in Billed Charges for Rev 531 Proc 11446 = $7,047.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,HUMANA,HUMANA MEDICARE,2635.37,,,,,,,261.2200,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2635.37,,,,,,,261.2200,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,MEDCOST,MEDCOST VHN,3726.77,,,,,,,261.2200,7831.0000,percent of total billed charges,"47.59% of $7,831.00 in Billed Charges for Rev 531 Proc 11446 = $3,726.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2600.24,,,,,,,261.2200,7831.0000,fee schedule,"APG 00011 Proc 11446 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 100% = $2,476.42... $2,476.42 at 105% = $2,600.24 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,2767.14,,,,,,,261.2200,7831.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,2767.14,,,,,,,261.2200,7831.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,NHC ADVANTAGE,NHC ADVANTAGE,2767.14,,,,,,,261.2200,7831.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2553.19,,,,,,,261.2200,7831.0000,fee schedule,"APG 00011 Proc 11446 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 100% = $2,476.42... $2,476.42 at 103.1% = $2,553.19 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,SENTARA HEALTH,SENTARA HEALTH,2021.18,,,,,,,261.2200,7831.0000,percent of total billed charges,"25.81% of $7,831.00 in Billed Charges for Rev 531 Proc 11446 = $2,021.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,SENTARA HEALTH,SENTARA MEDICARE,2635.37,,,,,,,261.2200,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7831.00,,,,,,,261.2200,7831.0000,percent of total billed charges,"100% of $7,831.00 in Billed Charges for Rev 531 Proc 11446 = $7,831.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,912.16,,,,,,,261.2200,7831.0000,fee schedule,"$1,824.31 from Fee Schedule TCUHC24 for Rev 531 Proc 11446 * Qty 1 = $1,824.31 at 50% = $912.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2529.41,,,,,,,261.2200,7831.0000,other,"32.3% of $7,831.00 in Billed Charges for Rev 531 Proc 11446 = $2,529.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2404.12,,,,,,,261.2200,7831.0000,other,"30.7% of $7,831.00 in Billed Charges for Rev 531 Proc 11446 = $2,404.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,2529.41,,,,,,,261.2200,7831.0000,percent of total billed charges,"32.3% of $7,831.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2550.71,,,,,,,261.2200,7831.0000,fee schedule,"APG 00011 Proc 11446 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 103% = $2,550.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2635.37,,,,,,,261.2200,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2635.37,,,,,,,261.2200,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,WELLCARE,WELLCARE MEDICAID,7831.00,,,,,,,261.2200,7831.0000,percent of total billed charges,"100% of $7,831.00 in Billed Charges for Rev 531 Proc 11446 = $7,831.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION MRGN XCP SK TG F/E/E/N/L/M >4.0 CM,11446,CPT,531,RC,52100038,CDM,,,,both,,,7831.0000,1174.6500,WELLCARE,WELLCARE MEDICARE,2793.50,,,,,,,261.2200,7831.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,AETNA,AETNA,3343.84,,,,,,,221.4200,7831.0000,percent of total billed charges,"42.7% of $7,831.00 in Billed Charges for Rev 521 Proc 11450 = $3,343.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2575.48,,,,,,,221.4200,7831.0000,fee schedule,"APG 00011 Proc 11450 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 104% = $2,575.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2635.37,,,,,,,221.4200,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,AETNA,AETNA HEALTHCARE MEDICARE,2635.37,,,,,,,221.4200,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,2635.37,,,,,,,221.4200,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,AMBETTER,AMBETTER,5745.12,,,,,,,221.4200,7831.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2740.79,,,,,,,221.4200,7831.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,BLUE CROSS,ANTHEM EXCHANGE,6488.44,,,,,,,221.4200,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2550.71,,,,,,,221.4200,7831.0000,fee schedule,"APG 00011 Proc 11450 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 103% = $2,550.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,BLUE CROSS,ANTHEM HMO,6893.58,,,,,,,221.4200,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2714.44,,,,,,,221.4200,7831.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",7831.00,,,,,,,221.4200,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,221.42,,,,,,,221.4200,7831.0000,fee schedule,$221.42 from Fee Schedule BLDTM_23 for Rev 521 Proc 11450 * Qty 1 = $221.42 at 100% = $221.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,BLUE CROSS,BLUE CROSS MEDICARE,2740.79,,,,,,,221.4200,7831.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,CIGNA HEALTHCARE,CIGNA HMO,3265.53,,,,,,,221.4200,7831.0000,percent of total billed charges,"41.7% of $7,831.00 in Billed Charges for Rev 521 Proc 11450 = $3,265.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3633.58,,,,,,,221.4200,7831.0000,percent of total billed charges,"46.4% of $7,831.00 in Billed Charges for Rev 521 Proc 11450 = $3,633.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,2767.14,,,,,,,221.4200,7831.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3265.53,,,,,,,221.4200,7831.0000,percent of total billed charges,"41.7% of $7,831.00 in Billed Charges for Rev 521 Proc 11450 = $3,265.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,CIGNA HEALTHCARE,CIGNA PPO,3265.53,,,,,,,221.4200,7831.0000,percent of total billed charges,"41.7% of $7,831.00 in Billed Charges for Rev 521 Proc 11450 = $3,265.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,2767.14,,,,,,,221.4200,7831.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7047.90,,,,,,,221.4200,7831.0000,percent of total billed charges,"90% of $7,831.00 in Billed Charges for Rev 521 Proc 11450 = $7,047.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,HUMANA,HUMANA MEDICARE,2635.37,,,,,,,221.4200,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2635.37,,,,,,,221.4200,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,MEDCOST,MEDCOST VHN,3726.77,,,,,,,221.4200,7831.0000,percent of total billed charges,"47.59% of $7,831.00 in Billed Charges for Rev 521 Proc 11450 = $3,726.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2600.24,,,,,,,221.4200,7831.0000,fee schedule,"APG 00011 Proc 11450 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 100% = $2,476.42... $2,476.42 at 105% = $2,600.24 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,2767.14,,,,,,,221.4200,7831.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,2767.14,,,,,,,221.4200,7831.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,NHC ADVANTAGE,NHC ADVANTAGE,2767.14,,,,,,,221.4200,7831.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2553.19,,,,,,,221.4200,7831.0000,fee schedule,"APG 00011 Proc 11450 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 100% = $2,476.42... $2,476.42 at 103.1% = $2,553.19 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,SENTARA HEALTH,SENTARA HEALTH,2021.18,,,,,,,221.4200,7831.0000,percent of total billed charges,"25.81% of $7,831.00 in Billed Charges for Rev 521 Proc 11450 = $2,021.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,SENTARA HEALTH,SENTARA MEDICARE,2635.37,,,,,,,221.4200,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7831.00,,,,,,,221.4200,7831.0000,percent of total billed charges,"100% of $7,831.00 in Billed Charges for Rev 521 Proc 11450 = $7,831.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,912.16,,,,,,,221.4200,7831.0000,fee schedule,"$1,824.31 from Fee Schedule TCUHC24 for Rev 521 Proc 11450 * Qty 1 = $1,824.31 at 50% = $912.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2550.71,,,,,,,221.4200,7831.0000,fee schedule,"APG 00011 Proc 11450 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 103% = $2,550.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2635.37,,,,,,,221.4200,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2635.37,,,,,,,221.4200,7831.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,WELLCARE,WELLCARE MEDICAID,7831.00,,,,,,,221.4200,7831.0000,percent of total billed charges,"100% of $7,831.00 in Billed Charges for Rev 521 Proc 11450 = $7,831.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN/SQ HIDRADENITIS AXILLARY SMPL/INTRM RPR,11450,CPT,521,RC,52100039,CDM,,,,both,,,7831.0000,1174.6500,WELLCARE,WELLCARE MEDICARE,2793.50,,,,,,,221.4200,7831.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,AETNA,AETNA,1471.44,,,,,,,250.6700,5745.1200,percent of total billed charges,"42.7% of $3,446.00 in Billed Charges for Rev 510 Proc 11470 = $1,471.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2575.48,,,,,,,250.6700,5745.1200,fee schedule,"APG 00011 Proc 11470 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 104% = $2,575.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2635.37,,,,,,,250.6700,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,AETNA,AETNA HEALTHCARE MEDICARE,2635.37,,,,,,,250.6700,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,2635.37,,,,,,,250.6700,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,AMBETTER,AMBETTER,5745.12,,,,,,,250.6700,5745.1200,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2740.79,,,,,,,250.6700,5745.1200,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,BLUE CROSS,ANTHEM EXCHANGE,3446.00,,,,,,,250.6700,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2550.71,,,,,,,250.6700,5745.1200,fee schedule,"APG 00011 Proc 11470 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 103% = $2,550.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,BLUE CROSS,ANTHEM HMO,3446.00,,,,,,,250.6700,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2714.44,,,,,,,250.6700,5745.1200,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3446.00,,,,,,,250.6700,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,250.67,,,,,,,250.6700,5745.1200,fee schedule,$250.67 from Fee Schedule BLDTM_23 for Rev 510 Proc 11470 * Qty 1 = $250.67 at 100% = $250.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,BLUE CROSS,BLUE CROSS MEDICARE,2740.79,,,,,,,250.6700,5745.1200,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,CIGNA HEALTHCARE,CIGNA HMO,1436.98,,,,,,,250.6700,5745.1200,percent of total billed charges,"41.7% of $3,446.00 in Billed Charges for Rev 510 Proc 11470 = $1,436.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1598.94,,,,,,,250.6700,5745.1200,percent of total billed charges,"46.4% of $3,446.00 in Billed Charges for Rev 510 Proc 11470 = $1,598.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,2767.14,,,,,,,250.6700,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1436.98,,,,,,,250.6700,5745.1200,percent of total billed charges,"41.7% of $3,446.00 in Billed Charges for Rev 510 Proc 11470 = $1,436.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,CIGNA HEALTHCARE,CIGNA PPO,1436.98,,,,,,,250.6700,5745.1200,percent of total billed charges,"41.7% of $3,446.00 in Billed Charges for Rev 510 Proc 11470 = $1,436.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,2767.14,,,,,,,250.6700,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3101.40,,,,,,,250.6700,5745.1200,percent of total billed charges,"90% of $3,446.00 in Billed Charges for Rev 510 Proc 11470 = $3,101.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,HUMANA,HUMANA MEDICARE,2635.37,,,,,,,250.6700,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2635.37,,,,,,,250.6700,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,MEDCOST,MEDCOST VHN,1639.95,,,,,,,250.6700,5745.1200,percent of total billed charges,"47.59% of $3,446.00 in Billed Charges for Rev 510 Proc 11470 = $1,639.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2600.24,,,,,,,250.6700,5745.1200,fee schedule,"APG 00011 Proc 11470 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 100% = $2,476.42... $2,476.42 at 105% = $2,600.24 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,2767.14,,,,,,,250.6700,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,2767.14,,,,,,,250.6700,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,NHC ADVANTAGE,NHC ADVANTAGE,2767.14,,,,,,,250.6700,5745.1200,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2553.19,,,,,,,250.6700,5745.1200,fee schedule,"APG 00011 Proc 11470 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 100% = $2,476.42... $2,476.42 at 103.1% = $2,553.19 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,SENTARA HEALTH,SENTARA HEALTH,889.41,,,,,,,250.6700,5745.1200,percent of total billed charges,"25.81% of $3,446.00 in Billed Charges for Rev 510 Proc 11470 = $889.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,SENTARA HEALTH,SENTARA MEDICARE,2635.37,,,,,,,250.6700,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3446.00,,,,,,,250.6700,5745.1200,percent of total billed charges,"100% of $3,446.00 in Billed Charges for Rev 510 Proc 11470 = $3,446.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,912.16,,,,,,,250.6700,5745.1200,fee schedule,"$1,824.31 from Fee Schedule TCUHC24 for Rev 510 Proc 11470 * Qty 1 = $1,824.31 at 50% = $912.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1113.06,,,,,,,250.6700,5745.1200,other,"32.3% of $3,446.00 in Billed Charges for Rev 510 Proc 11470 = $1,113.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1057.92,,,,,,,250.6700,5745.1200,other,"30.7% of $3,446.00 in Billed Charges for Rev 510 Proc 11470 = $1,057.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,1113.06,,,,,,,250.6700,5745.1200,percent of total billed charges,"32.3% of $3,446.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2550.71,,,,,,,250.6700,5745.1200,fee schedule,"APG 00011 Proc 11470 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 103% = $2,550.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2635.37,,,,,,,250.6700,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2635.37,,,,,,,250.6700,5745.1200,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,WELLCARE,WELLCARE MEDICAID,3446.00,,,,,,,250.6700,5745.1200,percent of total billed charges,"100% of $3,446.00 in Billed Charges for Rev 510 Proc 11470 = $3,446.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC WC EXCISION/SKIN & SUBCU TISSUE,11470,CPT,510,RC,51000014,CDM,,,,both,,,3446.0000,516.9000,WELLCARE,WELLCARE MEDICARE,2793.50,,,,,,,250.6700,5745.1200,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,AETNA,AETNA,839.06,,,,,,,47.0800,1965.0000,percent of total billed charges,"42.7% of $1,965.00 in Billed Charges for Rev 510 Proc 11600 = $839.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,47.0800,1965.0000,fee schedule,"APG 00009 Proc 11600 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,47.0800,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,47.0800,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,47.0800,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,AMBETTER,AMBETTER,1400.59,,,,,,,47.0800,1965.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,47.0800,1965.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,47.0800,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,47.0800,1965.0000,fee schedule,"APG 00009 Proc 11600 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,47.0800,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,47.0800,1965.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1965.00,,,,,,,47.0800,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,105.55,,,,,,,47.0800,1965.0000,fee schedule,$105.55 from Fee Schedule BLDTM_23 for Rev 510 Proc 11600 * Qty 1 = $105.55 at 100% = $105.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,47.0800,1965.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,TENNCARE BLUE CARE,47.08,,,,,,,47.0800,1965.0000,fee schedule,$40.59 from Fee Schedule TC_24 for Rev 510 Proc 11600 * Qty 1 = $40.59 at 116% = $47.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,BLUE CROSS,TENNCARE BLUE SELECT,47.08,,,,,,,47.0800,1965.0000,fee schedule,$40.59 from Fee Schedule TC_24 for Rev 510 Proc 11600 * Qty 1 = $40.59 at 116% = $47.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,CIGNA HEALTHCARE,CIGNA HMO,819.41,,,,,,,47.0800,1965.0000,percent of total billed charges,"41.7% of $1,965.00 in Billed Charges for Rev 510 Proc 11600 = $819.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,911.76,,,,,,,47.0800,1965.0000,percent of total billed charges,"46.4% of $1,965.00 in Billed Charges for Rev 510 Proc 11600 = $911.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,47.0800,1965.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,819.41,,,,,,,47.0800,1965.0000,percent of total billed charges,"41.7% of $1,965.00 in Billed Charges for Rev 510 Proc 11600 = $819.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,CIGNA HEALTHCARE,CIGNA PPO,819.41,,,,,,,47.0800,1965.0000,percent of total billed charges,"41.7% of $1,965.00 in Billed Charges for Rev 510 Proc 11600 = $819.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,47.0800,1965.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1768.50,,,,,,,47.0800,1965.0000,percent of total billed charges,"90% of $1,965.00 in Billed Charges for Rev 510 Proc 11600 = $1,768.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,HUMANA,HUMANA MEDICARE,642.47,,,,,,,47.0800,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,47.0800,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,MEDCOST,MEDCOST VHN,935.14,,,,,,,47.0800,1965.0000,percent of total billed charges,"47.59% of $1,965.00 in Billed Charges for Rev 510 Proc 11600 = $935.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,47.0800,1965.0000,fee schedule,"APG 00009 Proc 11600 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,47.0800,1965.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,47.0800,1965.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,47.0800,1965.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,47.0800,1965.0000,fee schedule,"APG 00009 Proc 11600 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,SENTARA HEALTH,SENTARA HEALTH,507.17,,,,,,,47.0800,1965.0000,percent of total billed charges,"25.81% of $1,965.00 in Billed Charges for Rev 510 Proc 11600 = $507.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,47.0800,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1965.00,,,,,,,47.0800,1965.0000,percent of total billed charges,"100% of $1,965.00 in Billed Charges for Rev 510 Proc 11600 = $1,965.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,413.29,,,,,,,47.0800,1965.0000,fee schedule,$826.58 from Fee Schedule TCUHC24 for Rev 510 Proc 11600 * Qty 1 = $826.58 at 50% = $413.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,634.70,,,,,,,47.0800,1965.0000,other,"32.3% of $1,965.00 in Billed Charges for Rev 510 Proc 11600 = $634.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,603.26,,,,,,,47.0800,1965.0000,other,"30.7% of $1,965.00 in Billed Charges for Rev 510 Proc 11600 = $603.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,634.70,,,,,,,47.0800,1965.0000,percent of total billed charges,"32.3% of $1,965.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,47.0800,1965.0000,fee schedule,"APG 00009 Proc 11600 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,47.0800,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,47.0800,1965.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,WELLCARE,WELLCARE MEDICAID,1965.00,,,,,,,47.0800,1965.0000,percent of total billed charges,"100% of $1,965.00 in Billed Charges for Rev 510 Proc 11600 = $1,965.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC SKIN MALG<0.5 CM TRUNK ARM LEG,11600,CPT,510,RC,51000125,CDM,,,,both,,,1965.0000,294.7500,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,47.0800,1965.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,AETNA,AETNA,386.01,,,,,,,62.7800,1400.5900,percent of total billed charges,42.7% of $904.00 in Billed Charges for Rev 510 Proc 11601 = $386.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,62.7800,1400.5900,fee schedule,"APG 00009 Proc 11601 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,62.7800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,62.7800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,62.7800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,AMBETTER,AMBETTER,1400.59,,,,,,,62.7800,1400.5900,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,62.7800,1400.5900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,BLUE CROSS,ANTHEM EXCHANGE,904.00,,,,,,,62.7800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,62.7800,1400.5900,fee schedule,"APG 00009 Proc 11601 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,BLUE CROSS,ANTHEM HMO,904.00,,,,,,,62.7800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,62.7800,1400.5900,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",904.00,,,,,,,62.7800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,131.36,,,,,,,62.7800,1400.5900,fee schedule,$131.36 from Fee Schedule BLDTM_23 for Rev 510 Proc 11601 * Qty 1 = $131.36 at 100% = $131.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,62.7800,1400.5900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,BLUE CROSS,TENNCARE BLUE CARE,62.78,,,,,,,62.7800,1400.5900,fee schedule,$54.12 from Fee Schedule TC_24 for Rev 510 Proc 11601 * Qty 1 = $54.12 at 116% = $62.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,BLUE CROSS,TENNCARE BLUE SELECT,62.78,,,,,,,62.7800,1400.5900,fee schedule,$54.12 from Fee Schedule TC_24 for Rev 510 Proc 11601 * Qty 1 = $54.12 at 116% = $62.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,CIGNA HEALTHCARE,CIGNA HMO,376.97,,,,,,,62.7800,1400.5900,percent of total billed charges,41.7% of $904.00 in Billed Charges for Rev 510 Proc 11601 = $376.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,419.46,,,,,,,62.7800,1400.5900,percent of total billed charges,46.4% of $904.00 in Billed Charges for Rev 510 Proc 11601 = $419.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,62.7800,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,376.97,,,,,,,62.7800,1400.5900,percent of total billed charges,41.7% of $904.00 in Billed Charges for Rev 510 Proc 11601 = $376.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,CIGNA HEALTHCARE,CIGNA PPO,376.97,,,,,,,62.7800,1400.5900,percent of total billed charges,41.7% of $904.00 in Billed Charges for Rev 510 Proc 11601 = $376.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,62.7800,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,813.60,,,,,,,62.7800,1400.5900,percent of total billed charges,90% of $904.00 in Billed Charges for Rev 510 Proc 11601 = $813.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,HUMANA,HUMANA MEDICARE,642.47,,,,,,,62.7800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,62.7800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,MEDCOST,MEDCOST VHN,430.21,,,,,,,62.7800,1400.5900,percent of total billed charges,47.59% of $904.00 in Billed Charges for Rev 510 Proc 11601 = $430.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,62.7800,1400.5900,fee schedule,"APG 00009 Proc 11601 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,62.7800,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,62.7800,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,62.7800,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,62.7800,1400.5900,fee schedule,"APG 00009 Proc 11601 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,SENTARA HEALTH,SENTARA HEALTH,233.32,,,,,,,62.7800,1400.5900,percent of total billed charges,25.81% of $904.00 in Billed Charges for Rev 510 Proc 11601 = $233.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,62.7800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",904.00,,,,,,,62.7800,1400.5900,percent of total billed charges,100% of $904.00 in Billed Charges for Rev 510 Proc 11601 = $904.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,189.28,,,,,,,62.7800,1400.5900,fee schedule,$378.56 from Fee Schedule TCUHC24 for Rev 510 Proc 11601 * Qty 1 = $378.56 at 50% = $189.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,291.99,,,,,,,62.7800,1400.5900,other,32.3% of $904.00 in Billed Charges for Rev 510 Proc 11601 = $291.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.53,,,,,,,62.7800,1400.5900,other,30.7% of $904.00 in Billed Charges for Rev 510 Proc 11601 = $277.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,291.99,,,,,,,62.7800,1400.5900,percent of total billed charges,32.3% of $904.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,62.7800,1400.5900,fee schedule,"APG 00009 Proc 11601 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,62.7800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,62.7800,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,WELLCARE,WELLCARE MEDICAID,904.00,,,,,,,62.7800,1400.5900,percent of total billed charges,100% of $904.00 in Billed Charges for Rev 510 Proc 11601 = $904.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EXC MALGN LESION TRUNK/ARM/LEG 0.6-1.0 CM,11601,CPT,510,RC,51000015,CDM,,,,both,,,904.0000,135.6000,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,62.7800,1400.5900,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,AETNA,AETNA,513.68,,,,,,,199.3600,1792.8800,percent of total billed charges,"42.7% of $1,203.00 in Billed Charges for Rev 510 Proc 11604 = $513.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1775.80,,,,,,,199.3600,1792.8800,fee schedule,"APG 00010 Proc 11604 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,707.50 at 104% = $1,775.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,199.3600,1792.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,199.3600,1792.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,199.3600,1792.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,AMBETTER,AMBETTER,1400.59,,,,,,,199.3600,1792.8800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,199.3600,1792.8800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,BLUE CROSS,ANTHEM EXCHANGE,1203.00,,,,,,,199.3600,1792.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1203.00,,,,,,,199.3600,1792.8800,fee schedule,"APG 00010 Proc 11604 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,707.50 at 103% = $1,758.73 (Service Line reduced to $1,203.00, claim capped at $1,203.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,BLUE CROSS,ANTHEM HMO,1203.00,,,,,,,199.3600,1792.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,199.3600,1792.8800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1203.00,,,,,,,199.3600,1792.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,199.36,,,,,,,199.3600,1792.8800,fee schedule,$199.36 from Fee Schedule BLDTM_23 for Rev 510 Proc 11604 * Qty 1 = $199.36 at 100% = $199.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,199.3600,1792.8800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,CIGNA HEALTHCARE,CIGNA HMO,501.65,,,,,,,199.3600,1792.8800,percent of total billed charges,"41.7% of $1,203.00 in Billed Charges for Rev 510 Proc 11604 = $501.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,558.19,,,,,,,199.3600,1792.8800,percent of total billed charges,"46.4% of $1,203.00 in Billed Charges for Rev 510 Proc 11604 = $558.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,199.3600,1792.8800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,501.65,,,,,,,199.3600,1792.8800,percent of total billed charges,"41.7% of $1,203.00 in Billed Charges for Rev 510 Proc 11604 = $501.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,CIGNA HEALTHCARE,CIGNA PPO,501.65,,,,,,,199.3600,1792.8800,percent of total billed charges,"41.7% of $1,203.00 in Billed Charges for Rev 510 Proc 11604 = $501.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,199.3600,1792.8800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1082.70,,,,,,,199.3600,1792.8800,percent of total billed charges,"90% of $1,203.00 in Billed Charges for Rev 510 Proc 11604 = $1,082.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,HUMANA,HUMANA MEDICARE,642.47,,,,,,,199.3600,1792.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,199.3600,1792.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,MEDCOST,MEDCOST VHN,572.51,,,,,,,199.3600,1792.8800,percent of total billed charges,"47.59% of $1,203.00 in Billed Charges for Rev 510 Proc 11604 = $572.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1792.88,,,,,,,199.3600,1792.8800,fee schedule,"APG 00010 Proc 11604 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,707.50 at 100% = $1,707.50... $1,707.50 at 105% = $1,792.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,199.3600,1792.8800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,199.3600,1792.8800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,199.3600,1792.8800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1760.43,,,,,,,199.3600,1792.8800,fee schedule,"APG 00010 Proc 11604 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,707.50 at 100% = $1,707.50... $1,707.50 at 103.1% = $1,760.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,SENTARA HEALTH,SENTARA HEALTH,310.49,,,,,,,199.3600,1792.8800,percent of total billed charges,"25.81% of $1,203.00 in Billed Charges for Rev 510 Proc 11604 = $310.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,199.3600,1792.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1203.00,,,,,,,199.3600,1792.8800,percent of total billed charges,"100% of $1,203.00 in Billed Charges for Rev 510 Proc 11604 = $1,203.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,413.29,,,,,,,199.3600,1792.8800,fee schedule,$826.58 from Fee Schedule TCUHC24 for Rev 510 Proc 11604 * Qty 1 = $826.58 at 50% = $413.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,388.57,,,,,,,199.3600,1792.8800,other,"32.3% of $1,203.00 in Billed Charges for Rev 510 Proc 11604 = $388.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,369.32,,,,,,,199.3600,1792.8800,other,"30.7% of $1,203.00 in Billed Charges for Rev 510 Proc 11604 = $369.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,388.57,,,,,,,199.3600,1792.8800,percent of total billed charges,"32.3% of $1,203.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1758.73,,,,,,,199.3600,1792.8800,fee schedule,"APG 00010 Proc 11604 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,707.50 at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,199.3600,1792.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,199.3600,1792.8800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,WELLCARE,WELLCARE MEDICAID,1203.00,,,,,,,199.3600,1792.8800,percent of total billed charges,"100% of $1,203.00 in Billed Charges for Rev 510 Proc 11604 = $1,203.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION TRUNK/ARM/LEG 3.1-4.0 CM,11604,CPT,510,RC,51000128,CDM,,,,both,,,1203.0000,180.4500,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,199.3600,1792.8800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,AETNA,AETNA,1745.15,,,,,,,775.0000,4087.0000,percent of total billed charges,"42.7% of $4,087.00 in Billed Charges for Rev 361 Proc 11606 = $1,745.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2575.48,,,,,,,775.0000,4087.0000,fee schedule,"APG 00011 Proc 11606 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 104% = $2,575.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,775.0000,4087.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,775.0000,4087.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,775.0000,4087.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,AMBETTER,AMBETTER,3266.63,,,,,,,775.0000,4087.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,775.0000,4087.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,BLUE CROSS,ANTHEM EXCHANGE,3689.28,,,,,,,775.0000,4087.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2550.71,,,,,,,775.0000,4087.0000,fee schedule,"APG 00011 Proc 11606 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 103% = $2,550.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,BLUE CROSS,ANTHEM HMO,3919.64,,,,,,,775.0000,4087.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,775.0000,4087.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4087.00,,,,,,,775.0000,4087.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,948.00,,,,,,,775.0000,4087.0000,case rate,Rev 361 Proc 11606 ASG Rate of $948.00 at 100% of $948.00 = $948.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,775.0000,4087.0000,case rate,"Rev 361 Proc 11606 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,775.0000,4087.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,775.0000,4087.0000,case rate,"Rev 361 Proc 11606 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,775.0000,4087.0000,case rate,"Rev 361 Proc 11606 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,4087.0000,case rate,Rev 361 Proc 11606 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,4087.0000,case rate,Rev 361 Proc 11606 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,CIGNA HEALTHCARE,CIGNA HMO,2588.00,,,,,,,775.0000,4087.0000,case rate,"Rev 361 Proc 11606 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1956.00,,,,,,,775.0000,4087.0000,case rate,"Rev 361 Proc 11606 ASG Rate of $1,956.00 at 100% of $1,956.00 = $1,956.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,775.0000,4087.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2588.00,,,,,,,775.0000,4087.0000,case rate,"Rev 361 Proc 11606 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,CIGNA HEALTHCARE,CIGNA PPO,2588.00,,,,,,,775.0000,4087.0000,case rate,"Rev 361 Proc 11606 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,775.0000,4087.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3678.30,,,,,,,775.0000,4087.0000,percent of total billed charges,"90% of $4,087.00 in Billed Charges for Rev 361 Proc 11606 = $3,678.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,775.0000,4087.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,775.0000,4087.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,MEDCOST,MEDCOST VHN,1945.00,,,,,,,775.0000,4087.0000,percent of total billed charges,"47.59% of $4,087.00 in Billed Charges for Rev 361 Proc 11606 = $1,945.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2600.24,,,,,,,775.0000,4087.0000,fee schedule,"APG 00011 Proc 11606 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 100% = $2,476.42... $2,476.42 at 105% = $2,600.24 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,775.0000,4087.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,775.0000,4087.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,775.0000,4087.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2553.19,,,,,,,775.0000,4087.0000,fee schedule,"APG 00011 Proc 11606 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 100% = $2,476.42... $2,476.42 at 103.1% = $2,553.19 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,SENTARA HEALTH,SENTARA HEALTH,1054.85,,,,,,,775.0000,4087.0000,percent of total billed charges,"25.81% of $4,087.00 in Billed Charges for Rev 361 Proc 11606 = $1,054.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,775.0000,4087.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4087.00,,,,,,,775.0000,4087.0000,percent of total billed charges,"100% of $4,087.00 in Billed Charges for Rev 361 Proc 11606 = $4,087.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,775.0000,4087.0000,case rate,Rev 361 Proc 11606 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,775.0000,4087.0000,case rate,"Rev 361 Proc 11606 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,775.0000,4087.0000,case rate,"Rev 361 Proc 11606 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,775.0000,4087.0000,case rate,"Rev 361 Proc 11606 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2550.71,,,,,,,775.0000,4087.0000,fee schedule,"APG 00011 Proc 11606 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 103% = $2,550.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,775.0000,4087.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,775.0000,4087.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,WELLCARE,WELLCARE MEDICAID,4087.00,,,,,,,775.0000,4087.0000,percent of total billed charges,"100% of $4,087.00 in Billed Charges for Rev 361 Proc 11606 = $4,087.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION OVER 4.0 CM,11606,CPT,361,RC,36100202,CDM,,,,both,,,4087.0000,613.0500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,775.0000,4087.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,AETNA,AETNA,689.61,,,,,,,109.0000,3227.1800,percent of total billed charges,"42.7% of $1,615.00 in Billed Charges for Rev 450 Proc 31603 = $689.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3196.44,,,,,,,109.0000,3227.1800,fee schedule,"APG 00072 Proc 31603 at $836.60 (Base Rate) * 3.6738 (Relative Weight) = $3,073.50 (Total Line Payment) at 104% = $3,196.44. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1407.71,,,,,,,109.0000,3227.1800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,AETNA,AETNA HEALTHCARE MEDICARE,1407.71,,,,,,,109.0000,3227.1800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,1407.71,,,,,,,109.0000,3227.1800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,AMBETTER,AMBETTER,3068.81,,,,,,,109.0000,3227.1800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1464.02,,,,,,,109.0000,3227.1800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,BLUE CROSS,ANTHEM EXCHANGE,1615.00,,,,,,,109.0000,3227.1800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1615.00,,,,,,,109.0000,3227.1800,fee schedule,"APG 00072 Proc 31603 at $836.60 (Base Rate) * 3.6738 (Relative Weight) = $3,073.50 (Total Line Payment) at 103% = $3,165.71 (Service Line reduced to $1,615.00, claim capped at $1,615.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,BLUE CROSS,ANTHEM HMO,1615.00,,,,,,,109.0000,3227.1800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1449.94,,,,,,,109.0000,3227.1800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1615.00,,,,,,,109.0000,3227.1800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,319.54,,,,,,,109.0000,3227.1800,fee schedule,$319.54 from Fee Schedule BLDTM_23 for Rev 450 Proc 31603 * Qty 1 = $319.54 at 100% = $319.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,BLUE CROSS,BLUE CROSS MEDICARE,1464.02,,,,,,,109.0000,3227.1800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,1478.10,,,,,,,109.0000,3227.1800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1478.10,,,,,,,109.0000,3227.1800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1453.50,,,,,,,109.0000,3227.1800,percent of total billed charges,"90% of $1,615.00 in Billed Charges for Rev 450 Proc 31603 = $1,453.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,HUMANA,HUMANA MEDICARE,1407.71,,,,,,,109.0000,3227.1800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1407.71,,,,,,,109.0000,3227.1800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,MEDCOST,MEDCOST VHN,768.58,,,,,,,109.0000,3227.1800,percent of total billed charges,"47.59% of $1,615.00 in Billed Charges for Rev 450 Proc 31603 = $768.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3227.18,,,,,,,109.0000,3227.1800,fee schedule,"APG 00072 Proc 31603 at $836.60 (Base Rate) * 3.6738 (Relative Weight) = $3,073.50 (Total Line Payment) at 100% = $3,073.50... $3,073.50 at 105% = $3,227.18 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1478.10,,,,,,,109.0000,3227.1800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1478.10,,,,,,,109.0000,3227.1800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,NHC ADVANTAGE,NHC ADVANTAGE,1478.10,,,,,,,109.0000,3227.1800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3168.78,,,,,,,109.0000,3227.1800,fee schedule,"APG 00072 Proc 31603 at $836.60 (Base Rate) * 3.6738 (Relative Weight) = $3,073.50 (Total Line Payment) at 100% = $3,073.50... $3,073.50 at 103.1% = $3,168.78 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,SENTARA HEALTH,SENTARA HEALTH,416.83,,,,,,,109.0000,3227.1800,percent of total billed charges,"25.81% of $1,615.00 in Billed Charges for Rev 450 Proc 31603 = $416.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,SENTARA HEALTH,SENTARA MEDICARE,1407.71,,,,,,,109.0000,3227.1800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1615.00,,,,,,,109.0000,3227.1800,percent of total billed charges,"100% of $1,615.00 in Billed Charges for Rev 450 Proc 31603 = $1,615.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3227.1800,case rate,Rev 450 Proc 31603 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3227.1800,case rate,Rev 450 Proc 31603 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3227.1800,case rate,Rev 450 Proc 31603 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3227.1800,case rate,Rev 450 Proc 31603 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3165.71,,,,,,,109.0000,3227.1800,fee schedule,"APG 00072 Proc 31603 at $836.60 (Base Rate) * 3.6738 (Relative Weight) = $3,073.50 (Total Line Payment) at 103% = $3,165.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1407.71,,,,,,,109.0000,3227.1800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1407.71,,,,,,,109.0000,3227.1800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,WELLCARE,WELLCARE MEDICAID,1615.00,,,,,,,109.0000,3227.1800,percent of total billed charges,"100% of $1,615.00 in Billed Charges for Rev 450 Proc 31603 = $1,615.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRACHEOSTOMY EMERGENCY PROCED,31603,CPT,450,RC,45000221,CDM,,,,both,,,1615.0000,242.2500,WELLCARE,WELLCARE MEDICARE,1492.17,,,,,,,109.0000,3227.1800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,AETNA,AETNA,2022.27,,,,,,,775.0000,4736.0000,percent of total billed charges,"42.7% of $4,736.00 in Billed Charges for Rev 361 Proc 31623 = $2,022.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2622.29,,,,,,,775.0000,4736.0000,fee schedule,"APG 00064 Proc 31623 at $836.60 (Base Rate) * 3.0139 (Relative Weight) = $2,521.43 (Total Line Payment) at 104% = $2,622.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1614.86,,,,,,,775.0000,4736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,AETNA,AETNA HEALTHCARE MEDICARE,1614.86,,,,,,,775.0000,4736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,1614.86,,,,,,,775.0000,4736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,AMBETTER,AMBETTER,3520.39,,,,,,,775.0000,4736.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1679.45,,,,,,,775.0000,4736.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,BLUE CROSS,ANTHEM EXCHANGE,3975.85,,,,,,,775.0000,4736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2597.07,,,,,,,775.0000,4736.0000,fee schedule,"APG 00064 Proc 31623 at $836.60 (Base Rate) * 3.0139 (Relative Weight) = $2,521.43 (Total Line Payment) at 103% = $2,597.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,BLUE CROSS,ANTHEM HMO,4224.11,,,,,,,775.0000,4736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1663.30,,,,,,,775.0000,4736.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4736.00,,,,,,,775.0000,4736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,948.00,,,,,,,775.0000,4736.0000,case rate,Rev 361 Proc 31623 ASG Rate of $948.00 at 100% of $948.00 = $948.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,775.0000,4736.0000,case rate,"Rev 361 Proc 31623 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,BLUE CROSS,BLUE CROSS MEDICARE,1679.45,,,,,,,775.0000,4736.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,775.0000,4736.0000,case rate,"Rev 361 Proc 31623 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,775.0000,4736.0000,case rate,"Rev 361 Proc 31623 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,4736.0000,case rate,Rev 361 Proc 31623 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,4736.0000,case rate,Rev 361 Proc 31623 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,CIGNA HEALTHCARE,CIGNA HMO,2588.00,,,,,,,775.0000,4736.0000,case rate,"Rev 361 Proc 31623 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1956.00,,,,,,,775.0000,4736.0000,case rate,"Rev 361 Proc 31623 ASG Rate of $1,956.00 at 100% of $1,956.00 = $1,956.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,1695.60,,,,,,,775.0000,4736.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2588.00,,,,,,,775.0000,4736.0000,case rate,"Rev 361 Proc 31623 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,CIGNA HEALTHCARE,CIGNA PPO,2588.00,,,,,,,775.0000,4736.0000,case rate,"Rev 361 Proc 31623 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1695.60,,,,,,,775.0000,4736.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4262.40,,,,,,,775.0000,4736.0000,percent of total billed charges,"90% of $4,736.00 in Billed Charges for Rev 361 Proc 31623 = $4,262.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,HUMANA,HUMANA MEDICARE,1614.86,,,,,,,775.0000,4736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1614.86,,,,,,,775.0000,4736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,MEDCOST,MEDCOST VHN,2253.86,,,,,,,775.0000,4736.0000,percent of total billed charges,"47.59% of $4,736.00 in Billed Charges for Rev 361 Proc 31623 = $2,253.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2647.50,,,,,,,775.0000,4736.0000,fee schedule,"APG 00064 Proc 31623 at $836.60 (Base Rate) * 3.0139 (Relative Weight) = $2,521.43 (Total Line Payment) at 100% = $2,521.43... $2,521.43 at 105% = $2,647.50 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1695.60,,,,,,,775.0000,4736.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1695.60,,,,,,,775.0000,4736.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,NHC ADVANTAGE,NHC ADVANTAGE,1695.60,,,,,,,775.0000,4736.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2599.59,,,,,,,775.0000,4736.0000,fee schedule,"APG 00064 Proc 31623 at $836.60 (Base Rate) * 3.0139 (Relative Weight) = $2,521.43 (Total Line Payment) at 100% = $2,521.43... $2,521.43 at 103.1% = $2,599.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,SENTARA HEALTH,SENTARA HEALTH,1222.36,,,,,,,775.0000,4736.0000,percent of total billed charges,"25.81% of $4,736.00 in Billed Charges for Rev 361 Proc 31623 = $1,222.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,SENTARA HEALTH,SENTARA MEDICARE,1614.86,,,,,,,775.0000,4736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4736.00,,,,,,,775.0000,4736.0000,percent of total billed charges,"100% of $4,736.00 in Billed Charges for Rev 361 Proc 31623 = $4,736.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,775.0000,4736.0000,case rate,Rev 361 Proc 31623 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,775.0000,4736.0000,case rate,"Rev 361 Proc 31623 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,775.0000,4736.0000,case rate,"Rev 361 Proc 31623 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,775.0000,4736.0000,case rate,"Rev 361 Proc 31623 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2597.07,,,,,,,775.0000,4736.0000,fee schedule,"APG 00064 Proc 31623 at $836.60 (Base Rate) * 3.0139 (Relative Weight) = $2,521.43 (Total Line Payment) at 103% = $2,597.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1614.86,,,,,,,775.0000,4736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1614.86,,,,,,,775.0000,4736.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,WELLCARE,WELLCARE MEDICAID,4736.00,,,,,,,775.0000,4736.0000,percent of total billed charges,"100% of $4,736.00 in Billed Charges for Rev 361 Proc 31623 = $4,736.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BRNCHSC BRUSHING/PROTECTED BRUSHINGS,31623,CPT,361,RC,36100520,CDM,,,,both,,,4736.0000,710.4000,WELLCARE,WELLCARE MEDICARE,1711.75,,,,,,,775.0000,4736.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,AETNA,AETNA,2232.36,,,,,,,109.0000,5228.0000,percent of total billed charges,"42.7% of $5,228.00 in Billed Charges for Rev 450 Proc 31624 = $2,232.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2622.29,,,,,,,109.0000,5228.0000,fee schedule,"APG 00064 Proc 31624 at $836.60 (Base Rate) * 3.0139 (Relative Weight) = $2,521.43 (Total Line Payment) at 104% = $2,622.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1614.86,,,,,,,109.0000,5228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,AETNA,AETNA HEALTHCARE MEDICARE,1614.86,,,,,,,109.0000,5228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,1614.86,,,,,,,109.0000,5228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,AMBETTER,AMBETTER,3520.39,,,,,,,109.0000,5228.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1679.45,,,,,,,109.0000,5228.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,BLUE CROSS,ANTHEM EXCHANGE,3975.85,,,,,,,109.0000,5228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2597.07,,,,,,,109.0000,5228.0000,fee schedule,"APG 00064 Proc 31624 at $836.60 (Base Rate) * 3.0139 (Relative Weight) = $2,521.43 (Total Line Payment) at 103% = $2,597.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,BLUE CROSS,ANTHEM HMO,4224.11,,,,,,,109.0000,5228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1663.30,,,,,,,109.0000,5228.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4969.27,,,,,,,109.0000,5228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,247.32,,,,,,,109.0000,5228.0000,fee schedule,$247.32 from Fee Schedule BLDTM_23 for Rev 450 Proc 31624 * Qty 1 = $247.32 at 100% = $247.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,BLUE CROSS,BLUE CROSS MEDICARE,1679.45,,,,,,,109.0000,5228.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,1695.60,,,,,,,109.0000,5228.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1695.60,,,,,,,109.0000,5228.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4705.20,,,,,,,109.0000,5228.0000,percent of total billed charges,"90% of $5,228.00 in Billed Charges for Rev 450 Proc 31624 = $4,705.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,HUMANA,HUMANA MEDICARE,1614.86,,,,,,,109.0000,5228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1614.86,,,,,,,109.0000,5228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,MEDCOST,MEDCOST VHN,2488.01,,,,,,,109.0000,5228.0000,percent of total billed charges,"47.59% of $5,228.00 in Billed Charges for Rev 450 Proc 31624 = $2,488.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2647.50,,,,,,,109.0000,5228.0000,fee schedule,"APG 00064 Proc 31624 at $836.60 (Base Rate) * 3.0139 (Relative Weight) = $2,521.43 (Total Line Payment) at 100% = $2,521.43... $2,521.43 at 105% = $2,647.50 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1695.60,,,,,,,109.0000,5228.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1695.60,,,,,,,109.0000,5228.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,NHC ADVANTAGE,NHC ADVANTAGE,1695.60,,,,,,,109.0000,5228.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2599.59,,,,,,,109.0000,5228.0000,fee schedule,"APG 00064 Proc 31624 at $836.60 (Base Rate) * 3.0139 (Relative Weight) = $2,521.43 (Total Line Payment) at 100% = $2,521.43... $2,521.43 at 103.1% = $2,599.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,SENTARA HEALTH,SENTARA HEALTH,1349.35,,,,,,,109.0000,5228.0000,percent of total billed charges,"25.81% of $5,228.00 in Billed Charges for Rev 450 Proc 31624 = $1,349.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,SENTARA HEALTH,SENTARA MEDICARE,1614.86,,,,,,,109.0000,5228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5228.00,,,,,,,109.0000,5228.0000,percent of total billed charges,"100% of $5,228.00 in Billed Charges for Rev 450 Proc 31624 = $5,228.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,5228.0000,case rate,Rev 450 Proc 31624 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,5228.0000,case rate,Rev 450 Proc 31624 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,5228.0000,case rate,Rev 450 Proc 31624 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,5228.0000,case rate,Rev 450 Proc 31624 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2597.07,,,,,,,109.0000,5228.0000,fee schedule,"APG 00064 Proc 31624 at $836.60 (Base Rate) * 3.0139 (Relative Weight) = $2,521.43 (Total Line Payment) at 103% = $2,597.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1614.86,,,,,,,109.0000,5228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1614.86,,,,,,,109.0000,5228.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,WELLCARE,WELLCARE MEDICAID,5228.00,,,,,,,109.0000,5228.0000,percent of total billed charges,"100% of $5,228.00 in Billed Charges for Rev 450 Proc 31624 = $5,228.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BRONCH W BRONCHIAL ALVEOLAR LVAGE,31624,CPT,450,RC,45000310,CDM,,,,both,,,5228.0000,784.2000,WELLCARE,WELLCARE MEDICARE,1711.75,,,,,,,109.0000,5228.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,AETNA,AETNA,2020.56,,,,,,,775.0000,4732.0000,percent of total billed charges,"42.7% of $4,732.00 in Billed Charges for Rev 361 Proc 31625 = $2,020.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2622.29,,,,,,,775.0000,4732.0000,fee schedule,"APG 00064 Proc 31625 at $836.60 (Base Rate) * 3.0139 (Relative Weight) = $2,521.43 (Total Line Payment) at 104% = $2,622.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1614.86,,,,,,,775.0000,4732.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,AETNA,AETNA HEALTHCARE MEDICARE,1614.86,,,,,,,775.0000,4732.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,1614.86,,,,,,,775.0000,4732.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,AMBETTER,AMBETTER,3520.39,,,,,,,775.0000,4732.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1679.45,,,,,,,775.0000,4732.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,BLUE CROSS,ANTHEM EXCHANGE,3975.85,,,,,,,775.0000,4732.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2597.07,,,,,,,775.0000,4732.0000,fee schedule,"APG 00064 Proc 31625 at $836.60 (Base Rate) * 3.0139 (Relative Weight) = $2,521.43 (Total Line Payment) at 103% = $2,597.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,BLUE CROSS,ANTHEM HMO,4224.11,,,,,,,775.0000,4732.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1663.30,,,,,,,775.0000,4732.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4732.00,,,,,,,775.0000,4732.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,948.00,,,,,,,775.0000,4732.0000,case rate,Rev 361 Proc 31625 ASG Rate of $948.00 at 100% of $948.00 = $948.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,775.0000,4732.0000,case rate,"Rev 361 Proc 31625 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,BLUE CROSS,BLUE CROSS MEDICARE,1679.45,,,,,,,775.0000,4732.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,775.0000,4732.0000,case rate,"Rev 361 Proc 31625 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,775.0000,4732.0000,case rate,"Rev 361 Proc 31625 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,4732.0000,case rate,Rev 361 Proc 31625 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,4732.0000,case rate,Rev 361 Proc 31625 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,CIGNA HEALTHCARE,CIGNA HMO,2588.00,,,,,,,775.0000,4732.0000,case rate,"Rev 361 Proc 31625 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1956.00,,,,,,,775.0000,4732.0000,case rate,"Rev 361 Proc 31625 ASG Rate of $1,956.00 at 100% of $1,956.00 = $1,956.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,1695.60,,,,,,,775.0000,4732.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2588.00,,,,,,,775.0000,4732.0000,case rate,"Rev 361 Proc 31625 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,CIGNA HEALTHCARE,CIGNA PPO,2588.00,,,,,,,775.0000,4732.0000,case rate,"Rev 361 Proc 31625 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1695.60,,,,,,,775.0000,4732.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4258.80,,,,,,,775.0000,4732.0000,percent of total billed charges,"90% of $4,732.00 in Billed Charges for Rev 361 Proc 31625 = $4,258.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,HUMANA,HUMANA MEDICARE,1614.86,,,,,,,775.0000,4732.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1614.86,,,,,,,775.0000,4732.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,MEDCOST,MEDCOST VHN,2251.96,,,,,,,775.0000,4732.0000,percent of total billed charges,"47.59% of $4,732.00 in Billed Charges for Rev 361 Proc 31625 = $2,251.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2647.50,,,,,,,775.0000,4732.0000,fee schedule,"APG 00064 Proc 31625 at $836.60 (Base Rate) * 3.0139 (Relative Weight) = $2,521.43 (Total Line Payment) at 100% = $2,521.43... $2,521.43 at 105% = $2,647.50 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1695.60,,,,,,,775.0000,4732.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1695.60,,,,,,,775.0000,4732.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,NHC ADVANTAGE,NHC ADVANTAGE,1695.60,,,,,,,775.0000,4732.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2599.59,,,,,,,775.0000,4732.0000,fee schedule,"APG 00064 Proc 31625 at $836.60 (Base Rate) * 3.0139 (Relative Weight) = $2,521.43 (Total Line Payment) at 100% = $2,521.43... $2,521.43 at 103.1% = $2,599.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,SENTARA HEALTH,SENTARA HEALTH,1221.33,,,,,,,775.0000,4732.0000,percent of total billed charges,"25.81% of $4,732.00 in Billed Charges for Rev 361 Proc 31625 = $1,221.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,SENTARA HEALTH,SENTARA MEDICARE,1614.86,,,,,,,775.0000,4732.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4732.00,,,,,,,775.0000,4732.0000,percent of total billed charges,"100% of $4,732.00 in Billed Charges for Rev 361 Proc 31625 = $4,732.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,775.0000,4732.0000,case rate,Rev 361 Proc 31625 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,775.0000,4732.0000,case rate,"Rev 361 Proc 31625 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,775.0000,4732.0000,case rate,"Rev 361 Proc 31625 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,775.0000,4732.0000,case rate,"Rev 361 Proc 31625 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2597.07,,,,,,,775.0000,4732.0000,fee schedule,"APG 00064 Proc 31625 at $836.60 (Base Rate) * 3.0139 (Relative Weight) = $2,521.43 (Total Line Payment) at 103% = $2,597.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1614.86,,,,,,,775.0000,4732.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1614.86,,,,,,,775.0000,4732.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,WELLCARE,WELLCARE MEDICAID,4732.00,,,,,,,775.0000,4732.0000,percent of total billed charges,"100% of $4,732.00 in Billed Charges for Rev 361 Proc 31625 = $4,732.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BRONCH BRONCHIAL/ENDOBRNCL BX 1+ SITES,31625,CPT,361,RC,36100512,CDM,,,,both,,,4732.0000,709.8000,WELLCARE,WELLCARE MEDICARE,1711.75,,,,,,,775.0000,4732.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,AETNA,AETNA,259.62,,,,,,,156.9200,846.1000,percent of total billed charges,42.7% of $608.00 in Billed Charges for Rev 360 Proc 31725 = $259.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,838.05,,,,,,,156.9200,846.1000,fee schedule,APG 00062 Proc 31725 at $836.60 (Base Rate) * 0.9632 (Relative Weight) = $805.81 (Total Line Payment) at 104% = $838.05. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,BLUE CROSS,ANTHEM EXCHANGE,608.00,,,,,,,156.9200,846.1000,fee schedule,"$1,933.94 from Fee Schedule ANT_C_APC for Rev 360 Proc 31725 * Qty 1 = $1,933.94 at 199.87% = $3,865.37 (Service Line reduced to $608.00, claim capped at $608.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,608.00,,,,,,,156.9200,846.1000,fee schedule,"APG 00062 Proc 31725 at $836.60 (Base Rate) * 0.9632 (Relative Weight) = $805.81 (Total Line Payment) at 103% = $829.99 (Service Line reduced to $608.00, claim capped at $608.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,BLUE CROSS,ANTHEM HMO,608.00,,,,,,,156.9200,846.1000,fee schedule,"$1,933.94 from Fee Schedule ANT_C_APC for Rev 360 Proc 31725 * Qty 1 = $1,933.94 at 212.35% = $4,106.72 (Service Line reduced to $608.00, claim capped at $608.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",608.00,,,,,,,156.9200,846.1000,fee schedule,"$1,933.94 from Fee Schedule ANT_C_APC for Rev 360 Proc 31725 * Qty 1 = $1,933.94 at 249.81% = $4,831.18 (Service Line reduced to $608.00, claim capped at $608.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,608.00,,,,,,,156.9200,846.1000,case rate,"Rev 360 Proc 31725 ASG Rate of $1,082.00 at 100% of $1,082.00 = $1,082.00 Total (Limited to $608.00 in Billed Charges - $0.00 in ASG Allowed Amount = $608.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,BLUE CROSS,BLUE CROSS E NETWORK,608.00,,,,,,,156.9200,846.1000,case rate,"Rev 360 Proc 31725 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total (Service Line reduced to $608.00, claim capped at $608.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,BLUE CROSS,BLUE CROSS P NETWORK,608.00,,,,,,,156.9200,846.1000,case rate,"Rev 360 Proc 31725 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total (Service Line reduced to $608.00, claim capped at $608.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,BLUE CROSS,BLUE CROSS S NETWORK,608.00,,,,,,,156.9200,846.1000,case rate,"Rev 360 Proc 31725 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total (Service Line reduced to $608.00, claim capped at $608.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,156.9200,846.1000,case rate,Rev 360 Proc 31725 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,156.9200,846.1000,case rate,Rev 360 Proc 31725 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,CIGNA HEALTHCARE,CIGNA HMO,608.00,,,,,,,156.9200,846.1000,case rate,"Rev 360 Proc 31725 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $608.00 in Billed Charges - $0.00 in ASG Allowed Amount = $608.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,608.00,,,,,,,156.9200,846.1000,case rate,"Rev 360 Proc 31725 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $608.00 in Billed Charges - $0.00 in ASG Allowed Amount = $608.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,608.00,,,,,,,156.9200,846.1000,case rate,"Rev 360 Proc 31725 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $608.00 in Billed Charges - $0.00 in ASG Allowed Amount = $608.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,CIGNA HEALTHCARE,CIGNA PPO,608.00,,,,,,,156.9200,846.1000,case rate,"Rev 360 Proc 31725 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $608.00 in Billed Charges - $0.00 in ASG Allowed Amount = $608.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,547.20,,,,,,,156.9200,846.1000,percent of total billed charges,90% of $608.00 in Billed Charges for Rev 360 Proc 31725 = $547.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,MEDCOST,MEDCOST VHN,289.35,,,,,,,156.9200,846.1000,percent of total billed charges,47.59% of $608.00 in Billed Charges for Rev 360 Proc 31725 = $289.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,846.10,,,,,,,156.9200,846.1000,fee schedule,APG 00062 Proc 31725 at $836.60 (Base Rate) * 0.9632 (Relative Weight) = $805.81 (Total Line Payment) at 100% = $805.81... $805.81 at 105% = $846.10 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,830.79,,,,,,,156.9200,846.1000,fee schedule,APG 00062 Proc 31725 at $836.60 (Base Rate) * 0.9632 (Relative Weight) = $805.81 (Total Line Payment) at 100% = $805.81... $805.81 at 103.1% = $830.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,SENTARA HEALTH,SENTARA HEALTH,156.92,,,,,,,156.9200,846.1000,percent of total billed charges,25.81% of $608.00 in Billed Charges for Rev 360 Proc 31725 = $156.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",608.00,,,,,,,156.9200,846.1000,percent of total billed charges,100% of $608.00 in Billed Charges for Rev 360 Proc 31725 = $608.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,608.00,,,,,,,156.9200,846.1000,case rate,Rev 360 Proc 31725 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total (Limited to $608.00 in Billed Charges - $0.00 in ASG Allowed Amount = $608.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,608.00,,,,,,,156.9200,846.1000,case rate,"Rev 360 Proc 31725 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total (Service Line reduced to $608.00, claim capped at $608.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,608.00,,,,,,,156.9200,846.1000,case rate,"Rev 360 Proc 31725 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total (Service Line reduced to $608.00, claim capped at $608.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,608.00,,,,,,,156.9200,846.1000,case rate,"Rev 360 Proc 31725 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total (Service Line reduced to $608.00, claim capped at $608.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,829.99,,,,,,,156.9200,846.1000,fee schedule,APG 00062 Proc 31725 at $836.60 (Base Rate) * 0.9632 (Relative Weight) = $805.81 (Total Line Payment) at 103% = $829.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX,31725,CPT,360,RC,36000238,CDM,,,,both,,,608.0000,91.2000,WELLCARE,WELLCARE MEDICAID,608.00,,,,,,,156.9200,846.1000,percent of total billed charges,100% of $608.00 in Billed Charges for Rev 360 Proc 31725 = $608.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC THORACOTOMY W CARDIAC MASSAGE,32160,CPT,450,RC,45000318,CDM,,,,both,,,12753.0000,1912.9500,AETNA,AETNA,5445.53,,,,,,,109.0000,12753.0000,percent of total billed charges,"42.7% of $12,753.00 in Billed Charges for Rev 450 Proc 32160 = $5,445.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACOTOMY W CARDIAC MASSAGE,32160,CPT,450,RC,45000318,CDM,,,,both,,,12753.0000,1912.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,7306.71,,,,,,,109.0000,12753.0000,fee schedule,"APG 00070 Proc 32160 at $836.60 (Base Rate) * 8.3979 (Relative Weight) = $7,025.68 (Total Line Payment) at 104% = $7,306.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACOTOMY W CARDIAC MASSAGE,32160,CPT,450,RC,45000318,CDM,,,,both,,,12753.0000,1912.9500,BLUE CROSS,ANTHEM EXCHANGE,12753.00,,,,,,,109.0000,12753.0000,fee schedule,"$6,543.04 from Fee Schedule ANT_C_APC for Rev 450 Proc 32160 * Qty 1 = $6,543.04 at 199.87% = $13,077.57 (Service Line reduced to $12,753.00, claim capped at $12,753.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACOTOMY W CARDIAC MASSAGE,32160,CPT,450,RC,45000318,CDM,,,,both,,,12753.0000,1912.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,7236.45,,,,,,,109.0000,12753.0000,fee schedule,"APG 00070 Proc 32160 at $836.60 (Base Rate) * 8.3979 (Relative Weight) = $7,025.68 (Total Line Payment) at 103% = $7,236.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACOTOMY W CARDIAC MASSAGE,32160,CPT,450,RC,45000318,CDM,,,,both,,,12753.0000,1912.9500,BLUE CROSS,ANTHEM HMO,12753.00,,,,,,,109.0000,12753.0000,fee schedule,"$6,543.04 from Fee Schedule ANT_C_APC for Rev 450 Proc 32160 * Qty 1 = $6,543.04 at 212.35% = $13,894.15 (Service Line reduced to $12,753.00, claim capped at $12,753.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACOTOMY W CARDIAC MASSAGE,32160,CPT,450,RC,45000318,CDM,,,,both,,,12753.0000,1912.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",12753.00,,,,,,,109.0000,12753.0000,fee schedule,"$6,543.04 from Fee Schedule ANT_C_APC for Rev 450 Proc 32160 * Qty 1 = $6,543.04 at 249.81% = $16,345.17 (Service Line reduced to $12,753.00, claim capped at $12,753.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACOTOMY W CARDIAC MASSAGE,32160,CPT,450,RC,45000318,CDM,,,,both,,,12753.0000,1912.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,508.26,,,,,,,109.0000,12753.0000,fee schedule,$508.26 from Fee Schedule BLDTM_23 for Rev 450 Proc 32160 * Qty 1 = $508.26 at 100% = $508.26 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACOTOMY W CARDIAC MASSAGE,32160,CPT,450,RC,45000318,CDM,,,,both,,,12753.0000,1912.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11477.70,,,,,,,109.0000,12753.0000,percent of total billed charges,"90% of $12,753.00 in Billed Charges for Rev 450 Proc 32160 = $11,477.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACOTOMY W CARDIAC MASSAGE,32160,CPT,450,RC,45000318,CDM,,,,both,,,12753.0000,1912.9500,MEDCOST,MEDCOST VHN,6069.15,,,,,,,109.0000,12753.0000,percent of total billed charges,"47.59% of $12,753.00 in Billed Charges for Rev 450 Proc 32160 = $6,069.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACOTOMY W CARDIAC MASSAGE,32160,CPT,450,RC,45000318,CDM,,,,both,,,12753.0000,1912.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,7376.96,,,,,,,109.0000,12753.0000,fee schedule,"APG 00070 Proc 32160 at $836.60 (Base Rate) * 8.3979 (Relative Weight) = $7,025.68 (Total Line Payment) at 100% = $7,025.68... $7,025.68 at 105% = $7,376.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACOTOMY W CARDIAC MASSAGE,32160,CPT,450,RC,45000318,CDM,,,,both,,,12753.0000,1912.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,7243.48,,,,,,,109.0000,12753.0000,fee schedule,"APG 00070 Proc 32160 at $836.60 (Base Rate) * 8.3979 (Relative Weight) = $7,025.68 (Total Line Payment) at 100% = $7,025.68... $7,025.68 at 103.1% = $7,243.48 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACOTOMY W CARDIAC MASSAGE,32160,CPT,450,RC,45000318,CDM,,,,both,,,12753.0000,1912.9500,SENTARA HEALTH,SENTARA HEALTH,3291.55,,,,,,,109.0000,12753.0000,percent of total billed charges,"25.81% of $12,753.00 in Billed Charges for Rev 450 Proc 32160 = $3,291.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACOTOMY W CARDIAC MASSAGE,32160,CPT,450,RC,45000318,CDM,,,,both,,,12753.0000,1912.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12753.00,,,,,,,109.0000,12753.0000,percent of total billed charges,"100% of $12,753.00 in Billed Charges for Rev 450 Proc 32160 = $12,753.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACOTOMY W CARDIAC MASSAGE,32160,CPT,450,RC,45000318,CDM,,,,both,,,12753.0000,1912.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,12753.0000,case rate,Rev 450 Proc 32160 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACOTOMY W CARDIAC MASSAGE,32160,CPT,450,RC,45000318,CDM,,,,both,,,12753.0000,1912.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,12753.0000,case rate,Rev 450 Proc 32160 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACOTOMY W CARDIAC MASSAGE,32160,CPT,450,RC,45000318,CDM,,,,both,,,12753.0000,1912.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,12753.0000,case rate,Rev 450 Proc 32160 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACOTOMY W CARDIAC MASSAGE,32160,CPT,450,RC,45000318,CDM,,,,both,,,12753.0000,1912.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,12753.0000,case rate,Rev 450 Proc 32160 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACOTOMY W CARDIAC MASSAGE,32160,CPT,450,RC,45000318,CDM,,,,both,,,12753.0000,1912.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,7236.45,,,,,,,109.0000,12753.0000,fee schedule,"APG 00070 Proc 32160 at $836.60 (Base Rate) * 8.3979 (Relative Weight) = $7,025.68 (Total Line Payment) at 103% = $7,236.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACOTOMY W CARDIAC MASSAGE,32160,CPT,450,RC,45000318,CDM,,,,both,,,12753.0000,1912.9500,WELLCARE,WELLCARE MEDICAID,12753.00,,,,,,,109.0000,12753.0000,percent of total billed charges,"100% of $12,753.00 in Billed Charges for Rev 450 Proc 32160 = $12,753.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,AETNA,AETNA,1105.50,,,,,,,578.0000,3266.6300,percent of total billed charges,"42.7% of $2,589.00 in Billed Charges for Rev 361 Proc 32400 = $1,105.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1446.31,,,,,,,578.0000,3266.6300,fee schedule,"APG 00068 Proc 32400 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 104% = $1,446.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,AMBETTER,AMBETTER,3266.63,,,,,,,578.0000,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,578.0000,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,ANTHEM EXCHANGE,2589.00,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1432.40,,,,,,,578.0000,3266.6300,fee schedule,"APG 00068 Proc 32400 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,ANTHEM HMO,2589.00,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,578.0000,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2589.00,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,578.0000,3266.6300,case rate,Rev 361 Proc 32400 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 32400 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,578.0000,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 32400 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 32400 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,3266.6300,case rate,Rev 361 Proc 32400 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,3266.6300,case rate,Rev 361 Proc 32400 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 32400 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 32400 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,578.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 32400 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 32400 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,578.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2330.10,,,,,,,578.0000,3266.6300,percent of total billed charges,"90% of $2,589.00 in Billed Charges for Rev 361 Proc 32400 = $2,330.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,MEDCOST,MEDCOST VHN,1232.11,,,,,,,578.0000,3266.6300,percent of total billed charges,"47.59% of $2,589.00 in Billed Charges for Rev 361 Proc 32400 = $1,232.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1460.21,,,,,,,578.0000,3266.6300,fee schedule,"APG 00068 Proc 32400 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 100% = $1,390.68... $1,390.68 at 105% = $1,460.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,578.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,578.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,578.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1433.79,,,,,,,578.0000,3266.6300,fee schedule,"APG 00068 Proc 32400 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 100% = $1,390.68... $1,390.68 at 103.1% = $1,433.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,SENTARA HEALTH,SENTARA HEALTH,668.22,,,,,,,578.0000,3266.6300,percent of total billed charges,"25.81% of $2,589.00 in Billed Charges for Rev 361 Proc 32400 = $668.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2589.00,,,,,,,578.0000,3266.6300,percent of total billed charges,"100% of $2,589.00 in Billed Charges for Rev 361 Proc 32400 = $2,589.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,578.0000,3266.6300,case rate,Rev 361 Proc 32400 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 32400 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 32400 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 32400 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1432.40,,,,,,,578.0000,3266.6300,fee schedule,"APG 00068 Proc 32400 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,WELLCARE,WELLCARE MEDICAID,2589.00,,,,,,,578.0000,3266.6300,percent of total billed charges,"100% of $2,589.00 in Billed Charges for Rev 361 Proc 32400 = $2,589.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX PLEURA PERC NEEDLE,32400,CPT,361,RC,36100290,CDM,,,,both,,,2589.0000,388.3500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,578.0000,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,AETNA,AETNA,1901.43,,,,,,,578.0000,4453.0000,percent of total billed charges,"42.7% of $4,453.00 in Billed Charges for Rev 361 Proc 32408 = $1,901.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1446.31,,,,,,,578.0000,4453.0000,fee schedule,"APG 00068 Proc 32408 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 104% = $1,446.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,578.0000,4453.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,578.0000,4453.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,578.0000,4453.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,AMBETTER,AMBETTER,3266.63,,,,,,,578.0000,4453.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,578.0000,4453.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,BLUE CROSS,ANTHEM EXCHANGE,3689.28,,,,,,,578.0000,4453.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1432.40,,,,,,,578.0000,4453.0000,fee schedule,"APG 00068 Proc 32408 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,BLUE CROSS,ANTHEM HMO,3919.64,,,,,,,578.0000,4453.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,578.0000,4453.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4453.00,,,,,,,578.0000,4453.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,578.0000,4453.0000,case rate,"Rev 361 Proc 32408 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,578.0000,4453.0000,case rate,"Rev 361 Proc 32408 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,578.0000,4453.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,578.0000,4453.0000,case rate,"Rev 361 Proc 32408 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,578.0000,4453.0000,case rate,"Rev 361 Proc 32408 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,4453.0000,case rate,Rev 361 Proc 32408 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,4453.0000,case rate,Rev 361 Proc 32408 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,578.0000,4453.0000,case rate,"Rev 361 Proc 32408 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,578.0000,4453.0000,case rate,"Rev 361 Proc 32408 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,578.0000,4453.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,578.0000,4453.0000,case rate,"Rev 361 Proc 32408 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,578.0000,4453.0000,case rate,"Rev 361 Proc 32408 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,578.0000,4453.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4007.70,,,,,,,578.0000,4453.0000,percent of total billed charges,"90% of $4,453.00 in Billed Charges for Rev 361 Proc 32408 = $4,007.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,578.0000,4453.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,578.0000,4453.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,MEDCOST,MEDCOST VHN,2119.18,,,,,,,578.0000,4453.0000,percent of total billed charges,"47.59% of $4,453.00 in Billed Charges for Rev 361 Proc 32408 = $2,119.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1460.21,,,,,,,578.0000,4453.0000,fee schedule,"APG 00068 Proc 32408 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 100% = $1,390.68... $1,390.68 at 105% = $1,460.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,578.0000,4453.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,578.0000,4453.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,578.0000,4453.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1433.79,,,,,,,578.0000,4453.0000,fee schedule,"APG 00068 Proc 32408 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 100% = $1,390.68... $1,390.68 at 103.1% = $1,433.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,SENTARA HEALTH,SENTARA HEALTH,1149.32,,,,,,,578.0000,4453.0000,percent of total billed charges,"25.81% of $4,453.00 in Billed Charges for Rev 361 Proc 32408 = $1,149.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,578.0000,4453.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4453.00,,,,,,,578.0000,4453.0000,percent of total billed charges,"100% of $4,453.00 in Billed Charges for Rev 361 Proc 32408 = $4,453.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,578.0000,4453.0000,case rate,Rev 361 Proc 32408 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,578.0000,4453.0000,case rate,"Rev 361 Proc 32408 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,578.0000,4453.0000,case rate,"Rev 361 Proc 32408 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,578.0000,4453.0000,case rate,"Rev 361 Proc 32408 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1432.40,,,,,,,578.0000,4453.0000,fee schedule,"APG 00068 Proc 32408 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,578.0000,4453.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,578.0000,4453.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,WELLCARE,WELLCARE MEDICAID,4453.00,,,,,,,578.0000,4453.0000,percent of total billed charges,"100% of $4,453.00 in Billed Charges for Rev 361 Proc 32408 = $4,453.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG,32408,CPT,361,RC,36100510,CDM,,,,both,,,4453.0000,667.9500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,578.0000,4453.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER,33986,CPT,360,RC,36000258,CDM,,,,both,,,1976.0000,296.4000,AETNA,AETNA,843.75,,,,,,,510.0100,11503.0400,percent of total billed charges,"42.7% of $1,976.00 in Billed Charges for Rev 360 Proc 33986 = $843.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER,33986,CPT,360,RC,36000258,CDM,,,,both,,,1976.0000,296.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11393.49,,,,,,,510.0100,11503.0400,fee schedule,"APG 03070 Proc 33986 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 104% = $11,393.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER,33986,CPT,360,RC,36000258,CDM,,,,both,,,1976.0000,296.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1976.00,,,,,,,510.0100,11503.0400,fee schedule,"APG 03070 Proc 33986 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94 (Service Line reduced to $1,976.00, claim capped at $1,976.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER,33986,CPT,360,RC,36000258,CDM,,,,both,,,1976.0000,296.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33986 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER,33986,CPT,360,RC,36000258,CDM,,,,both,,,1976.0000,296.4000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33986 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER,33986,CPT,360,RC,36000258,CDM,,,,both,,,1976.0000,296.4000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33986 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER,33986,CPT,360,RC,36000258,CDM,,,,both,,,1976.0000,296.4000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33986 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER,33986,CPT,360,RC,36000258,CDM,,,,both,,,1976.0000,296.4000,CIGNA HEALTHCARE,CIGNA HMO,1976.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33986 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,976.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,976.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER,33986,CPT,360,RC,36000258,CDM,,,,both,,,1976.0000,296.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1976.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33986 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $1,976.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,976.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER,33986,CPT,360,RC,36000258,CDM,,,,both,,,1976.0000,296.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1976.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33986 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,976.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,976.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER,33986,CPT,360,RC,36000258,CDM,,,,both,,,1976.0000,296.4000,CIGNA HEALTHCARE,CIGNA PPO,1976.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33986 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,976.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,976.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER,33986,CPT,360,RC,36000258,CDM,,,,both,,,1976.0000,296.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1778.40,,,,,,,510.0100,11503.0400,percent of total billed charges,"90% of $1,976.00 in Billed Charges for Rev 360 Proc 33986 = $1,778.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER,33986,CPT,360,RC,36000258,CDM,,,,both,,,1976.0000,296.4000,MEDCOST,MEDCOST VHN,940.38,,,,,,,510.0100,11503.0400,percent of total billed charges,"47.59% of $1,976.00 in Billed Charges for Rev 360 Proc 33986 = $940.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER,33986,CPT,360,RC,36000258,CDM,,,,both,,,1976.0000,296.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11503.04,,,,,,,510.0100,11503.0400,fee schedule,"APG 03070 Proc 33986 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 105% = $11,503.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER,33986,CPT,360,RC,36000258,CDM,,,,both,,,1976.0000,296.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11294.89,,,,,,,510.0100,11503.0400,fee schedule,"APG 03070 Proc 33986 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 103.1% = $11,294.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER,33986,CPT,360,RC,36000258,CDM,,,,both,,,1976.0000,296.4000,SENTARA HEALTH,SENTARA HEALTH,510.01,,,,,,,510.0100,11503.0400,percent of total billed charges,"25.81% of $1,976.00 in Billed Charges for Rev 360 Proc 33986 = $510.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER,33986,CPT,360,RC,36000258,CDM,,,,both,,,1976.0000,296.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1976.00,,,,,,,510.0100,11503.0400,percent of total billed charges,"100% of $1,976.00 in Billed Charges for Rev 360 Proc 33986 = $1,976.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER,33986,CPT,360,RC,36000258,CDM,,,,both,,,1976.0000,296.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,510.0100,11503.0400,case rate,Rev 360 Proc 33986 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER,33986,CPT,360,RC,36000258,CDM,,,,both,,,1976.0000,296.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33986 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER,33986,CPT,360,RC,36000258,CDM,,,,both,,,1976.0000,296.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33986 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER,33986,CPT,360,RC,36000258,CDM,,,,both,,,1976.0000,296.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33986 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER,33986,CPT,360,RC,36000258,CDM,,,,both,,,1976.0000,296.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11283.94,,,,,,,510.0100,11503.0400,fee schedule,"APG 03070 Proc 33986 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER,33986,CPT,360,RC,36000258,CDM,,,,both,,,1976.0000,296.4000,WELLCARE,WELLCARE MEDICAID,1976.00,,,,,,,510.0100,11503.0400,percent of total billed charges,"100% of $1,976.00 in Billed Charges for Rev 360 Proc 33986 = $1,976.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS,33988,CPT,360,RC,36000260,CDM,,,,both,,,3087.0000,463.0500,AETNA,AETNA,1318.15,,,,,,,796.7500,11503.0400,percent of total billed charges,"42.7% of $3,087.00 in Billed Charges for Rev 360 Proc 33988 = $1,318.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS,33988,CPT,360,RC,36000260,CDM,,,,both,,,3087.0000,463.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11393.49,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33988 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 104% = $11,393.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS,33988,CPT,360,RC,36000260,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3087.00,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33988 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94 (Service Line reduced to $3,087.00, claim capped at $3,087.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS,33988,CPT,360,RC,36000260,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33988 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS,33988,CPT,360,RC,36000260,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33988 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS,33988,CPT,360,RC,36000260,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33988 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS,33988,CPT,360,RC,36000260,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33988 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS,33988,CPT,360,RC,36000260,CDM,,,,both,,,3087.0000,463.0500,CIGNA HEALTHCARE,CIGNA HMO,3087.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33988 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $3,087.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,087.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS,33988,CPT,360,RC,36000260,CDM,,,,both,,,3087.0000,463.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3087.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33988 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $3,087.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,087.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS,33988,CPT,360,RC,36000260,CDM,,,,both,,,3087.0000,463.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3087.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33988 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $3,087.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,087.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS,33988,CPT,360,RC,36000260,CDM,,,,both,,,3087.0000,463.0500,CIGNA HEALTHCARE,CIGNA PPO,3087.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33988 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $3,087.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,087.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS,33988,CPT,360,RC,36000260,CDM,,,,both,,,3087.0000,463.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2778.30,,,,,,,796.7500,11503.0400,percent of total billed charges,"90% of $3,087.00 in Billed Charges for Rev 360 Proc 33988 = $2,778.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS,33988,CPT,360,RC,36000260,CDM,,,,both,,,3087.0000,463.0500,MEDCOST,MEDCOST VHN,1469.10,,,,,,,796.7500,11503.0400,percent of total billed charges,"47.59% of $3,087.00 in Billed Charges for Rev 360 Proc 33988 = $1,469.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS,33988,CPT,360,RC,36000260,CDM,,,,both,,,3087.0000,463.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11503.04,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33988 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 105% = $11,503.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS,33988,CPT,360,RC,36000260,CDM,,,,both,,,3087.0000,463.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11294.89,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33988 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 103.1% = $11,294.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS,33988,CPT,360,RC,36000260,CDM,,,,both,,,3087.0000,463.0500,SENTARA HEALTH,SENTARA HEALTH,796.75,,,,,,,796.7500,11503.0400,percent of total billed charges,"25.81% of $3,087.00 in Billed Charges for Rev 360 Proc 33988 = $796.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS,33988,CPT,360,RC,36000260,CDM,,,,both,,,3087.0000,463.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3087.00,,,,,,,796.7500,11503.0400,percent of total billed charges,"100% of $3,087.00 in Billed Charges for Rev 360 Proc 33988 = $3,087.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS,33988,CPT,360,RC,36000260,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,796.7500,11503.0400,case rate,Rev 360 Proc 33988 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS,33988,CPT,360,RC,36000260,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33988 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS,33988,CPT,360,RC,36000260,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33988 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS,33988,CPT,360,RC,36000260,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33988 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS,33988,CPT,360,RC,36000260,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11283.94,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33988 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS,33988,CPT,360,RC,36000260,CDM,,,,both,,,3087.0000,463.0500,WELLCARE,WELLCARE MEDICAID,3087.00,,,,,,,796.7500,11503.0400,percent of total billed charges,"100% of $3,087.00 in Billed Charges for Rev 360 Proc 33988 = $3,087.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT VENTRICULAR ASST DEVICE PERCU ARTERIAL,33990,CPT,360,RC,36000106,CDM,,,,both,,,35768.0000,5365.2000,AETNA,AETNA,15272.94,,,,,,,968.0000,45600.2700,percent of total billed charges,"42.7% of $35,768.00 in Billed Charges for Rev 360 Proc 33990 = $15,272.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT VENTRICULAR ASST DEVICE PERCU ARTERIAL,33990,CPT,360,RC,36000106,CDM,,,,both,,,35768.0000,5365.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,45165.98,,,,,,,968.0000,45600.2700,fee schedule,"APG 03060 Proc 33990 at $836.60 (Base Rate) * 51.9111 (Relative Weight) = $43,428.83 (Total Line Payment) at 104% = $45,165.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE PERCU ARTERIAL,33990,CPT,360,RC,36000106,CDM,,,,both,,,35768.0000,5365.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,35768.00,,,,,,,968.0000,45600.2700,fee schedule,"APG 03060 Proc 33990 at $836.60 (Base Rate) * 51.9111 (Relative Weight) = $43,428.83 (Total Line Payment) at 103% = $44,731.69 (Service Line reduced to $35,768.00, claim capped at $35,768.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE PERCU ARTERIAL,33990,CPT,360,RC,36000106,CDM,,,,both,,,35768.0000,5365.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,968.0000,45600.2700,case rate,"Rev 360 Proc 33990 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE PERCU ARTERIAL,33990,CPT,360,RC,36000106,CDM,,,,both,,,35768.0000,5365.2000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,968.0000,45600.2700,case rate,"Rev 360 Proc 33990 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE PERCU ARTERIAL,33990,CPT,360,RC,36000106,CDM,,,,both,,,35768.0000,5365.2000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,968.0000,45600.2700,case rate,"Rev 360 Proc 33990 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE PERCU ARTERIAL,33990,CPT,360,RC,36000106,CDM,,,,both,,,35768.0000,5365.2000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,968.0000,45600.2700,case rate,"Rev 360 Proc 33990 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE PERCU ARTERIAL,33990,CPT,360,RC,36000106,CDM,,,,both,,,35768.0000,5365.2000,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,968.0000,45600.2700,case rate,"Rev 360 Proc 33990 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE PERCU ARTERIAL,33990,CPT,360,RC,36000106,CDM,,,,both,,,35768.0000,5365.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,968.0000,45600.2700,case rate,"Rev 360 Proc 33990 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE PERCU ARTERIAL,33990,CPT,360,RC,36000106,CDM,,,,both,,,35768.0000,5365.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,968.0000,45600.2700,case rate,"Rev 360 Proc 33990 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE PERCU ARTERIAL,33990,CPT,360,RC,36000106,CDM,,,,both,,,35768.0000,5365.2000,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,968.0000,45600.2700,case rate,"Rev 360 Proc 33990 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE PERCU ARTERIAL,33990,CPT,360,RC,36000106,CDM,,,,both,,,35768.0000,5365.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,32191.20,,,,,,,968.0000,45600.2700,percent of total billed charges,"90% of $35,768.00 in Billed Charges for Rev 360 Proc 33990 = $32,191.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT VENTRICULAR ASST DEVICE PERCU ARTERIAL,33990,CPT,360,RC,36000106,CDM,,,,both,,,35768.0000,5365.2000,MEDCOST,MEDCOST VHN,17021.99,,,,,,,968.0000,45600.2700,percent of total billed charges,"47.59% of $35,768.00 in Billed Charges for Rev 360 Proc 33990 = $17,021.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT VENTRICULAR ASST DEVICE PERCU ARTERIAL,33990,CPT,360,RC,36000106,CDM,,,,both,,,35768.0000,5365.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,45600.27,,,,,,,968.0000,45600.2700,fee schedule,"APG 03060 Proc 33990 at $836.60 (Base Rate) * 51.9111 (Relative Weight) = $43,428.83 (Total Line Payment) at 100% = $43,428.83... $43,428.83 at 105% = $45,600.27 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE PERCU ARTERIAL,33990,CPT,360,RC,36000106,CDM,,,,both,,,35768.0000,5365.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,44775.12,,,,,,,968.0000,45600.2700,fee schedule,"APG 03060 Proc 33990 at $836.60 (Base Rate) * 51.9111 (Relative Weight) = $43,428.83 (Total Line Payment) at 100% = $43,428.83... $43,428.83 at 103.1% = $44,775.12 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE PERCU ARTERIAL,33990,CPT,360,RC,36000106,CDM,,,,both,,,35768.0000,5365.2000,SENTARA HEALTH,SENTARA HEALTH,9231.72,,,,,,,968.0000,45600.2700,percent of total billed charges,"25.81% of $35,768.00 in Billed Charges for Rev 360 Proc 33990 = $9,231.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT VENTRICULAR ASST DEVICE PERCU ARTERIAL,33990,CPT,360,RC,36000106,CDM,,,,both,,,35768.0000,5365.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",35768.00,,,,,,,968.0000,45600.2700,percent of total billed charges,"100% of $35,768.00 in Billed Charges for Rev 360 Proc 33990 = $35,768.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT VENTRICULAR ASST DEVICE PERCU ARTERIAL,33990,CPT,360,RC,36000106,CDM,,,,both,,,35768.0000,5365.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,968.0000,45600.2700,case rate,Rev 360 Proc 33990 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT VENTRICULAR ASST DEVICE PERCU ARTERIAL,33990,CPT,360,RC,36000106,CDM,,,,both,,,35768.0000,5365.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,968.0000,45600.2700,case rate,"Rev 360 Proc 33990 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE PERCU ARTERIAL,33990,CPT,360,RC,36000106,CDM,,,,both,,,35768.0000,5365.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,968.0000,45600.2700,case rate,"Rev 360 Proc 33990 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE PERCU ARTERIAL,33990,CPT,360,RC,36000106,CDM,,,,both,,,35768.0000,5365.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,968.0000,45600.2700,case rate,"Rev 360 Proc 33990 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE PERCU ARTERIAL,33990,CPT,360,RC,36000106,CDM,,,,both,,,35768.0000,5365.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,44731.69,,,,,,,968.0000,45600.2700,fee schedule,"APG 03060 Proc 33990 at $836.60 (Base Rate) * 51.9111 (Relative Weight) = $43,428.83 (Total Line Payment) at 103% = $44,731.69. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE PERCU ARTERIAL,33990,CPT,360,RC,36000106,CDM,,,,both,,,35768.0000,5365.2000,WELLCARE,WELLCARE MEDICAID,35768.00,,,,,,,968.0000,45600.2700,percent of total billed charges,"100% of $35,768.00 in Billed Charges for Rev 360 Proc 33990 = $35,768.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT VENTRICULAR ASST DEVICE ARTERIAL & VENOUS W TRANSSEPTAL PUNC,33991,CPT,360,RC,36000107,CDM,,,,both,,,18306.0000,2745.9000,AETNA,AETNA,7816.66,,,,,,,968.0000,45600.2700,percent of total billed charges,"42.7% of $18,306.00 in Billed Charges for Rev 360 Proc 33991 = $7,816.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT VENTRICULAR ASST DEVICE ARTERIAL & VENOUS W TRANSSEPTAL PUNC,33991,CPT,360,RC,36000107,CDM,,,,both,,,18306.0000,2745.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,45165.98,,,,,,,968.0000,45600.2700,fee schedule,"APG 03060 Proc 33991 at $836.60 (Base Rate) * 51.9111 (Relative Weight) = $43,428.83 (Total Line Payment) at 104% = $45,165.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE ARTERIAL & VENOUS W TRANSSEPTAL PUNC,33991,CPT,360,RC,36000107,CDM,,,,both,,,18306.0000,2745.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,18306.00,,,,,,,968.0000,45600.2700,fee schedule,"APG 03060 Proc 33991 at $836.60 (Base Rate) * 51.9111 (Relative Weight) = $43,428.83 (Total Line Payment) at 103% = $44,731.69 (Service Line reduced to $18,306.00, claim capped at $18,306.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE ARTERIAL & VENOUS W TRANSSEPTAL PUNC,33991,CPT,360,RC,36000107,CDM,,,,both,,,18306.0000,2745.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,968.0000,45600.2700,case rate,"Rev 360 Proc 33991 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE ARTERIAL & VENOUS W TRANSSEPTAL PUNC,33991,CPT,360,RC,36000107,CDM,,,,both,,,18306.0000,2745.9000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,968.0000,45600.2700,case rate,"Rev 360 Proc 33991 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE ARTERIAL & VENOUS W TRANSSEPTAL PUNC,33991,CPT,360,RC,36000107,CDM,,,,both,,,18306.0000,2745.9000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,968.0000,45600.2700,case rate,"Rev 360 Proc 33991 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE ARTERIAL & VENOUS W TRANSSEPTAL PUNC,33991,CPT,360,RC,36000107,CDM,,,,both,,,18306.0000,2745.9000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,968.0000,45600.2700,case rate,"Rev 360 Proc 33991 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE ARTERIAL & VENOUS W TRANSSEPTAL PUNC,33991,CPT,360,RC,36000107,CDM,,,,both,,,18306.0000,2745.9000,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,968.0000,45600.2700,case rate,"Rev 360 Proc 33991 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE ARTERIAL & VENOUS W TRANSSEPTAL PUNC,33991,CPT,360,RC,36000107,CDM,,,,both,,,18306.0000,2745.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,968.0000,45600.2700,case rate,"Rev 360 Proc 33991 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE ARTERIAL & VENOUS W TRANSSEPTAL PUNC,33991,CPT,360,RC,36000107,CDM,,,,both,,,18306.0000,2745.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,968.0000,45600.2700,case rate,"Rev 360 Proc 33991 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE ARTERIAL & VENOUS W TRANSSEPTAL PUNC,33991,CPT,360,RC,36000107,CDM,,,,both,,,18306.0000,2745.9000,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,968.0000,45600.2700,case rate,"Rev 360 Proc 33991 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE ARTERIAL & VENOUS W TRANSSEPTAL PUNC,33991,CPT,360,RC,36000107,CDM,,,,both,,,18306.0000,2745.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,16475.40,,,,,,,968.0000,45600.2700,percent of total billed charges,"90% of $18,306.00 in Billed Charges for Rev 360 Proc 33991 = $16,475.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT VENTRICULAR ASST DEVICE ARTERIAL & VENOUS W TRANSSEPTAL PUNC,33991,CPT,360,RC,36000107,CDM,,,,both,,,18306.0000,2745.9000,MEDCOST,MEDCOST VHN,8711.83,,,,,,,968.0000,45600.2700,percent of total billed charges,"47.59% of $18,306.00 in Billed Charges for Rev 360 Proc 33991 = $8,711.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT VENTRICULAR ASST DEVICE ARTERIAL & VENOUS W TRANSSEPTAL PUNC,33991,CPT,360,RC,36000107,CDM,,,,both,,,18306.0000,2745.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,45600.27,,,,,,,968.0000,45600.2700,fee schedule,"APG 03060 Proc 33991 at $836.60 (Base Rate) * 51.9111 (Relative Weight) = $43,428.83 (Total Line Payment) at 100% = $43,428.83... $43,428.83 at 105% = $45,600.27 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE ARTERIAL & VENOUS W TRANSSEPTAL PUNC,33991,CPT,360,RC,36000107,CDM,,,,both,,,18306.0000,2745.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,44775.12,,,,,,,968.0000,45600.2700,fee schedule,"APG 03060 Proc 33991 at $836.60 (Base Rate) * 51.9111 (Relative Weight) = $43,428.83 (Total Line Payment) at 100% = $43,428.83... $43,428.83 at 103.1% = $44,775.12 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE ARTERIAL & VENOUS W TRANSSEPTAL PUNC,33991,CPT,360,RC,36000107,CDM,,,,both,,,18306.0000,2745.9000,SENTARA HEALTH,SENTARA HEALTH,4724.78,,,,,,,968.0000,45600.2700,percent of total billed charges,"25.81% of $18,306.00 in Billed Charges for Rev 360 Proc 33991 = $4,724.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT VENTRICULAR ASST DEVICE ARTERIAL & VENOUS W TRANSSEPTAL PUNC,33991,CPT,360,RC,36000107,CDM,,,,both,,,18306.0000,2745.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",18306.00,,,,,,,968.0000,45600.2700,percent of total billed charges,"100% of $18,306.00 in Billed Charges for Rev 360 Proc 33991 = $18,306.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT VENTRICULAR ASST DEVICE ARTERIAL & VENOUS W TRANSSEPTAL PUNC,33991,CPT,360,RC,36000107,CDM,,,,both,,,18306.0000,2745.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,968.0000,45600.2700,case rate,Rev 360 Proc 33991 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT VENTRICULAR ASST DEVICE ARTERIAL & VENOUS W TRANSSEPTAL PUNC,33991,CPT,360,RC,36000107,CDM,,,,both,,,18306.0000,2745.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,968.0000,45600.2700,case rate,"Rev 360 Proc 33991 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE ARTERIAL & VENOUS W TRANSSEPTAL PUNC,33991,CPT,360,RC,36000107,CDM,,,,both,,,18306.0000,2745.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,968.0000,45600.2700,case rate,"Rev 360 Proc 33991 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE ARTERIAL & VENOUS W TRANSSEPTAL PUNC,33991,CPT,360,RC,36000107,CDM,,,,both,,,18306.0000,2745.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,968.0000,45600.2700,case rate,"Rev 360 Proc 33991 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE ARTERIAL & VENOUS W TRANSSEPTAL PUNC,33991,CPT,360,RC,36000107,CDM,,,,both,,,18306.0000,2745.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,44731.69,,,,,,,968.0000,45600.2700,fee schedule,"APG 03060 Proc 33991 at $836.60 (Base Rate) * 51.9111 (Relative Weight) = $43,428.83 (Total Line Payment) at 103% = $44,731.69. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT VENTRICULAR ASST DEVICE ARTERIAL & VENOUS W TRANSSEPTAL PUNC,33991,CPT,360,RC,36000107,CDM,,,,both,,,18306.0000,2745.9000,WELLCARE,WELLCARE MEDICAID,18306.00,,,,,,,968.0000,45600.2700,percent of total billed charges,"100% of $18,306.00 in Billed Charges for Rev 360 Proc 33991 = $18,306.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION PERCU VENT ASST DEVICE W IMG GUID SEP DIST SESS FR INS,33993,CPT,360,RC,36000109,CDM,,,,both,,,4624.0000,693.6000,AETNA,AETNA,1974.45,,,,,,,968.0000,10420.9900,percent of total billed charges,"42.7% of $4,624.00 in Billed Charges for Rev 360 Proc 33993 = $1,974.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION PERCU VENT ASST DEVICE W IMG GUID SEP DIST SESS FR INS,33993,CPT,360,RC,36000109,CDM,,,,both,,,4624.0000,693.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,10321.74,,,,,,,968.0000,10420.9900,fee schedule,"APG 00087 Proc 33993 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 104% = $10,321.74. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PERCU VENT ASST DEVICE W IMG GUID SEP DIST SESS FR INS,33993,CPT,360,RC,36000109,CDM,,,,both,,,4624.0000,693.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,4624.00,,,,,,,968.0000,10420.9900,fee schedule,"APG 00087 Proc 33993 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 103% = $10,222.50 (Service Line reduced to $4,624.00, claim capped at $4,624.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PERCU VENT ASST DEVICE W IMG GUID SEP DIST SESS FR INS,33993,CPT,360,RC,36000109,CDM,,,,both,,,4624.0000,693.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,968.0000,10420.9900,case rate,"Rev 360 Proc 33993 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PERCU VENT ASST DEVICE W IMG GUID SEP DIST SESS FR INS,33993,CPT,360,RC,36000109,CDM,,,,both,,,4624.0000,693.6000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,968.0000,10420.9900,case rate,"Rev 360 Proc 33993 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PERCU VENT ASST DEVICE W IMG GUID SEP DIST SESS FR INS,33993,CPT,360,RC,36000109,CDM,,,,both,,,4624.0000,693.6000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,968.0000,10420.9900,case rate,"Rev 360 Proc 33993 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PERCU VENT ASST DEVICE W IMG GUID SEP DIST SESS FR INS,33993,CPT,360,RC,36000109,CDM,,,,both,,,4624.0000,693.6000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,968.0000,10420.9900,case rate,"Rev 360 Proc 33993 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PERCU VENT ASST DEVICE W IMG GUID SEP DIST SESS FR INS,33993,CPT,360,RC,36000109,CDM,,,,both,,,4624.0000,693.6000,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,968.0000,10420.9900,case rate,"Rev 360 Proc 33993 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PERCU VENT ASST DEVICE W IMG GUID SEP DIST SESS FR INS,33993,CPT,360,RC,36000109,CDM,,,,both,,,4624.0000,693.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,968.0000,10420.9900,case rate,"Rev 360 Proc 33993 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PERCU VENT ASST DEVICE W IMG GUID SEP DIST SESS FR INS,33993,CPT,360,RC,36000109,CDM,,,,both,,,4624.0000,693.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,968.0000,10420.9900,case rate,"Rev 360 Proc 33993 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PERCU VENT ASST DEVICE W IMG GUID SEP DIST SESS FR INS,33993,CPT,360,RC,36000109,CDM,,,,both,,,4624.0000,693.6000,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,968.0000,10420.9900,case rate,"Rev 360 Proc 33993 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PERCU VENT ASST DEVICE W IMG GUID SEP DIST SESS FR INS,33993,CPT,360,RC,36000109,CDM,,,,both,,,4624.0000,693.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4161.60,,,,,,,968.0000,10420.9900,percent of total billed charges,"90% of $4,624.00 in Billed Charges for Rev 360 Proc 33993 = $4,161.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION PERCU VENT ASST DEVICE W IMG GUID SEP DIST SESS FR INS,33993,CPT,360,RC,36000109,CDM,,,,both,,,4624.0000,693.6000,MEDCOST,MEDCOST VHN,2200.56,,,,,,,968.0000,10420.9900,percent of total billed charges,"47.59% of $4,624.00 in Billed Charges for Rev 360 Proc 33993 = $2,200.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION PERCU VENT ASST DEVICE W IMG GUID SEP DIST SESS FR INS,33993,CPT,360,RC,36000109,CDM,,,,both,,,4624.0000,693.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,10420.99,,,,,,,968.0000,10420.9900,fee schedule,"APG 00087 Proc 33993 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 100% = $9,924.75... $9,924.75 at 105% = $10,420.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PERCU VENT ASST DEVICE W IMG GUID SEP DIST SESS FR INS,33993,CPT,360,RC,36000109,CDM,,,,both,,,4624.0000,693.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,10232.42,,,,,,,968.0000,10420.9900,fee schedule,"APG 00087 Proc 33993 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 100% = $9,924.75... $9,924.75 at 103.1% = $10,232.42 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PERCU VENT ASST DEVICE W IMG GUID SEP DIST SESS FR INS,33993,CPT,360,RC,36000109,CDM,,,,both,,,4624.0000,693.6000,SENTARA HEALTH,SENTARA HEALTH,1193.45,,,,,,,968.0000,10420.9900,percent of total billed charges,"25.81% of $4,624.00 in Billed Charges for Rev 360 Proc 33993 = $1,193.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION PERCU VENT ASST DEVICE W IMG GUID SEP DIST SESS FR INS,33993,CPT,360,RC,36000109,CDM,,,,both,,,4624.0000,693.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4624.00,,,,,,,968.0000,10420.9900,percent of total billed charges,"100% of $4,624.00 in Billed Charges for Rev 360 Proc 33993 = $4,624.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOSITION PERCU VENT ASST DEVICE W IMG GUID SEP DIST SESS FR INS,33993,CPT,360,RC,36000109,CDM,,,,both,,,4624.0000,693.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,968.0000,10420.9900,case rate,Rev 360 Proc 33993 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOSITION PERCU VENT ASST DEVICE W IMG GUID SEP DIST SESS FR INS,33993,CPT,360,RC,36000109,CDM,,,,both,,,4624.0000,693.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,968.0000,10420.9900,case rate,"Rev 360 Proc 33993 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PERCU VENT ASST DEVICE W IMG GUID SEP DIST SESS FR INS,33993,CPT,360,RC,36000109,CDM,,,,both,,,4624.0000,693.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,968.0000,10420.9900,case rate,"Rev 360 Proc 33993 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PERCU VENT ASST DEVICE W IMG GUID SEP DIST SESS FR INS,33993,CPT,360,RC,36000109,CDM,,,,both,,,4624.0000,693.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,968.0000,10420.9900,case rate,"Rev 360 Proc 33993 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PERCU VENT ASST DEVICE W IMG GUID SEP DIST SESS FR INS,33993,CPT,360,RC,36000109,CDM,,,,both,,,4624.0000,693.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,10222.50,,,,,,,968.0000,10420.9900,fee schedule,"APG 00087 Proc 33993 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 103% = $10,222.50. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOSITION PERCU VENT ASST DEVICE W IMG GUID SEP DIST SESS FR INS,33993,CPT,360,RC,36000109,CDM,,,,both,,,4624.0000,693.6000,WELLCARE,WELLCARE MEDICAID,4624.00,,,,,,,968.0000,10420.9900,percent of total billed charges,"100% of $4,624.00 in Billed Charges for Rev 360 Proc 33993 = $4,624.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,AETNA,AETNA,1178.52,,,,,,,712.3600,45600.2700,percent of total billed charges,"42.7% of $2,760.00 in Billed Charges for Rev 360 Proc 33995 = $1,178.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,45165.98,,,,,,,712.3600,45600.2700,fee schedule,"APG 03060 Proc 33995 at $836.60 (Base Rate) * 51.9111 (Relative Weight) = $43,428.83 (Total Line Payment) at 104% = $45,165.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,ANTHEM EXCHANGE,2760.00,,,,,,,712.3600,45600.2700,fee schedule,"$9,281.23 from Fee Schedule ANT_C_APC for Rev 360 Proc 33995 * Qty 1 = $9,281.23 at 199.87% = $18,550.39 (Service Line reduced to $2,760.00, claim capped at $2,760.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2760.00,,,,,,,712.3600,45600.2700,fee schedule,"APG 03060 Proc 33995 at $836.60 (Base Rate) * 51.9111 (Relative Weight) = $43,428.83 (Total Line Payment) at 103% = $44,731.69 (Service Line reduced to $2,760.00, claim capped at $2,760.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,ANTHEM HMO,2760.00,,,,,,,712.3600,45600.2700,fee schedule,"$9,281.23 from Fee Schedule ANT_C_APC for Rev 360 Proc 33995 * Qty 1 = $9,281.23 at 212.35% = $19,708.69 (Service Line reduced to $2,760.00, claim capped at $2,760.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2760.00,,,,,,,712.3600,45600.2700,fee schedule,"$9,281.23 from Fee Schedule ANT_C_APC for Rev 360 Proc 33995 * Qty 1 = $9,281.23 at 249.81% = $23,185.44 (Service Line reduced to $2,760.00, claim capped at $2,760.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,712.3600,45600.2700,case rate,"Rev 360 Proc 33995 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,712.3600,45600.2700,case rate,"Rev 360 Proc 33995 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,712.3600,45600.2700,case rate,"Rev 360 Proc 33995 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,712.3600,45600.2700,case rate,"Rev 360 Proc 33995 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,TENNCARE BLUE CARE,1584.00,,,,,,,712.3600,45600.2700,case rate,"Rev 360 Proc 33995 ASG Rate of $1,584.00 at 100% of $1,584.00 = $1,584.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,TENNCARE BLUE SELECT,1584.00,,,,,,,712.3600,45600.2700,case rate,"Rev 360 Proc 33995 ASG Rate of $1,584.00 at 100% of $1,584.00 = $1,584.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,CIGNA HEALTHCARE,CIGNA HMO,2760.00,,,,,,,712.3600,45600.2700,case rate,"Rev 360 Proc 33995 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,760.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,760.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2760.00,,,,,,,712.3600,45600.2700,case rate,"Rev 360 Proc 33995 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $2,760.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,760.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2760.00,,,,,,,712.3600,45600.2700,case rate,"Rev 360 Proc 33995 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,760.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,760.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,CIGNA HEALTHCARE,CIGNA PPO,2760.00,,,,,,,712.3600,45600.2700,case rate,"Rev 360 Proc 33995 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,760.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,760.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2484.00,,,,,,,712.3600,45600.2700,percent of total billed charges,"90% of $2,760.00 in Billed Charges for Rev 360 Proc 33995 = $2,484.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,MEDCOST,MEDCOST VHN,1313.48,,,,,,,712.3600,45600.2700,percent of total billed charges,"47.59% of $2,760.00 in Billed Charges for Rev 360 Proc 33995 = $1,313.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,45600.27,,,,,,,712.3600,45600.2700,fee schedule,"APG 03060 Proc 33995 at $836.60 (Base Rate) * 51.9111 (Relative Weight) = $43,428.83 (Total Line Payment) at 100% = $43,428.83... $43,428.83 at 105% = $45,600.27 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,44775.12,,,,,,,712.3600,45600.2700,fee schedule,"APG 03060 Proc 33995 at $836.60 (Base Rate) * 51.9111 (Relative Weight) = $43,428.83 (Total Line Payment) at 100% = $43,428.83... $43,428.83 at 103.1% = $44,775.12 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,SENTARA HEALTH,SENTARA HEALTH,712.36,,,,,,,712.3600,45600.2700,percent of total billed charges,"25.81% of $2,760.00 in Billed Charges for Rev 360 Proc 33995 = $712.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2760.00,,,,,,,712.3600,45600.2700,percent of total billed charges,"100% of $2,760.00 in Billed Charges for Rev 360 Proc 33995 = $2,760.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,712.3600,45600.2700,case rate,Rev 360 Proc 33995 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,712.3600,45600.2700,case rate,"Rev 360 Proc 33995 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,712.3600,45600.2700,case rate,"Rev 360 Proc 33995 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,712.3600,45600.2700,case rate,"Rev 360 Proc 33995 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,44731.69,,,,,,,712.3600,45600.2700,fee schedule,"APG 03060 Proc 33995 at $836.60 (Base Rate) * 51.9111 (Relative Weight) = $43,428.83 (Total Line Payment) at 103% = $44,731.69. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PERQ VAD INCL RAD S&I  RT HRT VENOUS ACCESS ONLY,33995,CPT,360,RC,36000233,CDM,,,,both,,,2760.0000,414.0000,WELLCARE,WELLCARE MEDICAID,2760.00,,,,,,,712.3600,45600.2700,percent of total billed charges,"100% of $2,760.00 in Billed Charges for Rev 360 Proc 33995 = $2,760.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,AETNA,AETNA,1178.52,,,,,,,578.0000,10420.9900,percent of total billed charges,"42.7% of $2,760.00 in Billed Charges for Rev 360 Proc 33997 = $1,178.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,10321.74,,,,,,,578.0000,10420.9900,fee schedule,"APG 00087 Proc 33997 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 104% = $10,321.74. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,ANTHEM EXCHANGE,2760.00,,,,,,,578.0000,10420.9900,fee schedule,"$4,081.35 from Fee Schedule ANT_C_APC for Rev 360 Proc 33997 * Qty 1 = $4,081.35 at 199.87% = $8,157.39 (Service Line reduced to $2,760.00, claim capped at $2,760.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2760.00,,,,,,,578.0000,10420.9900,fee schedule,"APG 00087 Proc 33997 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 103% = $10,222.50 (Service Line reduced to $2,760.00, claim capped at $2,760.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,ANTHEM HMO,2760.00,,,,,,,578.0000,10420.9900,fee schedule,"$4,081.35 from Fee Schedule ANT_C_APC for Rev 360 Proc 33997 * Qty 1 = $4,081.35 at 212.35% = $8,666.75 (Service Line reduced to $2,760.00, claim capped at $2,760.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2760.00,,,,,,,578.0000,10420.9900,fee schedule,"$4,081.35 from Fee Schedule ANT_C_APC for Rev 360 Proc 33997 * Qty 1 = $4,081.35 at 249.81% = $10,195.62 (Service Line reduced to $2,760.00, claim capped at $2,760.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,578.0000,10420.9900,case rate,"Rev 360 Proc 33997 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,578.0000,10420.9900,case rate,"Rev 360 Proc 33997 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,578.0000,10420.9900,case rate,"Rev 360 Proc 33997 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,578.0000,10420.9900,case rate,"Rev 360 Proc 33997 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,10420.9900,case rate,Rev 360 Proc 33997 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,10420.9900,case rate,Rev 360 Proc 33997 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,CIGNA HEALTHCARE,CIGNA HMO,2760.00,,,,,,,578.0000,10420.9900,case rate,"Rev 360 Proc 33997 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,760.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,760.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2760.00,,,,,,,578.0000,10420.9900,case rate,"Rev 360 Proc 33997 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $2,760.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,760.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2760.00,,,,,,,578.0000,10420.9900,case rate,"Rev 360 Proc 33997 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,760.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,760.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,CIGNA HEALTHCARE,CIGNA PPO,2760.00,,,,,,,578.0000,10420.9900,case rate,"Rev 360 Proc 33997 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,760.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,760.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2484.00,,,,,,,578.0000,10420.9900,percent of total billed charges,"90% of $2,760.00 in Billed Charges for Rev 360 Proc 33997 = $2,484.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,MEDCOST,MEDCOST VHN,1313.48,,,,,,,578.0000,10420.9900,percent of total billed charges,"47.59% of $2,760.00 in Billed Charges for Rev 360 Proc 33997 = $1,313.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,10420.99,,,,,,,578.0000,10420.9900,fee schedule,"APG 00087 Proc 33997 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 100% = $9,924.75... $9,924.75 at 105% = $10,420.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,10232.42,,,,,,,578.0000,10420.9900,fee schedule,"APG 00087 Proc 33997 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 100% = $9,924.75... $9,924.75 at 103.1% = $10,232.42 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,SENTARA HEALTH,SENTARA HEALTH,712.36,,,,,,,578.0000,10420.9900,percent of total billed charges,"25.81% of $2,760.00 in Billed Charges for Rev 360 Proc 33997 = $712.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2760.00,,,,,,,578.0000,10420.9900,percent of total billed charges,"100% of $2,760.00 in Billed Charges for Rev 360 Proc 33997 = $2,760.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,578.0000,10420.9900,case rate,Rev 360 Proc 33997 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,578.0000,10420.9900,case rate,"Rev 360 Proc 33997 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,578.0000,10420.9900,case rate,"Rev 360 Proc 33997 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,578.0000,10420.9900,case rate,"Rev 360 Proc 33997 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,10222.50,,,,,,,578.0000,10420.9900,fee schedule,"APG 00087 Proc 33997 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 103% = $10,222.50. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL PERQ RT HRT VAD VENOUS CANNULA SEP INSRT,33997,CPT,360,RC,36000234,CDM,,,,both,,,2760.0000,414.0000,WELLCARE,WELLCARE MEDICAID,2760.00,,,,,,,578.0000,10420.9900,percent of total billed charges,"100% of $2,760.00 in Billed Charges for Rev 360 Proc 33997 = $2,760.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,AETNA,AETNA,565.35,,,,,,,70.6300,1400.5900,percent of total billed charges,"42.7% of $1,324.00 in Billed Charges for Rev 510 Proc 11621 = $565.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,70.6300,1400.5900,fee schedule,"APG 00009 Proc 11621 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,70.6300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,70.6300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,70.6300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,AMBETTER,AMBETTER,1400.59,,,,,,,70.6300,1400.5900,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,70.6300,1400.5900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,BLUE CROSS,ANTHEM EXCHANGE,1324.00,,,,,,,70.6300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,70.6300,1400.5900,fee schedule,"APG 00009 Proc 11621 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,BLUE CROSS,ANTHEM HMO,1324.00,,,,,,,70.6300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,70.6300,1400.5900,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1324.00,,,,,,,70.6300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,149.99,,,,,,,70.6300,1400.5900,fee schedule,$149.99 from Fee Schedule BLDTM_23 for Rev 510 Proc 11621 * Qty 1 = $149.99 at 100% = $149.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,70.6300,1400.5900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,BLUE CROSS,TENNCARE BLUE CARE,70.63,,,,,,,70.6300,1400.5900,fee schedule,$60.89 from Fee Schedule TC_24 for Rev 510 Proc 11621 * Qty 1 = $60.89 at 116% = $70.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,BLUE CROSS,TENNCARE BLUE SELECT,70.63,,,,,,,70.6300,1400.5900,fee schedule,$60.89 from Fee Schedule TC_24 for Rev 510 Proc 11621 * Qty 1 = $60.89 at 116% = $70.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,CIGNA HEALTHCARE,CIGNA HMO,552.11,,,,,,,70.6300,1400.5900,percent of total billed charges,"41.7% of $1,324.00 in Billed Charges for Rev 510 Proc 11621 = $552.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,614.34,,,,,,,70.6300,1400.5900,percent of total billed charges,"46.4% of $1,324.00 in Billed Charges for Rev 510 Proc 11621 = $614.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,70.6300,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,552.11,,,,,,,70.6300,1400.5900,percent of total billed charges,"41.7% of $1,324.00 in Billed Charges for Rev 510 Proc 11621 = $552.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,CIGNA HEALTHCARE,CIGNA PPO,552.11,,,,,,,70.6300,1400.5900,percent of total billed charges,"41.7% of $1,324.00 in Billed Charges for Rev 510 Proc 11621 = $552.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,70.6300,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1191.60,,,,,,,70.6300,1400.5900,percent of total billed charges,"90% of $1,324.00 in Billed Charges for Rev 510 Proc 11621 = $1,191.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,HUMANA,HUMANA MEDICARE,642.47,,,,,,,70.6300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,70.6300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,MEDCOST,MEDCOST VHN,630.09,,,,,,,70.6300,1400.5900,percent of total billed charges,"47.59% of $1,324.00 in Billed Charges for Rev 510 Proc 11621 = $630.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,70.6300,1400.5900,fee schedule,"APG 00009 Proc 11621 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,70.6300,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,70.6300,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,70.6300,1400.5900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,70.6300,1400.5900,fee schedule,"APG 00009 Proc 11621 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,SENTARA HEALTH,SENTARA HEALTH,341.72,,,,,,,70.6300,1400.5900,percent of total billed charges,"25.81% of $1,324.00 in Billed Charges for Rev 510 Proc 11621 = $341.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,70.6300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1324.00,,,,,,,70.6300,1400.5900,percent of total billed charges,"100% of $1,324.00 in Billed Charges for Rev 510 Proc 11621 = $1,324.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,413.29,,,,,,,70.6300,1400.5900,fee schedule,$826.58 from Fee Schedule TCUHC24 for Rev 510 Proc 11621 * Qty 1 = $826.58 at 50% = $413.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,427.65,,,,,,,70.6300,1400.5900,other,"32.3% of $1,324.00 in Billed Charges for Rev 510 Proc 11621 = $427.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,406.47,,,,,,,70.6300,1400.5900,other,"30.7% of $1,324.00 in Billed Charges for Rev 510 Proc 11621 = $406.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,427.65,,,,,,,70.6300,1400.5900,percent of total billed charges,"32.3% of $1,324.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,70.6300,1400.5900,fee schedule,"APG 00009 Proc 11621 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,70.6300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,70.6300,1400.5900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,WELLCARE,WELLCARE MEDICAID,1324.00,,,,,,,70.6300,1400.5900,percent of total billed charges,"100% of $1,324.00 in Billed Charges for Rev 510 Proc 11621 = $1,324.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION S/N/H/F/G 0.6-1.0 CM,11621,CPT,510,RC,51000129,CDM,,,,both,,,1324.0000,198.6000,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,70.6300,1400.5900,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,AETNA,AETNA,2117.07,,,,,,,213.9700,4958.0000,percent of total billed charges,"42.7% of $4,958.00 in Billed Charges for Rev 521 Proc 11623 = $2,117.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1775.80,,,,,,,213.9700,4958.0000,fee schedule,"APG 00010 Proc 11623 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 104% = $1,775.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,213.9700,4958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,213.9700,4958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,213.9700,4958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,AMBETTER,AMBETTER,3266.63,,,,,,,213.9700,4958.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,213.9700,4958.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,BLUE CROSS,ANTHEM EXCHANGE,3689.28,,,,,,,213.9700,4958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1758.73,,,,,,,213.9700,4958.0000,fee schedule,"APG 00010 Proc 11623 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,BLUE CROSS,ANTHEM HMO,3919.64,,,,,,,213.9700,4958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,213.9700,4958.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4611.09,,,,,,,213.9700,4958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,213.97,,,,,,,213.9700,4958.0000,fee schedule,$213.97 from Fee Schedule BLDTM_23 for Rev 521 Proc 11623 * Qty 1 = $213.97 at 100% = $213.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,213.9700,4958.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,CIGNA HEALTHCARE,CIGNA HMO,2067.49,,,,,,,213.9700,4958.0000,percent of total billed charges,"41.7% of $4,958.00 in Billed Charges for Rev 521 Proc 11623 = $2,067.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2300.51,,,,,,,213.9700,4958.0000,percent of total billed charges,"46.4% of $4,958.00 in Billed Charges for Rev 521 Proc 11623 = $2,300.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,213.9700,4958.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2067.49,,,,,,,213.9700,4958.0000,percent of total billed charges,"41.7% of $4,958.00 in Billed Charges for Rev 521 Proc 11623 = $2,067.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,CIGNA HEALTHCARE,CIGNA PPO,2067.49,,,,,,,213.9700,4958.0000,percent of total billed charges,"41.7% of $4,958.00 in Billed Charges for Rev 521 Proc 11623 = $2,067.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,213.9700,4958.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4462.20,,,,,,,213.9700,4958.0000,percent of total billed charges,"90% of $4,958.00 in Billed Charges for Rev 521 Proc 11623 = $4,462.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,213.9700,4958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,213.9700,4958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,MEDCOST,MEDCOST VHN,2359.51,,,,,,,213.9700,4958.0000,percent of total billed charges,"47.59% of $4,958.00 in Billed Charges for Rev 521 Proc 11623 = $2,359.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1792.88,,,,,,,213.9700,4958.0000,fee schedule,"APG 00010 Proc 11623 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 105% = $1,792.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,213.9700,4958.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,213.9700,4958.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,213.9700,4958.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1760.43,,,,,,,213.9700,4958.0000,fee schedule,"APG 00010 Proc 11623 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 103.1% = $1,760.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,SENTARA HEALTH,SENTARA HEALTH,1279.66,,,,,,,213.9700,4958.0000,percent of total billed charges,"25.81% of $4,958.00 in Billed Charges for Rev 521 Proc 11623 = $1,279.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,213.9700,4958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4958.00,,,,,,,213.9700,4958.0000,percent of total billed charges,"100% of $4,958.00 in Billed Charges for Rev 521 Proc 11623 = $4,958.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,413.29,,,,,,,213.9700,4958.0000,fee schedule,$826.58 from Fee Schedule TCUHC24 for Rev 521 Proc 11623 * Qty 1 = $826.58 at 50% = $413.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1758.73,,,,,,,213.9700,4958.0000,fee schedule,"APG 00010 Proc 11623 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,213.9700,4958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,213.9700,4958.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,WELLCARE,WELLCARE MEDICAID,4958.00,,,,,,,213.9700,4958.0000,percent of total billed charges,"100% of $4,958.00 in Billed Charges for Rev 521 Proc 11623 = $4,958.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G 2.1-3.0 CM,11623,CPT,521,RC,52100047,CDM,,,,both,,,4958.0000,743.7000,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,213.9700,4958.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,AETNA,AETNA,2328.43,,,,,,,255.0800,5453.0000,percent of total billed charges,"42.7% of $5,453.00 in Billed Charges for Rev 521 Proc 11624 = $2,328.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1775.80,,,,,,,255.0800,5453.0000,fee schedule,"APG 00010 Proc 11624 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 104% = $1,775.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,255.0800,5453.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,255.0800,5453.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,255.0800,5453.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,AMBETTER,AMBETTER,3266.63,,,,,,,255.0800,5453.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,255.0800,5453.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,BLUE CROSS,ANTHEM EXCHANGE,3689.28,,,,,,,255.0800,5453.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1758.73,,,,,,,255.0800,5453.0000,fee schedule,"APG 00010 Proc 11624 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,BLUE CROSS,ANTHEM HMO,3919.64,,,,,,,255.0800,5453.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,255.0800,5453.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4611.09,,,,,,,255.0800,5453.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,255.08,,,,,,,255.0800,5453.0000,fee schedule,$255.08 from Fee Schedule BLDTM_23 for Rev 521 Proc 11624 * Qty 1 = $255.08 at 100% = $255.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,255.0800,5453.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,CIGNA HEALTHCARE,CIGNA HMO,2273.90,,,,,,,255.0800,5453.0000,percent of total billed charges,"41.7% of $5,453.00 in Billed Charges for Rev 521 Proc 11624 = $2,273.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2530.19,,,,,,,255.0800,5453.0000,percent of total billed charges,"46.4% of $5,453.00 in Billed Charges for Rev 521 Proc 11624 = $2,530.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,255.0800,5453.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2273.90,,,,,,,255.0800,5453.0000,percent of total billed charges,"41.7% of $5,453.00 in Billed Charges for Rev 521 Proc 11624 = $2,273.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,CIGNA HEALTHCARE,CIGNA PPO,2273.90,,,,,,,255.0800,5453.0000,percent of total billed charges,"41.7% of $5,453.00 in Billed Charges for Rev 521 Proc 11624 = $2,273.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,255.0800,5453.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4907.70,,,,,,,255.0800,5453.0000,percent of total billed charges,"90% of $5,453.00 in Billed Charges for Rev 521 Proc 11624 = $4,907.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,255.0800,5453.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,255.0800,5453.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,MEDCOST,MEDCOST VHN,2595.08,,,,,,,255.0800,5453.0000,percent of total billed charges,"47.59% of $5,453.00 in Billed Charges for Rev 521 Proc 11624 = $2,595.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1792.88,,,,,,,255.0800,5453.0000,fee schedule,"APG 00010 Proc 11624 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 105% = $1,792.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,255.0800,5453.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,255.0800,5453.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,255.0800,5453.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1760.43,,,,,,,255.0800,5453.0000,fee schedule,"APG 00010 Proc 11624 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 103.1% = $1,760.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,SENTARA HEALTH,SENTARA HEALTH,1407.42,,,,,,,255.0800,5453.0000,percent of total billed charges,"25.81% of $5,453.00 in Billed Charges for Rev 521 Proc 11624 = $1,407.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,255.0800,5453.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5453.00,,,,,,,255.0800,5453.0000,percent of total billed charges,"100% of $5,453.00 in Billed Charges for Rev 521 Proc 11624 = $5,453.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,670.71,,,,,,,255.0800,5453.0000,fee schedule,"$1,341.41 from Fee Schedule TCUHC24 for Rev 521 Proc 11624 * Qty 1 = $1,341.41 at 50% = $670.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1758.73,,,,,,,255.0800,5453.0000,fee schedule,"APG 00010 Proc 11624 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,255.0800,5453.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,255.0800,5453.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,WELLCARE,WELLCARE MEDICAID,5453.00,,,,,,,255.0800,5453.0000,percent of total billed charges,"100% of $5,453.00 in Billed Charges for Rev 521 Proc 11624 = $5,453.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESIONS S/N/H/F/G 3.1-4.0,11624,CPT,521,RC,52100048,CDM,,,,both,,,5453.0000,817.9500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,255.0800,5453.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,AETNA,AETNA,2561.57,,,,,,,305.5600,5999.0000,percent of total billed charges,"42.7% of $5,999.00 in Billed Charges for Rev 521 Proc 11626 = $2,561.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2575.48,,,,,,,305.5600,5999.0000,fee schedule,"APG 00011 Proc 11626 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 104% = $2,575.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2635.37,,,,,,,305.5600,5999.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,AETNA,AETNA HEALTHCARE MEDICARE,2635.37,,,,,,,305.5600,5999.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,2635.37,,,,,,,305.5600,5999.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,AMBETTER,AMBETTER,5745.12,,,,,,,305.5600,5999.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2740.79,,,,,,,305.5600,5999.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,BLUE CROSS,ANTHEM EXCHANGE,5999.00,,,,,,,305.5600,5999.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2550.71,,,,,,,305.5600,5999.0000,fee schedule,"APG 00011 Proc 11626 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 103% = $2,550.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,BLUE CROSS,ANTHEM HMO,5999.00,,,,,,,305.5600,5999.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2714.44,,,,,,,305.5600,5999.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5999.00,,,,,,,305.5600,5999.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,305.56,,,,,,,305.5600,5999.0000,fee schedule,$305.56 from Fee Schedule BLDTM_23 for Rev 521 Proc 11626 * Qty 1 = $305.56 at 100% = $305.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,BLUE CROSS,BLUE CROSS MEDICARE,2740.79,,,,,,,305.5600,5999.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,CIGNA HEALTHCARE,CIGNA HMO,2501.58,,,,,,,305.5600,5999.0000,percent of total billed charges,"41.7% of $5,999.00 in Billed Charges for Rev 521 Proc 11626 = $2,501.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2783.54,,,,,,,305.5600,5999.0000,percent of total billed charges,"46.4% of $5,999.00 in Billed Charges for Rev 521 Proc 11626 = $2,783.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,2767.14,,,,,,,305.5600,5999.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2501.58,,,,,,,305.5600,5999.0000,percent of total billed charges,"41.7% of $5,999.00 in Billed Charges for Rev 521 Proc 11626 = $2,501.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,CIGNA HEALTHCARE,CIGNA PPO,2501.58,,,,,,,305.5600,5999.0000,percent of total billed charges,"41.7% of $5,999.00 in Billed Charges for Rev 521 Proc 11626 = $2,501.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,2767.14,,,,,,,305.5600,5999.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5399.10,,,,,,,305.5600,5999.0000,percent of total billed charges,"90% of $5,999.00 in Billed Charges for Rev 521 Proc 11626 = $5,399.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,HUMANA,HUMANA MEDICARE,2635.37,,,,,,,305.5600,5999.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2635.37,,,,,,,305.5600,5999.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,MEDCOST,MEDCOST VHN,2854.92,,,,,,,305.5600,5999.0000,percent of total billed charges,"47.59% of $5,999.00 in Billed Charges for Rev 521 Proc 11626 = $2,854.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2600.24,,,,,,,305.5600,5999.0000,fee schedule,"APG 00011 Proc 11626 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 100% = $2,476.42... $2,476.42 at 105% = $2,600.24 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,2767.14,,,,,,,305.5600,5999.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,2767.14,,,,,,,305.5600,5999.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,NHC ADVANTAGE,NHC ADVANTAGE,2767.14,,,,,,,305.5600,5999.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2553.19,,,,,,,305.5600,5999.0000,fee schedule,"APG 00011 Proc 11626 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 100% = $2,476.42... $2,476.42 at 103.1% = $2,553.19 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,SENTARA HEALTH,SENTARA HEALTH,1548.34,,,,,,,305.5600,5999.0000,percent of total billed charges,"25.81% of $5,999.00 in Billed Charges for Rev 521 Proc 11626 = $1,548.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,SENTARA HEALTH,SENTARA MEDICARE,2635.37,,,,,,,305.5600,5999.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5999.00,,,,,,,305.5600,5999.0000,percent of total billed charges,"100% of $5,999.00 in Billed Charges for Rev 521 Proc 11626 = $5,999.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,912.16,,,,,,,305.5600,5999.0000,fee schedule,"$1,824.31 from Fee Schedule TCUHC24 for Rev 521 Proc 11626 * Qty 1 = $1,824.31 at 50% = $912.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2550.71,,,,,,,305.5600,5999.0000,fee schedule,"APG 00011 Proc 11626 at $836.60 (Base Rate) * 2.9601 (Relative Weight) = $2,476.42 (Total Line Payment) at 103% = $2,550.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2635.37,,,,,,,305.5600,5999.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2635.37,,,,,,,305.5600,5999.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,WELLCARE,WELLCARE MEDICAID,5999.00,,,,,,,305.5600,5999.0000,percent of total billed charges,"100% of $5,999.00 in Billed Charges for Rev 521 Proc 11626 = $5,999.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIGN LESION S/N/H/F/G >4.0 CM,11626,CPT,521,RC,52100049,CDM,,,,both,,,5999.0000,899.8500,WELLCARE,WELLCARE MEDICARE,2793.50,,,,,,,305.5600,5999.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,AETNA,AETNA,684.05,,,,,,,59.6400,1602.0000,percent of total billed charges,"42.7% of $1,602.00 in Billed Charges for Rev 510 Proc 11640 = $684.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,59.6400,1602.0000,fee schedule,"APG 00009 Proc 11640 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,59.6400,1602.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,59.6400,1602.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,59.6400,1602.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,AMBETTER,AMBETTER,1400.59,,,,,,,59.6400,1602.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,59.6400,1602.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,59.6400,1602.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,59.6400,1602.0000,fee schedule,"APG 00009 Proc 11640 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,BLUE CROSS,ANTHEM HMO,1602.00,,,,,,,59.6400,1602.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,59.6400,1602.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1602.00,,,,,,,59.6400,1602.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,138.01,,,,,,,59.6400,1602.0000,fee schedule,$138.01 from Fee Schedule BLDTM_23 for Rev 510 Proc 11640 * Qty 1 = $138.01 at 100% = $138.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,59.6400,1602.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,BLUE CROSS,TENNCARE BLUE CARE,59.64,,,,,,,59.6400,1602.0000,fee schedule,$51.41 from Fee Schedule TC_24 for Rev 510 Proc 11640 * Qty 1 = $51.41 at 116% = $59.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,BLUE CROSS,TENNCARE BLUE SELECT,59.64,,,,,,,59.6400,1602.0000,fee schedule,$51.41 from Fee Schedule TC_24 for Rev 510 Proc 11640 * Qty 1 = $51.41 at 116% = $59.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,CIGNA HEALTHCARE,CIGNA HMO,668.03,,,,,,,59.6400,1602.0000,percent of total billed charges,"41.7% of $1,602.00 in Billed Charges for Rev 510 Proc 11640 = $668.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,743.33,,,,,,,59.6400,1602.0000,percent of total billed charges,"46.4% of $1,602.00 in Billed Charges for Rev 510 Proc 11640 = $743.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,59.6400,1602.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,668.03,,,,,,,59.6400,1602.0000,percent of total billed charges,"41.7% of $1,602.00 in Billed Charges for Rev 510 Proc 11640 = $668.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,CIGNA HEALTHCARE,CIGNA PPO,668.03,,,,,,,59.6400,1602.0000,percent of total billed charges,"41.7% of $1,602.00 in Billed Charges for Rev 510 Proc 11640 = $668.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,59.6400,1602.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1441.80,,,,,,,59.6400,1602.0000,percent of total billed charges,"90% of $1,602.00 in Billed Charges for Rev 510 Proc 11640 = $1,441.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,HUMANA,HUMANA MEDICARE,642.47,,,,,,,59.6400,1602.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,59.6400,1602.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,MEDCOST,MEDCOST VHN,762.39,,,,,,,59.6400,1602.0000,percent of total billed charges,"47.59% of $1,602.00 in Billed Charges for Rev 510 Proc 11640 = $762.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,59.6400,1602.0000,fee schedule,"APG 00009 Proc 11640 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,59.6400,1602.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,59.6400,1602.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,59.6400,1602.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,59.6400,1602.0000,fee schedule,"APG 00009 Proc 11640 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,SENTARA HEALTH,SENTARA HEALTH,413.48,,,,,,,59.6400,1602.0000,percent of total billed charges,"25.81% of $1,602.00 in Billed Charges for Rev 510 Proc 11640 = $413.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,59.6400,1602.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1602.00,,,,,,,59.6400,1602.0000,percent of total billed charges,"100% of $1,602.00 in Billed Charges for Rev 510 Proc 11640 = $1,602.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,413.29,,,,,,,59.6400,1602.0000,fee schedule,$826.58 from Fee Schedule TCUHC24 for Rev 510 Proc 11640 * Qty 1 = $826.58 at 50% = $413.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,517.45,,,,,,,59.6400,1602.0000,other,"32.3% of $1,602.00 in Billed Charges for Rev 510 Proc 11640 = $517.45 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,491.81,,,,,,,59.6400,1602.0000,other,"30.7% of $1,602.00 in Billed Charges for Rev 510 Proc 11640 = $491.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,517.45,,,,,,,59.6400,1602.0000,percent of total billed charges,"32.3% of $1,602.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,59.6400,1602.0000,fee schedule,"APG 00009 Proc 11640 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,59.6400,1602.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,59.6400,1602.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,WELLCARE,WELLCARE MEDICAID,1602.00,,,,,,,59.6400,1602.0000,percent of total billed charges,"100% of $1,602.00 in Billed Charges for Rev 510 Proc 11640 = $1,602.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 0.5 CM OR LESS,11640,CPT,510,RC,51000131,CDM,,,,both,,,1602.0000,240.3000,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,59.6400,1602.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,AETNA,AETNA,827.53,,,,,,,313.9500,3266.6300,percent of total billed charges,"42.7% of $1,938.00 in Billed Charges for Rev 510 Proc 11644 = $827.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1775.80,,,,,,,313.9500,3266.6300,fee schedule,"APG 00010 Proc 11644 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 104% = $1,775.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,313.9500,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,313.9500,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,313.9500,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,AMBETTER,AMBETTER,3266.63,,,,,,,313.9500,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,313.9500,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,BLUE CROSS,ANTHEM EXCHANGE,1938.00,,,,,,,313.9500,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1758.73,,,,,,,313.9500,3266.6300,fee schedule,"APG 00010 Proc 11644 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,BLUE CROSS,ANTHEM HMO,1938.00,,,,,,,313.9500,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,313.9500,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1938.00,,,,,,,313.9500,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,313.95,,,,,,,313.9500,3266.6300,fee schedule,$313.95 from Fee Schedule BLDTM_23 for Rev 510 Proc 11644 * Qty 1 = $313.95 at 100% = $313.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,313.9500,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,CIGNA HEALTHCARE,CIGNA HMO,808.15,,,,,,,313.9500,3266.6300,percent of total billed charges,"41.7% of $1,938.00 in Billed Charges for Rev 510 Proc 11644 = $808.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,899.23,,,,,,,313.9500,3266.6300,percent of total billed charges,"46.4% of $1,938.00 in Billed Charges for Rev 510 Proc 11644 = $899.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,313.9500,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,808.15,,,,,,,313.9500,3266.6300,percent of total billed charges,"41.7% of $1,938.00 in Billed Charges for Rev 510 Proc 11644 = $808.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,CIGNA HEALTHCARE,CIGNA PPO,808.15,,,,,,,313.9500,3266.6300,percent of total billed charges,"41.7% of $1,938.00 in Billed Charges for Rev 510 Proc 11644 = $808.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,313.9500,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1744.20,,,,,,,313.9500,3266.6300,percent of total billed charges,"90% of $1,938.00 in Billed Charges for Rev 510 Proc 11644 = $1,744.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,313.9500,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,313.9500,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,MEDCOST,MEDCOST VHN,922.29,,,,,,,313.9500,3266.6300,percent of total billed charges,"47.59% of $1,938.00 in Billed Charges for Rev 510 Proc 11644 = $922.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1792.88,,,,,,,313.9500,3266.6300,fee schedule,"APG 00010 Proc 11644 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 105% = $1,792.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,313.9500,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,313.9500,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,313.9500,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1760.43,,,,,,,313.9500,3266.6300,fee schedule,"APG 00010 Proc 11644 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 100% = $1,707.50... $1,707.50 at 103.1% = $1,760.43 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,SENTARA HEALTH,SENTARA HEALTH,500.20,,,,,,,313.9500,3266.6300,percent of total billed charges,"25.81% of $1,938.00 in Billed Charges for Rev 510 Proc 11644 = $500.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,313.9500,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1938.00,,,,,,,313.9500,3266.6300,percent of total billed charges,"100% of $1,938.00 in Billed Charges for Rev 510 Proc 11644 = $1,938.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,670.71,,,,,,,313.9500,3266.6300,fee schedule,"$1,341.41 from Fee Schedule TCUHC24 for Rev 510 Proc 11644 * Qty 1 = $1,341.41 at 50% = $670.71 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,625.97,,,,,,,313.9500,3266.6300,other,"32.3% of $1,938.00 in Billed Charges for Rev 510 Proc 11644 = $625.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,594.97,,,,,,,313.9500,3266.6300,other,"30.7% of $1,938.00 in Billed Charges for Rev 510 Proc 11644 = $594.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,625.97,,,,,,,313.9500,3266.6300,percent of total billed charges,"32.3% of $1,938.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1758.73,,,,,,,313.9500,3266.6300,fee schedule,"APG 00010 Proc 11644 at $836.60 (Base Rate) * 2.041 (Relative Weight) = $1,707.50 (Total Line Payment) at 103% = $1,758.73. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,313.9500,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,313.9500,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,WELLCARE,WELLCARE MEDICAID,1938.00,,,,,,,313.9500,3266.6300,percent of total billed charges,"100% of $1,938.00 in Billed Charges for Rev 510 Proc 11644 = $1,938.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC MALIG LESION F/E/E/N/L 3.1-4.0 CM,11644,CPT,510,RC,51000135,CDM,,,,both,,,1938.0000,290.7000,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,313.9500,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,AETNA,AETNA,34.59,,,,,,,15.8800,116.6800,percent of total billed charges,42.7% of $81.00 in Billed Charges for Rev 510 Proc 11719 = $34.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,95.10,,,,,,,15.8800,116.6800,fee schedule,APG 00005 Proc 11719 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 104% = $95.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,53.52,,,,,,,15.8800,116.6800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,AETNA,AETNA HEALTHCARE MEDICARE,53.52,,,,,,,15.8800,116.6800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,53.52,,,,,,,15.8800,116.6800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,AMBETTER,AMBETTER,116.68,,,,,,,15.8800,116.6800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,55.66,,,,,,,15.8800,116.6800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,ANTHEM EXCHANGE,81.00,,,,,,,15.8800,116.6800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,81.00,,,,,,,15.8800,116.6800,fee schedule,"APG 00005 Proc 11719 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 103% = $94.18 (Service Line reduced to $81.00, claim capped at $81.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,ANTHEM HMO,81.00,,,,,,,15.8800,116.6800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,55.13,,,,,,,15.8800,116.6800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",81.00,,,,,,,15.8800,116.6800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,15.88,,,,,,,15.8800,116.6800,fee schedule,$15.88 from Fee Schedule BLDTM_23 for Rev 510 Proc 11719 * Qty 1 = $15.88 at 100% = $15.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,BLUE CROSS,BLUE CROSS MEDICARE,55.66,,,,,,,15.8800,116.6800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,CIGNA HEALTHCARE,CIGNA HMO,33.78,,,,,,,15.8800,116.6800,percent of total billed charges,41.7% of $81.00 in Billed Charges for Rev 510 Proc 11719 = $33.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,37.58,,,,,,,15.8800,116.6800,percent of total billed charges,46.4% of $81.00 in Billed Charges for Rev 510 Proc 11719 = $37.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,56.20,,,,,,,15.8800,116.6800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,33.78,,,,,,,15.8800,116.6800,percent of total billed charges,41.7% of $81.00 in Billed Charges for Rev 510 Proc 11719 = $33.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,CIGNA HEALTHCARE,CIGNA PPO,33.78,,,,,,,15.8800,116.6800,percent of total billed charges,41.7% of $81.00 in Billed Charges for Rev 510 Proc 11719 = $33.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,56.20,,,,,,,15.8800,116.6800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,72.90,,,,,,,15.8800,116.6800,percent of total billed charges,90% of $81.00 in Billed Charges for Rev 510 Proc 11719 = $72.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,HUMANA,HUMANA MEDICARE,53.52,,,,,,,15.8800,116.6800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,53.52,,,,,,,15.8800,116.6800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,MEDCOST,MEDCOST VHN,38.55,,,,,,,15.8800,116.6800,percent of total billed charges,47.59% of $81.00 in Billed Charges for Rev 510 Proc 11719 = $38.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,96.01,,,,,,,15.8800,116.6800,fee schedule,APG 00005 Proc 11719 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 100% = $91.44... $91.44 at 105% = $96.01 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,56.20,,,,,,,15.8800,116.6800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,56.20,,,,,,,15.8800,116.6800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,NHC ADVANTAGE,NHC ADVANTAGE,56.20,,,,,,,15.8800,116.6800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,94.27,,,,,,,15.8800,116.6800,fee schedule,APG 00005 Proc 11719 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 100% = $91.44... $91.44 at 103.1% = $94.27 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,SENTARA HEALTH,SENTARA HEALTH,20.91,,,,,,,15.8800,116.6800,percent of total billed charges,25.81% of $81.00 in Billed Charges for Rev 510 Proc 11719 = $20.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,SENTARA HEALTH,SENTARA MEDICARE,53.52,,,,,,,15.8800,116.6800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",81.00,,,,,,,15.8800,116.6800,percent of total billed charges,100% of $81.00 in Billed Charges for Rev 510 Proc 11719 = $81.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,26.19,,,,,,,15.8800,116.6800,fee schedule,$52.37 from Fee Schedule TCUHC24 for Rev 510 Proc 11719 * Qty 1 = $52.37 at 50% = $26.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,26.16,,,,,,,15.8800,116.6800,other,32.3% of $81.00 in Billed Charges for Rev 510 Proc 11719 = $26.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,24.87,,,,,,,15.8800,116.6800,other,30.7% of $81.00 in Billed Charges for Rev 510 Proc 11719 = $24.87 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,26.16,,,,,,,15.8800,116.6800,percent of total billed charges,32.3% of $81.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,94.18,,,,,,,15.8800,116.6800,fee schedule,APG 00005 Proc 11719 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 103% = $94.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,53.52,,,,,,,15.8800,116.6800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,53.52,,,,,,,15.8800,116.6800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,WELLCARE,WELLCARE MEDICAID,81.00,,,,,,,15.8800,116.6800,percent of total billed charges,100% of $81.00 in Billed Charges for Rev 510 Proc 11719 = $81.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC TRIM NONDYSTRPHC NAILS,11719,CPT,510,RC,51000016,CDM,,,,both,,,81.0000,12.1500,WELLCARE,WELLCARE MEDICARE,56.73,,,,,,,15.8800,116.6800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,AETNA,AETNA,46.97,,,,,,,12.5500,116.6800,percent of total billed charges,42.7% of $110.00 in Billed Charges for Rev 510 Proc 11720 = $46.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,95.10,,,,,,,12.5500,116.6800,fee schedule,APG 00005 Proc 11720 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 104% = $95.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,53.52,,,,,,,12.5500,116.6800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,AETNA,AETNA HEALTHCARE MEDICARE,53.52,,,,,,,12.5500,116.6800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,53.52,,,,,,,12.5500,116.6800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,AMBETTER,AMBETTER,116.68,,,,,,,12.5500,116.6800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,55.66,,,,,,,12.5500,116.6800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,BLUE CROSS,ANTHEM EXCHANGE,110.00,,,,,,,12.5500,116.6800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,94.18,,,,,,,12.5500,116.6800,fee schedule,APG 00005 Proc 11720 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 103% = $94.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,BLUE CROSS,ANTHEM HMO,110.00,,,,,,,12.5500,116.6800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,55.13,,,,,,,12.5500,116.6800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",110.00,,,,,,,12.5500,116.6800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,25.54,,,,,,,12.5500,116.6800,fee schedule,$25.54 from Fee Schedule BLDTM_23 for Rev 510 Proc 11720 * Qty 1 = $25.54 at 100% = $25.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,BLUE CROSS,BLUE CROSS MEDICARE,55.66,,,,,,,12.5500,116.6800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,BLUE CROSS,TENNCARE BLUE CARE,12.55,,,,,,,12.5500,116.6800,fee schedule,$10.82 from Fee Schedule TC_24 for Rev 510 Proc 11720 * Qty 1 = $10.82 at 116% = $12.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,BLUE CROSS,TENNCARE BLUE SELECT,12.55,,,,,,,12.5500,116.6800,fee schedule,$10.82 from Fee Schedule TC_24 for Rev 510 Proc 11720 * Qty 1 = $10.82 at 116% = $12.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,CIGNA HEALTHCARE,CIGNA HMO,45.87,,,,,,,12.5500,116.6800,percent of total billed charges,41.7% of $110.00 in Billed Charges for Rev 510 Proc 11720 = $45.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,51.04,,,,,,,12.5500,116.6800,percent of total billed charges,46.4% of $110.00 in Billed Charges for Rev 510 Proc 11720 = $51.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,56.20,,,,,,,12.5500,116.6800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,45.87,,,,,,,12.5500,116.6800,percent of total billed charges,41.7% of $110.00 in Billed Charges for Rev 510 Proc 11720 = $45.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,CIGNA HEALTHCARE,CIGNA PPO,45.87,,,,,,,12.5500,116.6800,percent of total billed charges,41.7% of $110.00 in Billed Charges for Rev 510 Proc 11720 = $45.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,56.20,,,,,,,12.5500,116.6800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,99.00,,,,,,,12.5500,116.6800,percent of total billed charges,90% of $110.00 in Billed Charges for Rev 510 Proc 11720 = $99.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,HUMANA,HUMANA MEDICARE,53.52,,,,,,,12.5500,116.6800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,53.52,,,,,,,12.5500,116.6800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,MEDCOST,MEDCOST VHN,52.35,,,,,,,12.5500,116.6800,percent of total billed charges,47.59% of $110.00 in Billed Charges for Rev 510 Proc 11720 = $52.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,96.01,,,,,,,12.5500,116.6800,fee schedule,APG 00005 Proc 11720 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 100% = $91.44... $91.44 at 105% = $96.01 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,56.20,,,,,,,12.5500,116.6800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,56.20,,,,,,,12.5500,116.6800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,NHC ADVANTAGE,NHC ADVANTAGE,56.20,,,,,,,12.5500,116.6800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,94.27,,,,,,,12.5500,116.6800,fee schedule,APG 00005 Proc 11720 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 100% = $91.44... $91.44 at 103.1% = $94.27 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,SENTARA HEALTH,SENTARA HEALTH,28.39,,,,,,,12.5500,116.6800,percent of total billed charges,25.81% of $110.00 in Billed Charges for Rev 510 Proc 11720 = $28.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,SENTARA HEALTH,SENTARA MEDICARE,53.52,,,,,,,12.5500,116.6800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",110.00,,,,,,,12.5500,116.6800,percent of total billed charges,100% of $110.00 in Billed Charges for Rev 510 Proc 11720 = $110.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,26.19,,,,,,,12.5500,116.6800,fee schedule,$52.37 from Fee Schedule TCUHC24 for Rev 510 Proc 11720 * Qty 1 = $52.37 at 50% = $26.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,35.53,,,,,,,12.5500,116.6800,other,32.3% of $110.00 in Billed Charges for Rev 510 Proc 11720 = $35.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,33.77,,,,,,,12.5500,116.6800,other,30.7% of $110.00 in Billed Charges for Rev 510 Proc 11720 = $33.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,35.53,,,,,,,12.5500,116.6800,percent of total billed charges,32.3% of $110.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,94.18,,,,,,,12.5500,116.6800,fee schedule,APG 00005 Proc 11720 at $836.60 (Base Rate) * 0.1093 (Relative Weight) = $91.44 (Total Line Payment) at 103% = $94.18. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,53.52,,,,,,,12.5500,116.6800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,53.52,,,,,,,12.5500,116.6800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,WELLCARE,WELLCARE MEDICAID,110.00,,,,,,,12.5500,116.6800,percent of total billed charges,100% of $110.00 in Billed Charges for Rev 510 Proc 11720 = $110.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC WC DEBRID NAILS 1-5,11720,CPT,510,RC,51000017,CDM,,,,both,,,110.0000,16.5000,WELLCARE,WELLCARE MEDICARE,56.73,,,,,,,12.5500,116.6800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,AETNA,AETNA,383.02,,,,,,,141.5700,1461.7800,percent of total billed charges,42.7% of $897.00 in Billed Charges for Rev 521 Proc 17286 = $383.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,141.5700,1461.7800,fee schedule,"APG 00003 Proc 17286 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,670.54,,,,,,,141.5700,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,AETNA,AETNA HEALTHCARE MEDICARE,670.54,,,,,,,141.5700,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,670.54,,,,,,,141.5700,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,AMBETTER,AMBETTER,1461.78,,,,,,,141.5700,1461.7800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,697.36,,,,,,,141.5700,1461.7800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,BLUE CROSS,ANTHEM EXCHANGE,897.00,,,,,,,141.5700,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,141.5700,1461.7800,fee schedule,"APG 00003 Proc 17286 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,BLUE CROSS,ANTHEM HMO,897.00,,,,,,,141.5700,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,690.66,,,,,,,141.5700,1461.7800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",897.00,,,,,,,141.5700,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,290.01,,,,,,,141.5700,1461.7800,fee schedule,$290.01 from Fee Schedule BLDTM_23 for Rev 521 Proc 17286 * Qty 1 = $290.01 at 100% = $290.01 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,BLUE CROSS,BLUE CROSS MEDICARE,697.36,,,,,,,141.5700,1461.7800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,CIGNA HEALTHCARE,CIGNA HMO,374.05,,,,,,,141.5700,1461.7800,percent of total billed charges,41.7% of $897.00 in Billed Charges for Rev 521 Proc 17286 = $374.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,416.21,,,,,,,141.5700,1461.7800,percent of total billed charges,46.4% of $897.00 in Billed Charges for Rev 521 Proc 17286 = $416.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,704.07,,,,,,,141.5700,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,374.05,,,,,,,141.5700,1461.7800,percent of total billed charges,41.7% of $897.00 in Billed Charges for Rev 521 Proc 17286 = $374.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,CIGNA HEALTHCARE,CIGNA PPO,374.05,,,,,,,141.5700,1461.7800,percent of total billed charges,41.7% of $897.00 in Billed Charges for Rev 521 Proc 17286 = $374.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,704.07,,,,,,,141.5700,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,807.30,,,,,,,141.5700,1461.7800,percent of total billed charges,90% of $897.00 in Billed Charges for Rev 521 Proc 17286 = $807.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,HUMANA,HUMANA MEDICARE,670.54,,,,,,,141.5700,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,670.54,,,,,,,141.5700,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,MEDCOST,MEDCOST VHN,426.88,,,,,,,141.5700,1461.7800,percent of total billed charges,47.59% of $897.00 in Billed Charges for Rev 521 Proc 17286 = $426.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,141.5700,1461.7800,fee schedule,"APG 00003 Proc 17286 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,704.07,,,,,,,141.5700,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,704.07,,,,,,,141.5700,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,NHC ADVANTAGE,NHC ADVANTAGE,704.07,,,,,,,141.5700,1461.7800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,141.5700,1461.7800,fee schedule,"APG 00003 Proc 17286 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,SENTARA HEALTH,SENTARA HEALTH,231.52,,,,,,,141.5700,1461.7800,percent of total billed charges,25.81% of $897.00 in Billed Charges for Rev 521 Proc 17286 = $231.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,SENTARA HEALTH,SENTARA MEDICARE,670.54,,,,,,,141.5700,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",897.00,,,,,,,141.5700,1461.7800,percent of total billed charges,100% of $897.00 in Billed Charges for Rev 521 Proc 17286 = $897.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,141.57,,,,,,,141.5700,1461.7800,fee schedule,$283.14 from Fee Schedule TCUHC24 for Rev 521 Proc 17286 * Qty 1 = $283.14 at 50% = $141.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,141.5700,1461.7800,fee schedule,"APG 00003 Proc 17286 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,670.54,,,,,,,141.5700,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,670.54,,,,,,,141.5700,1461.7800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,WELLCARE,WELLCARE MEDICAID,897.00,,,,,,,141.5700,1461.7800,percent of total billed charges,100% of $897.00 in Billed Charges for Rev 521 Proc 17286 = $897.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M > 4.0 CM,17286,CPT,521,RC,52100084,CDM,,,,both,,,897.0000,134.5500,WELLCARE,WELLCARE MEDICARE,710.77,,,,,,,141.5700,1461.7800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,AETNA,AETNA,802.76,,,,,,,23.5500,1880.0000,percent of total billed charges,"42.7% of $1,880.00 in Billed Charges for Rev 361 Proc 19000 = $802.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,23.5500,1880.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,23.5500,1880.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,23.5500,1880.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,AMBETTER,AMBETTER,1400.59,,,,,,,23.5500,1880.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,23.5500,1880.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,23.5500,1880.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,23.5500,1880.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,23.5500,1880.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1880.00,,,,,,,23.5500,1880.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,948.00,,,,,,,23.5500,1880.0000,case rate,Rev 361 Proc 19000 ASG Rate of $948.00 at 100% of $948.00 = $948.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,23.5500,1880.0000,case rate,Rev 361 Proc 19000 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,23.5500,1880.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,23.5500,1880.0000,case rate,Rev 361 Proc 19000 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,23.5500,1880.0000,case rate,Rev 361 Proc 19000 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,BLUE CROSS,TENNCARE BLUE CARE,23.55,,,,,,,23.5500,1880.0000,fee schedule,$20.30 from Fee Schedule TC_24 for Rev 361 Proc 19000 * Qty 1 = $20.30 at 116% = $23.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,BLUE CROSS,TENNCARE BLUE SELECT,23.55,,,,,,,23.5500,1880.0000,fee schedule,$20.30 from Fee Schedule TC_24 for Rev 361 Proc 19000 * Qty 1 = $20.30 at 116% = $23.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,CIGNA HEALTHCARE,CIGNA HMO,1880.00,,,,,,,23.5500,1880.0000,case rate,"Rev 361 Proc 19000 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,880.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,880.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,23.5500,1880.0000,case rate,"Rev 361 Proc 19000 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,23.5500,1880.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1880.00,,,,,,,23.5500,1880.0000,case rate,"Rev 361 Proc 19000 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,880.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,880.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,CIGNA HEALTHCARE,CIGNA PPO,1880.00,,,,,,,23.5500,1880.0000,case rate,"Rev 361 Proc 19000 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,880.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,880.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,23.5500,1880.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1692.00,,,,,,,23.5500,1880.0000,percent of total billed charges,"90% of $1,880.00 in Billed Charges for Rev 361 Proc 19000 = $1,692.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,HUMANA,HUMANA MEDICARE,642.47,,,,,,,23.5500,1880.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,23.5500,1880.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,MEDCOST,MEDCOST VHN,894.69,,,,,,,23.5500,1880.0000,percent of total billed charges,"47.59% of $1,880.00 in Billed Charges for Rev 361 Proc 19000 = $894.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,23.5500,1880.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,23.5500,1880.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,23.5500,1880.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,SENTARA HEALTH,SENTARA HEALTH,485.23,,,,,,,23.5500,1880.0000,percent of total billed charges,"25.81% of $1,880.00 in Billed Charges for Rev 361 Proc 19000 = $485.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,23.5500,1880.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1880.00,,,,,,,23.5500,1880.0000,percent of total billed charges,"100% of $1,880.00 in Billed Charges for Rev 361 Proc 19000 = $1,880.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,23.5500,1880.0000,case rate,Rev 361 Proc 19000 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,23.5500,1880.0000,case rate,Rev 361 Proc 19000 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,23.5500,1880.0000,case rate,Rev 361 Proc 19000 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,23.5500,1880.0000,case rate,"Rev 361 Proc 19000 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,23.5500,1880.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,23.5500,1880.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,WELLCARE,WELLCARE MEDICAID,1880.00,,,,,,,23.5500,1880.0000,percent of total billed charges,"100% of $1,880.00 in Billed Charges for Rev 361 Proc 19000 = $1,880.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIR BREAST SINGLE CYST,19000,CPT,361,RC,36100057,CDM,,,,both,,,1880.0000,282.0000,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,23.5500,1880.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST EA ADDT CYST,19001,CPT,361,RC,36100058,CDM,,,,both,,,1189.0000,178.3500,AETNA,AETNA,507.70,,,,,,,12.5500,1189.0000,percent of total billed charges,"42.7% of $1,189.00 in Billed Charges for Rev 361 Proc 19001 = $507.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIR BREAST EA ADDT CYST,19001,CPT,361,RC,36100058,CDM,,,,both,,,1189.0000,178.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,12.5500,1189.0000,case rate,Rev 361 Proc 19001 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST EA ADDT CYST,19001,CPT,361,RC,36100058,CDM,,,,both,,,1189.0000,178.3500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,12.5500,1189.0000,case rate,Rev 361 Proc 19001 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST EA ADDT CYST,19001,CPT,361,RC,36100058,CDM,,,,both,,,1189.0000,178.3500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,12.5500,1189.0000,case rate,Rev 361 Proc 19001 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST EA ADDT CYST,19001,CPT,361,RC,36100058,CDM,,,,both,,,1189.0000,178.3500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,12.5500,1189.0000,case rate,Rev 361 Proc 19001 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST EA ADDT CYST,19001,CPT,361,RC,36100058,CDM,,,,both,,,1189.0000,178.3500,BLUE CROSS,TENNCARE BLUE CARE,12.55,,,,,,,12.5500,1189.0000,fee schedule,$10.82 from Fee Schedule TC_24 for Rev 361 Proc 19001 * Qty 1 = $10.82 at 116% = $12.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST EA ADDT CYST,19001,CPT,361,RC,36100058,CDM,,,,both,,,1189.0000,178.3500,BLUE CROSS,TENNCARE BLUE SELECT,12.55,,,,,,,12.5500,1189.0000,fee schedule,$10.82 from Fee Schedule TC_24 for Rev 361 Proc 19001 * Qty 1 = $10.82 at 116% = $12.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST EA ADDT CYST,19001,CPT,361,RC,36100058,CDM,,,,both,,,1189.0000,178.3500,CIGNA HEALTHCARE,CIGNA HMO,1189.00,,,,,,,12.5500,1189.0000,case rate,"Rev 361 Proc 19001 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,189.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,189.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIR BREAST EA ADDT CYST,19001,CPT,361,RC,36100058,CDM,,,,both,,,1189.0000,178.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1189.00,,,,,,,12.5500,1189.0000,case rate,"Rev 361 Proc 19001 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,189.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,189.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIR BREAST EA ADDT CYST,19001,CPT,361,RC,36100058,CDM,,,,both,,,1189.0000,178.3500,CIGNA HEALTHCARE,CIGNA PPO,1189.00,,,,,,,12.5500,1189.0000,case rate,"Rev 361 Proc 19001 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,189.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,189.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASPIR BREAST EA ADDT CYST,19001,CPT,361,RC,36100058,CDM,,,,both,,,1189.0000,178.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1070.10,,,,,,,12.5500,1189.0000,percent of total billed charges,"90% of $1,189.00 in Billed Charges for Rev 361 Proc 19001 = $1,070.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIR BREAST EA ADDT CYST,19001,CPT,361,RC,36100058,CDM,,,,both,,,1189.0000,178.3500,MEDCOST,MEDCOST VHN,565.85,,,,,,,12.5500,1189.0000,percent of total billed charges,"47.59% of $1,189.00 in Billed Charges for Rev 361 Proc 19001 = $565.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIR BREAST EA ADDT CYST,19001,CPT,361,RC,36100058,CDM,,,,both,,,1189.0000,178.3500,SENTARA HEALTH,SENTARA HEALTH,306.88,,,,,,,12.5500,1189.0000,percent of total billed charges,"25.81% of $1,189.00 in Billed Charges for Rev 361 Proc 19001 = $306.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIR BREAST EA ADDT CYST,19001,CPT,361,RC,36100058,CDM,,,,both,,,1189.0000,178.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1189.00,,,,,,,12.5500,1189.0000,percent of total billed charges,"100% of $1,189.00 in Billed Charges for Rev 361 Proc 19001 = $1,189.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASPIR BREAST EA ADDT CYST,19001,CPT,361,RC,36100058,CDM,,,,both,,,1189.0000,178.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,12.5500,1189.0000,case rate,Rev 361 Proc 19001 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST EA ADDT CYST,19001,CPT,361,RC,36100058,CDM,,,,both,,,1189.0000,178.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,12.5500,1189.0000,case rate,Rev 361 Proc 19001 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST EA ADDT CYST,19001,CPT,361,RC,36100058,CDM,,,,both,,,1189.0000,178.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,12.5500,1189.0000,case rate,Rev 361 Proc 19001 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST EA ADDT CYST,19001,CPT,361,RC,36100058,CDM,,,,both,,,1189.0000,178.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,12.5500,1189.0000,case rate,Rev 361 Proc 19001 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASPIR BREAST EA ADDT CYST,19001,CPT,361,RC,36100058,CDM,,,,both,,,1189.0000,178.3500,WELLCARE,WELLCARE MEDICAID,1189.00,,,,,,,12.5500,1189.0000,percent of total billed charges,"100% of $1,189.00 in Billed Charges for Rev 361 Proc 19001 = $1,189.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ DUCTOGRAM GALACTOGRAM,19030,CPT,361,RC,36100059,CDM,,,,both,,,1076.0000,161.4000,AETNA,AETNA,459.45,,,,,,,148.0000,1076.0000,percent of total billed charges,"42.7% of $1,076.00 in Billed Charges for Rev 361 Proc 19030 = $459.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ DUCTOGRAM GALACTOGRAM,19030,CPT,361,RC,36100059,CDM,,,,both,,,1076.0000,161.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,495.24,,,,,,,148.0000,1076.0000,fee schedule,APG 00278 Proc 19030 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 104% = $495.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM,19030,CPT,361,RC,36100059,CDM,,,,both,,,1076.0000,161.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,490.48,,,,,,,148.0000,1076.0000,fee schedule,APG 00278 Proc 19030 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 103% = $490.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM,19030,CPT,361,RC,36100059,CDM,,,,both,,,1076.0000,161.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,148.0000,1076.0000,case rate,Rev 361 Proc 19030 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM,19030,CPT,361,RC,36100059,CDM,,,,both,,,1076.0000,161.4000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,1076.0000,case rate,Rev 361 Proc 19030 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM,19030,CPT,361,RC,36100059,CDM,,,,both,,,1076.0000,161.4000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,1076.0000,case rate,Rev 361 Proc 19030 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM,19030,CPT,361,RC,36100059,CDM,,,,both,,,1076.0000,161.4000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,1076.0000,case rate,Rev 361 Proc 19030 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM,19030,CPT,361,RC,36100059,CDM,,,,both,,,1076.0000,161.4000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,148.0000,1076.0000,case rate,Rev 361 Proc 19030 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM,19030,CPT,361,RC,36100059,CDM,,,,both,,,1076.0000,161.4000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,148.0000,1076.0000,case rate,Rev 361 Proc 19030 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM,19030,CPT,361,RC,36100059,CDM,,,,both,,,1076.0000,161.4000,CIGNA HEALTHCARE,CIGNA HMO,1076.00,,,,,,,148.0000,1076.0000,case rate,"Rev 361 Proc 19030 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,076.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,076.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ DUCTOGRAM GALACTOGRAM,19030,CPT,361,RC,36100059,CDM,,,,both,,,1076.0000,161.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1076.00,,,,,,,148.0000,1076.0000,case rate,"Rev 361 Proc 19030 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,076.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,076.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ DUCTOGRAM GALACTOGRAM,19030,CPT,361,RC,36100059,CDM,,,,both,,,1076.0000,161.4000,CIGNA HEALTHCARE,CIGNA PPO,1076.00,,,,,,,148.0000,1076.0000,case rate,"Rev 361 Proc 19030 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,076.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,076.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ DUCTOGRAM GALACTOGRAM,19030,CPT,361,RC,36100059,CDM,,,,both,,,1076.0000,161.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,968.40,,,,,,,148.0000,1076.0000,percent of total billed charges,"90% of $1,076.00 in Billed Charges for Rev 361 Proc 19030 = $968.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ DUCTOGRAM GALACTOGRAM,19030,CPT,361,RC,36100059,CDM,,,,both,,,1076.0000,161.4000,MEDCOST,MEDCOST VHN,512.07,,,,,,,148.0000,1076.0000,percent of total billed charges,"47.59% of $1,076.00 in Billed Charges for Rev 361 Proc 19030 = $512.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ DUCTOGRAM GALACTOGRAM,19030,CPT,361,RC,36100059,CDM,,,,both,,,1076.0000,161.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,500.00,,,,,,,148.0000,1076.0000,fee schedule,APG 00278 Proc 19030 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 100% = $476.19... $476.19 at 105% = $500.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM,19030,CPT,361,RC,36100059,CDM,,,,both,,,1076.0000,161.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,490.95,,,,,,,148.0000,1076.0000,fee schedule,APG 00278 Proc 19030 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 100% = $476.19... $476.19 at 103.1% = $490.95 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM,19030,CPT,361,RC,36100059,CDM,,,,both,,,1076.0000,161.4000,SENTARA HEALTH,SENTARA HEALTH,277.72,,,,,,,148.0000,1076.0000,percent of total billed charges,"25.81% of $1,076.00 in Billed Charges for Rev 361 Proc 19030 = $277.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ DUCTOGRAM GALACTOGRAM,19030,CPT,361,RC,36100059,CDM,,,,both,,,1076.0000,161.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1076.00,,,,,,,148.0000,1076.0000,percent of total billed charges,"100% of $1,076.00 in Billed Charges for Rev 361 Proc 19030 = $1,076.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ DUCTOGRAM GALACTOGRAM,19030,CPT,361,RC,36100059,CDM,,,,both,,,1076.0000,161.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,148.0000,1076.0000,case rate,Rev 361 Proc 19030 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM,19030,CPT,361,RC,36100059,CDM,,,,both,,,1076.0000,161.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,148.0000,1076.0000,case rate,Rev 361 Proc 19030 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM,19030,CPT,361,RC,36100059,CDM,,,,both,,,1076.0000,161.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,148.0000,1076.0000,case rate,Rev 361 Proc 19030 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM,19030,CPT,361,RC,36100059,CDM,,,,both,,,1076.0000,161.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,148.0000,1076.0000,case rate,Rev 361 Proc 19030 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM,19030,CPT,361,RC,36100059,CDM,,,,both,,,1076.0000,161.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,490.48,,,,,,,148.0000,1076.0000,fee schedule,APG 00278 Proc 19030 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 103% = $490.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ DUCTOGRAM GALACTOGRAM,19030,CPT,361,RC,36100059,CDM,,,,both,,,1076.0000,161.4000,WELLCARE,WELLCARE MEDICAID,1076.00,,,,,,,148.0000,1076.0000,percent of total billed charges,"100% of $1,076.00 in Billed Charges for Rev 361 Proc 19030 = $1,076.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,AETNA,AETNA,1231.47,,,,,,,744.3600,3266.6300,percent of total billed charges,"42.7% of $2,884.00 in Billed Charges for Rev 361 Proc 19083 = $1,231.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1899.70,,,,,,,744.3600,3266.6300,fee schedule,"APG 00020 Proc 19083 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 104% = $1,899.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,744.3600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,744.3600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,744.3600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,AMBETTER,AMBETTER,3266.63,,,,,,,744.3600,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,744.3600,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,BLUE CROSS,ANTHEM EXCHANGE,2884.00,,,,,,,744.3600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1881.43,,,,,,,744.3600,3266.6300,fee schedule,"APG 00020 Proc 19083 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,BLUE CROSS,ANTHEM HMO,2884.00,,,,,,,744.3600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,744.3600,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2884.00,,,,,,,744.3600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,744.3600,3266.6300,case rate,"Rev 361 Proc 19083 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,744.3600,3266.6300,case rate,"Rev 361 Proc 19083 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,744.3600,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,744.3600,3266.6300,case rate,"Rev 361 Proc 19083 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,744.3600,3266.6300,case rate,"Rev 361 Proc 19083 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,744.3600,3266.6300,case rate,Rev 361 Proc 19083 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,744.3600,3266.6300,case rate,Rev 361 Proc 19083 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,CIGNA HEALTHCARE,CIGNA HMO,2884.00,,,,,,,744.3600,3266.6300,case rate,"Rev 361 Proc 19083 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total (Limited to $2,884.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,884.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2246.00,,,,,,,744.3600,3266.6300,case rate,"Rev 361 Proc 19083 ASG Rate of $2,246.00 at 100% of $2,246.00 = $2,246.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,744.3600,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2884.00,,,,,,,744.3600,3266.6300,case rate,"Rev 361 Proc 19083 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total (Limited to $2,884.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,884.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,CIGNA HEALTHCARE,CIGNA PPO,2884.00,,,,,,,744.3600,3266.6300,case rate,"Rev 361 Proc 19083 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total (Limited to $2,884.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,884.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,744.3600,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2595.60,,,,,,,744.3600,3266.6300,percent of total billed charges,"90% of $2,884.00 in Billed Charges for Rev 361 Proc 19083 = $2,595.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,744.3600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,744.3600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,MEDCOST,MEDCOST VHN,1372.50,,,,,,,744.3600,3266.6300,percent of total billed charges,"47.59% of $2,884.00 in Billed Charges for Rev 361 Proc 19083 = $1,372.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1917.96,,,,,,,744.3600,3266.6300,fee schedule,"APG 00020 Proc 19083 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 105% = $1,917.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,744.3600,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,744.3600,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,744.3600,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1883.26,,,,,,,744.3600,3266.6300,fee schedule,"APG 00020 Proc 19083 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 103.1% = $1,883.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,SENTARA HEALTH,SENTARA HEALTH,744.36,,,,,,,744.3600,3266.6300,percent of total billed charges,"25.81% of $2,884.00 in Billed Charges for Rev 361 Proc 19083 = $744.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,744.3600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2884.00,,,,,,,744.3600,3266.6300,percent of total billed charges,"100% of $2,884.00 in Billed Charges for Rev 361 Proc 19083 = $2,884.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,744.3600,3266.6300,case rate,Rev 361 Proc 19083 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,744.3600,3266.6300,case rate,"Rev 361 Proc 19083 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,744.3600,3266.6300,case rate,"Rev 361 Proc 19083 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,744.3600,3266.6300,case rate,"Rev 361 Proc 19083 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1881.43,,,,,,,744.3600,3266.6300,fee schedule,"APG 00020 Proc 19083 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,744.3600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,744.3600,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,WELLCARE,WELLCARE MEDICAID,2884.00,,,,,,,744.3600,3266.6300,percent of total billed charges,"100% of $2,884.00 in Billed Charges for Rev 361 Proc 19083 = $2,884.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC US GUIDE FOR BX 1ST LESION,19083,CPT,361,RC,36100243,CDM,,,,both,,,2884.0000,432.6000,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,744.3600,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX EA ADD LESION,19084,CPT,361,RC,36100218,CDM,,,,both,,,468.0000,70.2000,AETNA,AETNA,199.84,,,,,,,120.7900,1917.9600,percent of total billed charges,42.7% of $468.00 in Billed Charges for Rev 361 Proc 19084 = $199.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDE FOR BX EA ADD LESION,19084,CPT,361,RC,36100218,CDM,,,,both,,,468.0000,70.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1899.70,,,,,,,120.7900,1917.9600,fee schedule,"APG 00020 Proc 19084 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 104% = $1,899.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX EA ADD LESION,19084,CPT,361,RC,36100218,CDM,,,,both,,,468.0000,70.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,468.00,,,,,,,120.7900,1917.9600,fee schedule,"APG 00020 Proc 19084 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43 (Service Line reduced to $468.00, claim capped at $468.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX EA ADD LESION,19084,CPT,361,RC,36100218,CDM,,,,both,,,468.0000,70.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,468.00,,,,,,,120.7900,1917.9600,case rate,"Rev 361 Proc 19084 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $468.00 in Billed Charges - $0.00 in ASG Allowed Amount = $468.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX EA ADD LESION,19084,CPT,361,RC,36100218,CDM,,,,both,,,468.0000,70.2000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,120.7900,1917.9600,case rate,Rev 361 Proc 19084 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX EA ADD LESION,19084,CPT,361,RC,36100218,CDM,,,,both,,,468.0000,70.2000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,120.7900,1917.9600,case rate,Rev 361 Proc 19084 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX EA ADD LESION,19084,CPT,361,RC,36100218,CDM,,,,both,,,468.0000,70.2000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,120.7900,1917.9600,case rate,Rev 361 Proc 19084 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX EA ADD LESION,19084,CPT,361,RC,36100218,CDM,,,,both,,,468.0000,70.2000,CIGNA HEALTHCARE,CIGNA HMO,468.00,,,,,,,120.7900,1917.9600,case rate,"Rev 361 Proc 19084 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $468.00 in Billed Charges - $0.00 in ASG Allowed Amount = $468.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX EA ADD LESION,19084,CPT,361,RC,36100218,CDM,,,,both,,,468.0000,70.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,468.00,,,,,,,120.7900,1917.9600,case rate,"Rev 361 Proc 19084 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $468.00 in Billed Charges - $0.00 in ASG Allowed Amount = $468.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX EA ADD LESION,19084,CPT,361,RC,36100218,CDM,,,,both,,,468.0000,70.2000,CIGNA HEALTHCARE,CIGNA PPO,468.00,,,,,,,120.7900,1917.9600,case rate,"Rev 361 Proc 19084 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $468.00 in Billed Charges - $0.00 in ASG Allowed Amount = $468.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX EA ADD LESION,19084,CPT,361,RC,36100218,CDM,,,,both,,,468.0000,70.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,421.20,,,,,,,120.7900,1917.9600,percent of total billed charges,90% of $468.00 in Billed Charges for Rev 361 Proc 19084 = $421.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDE FOR BX EA ADD LESION,19084,CPT,361,RC,36100218,CDM,,,,both,,,468.0000,70.2000,MEDCOST,MEDCOST VHN,222.72,,,,,,,120.7900,1917.9600,percent of total billed charges,47.59% of $468.00 in Billed Charges for Rev 361 Proc 19084 = $222.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDE FOR BX EA ADD LESION,19084,CPT,361,RC,36100218,CDM,,,,both,,,468.0000,70.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1917.96,,,,,,,120.7900,1917.9600,fee schedule,"APG 00020 Proc 19084 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 105% = $1,917.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX EA ADD LESION,19084,CPT,361,RC,36100218,CDM,,,,both,,,468.0000,70.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1883.26,,,,,,,120.7900,1917.9600,fee schedule,"APG 00020 Proc 19084 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 103.1% = $1,883.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX EA ADD LESION,19084,CPT,361,RC,36100218,CDM,,,,both,,,468.0000,70.2000,SENTARA HEALTH,SENTARA HEALTH,120.79,,,,,,,120.7900,1917.9600,percent of total billed charges,25.81% of $468.00 in Billed Charges for Rev 361 Proc 19084 = $120.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDE FOR BX EA ADD LESION,19084,CPT,361,RC,36100218,CDM,,,,both,,,468.0000,70.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",468.00,,,,,,,120.7900,1917.9600,percent of total billed charges,100% of $468.00 in Billed Charges for Rev 361 Proc 19084 = $468.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC US GUIDE FOR BX EA ADD LESION,19084,CPT,361,RC,36100218,CDM,,,,both,,,468.0000,70.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,120.7900,1917.9600,case rate,Rev 361 Proc 19084 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX EA ADD LESION,19084,CPT,361,RC,36100218,CDM,,,,both,,,468.0000,70.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,120.7900,1917.9600,case rate,Rev 361 Proc 19084 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX EA ADD LESION,19084,CPT,361,RC,36100218,CDM,,,,both,,,468.0000,70.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,120.7900,1917.9600,case rate,Rev 361 Proc 19084 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC US GUIDE FOR BX EA ADD LESION,19084,CPT,361,RC,36100218,CDM,,,,both,,,468.0000,70.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,468.00,,,,,,,120.7900,1917.9600,case rate,"Rev 361 Proc 19084 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total (Service Line reduced to $468.00, claim capped at $468.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX EA ADD LESION,19084,CPT,361,RC,36100218,CDM,,,,both,,,468.0000,70.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1881.43,,,,,,,120.7900,1917.9600,fee schedule,"APG 00020 Proc 19084 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC US GUIDE FOR BX EA ADD LESION,19084,CPT,361,RC,36100218,CDM,,,,both,,,468.0000,70.2000,WELLCARE,WELLCARE MEDICAID,468.00,,,,,,,120.7900,1917.9600,percent of total billed charges,100% of $468.00 in Billed Charges for Rev 361 Proc 19084 = $468.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,AETNA,AETNA,1942.85,,,,,,,37.6700,4550.0000,percent of total billed charges,"42.7% of $4,550.00 in Billed Charges for Rev 361 Proc 19100 = $1,942.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1899.70,,,,,,,37.6700,4550.0000,fee schedule,"APG 00020 Proc 19100 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 104% = $1,899.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,37.6700,4550.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,37.6700,4550.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,37.6700,4550.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,AMBETTER,AMBETTER,3266.63,,,,,,,37.6700,4550.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,37.6700,4550.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,BLUE CROSS,ANTHEM EXCHANGE,3689.28,,,,,,,37.6700,4550.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1881.43,,,,,,,37.6700,4550.0000,fee schedule,"APG 00020 Proc 19100 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,BLUE CROSS,ANTHEM HMO,3919.64,,,,,,,37.6700,4550.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,37.6700,4550.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4550.00,,,,,,,37.6700,4550.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,37.6700,4550.0000,case rate,Rev 361 Proc 19100 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,37.6700,4550.0000,case rate,"Rev 361 Proc 19100 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,37.6700,4550.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,37.6700,4550.0000,case rate,"Rev 361 Proc 19100 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,37.6700,4550.0000,case rate,"Rev 361 Proc 19100 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,BLUE CROSS,TENNCARE BLUE CARE,37.67,,,,,,,37.6700,4550.0000,fee schedule,$32.47 from Fee Schedule TC_24 for Rev 361 Proc 19100 * Qty 1 = $32.47 at 116% = $37.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,BLUE CROSS,TENNCARE BLUE SELECT,37.67,,,,,,,37.6700,4550.0000,fee schedule,$32.47 from Fee Schedule TC_24 for Rev 361 Proc 19100 * Qty 1 = $32.47 at 116% = $37.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,37.6700,4550.0000,case rate,"Rev 361 Proc 19100 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,37.6700,4550.0000,case rate,"Rev 361 Proc 19100 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,37.6700,4550.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,37.6700,4550.0000,case rate,"Rev 361 Proc 19100 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,37.6700,4550.0000,case rate,"Rev 361 Proc 19100 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,37.6700,4550.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4095.00,,,,,,,37.6700,4550.0000,percent of total billed charges,"90% of $4,550.00 in Billed Charges for Rev 361 Proc 19100 = $4,095.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,37.6700,4550.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,37.6700,4550.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,MEDCOST,MEDCOST VHN,2165.35,,,,,,,37.6700,4550.0000,percent of total billed charges,"47.59% of $4,550.00 in Billed Charges for Rev 361 Proc 19100 = $2,165.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1917.96,,,,,,,37.6700,4550.0000,fee schedule,"APG 00020 Proc 19100 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 105% = $1,917.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,37.6700,4550.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,37.6700,4550.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,37.6700,4550.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1883.26,,,,,,,37.6700,4550.0000,fee schedule,"APG 00020 Proc 19100 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 103.1% = $1,883.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,SENTARA HEALTH,SENTARA HEALTH,1174.36,,,,,,,37.6700,4550.0000,percent of total billed charges,"25.81% of $4,550.00 in Billed Charges for Rev 361 Proc 19100 = $1,174.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,37.6700,4550.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4550.00,,,,,,,37.6700,4550.0000,percent of total billed charges,"100% of $4,550.00 in Billed Charges for Rev 361 Proc 19100 = $4,550.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,37.6700,4550.0000,case rate,Rev 361 Proc 19100 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,37.6700,4550.0000,case rate,"Rev 361 Proc 19100 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,37.6700,4550.0000,case rate,"Rev 361 Proc 19100 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,37.6700,4550.0000,case rate,"Rev 361 Proc 19100 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1881.43,,,,,,,37.6700,4550.0000,fee schedule,"APG 00020 Proc 19100 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,37.6700,4550.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,37.6700,4550.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,WELLCARE,WELLCARE MEDICAID,4550.00,,,,,,,37.6700,4550.0000,percent of total billed charges,"100% of $4,550.00 in Billed Charges for Rev 361 Proc 19100 = $4,550.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX BREAST NDL CORE WO IMG GUID,19100,CPT,361,RC,36100439,CDM,,,,both,,,4550.0000,682.5000,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,37.6700,4550.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,AETNA,AETNA,3977.08,,,,,,,775.0000,9314.0000,percent of total billed charges,"42.7% of $9,314.00 in Billed Charges for Rev 361 Proc 19101 = $3,977.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1899.70,,,,,,,775.0000,9314.0000,fee schedule,"APG 00020 Proc 19101 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 104% = $1,899.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3552.37,,,,,,,775.0000,9314.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,AETNA,AETNA HEALTHCARE MEDICARE,3552.37,,,,,,,775.0000,9314.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,3552.37,,,,,,,775.0000,9314.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,AMBETTER,AMBETTER,7744.17,,,,,,,775.0000,9314.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3694.47,,,,,,,775.0000,9314.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,BLUE CROSS,ANTHEM EXCHANGE,8746.13,,,,,,,775.0000,9314.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1881.43,,,,,,,775.0000,9314.0000,fee schedule,"APG 00020 Proc 19101 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,BLUE CROSS,ANTHEM HMO,9292.24,,,,,,,775.0000,9314.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3658.94,,,,,,,775.0000,9314.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9314.00,,,,,,,775.0000,9314.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,948.00,,,,,,,775.0000,9314.0000,case rate,Rev 361 Proc 19101 ASG Rate of $948.00 at 100% of $948.00 = $948.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,775.0000,9314.0000,case rate,"Rev 361 Proc 19101 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,BLUE CROSS,BLUE CROSS MEDICARE,3694.47,,,,,,,775.0000,9314.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,775.0000,9314.0000,case rate,"Rev 361 Proc 19101 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,775.0000,9314.0000,case rate,"Rev 361 Proc 19101 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,9314.0000,case rate,Rev 361 Proc 19101 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,9314.0000,case rate,Rev 361 Proc 19101 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,CIGNA HEALTHCARE,CIGNA HMO,2588.00,,,,,,,775.0000,9314.0000,case rate,"Rev 361 Proc 19101 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1956.00,,,,,,,775.0000,9314.0000,case rate,"Rev 361 Proc 19101 ASG Rate of $1,956.00 at 100% of $1,956.00 = $1,956.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,3729.99,,,,,,,775.0000,9314.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2588.00,,,,,,,775.0000,9314.0000,case rate,"Rev 361 Proc 19101 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,CIGNA HEALTHCARE,CIGNA PPO,2588.00,,,,,,,775.0000,9314.0000,case rate,"Rev 361 Proc 19101 ASG Rate of $2,588.00 at 100% of $2,588.00 = $2,588.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3729.99,,,,,,,775.0000,9314.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8382.60,,,,,,,775.0000,9314.0000,percent of total billed charges,"90% of $9,314.00 in Billed Charges for Rev 361 Proc 19101 = $8,382.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,HUMANA,HUMANA MEDICARE,3552.37,,,,,,,775.0000,9314.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3552.37,,,,,,,775.0000,9314.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,MEDCOST,MEDCOST VHN,4432.53,,,,,,,775.0000,9314.0000,percent of total billed charges,"47.59% of $9,314.00 in Billed Charges for Rev 361 Proc 19101 = $4,432.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1917.96,,,,,,,775.0000,9314.0000,fee schedule,"APG 00020 Proc 19101 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 105% = $1,917.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3729.99,,,,,,,775.0000,9314.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3729.99,,,,,,,775.0000,9314.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,NHC ADVANTAGE,NHC ADVANTAGE,3729.99,,,,,,,775.0000,9314.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1883.26,,,,,,,775.0000,9314.0000,fee schedule,"APG 00020 Proc 19101 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 103.1% = $1,883.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,SENTARA HEALTH,SENTARA HEALTH,2403.94,,,,,,,775.0000,9314.0000,percent of total billed charges,"25.81% of $9,314.00 in Billed Charges for Rev 361 Proc 19101 = $2,403.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,SENTARA HEALTH,SENTARA MEDICARE,3552.37,,,,,,,775.0000,9314.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9314.00,,,,,,,775.0000,9314.0000,percent of total billed charges,"100% of $9,314.00 in Billed Charges for Rev 361 Proc 19101 = $9,314.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1418.00,,,,,,,775.0000,9314.0000,case rate,"Rev 361 Proc 19101 ASG Rate of $1,418.00 at 100% of $1,418.00 = $1,418.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2547.00,,,,,,,775.0000,9314.0000,case rate,"Rev 361 Proc 19101 ASG Rate of $2,547.00 at 100% of $2,547.00 = $2,547.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2436.00,,,,,,,775.0000,9314.0000,case rate,"Rev 361 Proc 19101 ASG Rate of $2,436.00 at 100% of $2,436.00 = $2,436.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,4296.00,,,,,,,775.0000,9314.0000,case rate,"Rev 361 Proc 19101 ASG Rate of $4,296.00 at 100% of $4,296.00 = $4,296.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1881.43,,,,,,,775.0000,9314.0000,fee schedule,"APG 00020 Proc 19101 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3552.37,,,,,,,775.0000,9314.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3552.37,,,,,,,775.0000,9314.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,WELLCARE,WELLCARE MEDICAID,9314.00,,,,,,,775.0000,9314.0000,percent of total billed charges,"100% of $9,314.00 in Billed Charges for Rev 361 Proc 19101 = $9,314.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX BREAST OPEN INCISIONAL,19101,CPT,361,RC,36100440,CDM,,,,both,,,9314.0000,1397.1000,WELLCARE,WELLCARE MEDICARE,3765.52,,,,,,,775.0000,9314.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,AETNA,AETNA,4609.47,,,,,,,968.0000,22390.4700,percent of total billed charges,"42.7% of $10,795.00 in Billed Charges for Rev 361 Proc 34701 = $4,609.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,22177.24,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34701 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 104% = $22,177.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,ANTHEM EXCHANGE,10795.00,,,,,,,968.0000,22390.4700,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 361 Proc 34701 * Qty 1 = $12,718.06 at 199.87% = $25,419.59 (Service Line reduced to $10,795.00, claim capped at $10,795.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,10795.00,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34701 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99 (Service Line reduced to $10,795.00, claim capped at $10,795.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,ANTHEM HMO,10795.00,,,,,,,968.0000,22390.4700,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 361 Proc 34701 * Qty 1 = $12,718.06 at 212.35% = $27,006.80 (Service Line reduced to $10,795.00, claim capped at $10,795.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",10795.00,,,,,,,968.0000,22390.4700,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 361 Proc 34701 * Qty 1 = $12,718.06 at 249.81% = $31,770.99 (Service Line reduced to $10,795.00, claim capped at $10,795.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34701 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34701 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34701 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34701 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,TENNCARE BLUE CARE,1733.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34701 ASG Rate of $1,733.00 at 100% of $1,733.00 = $1,733.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,TENNCARE BLUE SELECT,1733.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34701 ASG Rate of $1,733.00 at 100% of $1,733.00 = $1,733.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34701 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34701 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34701 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34701 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9715.50,,,,,,,968.0000,22390.4700,percent of total billed charges,"90% of $10,795.00 in Billed Charges for Rev 361 Proc 34701 = $9,715.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,MEDCOST,MEDCOST VHN,5137.34,,,,,,,968.0000,22390.4700,percent of total billed charges,"47.59% of $10,795.00 in Billed Charges for Rev 361 Proc 34701 = $5,137.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,22390.47,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34701 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 105% = $22,390.47 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,21985.31,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34701 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 103.1% = $21,985.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,SENTARA HEALTH,SENTARA HEALTH,2786.19,,,,,,,968.0000,22390.4700,percent of total billed charges,"25.81% of $10,795.00 in Billed Charges for Rev 361 Proc 34701 = $2,786.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10795.00,,,,,,,968.0000,22390.4700,percent of total billed charges,"100% of $10,795.00 in Billed Charges for Rev 361 Proc 34701 = $10,795.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,968.0000,22390.4700,case rate,Rev 361 Proc 34701 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34701 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34701 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34701 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,21963.99,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34701 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-AORTIC NDGFT,34701,CPT,361,RC,36100367,CDM,,,,both,,,10795.0000,1619.2500,WELLCARE,WELLCARE MEDICAID,10795.00,,,,,,,968.0000,22390.4700,percent of total billed charges,"100% of $10,795.00 in Billed Charges for Rev 361 Proc 34701 = $10,795.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,AETNA,AETNA,4609.47,,,,,,,968.0000,22390.4700,percent of total billed charges,"42.7% of $10,795.00 in Billed Charges for Rev 361 Proc 34704 = $4,609.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,22177.24,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34704 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 104% = $22,177.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,ANTHEM EXCHANGE,10795.00,,,,,,,968.0000,22390.4700,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 361 Proc 34704 * Qty 1 = $12,718.06 at 199.87% = $25,419.59 (Service Line reduced to $10,795.00, claim capped at $10,795.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,10795.00,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34704 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99 (Service Line reduced to $10,795.00, claim capped at $10,795.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,ANTHEM HMO,10795.00,,,,,,,968.0000,22390.4700,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 361 Proc 34704 * Qty 1 = $12,718.06 at 212.35% = $27,006.80 (Service Line reduced to $10,795.00, claim capped at $10,795.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",10795.00,,,,,,,968.0000,22390.4700,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 361 Proc 34704 * Qty 1 = $12,718.06 at 249.81% = $31,770.99 (Service Line reduced to $10,795.00, claim capped at $10,795.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34704 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34704 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34704 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34704 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,TENNCARE BLUE CARE,1837.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34704 ASG Rate of $1,837.00 at 100% of $1,837.00 = $1,837.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,TENNCARE BLUE SELECT,1837.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34704 ASG Rate of $1,837.00 at 100% of $1,837.00 = $1,837.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34704 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34704 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34704 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34704 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9715.50,,,,,,,968.0000,22390.4700,percent of total billed charges,"90% of $10,795.00 in Billed Charges for Rev 361 Proc 34704 = $9,715.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,MEDCOST,MEDCOST VHN,5137.34,,,,,,,968.0000,22390.4700,percent of total billed charges,"47.59% of $10,795.00 in Billed Charges for Rev 361 Proc 34704 = $5,137.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,22390.47,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34704 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 105% = $22,390.47 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,21985.31,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34704 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 103.1% = $21,985.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,SENTARA HEALTH,SENTARA HEALTH,2786.19,,,,,,,968.0000,22390.4700,percent of total billed charges,"25.81% of $10,795.00 in Billed Charges for Rev 361 Proc 34704 = $2,786.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10795.00,,,,,,,968.0000,22390.4700,percent of total billed charges,"100% of $10,795.00 in Billed Charges for Rev 361 Proc 34704 = $10,795.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,968.0000,22390.4700,case rate,Rev 361 Proc 34704 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34704 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34704 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34704 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,21963.99,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34704 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-UNI-ILIAC NDGFT RPT,34704,CPT,361,RC,36100370,CDM,,,,both,,,10795.0000,1619.2500,WELLCARE,WELLCARE MEDICAID,10795.00,,,,,,,968.0000,22390.4700,percent of total billed charges,"100% of $10,795.00 in Billed Charges for Rev 361 Proc 34704 = $10,795.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,AETNA,AETNA,4609.47,,,,,,,968.0000,22390.4700,percent of total billed charges,"42.7% of $10,795.00 in Billed Charges for Rev 361 Proc 34705 = $4,609.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,22177.24,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34705 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 104% = $22,177.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,ANTHEM EXCHANGE,10795.00,,,,,,,968.0000,22390.4700,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 361 Proc 34705 * Qty 1 = $12,718.06 at 199.87% = $25,419.59 (Service Line reduced to $10,795.00, claim capped at $10,795.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,10795.00,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34705 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99 (Service Line reduced to $10,795.00, claim capped at $10,795.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,ANTHEM HMO,10795.00,,,,,,,968.0000,22390.4700,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 361 Proc 34705 * Qty 1 = $12,718.06 at 212.35% = $27,006.80 (Service Line reduced to $10,795.00, claim capped at $10,795.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",10795.00,,,,,,,968.0000,22390.4700,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 361 Proc 34705 * Qty 1 = $12,718.06 at 249.81% = $31,770.99 (Service Line reduced to $10,795.00, claim capped at $10,795.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34705 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34705 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34705 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34705 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,TENNCARE BLUE CARE,1733.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34705 ASG Rate of $1,733.00 at 100% of $1,733.00 = $1,733.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,TENNCARE BLUE SELECT,1733.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34705 ASG Rate of $1,733.00 at 100% of $1,733.00 = $1,733.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34705 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34705 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34705 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34705 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9715.50,,,,,,,968.0000,22390.4700,percent of total billed charges,"90% of $10,795.00 in Billed Charges for Rev 361 Proc 34705 = $9,715.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,MEDCOST,MEDCOST VHN,5137.34,,,,,,,968.0000,22390.4700,percent of total billed charges,"47.59% of $10,795.00 in Billed Charges for Rev 361 Proc 34705 = $5,137.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,22390.47,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34705 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 105% = $22,390.47 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,21985.31,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34705 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 103.1% = $21,985.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,SENTARA HEALTH,SENTARA HEALTH,2786.19,,,,,,,968.0000,22390.4700,percent of total billed charges,"25.81% of $10,795.00 in Billed Charges for Rev 361 Proc 34705 = $2,786.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10795.00,,,,,,,968.0000,22390.4700,percent of total billed charges,"100% of $10,795.00 in Billed Charges for Rev 361 Proc 34705 = $10,795.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,968.0000,22390.4700,case rate,Rev 361 Proc 34705 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34705 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34705 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34705 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,21963.99,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34705 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT,34705,CPT,361,RC,36100371,CDM,,,,both,,,10795.0000,1619.2500,WELLCARE,WELLCARE MEDICAID,10795.00,,,,,,,968.0000,22390.4700,percent of total billed charges,"100% of $10,795.00 in Billed Charges for Rev 361 Proc 34705 = $10,795.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,AETNA,AETNA,4609.47,,,,,,,968.0000,22390.4700,percent of total billed charges,"42.7% of $10,795.00 in Billed Charges for Rev 361 Proc 34706 = $4,609.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,22177.24,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34706 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 104% = $22,177.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,ANTHEM EXCHANGE,10795.00,,,,,,,968.0000,22390.4700,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 361 Proc 34706 * Qty 1 = $12,718.06 at 199.87% = $25,419.59 (Service Line reduced to $10,795.00, claim capped at $10,795.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,10795.00,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34706 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99 (Service Line reduced to $10,795.00, claim capped at $10,795.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,ANTHEM HMO,10795.00,,,,,,,968.0000,22390.4700,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 361 Proc 34706 * Qty 1 = $12,718.06 at 212.35% = $27,006.80 (Service Line reduced to $10,795.00, claim capped at $10,795.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",10795.00,,,,,,,968.0000,22390.4700,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 361 Proc 34706 * Qty 1 = $12,718.06 at 249.81% = $31,770.99 (Service Line reduced to $10,795.00, claim capped at $10,795.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34706 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34706 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34706 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34706 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,TENNCARE BLUE CARE,1837.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34706 ASG Rate of $1,837.00 at 100% of $1,837.00 = $1,837.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,BLUE CROSS,TENNCARE BLUE SELECT,1837.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34706 ASG Rate of $1,837.00 at 100% of $1,837.00 = $1,837.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34706 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34706 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34706 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34706 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9715.50,,,,,,,968.0000,22390.4700,percent of total billed charges,"90% of $10,795.00 in Billed Charges for Rev 361 Proc 34706 = $9,715.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,MEDCOST,MEDCOST VHN,5137.34,,,,,,,968.0000,22390.4700,percent of total billed charges,"47.59% of $10,795.00 in Billed Charges for Rev 361 Proc 34706 = $5,137.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,22390.47,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34706 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 105% = $22,390.47 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,21985.31,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34706 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 103.1% = $21,985.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,SENTARA HEALTH,SENTARA HEALTH,2786.19,,,,,,,968.0000,22390.4700,percent of total billed charges,"25.81% of $10,795.00 in Billed Charges for Rev 361 Proc 34706 = $2,786.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10795.00,,,,,,,968.0000,22390.4700,percent of total billed charges,"100% of $10,795.00 in Billed Charges for Rev 361 Proc 34706 = $10,795.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,968.0000,22390.4700,case rate,Rev 361 Proc 34706 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34706 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34706 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34706 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,21963.99,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34706 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT,34706,CPT,361,RC,36100372,CDM,,,,both,,,10795.0000,1619.2500,WELLCARE,WELLCARE MEDICAID,10795.00,,,,,,,968.0000,22390.4700,percent of total billed charges,"100% of $10,795.00 in Billed Charges for Rev 361 Proc 34706 = $10,795.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,AETNA,AETNA,1178.52,,,,,,,148.0000,22390.4700,percent of total billed charges,"42.7% of $2,760.00 in Billed Charges for Rev 361 Proc 34709 = $1,178.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,22177.24,,,,,,,148.0000,22390.4700,fee schedule,"APG 00122 Proc 34709 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 104% = $22,177.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,ANTHEM EXCHANGE,2760.00,,,,,,,148.0000,22390.4700,fee schedule,"$6,394.06 from Fee Schedule ANT_C_APC for Rev 361 Proc 34709 * Qty 1 = $6,394.06 at 199.87% = $12,779.81 (Service Line reduced to $2,760.00, claim capped at $2,760.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2760.00,,,,,,,148.0000,22390.4700,fee schedule,"APG 00122 Proc 34709 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99 (Service Line reduced to $2,760.00, claim capped at $2,760.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,ANTHEM HMO,2760.00,,,,,,,148.0000,22390.4700,fee schedule,"$6,394.06 from Fee Schedule ANT_C_APC for Rev 361 Proc 34709 * Qty 1 = $6,394.06 at 212.35% = $13,577.79 (Service Line reduced to $2,760.00, claim capped at $2,760.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2760.00,,,,,,,148.0000,22390.4700,fee schedule,"$6,394.06 from Fee Schedule ANT_C_APC for Rev 361 Proc 34709 * Qty 1 = $6,394.06 at 249.81% = $15,973.00 (Service Line reduced to $2,760.00, claim capped at $2,760.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,148.0000,22390.4700,case rate,"Rev 361 Proc 34709 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,22390.4700,case rate,Rev 361 Proc 34709 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,22390.4700,case rate,Rev 361 Proc 34709 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,22390.4700,case rate,Rev 361 Proc 34709 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,TENNCARE BLUE CARE,1093.00,,,,,,,148.0000,22390.4700,case rate,"Rev 361 Proc 34709 ASG Rate of $1,093.00 at 100% of $1,093.00 = $1,093.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,BLUE CROSS,TENNCARE BLUE SELECT,1093.00,,,,,,,148.0000,22390.4700,case rate,"Rev 361 Proc 34709 ASG Rate of $1,093.00 at 100% of $1,093.00 = $1,093.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,CIGNA HEALTHCARE,CIGNA HMO,2760.00,,,,,,,148.0000,22390.4700,case rate,"Rev 361 Proc 34709 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,760.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,760.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2760.00,,,,,,,148.0000,22390.4700,case rate,"Rev 361 Proc 34709 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $2,760.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,760.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2760.00,,,,,,,148.0000,22390.4700,case rate,"Rev 361 Proc 34709 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,760.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,760.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,CIGNA HEALTHCARE,CIGNA PPO,2760.00,,,,,,,148.0000,22390.4700,case rate,"Rev 361 Proc 34709 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,760.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,760.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2484.00,,,,,,,148.0000,22390.4700,percent of total billed charges,"90% of $2,760.00 in Billed Charges for Rev 361 Proc 34709 = $2,484.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,MEDCOST,MEDCOST VHN,1313.48,,,,,,,148.0000,22390.4700,percent of total billed charges,"47.59% of $2,760.00 in Billed Charges for Rev 361 Proc 34709 = $1,313.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,22390.47,,,,,,,148.0000,22390.4700,fee schedule,"APG 00122 Proc 34709 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 105% = $22,390.47 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,21985.31,,,,,,,148.0000,22390.4700,fee schedule,"APG 00122 Proc 34709 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 103.1% = $21,985.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,SENTARA HEALTH,SENTARA HEALTH,712.36,,,,,,,148.0000,22390.4700,percent of total billed charges,"25.81% of $2,760.00 in Billed Charges for Rev 361 Proc 34709 = $712.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2760.00,,,,,,,148.0000,22390.4700,percent of total billed charges,"100% of $2,760.00 in Billed Charges for Rev 361 Proc 34709 = $2,760.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,148.0000,22390.4700,case rate,Rev 361 Proc 34709 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,148.0000,22390.4700,case rate,"Rev 361 Proc 34709 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,148.0000,22390.4700,case rate,"Rev 361 Proc 34709 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,148.0000,22390.4700,case rate,"Rev 361 Proc 34709 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,21963.99,,,,,,,148.0000,22390.4700,fee schedule,"APG 00122 Proc 34709 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR,34709,CPT,361,RC,36100375,CDM,,,,both,,,2760.0000,414.0000,WELLCARE,WELLCARE MEDICAID,2760.00,,,,,,,148.0000,22390.4700,percent of total billed charges,"100% of $2,760.00 in Billed Charges for Rev 361 Proc 34709 = $2,760.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,AETNA,AETNA,191.72,,,,,,,115.8900,22390.4700,percent of total billed charges,42.7% of $449.00 in Billed Charges for Rev 361 Proc 34713 = $191.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,22177.24,,,,,,,115.8900,22390.4700,fee schedule,"APG 00122 Proc 34713 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 104% = $22,177.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,449.00,,,,,,,115.8900,22390.4700,fee schedule,"APG 00122 Proc 34713 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99 (Service Line reduced to $449.00, claim capped at $449.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,449.00,,,,,,,115.8900,22390.4700,case rate,"Rev 361 Proc 34713 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $449.00 in Billed Charges - $0.00 in ASG Allowed Amount = $449.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,115.8900,22390.4700,case rate,Rev 361 Proc 34713 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,115.8900,22390.4700,case rate,Rev 361 Proc 34713 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,115.8900,22390.4700,case rate,Rev 361 Proc 34713 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,BLUE CROSS,TENNCARE BLUE CARE,449.00,,,,,,,115.8900,22390.4700,case rate,"Rev 361 Proc 34713 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total (Service Line reduced to $449.00, claim capped at $449.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,BLUE CROSS,TENNCARE BLUE SELECT,449.00,,,,,,,115.8900,22390.4700,case rate,"Rev 361 Proc 34713 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total (Service Line reduced to $449.00, claim capped at $449.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,CIGNA HEALTHCARE,CIGNA HMO,449.00,,,,,,,115.8900,22390.4700,case rate,"Rev 361 Proc 34713 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $449.00 in Billed Charges - $0.00 in ASG Allowed Amount = $449.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,449.00,,,,,,,115.8900,22390.4700,case rate,"Rev 361 Proc 34713 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $449.00 in Billed Charges - $0.00 in ASG Allowed Amount = $449.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,449.00,,,,,,,115.8900,22390.4700,case rate,"Rev 361 Proc 34713 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $449.00 in Billed Charges - $0.00 in ASG Allowed Amount = $449.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,CIGNA HEALTHCARE,CIGNA PPO,449.00,,,,,,,115.8900,22390.4700,case rate,"Rev 361 Proc 34713 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $449.00 in Billed Charges - $0.00 in ASG Allowed Amount = $449.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,404.10,,,,,,,115.8900,22390.4700,percent of total billed charges,90% of $449.00 in Billed Charges for Rev 361 Proc 34713 = $404.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,MEDCOST,MEDCOST VHN,213.68,,,,,,,115.8900,22390.4700,percent of total billed charges,47.59% of $449.00 in Billed Charges for Rev 361 Proc 34713 = $213.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,22390.47,,,,,,,115.8900,22390.4700,fee schedule,"APG 00122 Proc 34713 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 105% = $22,390.47 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,21985.31,,,,,,,115.8900,22390.4700,fee schedule,"APG 00122 Proc 34713 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 103.1% = $21,985.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,SENTARA HEALTH,SENTARA HEALTH,115.89,,,,,,,115.8900,22390.4700,percent of total billed charges,25.81% of $449.00 in Billed Charges for Rev 361 Proc 34713 = $115.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",449.00,,,,,,,115.8900,22390.4700,percent of total billed charges,100% of $449.00 in Billed Charges for Rev 361 Proc 34713 = $449.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,115.8900,22390.4700,case rate,Rev 361 Proc 34713 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,115.8900,22390.4700,case rate,Rev 361 Proc 34713 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,115.8900,22390.4700,case rate,Rev 361 Proc 34713 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,449.00,,,,,,,115.8900,22390.4700,case rate,"Rev 361 Proc 34713 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total (Service Line reduced to $449.00, claim capped at $449.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,21963.99,,,,,,,115.8900,22390.4700,fee schedule,"APG 00122 Proc 34713 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT,34713,CPT,361,RC,36100379,CDM,,,,both,,,449.0000,67.3500,WELLCARE,WELLCARE MEDICAID,449.00,,,,,,,115.8900,22390.4700,percent of total billed charges,100% of $449.00 in Billed Charges for Rev 361 Proc 34713 = $449.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH,34714,CPT,361,RC,36100380,CDM,,,,both,,,449.0000,67.3500,AETNA,AETNA,191.72,,,,,,,115.8900,449.0000,percent of total billed charges,42.7% of $449.00 in Billed Charges for Rev 361 Proc 34714 = $191.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH,34714,CPT,361,RC,36100380,CDM,,,,both,,,449.0000,67.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,449.00,,,,,,,115.8900,449.0000,case rate,"Rev 361 Proc 34714 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $449.00 in Billed Charges - $0.00 in ASG Allowed Amount = $449.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH,34714,CPT,361,RC,36100380,CDM,,,,both,,,449.0000,67.3500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,115.8900,449.0000,case rate,Rev 361 Proc 34714 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH,34714,CPT,361,RC,36100380,CDM,,,,both,,,449.0000,67.3500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,115.8900,449.0000,case rate,Rev 361 Proc 34714 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH,34714,CPT,361,RC,36100380,CDM,,,,both,,,449.0000,67.3500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,115.8900,449.0000,case rate,Rev 361 Proc 34714 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH,34714,CPT,361,RC,36100380,CDM,,,,both,,,449.0000,67.3500,BLUE CROSS,TENNCARE BLUE CARE,449.00,,,,,,,115.8900,449.0000,case rate,"Rev 361 Proc 34714 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total (Service Line reduced to $449.00, claim capped at $449.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH,34714,CPT,361,RC,36100380,CDM,,,,both,,,449.0000,67.3500,BLUE CROSS,TENNCARE BLUE SELECT,449.00,,,,,,,115.8900,449.0000,case rate,"Rev 361 Proc 34714 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total (Service Line reduced to $449.00, claim capped at $449.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH,34714,CPT,361,RC,36100380,CDM,,,,both,,,449.0000,67.3500,CIGNA HEALTHCARE,CIGNA HMO,449.00,,,,,,,115.8900,449.0000,case rate,"Rev 361 Proc 34714 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $449.00 in Billed Charges - $0.00 in ASG Allowed Amount = $449.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH,34714,CPT,361,RC,36100380,CDM,,,,both,,,449.0000,67.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,449.00,,,,,,,115.8900,449.0000,case rate,"Rev 361 Proc 34714 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $449.00 in Billed Charges - $0.00 in ASG Allowed Amount = $449.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH,34714,CPT,361,RC,36100380,CDM,,,,both,,,449.0000,67.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,449.00,,,,,,,115.8900,449.0000,case rate,"Rev 361 Proc 34714 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $449.00 in Billed Charges - $0.00 in ASG Allowed Amount = $449.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH,34714,CPT,361,RC,36100380,CDM,,,,both,,,449.0000,67.3500,CIGNA HEALTHCARE,CIGNA PPO,449.00,,,,,,,115.8900,449.0000,case rate,"Rev 361 Proc 34714 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $449.00 in Billed Charges - $0.00 in ASG Allowed Amount = $449.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH,34714,CPT,361,RC,36100380,CDM,,,,both,,,449.0000,67.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,404.10,,,,,,,115.8900,449.0000,percent of total billed charges,90% of $449.00 in Billed Charges for Rev 361 Proc 34714 = $404.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH,34714,CPT,361,RC,36100380,CDM,,,,both,,,449.0000,67.3500,MEDCOST,MEDCOST VHN,213.68,,,,,,,115.8900,449.0000,percent of total billed charges,47.59% of $449.00 in Billed Charges for Rev 361 Proc 34714 = $213.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH,34714,CPT,361,RC,36100380,CDM,,,,both,,,449.0000,67.3500,SENTARA HEALTH,SENTARA HEALTH,115.89,,,,,,,115.8900,449.0000,percent of total billed charges,25.81% of $449.00 in Billed Charges for Rev 361 Proc 34714 = $115.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH,34714,CPT,361,RC,36100380,CDM,,,,both,,,449.0000,67.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",449.00,,,,,,,115.8900,449.0000,percent of total billed charges,100% of $449.00 in Billed Charges for Rev 361 Proc 34714 = $449.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH,34714,CPT,361,RC,36100380,CDM,,,,both,,,449.0000,67.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,115.8900,449.0000,case rate,Rev 361 Proc 34714 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH,34714,CPT,361,RC,36100380,CDM,,,,both,,,449.0000,67.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,115.8900,449.0000,case rate,Rev 361 Proc 34714 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH,34714,CPT,361,RC,36100380,CDM,,,,both,,,449.0000,67.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,115.8900,449.0000,case rate,Rev 361 Proc 34714 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH,34714,CPT,361,RC,36100380,CDM,,,,both,,,449.0000,67.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,449.00,,,,,,,115.8900,449.0000,case rate,"Rev 361 Proc 34714 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total (Service Line reduced to $449.00, claim capped at $449.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH,34714,CPT,361,RC,36100380,CDM,,,,both,,,449.0000,67.3500,WELLCARE,WELLCARE MEDICAID,449.00,,,,,,,115.8900,449.0000,percent of total billed charges,100% of $449.00 in Billed Charges for Rev 361 Proc 34714 = $449.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ,34716,CPT,361,RC,36100382,CDM,,,,both,,,449.0000,67.3500,AETNA,AETNA,191.72,,,,,,,115.8900,449.0000,percent of total billed charges,42.7% of $449.00 in Billed Charges for Rev 361 Proc 34716 = $191.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ,34716,CPT,361,RC,36100382,CDM,,,,both,,,449.0000,67.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,449.00,,,,,,,115.8900,449.0000,case rate,"Rev 361 Proc 34716 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $449.00 in Billed Charges - $0.00 in ASG Allowed Amount = $449.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ,34716,CPT,361,RC,36100382,CDM,,,,both,,,449.0000,67.3500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,115.8900,449.0000,case rate,Rev 361 Proc 34716 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ,34716,CPT,361,RC,36100382,CDM,,,,both,,,449.0000,67.3500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,115.8900,449.0000,case rate,Rev 361 Proc 34716 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ,34716,CPT,361,RC,36100382,CDM,,,,both,,,449.0000,67.3500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,115.8900,449.0000,case rate,Rev 361 Proc 34716 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ,34716,CPT,361,RC,36100382,CDM,,,,both,,,449.0000,67.3500,BLUE CROSS,TENNCARE BLUE CARE,449.00,,,,,,,115.8900,449.0000,case rate,"Rev 361 Proc 34716 ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total (Service Line reduced to $449.00, claim capped at $449.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ,34716,CPT,361,RC,36100382,CDM,,,,both,,,449.0000,67.3500,BLUE CROSS,TENNCARE BLUE SELECT,449.00,,,,,,,115.8900,449.0000,case rate,"Rev 361 Proc 34716 ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total (Service Line reduced to $449.00, claim capped at $449.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ,34716,CPT,361,RC,36100382,CDM,,,,both,,,449.0000,67.3500,CIGNA HEALTHCARE,CIGNA HMO,449.00,,,,,,,115.8900,449.0000,case rate,"Rev 361 Proc 34716 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $449.00 in Billed Charges - $0.00 in ASG Allowed Amount = $449.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ,34716,CPT,361,RC,36100382,CDM,,,,both,,,449.0000,67.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,449.00,,,,,,,115.8900,449.0000,case rate,"Rev 361 Proc 34716 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $449.00 in Billed Charges - $0.00 in ASG Allowed Amount = $449.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ,34716,CPT,361,RC,36100382,CDM,,,,both,,,449.0000,67.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,449.00,,,,,,,115.8900,449.0000,case rate,"Rev 361 Proc 34716 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $449.00 in Billed Charges - $0.00 in ASG Allowed Amount = $449.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ,34716,CPT,361,RC,36100382,CDM,,,,both,,,449.0000,67.3500,CIGNA HEALTHCARE,CIGNA PPO,449.00,,,,,,,115.8900,449.0000,case rate,"Rev 361 Proc 34716 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $449.00 in Billed Charges - $0.00 in ASG Allowed Amount = $449.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ,34716,CPT,361,RC,36100382,CDM,,,,both,,,449.0000,67.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,404.10,,,,,,,115.8900,449.0000,percent of total billed charges,90% of $449.00 in Billed Charges for Rev 361 Proc 34716 = $404.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ,34716,CPT,361,RC,36100382,CDM,,,,both,,,449.0000,67.3500,MEDCOST,MEDCOST VHN,213.68,,,,,,,115.8900,449.0000,percent of total billed charges,47.59% of $449.00 in Billed Charges for Rev 361 Proc 34716 = $213.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ,34716,CPT,361,RC,36100382,CDM,,,,both,,,449.0000,67.3500,SENTARA HEALTH,SENTARA HEALTH,115.89,,,,,,,115.8900,449.0000,percent of total billed charges,25.81% of $449.00 in Billed Charges for Rev 361 Proc 34716 = $115.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ,34716,CPT,361,RC,36100382,CDM,,,,both,,,449.0000,67.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",449.00,,,,,,,115.8900,449.0000,percent of total billed charges,100% of $449.00 in Billed Charges for Rev 361 Proc 34716 = $449.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ,34716,CPT,361,RC,36100382,CDM,,,,both,,,449.0000,67.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,115.8900,449.0000,case rate,Rev 361 Proc 34716 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ,34716,CPT,361,RC,36100382,CDM,,,,both,,,449.0000,67.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,115.8900,449.0000,case rate,Rev 361 Proc 34716 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ,34716,CPT,361,RC,36100382,CDM,,,,both,,,449.0000,67.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,115.8900,449.0000,case rate,Rev 361 Proc 34716 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ,34716,CPT,361,RC,36100382,CDM,,,,both,,,449.0000,67.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,449.00,,,,,,,115.8900,449.0000,case rate,"Rev 361 Proc 34716 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total (Service Line reduced to $449.00, claim capped at $449.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ,34716,CPT,361,RC,36100382,CDM,,,,both,,,449.0000,67.3500,WELLCARE,WELLCARE MEDICAID,449.00,,,,,,,115.8900,449.0000,percent of total billed charges,100% of $449.00 in Billed Charges for Rev 361 Proc 34716 = $449.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,AETNA,AETNA,2265.24,,,,,,,148.0000,22390.4700,percent of total billed charges,"42.7% of $5,305.00 in Billed Charges for Rev 361 Proc 34717 = $2,265.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,22177.24,,,,,,,148.0000,22390.4700,fee schedule,"APG 00122 Proc 34717 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 104% = $22,177.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,BLUE CROSS,ANTHEM EXCHANGE,5305.00,,,,,,,148.0000,22390.4700,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 361 Proc 34717 * Qty 1 = $12,718.06 at 199.87% = $25,419.59 (Service Line reduced to $5,305.00, claim capped at $5,305.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,5305.00,,,,,,,148.0000,22390.4700,fee schedule,"APG 00122 Proc 34717 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99 (Service Line reduced to $5,305.00, claim capped at $5,305.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,BLUE CROSS,ANTHEM HMO,5305.00,,,,,,,148.0000,22390.4700,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 361 Proc 34717 * Qty 1 = $12,718.06 at 212.35% = $27,006.80 (Service Line reduced to $5,305.00, claim capped at $5,305.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5305.00,,,,,,,148.0000,22390.4700,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 361 Proc 34717 * Qty 1 = $12,718.06 at 249.81% = $31,770.99 (Service Line reduced to $5,305.00, claim capped at $5,305.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,148.0000,22390.4700,case rate,"Rev 361 Proc 34717 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,22390.4700,case rate,Rev 361 Proc 34717 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,22390.4700,case rate,Rev 361 Proc 34717 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,22390.4700,case rate,Rev 361 Proc 34717 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,148.0000,22390.4700,case rate,Rev 361 Proc 34717 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,148.0000,22390.4700,case rate,Rev 361 Proc 34717 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,148.0000,22390.4700,case rate,"Rev 361 Proc 34717 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,148.0000,22390.4700,case rate,"Rev 361 Proc 34717 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,148.0000,22390.4700,case rate,"Rev 361 Proc 34717 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,148.0000,22390.4700,case rate,"Rev 361 Proc 34717 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4774.50,,,,,,,148.0000,22390.4700,percent of total billed charges,"90% of $5,305.00 in Billed Charges for Rev 361 Proc 34717 = $4,774.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,MEDCOST,MEDCOST VHN,2524.65,,,,,,,148.0000,22390.4700,percent of total billed charges,"47.59% of $5,305.00 in Billed Charges for Rev 361 Proc 34717 = $2,524.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,22390.47,,,,,,,148.0000,22390.4700,fee schedule,"APG 00122 Proc 34717 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 105% = $22,390.47 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,21985.31,,,,,,,148.0000,22390.4700,fee schedule,"APG 00122 Proc 34717 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 103.1% = $21,985.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,SENTARA HEALTH,SENTARA HEALTH,1369.22,,,,,,,148.0000,22390.4700,percent of total billed charges,"25.81% of $5,305.00 in Billed Charges for Rev 361 Proc 34717 = $1,369.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5305.00,,,,,,,148.0000,22390.4700,percent of total billed charges,"100% of $5,305.00 in Billed Charges for Rev 361 Proc 34717 = $5,305.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,148.0000,22390.4700,case rate,Rev 361 Proc 34717 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,148.0000,22390.4700,case rate,"Rev 361 Proc 34717 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,148.0000,22390.4700,case rate,"Rev 361 Proc 34717 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,148.0000,22390.4700,case rate,"Rev 361 Proc 34717 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,21963.99,,,,,,,148.0000,22390.4700,fee schedule,"APG 00122 Proc 34717 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNILAT,34717,CPT,361,RC,36100463,CDM,,,,both,,,5305.0000,795.7500,WELLCARE,WELLCARE MEDICAID,5305.00,,,,,,,148.0000,22390.4700,percent of total billed charges,"100% of $5,305.00 in Billed Charges for Rev 361 Proc 34717 = $5,305.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,AETNA,AETNA,2265.24,,,,,,,968.0000,22390.4700,percent of total billed charges,"42.7% of $5,305.00 in Billed Charges for Rev 361 Proc 34718 = $2,265.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,22177.24,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34718 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 104% = $22,177.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,BLUE CROSS,ANTHEM EXCHANGE,5305.00,,,,,,,968.0000,22390.4700,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 361 Proc 34718 * Qty 1 = $12,718.06 at 199.87% = $25,419.59 (Service Line reduced to $5,305.00, claim capped at $5,305.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,5305.00,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34718 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99 (Service Line reduced to $5,305.00, claim capped at $5,305.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,BLUE CROSS,ANTHEM HMO,5305.00,,,,,,,968.0000,22390.4700,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 361 Proc 34718 * Qty 1 = $12,718.06 at 212.35% = $27,006.80 (Service Line reduced to $5,305.00, claim capped at $5,305.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5305.00,,,,,,,968.0000,22390.4700,fee schedule,"$12,718.06 from Fee Schedule ANT_C_APC for Rev 361 Proc 34718 * Qty 1 = $12,718.06 at 249.81% = $31,770.99 (Service Line reduced to $5,305.00, claim capped at $5,305.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34718 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34718 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34718 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34718 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,BLUE CROSS,TENNCARE BLUE CARE,1733.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34718 ASG Rate of $1,733.00 at 100% of $1,733.00 = $1,733.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,BLUE CROSS,TENNCARE BLUE SELECT,1733.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34718 ASG Rate of $1,733.00 at 100% of $1,733.00 = $1,733.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34718 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34718 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34718 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34718 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4774.50,,,,,,,968.0000,22390.4700,percent of total billed charges,"90% of $5,305.00 in Billed Charges for Rev 361 Proc 34718 = $4,774.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,MEDCOST,MEDCOST VHN,2524.65,,,,,,,968.0000,22390.4700,percent of total billed charges,"47.59% of $5,305.00 in Billed Charges for Rev 361 Proc 34718 = $2,524.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,22390.47,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34718 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 105% = $22,390.47 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,21985.31,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34718 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 100% = $21,324.26... $21,324.26 at 103.1% = $21,985.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,SENTARA HEALTH,SENTARA HEALTH,1369.22,,,,,,,968.0000,22390.4700,percent of total billed charges,"25.81% of $5,305.00 in Billed Charges for Rev 361 Proc 34718 = $1,369.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5305.00,,,,,,,968.0000,22390.4700,percent of total billed charges,"100% of $5,305.00 in Billed Charges for Rev 361 Proc 34718 = $5,305.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,968.0000,22390.4700,case rate,Rev 361 Proc 34718 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34718 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34718 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,968.0000,22390.4700,case rate,"Rev 361 Proc 34718 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,21963.99,,,,,,,968.0000,22390.4700,fee schedule,"APG 00122 Proc 34718 at $836.60 (Base Rate) * 25.4892 (Relative Weight) = $21,324.26 (Total Line Payment) at 103% = $21,963.99. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNILAT,34718,CPT,361,RC,36100464,CDM,,,,both,,,5305.0000,795.7500,WELLCARE,WELLCARE MEDICAID,5305.00,,,,,,,968.0000,22390.4700,percent of total billed charges,"100% of $5,305.00 in Billed Charges for Rev 361 Proc 34718 = $5,305.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,AETNA,AETNA,3926.69,,,,,,,1452.0000,9196.0000,percent of total billed charges,"42.7% of $9,196.00 in Billed Charges for Rev 360 Proc 34812 Mod 50 = $3,926.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,8709.17,,,,,,,1452.0000,9196.0000,fee schedule,"APG 00091 Proc 34812 at $836.60 (Base Rate) * 6.6732 (Relative Weight) = $5,582.80 (Total Line Payment) at 150% Mod Percentage = $8,374.20 at 104% = $8,709.17. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,BLUE CROSS,ANTHEM EXCHANGE,3587.29,,,,,,,1452.0000,9196.0000,fee schedule,"$1,794.81 from Fee Schedule ANT_C_APC for Rev 360 Proc 34812 Mod 50 * Qty 1 = $1,794.81 at 199.87% = $3,587.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,8625.42,,,,,,,1452.0000,9196.0000,fee schedule,"APG 00091 Proc 34812 at $836.60 (Base Rate) * 6.6732 (Relative Weight) = $5,582.80 (Total Line Payment) at 150% Mod Percentage = $8,374.20 at 103% = $8,625.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,BLUE CROSS,ANTHEM HMO,3811.28,,,,,,,1452.0000,9196.0000,fee schedule,"$1,794.81 from Fee Schedule ANT_C_APC for Rev 360 Proc 34812 Mod 50 * Qty 1 = $1,794.81 at 212.35% = $3,811.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4483.61,,,,,,,1452.0000,9196.0000,fee schedule,"$1,794.81 from Fee Schedule ANT_C_APC for Rev 360 Proc 34812 Mod 50 * Qty 1 = $1,794.81 at 249.81% = $4,483.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1623.00,,,,,,,1452.0000,9196.0000,case rate,"Rev 360 Proc 34812 Mod 50 ASG Rate of $1,082.00 at 100% of $1,082.00 + 50% of $1,082.00 = $1,623.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,BLUE CROSS,BLUE CROSS E NETWORK,2716.50,,,,,,,1452.0000,9196.0000,case rate,"Rev 360 Proc 34812 Mod 50 ASG Rate of $1,811.00 at 100% of $1,811.00 + 50% of $1,811.00 = $2,716.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,BLUE CROSS,BLUE CROSS P NETWORK,2778.00,,,,,,,1452.0000,9196.0000,case rate,"Rev 360 Proc 34812 Mod 50 ASG Rate of $1,852.00 at 100% of $1,852.00 + 50% of $1,852.00 = $2,778.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,BLUE CROSS,BLUE CROSS S NETWORK,2778.00,,,,,,,1452.0000,9196.0000,case rate,"Rev 360 Proc 34812 Mod 50 ASG Rate of $1,852.00 at 100% of $1,852.00 + 50% of $1,852.00 = $2,778.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,BLUE CROSS,TENNCARE BLUE CARE,2755.50,,,,,,,1452.0000,9196.0000,case rate,"Rev 360 Proc 34812 Mod 50 ASG Rate of $1,837.00 at 100% of $1,837.00 + 50% of $1,837.00 = $2,755.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,BLUE CROSS,TENNCARE BLUE SELECT,2755.50,,,,,,,1452.0000,9196.0000,case rate,"Rev 360 Proc 34812 Mod 50 ASG Rate of $1,837.00 at 100% of $1,837.00 + 50% of $1,837.00 = $2,755.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,CIGNA HEALTHCARE,CIGNA HMO,6358.50,,,,,,,1452.0000,9196.0000,case rate,"Rev 360 Proc 34812 Mod 50 ASG Rate of $4,239.00 at 100% of $4,239.00 + 50% of $4,239.00 = $6,358.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4806.00,,,,,,,1452.0000,9196.0000,case rate,"Rev 360 Proc 34812 Mod 50 ASG Rate of $3,204.00 at 100% of $3,204.00 + 50% of $3,204.00 = $4,806.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6358.50,,,,,,,1452.0000,9196.0000,case rate,"Rev 360 Proc 34812 Mod 50 ASG Rate of $4,239.00 at 100% of $4,239.00 + 50% of $4,239.00 = $6,358.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,CIGNA HEALTHCARE,CIGNA PPO,6358.50,,,,,,,1452.0000,9196.0000,case rate,"Rev 360 Proc 34812 Mod 50 ASG Rate of $4,239.00 at 100% of $4,239.00 + 50% of $4,239.00 = $6,358.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8276.40,,,,,,,1452.0000,9196.0000,percent of total billed charges,"90% of $9,196.00 in Billed Charges for Rev 360 Proc 34812 Mod 50 = $8,276.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,MEDCOST,MEDCOST VHN,4376.38,,,,,,,1452.0000,9196.0000,percent of total billed charges,"47.59% of $9,196.00 in Billed Charges for Rev 360 Proc 34812 Mod 50 = $4,376.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,8792.91,,,,,,,1452.0000,9196.0000,fee schedule,"APG 00091 Proc 34812 at $836.60 (Base Rate) * 6.6732 (Relative Weight) = $5,582.80 (Total Line Payment) at 150% Mod Percentage = $8,374.20 at 100% = $8,374.20... $8,374.20 at 105% = $8,792.91 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,8633.80,,,,,,,1452.0000,9196.0000,fee schedule,"APG 00091 Proc 34812 at $836.60 (Base Rate) * 6.6732 (Relative Weight) = $5,582.80 (Total Line Payment) at 150% Mod Percentage = $8,374.20 at 100% = $8,374.20... $8,374.20 at 103.1% = $8,633.80 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,SENTARA HEALTH,SENTARA HEALTH,2373.49,,,,,,,1452.0000,9196.0000,percent of total billed charges,"25.81% of $9,196.00 in Billed Charges for Rev 360 Proc 34812 Mod 50 = $2,373.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9196.00,,,,,,,1452.0000,9196.0000,percent of total billed charges,"100% of $9,196.00 in Billed Charges for Rev 360 Proc 34812 Mod 50 = $9,196.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1452.00,,,,,,,1452.0000,9196.0000,case rate,"Rev 360 Proc 34812 Mod 50 ASG Rate of $968.00 at 100% of $968.00 + 50% of $968.00 = $1,452.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1654.50,,,,,,,1452.0000,9196.0000,case rate,"Rev 360 Proc 34812 Mod 50 ASG Rate of $1,103.00 at 100% of $1,103.00 + 50% of $1,103.00 = $1,654.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1582.50,,,,,,,1452.0000,9196.0000,case rate,"Rev 360 Proc 34812 Mod 50 ASG Rate of $1,055.00 at 100% of $1,055.00 + 50% of $1,055.00 = $1,582.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,2791.50,,,,,,,1452.0000,9196.0000,case rate,"Rev 360 Proc 34812 Mod 50 ASG Rate of $1,861.00 at 100% of $1,861.00 + 50% of $1,861.00 = $2,791.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,8625.42,,,,,,,1452.0000,9196.0000,fee schedule,"APG 00091 Proc 34812 at $836.60 (Base Rate) * 6.6732 (Relative Weight) = $5,582.80 (Total Line Payment) at 150% Mod Percentage = $8,374.20 at 103% = $8,625.42. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC OPEN FEM ART EXP DEL ENDOVAS PROSTH BILAT,34812,CPT,360,RC,36000101,CDM,,,50,both,,,9196.0000,1379.4000,WELLCARE,WELLCARE MEDICAID,9196.00,,,,,,,1452.0000,9196.0000,percent of total billed charges,"100% of $9,196.00 in Billed Charges for Rev 360 Proc 34812 Mod 50 = $9,196.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,AETNA,AETNA,3526.17,,,,,,,109.0000,11005.7700,percent of total billed charges,"42.7% of $8,258.00 in Billed Charges for Rev 450 Proc 35201 = $3,526.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3046.27,,,,,,,109.0000,11005.7700,fee schedule,"APG 00078 Proc 35201 at $836.60 (Base Rate) * 3.5012 (Relative Weight) = $2,929.10 (Total Line Payment) at 104% = $3,046.27. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5048.52,,,,,,,109.0000,11005.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,AETNA,AETNA HEALTHCARE MEDICARE,5048.52,,,,,,,109.0000,11005.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,5048.52,,,,,,,109.0000,11005.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,AMBETTER,AMBETTER,11005.77,,,,,,,109.0000,11005.7700,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,5250.46,,,,,,,109.0000,11005.7700,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,BLUE CROSS,ANTHEM EXCHANGE,8258.00,,,,,,,109.0000,11005.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3016.98,,,,,,,109.0000,11005.7700,fee schedule,"APG 00078 Proc 35201 at $836.60 (Base Rate) * 3.5012 (Relative Weight) = $2,929.10 (Total Line Payment) at 103% = $3,016.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,BLUE CROSS,ANTHEM HMO,8258.00,,,,,,,109.0000,11005.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5199.97,,,,,,,109.0000,11005.7700,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8258.00,,,,,,,109.0000,11005.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,901.82,,,,,,,109.0000,11005.7700,fee schedule,$901.82 from Fee Schedule BLDTM_23 for Rev 450 Proc 35201 * Qty 1 = $901.82 at 100% = $901.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,BLUE CROSS,BLUE CROSS MEDICARE,5250.46,,,,,,,109.0000,11005.7700,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,5300.94,,,,,,,109.0000,11005.7700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,5300.94,,,,,,,109.0000,11005.7700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,7432.20,,,,,,,109.0000,11005.7700,percent of total billed charges,"90% of $8,258.00 in Billed Charges for Rev 450 Proc 35201 = $7,432.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,HUMANA,HUMANA MEDICARE,5048.52,,,,,,,109.0000,11005.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5048.52,,,,,,,109.0000,11005.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,MEDCOST,MEDCOST VHN,3929.98,,,,,,,109.0000,11005.7700,percent of total billed charges,"47.59% of $8,258.00 in Billed Charges for Rev 450 Proc 35201 = $3,929.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3075.56,,,,,,,109.0000,11005.7700,fee schedule,"APG 00078 Proc 35201 at $836.60 (Base Rate) * 3.5012 (Relative Weight) = $2,929.10 (Total Line Payment) at 100% = $2,929.10... $2,929.10 at 105% = $3,075.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,5300.94,,,,,,,109.0000,11005.7700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,5300.94,,,,,,,109.0000,11005.7700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,NHC ADVANTAGE,NHC ADVANTAGE,5300.94,,,,,,,109.0000,11005.7700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3019.90,,,,,,,109.0000,11005.7700,fee schedule,"APG 00078 Proc 35201 at $836.60 (Base Rate) * 3.5012 (Relative Weight) = $2,929.10 (Total Line Payment) at 100% = $2,929.10... $2,929.10 at 103.1% = $3,019.90 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,SENTARA HEALTH,SENTARA HEALTH,2131.39,,,,,,,109.0000,11005.7700,percent of total billed charges,"25.81% of $8,258.00 in Billed Charges for Rev 450 Proc 35201 = $2,131.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,SENTARA HEALTH,SENTARA MEDICARE,5048.52,,,,,,,109.0000,11005.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",8258.00,,,,,,,109.0000,11005.7700,percent of total billed charges,"100% of $8,258.00 in Billed Charges for Rev 450 Proc 35201 = $8,258.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,11005.7700,case rate,Rev 450 Proc 35201 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,11005.7700,case rate,Rev 450 Proc 35201 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,11005.7700,case rate,Rev 450 Proc 35201 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,11005.7700,case rate,Rev 450 Proc 35201 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3016.98,,,,,,,109.0000,11005.7700,fee schedule,"APG 00078 Proc 35201 at $836.60 (Base Rate) * 3.5012 (Relative Weight) = $2,929.10 (Total Line Payment) at 103% = $3,016.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5048.52,,,,,,,109.0000,11005.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5048.52,,,,,,,109.0000,11005.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,WELLCARE,WELLCARE MEDICAID,8258.00,,,,,,,109.0000,11005.7700,percent of total billed charges,"100% of $8,258.00 in Billed Charges for Rev 450 Proc 35201 = $8,258.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR BLOOD VESSEL DIRECT NECK,35201,CPT,450,RC,45000233,CDM,,,,both,,,8258.0000,1238.7000,WELLCARE,WELLCARE MEDICARE,5351.43,,,,,,,109.0000,11005.7700,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH STENT CCA W/O EPS,37216,CPT,481,RC,48100146,CDM,,,,both,,,18747.0000,2812.0500,AETNA,AETNA,8004.97,,,,,,,968.0000,20061.2400,percent of total billed charges,"42.7% of $18,747.00 in Billed Charges for Rev 481 Proc 37216 = $8,004.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH STENT CCA W/O EPS,37216,CPT,481,RC,48100146,CDM,,,,both,,,18747.0000,2812.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,19870.17,,,,,,,968.0000,20061.2400,fee schedule,"APG 00265 Proc 37216 at $836.60 (Base Rate) * 22.8376 (Relative Weight) = $19,105.94 (Total Line Payment) at 104% = $19,870.17. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH STENT CCA W/O EPS,37216,CPT,481,RC,48100146,CDM,,,,both,,,18747.0000,2812.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,18747.00,,,,,,,968.0000,20061.2400,fee schedule,"APG 00265 Proc 37216 at $836.60 (Base Rate) * 22.8376 (Relative Weight) = $19,105.94 (Total Line Payment) at 103% = $19,679.11 (Service Line reduced to $18,747.00, claim capped at $18,747.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH STENT CCA W/O EPS,37216,CPT,481,RC,48100146,CDM,,,,both,,,18747.0000,2812.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1003.42,,,,,,,968.0000,20061.2400,fee schedule,"$1,003.42 from Fee Schedule BLDTM_23 for Rev 481 Proc 37216 * Qty 1 = $1,003.42 at 100% = $1,003.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH STENT CCA W/O EPS,37216,CPT,481,RC,48100146,CDM,,,,both,,,18747.0000,2812.0500,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,968.0000,20061.2400,case rate,"Rev 481 Proc 37216 ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH STENT CCA W/O EPS,37216,CPT,481,RC,48100146,CDM,,,,both,,,18747.0000,2812.0500,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,968.0000,20061.2400,case rate,"Rev 481 Proc 37216 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH STENT CCA W/O EPS,37216,CPT,481,RC,48100146,CDM,,,,both,,,18747.0000,2812.0500,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,968.0000,20061.2400,case rate,"Rev 481 Proc 37216 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH STENT CCA W/O EPS,37216,CPT,481,RC,48100146,CDM,,,,both,,,18747.0000,2812.0500,CIGNA HEALTHCARE,CIGNA HMO,7817.50,,,,,,,968.0000,20061.2400,percent of total billed charges,"41.7% of $18,747.00 in Billed Charges for Rev 481 Proc 37216 = $7,817.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH STENT CCA W/O EPS,37216,CPT,481,RC,48100146,CDM,,,,both,,,18747.0000,2812.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,8698.61,,,,,,,968.0000,20061.2400,percent of total billed charges,"46.4% of $18,747.00 in Billed Charges for Rev 481 Proc 37216 = $8,698.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH STENT CCA W/O EPS,37216,CPT,481,RC,48100146,CDM,,,,both,,,18747.0000,2812.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7817.50,,,,,,,968.0000,20061.2400,percent of total billed charges,"41.7% of $18,747.00 in Billed Charges for Rev 481 Proc 37216 = $7,817.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH STENT CCA W/O EPS,37216,CPT,481,RC,48100146,CDM,,,,both,,,18747.0000,2812.0500,CIGNA HEALTHCARE,CIGNA PPO,7817.50,,,,,,,968.0000,20061.2400,percent of total billed charges,"41.7% of $18,747.00 in Billed Charges for Rev 481 Proc 37216 = $7,817.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH STENT CCA W/O EPS,37216,CPT,481,RC,48100146,CDM,,,,both,,,18747.0000,2812.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,16872.30,,,,,,,968.0000,20061.2400,percent of total billed charges,"90% of $18,747.00 in Billed Charges for Rev 481 Proc 37216 = $16,872.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH STENT CCA W/O EPS,37216,CPT,481,RC,48100146,CDM,,,,both,,,18747.0000,2812.0500,MEDCOST,MEDCOST VHN,8921.70,,,,,,,968.0000,20061.2400,percent of total billed charges,"47.59% of $18,747.00 in Billed Charges for Rev 481 Proc 37216 = $8,921.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH STENT CCA W/O EPS,37216,CPT,481,RC,48100146,CDM,,,,both,,,18747.0000,2812.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,20061.24,,,,,,,968.0000,20061.2400,fee schedule,"APG 00265 Proc 37216 at $836.60 (Base Rate) * 22.8376 (Relative Weight) = $19,105.94 (Total Line Payment) at 100% = $19,105.94... $19,105.94 at 105% = $20,061.24 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH STENT CCA W/O EPS,37216,CPT,481,RC,48100146,CDM,,,,both,,,18747.0000,2812.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,19698.22,,,,,,,968.0000,20061.2400,fee schedule,"APG 00265 Proc 37216 at $836.60 (Base Rate) * 22.8376 (Relative Weight) = $19,105.94 (Total Line Payment) at 100% = $19,105.94... $19,105.94 at 103.1% = $19,698.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH STENT CCA W/O EPS,37216,CPT,481,RC,48100146,CDM,,,,both,,,18747.0000,2812.0500,SENTARA HEALTH,SENTARA HEALTH,4838.60,,,,,,,968.0000,20061.2400,percent of total billed charges,"25.81% of $18,747.00 in Billed Charges for Rev 481 Proc 37216 = $4,838.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH STENT CCA W/O EPS,37216,CPT,481,RC,48100146,CDM,,,,both,,,18747.0000,2812.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",18747.00,,,,,,,968.0000,20061.2400,percent of total billed charges,"100% of $18,747.00 in Billed Charges for Rev 481 Proc 37216 = $18,747.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH STENT CCA W/O EPS,37216,CPT,481,RC,48100146,CDM,,,,both,,,18747.0000,2812.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,968.0000,20061.2400,case rate,Rev 481 Proc 37216 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH STENT CCA W/O EPS,37216,CPT,481,RC,48100146,CDM,,,,both,,,18747.0000,2812.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,968.0000,20061.2400,case rate,"Rev 481 Proc 37216 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH STENT CCA W/O EPS,37216,CPT,481,RC,48100146,CDM,,,,both,,,18747.0000,2812.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,968.0000,20061.2400,case rate,"Rev 481 Proc 37216 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH STENT CCA W/O EPS,37216,CPT,481,RC,48100146,CDM,,,,both,,,18747.0000,2812.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,968.0000,20061.2400,case rate,"Rev 481 Proc 37216 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH STENT CCA W/O EPS,37216,CPT,481,RC,48100146,CDM,,,,both,,,18747.0000,2812.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,19679.11,,,,,,,968.0000,20061.2400,fee schedule,"APG 00265 Proc 37216 at $836.60 (Base Rate) * 22.8376 (Relative Weight) = $19,105.94 (Total Line Payment) at 103% = $19,679.11. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH STENT CCA W/O EPS,37216,CPT,481,RC,48100146,CDM,,,,both,,,18747.0000,2812.0500,WELLCARE,WELLCARE MEDICAID,18747.00,,,,,,,968.0000,20061.2400,percent of total billed charges,"100% of $18,747.00 in Billed Charges for Rev 481 Proc 37216 = $18,747.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACEMT RETRO CAROTID,37217,CPT,481,RC,48100147,CDM,,,,both,,,37860.0000,5679.0000,AETNA,AETNA,16166.22,,,,,,,968.0000,37860.0000,percent of total billed charges,"42.7% of $37,860.00 in Billed Charges for Rev 481 Proc 37217 = $16,166.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACEMT RETRO CAROTID,37217,CPT,481,RC,48100147,CDM,,,,both,,,37860.0000,5679.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,19870.17,,,,,,,968.0000,37860.0000,fee schedule,"APG 00265 Proc 37217 at $836.60 (Base Rate) * 22.8376 (Relative Weight) = $19,105.94 (Total Line Payment) at 104% = $19,870.17. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT RETRO CAROTID,37217,CPT,481,RC,48100147,CDM,,,,both,,,37860.0000,5679.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,19679.11,,,,,,,968.0000,37860.0000,fee schedule,"APG 00265 Proc 37217 at $836.60 (Base Rate) * 22.8376 (Relative Weight) = $19,105.94 (Total Line Payment) at 103% = $19,679.11. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT RETRO CAROTID,37217,CPT,481,RC,48100147,CDM,,,,both,,,37860.0000,5679.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,26502.00,,,,,,,968.0000,37860.0000,percent of total billed charges,"Rev 481 Proc 37217 $37,860.00 in Billed Charges at 70% = $26,502.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACEMT RETRO CAROTID,37217,CPT,481,RC,48100147,CDM,,,,both,,,37860.0000,5679.0000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,968.0000,37860.0000,case rate,"Rev 481 Proc 37217 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT RETRO CAROTID,37217,CPT,481,RC,48100147,CDM,,,,both,,,37860.0000,5679.0000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,968.0000,37860.0000,case rate,"Rev 481 Proc 37217 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT RETRO CAROTID,37217,CPT,481,RC,48100147,CDM,,,,both,,,37860.0000,5679.0000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,968.0000,37860.0000,case rate,"Rev 481 Proc 37217 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT RETRO CAROTID,37217,CPT,481,RC,48100147,CDM,,,,both,,,37860.0000,5679.0000,CIGNA HEALTHCARE,CIGNA HMO,15787.62,,,,,,,968.0000,37860.0000,percent of total billed charges,"41.7% of $37,860.00 in Billed Charges for Rev 481 Proc 37217 = $15,787.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACEMT RETRO CAROTID,37217,CPT,481,RC,48100147,CDM,,,,both,,,37860.0000,5679.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,17567.04,,,,,,,968.0000,37860.0000,percent of total billed charges,"46.4% of $37,860.00 in Billed Charges for Rev 481 Proc 37217 = $17,567.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACEMT RETRO CAROTID,37217,CPT,481,RC,48100147,CDM,,,,both,,,37860.0000,5679.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,15787.62,,,,,,,968.0000,37860.0000,percent of total billed charges,"41.7% of $37,860.00 in Billed Charges for Rev 481 Proc 37217 = $15,787.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACEMT RETRO CAROTID,37217,CPT,481,RC,48100147,CDM,,,,both,,,37860.0000,5679.0000,CIGNA HEALTHCARE,CIGNA PPO,15787.62,,,,,,,968.0000,37860.0000,percent of total billed charges,"41.7% of $37,860.00 in Billed Charges for Rev 481 Proc 37217 = $15,787.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACEMT RETRO CAROTID,37217,CPT,481,RC,48100147,CDM,,,,both,,,37860.0000,5679.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,34074.00,,,,,,,968.0000,37860.0000,percent of total billed charges,"90% of $37,860.00 in Billed Charges for Rev 481 Proc 37217 = $34,074.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACEMT RETRO CAROTID,37217,CPT,481,RC,48100147,CDM,,,,both,,,37860.0000,5679.0000,MEDCOST,MEDCOST VHN,18017.57,,,,,,,968.0000,37860.0000,percent of total billed charges,"47.59% of $37,860.00 in Billed Charges for Rev 481 Proc 37217 = $18,017.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACEMT RETRO CAROTID,37217,CPT,481,RC,48100147,CDM,,,,both,,,37860.0000,5679.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,20061.24,,,,,,,968.0000,37860.0000,fee schedule,"APG 00265 Proc 37217 at $836.60 (Base Rate) * 22.8376 (Relative Weight) = $19,105.94 (Total Line Payment) at 100% = $19,105.94... $19,105.94 at 105% = $20,061.24 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT RETRO CAROTID,37217,CPT,481,RC,48100147,CDM,,,,both,,,37860.0000,5679.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,19698.22,,,,,,,968.0000,37860.0000,fee schedule,"APG 00265 Proc 37217 at $836.60 (Base Rate) * 22.8376 (Relative Weight) = $19,105.94 (Total Line Payment) at 100% = $19,105.94... $19,105.94 at 103.1% = $19,698.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT RETRO CAROTID,37217,CPT,481,RC,48100147,CDM,,,,both,,,37860.0000,5679.0000,SENTARA HEALTH,SENTARA HEALTH,9771.67,,,,,,,968.0000,37860.0000,percent of total billed charges,"25.81% of $37,860.00 in Billed Charges for Rev 481 Proc 37217 = $9,771.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACEMT RETRO CAROTID,37217,CPT,481,RC,48100147,CDM,,,,both,,,37860.0000,5679.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",37860.00,,,,,,,968.0000,37860.0000,percent of total billed charges,"100% of $37,860.00 in Billed Charges for Rev 481 Proc 37217 = $37,860.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACEMT RETRO CAROTID,37217,CPT,481,RC,48100147,CDM,,,,both,,,37860.0000,5679.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,968.0000,37860.0000,case rate,Rev 481 Proc 37217 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACEMT RETRO CAROTID,37217,CPT,481,RC,48100147,CDM,,,,both,,,37860.0000,5679.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,968.0000,37860.0000,case rate,"Rev 481 Proc 37217 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT RETRO CAROTID,37217,CPT,481,RC,48100147,CDM,,,,both,,,37860.0000,5679.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,968.0000,37860.0000,case rate,"Rev 481 Proc 37217 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT RETRO CAROTID,37217,CPT,481,RC,48100147,CDM,,,,both,,,37860.0000,5679.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,968.0000,37860.0000,case rate,"Rev 481 Proc 37217 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT RETRO CAROTID,37217,CPT,481,RC,48100147,CDM,,,,both,,,37860.0000,5679.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,19679.11,,,,,,,968.0000,37860.0000,fee schedule,"APG 00265 Proc 37217 at $836.60 (Base Rate) * 22.8376 (Relative Weight) = $19,105.94 (Total Line Payment) at 103% = $19,679.11. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT RETRO CAROTID,37217,CPT,481,RC,48100147,CDM,,,,both,,,37860.0000,5679.0000,WELLCARE,WELLCARE MEDICAID,37860.00,,,,,,,968.0000,37860.0000,percent of total billed charges,"100% of $37,860.00 in Billed Charges for Rev 481 Proc 37217 = $37,860.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,AETNA,AETNA,16721.75,,,,,,,968.0000,39161.0000,percent of total billed charges,"42.7% of $39,161.00 in Billed Charges for Rev 481 Proc 37218 = $16,721.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,19870.17,,,,,,,968.0000,39161.0000,fee schedule,"APG 00265 Proc 37218 at $836.60 (Base Rate) * 22.8376 (Relative Weight) = $19,105.94 (Total Line Payment) at 104% = $19,870.17. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,BLUE CROSS,ANTHEM EXCHANGE,7209.51,,,,,,,968.0000,39161.0000,fee schedule,"$3,607.10 from Fee Schedule ANT_C_APC for Rev 481 Proc 37218 * Qty 1 = $3,607.10 at 199.87% = $7,209.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,19679.11,,,,,,,968.0000,39161.0000,fee schedule,"APG 00265 Proc 37218 at $836.60 (Base Rate) * 22.8376 (Relative Weight) = $19,105.94 (Total Line Payment) at 103% = $19,679.11. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,BLUE CROSS,ANTHEM HMO,7659.68,,,,,,,968.0000,39161.0000,fee schedule,"$3,607.10 from Fee Schedule ANT_C_APC for Rev 481 Proc 37218 * Qty 1 = $3,607.10 at 212.35% = $7,659.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9010.90,,,,,,,968.0000,39161.0000,fee schedule,"$3,607.10 from Fee Schedule ANT_C_APC for Rev 481 Proc 37218 * Qty 1 = $3,607.10 at 249.81% = $9,010.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,27412.70,,,,,,,968.0000,39161.0000,percent of total billed charges,"Rev 481 Proc 37218 $39,161.00 in Billed Charges at 70% = $27,412.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,968.0000,39161.0000,case rate,"Rev 481 Proc 37218 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,968.0000,39161.0000,case rate,"Rev 481 Proc 37218 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,968.0000,39161.0000,case rate,"Rev 481 Proc 37218 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,CIGNA HEALTHCARE,CIGNA HMO,16330.14,,,,,,,968.0000,39161.0000,percent of total billed charges,"41.7% of $39,161.00 in Billed Charges for Rev 481 Proc 37218 = $16,330.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,18170.70,,,,,,,968.0000,39161.0000,percent of total billed charges,"46.4% of $39,161.00 in Billed Charges for Rev 481 Proc 37218 = $18,170.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,16330.14,,,,,,,968.0000,39161.0000,percent of total billed charges,"41.7% of $39,161.00 in Billed Charges for Rev 481 Proc 37218 = $16,330.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,CIGNA HEALTHCARE,CIGNA PPO,16330.14,,,,,,,968.0000,39161.0000,percent of total billed charges,"41.7% of $39,161.00 in Billed Charges for Rev 481 Proc 37218 = $16,330.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,35244.90,,,,,,,968.0000,39161.0000,percent of total billed charges,"90% of $39,161.00 in Billed Charges for Rev 481 Proc 37218 = $35,244.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,MEDCOST,MEDCOST VHN,18636.72,,,,,,,968.0000,39161.0000,percent of total billed charges,"47.59% of $39,161.00 in Billed Charges for Rev 481 Proc 37218 = $18,636.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,20061.24,,,,,,,968.0000,39161.0000,fee schedule,"APG 00265 Proc 37218 at $836.60 (Base Rate) * 22.8376 (Relative Weight) = $19,105.94 (Total Line Payment) at 100% = $19,105.94... $19,105.94 at 105% = $20,061.24 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,19698.22,,,,,,,968.0000,39161.0000,fee schedule,"APG 00265 Proc 37218 at $836.60 (Base Rate) * 22.8376 (Relative Weight) = $19,105.94 (Total Line Payment) at 100% = $19,105.94... $19,105.94 at 103.1% = $19,698.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,SENTARA HEALTH,SENTARA HEALTH,10107.45,,,,,,,968.0000,39161.0000,percent of total billed charges,"25.81% of $39,161.00 in Billed Charges for Rev 481 Proc 37218 = $10,107.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",39161.00,,,,,,,968.0000,39161.0000,percent of total billed charges,"100% of $39,161.00 in Billed Charges for Rev 481 Proc 37218 = $39,161.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,968.0000,39161.0000,case rate,Rev 481 Proc 37218 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,968.0000,39161.0000,case rate,"Rev 481 Proc 37218 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,968.0000,39161.0000,case rate,"Rev 481 Proc 37218 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,968.0000,39161.0000,case rate,"Rev 481 Proc 37218 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,19679.11,,,,,,,968.0000,39161.0000,fee schedule,"APG 00265 Proc 37218 at $836.60 (Base Rate) * 22.8376 (Relative Weight) = $19,105.94 (Total Line Payment) at 103% = $19,679.11. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACEMT ANTE CAROTID,37218,CPT,481,RC,48100148,CDM,,,,both,,,39161.0000,5874.1500,WELLCARE,WELLCARE MEDICAID,39161.00,,,,,,,968.0000,39161.0000,percent of total billed charges,"100% of $39,161.00 in Billed Charges for Rev 481 Proc 37218 = $39,161.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA ILIAC INITIAL VESSEL,37220,CPT,481,RC,48100069,CDM,,,,both,,,16557.0000,2483.5500,AETNA,AETNA,7069.84,,,,,,,2853.0000,16557.0000,percent of total billed charges,"42.7% of $16,557.00 in Billed Charges for Rev 481 Proc 37220 = $7,069.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA ILIAC INITIAL VESSEL,37220,CPT,481,RC,48100069,CDM,,,,both,,,16557.0000,2483.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,9404.09,,,,,,,2853.0000,16557.0000,fee schedule,"APG 00079 Proc 37220 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 104% = $9,404.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA ILIAC INITIAL VESSEL,37220,CPT,481,RC,48100069,CDM,,,,both,,,16557.0000,2483.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,9313.66,,,,,,,2853.0000,16557.0000,fee schedule,"APG 00079 Proc 37220 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 103% = $9,313.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA ILIAC INITIAL VESSEL,37220,CPT,481,RC,48100069,CDM,,,,both,,,16557.0000,2483.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2990.98,,,,,,,2853.0000,16557.0000,fee schedule,"$2,990.98 from Fee Schedule BLDTM_23 for Rev 481 Proc 37220 * Qty 1 = $2,990.98 at 100% = $2,990.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA ILIAC INITIAL VESSEL,37220,CPT,481,RC,48100069,CDM,,,,both,,,16557.0000,2483.5500,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,2853.0000,16557.0000,case rate,"Rev 481 Proc 37220 ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA ILIAC INITIAL VESSEL,37220,CPT,481,RC,48100069,CDM,,,,both,,,16557.0000,2483.5500,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,2853.0000,16557.0000,case rate,"Rev 481 Proc 37220 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA ILIAC INITIAL VESSEL,37220,CPT,481,RC,48100069,CDM,,,,both,,,16557.0000,2483.5500,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,2853.0000,16557.0000,case rate,"Rev 481 Proc 37220 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA ILIAC INITIAL VESSEL,37220,CPT,481,RC,48100069,CDM,,,,both,,,16557.0000,2483.5500,CIGNA HEALTHCARE,CIGNA HMO,6904.27,,,,,,,2853.0000,16557.0000,percent of total billed charges,"41.7% of $16,557.00 in Billed Charges for Rev 481 Proc 37220 = $6,904.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA ILIAC INITIAL VESSEL,37220,CPT,481,RC,48100069,CDM,,,,both,,,16557.0000,2483.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7682.45,,,,,,,2853.0000,16557.0000,percent of total billed charges,"46.4% of $16,557.00 in Billed Charges for Rev 481 Proc 37220 = $7,682.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA ILIAC INITIAL VESSEL,37220,CPT,481,RC,48100069,CDM,,,,both,,,16557.0000,2483.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6904.27,,,,,,,2853.0000,16557.0000,percent of total billed charges,"41.7% of $16,557.00 in Billed Charges for Rev 481 Proc 37220 = $6,904.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA ILIAC INITIAL VESSEL,37220,CPT,481,RC,48100069,CDM,,,,both,,,16557.0000,2483.5500,CIGNA HEALTHCARE,CIGNA PPO,6904.27,,,,,,,2853.0000,16557.0000,percent of total billed charges,"41.7% of $16,557.00 in Billed Charges for Rev 481 Proc 37220 = $6,904.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA ILIAC INITIAL VESSEL,37220,CPT,481,RC,48100069,CDM,,,,both,,,16557.0000,2483.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,14901.30,,,,,,,2853.0000,16557.0000,percent of total billed charges,"90% of $16,557.00 in Billed Charges for Rev 481 Proc 37220 = $14,901.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA ILIAC INITIAL VESSEL,37220,CPT,481,RC,48100069,CDM,,,,both,,,16557.0000,2483.5500,MEDCOST,MEDCOST VHN,7879.48,,,,,,,2853.0000,16557.0000,percent of total billed charges,"47.59% of $16,557.00 in Billed Charges for Rev 481 Proc 37220 = $7,879.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA ILIAC INITIAL VESSEL,37220,CPT,481,RC,48100069,CDM,,,,both,,,16557.0000,2483.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,9494.51,,,,,,,2853.0000,16557.0000,fee schedule,"APG 00079 Proc 37220 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 100% = $9,042.39... $9,042.39 at 105% = $9,494.51 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA ILIAC INITIAL VESSEL,37220,CPT,481,RC,48100069,CDM,,,,both,,,16557.0000,2483.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,9322.70,,,,,,,2853.0000,16557.0000,fee schedule,"APG 00079 Proc 37220 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 100% = $9,042.39... $9,042.39 at 103.1% = $9,322.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA ILIAC INITIAL VESSEL,37220,CPT,481,RC,48100069,CDM,,,,both,,,16557.0000,2483.5500,SENTARA HEALTH,SENTARA HEALTH,4273.36,,,,,,,2853.0000,16557.0000,percent of total billed charges,"25.81% of $16,557.00 in Billed Charges for Rev 481 Proc 37220 = $4,273.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA ILIAC INITIAL VESSEL,37220,CPT,481,RC,48100069,CDM,,,,both,,,16557.0000,2483.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",16557.00,,,,,,,2853.0000,16557.0000,percent of total billed charges,"100% of $16,557.00 in Billed Charges for Rev 481 Proc 37220 = $16,557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA ILIAC INITIAL VESSEL,37220,CPT,481,RC,48100069,CDM,,,,both,,,16557.0000,2483.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,2853.0000,16557.0000,case rate,"Rev 481 Proc 37220 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA ILIAC INITIAL VESSEL,37220,CPT,481,RC,48100069,CDM,,,,both,,,16557.0000,2483.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,2853.0000,16557.0000,case rate,"Rev 481 Proc 37220 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA ILIAC INITIAL VESSEL,37220,CPT,481,RC,48100069,CDM,,,,both,,,16557.0000,2483.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,2853.0000,16557.0000,case rate,"Rev 481 Proc 37220 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA ILIAC INITIAL VESSEL,37220,CPT,481,RC,48100069,CDM,,,,both,,,16557.0000,2483.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,2853.0000,16557.0000,case rate,"Rev 481 Proc 37220 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA ILIAC INITIAL VESSEL,37220,CPT,481,RC,48100069,CDM,,,,both,,,16557.0000,2483.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,9313.66,,,,,,,2853.0000,16557.0000,fee schedule,"APG 00079 Proc 37220 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 103% = $9,313.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA ILIAC INITIAL VESSEL,37220,CPT,481,RC,48100069,CDM,,,,both,,,16557.0000,2483.5500,WELLCARE,WELLCARE MEDICAID,16557.00,,,,,,,2853.0000,16557.0000,percent of total billed charges,"100% of $16,557.00 in Billed Charges for Rev 481 Proc 37220 = $16,557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT ILIAC INITIAL VESSEL,37221,CPT,481,RC,48100070,CDM,,,,both,,,16557.0000,2483.5500,AETNA,AETNA,7069.84,,,,,,,4273.3600,16557.0000,percent of total billed charges,"42.7% of $16,557.00 in Billed Charges for Rev 481 Proc 37221 = $7,069.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT ILIAC INITIAL VESSEL,37221,CPT,481,RC,48100070,CDM,,,,both,,,16557.0000,2483.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15721.62,,,,,,,4273.3600,16557.0000,fee schedule,"APG 00085 Proc 37221 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 104% = $15,721.62. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT ILIAC INITIAL VESSEL,37221,CPT,481,RC,48100070,CDM,,,,both,,,16557.0000,2483.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15570.45,,,,,,,4273.3600,16557.0000,fee schedule,"APG 00085 Proc 37221 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT ILIAC INITIAL VESSEL,37221,CPT,481,RC,48100070,CDM,,,,both,,,16557.0000,2483.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4422.96,,,,,,,4273.3600,16557.0000,fee schedule,"$4,422.96 from Fee Schedule BLDTM_23 for Rev 481 Proc 37221 * Qty 1 = $4,422.96 at 100% = $4,422.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT ILIAC INITIAL VESSEL,37221,CPT,481,RC,48100070,CDM,,,,both,,,16557.0000,2483.5500,BLUE CROSS,BLUE CROSS E NETWORK,8571.00,,,,,,,4273.3600,16557.0000,case rate,"Rev 481 Proc 37221 ASG Rate of $8,571.00 at 100% of $8,571.00 = $8,571.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT ILIAC INITIAL VESSEL,37221,CPT,481,RC,48100070,CDM,,,,both,,,16557.0000,2483.5500,BLUE CROSS,BLUE CROSS P NETWORK,8764.00,,,,,,,4273.3600,16557.0000,case rate,"Rev 481 Proc 37221 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT ILIAC INITIAL VESSEL,37221,CPT,481,RC,48100070,CDM,,,,both,,,16557.0000,2483.5500,BLUE CROSS,BLUE CROSS S NETWORK,8764.00,,,,,,,4273.3600,16557.0000,case rate,"Rev 481 Proc 37221 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT ILIAC INITIAL VESSEL,37221,CPT,481,RC,48100070,CDM,,,,both,,,16557.0000,2483.5500,CIGNA HEALTHCARE,CIGNA HMO,6904.27,,,,,,,4273.3600,16557.0000,percent of total billed charges,"41.7% of $16,557.00 in Billed Charges for Rev 481 Proc 37221 = $6,904.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT ILIAC INITIAL VESSEL,37221,CPT,481,RC,48100070,CDM,,,,both,,,16557.0000,2483.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7682.45,,,,,,,4273.3600,16557.0000,percent of total billed charges,"46.4% of $16,557.00 in Billed Charges for Rev 481 Proc 37221 = $7,682.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT ILIAC INITIAL VESSEL,37221,CPT,481,RC,48100070,CDM,,,,both,,,16557.0000,2483.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6904.27,,,,,,,4273.3600,16557.0000,percent of total billed charges,"41.7% of $16,557.00 in Billed Charges for Rev 481 Proc 37221 = $6,904.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT ILIAC INITIAL VESSEL,37221,CPT,481,RC,48100070,CDM,,,,both,,,16557.0000,2483.5500,CIGNA HEALTHCARE,CIGNA PPO,6904.27,,,,,,,4273.3600,16557.0000,percent of total billed charges,"41.7% of $16,557.00 in Billed Charges for Rev 481 Proc 37221 = $6,904.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT ILIAC INITIAL VESSEL,37221,CPT,481,RC,48100070,CDM,,,,both,,,16557.0000,2483.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,14901.30,,,,,,,4273.3600,16557.0000,percent of total billed charges,"90% of $16,557.00 in Billed Charges for Rev 481 Proc 37221 = $14,901.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT ILIAC INITIAL VESSEL,37221,CPT,481,RC,48100070,CDM,,,,both,,,16557.0000,2483.5500,MEDCOST,MEDCOST VHN,7879.48,,,,,,,4273.3600,16557.0000,percent of total billed charges,"47.59% of $16,557.00 in Billed Charges for Rev 481 Proc 37221 = $7,879.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT ILIAC INITIAL VESSEL,37221,CPT,481,RC,48100070,CDM,,,,both,,,16557.0000,2483.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15872.79,,,,,,,4273.3600,16557.0000,fee schedule,"APG 00085 Proc 37221 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 105% = $15,872.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT ILIAC INITIAL VESSEL,37221,CPT,481,RC,48100070,CDM,,,,both,,,16557.0000,2483.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15585.57,,,,,,,4273.3600,16557.0000,fee schedule,"APG 00085 Proc 37221 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 103.1% = $15,585.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT ILIAC INITIAL VESSEL,37221,CPT,481,RC,48100070,CDM,,,,both,,,16557.0000,2483.5500,SENTARA HEALTH,SENTARA HEALTH,4273.36,,,,,,,4273.3600,16557.0000,percent of total billed charges,"25.81% of $16,557.00 in Billed Charges for Rev 481 Proc 37221 = $4,273.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT ILIAC INITIAL VESSEL,37221,CPT,481,RC,48100070,CDM,,,,both,,,16557.0000,2483.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",16557.00,,,,,,,4273.3600,16557.0000,percent of total billed charges,"100% of $16,557.00 in Billed Charges for Rev 481 Proc 37221 = $16,557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT ILIAC INITIAL VESSEL,37221,CPT,481,RC,48100070,CDM,,,,both,,,16557.0000,2483.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,4273.3600,16557.0000,case rate,"Rev 481 Proc 37221 ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT ILIAC INITIAL VESSEL,37221,CPT,481,RC,48100070,CDM,,,,both,,,16557.0000,2483.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,4273.3600,16557.0000,case rate,"Rev 481 Proc 37221 ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT ILIAC INITIAL VESSEL,37221,CPT,481,RC,48100070,CDM,,,,both,,,16557.0000,2483.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,4273.3600,16557.0000,case rate,"Rev 481 Proc 37221 ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT ILIAC INITIAL VESSEL,37221,CPT,481,RC,48100070,CDM,,,,both,,,16557.0000,2483.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,16557.00,,,,,,,4273.3600,16557.0000,case rate,"Rev 481 Proc 37221 ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total (Service Line reduced to $16,557.00, claim capped at $16,557.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT ILIAC INITIAL VESSEL,37221,CPT,481,RC,48100070,CDM,,,,both,,,16557.0000,2483.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15570.45,,,,,,,4273.3600,16557.0000,fee schedule,"APG 00085 Proc 37221 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT ILIAC INITIAL VESSEL,37221,CPT,481,RC,48100070,CDM,,,,both,,,16557.0000,2483.5500,WELLCARE,WELLCARE MEDICAID,16557.00,,,,,,,4273.3600,16557.0000,percent of total billed charges,"100% of $16,557.00 in Billed Charges for Rev 481 Proc 37221 = $16,557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA ILIAC ADDTL VESSEL,37222,CPT,481,RC,48100071,CDM,,,,both,,,10428.0000,1564.2000,AETNA,AETNA,4452.76,,,,,,,148.0000,15872.7900,percent of total billed charges,"42.7% of $10,428.00 in Billed Charges for Rev 481 Proc 37222 = $4,452.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA ILIAC ADDTL VESSEL,37222,CPT,481,RC,48100071,CDM,,,,both,,,10428.0000,1564.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15721.62,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 37222 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 104% = $15,721.62. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA ILIAC ADDTL VESSEL,37222,CPT,481,RC,48100071,CDM,,,,both,,,10428.0000,1564.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,10428.00,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 37222 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45 (Service Line reduced to $10,428.00, claim capped at $10,428.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA ILIAC ADDTL VESSEL,37222,CPT,481,RC,48100071,CDM,,,,both,,,10428.0000,1564.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,861.52,,,,,,,148.0000,15872.7900,fee schedule,$861.52 from Fee Schedule BLDTM_23 for Rev 481 Proc 37222 * Qty 1 = $861.52 at 100% = $861.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTA ILIAC ADDTL VESSEL,37222,CPT,481,RC,48100071,CDM,,,,both,,,10428.0000,1564.2000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,15872.7900,case rate,Rev 481 Proc 37222 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTA ILIAC ADDTL VESSEL,37222,CPT,481,RC,48100071,CDM,,,,both,,,10428.0000,1564.2000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,15872.7900,case rate,Rev 481 Proc 37222 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTA ILIAC ADDTL VESSEL,37222,CPT,481,RC,48100071,CDM,,,,both,,,10428.0000,1564.2000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,15872.7900,case rate,Rev 481 Proc 37222 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PTA ILIAC ADDTL VESSEL,37222,CPT,481,RC,48100071,CDM,,,,both,,,10428.0000,1564.2000,CIGNA HEALTHCARE,CIGNA HMO,4348.48,,,,,,,148.0000,15872.7900,percent of total billed charges,"41.7% of $10,428.00 in Billed Charges for Rev 481 Proc 37222 = $4,348.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA ILIAC ADDTL VESSEL,37222,CPT,481,RC,48100071,CDM,,,,both,,,10428.0000,1564.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4838.59,,,,,,,148.0000,15872.7900,percent of total billed charges,"46.4% of $10,428.00 in Billed Charges for Rev 481 Proc 37222 = $4,838.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA ILIAC ADDTL VESSEL,37222,CPT,481,RC,48100071,CDM,,,,both,,,10428.0000,1564.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4348.48,,,,,,,148.0000,15872.7900,percent of total billed charges,"41.7% of $10,428.00 in Billed Charges for Rev 481 Proc 37222 = $4,348.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA ILIAC ADDTL VESSEL,37222,CPT,481,RC,48100071,CDM,,,,both,,,10428.0000,1564.2000,CIGNA HEALTHCARE,CIGNA PPO,4348.48,,,,,,,148.0000,15872.7900,percent of total billed charges,"41.7% of $10,428.00 in Billed Charges for Rev 481 Proc 37222 = $4,348.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA ILIAC ADDTL VESSEL,37222,CPT,481,RC,48100071,CDM,,,,both,,,10428.0000,1564.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9385.20,,,,,,,148.0000,15872.7900,percent of total billed charges,"90% of $10,428.00 in Billed Charges for Rev 481 Proc 37222 = $9,385.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA ILIAC ADDTL VESSEL,37222,CPT,481,RC,48100071,CDM,,,,both,,,10428.0000,1564.2000,MEDCOST,MEDCOST VHN,4962.69,,,,,,,148.0000,15872.7900,percent of total billed charges,"47.59% of $10,428.00 in Billed Charges for Rev 481 Proc 37222 = $4,962.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA ILIAC ADDTL VESSEL,37222,CPT,481,RC,48100071,CDM,,,,both,,,10428.0000,1564.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15872.79,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 37222 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 105% = $15,872.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA ILIAC ADDTL VESSEL,37222,CPT,481,RC,48100071,CDM,,,,both,,,10428.0000,1564.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15585.57,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 37222 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 103.1% = $15,585.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA ILIAC ADDTL VESSEL,37222,CPT,481,RC,48100071,CDM,,,,both,,,10428.0000,1564.2000,SENTARA HEALTH,SENTARA HEALTH,2691.47,,,,,,,148.0000,15872.7900,percent of total billed charges,"25.81% of $10,428.00 in Billed Charges for Rev 481 Proc 37222 = $2,691.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA ILIAC ADDTL VESSEL,37222,CPT,481,RC,48100071,CDM,,,,both,,,10428.0000,1564.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10428.00,,,,,,,148.0000,15872.7900,percent of total billed charges,"100% of $10,428.00 in Billed Charges for Rev 481 Proc 37222 = $10,428.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA ILIAC ADDTL VESSEL,37222,CPT,481,RC,48100071,CDM,,,,both,,,10428.0000,1564.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,148.0000,15872.7900,case rate,"Rev 481 Proc 37222 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA ILIAC ADDTL VESSEL,37222,CPT,481,RC,48100071,CDM,,,,both,,,10428.0000,1564.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,148.0000,15872.7900,case rate,"Rev 481 Proc 37222 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA ILIAC ADDTL VESSEL,37222,CPT,481,RC,48100071,CDM,,,,both,,,10428.0000,1564.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,148.0000,15872.7900,case rate,"Rev 481 Proc 37222 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA ILIAC ADDTL VESSEL,37222,CPT,481,RC,48100071,CDM,,,,both,,,10428.0000,1564.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,148.0000,15872.7900,case rate,"Rev 481 Proc 37222 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA ILIAC ADDTL VESSEL,37222,CPT,481,RC,48100071,CDM,,,,both,,,10428.0000,1564.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15570.45,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 37222 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA ILIAC ADDTL VESSEL,37222,CPT,481,RC,48100071,CDM,,,,both,,,10428.0000,1564.2000,WELLCARE,WELLCARE MEDICAID,10428.00,,,,,,,148.0000,15872.7900,percent of total billed charges,"100% of $10,428.00 in Billed Charges for Rev 481 Proc 37222 = $10,428.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT EA ADD/ ILIA,37223,CPT,481,RC,48100072,CDM,,,,both,,,13360.0000,2004.0000,AETNA,AETNA,5704.72,,,,,,,148.0000,15872.7900,percent of total billed charges,"42.7% of $13,360.00 in Billed Charges for Rev 481 Proc 37223 = $5,704.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT EA ADD/ ILIA,37223,CPT,481,RC,48100072,CDM,,,,both,,,13360.0000,2004.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15721.62,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 37223 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 104% = $15,721.62. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT EA ADD/ ILIA,37223,CPT,481,RC,48100072,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13360.00,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 37223 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45 (Service Line reduced to $13,360.00, claim capped at $13,360.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT EA ADD/ ILIA,37223,CPT,481,RC,48100072,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2436.03,,,,,,,148.0000,15872.7900,fee schedule,"$2,436.03 from Fee Schedule BLDTM_23 for Rev 481 Proc 37223 * Qty 1 = $2,436.03 at 100% = $2,436.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT EA ADD/ ILIA,37223,CPT,481,RC,48100072,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,15872.7900,case rate,Rev 481 Proc 37223 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE VASC STENT EA ADD/ ILIA,37223,CPT,481,RC,48100072,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,15872.7900,case rate,Rev 481 Proc 37223 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE VASC STENT EA ADD/ ILIA,37223,CPT,481,RC,48100072,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,15872.7900,case rate,Rev 481 Proc 37223 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE VASC STENT EA ADD/ ILIA,37223,CPT,481,RC,48100072,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA HMO,5571.12,,,,,,,148.0000,15872.7900,percent of total billed charges,"41.7% of $13,360.00 in Billed Charges for Rev 481 Proc 37223 = $5,571.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT EA ADD/ ILIA,37223,CPT,481,RC,48100072,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6199.04,,,,,,,148.0000,15872.7900,percent of total billed charges,"46.4% of $13,360.00 in Billed Charges for Rev 481 Proc 37223 = $6,199.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT EA ADD/ ILIA,37223,CPT,481,RC,48100072,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5571.12,,,,,,,148.0000,15872.7900,percent of total billed charges,"41.7% of $13,360.00 in Billed Charges for Rev 481 Proc 37223 = $5,571.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT EA ADD/ ILIA,37223,CPT,481,RC,48100072,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA PPO,5571.12,,,,,,,148.0000,15872.7900,percent of total billed charges,"41.7% of $13,360.00 in Billed Charges for Rev 481 Proc 37223 = $5,571.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT EA ADD/ ILIA,37223,CPT,481,RC,48100072,CDM,,,,both,,,13360.0000,2004.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12024.00,,,,,,,148.0000,15872.7900,percent of total billed charges,"90% of $13,360.00 in Billed Charges for Rev 481 Proc 37223 = $12,024.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT EA ADD/ ILIA,37223,CPT,481,RC,48100072,CDM,,,,both,,,13360.0000,2004.0000,MEDCOST,MEDCOST VHN,6358.02,,,,,,,148.0000,15872.7900,percent of total billed charges,"47.59% of $13,360.00 in Billed Charges for Rev 481 Proc 37223 = $6,358.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT EA ADD/ ILIA,37223,CPT,481,RC,48100072,CDM,,,,both,,,13360.0000,2004.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15872.79,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 37223 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 105% = $15,872.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT EA ADD/ ILIA,37223,CPT,481,RC,48100072,CDM,,,,both,,,13360.0000,2004.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15585.57,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 37223 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 103.1% = $15,585.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT EA ADD/ ILIA,37223,CPT,481,RC,48100072,CDM,,,,both,,,13360.0000,2004.0000,SENTARA HEALTH,SENTARA HEALTH,3448.22,,,,,,,148.0000,15872.7900,percent of total billed charges,"25.81% of $13,360.00 in Billed Charges for Rev 481 Proc 37223 = $3,448.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT EA ADD/ ILIA,37223,CPT,481,RC,48100072,CDM,,,,both,,,13360.0000,2004.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13360.00,,,,,,,148.0000,15872.7900,percent of total billed charges,"100% of $13,360.00 in Billed Charges for Rev 481 Proc 37223 = $13,360.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT EA ADD/ ILIA,37223,CPT,481,RC,48100072,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,148.0000,15872.7900,case rate,"Rev 481 Proc 37223 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT EA ADD/ ILIA,37223,CPT,481,RC,48100072,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,148.0000,15872.7900,case rate,"Rev 481 Proc 37223 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT EA ADD/ ILIA,37223,CPT,481,RC,48100072,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,148.0000,15872.7900,case rate,"Rev 481 Proc 37223 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT EA ADD/ ILIA,37223,CPT,481,RC,48100072,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,148.0000,15872.7900,case rate,"Rev 481 Proc 37223 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT EA ADD/ ILIA,37223,CPT,481,RC,48100072,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15570.45,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 37223 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT EA ADD/ ILIA,37223,CPT,481,RC,48100072,CDM,,,,both,,,13360.0000,2004.0000,WELLCARE,WELLCARE MEDICAID,13360.00,,,,,,,148.0000,15872.7900,percent of total billed charges,"100% of $13,360.00 in Billed Charges for Rev 481 Proc 37223 = $13,360.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT FEMOR POPLIT,37226,CPT,481,RC,48100076,CDM,,,,both,,,27475.0000,4121.2500,AETNA,AETNA,11731.83,,,,,,,6290.0000,27475.0000,percent of total billed charges,"42.7% of $27,475.00 in Billed Charges for Rev 481 Proc 37226 = $11,731.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT FEMOR POPLIT,37226,CPT,481,RC,48100076,CDM,,,,both,,,27475.0000,4121.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15721.62,,,,,,,6290.0000,27475.0000,fee schedule,"APG 00085 Proc 37226 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 104% = $15,721.62. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT FEMOR POPLIT,37226,CPT,481,RC,48100076,CDM,,,,both,,,27475.0000,4121.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15570.45,,,,,,,6290.0000,27475.0000,fee schedule,"APG 00085 Proc 37226 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT FEMOR POPLIT,37226,CPT,481,RC,48100076,CDM,,,,both,,,27475.0000,4121.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8511.85,,,,,,,6290.0000,27475.0000,fee schedule,"$8,511.85 from Fee Schedule BLDTM_23 for Rev 481 Proc 37226 * Qty 1 = $8,511.85 at 100% = $8,511.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT FEMOR POPLIT,37226,CPT,481,RC,48100076,CDM,,,,both,,,27475.0000,4121.2500,BLUE CROSS,BLUE CROSS E NETWORK,8571.00,,,,,,,6290.0000,27475.0000,case rate,"Rev 481 Proc 37226 ASG Rate of $8,571.00 at 100% of $8,571.00 = $8,571.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT FEMOR POPLIT,37226,CPT,481,RC,48100076,CDM,,,,both,,,27475.0000,4121.2500,BLUE CROSS,BLUE CROSS P NETWORK,8764.00,,,,,,,6290.0000,27475.0000,case rate,"Rev 481 Proc 37226 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT FEMOR POPLIT,37226,CPT,481,RC,48100076,CDM,,,,both,,,27475.0000,4121.2500,BLUE CROSS,BLUE CROSS S NETWORK,8764.00,,,,,,,6290.0000,27475.0000,case rate,"Rev 481 Proc 37226 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT FEMOR POPLIT,37226,CPT,481,RC,48100076,CDM,,,,both,,,27475.0000,4121.2500,CIGNA HEALTHCARE,CIGNA HMO,11457.08,,,,,,,6290.0000,27475.0000,percent of total billed charges,"41.7% of $27,475.00 in Billed Charges for Rev 481 Proc 37226 = $11,457.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT FEMOR POPLIT,37226,CPT,481,RC,48100076,CDM,,,,both,,,27475.0000,4121.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12748.40,,,,,,,6290.0000,27475.0000,percent of total billed charges,"46.4% of $27,475.00 in Billed Charges for Rev 481 Proc 37226 = $12,748.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT FEMOR POPLIT,37226,CPT,481,RC,48100076,CDM,,,,both,,,27475.0000,4121.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11457.08,,,,,,,6290.0000,27475.0000,percent of total billed charges,"41.7% of $27,475.00 in Billed Charges for Rev 481 Proc 37226 = $11,457.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT FEMOR POPLIT,37226,CPT,481,RC,48100076,CDM,,,,both,,,27475.0000,4121.2500,CIGNA HEALTHCARE,CIGNA PPO,11457.08,,,,,,,6290.0000,27475.0000,percent of total billed charges,"41.7% of $27,475.00 in Billed Charges for Rev 481 Proc 37226 = $11,457.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT FEMOR POPLIT,37226,CPT,481,RC,48100076,CDM,,,,both,,,27475.0000,4121.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,24727.50,,,,,,,6290.0000,27475.0000,percent of total billed charges,"90% of $27,475.00 in Billed Charges for Rev 481 Proc 37226 = $24,727.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT FEMOR POPLIT,37226,CPT,481,RC,48100076,CDM,,,,both,,,27475.0000,4121.2500,MEDCOST,MEDCOST VHN,13075.35,,,,,,,6290.0000,27475.0000,percent of total billed charges,"47.59% of $27,475.00 in Billed Charges for Rev 481 Proc 37226 = $13,075.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT FEMOR POPLIT,37226,CPT,481,RC,48100076,CDM,,,,both,,,27475.0000,4121.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15872.79,,,,,,,6290.0000,27475.0000,fee schedule,"APG 00085 Proc 37226 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 105% = $15,872.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT FEMOR POPLIT,37226,CPT,481,RC,48100076,CDM,,,,both,,,27475.0000,4121.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15585.57,,,,,,,6290.0000,27475.0000,fee schedule,"APG 00085 Proc 37226 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 103.1% = $15,585.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT FEMOR POPLIT,37226,CPT,481,RC,48100076,CDM,,,,both,,,27475.0000,4121.2500,SENTARA HEALTH,SENTARA HEALTH,7091.30,,,,,,,6290.0000,27475.0000,percent of total billed charges,"25.81% of $27,475.00 in Billed Charges for Rev 481 Proc 37226 = $7,091.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT FEMOR POPLIT,37226,CPT,481,RC,48100076,CDM,,,,both,,,27475.0000,4121.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",27475.00,,,,,,,6290.0000,27475.0000,percent of total billed charges,"100% of $27,475.00 in Billed Charges for Rev 481 Proc 37226 = $27,475.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT FEMOR POPLIT,37226,CPT,481,RC,48100076,CDM,,,,both,,,27475.0000,4121.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,6290.0000,27475.0000,case rate,"Rev 481 Proc 37226 ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT FEMOR POPLIT,37226,CPT,481,RC,48100076,CDM,,,,both,,,27475.0000,4121.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,6290.0000,27475.0000,case rate,"Rev 481 Proc 37226 ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT FEMOR POPLIT,37226,CPT,481,RC,48100076,CDM,,,,both,,,27475.0000,4121.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,6290.0000,27475.0000,case rate,"Rev 481 Proc 37226 ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT FEMOR POPLIT,37226,CPT,481,RC,48100076,CDM,,,,both,,,27475.0000,4121.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,20054.00,,,,,,,6290.0000,27475.0000,case rate,"Rev 481 Proc 37226 ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT FEMOR POPLIT,37226,CPT,481,RC,48100076,CDM,,,,both,,,27475.0000,4121.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15570.45,,,,,,,6290.0000,27475.0000,fee schedule,"APG 00085 Proc 37226 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT FEMOR POPLIT,37226,CPT,481,RC,48100076,CDM,,,,both,,,27475.0000,4121.2500,WELLCARE,WELLCARE MEDICAID,27475.00,,,,,,,6290.0000,27475.0000,percent of total billed charges,"100% of $27,475.00 in Billed Charges for Rev 481 Proc 37226 = $27,475.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,AETNA,AETNA,798.06,,,,,,,482.3900,1917.9600,percent of total billed charges,"42.7% of $1,869.00 in Billed Charges for Rev 361 Proc 19283 = $798.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1899.70,,,,,,,482.3900,1917.9600,fee schedule,"APG 00020 Proc 19283 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,826.63 at 104% = $1,899.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,AMBETTER,AMBETTER,1400.59,,,,,,,482.3900,1917.9600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,482.3900,1917.9600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1869.00,,,,,,,482.3900,1917.9600,fee schedule,"APG 00020 Proc 19283 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,826.63 at 103% = $1,881.43 (Service Line reduced to $1,869.00, claim capped at $1,869.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,482.3900,1917.9600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1869.00,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,482.3900,1917.9600,case rate,"Rev 361 Proc 19283 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,482.3900,1917.9600,case rate,Rev 361 Proc 19283 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,482.3900,1917.9600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,482.3900,1917.9600,case rate,Rev 361 Proc 19283 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,482.3900,1917.9600,case rate,Rev 361 Proc 19283 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,CIGNA HEALTHCARE,CIGNA HMO,1869.00,,,,,,,482.3900,1917.9600,case rate,"Rev 361 Proc 19283 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,869.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,869.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,482.3900,1917.9600,case rate,"Rev 361 Proc 19283 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,482.3900,1917.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1869.00,,,,,,,482.3900,1917.9600,case rate,"Rev 361 Proc 19283 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,869.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,869.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,CIGNA HEALTHCARE,CIGNA PPO,1869.00,,,,,,,482.3900,1917.9600,case rate,"Rev 361 Proc 19283 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,869.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,869.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,482.3900,1917.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1682.10,,,,,,,482.3900,1917.9600,percent of total billed charges,"90% of $1,869.00 in Billed Charges for Rev 361 Proc 19283 = $1,682.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,HUMANA,HUMANA MEDICARE,642.47,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,MEDCOST,MEDCOST VHN,889.46,,,,,,,482.3900,1917.9600,percent of total billed charges,"47.59% of $1,869.00 in Billed Charges for Rev 361 Proc 19283 = $889.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1917.96,,,,,,,482.3900,1917.9600,fee schedule,"APG 00020 Proc 19283 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,826.63 at 100% = $1,826.63... $1,826.63 at 105% = $1,917.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,482.3900,1917.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,482.3900,1917.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,482.3900,1917.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1883.26,,,,,,,482.3900,1917.9600,fee schedule,"APG 00020 Proc 19283 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,826.63 at 100% = $1,826.63... $1,826.63 at 103.1% = $1,883.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,SENTARA HEALTH,SENTARA HEALTH,482.39,,,,,,,482.3900,1917.9600,percent of total billed charges,"25.81% of $1,869.00 in Billed Charges for Rev 361 Proc 19283 = $482.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1869.00,,,,,,,482.3900,1917.9600,percent of total billed charges,"100% of $1,869.00 in Billed Charges for Rev 361 Proc 19283 = $1,869.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,482.3900,1917.9600,case rate,Rev 361 Proc 19283 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,482.3900,1917.9600,case rate,Rev 361 Proc 19283 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,482.3900,1917.9600,case rate,Rev 361 Proc 19283 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,482.3900,1917.9600,case rate,"Rev 361 Proc 19283 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1881.43,,,,,,,482.3900,1917.9600,fee schedule,"APG 00020 Proc 19283 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,826.63 at 103% = $1,881.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,WELLCARE,WELLCARE MEDICAID,1869.00,,,,,,,482.3900,1917.9600,percent of total billed charges,"100% of $1,869.00 in Billed Charges for Rev 361 Proc 19283 = $1,869.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CB STERO LOC BRST PLC WIRE 1ST LESION,19283,CPT,361,RC,36100219,CDM,,,,both,,,1869.0000,280.3500,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,482.3900,1917.9600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE EA ADD,19284,CPT,361,RC,36100220,CDM,,,,both,,,468.0000,70.2000,AETNA,AETNA,199.84,,,,,,,120.7900,1917.9600,percent of total billed charges,42.7% of $468.00 in Billed Charges for Rev 361 Proc 19284 = $199.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CB STERO LOC BRST PLC WIRE EA ADD,19284,CPT,361,RC,36100220,CDM,,,,both,,,468.0000,70.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1899.70,,,,,,,120.7900,1917.9600,fee schedule,"APG 00020 Proc 19284 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 104% = $1,899.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST PLC WIRE EA ADD,19284,CPT,361,RC,36100220,CDM,,,,both,,,468.0000,70.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,468.00,,,,,,,120.7900,1917.9600,fee schedule,"APG 00020 Proc 19284 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43 (Service Line reduced to $468.00, claim capped at $468.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST PLC WIRE EA ADD,19284,CPT,361,RC,36100220,CDM,,,,both,,,468.0000,70.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,468.00,,,,,,,120.7900,1917.9600,case rate,"Rev 361 Proc 19284 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $468.00 in Billed Charges - $0.00 in ASG Allowed Amount = $468.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST PLC WIRE EA ADD,19284,CPT,361,RC,36100220,CDM,,,,both,,,468.0000,70.2000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,120.7900,1917.9600,case rate,Rev 361 Proc 19284 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE EA ADD,19284,CPT,361,RC,36100220,CDM,,,,both,,,468.0000,70.2000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,120.7900,1917.9600,case rate,Rev 361 Proc 19284 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE EA ADD,19284,CPT,361,RC,36100220,CDM,,,,both,,,468.0000,70.2000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,120.7900,1917.9600,case rate,Rev 361 Proc 19284 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE EA ADD,19284,CPT,361,RC,36100220,CDM,,,,both,,,468.0000,70.2000,CIGNA HEALTHCARE,CIGNA HMO,468.00,,,,,,,120.7900,1917.9600,case rate,"Rev 361 Proc 19284 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $468.00 in Billed Charges - $0.00 in ASG Allowed Amount = $468.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST PLC WIRE EA ADD,19284,CPT,361,RC,36100220,CDM,,,,both,,,468.0000,70.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,468.00,,,,,,,120.7900,1917.9600,case rate,"Rev 361 Proc 19284 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $468.00 in Billed Charges - $0.00 in ASG Allowed Amount = $468.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST PLC WIRE EA ADD,19284,CPT,361,RC,36100220,CDM,,,,both,,,468.0000,70.2000,CIGNA HEALTHCARE,CIGNA PPO,468.00,,,,,,,120.7900,1917.9600,case rate,"Rev 361 Proc 19284 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $468.00 in Billed Charges - $0.00 in ASG Allowed Amount = $468.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST PLC WIRE EA ADD,19284,CPT,361,RC,36100220,CDM,,,,both,,,468.0000,70.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,421.20,,,,,,,120.7900,1917.9600,percent of total billed charges,90% of $468.00 in Billed Charges for Rev 361 Proc 19284 = $421.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CB STERO LOC BRST PLC WIRE EA ADD,19284,CPT,361,RC,36100220,CDM,,,,both,,,468.0000,70.2000,MEDCOST,MEDCOST VHN,222.72,,,,,,,120.7900,1917.9600,percent of total billed charges,47.59% of $468.00 in Billed Charges for Rev 361 Proc 19284 = $222.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CB STERO LOC BRST PLC WIRE EA ADD,19284,CPT,361,RC,36100220,CDM,,,,both,,,468.0000,70.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1917.96,,,,,,,120.7900,1917.9600,fee schedule,"APG 00020 Proc 19284 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 105% = $1,917.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST PLC WIRE EA ADD,19284,CPT,361,RC,36100220,CDM,,,,both,,,468.0000,70.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1883.26,,,,,,,120.7900,1917.9600,fee schedule,"APG 00020 Proc 19284 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 103.1% = $1,883.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST PLC WIRE EA ADD,19284,CPT,361,RC,36100220,CDM,,,,both,,,468.0000,70.2000,SENTARA HEALTH,SENTARA HEALTH,120.79,,,,,,,120.7900,1917.9600,percent of total billed charges,25.81% of $468.00 in Billed Charges for Rev 361 Proc 19284 = $120.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CB STERO LOC BRST PLC WIRE EA ADD,19284,CPT,361,RC,36100220,CDM,,,,both,,,468.0000,70.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",468.00,,,,,,,120.7900,1917.9600,percent of total billed charges,100% of $468.00 in Billed Charges for Rev 361 Proc 19284 = $468.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CB STERO LOC BRST PLC WIRE EA ADD,19284,CPT,361,RC,36100220,CDM,,,,both,,,468.0000,70.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,120.7900,1917.9600,case rate,Rev 361 Proc 19284 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE EA ADD,19284,CPT,361,RC,36100220,CDM,,,,both,,,468.0000,70.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,120.7900,1917.9600,case rate,Rev 361 Proc 19284 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE EA ADD,19284,CPT,361,RC,36100220,CDM,,,,both,,,468.0000,70.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,120.7900,1917.9600,case rate,Rev 361 Proc 19284 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CB STERO LOC BRST PLC WIRE EA ADD,19284,CPT,361,RC,36100220,CDM,,,,both,,,468.0000,70.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,468.00,,,,,,,120.7900,1917.9600,case rate,"Rev 361 Proc 19284 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total (Service Line reduced to $468.00, claim capped at $468.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST PLC WIRE EA ADD,19284,CPT,361,RC,36100220,CDM,,,,both,,,468.0000,70.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1881.43,,,,,,,120.7900,1917.9600,fee schedule,"APG 00020 Proc 19284 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CB STERO LOC BRST PLC WIRE EA ADD,19284,CPT,361,RC,36100220,CDM,,,,both,,,468.0000,70.2000,WELLCARE,WELLCARE MEDICAID,468.00,,,,,,,120.7900,1917.9600,percent of total billed charges,100% of $468.00 in Billed Charges for Rev 361 Proc 19284 = $468.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CBU BREAST PLC WIRE EA ADD,19286,CPT,361,RC,36100222,CDM,,,,both,,,626.0000,93.9000,AETNA,AETNA,267.30,,,,,,,148.0000,1917.9600,percent of total billed charges,42.7% of $626.00 in Billed Charges for Rev 361 Proc 19286 = $267.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CBU BREAST PLC WIRE EA ADD,19286,CPT,361,RC,36100222,CDM,,,,both,,,626.0000,93.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1899.70,,,,,,,148.0000,1917.9600,fee schedule,"APG 00020 Proc 19286 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 104% = $1,899.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CBU BREAST PLC WIRE EA ADD,19286,CPT,361,RC,36100222,CDM,,,,both,,,626.0000,93.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,626.00,,,,,,,148.0000,1917.9600,fee schedule,"APG 00020 Proc 19286 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43 (Service Line reduced to $626.00, claim capped at $626.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CBU BREAST PLC WIRE EA ADD,19286,CPT,361,RC,36100222,CDM,,,,both,,,626.0000,93.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,626.00,,,,,,,148.0000,1917.9600,case rate,"Rev 361 Proc 19286 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $626.00 in Billed Charges - $0.00 in ASG Allowed Amount = $626.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CBU BREAST PLC WIRE EA ADD,19286,CPT,361,RC,36100222,CDM,,,,both,,,626.0000,93.9000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,1917.9600,case rate,Rev 361 Proc 19286 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE EA ADD,19286,CPT,361,RC,36100222,CDM,,,,both,,,626.0000,93.9000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,1917.9600,case rate,Rev 361 Proc 19286 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE EA ADD,19286,CPT,361,RC,36100222,CDM,,,,both,,,626.0000,93.9000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,1917.9600,case rate,Rev 361 Proc 19286 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE EA ADD,19286,CPT,361,RC,36100222,CDM,,,,both,,,626.0000,93.9000,CIGNA HEALTHCARE,CIGNA HMO,626.00,,,,,,,148.0000,1917.9600,case rate,"Rev 361 Proc 19286 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $626.00 in Billed Charges - $0.00 in ASG Allowed Amount = $626.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CBU BREAST PLC WIRE EA ADD,19286,CPT,361,RC,36100222,CDM,,,,both,,,626.0000,93.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,626.00,,,,,,,148.0000,1917.9600,case rate,"Rev 361 Proc 19286 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $626.00 in Billed Charges - $0.00 in ASG Allowed Amount = $626.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CBU BREAST PLC WIRE EA ADD,19286,CPT,361,RC,36100222,CDM,,,,both,,,626.0000,93.9000,CIGNA HEALTHCARE,CIGNA PPO,626.00,,,,,,,148.0000,1917.9600,case rate,"Rev 361 Proc 19286 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $626.00 in Billed Charges - $0.00 in ASG Allowed Amount = $626.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CBU BREAST PLC WIRE EA ADD,19286,CPT,361,RC,36100222,CDM,,,,both,,,626.0000,93.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,563.40,,,,,,,148.0000,1917.9600,percent of total billed charges,90% of $626.00 in Billed Charges for Rev 361 Proc 19286 = $563.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CBU BREAST PLC WIRE EA ADD,19286,CPT,361,RC,36100222,CDM,,,,both,,,626.0000,93.9000,MEDCOST,MEDCOST VHN,297.91,,,,,,,148.0000,1917.9600,percent of total billed charges,47.59% of $626.00 in Billed Charges for Rev 361 Proc 19286 = $297.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CBU BREAST PLC WIRE EA ADD,19286,CPT,361,RC,36100222,CDM,,,,both,,,626.0000,93.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1917.96,,,,,,,148.0000,1917.9600,fee schedule,"APG 00020 Proc 19286 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 105% = $1,917.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CBU BREAST PLC WIRE EA ADD,19286,CPT,361,RC,36100222,CDM,,,,both,,,626.0000,93.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1883.26,,,,,,,148.0000,1917.9600,fee schedule,"APG 00020 Proc 19286 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 100% = $1,826.63... $1,826.63 at 103.1% = $1,883.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CBU BREAST PLC WIRE EA ADD,19286,CPT,361,RC,36100222,CDM,,,,both,,,626.0000,93.9000,SENTARA HEALTH,SENTARA HEALTH,161.57,,,,,,,148.0000,1917.9600,percent of total billed charges,25.81% of $626.00 in Billed Charges for Rev 361 Proc 19286 = $161.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CBU BREAST PLC WIRE EA ADD,19286,CPT,361,RC,36100222,CDM,,,,both,,,626.0000,93.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",626.00,,,,,,,148.0000,1917.9600,percent of total billed charges,100% of $626.00 in Billed Charges for Rev 361 Proc 19286 = $626.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CBU BREAST PLC WIRE EA ADD,19286,CPT,361,RC,36100222,CDM,,,,both,,,626.0000,93.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,148.0000,1917.9600,case rate,Rev 361 Proc 19286 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE EA ADD,19286,CPT,361,RC,36100222,CDM,,,,both,,,626.0000,93.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,148.0000,1917.9600,case rate,Rev 361 Proc 19286 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE EA ADD,19286,CPT,361,RC,36100222,CDM,,,,both,,,626.0000,93.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,148.0000,1917.9600,case rate,Rev 361 Proc 19286 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE EA ADD,19286,CPT,361,RC,36100222,CDM,,,,both,,,626.0000,93.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,148.0000,1917.9600,case rate,Rev 361 Proc 19286 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CBU BREAST PLC WIRE EA ADD,19286,CPT,361,RC,36100222,CDM,,,,both,,,626.0000,93.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1881.43,,,,,,,148.0000,1917.9600,fee schedule,"APG 00020 Proc 19286 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment) at 103% = $1,881.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CBU BREAST PLC WIRE EA ADD,19286,CPT,361,RC,36100222,CDM,,,,both,,,626.0000,93.9000,WELLCARE,WELLCARE MEDICAID,626.00,,,,,,,148.0000,1917.9600,percent of total billed charges,100% of $626.00 in Billed Charges for Rev 361 Proc 19286 = $626.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,AETNA,AETNA,798.06,,,,,,,482.3900,1917.9600,percent of total billed charges,"42.7% of $1,869.00 in Billed Charges for Rev 361 Proc 19287 = $798.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1899.70,,,,,,,482.3900,1917.9600,fee schedule,"APG 00020 Proc 19287 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,826.63 at 104% = $1,899.70. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,AMBETTER,AMBETTER,1400.59,,,,,,,482.3900,1917.9600,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,482.3900,1917.9600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1869.00,,,,,,,482.3900,1917.9600,fee schedule,"APG 00020 Proc 19287 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,826.63 at 103% = $1,881.43 (Service Line reduced to $1,869.00, claim capped at $1,869.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,482.3900,1917.9600,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1869.00,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,482.3900,1917.9600,case rate,"Rev 361 Proc 19287 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,482.3900,1917.9600,case rate,Rev 361 Proc 19287 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,482.3900,1917.9600,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,482.3900,1917.9600,case rate,Rev 361 Proc 19287 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,482.3900,1917.9600,case rate,Rev 361 Proc 19287 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,CIGNA HEALTHCARE,CIGNA HMO,1869.00,,,,,,,482.3900,1917.9600,case rate,"Rev 361 Proc 19287 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,869.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,869.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,482.3900,1917.9600,case rate,"Rev 361 Proc 19287 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,482.3900,1917.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1869.00,,,,,,,482.3900,1917.9600,case rate,"Rev 361 Proc 19287 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,869.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,869.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,CIGNA HEALTHCARE,CIGNA PPO,1869.00,,,,,,,482.3900,1917.9600,case rate,"Rev 361 Proc 19287 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,869.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,869.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,482.3900,1917.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1682.10,,,,,,,482.3900,1917.9600,percent of total billed charges,"90% of $1,869.00 in Billed Charges for Rev 361 Proc 19287 = $1,682.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,HUMANA,HUMANA MEDICARE,642.47,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,MEDCOST,MEDCOST VHN,889.46,,,,,,,482.3900,1917.9600,percent of total billed charges,"47.59% of $1,869.00 in Billed Charges for Rev 361 Proc 19287 = $889.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1917.96,,,,,,,482.3900,1917.9600,fee schedule,"APG 00020 Proc 19287 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,826.63 at 100% = $1,826.63... $1,826.63 at 105% = $1,917.96 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,482.3900,1917.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,482.3900,1917.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,482.3900,1917.9600,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1883.26,,,,,,,482.3900,1917.9600,fee schedule,"APG 00020 Proc 19287 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,826.63 at 100% = $1,826.63... $1,826.63 at 103.1% = $1,883.26 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,SENTARA HEALTH,SENTARA HEALTH,482.39,,,,,,,482.3900,1917.9600,percent of total billed charges,"25.81% of $1,869.00 in Billed Charges for Rev 361 Proc 19287 = $482.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1869.00,,,,,,,482.3900,1917.9600,percent of total billed charges,"100% of $1,869.00 in Billed Charges for Rev 361 Proc 19287 = $1,869.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,482.3900,1917.9600,case rate,Rev 361 Proc 19287 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,482.3900,1917.9600,case rate,Rev 361 Proc 19287 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,482.3900,1917.9600,case rate,Rev 361 Proc 19287 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,482.3900,1917.9600,case rate,"Rev 361 Proc 19287 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1881.43,,,,,,,482.3900,1917.9600,fee schedule,"APG 00020 Proc 19287 at $836.60 (Base Rate) * 2.1834 (Relative Weight) = $1,826.63 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,826.63 at 103% = $1,881.43. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,482.3900,1917.9600,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,WELLCARE,WELLCARE MEDICAID,1869.00,,,,,,,482.3900,1917.9600,percent of total billed charges,"100% of $1,869.00 in Billed Charges for Rev 361 Proc 19287 = $1,869.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR BREAST PLC WIRE 1ST LESION,19287,CPT,361,RC,36100225,CDM,,,,both,,,1869.0000,280.3500,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,482.3900,1917.9600,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,AETNA,AETNA,2428.78,,,,,,,87.8900,5688.0000,percent of total billed charges,"42.7% of $5,688.00 in Billed Charges for Rev 450 Proc 20101 = $2,428.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1463.97,,,,,,,87.8900,5688.0000,fee schedule,"APG 00018 Proc 20101 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,407.66 at 104% = $1,463.97. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1871.96,,,,,,,87.8900,5688.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,AETNA,AETNA HEALTHCARE MEDICARE,1871.96,,,,,,,87.8900,5688.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,1871.96,,,,,,,87.8900,5688.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,AMBETTER,AMBETTER,4080.88,,,,,,,87.8900,5688.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1946.84,,,,,,,87.8900,5688.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,BLUE CROSS,ANTHEM EXCHANGE,4608.86,,,,,,,87.8900,5688.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1449.89,,,,,,,87.8900,5688.0000,fee schedule,"APG 00018 Proc 20101 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,407.66 at 103% = $1,449.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,BLUE CROSS,ANTHEM HMO,4896.64,,,,,,,87.8900,5688.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1928.12,,,,,,,87.8900,5688.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5688.00,,,,,,,87.8900,5688.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,168.77,,,,,,,87.8900,5688.0000,fee schedule,$168.77 from Fee Schedule BLDTM_23 for Rev 450 Proc 20101 * Qty 1 = $168.77 at 100% = $168.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,BLUE CROSS,BLUE CROSS MEDICARE,1946.84,,,,,,,87.8900,5688.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,BLUE CROSS,TENNCARE BLUE CARE,87.89,,,,,,,87.8900,5688.0000,fee schedule,$75.77 from Fee Schedule TC_24 for Rev 450 Proc 20101 * Qty 1 = $75.77 at 116% = $87.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,BLUE CROSS,TENNCARE BLUE SELECT,87.89,,,,,,,87.8900,5688.0000,fee schedule,$75.77 from Fee Schedule TC_24 for Rev 450 Proc 20101 * Qty 1 = $75.77 at 116% = $87.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,1965.56,,,,,,,87.8900,5688.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1965.56,,,,,,,87.8900,5688.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5119.20,,,,,,,87.8900,5688.0000,percent of total billed charges,"90% of $5,688.00 in Billed Charges for Rev 450 Proc 20101 = $5,119.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,HUMANA,HUMANA MEDICARE,1871.96,,,,,,,87.8900,5688.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1871.96,,,,,,,87.8900,5688.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,MEDCOST,MEDCOST VHN,2706.92,,,,,,,87.8900,5688.0000,percent of total billed charges,"47.59% of $5,688.00 in Billed Charges for Rev 450 Proc 20101 = $2,706.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1478.04,,,,,,,87.8900,5688.0000,fee schedule,"APG 00018 Proc 20101 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,407.66 at 100% = $1,407.66... $1,407.66 at 105% = $1,478.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1965.56,,,,,,,87.8900,5688.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1965.56,,,,,,,87.8900,5688.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,NHC ADVANTAGE,NHC ADVANTAGE,1965.56,,,,,,,87.8900,5688.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1451.30,,,,,,,87.8900,5688.0000,fee schedule,"APG 00018 Proc 20101 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,407.66 at 100% = $1,407.66... $1,407.66 at 103.1% = $1,451.30 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,SENTARA HEALTH,SENTARA HEALTH,1468.07,,,,,,,87.8900,5688.0000,percent of total billed charges,"25.81% of $5,688.00 in Billed Charges for Rev 450 Proc 20101 = $1,468.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,SENTARA HEALTH,SENTARA MEDICARE,1871.96,,,,,,,87.8900,5688.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5688.00,,,,,,,87.8900,5688.0000,percent of total billed charges,"100% of $5,688.00 in Billed Charges for Rev 450 Proc 20101 = $5,688.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,87.8900,5688.0000,case rate,Rev 450 Proc 20101 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,87.8900,5688.0000,case rate,Rev 450 Proc 20101 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,87.8900,5688.0000,case rate,Rev 450 Proc 20101 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,87.8900,5688.0000,case rate,Rev 450 Proc 20101 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1449.89,,,,,,,87.8900,5688.0000,fee schedule,"APG 00018 Proc 20101 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,407.66 at 103% = $1,449.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1871.96,,,,,,,87.8900,5688.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1871.96,,,,,,,87.8900,5688.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,WELLCARE,WELLCARE MEDICAID,5688.00,,,,,,,87.8900,5688.0000,percent of total billed charges,"100% of $5,688.00 in Billed Charges for Rev 450 Proc 20101 = $5,688.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXPL PENETRAT WND CHEST,20101,CPT,450,RC,45000358,CDM,,,,both,,,5688.0000,853.2000,WELLCARE,WELLCARE MEDICARE,1984.28,,,,,,,87.8900,5688.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,AETNA,AETNA,2428.78,,,,,,,109.0000,5688.0000,percent of total billed charges,"42.7% of $5,688.00 in Billed Charges for Rev 450 Proc 20102 = $2,428.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1463.97,,,,,,,109.0000,5688.0000,fee schedule,"APG 00018 Proc 20102 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,407.66 at 104% = $1,463.97. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1871.96,,,,,,,109.0000,5688.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,AETNA,AETNA HEALTHCARE MEDICARE,1871.96,,,,,,,109.0000,5688.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,1871.96,,,,,,,109.0000,5688.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,AMBETTER,AMBETTER,4080.88,,,,,,,109.0000,5688.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1946.84,,,,,,,109.0000,5688.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,BLUE CROSS,ANTHEM EXCHANGE,4608.86,,,,,,,109.0000,5688.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1449.89,,,,,,,109.0000,5688.0000,fee schedule,"APG 00018 Proc 20102 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,407.66 at 103% = $1,449.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,BLUE CROSS,ANTHEM HMO,4896.64,,,,,,,109.0000,5688.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1928.12,,,,,,,109.0000,5688.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5688.00,,,,,,,109.0000,5688.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,207.50,,,,,,,109.0000,5688.0000,fee schedule,$207.50 from Fee Schedule BLDTM_23 for Rev 450 Proc 20102 * Qty 1 = $207.50 at 100% = $207.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,BLUE CROSS,BLUE CROSS MEDICARE,1946.84,,,,,,,109.0000,5688.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,1965.56,,,,,,,109.0000,5688.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1965.56,,,,,,,109.0000,5688.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5119.20,,,,,,,109.0000,5688.0000,percent of total billed charges,"90% of $5,688.00 in Billed Charges for Rev 450 Proc 20102 = $5,119.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,HUMANA,HUMANA MEDICARE,1871.96,,,,,,,109.0000,5688.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1871.96,,,,,,,109.0000,5688.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,MEDCOST,MEDCOST VHN,2706.92,,,,,,,109.0000,5688.0000,percent of total billed charges,"47.59% of $5,688.00 in Billed Charges for Rev 450 Proc 20102 = $2,706.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1478.04,,,,,,,109.0000,5688.0000,fee schedule,"APG 00018 Proc 20102 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,407.66 at 100% = $1,407.66... $1,407.66 at 105% = $1,478.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1965.56,,,,,,,109.0000,5688.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1965.56,,,,,,,109.0000,5688.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,NHC ADVANTAGE,NHC ADVANTAGE,1965.56,,,,,,,109.0000,5688.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1451.30,,,,,,,109.0000,5688.0000,fee schedule,"APG 00018 Proc 20102 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,407.66 at 100% = $1,407.66... $1,407.66 at 103.1% = $1,451.30 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,SENTARA HEALTH,SENTARA HEALTH,1468.07,,,,,,,109.0000,5688.0000,percent of total billed charges,"25.81% of $5,688.00 in Billed Charges for Rev 450 Proc 20102 = $1,468.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,SENTARA HEALTH,SENTARA MEDICARE,1871.96,,,,,,,109.0000,5688.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5688.00,,,,,,,109.0000,5688.0000,percent of total billed charges,"100% of $5,688.00 in Billed Charges for Rev 450 Proc 20102 = $5,688.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,5688.0000,case rate,Rev 450 Proc 20102 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,5688.0000,case rate,Rev 450 Proc 20102 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,5688.0000,case rate,Rev 450 Proc 20102 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,5688.0000,case rate,Rev 450 Proc 20102 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1449.89,,,,,,,109.0000,5688.0000,fee schedule,"APG 00018 Proc 20102 at $836.60 (Base Rate) * 1.6826 (Relative Weight) = $1,407.66 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,407.66 at 103% = $1,449.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1871.96,,,,,,,109.0000,5688.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1871.96,,,,,,,109.0000,5688.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,WELLCARE,WELLCARE MEDICAID,5688.00,,,,,,,109.0000,5688.0000,percent of total billed charges,"100% of $5,688.00 in Billed Charges for Rev 450 Proc 20102 = $5,688.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXPL PENETRAT WND ABD/FLANK/BACK,20102,CPT,450,RC,45000359,CDM,,,,both,,,5688.0000,853.2000,WELLCARE,WELLCARE MEDICARE,1984.28,,,,,,,109.0000,5688.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,AETNA,AETNA,3202.07,,,,,,,890.0000,7499.0000,percent of total billed charges,"42.7% of $7,499.00 in Billed Charges for Rev 361 Proc 20205 = $3,202.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2612.63,,,,,,,890.0000,7499.0000,fee schedule,"APG 00051 Proc 20205 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 104% = $2,612.63. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2635.37,,,,,,,890.0000,7499.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,AETNA,AETNA HEALTHCARE MEDICARE,2635.37,,,,,,,890.0000,7499.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,2635.37,,,,,,,890.0000,7499.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,AMBETTER,AMBETTER,5745.12,,,,,,,890.0000,7499.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2740.79,,,,,,,890.0000,7499.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,BLUE CROSS,ANTHEM EXCHANGE,6488.44,,,,,,,890.0000,7499.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2587.51,,,,,,,890.0000,7499.0000,fee schedule,"APG 00051 Proc 20205 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,BLUE CROSS,ANTHEM HMO,6893.58,,,,,,,890.0000,7499.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2714.44,,,,,,,890.0000,7499.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",7499.00,,,,,,,890.0000,7499.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1082.00,,,,,,,890.0000,7499.0000,case rate,"Rev 361 Proc 20205 ASG Rate of $1,082.00 at 100% of $1,082.00 = $1,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,890.0000,7499.0000,case rate,"Rev 361 Proc 20205 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,BLUE CROSS,BLUE CROSS MEDICARE,2740.79,,,,,,,890.0000,7499.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,890.0000,7499.0000,case rate,"Rev 361 Proc 20205 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,890.0000,7499.0000,case rate,"Rev 361 Proc 20205 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,BLUE CROSS,TENNCARE BLUE CARE,890.00,,,,,,,890.0000,7499.0000,case rate,Rev 361 Proc 20205 ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,BLUE CROSS,TENNCARE BLUE SELECT,890.00,,,,,,,890.0000,7499.0000,case rate,Rev 361 Proc 20205 ASG Rate of $890.00 at 100% of $890.00 = $890.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,CIGNA HEALTHCARE,CIGNA HMO,2967.00,,,,,,,890.0000,7499.0000,case rate,"Rev 361 Proc 20205 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2246.00,,,,,,,890.0000,7499.0000,case rate,"Rev 361 Proc 20205 ASG Rate of $2,246.00 at 100% of $2,246.00 = $2,246.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,2767.14,,,,,,,890.0000,7499.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2967.00,,,,,,,890.0000,7499.0000,case rate,"Rev 361 Proc 20205 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,CIGNA HEALTHCARE,CIGNA PPO,2967.00,,,,,,,890.0000,7499.0000,case rate,"Rev 361 Proc 20205 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,2767.14,,,,,,,890.0000,7499.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6749.10,,,,,,,890.0000,7499.0000,percent of total billed charges,"90% of $7,499.00 in Billed Charges for Rev 361 Proc 20205 = $6,749.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,HUMANA,HUMANA MEDICARE,2635.37,,,,,,,890.0000,7499.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2635.37,,,,,,,890.0000,7499.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,MEDCOST,MEDCOST VHN,3568.77,,,,,,,890.0000,7499.0000,percent of total billed charges,"47.59% of $7,499.00 in Billed Charges for Rev 361 Proc 20205 = $3,568.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2637.75,,,,,,,890.0000,7499.0000,fee schedule,"APG 00051 Proc 20205 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 105% = $2,637.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,2767.14,,,,,,,890.0000,7499.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,2767.14,,,,,,,890.0000,7499.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,NHC ADVANTAGE,NHC ADVANTAGE,2767.14,,,,,,,890.0000,7499.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2590.02,,,,,,,890.0000,7499.0000,fee schedule,"APG 00051 Proc 20205 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 103.1% = $2,590.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,SENTARA HEALTH,SENTARA HEALTH,1935.49,,,,,,,890.0000,7499.0000,percent of total billed charges,"25.81% of $7,499.00 in Billed Charges for Rev 361 Proc 20205 = $1,935.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,SENTARA HEALTH,SENTARA MEDICARE,2635.37,,,,,,,890.0000,7499.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7499.00,,,,,,,890.0000,7499.0000,percent of total billed charges,"100% of $7,499.00 in Billed Charges for Rev 361 Proc 20205 = $7,499.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,890.0000,7499.0000,case rate,Rev 361 Proc 20205 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,890.0000,7499.0000,case rate,"Rev 361 Proc 20205 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,890.0000,7499.0000,case rate,"Rev 361 Proc 20205 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,890.0000,7499.0000,case rate,"Rev 361 Proc 20205 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2587.51,,,,,,,890.0000,7499.0000,fee schedule,"APG 00051 Proc 20205 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2635.37,,,,,,,890.0000,7499.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2635.37,,,,,,,890.0000,7499.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,WELLCARE,WELLCARE MEDICAID,7499.00,,,,,,,890.0000,7499.0000,percent of total billed charges,"100% of $7,499.00 in Billed Charges for Rev 361 Proc 20205 = $7,499.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT MUSCLE DEEP BIOPSY,20205,CPT,361,RC,36100515,CDM,,,,both,,,7499.0000,1124.8500,WELLCARE,WELLCARE MEDICARE,2793.50,,,,,,,890.0000,7499.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,AETNA,AETNA,962.89,,,,,,,578.0000,3266.6300,percent of total billed charges,"42.7% of $2,255.00 in Billed Charges for Rev 361 Proc 20220 = $962.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,AETNA,AETNA HEALTHCARE MEDICARE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,AMBETTER,AMBETTER,3266.63,,,,,,,578.0000,3266.6300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1558.39,,,,,,,578.0000,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,BLUE CROSS,ANTHEM EXCHANGE,2255.00,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,BLUE CROSS,ANTHEM HMO,2255.00,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1543.41,,,,,,,578.0000,3266.6300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2255.00,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,578.0000,3266.6300,case rate,Rev 361 Proc 20220 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 20220 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,BLUE CROSS,BLUE CROSS MEDICARE,1558.39,,,,,,,578.0000,3266.6300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 20220 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 20220 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,3266.6300,case rate,Rev 361 Proc 20220 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,3266.6300,case rate,Rev 361 Proc 20220 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 20220 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 20220 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,1573.37,,,,,,,578.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 20220 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 20220 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1573.37,,,,,,,578.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2029.50,,,,,,,578.0000,3266.6300,percent of total billed charges,"90% of $2,255.00 in Billed Charges for Rev 361 Proc 20220 = $2,029.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,HUMANA,HUMANA MEDICARE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,MEDCOST,MEDCOST VHN,1073.15,,,,,,,578.0000,3266.6300,percent of total billed charges,"47.59% of $2,255.00 in Billed Charges for Rev 361 Proc 20220 = $1,073.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1573.37,,,,,,,578.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1573.37,,,,,,,578.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,NHC ADVANTAGE,NHC ADVANTAGE,1573.37,,,,,,,578.0000,3266.6300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,SENTARA HEALTH,SENTARA HEALTH,582.02,,,,,,,578.0000,3266.6300,percent of total billed charges,"25.81% of $2,255.00 in Billed Charges for Rev 361 Proc 20220 = $582.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,SENTARA HEALTH,SENTARA MEDICARE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2255.00,,,,,,,578.0000,3266.6300,percent of total billed charges,"100% of $2,255.00 in Billed Charges for Rev 361 Proc 20220 = $2,255.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,578.0000,3266.6300,case rate,Rev 361 Proc 20220 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,578.0000,3266.6300,case rate,Rev 361 Proc 20220 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,578.0000,3266.6300,case rate,Rev 361 Proc 20220 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,578.0000,3266.6300,case rate,"Rev 361 Proc 20220 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1498.45,,,,,,,578.0000,3266.6300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,WELLCARE,WELLCARE MEDICAID,2255.00,,,,,,,578.0000,3266.6300,percent of total billed charges,"100% of $2,255.00 in Billed Charges for Rev 361 Proc 20220 = $2,255.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX BONE TROCAR NEEDLE SUPER,20220,CPT,361,RC,36100066,CDM,,,,both,,,2255.0000,338.2500,WELLCARE,WELLCARE MEDICARE,1588.36,,,,,,,578.0000,3266.6300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM HIP,27093,CPT,361,RC,36100085,CDM,,,,both,,,1127.0000,169.0500,AETNA,AETNA,481.23,,,,,,,148.0000,1127.0000,percent of total billed charges,"42.7% of $1,127.00 in Billed Charges for Rev 361 Proc 27093 = $481.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ARTHROGRAM HIP,27093,CPT,361,RC,36100085,CDM,,,,both,,,1127.0000,169.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,495.24,,,,,,,148.0000,1127.0000,fee schedule,APG 00278 Proc 27093 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 104% = $495.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM HIP,27093,CPT,361,RC,36100085,CDM,,,,both,,,1127.0000,169.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,490.48,,,,,,,148.0000,1127.0000,fee schedule,APG 00278 Proc 27093 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 103% = $490.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM HIP,27093,CPT,361,RC,36100085,CDM,,,,both,,,1127.0000,169.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1127.00,,,,,,,148.0000,1127.0000,case rate,"Rev 361 Proc 27093 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total (Limited to $1,127.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,127.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ARTHROGRAM HIP,27093,CPT,361,RC,36100085,CDM,,,,both,,,1127.0000,169.0500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,1127.0000,case rate,Rev 361 Proc 27093 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM HIP,27093,CPT,361,RC,36100085,CDM,,,,both,,,1127.0000,169.0500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,1127.0000,case rate,Rev 361 Proc 27093 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM HIP,27093,CPT,361,RC,36100085,CDM,,,,both,,,1127.0000,169.0500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,1127.0000,case rate,Rev 361 Proc 27093 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM HIP,27093,CPT,361,RC,36100085,CDM,,,,both,,,1127.0000,169.0500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,148.0000,1127.0000,case rate,Rev 361 Proc 27093 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM HIP,27093,CPT,361,RC,36100085,CDM,,,,both,,,1127.0000,169.0500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,148.0000,1127.0000,case rate,Rev 361 Proc 27093 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM HIP,27093,CPT,361,RC,36100085,CDM,,,,both,,,1127.0000,169.0500,CIGNA HEALTHCARE,CIGNA HMO,1127.00,,,,,,,148.0000,1127.0000,case rate,"Rev 361 Proc 27093 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,127.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,127.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ARTHROGRAM HIP,27093,CPT,361,RC,36100085,CDM,,,,both,,,1127.0000,169.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1127.00,,,,,,,148.0000,1127.0000,case rate,"Rev 361 Proc 27093 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,127.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,127.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ARTHROGRAM HIP,27093,CPT,361,RC,36100085,CDM,,,,both,,,1127.0000,169.0500,CIGNA HEALTHCARE,CIGNA PPO,1127.00,,,,,,,148.0000,1127.0000,case rate,"Rev 361 Proc 27093 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,127.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,127.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ARTHROGRAM HIP,27093,CPT,361,RC,36100085,CDM,,,,both,,,1127.0000,169.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1014.30,,,,,,,148.0000,1127.0000,percent of total billed charges,"90% of $1,127.00 in Billed Charges for Rev 361 Proc 27093 = $1,014.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ARTHROGRAM HIP,27093,CPT,361,RC,36100085,CDM,,,,both,,,1127.0000,169.0500,MEDCOST,MEDCOST VHN,536.34,,,,,,,148.0000,1127.0000,percent of total billed charges,"47.59% of $1,127.00 in Billed Charges for Rev 361 Proc 27093 = $536.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ARTHROGRAM HIP,27093,CPT,361,RC,36100085,CDM,,,,both,,,1127.0000,169.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,500.00,,,,,,,148.0000,1127.0000,fee schedule,APG 00278 Proc 27093 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 100% = $476.19... $476.19 at 105% = $500.00 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM HIP,27093,CPT,361,RC,36100085,CDM,,,,both,,,1127.0000,169.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,490.95,,,,,,,148.0000,1127.0000,fee schedule,APG 00278 Proc 27093 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 100% = $476.19... $476.19 at 103.1% = $490.95 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM HIP,27093,CPT,361,RC,36100085,CDM,,,,both,,,1127.0000,169.0500,SENTARA HEALTH,SENTARA HEALTH,290.88,,,,,,,148.0000,1127.0000,percent of total billed charges,"25.81% of $1,127.00 in Billed Charges for Rev 361 Proc 27093 = $290.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ARTHROGRAM HIP,27093,CPT,361,RC,36100085,CDM,,,,both,,,1127.0000,169.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1127.00,,,,,,,148.0000,1127.0000,percent of total billed charges,"100% of $1,127.00 in Billed Charges for Rev 361 Proc 27093 = $1,127.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ARTHROGRAM HIP,27093,CPT,361,RC,36100085,CDM,,,,both,,,1127.0000,169.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,148.0000,1127.0000,case rate,Rev 361 Proc 27093 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM HIP,27093,CPT,361,RC,36100085,CDM,,,,both,,,1127.0000,169.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,148.0000,1127.0000,case rate,Rev 361 Proc 27093 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM HIP,27093,CPT,361,RC,36100085,CDM,,,,both,,,1127.0000,169.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,148.0000,1127.0000,case rate,Rev 361 Proc 27093 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM HIP,27093,CPT,361,RC,36100085,CDM,,,,both,,,1127.0000,169.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,148.0000,1127.0000,case rate,Rev 361 Proc 27093 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM HIP,27093,CPT,361,RC,36100085,CDM,,,,both,,,1127.0000,169.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,490.48,,,,,,,148.0000,1127.0000,fee schedule,APG 00278 Proc 27093 at $836.60 (Base Rate) * 0.5692 (Relative Weight) = $476.19 (Total Line Payment) at 103% = $490.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ARTHROGRAM HIP,27093,CPT,361,RC,36100085,CDM,,,,both,,,1127.0000,169.0500,WELLCARE,WELLCARE MEDICAID,1127.00,,,,,,,148.0000,1127.0000,percent of total billed charges,"100% of $1,127.00 in Billed Charges for Rev 361 Proc 27093 = $1,127.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION SACROILIAC JOINT BILAT,27096,CPT,510,RC,51000044,CDM,,,50,both,,,2281.0000,342.1500,AETNA,AETNA,973.99,,,,,,,162.3400,2281.0000,percent of total billed charges,"42.7% of $2,281.00 in Billed Charges for Rev 510 Proc 27096 Mod 50 = $973.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION SACROILIAC JOINT BILAT,27096,CPT,510,RC,51000044,CDM,,,50,both,,,2281.0000,342.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1277.60,,,,,,,162.3400,2281.0000,fee schedule,"APG 00050 Proc 27096 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by increasing by 2 times = $1,228.46 at 104% = $1,277.60. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECTION SACROILIAC JOINT BILAT,27096,CPT,510,RC,51000044,CDM,,,50,both,,,2281.0000,342.1500,BLUE CROSS,ANTHEM EXCHANGE,162.34,,,,,,,162.3400,2281.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION SACROILIAC JOINT BILAT,27096,CPT,510,RC,51000044,CDM,,,50,both,,,2281.0000,342.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1265.32,,,,,,,162.3400,2281.0000,fee schedule,"APG 00050 Proc 27096 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by increasing by 2 times = $1,228.46 at 103% = $1,265.32. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECTION SACROILIAC JOINT BILAT,27096,CPT,510,RC,51000044,CDM,,,50,both,,,2281.0000,342.1500,BLUE CROSS,ANTHEM HMO,162.34,,,,,,,162.3400,2281.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION SACROILIAC JOINT BILAT,27096,CPT,510,RC,51000044,CDM,,,50,both,,,2281.0000,342.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",162.34,,,,,,,162.3400,2281.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION SACROILIAC JOINT BILAT,27096,CPT,510,RC,51000044,CDM,,,50,both,,,2281.0000,342.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,393.75,,,,,,,162.3400,2281.0000,fee schedule,$393.75 from Fee Schedule BLDTM_23 for Rev 510 Proc 27096 Mod 50 * Qty 1 = $393.75 at 100% = $393.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION SACROILIAC JOINT BILAT,27096,CPT,510,RC,51000044,CDM,,,50,both,,,2281.0000,342.1500,CIGNA HEALTHCARE,CIGNA HMO,951.18,,,,,,,162.3400,2281.0000,percent of total billed charges,"41.7% of $2,281.00 in Billed Charges for Rev 510 Proc 27096 Mod 50 = $951.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION SACROILIAC JOINT BILAT,27096,CPT,510,RC,51000044,CDM,,,50,both,,,2281.0000,342.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1058.38,,,,,,,162.3400,2281.0000,percent of total billed charges,"46.4% of $2,281.00 in Billed Charges for Rev 510 Proc 27096 Mod 50 = $1,058.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION SACROILIAC JOINT BILAT,27096,CPT,510,RC,51000044,CDM,,,50,both,,,2281.0000,342.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,951.18,,,,,,,162.3400,2281.0000,percent of total billed charges,"41.7% of $2,281.00 in Billed Charges for Rev 510 Proc 27096 Mod 50 = $951.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION SACROILIAC JOINT BILAT,27096,CPT,510,RC,51000044,CDM,,,50,both,,,2281.0000,342.1500,CIGNA HEALTHCARE,CIGNA PPO,951.18,,,,,,,162.3400,2281.0000,percent of total billed charges,"41.7% of $2,281.00 in Billed Charges for Rev 510 Proc 27096 Mod 50 = $951.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION SACROILIAC JOINT BILAT,27096,CPT,510,RC,51000044,CDM,,,50,both,,,2281.0000,342.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2052.90,,,,,,,162.3400,2281.0000,percent of total billed charges,"90% of $2,281.00 in Billed Charges for Rev 510 Proc 27096 Mod 50 = $2,052.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION SACROILIAC JOINT BILAT,27096,CPT,510,RC,51000044,CDM,,,50,both,,,2281.0000,342.1500,MEDCOST,MEDCOST VHN,1085.53,,,,,,,162.3400,2281.0000,percent of total billed charges,"47.59% of $2,281.00 in Billed Charges for Rev 510 Proc 27096 Mod 50 = $1,085.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION SACROILIAC JOINT BILAT,27096,CPT,510,RC,51000044,CDM,,,50,both,,,2281.0000,342.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1289.88,,,,,,,162.3400,2281.0000,fee schedule,"APG 00050 Proc 27096 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by increasing by 2 times = $1,228.46 at 100% = $1,228.46... $1,228.46 at 105% = $1,289.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECTION SACROILIAC JOINT BILAT,27096,CPT,510,RC,51000044,CDM,,,50,both,,,2281.0000,342.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1266.54,,,,,,,162.3400,2281.0000,fee schedule,"APG 00050 Proc 27096 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by increasing by 2 times = $1,228.46 at 100% = $1,228.46... $1,228.46 at 103.1% = $1,266.54 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECTION SACROILIAC JOINT BILAT,27096,CPT,510,RC,51000044,CDM,,,50,both,,,2281.0000,342.1500,SENTARA HEALTH,SENTARA HEALTH,588.73,,,,,,,162.3400,2281.0000,percent of total billed charges,"25.81% of $2,281.00 in Billed Charges for Rev 510 Proc 27096 Mod 50 = $588.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION SACROILIAC JOINT BILAT,27096,CPT,510,RC,51000044,CDM,,,50,both,,,2281.0000,342.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2281.00,,,,,,,162.3400,2281.0000,percent of total billed charges,"100% of $2,281.00 in Billed Charges for Rev 510 Proc 27096 Mod 50 = $2,281.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION SACROILIAC JOINT BILAT,27096,CPT,510,RC,51000044,CDM,,,50,both,,,2281.0000,342.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,736.76,,,,,,,162.3400,2281.0000,other,"32.3% of $2,281.00 in Billed Charges for Rev 510 Proc 27096 Mod 50 = $736.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECTION SACROILIAC JOINT BILAT,27096,CPT,510,RC,51000044,CDM,,,50,both,,,2281.0000,342.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,700.27,,,,,,,162.3400,2281.0000,other,"30.7% of $2,281.00 in Billed Charges for Rev 510 Proc 27096 Mod 50 = $700.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECTION SACROILIAC JOINT BILAT,27096,CPT,510,RC,51000044,CDM,,,50,both,,,2281.0000,342.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,736.76,,,,,,,162.3400,2281.0000,percent of total billed charges,"32.3% of $2,281.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION SACROILIAC JOINT BILAT,27096,CPT,510,RC,51000044,CDM,,,50,both,,,2281.0000,342.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1265.32,,,,,,,162.3400,2281.0000,fee schedule,"APG 00050 Proc 27096 at $836.60 (Base Rate) * 0.7342 (Relative Weight) = $614.23 (Total Line Payment), Adjusted by increasing by 2 times = $1,228.46 at 103% = $1,265.32. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECTION SACROILIAC JOINT BILAT,27096,CPT,510,RC,51000044,CDM,,,50,both,,,2281.0000,342.1500,WELLCARE,WELLCARE MEDICAID,2281.00,,,,,,,162.3400,2281.0000,percent of total billed charges,"100% of $2,281.00 in Billed Charges for Rev 510 Proc 27096 Mod 50 = $2,281.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA TIBIO PERONEAL INIT VESS,37228,CPT,481,RC,48100078,CDM,,,,both,,,16557.0000,2483.5500,AETNA,AETNA,7069.84,,,,,,,2853.0000,16557.0000,percent of total billed charges,"42.7% of $16,557.00 in Billed Charges for Rev 481 Proc 37228 = $7,069.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA TIBIO PERONEAL INIT VESS,37228,CPT,481,RC,48100078,CDM,,,,both,,,16557.0000,2483.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,9404.09,,,,,,,2853.0000,16557.0000,fee schedule,"APG 00079 Proc 37228 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 104% = $9,404.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA TIBIO PERONEAL INIT VESS,37228,CPT,481,RC,48100078,CDM,,,,both,,,16557.0000,2483.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,9313.66,,,,,,,2853.0000,16557.0000,fee schedule,"APG 00079 Proc 37228 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 103% = $9,313.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA TIBIO PERONEAL INIT VESS,37228,CPT,481,RC,48100078,CDM,,,,both,,,16557.0000,2483.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5117.13,,,,,,,2853.0000,16557.0000,fee schedule,"$5,117.13 from Fee Schedule BLDTM_23 for Rev 481 Proc 37228 * Qty 1 = $5,117.13 at 100% = $5,117.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA TIBIO PERONEAL INIT VESS,37228,CPT,481,RC,48100078,CDM,,,,both,,,16557.0000,2483.5500,BLUE CROSS,BLUE CROSS E NETWORK,8571.00,,,,,,,2853.0000,16557.0000,case rate,"Rev 481 Proc 37228 ASG Rate of $8,571.00 at 100% of $8,571.00 = $8,571.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA TIBIO PERONEAL INIT VESS,37228,CPT,481,RC,48100078,CDM,,,,both,,,16557.0000,2483.5500,BLUE CROSS,BLUE CROSS P NETWORK,8764.00,,,,,,,2853.0000,16557.0000,case rate,"Rev 481 Proc 37228 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA TIBIO PERONEAL INIT VESS,37228,CPT,481,RC,48100078,CDM,,,,both,,,16557.0000,2483.5500,BLUE CROSS,BLUE CROSS S NETWORK,8764.00,,,,,,,2853.0000,16557.0000,case rate,"Rev 481 Proc 37228 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA TIBIO PERONEAL INIT VESS,37228,CPT,481,RC,48100078,CDM,,,,both,,,16557.0000,2483.5500,CIGNA HEALTHCARE,CIGNA HMO,6904.27,,,,,,,2853.0000,16557.0000,percent of total billed charges,"41.7% of $16,557.00 in Billed Charges for Rev 481 Proc 37228 = $6,904.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA TIBIO PERONEAL INIT VESS,37228,CPT,481,RC,48100078,CDM,,,,both,,,16557.0000,2483.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7682.45,,,,,,,2853.0000,16557.0000,percent of total billed charges,"46.4% of $16,557.00 in Billed Charges for Rev 481 Proc 37228 = $7,682.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA TIBIO PERONEAL INIT VESS,37228,CPT,481,RC,48100078,CDM,,,,both,,,16557.0000,2483.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6904.27,,,,,,,2853.0000,16557.0000,percent of total billed charges,"41.7% of $16,557.00 in Billed Charges for Rev 481 Proc 37228 = $6,904.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA TIBIO PERONEAL INIT VESS,37228,CPT,481,RC,48100078,CDM,,,,both,,,16557.0000,2483.5500,CIGNA HEALTHCARE,CIGNA PPO,6904.27,,,,,,,2853.0000,16557.0000,percent of total billed charges,"41.7% of $16,557.00 in Billed Charges for Rev 481 Proc 37228 = $6,904.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA TIBIO PERONEAL INIT VESS,37228,CPT,481,RC,48100078,CDM,,,,both,,,16557.0000,2483.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,14901.30,,,,,,,2853.0000,16557.0000,percent of total billed charges,"90% of $16,557.00 in Billed Charges for Rev 481 Proc 37228 = $14,901.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA TIBIO PERONEAL INIT VESS,37228,CPT,481,RC,48100078,CDM,,,,both,,,16557.0000,2483.5500,MEDCOST,MEDCOST VHN,7879.48,,,,,,,2853.0000,16557.0000,percent of total billed charges,"47.59% of $16,557.00 in Billed Charges for Rev 481 Proc 37228 = $7,879.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA TIBIO PERONEAL INIT VESS,37228,CPT,481,RC,48100078,CDM,,,,both,,,16557.0000,2483.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,9494.51,,,,,,,2853.0000,16557.0000,fee schedule,"APG 00079 Proc 37228 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 100% = $9,042.39... $9,042.39 at 105% = $9,494.51 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA TIBIO PERONEAL INIT VESS,37228,CPT,481,RC,48100078,CDM,,,,both,,,16557.0000,2483.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,9322.70,,,,,,,2853.0000,16557.0000,fee schedule,"APG 00079 Proc 37228 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 100% = $9,042.39... $9,042.39 at 103.1% = $9,322.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA TIBIO PERONEAL INIT VESS,37228,CPT,481,RC,48100078,CDM,,,,both,,,16557.0000,2483.5500,SENTARA HEALTH,SENTARA HEALTH,4273.36,,,,,,,2853.0000,16557.0000,percent of total billed charges,"25.81% of $16,557.00 in Billed Charges for Rev 481 Proc 37228 = $4,273.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA TIBIO PERONEAL INIT VESS,37228,CPT,481,RC,48100078,CDM,,,,both,,,16557.0000,2483.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",16557.00,,,,,,,2853.0000,16557.0000,percent of total billed charges,"100% of $16,557.00 in Billed Charges for Rev 481 Proc 37228 = $16,557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PTA TIBIO PERONEAL INIT VESS,37228,CPT,481,RC,48100078,CDM,,,,both,,,16557.0000,2483.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,2853.0000,16557.0000,case rate,"Rev 481 Proc 37228 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA TIBIO PERONEAL INIT VESS,37228,CPT,481,RC,48100078,CDM,,,,both,,,16557.0000,2483.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,2853.0000,16557.0000,case rate,"Rev 481 Proc 37228 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA TIBIO PERONEAL INIT VESS,37228,CPT,481,RC,48100078,CDM,,,,both,,,16557.0000,2483.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,2853.0000,16557.0000,case rate,"Rev 481 Proc 37228 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA TIBIO PERONEAL INIT VESS,37228,CPT,481,RC,48100078,CDM,,,,both,,,16557.0000,2483.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,2853.0000,16557.0000,case rate,"Rev 481 Proc 37228 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA TIBIO PERONEAL INIT VESS,37228,CPT,481,RC,48100078,CDM,,,,both,,,16557.0000,2483.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,9313.66,,,,,,,2853.0000,16557.0000,fee schedule,"APG 00079 Proc 37228 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 103% = $9,313.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PTA TIBIO PERONEAL INIT VESS,37228,CPT,481,RC,48100078,CDM,,,,both,,,16557.0000,2483.5500,WELLCARE,WELLCARE MEDICAID,16557.00,,,,,,,2853.0000,16557.0000,percent of total billed charges,"100% of $16,557.00 in Billed Charges for Rev 481 Proc 37228 = $16,557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHER PTA TIB PER INITIAL,37229,CPT,481,RC,48100079,CDM,,,,both,,,30457.0000,4568.5500,AETNA,AETNA,13005.14,,,,,,,6290.0000,30457.0000,percent of total billed charges,"42.7% of $30,457.00 in Billed Charges for Rev 481 Proc 37229 = $13,005.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHER PTA TIB PER INITIAL,37229,CPT,481,RC,48100079,CDM,,,,both,,,30457.0000,4568.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15721.62,,,,,,,6290.0000,30457.0000,fee schedule,"APG 00085 Proc 37229 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 104% = $15,721.62. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHER PTA TIB PER INITIAL,37229,CPT,481,RC,48100079,CDM,,,,both,,,30457.0000,4568.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15570.45,,,,,,,6290.0000,30457.0000,fee schedule,"APG 00085 Proc 37229 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHER PTA TIB PER INITIAL,37229,CPT,481,RC,48100079,CDM,,,,both,,,30457.0000,4568.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,10066.81,,,,,,,6290.0000,30457.0000,fee schedule,"$10,066.81 from Fee Schedule BLDTM_23 for Rev 481 Proc 37229 * Qty 1 = $10,066.81 at 100% = $10,066.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHER PTA TIB PER INITIAL,37229,CPT,481,RC,48100079,CDM,,,,both,,,30457.0000,4568.5500,BLUE CROSS,BLUE CROSS E NETWORK,9347.00,,,,,,,6290.0000,30457.0000,case rate,"Rev 481 Proc 37229 ASG Rate of $9,347.00 at 100% of $9,347.00 = $9,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHER PTA TIB PER INITIAL,37229,CPT,481,RC,48100079,CDM,,,,both,,,30457.0000,4568.5500,BLUE CROSS,BLUE CROSS P NETWORK,9558.00,,,,,,,6290.0000,30457.0000,case rate,"Rev 481 Proc 37229 ASG Rate of $9,558.00 at 100% of $9,558.00 = $9,558.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHER PTA TIB PER INITIAL,37229,CPT,481,RC,48100079,CDM,,,,both,,,30457.0000,4568.5500,BLUE CROSS,BLUE CROSS S NETWORK,9558.00,,,,,,,6290.0000,30457.0000,case rate,"Rev 481 Proc 37229 ASG Rate of $9,558.00 at 100% of $9,558.00 = $9,558.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHER PTA TIB PER INITIAL,37229,CPT,481,RC,48100079,CDM,,,,both,,,30457.0000,4568.5500,CIGNA HEALTHCARE,CIGNA HMO,12700.57,,,,,,,6290.0000,30457.0000,percent of total billed charges,"41.7% of $30,457.00 in Billed Charges for Rev 481 Proc 37229 = $12,700.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHER PTA TIB PER INITIAL,37229,CPT,481,RC,48100079,CDM,,,,both,,,30457.0000,4568.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,14132.05,,,,,,,6290.0000,30457.0000,percent of total billed charges,"46.4% of $30,457.00 in Billed Charges for Rev 481 Proc 37229 = $14,132.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHER PTA TIB PER INITIAL,37229,CPT,481,RC,48100079,CDM,,,,both,,,30457.0000,4568.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,12700.57,,,,,,,6290.0000,30457.0000,percent of total billed charges,"41.7% of $30,457.00 in Billed Charges for Rev 481 Proc 37229 = $12,700.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHER PTA TIB PER INITIAL,37229,CPT,481,RC,48100079,CDM,,,,both,,,30457.0000,4568.5500,CIGNA HEALTHCARE,CIGNA PPO,12700.57,,,,,,,6290.0000,30457.0000,percent of total billed charges,"41.7% of $30,457.00 in Billed Charges for Rev 481 Proc 37229 = $12,700.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHER PTA TIB PER INITIAL,37229,CPT,481,RC,48100079,CDM,,,,both,,,30457.0000,4568.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,27411.30,,,,,,,6290.0000,30457.0000,percent of total billed charges,"90% of $30,457.00 in Billed Charges for Rev 481 Proc 37229 = $27,411.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHER PTA TIB PER INITIAL,37229,CPT,481,RC,48100079,CDM,,,,both,,,30457.0000,4568.5500,MEDCOST,MEDCOST VHN,14494.49,,,,,,,6290.0000,30457.0000,percent of total billed charges,"47.59% of $30,457.00 in Billed Charges for Rev 481 Proc 37229 = $14,494.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHER PTA TIB PER INITIAL,37229,CPT,481,RC,48100079,CDM,,,,both,,,30457.0000,4568.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15872.79,,,,,,,6290.0000,30457.0000,fee schedule,"APG 00085 Proc 37229 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 105% = $15,872.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHER PTA TIB PER INITIAL,37229,CPT,481,RC,48100079,CDM,,,,both,,,30457.0000,4568.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15585.57,,,,,,,6290.0000,30457.0000,fee schedule,"APG 00085 Proc 37229 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 103.1% = $15,585.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHER PTA TIB PER INITIAL,37229,CPT,481,RC,48100079,CDM,,,,both,,,30457.0000,4568.5500,SENTARA HEALTH,SENTARA HEALTH,7860.95,,,,,,,6290.0000,30457.0000,percent of total billed charges,"25.81% of $30,457.00 in Billed Charges for Rev 481 Proc 37229 = $7,860.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHER PTA TIB PER INITIAL,37229,CPT,481,RC,48100079,CDM,,,,both,,,30457.0000,4568.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",30457.00,,,,,,,6290.0000,30457.0000,percent of total billed charges,"100% of $30,457.00 in Billed Charges for Rev 481 Proc 37229 = $30,457.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ATHER PTA TIB PER INITIAL,37229,CPT,481,RC,48100079,CDM,,,,both,,,30457.0000,4568.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,6290.0000,30457.0000,case rate,"Rev 481 Proc 37229 ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHER PTA TIB PER INITIAL,37229,CPT,481,RC,48100079,CDM,,,,both,,,30457.0000,4568.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,6290.0000,30457.0000,case rate,"Rev 481 Proc 37229 ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHER PTA TIB PER INITIAL,37229,CPT,481,RC,48100079,CDM,,,,both,,,30457.0000,4568.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,6290.0000,30457.0000,case rate,"Rev 481 Proc 37229 ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHER PTA TIB PER INITIAL,37229,CPT,481,RC,48100079,CDM,,,,both,,,30457.0000,4568.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,20054.00,,,,,,,6290.0000,30457.0000,case rate,"Rev 481 Proc 37229 ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHER PTA TIB PER INITIAL,37229,CPT,481,RC,48100079,CDM,,,,both,,,30457.0000,4568.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15570.45,,,,,,,6290.0000,30457.0000,fee schedule,"APG 00085 Proc 37229 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ATHER PTA TIB PER INITIAL,37229,CPT,481,RC,48100079,CDM,,,,both,,,30457.0000,4568.5500,WELLCARE,WELLCARE MEDICAID,30457.00,,,,,,,6290.0000,30457.0000,percent of total billed charges,"100% of $30,457.00 in Billed Charges for Rev 481 Proc 37229 = $30,457.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT TIBO PERONEA,37230,CPT,481,RC,48100080,CDM,,,,both,,,30222.0000,4533.3000,AETNA,AETNA,12904.79,,,,,,,6290.0000,30222.0000,percent of total billed charges,"42.7% of $30,222.00 in Billed Charges for Rev 481 Proc 37230 = $12,904.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT TIBO PERONEA,37230,CPT,481,RC,48100080,CDM,,,,both,,,30222.0000,4533.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15721.62,,,,,,,6290.0000,30222.0000,fee schedule,"APG 00085 Proc 37230 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 104% = $15,721.62. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT TIBO PERONEA,37230,CPT,481,RC,48100080,CDM,,,,both,,,30222.0000,4533.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15570.45,,,,,,,6290.0000,30222.0000,fee schedule,"APG 00085 Proc 37230 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT TIBO PERONEA,37230,CPT,481,RC,48100080,CDM,,,,both,,,30222.0000,4533.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7910.90,,,,,,,6290.0000,30222.0000,fee schedule,"$7,910.90 from Fee Schedule BLDTM_23 for Rev 481 Proc 37230 * Qty 1 = $7,910.90 at 100% = $7,910.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT TIBO PERONEA,37230,CPT,481,RC,48100080,CDM,,,,both,,,30222.0000,4533.3000,BLUE CROSS,BLUE CROSS E NETWORK,9347.00,,,,,,,6290.0000,30222.0000,case rate,"Rev 481 Proc 37230 ASG Rate of $9,347.00 at 100% of $9,347.00 = $9,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT TIBO PERONEA,37230,CPT,481,RC,48100080,CDM,,,,both,,,30222.0000,4533.3000,BLUE CROSS,BLUE CROSS P NETWORK,9558.00,,,,,,,6290.0000,30222.0000,case rate,"Rev 481 Proc 37230 ASG Rate of $9,558.00 at 100% of $9,558.00 = $9,558.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT TIBO PERONEA,37230,CPT,481,RC,48100080,CDM,,,,both,,,30222.0000,4533.3000,BLUE CROSS,BLUE CROSS S NETWORK,9558.00,,,,,,,6290.0000,30222.0000,case rate,"Rev 481 Proc 37230 ASG Rate of $9,558.00 at 100% of $9,558.00 = $9,558.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT TIBO PERONEA,37230,CPT,481,RC,48100080,CDM,,,,both,,,30222.0000,4533.3000,CIGNA HEALTHCARE,CIGNA HMO,12602.57,,,,,,,6290.0000,30222.0000,percent of total billed charges,"41.7% of $30,222.00 in Billed Charges for Rev 481 Proc 37230 = $12,602.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT TIBO PERONEA,37230,CPT,481,RC,48100080,CDM,,,,both,,,30222.0000,4533.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,14023.01,,,,,,,6290.0000,30222.0000,percent of total billed charges,"46.4% of $30,222.00 in Billed Charges for Rev 481 Proc 37230 = $14,023.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT TIBO PERONEA,37230,CPT,481,RC,48100080,CDM,,,,both,,,30222.0000,4533.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,12602.57,,,,,,,6290.0000,30222.0000,percent of total billed charges,"41.7% of $30,222.00 in Billed Charges for Rev 481 Proc 37230 = $12,602.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT TIBO PERONEA,37230,CPT,481,RC,48100080,CDM,,,,both,,,30222.0000,4533.3000,CIGNA HEALTHCARE,CIGNA PPO,12602.57,,,,,,,6290.0000,30222.0000,percent of total billed charges,"41.7% of $30,222.00 in Billed Charges for Rev 481 Proc 37230 = $12,602.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT TIBO PERONEA,37230,CPT,481,RC,48100080,CDM,,,,both,,,30222.0000,4533.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,27199.80,,,,,,,6290.0000,30222.0000,percent of total billed charges,"90% of $30,222.00 in Billed Charges for Rev 481 Proc 37230 = $27,199.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT TIBO PERONEA,37230,CPT,481,RC,48100080,CDM,,,,both,,,30222.0000,4533.3000,MEDCOST,MEDCOST VHN,14382.65,,,,,,,6290.0000,30222.0000,percent of total billed charges,"47.59% of $30,222.00 in Billed Charges for Rev 481 Proc 37230 = $14,382.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT TIBO PERONEA,37230,CPT,481,RC,48100080,CDM,,,,both,,,30222.0000,4533.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15872.79,,,,,,,6290.0000,30222.0000,fee schedule,"APG 00085 Proc 37230 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 105% = $15,872.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT TIBO PERONEA,37230,CPT,481,RC,48100080,CDM,,,,both,,,30222.0000,4533.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15585.57,,,,,,,6290.0000,30222.0000,fee schedule,"APG 00085 Proc 37230 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 103.1% = $15,585.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT TIBO PERONEA,37230,CPT,481,RC,48100080,CDM,,,,both,,,30222.0000,4533.3000,SENTARA HEALTH,SENTARA HEALTH,7800.30,,,,,,,6290.0000,30222.0000,percent of total billed charges,"25.81% of $30,222.00 in Billed Charges for Rev 481 Proc 37230 = $7,800.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT TIBO PERONEA,37230,CPT,481,RC,48100080,CDM,,,,both,,,30222.0000,4533.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",30222.00,,,,,,,6290.0000,30222.0000,percent of total billed charges,"100% of $30,222.00 in Billed Charges for Rev 481 Proc 37230 = $30,222.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT TIBO PERONEA,37230,CPT,481,RC,48100080,CDM,,,,both,,,30222.0000,4533.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,6290.0000,30222.0000,case rate,"Rev 481 Proc 37230 ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT TIBO PERONEA,37230,CPT,481,RC,48100080,CDM,,,,both,,,30222.0000,4533.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,6290.0000,30222.0000,case rate,"Rev 481 Proc 37230 ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT TIBO PERONEA,37230,CPT,481,RC,48100080,CDM,,,,both,,,30222.0000,4533.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,6290.0000,30222.0000,case rate,"Rev 481 Proc 37230 ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT TIBO PERONEA,37230,CPT,481,RC,48100080,CDM,,,,both,,,30222.0000,4533.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,20054.00,,,,,,,6290.0000,30222.0000,case rate,"Rev 481 Proc 37230 ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT TIBO PERONEA,37230,CPT,481,RC,48100080,CDM,,,,both,,,30222.0000,4533.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15570.45,,,,,,,6290.0000,30222.0000,fee schedule,"APG 00085 Proc 37230 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT TIBO PERONEA,37230,CPT,481,RC,48100080,CDM,,,,both,,,30222.0000,4533.3000,WELLCARE,WELLCARE MEDICAID,30222.00,,,,,,,6290.0000,30222.0000,percent of total billed charges,"100% of $30,222.00 in Billed Charges for Rev 481 Proc 37230 = $30,222.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT/TIB-PERON W/ATHR,37231,CPT,481,RC,48100081,CDM,,,,both,,,52339.0000,7850.8500,AETNA,AETNA,22348.75,,,,,,,9347.0000,52339.0000,percent of total billed charges,"42.7% of $52,339.00 in Billed Charges for Rev 481 Proc 37231 = $22,348.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT/TIB-PERON W/ATHR,37231,CPT,481,RC,48100081,CDM,,,,both,,,52339.0000,7850.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15721.62,,,,,,,9347.0000,52339.0000,fee schedule,"APG 00085 Proc 37231 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 104% = $15,721.62. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT/TIB-PERON W/ATHR,37231,CPT,481,RC,48100081,CDM,,,,both,,,52339.0000,7850.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15570.45,,,,,,,9347.0000,52339.0000,fee schedule,"APG 00085 Proc 37231 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT/TIB-PERON W/ATHR,37231,CPT,481,RC,48100081,CDM,,,,both,,,52339.0000,7850.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,12697.12,,,,,,,9347.0000,52339.0000,fee schedule,"$12,697.12 from Fee Schedule BLDTM_23 for Rev 481 Proc 37231 * Qty 1 = $12,697.12 at 100% = $12,697.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT/TIB-PERON W/ATHR,37231,CPT,481,RC,48100081,CDM,,,,both,,,52339.0000,7850.8500,BLUE CROSS,BLUE CROSS E NETWORK,9347.00,,,,,,,9347.0000,52339.0000,case rate,"Rev 481 Proc 37231 ASG Rate of $9,347.00 at 100% of $9,347.00 = $9,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT/TIB-PERON W/ATHR,37231,CPT,481,RC,48100081,CDM,,,,both,,,52339.0000,7850.8500,BLUE CROSS,BLUE CROSS P NETWORK,9558.00,,,,,,,9347.0000,52339.0000,case rate,"Rev 481 Proc 37231 ASG Rate of $9,558.00 at 100% of $9,558.00 = $9,558.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT/TIB-PERON W/ATHR,37231,CPT,481,RC,48100081,CDM,,,,both,,,52339.0000,7850.8500,BLUE CROSS,BLUE CROSS S NETWORK,9558.00,,,,,,,9347.0000,52339.0000,case rate,"Rev 481 Proc 37231 ASG Rate of $9,558.00 at 100% of $9,558.00 = $9,558.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT/TIB-PERON W/ATHR,37231,CPT,481,RC,48100081,CDM,,,,both,,,52339.0000,7850.8500,CIGNA HEALTHCARE,CIGNA HMO,21825.36,,,,,,,9347.0000,52339.0000,percent of total billed charges,"41.7% of $52,339.00 in Billed Charges for Rev 481 Proc 37231 = $21,825.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT/TIB-PERON W/ATHR,37231,CPT,481,RC,48100081,CDM,,,,both,,,52339.0000,7850.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,24285.30,,,,,,,9347.0000,52339.0000,percent of total billed charges,"46.4% of $52,339.00 in Billed Charges for Rev 481 Proc 37231 = $24,285.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT/TIB-PERON W/ATHR,37231,CPT,481,RC,48100081,CDM,,,,both,,,52339.0000,7850.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,21825.36,,,,,,,9347.0000,52339.0000,percent of total billed charges,"41.7% of $52,339.00 in Billed Charges for Rev 481 Proc 37231 = $21,825.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT/TIB-PERON W/ATHR,37231,CPT,481,RC,48100081,CDM,,,,both,,,52339.0000,7850.8500,CIGNA HEALTHCARE,CIGNA PPO,21825.36,,,,,,,9347.0000,52339.0000,percent of total billed charges,"41.7% of $52,339.00 in Billed Charges for Rev 481 Proc 37231 = $21,825.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT/TIB-PERON W/ATHR,37231,CPT,481,RC,48100081,CDM,,,,both,,,52339.0000,7850.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,47105.10,,,,,,,9347.0000,52339.0000,percent of total billed charges,"90% of $52,339.00 in Billed Charges for Rev 481 Proc 37231 = $47,105.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT/TIB-PERON W/ATHR,37231,CPT,481,RC,48100081,CDM,,,,both,,,52339.0000,7850.8500,MEDCOST,MEDCOST VHN,24908.13,,,,,,,9347.0000,52339.0000,percent of total billed charges,"47.59% of $52,339.00 in Billed Charges for Rev 481 Proc 37231 = $24,908.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT/TIB-PERON W/ATHR,37231,CPT,481,RC,48100081,CDM,,,,both,,,52339.0000,7850.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15872.79,,,,,,,9347.0000,52339.0000,fee schedule,"APG 00085 Proc 37231 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 105% = $15,872.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT/TIB-PERON W/ATHR,37231,CPT,481,RC,48100081,CDM,,,,both,,,52339.0000,7850.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15585.57,,,,,,,9347.0000,52339.0000,fee schedule,"APG 00085 Proc 37231 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 103.1% = $15,585.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT/TIB-PERON W/ATHR,37231,CPT,481,RC,48100081,CDM,,,,both,,,52339.0000,7850.8500,SENTARA HEALTH,SENTARA HEALTH,13508.70,,,,,,,9347.0000,52339.0000,percent of total billed charges,"25.81% of $52,339.00 in Billed Charges for Rev 481 Proc 37231 = $13,508.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT/TIB-PERON W/ATHR,37231,CPT,481,RC,48100081,CDM,,,,both,,,52339.0000,7850.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",52339.00,,,,,,,9347.0000,52339.0000,percent of total billed charges,"100% of $52,339.00 in Billed Charges for Rev 481 Proc 37231 = $52,339.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE VASC STENT/TIB-PERON W/ATHR,37231,CPT,481,RC,48100081,CDM,,,,both,,,52339.0000,7850.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,11895.00,,,,,,,9347.0000,52339.0000,case rate,"Rev 481 Proc 37231 ASG Rate of $11,895.00 at 100% of $11,895.00 = $11,895.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT/TIB-PERON W/ATHR,37231,CPT,481,RC,48100081,CDM,,,,both,,,52339.0000,7850.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,13136.00,,,,,,,9347.0000,52339.0000,case rate,"Rev 481 Proc 37231 ASG Rate of $13,136.00 at 100% of $13,136.00 = $13,136.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT/TIB-PERON W/ATHR,37231,CPT,481,RC,48100081,CDM,,,,both,,,52339.0000,7850.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,12568.00,,,,,,,9347.0000,52339.0000,case rate,"Rev 481 Proc 37231 ASG Rate of $12,568.00 at 100% of $12,568.00 = $12,568.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT/TIB-PERON W/ATHR,37231,CPT,481,RC,48100081,CDM,,,,both,,,52339.0000,7850.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,21337.00,,,,,,,9347.0000,52339.0000,case rate,"Rev 481 Proc 37231 ASG Rate of $21,337.00 at 100% of $21,337.00 = $21,337.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT/TIB-PERON W/ATHR,37231,CPT,481,RC,48100081,CDM,,,,both,,,52339.0000,7850.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15570.45,,,,,,,9347.0000,52339.0000,fee schedule,"APG 00085 Proc 37231 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE VASC STENT/TIB-PERON W/ATHR,37231,CPT,481,RC,48100081,CDM,,,,both,,,52339.0000,7850.8500,WELLCARE,WELLCARE MEDICAID,52339.00,,,,,,,9347.0000,52339.0000,percent of total billed charges,"100% of $52,339.00 in Billed Charges for Rev 481 Proc 37231 = $52,339.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SP ATHER PTA TIB PER ADDTL,37233,CPT,361,RC,36100146,CDM,,,,both,,,24933.0000,3739.9500,AETNA,AETNA,10646.39,,,,,,,148.0000,24933.0000,percent of total billed charges,"42.7% of $24,933.00 in Billed Charges for Rev 361 Proc 37233 = $10,646.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SP ATHER PTA TIB PER ADDTL,37233,CPT,361,RC,36100146,CDM,,,,both,,,24933.0000,3739.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15721.62,,,,,,,148.0000,24933.0000,fee schedule,"APG 00085 Proc 37233 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 104% = $15,721.62. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER PTA TIB PER ADDTL,37233,CPT,361,RC,36100146,CDM,,,,both,,,24933.0000,3739.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15570.45,,,,,,,148.0000,24933.0000,fee schedule,"APG 00085 Proc 37233 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER PTA TIB PER ADDTL,37233,CPT,361,RC,36100146,CDM,,,,both,,,24933.0000,3739.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,148.0000,24933.0000,case rate,"Rev 361 Proc 37233 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER PTA TIB PER ADDTL,37233,CPT,361,RC,36100146,CDM,,,,both,,,24933.0000,3739.9500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,24933.0000,case rate,Rev 361 Proc 37233 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER PTA TIB PER ADDTL,37233,CPT,361,RC,36100146,CDM,,,,both,,,24933.0000,3739.9500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,24933.0000,case rate,Rev 361 Proc 37233 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER PTA TIB PER ADDTL,37233,CPT,361,RC,36100146,CDM,,,,both,,,24933.0000,3739.9500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,24933.0000,case rate,Rev 361 Proc 37233 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SP ATHER PTA TIB PER ADDTL,37233,CPT,361,RC,36100146,CDM,,,,both,,,24933.0000,3739.9500,BLUE CROSS,TENNCARE BLUE CARE,1733.00,,,,,,,148.0000,24933.0000,case rate,"Rev 361 Proc 37233 ASG Rate of $1,733.00 at 100% of $1,733.00 = $1,733.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER PTA TIB PER ADDTL,37233,CPT,361,RC,36100146,CDM,,,,both,,,24933.0000,3739.9500,BLUE CROSS,TENNCARE BLUE SELECT,1733.00,,,,,,,148.0000,24933.0000,case rate,"Rev 361 Proc 37233 ASG Rate of $1,733.00 at 100% of $1,733.00 = $1,733.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER PTA TIB PER ADDTL,37233,CPT,361,RC,36100146,CDM,,,,both,,,24933.0000,3739.9500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,148.0000,24933.0000,case rate,"Rev 361 Proc 37233 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER PTA TIB PER ADDTL,37233,CPT,361,RC,36100146,CDM,,,,both,,,24933.0000,3739.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,148.0000,24933.0000,case rate,"Rev 361 Proc 37233 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER PTA TIB PER ADDTL,37233,CPT,361,RC,36100146,CDM,,,,both,,,24933.0000,3739.9500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,148.0000,24933.0000,case rate,"Rev 361 Proc 37233 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER PTA TIB PER ADDTL,37233,CPT,361,RC,36100146,CDM,,,,both,,,24933.0000,3739.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,22439.70,,,,,,,148.0000,24933.0000,percent of total billed charges,"90% of $24,933.00 in Billed Charges for Rev 361 Proc 37233 = $22,439.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SP ATHER PTA TIB PER ADDTL,37233,CPT,361,RC,36100146,CDM,,,,both,,,24933.0000,3739.9500,MEDCOST,MEDCOST VHN,11865.61,,,,,,,148.0000,24933.0000,percent of total billed charges,"47.59% of $24,933.00 in Billed Charges for Rev 361 Proc 37233 = $11,865.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SP ATHER PTA TIB PER ADDTL,37233,CPT,361,RC,36100146,CDM,,,,both,,,24933.0000,3739.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15872.79,,,,,,,148.0000,24933.0000,fee schedule,"APG 00085 Proc 37233 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 105% = $15,872.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER PTA TIB PER ADDTL,37233,CPT,361,RC,36100146,CDM,,,,both,,,24933.0000,3739.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15585.57,,,,,,,148.0000,24933.0000,fee schedule,"APG 00085 Proc 37233 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 103.1% = $15,585.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER PTA TIB PER ADDTL,37233,CPT,361,RC,36100146,CDM,,,,both,,,24933.0000,3739.9500,SENTARA HEALTH,SENTARA HEALTH,6435.21,,,,,,,148.0000,24933.0000,percent of total billed charges,"25.81% of $24,933.00 in Billed Charges for Rev 361 Proc 37233 = $6,435.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SP ATHER PTA TIB PER ADDTL,37233,CPT,361,RC,36100146,CDM,,,,both,,,24933.0000,3739.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",24933.00,,,,,,,148.0000,24933.0000,percent of total billed charges,"100% of $24,933.00 in Billed Charges for Rev 361 Proc 37233 = $24,933.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SP ATHER PTA TIB PER ADDTL,37233,CPT,361,RC,36100146,CDM,,,,both,,,24933.0000,3739.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,148.0000,24933.0000,case rate,"Rev 361 Proc 37233 ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER PTA TIB PER ADDTL,37233,CPT,361,RC,36100146,CDM,,,,both,,,24933.0000,3739.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,148.0000,24933.0000,case rate,"Rev 361 Proc 37233 ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER PTA TIB PER ADDTL,37233,CPT,361,RC,36100146,CDM,,,,both,,,24933.0000,3739.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,148.0000,24933.0000,case rate,"Rev 361 Proc 37233 ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER PTA TIB PER ADDTL,37233,CPT,361,RC,36100146,CDM,,,,both,,,24933.0000,3739.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,20054.00,,,,,,,148.0000,24933.0000,case rate,"Rev 361 Proc 37233 ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER PTA TIB PER ADDTL,37233,CPT,361,RC,36100146,CDM,,,,both,,,24933.0000,3739.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15570.45,,,,,,,148.0000,24933.0000,fee schedule,"APG 00085 Proc 37233 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SP ATHER PTA TIB PER ADDTL,37233,CPT,361,RC,36100146,CDM,,,,both,,,24933.0000,3739.9500,WELLCARE,WELLCARE MEDICAID,24933.00,,,,,,,148.0000,24933.0000,percent of total billed charges,"100% of $24,933.00 in Billed Charges for Rev 361 Proc 37233 = $24,933.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT INCL PTA SAME VESSEL,37234,CPT,481,RC,48100157,CDM,,,,both,,,13360.0000,2004.0000,AETNA,AETNA,5704.72,,,,,,,148.0000,15872.7900,percent of total billed charges,"42.7% of $13,360.00 in Billed Charges for Rev 481 Proc 37234 = $5,704.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT INCL PTA SAME VESSEL,37234,CPT,481,RC,48100157,CDM,,,,both,,,13360.0000,2004.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15721.62,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 37234 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 104% = $15,721.62. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT INCL PTA SAME VESSEL,37234,CPT,481,RC,48100157,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13360.00,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 37234 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45 (Service Line reduced to $13,360.00, claim capped at $13,360.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT INCL PTA SAME VESSEL,37234,CPT,481,RC,48100157,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3661.98,,,,,,,148.0000,15872.7900,fee schedule,"$3,661.98 from Fee Schedule BLDTM_23 for Rev 481 Proc 37234 * Qty 1 = $3,661.98 at 100% = $3,661.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT INCL PTA SAME VESSEL,37234,CPT,481,RC,48100157,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,15872.7900,case rate,Rev 481 Proc 37234 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT INCL PTA SAME VESSEL,37234,CPT,481,RC,48100157,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,15872.7900,case rate,Rev 481 Proc 37234 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT INCL PTA SAME VESSEL,37234,CPT,481,RC,48100157,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,15872.7900,case rate,Rev 481 Proc 37234 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT INCL PTA SAME VESSEL,37234,CPT,481,RC,48100157,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA HMO,5571.12,,,,,,,148.0000,15872.7900,percent of total billed charges,"41.7% of $13,360.00 in Billed Charges for Rev 481 Proc 37234 = $5,571.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT INCL PTA SAME VESSEL,37234,CPT,481,RC,48100157,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6199.04,,,,,,,148.0000,15872.7900,percent of total billed charges,"46.4% of $13,360.00 in Billed Charges for Rev 481 Proc 37234 = $6,199.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT INCL PTA SAME VESSEL,37234,CPT,481,RC,48100157,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5571.12,,,,,,,148.0000,15872.7900,percent of total billed charges,"41.7% of $13,360.00 in Billed Charges for Rev 481 Proc 37234 = $5,571.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT INCL PTA SAME VESSEL,37234,CPT,481,RC,48100157,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA PPO,5571.12,,,,,,,148.0000,15872.7900,percent of total billed charges,"41.7% of $13,360.00 in Billed Charges for Rev 481 Proc 37234 = $5,571.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT INCL PTA SAME VESSEL,37234,CPT,481,RC,48100157,CDM,,,,both,,,13360.0000,2004.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12024.00,,,,,,,148.0000,15872.7900,percent of total billed charges,"90% of $13,360.00 in Billed Charges for Rev 481 Proc 37234 = $12,024.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT INCL PTA SAME VESSEL,37234,CPT,481,RC,48100157,CDM,,,,both,,,13360.0000,2004.0000,MEDCOST,MEDCOST VHN,6358.02,,,,,,,148.0000,15872.7900,percent of total billed charges,"47.59% of $13,360.00 in Billed Charges for Rev 481 Proc 37234 = $6,358.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT INCL PTA SAME VESSEL,37234,CPT,481,RC,48100157,CDM,,,,both,,,13360.0000,2004.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15872.79,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 37234 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 105% = $15,872.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT INCL PTA SAME VESSEL,37234,CPT,481,RC,48100157,CDM,,,,both,,,13360.0000,2004.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15585.57,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 37234 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 103.1% = $15,585.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT INCL PTA SAME VESSEL,37234,CPT,481,RC,48100157,CDM,,,,both,,,13360.0000,2004.0000,SENTARA HEALTH,SENTARA HEALTH,3448.22,,,,,,,148.0000,15872.7900,percent of total billed charges,"25.81% of $13,360.00 in Billed Charges for Rev 481 Proc 37234 = $3,448.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT INCL PTA SAME VESSEL,37234,CPT,481,RC,48100157,CDM,,,,both,,,13360.0000,2004.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13360.00,,,,,,,148.0000,15872.7900,percent of total billed charges,"100% of $13,360.00 in Billed Charges for Rev 481 Proc 37234 = $13,360.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT INCL PTA SAME VESSEL,37234,CPT,481,RC,48100157,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,148.0000,15872.7900,case rate,"Rev 481 Proc 37234 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT INCL PTA SAME VESSEL,37234,CPT,481,RC,48100157,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,148.0000,15872.7900,case rate,"Rev 481 Proc 37234 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT INCL PTA SAME VESSEL,37234,CPT,481,RC,48100157,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,148.0000,15872.7900,case rate,"Rev 481 Proc 37234 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT INCL PTA SAME VESSEL,37234,CPT,481,RC,48100157,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,148.0000,15872.7900,case rate,"Rev 481 Proc 37234 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT INCL PTA SAME VESSEL,37234,CPT,481,RC,48100157,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15570.45,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 37234 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT INCL PTA SAME VESSEL,37234,CPT,481,RC,48100157,CDM,,,,both,,,13360.0000,2004.0000,WELLCARE,WELLCARE MEDICAID,13360.00,,,,,,,148.0000,15872.7900,percent of total billed charges,"100% of $13,360.00 in Billed Charges for Rev 481 Proc 37234 = $13,360.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT ATHER INCL PTA SAME VESSEL,37235,CPT,481,RC,48100158,CDM,,,,both,,,13360.0000,2004.0000,AETNA,AETNA,5704.72,,,,,,,148.0000,15872.7900,percent of total billed charges,"42.7% of $13,360.00 in Billed Charges for Rev 481 Proc 37235 = $5,704.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT ATHER INCL PTA SAME VESSEL,37235,CPT,481,RC,48100158,CDM,,,,both,,,13360.0000,2004.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15721.62,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 37235 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 104% = $15,721.62. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT ATHER INCL PTA SAME VESSEL,37235,CPT,481,RC,48100158,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,13360.00,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 37235 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45 (Service Line reduced to $13,360.00, claim capped at $13,360.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT ATHER INCL PTA SAME VESSEL,37235,CPT,481,RC,48100158,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3911.11,,,,,,,148.0000,15872.7900,fee schedule,"$3,911.11 from Fee Schedule BLDTM_23 for Rev 481 Proc 37235 * Qty 1 = $3,911.11 at 100% = $3,911.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT ATHER INCL PTA SAME VESSEL,37235,CPT,481,RC,48100158,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,15872.7900,case rate,Rev 481 Proc 37235 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT ATHER INCL PTA SAME VESSEL,37235,CPT,481,RC,48100158,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,15872.7900,case rate,Rev 481 Proc 37235 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT ATHER INCL PTA SAME VESSEL,37235,CPT,481,RC,48100158,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,15872.7900,case rate,Rev 481 Proc 37235 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT ATHER INCL PTA SAME VESSEL,37235,CPT,481,RC,48100158,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA HMO,5571.12,,,,,,,148.0000,15872.7900,percent of total billed charges,"41.7% of $13,360.00 in Billed Charges for Rev 481 Proc 37235 = $5,571.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT ATHER INCL PTA SAME VESSEL,37235,CPT,481,RC,48100158,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6199.04,,,,,,,148.0000,15872.7900,percent of total billed charges,"46.4% of $13,360.00 in Billed Charges for Rev 481 Proc 37235 = $6,199.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT ATHER INCL PTA SAME VESSEL,37235,CPT,481,RC,48100158,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5571.12,,,,,,,148.0000,15872.7900,percent of total billed charges,"41.7% of $13,360.00 in Billed Charges for Rev 481 Proc 37235 = $5,571.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT ATHER INCL PTA SAME VESSEL,37235,CPT,481,RC,48100158,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA PPO,5571.12,,,,,,,148.0000,15872.7900,percent of total billed charges,"41.7% of $13,360.00 in Billed Charges for Rev 481 Proc 37235 = $5,571.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT ATHER INCL PTA SAME VESSEL,37235,CPT,481,RC,48100158,CDM,,,,both,,,13360.0000,2004.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12024.00,,,,,,,148.0000,15872.7900,percent of total billed charges,"90% of $13,360.00 in Billed Charges for Rev 481 Proc 37235 = $12,024.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT ATHER INCL PTA SAME VESSEL,37235,CPT,481,RC,48100158,CDM,,,,both,,,13360.0000,2004.0000,MEDCOST,MEDCOST VHN,6358.02,,,,,,,148.0000,15872.7900,percent of total billed charges,"47.59% of $13,360.00 in Billed Charges for Rev 481 Proc 37235 = $6,358.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT ATHER INCL PTA SAME VESSEL,37235,CPT,481,RC,48100158,CDM,,,,both,,,13360.0000,2004.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15872.79,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 37235 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 105% = $15,872.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT ATHER INCL PTA SAME VESSEL,37235,CPT,481,RC,48100158,CDM,,,,both,,,13360.0000,2004.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15585.57,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 37235 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 103.1% = $15,585.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT ATHER INCL PTA SAME VESSEL,37235,CPT,481,RC,48100158,CDM,,,,both,,,13360.0000,2004.0000,SENTARA HEALTH,SENTARA HEALTH,3448.22,,,,,,,148.0000,15872.7900,percent of total billed charges,"25.81% of $13,360.00 in Billed Charges for Rev 481 Proc 37235 = $3,448.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT ATHER INCL PTA SAME VESSEL,37235,CPT,481,RC,48100158,CDM,,,,both,,,13360.0000,2004.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13360.00,,,,,,,148.0000,15872.7900,percent of total billed charges,"100% of $13,360.00 in Billed Charges for Rev 481 Proc 37235 = $13,360.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT ATHER INCL PTA SAME VESSEL,37235,CPT,481,RC,48100158,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,148.0000,15872.7900,case rate,"Rev 481 Proc 37235 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT ATHER INCL PTA SAME VESSEL,37235,CPT,481,RC,48100158,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,148.0000,15872.7900,case rate,"Rev 481 Proc 37235 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT ATHER INCL PTA SAME VESSEL,37235,CPT,481,RC,48100158,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,148.0000,15872.7900,case rate,"Rev 481 Proc 37235 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT ATHER INCL PTA SAME VESSEL,37235,CPT,481,RC,48100158,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,148.0000,15872.7900,case rate,"Rev 481 Proc 37235 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT ATHER INCL PTA SAME VESSEL,37235,CPT,481,RC,48100158,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15570.45,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 37235 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT ATHER INCL PTA SAME VESSEL,37235,CPT,481,RC,48100158,CDM,,,,both,,,13360.0000,2004.0000,WELLCARE,WELLCARE MEDICAID,13360.00,,,,,,,148.0000,15872.7900,percent of total billed charges,"100% of $13,360.00 in Billed Charges for Rev 481 Proc 37235 = $13,360.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACE ART EA ADD,37237,CPT,361,RC,36100228,CDM,,,,both,,,24666.0000,3699.9000,AETNA,AETNA,10532.38,,,,,,,148.0000,24666.0000,percent of total billed charges,"42.7% of $24,666.00 in Billed Charges for Rev 361 Proc 37237 = $10,532.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACE ART EA ADD,37237,CPT,361,RC,36100228,CDM,,,,both,,,24666.0000,3699.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15721.62,,,,,,,148.0000,24666.0000,fee schedule,"APG 00085 Proc 37237 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 104% = $15,721.62. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE ART EA ADD,37237,CPT,361,RC,36100228,CDM,,,,both,,,24666.0000,3699.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15570.45,,,,,,,148.0000,24666.0000,fee schedule,"APG 00085 Proc 37237 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE ART EA ADD,37237,CPT,361,RC,36100228,CDM,,,,both,,,24666.0000,3699.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,148.0000,24666.0000,case rate,"Rev 361 Proc 37237 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE ART EA ADD,37237,CPT,361,RC,36100228,CDM,,,,both,,,24666.0000,3699.9000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,24666.0000,case rate,Rev 361 Proc 37237 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE ART EA ADD,37237,CPT,361,RC,36100228,CDM,,,,both,,,24666.0000,3699.9000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,24666.0000,case rate,Rev 361 Proc 37237 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE ART EA ADD,37237,CPT,361,RC,36100228,CDM,,,,both,,,24666.0000,3699.9000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,24666.0000,case rate,Rev 361 Proc 37237 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE ART EA ADD,37237,CPT,361,RC,36100228,CDM,,,,both,,,24666.0000,3699.9000,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,148.0000,24666.0000,case rate,"Rev 361 Proc 37237 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE ART EA ADD,37237,CPT,361,RC,36100228,CDM,,,,both,,,24666.0000,3699.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,148.0000,24666.0000,case rate,"Rev 361 Proc 37237 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE ART EA ADD,37237,CPT,361,RC,36100228,CDM,,,,both,,,24666.0000,3699.9000,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,148.0000,24666.0000,case rate,"Rev 361 Proc 37237 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE ART EA ADD,37237,CPT,361,RC,36100228,CDM,,,,both,,,24666.0000,3699.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,22199.40,,,,,,,148.0000,24666.0000,percent of total billed charges,"90% of $24,666.00 in Billed Charges for Rev 361 Proc 37237 = $22,199.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACE ART EA ADD,37237,CPT,361,RC,36100228,CDM,,,,both,,,24666.0000,3699.9000,MEDCOST,MEDCOST VHN,11738.55,,,,,,,148.0000,24666.0000,percent of total billed charges,"47.59% of $24,666.00 in Billed Charges for Rev 361 Proc 37237 = $11,738.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACE ART EA ADD,37237,CPT,361,RC,36100228,CDM,,,,both,,,24666.0000,3699.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15872.79,,,,,,,148.0000,24666.0000,fee schedule,"APG 00085 Proc 37237 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 105% = $15,872.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE ART EA ADD,37237,CPT,361,RC,36100228,CDM,,,,both,,,24666.0000,3699.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15585.57,,,,,,,148.0000,24666.0000,fee schedule,"APG 00085 Proc 37237 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 103.1% = $15,585.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE ART EA ADD,37237,CPT,361,RC,36100228,CDM,,,,both,,,24666.0000,3699.9000,SENTARA HEALTH,SENTARA HEALTH,6366.29,,,,,,,148.0000,24666.0000,percent of total billed charges,"25.81% of $24,666.00 in Billed Charges for Rev 361 Proc 37237 = $6,366.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACE ART EA ADD,37237,CPT,361,RC,36100228,CDM,,,,both,,,24666.0000,3699.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",24666.00,,,,,,,148.0000,24666.0000,percent of total billed charges,"100% of $24,666.00 in Billed Charges for Rev 361 Proc 37237 = $24,666.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACE ART EA ADD,37237,CPT,361,RC,36100228,CDM,,,,both,,,24666.0000,3699.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,148.0000,24666.0000,case rate,"Rev 361 Proc 37237 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE ART EA ADD,37237,CPT,361,RC,36100228,CDM,,,,both,,,24666.0000,3699.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,148.0000,24666.0000,case rate,"Rev 361 Proc 37237 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE ART EA ADD,37237,CPT,361,RC,36100228,CDM,,,,both,,,24666.0000,3699.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,148.0000,24666.0000,case rate,"Rev 361 Proc 37237 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE ART EA ADD,37237,CPT,361,RC,36100228,CDM,,,,both,,,24666.0000,3699.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,148.0000,24666.0000,case rate,"Rev 361 Proc 37237 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE ART EA ADD,37237,CPT,361,RC,36100228,CDM,,,,both,,,24666.0000,3699.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15570.45,,,,,,,148.0000,24666.0000,fee schedule,"APG 00085 Proc 37237 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE ART EA ADD,37237,CPT,361,RC,36100228,CDM,,,,both,,,24666.0000,3699.9000,WELLCARE,WELLCARE MEDICAID,24666.00,,,,,,,148.0000,24666.0000,percent of total billed charges,"100% of $24,666.00 in Billed Charges for Rev 361 Proc 37237 = $24,666.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA,353.13,,,,,,,109.0000,827.0000,percent of total billed charges,42.7% of $827.00 in Billed Charges for Rev 450 Proc 27200 = $353.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27200 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,827.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27200 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,827.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,135.50,,,,,,,109.0000,827.0000,fee schedule,$135.50 from Fee Schedule BLDTM_23 for Rev 450 Proc 27200 * Qty 1 = $135.50 at 100% = $135.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,744.30,,,,,,,109.0000,827.0000,percent of total billed charges,90% of $827.00 in Billed Charges for Rev 450 Proc 27200 = $744.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,MEDCOST,MEDCOST VHN,393.57,,,,,,,109.0000,827.0000,percent of total billed charges,47.59% of $827.00 in Billed Charges for Rev 450 Proc 27200 = $393.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27200 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27200 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA HEALTH,213.45,,,,,,,109.0000,827.0000,percent of total billed charges,25.81% of $827.00 in Billed Charges for Rev 450 Proc 27200 = $213.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",827.00,,,,,,,109.0000,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 27200 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 27200 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 27200 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 27200 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,827.00,,,,,,,109.0000,827.0000,case rate,"Rev 450 Proc 27200 at Case Rate $847.00 (Service Line reduced to $827.00, claim capped at $827.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27200 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICAID,827.00,,,,,,,109.0000,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 27200 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX COCCYGEAL FX,27200,CPT,450,RC,45000393,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,827.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA,353.13,,,,,,,109.0000,827.0000,percent of total billed charges,42.7% of $827.00 in Billed Charges for Rev 450 Proc 27220 = $353.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27220 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,827.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27220 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,827.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,428.98,,,,,,,109.0000,827.0000,fee schedule,$428.98 from Fee Schedule BLDTM_23 for Rev 450 Proc 27220 * Qty 1 = $428.98 at 100% = $428.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,744.30,,,,,,,109.0000,827.0000,percent of total billed charges,90% of $827.00 in Billed Charges for Rev 450 Proc 27220 = $744.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,MEDCOST,MEDCOST VHN,393.57,,,,,,,109.0000,827.0000,percent of total billed charges,47.59% of $827.00 in Billed Charges for Rev 450 Proc 27220 = $393.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27220 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27220 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA HEALTH,213.45,,,,,,,109.0000,827.0000,percent of total billed charges,25.81% of $827.00 in Billed Charges for Rev 450 Proc 27220 = $213.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",827.00,,,,,,,109.0000,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 27220 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 27220 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 27220 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 27220 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,827.00,,,,,,,109.0000,827.0000,case rate,"Rev 450 Proc 27220 at Case Rate $847.00 (Service Line reduced to $827.00, claim capped at $827.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27220 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICAID,827.00,,,,,,,109.0000,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 27220 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX ACETABULUM HIP SOCKET FX W/O MANIP,27220,CPT,450,RC,45000394,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,827.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA,353.13,,,,,,,109.0000,827.0000,percent of total billed charges,42.7% of $827.00 in Billed Charges for Rev 450 Proc 27246 = $353.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27246 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,827.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27246 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,827.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,355.41,,,,,,,109.0000,827.0000,fee schedule,$355.41 from Fee Schedule BLDTM_23 for Rev 450 Proc 27246 * Qty 1 = $355.41 at 100% = $355.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,827.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,744.30,,,,,,,109.0000,827.0000,percent of total billed charges,90% of $827.00 in Billed Charges for Rev 450 Proc 27246 = $744.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,MEDCOST,MEDCOST VHN,393.57,,,,,,,109.0000,827.0000,percent of total billed charges,47.59% of $827.00 in Billed Charges for Rev 450 Proc 27246 = $393.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27246 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,827.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27246 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA HEALTH,213.45,,,,,,,109.0000,827.0000,percent of total billed charges,25.81% of $827.00 in Billed Charges for Rev 450 Proc 27246 = $213.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",827.00,,,,,,,109.0000,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 27246 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 27246 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 27246 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,827.0000,case rate,Rev 450 Proc 27246 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,827.00,,,,,,,109.0000,827.0000,case rate,"Rev 450 Proc 27246 at Case Rate $847.00 (Service Line reduced to $827.00, claim capped at $827.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,827.0000,fee schedule,"APG 00041 Proc 27246 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,827.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICAID,827.00,,,,,,,109.0000,827.0000,percent of total billed charges,100% of $827.00 in Billed Charges for Rev 450 Proc 27246 = $827.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLSD TX GRTR TROCHANTERIC FX W/O MANIP,27246,CPT,450,RC,45000397,CDM,,,,both,,,827.0000,124.0500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,827.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA,699.85,,,,,,,109.0000,1639.0000,percent of total billed charges,"42.7% of $1,639.00 in Billed Charges for Rev 450 Proc 27250 = $699.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,1639.0000,fee schedule,"APG 00041 Proc 27250 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,1639.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,1639.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,1639.0000,fee schedule,"APG 00041 Proc 27250 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,1639.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,410.00,,,,,,,109.0000,1639.0000,fee schedule,$410.00 from Fee Schedule BLDTM_23 for Rev 450 Proc 27250 * Qty 1 = $410.00 at 100% = $410.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,1639.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1475.10,,,,,,,109.0000,1639.0000,percent of total billed charges,"90% of $1,639.00 in Billed Charges for Rev 450 Proc 27250 = $1,475.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,MEDCOST,MEDCOST VHN,780.00,,,,,,,109.0000,1639.0000,percent of total billed charges,"47.59% of $1,639.00 in Billed Charges for Rev 450 Proc 27250 = $780.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,1639.0000,fee schedule,"APG 00041 Proc 27250 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,1639.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,1639.0000,fee schedule,"APG 00041 Proc 27250 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,SENTARA HEALTH,SENTARA HEALTH,423.03,,,,,,,109.0000,1639.0000,percent of total billed charges,"25.81% of $1,639.00 in Billed Charges for Rev 450 Proc 27250 = $423.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1639.00,,,,,,,109.0000,1639.0000,percent of total billed charges,"100% of $1,639.00 in Billed Charges for Rev 450 Proc 27250 = $1,639.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1639.0000,case rate,Rev 450 Proc 27250 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1639.0000,case rate,Rev 450 Proc 27250 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1639.0000,case rate,Rev 450 Proc 27250 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1639.0000,case rate,Rev 450 Proc 27250 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,1639.0000,fee schedule,"APG 00041 Proc 27250 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,1639.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,WELLCARE,WELLCARE MEDICAID,1639.00,,,,,,,109.0000,1639.0000,percent of total billed charges,"100% of $1,639.00 in Billed Charges for Rev 450 Proc 27250 = $1,639.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX TRAUMATIC HIP DISLOC WO AN,27250,CPT,450,RC,45000157,CDM,,,,both,,,1639.0000,245.8500,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,1639.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,AETNA,AETNA,1073.48,,,,,,,109.0000,2514.0000,percent of total billed charges,"42.7% of $2,514.00 in Billed Charges for Rev 450 Proc 27256 = $1,073.48. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,2514.0000,fee schedule,"APG 00041 Proc 27256 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,109.0000,2514.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,2514.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,109.0000,2514.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,AMBETTER,AMBETTER,487.87,,,,,,,109.0000,2514.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,109.0000,2514.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,109.0000,2514.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,2514.0000,fee schedule,"APG 00041 Proc 27256 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,109.0000,2514.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,109.0000,2514.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,109.0000,2514.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,244.30,,,,,,,109.0000,2514.0000,fee schedule,$244.30 from Fee Schedule BLDTM_23 for Rev 450 Proc 27256 * Qty 1 = $244.30 at 100% = $244.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,109.0000,2514.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,109.0000,2514.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,109.0000,2514.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2262.60,,,,,,,109.0000,2514.0000,percent of total billed charges,"90% of $2,514.00 in Billed Charges for Rev 450 Proc 27256 = $2,262.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,109.0000,2514.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,109.0000,2514.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,MEDCOST,MEDCOST VHN,1196.41,,,,,,,109.0000,2514.0000,percent of total billed charges,"47.59% of $2,514.00 in Billed Charges for Rev 450 Proc 27256 = $1,196.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,2514.0000,fee schedule,"APG 00041 Proc 27256 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,109.0000,2514.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,109.0000,2514.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,109.0000,2514.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,2514.0000,fee schedule,"APG 00041 Proc 27256 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,SENTARA HEALTH,SENTARA HEALTH,648.86,,,,,,,109.0000,2514.0000,percent of total billed charges,"25.81% of $2,514.00 in Billed Charges for Rev 450 Proc 27256 = $648.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,109.0000,2514.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2514.00,,,,,,,109.0000,2514.0000,percent of total billed charges,"100% of $2,514.00 in Billed Charges for Rev 450 Proc 27256 = $2,514.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,2514.0000,case rate,Rev 450 Proc 27256 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,2514.0000,case rate,Rev 450 Proc 27256 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,2514.0000,case rate,Rev 450 Proc 27256 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,2514.0000,case rate,Rev 450 Proc 27256 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,2514.0000,fee schedule,"APG 00041 Proc 27256 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,109.0000,2514.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,109.0000,2514.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,WELLCARE,WELLCARE MEDICAID,2514.00,,,,,,,109.0000,2514.0000,percent of total billed charges,"100% of $2,514.00 in Billed Charges for Rev 450 Proc 27256 = $2,514.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TX SPONT HIP DISLOC ABDCT SPLINT/TRCTN WO ANES WO MANIP,27256,CPT,450,RC,45000348,CDM,,,,both,,,2514.0000,377.1000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,109.0000,2514.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA,2059.42,,,,,,,109.0000,4823.0000,percent of total billed charges,"42.7% of $4,823.00 in Billed Charges for Rev 450 Proc 27266 = $2,059.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1450.92,,,,,,,109.0000,4823.0000,fee schedule,"APG 00044 Proc 27266 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 104% = $1,450.92. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,4823.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,4823.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1436.97,,,,,,,109.0000,4823.0000,fee schedule,"APG 00044 Proc 27266 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 103% = $1,436.97. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,4823.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4489.34,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,489.76,,,,,,,109.0000,4823.0000,fee schedule,$489.76 from Fee Schedule BLDTM_23 for Rev 450 Proc 27266 * Qty 1 = $489.76 at 100% = $489.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,4823.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4340.70,,,,,,,109.0000,4823.0000,percent of total billed charges,"90% of $4,823.00 in Billed Charges for Rev 450 Proc 27266 = $4,340.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,MEDCOST,MEDCOST VHN,2295.27,,,,,,,109.0000,4823.0000,percent of total billed charges,"47.59% of $4,823.00 in Billed Charges for Rev 450 Proc 27266 = $2,295.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1464.87,,,,,,,109.0000,4823.0000,fee schedule,"APG 00044 Proc 27266 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 100% = $1,395.11... $1,395.11 at 105% = $1,464.87 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,4823.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1438.36,,,,,,,109.0000,4823.0000,fee schedule,"APG 00044 Proc 27266 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 100% = $1,395.11... $1,395.11 at 103.1% = $1,438.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,SENTARA HEALTH,SENTARA HEALTH,1244.82,,,,,,,109.0000,4823.0000,percent of total billed charges,"25.81% of $4,823.00 in Billed Charges for Rev 450 Proc 27266 = $1,244.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4823.00,,,,,,,109.0000,4823.0000,percent of total billed charges,"100% of $4,823.00 in Billed Charges for Rev 450 Proc 27266 = $4,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 27266 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 27266 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 27266 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,4823.0000,case rate,Rev 450 Proc 27266 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1436.97,,,,,,,109.0000,4823.0000,fee schedule,"APG 00044 Proc 27266 at $836.60 (Base Rate) * 1.6676 (Relative Weight) = $1,395.11 (Total Line Payment) at 103% = $1,436.97. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,4823.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,WELLCARE,WELLCARE MEDICAID,4823.00,,,,,,,109.0000,4823.0000,percent of total billed charges,"100% of $4,823.00 in Billed Charges for Rev 450 Proc 27266 = $4,823.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLSD TX POST HIP ARTHROPLASTY DISLOC REQ ANES,27266,CPT,450,RC,45000399,CDM,,,,both,,,4823.0000,723.4500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,4823.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,AETNA,AETNA,2689.67,,,,,,,578.0000,6299.0000,percent of total billed charges,"42.7% of $6,299.00 in Billed Charges for Rev 361 Proc 27324 = $2,689.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2612.63,,,,,,,578.0000,6299.0000,fee schedule,"APG 00051 Proc 27324 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 104% = $2,612.63. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2635.37,,,,,,,578.0000,6299.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,AETNA,AETNA HEALTHCARE MEDICARE,2635.37,,,,,,,578.0000,6299.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,2635.37,,,,,,,578.0000,6299.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,AMBETTER,AMBETTER,5745.12,,,,,,,578.0000,6299.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2740.79,,,,,,,578.0000,6299.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,BLUE CROSS,ANTHEM EXCHANGE,6299.00,,,,,,,578.0000,6299.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2587.51,,,,,,,578.0000,6299.0000,fee schedule,"APG 00051 Proc 27324 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,BLUE CROSS,ANTHEM HMO,6299.00,,,,,,,578.0000,6299.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2714.44,,,,,,,578.0000,6299.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",6299.00,,,,,,,578.0000,6299.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,578.0000,6299.0000,case rate,Rev 361 Proc 27324 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,578.0000,6299.0000,case rate,"Rev 361 Proc 27324 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,BLUE CROSS,BLUE CROSS MEDICARE,2740.79,,,,,,,578.0000,6299.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,578.0000,6299.0000,case rate,"Rev 361 Proc 27324 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,578.0000,6299.0000,case rate,"Rev 361 Proc 27324 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,6299.0000,case rate,Rev 361 Proc 27324 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,6299.0000,case rate,Rev 361 Proc 27324 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,578.0000,6299.0000,case rate,"Rev 361 Proc 27324 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,578.0000,6299.0000,case rate,"Rev 361 Proc 27324 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,2767.14,,,,,,,578.0000,6299.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,578.0000,6299.0000,case rate,"Rev 361 Proc 27324 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,578.0000,6299.0000,case rate,"Rev 361 Proc 27324 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,2767.14,,,,,,,578.0000,6299.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5669.10,,,,,,,578.0000,6299.0000,percent of total billed charges,"90% of $6,299.00 in Billed Charges for Rev 361 Proc 27324 = $5,669.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,HUMANA,HUMANA MEDICARE,2635.37,,,,,,,578.0000,6299.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2635.37,,,,,,,578.0000,6299.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,MEDCOST,MEDCOST VHN,2997.69,,,,,,,578.0000,6299.0000,percent of total billed charges,"47.59% of $6,299.00 in Billed Charges for Rev 361 Proc 27324 = $2,997.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2637.75,,,,,,,578.0000,6299.0000,fee schedule,"APG 00051 Proc 27324 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 105% = $2,637.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,2767.14,,,,,,,578.0000,6299.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,2767.14,,,,,,,578.0000,6299.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,NHC ADVANTAGE,NHC ADVANTAGE,2767.14,,,,,,,578.0000,6299.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2590.02,,,,,,,578.0000,6299.0000,fee schedule,"APG 00051 Proc 27324 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 103.1% = $2,590.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,SENTARA HEALTH,SENTARA HEALTH,1625.77,,,,,,,578.0000,6299.0000,percent of total billed charges,"25.81% of $6,299.00 in Billed Charges for Rev 361 Proc 27324 = $1,625.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,SENTARA HEALTH,SENTARA MEDICARE,2635.37,,,,,,,578.0000,6299.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6299.00,,,,,,,578.0000,6299.0000,percent of total billed charges,"100% of $6,299.00 in Billed Charges for Rev 361 Proc 27324 = $6,299.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1418.00,,,,,,,578.0000,6299.0000,case rate,"Rev 361 Proc 27324 ASG Rate of $1,418.00 at 100% of $1,418.00 = $1,418.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2547.00,,,,,,,578.0000,6299.0000,case rate,"Rev 361 Proc 27324 ASG Rate of $2,547.00 at 100% of $2,547.00 = $2,547.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2436.00,,,,,,,578.0000,6299.0000,case rate,"Rev 361 Proc 27324 ASG Rate of $2,436.00 at 100% of $2,436.00 = $2,436.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,4296.00,,,,,,,578.0000,6299.0000,case rate,"Rev 361 Proc 27324 ASG Rate of $4,296.00 at 100% of $4,296.00 = $4,296.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2587.51,,,,,,,578.0000,6299.0000,fee schedule,"APG 00051 Proc 27324 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2635.37,,,,,,,578.0000,6299.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2635.37,,,,,,,578.0000,6299.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,WELLCARE,WELLCARE MEDICAID,6299.00,,,,,,,578.0000,6299.0000,percent of total billed charges,"100% of $6,299.00 in Billed Charges for Rev 361 Proc 27324 = $6,299.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC BX SOFT TISSUE THIGH/KNEE DEEP,27324,CPT,361,RC,36100086,CDM,,,,both,,,6299.0000,944.8500,WELLCARE,WELLCARE MEDICARE,2793.50,,,,,,,578.0000,6299.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,AETNA,AETNA,2661.49,,,,,,,109.0000,6233.0000,percent of total billed charges,"42.7% of $6,233.00 in Billed Charges for Rev 450 Proc 27372 = $2,661.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2612.63,,,,,,,109.0000,6233.0000,fee schedule,"APG 00051 Proc 27372 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 104% = $2,612.63. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2635.37,,,,,,,109.0000,6233.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,AETNA,AETNA HEALTHCARE MEDICARE,2635.37,,,,,,,109.0000,6233.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,2635.37,,,,,,,109.0000,6233.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,AMBETTER,AMBETTER,5745.12,,,,,,,109.0000,6233.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2740.79,,,,,,,109.0000,6233.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,BLUE CROSS,ANTHEM EXCHANGE,6233.00,,,,,,,109.0000,6233.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2587.51,,,,,,,109.0000,6233.0000,fee schedule,"APG 00051 Proc 27372 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,BLUE CROSS,ANTHEM HMO,6233.00,,,,,,,109.0000,6233.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2714.44,,,,,,,109.0000,6233.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",6233.00,,,,,,,109.0000,6233.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,410.97,,,,,,,109.0000,6233.0000,fee schedule,$410.97 from Fee Schedule BLDTM_23 for Rev 450 Proc 27372 * Qty 1 = $410.97 at 100% = $410.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,BLUE CROSS,BLUE CROSS MEDICARE,2740.79,,,,,,,109.0000,6233.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,2767.14,,,,,,,109.0000,6233.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,2767.14,,,,,,,109.0000,6233.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5609.70,,,,,,,109.0000,6233.0000,percent of total billed charges,"90% of $6,233.00 in Billed Charges for Rev 450 Proc 27372 = $5,609.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,HUMANA,HUMANA MEDICARE,2635.37,,,,,,,109.0000,6233.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2635.37,,,,,,,109.0000,6233.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,MEDCOST,MEDCOST VHN,2966.28,,,,,,,109.0000,6233.0000,percent of total billed charges,"47.59% of $6,233.00 in Billed Charges for Rev 450 Proc 27372 = $2,966.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2637.75,,,,,,,109.0000,6233.0000,fee schedule,"APG 00051 Proc 27372 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 105% = $2,637.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,2767.14,,,,,,,109.0000,6233.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,2767.14,,,,,,,109.0000,6233.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,NHC ADVANTAGE,NHC ADVANTAGE,2767.14,,,,,,,109.0000,6233.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2590.02,,,,,,,109.0000,6233.0000,fee schedule,"APG 00051 Proc 27372 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 100% = $2,512.14... $2,512.14 at 103.1% = $2,590.02 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,SENTARA HEALTH,SENTARA HEALTH,1608.74,,,,,,,109.0000,6233.0000,percent of total billed charges,"25.81% of $6,233.00 in Billed Charges for Rev 450 Proc 27372 = $1,608.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,SENTARA HEALTH,SENTARA MEDICARE,2635.37,,,,,,,109.0000,6233.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6233.00,,,,,,,109.0000,6233.0000,percent of total billed charges,"100% of $6,233.00 in Billed Charges for Rev 450 Proc 27372 = $6,233.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,6233.0000,case rate,Rev 450 Proc 27372 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,6233.0000,case rate,Rev 450 Proc 27372 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,6233.0000,case rate,Rev 450 Proc 27372 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,6233.0000,case rate,Rev 450 Proc 27372 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2587.51,,,,,,,109.0000,6233.0000,fee schedule,"APG 00051 Proc 27372 at $836.60 (Base Rate) * 3.0028 (Relative Weight) = $2,512.14 (Total Line Payment) at 103% = $2,587.51. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2635.37,,,,,,,109.0000,6233.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2635.37,,,,,,,109.0000,6233.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,WELLCARE,WELLCARE MEDICAID,6233.00,,,,,,,109.0000,6233.0000,percent of total billed charges,"100% of $6,233.00 in Billed Charges for Rev 450 Proc 27372 = $6,233.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL FB DEEP THIGH/KNEE,27372,CPT,450,RC,45000159,CDM,,,,both,,,6233.0000,934.9500,WELLCARE,WELLCARE MEDICARE,2793.50,,,,,,,109.0000,6233.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,AETNA,AETNA,2461.66,,,,,,,109.0000,5765.0000,percent of total billed charges,"42.7% of $5,765.00 in Billed Charges for Rev 450 Proc 27502 = $2,461.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,109.0000,5765.0000,fee schedule,APG 00041 Proc 27502 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1458.89,,,,,,,109.0000,5765.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,AETNA,AETNA HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,5765.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,1458.89,,,,,,,109.0000,5765.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,AMBETTER,AMBETTER,3180.38,,,,,,,109.0000,5765.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1517.25,,,,,,,109.0000,5765.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,BLUE CROSS,ANTHEM EXCHANGE,3591.86,,,,,,,109.0000,5765.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,109.0000,5765.0000,fee schedule,APG 00041 Proc 27502 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,BLUE CROSS,ANTHEM HMO,3816.14,,,,,,,109.0000,5765.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1502.66,,,,,,,109.0000,5765.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4489.34,,,,,,,109.0000,5765.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,964.08,,,,,,,109.0000,5765.0000,fee schedule,$964.08 from Fee Schedule BLDTM_23 for Rev 450 Proc 27502 * Qty 1 = $964.08 at 100% = $964.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,BLUE CROSS,BLUE CROSS MEDICARE,1517.25,,,,,,,109.0000,5765.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,1531.83,,,,,,,109.0000,5765.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1531.83,,,,,,,109.0000,5765.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5188.50,,,,,,,109.0000,5765.0000,percent of total billed charges,"90% of $5,765.00 in Billed Charges for Rev 450 Proc 27502 = $5,188.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,HUMANA,HUMANA MEDICARE,1458.89,,,,,,,109.0000,5765.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1458.89,,,,,,,109.0000,5765.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,MEDCOST,MEDCOST VHN,2743.56,,,,,,,109.0000,5765.0000,percent of total billed charges,"47.59% of $5,765.00 in Billed Charges for Rev 450 Proc 27502 = $2,743.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,109.0000,5765.0000,fee schedule,APG 00041 Proc 27502 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1531.83,,,,,,,109.0000,5765.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1531.83,,,,,,,109.0000,5765.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,NHC ADVANTAGE,NHC ADVANTAGE,1531.83,,,,,,,109.0000,5765.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,109.0000,5765.0000,fee schedule,APG 00041 Proc 27502 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,SENTARA HEALTH,SENTARA HEALTH,1487.95,,,,,,,109.0000,5765.0000,percent of total billed charges,"25.81% of $5,765.00 in Billed Charges for Rev 450 Proc 27502 = $1,487.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,SENTARA HEALTH,SENTARA MEDICARE,1458.89,,,,,,,109.0000,5765.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5765.00,,,,,,,109.0000,5765.0000,percent of total billed charges,"100% of $5,765.00 in Billed Charges for Rev 450 Proc 27502 = $5,765.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,5765.0000,case rate,Rev 450 Proc 27502 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,5765.0000,case rate,Rev 450 Proc 27502 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,5765.0000,case rate,Rev 450 Proc 27502 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,5765.0000,case rate,Rev 450 Proc 27502 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,109.0000,5765.0000,fee schedule,APG 00041 Proc 27502 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment) at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1458.89,,,,,,,109.0000,5765.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1458.89,,,,,,,109.0000,5765.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,WELLCARE,WELLCARE MEDICAID,5765.00,,,,,,,109.0000,5765.0000,percent of total billed charges,"100% of $5,765.00 in Billed Charges for Rev 450 Proc 27502 = $5,765.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CLOSE REDUCT FEMUR SHAFT FRACT,27502,CPT,450,RC,45000160,CDM,,,,both,,,5765.0000,864.7500,WELLCARE,WELLCARE MEDICARE,1546.42,,,,,,,109.0000,5765.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,AETNA,AETNA,310.86,,,,,,,106.9200,728.0000,percent of total billed charges,42.7% of $728.00 in Billed Charges for Rev 521 Proc 27520 = $310.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,106.9200,728.0000,fee schedule,"APG 00041 Proc 27520 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,106.9200,728.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,106.9200,728.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,106.9200,728.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,AMBETTER,AMBETTER,487.87,,,,,,,106.9200,728.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,106.9200,728.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,106.9200,728.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,106.9200,728.0000,fee schedule,"APG 00041 Proc 27520 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,106.9200,728.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,106.9200,728.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,106.9200,728.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,346.56,,,,,,,106.9200,728.0000,fee schedule,$346.56 from Fee Schedule BLDTM_23 for Rev 521 Proc 27520 * Qty 1 = $346.56 at 100% = $346.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,106.9200,728.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,CIGNA HEALTHCARE,CIGNA HMO,303.58,,,,,,,106.9200,728.0000,percent of total billed charges,41.7% of $728.00 in Billed Charges for Rev 521 Proc 27520 = $303.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,337.79,,,,,,,106.9200,728.0000,percent of total billed charges,46.4% of $728.00 in Billed Charges for Rev 521 Proc 27520 = $337.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,106.9200,728.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,303.58,,,,,,,106.9200,728.0000,percent of total billed charges,41.7% of $728.00 in Billed Charges for Rev 521 Proc 27520 = $303.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,CIGNA HEALTHCARE,CIGNA PPO,303.58,,,,,,,106.9200,728.0000,percent of total billed charges,41.7% of $728.00 in Billed Charges for Rev 521 Proc 27520 = $303.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,106.9200,728.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,655.20,,,,,,,106.9200,728.0000,percent of total billed charges,90% of $728.00 in Billed Charges for Rev 521 Proc 27520 = $655.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,106.9200,728.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,106.9200,728.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,MEDCOST,MEDCOST VHN,346.46,,,,,,,106.9200,728.0000,percent of total billed charges,47.59% of $728.00 in Billed Charges for Rev 521 Proc 27520 = $346.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,106.9200,728.0000,fee schedule,"APG 00041 Proc 27520 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,106.9200,728.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,106.9200,728.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,106.9200,728.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,106.9200,728.0000,fee schedule,"APG 00041 Proc 27520 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,SENTARA HEALTH,SENTARA HEALTH,187.90,,,,,,,106.9200,728.0000,percent of total billed charges,25.81% of $728.00 in Billed Charges for Rev 521 Proc 27520 = $187.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,106.9200,728.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",728.00,,,,,,,106.9200,728.0000,percent of total billed charges,100% of $728.00 in Billed Charges for Rev 521 Proc 27520 = $728.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,106.92,,,,,,,106.9200,728.0000,fee schedule,$213.83 from Fee Schedule TCUHC24 for Rev 521 Proc 27520 * Qty 1 = $213.83 at 50% = $106.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,106.9200,728.0000,fee schedule,"APG 00041 Proc 27520 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,106.9200,728.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,106.9200,728.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,WELLCARE,WELLCARE MEDICAID,728.00,,,,,,,106.9200,728.0000,percent of total billed charges,100% of $728.00 in Billed Charges for Rev 521 Proc 27520 = $728.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX PATELLAR FX WO MANIP,27520,CPT,521,RC,52100091,CDM,,,,both,,,728.0000,109.2000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,106.9200,728.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,AETNA,AETNA,310.86,,,,,,,106.9200,728.0000,percent of total billed charges,42.7% of $728.00 in Billed Charges for Rev 521 Proc 27530 = $310.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,696.66,,,,,,,106.9200,728.0000,fee schedule,"APG 00041 Proc 27530 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 104% = $696.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,223.80,,,,,,,106.9200,728.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,AETNA,AETNA HEALTHCARE MEDICARE,223.80,,,,,,,106.9200,728.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,223.80,,,,,,,106.9200,728.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,AMBETTER,AMBETTER,487.87,,,,,,,106.9200,728.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,232.75,,,,,,,106.9200,728.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,BLUE CROSS,ANTHEM EXCHANGE,551.00,,,,,,,106.9200,728.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,689.96,,,,,,,106.9200,728.0000,fee schedule,"APG 00041 Proc 27530 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,BLUE CROSS,ANTHEM HMO,585.41,,,,,,,106.9200,728.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,230.51,,,,,,,106.9200,728.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",688.68,,,,,,,106.9200,728.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,414.07,,,,,,,106.9200,728.0000,fee schedule,$414.07 from Fee Schedule BLDTM_23 for Rev 521 Proc 27530 * Qty 1 = $414.07 at 100% = $414.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,BLUE CROSS,BLUE CROSS MEDICARE,232.75,,,,,,,106.9200,728.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,CIGNA HEALTHCARE,CIGNA HMO,303.58,,,,,,,106.9200,728.0000,percent of total billed charges,41.7% of $728.00 in Billed Charges for Rev 521 Proc 27530 = $303.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,337.79,,,,,,,106.9200,728.0000,percent of total billed charges,46.4% of $728.00 in Billed Charges for Rev 521 Proc 27530 = $337.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,234.98,,,,,,,106.9200,728.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,303.58,,,,,,,106.9200,728.0000,percent of total billed charges,41.7% of $728.00 in Billed Charges for Rev 521 Proc 27530 = $303.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,CIGNA HEALTHCARE,CIGNA PPO,303.58,,,,,,,106.9200,728.0000,percent of total billed charges,41.7% of $728.00 in Billed Charges for Rev 521 Proc 27530 = $303.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,234.98,,,,,,,106.9200,728.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,655.20,,,,,,,106.9200,728.0000,percent of total billed charges,90% of $728.00 in Billed Charges for Rev 521 Proc 27530 = $655.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,HUMANA,HUMANA MEDICARE,223.80,,,,,,,106.9200,728.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,223.80,,,,,,,106.9200,728.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,MEDCOST,MEDCOST VHN,346.46,,,,,,,106.9200,728.0000,percent of total billed charges,47.59% of $728.00 in Billed Charges for Rev 521 Proc 27530 = $346.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,703.36,,,,,,,106.9200,728.0000,fee schedule,"APG 00041 Proc 27530 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 105% = $703.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,234.98,,,,,,,106.9200,728.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,234.98,,,,,,,106.9200,728.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,NHC ADVANTAGE,NHC ADVANTAGE,234.98,,,,,,,106.9200,728.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,690.64,,,,,,,106.9200,728.0000,fee schedule,"APG 00041 Proc 27530 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 100% = $669.87... $669.87 at 103.1% = $690.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,SENTARA HEALTH,SENTARA HEALTH,187.90,,,,,,,106.9200,728.0000,percent of total billed charges,25.81% of $728.00 in Billed Charges for Rev 521 Proc 27530 = $187.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,SENTARA HEALTH,SENTARA MEDICARE,223.80,,,,,,,106.9200,728.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",728.00,,,,,,,106.9200,728.0000,percent of total billed charges,100% of $728.00 in Billed Charges for Rev 521 Proc 27530 = $728.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,106.92,,,,,,,106.9200,728.0000,fee schedule,$213.83 from Fee Schedule TCUHC24 for Rev 521 Proc 27530 * Qty 1 = $213.83 at 50% = $106.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,689.96,,,,,,,106.9200,728.0000,fee schedule,"APG 00041 Proc 27530 at $836.60 (Base Rate) * 0.8007 (Relative Weight) = $669.87 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $669.87 at 103% = $689.96. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,223.80,,,,,,,106.9200,728.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,223.80,,,,,,,106.9200,728.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,WELLCARE,WELLCARE MEDICAID,728.00,,,,,,,106.9200,728.0000,percent of total billed charges,100% of $728.00 in Billed Charges for Rev 521 Proc 27530 = $728.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CLOS TX TIB FX PROX WO MANIP,27530,CPT,521,RC,52100092,CDM,,,,both,,,728.0000,109.2000,WELLCARE,WELLCARE MEDICARE,237.22,,,,,,,106.9200,728.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,AETNA,AETNA,1397.14,,,,,,,650.0000,3272.0000,percent of total billed charges,"42.7% of $3,272.00 in Billed Charges for Rev 361 Proc 32551 = $1,397.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1446.31,,,,,,,650.0000,3272.0000,fee schedule,"APG 00068 Proc 32551 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 104% = $1,446.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1428.19,,,,,,,650.0000,3272.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,AETNA,AETNA HEALTHCARE MEDICARE,1428.19,,,,,,,650.0000,3272.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,1428.19,,,,,,,650.0000,3272.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,AMBETTER,AMBETTER,3113.45,,,,,,,650.0000,3272.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1485.32,,,,,,,650.0000,3272.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,BLUE CROSS,ANTHEM EXCHANGE,3272.00,,,,,,,650.0000,3272.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1432.40,,,,,,,650.0000,3272.0000,fee schedule,"APG 00068 Proc 32551 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,BLUE CROSS,ANTHEM HMO,3272.00,,,,,,,650.0000,3272.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1471.04,,,,,,,650.0000,3272.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3272.00,,,,,,,650.0000,3272.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,948.00,,,,,,,650.0000,3272.0000,case rate,Rev 361 Proc 32551 ASG Rate of $948.00 at 100% of $948.00 = $948.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,650.0000,3272.0000,case rate,"Rev 361 Proc 32551 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,BLUE CROSS,BLUE CROSS MEDICARE,1485.32,,,,,,,650.0000,3272.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,650.0000,3272.0000,case rate,"Rev 361 Proc 32551 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,650.0000,3272.0000,case rate,"Rev 361 Proc 32551 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,650.0000,3272.0000,case rate,Rev 361 Proc 32551 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,650.0000,3272.0000,case rate,Rev 361 Proc 32551 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,650.0000,3272.0000,case rate,"Rev 361 Proc 32551 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,650.0000,3272.0000,case rate,"Rev 361 Proc 32551 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,1499.60,,,,,,,650.0000,3272.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,650.0000,3272.0000,case rate,"Rev 361 Proc 32551 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,650.0000,3272.0000,case rate,"Rev 361 Proc 32551 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1499.60,,,,,,,650.0000,3272.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2944.80,,,,,,,650.0000,3272.0000,percent of total billed charges,"90% of $3,272.00 in Billed Charges for Rev 361 Proc 32551 = $2,944.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,HUMANA,HUMANA MEDICARE,1428.19,,,,,,,650.0000,3272.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1428.19,,,,,,,650.0000,3272.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,MEDCOST,MEDCOST VHN,1557.14,,,,,,,650.0000,3272.0000,percent of total billed charges,"47.59% of $3,272.00 in Billed Charges for Rev 361 Proc 32551 = $1,557.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1460.21,,,,,,,650.0000,3272.0000,fee schedule,"APG 00068 Proc 32551 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 100% = $1,390.68... $1,390.68 at 105% = $1,460.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1499.60,,,,,,,650.0000,3272.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1499.60,,,,,,,650.0000,3272.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,NHC ADVANTAGE,NHC ADVANTAGE,1499.60,,,,,,,650.0000,3272.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1433.79,,,,,,,650.0000,3272.0000,fee schedule,"APG 00068 Proc 32551 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 100% = $1,390.68... $1,390.68 at 103.1% = $1,433.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,SENTARA HEALTH,SENTARA HEALTH,844.50,,,,,,,650.0000,3272.0000,percent of total billed charges,"25.81% of $3,272.00 in Billed Charges for Rev 361 Proc 32551 = $844.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,SENTARA HEALTH,SENTARA MEDICARE,1428.19,,,,,,,650.0000,3272.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3272.00,,,,,,,650.0000,3272.0000,percent of total billed charges,"100% of $3,272.00 in Billed Charges for Rev 361 Proc 32551 = $3,272.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,650.0000,3272.0000,case rate,Rev 361 Proc 32551 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,650.0000,3272.0000,case rate,Rev 361 Proc 32551 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,650.0000,3272.0000,case rate,Rev 361 Proc 32551 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,650.0000,3272.0000,case rate,"Rev 361 Proc 32551 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1432.40,,,,,,,650.0000,3272.0000,fee schedule,"APG 00068 Proc 32551 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1428.19,,,,,,,650.0000,3272.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1428.19,,,,,,,650.0000,3272.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,WELLCARE,WELLCARE MEDICAID,3272.00,,,,,,,650.0000,3272.0000,percent of total billed charges,"100% of $3,272.00 in Billed Charges for Rev 361 Proc 32551 = $3,272.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TUBE THORACOSTOMY SEP PROC,32551,CPT,361,RC,36100115,CDM,,,,both,,,3272.0000,490.8000,WELLCARE,WELLCARE MEDICARE,1513.88,,,,,,,650.0000,3272.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,AETNA,AETNA,1341.21,,,,,,,109.0000,3141.0000,percent of total billed charges,"42.7% of $3,141.00 in Billed Charges for Rev 450 Proc 32554 = $1,341.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1446.31,,,,,,,109.0000,3141.0000,fee schedule,"APG 00068 Proc 32554 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,390.68 at 104% = $1,446.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,569.14,,,,,,,109.0000,3141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,AETNA,AETNA HEALTHCARE MEDICARE,569.14,,,,,,,109.0000,3141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,569.14,,,,,,,109.0000,3141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,AMBETTER,AMBETTER,1240.72,,,,,,,109.0000,3141.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,591.90,,,,,,,109.0000,3141.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,BLUE CROSS,ANTHEM EXCHANGE,1401.25,,,,,,,109.0000,3141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1432.40,,,,,,,109.0000,3141.0000,fee schedule,"APG 00068 Proc 32554 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,390.68 at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,BLUE CROSS,ANTHEM HMO,1488.74,,,,,,,109.0000,3141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,586.21,,,,,,,109.0000,3141.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1751.37,,,,,,,109.0000,3141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2198.70,,,,,,,109.0000,3141.0000,percent of total billed charges,"Rev 450 Proc 32554 $3,141.00 in Billed Charges at 70% = $2,198.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,BLUE CROSS,BLUE CROSS MEDICARE,591.90,,,,,,,109.0000,3141.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,597.59,,,,,,,109.0000,3141.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,597.59,,,,,,,109.0000,3141.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2826.90,,,,,,,109.0000,3141.0000,percent of total billed charges,"90% of $3,141.00 in Billed Charges for Rev 450 Proc 32554 = $2,826.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,HUMANA,HUMANA MEDICARE,569.14,,,,,,,109.0000,3141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,569.14,,,,,,,109.0000,3141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,MEDCOST,MEDCOST VHN,1494.80,,,,,,,109.0000,3141.0000,percent of total billed charges,"47.59% of $3,141.00 in Billed Charges for Rev 450 Proc 32554 = $1,494.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1460.21,,,,,,,109.0000,3141.0000,fee schedule,"APG 00068 Proc 32554 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,390.68 at 100% = $1,390.68... $1,390.68 at 105% = $1,460.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,597.59,,,,,,,109.0000,3141.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,597.59,,,,,,,109.0000,3141.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,NHC ADVANTAGE,NHC ADVANTAGE,597.59,,,,,,,109.0000,3141.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1433.79,,,,,,,109.0000,3141.0000,fee schedule,"APG 00068 Proc 32554 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,390.68 at 100% = $1,390.68... $1,390.68 at 103.1% = $1,433.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,SENTARA HEALTH,SENTARA HEALTH,810.69,,,,,,,109.0000,3141.0000,percent of total billed charges,"25.81% of $3,141.00 in Billed Charges for Rev 450 Proc 32554 = $810.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,SENTARA HEALTH,SENTARA MEDICARE,569.14,,,,,,,109.0000,3141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3141.00,,,,,,,109.0000,3141.0000,percent of total billed charges,"100% of $3,141.00 in Billed Charges for Rev 450 Proc 32554 = $3,141.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,3141.0000,case rate,Rev 450 Proc 32554 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,3141.0000,case rate,Rev 450 Proc 32554 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,3141.0000,case rate,Rev 450 Proc 32554 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,3141.0000,case rate,Rev 450 Proc 32554 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1432.40,,,,,,,109.0000,3141.0000,fee schedule,"APG 00068 Proc 32554 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,390.68 at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,569.14,,,,,,,109.0000,3141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,569.14,,,,,,,109.0000,3141.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,WELLCARE,WELLCARE MEDICAID,3141.00,,,,,,,109.0000,3141.0000,percent of total billed charges,"100% of $3,141.00 in Billed Charges for Rev 450 Proc 32554 = $3,141.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THORACENTESIS ASPIRAT WO GUID,32554,CPT,450,RC,45000228,CDM,,,,both,,,3141.0000,471.1500,WELLCARE,WELLCARE MEDICARE,603.28,,,,,,,109.0000,3141.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,AETNA,AETNA,13266.04,,,,,,,775.0000,31068.0000,percent of total billed charges,"42.7% of $31,068.00 in Billed Charges for Rev 361 Proc 37238 = $13,266.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15721.62,,,,,,,775.0000,31068.0000,fee schedule,"APG 00085 Proc 37238 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 104% = $15,721.62. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,10473.75,,,,,,,775.0000,31068.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,AETNA,AETNA HEALTHCARE MEDICARE,10473.75,,,,,,,775.0000,31068.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,10473.75,,,,,,,775.0000,31068.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,AMBETTER,AMBETTER,22832.77,,,,,,,775.0000,31068.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,10892.70,,,,,,,775.0000,31068.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,BLUE CROSS,ANTHEM EXCHANGE,25786.93,,,,,,,775.0000,31068.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15570.45,,,,,,,775.0000,31068.0000,fee schedule,"APG 00085 Proc 37238 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,BLUE CROSS,ANTHEM HMO,27397.08,,,,,,,775.0000,31068.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,10787.96,,,,,,,775.0000,31068.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",31068.00,,,,,,,775.0000,31068.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,775.0000,31068.0000,case rate,"Rev 361 Proc 37238 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,BLUE CROSS,BLUE CROSS E NETWORK,8571.00,,,,,,,775.0000,31068.0000,case rate,"Rev 361 Proc 37238 ASG Rate of $8,571.00 at 100% of $8,571.00 = $8,571.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,BLUE CROSS,BLUE CROSS MEDICARE,10892.70,,,,,,,775.0000,31068.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,BLUE CROSS,BLUE CROSS P NETWORK,8764.00,,,,,,,775.0000,31068.0000,case rate,"Rev 361 Proc 37238 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,BLUE CROSS,BLUE CROSS S NETWORK,8764.00,,,,,,,775.0000,31068.0000,case rate,"Rev 361 Proc 37238 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,31068.0000,case rate,Rev 361 Proc 37238 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,31068.0000,case rate,Rev 361 Proc 37238 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,775.0000,31068.0000,case rate,"Rev 361 Proc 37238 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,775.0000,31068.0000,case rate,"Rev 361 Proc 37238 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,10997.44,,,,,,,775.0000,31068.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,775.0000,31068.0000,case rate,"Rev 361 Proc 37238 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,775.0000,31068.0000,case rate,"Rev 361 Proc 37238 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,10997.44,,,,,,,775.0000,31068.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,27961.20,,,,,,,775.0000,31068.0000,percent of total billed charges,"90% of $31,068.00 in Billed Charges for Rev 361 Proc 37238 = $27,961.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,HUMANA,HUMANA MEDICARE,10473.75,,,,,,,775.0000,31068.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,10473.75,,,,,,,775.0000,31068.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,MEDCOST,MEDCOST VHN,14785.26,,,,,,,775.0000,31068.0000,percent of total billed charges,"47.59% of $31,068.00 in Billed Charges for Rev 361 Proc 37238 = $14,785.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15872.79,,,,,,,775.0000,31068.0000,fee schedule,"APG 00085 Proc 37238 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 105% = $15,872.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,10997.44,,,,,,,775.0000,31068.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,10997.44,,,,,,,775.0000,31068.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,NHC ADVANTAGE,NHC ADVANTAGE,10997.44,,,,,,,775.0000,31068.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15585.57,,,,,,,775.0000,31068.0000,fee schedule,"APG 00085 Proc 37238 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 103.1% = $15,585.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,SENTARA HEALTH,SENTARA HEALTH,8018.65,,,,,,,775.0000,31068.0000,percent of total billed charges,"25.81% of $31,068.00 in Billed Charges for Rev 361 Proc 37238 = $8,018.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,SENTARA HEALTH,SENTARA MEDICARE,10473.75,,,,,,,775.0000,31068.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",31068.00,,,,,,,775.0000,31068.0000,percent of total billed charges,"100% of $31,068.00 in Billed Charges for Rev 361 Proc 37238 = $31,068.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,775.0000,31068.0000,case rate,"Rev 361 Proc 37238 ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,775.0000,31068.0000,case rate,"Rev 361 Proc 37238 ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,775.0000,31068.0000,case rate,"Rev 361 Proc 37238 ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,20054.00,,,,,,,775.0000,31068.0000,case rate,"Rev 361 Proc 37238 ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15570.45,,,,,,,775.0000,31068.0000,fee schedule,"APG 00085 Proc 37238 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,10473.75,,,,,,,775.0000,31068.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,10473.75,,,,,,,775.0000,31068.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,WELLCARE,WELLCARE MEDICAID,31068.00,,,,,,,775.0000,31068.0000,percent of total billed charges,"100% of $31,068.00 in Billed Charges for Rev 361 Proc 37238 = $31,068.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACE VEIN 1ST VESSEL,37238,CPT,361,RC,36100229,CDM,,,,both,,,31068.0000,4660.2000,WELLCARE,WELLCARE MEDICARE,11102.17,,,,,,,775.0000,31068.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN EA ADD,37239,CPT,361,RC,36100230,CDM,,,,both,,,18058.0000,2708.7000,AETNA,AETNA,7710.77,,,,,,,148.0000,18058.0000,percent of total billed charges,"42.7% of $18,058.00 in Billed Charges for Rev 361 Proc 37239 = $7,710.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACE VEIN EA ADD,37239,CPT,361,RC,36100230,CDM,,,,both,,,18058.0000,2708.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15721.62,,,,,,,148.0000,18058.0000,fee schedule,"APG 00085 Proc 37239 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 104% = $15,721.62. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN EA ADD,37239,CPT,361,RC,36100230,CDM,,,,both,,,18058.0000,2708.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15570.45,,,,,,,148.0000,18058.0000,fee schedule,"APG 00085 Proc 37239 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN EA ADD,37239,CPT,361,RC,36100230,CDM,,,,both,,,18058.0000,2708.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,148.0000,18058.0000,case rate,"Rev 361 Proc 37239 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN EA ADD,37239,CPT,361,RC,36100230,CDM,,,,both,,,18058.0000,2708.7000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,18058.0000,case rate,Rev 361 Proc 37239 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN EA ADD,37239,CPT,361,RC,36100230,CDM,,,,both,,,18058.0000,2708.7000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,18058.0000,case rate,Rev 361 Proc 37239 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN EA ADD,37239,CPT,361,RC,36100230,CDM,,,,both,,,18058.0000,2708.7000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,18058.0000,case rate,Rev 361 Proc 37239 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC STENT PLACE VEIN EA ADD,37239,CPT,361,RC,36100230,CDM,,,,both,,,18058.0000,2708.7000,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,148.0000,18058.0000,case rate,"Rev 361 Proc 37239 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN EA ADD,37239,CPT,361,RC,36100230,CDM,,,,both,,,18058.0000,2708.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,148.0000,18058.0000,case rate,"Rev 361 Proc 37239 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN EA ADD,37239,CPT,361,RC,36100230,CDM,,,,both,,,18058.0000,2708.7000,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,148.0000,18058.0000,case rate,"Rev 361 Proc 37239 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN EA ADD,37239,CPT,361,RC,36100230,CDM,,,,both,,,18058.0000,2708.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,16252.20,,,,,,,148.0000,18058.0000,percent of total billed charges,"90% of $18,058.00 in Billed Charges for Rev 361 Proc 37239 = $16,252.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACE VEIN EA ADD,37239,CPT,361,RC,36100230,CDM,,,,both,,,18058.0000,2708.7000,MEDCOST,MEDCOST VHN,8593.80,,,,,,,148.0000,18058.0000,percent of total billed charges,"47.59% of $18,058.00 in Billed Charges for Rev 361 Proc 37239 = $8,593.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACE VEIN EA ADD,37239,CPT,361,RC,36100230,CDM,,,,both,,,18058.0000,2708.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15872.79,,,,,,,148.0000,18058.0000,fee schedule,"APG 00085 Proc 37239 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 105% = $15,872.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN EA ADD,37239,CPT,361,RC,36100230,CDM,,,,both,,,18058.0000,2708.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15585.57,,,,,,,148.0000,18058.0000,fee schedule,"APG 00085 Proc 37239 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 103.1% = $15,585.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN EA ADD,37239,CPT,361,RC,36100230,CDM,,,,both,,,18058.0000,2708.7000,SENTARA HEALTH,SENTARA HEALTH,4660.77,,,,,,,148.0000,18058.0000,percent of total billed charges,"25.81% of $18,058.00 in Billed Charges for Rev 361 Proc 37239 = $4,660.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACE VEIN EA ADD,37239,CPT,361,RC,36100230,CDM,,,,both,,,18058.0000,2708.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",18058.00,,,,,,,148.0000,18058.0000,percent of total billed charges,"100% of $18,058.00 in Billed Charges for Rev 361 Proc 37239 = $18,058.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC STENT PLACE VEIN EA ADD,37239,CPT,361,RC,36100230,CDM,,,,both,,,18058.0000,2708.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,148.0000,18058.0000,case rate,"Rev 361 Proc 37239 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN EA ADD,37239,CPT,361,RC,36100230,CDM,,,,both,,,18058.0000,2708.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,148.0000,18058.0000,case rate,"Rev 361 Proc 37239 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN EA ADD,37239,CPT,361,RC,36100230,CDM,,,,both,,,18058.0000,2708.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,148.0000,18058.0000,case rate,"Rev 361 Proc 37239 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN EA ADD,37239,CPT,361,RC,36100230,CDM,,,,both,,,18058.0000,2708.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,148.0000,18058.0000,case rate,"Rev 361 Proc 37239 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN EA ADD,37239,CPT,361,RC,36100230,CDM,,,,both,,,18058.0000,2708.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15570.45,,,,,,,148.0000,18058.0000,fee schedule,"APG 00085 Proc 37239 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC STENT PLACE VEIN EA ADD,37239,CPT,361,RC,36100230,CDM,,,,both,,,18058.0000,2708.7000,WELLCARE,WELLCARE MEDICAID,18058.00,,,,,,,148.0000,18058.0000,percent of total billed charges,"100% of $18,058.00 in Billed Charges for Rev 361 Proc 37239 = $18,058.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,AETNA,AETNA,12863.80,,,,,,,775.0000,30126.0000,percent of total billed charges,"42.7% of $30,126.00 in Billed Charges for Rev 361 Proc 37241 = $12,863.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15721.62,,,,,,,775.0000,30126.0000,fee schedule,"APG 00085 Proc 37241 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 104% = $15,721.62. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,10473.75,,,,,,,775.0000,30126.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,AETNA,AETNA HEALTHCARE MEDICARE,10473.75,,,,,,,775.0000,30126.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,10473.75,,,,,,,775.0000,30126.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,AMBETTER,AMBETTER,22832.77,,,,,,,775.0000,30126.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,10892.70,,,,,,,775.0000,30126.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,BLUE CROSS,ANTHEM EXCHANGE,25786.93,,,,,,,775.0000,30126.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15570.45,,,,,,,775.0000,30126.0000,fee schedule,"APG 00085 Proc 37241 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,BLUE CROSS,ANTHEM HMO,27397.08,,,,,,,775.0000,30126.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,10787.96,,,,,,,775.0000,30126.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",30126.00,,,,,,,775.0000,30126.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,775.0000,30126.0000,case rate,"Rev 361 Proc 37241 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,BLUE CROSS,BLUE CROSS E NETWORK,8571.00,,,,,,,775.0000,30126.0000,case rate,"Rev 361 Proc 37241 ASG Rate of $8,571.00 at 100% of $8,571.00 = $8,571.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,BLUE CROSS,BLUE CROSS MEDICARE,10892.70,,,,,,,775.0000,30126.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,BLUE CROSS,BLUE CROSS P NETWORK,8764.00,,,,,,,775.0000,30126.0000,case rate,"Rev 361 Proc 37241 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,BLUE CROSS,BLUE CROSS S NETWORK,8764.00,,,,,,,775.0000,30126.0000,case rate,"Rev 361 Proc 37241 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,30126.0000,case rate,Rev 361 Proc 37241 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,30126.0000,case rate,Rev 361 Proc 37241 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,775.0000,30126.0000,case rate,"Rev 361 Proc 37241 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,775.0000,30126.0000,case rate,"Rev 361 Proc 37241 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,10997.44,,,,,,,775.0000,30126.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,775.0000,30126.0000,case rate,"Rev 361 Proc 37241 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,775.0000,30126.0000,case rate,"Rev 361 Proc 37241 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,10997.44,,,,,,,775.0000,30126.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,27113.40,,,,,,,775.0000,30126.0000,percent of total billed charges,"90% of $30,126.00 in Billed Charges for Rev 361 Proc 37241 = $27,113.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,HUMANA,HUMANA MEDICARE,10473.75,,,,,,,775.0000,30126.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,10473.75,,,,,,,775.0000,30126.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,MEDCOST,MEDCOST VHN,14336.96,,,,,,,775.0000,30126.0000,percent of total billed charges,"47.59% of $30,126.00 in Billed Charges for Rev 361 Proc 37241 = $14,336.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15872.79,,,,,,,775.0000,30126.0000,fee schedule,"APG 00085 Proc 37241 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 105% = $15,872.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,10997.44,,,,,,,775.0000,30126.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,10997.44,,,,,,,775.0000,30126.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,NHC ADVANTAGE,NHC ADVANTAGE,10997.44,,,,,,,775.0000,30126.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15585.57,,,,,,,775.0000,30126.0000,fee schedule,"APG 00085 Proc 37241 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 103.1% = $15,585.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,SENTARA HEALTH,SENTARA HEALTH,7775.52,,,,,,,775.0000,30126.0000,percent of total billed charges,"25.81% of $30,126.00 in Billed Charges for Rev 361 Proc 37241 = $7,775.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,SENTARA HEALTH,SENTARA MEDICARE,10473.75,,,,,,,775.0000,30126.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",30126.00,,,,,,,775.0000,30126.0000,percent of total billed charges,"100% of $30,126.00 in Billed Charges for Rev 361 Proc 37241 = $30,126.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,775.0000,30126.0000,case rate,"Rev 361 Proc 37241 ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,775.0000,30126.0000,case rate,"Rev 361 Proc 37241 ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,775.0000,30126.0000,case rate,"Rev 361 Proc 37241 ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,20054.00,,,,,,,775.0000,30126.0000,case rate,"Rev 361 Proc 37241 ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15570.45,,,,,,,775.0000,30126.0000,fee schedule,"APG 00085 Proc 37241 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,10473.75,,,,,,,775.0000,30126.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,10473.75,,,,,,,775.0000,30126.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,WELLCARE,WELLCARE MEDICAID,30126.00,,,,,,,775.0000,30126.0000,percent of total billed charges,"100% of $30,126.00 in Billed Charges for Rev 361 Proc 37241 = $30,126.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCAT THER EMBOLIZATION VEN AVM,37241,CPT,361,RC,36100244,CDM,,,,both,,,30126.0000,4518.9000,WELLCARE,WELLCARE MEDICARE,11102.17,,,,,,,775.0000,30126.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,AETNA,AETNA,842.04,,,,,,,508.9700,1972.0000,percent of total billed charges,"42.7% of $1,972.00 in Billed Charges for Rev 361 Proc 50389 = $842.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,572.85,,,,,,,508.9700,1972.0000,fee schedule,APG 00161 Proc 50389 at $836.60 (Base Rate) * 0.6584 (Relative Weight) = $550.82 (Total Line Payment) at 104% = $572.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,632.64,,,,,,,508.9700,1972.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,AETNA,AETNA HEALTHCARE MEDICARE,632.64,,,,,,,508.9700,1972.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,632.64,,,,,,,508.9700,1972.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,AMBETTER,AMBETTER,1379.15,,,,,,,508.9700,1972.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,657.95,,,,,,,508.9700,1972.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,BLUE CROSS,ANTHEM EXCHANGE,1557.59,,,,,,,508.9700,1972.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,567.34,,,,,,,508.9700,1972.0000,fee schedule,APG 00161 Proc 50389 at $836.60 (Base Rate) * 0.6584 (Relative Weight) = $550.82 (Total Line Payment) at 103% = $567.34. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,BLUE CROSS,ANTHEM HMO,1654.84,,,,,,,508.9700,1972.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,651.62,,,,,,,508.9700,1972.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1946.77,,,,,,,508.9700,1972.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,508.9700,1972.0000,case rate,Rev 361 Proc 50389 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,508.9700,1972.0000,case rate,Rev 361 Proc 50389 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,BLUE CROSS,BLUE CROSS MEDICARE,657.95,,,,,,,508.9700,1972.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,508.9700,1972.0000,case rate,Rev 361 Proc 50389 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,508.9700,1972.0000,case rate,Rev 361 Proc 50389 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,508.9700,1972.0000,case rate,Rev 361 Proc 50389 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,508.9700,1972.0000,case rate,Rev 361 Proc 50389 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,508.9700,1972.0000,case rate,"Rev 361 Proc 50389 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,508.9700,1972.0000,case rate,"Rev 361 Proc 50389 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,664.27,,,,,,,508.9700,1972.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,508.9700,1972.0000,case rate,"Rev 361 Proc 50389 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,508.9700,1972.0000,case rate,"Rev 361 Proc 50389 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,664.27,,,,,,,508.9700,1972.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1774.80,,,,,,,508.9700,1972.0000,percent of total billed charges,"90% of $1,972.00 in Billed Charges for Rev 361 Proc 50389 = $1,774.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,HUMANA,HUMANA MEDICARE,632.64,,,,,,,508.9700,1972.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,632.64,,,,,,,508.9700,1972.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,MEDCOST,MEDCOST VHN,938.47,,,,,,,508.9700,1972.0000,percent of total billed charges,"47.59% of $1,972.00 in Billed Charges for Rev 361 Proc 50389 = $938.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,578.36,,,,,,,508.9700,1972.0000,fee schedule,APG 00161 Proc 50389 at $836.60 (Base Rate) * 0.6584 (Relative Weight) = $550.82 (Total Line Payment) at 100% = $550.82... $550.82 at 105% = $578.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,664.27,,,,,,,508.9700,1972.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,664.27,,,,,,,508.9700,1972.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,NHC ADVANTAGE,NHC ADVANTAGE,664.27,,,,,,,508.9700,1972.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,567.90,,,,,,,508.9700,1972.0000,fee schedule,APG 00161 Proc 50389 at $836.60 (Base Rate) * 0.6584 (Relative Weight) = $550.82 (Total Line Payment) at 100% = $550.82... $550.82 at 103.1% = $567.90 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,SENTARA HEALTH,SENTARA HEALTH,508.97,,,,,,,508.9700,1972.0000,percent of total billed charges,"25.81% of $1,972.00 in Billed Charges for Rev 361 Proc 50389 = $508.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,SENTARA HEALTH,SENTARA MEDICARE,632.64,,,,,,,508.9700,1972.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1972.00,,,,,,,508.9700,1972.0000,percent of total billed charges,"100% of $1,972.00 in Billed Charges for Rev 361 Proc 50389 = $1,972.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,508.9700,1972.0000,case rate,Rev 361 Proc 50389 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,508.9700,1972.0000,case rate,Rev 361 Proc 50389 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,508.9700,1972.0000,case rate,Rev 361 Proc 50389 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,508.9700,1972.0000,case rate,"Rev 361 Proc 50389 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,567.34,,,,,,,508.9700,1972.0000,fee schedule,APG 00161 Proc 50389 at $836.60 (Base Rate) * 0.6584 (Relative Weight) = $550.82 (Total Line Payment) at 103% = $567.34. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,632.64,,,,,,,508.9700,1972.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,632.64,,,,,,,508.9700,1972.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,WELLCARE,WELLCARE MEDICAID,1972.00,,,,,,,508.9700,1972.0000,percent of total billed charges,"100% of $1,972.00 in Billed Charges for Rev 361 Proc 50389 = $1,972.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REMOVAL NEPH TUBE W FLUORO UNILAT,50389,CPT,361,RC,36100386,CDM,,,,both,,,1972.0000,295.8000,WELLCARE,WELLCARE MEDICARE,670.60,,,,,,,508.9700,1972.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,AETNA,AETNA,1051.70,,,,,,,567.3400,2463.0000,percent of total billed charges,"42.7% of $2,463.00 in Billed Charges for Rev 361 Proc 50390 = $1,051.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,572.85,,,,,,,567.3400,2463.0000,fee schedule,"APG 00161 Proc 50390 at $836.60 (Base Rate) * 0.6584 (Relative Weight) = $550.82 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $550.82 at 104% = $572.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,642.47,,,,,,,567.3400,2463.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,AETNA,AETNA HEALTHCARE MEDICARE,642.47,,,,,,,567.3400,2463.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,642.47,,,,,,,567.3400,2463.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,AMBETTER,AMBETTER,1400.59,,,,,,,567.3400,2463.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,668.17,,,,,,,567.3400,2463.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,BLUE CROSS,ANTHEM EXCHANGE,1581.79,,,,,,,567.3400,2463.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,567.34,,,,,,,567.3400,2463.0000,fee schedule,"APG 00161 Proc 50390 at $836.60 (Base Rate) * 0.6584 (Relative Weight) = $550.82 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $550.82 at 103% = $567.34. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,BLUE CROSS,ANTHEM HMO,1680.56,,,,,,,567.3400,2463.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,661.74,,,,,,,567.3400,2463.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1977.02,,,,,,,567.3400,2463.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,567.3400,2463.0000,case rate,Rev 361 Proc 50390 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,567.3400,2463.0000,case rate,Rev 361 Proc 50390 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,BLUE CROSS,BLUE CROSS MEDICARE,668.17,,,,,,,567.3400,2463.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,567.3400,2463.0000,case rate,Rev 361 Proc 50390 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,567.3400,2463.0000,case rate,Rev 361 Proc 50390 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,567.3400,2463.0000,case rate,Rev 361 Proc 50390 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,567.3400,2463.0000,case rate,Rev 361 Proc 50390 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,567.3400,2463.0000,case rate,"Rev 361 Proc 50390 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,567.3400,2463.0000,case rate,"Rev 361 Proc 50390 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,674.59,,,,,,,567.3400,2463.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,567.3400,2463.0000,case rate,"Rev 361 Proc 50390 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,567.3400,2463.0000,case rate,"Rev 361 Proc 50390 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,674.59,,,,,,,567.3400,2463.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2216.70,,,,,,,567.3400,2463.0000,percent of total billed charges,"90% of $2,463.00 in Billed Charges for Rev 361 Proc 50390 = $2,216.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,HUMANA,HUMANA MEDICARE,642.47,,,,,,,567.3400,2463.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,642.47,,,,,,,567.3400,2463.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,MEDCOST,MEDCOST VHN,1172.14,,,,,,,567.3400,2463.0000,percent of total billed charges,"47.59% of $2,463.00 in Billed Charges for Rev 361 Proc 50390 = $1,172.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,578.36,,,,,,,567.3400,2463.0000,fee schedule,"APG 00161 Proc 50390 at $836.60 (Base Rate) * 0.6584 (Relative Weight) = $550.82 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $550.82 at 100% = $550.82... $550.82 at 105% = $578.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,674.59,,,,,,,567.3400,2463.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,674.59,,,,,,,567.3400,2463.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,NHC ADVANTAGE,NHC ADVANTAGE,674.59,,,,,,,567.3400,2463.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,567.90,,,,,,,567.3400,2463.0000,fee schedule,"APG 00161 Proc 50390 at $836.60 (Base Rate) * 0.6584 (Relative Weight) = $550.82 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $550.82 at 100% = $550.82... $550.82 at 103.1% = $567.90 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,SENTARA HEALTH,SENTARA HEALTH,635.70,,,,,,,567.3400,2463.0000,percent of total billed charges,"25.81% of $2,463.00 in Billed Charges for Rev 361 Proc 50390 = $635.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,SENTARA HEALTH,SENTARA MEDICARE,642.47,,,,,,,567.3400,2463.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2463.00,,,,,,,567.3400,2463.0000,percent of total billed charges,"100% of $2,463.00 in Billed Charges for Rev 361 Proc 50390 = $2,463.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,567.3400,2463.0000,case rate,Rev 361 Proc 50390 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,567.3400,2463.0000,case rate,Rev 361 Proc 50390 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,567.3400,2463.0000,case rate,Rev 361 Proc 50390 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,567.3400,2463.0000,case rate,"Rev 361 Proc 50390 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,567.34,,,,,,,567.3400,2463.0000,fee schedule,"APG 00161 Proc 50390 at $836.60 (Base Rate) * 0.6584 (Relative Weight) = $550.82 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $550.82 at 103% = $567.34. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,642.47,,,,,,,567.3400,2463.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,642.47,,,,,,,567.3400,2463.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,WELLCARE,WELLCARE MEDICAID,2463.00,,,,,,,567.3400,2463.0000,percent of total billed charges,"100% of $2,463.00 in Billed Charges for Rev 361 Proc 50390 = $2,463.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ASP INJ RENAL CYST PERC,50390,CPT,361,RC,36100168,CDM,,,,both,,,2463.0000,369.4500,WELLCARE,WELLCARE MEDICARE,681.02,,,,,,,567.3400,2463.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,AETNA,AETNA,1999.64,,,,,,,567.3400,4683.0000,percent of total billed charges,"42.7% of $4,683.00 in Billed Charges for Rev 361 Proc 50430 = $1,999.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,572.85,,,,,,,567.3400,4683.0000,fee schedule,APG 00161 Proc 50430 at $836.60 (Base Rate) * 0.6584 (Relative Weight) = $550.82 (Total Line Payment) at 104% = $572.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,632.64,,,,,,,567.3400,4683.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,AETNA,AETNA HEALTHCARE MEDICARE,632.64,,,,,,,567.3400,4683.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,632.64,,,,,,,567.3400,4683.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,AMBETTER,AMBETTER,1379.15,,,,,,,567.3400,4683.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,657.95,,,,,,,567.3400,4683.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,BLUE CROSS,ANTHEM EXCHANGE,1557.59,,,,,,,567.3400,4683.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,567.34,,,,,,,567.3400,4683.0000,fee schedule,APG 00161 Proc 50430 at $836.60 (Base Rate) * 0.6584 (Relative Weight) = $550.82 (Total Line Payment) at 103% = $567.34. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,BLUE CROSS,ANTHEM HMO,1654.84,,,,,,,567.3400,4683.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,651.62,,,,,,,567.3400,4683.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1946.77,,,,,,,567.3400,4683.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,567.3400,4683.0000,case rate,"Rev 361 Proc 50430 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,567.3400,4683.0000,case rate,Rev 361 Proc 50430 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,BLUE CROSS,BLUE CROSS MEDICARE,657.95,,,,,,,567.3400,4683.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,567.3400,4683.0000,case rate,Rev 361 Proc 50430 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,567.3400,4683.0000,case rate,Rev 361 Proc 50430 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,567.3400,4683.0000,case rate,Rev 361 Proc 50430 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,567.3400,4683.0000,case rate,Rev 361 Proc 50430 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,CIGNA HEALTHCARE,CIGNA HMO,2967.00,,,,,,,567.3400,4683.0000,case rate,"Rev 361 Proc 50430 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2246.00,,,,,,,567.3400,4683.0000,case rate,"Rev 361 Proc 50430 ASG Rate of $2,246.00 at 100% of $2,246.00 = $2,246.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,664.27,,,,,,,567.3400,4683.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2967.00,,,,,,,567.3400,4683.0000,case rate,"Rev 361 Proc 50430 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,CIGNA HEALTHCARE,CIGNA PPO,2967.00,,,,,,,567.3400,4683.0000,case rate,"Rev 361 Proc 50430 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,664.27,,,,,,,567.3400,4683.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4214.70,,,,,,,567.3400,4683.0000,percent of total billed charges,"90% of $4,683.00 in Billed Charges for Rev 361 Proc 50430 = $4,214.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,HUMANA,HUMANA MEDICARE,632.64,,,,,,,567.3400,4683.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,632.64,,,,,,,567.3400,4683.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,MEDCOST,MEDCOST VHN,2228.64,,,,,,,567.3400,4683.0000,percent of total billed charges,"47.59% of $4,683.00 in Billed Charges for Rev 361 Proc 50430 = $2,228.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,578.36,,,,,,,567.3400,4683.0000,fee schedule,APG 00161 Proc 50430 at $836.60 (Base Rate) * 0.6584 (Relative Weight) = $550.82 (Total Line Payment) at 100% = $550.82... $550.82 at 105% = $578.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,664.27,,,,,,,567.3400,4683.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,664.27,,,,,,,567.3400,4683.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,NHC ADVANTAGE,NHC ADVANTAGE,664.27,,,,,,,567.3400,4683.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,567.90,,,,,,,567.3400,4683.0000,fee schedule,APG 00161 Proc 50430 at $836.60 (Base Rate) * 0.6584 (Relative Weight) = $550.82 (Total Line Payment) at 100% = $550.82... $550.82 at 103.1% = $567.90 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,SENTARA HEALTH,SENTARA HEALTH,1208.68,,,,,,,567.3400,4683.0000,percent of total billed charges,"25.81% of $4,683.00 in Billed Charges for Rev 361 Proc 50430 = $1,208.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,SENTARA HEALTH,SENTARA MEDICARE,632.64,,,,,,,567.3400,4683.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4683.00,,,,,,,567.3400,4683.0000,percent of total billed charges,"100% of $4,683.00 in Billed Charges for Rev 361 Proc 50430 = $4,683.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,567.3400,4683.0000,case rate,Rev 361 Proc 50430 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,567.3400,4683.0000,case rate,Rev 361 Proc 50430 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,567.3400,4683.0000,case rate,Rev 361 Proc 50430 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,567.3400,4683.0000,case rate,"Rev 361 Proc 50430 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,567.34,,,,,,,567.3400,4683.0000,fee schedule,APG 00161 Proc 50430 at $836.60 (Base Rate) * 0.6584 (Relative Weight) = $550.82 (Total Line Payment) at 103% = $567.34. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,632.64,,,,,,,567.3400,4683.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,632.64,,,,,,,567.3400,4683.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,WELLCARE,WELLCARE MEDICAID,4683.00,,,,,,,567.3400,4683.0000,percent of total billed charges,"100% of $4,683.00 in Billed Charges for Rev 361 Proc 50430 = $4,683.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I NEW ACCESS,50430,CPT,361,RC,36100311,CDM,,,,both,,,4683.0000,702.4500,WELLCARE,WELLCARE MEDICARE,670.60,,,,,,,567.3400,4683.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,AETNA,AETNA,1999.64,,,,,,,567.3400,4683.0000,percent of total billed charges,"42.7% of $4,683.00 in Billed Charges for Rev 361 Proc 50431 = $1,999.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,572.85,,,,,,,567.3400,4683.0000,fee schedule,APG 00161 Proc 50431 at $836.60 (Base Rate) * 0.6584 (Relative Weight) = $550.82 (Total Line Payment) at 104% = $572.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,632.64,,,,,,,567.3400,4683.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,AETNA,AETNA HEALTHCARE MEDICARE,632.64,,,,,,,567.3400,4683.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,632.64,,,,,,,567.3400,4683.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,AMBETTER,AMBETTER,1379.15,,,,,,,567.3400,4683.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,657.95,,,,,,,567.3400,4683.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,BLUE CROSS,ANTHEM EXCHANGE,1557.59,,,,,,,567.3400,4683.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,567.34,,,,,,,567.3400,4683.0000,fee schedule,APG 00161 Proc 50431 at $836.60 (Base Rate) * 0.6584 (Relative Weight) = $550.82 (Total Line Payment) at 103% = $567.34. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,BLUE CROSS,ANTHEM HMO,1654.84,,,,,,,567.3400,4683.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,651.62,,,,,,,567.3400,4683.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1946.77,,,,,,,567.3400,4683.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,567.3400,4683.0000,case rate,"Rev 361 Proc 50431 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,567.3400,4683.0000,case rate,Rev 361 Proc 50431 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,BLUE CROSS,BLUE CROSS MEDICARE,657.95,,,,,,,567.3400,4683.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,567.3400,4683.0000,case rate,Rev 361 Proc 50431 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,567.3400,4683.0000,case rate,Rev 361 Proc 50431 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,567.3400,4683.0000,case rate,Rev 361 Proc 50431 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,567.3400,4683.0000,case rate,Rev 361 Proc 50431 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,CIGNA HEALTHCARE,CIGNA HMO,2967.00,,,,,,,567.3400,4683.0000,case rate,"Rev 361 Proc 50431 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2246.00,,,,,,,567.3400,4683.0000,case rate,"Rev 361 Proc 50431 ASG Rate of $2,246.00 at 100% of $2,246.00 = $2,246.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,664.27,,,,,,,567.3400,4683.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2967.00,,,,,,,567.3400,4683.0000,case rate,"Rev 361 Proc 50431 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,CIGNA HEALTHCARE,CIGNA PPO,2967.00,,,,,,,567.3400,4683.0000,case rate,"Rev 361 Proc 50431 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,664.27,,,,,,,567.3400,4683.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4214.70,,,,,,,567.3400,4683.0000,percent of total billed charges,"90% of $4,683.00 in Billed Charges for Rev 361 Proc 50431 = $4,214.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,HUMANA,HUMANA MEDICARE,632.64,,,,,,,567.3400,4683.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,632.64,,,,,,,567.3400,4683.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,MEDCOST,MEDCOST VHN,2228.64,,,,,,,567.3400,4683.0000,percent of total billed charges,"47.59% of $4,683.00 in Billed Charges for Rev 361 Proc 50431 = $2,228.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,578.36,,,,,,,567.3400,4683.0000,fee schedule,APG 00161 Proc 50431 at $836.60 (Base Rate) * 0.6584 (Relative Weight) = $550.82 (Total Line Payment) at 100% = $550.82... $550.82 at 105% = $578.36 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,664.27,,,,,,,567.3400,4683.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,664.27,,,,,,,567.3400,4683.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,NHC ADVANTAGE,NHC ADVANTAGE,664.27,,,,,,,567.3400,4683.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,567.90,,,,,,,567.3400,4683.0000,fee schedule,APG 00161 Proc 50431 at $836.60 (Base Rate) * 0.6584 (Relative Weight) = $550.82 (Total Line Payment) at 100% = $550.82... $550.82 at 103.1% = $567.90 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,SENTARA HEALTH,SENTARA HEALTH,1208.68,,,,,,,567.3400,4683.0000,percent of total billed charges,"25.81% of $4,683.00 in Billed Charges for Rev 361 Proc 50431 = $1,208.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,SENTARA HEALTH,SENTARA MEDICARE,632.64,,,,,,,567.3400,4683.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4683.00,,,,,,,567.3400,4683.0000,percent of total billed charges,"100% of $4,683.00 in Billed Charges for Rev 361 Proc 50431 = $4,683.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,567.3400,4683.0000,case rate,Rev 361 Proc 50431 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,567.3400,4683.0000,case rate,Rev 361 Proc 50431 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,567.3400,4683.0000,case rate,Rev 361 Proc 50431 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,567.3400,4683.0000,case rate,"Rev 361 Proc 50431 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,567.34,,,,,,,567.3400,4683.0000,fee schedule,APG 00161 Proc 50431 at $836.60 (Base Rate) * 0.6584 (Relative Weight) = $550.82 (Total Line Payment) at 103% = $567.34. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,632.64,,,,,,,567.3400,4683.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,632.64,,,,,,,567.3400,4683.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,WELLCARE,WELLCARE MEDICAID,4683.00,,,,,,,567.3400,4683.0000,percent of total billed charges,"100% of $4,683.00 in Billed Charges for Rev 361 Proc 50431 = $4,683.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANTE NEPHROSTO-/URETEROGRAM INCL IMG RAD S&I EXISTING ACCESS,50431,CPT,361,RC,36100312,CDM,,,,both,,,4683.0000,702.4500,WELLCARE,WELLCARE MEDICARE,670.60,,,,,,,567.3400,4683.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,AETNA,AETNA,3906.62,,,,,,,1162.5000,9149.0000,percent of total billed charges,"42.7% of $9,149.00 in Billed Charges for Rev 361 Proc 50432 Mod 50 = $3,906.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3199.83,,,,,,,1162.5000,9149.0000,fee schedule,"APG 00170 Proc 50432 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 150% Mod Percentage = $3,076.76 at 104% = $3,199.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3198.13,,,,,,,1162.5000,9149.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,AETNA,AETNA HEALTHCARE MEDICARE,3198.13,,,,,,,1162.5000,9149.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,3198.13,,,,,,,1162.5000,9149.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,AMBETTER,AMBETTER,6971.91,,,,,,,1162.5000,9149.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3326.05,,,,,,,1162.5000,9149.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,BLUE CROSS,ANTHEM EXCHANGE,7873.96,,,,,,,1162.5000,9149.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3169.07,,,,,,,1162.5000,9149.0000,fee schedule,"APG 00170 Proc 50432 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 150% Mod Percentage = $3,076.76 at 103% = $3,169.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,BLUE CROSS,ANTHEM HMO,8365.61,,,,,,,1162.5000,9149.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3294.07,,,,,,,1162.5000,9149.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9149.00,,,,,,,1162.5000,9149.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2284.50,,,,,,,1162.5000,9149.0000,case rate,"Rev 361 Proc 50432 Mod 50 ASG Rate of $1,523.00 at 100% of $1,523.00 + 50% of $1,523.00 = $2,284.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,BLUE CROSS,BLUE CROSS E NETWORK,4429.50,,,,,,,1162.5000,9149.0000,case rate,"Rev 361 Proc 50432 Mod 50 ASG Rate of $2,953.00 at 100% of $2,953.00 + 50% of $2,953.00 = $4,429.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,BLUE CROSS,BLUE CROSS MEDICARE,3326.05,,,,,,,1162.5000,9149.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,BLUE CROSS,BLUE CROSS P NETWORK,4528.50,,,,,,,1162.5000,9149.0000,case rate,"Rev 361 Proc 50432 Mod 50 ASG Rate of $3,019.00 at 100% of $3,019.00 + 50% of $3,019.00 = $4,528.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,BLUE CROSS,BLUE CROSS S NETWORK,4528.50,,,,,,,1162.5000,9149.0000,case rate,"Rev 361 Proc 50432 Mod 50 ASG Rate of $3,019.00 at 100% of $3,019.00 + 50% of $3,019.00 = $4,528.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,BLUE CROSS,TENNCARE BLUE CARE,1162.50,,,,,,,1162.5000,9149.0000,case rate,"Rev 361 Proc 50432 Mod 50 ASG Rate of $775.00 at 100% of $775.00 + 50% of $775.00 = $1,162.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,BLUE CROSS,TENNCARE BLUE SELECT,1162.50,,,,,,,1162.5000,9149.0000,case rate,"Rev 361 Proc 50432 Mod 50 ASG Rate of $775.00 at 100% of $775.00 + 50% of $775.00 = $1,162.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,CIGNA HEALTHCARE,CIGNA HMO,8641.50,,,,,,,1162.5000,9149.0000,case rate,"Rev 361 Proc 50432 Mod 50 ASG Rate of $5,761.00 at 100% of $5,761.00 + 50% of $5,761.00 = $8,641.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6529.50,,,,,,,1162.5000,9149.0000,case rate,"Rev 361 Proc 50432 Mod 50 ASG Rate of $4,353.00 at 100% of $4,353.00 + 50% of $4,353.00 = $6,529.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,3358.03,,,,,,,1162.5000,9149.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,8641.50,,,,,,,1162.5000,9149.0000,case rate,"Rev 361 Proc 50432 Mod 50 ASG Rate of $5,761.00 at 100% of $5,761.00 + 50% of $5,761.00 = $8,641.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,CIGNA HEALTHCARE,CIGNA PPO,8641.50,,,,,,,1162.5000,9149.0000,case rate,"Rev 361 Proc 50432 Mod 50 ASG Rate of $5,761.00 at 100% of $5,761.00 + 50% of $5,761.00 = $8,641.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3358.03,,,,,,,1162.5000,9149.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8234.10,,,,,,,1162.5000,9149.0000,percent of total billed charges,"90% of $9,149.00 in Billed Charges for Rev 361 Proc 50432 Mod 50 = $8,234.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,HUMANA,HUMANA MEDICARE,3198.13,,,,,,,1162.5000,9149.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3198.13,,,,,,,1162.5000,9149.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,MEDCOST,MEDCOST VHN,4354.01,,,,,,,1162.5000,9149.0000,percent of total billed charges,"47.59% of $9,149.00 in Billed Charges for Rev 361 Proc 50432 Mod 50 = $4,354.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3230.60,,,,,,,1162.5000,9149.0000,fee schedule,"APG 00170 Proc 50432 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 150% Mod Percentage = $3,076.76 at 100% = $3,076.76... $3,076.76 at 105% = $3,230.60 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3358.03,,,,,,,1162.5000,9149.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3358.03,,,,,,,1162.5000,9149.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,NHC ADVANTAGE,NHC ADVANTAGE,3358.03,,,,,,,1162.5000,9149.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3172.14,,,,,,,1162.5000,9149.0000,fee schedule,"APG 00170 Proc 50432 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 150% Mod Percentage = $3,076.76 at 100% = $3,076.76... $3,076.76 at 103.1% = $3,172.14 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,SENTARA HEALTH,SENTARA HEALTH,2361.36,,,,,,,1162.5000,9149.0000,percent of total billed charges,"25.81% of $9,149.00 in Billed Charges for Rev 361 Proc 50432 Mod 50 = $2,361.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,SENTARA HEALTH,SENTARA MEDICARE,3198.13,,,,,,,1162.5000,9149.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9149.00,,,,,,,1162.5000,9149.0000,percent of total billed charges,"100% of $9,149.00 in Billed Charges for Rev 361 Proc 50432 Mod 50 = $9,149.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2127.00,,,,,,,1162.5000,9149.0000,case rate,"Rev 361 Proc 50432 Mod 50 ASG Rate of $1,418.00 at 100% of $1,418.00 + 50% of $1,418.00 = $2,127.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3820.50,,,,,,,1162.5000,9149.0000,case rate,"Rev 361 Proc 50432 Mod 50 ASG Rate of $2,547.00 at 100% of $2,547.00 + 50% of $2,547.00 = $3,820.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3654.00,,,,,,,1162.5000,9149.0000,case rate,"Rev 361 Proc 50432 Mod 50 ASG Rate of $2,436.00 at 100% of $2,436.00 + 50% of $2,436.00 = $3,654.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,6444.00,,,,,,,1162.5000,9149.0000,case rate,"Rev 361 Proc 50432 Mod 50 ASG Rate of $4,296.00 at 100% of $4,296.00 + 50% of $4,296.00 = $6,444.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3169.07,,,,,,,1162.5000,9149.0000,fee schedule,"APG 00170 Proc 50432 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 150% Mod Percentage = $3,076.76 at 103% = $3,169.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3198.13,,,,,,,1162.5000,9149.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3198.13,,,,,,,1162.5000,9149.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,WELLCARE,WELLCARE MEDICAID,9149.00,,,,,,,1162.5000,9149.0000,percent of total billed charges,"100% of $9,149.00 in Billed Charges for Rev 361 Proc 50432 Mod 50 = $9,149.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50432,CPT,361,RC,36100384,CDM,,,50,both,,,9149.0000,1372.3500,WELLCARE,WELLCARE MEDICARE,3390.01,,,,,,,1162.5000,9149.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,AETNA,AETNA,2010.32,,,,,,,109.0000,4708.0000,percent of total billed charges,"42.7% of $4,708.00 in Billed Charges for Rev 450 Proc 32556 = $2,010.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1446.31,,,,,,,109.0000,4708.0000,fee schedule,"APG 00068 Proc 32556 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 104% = $1,446.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1740.98,,,,,,,109.0000,4708.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,AETNA,AETNA HEALTHCARE MEDICARE,1740.98,,,,,,,109.0000,4708.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,1740.98,,,,,,,109.0000,4708.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,AMBETTER,AMBETTER,3795.33,,,,,,,109.0000,4708.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1810.61,,,,,,,109.0000,4708.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,BLUE CROSS,ANTHEM EXCHANGE,4286.37,,,,,,,109.0000,4708.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1432.40,,,,,,,109.0000,4708.0000,fee schedule,"APG 00068 Proc 32556 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,BLUE CROSS,ANTHEM HMO,4554.02,,,,,,,109.0000,4708.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1793.21,,,,,,,109.0000,4708.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4708.00,,,,,,,109.0000,4708.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3295.60,,,,,,,109.0000,4708.0000,percent of total billed charges,"Rev 450 Proc 32556 $4,708.00 in Billed Charges at 70% = $3,295.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,BLUE CROSS,BLUE CROSS MEDICARE,1810.61,,,,,,,109.0000,4708.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,1828.02,,,,,,,109.0000,4708.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1828.02,,,,,,,109.0000,4708.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4237.20,,,,,,,109.0000,4708.0000,percent of total billed charges,"90% of $4,708.00 in Billed Charges for Rev 450 Proc 32556 = $4,237.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,HUMANA,HUMANA MEDICARE,1740.98,,,,,,,109.0000,4708.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1740.98,,,,,,,109.0000,4708.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,MEDCOST,MEDCOST VHN,2240.54,,,,,,,109.0000,4708.0000,percent of total billed charges,"47.59% of $4,708.00 in Billed Charges for Rev 450 Proc 32556 = $2,240.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1460.21,,,,,,,109.0000,4708.0000,fee schedule,"APG 00068 Proc 32556 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 100% = $1,390.68... $1,390.68 at 105% = $1,460.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1828.02,,,,,,,109.0000,4708.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1828.02,,,,,,,109.0000,4708.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,NHC ADVANTAGE,NHC ADVANTAGE,1828.02,,,,,,,109.0000,4708.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1433.79,,,,,,,109.0000,4708.0000,fee schedule,"APG 00068 Proc 32556 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 100% = $1,390.68... $1,390.68 at 103.1% = $1,433.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,SENTARA HEALTH,SENTARA HEALTH,1215.13,,,,,,,109.0000,4708.0000,percent of total billed charges,"25.81% of $4,708.00 in Billed Charges for Rev 450 Proc 32556 = $1,215.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,SENTARA HEALTH,SENTARA MEDICARE,1740.98,,,,,,,109.0000,4708.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4708.00,,,,,,,109.0000,4708.0000,percent of total billed charges,"100% of $4,708.00 in Billed Charges for Rev 450 Proc 32556 = $4,708.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,4708.0000,case rate,Rev 450 Proc 32556 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,4708.0000,case rate,Rev 450 Proc 32556 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,4708.0000,case rate,Rev 450 Proc 32556 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,4708.0000,case rate,Rev 450 Proc 32556 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1432.40,,,,,,,109.0000,4708.0000,fee schedule,"APG 00068 Proc 32556 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1740.98,,,,,,,109.0000,4708.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1740.98,,,,,,,109.0000,4708.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,WELLCARE,WELLCARE MEDICAID,4708.00,,,,,,,109.0000,4708.0000,percent of total billed charges,"100% of $4,708.00 in Billed Charges for Rev 450 Proc 32556 = $4,708.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLEURAL DRAIN CATH WO IMG GUID,32556,CPT,450,RC,45000231,CDM,,,,both,,,4708.0000,706.2000,WELLCARE,WELLCARE MEDICARE,1845.43,,,,,,,109.0000,4708.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,AETNA,AETNA,3015.47,,,,,,,109.0000,7062.0000,percent of total billed charges,"42.7% of $7,062.00 in Billed Charges for Rev 450 Proc 32556 Mod 50 = $3,015.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2169.46,,,,,,,109.0000,7062.0000,fee schedule,"APG 00068 Proc 32556 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 150% Mod Percentage = $2,086.02 at 104% = $2,169.46. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1740.98,,,,,,,109.0000,7062.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,AETNA,AETNA HEALTHCARE MEDICARE,1740.98,,,,,,,109.0000,7062.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,1740.98,,,,,,,109.0000,7062.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,AMBETTER,AMBETTER,3795.33,,,,,,,109.0000,7062.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1810.61,,,,,,,109.0000,7062.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,BLUE CROSS,ANTHEM EXCHANGE,4286.37,,,,,,,109.0000,7062.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2148.60,,,,,,,109.0000,7062.0000,fee schedule,"APG 00068 Proc 32556 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 150% Mod Percentage = $2,086.02 at 103% = $2,148.60. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,BLUE CROSS,ANTHEM HMO,4554.02,,,,,,,109.0000,7062.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1793.21,,,,,,,109.0000,7062.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5357.38,,,,,,,109.0000,7062.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4943.40,,,,,,,109.0000,7062.0000,percent of total billed charges,"Rev 450 Proc 32556 Mod 50 $7,062.00 in Billed Charges at 70% = $4,943.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,BLUE CROSS,BLUE CROSS MEDICARE,1810.61,,,,,,,109.0000,7062.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,1828.02,,,,,,,109.0000,7062.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1828.02,,,,,,,109.0000,7062.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6355.80,,,,,,,109.0000,7062.0000,percent of total billed charges,"90% of $7,062.00 in Billed Charges for Rev 450 Proc 32556 Mod 50 = $6,355.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,HUMANA,HUMANA MEDICARE,1740.98,,,,,,,109.0000,7062.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1740.98,,,,,,,109.0000,7062.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,MEDCOST,MEDCOST VHN,3360.81,,,,,,,109.0000,7062.0000,percent of total billed charges,"47.59% of $7,062.00 in Billed Charges for Rev 450 Proc 32556 Mod 50 = $3,360.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2190.32,,,,,,,109.0000,7062.0000,fee schedule,"APG 00068 Proc 32556 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 150% Mod Percentage = $2,086.02 at 100% = $2,086.02... $2,086.02 at 105% = $2,190.32 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1828.02,,,,,,,109.0000,7062.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1828.02,,,,,,,109.0000,7062.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,NHC ADVANTAGE,NHC ADVANTAGE,1828.02,,,,,,,109.0000,7062.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2150.69,,,,,,,109.0000,7062.0000,fee schedule,"APG 00068 Proc 32556 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 150% Mod Percentage = $2,086.02 at 100% = $2,086.02... $2,086.02 at 103.1% = $2,150.69 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,SENTARA HEALTH,SENTARA HEALTH,1822.70,,,,,,,109.0000,7062.0000,percent of total billed charges,"25.81% of $7,062.00 in Billed Charges for Rev 450 Proc 32556 Mod 50 = $1,822.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,SENTARA HEALTH,SENTARA MEDICARE,1740.98,,,,,,,109.0000,7062.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7062.00,,,,,,,109.0000,7062.0000,percent of total billed charges,"100% of $7,062.00 in Billed Charges for Rev 450 Proc 32556 Mod 50 = $7,062.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,7062.0000,case rate,Rev 450 Proc 32556 Mod 50 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,7062.0000,case rate,Rev 450 Proc 32556 Mod 50 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,7062.0000,case rate,Rev 450 Proc 32556 Mod 50 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,7062.0000,case rate,Rev 450 Proc 32556 Mod 50 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2148.60,,,,,,,109.0000,7062.0000,fee schedule,"APG 00068 Proc 32556 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 150% Mod Percentage = $2,086.02 at 103% = $2,148.60. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1740.98,,,,,,,109.0000,7062.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1740.98,,,,,,,109.0000,7062.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,WELLCARE,WELLCARE MEDICAID,7062.00,,,,,,,109.0000,7062.0000,percent of total billed charges,"100% of $7,062.00 in Billed Charges for Rev 450 Proc 32556 Mod 50 = $7,062.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLEURAL DRAIN CATH WO IMG GUID BILAT,32556,CPT,450,RC,45000404,CDM,,,50,both,,,7062.0000,1059.3000,WELLCARE,WELLCARE MEDICARE,1845.43,,,,,,,109.0000,7062.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,AETNA,AETNA,1472.72,,,,,,,650.0000,3449.0000,percent of total billed charges,"42.7% of $3,449.00 in Billed Charges for Rev 361 Proc 32557 = $1,472.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1446.31,,,,,,,650.0000,3449.0000,fee schedule,"APG 00068 Proc 32557 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 104% = $1,446.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1428.19,,,,,,,650.0000,3449.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,AETNA,AETNA HEALTHCARE MEDICARE,1428.19,,,,,,,650.0000,3449.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,1428.19,,,,,,,650.0000,3449.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,AMBETTER,AMBETTER,3113.45,,,,,,,650.0000,3449.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1485.32,,,,,,,650.0000,3449.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,BLUE CROSS,ANTHEM EXCHANGE,3449.00,,,,,,,650.0000,3449.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1432.40,,,,,,,650.0000,3449.0000,fee schedule,"APG 00068 Proc 32557 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,BLUE CROSS,ANTHEM HMO,3449.00,,,,,,,650.0000,3449.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1471.04,,,,,,,650.0000,3449.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3449.00,,,,,,,650.0000,3449.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,650.0000,3449.0000,case rate,"Rev 361 Proc 32557 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,650.0000,3449.0000,case rate,"Rev 361 Proc 32557 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,BLUE CROSS,BLUE CROSS MEDICARE,1485.32,,,,,,,650.0000,3449.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,650.0000,3449.0000,case rate,"Rev 361 Proc 32557 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,650.0000,3449.0000,case rate,"Rev 361 Proc 32557 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,650.0000,3449.0000,case rate,Rev 361 Proc 32557 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,650.0000,3449.0000,case rate,Rev 361 Proc 32557 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,650.0000,3449.0000,case rate,"Rev 361 Proc 32557 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,650.0000,3449.0000,case rate,"Rev 361 Proc 32557 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,1499.60,,,,,,,650.0000,3449.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,650.0000,3449.0000,case rate,"Rev 361 Proc 32557 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,650.0000,3449.0000,case rate,"Rev 361 Proc 32557 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1499.60,,,,,,,650.0000,3449.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3104.10,,,,,,,650.0000,3449.0000,percent of total billed charges,"90% of $3,449.00 in Billed Charges for Rev 361 Proc 32557 = $3,104.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,HUMANA,HUMANA MEDICARE,1428.19,,,,,,,650.0000,3449.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1428.19,,,,,,,650.0000,3449.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,MEDCOST,MEDCOST VHN,1641.38,,,,,,,650.0000,3449.0000,percent of total billed charges,"47.59% of $3,449.00 in Billed Charges for Rev 361 Proc 32557 = $1,641.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1460.21,,,,,,,650.0000,3449.0000,fee schedule,"APG 00068 Proc 32557 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 100% = $1,390.68... $1,390.68 at 105% = $1,460.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1499.60,,,,,,,650.0000,3449.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1499.60,,,,,,,650.0000,3449.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,NHC ADVANTAGE,NHC ADVANTAGE,1499.60,,,,,,,650.0000,3449.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1433.79,,,,,,,650.0000,3449.0000,fee schedule,"APG 00068 Proc 32557 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 100% = $1,390.68... $1,390.68 at 103.1% = $1,433.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,SENTARA HEALTH,SENTARA HEALTH,890.19,,,,,,,650.0000,3449.0000,percent of total billed charges,"25.81% of $3,449.00 in Billed Charges for Rev 361 Proc 32557 = $890.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,SENTARA HEALTH,SENTARA MEDICARE,1428.19,,,,,,,650.0000,3449.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3449.00,,,,,,,650.0000,3449.0000,percent of total billed charges,"100% of $3,449.00 in Billed Charges for Rev 361 Proc 32557 = $3,449.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,650.0000,3449.0000,case rate,Rev 361 Proc 32557 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,650.0000,3449.0000,case rate,Rev 361 Proc 32557 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,650.0000,3449.0000,case rate,Rev 361 Proc 32557 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,650.0000,3449.0000,case rate,"Rev 361 Proc 32557 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1432.40,,,,,,,650.0000,3449.0000,fee schedule,"APG 00068 Proc 32557 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1428.19,,,,,,,650.0000,3449.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1428.19,,,,,,,650.0000,3449.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,WELLCARE,WELLCARE MEDICAID,3449.00,,,,,,,650.0000,3449.0000,percent of total billed charges,"100% of $3,449.00 in Billed Charges for Rev 361 Proc 32557 = $3,449.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLURAL DRAIN CTH W IMG GUID,32557,CPT,361,RC,36100122,CDM,,,,both,,,3449.0000,517.3500,WELLCARE,WELLCARE MEDICARE,1513.88,,,,,,,650.0000,3449.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,AETNA,AETNA,2203.75,,,,,,,578.0000,5161.0000,percent of total billed charges,"42.7% of $5,161.00 in Billed Charges for Rev 361 Proc 33016 = $2,203.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1446.31,,,,,,,578.0000,5161.0000,fee schedule,"APG 00068 Proc 33016 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 104% = $1,446.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1428.19,,,,,,,578.0000,5161.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,AETNA,AETNA HEALTHCARE MEDICARE,1428.19,,,,,,,578.0000,5161.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,1428.19,,,,,,,578.0000,5161.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,AMBETTER,AMBETTER,3113.45,,,,,,,578.0000,5161.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1485.32,,,,,,,578.0000,5161.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,BLUE CROSS,ANTHEM EXCHANGE,3516.27,,,,,,,578.0000,5161.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1432.40,,,,,,,578.0000,5161.0000,fee schedule,"APG 00068 Proc 33016 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,BLUE CROSS,ANTHEM HMO,3735.83,,,,,,,578.0000,5161.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1471.04,,,,,,,578.0000,5161.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4394.86,,,,,,,578.0000,5161.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,578.0000,5161.0000,case rate,"Rev 361 Proc 33016 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,578.0000,5161.0000,case rate,"Rev 361 Proc 33016 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,BLUE CROSS,BLUE CROSS MEDICARE,1485.32,,,,,,,578.0000,5161.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,578.0000,5161.0000,case rate,"Rev 361 Proc 33016 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,578.0000,5161.0000,case rate,"Rev 361 Proc 33016 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,5161.0000,case rate,Rev 361 Proc 33016 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,5161.0000,case rate,Rev 361 Proc 33016 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,578.0000,5161.0000,case rate,"Rev 361 Proc 33016 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,578.0000,5161.0000,case rate,"Rev 361 Proc 33016 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,1499.60,,,,,,,578.0000,5161.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,578.0000,5161.0000,case rate,"Rev 361 Proc 33016 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,578.0000,5161.0000,case rate,"Rev 361 Proc 33016 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1499.60,,,,,,,578.0000,5161.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4644.90,,,,,,,578.0000,5161.0000,percent of total billed charges,"90% of $5,161.00 in Billed Charges for Rev 361 Proc 33016 = $4,644.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,HUMANA,HUMANA MEDICARE,1428.19,,,,,,,578.0000,5161.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1428.19,,,,,,,578.0000,5161.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,MEDCOST,MEDCOST VHN,2456.12,,,,,,,578.0000,5161.0000,percent of total billed charges,"47.59% of $5,161.00 in Billed Charges for Rev 361 Proc 33016 = $2,456.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1460.21,,,,,,,578.0000,5161.0000,fee schedule,"APG 00068 Proc 33016 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 100% = $1,390.68... $1,390.68 at 105% = $1,460.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1499.60,,,,,,,578.0000,5161.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1499.60,,,,,,,578.0000,5161.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,NHC ADVANTAGE,NHC ADVANTAGE,1499.60,,,,,,,578.0000,5161.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1433.79,,,,,,,578.0000,5161.0000,fee schedule,"APG 00068 Proc 33016 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 100% = $1,390.68... $1,390.68 at 103.1% = $1,433.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,SENTARA HEALTH,SENTARA HEALTH,1332.05,,,,,,,578.0000,5161.0000,percent of total billed charges,"25.81% of $5,161.00 in Billed Charges for Rev 361 Proc 33016 = $1,332.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,SENTARA HEALTH,SENTARA MEDICARE,1428.19,,,,,,,578.0000,5161.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5161.00,,,,,,,578.0000,5161.0000,percent of total billed charges,"100% of $5,161.00 in Billed Charges for Rev 361 Proc 33016 = $5,161.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,578.0000,5161.0000,case rate,Rev 361 Proc 33016 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,578.0000,5161.0000,case rate,Rev 361 Proc 33016 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,578.0000,5161.0000,case rate,Rev 361 Proc 33016 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,578.0000,5161.0000,case rate,"Rev 361 Proc 33016 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1432.40,,,,,,,578.0000,5161.0000,fee schedule,"APG 00068 Proc 33016 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1428.19,,,,,,,578.0000,5161.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1428.19,,,,,,,578.0000,5161.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,WELLCARE,WELLCARE MEDICAID,5161.00,,,,,,,578.0000,5161.0000,percent of total billed charges,"100% of $5,161.00 in Billed Charges for Rev 361 Proc 33016 = $5,161.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERICARDIOCENTESIS W IMG GUID,33016,CPT,361,RC,36100459,CDM,,,,both,,,5161.0000,774.1500,WELLCARE,WELLCARE MEDICARE,1513.88,,,,,,,578.0000,5161.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,AETNA,AETNA,2600.86,,,,,,,775.0000,6091.0000,percent of total billed charges,"42.7% of $6,091.00 in Billed Charges for Rev 361 Proc 33017 = $2,600.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1446.31,,,,,,,775.0000,6091.0000,fee schedule,"APG 00068 Proc 33017 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 104% = $1,446.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,ANTHEM EXCHANGE,3482.00,,,,,,,775.0000,6091.0000,fee schedule,"$1,742.13 from Fee Schedule ANT_C_APC for Rev 361 Proc 33017 * Qty 1 = $1,742.13 at 199.87% = $3,482.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1432.40,,,,,,,775.0000,6091.0000,fee schedule,"APG 00068 Proc 33017 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,ANTHEM HMO,3699.41,,,,,,,775.0000,6091.0000,fee schedule,"$1,742.13 from Fee Schedule ANT_C_APC for Rev 361 Proc 33017 * Qty 1 = $1,742.13 at 212.35% = $3,699.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4352.02,,,,,,,775.0000,6091.0000,fee schedule,"$1,742.13 from Fee Schedule ANT_C_APC for Rev 361 Proc 33017 * Qty 1 = $1,742.13 at 249.81% = $4,352.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33017 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33017 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33017 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33017 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,6091.0000,case rate,Rev 361 Proc 33017 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,6091.0000,case rate,Rev 361 Proc 33017 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33017 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33017 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33017 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33017 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5481.90,,,,,,,775.0000,6091.0000,percent of total billed charges,"90% of $6,091.00 in Billed Charges for Rev 361 Proc 33017 = $5,481.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,MEDCOST,MEDCOST VHN,2898.71,,,,,,,775.0000,6091.0000,percent of total billed charges,"47.59% of $6,091.00 in Billed Charges for Rev 361 Proc 33017 = $2,898.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1460.21,,,,,,,775.0000,6091.0000,fee schedule,"APG 00068 Proc 33017 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 100% = $1,390.68... $1,390.68 at 105% = $1,460.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1433.79,,,,,,,775.0000,6091.0000,fee schedule,"APG 00068 Proc 33017 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 100% = $1,390.68... $1,390.68 at 103.1% = $1,433.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,SENTARA HEALTH,SENTARA HEALTH,1572.09,,,,,,,775.0000,6091.0000,percent of total billed charges,"25.81% of $6,091.00 in Billed Charges for Rev 361 Proc 33017 = $1,572.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6091.00,,,,,,,775.0000,6091.0000,percent of total billed charges,"100% of $6,091.00 in Billed Charges for Rev 361 Proc 33017 = $6,091.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,775.0000,6091.0000,case rate,Rev 361 Proc 33017 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33017 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33017 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33017 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1432.40,,,,,,,775.0000,6091.0000,fee schedule,"APG 00068 Proc 33017 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 6YR+ WO CONG CARD ANOMALY,33017,CPT,361,RC,36100460,CDM,,,,both,,,6091.0000,913.6500,WELLCARE,WELLCARE MEDICAID,6091.00,,,,,,,775.0000,6091.0000,percent of total billed charges,"100% of $6,091.00 in Billed Charges for Rev 361 Proc 33017 = $6,091.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,AETNA,AETNA,2600.86,,,,,,,775.0000,6091.0000,percent of total billed charges,"42.7% of $6,091.00 in Billed Charges for Rev 361 Proc 33018 = $2,600.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1446.31,,,,,,,775.0000,6091.0000,fee schedule,"APG 00068 Proc 33018 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 104% = $1,446.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,ANTHEM EXCHANGE,3482.00,,,,,,,775.0000,6091.0000,fee schedule,"$1,742.13 from Fee Schedule ANT_C_APC for Rev 361 Proc 33018 * Qty 1 = $1,742.13 at 199.87% = $3,482.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1432.40,,,,,,,775.0000,6091.0000,fee schedule,"APG 00068 Proc 33018 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,ANTHEM HMO,3699.41,,,,,,,775.0000,6091.0000,fee schedule,"$1,742.13 from Fee Schedule ANT_C_APC for Rev 361 Proc 33018 * Qty 1 = $1,742.13 at 212.35% = $3,699.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4352.02,,,,,,,775.0000,6091.0000,fee schedule,"$1,742.13 from Fee Schedule ANT_C_APC for Rev 361 Proc 33018 * Qty 1 = $1,742.13 at 249.81% = $4,352.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33018 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33018 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33018 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33018 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,6091.0000,case rate,Rev 361 Proc 33018 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,6091.0000,case rate,Rev 361 Proc 33018 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33018 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33018 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33018 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33018 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5481.90,,,,,,,775.0000,6091.0000,percent of total billed charges,"90% of $6,091.00 in Billed Charges for Rev 361 Proc 33018 = $5,481.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,MEDCOST,MEDCOST VHN,2898.71,,,,,,,775.0000,6091.0000,percent of total billed charges,"47.59% of $6,091.00 in Billed Charges for Rev 361 Proc 33018 = $2,898.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1460.21,,,,,,,775.0000,6091.0000,fee schedule,"APG 00068 Proc 33018 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 100% = $1,390.68... $1,390.68 at 105% = $1,460.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1433.79,,,,,,,775.0000,6091.0000,fee schedule,"APG 00068 Proc 33018 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 100% = $1,390.68... $1,390.68 at 103.1% = $1,433.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,SENTARA HEALTH,SENTARA HEALTH,1572.09,,,,,,,775.0000,6091.0000,percent of total billed charges,"25.81% of $6,091.00 in Billed Charges for Rev 361 Proc 33018 = $1,572.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6091.00,,,,,,,775.0000,6091.0000,percent of total billed charges,"100% of $6,091.00 in Billed Charges for Rev 361 Proc 33018 = $6,091.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,775.0000,6091.0000,case rate,Rev 361 Proc 33018 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33018 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33018 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33018 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1432.40,,,,,,,775.0000,6091.0000,fee schedule,"APG 00068 Proc 33018 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL FLUORO/US GUID 0-5YR/ANY W CONG CARD ANOMALY,33018,CPT,361,RC,36100461,CDM,,,,both,,,6091.0000,913.6500,WELLCARE,WELLCARE MEDICAID,6091.00,,,,,,,775.0000,6091.0000,percent of total billed charges,"100% of $6,091.00 in Billed Charges for Rev 361 Proc 33018 = $6,091.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,AETNA,AETNA,2600.86,,,,,,,775.0000,6091.0000,percent of total billed charges,"42.7% of $6,091.00 in Billed Charges for Rev 361 Proc 33019 = $2,600.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1446.31,,,,,,,775.0000,6091.0000,fee schedule,"APG 00068 Proc 33019 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 104% = $1,446.31. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,ANTHEM EXCHANGE,3482.00,,,,,,,775.0000,6091.0000,fee schedule,"$1,742.13 from Fee Schedule ANT_C_APC for Rev 361 Proc 33019 * Qty 1 = $1,742.13 at 199.87% = $3,482.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1432.40,,,,,,,775.0000,6091.0000,fee schedule,"APG 00068 Proc 33019 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,ANTHEM HMO,3699.41,,,,,,,775.0000,6091.0000,fee schedule,"$1,742.13 from Fee Schedule ANT_C_APC for Rev 361 Proc 33019 * Qty 1 = $1,742.13 at 212.35% = $3,699.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4352.02,,,,,,,775.0000,6091.0000,fee schedule,"$1,742.13 from Fee Schedule ANT_C_APC for Rev 361 Proc 33019 * Qty 1 = $1,742.13 at 249.81% = $4,352.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33019 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33019 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33019 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33019 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,6091.0000,case rate,Rev 361 Proc 33019 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,6091.0000,case rate,Rev 361 Proc 33019 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33019 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33019 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33019 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33019 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5481.90,,,,,,,775.0000,6091.0000,percent of total billed charges,"90% of $6,091.00 in Billed Charges for Rev 361 Proc 33019 = $5,481.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,MEDCOST,MEDCOST VHN,2898.71,,,,,,,775.0000,6091.0000,percent of total billed charges,"47.59% of $6,091.00 in Billed Charges for Rev 361 Proc 33019 = $2,898.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1460.21,,,,,,,775.0000,6091.0000,fee schedule,"APG 00068 Proc 33019 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 100% = $1,390.68... $1,390.68 at 105% = $1,460.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1433.79,,,,,,,775.0000,6091.0000,fee schedule,"APG 00068 Proc 33019 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 100% = $1,390.68... $1,390.68 at 103.1% = $1,433.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,SENTARA HEALTH,SENTARA HEALTH,1572.09,,,,,,,775.0000,6091.0000,percent of total billed charges,"25.81% of $6,091.00 in Billed Charges for Rev 361 Proc 33019 = $1,572.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6091.00,,,,,,,775.0000,6091.0000,percent of total billed charges,"100% of $6,091.00 in Billed Charges for Rev 361 Proc 33019 = $6,091.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,775.0000,6091.0000,case rate,Rev 361 Proc 33019 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33019 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33019 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,775.0000,6091.0000,case rate,"Rev 361 Proc 33019 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1432.40,,,,,,,775.0000,6091.0000,fee schedule,"APG 00068 Proc 33019 at $836.60 (Base Rate) * 1.6623 (Relative Weight) = $1,390.68 (Total Line Payment) at 103% = $1,432.40. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PERCU PRCARDL DRNG W INDWL CATH INCL CT GUID,33019,CPT,361,RC,36100462,CDM,,,,both,,,6091.0000,913.6500,WELLCARE,WELLCARE MEDICAID,6091.00,,,,,,,775.0000,6091.0000,percent of total billed charges,"100% of $6,091.00 in Billed Charges for Rev 361 Proc 33019 = $6,091.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,AETNA,AETNA,12370.62,,,,,,,619.9800,28971.0000,percent of total billed charges,"42.7% of $28,971.00 in Billed Charges for Rev 481 Proc 33208 = $12,370.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11330.93,,,,,,,619.9800,28971.0000,fee schedule,"APG 00086 Proc 33208 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 104% = $11,330.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,9482.83,,,,,,,619.9800,28971.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,AETNA,AETNA HEALTHCARE MEDICARE,9482.83,,,,,,,619.9800,28971.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,9482.83,,,,,,,619.9800,28971.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,AMBETTER,AMBETTER,20672.57,,,,,,,619.9800,28971.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,9862.14,,,,,,,619.9800,28971.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,BLUE CROSS,ANTHEM EXCHANGE,23347.23,,,,,,,619.9800,28971.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11221.98,,,,,,,619.9800,28971.0000,fee schedule,"APG 00086 Proc 33208 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,BLUE CROSS,ANTHEM HMO,24805.05,,,,,,,619.9800,28971.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,9767.31,,,,,,,619.9800,28971.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",28971.00,,,,,,,619.9800,28971.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,619.98,,,,,,,619.9800,28971.0000,fee schedule,$619.98 from Fee Schedule BLDTM_23 for Rev 481 Proc 33208 * Qty 1 = $619.98 at 100% = $619.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,BLUE CROSS,BLUE CROSS E NETWORK,8571.00,,,,,,,619.9800,28971.0000,case rate,"Rev 481 Proc 33208 ASG Rate of $8,571.00 at 100% of $8,571.00 = $8,571.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,BLUE CROSS,BLUE CROSS MEDICARE,9862.14,,,,,,,619.9800,28971.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,BLUE CROSS,BLUE CROSS P NETWORK,8764.00,,,,,,,619.9800,28971.0000,case rate,"Rev 481 Proc 33208 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,BLUE CROSS,BLUE CROSS S NETWORK,8764.00,,,,,,,619.9800,28971.0000,case rate,"Rev 481 Proc 33208 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,CIGNA HEALTHCARE,CIGNA HMO,12080.91,,,,,,,619.9800,28971.0000,percent of total billed charges,"41.7% of $28,971.00 in Billed Charges for Rev 481 Proc 33208 = $12,080.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,13442.54,,,,,,,619.9800,28971.0000,percent of total billed charges,"46.4% of $28,971.00 in Billed Charges for Rev 481 Proc 33208 = $13,442.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,9956.97,,,,,,,619.9800,28971.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,12080.91,,,,,,,619.9800,28971.0000,percent of total billed charges,"41.7% of $28,971.00 in Billed Charges for Rev 481 Proc 33208 = $12,080.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,CIGNA HEALTHCARE,CIGNA PPO,12080.91,,,,,,,619.9800,28971.0000,percent of total billed charges,"41.7% of $28,971.00 in Billed Charges for Rev 481 Proc 33208 = $12,080.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,9956.97,,,,,,,619.9800,28971.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,26073.90,,,,,,,619.9800,28971.0000,percent of total billed charges,"90% of $28,971.00 in Billed Charges for Rev 481 Proc 33208 = $26,073.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,HUMANA,HUMANA MEDICARE,9482.83,,,,,,,619.9800,28971.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,9482.83,,,,,,,619.9800,28971.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,MEDCOST,MEDCOST VHN,13787.30,,,,,,,619.9800,28971.0000,percent of total billed charges,"47.59% of $28,971.00 in Billed Charges for Rev 481 Proc 33208 = $13,787.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11439.89,,,,,,,619.9800,28971.0000,fee schedule,"APG 00086 Proc 33208 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 105% = $11,439.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,9956.97,,,,,,,619.9800,28971.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,9956.97,,,,,,,619.9800,28971.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,NHC ADVANTAGE,NHC ADVANTAGE,9956.97,,,,,,,619.9800,28971.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11232.88,,,,,,,619.9800,28971.0000,fee schedule,"APG 00086 Proc 33208 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 103.1% = $11,232.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,SENTARA HEALTH,SENTARA HEALTH,7477.42,,,,,,,619.9800,28971.0000,percent of total billed charges,"25.81% of $28,971.00 in Billed Charges for Rev 481 Proc 33208 = $7,477.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,SENTARA HEALTH,SENTARA MEDICARE,9482.83,,,,,,,619.9800,28971.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",28971.00,,,,,,,619.9800,28971.0000,percent of total billed charges,"100% of $28,971.00 in Billed Charges for Rev 481 Proc 33208 = $28,971.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8660.00,,,,,,,619.9800,28971.0000,case rate,"Rev 481 Proc 33208 ASG Rate of $8,660.00 at 100% of $8,660.00 = $8,660.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12800.00,,,,,,,619.9800,28971.0000,case rate,"Rev 481 Proc 33208 ASG Rate of $12,800.00 at 100% of $12,800.00 = $12,800.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,12245.00,,,,,,,619.9800,28971.0000,case rate,"Rev 481 Proc 33208 ASG Rate of $12,245.00 at 100% of $12,245.00 = $12,245.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,20790.00,,,,,,,619.9800,28971.0000,case rate,"Rev 481 Proc 33208 ASG Rate of $20,790.00 at 100% of $20,790.00 = $20,790.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11221.98,,,,,,,619.9800,28971.0000,fee schedule,"APG 00086 Proc 33208 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,9482.83,,,,,,,619.9800,28971.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,9482.83,,,,,,,619.9800,28971.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,WELLCARE,WELLCARE MEDICAID,28971.00,,,,,,,619.9800,28971.0000,percent of total billed charges,"100% of $28,971.00 in Billed Charges for Rev 481 Proc 33208 = $28,971.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC PACEMAKER DUAL,33208,CPT,481,RC,48100003,CDM,,,,both,,,28971.0000,4345.6500,WELLCARE,WELLCARE MEDICARE,10051.80,,,,,,,619.9800,28971.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,AETNA,AETNA,4357.54,,,,,,,775.0000,10205.0000,percent of total billed charges,"42.7% of $10,205.00 in Billed Charges for Rev 361 Proc 50433 = $4,357.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,4192.84,,,,,,,775.0000,10205.0000,fee schedule,"APG 00171 Proc 50433 at $836.60 (Base Rate) * 4.819 (Relative Weight) = $4,031.58 (Total Line Payment) at 104% = $4,192.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3198.13,,,,,,,775.0000,10205.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,AETNA,AETNA HEALTHCARE MEDICARE,3198.13,,,,,,,775.0000,10205.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,3198.13,,,,,,,775.0000,10205.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,AMBETTER,AMBETTER,6971.91,,,,,,,775.0000,10205.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3326.05,,,,,,,775.0000,10205.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,BLUE CROSS,ANTHEM EXCHANGE,7873.96,,,,,,,775.0000,10205.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,4152.52,,,,,,,775.0000,10205.0000,fee schedule,"APG 00171 Proc 50433 at $836.60 (Base Rate) * 4.819 (Relative Weight) = $4,031.58 (Total Line Payment) at 103% = $4,152.52. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,BLUE CROSS,ANTHEM HMO,8365.61,,,,,,,775.0000,10205.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3294.07,,,,,,,775.0000,10205.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9841.36,,,,,,,775.0000,10205.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,775.0000,10205.0000,case rate,"Rev 361 Proc 50433 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,775.0000,10205.0000,case rate,"Rev 361 Proc 50433 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,BLUE CROSS,BLUE CROSS MEDICARE,3326.05,,,,,,,775.0000,10205.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,775.0000,10205.0000,case rate,"Rev 361 Proc 50433 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,775.0000,10205.0000,case rate,"Rev 361 Proc 50433 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,10205.0000,case rate,Rev 361 Proc 50433 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,10205.0000,case rate,Rev 361 Proc 50433 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,CIGNA HEALTHCARE,CIGNA HMO,5761.00,,,,,,,775.0000,10205.0000,case rate,"Rev 361 Proc 50433 ASG Rate of $5,761.00 at 100% of $5,761.00 = $5,761.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4353.00,,,,,,,775.0000,10205.0000,case rate,"Rev 361 Proc 50433 ASG Rate of $4,353.00 at 100% of $4,353.00 = $4,353.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,3358.03,,,,,,,775.0000,10205.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5761.00,,,,,,,775.0000,10205.0000,case rate,"Rev 361 Proc 50433 ASG Rate of $5,761.00 at 100% of $5,761.00 = $5,761.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,CIGNA HEALTHCARE,CIGNA PPO,5761.00,,,,,,,775.0000,10205.0000,case rate,"Rev 361 Proc 50433 ASG Rate of $5,761.00 at 100% of $5,761.00 = $5,761.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3358.03,,,,,,,775.0000,10205.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9184.50,,,,,,,775.0000,10205.0000,percent of total billed charges,"90% of $10,205.00 in Billed Charges for Rev 361 Proc 50433 = $9,184.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,HUMANA,HUMANA MEDICARE,3198.13,,,,,,,775.0000,10205.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3198.13,,,,,,,775.0000,10205.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,MEDCOST,MEDCOST VHN,4856.56,,,,,,,775.0000,10205.0000,percent of total billed charges,"47.59% of $10,205.00 in Billed Charges for Rev 361 Proc 50433 = $4,856.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,4233.16,,,,,,,775.0000,10205.0000,fee schedule,"APG 00171 Proc 50433 at $836.60 (Base Rate) * 4.819 (Relative Weight) = $4,031.58 (Total Line Payment) at 100% = $4,031.58... $4,031.58 at 105% = $4,233.16 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3358.03,,,,,,,775.0000,10205.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3358.03,,,,,,,775.0000,10205.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,NHC ADVANTAGE,NHC ADVANTAGE,3358.03,,,,,,,775.0000,10205.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,4156.56,,,,,,,775.0000,10205.0000,fee schedule,"APG 00171 Proc 50433 at $836.60 (Base Rate) * 4.819 (Relative Weight) = $4,031.58 (Total Line Payment) at 100% = $4,031.58... $4,031.58 at 103.1% = $4,156.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,SENTARA HEALTH,SENTARA HEALTH,2633.91,,,,,,,775.0000,10205.0000,percent of total billed charges,"25.81% of $10,205.00 in Billed Charges for Rev 361 Proc 50433 = $2,633.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,SENTARA HEALTH,SENTARA MEDICARE,3198.13,,,,,,,775.0000,10205.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10205.00,,,,,,,775.0000,10205.0000,percent of total billed charges,"100% of $10,205.00 in Billed Charges for Rev 361 Proc 50433 = $10,205.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1418.00,,,,,,,775.0000,10205.0000,case rate,"Rev 361 Proc 50433 ASG Rate of $1,418.00 at 100% of $1,418.00 = $1,418.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2547.00,,,,,,,775.0000,10205.0000,case rate,"Rev 361 Proc 50433 ASG Rate of $2,547.00 at 100% of $2,547.00 = $2,547.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2436.00,,,,,,,775.0000,10205.0000,case rate,"Rev 361 Proc 50433 ASG Rate of $2,436.00 at 100% of $2,436.00 = $2,436.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,4296.00,,,,,,,775.0000,10205.0000,case rate,"Rev 361 Proc 50433 ASG Rate of $4,296.00 at 100% of $4,296.00 = $4,296.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,4152.52,,,,,,,775.0000,10205.0000,fee schedule,"APG 00171 Proc 50433 at $836.60 (Base Rate) * 4.819 (Relative Weight) = $4,031.58 (Total Line Payment) at 103% = $4,152.52. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3198.13,,,,,,,775.0000,10205.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3198.13,,,,,,,775.0000,10205.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,WELLCARE,WELLCARE MEDICAID,10205.00,,,,,,,775.0000,10205.0000,percent of total billed charges,"100% of $10,205.00 in Billed Charges for Rev 361 Proc 50433 = $10,205.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE NEPHROURETERAL CATH PERCU INCL IMG RAD S&I  NEW ACCESS,50433,CPT,361,RC,36100314,CDM,,,,both,,,10205.0000,1530.7500,WELLCARE,WELLCARE MEDICARE,3390.01,,,,,,,775.0000,10205.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,AETNA,AETNA,1052.13,,,,,,,635.9600,4134.4800,percent of total billed charges,"42.7% of $2,464.00 in Billed Charges for Rev 361 Proc 50434 = $1,052.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2133.22,,,,,,,635.9600,4134.4800,fee schedule,"APG 00170 Proc 50434 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 104% = $2,133.22. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1896.55,,,,,,,635.9600,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,AETNA,AETNA HEALTHCARE MEDICARE,1896.55,,,,,,,635.9600,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,1896.55,,,,,,,635.9600,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,AMBETTER,AMBETTER,4134.48,,,,,,,635.9600,4134.4800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1972.41,,,,,,,635.9600,4134.4800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,BLUE CROSS,ANTHEM EXCHANGE,2464.00,,,,,,,635.9600,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2112.71,,,,,,,635.9600,4134.4800,fee schedule,"APG 00170 Proc 50434 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 103% = $2,112.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,BLUE CROSS,ANTHEM HMO,2464.00,,,,,,,635.9600,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1953.45,,,,,,,635.9600,4134.4800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2464.00,,,,,,,635.9600,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,635.9600,4134.4800,case rate,"Rev 361 Proc 50434 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,BLUE CROSS,BLUE CROSS E NETWORK,2464.00,,,,,,,635.9600,4134.4800,case rate,"Rev 361 Proc 50434 ASG Rate of $2,953.00 at 100% of $2,953.00 = $2,953.00 Total (Service Line reduced to $2,464.00, claim capped at $2,464.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,BLUE CROSS,BLUE CROSS MEDICARE,1972.41,,,,,,,635.9600,4134.4800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,BLUE CROSS,BLUE CROSS P NETWORK,2464.00,,,,,,,635.9600,4134.4800,case rate,"Rev 361 Proc 50434 ASG Rate of $3,019.00 at 100% of $3,019.00 = $3,019.00 Total (Service Line reduced to $2,464.00, claim capped at $2,464.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,BLUE CROSS,BLUE CROSS S NETWORK,2464.00,,,,,,,635.9600,4134.4800,case rate,"Rev 361 Proc 50434 ASG Rate of $3,019.00 at 100% of $3,019.00 = $3,019.00 Total (Service Line reduced to $2,464.00, claim capped at $2,464.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,635.9600,4134.4800,case rate,Rev 361 Proc 50434 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,635.9600,4134.4800,case rate,Rev 361 Proc 50434 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,CIGNA HEALTHCARE,CIGNA HMO,2464.00,,,,,,,635.9600,4134.4800,case rate,"Rev 361 Proc 50434 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total (Limited to $2,464.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,464.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2246.00,,,,,,,635.9600,4134.4800,case rate,"Rev 361 Proc 50434 ASG Rate of $2,246.00 at 100% of $2,246.00 = $2,246.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,1991.38,,,,,,,635.9600,4134.4800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2464.00,,,,,,,635.9600,4134.4800,case rate,"Rev 361 Proc 50434 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total (Limited to $2,464.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,464.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,CIGNA HEALTHCARE,CIGNA PPO,2464.00,,,,,,,635.9600,4134.4800,case rate,"Rev 361 Proc 50434 ASG Rate of $2,967.00 at 100% of $2,967.00 = $2,967.00 Total (Limited to $2,464.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,464.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1991.38,,,,,,,635.9600,4134.4800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2217.60,,,,,,,635.9600,4134.4800,percent of total billed charges,"90% of $2,464.00 in Billed Charges for Rev 361 Proc 50434 = $2,217.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,HUMANA,HUMANA MEDICARE,1896.55,,,,,,,635.9600,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1896.55,,,,,,,635.9600,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,MEDCOST,MEDCOST VHN,1172.62,,,,,,,635.9600,4134.4800,percent of total billed charges,"47.59% of $2,464.00 in Billed Charges for Rev 361 Proc 50434 = $1,172.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2153.74,,,,,,,635.9600,4134.4800,fee schedule,"APG 00170 Proc 50434 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 100% = $2,051.18... $2,051.18 at 105% = $2,153.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1991.38,,,,,,,635.9600,4134.4800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1991.38,,,,,,,635.9600,4134.4800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,NHC ADVANTAGE,NHC ADVANTAGE,1991.38,,,,,,,635.9600,4134.4800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2114.77,,,,,,,635.9600,4134.4800,fee schedule,"APG 00170 Proc 50434 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 100% = $2,051.18... $2,051.18 at 103.1% = $2,114.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,SENTARA HEALTH,SENTARA HEALTH,635.96,,,,,,,635.9600,4134.4800,percent of total billed charges,"25.81% of $2,464.00 in Billed Charges for Rev 361 Proc 50434 = $635.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,SENTARA HEALTH,SENTARA MEDICARE,1896.55,,,,,,,635.9600,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2464.00,,,,,,,635.9600,4134.4800,percent of total billed charges,"100% of $2,464.00 in Billed Charges for Rev 361 Proc 50434 = $2,464.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,635.9600,4134.4800,case rate,Rev 361 Proc 50434 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,635.9600,4134.4800,case rate,Rev 361 Proc 50434 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,635.9600,4134.4800,case rate,Rev 361 Proc 50434 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,635.9600,4134.4800,case rate,"Rev 361 Proc 50434 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2112.71,,,,,,,635.9600,4134.4800,fee schedule,"APG 00170 Proc 50434 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 103% = $2,112.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1896.55,,,,,,,635.9600,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1896.55,,,,,,,635.9600,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,WELLCARE,WELLCARE MEDICAID,2464.00,,,,,,,635.9600,4134.4800,percent of total billed charges,"100% of $2,464.00 in Billed Charges for Rev 361 Proc 50434 = $2,464.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CNVRT NPHRSTOMY CATH TO NEPHRRETERAL CATH PERCU INCL IMG RAD S&I,50434,CPT,361,RC,36100315,CDM,,,,both,,,2464.0000,369.6000,WELLCARE,WELLCARE MEDICARE,2010.34,,,,,,,635.9600,4134.4800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,AETNA,AETNA,1468.88,,,,,,,887.8600,4134.4800,percent of total billed charges,"42.7% of $3,440.00 in Billed Charges for Rev 361 Proc 50435 Mod 50 = $1,468.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3199.83,,,,,,,887.8600,4134.4800,fee schedule,"APG 00170 Proc 50435 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 150% Mod Percentage = $3,076.76 at 104% = $3,199.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1896.55,,,,,,,887.8600,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,AETNA,AETNA HEALTHCARE MEDICARE,1896.55,,,,,,,887.8600,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,ALLCARE MEDICARE,ALLCARE MEDICARE,1896.55,,,,,,,887.8600,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,AMBETTER,AMBETTER,4134.48,,,,,,,887.8600,4134.4800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1972.41,,,,,,,887.8600,4134.4800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,BLUE CROSS,ANTHEM EXCHANGE,3440.00,,,,,,,887.8600,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3169.07,,,,,,,887.8600,4134.4800,fee schedule,"APG 00170 Proc 50435 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 150% Mod Percentage = $3,076.76 at 103% = $3,169.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,BLUE CROSS,ANTHEM HMO,3440.00,,,,,,,887.8600,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1953.45,,,,,,,887.8600,4134.4800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3440.00,,,,,,,887.8600,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2284.50,,,,,,,887.8600,4134.4800,case rate,"Rev 361 Proc 50435 Mod 50 ASG Rate of $1,523.00 at 100% of $1,523.00 + 50% of $1,523.00 = $2,284.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,BLUE CROSS,BLUE CROSS E NETWORK,3440.00,,,,,,,887.8600,4134.4800,case rate,"Rev 361 Proc 50435 Mod 50 ASG Rate of $2,953.00 at 100% of $2,953.00 + 50% of $2,953.00 = $4,429.50 Total (Service Line reduced to $3,440.00, claim capped at $3,440.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,BLUE CROSS,BLUE CROSS MEDICARE,1972.41,,,,,,,887.8600,4134.4800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,BLUE CROSS,BLUE CROSS P NETWORK,3440.00,,,,,,,887.8600,4134.4800,case rate,"Rev 361 Proc 50435 Mod 50 ASG Rate of $3,019.00 at 100% of $3,019.00 + 50% of $3,019.00 = $4,528.50 Total (Service Line reduced to $3,440.00, claim capped at $3,440.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,BLUE CROSS,BLUE CROSS S NETWORK,3440.00,,,,,,,887.8600,4134.4800,case rate,"Rev 361 Proc 50435 Mod 50 ASG Rate of $3,019.00 at 100% of $3,019.00 + 50% of $3,019.00 = $4,528.50 Total (Service Line reduced to $3,440.00, claim capped at $3,440.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,BLUE CROSS,TENNCARE BLUE CARE,1162.50,,,,,,,887.8600,4134.4800,case rate,"Rev 361 Proc 50435 Mod 50 ASG Rate of $775.00 at 100% of $775.00 + 50% of $775.00 = $1,162.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,BLUE CROSS,TENNCARE BLUE SELECT,1162.50,,,,,,,887.8600,4134.4800,case rate,"Rev 361 Proc 50435 Mod 50 ASG Rate of $775.00 at 100% of $775.00 + 50% of $775.00 = $1,162.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,CIGNA HEALTHCARE,CIGNA HMO,3440.00,,,,,,,887.8600,4134.4800,case rate,"Rev 361 Proc 50435 Mod 50 ASG Rate of $2,967.00 at 100% of $2,967.00 + 50% of $2,967.00 = $4,450.50 Total (Limited to $3,440.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,440.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3369.00,,,,,,,887.8600,4134.4800,case rate,"Rev 361 Proc 50435 Mod 50 ASG Rate of $2,246.00 at 100% of $2,246.00 + 50% of $2,246.00 = $3,369.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,CIGNA HEALTHCARE,CIGNA MEDICARE,1991.38,,,,,,,887.8600,4134.4800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3440.00,,,,,,,887.8600,4134.4800,case rate,"Rev 361 Proc 50435 Mod 50 ASG Rate of $2,967.00 at 100% of $2,967.00 + 50% of $2,967.00 = $4,450.50 Total (Limited to $3,440.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,440.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,CIGNA HEALTHCARE,CIGNA PPO,3440.00,,,,,,,887.8600,4134.4800,case rate,"Rev 361 Proc 50435 Mod 50 ASG Rate of $2,967.00 at 100% of $2,967.00 + 50% of $2,967.00 = $4,450.50 Total (Limited to $3,440.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,440.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1991.38,,,,,,,887.8600,4134.4800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3096.00,,,,,,,887.8600,4134.4800,percent of total billed charges,"90% of $3,440.00 in Billed Charges for Rev 361 Proc 50435 Mod 50 = $3,096.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,HUMANA,HUMANA MEDICARE,1896.55,,,,,,,887.8600,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1896.55,,,,,,,887.8600,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,MEDCOST,MEDCOST VHN,1637.10,,,,,,,887.8600,4134.4800,percent of total billed charges,"47.59% of $3,440.00 in Billed Charges for Rev 361 Proc 50435 Mod 50 = $1,637.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3230.60,,,,,,,887.8600,4134.4800,fee schedule,"APG 00170 Proc 50435 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 150% Mod Percentage = $3,076.76 at 100% = $3,076.76... $3,076.76 at 105% = $3,230.60 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1991.38,,,,,,,887.8600,4134.4800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1991.38,,,,,,,887.8600,4134.4800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,NHC ADVANTAGE,NHC ADVANTAGE,1991.38,,,,,,,887.8600,4134.4800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3172.14,,,,,,,887.8600,4134.4800,fee schedule,"APG 00170 Proc 50435 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 150% Mod Percentage = $3,076.76 at 100% = $3,076.76... $3,076.76 at 103.1% = $3,172.14 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,SENTARA HEALTH,SENTARA HEALTH,887.86,,,,,,,887.8600,4134.4800,percent of total billed charges,"25.81% of $3,440.00 in Billed Charges for Rev 361 Proc 50435 Mod 50 = $887.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,SENTARA HEALTH,SENTARA MEDICARE,1896.55,,,,,,,887.8600,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3440.00,,,,,,,887.8600,4134.4800,percent of total billed charges,"100% of $3,440.00 in Billed Charges for Rev 361 Proc 50435 Mod 50 = $3,440.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1158.00,,,,,,,887.8600,4134.4800,case rate,"Rev 361 Proc 50435 Mod 50 ASG Rate of $772.00 at 100% of $772.00 + 50% of $772.00 = $1,158.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1018.50,,,,,,,887.8600,4134.4800,case rate,"Rev 361 Proc 50435 Mod 50 ASG Rate of $679.00 at 100% of $679.00 + 50% of $679.00 = $1,018.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,975.00,,,,,,,887.8600,4134.4800,case rate,Rev 361 Proc 50435 Mod 50 ASG Rate of $650.00 at 100% of $650.00 + 50% of $650.00 = $975.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,1651.50,,,,,,,887.8600,4134.4800,case rate,"Rev 361 Proc 50435 Mod 50 ASG Rate of $1,101.00 at 100% of $1,101.00 + 50% of $1,101.00 = $1,651.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3169.07,,,,,,,887.8600,4134.4800,fee schedule,"APG 00170 Proc 50435 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 150% Mod Percentage = $3,076.76 at 103% = $3,169.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1896.55,,,,,,,887.8600,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1896.55,,,,,,,887.8600,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,WELLCARE,WELLCARE MEDICAID,3440.00,,,,,,,887.8600,4134.4800,percent of total billed charges,"100% of $3,440.00 in Billed Charges for Rev 361 Proc 50435 Mod 50 = $3,440.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXCHANGE NEPHROSTOMY CATH PERCU INCL IMG RAD S&I BILAT,50435,CPT,361,RC,36100332,CDM,,,50,both,,,3440.0000,516.0000,WELLCARE,WELLCARE MEDICARE,2010.34,,,,,,,887.8600,4134.4800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,AETNA,AETNA,5046.29,,,,,,,775.0000,11957.2000,percent of total billed charges,"42.7% of $11,818.00 in Billed Charges for Rev 361 Proc 50592 = $5,046.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,4192.84,,,,,,,775.0000,11957.2000,fee schedule,"APG 00171 Proc 50592 at $836.60 (Base Rate) * 4.819 (Relative Weight) = $4,031.58 (Total Line Payment) at 104% = $4,192.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5484.95,,,,,,,775.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,AETNA,AETNA HEALTHCARE MEDICARE,5484.95,,,,,,,775.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,5484.95,,,,,,,775.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,AMBETTER,AMBETTER,11957.20,,,,,,,775.0000,11957.2000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,5704.35,,,,,,,775.0000,11957.2000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,BLUE CROSS,ANTHEM EXCHANGE,11818.00,,,,,,,775.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,4152.52,,,,,,,775.0000,11957.2000,fee schedule,"APG 00171 Proc 50592 at $836.60 (Base Rate) * 4.819 (Relative Weight) = $4,031.58 (Total Line Payment) at 103% = $4,152.52. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,BLUE CROSS,ANTHEM HMO,11818.00,,,,,,,775.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5649.50,,,,,,,775.0000,11957.2000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",11818.00,,,,,,,775.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1336.00,,,,,,,775.0000,11957.2000,case rate,"Rev 361 Proc 50592 ASG Rate of $1,336.00 at 100% of $1,336.00 = $1,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,775.0000,11957.2000,case rate,"Rev 361 Proc 50592 ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,BLUE CROSS,BLUE CROSS MEDICARE,5704.35,,,,,,,775.0000,11957.2000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,775.0000,11957.2000,case rate,"Rev 361 Proc 50592 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,775.0000,11957.2000,case rate,"Rev 361 Proc 50592 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,11957.2000,case rate,Rev 361 Proc 50592 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,11957.2000,case rate,Rev 361 Proc 50592 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,775.0000,11957.2000,case rate,"Rev 361 Proc 50592 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,775.0000,11957.2000,case rate,"Rev 361 Proc 50592 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,5759.20,,,,,,,775.0000,11957.2000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,775.0000,11957.2000,case rate,"Rev 361 Proc 50592 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,775.0000,11957.2000,case rate,"Rev 361 Proc 50592 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,5759.20,,,,,,,775.0000,11957.2000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10636.20,,,,,,,775.0000,11957.2000,percent of total billed charges,"90% of $11,818.00 in Billed Charges for Rev 361 Proc 50592 = $10,636.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,HUMANA,HUMANA MEDICARE,5484.95,,,,,,,775.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5484.95,,,,,,,775.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,MEDCOST,MEDCOST VHN,5624.19,,,,,,,775.0000,11957.2000,percent of total billed charges,"47.59% of $11,818.00 in Billed Charges for Rev 361 Proc 50592 = $5,624.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,4233.16,,,,,,,775.0000,11957.2000,fee schedule,"APG 00171 Proc 50592 at $836.60 (Base Rate) * 4.819 (Relative Weight) = $4,031.58 (Total Line Payment) at 100% = $4,031.58... $4,031.58 at 105% = $4,233.16 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,5759.20,,,,,,,775.0000,11957.2000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,5759.20,,,,,,,775.0000,11957.2000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,NHC ADVANTAGE,NHC ADVANTAGE,5759.20,,,,,,,775.0000,11957.2000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,4156.56,,,,,,,775.0000,11957.2000,fee schedule,"APG 00171 Proc 50592 at $836.60 (Base Rate) * 4.819 (Relative Weight) = $4,031.58 (Total Line Payment) at 100% = $4,031.58... $4,031.58 at 103.1% = $4,156.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,SENTARA HEALTH,SENTARA HEALTH,3050.23,,,,,,,775.0000,11957.2000,percent of total billed charges,"25.81% of $11,818.00 in Billed Charges for Rev 361 Proc 50592 = $3,050.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,SENTARA HEALTH,SENTARA MEDICARE,5484.95,,,,,,,775.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",11818.00,,,,,,,775.0000,11957.2000,percent of total billed charges,"100% of $11,818.00 in Billed Charges for Rev 361 Proc 50592 = $11,818.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,775.0000,11957.2000,case rate,"Rev 361 Proc 50592 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,775.0000,11957.2000,case rate,"Rev 361 Proc 50592 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,775.0000,11957.2000,case rate,"Rev 361 Proc 50592 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,775.0000,11957.2000,case rate,"Rev 361 Proc 50592 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,4152.52,,,,,,,775.0000,11957.2000,fee schedule,"APG 00171 Proc 50592 at $836.60 (Base Rate) * 4.819 (Relative Weight) = $4,031.58 (Total Line Payment) at 103% = $4,152.52. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5484.95,,,,,,,775.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5484.95,,,,,,,775.0000,11957.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,WELLCARE,WELLCARE MEDICAID,11818.00,,,,,,,775.0000,11957.2000,percent of total billed charges,"100% of $11,818.00 in Billed Charges for Rev 361 Proc 50592 = $11,818.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT ABLAT 1 OR MORE RENAL TUMOR,50592,CPT,361,RC,36100170,CDM,,,,both,,,11818.0000,1772.7000,WELLCARE,WELLCARE MEDICARE,5814.05,,,,,,,775.0000,11957.2000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,AETNA,AETNA,4278.11,,,,,,,427.0000,21024.3000,percent of total billed charges,"42.7% of $10,019.00 in Billed Charges for Rev 350 Proc 50593 = $4,278.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,9986.94,,,,,,,427.0000,21024.3000,fee schedule,"APG 00172 Proc 50593 at $836.60 (Base Rate) * 11.4784 (Relative Weight) = $9,602.83 (Total Line Payment) at 104% = $9,986.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,9644.18,,,,,,,427.0000,21024.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,AETNA,AETNA HEALTHCARE MEDICARE,9644.18,,,,,,,427.0000,21024.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,9644.18,,,,,,,427.0000,21024.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,AMBETTER,AMBETTER,21024.30,,,,,,,427.0000,21024.3000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,10019.00,,,,,,,427.0000,21024.3000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,BLUE CROSS,ANTHEM EXCHANGE,10019.00,,,,,,,427.0000,21024.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,9890.91,,,,,,,427.0000,21024.3000,fee schedule,"APG 00172 Proc 50593 at $836.60 (Base Rate) * 11.4784 (Relative Weight) = $9,602.83 (Total Line Payment) at 103% = $9,890.91. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,BLUE CROSS,ANTHEM HMO,10019.00,,,,,,,427.0000,21024.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,9933.50,,,,,,,427.0000,21024.3000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",10019.00,,,,,,,427.0000,21024.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,4177.41,,,,,,,427.0000,21024.3000,fee schedule,"$4,177.41 from Fee Schedule BLDTM_23 for Rev 350 Proc 50593 * Qty 1 = $4,177.41 at 100% = $4,177.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,BLUE CROSS,BLUE CROSS MEDICARE,10029.94,,,,,,,427.0000,21024.3000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,CIGNA HEALTHCARE,CIGNA HMO,642.00,,,,,,,427.0000,21024.3000,other,Rev 350 Proc 50593 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,427.00,,,,,,,427.0000,21024.3000,other,Rev 350 Proc 50593 Qty 1 * $427.00 = $427.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,10019.00,,,,,,,427.0000,21024.3000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,642.00,,,,,,,427.0000,21024.3000,other,Rev 350 Proc 50593 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,CIGNA HEALTHCARE,CIGNA PPO,642.00,,,,,,,427.0000,21024.3000,other,Rev 350 Proc 50593 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,10019.00,,,,,,,427.0000,21024.3000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9017.10,,,,,,,427.0000,21024.3000,percent of total billed charges,"90% of $10,019.00 in Billed Charges for Rev 350 Proc 50593 = $9,017.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,HUMANA,HUMANA MEDICARE,9644.18,,,,,,,427.0000,21024.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,9644.18,,,,,,,427.0000,21024.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,MEDCOST,MEDCOST VHN,4768.04,,,,,,,427.0000,21024.3000,percent of total billed charges,"47.59% of $10,019.00 in Billed Charges for Rev 350 Proc 50593 = $4,768.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,10082.97,,,,,,,427.0000,21024.3000,fee schedule,"APG 00172 Proc 50593 at $836.60 (Base Rate) * 11.4784 (Relative Weight) = $9,602.83 (Total Line Payment) at 100% = $9,602.83... $9,602.83 at 105% = $10,082.97 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,10019.00,,,,,,,427.0000,21024.3000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,10019.00,,,,,,,427.0000,21024.3000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,NHC ADVANTAGE,NHC ADVANTAGE,10019.00,,,,,,,427.0000,21024.3000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,9900.52,,,,,,,427.0000,21024.3000,fee schedule,"APG 00172 Proc 50593 at $836.60 (Base Rate) * 11.4784 (Relative Weight) = $9,602.83 (Total Line Payment) at 100% = $9,602.83... $9,602.83 at 103.1% = $9,900.52 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,SENTARA HEALTH,SENTARA HEALTH,2585.90,,,,,,,427.0000,21024.3000,percent of total billed charges,"25.81% of $10,019.00 in Billed Charges for Rev 350 Proc 50593 = $2,585.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,SENTARA HEALTH,SENTARA MEDICARE,9644.18,,,,,,,427.0000,21024.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10019.00,,,,,,,427.0000,21024.3000,percent of total billed charges,"100% of $10,019.00 in Billed Charges for Rev 350 Proc 50593 = $10,019.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2047.95,,,,,,,427.0000,21024.3000,fee schedule,"$4,095.89 from Fee Schedule TCUHC24 for Rev 350 Proc 50593 * Qty 1 = $4,095.89 at 50% = $2,047.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1919.00,,,,,,,427.0000,21024.3000,other,"Rev 350 Proc 50593 1 Visit at $1,919.00 per Visit = $1,919.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1835.00,,,,,,,427.0000,21024.3000,other,"Rev 350 Proc 50593 1 Visit at $1,835.00 per Visit = $1,835.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,3026.00,,,,,,,427.0000,21024.3000,other,"Rev 350 Proc 50593 1 Visit at $3,026.00 per Visit = $3,026.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,9890.91,,,,,,,427.0000,21024.3000,fee schedule,"APG 00172 Proc 50593 at $836.60 (Base Rate) * 11.4784 (Relative Weight) = $9,602.83 (Total Line Payment) at 103% = $9,890.91. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,9644.18,,,,,,,427.0000,21024.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,9644.18,,,,,,,427.0000,21024.3000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,WELLCARE,WELLCARE MEDICAID,10019.00,,,,,,,427.0000,21024.3000,percent of total billed charges,"100% of $10,019.00 in Billed Charges for Rev 350 Proc 50593 = $10,019.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RENAL TUMOR CRYO ABLATION,50593,CPT,350,RC,35000051,CDM,,,,both,,,10019.0000,1502.8500,WELLCARE,WELLCARE MEDICARE,10222.83,,,,,,,427.0000,21024.3000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,AETNA,AETNA,1792.97,,,,,,,1056.0000,4199.0000,percent of total billed charges,"42.7% of $4,199.00 in Billed Charges for Rev 361 Proc 50688 Mod 50 = $1,792.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,3199.83,,,,,,,1056.0000,4199.0000,fee schedule,"APG 00170 Proc 50688 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 150% Mod Percentage = $3,076.76 at 104% = $3,199.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1896.55,,,,,,,1056.0000,4199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,AETNA,AETNA HEALTHCARE MEDICARE,1896.55,,,,,,,1056.0000,4199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,1896.55,,,,,,,1056.0000,4199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,AMBETTER,AMBETTER,4134.48,,,,,,,1056.0000,4199.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1972.41,,,,,,,1056.0000,4199.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,BLUE CROSS,ANTHEM EXCHANGE,4199.00,,,,,,,1056.0000,4199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3169.07,,,,,,,1056.0000,4199.0000,fee schedule,"APG 00170 Proc 50688 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 150% Mod Percentage = $3,076.76 at 103% = $3,169.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,BLUE CROSS,ANTHEM HMO,4199.00,,,,,,,1056.0000,4199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1953.45,,,,,,,1056.0000,4199.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",4199.00,,,,,,,1056.0000,4199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1056.00,,,,,,,1056.0000,4199.0000,case rate,"Rev 361 Proc 50688 Mod 50 ASG Rate of $704.00 at 100% of $704.00 + 50% of $704.00 = $1,056.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,BLUE CROSS,BLUE CROSS E NETWORK,4199.00,,,,,,,1056.0000,4199.0000,case rate,"Rev 361 Proc 50688 Mod 50 ASG Rate of $2,953.00 at 100% of $2,953.00 + 50% of $2,953.00 = $4,429.50 Total (Service Line reduced to $4,199.00, claim capped at $4,199.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,BLUE CROSS,BLUE CROSS MEDICARE,1972.41,,,,,,,1056.0000,4199.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,BLUE CROSS,BLUE CROSS P NETWORK,4199.00,,,,,,,1056.0000,4199.0000,case rate,"Rev 361 Proc 50688 Mod 50 ASG Rate of $3,019.00 at 100% of $3,019.00 + 50% of $3,019.00 = $4,528.50 Total (Service Line reduced to $4,199.00, claim capped at $4,199.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,BLUE CROSS,BLUE CROSS S NETWORK,4199.00,,,,,,,1056.0000,4199.0000,case rate,"Rev 361 Proc 50688 Mod 50 ASG Rate of $3,019.00 at 100% of $3,019.00 + 50% of $3,019.00 = $4,528.50 Total (Service Line reduced to $4,199.00, claim capped at $4,199.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,BLUE CROSS,TENNCARE BLUE CARE,1162.50,,,,,,,1056.0000,4199.0000,case rate,"Rev 361 Proc 50688 Mod 50 ASG Rate of $775.00 at 100% of $775.00 + 50% of $775.00 = $1,162.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,BLUE CROSS,TENNCARE BLUE SELECT,1162.50,,,,,,,1056.0000,4199.0000,case rate,"Rev 361 Proc 50688 Mod 50 ASG Rate of $775.00 at 100% of $775.00 + 50% of $775.00 = $1,162.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,CIGNA HEALTHCARE,CIGNA HMO,2898.00,,,,,,,1056.0000,4199.0000,case rate,"Rev 361 Proc 50688 Mod 50 ASG Rate of $1,932.00 at 100% of $1,932.00 + 50% of $1,932.00 = $2,898.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2194.50,,,,,,,1056.0000,4199.0000,case rate,"Rev 361 Proc 50688 Mod 50 ASG Rate of $1,463.00 at 100% of $1,463.00 + 50% of $1,463.00 = $2,194.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,1991.38,,,,,,,1056.0000,4199.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2898.00,,,,,,,1056.0000,4199.0000,case rate,"Rev 361 Proc 50688 Mod 50 ASG Rate of $1,932.00 at 100% of $1,932.00 + 50% of $1,932.00 = $2,898.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,CIGNA HEALTHCARE,CIGNA PPO,2898.00,,,,,,,1056.0000,4199.0000,case rate,"Rev 361 Proc 50688 Mod 50 ASG Rate of $1,932.00 at 100% of $1,932.00 + 50% of $1,932.00 = $2,898.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1991.38,,,,,,,1056.0000,4199.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3779.10,,,,,,,1056.0000,4199.0000,percent of total billed charges,"90% of $4,199.00 in Billed Charges for Rev 361 Proc 50688 Mod 50 = $3,779.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,HUMANA,HUMANA MEDICARE,1896.55,,,,,,,1056.0000,4199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1896.55,,,,,,,1056.0000,4199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,MEDCOST,MEDCOST VHN,1998.30,,,,,,,1056.0000,4199.0000,percent of total billed charges,"47.59% of $4,199.00 in Billed Charges for Rev 361 Proc 50688 Mod 50 = $1,998.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,3230.60,,,,,,,1056.0000,4199.0000,fee schedule,"APG 00170 Proc 50688 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 150% Mod Percentage = $3,076.76 at 100% = $3,076.76... $3,076.76 at 105% = $3,230.60 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1991.38,,,,,,,1056.0000,4199.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1991.38,,,,,,,1056.0000,4199.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,NHC ADVANTAGE,NHC ADVANTAGE,1991.38,,,,,,,1056.0000,4199.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,3172.14,,,,,,,1056.0000,4199.0000,fee schedule,"APG 00170 Proc 50688 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 150% Mod Percentage = $3,076.76 at 100% = $3,076.76... $3,076.76 at 103.1% = $3,172.14 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,SENTARA HEALTH,SENTARA HEALTH,1083.76,,,,,,,1056.0000,4199.0000,percent of total billed charges,"25.81% of $4,199.00 in Billed Charges for Rev 361 Proc 50688 Mod 50 = $1,083.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,SENTARA HEALTH,SENTARA MEDICARE,1896.55,,,,,,,1056.0000,4199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4199.00,,,,,,,1056.0000,4199.0000,percent of total billed charges,"100% of $4,199.00 in Billed Charges for Rev 361 Proc 50688 Mod 50 = $4,199.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1452.00,,,,,,,1056.0000,4199.0000,case rate,"Rev 361 Proc 50688 Mod 50 ASG Rate of $968.00 at 100% of $968.00 + 50% of $968.00 = $1,452.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1654.50,,,,,,,1056.0000,4199.0000,case rate,"Rev 361 Proc 50688 Mod 50 ASG Rate of $1,103.00 at 100% of $1,103.00 + 50% of $1,103.00 = $1,654.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1582.50,,,,,,,1056.0000,4199.0000,case rate,"Rev 361 Proc 50688 Mod 50 ASG Rate of $1,055.00 at 100% of $1,055.00 + 50% of $1,055.00 = $1,582.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,2791.50,,,,,,,1056.0000,4199.0000,case rate,"Rev 361 Proc 50688 Mod 50 ASG Rate of $1,861.00 at 100% of $1,861.00 + 50% of $1,861.00 = $2,791.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,3169.07,,,,,,,1056.0000,4199.0000,fee schedule,"APG 00170 Proc 50688 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 150% Mod Percentage = $3,076.76 at 103% = $3,169.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1896.55,,,,,,,1056.0000,4199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1896.55,,,,,,,1056.0000,4199.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,WELLCARE,WELLCARE MEDICAID,4199.00,,,,,,,1056.0000,4199.0000,percent of total billed charges,"100% of $4,199.00 in Billed Charges for Rev 361 Proc 50688 Mod 50 = $4,199.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHANGE URETEROSTOMY TUBE/ EXT ACC URTRAL STENT VIA ILEAL CONDT BILT,50688,CPT,361,RC,36100294,CDM,,,50,both,,,4199.0000,629.8500,WELLCARE,WELLCARE MEDICARE,2010.34,,,,,,,1056.0000,4199.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,AETNA,AETNA,1195.17,,,,,,,704.0000,4134.4800,percent of total billed charges,"42.7% of $2,799.00 in Billed Charges for Rev 361 Proc 50688 = $1,195.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2133.22,,,,,,,704.0000,4134.4800,fee schedule,"APG 00170 Proc 50688 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 104% = $2,133.22. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1896.55,,,,,,,704.0000,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,AETNA,AETNA HEALTHCARE MEDICARE,1896.55,,,,,,,704.0000,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,1896.55,,,,,,,704.0000,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,AMBETTER,AMBETTER,4134.48,,,,,,,704.0000,4134.4800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1972.41,,,,,,,704.0000,4134.4800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,BLUE CROSS,ANTHEM EXCHANGE,2799.00,,,,,,,704.0000,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2112.71,,,,,,,704.0000,4134.4800,fee schedule,"APG 00170 Proc 50688 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 103% = $2,112.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,BLUE CROSS,ANTHEM HMO,2799.00,,,,,,,704.0000,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1953.45,,,,,,,704.0000,4134.4800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2799.00,,,,,,,704.0000,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,704.0000,4134.4800,case rate,Rev 361 Proc 50688 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,BLUE CROSS,BLUE CROSS E NETWORK,2799.00,,,,,,,704.0000,4134.4800,case rate,"Rev 361 Proc 50688 ASG Rate of $2,953.00 at 100% of $2,953.00 = $2,953.00 Total (Service Line reduced to $2,799.00, claim capped at $2,799.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,BLUE CROSS,BLUE CROSS MEDICARE,1972.41,,,,,,,704.0000,4134.4800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,BLUE CROSS,BLUE CROSS P NETWORK,2799.00,,,,,,,704.0000,4134.4800,case rate,"Rev 361 Proc 50688 ASG Rate of $3,019.00 at 100% of $3,019.00 = $3,019.00 Total (Service Line reduced to $2,799.00, claim capped at $2,799.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,BLUE CROSS,BLUE CROSS S NETWORK,2799.00,,,,,,,704.0000,4134.4800,case rate,"Rev 361 Proc 50688 ASG Rate of $3,019.00 at 100% of $3,019.00 = $3,019.00 Total (Service Line reduced to $2,799.00, claim capped at $2,799.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,704.0000,4134.4800,case rate,Rev 361 Proc 50688 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,704.0000,4134.4800,case rate,Rev 361 Proc 50688 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,704.0000,4134.4800,case rate,"Rev 361 Proc 50688 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,704.0000,4134.4800,case rate,"Rev 361 Proc 50688 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,1991.38,,,,,,,704.0000,4134.4800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,704.0000,4134.4800,case rate,"Rev 361 Proc 50688 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,704.0000,4134.4800,case rate,"Rev 361 Proc 50688 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1991.38,,,,,,,704.0000,4134.4800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2519.10,,,,,,,704.0000,4134.4800,percent of total billed charges,"90% of $2,799.00 in Billed Charges for Rev 361 Proc 50688 = $2,519.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,HUMANA,HUMANA MEDICARE,1896.55,,,,,,,704.0000,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1896.55,,,,,,,704.0000,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,MEDCOST,MEDCOST VHN,1332.04,,,,,,,704.0000,4134.4800,percent of total billed charges,"47.59% of $2,799.00 in Billed Charges for Rev 361 Proc 50688 = $1,332.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2153.74,,,,,,,704.0000,4134.4800,fee schedule,"APG 00170 Proc 50688 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 100% = $2,051.18... $2,051.18 at 105% = $2,153.74 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1991.38,,,,,,,704.0000,4134.4800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1991.38,,,,,,,704.0000,4134.4800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,NHC ADVANTAGE,NHC ADVANTAGE,1991.38,,,,,,,704.0000,4134.4800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2114.77,,,,,,,704.0000,4134.4800,fee schedule,"APG 00170 Proc 50688 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 100% = $2,051.18... $2,051.18 at 103.1% = $2,114.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,SENTARA HEALTH,SENTARA HEALTH,722.42,,,,,,,704.0000,4134.4800,percent of total billed charges,"25.81% of $2,799.00 in Billed Charges for Rev 361 Proc 50688 = $722.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,SENTARA HEALTH,SENTARA MEDICARE,1896.55,,,,,,,704.0000,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2799.00,,,,,,,704.0000,4134.4800,percent of total billed charges,"100% of $2,799.00 in Billed Charges for Rev 361 Proc 50688 = $2,799.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,704.0000,4134.4800,case rate,Rev 361 Proc 50688 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,704.0000,4134.4800,case rate,"Rev 361 Proc 50688 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,704.0000,4134.4800,case rate,"Rev 361 Proc 50688 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,704.0000,4134.4800,case rate,"Rev 361 Proc 50688 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2112.71,,,,,,,704.0000,4134.4800,fee schedule,"APG 00170 Proc 50688 at $836.60 (Base Rate) * 2.4518 (Relative Weight) = $2,051.18 (Total Line Payment) at 103% = $2,112.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1896.55,,,,,,,704.0000,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1896.55,,,,,,,704.0000,4134.4800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,WELLCARE,WELLCARE MEDICAID,2799.00,,,,,,,704.0000,4134.4800,percent of total billed charges,"100% of $2,799.00 in Billed Charges for Rev 361 Proc 50688 = $2,799.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CHNG URETEROSTOMY TUBE /EXT ACC URTRL STENT VIA ILEAL CONDT UNILAT,50688,CPT,361,RC,36100293,CDM,,,,both,,,2799.0000,419.8500,WELLCARE,WELLCARE MEDICARE,2010.34,,,,,,,704.0000,4134.4800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,AETNA,AETNA,5404.54,,,,,,,235.7400,16367.5500,percent of total billed charges,"42.7% of $12,657.00 in Billed Charges for Rev 481 Proc 33211 = $5,404.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2176.64,,,,,,,235.7400,16367.5500,fee schedule,"APG 00074 Proc 33211 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 104% = $2,176.64. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,7508.05,,,,,,,235.7400,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,AETNA,AETNA HEALTHCARE MEDICARE,7508.05,,,,,,,235.7400,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,7508.05,,,,,,,235.7400,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,AMBETTER,AMBETTER,16367.55,,,,,,,235.7400,16367.5500,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,7808.37,,,,,,,235.7400,16367.5500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,ANTHEM EXCHANGE,12657.00,,,,,,,235.7400,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2155.71,,,,,,,235.7400,16367.5500,fee schedule,"APG 00074 Proc 33211 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,ANTHEM HMO,12657.00,,,,,,,235.7400,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,7733.29,,,,,,,235.7400,16367.5500,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",12657.00,,,,,,,235.7400,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,235.74,,,,,,,235.7400,16367.5500,fee schedule,$235.74 from Fee Schedule BLDTM_23 for Rev 481 Proc 33211 * Qty 1 = $235.74 at 100% = $235.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,235.7400,16367.5500,case rate,"Rev 481 Proc 33211 ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,BLUE CROSS MEDICARE,7808.37,,,,,,,235.7400,16367.5500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,235.7400,16367.5500,case rate,"Rev 481 Proc 33211 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,235.7400,16367.5500,case rate,"Rev 481 Proc 33211 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,CIGNA HEALTHCARE,CIGNA HMO,5277.97,,,,,,,235.7400,16367.5500,percent of total billed charges,"41.7% of $12,657.00 in Billed Charges for Rev 481 Proc 33211 = $5,277.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5872.85,,,,,,,235.7400,16367.5500,percent of total billed charges,"46.4% of $12,657.00 in Billed Charges for Rev 481 Proc 33211 = $5,872.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,7883.45,,,,,,,235.7400,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5277.97,,,,,,,235.7400,16367.5500,percent of total billed charges,"41.7% of $12,657.00 in Billed Charges for Rev 481 Proc 33211 = $5,277.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,CIGNA HEALTHCARE,CIGNA PPO,5277.97,,,,,,,235.7400,16367.5500,percent of total billed charges,"41.7% of $12,657.00 in Billed Charges for Rev 481 Proc 33211 = $5,277.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,7883.45,,,,,,,235.7400,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11391.30,,,,,,,235.7400,16367.5500,percent of total billed charges,"90% of $12,657.00 in Billed Charges for Rev 481 Proc 33211 = $11,391.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,HUMANA,HUMANA MEDICARE,7508.05,,,,,,,235.7400,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,7508.05,,,,,,,235.7400,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,MEDCOST,MEDCOST VHN,6023.47,,,,,,,235.7400,16367.5500,percent of total billed charges,"47.59% of $12,657.00 in Billed Charges for Rev 481 Proc 33211 = $6,023.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2197.57,,,,,,,235.7400,16367.5500,fee schedule,"APG 00074 Proc 33211 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 100% = $2,092.92... $2,092.92 at 105% = $2,197.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,7883.45,,,,,,,235.7400,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,7883.45,,,,,,,235.7400,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,NHC ADVANTAGE,NHC ADVANTAGE,7883.45,,,,,,,235.7400,16367.5500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2157.80,,,,,,,235.7400,16367.5500,fee schedule,"APG 00074 Proc 33211 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 100% = $2,092.92... $2,092.92 at 103.1% = $2,157.80 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,SENTARA HEALTH,SENTARA HEALTH,3266.77,,,,,,,235.7400,16367.5500,percent of total billed charges,"25.81% of $12,657.00 in Billed Charges for Rev 481 Proc 33211 = $3,266.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,SENTARA HEALTH,SENTARA MEDICARE,7508.05,,,,,,,235.7400,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12657.00,,,,,,,235.7400,16367.5500,percent of total billed charges,"100% of $12,657.00 in Billed Charges for Rev 481 Proc 33211 = $12,657.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,235.7400,16367.5500,case rate,"Rev 481 Proc 33211 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,235.7400,16367.5500,case rate,"Rev 481 Proc 33211 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,235.7400,16367.5500,case rate,"Rev 481 Proc 33211 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,235.7400,16367.5500,case rate,"Rev 481 Proc 33211 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2155.71,,,,,,,235.7400,16367.5500,fee schedule,"APG 00074 Proc 33211 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,7508.05,,,,,,,235.7400,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,7508.05,,,,,,,235.7400,16367.5500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,WELLCARE,WELLCARE MEDICAID,12657.00,,,,,,,235.7400,16367.5500,percent of total billed charges,"100% of $12,657.00 in Billed Charges for Rev 481 Proc 33211 = $12,657.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT TEMP PACEMAKER DUAL,33211,CPT,481,RC,48100005,CDM,,,,both,,,12657.0000,1898.5500,WELLCARE,WELLCARE MEDICARE,7958.53,,,,,,,235.7400,16367.5500,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,AETNA,AETNA,11834.31,,,,,,,434.6800,27715.0000,percent of total billed charges,"42.7% of $27,715.00 in Billed Charges for Rev 481 Proc 33213 = $11,834.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11330.93,,,,,,,434.6800,27715.0000,fee schedule,"APG 00086 Proc 33213 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 104% = $11,330.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,9482.83,,,,,,,434.6800,27715.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,AETNA,AETNA HEALTHCARE MEDICARE,9482.83,,,,,,,434.6800,27715.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,9482.83,,,,,,,434.6800,27715.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,AMBETTER,AMBETTER,20672.57,,,,,,,434.6800,27715.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,9862.14,,,,,,,434.6800,27715.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,BLUE CROSS,ANTHEM EXCHANGE,23347.23,,,,,,,434.6800,27715.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11221.98,,,,,,,434.6800,27715.0000,fee schedule,"APG 00086 Proc 33213 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,BLUE CROSS,ANTHEM HMO,24805.05,,,,,,,434.6800,27715.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,9767.31,,,,,,,434.6800,27715.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",27715.00,,,,,,,434.6800,27715.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,434.68,,,,,,,434.6800,27715.0000,fee schedule,$434.68 from Fee Schedule BLDTM_23 for Rev 481 Proc 33213 * Qty 1 = $434.68 at 100% = $434.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,BLUE CROSS,BLUE CROSS E NETWORK,8571.00,,,,,,,434.6800,27715.0000,case rate,"Rev 481 Proc 33213 ASG Rate of $8,571.00 at 100% of $8,571.00 = $8,571.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,BLUE CROSS,BLUE CROSS MEDICARE,9862.14,,,,,,,434.6800,27715.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,BLUE CROSS,BLUE CROSS P NETWORK,8764.00,,,,,,,434.6800,27715.0000,case rate,"Rev 481 Proc 33213 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,BLUE CROSS,BLUE CROSS S NETWORK,8764.00,,,,,,,434.6800,27715.0000,case rate,"Rev 481 Proc 33213 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,CIGNA HEALTHCARE,CIGNA HMO,11557.16,,,,,,,434.6800,27715.0000,percent of total billed charges,"41.7% of $27,715.00 in Billed Charges for Rev 481 Proc 33213 = $11,557.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12859.76,,,,,,,434.6800,27715.0000,percent of total billed charges,"46.4% of $27,715.00 in Billed Charges for Rev 481 Proc 33213 = $12,859.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,9956.97,,,,,,,434.6800,27715.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11557.16,,,,,,,434.6800,27715.0000,percent of total billed charges,"41.7% of $27,715.00 in Billed Charges for Rev 481 Proc 33213 = $11,557.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,CIGNA HEALTHCARE,CIGNA PPO,11557.16,,,,,,,434.6800,27715.0000,percent of total billed charges,"41.7% of $27,715.00 in Billed Charges for Rev 481 Proc 33213 = $11,557.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,9956.97,,,,,,,434.6800,27715.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,24943.50,,,,,,,434.6800,27715.0000,percent of total billed charges,"90% of $27,715.00 in Billed Charges for Rev 481 Proc 33213 = $24,943.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,HUMANA,HUMANA MEDICARE,9482.83,,,,,,,434.6800,27715.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,9482.83,,,,,,,434.6800,27715.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,MEDCOST,MEDCOST VHN,13189.57,,,,,,,434.6800,27715.0000,percent of total billed charges,"47.59% of $27,715.00 in Billed Charges for Rev 481 Proc 33213 = $13,189.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11439.89,,,,,,,434.6800,27715.0000,fee schedule,"APG 00086 Proc 33213 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 105% = $11,439.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,9956.97,,,,,,,434.6800,27715.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,9956.97,,,,,,,434.6800,27715.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,NHC ADVANTAGE,NHC ADVANTAGE,9956.97,,,,,,,434.6800,27715.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11232.88,,,,,,,434.6800,27715.0000,fee schedule,"APG 00086 Proc 33213 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 103.1% = $11,232.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,SENTARA HEALTH,SENTARA HEALTH,7153.24,,,,,,,434.6800,27715.0000,percent of total billed charges,"25.81% of $27,715.00 in Billed Charges for Rev 481 Proc 33213 = $7,153.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,SENTARA HEALTH,SENTARA MEDICARE,9482.83,,,,,,,434.6800,27715.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",27715.00,,,,,,,434.6800,27715.0000,percent of total billed charges,"100% of $27,715.00 in Billed Charges for Rev 481 Proc 33213 = $27,715.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,434.6800,27715.0000,case rate,"Rev 481 Proc 33213 ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,434.6800,27715.0000,case rate,"Rev 481 Proc 33213 ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,434.6800,27715.0000,case rate,"Rev 481 Proc 33213 ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,20054.00,,,,,,,434.6800,27715.0000,case rate,"Rev 481 Proc 33213 ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11221.98,,,,,,,434.6800,27715.0000,fee schedule,"APG 00086 Proc 33213 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,9482.83,,,,,,,434.6800,27715.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,9482.83,,,,,,,434.6800,27715.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,WELLCARE,WELLCARE MEDICAID,27715.00,,,,,,,434.6800,27715.0000,percent of total billed charges,"100% of $27,715.00 in Billed Charges for Rev 481 Proc 33213 = $27,715.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT / REPLC GENER DUAL,33213,CPT,481,RC,48100007,CDM,,,,both,,,27715.0000,4157.2500,WELLCARE,WELLCARE MEDICARE,10051.80,,,,,,,434.6800,27715.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,AETNA,AETNA,13608.06,,,,,,,498.1900,31869.0000,percent of total billed charges,"42.7% of $31,869.00 in Billed Charges for Rev 481 Proc 33214 = $13,608.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11330.93,,,,,,,498.1900,31869.0000,fee schedule,"APG 00086 Proc 33214 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 104% = $11,330.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,9482.83,,,,,,,498.1900,31869.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,AETNA,AETNA HEALTHCARE MEDICARE,9482.83,,,,,,,498.1900,31869.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,9482.83,,,,,,,498.1900,31869.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,AMBETTER,AMBETTER,20672.57,,,,,,,498.1900,31869.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,9862.14,,,,,,,498.1900,31869.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,BLUE CROSS,ANTHEM EXCHANGE,23347.23,,,,,,,498.1900,31869.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11221.98,,,,,,,498.1900,31869.0000,fee schedule,"APG 00086 Proc 33214 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,BLUE CROSS,ANTHEM HMO,24805.05,,,,,,,498.1900,31869.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,9767.31,,,,,,,498.1900,31869.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",29180.83,,,,,,,498.1900,31869.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,498.19,,,,,,,498.1900,31869.0000,fee schedule,$498.19 from Fee Schedule BLDTM_23 for Rev 481 Proc 33214 * Qty 1 = $498.19 at 100% = $498.19 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,BLUE CROSS,BLUE CROSS E NETWORK,8571.00,,,,,,,498.1900,31869.0000,case rate,"Rev 481 Proc 33214 ASG Rate of $8,571.00 at 100% of $8,571.00 = $8,571.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,BLUE CROSS,BLUE CROSS MEDICARE,9862.14,,,,,,,498.1900,31869.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,BLUE CROSS,BLUE CROSS P NETWORK,8764.00,,,,,,,498.1900,31869.0000,case rate,"Rev 481 Proc 33214 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,BLUE CROSS,BLUE CROSS S NETWORK,8764.00,,,,,,,498.1900,31869.0000,case rate,"Rev 481 Proc 33214 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,CIGNA HEALTHCARE,CIGNA HMO,13289.37,,,,,,,498.1900,31869.0000,percent of total billed charges,"41.7% of $31,869.00 in Billed Charges for Rev 481 Proc 33214 = $13,289.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,14787.22,,,,,,,498.1900,31869.0000,percent of total billed charges,"46.4% of $31,869.00 in Billed Charges for Rev 481 Proc 33214 = $14,787.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,9956.97,,,,,,,498.1900,31869.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,13289.37,,,,,,,498.1900,31869.0000,percent of total billed charges,"41.7% of $31,869.00 in Billed Charges for Rev 481 Proc 33214 = $13,289.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,CIGNA HEALTHCARE,CIGNA PPO,13289.37,,,,,,,498.1900,31869.0000,percent of total billed charges,"41.7% of $31,869.00 in Billed Charges for Rev 481 Proc 33214 = $13,289.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,9956.97,,,,,,,498.1900,31869.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,28682.10,,,,,,,498.1900,31869.0000,percent of total billed charges,"90% of $31,869.00 in Billed Charges for Rev 481 Proc 33214 = $28,682.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,HUMANA,HUMANA MEDICARE,9482.83,,,,,,,498.1900,31869.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,9482.83,,,,,,,498.1900,31869.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,MEDCOST,MEDCOST VHN,15166.46,,,,,,,498.1900,31869.0000,percent of total billed charges,"47.59% of $31,869.00 in Billed Charges for Rev 481 Proc 33214 = $15,166.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11439.89,,,,,,,498.1900,31869.0000,fee schedule,"APG 00086 Proc 33214 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 105% = $11,439.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,9956.97,,,,,,,498.1900,31869.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,9956.97,,,,,,,498.1900,31869.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,NHC ADVANTAGE,NHC ADVANTAGE,9956.97,,,,,,,498.1900,31869.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11232.88,,,,,,,498.1900,31869.0000,fee schedule,"APG 00086 Proc 33214 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 103.1% = $11,232.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,SENTARA HEALTH,SENTARA HEALTH,8225.39,,,,,,,498.1900,31869.0000,percent of total billed charges,"25.81% of $31,869.00 in Billed Charges for Rev 481 Proc 33214 = $8,225.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,SENTARA HEALTH,SENTARA MEDICARE,9482.83,,,,,,,498.1900,31869.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",31869.00,,,,,,,498.1900,31869.0000,percent of total billed charges,"100% of $31,869.00 in Billed Charges for Rev 481 Proc 33214 = $31,869.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,8660.00,,,,,,,498.1900,31869.0000,case rate,"Rev 481 Proc 33214 ASG Rate of $8,660.00 at 100% of $8,660.00 = $8,660.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12800.00,,,,,,,498.1900,31869.0000,case rate,"Rev 481 Proc 33214 ASG Rate of $12,800.00 at 100% of $12,800.00 = $12,800.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,12245.00,,,,,,,498.1900,31869.0000,case rate,"Rev 481 Proc 33214 ASG Rate of $12,245.00 at 100% of $12,245.00 = $12,245.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,20790.00,,,,,,,498.1900,31869.0000,case rate,"Rev 481 Proc 33214 ASG Rate of $20,790.00 at 100% of $20,790.00 = $20,790.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11221.98,,,,,,,498.1900,31869.0000,fee schedule,"APG 00086 Proc 33214 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,9482.83,,,,,,,498.1900,31869.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,9482.83,,,,,,,498.1900,31869.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,WELLCARE,WELLCARE MEDICAID,31869.00,,,,,,,498.1900,31869.0000,percent of total billed charges,"100% of $31,869.00 in Billed Charges for Rev 481 Proc 33214 = $31,869.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSRT BI V LEAD UPGRAD PM / I,33214,CPT,481,RC,48100008,CDM,,,,both,,,31869.0000,4780.3500,WELLCARE,WELLCARE MEDICARE,10051.80,,,,,,,498.1900,31869.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA,5175.67,,,,,,,307.2100,12121.0000,percent of total billed charges,"42.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33215 = $5,175.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2176.64,,,,,,,307.2100,12121.0000,fee schedule,"APG 00074 Proc 33215 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 104% = $2,176.64. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2864.70,,,,,,,307.2100,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA HEALTHCARE MEDICARE,2864.70,,,,,,,307.2100,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,2864.70,,,,,,,307.2100,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,AMBETTER,AMBETTER,6245.05,,,,,,,307.2100,12121.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2979.29,,,,,,,307.2100,12121.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM EXCHANGE,7053.05,,,,,,,307.2100,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2155.71,,,,,,,307.2100,12121.0000,fee schedule,"APG 00074 Proc 33215 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM HMO,7493.45,,,,,,,307.2100,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2950.64,,,,,,,307.2100,12121.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8815.35,,,,,,,307.2100,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,307.21,,,,,,,307.2100,12121.0000,fee schedule,$307.21 from Fee Schedule BLDTM_23 for Rev 481 Proc 33215 * Qty 1 = $307.21 at 100% = $307.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,307.2100,12121.0000,case rate,"Rev 481 Proc 33215 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS MEDICARE,2979.29,,,,,,,307.2100,12121.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,307.2100,12121.0000,case rate,"Rev 481 Proc 33215 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,307.2100,12121.0000,case rate,"Rev 481 Proc 33215 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA HMO,5054.46,,,,,,,307.2100,12121.0000,percent of total billed charges,"41.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33215 = $5,054.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5624.14,,,,,,,307.2100,12121.0000,percent of total billed charges,"46.4% of $12,121.00 in Billed Charges for Rev 481 Proc 33215 = $5,624.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,3007.94,,,,,,,307.2100,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5054.46,,,,,,,307.2100,12121.0000,percent of total billed charges,"41.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33215 = $5,054.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA PPO,5054.46,,,,,,,307.2100,12121.0000,percent of total billed charges,"41.7% of $12,121.00 in Billed Charges for Rev 481 Proc 33215 = $5,054.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3007.94,,,,,,,307.2100,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10908.90,,,,,,,307.2100,12121.0000,percent of total billed charges,"90% of $12,121.00 in Billed Charges for Rev 481 Proc 33215 = $10,908.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,HUMANA,HUMANA MEDICARE,2864.70,,,,,,,307.2100,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2864.70,,,,,,,307.2100,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,MEDCOST,MEDCOST VHN,5768.38,,,,,,,307.2100,12121.0000,percent of total billed charges,"47.59% of $12,121.00 in Billed Charges for Rev 481 Proc 33215 = $5,768.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2197.57,,,,,,,307.2100,12121.0000,fee schedule,"APG 00074 Proc 33215 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 100% = $2,092.92... $2,092.92 at 105% = $2,197.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3007.94,,,,,,,307.2100,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3007.94,,,,,,,307.2100,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,NHC ADVANTAGE,NHC ADVANTAGE,3007.94,,,,,,,307.2100,12121.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2157.80,,,,,,,307.2100,12121.0000,fee schedule,"APG 00074 Proc 33215 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 100% = $2,092.92... $2,092.92 at 103.1% = $2,157.80 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,SENTARA HEALTH,SENTARA HEALTH,3128.43,,,,,,,307.2100,12121.0000,percent of total billed charges,"25.81% of $12,121.00 in Billed Charges for Rev 481 Proc 33215 = $3,128.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,SENTARA HEALTH,SENTARA MEDICARE,2864.70,,,,,,,307.2100,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12121.00,,,,,,,307.2100,12121.0000,percent of total billed charges,"100% of $12,121.00 in Billed Charges for Rev 481 Proc 33215 = $12,121.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,307.2100,12121.0000,case rate,"Rev 481 Proc 33215 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,307.2100,12121.0000,case rate,"Rev 481 Proc 33215 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,307.2100,12121.0000,case rate,"Rev 481 Proc 33215 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,307.2100,12121.0000,case rate,"Rev 481 Proc 33215 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2155.71,,,,,,,307.2100,12121.0000,fee schedule,"APG 00074 Proc 33215 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment) at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2864.70,,,,,,,307.2100,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2864.70,,,,,,,307.2100,12121.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,WELLCARE,WELLCARE MEDICAID,12121.00,,,,,,,307.2100,12121.0000,percent of total billed charges,"100% of $12,121.00 in Billed Charges for Rev 481 Proc 33215 = $12,121.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPOS RT ATR/VENT LEAD PM/ICD,33215,CPT,481,RC,48100009,CDM,,,,both,,,12121.0000,1818.1500,WELLCARE,WELLCARE MEDICARE,3036.58,,,,,,,307.2100,12121.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,AETNA,AETNA,7062.58,,,,,,,370.8500,16540.0000,percent of total billed charges,"42.7% of $16,540.00 in Billed Charges for Rev 481 Proc 33218 = $7,062.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2176.64,,,,,,,370.8500,16540.0000,fee schedule,"APG 00074 Proc 33218 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 104% = $2,176.64. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3390.45,,,,,,,370.8500,16540.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,AETNA,AETNA HEALTHCARE MEDICARE,3390.45,,,,,,,370.8500,16540.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,ALLCARE MEDICARE,ALLCARE MEDICARE,3390.45,,,,,,,370.8500,16540.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,AMBETTER,AMBETTER,7391.18,,,,,,,370.8500,16540.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3526.07,,,,,,,370.8500,16540.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,BLUE CROSS,ANTHEM EXCHANGE,8347.47,,,,,,,370.8500,16540.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2155.71,,,,,,,370.8500,16540.0000,fee schedule,"APG 00074 Proc 33218 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,BLUE CROSS,ANTHEM HMO,8868.69,,,,,,,370.8500,16540.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3492.16,,,,,,,370.8500,16540.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",10433.19,,,,,,,370.8500,16540.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,370.85,,,,,,,370.8500,16540.0000,fee schedule,$370.85 from Fee Schedule BLDTM_23 for Rev 481 Proc 33218 * Qty 1 = $370.85 at 100% = $370.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,370.8500,16540.0000,case rate,"Rev 481 Proc 33218 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,BLUE CROSS,BLUE CROSS MEDICARE,3526.07,,,,,,,370.8500,16540.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,370.8500,16540.0000,case rate,"Rev 481 Proc 33218 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,370.8500,16540.0000,case rate,"Rev 481 Proc 33218 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,CIGNA HEALTHCARE,CIGNA HMO,6897.18,,,,,,,370.8500,16540.0000,percent of total billed charges,"41.7% of $16,540.00 in Billed Charges for Rev 481 Proc 33218 = $6,897.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7674.56,,,,,,,370.8500,16540.0000,percent of total billed charges,"46.4% of $16,540.00 in Billed Charges for Rev 481 Proc 33218 = $7,674.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,CIGNA HEALTHCARE,CIGNA MEDICARE,3559.97,,,,,,,370.8500,16540.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6897.18,,,,,,,370.8500,16540.0000,percent of total billed charges,"41.7% of $16,540.00 in Billed Charges for Rev 481 Proc 33218 = $6,897.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,CIGNA HEALTHCARE,CIGNA PPO,6897.18,,,,,,,370.8500,16540.0000,percent of total billed charges,"41.7% of $16,540.00 in Billed Charges for Rev 481 Proc 33218 = $6,897.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3559.97,,,,,,,370.8500,16540.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,14886.00,,,,,,,370.8500,16540.0000,percent of total billed charges,"90% of $16,540.00 in Billed Charges for Rev 481 Proc 33218 = $14,886.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,HUMANA,HUMANA MEDICARE,3390.45,,,,,,,370.8500,16540.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3390.45,,,,,,,370.8500,16540.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,MEDCOST,MEDCOST VHN,7871.39,,,,,,,370.8500,16540.0000,percent of total billed charges,"47.59% of $16,540.00 in Billed Charges for Rev 481 Proc 33218 = $7,871.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2197.57,,,,,,,370.8500,16540.0000,fee schedule,"APG 00074 Proc 33218 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 105% = $2,197.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3559.97,,,,,,,370.8500,16540.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3559.97,,,,,,,370.8500,16540.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,NHC ADVANTAGE,NHC ADVANTAGE,3559.97,,,,,,,370.8500,16540.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2157.80,,,,,,,370.8500,16540.0000,fee schedule,"APG 00074 Proc 33218 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 100% = $2,092.92... $2,092.92 at 103.1% = $2,157.80 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,SENTARA HEALTH,SENTARA HEALTH,4268.97,,,,,,,370.8500,16540.0000,percent of total billed charges,"25.81% of $16,540.00 in Billed Charges for Rev 481 Proc 33218 = $4,268.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,SENTARA HEALTH,SENTARA MEDICARE,3390.45,,,,,,,370.8500,16540.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",16540.00,,,,,,,370.8500,16540.0000,percent of total billed charges,"100% of $16,540.00 in Billed Charges for Rev 481 Proc 33218 = $16,540.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,370.8500,16540.0000,case rate,"Rev 481 Proc 33218 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,370.8500,16540.0000,case rate,"Rev 481 Proc 33218 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,370.8500,16540.0000,case rate,"Rev 481 Proc 33218 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,370.8500,16540.0000,case rate,"Rev 481 Proc 33218 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2155.71,,,,,,,370.8500,16540.0000,fee schedule,"APG 00074 Proc 33218 at $836.60 (Base Rate) * 2.5017 (Relative Weight) = $2,092.92 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,092.92 at 103% = $2,155.71. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3390.45,,,,,,,370.8500,16540.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3390.45,,,,,,,370.8500,16540.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,WELLCARE,WELLCARE MEDICAID,16540.00,,,,,,,370.8500,16540.0000,percent of total billed charges,"100% of $16,540.00 in Billed Charges for Rev 481 Proc 33218 = $16,540.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REPAIR SGL TV LEAD PM/ICD,33218,CPT,481,RC,48100012,CDM,,,,both,,,16540.0000,2481.0000,WELLCARE,WELLCARE MEDICARE,3593.87,,,,,,,370.8500,16540.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,AETNA,AETNA,11445.31,,,,,,,6290.0000,38096.9000,percent of total billed charges,"42.7% of $26,804.00 in Billed Charges for Rev 481 Proc 33221 = $11,445.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11330.93,,,,,,,6290.0000,38096.9000,fee schedule,"APG 00086 Proc 33221 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 104% = $11,330.93. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,17475.64,,,,,,,6290.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,AETNA,AETNA HEALTHCARE MEDICARE,17475.64,,,,,,,6290.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,17475.64,,,,,,,6290.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,AMBETTER,AMBETTER,38096.90,,,,,,,6290.0000,38096.9000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,18174.67,,,,,,,6290.0000,38096.9000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,BLUE CROSS,ANTHEM EXCHANGE,26804.00,,,,,,,6290.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,11221.98,,,,,,,6290.0000,38096.9000,fee schedule,"APG 00086 Proc 33221 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,BLUE CROSS,ANTHEM HMO,26804.00,,,,,,,6290.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,17999.91,,,,,,,6290.0000,38096.9000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",26804.00,,,,,,,6290.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,18762.80,,,,,,,6290.0000,38096.9000,percent of total billed charges,"Rev 481 Proc 33221 $26,804.00 in Billed Charges at 70% = $18,762.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,BLUE CROSS,BLUE CROSS E NETWORK,11219.00,,,,,,,6290.0000,38096.9000,case rate,"Rev 481 Proc 33221 ASG Rate of $11,219.00 at 100% of $11,219.00 = $11,219.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,BLUE CROSS,BLUE CROSS MEDICARE,18174.67,,,,,,,6290.0000,38096.9000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,BLUE CROSS,BLUE CROSS P NETWORK,11472.00,,,,,,,6290.0000,38096.9000,case rate,"Rev 481 Proc 33221 ASG Rate of $11,472.00 at 100% of $11,472.00 = $11,472.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,BLUE CROSS,BLUE CROSS S NETWORK,11472.00,,,,,,,6290.0000,38096.9000,case rate,"Rev 481 Proc 33221 ASG Rate of $11,472.00 at 100% of $11,472.00 = $11,472.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,CIGNA HEALTHCARE,CIGNA HMO,11177.27,,,,,,,6290.0000,38096.9000,percent of total billed charges,"41.7% of $26,804.00 in Billed Charges for Rev 481 Proc 33221 = $11,177.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,12437.06,,,,,,,6290.0000,38096.9000,percent of total billed charges,"46.4% of $26,804.00 in Billed Charges for Rev 481 Proc 33221 = $12,437.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,18349.42,,,,,,,6290.0000,38096.9000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,11177.27,,,,,,,6290.0000,38096.9000,percent of total billed charges,"41.7% of $26,804.00 in Billed Charges for Rev 481 Proc 33221 = $11,177.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,CIGNA HEALTHCARE,CIGNA PPO,11177.27,,,,,,,6290.0000,38096.9000,percent of total billed charges,"41.7% of $26,804.00 in Billed Charges for Rev 481 Proc 33221 = $11,177.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,18349.42,,,,,,,6290.0000,38096.9000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,24123.60,,,,,,,6290.0000,38096.9000,percent of total billed charges,"90% of $26,804.00 in Billed Charges for Rev 481 Proc 33221 = $24,123.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,HUMANA,HUMANA MEDICARE,17475.64,,,,,,,6290.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,17475.64,,,,,,,6290.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,MEDCOST,MEDCOST VHN,12756.02,,,,,,,6290.0000,38096.9000,percent of total billed charges,"47.59% of $26,804.00 in Billed Charges for Rev 481 Proc 33221 = $12,756.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11439.89,,,,,,,6290.0000,38096.9000,fee schedule,"APG 00086 Proc 33221 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 105% = $11,439.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,18349.42,,,,,,,6290.0000,38096.9000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,18349.42,,,,,,,6290.0000,38096.9000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,NHC ADVANTAGE,NHC ADVANTAGE,18349.42,,,,,,,6290.0000,38096.9000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11232.88,,,,,,,6290.0000,38096.9000,fee schedule,"APG 00086 Proc 33221 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 100% = $10,895.13... $10,895.13 at 103.1% = $11,232.88 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,SENTARA HEALTH,SENTARA HEALTH,6918.11,,,,,,,6290.0000,38096.9000,percent of total billed charges,"25.81% of $26,804.00 in Billed Charges for Rev 481 Proc 33221 = $6,918.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,SENTARA HEALTH,SENTARA MEDICARE,17475.64,,,,,,,6290.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",26804.00,,,,,,,6290.0000,38096.9000,percent of total billed charges,"100% of $26,804.00 in Billed Charges for Rev 481 Proc 33221 = $26,804.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,6290.0000,38096.9000,case rate,"Rev 481 Proc 33221 ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,6290.0000,38096.9000,case rate,"Rev 481 Proc 33221 ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,6290.0000,38096.9000,case rate,"Rev 481 Proc 33221 ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,20054.00,,,,,,,6290.0000,38096.9000,case rate,"Rev 481 Proc 33221 ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11221.98,,,,,,,6290.0000,38096.9000,fee schedule,"APG 00086 Proc 33221 at $836.60 (Base Rate) * 13.0231 (Relative Weight) = $10,895.13 (Total Line Payment) at 103% = $11,221.98. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,17475.64,,,,,,,6290.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,17475.64,,,,,,,6290.0000,38096.9000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,WELLCARE,WELLCARE MEDICAID,26804.00,,,,,,,6290.0000,38096.9000,percent of total billed charges,"100% of $26,804.00 in Billed Charges for Rev 481 Proc 33221 = $26,804.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT PULSE GEN MULT LEADS,33221,CPT,481,RC,48100014,CDM,,,,both,,,26804.0000,4020.6000,WELLCARE,WELLCARE MEDICARE,18524.18,,,,,,,6290.0000,38096.9000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,AETNA,AETNA,3147.84,,,,,,,775.0000,7372.0000,percent of total billed charges,"42.7% of $7,372.00 in Billed Charges for Rev 361 Proc 50694 = $3,147.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,4192.84,,,,,,,775.0000,7372.0000,fee schedule,"APG 00171 Proc 50694 at $836.60 (Base Rate) * 4.819 (Relative Weight) = $4,031.58 (Total Line Payment) at 104% = $4,192.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,3198.13,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,AETNA,AETNA HEALTHCARE MEDICARE,3198.13,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,3198.13,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,AMBETTER,AMBETTER,6971.91,,,,,,,775.0000,7372.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,3326.05,,,,,,,775.0000,7372.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,ANTHEM EXCHANGE,7372.00,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,4152.52,,,,,,,775.0000,7372.0000,fee schedule,"APG 00171 Proc 50694 at $836.60 (Base Rate) * 4.819 (Relative Weight) = $4,031.58 (Total Line Payment) at 103% = $4,152.52. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,ANTHEM HMO,7372.00,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,3294.07,,,,,,,775.0000,7372.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",7372.00,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 50694 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,BLUE CROSS E NETWORK,3993.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 50694 ASG Rate of $3,993.00 at 100% of $3,993.00 = $3,993.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,BLUE CROSS MEDICARE,3326.05,,,,,,,775.0000,7372.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,BLUE CROSS P NETWORK,4082.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 50694 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,BLUE CROSS S NETWORK,4082.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 50694 ASG Rate of $4,082.00 at 100% of $4,082.00 = $4,082.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,TENNCARE BLUE CARE,775.00,,,,,,,775.0000,7372.0000,case rate,Rev 361 Proc 50694 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,BLUE CROSS,TENNCARE BLUE SELECT,775.00,,,,,,,775.0000,7372.0000,case rate,Rev 361 Proc 50694 ASG Rate of $775.00 at 100% of $775.00 = $775.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,CIGNA HEALTHCARE,CIGNA HMO,7372.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 50694 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total (Limited to $7,372.00 in Billed Charges - $0.00 in ASG Allowed Amount = $7,372.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6048.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 50694 ASG Rate of $6,048.00 at 100% of $6,048.00 = $6,048.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,3358.03,,,,,,,775.0000,7372.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7372.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 50694 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total (Limited to $7,372.00 in Billed Charges - $0.00 in ASG Allowed Amount = $7,372.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,CIGNA HEALTHCARE,CIGNA PPO,7372.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 50694 ASG Rate of $8,003.00 at 100% of $8,003.00 = $8,003.00 Total (Limited to $7,372.00 in Billed Charges - $0.00 in ASG Allowed Amount = $7,372.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3358.03,,,,,,,775.0000,7372.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6634.80,,,,,,,775.0000,7372.0000,percent of total billed charges,"90% of $7,372.00 in Billed Charges for Rev 361 Proc 50694 = $6,634.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,HUMANA,HUMANA MEDICARE,3198.13,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,3198.13,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,MEDCOST,MEDCOST VHN,3508.33,,,,,,,775.0000,7372.0000,percent of total billed charges,"47.59% of $7,372.00 in Billed Charges for Rev 361 Proc 50694 = $3,508.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,4233.16,,,,,,,775.0000,7372.0000,fee schedule,"APG 00171 Proc 50694 at $836.60 (Base Rate) * 4.819 (Relative Weight) = $4,031.58 (Total Line Payment) at 100% = $4,031.58... $4,031.58 at 105% = $4,233.16 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3358.03,,,,,,,775.0000,7372.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3358.03,,,,,,,775.0000,7372.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,NHC ADVANTAGE,NHC ADVANTAGE,3358.03,,,,,,,775.0000,7372.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,4156.56,,,,,,,775.0000,7372.0000,fee schedule,"APG 00171 Proc 50694 at $836.60 (Base Rate) * 4.819 (Relative Weight) = $4,031.58 (Total Line Payment) at 100% = $4,031.58... $4,031.58 at 103.1% = $4,156.56 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,SENTARA HEALTH,SENTARA HEALTH,1902.71,,,,,,,775.0000,7372.0000,percent of total billed charges,"25.81% of $7,372.00 in Billed Charges for Rev 361 Proc 50694 = $1,902.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,SENTARA HEALTH,SENTARA MEDICARE,3198.13,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7372.00,,,,,,,775.0000,7372.0000,percent of total billed charges,"100% of $7,372.00 in Billed Charges for Rev 361 Proc 50694 = $7,372.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1881.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 50694 ASG Rate of $1,881.00 at 100% of $1,881.00 = $1,881.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3488.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 50694 ASG Rate of $3,488.00 at 100% of $3,488.00 = $3,488.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,3336.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 50694 ASG Rate of $3,336.00 at 100% of $3,336.00 = $3,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,5883.00,,,,,,,775.0000,7372.0000,case rate,"Rev 361 Proc 50694 ASG Rate of $5,883.00 at 100% of $5,883.00 = $5,883.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,4152.52,,,,,,,775.0000,7372.0000,fee schedule,"APG 00171 Proc 50694 at $836.60 (Base Rate) * 4.819 (Relative Weight) = $4,031.58 (Total Line Payment) at 103% = $4,152.52. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,3198.13,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,3198.13,,,,,,,775.0000,7372.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,WELLCARE,WELLCARE MEDICAID,7372.00,,,,,,,775.0000,7372.0000,percent of total billed charges,"100% of $7,372.00 in Billed Charges for Rev 361 Proc 50694 = $7,372.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PLACE URETERAL STENT PERCU INCL IMG NEW ACCESS WO NEPHROSTOMY CATH,50694,CPT,361,RC,36100318,CDM,,,,both,,,7372.0000,1105.8000,WELLCARE,WELLCARE MEDICARE,3390.01,,,,,,,775.0000,7372.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,AETNA,AETNA,535.03,,,,,,,81.6700,2121.4900,percent of total billed charges,"42.7% of $1,253.00 in Billed Charges for Rev 370 Proc 64415 = $535.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2101.29,,,,,,,81.6700,2121.4900,fee schedule,"APG 00220 Proc 64415 at $836.60 (Base Rate) * 2.4151 (Relative Weight) = $2,020.47 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,020.47 at 104% = $2,101.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,802.46,,,,,,,81.6700,2121.4900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,AETNA,AETNA HEALTHCARE MEDICARE,802.46,,,,,,,81.6700,2121.4900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,802.46,,,,,,,81.6700,2121.4900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,AMBETTER,AMBETTER,1749.36,,,,,,,81.6700,2121.4900,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,834.56,,,,,,,81.6700,2121.4900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,BLUE CROSS,ANTHEM EXCHANGE,1253.00,,,,,,,81.6700,2121.4900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1253.00,,,,,,,81.6700,2121.4900,fee schedule,"APG 00220 Proc 64415 at $836.60 (Base Rate) * 2.4151 (Relative Weight) = $2,020.47 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,020.47 at 103% = $2,081.09 (Service Line reduced to $1,253.00, claim capped at $1,253.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,BLUE CROSS,ANTHEM HMO,1253.00,,,,,,,81.6700,2121.4900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,826.53,,,,,,,81.6700,2121.4900,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1253.00,,,,,,,81.6700,2121.4900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,81.67,,,,,,,81.6700,2121.4900,fee schedule,$81.67 from Fee Schedule BLDTM_23 for Rev 370 Proc 64415 * Qty 1 = $81.67 at 100% = $81.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,BLUE CROSS,BLUE CROSS MEDICARE,834.56,,,,,,,81.6700,2121.4900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,CIGNA HEALTHCARE,CIGNA HMO,522.50,,,,,,,81.6700,2121.4900,percent of total billed charges,"41.7% of $1,253.00 in Billed Charges for Rev 370 Proc 64415 = $522.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,581.39,,,,,,,81.6700,2121.4900,percent of total billed charges,"46.4% of $1,253.00 in Billed Charges for Rev 370 Proc 64415 = $581.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,842.58,,,,,,,81.6700,2121.4900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,522.50,,,,,,,81.6700,2121.4900,percent of total billed charges,"41.7% of $1,253.00 in Billed Charges for Rev 370 Proc 64415 = $522.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,CIGNA HEALTHCARE,CIGNA PPO,522.50,,,,,,,81.6700,2121.4900,percent of total billed charges,"41.7% of $1,253.00 in Billed Charges for Rev 370 Proc 64415 = $522.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,842.58,,,,,,,81.6700,2121.4900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1127.70,,,,,,,81.6700,2121.4900,percent of total billed charges,"90% of $1,253.00 in Billed Charges for Rev 370 Proc 64415 = $1,127.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,HUMANA,HUMANA MEDICARE,802.46,,,,,,,81.6700,2121.4900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,802.46,,,,,,,81.6700,2121.4900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,MEDCOST,MEDCOST VHN,596.30,,,,,,,81.6700,2121.4900,percent of total billed charges,"47.59% of $1,253.00 in Billed Charges for Rev 370 Proc 64415 = $596.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2121.49,,,,,,,81.6700,2121.4900,fee schedule,"APG 00220 Proc 64415 at $836.60 (Base Rate) * 2.4151 (Relative Weight) = $2,020.47 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,020.47 at 100% = $2,020.47... $2,020.47 at 105% = $2,121.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,842.58,,,,,,,81.6700,2121.4900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,842.58,,,,,,,81.6700,2121.4900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,NHC ADVANTAGE,NHC ADVANTAGE,842.58,,,,,,,81.6700,2121.4900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2083.10,,,,,,,81.6700,2121.4900,fee schedule,"APG 00220 Proc 64415 at $836.60 (Base Rate) * 2.4151 (Relative Weight) = $2,020.47 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,020.47 at 100% = $2,020.47... $2,020.47 at 103.1% = $2,083.10 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,SENTARA HEALTH,SENTARA HEALTH,323.40,,,,,,,81.6700,2121.4900,percent of total billed charges,"25.81% of $1,253.00 in Billed Charges for Rev 370 Proc 64415 = $323.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,SENTARA HEALTH,SENTARA MEDICARE,802.46,,,,,,,81.6700,2121.4900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1253.00,,,,,,,81.6700,2121.4900,percent of total billed charges,"100% of $1,253.00 in Billed Charges for Rev 370 Proc 64415 = $1,253.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,186.38,,,,,,,81.6700,2121.4900,fee schedule,$372.76 from Fee Schedule TCUHC24 for Rev 370 Proc 64415 * Qty 1 = $372.76 at 50% = $186.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,404.72,,,,,,,81.6700,2121.4900,other,"32.3% of $1,253.00 in Billed Charges for Rev 370 Proc 64415 = $404.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,384.67,,,,,,,81.6700,2121.4900,other,"30.7% of $1,253.00 in Billed Charges for Rev 370 Proc 64415 = $384.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,404.72,,,,,,,81.6700,2121.4900,percent of total billed charges,"32.3% of $1,253.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2081.09,,,,,,,81.6700,2121.4900,fee schedule,"APG 00220 Proc 64415 at $836.60 (Base Rate) * 2.4151 (Relative Weight) = $2,020.47 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,020.47 at 103% = $2,081.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,802.46,,,,,,,81.6700,2121.4900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,802.46,,,,,,,81.6700,2121.4900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,WELLCARE,WELLCARE MEDICAID,1253.00,,,,,,,81.6700,2121.4900,percent of total billed charges,"100% of $1,253.00 in Billed Charges for Rev 370 Proc 64415 = $1,253.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES AGNT BRACHIAL PLEXUS SNG,64415,CPT,370,RC,37000003,CDM,,,,both,,,1253.0000,187.9500,WELLCARE,WELLCARE MEDICARE,850.61,,,,,,,81.6700,2121.4900,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,AETNA,AETNA,849.73,,,,,,,40.8100,1990.0000,percent of total billed charges,"42.7% of $1,990.00 in Billed Charges for Rev 361 Proc 64420 = $849.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,574.07,,,,,,,40.8100,1990.0000,fee schedule,"APG 00214 Proc 64420 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 104% = $574.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,640.43,,,,,,,40.8100,1990.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,AETNA,AETNA HEALTHCARE MEDICARE,640.43,,,,,,,40.8100,1990.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,640.43,,,,,,,40.8100,1990.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,AMBETTER,AMBETTER,1396.13,,,,,,,40.8100,1990.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,666.04,,,,,,,40.8100,1990.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,ANTHEM EXCHANGE,1576.77,,,,,,,40.8100,1990.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,568.55,,,,,,,40.8100,1990.0000,fee schedule,"APG 00214 Proc 64420 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 103% = $568.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,ANTHEM HMO,1675.23,,,,,,,40.8100,1990.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,659.64,,,,,,,40.8100,1990.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1970.75,,,,,,,40.8100,1990.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,40.8100,1990.0000,case rate,Rev 361 Proc 64420 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,40.8100,1990.0000,case rate,Rev 361 Proc 64420 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,BLUE CROSS MEDICARE,666.04,,,,,,,40.8100,1990.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,40.8100,1990.0000,case rate,Rev 361 Proc 64420 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,40.8100,1990.0000,case rate,Rev 361 Proc 64420 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,TENNCARE BLUE CARE,40.81,,,,,,,40.8100,1990.0000,fee schedule,$35.18 from Fee Schedule TC_24 for Rev 361 Proc 64420 * Qty 1 = $35.18 at 116% = $40.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,TENNCARE BLUE SELECT,40.81,,,,,,,40.8100,1990.0000,fee schedule,$35.18 from Fee Schedule TC_24 for Rev 361 Proc 64420 * Qty 1 = $35.18 at 116% = $40.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,CIGNA HEALTHCARE,CIGNA HMO,1932.00,,,,,,,40.8100,1990.0000,case rate,"Rev 361 Proc 64420 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.00,,,,,,,40.8100,1990.0000,case rate,"Rev 361 Proc 64420 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,672.45,,,,,,,40.8100,1990.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1932.00,,,,,,,40.8100,1990.0000,case rate,"Rev 361 Proc 64420 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,CIGNA HEALTHCARE,CIGNA PPO,1932.00,,,,,,,40.8100,1990.0000,case rate,"Rev 361 Proc 64420 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,672.45,,,,,,,40.8100,1990.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1791.00,,,,,,,40.8100,1990.0000,percent of total billed charges,"90% of $1,990.00 in Billed Charges for Rev 361 Proc 64420 = $1,791.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,HUMANA,HUMANA MEDICARE,640.43,,,,,,,40.8100,1990.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,640.43,,,,,,,40.8100,1990.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,MEDCOST,MEDCOST VHN,947.04,,,,,,,40.8100,1990.0000,percent of total billed charges,"47.59% of $1,990.00 in Billed Charges for Rev 361 Proc 64420 = $947.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,579.59,,,,,,,40.8100,1990.0000,fee schedule,"APG 00214 Proc 64420 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 100% = $551.99... $551.99 at 105% = $579.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,672.45,,,,,,,40.8100,1990.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,672.45,,,,,,,40.8100,1990.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,NHC ADVANTAGE,NHC ADVANTAGE,672.45,,,,,,,40.8100,1990.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,569.10,,,,,,,40.8100,1990.0000,fee schedule,"APG 00214 Proc 64420 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 100% = $551.99... $551.99 at 103.1% = $569.10 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,SENTARA HEALTH,SENTARA HEALTH,513.62,,,,,,,40.8100,1990.0000,percent of total billed charges,"25.81% of $1,990.00 in Billed Charges for Rev 361 Proc 64420 = $513.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,SENTARA HEALTH,SENTARA MEDICARE,640.43,,,,,,,40.8100,1990.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1990.00,,,,,,,40.8100,1990.0000,percent of total billed charges,"100% of $1,990.00 in Billed Charges for Rev 361 Proc 64420 = $1,990.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,40.8100,1990.0000,case rate,Rev 361 Proc 64420 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,40.8100,1990.0000,case rate,Rev 361 Proc 64420 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,40.8100,1990.0000,case rate,Rev 361 Proc 64420 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,40.8100,1990.0000,case rate,"Rev 361 Proc 64420 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,568.55,,,,,,,40.8100,1990.0000,fee schedule,"APG 00214 Proc 64420 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 103% = $568.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,640.43,,,,,,,40.8100,1990.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,640.43,,,,,,,40.8100,1990.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,WELLCARE,WELLCARE MEDICAID,1990.00,,,,,,,40.8100,1990.0000,percent of total billed charges,"100% of $1,990.00 in Billed Charges for Rev 361 Proc 64420 = $1,990.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID NERV BLCK INTERCOSTAL SNGL LVL,64420,CPT,361,RC,36100401,CDM,,,,both,,,1990.0000,298.5000,WELLCARE,WELLCARE MEDICARE,678.85,,,,,,,40.8100,1990.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE OM 8075,272,RC,,,,,,,,both,,,3324.8400,498.7300,AETNA,AETNA,1419.71,,,,,,,858.1400,3324.8400,percent of total billed charges,"42.7% of $3,324.84 in Billed Charges for Rev 272 = $1,419.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE OM 8075,272,RC,,,,,,,,both,,,3324.8400,498.7300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2327.39,,,,,,,858.1400,3324.8400,percent of total billed charges,"Rev 272 $3,324.84 in Billed Charges at 70% = $2,327.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE OM 8075,272,RC,,,,,,,,both,,,3324.8400,498.7300,CIGNA HEALTHCARE,CIGNA HMO,1386.46,,,,,,,858.1400,3324.8400,percent of total billed charges,"41.7% of $3,324.84 in Billed Charges for Rev 272 = $1,386.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE OM 8075,272,RC,,,,,,,,both,,,3324.8400,498.7300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1542.73,,,,,,,858.1400,3324.8400,percent of total billed charges,"46.4% of $3,324.84 in Billed Charges for Rev 272 = $1,542.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE OM 8075,272,RC,,,,,,,,both,,,3324.8400,498.7300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1386.46,,,,,,,858.1400,3324.8400,percent of total billed charges,"41.7% of $3,324.84 in Billed Charges for Rev 272 = $1,386.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE OM 8075,272,RC,,,,,,,,both,,,3324.8400,498.7300,CIGNA HEALTHCARE,CIGNA PPO,1386.46,,,,,,,858.1400,3324.8400,percent of total billed charges,"41.7% of $3,324.84 in Billed Charges for Rev 272 = $1,386.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE OM 8075,272,RC,,,,,,,,both,,,3324.8400,498.7300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2992.36,,,,,,,858.1400,3324.8400,percent of total billed charges,"90% of $3,324.84 in Billed Charges for Rev 272 = $2,992.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE OM 8075,272,RC,,,,,,,,both,,,3324.8400,498.7300,MEDCOST,MEDCOST VHN,1582.29,,,,,,,858.1400,3324.8400,percent of total billed charges,"47.59% of $3,324.84 in Billed Charges for Rev 272 = $1,582.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE OM 8075,272,RC,,,,,,,,both,,,3324.8400,498.7300,SENTARA HEALTH,SENTARA HEALTH,858.14,,,,,,,858.1400,3324.8400,percent of total billed charges,"25.81% of $3,324.84 in Billed Charges for Rev 272 = $858.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE OM 8075,272,RC,,,,,,,,both,,,3324.8400,498.7300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3324.84,,,,,,,858.1400,3324.8400,percent of total billed charges,"100% of $3,324.84 in Billed Charges for Rev 272 = $3,324.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE OM 8075,272,RC,,,,,,,,both,,,3324.8400,498.7300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1662.42,,,,,,,858.1400,3324.8400,percent of total billed charges,"Rev 272 $3,324.84 in Billed Charges at 50% = $1,662.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE OM 8075,272,RC,,,,,,,,both,,,3324.8400,498.7300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1073.92,,,,,,,858.1400,3324.8400,other,"32.3% of $3,324.84 in Billed Charges for Rev 272 = $1,073.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE OM 8075,272,RC,,,,,,,,both,,,3324.8400,498.7300,UNITED HEALTHCARE,UHC HERITAGE SELECT,1020.73,,,,,,,858.1400,3324.8400,other,"30.7% of $3,324.84 in Billed Charges for Rev 272 = $1,020.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE OM 8075,272,RC,,,,,,,,both,,,3324.8400,498.7300,UNITED HEALTHCARE,UNITED HEALTHCARE,1073.92,,,,,,,858.1400,3324.8400,percent of total billed charges,"32.3% of $3,324.84 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE OM 8075,272,RC,,,,,,,,both,,,3324.8400,498.7300,WELLCARE,WELLCARE MEDICAID,3324.84,,,,,,,858.1400,3324.8400,percent of total billed charges,"100% of $3,324.84 in Billed Charges for Rev 272 = $3,324.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,AETNA,AETNA,892.43,,,,,,,98.9900,2090.0000,percent of total billed charges,"42.7% of $2,090.00 in Billed Charges for Rev 450 Proc 64425 = $892.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,574.07,,,,,,,98.9900,2090.0000,fee schedule,"APG 00214 Proc 64425 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 104% = $574.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,640.43,,,,,,,98.9900,2090.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,AETNA,AETNA HEALTHCARE MEDICARE,640.43,,,,,,,98.9900,2090.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,640.43,,,,,,,98.9900,2090.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,AMBETTER,AMBETTER,1396.13,,,,,,,98.9900,2090.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,666.04,,,,,,,98.9900,2090.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,BLUE CROSS,ANTHEM EXCHANGE,1576.77,,,,,,,98.9900,2090.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,568.55,,,,,,,98.9900,2090.0000,fee schedule,"APG 00214 Proc 64425 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 103% = $568.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,BLUE CROSS,ANTHEM HMO,1675.23,,,,,,,98.9900,2090.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,659.64,,,,,,,98.9900,2090.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1970.75,,,,,,,98.9900,2090.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,98.99,,,,,,,98.9900,2090.0000,fee schedule,$98.99 from Fee Schedule BLDTM_23 for Rev 450 Proc 64425 * Qty 1 = $98.99 at 100% = $98.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,BLUE CROSS,BLUE CROSS MEDICARE,666.04,,,,,,,98.9900,2090.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,672.45,,,,,,,98.9900,2090.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,672.45,,,,,,,98.9900,2090.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1881.00,,,,,,,98.9900,2090.0000,percent of total billed charges,"90% of $2,090.00 in Billed Charges for Rev 450 Proc 64425 = $1,881.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,HUMANA,HUMANA MEDICARE,640.43,,,,,,,98.9900,2090.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,640.43,,,,,,,98.9900,2090.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,MEDCOST,MEDCOST VHN,994.63,,,,,,,98.9900,2090.0000,percent of total billed charges,"47.59% of $2,090.00 in Billed Charges for Rev 450 Proc 64425 = $994.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,579.59,,,,,,,98.9900,2090.0000,fee schedule,"APG 00214 Proc 64425 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 100% = $551.99... $551.99 at 105% = $579.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,672.45,,,,,,,98.9900,2090.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,672.45,,,,,,,98.9900,2090.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,NHC ADVANTAGE,NHC ADVANTAGE,672.45,,,,,,,98.9900,2090.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,569.10,,,,,,,98.9900,2090.0000,fee schedule,"APG 00214 Proc 64425 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 100% = $551.99... $551.99 at 103.1% = $569.10 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,SENTARA HEALTH,SENTARA HEALTH,539.43,,,,,,,98.9900,2090.0000,percent of total billed charges,"25.81% of $2,090.00 in Billed Charges for Rev 450 Proc 64425 = $539.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,SENTARA HEALTH,SENTARA MEDICARE,640.43,,,,,,,98.9900,2090.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2090.00,,,,,,,98.9900,2090.0000,percent of total billed charges,"100% of $2,090.00 in Billed Charges for Rev 450 Proc 64425 = $2,090.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,98.9900,2090.0000,case rate,Rev 450 Proc 64425 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,98.9900,2090.0000,case rate,Rev 450 Proc 64425 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,98.9900,2090.0000,case rate,Rev 450 Proc 64425 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,98.9900,2090.0000,case rate,Rev 450 Proc 64425 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,568.55,,,,,,,98.9900,2090.0000,fee schedule,"APG 00214 Proc 64425 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 103% = $568.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,640.43,,,,,,,98.9900,2090.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,640.43,,,,,,,98.9900,2090.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,WELLCARE,WELLCARE MEDICAID,2090.00,,,,,,,98.9900,2090.0000,percent of total billed charges,"100% of $2,090.00 in Billed Charges for Rev 450 Proc 64425 = $2,090.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID ILIOINGUINAL ILIOHYPOGASTRIC NERVES,64425,CPT,450,RC,45000332,CDM,,,,both,,,2090.0000,313.5000,WELLCARE,WELLCARE MEDICARE,678.85,,,,,,,98.9900,2090.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,AETNA,AETNA,849.73,,,,,,,98.0000,2121.4900,percent of total billed charges,"42.7% of $1,990.00 in Billed Charges for Rev 510 Proc 64430 = $849.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2101.29,,,,,,,98.0000,2121.4900,fee schedule,"APG 00220 Proc 64430 at $836.60 (Base Rate) * 2.4151 (Relative Weight) = $2,020.47 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,020.47 at 104% = $2,101.29. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,802.46,,,,,,,98.0000,2121.4900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,AETNA,AETNA HEALTHCARE MEDICARE,802.46,,,,,,,98.0000,2121.4900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,802.46,,,,,,,98.0000,2121.4900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,AMBETTER,AMBETTER,1749.36,,,,,,,98.0000,2121.4900,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,834.56,,,,,,,98.0000,2121.4900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,ANTHEM EXCHANGE,1975.70,,,,,,,98.0000,2121.4900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1990.00,,,,,,,98.0000,2121.4900,fee schedule,"APG 00220 Proc 64430 at $836.60 (Base Rate) * 2.4151 (Relative Weight) = $2,020.47 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,020.47 at 103% = $2,081.09 (Service Line reduced to $1,990.00, claim capped at $1,990.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,ANTHEM HMO,1990.00,,,,,,,98.0000,2121.4900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,826.53,,,,,,,98.0000,2121.4900,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1990.00,,,,,,,98.0000,2121.4900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,98.00,,,,,,,98.0000,2121.4900,fee schedule,$98.00 from Fee Schedule BLDTM_23 for Rev 510 Proc 64430 * Qty 1 = $98.00 at 100% = $98.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,BLUE CROSS MEDICARE,834.56,,,,,,,98.0000,2121.4900,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,CIGNA HEALTHCARE,CIGNA HMO,829.83,,,,,,,98.0000,2121.4900,percent of total billed charges,"41.7% of $1,990.00 in Billed Charges for Rev 510 Proc 64430 = $829.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,923.36,,,,,,,98.0000,2121.4900,percent of total billed charges,"46.4% of $1,990.00 in Billed Charges for Rev 510 Proc 64430 = $923.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,842.58,,,,,,,98.0000,2121.4900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,829.83,,,,,,,98.0000,2121.4900,percent of total billed charges,"41.7% of $1,990.00 in Billed Charges for Rev 510 Proc 64430 = $829.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,CIGNA HEALTHCARE,CIGNA PPO,829.83,,,,,,,98.0000,2121.4900,percent of total billed charges,"41.7% of $1,990.00 in Billed Charges for Rev 510 Proc 64430 = $829.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,842.58,,,,,,,98.0000,2121.4900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1791.00,,,,,,,98.0000,2121.4900,percent of total billed charges,"90% of $1,990.00 in Billed Charges for Rev 510 Proc 64430 = $1,791.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,HUMANA,HUMANA MEDICARE,802.46,,,,,,,98.0000,2121.4900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,802.46,,,,,,,98.0000,2121.4900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,MEDCOST,MEDCOST VHN,947.04,,,,,,,98.0000,2121.4900,percent of total billed charges,"47.59% of $1,990.00 in Billed Charges for Rev 510 Proc 64430 = $947.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2121.49,,,,,,,98.0000,2121.4900,fee schedule,"APG 00220 Proc 64430 at $836.60 (Base Rate) * 2.4151 (Relative Weight) = $2,020.47 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,020.47 at 100% = $2,020.47... $2,020.47 at 105% = $2,121.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,842.58,,,,,,,98.0000,2121.4900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,842.58,,,,,,,98.0000,2121.4900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,NHC ADVANTAGE,NHC ADVANTAGE,842.58,,,,,,,98.0000,2121.4900,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2083.10,,,,,,,98.0000,2121.4900,fee schedule,"APG 00220 Proc 64430 at $836.60 (Base Rate) * 2.4151 (Relative Weight) = $2,020.47 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,020.47 at 100% = $2,020.47... $2,020.47 at 103.1% = $2,083.10 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,SENTARA HEALTH,SENTARA HEALTH,513.62,,,,,,,98.0000,2121.4900,percent of total billed charges,"25.81% of $1,990.00 in Billed Charges for Rev 510 Proc 64430 = $513.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,SENTARA HEALTH,SENTARA MEDICARE,802.46,,,,,,,98.0000,2121.4900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1990.00,,,,,,,98.0000,2121.4900,percent of total billed charges,"100% of $1,990.00 in Billed Charges for Rev 510 Proc 64430 = $1,990.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,336.03,,,,,,,98.0000,2121.4900,fee schedule,$672.06 from Fee Schedule TCUHC24 for Rev 510 Proc 64430 * Qty 1 = $672.06 at 50% = $336.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,642.77,,,,,,,98.0000,2121.4900,other,"32.3% of $1,990.00 in Billed Charges for Rev 510 Proc 64430 = $642.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,610.93,,,,,,,98.0000,2121.4900,other,"30.7% of $1,990.00 in Billed Charges for Rev 510 Proc 64430 = $610.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,642.77,,,,,,,98.0000,2121.4900,percent of total billed charges,"32.3% of $1,990.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2081.09,,,,,,,98.0000,2121.4900,fee schedule,"APG 00220 Proc 64430 at $836.60 (Base Rate) * 2.4151 (Relative Weight) = $2,020.47 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $2,020.47 at 103% = $2,081.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,802.46,,,,,,,98.0000,2121.4900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,802.46,,,,,,,98.0000,2121.4900,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,WELLCARE,WELLCARE MEDICAID,1990.00,,,,,,,98.0000,2121.4900,percent of total billed charges,"100% of $1,990.00 in Billed Charges for Rev 510 Proc 64430 = $1,990.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID AGENT PUDENDAL NERVE,64430,CPT,510,RC,51000213,CDM,,,,both,,,1990.0000,298.5000,WELLCARE,WELLCARE MEDICARE,850.61,,,,,,,98.0000,2121.4900,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,AETNA,AETNA,849.73,,,,,,,92.2500,1990.0000,percent of total billed charges,"42.7% of $1,990.00 in Billed Charges for Rev 370 Proc 64445 = $849.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,574.07,,,,,,,92.2500,1990.0000,fee schedule,"APG 00214 Proc 64445 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 104% = $574.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,640.43,,,,,,,92.2500,1990.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,AETNA,AETNA HEALTHCARE MEDICARE,640.43,,,,,,,92.2500,1990.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,640.43,,,,,,,92.2500,1990.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,AMBETTER,AMBETTER,1396.13,,,,,,,92.2500,1990.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,666.04,,,,,,,92.2500,1990.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,ANTHEM EXCHANGE,1576.77,,,,,,,92.2500,1990.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,568.55,,,,,,,92.2500,1990.0000,fee schedule,"APG 00214 Proc 64445 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 103% = $568.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,ANTHEM HMO,1675.23,,,,,,,92.2500,1990.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,659.64,,,,,,,92.2500,1990.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1970.75,,,,,,,92.2500,1990.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,92.25,,,,,,,92.2500,1990.0000,fee schedule,$92.25 from Fee Schedule BLDTM_23 for Rev 370 Proc 64445 * Qty 1 = $92.25 at 100% = $92.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,BLUE CROSS,BLUE CROSS MEDICARE,666.04,,,,,,,92.2500,1990.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,CIGNA HEALTHCARE,CIGNA HMO,829.83,,,,,,,92.2500,1990.0000,percent of total billed charges,"41.7% of $1,990.00 in Billed Charges for Rev 370 Proc 64445 = $829.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,923.36,,,,,,,92.2500,1990.0000,percent of total billed charges,"46.4% of $1,990.00 in Billed Charges for Rev 370 Proc 64445 = $923.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,672.45,,,,,,,92.2500,1990.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,829.83,,,,,,,92.2500,1990.0000,percent of total billed charges,"41.7% of $1,990.00 in Billed Charges for Rev 370 Proc 64445 = $829.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,CIGNA HEALTHCARE,CIGNA PPO,829.83,,,,,,,92.2500,1990.0000,percent of total billed charges,"41.7% of $1,990.00 in Billed Charges for Rev 370 Proc 64445 = $829.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,672.45,,,,,,,92.2500,1990.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1791.00,,,,,,,92.2500,1990.0000,percent of total billed charges,"90% of $1,990.00 in Billed Charges for Rev 370 Proc 64445 = $1,791.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,HUMANA,HUMANA MEDICARE,640.43,,,,,,,92.2500,1990.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,640.43,,,,,,,92.2500,1990.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,MEDCOST,MEDCOST VHN,947.04,,,,,,,92.2500,1990.0000,percent of total billed charges,"47.59% of $1,990.00 in Billed Charges for Rev 370 Proc 64445 = $947.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,579.59,,,,,,,92.2500,1990.0000,fee schedule,"APG 00214 Proc 64445 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 100% = $551.99... $551.99 at 105% = $579.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,672.45,,,,,,,92.2500,1990.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,672.45,,,,,,,92.2500,1990.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,NHC ADVANTAGE,NHC ADVANTAGE,672.45,,,,,,,92.2500,1990.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,569.10,,,,,,,92.2500,1990.0000,fee schedule,"APG 00214 Proc 64445 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 100% = $551.99... $551.99 at 103.1% = $569.10 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,SENTARA HEALTH,SENTARA HEALTH,513.62,,,,,,,92.2500,1990.0000,percent of total billed charges,"25.81% of $1,990.00 in Billed Charges for Rev 370 Proc 64445 = $513.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,SENTARA HEALTH,SENTARA MEDICARE,640.43,,,,,,,92.2500,1990.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1990.00,,,,,,,92.2500,1990.0000,percent of total billed charges,"100% of $1,990.00 in Billed Charges for Rev 370 Proc 64445 = $1,990.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,336.03,,,,,,,92.2500,1990.0000,fee schedule,$672.06 from Fee Schedule TCUHC24 for Rev 370 Proc 64445 * Qty 1 = $672.06 at 50% = $336.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,642.77,,,,,,,92.2500,1990.0000,other,"32.3% of $1,990.00 in Billed Charges for Rev 370 Proc 64445 = $642.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,610.93,,,,,,,92.2500,1990.0000,other,"30.7% of $1,990.00 in Billed Charges for Rev 370 Proc 64445 = $610.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,642.77,,,,,,,92.2500,1990.0000,percent of total billed charges,"32.3% of $1,990.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,568.55,,,,,,,92.2500,1990.0000,fee schedule,"APG 00214 Proc 64445 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 103% = $568.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,640.43,,,,,,,92.2500,1990.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,640.43,,,,,,,92.2500,1990.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,WELLCARE,WELLCARE MEDICAID,1990.00,,,,,,,92.2500,1990.0000,percent of total billed charges,"100% of $1,990.00 in Billed Charges for Rev 370 Proc 64445 = $1,990.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID SCIATIC NERVE,64445,CPT,370,RC,37000005,CDM,,,,both,,,1990.0000,298.5000,WELLCARE,WELLCARE MEDICARE,678.85,,,,,,,92.2500,1990.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,AETNA,AETNA,836.07,,,,,,,57.1600,2094.2000,percent of total billed charges,"42.7% of $1,958.00 in Billed Charges for Rev 510 Proc 64450 Mod 50 = $836.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,861.10,,,,,,,57.1600,2094.2000,fee schedule,"APG 00214 Proc 64450 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $827.98 at 104% = $861.10. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,960.64,,,,,,,57.1600,2094.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,AETNA,AETNA HEALTHCARE MEDICARE,960.64,,,,,,,57.1600,2094.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,ALLCARE MEDICARE,ALLCARE MEDICARE,960.64,,,,,,,57.1600,2094.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,AMBETTER,AMBETTER,2094.20,,,,,,,57.1600,2094.2000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,999.07,,,,,,,57.1600,2094.2000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,BLUE CROSS,ANTHEM EXCHANGE,1958.00,,,,,,,57.1600,2094.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,852.82,,,,,,,57.1600,2094.2000,fee schedule,"APG 00214 Proc 64450 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $827.98 at 103% = $852.82. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,BLUE CROSS,ANTHEM HMO,1958.00,,,,,,,57.1600,2094.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,989.46,,,,,,,57.1600,2094.2000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1958.00,,,,,,,57.1600,2094.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,57.16,,,,,,,57.1600,2094.2000,fee schedule,$57.16 from Fee Schedule BLDTM_23 for Rev 510 Proc 64450 Mod 50 * Qty 1 = $57.16 at 100% = $57.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,BLUE CROSS,BLUE CROSS MEDICARE,999.07,,,,,,,57.1600,2094.2000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,CIGNA HEALTHCARE,CIGNA HMO,816.49,,,,,,,57.1600,2094.2000,percent of total billed charges,"41.7% of $1,958.00 in Billed Charges for Rev 510 Proc 64450 Mod 50 = $816.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,908.51,,,,,,,57.1600,2094.2000,percent of total billed charges,"46.4% of $1,958.00 in Billed Charges for Rev 510 Proc 64450 Mod 50 = $908.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,CIGNA HEALTHCARE,CIGNA MEDICARE,1008.67,,,,,,,57.1600,2094.2000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,816.49,,,,,,,57.1600,2094.2000,percent of total billed charges,"41.7% of $1,958.00 in Billed Charges for Rev 510 Proc 64450 Mod 50 = $816.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,CIGNA HEALTHCARE,CIGNA PPO,816.49,,,,,,,57.1600,2094.2000,percent of total billed charges,"41.7% of $1,958.00 in Billed Charges for Rev 510 Proc 64450 Mod 50 = $816.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1008.67,,,,,,,57.1600,2094.2000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1762.20,,,,,,,57.1600,2094.2000,percent of total billed charges,"90% of $1,958.00 in Billed Charges for Rev 510 Proc 64450 Mod 50 = $1,762.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,HUMANA,HUMANA MEDICARE,960.64,,,,,,,57.1600,2094.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,960.64,,,,,,,57.1600,2094.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,MEDCOST,MEDCOST VHN,931.81,,,,,,,57.1600,2094.2000,percent of total billed charges,"47.59% of $1,958.00 in Billed Charges for Rev 510 Proc 64450 Mod 50 = $931.81. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,869.38,,,,,,,57.1600,2094.2000,fee schedule,"APG 00214 Proc 64450 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $827.98 at 100% = $827.98... $827.98 at 105% = $869.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1008.67,,,,,,,57.1600,2094.2000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1008.67,,,,,,,57.1600,2094.2000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,NHC ADVANTAGE,NHC ADVANTAGE,1008.67,,,,,,,57.1600,2094.2000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,853.65,,,,,,,57.1600,2094.2000,fee schedule,"APG 00214 Proc 64450 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $827.98 at 100% = $827.98... $827.98 at 103.1% = $853.65 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,SENTARA HEALTH,SENTARA HEALTH,505.36,,,,,,,57.1600,2094.2000,percent of total billed charges,"25.81% of $1,958.00 in Billed Charges for Rev 510 Proc 64450 Mod 50 = $505.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,SENTARA HEALTH,SENTARA MEDICARE,960.64,,,,,,,57.1600,2094.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1958.00,,,,,,,57.1600,2094.2000,percent of total billed charges,"100% of $1,958.00 in Billed Charges for Rev 510 Proc 64450 Mod 50 = $1,958.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,186.38,,,,,,,57.1600,2094.2000,fee schedule,$372.76 from Fee Schedule TCUHC24 for Rev 510 Proc 64450 Mod 50 * Qty 1 = $372.76 at 50% = $186.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,632.43,,,,,,,57.1600,2094.2000,other,"32.3% of $1,958.00 in Billed Charges for Rev 510 Proc 64450 Mod 50 = $632.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,601.11,,,,,,,57.1600,2094.2000,other,"30.7% of $1,958.00 in Billed Charges for Rev 510 Proc 64450 Mod 50 = $601.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,632.43,,,,,,,57.1600,2094.2000,percent of total billed charges,"32.3% of $1,958.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,852.82,,,,,,,57.1600,2094.2000,fee schedule,"APG 00214 Proc 64450 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + 0.5) / 1) = $827.98 at 103% = $852.82. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,960.64,,,,,,,57.1600,2094.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,960.64,,,,,,,57.1600,2094.2000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,WELLCARE,WELLCARE MEDICAID,1958.00,,,,,,,57.1600,2094.2000,percent of total billed charges,"100% of $1,958.00 in Billed Charges for Rev 510 Proc 64450 Mod 50 = $1,958.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID OTHER PERIPH NERVE BILAT,64450,CPT,510,RC,51000236,CDM,,,50,both,,,1958.0000,293.7000,WELLCARE,WELLCARE MEDICARE,1018.28,,,,,,,57.1600,2094.2000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA,584.99,,,,,,,57.1600,1396.1300,percent of total billed charges,"42.7% of $1,370.00 in Billed Charges for Rev 450 Proc 64450 = $584.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,574.07,,,,,,,57.1600,1396.1300,fee schedule,"APG 00214 Proc 64450 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 104% = $574.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,640.43,,,,,,,57.1600,1396.1300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,AETNA,AETNA HEALTHCARE MEDICARE,640.43,,,,,,,57.1600,1396.1300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,640.43,,,,,,,57.1600,1396.1300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,AMBETTER,AMBETTER,1396.13,,,,,,,57.1600,1396.1300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,666.04,,,,,,,57.1600,1396.1300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM EXCHANGE,1370.00,,,,,,,57.1600,1396.1300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,568.55,,,,,,,57.1600,1396.1300,fee schedule,"APG 00214 Proc 64450 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 103% = $568.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM HMO,1370.00,,,,,,,57.1600,1396.1300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,659.64,,,,,,,57.1600,1396.1300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1370.00,,,,,,,57.1600,1396.1300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,57.16,,,,,,,57.1600,1396.1300,fee schedule,$57.16 from Fee Schedule BLDTM_23 for Rev 450 Proc 64450 * Qty 1 = $57.16 at 100% = $57.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,BLUE CROSS,BLUE CROSS MEDICARE,666.04,,,,,,,57.1600,1396.1300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,672.45,,,,,,,57.1600,1396.1300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,672.45,,,,,,,57.1600,1396.1300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1233.00,,,,,,,57.1600,1396.1300,percent of total billed charges,"90% of $1,370.00 in Billed Charges for Rev 450 Proc 64450 = $1,233.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,HUMANA,HUMANA MEDICARE,640.43,,,,,,,57.1600,1396.1300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,640.43,,,,,,,57.1600,1396.1300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,MEDCOST,MEDCOST VHN,651.98,,,,,,,57.1600,1396.1300,percent of total billed charges,"47.59% of $1,370.00 in Billed Charges for Rev 450 Proc 64450 = $651.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,579.59,,,,,,,57.1600,1396.1300,fee schedule,"APG 00214 Proc 64450 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 100% = $551.99... $551.99 at 105% = $579.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,672.45,,,,,,,57.1600,1396.1300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,672.45,,,,,,,57.1600,1396.1300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,NHC ADVANTAGE,NHC ADVANTAGE,672.45,,,,,,,57.1600,1396.1300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,569.10,,,,,,,57.1600,1396.1300,fee schedule,"APG 00214 Proc 64450 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 100% = $551.99... $551.99 at 103.1% = $569.10 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,SENTARA HEALTH,SENTARA HEALTH,353.60,,,,,,,57.1600,1396.1300,percent of total billed charges,"25.81% of $1,370.00 in Billed Charges for Rev 450 Proc 64450 = $353.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,SENTARA HEALTH,SENTARA MEDICARE,640.43,,,,,,,57.1600,1396.1300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1370.00,,,,,,,57.1600,1396.1300,percent of total billed charges,"100% of $1,370.00 in Billed Charges for Rev 450 Proc 64450 = $1,370.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,57.1600,1396.1300,case rate,Rev 450 Proc 64450 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,57.1600,1396.1300,case rate,Rev 450 Proc 64450 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,57.1600,1396.1300,case rate,Rev 450 Proc 64450 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,57.1600,1396.1300,case rate,Rev 450 Proc 64450 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,568.55,,,,,,,57.1600,1396.1300,fee schedule,"APG 00214 Proc 64450 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 103% = $568.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,640.43,,,,,,,57.1600,1396.1300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,640.43,,,,,,,57.1600,1396.1300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,WELLCARE,WELLCARE MEDICAID,1370.00,,,,,,,57.1600,1396.1300,percent of total billed charges,"100% of $1,370.00 in Billed Charges for Rev 450 Proc 64450 = $1,370.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES/STEROID OTHER PERIPH NERVE UNILAT,64450,CPT,450,RC,45000288,CDM,,,,both,,,1370.0000,205.5000,WELLCARE,WELLCARE MEDICARE,678.85,,,,,,,57.1600,1396.1300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,AETNA,AETNA,890.72,,,,,,,312.4900,2086.0000,percent of total billed charges,"42.7% of $2,086.00 in Billed Charges for Rev 510 Proc 64454 = $890.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,574.07,,,,,,,312.4900,2086.0000,fee schedule,"APG 00214 Proc 64454 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 104% = $574.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,640.43,,,,,,,312.4900,2086.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,AETNA,AETNA HEALTHCARE MEDICARE,640.43,,,,,,,312.4900,2086.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,640.43,,,,,,,312.4900,2086.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,AMBETTER,AMBETTER,1396.13,,,,,,,312.4900,2086.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,666.04,,,,,,,312.4900,2086.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,BLUE CROSS,ANTHEM EXCHANGE,1576.77,,,,,,,312.4900,2086.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,568.55,,,,,,,312.4900,2086.0000,fee schedule,"APG 00214 Proc 64454 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 103% = $568.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,BLUE CROSS,ANTHEM HMO,1675.23,,,,,,,312.4900,2086.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,659.64,,,,,,,312.4900,2086.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1970.75,,,,,,,312.4900,2086.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1460.20,,,,,,,312.4900,2086.0000,percent of total billed charges,"Rev 510 Proc 64454 $2,086.00 in Billed Charges at 70% = $1,460.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,BLUE CROSS,BLUE CROSS MEDICARE,666.04,,,,,,,312.4900,2086.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,CIGNA HEALTHCARE,CIGNA HMO,869.86,,,,,,,312.4900,2086.0000,percent of total billed charges,"41.7% of $2,086.00 in Billed Charges for Rev 510 Proc 64454 = $869.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,967.90,,,,,,,312.4900,2086.0000,percent of total billed charges,"46.4% of $2,086.00 in Billed Charges for Rev 510 Proc 64454 = $967.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,672.45,,,,,,,312.4900,2086.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,869.86,,,,,,,312.4900,2086.0000,percent of total billed charges,"41.7% of $2,086.00 in Billed Charges for Rev 510 Proc 64454 = $869.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,CIGNA HEALTHCARE,CIGNA PPO,869.86,,,,,,,312.4900,2086.0000,percent of total billed charges,"41.7% of $2,086.00 in Billed Charges for Rev 510 Proc 64454 = $869.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,672.45,,,,,,,312.4900,2086.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1877.40,,,,,,,312.4900,2086.0000,percent of total billed charges,"90% of $2,086.00 in Billed Charges for Rev 510 Proc 64454 = $1,877.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,HUMANA,HUMANA MEDICARE,640.43,,,,,,,312.4900,2086.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,640.43,,,,,,,312.4900,2086.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,MEDCOST,MEDCOST VHN,992.73,,,,,,,312.4900,2086.0000,percent of total billed charges,"47.59% of $2,086.00 in Billed Charges for Rev 510 Proc 64454 = $992.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,579.59,,,,,,,312.4900,2086.0000,fee schedule,"APG 00214 Proc 64454 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 100% = $551.99... $551.99 at 105% = $579.59 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,672.45,,,,,,,312.4900,2086.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,672.45,,,,,,,312.4900,2086.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,NHC ADVANTAGE,NHC ADVANTAGE,672.45,,,,,,,312.4900,2086.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,569.10,,,,,,,312.4900,2086.0000,fee schedule,"APG 00214 Proc 64454 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 100% = $551.99... $551.99 at 103.1% = $569.10 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,SENTARA HEALTH,SENTARA HEALTH,538.40,,,,,,,312.4900,2086.0000,percent of total billed charges,"25.81% of $2,086.00 in Billed Charges for Rev 510 Proc 64454 = $538.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,SENTARA HEALTH,SENTARA MEDICARE,640.43,,,,,,,312.4900,2086.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2086.00,,,,,,,312.4900,2086.0000,percent of total billed charges,"100% of $2,086.00 in Billed Charges for Rev 510 Proc 64454 = $2,086.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,312.49,,,,,,,312.4900,2086.0000,fee schedule,$624.98 from Fee Schedule TCUHC24 for Rev 510 Proc 64454 * Qty 1 = $624.98 at 50% = $312.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,673.78,,,,,,,312.4900,2086.0000,other,"32.3% of $2,086.00 in Billed Charges for Rev 510 Proc 64454 = $673.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,640.40,,,,,,,312.4900,2086.0000,other,"30.7% of $2,086.00 in Billed Charges for Rev 510 Proc 64454 = $640.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,673.78,,,,,,,312.4900,2086.0000,percent of total billed charges,"32.3% of $2,086.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,568.55,,,,,,,312.4900,2086.0000,fee schedule,"APG 00214 Proc 64454 at $836.60 (Base Rate) * 0.6598 (Relative Weight) = $551.99 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $551.99 at 103% = $568.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,640.43,,,,,,,312.4900,2086.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,640.43,,,,,,,312.4900,2086.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,WELLCARE,WELLCARE MEDICAID,2086.00,,,,,,,312.4900,2086.0000,percent of total billed charges,"100% of $2,086.00 in Billed Charges for Rev 510 Proc 64454 = $2,086.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IM,64454,CPT,510,RC,51000254,CDM,,,,both,,,2086.0000,312.9000,WELLCARE,WELLCARE MEDICARE,678.85,,,,,,,312.4900,2086.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,AETNA,AETNA,911.22,,,,,,,175.0000,2134.0000,percent of total billed charges,"42.7% of $2,134.00 in Billed Charges for Rev 361 Proc 64461 = $911.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1092.54,,,,,,,175.0000,2134.0000,fee schedule,"APG 00053 Proc 64461 at $836.60 (Base Rate) * 1.2557 (Relative Weight) = $1,050.52 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,050.52 at 104% = $1,092.54. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,640.43,,,,,,,175.0000,2134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,AETNA,AETNA HEALTHCARE MEDICARE,640.43,,,,,,,175.0000,2134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,640.43,,,,,,,175.0000,2134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,AMBETTER,AMBETTER,1396.13,,,,,,,175.0000,2134.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,666.04,,,,,,,175.0000,2134.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,BLUE CROSS,ANTHEM EXCHANGE,1576.77,,,,,,,175.0000,2134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1082.03,,,,,,,175.0000,2134.0000,fee schedule,"APG 00053 Proc 64461 at $836.60 (Base Rate) * 1.2557 (Relative Weight) = $1,050.52 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,050.52 at 103% = $1,082.03. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,BLUE CROSS,ANTHEM HMO,1675.23,,,,,,,175.0000,2134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,659.64,,,,,,,175.0000,2134.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1970.75,,,,,,,175.0000,2134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,175.0000,2134.0000,case rate,"Rev 361 Proc 64461 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,175.0000,2134.0000,case rate,Rev 361 Proc 64461 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,BLUE CROSS,BLUE CROSS MEDICARE,666.04,,,,,,,175.0000,2134.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,175.0000,2134.0000,case rate,Rev 361 Proc 64461 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,175.0000,2134.0000,case rate,Rev 361 Proc 64461 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,175.0000,2134.0000,case rate,Rev 361 Proc 64461 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,175.0000,2134.0000,case rate,Rev 361 Proc 64461 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,CIGNA HEALTHCARE,CIGNA HMO,228.00,,,,,,,175.0000,2134.0000,case rate,Rev 361 Proc 64461 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,175.00,,,,,,,175.0000,2134.0000,case rate,Rev 361 Proc 64461 ASG Rate of $175.00 at 100% of $175.00 = $175.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,672.45,,,,,,,175.0000,2134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.00,,,,,,,175.0000,2134.0000,case rate,Rev 361 Proc 64461 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,CIGNA HEALTHCARE,CIGNA PPO,228.00,,,,,,,175.0000,2134.0000,case rate,Rev 361 Proc 64461 ASG Rate of $228.00 at 100% of $228.00 = $228.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,672.45,,,,,,,175.0000,2134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1920.60,,,,,,,175.0000,2134.0000,percent of total billed charges,"90% of $2,134.00 in Billed Charges for Rev 361 Proc 64461 = $1,920.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,HUMANA,HUMANA MEDICARE,640.43,,,,,,,175.0000,2134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,640.43,,,,,,,175.0000,2134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,MEDCOST,MEDCOST VHN,1015.57,,,,,,,175.0000,2134.0000,percent of total billed charges,"47.59% of $2,134.00 in Billed Charges for Rev 361 Proc 64461 = $1,015.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1103.05,,,,,,,175.0000,2134.0000,fee schedule,"APG 00053 Proc 64461 at $836.60 (Base Rate) * 1.2557 (Relative Weight) = $1,050.52 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,050.52 at 100% = $1,050.52... $1,050.52 at 105% = $1,103.05 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,672.45,,,,,,,175.0000,2134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,672.45,,,,,,,175.0000,2134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,NHC ADVANTAGE,NHC ADVANTAGE,672.45,,,,,,,175.0000,2134.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1083.09,,,,,,,175.0000,2134.0000,fee schedule,"APG 00053 Proc 64461 at $836.60 (Base Rate) * 1.2557 (Relative Weight) = $1,050.52 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,050.52 at 100% = $1,050.52... $1,050.52 at 103.1% = $1,083.09 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,SENTARA HEALTH,SENTARA HEALTH,550.79,,,,,,,175.0000,2134.0000,percent of total billed charges,"25.81% of $2,134.00 in Billed Charges for Rev 361 Proc 64461 = $550.79. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,SENTARA HEALTH,SENTARA MEDICARE,640.43,,,,,,,175.0000,2134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2134.00,,,,,,,175.0000,2134.0000,percent of total billed charges,"100% of $2,134.00 in Billed Charges for Rev 361 Proc 64461 = $2,134.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,772.00,,,,,,,175.0000,2134.0000,case rate,Rev 361 Proc 64461 ASG Rate of $772.00 at 100% of $772.00 = $772.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,679.00,,,,,,,175.0000,2134.0000,case rate,Rev 361 Proc 64461 ASG Rate of $679.00 at 100% of $679.00 = $679.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,650.00,,,,,,,175.0000,2134.0000,case rate,Rev 361 Proc 64461 ASG Rate of $650.00 at 100% of $650.00 = $650.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,1101.00,,,,,,,175.0000,2134.0000,case rate,"Rev 361 Proc 64461 ASG Rate of $1,101.00 at 100% of $1,101.00 = $1,101.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1082.03,,,,,,,175.0000,2134.0000,fee schedule,"APG 00053 Proc 64461 at $836.60 (Base Rate) * 1.2557 (Relative Weight) = $1,050.52 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $1,050.52 at 103% = $1,082.03. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,640.43,,,,,,,175.0000,2134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,640.43,,,,,,,175.0000,2134.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,WELLCARE,WELLCARE MEDICAID,2134.00,,,,,,,175.0000,2134.0000,percent of total billed charges,"100% of $2,134.00 in Billed Charges for Rev 361 Proc 64461 = $2,134.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC PARAVERTEBRAL BLOCK THORACIC INCL IMG SNGL INJ,64461,CPT,361,RC,36100320,CDM,,,,both,,,2134.0000,320.1000,WELLCARE,WELLCARE MEDICARE,678.85,,,,,,,175.0000,2134.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LWR XTR FSCL PLN BLK UNI NJX,64473,CPT,450,RC,45000424,CDM,,,,both,,,1043.0000,156.4500,AETNA,AETNA,445.36,,,,,,,109.0000,1043.0000,percent of total billed charges,"42.7% of $1,043.00 in Billed Charges for Rev 450 Proc 64473 = $445.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LWR XTR FSCL PLN BLK UNI NJX,64473,CPT,450,RC,45000424,CDM,,,,both,,,1043.0000,156.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,730.10,,,,,,,109.0000,1043.0000,percent of total billed charges,"Rev 450 Proc 64473 $1,043.00 in Billed Charges at 70% = $730.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LWR XTR FSCL PLN BLK UNI NJX,64473,CPT,450,RC,45000424,CDM,,,,both,,,1043.0000,156.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,938.70,,,,,,,109.0000,1043.0000,percent of total billed charges,"90% of $1,043.00 in Billed Charges for Rev 450 Proc 64473 = $938.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LWR XTR FSCL PLN BLK UNI NJX,64473,CPT,450,RC,45000424,CDM,,,,both,,,1043.0000,156.4500,MEDCOST,MEDCOST VHN,496.36,,,,,,,109.0000,1043.0000,percent of total billed charges,"47.59% of $1,043.00 in Billed Charges for Rev 450 Proc 64473 = $496.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LWR XTR FSCL PLN BLK UNI NJX,64473,CPT,450,RC,45000424,CDM,,,,both,,,1043.0000,156.4500,SENTARA HEALTH,SENTARA HEALTH,269.20,,,,,,,109.0000,1043.0000,percent of total billed charges,"25.81% of $1,043.00 in Billed Charges for Rev 450 Proc 64473 = $269.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LWR XTR FSCL PLN BLK UNI NJX,64473,CPT,450,RC,45000424,CDM,,,,both,,,1043.0000,156.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1043.00,,,,,,,109.0000,1043.0000,percent of total billed charges,"100% of $1,043.00 in Billed Charges for Rev 450 Proc 64473 = $1,043.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LWR XTR FSCL PLN BLK UNI NJX,64473,CPT,450,RC,45000424,CDM,,,,both,,,1043.0000,156.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,109.0000,1043.0000,case rate,Rev 450 Proc 64473 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LWR XTR FSCL PLN BLK UNI NJX,64473,CPT,450,RC,45000424,CDM,,,,both,,,1043.0000,156.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,109.0000,1043.0000,case rate,Rev 450 Proc 64473 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LWR XTR FSCL PLN BLK UNI NJX,64473,CPT,450,RC,45000424,CDM,,,,both,,,1043.0000,156.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,109.0000,1043.0000,case rate,Rev 450 Proc 64473 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LWR XTR FSCL PLN BLK UNI NJX,64473,CPT,450,RC,45000424,CDM,,,,both,,,1043.0000,156.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,109.0000,1043.0000,case rate,Rev 450 Proc 64473 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LWR XTR FSCL PLN BLK UNI NJX,64473,CPT,450,RC,45000424,CDM,,,,both,,,1043.0000,156.4500,WELLCARE,WELLCARE MEDICAID,1043.00,,,,,,,109.0000,1043.0000,percent of total billed charges,"100% of $1,043.00 in Billed Charges for Rev 450 Proc 64473 = $1,043.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER CROSS BOW,272,RC,27200002,CDM,,,,,,both,,,928.7000,139.3100,AETNA,AETNA,396.55,,,,,,,239.7000,928.7000,percent of total billed charges,42.7% of $928.70 in Billed Charges for Rev 272 = $396.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PASSER CROSS BOW,272,RC,27200002,CDM,,,,,,both,,,928.7000,139.3100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,650.09,,,,,,,239.7000,928.7000,percent of total billed charges,Rev 272 $928.70 in Billed Charges at 70% = $650.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PASSER CROSS BOW,272,RC,27200002,CDM,,,,,,both,,,928.7000,139.3100,CIGNA HEALTHCARE,CIGNA HMO,387.27,,,,,,,239.7000,928.7000,percent of total billed charges,41.7% of $928.70 in Billed Charges for Rev 272 = $387.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PASSER CROSS BOW,272,RC,27200002,CDM,,,,,,both,,,928.7000,139.3100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,430.92,,,,,,,239.7000,928.7000,percent of total billed charges,46.4% of $928.70 in Billed Charges for Rev 272 = $430.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PASSER CROSS BOW,272,RC,27200002,CDM,,,,,,both,,,928.7000,139.3100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,387.27,,,,,,,239.7000,928.7000,percent of total billed charges,41.7% of $928.70 in Billed Charges for Rev 272 = $387.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PASSER CROSS BOW,272,RC,27200002,CDM,,,,,,both,,,928.7000,139.3100,CIGNA HEALTHCARE,CIGNA PPO,387.27,,,,,,,239.7000,928.7000,percent of total billed charges,41.7% of $928.70 in Billed Charges for Rev 272 = $387.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PASSER CROSS BOW,272,RC,27200002,CDM,,,,,,both,,,928.7000,139.3100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,835.83,,,,,,,239.7000,928.7000,percent of total billed charges,90% of $928.70 in Billed Charges for Rev 272 = $835.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PASSER CROSS BOW,272,RC,27200002,CDM,,,,,,both,,,928.7000,139.3100,MEDCOST,MEDCOST VHN,441.97,,,,,,,239.7000,928.7000,percent of total billed charges,47.59% of $928.70 in Billed Charges for Rev 272 = $441.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PASSER CROSS BOW,272,RC,27200002,CDM,,,,,,both,,,928.7000,139.3100,SENTARA HEALTH,SENTARA HEALTH,239.70,,,,,,,239.7000,928.7000,percent of total billed charges,25.81% of $928.70 in Billed Charges for Rev 272 = $239.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PASSER CROSS BOW,272,RC,27200002,CDM,,,,,,both,,,928.7000,139.3100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",928.70,,,,,,,239.7000,928.7000,percent of total billed charges,100% of $928.70 in Billed Charges for Rev 272 = $928.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PASSER CROSS BOW,272,RC,27200002,CDM,,,,,,both,,,928.7000,139.3100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,464.35,,,,,,,239.7000,928.7000,percent of total billed charges,Rev 272 $928.70 in Billed Charges at 50% = $464.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PASSER CROSS BOW,272,RC,27200002,CDM,,,,,,both,,,928.7000,139.3100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,299.97,,,,,,,239.7000,928.7000,other,32.3% of $928.70 in Billed Charges for Rev 272 = $299.97 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE PASSER CROSS BOW,272,RC,27200002,CDM,,,,,,both,,,928.7000,139.3100,UNITED HEALTHCARE,UHC HERITAGE SELECT,285.11,,,,,,,239.7000,928.7000,other,30.7% of $928.70 in Billed Charges for Rev 272 = $285.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
SUTURE PASSER CROSS BOW,272,RC,27200002,CDM,,,,,,both,,,928.7000,139.3100,UNITED HEALTHCARE,UNITED HEALTHCARE,299.97,,,,,,,239.7000,928.7000,percent of total billed charges,32.3% of $928.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PASSER CROSS BOW,272,RC,27200002,CDM,,,,,,both,,,928.7000,139.3100,WELLCARE,WELLCARE MEDICAID,928.70,,,,,,,239.7000,928.7000,percent of total billed charges,100% of $928.70 in Billed Charges for Rev 272 = $928.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
SUTURE PASSER SWIFTSTICH,272,RC,,,,,,,,both,,,2966.1100,444.9200,AETNA,AETNA,1266.53,,,,,,,765.5500,2966.1100,percent of total billed charges,"42.7% of $2,966.11 in Billed Charges for Rev 272 = $1,266.53. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SWIFTSTICH,272,RC,,,,,,,,both,,,2966.1100,444.9200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2076.28,,,,,,,765.5500,2966.1100,percent of total billed charges,"Rev 272 $2,966.11 in Billed Charges at 70% = $2,076.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SWIFTSTICH,272,RC,,,,,,,,both,,,2966.1100,444.9200,CIGNA HEALTHCARE,CIGNA HMO,1236.87,,,,,,,765.5500,2966.1100,percent of total billed charges,"41.7% of $2,966.11 in Billed Charges for Rev 272 = $1,236.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SWIFTSTICH,272,RC,,,,,,,,both,,,2966.1100,444.9200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1376.28,,,,,,,765.5500,2966.1100,percent of total billed charges,"46.4% of $2,966.11 in Billed Charges for Rev 272 = $1,376.28. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SWIFTSTICH,272,RC,,,,,,,,both,,,2966.1100,444.9200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1236.87,,,,,,,765.5500,2966.1100,percent of total billed charges,"41.7% of $2,966.11 in Billed Charges for Rev 272 = $1,236.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SWIFTSTICH,272,RC,,,,,,,,both,,,2966.1100,444.9200,CIGNA HEALTHCARE,CIGNA PPO,1236.87,,,,,,,765.5500,2966.1100,percent of total billed charges,"41.7% of $2,966.11 in Billed Charges for Rev 272 = $1,236.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SWIFTSTICH,272,RC,,,,,,,,both,,,2966.1100,444.9200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2669.50,,,,,,,765.5500,2966.1100,percent of total billed charges,"90% of $2,966.11 in Billed Charges for Rev 272 = $2,669.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SWIFTSTICH,272,RC,,,,,,,,both,,,2966.1100,444.9200,MEDCOST,MEDCOST VHN,1411.57,,,,,,,765.5500,2966.1100,percent of total billed charges,"47.59% of $2,966.11 in Billed Charges for Rev 272 = $1,411.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SWIFTSTICH,272,RC,,,,,,,,both,,,2966.1100,444.9200,SENTARA HEALTH,SENTARA HEALTH,765.55,,,,,,,765.5500,2966.1100,percent of total billed charges,"25.81% of $2,966.11 in Billed Charges for Rev 272 = $765.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SWIFTSTICH,272,RC,,,,,,,,both,,,2966.1100,444.9200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2966.11,,,,,,,765.5500,2966.1100,percent of total billed charges,"100% of $2,966.11 in Billed Charges for Rev 272 = $2,966.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SWIFTSTICH,272,RC,,,,,,,,both,,,2966.1100,444.9200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1483.06,,,,,,,765.5500,2966.1100,percent of total billed charges,"Rev 272 $2,966.11 in Billed Charges at 50% = $1,483.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SWIFTSTICH,272,RC,,,,,,,,both,,,2966.1100,444.9200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,958.05,,,,,,,765.5500,2966.1100,other,"32.3% of $2,966.11 in Billed Charges for Rev 272 = $958.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PASSER SWIFTSTICH,272,RC,,,,,,,,both,,,2966.1100,444.9200,UNITED HEALTHCARE,UHC HERITAGE SELECT,910.60,,,,,,,765.5500,2966.1100,other,"30.7% of $2,966.11 in Billed Charges for Rev 272 = $910.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
SUTURE PASSER SWIFTSTICH,272,RC,,,,,,,,both,,,2966.1100,444.9200,UNITED HEALTHCARE,UNITED HEALTHCARE,958.05,,,,,,,765.5500,2966.1100,percent of total billed charges,"32.3% of $2,966.11 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
SUTURE PASSER SWIFTSTICH,272,RC,,,,,,,,both,,,2966.1100,444.9200,WELLCARE,WELLCARE MEDICAID,2966.11,,,,,,,765.5500,2966.1100,percent of total billed charges,"100% of $2,966.11 in Billed Charges for Rev 272 = $2,966.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES &/ STEROID TRFML EPIDURAL CRV/THRC BILAT EA ADDL LEVEL,64480,CPT,361,RC,36100400,CDM,,,50,both,,,3411.0000,511.6500,AETNA,AETNA,1456.50,,,,,,,222.0000,3411.0000,percent of total billed charges,"42.7% of $3,411.00 in Billed Charges for Rev 361 Proc 64480 Mod 50 = $1,456.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES &/ STEROID TRFML EPIDURAL CRV/THRC BILAT EA ADDL LEVEL,64480,CPT,361,RC,36100400,CDM,,,50,both,,,3411.0000,511.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1638.81,,,,,,,222.0000,3411.0000,fee schedule,"APG 00053 Proc 64480 at $836.60 (Base Rate) * 1.2557 (Relative Weight) = $1,050.52 (Total Line Payment) at 150% Mod Percentage = $1,575.78 at 104% = $1,638.81. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES &/ STEROID TRFML EPIDURAL CRV/THRC BILAT EA ADDL LEVEL,64480,CPT,361,RC,36100400,CDM,,,50,both,,,3411.0000,511.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1623.05,,,,,,,222.0000,3411.0000,fee schedule,"APG 00053 Proc 64480 at $836.60 (Base Rate) * 1.2557 (Relative Weight) = $1,050.52 (Total Line Payment) at 150% Mod Percentage = $1,575.78 at 103% = $1,623.05. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES &/ STEROID TRFML EPIDURAL CRV/THRC BILAT EA ADDL LEVEL,64480,CPT,361,RC,36100400,CDM,,,50,both,,,3411.0000,511.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1056.00,,,,,,,222.0000,3411.0000,case rate,"Rev 361 Proc 64480 Mod 50 ASG Rate of $704.00 at 100% of $704.00 + 50% of $704.00 = $1,056.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES &/ STEROID TRFML EPIDURAL CRV/THRC BILAT EA ADDL LEVEL,64480,CPT,361,RC,36100400,CDM,,,50,both,,,3411.0000,511.6500,BLUE CROSS,BLUE CROSS E NETWORK,222.00,,,,,,,222.0000,3411.0000,case rate,Rev 361 Proc 64480 Mod 50 ASG Rate of $148.00 at 100% of $148.00 + 50% of $148.00 = $222.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES &/ STEROID TRFML EPIDURAL CRV/THRC BILAT EA ADDL LEVEL,64480,CPT,361,RC,36100400,CDM,,,50,both,,,3411.0000,511.6500,BLUE CROSS,BLUE CROSS P NETWORK,226.50,,,,,,,222.0000,3411.0000,case rate,Rev 361 Proc 64480 Mod 50 ASG Rate of $151.00 at 100% of $151.00 + 50% of $151.00 = $226.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES &/ STEROID TRFML EPIDURAL CRV/THRC BILAT EA ADDL LEVEL,64480,CPT,361,RC,36100400,CDM,,,50,both,,,3411.0000,511.6500,BLUE CROSS,BLUE CROSS S NETWORK,226.50,,,,,,,222.0000,3411.0000,case rate,Rev 361 Proc 64480 Mod 50 ASG Rate of $151.00 at 100% of $151.00 + 50% of $151.00 = $226.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES &/ STEROID TRFML EPIDURAL CRV/THRC BILAT EA ADDL LEVEL,64480,CPT,361,RC,36100400,CDM,,,50,both,,,3411.0000,511.6500,BLUE CROSS,TENNCARE BLUE CARE,867.00,,,,,,,222.0000,3411.0000,case rate,Rev 361 Proc 64480 Mod 50 ASG Rate of $578.00 at 100% of $578.00 + 50% of $578.00 = $867.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES &/ STEROID TRFML EPIDURAL CRV/THRC BILAT EA ADDL LEVEL,64480,CPT,361,RC,36100400,CDM,,,50,both,,,3411.0000,511.6500,BLUE CROSS,TENNCARE BLUE SELECT,867.00,,,,,,,222.0000,3411.0000,case rate,Rev 361 Proc 64480 Mod 50 ASG Rate of $578.00 at 100% of $578.00 + 50% of $578.00 = $867.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES &/ STEROID TRFML EPIDURAL CRV/THRC BILAT EA ADDL LEVEL,64480,CPT,361,RC,36100400,CDM,,,50,both,,,3411.0000,511.6500,CIGNA HEALTHCARE,CIGNA HMO,3411.00,,,,,,,222.0000,3411.0000,case rate,"Rev 361 Proc 64480 Mod 50 ASG Rate of $4,239.00 at 100% of $4,239.00 + 50% of $4,239.00 = $6,358.50 Total (Limited to $3,411.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,411.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES &/ STEROID TRFML EPIDURAL CRV/THRC BILAT EA ADDL LEVEL,64480,CPT,361,RC,36100400,CDM,,,50,both,,,3411.0000,511.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3411.00,,,,,,,222.0000,3411.0000,case rate,"Rev 361 Proc 64480 Mod 50 ASG Rate of $4,239.00 at 100% of $4,239.00 + 50% of $4,239.00 = $6,358.50 Total (Limited to $3,411.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,411.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES &/ STEROID TRFML EPIDURAL CRV/THRC BILAT EA ADDL LEVEL,64480,CPT,361,RC,36100400,CDM,,,50,both,,,3411.0000,511.6500,CIGNA HEALTHCARE,CIGNA PPO,3411.00,,,,,,,222.0000,3411.0000,case rate,"Rev 361 Proc 64480 Mod 50 ASG Rate of $4,239.00 at 100% of $4,239.00 + 50% of $4,239.00 = $6,358.50 Total (Limited to $3,411.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,411.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES &/ STEROID TRFML EPIDURAL CRV/THRC BILAT EA ADDL LEVEL,64480,CPT,361,RC,36100400,CDM,,,50,both,,,3411.0000,511.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3069.90,,,,,,,222.0000,3411.0000,percent of total billed charges,"90% of $3,411.00 in Billed Charges for Rev 361 Proc 64480 Mod 50 = $3,069.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES &/ STEROID TRFML EPIDURAL CRV/THRC BILAT EA ADDL LEVEL,64480,CPT,361,RC,36100400,CDM,,,50,both,,,3411.0000,511.6500,MEDCOST,MEDCOST VHN,1623.29,,,,,,,222.0000,3411.0000,percent of total billed charges,"47.59% of $3,411.00 in Billed Charges for Rev 361 Proc 64480 Mod 50 = $1,623.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES &/ STEROID TRFML EPIDURAL CRV/THRC BILAT EA ADDL LEVEL,64480,CPT,361,RC,36100400,CDM,,,50,both,,,3411.0000,511.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1654.57,,,,,,,222.0000,3411.0000,fee schedule,"APG 00053 Proc 64480 at $836.60 (Base Rate) * 1.2557 (Relative Weight) = $1,050.52 (Total Line Payment) at 150% Mod Percentage = $1,575.78 at 100% = $1,575.78... $1,575.78 at 105% = $1,654.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES &/ STEROID TRFML EPIDURAL CRV/THRC BILAT EA ADDL LEVEL,64480,CPT,361,RC,36100400,CDM,,,50,both,,,3411.0000,511.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1624.63,,,,,,,222.0000,3411.0000,fee schedule,"APG 00053 Proc 64480 at $836.60 (Base Rate) * 1.2557 (Relative Weight) = $1,050.52 (Total Line Payment) at 150% Mod Percentage = $1,575.78 at 100% = $1,575.78... $1,575.78 at 103.1% = $1,624.63 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES &/ STEROID TRFML EPIDURAL CRV/THRC BILAT EA ADDL LEVEL,64480,CPT,361,RC,36100400,CDM,,,50,both,,,3411.0000,511.6500,SENTARA HEALTH,SENTARA HEALTH,880.38,,,,,,,222.0000,3411.0000,percent of total billed charges,"25.81% of $3,411.00 in Billed Charges for Rev 361 Proc 64480 Mod 50 = $880.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES &/ STEROID TRFML EPIDURAL CRV/THRC BILAT EA ADDL LEVEL,64480,CPT,361,RC,36100400,CDM,,,50,both,,,3411.0000,511.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3411.00,,,,,,,222.0000,3411.0000,percent of total billed charges,"100% of $3,411.00 in Billed Charges for Rev 361 Proc 64480 Mod 50 = $3,411.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INJ ANES &/ STEROID TRFML EPIDURAL CRV/THRC BILAT EA ADDL LEVEL,64480,CPT,361,RC,36100400,CDM,,,50,both,,,3411.0000,511.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,259.50,,,,,,,222.0000,3411.0000,case rate,Rev 361 Proc 64480 Mod 50 ASG Rate of $173.00 at 100% of $173.00 + 50% of $173.00 = $259.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES &/ STEROID TRFML EPIDURAL CRV/THRC BILAT EA ADDL LEVEL,64480,CPT,361,RC,36100400,CDM,,,50,both,,,3411.0000,511.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,433.50,,,,,,,222.0000,3411.0000,case rate,Rev 361 Proc 64480 Mod 50 ASG Rate of $289.00 at 100% of $289.00 + 50% of $289.00 = $433.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES &/ STEROID TRFML EPIDURAL CRV/THRC BILAT EA ADDL LEVEL,64480,CPT,361,RC,36100400,CDM,,,50,both,,,3411.0000,511.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,415.50,,,,,,,222.0000,3411.0000,case rate,Rev 361 Proc 64480 Mod 50 ASG Rate of $277.00 at 100% of $277.00 + 50% of $277.00 = $415.50 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES &/ STEROID TRFML EPIDURAL CRV/THRC BILAT EA ADDL LEVEL,64480,CPT,361,RC,36100400,CDM,,,50,both,,,3411.0000,511.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,792.00,,,,,,,222.0000,3411.0000,case rate,Rev 361 Proc 64480 Mod 50 ASG Rate of $528.00 at 100% of $528.00 + 50% of $528.00 = $792.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INJ ANES &/ STEROID TRFML EPIDURAL CRV/THRC BILAT EA ADDL LEVEL,64480,CPT,361,RC,36100400,CDM,,,50,both,,,3411.0000,511.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1623.05,,,,,,,222.0000,3411.0000,fee schedule,"APG 00053 Proc 64480 at $836.60 (Base Rate) * 1.2557 (Relative Weight) = $1,050.52 (Total Line Payment) at 150% Mod Percentage = $1,575.78 at 103% = $1,623.05. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INJ ANES &/ STEROID TRFML EPIDURAL CRV/THRC BILAT EA ADDL LEVEL,64480,CPT,361,RC,36100400,CDM,,,50,both,,,3411.0000,511.6500,WELLCARE,WELLCARE MEDICAID,3411.00,,,,,,,222.0000,3411.0000,percent of total billed charges,"100% of $3,411.00 in Billed Charges for Rev 361 Proc 64480 Mod 50 = $3,411.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,AETNA,AETNA,1903.14,,,,,,,267.0200,4457.0000,percent of total billed charges,"42.7% of $4,457.00 in Billed Charges for Rev 610 Proc 70549 = $1,903.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,731.55,,,,,,,267.0200,4457.0000,fee schedule,APG 00282 Proc 70549 at $836.60 (Base Rate) * 0.8408 (Relative Weight) = $703.41 (Total Line Payment) at 104% = $731.55. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,316.52,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,AETNA,AETNA HEALTHCARE MEDICARE,316.52,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,316.52,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,AMBETTER,AMBETTER,690.02,,,,,,,267.0200,4457.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,329.19,,,,,,,267.0200,4457.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,ANTHEM EXCHANGE,779.29,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,724.52,,,,,,,267.0200,4457.0000,fee schedule,APG 00282 Proc 70549 at $836.60 (Base Rate) * 0.8408 (Relative Weight) = $703.41 (Total Line Payment) at 103% = $724.52. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,ANTHEM HMO,827.95,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,326.02,,,,,,,267.0200,4457.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",974.01,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1500.86,,,,,,,267.0200,4457.0000,fee schedule,"$1,500.86 from Fee Schedule BLDTM_23 for Rev 610 Proc 70549 * Qty 1 = $1,500.86 at 100% = $1,500.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,BLUE CROSS E NETWORK,1514.85,,,,,,,267.0200,4457.0000,fee schedule,"$473.39 from Fee Schedule BCFSD for Rev 610 Proc 70549 * Qty 1 = $473.39 at 320% = $1,514.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,BLUE CROSS MEDICARE,329.19,,,,,,,267.0200,4457.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,BLUE CROSS P NETWORK,1547.99,,,,,,,267.0200,4457.0000,fee schedule,"$473.39 from Fee Schedule BCFSD for Rev 610 Proc 70549 * Qty 1 = $473.39 at 327% = $1,547.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,BLUE CROSS S NETWORK,1547.99,,,,,,,267.0200,4457.0000,fee schedule,"$473.39 from Fee Schedule BCFSD for Rev 610 Proc 70549 * Qty 1 = $473.39 at 327% = $1,547.99 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,TENNCARE BLUE CARE,732.12,,,,,,,267.0200,4457.0000,fee schedule,$631.14 from Fee Schedule TC_24 for Rev 610 Proc 70549 * Qty 1 = $631.14 at 116% = $732.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,TENNCARE BLUE SELECT,732.12,,,,,,,267.0200,4457.0000,fee schedule,$631.14 from Fee Schedule TC_24 for Rev 610 Proc 70549 * Qty 1 = $631.14 at 116% = $732.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,CIGNA HEALTHCARE,CIGNA HMO,1215.00,,,,,,,267.0200,4457.0000,other,"Rev 610 Proc 70549 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,786.00,,,,,,,267.0200,4457.0000,other,Rev 610 Proc 70549 Qty 1 * $786.00 = $786.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,332.35,,,,,,,267.0200,4457.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1215.00,,,,,,,267.0200,4457.0000,other,"Rev 610 Proc 70549 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,CIGNA HEALTHCARE,CIGNA PPO,1215.00,,,,,,,267.0200,4457.0000,other,"Rev 610 Proc 70549 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,332.35,,,,,,,267.0200,4457.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4011.30,,,,,,,267.0200,4457.0000,percent of total billed charges,"90% of $4,457.00 in Billed Charges for Rev 610 Proc 70549 = $4,011.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,HUMANA,HUMANA MEDICARE,316.52,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,316.52,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,MEDCOST,MEDCOST VHN,2121.09,,,,,,,267.0200,4457.0000,percent of total billed charges,"47.59% of $4,457.00 in Billed Charges for Rev 610 Proc 70549 = $2,121.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,738.58,,,,,,,267.0200,4457.0000,fee schedule,APG 00282 Proc 70549 at $836.60 (Base Rate) * 0.8408 (Relative Weight) = $703.41 (Total Line Payment) at 100% = $703.41... $703.41 at 105% = $738.58 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,332.35,,,,,,,267.0200,4457.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,332.35,,,,,,,267.0200,4457.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,NHC ADVANTAGE,NHC ADVANTAGE,332.35,,,,,,,267.0200,4457.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,725.22,,,,,,,267.0200,4457.0000,fee schedule,APG 00282 Proc 70549 at $836.60 (Base Rate) * 0.8408 (Relative Weight) = $703.41 (Total Line Payment) at 100% = $703.41... $703.41 at 103.1% = $725.22 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,SENTARA HEALTH,SENTARA HEALTH,1150.35,,,,,,,267.0200,4457.0000,percent of total billed charges,"25.81% of $4,457.00 in Billed Charges for Rev 610 Proc 70549 = $1,150.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,SENTARA HEALTH,SENTARA MEDICARE,316.52,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4457.00,,,,,,,267.0200,4457.0000,percent of total billed charges,"100% of $4,457.00 in Billed Charges for Rev 610 Proc 70549 = $4,457.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,267.02,,,,,,,267.0200,4457.0000,fee schedule,$534.03 from Fee Schedule TCUHC24 for Rev 610 Proc 70549 * Qty 1 = $534.03 at 50% = $267.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2559.00,,,,,,,267.0200,4457.0000,other,"Rev 610 Proc 70549 1 Visit at $2,559.00 per Visit = $2,559.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2448.00,,,,,,,267.0200,4457.0000,other,"Rev 610 Proc 70549 1 Visit at $2,448.00 per Visit = $2,448.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,4035.00,,,,,,,267.0200,4457.0000,other,"Rev 610 Proc 70549 1 Visit at $4,035.00 per Visit = $4,035.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,724.52,,,,,,,267.0200,4457.0000,fee schedule,APG 00282 Proc 70549 at $836.60 (Base Rate) * 0.8408 (Relative Weight) = $703.41 (Total Line Payment) at 103% = $724.52. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,316.52,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,316.52,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,WELLCARE,WELLCARE MEDICAID,4457.00,,,,,,,267.0200,4457.0000,percent of total billed charges,"100% of $4,457.00 in Billed Charges for Rev 610 Proc 70549 = $4,457.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MRA NECK WOW CON,70549,CPT,610,RC,61000010,CDM,,,,both,,,4457.0000,668.5500,WELLCARE,WELLCARE MEDICARE,335.52,,,,,,,267.0200,4457.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,AETNA,AETNA,1722.09,,,,,,,169.2100,4033.0000,percent of total billed charges,"42.7% of $4,033.00 in Billed Charges for Rev 611 Proc 70551 = $1,722.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,343.24,,,,,,,169.2100,4033.0000,fee schedule,APG 00293 Proc 70551 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 104% = $343.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,216.48,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,AETNA,AETNA HEALTHCARE MEDICARE,216.48,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,216.48,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,AMBETTER,AMBETTER,471.92,,,,,,,169.2100,4033.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,225.14,,,,,,,169.2100,4033.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,ANTHEM EXCHANGE,532.97,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,339.94,,,,,,,169.2100,4033.0000,fee schedule,APG 00293 Proc 70551 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 103% = $339.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,ANTHEM HMO,566.25,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,222.97,,,,,,,169.2100,4033.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",666.14,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,694.66,,,,,,,169.2100,4033.0000,fee schedule,$694.66 from Fee Schedule BLDTM_23 for Rev 611 Proc 70551 * Qty 1 = $694.66 at 100% = $694.66 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,BLUE CROSS E NETWORK,494.72,,,,,,,169.2100,4033.0000,fee schedule,$154.60 from Fee Schedule BCFSD for Rev 611 Proc 70551 * Qty 1 = $154.60 at 320% = $494.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,BLUE CROSS MEDICARE,225.14,,,,,,,169.2100,4033.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,BLUE CROSS P NETWORK,505.54,,,,,,,169.2100,4033.0000,fee schedule,$154.60 from Fee Schedule BCFSD for Rev 611 Proc 70551 * Qty 1 = $154.60 at 327% = $505.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,BLUE CROSS S NETWORK,505.54,,,,,,,169.2100,4033.0000,fee schedule,$154.60 from Fee Schedule BCFSD for Rev 611 Proc 70551 * Qty 1 = $154.60 at 327% = $505.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,TENNCARE BLUE CARE,368.16,,,,,,,169.2100,4033.0000,fee schedule,$317.38 from Fee Schedule TC_24 for Rev 611 Proc 70551 * Qty 1 = $317.38 at 116% = $368.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,TENNCARE BLUE SELECT,368.16,,,,,,,169.2100,4033.0000,fee schedule,$317.38 from Fee Schedule TC_24 for Rev 611 Proc 70551 * Qty 1 = $317.38 at 116% = $368.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,CIGNA HEALTHCARE,CIGNA HMO,1215.00,,,,,,,169.2100,4033.0000,other,"Rev 611 Proc 70551 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,786.00,,,,,,,169.2100,4033.0000,other,Rev 611 Proc 70551 Qty 1 * $786.00 = $786.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,227.30,,,,,,,169.2100,4033.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1215.00,,,,,,,169.2100,4033.0000,other,"Rev 611 Proc 70551 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,CIGNA HEALTHCARE,CIGNA PPO,1215.00,,,,,,,169.2100,4033.0000,other,"Rev 611 Proc 70551 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,227.30,,,,,,,169.2100,4033.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3629.70,,,,,,,169.2100,4033.0000,percent of total billed charges,"90% of $4,033.00 in Billed Charges for Rev 611 Proc 70551 = $3,629.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,HUMANA,HUMANA MEDICARE,216.48,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,216.48,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,MEDCOST,MEDCOST VHN,1919.30,,,,,,,169.2100,4033.0000,percent of total billed charges,"47.59% of $4,033.00 in Billed Charges for Rev 611 Proc 70551 = $1,919.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,346.54,,,,,,,169.2100,4033.0000,fee schedule,APG 00293 Proc 70551 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 100% = $330.04... $330.04 at 105% = $346.54 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,227.30,,,,,,,169.2100,4033.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,227.30,,,,,,,169.2100,4033.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,NHC ADVANTAGE,NHC ADVANTAGE,227.30,,,,,,,169.2100,4033.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,340.27,,,,,,,169.2100,4033.0000,fee schedule,APG 00293 Proc 70551 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 100% = $330.04... $330.04 at 103.1% = $340.27 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,SENTARA HEALTH,SENTARA HEALTH,1040.92,,,,,,,169.2100,4033.0000,percent of total billed charges,"25.81% of $4,033.00 in Billed Charges for Rev 611 Proc 70551 = $1,040.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,SENTARA HEALTH,SENTARA MEDICARE,216.48,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4033.00,,,,,,,169.2100,4033.0000,percent of total billed charges,"100% of $4,033.00 in Billed Charges for Rev 611 Proc 70551 = $4,033.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,169.21,,,,,,,169.2100,4033.0000,fee schedule,$338.41 from Fee Schedule TCUHC24 for Rev 611 Proc 70551 * Qty 1 = $338.41 at 50% = $169.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2559.00,,,,,,,169.2100,4033.0000,other,"Rev 611 Proc 70551 1 Visit at $2,559.00 per Visit = $2,559.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2448.00,,,,,,,169.2100,4033.0000,other,"Rev 611 Proc 70551 1 Visit at $2,448.00 per Visit = $2,448.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,4033.00,,,,,,,169.2100,4033.0000,other,"Rev 611 Proc 70551 1 Visit at $4,035.00 per Visit = $4,035.00 (Service Line reduced to $4,033.00, claim capped at $4,033.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,339.94,,,,,,,169.2100,4033.0000,fee schedule,APG 00293 Proc 70551 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 103% = $339.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,216.48,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,216.48,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,WELLCARE,WELLCARE MEDICAID,4033.00,,,,,,,169.2100,4033.0000,percent of total billed charges,"100% of $4,033.00 in Billed Charges for Rev 611 Proc 70551 = $4,033.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR BRAIN WO CON,70551,CPT,611,RC,61100001,CDM,,,,both,,,4033.0000,604.9500,WELLCARE,WELLCARE MEDICARE,229.47,,,,,,,169.2100,4033.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,16.6800,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 324 Proc 71046 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,16.6800,462.0000,fee schedule,APG 00471 Proc 71046 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,16.6800,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,16.6800,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,16.6800,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,172.12,,,,,,,16.6800,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,16.6800,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,16.6800,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,16.6800,462.0000,fee schedule,APG 00471 Proc 71046 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,16.6800,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,16.6800,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,16.6800,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,323.40,,,,,,,16.6800,462.0000,percent of total billed charges,Rev 324 Proc 71046 $462.00 in Billed Charges at 70% = $323.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,56.64,,,,,,,16.6800,462.0000,fee schedule,$17.70 from Fee Schedule BCFSC for Rev 324 Proc 71046 * Qty 1 = $17.70 at 320% = $56.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,16.6800,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,57.88,,,,,,,16.6800,462.0000,fee schedule,$17.70 from Fee Schedule BCFSC for Rev 324 Proc 71046 * Qty 1 = $17.70 at 327% = $57.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,57.88,,,,,,,16.6800,462.0000,fee schedule,$17.70 from Fee Schedule BCFSC for Rev 324 Proc 71046 * Qty 1 = $17.70 at 327% = $57.88 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,16.68,,,,,,,16.6800,462.0000,fee schedule,$14.38 from Fee Schedule TC_24 for Rev 324 Proc 71046 * Qty 1 = $14.38 at 116% = $16.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,16.68,,,,,,,16.6800,462.0000,fee schedule,$14.38 from Fee Schedule TC_24 for Rev 324 Proc 71046 * Qty 1 = $14.38 at 116% = $16.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,192.65,,,,,,,16.6800,462.0000,percent of total billed charges,Rev 324 Proc 71046 $462.00 in Billed Charges at 41.7% = $192.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,43.60,,,,,,,16.6800,462.0000,fee schedule,$43.60 from Fee Schedule CGIFP_25LR for Rev 324 Proc 71046 * Qty 1 = $43.60 at 100% = $43.60 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,16.6800,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,192.65,,,,,,,16.6800,462.0000,percent of total billed charges,Rev 324 Proc 71046 $462.00 in Billed Charges at 41.7% = $192.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,192.65,,,,,,,16.6800,462.0000,percent of total billed charges,Rev 324 Proc 71046 $462.00 in Billed Charges at 41.7% = $192.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,16.6800,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,16.6800,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 324 Proc 71046 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,78.96,,,,,,,16.6800,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,16.6800,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,16.6800,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 324 Proc 71046 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,16.6800,462.0000,fee schedule,APG 00471 Proc 71046 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,16.6800,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,16.6800,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,16.6800,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,16.6800,462.0000,fee schedule,APG 00471 Proc 71046 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,16.6800,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 324 Proc 71046 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,16.6800,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,16.6800,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 324 Proc 71046 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,31.06,,,,,,,16.6800,462.0000,fee schedule,$62.12 from Fee Schedule TCUHC24 for Rev 324 Proc 71046 * Qty 1 = $62.12 at 50% = $31.06 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,16.6800,462.0000,other,Rev 324 Proc 71046 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,16.6800,462.0000,other,Rev 324 Proc 71046 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,16.6800,462.0000,other,Rev 324 Proc 71046 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,16.6800,462.0000,fee schedule,APG 00471 Proc 71046 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,16.6800,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,16.6800,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,16.6800,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 324 Proc 71046 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX CHEST 2 VIEWS,71046,CPT,324,RC,32400012,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,16.6800,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA,187.45,,,,,,,18.9100,439.0000,percent of total billed charges,42.7% of $439.00 in Billed Charges for Rev 320 Proc 71100 = $187.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,18.9100,439.0000,fee schedule,APG 00471 Proc 71100 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,18.9100,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,18.9100,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,18.9100,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,AMBETTER,AMBETTER,172.12,,,,,,,18.9100,439.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,18.9100,439.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,18.9100,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,18.9100,439.0000,fee schedule,APG 00471 Proc 71100 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,18.9100,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,18.9100,439.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,18.9100,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,34.04,,,,,,,18.9100,439.0000,fee schedule,$34.04 from Fee Schedule BLDTM_23 for Rev 320 Proc 71100 * Qty 1 = $34.04 at 100% = $34.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS E NETWORK,63.39,,,,,,,18.9100,439.0000,fee schedule,$19.81 from Fee Schedule BCFSC for Rev 320 Proc 71100 * Qty 1 = $19.81 at 320% = $63.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,18.9100,439.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS P NETWORK,64.78,,,,,,,18.9100,439.0000,fee schedule,$19.81 from Fee Schedule BCFSC for Rev 320 Proc 71100 * Qty 1 = $19.81 at 327% = $64.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS S NETWORK,64.78,,,,,,,18.9100,439.0000,fee schedule,$19.81 from Fee Schedule BCFSC for Rev 320 Proc 71100 * Qty 1 = $19.81 at 327% = $64.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,TENNCARE BLUE CARE,18.91,,,,,,,18.9100,439.0000,fee schedule,$16.30 from Fee Schedule TC_24 for Rev 320 Proc 71100 * Qty 1 = $16.30 at 116% = $18.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,TENNCARE BLUE SELECT,18.91,,,,,,,18.9100,439.0000,fee schedule,$16.30 from Fee Schedule TC_24 for Rev 320 Proc 71100 * Qty 1 = $16.30 at 116% = $18.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,18.9100,439.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 71100 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,49.23,,,,,,,18.9100,439.0000,fee schedule,$49.23 from Fee Schedule CGIFP_25LR for Rev 320 Proc 71100 * Qty 1 = $49.23 at 100% = $49.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,18.9100,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,18.9100,439.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 71100 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,18.9100,439.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 71100 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,18.9100,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,395.10,,,,,,,18.9100,439.0000,percent of total billed charges,90% of $439.00 in Billed Charges for Rev 320 Proc 71100 = $395.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,HUMANA,HUMANA MEDICARE,78.96,,,,,,,18.9100,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,18.9100,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,MEDCOST,MEDCOST VHN,208.92,,,,,,,18.9100,439.0000,percent of total billed charges,47.59% of $439.00 in Billed Charges for Rev 320 Proc 71100 = $208.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,18.9100,439.0000,fee schedule,APG 00471 Proc 71100 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,18.9100,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,18.9100,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,18.9100,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,18.9100,439.0000,fee schedule,APG 00471 Proc 71100 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,SENTARA HEALTH,SENTARA HEALTH,113.31,,,,,,,18.9100,439.0000,percent of total billed charges,25.81% of $439.00 in Billed Charges for Rev 320 Proc 71100 = $113.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,18.9100,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",439.00,,,,,,,18.9100,439.0000,percent of total billed charges,100% of $439.00 in Billed Charges for Rev 320 Proc 71100 = $439.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,18.9100,439.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 71100 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,18.9100,439.0000,other,Rev 320 Proc 71100 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,18.9100,439.0000,other,Rev 320 Proc 71100 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,18.9100,439.0000,other,Rev 320 Proc 71100 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,18.9100,439.0000,fee schedule,APG 00471 Proc 71100 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,18.9100,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,18.9100,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,WELLCARE,WELLCARE MEDICAID,439.00,,,,,,,18.9100,439.0000,percent of total billed charges,100% of $439.00 in Billed Charges for Rev 320 Proc 71100 = $439.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX RIBS 2 VIEW UNILAT,71100,CPT,320,RC,32000034,CDM,,,,both,,,439.0000,65.8500,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,18.9100,439.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA,187.45,,,,,,,21.5400,439.0000,percent of total billed charges,42.7% of $439.00 in Billed Charges for Rev 320 Proc 71120 = $187.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,21.5400,439.0000,fee schedule,APG 00471 Proc 71120 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,21.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,21.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,21.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,AMBETTER,AMBETTER,172.12,,,,,,,21.5400,439.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,21.5400,439.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,21.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,21.5400,439.0000,fee schedule,APG 00471 Proc 71120 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,21.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,21.5400,439.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,21.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,34.34,,,,,,,21.5400,439.0000,fee schedule,$34.34 from Fee Schedule BLDTM_23 for Rev 320 Proc 71120 * Qty 1 = $34.34 at 100% = $34.34 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS E NETWORK,63.39,,,,,,,21.5400,439.0000,fee schedule,$19.81 from Fee Schedule BCFSC for Rev 320 Proc 71120 * Qty 1 = $19.81 at 320% = $63.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,21.5400,439.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS P NETWORK,64.78,,,,,,,21.5400,439.0000,fee schedule,$19.81 from Fee Schedule BCFSC for Rev 320 Proc 71120 * Qty 1 = $19.81 at 327% = $64.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS S NETWORK,64.78,,,,,,,21.5400,439.0000,fee schedule,$19.81 from Fee Schedule BCFSC for Rev 320 Proc 71120 * Qty 1 = $19.81 at 327% = $64.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,TENNCARE BLUE CARE,21.54,,,,,,,21.5400,439.0000,fee schedule,$18.57 from Fee Schedule TC_24 for Rev 320 Proc 71120 * Qty 1 = $18.57 at 116% = $21.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,TENNCARE BLUE SELECT,21.54,,,,,,,21.5400,439.0000,fee schedule,$18.57 from Fee Schedule TC_24 for Rev 320 Proc 71120 * Qty 1 = $18.57 at 116% = $21.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,21.5400,439.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 71120 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,45.48,,,,,,,21.5400,439.0000,fee schedule,$45.48 from Fee Schedule CGIFP_25LR for Rev 320 Proc 71120 * Qty 1 = $45.48 at 100% = $45.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,21.5400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,21.5400,439.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 71120 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,21.5400,439.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 71120 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,21.5400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,395.10,,,,,,,21.5400,439.0000,percent of total billed charges,90% of $439.00 in Billed Charges for Rev 320 Proc 71120 = $395.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,HUMANA,HUMANA MEDICARE,78.96,,,,,,,21.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,21.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,MEDCOST,MEDCOST VHN,208.92,,,,,,,21.5400,439.0000,percent of total billed charges,47.59% of $439.00 in Billed Charges for Rev 320 Proc 71120 = $208.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,21.5400,439.0000,fee schedule,APG 00471 Proc 71120 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,21.5400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,21.5400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,21.5400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,21.5400,439.0000,fee schedule,APG 00471 Proc 71120 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,SENTARA HEALTH,SENTARA HEALTH,113.31,,,,,,,21.5400,439.0000,percent of total billed charges,25.81% of $439.00 in Billed Charges for Rev 320 Proc 71120 = $113.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,21.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",439.00,,,,,,,21.5400,439.0000,percent of total billed charges,100% of $439.00 in Billed Charges for Rev 320 Proc 71120 = $439.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,21.5400,439.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 71120 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,21.5400,439.0000,other,Rev 320 Proc 71120 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,21.5400,439.0000,other,Rev 320 Proc 71120 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,21.5400,439.0000,other,Rev 320 Proc 71120 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,21.5400,439.0000,fee schedule,APG 00471 Proc 71120 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,21.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,21.5400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,WELLCARE,WELLCARE MEDICAID,439.00,,,,,,,21.5400,439.0000,percent of total billed charges,100% of $439.00 in Billed Charges for Rev 320 Proc 71120 = $439.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX STERNUM 2 VIEW,71120,CPT,320,RC,32000038,CDM,,,,both,,,439.0000,65.8500,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,21.5400,439.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TALUS FRESH ASEPTIC RIGHT,272,RC,,,,,,,,both,,,71041.3500,10656.2000,AETNA,AETNA,30334.66,,,,,,,18335.7700,71041.3500,percent of total billed charges,"42.7% of $71,041.35 in Billed Charges for Rev 272 = $30,334.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TALUS FRESH ASEPTIC RIGHT,272,RC,,,,,,,,both,,,71041.3500,10656.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,49728.95,,,,,,,18335.7700,71041.3500,percent of total billed charges,"Rev 272 $71,041.35 in Billed Charges at 70% = $49,728.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TALUS FRESH ASEPTIC RIGHT,272,RC,,,,,,,,both,,,71041.3500,10656.2000,CIGNA HEALTHCARE,CIGNA HMO,29624.24,,,,,,,18335.7700,71041.3500,percent of total billed charges,"41.7% of $71,041.35 in Billed Charges for Rev 272 = $29,624.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TALUS FRESH ASEPTIC RIGHT,272,RC,,,,,,,,both,,,71041.3500,10656.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,32963.19,,,,,,,18335.7700,71041.3500,percent of total billed charges,"46.4% of $71,041.35 in Billed Charges for Rev 272 = $32,963.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TALUS FRESH ASEPTIC RIGHT,272,RC,,,,,,,,both,,,71041.3500,10656.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,29624.24,,,,,,,18335.7700,71041.3500,percent of total billed charges,"41.7% of $71,041.35 in Billed Charges for Rev 272 = $29,624.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TALUS FRESH ASEPTIC RIGHT,272,RC,,,,,,,,both,,,71041.3500,10656.2000,CIGNA HEALTHCARE,CIGNA PPO,29624.24,,,,,,,18335.7700,71041.3500,percent of total billed charges,"41.7% of $71,041.35 in Billed Charges for Rev 272 = $29,624.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TALUS FRESH ASEPTIC RIGHT,272,RC,,,,,,,,both,,,71041.3500,10656.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,63937.22,,,,,,,18335.7700,71041.3500,percent of total billed charges,"90% of $71,041.35 in Billed Charges for Rev 272 = $63,937.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TALUS FRESH ASEPTIC RIGHT,272,RC,,,,,,,,both,,,71041.3500,10656.2000,MEDCOST,MEDCOST VHN,33808.58,,,,,,,18335.7700,71041.3500,percent of total billed charges,"47.59% of $71,041.35 in Billed Charges for Rev 272 = $33,808.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TALUS FRESH ASEPTIC RIGHT,272,RC,,,,,,,,both,,,71041.3500,10656.2000,SENTARA HEALTH,SENTARA HEALTH,18335.77,,,,,,,18335.7700,71041.3500,percent of total billed charges,"25.81% of $71,041.35 in Billed Charges for Rev 272 = $18,335.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TALUS FRESH ASEPTIC RIGHT,272,RC,,,,,,,,both,,,71041.3500,10656.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",71041.35,,,,,,,18335.7700,71041.3500,percent of total billed charges,"100% of $71,041.35 in Billed Charges for Rev 272 = $71,041.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TALUS FRESH ASEPTIC RIGHT,272,RC,,,,,,,,both,,,71041.3500,10656.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,35520.68,,,,,,,18335.7700,71041.3500,percent of total billed charges,"Rev 272 $71,041.35 in Billed Charges at 50% = $35,520.68. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TALUS FRESH ASEPTIC RIGHT,272,RC,,,,,,,,both,,,71041.3500,10656.2000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,22946.36,,,,,,,18335.7700,71041.3500,other,"32.3% of $71,041.35 in Billed Charges for Rev 272 = $22,946.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TALUS FRESH ASEPTIC RIGHT,272,RC,,,,,,,,both,,,71041.3500,10656.2000,UNITED HEALTHCARE,UHC HERITAGE SELECT,21809.69,,,,,,,18335.7700,71041.3500,other,"30.7% of $71,041.35 in Billed Charges for Rev 272 = $21,809.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TALUS FRESH ASEPTIC RIGHT,272,RC,,,,,,,,both,,,71041.3500,10656.2000,UNITED HEALTHCARE,UNITED HEALTHCARE,22946.36,,,,,,,18335.7700,71041.3500,percent of total billed charges,"32.3% of $71,041.35 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TALUS FRESH ASEPTIC RIGHT,272,RC,,,,,,,,both,,,71041.3500,10656.2000,WELLCARE,WELLCARE MEDICAID,71041.35,,,,,,,18335.7700,71041.3500,percent of total billed charges,"100% of $71,041.35 in Billed Charges for Rev 272 = $71,041.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP 5.5MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,12652.6200,1897.8900,AETNA,AETNA,5402.67,,,,,,,3265.6400,12652.6200,percent of total billed charges,"42.7% of $12,652.62 in Billed Charges for Rev 272 = $5,402.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP 5.5MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,12652.6200,1897.8900,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,8856.83,,,,,,,3265.6400,12652.6200,percent of total billed charges,"Rev 272 $12,652.62 in Billed Charges at 70% = $8,856.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP 5.5MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,12652.6200,1897.8900,CIGNA HEALTHCARE,CIGNA HMO,5276.14,,,,,,,3265.6400,12652.6200,percent of total billed charges,"41.7% of $12,652.62 in Billed Charges for Rev 272 = $5,276.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP 5.5MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,12652.6200,1897.8900,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5870.82,,,,,,,3265.6400,12652.6200,percent of total billed charges,"46.4% of $12,652.62 in Billed Charges for Rev 272 = $5,870.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP 5.5MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,12652.6200,1897.8900,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5276.14,,,,,,,3265.6400,12652.6200,percent of total billed charges,"41.7% of $12,652.62 in Billed Charges for Rev 272 = $5,276.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP 5.5MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,12652.6200,1897.8900,CIGNA HEALTHCARE,CIGNA PPO,5276.14,,,,,,,3265.6400,12652.6200,percent of total billed charges,"41.7% of $12,652.62 in Billed Charges for Rev 272 = $5,276.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP 5.5MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,12652.6200,1897.8900,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,11387.36,,,,,,,3265.6400,12652.6200,percent of total billed charges,"90% of $12,652.62 in Billed Charges for Rev 272 = $11,387.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP 5.5MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,12652.6200,1897.8900,MEDCOST,MEDCOST VHN,6021.38,,,,,,,3265.6400,12652.6200,percent of total billed charges,"47.59% of $12,652.62 in Billed Charges for Rev 272 = $6,021.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP 5.5MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,12652.6200,1897.8900,SENTARA HEALTH,SENTARA HEALTH,3265.64,,,,,,,3265.6400,12652.6200,percent of total billed charges,"25.81% of $12,652.62 in Billed Charges for Rev 272 = $3,265.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP 5.5MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,12652.6200,1897.8900,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12652.62,,,,,,,3265.6400,12652.6200,percent of total billed charges,"100% of $12,652.62 in Billed Charges for Rev 272 = $12,652.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP 5.5MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,12652.6200,1897.8900,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6326.31,,,,,,,3265.6400,12652.6200,percent of total billed charges,"Rev 272 $12,652.62 in Billed Charges at 50% = $6,326.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP 5.5MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,12652.6200,1897.8900,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4086.80,,,,,,,3265.6400,12652.6200,other,"32.3% of $12,652.62 in Billed Charges for Rev 272 = $4,086.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TAP 5.5MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,12652.6200,1897.8900,UNITED HEALTHCARE,UHC HERITAGE SELECT,3884.35,,,,,,,3265.6400,12652.6200,other,"30.7% of $12,652.62 in Billed Charges for Rev 272 = $3,884.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TAP 5.5MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,12652.6200,1897.8900,UNITED HEALTHCARE,UNITED HEALTHCARE,4086.80,,,,,,,3265.6400,12652.6200,percent of total billed charges,"32.3% of $12,652.62 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TAP 5.5MM NAVIGATED,272,RC,27200002,CDM,,,,,,both,,,12652.6200,1897.8900,WELLCARE,WELLCARE MEDICAID,12652.62,,,,,,,3265.6400,12652.6200,percent of total billed charges,"100% of $12,652.62 in Billed Charges for Rev 272 = $12,652.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,AETNA,AETNA,1593.14,,,,,,,150.2500,3731.0000,percent of total billed charges,"42.7% of $3,731.00 in Billed Charges for Rev 352 Proc 71260 = $1,593.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,459.22,,,,,,,150.2500,3731.0000,fee schedule,APG 00300 Proc 71260 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 104% = $459.22. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,159.14,,,,,,,150.2500,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,AETNA,AETNA HEALTHCARE MEDICARE,159.14,,,,,,,150.2500,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,159.14,,,,,,,150.2500,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,AMBETTER,AMBETTER,346.92,,,,,,,150.2500,3731.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,165.50,,,,,,,150.2500,3731.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,ANTHEM EXCHANGE,391.81,,,,,,,150.2500,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,454.80,,,,,,,150.2500,3731.0000,fee schedule,APG 00300 Proc 71260 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 103% = $454.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,ANTHEM HMO,416.27,,,,,,,150.2500,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,163.91,,,,,,,150.2500,3731.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",489.70,,,,,,,150.2500,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,419.58,,,,,,,150.2500,3731.0000,fee schedule,$419.58 from Fee Schedule BLDTM_23 for Rev 352 Proc 71260 * Qty 1 = $419.58 at 100% = $419.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,BLUE CROSS E NETWORK,512.22,,,,,,,150.2500,3731.0000,fee schedule,$160.07 from Fee Schedule BCFSD for Rev 352 Proc 71260 * Qty 1 = $160.07 at 320% = $512.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,BLUE CROSS MEDICARE,165.50,,,,,,,150.2500,3731.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,BLUE CROSS P NETWORK,523.43,,,,,,,150.2500,3731.0000,fee schedule,$160.07 from Fee Schedule BCFSD for Rev 352 Proc 71260 * Qty 1 = $160.07 at 327% = $523.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,BLUE CROSS S NETWORK,523.43,,,,,,,150.2500,3731.0000,fee schedule,$160.07 from Fee Schedule BCFSD for Rev 352 Proc 71260 * Qty 1 = $160.07 at 327% = $523.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,TENNCARE BLUE CARE,232.29,,,,,,,150.2500,3731.0000,fee schedule,$200.25 from Fee Schedule TC_24 for Rev 352 Proc 71260 * Qty 1 = $200.25 at 116% = $232.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,BLUE CROSS,TENNCARE BLUE SELECT,232.29,,,,,,,150.2500,3731.0000,fee schedule,$200.25 from Fee Schedule TC_24 for Rev 352 Proc 71260 * Qty 1 = $200.25 at 116% = $232.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,CIGNA HEALTHCARE,CIGNA HMO,642.00,,,,,,,150.2500,3731.0000,other,Rev 352 Proc 71260 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,427.00,,,,,,,150.2500,3731.0000,other,Rev 352 Proc 71260 Qty 1 * $427.00 = $427.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,167.09,,,,,,,150.2500,3731.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,642.00,,,,,,,150.2500,3731.0000,other,Rev 352 Proc 71260 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,CIGNA HEALTHCARE,CIGNA PPO,642.00,,,,,,,150.2500,3731.0000,other,Rev 352 Proc 71260 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,167.09,,,,,,,150.2500,3731.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3357.90,,,,,,,150.2500,3731.0000,percent of total billed charges,"90% of $3,731.00 in Billed Charges for Rev 352 Proc 71260 = $3,357.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,HUMANA,HUMANA MEDICARE,159.14,,,,,,,150.2500,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,159.14,,,,,,,150.2500,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,MEDCOST,MEDCOST VHN,1775.58,,,,,,,150.2500,3731.0000,percent of total billed charges,"47.59% of $3,731.00 in Billed Charges for Rev 352 Proc 71260 = $1,775.58. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,463.64,,,,,,,150.2500,3731.0000,fee schedule,APG 00300 Proc 71260 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 100% = $441.56... $441.56 at 105% = $463.64 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,167.09,,,,,,,150.2500,3731.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,167.09,,,,,,,150.2500,3731.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,NHC ADVANTAGE,NHC ADVANTAGE,167.09,,,,,,,150.2500,3731.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,455.25,,,,,,,150.2500,3731.0000,fee schedule,APG 00300 Proc 71260 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 100% = $441.56... $441.56 at 103.1% = $455.25 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,SENTARA HEALTH,SENTARA HEALTH,962.97,,,,,,,150.2500,3731.0000,percent of total billed charges,"25.81% of $3,731.00 in Billed Charges for Rev 352 Proc 71260 = $962.97. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,SENTARA HEALTH,SENTARA MEDICARE,159.14,,,,,,,150.2500,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3731.00,,,,,,,150.2500,3731.0000,percent of total billed charges,"100% of $3,731.00 in Billed Charges for Rev 352 Proc 71260 = $3,731.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,150.25,,,,,,,150.2500,3731.0000,fee schedule,$300.49 from Fee Schedule TCUHC24 for Rev 352 Proc 71260 * Qty 1 = $300.49 at 50% = $150.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1919.00,,,,,,,150.2500,3731.0000,other,"Rev 352 Proc 71260 1 Visit at $1,919.00 per Visit = $1,919.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1835.00,,,,,,,150.2500,3731.0000,other,"Rev 352 Proc 71260 1 Visit at $1,835.00 per Visit = $1,835.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,3026.00,,,,,,,150.2500,3731.0000,other,"Rev 352 Proc 71260 1 Visit at $3,026.00 per Visit = $3,026.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,454.80,,,,,,,150.2500,3731.0000,fee schedule,APG 00300 Proc 71260 at $836.60 (Base Rate) * 0.5278 (Relative Weight) = $441.56 (Total Line Payment) at 103% = $454.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,159.14,,,,,,,150.2500,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,159.14,,,,,,,150.2500,3731.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,WELLCARE,WELLCARE MEDICAID,3731.00,,,,,,,150.2500,3731.0000,percent of total billed charges,"100% of $3,731.00 in Billed Charges for Rev 352 Proc 71260 = $3,731.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT CHEST W CON,71260,CPT,352,RC,35200002,CDM,,,,both,,,3731.0000,559.6500,WELLCARE,WELLCARE MEDICARE,168.69,,,,,,,150.2500,3731.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,AETNA,AETNA,1812.62,,,,,,,169.2100,4245.0000,percent of total billed charges,"42.7% of $4,245.00 in Billed Charges for Rev 610 Proc 73218 Mod 50 = $1,812.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,514.86,,,,,,,169.2100,4245.0000,fee schedule,APG 00293 Proc 73218 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 150% Mod Percentage = $495.06 at 104% = $514.86. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,477.63,,,,,,,169.2100,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,AETNA,AETNA HEALTHCARE MEDICARE,477.63,,,,,,,169.2100,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,477.63,,,,,,,169.2100,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,AMBETTER,AMBETTER,1041.24,,,,,,,169.2100,4245.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,496.74,,,,,,,169.2100,4245.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,BLUE CROSS,ANTHEM EXCHANGE,1175.96,,,,,,,169.2100,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,509.91,,,,,,,169.2100,4245.0000,fee schedule,APG 00293 Proc 73218 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 150% Mod Percentage = $495.06 at 103% = $509.91. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,BLUE CROSS,ANTHEM HMO,1249.38,,,,,,,169.2100,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,491.96,,,,,,,169.2100,4245.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1469.78,,,,,,,169.2100,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,753.92,,,,,,,169.2100,4245.0000,fee schedule,$753.92 from Fee Schedule BLDTM_23 for Rev 610 Proc 73218 Mod 50 * Qty 1 = $753.92 at 100% = $753.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,BLUE CROSS,BLUE CROSS E NETWORK,868.38,,,,,,,169.2100,4245.0000,fee schedule,$271.37 from Fee Schedule BCFSD for Rev 610 Proc 73218 Mod 50 * Qty 1 = $271.37 at 320% = $868.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,BLUE CROSS,BLUE CROSS MEDICARE,496.74,,,,,,,169.2100,4245.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,BLUE CROSS,BLUE CROSS P NETWORK,887.38,,,,,,,169.2100,4245.0000,fee schedule,$271.37 from Fee Schedule BCFSD for Rev 610 Proc 73218 Mod 50 * Qty 1 = $271.37 at 327% = $887.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,BLUE CROSS,BLUE CROSS S NETWORK,887.38,,,,,,,169.2100,4245.0000,fee schedule,$271.37 from Fee Schedule BCFSD for Rev 610 Proc 73218 Mod 50 * Qty 1 = $271.37 at 327% = $887.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,BLUE CROSS,TENNCARE BLUE CARE,367.77,,,,,,,169.2100,4245.0000,fee schedule,$317.04 from Fee Schedule TC_24 for Rev 610 Proc 73218 Mod 50 * Qty 1 = $317.04 at 116% = $367.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,BLUE CROSS,TENNCARE BLUE SELECT,367.77,,,,,,,169.2100,4245.0000,fee schedule,$317.04 from Fee Schedule TC_24 for Rev 610 Proc 73218 Mod 50 * Qty 1 = $317.04 at 116% = $367.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,CIGNA HEALTHCARE,CIGNA HMO,1215.00,,,,,,,169.2100,4245.0000,other,"Rev 610 Proc 73218 Mod 50 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,786.00,,,,,,,169.2100,4245.0000,other,Rev 610 Proc 73218 Mod 50 Qty 1 * $786.00 = $786.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,501.51,,,,,,,169.2100,4245.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1215.00,,,,,,,169.2100,4245.0000,other,"Rev 610 Proc 73218 Mod 50 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,CIGNA HEALTHCARE,CIGNA PPO,1215.00,,,,,,,169.2100,4245.0000,other,"Rev 610 Proc 73218 Mod 50 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,501.51,,,,,,,169.2100,4245.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3820.50,,,,,,,169.2100,4245.0000,percent of total billed charges,"90% of $4,245.00 in Billed Charges for Rev 610 Proc 73218 Mod 50 = $3,820.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,HUMANA,HUMANA MEDICARE,477.63,,,,,,,169.2100,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,477.63,,,,,,,169.2100,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,MEDCOST,MEDCOST VHN,2020.20,,,,,,,169.2100,4245.0000,percent of total billed charges,"47.59% of $4,245.00 in Billed Charges for Rev 610 Proc 73218 Mod 50 = $2,020.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,519.81,,,,,,,169.2100,4245.0000,fee schedule,APG 00293 Proc 73218 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 150% Mod Percentage = $495.06 at 100% = $495.06... $495.06 at 105% = $519.81 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,501.51,,,,,,,169.2100,4245.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,501.51,,,,,,,169.2100,4245.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,NHC ADVANTAGE,NHC ADVANTAGE,501.51,,,,,,,169.2100,4245.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,510.41,,,,,,,169.2100,4245.0000,fee schedule,APG 00293 Proc 73218 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 150% Mod Percentage = $495.06 at 100% = $495.06... $495.06 at 103.1% = $510.41 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,SENTARA HEALTH,SENTARA HEALTH,1095.63,,,,,,,169.2100,4245.0000,percent of total billed charges,"25.81% of $4,245.00 in Billed Charges for Rev 610 Proc 73218 Mod 50 = $1,095.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,SENTARA HEALTH,SENTARA MEDICARE,477.63,,,,,,,169.2100,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4245.00,,,,,,,169.2100,4245.0000,percent of total billed charges,"100% of $4,245.00 in Billed Charges for Rev 610 Proc 73218 Mod 50 = $4,245.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,169.21,,,,,,,169.2100,4245.0000,fee schedule,$338.41 from Fee Schedule TCUHC24 for Rev 610 Proc 73218 Mod 50 * Qty 1 = $338.41 at 50% = $169.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2559.00,,,,,,,169.2100,4245.0000,other,"Rev 610 Proc 73218 Mod 50 1 Visit at $2,559.00 per Visit = $2,559.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2448.00,,,,,,,169.2100,4245.0000,other,"Rev 610 Proc 73218 Mod 50 1 Visit at $2,448.00 per Visit = $2,448.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,4035.00,,,,,,,169.2100,4245.0000,other,"Rev 610 Proc 73218 Mod 50 1 Visit at $4,035.00 per Visit = $4,035.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,509.91,,,,,,,169.2100,4245.0000,fee schedule,APG 00293 Proc 73218 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 150% Mod Percentage = $495.06 at 103% = $509.91. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,477.63,,,,,,,169.2100,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,477.63,,,,,,,169.2100,4245.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,WELLCARE,WELLCARE MEDICAID,4245.00,,,,,,,169.2100,4245.0000,percent of total billed charges,"100% of $4,245.00 in Billed Charges for Rev 610 Proc 73218 Mod 50 = $4,245.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR UPPER EXTREM NON JT WO CON BILAT,73218,CPT,610,RC,61000076,CDM,,,50,both,,,4245.0000,636.7500,WELLCARE,WELLCARE MEDICARE,506.29,,,,,,,169.2100,4245.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,AETNA,AETNA,2765.25,,,,,,,217.9200,6476.0000,percent of total billed charges,"42.7% of $6,476.00 in Billed Charges for Rev 610 Proc 73219 Mod 50 = $2,765.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,865.80,,,,,,,217.9200,6476.0000,fee schedule,APG 00295 Proc 73219 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 150% Mod Percentage = $832.50 at 104% = $865.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,770.00,,,,,,,217.9200,6476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,AETNA,AETNA HEALTHCARE MEDICARE,770.00,,,,,,,217.9200,6476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,770.00,,,,,,,217.9200,6476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,AMBETTER,AMBETTER,1678.60,,,,,,,217.9200,6476.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,800.80,,,,,,,217.9200,6476.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,BLUE CROSS,ANTHEM EXCHANGE,1895.79,,,,,,,217.9200,6476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,857.48,,,,,,,217.9200,6476.0000,fee schedule,APG 00295 Proc 73219 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 150% Mod Percentage = $832.50 at 103% = $857.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,BLUE CROSS,ANTHEM HMO,2014.16,,,,,,,217.9200,6476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,793.10,,,,,,,217.9200,6476.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2369.47,,,,,,,217.9200,6476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,903.90,,,,,,,217.9200,6476.0000,fee schedule,$903.90 from Fee Schedule BLDTM_23 for Rev 610 Proc 73219 Mod 50 * Qty 1 = $903.90 at 100% = $903.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,BLUE CROSS,BLUE CROSS E NETWORK,973.38,,,,,,,217.9200,6476.0000,fee schedule,$304.18 from Fee Schedule BCFSD for Rev 610 Proc 73219 Mod 50 * Qty 1 = $304.18 at 320% = $973.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,BLUE CROSS,BLUE CROSS MEDICARE,800.80,,,,,,,217.9200,6476.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,BLUE CROSS,BLUE CROSS P NETWORK,994.67,,,,,,,217.9200,6476.0000,fee schedule,$304.18 from Fee Schedule BCFSD for Rev 610 Proc 73219 Mod 50 * Qty 1 = $304.18 at 327% = $994.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,BLUE CROSS,BLUE CROSS S NETWORK,994.67,,,,,,,217.9200,6476.0000,fee schedule,$304.18 from Fee Schedule BCFSD for Rev 610 Proc 73219 Mod 50 * Qty 1 = $304.18 at 327% = $994.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,BLUE CROSS,TENNCARE BLUE CARE,440.93,,,,,,,217.9200,6476.0000,fee schedule,$380.11 from Fee Schedule TC_24 for Rev 610 Proc 73219 Mod 50 * Qty 1 = $380.11 at 116% = $440.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,BLUE CROSS,TENNCARE BLUE SELECT,440.93,,,,,,,217.9200,6476.0000,fee schedule,$380.11 from Fee Schedule TC_24 for Rev 610 Proc 73219 Mod 50 * Qty 1 = $380.11 at 116% = $440.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,CIGNA HEALTHCARE,CIGNA HMO,1215.00,,,,,,,217.9200,6476.0000,other,"Rev 610 Proc 73219 Mod 50 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,786.00,,,,,,,217.9200,6476.0000,other,Rev 610 Proc 73219 Mod 50 Qty 1 * $786.00 = $786.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,808.50,,,,,,,217.9200,6476.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1215.00,,,,,,,217.9200,6476.0000,other,"Rev 610 Proc 73219 Mod 50 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,CIGNA HEALTHCARE,CIGNA PPO,1215.00,,,,,,,217.9200,6476.0000,other,"Rev 610 Proc 73219 Mod 50 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,808.50,,,,,,,217.9200,6476.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5828.40,,,,,,,217.9200,6476.0000,percent of total billed charges,"90% of $6,476.00 in Billed Charges for Rev 610 Proc 73219 Mod 50 = $5,828.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,HUMANA,HUMANA MEDICARE,770.00,,,,,,,217.9200,6476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,770.00,,,,,,,217.9200,6476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,MEDCOST,MEDCOST VHN,3081.93,,,,,,,217.9200,6476.0000,percent of total billed charges,"47.59% of $6,476.00 in Billed Charges for Rev 610 Proc 73219 Mod 50 = $3,081.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,874.13,,,,,,,217.9200,6476.0000,fee schedule,APG 00295 Proc 73219 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 150% Mod Percentage = $832.50 at 100% = $832.50... $832.50 at 105% = $874.13 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,808.50,,,,,,,217.9200,6476.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,808.50,,,,,,,217.9200,6476.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,NHC ADVANTAGE,NHC ADVANTAGE,808.50,,,,,,,217.9200,6476.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,858.31,,,,,,,217.9200,6476.0000,fee schedule,APG 00295 Proc 73219 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 150% Mod Percentage = $832.50 at 100% = $832.50... $832.50 at 103.1% = $858.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,SENTARA HEALTH,SENTARA HEALTH,1671.46,,,,,,,217.9200,6476.0000,percent of total billed charges,"25.81% of $6,476.00 in Billed Charges for Rev 610 Proc 73219 Mod 50 = $1,671.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,SENTARA HEALTH,SENTARA MEDICARE,770.00,,,,,,,217.9200,6476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6476.00,,,,,,,217.9200,6476.0000,percent of total billed charges,"100% of $6,476.00 in Billed Charges for Rev 610 Proc 73219 Mod 50 = $6,476.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,217.92,,,,,,,217.9200,6476.0000,fee schedule,$435.84 from Fee Schedule TCUHC24 for Rev 610 Proc 73219 Mod 50 * Qty 1 = $435.84 at 50% = $217.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2559.00,,,,,,,217.9200,6476.0000,other,"Rev 610 Proc 73219 Mod 50 1 Visit at $2,559.00 per Visit = $2,559.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2448.00,,,,,,,217.9200,6476.0000,other,"Rev 610 Proc 73219 Mod 50 1 Visit at $2,448.00 per Visit = $2,448.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,4035.00,,,,,,,217.9200,6476.0000,other,"Rev 610 Proc 73219 Mod 50 1 Visit at $4,035.00 per Visit = $4,035.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,857.48,,,,,,,217.9200,6476.0000,fee schedule,APG 00295 Proc 73219 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 150% Mod Percentage = $832.50 at 103% = $857.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,770.00,,,,,,,217.9200,6476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,770.00,,,,,,,217.9200,6476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,WELLCARE,WELLCARE MEDICAID,6476.00,,,,,,,217.9200,6476.0000,percent of total billed charges,"100% of $6,476.00 in Billed Charges for Rev 610 Proc 73219 Mod 50 = $6,476.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR UPPER EXTREM NON JT W CON BILAT,73219,CPT,610,RC,61000075,CDM,,,50,both,,,6476.0000,971.4000,WELLCARE,WELLCARE MEDICARE,816.20,,,,,,,217.9200,6476.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,AETNA,AETNA,1722.09,,,,,,,169.2100,4033.0000,percent of total billed charges,"42.7% of $4,033.00 in Billed Charges for Rev 610 Proc 73221 = $1,722.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,343.24,,,,,,,169.2100,4033.0000,fee schedule,APG 00293 Proc 73221 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 104% = $343.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,216.48,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,AETNA,AETNA HEALTHCARE MEDICARE,216.48,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,216.48,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,AMBETTER,AMBETTER,471.92,,,,,,,169.2100,4033.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,225.14,,,,,,,169.2100,4033.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,ANTHEM EXCHANGE,532.97,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,339.94,,,,,,,169.2100,4033.0000,fee schedule,APG 00293 Proc 73221 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 103% = $339.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,ANTHEM HMO,566.25,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,222.97,,,,,,,169.2100,4033.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",666.14,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,678.20,,,,,,,169.2100,4033.0000,fee schedule,$678.20 from Fee Schedule BLDTM_23 for Rev 610 Proc 73221 * Qty 1 = $678.20 at 100% = $678.20 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,BLUE CROSS E NETWORK,536.93,,,,,,,169.2100,4033.0000,fee schedule,$167.79 from Fee Schedule BCFSD for Rev 610 Proc 73221 * Qty 1 = $167.79 at 320% = $536.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,BLUE CROSS MEDICARE,225.14,,,,,,,169.2100,4033.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,BLUE CROSS P NETWORK,548.67,,,,,,,169.2100,4033.0000,fee schedule,$167.79 from Fee Schedule BCFSD for Rev 610 Proc 73221 * Qty 1 = $167.79 at 327% = $548.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,BLUE CROSS S NETWORK,548.67,,,,,,,169.2100,4033.0000,fee schedule,$167.79 from Fee Schedule BCFSD for Rev 610 Proc 73221 * Qty 1 = $167.79 at 327% = $548.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,TENNCARE BLUE CARE,368.16,,,,,,,169.2100,4033.0000,fee schedule,$317.38 from Fee Schedule TC_24 for Rev 610 Proc 73221 * Qty 1 = $317.38 at 116% = $368.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,BLUE CROSS,TENNCARE BLUE SELECT,368.16,,,,,,,169.2100,4033.0000,fee schedule,$317.38 from Fee Schedule TC_24 for Rev 610 Proc 73221 * Qty 1 = $317.38 at 116% = $368.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,CIGNA HEALTHCARE,CIGNA HMO,1215.00,,,,,,,169.2100,4033.0000,other,"Rev 610 Proc 73221 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,786.00,,,,,,,169.2100,4033.0000,other,Rev 610 Proc 73221 Qty 1 * $786.00 = $786.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,227.30,,,,,,,169.2100,4033.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1215.00,,,,,,,169.2100,4033.0000,other,"Rev 610 Proc 73221 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,CIGNA HEALTHCARE,CIGNA PPO,1215.00,,,,,,,169.2100,4033.0000,other,"Rev 610 Proc 73221 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,227.30,,,,,,,169.2100,4033.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3629.70,,,,,,,169.2100,4033.0000,percent of total billed charges,"90% of $4,033.00 in Billed Charges for Rev 610 Proc 73221 = $3,629.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,HUMANA,HUMANA MEDICARE,216.48,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,216.48,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,MEDCOST,MEDCOST VHN,1919.30,,,,,,,169.2100,4033.0000,percent of total billed charges,"47.59% of $4,033.00 in Billed Charges for Rev 610 Proc 73221 = $1,919.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,346.54,,,,,,,169.2100,4033.0000,fee schedule,APG 00293 Proc 73221 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 100% = $330.04... $330.04 at 105% = $346.54 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,227.30,,,,,,,169.2100,4033.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,227.30,,,,,,,169.2100,4033.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,NHC ADVANTAGE,NHC ADVANTAGE,227.30,,,,,,,169.2100,4033.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,340.27,,,,,,,169.2100,4033.0000,fee schedule,APG 00293 Proc 73221 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 100% = $330.04... $330.04 at 103.1% = $340.27 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,SENTARA HEALTH,SENTARA HEALTH,1040.92,,,,,,,169.2100,4033.0000,percent of total billed charges,"25.81% of $4,033.00 in Billed Charges for Rev 610 Proc 73221 = $1,040.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,SENTARA HEALTH,SENTARA MEDICARE,216.48,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4033.00,,,,,,,169.2100,4033.0000,percent of total billed charges,"100% of $4,033.00 in Billed Charges for Rev 610 Proc 73221 = $4,033.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,169.21,,,,,,,169.2100,4033.0000,fee schedule,$338.41 from Fee Schedule TCUHC24 for Rev 610 Proc 73221 * Qty 1 = $338.41 at 50% = $169.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2559.00,,,,,,,169.2100,4033.0000,other,"Rev 610 Proc 73221 1 Visit at $2,559.00 per Visit = $2,559.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2448.00,,,,,,,169.2100,4033.0000,other,"Rev 610 Proc 73221 1 Visit at $2,448.00 per Visit = $2,448.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,4033.00,,,,,,,169.2100,4033.0000,other,"Rev 610 Proc 73221 1 Visit at $4,035.00 per Visit = $4,035.00 (Service Line reduced to $4,033.00, claim capped at $4,033.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,339.94,,,,,,,169.2100,4033.0000,fee schedule,APG 00293 Proc 73221 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 103% = $339.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,216.48,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,216.48,,,,,,,169.2100,4033.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,WELLCARE,WELLCARE MEDICAID,4033.00,,,,,,,169.2100,4033.0000,percent of total billed charges,"100% of $4,033.00 in Billed Charges for Rev 610 Proc 73221 = $4,033.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR JOINT UPR EXTREM WO CON,73221,CPT,610,RC,61000020,CDM,,,,both,,,4033.0000,604.9500,WELLCARE,WELLCARE MEDICARE,229.47,,,,,,,169.2100,4033.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TRAY THORA/PARA SAFE-T-PLUS SURPASS SEE LN 151949,272,RC,27200002,CDM,,,,,,both,,,750.7000,112.6100,AETNA,AETNA,320.55,,,,,,,193.7600,750.7000,percent of total billed charges,42.7% of $750.70 in Billed Charges for Rev 272 = $320.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY THORA/PARA SAFE-T-PLUS SURPASS SEE LN 151949,272,RC,27200002,CDM,,,,,,both,,,750.7000,112.6100,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,525.49,,,,,,,193.7600,750.7000,percent of total billed charges,Rev 272 $750.70 in Billed Charges at 70% = $525.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY THORA/PARA SAFE-T-PLUS SURPASS SEE LN 151949,272,RC,27200002,CDM,,,,,,both,,,750.7000,112.6100,CIGNA HEALTHCARE,CIGNA HMO,313.04,,,,,,,193.7600,750.7000,percent of total billed charges,41.7% of $750.70 in Billed Charges for Rev 272 = $313.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY THORA/PARA SAFE-T-PLUS SURPASS SEE LN 151949,272,RC,27200002,CDM,,,,,,both,,,750.7000,112.6100,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,348.32,,,,,,,193.7600,750.7000,percent of total billed charges,46.4% of $750.70 in Billed Charges for Rev 272 = $348.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY THORA/PARA SAFE-T-PLUS SURPASS SEE LN 151949,272,RC,27200002,CDM,,,,,,both,,,750.7000,112.6100,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,313.04,,,,,,,193.7600,750.7000,percent of total billed charges,41.7% of $750.70 in Billed Charges for Rev 272 = $313.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY THORA/PARA SAFE-T-PLUS SURPASS SEE LN 151949,272,RC,27200002,CDM,,,,,,both,,,750.7000,112.6100,CIGNA HEALTHCARE,CIGNA PPO,313.04,,,,,,,193.7600,750.7000,percent of total billed charges,41.7% of $750.70 in Billed Charges for Rev 272 = $313.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY THORA/PARA SAFE-T-PLUS SURPASS SEE LN 151949,272,RC,27200002,CDM,,,,,,both,,,750.7000,112.6100,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,675.63,,,,,,,193.7600,750.7000,percent of total billed charges,90% of $750.70 in Billed Charges for Rev 272 = $675.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY THORA/PARA SAFE-T-PLUS SURPASS SEE LN 151949,272,RC,27200002,CDM,,,,,,both,,,750.7000,112.6100,MEDCOST,MEDCOST VHN,357.26,,,,,,,193.7600,750.7000,percent of total billed charges,47.59% of $750.70 in Billed Charges for Rev 272 = $357.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY THORA/PARA SAFE-T-PLUS SURPASS SEE LN 151949,272,RC,27200002,CDM,,,,,,both,,,750.7000,112.6100,SENTARA HEALTH,SENTARA HEALTH,193.76,,,,,,,193.7600,750.7000,percent of total billed charges,25.81% of $750.70 in Billed Charges for Rev 272 = $193.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY THORA/PARA SAFE-T-PLUS SURPASS SEE LN 151949,272,RC,27200002,CDM,,,,,,both,,,750.7000,112.6100,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",750.70,,,,,,,193.7600,750.7000,percent of total billed charges,100% of $750.70 in Billed Charges for Rev 272 = $750.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY THORA/PARA SAFE-T-PLUS SURPASS SEE LN 151949,272,RC,27200002,CDM,,,,,,both,,,750.7000,112.6100,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,375.35,,,,,,,193.7600,750.7000,percent of total billed charges,Rev 272 $750.70 in Billed Charges at 50% = $375.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY THORA/PARA SAFE-T-PLUS SURPASS SEE LN 151949,272,RC,27200002,CDM,,,,,,both,,,750.7000,112.6100,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,242.48,,,,,,,193.7600,750.7000,other,32.3% of $750.70 in Billed Charges for Rev 272 = $242.48 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TRAY THORA/PARA SAFE-T-PLUS SURPASS SEE LN 151949,272,RC,27200002,CDM,,,,,,both,,,750.7000,112.6100,UNITED HEALTHCARE,UHC HERITAGE SELECT,230.46,,,,,,,193.7600,750.7000,other,30.7% of $750.70 in Billed Charges for Rev 272 = $230.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TRAY THORA/PARA SAFE-T-PLUS SURPASS SEE LN 151949,272,RC,27200002,CDM,,,,,,both,,,750.7000,112.6100,UNITED HEALTHCARE,UNITED HEALTHCARE,242.48,,,,,,,193.7600,750.7000,percent of total billed charges,32.3% of $750.70 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
TRAY THORA/PARA SAFE-T-PLUS SURPASS SEE LN 151949,272,RC,27200002,CDM,,,,,,both,,,750.7000,112.6100,WELLCARE,WELLCARE MEDICAID,750.70,,,,,,,193.7600,750.7000,percent of total billed charges,100% of $750.70 in Billed Charges for Rev 272 = $750.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,AETNA,AETNA,2765.25,,,,,,,217.9200,6476.0000,percent of total billed charges,"42.7% of $6,476.00 in Billed Charges for Rev 610 Proc 73222 Mod 50 = $2,765.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,865.80,,,,,,,217.9200,6476.0000,fee schedule,APG 00295 Proc 73222 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 150% Mod Percentage = $832.50 at 104% = $865.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,770.00,,,,,,,217.9200,6476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,AETNA,AETNA HEALTHCARE MEDICARE,770.00,,,,,,,217.9200,6476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,770.00,,,,,,,217.9200,6476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,AMBETTER,AMBETTER,1678.60,,,,,,,217.9200,6476.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,800.80,,,,,,,217.9200,6476.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,BLUE CROSS,ANTHEM EXCHANGE,1895.79,,,,,,,217.9200,6476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,857.48,,,,,,,217.9200,6476.0000,fee schedule,APG 00295 Proc 73222 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 150% Mod Percentage = $832.50 at 103% = $857.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,BLUE CROSS,ANTHEM HMO,2014.16,,,,,,,217.9200,6476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,793.10,,,,,,,217.9200,6476.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2369.47,,,,,,,217.9200,6476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,903.90,,,,,,,217.9200,6476.0000,fee schedule,$903.90 from Fee Schedule BLDTM_23 for Rev 610 Proc 73222 Mod 50 * Qty 1 = $903.90 at 100% = $903.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,BLUE CROSS,BLUE CROSS E NETWORK,893.09,,,,,,,217.9200,6476.0000,fee schedule,$279.09 from Fee Schedule BCFSD for Rev 610 Proc 73222 Mod 50 * Qty 1 = $279.09 at 320% = $893.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,BLUE CROSS,BLUE CROSS MEDICARE,800.80,,,,,,,217.9200,6476.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,BLUE CROSS,BLUE CROSS P NETWORK,912.62,,,,,,,217.9200,6476.0000,fee schedule,$279.09 from Fee Schedule BCFSD for Rev 610 Proc 73222 Mod 50 * Qty 1 = $279.09 at 327% = $912.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,BLUE CROSS,BLUE CROSS S NETWORK,912.62,,,,,,,217.9200,6476.0000,fee schedule,$279.09 from Fee Schedule BCFSD for Rev 610 Proc 73222 Mod 50 * Qty 1 = $279.09 at 327% = $912.62 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,BLUE CROSS,TENNCARE BLUE CARE,440.93,,,,,,,217.9200,6476.0000,fee schedule,$380.11 from Fee Schedule TC_24 for Rev 610 Proc 73222 Mod 50 * Qty 1 = $380.11 at 116% = $440.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,BLUE CROSS,TENNCARE BLUE SELECT,440.93,,,,,,,217.9200,6476.0000,fee schedule,$380.11 from Fee Schedule TC_24 for Rev 610 Proc 73222 Mod 50 * Qty 1 = $380.11 at 116% = $440.93 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,CIGNA HEALTHCARE,CIGNA HMO,1215.00,,,,,,,217.9200,6476.0000,other,"Rev 610 Proc 73222 Mod 50 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,786.00,,,,,,,217.9200,6476.0000,other,Rev 610 Proc 73222 Mod 50 Qty 1 * $786.00 = $786.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,808.50,,,,,,,217.9200,6476.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1215.00,,,,,,,217.9200,6476.0000,other,"Rev 610 Proc 73222 Mod 50 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,CIGNA HEALTHCARE,CIGNA PPO,1215.00,,,,,,,217.9200,6476.0000,other,"Rev 610 Proc 73222 Mod 50 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,808.50,,,,,,,217.9200,6476.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,5828.40,,,,,,,217.9200,6476.0000,percent of total billed charges,"90% of $6,476.00 in Billed Charges for Rev 610 Proc 73222 Mod 50 = $5,828.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,HUMANA,HUMANA MEDICARE,770.00,,,,,,,217.9200,6476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,770.00,,,,,,,217.9200,6476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,MEDCOST,MEDCOST VHN,3081.93,,,,,,,217.9200,6476.0000,percent of total billed charges,"47.59% of $6,476.00 in Billed Charges for Rev 610 Proc 73222 Mod 50 = $3,081.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,874.13,,,,,,,217.9200,6476.0000,fee schedule,APG 00295 Proc 73222 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 150% Mod Percentage = $832.50 at 100% = $832.50... $832.50 at 105% = $874.13 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,808.50,,,,,,,217.9200,6476.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,808.50,,,,,,,217.9200,6476.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,NHC ADVANTAGE,NHC ADVANTAGE,808.50,,,,,,,217.9200,6476.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,858.31,,,,,,,217.9200,6476.0000,fee schedule,APG 00295 Proc 73222 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 150% Mod Percentage = $832.50 at 100% = $832.50... $832.50 at 103.1% = $858.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,SENTARA HEALTH,SENTARA HEALTH,1671.46,,,,,,,217.9200,6476.0000,percent of total billed charges,"25.81% of $6,476.00 in Billed Charges for Rev 610 Proc 73222 Mod 50 = $1,671.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,SENTARA HEALTH,SENTARA MEDICARE,770.00,,,,,,,217.9200,6476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",6476.00,,,,,,,217.9200,6476.0000,percent of total billed charges,"100% of $6,476.00 in Billed Charges for Rev 610 Proc 73222 Mod 50 = $6,476.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,217.92,,,,,,,217.9200,6476.0000,fee schedule,$435.84 from Fee Schedule TCUHC24 for Rev 610 Proc 73222 Mod 50 * Qty 1 = $435.84 at 50% = $217.92 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2559.00,,,,,,,217.9200,6476.0000,other,"Rev 610 Proc 73222 Mod 50 1 Visit at $2,559.00 per Visit = $2,559.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2448.00,,,,,,,217.9200,6476.0000,other,"Rev 610 Proc 73222 Mod 50 1 Visit at $2,448.00 per Visit = $2,448.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,4035.00,,,,,,,217.9200,6476.0000,other,"Rev 610 Proc 73222 Mod 50 1 Visit at $4,035.00 per Visit = $4,035.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,857.48,,,,,,,217.9200,6476.0000,fee schedule,APG 00295 Proc 73222 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 150% Mod Percentage = $832.50 at 103% = $857.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,770.00,,,,,,,217.9200,6476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,770.00,,,,,,,217.9200,6476.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,WELLCARE,WELLCARE MEDICAID,6476.00,,,,,,,217.9200,6476.0000,percent of total billed charges,"100% of $6,476.00 in Billed Charges for Rev 610 Proc 73222 Mod 50 = $6,476.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR JOINT UP EXT W CON BILAT,73222,CPT,610,RC,61000073,CDM,,,50,both,,,6476.0000,971.4000,WELLCARE,WELLCARE MEDICARE,816.20,,,,,,,217.9200,6476.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,AETNA,AETNA,1903.14,,,,,,,267.0200,4457.0000,percent of total billed charges,"42.7% of $4,457.00 in Billed Charges for Rev 610 Proc 73223 = $1,903.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,577.20,,,,,,,267.0200,4457.0000,fee schedule,APG 00295 Proc 73223 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 104% = $577.20. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,316.52,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,AETNA,AETNA HEALTHCARE MEDICARE,316.52,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,316.52,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,AMBETTER,AMBETTER,690.02,,,,,,,267.0200,4457.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,329.19,,,,,,,267.0200,4457.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,ANTHEM EXCHANGE,779.29,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,571.65,,,,,,,267.0200,4457.0000,fee schedule,APG 00295 Proc 73223 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 103% = $571.65. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,ANTHEM HMO,827.95,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,326.02,,,,,,,267.0200,4457.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",974.01,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1673.39,,,,,,,267.0200,4457.0000,fee schedule,"$1,673.39 from Fee Schedule BLDTM_23 for Rev 610 Proc 73223 * Qty 1 = $1,673.39 at 100% = $1,673.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,BLUE CROSS E NETWORK,1088.67,,,,,,,267.0200,4457.0000,fee schedule,"$340.21 from Fee Schedule BCFSD for Rev 610 Proc 73223 * Qty 1 = $340.21 at 320% = $1,088.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,BLUE CROSS MEDICARE,329.19,,,,,,,267.0200,4457.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,BLUE CROSS P NETWORK,1112.49,,,,,,,267.0200,4457.0000,fee schedule,"$340.21 from Fee Schedule BCFSD for Rev 610 Proc 73223 * Qty 1 = $340.21 at 327% = $1,112.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,BLUE CROSS S NETWORK,1112.49,,,,,,,267.0200,4457.0000,fee schedule,"$340.21 from Fee Schedule BCFSD for Rev 610 Proc 73223 * Qty 1 = $340.21 at 327% = $1,112.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,TENNCARE BLUE CARE,816.28,,,,,,,267.0200,4457.0000,fee schedule,$703.69 from Fee Schedule TC_24 for Rev 610 Proc 73223 * Qty 1 = $703.69 at 116% = $816.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,BLUE CROSS,TENNCARE BLUE SELECT,816.28,,,,,,,267.0200,4457.0000,fee schedule,$703.69 from Fee Schedule TC_24 for Rev 610 Proc 73223 * Qty 1 = $703.69 at 116% = $816.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,CIGNA HEALTHCARE,CIGNA HMO,1215.00,,,,,,,267.0200,4457.0000,other,"Rev 610 Proc 73223 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,786.00,,,,,,,267.0200,4457.0000,other,Rev 610 Proc 73223 Qty 1 * $786.00 = $786.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,332.35,,,,,,,267.0200,4457.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1215.00,,,,,,,267.0200,4457.0000,other,"Rev 610 Proc 73223 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,CIGNA HEALTHCARE,CIGNA PPO,1215.00,,,,,,,267.0200,4457.0000,other,"Rev 610 Proc 73223 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,332.35,,,,,,,267.0200,4457.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4011.30,,,,,,,267.0200,4457.0000,percent of total billed charges,"90% of $4,457.00 in Billed Charges for Rev 610 Proc 73223 = $4,011.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,HUMANA,HUMANA MEDICARE,316.52,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,316.52,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,MEDCOST,MEDCOST VHN,2121.09,,,,,,,267.0200,4457.0000,percent of total billed charges,"47.59% of $4,457.00 in Billed Charges for Rev 610 Proc 73223 = $2,121.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,582.75,,,,,,,267.0200,4457.0000,fee schedule,APG 00295 Proc 73223 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 100% = $555.00... $555.00 at 105% = $582.75 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,332.35,,,,,,,267.0200,4457.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,332.35,,,,,,,267.0200,4457.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,NHC ADVANTAGE,NHC ADVANTAGE,332.35,,,,,,,267.0200,4457.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,572.21,,,,,,,267.0200,4457.0000,fee schedule,APG 00295 Proc 73223 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 100% = $555.00... $555.00 at 103.1% = $572.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,SENTARA HEALTH,SENTARA HEALTH,1150.35,,,,,,,267.0200,4457.0000,percent of total billed charges,"25.81% of $4,457.00 in Billed Charges for Rev 610 Proc 73223 = $1,150.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,SENTARA HEALTH,SENTARA MEDICARE,316.52,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4457.00,,,,,,,267.0200,4457.0000,percent of total billed charges,"100% of $4,457.00 in Billed Charges for Rev 610 Proc 73223 = $4,457.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,267.02,,,,,,,267.0200,4457.0000,fee schedule,$534.03 from Fee Schedule TCUHC24 for Rev 610 Proc 73223 * Qty 1 = $534.03 at 50% = $267.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2559.00,,,,,,,267.0200,4457.0000,other,"Rev 610 Proc 73223 1 Visit at $2,559.00 per Visit = $2,559.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2448.00,,,,,,,267.0200,4457.0000,other,"Rev 610 Proc 73223 1 Visit at $2,448.00 per Visit = $2,448.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,4035.00,,,,,,,267.0200,4457.0000,other,"Rev 610 Proc 73223 1 Visit at $4,035.00 per Visit = $4,035.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,571.65,,,,,,,267.0200,4457.0000,fee schedule,APG 00295 Proc 73223 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 103% = $571.65. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,316.52,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,316.52,,,,,,,267.0200,4457.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,WELLCARE,WELLCARE MEDICAID,4457.00,,,,,,,267.0200,4457.0000,percent of total billed charges,"100% of $4,457.00 in Billed Charges for Rev 610 Proc 73223 = $4,457.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR JOINT UPR EXTR WOW CON,73223,CPT,610,RC,61000022,CDM,,,,both,,,4457.0000,668.5500,WELLCARE,WELLCARE MEDICARE,335.52,,,,,,,267.0200,4457.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,AETNA,AETNA,1842.93,,,,,,,267.0200,4316.0000,percent of total billed charges,"42.7% of $4,316.00 in Billed Charges for Rev 610 Proc 73223 Mod 50 = $1,842.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,865.80,,,,,,,267.0200,4316.0000,fee schedule,APG 00295 Proc 73223 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 150% Mod Percentage = $832.50 at 104% = $865.80. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,770.00,,,,,,,267.0200,4316.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,AETNA,AETNA HEALTHCARE MEDICARE,770.00,,,,,,,267.0200,4316.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,ALLCARE MEDICARE,ALLCARE MEDICARE,770.00,,,,,,,267.0200,4316.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,AMBETTER,AMBETTER,1678.60,,,,,,,267.0200,4316.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,800.80,,,,,,,267.0200,4316.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,BLUE CROSS,ANTHEM EXCHANGE,1895.79,,,,,,,267.0200,4316.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,857.48,,,,,,,267.0200,4316.0000,fee schedule,APG 00295 Proc 73223 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 150% Mod Percentage = $832.50 at 103% = $857.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,BLUE CROSS,ANTHEM HMO,2014.16,,,,,,,267.0200,4316.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,793.10,,,,,,,267.0200,4316.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",2369.47,,,,,,,267.0200,4316.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1673.39,,,,,,,267.0200,4316.0000,fee schedule,"$1,673.39 from Fee Schedule BLDTM_23 for Rev 610 Proc 73223 Mod 50 * Qty 1 = $1,673.39 at 100% = $1,673.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,BLUE CROSS,BLUE CROSS E NETWORK,1088.67,,,,,,,267.0200,4316.0000,fee schedule,"$340.21 from Fee Schedule BCFSD for Rev 610 Proc 73223 Mod 50 * Qty 1 = $340.21 at 320% = $1,088.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,BLUE CROSS,BLUE CROSS MEDICARE,800.80,,,,,,,267.0200,4316.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,BLUE CROSS,BLUE CROSS P NETWORK,1112.49,,,,,,,267.0200,4316.0000,fee schedule,"$340.21 from Fee Schedule BCFSD for Rev 610 Proc 73223 Mod 50 * Qty 1 = $340.21 at 327% = $1,112.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,BLUE CROSS,BLUE CROSS S NETWORK,1112.49,,,,,,,267.0200,4316.0000,fee schedule,"$340.21 from Fee Schedule BCFSD for Rev 610 Proc 73223 Mod 50 * Qty 1 = $340.21 at 327% = $1,112.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,BLUE CROSS,TENNCARE BLUE CARE,816.28,,,,,,,267.0200,4316.0000,fee schedule,$703.69 from Fee Schedule TC_24 for Rev 610 Proc 73223 Mod 50 * Qty 1 = $703.69 at 116% = $816.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,BLUE CROSS,TENNCARE BLUE SELECT,816.28,,,,,,,267.0200,4316.0000,fee schedule,$703.69 from Fee Schedule TC_24 for Rev 610 Proc 73223 Mod 50 * Qty 1 = $703.69 at 116% = $816.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,CIGNA HEALTHCARE,CIGNA HMO,1215.00,,,,,,,267.0200,4316.0000,other,"Rev 610 Proc 73223 Mod 50 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,786.00,,,,,,,267.0200,4316.0000,other,Rev 610 Proc 73223 Mod 50 Qty 1 * $786.00 = $786.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,CIGNA HEALTHCARE,CIGNA MEDICARE,808.50,,,,,,,267.0200,4316.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1215.00,,,,,,,267.0200,4316.0000,other,"Rev 610 Proc 73223 Mod 50 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,CIGNA HEALTHCARE,CIGNA PPO,1215.00,,,,,,,267.0200,4316.0000,other,"Rev 610 Proc 73223 Mod 50 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,808.50,,,,,,,267.0200,4316.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3884.40,,,,,,,267.0200,4316.0000,percent of total billed charges,"90% of $4,316.00 in Billed Charges for Rev 610 Proc 73223 Mod 50 = $3,884.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,HUMANA,HUMANA MEDICARE,770.00,,,,,,,267.0200,4316.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,770.00,,,,,,,267.0200,4316.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,MEDCOST,MEDCOST VHN,2053.98,,,,,,,267.0200,4316.0000,percent of total billed charges,"47.59% of $4,316.00 in Billed Charges for Rev 610 Proc 73223 Mod 50 = $2,053.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,874.13,,,,,,,267.0200,4316.0000,fee schedule,APG 00295 Proc 73223 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 150% Mod Percentage = $832.50 at 100% = $832.50... $832.50 at 105% = $874.13 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,808.50,,,,,,,267.0200,4316.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,808.50,,,,,,,267.0200,4316.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,NHC ADVANTAGE,NHC ADVANTAGE,808.50,,,,,,,267.0200,4316.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,858.31,,,,,,,267.0200,4316.0000,fee schedule,APG 00295 Proc 73223 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 150% Mod Percentage = $832.50 at 100% = $832.50... $832.50 at 103.1% = $858.31 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,SENTARA HEALTH,SENTARA HEALTH,1113.96,,,,,,,267.0200,4316.0000,percent of total billed charges,"25.81% of $4,316.00 in Billed Charges for Rev 610 Proc 73223 Mod 50 = $1,113.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,SENTARA HEALTH,SENTARA MEDICARE,770.00,,,,,,,267.0200,4316.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4316.00,,,,,,,267.0200,4316.0000,percent of total billed charges,"100% of $4,316.00 in Billed Charges for Rev 610 Proc 73223 Mod 50 = $4,316.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,267.02,,,,,,,267.0200,4316.0000,fee schedule,$534.03 from Fee Schedule TCUHC24 for Rev 610 Proc 73223 Mod 50 * Qty 1 = $534.03 at 50% = $267.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2559.00,,,,,,,267.0200,4316.0000,other,"Rev 610 Proc 73223 Mod 50 1 Visit at $2,559.00 per Visit = $2,559.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,2448.00,,,,,,,267.0200,4316.0000,other,"Rev 610 Proc 73223 Mod 50 1 Visit at $2,448.00 per Visit = $2,448.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,4035.00,,,,,,,267.0200,4316.0000,other,"Rev 610 Proc 73223 Mod 50 1 Visit at $4,035.00 per Visit = $4,035.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,857.48,,,,,,,267.0200,4316.0000,fee schedule,APG 00295 Proc 73223 at $836.60 (Base Rate) * 0.6634 (Relative Weight) = $555.00 (Total Line Payment) at 150% Mod Percentage = $832.50 at 103% = $857.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,770.00,,,,,,,267.0200,4316.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,770.00,,,,,,,267.0200,4316.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,WELLCARE,WELLCARE MEDICAID,4316.00,,,,,,,267.0200,4316.0000,percent of total billed charges,"100% of $4,316.00 in Billed Charges for Rev 610 Proc 73223 Mod 50 = $4,316.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR JOINT UPR EXTR WOW CON BILAT,73223,CPT,610,RC,61000074,CDM,,,50,both,,,4316.0000,647.4000,WELLCARE,WELLCARE MEDICARE,816.20,,,,,,,267.0200,4316.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA,187.45,,,,,,,16.8400,439.0000,percent of total billed charges,42.7% of $439.00 in Billed Charges for Rev 320 Proc 73501 = $187.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,16.8400,439.0000,fee schedule,APG 00471 Proc 73501 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,16.8400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,16.8400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,16.8400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,AMBETTER,AMBETTER,172.12,,,,,,,16.8400,439.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,16.8400,439.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,16.8400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,16.8400,439.0000,fee schedule,APG 00471 Proc 73501 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,16.8400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,16.8400,439.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,16.8400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,307.30,,,,,,,16.8400,439.0000,percent of total billed charges,Rev 320 Proc 73501 $439.00 in Billed Charges at 70% = $307.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS E NETWORK,57.18,,,,,,,16.8400,439.0000,fee schedule,$17.87 from Fee Schedule BCFSC for Rev 320 Proc 73501 * Qty 1 = $17.87 at 320% = $57.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,16.8400,439.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS P NETWORK,58.43,,,,,,,16.8400,439.0000,fee schedule,$17.87 from Fee Schedule BCFSC for Rev 320 Proc 73501 * Qty 1 = $17.87 at 327% = $58.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS S NETWORK,58.43,,,,,,,16.8400,439.0000,fee schedule,$17.87 from Fee Schedule BCFSC for Rev 320 Proc 73501 * Qty 1 = $17.87 at 327% = $58.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,TENNCARE BLUE CARE,16.84,,,,,,,16.8400,439.0000,fee schedule,$14.52 from Fee Schedule TC_24 for Rev 320 Proc 73501 * Qty 1 = $14.52 at 116% = $16.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,TENNCARE BLUE SELECT,16.84,,,,,,,16.8400,439.0000,fee schedule,$14.52 from Fee Schedule TC_24 for Rev 320 Proc 73501 * Qty 1 = $14.52 at 116% = $16.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA HMO,183.06,,,,,,,16.8400,439.0000,percent of total billed charges,Rev 320 Proc 73501 $439.00 in Billed Charges at 41.7% = $183.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,44.85,,,,,,,16.8400,439.0000,fee schedule,$44.85 from Fee Schedule CGIFP_25LR for Rev 320 Proc 73501 * Qty 1 = $44.85 at 100% = $44.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,16.8400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,183.06,,,,,,,16.8400,439.0000,percent of total billed charges,Rev 320 Proc 73501 $439.00 in Billed Charges at 41.7% = $183.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA PPO,183.06,,,,,,,16.8400,439.0000,percent of total billed charges,Rev 320 Proc 73501 $439.00 in Billed Charges at 41.7% = $183.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,16.8400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,395.10,,,,,,,16.8400,439.0000,percent of total billed charges,90% of $439.00 in Billed Charges for Rev 320 Proc 73501 = $395.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,HUMANA,HUMANA MEDICARE,78.96,,,,,,,16.8400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,16.8400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,MEDCOST,MEDCOST VHN,208.92,,,,,,,16.8400,439.0000,percent of total billed charges,47.59% of $439.00 in Billed Charges for Rev 320 Proc 73501 = $208.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,16.8400,439.0000,fee schedule,APG 00471 Proc 73501 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,16.8400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,16.8400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,16.8400,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,16.8400,439.0000,fee schedule,APG 00471 Proc 73501 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,SENTARA HEALTH,SENTARA HEALTH,113.31,,,,,,,16.8400,439.0000,percent of total billed charges,25.81% of $439.00 in Billed Charges for Rev 320 Proc 73501 = $113.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,16.8400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",439.00,,,,,,,16.8400,439.0000,percent of total billed charges,100% of $439.00 in Billed Charges for Rev 320 Proc 73501 = $439.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,30.40,,,,,,,16.8400,439.0000,fee schedule,$60.80 from Fee Schedule TCUHC24 for Rev 320 Proc 73501 * Qty 1 = $60.80 at 50% = $30.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,16.8400,439.0000,other,Rev 320 Proc 73501 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,16.8400,439.0000,other,Rev 320 Proc 73501 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,16.8400,439.0000,other,Rev 320 Proc 73501 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,16.8400,439.0000,fee schedule,APG 00471 Proc 73501 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,16.8400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,16.8400,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,WELLCARE,WELLCARE MEDICAID,439.00,,,,,,,16.8400,439.0000,percent of total billed charges,100% of $439.00 in Billed Charges for Rev 320 Proc 73501 = $439.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 1 VIEW,73501,CPT,320,RC,32000280,CDM,,,,both,,,439.0000,65.8500,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,16.8400,439.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,25.3200,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 73502 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,25.3200,462.0000,fee schedule,APG 00471 Proc 73502 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,25.3200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,25.3200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,25.3200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,172.12,,,,,,,25.3200,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,25.3200,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,25.3200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,25.3200,462.0000,fee schedule,APG 00471 Proc 73502 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,25.3200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,25.3200,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,25.3200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,323.40,,,,,,,25.3200,462.0000,percent of total billed charges,Rev 320 Proc 73502 $462.00 in Billed Charges at 70% = $323.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,85.98,,,,,,,25.3200,462.0000,fee schedule,$26.87 from Fee Schedule BCFSC for Rev 320 Proc 73502 * Qty 1 = $26.87 at 320% = $85.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,25.3200,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,87.86,,,,,,,25.3200,462.0000,fee schedule,$26.87 from Fee Schedule BCFSC for Rev 320 Proc 73502 * Qty 1 = $26.87 at 327% = $87.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,87.86,,,,,,,25.3200,462.0000,fee schedule,$26.87 from Fee Schedule BCFSC for Rev 320 Proc 73502 * Qty 1 = $26.87 at 327% = $87.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,25.32,,,,,,,25.3200,462.0000,fee schedule,$21.83 from Fee Schedule TC_24 for Rev 320 Proc 73502 * Qty 1 = $21.83 at 116% = $25.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,25.32,,,,,,,25.3200,462.0000,fee schedule,$21.83 from Fee Schedule TC_24 for Rev 320 Proc 73502 * Qty 1 = $21.83 at 116% = $25.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,192.65,,,,,,,25.3200,462.0000,percent of total billed charges,Rev 320 Proc 73502 $462.00 in Billed Charges at 41.7% = $192.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,69.28,,,,,,,25.3200,462.0000,fee schedule,$69.28 from Fee Schedule CGIFP_25LR for Rev 320 Proc 73502 * Qty 1 = $69.28 at 100% = $69.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,25.3200,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,192.65,,,,,,,25.3200,462.0000,percent of total billed charges,Rev 320 Proc 73502 $462.00 in Billed Charges at 41.7% = $192.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,192.65,,,,,,,25.3200,462.0000,percent of total billed charges,Rev 320 Proc 73502 $462.00 in Billed Charges at 41.7% = $192.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,25.3200,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,25.3200,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 73502 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,78.96,,,,,,,25.3200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,25.3200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,25.3200,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 73502 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,25.3200,462.0000,fee schedule,APG 00471 Proc 73502 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,25.3200,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,25.3200,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,25.3200,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,25.3200,462.0000,fee schedule,APG 00471 Proc 73502 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,25.3200,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 73502 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,25.3200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,25.3200,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 73502 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,30.40,,,,,,,25.3200,462.0000,fee schedule,$60.80 from Fee Schedule TCUHC24 for Rev 320 Proc 73502 * Qty 1 = $60.80 at 50% = $30.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,25.3200,462.0000,other,Rev 320 Proc 73502 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,25.3200,462.0000,other,Rev 320 Proc 73502 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,25.3200,462.0000,other,Rev 320 Proc 73502 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,25.3200,462.0000,fee schedule,APG 00471 Proc 73502 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,25.3200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,25.3200,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,25.3200,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 73502 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP UNILAT W PELVIS WHEN PERFORMED 2-3 VIEWS,73502,CPT,320,RC,32000281,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,25.3200,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA,187.45,,,,,,,23.5000,439.0000,percent of total billed charges,42.7% of $439.00 in Billed Charges for Rev 320 Proc 73521 = $187.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,23.5000,439.0000,fee schedule,APG 00471 Proc 73521 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,23.5000,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,23.5000,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,23.5000,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,AMBETTER,AMBETTER,206.78,,,,,,,23.5000,439.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,23.5000,439.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,23.5000,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,23.5000,439.0000,fee schedule,APG 00471 Proc 73521 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,23.5000,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,23.5000,439.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,23.5000,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,307.30,,,,,,,23.5000,439.0000,percent of total billed charges,Rev 320 Proc 73521 $439.00 in Billed Charges at 70% = $307.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS E NETWORK,79.81,,,,,,,23.5000,439.0000,fee schedule,$24.94 from Fee Schedule BCFSC for Rev 320 Proc 73521 * Qty 1 = $24.94 at 320% = $79.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,23.5000,439.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS P NETWORK,81.55,,,,,,,23.5000,439.0000,fee schedule,$24.94 from Fee Schedule BCFSC for Rev 320 Proc 73521 * Qty 1 = $24.94 at 327% = $81.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,BLUE CROSS S NETWORK,81.55,,,,,,,23.5000,439.0000,fee schedule,$24.94 from Fee Schedule BCFSC for Rev 320 Proc 73521 * Qty 1 = $24.94 at 327% = $81.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,TENNCARE BLUE CARE,23.50,,,,,,,23.5000,439.0000,fee schedule,$20.26 from Fee Schedule TC_24 for Rev 320 Proc 73521 * Qty 1 = $20.26 at 116% = $23.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,BLUE CROSS,TENNCARE BLUE SELECT,23.50,,,,,,,23.5000,439.0000,fee schedule,$20.26 from Fee Schedule TC_24 for Rev 320 Proc 73521 * Qty 1 = $20.26 at 116% = $23.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA HMO,183.06,,,,,,,23.5000,439.0000,percent of total billed charges,Rev 320 Proc 73521 $439.00 in Billed Charges at 41.7% = $183.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,57.38,,,,,,,23.5000,439.0000,fee schedule,$57.38 from Fee Schedule CGIFP_25LR for Rev 320 Proc 73521 * Qty 1 = $57.38 at 100% = $57.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,23.5000,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,183.06,,,,,,,23.5000,439.0000,percent of total billed charges,Rev 320 Proc 73521 $439.00 in Billed Charges at 41.7% = $183.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,CIGNA HEALTHCARE,CIGNA PPO,183.06,,,,,,,23.5000,439.0000,percent of total billed charges,Rev 320 Proc 73521 $439.00 in Billed Charges at 41.7% = $183.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,23.5000,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,395.10,,,,,,,23.5000,439.0000,percent of total billed charges,90% of $439.00 in Billed Charges for Rev 320 Proc 73521 = $395.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,HUMANA,HUMANA MEDICARE,94.85,,,,,,,23.5000,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,23.5000,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,MEDCOST,MEDCOST VHN,208.92,,,,,,,23.5000,439.0000,percent of total billed charges,47.59% of $439.00 in Billed Charges for Rev 320 Proc 73521 = $208.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,23.5000,439.0000,fee schedule,APG 00471 Proc 73521 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,23.5000,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,23.5000,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,23.5000,439.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,23.5000,439.0000,fee schedule,APG 00471 Proc 73521 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,SENTARA HEALTH,SENTARA HEALTH,113.31,,,,,,,23.5000,439.0000,percent of total billed charges,25.81% of $439.00 in Billed Charges for Rev 320 Proc 73521 = $113.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,23.5000,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",439.00,,,,,,,23.5000,439.0000,percent of total billed charges,100% of $439.00 in Billed Charges for Rev 320 Proc 73521 = $439.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,50.35,,,,,,,23.5000,439.0000,fee schedule,$100.69 from Fee Schedule TCUHC24 for Rev 320 Proc 73521 * Qty 1 = $100.69 at 50% = $50.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,23.5000,439.0000,other,Rev 320 Proc 73521 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,23.5000,439.0000,other,Rev 320 Proc 73521 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,23.5000,439.0000,other,Rev 320 Proc 73521 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,23.5000,439.0000,fee schedule,APG 00471 Proc 73521 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,23.5000,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,23.5000,439.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,WELLCARE,WELLCARE MEDICAID,439.00,,,,,,,23.5000,439.0000,percent of total billed charges,100% of $439.00 in Billed Charges for Rev 320 Proc 73521 = $439.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 2 VIEWS,73521,CPT,320,RC,32000283,CDM,,,,both,,,439.0000,65.8500,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,23.5000,439.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TRAY XPAND 15/3 1ST ADDITIONAL,270,RC,,,,,,,,both,,,15125.0700,2268.7600,AETNA,AETNA,6458.40,,,,,,,3903.7800,15125.0700,percent of total billed charges,"42.7% of $15,125.07 in Billed Charges for Rev 270 = $6,458.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY XPAND 15/3 1ST ADDITIONAL,270,RC,,,,,,,,both,,,15125.0700,2268.7600,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,10587.55,,,,,,,3903.7800,15125.0700,percent of total billed charges,"Rev 270 $15,125.07 in Billed Charges at 70% = $10,587.55. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY XPAND 15/3 1ST ADDITIONAL,270,RC,,,,,,,,both,,,15125.0700,2268.7600,CIGNA HEALTHCARE,CIGNA HMO,6307.15,,,,,,,3903.7800,15125.0700,percent of total billed charges,"41.7% of $15,125.07 in Billed Charges for Rev 270 = $6,307.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY XPAND 15/3 1ST ADDITIONAL,270,RC,,,,,,,,both,,,15125.0700,2268.7600,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,7018.03,,,,,,,3903.7800,15125.0700,percent of total billed charges,"46.4% of $15,125.07 in Billed Charges for Rev 270 = $7,018.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY XPAND 15/3 1ST ADDITIONAL,270,RC,,,,,,,,both,,,15125.0700,2268.7600,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,6307.15,,,,,,,3903.7800,15125.0700,percent of total billed charges,"41.7% of $15,125.07 in Billed Charges for Rev 270 = $6,307.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY XPAND 15/3 1ST ADDITIONAL,270,RC,,,,,,,,both,,,15125.0700,2268.7600,CIGNA HEALTHCARE,CIGNA PPO,6307.15,,,,,,,3903.7800,15125.0700,percent of total billed charges,"41.7% of $15,125.07 in Billed Charges for Rev 270 = $6,307.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY XPAND 15/3 1ST ADDITIONAL,270,RC,,,,,,,,both,,,15125.0700,2268.7600,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,13612.56,,,,,,,3903.7800,15125.0700,percent of total billed charges,"90% of $15,125.07 in Billed Charges for Rev 270 = $13,612.56. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY XPAND 15/3 1ST ADDITIONAL,270,RC,,,,,,,,both,,,15125.0700,2268.7600,MEDCOST,MEDCOST VHN,7198.02,,,,,,,3903.7800,15125.0700,percent of total billed charges,"47.59% of $15,125.07 in Billed Charges for Rev 270 = $7,198.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY XPAND 15/3 1ST ADDITIONAL,270,RC,,,,,,,,both,,,15125.0700,2268.7600,SENTARA HEALTH,SENTARA HEALTH,3903.78,,,,,,,3903.7800,15125.0700,percent of total billed charges,"25.81% of $15,125.07 in Billed Charges for Rev 270 = $3,903.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY XPAND 15/3 1ST ADDITIONAL,270,RC,,,,,,,,both,,,15125.0700,2268.7600,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",15125.07,,,,,,,3903.7800,15125.0700,percent of total billed charges,"100% of $15,125.07 in Billed Charges for Rev 270 = $15,125.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY XPAND 15/3 1ST ADDITIONAL,270,RC,,,,,,,,both,,,15125.0700,2268.7600,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,7562.54,,,,,,,3903.7800,15125.0700,percent of total billed charges,"Rev 270 $15,125.07 in Billed Charges at 50% = $7,562.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY XPAND 15/3 1ST ADDITIONAL,270,RC,,,,,,,,both,,,15125.0700,2268.7600,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,4885.40,,,,,,,3903.7800,15125.0700,other,"32.3% of $15,125.07 in Billed Charges for Rev 270 = $4,885.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TRAY XPAND 15/3 1ST ADDITIONAL,270,RC,,,,,,,,both,,,15125.0700,2268.7600,UNITED HEALTHCARE,UHC HERITAGE SELECT,4643.40,,,,,,,3903.7800,15125.0700,other,"30.7% of $15,125.07 in Billed Charges for Rev 270 = $4,643.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TRAY XPAND 15/3 1ST ADDITIONAL,270,RC,,,,,,,,both,,,15125.0700,2268.7600,UNITED HEALTHCARE,UNITED HEALTHCARE,4885.40,,,,,,,3903.7800,15125.0700,percent of total billed charges,"32.3% of $15,125.07 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRAY XPAND 15/3 1ST ADDITIONAL,270,RC,,,,,,,,both,,,15125.0700,2268.7600,WELLCARE,WELLCARE MEDICAID,15125.07,,,,,,,3903.7800,15125.0700,percent of total billed charges,"100% of $15,125.07 in Billed Charges for Rev 270 = $15,125.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRI STAPLE ENDO GIA 45MM CVD SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,7478.1300,1121.7200,AETNA,AETNA,3193.16,,,,,,,1930.1100,7478.1300,percent of total billed charges,"42.7% of $7,478.13 in Billed Charges for Rev 272 = $3,193.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRI STAPLE ENDO GIA 45MM CVD SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,7478.1300,1121.7200,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,5234.69,,,,,,,1930.1100,7478.1300,percent of total billed charges,"Rev 272 $7,478.13 in Billed Charges at 70% = $5,234.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRI STAPLE ENDO GIA 45MM CVD SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,7478.1300,1121.7200,CIGNA HEALTHCARE,CIGNA HMO,3118.38,,,,,,,1930.1100,7478.1300,percent of total billed charges,"41.7% of $7,478.13 in Billed Charges for Rev 272 = $3,118.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRI STAPLE ENDO GIA 45MM CVD SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,7478.1300,1121.7200,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3469.85,,,,,,,1930.1100,7478.1300,percent of total billed charges,"46.4% of $7,478.13 in Billed Charges for Rev 272 = $3,469.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRI STAPLE ENDO GIA 45MM CVD SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,7478.1300,1121.7200,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3118.38,,,,,,,1930.1100,7478.1300,percent of total billed charges,"41.7% of $7,478.13 in Billed Charges for Rev 272 = $3,118.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRI STAPLE ENDO GIA 45MM CVD SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,7478.1300,1121.7200,CIGNA HEALTHCARE,CIGNA PPO,3118.38,,,,,,,1930.1100,7478.1300,percent of total billed charges,"41.7% of $7,478.13 in Billed Charges for Rev 272 = $3,118.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRI STAPLE ENDO GIA 45MM CVD SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,7478.1300,1121.7200,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,6730.32,,,,,,,1930.1100,7478.1300,percent of total billed charges,"90% of $7,478.13 in Billed Charges for Rev 272 = $6,730.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRI STAPLE ENDO GIA 45MM CVD SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,7478.1300,1121.7200,MEDCOST,MEDCOST VHN,3558.84,,,,,,,1930.1100,7478.1300,percent of total billed charges,"47.59% of $7,478.13 in Billed Charges for Rev 272 = $3,558.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRI STAPLE ENDO GIA 45MM CVD SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,7478.1300,1121.7200,SENTARA HEALTH,SENTARA HEALTH,1930.11,,,,,,,1930.1100,7478.1300,percent of total billed charges,"25.81% of $7,478.13 in Billed Charges for Rev 272 = $1,930.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRI STAPLE ENDO GIA 45MM CVD SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,7478.1300,1121.7200,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",7478.13,,,,,,,1930.1100,7478.1300,percent of total billed charges,"100% of $7,478.13 in Billed Charges for Rev 272 = $7,478.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRI STAPLE ENDO GIA 45MM CVD SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,7478.1300,1121.7200,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,3739.07,,,,,,,1930.1100,7478.1300,percent of total billed charges,"Rev 272 $7,478.13 in Billed Charges at 50% = $3,739.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRI STAPLE ENDO GIA 45MM CVD SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,7478.1300,1121.7200,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2415.44,,,,,,,1930.1100,7478.1300,other,"32.3% of $7,478.13 in Billed Charges for Rev 272 = $2,415.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TRI STAPLE ENDO GIA 45MM CVD SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,7478.1300,1121.7200,UNITED HEALTHCARE,UHC HERITAGE SELECT,2295.79,,,,,,,1930.1100,7478.1300,other,"30.7% of $7,478.13 in Billed Charges for Rev 272 = $2,295.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TRI STAPLE ENDO GIA 45MM CVD SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,7478.1300,1121.7200,UNITED HEALTHCARE,UNITED HEALTHCARE,2415.44,,,,,,,1930.1100,7478.1300,percent of total billed charges,"32.3% of $7,478.13 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TRI STAPLE ENDO GIA 45MM CVD SURPASS SEE LN 69026,272,RC,27200002,CDM,,,,,,both,,,7478.1300,1121.7200,WELLCARE,WELLCARE MEDICAID,7478.13,,,,,,,1930.1100,7478.1300,percent of total billed charges,"100% of $7,478.13 in Billed Charges for Rev 272 = $7,478.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AIRSEAL 12 X 150MM BLADELESS,272,RC,,,,,,,,both,,,1029.0300,154.3500,AETNA,AETNA,439.40,,,,,,,265.5900,1029.0300,percent of total billed charges,"42.7% of $1,029.03 in Billed Charges for Rev 272 = $439.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AIRSEAL 12 X 150MM BLADELESS,272,RC,,,,,,,,both,,,1029.0300,154.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,720.32,,,,,,,265.5900,1029.0300,percent of total billed charges,"Rev 272 $1,029.03 in Billed Charges at 70% = $720.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AIRSEAL 12 X 150MM BLADELESS,272,RC,,,,,,,,both,,,1029.0300,154.3500,CIGNA HEALTHCARE,CIGNA HMO,429.11,,,,,,,265.5900,1029.0300,percent of total billed charges,"41.7% of $1,029.03 in Billed Charges for Rev 272 = $429.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AIRSEAL 12 X 150MM BLADELESS,272,RC,,,,,,,,both,,,1029.0300,154.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,477.47,,,,,,,265.5900,1029.0300,percent of total billed charges,"46.4% of $1,029.03 in Billed Charges for Rev 272 = $477.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AIRSEAL 12 X 150MM BLADELESS,272,RC,,,,,,,,both,,,1029.0300,154.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,429.11,,,,,,,265.5900,1029.0300,percent of total billed charges,"41.7% of $1,029.03 in Billed Charges for Rev 272 = $429.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AIRSEAL 12 X 150MM BLADELESS,272,RC,,,,,,,,both,,,1029.0300,154.3500,CIGNA HEALTHCARE,CIGNA PPO,429.11,,,,,,,265.5900,1029.0300,percent of total billed charges,"41.7% of $1,029.03 in Billed Charges for Rev 272 = $429.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AIRSEAL 12 X 150MM BLADELESS,272,RC,,,,,,,,both,,,1029.0300,154.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,926.13,,,,,,,265.5900,1029.0300,percent of total billed charges,"90% of $1,029.03 in Billed Charges for Rev 272 = $926.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AIRSEAL 12 X 150MM BLADELESS,272,RC,,,,,,,,both,,,1029.0300,154.3500,MEDCOST,MEDCOST VHN,489.72,,,,,,,265.5900,1029.0300,percent of total billed charges,"47.59% of $1,029.03 in Billed Charges for Rev 272 = $489.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AIRSEAL 12 X 150MM BLADELESS,272,RC,,,,,,,,both,,,1029.0300,154.3500,SENTARA HEALTH,SENTARA HEALTH,265.59,,,,,,,265.5900,1029.0300,percent of total billed charges,"25.81% of $1,029.03 in Billed Charges for Rev 272 = $265.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AIRSEAL 12 X 150MM BLADELESS,272,RC,,,,,,,,both,,,1029.0300,154.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1029.03,,,,,,,265.5900,1029.0300,percent of total billed charges,"100% of $1,029.03 in Billed Charges for Rev 272 = $1,029.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AIRSEAL 12 X 150MM BLADELESS,272,RC,,,,,,,,both,,,1029.0300,154.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,514.52,,,,,,,265.5900,1029.0300,percent of total billed charges,"Rev 272 $1,029.03 in Billed Charges at 50% = $514.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AIRSEAL 12 X 150MM BLADELESS,272,RC,,,,,,,,both,,,1029.0300,154.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,332.38,,,,,,,265.5900,1029.0300,other,"32.3% of $1,029.03 in Billed Charges for Rev 272 = $332.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TROCAR AIRSEAL 12 X 150MM BLADELESS,272,RC,,,,,,,,both,,,1029.0300,154.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,315.91,,,,,,,265.5900,1029.0300,other,"30.7% of $1,029.03 in Billed Charges for Rev 272 = $315.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TROCAR AIRSEAL 12 X 150MM BLADELESS,272,RC,,,,,,,,both,,,1029.0300,154.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,332.38,,,,,,,265.5900,1029.0300,percent of total billed charges,"32.3% of $1,029.03 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR AIRSEAL 12 X 150MM BLADELESS,272,RC,,,,,,,,both,,,1029.0300,154.3500,WELLCARE,WELLCARE MEDICAID,1029.03,,,,,,,265.5900,1029.0300,percent of total billed charges,"100% of $1,029.03 in Billed Charges for Rev 272 = $1,029.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,28.3600,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 73522 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,28.3600,462.0000,fee schedule,APG 00471 Proc 73522 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,28.3600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,28.3600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,28.3600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,206.78,,,,,,,28.3600,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,28.3600,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,28.3600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,28.3600,462.0000,fee schedule,APG 00471 Proc 73522 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,28.3600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,28.3600,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,28.3600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,323.40,,,,,,,28.3600,462.0000,percent of total billed charges,Rev 320 Proc 73522 $462.00 in Billed Charges at 70% = $323.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,96.29,,,,,,,28.3600,462.0000,fee schedule,$30.09 from Fee Schedule BCFSC for Rev 320 Proc 73522 * Qty 1 = $30.09 at 320% = $96.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,28.3600,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,98.39,,,,,,,28.3600,462.0000,fee schedule,$30.09 from Fee Schedule BCFSC for Rev 320 Proc 73522 * Qty 1 = $30.09 at 327% = $98.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,98.39,,,,,,,28.3600,462.0000,fee schedule,$30.09 from Fee Schedule BCFSC for Rev 320 Proc 73522 * Qty 1 = $30.09 at 327% = $98.39 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,28.36,,,,,,,28.3600,462.0000,fee schedule,$24.45 from Fee Schedule TC_24 for Rev 320 Proc 73522 * Qty 1 = $24.45 at 116% = $28.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,28.36,,,,,,,28.3600,462.0000,fee schedule,$24.45 from Fee Schedule TC_24 for Rev 320 Proc 73522 * Qty 1 = $24.45 at 116% = $28.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,192.65,,,,,,,28.3600,462.0000,percent of total billed charges,Rev 320 Proc 73522 $462.00 in Billed Charges at 41.7% = $192.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,74.91,,,,,,,28.3600,462.0000,fee schedule,$74.91 from Fee Schedule CGIFP_25LR for Rev 320 Proc 73522 * Qty 1 = $74.91 at 100% = $74.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,28.3600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,192.65,,,,,,,28.3600,462.0000,percent of total billed charges,Rev 320 Proc 73522 $462.00 in Billed Charges at 41.7% = $192.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,192.65,,,,,,,28.3600,462.0000,percent of total billed charges,Rev 320 Proc 73522 $462.00 in Billed Charges at 41.7% = $192.65. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,28.3600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,28.3600,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 73522 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,94.85,,,,,,,28.3600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,28.3600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,28.3600,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 73522 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,28.3600,462.0000,fee schedule,APG 00471 Proc 73522 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,28.3600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,28.3600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,28.3600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,28.3600,462.0000,fee schedule,APG 00471 Proc 73522 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,28.3600,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 73522 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,28.3600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,28.3600,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 73522 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,50.35,,,,,,,28.3600,462.0000,fee schedule,$100.69 from Fee Schedule TCUHC24 for Rev 320 Proc 73522 * Qty 1 = $100.69 at 50% = $50.35 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,28.3600,462.0000,other,Rev 320 Proc 73522 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,28.3600,462.0000,other,Rev 320 Proc 73522 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,28.3600,462.0000,other,Rev 320 Proc 73522 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,28.3600,462.0000,fee schedule,APG 00471 Proc 73522 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,28.3600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,28.3600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,28.3600,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 73522 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX HIP BILAT W PELVIS WHEN PERFORMED 3-4 VIEWS,73522,CPT,320,RC,32000284,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,28.3600,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,AETNA,AETNA,3865.20,,,,,,,224.0000,9052.0000,percent of total billed charges,"42.7% of $9,052.00 in Billed Charges for Rev 323 Proc 75600 = $3,865.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2491.25,,,,,,,224.0000,9052.0000,fee schedule,"APG 00279 Proc 75600 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 104% = $2,491.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2864.70,,,,,,,224.0000,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,AETNA,AETNA HEALTHCARE MEDICARE,2864.70,,,,,,,224.0000,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,2864.70,,,,,,,224.0000,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,AMBETTER,AMBETTER,6245.05,,,,,,,224.0000,9052.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2979.29,,,,,,,224.0000,9052.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,ANTHEM EXCHANGE,7053.05,,,,,,,224.0000,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2467.30,,,,,,,224.0000,9052.0000,fee schedule,"APG 00279 Proc 75600 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 103% = $2,467.30. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,ANTHEM HMO,7493.45,,,,,,,224.0000,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2950.64,,,,,,,224.0000,9052.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8815.35,,,,,,,224.0000,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,597.63,,,,,,,224.0000,9052.0000,fee schedule,$597.63 from Fee Schedule BLDTM_23 for Rev 323 Proc 75600 * Qty 1 = $597.63 at 100% = $597.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS E NETWORK,538.98,,,,,,,224.0000,9052.0000,fee schedule,$168.43 from Fee Schedule BCFSC for Rev 323 Proc 75600 * Qty 1 = $168.43 at 320% = $538.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS MEDICARE,2979.29,,,,,,,224.0000,9052.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS P NETWORK,550.77,,,,,,,224.0000,9052.0000,fee schedule,$168.43 from Fee Schedule BCFSC for Rev 323 Proc 75600 * Qty 1 = $168.43 at 327% = $550.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS S NETWORK,550.77,,,,,,,224.0000,9052.0000,fee schedule,$168.43 from Fee Schedule BCFSC for Rev 323 Proc 75600 * Qty 1 = $168.43 at 327% = $550.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,TENNCARE BLUE CARE,413.85,,,,,,,224.0000,9052.0000,fee schedule,$356.77 from Fee Schedule TC_24 for Rev 323 Proc 75600 * Qty 1 = $356.77 at 116% = $413.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,TENNCARE BLUE SELECT,413.85,,,,,,,224.0000,9052.0000,fee schedule,$356.77 from Fee Schedule TC_24 for Rev 323 Proc 75600 * Qty 1 = $356.77 at 116% = $413.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA HMO,7897.41,,,,,,,224.0000,9052.0000,fee schedule,"$7,897.41 from Fee Schedule CIGWHS_23 for Rev 323 Proc 75600 * Qty 1 = $7,897.41 at 100% = $7,897.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,298.90,,,,,,,224.0000,9052.0000,fee schedule,$298.90 from Fee Schedule CGIFP_25LR for Rev 323 Proc 75600 * Qty 1 = $298.90 at 100% = $298.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,3007.94,,,,,,,224.0000,9052.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7897.41,,,,,,,224.0000,9052.0000,fee schedule,"$7,897.41 from Fee Schedule CIGWHS_23 for Rev 323 Proc 75600 * Qty 1 = $7,897.41 at 100% = $7,897.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA PPO,7897.41,,,,,,,224.0000,9052.0000,fee schedule,"$7,897.41 from Fee Schedule CIGWHS_23 for Rev 323 Proc 75600 * Qty 1 = $7,897.41 at 100% = $7,897.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3007.94,,,,,,,224.0000,9052.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8146.80,,,,,,,224.0000,9052.0000,percent of total billed charges,"90% of $9,052.00 in Billed Charges for Rev 323 Proc 75600 = $8,146.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,HUMANA,HUMANA MEDICARE,2864.70,,,,,,,224.0000,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2864.70,,,,,,,224.0000,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,MEDCOST,MEDCOST VHN,4307.85,,,,,,,224.0000,9052.0000,percent of total billed charges,"47.59% of $9,052.00 in Billed Charges for Rev 323 Proc 75600 = $4,307.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2515.21,,,,,,,224.0000,9052.0000,fee schedule,"APG 00279 Proc 75600 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 100% = $2,395.44... $2,395.44 at 105% = $2,515.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3007.94,,,,,,,224.0000,9052.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3007.94,,,,,,,224.0000,9052.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,NHC ADVANTAGE,NHC ADVANTAGE,3007.94,,,,,,,224.0000,9052.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2469.70,,,,,,,224.0000,9052.0000,fee schedule,"APG 00279 Proc 75600 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 100% = $2,395.44... $2,395.44 at 103.1% = $2,469.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,SENTARA HEALTH,SENTARA HEALTH,2336.32,,,,,,,224.0000,9052.0000,percent of total billed charges,"25.81% of $9,052.00 in Billed Charges for Rev 323 Proc 75600 = $2,336.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,SENTARA HEALTH,SENTARA MEDICARE,2864.70,,,,,,,224.0000,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9052.00,,,,,,,224.0000,9052.0000,percent of total billed charges,"100% of $9,052.00 in Billed Charges for Rev 323 Proc 75600 = $9,052.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1043.32,,,,,,,224.0000,9052.0000,fee schedule,"$2,086.63 from Fee Schedule TCUHC24 for Rev 323 Proc 75600 * Qty 1 = $2,086.63 at 50% = $1,043.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,224.0000,9052.0000,other,Rev 323 Proc 75600 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,224.0000,9052.0000,other,Rev 323 Proc 75600 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,224.0000,9052.0000,other,Rev 323 Proc 75600 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2467.30,,,,,,,224.0000,9052.0000,fee schedule,"APG 00279 Proc 75600 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 103% = $2,467.30. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2864.70,,,,,,,224.0000,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2864.70,,,,,,,224.0000,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,WELLCARE,WELLCARE MEDICAID,9052.00,,,,,,,224.0000,9052.0000,percent of total billed charges,"100% of $9,052.00 in Billed Charges for Rev 323 Proc 75600 = $9,052.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I,75600,CPT,323,RC,32300002,CDM,,,,both,,,9052.0000,1357.8000,WELLCARE,WELLCARE MEDICARE,3036.58,,,,,,,224.0000,9052.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,AETNA,AETNA,3865.20,,,,,,,121.0200,9052.0000,percent of total billed charges,"42.7% of $9,052.00 in Billed Charges for Rev 320 Proc 75630 = $3,865.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2491.25,,,,,,,121.0200,9052.0000,fee schedule,"APG 00279 Proc 75630 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 104% = $2,491.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2864.70,,,,,,,121.0200,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,AETNA,AETNA HEALTHCARE MEDICARE,2864.70,,,,,,,121.0200,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,2864.70,,,,,,,121.0200,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,AMBETTER,AMBETTER,6245.05,,,,,,,121.0200,9052.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2979.29,,,,,,,121.0200,9052.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,ANTHEM EXCHANGE,7053.05,,,,,,,121.0200,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2467.30,,,,,,,121.0200,9052.0000,fee schedule,"APG 00279 Proc 75630 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 103% = $2,467.30. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,ANTHEM HMO,7493.45,,,,,,,121.0200,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2950.64,,,,,,,121.0200,9052.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8815.35,,,,,,,121.0200,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,848.84,,,,,,,121.0200,9052.0000,fee schedule,$848.84 from Fee Schedule BLDTM_23 for Rev 320 Proc 75630 * Qty 1 = $848.84 at 100% = $848.84 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS E NETWORK,274.43,,,,,,,121.0200,9052.0000,fee schedule,$85.76 from Fee Schedule BCFSC for Rev 320 Proc 75630 * Qty 1 = $85.76 at 320% = $274.43 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS MEDICARE,2979.29,,,,,,,121.0200,9052.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS P NETWORK,280.44,,,,,,,121.0200,9052.0000,fee schedule,$85.76 from Fee Schedule BCFSC for Rev 320 Proc 75630 * Qty 1 = $85.76 at 327% = $280.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS S NETWORK,280.44,,,,,,,121.0200,9052.0000,fee schedule,$85.76 from Fee Schedule BCFSC for Rev 320 Proc 75630 * Qty 1 = $85.76 at 327% = $280.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,TENNCARE BLUE CARE,431.46,,,,,,,121.0200,9052.0000,fee schedule,$371.95 from Fee Schedule TC_24 for Rev 320 Proc 75630 * Qty 1 = $371.95 at 116% = $431.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,TENNCARE BLUE SELECT,431.46,,,,,,,121.0200,9052.0000,fee schedule,$371.95 from Fee Schedule TC_24 for Rev 320 Proc 75630 * Qty 1 = $371.95 at 116% = $431.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA HMO,7897.41,,,,,,,121.0200,9052.0000,fee schedule,"$7,897.41 from Fee Schedule CIGWHS_23 for Rev 320 Proc 75630 * Qty 1 = $7,897.41 at 100% = $7,897.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,121.02,,,,,,,121.0200,9052.0000,fee schedule,$121.02 from Fee Schedule CGIFP_25LR for Rev 320 Proc 75630 * Qty 1 = $121.02 at 100% = $121.02 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,3007.94,,,,,,,121.0200,9052.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7897.41,,,,,,,121.0200,9052.0000,fee schedule,"$7,897.41 from Fee Schedule CIGWHS_23 for Rev 320 Proc 75630 * Qty 1 = $7,897.41 at 100% = $7,897.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA PPO,7897.41,,,,,,,121.0200,9052.0000,fee schedule,"$7,897.41 from Fee Schedule CIGWHS_23 for Rev 320 Proc 75630 * Qty 1 = $7,897.41 at 100% = $7,897.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3007.94,,,,,,,121.0200,9052.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8146.80,,,,,,,121.0200,9052.0000,percent of total billed charges,"90% of $9,052.00 in Billed Charges for Rev 320 Proc 75630 = $8,146.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,HUMANA,HUMANA MEDICARE,2864.70,,,,,,,121.0200,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2864.70,,,,,,,121.0200,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,MEDCOST,MEDCOST VHN,4307.85,,,,,,,121.0200,9052.0000,percent of total billed charges,"47.59% of $9,052.00 in Billed Charges for Rev 320 Proc 75630 = $4,307.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2515.21,,,,,,,121.0200,9052.0000,fee schedule,"APG 00279 Proc 75630 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 100% = $2,395.44... $2,395.44 at 105% = $2,515.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3007.94,,,,,,,121.0200,9052.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3007.94,,,,,,,121.0200,9052.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,NHC ADVANTAGE,NHC ADVANTAGE,3007.94,,,,,,,121.0200,9052.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2469.70,,,,,,,121.0200,9052.0000,fee schedule,"APG 00279 Proc 75630 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 100% = $2,395.44... $2,395.44 at 103.1% = $2,469.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,SENTARA HEALTH,SENTARA HEALTH,2336.32,,,,,,,121.0200,9052.0000,percent of total billed charges,"25.81% of $9,052.00 in Billed Charges for Rev 320 Proc 75630 = $2,336.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,SENTARA HEALTH,SENTARA MEDICARE,2864.70,,,,,,,121.0200,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9052.00,,,,,,,121.0200,9052.0000,percent of total billed charges,"100% of $9,052.00 in Billed Charges for Rev 320 Proc 75630 = $9,052.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1043.32,,,,,,,121.0200,9052.0000,fee schedule,"$2,086.63 from Fee Schedule TCUHC24 for Rev 320 Proc 75630 * Qty 1 = $2,086.63 at 50% = $1,043.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,121.0200,9052.0000,other,Rev 320 Proc 75630 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,121.0200,9052.0000,other,Rev 320 Proc 75630 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,121.0200,9052.0000,other,Rev 320 Proc 75630 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2467.30,,,,,,,121.0200,9052.0000,fee schedule,"APG 00279 Proc 75630 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 103% = $2,467.30. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2864.70,,,,,,,121.0200,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2864.70,,,,,,,121.0200,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,WELLCARE,WELLCARE MEDICAID,9052.00,,,,,,,121.0200,9052.0000,percent of total billed charges,"100% of $9,052.00 in Billed Charges for Rev 320 Proc 75630 = $9,052.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC AORTOGRAM ABD W RUNOFF SI,75630,CPT,320,RC,32000186,CDM,,,,both,,,9052.0000,1357.8000,WELLCARE,WELLCARE MEDICARE,3036.58,,,,,,,121.0200,9052.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
TROCAR BLUNT TIP 12MM ROUND DISSECTION BALLOON,272,RC,,,,,,,,both,,,9756.2400,1463.4400,AETNA,AETNA,4165.91,,,,,,,2518.0900,9756.2400,percent of total billed charges,"42.7% of $9,756.24 in Billed Charges for Rev 272 = $4,165.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR BLUNT TIP 12MM ROUND DISSECTION BALLOON,272,RC,,,,,,,,both,,,9756.2400,1463.4400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,6829.37,,,,,,,2518.0900,9756.2400,percent of total billed charges,"Rev 272 $9,756.24 in Billed Charges at 70% = $6,829.37. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR BLUNT TIP 12MM ROUND DISSECTION BALLOON,272,RC,,,,,,,,both,,,9756.2400,1463.4400,CIGNA HEALTHCARE,CIGNA HMO,4068.35,,,,,,,2518.0900,9756.2400,percent of total billed charges,"41.7% of $9,756.24 in Billed Charges for Rev 272 = $4,068.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR BLUNT TIP 12MM ROUND DISSECTION BALLOON,272,RC,,,,,,,,both,,,9756.2400,1463.4400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4526.90,,,,,,,2518.0900,9756.2400,percent of total billed charges,"46.4% of $9,756.24 in Billed Charges for Rev 272 = $4,526.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR BLUNT TIP 12MM ROUND DISSECTION BALLOON,272,RC,,,,,,,,both,,,9756.2400,1463.4400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4068.35,,,,,,,2518.0900,9756.2400,percent of total billed charges,"41.7% of $9,756.24 in Billed Charges for Rev 272 = $4,068.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR BLUNT TIP 12MM ROUND DISSECTION BALLOON,272,RC,,,,,,,,both,,,9756.2400,1463.4400,CIGNA HEALTHCARE,CIGNA PPO,4068.35,,,,,,,2518.0900,9756.2400,percent of total billed charges,"41.7% of $9,756.24 in Billed Charges for Rev 272 = $4,068.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR BLUNT TIP 12MM ROUND DISSECTION BALLOON,272,RC,,,,,,,,both,,,9756.2400,1463.4400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8780.62,,,,,,,2518.0900,9756.2400,percent of total billed charges,"90% of $9,756.24 in Billed Charges for Rev 272 = $8,780.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR BLUNT TIP 12MM ROUND DISSECTION BALLOON,272,RC,,,,,,,,both,,,9756.2400,1463.4400,MEDCOST,MEDCOST VHN,4642.99,,,,,,,2518.0900,9756.2400,percent of total billed charges,"47.59% of $9,756.24 in Billed Charges for Rev 272 = $4,642.99. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR BLUNT TIP 12MM ROUND DISSECTION BALLOON,272,RC,,,,,,,,both,,,9756.2400,1463.4400,SENTARA HEALTH,SENTARA HEALTH,2518.09,,,,,,,2518.0900,9756.2400,percent of total billed charges,"25.81% of $9,756.24 in Billed Charges for Rev 272 = $2,518.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR BLUNT TIP 12MM ROUND DISSECTION BALLOON,272,RC,,,,,,,,both,,,9756.2400,1463.4400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9756.24,,,,,,,2518.0900,9756.2400,percent of total billed charges,"100% of $9,756.24 in Billed Charges for Rev 272 = $9,756.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR BLUNT TIP 12MM ROUND DISSECTION BALLOON,272,RC,,,,,,,,both,,,9756.2400,1463.4400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,4878.12,,,,,,,2518.0900,9756.2400,percent of total billed charges,"Rev 272 $9,756.24 in Billed Charges at 50% = $4,878.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR BLUNT TIP 12MM ROUND DISSECTION BALLOON,272,RC,,,,,,,,both,,,9756.2400,1463.4400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3151.27,,,,,,,2518.0900,9756.2400,other,"32.3% of $9,756.24 in Billed Charges for Rev 272 = $3,151.27 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TROCAR BLUNT TIP 12MM ROUND DISSECTION BALLOON,272,RC,,,,,,,,both,,,9756.2400,1463.4400,UNITED HEALTHCARE,UHC HERITAGE SELECT,2995.17,,,,,,,2518.0900,9756.2400,other,"30.7% of $9,756.24 in Billed Charges for Rev 272 = $2,995.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
TROCAR BLUNT TIP 12MM ROUND DISSECTION BALLOON,272,RC,,,,,,,,both,,,9756.2400,1463.4400,UNITED HEALTHCARE,UNITED HEALTHCARE,3151.27,,,,,,,2518.0900,9756.2400,percent of total billed charges,"32.3% of $9,756.24 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
TROCAR BLUNT TIP 12MM ROUND DISSECTION BALLOON,272,RC,,,,,,,,both,,,9756.2400,1463.4400,WELLCARE,WELLCARE MEDICAID,9756.24,,,,,,,2518.0900,9756.2400,percent of total billed charges,"100% of $9,756.24 in Billed Charges for Rev 272 = $9,756.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,10244.8900,1536.7300,AETNA,AETNA,4374.57,,,,,,,2644.2100,10244.8900,percent of total billed charges,"42.7% of $10,244.89 in Billed Charges for Rev 272 = $4,374.57. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,10244.8900,1536.7300,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,7171.42,,,,,,,2644.2100,10244.8900,percent of total billed charges,"Rev 272 $10,244.89 in Billed Charges at 70% = $7,171.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,10244.8900,1536.7300,CIGNA HEALTHCARE,CIGNA HMO,4272.12,,,,,,,2644.2100,10244.8900,percent of total billed charges,"41.7% of $10,244.89 in Billed Charges for Rev 272 = $4,272.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,10244.8900,1536.7300,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,4753.63,,,,,,,2644.2100,10244.8900,percent of total billed charges,"46.4% of $10,244.89 in Billed Charges for Rev 272 = $4,753.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,10244.8900,1536.7300,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4272.12,,,,,,,2644.2100,10244.8900,percent of total billed charges,"41.7% of $10,244.89 in Billed Charges for Rev 272 = $4,272.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,10244.8900,1536.7300,CIGNA HEALTHCARE,CIGNA PPO,4272.12,,,,,,,2644.2100,10244.8900,percent of total billed charges,"41.7% of $10,244.89 in Billed Charges for Rev 272 = $4,272.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,10244.8900,1536.7300,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,9220.40,,,,,,,2644.2100,10244.8900,percent of total billed charges,"90% of $10,244.89 in Billed Charges for Rev 272 = $9,220.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,10244.8900,1536.7300,MEDCOST,MEDCOST VHN,4875.54,,,,,,,2644.2100,10244.8900,percent of total billed charges,"47.59% of $10,244.89 in Billed Charges for Rev 272 = $4,875.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,10244.8900,1536.7300,SENTARA HEALTH,SENTARA HEALTH,2644.21,,,,,,,2644.2100,10244.8900,percent of total billed charges,"25.81% of $10,244.89 in Billed Charges for Rev 272 = $2,644.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,10244.8900,1536.7300,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",10244.89,,,,,,,2644.2100,10244.8900,percent of total billed charges,"100% of $10,244.89 in Billed Charges for Rev 272 = $10,244.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,10244.8900,1536.7300,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5122.45,,,,,,,2644.2100,10244.8900,percent of total billed charges,"Rev 272 $10,244.89 in Billed Charges at 50% = $5,122.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,10244.8900,1536.7300,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3309.10,,,,,,,2644.2100,10244.8900,other,"32.3% of $10,244.89 in Billed Charges for Rev 272 = $3,309.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,10244.8900,1536.7300,UNITED HEALTHCARE,UHC HERITAGE SELECT,3145.18,,,,,,,2644.2100,10244.8900,other,"30.7% of $10,244.89 in Billed Charges for Rev 272 = $3,145.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,10244.8900,1536.7300,UNITED HEALTHCARE,UNITED HEALTHCARE,3309.10,,,,,,,2644.2100,10244.8900,percent of total billed charges,"32.3% of $10,244.89 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE CSF FLOW CONTROL SM MED,272,RC,,,,,,,,both,,,10244.8900,1536.7300,WELLCARE,WELLCARE MEDICAID,10244.89,,,,,,,2644.2100,10244.8900,percent of total billed charges,"100% of $10,244.89 in Billed Charges for Rev 272 = $10,244.89. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,AETNA,AETNA,3865.20,,,,,,,187.1600,9052.0000,percent of total billed charges,"42.7% of $9,052.00 in Billed Charges for Rev 323 Proc 75731 = $3,865.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2491.25,,,,,,,187.1600,9052.0000,fee schedule,"APG 00279 Proc 75731 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 104% = $2,491.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2864.70,,,,,,,187.1600,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,AETNA,AETNA HEALTHCARE MEDICARE,2864.70,,,,,,,187.1600,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,2864.70,,,,,,,187.1600,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,AMBETTER,AMBETTER,6245.05,,,,,,,187.1600,9052.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2979.29,,,,,,,187.1600,9052.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,ANTHEM EXCHANGE,7053.05,,,,,,,187.1600,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2467.30,,,,,,,187.1600,9052.0000,fee schedule,"APG 00279 Proc 75731 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 103% = $2,467.30. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,ANTHEM HMO,7493.45,,,,,,,187.1600,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2950.64,,,,,,,187.1600,9052.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8815.35,,,,,,,187.1600,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,779.12,,,,,,,187.1600,9052.0000,fee schedule,$779.12 from Fee Schedule BLDTM_23 for Rev 323 Proc 75731 * Qty 1 = $779.12 at 100% = $779.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS E NETWORK,360.90,,,,,,,187.1600,9052.0000,fee schedule,$112.78 from Fee Schedule BCFSC for Rev 323 Proc 75731 * Qty 1 = $112.78 at 320% = $360.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS MEDICARE,2979.29,,,,,,,187.1600,9052.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS P NETWORK,368.79,,,,,,,187.1600,9052.0000,fee schedule,$112.78 from Fee Schedule BCFSC for Rev 323 Proc 75731 * Qty 1 = $112.78 at 327% = $368.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS S NETWORK,368.79,,,,,,,187.1600,9052.0000,fee schedule,$112.78 from Fee Schedule BCFSC for Rev 323 Proc 75731 * Qty 1 = $112.78 at 327% = $368.79 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,TENNCARE BLUE CARE,413.85,,,,,,,187.1600,9052.0000,fee schedule,$356.77 from Fee Schedule TC_24 for Rev 323 Proc 75731 * Qty 1 = $356.77 at 116% = $413.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,TENNCARE BLUE SELECT,413.85,,,,,,,187.1600,9052.0000,fee schedule,$356.77 from Fee Schedule TC_24 for Rev 323 Proc 75731 * Qty 1 = $356.77 at 116% = $413.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA HMO,7897.41,,,,,,,187.1600,9052.0000,fee schedule,"$7,897.41 from Fee Schedule CIGWHS_23 for Rev 323 Proc 75731 * Qty 1 = $7,897.41 at 100% = $7,897.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,187.16,,,,,,,187.1600,9052.0000,fee schedule,$187.16 from Fee Schedule CGIFP_25LR for Rev 323 Proc 75731 * Qty 1 = $187.16 at 100% = $187.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,3007.94,,,,,,,187.1600,9052.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7897.41,,,,,,,187.1600,9052.0000,fee schedule,"$7,897.41 from Fee Schedule CIGWHS_23 for Rev 323 Proc 75731 * Qty 1 = $7,897.41 at 100% = $7,897.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA PPO,7897.41,,,,,,,187.1600,9052.0000,fee schedule,"$7,897.41 from Fee Schedule CIGWHS_23 for Rev 323 Proc 75731 * Qty 1 = $7,897.41 at 100% = $7,897.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3007.94,,,,,,,187.1600,9052.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8146.80,,,,,,,187.1600,9052.0000,percent of total billed charges,"90% of $9,052.00 in Billed Charges for Rev 323 Proc 75731 = $8,146.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,HUMANA,HUMANA MEDICARE,2864.70,,,,,,,187.1600,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2864.70,,,,,,,187.1600,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,MEDCOST,MEDCOST VHN,4307.85,,,,,,,187.1600,9052.0000,percent of total billed charges,"47.59% of $9,052.00 in Billed Charges for Rev 323 Proc 75731 = $4,307.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2515.21,,,,,,,187.1600,9052.0000,fee schedule,"APG 00279 Proc 75731 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 100% = $2,395.44... $2,395.44 at 105% = $2,515.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3007.94,,,,,,,187.1600,9052.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3007.94,,,,,,,187.1600,9052.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,NHC ADVANTAGE,NHC ADVANTAGE,3007.94,,,,,,,187.1600,9052.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2469.70,,,,,,,187.1600,9052.0000,fee schedule,"APG 00279 Proc 75731 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 100% = $2,395.44... $2,395.44 at 103.1% = $2,469.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,SENTARA HEALTH,SENTARA HEALTH,2336.32,,,,,,,187.1600,9052.0000,percent of total billed charges,"25.81% of $9,052.00 in Billed Charges for Rev 323 Proc 75731 = $2,336.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,SENTARA HEALTH,SENTARA MEDICARE,2864.70,,,,,,,187.1600,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9052.00,,,,,,,187.1600,9052.0000,percent of total billed charges,"100% of $9,052.00 in Billed Charges for Rev 323 Proc 75731 = $9,052.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1043.32,,,,,,,187.1600,9052.0000,fee schedule,"$2,086.63 from Fee Schedule TCUHC24 for Rev 323 Proc 75731 * Qty 1 = $2,086.63 at 50% = $1,043.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,187.1600,9052.0000,other,Rev 323 Proc 75731 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,187.1600,9052.0000,other,Rev 323 Proc 75731 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,187.1600,9052.0000,other,Rev 323 Proc 75731 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2467.30,,,,,,,187.1600,9052.0000,fee schedule,"APG 00279 Proc 75731 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 103% = $2,467.30. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2864.70,,,,,,,187.1600,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2864.70,,,,,,,187.1600,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,WELLCARE,WELLCARE MEDICAID,9052.00,,,,,,,187.1600,9052.0000,percent of total billed charges,"100% of $9,052.00 in Billed Charges for Rev 323 Proc 75731 = $9,052.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RAD S&I,75731,CPT,323,RC,32300006,CDM,,,,both,,,9052.0000,1357.8000,WELLCARE,WELLCARE MEDICARE,3036.58,,,,,,,187.1600,9052.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,AETNA,AETNA,3865.20,,,,,,,172.7600,11005.7700,percent of total billed charges,"42.7% of $9,052.00 in Billed Charges for Rev 320 Proc 75736 = $3,865.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,6666.17,,,,,,,172.7600,11005.7700,fee schedule,"APG 00280 Proc 75736 at $836.60 (Base Rate) * 7.6617 (Relative Weight) = $6,409.78 (Total Line Payment) at 104% = $6,666.17. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5048.52,,,,,,,172.7600,11005.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,AETNA,AETNA HEALTHCARE MEDICARE,5048.52,,,,,,,172.7600,11005.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,5048.52,,,,,,,172.7600,11005.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,AMBETTER,AMBETTER,11005.77,,,,,,,172.7600,11005.7700,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,5250.46,,,,,,,172.7600,11005.7700,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,ANTHEM EXCHANGE,9052.00,,,,,,,172.7600,11005.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,6602.07,,,,,,,172.7600,11005.7700,fee schedule,"APG 00280 Proc 75736 at $836.60 (Base Rate) * 7.6617 (Relative Weight) = $6,409.78 (Total Line Payment) at 103% = $6,602.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,ANTHEM HMO,9052.00,,,,,,,172.7600,11005.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5199.97,,,,,,,172.7600,11005.7700,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",9052.00,,,,,,,172.7600,11005.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,779.12,,,,,,,172.7600,11005.7700,fee schedule,$779.12 from Fee Schedule BLDTM_23 for Rev 320 Proc 75736 * Qty 1 = $779.12 at 100% = $779.12 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS E NETWORK,340.32,,,,,,,172.7600,11005.7700,fee schedule,$106.35 from Fee Schedule BCFSC for Rev 320 Proc 75736 * Qty 1 = $106.35 at 320% = $340.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS MEDICARE,5250.46,,,,,,,172.7600,11005.7700,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS P NETWORK,347.76,,,,,,,172.7600,11005.7700,fee schedule,$106.35 from Fee Schedule BCFSC for Rev 320 Proc 75736 * Qty 1 = $106.35 at 327% = $347.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS S NETWORK,347.76,,,,,,,172.7600,11005.7700,fee schedule,$106.35 from Fee Schedule BCFSC for Rev 320 Proc 75736 * Qty 1 = $106.35 at 327% = $347.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,TENNCARE BLUE CARE,413.85,,,,,,,172.7600,11005.7700,fee schedule,$356.77 from Fee Schedule TC_24 for Rev 320 Proc 75736 * Qty 1 = $356.77 at 116% = $413.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,TENNCARE BLUE SELECT,413.85,,,,,,,172.7600,11005.7700,fee schedule,$356.77 from Fee Schedule TC_24 for Rev 320 Proc 75736 * Qty 1 = $356.77 at 116% = $413.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA HMO,7897.41,,,,,,,172.7600,11005.7700,fee schedule,"$7,897.41 from Fee Schedule CIGWHS_23 for Rev 320 Proc 75736 * Qty 1 = $7,897.41 at 100% = $7,897.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,172.76,,,,,,,172.7600,11005.7700,fee schedule,$172.76 from Fee Schedule CGIFP_25LR for Rev 320 Proc 75736 * Qty 1 = $172.76 at 100% = $172.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,5300.94,,,,,,,172.7600,11005.7700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7897.41,,,,,,,172.7600,11005.7700,fee schedule,"$7,897.41 from Fee Schedule CIGWHS_23 for Rev 320 Proc 75736 * Qty 1 = $7,897.41 at 100% = $7,897.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA PPO,7897.41,,,,,,,172.7600,11005.7700,fee schedule,"$7,897.41 from Fee Schedule CIGWHS_23 for Rev 320 Proc 75736 * Qty 1 = $7,897.41 at 100% = $7,897.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,5300.94,,,,,,,172.7600,11005.7700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8146.80,,,,,,,172.7600,11005.7700,percent of total billed charges,"90% of $9,052.00 in Billed Charges for Rev 320 Proc 75736 = $8,146.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,HUMANA,HUMANA MEDICARE,5048.52,,,,,,,172.7600,11005.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5048.52,,,,,,,172.7600,11005.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,MEDCOST,MEDCOST VHN,4307.85,,,,,,,172.7600,11005.7700,percent of total billed charges,"47.59% of $9,052.00 in Billed Charges for Rev 320 Proc 75736 = $4,307.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,6730.27,,,,,,,172.7600,11005.7700,fee schedule,"APG 00280 Proc 75736 at $836.60 (Base Rate) * 7.6617 (Relative Weight) = $6,409.78 (Total Line Payment) at 100% = $6,409.78... $6,409.78 at 105% = $6,730.27 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,5300.94,,,,,,,172.7600,11005.7700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,5300.94,,,,,,,172.7600,11005.7700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,NHC ADVANTAGE,NHC ADVANTAGE,5300.94,,,,,,,172.7600,11005.7700,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,6608.48,,,,,,,172.7600,11005.7700,fee schedule,"APG 00280 Proc 75736 at $836.60 (Base Rate) * 7.6617 (Relative Weight) = $6,409.78 (Total Line Payment) at 100% = $6,409.78... $6,409.78 at 103.1% = $6,608.48 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,SENTARA HEALTH,SENTARA HEALTH,2336.32,,,,,,,172.7600,11005.7700,percent of total billed charges,"25.81% of $9,052.00 in Billed Charges for Rev 320 Proc 75736 = $2,336.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,SENTARA HEALTH,SENTARA MEDICARE,5048.52,,,,,,,172.7600,11005.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9052.00,,,,,,,172.7600,11005.7700,percent of total billed charges,"100% of $9,052.00 in Billed Charges for Rev 320 Proc 75736 = $9,052.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1043.32,,,,,,,172.7600,11005.7700,fee schedule,"$2,086.63 from Fee Schedule TCUHC24 for Rev 320 Proc 75736 * Qty 1 = $2,086.63 at 50% = $1,043.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,172.7600,11005.7700,other,Rev 320 Proc 75736 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,172.7600,11005.7700,other,Rev 320 Proc 75736 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,172.7600,11005.7700,other,Rev 320 Proc 75736 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,6602.07,,,,,,,172.7600,11005.7700,fee schedule,"APG 00280 Proc 75736 at $836.60 (Base Rate) * 7.6617 (Relative Weight) = $6,409.78 (Total Line Payment) at 103% = $6,602.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5048.52,,,,,,,172.7600,11005.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5048.52,,,,,,,172.7600,11005.7700,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,WELLCARE,WELLCARE MEDICAID,9052.00,,,,,,,172.7600,11005.7700,percent of total billed charges,"100% of $9,052.00 in Billed Charges for Rev 320 Proc 75736 = $9,052.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIO PELVIS,75736,CPT,320,RC,32000198,CDM,,,,both,,,9052.0000,1357.8000,WELLCARE,WELLCARE MEDICARE,5351.43,,,,,,,172.7600,11005.7700,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,AETNA,AETNA,3865.20,,,,,,,134.8000,9052.0000,percent of total billed charges,"42.7% of $9,052.00 in Billed Charges for Rev 320 Proc 75743 = $3,865.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2491.25,,,,,,,134.8000,9052.0000,fee schedule,"APG 00279 Proc 75743 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 104% = $2,491.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2864.70,,,,,,,134.8000,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,AETNA,AETNA HEALTHCARE MEDICARE,2864.70,,,,,,,134.8000,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,ALLCARE MEDICARE,ALLCARE MEDICARE,2864.70,,,,,,,134.8000,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,AMBETTER,AMBETTER,6245.05,,,,,,,134.8000,9052.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2979.29,,,,,,,134.8000,9052.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,ANTHEM EXCHANGE,7053.05,,,,,,,134.8000,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2467.30,,,,,,,134.8000,9052.0000,fee schedule,"APG 00279 Proc 75743 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 103% = $2,467.30. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,ANTHEM HMO,7493.45,,,,,,,134.8000,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2950.64,,,,,,,134.8000,9052.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",8815.35,,,,,,,134.8000,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,818.81,,,,,,,134.8000,9052.0000,fee schedule,$818.81 from Fee Schedule BLDTM_23 for Rev 320 Proc 75743 * Qty 1 = $818.81 at 100% = $818.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS E NETWORK,308.38,,,,,,,134.8000,9052.0000,fee schedule,$96.37 from Fee Schedule BCFSC for Rev 320 Proc 75743 * Qty 1 = $96.37 at 320% = $308.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS MEDICARE,2979.29,,,,,,,134.8000,9052.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS P NETWORK,315.13,,,,,,,134.8000,9052.0000,fee schedule,$96.37 from Fee Schedule BCFSC for Rev 320 Proc 75743 * Qty 1 = $96.37 at 327% = $315.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,BLUE CROSS S NETWORK,315.13,,,,,,,134.8000,9052.0000,fee schedule,$96.37 from Fee Schedule BCFSC for Rev 320 Proc 75743 * Qty 1 = $96.37 at 327% = $315.13 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,TENNCARE BLUE CARE,413.85,,,,,,,134.8000,9052.0000,fee schedule,$356.77 from Fee Schedule TC_24 for Rev 320 Proc 75743 * Qty 1 = $356.77 at 116% = $413.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,BLUE CROSS,TENNCARE BLUE SELECT,413.85,,,,,,,134.8000,9052.0000,fee schedule,$356.77 from Fee Schedule TC_24 for Rev 320 Proc 75743 * Qty 1 = $356.77 at 116% = $413.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA HMO,7897.41,,,,,,,134.8000,9052.0000,fee schedule,"$7,897.41 from Fee Schedule CIGWHS_23 for Rev 320 Proc 75743 * Qty 1 = $7,897.41 at 100% = $7,897.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,134.80,,,,,,,134.8000,9052.0000,fee schedule,$134.80 from Fee Schedule CGIFP_25LR for Rev 320 Proc 75743 * Qty 1 = $134.80 at 100% = $134.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA MEDICARE,3007.94,,,,,,,134.8000,9052.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,7897.41,,,,,,,134.8000,9052.0000,fee schedule,"$7,897.41 from Fee Schedule CIGWHS_23 for Rev 320 Proc 75743 * Qty 1 = $7,897.41 at 100% = $7,897.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,CIGNA HEALTHCARE,CIGNA PPO,7897.41,,,,,,,134.8000,9052.0000,fee schedule,"$7,897.41 from Fee Schedule CIGWHS_23 for Rev 320 Proc 75743 * Qty 1 = $7,897.41 at 100% = $7,897.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3007.94,,,,,,,134.8000,9052.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8146.80,,,,,,,134.8000,9052.0000,percent of total billed charges,"90% of $9,052.00 in Billed Charges for Rev 320 Proc 75743 = $8,146.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,HUMANA,HUMANA MEDICARE,2864.70,,,,,,,134.8000,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2864.70,,,,,,,134.8000,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,MEDCOST,MEDCOST VHN,4307.85,,,,,,,134.8000,9052.0000,percent of total billed charges,"47.59% of $9,052.00 in Billed Charges for Rev 320 Proc 75743 = $4,307.85. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2515.21,,,,,,,134.8000,9052.0000,fee schedule,"APG 00279 Proc 75743 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 100% = $2,395.44... $2,395.44 at 105% = $2,515.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3007.94,,,,,,,134.8000,9052.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3007.94,,,,,,,134.8000,9052.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,NHC ADVANTAGE,NHC ADVANTAGE,3007.94,,,,,,,134.8000,9052.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2469.70,,,,,,,134.8000,9052.0000,fee schedule,"APG 00279 Proc 75743 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 100% = $2,395.44... $2,395.44 at 103.1% = $2,469.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,SENTARA HEALTH,SENTARA HEALTH,2336.32,,,,,,,134.8000,9052.0000,percent of total billed charges,"25.81% of $9,052.00 in Billed Charges for Rev 320 Proc 75743 = $2,336.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,SENTARA HEALTH,SENTARA MEDICARE,2864.70,,,,,,,134.8000,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9052.00,,,,,,,134.8000,9052.0000,percent of total billed charges,"100% of $9,052.00 in Billed Charges for Rev 320 Proc 75743 = $9,052.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1043.32,,,,,,,134.8000,9052.0000,fee schedule,"$2,086.63 from Fee Schedule TCUHC24 for Rev 320 Proc 75743 * Qty 1 = $2,086.63 at 50% = $1,043.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,134.8000,9052.0000,other,Rev 320 Proc 75743 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,134.8000,9052.0000,other,Rev 320 Proc 75743 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,134.8000,9052.0000,other,Rev 320 Proc 75743 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2467.30,,,,,,,134.8000,9052.0000,fee schedule,"APG 00279 Proc 75743 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 103% = $2,467.30. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2864.70,,,,,,,134.8000,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2864.70,,,,,,,134.8000,9052.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,WELLCARE,WELLCARE MEDICAID,9052.00,,,,,,,134.8000,9052.0000,percent of total billed charges,"100% of $9,052.00 in Billed Charges for Rev 320 Proc 75743 = $9,052.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIO PULMONARY BILAT SELECT RAD S&I,75743,CPT,320,RC,32000223,CDM,,,,both,,,9052.0000,1357.8000,WELLCARE,WELLCARE MEDICARE,3036.58,,,,,,,134.8000,9052.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,AETNA,AETNA,1402.27,,,,,,,155.4700,6245.0500,percent of total billed charges,"42.7% of $3,284.00 in Billed Charges for Rev 323 Proc 75746 = $1,402.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,2491.25,,,,,,,155.4700,6245.0500,fee schedule,"APG 00279 Proc 75746 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 104% = $2,491.25. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2864.70,,,,,,,155.4700,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,AETNA,AETNA HEALTHCARE MEDICARE,2864.70,,,,,,,155.4700,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,2864.70,,,,,,,155.4700,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,AMBETTER,AMBETTER,6245.05,,,,,,,155.4700,6245.0500,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2979.29,,,,,,,155.4700,6245.0500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,BLUE CROSS,ANTHEM EXCHANGE,3284.00,,,,,,,155.4700,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2467.30,,,,,,,155.4700,6245.0500,fee schedule,"APG 00279 Proc 75746 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 103% = $2,467.30. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,BLUE CROSS,ANTHEM HMO,3284.00,,,,,,,155.4700,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2950.64,,,,,,,155.4700,6245.0500,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3284.00,,,,,,,155.4700,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,779.63,,,,,,,155.4700,6245.0500,fee schedule,$779.63 from Fee Schedule BLDTM_23 for Rev 323 Proc 75746 * Qty 1 = $779.63 at 100% = $779.63 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,BLUE CROSS,BLUE CROSS E NETWORK,321.76,,,,,,,155.4700,6245.0500,fee schedule,$100.55 from Fee Schedule BCFSC for Rev 323 Proc 75746 * Qty 1 = $100.55 at 320% = $321.76 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,BLUE CROSS,BLUE CROSS MEDICARE,2979.29,,,,,,,155.4700,6245.0500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,BLUE CROSS,BLUE CROSS P NETWORK,328.80,,,,,,,155.4700,6245.0500,fee schedule,$100.55 from Fee Schedule BCFSC for Rev 323 Proc 75746 * Qty 1 = $100.55 at 327% = $328.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,BLUE CROSS,BLUE CROSS S NETWORK,328.80,,,,,,,155.4700,6245.0500,fee schedule,$100.55 from Fee Schedule BCFSC for Rev 323 Proc 75746 * Qty 1 = $100.55 at 327% = $328.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,BLUE CROSS,TENNCARE BLUE CARE,413.85,,,,,,,155.4700,6245.0500,fee schedule,$356.77 from Fee Schedule TC_24 for Rev 323 Proc 75746 * Qty 1 = $356.77 at 116% = $413.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,BLUE CROSS,TENNCARE BLUE SELECT,413.85,,,,,,,155.4700,6245.0500,fee schedule,$356.77 from Fee Schedule TC_24 for Rev 323 Proc 75746 * Qty 1 = $356.77 at 116% = $413.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,CIGNA HEALTHCARE,CIGNA HMO,2495.94,,,,,,,155.4700,6245.0500,fee schedule,"$2,495.94 from Fee Schedule CIGWHS_23 for Rev 323 Proc 75746 * Qty 1 = $2,495.94 at 100% = $2,495.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,155.47,,,,,,,155.4700,6245.0500,fee schedule,$155.47 from Fee Schedule CGIFP_25LR for Rev 323 Proc 75746 * Qty 1 = $155.47 at 100% = $155.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,3007.94,,,,,,,155.4700,6245.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2495.94,,,,,,,155.4700,6245.0500,fee schedule,"$2,495.94 from Fee Schedule CIGWHS_23 for Rev 323 Proc 75746 * Qty 1 = $2,495.94 at 100% = $2,495.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,CIGNA HEALTHCARE,CIGNA PPO,2495.94,,,,,,,155.4700,6245.0500,fee schedule,"$2,495.94 from Fee Schedule CIGWHS_23 for Rev 323 Proc 75746 * Qty 1 = $2,495.94 at 100% = $2,495.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3007.94,,,,,,,155.4700,6245.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2955.60,,,,,,,155.4700,6245.0500,percent of total billed charges,"90% of $3,284.00 in Billed Charges for Rev 323 Proc 75746 = $2,955.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,HUMANA,HUMANA MEDICARE,2864.70,,,,,,,155.4700,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2864.70,,,,,,,155.4700,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,MEDCOST,MEDCOST VHN,1562.86,,,,,,,155.4700,6245.0500,percent of total billed charges,"47.59% of $3,284.00 in Billed Charges for Rev 323 Proc 75746 = $1,562.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,2515.21,,,,,,,155.4700,6245.0500,fee schedule,"APG 00279 Proc 75746 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 100% = $2,395.44... $2,395.44 at 105% = $2,515.21 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3007.94,,,,,,,155.4700,6245.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3007.94,,,,,,,155.4700,6245.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,NHC ADVANTAGE,NHC ADVANTAGE,3007.94,,,,,,,155.4700,6245.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,2469.70,,,,,,,155.4700,6245.0500,fee schedule,"APG 00279 Proc 75746 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 100% = $2,395.44... $2,395.44 at 103.1% = $2,469.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,SENTARA HEALTH,SENTARA HEALTH,847.60,,,,,,,155.4700,6245.0500,percent of total billed charges,"25.81% of $3,284.00 in Billed Charges for Rev 323 Proc 75746 = $847.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,SENTARA HEALTH,SENTARA MEDICARE,2864.70,,,,,,,155.4700,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3284.00,,,,,,,155.4700,6245.0500,percent of total billed charges,"100% of $3,284.00 in Billed Charges for Rev 323 Proc 75746 = $3,284.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,329.74,,,,,,,155.4700,6245.0500,fee schedule,$659.47 from Fee Schedule TCUHC24 for Rev 323 Proc 75746 * Qty 1 = $659.47 at 50% = $329.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,155.4700,6245.0500,other,Rev 323 Proc 75746 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,155.4700,6245.0500,other,Rev 323 Proc 75746 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,155.4700,6245.0500,other,Rev 323 Proc 75746 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,2467.30,,,,,,,155.4700,6245.0500,fee schedule,"APG 00279 Proc 75746 at $836.60 (Base Rate) * 2.8633 (Relative Weight) = $2,395.44 (Total Line Payment) at 103% = $2,467.30. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2864.70,,,,,,,155.4700,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2864.70,,,,,,,155.4700,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,WELLCARE,WELLCARE MEDICAID,3284.00,,,,,,,155.4700,6245.0500,percent of total billed charges,"100% of $3,284.00 in Billed Charges for Rev 323 Proc 75746 = $3,284.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ANGIOGRAPHY PULMONARY NONSLCTV CATH/VEIN INJ RS&I,75746,CPT,323,RC,32300004,CDM,,,,both,,,3284.0000,492.6000,WELLCARE,WELLCARE MEDICARE,3036.58,,,,,,,155.4700,6245.0500,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
VALVE MV STANDARD 700-23,278,RC,,,,,,,,both,,,50537.8800,7580.6800,AETNA,AETNA,24258.18,,,,,,,3588.1900,50537.8800,percent of total billed charges,"48% of $50,537.88 in Billed Charges for Rev 278 = $24,258.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE MV STANDARD 700-23,278,RC,,,,,,,,both,,,50537.8800,7580.6800,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,25268.94,,,,,,,3588.1900,50537.8800,percent of total billed charges,"50% of $50,537.88 in Billed Charges for Rev 278 = $25,268.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE MV STANDARD 700-23,278,RC,,,,,,,,both,,,50537.8800,7580.6800,CIGNA HEALTHCARE,CIGNA HMO,21074.30,,,,,,,3588.1900,50537.8800,percent of total billed charges,"41.7% of $50,537.88 in Billed Charges for Rev 278 = $21,074.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE MV STANDARD 700-23,278,RC,,,,,,,,both,,,50537.8800,7580.6800,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,20215.15,,,,,,,3588.1900,50537.8800,percent of total billed charges,"40% of $50,537.88 in Billed Charges for Rev 278 = $20,215.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE MV STANDARD 700-23,278,RC,,,,,,,,both,,,50537.8800,7580.6800,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,21074.30,,,,,,,3588.1900,50537.8800,percent of total billed charges,"41.7% of $50,537.88 in Billed Charges for Rev 278 = $21,074.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE MV STANDARD 700-23,278,RC,,,,,,,,both,,,50537.8800,7580.6800,CIGNA HEALTHCARE,CIGNA PPO,21074.30,,,,,,,3588.1900,50537.8800,percent of total billed charges,"41.7% of $50,537.88 in Billed Charges for Rev 278 = $21,074.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE MV STANDARD 700-23,278,RC,,,,,,,,both,,,50537.8800,7580.6800,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,45484.09,,,,,,,3588.1900,50537.8800,percent of total billed charges,"90% of $50,537.88 in Billed Charges for Rev 278 = $45,484.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE MV STANDARD 700-23,278,RC,,,,,,,,both,,,50537.8800,7580.6800,MEDCOST,MEDCOST VHN,24050.98,,,,,,,3588.1900,50537.8800,percent of total billed charges,"47.59% of $50,537.88 in Billed Charges for Rev 278 = $24,050.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE MV STANDARD 700-23,278,RC,,,,,,,,both,,,50537.8800,7580.6800,SENTARA HEALTH,SENTARA HEALTH,13043.83,,,,,,,3588.1900,50537.8800,percent of total billed charges,"25.81% of $50,537.88 in Billed Charges for Rev 278 = $13,043.83. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE MV STANDARD 700-23,278,RC,,,,,,,,both,,,50537.8800,7580.6800,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",50537.88,,,,,,,3588.1900,50537.8800,percent of total billed charges,"100% of $50,537.88 in Billed Charges for Rev 278 = $50,537.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE MV STANDARD 700-23,278,RC,,,,,,,,both,,,50537.8800,7580.6800,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,25268.94,,,,,,,3588.1900,50537.8800,percent of total billed charges,"Rev 278 $50,537.88 in Billed Charges at 50% = $25,268.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE MV STANDARD 700-23,278,RC,,,,,,,,both,,,50537.8800,7580.6800,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,3790.34,,,,,,,3588.1900,50537.8800,percent of total billed charges,"7.5% of $50,537.88 in Billed Charges for Rev 278 = $3,790.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE MV STANDARD 700-23,278,RC,,,,,,,,both,,,50537.8800,7580.6800,UNITED HEALTHCARE,UHC HERITAGE SELECT,3588.19,,,,,,,3588.1900,50537.8800,percent of total billed charges,"7.1% of $50,537.88 in Billed Charges for Rev 278 = $3,588.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE MV STANDARD 700-23,278,RC,,,,,,,,both,,,50537.8800,7580.6800,UNITED HEALTHCARE,UNITED HEALTHCARE,3588.19,,,,,,,3588.1900,50537.8800,percent of total billed charges,"7.1% of $50,537.88 in Billed Charges for Rev 278 = $3,588.19. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE MV STANDARD 700-23,278,RC,,,,,,,,both,,,50537.8800,7580.6800,WELLCARE,WELLCARE MEDICAID,50537.88,,,,,,,3588.1900,50537.8800,percent of total billed charges,"100% of $50,537.88 in Billed Charges for Rev 278 = $50,537.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
VALVE STORZ SUCTION 11301CA,270,RC,,,,,,,,both,,,102.4600,15.3700,AETNA,AETNA,43.75,,,,,,,26.4400,102.4600,percent of total billed charges,42.7% of $102.46 in Billed Charges for Rev 270 = $43.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
VALVE STORZ SUCTION 11301CA,270,RC,,,,,,,,both,,,102.4600,15.3700,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,71.72,,,,,,,26.4400,102.4600,percent of total billed charges,Rev 270 $102.46 in Billed Charges at 70% = $71.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
VALVE STORZ SUCTION 11301CA,270,RC,,,,,,,,both,,,102.4600,15.3700,CIGNA HEALTHCARE,CIGNA HMO,42.73,,,,,,,26.4400,102.4600,percent of total billed charges,41.7% of $102.46 in Billed Charges for Rev 270 = $42.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
VALVE STORZ SUCTION 11301CA,270,RC,,,,,,,,both,,,102.4600,15.3700,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,47.54,,,,,,,26.4400,102.4600,percent of total billed charges,46.4% of $102.46 in Billed Charges for Rev 270 = $47.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
VALVE STORZ SUCTION 11301CA,270,RC,,,,,,,,both,,,102.4600,15.3700,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,42.73,,,,,,,26.4400,102.4600,percent of total billed charges,41.7% of $102.46 in Billed Charges for Rev 270 = $42.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
VALVE STORZ SUCTION 11301CA,270,RC,,,,,,,,both,,,102.4600,15.3700,CIGNA HEALTHCARE,CIGNA PPO,42.73,,,,,,,26.4400,102.4600,percent of total billed charges,41.7% of $102.46 in Billed Charges for Rev 270 = $42.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
VALVE STORZ SUCTION 11301CA,270,RC,,,,,,,,both,,,102.4600,15.3700,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,92.21,,,,,,,26.4400,102.4600,percent of total billed charges,90% of $102.46 in Billed Charges for Rev 270 = $92.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
VALVE STORZ SUCTION 11301CA,270,RC,,,,,,,,both,,,102.4600,15.3700,MEDCOST,MEDCOST VHN,48.76,,,,,,,26.4400,102.4600,percent of total billed charges,47.59% of $102.46 in Billed Charges for Rev 270 = $48.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
VALVE STORZ SUCTION 11301CA,270,RC,,,,,,,,both,,,102.4600,15.3700,SENTARA HEALTH,SENTARA HEALTH,26.44,,,,,,,26.4400,102.4600,percent of total billed charges,25.81% of $102.46 in Billed Charges for Rev 270 = $26.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
VALVE STORZ SUCTION 11301CA,270,RC,,,,,,,,both,,,102.4600,15.3700,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",102.46,,,,,,,26.4400,102.4600,percent of total billed charges,100% of $102.46 in Billed Charges for Rev 270 = $102.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
VALVE STORZ SUCTION 11301CA,270,RC,,,,,,,,both,,,102.4600,15.3700,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,51.23,,,,,,,26.4400,102.4600,percent of total billed charges,Rev 270 $102.46 in Billed Charges at 50% = $51.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
VALVE STORZ SUCTION 11301CA,270,RC,,,,,,,,both,,,102.4600,15.3700,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,33.09,,,,,,,26.4400,102.4600,other,32.3% of $102.46 in Billed Charges for Rev 270 = $33.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
VALVE STORZ SUCTION 11301CA,270,RC,,,,,,,,both,,,102.4600,15.3700,UNITED HEALTHCARE,UHC HERITAGE SELECT,31.46,,,,,,,26.4400,102.4600,other,30.7% of $102.46 in Billed Charges for Rev 270 = $31.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
VALVE STORZ SUCTION 11301CA,270,RC,,,,,,,,both,,,102.4600,15.3700,UNITED HEALTHCARE,UNITED HEALTHCARE,33.09,,,,,,,26.4400,102.4600,percent of total billed charges,32.3% of $102.46 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
VALVE STORZ SUCTION 11301CA,270,RC,,,,,,,,both,,,102.4600,15.3700,WELLCARE,WELLCARE MEDICAID,102.46,,,,,,,26.4400,102.4600,percent of total billed charges,100% of $102.46 in Billed Charges for Rev 270 = $102.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,AETNA,AETNA,1286.98,,,,,,,200.1600,6245.0500,percent of total billed charges,"42.7% of $3,014.00 in Billed Charges for Rev 320 Proc 75805 = $1,286.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1616.14,,,,,,,200.1600,6245.0500,fee schedule,"APG 00277 Proc 75805 at $836.60 (Base Rate) * 1.8575 (Relative Weight) = $1,553.98 (Total Line Payment) at 104% = $1,616.14. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,2864.70,,,,,,,200.1600,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,AETNA,AETNA HEALTHCARE MEDICARE,2864.70,,,,,,,200.1600,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,2864.70,,,,,,,200.1600,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,AMBETTER,AMBETTER,6245.05,,,,,,,200.1600,6245.0500,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,2979.29,,,,,,,200.1600,6245.0500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,BLUE CROSS,ANTHEM EXCHANGE,3014.00,,,,,,,200.1600,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1600.60,,,,,,,200.1600,6245.0500,fee schedule,"APG 00277 Proc 75805 at $836.60 (Base Rate) * 1.8575 (Relative Weight) = $1,553.98 (Total Line Payment) at 103% = $1,600.60. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,BLUE CROSS,ANTHEM HMO,3014.00,,,,,,,200.1600,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,2950.64,,,,,,,200.1600,6245.0500,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3014.00,,,,,,,200.1600,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,387.14,,,,,,,200.1600,6245.0500,fee schedule,$387.14 from Fee Schedule BLDTM_23 for Rev 320 Proc 75805 * Qty 1 = $387.14 at 100% = $387.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,BLUE CROSS,BLUE CROSS E NETWORK,709.44,,,,,,,200.1600,6245.0500,fee schedule,$221.70 from Fee Schedule BCFSC for Rev 320 Proc 75805 * Qty 1 = $221.70 at 320% = $709.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,BLUE CROSS,BLUE CROSS MEDICARE,2979.29,,,,,,,200.1600,6245.0500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,BLUE CROSS,BLUE CROSS P NETWORK,724.96,,,,,,,200.1600,6245.0500,fee schedule,$221.70 from Fee Schedule BCFSC for Rev 320 Proc 75805 * Qty 1 = $221.70 at 327% = $724.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,BLUE CROSS,BLUE CROSS S NETWORK,724.96,,,,,,,200.1600,6245.0500,fee schedule,$221.70 from Fee Schedule BCFSC for Rev 320 Proc 75805 * Qty 1 = $221.70 at 327% = $724.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,BLUE CROSS,TENNCARE BLUE CARE,200.16,,,,,,,200.1600,6245.0500,fee schedule,$172.55 from Fee Schedule TC_24 for Rev 320 Proc 75805 * Qty 1 = $172.55 at 116% = $200.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,BLUE CROSS,TENNCARE BLUE SELECT,200.16,,,,,,,200.1600,6245.0500,fee schedule,$172.55 from Fee Schedule TC_24 for Rev 320 Proc 75805 * Qty 1 = $172.55 at 116% = $200.16 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,CIGNA HEALTHCARE,CIGNA HMO,1608.72,,,,,,,200.1600,6245.0500,fee schedule,"$1,608.72 from Fee Schedule CIGWHS_23 for Rev 320 Proc 75805 * Qty 1 = $1,608.72 at 100% = $1,608.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,396.74,,,,,,,200.1600,6245.0500,fee schedule,$396.74 from Fee Schedule CGIFP_25LR for Rev 320 Proc 75805 * Qty 1 = $396.74 at 100% = $396.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,3007.94,,,,,,,200.1600,6245.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1608.72,,,,,,,200.1600,6245.0500,fee schedule,"$1,608.72 from Fee Schedule CIGWHS_23 for Rev 320 Proc 75805 * Qty 1 = $1,608.72 at 100% = $1,608.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,CIGNA HEALTHCARE,CIGNA PPO,1608.72,,,,,,,200.1600,6245.0500,fee schedule,"$1,608.72 from Fee Schedule CIGWHS_23 for Rev 320 Proc 75805 * Qty 1 = $1,608.72 at 100% = $1,608.72 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,3007.94,,,,,,,200.1600,6245.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2712.60,,,,,,,200.1600,6245.0500,percent of total billed charges,"90% of $3,014.00 in Billed Charges for Rev 320 Proc 75805 = $2,712.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,HUMANA,HUMANA MEDICARE,2864.70,,,,,,,200.1600,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,2864.70,,,,,,,200.1600,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,MEDCOST,MEDCOST VHN,1434.36,,,,,,,200.1600,6245.0500,percent of total billed charges,"47.59% of $3,014.00 in Billed Charges for Rev 320 Proc 75805 = $1,434.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1631.68,,,,,,,200.1600,6245.0500,fee schedule,"APG 00277 Proc 75805 at $836.60 (Base Rate) * 1.8575 (Relative Weight) = $1,553.98 (Total Line Payment) at 100% = $1,553.98... $1,553.98 at 105% = $1,631.68 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,3007.94,,,,,,,200.1600,6245.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,3007.94,,,,,,,200.1600,6245.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,NHC ADVANTAGE,NHC ADVANTAGE,3007.94,,,,,,,200.1600,6245.0500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1602.15,,,,,,,200.1600,6245.0500,fee schedule,"APG 00277 Proc 75805 at $836.60 (Base Rate) * 1.8575 (Relative Weight) = $1,553.98 (Total Line Payment) at 100% = $1,553.98... $1,553.98 at 103.1% = $1,602.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,SENTARA HEALTH,SENTARA HEALTH,777.91,,,,,,,200.1600,6245.0500,percent of total billed charges,"25.81% of $3,014.00 in Billed Charges for Rev 320 Proc 75805 = $777.91. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,SENTARA HEALTH,SENTARA MEDICARE,2864.70,,,,,,,200.1600,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3014.00,,,,,,,200.1600,6245.0500,percent of total billed charges,"100% of $3,014.00 in Billed Charges for Rev 320 Proc 75805 = $3,014.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,212.53,,,,,,,200.1600,6245.0500,fee schedule,$425.05 from Fee Schedule TCUHC24 for Rev 320 Proc 75805 * Qty 1 = $425.05 at 50% = $212.53 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,200.1600,6245.0500,other,Rev 320 Proc 75805 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,200.1600,6245.0500,other,Rev 320 Proc 75805 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,200.1600,6245.0500,other,Rev 320 Proc 75805 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1600.60,,,,,,,200.1600,6245.0500,fee schedule,"APG 00277 Proc 75805 at $836.60 (Base Rate) * 1.8575 (Relative Weight) = $1,553.98 (Total Line Payment) at 103% = $1,600.60. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,2864.70,,,,,,,200.1600,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,2864.70,,,,,,,200.1600,6245.0500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,WELLCARE,WELLCARE MEDICAID,3014.00,,,,,,,200.1600,6245.0500,percent of total billed charges,"100% of $3,014.00 in Billed Charges for Rev 320 Proc 75805 = $3,014.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC LYMPHANGIOGRAPHY PELVIC/ABD UNILAT RAD R&I,75805,CPT,320,RC,32000313,CDM,,,,both,,,3014.0000,452.1000,WELLCARE,WELLCARE MEDICARE,3036.58,,,,,,,200.1600,6245.0500,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,AETNA,AETNA,1282.71,,,,,,,48.7800,3113.4500,percent of total billed charges,"42.7% of $3,004.00 in Billed Charges for Rev 320 Proc 75822 = $1,282.71. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1616.14,,,,,,,48.7800,3113.4500,fee schedule,"APG 00277 Proc 75822 at $836.60 (Base Rate) * 1.8575 (Relative Weight) = $1,553.98 (Total Line Payment) at 104% = $1,616.14. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1428.19,,,,,,,48.7800,3113.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,AETNA,AETNA HEALTHCARE MEDICARE,1428.19,,,,,,,48.7800,3113.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,1428.19,,,,,,,48.7800,3113.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,AMBETTER,AMBETTER,3113.45,,,,,,,48.7800,3113.4500,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1485.32,,,,,,,48.7800,3113.4500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,BLUE CROSS,ANTHEM EXCHANGE,3004.00,,,,,,,48.7800,3113.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1600.60,,,,,,,48.7800,3113.4500,fee schedule,"APG 00277 Proc 75822 at $836.60 (Base Rate) * 1.8575 (Relative Weight) = $1,553.98 (Total Line Payment) at 103% = $1,600.60. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,BLUE CROSS,ANTHEM HMO,3004.00,,,,,,,48.7800,3113.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1471.04,,,,,,,48.7800,3113.4500,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3004.00,,,,,,,48.7800,3113.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,130.23,,,,,,,48.7800,3113.4500,fee schedule,$130.23 from Fee Schedule BLDTM_23 for Rev 320 Proc 75822 * Qty 1 = $130.23 at 100% = $130.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,BLUE CROSS,BLUE CROSS E NETWORK,299.14,,,,,,,48.7800,3113.4500,fee schedule,$93.48 from Fee Schedule BCFSC for Rev 320 Proc 75822 * Qty 1 = $93.48 at 320% = $299.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,BLUE CROSS,BLUE CROSS MEDICARE,1485.32,,,,,,,48.7800,3113.4500,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,BLUE CROSS,BLUE CROSS P NETWORK,305.68,,,,,,,48.7800,3113.4500,fee schedule,$93.48 from Fee Schedule BCFSC for Rev 320 Proc 75822 * Qty 1 = $93.48 at 327% = $305.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,BLUE CROSS,BLUE CROSS S NETWORK,305.68,,,,,,,48.7800,3113.4500,fee schedule,$93.48 from Fee Schedule BCFSC for Rev 320 Proc 75822 * Qty 1 = $93.48 at 327% = $305.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,BLUE CROSS,TENNCARE BLUE CARE,48.78,,,,,,,48.7800,3113.4500,fee schedule,$42.05 from Fee Schedule TC_24 for Rev 320 Proc 75822 * Qty 1 = $42.05 at 116% = $48.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,BLUE CROSS,TENNCARE BLUE SELECT,48.78,,,,,,,48.7800,3113.4500,fee schedule,$42.05 from Fee Schedule TC_24 for Rev 320 Proc 75822 * Qty 1 = $42.05 at 116% = $48.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,CIGNA HEALTHCARE,CIGNA HMO,2495.94,,,,,,,48.7800,3113.4500,fee schedule,"$2,495.94 from Fee Schedule CIGWHS_23 for Rev 320 Proc 75822 * Qty 1 = $2,495.94 at 100% = $2,495.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,123.14,,,,,,,48.7800,3113.4500,fee schedule,$123.14 from Fee Schedule CGIFP_25LR for Rev 320 Proc 75822 * Qty 1 = $123.14 at 100% = $123.14 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,1499.60,,,,,,,48.7800,3113.4500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2495.94,,,,,,,48.7800,3113.4500,fee schedule,"$2,495.94 from Fee Schedule CIGWHS_23 for Rev 320 Proc 75822 * Qty 1 = $2,495.94 at 100% = $2,495.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,CIGNA HEALTHCARE,CIGNA PPO,2495.94,,,,,,,48.7800,3113.4500,fee schedule,"$2,495.94 from Fee Schedule CIGWHS_23 for Rev 320 Proc 75822 * Qty 1 = $2,495.94 at 100% = $2,495.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1499.60,,,,,,,48.7800,3113.4500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2703.60,,,,,,,48.7800,3113.4500,percent of total billed charges,"90% of $3,004.00 in Billed Charges for Rev 320 Proc 75822 = $2,703.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,HUMANA,HUMANA MEDICARE,1428.19,,,,,,,48.7800,3113.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1428.19,,,,,,,48.7800,3113.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,MEDCOST,MEDCOST VHN,1429.60,,,,,,,48.7800,3113.4500,percent of total billed charges,"47.59% of $3,004.00 in Billed Charges for Rev 320 Proc 75822 = $1,429.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1631.68,,,,,,,48.7800,3113.4500,fee schedule,"APG 00277 Proc 75822 at $836.60 (Base Rate) * 1.8575 (Relative Weight) = $1,553.98 (Total Line Payment) at 100% = $1,553.98... $1,553.98 at 105% = $1,631.68 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1499.60,,,,,,,48.7800,3113.4500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1499.60,,,,,,,48.7800,3113.4500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,NHC ADVANTAGE,NHC ADVANTAGE,1499.60,,,,,,,48.7800,3113.4500,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1602.15,,,,,,,48.7800,3113.4500,fee schedule,"APG 00277 Proc 75822 at $836.60 (Base Rate) * 1.8575 (Relative Weight) = $1,553.98 (Total Line Payment) at 100% = $1,553.98... $1,553.98 at 103.1% = $1,602.15 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,SENTARA HEALTH,SENTARA HEALTH,775.33,,,,,,,48.7800,3113.4500,percent of total billed charges,"25.81% of $3,004.00 in Billed Charges for Rev 320 Proc 75822 = $775.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,SENTARA HEALTH,SENTARA MEDICARE,1428.19,,,,,,,48.7800,3113.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3004.00,,,,,,,48.7800,3113.4500,percent of total billed charges,"100% of $3,004.00 in Billed Charges for Rev 320 Proc 75822 = $3,004.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,329.74,,,,,,,48.7800,3113.4500,fee schedule,$659.47 from Fee Schedule TCUHC24 for Rev 320 Proc 75822 * Qty 1 = $659.47 at 50% = $329.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,48.7800,3113.4500,other,Rev 320 Proc 75822 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,48.7800,3113.4500,other,Rev 320 Proc 75822 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,48.7800,3113.4500,other,Rev 320 Proc 75822 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1600.60,,,,,,,48.7800,3113.4500,fee schedule,"APG 00277 Proc 75822 at $836.60 (Base Rate) * 1.8575 (Relative Weight) = $1,553.98 (Total Line Payment) at 103% = $1,600.60. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1428.19,,,,,,,48.7800,3113.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1428.19,,,,,,,48.7800,3113.4500,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,WELLCARE,WELLCARE MEDICAID,3004.00,,,,,,,48.7800,3113.4500,percent of total billed charges,"100% of $3,004.00 in Billed Charges for Rev 320 Proc 75822 = $3,004.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC VENOGRAM EXTREM BILAT,75822,CPT,320,RC,32000204,CDM,,,,both,,,3004.0000,450.6000,WELLCARE,WELLCARE MEDICARE,1513.88,,,,,,,48.7800,3113.4500,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,22.4000,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 77073 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 77073 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,206.78,,,,,,,22.4000,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,22.4000,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 77073 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,22.4000,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,25.22,,,,,,,22.4000,462.0000,fee schedule,$25.22 from Fee Schedule BLDTM_23 for Rev 320 Proc 77073 * Qty 1 = $25.22 at 100% = $25.22 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,66.50,,,,,,,22.4000,462.0000,fee schedule,$20.78 from Fee Schedule BCFSC for Rev 320 Proc 77073 * Qty 1 = $20.78 at 320% = $66.50 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,22.4000,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,67.95,,,,,,,22.4000,462.0000,fee schedule,$20.78 from Fee Schedule BCFSC for Rev 320 Proc 77073 * Qty 1 = $20.78 at 327% = $67.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,67.95,,,,,,,22.4000,462.0000,fee schedule,$20.78 from Fee Schedule BCFSC for Rev 320 Proc 77073 * Qty 1 = $20.78 at 327% = $67.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,23.77,,,,,,,22.4000,462.0000,fee schedule,$20.49 from Fee Schedule TC_24 for Rev 320 Proc 77073 * Qty 1 = $20.49 at 116% = $23.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,23.77,,,,,,,22.4000,462.0000,fee schedule,$20.49 from Fee Schedule TC_24 for Rev 320 Proc 77073 * Qty 1 = $20.49 at 116% = $23.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,22.4000,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 77073 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,60.51,,,,,,,22.4000,462.0000,fee schedule,$60.51 from Fee Schedule CGIFP_25LR for Rev 320 Proc 77073 * Qty 1 = $60.51 at 100% = $60.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,22.4000,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 77073 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,22.4000,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 77073 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,22.4000,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 77073 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,22.4000,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 77073 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 77073 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 77073 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,22.4000,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 77073 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,22.4000,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 77073 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,22.4000,462.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 77073 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,22.4000,462.0000,other,Rev 320 Proc 77073 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,22.4000,462.0000,other,Rev 320 Proc 77073 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,22.4000,462.0000,other,Rev 320 Proc 77073 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 77073 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,22.4000,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 77073 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX LEG LENGTH MEASUREMENT,77073,CPT,320,RC,32000258,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,22.4000,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,31.9600,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 77076 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,31.9600,462.0000,fee schedule,APG 00471 Proc 77076 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,31.9600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,31.9600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,31.9600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,206.78,,,,,,,31.9600,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,31.9600,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,31.9600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,31.9600,462.0000,fee schedule,APG 00471 Proc 77076 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,31.9600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,31.9600,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,31.9600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,33.90,,,,,,,31.9600,462.0000,fee schedule,$33.90 from Fee Schedule BLDTM_23 for Rev 320 Proc 77076 * Qty 1 = $33.90 at 100% = $33.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,209.57,,,,,,,31.9600,462.0000,fee schedule,$65.49 from Fee Schedule BCFSC for Rev 320 Proc 77076 * Qty 1 = $65.49 at 320% = $209.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,31.9600,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,214.15,,,,,,,31.9600,462.0000,fee schedule,$65.49 from Fee Schedule BCFSC for Rev 320 Proc 77076 * Qty 1 = $65.49 at 327% = $214.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,214.15,,,,,,,31.9600,462.0000,fee schedule,$65.49 from Fee Schedule BCFSC for Rev 320 Proc 77076 * Qty 1 = $65.49 at 327% = $214.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,31.96,,,,,,,31.9600,462.0000,fee schedule,$27.55 from Fee Schedule TC_24 for Rev 320 Proc 77076 * Qty 1 = $27.55 at 116% = $31.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,31.96,,,,,,,31.9600,462.0000,fee schedule,$27.55 from Fee Schedule TC_24 for Rev 320 Proc 77076 * Qty 1 = $27.55 at 116% = $31.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,285.67,,,,,,,31.9600,462.0000,fee schedule,$285.67 from Fee Schedule CIGWHS_23 for Rev 320 Proc 77076 * Qty 1 = $285.67 at 100% = $285.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,139.18,,,,,,,31.9600,462.0000,fee schedule,$139.18 from Fee Schedule CGIFP_25LR for Rev 320 Proc 77076 * Qty 1 = $139.18 at 100% = $139.18 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,31.9600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,285.67,,,,,,,31.9600,462.0000,fee schedule,$285.67 from Fee Schedule CIGWHS_23 for Rev 320 Proc 77076 * Qty 1 = $285.67 at 100% = $285.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,285.67,,,,,,,31.9600,462.0000,fee schedule,$285.67 from Fee Schedule CIGWHS_23 for Rev 320 Proc 77076 * Qty 1 = $285.67 at 100% = $285.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,31.9600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,31.9600,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 77076 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,94.85,,,,,,,31.9600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,31.9600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,31.9600,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 77076 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,31.9600,462.0000,fee schedule,APG 00471 Proc 77076 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,31.9600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,31.9600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,31.9600,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,31.9600,462.0000,fee schedule,APG 00471 Proc 77076 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,31.9600,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 77076 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,31.9600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,31.9600,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 77076 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,37.74,,,,,,,31.9600,462.0000,fee schedule,$75.48 from Fee Schedule TCUHC24 for Rev 320 Proc 77076 * Qty 1 = $75.48 at 50% = $37.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,31.9600,462.0000,other,Rev 320 Proc 77076 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,31.9600,462.0000,other,Rev 320 Proc 77076 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,31.9600,462.0000,other,Rev 320 Proc 77076 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,31.9600,462.0000,fee schedule,APG 00471 Proc 77076 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,31.9600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,31.9600,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,31.9600,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 77076 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX OSSEOUS SURVEY INFANT,77076,CPT,320,RC,32000025,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,31.9600,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
WAND COBLATION REFLEX ULTRA PT,272,RC,27200002,CDM,,,,,,both,,,3154.0300,473.1000,AETNA,AETNA,1346.77,,,,,,,814.0600,3154.0300,percent of total billed charges,"42.7% of $3,154.03 in Billed Charges for Rev 272 = $1,346.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND COBLATION REFLEX ULTRA PT,272,RC,27200002,CDM,,,,,,both,,,3154.0300,473.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2207.82,,,,,,,814.0600,3154.0300,percent of total billed charges,"Rev 272 $3,154.03 in Billed Charges at 70% = $2,207.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND COBLATION REFLEX ULTRA PT,272,RC,27200002,CDM,,,,,,both,,,3154.0300,473.1000,CIGNA HEALTHCARE,CIGNA HMO,1315.23,,,,,,,814.0600,3154.0300,percent of total billed charges,"41.7% of $3,154.03 in Billed Charges for Rev 272 = $1,315.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND COBLATION REFLEX ULTRA PT,272,RC,27200002,CDM,,,,,,both,,,3154.0300,473.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1463.47,,,,,,,814.0600,3154.0300,percent of total billed charges,"46.4% of $3,154.03 in Billed Charges for Rev 272 = $1,463.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND COBLATION REFLEX ULTRA PT,272,RC,27200002,CDM,,,,,,both,,,3154.0300,473.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1315.23,,,,,,,814.0600,3154.0300,percent of total billed charges,"41.7% of $3,154.03 in Billed Charges for Rev 272 = $1,315.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND COBLATION REFLEX ULTRA PT,272,RC,27200002,CDM,,,,,,both,,,3154.0300,473.1000,CIGNA HEALTHCARE,CIGNA PPO,1315.23,,,,,,,814.0600,3154.0300,percent of total billed charges,"41.7% of $3,154.03 in Billed Charges for Rev 272 = $1,315.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND COBLATION REFLEX ULTRA PT,272,RC,27200002,CDM,,,,,,both,,,3154.0300,473.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2838.63,,,,,,,814.0600,3154.0300,percent of total billed charges,"90% of $3,154.03 in Billed Charges for Rev 272 = $2,838.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND COBLATION REFLEX ULTRA PT,272,RC,27200002,CDM,,,,,,both,,,3154.0300,473.1000,MEDCOST,MEDCOST VHN,1501.00,,,,,,,814.0600,3154.0300,percent of total billed charges,"47.59% of $3,154.03 in Billed Charges for Rev 272 = $1,501.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND COBLATION REFLEX ULTRA PT,272,RC,27200002,CDM,,,,,,both,,,3154.0300,473.1000,SENTARA HEALTH,SENTARA HEALTH,814.06,,,,,,,814.0600,3154.0300,percent of total billed charges,"25.81% of $3,154.03 in Billed Charges for Rev 272 = $814.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND COBLATION REFLEX ULTRA PT,272,RC,27200002,CDM,,,,,,both,,,3154.0300,473.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3154.03,,,,,,,814.0600,3154.0300,percent of total billed charges,"100% of $3,154.03 in Billed Charges for Rev 272 = $3,154.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND COBLATION REFLEX ULTRA PT,272,RC,27200002,CDM,,,,,,both,,,3154.0300,473.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,1577.02,,,,,,,814.0600,3154.0300,percent of total billed charges,"Rev 272 $3,154.03 in Billed Charges at 50% = $1,577.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND COBLATION REFLEX ULTRA PT,272,RC,27200002,CDM,,,,,,both,,,3154.0300,473.1000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1018.75,,,,,,,814.0600,3154.0300,other,"32.3% of $3,154.03 in Billed Charges for Rev 272 = $1,018.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND COBLATION REFLEX ULTRA PT,272,RC,27200002,CDM,,,,,,both,,,3154.0300,473.1000,UNITED HEALTHCARE,UHC HERITAGE SELECT,968.29,,,,,,,814.0600,3154.0300,other,"30.7% of $3,154.03 in Billed Charges for Rev 272 = $968.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND COBLATION REFLEX ULTRA PT,272,RC,27200002,CDM,,,,,,both,,,3154.0300,473.1000,UNITED HEALTHCARE,UNITED HEALTHCARE,1018.75,,,,,,,814.0600,3154.0300,percent of total billed charges,"32.3% of $3,154.03 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND COBLATION REFLEX ULTRA PT,272,RC,27200002,CDM,,,,,,both,,,3154.0300,473.1000,WELLCARE,WELLCARE MEDICAID,3154.03,,,,,,,814.0600,3154.0300,percent of total billed charges,"100% of $3,154.03 in Billed Charges for Rev 272 = $3,154.03. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND ELECTROSURG MICRODEBRIDER TOPAZ EX,272,RC,27200002,CDM,,,,,,both,,,4724.9200,708.7400,AETNA,AETNA,2017.54,,,,,,,1219.5000,4724.9200,percent of total billed charges,"42.7% of $4,724.92 in Billed Charges for Rev 272 = $2,017.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND ELECTROSURG MICRODEBRIDER TOPAZ EX,272,RC,27200002,CDM,,,,,,both,,,4724.9200,708.7400,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,3307.44,,,,,,,1219.5000,4724.9200,percent of total billed charges,"Rev 272 $4,724.92 in Billed Charges at 70% = $3,307.44. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND ELECTROSURG MICRODEBRIDER TOPAZ EX,272,RC,27200002,CDM,,,,,,both,,,4724.9200,708.7400,CIGNA HEALTHCARE,CIGNA HMO,1970.29,,,,,,,1219.5000,4724.9200,percent of total billed charges,"41.7% of $4,724.92 in Billed Charges for Rev 272 = $1,970.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND ELECTROSURG MICRODEBRIDER TOPAZ EX,272,RC,27200002,CDM,,,,,,both,,,4724.9200,708.7400,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2192.36,,,,,,,1219.5000,4724.9200,percent of total billed charges,"46.4% of $4,724.92 in Billed Charges for Rev 272 = $2,192.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND ELECTROSURG MICRODEBRIDER TOPAZ EX,272,RC,27200002,CDM,,,,,,both,,,4724.9200,708.7400,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1970.29,,,,,,,1219.5000,4724.9200,percent of total billed charges,"41.7% of $4,724.92 in Billed Charges for Rev 272 = $1,970.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND ELECTROSURG MICRODEBRIDER TOPAZ EX,272,RC,27200002,CDM,,,,,,both,,,4724.9200,708.7400,CIGNA HEALTHCARE,CIGNA PPO,1970.29,,,,,,,1219.5000,4724.9200,percent of total billed charges,"41.7% of $4,724.92 in Billed Charges for Rev 272 = $1,970.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND ELECTROSURG MICRODEBRIDER TOPAZ EX,272,RC,27200002,CDM,,,,,,both,,,4724.9200,708.7400,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4252.43,,,,,,,1219.5000,4724.9200,percent of total billed charges,"90% of $4,724.92 in Billed Charges for Rev 272 = $4,252.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND ELECTROSURG MICRODEBRIDER TOPAZ EX,272,RC,27200002,CDM,,,,,,both,,,4724.9200,708.7400,MEDCOST,MEDCOST VHN,2248.59,,,,,,,1219.5000,4724.9200,percent of total billed charges,"47.59% of $4,724.92 in Billed Charges for Rev 272 = $2,248.59. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND ELECTROSURG MICRODEBRIDER TOPAZ EX,272,RC,27200002,CDM,,,,,,both,,,4724.9200,708.7400,SENTARA HEALTH,SENTARA HEALTH,1219.50,,,,,,,1219.5000,4724.9200,percent of total billed charges,"25.81% of $4,724.92 in Billed Charges for Rev 272 = $1,219.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND ELECTROSURG MICRODEBRIDER TOPAZ EX,272,RC,27200002,CDM,,,,,,both,,,4724.9200,708.7400,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",4724.92,,,,,,,1219.5000,4724.9200,percent of total billed charges,"100% of $4,724.92 in Billed Charges for Rev 272 = $4,724.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND ELECTROSURG MICRODEBRIDER TOPAZ EX,272,RC,27200002,CDM,,,,,,both,,,4724.9200,708.7400,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2362.46,,,,,,,1219.5000,4724.9200,percent of total billed charges,"Rev 272 $4,724.92 in Billed Charges at 50% = $2,362.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND ELECTROSURG MICRODEBRIDER TOPAZ EX,272,RC,27200002,CDM,,,,,,both,,,4724.9200,708.7400,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1526.15,,,,,,,1219.5000,4724.9200,other,"32.3% of $4,724.92 in Billed Charges for Rev 272 = $1,526.15 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND ELECTROSURG MICRODEBRIDER TOPAZ EX,272,RC,27200002,CDM,,,,,,both,,,4724.9200,708.7400,UNITED HEALTHCARE,UHC HERITAGE SELECT,1450.55,,,,,,,1219.5000,4724.9200,other,"30.7% of $4,724.92 in Billed Charges for Rev 272 = $1,450.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
WAND ELECTROSURG MICRODEBRIDER TOPAZ EX,272,RC,27200002,CDM,,,,,,both,,,4724.9200,708.7400,UNITED HEALTHCARE,UNITED HEALTHCARE,1526.15,,,,,,,1219.5000,4724.9200,percent of total billed charges,"32.3% of $4,724.92 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
WAND ELECTROSURG MICRODEBRIDER TOPAZ EX,272,RC,27200002,CDM,,,,,,both,,,4724.9200,708.7400,WELLCARE,WELLCARE MEDICAID,4724.92,,,,,,,1219.5000,4724.9200,percent of total billed charges,"100% of $4,724.92 in Billed Charges for Rev 272 = $4,724.92. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA,197.27,,,,,,,22.4000,462.0000,percent of total billed charges,42.7% of $462.00 in Billed Charges for Rev 320 Proc 77077 = $197.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,79.61,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 77077 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 104% = $79.61. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,AMBETTER,AMBETTER,206.78,,,,,,,22.4000,462.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,22.4000,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,78.85,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 77077 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,22.4000,462.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,33.80,,,,,,,22.4000,462.0000,fee schedule,$33.80 from Fee Schedule BLDTM_23 for Rev 320 Proc 77077 * Qty 1 = $33.80 at 100% = $33.80 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS E NETWORK,67.52,,,,,,,22.4000,462.0000,fee schedule,$21.10 from Fee Schedule BCFSC for Rev 320 Proc 77077 * Qty 1 = $21.10 at 320% = $67.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,22.4000,462.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS P NETWORK,69.00,,,,,,,22.4000,462.0000,fee schedule,$21.10 from Fee Schedule BCFSC for Rev 320 Proc 77077 * Qty 1 = $21.10 at 327% = $69.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,BLUE CROSS S NETWORK,69.00,,,,,,,22.4000,462.0000,fee schedule,$21.10 from Fee Schedule BCFSC for Rev 320 Proc 77077 * Qty 1 = $21.10 at 327% = $69.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE CARE,31.85,,,,,,,22.4000,462.0000,fee schedule,$27.46 from Fee Schedule TC_24 for Rev 320 Proc 77077 * Qty 1 = $27.46 at 116% = $31.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,BLUE CROSS,TENNCARE BLUE SELECT,31.85,,,,,,,22.4000,462.0000,fee schedule,$27.46 from Fee Schedule TC_24 for Rev 320 Proc 77077 * Qty 1 = $27.46 at 116% = $31.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA HMO,169.56,,,,,,,22.4000,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 77077 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,57.38,,,,,,,22.4000,462.0000,fee schedule,$57.38 from Fee Schedule CGIFP_25LR for Rev 320 Proc 77077 * Qty 1 = $57.38 at 100% = $57.38 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,169.56,,,,,,,22.4000,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 77077 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,CIGNA HEALTHCARE,CIGNA PPO,169.56,,,,,,,22.4000,462.0000,fee schedule,$169.56 from Fee Schedule CIGWHS_23 for Rev 320 Proc 77077 * Qty 1 = $169.56 at 100% = $169.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,415.80,,,,,,,22.4000,462.0000,percent of total billed charges,90% of $462.00 in Billed Charges for Rev 320 Proc 77077 = $415.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,HUMANA,HUMANA MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,MEDCOST,MEDCOST VHN,219.87,,,,,,,22.4000,462.0000,percent of total billed charges,47.59% of $462.00 in Billed Charges for Rev 320 Proc 77077 = $219.87. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,80.38,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 77077 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 105% = $80.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,22.4000,462.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,78.92,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 77077 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 100% = $76.55... $76.55 at 103.1% = $78.92 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA HEALTH,119.24,,,,,,,22.4000,462.0000,percent of total billed charges,25.81% of $462.00 in Billed Charges for Rev 320 Proc 77077 = $119.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",462.00,,,,,,,22.4000,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 77077 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,22.40,,,,,,,22.4000,462.0000,fee schedule,$44.80 from Fee Schedule TCUHC24 for Rev 320 Proc 77077 * Qty 1 = $44.80 at 50% = $22.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,22.4000,462.0000,other,Rev 320 Proc 77077 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,22.4000,462.0000,other,Rev 320 Proc 77077 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,22.4000,462.0000,other,Rev 320 Proc 77077 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,78.85,,,,,,,22.4000,462.0000,fee schedule,APG 00471 Proc 77077 at $836.60 (Base Rate) * 0.0915 (Relative Weight) = $76.55 (Total Line Payment) at 103% = $78.85. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,22.4000,462.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICAID,462.00,,,,,,,22.4000,462.0000,percent of total billed charges,100% of $462.00 in Billed Charges for Rev 320 Proc 77077 = $462.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DX JOINT SURVEY 2 OR MORE JNTS,77077,CPT,320,RC,32000026,CDM,,,,both,,,462.0000,69.3000,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,22.4000,462.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,AETNA,AETNA,1475.29,,,,,,,35.7400,3455.0000,percent of total billed charges,"42.7% of $3,455.00 in Billed Charges for Rev 350 Proc 77078 = $1,475.29. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,108.06,,,,,,,35.7400,3455.0000,fee schedule,APG 00291 Proc 77078 at $836.60 (Base Rate) * 0.1242 (Relative Weight) = $103.91 (Total Line Payment) at 104% = $108.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,78.96,,,,,,,35.7400,3455.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,AETNA,AETNA HEALTHCARE MEDICARE,78.96,,,,,,,35.7400,3455.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,78.96,,,,,,,35.7400,3455.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,AMBETTER,AMBETTER,172.12,,,,,,,35.7400,3455.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,82.11,,,,,,,35.7400,3455.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,BLUE CROSS,ANTHEM EXCHANGE,194.39,,,,,,,35.7400,3455.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,107.02,,,,,,,35.7400,3455.0000,fee schedule,APG 00291 Proc 77078 at $836.60 (Base Rate) * 0.1242 (Relative Weight) = $103.91 (Total Line Payment) at 103% = $107.02. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,BLUE CROSS,ANTHEM HMO,206.53,,,,,,,35.7400,3455.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,81.32,,,,,,,35.7400,3455.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",242.97,,,,,,,35.7400,3455.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,114.95,,,,,,,35.7400,3455.0000,fee schedule,$114.95 from Fee Schedule BLDTM_23 for Rev 350 Proc 77078 * Qty 1 = $114.95 at 100% = $114.95 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,BLUE CROSS,BLUE CROSS E NETWORK,291.94,,,,,,,35.7400,3455.0000,fee schedule,$91.23 from Fee Schedule BCFSD for Rev 350 Proc 77078 * Qty 1 = $91.23 at 320% = $291.94 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,BLUE CROSS,BLUE CROSS MEDICARE,82.11,,,,,,,35.7400,3455.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,BLUE CROSS,BLUE CROSS P NETWORK,298.32,,,,,,,35.7400,3455.0000,fee schedule,$91.23 from Fee Schedule BCFSD for Rev 350 Proc 77078 * Qty 1 = $91.23 at 327% = $298.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,BLUE CROSS,BLUE CROSS S NETWORK,298.32,,,,,,,35.7400,3455.0000,fee schedule,$91.23 from Fee Schedule BCFSD for Rev 350 Proc 77078 * Qty 1 = $91.23 at 327% = $298.32 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,BLUE CROSS,TENNCARE BLUE CARE,108.33,,,,,,,35.7400,3455.0000,fee schedule,$93.39 from Fee Schedule TC_24 for Rev 350 Proc 77078 * Qty 1 = $93.39 at 116% = $108.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,BLUE CROSS,TENNCARE BLUE SELECT,108.33,,,,,,,35.7400,3455.0000,fee schedule,$93.39 from Fee Schedule TC_24 for Rev 350 Proc 77078 * Qty 1 = $93.39 at 116% = $108.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,CIGNA HEALTHCARE,CIGNA HMO,642.00,,,,,,,35.7400,3455.0000,other,Rev 350 Proc 77078 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,427.00,,,,,,,35.7400,3455.0000,other,Rev 350 Proc 77078 Qty 1 * $427.00 = $427.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,82.90,,,,,,,35.7400,3455.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,642.00,,,,,,,35.7400,3455.0000,other,Rev 350 Proc 77078 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,CIGNA HEALTHCARE,CIGNA PPO,642.00,,,,,,,35.7400,3455.0000,other,Rev 350 Proc 77078 Qty 1 * $642.00 = $642.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,82.90,,,,,,,35.7400,3455.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3109.50,,,,,,,35.7400,3455.0000,percent of total billed charges,"90% of $3,455.00 in Billed Charges for Rev 350 Proc 77078 = $3,109.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,HUMANA,HUMANA MEDICARE,78.96,,,,,,,35.7400,3455.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,78.96,,,,,,,35.7400,3455.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,MEDCOST,MEDCOST VHN,1644.23,,,,,,,35.7400,3455.0000,percent of total billed charges,"47.59% of $3,455.00 in Billed Charges for Rev 350 Proc 77078 = $1,644.23. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,109.11,,,,,,,35.7400,3455.0000,fee schedule,APG 00291 Proc 77078 at $836.60 (Base Rate) * 0.1242 (Relative Weight) = $103.91 (Total Line Payment) at 100% = $103.91... $103.91 at 105% = $109.11 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,82.90,,,,,,,35.7400,3455.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,82.90,,,,,,,35.7400,3455.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,NHC ADVANTAGE,NHC ADVANTAGE,82.90,,,,,,,35.7400,3455.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,107.13,,,,,,,35.7400,3455.0000,fee schedule,APG 00291 Proc 77078 at $836.60 (Base Rate) * 0.1242 (Relative Weight) = $103.91 (Total Line Payment) at 100% = $103.91... $103.91 at 103.1% = $107.13 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,SENTARA HEALTH,SENTARA HEALTH,891.74,,,,,,,35.7400,3455.0000,percent of total billed charges,"25.81% of $3,455.00 in Billed Charges for Rev 350 Proc 77078 = $891.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,SENTARA HEALTH,SENTARA MEDICARE,78.96,,,,,,,35.7400,3455.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3455.00,,,,,,,35.7400,3455.0000,percent of total billed charges,"100% of $3,455.00 in Billed Charges for Rev 350 Proc 77078 = $3,455.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,35.74,,,,,,,35.7400,3455.0000,fee schedule,$71.48 from Fee Schedule TCUHC24 for Rev 350 Proc 77078 * Qty 1 = $71.48 at 50% = $35.74 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1919.00,,,,,,,35.7400,3455.0000,other,"Rev 350 Proc 77078 1 Visit at $1,919.00 per Visit = $1,919.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1835.00,,,,,,,35.7400,3455.0000,other,"Rev 350 Proc 77078 1 Visit at $1,835.00 per Visit = $1,835.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,UNITED HEALTHCARE,UNITED HEALTHCARE,3026.00,,,,,,,35.7400,3455.0000,other,"Rev 350 Proc 77078 1 Visit at $3,026.00 per Visit = $3,026.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,107.02,,,,,,,35.7400,3455.0000,fee schedule,APG 00291 Proc 77078 at $836.60 (Base Rate) * 0.1242 (Relative Weight) = $103.91 (Total Line Payment) at 103% = $107.02. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,78.96,,,,,,,35.7400,3455.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,78.96,,,,,,,35.7400,3455.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,WELLCARE,WELLCARE MEDICAID,3455.00,,,,,,,35.7400,3455.0000,percent of total billed charges,"100% of $3,455.00 in Billed Charges for Rev 350 Proc 77078 = $3,455.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC CT BONE DENSITY AXIAL,77078,CPT,350,RC,35000008,CDM,,,,both,,,3455.0000,518.2500,WELLCARE,WELLCARE MEDICARE,83.69,,,,,,,35.7400,3455.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,AETNA,AETNA,1529.09,,,,,,,169.2100,3581.0000,percent of total billed charges,"42.7% of $3,581.00 in Billed Charges for Rev 612 Proc 77084 = $1,529.09. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,343.24,,,,,,,169.2100,3581.0000,fee schedule,APG 00293 Proc 77084 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 104% = $343.24. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,216.48,,,,,,,169.2100,3581.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,AETNA,AETNA HEALTHCARE MEDICARE,216.48,,,,,,,169.2100,3581.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,216.48,,,,,,,169.2100,3581.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,AMBETTER,AMBETTER,471.92,,,,,,,169.2100,3581.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,225.14,,,,,,,169.2100,3581.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,BLUE CROSS,ANTHEM EXCHANGE,532.97,,,,,,,169.2100,3581.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,339.94,,,,,,,169.2100,3581.0000,fee schedule,APG 00293 Proc 77084 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 103% = $339.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,BLUE CROSS,ANTHEM HMO,566.25,,,,,,,169.2100,3581.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,222.97,,,,,,,169.2100,3581.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",666.14,,,,,,,169.2100,3581.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,405.52,,,,,,,169.2100,3581.0000,fee schedule,$405.52 from Fee Schedule BLDTM_23 for Rev 612 Proc 77084 * Qty 1 = $405.52 at 100% = $405.52 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,BLUE CROSS,BLUE CROSS E NETWORK,906.46,,,,,,,169.2100,3581.0000,fee schedule,$283.27 from Fee Schedule BCFSD for Rev 612 Proc 77084 * Qty 1 = $283.27 at 320% = $906.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,BLUE CROSS,BLUE CROSS MEDICARE,225.14,,,,,,,169.2100,3581.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,BLUE CROSS,BLUE CROSS P NETWORK,926.29,,,,,,,169.2100,3581.0000,fee schedule,$283.27 from Fee Schedule BCFSD for Rev 612 Proc 77084 * Qty 1 = $283.27 at 327% = $926.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,BLUE CROSS,BLUE CROSS S NETWORK,926.29,,,,,,,169.2100,3581.0000,fee schedule,$283.27 from Fee Schedule BCFSD for Rev 612 Proc 77084 * Qty 1 = $283.27 at 327% = $926.29 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,BLUE CROSS,TENNCARE BLUE CARE,382.17,,,,,,,169.2100,3581.0000,fee schedule,$329.46 from Fee Schedule TC_24 for Rev 612 Proc 77084 * Qty 1 = $329.46 at 116% = $382.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,BLUE CROSS,TENNCARE BLUE SELECT,382.17,,,,,,,169.2100,3581.0000,fee schedule,$329.46 from Fee Schedule TC_24 for Rev 612 Proc 77084 * Qty 1 = $329.46 at 116% = $382.17 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,CIGNA HEALTHCARE,CIGNA HMO,1215.00,,,,,,,169.2100,3581.0000,other,"Rev 612 Proc 77084 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,786.00,,,,,,,169.2100,3581.0000,other,Rev 612 Proc 77084 Qty 1 * $786.00 = $786.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,227.30,,,,,,,169.2100,3581.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1215.00,,,,,,,169.2100,3581.0000,other,"Rev 612 Proc 77084 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,CIGNA HEALTHCARE,CIGNA PPO,1215.00,,,,,,,169.2100,3581.0000,other,"Rev 612 Proc 77084 Qty 1 * $1,215.00 = $1,215.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,227.30,,,,,,,169.2100,3581.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,3222.90,,,,,,,169.2100,3581.0000,percent of total billed charges,"90% of $3,581.00 in Billed Charges for Rev 612 Proc 77084 = $3,222.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,HUMANA,HUMANA MEDICARE,216.48,,,,,,,169.2100,3581.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,216.48,,,,,,,169.2100,3581.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,MEDCOST,MEDCOST VHN,1704.20,,,,,,,169.2100,3581.0000,percent of total billed charges,"47.59% of $3,581.00 in Billed Charges for Rev 612 Proc 77084 = $1,704.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,346.54,,,,,,,169.2100,3581.0000,fee schedule,APG 00293 Proc 77084 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 100% = $330.04... $330.04 at 105% = $346.54 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,227.30,,,,,,,169.2100,3581.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,227.30,,,,,,,169.2100,3581.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,NHC ADVANTAGE,NHC ADVANTAGE,227.30,,,,,,,169.2100,3581.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,340.27,,,,,,,169.2100,3581.0000,fee schedule,APG 00293 Proc 77084 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 100% = $330.04... $330.04 at 103.1% = $340.27 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,SENTARA HEALTH,SENTARA HEALTH,924.26,,,,,,,169.2100,3581.0000,percent of total billed charges,"25.81% of $3,581.00 in Billed Charges for Rev 612 Proc 77084 = $924.26. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,SENTARA HEALTH,SENTARA MEDICARE,216.48,,,,,,,169.2100,3581.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3581.00,,,,,,,169.2100,3581.0000,percent of total billed charges,"100% of $3,581.00 in Billed Charges for Rev 612 Proc 77084 = $3,581.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,169.21,,,,,,,169.2100,3581.0000,fee schedule,$338.41 from Fee Schedule TCUHC24 for Rev 612 Proc 77084 * Qty 1 = $338.41 at 50% = $169.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,2559.00,,,,,,,169.2100,3581.0000,other,"Rev 612 Proc 77084 1 Visit at $2,559.00 per Visit = $2,559.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,2448.00,,,,,,,169.2100,3581.0000,other,"Rev 612 Proc 77084 1 Visit at $2,448.00 per Visit = $2,448.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,3581.00,,,,,,,169.2100,3581.0000,other,"Rev 612 Proc 77084 1 Visit at $4,035.00 per Visit = $4,035.00 (Service Line reduced to $3,581.00, claim capped at $3,581.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,339.94,,,,,,,169.2100,3581.0000,fee schedule,APG 00293 Proc 77084 at $836.60 (Base Rate) * 0.3945 (Relative Weight) = $330.04 (Total Line Payment) at 103% = $339.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,216.48,,,,,,,169.2100,3581.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,216.48,,,,,,,169.2100,3581.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,WELLCARE,WELLCARE MEDICAID,3581.00,,,,,,,169.2100,3581.0000,percent of total billed charges,"100% of $3,581.00 in Billed Charges for Rev 612 Proc 77084 = $3,581.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC MR BONE MARROW BLOOD SUPPLY,77084,CPT,612,RC,61200011,CDM,,,,both,,,3581.0000,537.1500,WELLCARE,WELLCARE MEDICARE,229.47,,,,,,,169.2100,3581.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,AETNA,AETNA,181.90,,,,,,,34.6700,426.0000,percent of total billed charges,42.7% of $426.00 in Billed Charges for Rev 320 Proc 77085 = $181.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,108.06,,,,,,,34.6700,426.0000,fee schedule,APG 00291 Proc 77085 at $836.60 (Base Rate) * 0.1242 (Relative Weight) = $103.91 (Total Line Payment) at 104% = $108.06. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,94.85,,,,,,,34.6700,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,AETNA,AETNA HEALTHCARE MEDICARE,94.85,,,,,,,34.6700,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,94.85,,,,,,,34.6700,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,AMBETTER,AMBETTER,206.78,,,,,,,34.6700,426.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,98.65,,,,,,,34.6700,426.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,ANTHEM EXCHANGE,233.53,,,,,,,34.6700,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,107.02,,,,,,,34.6700,426.0000,fee schedule,APG 00291 Proc 77085 at $836.60 (Base Rate) * 0.1242 (Relative Weight) = $103.91 (Total Line Payment) at 103% = $107.02. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,ANTHEM HMO,248.11,,,,,,,34.6700,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,97.70,,,,,,,34.6700,426.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",291.88,,,,,,,34.6700,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,298.20,,,,,,,34.6700,426.0000,percent of total billed charges,Rev 320 Proc 77085 $426.00 in Billed Charges at 70% = $298.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,BLUE CROSS E NETWORK,117.73,,,,,,,34.6700,426.0000,fee schedule,$36.79 from Fee Schedule BCFSC for Rev 320 Proc 77085 * Qty 1 = $36.79 at 320% = $117.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,BLUE CROSS MEDICARE,98.65,,,,,,,34.6700,426.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,BLUE CROSS P NETWORK,120.30,,,,,,,34.6700,426.0000,fee schedule,$36.79 from Fee Schedule BCFSC for Rev 320 Proc 77085 * Qty 1 = $36.79 at 327% = $120.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,BLUE CROSS S NETWORK,120.30,,,,,,,34.6700,426.0000,fee schedule,$36.79 from Fee Schedule BCFSC for Rev 320 Proc 77085 * Qty 1 = $36.79 at 327% = $120.30 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,TENNCARE BLUE CARE,34.67,,,,,,,34.6700,426.0000,fee schedule,$29.89 from Fee Schedule TC_24 for Rev 320 Proc 77085 * Qty 1 = $29.89 at 116% = $34.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,BLUE CROSS,TENNCARE BLUE SELECT,34.67,,,,,,,34.6700,426.0000,fee schedule,$29.89 from Fee Schedule TC_24 for Rev 320 Proc 77085 * Qty 1 = $29.89 at 116% = $34.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,CIGNA HEALTHCARE,CIGNA HMO,177.64,,,,,,,34.6700,426.0000,percent of total billed charges,Rev 320 Proc 77085 $426.00 in Billed Charges at 41.7% = $177.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,73.42,,,,,,,34.6700,426.0000,fee schedule,$73.42 from Fee Schedule CGIFP_25LR for Rev 320 Proc 77085 * Qty 1 = $73.42 at 100% = $73.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,99.59,,,,,,,34.6700,426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,177.64,,,,,,,34.6700,426.0000,percent of total billed charges,Rev 320 Proc 77085 $426.00 in Billed Charges at 41.7% = $177.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,CIGNA HEALTHCARE,CIGNA PPO,177.64,,,,,,,34.6700,426.0000,percent of total billed charges,Rev 320 Proc 77085 $426.00 in Billed Charges at 41.7% = $177.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,99.59,,,,,,,34.6700,426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,383.40,,,,,,,34.6700,426.0000,percent of total billed charges,90% of $426.00 in Billed Charges for Rev 320 Proc 77085 = $383.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,HUMANA,HUMANA MEDICARE,94.85,,,,,,,34.6700,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,94.85,,,,,,,34.6700,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,MEDCOST,MEDCOST VHN,202.73,,,,,,,34.6700,426.0000,percent of total billed charges,47.59% of $426.00 in Billed Charges for Rev 320 Proc 77085 = $202.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,109.11,,,,,,,34.6700,426.0000,fee schedule,APG 00291 Proc 77085 at $836.60 (Base Rate) * 0.1242 (Relative Weight) = $103.91 (Total Line Payment) at 100% = $103.91... $103.91 at 105% = $109.11 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,99.59,,,,,,,34.6700,426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,99.59,,,,,,,34.6700,426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,NHC ADVANTAGE,NHC ADVANTAGE,99.59,,,,,,,34.6700,426.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,107.13,,,,,,,34.6700,426.0000,fee schedule,APG 00291 Proc 77085 at $836.60 (Base Rate) * 0.1242 (Relative Weight) = $103.91 (Total Line Payment) at 100% = $103.91... $103.91 at 103.1% = $107.13 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,SENTARA HEALTH,SENTARA HEALTH,109.95,,,,,,,34.6700,426.0000,percent of total billed charges,25.81% of $426.00 in Billed Charges for Rev 320 Proc 77085 = $109.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,SENTARA HEALTH,SENTARA MEDICARE,94.85,,,,,,,34.6700,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",426.00,,,,,,,34.6700,426.0000,percent of total billed charges,100% of $426.00 in Billed Charges for Rev 320 Proc 77085 = $426.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,47.49,,,,,,,34.6700,426.0000,fee schedule,$94.98 from Fee Schedule TCUHC24 for Rev 320 Proc 77085 * Qty 1 = $94.98 at 50% = $47.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,233.00,,,,,,,34.6700,426.0000,other,Rev 320 Proc 77085 1 Visit at $233.00 per Visit = $233.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,224.00,,,,,,,34.6700,426.0000,other,Rev 320 Proc 77085 1 Visit at $224.00 per Visit = $224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,370.00,,,,,,,34.6700,426.0000,other,Rev 320 Proc 77085 1 Visit at $370.00 per Visit = $370.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,107.02,,,,,,,34.6700,426.0000,fee schedule,APG 00291 Proc 77085 at $836.60 (Base Rate) * 0.1242 (Relative Weight) = $103.91 (Total Line Payment) at 103% = $107.02. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,94.85,,,,,,,34.6700,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,94.85,,,,,,,34.6700,426.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,WELLCARE,WELLCARE MEDICAID,426.00,,,,,,,34.6700,426.0000,percent of total billed charges,100% of $426.00 in Billed Charges for Rev 320 Proc 77085 = $426.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DXA BONE DENS 1 OR MORE AXIAL SKEL VERT FX ASSESSMENT,77085,CPT,320,RC,32000272,CDM,,,,both,,,426.0000,63.9000,WELLCARE,WELLCARE MEDICARE,100.54,,,,,,,34.6700,426.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,AETNA,AETNA,1368.11,,,,,,,131.8200,3204.0000,percent of total billed charges,"42.7% of $3,204.00 in Billed Charges for Rev 333 Proc 77290 = $1,368.11. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,254.58,,,,,,,131.8200,3204.0000,fee schedule,APG 00477 Proc 77290 at $836.60 (Base Rate) * 0.2926 (Relative Weight) = $244.79 (Total Line Payment) at 104% = $254.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,339.71,,,,,,,131.8200,3204.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,AETNA,AETNA HEALTHCARE MEDICARE,339.71,,,,,,,131.8200,3204.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,339.71,,,,,,,131.8200,3204.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,AMBETTER,AMBETTER,740.57,,,,,,,131.8200,3204.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,353.30,,,,,,,131.8200,3204.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,BLUE CROSS,ANTHEM EXCHANGE,836.38,,,,,,,131.8200,3204.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,252.13,,,,,,,131.8200,3204.0000,fee schedule,APG 00477 Proc 77290 at $836.60 (Base Rate) * 0.2926 (Relative Weight) = $244.79 (Total Line Payment) at 103% = $252.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,BLUE CROSS,ANTHEM HMO,888.60,,,,,,,131.8200,3204.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,349.90,,,,,,,131.8200,3204.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1045.35,,,,,,,131.8200,3204.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,389.42,,,,,,,131.8200,3204.0000,fee schedule,$389.42 from Fee Schedule BLDTM_23 for Rev 333 Proc 77290 * Qty 1 = $389.42 at 100% = $389.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,BLUE CROSS,BLUE CROSS E NETWORK,1224.58,,,,,,,131.8200,3204.0000,fee schedule,"$382.68 from Fee Schedule BCFSC for Rev 333 Proc 77290 * Qty 1 = $382.68 at 320% = $1,224.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,BLUE CROSS,BLUE CROSS MEDICARE,353.30,,,,,,,131.8200,3204.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,BLUE CROSS,BLUE CROSS P NETWORK,1251.36,,,,,,,131.8200,3204.0000,fee schedule,"$382.68 from Fee Schedule BCFSC for Rev 333 Proc 77290 * Qty 1 = $382.68 at 327% = $1,251.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,BLUE CROSS,BLUE CROSS S NETWORK,1251.36,,,,,,,131.8200,3204.0000,fee schedule,"$382.68 from Fee Schedule BCFSC for Rev 333 Proc 77290 * Qty 1 = $382.68 at 327% = $1,251.36 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,BLUE CROSS,TENNCARE BLUE CARE,213.70,,,,,,,131.8200,3204.0000,fee schedule,$184.22 from Fee Schedule TC_24 for Rev 333 Proc 77290 * Qty 1 = $184.22 at 116% = $213.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,BLUE CROSS,TENNCARE BLUE SELECT,213.70,,,,,,,131.8200,3204.0000,fee schedule,$184.22 from Fee Schedule TC_24 for Rev 333 Proc 77290 * Qty 1 = $184.22 at 116% = $213.70 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,CIGNA HEALTHCARE,CIGNA HMO,997.82,,,,,,,131.8200,3204.0000,fee schedule,$997.82 from Fee Schedule CIGWHS_23 for Rev 333 Proc 77290 * Qty 1 = $997.82 at 100% = $997.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,686.98,,,,,,,131.8200,3204.0000,fee schedule,$686.98 from Fee Schedule CGIFP_25LR for Rev 333 Proc 77290 * Qty 1 = $686.98 at 100% = $686.98 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,356.70,,,,,,,131.8200,3204.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,997.82,,,,,,,131.8200,3204.0000,fee schedule,$997.82 from Fee Schedule CIGWHS_23 for Rev 333 Proc 77290 * Qty 1 = $997.82 at 100% = $997.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,CIGNA HEALTHCARE,CIGNA PPO,997.82,,,,,,,131.8200,3204.0000,fee schedule,$997.82 from Fee Schedule CIGWHS_23 for Rev 333 Proc 77290 * Qty 1 = $997.82 at 100% = $997.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,356.70,,,,,,,131.8200,3204.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2883.60,,,,,,,131.8200,3204.0000,percent of total billed charges,"90% of $3,204.00 in Billed Charges for Rev 333 Proc 77290 = $2,883.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,HUMANA,HUMANA MEDICARE,339.71,,,,,,,131.8200,3204.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,339.71,,,,,,,131.8200,3204.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,MEDCOST,MEDCOST VHN,1524.78,,,,,,,131.8200,3204.0000,percent of total billed charges,"47.59% of $3,204.00 in Billed Charges for Rev 333 Proc 77290 = $1,524.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,257.03,,,,,,,131.8200,3204.0000,fee schedule,APG 00477 Proc 77290 at $836.60 (Base Rate) * 0.2926 (Relative Weight) = $244.79 (Total Line Payment) at 100% = $244.79... $244.79 at 105% = $257.03 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,356.70,,,,,,,131.8200,3204.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,356.70,,,,,,,131.8200,3204.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,NHC ADVANTAGE,NHC ADVANTAGE,356.70,,,,,,,131.8200,3204.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,252.38,,,,,,,131.8200,3204.0000,fee schedule,APG 00477 Proc 77290 at $836.60 (Base Rate) * 0.2926 (Relative Weight) = $244.79 (Total Line Payment) at 100% = $244.79... $244.79 at 103.1% = $252.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,SENTARA HEALTH,SENTARA HEALTH,826.95,,,,,,,131.8200,3204.0000,percent of total billed charges,"25.81% of $3,204.00 in Billed Charges for Rev 333 Proc 77290 = $826.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,SENTARA HEALTH,SENTARA MEDICARE,339.71,,,,,,,131.8200,3204.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3204.00,,,,,,,131.8200,3204.0000,percent of total billed charges,"100% of $3,204.00 in Billed Charges for Rev 333 Proc 77290 = $3,204.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,131.82,,,,,,,131.8200,3204.0000,fee schedule,$263.64 from Fee Schedule TCUHC24 for Rev 333 Proc 77290 * Qty 1 = $263.64 at 50% = $131.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1411.00,,,,,,,131.8200,3204.0000,other,"Rev 333 Proc 77290 1 Visit at $1,411.00 per Visit = $1,411.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1350.00,,,,,,,131.8200,3204.0000,other,"Rev 333 Proc 77290 1 Visit at $1,350.00 per Visit = $1,350.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,2224.00,,,,,,,131.8200,3204.0000,other,"Rev 333 Proc 77290 1 Visit at $2,224.00 per Visit = $2,224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,252.13,,,,,,,131.8200,3204.0000,fee schedule,APG 00477 Proc 77290 at $836.60 (Base Rate) * 0.2926 (Relative Weight) = $244.79 (Total Line Payment) at 103% = $252.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,339.71,,,,,,,131.8200,3204.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,339.71,,,,,,,131.8200,3204.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,WELLCARE,WELLCARE MEDICAID,3204.00,,,,,,,131.8200,3204.0000,percent of total billed charges,"100% of $3,204.00 in Billed Charges for Rev 333 Proc 77290 = $3,204.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC SIMULATION COMPLEX,77290,CPT,333,RC,33300005,CDM,,,,both,,,3204.0000,480.6000,WELLCARE,WELLCARE MEDICARE,360.09,,,,,,,131.8200,3204.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,AETNA,AETNA,3997.15,,,,,,,476.7700,9361.0000,percent of total billed charges,"42.7% of $9,361.00 in Billed Charges for Rev 333 Proc 77295 = $3,997.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,1515.22,,,,,,,476.7700,9361.0000,fee schedule,"APG 00478 Proc 77295 at $836.60 (Base Rate) * 1.7415 (Relative Weight) = $1,456.94 (Total Line Payment) at 104% = $1,515.22. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,1255.79,,,,,,,476.7700,9361.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,AETNA,AETNA HEALTHCARE MEDICARE,1255.79,,,,,,,476.7700,9361.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,1255.79,,,,,,,476.7700,9361.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,AMBETTER,AMBETTER,2737.61,,,,,,,476.7700,9361.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,1306.02,,,,,,,476.7700,9361.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,BLUE CROSS,ANTHEM EXCHANGE,3091.81,,,,,,,476.7700,9361.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1500.65,,,,,,,476.7700,9361.0000,fee schedule,"APG 00478 Proc 77295 at $836.60 (Base Rate) * 1.7415 (Relative Weight) = $1,456.94 (Total Line Payment) at 103% = $1,500.65. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,BLUE CROSS,ANTHEM HMO,3284.86,,,,,,,476.7700,9361.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,1293.46,,,,,,,476.7700,9361.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",3864.34,,,,,,,476.7700,9361.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,814.04,,,,,,,476.7700,9361.0000,fee schedule,$814.04 from Fee Schedule BLDTM_23 for Rev 333 Proc 77295 * Qty 1 = $814.04 at 100% = $814.04 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,BLUE CROSS,BLUE CROSS E NETWORK,751.81,,,,,,,476.7700,9361.0000,fee schedule,$234.94 from Fee Schedule BCFSC for Rev 333 Proc 77295 * Qty 1 = $234.94 at 320% = $751.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,BLUE CROSS,BLUE CROSS MEDICARE,1306.02,,,,,,,476.7700,9361.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,BLUE CROSS,BLUE CROSS P NETWORK,768.25,,,,,,,476.7700,9361.0000,fee schedule,$234.94 from Fee Schedule BCFSC for Rev 333 Proc 77295 * Qty 1 = $234.94 at 327% = $768.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,BLUE CROSS,BLUE CROSS S NETWORK,768.25,,,,,,,476.7700,9361.0000,fee schedule,$234.94 from Fee Schedule BCFSC for Rev 333 Proc 77295 * Qty 1 = $234.94 at 327% = $768.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,BLUE CROSS,TENNCARE BLUE CARE,906.25,,,,,,,476.7700,9361.0000,fee schedule,$781.25 from Fee Schedule TC_24 for Rev 333 Proc 77295 * Qty 1 = $781.25 at 116% = $906.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,BLUE CROSS,TENNCARE BLUE SELECT,906.25,,,,,,,476.7700,9361.0000,fee schedule,$781.25 from Fee Schedule TC_24 for Rev 333 Proc 77295 * Qty 1 = $781.25 at 116% = $906.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,CIGNA HEALTHCARE,CIGNA HMO,3608.89,,,,,,,476.7700,9361.0000,fee schedule,"$3,608.89 from Fee Schedule CIGWHS_23 for Rev 333 Proc 77295 * Qty 1 = $3,608.89 at 100% = $3,608.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,481.81,,,,,,,476.7700,9361.0000,fee schedule,$481.81 from Fee Schedule CGIFP_25LR for Rev 333 Proc 77295 * Qty 1 = $481.81 at 100% = $481.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,1318.58,,,,,,,476.7700,9361.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3608.89,,,,,,,476.7700,9361.0000,fee schedule,"$3,608.89 from Fee Schedule CIGWHS_23 for Rev 333 Proc 77295 * Qty 1 = $3,608.89 at 100% = $3,608.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,CIGNA HEALTHCARE,CIGNA PPO,3608.89,,,,,,,476.7700,9361.0000,fee schedule,"$3,608.89 from Fee Schedule CIGWHS_23 for Rev 333 Proc 77295 * Qty 1 = $3,608.89 at 100% = $3,608.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,1318.58,,,,,,,476.7700,9361.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,8424.90,,,,,,,476.7700,9361.0000,percent of total billed charges,"90% of $9,361.00 in Billed Charges for Rev 333 Proc 77295 = $8,424.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,HUMANA,HUMANA MEDICARE,1255.79,,,,,,,476.7700,9361.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,1255.79,,,,,,,476.7700,9361.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,MEDCOST,MEDCOST VHN,4454.90,,,,,,,476.7700,9361.0000,percent of total billed charges,"47.59% of $9,361.00 in Billed Charges for Rev 333 Proc 77295 = $4,454.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,1529.79,,,,,,,476.7700,9361.0000,fee schedule,"APG 00478 Proc 77295 at $836.60 (Base Rate) * 1.7415 (Relative Weight) = $1,456.94 (Total Line Payment) at 100% = $1,456.94... $1,456.94 at 105% = $1,529.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,1318.58,,,,,,,476.7700,9361.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,1318.58,,,,,,,476.7700,9361.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,NHC ADVANTAGE,NHC ADVANTAGE,1318.58,,,,,,,476.7700,9361.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,1502.11,,,,,,,476.7700,9361.0000,fee schedule,"APG 00478 Proc 77295 at $836.60 (Base Rate) * 1.7415 (Relative Weight) = $1,456.94 (Total Line Payment) at 100% = $1,456.94... $1,456.94 at 103.1% = $1,502.11 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,SENTARA HEALTH,SENTARA HEALTH,2416.07,,,,,,,476.7700,9361.0000,percent of total billed charges,"25.81% of $9,361.00 in Billed Charges for Rev 333 Proc 77295 = $2,416.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,SENTARA HEALTH,SENTARA MEDICARE,1255.79,,,,,,,476.7700,9361.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",9361.00,,,,,,,476.7700,9361.0000,percent of total billed charges,"100% of $9,361.00 in Billed Charges for Rev 333 Proc 77295 = $9,361.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,476.77,,,,,,,476.7700,9361.0000,fee schedule,$953.53 from Fee Schedule TCUHC24 for Rev 333 Proc 77295 * Qty 1 = $953.53 at 50% = $476.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1411.00,,,,,,,476.7700,9361.0000,other,"Rev 333 Proc 77295 1 Visit at $1,411.00 per Visit = $1,411.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1350.00,,,,,,,476.7700,9361.0000,other,"Rev 333 Proc 77295 1 Visit at $1,350.00 per Visit = $1,350.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,2224.00,,,,,,,476.7700,9361.0000,other,"Rev 333 Proc 77295 1 Visit at $2,224.00 per Visit = $2,224.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,1500.65,,,,,,,476.7700,9361.0000,fee schedule,"APG 00478 Proc 77295 at $836.60 (Base Rate) * 1.7415 (Relative Weight) = $1,456.94 (Total Line Payment) at 103% = $1,500.65. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,1255.79,,,,,,,476.7700,9361.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,1255.79,,,,,,,476.7700,9361.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,WELLCARE,WELLCARE MEDICAID,9361.00,,,,,,,476.7700,9361.0000,percent of total billed charges,"100% of $9,361.00 in Billed Charges for Rev 333 Proc 77295 = $9,361.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC 3D SIMULATION,77295,CPT,333,RC,33300006,CDM,,,,both,,,9361.0000,1404.1500,WELLCARE,WELLCARE MEDICARE,1331.13,,,,,,,476.7700,9361.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,AETNA,AETNA,214.78,,,,,,,88.2300,804.0300,percent of total billed charges,42.7% of $503.00 in Billed Charges for Rev 510 Proc 11104 = $214.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,88.2300,804.0300,fee schedule,"APG 00009 Proc 11104 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,88.2300,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,88.2300,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,88.2300,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,AMBETTER,AMBETTER,804.03,,,,,,,88.2300,804.0300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,88.2300,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,BLUE CROSS,ANTHEM EXCHANGE,503.00,,,,,,,88.2300,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,503.00,,,,,,,88.2300,804.0300,fee schedule,"APG 00009 Proc 11104 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89 (Service Line reduced to $503.00, claim capped at $503.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,BLUE CROSS,ANTHEM HMO,503.00,,,,,,,88.2300,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,88.2300,804.0300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",503.00,,,,,,,88.2300,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,352.10,,,,,,,88.2300,804.0300,percent of total billed charges,Rev 510 Proc 11104 $503.00 in Billed Charges at 70% = $352.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,88.2300,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,CIGNA HEALTHCARE,CIGNA HMO,209.75,,,,,,,88.2300,804.0300,percent of total billed charges,41.7% of $503.00 in Billed Charges for Rev 510 Proc 11104 = $209.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,233.39,,,,,,,88.2300,804.0300,percent of total billed charges,46.4% of $503.00 in Billed Charges for Rev 510 Proc 11104 = $233.39. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,88.2300,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,209.75,,,,,,,88.2300,804.0300,percent of total billed charges,41.7% of $503.00 in Billed Charges for Rev 510 Proc 11104 = $209.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,CIGNA HEALTHCARE,CIGNA PPO,209.75,,,,,,,88.2300,804.0300,percent of total billed charges,41.7% of $503.00 in Billed Charges for Rev 510 Proc 11104 = $209.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,88.2300,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,452.70,,,,,,,88.2300,804.0300,percent of total billed charges,90% of $503.00 in Billed Charges for Rev 510 Proc 11104 = $452.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,88.2300,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,88.2300,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,MEDCOST,MEDCOST VHN,239.38,,,,,,,88.2300,804.0300,percent of total billed charges,47.59% of $503.00 in Billed Charges for Rev 510 Proc 11104 = $239.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,88.2300,804.0300,fee schedule,"APG 00009 Proc 11104 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,88.2300,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,88.2300,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,88.2300,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,88.2300,804.0300,fee schedule,"APG 00009 Proc 11104 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,SENTARA HEALTH,SENTARA HEALTH,129.82,,,,,,,88.2300,804.0300,percent of total billed charges,25.81% of $503.00 in Billed Charges for Rev 510 Proc 11104 = $129.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,88.2300,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",503.00,,,,,,,88.2300,804.0300,percent of total billed charges,100% of $503.00 in Billed Charges for Rev 510 Proc 11104 = $503.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,88.23,,,,,,,88.2300,804.0300,fee schedule,$176.45 from Fee Schedule TCUHC24 for Rev 510 Proc 11104 * Qty 1 = $176.45 at 50% = $88.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,162.47,,,,,,,88.2300,804.0300,other,32.3% of $503.00 in Billed Charges for Rev 510 Proc 11104 = $162.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,154.42,,,,,,,88.2300,804.0300,other,30.7% of $503.00 in Billed Charges for Rev 510 Proc 11104 = $154.42 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,162.47,,,,,,,88.2300,804.0300,percent of total billed charges,32.3% of $503.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,88.2300,804.0300,fee schedule,"APG 00009 Proc 11104 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,88.2300,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,88.2300,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,WELLCARE,WELLCARE MEDICAID,503.00,,,,,,,88.2300,804.0300,percent of total billed charges,100% of $503.00 in Billed Charges for Rev 510 Proc 11104 = $503.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUNCH BX SKIN SNGL LESION,11104,CPT,510,RC,51000229,CDM,,,,both,,,503.0000,75.4500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,88.2300,804.0300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN EA ADDL LESION,11105,CPT,510,RC,51000230,CDM,,,,both,,,139.0000,20.8500,AETNA,AETNA,59.35,,,,,,,35.8800,623.7700,percent of total billed charges,42.7% of $139.00 in Billed Charges for Rev 510 Proc 11105 = $59.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUNCH BX SKIN EA ADDL LESION,11105,CPT,510,RC,51000230,CDM,,,,both,,,139.0000,20.8500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,35.8800,623.7700,fee schedule,APG 00009 Proc 11105 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN EA ADDL LESION,11105,CPT,510,RC,51000230,CDM,,,,both,,,139.0000,20.8500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,139.00,,,,,,,35.8800,623.7700,fee schedule,"APG 00009 Proc 11105 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 103% = $611.89 (Service Line reduced to $139.00, claim capped at $139.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC PUNCH BX SKIN EA ADDL LESION,11105,CPT,510,RC,51000230,CDM,,,,both,,,139.0000,20.8500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,97.30,,,,,,,35.8800,623.7700,percent of total billed charges,Rev 510 Proc 11105 $139.00 in Billed Charges at 70% = $97.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUNCH BX SKIN EA ADDL LESION,11105,CPT,510,RC,51000230,CDM,,,,both,,,139.0000,20.8500,CIGNA HEALTHCARE,CIGNA HMO,57.96,,,,,,,35.8800,623.7700,percent of total billed charges,41.7% of $139.00 in Billed Charges for Rev 510 Proc 11105 = $57.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUNCH BX SKIN EA ADDL LESION,11105,CPT,510,RC,51000230,CDM,,,,both,,,139.0000,20.8500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,64.50,,,,,,,35.8800,623.7700,percent of total billed charges,46.4% of $139.00 in Billed Charges for Rev 510 Proc 11105 = $64.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUNCH BX SKIN EA ADDL LESION,11105,CPT,510,RC,51000230,CDM,,,,both,,,139.0000,20.8500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,57.96,,,,,,,35.8800,623.7700,percent of total billed charges,41.7% of $139.00 in Billed Charges for Rev 510 Proc 11105 = $57.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUNCH BX SKIN EA ADDL LESION,11105,CPT,510,RC,51000230,CDM,,,,both,,,139.0000,20.8500,CIGNA HEALTHCARE,CIGNA PPO,57.96,,,,,,,35.8800,623.7700,percent of total billed charges,41.7% of $139.00 in Billed Charges for Rev 510 Proc 11105 = $57.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUNCH BX SKIN EA ADDL LESION,11105,CPT,510,RC,51000230,CDM,,,,both,,,139.0000,20.8500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,125.10,,,,,,,35.8800,623.7700,percent of total billed charges,90% of $139.00 in Billed Charges for Rev 510 Proc 11105 = $125.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUNCH BX SKIN EA ADDL LESION,11105,CPT,510,RC,51000230,CDM,,,,both,,,139.0000,20.8500,MEDCOST,MEDCOST VHN,66.15,,,,,,,35.8800,623.7700,percent of total billed charges,47.59% of $139.00 in Billed Charges for Rev 510 Proc 11105 = $66.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUNCH BX SKIN EA ADDL LESION,11105,CPT,510,RC,51000230,CDM,,,,both,,,139.0000,20.8500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,35.8800,623.7700,fee schedule,APG 00009 Proc 11105 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN EA ADDL LESION,11105,CPT,510,RC,51000230,CDM,,,,both,,,139.0000,20.8500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,35.8800,623.7700,fee schedule,APG 00009 Proc 11105 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN EA ADDL LESION,11105,CPT,510,RC,51000230,CDM,,,,both,,,139.0000,20.8500,SENTARA HEALTH,SENTARA HEALTH,35.88,,,,,,,35.8800,623.7700,percent of total billed charges,25.81% of $139.00 in Billed Charges for Rev 510 Proc 11105 = $35.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUNCH BX SKIN EA ADDL LESION,11105,CPT,510,RC,51000230,CDM,,,,both,,,139.0000,20.8500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",139.00,,,,,,,35.8800,623.7700,percent of total billed charges,100% of $139.00 in Billed Charges for Rev 510 Proc 11105 = $139.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUNCH BX SKIN EA ADDL LESION,11105,CPT,510,RC,51000230,CDM,,,,both,,,139.0000,20.8500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,44.90,,,,,,,35.8800,623.7700,other,32.3% of $139.00 in Billed Charges for Rev 510 Proc 11105 = $44.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN EA ADDL LESION,11105,CPT,510,RC,51000230,CDM,,,,both,,,139.0000,20.8500,UNITED HEALTHCARE,UHC HERITAGE SELECT,42.67,,,,,,,35.8800,623.7700,other,30.7% of $139.00 in Billed Charges for Rev 510 Proc 11105 = $42.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN EA ADDL LESION,11105,CPT,510,RC,51000230,CDM,,,,both,,,139.0000,20.8500,UNITED HEALTHCARE,UNITED HEALTHCARE,44.90,,,,,,,35.8800,623.7700,percent of total billed charges,32.3% of $139.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC PUNCH BX SKIN EA ADDL LESION,11105,CPT,510,RC,51000230,CDM,,,,both,,,139.0000,20.8500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,35.8800,623.7700,fee schedule,APG 00009 Proc 11105 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC PUNCH BX SKIN EA ADDL LESION,11105,CPT,510,RC,51000230,CDM,,,,both,,,139.0000,20.8500,WELLCARE,WELLCARE MEDICAID,139.00,,,,,,,35.8800,623.7700,percent of total billed charges,100% of $139.00 in Billed Charges for Rev 510 Proc 11105 = $139.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN EA ADDL LESION,11107,CPT,510,RC,51000232,CDM,,,,both,,,549.0000,82.3500,AETNA,AETNA,234.42,,,,,,,141.7000,623.7700,percent of total billed charges,42.7% of $549.00 in Billed Charges for Rev 510 Proc 11107 = $234.42. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN EA ADDL LESION,11107,CPT,510,RC,51000232,CDM,,,,both,,,549.0000,82.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,141.7000,623.7700,fee schedule,APG 00009 Proc 11107 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN EA ADDL LESION,11107,CPT,510,RC,51000232,CDM,,,,both,,,549.0000,82.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,549.00,,,,,,,141.7000,623.7700,fee schedule,"APG 00009 Proc 11107 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 103% = $611.89 (Service Line reduced to $549.00, claim capped at $549.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INCISIONAL BX SKIN EA ADDL LESION,11107,CPT,510,RC,51000232,CDM,,,,both,,,549.0000,82.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,384.30,,,,,,,141.7000,623.7700,percent of total billed charges,Rev 510 Proc 11107 $549.00 in Billed Charges at 70% = $384.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN EA ADDL LESION,11107,CPT,510,RC,51000232,CDM,,,,both,,,549.0000,82.3500,CIGNA HEALTHCARE,CIGNA HMO,228.93,,,,,,,141.7000,623.7700,percent of total billed charges,41.7% of $549.00 in Billed Charges for Rev 510 Proc 11107 = $228.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN EA ADDL LESION,11107,CPT,510,RC,51000232,CDM,,,,both,,,549.0000,82.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,254.74,,,,,,,141.7000,623.7700,percent of total billed charges,46.4% of $549.00 in Billed Charges for Rev 510 Proc 11107 = $254.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN EA ADDL LESION,11107,CPT,510,RC,51000232,CDM,,,,both,,,549.0000,82.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,228.93,,,,,,,141.7000,623.7700,percent of total billed charges,41.7% of $549.00 in Billed Charges for Rev 510 Proc 11107 = $228.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN EA ADDL LESION,11107,CPT,510,RC,51000232,CDM,,,,both,,,549.0000,82.3500,CIGNA HEALTHCARE,CIGNA PPO,228.93,,,,,,,141.7000,623.7700,percent of total billed charges,41.7% of $549.00 in Billed Charges for Rev 510 Proc 11107 = $228.93. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN EA ADDL LESION,11107,CPT,510,RC,51000232,CDM,,,,both,,,549.0000,82.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,494.10,,,,,,,141.7000,623.7700,percent of total billed charges,90% of $549.00 in Billed Charges for Rev 510 Proc 11107 = $494.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN EA ADDL LESION,11107,CPT,510,RC,51000232,CDM,,,,both,,,549.0000,82.3500,MEDCOST,MEDCOST VHN,261.27,,,,,,,141.7000,623.7700,percent of total billed charges,47.59% of $549.00 in Billed Charges for Rev 510 Proc 11107 = $261.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN EA ADDL LESION,11107,CPT,510,RC,51000232,CDM,,,,both,,,549.0000,82.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,141.7000,623.7700,fee schedule,APG 00009 Proc 11107 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN EA ADDL LESION,11107,CPT,510,RC,51000232,CDM,,,,both,,,549.0000,82.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,141.7000,623.7700,fee schedule,APG 00009 Proc 11107 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN EA ADDL LESION,11107,CPT,510,RC,51000232,CDM,,,,both,,,549.0000,82.3500,SENTARA HEALTH,SENTARA HEALTH,141.70,,,,,,,141.7000,623.7700,percent of total billed charges,25.81% of $549.00 in Billed Charges for Rev 510 Proc 11107 = $141.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN EA ADDL LESION,11107,CPT,510,RC,51000232,CDM,,,,both,,,549.0000,82.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",549.00,,,,,,,141.7000,623.7700,percent of total billed charges,100% of $549.00 in Billed Charges for Rev 510 Proc 11107 = $549.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN EA ADDL LESION,11107,CPT,510,RC,51000232,CDM,,,,both,,,549.0000,82.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,177.33,,,,,,,141.7000,623.7700,other,32.3% of $549.00 in Billed Charges for Rev 510 Proc 11107 = $177.33 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN EA ADDL LESION,11107,CPT,510,RC,51000232,CDM,,,,both,,,549.0000,82.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,168.54,,,,,,,141.7000,623.7700,other,30.7% of $549.00 in Billed Charges for Rev 510 Proc 11107 = $168.54 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN EA ADDL LESION,11107,CPT,510,RC,51000232,CDM,,,,both,,,549.0000,82.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,177.33,,,,,,,141.7000,623.7700,percent of total billed charges,32.3% of $549.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC INCISIONAL BX SKIN EA ADDL LESION,11107,CPT,510,RC,51000232,CDM,,,,both,,,549.0000,82.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,141.7000,623.7700,fee schedule,APG 00009 Proc 11107 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment) at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INCISIONAL BX SKIN EA ADDL LESION,11107,CPT,510,RC,51000232,CDM,,,,both,,,549.0000,82.3500,WELLCARE,WELLCARE MEDICAID,549.00,,,,,,,141.7000,623.7700,percent of total billed charges,100% of $549.00 in Billed Charges for Rev 510 Proc 11107 = $549.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,AETNA,AETNA,261.75,,,,,,,29.8200,613.0000,percent of total billed charges,42.7% of $613.00 in Billed Charges for Rev 521 Proc 11301 = $261.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,29.8200,613.0000,fee schedule,"APG 00003 Proc 11301 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,29.8200,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,29.8200,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,29.8200,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,AMBETTER,AMBETTER,396.83,,,,,,,29.8200,613.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,29.8200,613.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,29.8200,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,29.8200,613.0000,fee schedule,"APG 00003 Proc 11301 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,29.8200,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,29.8200,613.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",560.15,,,,,,,29.8200,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,61.81,,,,,,,29.8200,613.0000,fee schedule,$61.81 from Fee Schedule BLDTM_23 for Rev 521 Proc 11301 * Qty 1 = $61.81 at 100% = $61.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,29.8200,613.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,TENNCARE BLUE CARE,29.82,,,,,,,29.8200,613.0000,fee schedule,$25.71 from Fee Schedule TC_24 for Rev 521 Proc 11301 * Qty 1 = $25.71 at 116% = $29.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,TENNCARE BLUE SELECT,29.82,,,,,,,29.8200,613.0000,fee schedule,$25.71 from Fee Schedule TC_24 for Rev 521 Proc 11301 * Qty 1 = $25.71 at 116% = $29.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA HMO,255.62,,,,,,,29.8200,613.0000,percent of total billed charges,41.7% of $613.00 in Billed Charges for Rev 521 Proc 11301 = $255.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,284.43,,,,,,,29.8200,613.0000,percent of total billed charges,46.4% of $613.00 in Billed Charges for Rev 521 Proc 11301 = $284.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,29.8200,613.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,255.62,,,,,,,29.8200,613.0000,percent of total billed charges,41.7% of $613.00 in Billed Charges for Rev 521 Proc 11301 = $255.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA PPO,255.62,,,,,,,29.8200,613.0000,percent of total billed charges,41.7% of $613.00 in Billed Charges for Rev 521 Proc 11301 = $255.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,29.8200,613.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,551.70,,,,,,,29.8200,613.0000,percent of total billed charges,90% of $613.00 in Billed Charges for Rev 521 Proc 11301 = $551.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,29.8200,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,29.8200,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,MEDCOST,MEDCOST VHN,291.73,,,,,,,29.8200,613.0000,percent of total billed charges,47.59% of $613.00 in Billed Charges for Rev 521 Proc 11301 = $291.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,29.8200,613.0000,fee schedule,"APG 00003 Proc 11301 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,29.8200,613.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,29.8200,613.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,29.8200,613.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,29.8200,613.0000,fee schedule,"APG 00003 Proc 11301 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,SENTARA HEALTH,SENTARA HEALTH,158.22,,,,,,,29.8200,613.0000,percent of total billed charges,25.81% of $613.00 in Billed Charges for Rev 521 Proc 11301 = $158.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,29.8200,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",613.00,,,,,,,29.8200,613.0000,percent of total billed charges,100% of $613.00 in Billed Charges for Rev 521 Proc 11301 = $613.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,29.8200,613.0000,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 521 Proc 11301 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,29.8200,613.0000,fee schedule,"APG 00003 Proc 11301 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,29.8200,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,29.8200,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,WELLCARE,WELLCARE MEDICAID,613.00,,,,,,,29.8200,613.0000,percent of total billed charges,100% of $613.00 in Billed Charges for Rev 521 Proc 11301 = $613.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM,11301,CPT,521,RC,52100000,CDM,,,,both,,,613.0000,91.9500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,29.8200,613.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,AETNA,AETNA,287.80,,,,,,,39.2400,674.0000,percent of total billed charges,42.7% of $674.00 in Billed Charges for Rev 521 Proc 11302 = $287.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,39.2400,674.0000,fee schedule,"APG 00003 Proc 11302 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,39.2400,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,39.2400,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,39.2400,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,AMBETTER,AMBETTER,396.83,,,,,,,39.2400,674.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,39.2400,674.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,39.2400,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,39.2400,674.0000,fee schedule,"APG 00003 Proc 11302 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,39.2400,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,39.2400,674.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",560.15,,,,,,,39.2400,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,77.44,,,,,,,39.2400,674.0000,fee schedule,$77.44 from Fee Schedule BLDTM_23 for Rev 521 Proc 11302 * Qty 1 = $77.44 at 100% = $77.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,39.2400,674.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,TENNCARE BLUE CARE,39.24,,,,,,,39.2400,674.0000,fee schedule,$33.83 from Fee Schedule TC_24 for Rev 521 Proc 11302 * Qty 1 = $33.83 at 116% = $39.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,TENNCARE BLUE SELECT,39.24,,,,,,,39.2400,674.0000,fee schedule,$33.83 from Fee Schedule TC_24 for Rev 521 Proc 11302 * Qty 1 = $33.83 at 116% = $39.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,CIGNA HEALTHCARE,CIGNA HMO,281.06,,,,,,,39.2400,674.0000,percent of total billed charges,41.7% of $674.00 in Billed Charges for Rev 521 Proc 11302 = $281.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,312.74,,,,,,,39.2400,674.0000,percent of total billed charges,46.4% of $674.00 in Billed Charges for Rev 521 Proc 11302 = $312.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,39.2400,674.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,281.06,,,,,,,39.2400,674.0000,percent of total billed charges,41.7% of $674.00 in Billed Charges for Rev 521 Proc 11302 = $281.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,CIGNA HEALTHCARE,CIGNA PPO,281.06,,,,,,,39.2400,674.0000,percent of total billed charges,41.7% of $674.00 in Billed Charges for Rev 521 Proc 11302 = $281.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,39.2400,674.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,606.60,,,,,,,39.2400,674.0000,percent of total billed charges,90% of $674.00 in Billed Charges for Rev 521 Proc 11302 = $606.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,HUMANA,HUMANA MEDICARE,182.03,,,,,,,39.2400,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,39.2400,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,MEDCOST,MEDCOST VHN,320.76,,,,,,,39.2400,674.0000,percent of total billed charges,47.59% of $674.00 in Billed Charges for Rev 521 Proc 11302 = $320.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,39.2400,674.0000,fee schedule,"APG 00003 Proc 11302 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,39.2400,674.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,39.2400,674.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,39.2400,674.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,39.2400,674.0000,fee schedule,"APG 00003 Proc 11302 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,SENTARA HEALTH,SENTARA HEALTH,173.96,,,,,,,39.2400,674.0000,percent of total billed charges,25.81% of $674.00 in Billed Charges for Rev 521 Proc 11302 = $173.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,39.2400,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",674.00,,,,,,,39.2400,674.0000,percent of total billed charges,100% of $674.00 in Billed Charges for Rev 521 Proc 11302 = $674.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,39.2400,674.0000,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 521 Proc 11302 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,39.2400,674.0000,fee schedule,"APG 00003 Proc 11302 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,39.2400,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,39.2400,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,WELLCARE,WELLCARE MEDICAID,674.00,,,,,,,39.2400,674.0000,percent of total billed charges,100% of $674.00 in Billed Charges for Rev 521 Proc 11302 = $674.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM,11302,CPT,521,RC,52100020,CDM,,,,both,,,674.0000,101.1000,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,39.2400,674.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,AETNA,AETNA,421.02,,,,,,,56.5600,986.0000,percent of total billed charges,42.7% of $986.00 in Billed Charges for Rev 333 Proc 77316 = $421.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,171.05,,,,,,,56.5600,986.0000,fee schedule,APG 00476 Proc 77316 at $836.60 (Base Rate) * 0.1966 (Relative Weight) = $164.48 (Total Line Payment) at 104% = $171.05. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,339.71,,,,,,,56.5600,986.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,AETNA,AETNA HEALTHCARE MEDICARE,339.71,,,,,,,56.5600,986.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,339.71,,,,,,,56.5600,986.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,AMBETTER,AMBETTER,740.57,,,,,,,56.5600,986.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,353.30,,,,,,,56.5600,986.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,BLUE CROSS,ANTHEM EXCHANGE,836.38,,,,,,,56.5600,986.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,169.41,,,,,,,56.5600,986.0000,fee schedule,APG 00476 Proc 77316 at $836.60 (Base Rate) * 0.1966 (Relative Weight) = $164.48 (Total Line Payment) at 103% = $169.41. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,BLUE CROSS,ANTHEM HMO,888.60,,,,,,,56.5600,986.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,349.90,,,,,,,56.5600,986.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",986.00,,,,,,,56.5600,986.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,690.20,,,,,,,56.5600,986.0000,percent of total billed charges,Rev 333 Proc 77316 $986.00 in Billed Charges at 70% = $690.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,BLUE CROSS,BLUE CROSS E NETWORK,327.49,,,,,,,56.5600,986.0000,fee schedule,$102.34 from Fee Schedule BCFSC for Rev 333 Proc 77316 * Qty 1 = $102.34 at 320% = $327.49 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,BLUE CROSS,BLUE CROSS MEDICARE,353.30,,,,,,,56.5600,986.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,BLUE CROSS,BLUE CROSS P NETWORK,334.65,,,,,,,56.5600,986.0000,fee schedule,$102.34 from Fee Schedule BCFSC for Rev 333 Proc 77316 * Qty 1 = $102.34 at 327% = $334.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,BLUE CROSS,BLUE CROSS S NETWORK,334.65,,,,,,,56.5600,986.0000,fee schedule,$102.34 from Fee Schedule BCFSC for Rev 333 Proc 77316 * Qty 1 = $102.34 at 327% = $334.65 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,BLUE CROSS,TENNCARE BLUE CARE,96.44,,,,,,,56.5600,986.0000,fee schedule,$83.14 from Fee Schedule TC_24 for Rev 333 Proc 77316 * Qty 1 = $83.14 at 116% = $96.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,BLUE CROSS,TENNCARE BLUE SELECT,96.44,,,,,,,56.5600,986.0000,fee schedule,$83.14 from Fee Schedule TC_24 for Rev 333 Proc 77316 * Qty 1 = $83.14 at 116% = $96.44 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,CIGNA HEALTHCARE,CIGNA HMO,411.16,,,,,,,56.5600,986.0000,percent of total billed charges,Rev 333 Proc 77316 $986.00 in Billed Charges at 41.7% = $411.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,324.47,,,,,,,56.5600,986.0000,fee schedule,$324.47 from Fee Schedule CGIFP_25LR for Rev 333 Proc 77316 * Qty 1 = $324.47 at 100% = $324.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,356.70,,,,,,,56.5600,986.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,411.16,,,,,,,56.5600,986.0000,percent of total billed charges,Rev 333 Proc 77316 $986.00 in Billed Charges at 41.7% = $411.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,CIGNA HEALTHCARE,CIGNA PPO,411.16,,,,,,,56.5600,986.0000,percent of total billed charges,Rev 333 Proc 77316 $986.00 in Billed Charges at 41.7% = $411.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,356.70,,,,,,,56.5600,986.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,887.40,,,,,,,56.5600,986.0000,percent of total billed charges,90% of $986.00 in Billed Charges for Rev 333 Proc 77316 = $887.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,HUMANA,HUMANA MEDICARE,339.71,,,,,,,56.5600,986.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,339.71,,,,,,,56.5600,986.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,MEDCOST,MEDCOST VHN,469.24,,,,,,,56.5600,986.0000,percent of total billed charges,47.59% of $986.00 in Billed Charges for Rev 333 Proc 77316 = $469.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,172.70,,,,,,,56.5600,986.0000,fee schedule,APG 00476 Proc 77316 at $836.60 (Base Rate) * 0.1966 (Relative Weight) = $164.48 (Total Line Payment) at 100% = $164.48... $164.48 at 105% = $172.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,356.70,,,,,,,56.5600,986.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,356.70,,,,,,,56.5600,986.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,NHC ADVANTAGE,NHC ADVANTAGE,356.70,,,,,,,56.5600,986.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,169.58,,,,,,,56.5600,986.0000,fee schedule,APG 00476 Proc 77316 at $836.60 (Base Rate) * 0.1966 (Relative Weight) = $164.48 (Total Line Payment) at 100% = $164.48... $164.48 at 103.1% = $169.58 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,SENTARA HEALTH,SENTARA HEALTH,254.49,,,,,,,56.5600,986.0000,percent of total billed charges,25.81% of $986.00 in Billed Charges for Rev 333 Proc 77316 = $254.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,SENTARA HEALTH,SENTARA MEDICARE,339.71,,,,,,,56.5600,986.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",986.00,,,,,,,56.5600,986.0000,percent of total billed charges,100% of $986.00 in Billed Charges for Rev 333 Proc 77316 = $986.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,56.56,,,,,,,56.5600,986.0000,fee schedule,$113.12 from Fee Schedule TCUHC24 for Rev 333 Proc 77316 * Qty 1 = $113.12 at 50% = $56.56 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,986.00,,,,,,,56.5600,986.0000,other,"Rev 333 Proc 77316 1 Visit at $1,411.00 per Visit = $1,411.00 (Service Line reduced to $986.00, claim capped at $986.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,986.00,,,,,,,56.5600,986.0000,other,"Rev 333 Proc 77316 1 Visit at $1,350.00 per Visit = $1,350.00 (Service Line reduced to $986.00, claim capped at $986.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,986.00,,,,,,,56.5600,986.0000,other,"Rev 333 Proc 77316 1 Visit at $2,224.00 per Visit = $2,224.00 (Service Line reduced to $986.00, claim capped at $986.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,169.41,,,,,,,56.5600,986.0000,fee schedule,APG 00476 Proc 77316 at $836.60 (Base Rate) * 0.1966 (Relative Weight) = $164.48 (Total Line Payment) at 103% = $169.41. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,339.71,,,,,,,56.5600,986.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,339.71,,,,,,,56.5600,986.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,WELLCARE,WELLCARE MEDICAID,986.00,,,,,,,56.5600,986.0000,percent of total billed charges,100% of $986.00 in Billed Charges for Rev 333 Proc 77316 = $986.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC BRACHYTX ISODOSE PLAN SIMPLE,77316,CPT,333,RC,33300059,CDM,,,,both,,,986.0000,147.9000,WELLCARE,WELLCARE MEDICARE,360.09,,,,,,,56.5600,986.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,AETNA,AETNA,813.86,,,,,,,83.6800,1906.0000,percent of total billed charges,"42.7% of $1,906.00 in Billed Charges for Rev 333 Proc 77321 = $813.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,254.58,,,,,,,83.6800,1906.0000,fee schedule,APG 00477 Proc 77321 at $836.60 (Base Rate) * 0.2926 (Relative Weight) = $244.79 (Total Line Payment) at 104% = $254.58. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,339.71,,,,,,,83.6800,1906.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,AETNA,AETNA HEALTHCARE MEDICARE,339.71,,,,,,,83.6800,1906.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,339.71,,,,,,,83.6800,1906.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,AMBETTER,AMBETTER,740.57,,,,,,,83.6800,1906.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,353.30,,,,,,,83.6800,1906.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,BLUE CROSS,ANTHEM EXCHANGE,836.38,,,,,,,83.6800,1906.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,252.13,,,,,,,83.6800,1906.0000,fee schedule,APG 00477 Proc 77321 at $836.60 (Base Rate) * 0.2926 (Relative Weight) = $244.79 (Total Line Payment) at 103% = $252.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,BLUE CROSS,ANTHEM HMO,888.60,,,,,,,83.6800,1906.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,349.90,,,,,,,83.6800,1906.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1045.35,,,,,,,83.6800,1906.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,223.21,,,,,,,83.6800,1906.0000,fee schedule,$223.21 from Fee Schedule BLDTM_23 for Rev 333 Proc 77321 * Qty 1 = $223.21 at 100% = $223.21 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,BLUE CROSS,BLUE CROSS E NETWORK,122.08,,,,,,,83.6800,1906.0000,fee schedule,$38.15 from Fee Schedule BCFSC for Rev 333 Proc 77321 * Qty 1 = $38.15 at 320% = $122.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,BLUE CROSS,BLUE CROSS MEDICARE,353.30,,,,,,,83.6800,1906.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,BLUE CROSS,BLUE CROSS P NETWORK,124.75,,,,,,,83.6800,1906.0000,fee schedule,$38.15 from Fee Schedule BCFSC for Rev 333 Proc 77321 * Qty 1 = $38.15 at 327% = $124.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,BLUE CROSS,BLUE CROSS S NETWORK,124.75,,,,,,,83.6800,1906.0000,fee schedule,$38.15 from Fee Schedule BCFSC for Rev 333 Proc 77321 * Qty 1 = $38.15 at 327% = $124.75 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,BLUE CROSS,TENNCARE BLUE CARE,132.46,,,,,,,83.6800,1906.0000,fee schedule,$114.19 from Fee Schedule TC_24 for Rev 333 Proc 77321 * Qty 1 = $114.19 at 116% = $132.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,BLUE CROSS,TENNCARE BLUE SELECT,132.46,,,,,,,83.6800,1906.0000,fee schedule,$114.19 from Fee Schedule TC_24 for Rev 333 Proc 77321 * Qty 1 = $114.19 at 116% = $132.46 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,CIGNA HEALTHCARE,CIGNA HMO,997.82,,,,,,,83.6800,1906.0000,fee schedule,$997.82 from Fee Schedule CIGWHS_23 for Rev 333 Proc 77321 * Qty 1 = $997.82 at 100% = $997.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,83.68,,,,,,,83.6800,1906.0000,fee schedule,$83.68 from Fee Schedule CGIFP_25LR for Rev 333 Proc 77321 * Qty 1 = $83.68 at 100% = $83.68 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,356.70,,,,,,,83.6800,1906.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,997.82,,,,,,,83.6800,1906.0000,fee schedule,$997.82 from Fee Schedule CIGWHS_23 for Rev 333 Proc 77321 * Qty 1 = $997.82 at 100% = $997.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,CIGNA HEALTHCARE,CIGNA PPO,997.82,,,,,,,83.6800,1906.0000,fee schedule,$997.82 from Fee Schedule CIGWHS_23 for Rev 333 Proc 77321 * Qty 1 = $997.82 at 100% = $997.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,356.70,,,,,,,83.6800,1906.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1715.40,,,,,,,83.6800,1906.0000,percent of total billed charges,"90% of $1,906.00 in Billed Charges for Rev 333 Proc 77321 = $1,715.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,HUMANA,HUMANA MEDICARE,339.71,,,,,,,83.6800,1906.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,339.71,,,,,,,83.6800,1906.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,MEDCOST,MEDCOST VHN,907.07,,,,,,,83.6800,1906.0000,percent of total billed charges,"47.59% of $1,906.00 in Billed Charges for Rev 333 Proc 77321 = $907.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,257.03,,,,,,,83.6800,1906.0000,fee schedule,APG 00477 Proc 77321 at $836.60 (Base Rate) * 0.2926 (Relative Weight) = $244.79 (Total Line Payment) at 100% = $244.79... $244.79 at 105% = $257.03 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,356.70,,,,,,,83.6800,1906.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,356.70,,,,,,,83.6800,1906.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,NHC ADVANTAGE,NHC ADVANTAGE,356.70,,,,,,,83.6800,1906.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,252.38,,,,,,,83.6800,1906.0000,fee schedule,APG 00477 Proc 77321 at $836.60 (Base Rate) * 0.2926 (Relative Weight) = $244.79 (Total Line Payment) at 100% = $244.79... $244.79 at 103.1% = $252.38 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,SENTARA HEALTH,SENTARA HEALTH,491.94,,,,,,,83.6800,1906.0000,percent of total billed charges,"25.81% of $1,906.00 in Billed Charges for Rev 333 Proc 77321 = $491.94. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,SENTARA HEALTH,SENTARA MEDICARE,339.71,,,,,,,83.6800,1906.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1906.00,,,,,,,83.6800,1906.0000,percent of total billed charges,"100% of $1,906.00 in Billed Charges for Rev 333 Proc 77321 = $1,906.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,131.82,,,,,,,83.6800,1906.0000,fee schedule,$263.64 from Fee Schedule TCUHC24 for Rev 333 Proc 77321 * Qty 1 = $263.64 at 50% = $131.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1411.00,,,,,,,83.6800,1906.0000,other,"Rev 333 Proc 77321 1 Visit at $1,411.00 per Visit = $1,411.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1350.00,,,,,,,83.6800,1906.0000,other,"Rev 333 Proc 77321 1 Visit at $1,350.00 per Visit = $1,350.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,UNITED HEALTHCARE,UNITED HEALTHCARE,1906.00,,,,,,,83.6800,1906.0000,other,"Rev 333 Proc 77321 1 Visit at $2,224.00 per Visit = $2,224.00 (Service Line reduced to $1,906.00, claim capped at $1,906.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,252.13,,,,,,,83.6800,1906.0000,fee schedule,APG 00477 Proc 77321 at $836.60 (Base Rate) * 0.2926 (Relative Weight) = $244.79 (Total Line Payment) at 103% = $252.13. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,339.71,,,,,,,83.6800,1906.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,339.71,,,,,,,83.6800,1906.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,WELLCARE,WELLCARE MEDICAID,1906.00,,,,,,,83.6800,1906.0000,percent of total billed charges,"100% of $1,906.00 in Billed Charges for Rev 333 Proc 77321 = $1,906.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ONC SPECIAL TELETHERAPY PORT PLAN,77321,CPT,333,RC,33300045,CDM,,,,both,,,1906.0000,285.9000,WELLCARE,WELLCARE MEDICARE,360.09,,,,,,,83.6800,1906.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,AETNA,AETNA,331.78,,,,,,,16.8100,777.0000,percent of total billed charges,42.7% of $777.00 in Billed Charges for Rev 333 Proc 77331 = $331.78. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,171.05,,,,,,,16.8100,777.0000,fee schedule,APG 00476 Proc 77331 at $836.60 (Base Rate) * 0.1966 (Relative Weight) = $164.48 (Total Line Payment) at 104% = $171.05. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,121.95,,,,,,,16.8100,777.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,AETNA,AETNA HEALTHCARE MEDICARE,121.95,,,,,,,16.8100,777.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,121.95,,,,,,,16.8100,777.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,AMBETTER,AMBETTER,265.84,,,,,,,16.8100,777.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,126.82,,,,,,,16.8100,777.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,BLUE CROSS,ANTHEM EXCHANGE,300.24,,,,,,,16.8100,777.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,169.41,,,,,,,16.8100,777.0000,fee schedule,APG 00476 Proc 77331 at $836.60 (Base Rate) * 0.1966 (Relative Weight) = $164.48 (Total Line Payment) at 103% = $169.41. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,BLUE CROSS,ANTHEM HMO,318.99,,,,,,,16.8100,777.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,125.60,,,,,,,16.8100,777.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",375.26,,,,,,,16.8100,777.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,21.82,,,,,,,16.8100,777.0000,fee schedule,$21.82 from Fee Schedule BLDTM_23 for Rev 333 Proc 77331 * Qty 1 = $21.82 at 100% = $21.82 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,BLUE CROSS,BLUE CROSS E NETWORK,53.09,,,,,,,16.8100,777.0000,fee schedule,$16.59 from Fee Schedule BCFSC for Rev 333 Proc 77331 * Qty 1 = $16.59 at 320% = $53.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,BLUE CROSS,BLUE CROSS MEDICARE,126.82,,,,,,,16.8100,777.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,BLUE CROSS,BLUE CROSS P NETWORK,54.25,,,,,,,16.8100,777.0000,fee schedule,$16.59 from Fee Schedule BCFSC for Rev 333 Proc 77331 * Qty 1 = $16.59 at 327% = $54.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,BLUE CROSS,BLUE CROSS S NETWORK,54.25,,,,,,,16.8100,777.0000,fee schedule,$16.59 from Fee Schedule BCFSC for Rev 333 Proc 77331 * Qty 1 = $16.59 at 327% = $54.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,BLUE CROSS,TENNCARE BLUE CARE,16.81,,,,,,,16.8100,777.0000,fee schedule,$14.49 from Fee Schedule TC_24 for Rev 333 Proc 77331 * Qty 1 = $14.49 at 116% = $16.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,BLUE CROSS,TENNCARE BLUE SELECT,16.81,,,,,,,16.8100,777.0000,fee schedule,$14.49 from Fee Schedule TC_24 for Rev 333 Proc 77331 * Qty 1 = $14.49 at 116% = $16.81 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,CIGNA HEALTHCARE,CIGNA HMO,407.09,,,,,,,16.8100,777.0000,fee schedule,$407.09 from Fee Schedule CIGWHS_23 for Rev 333 Proc 77331 * Qty 1 = $407.09 at 100% = $407.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,36.08,,,,,,,16.8100,777.0000,fee schedule,$36.08 from Fee Schedule CGIFP_25LR for Rev 333 Proc 77331 * Qty 1 = $36.08 at 100% = $36.08 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,128.04,,,,,,,16.8100,777.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,407.09,,,,,,,16.8100,777.0000,fee schedule,$407.09 from Fee Schedule CIGWHS_23 for Rev 333 Proc 77331 * Qty 1 = $407.09 at 100% = $407.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,CIGNA HEALTHCARE,CIGNA PPO,407.09,,,,,,,16.8100,777.0000,fee schedule,$407.09 from Fee Schedule CIGWHS_23 for Rev 333 Proc 77331 * Qty 1 = $407.09 at 100% = $407.09 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,128.04,,,,,,,16.8100,777.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,699.30,,,,,,,16.8100,777.0000,percent of total billed charges,90% of $777.00 in Billed Charges for Rev 333 Proc 77331 = $699.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,HUMANA,HUMANA MEDICARE,121.95,,,,,,,16.8100,777.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,121.95,,,,,,,16.8100,777.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,MEDCOST,MEDCOST VHN,369.77,,,,,,,16.8100,777.0000,percent of total billed charges,47.59% of $777.00 in Billed Charges for Rev 333 Proc 77331 = $369.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,172.70,,,,,,,16.8100,777.0000,fee schedule,APG 00476 Proc 77331 at $836.60 (Base Rate) * 0.1966 (Relative Weight) = $164.48 (Total Line Payment) at 100% = $164.48... $164.48 at 105% = $172.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,128.04,,,,,,,16.8100,777.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,128.04,,,,,,,16.8100,777.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,NHC ADVANTAGE,NHC ADVANTAGE,128.04,,,,,,,16.8100,777.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,169.58,,,,,,,16.8100,777.0000,fee schedule,APG 00476 Proc 77331 at $836.60 (Base Rate) * 0.1966 (Relative Weight) = $164.48 (Total Line Payment) at 100% = $164.48... $164.48 at 103.1% = $169.58 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,SENTARA HEALTH,SENTARA HEALTH,200.54,,,,,,,16.8100,777.0000,percent of total billed charges,25.81% of $777.00 in Billed Charges for Rev 333 Proc 77331 = $200.54. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,SENTARA HEALTH,SENTARA MEDICARE,121.95,,,,,,,16.8100,777.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",777.00,,,,,,,16.8100,777.0000,percent of total billed charges,100% of $777.00 in Billed Charges for Rev 333 Proc 77331 = $777.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,53.78,,,,,,,16.8100,777.0000,fee schedule,$107.56 from Fee Schedule TCUHC24 for Rev 333 Proc 77331 * Qty 1 = $107.56 at 50% = $53.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,777.00,,,,,,,16.8100,777.0000,other,"Rev 333 Proc 77331 1 Visit at $1,411.00 per Visit = $1,411.00 (Service Line reduced to $777.00, claim capped at $777.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,777.00,,,,,,,16.8100,777.0000,other,"Rev 333 Proc 77331 1 Visit at $1,350.00 per Visit = $1,350.00 (Service Line reduced to $777.00, claim capped at $777.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,777.00,,,,,,,16.8100,777.0000,other,"Rev 333 Proc 77331 1 Visit at $2,224.00 per Visit = $2,224.00 (Service Line reduced to $777.00, claim capped at $777.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,169.41,,,,,,,16.8100,777.0000,fee schedule,APG 00476 Proc 77331 at $836.60 (Base Rate) * 0.1966 (Relative Weight) = $164.48 (Total Line Payment) at 103% = $169.41. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,121.95,,,,,,,16.8100,777.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,121.95,,,,,,,16.8100,777.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,WELLCARE,WELLCARE MEDICAID,777.00,,,,,,,16.8100,777.0000,percent of total billed charges,100% of $777.00 in Billed Charges for Rev 333 Proc 77331 = $777.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ONC SPECIAL MICRODOSIMETRY,77331,CPT,333,RC,33300013,CDM,,,,both,,,777.0000,116.5500,WELLCARE,WELLCARE MEDICARE,129.26,,,,,,,16.8100,777.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ,33952,CPT,360,RC,36000242,CDM,,,,both,,,3087.0000,463.0500,AETNA,AETNA,1318.15,,,,,,,796.7500,11503.0400,percent of total billed charges,"42.7% of $3,087.00 in Billed Charges for Rev 360 Proc 33952 = $1,318.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ,33952,CPT,360,RC,36000242,CDM,,,,both,,,3087.0000,463.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11393.49,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33952 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 104% = $11,393.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ,33952,CPT,360,RC,36000242,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3087.00,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33952 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94 (Service Line reduced to $3,087.00, claim capped at $3,087.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ,33952,CPT,360,RC,36000242,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33952 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ,33952,CPT,360,RC,36000242,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33952 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ,33952,CPT,360,RC,36000242,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33952 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ,33952,CPT,360,RC,36000242,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33952 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ,33952,CPT,360,RC,36000242,CDM,,,,both,,,3087.0000,463.0500,CIGNA HEALTHCARE,CIGNA HMO,3087.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33952 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $3,087.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,087.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ,33952,CPT,360,RC,36000242,CDM,,,,both,,,3087.0000,463.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3087.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33952 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $3,087.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,087.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ,33952,CPT,360,RC,36000242,CDM,,,,both,,,3087.0000,463.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3087.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33952 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $3,087.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,087.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ,33952,CPT,360,RC,36000242,CDM,,,,both,,,3087.0000,463.0500,CIGNA HEALTHCARE,CIGNA PPO,3087.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33952 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $3,087.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,087.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ,33952,CPT,360,RC,36000242,CDM,,,,both,,,3087.0000,463.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2778.30,,,,,,,796.7500,11503.0400,percent of total billed charges,"90% of $3,087.00 in Billed Charges for Rev 360 Proc 33952 = $2,778.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ,33952,CPT,360,RC,36000242,CDM,,,,both,,,3087.0000,463.0500,MEDCOST,MEDCOST VHN,1469.10,,,,,,,796.7500,11503.0400,percent of total billed charges,"47.59% of $3,087.00 in Billed Charges for Rev 360 Proc 33952 = $1,469.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ,33952,CPT,360,RC,36000242,CDM,,,,both,,,3087.0000,463.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11503.04,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33952 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 105% = $11,503.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ,33952,CPT,360,RC,36000242,CDM,,,,both,,,3087.0000,463.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11294.89,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33952 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 103.1% = $11,294.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ,33952,CPT,360,RC,36000242,CDM,,,,both,,,3087.0000,463.0500,SENTARA HEALTH,SENTARA HEALTH,796.75,,,,,,,796.7500,11503.0400,percent of total billed charges,"25.81% of $3,087.00 in Billed Charges for Rev 360 Proc 33952 = $796.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ,33952,CPT,360,RC,36000242,CDM,,,,both,,,3087.0000,463.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3087.00,,,,,,,796.7500,11503.0400,percent of total billed charges,"100% of $3,087.00 in Billed Charges for Rev 360 Proc 33952 = $3,087.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ,33952,CPT,360,RC,36000242,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,796.7500,11503.0400,case rate,Rev 360 Proc 33952 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ,33952,CPT,360,RC,36000242,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33952 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ,33952,CPT,360,RC,36000242,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33952 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ,33952,CPT,360,RC,36000242,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33952 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ,33952,CPT,360,RC,36000242,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11283.94,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33952 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ,33952,CPT,360,RC,36000242,CDM,,,,both,,,3087.0000,463.0500,WELLCARE,WELLCARE MEDICAID,3087.00,,,,,,,796.7500,11503.0400,percent of total billed charges,"100% of $3,087.00 in Billed Charges for Rev 360 Proc 33952 = $3,087.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN,33953,CPT,360,RC,36000243,CDM,,,,both,,,3087.0000,463.0500,AETNA,AETNA,1318.15,,,,,,,796.7500,11503.0400,percent of total billed charges,"42.7% of $3,087.00 in Billed Charges for Rev 360 Proc 33953 = $1,318.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN,33953,CPT,360,RC,36000243,CDM,,,,both,,,3087.0000,463.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11393.49,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33953 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 104% = $11,393.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN,33953,CPT,360,RC,36000243,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3087.00,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33953 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94 (Service Line reduced to $3,087.00, claim capped at $3,087.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN,33953,CPT,360,RC,36000243,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33953 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN,33953,CPT,360,RC,36000243,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33953 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN,33953,CPT,360,RC,36000243,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33953 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN,33953,CPT,360,RC,36000243,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33953 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN,33953,CPT,360,RC,36000243,CDM,,,,both,,,3087.0000,463.0500,CIGNA HEALTHCARE,CIGNA HMO,3087.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33953 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $3,087.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,087.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN,33953,CPT,360,RC,36000243,CDM,,,,both,,,3087.0000,463.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3087.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33953 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $3,087.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,087.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN,33953,CPT,360,RC,36000243,CDM,,,,both,,,3087.0000,463.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3087.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33953 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $3,087.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,087.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN,33953,CPT,360,RC,36000243,CDM,,,,both,,,3087.0000,463.0500,CIGNA HEALTHCARE,CIGNA PPO,3087.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33953 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $3,087.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,087.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN,33953,CPT,360,RC,36000243,CDM,,,,both,,,3087.0000,463.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2778.30,,,,,,,796.7500,11503.0400,percent of total billed charges,"90% of $3,087.00 in Billed Charges for Rev 360 Proc 33953 = $2,778.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN,33953,CPT,360,RC,36000243,CDM,,,,both,,,3087.0000,463.0500,MEDCOST,MEDCOST VHN,1469.10,,,,,,,796.7500,11503.0400,percent of total billed charges,"47.59% of $3,087.00 in Billed Charges for Rev 360 Proc 33953 = $1,469.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN,33953,CPT,360,RC,36000243,CDM,,,,both,,,3087.0000,463.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11503.04,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33953 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 105% = $11,503.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN,33953,CPT,360,RC,36000243,CDM,,,,both,,,3087.0000,463.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11294.89,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33953 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 103.1% = $11,294.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN,33953,CPT,360,RC,36000243,CDM,,,,both,,,3087.0000,463.0500,SENTARA HEALTH,SENTARA HEALTH,796.75,,,,,,,796.7500,11503.0400,percent of total billed charges,"25.81% of $3,087.00 in Billed Charges for Rev 360 Proc 33953 = $796.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN,33953,CPT,360,RC,36000243,CDM,,,,both,,,3087.0000,463.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3087.00,,,,,,,796.7500,11503.0400,percent of total billed charges,"100% of $3,087.00 in Billed Charges for Rev 360 Proc 33953 = $3,087.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN,33953,CPT,360,RC,36000243,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,796.7500,11503.0400,case rate,Rev 360 Proc 33953 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN,33953,CPT,360,RC,36000243,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33953 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN,33953,CPT,360,RC,36000243,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33953 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN,33953,CPT,360,RC,36000243,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33953 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN,33953,CPT,360,RC,36000243,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11283.94,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33953 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN,33953,CPT,360,RC,36000243,CDM,,,,both,,,3087.0000,463.0500,WELLCARE,WELLCARE MEDICAID,3087.00,,,,,,,796.7500,11503.0400,percent of total billed charges,"100% of $3,087.00 in Billed Charges for Rev 360 Proc 33953 = $3,087.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,AETNA,AETNA,316.41,,,,,,,50.2300,804.0300,percent of total billed charges,42.7% of $741.00 in Billed Charges for Rev 521 Proc 11303 = $316.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,50.2300,804.0300,fee schedule,"APG 00003 Proc 11303 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,50.2300,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,50.2300,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,50.2300,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,AMBETTER,AMBETTER,804.03,,,,,,,50.2300,804.0300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,50.2300,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,ANTHEM EXCHANGE,741.00,,,,,,,50.2300,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,50.2300,804.0300,fee schedule,"APG 00003 Proc 11303 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,ANTHEM HMO,741.00,,,,,,,50.2300,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,50.2300,804.0300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",741.00,,,,,,,50.2300,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,100.73,,,,,,,50.2300,804.0300,fee schedule,$100.73 from Fee Schedule BLDTM_23 for Rev 521 Proc 11303 * Qty 1 = $100.73 at 100% = $100.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,50.2300,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,TENNCARE BLUE CARE,50.23,,,,,,,50.2300,804.0300,fee schedule,$43.30 from Fee Schedule TC_24 for Rev 521 Proc 11303 * Qty 1 = $43.30 at 116% = $50.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,TENNCARE BLUE SELECT,50.23,,,,,,,50.2300,804.0300,fee schedule,$43.30 from Fee Schedule TC_24 for Rev 521 Proc 11303 * Qty 1 = $43.30 at 116% = $50.23 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,CIGNA HEALTHCARE,CIGNA HMO,309.00,,,,,,,50.2300,804.0300,percent of total billed charges,41.7% of $741.00 in Billed Charges for Rev 521 Proc 11303 = $309.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,343.82,,,,,,,50.2300,804.0300,percent of total billed charges,46.4% of $741.00 in Billed Charges for Rev 521 Proc 11303 = $343.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,50.2300,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,309.00,,,,,,,50.2300,804.0300,percent of total billed charges,41.7% of $741.00 in Billed Charges for Rev 521 Proc 11303 = $309.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,CIGNA HEALTHCARE,CIGNA PPO,309.00,,,,,,,50.2300,804.0300,percent of total billed charges,41.7% of $741.00 in Billed Charges for Rev 521 Proc 11303 = $309.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,50.2300,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,666.90,,,,,,,50.2300,804.0300,percent of total billed charges,90% of $741.00 in Billed Charges for Rev 521 Proc 11303 = $666.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,50.2300,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,50.2300,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,MEDCOST,MEDCOST VHN,352.64,,,,,,,50.2300,804.0300,percent of total billed charges,47.59% of $741.00 in Billed Charges for Rev 521 Proc 11303 = $352.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,50.2300,804.0300,fee schedule,"APG 00003 Proc 11303 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,50.2300,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,50.2300,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,50.2300,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,50.2300,804.0300,fee schedule,"APG 00003 Proc 11303 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,SENTARA HEALTH,SENTARA HEALTH,191.25,,,,,,,50.2300,804.0300,percent of total billed charges,25.81% of $741.00 in Billed Charges for Rev 521 Proc 11303 = $191.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,50.2300,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",741.00,,,,,,,50.2300,804.0300,percent of total billed charges,100% of $741.00 in Billed Charges for Rev 521 Proc 11303 = $741.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,50.2300,804.0300,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 521 Proc 11303 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,50.2300,804.0300,fee schedule,"APG 00003 Proc 11303 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,50.2300,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,50.2300,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,WELLCARE,WELLCARE MEDICAID,741.00,,,,,,,50.2300,804.0300,percent of total billed charges,100% of $741.00 in Billed Charges for Rev 521 Proc 11303 = $741.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM,11303,CPT,521,RC,52100021,CDM,,,,both,,,741.0000,111.1500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,50.2300,804.0300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA,237.84,,,,,,,23.5500,557.0000,percent of total billed charges,42.7% of $557.00 in Billed Charges for Rev 521 Proc 11305 = $237.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,23.5500,557.0000,fee schedule,"APG 00003 Proc 11305 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,23.5500,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,23.5500,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,23.5500,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,AMBETTER,AMBETTER,396.83,,,,,,,23.5500,557.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,23.5500,557.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,23.5500,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,23.5500,557.0000,fee schedule,"APG 00003 Proc 11305 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,23.5500,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,23.5500,557.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",557.00,,,,,,,23.5500,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,51.73,,,,,,,23.5500,557.0000,fee schedule,$51.73 from Fee Schedule BLDTM_23 for Rev 521 Proc 11305 * Qty 1 = $51.73 at 100% = $51.73 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,23.5500,557.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,TENNCARE BLUE CARE,23.55,,,,,,,23.5500,557.0000,fee schedule,$20.30 from Fee Schedule TC_24 for Rev 521 Proc 11305 * Qty 1 = $20.30 at 116% = $23.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,TENNCARE BLUE SELECT,23.55,,,,,,,23.5500,557.0000,fee schedule,$20.30 from Fee Schedule TC_24 for Rev 521 Proc 11305 * Qty 1 = $20.30 at 116% = $23.55 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA HMO,232.27,,,,,,,23.5500,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 521 Proc 11305 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,258.45,,,,,,,23.5500,557.0000,percent of total billed charges,46.4% of $557.00 in Billed Charges for Rev 521 Proc 11305 = $258.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,23.5500,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,232.27,,,,,,,23.5500,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 521 Proc 11305 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA PPO,232.27,,,,,,,23.5500,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 521 Proc 11305 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,23.5500,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,501.30,,,,,,,23.5500,557.0000,percent of total billed charges,90% of $557.00 in Billed Charges for Rev 521 Proc 11305 = $501.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,23.5500,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,23.5500,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,MEDCOST,MEDCOST VHN,265.08,,,,,,,23.5500,557.0000,percent of total billed charges,47.59% of $557.00 in Billed Charges for Rev 521 Proc 11305 = $265.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,23.5500,557.0000,fee schedule,"APG 00003 Proc 11305 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,23.5500,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,23.5500,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,23.5500,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,23.5500,557.0000,fee schedule,"APG 00003 Proc 11305 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,SENTARA HEALTH,SENTARA HEALTH,143.76,,,,,,,23.5500,557.0000,percent of total billed charges,25.81% of $557.00 in Billed Charges for Rev 521 Proc 11305 = $143.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,23.5500,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",557.00,,,,,,,23.5500,557.0000,percent of total billed charges,100% of $557.00 in Billed Charges for Rev 521 Proc 11305 = $557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,49.25,,,,,,,23.5500,557.0000,fee schedule,$98.49 from Fee Schedule TCUHC24 for Rev 521 Proc 11305 * Qty 1 = $98.49 at 50% = $49.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,23.5500,557.0000,fee schedule,"APG 00003 Proc 11305 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,23.5500,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,23.5500,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,WELLCARE,WELLCARE MEDICAID,557.00,,,,,,,23.5500,557.0000,percent of total billed charges,100% of $557.00 in Billed Charges for Rev 521 Proc 11305 = $557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM OR LESS,11305,CPT,521,RC,52100022,CDM,,,,both,,,557.0000,83.5500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,23.5500,557.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,AETNA,AETNA,122.98,,,,,,,36.1000,396.8300,percent of total billed charges,42.7% of $288.00 in Billed Charges for Rev 521 Proc 11311 = $122.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,36.1000,396.8300,fee schedule,"APG 00003 Proc 11311 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,36.1000,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,36.1000,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,36.1000,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,AMBETTER,AMBETTER,396.83,,,,,,,36.1000,396.8300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,36.1000,396.8300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,ANTHEM EXCHANGE,288.00,,,,,,,36.1000,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,36.1000,396.8300,fee schedule,"APG 00003 Proc 11311 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,ANTHEM HMO,288.00,,,,,,,36.1000,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,36.1000,396.8300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",288.00,,,,,,,36.1000,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,73.41,,,,,,,36.1000,396.8300,fee schedule,$73.41 from Fee Schedule BLDTM_23 for Rev 521 Proc 11311 * Qty 1 = $73.41 at 100% = $73.41 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,36.1000,396.8300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,TENNCARE BLUE CARE,36.10,,,,,,,36.1000,396.8300,fee schedule,$31.12 from Fee Schedule TC_24 for Rev 521 Proc 11311 * Qty 1 = $31.12 at 116% = $36.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,BLUE CROSS,TENNCARE BLUE SELECT,36.10,,,,,,,36.1000,396.8300,fee schedule,$31.12 from Fee Schedule TC_24 for Rev 521 Proc 11311 * Qty 1 = $31.12 at 116% = $36.10 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,CIGNA HEALTHCARE,CIGNA HMO,120.10,,,,,,,36.1000,396.8300,percent of total billed charges,41.7% of $288.00 in Billed Charges for Rev 521 Proc 11311 = $120.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,133.63,,,,,,,36.1000,396.8300,percent of total billed charges,46.4% of $288.00 in Billed Charges for Rev 521 Proc 11311 = $133.63. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,36.1000,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,120.10,,,,,,,36.1000,396.8300,percent of total billed charges,41.7% of $288.00 in Billed Charges for Rev 521 Proc 11311 = $120.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,CIGNA HEALTHCARE,CIGNA PPO,120.10,,,,,,,36.1000,396.8300,percent of total billed charges,41.7% of $288.00 in Billed Charges for Rev 521 Proc 11311 = $120.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,36.1000,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,259.20,,,,,,,36.1000,396.8300,percent of total billed charges,90% of $288.00 in Billed Charges for Rev 521 Proc 11311 = $259.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,HUMANA,HUMANA MEDICARE,182.03,,,,,,,36.1000,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,36.1000,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,MEDCOST,MEDCOST VHN,137.06,,,,,,,36.1000,396.8300,percent of total billed charges,47.59% of $288.00 in Billed Charges for Rev 521 Proc 11311 = $137.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,36.1000,396.8300,fee schedule,"APG 00003 Proc 11311 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,36.1000,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,36.1000,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,36.1000,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,36.1000,396.8300,fee schedule,"APG 00003 Proc 11311 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,SENTARA HEALTH,SENTARA HEALTH,74.33,,,,,,,36.1000,396.8300,percent of total billed charges,25.81% of $288.00 in Billed Charges for Rev 521 Proc 11311 = $74.33. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,36.1000,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",288.00,,,,,,,36.1000,396.8300,percent of total billed charges,100% of $288.00 in Billed Charges for Rev 521 Proc 11311 = $288.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,36.1000,396.8300,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 521 Proc 11311 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,36.1000,396.8300,fee schedule,"APG 00003 Proc 11311 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,36.1000,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,36.1000,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,WELLCARE,WELLCARE MEDICAID,288.00,,,,,,,36.1000,396.8300,percent of total billed charges,100% of $288.00 in Billed Charges for Rev 521 Proc 11311 = $288.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM,11311,CPT,521,RC,52100026,CDM,,,,both,,,288.0000,43.2000,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,36.1000,396.8300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,AETNA,AETNA,148.60,,,,,,,59.6400,804.0300,percent of total billed charges,42.7% of $348.00 in Billed Charges for Rev 521 Proc 11313 = $148.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,59.6400,804.0300,fee schedule,"APG 00003 Proc 11313 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,348.00,,,,,,,59.6400,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,AETNA,AETNA HEALTHCARE MEDICARE,348.00,,,,,,,59.6400,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,ALLCARE MEDICARE,ALLCARE MEDICARE,348.00,,,,,,,59.6400,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,AMBETTER,AMBETTER,804.03,,,,,,,59.6400,804.0300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,348.00,,,,,,,59.6400,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,BLUE CROSS,ANTHEM EXCHANGE,348.00,,,,,,,59.6400,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,59.6400,804.0300,fee schedule,"APG 00003 Proc 11313 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,BLUE CROSS,ANTHEM HMO,348.00,,,,,,,59.6400,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,348.00,,,,,,,59.6400,804.0300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",348.00,,,,,,,59.6400,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,120.91,,,,,,,59.6400,804.0300,fee schedule,$120.91 from Fee Schedule BLDTM_23 for Rev 521 Proc 11313 * Qty 1 = $120.91 at 100% = $120.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,59.6400,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,BLUE CROSS,TENNCARE BLUE CARE,59.64,,,,,,,59.6400,804.0300,fee schedule,$51.41 from Fee Schedule TC_24 for Rev 521 Proc 11313 * Qty 1 = $51.41 at 116% = $59.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,BLUE CROSS,TENNCARE BLUE SELECT,59.64,,,,,,,59.6400,804.0300,fee schedule,$51.41 from Fee Schedule TC_24 for Rev 521 Proc 11313 * Qty 1 = $51.41 at 116% = $59.64 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,CIGNA HEALTHCARE,CIGNA HMO,145.12,,,,,,,59.6400,804.0300,percent of total billed charges,41.7% of $348.00 in Billed Charges for Rev 521 Proc 11313 = $145.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,161.47,,,,,,,59.6400,804.0300,percent of total billed charges,46.4% of $348.00 in Billed Charges for Rev 521 Proc 11313 = $161.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,CIGNA HEALTHCARE,CIGNA MEDICARE,348.00,,,,,,,59.6400,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,145.12,,,,,,,59.6400,804.0300,percent of total billed charges,41.7% of $348.00 in Billed Charges for Rev 521 Proc 11313 = $145.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,CIGNA HEALTHCARE,CIGNA PPO,145.12,,,,,,,59.6400,804.0300,percent of total billed charges,41.7% of $348.00 in Billed Charges for Rev 521 Proc 11313 = $145.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,348.00,,,,,,,59.6400,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,313.20,,,,,,,59.6400,804.0300,percent of total billed charges,90% of $348.00 in Billed Charges for Rev 521 Proc 11313 = $313.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,HUMANA,HUMANA MEDICARE,348.00,,,,,,,59.6400,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,348.00,,,,,,,59.6400,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,MEDCOST,MEDCOST VHN,165.61,,,,,,,59.6400,804.0300,percent of total billed charges,47.59% of $348.00 in Billed Charges for Rev 521 Proc 11313 = $165.61. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,59.6400,804.0300,fee schedule,"APG 00003 Proc 11313 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,348.00,,,,,,,59.6400,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,348.00,,,,,,,59.6400,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,NHC ADVANTAGE,NHC ADVANTAGE,348.00,,,,,,,59.6400,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,59.6400,804.0300,fee schedule,"APG 00003 Proc 11313 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,SENTARA HEALTH,SENTARA HEALTH,89.82,,,,,,,59.6400,804.0300,percent of total billed charges,25.81% of $348.00 in Billed Charges for Rev 521 Proc 11313 = $89.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,SENTARA HEALTH,SENTARA MEDICARE,348.00,,,,,,,59.6400,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",348.00,,,,,,,59.6400,804.0300,percent of total billed charges,100% of $348.00 in Billed Charges for Rev 521 Proc 11313 = $348.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,59.6400,804.0300,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 521 Proc 11313 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,59.6400,804.0300,fee schedule,"APG 00003 Proc 11313 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,348.00,,,,,,,59.6400,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,348.00,,,,,,,59.6400,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,WELLCARE,WELLCARE MEDICAID,348.00,,,,,,,59.6400,804.0300,percent of total billed charges,100% of $348.00 in Billed Charges for Rev 521 Proc 11313 = $348.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC SHVG SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM,11313,CPT,521,RC,52100028,CDM,,,,both,,,348.0000,52.2000,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,59.6400,804.0300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,AETNA,AETNA,523.08,,,,,,,37.6700,1225.0000,percent of total billed charges,"42.7% of $1,225.00 in Billed Charges for Rev 361 Proc 11401 = $523.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,617.83,,,,,,,37.6700,1225.0000,fee schedule,"APG 00009 Proc 11401 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 104% = $617.83. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,37.6700,1225.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,37.6700,1225.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,37.6700,1225.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,AMBETTER,AMBETTER,804.03,,,,,,,37.6700,1225.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,37.6700,1225.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,37.6700,1225.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,611.89,,,,,,,37.6700,1225.0000,fee schedule,"APG 00009 Proc 11401 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,37.6700,1225.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,37.6700,1225.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1134.94,,,,,,,37.6700,1225.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,704.00,,,,,,,37.6700,1225.0000,case rate,Rev 361 Proc 11401 ASG Rate of $704.00 at 100% of $704.00 = $704.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,BLUE CROSS,BLUE CROSS E NETWORK,670.00,,,,,,,37.6700,1225.0000,case rate,Rev 361 Proc 11401 ASG Rate of $670.00 at 100% of $670.00 = $670.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,37.6700,1225.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,BLUE CROSS,BLUE CROSS P NETWORK,685.00,,,,,,,37.6700,1225.0000,case rate,Rev 361 Proc 11401 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,BLUE CROSS,BLUE CROSS S NETWORK,685.00,,,,,,,37.6700,1225.0000,case rate,Rev 361 Proc 11401 ASG Rate of $685.00 at 100% of $685.00 = $685.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,BLUE CROSS,TENNCARE BLUE CARE,37.67,,,,,,,37.6700,1225.0000,fee schedule,$32.47 from Fee Schedule TC_24 for Rev 361 Proc 11401 * Qty 1 = $32.47 at 116% = $37.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,BLUE CROSS,TENNCARE BLUE SELECT,37.67,,,,,,,37.6700,1225.0000,fee schedule,$32.47 from Fee Schedule TC_24 for Rev 361 Proc 11401 * Qty 1 = $32.47 at 116% = $37.67 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,CIGNA HEALTHCARE,CIGNA HMO,1225.00,,,,,,,37.6700,1225.0000,case rate,"Rev 361 Proc 11401 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,225.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,225.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1225.00,,,,,,,37.6700,1225.0000,case rate,"Rev 361 Proc 11401 ASG Rate of $1,463.00 at 100% of $1,463.00 = $1,463.00 Total (Limited to $1,225.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,225.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,37.6700,1225.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1225.00,,,,,,,37.6700,1225.0000,case rate,"Rev 361 Proc 11401 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,225.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,225.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,CIGNA HEALTHCARE,CIGNA PPO,1225.00,,,,,,,37.6700,1225.0000,case rate,"Rev 361 Proc 11401 ASG Rate of $1,932.00 at 100% of $1,932.00 = $1,932.00 Total (Limited to $1,225.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,225.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,37.6700,1225.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1102.50,,,,,,,37.6700,1225.0000,percent of total billed charges,"90% of $1,225.00 in Billed Charges for Rev 361 Proc 11401 = $1,102.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,37.6700,1225.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,37.6700,1225.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,MEDCOST,MEDCOST VHN,582.98,,,,,,,37.6700,1225.0000,percent of total billed charges,"47.59% of $1,225.00 in Billed Charges for Rev 361 Proc 11401 = $582.98. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,623.77,,,,,,,37.6700,1225.0000,fee schedule,"APG 00009 Proc 11401 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 105% = $623.77 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,37.6700,1225.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,37.6700,1225.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,37.6700,1225.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,612.49,,,,,,,37.6700,1225.0000,fee schedule,"APG 00009 Proc 11401 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 100% = $594.07... $594.07 at 103.1% = $612.49 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,SENTARA HEALTH,SENTARA HEALTH,316.17,,,,,,,37.6700,1225.0000,percent of total billed charges,"25.81% of $1,225.00 in Billed Charges for Rev 361 Proc 11401 = $316.17. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,37.6700,1225.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1225.00,,,,,,,37.6700,1225.0000,percent of total billed charges,"100% of $1,225.00 in Billed Charges for Rev 361 Proc 11401 = $1,225.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,37.6700,1225.0000,case rate,Rev 361 Proc 11401 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,37.6700,1225.0000,case rate,Rev 361 Proc 11401 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,37.6700,1225.0000,case rate,Rev 361 Proc 11401 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,37.6700,1225.0000,case rate,Rev 361 Proc 11401 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,611.89,,,,,,,37.6700,1225.0000,fee schedule,"APG 00009 Proc 11401 at $836.60 (Base Rate) * 0.7101 (Relative Weight) = $594.07 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $594.07 at 103% = $611.89. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,37.6700,1225.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,37.6700,1225.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,WELLCARE,WELLCARE MEDICAID,1225.00,,,,,,,37.6700,1225.0000,percent of total billed charges,"100% of $1,225.00 in Billed Charges for Rev 361 Proc 11401 = $1,225.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC EXC BENIGN LESION 0.6 TO 1.0CM,11401,CPT,361,RC,36100043,CDM,,,,both,,,1225.0000,183.7500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,37.6700,1225.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER,33956,CPT,360,RC,36000246,CDM,,,,both,,,3087.0000,463.0500,AETNA,AETNA,1318.15,,,,,,,796.7500,11503.0400,percent of total billed charges,"42.7% of $3,087.00 in Billed Charges for Rev 360 Proc 33956 = $1,318.15. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER,33956,CPT,360,RC,36000246,CDM,,,,both,,,3087.0000,463.0500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11393.49,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33956 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 104% = $11,393.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER,33956,CPT,360,RC,36000246,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,3087.00,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33956 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94 (Service Line reduced to $3,087.00, claim capped at $3,087.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER,33956,CPT,360,RC,36000246,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33956 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER,33956,CPT,360,RC,36000246,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33956 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER,33956,CPT,360,RC,36000246,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33956 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER,33956,CPT,360,RC,36000246,CDM,,,,both,,,3087.0000,463.0500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33956 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER,33956,CPT,360,RC,36000246,CDM,,,,both,,,3087.0000,463.0500,CIGNA HEALTHCARE,CIGNA HMO,3087.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33956 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $3,087.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,087.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER,33956,CPT,360,RC,36000246,CDM,,,,both,,,3087.0000,463.0500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3087.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33956 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $3,087.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,087.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER,33956,CPT,360,RC,36000246,CDM,,,,both,,,3087.0000,463.0500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,3087.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33956 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $3,087.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,087.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER,33956,CPT,360,RC,36000246,CDM,,,,both,,,3087.0000,463.0500,CIGNA HEALTHCARE,CIGNA PPO,3087.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33956 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $3,087.00 in Billed Charges - $0.00 in ASG Allowed Amount = $3,087.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER,33956,CPT,360,RC,36000246,CDM,,,,both,,,3087.0000,463.0500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2778.30,,,,,,,796.7500,11503.0400,percent of total billed charges,"90% of $3,087.00 in Billed Charges for Rev 360 Proc 33956 = $2,778.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER,33956,CPT,360,RC,36000246,CDM,,,,both,,,3087.0000,463.0500,MEDCOST,MEDCOST VHN,1469.10,,,,,,,796.7500,11503.0400,percent of total billed charges,"47.59% of $3,087.00 in Billed Charges for Rev 360 Proc 33956 = $1,469.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER,33956,CPT,360,RC,36000246,CDM,,,,both,,,3087.0000,463.0500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11503.04,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33956 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 105% = $11,503.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER,33956,CPT,360,RC,36000246,CDM,,,,both,,,3087.0000,463.0500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11294.89,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33956 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 103.1% = $11,294.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER,33956,CPT,360,RC,36000246,CDM,,,,both,,,3087.0000,463.0500,SENTARA HEALTH,SENTARA HEALTH,796.75,,,,,,,796.7500,11503.0400,percent of total billed charges,"25.81% of $3,087.00 in Billed Charges for Rev 360 Proc 33956 = $796.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER,33956,CPT,360,RC,36000246,CDM,,,,both,,,3087.0000,463.0500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",3087.00,,,,,,,796.7500,11503.0400,percent of total billed charges,"100% of $3,087.00 in Billed Charges for Rev 360 Proc 33956 = $3,087.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER,33956,CPT,360,RC,36000246,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,796.7500,11503.0400,case rate,Rev 360 Proc 33956 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER,33956,CPT,360,RC,36000246,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33956 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER,33956,CPT,360,RC,36000246,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33956 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER,33956,CPT,360,RC,36000246,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,796.7500,11503.0400,case rate,"Rev 360 Proc 33956 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER,33956,CPT,360,RC,36000246,CDM,,,,both,,,3087.0000,463.0500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11283.94,,,,,,,796.7500,11503.0400,fee schedule,"APG 03070 Proc 33956 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER,33956,CPT,360,RC,36000246,CDM,,,,both,,,3087.0000,463.0500,WELLCARE,WELLCARE MEDICAID,3087.00,,,,,,,796.7500,11503.0400,percent of total billed charges,"100% of $3,087.00 in Billed Charges for Rev 360 Proc 33956 = $3,087.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER,33958,CPT,360,RC,36000248,CDM,,,,both,,,2470.0000,370.5000,AETNA,AETNA,1054.69,,,,,,,637.5100,11503.0400,percent of total billed charges,"42.7% of $2,470.00 in Billed Charges for Rev 360 Proc 33958 = $1,054.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER,33958,CPT,360,RC,36000248,CDM,,,,both,,,2470.0000,370.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11393.49,,,,,,,637.5100,11503.0400,fee schedule,"APG 03070 Proc 33958 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 104% = $11,393.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER,33958,CPT,360,RC,36000248,CDM,,,,both,,,2470.0000,370.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2470.00,,,,,,,637.5100,11503.0400,fee schedule,"APG 03070 Proc 33958 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94 (Service Line reduced to $2,470.00, claim capped at $2,470.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER,33958,CPT,360,RC,36000248,CDM,,,,both,,,2470.0000,370.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33958 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER,33958,CPT,360,RC,36000248,CDM,,,,both,,,2470.0000,370.5000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33958 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER,33958,CPT,360,RC,36000248,CDM,,,,both,,,2470.0000,370.5000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33958 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER,33958,CPT,360,RC,36000248,CDM,,,,both,,,2470.0000,370.5000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33958 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER,33958,CPT,360,RC,36000248,CDM,,,,both,,,2470.0000,370.5000,CIGNA HEALTHCARE,CIGNA HMO,2470.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33958 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,470.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,470.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER,33958,CPT,360,RC,36000248,CDM,,,,both,,,2470.0000,370.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2470.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33958 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $2,470.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,470.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER,33958,CPT,360,RC,36000248,CDM,,,,both,,,2470.0000,370.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2470.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33958 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,470.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,470.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER,33958,CPT,360,RC,36000248,CDM,,,,both,,,2470.0000,370.5000,CIGNA HEALTHCARE,CIGNA PPO,2470.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33958 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,470.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,470.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER,33958,CPT,360,RC,36000248,CDM,,,,both,,,2470.0000,370.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2223.00,,,,,,,637.5100,11503.0400,percent of total billed charges,"90% of $2,470.00 in Billed Charges for Rev 360 Proc 33958 = $2,223.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER,33958,CPT,360,RC,36000248,CDM,,,,both,,,2470.0000,370.5000,MEDCOST,MEDCOST VHN,1175.47,,,,,,,637.5100,11503.0400,percent of total billed charges,"47.59% of $2,470.00 in Billed Charges for Rev 360 Proc 33958 = $1,175.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER,33958,CPT,360,RC,36000248,CDM,,,,both,,,2470.0000,370.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11503.04,,,,,,,637.5100,11503.0400,fee schedule,"APG 03070 Proc 33958 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 105% = $11,503.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER,33958,CPT,360,RC,36000248,CDM,,,,both,,,2470.0000,370.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11294.89,,,,,,,637.5100,11503.0400,fee schedule,"APG 03070 Proc 33958 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 103.1% = $11,294.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER,33958,CPT,360,RC,36000248,CDM,,,,both,,,2470.0000,370.5000,SENTARA HEALTH,SENTARA HEALTH,637.51,,,,,,,637.5100,11503.0400,percent of total billed charges,"25.81% of $2,470.00 in Billed Charges for Rev 360 Proc 33958 = $637.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER,33958,CPT,360,RC,36000248,CDM,,,,both,,,2470.0000,370.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2470.00,,,,,,,637.5100,11503.0400,percent of total billed charges,"100% of $2,470.00 in Billed Charges for Rev 360 Proc 33958 = $2,470.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER,33958,CPT,360,RC,36000248,CDM,,,,both,,,2470.0000,370.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,637.5100,11503.0400,case rate,Rev 360 Proc 33958 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER,33958,CPT,360,RC,36000248,CDM,,,,both,,,2470.0000,370.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33958 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER,33958,CPT,360,RC,36000248,CDM,,,,both,,,2470.0000,370.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33958 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER,33958,CPT,360,RC,36000248,CDM,,,,both,,,2470.0000,370.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33958 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER,33958,CPT,360,RC,36000248,CDM,,,,both,,,2470.0000,370.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11283.94,,,,,,,637.5100,11503.0400,fee schedule,"APG 03070 Proc 33958 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER,33958,CPT,360,RC,36000248,CDM,,,,both,,,2470.0000,370.5000,WELLCARE,WELLCARE MEDICAID,2470.00,,,,,,,637.5100,11503.0400,percent of total billed charges,"100% of $2,470.00 in Billed Charges for Rev 360 Proc 33958 = $2,470.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS,33959,CPT,360,RC,36000249,CDM,,,,both,,,2470.0000,370.5000,AETNA,AETNA,1054.69,,,,,,,637.5100,11503.0400,percent of total billed charges,"42.7% of $2,470.00 in Billed Charges for Rev 360 Proc 33959 = $1,054.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS,33959,CPT,360,RC,36000249,CDM,,,,both,,,2470.0000,370.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11393.49,,,,,,,637.5100,11503.0400,fee schedule,"APG 03070 Proc 33959 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 104% = $11,393.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS,33959,CPT,360,RC,36000249,CDM,,,,both,,,2470.0000,370.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2470.00,,,,,,,637.5100,11503.0400,fee schedule,"APG 03070 Proc 33959 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94 (Service Line reduced to $2,470.00, claim capped at $2,470.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS,33959,CPT,360,RC,36000249,CDM,,,,both,,,2470.0000,370.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33959 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS,33959,CPT,360,RC,36000249,CDM,,,,both,,,2470.0000,370.5000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33959 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS,33959,CPT,360,RC,36000249,CDM,,,,both,,,2470.0000,370.5000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33959 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS,33959,CPT,360,RC,36000249,CDM,,,,both,,,2470.0000,370.5000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33959 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS,33959,CPT,360,RC,36000249,CDM,,,,both,,,2470.0000,370.5000,CIGNA HEALTHCARE,CIGNA HMO,2470.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33959 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,470.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,470.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS,33959,CPT,360,RC,36000249,CDM,,,,both,,,2470.0000,370.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2470.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33959 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $2,470.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,470.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS,33959,CPT,360,RC,36000249,CDM,,,,both,,,2470.0000,370.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2470.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33959 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,470.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,470.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS,33959,CPT,360,RC,36000249,CDM,,,,both,,,2470.0000,370.5000,CIGNA HEALTHCARE,CIGNA PPO,2470.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33959 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,470.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,470.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS,33959,CPT,360,RC,36000249,CDM,,,,both,,,2470.0000,370.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2223.00,,,,,,,637.5100,11503.0400,percent of total billed charges,"90% of $2,470.00 in Billed Charges for Rev 360 Proc 33959 = $2,223.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS,33959,CPT,360,RC,36000249,CDM,,,,both,,,2470.0000,370.5000,MEDCOST,MEDCOST VHN,1175.47,,,,,,,637.5100,11503.0400,percent of total billed charges,"47.59% of $2,470.00 in Billed Charges for Rev 360 Proc 33959 = $1,175.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS,33959,CPT,360,RC,36000249,CDM,,,,both,,,2470.0000,370.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11503.04,,,,,,,637.5100,11503.0400,fee schedule,"APG 03070 Proc 33959 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 105% = $11,503.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS,33959,CPT,360,RC,36000249,CDM,,,,both,,,2470.0000,370.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11294.89,,,,,,,637.5100,11503.0400,fee schedule,"APG 03070 Proc 33959 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 103.1% = $11,294.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS,33959,CPT,360,RC,36000249,CDM,,,,both,,,2470.0000,370.5000,SENTARA HEALTH,SENTARA HEALTH,637.51,,,,,,,637.5100,11503.0400,percent of total billed charges,"25.81% of $2,470.00 in Billed Charges for Rev 360 Proc 33959 = $637.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS,33959,CPT,360,RC,36000249,CDM,,,,both,,,2470.0000,370.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2470.00,,,,,,,637.5100,11503.0400,percent of total billed charges,"100% of $2,470.00 in Billed Charges for Rev 360 Proc 33959 = $2,470.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS,33959,CPT,360,RC,36000249,CDM,,,,both,,,2470.0000,370.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,637.5100,11503.0400,case rate,Rev 360 Proc 33959 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS,33959,CPT,360,RC,36000249,CDM,,,,both,,,2470.0000,370.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33959 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS,33959,CPT,360,RC,36000249,CDM,,,,both,,,2470.0000,370.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33959 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS,33959,CPT,360,RC,36000249,CDM,,,,both,,,2470.0000,370.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33959 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS,33959,CPT,360,RC,36000249,CDM,,,,both,,,2470.0000,370.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11283.94,,,,,,,637.5100,11503.0400,fee schedule,"APG 03070 Proc 33959 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS,33959,CPT,360,RC,36000249,CDM,,,,both,,,2470.0000,370.5000,WELLCARE,WELLCARE MEDICAID,2470.00,,,,,,,637.5100,11503.0400,percent of total billed charges,"100% of $2,470.00 in Billed Charges for Rev 360 Proc 33959 = $2,470.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS,33963,CPT,360,RC,36000251,CDM,,,,both,,,2470.0000,370.5000,AETNA,AETNA,1054.69,,,,,,,637.5100,11503.0400,percent of total billed charges,"42.7% of $2,470.00 in Billed Charges for Rev 360 Proc 33963 = $1,054.69. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS,33963,CPT,360,RC,36000251,CDM,,,,both,,,2470.0000,370.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11393.49,,,,,,,637.5100,11503.0400,fee schedule,"APG 03070 Proc 33963 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 104% = $11,393.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS,33963,CPT,360,RC,36000251,CDM,,,,both,,,2470.0000,370.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,2470.00,,,,,,,637.5100,11503.0400,fee schedule,"APG 03070 Proc 33963 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94 (Service Line reduced to $2,470.00, claim capped at $2,470.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS,33963,CPT,360,RC,36000251,CDM,,,,both,,,2470.0000,370.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33963 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS,33963,CPT,360,RC,36000251,CDM,,,,both,,,2470.0000,370.5000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33963 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS,33963,CPT,360,RC,36000251,CDM,,,,both,,,2470.0000,370.5000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33963 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS,33963,CPT,360,RC,36000251,CDM,,,,both,,,2470.0000,370.5000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33963 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS,33963,CPT,360,RC,36000251,CDM,,,,both,,,2470.0000,370.5000,CIGNA HEALTHCARE,CIGNA HMO,2470.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33963 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,470.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,470.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS,33963,CPT,360,RC,36000251,CDM,,,,both,,,2470.0000,370.5000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,2470.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33963 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $2,470.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,470.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS,33963,CPT,360,RC,36000251,CDM,,,,both,,,2470.0000,370.5000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,2470.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33963 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,470.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,470.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS,33963,CPT,360,RC,36000251,CDM,,,,both,,,2470.0000,370.5000,CIGNA HEALTHCARE,CIGNA PPO,2470.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33963 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $2,470.00 in Billed Charges - $0.00 in ASG Allowed Amount = $2,470.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS,33963,CPT,360,RC,36000251,CDM,,,,both,,,2470.0000,370.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,2223.00,,,,,,,637.5100,11503.0400,percent of total billed charges,"90% of $2,470.00 in Billed Charges for Rev 360 Proc 33963 = $2,223.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS,33963,CPT,360,RC,36000251,CDM,,,,both,,,2470.0000,370.5000,MEDCOST,MEDCOST VHN,1175.47,,,,,,,637.5100,11503.0400,percent of total billed charges,"47.59% of $2,470.00 in Billed Charges for Rev 360 Proc 33963 = $1,175.47. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS,33963,CPT,360,RC,36000251,CDM,,,,both,,,2470.0000,370.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11503.04,,,,,,,637.5100,11503.0400,fee schedule,"APG 03070 Proc 33963 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 105% = $11,503.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS,33963,CPT,360,RC,36000251,CDM,,,,both,,,2470.0000,370.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11294.89,,,,,,,637.5100,11503.0400,fee schedule,"APG 03070 Proc 33963 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 103.1% = $11,294.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS,33963,CPT,360,RC,36000251,CDM,,,,both,,,2470.0000,370.5000,SENTARA HEALTH,SENTARA HEALTH,637.51,,,,,,,637.5100,11503.0400,percent of total billed charges,"25.81% of $2,470.00 in Billed Charges for Rev 360 Proc 33963 = $637.51. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS,33963,CPT,360,RC,36000251,CDM,,,,both,,,2470.0000,370.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",2470.00,,,,,,,637.5100,11503.0400,percent of total billed charges,"100% of $2,470.00 in Billed Charges for Rev 360 Proc 33963 = $2,470.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS,33963,CPT,360,RC,36000251,CDM,,,,both,,,2470.0000,370.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,637.5100,11503.0400,case rate,Rev 360 Proc 33963 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS,33963,CPT,360,RC,36000251,CDM,,,,both,,,2470.0000,370.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33963 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS,33963,CPT,360,RC,36000251,CDM,,,,both,,,2470.0000,370.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33963 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS,33963,CPT,360,RC,36000251,CDM,,,,both,,,2470.0000,370.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,637.5100,11503.0400,case rate,"Rev 360 Proc 33963 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS,33963,CPT,360,RC,36000251,CDM,,,,both,,,2470.0000,370.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11283.94,,,,,,,637.5100,11503.0400,fee schedule,"APG 03070 Proc 33963 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS,33963,CPT,360,RC,36000251,CDM,,,,both,,,2470.0000,370.5000,WELLCARE,WELLCARE MEDICAID,2470.00,,,,,,,637.5100,11503.0400,percent of total billed charges,"100% of $2,470.00 in Billed Charges for Rev 360 Proc 33963 = $2,470.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS,33965,CPT,360,RC,36000253,CDM,,,,both,,,1976.0000,296.4000,AETNA,AETNA,843.75,,,,,,,510.0100,11503.0400,percent of total billed charges,"42.7% of $1,976.00 in Billed Charges for Rev 360 Proc 33965 = $843.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS,33965,CPT,360,RC,36000253,CDM,,,,both,,,1976.0000,296.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11393.49,,,,,,,510.0100,11503.0400,fee schedule,"APG 03070 Proc 33965 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 104% = $11,393.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS,33965,CPT,360,RC,36000253,CDM,,,,both,,,1976.0000,296.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1976.00,,,,,,,510.0100,11503.0400,fee schedule,"APG 03070 Proc 33965 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94 (Service Line reduced to $1,976.00, claim capped at $1,976.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS,33965,CPT,360,RC,36000253,CDM,,,,both,,,1976.0000,296.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33965 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS,33965,CPT,360,RC,36000253,CDM,,,,both,,,1976.0000,296.4000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33965 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS,33965,CPT,360,RC,36000253,CDM,,,,both,,,1976.0000,296.4000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33965 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS,33965,CPT,360,RC,36000253,CDM,,,,both,,,1976.0000,296.4000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33965 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS,33965,CPT,360,RC,36000253,CDM,,,,both,,,1976.0000,296.4000,CIGNA HEALTHCARE,CIGNA HMO,1976.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33965 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,976.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,976.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS,33965,CPT,360,RC,36000253,CDM,,,,both,,,1976.0000,296.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1976.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33965 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $1,976.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,976.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS,33965,CPT,360,RC,36000253,CDM,,,,both,,,1976.0000,296.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1976.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33965 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,976.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,976.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS,33965,CPT,360,RC,36000253,CDM,,,,both,,,1976.0000,296.4000,CIGNA HEALTHCARE,CIGNA PPO,1976.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33965 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,976.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,976.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS,33965,CPT,360,RC,36000253,CDM,,,,both,,,1976.0000,296.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1778.40,,,,,,,510.0100,11503.0400,percent of total billed charges,"90% of $1,976.00 in Billed Charges for Rev 360 Proc 33965 = $1,778.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS,33965,CPT,360,RC,36000253,CDM,,,,both,,,1976.0000,296.4000,MEDCOST,MEDCOST VHN,940.38,,,,,,,510.0100,11503.0400,percent of total billed charges,"47.59% of $1,976.00 in Billed Charges for Rev 360 Proc 33965 = $940.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS,33965,CPT,360,RC,36000253,CDM,,,,both,,,1976.0000,296.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11503.04,,,,,,,510.0100,11503.0400,fee schedule,"APG 03070 Proc 33965 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 105% = $11,503.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS,33965,CPT,360,RC,36000253,CDM,,,,both,,,1976.0000,296.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11294.89,,,,,,,510.0100,11503.0400,fee schedule,"APG 03070 Proc 33965 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 103.1% = $11,294.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS,33965,CPT,360,RC,36000253,CDM,,,,both,,,1976.0000,296.4000,SENTARA HEALTH,SENTARA HEALTH,510.01,,,,,,,510.0100,11503.0400,percent of total billed charges,"25.81% of $1,976.00 in Billed Charges for Rev 360 Proc 33965 = $510.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS,33965,CPT,360,RC,36000253,CDM,,,,both,,,1976.0000,296.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1976.00,,,,,,,510.0100,11503.0400,percent of total billed charges,"100% of $1,976.00 in Billed Charges for Rev 360 Proc 33965 = $1,976.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS,33965,CPT,360,RC,36000253,CDM,,,,both,,,1976.0000,296.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,510.0100,11503.0400,case rate,Rev 360 Proc 33965 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS,33965,CPT,360,RC,36000253,CDM,,,,both,,,1976.0000,296.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33965 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS,33965,CPT,360,RC,36000253,CDM,,,,both,,,1976.0000,296.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33965 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS,33965,CPT,360,RC,36000253,CDM,,,,both,,,1976.0000,296.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33965 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS,33965,CPT,360,RC,36000253,CDM,,,,both,,,1976.0000,296.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11283.94,,,,,,,510.0100,11503.0400,fee schedule,"APG 03070 Proc 33965 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS,33965,CPT,360,RC,36000253,CDM,,,,both,,,1976.0000,296.4000,WELLCARE,WELLCARE MEDICAID,1976.00,,,,,,,510.0100,11503.0400,percent of total billed charges,"100% of $1,976.00 in Billed Charges for Rev 360 Proc 33965 = $1,976.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,AETNA,AETNA,650.75,,,,,,,48.2800,1524.0000,percent of total billed charges,"42.7% of $1,524.00 in Billed Charges for Rev 450 Proc 16025 = $650.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,272.07,,,,,,,48.2800,1524.0000,fee schedule,"APG 00016 Proc 16025 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 104% = $272.07. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,48.2800,1524.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,48.2800,1524.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,48.2800,1524.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,AMBETTER,AMBETTER,396.83,,,,,,,48.2800,1524.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,48.2800,1524.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,48.2800,1524.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,269.45,,,,,,,48.2800,1524.0000,fee schedule,"APG 00016 Proc 16025 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,48.2800,1524.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,48.2800,1524.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",560.15,,,,,,,48.2800,1524.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,98.47,,,,,,,48.2800,1524.0000,fee schedule,$98.47 from Fee Schedule BLDTM_23 for Rev 450 Proc 16025 * Qty 1 = $98.47 at 100% = $98.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,48.2800,1524.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,BLUE CROSS,TENNCARE BLUE CARE,48.28,,,,,,,48.2800,1524.0000,fee schedule,$41.62 from Fee Schedule TC_24 for Rev 450 Proc 16025 * Qty 1 = $41.62 at 116% = $48.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,BLUE CROSS,TENNCARE BLUE SELECT,48.28,,,,,,,48.2800,1524.0000,fee schedule,$41.62 from Fee Schedule TC_24 for Rev 450 Proc 16025 * Qty 1 = $41.62 at 116% = $48.28 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,48.2800,1524.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,48.2800,1524.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1371.60,,,,,,,48.2800,1524.0000,percent of total billed charges,"90% of $1,524.00 in Billed Charges for Rev 450 Proc 16025 = $1,371.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,HUMANA,HUMANA MEDICARE,182.03,,,,,,,48.2800,1524.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,48.2800,1524.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,MEDCOST,MEDCOST VHN,725.27,,,,,,,48.2800,1524.0000,percent of total billed charges,"47.59% of $1,524.00 in Billed Charges for Rev 450 Proc 16025 = $725.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,274.68,,,,,,,48.2800,1524.0000,fee schedule,"APG 00016 Proc 16025 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 105% = $274.68 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,48.2800,1524.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,48.2800,1524.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,48.2800,1524.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,269.71,,,,,,,48.2800,1524.0000,fee schedule,"APG 00016 Proc 16025 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 100% = $261.60... $261.60 at 103.1% = $269.71 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,SENTARA HEALTH,SENTARA HEALTH,393.34,,,,,,,48.2800,1524.0000,percent of total billed charges,"25.81% of $1,524.00 in Billed Charges for Rev 450 Proc 16025 = $393.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,48.2800,1524.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1524.00,,,,,,,48.2800,1524.0000,percent of total billed charges,"100% of $1,524.00 in Billed Charges for Rev 450 Proc 16025 = $1,524.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,48.2800,1524.0000,case rate,Rev 450 Proc 16025 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,491.00,,,,,,,48.2800,1524.0000,case rate,Rev 450 Proc 16025 at Case Rate $491.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,UNITED HEALTHCARE,UHC HERITAGE SELECT,471.00,,,,,,,48.2800,1524.0000,case rate,Rev 450 Proc 16025 at Case Rate $471.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,UNITED HEALTHCARE,UNITED HEALTHCARE,847.00,,,,,,,48.2800,1524.0000,case rate,Rev 450 Proc 16025 at Case Rate $847.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,269.45,,,,,,,48.2800,1524.0000,fee schedule,"APG 00016 Proc 16025 at $836.60 (Base Rate) * 0.3127 (Relative Weight) = $261.60 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $261.60 at 103% = $269.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,48.2800,1524.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,48.2800,1524.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,WELLCARE,WELLCARE MEDICAID,1524.00,,,,,,,48.2800,1524.0000,percent of total billed charges,"100% of $1,524.00 in Billed Charges for Rev 450 Proc 16025 = $1,524.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DSG DEBR INIT SUBS MED 5%-10%,16025,CPT,450,RC,45000080,CDM,,,,both,,,1524.0000,228.6000,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,48.2800,1524.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,AETNA,AETNA,179.77,,,,,,,108.6600,804.0300,percent of total billed charges,42.7% of $421.00 in Billed Charges for Rev 450 Proc 16035 = $179.77. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,560.84,,,,,,,108.6600,804.0300,fee schedule,"APG 00017 Proc 16035 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 104% = $560.84. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,108.6600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,108.6600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,108.6600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,AMBETTER,AMBETTER,804.03,,,,,,,108.6600,804.0300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,108.6600,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,BLUE CROSS,ANTHEM EXCHANGE,421.00,,,,,,,108.6600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,421.00,,,,,,,108.6600,804.0300,fee schedule,"APG 00017 Proc 16035 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45 (Service Line reduced to $421.00, claim capped at $421.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,BLUE CROSS,ANTHEM HMO,421.00,,,,,,,108.6600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,108.6600,804.0300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",421.00,,,,,,,108.6600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,265.85,,,,,,,108.6600,804.0300,fee schedule,$265.85 from Fee Schedule BLDTM_23 for Rev 450 Proc 16035 * Qty 1 = $265.85 at 100% = $265.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,108.6600,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,108.6600,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,108.6600,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,378.90,,,,,,,108.6600,804.0300,percent of total billed charges,90% of $421.00 in Billed Charges for Rev 450 Proc 16035 = $378.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,108.6600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,108.6600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,MEDCOST,MEDCOST VHN,200.35,,,,,,,108.6600,804.0300,percent of total billed charges,47.59% of $421.00 in Billed Charges for Rev 450 Proc 16035 = $200.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,566.23,,,,,,,108.6600,804.0300,fee schedule,"APG 00017 Proc 16035 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 105% = $566.23 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,108.6600,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,108.6600,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,108.6600,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,555.99,,,,,,,108.6600,804.0300,fee schedule,"APG 00017 Proc 16035 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 100% = $539.27... $539.27 at 103.1% = $555.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,SENTARA HEALTH,SENTARA HEALTH,108.66,,,,,,,108.6600,804.0300,percent of total billed charges,25.81% of $421.00 in Billed Charges for Rev 450 Proc 16035 = $108.66. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,108.6600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",421.00,,,,,,,108.6600,804.0300,percent of total billed charges,100% of $421.00 in Billed Charges for Rev 450 Proc 16035 = $421.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,108.6600,804.0300,case rate,Rev 450 Proc 16035 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,421.00,,,,,,,108.6600,804.0300,case rate,"Rev 450 Proc 16035 at Case Rate $491.00 (Service Line reduced to $421.00, claim capped at $421.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,UNITED HEALTHCARE,UHC HERITAGE SELECT,421.00,,,,,,,108.6600,804.0300,case rate,"Rev 450 Proc 16035 at Case Rate $471.00 (Service Line reduced to $421.00, claim capped at $421.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,UNITED HEALTHCARE,UNITED HEALTHCARE,421.00,,,,,,,108.6600,804.0300,case rate,"Rev 450 Proc 16035 at Case Rate $847.00 (Service Line reduced to $421.00, claim capped at $421.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,555.45,,,,,,,108.6600,804.0300,fee schedule,"APG 00017 Proc 16035 at $836.60 (Base Rate) * 0.6446 (Relative Weight) = $539.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $539.27 at 103% = $555.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,108.6600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,108.6600,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,WELLCARE,WELLCARE MEDICAID,421.00,,,,,,,108.6600,804.0300,percent of total billed charges,100% of $421.00 in Billed Charges for Rev 450 Proc 16035 = $421.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC ESCHAROTOMY INITIAL INCISION,16035,CPT,450,RC,45000082,CDM,,,,both,,,421.0000,63.1500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,108.6600,804.0300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,AETNA,AETNA,455.18,,,,,,,98.6100,1066.0000,percent of total billed charges,"42.7% of $1,066.00 in Billed Charges for Rev 521 Proc 17004 = $455.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,98.6100,1066.0000,fee schedule,"APG 00003 Proc 17004 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,98.6100,1066.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,98.6100,1066.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,98.6100,1066.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,AMBETTER,AMBETTER,804.03,,,,,,,98.6100,1066.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,98.6100,1066.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,BLUE CROSS,ANTHEM EXCHANGE,908.05,,,,,,,98.6100,1066.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,98.6100,1066.0000,fee schedule,"APG 00003 Proc 17004 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,BLUE CROSS,ANTHEM HMO,964.75,,,,,,,98.6100,1066.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,98.6100,1066.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",1066.00,,,,,,,98.6100,1066.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,197.78,,,,,,,98.6100,1066.0000,fee schedule,$197.78 from Fee Schedule BLDTM_23 for Rev 521 Proc 17004 * Qty 1 = $197.78 at 100% = $197.78 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,98.6100,1066.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,BLUE CROSS,TENNCARE BLUE CARE,98.61,,,,,,,98.6100,1066.0000,fee schedule,$85.01 from Fee Schedule TC_24 for Rev 521 Proc 17004 * Qty 1 = $85.01 at 116% = $98.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,BLUE CROSS,TENNCARE BLUE SELECT,98.61,,,,,,,98.6100,1066.0000,fee schedule,$85.01 from Fee Schedule TC_24 for Rev 521 Proc 17004 * Qty 1 = $85.01 at 116% = $98.61 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,CIGNA HEALTHCARE,CIGNA HMO,444.52,,,,,,,98.6100,1066.0000,percent of total billed charges,"41.7% of $1,066.00 in Billed Charges for Rev 521 Proc 17004 = $444.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,494.62,,,,,,,98.6100,1066.0000,percent of total billed charges,"46.4% of $1,066.00 in Billed Charges for Rev 521 Proc 17004 = $494.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,98.6100,1066.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,444.52,,,,,,,98.6100,1066.0000,percent of total billed charges,"41.7% of $1,066.00 in Billed Charges for Rev 521 Proc 17004 = $444.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,CIGNA HEALTHCARE,CIGNA PPO,444.52,,,,,,,98.6100,1066.0000,percent of total billed charges,"41.7% of $1,066.00 in Billed Charges for Rev 521 Proc 17004 = $444.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,98.6100,1066.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,959.40,,,,,,,98.6100,1066.0000,percent of total billed charges,"90% of $1,066.00 in Billed Charges for Rev 521 Proc 17004 = $959.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,HUMANA,HUMANA MEDICARE,368.82,,,,,,,98.6100,1066.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,98.6100,1066.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,MEDCOST,MEDCOST VHN,507.31,,,,,,,98.6100,1066.0000,percent of total billed charges,"47.59% of $1,066.00 in Billed Charges for Rev 521 Proc 17004 = $507.31. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,98.6100,1066.0000,fee schedule,"APG 00003 Proc 17004 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,98.6100,1066.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,98.6100,1066.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,98.6100,1066.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,98.6100,1066.0000,fee schedule,"APG 00003 Proc 17004 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,SENTARA HEALTH,SENTARA HEALTH,275.13,,,,,,,98.6100,1066.0000,percent of total billed charges,"25.81% of $1,066.00 in Billed Charges for Rev 521 Proc 17004 = $275.13. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,98.6100,1066.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1066.00,,,,,,,98.6100,1066.0000,percent of total billed charges,"100% of $1,066.00 in Billed Charges for Rev 521 Proc 17004 = $1,066.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,141.57,,,,,,,98.6100,1066.0000,fee schedule,$283.14 from Fee Schedule TCUHC24 for Rev 521 Proc 17004 * Qty 1 = $283.14 at 50% = $141.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,98.6100,1066.0000,fee schedule,"APG 00003 Proc 17004 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,98.6100,1066.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,98.6100,1066.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,WELLCARE,WELLCARE MEDICAID,1066.00,,,,,,,98.6100,1066.0000,percent of total billed charges,"100% of $1,066.00 in Billed Charges for Rev 521 Proc 17004 = $1,066.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCTION PREMALIGNANT LESION 15 OR MORE LESIONS,17004,CPT,521,RC,52100062,CDM,,,,both,,,1066.0000,159.9000,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,98.6100,1066.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER,33966,CPT,360,RC,36000254,CDM,,,,both,,,1976.0000,296.4000,AETNA,AETNA,843.75,,,,,,,510.0100,11503.0400,percent of total billed charges,"42.7% of $1,976.00 in Billed Charges for Rev 360 Proc 33966 = $843.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER,33966,CPT,360,RC,36000254,CDM,,,,both,,,1976.0000,296.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11393.49,,,,,,,510.0100,11503.0400,fee schedule,"APG 03070 Proc 33966 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 104% = $11,393.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER,33966,CPT,360,RC,36000254,CDM,,,,both,,,1976.0000,296.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1976.00,,,,,,,510.0100,11503.0400,fee schedule,"APG 03070 Proc 33966 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94 (Service Line reduced to $1,976.00, claim capped at $1,976.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER,33966,CPT,360,RC,36000254,CDM,,,,both,,,1976.0000,296.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33966 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER,33966,CPT,360,RC,36000254,CDM,,,,both,,,1976.0000,296.4000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33966 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER,33966,CPT,360,RC,36000254,CDM,,,,both,,,1976.0000,296.4000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33966 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER,33966,CPT,360,RC,36000254,CDM,,,,both,,,1976.0000,296.4000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33966 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER,33966,CPT,360,RC,36000254,CDM,,,,both,,,1976.0000,296.4000,CIGNA HEALTHCARE,CIGNA HMO,1976.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33966 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,976.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,976.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER,33966,CPT,360,RC,36000254,CDM,,,,both,,,1976.0000,296.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1976.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33966 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $1,976.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,976.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER,33966,CPT,360,RC,36000254,CDM,,,,both,,,1976.0000,296.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1976.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33966 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,976.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,976.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER,33966,CPT,360,RC,36000254,CDM,,,,both,,,1976.0000,296.4000,CIGNA HEALTHCARE,CIGNA PPO,1976.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33966 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,976.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,976.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER,33966,CPT,360,RC,36000254,CDM,,,,both,,,1976.0000,296.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1778.40,,,,,,,510.0100,11503.0400,percent of total billed charges,"90% of $1,976.00 in Billed Charges for Rev 360 Proc 33966 = $1,778.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER,33966,CPT,360,RC,36000254,CDM,,,,both,,,1976.0000,296.4000,MEDCOST,MEDCOST VHN,940.38,,,,,,,510.0100,11503.0400,percent of total billed charges,"47.59% of $1,976.00 in Billed Charges for Rev 360 Proc 33966 = $940.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER,33966,CPT,360,RC,36000254,CDM,,,,both,,,1976.0000,296.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11503.04,,,,,,,510.0100,11503.0400,fee schedule,"APG 03070 Proc 33966 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 105% = $11,503.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER,33966,CPT,360,RC,36000254,CDM,,,,both,,,1976.0000,296.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11294.89,,,,,,,510.0100,11503.0400,fee schedule,"APG 03070 Proc 33966 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 103.1% = $11,294.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER,33966,CPT,360,RC,36000254,CDM,,,,both,,,1976.0000,296.4000,SENTARA HEALTH,SENTARA HEALTH,510.01,,,,,,,510.0100,11503.0400,percent of total billed charges,"25.81% of $1,976.00 in Billed Charges for Rev 360 Proc 33966 = $510.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER,33966,CPT,360,RC,36000254,CDM,,,,both,,,1976.0000,296.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1976.00,,,,,,,510.0100,11503.0400,percent of total billed charges,"100% of $1,976.00 in Billed Charges for Rev 360 Proc 33966 = $1,976.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER,33966,CPT,360,RC,36000254,CDM,,,,both,,,1976.0000,296.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,510.0100,11503.0400,case rate,Rev 360 Proc 33966 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER,33966,CPT,360,RC,36000254,CDM,,,,both,,,1976.0000,296.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33966 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER,33966,CPT,360,RC,36000254,CDM,,,,both,,,1976.0000,296.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33966 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER,33966,CPT,360,RC,36000254,CDM,,,,both,,,1976.0000,296.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33966 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER,33966,CPT,360,RC,36000254,CDM,,,,both,,,1976.0000,296.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11283.94,,,,,,,510.0100,11503.0400,fee schedule,"APG 03070 Proc 33966 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER,33966,CPT,360,RC,36000254,CDM,,,,both,,,1976.0000,296.4000,WELLCARE,WELLCARE MEDICAID,1976.00,,,,,,,510.0100,11503.0400,percent of total billed charges,"100% of $1,976.00 in Billed Charges for Rev 360 Proc 33966 = $1,976.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,AETNA,AETNA,2234.49,,,,,,,578.0000,10420.9900,percent of total billed charges,"42.7% of $5,233.00 in Billed Charges for Rev 360 Proc 33968 = $2,234.49. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,10321.74,,,,,,,578.0000,10420.9900,fee schedule,"APG 00087 Proc 33968 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 104% = $10,321.74. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,BLUE CROSS,ANTHEM EXCHANGE,5233.00,,,,,,,578.0000,10420.9900,fee schedule,"$4,081.35 from Fee Schedule ANT_C_APC for Rev 360 Proc 33968 * Qty 1 = $4,081.35 at 199.87% = $8,157.39 (Service Line reduced to $5,233.00, claim capped at $5,233.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,5233.00,,,,,,,578.0000,10420.9900,fee schedule,"APG 00087 Proc 33968 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 103% = $10,222.50 (Service Line reduced to $5,233.00, claim capped at $5,233.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,BLUE CROSS,ANTHEM HMO,5233.00,,,,,,,578.0000,10420.9900,fee schedule,"$4,081.35 from Fee Schedule ANT_C_APC for Rev 360 Proc 33968 * Qty 1 = $4,081.35 at 212.35% = $8,666.75 (Service Line reduced to $5,233.00, claim capped at $5,233.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",5233.00,,,,,,,578.0000,10420.9900,fee schedule,"$4,081.35 from Fee Schedule ANT_C_APC for Rev 360 Proc 33968 * Qty 1 = $4,081.35 at 249.81% = $10,195.62 (Service Line reduced to $5,233.00, claim capped at $5,233.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,578.0000,10420.9900,case rate,"Rev 360 Proc 33968 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,578.0000,10420.9900,case rate,"Rev 360 Proc 33968 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,578.0000,10420.9900,case rate,"Rev 360 Proc 33968 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,578.0000,10420.9900,case rate,"Rev 360 Proc 33968 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,578.0000,10420.9900,case rate,Rev 360 Proc 33968 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,578.0000,10420.9900,case rate,Rev 360 Proc 33968 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,578.0000,10420.9900,case rate,"Rev 360 Proc 33968 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,578.0000,10420.9900,case rate,"Rev 360 Proc 33968 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,578.0000,10420.9900,case rate,"Rev 360 Proc 33968 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,578.0000,10420.9900,case rate,"Rev 360 Proc 33968 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,4709.70,,,,,,,578.0000,10420.9900,percent of total billed charges,"90% of $5,233.00 in Billed Charges for Rev 360 Proc 33968 = $4,709.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,MEDCOST,MEDCOST VHN,2490.38,,,,,,,578.0000,10420.9900,percent of total billed charges,"47.59% of $5,233.00 in Billed Charges for Rev 360 Proc 33968 = $2,490.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,10420.99,,,,,,,578.0000,10420.9900,fee schedule,"APG 00087 Proc 33968 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 100% = $9,924.75... $9,924.75 at 105% = $10,420.99 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,10232.42,,,,,,,578.0000,10420.9900,fee schedule,"APG 00087 Proc 33968 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 100% = $9,924.75... $9,924.75 at 103.1% = $10,232.42 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,SENTARA HEALTH,SENTARA HEALTH,1350.64,,,,,,,578.0000,10420.9900,percent of total billed charges,"25.81% of $5,233.00 in Billed Charges for Rev 360 Proc 33968 = $1,350.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",5233.00,,,,,,,578.0000,10420.9900,percent of total billed charges,"100% of $5,233.00 in Billed Charges for Rev 360 Proc 33968 = $5,233.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,5233.00,,,,,,,578.0000,10420.9900,case rate,"Rev 360 Proc 33968 ASG Rate of $11,895.00 at 100% of $11,895.00 = $11,895.00 Total (Limited to $5,233.00 in Billed Charges - $0.00 in ASG Allowed Amount = $5,233.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,5233.00,,,,,,,578.0000,10420.9900,case rate,"Rev 360 Proc 33968 ASG Rate of $13,136.00 at 100% of $13,136.00 = $13,136.00 Total (Service Line reduced to $5,233.00, claim capped at $5,233.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,UNITED HEALTHCARE,UHC HERITAGE SELECT,5233.00,,,,,,,578.0000,10420.9900,case rate,"Rev 360 Proc 33968 ASG Rate of $12,568.00 at 100% of $12,568.00 = $12,568.00 Total (Service Line reduced to $5,233.00, claim capped at $5,233.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,UNITED HEALTHCARE,UNITED HEALTHCARE,5233.00,,,,,,,578.0000,10420.9900,case rate,"Rev 360 Proc 33968 ASG Rate of $21,337.00 at 100% of $21,337.00 = $21,337.00 Total (Service Line reduced to $5,233.00, claim capped at $5,233.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,10222.50,,,,,,,578.0000,10420.9900,fee schedule,"APG 00087 Proc 33968 at $836.60 (Base Rate) * 11.8632 (Relative Weight) = $9,924.75 (Total Line Payment) at 103% = $10,222.50. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC RMVL IAB ASSIST DEVICE PERCU,33968,CPT,360,RC,36000219,CDM,,,,both,,,5233.0000,784.9500,WELLCARE,WELLCARE MEDICAID,5233.00,,,,,,,578.0000,10420.9900,percent of total billed charges,"100% of $5,233.00 in Billed Charges for Rev 360 Proc 33968 = $5,233.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS,33969,CPT,360,RC,36000255,CDM,,,,both,,,1976.0000,296.4000,AETNA,AETNA,843.75,,,,,,,510.0100,11503.0400,percent of total billed charges,"42.7% of $1,976.00 in Billed Charges for Rev 360 Proc 33969 = $843.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS,33969,CPT,360,RC,36000255,CDM,,,,both,,,1976.0000,296.4000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,11393.49,,,,,,,510.0100,11503.0400,fee schedule,"APG 03070 Proc 33969 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 104% = $11,393.49. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS,33969,CPT,360,RC,36000255,CDM,,,,both,,,1976.0000,296.4000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,1976.00,,,,,,,510.0100,11503.0400,fee schedule,"APG 03070 Proc 33969 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94 (Service Line reduced to $1,976.00, claim capped at $1,976.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS,33969,CPT,360,RC,36000255,CDM,,,,both,,,1976.0000,296.4000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33969 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS,33969,CPT,360,RC,36000255,CDM,,,,both,,,1976.0000,296.4000,BLUE CROSS,BLUE CROSS E NETWORK,1871.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33969 ASG Rate of $1,871.00 at 100% of $1,871.00 = $1,871.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS,33969,CPT,360,RC,36000255,CDM,,,,both,,,1976.0000,296.4000,BLUE CROSS,BLUE CROSS P NETWORK,1913.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33969 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS,33969,CPT,360,RC,36000255,CDM,,,,both,,,1976.0000,296.4000,BLUE CROSS,BLUE CROSS S NETWORK,1913.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33969 ASG Rate of $1,913.00 at 100% of $1,913.00 = $1,913.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS,33969,CPT,360,RC,36000255,CDM,,,,both,,,1976.0000,296.4000,CIGNA HEALTHCARE,CIGNA HMO,1976.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33969 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,976.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,976.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS,33969,CPT,360,RC,36000255,CDM,,,,both,,,1976.0000,296.4000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,1976.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33969 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total (Limited to $1,976.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,976.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS,33969,CPT,360,RC,36000255,CDM,,,,both,,,1976.0000,296.4000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,1976.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33969 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,976.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,976.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS,33969,CPT,360,RC,36000255,CDM,,,,both,,,1976.0000,296.4000,CIGNA HEALTHCARE,CIGNA PPO,1976.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33969 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total (Limited to $1,976.00 in Billed Charges - $0.00 in ASG Allowed Amount = $1,976.00) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS,33969,CPT,360,RC,36000255,CDM,,,,both,,,1976.0000,296.4000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,1778.40,,,,,,,510.0100,11503.0400,percent of total billed charges,"90% of $1,976.00 in Billed Charges for Rev 360 Proc 33969 = $1,778.40. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS,33969,CPT,360,RC,36000255,CDM,,,,both,,,1976.0000,296.4000,MEDCOST,MEDCOST VHN,940.38,,,,,,,510.0100,11503.0400,percent of total billed charges,"47.59% of $1,976.00 in Billed Charges for Rev 360 Proc 33969 = $940.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS,33969,CPT,360,RC,36000255,CDM,,,,both,,,1976.0000,296.4000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,11503.04,,,,,,,510.0100,11503.0400,fee schedule,"APG 03070 Proc 33969 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 105% = $11,503.04 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS,33969,CPT,360,RC,36000255,CDM,,,,both,,,1976.0000,296.4000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,11294.89,,,,,,,510.0100,11503.0400,fee schedule,"APG 03070 Proc 33969 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 100% = $10,955.28... $10,955.28 at 103.1% = $11,294.89 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS,33969,CPT,360,RC,36000255,CDM,,,,both,,,1976.0000,296.4000,SENTARA HEALTH,SENTARA HEALTH,510.01,,,,,,,510.0100,11503.0400,percent of total billed charges,"25.81% of $1,976.00 in Billed Charges for Rev 360 Proc 33969 = $510.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS,33969,CPT,360,RC,36000255,CDM,,,,both,,,1976.0000,296.4000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",1976.00,,,,,,,510.0100,11503.0400,percent of total billed charges,"100% of $1,976.00 in Billed Charges for Rev 360 Proc 33969 = $1,976.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS,33969,CPT,360,RC,36000255,CDM,,,,both,,,1976.0000,296.4000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,968.00,,,,,,,510.0100,11503.0400,case rate,Rev 360 Proc 33969 ASG Rate of $968.00 at 100% of $968.00 = $968.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS,33969,CPT,360,RC,36000255,CDM,,,,both,,,1976.0000,296.4000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,1103.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33969 ASG Rate of $1,103.00 at 100% of $1,103.00 = $1,103.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS,33969,CPT,360,RC,36000255,CDM,,,,both,,,1976.0000,296.4000,UNITED HEALTHCARE,UHC HERITAGE SELECT,1055.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33969 ASG Rate of $1,055.00 at 100% of $1,055.00 = $1,055.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS,33969,CPT,360,RC,36000255,CDM,,,,both,,,1976.0000,296.4000,UNITED HEALTHCARE,UNITED HEALTHCARE,1861.00,,,,,,,510.0100,11503.0400,case rate,"Rev 360 Proc 33969 ASG Rate of $1,861.00 at 100% of $1,861.00 = $1,861.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS,33969,CPT,360,RC,36000255,CDM,,,,both,,,1976.0000,296.4000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,11283.94,,,,,,,510.0100,11503.0400,fee schedule,"APG 03070 Proc 33969 at $836.60 (Base Rate) * 13.095 (Relative Weight) = $10,955.28 (Total Line Payment) at 103% = $11,283.94. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS,33969,CPT,360,RC,36000255,CDM,,,,both,,,1976.0000,296.4000,WELLCARE,WELLCARE MEDICAID,1976.00,,,,,,,510.0100,11503.0400,percent of total billed charges,"100% of $1,976.00 in Billed Charges for Rev 360 Proc 33969 = $1,976.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH PLCMT INTRAVAS STENT CNTRL DIALYSIS SEGMENT,36908,CPT,361,RC,36100343,CDM,,,,both,,,42123.0000,6318.4500,AETNA,AETNA,17986.52,,,,,,,148.0000,42123.0000,percent of total billed charges,"42.7% of $42,123.00 in Billed Charges for Rev 361 Proc 36908 = $17,986.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH PLCMT INTRAVAS STENT CNTRL DIALYSIS SEGMENT,36908,CPT,361,RC,36100343,CDM,,,,both,,,42123.0000,6318.4500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,9404.09,,,,,,,148.0000,42123.0000,fee schedule,"APG 00079 Proc 36908 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 104% = $9,404.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH PLCMT INTRAVAS STENT CNTRL DIALYSIS SEGMENT,36908,CPT,361,RC,36100343,CDM,,,,both,,,42123.0000,6318.4500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,9313.66,,,,,,,148.0000,42123.0000,fee schedule,"APG 00079 Proc 36908 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 103% = $9,313.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH PLCMT INTRAVAS STENT CNTRL DIALYSIS SEGMENT,36908,CPT,361,RC,36100343,CDM,,,,both,,,42123.0000,6318.4500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,148.0000,42123.0000,case rate,"Rev 361 Proc 36908 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH PLCMT INTRAVAS STENT CNTRL DIALYSIS SEGMENT,36908,CPT,361,RC,36100343,CDM,,,,both,,,42123.0000,6318.4500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,42123.0000,case rate,Rev 361 Proc 36908 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH PLCMT INTRAVAS STENT CNTRL DIALYSIS SEGMENT,36908,CPT,361,RC,36100343,CDM,,,,both,,,42123.0000,6318.4500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,42123.0000,case rate,Rev 361 Proc 36908 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH PLCMT INTRAVAS STENT CNTRL DIALYSIS SEGMENT,36908,CPT,361,RC,36100343,CDM,,,,both,,,42123.0000,6318.4500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,42123.0000,case rate,Rev 361 Proc 36908 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH PLCMT INTRAVAS STENT CNTRL DIALYSIS SEGMENT,36908,CPT,361,RC,36100343,CDM,,,,both,,,42123.0000,6318.4500,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,148.0000,42123.0000,case rate,Rev 361 Proc 36908 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH PLCMT INTRAVAS STENT CNTRL DIALYSIS SEGMENT,36908,CPT,361,RC,36100343,CDM,,,,both,,,42123.0000,6318.4500,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,148.0000,42123.0000,case rate,Rev 361 Proc 36908 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH PLCMT INTRAVAS STENT CNTRL DIALYSIS SEGMENT,36908,CPT,361,RC,36100343,CDM,,,,both,,,42123.0000,6318.4500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,148.0000,42123.0000,case rate,"Rev 361 Proc 36908 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH PLCMT INTRAVAS STENT CNTRL DIALYSIS SEGMENT,36908,CPT,361,RC,36100343,CDM,,,,both,,,42123.0000,6318.4500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,148.0000,42123.0000,case rate,"Rev 361 Proc 36908 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH PLCMT INTRAVAS STENT CNTRL DIALYSIS SEGMENT,36908,CPT,361,RC,36100343,CDM,,,,both,,,42123.0000,6318.4500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,148.0000,42123.0000,case rate,"Rev 361 Proc 36908 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH PLCMT INTRAVAS STENT CNTRL DIALYSIS SEGMENT,36908,CPT,361,RC,36100343,CDM,,,,both,,,42123.0000,6318.4500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,37910.70,,,,,,,148.0000,42123.0000,percent of total billed charges,"90% of $42,123.00 in Billed Charges for Rev 361 Proc 36908 = $37,910.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH PLCMT INTRAVAS STENT CNTRL DIALYSIS SEGMENT,36908,CPT,361,RC,36100343,CDM,,,,both,,,42123.0000,6318.4500,MEDCOST,MEDCOST VHN,20046.34,,,,,,,148.0000,42123.0000,percent of total billed charges,"47.59% of $42,123.00 in Billed Charges for Rev 361 Proc 36908 = $20,046.34. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH PLCMT INTRAVAS STENT CNTRL DIALYSIS SEGMENT,36908,CPT,361,RC,36100343,CDM,,,,both,,,42123.0000,6318.4500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,9494.51,,,,,,,148.0000,42123.0000,fee schedule,"APG 00079 Proc 36908 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 100% = $9,042.39... $9,042.39 at 105% = $9,494.51 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH PLCMT INTRAVAS STENT CNTRL DIALYSIS SEGMENT,36908,CPT,361,RC,36100343,CDM,,,,both,,,42123.0000,6318.4500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,9322.70,,,,,,,148.0000,42123.0000,fee schedule,"APG 00079 Proc 36908 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 100% = $9,042.39... $9,042.39 at 103.1% = $9,322.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH PLCMT INTRAVAS STENT CNTRL DIALYSIS SEGMENT,36908,CPT,361,RC,36100343,CDM,,,,both,,,42123.0000,6318.4500,SENTARA HEALTH,SENTARA HEALTH,10871.95,,,,,,,148.0000,42123.0000,percent of total billed charges,"25.81% of $42,123.00 in Billed Charges for Rev 361 Proc 36908 = $10,871.95. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH PLCMT INTRAVAS STENT CNTRL DIALYSIS SEGMENT,36908,CPT,361,RC,36100343,CDM,,,,both,,,42123.0000,6318.4500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",42123.00,,,,,,,148.0000,42123.0000,percent of total billed charges,"100% of $42,123.00 in Billed Charges for Rev 361 Proc 36908 = $42,123.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC TRANSCATH PLCMT INTRAVAS STENT CNTRL DIALYSIS SEGMENT,36908,CPT,361,RC,36100343,CDM,,,,both,,,42123.0000,6318.4500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,148.0000,42123.0000,case rate,Rev 361 Proc 36908 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH PLCMT INTRAVAS STENT CNTRL DIALYSIS SEGMENT,36908,CPT,361,RC,36100343,CDM,,,,both,,,42123.0000,6318.4500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,148.0000,42123.0000,case rate,Rev 361 Proc 36908 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH PLCMT INTRAVAS STENT CNTRL DIALYSIS SEGMENT,36908,CPT,361,RC,36100343,CDM,,,,both,,,42123.0000,6318.4500,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,148.0000,42123.0000,case rate,Rev 361 Proc 36908 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH PLCMT INTRAVAS STENT CNTRL DIALYSIS SEGMENT,36908,CPT,361,RC,36100343,CDM,,,,both,,,42123.0000,6318.4500,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,148.0000,42123.0000,case rate,Rev 361 Proc 36908 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC TRANSCATH PLCMT INTRAVAS STENT CNTRL DIALYSIS SEGMENT,36908,CPT,361,RC,36100343,CDM,,,,both,,,42123.0000,6318.4500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,9313.66,,,,,,,148.0000,42123.0000,fee schedule,"APG 00079 Proc 36908 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 103% = $9,313.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC TRANSCATH PLCMT INTRAVAS STENT CNTRL DIALYSIS SEGMENT,36908,CPT,361,RC,36100343,CDM,,,,both,,,42123.0000,6318.4500,WELLCARE,WELLCARE MEDICAID,42123.00,,,,,,,148.0000,42123.0000,percent of total billed charges,"100% of $42,123.00 in Billed Charges for Rev 361 Proc 36908 = $42,123.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOVAS DIALYSIS CIRCUIT PERM VASC EMBOLIZATION/OCCLUSION,36909,CPT,361,RC,36100344,CDM,,,,both,,,23558.0000,3533.7000,AETNA,AETNA,10059.27,,,,,,,148.0000,23558.0000,percent of total billed charges,"42.7% of $23,558.00 in Billed Charges for Rev 361 Proc 36909 = $10,059.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOVAS DIALYSIS CIRCUIT PERM VASC EMBOLIZATION/OCCLUSION,36909,CPT,361,RC,36100344,CDM,,,,both,,,23558.0000,3533.7000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15721.62,,,,,,,148.0000,23558.0000,fee schedule,"APG 00085 Proc 36909 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 104% = $15,721.62. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVAS DIALYSIS CIRCUIT PERM VASC EMBOLIZATION/OCCLUSION,36909,CPT,361,RC,36100344,CDM,,,,both,,,23558.0000,3533.7000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15570.45,,,,,,,148.0000,23558.0000,fee schedule,"APG 00085 Proc 36909 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVAS DIALYSIS CIRCUIT PERM VASC EMBOLIZATION/OCCLUSION,36909,CPT,361,RC,36100344,CDM,,,,both,,,23558.0000,3533.7000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,148.0000,23558.0000,case rate,"Rev 361 Proc 36909 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVAS DIALYSIS CIRCUIT PERM VASC EMBOLIZATION/OCCLUSION,36909,CPT,361,RC,36100344,CDM,,,,both,,,23558.0000,3533.7000,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,23558.0000,case rate,Rev 361 Proc 36909 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOVAS DIALYSIS CIRCUIT PERM VASC EMBOLIZATION/OCCLUSION,36909,CPT,361,RC,36100344,CDM,,,,both,,,23558.0000,3533.7000,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,23558.0000,case rate,Rev 361 Proc 36909 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOVAS DIALYSIS CIRCUIT PERM VASC EMBOLIZATION/OCCLUSION,36909,CPT,361,RC,36100344,CDM,,,,both,,,23558.0000,3533.7000,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,23558.0000,case rate,Rev 361 Proc 36909 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOVAS DIALYSIS CIRCUIT PERM VASC EMBOLIZATION/OCCLUSION,36909,CPT,361,RC,36100344,CDM,,,,both,,,23558.0000,3533.7000,BLUE CROSS,TENNCARE BLUE CARE,578.00,,,,,,,148.0000,23558.0000,case rate,Rev 361 Proc 36909 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOVAS DIALYSIS CIRCUIT PERM VASC EMBOLIZATION/OCCLUSION,36909,CPT,361,RC,36100344,CDM,,,,both,,,23558.0000,3533.7000,BLUE CROSS,TENNCARE BLUE SELECT,578.00,,,,,,,148.0000,23558.0000,case rate,Rev 361 Proc 36909 ASG Rate of $578.00 at 100% of $578.00 = $578.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOVAS DIALYSIS CIRCUIT PERM VASC EMBOLIZATION/OCCLUSION,36909,CPT,361,RC,36100344,CDM,,,,both,,,23558.0000,3533.7000,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,148.0000,23558.0000,case rate,"Rev 361 Proc 36909 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVAS DIALYSIS CIRCUIT PERM VASC EMBOLIZATION/OCCLUSION,36909,CPT,361,RC,36100344,CDM,,,,both,,,23558.0000,3533.7000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,148.0000,23558.0000,case rate,"Rev 361 Proc 36909 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVAS DIALYSIS CIRCUIT PERM VASC EMBOLIZATION/OCCLUSION,36909,CPT,361,RC,36100344,CDM,,,,both,,,23558.0000,3533.7000,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,148.0000,23558.0000,case rate,"Rev 361 Proc 36909 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVAS DIALYSIS CIRCUIT PERM VASC EMBOLIZATION/OCCLUSION,36909,CPT,361,RC,36100344,CDM,,,,both,,,23558.0000,3533.7000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,21202.20,,,,,,,148.0000,23558.0000,percent of total billed charges,"90% of $23,558.00 in Billed Charges for Rev 361 Proc 36909 = $21,202.20. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOVAS DIALYSIS CIRCUIT PERM VASC EMBOLIZATION/OCCLUSION,36909,CPT,361,RC,36100344,CDM,,,,both,,,23558.0000,3533.7000,MEDCOST,MEDCOST VHN,11211.25,,,,,,,148.0000,23558.0000,percent of total billed charges,"47.59% of $23,558.00 in Billed Charges for Rev 361 Proc 36909 = $11,211.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOVAS DIALYSIS CIRCUIT PERM VASC EMBOLIZATION/OCCLUSION,36909,CPT,361,RC,36100344,CDM,,,,both,,,23558.0000,3533.7000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15872.79,,,,,,,148.0000,23558.0000,fee schedule,"APG 00085 Proc 36909 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 105% = $15,872.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVAS DIALYSIS CIRCUIT PERM VASC EMBOLIZATION/OCCLUSION,36909,CPT,361,RC,36100344,CDM,,,,both,,,23558.0000,3533.7000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15585.57,,,,,,,148.0000,23558.0000,fee schedule,"APG 00085 Proc 36909 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 103.1% = $15,585.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVAS DIALYSIS CIRCUIT PERM VASC EMBOLIZATION/OCCLUSION,36909,CPT,361,RC,36100344,CDM,,,,both,,,23558.0000,3533.7000,SENTARA HEALTH,SENTARA HEALTH,6080.32,,,,,,,148.0000,23558.0000,percent of total billed charges,"25.81% of $23,558.00 in Billed Charges for Rev 361 Proc 36909 = $6,080.32. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOVAS DIALYSIS CIRCUIT PERM VASC EMBOLIZATION/OCCLUSION,36909,CPT,361,RC,36100344,CDM,,,,both,,,23558.0000,3533.7000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",23558.00,,,,,,,148.0000,23558.0000,percent of total billed charges,"100% of $23,558.00 in Billed Charges for Rev 361 Proc 36909 = $23,558.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC ENDOVAS DIALYSIS CIRCUIT PERM VASC EMBOLIZATION/OCCLUSION,36909,CPT,361,RC,36100344,CDM,,,,both,,,23558.0000,3533.7000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,148.0000,23558.0000,case rate,Rev 361 Proc 36909 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOVAS DIALYSIS CIRCUIT PERM VASC EMBOLIZATION/OCCLUSION,36909,CPT,361,RC,36100344,CDM,,,,both,,,23558.0000,3533.7000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,289.00,,,,,,,148.0000,23558.0000,case rate,Rev 361 Proc 36909 ASG Rate of $289.00 at 100% of $289.00 = $289.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOVAS DIALYSIS CIRCUIT PERM VASC EMBOLIZATION/OCCLUSION,36909,CPT,361,RC,36100344,CDM,,,,both,,,23558.0000,3533.7000,UNITED HEALTHCARE,UHC HERITAGE SELECT,277.00,,,,,,,148.0000,23558.0000,case rate,Rev 361 Proc 36909 ASG Rate of $277.00 at 100% of $277.00 = $277.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOVAS DIALYSIS CIRCUIT PERM VASC EMBOLIZATION/OCCLUSION,36909,CPT,361,RC,36100344,CDM,,,,both,,,23558.0000,3533.7000,UNITED HEALTHCARE,UNITED HEALTHCARE,528.00,,,,,,,148.0000,23558.0000,case rate,Rev 361 Proc 36909 ASG Rate of $528.00 at 100% of $528.00 = $528.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC ENDOVAS DIALYSIS CIRCUIT PERM VASC EMBOLIZATION/OCCLUSION,36909,CPT,361,RC,36100344,CDM,,,,both,,,23558.0000,3533.7000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15570.45,,,,,,,148.0000,23558.0000,fee schedule,"APG 00085 Proc 36909 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC ENDOVAS DIALYSIS CIRCUIT PERM VASC EMBOLIZATION/OCCLUSION,36909,CPT,361,RC,36100344,CDM,,,,both,,,23558.0000,3533.7000,WELLCARE,WELLCARE MEDICAID,23558.00,,,,,,,148.0000,23558.0000,percent of total billed charges,"100% of $23,558.00 in Billed Charges for Rev 361 Proc 36909 = $23,558.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA,111.45,,,,,,,20.4000,396.8300,percent of total billed charges,42.7% of $261.00 in Billed Charges for Rev 521 Proc 17110 = $111.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,20.4000,396.8300,fee schedule,"APG 00003 Proc 17110 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,20.4000,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,20.4000,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,20.4000,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,AMBETTER,AMBETTER,396.83,,,,,,,20.4000,396.8300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,20.4000,396.8300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM EXCHANGE,261.00,,,,,,,20.4000,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,20.4000,396.8300,fee schedule,"APG 00003 Proc 17110 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM HMO,261.00,,,,,,,20.4000,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,20.4000,396.8300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",261.00,,,,,,,20.4000,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,46.85,,,,,,,20.4000,396.8300,fee schedule,$46.85 from Fee Schedule BLDTM_23 for Rev 521 Proc 17110 * Qty 1 = $46.85 at 100% = $46.85 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,20.4000,396.8300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,TENNCARE BLUE CARE,20.40,,,,,,,20.4000,396.8300,fee schedule,$17.59 from Fee Schedule TC_24 for Rev 521 Proc 17110 * Qty 1 = $17.59 at 116% = $20.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,BLUE CROSS,TENNCARE BLUE SELECT,20.40,,,,,,,20.4000,396.8300,fee schedule,$17.59 from Fee Schedule TC_24 for Rev 521 Proc 17110 * Qty 1 = $17.59 at 116% = $20.40 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA HMO,108.84,,,,,,,20.4000,396.8300,percent of total billed charges,41.7% of $261.00 in Billed Charges for Rev 521 Proc 17110 = $108.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,121.10,,,,,,,20.4000,396.8300,percent of total billed charges,46.4% of $261.00 in Billed Charges for Rev 521 Proc 17110 = $121.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,20.4000,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,108.84,,,,,,,20.4000,396.8300,percent of total billed charges,41.7% of $261.00 in Billed Charges for Rev 521 Proc 17110 = $108.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,CIGNA HEALTHCARE,CIGNA PPO,108.84,,,,,,,20.4000,396.8300,percent of total billed charges,41.7% of $261.00 in Billed Charges for Rev 521 Proc 17110 = $108.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,20.4000,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,234.90,,,,,,,20.4000,396.8300,percent of total billed charges,90% of $261.00 in Billed Charges for Rev 521 Proc 17110 = $234.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,20.4000,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,20.4000,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,MEDCOST,MEDCOST VHN,124.21,,,,,,,20.4000,396.8300,percent of total billed charges,47.59% of $261.00 in Billed Charges for Rev 521 Proc 17110 = $124.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,20.4000,396.8300,fee schedule,"APG 00003 Proc 17110 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,20.4000,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,20.4000,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,20.4000,396.8300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,20.4000,396.8300,fee schedule,"APG 00003 Proc 17110 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,SENTARA HEALTH,SENTARA HEALTH,67.36,,,,,,,20.4000,396.8300,percent of total billed charges,25.81% of $261.00 in Billed Charges for Rev 521 Proc 17110 = $67.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,20.4000,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",261.00,,,,,,,20.4000,396.8300,percent of total billed charges,100% of $261.00 in Billed Charges for Rev 521 Proc 17110 = $261.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,49.25,,,,,,,20.4000,396.8300,fee schedule,$98.49 from Fee Schedule TCUHC24 for Rev 521 Proc 17110 * Qty 1 = $98.49 at 50% = $49.25 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,20.4000,396.8300,fee schedule,"APG 00003 Proc 17110 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,20.4000,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,20.4000,396.8300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,WELLCARE,WELLCARE MEDICAID,261.00,,,,,,,20.4000,396.8300,percent of total billed charges,100% of $261.00 in Billed Charges for Rev 521 Proc 17110 = $261.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION BENIGN LESIONS UP TO 14,17110,CPT,521,RC,52100003,CDM,,,,both,,,261.0000,39.1500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,20.4000,396.8300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA,237.84,,,,,,,65.1100,557.0000,percent of total billed charges,42.7% of $557.00 in Billed Charges for Rev 510 Proc 17111 = $237.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,65.1100,557.0000,fee schedule,"APG 00003 Proc 17111 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,65.1100,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,65.1100,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,65.1100,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,AMBETTER,AMBETTER,396.83,,,,,,,65.1100,557.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,65.1100,557.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,65.1100,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,65.1100,557.0000,fee schedule,"APG 00003 Proc 17111 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,65.1100,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,65.1100,557.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",557.00,,,,,,,65.1100,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,65.11,,,,,,,65.1100,557.0000,fee schedule,$65.11 from Fee Schedule BLDTM_23 for Rev 510 Proc 17111 * Qty 1 = $65.11 at 100% = $65.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,65.1100,557.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA HMO,232.27,,,,,,,65.1100,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 510 Proc 17111 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,258.45,,,,,,,65.1100,557.0000,percent of total billed charges,46.4% of $557.00 in Billed Charges for Rev 510 Proc 17111 = $258.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,65.1100,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,232.27,,,,,,,65.1100,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 510 Proc 17111 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA PPO,232.27,,,,,,,65.1100,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 510 Proc 17111 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,65.1100,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,501.30,,,,,,,65.1100,557.0000,percent of total billed charges,90% of $557.00 in Billed Charges for Rev 510 Proc 17111 = $501.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,65.1100,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,65.1100,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,MEDCOST,MEDCOST VHN,265.08,,,,,,,65.1100,557.0000,percent of total billed charges,47.59% of $557.00 in Billed Charges for Rev 510 Proc 17111 = $265.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,65.1100,557.0000,fee schedule,"APG 00003 Proc 17111 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,65.1100,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,65.1100,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,65.1100,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,65.1100,557.0000,fee schedule,"APG 00003 Proc 17111 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,SENTARA HEALTH,SENTARA HEALTH,143.76,,,,,,,65.1100,557.0000,percent of total billed charges,25.81% of $557.00 in Billed Charges for Rev 510 Proc 17111 = $143.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,65.1100,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",557.00,,,,,,,65.1100,557.0000,percent of total billed charges,100% of $557.00 in Billed Charges for Rev 510 Proc 17111 = $557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,65.1100,557.0000,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 510 Proc 17111 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,179.91,,,,,,,65.1100,557.0000,other,32.3% of $557.00 in Billed Charges for Rev 510 Proc 17111 = $179.91 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UHC HERITAGE SELECT,171.00,,,,,,,65.1100,557.0000,other,30.7% of $557.00 in Billed Charges for Rev 510 Proc 17111 = $171.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UNITED HEALTHCARE,179.91,,,,,,,65.1100,557.0000,percent of total billed charges,32.3% of $557.00 in Billed Charges. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,65.1100,557.0000,fee schedule,"APG 00003 Proc 17111 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,65.1100,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,65.1100,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,WELLCARE,WELLCARE MEDICAID,557.00,,,,,,,65.1100,557.0000,percent of total billed charges,100% of $557.00 in Billed Charges for Rev 510 Proc 17111 = $557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT LESION 15 OR MORE,17111,CPT,510,RC,51000138,CDM,,,,both,,,557.0000,83.5500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,65.1100,557.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA,237.84,,,,,,,65.1100,557.0000,percent of total billed charges,42.7% of $557.00 in Billed Charges for Rev 521 Proc 17111 = $237.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,65.1100,557.0000,fee schedule,"APG 00003 Proc 17111 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,65.1100,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,65.1100,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,65.1100,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,AMBETTER,AMBETTER,396.83,,,,,,,65.1100,557.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,65.1100,557.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,65.1100,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,65.1100,557.0000,fee schedule,"APG 00003 Proc 17111 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,65.1100,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,65.1100,557.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",557.00,,,,,,,65.1100,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,65.11,,,,,,,65.1100,557.0000,fee schedule,$65.11 from Fee Schedule BLDTM_23 for Rev 521 Proc 17111 * Qty 1 = $65.11 at 100% = $65.11 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,65.1100,557.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA HMO,232.27,,,,,,,65.1100,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 521 Proc 17111 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,258.45,,,,,,,65.1100,557.0000,percent of total billed charges,46.4% of $557.00 in Billed Charges for Rev 521 Proc 17111 = $258.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,65.1100,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,232.27,,,,,,,65.1100,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 521 Proc 17111 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA PPO,232.27,,,,,,,65.1100,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 521 Proc 17111 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,65.1100,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,501.30,,,,,,,65.1100,557.0000,percent of total billed charges,90% of $557.00 in Billed Charges for Rev 521 Proc 17111 = $501.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,65.1100,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,65.1100,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,MEDCOST,MEDCOST VHN,265.08,,,,,,,65.1100,557.0000,percent of total billed charges,47.59% of $557.00 in Billed Charges for Rev 521 Proc 17111 = $265.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,65.1100,557.0000,fee schedule,"APG 00003 Proc 17111 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,65.1100,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,65.1100,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,65.1100,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,65.1100,557.0000,fee schedule,"APG 00003 Proc 17111 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,SENTARA HEALTH,SENTARA HEALTH,143.76,,,,,,,65.1100,557.0000,percent of total billed charges,25.81% of $557.00 in Billed Charges for Rev 521 Proc 17111 = $143.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,65.1100,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",557.00,,,,,,,65.1100,557.0000,percent of total billed charges,100% of $557.00 in Billed Charges for Rev 521 Proc 17111 = $557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,65.1100,557.0000,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 521 Proc 17111 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,65.1100,557.0000,fee schedule,"APG 00003 Proc 17111 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,65.1100,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,65.1100,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,WELLCARE,WELLCARE MEDICAID,557.00,,,,,,,65.1100,557.0000,percent of total billed charges,100% of $557.00 in Billed Charges for Rev 521 Proc 17111 = $557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCTION BENIGN LESIONS 15 OR MORE,17111,CPT,521,RC,52100066,CDM,,,,both,,,557.0000,83.5500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,65.1100,557.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,AETNA,AETNA,175.07,,,,,,,15.6900,410.0000,percent of total billed charges,42.7% of $410.00 in Billed Charges for Rev 450 Proc 17250 = $175.07. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,15.6900,410.0000,fee schedule,"APG 00003 Proc 17250 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,15.6900,410.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,15.6900,410.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,15.6900,410.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,AMBETTER,AMBETTER,396.83,,,,,,,15.6900,410.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,15.6900,410.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,BLUE CROSS,ANTHEM EXCHANGE,410.00,,,,,,,15.6900,410.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,15.6900,410.0000,fee schedule,"APG 00003 Proc 17250 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,BLUE CROSS,ANTHEM HMO,410.00,,,,,,,15.6900,410.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,15.6900,410.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",410.00,,,,,,,15.6900,410.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,36.89,,,,,,,15.6900,410.0000,fee schedule,$36.89 from Fee Schedule BLDTM_23 for Rev 450 Proc 17250 * Qty 1 = $36.89 at 100% = $36.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,15.6900,410.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,BLUE CROSS,TENNCARE BLUE CARE,15.69,,,,,,,15.6900,410.0000,fee schedule,$13.53 from Fee Schedule TC_24 for Rev 450 Proc 17250 * Qty 1 = $13.53 at 116% = $15.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,BLUE CROSS,TENNCARE BLUE SELECT,15.69,,,,,,,15.6900,410.0000,fee schedule,$13.53 from Fee Schedule TC_24 for Rev 450 Proc 17250 * Qty 1 = $13.53 at 116% = $15.69 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,15.6900,410.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,15.6900,410.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,369.00,,,,,,,15.6900,410.0000,percent of total billed charges,90% of $410.00 in Billed Charges for Rev 450 Proc 17250 = $369.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,HUMANA,HUMANA MEDICARE,182.03,,,,,,,15.6900,410.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,15.6900,410.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,MEDCOST,MEDCOST VHN,195.12,,,,,,,15.6900,410.0000,percent of total billed charges,47.59% of $410.00 in Billed Charges for Rev 450 Proc 17250 = $195.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,15.6900,410.0000,fee schedule,"APG 00003 Proc 17250 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,15.6900,410.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,15.6900,410.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,15.6900,410.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,15.6900,410.0000,fee schedule,"APG 00003 Proc 17250 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,SENTARA HEALTH,SENTARA HEALTH,105.82,,,,,,,15.6900,410.0000,percent of total billed charges,25.81% of $410.00 in Billed Charges for Rev 450 Proc 17250 = $105.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,15.6900,410.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",410.00,,,,,,,15.6900,410.0000,percent of total billed charges,100% of $410.00 in Billed Charges for Rev 450 Proc 17250 = $410.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,109.00,,,,,,,15.6900,410.0000,case rate,Rev 450 Proc 17250 at Case Rate $109.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,410.00,,,,,,,15.6900,410.0000,case rate,"Rev 450 Proc 17250 at Case Rate $491.00 (Service Line reduced to $410.00, claim capped at $410.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,UNITED HEALTHCARE,UHC HERITAGE SELECT,410.00,,,,,,,15.6900,410.0000,case rate,"Rev 450 Proc 17250 at Case Rate $471.00 (Service Line reduced to $410.00, claim capped at $410.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,UNITED HEALTHCARE,UNITED HEALTHCARE,410.00,,,,,,,15.6900,410.0000,case rate,"Rev 450 Proc 17250 at Case Rate $847.00 (Service Line reduced to $410.00, claim capped at $410.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,15.6900,410.0000,fee schedule,"APG 00003 Proc 17250 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,15.6900,410.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,15.6900,410.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,WELLCARE,WELLCARE MEDICAID,410.00,,,,,,,15.6900,410.0000,percent of total billed charges,100% of $410.00 in Billed Charges for Rev 450 Proc 17250 = $410.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC CHEMICAL CAUT GRANULATION TISS,17250,CPT,450,RC,45000083,CDM,,,,both,,,410.0000,61.5000,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,15.6900,410.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA,237.84,,,,,,,73.0700,557.0000,percent of total billed charges,42.7% of $557.00 in Billed Charges for Rev 521 Proc 17260 = $237.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,73.0700,557.0000,fee schedule,"APG 00003 Proc 17260 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,AMBETTER,AMBETTER,396.83,,,,,,,73.0700,557.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,73.0700,557.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,73.0700,557.0000,fee schedule,"APG 00003 Proc 17260 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,73.0700,557.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",557.00,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,80.96,,,,,,,73.0700,557.0000,fee schedule,$80.96 from Fee Schedule BLDTM_23 for Rev 521 Proc 17260 * Qty 1 = $80.96 at 100% = $80.96 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,73.0700,557.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA HMO,232.27,,,,,,,73.0700,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 521 Proc 17260 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,258.45,,,,,,,73.0700,557.0000,percent of total billed charges,46.4% of $557.00 in Billed Charges for Rev 521 Proc 17260 = $258.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,73.0700,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,232.27,,,,,,,73.0700,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 521 Proc 17260 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA PPO,232.27,,,,,,,73.0700,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 521 Proc 17260 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,73.0700,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,501.30,,,,,,,73.0700,557.0000,percent of total billed charges,90% of $557.00 in Billed Charges for Rev 521 Proc 17260 = $501.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,MEDCOST,MEDCOST VHN,265.08,,,,,,,73.0700,557.0000,percent of total billed charges,47.59% of $557.00 in Billed Charges for Rev 521 Proc 17260 = $265.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,73.0700,557.0000,fee schedule,"APG 00003 Proc 17260 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,73.0700,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,73.0700,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,73.0700,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,73.0700,557.0000,fee schedule,"APG 00003 Proc 17260 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,SENTARA HEALTH,SENTARA HEALTH,143.76,,,,,,,73.0700,557.0000,percent of total billed charges,25.81% of $557.00 in Billed Charges for Rev 521 Proc 17260 = $143.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",557.00,,,,,,,73.0700,557.0000,percent of total billed charges,100% of $557.00 in Billed Charges for Rev 521 Proc 17260 = $557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,73.0700,557.0000,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 521 Proc 17260 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,73.0700,557.0000,fee schedule,"APG 00003 Proc 17260 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,WELLCARE,WELLCARE MEDICAID,557.00,,,,,,,73.0700,557.0000,percent of total billed charges,100% of $557.00 in Billed Charges for Rev 521 Proc 17260 = $557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 0.5 CM OR LESS,17260,CPT,521,RC,52100067,CDM,,,,both,,,557.0000,83.5500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,73.0700,557.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,AETNA,AETNA,261.75,,,,,,,73.0700,613.0000,percent of total billed charges,42.7% of $613.00 in Billed Charges for Rev 521 Proc 17261 = $261.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,73.0700,613.0000,fee schedule,"APG 00003 Proc 17261 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,AMBETTER,AMBETTER,396.83,,,,,,,73.0700,613.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,73.0700,613.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,73.0700,613.0000,fee schedule,"APG 00003 Proc 17261 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,73.0700,613.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",560.15,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,100.24,,,,,,,73.0700,613.0000,fee schedule,$100.24 from Fee Schedule BLDTM_23 for Rev 521 Proc 17261 * Qty 1 = $100.24 at 100% = $100.24 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,73.0700,613.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA HMO,255.62,,,,,,,73.0700,613.0000,percent of total billed charges,41.7% of $613.00 in Billed Charges for Rev 521 Proc 17261 = $255.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,284.43,,,,,,,73.0700,613.0000,percent of total billed charges,46.4% of $613.00 in Billed Charges for Rev 521 Proc 17261 = $284.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,73.0700,613.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,255.62,,,,,,,73.0700,613.0000,percent of total billed charges,41.7% of $613.00 in Billed Charges for Rev 521 Proc 17261 = $255.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA PPO,255.62,,,,,,,73.0700,613.0000,percent of total billed charges,41.7% of $613.00 in Billed Charges for Rev 521 Proc 17261 = $255.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,73.0700,613.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,551.70,,,,,,,73.0700,613.0000,percent of total billed charges,90% of $613.00 in Billed Charges for Rev 521 Proc 17261 = $551.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,MEDCOST,MEDCOST VHN,291.73,,,,,,,73.0700,613.0000,percent of total billed charges,47.59% of $613.00 in Billed Charges for Rev 521 Proc 17261 = $291.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,73.0700,613.0000,fee schedule,"APG 00003 Proc 17261 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,73.0700,613.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,73.0700,613.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,73.0700,613.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,73.0700,613.0000,fee schedule,"APG 00003 Proc 17261 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,SENTARA HEALTH,SENTARA HEALTH,158.22,,,,,,,73.0700,613.0000,percent of total billed charges,25.81% of $613.00 in Billed Charges for Rev 521 Proc 17261 = $158.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",613.00,,,,,,,73.0700,613.0000,percent of total billed charges,100% of $613.00 in Billed Charges for Rev 521 Proc 17261 = $613.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,73.0700,613.0000,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 521 Proc 17261 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,73.0700,613.0000,fee schedule,"APG 00003 Proc 17261 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,WELLCARE,WELLCARE MEDICAID,613.00,,,,,,,73.0700,613.0000,percent of total billed charges,100% of $613.00 in Billed Charges for Rev 521 Proc 17261 = $613.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESIONS T/A/L 0.6-1.0 CM,17261,CPT,521,RC,52100068,CDM,,,,both,,,613.0000,91.9500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,73.0700,613.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,AETNA,AETNA,287.80,,,,,,,73.0700,674.0000,percent of total billed charges,42.7% of $674.00 in Billed Charges for Rev 521 Proc 17262 = $287.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,73.0700,674.0000,fee schedule,"APG 00003 Proc 17262 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,73.0700,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,73.0700,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,73.0700,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,AMBETTER,AMBETTER,396.83,,,,,,,73.0700,674.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,73.0700,674.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,73.0700,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,73.0700,674.0000,fee schedule,"APG 00003 Proc 17262 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,73.0700,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,73.0700,674.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",560.15,,,,,,,73.0700,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,132.00,,,,,,,73.0700,674.0000,fee schedule,$132.00 from Fee Schedule BLDTM_23 for Rev 521 Proc 17262 * Qty 1 = $132.00 at 100% = $132.00 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,73.0700,674.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,CIGNA HEALTHCARE,CIGNA HMO,281.06,,,,,,,73.0700,674.0000,percent of total billed charges,41.7% of $674.00 in Billed Charges for Rev 521 Proc 17262 = $281.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,312.74,,,,,,,73.0700,674.0000,percent of total billed charges,46.4% of $674.00 in Billed Charges for Rev 521 Proc 17262 = $312.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,73.0700,674.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,281.06,,,,,,,73.0700,674.0000,percent of total billed charges,41.7% of $674.00 in Billed Charges for Rev 521 Proc 17262 = $281.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,CIGNA HEALTHCARE,CIGNA PPO,281.06,,,,,,,73.0700,674.0000,percent of total billed charges,41.7% of $674.00 in Billed Charges for Rev 521 Proc 17262 = $281.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,73.0700,674.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,606.60,,,,,,,73.0700,674.0000,percent of total billed charges,90% of $674.00 in Billed Charges for Rev 521 Proc 17262 = $606.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,HUMANA,HUMANA MEDICARE,182.03,,,,,,,73.0700,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,73.0700,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,MEDCOST,MEDCOST VHN,320.76,,,,,,,73.0700,674.0000,percent of total billed charges,47.59% of $674.00 in Billed Charges for Rev 521 Proc 17262 = $320.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,73.0700,674.0000,fee schedule,"APG 00003 Proc 17262 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,73.0700,674.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,73.0700,674.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,73.0700,674.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,73.0700,674.0000,fee schedule,"APG 00003 Proc 17262 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,SENTARA HEALTH,SENTARA HEALTH,173.96,,,,,,,73.0700,674.0000,percent of total billed charges,25.81% of $674.00 in Billed Charges for Rev 521 Proc 17262 = $173.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,73.0700,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",674.00,,,,,,,73.0700,674.0000,percent of total billed charges,100% of $674.00 in Billed Charges for Rev 521 Proc 17262 = $674.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,73.0700,674.0000,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 521 Proc 17262 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,73.0700,674.0000,fee schedule,"APG 00003 Proc 17262 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,73.0700,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,73.0700,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,WELLCARE,WELLCARE MEDICAID,674.00,,,,,,,73.0700,674.0000,percent of total billed charges,100% of $674.00 in Billed Charges for Rev 521 Proc 17262 = $674.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESIONS T/A/L 1.1-2.0 CM,17262,CPT,521,RC,52100069,CDM,,,,both,,,674.0000,101.1000,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,73.0700,674.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,AETNA,AETNA,316.41,,,,,,,73.0700,741.0000,percent of total billed charges,42.7% of $741.00 in Billed Charges for Rev 521 Proc 17263 = $316.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,73.0700,741.0000,fee schedule,"APG 00003 Proc 17263 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,73.0700,741.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,73.0700,741.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,73.0700,741.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,AMBETTER,AMBETTER,396.83,,,,,,,73.0700,741.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,73.0700,741.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,73.0700,741.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,73.0700,741.0000,fee schedule,"APG 00003 Proc 17263 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,73.0700,741.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,73.0700,741.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",560.15,,,,,,,73.0700,741.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,154.51,,,,,,,73.0700,741.0000,fee schedule,$154.51 from Fee Schedule BLDTM_23 for Rev 521 Proc 17263 * Qty 1 = $154.51 at 100% = $154.51 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,73.0700,741.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,CIGNA HEALTHCARE,CIGNA HMO,309.00,,,,,,,73.0700,741.0000,percent of total billed charges,41.7% of $741.00 in Billed Charges for Rev 521 Proc 17263 = $309.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,343.82,,,,,,,73.0700,741.0000,percent of total billed charges,46.4% of $741.00 in Billed Charges for Rev 521 Proc 17263 = $343.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,73.0700,741.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,309.00,,,,,,,73.0700,741.0000,percent of total billed charges,41.7% of $741.00 in Billed Charges for Rev 521 Proc 17263 = $309.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,CIGNA HEALTHCARE,CIGNA PPO,309.00,,,,,,,73.0700,741.0000,percent of total billed charges,41.7% of $741.00 in Billed Charges for Rev 521 Proc 17263 = $309.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,73.0700,741.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,666.90,,,,,,,73.0700,741.0000,percent of total billed charges,90% of $741.00 in Billed Charges for Rev 521 Proc 17263 = $666.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,73.0700,741.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,73.0700,741.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,MEDCOST,MEDCOST VHN,352.64,,,,,,,73.0700,741.0000,percent of total billed charges,47.59% of $741.00 in Billed Charges for Rev 521 Proc 17263 = $352.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,73.0700,741.0000,fee schedule,"APG 00003 Proc 17263 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,73.0700,741.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,73.0700,741.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,73.0700,741.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,73.0700,741.0000,fee schedule,"APG 00003 Proc 17263 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,SENTARA HEALTH,SENTARA HEALTH,191.25,,,,,,,73.0700,741.0000,percent of total billed charges,25.81% of $741.00 in Billed Charges for Rev 521 Proc 17263 = $191.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,73.0700,741.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",741.00,,,,,,,73.0700,741.0000,percent of total billed charges,100% of $741.00 in Billed Charges for Rev 521 Proc 17263 = $741.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,73.0700,741.0000,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 521 Proc 17263 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,73.0700,741.0000,fee schedule,"APG 00003 Proc 17263 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,73.0700,741.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,73.0700,741.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,WELLCARE,WELLCARE MEDICAID,741.00,,,,,,,73.0700,741.0000,percent of total billed charges,100% of $741.00 in Billed Charges for Rev 521 Proc 17263 = $741.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 2.1-3.0 CM,17263,CPT,521,RC,52100070,CDM,,,,both,,,741.0000,111.1500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,73.0700,741.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,AETNA,AETNA,348.01,,,,,,,73.0700,815.0000,percent of total billed charges,42.7% of $815.00 in Billed Charges for Rev 521 Proc 17264 = $348.01. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,73.0700,815.0000,fee schedule,"APG 00003 Proc 17264 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,73.0700,815.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,73.0700,815.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,73.0700,815.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,AMBETTER,AMBETTER,804.03,,,,,,,73.0700,815.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,73.0700,815.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,BLUE CROSS,ANTHEM EXCHANGE,815.00,,,,,,,73.0700,815.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,73.0700,815.0000,fee schedule,"APG 00003 Proc 17264 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,BLUE CROSS,ANTHEM HMO,815.00,,,,,,,73.0700,815.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,73.0700,815.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",815.00,,,,,,,73.0700,815.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,146.86,,,,,,,73.0700,815.0000,fee schedule,$146.86 from Fee Schedule BLDTM_23 for Rev 521 Proc 17264 * Qty 1 = $146.86 at 100% = $146.86 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,73.0700,815.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,CIGNA HEALTHCARE,CIGNA HMO,339.86,,,,,,,73.0700,815.0000,percent of total billed charges,41.7% of $815.00 in Billed Charges for Rev 521 Proc 17264 = $339.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,378.16,,,,,,,73.0700,815.0000,percent of total billed charges,46.4% of $815.00 in Billed Charges for Rev 521 Proc 17264 = $378.16. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,73.0700,815.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,339.86,,,,,,,73.0700,815.0000,percent of total billed charges,41.7% of $815.00 in Billed Charges for Rev 521 Proc 17264 = $339.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,CIGNA HEALTHCARE,CIGNA PPO,339.86,,,,,,,73.0700,815.0000,percent of total billed charges,41.7% of $815.00 in Billed Charges for Rev 521 Proc 17264 = $339.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,73.0700,815.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,733.50,,,,,,,73.0700,815.0000,percent of total billed charges,90% of $815.00 in Billed Charges for Rev 521 Proc 17264 = $733.50. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,73.0700,815.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,73.0700,815.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,MEDCOST,MEDCOST VHN,387.86,,,,,,,73.0700,815.0000,percent of total billed charges,47.59% of $815.00 in Billed Charges for Rev 521 Proc 17264 = $387.86. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,73.0700,815.0000,fee schedule,"APG 00003 Proc 17264 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,73.0700,815.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,73.0700,815.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,73.0700,815.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,73.0700,815.0000,fee schedule,"APG 00003 Proc 17264 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,SENTARA HEALTH,SENTARA HEALTH,210.35,,,,,,,73.0700,815.0000,percent of total billed charges,25.81% of $815.00 in Billed Charges for Rev 521 Proc 17264 = $210.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,73.0700,815.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",815.00,,,,,,,73.0700,815.0000,percent of total billed charges,100% of $815.00 in Billed Charges for Rev 521 Proc 17264 = $815.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,73.0700,815.0000,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 521 Proc 17264 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,73.0700,815.0000,fee schedule,"APG 00003 Proc 17264 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,73.0700,815.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,73.0700,815.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,WELLCARE,WELLCARE MEDICAID,815.00,,,,,,,73.0700,815.0000,percent of total billed charges,100% of $815.00 in Billed Charges for Rev 521 Proc 17264 = $815.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION T/A/L 3.1-4.0 CM,17264,CPT,521,RC,52100071,CDM,,,,both,,,815.0000,122.2500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,73.0700,815.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA,237.84,,,,,,,73.0700,557.0000,percent of total billed charges,42.7% of $557.00 in Billed Charges for Rev 521 Proc 17270 = $237.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,73.0700,557.0000,fee schedule,"APG 00003 Proc 17270 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,AMBETTER,AMBETTER,396.83,,,,,,,73.0700,557.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,73.0700,557.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,73.0700,557.0000,fee schedule,"APG 00003 Proc 17270 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,73.0700,557.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",557.00,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,89.89,,,,,,,73.0700,557.0000,fee schedule,$89.89 from Fee Schedule BLDTM_23 for Rev 521 Proc 17270 * Qty 1 = $89.89 at 100% = $89.89 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,73.0700,557.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA HMO,232.27,,,,,,,73.0700,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 521 Proc 17270 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,258.45,,,,,,,73.0700,557.0000,percent of total billed charges,46.4% of $557.00 in Billed Charges for Rev 521 Proc 17270 = $258.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,73.0700,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,232.27,,,,,,,73.0700,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 521 Proc 17270 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA PPO,232.27,,,,,,,73.0700,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 521 Proc 17270 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,73.0700,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,501.30,,,,,,,73.0700,557.0000,percent of total billed charges,90% of $557.00 in Billed Charges for Rev 521 Proc 17270 = $501.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,MEDCOST,MEDCOST VHN,265.08,,,,,,,73.0700,557.0000,percent of total billed charges,47.59% of $557.00 in Billed Charges for Rev 521 Proc 17270 = $265.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,73.0700,557.0000,fee schedule,"APG 00003 Proc 17270 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,73.0700,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,73.0700,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,73.0700,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,73.0700,557.0000,fee schedule,"APG 00003 Proc 17270 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,SENTARA HEALTH,SENTARA HEALTH,143.76,,,,,,,73.0700,557.0000,percent of total billed charges,25.81% of $557.00 in Billed Charges for Rev 521 Proc 17270 = $143.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",557.00,,,,,,,73.0700,557.0000,percent of total billed charges,100% of $557.00 in Billed Charges for Rev 521 Proc 17270 = $557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,73.0700,557.0000,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 521 Proc 17270 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,73.0700,557.0000,fee schedule,"APG 00003 Proc 17270 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,WELLCARE,WELLCARE MEDICAID,557.00,,,,,,,73.0700,557.0000,percent of total billed charges,100% of $557.00 in Billed Charges for Rev 521 Proc 17270 = $557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 0.5CM OR LESS,17270,CPT,521,RC,52100073,CDM,,,,both,,,557.0000,83.5500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,73.0700,557.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,AETNA,AETNA,287.80,,,,,,,73.0700,674.0000,percent of total billed charges,42.7% of $674.00 in Billed Charges for Rev 521 Proc 17272 = $287.80. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,73.0700,674.0000,fee schedule,"APG 00003 Proc 17272 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,73.0700,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,73.0700,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,73.0700,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,AMBETTER,AMBETTER,396.83,,,,,,,73.0700,674.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,73.0700,674.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,73.0700,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,73.0700,674.0000,fee schedule,"APG 00003 Proc 17272 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,73.0700,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,73.0700,674.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",560.15,,,,,,,73.0700,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,152.03,,,,,,,73.0700,674.0000,fee schedule,$152.03 from Fee Schedule BLDTM_23 for Rev 521 Proc 17272 * Qty 1 = $152.03 at 100% = $152.03 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,73.0700,674.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,CIGNA HEALTHCARE,CIGNA HMO,281.06,,,,,,,73.0700,674.0000,percent of total billed charges,41.7% of $674.00 in Billed Charges for Rev 521 Proc 17272 = $281.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,312.74,,,,,,,73.0700,674.0000,percent of total billed charges,46.4% of $674.00 in Billed Charges for Rev 521 Proc 17272 = $312.74. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,73.0700,674.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,281.06,,,,,,,73.0700,674.0000,percent of total billed charges,41.7% of $674.00 in Billed Charges for Rev 521 Proc 17272 = $281.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,CIGNA HEALTHCARE,CIGNA PPO,281.06,,,,,,,73.0700,674.0000,percent of total billed charges,41.7% of $674.00 in Billed Charges for Rev 521 Proc 17272 = $281.06. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,73.0700,674.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,606.60,,,,,,,73.0700,674.0000,percent of total billed charges,90% of $674.00 in Billed Charges for Rev 521 Proc 17272 = $606.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,HUMANA,HUMANA MEDICARE,182.03,,,,,,,73.0700,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,73.0700,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,MEDCOST,MEDCOST VHN,320.76,,,,,,,73.0700,674.0000,percent of total billed charges,47.59% of $674.00 in Billed Charges for Rev 521 Proc 17272 = $320.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,73.0700,674.0000,fee schedule,"APG 00003 Proc 17272 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,73.0700,674.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,73.0700,674.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,73.0700,674.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,73.0700,674.0000,fee schedule,"APG 00003 Proc 17272 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,SENTARA HEALTH,SENTARA HEALTH,173.96,,,,,,,73.0700,674.0000,percent of total billed charges,25.81% of $674.00 in Billed Charges for Rev 521 Proc 17272 = $173.96. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,73.0700,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",674.00,,,,,,,73.0700,674.0000,percent of total billed charges,100% of $674.00 in Billed Charges for Rev 521 Proc 17272 = $674.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,73.0700,674.0000,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 521 Proc 17272 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,73.0700,674.0000,fee schedule,"APG 00003 Proc 17272 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,73.0700,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,73.0700,674.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,WELLCARE,WELLCARE MEDICAID,674.00,,,,,,,73.0700,674.0000,percent of total billed charges,100% of $674.00 in Billed Charges for Rev 521 Proc 17272 = $674.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 1.1-2.0 CM,17272,CPT,521,RC,52100075,CDM,,,,both,,,674.0000,101.1000,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,73.0700,674.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,AETNA,AETNA,316.41,,,,,,,141.5700,804.0300,percent of total billed charges,42.7% of $741.00 in Billed Charges for Rev 521 Proc 17273 = $316.41. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,141.5700,804.0300,fee schedule,"APG 00003 Proc 17273 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,141.5700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,141.5700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,141.5700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,AMBETTER,AMBETTER,804.03,,,,,,,141.5700,804.0300,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,141.5700,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,ANTHEM EXCHANGE,741.00,,,,,,,141.5700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,141.5700,804.0300,fee schedule,"APG 00003 Proc 17273 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,ANTHEM HMO,741.00,,,,,,,141.5700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,141.5700,804.0300,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",741.00,,,,,,,141.5700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,150.58,,,,,,,141.5700,804.0300,fee schedule,$150.58 from Fee Schedule BLDTM_23 for Rev 521 Proc 17273 * Qty 1 = $150.58 at 100% = $150.58 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,141.5700,804.0300,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,CIGNA HEALTHCARE,CIGNA HMO,309.00,,,,,,,141.5700,804.0300,percent of total billed charges,41.7% of $741.00 in Billed Charges for Rev 521 Proc 17273 = $309.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,343.82,,,,,,,141.5700,804.0300,percent of total billed charges,46.4% of $741.00 in Billed Charges for Rev 521 Proc 17273 = $343.82. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,141.5700,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,309.00,,,,,,,141.5700,804.0300,percent of total billed charges,41.7% of $741.00 in Billed Charges for Rev 521 Proc 17273 = $309.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,CIGNA HEALTHCARE,CIGNA PPO,309.00,,,,,,,141.5700,804.0300,percent of total billed charges,41.7% of $741.00 in Billed Charges for Rev 521 Proc 17273 = $309.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,141.5700,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,666.90,,,,,,,141.5700,804.0300,percent of total billed charges,90% of $741.00 in Billed Charges for Rev 521 Proc 17273 = $666.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,141.5700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,141.5700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,MEDCOST,MEDCOST VHN,352.64,,,,,,,141.5700,804.0300,percent of total billed charges,47.59% of $741.00 in Billed Charges for Rev 521 Proc 17273 = $352.64. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,141.5700,804.0300,fee schedule,"APG 00003 Proc 17273 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,141.5700,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,141.5700,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,141.5700,804.0300,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,141.5700,804.0300,fee schedule,"APG 00003 Proc 17273 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,SENTARA HEALTH,SENTARA HEALTH,191.25,,,,,,,141.5700,804.0300,percent of total billed charges,25.81% of $741.00 in Billed Charges for Rev 521 Proc 17273 = $191.25. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,141.5700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",741.00,,,,,,,141.5700,804.0300,percent of total billed charges,100% of $741.00 in Billed Charges for Rev 521 Proc 17273 = $741.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,141.57,,,,,,,141.5700,804.0300,fee schedule,$283.14 from Fee Schedule TCUHC24 for Rev 521 Proc 17273 * Qty 1 = $283.14 at 50% = $141.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,141.5700,804.0300,fee schedule,"APG 00003 Proc 17273 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,141.5700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,141.5700,804.0300,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,WELLCARE,WELLCARE MEDICAID,741.00,,,,,,,141.5700,804.0300,percent of total billed charges,100% of $741.00 in Billed Charges for Rev 521 Proc 17273 = $741.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G 2.1-3.0 CM,17273,CPT,521,RC,52100076,CDM,,,,both,,,741.0000,111.1500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,141.5700,804.0300,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,AETNA,AETNA,383.02,,,,,,,141.5700,897.0000,percent of total billed charges,42.7% of $897.00 in Billed Charges for Rev 521 Proc 17276 = $383.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,141.5700,897.0000,fee schedule,"APG 00003 Proc 17276 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,368.82,,,,,,,141.5700,897.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,AETNA,AETNA HEALTHCARE MEDICARE,368.82,,,,,,,141.5700,897.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,368.82,,,,,,,141.5700,897.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,AMBETTER,AMBETTER,804.03,,,,,,,141.5700,897.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,383.57,,,,,,,141.5700,897.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,BLUE CROSS,ANTHEM EXCHANGE,897.00,,,,,,,141.5700,897.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,141.5700,897.0000,fee schedule,"APG 00003 Proc 17276 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,BLUE CROSS,ANTHEM HMO,897.00,,,,,,,141.5700,897.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,379.89,,,,,,,141.5700,897.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",897.00,,,,,,,141.5700,897.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,218.77,,,,,,,141.5700,897.0000,fee schedule,$218.77 from Fee Schedule BLDTM_23 for Rev 521 Proc 17276 * Qty 1 = $218.77 at 100% = $218.77 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,BLUE CROSS,BLUE CROSS MEDICARE,383.57,,,,,,,141.5700,897.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,CIGNA HEALTHCARE,CIGNA HMO,374.05,,,,,,,141.5700,897.0000,percent of total billed charges,41.7% of $897.00 in Billed Charges for Rev 521 Proc 17276 = $374.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,416.21,,,,,,,141.5700,897.0000,percent of total billed charges,46.4% of $897.00 in Billed Charges for Rev 521 Proc 17276 = $416.21. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,387.26,,,,,,,141.5700,897.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,374.05,,,,,,,141.5700,897.0000,percent of total billed charges,41.7% of $897.00 in Billed Charges for Rev 521 Proc 17276 = $374.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,CIGNA HEALTHCARE,CIGNA PPO,374.05,,,,,,,141.5700,897.0000,percent of total billed charges,41.7% of $897.00 in Billed Charges for Rev 521 Proc 17276 = $374.05. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,387.26,,,,,,,141.5700,897.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,807.30,,,,,,,141.5700,897.0000,percent of total billed charges,90% of $897.00 in Billed Charges for Rev 521 Proc 17276 = $807.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,HUMANA,HUMANA MEDICARE,368.82,,,,,,,141.5700,897.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,368.82,,,,,,,141.5700,897.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,MEDCOST,MEDCOST VHN,426.88,,,,,,,141.5700,897.0000,percent of total billed charges,47.59% of $897.00 in Billed Charges for Rev 521 Proc 17276 = $426.88. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,141.5700,897.0000,fee schedule,"APG 00003 Proc 17276 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,387.26,,,,,,,141.5700,897.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,387.26,,,,,,,141.5700,897.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,NHC ADVANTAGE,NHC ADVANTAGE,387.26,,,,,,,141.5700,897.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,141.5700,897.0000,fee schedule,"APG 00003 Proc 17276 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,SENTARA HEALTH,SENTARA HEALTH,231.52,,,,,,,141.5700,897.0000,percent of total billed charges,25.81% of $897.00 in Billed Charges for Rev 521 Proc 17276 = $231.52. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,SENTARA HEALTH,SENTARA MEDICARE,368.82,,,,,,,141.5700,897.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",897.00,,,,,,,141.5700,897.0000,percent of total billed charges,100% of $897.00 in Billed Charges for Rev 521 Proc 17276 = $897.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,141.57,,,,,,,141.5700,897.0000,fee schedule,$283.14 from Fee Schedule TCUHC24 for Rev 521 Proc 17276 * Qty 1 = $283.14 at 50% = $141.57 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,141.5700,897.0000,fee schedule,"APG 00003 Proc 17276 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,368.82,,,,,,,141.5700,897.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,368.82,,,,,,,141.5700,897.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,WELLCARE,WELLCARE MEDICAID,897.00,,,,,,,141.5700,897.0000,percent of total billed charges,100% of $897.00 in Billed Charges for Rev 521 Proc 17276 = $897.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION S/N/H/F/G > 4.0 CM,17276,CPT,521,RC,52100078,CDM,,,,both,,,897.0000,134.5500,WELLCARE,WELLCARE MEDICARE,390.95,,,,,,,141.5700,897.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA,237.84,,,,,,,73.0700,557.0000,percent of total billed charges,42.7% of $557.00 in Billed Charges for Rev 521 Proc 17280 = $237.84. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,73.0700,557.0000,fee schedule,"APG 00003 Proc 17280 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,AMBETTER,AMBETTER,396.83,,,,,,,73.0700,557.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,73.0700,557.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,73.0700,557.0000,fee schedule,"APG 00003 Proc 17280 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,73.0700,557.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",557.00,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,108.59,,,,,,,73.0700,557.0000,fee schedule,$108.59 from Fee Schedule BLDTM_23 for Rev 521 Proc 17280 * Qty 1 = $108.59 at 100% = $108.59 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,73.0700,557.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA HMO,232.27,,,,,,,73.0700,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 521 Proc 17280 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,258.45,,,,,,,73.0700,557.0000,percent of total billed charges,46.4% of $557.00 in Billed Charges for Rev 521 Proc 17280 = $258.45. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,73.0700,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,232.27,,,,,,,73.0700,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 521 Proc 17280 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,CIGNA HEALTHCARE,CIGNA PPO,232.27,,,,,,,73.0700,557.0000,percent of total billed charges,41.7% of $557.00 in Billed Charges for Rev 521 Proc 17280 = $232.27. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,73.0700,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,501.30,,,,,,,73.0700,557.0000,percent of total billed charges,90% of $557.00 in Billed Charges for Rev 521 Proc 17280 = $501.30. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,MEDCOST,MEDCOST VHN,265.08,,,,,,,73.0700,557.0000,percent of total billed charges,47.59% of $557.00 in Billed Charges for Rev 521 Proc 17280 = $265.08. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,73.0700,557.0000,fee schedule,"APG 00003 Proc 17280 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,73.0700,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,73.0700,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,73.0700,557.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,73.0700,557.0000,fee schedule,"APG 00003 Proc 17280 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,SENTARA HEALTH,SENTARA HEALTH,143.76,,,,,,,73.0700,557.0000,percent of total billed charges,25.81% of $557.00 in Billed Charges for Rev 521 Proc 17280 = $143.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",557.00,,,,,,,73.0700,557.0000,percent of total billed charges,100% of $557.00 in Billed Charges for Rev 521 Proc 17280 = $557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,73.0700,557.0000,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 521 Proc 17280 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,73.0700,557.0000,fee schedule,"APG 00003 Proc 17280 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,73.0700,557.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,WELLCARE,WELLCARE MEDICAID,557.00,,,,,,,73.0700,557.0000,percent of total billed charges,100% of $557.00 in Billed Charges for Rev 521 Proc 17280 = $557.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.5CM OR LESS,17280,CPT,521,RC,52100079,CDM,,,,both,,,557.0000,83.5500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,73.0700,557.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,AETNA,AETNA,261.75,,,,,,,73.0700,613.0000,percent of total billed charges,42.7% of $613.00 in Billed Charges for Rev 521 Proc 17281 = $261.75. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,249.88,,,,,,,73.0700,613.0000,fee schedule,"APG 00003 Proc 17281 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 104% = $249.88. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,182.03,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,AETNA,AETNA HEALTHCARE MEDICARE,182.03,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,ALLCARE MEDICARE,ALLCARE MEDICARE,182.03,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,AMBETTER,AMBETTER,396.83,,,,,,,73.0700,613.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,189.31,,,,,,,73.0700,613.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,ANTHEM EXCHANGE,448.17,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,247.48,,,,,,,73.0700,613.0000,fee schedule,"APG 00003 Proc 17281 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,ANTHEM HMO,476.15,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,187.49,,,,,,,73.0700,613.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",560.15,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,124.90,,,,,,,73.0700,613.0000,fee schedule,$124.90 from Fee Schedule BLDTM_23 for Rev 521 Proc 17281 * Qty 1 = $124.90 at 100% = $124.90 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,BLUE CROSS,BLUE CROSS MEDICARE,189.31,,,,,,,73.0700,613.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA HMO,255.62,,,,,,,73.0700,613.0000,percent of total billed charges,41.7% of $613.00 in Billed Charges for Rev 521 Proc 17281 = $255.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,284.43,,,,,,,73.0700,613.0000,percent of total billed charges,46.4% of $613.00 in Billed Charges for Rev 521 Proc 17281 = $284.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA MEDICARE,191.13,,,,,,,73.0700,613.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,255.62,,,,,,,73.0700,613.0000,percent of total billed charges,41.7% of $613.00 in Billed Charges for Rev 521 Proc 17281 = $255.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,CIGNA HEALTHCARE,CIGNA PPO,255.62,,,,,,,73.0700,613.0000,percent of total billed charges,41.7% of $613.00 in Billed Charges for Rev 521 Proc 17281 = $255.62. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,191.13,,,,,,,73.0700,613.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,551.70,,,,,,,73.0700,613.0000,percent of total billed charges,90% of $613.00 in Billed Charges for Rev 521 Proc 17281 = $551.70. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,HUMANA,HUMANA MEDICARE,182.03,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,182.03,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,MEDCOST,MEDCOST VHN,291.73,,,,,,,73.0700,613.0000,percent of total billed charges,47.59% of $613.00 in Billed Charges for Rev 521 Proc 17281 = $291.73. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,252.28,,,,,,,73.0700,613.0000,fee schedule,"APG 00003 Proc 17281 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 105% = $252.28 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,191.13,,,,,,,73.0700,613.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,191.13,,,,,,,73.0700,613.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,NHC ADVANTAGE,NHC ADVANTAGE,191.13,,,,,,,73.0700,613.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,247.72,,,,,,,73.0700,613.0000,fee schedule,"APG 00003 Proc 17281 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 100% = $240.27... $240.27 at 103.1% = $247.72 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,SENTARA HEALTH,SENTARA HEALTH,158.22,,,,,,,73.0700,613.0000,percent of total billed charges,25.81% of $613.00 in Billed Charges for Rev 521 Proc 17281 = $158.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,SENTARA HEALTH,SENTARA MEDICARE,182.03,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",613.00,,,,,,,73.0700,613.0000,percent of total billed charges,100% of $613.00 in Billed Charges for Rev 521 Proc 17281 = $613.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,73.07,,,,,,,73.0700,613.0000,fee schedule,$146.14 from Fee Schedule TCUHC24 for Rev 521 Proc 17281 * Qty 1 = $146.14 at 50% = $73.07 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,247.48,,,,,,,73.0700,613.0000,fee schedule,"APG 00003 Proc 17281 at $836.60 (Base Rate) * 0.2872 (Relative Weight) = $240.27 (Total Line Payment), Adjusted by ((1 + (0.5 * (1 - 1))) / 1) = $240.27 at 103% = $247.48. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,182.03,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,182.03,,,,,,,73.0700,613.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,WELLCARE,WELLCARE MEDICAID,613.00,,,,,,,73.0700,613.0000,percent of total billed charges,100% of $613.00 in Billed Charges for Rev 521 Proc 17281 = $613.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person.
HC DESTRUCT MALIGN LESION F/E/E/N/L/M 0.6-1.0 CM,17281,CPT,521,RC,52100080,CDM,,,,both,,,613.0000,91.9500,WELLCARE,WELLCARE MEDICARE,192.95,,,,,,,73.0700,613.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,AETNA,AETNA,9731.76,,,,,,,1093.0000,36257.3800,percent of total billed charges,"42.7% of $22,791.00 in Billed Charges for Rev 361 Proc 37182 = $9,731.76. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15721.62,,,,,,,1093.0000,36257.3800,fee schedule,"APG 00085 Proc 37182 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 104% = $15,721.62. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,16631.83,,,,,,,1093.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,AETNA,AETNA HEALTHCARE MEDICARE,16631.83,,,,,,,1093.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,ALLCARE MEDICARE,ALLCARE MEDICARE,16631.83,,,,,,,1093.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,AMBETTER,AMBETTER,36257.38,,,,,,,1093.0000,36257.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,17297.10,,,,,,,1093.0000,36257.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,BLUE CROSS,ANTHEM EXCHANGE,22791.00,,,,,,,1093.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,15570.45,,,,,,,1093.0000,36257.3800,fee schedule,"APG 00085 Proc 37182 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,BLUE CROSS,ANTHEM HMO,22791.00,,,,,,,1093.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,17130.78,,,,,,,1093.0000,36257.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",22791.00,,,,,,,1093.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1336.00,,,,,,,1093.0000,36257.3800,case rate,"Rev 361 Proc 37182 ASG Rate of $1,336.00 at 100% of $1,336.00 = $1,336.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,BLUE CROSS,BLUE CROSS E NETWORK,8571.00,,,,,,,1093.0000,36257.3800,case rate,"Rev 361 Proc 37182 ASG Rate of $8,571.00 at 100% of $8,571.00 = $8,571.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,BLUE CROSS,BLUE CROSS MEDICARE,17297.10,,,,,,,1093.0000,36257.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,BLUE CROSS,BLUE CROSS P NETWORK,8764.00,,,,,,,1093.0000,36257.3800,case rate,"Rev 361 Proc 37182 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,BLUE CROSS,BLUE CROSS S NETWORK,8764.00,,,,,,,1093.0000,36257.3800,case rate,"Rev 361 Proc 37182 ASG Rate of $8,764.00 at 100% of $8,764.00 = $8,764.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,BLUE CROSS,TENNCARE BLUE CARE,1093.00,,,,,,,1093.0000,36257.3800,case rate,"Rev 361 Proc 37182 ASG Rate of $1,093.00 at 100% of $1,093.00 = $1,093.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,BLUE CROSS,TENNCARE BLUE SELECT,1093.00,,,,,,,1093.0000,36257.3800,case rate,"Rev 361 Proc 37182 ASG Rate of $1,093.00 at 100% of $1,093.00 = $1,093.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,1093.0000,36257.3800,case rate,"Rev 361 Proc 37182 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,1093.0000,36257.3800,case rate,"Rev 361 Proc 37182 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,CIGNA HEALTHCARE,CIGNA MEDICARE,17463.42,,,,,,,1093.0000,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,1093.0000,36257.3800,case rate,"Rev 361 Proc 37182 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,1093.0000,36257.3800,case rate,"Rev 361 Proc 37182 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,17463.42,,,,,,,1093.0000,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,20511.90,,,,,,,1093.0000,36257.3800,percent of total billed charges,"90% of $22,791.00 in Billed Charges for Rev 361 Proc 37182 = $20,511.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,HUMANA,HUMANA MEDICARE,16631.83,,,,,,,1093.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,16631.83,,,,,,,1093.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,MEDCOST,MEDCOST VHN,10846.24,,,,,,,1093.0000,36257.3800,percent of total billed charges,"47.59% of $22,791.00 in Billed Charges for Rev 361 Proc 37182 = $10,846.24. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15872.79,,,,,,,1093.0000,36257.3800,fee schedule,"APG 00085 Proc 37182 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 105% = $15,872.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,17463.42,,,,,,,1093.0000,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,17463.42,,,,,,,1093.0000,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,NHC ADVANTAGE,NHC ADVANTAGE,17463.42,,,,,,,1093.0000,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15585.57,,,,,,,1093.0000,36257.3800,fee schedule,"APG 00085 Proc 37182 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 103.1% = $15,585.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,SENTARA HEALTH,SENTARA HEALTH,5882.36,,,,,,,1093.0000,36257.3800,percent of total billed charges,"25.81% of $22,791.00 in Billed Charges for Rev 361 Proc 37182 = $5,882.36. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,SENTARA HEALTH,SENTARA MEDICARE,16631.83,,,,,,,1093.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",22791.00,,,,,,,1093.0000,36257.3800,percent of total billed charges,"100% of $22,791.00 in Billed Charges for Rev 361 Proc 37182 = $22,791.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,1093.0000,36257.3800,case rate,"Rev 361 Proc 37182 ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,1093.0000,36257.3800,case rate,"Rev 361 Proc 37182 ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,1093.0000,36257.3800,case rate,"Rev 361 Proc 37182 ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,UNITED HEALTHCARE,UNITED HEALTHCARE,20054.00,,,,,,,1093.0000,36257.3800,case rate,"Rev 361 Proc 37182 ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,15570.45,,,,,,,1093.0000,36257.3800,fee schedule,"APG 00085 Proc 37182 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,16631.83,,,,,,,1093.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,16631.83,,,,,,,1093.0000,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,WELLCARE,WELLCARE MEDICAID,22791.00,,,,,,,1093.0000,36257.3800,percent of total billed charges,"100% of $22,791.00 in Billed Charges for Rev 361 Proc 37182 = $22,791.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT TIPS,37182,CPT,361,RC,36100260,CDM,,,,both,,,22791.0000,3418.6500,WELLCARE,WELLCARE MEDICARE,17629.74,,,,,,,1093.0000,36257.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,AETNA,AETNA,8492.60,,,,,,,1093.0000,19889.0000,percent of total billed charges,"42.7% of $19,889.00 in Billed Charges for Rev 361 Proc 37183 = $8,492.60. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,9404.09,,,,,,,1093.0000,19889.0000,fee schedule,"APG 00079 Proc 37183 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 104% = $9,404.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,5163.81,,,,,,,1093.0000,19889.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,AETNA,AETNA HEALTHCARE MEDICARE,5163.81,,,,,,,1093.0000,19889.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,ALLCARE MEDICARE,ALLCARE MEDICARE,5163.81,,,,,,,1093.0000,19889.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,AMBETTER,AMBETTER,11257.11,,,,,,,1093.0000,19889.0000,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,5370.36,,,,,,,1093.0000,19889.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,BLUE CROSS,ANTHEM EXCHANGE,12713.57,,,,,,,1093.0000,19889.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,9313.66,,,,,,,1093.0000,19889.0000,fee schedule,"APG 00079 Proc 37183 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 103% = $9,313.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,BLUE CROSS,ANTHEM HMO,13507.41,,,,,,,1093.0000,19889.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,5318.72,,,,,,,1093.0000,19889.0000,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",15890.21,,,,,,,1093.0000,19889.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1523.00,,,,,,,1093.0000,19889.0000,case rate,"Rev 361 Proc 37183 ASG Rate of $1,523.00 at 100% of $1,523.00 = $1,523.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,BLUE CROSS,BLUE CROSS E NETWORK,7988.00,,,,,,,1093.0000,19889.0000,case rate,"Rev 361 Proc 37183 ASG Rate of $7,988.00 at 100% of $7,988.00 = $7,988.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,BLUE CROSS,BLUE CROSS MEDICARE,5370.36,,,,,,,1093.0000,19889.0000,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,BLUE CROSS,BLUE CROSS P NETWORK,8168.00,,,,,,,1093.0000,19889.0000,case rate,"Rev 361 Proc 37183 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,BLUE CROSS,BLUE CROSS S NETWORK,8168.00,,,,,,,1093.0000,19889.0000,case rate,"Rev 361 Proc 37183 ASG Rate of $8,168.00 at 100% of $8,168.00 = $8,168.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,BLUE CROSS,TENNCARE BLUE CARE,1093.00,,,,,,,1093.0000,19889.0000,case rate,"Rev 361 Proc 37183 ASG Rate of $1,093.00 at 100% of $1,093.00 = $1,093.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,BLUE CROSS,TENNCARE BLUE SELECT,1093.00,,,,,,,1093.0000,19889.0000,case rate,"Rev 361 Proc 37183 ASG Rate of $1,093.00 at 100% of $1,093.00 = $1,093.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,CIGNA HEALTHCARE,CIGNA HMO,4239.00,,,,,,,1093.0000,19889.0000,case rate,"Rev 361 Proc 37183 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,3204.00,,,,,,,1093.0000,19889.0000,case rate,"Rev 361 Proc 37183 ASG Rate of $3,204.00 at 100% of $3,204.00 = $3,204.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,CIGNA HEALTHCARE,CIGNA MEDICARE,5422.00,,,,,,,1093.0000,19889.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,4239.00,,,,,,,1093.0000,19889.0000,case rate,"Rev 361 Proc 37183 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,CIGNA HEALTHCARE,CIGNA PPO,4239.00,,,,,,,1093.0000,19889.0000,case rate,"Rev 361 Proc 37183 ASG Rate of $4,239.00 at 100% of $4,239.00 = $4,239.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,5422.00,,,,,,,1093.0000,19889.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,17900.10,,,,,,,1093.0000,19889.0000,percent of total billed charges,"90% of $19,889.00 in Billed Charges for Rev 361 Proc 37183 = $17,900.10. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,HUMANA,HUMANA MEDICARE,5163.81,,,,,,,1093.0000,19889.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,MANAGED MEDICAIRE,MANAGED MEDICAIRE,5163.81,,,,,,,1093.0000,19889.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,MEDCOST,MEDCOST VHN,9465.18,,,,,,,1093.0000,19889.0000,percent of total billed charges,"47.59% of $19,889.00 in Billed Charges for Rev 361 Proc 37183 = $9,465.18. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,9494.51,,,,,,,1093.0000,19889.0000,fee schedule,"APG 00079 Proc 37183 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 100% = $9,042.39... $9,042.39 at 105% = $9,494.51 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,5422.00,,,,,,,1093.0000,19889.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,5422.00,,,,,,,1093.0000,19889.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,NHC ADVANTAGE,NHC ADVANTAGE,5422.00,,,,,,,1093.0000,19889.0000,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,9322.70,,,,,,,1093.0000,19889.0000,fee schedule,"APG 00079 Proc 37183 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 100% = $9,042.39... $9,042.39 at 103.1% = $9,322.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,SENTARA HEALTH,SENTARA HEALTH,5133.35,,,,,,,1093.0000,19889.0000,percent of total billed charges,"25.81% of $19,889.00 in Billed Charges for Rev 361 Proc 37183 = $5,133.35. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,SENTARA HEALTH,SENTARA MEDICARE,5163.81,,,,,,,1093.0000,19889.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",19889.00,,,,,,,1093.0000,19889.0000,percent of total billed charges,"100% of $19,889.00 in Billed Charges for Rev 361 Proc 37183 = $19,889.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,6290.00,,,,,,,1093.0000,19889.0000,case rate,"Rev 361 Proc 37183 ASG Rate of $6,290.00 at 100% of $6,290.00 = $6,290.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,12347.00,,,,,,,1093.0000,19889.0000,case rate,"Rev 361 Proc 37183 ASG Rate of $12,347.00 at 100% of $12,347.00 = $12,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,UNITED HEALTHCARE,UHC HERITAGE SELECT,11813.00,,,,,,,1093.0000,19889.0000,case rate,"Rev 361 Proc 37183 ASG Rate of $11,813.00 at 100% of $11,813.00 = $11,813.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,UNITED HEALTHCARE,UNITED HEALTHCARE,19889.00,,,,,,,1093.0000,19889.0000,case rate,"Rev 361 Proc 37183 ASG Rate of $20,054.00 at 100% of $20,054.00 = $20,054.00 Total (Service Line reduced to $19,889.00, claim capped at $19,889.00 in billed charges) The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,9313.66,,,,,,,1093.0000,19889.0000,fee schedule,"APG 00079 Proc 37183 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 103% = $9,313.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,5163.81,,,,,,,1093.0000,19889.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,5163.81,,,,,,,1093.0000,19889.0000,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,WELLCARE,WELLCARE MEDICAID,19889.00,,,,,,,1093.0000,19889.0000,percent of total billed charges,"100% of $19,889.00 in Billed Charges for Rev 361 Proc 37183 = $19,889.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC REVIS TRANSVEN INTRAHEP PORTOSYS TIPS REVIS,37183,CPT,361,RC,36100261,CDM,,,,both,,,19889.0000,2983.3500,WELLCARE,WELLCARE MEDICARE,5473.64,,,,,,,1093.0000,19889.0000,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,AETNA,AETNA,5704.72,,,,,,,2736.4700,36257.3800,percent of total billed charges,"42.7% of $13,360.00 in Billed Charges for Rev 481 Proc 37184 = $5,704.72. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA,9404.09,,,,,,,2736.4700,36257.3800,fee schedule,"APG 00079 Proc 37184 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 104% = $9,404.09. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,AETNA,AETNA BETTER HEALTH OF VIRGINIA MEDICARE,13360.00,,,,,,,2736.4700,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,AETNA,AETNA HEALTHCARE MEDICARE,13360.00,,,,,,,2736.4700,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,ALLCARE MEDICARE,ALLCARE MEDICARE,13360.00,,,,,,,2736.4700,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,AMBETTER,AMBETTER,36257.38,,,,,,,2736.4700,36257.3800,fee schedule,218.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,AMERIGROUP,AMERIGROUP MEDICARE WELLPOINT,13360.00,,,,,,,2736.4700,36257.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,ANTHEM EXCHANGE,13360.00,,,,,,,2736.4700,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,9313.66,,,,,,,2736.4700,36257.3800,fee schedule,"APG 00079 Proc 37184 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 103% = $9,313.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,ANTHEM HMO,13360.00,,,,,,,2736.4700,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,ANTHEM MEDICARE VIRGINIA,13360.00,,,,,,,2736.4700,36257.3800,fee schedule,103.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,"ANTHEM PPO, TRADITIONAL INDEMNITY",13360.00,,,,,,,2736.4700,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,2736.47,,,,,,,2736.4700,36257.3800,fee schedule,"$2,736.47 from Fee Schedule BLDTM_23 for Rev 481 Proc 37184 * Qty 1 = $2,736.47 at 100% = $2,736.47 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS E NETWORK,9347.00,,,,,,,2736.4700,36257.3800,case rate,"Rev 481 Proc 37184 ASG Rate of $9,347.00 at 100% of $9,347.00 = $9,347.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS MEDICARE,17297.10,,,,,,,2736.4700,36257.3800,fee schedule,104.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS P NETWORK,9558.00,,,,,,,2736.4700,36257.3800,case rate,"Rev 481 Proc 37184 ASG Rate of $9,558.00 at 100% of $9,558.00 = $9,558.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,BLUE CROSS,BLUE CROSS S NETWORK,9558.00,,,,,,,2736.4700,36257.3800,case rate,"Rev 481 Proc 37184 ASG Rate of $9,558.00 at 100% of $9,558.00 = $9,558.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA HMO,5571.12,,,,,,,2736.4700,36257.3800,percent of total billed charges,"41.7% of $13,360.00 in Billed Charges for Rev 481 Proc 37184 = $5,571.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,6199.04,,,,,,,2736.4700,36257.3800,percent of total billed charges,"46.4% of $13,360.00 in Billed Charges for Rev 481 Proc 37184 = $6,199.04. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA MEDICARE,13360.00,,,,,,,2736.4700,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5571.12,,,,,,,2736.4700,36257.3800,percent of total billed charges,"41.7% of $13,360.00 in Billed Charges for Rev 481 Proc 37184 = $5,571.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,CIGNA HEALTHCARE,CIGNA PPO,5571.12,,,,,,,2736.4700,36257.3800,percent of total billed charges,"41.7% of $13,360.00 in Billed Charges for Rev 481 Proc 37184 = $5,571.12. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,DEVOTED HEALTH PLAN,DEVOTED HEALTH PLAN MEDICARE,13360.00,,,,,,,2736.4700,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,12024.00,,,,,,,2736.4700,36257.3800,percent of total billed charges,"90% of $13,360.00 in Billed Charges for Rev 481 Proc 37184 = $12,024.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,HUMANA,HUMANA MEDICARE,13360.00,,,,,,,2736.4700,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,MANAGED MEDICAIRE,MANAGED MEDICAIRE,13360.00,,,,,,,2736.4700,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,MEDCOST,MEDCOST VHN,6358.02,,,,,,,2736.4700,36257.3800,percent of total billed charges,"47.59% of $13,360.00 in Billed Charges for Rev 481 Proc 37184 = $6,358.02. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,9494.51,,,,,,,2736.4700,36257.3800,fee schedule,"APG 00079 Proc 37184 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 100% = $9,042.39... $9,042.39 at 105% = $9,494.51 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICARE,13360.00,,,,,,,2736.4700,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,MOUNTAIN EMPIRE PACE,MOUNTAIN EMPIRE PACE,13360.00,,,,,,,2736.4700,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,NHC ADVANTAGE,NHC ADVANTAGE,13360.00,,,,,,,2736.4700,36257.3800,fee schedule,105.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,9322.70,,,,,,,2736.4700,36257.3800,fee schedule,"APG 00079 Proc 37184 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 100% = $9,042.39... $9,042.39 at 103.1% = $9,322.70 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,SENTARA HEALTH,SENTARA HEALTH,3448.22,,,,,,,2736.4700,36257.3800,percent of total billed charges,"25.81% of $13,360.00 in Billed Charges for Rev 481 Proc 37184 = $3,448.22. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,SENTARA HEALTH,SENTARA MEDICARE,13360.00,,,,,,,2736.4700,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",13360.00,,,,,,,2736.4700,36257.3800,percent of total billed charges,"100% of $13,360.00 in Billed Charges for Rev 481 Proc 37184 = $13,360.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,2853.00,,,,,,,2736.4700,36257.3800,case rate,"Rev 481 Proc 37184 ASG Rate of $2,853.00 at 100% of $2,853.00 = $2,853.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UHC HERITAGE RIVER VALLEY,7525.00,,,,,,,2736.4700,36257.3800,case rate,"Rev 481 Proc 37184 ASG Rate of $7,525.00 at 100% of $7,525.00 = $7,525.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UHC HERITAGE SELECT,7198.00,,,,,,,2736.4700,36257.3800,case rate,"Rev 481 Proc 37184 ASG Rate of $7,198.00 at 100% of $7,198.00 = $7,198.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UNITED HEALTHCARE,9628.00,,,,,,,2736.4700,36257.3800,case rate,"Rev 481 Proc 37184 ASG Rate of $9,628.00 at 100% of $9,628.00 = $9,628.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICAID VIRGINIA,9313.66,,,,,,,2736.4700,36257.3800,fee schedule,"APG 00079 Proc 37184 at $836.60 (Base Rate) * 10.8085 (Relative Weight) = $9,042.39 (Total Line Payment) at 103% = $9,313.66. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,UNITED HEALTHCARE,UNITED HEALTHCARE MEDICARE,13360.00,,,,,,,2736.4700,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,UNITED MINE WORKERS OF AMERICA,UNITED MINE WORKERS OF AMERICA,13360.00,,,,,,,2736.4700,36257.3800,fee schedule,100.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,WELLCARE,WELLCARE MEDICAID,13360.00,,,,,,,2736.4700,36257.3800,percent of total billed charges,"100% of $13,360.00 in Billed Charges for Rev 481 Proc 37184 = $13,360.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THROMBECTOMY PRIM ART INT VES,37184,CPT,481,RC,48100056,CDM,,,,both,,,13360.0000,2004.0000,WELLCARE,WELLCARE MEDICARE,17629.74,,,,,,,2736.4700,36257.3800,fee schedule,106.00% of Hospitals Specific Medicare Reimbursement Rate The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECT SEC ART W/INTERVENT,37186,CPT,481,RC,48100058,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA,5175.67,,,,,,,148.0000,15872.7900,percent of total billed charges,"42.7% of $12,121.00 in Billed Charges for Rev 481 Proc 37186 = $5,175.67. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THROMBECT SEC ART W/INTERVENT,37186,CPT,481,RC,48100058,CDM,,,,both,,,12121.0000,1818.1500,AETNA,AETNA BETTER HEALTH OF VIRGINIA,15721.62,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 37186 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 104% = $15,721.62. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THROMBECT SEC ART W/INTERVENT,37186,CPT,481,RC,48100058,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,ANTHEM HLTHKEEP MEDICIAD,12121.00,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 37186 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 103% = $15,570.45 (Service Line reduced to $12,121.00, claim capped at $12,121.00 in billed charges). The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THROMBECT SEC ART W/INTERVENT,37186,CPT,481,RC,48100058,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS BALLAD HEALTH EMPLOYEE,1844.05,,,,,,,148.0000,15872.7900,fee schedule,"$1,844.05 from Fee Schedule BLDTM_23 for Rev 481 Proc 37186 * Qty 1 = $1,844.05 at 100% = $1,844.05 The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THROMBECT SEC ART W/INTERVENT,37186,CPT,481,RC,48100058,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS E NETWORK,148.00,,,,,,,148.0000,15872.7900,case rate,Rev 481 Proc 37186 ASG Rate of $148.00 at 100% of $148.00 = $148.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECT SEC ART W/INTERVENT,37186,CPT,481,RC,48100058,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS P NETWORK,151.00,,,,,,,148.0000,15872.7900,case rate,Rev 481 Proc 37186 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECT SEC ART W/INTERVENT,37186,CPT,481,RC,48100058,CDM,,,,both,,,12121.0000,1818.1500,BLUE CROSS,BLUE CROSS S NETWORK,151.00,,,,,,,148.0000,15872.7900,case rate,Rev 481 Proc 37186 ASG Rate of $151.00 at 100% of $151.00 = $151.00 Total The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate.
HC THROMBECT SEC ART W/INTERVENT,37186,CPT,481,RC,48100058,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA HMO,5054.46,,,,,,,148.0000,15872.7900,percent of total billed charges,"41.7% of $12,121.00 in Billed Charges for Rev 481 Proc 37186 = $5,054.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THROMBECT SEC ART W/INTERVENT,37186,CPT,481,RC,48100058,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA INDIVIDUAL FAMILY PLAN,5624.14,,,,,,,148.0000,15872.7900,percent of total billed charges,"46.4% of $12,121.00 in Billed Charges for Rev 481 Proc 37186 = $5,624.14. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THROMBECT SEC ART W/INTERVENT,37186,CPT,481,RC,48100058,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA OPEN ACCESS PLUS,5054.46,,,,,,,148.0000,15872.7900,percent of total billed charges,"41.7% of $12,121.00 in Billed Charges for Rev 481 Proc 37186 = $5,054.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THROMBECT SEC ART W/INTERVENT,37186,CPT,481,RC,48100058,CDM,,,,both,,,12121.0000,1818.1500,CIGNA HEALTHCARE,CIGNA PPO,5054.46,,,,,,,148.0000,15872.7900,percent of total billed charges,"41.7% of $12,121.00 in Billed Charges for Rev 481 Proc 37186 = $5,054.46. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THROMBECT SEC ART W/INTERVENT,37186,CPT,481,RC,48100058,CDM,,,,both,,,12121.0000,1818.1500,FIRST HEALTH COVENTRY,FIRST HEALTH COVENTRY,10908.90,,,,,,,148.0000,15872.7900,percent of total billed charges,"90% of $12,121.00 in Billed Charges for Rev 481 Proc 37186 = $10,908.90. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THROMBECT SEC ART W/INTERVENT,37186,CPT,481,RC,48100058,CDM,,,,both,,,12121.0000,1818.1500,MEDCOST,MEDCOST VHN,5768.38,,,,,,,148.0000,15872.7900,percent of total billed charges,"47.59% of $12,121.00 in Billed Charges for Rev 481 Proc 37186 = $5,768.38. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THROMBECT SEC ART W/INTERVENT,37186,CPT,481,RC,48100058,CDM,,,,both,,,12121.0000,1818.1500,MOLINA HEALTHCARE,MOLINA HEALTHCARE MEDICAID,15872.79,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 37186 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 105% = $15,872.79 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THROMBECT SEC ART W/INTERVENT,37186,CPT,481,RC,48100058,CDM,,,,both,,,12121.0000,1818.1500,OPTIMA HEALTH,OPTIMA HEALTH MEDICAID,15585.57,,,,,,,148.0000,15872.7900,fee schedule,"APG 00085 Proc 37186 at $836.60 (Base Rate) * 18.0695 (Relative Weight) = $15,116.94 (Total Line Payment) at 100% = $15,116.94... $15,116.94 at 103.1% = $15,585.57 Final Expected. The contract rate provided is when this service is billed outpatient.  The inpatient rate for this service is included with the inpatient rate."
HC THROMBECT SEC ART W/INTERVENT,37186,CPT,481,RC,48100058,CDM,,,,both,,,12121.0000,1818.1500,SENTARA HEALTH,SENTARA HEALTH,3128.43,,,,,,,148.0000,15872.7900,percent of total billed charges,"25.81% of $12,121.00 in Billed Charges for Rev 481 Proc 37186 = $3,128.43. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THROMBECT SEC ART W/INTERVENT,37186,CPT,481,RC,48100058,CDM,,,,both,,,12121.0000,1818.1500,"SEVEN CORNERS, INC.","SEVEN CORNERS, INC.",12121.00,,,,,,,148.0000,15872.7900,percent of total billed charges,"100% of $12,121.00 in Billed Charges for Rev 481 Proc 37186 = $12,121.00. Percent of Charge CDM service is reimbursed at a line level and those calculations will not change from person to person."
HC THROMBECT SEC ART W/INTERVENT,37186,CPT,481,RC,48100058,CDM,,,,both,,,12121.0000,1818.1500,UNITED HEALTHCARE,TENNCARE UNITED HEALTHCARE,173.00,,,,,,,148.0000,15872.7900,case rate,Rev 481 Proc 37186 ASG Rate of $173.00 at 100% of $173.00 = $173.00 Total T